Polymerization shrinkage and polymerization shrinkage stress in polymer-based restoratives

Clinical evaluation of a new chemically-cured bulk-fill composite in posterior restorations: 6-month multicenter double-blind randomized clinical trial

OBJECTIVE

To evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months.

METHODS

Fifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05).

RESULTS

Both chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05).

CONCLUSION

Chemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service.

CLINICAL SIGNIFICANCE

The chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch.

Marginal integrity of prototype bioactive glass-doped resin composites in class II cavities

OBJECTIVES

This in vitro study examined the marginal integrity of experimental composite materials doped with bioactive glass (BG).

MATERIALS AND METHODS

Class-II MOD cavities were prepared and restored with one of the following composite materials: a commercial composite material as a reference (Filtek Supreme XTE), an experimental composite doped with BG 45S5 (C-20), and an experimental composite doped with a fluoride-containing BG (F-20). Six experimental groups (n = 8) were used, as each of the three composites was applied with (+) or without (-) a universal adhesive (Adper Scotchbond Multipurpose). All specimens were subjected to thermocycling (10,000 x, 5-55 °C) and then additionally stored in artificial saliva for eight weeks. Scanning electron micrographs of the mesial and the distal box were taken at three time points (initial, after thermocycling, and after eight weeks of storage in artificial saliva). The margins were classified as "continuous" and "non-continuous" and the percentage of continuous margins (PCM) was statistically analyzed (α = 0.05).

RESULTS

In most experimental groups, thermocycling led to a significant decrease in PCM, while the additional 8-week aging had no significant effect. F-20 + performed significantly better (p = 0.005) after 8 weeks storage in artificial saliva than the reference material with adhesive, while no statistically significant differences were observed at the other two time points. C-20 + exhibited significantly better PCM than the reference material with adhesive after thermocycling (p = 0.026) and after 8 weeks (p = 0.003).

CONCLUSIONS

Overall, the experimental composites with BG showed at least as good marginal adaptation as the commercial reference, with an indication of possible re-sealing of marginal gaps.

CLINICAL RELEVANCE

Maintaining or improving the marginal integrity of composite restorations is important to prevent microleakage and its likely consequences such as pulp irritation and secondary caries.

Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage

OBJECTIVES

This study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types.

METHODS

Initially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure.

RESULTS AND DISCUSSION

The FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR). These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.

A Historical Perspective on Dental Composite Restorative Materials

This review article will discuss the origin of resin-based dental composite materials and their adoption as potentially useful adjuncts to the primary material used by most dentists for direct restorations. The evolution of the materials, largely driven by the industry's response to the needs of dentists, has produced materials that are esthetic, strong, and versatile enough to be used in most areas of the oral cavity to replace or restore missing tooth structures. Significant advancements, such as the transition from chemical to light-curing materials, refinements in reinforcing particles to produce optimum polishing and wear resistance, formulating pastes with altered viscosities to create highly flowable and highly stiff materials, and creating materials with enhanced depth of cure to facilitate placement, will be highlighted. Future advancements will likely reflect the movement away from simply being a biocompatible material to one that is designed to produce some type of beneficial effect upon interaction within the oral environment. These new materials have been called "bioactive" by virtue of their potential effects on bacterial biofilms and their ability to promote mineralization of adjacent tooth structures.

Influence of internal angle and shape of the lining on residual stress of Class II molar restorations

Polymerization shrinkage is a major side effect of resin composite materials that affects the success and longevity of caries restorations. This study was to analyze the effect of the internal angle and shape of the lining on the shrinkage residual stress of dental restorations in Class II mesio-occlusal-distal (MOD) cavities through finite element analysis (FEA). A 3D reconstructed model of a human mandibular first molar was created from micro-CT images, and then the tooth was prepared as a Class II MOD cavity. 3D models of four regular internal corner shapes of Class II MOD cavities with different internal angles of lining and one 90° filleted corner model were created. The thermal expansion technique was applied to approximate the shrinkage impact of composite resin polymerization in the FE software ABAQUS. Von Mises stress was taken as a metric. The results showed that the level of residual stresses in the Class II MOD cavities was greatly dependent on the internal angle of the lining. The maximum von Mises stress in tooth tissue decreased as the internal angle of the lining increased. The internal shapes of the lining had no obvious effect on the stress, and the filleted corner model had less stress. This lining strategy is appropriate for Class II MOD cavities with serious loss of tooth tissue.

Low and high viscosity bulk-fill composite resins stress distribution in primary molar tooth inlay cavity

The aim of this study is to evaluate the stress distributions of low and high viscosity bulk-fill composite resins at class II MOD inlay cavity in primary molar tooth using Finite Element Analysis (FEA). Original DICOM data of a primary molar tooth from a research archive was used to create a 3D model. Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with class II MOD inlay restoration. Two different bulk-fill composite resins were tested in study: Model 2 A (class II MOD inlay cavity model restored with low viscosity bulk-fill composite resin) and Model 2B (class II MOD inlay cavity model restored with high viscosity bulk-fill composite resin). Occlusal vertical loading of 232 N was applied to the teeth in occlusal contact areas. Maximum Von Mises stress values in the models for enamel, dentin, and restorative material were evaluated as MPa. More intense stress accumulation is observed in enamel than in dentin. In addition, more stress values were determined in Model 2B (206.15 MPa, 32.76 MPa, 128.95 MPa) than in Model 2 A (203.39 MPa, 29.77 MPa, 120.61 MPa) for enamel, dentin and restorative material, respectively.

Comparative Evaluation of Marginal Leakage of Various Bevel Designs Using Direct Composite Restoration in Fractured Anterior Teeth: An In Vitro Study

Background and objective Resin-based restorative materials are the backbone of modern restorative dentistry. But in spite of being an excellent material, there are many shortcomings with direct resin restorative materials such as polymerization shrinkage and microleakage that complicate the rate of clinical success. Hence, the aim of the present study is to compare the microleakage caused by composite restorations using two different bevels, primary and zigzag bevels, while restoring fractured anterior teeth. Materials and methodology Thirty non-carious maxillary central incisors were split into two divisions wherein Group I received the primary bevel and Group II received the zigzag bevel. After receiving the bevel, the samples are restored with direct filling composite material (Neo Spectra ST, Dentsply Sirona, Charlotte, NC, USA). The restored samples underwent thermocycling (Holmarc, Kochi, India) and were assessed for microleakage under a stereomicroscope (Leica M205, Wetzlar, Germany). For the statistical analysis, IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY) was used. Descriptive statistics were expressed in mean and standard deviation. Analytical statistics including the independent Student t-test was used to assess the difference derived from both groups at p<0.05. The normality of the data was assessed using the Shapiro-Wilk test. Results In the primary bevel, 53.3% of the samples showed first-degree microleakage, and 46.7% showed second-degree microleakage, respectively, and in samples restored using the zigzag bevel, 66.7% of the samples had no microleakage, and 33.3% of the samples had first-degree microleakage. The independent t-test revealed that the microleakage of the zigzag bevel showed a significant difference, being superior to the primary bevel at p<0.01. Conclusion Acknowledging the limitations of the study conducted, both bevel designs had a certain degree of microleakage when restored with composite material in anterior fractured teeth. However, the zigzag bevel produced significantly lesser microleakage as compared to the primary bevel restorations.

