New adhesive rehabilitation technique with indexed occlusal tabletops made by 3D printing technology

OBJECTIVE

In oral rehabilitation, a full mouth minimal invasive treatment can represent a major challenge for the patient and the dentist. The purpose of this article is to present a new technique to restore eroded teeth and recover the vertical dimension with a simple and predictable technique.

CLINICAL CONSIDERATIONS

Occlusal tabletop restorations are a suitable conservative option to restore anatomy and vertical dimension augmentation but highly sensitive. The cementation of those restorations without stable landmarks, the cement excess removal, the insertion path, or the time needed are some of the difficulties can be faced. Now a days with the new CAD-CAM techniques is possible to develop a new occlusal tabletop manufacturing alternative utilizing 3D-printed technology by unifying the restorations with a customized connector that allows us to print several onlays at same time, as a single object, also being cemented at once.

CONCLUSIONS

This protocol reduces the technique sensitivity of a vertical dimension oral rehabilitation process, reduce the chair time, enhancing the patient-comfort and delivers a unique way to restore dental lost anatomy as a definitive or temporary way with printing materials.

CLINICAL SIGNIFICANCE

With the advent of new CAD-CAM 3D printing materials, which are increasingly versatile and gaining favor among clinicians, it is now possible to address complex clinical situations with greater predictability. This technology enables the development of treatment solutions that are both effective and efficient, consequently reducing clinical time for the patient.

Simulating the shrinkage-induced interfacial damage around Class I composite resin restorations with damage mechanics

OBJECTIVES

To investigate the shrinkage-induced damage at the composite-tooth interface by finite element analysis (FEA) using the cohesive zone model (CZM).

METHODS

Axisymmetric models of Class I restorations were created to illustrate the interfacial damage around composite resin restorations of different dimensions, with polymerization shrinkage modeled analogously to thermal shrinkage. The damage to the adhesive interface was determined using a CZM based on the fracture strength and fracture energy. To show the effects of damage, conventional models with perfectly bonded composite resin restorations were created as controls.

RESULTS

The results indicated interfacial damage at the butt-joint cavosurface margin, dentinoenamel junction, and internal line angle. The percentage of damaged interfacial area was found to increase with decreasing diameter for restorations of the same height. For a given diameter, the damage was more severe for restorations of greater depth. The effects of the damage were further illustrated in the model with a restoration of 2-mm diameter and height. The interfacial damage occurred primarily at the internal line angle (83.3 % of all the damaged interfacial area), leading to local stress relief (from 18.3 MPa to 12.8 MPa), but also higher stress at the damage fronts. Greater local shrinkage was found in composites adjacent to the damage.

SIGNIFICANCE

The damage mechanics-based CZM is an essential refinement of the FEA to predict interfacial damage and its implications. The extent of damage was found to be greater around restorations with smaller diameters and greater depths. The entire simulation is available via an open-source platform to facilitate further applications in adhesive dentistry.

Repair or Observation of Resin Margin Defects: Clinical Trial After Five Years

OBJECTIVE

To assess the effectiveness of repair/resealing of stained composite margins as an alternative to controlled observation without treatment in a randomized clinical trial after five years.

METHODS AND MATERIALS

Each patient recruited had from one to three composite restorations with visible margin discoloration. Initially, the characteristics of each defect were recorded with direct vision through a surgical microscope at 20× magnification. Clinical evaluation was done by two independent examiners using modified USPHS criteria for color, margin discoloration, and margin adaptation. Each restoration was then randomly assigned to a control or treatment group. Control restorations were observed yearly for the presence of recurrent caries; treatment restorations were resealed by exposing the margin with a ¼ round bur, removing all interfacial stain, acid etching, placing an adhesive bonding agent, and a flowable composite to restore margin integrity. There were 152 patients recruited, with 360 restorations (180 control and 180 treatment).

RESULTS

At five years, 104 patients were recalled (68%) with 271 restorations (76%): 136 untreated control and 135 resealed restorations. At that time, 61 restorations had been lost or replaced for nonrelated reasons. Clinical evaluation of the remaining 210 restorations determined penetrating discoloration (control = 81%, resealed = 46%) and margin crevice formation (control = 21%, resealed = 11%). Recurrent caries was diagnosed cumulatively in only six control and five treatment restorations (<5%). Microscopically, 49 control restorations (49%) and 36 resealed restorations (33%) had crevice formation. Discoloration was distributed as follows: 9% vs 47% with no discoloration, 30% vs 33% in the composite, 49% vs 18% in the interface, and 12% vs 2% in tooth structure.

