Travel beyond Clinical Uses of Fiber Reinforced Composites (FRCs) in Dentistry: A Review of Past Employments, Present Applications, and Future Perspectives

Effect of natural silk fibers and synthetic fiber-reinforced composites on the cytotoxicity of fibroblast cell lines

Background

Synthetic fibers have many benefits in clinical practice; however, they cause microplastic pollution, and their unaffordable price increases treatment costs. Natural silk fibers require biocompatibility assessment. This study investigated the effects of natural and synthetic fiber-reinforced composites (FRCs) on the cytotoxicity of fibroblast cell lines.

Methods

Three commercial synthetic fibers (polyethylene, quartz, and E-glass) and two silk fibers from Bombyx mori and Samia ricini cocoons were employed. These fibers were made into FRC samples (n=6) by impregnation in flowable composite using a brass mold (25×2×2 mm). NIH/3T3 mouse fibroblasts were cultured in Dulbecco's modified eagle medium, supplemented, and seeded in 2×104 cells/mL. They were stored at 37 °C under 5% CO2 for 24 hours. The FRC samples were made into powder, eluted in dimethylsulfoxide, continued with PBS, supplemented with Dulbecco's modified eagle medium (DMEM), and exposed to cells for 24 hours. Blank (medium only) and control (cells and medium) samples were included. Subsequently, MTT was added for 4 h and read by enzyme-linked immunosorbent assay (λ=570 nm). Cell viability (%) was calculated and analyzed using one-way ANOVA (α=0.05).

Results

All groups of FRCs showed>80% cell viability. One-way ANOVA showed no significant difference between FRC groups regarding the viability of fibroblast cell lines (P>0.05).

Conclusion

Both natural silk and synthetic fibers exhibit low cytotoxicity to fibroblast cell lines. B. mori and S. ricini silk fibers showed the potential to be used as alternative synthetic fibers.

Properties of model E-glass fiber composites with varying matrix monomer ratios

OBJECTIVE

To evaluate properties of fiber-reinforced-composites (FRC) containing Bis-EMA/UDMA monomers but identical dispersed phase (60% wt BaSi glass power +10% wt E-glass fibre).

METHODS

A control (Group A), monomer mixture comprising 60% Bis-GMA, 30% TEGDMA, and 10% PMMA (typical FRC monomers) was used. The following monomer mass fractions were mixed: 50% bis-GMA plus 50% of different ratios of Bis-EMA+UDMA to produce consistent formulations (Groups B-E) of workable viscosities was also studied. Flexural strength (FS), fracture toughness (KIC), water sorption (SP), solubility (SL) and hygroscopic expansion (HE) were measured. FS and KIC specimens were stored for 1, 7 d, and 30 d in water at 37 °C. SP/SL specimens were water-immersed for 168d, weighed at intervals, then dried for 84 d at 37 °C. To analyze differences in FS, and KIC, a two-way ANOVA and Tukey post-hoc tests (α = 0.05) were conducted. For SP/SL, and HE, one-way ANOVA with subsequent Tukey post-hoc tests (α = 0.05) were utilized.

RESULTS

FS and KIC for groups A, D, E decreased progressively after 1 d. Groups B and C (highest amounts of Bis-EMA) did not decrease significantly. The modified matrix composites performed significantly better than the control group for SP and HE. The control group outperformed the experimental composites only for SL with up to 250% higher SL for group E (6.9 μg/mm) but still below the maximum permissible threshold of 7.5 μg/mm.

SIGNIFICANCE

EXPERIMENTAL: composites with highest amounts of Bis-EMA showed improved hydrolytic stability and overall enhancement in several clinically-relevant properties. This makes them potential candidates for alternative matrices to a semi-interpenetrating network in fiber-reinforced composites.

Fatigue and failure analysis of restored endodontically treated maxillary incisors without a dowel or ferrule

STATEMENT OF PROBLEM

Information on the survival and mode of failure of endodontically treated incisors without a ferrule and restored without dowels is lacking.