Fabrication of Soft Transparent Patient-Specific Vascular Models with Stereolithographic 3D printing and Thiol-Based Photopolymerizable Coatings

An ideal vascular phantom should be anatomically accurate, have mechanical properties as close as possible to the tissue, and be sufficiently transparent for ease of visualization. However, materials that enable the convergence of these characteristics have remained elusive. The fabrication of patient-specific vascular phantoms with high anatomical fidelity, optical transparency, and mechanical properties close to those of vascular tissue is reported. These final properties are achieved by 3D printing patient-specific vascular models with commercial elastomeric acrylic-based resins before coating them with thiol-based photopolymerizable resins. Ternary thiol-ene-acrylate chemistry is found optimal. A PETMP/allyl glycerol ether (AGE)/polyethylene glycol diacrylate (PEGDA) coating with a 30/70% AGE/PEGDA ratio applied on a flexible resin yielded elastic modulus, UTS, and elongation of 3.41 MPa, 1.76 MPa, and 63.2%, respectively, in range with the human aortic wall. The PETMP/AGE/PEGDA coating doubled the optical transmission from 40% to 80%, approaching 88% of the benchmark silicone-based elastomer. Higher transparency correlates with a decrease in surface roughness from 2000 to 90 nm after coating. Coated 3D-printed anatomical replicas are showcased for pre-procedural planning and medical training with good radio-opacity and echogenicity. Thiol-click chemistry coatings, as a surface treatment for elastomeric stereolithographic 3D-printed objects, address inherent limitations of photopolymer-based additive manufacturing.

Assessment of Degree of Conversion and Volumetric Shrinkage of Novel Self-Adhesive Cement

The degree of monomer conversion and polymerization shrinkage are two of the main reasons for potential adhesion failure between the tooth structure and the restoration substrate. To evaluate the degree of conversion and polymerization shrinkage of a newly developed self-adhesive resin cement, the degree of conversion (DC) was measured using FTIR under different activation modes, temperatures, and times. Volumetric shrinkage was tested using the AcuVol video imaging method. The experimental cement showed a higher DC than other cements under self-curing. The DC of the experimental cement was higher than that of other cements, except SpeedCem Plus under light curing. The experimental cement had a higher DC than other cements, except SpeedCem Plus in some conditions under dual curing. All self-adhesive cements had a higher DC at 37 °C than at 23 °C under self-curing, and there was no statistical difference between 23 °C and 37 °C under light curing. All self-adhesive cements showed a significantly higher DC at 10 min than at 5 min under self-curing. There was no statistical difference between 5 min and 10 min for most cements under dual curing. All self-adhesive cements statistically had the same volumetric shrinkage under light curing and self-curing. The newly developed self-adhesive resin cement exhibited a higher degree of conversion and similar volumetric shrinkage compared to these commercial self-adhesive resin cements.

Degree of conversion and physicomechanical properties of newly developed flowable composite derived from rice husk using urethane dimethacrylate monomer

This study evaluated the use of urethane dimethacrylate (UDMA) as a base monomer to prepare the newly developed flowable composite (FC) using nanohybrid silica derived from rice husk in comparison to bisphenol A-glycidyl methacrylate (Bis-GMA) on the degree of conversion and physicomechanical properties. The different loadings of base monomer to diluent monomer were used at the ratio of 40:60, 50:50, and 60:40. The bonding analysis confirmed the presence of nanohybrid silica in the newly developed FC. Independent t-test revealed a statistically significant increase in the degree of conversion, depth of cure and Vickers hardness of the UDMA-based FC, while surface roughness showed comparable results between the two base monomers. In conclusion, UDMA-based FC demonstrated superior performance with 60%-65% conversions, a significantly higher depth of cure exceeding 1 mm which complies with the Internal Standard of Organization 4049 (ISO 4049), and a substantial increase in Vickers hardness numbers compared to Bis-GMA-based FC, making UDMA a suitable alternative to Bis-GMA as a base monomer in the formulation of this newly developed FC derived from rice husk.

Application and limitations of configuration factor (C-factor) in stress analysis of dental restorations

OBJECTIVE

The configuration factor (C-factor) is an index used to evaluate the relationship between cavity configuration and the development of polymerization shrinkage stress in dental restorations. Although C-factor has been widely researched, its correlation with stress analysis in dental restorations remains controversial. This review aims to discuss the application and limitations of C-factor and define the restricted conditions under which the C-factor "rule of thumb" is applicable.

METHODS

A thorough literature review was conducted on the application and limitations of C-factor in stress analysis of dental restorations. This was principally based on MEDLINE/PubMed and Web of Science databases and a review of the relevant studies and publications in scientific papers in international peer-reviewed journals for the specific topic of C-factor and polymerization shrinkage.

RESULTS

The C-factor alone cannot provide an accurate prediction of the shrinkage stress of restorations and the mechanical behavior of material-tooth interfaces. C-factor is only applicable under one condition not typically seen in clinical practice: low, near-rigid compliance.

SIGNIFICANCE

Conditions for the application of C-factor have been explicitly defined. A more accurate and precise understanding and utilization of the C-factor is of benefit as it contributes to better understanding of polymerization shrinkage behavior of restorations.

Preparation and evaluation of (R)-(-)-carvone-doped polymeric resins as potential antibacterial dental materials

OBJECTIVES

This study aimed to develop and evaluate resin-based antibacterial materials incorporating carvone for restorative dentistry. The objectives included assessing antimicrobial activity, conversion degree, mechanical properties, hydrolytic and hygroscopic behavior, cytotoxicity, among others.

METHODOLOGY

Carvone was incorporated into resin-based materials following established protocols. Antimicrobial activity was evaluated against S. Aureus. Conversion degree, polimerization kinetics, mechanical properties, hydrolytic and hygroscopic behavior, cytotoxicity, and other properties were assessed using standardized tests and methodologies.

RESULTS

Carvone-incorporated materials demonstrated significant antimicrobial activity, minimal changes in conversion degree, comparable mechanical properties, improved hydrolytic and hygroscopic behavior, and lack of cytotoxicity. Antimicrobial resins were obtained due to the hydrophobic nature of carvone and its ability to diffuse through the cell walls of microorganisms, causing membrane damage. The polymerization process yielded successful conversion, ensuring adequate material performance.

SIGNIFICANCE

This study showcases that incorporating carvone into methacrylate-based resins can confer antimicrobial properties while preserving key material attributes. Antimicrobial activity against S. aureus is achieved without cytotoxicity in human fibroblasts. While flexural properties are affected only at carvone concentrations exceeding 9%, conversion degree and polymerization kinetics remain stable, except for a specific experimental formulation. These findings highlight the balanced integration of carvone. However, further work, including assessing antimicrobial performance against specific strains like S. Mutans and/or C. Albicans, and evaluating long-term effectiveness, is essential to establish the potential of these materials for dental restorations.

High-Precision 3D Printing of Microporous Cochlear Implants for Personalized Local Drug Delivery

Hearing loss is a highly prevalent multifactorial disorder affecting 20% of the global population. Current treatments using the systemic administration of drugs are therapeutically ineffective due to the anatomy of the cochlea and the existing blood-labyrinth barrier. Local drug delivery systems can ensure therapeutic drug concentrations locally while preventing adverse effects caused by high dosages of systemically administered drugs. Here, we aimed to design, fabricate, and characterize a local drug delivery system for the human cochlea. The design was relevant to the size of the human ear, included two different shapes, and incorporated two different microporous structures acting as reservoirs for drug loading and release. The four cochlear implant designs were printed using the two-photon polymerization (2PP) technique and the IP-Q photoresist. The optimized 2PP process enabled the fabrication of the cochlear implants with great reproducibility and shape fidelity. Rectangular and cylindrical implants featuring cylindrical and tapered tips, respectively, were successfully printed. Their outer dimensions were 0.6 × 0.6 × 2.4 mm3 (L × W × H). They incorporated internal porous networks that were printed with high accuracy, yielding pore sizes of 17.88 ± 0.95 μm and 58.15 ± 1.62 μm for the designed values of 20 μm and 60 μm, respectively. The average surface roughness was 1.67 ± 0.24 μm, and the water contact angle was 72.3 ± 3.0°. A high degree of polymerization (~90%) of the IP-Q was identified after printing, and the printed material was cytocompatible with murine macrophages. The cochlear implants designed and 3D printed in this study, featuring relevant sizes for the human ear and tunable internal microporosity, represent a novel approach for personalized treatment of hearing loss through local drug delivery.

