Physical Properties and Clinical Performance of Short Fiber Reinforced Resin-based Composite in Posterior Dentition: Systematic Review and Meta-analysis

OBJECTIVE

This study compares the physical properties and clinical performance of short fiber reinforced composites (SFRC) to those of particulate-filled resin-based composites (PFRC) for class I and II direct restorations in permanent dentition.

METHODS

Systematic review and meta-analysis was conducted using PubMed, Embase (Elsevier), and Dentistry and Oral Sciences Source (EBSCO) databases. The outcomes evaluated were physical properties including flexural strength, flexural modulus, elastic modulus, microhardness, shrinkage, fracture toughness, degree of conversion, and depth of cure. Clinical performance was evaluated with a systematic review.

RESULTS

The meta-analyses favored SFRC for flexural strength and fracture toughness compared to every PFRC subgroup, with a high quality of evidence. For all other properties, the meta-analyses favored SFRC to overall PFRC, with some non-significant differences with certain PFRC subgroups. The most recent clinical trial showed SFRC performed similarly to PFRC, however older studies suggest inferior surface texture and discoloration of SFRC compared to PFRC.

CONCLUSION

This study can aid dental professionals in clinical decision making, supporting that SFRC offers improved physical properties, especially fracture resistance and flexural strength, compared to PFRC.

The Influence of Distance on Radiant Exposure and Degree of Conversion Using Different Light-Emitting-Diode Curing Units

Objectives:

To investigate the influence of curing distance on the degree of conversion (DC) of a resin-based composite (RBC) when similar radiant exposure was achieved using six different light-curing units (LCUs) and to explore the correlation among irradiance, radiant exposure, and DC.

Methods and Materials:

A managing accurate resin curing-resin calibrator system was used to collect irradiance data for both top and bottom specimen surfaces with a curing distance of 2 mm and 8 mm while targeting a consistent top surface radiant exposure. Square nanohybrid-dual-photoinitiator RBC specimens (5 × 5 × 2 mm) were cured at each distance (n=6/LCU/distance). Irradiance and DC (micro-Raman spectroscopy) were determined for the top and bottom surfaces. The effect of distance and LCU on irradiance, radiant exposure, and DC as well as their linear associations were analyzed using analysis of variance and Pearson correlation coefficients, respectively (α=0.05).

Results:

While maintaining a similar radiant exposure, each LCU exhibited distinctive patterns in decreased irradiance and increased curing time. No significant differences in DC values (63.21%-70.28%) were observed between the 2- and 8-mm distances, except for a multiple-emission peak LCU. Significant differences in DC were detected among the LCUs. As expected, irradiance and radiant exposure were significantly lower on the bottom surfaces. However, a strong correlation between irradiance and radiant exposure did not necessarily result in a strong correlation with DC.

Conclusions:

The RBC exhibited DC values >63% when the top surface radiant exposure was maintained, although the same values were not reached for all lights. A moderate-strong correlation existed among irradiance, radiant exposure, and DC.

Comparison of Internal Adaptation of Bulk-fill and Increment-fill Resin Composite Materials

Objectives:

To evaluate 1) the internal adaptation of a light-activated incremental-fill and bulk-fill resin-based composite (RBC) materials by measuring the gap between the restorative material and the tooth structure and 2) the aging effect on internal adaptation.

Methods and Materials:

Seventy teeth with class I cavity preparations were randomly distributed into five groups; four groups were restored with bulk-fill RBCs: Tetric EvoCeram Bulk Fill (TEC), SonicFill (SF), QuiXX Posterior Restorative (QX), and X-tra fil (XF); the fifth group was restored with incremental-fill Filtek Supreme Ultra Universal Restorative (FSU). One-half of the specimens of each group were thermocycled. Each tooth was sectioned, digital images were recorded, and the dimensions of any existing gaps were measured. Data were analyzed using analysis of variance (α=0.05).

Results:

FSU had the smallest gap measurement values compared with the bulk-fill materials except QX and TEC (p≤0.008). FSU had the smallest sum of all gap category values compared with the bulk-fill materials, except QX (p≤0.021). The highest gap incidence and size values were found at the composite/adhesive interface. All aged groups had greater gap values in regard to the gap measurement and the sum of all gap categories compared with non-aged groups.

Significance:

The incrementally placed material FSU had the highest internal adaptation to the cavity surface, while the four bulk-fill materials showed varied results. Thermocycling influenced the existing gap area magnitudes. The findings suggest that the incremental-fill technique produces better internal adaptation than the bulk-fill technique.

