Trends in restorative composites research: what is in the future?

Effect of using different materials and restorative techniques on cuspal deflection and microleakage in endodontically treated teeth

BACKGROUND

This study aimed to evaluate the effects of different restorative techniques and materials on cuspal deflection and microleakage in MOD restorations. Eight groups were tested using incremental and bulk-fill techniques, with or without fiber reinforcement. The restorative materials included Filtek Z250 and Filtek Bulk-fill Posterior, while reinforcement materials such as Interlig glass fiber, EverX Posterior, and Surefill SDR were incorporated to assess their impact.

METHODS

In total, 96 freshly extracted, sound human maxillary first premolars were selected and stored in 0.1% thymol solution at 37 °C. The teeth were randomly assigned into eight groups (n = 12). Standardized MOD cavities were prepared, followed by endodontic treatment and sealing with glass ionomer cement. The groups were as follows: Group 1-Filtek Z250 applied incrementally in 2-mm layers; Group 2-U-shaped Interlig glass fiber followed by incremental Filtek Z250; Group 3-Filtek Bulk-fill Posterior using the bulk technique; Group 4-U-shaped Interlig glass fiber followed by Filtek Bulk-fill Posterior; Group 5-EverX Posterior followed by incremental Filtek Z250; Group 6-EverX Posterior followed by Filtek Bulk-fill Posterior; Group 7-Surefill SDR followed by incremental Filtek Z250; and Group 8-Surefill SDR followed by Filtek Bulk-fill Posterior. Cuspal deflection was measured using a digital micrometer with 0.05 μm precision. Microleakage was assessed using a 0.5% basic fuchsin dye solution at 37 °C for 24 h, followed by sectioning and examination under magnification.

RESULTS

The lowest mean cuspal deflection was observed in Group 2 (15.8 μm), while the highest was in Group 5 (27.2 μm). Statistically significant differences were observed in cuspal deflection across the groups and over time (p < 0.05). Significant differences in microleakage scores were also found among the groups, indicating the impact of restorative materials and techniques on these outcomes (p < 0.05).

CONCLUSION

This study demonstrated that Filtek Z250 and Filtek Bulk-fill Posterior showed different effects on cuspal deflection and microleakage. The use of glass fiber and EverX Posterior improved restoration performance by reducing polymerization effects. Surefill SDR also reduced cuspal deflection due to its low polymerization shrinkage. Clinically, selecting the appropriate restorative materials and techniques based on the extent of tooth structure loss can improve long-term outcomes.

The effect of photoinitiator systems on resin-based composite containing ZnO-nanoparticles

OBJECTIVE

Zinc oxide (ZnO) powder possesses antibacterial activity and although white in color, it can severely reduce the depth of cure (DoC) of resin-based composite (RBC). This study investigated the effect of unary and binary photoinitiator systems on the DoC and degree of conversion (DC) of formulated RBC containing ZnO-nanoparticles.

METHODS

Fourteen RBCs (n = 3/group) were formulated consisting of 50 wt% mixture of monomers (Bis-GMA, TEGDMA, and UDMA) and 50 wt% fillers (inert barium glass powder and silica nanoparticles). ZnO-nanoparticles were added at 0 (control), 0.5, 1, 1.5 and 2 wt%. A unary initiator system consists of camphorquinone (CQ) 0.25, 0.5 and 1 wt% and ethyl 4-(dimethylamino)benzoate (EDMAB) 0.75 wt% or a binary initiator system consisting of diphenyliodonium hexafluorophosphate (DPI) 0.25, 0.5 and 1 wt%, CQ 0.25, 0.5 and 1 wt% and EDMAB 0.75 wt% were added to the monomer mixture. To measure the DoC, each specimen was prepared in a custom-made mold with a slot (16 x 8×2 mm) and a top cover plate, irradiated from one end (40 s), stored dry (37° C, 1 d) and measured at increasing depths using Vickers hardness (0.5 mm intervals). 1 mm thick specimens were prepared to measure DC continuously using FTIR, from zero up to 24 h post-irradiation.

RESULTS

Increasing the concentrations of ZnO led to a significant reduction of DoC (p < 0.05). But most of the binary initiator groups showed significantly higher DoC (p < 0.05). Depth, at 80 % of max VHN, of unary initiator groups reduced from 6.8 mm (ZnO at 0 wt%) to 2.1 mm (ZnO at 2 wt%) and in binary initiator groups from 8.4 mm to 2.3 mm. Groups with lower photoinitiator concentrations (0.25 wt%) showed a significant increase in DoC compared with groups with higher concentrations (1 wt%) (p < 0.05). DC after 24 h was independent of either ZnO concentration or the photoinitiator system (p > 0.05). However, faster conversions were observed in binary initiator groups. The RPmax of binary groups ranged from 8.1 % to 10.1 %/s, and unary groups ranged from 5.2 % to 7.2 %/s.

SIGNIFICANCE

The addition of DPI resulted in an overall increased curing depth, which was enhanced when lower concentrations of photoinitiators were used. Also, DPI resulted in faster conversions. This is desirable in designing antibacterial RBC containing ZnO.

A review of new generation of dental restorative resin composites with antibacterial, remineralizing and self-healing capabilities

Dental restorative resin composites are widely used to repair tooth decay owing to attractive esthetics, adequate mechanical properties and minimally invasive tooth structure preparations. Nevertheless, dental restorative resin composites still face challenges because of their relatively high failure rate and short lifespan caused by secondary caries and bulk fracture. Thus, attempts have been carried out to explore a new generation of dental restorative resin composites with antibacterial, remineralizing, and self-healing capabilities to inhibit bacteria and lengthen the lifetime of the restorations. Such novel restorative composites can inhibit bacterial activity, reduce acid production, promote mineral regeneration and present a renewable advantage to achieve a higher performance, which are inspiring and provide support for further basic and clinical research. In this review, antibacterial dental restorative resin composites are first introduced, followed by remineralizing, self-healing, and multifunctional dental resin composites with two or more of the functions mentioned above. Meanwhile, we explain the mechanism of the corresponding dental restorative resin composites and describe their characteristics. Finally, we conclude and put forward prospects. This review will attract both researchers and clinicians in this field and help to provide innovative ideas to design new restorative resin composites for biomedical applications.

Diversity of short-term DC outcomes in bulk-fill RBCs subjected to a 3 s high-irradiance protocol

OBJECTIVES

To determine the short-term (5 min) initial effects of a high-irradiance light-curing (LC) protocol on light transmission (LT%), radiant exposure (RE) and degree of conversion (DC%) of different bulk-fill resin-based composites (RBCs).

MATERIALS AND METHODS

Six bulk-fill composites with different viscosities were investigated: OBF (One Bulk Fill, 3 M), EB (Estelite bulkfill,Tokuyama), PFill, PFlow, ECeram and EFlow (PowerFill, Poweflow, Tetric EvoCeram bulkfill, Tetric Evoflow bulkfill, Ivoclar), subjected to different LC protocols: one ultra-high-intensity (3 W/cm2 -3 s via PowerCure LCU) and two conventional (1.2 W/cm2 -10 s and 20 s via PowerCure and Elipar S10 LCUs). Specimens (n = 5) were polymerized within their molds (ϕ5 mm × 4 mm depth) to determine LT% and RE at 4 mm using a MARC-LC spectrometer. For real-time DC% measurements by FTIR, similar molds were utilized. Data were analyzed by one-way ANOVA and Tukey post-hoc tests at 5 % significance.

