Dental resin composites containing ceramic whiskers and precured glass ionomer particles

Recent Advances in Whiskers: Properties and Clinical Applications in Dentistry

Whiskers are nanoscale, high-strength fibrous crystals with a wide range of potential applications in dentistry owing to their unique mechanical, thermal, electrical, and biological properties. They possess high strength, a high modulus of elasticity and good biocompatibility. Hence, adding these crystals to dental composites as reinforcement can considerably improve the mechanical properties and durability of restorations. Additionally, whiskers are involved in inducing the value-added differentiation of osteoblasts, odontogenic osteocytes, and pulp stem cells, and promoting the regeneration of alveolar bone, periodontal tissue, and pulp tissue. They can also enhance the mucosal barrier function, inhibit the proliferation of tumor cells, control inflammation, and aid in cancer prevention. This review comprehensively summarizes the classification, properties, growth mechanisms and preparation methods of whiskers and focuses on their application in dentistry. Due to their unique physicochemical properties, excellent biological properties, and nanoscale characteristics, whiskers show great potential for application in bone, periodontal, and pulp tissue regeneration. Additionally, they can be used to prevent and treat oral cancer and improve medical devices, thus making them a promising new material in dentistry.

Nanotechnology for Dentistry: Prospects and Applications

In the XXI century, application of nanostructures in oral medicine has become common. In oral medicine, using nanostructures for the treatment of dental caries constitutes a great challenge. There are extensive studies on the implementation of nanomaterials to dental composites in order to improve their properties, e.g., their adhesive strength. Moreover, nanostructures are helpful in dental implant applications as well as in maxillofacial surgery for accelerated healing, promoting osseointegration, and others. Dental personal care products are an important part of oral medicine where nanomaterials are increasingly used, e.g., toothpaste for hypersensitivity. Nowadays, nanoparticles such as macrocycles are used in different formulations for early cancer diagnosis in the oral area. Cancer of the oral cavity-human squamous carcinoma-is the sixth leading cause of death. Detection in the early stage offers the best chance at total cure. Along with diagnosis, macrocycles are used for photodynamic mechanism-based treatments, which possess many advantages, such as protecting healthy tissues and producing good cosmetic results. Application of nanostructures in medicine carries potential risks, like long-term influence of toxicity on body, which need to be studied further. The introduction and development of nanotechnologies and nanomaterials are no longer part of a hypothetical future, but an increasingly important element of today's medicine.

Effect of Nanostructures on the Properties of Glass Ionomer Dental Restoratives/Cements: A Comprehensive Narrative Review

Overall perspective of nanotechnology and reinforcement of dental biomaterials by nanoparticles has been reported in the literature. However, the literature regarding the reinforcement of dental biomaterials after incorporating various nanostructures is sparse. The present review addresses current developments of glass ionomer cements (GICs) after incorporating various metallic, polymeric, inorganic and carbon-based nanostructures. In addition, types, applications, and implications of various nanostructures incorporated in GICs are discussed. Most of the attempts by researchers are based on the laboratory-based studies; hence, it warrants long-term clinical trials to aid the development of suitable materials for the load bearing posterior dentition. Nevertheless, a few meaningful conclusions are drawn from this substantial piece of work; they are as follows: (1) most of the nanostructures are likely to enhance the mechanical strength of GICs; (2) certain nanostructures improve the antibacterial activity of GICs against the cariogenic bacteria; (3) clinical translation of these promising outcomes are completely missing, and (4) the nanostructured modified GICs could perform better than their conventional counterparts in the load bearing posterior dentition.

Effect of co-precipitation plus spray-drying of nano-CaF2 on mechanical and fluoride properties of nanocomposite

OBJECTIVE

Fluoride (F)-releasing restoratives typically are either weak mechanically or release only low levels of F ions. The objectives of this study were to: (1) develop a novel photo-cured nanocomposite with strong mechanical properties and high levels of sustained F ion release via a two-step "co-precipitation + spray-drying" technique to synthesize CaF₂ nanoparticles (nCaF₂); and (2) investigate the effect of spray-drying treatment after co-precipitation of nCaF₂ on mechanical properties and F ion release of composite.

