Denture relining using digital replication method: A dental technique

The aim of this report was to digitize traditional denture relining using a digital duplication method, in addition to assessing the wear resistance of three-dimensional (3D) printed denture teeth. A complete denture was relined using light body impression. The denture with impression was scanned yielding a standard tessellation language file that was designed to print the denture base and teeth. The printed teeth were fitted into the sockets of the printed denture base and then bonded using auto-polymerized acrylic resins, followed by finishing and polishing. Dentures were inserted and fit and occlusion were adjusted as needed, and the patient was scheduled for follow-up appointments at one week, three months, and six months. At each follow-up visit, dentures were scanned using a 3Shape E3 desktop scanner and scans were superimposed. The occlusal wear was assessed in reference to the first scan after the denture insertion visit. The accuracy of the intaglio surface of dentures was within clinically acceptable limits. The clinical evaluation of inserted dentures in terms of retention, occlusion, esthetic, and patient satisfaction was encouraging. Using digital duplication, conventional dentures could be relined. The advantages of digital records include eliminating polymerization dimensional changes, and reducing cost and clinical time by minimizing the number of visits, which is particularly helpful with geriatric patients.

Flexural strength of 3D-printed nanocomposite provisional resins: Impact of SiO2 and ZrO2 nanoparticles and printing orientations in vitro

PURPOSE

The aim of this study was to investigate and compare the influence of zirconium dioxide nanoparticles (ZrO2 NPs) and silicon dioxide nanoparticles (SiO2 NPs) addition and printing orientation on the flexural strength (FS) of provisional three-dimensional (3D) printing resins undergoing thermal cycling (TC).

METHODS

Three dimensional-printed resin (NextDent C&B MFH) was used to fabricate 300 bar-shaped specimens (25 × 2 × 2 mm3 ). The ZrO2 NPs and SiO2 NPs specimens were divided into two groups, then subdivided into three groups, based on the nanoparticle concentration (i.e., 0 wt% (original group), 0.5 wt%, and 1 wt%). Each concentration was printed in three printing orientations (0°, 45°, and 90°). The printed specimens were exposed to 5000 cycles of TC, followed by a three-point bending test to assess the FS. Fracture surface analysis was conducted by using a scanning electron microscope (SEM). For data analysis, ANOVA and Tukey's post hoc were utilized (α = 0.05).

RESULTS

Compared to the original material, the addition of ZrO2 NPs and SiO2 NPs had a significantly positive impact on the FS, (P > 0.001). After TC, the FS of the original group decreased significantly and had the lowest value. The highest FS value was observed in 1% ZrO2 NPs at 0°. Regardless of the nanoparticle concentration, the 0° orientation consistently showed a higher FS, compared to the 45° and 90° orientations. At all orientations (i.e., 0°, 45°, and 90°), the FS significantly increased with the addition of NPs, compared with that of the original material (P > 0.001). TC had a significantly negative effect on the FS of the unmodified groups. However, no significant differences existed in FS among the modified groups after TC.

CONCLUSION

The addition of SiO2 NPs and ZrO2 NPs increased the FS of the 3D-printed provisional resin. Regardless of the nanoparticle concentration, the 0° orientation had the higher FS. TC had an effect on the original resin, whereas it had no significant effect on the nanoparticle-modified resins. In clinical practice, 3D-printed provisional nanocomposite resins printed at the 0° orientation could be recommended for long-term dental provisional restorations.

Effect of Duplication Techniques on the Fitting Accuracy of CAD-CAM Milled, 3D-Printed, and Injection-Molded Mandibular Complete Denture Bases

BACKGROUND

Digital technology has been introduced in prosthodontics, and it has been widely used in denture duplication instead of a conventional denture duplication technique. However, research comparing different denture duplication techniques and how they affect the fitting accuracy of the denture base is scarce.

OBJECTIVES

The aim was to assess the impact of duplication techniques on the accuracy of the fitting surface of computer-aided design and manufacturing (CAD-CAM) milled, 3D-printed, and injection-molded complete denture bases (CDBs).

