Composite pre-heating: effects on marginal adaptation, degree of conversion and mechanical properties

OBJECTIVES

This study evaluated the effect of composite pre-polymerization temperature and energy density on the marginal adaptation (MA), degree of conversion (DC), flexural strength (FS), and polymer cross-linking (PCL) of a resin composite (Filtek Z350, 3M/ESPE).

METHODS

For MA, class V cavities (4 mm x 2 mm x 2 mm) were prepared in 40 bovine incisors. The adhesive system Adper Single Bond 2 (3M/ESPE) was applied. Before being placed in the cavities, the resin composite was either kept at room-temperature (25 degrees C) or previously pre-heated to 68 degrees C in the Calset device (AdDent Inc., Danbury, CT, USA). The composite was then light polymerized for 20 or 40s at 600 mW/cm(2) (12 or 24 J/cm(2), respectively). The percentage of gaps was analyzed by scanning electron microscopy, after sectioning the restorations and preparing epoxy resin replicas. DC (n=3) was obtained by FT-Raman spectroscopy on irradiated and non-irradiated composite surfaces. FS (n=10) was measured by the three-point-bending test. KHN (n=6) was measured after 24 h dry storage and again after immersion in 100% ethanol solution for 24h, to calculate PCL density. Data were analyzed by appropriate statistical analyses.

RESULTS

The pre-heated composite showed better MA than the room-temperature groups. A higher number of gaps were observed in the room-temperature groups, irrespective of the energy density, mainly in the axial wall (p<0.05). Composite pre-heating and energy density did not affect the DC, FS and PCL (p>0.05).

SIGNIFICANCE

Pre-heating the composite prior to light polymerization similar in a clinical situation did not alter the mechanical properties and monomer conversion of the composite, but provided enhanced composite adaptation to cavity walls.

Conditioning effect on dentin, resin tags and hybrid layer of different acidity self-etch adhesives applied to thick and thin smear layer

OBJECTIVES

to assess the conditioning effect (CE) of self-etch adhesives of different acidity applied to thick and thin smear layer (SL), the corresponding resin tags (RT) and hybrid layer (HL).

METHODS

Twenty-seven molars had their occlusal dentin exposed and were sectioned into two halves. Each of them was ground with a 60 or 600-grit SiC paper, respectively for thick and thin SL production. Three self-etch adhesives: a mild (Clearfil SE Bond), an intermediary (Optibond Solo SE and Solo Plus) and a strong (Tyrian Self Priming Etchant+One Step Plus) and an etch-&-rinse system (Scotchbond Multi Purpose Plus) were used. For CE evaluation, the self-etch primers were applied and rinsed off with acetone and alcohol prior to SEM preparation. For RT and HL specimens self-etch adhesives were applied and restored with Z-250. For RT specimens, dentin was removed with HCl (6N) and NaClO (1%) baths. The HL specimens were fixed, dehydrated, dried with HMDS, embedded, polished and slightly demineralized (6N HCl) and deproteinized (1% NaClO). After gold sputtering they were observed by SEM.

RESULTS

The thick smear layer was clearly not totally removed by the mild self-etch primer. RT varied in density and shape among the self-etch adhesives. Thicker HL was observed for the strong self-etch and etch-&-rinse adhesives.

CONCLUSIONS

The etch-&-rinse adhesive presented the thickest HL and was the only adhesive to produce RT in high density and uniform distribution along the whole dentin surface, independently of the SL thickness.

Fluoride release from restorative materials and its effects on dentin demineralization

As the use of adhesive restorative materials has increased during the last several years, interest in adhesive materials that release fluoride has also grown. The purpose of this study was to measure fluoride release from several adhesive restorative materials and to evaluate its effect on dentin resistance to demineralization and on bacterial metabolism in a modified in vitro system. Standardized cavities (1.8 mm in diameter) were prepared in bovine teeth that had been ground to dentin. One cavity in each tooth was restored with one of the following restorative systems: (a) Single Bond and Z100; (b) Single Bond and Tetric Ceram; (c) Fuji Bond LC and Z100; (d) Fuji Bond LC and Tetric Ceram; (e) Fuji II LC; or (f) Fuji IX GP. The other cavity in each tooth was "restored" with wax as a control. For each restorative system, 12 specimens were evaluated for fluoride release during the first 24 hrs after restoration placement. Dentin adjacent to the restored sites was subjected to lactic acid challenge (pH 4.3) for 3 hrs, after which calcium release was measured. Another 12 specimens in each group were stored for 24 hrs in de-ionized water, and were exposed to an S. mutans suspension (1:1 THB/de-ionized water and 50 mM glucose, A660 = 0.2) for 6 hrs, followed by calcium release and pH measurement. Bulk specimens of each material were also made and stored in water. Fluoride released from Fuji Bond LC, Fuji IX GP, and Fuji II LC in bulk was significantly greater than from the other materials. In the restored dentin specimens, increased resistance to demineralization from a lactic acid challenge was directly related to fluoride release. The same effects were seen as a result of the S. mutans challenge. While fluoride release from restorative materials increased the resistance of dentin to demineralization in this system, the clinical relevance of the findings is not known.

