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

The effect of salbutamol sulphate inhalation (an anti-asthmatic medication) on the surfaces of orthodontic Archwires

OBJECTIVES

This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication.

METHODS

Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests.

RESULTS

Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002).

CONCLUSIONS

Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment.

Impact of fluoride-releasing orthodontic adhesives on the shear bond strength of orthodontic brackets to eroded enamel following different surface treatment protocols

PURPOSE:

To assess the impact of enamel surface treatment protocols and the types of adhesive materials on the shear bond strength (SBS) of brackets to eroded enamel substrate.

MATERIALS AND METHODS:

Eighty extracted premolars were randomly assigned to four main groups in which group C (no treatment) was the control group. The remaining groups were exposed to an erosion challenge through short-term acidic exposure to HCl solution (0.01 M, pH 2.3) for 30 s, with an agitation speed of 50 rpm at an environmental temperature of 25°C. The eroded enamel surface within each group was treated as follows: group N received no treatment; in group P, the eroded enamel was treated with 35% phosphoric acid (Ultradent Products, South Jordan, UT, USA) for 15 s, followed by a rinse for 10 s; and in group F, the eroded enamel was treated with fluoride gel (Bifluorid 12; Voco-GmbH, Cuxhaven, Germany) for 4 min. The brackets were bonded with either a resin composite adhesive (Transbond XT; light-cure adhesive, 3M Unitek, CA, USA) or resin-modified glass ionomer cement (Fuji Ortho LC-GC Corporation, Japan). The specimens were tested for SBS, and the bond failure was assessed according to the adhesive remnant index (ARI). Analysis of variance (ANOVA) and Tukey's post-hoc tests (P < 0.05) were used to compare the SBS of the groups. The ARI values between the groups were recorded.

RESULTS:

Statistically significant differences were found among the tested variables (P < 0.05). Group P showed the highest mean SBS values regardless of the type of adhesive used, and the difference was statistically significant (P < 0.05). The application of the fluoride gel showed no statistically significant improvement in SBS values. The failure mode distribution among the test groups indicated that failures at the adhesive–bracket interface were predominant in group C compared with the other study groups.

CONCLUSIONS:

Fluoride pretreatment, which was used to remineralize the eroded enamel surfaces before bonding, resulted in a decrease in the SBS of the orthodontic brackets in vitro compared with the other treated groups. The use of fluoride-releasing adhesive also enhances bonding to the eroded enamel surfaces.

Assessment of Color Stainability of Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Ceramic Materials After Hot and Cold Coffee Immersion at Different Time Intervals

BACKGROUND This spectrophotometric study assessed the color stability of CAD/CAM restorative materials with different exposed surfaces following staining by hot Arabic Qahwa and cold coffee. MATERIAL AND METHODS Ninety-six specimens were fabricated from 3 different CAD/CAM ceramic materials: Vita Suprinity (Vita-S), Vita Enamic (Vita-E), and Vitablocs Mark II (Vitablocs-MII). We divided 32 specimens for each group into glazed or polished surfaces, with 16 specimens in each group, then subdivided them according to staining materials: Arabic Qahwa and Frappuccino Cold Coffee. Color of specimens was measured during immersion in staining materials (BEFORE) as baseline with (Vita classic) and (L, a, b), for average color changes (ΔE₀₀), then remeasured after 2, 4, and 12 weeks, and described as 1st, 2nd, and 3rd measurements for VITAPAN Classic shade and T1, T2, and T3 for ΔE00 values using the CIE L*a*b* equation. We performed ANOVA and then post hoc testing. RESULTS We found significant differences in ΔE₀₀ values during immersing in hot Arabic Qahwa and cold coffee for tested materials in glazed or polished specimens. Polished specimens of Vita-S and Vita-E had the highest color changing and staining compared to glazed surfaces. Vitablocs-MII had the best color stability through immersion periods. Moreover, there were changes in relation to VITAPAN Classic shade guide for both Vita-S and Vita-E specimens during different immersion periods. CONCLUSIONS Coffee caused staining and contamination of ceramic material. Values of ΔE₀₀ for tested ceramic materials were significantly different but were within the clinically acceptable range. Polished specimens showed higher staining; therefore, we highly recommend re-glazing of ceramic restorations to maintain color stability.

