Filler particle leachability of experimental dental composites

Impact of erosive and abrasive wear on the surface characteristics of hybrid ceramic-polymer dental materials

PURPOSE

To evaluate the surface characteristics of hybrid ceramic-polymer materials before and after exposure to erosive and abrasive media.

METHODS

Samples were prepared from Vita Enamic (VE), Cerasmart (CS), VarseoSmile Crown plus (VSC), and VarseoSmile Temp (VST). Surface roughness (SR), scanning electron microscopy (SEM), and surface hardness (SH) analyses were performed before (T0) and after exposing the samples to gastric juice (GJ), toothbrushing (TB), or both (GJ TB) for a simulated period of one (T1) or two years (T2).

RESULTS

At T0, VSC and VST showed higher average (Ra) and maximum (Rz) roughness values, more homogeneous surfaces in SEM micrographs, and lower Vickers numbers (HV) than VE and CS. At T1 and T2, samples showed higher Ra values, greater surface damage on SEM micrographs, and reduced HV. The most pronounced changes were evident for GJ TB samples, followed in order by GJ (within VE and CS) and TB samples (within VSC and VST).

CONCLUSION

VE and CS showed initially lower SR and higher SH, lower resistance to GJ, and higher resistance to TB than VSC and VST, which would be essential when fabricating restorations for patients who are particularly susceptible to dental erosion and abrasion.

Preparation of Al-doped mesoporous silica spheres (Al-MSSs) for the improvement of mechanical properties and aging resistance of dental resin composites

OBJECTIVE

The purpose of this study was to synthesize Al-doped mesoporous silica spheres (Al-MSSs) and evaluate the effect of them as functional fillers on the mechanical properties and aging resistance of dental resin composites.

METHODS

Al-MSSs were prepared by a two-step method. The effect of Al-MSSs on the performance of the composites was evaluated using neat resin matrix, commercial composites 3M Z350XT and samples containing mesoporous silica spheres (MSSs) and nonporous silica spheres (NSSs) as control. The neat resin matrix consisted of resin monomer (Bisphenol A glycerolate dimethacrylate/triethylene glycol dimethacrylate, 49.5/49.5, wt%) and photoinitiator (camphor quinone/Ethyl-4-dimethylaminobenzoate, 0.2/0.8, wt%). The mechanical properties (flexural strength, flexural modulus, compressive strength and microhardness) of them were evaluated by a universal testing machine and microhardness tester. The mechanical stabilities of the prepared composites in wet environment were evaluated by immersing them in deionized water at 37 °C. In addition, we evaluated the effect of Al-MSSs on other properties of the dental resin composites such as polymerization shrinkage, degree of conversion, curing depth, contact angle, water sorption and solubility according to ISO 4049: 2019.

RESULTS

The synthesized Al-MSSs possessed good dispersibility with an average particle size of about 505 ± 16 nm. The mechanical properties of resin composites gradually increased with the increase of the loading amounts of inorganic fillers. The reinforcing effect of Al-MSSs was similar to that of MSSs and better than that of the NSSs groups at the same filler loading. After aging in deionized water at 37 °C for 30 days, the mechanical properties of all resin composites decreased. However, the decrease percentage of the composites filled with Al-MSSs was significantly lower than the other groups, indicating that the stability of the dental composites in wet environments was significantly improved by the Al-MSSs fillers. Furthermore, Al-MSSs had no obvious influence on the biocompatibility and other properties of dental resins.

SIGNIFICANCE

The prepared Al-MSSs could effectively improve the mechanical properties and aging resistance without sacrificing other physic-chemical properties of dental resin composites.

Unveiling the mechanisms behind surface degradation of dental resin composites in simulated oral environments

Dental resin composites are widely used as restorative materials due to their natural aesthetic and versatile properties. However, there has been limited research on the degradation mechanisms of these composites in gastric acid environments, which would be common in patients with gastroesophageal reflux. This study aims to investigate the degradation behavior of dental composites immersed in simulated oral environments, including acid, saliva, and water. Mechanical and morphological properties of the composites, upon immersion in the simulated environments, were thoroughly examined using hardness testing and SEM imaging. Qualitative analyses of the ions leached from the polymer matrix and fillers were conducted using XPS and ICP-MS. In addition, the thermodynamic stability of the inorganic fillers of the composites in aqueous solutions across a wide range of pH values was theoretically studied through construction of Pourbaix diagrams. This study proposed a mechanism for composite leaching involving interactions between the matrix's hydrophilic groups and the aqueous immersion media, leading to swelling and chemical degradation of the composites. Furthermore, it was demonstrated that filler leaching was followed by ion exchange with Ca and P, resulting in the formation of hard calcified layers on the composite surface. The current findings provide valuable insights into the development of new composite materials with improved durability and resistance to degradation, especially for patients suffering from gastroesophageal reflux.

Experimental Investigation of Dental Composites Degradation After Early Water Exposure

While dental composite long-term aging has already been studied in the past, no data exist about the early aging while it might be detrimental regarding the composites' longevity. This study aims to better understand the effects of early water exposure on dental composites. Dental resin composites with different fillers ratio were subjected to water exposure during 24 h, 1 week, or 1 month. After photopolymerization, the samples were stored at different conditions, whether in wet or dry condition (W, D, respectively) and in wet conditions after a first 24 h storage in dry conditions (DW). Three-point bending tests were performed to measure the flexural modulus. The samples were then subjected to a sorption/desorption protocol. While the matrix alone did not undergo any mechanical degradation with exposure time, the composites matrices presented a decrease in elastic modulus. This decrease was the highest for the matrix with nonsilanized fillers. Interestingly, the DW condition was detrimental for all the samples. Regarding the sample with nonsilanized fillers in DW for 1 month presented an elastic modulus lower than the matrix alone. These results were assigned to the sorption capacity of the polymer matrix, suggesting that the diffusion mechanisms and the nature of water molecules are determinant in the composite degradation. This study showed that dental composite early degradation mechanisms after water exposure are involved in the polymer matrix postpolymerization process as soon as after 24 h. Such mechanisms are detrimental in terms of the dental composite efficiency and have to be understood.

