Poly(propylene glycol) and urethane dimethacrylates improve conversion of dental composites and reveal complexity of cytocompatibility testing

Platelet Responses to Urethane Dimethacrylate-Based Bone Cements Containing Monocalcium Phosphate/ε-Polylysine: Role of ε-Polylysine in In Vitro Wound Healing Induced by Platelet-Derived Growth Factor-BB

Platelets play a pivotal role in initiating bone fracture healing. However, the interaction between platelets and bone cements used for fracture repair remains relatively unexplored. This study investigated the platelet response to recently developed urethane dimethacrylate-based bone cements containing 8% (w/w) monocalcium phosphate monohydrate (MCPM) and/or 5% (w/w) ε-polylysine (PLS). All experimental bone cements achieved final monomer conversions of 75-78%, compared with the 86% conversion of the commercial PMMA bone cement Kyphon. The MCPM and PLS microparticles, varying in size, were dispersed within the glass-filler-incorporated polymer matrix. In contrast to Kyphon, all experimental cements exhibited significantly smoother and more hydrophilic surfaces. Bone cements incorporating PLS, with or without MCPM, effectively activated platelets by inducing cellular adhesion, aggregation, and extracellular-signal-regulated kinase (ERK) activation, comparable to Kyphon. Flow cytometry analysis demonstrated a statistically significant increase in CD62P-positive platelets following exposure to PLS-incorporated bone cements and exogenously administered PLS in a concentration-dependent manner, but not with Kyphon. A wound healing assay revealed a 2-fold enhancement in wound closure within 24 h and exceeding 85% at 48 h by bone cements containing PLS, with or without MCPM, and Kyphon. Notably, platelet-derived growth factor BB (PDGF-BB) secretion was significantly elevated, specifically after platelet exposure to PLS-incorporated bone cements, a phenomenon not observed with Kyphon. Interestingly, PDGF-BB neutralization attenuated wound closure induced by the PLS-incorporated bone cements. In conclusion, the urethane dimethacrylate-based bone cements containing PLS demonstrated a significant enhancement in platelet activation and PDGF-BB secretion, which, at least partly, enhanced in vitro wound closure. The results suggest that PDGF-BB plays a crucial role in the PLS-mediated enhancement of wound healing in these bone cements.

Enhancing elemental release and antibacterial properties of resin-based dental sealants with calcium phosphate, bioactive glass, and polylysine

BACKGROUND

This study aimed to develop ion-releasing and antibacterial resin-based dental sealants comprising 3 to 6 wt% monocalcium phosphate monohydrate (MCPM, M), 3 to 6 wt% bioactive glass (BAG, B), and 3 to 6 wt% polylysine (PLS, P). The physical properties, mechanical performance, cytotoxicity, and inhibition of S. mutans biofilm by these materials were subsequently evaluated.

METHODS

Five experimental dental sealants were formulated as follows: F1 (M6B6P6), F2 (M6B6P3), F3 (M3B3P6), F4 (M3B3P3), and F5 (M0B0P0, serving as the control). ClinproXT (CP, 3 M, Saint Paul, MN, USA) was used for commercial comparison. The degree of monomer conversion (DC) was determined using attenuated total reflectance-Fourier transform infrared spectroscopy (n = 5). The biaxial flexural strength (n = 6) and Vickers surface microhardness (n = 5) of the materials were evaluated after a 24-hour immersion in water. The element release over 4 weeks was measured using inductively coupled plasma-optical emission spectrometry (ICP-OES) (n = 3). The cell viability of mouse fibrosarcoma cells exposed to the extract was assessed via an MTT assay (n = 3). Additionally, the inhibition of S. mutans biofilm was tested (n = 3). Statistical analysis was conducted using one-way ANOVA and the Tukey HSD test.

RESULTS

The lowest DC among experimental sealants was obtained from F1 (66 ± 4%), which was significantly higher than CP (54 ± 2%, p < 0.001). The lowest biaxial flexural strength was obtained from F3 (131 ± 47 MPa). This was comparable to that of CP (140 ± 58 MPa, p = 0.992). The lowest surface microhardness among experimental materials was detected with F2 (19 ± 2 Vickers hardness number), which was higher than that of CP (12 ± 1 Vickers hardness number, p = 0.003). Furthermore, high cell viability of > 90% after exposure to extracts from the experimental materials was detected, which was similar to that observed with CP. Additionally, the experimental materials exhibited higher Ca and P release compared to CP and showed a potential trend for reducing S. mutans biofilm formation. Increasing additive concentrations exhibited minimal effects on material properties, except for enhanced elemental release and a slight reduction in BFM with higher PLS content.

CONCLUSION

The experimental sealants provided sufficient physical and mechanical strength and maintained cell viability and bacterial inhibition with higher elemental release than the commercial product.

The in vitro assessment of resin coating materials containing calcium phosphate, bioactive glass, and polylysine for glass ionomer cement restorations

Objective

Glass ionomer cements (GICs) require protective surface coatings to enhance their clinical performance. This study developed novel protective resin coatings for GICs containing monocalcium phosphate monohydrate (MCPM), bioactive glass nanoparticles (BAGs), and poly-L-lysine (PLS) and evaluated their physical, mechanical, and biological properties when applied to GICs.

Materials and methods

Experimental resin coating materials were formulated with 5-10 wt% of MCPM, BAGs, and PLS. The degree of monomer conversion was measured usingAttenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) (n = 6). GICs coated with the experimental materials were evaluated for biaxial flexural strength and modulus after 24 h water immersion using a universal testing machine (n = 8). Vickers surface microhardness up to 4 weeks of water immersion was also determined (n = 5). Fluoride and elemental release in water were analyzed using a fluoride-specific electrode and inductively coupled plasma optical emission spectrometry (n = 3). Cell viability was assessed using an MTT assay with mouse fibrosarcoma (n = 3). A commercial resin coating (EQUIA Forte Coat, EQ) served as control. Data were analyzed using one-way ANOVA and Tukey HSD test.

Results

While EQ showed higher monomer conversion (87%) compared to experimental materials (72-74%) (p < 0.05), GICs coated with experimental materials demonstrated comparable strength to EQ-coated GICs. The experimental coatings exhibited similar F, Al, Na, and Si releases to EQ-coated GICs, with enhanced P release. All experimental coatings exhibited comparable cell viability (>70%) to the commercial material.

Conclusion

The novel GIC protective coatings containing MCPM, BAGs, and PLS demonstrated acceptable in vitro performance comparable to commercial materials while potentially offering enhanced remineralization through increased elemental release.

In Vitro Osteo-Immunological Responses of Bioactive Calcium Phosphate-Containing Urethane Dimethacrylate-Based Composites: A Potential Alternative to Poly(methyl methacrylate) Bone Cement

This investigation developed new composite bone cements using urethane dimethacrylate (UDMA), poly(propylene glycol) dimethacrylate (PPGDMA), and hydroxyethyl methacrylate (HEMA), with micrometer-sized aluminosilicate glass filler. Monocalcium phosphate monohydrate (MCPM) and hydroxyapatite (HA) particles were added to enhance biological performance, particularly osteo-immunomodulation. Free radical polymerization was triggered by mixing two pastes containing either benzoyl peroxide (BPO, an initiator) or N-tolyglycine glycidyl methacrylate (NTGGMA, an activator). Increasing butylated hydroxytoluene (BHT, an inhibitor) enabled a suitable delay after mixing at 25 °C for placement. At 37 °C, the delay time was reduced and the final conversion was enhanced. Findings also demonstrated the biocompatibility of the developed bone cement toward osteo-immunological cell lineages, including mesenchymal stem cells (MSCs), fibroblasts, osteoclast precursor RAW 246.7 cells, and peripheral blood mononuclear cells (PBMCs). Notably, the cement with both MCPM and HA combined facilitated sufficient MSC growth, enabling subsequent mineralization while concurrently suppressing the proliferation of fibroblasts, osteoclast progenitors, and PBMCs. Furthermore, composite cement exhibited the capacity to differentially regulate osteoblast differentiation, cell-(in)dependent mineralization, osteoclastogenesis, and PBMC-mediated inflammatory responses at both cellular and molecular levels in vitro. These observations suggested their potential use for bone repair, especially in cases of inflammation-associated bone defects.

The development of resin-coating materials for enhancing elemental release of coated glass ionomer cements

This study aimed to develop resin coatings containing monocalcium phosphate monohydrate (MCPM), Sr/F-doped bioactive glass (Sr/F-BAGs), and pre-reacted glass ionomer fillers (SPG) that enhance ion release without detrimentally affecting the mechanical properties of GIC. The objective of this study was to evaluate the degree of monomer conversion (DC), biaxial flexural strength, surface microhardness, and ion release of the GICs coated with experimental coating materials compared to a commercial product (EQUIA Coat, EC). Four experimental resin coating materials containing 10-20 wt% of MCPM with Sr/F-BAGs and 5-10 wt% SPG were prepared. The DC of the coating material was determined using ATR-FTIR. The flexural strength and surface microhardness of the coated GICs were assessed. Fluoride and elemental (Ca,P,Sr,Si,Al) release were measured using fluoride-specific electrodes and ICP-OES. The DC of the experimental coating material (60-69 %) was higher than that of EC (55 %). The strength of GICs coated with experimental materials (35-40 MPa) was comparable to EC (37 MPa). However, their surface microhardness (13-24 VHN) was lower than EC (44 VHN). The experimental coating materials reduced fluoride release by ∼43 %, similar to EC (∼40 %). However, experimental coating materials promoted higher P and Sr release than EC. In conclusion, GICs coated with the experimental resin coating containing ion-releasing additives exhibited mechanical properties similar to those of the commercial product. The new coating materials promoted a higher level of ion release for GICs. These properties could potentially enhance remineralizing actions for the coated GICs.