RESULTS

Regardless of the applied LC protocols, OBF and low-viscosity RBCs (EB, PFlow and EFlow) had the lowest and highest LT%, RE, DC% and RPmax, respectively. RE results of all RBCs were in the same sequence: Elipar-20 s > PCure-10 s > PCure-3 s. DC% of PFill and PFlow displayed no significant difference between the applied LC protocols (p > 0.05). The polymerization kinetic in all materials was well described by an exponential sum function (r2 varied between 0.85 and 0.98), showing a faster polymerization with the PCure-3 s protocol.

SIGNIFICANCE

The measurement of LT% and DC% at 5 min gave an insight into the developing polymerization process. The initial response of these bulk-fill composite to a high-irradiation protocol varied depending on their composition and viscosity, being faster for low viscosity materials. Nevertheless, even though multiple resin composites are designed to be efficient during photopolymerization, care should be taken when selecting materials/curing protocol.

The formation of cariogenic plaque to contemporary adhesive restorative materials: an in vitro study

The research exploiting the ability of dental materials to induce or prevent secondary caries (SC) development still seems inconclusive. Controlling bacterial adhesion by releasing bacteriostatic ions and improving the surface structure has been suggested to reduce the occurrence of SC. This paper analyses the impact of five distinctively composed dental materials on cariogenic biofilm formation. Forty-five specimens of three composites (CeramX Spectra ST, Admira Fusion, Beautifil II) and two glass-ionomers (Fuji II LC, Caredyne Restore), respectively, were incubated in bacterial suspension composed of Streptococcus mutans, Lactobacillus acidophilus, Streptococcus mitis, Streptococcus sanguinis, and Streptococcus salivarius at pH 7.0 and 5.5. Coverslips were used as a control. Adhered bacteria were collected after 2, 4, 6, 12, 24, and 48 h and analyzed using quantitative polymerase chain reaction (qPCR). Fluoride leakage was measured at each collection. The specimens' surface topography was assessed using interferometry. In the present study, surface roughness seemed to have a partial role in bacterial adhesion and biofilm formation, together with chemical composition of the materials tested. Despite differences in fluoride leakage, biofilm accumulation was similar across materials, but the number of adhered bacteria differed significantly. A release of other ions may also affect adhesion. These variations suggest that certain materials may be more prone to initiating secondary caries.

Transdentinal effects of S-PRG fillers on odontoblast-like cells

OBJECTIVES

To investigate the transdentinal effects of surface reaction-type pre-reacted glass-ionomer (S-PRG) fillers on odontoblast-like cells.

METHODS

An eluate of S-PRG fillers was obtained by dissolving the particles in distilled water (1:1 m/v). Dentin discs with similar permeability were mounted into artificial pulp chambers and MDPC-23 cells were seeded on their pulpal surface. The occlusal surface was treated with (n = 10): ultrapure water (negative control - NC), hydrogen peroxide (positive control - PC), S-PRG eluate exposure for 1 min (S-PRG 1 min), or S-PRG filler eluate exposure for 30 min (S-PRG 30 min). After 24 h, cell viability (alamarBlue) and morphology (SEM) were evaluated. The extract obtained from transdentinal diffusion was applied to MDPC-23 pre-cultured in plates for another 24 h to evaluate viability (alamarBlue, 1, 3, and 7 days), gene expression of Col1a1, Alpl, Dspp, and Dmp1 (RT-qPCR, 1 and 7 days), and mineralization (Alizarin Red, 7 days). Data were analyzed with ANOVA (α = 5 %).

RESULTS

While S-PRG 1 min did not differ from NC, S-PRG 30 min reduced 17.9 % viability of cells from discs. S-PRG treatments resulted in low cell detaching from dentin, and the remaining cells exhibited typical morphology or minor cytoplasmic contraction. S-PRG 30 min slightly increased cell viability (6 %) 1 day after contact with the extract. S-PRG treatments upregulated the expression of the investigated genes, especially after 1 day. S-PRG 30 min stimulated mineralization activity by 39.7 %.

CONCLUSIONS

S-PRG filler eluate does not cause transdentinal cytotoxicity on odontoblast-like cells, and long-term exposure can stimulate their dentinogenic-related mineralization activity.

SIGNIFICANCE

The transdentinal elution of ions from S-PRG fillers is not expected to be harmful to the dental pulp and may exert bioactive effects by inducing dentin matrix deposition through the metabolism of underlying odontoblasts.

Bond strength comparison of a fiber-reinforced composite resin: Different dentin conditions and preparation techniques

This study aimed to compare the bond strength of a fiber-reinforced composite resin with traditional and bulk-fill composite resins under different dentin conditions and preparation techniques. Eighty molar teeth, excluding the mesio-distal half of the occlusal dentin surfaces of each teeth, were isolated with acid-resistant nail varnish and stored in a demineralisation solution (pH 4.5). After mechanical removal of the varnish, the teeth were buried in acrylic resin blocks. In every composite resin group, one-half of the specimens were prepared with a diamond bur and another half with Er: YAG laser. Then, the specimens were divided into four groups of composite resins (Filtek Z250, G-aenial Posterior, SonicFill 2, Ever X Posterior) (n = 10). Shear bond strengths were measured using a universal testing device, and failure types were determined with stereomicroscope images. SEM images were obtained at 1000× magnification. Data were analyzed using a three-way analysis of variance (ANOVA), and Bonferroni correction was used for multiple comparisons (p = .05). Differences in the dentin surface affected the bond strength results (p < .05), whereas there was no significant difference between cavity preparation methods (p > .05). EverX Posterior showed the highest bond strength results. Within the limitations of this study, fiber-reinforced composite resin exhibited successful bond strength results in addition to improved mechanical properties. RESEARCH HIGHLIGHTS: Fiber-reinforced composite had successful bond strength values. Bond strength values of sound dentin groups were higher than those of caries-affected dentin groups. The use of an Er: YAG laser for preparation did not lead to insufficient bond strength results.

Comparative analysis of self-cure and dual cure-dental composites on their physico-mechanical behaviour

BACKGROUND

Clinical practitioners may have become familiar with the rapid transformation of dental composites. However, they may not scientifically understand the factors influencing the mechanical and physical properties. Scientific knowledge of filler-resin interaction can significantly improve clinical understanding of resin composites. Several independent studies have examined the mechanical and physico-mechanical properties of dental resin composites; however, no comprehensive study has examined the influence of fillers and resin materials on the physico-mechanical properties of both self-cure and dual-cure composites.

METHODS

This study performed investigations on the physico-mechanical behaviour of four commercially available dual-cure dental composites (Bioactive, Fill Up!, Surefil One, Cention N) and two commercially available self-cure dental composites (Stela Capsule and Stela Automix). Test specimens for flexural and compressive strength, microhardness, fracture toughness, and hydrolytic behaviour were prepared and tested as per respective standards. The data sets were statistically analysed using one-way ANOVA and Tukey's post-hoc comparison.

RESULTS

There was a substantial variation in flexural strength and modulus values in this study, ranging from 32.0 to 113.4 MPa and 2.36 to 12.07 GPa, respectively. Similarly, there were significant differences in compressive strength between the materials in this study, ranging from 119.3 to 223.5 MPa. The highest fracture toughness value was found to be 1.41 MPa.m0.5, while the lowest value was 0.43 MPa.m0.5. Variations in surface microhardness were significant (24.11-68.0 N/mm2), which correlated with the filler content. Water sorption and solubility demonstrated high variations among materials, with Surefil One exceeding ISO 4049 thresholds significantly.

CONCLUSIONS

A linear correlation can be established between surface microhardness (HV) and flexural and compressive moduli, as well as filler content (wt.%). However, both flexural and compressive strengths are impacted by the resin's constituent monomers and the resin-filler matrix's cross-linking capability. Additionally, factors such as filler size, shape, and the cross-linking ability of the resin-filler matrix play a crucial role in fracture toughness and the propagation of cracks within the restoration. Also, resin monomers and filler particle size affect the hydrolytic degradation characteristics of composites, which can also affect their mechanical properties. © 2023 Australian Dental Association.

