Effect of preheating resin composite and light-curing units on the microleakage of Class II restorations submitted to thermocycling

3D-2D microleakage assessment of preheated bulk-fill composite resin applied with different parameters: a micro-CT analysis

This study evaluated microleakage from class II cavities filled with bulk-fill composite preheated to different temperatures, applied at different thicknesses, and with different polymerization modes. A total of 60 mesio-occlusal cavity were drilled into the extracted human third molars at 2 mm and 4 mm thickness. Preheated bulk-fill composite resin (Viscalor; VOCO, Germany) was applied to the cavities at 68 °C and 37 °C after the adhesive resin was applied, and cured using standard and high-power light-curing modes of a VALO light-curing unit. An incrementally applied microhybrid composite was used as the control. The teeth were subjected to 2000 cycles of heating to 55 °C and cooling to 5 °C with a 30-s hold time. Then, they were immersed in a 50% silver nitrate solution for 24 h and scanned with micro-computed tomography. Scanned data were processed using the CTAn software. Two (2D) and three (3D) dimensional analyses of leached silver nitrate were performed. The data's normality was assessed using the Shapiro-Wilk test before comparisons using a three-way analysis of variance. In both 2D and 3D analysis, bulk-fill composite resin preheated to 68 °C and applied at 2 mm thickness showed less microleakage. In the 3D analysis, restorations applied at 37 °C and 4 mm thickness in high-power mode showed significantly higher values (p < 0.001). Preheated bulk-fill composite resin can be applied at 68 °C and effectively cured at both 2 mm and 4 mm thickness.

Effect of vibration during bulk and incremental filling on adaptation of a bulk-fill composite resin

This study evaluated the effect of vibration on adaptation of bulk-fill composite resin. A scanning laser doppler vibrometer measured the frequency and amplitude of a vibratory device (COMO; B&L Biotech) used for resin placement and visualized its effect on the resin according to depth. A bulk-fill composite resin (Filtek Bulk Fill; 3M ESPE) was placed in simulated cavities (4 mm diameter, 4 mm depth) by different layering methods (incremental filling with two 2-mm-thick layers vs. bulk filling with a single 4-mm-thick layer). The groups were further divided based on the application of vibration during restoration (no vibration vs. vibration). In addition to the surface void area at the cavity floor, the overall void volume and the void volumes of the bottom, middle, and top thirds were obtained for micro-computed tomography analysis. The frequency and amplitude of the COMO were approximately 149 Hz and between 26 and 51 µm, respectively. When vibration was not applied, incremental filling had a lower void volume in the bottom third of the cavity than did bulk filling (p < 0.05). Vibration applied with a 4-mm-thick bulk fill had no significant effect on the adaptation of composite resin (p > 0.05). In contrast, vibration reduced the amount of void formation in the bottom third of the cavity during incremental filling (p < 0.05). Application of vibration to resin with a 2-mm incremental-layering technique formed a smaller void at the interface between the cavity and resin and within the bulk-fill composite resin.

Comparison of the effect of preheating on the flexural strength of giomer and nanohybrid composite resin

Background. Considering the increased use of preheating and novel resin-based materials to restore teeth, the present study investigated the impact of preheating on the flexural strength of a giomer and compared it with a nanohybrid composite resin. Methods. Two restorative materials (Beautifil II giomer and Alpha III nanohybrid composite resin) were used. Thirty rod-shaped samples (adding up to 60 samples) were prepared from the materials above and divided into two subgroups: with and without preheating (n=15). Before sample preparation, the giomer and nanohybrid composite resin tubes were preheated at 68ºC for 15 minutes in the preheating subgroups. In the subgroups without preheating, the tubes were kept in a room at 25ºC. Then the flexural strength was compared between the two groups with two-way ANOVA at a significance level of P<0.05. Results. The results showed significantly higher flexural strength in the preheated subgroups than in the non-preheated subgroups (P<0.001). In addition, the mean flexural strength values were significantly higher in the giomer groups than in the nanohybrid composite resin groups (P<0.001). Conclusion. Preheating increased the studied materials' flexural strengths significantly. The flexural strength of the giomer restorative material was higher than that of the nanohybrid composite resin, irrespective of preheating.