Effect of Artificial Aging on Mechanical and Tribological Properties of CAD/CAM Composite Materials Used in Dentistry

With easy-to-process 3D printing materials and fast production, the quality of dental services can be improved. In the conventional procedure, the dentist makes temporary crowns directly in the patient’s mouth, e.g., from the most commonly used bis-acrylic composites. Temporary crowns made directly in the office without the use of CAD/CAM are often of inferior quality, which directly results in impaired hygiene, poorer masticatory mechanics, greater deposition of plaque, calculus and sediment, and may adversely affect periodontal and gum health. The mechanical strength, resistance to aging and abrasion of 3D printing materials are higher than those of the soft materials used in conventional methods. This translates into durability. The patient leaves the surgery with a restoration of higher utility quality compared to the conventional method. The objective of the paper was to determine the influence of aging in artificial saliva of AM (additive manufacturing) orthodontic composites on their functional properties. For the purpose of the study, fillings well-known worldwide were selected. These were traditional UV-curable resins (M I, M II, M III, M V) and a hybrid material based on a UV-curable resin (M VI). Samples were stored in artificial saliva at 37 ± 1 °C in a thermal chamber for 6 months. Indentation hardness, frictional tests and sliding wear measurements were conducted. A comparison between various materials was made. Descriptive statistics, degradation coefficients, H²E, Archard wear and specific wear rate were calculated. The Weibull statistical test for indentation hardness was performed and Hertzian contact stresses for the frictional association were calculated for unaged (M I, M II, M III, M V, M VI) and aged (M I AS, M II AS, M III AS, M V AS, M VI AS) samples. M I exhibited the lowest average hardness among the unaged materials, while M III AS had the lowest average hardness among the aged materials. Comparably low hardness was demonstrated by the M I AS material. The coefficient of friction values for the aged samples were found to be higher. The lowest wear value was demonstrated by the M I material. The wear resistance of most of the tested materials deteriorated after aging. The M VI AS material had the highest increase in wear. According to the results provided, not only the chemical composition and structure, but also aging have a great impact on the indentation hardness and wear resistance of the tested orthodontic materials.

Dynamic mechanical and thermal properties of clear aligners after thermoforming and aging

Background

Based on the role of properties of aligner materials on their efficiency, we aimed to assess their thermomechanical properties after thermoforming and simulated aging.

Methods

In this experimental study, 96 samples of polyethylene terephthalate glycol (PETG) aligners (Duran and Erkodur) were prepared and divided to three groups: control (C), after thermoforming (T), after thermoforming and aging (TA). Thermoforming was done through 3D-printed molds, and aging was exerted by 200 thermal cycles after immersion in 37°C distilled water for 24h. Flexural modulus, hardness, glass transition temperature (Tg), elastic and viscous modulus, and loss factor were evaluated. Two-way ANOVA, T-independent, and Tukey HSD tests were done for statistical analysis and significance level was set to 0.05.

Results

In both materials, flexural modulus decreased significantly after thermoforming, 88% in Duran and 70% in Erkodur, but did not change significantly after aging. After thermoforming, hardness decreased significantly in both materials (22% in Duran and 7.6% in Erkodur). Dynamic Tg was significantly lower in T and TA in both materials. At all temperatures (25, 37, 55°C) in Duran, the elastic modulus difference was only significant between C and TA, but in Erkodur, it decreased significantly in T, and there was no significant change after aging. Viscous modulus and loss factor showed the same change patterns at all temperatures. In both materials, they increased after thermoforming, but did not change significantly after aging.

Conclusion

Thermoforming had more prominent role than aging in diminishing of thermomechanical properties. In general, Duran had greater thermomechanical stability than Erkodur.

Mechanical Properties of Dental Alloys According to Manufacturing Process

The purpose of this study is to investigate the effect of the fabrication method of dental prosthesis on the mechanical properties. Casting was produced using the lost wax casting method, and milling was designed using a CAD/CAM program. The 3D printing method used the SLS technique to create a three-dimensional structure by sintering metal powder with a laser. When making the specimen, the specimen was oriented at 0, 30, 60, and 90 degrees. All test specimens complied with the requirements of the international standard ISO 22674 for dental alloys. Tensile strength was measured for yield strength, modulus of elasticity and elongation by applying a load until fracture of the specimen at a crosshead speed of 1.5 ± 0.5 mm/min (n = 6, modulus of elasticity n = 3). After the tensile test, the cross section of the fractured specimen was observed with a scanning electron microscope, and the statistics of the data were analyzed with a statistical program SPSS (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY, USA: IBM Corp.) and using Anova and multiple comparison post-tests (scheffe method). The yield strength was the highest at 1042 MPa at an angle of 0 degrees in the specimen produced by 3D printing method, and the elongation was the highest at 14% at an angle of 90 degrees in the specimen produced by 3D printing method. The modulus of elasticity was the highest at 235 GPa in the milled specimen. In particular, the 3D printing group showed a difference in yield strength and elongation according to the build direction. The introduction of various advanced technologies and digital equipment is expected to bring high prospects for the growth of the dental market.