METHODOLOGY

This study involved fabricating a mandibular complete denture base with three marked dimples as reference marks (A, B, and C at the incisive papilla, right molar, and left molar areas) using a conventional compression molded technique. This denture was then scanned to generate a standard tessellation language (STL) file; after that, it was duplicated using three different techniques (milling, 3D printing, and injection molding) and five denture base resin materials-two milled CAD-CAM materials (AvaDent and IvoBase), two 3D-printed materials (NextDent and HARZ Labs), and one injection-molded material (iFlextm). Based on the denture base type, the study divided them into five groups (each with n = 10). An evaluation of duplication accuracy was conducted on the fitting surface of each complete denture base (CDB) using two assessment methods. The first method was a two-dimensional evaluation, which entailed linear measurements of the distances (A-B, A-C, and B-C) between reference points on both the scanned reference mandibular denture and the duplicated dentures. Additionally, a three-dimensional superimposition technique was employed, involving the overlay of the STL files of the dentures onto the reference denture's STL file. The collected data underwent statistical analysis using a one-way analysis of variance and Tukey's pairwise post hoc tests.

RESULTS

Both evaluation techniques showed significant differences in fitting surface accuracy between the tested CDBs (p ˂ 0.001), as indicated by one-way ANOVA. In addition, the milled CDBs (AvaDent and IvoBase) had significantly higher fitting surface accuracy than the other groups (p ˂ 0.001) and were followed by 3D-printed CDBs (NextDent and HARZ Labs), while the injection-molded (iFlextm) CDBs had the lowest accuracy (p ˂ 0.001).

CONCLUSIONS

The duplication technique of complete dentures using a CAD-CAM milling system produced superior fitting surface accuracy compared to the 3D-printing and injection-molded techniques.

Denture care and oral health-related quality of life among complete denture wearers in Eastern Province of Saudi Arabia

INTRODUCTION

This study aimed to evaluate denture care and hygiene and oral health-related quality of life (OHRQoL) among complete denture (CD) wearers in the Eastern Province of Saudi Arabia.

METHODOLOGY

This cross-sectional study was conducted on CD wearers in the Eastern Province of Saudi Arabia. A pre-tested questionnaire was administered among study participants. Questionnaire was divided in three sections: (1) patients' demographic data, (2) awareness and maintenance of CD and (3) OHRQoL. Independent sample t-test and one-way ANOVA test were performed.

RESULTS

The study included data of 300 participants with 71% of males and 28% of females. Majority of participants (82.7%) cleaned CD daily, removed CD while sleeping (88.0%) and knew that unhygienic dentures can cause oral infection (92.7%). Only 19.3% used denture cleansing tables, 41% used toothpaste, and 60.7% rinsed CD with water. Regarding OHIP-DENT domains, highest score was for functional limitation domain (2.20 ± 1.67) and the lowest for handicap domain (0.94 ± 1.09). The mean OHIP-DENT score of the sample was 12.02 ± 8.52. Females (p = 0.006), participants below 65 years of age (p = 0.029), non-Saudis (p = 0.042), those with university education (p = 0.030) and low monthly income (p = 0.045) and participants who visited dentist due to problem with CD (p = 0.041) demonstrated significantly higher mean OHIP-DENT score.

CONCLUSION

Majority of participants demonstrated appropriate denture care behaviours because they were aware of the importance of denture care and hygiene. Female gender, age below 65 years, non-Saudi nationality, university education, low monthly income and visiting dentist due to problem were related to poor OHRQoL.

Effect of repair and surface treatments on the strength of digitally fabricated resin-based dental prostheses: A systematic review of in vitro studies

OBJECTIVE

This review investigated the current literature pertaining to the repairability of computer-aided design-computer-aided manufacturing (CAD-CAM) milled and three-dimensional (3D) printed resin-based dental prostheses (RBDPs) as well as the appropriate surface treatment for each repair material that will produce adequate repair bond strength.

DATA/SOURCES

PubMed, Web of Science, and Scopus databases were searched for published articles involving repair of CAD-CAM RBDPs between January 2010 and June 2023. Data were collected and analyzed to reveal the surface treatment effects, suggested repair materials, and strength of repaired RBDPs.