Are inert glasses really inert?

OBJECTIVES

The aim of this study was to investigate the degradation of inert glass fillers which are commonly used in conventional resin-based composites to provide radiopacity, reduce the polymerization shrinkage and improve the mechanical properties.

METHODS

75 mg of five different glass powders (1 µm) was immersed separately into 50 mL of acetic acid (pH 4) and tris buffer (pH 7.4) for up to 4 weeks. At each time point the glass powder was filtered and dried for characterization using ATR-FTIR and XRD to assess the degradation behavior and crystallization. ICP-OES, ISE and pH measurements were performed on the supernatant solutions to monitor the pH and ion release.

RESULTS

Although FTIR and XRD analysis showed no significant glass degradation or crystallization upon immersion, there was a substantial release of ions from the inert fillers, especially from BABFG and CDL. Barium release for these fillers were 270 and 165 ppm respectively. G018-373 glass presented the lowest ion release followed by GM27884 and BABG. The ion release was more pronounced in acidic conditions compared to neutral conditions apart from the fluoride release.

SIGNIFICANCE

Inert glasses are not as inert as previously thought. This may result in leaching of ions, potentially causing toxicity, reduction in mechanical properties, increased wear and subsequent failure of the composite material. The ions released from the inert glass may interfere with other glass fillers such as bioactive glass fillers, inhibiting degradation of the bioactive glass, beneficial ion release from the bioactive glass, pH neutralization and apatite formation.

Investigating the Cytotoxicity of Dual-Cure Bulk-Fill Resin Materials on L929 Cells

The aim of this in vitro study was to investigate cytotoxic effects of dual-cure bulk-fill resin materials polymerized with a third-generation LED light-curing unit (LCU) on L929 fibroblast cells in terms of morphology and viability. Three novel dual-cure, flowable bulk-fill materials (Fill-Up!™), a bioactive material (ACTIVA™ BioACTIVE-RESTORATIVE™), and a dual-cure bulk-fill composite material (HyperFIL® HAp) polymerized by LED LCU (VALO™ Cordless) were tested. Each material was placed in plastic rings (4 mm × 5 mm) in a single layer. Unpolymerized rings filled with each material were placed in direct contact with cells and then polymerized. After polymerization, the removed medium was readded to wells. In this study, four control groups were performed: the medium-free control group, medium control group, physical control group, and light applied control group. Three samples were prepared from each group. After 24 h, the morphology of cells was examined and a WST-1 test was performed. The percentage of cell viability (PCV) of each group was calculated. The experiment was repeated three times. Data were analyzed by a Kruskal–Wallis Test and a Mann–Whitney U test. p < 0.05 was considered significant. The PCV of all groups were found to be significantly lower than the medium control group (p < 0.05). The lowest PCV was obtained in HyperFIL® Hap, while highest was in the Fill-Up!™. In the morphology of cells related to the experimental groups, it was observed that the spindle structures of cells were disrupted due to cytotoxicity; cells became rounded and intercellular space increased. There were no significant differences between the control groups (p > 0.05). All control groups showed acceptable PCV (>70%) and cells were spindle-like, similar to the original fibroblast cells. It can be suggested that clinicians should pay attention when applying dual-cure bulk-fill materials in deep cavities, or they should use a liner material under these materials.

Acid Resistance of CAD/CAM Resin Composites

Acid resistance of CAD/CAM resin composites. Erosion-related tooth surface loss is closely related to acid exposure, such as contact with acidic beverages or disease-related reflux. As a result, dental restorations in affected patients are also exposed to acids, which indicates that the performance and longevity of a dental restoration is impacted by the acid resistance of the individually employed restorative materials. However, unlike for ceramic materials, the acid resistance of CAD/CAM resin composites is not commonly evaluated by the manufacturers, and no standardised test methods have yet been established. Against this background, the present in vitro study aimed to examine the long-term resistance of CAD/CAM resin composites (Brilliant Crios, Cerasmart, Grandio blocs, Lava Ultimate, Shofu Block HC) against three acidic media (tonic water, acetic acid, hydrochloric acid) as well as demineralized water and to investigate potential damage mechanisms. Changes in surface roughness (Sa) were detected by confocal laser scanning microscopy (CLSM), and changes in surface hardness were measured using Vickers hardness (HV). The damage mechanisms were analysed by scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) and micro X-ray computer tomography (µXCT). For each material, few changes in either Sa or HV were identified for at least one of the different media; for Cerasmart, the sharpest deterioration in surface properties was observed. SEM–EDS revealed leaching of barium, aluminium, and titanium from fillers in a 2 µm zone on the rough but not on the polished surface of the specimen. Within the limitations of the current study, it can be concluded that polished CAD/CAM resin composites can be recommended for clinical use in patients with erosive conditions.

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.

Laboratory methods to simulate the mechanical degradation of resin composite restorations

OBJECTIVES

This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations.

METHODS

A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively.

RESULTS

The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used.

SIGNIFICANCE

Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided.

Characterization and toxicity evaluation of air-borne particles released by grinding from two dental resin composites in vitro

OBJECTIVE

The project aims to evaluate whether inhalation of particles released upon grinding of dental composites may pose a health hazard to dentists. The main objective of the study was to characterize the dust from polymer-based dental composites ground with different grain sized burs and investigate particle uptake and the potential cytotoxic effects in human bronchial cells.

METHODS

Polymerized blocks of two dental composites, Filtek™ Z250 and Filtek™ Z500 from 3M™ ESPE, were ground with super coarse (black) and fine (red) burs inside a glass chamber. Ultrafine airborne dust concentration and particle size distribution was measured real-time during grinding with a scanning mobility particle sizer (SMPS). Filter-collected airborne particles were characterized with dynamic light scattering (DLS) and scanning electron microscopy (SEM). Human bronchial epithelial cells (HBEC-3KT) were exposed to the dusts in dose-effect experiments. Toxicity was measured with lactate dehydrogenase (LDH) assay and cell counting kit-8 (CCK8). Cellular uptake was observed with transmission electron microscopy (TEM).