CONCLUSIONS

Resealing of restorations with margin discoloration reduced the occurrence of penetrating stain from 81% in controls to 46% in resealed margins and crevicing from 21% to 11% after five years. Both controlled observation and resealing of margins resulted in a similar very low incidence (<6%) of recurrent caries.

Is Optical Coherence Tomography a Potential Tool to Evaluate Marginal Adaptation of Class III/IV Composite Restorations In Vivo?

OBJECTIVE

Margin analysis of Class III and IV composite restorations in vitro and in vivo occurred by scanning electron microscopy (SEM) and optical coherence tomography (OCT). The results were compared and related to clinical evaluation.

METHODS AND MATERIALS

Eight Class III composite restorations were imaged in vitro using OCT and SEM. The margins were analyzed quantitatively. OCT signals were verified by assignment to the criteria perfect margin, gap, and positive/negative ledge. In vivo quantitative margin analysis of Class III/IV composite restorations made of the micro-hybrid composite Venus combined with the self-etch adhesive iBond Gluma inside (1-SE) or etch-and-rinse adhesive Gluma Comfort Bond (2-ER) (all Heraeus Kulzer) was carried out using OCT and SEM after 90 months of clinical function. The results were compared with clinical evaluation (US Public Health Service criteria; marginal integrity, marginal discoloration).

RESULTS

In vitro, the correlation between OCT and SEM was high for all four margin criteria (Kendall tau b [τ_b] correlation: 0.64-0.92, p_i≤0.026), with no significant differences between OCT and SEM (p_i≥0.63). In vivo, a moderate correlation was observed (τ_b: 0.38-0.45, p_i<0.016). Clinically, the cumulative failure rate in the criterion marginal integrity was higher for the 1-SE group (baseline 90 M, p=0.011). Similarly, OCT and SEM detected higher percentages of the criterion gap in the 1-SE group (p: 0.027/0.002), in contrast to perfect margin. Both, gap and perfect margin ranged widely between 0.0% and 88.7% (OCT) and between 0.0% and 89.0% (SEM).

CONCLUSION

Despite the positive selection bias after 90 months with only a few patients left, quantitative margin analysis allows for differentiation between the two adhesives at this specific date. OCT in particular offers the possibility to evaluate marginal integrity directly in vivo.

Shear Bond Strength and Tooth-Composite Interaction With Self-Adhering Flowable Composites

PURPOSE

To evaluate the tooth-composite interaction (A) and shear bond strength (SBS; B) of self-adhering flowables.

METHODS AND MATERIALS

(A) Thirty-two human molars with one Class V cavity were restored with Vertise Flow (VF), Fusio Liquid Dentin (FLD), an experimental self-adhering flowable (EF), or Adper Prompt-L-Pop/Filtek Supreme XT Flowable (PLP). Teeth were prepared according to laboratory standard and stored in water (24 hours, 37°C). Microleakage (ML; percentage interface length at enamel [E]/dentin [D]) and tooth-composite interaction were investigated. (B) The buccal surface of 160 embedded human molars was abraded to expose an enamel/dentin area of diameter ≥3 mm. Composite specimens were produced on enamel/dentin with VF, FLD, EF, or PLP. Prior to loading, 80 samples were water stored (24 hours, 37°C) and 80 thermocycled (5°C-55°C, 1500 cycles). The SBS was measured, and failure modes were classified by scanning electron microscopy.

STATISTICS

Kruskal-Wallis, Mann-Whitney U, and Fisher exact tests were performed (α=0.05).

RESULTS

(A) At enamel margins, EF and VF showed significantly lower ML than did FLD and PLP (p_i≤0.009; 81%-89%); in dentin, lower values resulted with FLD and VF compared with PLP and EF (p_i≤0.01; 77%-94%). Adhesive tags at E were consistently verifiable with EF and VF but irregularly with FLD and PLP. At D, tags were detectable with all systems. (B) In all groups, SBS decreased by up to 97% after thermocycling. It was generally diminished with self-adhering flowables (E: 50%-98%, D: 59%-98%; p_i<0.02). More cohesive defects were observed with PLP (p_i<0.009).

CONCLUSION

Tooth-composite morphology and bond strength indicate that the clinical use of self-adhering flowables must be pursued cautiously.

Bonding resin thixotropy and viscosity influence on dentine bond strength

OBJECTIVES

To investigate the influence of bonding resin thixotropy and viscosity on dentine tubule penetration, blister formation and consequently on dentine bond strength as a function of air-blowing pressure (air-bp) intensity.

