Clinical criteria for the successful curing of composite materials

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

Clinical evaluation of bulk-fill and universal nanocomposites in class II cavities: Five-year results of a randomized clinical split-mouth trial

AIM

Evaluating the clinical survival and quality parameters of class-II restorations using 3M™ Filtek^TM Bulk Fill Posterior Restorative compared to 3M™ Filtek^TM Supreme XTE Universal Restorative over a period of five years.

MATERIALS AND METHODS

A longitudinal, randomized, prospective split-mouth study with 60 patients (29 female, 31 male; mean age 44 y; range 20-77 y) and a total of 120 load-bearing class II restorations (TEST: n=60 Filtek Bulk Fill Posterior Restorative; CONTROL: n=60 Filtek Supreme XTE Universal Restorative) was conducted. Clinical evaluation was performed by blinded evaluators according to FDI criteria. Kaplan-Meier method was used for survival analysis and an intergroup comparison (Mann-Whitney-U-Test) was carried out. A basic significance level of 0.05 was corrected by the Bonferroni method to account for multiple testing (significance after correction: p<0.00067).

RESULTS

The mean overall survival of restorations was 92% after 56.98±1.51 months in the TEST group (95 CI= 54.02;59.94) and 92% after 57.25±1.46 months (95 CI= 54.39; 60.12) in the CONTROL group (log-rank p=0.995). In total, four failures occurred in both TEST and CONTROL group during the observation period (mean annual failure rate: 1.6%). The most common reasons for failure were chipping-fractures, debonding, cracked-tooth-syndrome and recurrent decay. With regard to the FDI criteria, no significant differences between TEST and CONTROL material occurred for any of the evaluated variables. In the TEST group two restorations had to be repaired and two had to be replaced, in the CONTROL group four restorations had to be replaced.

CONCLUSION

Both materials showed acceptable clinical performance and survival during the 5-year observation period.

CLINICAL SIGNIFICANCE

The use of a nanofilled bulk-fill composite proved to be an aesthetically, functionally and biologically satisfactory alternative in posterior dentition.

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

Evaluation of degree of conversion, rate of cure, microhardness, depth of cure, and contraction stress of new nanohybrid composites containing pre-polymerized spherical filler

The aim of the present study was to characterize nanohybrid and nanofilled composites in terms of degree of conversion (DC), rate of cure (RC), microhardness (Vickers hardness number; VHN), depth of cure, and contraction stress (CS). Ceram.X® universal- A3, duo enamel E2, and duo dentin D3 composites were compared to Tetric EvoCeram® and FiltekTMSupreme XTE composites of equivalent dentin and enamel shades under a 40 s photopolymerization protocol. DC was measured by infrared spectroscopy, calculating RC from the kinetic curve. Top and bottom VHN were determined using a Vickers indenter, and bottom/top surface ratio (Vickers hardness ratio; VHR) calculated. CS vs. time was assessed by a universal testing machine and normalized for the specimen bonding area. All materials showed DC  < 60%, Ceram.X® composites reaching higher values than the other composites of corresponding shades. RC at 5 s of photopolymerization was always higher than that at 10 s. All the Ceram.X® composites and the lighter-shaded Tetric EvoCeram® and FiltekTMSupreme XTE composites reached the RC plateau after 25 s, the remaining materials showed a slower kinetic trend. Tetric EvoCeram® and FiltekTMSupreme XTE composites displayed the softest and the hardest surfaces, respectively. Differently from darker-shaded materials, the universal and the three enamel-shaded composites resulted optimally cured (VHR >  80%). The tested composites differed in CS both during and after light cure, Tetric EvoCeram® and FiltekTMSupreme XTE composites displaying the highest and the lowest CS, respectively. Only the Ceram.X® universal-A3 reached a CS plateau value. The tested composites exhibited material-dependent chemo-mechanical properties. Increasing the curing time and/or reducing the composite layer thickness for dentin-shaded composites appears advisable.

Training and experience effect on light-curing efficiency by dental practitioners

BACKGROUND

Light-curing is a crucial step during the application of composite resin restorations. Composite's success depends on delivering enough light energy to the resin to achieve adequate polymerization. However, dentists are not recognizing the importance of proper light-curing technique.

OBJECTIVES

To measure light energy delivered to simulated restorations by preclinical dental students and dentists in internship year. To evaluate the effect of experience and training on the clinician's ability to light-cure composite restorations.

