Comparative Effect of Self- or Dual-Curing on Polymerization Kinetics and Mechanical Properties in a Novel, Dental-Resin-Based Composite with Alkaline Filler. Running Title: Resin-Composites with Alkaline Fillers

Comparative evaluation of surface roughness and bacterial adhesion on two bioactive cements: an in-vitro study

BACKGROUND

Dental restorative materials are recognized as artificial niches that facilitate the adherence and accumulation of oral microorganisms. To mitigate oral diseases and extend the lifespan of restorations, it is advantageous to use dental materials that exhibit low susceptibility to bacterial adhesion.

OBJECTIVE

To evaluate and compare bacterial adhesion on two bioactive restorative materials, a glass hybrid restorative, and an alkasite with a nanohybrid resin composite as a positive control. The secondary objectives were to compare the surface roughness (SR) of the materials and determine the correlation between the bacterial adhesion and the SR.

MATERIALS AND METHODS

The samples consisted of 33 polished discs of each material: Group A: Tetric® N-Ceram (nanohybrid resin composite), Group B: Equia Forte™ HT Fil (glass hybrid restorative) and Group C: Cention N® (alkasite). Streptococcus mutans cultures were inoculated and after 24-hours of incubation, bacterial adhesion was measured by measuring optical density (OD) and number of colony forming units (CFUs). After 96-hours incubation, the bacterial cell count was determined using scanning electron microscopy (SEM). SR was assessed using surface profilometer.

RESULTS

Alkasite had significantly lower OD and CFUs (p < 0.001 and p = 0.015 respectively). According to the SEM analysis, the glass hybrid restorative had lower mean bacterial cell count with no significant difference between the groups. The nanohybrid composite had the smoothest surface that was significantly lower than the alkasite and glass hybrid restorative (p = 0.002). None of the groups demonstrated a correlation between bacterial adhesion and SR.

CONCLUSION

Alkasite impedes bacterial adhesion better than the glass hybrid restorative and nanohybrid composite, while smoother surfaces are achieved with the nanohybrid composite.

The effect of thermal aging on microhardness and SEM/EDS for characterisation bioactive filling materials

BACKGROUND

The aim of this study is to evaluate the surface microhardness, surface chemical composition of bioactive restorative materials pre- and post- thermal aging.

METHOD

A total of 200 disc-shaped samples were prepared by using the materials: Cention N, ACTIVA BioActive Restorative, Equia Forte HT Fil, Glass Fill glass carbomer cement (GCP), and Fuji II LC. Vickers microhardness test were used to measure surface hardness. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM/EDS) was used to determine the characterization of the microstructures and elemental analysis of the materials. These measurements were repeated after thermal aging. One-Way ANOVA test, Bonferroni test and the Games-Howell test was used for data analysis. The significance level was accepted as 0.05.

RESULTS

Cention N had the highest vickers microhardness value before thermal cycle. The highest fluoride ion ratio among the materials before thermal aging was detected in the Equia Forte HT Fil and Fuji II LC groups. While a decrease in fluorideF ion was detected in all groups except the Cention N group after thermal aging. It is observed that ACTIVA BioActive Restorative has a more microporous and rougher surface in the scanning electron microscopy image after the thermal cycle than in the image before the thermal cycle.

CONCLUSIONS

The chemical properties of the materials and the properties of the filler particles may be related to the differences in the mechanical properties, surface characterizations and ion releases of the materials Thermal aging affected the microhardness, surface characteristics and elemental mass ratios of the studied materials. Alkasite bioactive materials are more similar to composite restorative materials and show better mechanical properties than other materials, but do not have the same effect on fluoride release.

CLINICAL RELEVANCE

Most of the bioactive materials showed a decrease in the fluoride ion ratio after thermal aging, while no difference was found in the ion exchange of alkasite materials. Material selection should be made more carefully in caries-active individuals whose fluoride release is clinically important.

Comparison of Water Sorption and Water Solubility Properties of Current Restorative Materials with Different Contents

OBJECTIVES

 This study aimed to investigate and compare water sorption and solubility properties of current restorative materials with different contents.

MATERIALS AND METHODS

 Alkasite, self-adhesive restorative material (Cention N, Ivoclar Vivadent AG, Schaan, Liechtenstein), bulk-fill glass hybrid restorative material (EQUIA Forte HT, GC Corp., Tokyo, Japan), nanohybrid universal composite material (OptiShade, Kerr Dental, United States), and bulk-fill composite material (Filtek One Bulk Fill Restorative, 3M ESPE, St. Paul, Minnesota, United States) were used. Samples (n = 6) were prepared (2 × 10 mm) according to the ISO 4049 standards. Water sorption and solubility values were calculated according to the ISO 4049 standards.

STATISTICAL ANALYSIS

 One-way ANOVA, Tukey's post-hoc, Tamhane's T2 post-hoc, Pearson's correlation, and independent samples t-tests were used for statistical analysis (p < 0.05).

RESULTS

 Group EQUIA Forte HT significantly showed the highest water sorption values (57.278 ± 3.174), while Group Filtek One Bulk Fill Restorative exhibited the lowest (4.429 ± 0.174; p < 0.05). The water sorption values for Group Cention N were 5.000 ± 0.542. Group EQUIA Forte HT significantly had the lowest water solubility values (-99.799 ± 1.909), while Group Cention N (-2.966 ± 0.402) significantly exhibited the highest (p < 0.05). There was no significant correlation between water sorption and solubility values for each material (p > 0.05).

CONCLUSION

 The bulk-fill nano-filled composite resin material was successful in terms of water sorption while the bulk-fill glass hybrid restorative system in terms of water solubility. Alkasite can be recommended to be used as a base material due to its high solubility feature. Monomer, filler type, and amount had an impact on the water sorption and solubility properties of the tested materials.

Mechanical Properties of Alkasite Material with Different Curing Modes and Simulated Aging Conditions

This study aimed to evaluate the micro-mechanical and macro-mechanical properties of self-cured and light-cured alkasite and to investigate how accelerated degradation in acidic, alkaline, and ethanol solutions affects the macro-mechanical properties of self-cured and light-cured alkasite. The specimens of the alkasite material (Cention Forte, Ivoclar Vivadent) were prepared according to the following three curing modes: (1) light-cured immediately, (2) light-cured after a 5-min delay, and (3) self-cured. Microhardness was tested before and after immersion in absolute ethanol to indirectly determine crosslink density, while flexural strength and flexural modulus were measured using a three-point bending test after accelerated aging in the following solutions: (1) lactic acid solution (pH = 4.0), (2) NaOH solution (pH = 13.0), (3) phosphate-buffered saline solution (pH = 7.4), and (4) 75% ethanol solution. The data were statistically analyzed using a two-way ANOVA and Tukey post hoc test. The results showed that the microhardness, flexural strength, and flexural modulus were significantly lower in self-cured specimens compared to light-cured specimens. A 5-min delay between the extrusion of the material from the capsule and light curing had no significant effect on any of the measured properties. A significant effect of the accelerated aging solutions on macro-mechanical properties was observed, with ethanol and alkaline solutions having a particularly detrimental effect. In conclusion, light curing was preferable to self-curing, as it resulted in significantly better micro- and macro-mechanical properties, while a 5-min delay between mixing the capsule and light curing had no negative effects.

