Ageing of Dental Composites Based on Methacrylate Resins-A Critical Review of the Causes and Method of Assessment

Surface alterations and compound release from aligner attachments in vitro

AIM

The aim of the present study was to assess the alterations in morphology, roughness, and composition of the surfaces of a conventional and a flowable composite attachment engaged with aligners, and to evaluate the release of resin monomers and their derivatives in an aqueous environment.

METHODS

Zirconia tooth-arch frames (n = 20) and corresponding thermoformed PET-G aligners with bonded attachments comprising two composite materials (universal-C and flowable-F) were fabricated. The morphological features (stereomicroscopy), roughness (optical profilometry), and surface composition (ATR-FTIR) of the attachments were examined before and after immersion in water. To simulate intraoral use, the aligners were removed and re-seated to the frames four times per day for a 7-day immersion period. After testing, the eluents were analyzed by LC-MS/MS targeting the compounds Bis-GMA, UDMA, 2-HEMA, TEGDMA and BPA and by LC-HRMS for suspect screening of the leached dental material compounds and their degradation products.

RESULTS

After testing, abrasion-induced defects were found on attachment surfaces such as scratches, marginal cracks, loss of surface texturing, and fractures. The morphological changes and debonding rate were greater in F. Comparisons (before-after testing) revealed a significantly lower Sc roughness parameter in F. The surface composition of the aligners after testing showed minor changes from the control, with insignificant differences in the degree of C = C conversion, except for few cases with strong evidence of hydrolytic degradation. Targeted analysis results revealed a significant difference in the compounds released between Days 1 and 7 in both materials. Insignificant differences were found when C was compared with F in both timeframes. Several degradation products were detected on Day 7, with a strong reduction in the concentration of the targeted compounds.

CONCLUSIONS

The use of aligners affects the surface characteristics and degradation rate of composite attachments in an aqueous environment, releasing monomers, and monomer hydrolysates within 1-week simulated use.

Effects of printing orientation and artificial ageing on martens hardness and indentation modulus of 3D printed restorative resin materials

BACKGROUND

Three-dimensional (3D) printing is increasingly used to fabricate dental restorations due to its enhanced precision, consistency and time and cost-saving advantages. The properties of 3D-printed resin materials can be influenced by the chosen printing orientation which can impact the mechanical characteristics of the final products.

PURPOSE

The objective of this study was to evaluate the influence of printing orientation and artificial ageing on the Martens hardness (HM) and indentation modulus (EIT) of 3D-printed definitive and temporary dental restorative resins.

METHODS

Disk specimens (20 mm diameter × 2 mm height) were additively manufactured in three printing orientations (0°, 45°, 90°) using five 3D-printable resins: VarseoSmile Crownplus (VCP), Crowntec (CT), Nextdent C&B MFH (ND), Dima C&B temp (DT), and GC temp print (GC). The specimens were printed using a DLP 3D-printer (ASIGA MAX UV), while LavaTM Ultimate (LU) and Telio CAD (TC) served as milled control materials. Martens hardness (HM) and indentation modulus (EIT) were tested both before and after storage in distilled water and artificial saliva for 1, 30, and 90 days at 37 °C.

RESULTS

90° printed specimens exhibited higher HM than the other orientations at certain time points, but no significant differences were observed in HM and EIT between orientations for all 3D-printed materials after 90 days of ageing in both aging media. LU milled control material exhibited the highest HM and EIT among the tested materials, while TC, the other milled control, showed similar values to the 3D printed resins. CT and VCP (definitive resins) and ND displayed higher Martens parameters compared to DT and GC (temporary resins). The hardness of the 3D-printed materials was significantly impacted by artificial ageing compared to the controls, with ND having the least hardness reduction percentage amongst all 3D-printed materials. The hardness reduction percentage in distilled water and artificial saliva was similar for all materials except for TC, where higher reduction was noted in artificial saliva.

SIGNIFICANCE

The used 3D printed resins cannot yet be considered viable alternatives to milled materials intended for definitive restorations but are preferable for use as temporary restorations.

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.

Aging processes in dental thermoplastics - Thermoanalytical investigations and effects on Vickers as well as Martens hardness

OBJECTIVE

The influence of various aging protocols, representing and accelerating influences present in the dental context, on possible changes in the microstructure and mechanical properties of thermoplastics was investigated. In order to minimize the complexity of the systems, first pure polymers and then later the equivalent dental polymeric materials were analyzed.

MATERIALS AND METHODS

Pure polymers (Poly(methyl methacrylate) - PMMA, Polyoxymethylene homopolymer - POM-H, Polyether ether ketone - PEEK, Nylon 12 - PA12, Polypropylene - PP) were analyzed before as well as after applying different aging protocols relevant to the oral environment (ethanol, thermocycling, alkaline and acidic setting) by differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). The thermoanalytical parameters used were glass transition temperature (Tg), melting peak and crystallization peak temperature (Tpm, Tpc) and decomposition behavior. In a second step selected commercially available dental products (Telio CAD - PMMAD, Zirlux Acetal - POMD, Juvora Natural Dental Disc - PEEKD) aged by the protocol that previously showed strong effects were examined and additionally tested for changes in their Vickers and Martens hardness by Mann-Whitney-U test.

RESULTS

The combinations of pure polymers and viable aging protocols analyzed within this study were identified via TGA or DSC as PA12 & thermocycling, POM-H & denture cleanser/lactic acid/ethanol, PP & lactic acid. The dental polymeric materials PMMAD and POMD due to aging in lactic acid showed slight but significantly (p < 0.01) reduced Vickers and partly Martens hardness. PEEK showed the greatest material resistance within this study.

Awareness of possible complications associated with direct composite restorations: A multinational survey among dentists from 13 countries with meta-analysis

OBJECTIVES

Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material.

METHODS

The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials.

RESULTS

A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065).

CONCLUSIONS

Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists.

CLINICAL SIGNIFICANCE

Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries.

Effect of polymerisation protocols on water sorption, solubility and hygroscopic expansion of fast-cure bulk-fill composite

OBJECTIVE

This study examines the effect of two light-curing protocols from a LED polywave light curing unit (LCU) on water sorption, solubility, and hygroscopic expansion of fast and conventional bulk-fill resin-based composites (RBCs) aged in distilled water for 120 d.

METHODS

Three bulk-fill RBCs materials were studied: Tetric PowerFill® (fast photo-polymerised composite) (TPF), Tetric EvoCeram bulk-fill (EVO), and GrandioSo x-tra bulk-fill (GSO) (conventional photo-polymerised composites). Specimens were prepared within a 3D-printed resin mold (8-mm diameter x 4-mm height) and light-cured from one side only with 2 modes of polywave LCU (Bluephase® PowerCure): 3 s mode and for 20 s in "Standard" mode. Water sorption and solubility were measured at fixed time intervals for 120 d of distilled water storage, then reconditioned to dry to measure desorption for 75 d, all at 37 ± 1 °C. Hygroscopic (volumetric) expansion was recorded at the same time intervals up to 120 d. Data were analysed through SPSS using Two-way ANOVA, One-way ANOVA, independent t-tests, and Tukey's post-hoc correction tests (p < 0.05).

RESULTS

TPF, when irradiated for 3 s demonstrated minimal water sorption (0.83%), solubility (1.01 μg/mm3), and least volumetric expansion (1.64%) compared to EVO and GSO. While EVO showed the highest water sorption (1.03%) and solubility (1.95 μg/mm3) at 3 s. GSO had the lowest sorption (0.67%) and (0.56%) in 3 s and 20 s protocols, respectively. Nevertheless, all the sorption and solubility data were within the ISO 4049 limits.

