Volumetric shrinkage and film thickness of cementation materials for veneers: An in vitro 3D microcomputed tomography analysis

Fabrication trueness and marginal quality of additively manufactured resin-based definitive laminate veneers with different restoration thicknesses

OBJECTIVES

To evaluate how restoration thickness (0.5 mm and 0.7 mm) affects the fabrication trueness of additively manufactured definitive resin-based laminate veneers, and to analyze the effect of restoration thickness and margin location on margin quality.

METHODS

Two maxillary central incisors were prepared either for a 0.5 mm- or 0.7 mm-thick laminate veneer. After acquiring the partial-arch scans of each preparation, laminate veneers were designed and stored as reference data. By using these reference data, a total of 30 resin-based laminate veneers were additively manufactured (n = 15 per thickness). All veneers were digitized and stored as test data. The reference and test data were superimposed to calculate the root mean square values at overall, external, intaglio, and marginal surfaces. The margin quality at labial, incisal, mesial, and distal surfaces was evaluated. Fabrication trueness at each surface was analyzed with independent t-tests, while 2-way analysis of variance was used to analyze the effect of thickness and margin location on margin quality (α = 0.05).

RESULTS

Regardless of the evaluated surface, 0.7 mm-thick veneers had lower deviations (P < 0.001). Only the margin location (P < 0.001) affected the margin quality as labial margins had the lowest quality (P < 0.001).

CONCLUSION

Restoration thickness affected the fabrication trueness of resin-based laminate veneers as 0.7 mm-thick veneers had significantly higher trueness. However, restoration thickness did not affect the margin quality and labial margins had the lowest quality.

CLINICAL SIGNIFICANCE

Laminate veneers fabricated by using tested urethane-based acrylic resin may require less adjustment when fabricated in 0.7 mm thickness. However, marginal integrity issues may be encountered at the labial surface.

Short curing time bulk fill composite systems: volumetric shrinkage, degree of conversion and Vickers hardness

This study aimed to evaluate volumetric polymerization shrinkage, degree of conversion and Vickers hardness of four bulk-fill resin composites light-activated with their dedicated light curing units (LCUs). Four groups were evaluated, according to the type of composite and curing mode: Tetric EvoCeram Bulk-fill (TEBO) and Tetric EvoFlow Bulk-fill (TEBF) were light-activated with Bluephase Style 20i (20s, in high-mode), while Tetric Powerfill (TEPO) and Tetric Powerflow (TEPF) were light-activated with Bluephase PowerCure (3s). Volumetric polymerization shrinkage test (n = 6) was performed in standardized box-shaped class-I cavities of extracted third molars (4 x 4 x 4 mm). Teeth were scanned before and after resin composite application by micro-computed tomography, and acquired data were evaluated with Amira software. Degree of conversion (n = 5) was evaluated at the top and bottom surfaces of composite cylindric samples (4 mm diameter, 4 mm thickness) using an FT-IR spectrometer (spectra between 1,500 and 1,800 cm-1, 40 scans at a resolution of 4 cm-1). Three Vickers indentations (50 g / 15 s), spaced 500 μm apart, were performed on the top and bottom composite surfaces and averaged. One-way ANOVA was used for data evaluation. TEPF showed the lowest volumetric polymerization shrinkage (p < 0.05), while the other composites were not significantly different within each other (p > 0.05). All materials presented a significant decrease in degree of conversion and Vickers hardness when compared top to bottom surfaces (p < 0.05). Bottom to top surface ratios for degree of conversion ranged from 0.8 (TEBO and TEPO) to 0.9 (TEBF and TEPF), and from 0.4 (TEPO) to 0.7 (TEBF and TEPF) for hardness. In conclusion, resinous materials present a decrease in hardness and degree of conversion from top to bottom even when a higher power is used, while the flowable material TEPF showed the lowest volumetric shrinkage values compared to the other materials.

Does the use of preheated restorative resin composite as a luting agent influence the adaptation of fixed dental prostheses? A systematic review

STATEMENT OF PROBLEM

Although studies have explored the physical and mechanical properties of different composite resins with the preheating technique, evidence that the use of preheated restorative composite resin as a luting agent influences the adaptation of fixed dental prostheses is lacking.

PURPOSE

The purpose of this systematic review was to answer the question: Does the use of preheated restorative composite resin as a luting agent influence the adaptation of fixed dental prostheses?

MATERIAL AND METHODS

Seven databases and nonpeer-reviewed literature were searched, without language or year restrictions. Studies directly comparing the adaptation of fixed dental prostheses cemented with preheated restorative composite resin or resin cement were considered eligible for inclusion. Assessment of the risk of bias was based on a 9-item checklist.

RESULTS

Of 2109 retrieved articles, 4 in vitro studies met the inclusion criteria. Three of them concluded that preheated restorative composite resin produced a greater mismatch than resin cement, and the remaining study reported that composite resin improved the adaptation of fixed dental prostheses. All included studies had a medium risk of bias. The high level of heterogeneity among the studies precluded meta-analysis.

CONCLUSIONS

The use of preheated restorative composite resin as a luting agent seems to negatively influence the adaptation of fixed dental prostheses. It was not possible to evaluate whether variables such as the formulation of the resin material or its heating time and temperature influence the adaptation of fixed dental prostheses because of the high heterogeneity of the included studies.