Evaluation of setting kinetics, mechanical strength, ion release, and cytotoxicity of high-strength glass ionomer cement contained elastomeric micelles

BACKGROUND

Low mechanical properties are the main limitation of glass ionomer cements (GICs). The incorporation of elastomeric micelles is expected to enhance the strength of GICs without detrimentally affecting their physical properties and biocompatibility. This study compared the chemical and mechanical properties, as well as the cytotoxicity, of elastomeric micelles-containing glass ionomer cement (DeltaFil, DT) with commonly used materials, including EQUIA Forte Fil (EF), Fuji IX GP Extra (F9), and Ketac Molar (KT).

METHOD

Powder particles of GICs were examined with SEM-EDX. Setting kinetics were assessed using ATR-FTIR. Biaxial flexural strength/modulus and Vickers surface microhardness were measured after immersion in water for 24 h and 4 weeks. The release of F, Al, Sr, and P in water over 8 weeks was analyzed using a fluoride-specific electrode and ICP-OES. The toxicity of the material extract on mouse fibroblasts was also evaluated.

RESULTS

High fluoride levels in the powder were detected with EF and F9. DT demonstrated an initial delay followed by a faster acid reaction compared to other cements, suggesting an improved snap set. DT also exhibited superior flexural strength than other materials at both 24 h and 4 weeks but lower surface microhardness (p < 0.05). EF and F9 showed higher release of F, Al, and P than DT and KT. There was no statistically significant difference in fibroblast viability among the tested materials (p > 0.05).

CONCLUSIONS

Elastomeric micelles-containing glass ionomer cement (DT) exhibited satisfactory mechanical properties and cytocompatibility compared with other materials. DT could, therefore, potentially be considered an alternative high-strength GIC for load-bearing restorations.

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.

Modifying dental composites to formulate novel methacrylate-based bone cements with improved polymerisation kinetics, and mechanical properties

OBJECTIVES

The aim was to develop bone composites with similar working times, faster polymerisation and higher final conversion in comparison to Cortoss™. Additionally, low shrinkage/heat generation and improved short and longer-term mechanical properties are desirable.

METHODS

Four urethane dimethacrylate based composites were prepared using tri-ethylene-glycol dimethacrylate (TEGDMA) or polypropylene dimethacrylate (PPGDMA) diluent and 0 or 20 wt% fibres in the glass filler particles. FTIR was used to determine reaction kinetics, final degrees of conversions, and polymerisation shrinkage/heat generation at 37 °C. Biaxial flexural strength, Young's modulus and compressive strength were evaluated after 1 or 30 days in water.

RESULTS

Experimental materials all had similar inhibition times to Cortoss™ (140 s) but subsequent maximum polymerisation rate was more than doubled. Average experimental composite final conversion (76%) was higher than that of Cortoss™ (58%) but with less heat generation and shrinkage. Replacement of TEGDMA by PPGDMA gave higher polymerisation rates and conversions while reducing shrinkage. Early and aged flexural strengths of Cortoss™ were 93 and 45 MPa respectively. Corresponding compressive strengths were 164 and 99 MPa. Early and lagged experimental composite flexural strengths were 164-186 and 240-274 MPa whilst compressive strengths were 240-274 MPa and 226-261 MPa. Young's modulus for Cortoss™ was 3.3 and 2.2 GPa at 1 day and 1 month. Experimental material values were 3.4-4.8 and 3.0-4.1 GPa, respectively. PPGDMA and fibres marginally reduced strength but caused greater reduction in modulus. Fibres also made the composites quasi-ductile instead of brittle.

SIGNIFICANCE

The improved setting and higher strengths of the experimental materials compared to Cortoss™, could reduce monomer leakage from the injection site and material fracture, respectively. Lowering modulus may reduce stress shielding whilst quasi-ductile properties may improve fracture tolerance. The modified dental composites could therefore be a promising approach for future bone cements.

Assessment of physical/mechanical properties and cytotoxicity of dual-cured resin cements containing Sr-bioactive glass nanoparticles and calcium phosphate

The aim was to develop dual-cured resin cements containing Sr-bioactive glass nanoparticles (Sr-BGNPs; 5 or 10 wt%) and monocalcium phosphate monohydrate (MCPM; 3 or 6 wt%). Effects of additives on degree of monomer conversion (DC), biaxial flexural strength/modulus, shear bond strength (SBS), mass/volume change, color stability, ion release, and cytotoxicity were examined. Controls included material without reactive fillers and Panavia SA Plus (PV). Experimental cements showed higher DC than PV regardless of light activation (p<0.05). Mean SBS and color stability were comparable between experimental cements and PV. Cell viability upon the exposure to sample extracts of experimental cements was 80%-92%. High additive concentrations led to lower strength and modulus than PV (p<0.05). The additives increased mass change, reduced color stability, and promoted ion release. The experimental resin cements demonstrated acceptable mechanical/chemical properties and cytotoxicity. The additives reduced the strength but provided ion release, a desirable action to prevent recurrent caries.

Synergistic effect of ion-releasing fillers on the remineralization and mechanical properties of resin-dentin bonding interfaces

In modern restorative dentistry, adhesive resin materials are vital for achieving minimally invasive, esthetic, and tooth-preserving restorations. However, exposed collagen fibers are found in the hybrid layer of the resin-dentin bonding interface due to incomplete resin penetration. As a result, the hybrid layer is susceptible to attack by internal and external factors such as hydrolysis and enzymatic degradation, and the durability of dentin bonding remains limited. Therefore, efforts have been made to improve the stability of the resin-dentin interface and achieve long-term clinical success. New ion-releasing adhesive resin materials are synthesized by introducing remineralizing ions such as calcium and phosphorus, which continuously release mineral ions into the bonding interface in resin-bonded restorations to achieve dentin biomimetic remineralization and improve bond durability. As an adhesive resin material capable of biomimetic mineralization, maintaining excellent bond strength and restoring the mechanical properties of demineralized dentin is the key to its function. This paper reviews whether ion-releasing dental adhesive materials can maintain the mechanical properties of the resin-dentin bonding interface by supplementing the various active ingredients required for dentin remineralization from three aspects: phosphate, silicate, and bioactive glass.

Effect of varying functional monomers in experimental self-adhesive composites: polymerization kinetics, cell metabolism influence and sealing ability

The aim was to evaluate the effects of adding different functional monomers to experimental self-adhesive composites (SACs) on polymerization kinetics, cell metabolic activity, and sealing ability. SACs were formulated using urethane dimethacrylate as the base monomer and triethylene glycol dimethacrylate. Additionally, 10 wt.% of distinct functional monomers were added - 10-methacryloyloxydecyl dihydrogen phosphate, glycerol phosphate dimethacrylate (GPDM), 2-hydroxyethyl methacrylate (HEMA) or hydroxyethyl acrylamide (HEAA). ATR-FTIR was used to determine real-time polymerization kinetics (20 min,n= 3). The final extrapolated conversion and polymerization rates were determined (DC,max;Rp,max). TheDC,maxvalues were employed to calculate volumetric shrinkage. The MTT assay was performed on MDPC-23 cells using disc extracts at different concentrations (n= 8). Class V cavities were prepared in 60 sound human molars, assigned to six groups (n= 10), depending on the composite used and aging type (T0 or TC, if thermocycled for 10 000 cycles). One-way ANOVA, two-way, andKruskal-Wallistests were employed to treat the data (ɑ= 0.05). Varying the functional monomers had a large impact on DC,max, as confirmed by one-way ANOVA (p<0.001). The highest was obtained for HEMA (64 ± 3%). The HEMA and HEAA formulations were found to be significantly more toxic at concentrations below 100%. For microleakage, having a functional monomer or not did not show any improvement, irrespective of margin or aging period (Mann-Whitney U,p> 0.05). Larger functional monomers MDP and GPDM affected polymerization properties. Conversely, their acidity did not seem to be detrimental to cell metabolic activity. Regarding sealing ability, it seems that the functional monomers did not bring an advantage to the composites. Varying the functional monomer in SACs had a clear impact on the polymerization kinetics as well as on their cytotoxic potential. However, it did not confer better microleakage and sealing. Claiming self-adhesiveness based only on functional monomers seems dubious.

The effect of varying monocalcium phosphate and polylysine levels on dental composite properties

OBJECTIVES

The aim was to quantify effects of polylysine (PLS, 2 or 5 wt%) and monocalcium phosphate (MCP, 4 or 8 wt%) on properties of dental composites.