PURPOSE

The purpose of this in vitro study was to compare the survival and failure mode of endodontically treated incisors without a ferrule and restored with bonded ceramic crowns and various composite resin foundation restorations without dowels with a control group with fiber dowels.

MATERIAL AND METHODS

Forty-five decoronated endodontically treated bovine incisors without ferrule were divided into 3 experimental groups and restored with different adhesive foundation restorations without dowel: nanohybrid composite resin (Nd), bulk-fill composite resin foundation restoration (NdB), and fiber-reinforced bulk-fill composite resin (NdFR). A control group with conventional foundation restorations (glass-fiber dowel with nanohybrid composite resin foundation restoration without ferrule) (D) was included for comparison. All teeth were prepared to receive bonded lithium disilicate ceramic crowns luted with dual-polymerizing composite resin cement and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30 degrees and a frequency of 5 Hz, beginning with a load of 100 N (5000 cycles). A 100-N load increase was applied each 15 000 cycles. Specimens were loaded until failure or to a maximum for cycles endured of 1000 N (140 000 cycles). Groups were compared by using the Kaplan-Meier survival analysis (log rank test at α=.05 and pairwise post hoc comparisons) and life table analysis for load-at-failure (followed by Wilcoxon pairwise comparison α=.05).

RESULTS

All the specimens failed before 140 000 load cycles. Even though no statistically significant differences were found between the experimental groups without dowel (P>.127), the fiber-reinforced foundation restoration yielded the highest mean ±standard deviation cycles to failure (46 023 ±4326) compared with Nd (38 899 ±2975) and NdB (39 751 ±2998). NdFR, however, outperformed the foundation restoration with glass-fiber dowel (35 026 ±2687) (P<.05). Most failure in groups without dowel were restorable, while 100% of catastrophic failure (unrestorable) were found in the group with dowels.

CONCLUSIONS

Based on the present in vitro study, dowels did not improve the performance of the adhesive restoration of endodontically treated incisors without a ferrule. The use of a short fiber-reinforced composite resin foundation restoration without a dowel was able to not only improve the resistance of the restorations compared with adhesive foundation restorations with dowels but also minimize catastrophic failures.

Effects of aligner activation and power arm length and material on canine displacement and periodontal ligament stress: a finite element analysis

BACKGROUND

This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome.

METHODS

Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis.

RESULTS

Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm.

CONCLUSION

Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms.

Fracture Resistance of Fiber-Reinforced Composite Restorations: A Systematic Review and Meta-Analysis

Composite resin is universally used for posterior teeth restorations. Fibers have been suggested for the mechanical improvement of the restorations. This study assessed the fracture resistance of class II fiber-reinforced composite restorations and compared it with the fracture resistance of three control groups: (1) healthy teeth, (2) non-fiber-reinforced restorations and (3) unrestored cavities. A search was performed using PubMed, Web of Science and Google Scholar from 15 May to 12 June 2023. Only in vitro studies from the last 10 years were included for this systematic analysis. This study was registered in the PROSPERO database, it followed PRISMA guidelines and the risk of bias was assessed using the QUIN tool. Fracture resistance median values, in Newtons (N), were calculated for the experimental and control groups (95% confidence interval). For pairwise comparison, nonparametric tests (p < 0.05) were applied. Twenty-four in vitro studies met the inclusion criteria. The fracture resistance of the experimental group was 976.0 N and differed (p < 0.05) from all controls. The experimental group showed lower values of fracture resistance than healthy teeth (1459.9 N; p = 0.048) but higher values than non-fiber-reinforced restorations (771.0 N; p = 0.008) and unrestored cavities (386.6 N; p < 0.001). In vitro systematic outcomes evidenced that glass and/or polyethylene fibers improved the fracture resistance of composite restorations.

