The First Step in Standardizing an Artificial Aging Protocol for Dental Composites—Evaluation of Basic Protocols

Gingival margin interfacial microleakage, staining, and push-out strengths of gingival colored composite resins in denture bases

STATEMENT OF PROBLEM

Staining at the gingival margin could impact denture longevity, but the behavior of gingival colored composite resins (GCCs) in this area remains unclear.

PURPOSE

This in vitro study evaluated surface staining, microleakage, and push-out bond strength at the gingival margin of artificial teeth, comparing two consistencies of GCCs with two resin base materials.

MATERIAL AND METHODS

Specimens included artificial teeth (Ivostar; Ivoclar AG) and two acrylic resin base materials: conventional (Ondacryl; Clássico) and high-impact (Diamond D; Keystone Industries) (n=300). Specimens were divided in three groups: control (acrylic resin) and experimental groups, receiving one of the two GCCs consistencies: paste (SR Nexco; Ivoclar AG) or flowable (Gradia Plus Gum; GC Europe)). Initial artificial aging treatment in distilled water (5 days at 55º C) was performed and the specimens were then immersed in 5% methylene blue dye or coffee for 7 days at 37º C. Staining was visually assessed, and the specimens were sectioned for dye infiltration analysis at the gingival margin using a stereomicroscope. Bond strength was measured with the push-out test in the gingival colored composite resin specimens. Data were analyzed using 2-way and 3-way ANOVA with Bonferroni post hoc test and Kruskal-Wallis test with Dunn post hoc test (α=.05).

RESULTS

A significantly higher surface staining and microleakage was observed in experimental groups compared to the control (acrylic resin) (P<.001). Surface staining revealed that paste consistency GCC was more susceptible to discoloration in coffee, while flowable GCC was more affected by methylene blue. Lower microleakage values were observed in the control (acrylic resin) groups (0.11 ±0.13 mm for the conventional base and 0.08 ±0.11 mm for the high-impact base) in comparison with the experimental groups (P<.05). The flowable GCC showed the highest microleakage with methylene blue (0.98 ±0.21 mm for the conventional base and 0.91 ±0.31 mm for the high-impact base), significantly greater than the paste consistency for both base materials (0.53 ±0.22 mm for the conventional base and 0.66 ±0.34 mm for the high-impact base; P<.001). For coffee immersion, both GCC consistencies displayed similar microleakage values (P>.05). Push-out bond strength was comparable between paste and flowable GCCs (P>.05).

CONCLUSIONS

Microleakage at the gingival margin was significantly greater when GCC was applied, regardless of the consistency. However, the GCC consistency seems to not affect push-out bond strength. Further clinical studies are needed to better understand the impact of these findings on prosthesis longevity.

Synergistic effects of bacteria, enzymes, and cyclic mechanical stresses on the bond strength of composite restorations

Predicting how tooth and dental material bonds perform in the mouth requires a deep understanding of degrading factors. Yet, this understanding is incomplete, leading to significant uncertainties in designing and evaluating new dental adhesives. The durability of dental bonding interfaces in the oral microenvironment is compromised by bacterial acids, salivary enzymes, and masticatory fatigue. These factors degrade the bond between dental resins and tooth surfaces, making the strength of these bonds difficult to predict. Traditionally studied separately, a combined kinetic analysis of these interactions could enhance our understanding and improvement of dental adhesive durability. To address this issue, we developed and validated an original model to evaluate the bond strength of dental restorations using realistic environments that consider the different mechanical, chemical, and biological degradative challenges working simultaneously: bacteria, salivary esterases, and cyclic loading. We herein describe a comprehensive investigation on dissociating the factors that degrade the bond strength of dental restorations. Our results showed that cariogenic bacteria are the number one factor contributing to the degradation of the bonded interface, followed by cyclic loading and salivary esterases. When tested in combinatorial mode, negative and positive synergies towards the degradation of the interface were observed. Masticatory loads (i.e., cycling loading) enhanced the lactic acid bacterial production and the area occupied by the biofilm at the bonding interface, resulting in more damage at the interface and a reduction of 73 % in bond strength compared to no-degraded samples. Salivary enzymes also produced bond degradation caused by changes in the chemical composition of the resin/adhesive. However, the degradation rates are slowed compared to the bacteria and cyclic loading. These results demonstrate that our synergetic model could guide the design of new dental adhesives for biological applications without laborious trial-and-error experimentation.