Comparison of microleakage under orthodontic brackets bonded with five different adhesive systems: in vitro study

BACKGROUND

Orthodontic treatment is associated with numerous adverse side effects, such as enamel discoloration, demineralization or even caries. The presence of microleakage between the enamel and the adhesive and between the adhesive and the base of the orthodontic bracket allows penetration of the bacteria, molecules, and liquids into the enamel and can lead to unpleasant "white spot lesions" or secondary caries beneath and around the brackets. The aim of this in vitro study was to evaluate microleakage in five adhesive systems commonly used in orthodontic practice for bonding brackets.

METHODS

One hundred extracted premolars were divided into five groups of twenty teeth. Stainless steel Legend medium metal brackets were bonded to teeth using five adhesive systems: resin-reinforced glass ionomer cement GC Fuji Ortho LC (GCF) and composite materials Light Bond (LB), Transbond XT (TB), Trulock™ Light Activated Adhesive (TL), and GC Ortho Connect (GCO). The specimens were subjected to thermal cycling, stained with 2% methylene blue, sectioned with low-speed diamond saw Isomet and evaluated under a digital microscope. Microleakage was detected at the enamel-adhesive and adhesive-bracket interfaces from occlusal and gingival margins. Statistical analysis was performed using generalized linear mixed models with beta error distribution.

RESULTS

Microleakage was observed in all materials, with GCF showing the highest amount of microleakage. Composite materials GCO, TB, and LB exhibited the lowest amount of microleakage with no statistical difference between them, while TL showed a statistically significantly higher amount of microleakage (p < 0.001). The enamel-adhesive interface had more microleakage in all composite materials (GCO, LB, TB, and TL) than the adhesive bracket-interface (p < 0.001). The highest amount of microleakage occurred in the gingival region in all materials.

CONCLUSION

Composite materials showed better adhesive properties than a resin-reinforced glass ionomer cement. The presence of microleakage at the enamel-adhesive interface facilitates the penetration of various substances into enamel surfaces, causing enamel demineralization and the development of dental caries.

The clinical performance of bulk-fill versus the incremental layered application of direct resin composite restorations: a systematic review

OBJECTIVES

To systematically review the scientific evidence comparing the clinical effectiveness of bulk-fill versus incrementally layered conventional resin composites and to evaluate if one method offers clear merits with specific clinical outcomes.

MATERIALS AND METHODS

Using relevant mesh terms and pre-established eligibility criteria in PubMed, Embase, Scopus and Web of Science, a thorough scientific search was conducted with an end-date of 30.04.2023. Randomized controlled clinical trials that involved the direct comparison of Class I and Class II resin composite restorations applied using incremental layering techniques versus bulk-filled in permanent teeth with an observation period of at least six months were considered. To evaluate the bias risk of the finalized records, a revised version of the Cochrane risk-of-bias tool for randomized trials was implemented.

RESULTS

Out of the 1445 records determined, 18 eligible reports were chosen for qualitative analysis. Data obtained was categorized as per, the cavity design, the intervention, the comparator(s), the methods of success/failure assessment, the outcomes, and follow-up. Two studies demonstrated an overall low-risk of bias, fourteen studies raised some concerns, and two studies exhibited high-risk.

CONCLUSION

Bulk filled resin composite restorations demonstrated clinical outcomes similar to those of incrementally layered resin composite restorations within a review interval of 6 months to 10 years.

Effect of different finishing and polishing procedures on surface roughness and microbial adhesion on highly-filled composites for injectable mold technique

OBJECTIVE

To evaluate the effect of different finishing and polishing procedures on surface roughness and microbial adhesion and viability of Streptococcus mutans on novel highly-filled composites for injectable mold technique.

MATERIALS AND METHODS

One hundred sixty specimens were divided into four material groups: FSF (Filtek Supreme Flowable Restorative), TE (Tetric EvoFlow), GUI (G-aenial Universal Injectable) and GUF (G-aenial Universal Flo). Within each group, specimens were split regarding finishing and polishing (F/P) procedures into: SLD (Sof-Lex Discs), SLS (Sof-Lex Spirals), OG (OneGloss) and PG (PoGo). Surface roughness was analyzed using profilometer (Ra and Rz) and scanning electron microscopy (SEM) and Strep. mutans biofilm formation was analyzed using colony forming unit (CFU) and cell viability assay. Two-way analysis of variance (ANOVA) followed by Tukey's post hoc test were used for comparison among groups, Pearson's coefficient was applied for the correlation between Ra and CFU/ml and all data were presented as mean ± SD.

RESULTS

Both materials and F/P procedures affect Ra, Rz and Strep. mutans CFU/ml values (p ≤ 0.05). Considering the Ra and Rz, GUI and GUF revealed lower values, compared to FSF and TE and SLD and SLS revealed lower values, compared to OG and PG. Considering the Strep. mutans CFU/ml and viability, GUI and TE presented lower values, compared to GUF and FSF and SLD and SLS presented lower values, compared to OG and PG. Moderate positive correlation was found between Ra and CFU/ml (r = 0.552).

CONCLUSIONS

The smoothest surfaces possess GUI and GUF, among materials and SLD and SLS, among F/P procedures. GUI adhered the lowest amount of Strep. mutans, due to the smoothest surfaces. FSF and GUF revealed the highest amount of Strep. mutans, due to bis-GMA, bis-MEPP and TEGDMA in their composition.

CLINICAL SIGNIFICANCE

The findings of the present study may be beneficial for the proper selection of highly-filled composites and an adequate finishing and polishing procedure when performing the injectable mold composite resin veneer technique.

Novel Bioactive Nanocomposites Containing Calcium Fluoride and Calcium Phosphate with Antibacterial and Low-Shrinkage-Stress Capabilities to Inhibit Dental Caries

OBJECTIVES

Composites are commonly used for tooth restorations, but recurrent caries often lead to restoration failures due to polymerization shrinkage-stress-induced marginal leakage. The aims of this research were to: (1) develop novel low-shrinkage-stress (L.S.S.) nanocomposites containing dimethylaminododecyl methacrylate (DMADDM) with nanoparticles of calcium fluoride (nCaF2) or amorphous calcium phosphate (NACP) for remineralization; (2) investigate antibacterial and cytocompatibility properties.

METHODS

Nanocomposites were made by mixing triethylene glycol divinylbenzyl ether with urethane dimethacrylate containing 3% DMADDM, 20% nCaF2, and 20% NACP. Flexural strength, elastic modulus, antibacterial properties against Streptococcus mutans biofilms, and cytotoxicity against human gingival fibroblasts and dental pulp stem cells were tested.

RESULTS

Nanocomposites with DMADDM and nCaF2 or NACP had flexural strengths matching commercial composite control without bioactivity. The new nanocomposite provided potent antibacterial properties, reducing biofilm CFU by 6 logs, and reducing lactic acid synthesis and metabolic function of biofilms by 90%, compared to controls (p < 0.05). The new nanocomposites produced excellent cell viability matching commercial control (p > 0.05).

CONCLUSIONS

Bioactive L.S.S. antibacterial nanocomposites with nCaF2 and NACP had excellent bioactivity without compromising mechanical and cytocompatible properties. The new nanocomposites are promising for a wide range of dental restorations by improving marginal integrity by reducing shrinkage stress, defending tooth structures, and minimizing cariogenic biofilms.