METHODS

Light-activated, lower surface polymerisation kinetics versus sample depth (1-4 mm) of 4 formulations were quantified using ATR-FTIR. Water sorption and solubility (at 1 week) were assessed following ISO/4049. PLS release (over 1 month) and biaxial flexural strength (over 6 months) of fully-cured, water-immersed, 1 mm thick discs were determined. Surface mineral precipitation, following immersion in simulated body fluid (SBF), was assessed by SEM. Z250 was used as a conventional composite comparator.

RESULTS

With 40s light exposure, increasing depth (from 1 to 4 mm) led to enhanced delay before polymerisation (from 3 to 17s) and decreased final conversion (72-66%) irrespective of PLS and MCP level. Increasing PLS and MCP raised solubility (4-13 μg/mm3). Water sorption (between 32 and 55 μg/mm3) and final PLS release (8-13% of disc content) were raised primarily by increasing PLS. Higher PLS also reduced strength. Strength reached minimum values (69-94 MPa) at 3 months. Surface mineral deposition was enhanced by increased MCP. For Z250, polymerisation delays (3-6s) and final conversions (55-54%) at 1-4 mm depth, solubility (0 μg/mm3), water sorption (16 μg/mm3) and strength (180 MPa) were all significantly different.

CONCLUSION

Delay time increased whilst final conversion decreased with thicker samples. Higher PLS enhances its percentage release, but lower level is required to keep water sorption, solubility and mechanical properties within ISO 4049 recommendations. Doubling MCP raises solubility and enhances minerals reprecipitation with minimal mechanical property compromise.

Effect of monomer composition and filler fraction on surface microhardness and depth of cure of experimental resin composites

This study evaluated microhardness profiles and calculated depths of cure at 80% of the surface microhardness of experimental dental resin composites having different base monomer compositions and different filler fractions. Composites were prepared using four different base monomers (bisphenol A-glycidyl methacrylate [Bis-GMA], urethane dimethacrylate [UDMA], ethoxylated bisphenol-A dimethacrylate [Bis-EMA], and Fit-852) with triethylene glycol dimethacrylate (TEGDMA) used as a co-monomer at three filler:resin matrix weight percent fractions (50:50, 60:40, and 70:30). Uncured material was placed in 3D printed molds and light cured for 40 s from the top surface only. Knoop microhardness was measured at the top of the specimen, and at every 0.5 mm up to 4 mm in depth. Microhardness at the surface increased in all experimental composites as the filler fraction increased. When comparing base monomers, microhardness was the highest in UDMA-based composites, while Bis-GMA-based composites showed the lowest values. When comparing depth of cure as a function of base monomer type, both Bis-GMA and Bis-EMA showed significantly lower values than UDMA or Fit-852. Composites having 50 wt% filler showed a significantly higher depth of cure than those with 60 and 70 wt% filler. Base monomer and filler fraction significantly influence microhardness and depth of cure in these experimental composites.

Antifungal efficiency and cytocompatibility of polymethyl methacrylate modified with zinc dimethacrylate

Objectives

Considering the high incidence rates of denture stomatitis, research that providing dental biomaterials with antifungal property are essential for clinical dentistry. The objectives of the present study were to investigate the effect of zinc dimethacrylate (ZDMA) modification on the antifungal and cytotoxic properties, as well as the variance in surface characteristics and other physicochemical properties of polymethyl methacrylate (PMMA) denture base resin.

Methods

PMMA with various mass fraction of ZDMA (1 wt%, 2.5 wt% and 5 wt%) were prepared for experimental groups, and unmodified PMMA for the control. Fourier-transform infrared spectroscopy (FTIR) was applied for characterization. Thermogravimetric analysis, atomic force microscopy and water contact angle were performed to investigate the thermal stability and surface characteristics (n=5). Antifungal capacities and cytocompatibility were evaluated with Candida albicans (C. albicans) and human oral fibroblasts (HGFs), respectively. Colony-forming unit counting, crystal violet assay, live/dead biofilm staining and scanning electron microscopy observation were performed to assess antifungal effects, and the detection of intracellular reactive oxygen species production was applied to explore the possible antimicrobial mechanism. Finally, the cytotoxicity of ZDMA modified PMMA resin was evaluated by the 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and live/dead double staining.

Results

The FTIR analyses confirmed some variation in chemical bonding and physical blend of the composites. Incorporation of ZDMA significantly enhanced the thermal stability and hydrophilicity compared with unmodified PMMA (p < 0.05). The surface roughness increased with the addition of ZDMA while remained below the suggested threshold (≤ 0.2 µm). The antifungal activity significantly improved with ZDMA incorporation, and cytocompatibility assays indicated no obvious cytotoxicity on HGFs.

Conclusions

In the present study, the ZDMA mass fraction up to 5 wt% in PMMA performed better thermal stability, and an increase in surface roughness and hydrophilicity without enhancing microbial adhesion. Moreover, the ZDMA modified PMMA showed effective antifungal activity without inducing any cellular side effects.

Assessment of Physical/Mechanical Performance of Dental Resin Sealants Containing Sr-Bioactive Glass Nanoparticles and Calcium Phosphate

The aim of this study was to assess the chemical/mechanical properties of ion-releasing dental sealants containing strontium-bioactive glass nanoparticles (Sr-BGNPs) and monocalcium phosphate monohydrate (MCPM). Two experimental sealants, TS1 (10 wt% Sr-BGNPs and 2 wt% MCPM) and TS2 (5 wt% Sr-BGNPs and 4 wt% MCPM), were prepared. Commercial controls were ClinproXT (CP) and BeautiSealant (BT). The monomer conversion (DC) was tested using ATR−FTIR (n = 5). The biaxial flexural strength (BFS) and modulus (BFM) were determined (n = 5) following 24 h and 7 days of immersion in water. The Vickers surface microhardness (SH) after 1 day in acetic acid (conc) versus water was tested (n = 5). The bulk and surface calcium phosphate precipitation in simulated body fluid was examined under SEM-EDX. The ion release at 4 weeks was analyzed using ICP-MS (n = 5). The DC after 40 s of light exposure of TS1 (43%) and TS2 (46%) was significantly lower than that of CP (58%) and BT (61%) (p < 0.05). The average BFS of TS1 (103 MPa), TS2 (123 MPa), and BT (94 MPa) were lower than that of CP (173 MPa). The average BFM and SH of TS1 (2.2 GPa, 19 VHN) and TS2 (2.0 GPa, 16 VHN) were higher than that of CP (1.6 GPa, 11 VHN) and BT (1.3 GPa, 12 VHN). TS1 showed higher Ca, P, and Sr release than TS2. Bulk calcium phosphate precipitation was detected on TS1 and TS2 suggesting some ion exchange. In conclusion, the DC of experimental sealants was lower than that of commercial materials, but their mechanical properties were within the acceptable ranges. The released ions may support remineralizing actions.

Alternative co-initiators for photocurable dental resins: Polymerisation, quantum yield of conversion and cytotoxicity

OBJECTIVE

Cyclic acetals such as are naturally occurring compounds capable of acting as co-initiators during free-radical polymerisation, and potentially serve to offer non-allergic and biologically less toxic alternatives to conventional (tertiary) amines. The current study aimed to evaluate the polymerisation efficiency and potential toxicity of cyclic acetals compared with conventional photoinitiator systems in photocurable dental resins.

METHODS

Both, 1,3 benzodioxole (BZD) and piperonyl alcohol (PA) were used in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 and 6.0 mol% concentrations. Whereas, N-phenyl glycine (NPG) was utilised in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 mol% concentrations for photopolymerisation of an unfilled model resin system, BisGMA and TEGDMA (1:1 mass %), involving three separate camphorquinone (CQ) concentrations of 0.5 (Low), 1.0 (Intermediate) and 1.5 (High) mol%. Conventional tertiary amines; ethyl-4-dimethyamino benzoate (EDMAB) and dimethylaminoethyl methacrylate (DMAEMA) were utilised for comparison. Real-time degree of conversion (DC, %) was evaluated using Fourier transform near-infra-red spectroscopy and quantum yield of conversion of CQ was calculated using UV-Vis spectroscopy. Cytotoxicity of NPG and cyclic acetals were assessed using MTT to determine metabolic activity of human dental pulp cells (HDPCs).