Polymerization development of "low-shrink" resin composites: Reaction kinetics, polymerization stress and quality of network

OBJECTIVES

To evaluate "low-shrink" composites in terms of polymerization kinetics, stress development and mechanical properties.

METHODS

"Low-shrink" materials (Kalore/KAL, N'Durance/NDUR, and Filtek P90/P90) and one control (Esthet X HD/EHD) were tested. Polymerization stress (PS) was measured using the Instron 5565 tensometer. Volumetric shrinkage (VS) was determined by the ACTA linometer. Elastic modulus (E) and flexural strength (FS) were obtained by a three-point bending test. Degree of conversion (DC) and polymerization rate (Rp) were determined by NIR spectroscopy (6165cm(-1) for dimethacrylates; 4156 and 4071cm(-1) for P90). Photopolymerization was performed at 740mW/cm(2)×27s. Glass transition temperature (Tg), degree of heterogeneity and crosslink density were obtained in a DMA for the fully cured specimens. Analysis of extracts was done by (1)H NMR. Data were analyzed with one-way ANOVA/Tukey's test (α=0.05).

RESULTS

The control presented the highest shrinkage and Tg. P90 showed the highest modulus, and NDUR demonstrated the highest conversion. The polymerization rates were comparable for all materials. NDUR and KAL had the highest and the lowest network homogeneity, respectively. The multifunctional P90 had the highest crosslink density, with no difference between other composites. The control had the greatest stress development, similar to NDUR. Crosslinking density and polymer network homogeneity were influenced by degree of conversion and monomer structure.

SIGNIFICANCE

Not all "low-shrink" composites reduced polymerization stress. P90 and NDUR had no leachable monomers, which was also a function of high crosslinking (P90) and high conversion (NDUR).

Temperature increase at the light guide tip of 15 contemporary LED units and thermal variation at the pulpal floor of cavities: an infrared thermographic analysis

In this study, a comprehensive investigation on the temperature increase at the light guide tip of several commercial light-emitting diode (LED) light-curing units (LCUs) and the associated thermal variation (ΔT) at the pulpal floor of dental cavities was carried out. In total, 15 LEDs from all generations were investigated, testing a quartz-tungsten-halogen (QTH) unit as a reference. The irradiance level was measured with a power meter, and spectral distribution was analyzed using a spectrometer. Temperature increase at the tip was measured with a type-K thermocouple connected to a thermometer, while ΔT at the pulpal floor was measured by an infrared photodetector in class V cavities, with a 1-mm-thick dentin pulpal floor. The relationship among measured irradiance, ΔT at the tip, and ΔT at the pulpal floor was investigated using regression analyses. Large discrepancies between the expected and measured irradiances were detected for some LCUs. Most of the LCUs showed an emission spectrum narrower than the QTH unit, with emission peaks usually between 450 and 470 nm. The temperature increase at the tip followed a logarithmic growth for LCUs with irradiance ≥1000 mW/cm(2), with ΔT at the tip following the measured irradiance linearly (R(2)=0.67). Linear temperature increase at the pulpal floor over the 40-second exposure time was observed for several LCUs, with linear association between ΔT at the pulpal floor and measured irradiance (R(2)=0.39) or ΔT at the tip (R(2)=0.28). In conclusion, contemporary LED units show varied irradiance levels that affect the temperature increase at the light guide tip and, as a consequence, the thermal variation at the pulpal floor of dental cavities.

Qualitative SEM/EDS analysis of microleakage and apical gap formation of adhesive root-filling materials

Objective

The aim of this study was to compare the correspondence between gap formation and apical microleakage in root canals filled with epoxy resin-based (AH Plus) combined or not with resinous primer or with a dimethacrylate-based root canal sealer (Epiphany).