Cuspal Deflection in Premolar Teeth Restored with Bulk-Fill Resin-Based Composite Materials

The present study investigated the effect of three high-viscosity bulk-fill resin-based composite materials on cuspal deflection in natural teeth. Thirty-two sound maxillary premolar teeth with large slot mesio-occlusal-distal cavities were distributed into four groups (n=8). Three groups were restored with bulk-fill resin composite materials (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein; x-tra fil, VOCO, Cuxhaven, Germany; and SonicFill, Kerr, Orange, CA, USA) in a single 4-mm increment. The conventional composite group, Filtek Z100 (3M ESPE, St Paul, MN, USA), was used to restore the cavities in 2-mm increments. Cusp deflection was recorded postirradiation using a Nikon measurescope UM-2 (Nikon, Tokyo, Japan) by measuring the changes in the bucco-palatal widths of the teeth at five minutes, 24 hours, and 48 hours after completion of the restorations. Cuspal deflection was significantly higher in the conventional composite than in the Tetric EvoCeram Bulk Fill (p=0.0031), x-tra fil (p=0.0029), and SonicFill Bulk (p=0.0002) groups. There were no significant differences in cuspal deflection among the three bulk-fill materials (all p<0.05). In conclusion, all the investigated bulk-fill resin composites exhibited cuspal deflection values that were smaller than those associated with a conventional incrementally placed resin composite.

Effect of Base and Inlay Restorative Material on the Stress Distribution and Fracture Resistance of Weakened Premolars

The purpose of this study was to evaluate the influence of direct base and indirect inlay materials on stress distribution and fracture resistance of endodontically treated premolars with weakened cusps. Forty healthy human premolars were selected; five were left intact as controls (group C+), and the others were subjected to endodontic treatment and removal of buccal and lingual cusp dentin. Five teeth were left as negative controls (group C−). The remaining 30 teeth were divided into two groups according to the direct base material (glass ionomer [GIC] or composite resin [CR]). After base placement, each group was subjected to extensive inlay preparation, and then three subgroups were created (n=5): no inlay restoration (GIC and CR), restored with an indirect composite resin inlay (GIC+IR and CR+IR), and restored with a ceramic inlay (GIC+C and CR+C). Each specimen was loaded until fracture in a universal testing machine. For finite element analysis, the results showed that the removal of tooth structure significantly affected fracture resistance. The lowest values were presented by the negative control group, followed by the restored and based groups (not statistically different from each other) and all lower than the positive control group. In finite element analysis, the stress concentration was lower in the restored tooth compared to the tooth without restoration, whereas in the restored teeth, the stress concentration was similar, regardless of the material used for the base or restoration. It can be concluded that the inlay materials combined with a base showed similar behavior and were not able to regain the strength of intact tooth structure.

Fracture resistance and microleakage of endocrowns utilizing three CAD-CAM blocks

This study assessed marginal leakage and fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) fabricated ceramic crowns with intracoronal extensions into the pulp chambers of endodontically treated teeth (endocrowns) using either feldspathic porcelain (CEREC Blocks [CB], Sirona Dental Systems GmbH, Bensheim, Germany), lithium disilicate (e.max [EX], Ivoclar Vivadent, Schaan, Liechtenstein), or resin nanoceramic (Lava Ultimate [LU], 3M ESPE, St Paul, MN, USA).). Thirty extracted human permanent maxillary molars were endodontically treated. Standardized preparations were done with 2-mm intracoronal extensions of the endocrowns into the pulp chamber. Teeth were divided into three groups (n=10); each group was restored with standardized CAD/CAM fabricated endocrowns using one of the three tested materials. After cementation with resin cement, specimens were stored in distilled water at 37°C for one week, subjected to thermocycling, and immersed in a 5% methylene-blue dye solution for 24 hours. A compressive load was applied at 35 degrees to long axis of the teeth using a universal testing machine until failure. Failure load was recorded, and specimens were examined under a stereomicroscope for modes of failure and microleakage. Results were analyzed using one-way analysis of variance and Bonferroni post hoc multiple comparison tests (α=0.05). LU showed significantly (p<0.05) higher fracture resistance and more favorable fracture mode (ie, fracture of the endocrown without fracture of tooth) as well as higher dye penetration than CB and EX. In conclusion, although using resin nanoceramic blocks for fabrication of endocrowns may result in better fracture resistance and a more favorable fracture mode than other investigated ceramic blocks, more microleakage may be expected with this material.

Influence of Light Intensity on Surface Free Energy and Dentin Bond Strength of Core Build-up Resins

Objective

We examined the influence of light intensity on surface free energy characteristics and dentin bond strength of dual-cure direct core build-up resin systems.