Riboflavin (Vitamin B2), Turmeric (Curcumin) Photosensitizers Mediated Photodynamic Therapy, and Er, Cr: YSGG on Microleakage of Class V Cavities Restored by Resin-Modified Glass-Ionomer Cement

Purpose: The present study aimed to assess the effect of RF and CP intervened PDT and Er, Cr: YSGG laser on microleakage in class V RMGIC restorations in permanent teeth. Materials and Methods: In-vitro eighty standardized class V cavities (4×4×2) were prepared in extracted permanent molars based on ICDAS II (International Caries Detection and Assessment System II) caries severity code 0. All samples were arbitrarily alienated into four groups: Group 1, PDT mediated riboflavin photosensitizer (RF) [concentration of 150 μg/mL]; Group 2, PDT with curcumin photosensitizer (CP) [concentration of 100 μg/mL]; Group 3, Er, Cr: YSGG laser application; Group 4, control group: rinsed and dried dentin. Cavities were restored with conventional RMGIC. The specimens were immersed in 0.5% Fuchsine solution for 24 hrs. and sectioned. Microleakage scores were assessed under a microscope. Intergroup and intragroup comparisons were made at enamel and cementum margin respectively. Data were analyzed by non-parametric Kruskal-Wallis test and Wilcoxon tests at the level of significance deemed p < 0.05. Results: Riboflavin and curcuminmediated PDT would produce a superior reduction (95% viz 90%) of microleakage as compared to Er, Cr: YSGG laser (85%), and no control groups. Cu-PDT observed the highest amount of microleakage with the least amount of microleakage in the control group. Conclusion: Riboflavin and curcumin photosensitizers mediated PDT and Er, Cr: YSGG laser has the potential to be utilized in class V cavities before RMGIC restorations at enamel margins without adversely affecting the marginal integrity.

Full mapping tensile bond strength of luting in search for differences due to centripetal curing shrinkage

OBJECTIVES

testing if hypothetical transverse centripetal strains due to polymerization contraction of luting materials produce differential alterations in its bonding to luted structures, depending on distances to the center of the luting mass, and if this effect is C-factor related. Two hypotheses were tested: (1) there is a statistically significant decreasing relationship between the bonding strength and the transverse distances to the center of the luting material, and (2) there is a statistically significant difference between bonding strengths among luting spaces with different configuration factors.

METHODS

10 PMMA (15 mm Ø) pairs of cylinders were cemented (Scotchbond Universal adhesive & Relyx Universal, both chemically cured) in a compliant setup under two (20 and 70 N) luting forces forming 2 groups (5 samples each), resulting in different C-factors. Whole samples were sectioned in x and y directions obtaining non-trimmed beams from all along the luting surfaces. Their relative positions in each sample were assessed before separating and categorized (10 categories) according to their distances to the center of the sample. All beams were tested in tension and, because of their uneven bonding areas and to balance its influence, UTS results were transformed into UTS_res. First hypothesis was tested trough a linear relationship between UTS_res and distances to vertical centers per samples. Second hypothesis was tested using Mann-Whitney U tests to compare UTS_res between groups, along all categories. Further Weibull analysis was applied.

RESULTS

ANOVA's p of the regression UTS_res - categories were statistically significant for all samples in group 70 N and for all except one in group 20 N: first hypothesis is partially maintained. Although Mann-Whitney tests p comparing UTS_res of both groups for all categories but the first were statistically significant this hypothesis was maintained relying in Weibull analysis.

SIGNIFICANCE

bonded attachment of cemented materials decreases from centers to outbounds in plane, extensive surfaces, and this decrease is C-factor related.

Tensile Bond Strength and Marginal Integrity of a Self-adhering and a Self-etch Adhesive Flowable Composite after Artificial Thermomechanical Aging

Aim

This study aims to compare the self-etch adhesive (SEA) and self-adhesive flowable composite (SAF) concerning tensile bond strength (TBS) and marginal integrity by microleakage (µ LK) test in deciduous molars after artificial thermomechanical aging.

Materials and methods

120 extracted primary molars were collected. Sixty teeth were mounted for testing TBS. Teeth were restored using SAF (n = 30) and SEA-conventional flowable (CF) composite (n = 30) and subjected to artificial thermal aging. Half the teeth (n = 15) from each material were subjected to mechanical loading (SEA-TBS-L and SAF-TBS-L). The specimens with no-load (NL) served as control (SEA-TBS-NL and SAF-TBS-NL). Class V cavity prepared and restored with SAF (n = 30) and SEA-CF (n = 30) to test µ LK after thermal aging. The subgroups were as same as the TBS based on with or without mechanical loading (SEA-µ LK-L, SEA-µ LK-NL, SAF-µ LK-L, SAF-µ LK-L; n = 15 each). µ LK was determined by employing the dye immersion technique.

Results

Concerning TBS, there is a significant difference between SEA and SAF with load or no load. Concerning µ LK, there is a significant difference between the materials under loading and no difference was found when not mechanically loaded. Also, concerning both TBS and µ LK, a significant difference was observed between the load and no-load subgroups within each material.

Conclusion

SAF exhibited higher TBS than the SEA. Mechanical loading not only adversely affected the TBS but also increased the µLK of the compared materials.

Clinical Significance

Restoring the primary teeth with SAF not only shortens the laborious operatory time but also yields good clinical serviceability with the good bond strength and minimal µ LK, thus preventing premature loss of teeth and consequential malocclusion.

How to cite this article

Kamatchi M, Ajay R, Gawthaman M, et al. Tensile Bond Strength and Marginal Integrity of a Self-adhering and a Self-etch Adhesive Flowable Composite after Artificial Thermomechanical Aging. Int J Clin Pediatr Dent 2022;15(2):204-209.

Physical and Mechanical Properties of Bulk-Fill, Conventional, and Flowable Resin Composites Stored Dry and Wet

Surface degradation, margin, and bulk fracture are common reasons that necessitate replacement of resin composite restorations. The purpose of this study was to determine filler weight (FW), fracture toughness (FT), Vickers hardness (VHN), sorption/solubility (S/S), and colour change (ΔE) of four resin composites in dry and wet conditions. Four resin composites of shade A2 were investigated: Aura bulk-fill (AB) (SDI), Tetric Evoceram (TE) (Ivoclar), G-ænial Universal Flo (GUF) (GC), and GC Kalore (GCK) (GC). For FT, VHN, and ΔE, the specimens were prepared, divided into 2 groups, and stored dry or immersed in distilled water. The specimens were subdivided into three subgroups and stored for 1, 7, and 60 days and then subjected to the relevant tests. Six fractured remnants were weighed for each material to measure FW%. To test S/S, ISO 4049 was used. The data were analysed using ANOVA and Tukey's test. There was an inverse correlation between FW and FT. A significantly higher FT was found for GUF. There were no significant differences between conditions in materials except for AB. The highest VHN was found for GCK and AB. After 1 and 7 days, a significant difference was observed in S/S between all materials with the highest values for GUF. There was a correlation between sorption and solubility. The material, the media, and aging have an influence on the properties of resin composites. It is important to emphasise that each material should be used for a specific clinical need based on their properties.

Microtensile bond strength of glass ionomer cements to a resin composite using universal bonding agents with and without acid etching

OBJECTIVES

To assess the effect of two universal bonding agents on the microtensile bond strength (μTBS) of encapsulated conventional glass ionomers (CGICs) and resin-modified glass ionomers (RMGICs) to a resin composite, with or without the use of 35% phosphoric acid.

METHODS

Four materials were used in this study: Riva Self-cure and Riva Light-cure; SDI and Equia Forte Fil and Fuji II LC; GC. The specimens were prepared in Teflon moulds with half the specimens for each GIC etched using 35% phosphoric acid (Ultra-Etch) and the remainder not etched. Each group was randomly subdivided into three groups, where the first two groups received an air-thin layer of bonding agent (G-Premio Bond = GPB or Clearfil Universal Bond = CUB) then light cured; and the third group had no bonding agent. For all groups, a nanohybrid composite (GC Kalore; GC) was placed incrementally on the GIC. Following 24 h immersion in distilled water, each block was embedded in epoxy resin in a cubic mould and sectioned by a cutting device. The stick specimens were then subjected to μTBS testing.

