Optimum radiopacity of composite inlay materials and cements

In vitro comparison of high-definition US, CBCT and periapical radiography in the diagnosis of proximal and recurrent caries

OBJECTIVE

To assess the in vitro performance of high-definition (HD) US, CBCT and periapical radiography for the visibility of proximal and recurrent caries in teeth with and without restoration.

METHODS

A total of 240 molar teeth were divided into eight groups each comprised of 30 teeth. Control groups consisted of teeth without caries (Group 1-4; N = 120), whereas diseased groups consisted of teeth with proximal caries (Group 5-8; N = 120 teeth). Finally, a total of four image sets were obtained as follows: i) PSP periapical radiography, ii) CBCT 0.075 mm voxel size, iii) CBCT 0.2 mm voxel size and iv) HD US images. The image sets were viewed separately by four observers by using a 5-point confidence scale. Intraclass correlation coefficients were calculated. The areas under the ROC curves were compared using chi-square tests. Significance level was set at α = 0.05.

RESULTS

Intraobserver agreement for both readings for the four observers ranged between 0.848 and 0.988 for CBCT (0.075 mm) images; 0.658 and 0.952 for CBCT (0.2 mm) images; 0.555 and 0.810 for periapical images; 0.427 and 0.676 for US images. Highest AUC values were found for CBCT (0.075 mm) images and lowest for US images. Statistically significant differences were found among CBCT (0.075 mm) images and US images (p < 0.001), CBCT (0.2 mm) images and US images (p < 0.001) and periapical images and US images (p < 0.001) for the detection of proximal caries.

CONCLUSION

Periapical and CBCT images outperformed HD US imaging in the detection of proximal dental caries.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations

Abstract Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

The visibility of secondary caries under bonding agents with two different imaging modalities

This study investigated the visibility of secondary caries lesions associated with two different adhesive systems of composite restorations (Optibond Solo Plus and Clearfil SE Bond) using a conventional dental x-ray film (Kodak D Speed) and a digital system (Digora) based on storage phosphor-plate technology for detection of secondary caries. For imaging techniques and adhesive systems, false positive scores were high. Intraobserver agreements ranged between 0.432 and 0.778, while interobserver agreements for the readings ranged 0.321-0.731 and 0.411-0.701, respectively. No statistical difference was found between the Az (area under curve) values obtained from PSP (photostimulable storage phosphor) and film images with the exception of the second observer's first reading for total etch adhesive system (Optibond Solo Plus) (p=0.0258). Furthermore, no statistical difference was found between both the bonding systems assessed (p>0.05). Adhesive materials should also have enough radiopacity to facilitate diagnosis of secondary caries.

Radiopacity of conventional, resin-modified glass ionomer, and resin-based luting materials

The purpose of the present study was to evaluate the radiopacity of currently available dental luting materials. Five conventional cements, six resin-modified glass ionomers (RMGIs), two methyl methacrylate (MMA)-based acrylic resins (eight shades), and nine composite luting materials were evaluated. Radiographs of the specimens were taken together with tooth slices and aluminum step wedges. The density of the specimens was determined with a densitometer and was expressed in terms of the equivalent thickness of aluminum per 2.0-mm unit thickness of specimen. The radiopacity values for human enamel and dentin were 4.3 and 2.3 mm Al/2.0 mm specimen, respectively. The values for materials ranged from 5.1 to 12.9 for conventional luting materials, from 3.4 to 6.3 for RMGIs, from less than 0.5 to 7.3 for MMA resins, and from 2.3 to 9.9 for the composite luting materials. A zinc phosphate cement showed the highest value (12.9), whereas five shades of MMA resin resulted in the lowest value (less than 0.5). Two RMGIs and three composite luting materials exhibited radiopacity values between those of enamel (4.3) and dentin (2.3). It can be concluded that the radiopacity value of luting materials varies considerably, and that care must be taken when selecting luting materials, considering the material composition of restorations.