Methods

Two commercially available dual-cure direct core build-up resin systems, Clearfil DC Core Automix with Clearfil Bond SE One and UniFil Core EM with Self-Etching Bond, were studied. Bovine mandibular incisors were mounted in acrylic resin and the facial dentin surfaces were wet ground on 600-grit silicon carbide paper. Adhesives were applied to dentin surfaces and cured with light intensities of 0 (no irradiation), 200, 400, and 600 mW/cm2. The surface free energy of the adhesives (five samples per group) was determined by measuring the contact angles of three test liquids placed on the cured adhesives. To determine the strength of the dentin bond, the core build-up resin pastes were condensed into the mold on the adhesive-treated dentin surfaces according to the methods described for the surface free energy measurement. The resin pastes were cured with the same light intensities as those used for the adhesives. Ten specimens per group were stored in water maintained at 37°C for 24 hours, after which they were shear tested at a crosshead speed of 1.0 mm/minute in a universal testing machine. Two-way analysis of variance (ANOVA) and a Tukey-Kramer test were performed, with the significance level set at 0.05.

Results

The surface free energies of the adhesive-treated dentin surfaces decreased with an increase in the light intensity of the curing unit. Two-way ANOVA revealed that the type of core build-up system and the light intensity significantly influence the bond strength, although there was no significant interaction between the two factors. The highest bond strengths were achieved when the resin pastes were cured with the strongest light intensity for all the core build-up systems. When polymerized with a light intensity of 200 mW/cm2 or less, significantly lower bond strengths were observed.

Conclusions

The data suggest that the dentin bond strength of core build-up systems are still affected by the light intensity of the curing unit, which is based on the surface free energy of the adhesives. On the basis of the results and limitations of the test conditions used in this study, it appears that a light intensity of &gt;400 mW/cm2 may be required for achieving the optimal dentin bond strength.

Monitoring of sound and carious surfaces under sealants over 44 months

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 (i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.

Doxycycline-encapsulated nanotube-modified dentin adhesives

This article presents details of fabrication, biological activity (i.e., anti-matrix metalloproteinase [anti-MMP] inhibition), cytocompatibility, and bonding characteristics to dentin of a unique doxycycline (DOX)-encapsulated halloysite nanotube (HNT)-modified adhesive. We tested the hypothesis that the release of DOX from the DOX-encapsulated nanotube-modified adhesive can effectively inhibit MMP activity. We incorporated nanotubes, encapsulated or not with DOX, into the adhesive resin of a commercially available bonding system (Scotchbond Multi-Purpose [SBMP]). The following groups were tested: unmodified SBMP (control), SBMP with nanotubes (HNT), and DOX-encapsulated nanotube-modified adhesive (HNT+DOX). Changes in degree of conversion (DC) and microtensile bond strength were evaluated. Cytotoxicity was examined on human dental pulp stem cells (hDPSCs). To prove the successful encapsulation of DOX within the adhesives-but, more important, to support the hypothesis that the HNT+DOX adhesive would release DOX at subantimicrobial levels-we tested the antimicrobial activity of synthesized adhesives and the DOX-containing eluates against Streptococcus mutans through agar diffusion assays. Anti-MMP properties were assessed via β-casein cleavage assays. Increasing curing times (10, 20, 40 sec) led to increased DC values. There were no statistically significant differences (p > .05) in DC within each increasing curing time between the modified adhesives compared to SBMP. No statistically significant differences in microtensile bond strength were noted. None of the adhesives eluates were cytotoxic to the human dental pulp stem cells. A significant growth inhibition of S. mutans by direct contact illustrates successful encapsulation of DOX into the experimental adhesive. More important, DOX-containing eluates promoted inhibition of MMP-1 activity when compared to the control. Collectively, our findings provide a solid background for further testing of encapsulated MMP inhibitors into the synthesis of therapeutic adhesives that may enhance the longevity of hybrid layers and the overall clinical performance of adhesively bonded resin composite restorations.

Polymerization Shrinkage Stress Kinetics and Related Properties of Bulk-fill Resin Composites