SIGNIFICANCE

For TPF, fast (3 s) polymerisation did not increase either water sorption or solubility, compared with 20 s irradiation. However, with the two comparative bulk-fill composites, fast cure increased water sorption by 15-25% and more than doubled solubility. These findings were consistent with the lesser volumetric expansions observed for Tetric PowerFill at both the fast and standard protocols, indicating its relative stability across polymerisation protocols.

Urchin-like multiscale structured fluorinated hydroxyapatite as versatile filler for caries restoration dental resin composites

Caries is one of the most prevalent human diseases, resulting from demineralization of tooth hard tissue caused by acids produced from bacteria, and can progress to pulpal inflammation. Filling restoration with dental resin composites (DRCs) is currently the most common treatment for caries. However, existing DRCs suffer from low fracture strength and lack comprehensive anti-caries bioactivity including remineralization, pulp protection, and anti-cariogenic bacteria effects. In this study, inspired by plant roots' ability to stabilize and improve soil, fluorinated urchin-like hydroxyapatite (FUHA) with a three-dimensional whisker structure and bioactive components of calcium, phosphorus, and fluorine was designed and synthesized by a dynamic self-assembly method. Furthermore, versatile FUHA particles with different loading fractions were used as functional fillers to fabricate methacrylate-based DRCs, where the urchin-like hydroxyapatite (UHA) filled DRCs and commercial DRCs (Z350XT and BEAUTIFIL II) served as the control groups. The results demonstrated that FUHA with 50 wt% loading in resin matrix endowed DRC (F5) with excellent physicochemical properties, dentin remineralization property, cell viability, promotion of dental pulp stem cells mineralization, and antibacterial properties. Meanwhile, F5 also presented good clinical handling and aesthetic characteristics. Therefore, structure/functional-integrated FUHA filled DRCs have potential as a promising strategy for tooth restoration and anti-caries bioactivity.

Relation between internal adaptation and degree of conversion of short-fiber reinforced resin composites applied in bulk or layered technique in deep MOD cavities

OBJECTIVE

The purpose was to evaluate the degree of conversion (DC), internal adaptation (IA) and closed porosity (CP) of short-fiber reinforced resin composites (SFRC) associated with layered or bulk restorative procedures in deep MOD cavities.

METHODS

Eighty third molars with standardized MOD cavities (5-mm-depth, 2.5-mm-width) were randomly divided into four groups and restored as follows: 1) bulk SFRC; 2) layered SFRC; 3) flowable bulk-fill resin-based composites (RBC); 4) layered conventional RBC. After one-month wet storage the samples were subjected to micro-computed tomography measurements and scanning electron microscopy to assess the IA and CP. Micro-Raman spectroscopy was used to determine the DC in different depths. Data were subjected to ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics (p < 0.05). Pearson correlation coefficient was determined to assess the relationship among the parameters of interest.

RESULTS

Gap/total interface volume ratio ranged between 0.22-0.47%. RBCs applied in bulk revealed significantly lower gap volume (p < 0.001) and CP (p < 0.05). Each group showed complete detachment on the pulpal and partial on the lateral walls, except for group3. While the highest DC% was achieved by the conventional RBC (87.2%), followed by the flowable bulk-fill (81.2%), SFRC provided the best bottom to top DC ratio (bulk: 96.4%, layered: 98.7%). The effect of factors studied (RBC type, filling technique) on IA and DC was significant (p < 0.001).

SIGNIFICANCE

Bulk placement of RBCs exhibited lower interfacial gap volume and achieved satisfactory DC without significant correlation between these parameters. Incremental insertion of SFRC had no advantage over bulk placement in terms of IA and DC.

Fracture strength of 3-units fixed partial dentures fabricated with metal-ceramic, graphene doped PMMA and PMMA before and after ageing: An in-vitro study

OBJECTIVES

To evaluate the fracture strength and linear elongation at break of three-units fixed partial dentures (FPDs) fabricated with traditional and new materials for fixed prosthodontics before and after ageing.

METHODS

Sixty models of three-units FPDs were fabricated and cemented onto a Co-Cr model simulating the replacement of a maxillary second premolar. The samples were randomly divided into 3 groups: metal-ceramic (MCR), graphene-doped polymethylmethacrylate (PMMA-GR) and polymethylmethacrylate (PMMA). Half of the samples were directly subjected to fracture test, while the remaining half underwent an ageing process and then a fracture loading test using an electrodynamic testing machine. Fracture load and elongation at break values were taken and statistically analysed.

RESULTS

Significant differences were detected between the different materials (p<0.05). All groups showed a reduction of the fracture load and elongation at break values after ageing, but not statistically significant, except for PMMA group (p = 2.012e-19) (p = 3.8e-11).

CONCLUSIONS

MCR and PMMA-GR three-units FPDs showed higher fracture strength and lower elongation at break compared to PMMA. MCR and PMMA-GR had higher resistance to ageing processes compared to PMMA.

CLINICAL SIGNIFICANCE

PMMA-GR could be considered a material for long-term provisional restorations as its mechanical behaviour and ageing resistance are more like MCR than PMMA.

Dental composite biodeterioration in the presence of oral Streptococci and extracellular metabolic products

OBJECTIVE

Secondary caries is a primary cause of early restoration failure. While primary dental caries has been extensively researched, our knowledge about the impact of secondary caries on dental restorations is relatively limited. In this study, we examined how different clinically relevant microbially-influenced environments impact the degradation of nano-filled (FIL) and micro-hybrid (AEL) dental composites.

METHODS

Material strength of two commercial dental composites was measured following incubation in aqueous media containing: i) cariogenic (Streptococcus mutans) and non-cariogenic bacteria (Streptococcus sanguinis) grown on sucrose or glucose, ii) abiotic mixtures of artificial saliva and sucrose and glucose fermentation products (volatile fatty acids and ethanol) in proportions known to be produced by these microorganisms, and iii) abiotic mixtures of artificial saliva and esterase, a common oral extracellular enzyme.

RESULTS

Nano-filled FIL composite strength decreased in all three types of incubations, while micro-hybrid AEL composite strength only decreased significantly in biotic incubations. The strength of both composites was statistically significantly decreased in all biotic incubations containing both cariogenic and non-cariogenic bacteria beyond that induced by either abiotic mixtures of fermentation products or esterase alone. Finally, there were no statistically significant differences in composite strength decrease among the tested biotic conditions.

CONCLUSIONS

The results show that conditions created during the growth of both cariogenic and non-cariogenic oral Streptococci substantially reduce commercial composite strength, and this effect warrants further study to identify the mechanism(s).

CLINICAL SIGNIFICANCE

Dental biofilms of oral Streptococci bacteria significantly affect the mechanical strength of dental restorations.

Comparison of discoloration of ceramic containing 3D printable material and CAD/CAM blocks

This study aimed to clarify aspects of the color and translucency of 3D printed dental material with CAD/CAM blocks. Three different ceramic-containing, resin-based CAD/CAM blocks and a 3D printable resin were evaluated after thermocycled and assessed for their degree of discoloration based on colorant types and storage times. Data were analyzed using repeated-measures analysis of variance followed by Tukey's post-hoc test. All materials in red wine had ∆E00 values higher than the clinically accepted threshold value. At 1 week and 1 month, the 3D material was statistically significantly more discolored than the other 3 materials (p<0.05). None of the materials exceeded the acceptable threshold value at any time point. The color changes increased over time in resin-based CAD/CAM blocks and 3D printable dental materials. After 1 week and 1 month, there was a statistically significant difference in the color change between the 3D printed material and the CAD/CAM blocks.

