Effect of Two Different Intraoral Polishing Systems on Surface Roughness, Color Stability, and Bacterial Accumulation of Zirconia-Reinforced Lithium Silicate Ceramic

OBJECTIVE

 The aim of this study was to investigate the effects of two intraoral polishing methods on zirconia-reinforced lithium silicate ceramic after ultrasonic scaling.

MATERIALS AND METHODS

 Thirty disc-shaped samples of zirconia-reinforced lithium silicate were constructed. Freshly extracted bovine teeth were collected and cleaned then the discs were cemented into a cavity prepared onto their labial surface. The samples were divided into three groups (10 samples per group); S: Scaling only, SE: Scaling followed by polishing using Eve Diapro lithium disilicate polishers, SD: Scaling followed by polishing using Diatech ShapeGuard ceramic polishing plus kit. The surface roughness was evaluated after scaling and polishing the samples. For color stability, the samples were stored for 12 days at 37°C in an incubator to simulate 1-year consumption of coffee. L*a*b* color parameters were assessed using VITA Easyshade Advance 4.0 before and after the staining procedure and the color difference was measured. Finally, bacterial accumulation was evaluated by incubating the samples with a suspension of Streptococcus mutans ( S. mutans), after that the S. mutans colonies were counted to obtain the values of colony-forming units (CFU). The final overall roughness, change in color and bacterial count were compared between all groups using one-way ANOVA and Tukey's post-hoc analysis. The Pearson correlation coefficient was used to determine the correlation between continuous variables. The cutoff for significance was chosen at p ≤ 0.05.

RESULTS

 Scaling induced surface roughness of the zirconia-reinforced lithium silicate ceramic was significantly decreased after using both intraoral polishing systems and this was accompanied by a significant decrease in color change and bacterial count.

CONCLUSION

 Intraoral polishing techniques can reduce the roughness of the surface of zirconia reinforced lithium silicate restorations induced due to scaling and subsequently reduce the stainability and bacterial accumulation.

Effect of different techniques on removal of residual resin cement and marginal roughness of porcelain laminate veneers

STATEMENT OF PROBLEM

A consensus regarding how to effectively remove residual resin cement and polish the restoration margin during the cementation of porcelain laminate veneers (PLVs) is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different cleaning and polishing techniques on the removal of residual resin cement and margin surface roughness of PLVs.

MATERIAL AND METHODS

PLVs were bonded to prepared buccal surfaces of extracted human premolars. All specimens were randomly divided by using a random number table into 8 groups (n=6): curette (C); brush (B); curette + polisher (CP); curette + rotary instrument (CR); curette + rotary instrument + polisher (CRP); brush + polisher (BP); brush + rotary instrument (BR); brush + rotary instrument + polisher (BRP). The relative amount of residual cement along the PLV margins were observed with a stereomicroscope and evaluated with a software program of Image J. The surface roughness and 3-dimensional (3D) morphology of the restoration margins were evaluated with a 3D topography scanner. Scanning electron microscopy (SEM) was used to detect the microscopic morphological characteristics of the restoration margins. Statistical analysis was performed by 2-way analysis of variance (α=.05).

RESULTS

Different techniques were associated with significantly different efficiencies in terms of removing residual cement and the surface roughness at the restoration margins (P<.001). The lowest relative amount of residual cement, as well as the lowest surface roughness, was detected in the BRP group (P<.001). SEM observation indicated that the BRP technique also maintained the integrity of the cement layer.

CONCLUSIONS

The removal of excess cement before polymerization using a brush, followed by sequential polishing with high-speed rotary instruments and low-speed polishers represents an effective technique in the removal of residual cement and smoothing the restoration margin without impairing the integrity of the bonded interface.