RESULTS

Airborne ultrafine particles showed that most particles were in the size range 15-35 nm (SMPS). SEM analysis proved that more than 80% of the particles have a minimum Feret diameter less than 1 μm. In solution (DLS), the particles have larger diameters and tend to agglomerate. Cell toxicity (LDH, CCK8) is shown after 48 h and 72 h exposure times and at the highest doses. TEM showed presence of the particles within the cell cytoplasm.

SIGNIFICANCE

Prolonged and frequent exposure through inhalation may have negative health implications for dentists.

Validation of a Simple HPLC-UV Method for the Determination of Monomers Released from Dental Resin Composites in Artificial Saliva

Bisphenol-A (BPA), bisphenol A glycerolate dimethacrylate (Bis-GMA), triethylene glycol dimethacrylate (TEGDMA), and urethane dimethacrylate (UDMA) are organic monomers that can be released from dental composites into the oral cavity. Over specific concentrations, they can act as endocrine disruptors or cause toxic effects. The purpose of this work is to develop and validate an analytical method to determine BPA, Bis-GMA, TEGDMA, and UDMA monomers released from synthetic dental resins in artificial saliva. The method was validated before its application to new hybrid ceramic materials used in computer-aided design and computer-aided manufacturing (CAD/CAM) restorations to determine the release of monomers in various time intervals (e.g., 24 h, and 7, 14, 30, and 60 days), both in methanolic solutions, as well as in artificial saliva. Chromatographic analysis was performed isocratically on a Perfect Sil Target ODS-3 analytical column (250 mm × 4.6 mm, 5 µm) with CH3CN/H2O, 58/42% v/v as mobile phase within 23 min. The developed method was validated in terms of selectivity, linearity, accuracy, and precision.

The effect of esterase enzyme on aging dental composites

We measured the push-out and diametral tensile strength of dental restorative composites following aging under environmental conditions relevant to the oral cavity; air (A), artificial saliva (AS), acidified (50 mM CH₃ COOH, pH = 4.7) artificial saliva (AS + HAc), and AS with esterase enzyme (AS + ENZ). Cylindrical test specimens (6.3 mm diameter by 5.1 mm long) were prepared by placing 0.3 g of nanofilled composite in an epoxy ring and cured. Twenty samples were aged in each environment for 163-186 days at 37°C. The push-out strengths (mean ± standard error of the mean [SEM], in MPa) for specimens were: A-2.4 ± 0.2, AS-7.3 ± 0.5, AS + HAc-7.2 ± 0.9, and AS + ENZ-6.0 ± 0.6. Following the push-out test, the diametral tensile strength and elasticity were immediately determined. The diametral tensile strengths (mean ± SEM, in MPa) for specimens were: A-54.0 ± 1.6, AS-31.4 ± 1.3, AS + HAc-34.3 ± 1.2, and AS + ENZ-22.5 ± 0.7. The push-out strength was lowest for the A environment due to shrinkage of the composite. The push-out strength increased significantly as water diffused into the specimens (AS and AS + HAc) but decreased significantly in the enzyme environment (AS + ENZ). The diametral tensile strength was highest for specimens in the A environment, which was significantly higher than both the AS and AS + HAc specimens and > 2× higher than the AS + ENZ specimens. The results indicated that a water environment (with or without acid) caused a significant decrease in the mechanical properties of this composite, but the greatest decrease was seen in water with esterase. This is the first study to demonstrate that esterase enzymes affect the bulk strength of a commonly used commercial dental composite. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2178-2184, 2019.

Viscoelastic Properties of Contemporary Bulk-fill Restoratives: A Dynamic-mechanical Analysis

This study investigated the viscoelastic properties of contemporary bulk-fill restoratives in distilled water and artificial saliva using dynamic mechanical analysis. The materials evaluated included a conventional composite (Filtek Z350), two bulk-fill composites (Filtek Bulk-fill and Tetric N Ceram), a bulk-fill giomer (Beautifil-Bulk Restorative), and two novel reinforced glass ionomer cements (Zirconomer [ZR] and Equia Forte [EQ]). The glass ionomer materials were also assessed with and without resin coating (Equia Forte Coat). Test specimens 12 × 2 × 2 mm of the various materials were fabricated using customized stainless-steel molds. After light polymerization/initial set, the specimens were removed from the molds, finished, measured, and conditioned in distilled water or artificial saliva at 37°C for seven days. The materials (n=10) were then subjected to dynamic mechanical testing in flexure mode at 37°C and a frequency of 0.1 to 10 Hz. Storage modulus, loss modulus, and loss tangent data were subjected to normality testing and statistical analysis using one-way analysis of variance/Dunnett's test and t-test at a significance level of p < 0.05. Mean storage modulus ranged from 3.16 ± 0.25 to 8.98 ± 0.44 GPa, while mean loss modulus ranged from 0.24 ± 0.03 to 0.65 ± 0.12 GPa for distilled water and artificial saliva. Values for loss tangent ranged from 45.7 ± 7.33 to 134.2 ± 12.36 (10^-3). Significant differences in storage/loss modulus and loss tangent were observed between the various bulk-fill restoratives and two conditioning mediums. Storage modulus was significantly improved when EQ and ZR was not coated with resin.

Effect of nanostructured zirconium dioxide incorporation in an experimental adhesive resin

OBJECTIVES

The aim of this study was to evaluate the influence of nanostructured zirconium dioxide incorporation in an experimental adhesive resin.

METHODS

ZrO₂ particles were characterized by X-ray diffraction (XRD), micro-Raman spectroscopy and Brunauer-Emmett-Teller (B.E.T). Experimental adhesive resins were formulated with 0, 0.5, 1, 4.8, and 9.1% ZrO₂ in weight. The adhesives were evaluated based on degree of conversion (DC), radiopacity, softening in solvent and microtensile bond strength (μTBS) 24 h and after 1 year of aging. Mineral deposition at the hybrid layer was assessed with micro-Raman spectroscopy at the baseline and after 14 days.