RESULTS

The application of both universal bonding agents significantly enhanced the μTBS of all GICs (p < 0.001). Both RMGICs exhibited higher μTBS compared to that of CGICs (p < 0.001). The application of universal bonding agents with acid etching significantly increased the μTBS of both CGICs and RMGICs to resin composite in contrast to without acid etching.

CONCLUSION

Using 35% phosphoric acid for 15 s prior to the application of universal bonding agents improved the μTBS of GIC to resin composite.

CLINICAL SIGNIFICANCE

Using Universal bonding agents with 15 s acid etching may increase the bond strength of both CGICs and RMGICs to resin composite when utilising the sandwich technique.

Water Sorption, Water Solubility, and Rheological Properties of Resin-Based Dental Composites Incorporating Immobilizable Eugenol-Derivative Monomer

The present study aimed to evaluate the properties of new dental formulations incorporating a new polymerizable-derivative of eugenol (EgGMA). The experimental composites were prepared (by weight) with 35% resin-based matrix (1:1, bisphenol A-glycidyl methacrylate/triethylene glycol dimethacrylate) and 65% reinforcing materials (4:3, hydroxyapatite/zirconium oxide). A portion of 0.0, 2.5, and 5.0% of the resins with respect to the total composite was replaced by EgGMA monomer to obtain TBEg0, TBEg2.5, and TBEg5, respectively. The complex viscosity (at 25 and 37 °C), degree of conversion (DC), and water sorption (W_SP) and water solubility (W_SL) (3 cycles of sorption-desorption process) were investigated. Data were statistically analyzed using one-way and Tukey post-hoc tests. The results revealed a viscosity reduction with shear-thinning behavior as the EgGMA amount and temperature increased. The average complex viscosities at a lower frequency (ω = 1.0 rad/s) and at 25 °C were 234.7 ± 13.4, 86.4 ± 16.5, and 57.3 ± 17.1 (kPa·s) for TBEg0, TBEg2.5, and TBEg5, respectively. The inclusion of EgGMA led to a lower DC and W_SP but higher W_SL, compared to those of the reference (TBEg0). However, no significant differences between TBEg2.5 and control were detected (p > 0.05). Therefore, the incorporation of EgGMA in a low quantity, e.g., up to 8.45 mol% of resins, within the matrix may enhance the composite’s performance, including handling and solubility properties without any apparent effect on DC and water sorption, making it a promising monomeric biomaterial for various applications including restorative dentistry.

A Novel Low-Shrinkage Resin for 3D Printing

OBJECTIVE

To evaluate the shrinkage, accuracy, and mechanical properties of a newly developed photo-polymerizable resin material for 3D printing dental applications and compare it with three commercially available resins.

METHODS

An experimental novel proprietary resin material for 3D printing was formulated. This new resin, Die and Model Tan (SprintRay), Formlabs Grey (FormLabs), and LCD Grey (Roxel 3D) were evaluated and tested for volumetric shrinkage, accuracy, and flexural and tensile properties. Volumetric shrinkage was measured using the AcuVol video imaging method. The accuracy of the 3D printed objects through the DLP (digital light processing) printing system was determined by the 3D deviation between the scanned model and the original CAD digital model. Parallelepiped specimens (2 × 2 × 25 mm, n= 5) were printed for flexural strength, flexural modulus, and modulus of resilience and measured in accordance with ISO-4049. Dumbbell-shaped specimens (Type V, n = 5) were printed to investigate the tensile strength and tested according to ASTM-D638. Data were analyzed using one-way ANOVA and post-hoc Tukey tests (p≤0.05).

RESULTS

The experimental resin exhibited significantly lower volumetric shrinkage and significantly higher accuracy than the other commercially available resins (p < 0.001). The experimental resin showed flexural strength, flexural modulus, and tensile strength similar to Die and Model Tan resin (SprintRay) (p > 0.05), and these parameters were significantly higher than those of Formlabs Grey resin (Formlabs) and lower than those of LCD Gray resin (Roxel3D)(p <0.001).

CONCLUSION

The newly formulated 3D printing resin demonstrated lower volumetric shrinkage, high accuracy, and adequate mechanical properties compared to the commercially available resin materials.

CLINICAL SIGNIFICANCE

The new 3D printed objects exhibited higher accuracy, good stability over time, and adequate mechanical properties. The new 3D printing resin is a good candidate for modeling applications for restoration, orthodontics and implants.

Development of a novel resin for provisional prostheses using hyperbranched polyurethane acrylate and triethylene glycol dimethacrylate - An in vitro study

PURPOSE

To develop a novel resin for provisional prostheses using hyperbranched polyurethane acrylate (HBPUA) and triethylene glycol dimethacrylate (TEGDMA) with promising mechanical properties and low volumetric shrinkage.

METHODS

Four groups including TIH3-0 (100 wt% TEGDMA), TIH3-30 (30 wt% HBPUA + 70 wt% TEGDMA), TIH3-60 (60 wt% HBPUA + 40 wt% TEGDMA), and TB-60 (60 wt% bisphenol A-glycidyl dimethacrylate + 40 wt% TEGDMA) were prepared and commercial Luxatemp (DMG) was used for comparison. Fourier transform infrared spectroscopy and gel permeation chromatography were used for material characterization. Mechanical properties including microhardness, flexural strength, flexural modulus, and load energy were measured before and after water immersion. Physical properties measurement included weight changes, solubility, water absorption, surface hydrophobicity, and volumetric shrinkage. Finally, biocompatibility was evaluated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay.

RESULTS

The number- and weight-average molecular weights of the HBPUA were approximately 870 and 1480, respectively. The addition of HBPUA to TEGDMA increased the mechanical strength considerably. Although the weight changes and water absorption of TIH3-60 were higher than those of Luxatemp, the microhardness, flexural strength, flexural modulus, load energy, solubility, shrinkage, and biocompatibility of TIH3-60 were either comparable or superior to those of Luxatemp.

CONCLUSION

Based on the findings of the present study, TIH3-60 has potential for development as a new provisional material.

Marginal quality of a full-body bulk-fill composite placed with an universal adhesive system in etch-and-rinse and self-etch mode: An in vitrostudy

Background

Marginal seal of a nanohybrid bulk-fill composite compared to a nanohybrid conventional composite, using a universal adhesive (UA) applied in etch-and-rinse (ER) and self-etch (SE) mode was investigated.

Material and Methods

Thirty-six intact molars were selected and two standardized cavities in each tooth were prepared and allocated into four groups according to restorative material and etching strategy. All samples were placed in a 1% methylene blue solution for 24 h, then cut in the middle of the restorations obtaining two parts (n=144) and used for microscopic evaluation (50x) for dye penetration measurements.

Results

The data were analysed by ANOVA and Tukey post-hoc test (p<0.05). Marginal seal was influenced by adhesive strategy (p<0.05) but not from the composite used (p>0.05).

Conclusions

Simplified restorations with nanohybrid bulk-fill composite showed comparable marginal leakage to incrementally placed nanohybrid composite. The UA used with a ER technique resulted in better marginal seal irrespective of the restorative material used.

Key words:Bulk-fill composite, universal adhesive, self-etching, etch-and-rinse, marginal seal.