Dentin adhesion of bulk-fill composites and universal adhesives in class I-cavities with high C-factor

OBJECTIVES

The aim of this study was to compare the dentin adhesion of bulk-fill composites in high C-factor class I-cavities before and after thermocycling to a control group using incremental layering technique.

METHODS

A standardized class I-cavity was prepared into 195 human molars, then different universal adhesives were applied either in self-etch or etch & rinse mode, and the cavity was filled according to each materials application protocol. The material combinations used were a conventional layered composite as control, the respective bulk-fill product, two other bulk-fill composites made by different manufacturers, with one of them being tested using two different polymerization times. Furthermore, one thermoviscous bulk-fill composite and one self-adhesive restorative were examined of which the latter can only be applied in self-etch mode. In each group the dentin adhesion to the cavity bottom was measured using microtensile bond strength test initially (24 h water storage) and after thermocycling. All results were statistically analyzed using STATA 17.0.

RESULTS

The statistical analysis showed significant differences between the control and the experimental groups (p < 0.001). The highest mean bond strength before (14.8 ± 10.7 MPa) and after aging (14.2 ± 11.5 MPa) was measured for the etch & rinse-control group. Among the bulk-fill groups, the etch & rinse technique consistently showed higher bond strengths. Bond strength of groups with shortened polymerization did not exceed 2.1 MPa. The bond strength of the self-adhesive restoration material was low before and after thermocycling (2.7 MPa/ 0.0 MPa). Groups with low bond strength values showed a high number of pre-testing-failures.

CONCLUSIONS

Bulk-fill materials used in high C-factor class I-cavities showed lower bond strength during self-etch application. The same applies for a shortened polymerization regime, which cannot be recommended for high C-factor cavities.

CLINICAL SIGNIFICANCE

Today, a large variety of materials and application techniques can be used when placing an adhesive restoration. Whether new instead of established procedures should be applied in high C-factor cavities has to be critically assessed, as they are a demanding scenario for adhesive restorations.

Performance Assessment of Three Similar Dental Restorative Composite Materials via Raman Spectroscopy Supported by Complementary Methods Such as Hardness and Density Measurements

(1) Background: A widespread problem in oral health is cavities produced by cariogenic bacteria that consume fermentable carbohydrates and lower pH to 5.5-6.5, thus extracting Ca2+ and phosphate ions (PO43-) from teeth. Dental restorative materials based on polymers are used to fill the gaps in damaged teeth, but their properties are different from those of dental enamel. Therefore, a question is raised about the similarity between dental composites and natural teeth in terms of density and hardness. (2) Methods: We have used Raman spectroscopy and density and microhardness measurements to compare physical characteristics of several restorative dental composites at different polymerization intervals. (3) Results: XRVHerculite®, Optishade®, and VertiseFlow® showed the very different characteristics of the physical properties following four polymerization intervals. Of the three composites, OptiShade showed the highest polymerization rate. (4) Conclusions: Only fully polymerized composites can be used in teeth restoring, because incomplete polymerization would result in cracks, pitting, and lead finally to failure.

A digital workflow for tooth-supported complete overdentures with a composite resin injection technique to manage the treatment of a child with ectodermal dysplasia

This clinical report describes a digital workflow for the rehabilitation of an 8-year-old patient diagnosed with ectodermal dysplasia. Based on the patient's digital primary casts, small custom trays and an arch tracer were designed and 3-dimensionally printed. The mandibular custom tray and retention plate with a tracing screw were assembled with tracing plate, forming an individual assembled mini-arch tracer system to record the jaw relationship together with a conventional facebow and a digital articulator. In addition, composite resin injection guides were designed and fabricated to form the predesigned targeted shape of the abutment teeth and provide a buffer. By following this workflow, complete overdentures with good fit, occlusion, and acceptable esthetics were delivered.

The effect of quaternary ammonium polyethylenimine nanoparticles on bacterial adherence, cytotoxicity, and physical and mechanical properties of experimental dental composites

A significant problem related to the functioning of resin-based composites for dental fillings is secondary or recurrent caries, which is the reason for the need for repeated treatment. The cross-linked quaternary ammonium polyethylenimine nanoparticles (QA-PEI-NPs) have been shown to be a promising antibacterial agent against different bacteria, including cariogenic ones. However, little is known about the properties of dental dimethacrylate polymer-based composites enriched with QA-PEI-NPs. This research was carried out on experimental composites based on bis-GMA/UDMA/TEGDMA matrix enriched with 0.5, 1, 1.5, 2 and 3 (wt%) QA-PEI-NPs and reinforced with two glass fillers. The cured composites were tested for their adherence of Streptococcus Mutans bacteria, cell viability (MTT assay) with 48 h and 10-days extracts , degree of conversion (DC), water sorption (WSO), and solubility (WSL), water contact angle (CA), flexural modulus (E), flexural strength (FS), compressive strength (CS), and Vickers microhardness (HV). The investigated materials have shown a complete reduction in bacteria adherence and satisfactory biocompatibility. The QA-PEI-NPs additive has no effect on the DC, VH, and E values. QA-PEI-NPs increased the CA (a favorable change), the WSO and WSL (unfavorable changes) and decreased flexural strength, and compressive strength (unfavorable changes). The changes mentioned were insignificant and acceptable for most composites, excluding the highest antibacterial filler content. Probably the reason for the deterioration of some properties was low compatibility between filler particles and the matrix; therefore, it is worth extending the research by surface modification of QA-PEI-NPs to achieve the optimum performance characteristics.

Inhibition of Caries around Restoration by Ion-Releasing Restorative Materials: An In Vitro Optical Coherence Tomography and Micro-Computed Tomography Evaluation

The objective of this study was firstly to assess the demineralization inhibitory effect of ion-releasing restorations in enamel adjacent to restoration using a biofilm caries model and secondly to compare the effect to that in a chemical caries model. Fifty-six bovine incisors were filled with either Surefil one (SuO), Cention N (CN) (both ion-releasing materials), Ketac-Molar (GIC) or Powerfill resin composite (RC). The restored teeth were then randomly divided into 2 groups according to the used caries model (biofilm or chemical caries model). The micro-computed tomography (MicroCt) and optical coherence tomography (OCT) outcome measures used to evaluate demineralization inhibition effects were lesion depth, LD and increase in OCT integrated reflectivity, ΔIR, at five different depths. It was observed that all outcome measures of CN were statistically the same as those of GIC and conversely with those of RC. This was also the case for SuO except for LD, which was statistically the same as RC. When comparing the two caries models, LD of the biofilm model was statistically deeper (p < 0.05) than the chemical model for all four materials. In conclusion, CN and SuO have similar demineralization inhibitory effects as GIC, and the biofilm caries model is more discriminatory in differentiating demineralization inhibitory effects of ion-releasing restorative material.

Current antibacterial agents in dental bonding systems: a comprehensive overview

Dental caries is mainly caused by oral biofilm acid, and the most common dental restoration treatment is composite dental restorations. The main cause of failure is secondary caries adjacent to the restoration. Long-term survival of dental materials is improved by the presence of antibacterial agents, which selectively inhibit bacterial growth or survival. Chemical, natural and biomaterials have been studied for their antimicrobial activities and antibacterial bonding agents have been improved. Their usage has been increased to inhibit the growth of invading and residual bacteria in the oral cavity, as biofilm accumulation increases the risk of treatment failure. In this article, the success and applications of antibacterial agents are discussed in dental bonding systems.