Internal Adaptation of Composite Fillings Made Using Universal Adhesives-A Micro-Computed Tomography Analysis

This study aimed to evaluate internal tooth-filling interfaces of composite fillings made using universal adhesives using micro-computed tomography (µCT). Sixty class V cavities were randomly assigned into six groups: Peak Universal etch and rinse (PER), Peak Universal self-etch (PSE), Adhese Universal etch and rinse (AER), and Adhese Universal self-etch (ASE). Two further adhesives considered gold standards were used as control groups: OptiBond FL (OER) for the etch and rinse technique and Clearfil SE for the self-etch technique (CSE). All teeth were subjected to thermomechanical loading and four-year water storage. Next, they were analyzed using µCT to investigate the internal tooth-filling interfaces. The proportions between the gap volume (GV) at the tooth-filling interface and the volume of applied composite filling (FV), between the gap and cavity volumes (CV), and between the gap volumes at the tooth-filling interface of the external (EGV) and internal (IGV) parts were calculated. Adhese Universal achieved the significantly lowest gap-to-filling- and gap-to-cavity-volume ratios for both types of etching techniques comparing to those of the Peak Universal and control groups. Significant differences between the gaps in external and internal parts of the tooth-filling interface were only noted in the control groups. Internal gap formation and development at the tooth-filling interface depend on the material as well as the type of its application.

Effect of Resin Cement at Different Thicknesses on the Fatigue Shear Bond Strength to Leucite Ceramic

OBJECTIVES

 This in vitro study was performed to evaluate fatigue survival by shear test in the union of leucite-reinforced feldspathic ceramic using different cement thicknesses.

MATERIALS AND METHODS

 Leucite-reinforced glass ceramics blocks were sectioned in 2-mm thick slices where resin cylinders were cemented. The samples were distributed in two experimental groups (n = 20) according to the cement thickness (60 and 300 μm). The specimens of each group were submitted to the stepwise fatigue test in the mechanical cycling machine under shear stress state, with a frequency of 2 Hz, a step-size of 0.16 bar, starting with a load of 31 N (1.0 bar) and a lifetime of 20,000 cycles at each load step.

RESULTS

 The samples were analyzed in a stereomicroscope and scanning electron microscopy to determine the failure type. There is no significant difference between the mean values of shear bond strength according to both groups. Log-rank (p = 0.925) and Wilcoxon (p = 0.520) tests revealed a similar survival probability in both cement layer thicknesses according to the confidence interval (95%). The fracture analysis showed that the mixed failure was the most common failure type in the 300-μm thickness group (80%), while adhesive failure was predominant in the 60-μm thickness group (67%). The different cement thicknesses did not influence the leucite ceramic bonding in fatigue shear testing; however, the thicker cement layer increased the predominance of the ceramic material failure.

CONCLUSION

 The resin cement thicknesses bonded to leucite ceramic did not influence the long-term interfacial shear bond strength, although thicker cement layer increased the ceramic material cohesive failure. Regardless the cement layer thickness, the shear bond strength lifetime decreases under fatigue.

The Influence of a Novel, Crenelated Design of CAD-CAM Ceramic Veneers on the Debonding Strength

(1) Background: Aesthetic dentistry has become one of the most dynamic fields in modern dental medicine. Ceramic veneers represent the most appropriate prosthetic restorations for smile enhancement, due to their minimal invasiveness and highly natural appearance. For long-term clinical success, accurate design of both tooth preparation and ceramic veneers is of paramount importance. The aims of this in vitro study were to assess the stress in anterior teeth restored with Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) ceramic veneers and compare the resistance to detachment and the fracture of ceramic veneers prepared using two different designs. (2) Methods: Sixteen lithium disilicate ceramic veneers were designed and milled using the CAD-CAM technology and divided into two groups according to the preparations (n = 8): Group 1, conventional (CO), with linear marginal contour and Group 2, crenelated (CR), the latter with our novel (patented) sinusoidal marginal design. All samples were bonded to anterior natural teeth. The mechanical resistance to detachment and fracture was investigated by applying bending forces on the incisal margin of the veneers in order to determine which type of preparation leads to better adhesion. An analytic method was employed, as well, and the results of the two approaches were compared. (3) Results: The mean values of the maximum force recorded at the veneer detachment were 78.82 ± 16.55 N for the CO group and 90.20 ± 29.81 N for the CR group. The relative increase, equal to 14.43%, demonstrated that the novel CR tooth preparation provided higher adhesive joints. In order to determine the stress distribution within the adhesive layer, a finite element analysis (FEA) was performed. The statistical t-test showed that the mean value of the maximum normal stresses is higher for the CR-type preparations. (4) Conclusions: The patented CR veneers represent a practical solution to augment the adhesion and mechanical properties of ceramic veneers. The obtained results demonstrated that CR adhesive joints triggered higher mechanical and adhesive forces, which subsequently led to a higher resistance to detachment and fracture.

Effect of thickness of CAD/CAM materials on light transmission and resin cement polymerization using a blue light-emitting diode light-curing unit

OBJECTIVE

Evaluate the effect of thickness of high-translucency (HT) CAD/CAM materials on irradiance and beam profile from a blue light-emitting diode light-curing unit (LCU) and on the degree of conversion (DC) and maximum polymerization rate (Rp_max ) of a light-cured resin cement (LCC).

