Three-dimensional X-ray micro-computed tomography analysis of polymerization shrinkage vectors in flowable composite

Effect of High-radiant Emittance and Short Curing Time on Polymerization Shrinkage Vectors of Bulk Fill Composites

PURPOSE

To evaluate the effect of short curing time using a high-radiant emittance light on polymerization shrinkage vectors in different consistency bulk-fill composites (BFRCs) using micro-computed tomography.

METHODS AND MATERIALS

Radiopaque zirconia fillers were homogeneously incorporated and functioned as radiopaque tracers into two regular-paste: TBFill (Tetric EvoCeram Bulk Fill) and TPFill (Tetric PowerFill), and two flowable (n=6): TBFlow (Tetric EvoFlow Bulk Fill) and TPFlow (Tetric PowerFlow) resin composites. Class I cavities (4 mm depth × 4 mm length × 4 mm width) were 3D-printed and filled in a single increment: TBFill and TBFlow were light-activated using a Bluephase Style 20i (10 seconds in high-mode); TPFill and TPFlow were light-activated using a Bluephase PowerCure (three seconds). The same adhesive system (Adhese Universal) was used for all groups. Microcomputed tomography scans were obtained before and after light-activation. Filler particle movement was identified by polymerization shrinkage vectors at five depths (from 0-4 mm): top, top-middle, middle, middle-bottom and bottom.

RESULTS

TPFlow showed the lowest total vector displacement, followed by TBFlow, TBFill and TPFill, significantly different among each other (p<0.05). Generally, BFRCs showed decreased vector displacement with increased depth, and higher displacement at the top-surface (p<0.05). Qualitative analysis showed a similar pattern of vector magnitude and displacement for groups TBFill and TPFill, with displacement vectors on occlusal (top) surfaces toward the center of the restoration from the top to middle areas, and relatively limited displacement at the bottom. TBFlow and TPFlow showed more displacement on the occlusal (top).

CONCLUSIONS

Short curing time with high-radiant emittance on fast-curing BFRCs was shown to be a feasible option in terms of vector displacement. Flowable BFRCs presented lower vector displacement than their regular-viscosity versions.

Full mapping tensile bond strength of luting in search for differences due to centripetal curing shrinkage

OBJECTIVES

testing if hypothetical transverse centripetal strains due to polymerization contraction of luting materials produce differential alterations in its bonding to luted structures, depending on distances to the center of the luting mass, and if this effect is C-factor related. Two hypotheses were tested: (1) there is a statistically significant decreasing relationship between the bonding strength and the transverse distances to the center of the luting material, and (2) there is a statistically significant difference between bonding strengths among luting spaces with different configuration factors.

METHODS

10 PMMA (15 mm Ø) pairs of cylinders were cemented (Scotchbond Universal adhesive & Relyx Universal, both chemically cured) in a compliant setup under two (20 and 70 N) luting forces forming 2 groups (5 samples each), resulting in different C-factors. Whole samples were sectioned in x and y directions obtaining non-trimmed beams from all along the luting surfaces. Their relative positions in each sample were assessed before separating and categorized (10 categories) according to their distances to the center of the sample. All beams were tested in tension and, because of their uneven bonding areas and to balance its influence, UTS results were transformed into UTS_res. First hypothesis was tested trough a linear relationship between UTS_res and distances to vertical centers per samples. Second hypothesis was tested using Mann-Whitney U tests to compare UTS_res between groups, along all categories. Further Weibull analysis was applied.

RESULTS

ANOVA's p of the regression UTS_res - categories were statistically significant for all samples in group 70 N and for all except one in group 20 N: first hypothesis is partially maintained. Although Mann-Whitney tests p comparing UTS_res of both groups for all categories but the first were statistically significant this hypothesis was maintained relying in Weibull analysis.

SIGNIFICANCE

bonded attachment of cemented materials decreases from centers to outbounds in plane, extensive surfaces, and this decrease is C-factor related.

Effects of application method on shrinkage vectors and volumetric shrinkage of bulk-fill composites in class-II restorations

OBJECTIVES

Upon initial proximal wall construction, the favorable C-factor of class-II cavities may become unfavorable. This study investigated the application method on bulk-fill resin composite polymerization shrinkage.