Chemical Characterisation of Silanised Zirconia Nanoparticles and Their Effects on the Properties of PMMA-Zirconia Nanocomposites

Objectives: The objective of this study was to investigate the mechanical properties of high-impact (HI) heat-cured acrylic resin (PMMA) reinforced with silane-treated zirconia nanoparticles. Methods: Forty-five PMMA specimens reinforced with zirconia were fabricated and divided into three groups: Pure HI PMMA (control group), PMMA reinforced with 3 wt.% of non-silanised zirconia nanoparticles and PMMA reinforced with 3 wt.% of silanised zirconia nanoparticles. Silanised and non-silanised zirconia nanoparticles were analysed with Fourier Transform Infrared (FTIR) Spectroscopy. For measuring the flexural modulus and strength, a Zwick universal tester was used, and for surface hardness, a Vickers hardness tester were used. Furthermore, raw materials and fractured surfaces were analysed using Scanning Electron Microscopy (SEM). A one-way ANOVA test followed by a post-hoc Bonferroni test was employed to analyse the data. Results: The results showed that the mean values for flexural strength (83.5 ± 6.2 MPa) and surface hardness (20.1 ± 2.3 kg/mm²) of the group containing 3 wt.% treated zirconia increased significantly (p < 0.05) in comparison to the specimens in the group containing non-treated zirconia (59.9 ± 7.1 MPa; 15.0 ± 0.2 kg/mm²) and the control group (72.4 ± 8.6 MPa; 17.1 ± 0.9 kg/mm²). However, the group with silanised zirconia showed an increase in flexural modulus (2313 ± 161 MPa) but was not significantly different (p > 0.05) from the non-silanised group (2207 ± 252 MPa) and the control group (1971 ± 235 MPa). Conclusion: Silane-treated zirconia nano-filler improves the surface hardness and flexural strength of HI PMMA-zirconia nanocomposites, giving a potentially longer service life of the denture base.

Evaluating the Mechanical Properties of Zinc-Coated Stainless Steel Orthodontic Wires Using Physical Vapor Deposition

The aim of this study was to evaluate the mechanical properties of stainless steel (SS) orthodontic wires coated with zinc (Zn), using a Physical Vapored Deposition (PVD) machine. A total of 100 straight SS orthodontic wires were cut into pieces of 5 centimeters in length and were divided into two groups. Half of the wires were coated with Zn using a PVD machine, and the others remained uncoated. Tensile strength (n = 15), three-point bending (n = 15), and frictional resistance at 0° (n = 10) and 10° (n = 10) were measured to compare the mechanical properties of the Zn-coated and uncoated orthodontic wires using the universal testing machine. The surface of the coated wires was observed by SEM and AFM. An independent t-test, multivariate ANOVA, and measurement ANOVA were used for data analysis. SEM and AFM showed a homogenous Zn layer of 0.28 ± 0.006 µm on the SS wires. The tensile strength and three-point bending strength significantly increased after Zn coating of wires with the PVD method (P < 0.05). The friction resistance significantly reduced at both angulations following the coating procedure. The angle between the wire and bracket had no significant effect on the frictional resistance (P > 0.05). Coating with Zn improved the tensile and load-bending strength of SS orthodontic wires and reduced their frictional resistance which might be advantageous in terms of reducing the risk of root resorption during the orthodontic treatment.

The Effect of Material Type and Location of an Orthodontic Retainer in Resisting Axial or Buccal Forces

The purpose of this study was to investigate the effect of retainer material and retainer position on a tooth to resist movement of the tooth in a simulation model. Bidirectional continuous glass fiber-reinforced composite (FRC) retainers and control retainers of steel wires were tested. The FRC retainers had a polymer matrix of bisphenol-A-glycidyldimethacrylate (bis-GMA) and poly(methylmethacrylate) (PMMA), and it was cured with a photoinitiator system. The retainers were adhered to a lower jaw Frasaco model in two different positions. Resistance against the movement of one tooth was measured from two directions. The average load values within the FRC retainer groups were higher than within the metal retainer groups. The load values for the groups loaded from the axial direction were higher than those loaded from the buccal direction. FRC retainers, which were located 1–2 mm from the incisal edge, showed higher load values than those located 4–5 mm from the incisal edge. There was a significant difference in load values between FRC retainers and metal retainers (p < 0.01). The wire position and the direction of force also had significant effects (p < 0.01). There were no significant differences between metal retainer groups. The results of this study suggest that metal retainers are more flexible, allowing for tooth movements of larger magnitude than with FRC retainers.