METHODS

Two types of CaF₂ particles were synthesized: A co-precipitation method yielded CaF₂cp; "co-precipitation + spray-drying" yielded nCaF₂cpsd. Composites were fabricated with fillers of: (1) 0% CaF₂ + 70% glass; (2) 10% CaF₂cp + 60% glass; (3) 15% CaF₂cp + 55% glass; (4) 20% CaF₂cp + 50% glass; (5) 10% nCaF₂cpsd + 60% glass; (6) 15% nCaF₂cpsd + 55% glass; and (7) 20% nCaF₂cpsd + 50% glass. A commercial F-releasing nanocomposite served as control.

RESULTS

The nCaF₂cpsd had much smaller particle size (median = 32 nm) and narrower distribution (22-57 nm) than CaF₂cp (median = 5.25 μm, 162 nm-67 μm). The composite containing nCaF₂cpsd had greater flowability, flexural strength, elastic modulus and hardness than CaF₂cp composite and commercial control composite. At 84-day immersion in water, the nanocomposites containing 20% nCaF₂cpsd had 65 times higher cumulative F release, and 77 times greater long-term F-release rate, than commercial control.

CONCLUSIONS

A novel two-step "co-precipitation + spray-drying" technique of synthesizing nCaF₂ was developed. The photo-cured nanocomposite containing 20% nCaF₂cpsd possessed strong mechanical properties and excellent long-term F-release ability, and hence is promising for dental restoration applications to inhibit secondary caries.

Assessment of the Impact of the Addition of Nanoparticles on the Properties of Glass-Ionomer Cements

The aim of the study was to evaluate the effects of incorporation of Al2O3, ZrO2 and TiO2 nanoparticles into glass-ionomer cements (GICs). Two different GICs were used in the study. Four groups were prepared for each material: the control group (without nanoparticles) and three groups modified by the incorporation of nanoparticles at 2, 5 or 10 wt %, respectively. Cements were mixed and placed in moulds (4 mm × 6 mm); after setting, the samples were stored in saline (one day and one week). Compressive strengths were measured and the morphology of the fractured surfaces was analyzed by scanning electron microscopy. The elements released into the storage solutions were determined by Inductively coupled plasma-optical emission spectrometry (ICP-OES). Addition of nanoparticles was found to alter the appearance of cements as examined by scanning electron microscopy. Compressive strength increased with the addition of ZrO2 and especially TiO2 nanoparticles, whereas the addition of Al2O3 nanoparticles generally weakened the cements. The ion release profile of the modified cements was the same in all cases. The addition of Al2O3, ZrO2 and TiO2 nanoparticles into GICs is beneficial, since it leads to reduction of the microscopic voids in the set cement. Of these, the use of ZrO2 and TiO2 nanoparticles also led to increased compressive strength. Nanoparticles did not release detectable levels of ions (Al, Zr or Ti), which makes them suitable for clinical use.

Mechanical performance of polymer-infiltrated zirconia ceramics

OBJECTIVE

The aim of this study was to evaluate the microstructure and mechanical behavior of polymer-infiltrated zirconia ceramics as a function of pre-sintering temperature (1000-1150°C).

METHODS

Polymer-infiltrated zirconia ceramics were prepared by combining the porous zirconia networks and polymer through infiltration and polymerization. XRD was employed to determine phase structure. The microstructure and fracture mechanism were observed by SEM. Flexural strength and fracture toughness were measured by three-point bending method and single-edge-notched beam method, respectively. A nanoindentation system was employed to determine elastic modulus and hardness.

RESULTS

Different porosities and polymer contents can be obtained by tuning the pre-sintered temperature of zirconia ceramic precursors. Zirconia network porosity varies from 46.3% to 34.7% and the relevant polymer content ranges from 18.4wt.% to 12.3wt.% when the pre-sintered temperature is set from 1000°C to 1150°C. The flexural strength, fracture toughness, hardness, and elastic modulus values of the specimen pre-sintered at 1150°C are 240.9MPa, 3.69MPam^1/2, 3.1GPa, and 58.8GPa, respectively.

CONCLUSION

The pre-sintering temperature has a significant effect on the microstructure and mechanical properties of polymer-infiltrated zirconia ceramics and the optimal pre-sintering temperature is 1150°C.

CLINICAL SIGNIFICANCE

Specimen pre-sintered at 1150°C shows tooth-like mechanical properties, suggesting a promising restorative material in dental clinic. Moreover, the synthesis process is simple and can be easily performed in a prosthesis laboratory.