METHODS

Two HEMA-free, acetone-based, one-bottle self-etch adhesives with similar composition except disparate silica filler contents and different bonding resin viscosities were investigated. The high-filler-containing adhesive (G-Bond) featured a lower viscous bonding resin with inherent thixotropic resin (TR) properties compared to the low-filler-containing adhesive (iBond) exhibiting a higher viscous bonding resin with non-thixotropic resin (NTR) properties. Shear bond strength tests for each adhesive with low (1.5bar; 0.15MPa; n=16) and high (3.0bar; 0.30MPa; n=16) air-bp application were performed after specimen storage in distilled water (24h; 37.0±1.0°C). Results were analysed using a Student's t-test to identify statistically significant differences (p<0.05). Fracture surfaces of TR adhesive specimens were morphologically characterised by SEM.

RESULTS

Statistically significant bond strength differences were obtained for the thixotropic resin adhesive (high-pressure: 24.6MPa, low-pressure: 9.6MPa). While high air-bp specimens provided SEM images revealing resin-plugged dentine tubules, resin tags and only marginally blister structures, low air-bp left copious droplets and open dentine tubules. In contrast, the non-thixotropic resin adhesive showed no significant bond strength differences (high-pressure: 9.3MPa, low-pressure: 7.6MPa).

CONCLUSIONS

A pressure-dependent distinct influence of bonding resin thixotropy and viscosity on dentine bond strength has been demonstrated. Stronger adhesion with high air-bp application is explained by improved resin fluidity and facilitated resin penetration into dentine tubules.

CLINICAL SIGNIFICANCE

Filler particles used in adhesive systems may induce thixotropic effects in bonding resin layers, accounting for improved free-flowing resin properties. In combination with high air-bp this effect allows an easy plugging of dentine tubules and elimination of blister structures, both resulting in superior dentine bond strength.

Influence of Organic Acids from the Oral Biofilm on the Bond Strength of Self-Etch Adhesives to Dentin

Abstract: The aim of this study was to evaluate the microtensile bond strength of self-etch adhesive systems to dentin after storage in acids from oral biofilm. Three adhesive systems were used in the study: a two-step self-etch adhesive for use with a silorane-based resin composite (Filtek P90 adhesive system - P90), a two-step self-etch adhesive (Clearfil SE Bond - CSE) and a one-step self-etch adhesive (Adper Easy One - AEO). The bond strength of these products was evaluated by bonding resin composite (Filtek Z350 for CSE and AEO; and Filtek P90 for P90) to 90 bovine dentin tooth fragments, according to the manufacturer's instructions. After 24 h of water storage at 37 °C, the specimens were sectioned into beams (1 mm2) divided and stored in distilled water, lactic acid and propionic acid, for 7 and 30 days. After storage, the specimens were tested for microtensile bond strength. Data were analyzed by three-way ANOVA and Tukey´s test (α=0.05). CSE presented the highest microtensile bond strength after storage in distilled water for 7 and 30 days. The microtensile bond strength of all adhesive systems was lower after storage in lactic acid and propionic acid than after water storage. Significant difference was not found between storage times.

Prediction and diagnosis of clinical outcomes affecting restoration margins

The longevity of dental restorations is largely dependent on the continuity at the interface between the restorative material and adjacent tooth structure (the restoration margin). Clinical decisions on restoration repair or replacement are usually based upon the weakest point along that margin interface. Physical properties of a restorative material, such as polymerisation shrinkage, water sorption, solubility, elastic modulus and shear strength, all have an effect on stress distribution and can significantly affect margin integrity. This review will focus on two aspects of margin deterioration in the oral environment: the in vitro testing of margin seal using emersion techniques to simulate the oral environment and to predict clinical margin failure and the relationship between clinically observable microleakage and secondary caries. The many variables associated with in vitro testing of marginal leakage and the interpretation of the data are presented in detail. The most recent studies of marginal leakage mirror earlier methodology and lack validity and reliability. The lack of standardised testing procedures makes it impossible to compare studies or to predict the clinical performance of adhesive materials. Continual repeated in vitro studies contribute little to the science in this area. Clinical evidence is cited to refute earlier conclusions that clinical microleakage (penetrating margin discoloration) leads to caries development and is an indication for restoration replacement. Margin defects, without visible evidence of soft dentin on the wall or base of the defect, should be monitored, repaired or resealed, in lieu of total restoration replacement.