Clinical evaluation of lithium disilicate versus indirect resin composite partial posterior restorations - A 7.8-year retrospective study

OBJECTIVE

To evaluate retrospectively the longevity of lithium disilicate ceramic (LidiSi) vs. laboratory-processed resin-based composite (RBC) inlay/onlay/overlay restorations and risk factors associated with restoration deficiencies and failures.

METHODS

Patients (n = 91) receiving LidiSi (73.1%) and RBC (36.9%) inlays/onlays/overlays between 2007 and 2017 were selected. The restorations were evaluated using the modified U.S. Public Health Service criteria. The survival of the restorations was analyzed using the Kaplan-Meier method and log rank test. Factors affecting the occurrence of deficiencies were examined by logistic regression analysis. This was performed with the use of the Generalized Estimating Equation model including Repeated measurements (GEER), with the consideration that the same patient had several teeth in the sample. Risk estimation was conducted for each evaluated criterion (p < 0.05).

RESULTS

The survival of LidiSi and RBC restorations were 96.8% and 84.9%, respectively after a mean observation period of 7.8 ± 3.3 years. The annual failure rate was 0.2% for LidiSi and 1.0% for RBC. The probability of survival was above 98% for both restorations in the first 6 years, however, it dropped to 60% for RBC by the end of the 15th year. For both materials the reasons for failure included secondary caries, restoration fracture, and endodontic complication. In addition, LidiSi also failed due to tooth fracture, while RBC due to marginal gap formation and loss of retention. Among the evaluated risk factors, material of restoration (OR=6.8, CI95%:3.1-14.9), oral hygiene (OR=8.0, CI95%: 2.9-22.1], and bruxism (OR=1.9, CI95%: 1.1-3.3) showed a significant impact on the evaluated criteria.

SIGNIFICANCE

LidiSi and RBC restorations showed similarly excellent 6-year survival, however, in the long term significantly more failures should be expected for RBCs.

Aging Processes and Their Influence on the Mechanical Properties of Printable Occlusal Splint Materials

Three-dimensional (3D)-printed occlusal splints are becoming more prevalent in the treatment of tooth substance loss due to their fast and cost-effective production. The purpose of this in vitro study was to investigate whether the mechanical properties (tensile strength-TS, modulus of elasticity in tension-ME, and Vickers hardness-HV) vary between the materials (printed dimethacrylate-based resins: Keyprint KeySplint soft-KEY, Luxaprint Ortho Plus-LUX, V-Print splint-VPR, printed methacrylate-based resins Freeprint splint 2.0-FRE, and milled methacrylate-based material, CLEAR splint-CLE), and the influence of aging processes (extraoral storage conditions and nightly or daily use) was examined. The printed methacrylate-based resins (FRE, LUX, and VPR) had much higher TS (43.7-48.5 MPa compared to 12.3-13.3 MPa), higher ME (2.01-2.37 GPa compared to 0.43-0.72 GPa), and higher HV (11.8-15.0 HV compared to 3.3-3.5 HV) than both of the methacrylate-based resins (KEY and CLE) after the production process. Although the TS, ME, and HV of the printed dimethacrylate resins (FRE, LUX, and VPR) decreased significantly under humid conditions with possibly elevated temperatures (thermocycling as well as 37 °C), these mechanical properties were significantly higher than both methacrylate-based resins (KEY and CLE). Therefore, printed dimethacrylate resins should be used rather than methacrylate-based resins for high expected masticatory forces, low wall thicknesses, or very long wearing times (≥6 months).

Investigation of aging resistance for dental resin composites with and without glass flakes

OBJECTIVES

Outstanding physical-mechanical properties and aging resistance are key requirements for dental resin composite since it will be placed in the oral environment for a long time. In this work, a new dental resin composite mainly modified by glass flakes was fabricated, and the aging resistance was evaluated by comparing with commercial composites without glass flakes.

MATERIALS AND METHODS

The new dental resin composite was produced through hand blending of inorganic glass flakes/Si-Al-borosilicate glass (58wt%:7wt% of dental resin composite), POSS-MA (5wt% of resin matrix), Bis-GMA/TEGDMA(64.4wt%:27.6wt% of resin matrix), and CQ/EDMAB (0.9wt%:2.1wt% of resin matrix) together. The flexural strength, elasticity modulus, and hardness, as well as wear were tested for evaluating the aging resistance of different dental resin composite.

RESULTS

Among 6 kinds of commercial composites in this study, after 6-month water storage, the maximum percentage of performance degradation is that the flexural strength decreased 39.96%, elasticity modulus decreased 51.53% and hardness decreased 12.52%. In contrast, the new synthesized material decreased 14.53%, 20.88%, and 0.61%, respectively, and performed lesser wear depth compared to some other groups (P < 0.05).

CONCLUSIONS

It was observed that the new dental resin composite performed better performance stability and wear resistance when compared with commercial dimethacrylate-based or low shrinkage dental resin composite tested in this study.

CLINICAL RELEVANCE

This possibly paves a path for designing tailored dental composite for practical application. Since the aging resistance of dental resin composite modified by glass flakes is superior, it has the potential to be used for promoting the durability of dental resin composite.

Unveiling the mechanisms behind surface degradation of dental resin composites in simulated oral environments

Dental resin composites are widely used as restorative materials due to their natural aesthetic and versatile properties. However, there has been limited research on the degradation mechanisms of these composites in gastric acid environments, which would be common in patients with gastroesophageal reflux. This study aims to investigate the degradation behavior of dental composites immersed in simulated oral environments, including acid, saliva, and water. Mechanical and morphological properties of the composites, upon immersion in the simulated environments, were thoroughly examined using hardness testing and SEM imaging. Qualitative analyses of the ions leached from the polymer matrix and fillers were conducted using XPS and ICP-MS. In addition, the thermodynamic stability of the inorganic fillers of the composites in aqueous solutions across a wide range of pH values was theoretically studied through construction of Pourbaix diagrams. This study proposed a mechanism for composite leaching involving interactions between the matrix's hydrophilic groups and the aqueous immersion media, leading to swelling and chemical degradation of the composites. Furthermore, it was demonstrated that filler leaching was followed by ion exchange with Ca and P, resulting in the formation of hard calcified layers on the composite surface. The current findings provide valuable insights into the development of new composite materials with improved durability and resistance to degradation, especially for patients suffering from gastroesophageal reflux.

Comparative Evaluation of the Repair Bond Strength of Dental Resin Composite after Sodium Bicarbonate or Aluminum Oxide Air-Abrasion

The dental prophylactic cleaning of a damaged resin-based composite (RBC) restoration with sodium bicarbonate can change the surface characteristics and influence the repair bond strength. The purpose of this study was to compare the effect of sodium bicarbonate (SB) and aluminum oxide (AO) surface treatments on the microtensile bond strength (µTBS) of repaired, aged RBC. Bar specimens were prepared from microhybrid RBC and aged in deionized water for 8 weeks. Different surface treatments (AO air-abrasion; SB air-polishing), as well as cleaning (phosphoric acid, PA; ethylene-diamine-tetraacetic-acid, EDTA) and adhesive applications (single bottle etch-and-rinse, ER; universal adhesive, UA), were used prior to the application of the repair RBC. Not aged and aged but not surface treated RBCs were used as positive and negative controls, respectively. The repaired blocks were cut into sticks using a precision grinding machine. The specimens were tested for tensile fracture and the µTBS values were calculated. Surface characteristics were assessed using scanning electron microscopy. AO-PA-UA (62.6 MPa) showed a 20% increase in µTBS compared to the NC (50.2 MPa), which proved to be the most significant. This was followed by SB-EDTA-UA (58.9 MPa) with an increase of 15%. In addition to AO-PA-UA, SB-EDTA-UA could also be a viable alternative in the RBC repair protocol.