Comparative Evaluation of Antimicrobial Efficacy of Resin-Modified Glass Ionomers, Compomers and Giomers - An Invitro Study

BACKGROUND

Dental restorative materials, especially those applied in direct contact with the contaminated substrate, should have appropriate antibacterial activity in order to prevent residual bacteria from continuing their metabolic activity in addition to impairing new bacteria from reaching the tooth-restoration interface.

AIM

To determine the antibacterial efficacy of three different restorative materials against the common cariogenic microorganism i.e., Streptococcus mutans.

MATERIALS AND METHODS

Three different restorative materials were evaluated in this study: Giomer (Beautifil), Compomer (F2000) & Resin modified Glass ionomer (Fuji II LC) for their anti microbial efficacy against Streptococcus mutans by standard agar diffusion method and zones of inhibition for each restorative material were calculated.

STATISTICAL ANALYSIS

Inhibition zones around each restorative material were measured and values were subjected to one-way ANOVA with least square difference (LSD) Post-hoc test.

RESULTS

The mean inhibitory zones for Resin modified glass ionomers, Giomers & Compomers ranged from 10.1 - 6.90mm. Fuji II LC exhibited the highest mean inhibitory zone of 10.1 ± 1.97 for S.mutans. Beautifil exhibited mean inhibitory zone of 8.20 ± 1.62, whereas F2000 showed the least mean inhibitory zone of 6.90 ± 1.29.

CONCLUSION

Based on the inhibitory zones of three restorative materials, Fuji II LC is recommended as the best restorative material among the three tested restorative materials.

The incorporation of nanoparticles into conventional glass-ionomer dental restorative cements

Conventional glass-ionomer cements (GICs) are popular restorative materials, but their use is limited by their relatively low mechanical strength. This paper reports an attempt to improve these materials by incorporation of 10 wt% of three different types of nanoparticles, aluminum oxide, zirconium oxide, and titanium dioxide, into two commercial GICs (ChemFil® Rock and EQUIA™ Fil). The results indicate that the nanoparticles readily dispersed into the cement matrix by hand mixing and reduced the porosity of set cements by filling the empty spaces between the glass particles. Both cements showed no significant difference in compressive strength with added alumina, and ChemFil® Rock also showed no significant difference with zirconia. By contrast, ChemFil® Rock showed significantly higher compressive strength with added titania, and EQUIA™ Fil showed significantly higher compressive strength with both zirconia and titania. Fewer air voids were observed in all nanoparticle-containing cements and this, in turn, reduced the development of cracks within the matrix of the cements. These changes in microstructure provide a likely reason for the observed increases in compressive strength, and overall the addition of nanoparticles appears to be a promising strategy for improving the physical properties of GICs.

Evaluation of the Clinical Impact of ISO 4049 in Comparison with Miniflexural Test on Mechanical Performances of Resin Based Composite

The aim of this study was to evaluate the effect of different specimens dimensions on the mechanical properties of a commercial microfilled resin composite by using a modified ISO 4049 standard protocol, that generally provides specimen dimensions of 25 mm length × 2 mm width × 2 mm height; these standard dimensions are not clinically realistic considering the teeth diameter and length average. Furthermore, the overlapping irradiations required lead to specimens that are not homogeneous with the presence of some flaws due to packaging steps. For this reason, a miniflexural test was employed in this work both to simulate clinically realistic dimensions and to concentrate fewer defects. The flexural tests were performed at varying span length, in the range between 18.5 mm as stated by the ISO 4049 flexural test (IFT) and 10.5 mm according to the miniflexural test (MFT), at the increasing of layers with a 1 mm buildup multilayering technique. The results evidenced the impact of specimen dimensions on mechanical performances and consequently stability of resin-based composite with the formation of an asymmetrical structure which possesses higher stiffness and strength at increasing layering steps.

Enhancement effect of pre-reacted glass on strength of glass-ionomer cement

In this paper, we report on the enhanced strength of glass ionomer cement (GIC) by using the process of pre acid-base reaction and spray drying in glass preparation. The pre acid-base reaction was induced by prior mixing of the glass powder with poly(alkenoic acid). The weight ratios of glass powder to poly(alkenoic acid) were varied to investigate the extent of the pre acid-base reaction of the glass. The effect of the spray drying process which produced spherical glass particles on cement strength was also studied and discussed. The results show that adding 2%-wt of poly(alkenoic acid) liquid in the pre-reacted step improved cement strength. GICs prepared using a mixture of pre-reacted glass with both spherical and irregular powders at 60:40 by weight exhibited the highest compressive strength at 138.64±7.73 MPa. It was concluded that glass ionomer cements containing pre-reacted glass with mixed glass morphology using both spherical and irregular forms are promising as restorative dental materials with improved mechanical properties and handling characteristics.