RESULTS

XRD showed monoclinic and tetragonal phases of ZrO_2.particles. B.E.T data revealed a surface area of 37.41 m²/g, and typical chemical groups were shown on the Raman spectra_. The addition of ZrO₂ did not influence the radiopacity. The addition of 4.8% and 9.1 wt.% ZrO₂ showed higher initial hardness with increased softening in solvent (P < 0.05) and promoted mineral deposition at the dentin interface. DC was significantly increased in the group with 1% ZrO₂ (P < 0.05). The μTBS test showed difference on the group with 9.1 wt.% of ZrO₂, with a significant reduction after aging.

CONCLUSION

The incorporation of ZrO₂ promoted mineral deposition on the adhesive interface and the addition of 1 wt.% caused a significant increase on the DC without compromising the other physicochemical characteristics, which may prove promising for the development of new dental adhesive systems.

CLINICAL RELEVANCE

The mineral deposition on the hybrid layer can result in a longer stability of the adhesive, thus delaying the hydrolytic degradation.

Review of titanate coupling agents and their application for dental composite fabrication

Silane is a dominant coupler that is widely used in dentistry to promote adhesion among the components of dental composites. Silica-based fillers can be easily silanized because of their similarly ordered structure. However, silane is hydrolytically degraded in the aqueous oral environment and inefficiently bonds to non-silica fillers. Thus, the development of hydrolytically stable dental composites is an important objective in the research on dental materials. Titanate coupling agents (TCAs) exhibit satisfactory interfacial bonding, enhanced homogeneous filler dispersion, and improved mechanical properties of the composites. Titanates also provide superior hydrolytic stability in wet environments, which should be considered in fabricating dental composites. The addition of a small amount of titanates can improve the resistance of the composites to moisture. This paper reviews the effects of the instability of silanes in moisture on the performance of dental composites and presents TCAs as alternative couplers to silanes for fabricating dental composites.

Fracture behavior of single-structure fiber-reinforced composite restorations

Objective: The applications of single-structure fiber-reinforced composite (FRC) in restorative dentistry have not been well reported. This study aimed to clarify the static mechanical properties of anterior crown restorations prepared using two types of single-structure FRC. Materials and methods: An experimental crown restoration was designed for an upper anterior incisor. The restorations were made from IPS Empress CAD for CEREC (Emp), IPS e.max^® CAD (eMx), experimental single-structure all-FRC (a-FRC), Filtek™ Supreme XTE (XTE), and commercially available single-structure short-FRC (everX Posterior™) (n = 8 for each material) (s-FRC). The a-FRC restorations were prepared from an experimental FRC blank using a computer-aided design and manufacturing (CAD/CAM) device. A fracture test was performed to assess the fracture load, toughness, and failure mode. The fracture loads were vertically applied on the restorations. The surface micromorphology of the FRC restorations was observed by scanning electron microscopy (SEM). The data were analyzed by analysis of variance (p = .05) followed by Tukey's test. Results: s-FRC showed the highest mean fracture load (1145.0 ± 89.6 N) and toughness (26.2 ± 5.8 Ncm) among all the groups tested. With regard to the micromorphology of the prosthetic surface, local crushing of the fiberglass was observed in s-FRC, whereas chopped fiberglass was observed in a-FRC. Conclusions: The restorations made of short-FRC showed a higher load-bearing capacity than those made of the experimental all-FRC blanks for CAD/CAM. The brittle-like fractures were exhibited in the recent dental esthetic materials, while local crushing fractures were shown for single-structure FRC restorations.

Laboratory mechanical parameters of composite resins and their relation to fractures and wear in clinical trials-A systematic review

OBJECTIVE

To evaluate a range of mechanical parameters of composite resins and compare the data to the frequency of fractures and wear in clinical studies.

METHODS

Based on a search of PubMed and SCOPUS, clinical studies on posterior composite restorations were investigated with regard to bias by two independent reviewers using Cochrane Collaboration's tool for assessing risk of bias in randomized trials. The target variables were chipping and/or fracture, loss of anatomical form (wear) and a combination of both (summary clinical index). These outcomes were modelled by time and material in a linear mixed effect model including random study and experiment effects. The laboratory data from one test institute were used: flexural strength, flexural modulus, compressive strength, and fracture toughness (all after 24-h storage in distilled water). For some materials flexural strength data after aging in water/saliva/ethanol were available. Besides calculating correlations between clinical and laboratory outcomes, we explored whether a model including a laboratory predictor dichotomized at a cut-off value better predicted a clinical outcome than a linear model.

RESULTS

A total of 74 clinical experiments from 45 studies were included involving 31 materials for which laboratory data were also available. A weak positive correlation between fracture toughness and clinical fractures was found (Spearman rho=0.34, p=0.11) in addition to a moderate and statistically significant correlation between flexural strength and clinical wear (Spearman rho=0.46, p=0.01). When excluding those studies with "high" risk of bias (n=18), the correlations were generally weaker with no statistically significant correlation. For aging in ethanol, a very strong correlation was found between flexural strength decrease and clinical index, but this finding was based on only 7 materials (Spearman rho=0.96, p=0.0001). Prediction was not consistently improved with cutoff values.

SIGNIFICANCE

Correlations between clinical and laboratory outcomes were moderately positive with few significant results, fracture toughness being correlated with clinical fractures and flexural strength with clinical wear. Whether artificial aging enhances the prognostic value needs further investigations.

Micro-sized erosions in a nanofilled composite after repeated acidic beverage exposures: consequences of clusters dislodgments

Objective

To evaluate the hardness (KHN), color stability (DE), and superficial micromorphology of two categories of composites after immersion in either distilled water or grape juice for up to 45 days.

Material and Methods

Cylindrical specimens (6 mm diameter x 2 mm thick) were obtained according to the factors: composite [Opallis (FGM) and Filtek Z350XT (3M ESPE)]; immersion solution (distilled water and grape juice); and evaluation time: 24 h and 7, 14, 21, 28, and 45 days. After photoactivation, the specimens were stored at 37ºC for 24 h. KHN (50 g/15 s) and ΔE were then repeatedly assessed according to the immersion solutions. Data were analyzed (three-way ANOVA/Tukey's test). Scanning electron microscopy (SEM) topographic analysis was also performed.