Simulation of oral environmental conditions through artificial aging of teeth for the assessment of enamel discoloration in orthodontics

BACKGROUND

The clinical performance of dental materials can be predicted via artificial aging approaches. The bracket bonding procedure may cause irreversible alterations to the enamel surface. The aim of this study was to introduce a novel artificial aging protocol and evaluate its effect on the discoloration of both bracket-bonded and unbonded teeth while also comparing the effects of four orthodontic adhesives on enamel color and whiteness.

METHODS

One hundred permanent lower incisors from humans were randomly divided into five groups, each including 20 specimens. The lower incisor metal brackets were bonded to the teeth via four different orthodontic adhesives (Transbond XT, Kurasper F, Bisco ORTHO, and Light Bond), and a control group was established. To simulate the cumulative effects of aging on the oral cavity, all the samples were subjected to mechanical cyclic loading (50,000 cycles), hydrothermal cycling (10,000 cycles), or exposure to stained beverages (25 days). A colorimeter device was used to measure the color of the teeth before and after testing. Statistical differences were calculated via one-way analysis of variance (ANOVA) and Tukey's test.

RESULTS

The combined aging protocol resulted in statistically significant and clinically unacceptable differences in tooth color alterations and whiteness index values across all groups (p < 0.05). The control group presented the least significant discoloration, whereas the bracket-bonded groups presented greater discoloration. Furthermore, there were statistically significant differences among the bracket-bonded groups (p < 0.05).

CONCLUSIONS

The combined artificial aging protocol can be employed to simulate the macroenvironmental conditions of the oral cavity in laboratory investigations. The composition of the orthodontic adhesive also influences the severity of tooth discoloration.

Compression Behavior of Dental Flowable Composites-Digital Image Correlation and Numerical Analysis

In the development of restorative materials, it is important to evaluate the elastic properties of the material in order to achieve good clinical results. The aim of this study was to evaluate the compression behavior of two dental flowable materials (EverX Flow and Flow-Art) using experimental methods and numerical simulation. The Poisson's ratio was determined using two methods of strain measurement: the electrical strain gauge method (ESG) and digital image correlation (DIC). Material constants determined in experimental studies were implemented in a numerical model, and displacement analysis was conducted using the finite element method (FEM). The tests showed higher compressive strength and modulus of elasticity for EverX Flow compared to Flow-Art. The values of the Poisson's ratio were similar for both measurement methods, ranging from 0.27 to 0.28 for EverX Flow and from 0.30 to 0.32 for Flow-Art. This demonstrated the feasibility of the DIC method for obtaining the Poisson's ratio values for this type of composites. Compression test conditions were reproduced in the numerical analysis. The obtained distributions of the displacement field on the surface of the sample from the DIC and numerical analyses were compared. A good match was observed between DIC displacement measurements and displacement values obtained in FEM analysis. The comprehensive approach used in the study allows us to analyze whether the results obtained in the numerical simulation correspond to the material response to the applied load and validate the model.

Effect of aging and fiber-reinforcement on color stability, translucency, and microhardness of single-shade resin composites versus multi-shade resin composite

OBJECTIVE

The purpose of this study was to evaluate the effect of aging and fiber-reinforcement on the color stability, translucency, and microhardness of single-shade resin composites versus multi-shade resin composite.

MATERIALS AND METHODS

Four resin composites (Filtek Z250, Omnichroma, Vittra APS Unique, Zenchroma) were tested. Three subgroups of specimens were prepared for each of the composites: control, polyethylene fiber-reinforcement, and glass fiber-reinforcement- groups (n = 10/per group). The samples were subjected to aging for 10,000 thermal cycles. Color differences (ΔE00 ) were calculated after aging. Relative translucency parameter (RTP00 ) and microhardness values were calculated before and after aging. A two-way analysis of variance and the generalized linear model was used (p < 0.05).

RESULTS

The lowest and highest ΔE00 values were found for Filtek Z250 (0.6 ± 0.2) and Omnichroma resin composites (1.6 ± 0.4), respectively. The ΔE00 value of the polyethylene fiber-reinforcement group (1.2 ± 0.6) was significantly higher than the ΔE00 value of the glass fiber-reinforcement group (1.0 ± 0.4, p < 0.001). The RTP00 value of the glass fiber-reinforcement group (1.92 ± 0.78) was significantly higher than the RTP00 value of the polyethylene fiber-reinforcement group (1.72 ± 0.77, p < 0.001). The highest microhardness values were found in glass fiber-reinforcement group (76.48 ± 17.07, p < 0.001).