METHODS

Occluso-proximal class-II cavities were prepared in 40 molars and bonded with a self-etch adhesive (Adhese Universal). The study groups varied according to the resin composite application: group-1: bulk application, Tetric EvoCeram Bulk Fill (TBF); group-2: proximal wall construction (TBF) and occlusal cavity filling (TBF); group-3: thin flowable liner layer, Tetric EvoFlow Bulk Fill (TEF) and bulk filling (TBF); group-4: flowable liner (TEF), proximal wall (TBF), occlusal cavity (TBF); and group-5: bulk application, SDR (3 mm) and capping layer (TBF, 1 mm). Each resin composite increment was scanned twice using micro-CT (uncured, cured 40 s) at a resolution of 16 µm. Shrinkage vectors and volumetric polymerization shrinkage were evaluated and statistically analyzed (one-way ANOVA). SEM images were used to investigate the tooth-restoration interface.

RESULTS

Shrinkage vectors differed significantly among the groups and were greatest in gp5-fl/SDR (47.6 µm), followed by gp1-TBF (23.8 µm) and least in gp5-fl/SDR+TBF (11.1 µm). Volumetric shrinkage varied significantly with the use of SDR (gp5-fl/SDR: 2.6%) and TEF (gp4-fl/TEF: 2.5%) to TBF (gp4-fl/TEF+wl/TBF: 0.6%) in the incremental application.

SIGNIFICANCE

Building a proximal resin composite wall yielded smaller shrinkage vectors than the bulk application. Applying a thin flowable liner decreased the shrinkage vectors, even more when building a proximal wall. A thin flowable liner is recommended when building a proximal resin composite wall.

Is Micro X-ray Computer Tomography a Suitable Non-Destructive Method for the Characterisation of Dental Materials?

The aim of the study was to investigate the effect of X-rays used in micro X-ray computer tomography (µXCT) on the mechanical performance and microstructure of a variety of dental materials. Standardised bending beams (2 × 2 × 25 mm3) were forwarded to irradiation with an industrial tomograph. Using three-dimensional datasets, the porosity of the materials was quantified and flexural strength was investigated prior to and after irradiation. The thermal properties of irradiated and unirradiated materials were analysed and compared by means of differential scanning calorimetry (DSC). Single µXCT measurements led to a significant decrease in flexural strength of polycarbonate with acrylnitril-butadien-styrol (PC-ABS). No significant influence in flexural strength was identified for resin-based composites (RBCs), poly(methyl methacrylate) (PMMA), and zinc phosphate cement (HAR) after a single irradiation by measurement. However, DSC results suggest that changes in the microstructure of PMMA are possible with increasing radiation doses (multiple measurements, longer measurements, higher output power from the X-ray tube). In summary, it must be assumed that X-ray radiation during µXCT measurement at high doses can lead to changes in the structure and properties of certain polymers.

Effects of flowable liners on the shrinkage vectors of bulk-fill composites

Objectives

This investigation evaluated the effect of flowable liners beneath a composite restoration applied via different methods on the pattern of shrinkage vectors.

Methods

Forty molars were divided into five groups (n = 8), and cylindrical cavities were prepared and bonded with a self-etch adhesive (AdheSe). Tetric EvoCeram Bulk Fill (TBF) was used as the filling material in all cavities. The flowable liners Tetric EvoFlow Bulk Fill (TEF) and SDR were used to line the cavity floor. In gp1-TBF, the flowable composite was not used. TEF was applied in a thin layer in gp2-fl/TEF + TBF and gp3-fl/TEF + TBFincremental. Two flowable composites with a layer thickness of 2 mm were compared in gp4-fl/TEF + TBF and gp5-fl/SDR + TBF. TEF and SDR were mixed with radiolucent glass beads, while air bubbles inherently present in TBF served as markers. Each material application was scanned twice by micro-computed tomography before and after light curing. Scans were subjected to image segmentation for calculation of the shrinkage vectors.