The present study assessed the polymerization shrinkage stress kinetics of five low-shrinkage light-cured bulk-fill resin composites: Surefil SDR flow (SF, Dentsply), Tetric EvoCeram Bulkfil (TE, Ivoclar Vivadent), Venus Bulk Fill (VB, Heraeus Kulzer), x-tra fil (XF, Voco), and experimental bulk fill (FB, 3M ESPE). Filtek Z250 (FZ, 3M ESPE) was used as a control. Real-time shrinkage stress of investigated composites was measured using a tensometer; maximum shrinkage stress, stress rate (Rmax), and time to reach maximum stress rate (tmax) were recorded. Flexural strength and modulus were measured using a standard procedure, and curing efficiency of 4-mm long specimens was determined using bottom/top percentage Knoop microhardness. Data were analyzed using one-way analysis of variance and Bonferroni multiple range tests at a significance level of α=0.05. Results of shrinkage stress, Rmax, and tmax of all bulk-fill materials were significantly lower (p&lt;0.05) than those of the control except for XF. All tested bulk-fill materials were able to achieve acceptable curing efficiency (≥80% bottom/top percentage) at 4-mm depth. In conclusion, this study reports a significant reduction in polymerization shrinkage stress while maintaining comparable curing efficiency at 4 mm for some bulk-fill composites and supports their potential use in posterior clinical situations.

Impact of Quantity of Resin, C-factor, and Geometry on Resin Composite Polymerization Shrinkage Stress in Class V Restorations

Objective

This study evaluated the effect of quantity of resin composite, C-factor, and geometry in Class V restorations on shrinkage stress after bulk fill insertion of resin using two-dimensional finite element analysis.

Methods

An image of a buccolingual longitudinal plane in the middle of an upper first premolar and supporting tissues was used for modeling 10 groups: cylindrical cavity, erosion, and abfraction lesions with the same C-factor (1.57), a second cylindrical cavity and abfraction lesion with the same quantity of resin (QR) as the erosion lesion, and then all repeated with a bevel on the occlusal cavosurface angle. The 10 groups were imported into Ansys 13.0 for two-dimensional finite element analysis. The mesh was built with 30,000 triangle and square elements of 0.1 mm in length for all the models. All materials were considered isotropic, homogeneous, elastic, and linear, and the resin composite shrinkage was simulated by thermal analogy. The maximum principal (MPS) and von Mises stresses (VMS) were analyzed for comparing the behavior of the groups.

Results

Different values of angles for the cavosurface margin in enamel and dentin were obtained for all groups and the higher the angle, the lower the stress concentration. When the groups with the same C-factor and QR were compared, the erosion shape cavity showed the highest MPS and VMS values, and abfraction shape, the lowest. A cavosurface bevel decreased the stress values on the occlusal margin. The geometry factor overcame the effects of C-factor and QR in some situations.

Conclusion

Within the limitations of the current methodology, it is possible to conclude that the combination of all variables studied influences the stress, but the geometry is the most important factor to be considered by the operator.

Bioactive nanofibrous scaffolds for regenerative endodontics

Here we report the synthesis, materials characterization, antimicrobial capacity, and cytocompatibility of novel antibiotic-containing scaffolds. Metronidazole (MET) or Ciprofloxacin/(CIP) was mixed with a polydioxanone (PDS)polymer solution at 5 and 25 wt% and processed into fibers. PDS fibers served as a control. Scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), tensile testing, and high-performance liquid chromatography (HPLC) were used to assess fiber morphology, chemical structure, mechanical properties, and drug release, respectively. Antimicrobial properties were evaluated against those of Porphyromonas gingivalis/Pg and Enterococcus faecalis/Ef. Cytotoxicity was assessed in human dental pulp stem cells (hDPSCs). Statistics were performed, and significance was set at the 5% level. SEM imaging revealed a submicron fiber diameter. FTIR confirmed antibiotic incorporation. The tensile values of hydrated 25 wt% CIP scaffold were significantly lower than those of all other groups. Analysis of HPLC data confirmed gradual, sustained drug release from the scaffolds over 48 hrs. CIP-containing scaffolds significantly (p < .00001) inhibited biofilm growth of both bacteria. Conversely, MET-containing scaffolds inhibited only Pg growth. Agar diffusion confirmed the antimicrobial properties against specific bacteria for the antibiotic-containing scaffolds. Only the 25 wt% CIP-containing scaffolds were cytotoxic. Collectively, this study suggests that polymer-based antibiotic-containing electrospun scaffolds could function as a biologically safe antimicrobial drug delivery system for regenerative endodontics.

Effect of Er,Cr:YSGG Laser, Air Abrasion, and Silane Application on Repaired Shear Bond Strength of Composites

Aged resin composites have a limited number of carbon-carbon double bonds to adhere to a new layer of resin. Study objectives were to 1) evaluate various surface treatments on repaired shear bond strength between aged and new resin composites and 2) to assess the influence of a silane coupling agent after surface treatments.