CONCLUSION

Single-shade resin composites were more translucent, had higher color change, and lower hardness than multi-shade resin composite. For relative translucency and microhardness, statistical significance was found in the material and fiber type interaction. The glass fiber-reinforcement provided higher translucency, lower color change and higher microhardness values than polyethylene fiber-reinforcement group after aging. Thermocycling had a significant impact on the color stability, translucency parameter, and microhardness of the tested resin composite materials.

CLINICAL SIGNIFICANCE

Single-shade resin composite materials have greater color-changing potential. The glass fiber-reinforcement optimize resin material mechanical properties and color stability more than polyethylene fiber-reinforcement.

Marginal adaptation of bulk-fill resin composites with different viscosities in class II restorations: a micro-CT evaluation

BACKGROUND

The purpose of this study is to evaluate the marginal adaptation of bulk-fill resin composites with different viscosities (paste-like and flowable) in Class II restorations using micro-CT imaging.

METHODS

Forty extracted human molars were used. Mesial and distal Class II box cavities (approximately 3 mm x 3 mm x 4 mm) were prepared for each tooth, with cavity floors located 1 mm below the enamel-cementum junction. Following adhesive application, teeth were restored using eight different groups: Group XB: X-tra Base Bulk-fill Flowable (VOCO), Group XF: X-tra Fill Bulk-fill (VOCO), Group FB: Filtek Bulk-fill Posterior (3 M ESPE), Group FF: Filtek Bulk-fill Flowable (3 M ESPE), Group BB: Beautifil-Bulk (SHOFU), Group BF: Beautifil-Bulk Flowable (SHOFU), and Group CO: "as a control group", Clearfil Majesty Posterior (KURARAY) and Group CF: "as a control group", Clearfil Majesty Flow + Clearfil Majesty Posterior (KURARAY). The restored teeth underwent an aging protocol involving 1000 cycles in a water bath fluctuating between 5 ± 1.0 °C and 55 ± 1.0 °C. Post-aging, teeth were immersed in 50% silver nitrate solution for 24 h and then in a film developer solution for 8 h. Microleakage analysis was performed using micro-CT, evaluated with 3D Slicer software. A two-way ANOVA was employed for statistical analysis.

RESULTS

Two-way ANOVA results indicated significant effects of both viscosity (p < 0.0001) and composite type (p < 0.0001) on marginal adaptation. Viscosity analysis (comparing flowable and paste-like) revealed no significant differences in the FB-FF, XB-XF and BB-BF groups but significant differences in the and CO-CF group, with flowable type exhibiting less microleakage than paste-like type.

CONCLUSIONS

The study suggests that while the viscosity of bulk-fill composites did not significantly affect marginal adaptation, the brand of bulk-fill composite did influence it.

Influence of the Loading with Newly Green Silver Nanoparticles Synthesized Using Equisetum sylvaticum on the Antibacterial Activity and Surface Hardness of a Composite Resin

The aim of the study was to evaluate the antibacterial activity and surface hardness of a light-activated microhybrid composite resin modified with green silver nanoparticles (AgNPs). AgNPs were synthesized using an Equisetum sylvaticum extract and characterized through different methods such as UV-Vis, EDX, and FTIR. The obtained AgNPs were mixed with a microhybrid composite resin (Herculite XRV, Kerr Corp., Orange, CA, USA) in different concentrations: 0% (group A-control); 0.5% (group B); 1% (group C); and 1.5% (group D). A total of 120 composite resin disk-shaped samples were obtained and divided into 4 groups (n = 30) according to AgNP concentration. Each group was then divided into 2 subgroups: subgroup 1-samples were not soaked in 0.01 M NaOH solution; and subgroup 2-samples were soaked in 0.01 M NaOH solution. The antibacterial activity against Streptococcus mutans was determined using a direct contact test. A digital electronic hardness tester was used to determine the composite resin's Vickers surface hardness (VH). Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis nonparametric tests with a confidence level of 95%. Groups C and D showed higher antibacterial activity against S. mutans when compared to the control group (p < 0.05). No significant differences were recorded between VH values (p > 0.05). The use of AgNPs synthesized from Equisetum sylvaticum as a composite resin filler in 1% wt. and 1.5% wt. reduced the activity of Streptococcus mutans. Soaking of the experimental composite resin decreased the antibacterial efficacy. The loading of a microhybrid composite resin with AgNPs in concentrations of 0.5% wt., 1% wt., and 1.5% wt. did not influence the surface hardness.

Can Modification with Urethane Derivatives or the Addition of an Anti-Hydrolysis Agent Influence the Hydrolytic Stability of Resin Dental Composite?