Results

The absence of a flowable liner resulted in the greatest shrinkage vectors. A thin flowable liner (gp2-fl/TEF + TBFbulk) resulted in larger overall shrinkage vectors for the whole restoration than a thick flowable liner (gp4-fl/TEF + TBF). A thin flowable liner and incremental application (gp3-fl/TEF + TBFincremental) yielded the smallest shrinkage vectors. SDR yielded slightly smaller shrinkage vectors for the whole restoration than that observed in gp4-fl/TEF + TBF.

Conclusions

Thick flowable liner layers had a more pronounced stress-relieving effect than thin layers regardless of the flowable liner type.

Clinical relevance

It is recommended to apply a flowable liner (thin or thick) beneath bulk-fill composites, preferably incrementally.

Shrinkage vectors in flowable bulk-fill and conventional composites: bulk versus incremental application

OBJECTIVES

Sufficient depth of cure allows bulk-fill composites to be placed with a 4-mm thickness. This study investigated bulk versus incremental application methods by visualizing shrinkage vectors in flowable bulk-fill and conventional composites.

MATERIALS AND METHODS

Cylindrical cavities (diameter = 6 mm, depth = 4 mm) were prepared in 24 teeth and then etched and bonded with OptiBond FL (Kerr, Italy). The composites were mixed with 2 wt% radiolucent glass beads. In one group, smart dentin replacement (SDR, Dentsply) was applied in bulk "SDR-bulk" (n = 8). In two groups, SDR and Tetric EvoFlow (Ivoclar Vivadent) were applied in two 2-mm-thick increments: "SDR-incremental" and "EvoFlow-incremental." Each material application was scanned with a micro-CT before and after light-curing (40 s, 1100 mW/cm²), and the shrinkage vectors were computed via image segmentation. Thereafter, linear polymerization shrinkage, shrinkage stress and gelation time were measured (n = 10).

RESULTS

The greatest shrinkage vectors were found in "SDR-bulk" and "SDR-increment2," and the smallest were found in "SDR-increment1-covered" and "EvoFlow-increment1-covered." Shrinkage away from and toward the cavity floor was greatest in "SDR-bulk" and "EvoFlow-increment2," respectively. The mean values of the shrinkage vectors were significantly different between groups (one-way ANOVA, Tamhane's T2 test, p < 0.05). The linear polymerization shrinkage and shrinkage stress were greatest in Tetric EvoFlow, and the gelation time was greatest in "SDR-bulk."

CONCLUSIONS

The bulk application method had greater values of shrinkage vectors and a higher debonding tendency at the cavity floor.

CLINICAL RELEVANCE

Incremental application remains the gold standard of composite insertion.

Polymerization shrinkage of resin-based composites for dental restorations: A digital volume correlation study

OBJECTIVE

Resin-based composites are widely used in dental restorations; however, their volumetric shrinkage during polymerization leads to several issues that reduce the restoration survival rates. For overcoming this problem, a deep study of shrinkage phenomena is necessary.

METHODS

In this study, micro-tomography (μ-CT) is combined with digital volume correlation (DVC) to investigate the effect of several factors on the polymerization strain of dental composites in model cavities: the presence/absence of an adhesive, the use of transparent/blackened cavities, and irradiation times between 1 and 40s.

RESULTS

The results indicate that the presence of an adhesive at the interface between the cavity and composite does not reduce the total strain but instead limits it to a preferential direction. In addition, regardless of the conditions, the main strain is generated along the axis parallel to the polymerization irradiation (the vertical axis). Finally, the total strain appears to occur in the first 5s of irradiation, with no further evolution observed for longer irradiation times.

SIGNIFICANCE

This work provides new insight into resin-based composite shrinkage and demonstrates the benefit of coupling DVC and μ-CT to better understand the degradation mechanisms of these materials.

Effects of boundary condition on shrinkage vectors of a flowable composite in experimental cavity models made of dental substrates

OBJECTIVES

Bond strength to enamel and dentin depends on the bonding approach or condition. This study investigated the effects of the boundary conditions, in terms of the bonding substrate and the bonding condition, on the shrinkage vectors of a flowable composite.