Methods

Eighty disk-shape resin composite specimens were fabricated and thermocycled 5000 times prior to surface treatment. Specimens were randomly assigned to one of the three surface treatment groups (n=20): 1) air abrasion with 50-μm aluminum oxide, 2) tribochemical silica coating (CoJet), or 3) Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) laser or to a no-treatment control group (n=20). Specimens were etched with 35% phosphoric acid, rinsed, and dried. Each group was divided into two subgroups (n=10): A) no silanization and B) with silanization. The adhesive agent was applied and new resin composite was bonded to each conditioned surface. Shear bond strength was evaluated and data analyzed using two-way analysis of variance (ANOVA).

Results

Air abrasion with 50-μm aluminum oxide showed significantly higher repair bond strength than the Er,Cr:YSGG laser and control groups. Air abrasion with 50-μm aluminum oxide was not significantly different from tribochemical silica coating. Tribochemical silica coating had significantly higher repair bond strength than Er,Cr:YSGG laser and the control. Er,Cr:YSGG laser and the control did not have significantly different repair bond strengths. Silanization had no influence on repair bond strength for any of the surface treatment methods.

Conclusion

Air abrasion with 50-μm aluminum oxide and tribochemical silica followed by the application of bonding agent provided the highest repair shear bond strength values, suggesting that they might be adequate methods to improve the quality of repairs of resin composites.

Effect of Surface Treatments on Microtensile Bond Strength of Repaired Aged Silorane Resin Composite

Objective: This laboratory study compared the repaired microtensile bond strengths of aged silorane resin composite using different surface treatments and either silorane or methacrylate resin composite. Methods: One hundred eight silorane resin composite blocks (Filtek LS) were fabricated and aged by thermocycling between 8°C and 48°C (5000 cycles). A control (solid resin composite) and four surface treatment groups (no treatment, acid treatment, aluminum oxide sandblasting, and diamond bur abrasion) were tested (N=12 blocks, 108 beams/group). Each treatment group was randomly divided in half and repaired with either silorane resin composite (LS adhesive) or methacrylate resin composite (Filtek Z250/Single Bond Plus). After 24 hours in 37°C distilled water, microtensile bond strength testing was performed using a non-trimming technique. Surface topography after surface treatment was analyzed using scanning electron microscopy (SEM). Failure mode was examined using optical microscopy (50×). Results: Weibull-distribution survival analysis revealed that aluminum oxide sandblasting followed by silorane or methacrylate resin composite and acid treatment with methacrylate resin composite provided insignificant differences from the control (p&gt;0.05). All other groups were significantly lower than the control. Failure was primarily adhesive in all groups. Conclusion: Aluminum oxide sandblasting produced microtensile bond strength not different from the cohesive strength of silorane resin composite. After aluminum oxide sandblasting, aged silorane resin composite can be repaired with either silorane resin composite with LS system adhesive or methacrylate resin composite with methacrylate dental adhesive.

Influence of Glazed Zirconia on Dual-Cure Luting Agent Bond Strength

Treatment of yttrium-stabilized tetragonal zirconia ceramic surfaces with a low-fusing porcelain layer as a glaze significantly increased the bond strength of dual-cure resin cement to the ceramic surface.

Effect of C-factor on microtensile bond strengths of low-shrinkage composites

This study evaluated the microtensile bond strength (μ-TBS) of low-shrinkage composites with their corresponding adhesive systems, Filtek Silorane/Silorane adhesive (SIL, 3M ESPE AG, Seefeld, Germany) and Aelite LS/One-Step Plus (AL, BISCO Inc, Schaumburg, IL, USA) in cavities with different C-factors. Filtek Z250/Adper Single Bond Plus (Z, 3M ESPE, St Paul, MN, USA) was used as a control.

METHOD

Standardized Class I cavities were prepared in extracted human molars after removing occlusal enamel. Cavities were assigned into six different C-factors by applying nail polish to four walls, three walls, two walls adjacent to each other, two walls opposite to each other, one wall, or no walls. Resin composites with their corresponding adhesive systems were applied according to manufacturer instructions. Specimens were sectioned to obtain four rectangular beams from the center of the restorations and μ-TBS was measured. Data were analyzed by Weibull survival analysis. Shrinkage stresses of the resin composites were determined after 30 minutes from the start of light-curing using a tensometer testing machine. Flexure elastic modulus was determined using standard procedures, in accordance with ISO 4049. Data for shrinkage stress and elastic modulus were analyzed by one-way analysis of variance followed by a Tukey multiple-comparisons test (p<0.05).

RESULTS

μ-TBS of both SIL and AL were not affected by different C-factors; however, the bond strength of Z decreased significantly when the C-factor increased. Shrinkage stress results were 0.94 ± 0.1, 1.79 ± 0.18, and 2.14 ± 0.23 MPa for SIL, AL, and Z, respectively. The flexural modulus of both the SIL and the AL was significantly lower than that of Z.