Due to the questionable durability of dental restorations, there is a need to increase the lifetime of composite restoration. The present study used diethylene glycol monomethacrylate/4,4'-methylenebis(cyclohexyl isocyanate) (DEGMMA/CHMDI), diethylene glycol monomethacrylate/isophorone diisocyanate (DEGMMA/IPDI) monomers, and bis(2,6-diisopropylphenyl)carbodiimide (CHINOX SA-1) as modifiers of a polymer matrix (40 wt% urethane dimethacrylate (UDMA), 40 wt% bisphenol A ethoxylateddimethacrylate (bis-EMA), and 20 wt% triethyleneglycol dimethacrylate (TEGDMA)). Flexural strength (FS), diametral tensile strength (DTS), hardness (HV), sorption, and solubility were determined. To assess hydrolytic stability, the materials were tested before and after two aging methods (I-7500 cycles, 5 °C and 55 °C, water and 7 days, 60 °C, 0.1 M NaOH; II-5 days, 55 °C, water and 7 days, 60 °C, 0.1 M NaOH). The aging protocol resulted in no noticeable change (median values were the same as or higher than the control value) or a decrease in the DTS value from 4 to 28%, and a decrease in the FS value by 2 to 14%. The hardness values after aging were more than 60% lower than those of the controls. The used additives did not improve the initial (control) properties of the composite material. The addition of CHINOX SA-1 improved the hydrolytic stability of composites based on UDMA/bis-EMA/TEGDMA monomers, which could potentially extend the service life of the modified material. Extended studies are needed to confirm the possible use of CHINOX SA-1 as an antihydrolysis agent in dental composites.

Effect of Different Surface Treatments on the Long-Term Repair Bond Strength of Aged Methacrylate-Based Resin Composite Restorations: A Systematic Review and Network Meta-analysis

This systematic review and network meta-analysis is aimed at investigating the effect of common surface treatments on the long-term repair bond strength of aged resin composite restorations and to rank and compare these surface treatments. In vitro studies evaluating the methacrylate-based resin composites subjected to rigorous aging protocols before and after being repaired with a new composite were included. A frequentist network meta-analysis was carried out using a random effects model. P scores were used to rank the efficacy of the surface treatments. Also, the global and node-split inconsistencies were evaluated. Web of Science, PubMed/Medline, Scopus, and Embase databases were searched until July 07, 2022. Twenty-six studies were included in the meta-analysis. The results showed that the application of silane and a total-etch (shear MD 32.35 MPa, 95% CI: 18.25 to 46.40, P score 0.95; tensile MD 33.25 MPa, 95% CI: 25.07 to 41.44; P score 0.77) or a self-etch (shear MD 38.87 MPa, 95% CI: 21.60 to 56.14, P score 0.99; tensile MD 32.52 MPa, 95% CI: 23.74 to 41.29; P score 0.73) adhesion protocol subsequent to the roughening with diamond bur produced the highest (micro)tensile and (micro)shear bond strengths compared to diamond bur alone as the control group. There was no difference between self- and total-etch adhesive protocols. Mechanical surface treatments yielded greater bond strength when used alongside the chemical adhesive agents. Further, it is possible to achieve acceptable repair bond strength using common dental clinic equipment. Therefore, clinicians could consider repairing old resin composites rather than replacing them.

An Evaluation of the Hydrolytic Stability of Selected Experimental Dental Matrices and Composites

Materials with potential use as dental restoration should be evaluated in an aggressive environment. Such accelerated aging is widely used in other industries and allows the assessment of service life. In the presented study, three neat resins (UDMA/Bis-GMA/TEGDMA 70/10/20 wt.%, UDMA/Bis-GMA/TEGDMA 40/40/20 wt.% and UDMA/Bis-EMA/TEGDMA 40/40/20 wt.%) and three composites based on these matrices were tested before and after aging protocols (I-7500 cycles, 5 °C and 55 °C, water and 7 days, 60 °C, 0.1 M NaOH; II-5 days, 55 °C, water and 7 days, 60 °C, 0.1 M NaOH). Flexural strength (FS), diametral tensile strength (DTS) and hardness (HV) were determined. Applied aging protocols resulted in a decrease in the value of the FS, DTS and HV. Larger changes were noticed for the neat resins. Materials in which the content of bis-GMA was lower or substituted by bis-EMA showed better resistance to degradation. The choice of mixtures with monomers characterized by lower sorption values may favorably affect hydrolytic stability. It was shown that for composites there was a drastic decrease in hardness, which suggests a more superficial effect of the used protocols. However, degradation of the surface layer can result in a growing problem over time given that the mastication processes are an inherent element in the oral environment.