Developments in Shrinkage Control of Adhesive Restoratives

Combining adhesive and nonadhesive injectable hydrogels for intervertebral disc repair in an ovine discectomy model

Background

Intervertebral disc (IVD) disorders (e.g., herniation) directly contribute to back pain, which is a leading cause of global disability. Next-generation treatments for IVD herniation need advanced preclinical testing to evaluate their ability to repair large defects, prevent reherniation, and limit progressive degeneration. This study tested whether experimental, injectable, and nonbioactive biomaterials could slow IVD degeneration in an ovine discectomy model.

Methods

Ten skeletally mature sheep (4-5.5 years) experienced partial discectomy injury with cruciate-style annulus fibrosus (AF) defects and 0.1 g nucleus pulposus (NP) removal in the L1-L2, L2-L3, and L3-L4 lumbar IVDs. L4-L5 IVDs were Intact controls. IVD injury levels received: (1) no treatment (Injury), (2) poly (ethylene glycol) diacrylate (PEGDA), (3) genipin-crosslinked fibrin (FibGen), (4) carboxymethylcellulose-methylcellulose (C-MC), or (5) C-MC and FibGen (FibGen + C-MC). Animals healed for 12 weeks, then IVDs were assessed using computed tomography (CT), magnetic resonance (MR) imaging, and histopathology.

Results

All repaired IVDs retained ~90% of their preoperative disc height and showed minor degenerative changes by Pfirrmann grading. All repairs had similar disc height loss and Pfirrmann grade as Injury IVDs. Adhesive AF sealants (i.e., PEGDA and FibGen) did not herniate, although repair caused local endplate (EP) changes and inflammation. NP repair biomaterials (i.e., C-MC) and combination repair (i.e., FibGen + C-MC) exhibited lower levels of degeneration, less EP damage, and less severe inflammation; however, C-MC showed signs of herniation via biomaterial expulsion.

Conclusions

All repair IVDs were noninferior to Injury IVDs by IVD height loss and Pfirrmann grade. C-MC and FibGen + C-MC IVDs had the best outcomes, and may be appropriate for enhancement with bioactive factors (e.g., cells, growth factors, and miRNAs). Such bioactive factors appear to be necessary to prevent injury-induced IVD degeneration. Application of AF sealants alone (i.e., PEGDA and FibGen) resulted in EP damage and inflammation, particularly for PEGDA IVDs, suggesting further material refinements are needed.

Polymerization Shrinkage, Hygroscopic Expansion, Elastic Modulus and Degree of Conversion of Different Composites for Dental Application

Objectives: To characterize the mechanical properties of different resin-composites for dental application. Methods: Thirteen universal dentin shade composites (n = 10) from different manufacturers were evaluated (4 Seasons, Grandio, Venus, Amelogen Plus, P90, Z350, Esthet-X, Amaris, Vita-l-escence, Natural-Look, Charisma, Z250 and Opallis). The polymerization shrinkage percentage was calculated using a video-image recording device (ACUVOL—Bisco Dental) and the hygroscopic expansion was measured after thermocycling aging in the same equipment. Equal volumes of material were used and, after 5 min of relaxation, baseline measurements were calculated with 18 J of energy delivered from the light-curing unit. Specimens were stored in a dry-dark environment for 24 h then thermocycled in distilled water (5–55 °C for 20,000 cycles) with volume measurement at each 5000 cycles. In addition, the pulse-excitatory method was applied to calculate the elastic modulus and Poisson ratio for each resin material and the degree of conversion was evaluated using Fourier transform infrared spectroscopy. Results: The ANOVA showed that all composite volumes were influenced by the number of cycles (α = 0.05). Volumes at 5 min post-polymerization (12.47 ± 0.08 cm3) were significantly lower than those at baseline (12.80 ± 0.09 cm3). With regard to the impact of aging, all resin materials showed a statistically significant increase in volume after 5000 cycles (13.04 ± 0.22 cm3). There was no statistical difference between volumes measured at the other cycle steps. The elastic modulus ranged from 22.15 to 10.06 GPa and the Poisson ratio from 0.54 to 0.22 with a significant difference between the evaluated materials (α = 0.05). The degree of conversion was higher than 60% for all evaluated resin composites.

Intracoronal stress transfer through enamel following RBC photopolymerisation: A synchrotron X-ray study

OBJECTIVES

To measure the spatial distribution of crystallographic strain in tooth enamel induced by the photo-polymerisation of a dimethacrylate resin based composite cavity restoration.

METHODS

Six sound first premolar teeth, allocated into two groups (n=3), were prepared with mesio-occlusal distal cavities. The enamel was machined at the point of maximum convexity on the outer tooth to create a vertical fin of thickness 100μm and 0.5mm depth to allow for synchrotron X-ray diffraction measurements. 2D diffraction patterns were used to determine crystallite orientation and quantify changes in the hydroxyapatite crystal lattice parameters, before and after photo-polymerisation of a composite material placed in the cavity, to calculate strain in the respective axis. The composite was photo-polymerised with either relatively high (1200mWcm^-2, group 1) or low (480mWcm^-2, group 2) irradiances using LED or quartz halogen light sources, respectively. A paired t-test was used to determine significant differences in strain between irradiance protocols at ɑ=0.001.