CONCLUSIONS

Increasing C-factor did not negatively affect the bond strength of low-shrinkage composites.

In Vitro Wear of New Indirect Resin Composites

The application of indirect resin composites for full-coverage restorative purposes still remains a concern due to wear. New indirect composites behave differently under different wear-testing conditions. Overall, Belleglass-NG showed the lowest wear when tested in vitro under different wear tests.

The Effect of Surface Treatments on the Micro-shear Bond Strength of a Resin Luting Agent and Four All-ceramic Systems

The bond strength between ceramics and a resin luting agent is affected by the ceramic surface treatment, which is dependent on the ceramic composition.

Influence of Power Density on Polymerization Behavior and Bond Strengths of Dual-cured Resin Direct Core Foundation Systems

The dentin bond strength and polymerization behavior of the dual-cured core foundation resins tested in this study were affected by the power densities of the curing unit. When using dual-cured core foundation systems, practitioners should consider power densities for getting optimal bond strength.

Effect of Bleaching on Fracture Toughness of Resin Composites

Bleaching after composite placement does not have a significant adverse effect on the fracture toughness of composite materials.

Bonding Durability of Single-Step Adhesives to Previously Acid-Etched Dentin

To achieve optimum bond strengths, acid etching of dentin prior to the application of single-step self-etch adhesive systems should be avoided.

Depth of Cure of Dental Resin Composites: ISO 4049 Depth and Microhardness of Types of Materials and Shades

Achieving a high degree of cure throughout a 2 mm thickness of light-activated resin composite did not occur for many types and shades of resin composite. Clinicians should check the depth of cure by using the scraping method.

Mechanical properties of four methylmethacrylate-based resins for provisional fixed restorations

The use of a provisional restoration is an important phase in the treatment of the dental prosthetic patient. A good provisional restoration should satisfy the following requirements: pulpal protection, positional stability, ease in cleaning, accurate margins, wear resistance, dimensional stability, and serve as a diagnostic aid in treatment assessment and esthetics. There is a tendency for discoloration, occlusal wear, and fracture that eventually leads to unnecessary repair. Heat-processed and reinforced methacrylate-based resins have been used to improve the mechanical and physical properties of provisional restorations. Among various improvements, the interpenetrating network crosslinked PMMA (IPN) has been shown to have superior mechanical properties if manufactured through a dough compression molding process at 130 degrees C. However, there have been no published data that relate with the use of this material for fixed provisional restorations. The objective of this study was to compare four methyl methacrylate-based resins for provisional crowns and bridges with varying processing cycles, including JET [self-cure], ACRALON [heat-cured], titanium dioxide filled PMMA [heat-cured], and IPN [heat-cured denture tooth resin]. Properties studied included transverse strength, toughness, rigidity, and hardness. From the results of this study the following conclusions can be made: the IPN group may have had a lower degree of conversion as demonstrated by decreased strength, toughness, and hardness data as compared with Acralon. Increasing the polymerization cycle of unmodified Acralon resin causes a significant increase in strength.

Microleakage of high-strength glass ionomer: resin composite restorations in minimally invasive treatment

Atraumatic Restorative Treatment (ART) has been investigated as an alternative caries treatment. The technique involves removal of loose tooth structure with a spoon excavator, followed by placement of an adhesive restorative material, often a high-strength glass ionomer. This study compares the microleakage of a high-strength glass ionomer/resin composite and two occlusal resin composite restoration techniques.

Alveolar type II cells expressing jaagsiekte sheep retrovirus capsid protein and surfactant proteins are the predominant neoplastic cell type in ovine pulmonary adenocarcinoma

Ovine pulmonary adenocarcinoma is caused by jaagsiekte sheep retrovirus. To gain insight into the histogenesis and viral pathogenesis of this neoplasm, the tumor cell phenotypes and differentiation state were correlated with the distribution of jaagsiekte sheep retrovirus capsid protein in neoplastic and normal cells of the lung in nine naturally occurring and 12 experimentally induced cases of ovine pulmonary adenocarcinoma. Overall, 82% of tumor cells had ultrastructural features consistent with alveolar type II cells, 7% of tumor cells had features of Clara cells, and 11% of tumor cells were insufficiently differentiated to classify. The proportion of the neoplastic cell phenotypes varied within tumors, and no tumor consisted of a morphologically uniform cell population. To further characterize the neoplastic cell population, sections of tumors were immunostained with antibodies to surfactant protein A, surfactant protein C, and Clara cell 10-kd protein. Overall, surfactant proteins A and C were expressed in 70% and 80% of tumor cells, respectively, whereas Clara cell 10-kd protein was expressed in 17% of tumor cells. Jaagsiekte sheep retrovirus capsid protein was detected in 71% of tumor cells and in macrophages (5/21 tumors examined) and in nonneoplastic alveolar and bronchiolar cells (6/14 tumors). Expression of this viral protein in neoplastic cells, classified morphologically and by immunophenotyping primarily as of the alveolar type II lineage, implies an important role for specific virus-cell interactions in the pathogenesis of ovine pulmonary adenocarcinoma.

