Polymerization stress development in dental composites: Effect of cavity design factor

Application and limitations of configuration factor (C-factor) in stress analysis of dental restorations

OBJECTIVE

The configuration factor (C-factor) is an index used to evaluate the relationship between cavity configuration and the development of polymerization shrinkage stress in dental restorations. Although C-factor has been widely researched, its correlation with stress analysis in dental restorations remains controversial. This review aims to discuss the application and limitations of C-factor and define the restricted conditions under which the C-factor "rule of thumb" is applicable.

METHODS

A thorough literature review was conducted on the application and limitations of C-factor in stress analysis of dental restorations. This was principally based on MEDLINE/PubMed and Web of Science databases and a review of the relevant studies and publications in scientific papers in international peer-reviewed journals for the specific topic of C-factor and polymerization shrinkage.

RESULTS

The C-factor alone cannot provide an accurate prediction of the shrinkage stress of restorations and the mechanical behavior of material-tooth interfaces. C-factor is only applicable under one condition not typically seen in clinical practice: low, near-rigid compliance.

SIGNIFICANCE

Conditions for the application of C-factor have been explicitly defined. A more accurate and precise understanding and utilization of the C-factor is of benefit as it contributes to better understanding of polymerization shrinkage behavior of restorations.

Polymerization shrinkage stress of resin-based dental materials: A systematic review and meta-analyses of technique protocol and photo-activation strategies

PURPOSE

A systematic review was conducted to determine whether there were any alternative technique or additional step strategies available to reduce and control polymerization shrinkage stress development in dental resin-based restorative materials.

DATA SOURCES

This report followed the PRISMA Statement. A total of 36 studies were included in this review. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO.

STUDY SELECTION

Only in vitro studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis or mathematical models were excluded. Of the 6.113 eligible articles, 36 studies were included in the qualitative analysis, and the meta-analysis was performed with 25 studies. A global comparison was performed with random-effects models (α = 0.05). The strategies were subdivided as follows: the use of an alternative technique protocol of placing the material inside the tooth cavity; the modification of the irradiation intensity or total energy delivered to the material; the use of an alternative light-curing source; or the use of an alternative photo-activation mode. All alternative strategies showed statistically significant differences when compared with their respective controls (p < 0.05).

CONCLUSION

The use of alternative light-curing sources contributed more to minimizing stress development than placing the material by means of an alternative technique protocol or by modifying the irradiant intensity or total energy delivered to the material during photo-activation. Moreover, the use of an alternative photo-activation mode (intermittent light, exponential, soft-start or pulse delay modes) was shown to be an effective strategy for reducing and controlling stress development in resin-based dental materials.

A new arginine-based dental adhesive system: formulation, mechanical and anti-caries properties

Secondary caries at the margins of composite restorations has been attributed to adhesive failure and consequent accumulation of cariogenic biofilms.

OBJECTIVES

To develop and evaluate an etch-and-rinse adhesive system containing arginine for sustainable release and recharge without affecting its mechanical properties. Arginine metabolism by oral bacteria generates ammonia, which neutralizes glycolytic acids and creates a neutral environmental pH that is less favorable to the growth of caries pathogens, thus reducing the caries risk at the tooth-composite interface.

METHODS

Experimental adhesives were formulated with methacrylate monomers and arginine at 5%, 7%, and 10% or no arginine (control). Adhesives were tested for: (i) mechanical properties of true stress (FS and UTS), modulus of elasticity (E), degree of conversion (DC), Knoop hardness number (KHN) and dentin microtensile bond strength (μ-TBS), (ii) arginine release and recharge, and (iii) antibacterial activities. Data was analyzed by t-test, one-way ANOVA and Tukey's tests.

RESULTS

FS and UTS results showed no statistically significant differences between the 7% arginine-adhesive and control, while the results for E, DC, KHN and μ-TBS showed no difference among all groups. The 7% arginine-adhesive showed a high release rate of arginine (75.0μmol/cm²) at 2h, and a more sustainable, controlled release rate (up to 0.2μmol/cm²) at 30days.

CONCLUSIONS

Incorporation of 7% arginine did not affect the physical and mechanical properties of the adhesive. Arginine was released from the adhesive at a rate and concentration that exhibited antibacterial effects, regardless of shifts in biofilm conditions such as sugar availability and pH.

CLINICAL SIGNIFICANCE

Secondary caries is recognized as the main reason for failure of dental restorations. The development of an arginine-based adhesive system has the potential to dramatically reduce the incidence and severity of secondary caries in adhesive restorations in a very economical fashion.