Radiopacity of restorative materials using digital images

The radiopacity of esthetic restorative materials has been established as an important requirement, improving the radiographic diagnosis. The aim of this study was to evaluate the radiopacity of six restorative materials using a direct digital image system, comparing them to the dental tissues (enamel-dentin), expressed as equivalent thickness of aluminum (millimeters of aluminum). Five specimens of each material were made. Three 2-mm thick longitudinal sections were cut from an intact extracted permanent molar tooth (including enamel and dentin). An aluminum step wedge with 9 steps was used. The samples of different materials were placed on a phosphor plate together with a tooth section, aluminum step wedge and metal code letter, and were exposed using a dental x-ray unit. Five measurements of radiographic density were obtained from each image of each item assessed (restorative material, enamel, dentin, each step of the aluminum step wedge) and the mean of these values was calculated. Radiopacity values were subsequently calculated as equivalents of aluminum thickness. Analysis of variance (ANOVA) indicated significant differences in radiopacity values among the materials (P<0.0001). The radiopacity values of the restorative materials evaluated were, in decreasing order: TPH, F2000, Synergy, Prisma Flow, Degufill, Luxat. Only Luxat had significantly lower radiopacity values than dentin. One material (Degufill) had similar radiopacity values to enamel and four (TPH, F2000, Synergy and Prisma Flow) had significantly higher radiopacity values than enamel. In conclusion, to assess the adequacy of posterior composite restorations it is important that the restorative material to be used has enough radiopacity, in order to be easily distinguished from the tooth structure in the radiographic image. Knowledge on the radiopacity of different materials helps professionals to select the most suitable material, along with other properties such as biocompatibility, adhesion and esthetic.

Digital radiographic evaluation of optical density of porcelains used for fabrication of inlay/onlay prosthesis

The purpose of this article was to compare the mean value of optical density of four porcelains commonly used for fabrication of inlay/onlay prostheses using direct digital radiograph. The sample consisted of 20 2-mm thick porcelain specimens (measured by digital pachymeter): Empress (Ivoclair), Simbios (Degussa), Vita Omega 900 and Vitadur Alpha (Vita Zahnfabrik). The values of optical density of the specimens were expressed in millimeters aluminum equivalent (mm eq Al). The samples were X-rayed using two charge coupled devices (CCD) - RVG (Trophy) - Visualix (Gendex) and a phosphor plate system - Digora (Soredex). The optical density reading was performed with Image Tool 1.28 in a total of 110 measurements. Statistical analysis showed that there were statistically significant differences in all materials studied (p < 0.05) regardless of the radiographic system used. The highest optical density value was found for Omega 900 (1.8988 mmeqAl - Visualix - Gendex) and the lowest for Vitadur Alpha (0.8647 - Visualix - Gendex). Thus, the material presenting the highest degree of optical density was Omega 900, Empress and Simbios presented intermediate optical density values, Vitadur Alpha presented the lowest value, and the optical density of porcelains was not influenced by the digital radiography systems.

Mechanical and physical properties of contemporary dental luting agents

STATEMENT OF PROBLEM

New luting agents, particularly with adhesive capability, are being introduced in an attempt to improve clinical success. Independent studies of basic comparative data are necessary to characterize these materials in relation to mechanical and physical properties.

PURPOSE

The purpose of this study was to compare the flexural strength, modulus of elasticity, and radiopacity and pH of representatives of 5 types (categories) of luting agents.

MATERIAL AND METHODS

The luting agents included a zinc phosphate, a conventional and a resin-modified glass ionomer, 2 dual-polymerizing resins ("photopolymerized" after mixing and "unphotopolymerized" conditions), and an auto-polymerizing resin. The specimens were prepared and the testing was conducted by 1 person to maximize standardization. Flexural strength (MPa) and modulus of elasticity (GPa) were determined on bar-shaped specimens (2 x 2 x 20 mm) at 24 hours and 3 months (n = 8). Radiopacity (mm Al) was measured by exposing 1 mm thick specimens along with an aluminum step wedge (n = 4). pH was measured using a pH electrode immediately after mixing; at 1, 5, 15, 30 minutes; and at 1, 2, 4, 6, and 24 hours (n = 4). The data were subjected to statistical analyses with analysis of variance and Duncan's multiple range test (P<.05).