RESULTS

The cyclic acetals were capable of facilitating free radical polymerisation as co-initiators at all three CQ concentrations. Furthermore, the use of NPG as a co-initiator resulted in post-irradiation DC (%) that were comparable to both EDMAB and DMAEMA for all CQ concentrations. Alternative compounds facilitated the hydrogen abstraction process, which provided high conversion of CQ molecules. Quantum yield increased from 0.009 ± 0.0001 (0.5 mol%) to 0.03 ± 0.006 (6.0 mol%), and 0.01 ± 0.0003 (0.5 mol%) to 0.04 ± 0.001 (6.0 mol%), for respective BZD and PA formulations involving 1.0 mol% CQ. The use of NPG led to relatively higher quantum yield values (Up to 0.09 ± 0.007 at 4.0 mol%), though it exhibited competitive effects in absorbing blue light, which might be attributed to the photolytic degradation of NPG and the formation of N-methylaniline. MTT assay indicated alternative co-initiators to be comparatively less cytotoxic than EDMAB and CQ. Relative metablic activity of HDPCs treated with BZD, PA, and NPG eluates were 58.3 ± 15.7, 57.5 ± 17.4 and 64.6 ± 12.2 %, when compared with untreated HDPCs group (Control), respectively. Exposure to DMAEMA-based eluate led to relative metabolic activity (60.0 ± 0.5 %) that was comparable to that of cyclic acetals. Treatment with neat model resin eluate displayed the highest relative reduction in metabolic activity (28.9 ± 22.4) (P < 0.05), suggesting bisGMA and TEGDMA monomers played significant role in the overall cytotoxicity of photocurable systems involving HDPCs.

SIGNIFICANCE

Cyclic acetals were capable of facilitating photo-induced free radical polymerisation reactions with relatively less cytotoxicity compared with their amine counterparts, which might realise reduced cytotoxicity of photocurable materials used for dentistry and biomaterial applications.

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.

Physical/mechanical and antibacterial properties of orthodontic adhesives containing Sr-bioactive glass nanoparticles, calcium phosphate, and andrographolide

White spot lesions around orthodontic brackets are the major complication during fixed orthodontic treatment. This study prepared orthodontic adhesives for promoting mineral precipitation and reducing bacterial growth. Adhesives with added calcium phosphate monohydrate/Sr-bioactive glass nanoparticles (Sr/CaP) and andrographolide were prepared. The physical/mechanical and antibacterial properties of the adhesives were tested. The additives reduced the monomer conversion of the materials (62 to 47%). The addition of Sr/CaP and andrographolide increased the water sorption (from 23 to 46 μg/mm³) and water solubility (from 0.2 to 5.9 μg/mm³) but reduced the biaxial flexural strength (from 193 to 119 MPa) of the adhesives. The enamel bond strengths of the experimental adhesives (19–34 MPa) were comparable to that of the commercial material (p > 0.05). The Sr/CaP fillers promoted Ca, Sr, and P ion release and the precipitation of calcium phosphate at the debonded interface. An increase in the Sr/CaP concentration enhanced the inhibition of S. mutans by 18%, while the effect of andrographolide was not detected. The abilities of the adhesives to promote ion release, calcium phosphate precipitation, and the growth inhibition of cariogenic bacteria were expected to reduce the occurrence of white spot lesions. The additives reduced the physical/mechanical properties of the materials, but the corresponding values were within the acceptable range.

Characteristics of a novel photoinitiator aceanthrenequinone-initiated polymerization and cytocompatibility of its triggered polymer

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AATQ is a novel photosensitizer with high-photoinitiating conversion efficiency at a relatively low concentration under 455 nm-blue light.

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Cytotoxicity of AATQ to different tissue types of cells is much lower than widely used-BAPO.

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Cytocompatibility of AATQ-initiated polymer is significantly superior to PANQ, but inferior to CQ.

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AATQ offers an alternative in industrial or biomedical areas, especially in the required low concentration of photoinitiators.

A number of photoinitiators are available in chemical industry, but less of them in biomedicine or clinical therapy due to the limitation of their cytotoxicity and biocompatibility. Thus, it is urgently necessary to find non-toxic or low-toxic photoinitiators to meet clinical demands. Aceanthrenequinone (AATQ) is a novel photosensitizer with high-photoinitiating ability, but no reports contribute, to date, to its cytotoxicity and biocompatibility. Here, primary cells and various cell lines were exposed to different concentrations of AATQ with or without irradiation. AATQ had the similar photoinitiating conversion efficiency to the extensively used bis(2,4,6-trimethylbenzoyl)-phenylphosphine oxide (BAPO) and higher one than 9,10-phenanthrenequinone (PANQ) with the similar extent of polymerization in depth within a certain range, but displayed much lower cytotoxicity than BAPO under non-irradiation or irradiation. The biocompatibility of BisGMA/TEGDMA polymer prepared by AATQ was superior to that of PANQ, but inferior to that of camphorquinone (CQ) although the far lower dose of AATQ is enough to initiate polymerization of monomer than that of CQ. Hence, AATQ offers a valuable alternative in applications of industrial or biomedical areas.

Monomer Elution from Three Resin Composites at Two Different Time Interval Using High Performance Liquid Chromatography-An In-Vitro Study

Esthetics, improved colour stability and ease of contour have made photo-activated resin based restorative materials being widely used in routine dental clinical practice. Perhaps improper and inadequate polymerization of resin based composite material might lead to elution of monomer. Thus, the aim of the current study was to quantify the monomer elution from three resin composites. The intended analysis was made using high performance liquid chromatography (HPLC) at two different time periods. Three different materials that were investigated in the current study included Swiss Tech resin composite (Group A), Ceram X (Group B) and Beautifil Injectable composite (Group C). Ten cylindrical samples were fabricated in each study group. In 75% wt of ethanol, the samples were ingressed immediately and stored at room temperature. A 0.5 mL of the samples was assessed at pre-defined time intervals at 24 h and 7th day. Later, assessment of the samples was performed with HPLC and the data was analyzed using statistical test. Bisphenol A-glycidyl methacrylate (Bis-GMA), Triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and Urethane dimethacrylate (UDMA) were quantified in the samples. When analyzing the release monomer, it was found that at the end of 24 h Bis-GMA was eluted more in the injectable resin composite whereas, TEGDMA was eluted from Swiss Tech and Ceram X resin composites. At the end of the 7th day it was evident that Bis-GMA was eluted maximum in all the three resin composites. Thus, monomer release was found to be evident among all three resin composites and it is of utmost important to be assessed in routine clinical practice.

Physical/Mechanical and Antibacterial Properties of Orthodontic Adhesives Containing Calcium Phosphate and Nisin

Enamel demineralization around orthodontic adhesive is a common esthetic concern during orthodontic treatment. The aim of this study was to prepare orthodontic adhesives containing monocalcium phosphate monohydrate (MCPM) and nisin to enable mineralizing and antibacterial actions. The physicomechanical properties and the inhibition of S. mutans growth of the adhesives with added MCPM (5, 10 wt %) and nisin (5, 10 wt %) were examined. Transbond XT (Trans) was used as the commercial comparison. The adhesive containing a low level of MCPM showed significantly higher monomer conversion (42–62%) than Trans (38%) (p < 0.05). Materials with additives showed lower monomer conversion (p < 0.05), biaxial flexural strength (p < 0.05), and shear bond strength to enamel than those of a control. Additives increased water sorption and solubility of the experimental materials. The addition of MCPM encouraged Ca and P ion release, and the precipitation of calcium phosphate at the bonding interface. The growth of S. mutans in all the groups was comparable (p > 0.05). In conclusion, experimental orthodontic adhesives with additives showed comparable conversion but lesser mechanical properties than the commercial material. The materials showed no antibacterial action, but exhibited ion release and calcium phosphate precipitation. These properties may promote remineralization of the demineralized enamel.

Effects of Color Modifier on Degree of Monomer Conversion, Biaxial Flexural Strength, Surface Microhardness, and Water Sorption/Solubility of Resin Composites

Color modifiers can be mixed with resin composites to mimic the shade of severely discolored tooth. The aim of this study was to assess the effects of a color modifier on the physical and mechanical properties of a resin composite. The composite was mixed with a color modifier at 0 wt% (group 1), 1 wt% (group 2), 2.5 wt% (group 3), or 5 wt% (group 4). The degree of monomer conversion (DC) was examined after light curing for 20 or 40 s. Biaxial flexural strength (BFS)/modulus (BFM), surface microhardness (SH), and water sorption (W_sp)/solubility (W_sl) were also tested. The DC of group 1 was significantly higher than that of groups 3 and 4. The increase in curing time from 20 to 40 s increased the DC by ~10%. The BFS, BFM, W_sp, and W_sl of all the groups were comparable. A negative correlation was detected between the concentration of color modifier and the BFS and DC, while a positive correlation was observed with W_sp. In conclusion, the color modifier reduced the DC of composites, but the conversion was improved by extending the curing time. The increase in color modifier concentration also correlated with a reduction in strength and the increase in the water sorption of the composites.

A modified TEGDMA-based resin infiltrant using polyurethane acrylate oligomer and remineralising nano-fillers with improved physical properties and remineralisation potential

OBJECTIVES

This study aimed to modify an experimental triethylene glycol dimethacrylate (TEGDMA) based resin infiltrant using PUA oligomer and two remineralising fillers, including fluorohydroxyapatite (FHA) and fluoride-doped bioactive glass (FD-BG), to improve the mechanical and physical properties and induce remineralising potential.