Effects of Preheating and Sonic Delivery Techniques on the Internal Adaptation of Bulk-fill Resin Composites

CLINICAL RELEVANCE

The internal adaptation of resin composites that are recommended to be placed with the conventional insertion technique could be improved when the resin composites are preheated prior to their placement. SonicFill 2 and VisCalor bulk show the best internal adaptation when they are inserted as per the manufacurer's recommended techniques.

SUMMARY

Objective: To compare the effects of conventional (hand-placed), sonic, or preheated insertion techniques on the internal adaptation of bulk-fill resin composites.Methods and Materials: A total of 150 freshly extracted human third molars were used to prepare standardized cylindrical occlusal cavities. Teeth were divided into five main groups according to the resin composites: 1 incremental (Clearfil Majesty Posterior [CMP]) and four paste-like bulk-fill (SonicFill 2 [SF2], VisCalor bulk [VCB], Filtek One bulk-fill restorative [FBR], and Tetric EvoCeram bulk-fill [TEB]). Each main group was divided into three subgroups according to the placement technique: conventional, preheating, and sonic delivery (n=10). In the conventional placement technique, cavities were filled manually. In the sonic insertion technique, a specific handpiece (SonicFill Handpiece; Kerr Corporation) was used. In the preheating technique, a heating device (Caps Warmer, Voco, Cuxhaven, Germany) was used to warm the resin composites before placement. Internal voids (%) of the completed restorations were calculated with microcomputed tomography. Data was analyzed with two-way analysis of variacne followed by Tukey's multiple comparisons test (α=0.05).Results: All resin composites showed fewer internal gaps with preheating compared with the conventional placement (p<0.05). For all resin composites other than SF2, preheating provided fewer internal gaps than that of the sonic placement (p<0.05). Sonic placement led to fewer internal gaps compared with the conventional placement, but only for SF2 and FBR (p<0.05). For the conventional placement, the lowest gap percentage was observed with the incremental resin composite (CMP, p<0.05). Among all groups, the lowest gap percentages were observed for preheated VCB followed by sonically inserted SF2 (p<0.05).Conclusion: The best internal adaptation was observed in sonically inserted SF2 and preheated VCB, which were the manufacturers' recommended insertion techniques. Preheating considerably improved the internal adaptation of all resin composites, except for that of SF2.

Solvent and HEMA Increase Adhesive Toxicity and Cytokine Release from Dental Pulp Cells

The aim of the present study was to evaluate the effect of the hydroxyethyl-methacrylate (HEMA) concentration and solvent content of dental adhesives on cell viability and cytokine (IL-1b, IL-6, IL-10, TNF-α) release by human dental pulp cells (HDPCs). HDPCs were obtained from fresh extracted human third molars. Experimental adhesives were prepared containing different concentrations of HEMA (0%, 10%, and 20%) with and without solvent (ethanol 10%). Cylindrical specimens were immersed on culture medium during 24 h to obtain the extracts. The cells were incubated with extracts (culture medium + components leached from the adhesives) of different adhesives, and cell viability and cytokine release were evaluated after 6 and 24 h of exposure. Adhesives containing HEMA promoted high cell viability reduction after 6 h of exposure; but after 24 h, the results were similar to the ones found among control group cells. These effects on cell viability were prominently increased with the addition of solvent. Although IL-1b release was not affected by exposure to eluates, other cytokines (IL-10, IL-6, TNF-α) were modulated by the different experiment conditions, directly influenced by the HEMA concentration and presence of solvent. Higher HEMA concentrations, combined with the presence of solvent, can promote significant reduction on HDPC viability, increasing the release of anti- and pro-inflammatory mediators.