STUDY SELECTION

Out of 164 retrieved titles, 11 studies were included, of which five investigated the repair of 3D-printed RBDPs, three investigated the repair of CAD-CAM milled resins, and three investigated both materials. Additionally, of the included studies, seven investigated denture base resins, three studied provisional restoration resins, and one evaluated 3D-printed intraoral splints. Various surface treatments were suggested, with air-abrasive methods being the most commonly used. Different materials for resin repair were proposed and used, including auto-polymerized, reline, and composite resins. For 3D-printed resins, repair with Bis-acrylic/Bis-GMA composites improved repair strength.

CONCLUSION

Surface treatments positively affected the repair strength of conventional and milled RBDPs. However, challenges remain relevant to the repair of 3D-printed resins owing to composition mismatches and fabrication techniques. Therefore, further investigation is required to develop new 3D-printed resins.

CLINICAL SIGNIFICANCE

CAD-CAM milled resins have satisfactory repair strength, which increases with surface treatment. The repair of 3D-printed resins has proven challenging even with surface treatments. However, composite resins are the materials of choice.

Influence of denture brushing on the surface properties and color stability of CAD-CAM, thermoformed, and conventionally fabricated denture base resins

PURPOSE

To assess the influence of denture brushing on the surface roughness, hardness, and color stability of conventional, thermoformed, and CAD-CAM denture base materials.

MATERIALS AND METHODS

Seven different denture base materials were included in this study; conventional heat-polymerized acrylic resin (PMMA) served as control, polyamide, acetal, two categories of milled acrylic discs (AvaDent and IvoCad), and two categories of 3D-printed resins (NextDent and FormLabs). The specimens were constructed according to manufacturers' instructions and then subjected to simulated brushing (20,000 cycles). According to the brushing method, the specimens were split into three groups, no brushing, brushing with water, and brushing with toothpaste. Surface roughness, hardness, and color change were evaluated before and after brushing. Collected data were analyzed using ANOVA, and post-hoc Tukey's tests (α = 0.05).

RESULTS

A significant difference was noted between the surface roughness of the tested materials before and after denture brushing (p < 0.05), and milled resin showed the least Ra values. Denture brushing with water significantly increased the Ra of PMMA (p = 0.004) and IvoCad (p = 0.032), while brushing using toothpaste did not show a significant increase. The brushing protocols did not alter the hardness of tested materials except that of PMMA (p = 0.001). The color stability of the tested materials showed comparable results with both brushing protocols.

CONCLUSION

The tested properties showed variations between the types of denture base resins. Hardness and color stability of CAD-CAM and thermoformed denture base resins were not altered by denture brushing and showed comparable results with both brushing methods. Surface roughness was the only property that showed alteration after denture brushing.

Highlights on Drug and Ion Release and Recharge Capacity of Antimicrobial Removable Prostheses

This article aimed to review the ion and drug release, recharge abilities, and antimicrobial properties of drug/ion-releasing removable prostheses, and to assess their capability in preventing and inhibiting denture stomatitis as well preventing caries and reversing carious lesions. Data was collected from published scientific papers listed in PubMed database from January 1975 to December 2021. English full-text articles, involving clinical or in vitro studies, focusing on removable prostheses and are concerned with drug/ion release and rechargeability as a way to prevent or inhibit denture stomatitis or dental caries were included. The relevant articles reported that ion- or drug-modified polymethylmethacrylate acts as a reservoir for these ions and drugs and is capable of releasing significant amounts with sustained release effect. Recharging of modified resin resulted in greater sustainability of ion and drug release, thus improving the long-term effects of protection against demineralization and reducing the adhesion of Streptococcus mutans and Candida albicans. Modifications of removable prostheses with rechargeable ions and drugs enhance remineralization, hinder demineralization, and reduce microbial adhesion in difficult-to-access areas. Selection of denture base for clinical use will consider its ability to act as an ion/drug reservoir that is capable of release and recharge.