Physical Properties and Clinical Performance of Short Fiber Reinforced Resin-based Composite in Posterior Dentition: Systematic Review and Meta-analysis

OBJECTIVE

This study compares the physical properties and clinical performance of short fiber reinforced composites (SFRC) to those of particulate-filled resin-based composites (PFRC) for class I and II direct restorations in permanent dentition.

METHODS

Systematic review and meta-analysis was conducted using PubMed, Embase (Elsevier), and Dentistry and Oral Sciences Source (EBSCO) databases. The outcomes evaluated were physical properties including flexural strength, flexural modulus, elastic modulus, microhardness, shrinkage, fracture toughness, degree of conversion, and depth of cure. Clinical performance was evaluated with a systematic review.

RESULTS

The meta-analyses favored SFRC for flexural strength and fracture toughness compared to every PFRC subgroup, with a high quality of evidence. For all other properties, the meta-analyses favored SFRC to overall PFRC, with some non-significant differences with certain PFRC subgroups. The most recent clinical trial showed SFRC performed similarly to PFRC, however older studies suggest inferior surface texture and discoloration of SFRC compared to PFRC.

CONCLUSION

This study can aid dental professionals in clinical decision making, supporting that SFRC offers improved physical properties, especially fracture resistance and flexural strength, compared to PFRC.

Trends and perspectives on the commercialization of bioactive glasses

At least 25 bioactive glass (BG) medical devices have been approved for clinical use by global regulatory agencies. Diverse applications include monolithic implants, bone void fillers, dentin hypersensitivity agents, wound dressing, and cancer therapeutics. The morphology and delivery systems of bioactive glasses have evolved dramatically since the first devices based on 45S5 Bioglass®. The particle size of these devices has generally decreased with the evolution of bioactive glass technology but primarily lies in the micron size range. Morphologies have progressed from glass monoliths to granules, putties, and cements, allowing medical professionals greater flexibility and control. Compositions of these commercial materials have primarily relied on silicate-based systems with varying concentrations of sodium, calcium, and phosphorus. Furthermore, therapeutic ions have been investigated and show promise for greater control of biological stimulation of genetic processes and increased bioactivity. Some commercial products have exploited the borate and phosphate-based compositions for soft tissue repair/regeneration. Mesoporous BGs also promise anticancer therapies due to their ability to deliver drugs in combination with radiotherapy, photothermal therapy, and magnetic hyperthermia. The objective of this article is to critically discuss all clinically approved bioactive glass products. Understanding essential regulatory standards and rules for production is presented through a review of the commercialization process. The future of bioactive glasses, their promising applications, and the challenges are outlined. STATEMENT OF SIGNIFICANCE: Bioactive glasses have evolved into a wide range of products used to treat various medical conditions. They are non-equilibrium, non-crystalline materials that have been designed to induce specific biological activity. They can bond to bone and soft tissues and contribute to their regeneration. They are promising in combating pathogens and malignancies by delivering drugs, inorganic therapeutic ions, and heat for magnetic-induced hyperthermia or laser-induced phototherapy. This review addresses each bioactive glass product approved by regulatory agencies for clinical use. A review of the commercialization process is also provided with insight into critical regulatory standards and guidelines for manufacturing. Finally, a critical evaluation of the future of bioactive glass development, applications, and challenges are discussed.

Fiber-reinforced composites in dentistry - An insight into adhesion aspects of the material and the restored tooth construct

OBJECTIVE

This review aimed to highlight the insight into adhesion aspects within the components of the glass FRC (i.e., fiber and matrix) and between resin luting material and the glass FRC construction.

METHODS

The fundamentals of semi-interpenetrating polymer network (semi-IPN) based FRCs and their advantages in forming a solid adhesive interface with indirect FRC restoration, dental adhesive, and luting cement are elaborated. The important resin matrix systems and glass fibers used in FRCs are discussed. This is principally based on a survey of the literature over Medline/PubMed, Web of Science, and Scopus databases and a review of the relevant studies and publications in scientific papers in international peer-reviewed journals for the specific topic of biomaterials science. The keywords used for the search approach were: adhesion, fiber-reinforced composite, glass fiber, and semi-interpenetrating polymer network.