Bioactive Restorative Materials Applied over Coronal Dentine-A Bibliometric and Critical Review

The objective of the research was to examine the scientific literature concerning restorative materials with bioactive properties for the purpose of covering dentin. Searches were performed in various databases including MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, and Embase. Inclusion criteria involved studies that utilized the terms "dentin" and "bioactive", along with "ion-releasing", "smart materials", "biomimetic materials" and "smart replacement for dentin". The information extracted included the title, authors, publication year, journal and the country of affiliation of the corresponding author. The studies were categorized based on their study design, type of material, substrate, analytical method, and bioactivity. A total of 7161 records were recovered and 159 were included for data extraction. Most of the publications were in vitro studies (n = 149), testing different types of materials in sound dentine (n = 115). Most studies were published in Dental Materials (n = 29), and an increase in publications could be observed after the year 2000. Most of the articles were from the USA (n = 34), followed by Brazil (n = 28). Interfacial analysis was the most investigated (n = 105), followed by bond strength (n = 86). Bioactivity potential was demonstrated for most tested materials (n = 148). This review presents insights into the current trends of bioactive materials development, clearly showing a severe lack of clinical studies.

Are universal adhesives in etch-and-rinse mode better than old 2-step etch-and-rinse adhesives? One-year evaluation of bonding properties to dentin

OBJECTIVES

This study compared the bonding properties of dentin of three 2-step etch-and-rinse adhesives (2-ERAs) to those of three universal adhesives (UAs) applied with an etch-and-rinse strategy (ER), immediately and after 1 year of water storage.

METHODS

Sixty caries-free molars were divided into 6 groups according to the adhesive systems used (n = 10). The 2-ERA systems included were: 1) Adper Single Bond 2 (SB), 2) Tetric N-Bond (TB), and 3) Ambar (AM); and the UAs systems were: 4) Single Bond Universal (SBU) 5) Tetric N-Bond Universal (TBU), and 6) Ambar Universal (AMU). The occlusal third of each tooth was removed and the adhesives were applied. After the composite build-up, specimens were sectioned and tested for microtensile bond strength (µTBS) and nanoleakage (NL) immediately and after 1 year of water storage. In situ degree of conversion (DC) was only evaluated in the immediate time. For water sorption (WS), solubility (SO), and mass change (MC) tests, 48 disk-shaped specimens were prepared (n = 8) and assessed according to ISO 4049:2009.

RESULTS

UAs showed higher µTBS and lower NL values than 2-ERAs did after 1 year of water storage (p = 0.001). Regarding DC, 2-ERAs showed higher DC values than UAs (p = 0.001). Regarding WS, 2-ERAs showed higher WS values than those of UAs (p = 0.00001), except for AM and AMU. Lower WS was observed for AM than for other 2-ERAs (p = 0.00001).

CONCLUSION

The use of UAs applied with the ER strategy seems to be a more effective technique for maintaining adhesion to dentin substrate than 2-ERAS.

CLINICAL SIGNIFICANCE

This study may support clinicians in selecting the most adequate adhesive system to be used in ER strategy in dentin, demonstrating that UAs were more effective, considering the longevity of the resin restorations.

Evaluation of Self-Adhesive Composite Restorations Bond on Primary Canines: An In Vitro Study

Background and purpose The aesthetic requirements for the restoration of the primary anterior teeth of both the child and his parents increased recently, especially with the presence of materials with good mechanical properties capable of giving a good aesthetic shape. However, the challenge remains in the possibility of applying these materials to primary teeth, where the child's cooperation and ability to keep their mouth open during the completion of the restoration is an important challenge for the dentist. Therefore, this study aimed to evaluate the bonding of self-adhesive composite by studying the microleakage in primary canines. Materials and methods The studied sample consisted of 60 extracted primary canines that were divided into three equal groups (n=20) according to the type of restoration: group 1 (experimental) - self-adhesive composite alone, group 2 (experimental) - self-adhesive composite with selective enamel etching, and group 3 (control) - conventional composite with the self-etching bond and selective enamel etching. A Class V cavity was prepared at the cementoenamel junction, 2 mm deep and 1 mm in diameter. In this way, the gingival wall is dentine, while the incisal wall is enamel-dentine. Restorations were placed according to the group to which the tooth belongs. After that, all teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and longitudinal sections of the teeth were made and studied under x20 magnification using a stereo microscope. Results In the gingival wall, the scores of microleakage in the conventional composite group after selective etching were lower than those of the self-adhesive composite groups, with a statistically significant difference. While in the incisal wall, there were no statistically significant differences in the frequencies of the scores of microleakage between the three groups. Conclusions Within the limitations of this study, the conventional composite bonded better to enamel and dentine than self-adhesive composite resin applied alone or after selective enamel etching. The bonding of the self-adhesive composite was lower than that of the conventional composite, and it is not recommended to use it in Class V restorations of primary anterior teeth.

Randomized clinical split-mouth study on a novel self-adhesive bulk-fill restorative vs. a conventional bulk-fill composite for restoration of class II cavities - results after three years

OBJECTIVES

This randomized prospective split-mouth study evaluated the clinical performance of a novel, tooth-colored, self-adhesive bulk-fill restorative (SABF, 3M) for restoration of class II cavities as compared to a conventional bulk-fill composite (Filtek One, 3M; FOBF) over 36 months. The null-hypothesis was that both materials perform equally regarding clinical success and performance according to the FDI clinical criteria and scoring system.

METHODS

30 patients received one SABF and one FOBF restoration each. For FOBF, Scotchbond Universal (3M) was used as adhesive (self-etch mode), whereas SABF was applied without adhesive. Two blinded examiners evaluated the restorations at baseline, 24 and 36 months using FDI criteria. Data were analyzed non-parametrically (χ²-tests; α=0.05).

RESULTS

29 patients were available for the 24- and 36-month examinations. Clinical success rate was 96.6% for both materials at 36-mo (one restoration failure due to secondary caries each). All other restorations revealed clinically acceptable FDI scores at all recalls. FOBF performed significantly better than SABF at all time points regarding surface lustre (p<0.001) and color match and translucency (p<0.001) and regarding marginal staining at 36-months (p=0.008). Marginal staining and marginal adaptation deteriorated significantly over time for both materials (both p<0.001).

CONCLUSIONS

The null-hypothesis could only partially be rejected. Both materials performed similarly regarding clinical success and performance within 36 months of clinical service, but SABF exhibited significantly inferior, but clinically fully acceptable esthetic properties as compared to FOBF. Both restorative materials showed clinically fully acceptable results over 36 months of clinical service and thus may be recommended for clinical use.

CLINICAL SIGNIFICANCE

The novel tooth-colored self-adhesive bulk-fill restorative exhibited clinically fully acceptable results over 36 months of clinical service, similarly to a conventional bulk-fill restorative used with a universal adhesive, but with slight shortcomings in esthetic properties. Therefore, both restorative materials may be recommended for clinical use.

Influence of the self-adhering strategy on microhardness, sorption, solubility, color stability, and cytotoxicity compared to bulk-fill and conventional resin composites

OBJECTIVES

To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE).

MATERIALS AND METHODS

Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal-Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05).

RESULTS

DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm³) and solubility (1.700 µg/mm³), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic.

CONCLUSIONS

The SARC presented inferior mechanical and physical-chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells.

CLINICAL RELEVANCE

The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical-chemical stability should be considered.

Effects of the crosslinking of chitosan/DCPA particles in the antimicrobial and mechanical properties of dental restorative composites

The development of restorative materials containing antibacterial agents is an alternative to reduce the progression of caries lesions.

OBJECTIVE

to compare the influence of the degree of crosslinking of chitosan particles loaded with dibasic calcium phosphate (DCPA) on the mechanical properties, degree of conversion (DC), and antimicrobial properties of experimental composites.