MATERIAL AND METHODS

The direct output from the LCU, the light transmission and irradiance ratio (IR) through one conventional composite and nine HT CAD/CAM materials (0.5, 1.0, 1.5, or 2.0-mm thick; n = 5) were measured with a integrating sphere coupled to a spectrometer. The light beam was assessed with a beam profiler camera. The DC at 600 s and the Rp_max of one LCC was determined using a Fourier transform infrared spectrometer (n = 5). Data were analyzed by ANOVA followed by Tukey's tests, and Dunnett's test was also used for irradiance data (α = 0.05).

RESULTS

A significant decrease in irradiance through all materials occurred as thickness increased. Thin CAD/CAM materials improved light homogeneity, which decreased with the increase in thickness. The DC of the LCC directly exposed to light was the same as when exposed to 45%, 25%, 15%, or 5% IRs. Rp_max decreased with the decrease in IR.

CONCLUSIONS

Although the HT CAD/CAM materials reduced the irradiance from the LCU, minor effects were observed in the LCC's DC.

CLINICAL SIGNIFICANCE

Despite the light attenuation of blue light through different CAD/CAM materials that were up to 2-mm thick, the degree of conversion of one brand of light-cured resin cement was clinically acceptable when the LCU was used for 30 s.

Biomechanical Testing of Two-Unit Bridges and a Comparison of Replacement Retention Depending on a Cementation Medium, Replacement Position, and Gap Size

Dental replacements are placed between the abutment teeth. The exceptions are two-unit bridges, as they are supported by a single tooth prepared only on one side of the missing tooth. The presented study deals with an analysis of a pressure force action on two-unit bridges placed in the frontal part (20 samples), where the pressure action is lower, and in the distal part (20 samples), where the pressure action is higher. A CAD program by 3Shape was used for digital designing with two different gap settings, 10 μm (20 samples) and 30 μm (20 samples). Two-unit bridges were attached to the prepared tooth using two types of dental cement (20/20 samples), which were selected for their physical and bioactive properties. All two-unit bridges (a total of 80 samples) were fabricated from CoCr alloys on Mlab cusing R by applying the Selective Laser Melting (SLM) technology. Mechanical testing was performed using the Inspekt5 table blue. The obtained data were used to verify the hypotheses-a difference between both types of cement (A ≠ B), a difference between the frontal and distal two-unit bridges (F ≠ D) and a difference between the gap sizes (10 ≠ 30). To confirm the given theories, data were statistically evaluated using the F-test and subsequent t-tests. The resulting p-value was compared with the level of significance (α = 0.05). A statistical evaluation revealed a significant difference between the compared groups; however, no explicit correlation between the individual groups of specimens was identified.

Operator versus material influence on film thickness using adhesive resin cement or pre‐heated resin composite

OBJECTIVE

There is a growing interest in using pre-heated composites instead of dual-cured cements when luting indirect restorations. This study evaluated the film thickness obtained from two pre-heated composites and two resin cements, by two different operators. The influence of the materials and the level of expertise of the operator were analyzed.

MATERIALS AND METHODS

Forty specimens of human dentin and composite discs were prepared and divided into four groups depending on the luting process. Each group was randomly equally divided to be handled by two operators with different levels of experience. Two of the initial four groups were luted using dual-cured cements and the two remaining groups using light-cured pre-heated composites. Specimen discs were cut after luting, and film thickness was measured using a Digital microscope. Data were analyzed using a 2-way ANOVA with the Holm-Sidak pairwise multiple comparison procedure (p < 0.05).

RESULTS

Mean film thickness ranged from 156.16 ± 4.7 to 33.82 ± 0.7 μm. Significant differences (p < 0.001) were noticed between expert and novice results with pre-heated composites.

CONCLUSION

Within the limits of this study, using pre-heated composites as a luting cement requires a better level of expertise to achieve a clinically acceptable film thickness.

CLINICAL SIGNIFICANCE

Using pre-heated composites as luting agent for indirect restorations requires an experimented skill level to achieve a clinically recommended film thickness.

Luting indirect restorations with resin cements versus composite resins: Effects of preheating and ultrasound energy on film thickness

OBJECTIVE

This study aims to evaluate and compare the film thickness obtained with a resin cement and two composite resins, preheated and/or ultrasonically vibrated, as luting agents.

MATERIALS AND METHODS

One hundred and twenty-six (126) pairs of resin discs were randomly assigned to six experimental groups (n = 21) according to luting agent (Variolink Esthetic LC, IPS Empress Direct or Estelite Omega) and cementation technique (preheating at 68°C and/or ultrasonic vibration). Specimens were luted by applying a controlled force. Following sectioning and film thickness measurement through field emission gun scanning electron microscopy, statistical analysis was carried out considering a 5% significance level.

RESULTS

Statistically significant lower film thickness was observed in Variolink Esthetic LC group when compared to all composite resin groups (p < 0.001), except IPS Empress Direct preheated and ultrasonically vibrated group (p = 0.073). IPS Empress Direct with ultrasonic vibration yielded statistically lower film thickness values than Estelite Omega groups, regardless of luting technique (p < 0.05). Ultrasonically vibrated Estelite Omega groups showed statistically lower film thickness values than solely preheated groups (p < 0.05).