Polymerization Shrinkage of Short Fiber Reinforced Dental Composite Using a Confocal Laser Analysis

The purpose of this study was to investigate the polymerization shrinkage of short fiber reinforced composite (SFRC) using a multicolor confocal displacement laser that can measure the polymerization shrinkage with high accuracy. The three types of SFRCs used in this study were XD (Ever X Flow Dentin), XB (Ever X Flow Bulk), and XP (EverX Posterior). In addition, CF (Clearfil majesty ES Flow) with hybrid type filler was used as a control. The measured values of the final polymerization shrinkage rate and amount of polymerization shrinkage rate when the polymerization shrinkage rate became constant (less than 0.1 µm/s) were approximated for all SFRCs. XP had a large aspect ratio of glass fiber filler and showed a significant difference from XD with a small aspect ratio (p < 0.05). There was no significant difference in the measured value of time when the polymerization contraction reached a constant speed (0.1 µm/s or less) for all SFRCs (p > 0.05). There was no significant difference in the measured values of polymerization shrinkage rate after the polymerization shrinkage reached a constant rate for all SFRCs (p > 0.05). These results show that glass fiber with large aspect ratio can alleviate polymerization shrinkage stress. The polymerization behavior of SFRC was found to be dependent on the amount of glass fiber filler, aspect ratio, and orientation.

3D Printing at Micro-Level: Laser-Induced Forward Transfer and Two-Photon Polymerization

Laser-induced forward transfer (LIFT) and two-photon polymerization (TPP) have proven their abilities to produce 3D complex microstructures at an extraordinary level of sophistication. Indeed, LIFT and TPP have supported the vision of providing a whole functional laboratory at a scale that can fit in the palm of a hand. This is only possible due to the developments in manufacturing at micro- and nano-scales. In a short time, LIFT and TPP have gained popularity, from being a microfabrication innovation utilized by laser experts to become a valuable instrument in the hands of researchers and technologists performing in various research and development areas, such as electronics, medicine, and micro-fluidics. In comparison with conventional micro-manufacturing methods, LIFT and TPP can produce exceptional 3D components. To gain benefits from LIFT and TPP, in-detail comprehension of the process and the manufactured parts' mechanical-chemical characteristics is required. This review article discusses the 3D printing perspectives by LIFT and TPP. In the case of the LIFT technique, the principle, classification of derivative methods, the importance of flyer velocity and shock wave formation, printed materials, and their properties, as well as various applications, have been discussed. For TPP, involved mechanisms, the difference between TPP and single-photon polymerization, proximity effect, printing resolution, printed material properties, and different applications have been analyzed. Besides this, future research directions for the 3D printing community are reviewed and summarized.

Hydrogels in Electrophoresis: Applications and Advances

A hydrogel is a solid form of polymer network absorbed in a substantial amount of aqueous solution. In electrophoresis, hydrogels play versatile roles including as support media, sieving matrixes, affinity scaffolds, and compositions of molecularly imprinting polymers. Recently, the study of hydrogels has been advancing with unprecedented speed, and the application of hydrogels in separation science has brought new opportunities and possible breakthroughs. A good understanding about the roles and effects of the material is essential for hydrogel applications. This review summarizes the hydrogels that has been described in various modes of electrophoretic separations, including isoelectric focusing gel electrophoresis (IEFGE), isotachophoresis (ITP), gel electrophoresis and affinity gel electrophoresis (AGE). As microchip electrophoresis (ME) is one of the future trends in electrophoresis, thought provoking studies related to hydrogels in ME are also introduced. Novel hydrogels and methods that improve separation performance, facilitate the experimental operation process, allow for rapid analysis, and promote the integration to microfluidic devices are highlighted.

24 hour polymerization shrinkage of resin composite core materials

PURPOSE

The study's purpose was to evaluate the 24-hour polymerization shrinkage of resin composite core materials.

MATERIAL AND METHODS

Eleven resin composite core material samples (n = 12) were evaluated using a non-contact imaging device with measurements obtained over 24 h. Shrinkage values were determined corresponding to proposed times involved with CAD/CAM same-day treatment and at 24 h. Shrinkage data was statistically compared using Friedman/Dunn's test for intragroup analysis and Kruskal Wallis/Dunn's test for intergroup analysis, all at a 95% level of confidence (α = 0.05).

RESULTS

Mean results identified a wide volumetric shrinkage range with considerable similarity overlap. Inconsistent shrinkage behavior was evident and all materials reached maximum values before 24 h. No significant difference was observed during proposed digital same day all ceramic crown procedures, but some differences were noted at 24 h.

CONCLUSIONS

Under this study's conditions results were material specific, at times inconsistent, with wide variation. Shrinkage consistently increased for all products and it is not known if the continued shrinkage magnitude may compromise the stability and fit of all-ceramic crowns at 24 h.

Enhancing Toughness and Reducing Volumetric Shrinkage for Bis-GMA/TEGDMA Resin Systems by Using Hyperbranched Thiol Oligomer HMDI-6SH

In order to improve the toughness and reduce polymerization shrinkage of traditional bisphenol A-glycidyl methacrylate (Bis-GMA)/triethylene glycol dimethacrylate (TEGDMA) based dental resin system, a hyperbranched thiol oligomer (HMDI-6SH) was synthesized via thiol-isocyanate click reaction using pentaerythritol tetra(3-mercaptopropionate (PETA) and dicyclohexylmethane 4,4′-diisocyanate (HMDI) as raw materials. Then HMDI-6SH was mixed with 1,3,5-Triallyl-1,3,5-Triazine-2,4,6(1H,3H,5H)-Trione (TTT) to prepare thiol-ene monomer systems, which were added into Bis-GMA/TEGDMA resins with different mass ratio from 10 wt% to 40 wt% to serve as anti-shrinking and toughening agent. The physicochemical properties of these thiol-ene-methacrylate ternary resins including functional groups conversion, volumetric shrinkage, flexural properties, water sorption, and water solubility were evaluated. The results showed that the incorporation of HMDI/TTT monomer systems into Bis-GMA/TEGDMA based resin could improve C=C double bond conversion from 62.1% to 82.8% and reduced volumetric shrinkage from 8.53% to 4.92%. When the mass fraction of HMDI/TTT monomer systems in the resins was no more than 20 wt%, the flexural strength of the resin was higher or comparable to Bis-GMA/TEGDMA based resins (p > 0.05). The toughness (it was measured from the stress–strain curves of three-point bending test) of the resins was improved. Water sorption and water solubility tests showed that the hydrophobicity of resin was enhanced with increasing the content of thioester moiety in resin.

Computer Aided Design Modelling and Finite Element Analysis of Premolar Proximal Cavities Restored with Resin Composites

This study evaluated the stress distribution in five different class II cavities of premolar models restored with conventional or bulk-fill flowable composite by means of finite element analysis (FEA) under shrinkage and occlusal loading. An upper validated premolar model was imported in the software, and five class II cavities with different occlusal extensions and dimensions were prepared: horizontal cavity on the mesial surface (horizontal slot), mesio-occlusal cavity, mesial cavity (vertical slot), tunnel type cavity and direct access cavity. The models were restored with conventional or bulk-fill flowable resin composite. The tested materials were considered as homogeneous, linear, and isotropic. The Maximum Principal Stress criteria was chosen to evaluate the tensile stress results. The lowest shrinkage stress value was observed in the direct access cavity restored with bulk-fill flowable resin composite (36.12 MPa). The same cavity, restored with conventional composite showed a score of 36.14 MPa. The horizontal slot cavity with bulk-fill flowable showed a score of 46.71 MPa. The mesio-occlusal cavity with bulk-fill flowable had a score of 53.10 MPa, while with conventional composite this was 55.35 MPa. Higher shrinkage stress was found in the vertical slot cavity with conventional resin 56.14 MPa, followed by the same cavity with bulk-fill flowable 56.08 MPa. Results indicated that the use of bulk-fill flowable composite resin more significantly decreased the polymerization shrinkage stress magnitude. The larger the cavity and the volume of material necessary to restore the tooth, the greater the residual stress on enamel and dentin tissue.