METHODS

Chitosan/DCPA particles were synthesized by the electrospraying, crosslinked by 0, 8, or 16 h in glutaraldehyde, and characterized by zeta potential and minimum inhibitory concentration (MIC) against S. mutans. Experimental resin composites of Bis-GMA and TEGDMA and 59.5% of barium glass were synthesized, chitosan/DCPA particles were added at 0 or 0.5 wt% with the different crosslinking time. The materials were subject to DC analysis, three-point bending test at 24 h and 7 days, and antimicrobial assays. Data were submitted to one-way ANOVA and Tukey test (α = 0.05).

RESULTS

The particles with longer crosslinking time presented higher zeta potential and MIC, and the composite containing these particles showed significantly higher biofilm inhibition than the control group. The other two groups were similar to each other and the control. The composite containing particles with 88 h crosslinking time showed the lowest flexural strength at 7 days in water, and materials with non-crosslinked particles and longer crosslinking time presented flexural strength similar to control. The flexural modulus and DC showed no statistical difference among groups.

SIGNIFICANCE

composite resin containing 0.5% chitosan/DCPA particles crosslinked by 16 h showed a reduction of biofilm formation without affecting the mechanical properties in relation to the control.

Proanthocyanidin encapsulation for sustained bioactivity in dentin bioadhesion: A two-year study

OBJECTIVES

To determine the long-term effect on the stability of dentin-resin interfaces after the addition of polylactide (PLA) capsules containing proanthocyanidin (PAC) to adhesive resin.

METHODS

Sub-micron (SM) and micron (M) size capsules containing PACs were produced using a combination of emulsification and solvent evaporation techniques and characterized. Human dentin surfaces (n = 8) were etched (35% glycolic acid) and primed (15% enriched Vitis vinifera extract solution - VV_e), followed by the application of an experimental adhesive containing 0 (control), 1.5 wt% of SM or M PAC-filled PLA capsules light cured for 40 s. A crown was built using commercial composite. After 24 h-immersion (37 °C) in simulated body fluid, specimens were serially sectioned into resin-dentin beams. Microtensile bond strength (TBS), micro-permeability and fracture pattern were assessed immediately and after 1 and 2 years. Data were statistically analyzed using two-way ANOVA and post-hoc test (α = 0.05).

RESULTS

Polydisperse capsules were manufactured with average diameter of 0.36 µm and 1.08 µm for SM and M, respectively. The addition of capsules did not affect TBS (p = 0.889). After 2 years, TBS significantly decreased in SM (p = 0.006), whereas M showed similar initial values (p = 0.291). Overall, less micro-permeability was found in M than the control and SM group (p < 0.001). After 2 years, fractured surfaces from capsule-containing groups failed within the adhesive layer while control fractured at the bottom of the hybrid layer.

SIGNIFICANCE

The addition of PAC-filled PLA microcapsules in a dental adhesive did not affect the bond strength while increased and sustained the protection against micro-permeability in the interface, likely due to release of PACs.

One-year results of a novel self-adhesive bulk-fill restorative and a conventional bulk-fill composite in class II cavities-a randomized clinical split-mouth study

Objectives

In the context of the phase-down of amalgam, development of easily applicable, permanent restorative materials is of high clinical interest. Aim of this study was to evaluate the clinical performance of a novel, tooth-colored, self-adhesive bulk-fill restorative (SABF, 3M Oral Care) and a conventional bulk-fill composite (Filtek One, 3M Oral Care; FOBF) for restoring class II cavities. The null-hypothesis tested was that both materials perform similar regarding clinical performance.

Materials and methods

In this randomized split-mouth study, 30 patients received one SABF and one FOBF restoration each. Scotchbond Universal (3M Oral Care) was used as adhesive for FOBF (self-etch mode), while SABF was applied directly without adhesive. Restorations were evaluated by two blinded examiners at baseline, 6 months and 12 months employing FDI criteria. Non-parametric statistical analyses and χ²-tests (α = 0.05) were applied.

Results

Thirty patients (60 restorations) were available for the 6- and 12-month recalls exhibiting 100% restoration survival. All restorations revealed clinically acceptable FDI scores at all time points and for all criteria. Only regarding esthetic properties, FOBF performed significantly better than SABF regarding surface lustre (A1) and color match and translucency (A3) at all time points and marginal staining (A2b) at 12 months.

Conclusions

The null-hypothesis could not be rejected. Both materials performed similarly regarding clinical performance within the first year of clinical service. SABF exhibited slightly inferior, but clinically fully acceptable esthetic properties as compared to FOBF.

Clinical relevance

Within the limitations of this study, the self-adhesive bulk-fill restorative showed promising results and may be recommended for clinical use.

Rapid high-intensity light-curing of bulk-fill composites: A quantitative analysis of marginal integrity

OBJECTIVES

To investigate the effect of rapid high-intensity light-curing on the marginal integrity of four bulk-fill composites, including two materials specifically designed for high-intensity curing.

METHODS

Class V cavities were prepared on buccal surfaces of intact human molars with simulated pulpal pressure, filled in a single increment and light-cured using a conventional (10 s @ 1,340 mW/cm²) or high-intensity (3 s @ 3,440 mW/cm²) protocol. The restorations were subjected to thermo-mechanical loading (TML) comprising 1,200,000 mechanical loading cycles and 3,000 thermocycles. Quantitative margin analysis was performed before and after TML using a scanning electron microscope, and the marginal integrity was expressed as percentage of continuous margin (PCM).

RESULTS

All PCM values measured before TML were statistically similar regardless of the material and curing protocol (p>0.05). A statistically significant effect of the curing protocol (p = 0.021) was identified only after TML for one material. PCM was significantly diminished by TML (p<0.001) for most combinations of material and curing protocol. The PCM values of the sculptable composites after TML were statistically similar regardless of the curing protocol (p>0.05). Compared to these values, significantly lower PCM after TML was identified for the flowable composites cured with the high-intensity protocol (p = 0.001-0.045).

CONCLUSION

In most cases, high-intensity and conventional curing generally led to similar marginal integrity. Although all of the investigated composites initially performed similarly well, the flowable composites light-cured using the high-intensity protocol showed a significantly inferior marginal integrity compared to the sculptable composites after loading.

CLINICAL SIGNIFICANCE

Rapid high-intensity light-curing cannot be recommended for flowable bulk-fill composites since it may compromise the tooth-restoration interface.

Influence of resin matrix on the rheology, translucency, and curing potential of experimental flowable composites for bulk-fill applications

OBJECTIVE

To propose monomer formulations that show an optimal degree of conversion as a function of depth for bulk-fill applications.

METHODS

Four resin blends were formulated with methacrylate-based monomers: BisGMA + TEGDMA (control); BisEMA + BisGMA + TEGDMA (BisEMA-based); UDMA + BisGMA + TEGDMA (UDMA-based) and BisEMA + UDMA + BisGMA + TEGDMA (BisEMA + UDMA-based). For each material, a photoinitiating system and silanized filler particles were added. The rheological analyses were performed with a rotational rheometer using the cone/plate geometry. CIELab coordinates were assessed over black and white backgrounds using a bench spectrophotometer (SP60, X-Rite) to calculate the translucency parameter (TP) for samples with 0.5, 4, and 6 mm thickness. The degree of CC conversion (DC) was determined by infrared spectroscopy (FTIR/ATR) at 0.05 mm (top), 4, and 6 mm depths (bottom), and the bottom-to-top ratio was considered. A broad spectrum-based LED was used for light activation. Analysis of variance and Tukey's test (95%) were performed on the results.