RESULTS

The resin luting agents (64 to 97 MPa) showed higher flexural strength than all other materials tested (7 to 27 MPa), with the "photopolymerized" (83 to 97 MPa) conditions higher than "unphotopolymerized" (64 to 81 MPa) (P<.0005). Zinc phosphate was the most radiopaque (6.4 mm Al) (P<.0001) and provided the highest rigidity (9.2 GPa) (P<.05). The autopolymerization resin cement was the most radiolucent (1.1 mm Al) (P<.0001). Zinc phosphate and conventional glass ionomer cements were the most acidic immediately after mixing (pH 1.5 to 2.2) but were the least acidic after 24 hours (pH 6.4 to 6.8) (P<.0001).

CONCLUSIONS

Within the limitations of this study the data showed a wide variation of material properties. The dual-polymerization resin luting agents tested showed the best combination of mechanical and physical properties combined with the highest setting pH. Photopolymerization of these resin-based materials was necessary to maximize strength and rigidity.

Detection of marginal defects of composite restorations with conventional and digital radiographs

The purpose of this study was to determine the validity of detecting approximal imperfections of composite fillings using three intraoral radiographic systems in vitro. Class II composite resin restorations (108) with three radiopacities (264, 306, 443% Al 99.5) of which 27 had marginal openings or overhangs, respectively, were conventionally (Ektaspeed plus) and digitally (Dexis, Digora) radiographed. Images were assessed by 10 observers for the presence of marginal gaps and overhangs, as well as for their need of restorative treatment according to a five-point confidence rating scale. The validity of the observations were expressed as areas under receiver operating characteristic (ROC) curves (Aroc). Repeated measures analysis of variance revealed significant effects of 'radiographic system' and 'diagnostic purpose'. Marginal overhangs (Aroc = 0.90) were significantly easier to diagnose than openings (Aroc = 0.63). Marginal gaps were better detected on conventional and Dexis radiographs than on Digora images. the range of sensitivities and specificities of the treatment decision was 0.53-0.56 and 0.87-0.88, respectively. It was concluded that the validity of detecting marginal defects of composite resin restorations based on radiographs was only slightly affected by the radiographic system being used. The diagnosis of marginal gaps frequently resulted in false-positive and false-negative decisions.

Radiopacity of tantalum oxide nanoparticle filled resins

OBJECTIVES

Radiopacity of composite resins allows radiographic distinction of existing restorations and recurrent caries. Current composites must be supplemented with heavy metal-containing glasses or minerals to achieve a desired radiopacity. The purpose of this study was to evaluate the radiopacity of Tantalum oxide (Ta2O5) filled resins at varying percentage loadings.

METHODS

Methacrylate functionalized Ta2O5 nanoparticles (< 50 nm) in methanol-dissolved or powder forms were mixed into either glycerol dimethacrylate (GDMA) or a bisGMA, TEGDMA, bisEMA mixture (GTE). Specimens were made in a split brass mold (2 x 2 x 15 mm) and compared with an aluminum stepwedge (99.5% pure Al) and a dentin slice of the same thickness. Kodak Ultraspeed periapical X-ray film on a lead plate at a target distance of 45 cm was exposed at 70 kVp and 10 mA, for 0.5 s and processed automatically. Optical density was measured (n = 3) with an RMI Processor Control Densitometer. Radiopacity was calculated as percent relative linear attenuation coefficient (Alpha). ANOVA and Student-Newman-Keuls comparisons were used to determine significance at the 95% confidence level.

RESULTS

Radiopacity increased significantly with Ta2O5 loading (p = 0.001). Ta2O5 nanoparticle filled resins enter the optimal range of diagnostic detectability (alpha = 150-250) at 50 wt.% and approach equivalence with enamel at approximately 70 wt.%.

SIGNIFICANCE

The introduction of tantalum oxide nanoparticle filler has potential as a miscible component of a resin composite to provide radiopacity for microfiller-type restorative materials and to circumvent the need for hydrolysis-prone glass reinforcing fillers.