Effects of Bio-Aging on Mechanical Properties and Microbial Behavior of Different Resin Composites

Under challenging oral environments, the overall performance of resin composites is affected by bio-aging. This study investigated the effects of saliva biofilm-induced bio-aging on the mechanical properties and microbial behavior of composites with different filler types. Microhybrid, nanohybrid, nano-filled and nano-filled flowable composites were bio-aged with saliva biofilm for 30 days. Surface morphology, roughness, mechanical and aesthetic properties were determined. A 48 h saliva biofilm model was used to evaluate the microbial behavior of different composites in vitro. Biofilm metabolic activity, lactic acid production and live/dead bacterial staining were tested. Six volunteers were selected to wear intra-oral appliances with composite slabs for 24 h and biofilms were collected and analyzed using 16S rRNA sequencing to assess the biofilm formation over those materials in situ. Although there were increasing trends, surface roughness, water resorption and material solubility had no significant changes for all groups after bio-aging (p > 0.05). There were no significant changes in elastic modulus for all groups after aging (p > 0.05). However, a decrease in flexural strength in all groups was observed (p < 0.05), except for the nanoflow composite group (p > 0.05). The Vickers hardness remained stable in all groups after aging (p > 0.05), except for the nano-filled group (p < 0.05). The nanoflow composite showed distinct color changes compared to the micro-hybrid group after aging (p < 0.05). Biofilm metabolic activity and lactic acid production in vitro increased slightly after bio-aging in all groups, but with no statistical significance (p > 0.05). The Shannon index diversity of biofilms in situ decreased after aging (p < 0.05), while no significant difference was shown in species composition at the genus level in all groups (p > 0.05). Resin composites with different sized fillers displayed a relatively stable mechanical performance and uncompromised microbial behavior both in vitro and in situ after 30 days of bio-aging. Based on the results, composites with different filler types can be selected flexibly according to clinical needs. However, a longer time for bio-aging is still needed to confirm the mechanical properties and microbial behaviors of composites in the long run.

Comparative Efficacy of Four Stain Removal Methods for Bleach-Shade Composite Resins after Immersion in Staining Solutions: An In Vitro Study

Introduction

Bleach-shade composite resins were recently introduced to the market due to the high demand of patients for whiter teeth. This study sought to compare four stain removal methods for bleach-shade composite resins.

Materials and Methods

Seventy-two discs were fabricated from each of the Filtek Z350 XT and Gradia XBW composite resins and immersed in coffee or sour cherry juice staining solutions. Each group was then divided into four subgroups to assess the efficacy of four stain removal methods (finishing with soft-lex disk "brush with pumice" bleaching with carbamide peroxide 16%, bleaching with hydrogen peroxide 40%). The color of each specimen was measured by Easyshade spectrophotometer, and data were analyzed using SPSS 25 statistical package for social sciences.

Results

The home-bleaching technique was more effective than the office-bleaching and pumice for the removal of sour cherry juice stain (ΔE = 1.93) and coffee stain (ΔE = 3.32) from Gradia composite discs, almost returning the baseline original color. The Sof-Lex discs were more effective than the pumice for the removal of sour cherry juice stain (ΔE = 4.11) and coffee stain (ΔE = 4.93) from Z350 composite discs but not return the baseline original color.

Conclusions

Filtek Z350 had more discoloration than Gradia Direct. The different materials and solutions reacted differently to the four stain removal methods. In GCJ group after all stain removal methods, ΔE reduced to a clinically acceptable level.

Evaluation of Physical-Chemical Properties of Contemporary CAD/CAM Materials with Chromatic Transition "Multicolor"

The use of materials for computer-aided design/computer-aided manufacturing (CAD/CAM) has been rapidly increasing in daily practice. However, one of the main issues regarding modern CAD/CAM materials is their aging in the oral environment, which may lead to significant changes in their overall properties. The aim of this study was to compare the flexural strength, water sorption, cross-link density (softening ratio%), surface roughness, and SEM analysis of three modern CAD/CAM "multicolor" composites. Grandio (Grandio disc multicolor-VOCO GmbH, Cuxhaven, Germany), Shofu (Shofu Block HC-Shofu Inc., Kyoto, Japan), and Vita (Vita Enamic multiColor-Vita Zahnfabrik, Bad Sackingen, Germany) were tested in this study. They were prepared in stick-shaped specimens and submitted to different tests after several aging protocols, such as thermocycling and mechanical cycle loading challenge. Further disc-shaped specimens were also created and tested for water sorption, cross-link density, surface roughness, and SEM ultramorphology, before and after storage in an ethanol-based solution. For flexural strength and ultimate tensile strength, Grandio showed the greatest values both at baseline and after aging (p < 0.05). Grandio and Vita Enamic presented the highest modulus of elasticity and the lowest water sorption (p < 0.05). A significant reduction (p < 0.05) in microhardness after ethanol storage (softening ratio%) was observed especially in Shofu. Grandio had the lowest roughness parameters compared to the other tested CAD/CAM materials, while ethanol storage significantly increased the Ra and RSm values in Shofu (p < 0.05). Despite the comparable modulus of elasticity of Vita and Grandio, this latter showed greater flexural strength and ultimate tensile strength both at baseline and after aging. Hence, Grandio and Vita Enamic may be employed for the anterior teeth and for those restorations requiring load-bearing capacity. Conversely, aging seems to affect several properties of Shofu, so its use for permanent restorations should be well-pondered based on the clinical situation.

Degree of conversion and residual monomer elution of 3D-printed, milled and self-cured resin-based composite materials for temporary dental crowns and bridges

The aim of this work was to investigate the elution of residual monomers as a function of the manufacturing process, which are CAD/CAM manufacturing, self-curing and 3D printing. The experimental materials used consisted of the base monomers TEGDMA, Bis-GMA and Bis-EMA and 50 wt.% fillers. Additionally, a 3D printing resin without fillers was tested. The elution of the base monomers into the different media (water, ethanol and ethanol/water (75/25 vol. %)) at 37 °C over a period of up to 120 d as well as the degree of conversion (DC) by FTIR were investigated. No monomer elution could be detected in water. Most residual monomers in both other media were released from the self-curing material whereas the 3D printing composite released relatively little. The CAD/CAM blanks released hardly any quantitatively detectable amounts of monomers. Relative to the base composition, TEGDMA eluted less than Bis-GMA and Bis-EMA. DC did not correlate with residual monomer release; thus, leaching was determined not only by the amount of residual monomers present but by further factors as possibly network density and structure. The CAD/CAM blanks and the 3D printing composite showed similar high DC but lower residual monomer release from the CAD/CAM blank, likewise the self-curing composite and the 3D printing resin exhibited similar DC but different monomer elution. In terms of residual monomer elution and DC, the 3D printing composite seems promising as a new material class for the use as temporary dental crowns and bridges.

Review of Antimicrobial Nanocoatings in Medicine and Dentistry: Mechanisms of Action, Biocompatibility Performance, Safety, and Benefits Compared to Antibiotics

This review discusses topics relevant to the development of antimicrobial nanocoatings and nanoscale surface modifications for medical and dental applications. Nanomaterials have unique properties compared to their micro- and macro-scale counterparts and can be used to reduce or inhibit bacterial growth, surface colonization and biofilm development. Generally, nanocoatings exert their antimicrobial effects through biochemical reactions, production of reactive oxygen species or ionic release, while modified nanotopographies create a physically hostile surface for bacteria, killing cells via biomechanical damage. Nanocoatings may consist of metal nanoparticles including silver, copper, gold, zinc, titanium, and aluminum, while nonmetallic compounds used in nanocoatings may be carbon-based in the form of graphene or carbon nanotubes, or composed of silica or chitosan. Surface nanotopography can be modified by the inclusion of nanoprotrusions or black silicon. Two or more nanomaterials can be combined to form nanocomposites with distinct chemical or physical characteristics, allowing combination of different properties such as antimicrobial activity, biocompatibility, strength, and durability. Despite their wide range of applications in medical engineering, questions have been raised regarding potential toxicity and hazards. Current legal frameworks do not effectively regulate antimicrobial nanocoatings in matters of safety, with open questions remaining about risk analysis and occupational exposure limits not considering coating-based approaches. Bacterial resistance to nanomaterials is also a concern, especially where it may affect wider antimicrobial resistance. Nanocoatings have excellent potential for future use, but safe development of antimicrobials requires careful consideration of the "One Health" agenda, appropriate legislation, and risk assessment.