Results

In general, KHN of both composites reduced after 24 h, irrespective of the immersion solution and time. A significantly lower KHN was noted for Opallis compared with Filtek Z350XT in all parameters. An increase in ΔE over time was noted for both composites, irrespective of the immersion solution. Significantly higher ΔE was noted for Filtek Z350XT immersed in grape juice compared with Opallis, regardless of the evaluation time. The grape juice caused significantly higher DE compared with water in all periods. SEM analysis showed eroded areas for Filtek Z350XT but not for Opallis.

Conclusions

The compositions and immersion solutions influence the composite hardness and the color stability. In spite of the higher hardness, the nanofilled composite is more susceptible to color change than the microhybrid when immersed in an acidic dyed solution.

The effect of different organic solvents on the degradation of restorative materials

Objective:

To evaluate the solubility of three restorative materials exposed to the different endodontic solvents.

Materials and Methods:

The organic solvents eucalyptus oil, xylol, chloroform, and orange oil, with distilled water as the control group was utilized. The restorative materials light-cured resin (Filtek Z250/3M ESPE), light-cured-resin-reinforced glass ionomer (Riva Light Cure LC/Southern Dental Industries SDI]) and resin-modified glass ionomer (Vitremer/3M ESPE) were analyzed. A total of 50 disks containing specimens (2 mm × 8 mm Ø) were prepared for each of the three classes of restorative materials, which were divided into 10 groups (n = 5) for immersion in eucalyptus oil, xylol, chloroform, orange oil or distilled water for periods of either 2 min or 10 min. The means of restorative material disintegration in solvents were obtained by the difference between the original preimmersion weight and the postimmersion weight in a digital analytical scale. Data were statistically analyzed by two-way analysis of variance while the difference between the materials was analyzed by Student-Newman-Keuls test. The significance level set at 0.05.

Results:

Vitremer showed the highest solubility, followed by Riva LC, and these were statistically different from eucalyptus oil, xylol, chloroform, and distilled water (P < 0.05). Regarding the immersion time in solvents, there were no significant differences between the two tested periods (P > 0.05).

Conclusions:

The solvents minimally degraded the composite resin, although they did influence the degradation of both resin-modified glass ionomer resin and resin reinforced with glass ionomer.

Effect of silanized nanosilica addition on remineralizing and mechanical properties of experimental composite materials with amorphous calcium phosphate

OBJECTIVES

Experimental composite resins with amorphous calcium phosphate (ACP) have the potential to regenerate demineralized tooth structures. The aim of the study was to investigate the effect of the addition of silanized silica nanofillers to the ACP-based composites on their mechanical properties and the kinetics of calcium and phosphate release.

MATERIALS AND METHODS

The test materials comprised 5 wt% (5-ACP) or 10 wt% (10-ACP) of silanized silica admixed to the 40 wt% ACP and 50 or 55 wt% resin. The ACP control (0-ACP) contained 40 wt% ACP and 60 wt% resin. Additionally, composite material CeramX (Dentsply, Germany) was included as control. Three-point bending test was performed to calculate flexural strength and modulus of elasticity. Inductively coupled plasma atomic emission spectroscopy was used for measurement of ion release. The micromorphology of calcium phosphate depositions on composite samples has been qualitatively evaluated using a scanning electron microscope. The results were analyzed using Mann-Whitney and Wilcoxon rank sum tests (α < 0.05).

RESULTS

Ion release was enhanced by the silica fillers, when compared to the 0-ACP. Although not statistically significant, flexural strength of 10-ACP was improved by 46 % compared to 0-ACP. Flexural modulus of 5-ACP was significantly higher than 0-ACP.

CONCLUSIONS

The admixture of silanized fillers seems to be a promising approach for the improvement of mechanical and remineralizing properties of ACP composite resins.

CLINICAL RELEVANCE

ACP-based composite resins with modified composition could serve as an effective remineralizing aid as base materials in restorative dental medicine.

The influence of mouthrinses and simulated toothbrushing on the surface roughness of a nanofilled composite resin

The aim of this study was to determine the influence of mouthrinses on the surface roughness of a nanofilled composite resin after toothbrushing. One hundred nanofilled composite resin specimens were prepared and randomly distributed into two groups-brushed and non-brushed-and then assigned to five subgroups, according to the mouthrinse solutions (n = 10): Colgate Plax Fresh Mint, Oral B, Cepacol, Colgate Plax, and artificial saliva. Each sample was immersed in 20 mL of the mouthrinses for 1 minute, 5 days per week, twice a day, for a 3-week period. The control group used in the study was one in which the specimens were not subjected to brushing and remained only in artificial saliva. Toothbrushing was performed once a week for 1 minute, for 3 weeks. Surface roughness measurements (Ra) were performed after the immersion period and toothbrushing, by means of a profilometer. Data were analyzed by two-way ANOVA and Tukey's test. Analysis revealed that the association between toothbrushing and Colgate Plax Fresh Mint produced the lowest surface roughness (p < 0.05). All other groups tested (Oral B, Cepacol, Colgate Plax, artificial saliva) exhibited no statistically significant differences between surfaces, whether subjected to toothbrushing or not (p < 0.05). It was concluded that the surface roughness of the nanofilled composite resin tested can be influenced by the mouthrinse associated with toothbrushing.