Comparison of Cell Viability and Chemical Composition of Six Latest Generation Orthodontic Wires

Orthodontic wires are made of alloys containing different metals, including nickel. It is important to evaluate their biocompatibility prior to use, owing to their long-term use in patients. This in vitro study compared the cytotoxicity and chemical composition of six latest orthodontic wires: Fantasia®, Tanzo®, FLI®, NT3®, DuoForce®, and Gummetal®. The before-use group consisted of wires that were not used in the mouth, and the after-use group consisted of wires that were used in the mouth for two months. The wires were placed in contact with human gingival fibroblasts (HGF) for 72 h, and cytotoxicity was determined using the resazurin test. The chemical composition and surface characterisation were evaluated by spectrometry and scanning electron microscopy. The groups were compared using ANOVA and Kruskal–Wallis test. Only the FLI® wires produced a 36% reduction in HGF viability (p < 0.05) and presented greater irregularities and loss of polymer structure. After-use wires showed a significant reduction in the percentage of nickel and the appearance of new elements (oxygen and carbon). Therefore, it can be concluded that no toxic ion release was noticed in this study. Rhodium-coated wires were more stable than PTFE-coated wires, and only the FLI® wires showed a slight cytotoxic effect.

Evaluation of the Effect of Probiotic Bacillus coagulans Unique IS2 on Mutans Streptococci and Lactobacilli Levels in Saliva and Plaque: A Double-Blind, Randomized, Placebo-Controlled Study in Children

Background

Probiotic organisms are known to reduce caries causing microorganisms mutans streptococci and lactobacilli. Aim of the Study. To evaluate the effect of probiotic Bacillus coagulans Unique IS2 on mutans streptococci and lactobacilli levels in saliva and plaque in children.

Introduction

Dental caries or tooth decay is because of the demineralization of the tooth enamel leading to the breakdown of the enamel causing cavities to be formed. Demineralization of the tooth happens because of the acid secreted by bacteria like mutans streptococci and lactobacilli. It is now suggested that probiotic usage prevents the overgrowth of these pathogenic microbes, thereby reducing caries activity. Methodology. In this double-blind, randomized, placebo-controlled study, 48 children with ages ranging from 5 to 15 years were divided into two groups, the probiotic and placebo groups. Chewable tablets with and without probiotic Bacillus coagulans Unique IS2 were administered for two weeks. Stimulated saliva samples and plaque were collected at baseline and at the end of 14 days to measure the pH, mutans streptococci, and lactobacilli count of saliva and plaque using chairside kits.

Results

A statistically significant reduction in mutans streptococci and lactobacilli counts of both saliva and plaque samples was observed in the B. coagulans Unique IS2 treated group after 14 days of administration compared to the baseline and placebo group (using paired t-test).

Conclusion

Probiotic Bacillus coagulans Unique IS2 (2 billion cfu) chewable tablet is effective in reduction and inhibition of caries causing mutans streptococci and lactobacilli levels in saliva and plaque in children.

Evaluation of the Flexural Strength, Water Sorption, and Solubility of a Glass Ionomer Dental Cement Modified Using Phytomedicine