Effect of oral environment on contemporary orthodontic materials and its clinical implications

Contemporary orthodontics entails using advanced materials and devices, simplifying the process of tooth movement. It is well documented that orthodontic materials are subjected to various fluctuations and stresses in the oral environment, such as salivary pH, dietary habits, temperature changes, and masticatory loads. These changes reduce bonding materials' longevity, plasticize resin polymers, and reduce elastic properties. In addition, the corrosion of orthodontic appliances in the oral environment has concerned clinicians for some time. This is focused on two principal issues: whether corrosion products are absorbed into the body and cause either localized or systemic effects, and the results of corrosion on the physical properties and the clinical performance of orthodontic appliances. Recently, another major concern is the potential release of bisphenol-A from materials containing polymers such as thermoplastic aligners and resins, which is known to induce xenoestrogenicity and cytotoxicity when the tissue level exceeds the daily recommended intake. However, most of these findings are based on in vitro studies that suffer from serious drawbacks such as failure to replicate the exact oral environment and process during orthodontic treatment. Therefore, developing clinically relevant methods should be the goal of future research related to the aging of orthodontic materials. The purpose of this review is to outline the impact of the oral environment on contemporary orthodontic materials.

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 Pre-Heating on the Monomer Elution and Porosity of Conventional and Bulk-Fill Resin-Based Dental Composites

The pre-heating of dental resin-based composites (RBCs) improves adaptability to cavity walls, reducing microleakages. However, the rapid cooling of the pre-heated RBC may change the polymerization kinetics, and thus the final network configuration of the RBC. It is well known that unreacted monomers remaining in the set RBC can leach into the oral cavity. However, it is still not clear how the pre-heating and cooling of RBCs alter monomer elution (ME). Thus, the purpose was to determine the ME from room-temperature and pre-heated RBCs, in addition to determining the closed porosity (CP) volume. Bulk-filled RBCs and layered conventional RBC samples were prepared. The pre-polymerization temperature was set at 24 °C and 55/65 °C. The ME from RBC samples was assessed with high-performance liquid chromatography using standard monomers. CP was measured with micro-computed tomography. ME decreased significantly from bulk fills and increased from layered samples as a result of pre-heating. Pre-heating was unfavorable in terms of CP in most RBCs. Based on the effect size analysis, ME and CP were greatly influenced by both material composition, pre-polymerization temperature, and their interaction. While the pre-heating of high-viscosity bulk-fill RBCs is advantageous from a clinical aspect regarding biocompatibility, it increases CP, which is undesirable from a mechanical point of view.

In Search of Novel Degradation-Resistant Monomers for Adhesive Dentistry: A Systematic Review and Meta-Analysis

This study aimed to assess whether degradation-resistant monomers included in experimental dental adhesives can improve long-term bond strength compared to conventional monomers. This study followed the latest PRISMA guidance (2020). The search for the systematic review was carried out in four electronic databases: PubMed/Medline, Scopus, SciELO and EMBASE, without restrictions on the year of publication and language. The last screening was conducted in July 2022. Interventions included were in vitro studies on experimental dental adhesives that tested short-term and long-term bond strength, but also water sorption and solubility data when available, in extracted human molars. Meta-analyses were performed using Rstudio v1.4.1106. A summary table analyzing the individual risk of bias was generated using the recent RoBDEMAT tool. Of the 177 potentially eligible studies, a total of 7 studies were included. Experimental monomers with acrylamides or methacrylamide−acrylamide hybrids in their composition showed better results of aged bond strength when compared to methacrylate controls (p < 0.05). The experimental monomers found better sorption and solubility compared to controls and were significantly different (p < 0.001). It is possible to achieve hydrolytically resistant formulations by adding novel experimental monomers, with chemical structures that bring benefit to degradation mechanisms.

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.

The Effect of Acrylic Surface Preparation on Bonding Denture Teeth to Cellulose Fiber-Reinforced Denture Base Acrylic

Patients who require dental prosthetic restoration using frame dentures in the front part of the mouth very frequently report that teeth fall out of their dentures. However, the available scientific papers are insufficient to compare the various methods of improving the connection between the denture base and the artificial tooth and choosing the best solution. This paper focuses on providing all parameters, enabling the reproduction of tests, and accounting for all variables. The paper uses an original method of creating grooves, sandpaper, sandblasting, and cutting the acrylate layer with a burr in one and two directions. Developed surfaces were additionally subjected to detailed examination. This study used 180 specimens divided into three groups and subjected to various environments (dry, artificial saliva, and thermocycles). Shearing and tensile strength tests were performed. The best results were obtained with a carbide burr. The increase in connection durability was as follows in the case of the shear test: 116.47% in dry samples, 155.38% in samples soaked in artificial saliva, and 46.59% in samples after thermocycles. The increase in tensile resistance was: 198.96% in a dry environment, 88.10% before being soaked in artificial saliva, and 94.04% after thermocycles.

Silanizing Effectiveness on the Bond Strength of Aged Bulk-Fill Composite Repaired After Sandblasting or Bur Abrasion Treatments: An in vitro Study

Objective

To measure the repair shear bond strength (SBS) of an aged bulk-fill composite after different mechanical (diamond bur vs sandblasting) and chemical (universal adhesive with or without a previous silanization) surface treatments.

Materials and Methods

Bulk-fill composite (Filtek One Bulk Fill, 3M ESPE) was used to construct seventy-two specimens aged through 10,000 thermal cycles. The specimens were allocated into two groups (n = 36 each) according to the mechanical roughening: Db, treated with a diamond bur, and Sb, treated by sandblasting. Each group was further subdivided into three subgroups (n = 12 each) according to the chemical conditioning: Db-only and Sb-only, unconditioned specimens; Db-U and Sb-U, specimens were conditioned with silane-containing universal adhesive (Scotchbond Universal adhesive, 3M ESPE); and Db-S-U and Sb-S-U, specimens were conditioned with a silane agent (Prosil, FGM) before employing the universal adhesive. The same composite material was used for repair. An additional reference group was constructed to measure the cohesive strengths of the bulk-fill composite. SBS testing was performed using a universal testing machine at a crosshead speed of 1 mm/min, and the failure modes were evaluated by stereomicroscope. The surface topography of resin composite after roughening was assessed by scanning electron microscopy. SBS data were statistically analyzed by ANOVA, Tukey’s test and independent t-test.

Results

The significantly highest SBS was recorded in the reference group (P ≤ 0.05). Sb-only obtained significantly higher SBS than Db-only (P < 0.001). No significant difference in SBS was noted between Db-U and Sb-U or Db-S-U and Sb-S-U. Likewise, no significant difference was observed between the subgroups treated with or without silane (P > 0.05).

Conclusion

The sandblasted specimens demonstrated a higher repair SBS than the diamond bur-treated specimens. The use of an additional silanizing step before applying silane-containing universal adhesive did not enhance the SBS of the repaired composite.