MATERIALS AND METHODS

An experimental cylindrical cavity (diameter = 6 mm, depth = 3 mm) consisting of the enamel floor and the surrounding dentin cavity walls was prepared for the "enamel-floor" group. Cylindrical cavities of the same dimensions were prepared with access from the occlusal enamel into dentin and served as controls. Each cavity model group was divided and bonded with two bonding conditions (n = 9): a self-etch (Adper Easy Bond, 3M ESPE) and a total-etch approach (OptiBond FL, Kerr). The composite (Tetric EvoFlow, Ivoclar Vivadent) was mixed with glass beads, applied to the cavity, scanned twice by micro-CT (uncured and cured states). The scans were evaluated by rigid registration, sphere segmentation, and registration for computing shrinkage vectors.

RESULTS

The free surface of all restorations moved downward. The shrinkage vectors in the experimental cavity model pointed downward towards the enamel cavity floor, and the net axial movement was downward. In the control group, shrinkage vectors additionally moved upward, away from the cavity floor. The effect of the bonding substrate and the bonding condition was investigated for the shrinkage vectors and the axial movement (univariate ANOVA).

CONCLUSION

The bonding substrate, enamel, influenced the shrinkage vectors' direction, while the bonding condition caused only variations in the magnitude.

CLINICAL RELEVANCE

Bonding to enamel influences shrinkage vectors' direction, while the bonding condition plays only a minor role. Graphical abstract ᅟ.

Micro-CT assessment of comparative radiopacity of adhesive/composite materials in a cylindrical cavity

This study was performed to evaluate the comparative radiopacity of adhesive/resin composite materials in cylindrical cavities using micro-computed X-ray tomography (μCT). The two-step self-etch adhesive systems, Clearfil SE Bond (SE) and FL-Bond II (FL), and flowable resin composites, Beautifil Flow F10 (BF) and Clearfil Majesty ES Flow High (MJ), were used. The radiopacity of bovine tooth structures and restorative materials was measured by μCT. In addition, cylindrical cavities prepared in bovine teeth were restored with the following adhesive/composite combinations: SE-BF, SE-MJ, FL-BF, and FL-MJ. The mean gray values of the composite restorations were calculated. The threshold values of the μCT images were evaluated using the Otsu's thresholding method. The current results show that the comparative radiopacity of the materials and tooth structure varied, which affected distinguishing the μCT images of the composite restorations in the cylindrical cavity. The proper combination of restorative materials should be considered when conducting in vitro μCT assessments of composite restorations.

µCT-3D visualization analysis of resin composite polymerization and dye penetration test of composite adaptation

This study evaluated the effects of the light curing methods and resin composite composition on composite polymerization contraction behavior and resin composite adaptation to the cavity wall using μCT-3D visualization analysis and dye penetration test. Cylindrical cavities were restored using Clearfil tri-S Bond ND Quick adhesive and filled with Clearfil AP-X or Clearfil Photo Bright composite. The composites were cured using the conventional or the slow-start curing method. The light-cured resin composite, which had increased contrast ratio during polymerization, improved adaptation to the cavity wall using the slow-start curing method. In the μCT-3D visualization method, the slow-start curing method reduced polymerization shrinkage volume of resin composite restoration to half of that produced by the conventional curing method in the cavity with adhesive for both composites. μCT-3D visualization method can be used to detect and analyze resin composite polymerization contraction behavior and shrinkage volume as 3D image in the cavity.

Effects of occlusal cavity configuration on 3D shrinkage vectors in a flowable composite

OBJECTIVE

The objective of this study was to investigate the effects of cavity configuration on the shrinkage vectors of a flowable resin-based composite (RBC) placed in occlusal cavities.