Effects of the lining material, thickness and coverage on residual stress of class II molar restorations by multilayer technique

OBJECTIVE

This study aims to analyse the influence of different lining material, thickness and coverage on residual stress of class II molar restoration by the multilayer technique through the three-dimensional (3D) finite element (FE) method. The objective is to reveal the correlations between the base layer configurations and the residual stress distributions of the tooth.

METHODS

A 3D reconstructed model of an extracted first molar was built through micro-CT images and a class II mesio-occlusal-distal cavity was prepared using computer-aided engineering (CAE) software. A bilayer technique was then applied, and 3D FE analyses were performed under polymerization contraction loading. Glass ionomer composites (Vitrebond and Ionosit) and flowable composite resin (Luxa Flow and Z350 Flowable Restorative) were used as lining materials. Moreover, several sensitivity analyses with dozens of hypothetical lining materials were conducted to provide definitive results. The thickness of the base layers was set to be distinct (0.5 mm or 1 mm) so as to reveal its effect on the stress alleviation. Various lining strategies with the liner covering different areas of the cavity walls (Closed Sandwich, Open Sandwich and Special Open Sandwich) were adopted to determine the effects of the base layers.

RESULTS

Adoption of an appropriate liner could effectively reduce the polymerization shrinkage stress. The mechanical properties of the base layer can affect the residual stresses, basically a lower Young's modulus and lower Poisson's ratio (of lining material) result in better stress mitigation, therefore reducing the stress transmitted to the dentin. Increase of the lining thickness within a certain range could lead to a decrease in the probability of stress concentration formation. Lining strategies had the strongest influence on the stress distributions. Different lining coverage could cause various stress responses, and covering all cavity walls with the lining material had the optimal performance among all the simulations in this study.

SIGNIFICANCE

The multilayer technique is an effective way to prolong the service life of resin composites restorations. A thorough evaluation of the sandwich technique through the FE method can provide a better understanding of the stress distributions of the restoration, and reveal its internal mechanisms.

Expanding Monomers as Anti-Shrinkage Additives

Commonly, volumetric shrinkage occurs during polymerizations due to the shortening of the equilibrium Van der Waals distance of two molecules to the length of a (significantly shorter) covalent bond. This volumetric shrinkage can have severe influence on the materials’ properties. One strategy to overcome this volumetric shrinkage is the use of expanding monomers that show volumetric expansion during polymerization reactions. Such monomers exhibit cyclic or even oligocyclic structural motifs with a correspondingly dense atomic packing. During the ring-opening reaction of such monomers, linear structures with atomic packing of lower density are formed, which results in volumetric expansion or at least reduced volumetric shrinkage. This review provides a concise overview of expanding monomers with a focus on the elucidation of structure-property relationships. Preceded by a brief introduction of measuring techniques for the quantification of volumetric changes, the most prominent classes of expanding monomers will be presented and discussed, namely cycloalkanes and cycloalkenes, oxacycles, benzoxazines, as well as thiocyclic compounds. Spiroorthoesters, spiroorthocarbonates, cyclic carbonates, and benzoxazines are particularly highlighted.

Effect of Shrinking and No Shrinking Dentine and Enamel Replacing Materials in Posterior Restoration: A 3D-FEA Study

The aim of the present study was to investigate the effect of shrinking and no shrinking dental filling materials combination in posterior restorations under the combined effects of polymerization shrinkage and occlusal load by means of 3D Finite Elements Analysis. Six computer-generated and restored class I or class II cavities models of a lower molar were designed in the CAD software and evaluated according to the cavity and restorative procedure. Different shrinking and no shrinking adhesive materials combination with diverse Young’s modulus were considered. A food bolus was modeled on the occlusal surface replicating the chewing load using static linear analyses Polymerization shrinkage was simulated for the shrinking different restorative materials. The maximum principal stress was selected as analysis criteria. All models exhibited higher stresses along the dentine restoration interfaces with different magnitude and a similar stress trend along enamel restoration interface. Stress values up to 22 MPa and 19 MPa were recorded in the enamel and restoration, respectively. The use of elastic not shrinking material layer in combination with bulk fill composite reduced the stress magnitude in dentine and enamel to replace dental tissues. Class I and class II posterior cavities adhesively restored with shrinking filling material’s combination showed the most unfavorable stress concentrations and the multilayer technique is a promising restorative alternative in posterior adhesive restorations when deep dentin and enamel volumes are missing.

Photopolymerization shrinkage-stress reduction in polymer-based dental restoratives by surface modification of fillers

OBJECTIVES

This research explores the use of polymer brushes for surface treatment of fillers used in polymer-based dental restoratives with focus on shrinkage stress reduction. The influence of interfacial reactive groups on shrinkage stress is explored.

METHODS

Oligomers of varying lengths and with varying number of reactive groups along the length were synthesized by modifying commercial oligomers. Surface of silica fillers (OX50) was treated with methylaminopropyltrimethoxysilane and this was further reacted with the synthesized oligomers to obtain a series of polymer brushes on the surface. Fillers modified with γ-methacryloxypropyltrimethoxysilane were used as a control. Filler surface treatment was confirmed using diffuse reflectance spectroscopy and thermogravimetric analysis. Fillers were added at 30 wt % to a resin made of BisGMA/TEGDMA and polymerization kinetics, shrinkage stress, volumetric shrinkage, flexural strength and modulus, viscosity were measured.

RESULTS

Composites with polymer brush functionalized fillers showed up to a 30 % reduction in shrinkage stress as compared to the control, with no reduction in flexural strength and modulus. Shrinkage stress reduced with increasing length of the polymer brush and increased with increase in number of reactive groups along the length of the polymer brush.

SIGNIFICANCE

The interface between inorganic fillers and an organic polymer matrix has been utilized to reduce shrinkage stress in a composite with no compromise in mechanical properties. This study gives insights into the stress development mechanism at the interface.

Effects of systematically varied thiourethane-functionalized filler concentration on polymerization behavior and relevant clinical properties of dental composites

Introduction of thiourethane (TU) oligomer to resin-based dental restorative materials reduces stress and improves fracture toughness without compromising conversion. Localization of TU at the resin-filler interface via silanization procedures may lead to more substantial stress reduction and clinical property enhancements. The objective of this study was to evaluate composite properties as a function of TU-functionalized filler concentration. TU oligomers were synthesized using click-chemistry techniques and subsequently silanized to barium glass filler. Resin-based composites were formulated using varying ratios of TU-functionalized filler and conventional methacrylate-silanized barium filler. Material property testing included thermogravimetric analysis, real-time polymerization kinetics and depth of cure, polymerization stress, stress relaxation and fracture toughness. Clinical property testing included water sorption/solubility, composite paste viscosity, and gloss and surface roughness measured before and after subjecting the samples to 6 h of continuous tooth brushing in a custom-built apparatus using a toothpaste/water mixture. Increasing TU-filler in the composite resulted in as much as a 78% reduction in stress, coupled with an increase in fracture toughness. Conversion was similar for all groups. After simulated tooth brushing, gloss reduction was lower for TU-containing composites and surface roughness was less than or equal to the control.

Influence of an Alkoxylation Grade of Acrylates on Shrinkage of UV-Curable Compositions

Commercially available UV curable restorative materials are composed of inorganic filler hydroxyapatite, multifunctional methacrylate, photoinitiator and alkoxylated acrylate. Especially, the application of alkoxylated monomers with different alkoxylation grade allows the reduction of polymerization shrinkage which plays the major role by application of low shrinkage composites as high quality restorative dental materials or other adhesive materials in the form of UV-polymerized self-adhesive acrylics layers (films). There are several ways to reduce polymerization shrinkage of restorative compositions, for example, by adjusting different alkoxylated acrylic monomers, which are integral part of investigated UV curable restorative composites. This article is focused on the studies of contraction-stress measured as shrinkage during UV-initiated curing of restorative composites containing various commercially available alkoxylated acrylates. Moreover, studies with experimental restorative materials and recent developments typical for UV curing technology using special photoreactive monomers are described.