MATERIALS AND METHODS

The polyurethane acrylate oligomer (PUA) was synthesised and characterised. Experimental resin infiltrant was prepared by mixing 10% of synthesised PUA with 88% TEGDMA. Water contact angle, penetration coefficient, and penetration depth were then measured. The FHA and FD-BG fillers were synthesised and characterised. To prepare nano-filled resin infiltrant, 5% of each powder was mixed with the prepared resin infiltrant. The prepared resin infiltrants were characterised to evaluate their degree of conversion, mechanical properties, water sorption, and solubility. The ion release of filled resin was also assessed. The non-infiltrated and infiltrated enamel specimens underwent fourteen days of pH-cycling, and a surface microhardness was done to assess the resistance to demineralisation.

RESULTS

The results showed that the addition of PUA to TEGDMA increased the mechanical properties and decreased water sorption and solubility. The addition of synthesised FD-BG fillers to resin infiltrant significantly improved the resistance to demineralisation of enamel samples compared with other groups (p ≤ 0.001). The FHA fillers also improved the resistance to demineralisation; however, the produced changes were not statistically meaningful (p > 0.05).

CONCLUSIONS

Based on the results, the PUA+TEGDMA+ FD-BG/FHA composite can be used as an alternative material for pure TEGDMA in enamel infiltration approaches owing to its better mechanical properties, lower water sorption and solubility, and also remineralisation potential.

CLINICAL SIGNIFICANCE

A resin infiltrant with remineralisation potential, lower water sorption and solubility and higher mechanical properties may enhance the management of early caries lesions.

A laboratory study to assess the physical, mechanical, and 3-D structural properties of nano-apatite grafted glass fibre-based endodontic posts

AIM

To fabricate and characterize nano-hydroxyapatite (nHA) grafted and non-grafted glass fibre-based endodontic posts.

METHODOLOGY

Experimental glass fibre posts were fabricated using silanized nHA grafted (ex-HA) and non-grafted glass fibre (ex-P) reinforced resins. The structural analysis and morphological patterns were analysed with Fourier transform infrared spectroscopy and scanning electron microscopy, respectively. EverStick^® glass fibre posts (eS) were used as a control group. The degree of conversion, flexural strength, and flexural modulus was investigated and the fractured structure was evaluated with a scanning electron microscope. Root canals were prepared in human extracted teeth restored with experimental and control posts. The push-out bond strength was evaluated with radicular dentine at days 7, 30, and 90, and the presence of voids at the interface were measured at day 1, 7, 30, and 90 with micro-computed tomography. The Shapiro-Wilk test and one-way ANOVA post-hoc Tukey's test were performed. The level of significance was set at 0.05.

RESULTS

The SEM and FTIR confirmed the presence of a silane-coupling agent on the glass fibres. The ex-HA post had a significantly lower degree of conversion compared to the ex-P post (p = .0008), but a significantly higher conversion than the eS post (p = .0014). The maximum flexural strength value was obtained with the ex-HA post with an insignificant difference (p = .366) compared to ex-P post and a significant difference (p = .029) compared to the eS post. The flexural modulus of ex-HA, ex-P, and eS posts were significantly different (p = .037). Similarly, the ex-HA post had a significantly higher push-out bond strength at days 7 and 30 (p = .037) compared to the ex-P and eS posts. The volume of voids had a nonlinear behaviour amongst the groups with no significant difference between the posts.

CONCLUSION

The fabrication of the experimental posts was successful and the ex-HA post had greater flexural strength and push-out bond strength compared to the ex-P post. The degree of conversion of the ex-HA post was lower than the ex-P and eS posts. The volume of voids of ex-HA and ex-P posts was lower than that of eS posts.

Monomer Conversion, Dimensional Stability, Biaxial Flexural Strength, Ion Release, and Cytotoxicity of Resin-Modified Glass Ionomer Cements Containing Methacrylate-Functionalized Polyacids and Spherical Pre-Reacted Glass Fillers

The aim of this study was to prepare RMGICs for pulp protection that contain polyacids functionalized with methacrylate groups (CMs) to enable light-activated polymerization without the need for toxic 2-hydroxyethyl methacrylate (HEMA) monomers. The effects of using CM liquids with 0 or 5 wt% HEMA on the physical/mechanical properties and cytotoxicity of the experimental RMGICs were assessed. Spherical pre-reacted glass fillers (SPG) were used as the powder phase. The experimental RMGICs were prepared by mixing SPG with CM liquid (0 wt% HEMA, F1) or CMH liquid (5 wt% HEMA, F2). Commercial materials (Vitrebond, VB; TheraCal LC, TC) were used for the comparisons. The degree of monomer conversion and fluoride release of both F1 and F2 were significantly lower than those of VB. F1 showed comparable biaxial flexural strength with VB but higher strength than TC. The dimensional stability (mass/volume changes) of the experimental materials was comparable with that of the commercial materials. F1 and F2 exhibited higher Sr/Ca ion release and relative cell viability than VB. The use of CMH liquid reduced the strength but enhanced the fluoride release of the experimental RMGICs. In conclusion, the experimental RMGICs showed comparable strength but lower cytotoxicity compared to the commercial RMGICs. These novel materials could be used as alternative materials for pulp protection.

Varying 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) level improves polymerisation kinetics and flexural strength in self-adhesive, remineralising composites

OBJECTIVES

To assess the influence of systematically varying concentrations of 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) versus 3% 4-META on the polymerisation kinetics and shrinkage, biaxial flexural strength (BFS) and modulus of remineralising composites.

METHODS

Composites were prepared by adding poly(propylene glycol) dimethacrylate (24 wt%), camphorquinone (1 wt%) and MDP (0%, 5%, 10%, 15% and 20 wt%) or 4-META (3%) to urethane dimethacrylate. These were mixed with glass fillers containing 8 wt% monocalcium phosphate and 4 wt% polylysine (powder-liquid ratio of 3:1). Continuous spectral changes, following 20 s light exposure (37 °C), were assessed with an ATR-FTIR to monitor polymerisation kinetics (n = 3). Final extrapolated conversions (D_C,max) were employed to calculate polymerisation shrinkage. BFS and modulus of 24-h dry stored disc specimens (10 × 1 mm; n = 10) were determined using a ball-on-ring jig setup.

RESULTS

Maximum rate of polymerisation and D_C,max increased linearly from 2.5 to 3.5% s^-1 and 67 to 83%, respectively, upon increasing MDP from 0 to 20 wt%. Values with 3% 4-META were 2.6% s^-1 and 78%. Shrinkage was 3.8 ± 0.3% for all formulations. Raising 4-META or MDP from 0 to 3 versus 5%, respectively, increased strength from 106 to 145 versus 136 MPa. A decreasing trend with higher MDP concentrations was noted. Elastic modulus showed no specific trend upon MDP increase.

SIGNIFICANCE

Whilst final conversion levels were enhanced by 3% 4-META or >5% MDP, trends did not correlate with strength. Peak strengths with 3% 4-META or 5% MDP may therefore be due to acidic monomers providing linkage between the hydrophilic, non-silane treated particles and the polymer matrix.

Methacrylate peak determination and selection recommendations using ATR-FTIR to investigate polymerisation of dental methacrylate mixtures

Investigation of polymerisation kinetics using ATR-FTIR systems is common in many dental studies. However, peak selection methods to calculate monomer-polymer conversion can vary, consequently affecting final results. Thus, the aim of this study is to experimentally confirm which method is less prone to systematic errors. Three commercial restorative materials were tested-Vertise Flow (VF), Constic and Activa Bioactive Restorative Kids. Firstly, Attenuated Total Reflectance Fourier Transform Infra-Red (ATR-FTIR) (Spectrum One, Perkin-Elmer, UK) spectra of monomers were acquired-10-methacryloyloxy decyl dihydrogen phosphate (10-MDP), bisphenol-A glycidyl dimethacrylate (Bis-GMA), 2-hydroxyethyl methacrylate (HEMA), triethyelene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA) to investigate proportionality of methacrylate peak heights versus concentration. Spectral changes upon light exposure of 2 mm discs of the restorative materials (irradiated for 20 s, LED curing unit 1100-1330 mW/cm2) were assessed to study polymerisation kinetics (n = 3), with continuous acquisition of spectra, before, during and after light exposure. Peak differences and degrees of conversion (DC %) were calculated using 1320/1336, 1320/1350 and 1636/1648 cm-1 as reaction/reference peaks. Inferential statistics included a MANOVA and within-subjects repeated measures ANOVA design (5% significance level). Proportionality of methacrylate peak height to concentration was confirmed, with the 1320/1352 cm-1 peak combination showing the lowest coefficient of variation (8%). Difference spectra of the polymerisation reaction showed noise interference around the 1500-1800 cm-1 region. Across the different materials, DC % results are highly dependent upon peak selection (p<0.001), with higher variability associated to the 1636 cm-1. Significant differences in the materials were only detected when the 1320 cm-1 peak was used (p<0.05). Within the same materials, methods were significantly different for Constic and Activa (p<0.05). It is possible to conclude that the 1320 cm-1 peak is more adequate to assess polymerisation of methacrylates and is therefore recommended.