Influence of nanometer scale particulate fillers on some properties of microfilled composite resin

The aim of this study was to evaluate the effect of different weight fractions of nanometer sized particulate filler on properties of microfilled composite resin. Composite resin was prepared by mixing 33 wt% of resin matrix to the 67 wt% of silane treated microfine silica particulate fillers with various fractions of nanometer sized fillers (0, 10, 15, 20, 30 wt%) using a high speed mixing machine. Test specimens made of the composites were tested with a three-point bending test with a speed of 1.0 mm/min until fracture. Surface microhardess (Vicker's microhardness) was also determined. The volumetric shrinkage in percent was calculated as a buoyancy change in distilled water by means of the Archimedes principle. The degree of monomer conversion (DC%) of the experimental composites containing different nanofiller fractions was measured using FTIR spectroscopy. Surface roughness (Ra) was determined using a surface profilometer. Nanowear measurements were carried out using a nanoindentation device. The water uptake of specimens was also measured. Parameters were statistically analysed by ANOVA (P < 0.05). The group without nanofillers showed the highest flexural strength and modulus, DC% and Ra value. The group with 30% nanofillers had the highest water uptake and volumetric shrinkage. No significant difference was found in Vicker's microhardness and the nanowear of the composites. The plain microfilled composite demonstrated superior properties compared to the composites loaded with nanofillers with the exception of surface roughness.

Adherence of Streptococcus mutans to Fiber-Reinforced Filling Composite and Conventional Restorative Materials

Objectives.

The aim was to investigate the adhesion of Streptococcus mutans (S. mutans) to a short glass fibers reinforced semi-IPN polymer matrix composite resin. The effect of surface roughness on adhesion was also studied. For comparison, different commercial restorative materials were also evaluated.

Materials and Methods.

Experimental composite FC resin was prepared by mixing 22.5 wt% of short E-glass fibers, 22.5 wt% of IPN-resin and 55 wt% of silane treated silica fillers using high speed mixing machine. Three direct composite resins (Z250, Grandio and Nulite), resin-modified glass ionomers (Fuji II LC), amalgam (ANA 2000), fiber-reinforced composite (FRC) (everStick and Ribbond), and pre-fabricated ceramic filling insert (Cerana class 1) were tested in this study. Enamel and dentin were used as controls. The specimens (n=3/group) with or without saliva were incubated in a suspension of S. mutans allowing initial adhesion to occur. For the enumeration of cells on the disc surfaces as colony forming units (CFU) the vials with the microbe samples were thoroughly Vortex-treated and after serial dilutions grown anaerobically for 2 days at +37°C on Mitis salivarius agars (Difco) containing bacitracin. Bacterial adhesion was also evaluated by using scanning electron microscopy. Surface roughness (Ra) of the materials was also determined using a surface profilometer. All results were statistically analyzed with one-way analysis of variance (ANOVA).

Results.

Composite FC resin and other commercial restorative materials showed similar adhesion of S. mutans, while adhesion to dentin and enamel was significantly higher (p<0.05). Surface roughness had no effect on bacterial adhesion. Saliva coating significantly decreased the adhesion for all materials (p<0.05). Composite FC resin had a significantly higher Ra value than control groups (p<0.05).

Conclusions.

Short fiber-reinforced composite with semi-IPN polymer matrix revealed similar S. mutans adhesion than commercial restorative materials.

Continuous and short fiber reinforced composite in root post-core system of severely damaged incisors

Purpose:

The aim of this study was to determine the static load-bearing capacity of endodontically treated maxillary incisors restored with post-core complex made of experimental fiber composite resin (FC) and complete crown made of particulate filler composite (PFC). Further aim was to evaluate the effect of FC resin on the failure mode of the restoration.

Material and Methods:

The experimental composite resin (FC) was prepared by mixing 22.5 wt% of short E-glass fibers (3 mm in length) and 22.5 wt% of semi-interpenetrating polymer network (IPN) resin with 55 wt% of silane treated silica fillers. Thirty extracted sound upper central incisors were used. Twenty teeth were prepared by cutting the clinical crown 2 mm above the cemento-enamel junction horizontally. Restorations were made by two techniques (n=10). Group A (control group) contained samples of sound incisor teeth. Group B had teeth restored using glass fiber post (everStick, Stick- Teck) and PFC (Filtek Z250, 3M-ESPE) to build up core and complete crown. In Group C, the teeth were restored with FC as post-core and complete crown of PFC. The root canals were prepared and posts were cemented with a dual cure resin cement. The restorations were polymerized with a hand-light curing unit. All restored teeth were stored in water at room temperature for 24 h before they were statically loaded with speed of 1.0 mm/min until fracture. Data were analyzed using ANOVA (p=0.05). Failure modes were visually examined.

Results:

ANOVA revealed that restored incisors (Group B and C) had a statistically significantly lower load-bearing capacity (p<0.05) than the control group. Restorations made from FC post-core and PFC coverage (Group C) gave force value of 363 N (112 SD), which was higher than the value of Group B (211 N, 50 SD).

Conclusions:

Within the limitations of this study, the teeth restored with experimental fiber composite post-core demonstrated higher load bearing capacity than those with fiber post and PFC core.

Effect of nanofiller fractions and temperature on polymerization shrinkage on glass fiber reinforced filling material

OBJECTIVES

The aim was to evaluate the effect of different nanofiller fractions and temperature on polymerization shrinkage strain and degree of monomer conversion of short glass fibers reinforced semi-interpenetrating polymer network (semi-IPN)-polymer matrix composite resin.

METHODS

Experimental composite resin was prepared by mixing 22.5 wt% of short E-glass fibers (3 mm in length) to the 22.5 wt% of resin matrix with various weight fractions of nanofillers (0, 10, 20, 30, 40, 50 wt%) and then 55 wt% of silane treated silica filler were added gradually using high speed mixing machine. Another study group contained composite resin prepared by mixing 22.5 wt% of resin matrix (without nanofillers) to 77.5 wt% of filler particles (without fiber fillers). As control material, commercial particulate filler composite resin was used. The shrinkage strain of the specimens was measured using the bonded-disk technique at 26 and 37 degrees C with respect to time. Degree of conversion of the experimental composites containing different nanofiller fractions was measured using FTIR spectroscopy.

RESULTS

ANOVA revealed that fraction of nanofillers and polymerization temperature had significant effect (p<0.05) on the shrinkage strain and degree of conversion of the composite resin. Shrinkage strain correlated with nanofiller fraction and polymerization temperature (r2=0.96 and 0.95).

SIGNIFICANCE

The use of high nanofiller fraction with short fiber fillers and IPN-polymer matrix yielded improved rate of shrinkage strain.