RESULTS

The polymer matrix systems of semi-IPN-based FRCs and formation of secondary-IPN layer are pivotal for bonding of multiphasic indirect dental constructs and repair. Additionally, describing areas of indication for FRCs in dentistry, explaining the adhesion aspects of FRC for the cohesion of the material itself, and for obtaining durable adhesion when the FRC construct is luted to tooth and remaining dentition. Current progress in the field of FRC research and future directions are summarized and presented.

SIGNIFICANCE

By understanding the isotropic-anisotropic nature of fibers and the interfacial adhesion within the components of the FRC; between resin cement and the FRC construction, the clinically successful FRC-based multiphasic indirect tooth construct can be achieved. The interfacial adhesion within the components of the FRC and between resin luting material and the FRC construction play a key role in adhesion-based unibody dental restorations.

Comparison of multistranded wire and fiber-reinforced composite retainers effects on periodontium: A randomized clinical trial

INTRODUCTION

Fixed orthodontic retainers are very important for treatment stability; however, adverse effects on the health of periodontium can be caused as a result of deposition of plaque and calculus.

OBJECTIVES

To compare and determine the effects of two mandibular fixed lingual retainers on the periodontal status, and to test the null hypothesis that there would be no significant difference on the periodontium health between the patients using fiber-reinforced composite (FRC) or multistranded wire (MSW) fixed retainers.

METHODS

A total of 60 subjects were recruited, out of which 6 were excluded and 2 dropped out during the study. Hence, 52 subjects with mean age of 21.5 ± 3.6 years were included in the study. The sample was composed by 8 males (15.4%) and 44 females (84.6%). The participants were randomly divided into two groups: Group 1 received fiber-reinforced composite retainer, while Group 2 received multistranded wire retainer. After insertion, plaque index, calculus index, gingival index and bleeding on probing were compared, after three months (T1), six months (T2), nine months (T3) and twelve months (T4), using Mann-Whitney test with p-value ≤ 0.05 as significant.

RESULTS

It could be seen that the health of periodontium deteriorated with the passage of time from T1 to T4 in both group of retainers. However, no statistically significant differences were found between the two groups (p> 0.05).

CONCLUSION

The results of the study indicate that there was no significant difference on the health of periodontium between the patients with FRC and MSW fixed retainers, hence, the null hypothesis was accepted.

Comparison of the debonding force of metal, glass and polyethylene Fiber reinforced composite retainers: Mechanical and finite element analyses

OBJECTIVE

The studies evaluating the efficiency of fiber reinforce composite (FRC) retainers are few and contradictory. This study aimed to compare the debonding force of metal, glass FRC (GFRC) and polyethylene FRC (PFRC) retainers, assess the interactions between the materials and forces, and pattern of load distribution by finite element analysis (FEA).

MATERIALS AND METHODS

Forty-eight sound lower incisors were collected and randomly assigned to 3 groups (n=8; each sample included 2 teeth). Next, 15mm of the three retainers (multi-stranded metal wire, GFRC, and PFRC) were bonded to the lingual surface of the teeth and debonding force was measured by a universal testing machine. For FEA, 3D models were designed. The data related to geometrical models and material properties were transferred to ANSYS software. A 187-Newton load was applied to the incisal edge of the two centrals. Then different parameters were assessed. The three groups were compared by one-way Anova and Tukey's test. Type one error was considered to be 0.05.

RESULTS

The debonding force decreased in the order: Metal (143.71N)≥GFRC (108.29N)>PFRC (45.08N). The difference between metal retainer and GFRC was not significant. In contrast, PFRC group showed significantly lower debonding force compared to other groups (P<0.05). FEA showed stress peak value in metal-composite interface. Maximum total deformation was noted in central, followed by lateral and canine.