RESULTS

The materials tested showed pseudoplastic and thixotropic behavior and a predominance of viscous effects over elastics. The control resin yielded the lowest viscosity for the entire shear rate investigated, followed by the BisEMA-based, BisEMA + UDMA-based, and UDMA-based group, which had the highest viscosity. The UDMA-based material showed the lowest TP as a function of thickness. Both the materials' formulations and depths significantly influenced the DC. The UDMA-based group promoted the highest DC ​​on the top (71 ± 1%) and 4 mm depth (68 ± 1%) but exhibited lower bottom-to-top DC ratio. The BisEMA + UDMA-based material promoted the highest bottom-to-top DC ratio at 4 mm (99%) and 6 mm (97%).

SIGNIFICANCE

The resin matrix interferes in the rheological behavior, translucency parameter, and polymerization capacity as a function of depth. The material formulated with the addition of UDMA and BisEMA demonstrated the highest curing potential as a function of depth and can be useful for bulk-fill applications.

Post-gel polymerisation shrinkage profiling of polymer biomaterials using a chirped fibre Bragg grating

A strain profile measurement technique using a chirped fibre Bragg grating (CFBG) sensor by implementing an integration of differences (IOD) method is reported in this paper. Using the IOD method the spatial distribution of strain along the length of the CFBG is extracted from its power reflectance spectra. As a proof of concept demonstration, the developed technique is applied to measure the polymerisation shrinkage strain profile of a photo-cured polymer dental composite which exhibits a non-uniform strain distribution attributed to the curing lamp characteristics. The result from the CFBG technique is compared with that of an FBG array embedded in the dental composite and is correlated with the degree of conversion of the material which also depends on the curing lamp intensity distribution. This technology will have significant impact and applications in a range of medical, materials and engineering areas where strain or temperature gradient profile measurement is required in smaller scales.

The use of bioactive glass (BAG) in dental composites: A critical review

OBJECTIVE

In recent years, numerous studies have analyzed the role of bioactive glass (BAG) as remineralizing additives in dental restorative composites. This current review provides a critical analysis of the existing literature, particularly focusing on BAGs prepared via the melt-quench route that form an "apatite-like" phase when immersed in physiological-like solutions.

METHODS

Online databases (Science Direct, PubMed and Google Scholar) were used to collect data published from 1962 to 2020. The research papers were analyzed and the relevant papers were selected for this review. Sol-gel BAGs were not included in this review since it is not a cost-effective manufacturing technique that can be upscaled and is difficult to incorporate fluoride.

RESULTS

BAGs release Ca²⁺, PO₄^3- and F^- ions, raise the pH and form apatite. There are numerous published papers on the bioactivity of BAGs, but the different glass compositions, volume fractions, particle sizes, immersion media, time points, and the characterization techniques used, make comparison difficult. Several papers only use certain characterization techniques that do not provide a full picture of the behavior of the glass. It was noted that in most studies, mechanical properties were measured on dry samples, which does not replicate the conditions in the oral environment. Therefore, it is recommended that samples should be immersed for longer time periods in physiological solutions to mimic clinical environments.

SIGNIFICANCE

BAGs present major benefits in dentistry, especially their capacity to form apatite, which could potentially fill any marginal gaps produced due to polymerization shrinkage.

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.

In Vitro Analysis of Quality of Dental Adhesive Bond Systems Applied in Various Conditions

Introduction: There are several methods of reducing a microleakage, and one of them is choosing appropriate adhesive material. The aim of the work was the in vitro analysis of 4 bonds: 3M ESPE “Single bond”, Dentsply “Prime and Bond Active”, Coltene “One Coat 7 Universal”, and Kuraray “Clearfil Universal Bond Quick”. Material and methods: 136 healthy molar teeth were collected and randomly split into 4 groups and Vth Class cavities were prepared. Chosen adhesives were used in four groups of teeth with the same composite. Teeth were the thermocycled, sealed, covered with lacquer, and submerged in 1% methylene blue solution for 24 h. After the thermocycling, the vertices of each tooth were sealed using dental wax. Each tooth was then fully covered with lacquer. All teeth were then submerged into 1% methylene blue solution for 24 h in room temperature. In the next step they were transversely cut through a center of restoration. The Olympus BX43 microscope was used to photograph each cut tooth. With the usage of Olympus stream software, measurement of the dye’s leakage was performed. Results. The statistical analysis proved that the most effective material when applied to ideally prepared cavity surface was Dentsply “Prime and Bond Active”. The second material was 3M ESPE “Single Bond”, third—Coltene “One Coat 7 Universal” and fourth—Kuraray “Clearfil Universal Bond Quick”. The most effective material applied to a too-dry surface was Dentsply “Prime and Bond Active”, second—3M ESPE “Single Bond”, third—Coltene “One Coat 7 Universal” and fourth—Kuraray “Clearfil Universal Bond Quick”. When it comes to too damp surfaces the best results were obtained with Dentsply “Prime and Bond Active” then Coltene “One Coat 7 Universal”, 3M ESPE “Single Bond” and Kuraray “Clearfil Universal Bond Quick”. Conclusion: The level of cavity dampness influences the quality of adhesives. Better results are obtained with over-dried surfaces than over-damp, which is connected with the dilution of the material.

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.

Novel Nanocomposite Inhibiting Caries at the Enamel Restoration Margins in an In Vitro Saliva-Derived Biofilm Secondary Caries Model

Secondary caries often occurs at the tooth-composite margins. This study developed a novel bioactive composite containing DMAHDM (dimethylaminohexadecyl methacrylate) and NACP (nanoparticles of amorphous calcium phosphate), inhibiting caries at the enamel restoration margins in an in vitro saliva-derived biofilm secondary caries model for the first time. Four composites were tested: (1) Heliomolar nanocomposite, (2) 0% DMAHDM + 0% NACP, (3) 3% DMAHDM + 0% NACP, (D) 3% DMAHDM + 30% NACP. Saliva-derived biofilms were tested for antibacterial effects of the composites. Bovine enamel restorations were cultured with biofilms, Ca and P ion release of nanocomposite and enamel hardness at the enamel restoration margins was measured. Incorporation of DMAHDM and NACP into composite did not affect the mechanical properties (p > 0.05). The biofilms’ CFU (colony-forming units) were reduced by 2 logs via DMAHDM (p < 0.05). Ca and P ion release of the nanocomposite was increased at cariogenic low pH. Enamel hardness at the margins for DMAHDM group was 25% higher than control (p < 0.05). With DMAHDM + NACP, the enamel hardness was the greatest and about 50% higher than control (p < 0.05). Therefore, the novel composite containing DMAHDM and NACP was strongly antibacterial and inhibited enamel demineralization, resulting in enamel hardness at the margins under biofilms that approached the hardness of healthy enamel.

In vitro evaluation of composite containing DMAHDM and calcium phosphate nanoparticles on recurrent caries inhibition at bovine enamel-restoration margins

OBJECTIVE

Recurrent caries is a primary reason for restoration failure caused by biofilm acids. The objectives of this study were to: (1) develop a novel multifunctional composite with antibacterial function and calcium (Ca) and phosphate (P) ion release, and (2) investigate the effects on enamel demineralization and hardness at the margins under biofilms.

METHODS

Dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) were incorporated into composite. Four groups were tested: (1) Commercial control (Heliomolar), (2) Experimental control (0% DMAHDM + 0% NACP), (3) antibacterial group (3% DMAHDM + 0% NACP), (D) antibacterial and remineralizing group (3% DMAHDM + 30% NACP). Mechanical properties and Ca and P ion release were measured. Colony-forming units (CFU), lactic acid and polysaccharide of Streptococcus mutans (S. mutans) biofilms were evaluated. Demineralization of bovine enamel with restorations was induced via S. mutans, and enamel hardness was measured. Data were analyzed via one-way and two-way analyses of variance and Tukey's multiple comparison tests.