Depth of cure and surface microhardness of experimental short fiber-reinforced composite

OBJECTIVES

The aim of this study was to analyze the depth of cure of a short fiber-reinforced composite (FRC) assessed by microhardness at different curing times and storage conditions.

MATERIAL AND METHODS

Experimental composite resin (FC) was prepared by high-speed mixing 22.5 wt% short E-glass fibers (3 mm in length) and 22.5 wt% resin matrix and gradually adding 55 wt% silane-treated silica filler. Half-split cylindrical test specimens were produced from both the FC and from the conventional particulate composite resin (control, Z250, 3M-ESPE). The test specimens (n=3/group) were polymerized at different exposure times (20, 40, 60 s) and then water-stored at 37 degrees C for 24 h and 30 days before testing. A universal testing machine was used for testing Vickers microhardness. All results were statistically analyzed with analysis of variance (ANOVA).

RESULTS

ANOVA revealed that curing time had a significant effect (p<0.05) on the microhardness of both composite resins. Depth of cure of conventional composite resin (control) was significantly greater than that of FC (p<0.05). Microhardness after water storage decreased as curing time increased.

CONCLUSIONS

The use of short fiber fillers in interpenetrating polymer network matrix (IPN) achieved the acceptable depth of cure and microhardness values recommended for clinical use, although lower than for commercial composite resin.

Direct restoration of severely damaged incisors using short fiber-reinforced composite resin

OBJECTIVES

The aim of this in vitro study was to evaluate the static load-bearing capacity and the failure mode of endodontically treated maxillary incisors restored with complete crowns made of experimental composite resin (FC) with short fiber fillers, with and without root canal posts. Further aim was to evaluate the effect of fiber-reinforced composite resin (FRC) on the failure mode of the restoration.

MATERIAL AND METHODS

The experimental composite resin (FC) was prepared by mixing 22.5 wt.% of short E-glass fibers (3mm in length) and 22.5 wt.% of semi-interpenetrating polymer network (IPN) resin with 55 wt.% of silane treated silica fillers. The clinical crowns of 30 human extracted maxillary incisors were sectioned at the cemento-enamel junction. Five groups of direct complete crowns were fabricated (n=6); Group A: made from particulate filler composite resin (PFC) (Grandio Caps, VOCO, control), Group B: PFC with fiber post (everStick, StickTeck), Group C: made from PFC with everStick fiber post and FRC-substructure, Group D: made from FC, Group E: made from FC with FRC-substructure. The root canals were prepared and posts were cemented with resin cement (ParaCem Universal). All restored teeth were stored in water at room temperature for 24h before they were statically loaded with speed of 1.0 mm/min until fracture. Data were analyzed using ANOVA (p=0.05). Failure modes were visually examined.

RESULTS

ANOVA revealed that restorations made from experimental fiber composite resin had higher load-bearing capacity (349N) (p<0.05) than the control restorations (173N). No significant difference was found in load-bearing capacity between restorations reinforced with FRC-substructure and those without (p>0.05).

CONCLUSIONS

Restorations made from short glass fiber containing composite resin with IPN-polymer matrix showed better load-bearing capacity than those made with either plain PFC or PFC reinforced with fiber post.

Fracture resistance of short, randomly oriented, glass fiber-reinforced composite premolar crowns

The aim of this work was to determine the static load-bearing capacity of posterior composite crowns made of experimental composite resin (FC) with short fiber fillers and a semi-interpenetrating polymer network (IPN) matrix. In addition, we wanted to investigate how load-bearing capacity of surface composite resins was affected by substructures of fiber-reinforced composite (FRC) and FC, and by different curing systems. Five groups of crowns were fabricated (n=6). The crowns were either polymerized with a hand-light curing unit (LCU) or cured in a vacuum curing device (VLC) before they were statically loaded at a speed of 1mm min(-1) until fracture. Failure modes were visually examined. Data were analyzed using ANOVA. ANOVA revealed that crowns made from the FC had a statistically significant higher load-bearing capacity than the control PFC composite. Crowns with FRC substructure and PFC covering gave force values of 348N (LCU) and 1199N (VLC), respectively, which were lower than the values of FC composite. No statistically significant difference was found between crowns made from plain FC composite and those made from FC composite with a surface layer of PFC (P=0.892 and 1.00). Restorations made from short glass fiber-containing composite resin with IPN-polymer matrix showed better load bearing capacity than those made with either plain PFC or PFC reinforced with FRC substructure.

Subsurface degradation of resin-based composites

OBJECTIVES

To determine the depth of a degraded subsurface layer produced in dental composites as a result of exposure to lactic acid or NaOH, by observing the penetration of AgNO(3) solution.

METHODS

Specimens were prepared from four resin composites; Point 4 (Kerr), Premise (Kerr), Filtek Supreme (3M/ESPE), Ceram X (Dentsply), and two polyacid-modified resin composites; Dyract (Dentsply) and F2000 (3M/ESPE). The specimens were immersed in distilled water for 1 week, transferred to one of three aqueous media at 60 degrees C for 2 weeks; distilled water, 0.01mol/L lactic acid or 0.1N NaOH, washed and immersed in 50% (w/w) aqueous silver nitrate for 10 days at 60 degrees C and placed in a photodeveloper solution. After reduction of the silver, specimens were embedded in epoxy resin, sectioned and polished, coated with carbon, and examined by backscattered mode scanning electron microscopy. The depth of silver penetration into the degraded area was measured from the SEM micrographs. Energy dispersive analysis X-ray (EDAX) was used to confirm the presence of silver.

RESULTS

NaOH produced the greatest depth of degradation and lactic acid the least. Premise showed the greatest depth of silver penetration when subjected to NaOH, and Filtek Supreme the second with peeling of the surface and cracking, whereas F2000 and Point 4 showed the least in NaOH and lactic acid.

SIGNIFICANCE

ANOVA and Tukey's test showed that the depth of silver penetration was material and solution dependent, and the differences were significant for most of the materials (P<0.05).