METHODS

A group of 50 preclinical dental students and a group of 50 internship dentists light-cured for 10 seconds, a simulated class III and class I restorations positioned in a patient simulator (MARC-Patient Simulator [BlueLight Analytics Inc., Canada]) that measured the irradiance and energy delivered by the curing light. Then participants received individualized training on optimizing their light-curing technique. They were retested after the training. Statistical analysis was done with two-way ANOVA and Tukey's test.

RESULTS

Participants delivered an average of 60% more energy after the instructions, which is a significant improvement (P < 0.05). The number of participants that failed to deliver the minimum amount of energy (6 J/cm²) decreased significantly from 37.5% to 2.5%. There was a significant difference in the amount of energy delivered by the Preclinical and Internship groups (P < 0.05).

CONCLUSION

Initially, many participants were not using the curing light properly. Light-curing technique improved with training and using a patient simulator. Experience can enhance the operator's ability to light-cure composite restorations. However, a training session can improve light-curing performance more than years of experience.

Effect of Contamination, Damage and Barriers on the Light Output of Light-Curing Units

Background:

Light-curing is a crucial step during the application of composite resin restorations. The clinical success of composite depends on the Light-Curing Units (LCU) to deliver adequate light energy to polymerize the resin. However, light-curing usually does not receive the proper awareness it deserves.

Objective:

This study aims to evaluate the effect of contamination and debris of the LCU’s tip on its light output. Determine the effect of damage to the LCU’s tip such as chipping, dents and scratches. Additionally, it evaluates the effect of plastic barrier sleeves.

Methods:

Sixty LED LCUs were tested using MARC™ Resin Calibrator (BlueLight Analytic Inc., Halifax, Canada) to measure their irradiance and energy before and after cleaning their tips. They were also tested with and without a clear plastic barrier. Additionally, four damaged LCUs received new tips and were tested again. Kruskal-Wallis H and One-Way ANOVA tests were used for statistical analysis.

Results:

Cleaning the LCUs’ tips showed significant improvement, an average increase of 8.2%. However, some units increased by up to 47% in irradiance and energy values. Replacing the damaged tip with a new one significantly improved the output of the LCUs, increasing light energy by up to 73%. The barrier used in this study caused 7% reduction in the energy delivered by the LCUs. The statistical analysis showed that cleaning the LCUs and replacing their damaged tips resulted in a significant increase in energy (p<0.05).

Conclusion:

Unclean or damaged LCUs’ tips can drastically reduce the light output of the LCUs, reducing the quality of the composite restorations. Clinicians are strongly recommended to regularly monitor, clean and maintain their curing lights.

Ocular hazards of curing light units used in dental practice - A systematic review

Objective

To examine the literature and summarize studies that describe the potential ocular hazards that are posed by different systems of light curing units mainly used in the dental clinics, to ensure the safety of the operator, patient and the auxiliary staff in the dental clinic.

Methods

This systematic review was reported and conducted according to the PRISMA guidelines. The online databases PubMed and Google Scholar were used for data search. MeSH terms were used for PubMed search. Randomized controlled clinical trials, original studies and in-vitro studies conducted up to 2018 in English language were included in the review. Eight articles were included in the study after application of eligibility criteria, all of which were in accordance to the review protocol.

Results

The total wavelength dose received can cause Ocular damage which suggest that light intensity is correlated to the duration required to cause a certain level of damage, and we can substitute the long light exposure by using of a lower intensity light.

Conclusion

This review concludes that blue light poses maximum risk to cause retinal degeneration based on the evaluated studies. Most of the studies recommend the use of protective eyewear in order to limit exposure of the patient, operator and assistant to the LCUs. It is not advisable to stare directly into the light source and the recommended safe exposure times and distances for patient, operator and assistant must be strictly adhered to in the dental practice.

Influence of adhesive-composite application modalities on their bonding to tooth structure and resistance of the performed restorations to failure

Background/purpose

The longevity of bonded composite restorations could be affected by the utilized adhesive-composite application techniques. This in vitro study aimed to evaluate the influence of adhesive-composite application modalities on their bonding values to tooth structure and on the failure resistance of the performed restorations on loading.