Post-Cure Development of the Degree of Conversion and Mechanical Properties of Dual-Curing Resin Cements

This study investigated the effect of different curing conditions on the degree of conversion and mechanical properties of contemporary dual-curing resin cements. The material specimens were either light-cured directly, light-cured through a 1-mm lithium disilicate glass-ceramic layer, or self-cured. The degree of conversion was measured in 0.1-mm films using Fourier-transform infrared spectroscopy 1 day, 7 days, and 28 days post-cure. Specimens used to study the flexural strength and modulus were prepared according to the ISO 4049 protocol, stored for 28 days post-cure, and subjected to accelerated aging by absolute ethanol immersion. The degree of conversion values ranged between 44.3–77.8%. Flexural strength varied between 11.4–111.1 MPa, while flexural modulus amounted to 0.7–5.5 GPa. The degree of conversion was significantly affected by material type, curing conditions, and post-cure time; however, variations in curing conditions were the least influential factor. A statistically significant effect of curing conditions on the degree of conversion was identified for only one of the five materials tested, whereas the flexural strength and modulus of all tested materials were significantly reduced in the experimental groups that were light-cured through a ceramic layer or self-cured. The effect size analysis showed that mechanical properties were most affected by the material type, while the differences in curing conditions were less influential. A comparison of the degree of conversion and mechanical properties indicated that different curing conditions may lead to significantly different flexural strength and modulus, which are not necessarily accompanied by identifiable variations in the degree of conversion.

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.

Effects of thermal cycling on mechanical and antibacterial durability of bioactive low-shrinkage-stress nanocomposite

OBJECTIVES

Recent studies developed low-shrinkage-stress composite with remineralizing and antibacterial properties to combat secondary caries and increase restoration longevity. However, their long-term durability in thermal cycling is unclear. The objectives of this study were to develop an antibacterial, remineralizing and low-shrinkage-stress composite, and to investigate its durability in thermal cycling for 20,000 cycles, equivalent to two years of clinical life.

METHODS

The resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE). Composites were made with 5% dimethylaminohexadecyl methacrylate (DMAHDM) and 20% of nanoparticles of amorphous calcium phosphate (NACP). Composites were thermal cycled at 5°C and 55°C for 20,000 cycles. A human salivary biofilm model was used to evaluate antibiofilm activity before and after thermal cycling.

RESULTS

After 20,000 cycles, the flexural strength of bioactive low-shrinkage-stress composite matched commercial control with no antibacterial activity (p > 0.05). Surface roughness was clinically acceptable at less than 0.2 μm. UV+NACP+DMAHDM composite reduced the total microorganisms, total streptococci, and mutans streptococci by 2-5 logs, compared to commercial composite. Biofilm lactic acid production was reduced by 11 folds. The antibacterial performance was maintained after thermal cycling, with no decrease after 20,000 cycles.

CONCLUSIONS

Bioactive low-shrinkage-stress composite possessed good mechanical properties that matched commercial composite both before and after thermal cycling. The new composite had potent antibacterial activity, which was maintained and did not decrease after thermal cycling.

CLINICAL SIGNIFICANCE

The new bioactive low-shrinkage-stress composite could reduce polymerization shrinkage stress and release calcium and phosphate ions, with good mechanical properties and strong antibacterial function that were durable after thermal cycling. These properties indicate great potential for inhibiting recurrent caries and increasing the restoration longevity.

Physical-chemical and microbiological performances of graphene-doped PMMA for CAD/CAM applications before and after accelerated aging protocols

OBJECTIVES

Innovative, nanotechnologies-featuring dental materials for CAD/CAM applications are becoming available. However, the interaction with the oral environment poses critical challenges to their longevity. The present study evaluated specific physical-chemical properties and antimicrobial potential of a CAD/CAM graphene-doped resin before and after accelerated aging protocols.

METHODS

Graphene nanofibers (GNF)-doped (<50 ppm) PMMA (GPMMA) and control PMMA CAD/CAM discs were used. Specimens underwent aging procedures of their bulk (thermo- and load-cycling) and surface (24 h-immersion in absolute ethanol), then they were tested for flexural strength, ultimate tensile strength, sorption/solubility, and methyl-methacrylate elution. Surface characterization included x-ray diffraction, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, surface roughness, microhardness, and scanning electron microscopy (SEM). Adherence of Streptococcus mutans and Candida albicans, and biofilm formation (continuous-flow bioreactor) by the same strains and an artificial oral microcosm were investigated.

RESULTS

GNF-doping improved the physical-chemical bulk properties of the PMMA resin. Surface aging reduced microhardness and increased the roughness of both test and control materials. Surfaces displayed signs of swelling and degradation at SEM. Microbiological data of non-aged surfaces showed that GNF-doping significantly reduced biofilm formation by all tested strains despite having no impact on microbial adherence. After aging, microbial adherence was higher on GPMMA surfaces, while biofilm formation was not promoted.

SIGNIFICANCE

GNF-doping improved the material's performance and influenced its antimicrobial potential. This strategy seems a valuable option to overcome the effects of surface degradation induced by aging on the antimicrobial potential of PMMA resin.

Analytical Methods for Determination of BPA Released from Dental Resin Composites and Related Materials: A Systematic Review

Knowing the impacts of bisphenol A (BPA) on human health, this systematic review aimed to gather the analytical methods for the quantification of BPA release of BPA in dental materials in in vitro and in vivo (biological fluids) studies. A brief critical discussion of the impacts of BPA on human health and the possible association with BPA in dental materials was also presented. The research was carried out by three independent researchers, (according to PRISMA guidelines) in PUBMED and SCOPUS databases, by searching for specific keywords and articles published between January 2011 and February 2022. Seventeen articles met the eligibility criteria and were included in this systematic review: 10 in vitro and 7 in vivo. In in vitro studies, the highest amounts of BPA released were from flowable to conventional resins, followed by resin-modified glass ionomer. In contrast, the smallest amount was released from "BPA-free" composites and CAD-CAM blocks. Regarding in vivo studies, a higher concentration of BPA were found in saliva than urine or blood. The best analytical method for trace quantifying BPA is LC-MS/MS (Liquid Chromatography with Tandem Mass Spectrometry) due to its selectivity, low quantification limits, and the unequivocal identification. However, further studies are required to develop faster and more sensitive methods, in order to obtain more reliable results.

Microhardness Evaluation of Microhybrid Versus Nanofilled Resin Composite After Exposure to Acidic Drinks

Objective

To investigate the effect of two acidic agents on microhardness of nanofilled and microhybrid resin composite materials.

Materials and Methods

70 resin composite discs (10 mm diameter and 2 mm thick) were prepared from 2 resin composites (35 from each type), nanofilled (Z350XT) and microhybrid (Z250), 3M/ESPE. Ten discs (5 from each group) were used as control (tested at 1 h before immersion). Each group was divided into 3 subgroups (n = 10) according to the storage media: distilled water (control), box-type cola and orange juice. Each subgroup was further subdivided into 2 divisions (n = 5) according to microhardness testing at 24 h and 7days after immersions. Digital Vickers Microhardness Tester (FM-7, Future Tech, Tokyo, Japan) was used to measure surface microhardness with a Vickers diamond indenter. The surface of the specimens received a load of 200 g for 10 seconds. Three indentations not less than 1 mm from each other were placed on the surface of all specimens. Vickers hardness number (VHN) was calculated for each indentation Data were statistically analyzed using one- way ANOVA followed by Newman-keuls tests (P ≤ 0.05).

Results

Orange juice showed statistically significantly the lowest VHN mean value (92.7) followed by the Cola group (95.15) then the water group (104.02) compared to the control group (117.4). Microhybrid composite groups showed statistically significant higher VHN mean value (108.1) than the nanofilled composite (100.2). The 7days groups showed statistically significant lower VHN mean value (97.3) than 24h groups (106.6).