CONCLUSIONS

Glass-FRC can serve as an alternative to metal retainers as the difference in debonding force is not significant. However, the difficulty of repairing or replacing the Glass-FRC should be taken into account given the large number of failure in the interproximal dental area.

Comparative evaluation of the fracture resistance of newly developed prefabricated fibreglass crowns and zirconium crowns

BACKGROUND

Prefabricated fibreglass crowns (PFCs) require less tooth structure reduction than prefabricated zirconium crowns (PZCs) for restoring primary molars. Little is known, however, about their mechanical properties.

AIM

To investigate the fatigue survival and fracture resistance of PZCs and PFCs cemented with two different types of luting cement [glass-ionomer cement (GIC) and resin-modified GIC (RMGIC)].

DESIGN

One hundred and twenty extracted human primary molars were randomly divided into subgroups (n = 15) according to the crown type (PFCs/PZCs), the luting cement (GIC/RMGIC) and crowns subjected to the chewing simulation test with thermocycling mechanical loading (CSTTML). The surfaces of the teeth were reduced by approximately 2 mm in the PZC group and 1 mm in the PFC group. All the samples were subjected to fracture tests.

RESULTS

None of the samples subjected to CSTTML exhibited signs of surface damage, fracture or premature debonding. The forces required to fracture PFCs were higher than those required for PZCs in all groups (p = .001). The highest mean fracture resistance values were obtained from the group of PFCs cemented with GIC that were subjected to the CSTTML (2515.8 N ± 619.2 N).

CONCLUSIONS

PFCs presented high fatigue survival and could be used as alternatives to PZCs as they require less tooth structure reduction. Crowns cemented with GIC had a similar fracture resistance value when compared with RMGIC.

[Light-curing effectiveness using led lamps: a review]

Introduction

LED lamps have a new light-curing technology which can be monowave or polywave, which allows it to reach more initiators such as camphorquinone, Lucirin TPO and Propanodione, which have a wide variety of advantages and disadvantages. These lamps have evolved over time, as have different ergonomics, longevity, systems and quality standards.

Objective

The objective of this literature review is to improve the clinician on the proper use of different LED lamps and how they influence the efficiency of resin photopolymerization.

Material and methods

Extensive research has been carried out in the existing literature on this topic. From the beginning of this information until April 18, 2022, the bibliographic search carried out includes 86 articles published in the Medline database through PubMed, LILACS, Science Direct and SciELO, and there is no language restriction.

Results

The photopolymerization effects of Polywave and Monowave LED lamps present significant differences between the compressive strength of the light-cured resin, with single-wave and polyvalent LED lamps where the types of light and lamp directly influence the compressive strength of the resin. composite resins.

Conclusion

The type of light and lamp directly affects the efficiency of the photopolymerization of the composite resin, so it is concluded that LED lamps with single wave technology (Monowave) produce a greater depth of photopolymerization than those with multiple wave technology (Polywave).

Metal versus Fiberglass Post-Orthodontic Retainers Short-Term Effects on Plaque Index and Microbial Colonization: An Observational Study

In orthodontics, post-treatment retention phase is crucial for maintaining the obtained clinical results. In cases of crowding, a bonded fixed retainer is often chosen to maintain teeth alignment in the anterior sector of the lower dental arch. A fixed retainer can remain in the mouth for years. Therefore, it is important that it is applied with harmless materials for the level of plaque control. The present study aimed to investigate the salivary concentrations of Streptococcus mutans (S. mutans) and Lactobacilli, and the Sillness and Loe plaque index, in patients wearing metal wire versus fiberglass orthodontic retainers. Forty post-orthodontic patients were included in the sample: in 20 subjects a metal wire retainer was applied (MR), while in the others a fiberglass retainer was applied (FR). The variables were recorded at baseline (T0), after 1 month (T1), and after 2 months (T2) of follow-up. The percentage of patients with a level of S. mutans and Lactobacilli colonization > 105 increased over time in the FR group (T0 = 0%, T1 = 5%, T2 = 35%), compared with the MR group. PI increased in the FR group (T0 = 0, T1 = 14, T2 = 27), and remained almost the same in the MR group (T0 = 3, T1 = 0, T2 = 2). From the present results it appears that the metal wire retainer is better than the fiberglass retainer for the level of plaque control performed by the patients.