Correlation between polymerization shrinkage stress and C-factor depends upon cavity compliance

OBJECTIVES

The literature reports inconsistent results regarding using configuration factor (C-factor) as an indicator to reflect the generation of polymerization shrinkage stress (PS) from dental restorative composites due to the constraint of cavity configuration. The current study aimed at unraveling the complex effects of C-factor on PS based on analytical and experimental approaches together, such that the reported inconsistency can be explained and a significance of C-factor in clinic can be comprehensively provided.

METHODS

Analytical models based on linear elasticity were established to predict PS measured in instruments (testing systems) with different compliances, and complex effects of C-factor on PS were derived. The analyses were validated by experiments using a cantilever beam-based instrument and systematic variation of instrumental compliance.

RESULTS

For a general trend, PS decreased with increasing C-factor when measured by instruments with high compliance. However, this trend gradually diminished and eventually reversed (PS became increased with increasing C-factor) by decreasing the system compliance.

SIGNIFICANCE

Our study indicates that the correlation between PS and C-factor are highly dependent on the compliance of testing instrument for PS measurement. This suggests that the current concept on the role of C-factor in the stress development and transmission to tooth structures, higher C-factor produces higher PS due to reduced flow capacity of more confined materials, can be misleading. Thus, the compliance of the prepared tooth (cavity) structure should also be considered in the effect of C-factor on PS.

Bioactive polymeric composites for tooth mineral regeneration: physicochemical and cellular aspects

Our studies of amorphous calcium phosphate (ACP)-based dental materials are focused on the design of bioactive, non-degradable, biocompatible, polymeric composites derived from acrylic monomer systems and ACP by photochemical or chemically activated polymerization. Their intended uses include remineralizing bases/liners, orthodontic adhesives and/or endodontic sealers. The bioactivity of these materials originates from the propensity of ACP, once exposed to oral fluids, to release Ca and PO₄ ions (building blocks of tooth and bone mineral) in a sustained manner while spontaneously converting to thermodynamically stable apatite. As a result of ACP's bioactivity, local Ca- and PO₄-enriched environments are created with supersaturation conditions favorable for the regeneration of tooth mineral lost to decay or wear. Besides its applicative purpose, our research also seeks to expand the fundamental knowledge base of structure-composition-property relationships existing in these complex systems and identify the mechanisms that govern filler/polymer and composite/tooth interfacial phenomena. In addition to an extensive physicochemical evaluation, we also assess the leachability of the unreacted monomers and in vitro cellular responses to these types of dental materials. The systematic physicochemical and cellular assessments presented in this study typically provide model materials suitable for further animal and/or clinical testing. In addition to their potential dental clinical value, these studies suggest the future development of calcium phosphate-based biomaterials based on composite materials derived from biodegradable polymers and ACP, and designed primarily for general bone tissue regeneration.

Role of filler and functional group conversion in the evolution of properties in polymeric dental restoratives

OBJECTIVES

To examine effects of shrinkage and modulus on the dynamic development of shrinkage stress as a function of methacrylate conversion and filler loading in a model photocurable dimethacrylate-based resin with a silanized barium glass filler.

METHODS

BisGMA/TEGDMA samples with filler loading levels of 0-70wt% were evaluated. Irradiation times and intensities were varied to achieve a wide range of conversion. Shrinkage stress measurements were accompanied with real-time conversion monitoring, while shrinkage and modulus measurements were made at different static conversion points.

RESULTS

Shrinkage increased nearly linearly with respect to conversion, while for a given value of conversion, it decreased proportionally with increasing filler content. Modulus advanced in an exponential fashion with conversion and also increased incrementally with filler content; however, modulus values rose disproportionately rapidly for the highest filler loading. At either high or low filler loading levels, stress at limiting conversion, which was inversely proportional to the filler load, was high while at an intermediate filler content, a minimum in stress was observed due to the combined effects of filler based shrinkage reduction, restricted limiting conversion and only moderately enhanced modulus. The level of polymerization stress predicted from the conversion-indexed shrinkage and modulus measurements over-estimated the experimental stress states as modulus evolved due to system compliance that to some degree mimics the clinical situation presented by photocuring bonded composite restorations. Significance Measurement of monomer conversion provides a common basis by which different material properties can be rationally compared.