Clinical performance of two ion-releasing bulk-fill composites in class I and class II restorations: A two-year evaluation

OBJECTIVES

This randomized clinical trial evaluated and compared the 2-year clinical performance of two ion-releasing bulk-fill composites (Cention N and Surefil One) with that of a conventional bulk-fill resin composite (Powerfil) in Class I and II cavities.

METHODS

Thirty-two patients, each with 3 Class I and/or Class II cavities under occlusion, were enrolled in this trial. A total of 96 restorations were placed, 32 for each material, as follows: a self-adhesive composite; Surefil-one, alkasite; Cention N, and a bulk-fill resin composite; Powerfil. The restorations were placed by a single operator. Clinical evaluation was performed at baseline (1-week), 6-months, 1-year, and 2-years by two independent examiners using the FDI criteria. Intergroup and intragroup comparisons were analyzed using the Kruskal-Wallis and Friedman Tests. Multiple comparisons between groups were analyzed using the Mann-Whitney and Wilcoxon-rank tests. The level of significance was set at α = 0.05.

RESULTS

Twenty-seven patients with a total of 81 restorations were evaluated at the end of the 2-years with 84.35% recall rates. Clinical success rates were 100%, 100%, and 96.3% for Powerfil, Surefil-one, and Cention N, respectively. Cention N showed a statistically significant (p < 0.05) decreased marginal integrity in comparison with resin composite at the 2-year evaluation. No recurrent decay was detected in any restoration.

CONCLUSIONS

Both ion-releasing bulk-fill composites provided acceptable clinical performance similar to bulk-fill composite in Class I and II restorations over a 2-year period.

CLINICAL RELEVANCE

The results of this trial suggests that there is a promising evidence supporting the use of ion-releasing composites.

The power of light - From dental materials processing to diagnostics and therapeutics

Harnessing the power of light and its photonic energy is a powerful tool in biomedical applications. Its use ranges from biomaterials processing and fabrication of polymers to diagnostics and therapeutics. Dental light curable materials have evolved over several decades and now offer very fast (≤ 10 s) and reliable polymerization through depth (4-6 mm thick). This has been achieved by developments on two fronts: (1) chemistries with more efficient light absorption characteristics (camphorquinone [CQ], ~30 L mol-1 cm1 [ʎmax 470 nm]; monoacylphosphine oxides [MAPO], ~800 L mol-1 cm-1 [ʎmax 385 nm]; bisacylphosphine oxide [BAPO], ~1,000 L mol-1 cm-1 [ʎmax 385 nm]) as well mechanistically efficient and prolonged radical generation processes during and after light irradiation, and; (2) introducing light curing technologies (light emitting diodes [LEDs] and less common lasers) with higher powers (≤ 2 W), better spectral range using multiple diodes (short: 390-405 nm; intermediate: 410-450 nm; and long: 450-480 nm), and better spatial power distribution (i.e. homogenous irradiance). However, adequate cure of materials falls short for several reasons, including improper selection of materials and lights, limitations in the chemistry of the materials, and limitations in delivering light through depth. Photonic energy has further applications in dentistry which include transillumination for diagnostics, and therapeutic applications that include photodynamic therapy, photobiomodulation, and photodisinfection. Light interactions with materials and biological tissues are complex and it is important to understand the advantages and limitations of these interactions for successful treatment outcomes. This article highlights the advent of photonic technologies in dentistry, its applications, the advantages and limitations, and possible future developments.

In vitro characterization of a novel resin-based restorative material containing alkaline fillers

OBJECTIVE

In this study, a comparative evaluation of the physicochemical properties of Cention N and other direct restorative materials was performed. Three restorative materials-a resin-modified glass ionomer (Fuji II LC), an alkasite-based resinous material (Cention N), and a resin composite (Tetric N Ceram)-were characterized in terms of degree of conversion, Knoop hardness number (KHN) ratio, flexural strength, elastic modulus, water sorption, water solubility, microshear bond strength to dentin, immediate microleakage, and radiopacity.

METHODOLOGY

The microshear bond strength to dentin and microleakage of Cention N were evaluated with and without the application of an adhesive system (Tetric N Bond Universal). A one-way ANOVA test was used to analyze the data in terms of degree of conversion, KHN ratio, water sorption, water solubility, microshear bond strength to dentin, and radiopacity. A two-way ANOVA test (carried out considering the material type and ethanol aging as factors) was used to analyze the data in terms of flexural strength and elastic modulus. The Kruskal-Wallis test was used to statistically analyze the data on microleakage. A significance level of α=0.05 was used for all tests.

RESULTS

Fuji II LC was found to have the highest degree of conversion, water sorption, and microleakage, as well as the lowest flexural strength. Cention N had the highest solubility; when used with an adhesive system, it achieved bond strength and microleakage similar to those of the Tetric N Ceram composite. Tetric N Ceram had the highest degree of conversion, KHN ratio, and radiopacity. Conclusion: The properties of Cention N validate its efficacy as an alternative direct restorative material when used in conjunction with an adhesive system.

Efficacy of bioactive materials in preventing Streptococcus mutans-induced caries on enamel and dentine

The study investigated the ability of bioactive materials used to restore enamel and dentine specimens to prevent caries. Enamel (n = 50) and dentine (n = 50) specimens were obtained from bovine incisors, prepared, and randomly allocated to one of five groups according to the restorative treatment: alkasite without adhesive system; alkasite with adhesive system; high viscosity glass ionomer cement; resin composite; no restoration; negative control group. Specimens were restored, exposed to a thermal cycling aging protocol, sterilized, and exposed to a cariogenic challenge induced by Streptococcus mutans and then submitted to surface and subsurface microhardness tests and polarized light microscopy to verify the caries lesion development in enamel or dentine surrounding the restorative materials. Data were analyzed using one-way ANOVA. In enamel and dentine, glass ionomer cement, alkasite without and with adhesive system presented a lower percentage surface microhardness loss than resin composite and negative control. Enamel subsurface microhardness presented no statistically significant differences between glass ionomer cement, alkasite without and with adhesive system. Glass ionomer cement also did not present statistically significant differences from resin composite and the negative control. In dentine, glass ionomer cement showed the highest subsurface microhardness values. In conclusion, bioactive restorative materials provide greater protection to enamel and dentine against surface caries development than resin composite.

Short-Term Fluoride Release from Ion- Releasing Dental Materials

Objective

To compare short-term release of fluoride ions from ion-releasing dental restorative materials.

Material and methods

Seven experimental groups were prepared using the following six different materials: alkasite (Cention Forte), resin-modified glass ionomer cement (Fuji II LC), bioactive composite (ACTIVA BioACTIVE-RESTORATIVE), fluoride-containing nano-hybrid composite (Luminos UN), coat-free glass hybrid (EQUIA Forte HT), coat-applied glass hybrid (EQUIA Forte HT), and glass ionomer cement (Fuji IX). A total of 40 samples for each group (n=40) were prepared in Teflon molds (8 mm x 2 mm) and placed in polyethylene vials with 5 ml of deionized water. Fluoride release was measured after 6, 24, 48 hours, and for 5 weeks using an ion-selective electrode. The results were expressed in mg/l and the data were statistically analyzed using ANOVA.