RESULTS

Photo-polymerisation of the composite in the adjacent cavity induced significant changes in both the crystallographic c and a axes of the enamel measurement area. However the magnitude of strain was low with ∼0.1% difference before and after composite photo-polymerisation. Strain in enamel was not uniformly distributed and varied spatially as a function of crystallite orientation. Increased alignment of crystallites perpendicular to the cavity wall was associated with higher c axis strain. Additionally, strain was significantly greater in the c (p<0.001) and a axis (p<0.001) when using a high irradiance photo-polymerisation protocol.

SIGNIFICANCE

Although cuspal deflection is routinely measured to indirectly assess the 'global' effect of composite shrinkage on the tooth-restoration complex, here we show that absolute strains generated in enamel are low, indicating strain relief mechanisms may be operative. The use of low irradiance protocols for photo-polymerisation resulted in reduced strain.

Mechanical weakening of devitalized teeth: three-dimensional Finite Element Analysis and prediction of tooth fracture

AIM

To determine to which extent cavity preparation and each step of dentine removal in the process of root canal treatment (access cavity preparation and root canal enlargement) both individually and jointly contribute to the weakening of the tooth.

METHODS

Numerical analysis using finite element method (FEM) of separate and combined influence of two-surface Class II preparation and root canal treatment was undertaken to evaluate the decrease in tooth strength. The influence of the two stages in root canal treatment, access cavity preparation and root canal enlargement, was also analysed separately and jointly. After each of these phases, the crown was restored with composite resin, and the FEA was performed only on restored teeth. To estimate the influence of all these procedures on tooth fracture resistance numerically, a Failure Index based on the maximum principal stress criterion (MPCS) was applied. Compressive and tensile stresses were analysed separately and corresponding Failure Indices were calculated.

RESULTS

A two-surface resin composite restoration weakened the tooth by 23.25%. Nevertheless, the Failure Indices showed that this tooth was not likely to fracture even under high occlusal stress (710N). However, after access cavity preparation, the Failure Indices reached the point where, under high occlusal force that may occur in the posterior area, a tooth fracture occurred. The enlargement of root canals had an additional, but relatively small impact on tooth weakening, making the tooth even more susceptible to fracture. The combined influence of both cavity preparation and root canal enlargement led to weakening of 62.6% under a load of 710N, ultimately causing tooth fracture.

CONCLUSION

The combined finite element method and the maximum principal stress analysis gave insight into the fracture mechanisms of teeth with two-surface composite restorations followed by root canal preparation. Removal of tooth tissue, despite its subsequent restoration with dental materials, weakened the tooth by changing the stress intensity and distribution through tooth structures. Access cavity preparation had the greatest influence on tooth strength whilst canal enlargement did not contribute to this process substantially.

Polymerization development of "low-shrink" resin composites: Reaction kinetics, polymerization stress and quality of network

OBJECTIVES

To evaluate "low-shrink" composites in terms of polymerization kinetics, stress development and mechanical properties.

METHODS

"Low-shrink" materials (Kalore/KAL, N'Durance/NDUR, and Filtek P90/P90) and one control (Esthet X HD/EHD) were tested. Polymerization stress (PS) was measured using the Instron 5565 tensometer. Volumetric shrinkage (VS) was determined by the ACTA linometer. Elastic modulus (E) and flexural strength (FS) were obtained by a three-point bending test. Degree of conversion (DC) and polymerization rate (Rp) were determined by NIR spectroscopy (6165cm(-1) for dimethacrylates; 4156 and 4071cm(-1) for P90). Photopolymerization was performed at 740mW/cm(2)×27s. Glass transition temperature (Tg), degree of heterogeneity and crosslink density were obtained in a DMA for the fully cured specimens. Analysis of extracts was done by (1)H NMR. Data were analyzed with one-way ANOVA/Tukey's test (α=0.05).

RESULTS

The control presented the highest shrinkage and Tg. P90 showed the highest modulus, and NDUR demonstrated the highest conversion. The polymerization rates were comparable for all materials. NDUR and KAL had the highest and the lowest network homogeneity, respectively. The multifunctional P90 had the highest crosslink density, with no difference between other composites. The control had the greatest stress development, similar to NDUR. Crosslinking density and polymer network homogeneity were influenced by degree of conversion and monomer structure.

SIGNIFICANCE

Not all "low-shrink" composites reduced polymerization stress. P90 and NDUR had no leachable monomers, which was also a function of high crosslinking (P90) and high conversion (NDUR).

Effect of lining with a flowable composite on internal adaptation of direct composite restorations using all-in-one adhesive systems

The purpose of this study was to evaluate the effect of lining with a flowable composite on internal adaptation of composite restorations using three all-in-one adhesive systems; Bond Force (BF), G-Bond Plus (GP), and OptiBond All-in-one (OP), and a two-step self-etching adhesive system; Clearfil SE Bond (SE). They were applied to each cylindrical cavity prepared on the human dentin. The cavity surface was lined with/without a flowable resin composite prior to filling with a resin composite (FL/NL). After water storage for 24 h, the specimens were sectioned and polished, and internal adaptation of the restorations was assessed using a confocal laser scanning microscopy. For SE, a perfect cavity adaptation was recognized in both FL and NL. For BF, GP and OP, cavity adaptation was material dependent in NL, whereas no gap formation was observed in FL. However, voids formation was observed at the composite-adhesive-dentin interface in every all-in-one adhesive system.