Material and Methods

Thirty-nine lower single-rooted human premolars were filled by the lateral condensation technique (LC) and immersed in a 50-wt% aqueous silver nitrate solution at 37ºC (24 h). After longitudinal sectioning, epoxy resin replicas were made from the tooth specimens. Both the replicas and the specimens were prepared for scanning electron microscopy (SEM). The gaps were observed in the replicas. Apical microleakage was detected in the specimens by SEM/energy dispersive spectroscopy (SEM/EDS). The data were analyzed statistically using an Ordinal Logistic Regression model and Analysis of Correspondence (α=0.05).

Results

Epiphany presented more regions containing gaps between dentin and sealer (p<0.05). There was correspondence between the presence of gaps and microleakage (p<0.05). Microleakage was similar among the root-filling materials (p>0.05).

Conclusions

The resinous primer did not improve the sealing ability of AH Plus sealer and the presence of gaps had an effect on apical microleakage for all materials.

A novel filling technique for packable composite resin in Class II restorations

The use of composite resin restorations in posterior teeth has increased considerably in the past few years. Specific composite resins for posterior teeth, as well as new operative techniques, have been developed to overcome some clinical difficulties. The present article describes a new technique to reconstitute the interproximal contour and contact of Class II restorations using a packable composite resin. Two lower first molars from the same patient are reported in detail, illustrating the technique step by step. The technique indicates the use of a metallic matrix band and wood wedges to provide an interproximal contour and contact with the adjacent tooth as well as to provide an adequate cervical adaptation. The first increment of the packable composite resin is applied on the gingival wall of the proximal box, packed cervically near the axial wall and, automatically, the resin climbs up in contact with the inner surface of the matrix band. This increment is sculpted and light-cured and the metallic matrix band is removed. Thus, the Class II cavities are transformed into Class I, with free access for light-curing. Small incremental layers of composite fill the remaining cavities. This technique is faster than conventional techniques and permits appropriate embrasure, better contour, and contact points.

CLINICAL SIGNIFICANCE

Packable composite resins present primarily new handling characteristics that permit the development of novel filling techniques. The technique proposed in this article allows easier Class II buildup, with proper proximal contact and proximal smooth surfaces, once there are no irregularities among the composite increments. Another advantage is that there is adequate light exposure for polymerization, because the metal matrix can be removed during the restorative procedure.

The influence of handling on the elasticity of addition silicone putties

The handling of vinyl polysiloxane (addition silicone) impression putties with latex gloves is said to interfere with the setting of these impression materials. The aim of this study is to evaluate the effect of handling techniques on the setting of vinyl polysiloxane impression putties using several types of gloves. The setting of these materials was evaluated by means of an elasticimeter. Four vinyl polysiloxane putty impression materials and five brands of gloves (one made of vinyl, one of synthetic rubber, and three of natural rubber) were studied. Based on the type of glove, they were previously washed or not, and a spatula was used or not for initial mixing (before handmixing). The vinyl, the synthetic and one of the natural rubber gloves did not require the previous washing procedure and/or the use of a spatula for initial mixing. Two other natural rubber gloves - depending on the silicone -, showed satisfactory results only when the initial mixing was performed with a spatula. It was concluded that setting inhibition depends on the kind of vinyl polysiloxane impression material and the kind of gloves used, but when the initial mixing was performed with the spatula this setting inhibition was overcome. The results of this study also showed that it is possible to associate cross-contamination control and satisfactory performance of addition silicone putty materials. When doubts arise from the compatibility between vinyl polysiloxane impression putties and gloves, the initial mixing should be performed with a spatula.

Microshear bond strength of self-etching systems associated with a hydrophobic resin layer

PURPOSE

To evaluate in vitro the microshear bond strength of adhesive systems applied to dentin according to manufacturers' instructions, associated or not with a hydrophobic layer of unfilled resin.

MATERIALS AND METHODS

Six self-etching adhesives (Clearfil SE Bond, Kuraray Medical; AdheSE, Ivoclar Vivadent; Xeno III, Dentsply; I Bond, Heraeus-Kulzer; Bond Force, Tokuyama; Futurabond DC, Voco) were tested. The labial dentin of sixty bovine incisors was exposed, and the teeth were divided into two groups according to the application or not of an extra hydrophobic resin layer (Scotchbond Multi Purpose Plus, bottle 3). Six composite cylinders (Filtek Z250, 3M ESPE) were built up on each treated surface. Specimens were stored in distilled water at 37ºC for 24 h and then subjected to the microshear bond strength test in a universal testing machine at a crosshead speed of 0.5 mm/min. Microshear bond strength values were analyzed by 2-way ANOVA and Tukey's post-hoc test. Failure mode was determined using a stereomicroscope under 20X magnification.