Effect of Saliva Contamination on Microleakage of Open Sandwich Restorations

Objectives

The purpose of the present study was to evaluate the microleakage of conventional glass-ionomer, resin modified glass-ionomer and glass hybrid ionomer Class II open sandwich restorations with or without saliva contamination.

Materials and methods

Sixty extracted sound human molar teeth were used and 120 class II slot cavities were prepared in mesial and distal surfaces. The gingival margins were located 1 mm below the cementoenamel junction. All specimens were randomly divided in 4 groups (n=15): Group I: High-Viscous Glass Ionomer (Fuji IX GP) Group II: Resin Modified Glass Ionomer (Fuji II LC) Group III: Glass Hybrid Ionomer (Equia-fil Forte), Group IV: Composite Resin (G'aenial Posterior). In open sandwich restoration groups, glass ionomer materials were placed to gingival floor in 1 mm thickness and rest of the cavity was filled with resin composite. After the restorations in mesial surfaces had been performed, distal cavities were restored with the same protocol after saliva contamination. The specimens were thermo-cycled for 10000 cycles at 5⁰C to 55⁰C and immersed in methylene blue dye solution (% 0,5) for 24 hours. Then, they were sectioned vertically through the center of the restorations from mesial to distal surface with a water-cooled diamond saw with 1mm thickness. Subsequently, the dye penetration was evaluated with image analysis software. Data were statistically analyzed (p<0.05).

Results

There was a statistically significant difference between gingival microleakage scores in no contamination groups, between high-viscous glass ionomer, Fuji IX GP and other materials tested (p<0.05). In saliva contaminated groups, there was no statistically significant difference between gingival microleakage scores (p>0.05). Additionally, there was not a statistically significant difference between the no contamination and saliva contaminated groups regardless of dental materials tested (p>0.05).

Conclusion

Within the limitations of this study, in open sandwich restorations, saliva contamination did not show an adverse effect on microleakage irrespective of dental materials tested. Glass hybrid ionomers and resin modified glass ionomers showed lower microleakage scores in gingival margins compared to high-viscous glass ionomer material in no contamination groups.

Effect of Layering Techniques on Polymerization Shrinkage Stress of High- and Low-viscosity Bulk-fill Resins

CLINICAL RELEVANCE

The use of layering techniques is still advisable with many bulk-fill resins and should be the default unless a particular resin is known to not need it.

SUMMARY

Objective: The purpose of this study was to investigate how layering techniques affect polymerization shrinkage stresses of high-and low-viscosity bulk-fill resins.Method: Six high-viscosity and six low-viscosity bulk-fill resins were evaluated. Aluminum blocks with a mesial-occlusal-distal (MOD) cavity were machined and randomly divided into groups for different filling techniques (bulk-fill vs horizontal layering vs oblique layering) and further subdivided according to type of resin (high- vs low-viscosity). The cuspal deflection resulting from the polymerization of bulk-fill resin bonded to a MOD cavity within an aluminum block was measured with a digimatic micrometer. Scanning electron microscopy analyses of tested resins were also conducted.Results: In the high-viscosity bulk-fill resins, cuspal deflection of the MOD cavity ranged from 11.2 to 18.2 μm with the bulk-filling technique, from 10.7 to 15.5 μm with the horizontal layering technique, and from 10.9 to 15.2 μm with the oblique layering technique. In the low-viscosity bulk-fill resins, cuspal deflection of the material ranged from 9.2 to 19.8 μm with the bulk-filling technique, from 8.2 to 15.7 μm with the horizontal layering technique, and from 8.4 to 16.4 μm with the oblique layering technique.Conclusion: Cuspal deflections for some high-and low-viscosity bulk-fill resins were significantly reduced by using layering techniques, but the resultant improvement of layering techniques was not applicable to all the bulk-fill resins used in this study.

The use of different adhesive filling material and mass combinations to restore class II cavities under loading and shrinkage effects: a 3D-FEA

3D tooth models were virtually restored: flowable composite resin + bulk-fill composite (A), glass ionomer cement + bulk-fill composite (B) or adhesive + bulk-fill composite (C). Polymerization shrinkage and masticatory loads were simulated. All models exhibited the highest stress concentration at the enamel-restoration interfaces. A and C showed similar pattern with lower magnitude in A in comparison to C. B showed lower stress in dentine and C the highest cusps displacement. The use of glass ionomer cement or flowable composite resin in combination with a bulk-fill composite improved the biomechanical behavior of deep class II MO cavities.

Margin Integrity of Bulk-Fill Composite Restorations in Primary Teeth

This in vitro study examined the margin integrity of sculptable and flowable bulk-fill resin composites in Class II cavities of primary molars. Standardized Class II cavities were prepared in human primary molars and restored with the following resin composite materials after application of a universal adhesive: a sculptable bulk-fill composite (Tetric EvoCeram Bulk Fill (TEC) or Admira Fusion x-tra (AFX)), a flowable bulk-fill composite (Venus Bulk Fill (VBF) or SDR), or a conventional composite (Filtek Supreme XTE (FS)). The bulk-fill materials were applied in 4 mm layers, while the conventional composite was applied in either 2 mm (FS2, positive control) or 4 mm layers (FS4, negative control). The specimens were exposed to thermo-mechanical loading (TML) in a computer-controlled masticator. A quantitative margin analysis was performed both before and after TML using scanning electron microscopy, and the percentage of continuous margins (margin integrity) was statistically analyzed (α = 0.05). All composites showed a significant decline in margin integrity after TML. AFX exhibited the significantly highest margin integrity of all materials after TML (97.5 ± 2.3%), followed by FS2 (79.2 ± 10.8%), TEC (73.0 ± 9.1%), and FS4 (71.3 ± 14.6%). SDR (43.6 ± 22.3%) and VBF (25.0 ± 8.5%) revealed the lowest margin integrity. In conclusion, the tested sculptable bulk-fill materials show similar or better margin integrity in primary molars than the conventional resin composite placed in 2 mm increments.

Effect of Tack Cure on Polymerization Shrinkage of Resin-based Luting Cements

CLINICAL RELEVANCE

Self-cure after tack cure could result in a lower polymerization shrinkage in some resin-based luting cements, which is closely related to lower degree of cure.

SUMMARY

CAD/CAM-fabricated inlay restorations: Can the resin-coating technique improve bond strength and internal adaptation?

This study assessed the effect of the resin-coating technique on the bond strength and internal adaptation of computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated inlays. Seventy-two mesio-occlusal-distal (MOD) cavities were prepared and distributed into 3 groups according to the resin-coating technique utilized: uncoated group, G-Premio Bond (1-step) group, and Clearfil SE Bond 2+Clearfil Majesty ES Flow (2-step+Flow) group. The MOD inlays were fabricated and cemented with RelyX Ultimate (RXU), G-CEM LinkForce (LinkForce), or Panavia V5 (PV5). After 5,000 thermal cycles, each specimen was sectioned and subjected to microtensile bond strength (MTBS) testing and an internal adaptation evaluation. For the uncoated group, RXU exhibited higher MTBS than LinkForce and PV5 (p<0.05). The MTBS of all 1-step and 2-step+Flow groups was greater than 30 MPa. Resin coating did not influence the MTBS of RXU, whereas resin coating increased the MTBS of LinkForce and PV5. More than 95% gap-free margins were found in all groups.