General dental practitioners' knowledge of polymerisation of resin-based composite restorations and light curing unit technology

OBJECTIVE

Clinical successful use of resin-based composite restorations (RBCs) depends on knowledge of material and light curing unit (LCU) related factors. The purpose of this study was to evaluate general dental practitioners' knowledge of polymerisation of RBCs and LCU technology.

METHODS

Members of the Active Research Group of the Faculty of General Dental Practice (UK) in England, Scotland and Wales engaged in primary dental care were sent a letter introducing the study and asking for their cooperation, followed by an email containing a link to the online survey questionnaire, hosted on Surveymonkey.com. The questionnaire enquired about current LCUs, and asked a series of questions on material science.

RESULTS

Sixty-six percent of the 274 members contacted responded. Fifty-seven percent used LED units, 25% quartz tungsten halogen (QTH), and 1% plasma arc (missing: 17%). Thirty percent reported having access to a radiometer. Appropriate responses regarding the degree of conversion of composite and adhesive materials were given by 32% and 23% respectively, and 22% agreed that LED and QTH LCUs had comparable efficiency in polymerising composites. Thirty-three percent were aware that RBCs eluted substances that may have adverse local or systemic consequences. Fifty-eight percent stated that if polymerisation of RBC is slowed down, polymerisation stress will be lower, and 43% said that polymerisation shrinkage will be reduced if the degree of conversion is reduced. Knowledge (measured by appropriate responses to these questions) was not related to years since qualification (r=-0.05, n=168, p=0.53).

CONCLUSION

The study suggests that dentists' knowledge of curing RBC restorations and LCUs is poor. This indicates that there is a need for training and guidance in this aspect of primary dental care.

Non-destructive examination of interfacial debonding using acoustic emission

OBJECTIVES

This study aims to assess the viability of using the acoustic emission (AE) measurement technique to detect and monitor in situ the interfacial debonding in resin composite restorations due to build-up of shrinkage stresses during polymerization of the composite.

MATERIALS AND METHODS

The non-destructive testing technique that measures acoustic emission (AE) was used to detect and monitor the interfacial debonding in resin composite during curing of the composite. Four groups of specimens, n=4 each, were tested: (1) intact human molars with Class-I cavities restored with the composite Z100 (3M ESPE, USA); (2) intact human molars with Class-I cavities restored with the composite Filtek™ P90 (3M ESPE, USA); (3) ring samples prepared from the root of a single bovine tooth and 'restored' with Z100; (4) freestanding pea-size specimens of Z100 directly placed on the AE sensor. The restorations in Groups (1)-(3) were bonded to the tooth tissues with the adhesive Adper™ Scotchbond™ SE Self-Etch (3M ESPE, USA). The composites in all the specimens were cured with a blue light (3M ESPE, USA) for 40s. The AE signals were recorded continuously for 10 min from the start of curing. Non-destructive 3D imaging was performed using X-ray micro-computed tomography (micro-CT) to examine the bonding condition at the tooth-restoration interface.

RESULTS

The development of AE events followed roughly that of the shrinkage stress, which was determined separately by the cantilever beam method. The number of AE events in the real human tooth samples was more than that in the ring samples, and no AE events were detected in the pea-size specimens placed directly on the AE sensor. The number of AE events recorded in the specimens restored using Z100 was more than that found in specimens restored with Filtek P90. The micro-CT imaging results showed clear interfacial debondings in the tooth specimens restored with Z100 after curing, but no clear debonding was found in the P90 specimens.

CONCLUSIONS

The AE technique is an effective tool for detecting and monitoring in situ the interfacial debonding of composite restorations during curing. It can potentially be employed to evaluate the development of shrinkage stress and the quality of interfacial bonds in teeth restored with different composite materials, cavity geometries, and restorative techniques.

Effect of C-factor on microtensile bond strengths of low-shrinkage composites

This study evaluated the microtensile bond strength (μ-TBS) of low-shrinkage composites with their corresponding adhesive systems, Filtek Silorane/Silorane adhesive (SIL, 3M ESPE AG, Seefeld, Germany) and Aelite LS/One-Step Plus (AL, BISCO Inc, Schaumburg, IL, USA) in cavities with different C-factors. Filtek Z250/Adper Single Bond Plus (Z, 3M ESPE, St Paul, MN, USA) was used as a control.

METHOD

Standardized Class I cavities were prepared in extracted human molars after removing occlusal enamel. Cavities were assigned into six different C-factors by applying nail polish to four walls, three walls, two walls adjacent to each other, two walls opposite to each other, one wall, or no walls. Resin composites with their corresponding adhesive systems were applied according to manufacturer instructions. Specimens were sectioned to obtain four rectangular beams from the center of the restorations and μ-TBS was measured. Data were analyzed by Weibull survival analysis. Shrinkage stresses of the resin composites were determined after 30 minutes from the start of light-curing using a tensometer testing machine. Flexure elastic modulus was determined using standard procedures, in accordance with ISO 4049. Data for shrinkage stress and elastic modulus were analyzed by one-way analysis of variance followed by a Tukey multiple-comparisons test (p<0.05).