Property evolution during vitrification of dimethacrylate photopolymer networks

OBJECTIVES

This study seeks to correlate the interrelated properties of conversion, shrinkage, modulus and stress as dimethacrylate networks transition from rubbery to glassy states during photopolymerization.

METHODS

An unfilled BisGMA/TEGDMA resin was photocured for various irradiation intervals (7-600 s) to provide controlled levels of immediate conversion, which was monitored continuously for 10 min. Fiber optic near-infrared spectroscopy permitted coupling of real-time conversion measurement with dynamic polymerization shrinkage (linometer), modulus (dynamic mechanical analyzer) and stress (tensometer) development profiles.

RESULTS

The varied irradiation conditions produced final conversion ranging from 6% to more than 60%. Post-irradiation conversion (dark cure) was quite limited when photopolymerization was interrupted either at very low or very high levels of conversion while significant dark cure contributions were possible for photocuring reactions suspended within the post-gel, rubbery regime. Analysis of conversion-based property evolution during and subsequent to photocuring demonstrated that the shrinkage rate increased significantly at about 40% conversion followed by late-stage suppression in the conversion-dependent shrinkage rate that begins at about 45-50% conversion. The gradual vitrification process over this conversion range is evident based on the broad but well-defined inflection in the modulus versus conversion data. As limiting conversion is approached, modulus and, to a somewhat lesser extent, stress rise precipitously as a result of vitrification with the stress profile showing little if any late-stage suppression as seen with shrinkage.

SIGNIFICANCE

Near the limiting conversion for this model resin, the volumetric polymerization shrinkage rate slows while an exponential rise in modulus promotes the vitrification process that appears to largely dictate stress development.

Analyses of a cantilever-beam based instrument for evaluating the development of polymerization stresses

OBJECTIVE

This investigation was to generate (1) guidelines for designing a tensometer that satisfies the necessary accuracy and sensitivity requirements for measuring polymerization stress (PS), and (2) a formula for calculating PS. Polymerization stress remains one of the most critical properties of polymeric dental materials, yet methods that can accurately quantify PS have been limited in part due to the complexity of polymerization, and in part due to the instrumentation itself.

METHOD

In this study, we performed analytical and finite element analyses on a cantilever-beam based tensometer that is used to evaluate shrinkage stresses during the polymerization of dental restorative composites.

RESULTS

The PS generated by a commercial dental composite determined using our new tensometer agrees with the predicted trend when the beam length and/or specimen height is varied.

SIGNIFICANCE

This work demonstrates the importance of beam dimension and component relative rigidity to the accuracy of PS evaluation. An analytical solution is also derived for the vertical beam deflection, which can be used for any combination of bending and shearing to properly calculate the PS. In addition, an easy-to-conduct calibration procedure is provided that is desirable for periodic tensometer recalibration.

Structure-Composition-Property Relationships in Polymeric Amorphous Calcium Phosphate-Based Dental Composites

Our studies of amorphous calcium phosphate (ACP)-based materials over the last decade have yielded bioactive polymeric composites capable of protecting teeth from demineralization or even regenerating lost tooth mineral. The anti-cariogenic/re-mineralizing potential of these ACP composites originates from their propensity, when exposed to the oral environment, to release in a sustained manner sufficient levels of mineral-forming calcium and phosphate ions to promote formation of stable apatitic tooth mineral. However, the less than optimal ACP filler/resin matrix cohesion, excessive polymerization shrinkage and water sorption of these experimental materials can adversely affect their physicochemical and mechanical properties, and, ultimately, limit their lifespan. This study demonstrates the effects of chemical structure and composition of the methacrylate monomers used to form the matrix phase of composites on degree of vinyl conversion (DVC) and water sorption of both copolymers and composites and the release of mineral ions from the composites. Modification of ACP surface via introducing cations and/or polymers ab initio during filler synthesis failed to yield mechanically improved composites. However, moderate improvement in composite’s mechanical stability without compromising its remineralization potential was achieved by silanization and/or milling of ACP filler. Using ethoxylated bisphenol A dimethacrylate or urethane dimethacrylate as base monomers and adding moderate amounts of hydrophilic 2-hydroxyethyl methacrylate or its isomer ethyl-α-hydroxymethacrylate appears to be a promising route to maximize the remineralizing ability of the filler while maintaining high DVC. Exploration of the structure/composition/property relationships of ACP fillers and polymer matrices is complex but essential for achieving a better understanding of the fundamental mechanisms that govern dissolution/re-precipitation of bioactive ACP fillers, and, ultimately, the suitability of the composites for clinical evaluation.