CONCLUSIONS

Both Variolink Esthetic LC and IPS Empress Direct preheated and ultrasonically vibrated provided the lowest film thickness. The addition of ultrasonic vibration during cementation proved to be effective in reducing film thickness of both tested composite resins.

CLINICAL SIGNIFICANCE

The cementation technique will have variable results depending on the luting material. Adhesive cementation protocols with composite resins should mainly consider ultrasonic vibration, but also preheating, as strategies for reducing film thickness. The tested resin cement, alongside with IPS Empress Direct composite resin preheated and ultrasonically vibrated, provided the lowest film thickness among the tested materials and techniques.

A systematic review and meta-analysis on using preheated resin composites as luting agents for indirect restorations

OBJECTIVES

This systematic review investigated the hypothesis that preheated resin composites (RCs) used as luting agents improve the mechanical properties, physicochemical performance, and color of indirect ceramic restorations.

MATERIALS AND METHODS

Literature search was performed in three databases (Medline/PubMed, Scopus, and Web of Science) and in the grey literature (OpenGrey, ProQuest, and Catalog of Theses & Dissertations from CAPES). Eligibility criteria included only studies comparing at least one preheated RC used as a luting agent with resin cements.

RESULTS

Data regarding the mechanical properties, physicochemical characteristics, and color were analyzed qualitatively, and the microtensile bond strength and film thickness were also evaluated by meta-analysis. The search strategy identified 3894 papers, and 28 were full-text screened. Seven studies were included in the review, and 5 were included in the meta-analysis. No significant difference was found for microtensile bond strength (P = 0.14). Preheated RCs showed significantly higher film thickness than resin cements (P = 0.001).

CONCLUSION

Overall, the use of preheated RCs as luting agents offers similar to poorer performance than using resin cements for bonding indirect restorations.

CLINICAL RELEVANCE

Despite the claim that preheated RC could be used as a luting agent, further studies should investigate the effect of clinically unacceptable film thickness.

Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.

Influence of filler geometry and viscosity of composite luting materials on marginal adhesive gap width and occlusal surface height of all-ceramic partial crowns

OBJECTIVES

To evaluate the influence of filler geometry and viscosity of luting composites on marginal adhesive gap width (MGW) and occlusal surface height (OSH) of all-ceramic partial crowns.

METHODS

Forty-eight all-ceramic partial crowns (Celtra Duo, Dentsply) were created and divided into six groups (n = 8). Restorations were bonded using universal adhesive (Prime & Bond Active, Dentsply) in combination with low-viscosity composites (LV) containing amorphous fillers (Calibra Ceram, Dentsply) (LV-AF), heterogeneous fillers (Tetric EvoFlow, Ivoclar Vivadent) (LV-HF) vs. high-viscosity composites (HV) containing spherical fillers (Ceram.x, Dentsply) (HV-SF) or heterogeneous fillers (Tetric EvoCeram, Ivoclar Vivadent) (HV-HF). HV materials were used either with or without sonication. MGW [µm] was measured by SEM. Displacements of the restorations after luting, such as changes (Δ) in OSH [µm], tilting and rotation [°], were measured using a dial gauge and 3D-analytical software (OraCeck, Cyfex). Statistical analysis was by Mann-Whitney U-test and t-test with α = 0.05.

RESULTS

MGW (p = 0.002) and tilting (p = 0.001) were significantly smaller with LV (228.0 ± 112.35 µm; 0.89 ± 1.25°) than with HV (338.1 ± 97.26 µm; 1.95 ± 1.26°). Sonication had no effect on MGW in HV-HF (332.32 ± 91.39 µm) and HV-SF (343.85 ± 105.48 µm; p = 0.74). Sonication decreased ΔOSH by ~50% with HV-SF (64.21 ± 27.90 µm) but remained unchanged with HV-HF (39.06 ± 14.08 µm; p = 0.004). There was no difference in rotation between HV (0.82 ± 0.81°) and LV (0.61 ± 0.74°; p = 0.29). The LV-AF and LV-HF groups showed no statistical differences in MGW, ΔOSH, tilting or rotation (p > 0.05).

SIGNIFICANCE

Irrespective of filler geometry and insertion technique, the use of high-viscosity composites for the adhesive cementation of modern all-ceramic partial crowns increases displacement, marginal misfit and occlusal surface height.

Effect of Cement Layer Thickness on the Immediate and Long-Term Bond Strength and Residual Stress between Lithium Disilicate Glass-Ceramic and Human Dentin

This study tested whether three different cement layer thicknesses (60, 120 and 180 μm) would provide the same bonding capacity between adhesively luted lithium disilicate and human dentin. Ceramic blocks were cut to 20 blocks with a low-speed diamond saw under cooling water and were then cemented to human flat dentin with an adhesive protocol. The assembly was sectioned into 1 mm² cross-section beams composed of ceramic/cement/dentin. Cement layer thickness was measured, and three groups were formed. Half of the samples were immediately tested to evaluate the short-term bond strength and the other half were submitted to an aging simulation. The microtensile test was performed in a universal testing machine, and the bond strength (MPa) was calculated. The fractured specimens were examined under stereomicroscopy. Applying the finite element method, the residual stress of polymerization shrinkage according to cement layer thickness was also calculated using first principal stress as analysis criteria. Kruskal–Wallis tests showed that the ‘‘cement layer thickness’’ factor significantly influenced the bond strength results for the aged samples (p = 0.028); however, no statistically significant difference was found between the immediately tested groups (p = 0.569). The higher the cement layer thickness, the higher the residual stress generated at the adhesive interface due to cement polymerization shrinkage. In conclusion, the cement layer thickness does not affect the immediate bond strength in lithium disilicate restorations; however, thinner cement layers are most stable in the short term, showing constant bond strength and lower residual stress.