Modelling ATR-FTIR Spectra of Dental Bonding Systems to Investigate Composition and Polymerisation Kinetics

Component ratios and kinetics are key to understanding and optimising novel formulations. This warrants investigation of valid methods. Attenuated Total Reflectance Fourier Transform Infra-Red (ATR)-FTIR spectra of separate primers/adhesives were modelled using summed spectra of solvents (water, ethanol), methacrylate monomers (HEMA (hydroxyethyl methacrylate), Bis-GMA (bisphenol A glycidyl methacrylate), and 10-MDP (10-methacryloyloxydecyl dihydrogen phosphate)), and fillers, multiplied by varying fractions. Filler loads were obtained following their separation from the adhesives, by analysing three repetitions (n = 3). Spectral changes during light exposure at 37 °C (20 s, LED 1100-1330 mW/cm2) were used to determine polymerisation kinetics (n = 3). Independent samples T-test was used for statistical analysis (significance level of 5%). FTIR modelling suggested a primer solvent percentage of OBFL (Optibond FL) (30%) was half that of CFSE (Clearfil SE 2) (60%). OBFL included ethanol and water, while CFSE included only water. Monomer peaks were largely those of HEMA with lower levels of phosphate monomers. OBFL/CFSE adhesive model spectra suggested that both contained equal volumes of Bis-GMA/HEMA, with CFSE having 10-MDP. Filler levels and spectra from OBFL (48 wt.%) and CFSE (5 wt.%) were different. Both systems reached a 50% conversion rate within seconds of light exposure. The final conversion for OBFL (74 ± 1%) was lower compared to CFSE (79 ± 2%) (p < 0.05). ATR-FTIR is a useful method to investigate relative levels of main components in bonding systems and their polymerisation kinetics. Such information is valuable to understanding such behaviour.

Effects of Different Amine Activators on the Monomer Conversion, Biaxial Flexural Strength, and Color Stability of Experimental Provisional Dental Restorations

Objective  The aim was to assess the effect of different amine activators including N, N-dimethyl-p-toluidine (DMPT) or Na-N-tolyglycine glycidyl methacrylate (NTGGMA) on chemical-activated monomer conversion, biaxial flexural strength (BFS), and color stability of composites for provisional dental restorations.

Materials and Methods  Two formulations of composites containing either DMPT (D-temp) or NTGGMA (N-temp) were prepared. The degree of monomer conversion was assessed. The BFS of the materials was tested using the ball-on-ring testing jig. The color difference (∆E ₀₀ ) of the materials after immersion in water was also determined. The commercial comparisons were Unifast (UF), Protemp (PT), Luxacrown, and Luxatemp (LT).

Results  The monomer conversion of D-temp (57.4 ± 1.3%) was comparable to that of N-temp (59.0 ± 1.3%). The conversion of both D-temp and N-temp were higher than that of PT (48.1 ± 3.4%) and LT (48.0 ± 1.6%). BFS of both D-temp (164.2 ± 18.1 MPa) and N-temp (168.6 ± 8.9 MPa) were comparable but higher than that of UF (119.8 ± 13.6 MPa). ∆E ₀₀ of D-temp (2.7 ± 0.7) and N-temp (2.5 ± 0.8) were comparable but higher than that of other commercial materials (0.6–1.2).

Conclusion  The use of DMPT or NTGGMA showed negligible effect on monomer conversion, BFS, and color stability of the experimental provisional restorations. The conversion and BFS of the experimental materials were in the range of that obtained from commercial bis-acryl-based materials. However, the color stability of the experimental materials was lower than that of commercial materials.

Detection and analysis of early degradation at resin-dentin interface by optical coherence tomography (OCT) and confocal laser scanning microscope (CLSM)

OBJECTIVE

To evaluate early degradation at resin-dentin interface using non-invasive swept-source optical coherence tomography (SS-OCT) and confocal laser scanning microscope (CLSM).

METHODS

Self-etch adhesives and resin-composites containing bisphenol-glycidyl-dimethacrylate (Bis-GMA), which is one of the most widely used monomers in restorative materials, were investigated in this study. Forty cervical cavities were prepared in bovine incisors and applied by the adhesive with/without Bis-GMA (AdhesiveBG/Adhesive), filled by the resin with/without Bis-GMA (ResinBG/Resin) and then challenged by cariogenic biofilm (37 °C, 24 h). Gap Formation and dentin demineralization around resin-composites were observed by SS-OCT and CLSM.

RESULTS

Three types of resin-dentin interfacial degradation could be detected from SS-OCT. Type I-dentin demineralization around resin without gap, showing feather-shaped dark zones without bright scattered lines at resin-dentin interfaces. Type II-dentin demineralization around resin with adhesive-dentin bonded gaps, showing feather-shaped dark zones with bright scattered lines at resin-dentin interfaces. Type III-dentin demineralization around resin with adhesive-dentin debonded gaps, showing edge-shaped dark zones with bright scattered lines at resin-dentin interface. From CLSM, the groups were compared in gap scale (GS), gap depth (GD), gap width (GW) and dentin wall lesion depth (WLD). Bis-GMA-containing adhesive groups showed significantly lower GS than Bis-GMA-free adhesive groups. Bis-GMA-containing resin groups showed significantly lower WLD than Bis-GMA-free resin groups. However, they did not show significant differences in GD and GW.

CONCLUSION

Three types of early degradation at resin-dentin interface can be noninvasively detected by SS-OCT. Bis-GMA-containing and Bis-GMA-free restorative materials show differences in gap scale and dentin wall lesion depth.

CLINICAL SIGNIFICANCE

SS-OCT can nondestructively detect early resin-dentin interfacial degradation. Gap scale can be used as a parameter to evaluate the risk factor of gaps.

Monomer conversion, biaxial flexural strength, apatite forming ability of experimental dual-cured and self-adhesive dental composites containing calcium phosphate and nisin

The aim was to develop dual-cured, self-adhesive composites containing monocalcium phosphate monohydrate (MCPM, 8 or 4 wt%) and nisin (6 or 3 wt%) with added adhesive monomer. The effect of additives on monomer conversion (MC), biaxial flexural strength (BFS), dentin shear bond strength (SBS), and surface apatite formation were examined. All experimental composites showed light-activated MC (70-75%) higher than the commercial self-adhesive composite (Vertise Flow; VF, 65%). The additives reduced BFS of the composites from 217 to 133 MPa. SBS of the experimental composites (2-6 MPa) was lower than that of VF (12 MPa). Rising MCPM level enabled apatite-like crystals precipitated on the surface of composites after immersion in simulated body fluid for 4 weeks. The additives showed negligible effect on MC and SBS. Rising level of additives reduced strength of the composites but the values were still higher than that required by the standard.

Bioactive low-shrinkage-stress nanocomposite suppresses S. mutans biofilm and preserves tooth dentin hardness

Recurrent dental caries is one of the main reasons for resin composite restoration failures. This study aimed to: (1) develop a bioactive, low-shrinkage-stress, antibacterial and remineralizing composite and evaluate the sustainability of its antibacterial effect against Streptococcus mutans (S. mutans) biofilms; and (2) evaluate the remineralization and cariostatic potential of the composite containing nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM), using dentin hardness measurement and a biofilm-induced recurrent caries model. The antibacterial and remineralizing low-shrinkage-stress composite consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), 3% DMAHDM and 20% NACP. S. mutans biofilm was used to evaluate antibiofilm activity, before and after 3 months of composite aging in acidic solution. Human dentin was used to develop a recurrent caries biofilm-model. Adding DMAHDM and NACP into low shrinkage-stress composite did not compromise the flexural strength. The low-shrinkage-stress composite with DMAHDM achieved substantial reductions in biofilm colony-forming units (CFU), lactic acid production, and biofilm biomass (p < 0.05). The low-shrinkage-stress DMAHDM+NACP composite exhibited no significant difference in antibacterial performance before and after 3 months of aging, demonstrating long-term antibacterial activity. Under S. mutans biofilm acidic attack, dentin hardness (GPa) was 0.24 ± 0.04 for commercial control, and 0.23 ± 0.03 for experimental control, but significantly higher at 0.34 ± 0.03 for DMAHDM+NACP group (p < 0.05). At an instrumental compliance of 0.33 μm/N, the polymerization shrinkage stress of the new composite was 36% lower than that of a traditional composite (p < 0.05). The triple strategy of antibacterial, remineralization and lower shrinkage-stress has great potential to inhibit recurrent caries and increase restoration longevity. Statement of Significance Polymerization shrinkage stress, masticatory load over time as well as biochemical degradation can lead to marginal failure and secondary caries. The present study developed a new low-shrinkage-stress, antibacterial and remineralizing dental nanocomposite. Polymerization shrinkage stress was greatly reduced, biofilm acid production was inhibited, and tooth dentin mineral and hardness were preserved. The antibacterial composite possessed a long-lasting antibiofilm effect against cariogenic bacteria S. mutans. The new bioactive nanocomposite has the potential to suppress recurrent caries at the restoration margins, protects tooth structures, and increases restoration longevity.