RESULTS

μ-TBS of both SIL and AL were not affected by different C-factors; however, the bond strength of Z decreased significantly when the C-factor increased. Shrinkage stress results were 0.94 ± 0.1, 1.79 ± 0.18, and 2.14 ± 0.23 MPa for SIL, AL, and Z, respectively. The flexural modulus of both the SIL and the AL was significantly lower than that of Z.

CONCLUSIONS

Increasing C-factor did not negatively affect the bond strength of low-shrinkage composites.

Evaluation of Bond Strength and Internal Adaptation Between the Dental Cavity and Adhesives Applied in One and Two Layers

The double layer of adhesive promoted a slight increase in bond strength for Scotchbond MP and Clearfil SE Bond. However, this technique did not promote improvement in the internal adaptation between the dental cavity and the adhesive systems tested.

A model for shrinkage strain in photo polymerization of dental composites

OBJECTIVES

We formulate a new model for the shrinkage strain developed during photo polymerization in dental composites. The model is based on the diffusion type fractional order equation, since it has been proved that polymerization reaction is diffusion controlled (Atai M, Watts DC. A new kinetic model for the photo polymerization shrinkage-strain of dental composites and resin-monomers. Dent Mater 2006;22:785-91). Our model strongly confirms the observation by Atai and Watts (see reference details above) and their experimental results. The shrinkage strain is modeled by a nonlinear differential equation in (see reference details above) and that equation must be solved numerically. In our approach, we use the linear fractional order differential equation to describe the strain rate due to photo polymerization. This equation is solved exactly.

RESULTS

As shrinkage is a consequence of the polymerization reaction and polymerization reaction is diffusion controlled, we postulate that shrinkage strain rate is described by a diffusion type equation. We find explicit form of solution to this equation and determine the strain in the resin monomers. Also by using equations of linear viscoelasticity, we determine stresses in the polymer due to the shrinkage. The time evolution of stresses implies that the maximal stresses are developed at the very beginning of the polymerization process.

SIGNIFICANCE

The stress in a dental composite that is light treated has the largest value short time after the treatment starts. The strain settles at the constant value in the time of about 100s (for the cases treated in Atai and Watts). From the model developed here, the shrinkage strain of dental composites and resin monomers is analytically determined. The maximal value of stresses is important, since this value must be smaller than the adhesive bond strength at cavo-restoration interface. The maximum stress determined here depends on the diffusivity coefficient. Since diffusivity coefficient increases as polymerization proceeds, it follows that the periods of light treatments should be shorter at the beginning of the treatment and longer at the end of the treatment, with dark interval between the initial low intensity and following high intensity curing. This is because at the end of polymerization the stress relaxation cannot take place.

Influence of light intensity on contraction stress of flowable resins

The purpose of this study was to evaluate the influence of power density on contraction stress of resin composite restorative materials during photo-polymerization. Six flowable resin composites, and a hybrid resin composite for comparison, were used. The composites were polymerized with the power density adjusted to either 100 or 600 mW/cm(2). Stress development was determined with a custom-made tensilometer. The adhesive was placed in a thin layer on a steel rod and resin paste was packed into the mold. The contraction force (N) generated during polymerization was continuously recorded and the maximum contraction stress (MPa) was calculated. Data were analyzed statistically. When the power density was adjusted to 100 mW/cm(2), the average contraction stress ranged from 0.30 to 0.50 MPa for the flowable composites, compared with 0.35 MPa for the hybrid composite. When the power density was adjusted to 600 mW/cm(2), the average contraction stress ranged from 0.34 to 1.00 MPa for the flowable composites and 0.69 MPa for the hybrid composite comparison. For all materials tested except Estelite Flow Quick, contraction stress increased with higher power density. The present results indicate that contraction stress during polymerization is influenced by power density and resin composite type.

Contraction stress determinants in dimethacrylate composites

The influence of composite organic content on polymerization stress development remains unclear. It was hypothesized that stress was directly related to differences in degree of conversion, volumetric shrinkage, elastic modulus, and maximum rate of polymerization encountered in composites containing different BisGMA (bisphenylglycidyl dimethacrylate) concentrations and TEGDMA (triethylene glycol dimethacrylate) and/or BisEMA (ethoxylated bisphenol-A dimethacrylate) as co-monomers. Stress was determined in a tensilometer. Volumetric shrinkage was measured with a mercury dilatometer. Elastic modulus was obtained by flexural test. We used fragments of flexural specimens to determine degree of conversion by FT-Raman spectroscopy. Reaction rate was determined by differential scanning calorimetry. Composites with lower BisGMA content and those containing TEGDMA showed higher stress, conversion, shrinkage, and elastic modulus. Polymerization rate did not vary significantly, except for the lower value of the 66% TEGDMA composite. We used linear regressions to evaluate the association between polymerization stress and conversion (R(2)=0.905), shrinkage (R(2)=0.825), and modulus (R(2)=0.623).

Polymerization stress of resin composites as a function of system compliance

OBJECTIVES

Evaluate the effect of testing system compliance on polymerization stress and stress distribution of composites.