Strength and fluoride release characteristics of a calcium fluoride based dental nanocomposite

Secondary caries and restoration fracture remain the two most common problems in restorative dentistry. Release of fluoride ions (F) could be a substantial benefit because F could enrich neighboring enamel or dentin to combat caries. The objective of this study was to incorporate novel CaF(2) nanoparticles into dental resin to develop stress-bearing, F-releasing nanocomposite. CaF(2) nanoparticles, prepared in our laboratories for the first time, were combined with reinforcing whisker fillers in a resin. Flexural strength (mean+/-sd; n=6) was 110+/-11 MPa for the composite containing 30% CaF(2) and 35% whiskers by mass. It matched the 108+/-19 MPa of a stress-bearing, non-releasing commercial composite (Tukey's at 0.05). The composite containing 20% CaF(2) had a cumulative F release of 2.34+/-0.26 mmol/L at 10 weeks. The initial F release rate was 2 microg/(hcm(2)), and the sustained release rate after 10 weeks was 0.29 microg/(hcm(2)). These values exceeded the reported releases of traditional and resin-modified glass ionomer materials. In summary, nanocomposites were developed with relatively high strength as well as sustained release of fluoride ions, a combination not available in current materials. These strong and F-releasing composites may yield restorations that can reduce the occurrence of both secondary caries and restoration fracture.

Review on fluoride-releasing restorative materials--fluoride release and uptake characteristics, antibacterial activity and influence on caries formation

OBJECTIVES

The purpose of this article was to review the fluoride release and recharge capabilities, and antibacterial properties, of fluoride-releasing dental restoratives, and discuss the current status concerning the prevention or inhibition of caries development and progression.

METHODS

Information from original scientific full papers or reviews listed in PubMed (search term: fluoride release AND (restorative OR glass-ionomer OR compomer OR polyacid-modified composite resin OR composite OR amalgam)), published from 1980 to 2004, was included in the review. Papers dealing with endodontic or orthodontic topics were not taken into consideration. Clinical studies concerning secondary caries development were only included when performed in split-mouth design with an observation period of at least three years.

RESULTS

Fluoride-containing dental materials show clear differences in the fluoride release and uptake characteristics. Short- and long-term fluoride releases from restoratives are related to their matrices, setting mechanisms and fluoride content and depend on several environmental conditions. Fluoride-releasing materials may act as a fluoride reservoir and may increase the fluoride level in saliva, plaque and dental hard tissues. However, clinical studies exhibited conflicting data as to whether or not these materials significantly prevent or inhibit secondary caries and affect the growth of caries-associated bacteria compared to non-fluoridated restoratives.

SIGNIFICANCE

Fluoride release and uptake characteristics depend on the matrices, fillers and fluoride content as well as on the setting mechanisms and environmental conditions of the restoratives. Fluoride-releasing materials, predominantly glass-ionomers and compomers, did show cariostatic properties and may affect bacterial metabolism under simulated cariogenic conditions in vitro. However, it is not proven by prospective clinical studies whether the incidence of secondary caries can be significantly reduced by the fluoride release of restorative materials.

Effects of incorporation of HA/ZrO2 into glass ionomer cement (GIC)

Glass ionomer cements (GICs) are a class of bioactive cements that bond directly to bone. In this paper, a new bioactive hydroxyapatite (HA)/zirconia (ZrO(2))-filled GIC composite was developed to improve the biocompatibility and bioactivity of the GICs with the surrounding bone and connective tissues. Nano-sized HA/30 wt% ZrO(2) powders were heat treated at 700 degrees Celsius and 800 degrees Celsius for 3 h to elucidate the influence of the crystallinity of composite powders on the performance of HA/ZrO(2)-GICs. The effects of different volume percentages of HA/ZrO(2) powders (4, 12, 28 and 40 vol%) substituted within GICs were investigated based on their microhardness, compressive strength and diametral tensile strength. The HA/ZrO(2)-GICs composite was soaked in distilled water for 1 day and 1 week before subjecting the samples to mechanical testing. Results showed that the glass and HA/ZrO(2) particles were distributed uniformly in the GIC matrix. The substitution of highly crystalline HA/ZrO(2) improved the mechanical properties of the HA/ZrO(2)-GICs due to the slow resorption rate for highly crystalline powders in distilled water. The mechanical properties of HA/ZrO(2)-GICs increased with increasing soak time due to the continuous formation of aluminium salt bridges, which improved the final strength of the cements. The compositions 4 and 12 vol% HA/ZrO(2)-GICs exhibited superior mechanical properties than the original GICs. The mechanical properties of HA/ZrO(2)-GICs were found to be much better than those of HA-GICs because ZrO(2) has the attributes of high strength, high modulus, and is significantly harder than glass and HA particles. Furthermore, ZrO(2) does not dissolve with increasing soaking time.