Does overlay preparation design affect polymerization shrinkage stress distribution? A 3D FEA study

This study evaluated the polymerization shrinkage stress of three tooth preparation designs for indirect ceramic overlay by finite element analysis: isthmus preparation (IST); without isthmus preparation (wIST); and non-retentive preparation (nRET). The models were created based in prepared dental typodonts and were digitally impressed with an intraoral scanner. The interfaces in all models were considered perfectly bonded and all materials were considered homogeneous, linear, and isotropic. The polymerization shrinkage of the cement layer (100 µm) was simulated and evaluated by maximum principal stress criteria. The stress peaks followed this sequence: restoration = IST (13.4 MPa) > wIST (9.3 MPa) > nRET (9 MPa); cement layer = IST (16.9 MPa) > wIST (12.6 MPa) > nRET (10-7.5 MPa); and teeth = IST (10.7 MPa) > wIST (10.5 MPa) > (9 MPa). For the cement layer, the non-retentive preparation (nRET) had the lowest shrinkage stress from all the groups, obtaining a more homogeneous stress distribution on the cement surface. Regarding the abutment teeth, the IST generated a higher shrinkage stress area on the dental structure, concentrating higher stress magnitude at the axiopulpar and axiogingival angles. Non-retentive preparation seems to reduce polymerization shrinkage stress.

Effect of Shortened Light-Curing Modes on Bulk-Fill Resin Composites

CLINICAL RELEVANCE

Shortened light curing does not affect volumetric polymerization shrinkage or cohesive tensile strength but negatively affects the shear bond strength of some bulk-fill resin composites. When performing shortened light curing, clinicians should be aware of the light output of their light-curing units.

SUMMARY

Purpose: To evaluate volumetric polymerization shrinkage (VPS), shear bond strength (SBS) to dentin, and cohesive tensile strength (CTS) of bulk-fill resin composites (BFRCs) light activated by different modes.Methods and Materials: Six groups were evaluated: Tetric EvoCeram bulk fill + high mode (10 seconds; TEC H10), Tetric EvoFlow bulk fill + high mode (TEF H10), experimental bulk fill + high mode (TEE H10), Tetric EvoCeram bulk fill + turbo mode (five seconds; TEC T5), Tetric EvoFlow bulk fill + turbo mode (TEF T5), and experimental bulk fill + turbo mode (TEE T5). Bluephase Style 20i and Adhese Universal Vivapen were used for all groups. All BFRC samples were built up on human molar bur-prepared occlusal cavities. VPS% and location were evaluated through micro-computed tomography. SBS and CTS tests were performed 24 hours after storage or after 5000 thermal cycles; fracture mode was analyzed for SBS.Results: Both TEC H10 and TEE H10 presented lower VPS% than TEF H10. However, no significant differences were observed with the turbo-curing mode. No differences were observed for the same BFRC within curing modes. Occlusal shrinkage was mostly observed. Regarding SBS, thermal cycling (TC) affected all groups. Without TC, all groups showed higher SBS values for high mode than turbo mode, while with TC, only TEC showed decreased SBS from high mode to turbo modes; modes of fracture were predominantly adhesive. For CTS, TC affected all groups except TEE H10. In general, no differences were observed between groups when comparing the curing modes.Conclusions: Increased light output with a shortened curing time did not jeopardize the VPS and SBS properties of the BFRCs, although a decreased SBS was observed in some groups. TEE generally showed similar or improved values for the tested properties in a shortened light-curing time. The VPS was mostly affected by the materials tested, whereas the SBS was affected by the materials, curing modes, and TC. The CTS was not affected by the curing modes.

Microcomputed tomography evaluation of cement film thickness of veneers and crowns made with conventional and 3D printed provisional materials

OBJECTIVE

To evaluate, through microcomputed tomography (μCT), the cement film thickness of veneers and crowns made with different provisional materials.

MATERIAL AND METHODS

A veneer and a crown preparation were performed on a central incisor and a second molar of a dental model, respectively, scanned with an intraoral scanner, and the .stl files were exported to an LCD-based SLA three-dimensional (3D)-Printer. Twenty-four preparations were 3D-printed for each veneer and crown and divided into four groups (n = 6/group): (a) Acrylic resin (Acrílico Marche); (b) Bisacrylic resin (Protemp 4); (c) PMMA computer-aided design and computer-aided manufacturing (CAD-CAM) (Vipiblock); and (d) 3D-printed resin for provisional restorations (Raydent C&B for temporary crown and bridge). Veneers and crowns restorations were performed and cemented with a flowable composite. Each specimen was scanned with a μCT apparatus, files were imported for data analysis, and cement film thickness was quantitatively measured. Data were analyzed by 2-way ANOVA and Tukey post-hoc tests (α = .05).