Conclusions

All storage media reduced hardness of resin composites with orange juice showing the highest reduction in hardness values. Microhybrid is more resistant to degradation than nanofilled composite. Over time, microhardness of resin composites decreased progressively.

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.

Effects of Sr/F-Bioactive Glass Nanoparticles and Calcium Phosphate on Monomer Conversion, Biaxial Flexural Strength, Surface Microhardness, Mass/Volume Changes, and Color Stability of Dual-Cured Dental Composites for Core Build-Up Materials

This study prepared composites for core build-up containing Sr/F bioactive glass nanoparticles (Sr/F-BGNPs) and monocalcium phosphate monohydrate (MCPM) to prevent dental caries. The effect of the additives on the physical/mechanical properties of the materials was examined. Dual-cured resin composites were prepared using dimethacrylate monomers with added Sr/F-BGNPs (5 or 10 wt%) and MCPM (3 or 6 wt%). The additives reduced the light-activated monomer conversion by ~10%, but their effect on the conversion upon self-curing was negligible. The conversions of light-curing or self-curing polymerization of the experimental materials were greater than that of the commercial material. The additives reduced biaxial flexural strength (191 to 155 MPa), modulus (4.4 to 3.3), and surface microhardness (53 to 45 VHN). These values were comparable to that of the commercial material or within the acceptable range of the standard. The changes in the experimental composites’ mass and volume (~1%) were similar to that of the commercial comparison. The color change of the commercial material (1.0) was lower than that of the experimental composites (1.5–5.8). The addition of Sr/F-BGNPs and MCPM negatively affected the physical/mechanical properties of the composites, but the results were satisfactory except for color stability.

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

The clinical performance of a dental restoration is strongly influenced by the complex and dynamically-changing oral environment; however, no standard procedure exists to evaluate this lifetime. This research provides an in-depth analysis of the effect of different aging procedures on the flexural strength (FS), diametral tensile strength (DTS) and hardness (HV) of selected dental materials (Resin F, Flow-Art and Arkon). Material structure was evaluated by scanning electron microscopy. It was found that each aging protocol had some influence on the tested properties, with continual erosion and degradation being observed. Greater mechanical degradation was observed for Resin F (neat resin) after the applied aging protocols, suggesting that a resin matrix is more susceptible for degradation. The most aggressive aging protocol was Protocol 5: 0.1 M NaOH, seven days, 60 °C. Further studies on the effect of artificial aging on dental materials should include a study of the thermal and chemical factors. A standardized aging procedure is crucial for improving the resistance of dental resin composite to oral conditions and their clinical performance.

The Effect of a Green Smoothie on Microhardness, Profile Roughness and Color Change of Dental Restorative Materials

Acidic drinks are known to exert negative effects on the surface properties of dental restorative materials. However, the effect of increasingly popular green smoothie drinks has not been addressed so far. The present study investigated the effect of cyclic immersions (5 min daily over 30 days) in a green smoothie drink on the surface properties of contemporary dental restorative materials, including resin composites, an alkasite, and a glass hybrid. Vickers microhardness, profile roughness, and perceptible color change in the CIE L* a* b* color space were evaluated as clinically relevant properties of the material surface. After 30-day green smoothie immersion, microhardness values either decreased by 8–28% (for resin composites) or increased by up to 91% (for glass hybrid). The increase in profile roughness (Ra parameter) of smoothie-immersed specimens was 7–26 times higher compared to the control group. The perceptible color change (ΔE*) in the smoothie group was 3–8 times higher compared to the control group. Overall, this study demonstrated that daily exposure of dental restorations made from resin composites, alkasites, and glass hybrid materials to a green smoothie drink can significantly accelerate material degradation, which is reflected as surface softening, as well as higher roughness and higher perceptible color change.

Cytotoxicity of Methacrylate Dental Resins to Human Gingival Fibroblasts

This study aimed to assess the acute and delayed cytotoxicity of three, popular light-cured methacrylate-based restorative resins (MRs): Charisma (C), Estelite (E), and Filtek (F), to human gingival fibroblasts in culture. Cells were grown for up to 24 h with light-cured (or pre-cured) resins. We evaluated resin cytotoxicity, redox imbalance, necrosis/apoptosis, miR-9, and heat shock protein 70 (HSP70). The role of resin-induced oxidative stress (damage) in HSP70-response (repair) was assessed using binary fluorescence labeling. All MRs decreased viable cell numbers and cell proliferation and damaged cell membranes, and their 24 h-delayed toxicity was lower (C), higher (F), or similar (E) to that induced by freshly-cured resins. Cell membrane damage induced by C and E decreased with time, while F produced a linear increase. All resins generated intracellular oxidative stress with the predominant necrotic outcome, and produced heterogeneous responses in miR-9 and HSP70. The double fluorescence (damage/repair) experiments pointed to common features of E and F but not C. In the subset of cells, the binary response induced by E and F was different from C, similar to each other, and positively interrelated. Experimental data show that selective MR cytotoxicity should be taken into account when considering repetitive use or massive reconstruction.

Monomer Release from Dental Resins: The Current Status on Study Setup, Detection and Quantification for In Vitro Testing

Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

The Influence of Low-Molecular-Weight Monomers (TEGDMA, HDDMA, HEMA) on the Properties of Selected Matrices and Composites Based on Bis-GMA and UDMA

Bisphenol A-glycidyl methacrylate (bis-GMA) and urethane dimethacrylate (UDMA) are usually combined with low-viscosity monomers to obtain more desirable viscosity, handling characteristics and general properties. The present study determined the flexural strength (FS), flexural modulus (FM), diametral tensile strength (DTS), and hardness (HV) of five matrices and composites based on these resins. The polymerization shrinkage stress (PSS) was also studied for the composites. The polymer matrices were formed using bis-GMA and UDMA. TEGDMA, HEMA and HDDMA acted as co-monomers. The composites had 45 wt.% of filler content. The highest FS and FM were obtained from the UDMA/bis-GMA/TEGDMA/HEMA matrix and the composite (matrix + filler). The best DTS values were obtained from the UDMA/bis-GMA/HEMA matrix and the composite. One of the lowest values of FS, FM, and DTS was obtained from the UDMA/bis-GMA/HDDMA matrix and the composite. All the composites demonstrated similar hardness values. The lowest polymerization shrinkage stress was observed for the UDMA/bis-GMA/TEGDMA/HEMA composite, and the highest PSS was observed for the UDMA/bis-GMA/TEGDMA/HDDMA composite. The addition of HEMA had a positive effect on the properties of the tested materials, which may be related to the improved mobility of the bis-GMA and UDMA monomers.

Real-time monitoring of the pH microenvironment at the interface of multispecies biofilm and dental composites

Bacterial-mediated local pH change plays an important role in altering the integrity of resin dental composite materials in a dynamic environment such as the oral cavity. To address this, we developed a 300-μm-diameter, flexible, solid-state potentiometric pH microsensor capable of detecting and quantifying the local pH microenvironment at the interface of multispecies biofilm and dental resin in real time over 10 days. We used fluorinated poly(3,4-ethylenedioxythiophene) as the back contact in our newly developed pH sensor, along with a PVC-based ion-selective membrane and PTFE-AF coating. The high temporal resolution pH data demonstrated pH changes from 7 to 6 and 7 to 5.8 for the first 2 days and then fluctuated between 6.5 to 6 and 6 to 5.5 for the remaining 8 days with the resin composite or glass slide substrate respectively. We could observe the fluctuations in pH mediated by lactic acid production within the biofilm and the re-establishment of pH back to 7. However, acid production started to overwhelm buffering capacity with the continuous feed of sucrose cycles and reduced the local pH nearer to 5.5. No such changes or fluctuations were observed above the biofilm, as the pH remained at 7.0 ± 0.2 for 10 days. The localized real-time monitoring of the pH within the biofilm showed that the pH shift underneath the biofilm could lead to damage to the underlying material and their interface but cannot be sensed external to the biofilm.