Randomized Controlled Trial of Postoperative Sensitivity with Warm and Room Temperature Composite

Physical properties of composite improve when it is preheated prior to polymerization. However, postoperative sensitivity may be considered a potential complication. A review of the literature revealed no reported randomized controlled trials (RCTs) of postoperative sensitivity when using preheated composite resin. The objective of the study was to determine if preheating composite leads to changes in postoperative sensitivity in a parallel RCT. In total, 120 eligible, consenting adults were recruited in private dental practice and randomized into 2 groups of 60 patients. One group had room temperature composite restorations placed and the second had composite preheated to 39°C. The primary outcome was sensitivity after 24 h by the visual analog scale (VAS), recorded blind by patients. Secondary outcomes were VAS scores recorded over a month. Blind statistical analysis used the Mann-Whitney U test to compare the 24-h VAS score between groups and repeated-measures analysis of variance to assess the change over time. Potential confounders were tested using regression models. A total of 115 patients completed the trial: 57 in the heated composite group and 58 in the room temperature group. Analysis of 24-h VAS scores found no statistically significant difference between the 2 groups ( P = 0.162). Examining the potential confounders confirmed the nonsignificant difference between heated and room temperature groups on the 24-h VAS score, after controlling teeth type and preoperative pulp test (effect size = 0.173, P = 0.317). Analysis of the secondary outcomes found significant changes (within-subject effect) in VAS scores over the review period ( F statistic = 4.7, P = 0.002) but not a significant (between-subject effect) difference between heated and room temperature groups over time (effect size = 0.102, P = 0.197). There was a significant correlation between preoperative VAS score and postoperative VAS score ( P < 0.001). For the restorations in this study, there was no detectable difference in postoperative VAS score between preheated and room temperature composite. Postoperative sensitivity decreased throughout the first month. Postoperative sensitivity was correlated to preoperative sensitivity (ISRCTN 76727312). Knowledge Transfer Statement: The results of this study can be used by clinicians when considering the advantages and disadvantages of preheated composite. The study found no evidence of any change in postoperative sensitivity when using preheated composite. Since preheated composite has superior physical properties, its use for routine care can be considered good practice.

Effect of diphenyliodonium hexafluorphosphate on resin cements containing different concentrations of ethyl 4-(dimethylamino)benzoate and 2-(dimethylamino)ethyl methacrylate as co-initiators

OBJECTIVE

The present study evaluated the influence of diphenyliodonium hexafluorphosphate (DPI) combined with two different amines [ethyl 4-(dimethylamino)benzoate (EDAB) and 2-(dimethylamino)ethyl methacrylate (DMAEMA)] on the properties of model resin cements.

METHODS

A comonomer base containing a 1:1 mass ratio of 2.2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (bis-GMA) and triethyleneglycol dimethacrylate (TEGDMA) was obtained, after which 1mol% of camphorquinone and 0.1mol% of hydroxyl butyl toluene were added to the comonomer blend. Concentrations of co-initiators varied at 0, 0.5 or 1mol% for DPI and in 1 or 2mol% for amines (DMAEMA or EDAB). Silanated Ba-Al-Si glass (60wt%) was added as filler. The combination of each amine and DPI concentration resulted in 12 formulations, which had the following properties analyzed: degree of conversion (DC), water sorption (Wsp) and solubility (Wsl), flexural strength (FS) and flexural modulus (Ef). Data for DC, FS and Ef were analyzed by two-way ANOVA and Tukey's test (α=0.05) and Wsp and Wsl by Kruskal-Wallis and Dunn tests (α=0.05).

RESULTS

EDAB promoted a higher DC than did DMAEMA; however, DPI increased DC for all materials with DMAEMA. The physical properties of resin formulations containing EDAB were significantly better than those of groups with DMAEMA; however, DPI had a positive influence on the chemical and physical properties of the model resin cement containing DMAEMA, especially with higher concentrations of amine.

SIGNIFICANCE

EDAB proved to be more reactive than DMAEMA, being less influenced by DPI. Resins containing a 1:2 CQ/amine ratio had better properties than those with 1:1.