Materials and methods

Resin composite studs, 2 mm in diameter and 4 mm high, were bonded in 2 groups to flattened enamel and dentin surfaces of 80 extracted premolars using pre-cured (PC) and co-cured (CC) self-etch resin adhesive. Studs in each group were built-up in 4 subgroups using either multiple increments of nano-filled composite (IF, control) or single increment of preheated nano-filled (PH), bulk-fill (BF) and sonic-activated bulk-fill composites (SF). Another 80 premolars with standard class II cavities were also restored using the same adhesive-composite application modalities. All specimens were then stressed on a universal testing machine to assess the composite-tooth shear bond strength and the resistance of the performed restorations to failure. The modes of specimens’ failure were also assessed following each test.

Results

The PC adhesive provided higher bond strength to dentin (p < 0.05) and comparable bond strength to enamel in comparison to the CC one (p>0.05%). Both PH and BF composites showed lower bond strength to dentin in presence of PC adhesive (p < 0.05). Comparable bond strengths were noticed for PH, BF and SF composites to dentin in presence of CC adhesive (p > 0.05). PH and SF restorations presented the highest resistance to failure (p < 0.05).

Conclusion

Both incrementally and bulky-inserted composites offer clinically acceptable bond strength in presence of pre-cured resin adhesive. Both Preheated and sonic-activated composite restorations offer the highest resistance to failure on loading. The preheating procedure renders regular composite material suitable for bulk-fill applications.

Properties of Experimental Dental Composites Containing Antibacterial Silver-Releasing Filler

Secondary caries is one of the important issues related to using dental composite restorations. Effective prevention of cariogenic bacteria survival may reduce this problem. The aim of this study was to evaluate the antibacterial activity and physical properties of composite materials with silver sodium hydrogen zirconium phosphate (SSHZP). The antibacterial filler was introduced at concentrations of 1%, 4%, 7%, 10%, 13%, and 16% (w/w) into model composite material consisting of methacrylate monomers and silanized glass and silica fillers. The in vitro reduction in the number of viable cariogenic bacteria Streptococcus mutans ATCC 33535 colonies, Vickers microhardness, compressive strength, diametral tensile strength, flexural strength, flexural modulus, sorption, solubility, degree of conversion, and color stability were investigated. An increase in antimicrobial filler concentration resulted in a statistically significant reduction in bacteria. There were no statistically significant differences caused by the introduction of the filler in compressive strength, diametral tensile strength, flexural modulus, and solubility. Statistically significant changes in degree of conversion, flexural strength, hardness (decrease), solubility (increase), and in color were registered. A favorable combination of antibacterial properties and other properties was achieved at SSHZP concentrations from 4% to 13%. These composites exhibited properties similar to the control material and enhanced in vitro antimicrobial efficiency.

Effect of Tooth-structure Thickness on Light Attenuation and Depth of Cure

Newer bulk-fill composites claim a greater depth of cure than conventional resin-based composites. To facilitate complete curing, the manufacturer of SonicFill (Kerr) recommends curing from the occlusal, as well as the buccal and lingual, surfaces of the tooth. The purpose of this study was to quantify the degree of curing light attenuation as it passes through natural tooth structure, and how this attenuation affects the depth of cure of different posterior resin composites. Ten noncarious extracted mandibular third molars were sectioned to produce 5-mm-thick pieces of buccal tooth structure. Sanding 0.5-mm increments from the flattened surface produced 4.5-, 4.0-, 3.5-, 3.0-, 2.5-, 2.0-, and finally 1.5-mm-thick sections. A Bluephase G2 (Ivoclar) curing light with an 8-mm-diameter light guide set on high for 20 seconds was used for measurement of irradiance as it passed through different thicknesses of tooth structure and air. The average irradiance (mW/cm(2)) was measured with a MARC-RC Resin Calibrator with a 4-mm-diameter sensor (BlueLight Analytics). To measure depth of cure of a conventional hybrid composite (Herculite Ultra; Kerr) vs a bulk-fill hybrid composite (SonicFill) through varying thicknesses of tooth structure, composites were cured in a 4-mm-diameter × 10.25-mm-long split mold according to International Organization for Standardization 4049. A mean and standard deviation was determined per group. Data were analyzed with a one-way analysis of variance (ANOVA)/Tukey test and two-way ANOVA/Tukey test (α=0.05). One-way ANOVA/Tukey found a significant decrease in irradiance based on thickness of tooth structure or distance through air (p<0.001). Two-way ANOVA/Tukey found a significant decrease in depth of cure based on thickness of tooth structure (p<0.001) and on composite type (p<0.001) with no significant interaction (p=0.623). SonicFill had a significantly greater depth of cure than Herculite Ultra.