RESULTS

Crowns presented a thicker cementation film than veneers (P < .05).The bisacrylic resin showed the smallest veneer film thickness, similar to the acrylic resin (P = .151), which was not significantly different than the PMMA CAD/CAM material (P = .153). The 3D printed provisional material showed the thicker film, different than all other materials (P < .05). The bisacrylic resin showed a cement film thickness with a high number of voids in its surface. For crowns cementation, the 3D printed provisional material showed the thicker cementation film, different than all other materials (P < .05).

CONCLUSIONS

Different provisional materials present different film thicknesses. The 3D printed provisional material showed the highest veneer and crown film thicknesses. Veneers film thicknesses were smaller than crowns for all provisional materials.

CLINICAL SIGNIFICANCE

The 3D printed provisional material studied can be satisfactorily used, presenting appropriate adaptation with the tooth preparation, however, it shows the highest cement film thickness for both veneers and crowns cementations when compared with other provisional materials. A better internal fit, or smaller cement film thickness is obtained by CAD/CAM materials, acrylic and bisacrylic resins. Veneer cementation showed a smaller cement film thickness compared with crown cementation for all provisional materials.

Viscosity and thermal kinetics of 10 preheated restorative resin composites and effect of ultrasound energy on film thickness

OBJECTIVE

This study investigated viscosity and thermal kinetics of 10 selected preheated restorative resin composites and the effect of ultrasound energy on film thickness.

METHODS

A range of different resin composites was tested: Charisma Diamond, IPS Empress Direct, Enamel Plus HRi, Essentia, Estelite Omega, Filtek Z100, Filtek Z350 XT, Gradia, TPH Spectrum and VisCalor. A flowable resin composite (Opallis Flow) and two resin cements (RelyX Veneer, Variolink Esthetic LC) also were tested. Viscosity (Pa s) was measured at 37 °C and 69 °C (preheating temperature) using a rheometer. Film thickness (μm) was measured before and after application of ultrasound energy. Temperature loss within resin composite following preheating (°C/s) was monitored. Data were statistically analyzed (α = 0.05).

RESULTS

Viscosity at 69 °C was lower than at 37 °C for all materials except the flowable resin composite. Preheating reduced viscosity between 47% and 92% for the restorative resin composites, which were generally more viscous than the flowable materials. Film thickness varied largely among materials. All preheated resin composites had films thicker than 50 μm without ultrasound energy. Application of ultrasound reduced film thickness between 21% and 49%. Linear and nonlinear regressions did not identify any relationship between filler loading, viscosity, and/or film thickness. All materials showed quick temperature reduction following preheating, showing maximum temperature loss rates after approximately 10 s.

SIGNIFICANCE

Distinct restorative resin composites react differently to preheating, affecting viscosity and film thickness. The overall performance of the preheating technique depends on proper material selection and use of ultrasound energy for reducing film thickness.

External Marginal Gap Evaluation of Different Resin-filling Techniques for Class II Restorations-A Micro-CT and SEM Analysis

CLINICAL RELEVANCE

Secondary caries are the main reason for the failure of restorations, class II being the most affected. Techniques that promote less gap percentage are important. Flowable bulk fill composites used at such locations have been shown to decrease gap formation while being a faster procedure than an incremental technique.

SUMMARY

Curing potential and color stability of different resin-based luting materials

PURPOSE

To determine the curing potential and color stability of resin-based luting materials for aesthetic restorations.

MATERIAL AND METHODS

Four resin-based luting agents were tested: traditional dual-activated resin cement (RelyX ARC, ARC), amine-free dual-activated resin cement (RelyX Ultimate, ULT), light-activated resin cement (RelyX Veneer, VEN), and pre-heated restorative resin composite (Filtek Supreme, PHC). Degree of C=C conversion was determined by infrared spectroscopy (n=3) with direct light exposure or with interposition of 1.5-mm-thick ceramic (e.max Press HT) between the luting material and light. The curing potential considered the ratio between these two scenarios. Color difference (n=6) was determined by CIELAB (ΔE_ab) and CIEDE2000 (ΔE₀₀) methods, by spectrophotometer measurements made 24h after photoactivation and 90 days after storage in water. Data was submitted to ANOVA and Tukey's test (α=0.05).

RESULTS

The luting agents affected both conversion and color stability. With ceramic, ARC produced the highest conversion among the tested groups (75±1%) and the pre-heated composite (PHC) the lowest one (51±3%), but the curing potential was similar for all materials. ULT produced lower ΔE_ab than ARC. PHC presented the lowest color difference when considered both CIELAB and CIE2000 methods (ΔE_ab 2.1±0.4; ΔE₀₀ 1.6±0.2).

SIGNIFICANCE

All luting strategies presented high curing potential. Amine-free dual-activated material was able to reduce color difference than that formulated with the amine component. Pre-heated composite produced the least color variation after storage.

Effect of luting materials, presence of tooth preparation, and functional loading on stress distribution on ceramic laminate veneers: A finite element analysis

STATEMENT OF PROBLEM

How the polymerization shrinkage, loading, and mechanical properties of luting materials affect the shrinkage and functional stresses in ceramic laminate veneers (CLVs) with and without tooth preparation is unclear.

PURPOSE

The purpose of this finite element analysis (FEA) study was to evaluate the effect of the polymerization shrinkage, functional loading, and mechanical properties of different luting materials on the stresses in ultrathin 0.3-mm CLVs with and without tooth preparation.