Improving Composite Resin Performance Through Decreasing its Viscosity by Different Methods

The aim of this work was to present the different current methods of decreasing viscosity of resin composite materials such as (using flowable composites, lowering the viscosity of the monomer mixture, heating composites and applying sonic vibration) and furnish dentists with a basis that can provide criteria for choosing one or another to suit their therapeutic requirements. The four discussed methods proved that lowering composite viscosity improves its handling and facilitates its application to cavities with complicated forms, decreasing time for procedure and improving marginal adaptation. Other properties improved by decreasing composite resin viscosity were controversial between the four methods and affected by other factors such as composite brand and light cure unit.

Comparison of microleakage and thickness of resin cement in ceramic inlays with various temperatures

Background and aims. Microleakage is still one of the major problems of composite-based restorations.This study compared the microleakage and thickness of resin cement in ceramic inlays with various temperatures. Materials and methods. Class V cavities were prepared on the buccal and lingual aspects of thirty human molars with occlusal margins in enamel and gingival margins in dentin (3 mm wide, 5 mm long and 2 mm deep). Laboratory-made inlays (LMI) were used for buccal cavities, and CAD/CAM inlays (CMI) were used for lingual cavities. All the cavities were divided into six groups (n=10): 1) LMI at -5°C; 2) LMI at 50°C; 3) LMI at room temperature (25°C); 4) CMI at -5°C; 5) CMI at 50°C; 6) CMI at room temperature (25°C). Inlays were bonded to cavities in a pulp pressure- and temperature-simulating device. After thermocycling and dye penetration, the teeth were divided into two mesiodistal halves. Amount of dye penetration and film thickness were measured under a stereomicroscope and analyzed with Kruskal-Wallis, Wilcoxon and Spearman's correlation tests ( = 0.05). Results. There were no statistically significant differences in leakage between different inlay temperatures (P > 0.05). The mean cement thickness in laboratory-made inlays (gingival margin, 83.7 ± 11 and occlusal margin, 84.7 ± 19) was greater than that in CAD/CAM inlays (gingival margin, 69 ± 16 and occlusal margin, 84.7 ± 16). No correlation was found be-tween cement thickness and microleakage either in enamel or dentin for any of the ceramic systems. Conclusion. Differences in inlay temperature had no effect on microleakage. CAD/CAM inlays had lower cement thickness than laboratory-made inlays, but this was not related to their microleakage.

Influence of preheating the bonding agent of a conventional three-step adhesive system and the light activated resin cement on dentin bond strength

Aims:

to evaluate the influence of preheating the bonding agent (Scotchbond Multipurpose Adhesive/3M ESPE) and the light-activated resin cement (RelyX Venner/3M ESPE) on dentin microtensile bond strength.

Materials and Methods:

The exposed flat dentin surface of 40 human third molars were randomly distributed into four groups for cementation (SR Adoro/Ivoclar Vivadent) (n = 10): G1-bond and resin cement, both at room temperature (22°C), G2-bond preheated to 58°C and cement at room temperature (22°C), G3-bond at room temperature (22°C) and the cement preheated to 58°C, G4-bond preheated to 58°C and cement preheated to 58°C. Sticks of dentin/block set measuring approximately 1 mm² were obtained and used for the microtensile bond strength test. All sticks had their failure mode classified.

Statistical analysis used:

Factorial analysis of variance was applied, 2 × 2 (bond × cement) (P < 0.05).

Results:

Preheating the bonding agent (P = 0.8411) or the cement (P = 0.7155), yielded no significant difference. The interaction bond × cement was not significant (P = 0.9389).

Conclusions:

Preheating the bond and/or the light-activated resin cement did not influence dentin bond strength or fracture failure mode.

Influence of flowable composite and restorative technique on microleakage of class II restorations

AIM

The aim of the present study was to evaluate the microleakage in class II cavities restored with dental composite by varying the thickness of two flowable composite resins and the restorative technique.