Contact versus flexure fatigue of a fiber-filled composite

OBJECTIVE

The intent of this project was to examine the effect of two different modes of fatigue loading, contact and flexure, on the flexure strength of a dental composite.

METHODS

The composite was Restolux (a fiber-filled composite) formed as bars 3 mm x 3 mm x 25 mm in size. The cyclic loading ranges were 30-50, 60-80, and 90-110 N for contact loading and 20-40 and 40-60 N for the flexure loading. Number of cycles completed was 1, 1000 or 100,000 in four different media: air, water, artificial saliva, and a 50/50 mixture of water and ethanol. Specimens were aged in sealed polyethylene containers in their respective media for 4 months at 37 degrees C.

RESULTS

Statistical analysis indicated a significantly lower flexure strength for the specimens flexure loaded versus contact loaded. For the flexure loaded specimens, the number of cycles had no significant effect, but the aging, load, and the media were all significant. For the contact loaded specimens, a significant effect was observed for the media, aging, and cycles completed, but no effect for the different cycling loads.

SIGNIFICANCE

In summary, the decrease in flexure strength from flexure loading was mainly affected by the aging media, whereas, the decrease from contact loading was attributed mainly to the number of cycles.

Short glass fiber reinforced restorative composite resin with semi-inter penetrating polymer network matrix

OBJECTIVES

The purpose of this study was to investigate the reinforcing effect of short E-glass fiber fillers on some mechanical properties of dental composite resin with interpenetrating polymer network (IPN)-polymer matrix.

MATERIALS AND METHODS

Experimental composite resin was prepared by mixing short fibers (3mm in length) with a fraction of 22.5 wt% and IPN-resin 22.5 wt% with silane treated silica filler 55 wt% using high speed mixing machine. Test specimens (2 mm x 2 mm x 25 mm) and (9.5 mm x 5.5 mm x 3 mm) were made from the experimental composite (FC) and conventional particulate composite resin (control, Z250, 3M-ESPE). The test specimens (n=6) were either dry stored or water stored (37 degrees C for 30 days) before the mechanical tests. Three-point bending test was carried out according to ISO 10477 and compression loading test was carried out using a steel ball (Ø3.0mm) with speed of 1.0mm/min until fracture. Degree of monomer conversion (DC%) of both composites was determined by FTIR spectrometry. Water sorption and solubility of specimens were also measured. Scanning electron microscopy was used to evaluate the microstructure of the composite.

RESULTS

ANOVA revealed that experimental fiber composite had statistically significantly higher mechanical performance of flexural strength (210 MPa) and compressive load-bearing capacity (1881 N) (p < 0.05) than control composite (111 MPa, 1031 N). Degree of conversion of the FC (59%) and conventional composite (57%) was at the same range.

SIGNIFICANCE

The use of short fiber fillers with IPN-polymer matrix yielded improved mechanical performance compared to conventional restorative composite.

Use of short fiber-reinforced composite with semi-interpenetrating polymer network matrix in fixed partial dentures

OBJECTIVES

The aim of this study was to determine the static load-bearing capacity of fixed partial dentures (FPDs) made of experimental composite resin (FC) with short fiber fillers and interpenetrating polymer network (IPN) polymer matrix.

MATERIALS AND METHODS

Experimental composite FC resin was prepared by mixing short E-glass fibers (3mm in length) of 22.5wt% and IPN-resin 22.5wt% with silane treated silica fillers 55wt%. Four groups of FPDs (3-unit) were fabricated (n=6); Group A: made from commercial composite resin (Sinfony dentin, 3M-ESPE, control), Group B: Sinfony and fiber-reinforced composite (FRC) substructure, Group C: made from FC, Group D: made from FC with 1mm surface layer of Sinfony. The bridges were polymerized with a hand-light curing unit for 40s then post-cured in vacuum curing device (Visio Beta) for 15min before they were statically loaded with speed of 1mm/min until fracture. Failure modes were visually examined. Data were analyzed using ANOVA (p=0.05).

RESULTS

ANOVA revealed that bridges made from experimental fiber composite had statistically significantly higher load-bearing capacity (2171N) (p<0.05) than the control restorations (1482N).

SIGNIFICANCE

Restorations made from short glass fiber containing composite resin with IPN-polymer matrix showed better load bearing capacity than in those made with conventional composites resin and similar with those reinforced with FRC-substructure.

Barium and strontium leaching from aged glass particle/resin matrix dental composites

OBJECTIVES

This study characterizes the loss of Ba and Sr from glass particle/resin-matrix dental composites during simulated aging.

METHODS

X-ray wavelength dispersive spectrometry and secondary ion mass spectrometry were used to analyze the Ba and Sr content from the surfaces of three commercial dental composites after aging for 4 and 8 months in humid air, artificial saliva, water, and 50% ethanol.

RESULTS

Aging in artificial saliva caused the greatest leaching of Ba or Sr for all the specimens, compared with either lesser or no leaching for aging in ethanol and water. Differences in leaching were observed between the different composites. Composites aged in artificial saliva also picked up elements in the saliva solution and displayed crystallite formation on the surface. Samples aged in ethanol displayed cracking which was not observed for water or artificial saliva.

SIGNIFICANCE

Dental composites display ion leaching from their surfaces over periods of four to eight months. Three mechanisms are proposed to explain differences in leaching for the various composites and aging solutions. Surface mineralization is also proposed to occur as a self-repair mechanism in artificial saliva.

Clinical wear performance of eight experimental dental composites over three years determined by two measuring methods

The effect of matrix selection, filler composition, filler silanization, operator variations, and test site (dental clinic) on the wear rate of eight composites were evaluated. The wear was measured on replicas using both a microscopic and a laser scanning measuring method. The average wear rate on contact-free surfaces was 9.2 +/- 4.2 microm/month with the microscopic measurement and 8.5 +/- 3.7 microm/ month with the laser scanner over the 36-month period. The urethane-based composites performed significantly better than those which were bisGMA-based. Restorations placed at one dental clinic showed significantly lower initial wear. There was also a significant difference between the operators that was most pronounced during the first 6 months. The other variable (filler composition and silane treatment) did not affect the wear rate significantly.