Spheroidization of glass powders for glass ionomer cements

Commercial angular glass powders were spheroidized using both the flame spraying and inductively coupled radio frequency plasma spraying techniques. Spherical powders with different particle size distributions were obtained after spheroidization. The effects of spherical glass powders on the mechanical properties of glass ionomer cements (GICs) were investigated. Results showed that the particle size distribution of the glass powders had a significant influence on the mechanical properties of GICs. Powders with a bimodal particle size distribution ensured a high packing density of glass ionomer cements, giving relatively high mechanical properties of GICs. GICs prepared by flame-spheroidized powders showed low strength values due to the loss of fine particles during flame spraying, leading to a low packing density and few metal ions reacting with polyacrylic acid to form cross-linking. GICs prepared by the nano-sized powders showed low strength because of the low bulk density of the nano-sized powders and hence low powder/liquid ratio of GICs.

Continuous-fiber preform reinforcement of dental resin composite restorations

OBJECTIVES

Direct-filling resin composites are used in relatively small restorations and are not recommended for large restorations with severe occlusal-stresses. The aim of this study was to reinforce composites with fiber preforms, and to investigate the effects of layer thickness and configurations on composite properties. It was hypothesized that fiber preforms would significantly increase the composite's flexural strength, work-of-fracture (toughness) and elastic modulus.

METHODS

Glass fibers were silanized, impregnated with a resin, cured, and cut to form inserts for tooth cavity restorations. Also fabricated were three groups of specimens of 2mm x 2mm x 25 mm: a fiber preform rod in the center of a hybrid composite; a thin fiber layer on the tensile side of the specimens; and a thin fiber layer sandwiched in between layers of a hybrid composite. These specimens were tested in three-point flexure to measure strength, work-of-fracture and modulus. Optical and scanning electron microscopy were used to examine the restorations and the fiber distributions.

RESULTS

Microscopic examinations of insert-filled tooth cavities showed that the fibers were relatively uniform in distribution within the preform, and the inserts were well bonded with the surrounding hybrid composite. Specimens consisting of a fiber preform rod in the center of a hybrid composite had a flexural strength (mean (SD); n=6) of 313 (19)MPa, significantly higher than 120 (16)MPa of the hybrid composite without fibers (Tukey's at family confidence of 0.95). The work-of-fracture was increased by nearly seven times, and the modulus was doubled, due to fiber preform reinforcement. Similar improvements were obtained for the other two groups of specimens.

SIGNIFICANCE

Substantial improvements in flexural strength, toughness and stiffness were achieved for dental resin composites reinforced with fiber preforms. The method of embedding a fiber preform insert imparts superior reinforcement to restorations and should improve the performance of direct-filling resin composites in large restorations with high occlusal-loads.

The glass-ionomer phase in resin-based restorative materials

Glass-ionomer (GI) fillers are added to restorative materials, but it is unclear if they truly react with these materials. This TEM study evaluated the existence of the GI phase in a conventional GIC (ChemFlex), a resin-modified GIC (Fuji II LC), a giomer (Reactmer Paste), a compomer (Dyract AP), and a composite (SpectrumTPH), before and after water uptake. Wafers were stored at 100% RH for 24 hrs, or in water for 7 or 84 days. ChemFlex glass particles were surrounded by 300-nm-thick silica gel layers. In Fuji II LC, we found thinner hydrogel layers (100 nm) that became thicker upon water storage. No appreciable change occurred in Reactmer Paste. Only a very thin hydrogel layer occurred in Dyract AP, and none was seen in SpectrumTPH after water storage for 84 days. We conclude that the variable extent of the GI phase is determined by differences in the resin composition of the restoratives.