Evaluation of the Behavior of Two CAD/CAM Fiber-Reinforced Composite Dental Materials by Immersion Tests

Fiber-reinforced composites are used as restorative materials for prosthetic oral rehabilitation. Gastroesophageal reflux disease (GERD) is an accustomed affection with various oral manifestations. This study aimed to evaluate the behavior of two high-performance CAD/CAM milled reinforced composites (Trinia™, TriLor) in artificial saliva at different pH levels through immersion tests, and to determine if changes in mass or surface morphology at variable pH, specific for patients affected by GERD, appear. After investigating the elemental composition and surface morphology, the specimens were immersed in Carter Brugirard artificial saliva for 21 days at different pH values (5.7, 7.6, and varying the pH from 5.7 to 3). The values of the weighed masses during the immersion tests were statistically processed in terms of mean and standard deviation. Results suggested that irrespective of the medium pH, the two composites presented a similar mass variation in the range of −0.18 (±0.01)–1.82 (±0.02) mg after immersion, suggesting their stability when in contact with artificial saliva, an aspect which was also highlighted by scanning electron microscope (SEM) analysis performed on the immersed surfaces. Novel composite biomaterials can be a proper alternative for metal alloys used for prosthetic frameworks in patients suffering from GERD.

Clinical Performance of Posterior Inlay-Retained and Wing-Retained Monolithic Zirconia Resin-Bonded Fixed Partial Dentures: Stage One Results of a Randomized Controlled Trial

PURPOSE

To prospectively compare the clinical performance of posterior inlay-retained and wing-retained monolithic zirconia fixed partial dentures (FPDs).

MATERIALS AND METHODS

After simple randomization, 30 participants received either one inlay-retained (n = 15; mean age: 56.38 ± 12.70 years; 10 men [66.7%]) or one wing-retained (n = 15; mean age: 45.90 ±13.24 years; 7 men [46.7%]) FPD. The restorations, which predominantly replaced first molars, were fabricated from translucent, 3 mol% yttria-stabilized zirconia and attached with self-etching resin cement. Restorations and abutment teeth were clinically followed up for complications one week and 3, 6, and 12 months after cementation. Plaque and gingival scores, probing pocket depths, and attachment levels were recorded for the abutment and contralateral reference teeth both before treatment and during follow-up examinations. The restorations were also assessed in accordance with FDI World Dental Federation criteria. Statistical analyses were conducted with R (α = 0.05). An adaptive, 2-stage study design based on the incidence of failure-free survival in the groups after 12 months (stage 1) was implemented. Predefined decision rules were used to determine whether further recruitment (stage 2) would enable the detection of a statistically significant difference between the restoration designs with sufficient power.

RESULTS

During 12 months, only one wing retainer debonded which required removal of the FPD. Failure-free survival was thus 93.3% for wing-retained and 100% for inlay-retained FPDs (log-rank test, p = 0.317). Moderate aftercare resulted in intervention-free rates of 78.8% and 86.7% for inlay-retained and wing-retained restorations, respectively (log-rank test, p = 0.605). Based on FDI World Dental Federation criteria, all restorations were acceptable at the 12-month follow-up (Fisher-Boschloo test, p = 0.161). Plaque, gingival, and periodontal scores remained practically unchanged from before treatment to the 12-month follow-up. Recruitment was stopped after stage 1 because, based on the small difference in the incidence of failure-free survival in the groups, it was accepted that it would not be possible to recruit the necessary number of participants to show a statistically significant difference between the retainer designs.

CONCLUSIONS

Both inlay-retained and wing-retained monolithic zirconia resin-bonded FPDs performed well for the 12-month, short-term follow-up period.