RESULTS

Adding DMAHDM and NACP into composite did not compromise the mechanical properties (P > 0.05). Ca and P ion release of 3% DMAHDM + 30% NACP was increased at cariogenic low pH. Biofilm lactic acid and polysaccharides were greatly decreased via DMAHDM, and CFU was reduced by 4 logs (P < 0.05). Under biofilm acids, enamel hardness at the margins was decreased to about 0.5 GPa for control; it was about 1 GPa for antibacterial group, and 1.3 GPa for antibacterial and remineralizing group (P < 0.05).

CONCLUSIONS

The novel 3% DMAHDM + 30% NACP composite had strong antibacterial effects. It substantially reduced enamel demineralization adjacent to restorations under biofilm acid attacks, yielding enamel hardness that was 2-fold greater than that of control composites. The novel multifunctional composite is promising to inhibit recurrent caries.

Remineralization of dentin slices using casein phosphopeptide-amorphous calcium phosphate combined with sodium tripolyphosphate

Background

The remineralization approach mechanically occludes the exposed dentinal tubules mechanically, reduces the permeability of dentinal tubules and eliminates the symptoms of dentin hypersensitivity. The aim of the present study was to investigate the remineralization of demineralized dentin slices using CPP–ACP combined with TPP, and the research hypothesis was that CPP–ACP combined with TPP could result in extrafibrillar and intrafibrillar remineralization of dentin.

Methods

Demineralized dentin slices were prepared and randomly divided into the following groups: A (the CPP–ACP group), B (the CPP–ACP + TPP combination group), C (the artificial saliva group), D (the negative control group), and E (the positive control group). Dentin slice samples from groups A, B and C were remineralized and the remineralization effect was evaluated using scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection–Fourier transform infrared spectroscopy (ATR–FTIR) and X-ray diffraction (XRD).

Results

Treatment with CPP–ACP combined with TPP occluded the dentinal tubules and resulted in remineralization of collagen fibrils. The hydroxyapatite crystals formed via remineralization were found to closely resemble the natural dentin components.

Conclusion

CPP–ACP combined with TPP has a good remineralization effect on demineralized dentin slices.

The quest for stable biomimetic repair of teeth: Technology of resin-bonded composites

The rationale leading to the present generation of resin composites is surveyed. There are many sub-classes such as flowable materials with specialized clinical indications. But a simplistic categorization of resin-composite materials is inappropriate. It is better to appreciate the factors that have driven recent developments. These include the search for low shrinkage composites and for greater depth of cure. Other necessary features are good handling behavior and sufficient strength for load-bearing situations. The esthetic challenge is for materials with superior and life-like optical properties and it is important to identify products that are good in every critical property. Nanotechnology has led to certain improvements, but the possibilities and limitations of nanoparticles must be appreciated. In all these developments, the structure and properties of the host tissues are a challenge and inspiration. Thus materials that can emulate the features of enamel and dentin are the goal of biomimetic design.

Effects of S. mutans gene-modification and antibacterial calcium phosphate nanocomposite on secondary caries and marginal enamel hardness

Secondary caries at the restoration-tooth margins is a main reason for dental restoration failures. Gene-modification for Streptococcus mutans (S. mutans) and composites containing dimethylaminohexadecyl methacrylate (DMAHDMA) and nanoparticles of amorphous calcium phosphate (NACP) all have the potential to suppress bacterial acids and promote remineralization. However, there has been no report of their effects on marginal caries-inhibition and enamel hardness. The objective of this study was to investigate the effects of gene-modification and DMAHDM-NACP composite restoration on enamel demineralization and hardness at the margins under biofilm acids for the first time. Parent S. mutans and rnc gene-deleted S. mutans were tested side by side. The bioactive composite contained 3% DMAHDM and 30% NACP. Mechanical properties and calcium (Ca) and phosphate (P) ion releases were measured. Colony-forming units (CFU), MTT, lactic acid and polysaccharide of biofilms were evaluated. Demineralization of bovine enamel with composite restorations was induced via biofilms, then enamel hardness was measured. The dual strategy of combining rnc-deletion with DMAHDM+30NACP: (1) achieved the strongest biofilm-inhibition, with the greatest reduction in biofilm CFU by 6 logs; (2) decreased biofilm lactic acid and polysaccharide production by more than 80%; (3) achieved enamel hardness that was 140% higher than that of a commercial fluoride-releasing composite under 30 days of biofilm acids. Therefore, the novel dual approach of rnc gene-deletion and DMAHDM+NACP nanocomposite is promising to inhibit secondary caries at the margins and increase the longevity of tooth restorations.

Evaluation of postoperative sensitivity in restorations with self-adhesive resin: a randomized split-mouth design controlled study

OBJECTIVES

To evaluate the postoperative sensitivity of restorations with self-adhesive resin composite (SAC) (Vertise Flow (VER)/Kerr) compared with conventional resin composite with self-etching adhesive (Filtek Z250 (Z250)/3M ESPE; Clearfil SE Bond (CSEB)/Kuraray).

MATERIALS AND METHODS

A randomized, controlled, double-blind, split-mouth, two-arm clinical trial was conducted. Twenty-seven volunteers with third molars indicated for extraction received two deep class I restorations, one with each material. Postoperative sensitivity was measured at 24 h and 15 or 30 days after the restorative procedures using a visual analog scale (VAS). When present, information on the characteristics of the pain was also collected. The data were submitted to the McNemar test (α = 0.05).

RESULTS

Regardless of the time intervals, the postoperative sensitivity was observed in 52% and 48% of the CSEB and VERT groups, respectively (p = 1.000). When the evaluation periods were analyzed, the 15-day evaluation presented the highest occurrence of pain, but of mild intensity, in both groups. All patients with sensitivity reported that the pain was localized and of short duration.

CONCLUSION

Self-adhesive resin composite Vertise Flow and conventional resin composite with a self-etching bonding agent promoted similar response regarding postoperative sensitivity in deep class I cavities. When postoperative sensitivity was present, mild pain was observed, especially after 15 days of the restorative procedure, which decreased over time.

CLINICAL RELEVANCE

Postoperative sensitivity to self-adhesive resin composite (SAC) restorations in deep cavities was comparable with that of conventional restorations with a self-etching bonding agent.

Effects of Different Application Techniques on Nanohybrid Composite Restorations Clinical Success

Introduction:

Dental composites have been used as a restorative material for a long time. However, they have their limitations.

Aims:

This study evaluated the effects of placement techniques on the clinical performance of class I composite resin restorations.

Methods:

A total of 40 patients with split-mouth design participated in this study. Each patient had two fillings according to the placement technique (either bulk or incremental packing) of the composite resin restorations. Group (A): was packed by Tetric EvoCeram bulk-fill composite resin and Group (B): was incrementally packed with Tetric EvoCeram composite resin. Restorations of the teeth were evaluated on the same day, at one week, 3 months and 6 months to determine any signs of failure according to the modified United States Public Health Service (USPHS) criteria.

Results:

At different follow-up periods, the results showed no significant differences for retention, marginal integrity, surface stain, gingival bleeding, and secondary caries; however, there were significant differences in color match, surface texture, and postoperative sensitivity.

Conclusion:

This study concluded that the nanohybrid resin composites demonstrated excellent clinical performance for 6 months follow up period.