METHODS

Composites tested were Filtek Z250 (FZ), Herculite (HL), Tetric Ceram (TC), Helio Fill-AP (HF) and Heliomolar (HM). Stress was determined in 1-mm thick specimens, inserted between two rods of either poly(methyl methacrylate), PMMA, or glass. Experimental nominal stress (sigmaexp) was calculated by dividing the maximum force recorded 5 min after photoactivation by the cross-sectional area of the rod. Composites' elastic modulus (E) was obtained by three-point bending. Data were submitted to one-way ANOVA/Tukey's test (alpha=0.05). Stress distribution on longitudinal (sigmay) and transverse (sigmax) axes of models representing the composites with the highest and lowest E (FZ and HM, respectively) were evaluated by finite element analysis (FEA).

RESULTS

sigmaexp ranged from 5.5 to 8.8 MPa in glass and from 2.6 to 3.4 MPa in PMMA. Composite ranking was not identical in both substrates, since FZ showed sigmaexp statistically higher than HM in glass, while in PMMA FZ showed values similar to the other composites. A strong correlation was found between stress reduction (%) from glass to PMMA and composite's E (r2=0.946). FEA revealed that system compliance was influenced by the composite (FZ led to higher compliance than HM). sigmax distribution was similar in both substrates, while sigmay distribution showed larger areas of compressive stresses in specimens built on PMMA.

SIGNIFICANCE

sigmaexp determined in PMMA was 53-68% lower than in glass. Composite ranking varied slightly due to differences in substrates' longitudinal and transverse deformation.

Influence of Tg, viscosity and chemical structure of monomers on shrinkage stress in light-cured dimethacrylate-based dental resins

OBJECTIVES

The aim of this study was to investigate the influence of the molecular mobility and the chemical structure of dimethacrylates most commonly used in dental composites on shrinkage stress from experimental matrices.

METHODS

Three established neat monomers BisGMA (B), UEDMA (U) and TEGDMA (T), two experimental comonomers BisGMA-based (B-T(70/30) and B-T(50/50)) and two comonomers UEDMA-based (U-T(88/11) and U-T(66/33)) in weight%, were elaborated. Camphorquinone (CQ) and N,N-cyanoethylmethylaniline (CEMA), as photoinitiator and reducing agent, were added. Then the matrices were mixed by centrifugal force at room temperature. The viscosity (eta), the glass transition temperature of the monomers and comonomers systems (T(g(monomer)) and the maximum shrinkage stress (MSS) of each material (five replications) were statistically analysed by one-way ANOVA/Tuckey's test and Pearson's correlation procedure (p = 0.05).

RESULTS

All formulations exhibited a newtonian rheological behavior. The viscosity of the comonomers systems can be divided in two groups: the pair B-T(70/30)/U-T(88/11) with the viscosity 3.5+/-3.10(-3)Pa.s and the pair B-T(50/50)/U-T(66/33) with the viscosity 0.28+/-3.10(-3)Pa.s. This pairs constituted samples allowing to compare the shrinkage stress of the BisGMA and UEDMA-based matrices with each other. The T(g(monomer)) of each group showed equivalent statistically values: -37.1 +/- 0.02 degrees C (U-T(88/11)) with -39.3 +/- 0.02 degrees C (B-T(70/30)) for the 3.5 Pa.s pair, and -53.1 +/- 0.03 degrees C (U-T(66/33)) with -58.5 +/- 0.01 degrees C (B-T(50/50)) for the 0.28 Pa.s one. There was a correlation between eta and T(g(monomer)) (r < 0.45 and p < 0.01). In decreasing order, the shrinkage stress was 14.11 +/- 0.3 MPa (T), 10.64 +/- 0.6 MPa (U-T(66/33)), 8.16 +/- 0.25 MPa (B-T(50/50)) without a significant difference compared to 8.04 +/- 0.5 MPa (U-T(88/11)), 6.83 +/- 0.52 MPa (U), 4.44 +/- 0.25 MPa (B-T(70/30)) and 0.33 +/- 0.3 MPa (B). There was a negative correlation between eta (r < -0.42 and p < 0.01), T(g(monomer)) (r < -0.41 and p < 0.01) and MSS. Whatever the viscosity, the UEDMA-based matrices developed higher shrinkage stresses than the BisGMA homologues.

SIGNIFICANCE

The shrinkage stress development increase with the molecular mobility of the reacting medium. For the same molecular mobility, the large differences in stress values of the matrices studied are correlated to the structure and particularly the functionality of the monomers used.

Microleakage in the proximal walls of direct and indirect posterior resin slot restorations

This study compared the degree of microleakage in the proximal walls of direct and indirect resin slot restorations in relation to the types of dentin bonding systems and the location of gingival margins. Two Class II slot preparations were prepared and restored in each of 60 extracted human molars using direct (Filtek Supreme) and indirect (Tescera ATL) restorative resin materials. Various types of dentin bonding systems, including self-etching (OneStep Plus/Tyrian SPE, iBond, Xeno III) and etch and rinse systems (All-Bond 2, Prime & Bond NT) were used to restore the prepared teeth. The gingival proximal wall was placed apical to the cementoenamel junction (CEJ) in 1 proximal box and coronal to the CEJ in the other. The specimens were stained and evaluated for microleakage using a digital imaging and analysis system. Significant differences were found in the degree of microleakage observed in the various restorative groups. In general, the group restored with indirect resin had less microleakage than the direct resin groups. Factors, such as type of dentin bonding system and location of gingival margins, exert a substantial influence on the degree of microleakage that occurred along the walls of proximal resin restorations.