A Conservative Approach to Ceramic Laminates in the Anterior Region: A Clinical Report

This clinical report presents a conservative approach to restoring aesthetic function in anterior maxillary teeth using digital dental technologies. A 40-year-old female patient sought treatment to enhance the aesthetics of her anterior maxillary teeth. The clinical examination revealed wear on the incisal surfaces and gingival asymmetry. Utilizing a digital workflow, intraoral and extraoral data were acquired through clinical photographs and an intraoral scanner. The patient's restorative needs were assessed using the 3Shape Smile Design system (3Shape, Copenhagen, Denmark). Minimal-thickness ceramic restorations were designed and fabricated using Computer-Aided Design-Computer-Aided Manufacturing (CAD-CAM) technologies. Lithium disilicate was selected for its strong mechanical properties and adhesive capabilities. The restorations were then placed using an adhesive cementation protocol under magnification. Digital technologies facilitated precise diagnosis, planning, and execution of the treatment. The ceramic restorations provided excellent aesthetic outcomes, aligning with the patient's expectations. The minimal thickness of the restorations ensured the preservation of natural tooth structure while maintaining structural integrity and adhesion performance. This case underscores the advantages of a digital workflow in achieving optimal restorative outcomes. The digital dental workflow demonstrated in this case report provides a reliable, efficient, and patient-centric approach to minimal thickness restorations, highlighting the potential for future advancements in restorative dentistry.

Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques

OBJECTIVES

To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface.

MATERIALS AND METHODS

Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1 min and 40 s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1 s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5 s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1 min and 40 s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin.

RESULTS

According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups.

CONCLUSIONS

Tack-curing for 1 s or 5 s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin.

CLINICAL RELEVANCE

The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1 s or 5 s is recommended to mitigate the excess resin cement.

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

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

Contemporary concepts on periodontal complications from prosthetic and restorative therapies

The clinical outcome of every prosthetic and restorative procedure depends on the maintenance of a healthy periodontium. It is, therefore, important that the prosthodontist and restorative dentist cause no harm or permanent damage to the underlying hard and soft tissues when performing clinical procedures necessary to carry out the planned treatment. Several factors involved in these procedures have been described to have an impact on gingival health. For the present article, a selection of four of these factors are presented with the goal of evaluating the current trends and their influence on periodontal structures: (1) tooth preparation configuration and apical extension, (2) gingival tissue sulcular expansion/retraction, (3) prosthetic contours, and (4) prosthesis marginal adaptation and the consequences of excess cement remnants. Based on the available scientific evidence and clinical experience, recommendations for the practitioner are given.

Porcelain Veneers in Vital vs. Non-Vital Teeth: A Retrospective Clinical Evaluation

Nowadays, the ceramic veneer approach can be considered more predictable than direct composite veneer. To date, there is a lack of studies comparing the clinical performance of anterior veneers cemented on vital teeth (VT) and non-vital teeth (NVT). This longitudinal clinical study investigated the performance of ceramic veneers in VT or anterior NVT. A total of 55 patients were evaluated in the study. Two groups were defined based on the vitality status of the teeth (93 teeth-vital and 61 teeth-non-vital). The United States Public Health Service (USPHS) criteria were used to assess the clinical status. The data were evaluated statistically with the Mann-Whitney U test. All restorations were considered acceptable, and only one veneer in VT failed for the criteria of secondary caries. There were no statistically significant differences in any of the criteria evaluated (p ≤ 0.671). The ceramic veneers evaluated showed a satisfactory clinical performance both in VT and NVT.

The Influence of Cement Removal Techniques on In Situ Bacterial Adhesion and Biodegradation at the Marginal Interface of Ceramic Laminates

Objectives

This in situ study aimed to analyze the influence of different resin cement removal techniques on bacterial adhesion and biodegradation at the marginal interface of ceramic laminates.

Methods and Materials

Eighty feldspathic ceramic (F) blocks were prepared and cemented onto bovine enamel slabs (7×2.5×2 mm). Excess cement was removed using a microbrush (MBR), a scalpel blade (SCP), or a Teflon spatula (TSP). For the biodegradation analysis, 40 disc-shaped resin cement specimens were prepared (7×1.5 mm) using a Teflon mold. The specimens were randomly allocated into two groups: (1) No finishing procedure (only Mylar strip), and (2) with finishing and polishing procedures using the Jiffy system (Ultradent, South Jordan, UT, USA) (n=20). The in situ phase consisted of using an intraoral palatal device by 20 volunteers for 7 days. Each device contained five cylindrical wells (8×3 mm), where three dental blocks and two cement specimens were included in the wells. Surface roughness (Ra) was measured using a contact profilometer. A micromorphological analysis was performed under a stereomicroscope and a scanning electron microscope. Bacterial adhesion was quantitated based on the number of colony-forming units (CFU/mL) and their biofilm development potential.