Novel metformin-containing resin promotes odontogenic differentiation and mineral synthesis of dental pulp stem cells

This represents the first report on the development of metformin-containing dental resins. The objectives were to use the resin as a carrier to deliver metformin locally to stimulate dental cells for dental tissue regeneration and to investigate the effects on odontogenic differentiation of dental pulp stem cells (DPSCs) and mineral synthesis. Metformin was incorporated into a resin at 20% by mass as a model system. DPSC proliferation attaching on resins was evaluated. Dentin sialophosphoprotein (DSPP), dentin matrix phosphoprotein 1 (DMP-1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (Runx2) genes expressions were measured. ALP activity and alizarin red staining (ARS) of mineral synthesis by the DPSCs on resins were determined. DPSCs on metformin-containing resin proliferated well (mean ± SD; n = 6), and the number of cells increased by 4-fold from 1 to 14 days (p > 0.1). DSPP, ALP, and DMP-1 gene expressions of DPSCs on metformin resin were much higher than DPSCs on control resin without metformin (p < 0.05). ALP activity of metformin group was 70% higher than that without metformin at 14 days (p < 0.05). Mineral synthesis by DPSCs on metformin-containing resin at 21 days was 9-fold that without metformin (p < 0.05). A novel metformin-containing resin was developed, achieving substantial enhancement of odontoblastic differentiation of DPSCs and greater mineral synthesis. The metformin resin is promising for deep cavities and perforated cavities to stimulate DPSCs for tertiary dentin formation, for tooth root coatings with metformin release for periodontal regeneration, and for root canal fillings with apical lesions to stimulate bone regeneration.

Experimental synthesis of size-controlled TiO2 nanofillers and their possible use as composites in restorative dentistry

The aim of this work was to obtain an efficient protocol with a green, fast and facile way to synthesize TiO2 NPs and its application as fillers for enhancement of desired dental properties of light curing dental composites. A comparative study comprised the fabrication of light curing restorative composite materials with incorporating different fillers with varying wt%, varying resin material composition, to determine optimal dental restoration by focusing on the physical properties of dental materials. It was observed that the as-prepared green synthesized TiO2 nanohybrid particles contributed to the improvement in physical properties, thus promoting the green and rapid synthesis of nanohybrid fillers. In addition, mechanical values for experimental cured resin materials with bare and surface modified fillers were obtained. The experimental light curing nanocomposites with 5 wt% (wt%) nanohybrid surface modified filler particles with BisGMA (60 wt%), TEGDMA (20 wt%) and UDMA (20 wt%) resin composition provided increased physical strength and durability with higher compressive stress 195.56 MPa and flexural stress 83.30 MPa. Furthermore, the dental property, such as polymerization shrinkage (PS) obtained from volumetric method was decreased up to 3.4% by the addition of nano-hybrid fillers. In addition to this, the biocompatible and antimicrobial nature of TiO2 and its aesthetics properties such as tooth-like color makes TiO2 favorable to use as fillers. This study presents a green and facile method for the synthesis of TiO2 nanohybrid particles that can be successfully used as fillers in an experimental light curing resin matrix for enhancing its dental properties. This describes the potential of the green synthesized TiO2 nanohybrid particles to use as fillers in restorative dentistry.

Toughening of Dental Composites with Thiourethane-Modified Filler Interfaces

Stress of polymerization is one of the most significant drawbacks of dental resin composites, since it is related to poor marginal adaptation, postoperative pain, and secondary caries. Previous studies have shown that thiourethane oligomers incorporated into the organic matrix represents a promising strategy to reduce stress and increase fracture toughness in dental composites. However, this strategy promotes a significant increase of the viscosity system, which may represent a challenge for clinical application. The objective of this study was to functionalize the surface of inorganic filler particles with thiouretanes and evaluate the impact on mechanical properties and kinetics of polymerization. Our results showed that composites filled with thiourethane-silanized inorganic fillers showed up to 35% lower stress while doubling mechanical properties values. This was achieved with no prejudice to the viscosity of the material and following a clinically acceptable photoactivation protocol.

Developing a New Generation of Therapeutic Dental Polymers to Inhibit Oral Biofilms and Protect Teeth

Polymeric tooth-colored restorations are increasingly popular in dentistry. However, restoration failures remain a major challenge, and more than 50% of all operative work was devoted to removing and replacing the failed restorations. This is a heavy burden, with the expense for restoring dental cavities in the U.S. exceeding $46 billion annually. In addition, the need is increasing dramatically as the population ages with increasing tooth retention in seniors. Traditional materials for cavity restorations are usually bioinert and replace the decayed tooth volumes. This article reviews cutting-edge research on the synthesis and evaluation of a new generation of bioactive dental polymers that not only restore the decayed tooth structures, but also have therapeutic functions. These materials include polymeric composites and bonding agents for tooth cavity restorations that inhibit saliva-based microcosm biofilms, bioactive resins for tooth root caries treatments, polymers that can suppress periodontal pathogens, and root canal sealers that can kill endodontic biofilms. These novel compositions substantially inhibit biofilm growth, greatly reduce acid production and polysaccharide synthesis of biofilms, and reduce biofilm colony-forming units by three to four orders of magnitude. This new class of bioactive and therapeutic polymeric materials is promising to inhibit tooth decay, suppress recurrent caries, control oral biofilms and acid production, protect the periodontium, and heal endodontic infections.

Properties of Experimental Dental Composites Containing Antibacterial Silver-Releasing Filler

Secondary caries is one of the important issues related to using dental composite restorations. Effective prevention of cariogenic bacteria survival may reduce this problem. The aim of this study was to evaluate the antibacterial activity and physical properties of composite materials with silver sodium hydrogen zirconium phosphate (SSHZP). The antibacterial filler was introduced at concentrations of 1%, 4%, 7%, 10%, 13%, and 16% (w/w) into model composite material consisting of methacrylate monomers and silanized glass and silica fillers. The in vitro reduction in the number of viable cariogenic bacteria Streptococcus mutans ATCC 33535 colonies, Vickers microhardness, compressive strength, diametral tensile strength, flexural strength, flexural modulus, sorption, solubility, degree of conversion, and color stability were investigated. An increase in antimicrobial filler concentration resulted in a statistically significant reduction in bacteria. There were no statistically significant differences caused by the introduction of the filler in compressive strength, diametral tensile strength, flexural modulus, and solubility. Statistically significant changes in degree of conversion, flexural strength, hardness (decrease), solubility (increase), and in color were registered. A favorable combination of antibacterial properties and other properties was achieved at SSHZP concentrations from 4% to 13%. These composites exhibited properties similar to the control material and enhanced in vitro antimicrobial efficiency.

Nanostructured Polymeric Materials with Protein-Repellent and Anti-Caries Properties for Dental Applications

Dental caries is prevalent worldwide. Tooth cavity restorations cost more than $46 billion annually in the United States alone. The current generation of esthetic polymeric restorations have unsatisfactory failure rates. Replacing the failed restorations accounts for 50–70% of all the restorations. This article reviewed developments in producing a new generation of bioactive and therapeutic restorations. This includes: Protein-repellent and anti-caries polymeric dental composites, especially the use of 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminododecyl methacrylate (DMAHDM); protein-repellent adhesives to greatly reduce biofilm acids; bioactive cements to inhibit tooth lesions; combining protein-repellency with antibacterial nanoparticles of silver; tooth surface coatings containing calcium phosphate nanoparticles for remineralization; therapeutic restorations to suppress periodontal pathogens; and long-term durability of bioactive and therapeutic dental polymers. MPC was chosen due to its strong ability to repel proteins. DMAHDM was selected because it had the most potent antibacterial activity when compared to a series of antibacterial monomers. The new generation of materials possessed potent antibacterial functions against cariogenic and periodontal pathogens, and reduced biofilm colony-forming units by up to 4 logs, provided calcium phosphate ions for remineralization and strengthening of tooth structures, and raised biofilm pH from a cariogenic pH 4.5 to a safe pH 6.5. The new materials achieved a long-term durability that was significantly beyond current commercial control materials. This new generation of bioactive and nanostructured polymers is promising for wide applications to provide therapeutic healing effects and greater longevity for dental restorations.