METHODS

A total of 130 cavities were prepared on proximal surfaces of bovine teeth and randomly divided in 13 groups. Twelve experimental groups were performed using flowable composite resin as the liner, and they were divided according to the type of flowable composite resin (Filtek Z350 Flow-Z350F and SureFil SDR Flow-SUR), the thickness of the flowable composite (0.5, 1, or 2 mm), and the restorative technique (flowable composite applied at the cavosurface angle or amelodentinal junction) (n = 10). A control group was performed without using a flowable composite. Following restorative procedures and thermocycling, the samples were immersed in Methylene Blue for 2 h, and prepared for analysis in an absorbance spectrophotometer. All results were statistically analyzed (α = 0.05).

RESULTS

There was no significant difference between the flowable composites (P > 0.05). The restorative techniques influenced microleakage and were flowable composite dependent (P ≤ 0.05). The lower thickness of the flowable composite provided less microleakage (P ≤ 0.05).

CONCLUSION

The use a lower thickness of a flowable composite resin provided less microleakage, suggesting a better sealing tooth-restoration interface.

Improvement of the orthodontic bracket bond strength with pre-heated composite restoratives

AIM

This study aimed to evaluate the effect of pre-heated composite restoratives on the shear bond strength (SBS) of orthodontic brackets.

METHODS

The following materials were tested: a microhybrid composite restorative (Filtek Z250), two nanofilled composite restoratives (Filtek Z350 and NT Premium), a nanohybrid composite restorative (Brilliant) and a conventional orthodontic adhesive (Transbond XT). All materials were stored for 1 h in the incubator either at 25°C (room temperature simulation) or 60°C before bonding 100 orthodontic brackets on bovine lower incisors (n = 10). One Coat Bond SL and Transbond XT were used to bond the composite restoratives and the Transbond XT adhesive paste, respectively. After storage in distilled water for 24 h, the brackets were subjected to SBS test at a speed of 0.5 mm/min until bracket debonding. The Adhesive Remnant Index (ARI) was assigned to the fractured specimens. Data were analyzed using the one-way ANOVA and the Tukey post-hoc test (p < 0.05). The Kruskal-Wallis test was used to compare ARI scores between the groups (p < 0.05).

RESULTS

There was no statistically significant difference between the materials at room temperature. Samples bonded with pre-heated materials showed a statistically higher SBS than those bonded with room temperature materials. Samples bonded with the pre-heated orthodontic adhesive showed the highest SBS among all the pre-heated materials. All preheated composite restoratives produced an SBS mean higher than that of Transbond XT stored at room temperature.

CONCLUSION

The use of pre-heated composite restoratives and orthodontic adhesives might be an alternative approach to bond orthodontic brackets.

Effect of light polymerization time, mode, and thermal and mechanical load cycling on microleakage in resin composite restorations

This study evaluated the effect of polymerization mode and time and thermal and mechanical loading cycling (TMC) on microleakage in composite resin restorations. One hundred and eighty cavities were prepared and randomly divided according to the light curing time (20, 40, or 60 s), modes (quartz-tungsten-halogen (QTH)-420 mW/cm(2), LED 2 (2nd degree generation)-1,100 mW/cm(2), or LED 3 (3rd degree generation)-700 mW/cm(2)), and TMC. Following standard restorative procedures, the samples were prepared for analysis in an absorbance spectrophotometer. All results were statistically analyzed using the three-way ANOVA and Tukey test (p ≤ 0.05). The results revealed that the groups QTH and LED 3 submitted to TMC showed higher microleakage than those that were not submitted to TMC. Only for LED 3, 60 s showed higher microleakage than 20 s. For LED 2 and QTH, there were no differences between the times. QTH showed lower microleakage means than LED 2, when photoactivated for 20 s, without TMC. When photoactivated for 60 s, QTH showed lower microleakage means than LED 3, for the groups with or without TMC. It was concluded that TMC, the increase in polymerization time, and the irradiance were factors that may increase the marginal microleakage of class II cavities.