Objectives: Various medicinal plant parts and extracts have been proven to be sources of biologically active compounds, many of which have been incorporated in the production of new pharmaceutical compounds. Thus, the aim of this study was to increase the antimicrobial properties of a glass ionomer cement (GIC) through its modification with a mixture of plant extracts, which were evaluated along with a 0.5% chlorohexidine-modified GIC (CHX-GIC) with regard to the water sorption, solubility, and flexural strength. Methods: Salvadora persica, Olea europaea, and Ficus carcia leaves were prepared for extraction with ethyll alcohol using a Soxhlet extractor for 12 h. The plant extract mixture (PE) was added in three different concentrations to the water used for preparation of a conventional freeze-dried GIC (groups 1:1, 2:1, and 1:2). Specimens were then mixed according to the manufacturer’s instructions and tested against the unmodified GIC (control) and a GIC modified with 0.5% chlorhexidine. Water sorption and solubility were evaluated after 7 days of immersion in distilled water. Flexural strength was evaluated in a three-point bending test after 24 h using a universal material testing machine at a crosshead speed of 1 mm/min. One-way analysis of variance (ANOVA) was used for comparison between the groups. Tukey’s post hoc test was used for pairwise comparison when the ANOVA test was significant. Results: There were no statistically significant differences between the control (M = 20.5%), CHX-GIC (M = 19.6%), 1:1 (M = 20.0%), 1:2 (M = 19.5%), and 2:1 (19.7%) groups with regard to the percentage of water sorption, while for water solubility the 2:1 (M = −0.39%) plant-modified group was significantly different from all of the other groups. Flexural strength test results showed that the 2:1 group (M = 26.1 MPa) recorded significantly higher mean values compared to all other tested groups. Conclusion and clinical relevance: The plant extracts did not negatively affect the water sorption and solubility of the GIC, while the flexural strength was improved by the addition of the plant extract at higher concentrations.

Awareness and Treatment Decisions on Tooth Wear among Jordanian Dentists and Prosthodontists: A Cross-Sectional Survey Study

Objectives

To assess the awareness, knowledge, and treatment decisions by dentists in Jordan regarding tooth wear.

Materials and Methods

A questionnaire was disseminated to a random sample of 200 general dentists and 100 prosthodontists working in the Ministry of Health, academia, private practices, and military services. Chi square and independent t-tests were performed for statistical analysis.

Results

Hundred and seventy-nine dentists and prosthodontists responded (59.7% response rate), of which 71.5% was females. 83.8% of the dentists reported they see patients with tooth wear. 61.5% registered wear lesions in the patient file, and 68.2% reported they find a probable cause of tooth wear. 87.2% of the dentists reported that bruxism is the most common cause in Jordan. 63.3% dentists treated their patients. 46.4% reported they “always” record a dietary history. 77.7% did not think that tooth wear is linked to caries. Low confidence levels were demonstrated among general practitioners in diagnosing and treating tooth wear. Regarding treatment decisions, most dentists decided to restore worn teeth with composite and to construct a night guard. Minimally affected anterior teeth were mostly treated with fluoride. Restoration of posterior worn teeth with overlay was suggested by one-third of the dentists.

Conclusion

The dentists and prosthodontists in Jordan are aware of tooth wear. However, examination and documentation were given a little priority by general dentists. On the other hand, there was an agreement among the dentists and prosthodontists on applying the minimally invasive approach. Clinical Significance. It is challenging for dentists to make the best treatment decision for tooth wear especially as no standard treatment is available. Therefore, this study investigated the awareness and treatment decisions of a sample of dentists and prosthodontists in Jordan.

Exposure of Biomimetic Composite Materials to Acidic Challenges: Influence on Flexural Resistance and Elastic Modulus

Acidic conditions of the oral cavity, including soft drinks and cariogenic bacteria, represent a damage for restorative biomimetic composite materials. The aim of this study is to assess the influence of two different acidic challenges on the flexural strength and elastic modulus of five composites: x-tra fil (Group 1, XTF), GrandioSO x-tra (Group 2, GXT), Admira Fusion x-tra (Group 3, AFX), VisCalor bulk (Group 4, VCB), and Enamel Plus HRi (Group 5, EPH). Thirty samples for each group were randomly divided and assigned to three different treatments: storage in distilled water as the controls (subgroups 1a–5a), 3 weeks distilled water + 1 week Coca-Cola (subgroups 1b-5b), and 4 weeks Coca-Cola (subgroups 1c–5c). For each subgroup, the flexural strength and elastic modulus were measured using an Instron universal testing machine, and data were submitted to statistical analysis. Considering subgroups B, no material showed a significant difference in the flexural strength with the controls (p > 0.05), whereas for subgroups C, only GXT and VCB showed significantly lower values (p < 0.05). AFX reported the lowest flexural strength among the materials tested. As regards the elastic modulus, no material showed a significant variation after acidic storages when compared with the respective control (p > 0.05). AFX and EPH reported the lowest elastic modulus compared to the other materials. All composites tested showed adequate flexural properties according to the standards, except for AFX. This biomimetic material, along with EPH, might be indicated for V class (cervical) restorations considering the lowest values of elasticity reported.

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.