Results

Significant differences in fluoride release were observed within the first 6 hours (ANOVA p<0.001). EQUIA Forte HT had the highest release, while the other materials showed no significant differences. After 24 hours, EQUIA Forte HT (p<0.001) and Luminos UN (p<0.05) exhibited significantly higher releases, compared to other tested materials. EQUIA Forte HT maintained the highest release at 48 hours (p<0.001), followed by Cention Forte (p<0.05) and Luminos UN (p<0.05). All material pairs showed significant differences in fluoride release at 5 weeks (p<0.001).

Conclusion

Coat-free EQUIA Forte HT had the overall highest fluoride release, while Cention Forte demonstrated the greatest increase over time. ACTIVA BioACTIVE-RESTORATIVE exhibited the lowest fluoride release in this study.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial

PURPOSE

To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up.

METHODS

In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N^® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test.

RESULTS

All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different.

CONCLUSIONS

The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children.

CLINICAL TRIAL REGISTRATION

The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Resin-Based Bulk-Fill Composites: Tried and Tested, New Trends, and Evaluation Compared to Human Dentin

A more-and-more-accepted alternative to the time-consuming and technique-sensitive, classic, incremental-layering technique of resin-based composites (RBCs) is their placement in large increments. The so-called bulk-fill RBCs had to be modified for a higher polymerization depth and already have a 20-year history behind them. From the initial simple mechanisms of increasing the depth of cure by increasing their translucency, bulk-fill RBCs have evolved into complex materials with novel polymerization mechanisms and bioactive properties. However, since the materials are intended to replace the tooth structure, they must be comparable in mechanical behavior to the substance they replace. The study compares already established bulk-fill RBCs with newer, less-studied materials and establishes their relationship to dentin with regard to basic material properties such as hardness and indentation modulus. Instrumented indentation testing enables a direct comparison of tooth and material substrates and provides clinically relevant information. The results underline the strong dependence of the measured properties on the amount of filler in contrast to the small influence of the material classes into which they are classified. The main difference of RBCs compared to dentin is a comparable hardness but a much lower indentation modulus, emphasizing further development potential.

Improved Flexural Properties of Experimental Resin Composites Functionalized with a Customized Low-Sodium Bioactive Glass

This study evaluated the flexural properties of an experimental composite series functionalized with 5-40 wt% of a low-Na F-containing bioactive glass (F-series) and compared it to another experimental composite series containing the same amounts of the conventional bioactive glass 45S5 (C-series). Flexural strength and modulus were evaluated using a three-point bending test. Degree of conversion was measured using Fourier-transform infrared spectroscopy. Weibull analysis was performed to evaluate material reliability. The control material with 0 wt% of bioactive glass demonstrated flexural strength values of 105.1-126.8 MPa). In the C-series, flexural strength ranged between 17.1 and 121.5 MPa and was considerably more diminished by the increasing amounts of bioactive glass than flexural strength in the F-series (83.8-130.2 MPa). Analogously, flexural modulus in the C-series (0.56-6.66 GPa) was more reduced by the increase in bioactive glass amount than in the F-series (5.24-7.56 GPa). The ISO-recommended "minimum acceptable" flexural strength for restorative resin composites of 80 MPa was achieved for all materials in the F-series, while in the C-series, the materials with higher bioactive glass amounts (20 and 40 wt%) failed to meet the requirement of 80 MPa. The degree of conversion in the F-series was statistically similar or higher compared to that of the control composite with no bioactive glass, while the C-series showed a declining degree of conversion with increasing bioactive glass amounts. In summary, the negative effect of the addition of bioactive glass on mechanical properties was notably less pronounced for the customized bioactive glass than for the bioactive glass 45S5; additionally, mechanical properties of the composites functionalized with the customized bioactive glass were significantly less diminished by artificial aging. Hence, the customized bioactive glass investigated in the present study represents a promising candidate for functionalizing ion-releasing resin composites.

Preparation and characterization of acrylic resins with bioactive glasses

This study aimed to prepare a bioactive acrylic material by adding different types of glasses. Commercially available polymerized acrylic resin was mixed with 10% of four different types of glasses in the powder form and cured. Flexural strength, sorption, and solubility of the samples were tested according to ISO 20795-1:2013. The total number of samples used in the tests were 60. The materials were placed in artificial saliva of pH 4 and 7, and elution was performed for 0, 1, 28, and 42 days. The collected samples were analyzed using inductively coupled plasma atomic emission spectrometry to detect Ca, P, and Si ions and using ion chromatography to detect F ions. The materials obtained after modification with glasses showed lower compressive strength compared with pure polymethyl methacrylate but met the standard requirements. Two glass types showed higher solubility values compared with the value defined by the ISO standard. Biomin C and S53P4 released Ca, P, and Si ions, respectively, after 42 days in artificial saliva. Acrylic resins modified with 10% Biomin C and S53P4 glasses can be a valuable source of Ca and P ions under acid conditions for 28 and 42 days.

Comparative Evaluation of Surface Roughness and Wettability of an Alkasite with Nano Bulk-Fill and Nanofilled Resin Composite Restorative Materials: In vitro Study

Context

Surface characteristics of resin-based composites (RBCs) can change with polishing and over time.

Aim

The aim of the study was to compare the surface roughness and wettability of three different posterior RBCs after polishing and the change in these surface characteristics over time, after aqueous aging.

Settings and Design

Experimental in vitro study.

Materials and Methods

Eleven disc-shaped RBC specimens were fabricated. The RBCs used were, alkasite composite, bulk-fill nanocomposite, conventional nanofilled composite. All the specimens underwent polishing with Soflex Diamond Polishing System and then analyzed for roughness and wettability at baseline and after aqueous aging for 3 months with the help of an atomic force microscope and a contact angle goniometer respectively.

Statistical Analysis

One-way ANOVA and Tamhane test were used for the multiple comparisons.

Results

Alkasite composite showed significantly higher surface roughness (P = 0.028 and P < 0.001, respectively) and lower wettability (P = 0.023 and P = 0.020, respectively) than conventional nanofilled composite at baseline and 3 months. Surface roughness of alkasite composite was also significantly higher than bulk-fill nanocomposite (P = 0.009 and P < 0.001, respectively) at both the time points.

Conclusions

Alkasite has higher surface roughness in comparison to conventional nanocomposite and bulk-fill nanocomposite and lower wettability than conventional nanocomposite after polishing and aqueous aging over a 3-month period. In terms of surface characteristics, alkasite composite may be advantageous in preventing initial plaque adhesion to the material surface, but the lower surface roughness of nano-filled composites may be more advantageous in terms of plaque retention prevention.