Microleakage of posterior packable resin composites with and without flowable liners

The use of flowable composites as liners in Class II packable composites has been suggested by some manufacturers. However, the contributions of this technique are unproven. This study evaluated marginal microleakage in Class II packable composite restorations with and without the use of a flowable composite liner. A conventional microhybrid composite was used as a control. Microleakage at occlusal and gingival margins of Class II cavities was evaluated using 45Ca and autoradiographs. Fifty non-carious, restoration-free human molar teeth were used. Separate mesio-occlusal and disto-occlusal Class II cavity preparations were made in each tooth. Gingival margins of all cavities were placed 1 mm apical to the cementoenamel junction (CEJ). Four Packable composites (Alert, Surefil, Pyramid and Solitaire) and one conventional microhybrid composite (Renew) with their respective manufacturer's bonding agents were used to restore the cavities. One side of each tooth was restored with composite alone, while the other side was restored with the composite lined with that manufacturer's flowable liner. The restored teeth were thermally stressed and 45Ca was used to evaluate microleakage. Two independent evaluators scored leakage based on the autoradiographs. The results showed flowable composites helped reduce microleakage at gingival margins of Class II restorations (p < 0.05). Gingival margins had higher microleakage than occlusal margins (p < 0.05). Without flowable liners, three packable composites (Alert, Pyramid and Surefil) showed higher leakage (p < 0.05) than the microhybrid control. Only Solitaire packable composite without liner showed no significant difference in microleakage to the control (p > 0.05). Although the flowable liners help reduce microleakage, Alert and Pyramid packable composites with liners still showed higher leakage than the control (p < 0.05). Surefil and Solitaire packable composites with flowable liners showed no significant difference in microleakage (p > 0.05) to the control.

The effect of double adhesive application on the shear bond strength to dentin of compomers using three one-bottle adhesive systems

The development of one-bottle dentin adhesive systems resulted in much optimism about providing simplified predictable esthetic dentistry. However, laboratory testing of these systems continues to provide significant variations between facilities. A potential effect of the number of applications was noted in this author's laboratory. This study evaluated the effect of doubling the manufacturer's recommended number of applications on shear bond strength to dentin. Ninety human molars were divided into groups of 15. The occlusal surfaces were finished to 600 grit SiC to provide a flat dentin bonding surface. Prime & Bond NT-Dyract, Optibond Solo-Elan and One Step-Dyract were evaluated. Each material was tested using: (1) the recommended number of adhesive applications and (2) twice the number of applications recommended. All adhesive applications were accomplished before light curing the adhesive. The specimens were thermocycled after one week of storage and tested in shear after two weeks. Specimens were also fabricated after adding Rhodamine D to the adhesive to allow for visualization using confocal microscopy. These teeth were sectioned and viewed 24 hours after fabrication. A t-test was used to compare differences within product groups. The results showed a significant effect (p < 0.001) when a double application of Prime & Bond NT was used. No difference was seen with Optibond Solo or One Step. All specimens appeared to have a uniform, glossy appearance of adhesive during fabrication. Therefore, the appearance of the adhesive after application may not be a reliable predictor of acceptable bonding. Confocal microscopy showed that single application Prime & Bond NT specimens did not exhibit a uniform thickness of adhesive across the entire interface. Tubule penetration and hybridization was apparent for all specimens.

Investigation of an adhesive system used with direct and indirect applications

A laboratory investigation was performed that examined the adhesive properties of a new adhesive system. Contrasts were made with other commercially established systems, and indirect and direct bonding procedures were investigated. For the indirect evaluation, simulated restorations were bonded with an experimental resin cement. Sealing was assessed through microleakage analysis. Adhesive strength value was measured by shear bond strength methods. Further, the marginal quality of the restorations was assessed using scanning electron microscopy. Finally, the adhesive shear bond strengths were established using direct bonding.

Resin cements: into the 21st century

Current trends in dentistry are largely dependent on adhesives. The use of indirect restorations in cosmetic dentistry often requires predictable adhesive luting systems. This article discusses the properties and performance of today's resin luting systems. Solubility, wear resistance, strength, and microleakage play an important role in the performance of a cement. Some critical handling issues are addressed and information about current resin cements is provided.