Results

The cement removal techniques directly affected surface roughness at the marginal interface (p&lt;0.001), and the SCP technique produced higher mean roughness, regardless of the surface area analyzed. Surface polishing protected cement specimens from further biodegradation (p=0.148). There were no differences in CFU counts between the groups after the in situ phase (p=0.96). All specimens showed CFU with a strong ability to develop a biofilm.

Conclusions

The techniques used for cement removal increased the surface roughness of ceramic laminates, particularly SCP, but they did not affect bacterial adhesion at the marginal interface. Surface polishing of the resin cement is recommended to mitigate biodegradation.

Laboratory Characterization of In-Service Full-Mouth Rehabilitation with Monolithic Translucent Zirconia Restorations

The chance to critically and microscopically inspect the quality of bonded restorations once they are delivered to the patient after several pre-cementation steps is rare or nonexistent. Replicas of in-service restorations can provide a wealth of information on the integrity of the restorations and moreover make it possible to bring this information to the laboratory for further detailed analysis. This study aimed to characterize the epoxy replicas of 27 cemented monolithic yttria-stabilized zirconia crowns of the maxillary and mandibular arch to assess surface roughness, topography, and symmetry. The topography of the facial, lingual, and occlusal/incisal surfaces of each crown was observed under the optical microscope and further characterized using the scanning electron microscope. Surface roughness measurements were performed using the atomic force microscope. The optical microscope was used to measure the golden proportion and visible width of the anterior maxillary crowns. Surface damage consistent with unpolished adjustment was identified mostly in the occlusal surface of the posterior teeth. Other irregularities, such as scratch marks, small pits, and coarse pits were also found. The surface roughness had great variability. Not all of the anterior maxillary and mandibular teeth followed the golden proportion concept. This study design allows in vitro characterization of in-service restorations. It provides a framework for using replicas for early identification of patterns or features that can trigger fracture and for analysis of morphology and symmetry.

Effect of different beverages on surface properties and cariogenic biofilm formation of composite resin materials

The consumption of certain beverages may affect the physical and biological properties of resin composites (RCs) according to type. This in vitro study aimed to evaluate the surface properties and cariogenic biofilm formation in microhybrid and nanohybrid RCs after immersion in different beverages. The effects of four beverages (distilled water-control, tea, coffee, and cola) on two RCs (microhybrid and nanohybrid) were evaluated. Changes in the surface properties were evaluated for each group using surface roughness measurement (n = 10), scanning electron microscopy (SEM) (n = 4) observation, and energy-dispersive X-ray spectroscopy (EDX) (n = 5) analysis. In vitro Streptococcus mutans biofilm formation on the specimens of each group was determined using confocal laser scanning microscopy and SEM analysis (n = 14). The data were analyzed using two-way analysis of variance, with Bonferroni as a post-hoc test and Pearson's correlation (p < .05). Microhybrid RC presented more surface roughness (p = .014) and cariogenic biofilm formation (p = .040). The surface roughness (F = 0.733, p = .536) and cariogenic biofilm formation (F = 1.685, p = .181) values were not affected by the beverages. However, according to qualitative SEM and EDX measurements, these parameters varied depending on the beverage groups. No correlation was found between surface roughness and cariogenic biofilm formation (r = 0.135, p = .287). Microhybrid RCs had a rougher surface and a higher amount of cariogenic biofilm formation than nanohybrid RCs after being subjected to different beverages.