Comparative Evaluation of Bond Strength and Microleakage of Three Ion-Releasing Restorative Materials at Various pH Levels

The aim of this study was a comparison of the micro-tensile bond strength (μTBS) to dentin and microleakage of in vitro class V restorations of three different ion-releasing restorative materials under various pH conditions: giomer, a resin-modified glass ionomer (RMGI), and a new alkasite material. A μTBS test was performed using a universal testing machine, immediately and after storage at different pH (4, 7, and 10) buffer solutions (n = 15) over 24 h, and the failure mode was analyzed. For microleakage analysis, class V restorations were performed on extracted premolars, which were sectioned and stored in pH 4-, 7-, and 10-buffered fluorescent 0.02% rhodamine B dye. The specimens were observed under a confocal laser scanning microscope (CLSM) and scored using the acquired images. There were no significant differences in the μTBS according to the type of material (p = 0.518). The giomer showed a decreased bond strength under the pH 4 condition compared with the immediately tested or pH 7-stored specimens (p ≤ 0.043). In the microleakage analysis, the class V restoration with giomer showed a higher microleakage than RMGI or alkasite (p = 0.001). For RMGI and alkasite, the specimens stored at pH 4 showed a significantly lower microleakage than those stored at pH 7 (p = 0.028). RMGI and alkasite can be adopted as restorative materials in generalized or localized low-pH conditions.

Long-Term Assessment of Contemporary Ion-Releasing Restorative Dental Materials

The objective was to evaluate new commercially available ion-releasing restorative materials and compare them to established anti-cariogenic materials. Four materials were tested: alkasite Cention (Ivoclar Vivadent) in self-cure or light-cure mode, giomer Beautifil II (Shofu), conventional glass-ionomer Fuji IX (GC), and resin composite Tetric EvoCeram (Ivoclar Vivadent) as a control. Flexural strength, flexural modulus, and Weibull modulus were measured one day, three months, and after three months with accelerated aging in ethanol. Water sorption and solubility were evaluated for up to one year. Degree of conversion was measured during 120 min for self-cured and light-cured Cention. In this study, Beautifil II was the ion-releasing material with the highest flexural strength and modulus and with the best resistance to aging. Alkasite Cention showed superior mechanical properties to Fuji IX. Weibull analysis showed that the glass-ionomer had the least reliable distribution of mechanical properties with the highest water sorption. The solubility of self-cured alkasite exceeded the permissible values according to ISO 4049. Degree of conversion of light-cured Cention was higher than in self-cure mode. The use of alkasite Cention is recommended only in the light-cure mode.

New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial

Background

The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth.

Aim

This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up.

Materials and methods

A total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%).

Results

The overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008).

Conclusion

All evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities.

Clinical significance

Cention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements.

Trial registration number RBR-9nqszr

How to cite this article

da Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.

Chemical and mechanical properties of dual-polymerizing core build-up materials

OBJECTIVES

To investigate the chemical (degree of conversion (DC)) and mechanical properties (Martens hardness (HM), elastic indentation modulus (E_IT), and biaxial flexural strength (BFS)) of four dual-polymerizing resin composite core build-up materials after light- and self-polymerization.

MATERIALS AND METHODS

Round specimens with a diameter of 12 mm and a thickness of 1.5 mm were manufactured from CLEARFIL DC CORE PLUS (CLE; Kuraray), core·X flow (COR; Dentsply Sirona), MultiCore Flow (MUL; Ivoclar Vivadent), and Rebilda DC (REB; VOCO) (N = 96, n = 24/material). Half of the specimens were light-polymerized (Elipar DeepCure-S, 3 M), while the other half cured by self-polymerization (n = 12/group). Immediately after fabrication, the DC, HM, E_IT, and BFS were determined. Data was analyzed using Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis tests, Spearman's correlation, and Weibull statistics (p < 0.05).

RESULTS

Light-polymerization either led to similar E_IT (MUL; p = 0.119) and BFS (MUL and REB; p = 0.094-0.326) values or higher DC, HM, E_IT, and BFS results (all other groups; p < 0.001-0.009). When compared with the other materials, COR showed a high DC (p < 0.001) and HM (p < 0.001) after self-polymerization and the highest BFS (p = 0.020) and Weibull modulus after light-polymerization. Positive correlations between all four tested parameters (R = 0.527-0.963, p < 0.001) were found.

CONCLUSIONS

For the tested resin composite core build-up materials, light-polymerization led to similar or superior values for the degree of conversion, Martens hardness, elastic indentation modulus, and biaxial flexural strength than observed after self-polymerization. Among the tested materials, COR should represent the resin composite core build-up material of choice due to its high chemical (degree of conversion) and mechanical (Martens hardness, elastic indentation modulus, and biaxial flexural strength) properties and its high reliability after light-polymerization. The examined chemical and mechanical properties showed a positive correlation.

CLINICAL RELEVANCE

The chemical and mechanical performance of dual-polymerizing resin composite core build-up materials is significantly affected by the chosen polymerization mode.

Comparative Evaluation of Compressive Strength and Flexural Strength of Self-cured Cention N with Dual-cured Cention N: An In Vitro Study

Aim and objective

This study aimed to investigate and compare compressive strength and flexural strength of self-cured Cention N with dual-cured Cention N.

Materials and methods

Cention N is mixed according to the proportions, as mentioned by the manufacturer. Dual cured samples are cured using a diode that emits blue light. Cylindrical plexiglass split mold of dimension 6 mm height, and 4 mm diameter used to fabricate samples for compressive strength. Compressive strength tested using Instron universal testing machine. Rectangular plexiglass split mold of dimension 25 mm length, 2 mm height, and 2 mm width were used to fabricate samples for flexural strength. Flexural strength tested using Instron universal testing machine. To compare the mean values independent t-test was used and the significance of the study was measured by calculating a p-value.

Result

There is no statistically significant difference between compressive strength and flexural strength of self-cured Cention N with dual-cured Cention N.

Conclusion

The type of polymerization does not affect flexural strength and compressive strength of Cention N.

Clinical Significance

Self-curing polymerization alone is sufficient for Cention N to achieve adequate compressive strength and flexural strength. So it can be inserted as a single layer on a prepared cavity and to fasten curing additional light curing can be used.

How to cite this article

Fousiya Ks, Balagopal VR, Suresh KJ, et al. Comparative Evaluation of Compressive Strength and Flexural Strength of Self-cured Cention N with Dual-cured Cention N: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):210-214.

Effect of curing method and thermocycling on flexural strength and microhardness of a new composite resin with alkaline filler

BACKGROUND

Cention N has been introduced as an alternative material for amalgam. The purpose was to investigate the flexural strength and microhardness of this material in self-cure and dual-cure modes before and after thermocycling.

MATERIALS AND METHODS

In this experimental study, 40 samples of Cention N were prepared in order to determine and compare the microhardness. Half of the samples were set by self-cure method and the other half with dual-cure method. The Vickers microhardness test was performed once after 24 h and again after 10000 thermocyclings. Three-point flexural test was used to determine and compare the flexural strength of 52 rod-shaped samples. Half of the samples were set by self-cure method and the other half with dual-cure method. Among 26 samples in each group, 13 samples were randomly selected and three-point flexural test was performed after 24 h and for another 13 samples after 10,000 thermocyclings. Data were analyzed using two-way ANOVA and paired samples t-test (P < 0.05).