Natural Tooth Pontic Using Recent Adhesive Technologies: An Esthetic and Minimally Invasive Prosthetic Solution

An implant-supported crown represents an established and validated option for single-tooth replacement; however, a restorative solution should be selected according to a wide number of factors including patient's desire, expectations, specific clinical conditions, and financial possibilities. The aim of this case report is to describe a conservative rehabilitation strategy for the replacement of a periodontally compromised mandibular incisor: the extracted natural tooth was used as a pontic bonded to adjacent elements with polyethylene fiber and resin composite. This way, a chairside fabrication of a resin-bonded fiber-reinforced prosthesis is possible, using the patient's own tooth. After showing a satisfactory functional and esthetic result, advantages and pitfalls of this technique along with available data on the literature regarding the natural tooth pontic are addressed. Both patients and clinicians should be aware of minimally invasive, successful solutions for single-tooth replacement; whether indicated or necessary, the natural tooth pontic technique leaves open other treatment options for the future.

Glass Fiber Reinforced Composite Orthodontic Retainer: In Vitro Effect of Tooth Brushing on the Surface Wear and Mechanical Properties

Fiber reinforced composites (FRCs) are metal free materials that have many applications in dentistry. In clinical orthodontics, they are used as retainers after active treatment in order to avoid relapse. However, although the modulus of the elasticity of FRCs is low, the rigidity of the material in the form of a relatively thick retainer with a surface cover of a flowable resin composite is known to have higher structural rigidity than stainless steel splints. The aim of the present study is to measure load and bending stress of stainless steel wires, as well as flowable resin composite covered and spot‑bonded FRC retainer materials after tooth brushing. These materials were tested with a three point bending test for three different conditions: no brushing, 26 min of brushing, and 60 min of brushing. SEM images were taken before and after different times of tooth brushing. Results showed that stainless steel was not significantly affected by tooth brushing. On the other hand, a significant reduction of values at maximum load at fracture was reported for both FRC groups, and uncovered FRCs were most affected. Concerning maximum bending stress, no significant reduction by pretreatment conditions was reported for the materials tested. SEM images showed no evident wear for stainless steel. Flowable resin composite covered FRCs showed some signs of composite wear, whereas spot‑bonded FRCs, i.e., without the surface cover of a flowable resin composite, showed signs of wear on the FRC and exposed glass fibers from the FRC's polymer matrix. Because of the significant changes of the reduction of maximum load values and the wear for spot‑bonded FRCs, this technique needs further in vitro and in vivo tests before it can be performed routinely in clinical practice.

Effect of Long-Term Brushing on Deflection, Maximum Load, and Wear of Stainless Steel Wires and Conventional and Spot Bonded Fiber-Reinforced Composites

Fiber-reinforced composite (FRC) retainers are an aesthetic alternative to conventional Stainless Steel splints. They are generally used with a full bonded technique, but some studies demonstrated that they could be managed with a spot bonding technique to significantly decrease their rigidity. In order to propose this FRC spot bonding technique for clinical use, the aim of this study was to evaluate mechanical properties and surface wear of fibers left uncovered. Tests were made by simulating tooth brushing, comparing FRC spot bonding technique splints with stainless steel and FRC traditional technique splints. Specimens were tested both at 0.1 mm of deflection and at maximum load, showing higher values of rigidity for the FRC full bonded technique. After tooth brushing, no significant reduction in values at 0.1 mm deflection was reported, while we found a similar reduction in these values for the Stainless Steel and FRC spot bonding technique at maximum load, and no significant variation for the FRC full bonded technique. SEM images after tooth brushing showed wear for FRC fibers left uncovered, while no relevant wear signs in metal and conventional FRC fibers were noticed. Results showed that FRC spot bonding technique has advantages in mechanical properties when compared to the FRC traditional full bonding technique, also after tooth brushing. However, the surface wear after tooth brushing in the FRC spot bonding technique is considerable and other tests must be performed before promoting this technique for routine clinical use.