Effect of Printing Layer Thickness and Postprinting Conditions on the Flexural Strength and Hardness of a 3D-Printed Resin

Background

Recently, dentists can utilize three-dimensional printing technology in fabricating dental restoration. However, to date, there is a lack of evidence regarding the effect of printing layer thicknesses and postprinting on the mechanical properties of the 3D-printed temporary restorations with the additive manufacturing technique. So, this study evaluated the mechanical properties of a 3D-printed dental resin material with different printing layer thicknesses and postprinting methods.

Methods

210 specimens of a temporary crown material (A2 EVERES TEMPORARY, SISMA, Italy) were 3D-printed with different printing layer thicknesses (25, 50, and 100 μm). Then, specimens were 3D-printed using DLP technology (EVERES ZERO, DLP 3D printer, SISMA, Italy) which received seven different treatment conditions after printing: water storage for 24 h or 1 month, light curing or heat curing for 5 or 15 minutes, and control. Flexural properties were evaluated using a three-point bending test on a universal testing machine (ISO standard 4049). The Vickers hardness test was used to evaluate the microhardness of the material system. The degree of conversion was measured using an FT-IR ATR spectrophotometer. Statistical analysis was performed using two-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) test (p ≤ 0.05).

Results

The 100 μm printing layer thickness had the highest flexural strength among the other thickness groups. As a combined effect printing thickness and postprinting conditions, the 100 μm with the dry storage group has the highest flexural strength among the tested groups (94.60 MPa). Thus, the group with 100 μm thickness that was heat cured for 5 minutes (HC 5 min 100 μm) has the highest VHN value (VHN = 17.95). Also, the highest mean DC% was reported by 50 μm layer thickness (42.84%).

Conclusions

The thickness of the 100 μm printing layer had the highest flexural strength compared to the 25 μm and 50 μm groups. Also, the postprinting treatment conditions influenced the flexural strength and hardness of the 3D-printed resin material.

Effects of Immediate Coating on Unset Composite with Different Bonding Agents to Surface Hardness

OBJECTIVES

 This study evaluated the surface microhardness of composite, affected by surface coating with different dental adhesive systems.

MATERIALS AND METHODS

 A total of 100 composite discs were divided into five groups. Group 1 was uncoated (control group C), and groups 2 to 5 were coated with different adhesive systems (OptiBond FL: FL, OptiBond SOLO Plus: SOLO, OptiBond XTR: XTR, and OptiBond All in one: AIO, respectively). The Vickers microhardness (VHN) was measured without and with 500 thermocycles.

STATISTICAL ANALYSIS

 The data were analyzed using two-way ANOVA and Tukey's posthoc test at the 95% confidence level.

RESULTS

 At 24 hours, the VHN of C (59.96 ± 3.68) and FL (59.83 ± 4.54) were significantly higher than SOLO (51.73 ± 4.63) and AIO (51.45 ± 4.11). The VHN of XTR (54.96 ± 3.68) was not significant compared with that of C and all other groups. After thermocycling, VHN were significantly decreased in all groups. However, there were no significant differences among all groups.

CONCLUSIONS

 At 24 hours, composite coated with different adhesive systems have different effects to VHN. Thermocycling all adhesive resin systems coated on composite surface significantly decreased the VHN.

Structural Changes in Resin-Based Composites in Saliva of Patients with Leukemia before Starting Chemotherapeutic Regimen

Background: The aim of this in vitro study was to assess the morphological characteristics and stability of dental composites immersed in saliva collected from patients with leukemia. Material and Methods: A total number of five patients without systemic disease and 20 patients with leukemia (acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML)) were included for saliva sampling. Composite disks were immersed in the leukemia, control, and artificial environments for 7 days. At the end of the experiment, atomic force microscopy (AFM), color stability (ΔE), and saliva elements analysis were performed. Statistical significance was considered for a p-value under 0.05. Results: The most changed surface resulted for ALL with a roughness that was almost double that of the untreated sample and was significantly increased compared to the healthy saliva. The effect of CLL was not as intense as observed for acute leukemia, but was significantly over the control. ALL seemed to modify structural components of the saliva, which were able to deteriorate the surface of the composite. ALL saliva promoted a significant dissolution of the initial feature of the samples and promoted nano-particle clusterization. All dental composites showed clinically acceptable color change values (ΔE < 3.3) in all four-leukemia salivas; CLL and CML showed large color differences for all composites. The total concentrations of P, Na, and K showed wide ranges of variations, while the coefficient of variation in Fe, Cu, and Mg showed narrow variations between the salvias’ investigated. The salivary concentration of zinc decreased considerably in the CLL and CML environments compared to the ALL and AML environments. Fe and Cu were significantly increased in the CML environment. Conclusions: Control and artificial salivas have a mild erosive effect on the surface of dental composites. The acute stage of the disease seems to deteriorate the surface roughness rather than its morphology, however, in the chronic stage, it is the surface morphology that mostly deteriorates.

Aging-Dependent Changes in Mechanical Properties of the New Generation of Bulk-Fill Composites

This study evaluated the behavior of a new generation of bulk-fill resin composites after prolonged exposure to an aqueous environment and accelerated aging in ethanol. Six bulk-fill materials were tested (Tetric PowerFill, Filtek One Bulk Fill Restorative, Tetric EvoCeram Bulk Fill, Fill-Up!, Tetric PowerFlow, SDR Plus Bulk Fill Flowable) and compared to two conventional reference materials (Tetric EvoCeram and Tetric EvoFlow). Flexural strength, modulus, and Weibull parameters were examined at three time points: 1 day, 30 days, and 30 days followed by ethanol immersion. Degree of conversion after 30 days, water sorption, and solubility up to 90 days were also investigated. Filtek One Bulk Fill had the highest flexural strength and modulus among the tested materials, followed by Tetric PowerFill and SDR plus. Flexural strength and modulus of high-viscosity bulk-fill materials showed higher stability after accelerated aging in ethanol compared to their low-viscosity counterparts and reference materials. After 30 days, the degree of conversion was above 80% for all tested materials. Dual-cure material Fill-Up! was the best-cured material. The water sorption was highest for Fill-Up!, Filtek One Bulk Fill Restorative, and Tetric EvoFlow, while solubility was highest for Tetric EvoCeram. After aging in water and ethanol, new generation high-viscosity bulk-fill materials showed better mechanical properties than low-viscosity bulk-fill and conventional composites under extended light curing conditions.

Simulating the Intraoral Aging of Dental Bonding Agents: A Narrative Review

Despite their popularity, resin composite restorations fail earlier and at higher rates than comparable amalgam restorations. One of the reasons for these rates of failure are the properties of current dental bonding agents. Modern bonding agents are vulnerable to gradual chemical and mechanical degradation from a number of avenues such as daily use in chewing, catalytic hydrolysis facilitated by salivary or bacterial enzymes, and thermal fluctuations. These stressors have been found to work synergistically, all contributing to the deterioration and eventual failure of the hybrid layer. Due to the expense and difficulty in conducting in vivo experiments, in vitro protocols meant to accurately simulate the oral environment’s stressors are important in the development of bonding agents and materials that are more resistant to these processes of degradation. This narrative review serves to summarize the currently employed methods of aging dental materials and critically appraise them in the context of our knowledge of the oral environment’s parameters.