MATERIAL AND METHODS

Three resin cements, RelyX Veneer (RV), Allcem Veneer APS (AV), Variolink Esthetic LC (VE), and 1 flowable composite resin, Tetric N-Flow (TF), were tested for post-gel shrinkage (Shr), Knoop hardness (KHN), elastic modulus (E), compressive strength (CS), and diametral tensile strength (DTS). IPS e.max CAD disks of 0.3-mm thickness were made for simulating the effects of light attenuation. Eight 2-dimensional finite element models (Marc-Mentat) of a maxillary central incisor were generated to evaluate the polymerization shrinkage stress of different materials for luting 0.3-mm CLVs with or without tooth preparation and the stress during functional loading by using a modified von Mises criterion (mvm). Collected data from Shr, KHN, and E were submitted to 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Light attenuation by the 0.3-mm ceramic disk did not significantly affect the E values, but Shr was significantly lower in VE (26%) and TF (35%). TF had lower volumetric Shr (%) when interposing a ceramic disk (0.31%). Both tested tooth preparation options showed similar stress distributions from polymerization shrinkage or functional loading, with higher stress concentration on the incisal edge and also on the cervical surface. The model featuring tooth preparation and RV resin cement had the highest and VE the lowest stress levels.

CONCLUSIONS

The flowable composite resin had similar mechanical properties as the resin cements. The stress distribution from shrinkage and functional loading was similar for both techniques with or without tooth preparation.

Microcomputed tomography evaluation of cement shrinkage under zirconia versus lithium disilicate veneers

STATEMENT OF PROBLEM

Computer-aided design and computer-aided manufacturing (CAD-CAM) technology and the improved translucency of recently developed high-strength monolithic zirconia could make them clinically acceptable for veneers if bonding to zirconia was as predictable as to glass-ceramics. Few studies have compared how resin cements behave between glass-ceramic and zirconia veneers before and after polymerization.

PURPOSE

The purpose of this in vitro study was to evaluate the volumetric polymerization shrinkage of resin cement, marginal discrepancy, and cement thickness before and after polymerization for glass-ceramic and zirconia veneers with light-polymerizing resin cement.

MATERIAL AND METHODS

Ten lithium disilicate veneers and 10 zirconia veneers were fabricated with a CAD-CAM workflow on extracted human maxillary anterior teeth with intact enamel surfaces. Zirconia veneers were treated with airborne-particle abrasion, and lithium disilicate veneers were etched with 5% hydrofluoric acid. All specimens were treated with ceramic primer and cemented with a light-polymerized resin cement. All specimens were scanned before and after resin cement polymerization by microcomputed tomography. The data were processed by the Amira software program to compare polymerization volumetric shrinkage, cement thickness, and marginal discrepancy. The data were compared by using a t test and analysis of variance (α=.05). Two bonded veneers were loaded in a mastication simulator for 400 000 cycles to investigate the effect of cyclic fatigue loading.

RESULTS

Mean volumetric polymerization shrinkage was 4.2 ±0.8% for the lithium disilicate group and 6.4 ±3.5% for the zirconia group. No significant difference was found for volumetric shrinkage between materials (P=.132). The mean ±standard deviations of the marginal discrepancies before and after polymerization were 178 ±41 μm and 158 ±37 μm for lithium disilicate and 115 ±33 μm and 107 ±32 μm for zirconia. A smaller marginal discrepancy was found for both materials after polymerization (P=.011) and for zirconia compared with lithium disilicate (P=.004). The mean ±standard deviation cement thickness values before and after polymerization were 157 ±27 μm and 147 ±27 μm for lithium disilicate and 162 ±53 μm and 147 ±52 μm for zirconia. Smaller cement thickness was found after polymerization (P<.001), whereas no significant difference was found in cement thickness between materials (P=.144). No changes were noted in marginal discrepancy and cement thickness as a result of the fatigue loading.

CONCLUSIONS

The difference in the volumetric polymerization shrinkage of cement between lithium disilicate and zirconia veneers was not statistically significant. Polymerization shrinkage resulted in smaller marginal discrepancy and cement thickness for both veneer materials.

Influence of Pre-Heating Regular Resin Composites and Flowable Composites on Luting Ceramic Veneers with Different Thicknesses

The aim of this study was to evaluate of pre-heating, filler contents and ceramic thickness on film thickness, microshear bond strength, degree of conversion and color change on ceramic veneers. Two experimental composites were prepared (Bis-GMA/UDMA/BisEMA/ TEGDMA), with different amounts of filler (65% or 50%wt) simulating a conventional and a flowable composite. The flowable (F) was used at room temperature and, the conventional either at room temperature (C) or pre-heated (CPH). Disk-shaped ceramics with different thickness (0.4 mm, 0.8 mm, 1.5 mm) were prepared. The film thickness was evaluated according to the ISO 4049 (n=10). The microshear bond strength (n=10) was evaluated in enamel using tubing specimens light-cured through the ceramic veneer. The degree of conversion was evaluated using Raman spectroscopy. The color change of the ceramic restorations (n=10) was evaluated by spectrophotometry. The results were submitted to 2-way ANOVA and Tukey's post hoc test (a=5%). For the film thickness 1-way ANOVA was used (a=5%). The C presented the thicker film thickness; the CPH produced a similar film thickness in comparison to the F. All composites showed similar microshear bond strength. The degree of conversion of the F was higher than the C and CPH. The degree of conversion of the composites photo-activated through a 0.4 mm was higher than the composites photo-activated through thicker ceramics. The C showed the highest color change, while the CPH showed similar color change to the F. In conclusion, pre-heated conventional composites seem to be a potential alternative to lute ceramic veneers such as the flowable composites.