Early Polylysine Release from Dental Composites and Its Effects on Planktonic Streptococcus mutans Growth

The study aim was to assess the effect of incorporating polylysine (PLS) filler at different mass fractions (0.5, 1 and 2 wt%) on PLS release and Streptococcus mutans planktonic growth. Composite containing PLS mass and volume change and PLS release upon water immersion were assessed gravimetrically and via high-performance liquid chromatography (HPLC), respectively. Disc effects on bacterial counts in broth initially containing 8 × 10⁵ versus 8 × 10⁶ CFU/mL Streptococcus mutans UA159 were determined after 24 h. Survival of sedimented bacteria after 72 h was determined following LIVE/DEAD staining of composite surfaces using confocal microscopy. Water sorption-induced mass change at two months increased from 0.7 to 1.7% with increasing PLS concentration. Average volume increases were 2.3% at two months whilst polylysine release levelled at 4% at 3 weeks irrespective of composite PLS level. Early percentage PLS release, however, was faster with higher composite content. With 0.5, 1 and 2% polylysine initially in the composite filler phase, 24-h PLS release into 1 mL of water yielded 8, 25 and 93 ppm respectively. With initial bacterial counts of 8 × 10⁵ CFU/mL, this PLS release reduced 24-h bacterial counts from 10⁹ down to 10⁸, 10⁷ and 10² CFU/mL respectively. With a high initial inoculum, 24-h bacterial counts were 10⁹ with 0, 0.5 or 1% PLS and 10⁷ with 2% PLS. As the PLS composite content was raised, the ratio of dead to live sedimented bacteria increased. The antibacterial action of the experimental composites could reduce residual bacteria remaining following minimally invasive tooth restorations.

Preparation of Zn doped mesoporous silica nanoparticles (Zn-MSNs) for the improvement of mechanical and antibacterial properties of dental resin composites

OBJECTIVE

The purpose of this work was to explore the enhancement effect of zinc doped mesoporous silica nanoparticles (Zn-MSNs), which could form micromechanical interlocking with resin matrix and sustainably release Zn²⁺, on the mechanical and antibacterial properties of the dental resin composites.

METHODS

Zn-MSNs were prepared by a sol-gel method, and characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and N₂ adsorption/desorption. The mechanical properties of the dental composites reinforced by Zn-MSNs were measured by a universal mechanical testing machine. Antibacterial activities of dental composites were evaluated by both qualitative and quantitative analysis using Streptococcus mutans (S. mutans). The cytotoxicity of the Zn-MSNs filled dental composites was investigated by osteoblasts (OBs).

RESULTS

The synthesized Zn-MSNs possessed good monodispersity with an average particle size of about 138nm. The mechanical properties of the composites gradually increased with the increase of the content of Zn-MSNs. The flexural strength, flexural modulus, compressive strength and micro-hardness of the composites containing 15wt% Zn-MSNs were 31.21%, 50.47%, 53.83% and 26.79% higher than the samples with no Zn-MSNs, respectively. The antibacterial performance was significantly improved by the addition of Zn-MSNs and the antibacterial rate of the composite with 15wt% of Zn-MSNs reached 100%. Cytotoxicity tests revealed that all the composites were biocompatible during OBs incubation.

SIGNIFICANCE

The prepared Zn-MSNs can effectively improve the mechanical and antibacterial properties of the dental resin composites.

Influence of Spectroscopic Techniques on the Estimation of the Degree of Conversion of Bulk-fill Composites

OBJECTIVES

To compare the degree of conversion (DC) of different flowable and sculptable bulk-fill composites (BFC), at 0- and 4-mm depths from the surface, by Fourier transform infrared (FTIR), attenuated total reflection FTIR (ATR-FTIR), and FT-Raman spectroscopic techniques.

METHODS AND MATERIALS

Six BFC were investigated, including three sculptable composites (Admira Fusion [Voco], Aura Bulk Fill [SDI], and X-tra Fill [Voco]) and three flowable composites (Venus Bulk Fill [Heraeus], Filtek [3M], and X-tra Base [Voco]). Three molds of each composite were light cured as specified by the manufacturer. For each mold, slices corresponding to 0-mm (surface) and 4-mm depth were analyzed by spectroscopic techniques: ATR-FTIR, FTIR, and FT-Raman. The spectra of uncured composite material were used as an analytical control for background subtraction of the treated composite. The area and amplitude of the reference peaks (1607 and 1637 cm^-1) were obtained to calculate the DC percentage at 0- and 4-mm depth. A Kruskal-Wallis nonparametric test was used for materials, and paired comparisons were made using Mann-Whitney nonparametric test. Wilcoxon's rank test was used for comparison between spectroscopic methods and between 0- and 4-mm depth in each composite. Significance was accepted at p<0.05.

RESULTS

FTIR showed significantly lower DC values, both in areas and amplitudes of the peaks, when compared with the results reported by different BFC. Differences between the surface and 4-mm depth were detected more precisely by FT-Raman. ATR-FTIR obtained DC values significantly higher than those obtained by FTIR.

CONCLUSIONS

The vibrational spectroscopy method significantly influenced DC measurements of the flowable and sculptable BFC explored.

In vitro and in silico evaluations of resin-based dental restorative material toxicity

OBJECTIVES

This study aims to evaluate the cytocompatibility of three provisional restoration materials and predict neurotoxic potential of their monomers. These materials are Tab 2000® (methyl methacrylate based), ProTemp 4™ (bis-acrylic based) and Structur 3® (urethane dimethacrylate based).

MATERIALS AND METHODS

Resin samples were incubated in a cell culture medium and the cytotoxic effects of these extracts were studied in 3T3 fibroblast cells through MTT and crystal violet assays as well as ROS assessment. The presence of relevant leached monomers was determined by HPLC. Additionally, the blood-brain barrier (BBB) permeability to these resin-based monomers was predicted using ACD/Labs algorithms model.

RESULTS

Cell survival rates were compared with the resin extracts, and Structur 3® was statistically significant different from the others (p < 0.001) at all-time incubation periods. All materials induced a dose-dependent loss of cell viability; however, only Structur 3 extracts were cytotoxic against 3T3 fibroblasts. The highest cytotoxic effect (77%, p < 0.001) was observed at 24 h incubation period, which may be associated with the presence of urethane dimethacrylate (UDMA) leached monomers. Furthermore, the computational model showed that most monomers under study are expectedly capable of crossing the BBB.

CONCLUSIONS

Our results showed that Structur 3® is not cytocompatible with our cell model and UDMA is a potential neurotoxic compound.

CLINICAL RELEVANCE

These results indicate that only ProTemp 4™ and Tab 2000® are safe for provisional restorations.

Polymerization kinetics stability, volumetric changes, apatite precipitation, strontium release and fatigue of novel bone composites for vertebroplasty

PURPOSE

The aim was to determine effects of diluent monomer and monocalcium phosphate monohydrate (MCPM) on polymerization kinetics and volumetric stability, apatite precipitation, strontium release and fatigue of novel dual-paste composites for vertebroplasty.

MATERIALS AND METHODS

Polypropylene (PPGDMA) or triethylene (TEGDMA) glycol dimethacrylates (25 wt%) diluents were combined with urethane dimethacrylate (70 wt%) and hydroxyethyl methacrylate (5 wt%). 70 wt% filler containing glass particles, glass fibers (20 wt%) and polylysine (5 wt%) was added. Benzoyl peroxide and MCPM (10 or 20 wt%) or N-tolyglycine glycidyl methacrylate and tristrontium phosphate (15 wt%) were included to give initiator or activator pastes. Commercial PMMA (Simplex) and bone composite (Cortoss) were used for comparison. ATR-FTIR was used to determine thermal activated polymerization kinetics of initiator pastes at 50-80°C. Paste stability, following storage at 4-37°C, was assessed visually or through mixed paste polymerization kinetics at 25°C. Polymerization shrinkage and heat generation were calculated from final monomer conversions. Subsequent expansion and surface apatite precipitation in simulated body fluid (SBF) were assessed gravimetrically and via SEM. Strontium release into water was assessed using ICP-MS. Biaxial flexural strength (BFS) and fatigue properties were determined at 37°C after 4 weeks in SBF.

RESULTS

Polymerization profiles all exhibited an inhibition time before polymerization as predicted by free radical polymerization mechanisms. Initiator paste inhibition times and maximum reaction rates were described well by Arrhenius plots. Plot extrapolation, however, underestimated lower temperature paste stability. Replacement of TEGDMA by PPGDMA, enhanced paste stability, final monomer conversion, water-sorption induced expansion and strontium release but reduced polymerization shrinkage and heat generation. Increasing MCPM level enhanced volume expansion, surface apatite precipitation and strontium release. Although the experimental composite flexural strengths were lower compared to those of commercially available Simplex, the extrapolated low load fatigue lives of all materials were comparable.

CONCLUSIONS

Increased inhibition times at high temperature give longer predicted shelf-life whilst stability of mixed paste inhibition times is important for consistent clinical application. Increased volumetric stability, strontium release and apatite formation should encourage bone integration. Replacing TEGDMA by PPGDMA and increasing MCPM could therefore increase suitability of the above novel bone composites for vertebroplasty. Long fatigue lives of the composites may also ensure long-term durability of the materials.