RESULTS

There was a statistically significant difference between the mean of microhardness values in two curing methods (P < 0.001) and in two storage conditions (P < 0.001). The mean of dual-cure microhardness (100.99 ± 7.22) was higher than that of self-cure (64.61 ± 12.51) and the mean value associated with pre-thermocycling (89.75 ± 15.84) was higher than that of the post-thermocycling (76.44 ± 23.56). There was no statistically significant difference between the mean flexural strength in the two curing methods (self-cure [72.85 ± 16.26], dual cure [79.87 ± 23.07]; [P > 0.05]). However, the mean flexural strength without thermocycling (85.98 ± 21.74) was higher than that of the thermocycled group (64.24 ± 6.40) (P < 0.001).

CONCLUSION

The microhardness of Cention N in dual-cure mode was higher than that of self-cure mode, but the flexural strength of dual-cure was not significantly different from that of self-cure. Thermocycling had a significant effect on the microhardness and flexural strength.

Fracture and viscoelastic behavior of novel self-adhesive materials for simplified restoration concepts

OBJECTIVE

The aim of the study was to offer a comparative perspective on the mechanical and viscoelastic behavior of currently developed materials for simplified restoration concepts. These materials have not yet been clearly assigned whether they are complex hybrids of already known material categories or new material classes.

METHODS

A dual-cured, bulk-fill, bioactive resin-based composite (alkasite), a resin-modified glass ionomer cements (RM-GIC) with novel polymerizable acid polymers, and a glass ionomer cement (GIC) with improved adaptation to an acidic environment were compared with regard to their macro-mechanical parameters (3-point bending test, 3-PBT), fracture mechanism, quasi-static and viscoelastic behaviour (instrumented indentation test, IIT), morphology and structural appearance of the filler system (SEM analysis). The influence of surface finishing was quantified on the outcome of the 3-PBT, while the influence of aging and frequency was monitored on the outcome of the IIT. One and multiple-way analysis of variance (ANOVA) with Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05) and Weibull analysis were applied.

RESULTS

Surface finishing strongly influenced the outcome of the 3-PBT for RM-GIC and GIC but not of the alkasite. The highest material reliability (Weibull parameter m) was found with the alkasite, irrespective of the curing mode. Ground specimens showed decrease reliability, except for the alkasite in the light-cured mode. The predominant failure mode originated from sub-surface defects (52.5%), followed by corner (25%), edge (18.1%), and crack arrest (4.4%). The effect of the parameter material on the quasi-static outcome of the IIT was highest on elastic/plastic parameters (p < 0.001; e.g. elastic indentation work, η_P² = 0.875), was moderate on the Martens Hardness (η_P² = 0.420), and was low on the Vickers hardness (η_P² = 0.218). The viscoelastic parameters, in particular the loss factor (tan δ) allow a clear documentation of the ongoing acid-base setting reaction during aging of one month, which was more pronounced in the GIC than in the RM-GIC. The decrease in tan δ with aging for GIC and RM-GIC reflects the maturation process and increased brittleness, while the increase in tan δ with aging reflects the polymer plasticization in the polymer-based alkasite.

CONCLUSIONS

The mechanical and viscoelastic behavior depending on surface refinement, aging and frequency clearly allow to classify the currently developed materials for simplified restoration concepts into known material categories such as RBCs (alkasite), RM-GIC or GIC.

Comparative evaluation of mechanical and physical properties of a new bulk-fill alkasite with conventional restorative materials

PURPOSE

The physical and mechanical performance of a newly commercialized dental restorative material (alkasite) was compared with glass ionomer cement (GIC) and nano-hybrid composite.

METHODOLOGY

Human extracted premolars were used to investigate the shear bond strength. Restorative materials were placed on the dentine surface and were aged in deionized water for 14 days. The 3-D surface roughness was evaluated before and after chewing simulation cycles (50,000). The samples were fatigued mechanically using a chewing simulator and investigated with a scanning electron microscope (SEM).

RESULTS

For shear bond strength, alkasite showed significantly high values than GIC, whereas non-significant difference was observed between alkasite and nano-hybrid composite. After the chewing simulation (50,000 cycles), non-significant difference was found between GIC and nano-hybrid composite, where surface roughness values were highest for GIC and lowest for alkasite.

CONCLUSION

The newly developed restorative material (alkasite) has shown better results than existing restorative materials.

The Development of Filler Morphology in Dental Resin Composites: A Review

Dental resin composites (DRCs) with diverse fillers added are widely-used restorative materials to repair tooth defects. The addition of fillers brings an improvement in the mechanical properties of DRCs. In the past decade, diverse fillers have emerged. However, the change of emerging fillers mainly focuses on the chemical composition, while the morphologic characteristics changes are often ignored. The fillers with new morphologies not only have the advantages of traditional fillers (particles, fibrous filler, etc.), but also endow some additional functional characteristics (stronger bonding ability to resin matrix, polymerization resistance, and wear resistance, drug release control ability, etc.). Moreover, some new morphologies are closely related to the improvement of traditional fillers, porous filler vs. glass particles, core-sheath fibrous vs. fibrous, etc. Some other new morphology fillers are combinations of traditional fillers, UHA vs. HA particles and fibrous, tetrapod-like whisker vs. whisker and fibrous filler, mesoporous silica vs. porous and silica particles. In this review, we give an overall description and a preliminary summary of the fillers, as well as our perspectives on the future direction of the development of novel fillers for next-generation DRCs.

Effect of Aging on Surface Roughness and Color Stability of a Novel Alkasite in Comparison with Current Direct Restorative Materials

AIM

To compare the surface roughness and color stability of a novel alkasite with current direct restorative materials with and without an aging step.

METHODS AND MATERIALS

Twenty-six specimens of each of the following materials were prepared: alkasite, ormocer, giomer, high-viscosity glass ionomer, glass carbomer, and nanohybrid composite (control). Half of the specimens in each group were stained, the other half of the specimens were aged and then stained. Color and surface roughness evaluations were conducted at baseline, after aging and after staining, using a dental spectrophotometer, and a three-dimentional (3D) noncontact optical profilometer, respectively. Statistical analyses were completed using one-way analysis of variance, post hoc Tukey test, and paired samples t-test.

RESULTS

At baseline and after aging, the surface of alkasite was found to be rougher than nanohybrid composite and ormocer surfaces (p<0.05). However, in terms of roughness increase caused by aging, ormocer, nanohybrid composite, and alkasite were affected in a similar way (p>0.05). In terms of color stability, alkasite was more colored than nanohybrid composite and ormocer (p<0.05), and performed similar to giomer (p>0.05).

CONCLUSIONS

The surface roughness and color stability characteristics of alkasite material was between composite resins and glass ionomer-based materials after aging.