Study of shrinkage–strain and contraction rates of commercial and experimental compomers

OBJECTIVE

To asses the contraction rate and shrinkage-strain of a new experimental compomer in comparison with four commercial compomers and a flowable composite resin.

METHOD

Shrinkage-strain and contraction rate were calculated by measuring the deflection of a disc in a developed instrument using "bonded disk" method.

RESULTS

Both shrinkage-strain and contraction rate are reported. Total shrinkage-strain for compomer systems varies from 2.59 to 3.34%, whereas the flowable composite resin showed a value of 3.50%. The contraction rate for compomers varies from 81.60 to 109.80 microm/min, whereas the flowable composite resin obtained 141.6 microm/min. Commercial compomers show a lower contraction rate than the control group, whereas the experimental group only shows statistical differences with a commercial compomer (Dyract AP).

SIGNIFICANCE

The shrinkage-strain and contraction rate results for the experimental compomer are as good as those obtained for a commercial flowable compomer and a flowable composite resin. The contraction rates of all compomers could be directly related to polymerization rates. The method used to measure shrinkage-strain and contraction rate is adequate because it simulates conditions in situ. It can be inferred that the contraction rate is directly related to shrinkage-strain.

Shrinkage stress in light-cured composite resins: influence of material and photoactivation mode

OBJECTIVES

The aim of this study was to record the effect of composite type and photoactivation mode on the stresses resulting from polymerization of five established composite resins: packable (Solitaire, Solitaire 2), micro-hybrid (Aelitefil, Z100) and hybrid (Clearfil AP-X).

METHODS

A mechanical testing machine was used to record the polymerization contraction stress (MPa) of cylindrical composite specimens (d=5mm; h=2mm; C-factor=1.25) at 0.1s intervals over a period of 400s. The samples were photopolymerized using a halogen light curing device under two types of light exposure: group 1, Standard (800mW.cm(-2)x60s); group 2, Exponential (logarithmic increase from 150 to 800mW.cm(-2) over 15s+800mW.cm(-2)x45s). The stress rate (SR: slope(MPa>0-60s)) and the maximum shrinkage stress (MSS: MPa(400s)) of each material (five replications) were statistically analysed by one-way ANOVA/Scheffe's test and Pearson's correlation procedure (alpha=0.05). Finally, Student's t-test (two matched series) enabled the assessment of the effect of the irradiation method on the results.

RESULTS

For group 1, in decreasing order, the MSS was 1.51+/-0.07MPa (Solitaire) statistically equivalent to 1.45+/-0.06MPa (Aelitefil), 1.29+/-0.08MPa (Solitaire 2), and 1.04+/-0.03MPa (Z100) statistically equivalent to 0.92+/-0.05MPa (Clearfil AP-X). Z100 showed the highest SR (0.045+/-6x10(-3)) and Solitaire, the lowest (0.017+/-2x10(-3)). There was no correlation between SR and MSS (r<-0.33, p<0.05). For group 2, the MSS and SR values were distributed in a similar way to those from group 1. There was a negative correlation between SR and MSS (r<-0.43 and p<0.01). The exponential ramp successfully reduced the MSS (-3.9%) and SR (-11%) values.

SIGNIFICANCE

There is no relationship between composite resin type, stress rate and shrinkage stress levels. The slower stress rate development, resulting from ramped light intensity, helped slightly to reduce the maximum polymerization stress.

The influence of curing times and light curing methods on the polymerization shrinkage stress of a shrinkage-optimized composite with hybrid-type prepolymer fillers

OBJECTIVES

The aim of the study was to determine the influence of different light curing units (LCU) and regimes on the polymerization shrinkage stress (PSS) and the mechanical properties of a nano-hybrid composite.

MATERIAL AND METHODS

The polymerization shrinkage force (PSF) was measured continuously with compliance compensation for 300s after photo-initiating the composite, Tetric EvoCeram (Ivoclar Vivadent, Schaan, FL, Shade A3) in a Stress-Strain Analyser. Astralis 10, Bluephase and MiniL.E.D LCU with exposure times 10, 20 and 40s were used (C-factor=0.33, n=8 per group). Immediately after the PSF measurements, mechanical properties of the samples were measured at the top and the bottom using a Fischerscope H100C (Helmut Fischer GmbH, Sindelfingen, Germany). Statistical analyses were done using one-way ANOVA (p<0.05) and Tukey post hoc test.

RESULTS

Significant differences in the PSS for 10, 20 and 40s polymerization using Astralis 10 were found. The MiniL.E.D recorded low stress values. Modulus of elasticity is high after curing the composite with Astralis 10 at 10, 20 and 40s and for Bluephase 40s. Low moduli of elasticity were recorded for the MiniL.E.D and for the Bluephase 20 and 10s. The hardness values (HV) followed the same pattern as the modulus of elasticity. The Ramping mode of the MiniL.E.D had prolonged gel point.