MATERIALS AND METHODS

Twenty-seven human molars were divided into three groups (n = 9) according to cavity configuration: "adhesive," "diverging," and "cylindrical." The "adhesive" cavity represented beveled enamel margins and occlusally converging walls, the "diverging" cavity had occlusally diverging walls, and the "cylindrical" cavity had parallel walls (diameter = 6 mm); all cavities were 3 mm deep. Each prepared cavity was treated with a self-etch adhesive (Adper Easy Bond, 3 M ESPE) and filled with a flowable RBC (Tetric EvoFlow, Ivoclar Vivadent) to which had been added 2 wt% traceable glass beads. Two micro-CT scans were performed on each sample (uncured and cured). The scans were then subjected to medical image registration for shrinkage vector calculation. Shrinkage vectors were evaluated three-dimensionally (3D) and in the axial direction.

RESULTS

The "adhesive" group had the greatest mean 3D shrinkage vector lengths and upward movement (31.1 ± 10.9 μm; - 13.7 ± 12.1 μm), followed by the "diverging" (27.4 ± 12.1 μm; - 5.7 ± 17.2 μm) and "cylindrical" groups (23.3 ± 11.1 μm; - 3.7 ± 13.6 μm); all groups differed significantly (p < 0.001 for each comparison, one-way ANOVA, Tamhane's T2).

CONCLUSION

The values and direction of the shrinkage vectors as well as interfacial debonding varied according to the cavity configuration.

CLINICAL RELEVANCE

Cavity configuration in terms of wall orientation and beveling of enamel margin influences the shrinkage pattern of composites.

Evaluation of Interfacial Gap Volume of Two Low-shrinkage Composites Using Micro-Computed Tomography

OBJECTIVES

To investigate the efficacy of X-ray micro-computed tomography (μCT) in the detection and quantification of interfacial gap formation in standardized Class I and Class II resin composite restorations, to compare the interfacial gaps for two low-shrinkage resin composites with a methacrylate composite material, and to determine any correlation between the cavity configuration factor (C-factor) and the volume of gaps formed.

METHODS AND MATERIALS

Sixty standardized Class I and Class II cavities were prepared and divided into six groups. Three types of composites, with their recommended self-etching adhesive systems, were used: Filtek Z250 XT; Estelite Sigma Quick; and Filtek P90. Each of the composite materials was placed in 10 Class I and 10 Class II cavities. The specimens were digitized using Skyscan 1172 μCT. They were examined for gap volume measurements, the thickness of the adhesive layer, and location of interfacial gaps.

RESULTS

There was a significant difference in the mean gap volume percentages of the three materials. The gap volume percent of Estelite Sigma quick was significantly lower than that of Filtek P90. No significant difference in the mean gap volume percentages of Class I and Class II restorations was found, except for Estelite Sigma Quick, in which the Class I gap volume percentage was higher than that of the Class II restorations.

CONCLUSIONS

μCT is an efficacious tool for the measurement of volumetric gaps formed at the tooth/restoration interface and for the evaluation of the adhesive layer. The differences in the C-factor do not always have a pronounced effect on the gap volumes of low-shrinkage composites.

Shrinkage vectors of a flowable composite in artificial cavity models with different boundary conditions: Ceramic and Teflon

Polymerization shrinkage of dental resin composites leads to stress build-up at the tooth-restoration interface that predisposes the restoration to debonding. In contrast to the heterogeneity of enamel and dentin, this study investigated the effect of boundary conditions in artificial cavity models such as ceramic and Teflon. Ceramic serves as a homogenous substrate that provides optimal bonding conditions, which we presented in the form of etched and silanized ceramic in addition to an etched, silanized and bonded ceramic cavity. In contrast, the Teflon cavity presented a non-adhesive boundary condition that provided an exaggerated condition of poor bonding as in the case of contamination during the application procedure or a poor bonding substrate such as sclerotic or deep dentin. The greatest 3D shrinkage vectors and movement in the axial direction were observed in the ceramic cavity with the bonding agent followed by the silanized ceramic cavity, and smallest shrinkage vectors and axial movements were observed in the Teflon cavity. The shrinkage vectors in the ceramic cavities exhibited downward movement toward the cavity bottom with great downward shrinkage of the free surface. The shrinkage vectors in the Teflon cavity pointed towards the center of the restoration with lateral movement greater at one side denoting the site of first detachment from the cavity walls. These results proved that the boundary conditions, in terms of bonding substrates, significantly influenced the shrinkage direction.