Core-shell structured SiO2@ZrO2@SiO2 filler for radiopacity and ultra-low shrinkage dental composite resins

To overcome the interfacial problem between X-ray radiopaque ZrO₂ fillers and polymer resin in dental composites, monodispersed SiO₂@ZrO₂@SiO₂ (SZS) microspheres with narrow size distribution were prepared by a controlled sol-gel method. In the presence of SiO₂ coating layer over SiO₂@ZrO₂ (SZ) microspheres, they were easily silanized same as SiO₂ microspheres. Ethoxylated bisphenol A dimethacrylate (EBPADMA) with a higher molecular weight and a lower viscosity was used as base resin monomer mixed with a low amount of diluent triethylene glycol dimethacrylate (TEGDMA). Additionally, the addition of a small amount of pore agent acetone dicarboxylic acid (ADCA) produced some voids, thereby effectively reducing the polymerization shrinkage of the resin. The prepared dental composites combining 52 wt% monodispersed silica microsphere, 20 wt% SZS microspheres, exhibited significantly enhanced capacity in radiopacity (higher than tooth enamel) and very low shrinkage (<0.1%). It also has better mechanical properties than resin composites filled with SiO₂ microspheres, and its strength can meet practical applications. The properties of the radiopaque dental composite were to be further tuned by varying the amount of SZS microspheres contents, and the radiopaque resin has an advantage over the commercial one in that it is clinically nondestructive.

Remineralising fluorine containing bioactive glass composites

OBJECTIVES

The objective was to investigate the mechanical properties, fluoride release and apatite formation of resin based dental composites based on a fluoride containing Bioactive Glass (BG) with and without a silylating agent.

METHODS

A SiO₂-P₂O₅-CaO-SrO-Na₂O-CaF₂ BG was synthesized by the melt quench route. This glass and a commercially available inert glass (IG) were incorporated into a light cured BisGMA-TEGMA resin. The composite resins were then evaluated in terms of their ability to form apatite by Fourier Transform Infrared spectroscopy (FTIR) and by scanning electron microscopy (SEM) following immersion in artificial saliva at pH 4 (AS4) and pH 7 (AS7). The experiments were performed with and without silylation of the BG. The compressive strength and flexural strength were determined after 1, 28 and 84 days of immersion in the AS4 and AS7 immersion media.

RESULTS

The FTIR spectra of the BG composites exhibited split bands at approximately 560 and 600 cm^-1 corresponding to a apatite formation in the surface or on the surface under all immersion conditions. SEM showed the presence of a reacted layer of glass particles in the composite surface and the presence of a surface layer of apatite in AS7. The compressive strength and flexural strength were significantly higher for the silylated BG composites. The strengths of both silylated and non silylated BG composites and IG composites decreased upon immersion.

SIGNIFICANCE

BG composites exhibit reduced strengths upon immersion but still exhibit strengths comparable to existing composites after 84 days of immersion.

Evaluation of physico-mechanical properties and filler particles characterization of conventional, bulk-fill, and bioactive resin-based composites

OBJECTIVE

This study evaluated physical and mechanical properties and characterized the filler particles of seven composites.

MATERIALS AND METHODS

Filtek Supreme (FS, 3M Oral Care), Forma (FO, Ultradent), Charisma Diamond (CD, Kulzer), Spectra Smart (SS, Dentsply), Filtek Bulk Fill (FB, 3M Oral Care), Tetric N-Ceram Bulk Fill (TB, Ivoclar), and Cention N (Ivoclar) in self- (CNSC) or dual-curing (CNDC) were evaluated. Fillers size, shape, and content were analyzed by scanning electron microscopy (SEM) and X-ray dispersive energy spectroscopy (EDX). Disk-shaped specimens (n = 5) were prepared for sorption (SP) and solubility (SL). Flexural strength and elastic modulus were tested at 24 h and 12 months (n = 10). Degree of conversion (DC%) and maximum rate of polymerization (Rp^max) were evaluated using micro-Raman spectroscopy. SP and SL results were submitted to Kruskal-Wallis one-way ANOVA and Dunn's pairwise test (α = 0.05). Mechanical properties were analyzed by 2-way ANOVA and Tukey's test (α = 0.05). DC% of CNSC and CNDC was compared by independent t-test (α = 0.05). Rp^max results were analyzed by 1-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The composites differed regarding filler size, shape, and content. CD and CNSC showed lower SP than FS. SS had lower SL than CNSC and CNDC. CNDC presented higher DC% than CNSC. CD, TB, and CNDC showed the highest Rp^max. TB, CNSC, and CNDC showed the lowest 24-h flexural strengths. Mechanical properties of CD did not decrease, while FO, TB, and CNSC showed a significant reduction after storage.

CONCLUSIONS

Monomer composition and fillers characteristics greatly influenced the physico-mechanical properties of the tested composites.

[Curing method affecting the formation of oxygen inhibition layer on the surface of resin cement]

OBJECTIVE

To explore the conversion of resin monomer, the change of inorganic component and the influencing factors on the oxygen inhibition layer formed on the cured surface of resin cement.

METHODS

Three kinds of resin cement were divided into three groups: (1) light-cured group: RelyX Veneer, NX3 (light-cured), Variolink N; (2) dual-cured group: RelyX U200 Automix, NX3 (dual-cured), Multilink Speed; (3) chemically-cured group, and the above 3 types of dual-cured resin cement cured without illumination could be used as chemically-cured resin cement. Each sample was provided with and without oxygen exposure of two matching surfaces, cured respectively, and the variables of light intensity and illumination time were set in the light-cured group and the dual-cured group. Scanning electron microscopy was used to observe the samples' surface morphology. Energy dispersive spectrometer was used to analyze the samples' composition of surface elements. Confocal Raman spectroscopy was used to measure the monomer conversion of resin cement and to obtain the thickness of the oxygen inhibition layer.

RESULTS

(1) On the surface of cured resin cement, the weight percentage of oxygen element in the aerobic side was higher than that in the anaerobic side (P < 0.05), and the weight percentage of inorganic element was lower than that in the anaerobic side (P < 0.05). (2) The surface monomer conversion of the cured resin cement on the aerobic surface was significantly lower than that on the anaerobic surface (P < 0.05), and the surface monomer conversion on the aerobic surface and the anaerobic surface was the lowest in the chemically-cured group (P < 0.05), the dual-cured group was the highest (P < 0.05), and the light-cured group was between them. With the increase of light intensity or illumination time, the surface monomer conversion increased (P < 0.05). (3) The thickness of the oxygen inhibition layer was the thickest in the chemically-cured group [(40.27±2.81) μm](P < 0.05), the thinnest in the dual-cured group [(21.87±5.42) μm](P < 0.05) and light-cured group [(23.73±3.84) μm] was between them. With the increase of light intensity or illumination time, the thickness of the oxygen inhibition layer of resin cement decreased (P < 0.05).

CONCLUSION

When resin cement is exposed to oxygen, it will form an oxygen inhibition layer, its surface's inorganic filler is less, the surface monomer conversion is lower. The surface monomer conversion and the thickness of oxygen inhibition layer are affected by curing mode and illumination factors.

Erratum: Ilie, N. Comparative Effect of Self- or Dual-Curing on Polymerization Kinetics and Mechanical Properties in a Novel, Dental-Resin-Based Composite with Alkaline Filler. Running Title: Resin-Composites with Alkaline Fillers. Materials 2018, 11, 108

Incorrect Title [...].

Characterisation of a Bioactive SiO2-CaO-CaF2-Na2O Glass Used in Composites

OBJECTIVES

To characterise the ion release, pH changes and apatite formation of a phosphate free bioactive glass.