In vitro study of fracture incidence and compressive fracture load of all-ceramic crowns cemented with resin-modified glass ionomer and other luting agents

STATEMENT OF PROBLEM

Anecdotal reports based on clinical observation have recently linked resin-modified glass ionomer luting agents with postcementation fracture of all-ceramic crowns.

PURPOSE

This study evaluated the fracture incidence of In-Ceram and VitaDur Alpha porcelain jacket all-ceramic crowns cemented with 5 luting agents (Fuji I, Fuji Plus, Vitremer, Advance, and Panavia 21) during 2 months storage in 0.8% NaCl solution.

MATERIAL AND METHODS

Fifty human maxillary premolar teeth were prepared for each ceramic system and divided into 5 subgroups of 10 teeth to be cemented with 5 luting cements. Specimens were observed for fracture lines and crack initiation at storage times up to 2 months. Incidence of fracture was analyzed with Fisher's Exact test. Specimens that did not fracture during storage were loaded in compression to failure. Failure loads were analyzed by analysis of variance and multiple pairwise comparisons.

RESULTS

Only all-ceramic crowns cemented with Advance cement fractured during the 2-month observation period, and porcelain jacket crowns were found to fracture earlier and more frequently than In-Ceram crowns. Cracks initiated at the crown margin, and multiple crack lines were found as the time of storage increased. In-Ceram crowns were significantly stronger (140 +/- 21.5 kg) than porcelain jacket crowns (98.6 +/- 17.8 kg) at P <.05. For In-Ceram crowns, cement type did not influence failure load while for porcelain jacket crowns, Fuji I (110.5 kg) was significantly higher than Vitremer (86.6 kg) at P <.05.

CONCLUSIONS

For the cements studied, only crowns cemented with Advance cement demonstrated fracture during 2-month storage. Results for the true resin-modified glass ionomer cements do not support anecdotal reports of fracture of all-ceramic crowns cemented with these materials.

Corrosion behavior of 2205 duplex stainless steel

The corrosion of 2205 duplex stainless steel was compared with that of AISI type 316L stainless steel. The 2205 stainless steel is a potential orthodontic bracket material with low nickel content (4 to 6 wt%), whereas the 316L stainless steel (nickel content: 10 to 14 wt%) is a currently used bracket material. Both stainless steels were subjected to electrochemical and immersion (crevice) corrosion tests in 37 degrees C, 0.9 wt% sodium chloride solution. Electrochemical testing indicates that 2205 has a longer passivation range than 316L. The corrosion rate of 2205 was 0.416 MPY (milli-inch per year), whereas 316L exhibited 0.647 MPY. When 2205 was coupled to 316L with equal surface area ratio, the corrosion rate of 2205 reduced to 0.260 MPY, indicating that 316L stainless steel behaved like a sacrificial anode. When 316L is coupled with NiTi, TMA, or stainless steel arch wire and was subjected to the immersion corrosion test, it was found that 316L suffered from crevice corrosion. On the other hand, 2205 stainless steel did not show any localized crevice corrosion, although the surface of 2205 was covered with corrosion products, formed when coupled to NiTi and stainless steel wires. This study indicates that considering corrosion resistance, 2205 duplex stainless steel is an improved alternative to 316L for orthodontic bracket fabrication when used in conjunction with titanium, its alloys, or stainless steel arch wires.

Influence of dentin primer application methods on dentin bond strength

This study was carried out to determine the influence of dentin primer application methods on bond strength to human dentin. Two dentin bonding restorative systems, Imperva Bond/Lite-Fil II A (Shofu) and Scotchbond Multi-Purpose/Z-100 (3M) were employed. Human molars were mounted in self-cured resin and the buccal surfaces were prepared with #600-grit SiC paper. These surfaces were then conditioned according to each manufacturer's instructions. Two experiments were designed: (1) effect of the primer application procedures (inactive and active application), and (2) effect of the air drying time (0, 1, 5, 10, 20, and 30 seconds). The adhesives were applied and resin composites were bonded to the teeth. Ten samples per test group were stored in 37 degrees C deionized water for 24 hours, and shear tested with a circular knife edge at a crosshead speed of 1.0 mm/minute. A one-way ANOVA followed by the Newman-Keuls multiple comparison at P < 0.05 was done. For both restorative systems, the bond strengths for active application were higher than those for inactive application, but there was no significant difference between the two mean values. According to the air drying time, there appeared to be an optimal range of drying times, longer for Imperva Bond (10-30 seconds) than for Scotchbond MP (1-5 seconds). The data suggest that the bond strengths of employed dentin bonding systems were greatly influenced by the methods of the dentin primer application.