Dental luting agents: A review of the current literature

STATEMENT OF PROBLEM

The practice of fixed prosthodontic has changed dramatically with the introduction of innovative techniques and materials. Adhesive resin systems are examples of these changes that have led to the popularity of bonded ceramics and resin-retained fixed partial dentures. Today's dentist has the choice of a water-based luting agent (zinc phosphate, zinc polycarboxylate, glass ionomer, or reinforced zinc oxide-eugenol) or a resin system with or without an adhesive. Recent formulations of glass ionomer luting agents include resin components (resin-modified glass ionomers), which are increasingly popular in clinical practice.

PURPOSE

This review summarizes the research on these systems with the goal of providing information that will help the reader choose the most suitable material.

MATERIAL

The scientific studies have been evaluated in relation to the following categories: (1) biocompatibility, (2) caries or plaque inhibition, (3) microleakage, (4) strength and other mechanical properties, (5) solubility, (6) water sorption, (7) adhesion, (8) setting stresses, (9) wear resistance, (10) color stability, (11) radiopacity, (12) film thickness or viscosity, and (13) working and setting times. In addition, guidelines on luting-agent manipulation are related to available literature and include: (1) temporary cement removal, (2) smear layer removal, (3) powder/liquid ratio, (4) mixing temperature and speed, (5) seating force and vibration, and (6) moisture control. Tables of available products and their properties are also presented together with current recommendations by the authors with a rationale.

Radiopacity of glass ionomer materials

To facilitate the detection of overhangs and defects adjacent to a filling, restorative materials should have a radiographic density higher than or at least similar to that of enamel. In the present study the density of 21 glass ionomer materials was measured and compared with the density of enamel, dentine, amalgam and aluminium. Most materials were more radiopaque than enamel, thereby satisfying the requirements as proposed by several investigators. The materials with lower density were mainly types intended for use in anterior teeth where the entire filling can more easily be examined clinically. They should not be used as a base under approximal fillings in order to avoid a false positive diagnosis of recurrent caries.

Radiographic detection of overhangs formed by resin composite luting agents

OBJECTIVES

An in vitro model was used to assess the ability of standard radiographic techniques to detect marginal overhangs of resin composite luting agents beside porcelain and resin composite inlays.

METHODS

The radiodensity of five commercially available luting resins was determined using ISO 4049 methodology. For four of the luting agents, artificial overhangs (0.5 x 0.5 x 2 mm) were created at the cervical margin of standard resin composite and porcelain inlays. Radiographs were recorded, using wax as a tissue equivalent, and the overhangs reduced incrementally in depth by 0.5 mm with serial images at each depth. The images were assessed in random sequence by three observers.

RESULTS

There were significant differences between the radiopacity of the luting resins. These correlated well with the ability of the observers to detect marginal overhangs adjacent to resin composite inlays.

CONCLUSIONS

Even with the most radiopaque luting material, a substantial marginal ledge could not be detected in association with a radiopaque resin composite inlay. The threshold for detection of the overhang was lower when using a radiolucent porcelain inlay.

Radiopacity of posterior composite resins, composite resin luting cements, and glass ionomer lining cements

The radiopacities of seven posterior composite resins, seven composite resin luting cements, and six glass ionomer lining cements were studied. The purpose was to obtain an indication of radiopacity values of different brands within each of these three groups of materials and to show differences in radiopacities of composite resin inlay materials and their accompanying luting cements. On radiographs, the optical densities of standardized samples were determined and radiopacity values of the materials were expressed in millimeter equivalent aluminum. The composite resins observed displayed higher radiopacities than aluminum. A luting cement and a glass ionomer cement were shown to be less radiopaque than aluminum. Generally the radiopacity of composite resins appeared to be higher than their accompanying luting cements. If materials with substantial differences in radiopacity are used in combined applications for the restorative treatment of teeth, lower radiopacity can interfere with the diagnosis of caries and the detection of gaps near the restoration.