Nanoparticles for the Treatment of Oral Biofilms: Current State, Mechanisms, Influencing Factors, and Prospects

Due to their excellent size, designability, and outstanding targeted antibacterial effects, nanoparticles have become a potential option for controlling oral biofilm-related infections. However, the formation of an oral biofilm is a dynamic process, and factors affecting the performance of antibiofilm treatments are complex. As such, when examining the existing literature on the antibiofilm effects of nanoparticles, attention should be paid to the specific mechanisms of action at different stages of oral biofilm formation, as well as relevant influencing factors, in order to achieve an objective and comprehensive evaluation. This review is intended to detail the antibacterial mechanisms of nanoparticles during the four stages of the formation of oral biofilms: 1) acquired film formation; 2) bacterial adhesion; 3) early biofilm development; and 4) biofilm maturation. In addition, factors influencing the antibiofilm properties of nanoparticles are summarized from the aspects of nanoparticles themselves, biofilm models, and host factors. The limitations of current research and possible trends for future research are also discussed. In summary, nanoparticles are a promising antioral biofilm strategy. It is hoped that this review can serve as a reference and inspire ideas for further research on the application of nanoparticles for effectively targeting and treating oral biofilms.

Influence of Dental Prosthesis and Restorative Materials Interface on Oral Biofilms

Oral biofilms attach onto both teeth surfaces and dental material surfaces in oral cavities. In the meantime, oral biofilms are not only the pathogenesis of dental caries and periodontitis, but also secondary caries and peri-implantitis, which would lead to the failure of clinical treatments. The material surfaces exposed to oral conditions can influence pellicle coating, initial bacterial adhesion, and biofilm formation, due to their specific physical and chemical characteristics. To define the effect of physical and chemical characteristics of dental prosthesis and restorative material on oral biofilms, we discuss resin-based composites, glass ionomer cements, amalgams, dental alloys, ceramic, and dental implant material surface properties. In conclusion, each particular chemical composition (organic matrix, inorganic filler, fluoride, and various metallic ions) can enhance or inhibit biofilm formation. Irregular topography and rough surfaces provide favorable interface for bacterial colonization, protecting bacteria against shear forces during their initial reversible binding and biofilm formation. Moreover, the surface free energy, hydrophobicity, and surface-coating techniques, also have a significant influence on oral biofilms. However, controversies still exist in the current research for the different methods and models applied. In addition, more in situ studies are needed to clarify the role and mechanism of each surface parameter on oral biofilm development.

Monolithic Ceramics: Effect of Finishing Techniques on Surface Properties, Bacterial Adhesion and Cell Viability

INTRODUCTION

This study evaluated the morphology, biofilm formation, and viability of human gingival fibroblasts in contact with two monolithic ceramics after two different finishing techniques: polishing or glazing. For this, 92 blocks (4.5 × 4.5 × 1.5 mm) of each ceramic were made using high translucency zirconia partially stabilized by yttrium (YZHT) and lithium silicate reinforced by zirconium (ZLS).

METHODS AND MATERIALS

Blocks were sintered and then divided into glazing (g) or polishing (p) surface finish. Surface roughness (Ra and RSm) was evaluated through a contact rugosimeter and profilometry. Specimens were contaminated for heterotypic biofilm formation with Streptococcus mutans, Streptococcus sanguinis and Candida albicans for 16 hours. Biofilm was quantified by counting the colony forming units (CFU/mL) and analyzed by scanning electron microscopy (SEM). Fibroblast viability was evaluated by MTT assay. Surface free energy (SFE) was also determined. Roughness data were evaluated using nonparametric tests, while SFE, MTT and CFU results were evaluated by analysis of variance and Tukey test, and MTT data were also submitted to t-test (all, α=0.05).

RESULTS

Results showed that polished samples presented a lower high profile mean ( p<0.001); however, YZHTg presented less space between defects ( p=0.0002). SFE showed that YZHT presented higher SFE than ZLS. Profilometry evidenced more homogeneity on polished surfaces. The interaction of finishing technique and microorganisms influenced the CFU ( p=0.00). MTT assay demonstrated initial severe cytotoxic behavior for polished surfaces. SEM images showed homogeneous surfaces, except for glazed YZHT.

CONCLUSION

Glazed surfaces have a greater roughness and tend to accumulate more biofilm. Polished surfaces have higher SFE; however, they are temporarily cytotoxic.