METHODS

A SiO₂-CaO-CaF₂-Na₂O glass was synthesized by a melt route with a composition close to the reactive glass in the commercial Cention N® composite. The glass was characterized after immersion in three media: Artificial Saliva pH4 (AS4) Artificial Saliva pH7 (AS7) and in a high phosphate artificial saliva at pH6.5 (AS6.5). The pH and fluoride release were measured using a pH meter and an ion selective electrode. The concentration of Ca, P, Na and Si were measured by ICP-OES. The glass powders after immersion were characterized by FTIR, X-ray powder diffraction and ¹⁹F MAS-NMR.

RESULTS

The glass increased the pH in all three media. Fluoride was detected in all three media but was much higher in AS 6.5. Calcium fluoride formed in AS4 with a small amount of fluorapatite at long immersion times. Fluorapatite and calcium fluoride formed in AS7, whilst in AS6.5 fluorapatite formed. The ion concentrations in solution after immersion reflected the glass composition and the immersion media with fluorapatite being favoured by higher pHs and phosphate contents in the media.

SIGNIFICANCE

The results demonstrated the ability of the glass to increase the pH and to form fluorapatite in phosphate containing media. This may explain the low incidence of secondary caries found in the commercial composite. Unlike the commercial composite evidence was found for the precipitation of fluorite, which will act to reduce the release of fluoride for preventing secondary caries.

Comparison of the effect of bleaching with 15% carbamide peroxide and 35% hydrogen peroxide on flexural strength of Cention N in selfcured and dual-cured polymerization modes

Background. The use of bleaching agents might result in microstructural changes in tooth structure and in restorative materials. This study compared the effects of bleaching with %15 carbamide peroxide and %35 hydrogen peroxide on the flexural strength of Cention N restorative material using the self-cured and dual-cured polymerization modes. Methods. Sixty bar-shaped samples of Cention N restorative material were included in this in vitro study and assigned to three groups (n=20) randomly: control, bleaching with %15 carbamide peroxide and bleaching with %35 hydrogen peroxide. Each group was divided into two subgroups: samples polymerized in the self-cured mode and samples polymerized in the dual-cured mode. Then the flexurals trengths of the samples were determined. Two-way ANOVA was used to compare flexural strengths between the three groups in two polymerization modes, followed by post hoc Tukey test. Statisticals ignificance was defined at P<0.05. Results. The difference in the mean flexural strength was significant in terms of the bleaching regimen (P<0.001), with significantly lower flexural strength in the two bleaching groups compared to the control group. However, the mean flexural strengths were not significantly different in terms of the polymerization mode applied (P=0.14). Conclusion. The application of %15 carbamide peroxide and %35 hydrogen peroxide bleaching agents decreased the flexural strength of Cention N restorative material. Irrespective of the bleaching regimen, there was no significant difference in the flexural strength of Cention N between the self-curing and dual-curing polymerization modes.

Evaluation of the Bond Strength and Cytotoxicity of Alkasite Restorative Material

Cention N (CN; Ivoclar Vivadent, Schaan, Liechtenstein), advertised as an alkasite, is a bioactive bulk-fill resin-based composite (BF-RBC) with alkaline fillers. This study evaluated the resin-dentin micro-tensile bond strength (μTBS) and cytotoxicity of CN. Methods: Flat dentin surfaces were obtained, bonded with a universal adhesive, and randomly distributed into two groups. CN (group I) and a flowable BF-RBC, namely, Tetric N-Flow Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein (group II), were used. After thermocycling, bonded samples were sectioned into micro-beams for μTBS evaluation. Resin-based composite (RBC) discs with a thickness of 2 and 4 mm were tested on human gingival fibroblast cells (HGFCs). Cytotoxicity was assessed by cell viability and growth using AlamarBlue® (Biosource, Camarillo, CA, USA) over a seven-day period. Independent t-test was utilized to statistically analyze μTBS data, while one- and two-way analysis of variance (ANOVA) and Tukey’s post-hoc tests were utilized to analyze the cell viability data. Results: There was no statistically significant difference (p > 0.05) in the μTBS between the flowable BF-RBC and CN. For both materials, the HGFCs were viable, with constant growing over the seven-day period. Conclusion: CN provided a resin-dentin μTBS that was comparable to that provided by the flowable BF-RBC. Both materials showed acceptable cytotoxicity over the seven-day period at a thickness of both 2 and 4 mm.

Comparative evaluation of fluoride release and re-release and recharge potential of Zirconomer Improved and Cention

BACKGROUND

The cariostatic action associated with fluoride-releasing restorative materials is mainly attributed to a sustained release of fluoride. This research aims on comparing Cention N and Zirconomer Improved in vitro fluoride release and re-release.

METHODS

Test materials were grouped into two categories containing 15 samples each. The cumulative fluoride release and re-release measurements was made during 1st, 7th and 15th day. The independent sample t-test and paired t-test was used to check mean differences. The level of significance was kept at p<0.05.

RESULTS

At day 1, 7 and 15 the initial fluoride release of zirconomer group was significantly higher (p<0.05) than the cention group. It was found that from day 1 to day 7 the mean initial fluoride release has significantly reduced (p<0.05) for both the groups. Similar results were also seen when comparisons were done between day 7 to day 15 (p<0.05) and day 1 to day 15 (p<0.05) for both the groups.

CONCLUSION

Zirconomer was more efficient in initial and fluoride re-release than the Cention N restorative material. Further in vivo studies with more parameters are recommended to evaluate fluoride release and cariostatic performance of Cention N and Zirconomer in real environmental circumstances.

Physicochemical and biological assessment of silver nanoparticles immobilized Halloysite nanotubes-based resin composite for dental applications

OBJECTIVE

The purpose of this study was to investigate the effect of Silver nanoparticle immobilized Halloysite Nanotubes (HNT/Ag) fillers on physicochemical, mechanical, and biological properties of novel experimental dental resin composite in order to compare with the properties of corresponding composites containing conventional glass fillers.

METHODS

Dental resin (Bis-GMA/TEGDMA with ratio 70/30) composites were prepared by incorporation of varied mass fraction of HNT/Ag. Experimental composites were divided into six groups, one control group and five experimental groups containing mass fraction 1 to 10.0 wt. % of HNT/Ag. Mechanical properties of the dental composites were recorded. Degree of conversion and depth of cure of the dental resin composites were assessed. Antimicrobial properties were assessed using agar diffusion test and evaluation of cytotoxicity were performed on NIH-3T3 cell line.

RESULTS

The inclusion of mass fractions (1-5 wt. %) of the HNT/Ag in dental resins composites, significantly improved mechanical properties. While, addition of larger mass fractions (7.5 and 10 wt. %) of the HNT/Ag did not show further improvement in the mechanical properties of dental resins composites. Theses composites also demonstrated satisfactory depth of cure and degree of conversion. A significant antibacterial activity was observed on S. mutans. No significant cytotoxicity was found on NIH-3T3 cell lines.

CONCLUSION

The incorporation of HNT/Ag in Bis-GMA/TEGDMA dental resins composites resulted in enhancement in mechanical as well as biological properties for dental applications.