CONCLUSIONS

High intensity LCU produce not just high HV but also high shrinkage, making it important to balance both the effects by choosing the appropriate curing time. Soft-start regimes have no paramount benefit in a LED regarding stresses in the clinical situation.

Influence of Elasticity on Gap Formation in a Lining Technique with Flowable Composite

The purpose of this study was to investigate the effect of flowable composites as liners for direct composite restorations, with key focus on the elastic moduli of flowable and condensable composites. After treating the composite mold cavity surface with an adhesive system, one of the flowable composites was placed as a 1 mm-thick layer on the cavity floor and irradiated for 20 seconds. The rest of cavity was subsequently filled with a condensable composite and irradiated for 40 seconds. Gap formation at both interfaces--between the cavity floor and flowable composite, and between the flowable and condensable composites--was examined. No gaps were detected at the interface between the cavity floor and flowable composite. Gap percentage at the interface between the flowable and condensable composites was dependent on the difference in elastic modulus. It was concluded that flowable composite with high elastic modulus could inhibit gap formation between flowable and condensable composites.

Investigations of step-growth thiol-ene polymerizations for novel dental restoratives

OBJECTIVES

The goal of this work was to investigate the feasibility of formulating novel dental restorative materials that utilize a step-growth thiol-ene photopolymerization. Particularly, we are aiming to significantly reduce the polymerization shrinkage and shrinkage stress while retaining adequate physical properties as compared to current dimethacrylatre-based systems.

METHODS

The thiol-ene system is composed of a 4:3 molar mixture of triallyl-1,3,5-triazine-2,4,6-trione (TATATO) and pentaerythritol tetramercaptopropionate (PETMP). The simultaneous measurement of shrinkage stress and functional group conversion was performed. Solvent extraction of unreacted monomers and dynamic mechanical analysis on the polymer networks that were formed were also studied. Flexural strength was measured for both filled and unfilled PETMP/TATATO and Bis-GMA/TEGDMA systems.

RESULTS

Photopolymerization of PETMP/TATATO occurs at a much higher rate, with the maximum polymerization rate six times faster, than Bis-GMA/TEGDMA cured under the identical conditions. The results from the simultaneous measurement of shrinkage stress and conversion showed that the onset of shrinkage stress coincides with the delayed gel point conversion, which is predicted to be 41% for the 3:4 stoichiometric PETMP/TATATO resin composition. The maximum shrinkage stress developed for PETMP/TATATO was about 0.4 MPa, which was only approximately 14% of the maximum shrinkage stress of the Bis-GMA/TEGDMA system. Adequate flexural strength and flexural modulus values were obtained for both filled and unfilled PETMP/TATATO systems.

SIGNIFICANCE

The dramatically reduced shrinkage stress, increased polymerization rate, significance increased functional group conversion, and decreased leachable species are all benefits for the use-of thiol-ene systems as potential dental restorative materials.

Effects of flowable resin on bond strength and gap formation in class I restorations

OBJECTIVES

This study measured resin/dentin bond strengths and evaluated gap formation at the pulpal floor of occlusal composite restorations using a flowable resin as a liner with either bulk or incremental placement of the restorative composite.

METHODS

Class I occlusal preparations were made in 16 extracted molars, and were randomly divided into two groups for restoration using either One-Step adhesive (OS, BISCO) and Renew composite (RW, BISCO) or OptiBond SOLO adhesive (SOLO, Kerr) and Herculite XRV composite (XRV, Kerr). A flowable resin [AEliteFlo (AE, BISCO) or Revolution (RV, Kerr)] was applied as a liner in half of the specimens of each group. The lined and unlined groups were restored with composite cured in bulk, or cured in 1.5 mm increments. After 24 h in water, the teeth were sectioned into 0.7-mm thick slabs and were examined with an optical microscope (400 x) to determine the presence of internal resin-dentin gaps. The gap-free specimens were trimmed and were subjected to microtensile bond strength testing. Specimens that contained gaps had Knoop hardness of the restorative material measured.

RESULTS

All incrementally filled restorations were well adapted to the pulpal floor but nearly all bulk-cured specimens had gaps between the flowable and the hybrid composites. The use of a flowable resin increased the bond strength of OS, but not SOLO.

SIGNIFICANCE

The incremental technique prevented gap formation regardless of the use of a flowable resin. In contrast, the use of a flowable composite did not guarantee gap-free restorations or improved bond strength of resin to dentin in bulk-filled restorations.

Polymerization contraction stress of low-shrinkage composites and its correlation with microleakage in class V restorations

OBJECTIVE

The aim of this study was to compare the behavior of two new, low-shrinkage hybrid composites (Aelite LS and Inten-S) with a microfilled (Heliomolar) and a hybrid composite (Filtek Z250), in terms of polymerization contraction stress and microleakage.

METHODS

Maximum contraction stress after 10 min was recorded in a "tensilometer", using a C-factor (C) of 2.5 and energy density of 26 J/cm(2). For the microleakage test, cylindrical cavities with enamel margins prepared in bovine incisors (4 mm diameter, 1.5 mm depth, C = 2.5) were restored in bulk, applying the same energy density used in the contraction stress test. After immersion in 0.5% methylene blue for 4 h, specimens were sectioned twice, perpendicularly, and the highest dye penetration score was recorded. Contraction stress results were analyzed by one-way ANOVA/Tukey's test and microleakage was analyzed by Kruskal-Wallis test. Regression analysis between the two variables was also performed.