Volumetric polymerization shrinkage and its comparison to internal adaptation in bulk fill and conventional composites: A μCT and OCT in vitro analysis

OBJECTIVE

To quantify the volumetric polymerization shrinkage (VPS) of different conventional and bulk fill resin composites, through micro-computed tomography (μCT), and qualitative comparison of gap formation through optical coherence tomography (OCT).

METHODS

Box-shaped class I cavities were prepared in 30 third-molars and divided into 5 groups (n=6): G1- Filtek Z100 (Z100); G2- Tetric Evoceram Bulk Fill (TEC); G3- Tetric EvoFlow Bulk fill (TEF); G4- Filtek Bulk fill (FBU); and G5- Filtek Bulk fill Flowable (FBF). All groups were treated with Adper Single Bond Plus adhesive and light cured (Bluephase 20i). Each tooth was scanned three times using a μCT apparatus: after cavity preparation (empty scan); after cavity filling (uncured scan) and after light curing of the restorations (cured scan). The μCT images were imported into a three-dimensional rendering software, and volumetric polymerization shrinkage percentage was calculated (%) for each sample. In the same images, interfacial gaps in the pulpal floor were qualitatively evaluated. After μCT evaluation, the pulpal floor from each tooth was polished until a thin tooth structure was obtained and OCT images were obtained by scanning the pulpal portion. Gap formation was observed and qualitatively compared to the μCT images.

RESULTS

VPS means ranged from 2.31 to 3.96% for the studied resin composites. The bulk fill materials, either high viscosity or flowable, were not statistically different from each other (p>0.05). The conventional resin composite Z100 presented statistically higher VPS than both high viscosity bulk fill materials studied (p<0.05), although it was statistically similar to the flowable bulk fill materials studied (p>0.05). Both μCT and OCT methodologies enabled gap formation visualization, and images from both technologies could be associated. Gap formation was mostly observed for G1-Z100, G4-FBU, and G5-FBF. VPS% and pulpal gap formation could not be completely associated with each other for all groups and samples. Voids were observed in most of the resin composite fillings, and most VPS were observed in the occlusal area of the samples.

SIGNIFICANCE

Volumetric polymerization shrinkage was material-dependent, although bulk fill materials did not differ from each other. Both μCT and OCT enabled interfacial pulpal gap formation visualization. VPS and gap formation cannot be completely associated with one another.

Micro-computed tomography evaluation of volumetric polymerization shrinkage and degree of conversion of composites cured by various light power outputs

This study evaluated the influence of different light-curing modes on the volumetric polymerization shrinkage and degree of conversion of a composite resin at different locations using micro-computed tomography and Fourier transform infrared spectroscopy (FTIR). Specimens were divided into 4 groups based on the light-curing mode used (Bluephase 20i): 1 -High (1,200 mW/cm²); 2 -Low (650 mW/cm²); 3 -Soft-start (650-1,200 mW/cm²); and 4 -Turbo (2,000 mW/cm²). Degree of conversion was calculated by the measurement of the peak absorbance height of the uncured and cured materials at the specific wavenumbers, and was performed by FTIR 48 h after curing resin samples. Degree of conversion was analyzed using two-way ANOVA. No significant differences were observed independent of the region of the restoration investigated (p>0.05). Different curing modes did not influence volumetric shrinkage neither degree of conversion of class I composite resin restorations.

Void and gap evaluation using microcomputed tomography of different fiber post cementation techniques

STATEMENT OF PROBLEM

Few studies have investigated the voids and gaps produced during the cementation of fiber posts using different techniques.

PURPOSE

The purpose of this study was to evaluate and quantify void and gap area formations of different fiber post cementation techniques using microcomputed tomography (μCT).

MATERIAL AND METHODS

Standardized endodontically treated acrylic resin roots (N=24) were divided into 4 groups (n=6) according to different fiber posts cemented with the resin cement (FB); fiber posts relined with composite resin followed by cementation (FBR); fiber posts cemented using an ultrasonic device (FBU); and fiber posts relined with composite resin and cemented using an ultrasonic device (FBRU). Each specimen was scanned twice using micro-computed tomography (μCT; empty root, followed by after fiber post cementation). Digital imaging and communications in medicine (DICOM) files were transferred into 3-dimensional (3D) reconstruction software for analysis. Void volume in the cementation system and gap area formation were evaluated; quantitative and qualitative analyses were performed. The data were analyzed using 2-way ANOVA and the Tukey honest significant difference post hoc test (α=.05).

RESULTS

FBR showed a lower percentage of voids than obtained for FB (P<.05). Groups FB, FBU, and FBRU did not show significant difference in void formation (P>.05). No significant differences were found in gap area formations among the experimental groups (P>.05).

CONCLUSIONS

The use of a composite resin to reline the fiber post significantly decreased the void formation in the cementation procedure when no ultrasonic device was used. The use of an ultrasonic device did not decrease the percentage of void or gap formation for any technique evaluated.