CLINICAL SIGNIFICANCE

HNT/Ag containing dental composite is proposed to be highly valuable in the development of restorative dental material for patients with high risk of dental caries.

Marginal integrity of aesthetic restorations following intracoronal bleaching with sweet potato extract as an additive: An SEM study

The aim of this in vitro study was to evaluate the marginal integrity of an alkasite restoration in comparison to that of a conventional composite resin restoration following intra-coronal bleaching with 30% hydrogen peroxide (HP) containing sweet potato extract (SPE) as an additive. Access cavities were prepared in 60 extracted human incisors. The teeth were decoronated 2mm below the CEJ and the pulp chambers were sealed cervically. The samples were divided into two groups (n = 30) based on the type of restorative material - group I: Hybrid composite resin and group II: Alkasite restorative material. Both the groups were divided into three subgroups (n = 10) based on the intra-coronal bleaching agent used namely, subgroup A: no bleaching (NB); subgroup B: 30% hydrogen peroxide (HP) and subgroup C: 30% hydrogen peroxide containing SPE (HSP). The tooth-restorative interface was observed under a scanning electron microscope (SEM) to determine the marginal integrity. The results were tabulated and statistically analyzed using one-way ANOVA. Specimens bleached with HP alone showed higher marginal gaps, irrespective of the restorative material used. Subgroups A and C showed lesser marginal gaps under both the restorative materials. An improved marginal integrity was seen with the alkasite material. It can be concluded that the addition of SPE to HP improves the marginal integrity of the coronal restorative material placed immediately post-bleaching. The new alkasite material holds promise as a permanent coronal seal in cases of intra-coronal bleaching.

Physicochemical and biological assessment of flowable resin composites incorporated with farnesol loaded halloysite nanotubes for dental applications

The aim of this study was to fabricate flowable resin composites, by incorporating Farnesol loaded Halloysite Nanotubes (Fa-HNT) as a filler and evaluate their physicochemical as well as biological properties. Chemical and morphological characterization of antibacterial filler, Fa-HNT were performed using Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), Transmission Electron Microscope (TEM), Scanning Electron Microscope (SEM). The antibacterial filler was mixed into composite material consisting of methacrylate monomers and dental glass fillers at concentrations of 1-20% (wt./wt.). It was observed that addition of mass fractions of Fa-HNT causes enhancement of compressive strength as well as flexural modulus of the composite. However, it significantly decreases flexural strength and degree of conversion. A significant antibacterial activity of dental composite was observed with increase in the area of zone of inhibition against the strains of Streptococcus mutans (S. mutans). There was no cytotoxicity observed by Fa-HNT resin composites on NIH-3T3 (mouse embryonic fibroblast cells) cell lines. A favourable integration of antibacterial filler with significant mechanical properties was achieved at concentrations from 7 to 13 wt% of Fa-HNT in dental composites, which is desirable in dentistry.

Monomer conversion, dimensional stability, biaxial flexural strength, and fluoride release of resin-based restorative material containing alkaline fillers

The aim of this study was to assess monomer conversion, dimensional stability (mass and volume changes), biaxial flexural strength (BFS), and fluoride release of recently developed resin composites containing alkaline fillers (Cention N; CN) compared with resin-modified glass ionomer cements (RMGICs: Riva LC; RL and Fuji II LC; FL), and conventional composite (Z350). FL showed highest monomer conversion (88±2%) followed by RL (73±10%), CN (59±2%), and Z350 (50±2%). RL exhibited highest mass and volume increase (10.22±0.04 wt% and 19.4±0.2 vol%). CN exhibited higher BFS (180±20 MPa) than RMGICs but lower than Z350 (248±27 MPa). The highest cumulative fluoride release at 6 weeks was observed with RL (136±22 ppm) followed by CN (36±4 ppm) and FL (30±3 ppm). CN exhibited monomer conversion higher than the composite. CN also released fluoride in the range of that observed with RMGICs but with higher flexural strength.

Characterization of the bioactivity of two commercial composites

The aim of this study was to characterize the ion release, pH changes and apatite formation ability of two potentially bioactive composites Cention N (CN) and Activa (ACT). Ion release and apatite formation was investigated in three different immersion media: Tris buffer pH 7.3 (TB), Artificial Saliva pH 4 (AS4) and Artificial Saliva pH 7 (AS7) in order to mimic the conditions present in the mouth. Fluoride release was followed using an ion selective electrode, whilst all other ions were determined by inductively coupled plasma optical emission spectroscopy. Apatite formation was followed by FTIR and XRD. SEM was used to follow glass degradation and apatite formation on both polished cross-sections and surfaces of the composites. ACT released very few ions including fluoride upon immersion in TB and AS7, but released more ions including significant quantities of Al in AS4. This would suggest the glasses in ACT are acid degradable fluoro-alumino-silicate glasses similar to the glasses used in glass ionomer cements. There was no evidence of any apatite formation with ACT. CN released more ions in TB and AS7 than ACT and formed an apatite like phase in AS7. The calcium fluoro-silicate glass in CN was observed to degrade significantly in AS4. CN has bioactive properties that may explain the low incidence of secondary caries found clinically with this composite.

Different depth-related polymerization kinetics of dual-cure, bulk-fill composites

OBJECTIVE

The aim of this study was to evaluate the polymerization kinetics qualitatively and quantitatively for dual-cure bulk-fill composites in comparison with light-cure bulk-fill and traditional incremental composites at two clinically relevant depths.

METHODS

Five commercial dental composites were evaluated, including three dual-cure bulk-fill composites (BulkEZ, HyperFIL and Injectafil), one light-cure bulk-fill composite Filtek Bulk Fill Flowable (FBF) and one traditional incremental composite Filtek Z250 (Z250) as controls. Specimens were prepared in two different depths (0.5 mm and 5 mm) for 20 s light irradiation. Self-cure was also evaluated for the three dual-cure composites. The polymerization kinetics were measured continuously in real-time for at least 10 min using a Fourier-transform infrared spectroscopy (FTIR) with an attenuated total reflectance (ATR) accessory. The experimental kinetic data were fitted using two mathematical models - a sigmoidal function and a superposition of two exponential functions characterizing the gel phase and glass phase. The degree of conversion (DC) and the rate of polymerization were calculated for all test conditions.

RESULTS

Both experimental FTIR measurements and mathematical modeling revealed distinct depth-related polymerization kinetics for BulkEZ compared to the other two dual-cure composites. Specifically, BulkEZ exhibited moderately-paced polymerization kinetics at both depths while HyperFIL and Injectafil exhibited faster polymerization at 0.5 mm and slower polymerization at 5 mm. The bulk-fill FBF and incremental Z250 exhibited relatively fast polymerization at both depths, a characteristic for light-cure. The DC values at the two depths were not significantly different for BulkEZ, but significantly higher at 0.5 mm than at 5 mm for the other four composites (α = 0.05).

SIGNIFICANCE

Polymerization kinetics and their depth variation for dual-cure bulk-fill composites are material dependent. The distinct depth-related polymerization kinetics revealed for BulkEZ compared to other composites may affect their contraction stress and clinical performance.