RESULTS

The application of the hydrophobic resin layer did not affect bond strength, except for AdheSE. However, the bond strengths with the hydrophobic layer were similar among the six tested systems (Clearfil: 17.1 ± 7.9; AdheSE: 14.5 ± 7.1; Xeno lll: 12.8 ± 7.7; I Bond: 9.5 ± 5.8; Bond Force: 17.5 ± 4.1; Futurabond: 7.7 ± 2.3). When used as recommended by the manufacturers, Bond Force presented statistically higher bond strength than AdheSE and I Bond (p < 0.05) (Clearfil 10.4 ± 4.9; AdheSE 1.6 ± 1.6; Xeno lll: 9.0 ± 3.8; I Bond: 3.0 ± 1.5; Bond Force: 14 ± 3.9; Futurabond: 8.8 ± 3.8). Failure mode was predominantly adhesive.

CONCLUSION

The bond strength of the self-etching systems tested was not significantly affected by the application of a hydrophobic layer, but a significant improvement was observed in AdheSE.

Ultra-morphological study of the interaction of dental adhesives with carbamide peroxide-bleached enamel

PURPOSE

To evaluate the effects of a carbamide peroxide bleaching agent on interfaces formed by two one-bottle dental adhesives to etched enamel. The null hypotheses tested in this study were that vital bleaching with a commercial 10% carbamide peroxide gel would not (1) increase the concentration of oxygen in the superficial layer of enamel or (2) induce ultra-morphological changes in resin-enamel interfaces.

MATERIALS AND METHODS

Five extracted human incisors were treated with 10% carbamide peroxide (Opalescence) for 4 h/day for 1 week and were compared with non-bleached teeth for oxygen, calcium, and phosphorus relative concentration using EDS. Mean elemental concentrations were analyzed using a t-test (bleached vs. unbleached enamel), one-way ANOVA (for surface location and also for depth) and three-way ANOVA (with bleaching treatment, surface location, and depth as the main factors). For TEM, fifteen extracted human molars were sectioned to obtain two crown halves. After roughening the occlusal surface, one half was bleached with Opalescence while the other half was stored in artificial saliva for 1 week. Enamel was etched for 15 s with a 35% phosphoric acid and bonded with one of three adhesives (Prime & Bond 2.1, Syntac Single-Component, or Scotchbond Multi-Purpose Adhesive-control) and a composite resin (Protect Liner F). Small enamel/resin sticks with a cross-section of 1.0 mm x 1.0 mm were removed and the specimens were processed for TEM observation.

RESULTS

Vital bleaching with 10% carbamide peroxide caused no significant changes in relative oxygen concentration of enamel. For calcium and phosphorus, bleaching resulted in significant decreased relative concentrations. Bleaching also resulted in morphological alterations in the most superficial enamel crystallites. Some altered crystallites exhibited electron-lucent cores and reduced thickness of material around the core.

Low and high hydrogen peroxide concentrations of in-office dental bleaching associated with violet light: an in vitro study

OBJECTIVES

This study aims to assess hydrogen peroxide (HP) penetration within the pulp chamber, color change (CC), physical-chemical properties, and temperature using in-office different concentration bleaching gels with or without violet light.

MATERIALS AND METHODS

Fifty teeth were divided into five groups (n = 10) based on the HP concentration bleaching gels used (6% and 35%) and the used violet light (with or without). HP penetration within the pulp chamber was measured using UV-Vis. The CC was evaluated with a digital spectrophotometer. Initial and final concentration, and pH were measured through titration, and a Digital pHmeter, respectively. Temperature analyses were measured through a thermocouple. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test (α = 0.05).

RESULTS

The presence of violet light did not affect the amount of HP within the pulp chamber, or the CC (p > 0.05). Greater penetration of HP was observed within the pulp chamber, as well as CC when using 35% HP (p < 0.05). The final concentration of both gels was lower than the initial concentration, regardless of the use of violet light (p < 0.05). The initial and final pH levels remained neutral and stable (p > 0.05). The pulp temperature increased when the gels were used in conjunction with violet light (p < 0.05).

CONCLUSIONS

Using violet light in conjunction with 6% or 35% HP does not alter the physical properties of the bleaching agents, the penetration of HP or enhance color change. However, an increase in temperature was observed when violet light was applied associated with bleaching gels.

CLINICAL RELEVANCE

While the simultaneous use of violet light with hydrogen peroxide 6% or 35% does not alter the material's properties, it also does not bring benefits in reducing hydrogen peroxide penetration and improving color change. Furthermore, the use of violet light increases pulp temperature.