The effect of hydrofluoric acid and resin cement formulation on the bond strength to lithium disilicate ceramic

To investigate how the hydrofluoric acid (HF) concentrations applied to a lithium disilicate glass-ceramic (EMX) affects the surface morphology and microtensile bond strength (μTBS) of ceramics to dentin, using light-cured resin cements with or without UDMA. Sixty-three EMX square ceramic blocks were etched for 20 seconds using different HF concentrations (1%, 5% and 10%) and luted to dentin using two types of resin cement combinations: BisGMA/TEGDMA and BisGMA/TEGDMA/UDMA (n = 10). Each bonded EMX-dentin block was sectioned to obtain 1 mm2 sticks for μTBS evaluation. Half of the sticks were tested after 24 hours and the other half was assessed after 6 months of water storage. Data were statistically assessed using split-plot three-way ANOVA and multiple comparisons were performed using the Tukey's post hoc test (α = 0.05). One EMX sample from each HF concentration was analyzed using field-emission scanning electron microscope (FE-SEM) to characterize the etching pattern. According to the FE-SEM images, increasing the concentration of HF from 1 to 5 and then to 10% led to increased removal of glassy matrix and greater exposure of lithium disilicate crystals. The 10% HF concentration yielded higher μTBS when compared to 1% for BisGMA/TEGDMA formulation (p < 0.05); whereas HF 1% and 5% showed similar μTBS values when compared to 10% HF for BisGMA/TEGDMA/UDMA resin matrix (p > 0.05) at both storage times. Water aging decreased the μTBS values (p < 0.05), except when 10% HF was associated with BisGMA/TEGDMA resin cement. Resin cement formulation and hydrofluoric acid concentrations can interfere with the immediate and long-term glass-ceramic bond strength to dentin.

Influence of Photoinitiator on Accelerated Artificial Aging and Bond Strength of Experimental Resin Cements

Abstract The goal of this study was to evaluate in vitro the effect of the photoinitiator phenylpropanedione (PPD), alone or combined with camphorquinone (CQ), on color stability of photoactivated resin cements and their bond strength to ceramics using a micro-shear test. Four resin cements were used: a commercial brand cement (RelyX Veneer®) and 3 experimental cements with different types and concentration of photoinitiators. For color analysis, ceramic discs were cemented on bovine dentin specimens to simulate indirect restorations (n=8) and were exposed to UV for 120 h and tested for color alteration using a reflectance spectrophotometer and the CIEL*a*b* system. Data were analyzed by Anova and Tukey’s test at 5% significance level. The color test results did not present statistically significant difference for the ∆E for all the studied cements, neither for ∆L, ∆a and ∆b. For the bond strength, all the studied cements showed statistically significant differences to each other, with the highest result for the RelyX Veneer® (29.07 MPa) cement, followed by the cement with CQ (21.74 MPa) and CQ+PPD (19.09 MPa) cement; the lowest result was obtained by the cement using only PPD as a photoinitiator (13.99 MPa). So, based on the studied parameters, PPD was not advantageous as photoinitiator of resin cements, because it showed a low value of bond strength to the ceramics and no superior color stability.

Monomer conversion, dimensional stability, strength, modulus, surface apatite precipitation and wear of novel, reactive calcium phosphate and polylysine-containing dental composites

Purpose

The aim was to assess monomer conversion, dimensional stability, flexural strength / modulus, surface apatite precipitation and wear of mono / tri calcium phosphate (CaP) and polylysine (PLS)—containing dental composites. These were formulated using a new, high molecular weight, fluid monomer phase that requires no polymerisation activator.

Materials and methods

Urethane and Polypropylene Glycol Dimethacrylates were combined with low levels of an adhesion promoting monomer and a light activated initiator. This liquid was mixed with a hybrid glass containing either 10 wt% CaP and 1 wt% PLS (F1) or 20 wt% CaP and 2 wt% PLS (F2). Powder to liquid mass ratio was 5:1. Commercial controls included Gradia Direct Posterior (GD) and Filtek Z250 (FZ). Monomer conversion and polymerisation shrinkage were calculated using Fourier Transform Infrared (FTIR). Subsequent volume increases in water over 7 weeks were determined using gravimetric studies. Biaxial flexural strength (BFS) / modulus (BFM) reduction and surface apatite precipitation upon 1 and 4 weeks immersion in water versus simulated body fluid (SBF) were assessed using a mechanical testing frame and scanning electron microscope (SEM). Mass / volume loss and surface roughness (R_a) following 7 weeks water immersion and subsequent accelerated tooth-brush abrasion were examined using gravimetric studies and profilometer.

Results

F1 and F2 exhibited much higher monomer conversion (72%) than FZ (54%) and low calculated polymerization shrinkage (2.2 vol%). Final hygroscopic expansions decreased in the order; F2 (3.5 vol%) > F1 (1.8 vol%) ~ Z250 (1.6 vol%) > Gradia (1.0 vol%). BFS and BFM were unaffected by storage medium type. Average BFS / BFM upon 4 weeks immersion reduced from 144 MPa / 8 GPa to 107 MPa / 5 GPa for F1 and 105 MPa / 6 GPa to 82 MPa / 4 GPa for F2. Much of this change was observed in the first week of immersion when water sorption rate was high. Surface apatite layers were incomplete at 1 week, but around 2 and 15 micron thick for F1 and F2 respectively following 4 weeks in SBF. Mass and volume loss following wear were equal. Average results for F1 (0.5%), F2 (0.7%), and FZ (0.5%) were comparable but lower than that of GD (1%). R_a, however, decreased in the order; F1 (15 μm) > F2 (11 μm) > GD (9 μm) > FZ (5 μm).

Conclusions

High monomer conversion in combination with large monomer size and lack of amine activator should improve cytocompatibility of the new composites. High monomer molecular weight and powder content enables low polymerisation shrinkage despite high conversion. Increasing active filler provides enhanced swelling to balance shrinkage, which, in combination with greater surface apatite precipitation, may help seal gaps and reduce bacterial microleakage. High monomer conversion also ensures competitive mechanical / wear characteristics despite enhanced water sorption. Furthermore, increased active filler could help reduce surface roughness upon wear.

New adhesive system based in metals cross-linking methacrylate

This study evaluated the anti-antibiofilm potential of silver methacrylate (Ag) or di-n-butyldimethacrylatetin (Sn) in experimental adhesive systems. Ag and Sn methacrylates were incorporated at 0.5mol%, 1mol% and 2mol% in an adhesive resin. The anti-antibiofilm potential, degree of conversion (DC), microtensile bond strength (μTBS), water sorption/solubility (W_SR/SL), bonded interfaces pattern (SEM), cytotoxicity and leaching of Ag and Sn ions were evaluated. Data were statistically analyzed considering α = 0.05. Only Ag at 2% affected DC and μTBS. Ag at 1% and 2% and Sn at 1% and 2% showed anti-biofilm potential against Mutans streptococci. Ag at 1% and 2% and Sn at 2% showed a statistically significant difference to the control in W_SR/SL (p < 0.05). The additions of metal methacrylate did not affect cell viability, being the adhesive resins statistically similar to controls. Leached metals of Ag were more than 100x higher than for Sn. Between the concentration tested, Ag and Sn methacrylate at 1% presented an anti-biofilm effect without altering the mechanical properties evaluated.

Extensive Assessment of the Physical, Mechanical, and Adhesion Behavior of a Low-viscosity Bulk Fill Composite and a Traditional Resin Composite in Tooth Cavities

Objectives:

To compare the degree of conversion (DC), depth of polymerization (DP), shrinkage stress (SS), flexural strength (FS), elastic modulus (EM), and bond strength (BS) of a low-viscosity bulk fill resin composite and a paste-like traditional composite.

Methods:

Tetric Evo-Flow Bulk Fill (TBF) and Empress Direct (ED; Ivoclar Vivadent) composites were used. DC (%) and FS/EM (MPa/GPa) were evaluated in bar specimens (7×2×1 mm; n=10) using Fourier-transform infrared spectroscopy and a three-point bending test in a universal testing machine (UTM), respectively. For DP and BS tests, conical cavities (n=10) were prepared in bovine dentin and restored with the composites. DP was analyzed by calculating the bottom-to-top surface microhardness ratio (BTHR), and BS (MPa) was determined by push-out testing in the UTM. SS (MPa) was measured for one increment of TBF and two increments of ED in a UTM attached to an extensometer (n=5). Data were analyzed using Student t-test and analysis of variance (α=0.05).

Results:

TBF presented higher values than ED for DC (85.7±6.6% vs 54.2±4.9%) and BS (0.95±0.70 MPa vs 0.35±0.15 MPa). TBF values were lower than ED values for FS (76.6±16.8 MPa vs 144.9±24.1 MPa) and maximum SS (0.77±0.07 MPa vs 1.07±0.15 MPa). TBF and ED values were similar for BTHR (0.83±0.16 vs 0.84±0.08) and EM (11.5±2.8 GPa vs 12.5±2.6 GPa).

Conclusions:

The physical and mechanical properties of TBF, a bulk fill resin composite, were similar or superior to those of ED, a conventional composite, with the exception of FS measurements.