RESULTS

Aelite LS showed significantly higher stress than the other composites tested. Inten-S and Filtek Z250 had similar stress levels, statistically higher than Heliomolar. In the microleakage test, a significant difference was observed between Aelite LS and Heliomolar only. Regression analysis showed a good linear correlation between the two variables (R2(adjusted) = 0.811).

CONCLUSIONS

The low-shrinkage materials exhibited contraction stress values similar or higher than the hybrid composite. A direct relationship between contraction stress values and microleakage for the composites evaluated was verified.

SIGNIFICANCE

The low-shrinkage composites tested did not seem to represent an improvement in terms of reducing contraction stress or microleakage.

Reduction of polymerization shrinkage stress and marginal microleakage using soft-start polymerization

PURPOSE

This study evaluated the influence of a soft-start light-curing exposure on polymerization shrinkage stress and marginal integrity of adhesive restorations.

MATERIALS AND METHODS

Six resin-based composites (Pertac II, Tetric Ceram, Definite, Surefil, Solitaire, and Visio-Molar) were adhesively bonded to a cylindrical cavity (n = 9 per material/light) in a photoelastic material. Visible light-curing was applied using either the standard polymerization mode (800 mW/cm2 exposure duration 40 s) of the curing light (Elipar TriLight, 3M ESPE) or the exponential mode from the same device (ramp-curing: 150 mW/cm2 to 800 mW/cm2 within the first 15 s of a total curing time of 40 s). Polymerization stress was calculated at 5 minutes, 1 hour, and 24 hours postexposure from the second-order isochromatic curves obtained from photoelastic images (Matrox-Inspector). Two standardized Class V preparations were made each on the facial and lingual surfaces of 80 extracted human molars and premolars. Resin restorative systems (Pertac II/EBS Multi, Tetric Ceram/Syntac, Definite/Etch&Prime 3.0, and Surefil/Prime & Bond 2.1) were exposed using both light exposure modes (n = 20). Marginal dye penetration (2% methylene blue) was investigated separately for enamel and cementum margins after thermocycling. To obtain information on equivalent depth of cure, relative surface hardness measurements were performed on resin samples of the same material at the top surface and at 1.5 mm and 3.0 mm thickness (Zwick 3212, 10 N).

RESULTS

A significant (p < .01) reduction in polymerization stress of 7.1% for Pertac II, 4.1% for Tetric Ceram, 3.6% for Definite, 3.7% for Surefil, and 6.2% for Solitaire was observed when using the exponential mode as opposed to the standard. A significant (p = .04) reduction of marginal dye penetration was found only for Pertac II/EBS Multi at the cementum margins when the soft-start polymerization was used. For the sample thickness of 3 mm, a significant higher relative bottom to top surface ratio in favor of the standard exposure mode was found (p = .001).

CLINICAL SIGNIFICANCE

Depending on the restorative material, soft-start polymerization may lead to a significant reduction in marginal microleakage of adhesive Class V restorations. This effect might be attributable to a significantly lower polymerization stress, as seen from photoelastic analysis, and/or a decrease in the degree of conversion, as deducted from surface hardness ratios. However, the effect of soft-start curing mode depends on the material itself, with the most effective response from hybrid resin-based composites.

Polymerization contraction stress in light-cured compomer restorative materials

OBJECTIVE

The magnitude and kinetics of polymerization contraction stress build-up may be potential predictors of bond failure of adhesive restorations. The present study determined these properties of seven commercial compomers (Dyract, Dyract AP, F2000 Rasant, Hytac, Compoglass F, Luxat, Glasiosite).

METHODS

Polymerization shrinkage was generated by 40 s light curing the test materials (800 mW/cm2). The contraction force induced was recorded for 300 s at room temperature (23-24 degrees C) by means of a Stress-Strain-Analyzer (C factor=0.33). Maximum contraction stress (MPa), coefficient of near linear fit of contraction force/time (gradient) and relative force rate (%/s) of each material were compared with that of two hybrid composites (Tetric Ceram, Prodigy). The statistical analysis was conducted by ANOVA (alpha=0.05) and post hoc Tukey's test.

RESULTS

No statistically significant differences in the maximum stress between Glasiosite (2.27+/-0.06 MPa), Hytac (2.31+/-0.07 MPa) and Tetric Ceram (2.21+/-0.11 MPa), and between Compoglass F (2.60+/-0.18 MPa) and Prodigy (2.70+/-0.06 MPa) were found. The contraction stress of F2000 Rasant (3.41+/-0.09 MPa) and Luxat (3.33+/-0.08 MPa) were significantly highest, whilst Dyract exhibited the significantly lowest shrinkage stress (1.27+/-0.08 MPa) among the tested materials.

SIGNIFICANCE

High contraction stress, early start of stress build-up and rapid contraction force development may lead to failure of bond to tooth structure. This study suggested that the contraction stress and kinetic behavior of compomers are generally similar to those of hybrid composites in a dry condition. Dyract might be superior in maintaining the bond with cavity walls compared to conventional hybrid composites in view of its low shrinkage stress.