Re-attachment of anterior fractured teeth: fracture strength using different techniques

Fracture of anterior teeth by trauma is a common problem in children and teenagers. Complex metal-ceramic crowns with considerable loss of remaining sound structure are no longer necessary due to adhesive techniques, such as composite restorations and re-attachment techniques. This study compared the fracture strength of sound and restored anterior teeth using a resin composite and four re-attachment techniques. A "one bottle" adhesive system (One-Step, BISCO) and a dual cure resin cement (Duo-Link, BISCO) were applied. Thirty-five sound permanent lower central incisors were fractured by an axial load applied to the buccal area and randomly divided into five groups. The teeth were restored as follows: 1) bonded only = just bonding the fragment; 2) chamfer-group = after bonding, a chamfer was prepared on the enamel at the bonding line and filled with composite; 3) overcontour group = after bonding, a thin composite overcontour was applied on the buccal surface around the fracture line; 4) internal dentinal groove = before bonding, an internal groove was made and filled with a resin composite; 5) resin composite group = after a bevel preparation on the enamel edge, the adhesive system was applied and the fractured part of the teeth rebuilt by resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedure was expressed as a percentage of the original fracture strength and the results analyzed by Kruskal-Wallis statistical analysis. The mean percentages of fracture strength were: Group 1: 37.09%, Group 2: 60.62%, Group 3: 97.2%, Group 4: 90.54% and Group 5: 95.8%. It was concluded that the re-attachment techniques used in Groups 3 and 4, as well as the composite restored group (Group 5), were statistically similar and reached the highest fracture resistance, similar to the fracture resistance of sound teeth.

Effects of Nd:YAG laser irradiation on the hybrid layer of different adhesive systems

PURPOSE

The aim of this in vitro study was to evaluate the microtensile bond strength (microTBS) and hybrid layer morphology of different adhesive systems, either followed by treatment with Nd:YAG laser irradiation or not. Previous studies have shown the effects of Nd:YAG laser irradiation on the dentin surface at restoration margins, but there are few reports about the significance of the irradiation on the hybrid layer.

MATERIALS AND METHODS

The flattened coronal and root dentin samples of 24 bovine teeth were randomly divided into 8 groups, according to the adhesive system used -- Scotchbond Multi Purpose (SBMP) or Clearfil SE Bond (CSEB) -- and were either irradiated with Nd:YAG or not, with different parameters: 0.8 W/10 Hz, 0.8 W/20 Hz, 1.2 W/10 Hz, 1.2 W/20 Hz. The left sides of specimens were the control groups, and right sides were irradiated. A composite crown was built over bonded surfaces and stored in water (24 h at 37 degrees C). Specimens were sectioned vertically into slabs that were subjected to microTBS testing and observed by SEM.

RESULTS

Control groups (27.81 +/- 1.38) showed statistically higher values than lased groups (21.37 +/- 0.99), and CSEB control group values (31.26 +/- 15.71) were statistically higher than those of SBMP (24.3 +/- 10.66). There were no significant differences between CSEB (20.34 +/- 10.01) and SBMP (22.43 +/- 9.82) lased groups. Among parameters tested, 0.8 W/10 Hz showed the highest value (25.54 +/- 11.74). Nd:YAG laser irradiation caused dentin to melt under the adhesive layer of both adhesive systems tested.

CONCLUSION

With the parameters used in this study, Nd:YAG laser irradiation of the hybrid layer promoted morphological changes in dentin and negatively influenced the bond strength of both adhesive systems.

Re-attachment of anterior fractured teeth: fracture strength using different materials

This study compared the fracture strength of two different techniques (bonded only and buccal chamfer) and different material combinations used to reattach tooth fragments. An axial load applied to the buccal area fractured 110 sound permanent lower incisors. Fifty teeth were designated for the bonded only group (no additional preparation) and 50 teeth were designated for a buccal chamfer group. For each group teeth were subdivided into five subgroups (n = 10) according to the restorative material combinations used: 1) adhesive system (A); 2) A + light cured luting cement; 3) A + dual cured luting cement; 4) A + flowable resin and 5) A + hybrid resin. In a control group (resin composite build-up), in the remaining 10 teeth, the crown portion was rebuilt with adhesive and resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedures for all groups was expressed as a percentage of the original fracture strength and the results were analyzed by two-way ANOVA and Tukey's test for pair-wise comparison. The interaction and the material factor were not statistically significant (p = 0.140 and p = 0.943, respectively). The chamfer group showed higher fracture strength recovery (67.9%) than the bonded only group (41.1%), and both were statistically lower than the resin composite build-up (103.2%). It was concluded that the material used to reattach the fragment is less important than the chosen technique.