Strength and Wear Behavior of Three-Dimensional Printed and Prefabricated Denture Teeth: An In Vitro Comparative Analysis

OBJECTIVES

 With advanced technology for complete denture fabrication, there is a lack of knowledge on the mechanical behavior of three-dimensional (3D) printed teeth despite the development of complete denture fabrication technologies. This study aimed to compare different types of 3D-printed teeth in terms of wear and fracture resistance in comparison to control prefabricated denture teeth.

MATERIALS AND METHODS

 One prefabricated tooth was selected and fixed in a resin holder and half of the tooth remained in anatomic form, while the other half was flattened for the wear test. One from each type was scanned and then printed with different resins; Asiga (DentaTOOTH, Asiga, Alexandria 2015,NSW, Australia), FormLabs (Denture Base LP, FormLabs, Berlin, Germany), and NextDent (NextDent C&B MFH, NextDent B.V., Soesterberg, the Netherlands) according to manufacturer recommendations. A total of 60 specimens (20/resin, n = 10) were thermo cycled (5,000 cycles) and wear test samples were further subjected to cyclic loading (1,70,000 cycles) in a chewing simulator machine CS-4.2 (SD Mechatronik GmbH, Germany). The fracture strength of anatomic teeth was measured using a universal testing machine (Instron model 5965, Massachusetts, United States), while Geomagic Control X software was used to assess the amount of wear of flattened teeth. Statistical analyses were performed with one-way analysis of variance with Tukey's post hoc test at significance level of α = 0.05.

RESULTS

 NextDent specimens showed the greatest volume loss, whereas FormLabs specimens showed the least volume loss. Comparing NextDent specimens to FromLabs specimens, FromLabs showed statistically significantly less volume loss (p < 0.001). No other group pairs differed significantly from one another in terms of volume loss (p > 0.06).

CONCLUSION

 3D-printed denture teeth showed comparable strength and wear resistance with the prefabricated denture teeth and were suitable for long-term clinical usage except for NextDent that significantly showed the lowest fracture resistance.

Effect of Different Occlusal Tooth Forms of Mandibular Overdenture Retained by an Immediate Loaded Single Implant on the Masticatory Efficiency and Oral Health-Related Quality of Life

Aim

To study the masticatory efficacy and oral health-related quality of life (OHRQoL) of participants wearing a mandibular overdenture retained by an immediate loading single implant with different occlusal tooth forms.

Materials and Methods

For this nonrandomized controlled trial study, 27 edentulous participants were selected and randomly divided into three groups (n = 9) based on occlusal tooth forms of the mandibular implant overdenture (MIOD). Group I: participants received an MIOD with an anatomical tooth form; Group II: participants received an MIOD with a semianatomical tooth form; and Group III: participants received an MIOD with a nonanatomical tooth form. For each participant, a single implant (screw root form) was inserted into the midline of the mandibular ridge to support the MIOD. For each group, the masticatory efficiency was evaluated after 3 months, and the OHRQoL of the participants was evaluated after 3 and 6 months. One-way ANOVA and post hoc Tukey's test were used for data analysis (P < 0.05).

Results

The masticatory efficiency of the anatomic and semianatomic tooth forms was higher than that of the nonanatomic (P < 0.05). Moreover, the improvement in the participants' OHRQoL in the anatomic group was more significant than that of other groups (P < 0.05).

Conclusion

There was a greater improvement in masticatory efficiency and participants' OHRQoL when fitted with an anatomic tooth form mandibular overdenture retained by an immediate loading single implant than with a semianatomic or nonanatomic tooth form.

Effect of treated zirconium dioxide nanoparticles on the flexural properties of autopolymerized resin for interim fixed restorations: An in vitro study

STATEMENT OF PROBLEM

Fractures of interim fixed restorations are a common complication. The autopolymerized polymethyl methacrylate resin materials used for interim fixed restorations have limited mechanical properties, but whether adding treated zirconium dioxide nanoparticles improves mechanical properties is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of treated zirconium dioxide nanoparticles on the flexural strength and elastic modulus of autopolymerized polymethyl methacrylate resin.

MATERIAL AND METHODS

A split-metal mold (60×10×3.3 mm) was used to fabricate 40 autopolymerized acrylic resin specimens. The specimens were divided into 4 groups (n=10) according to zirconium dioxide nanoparticle concentration: control (unmodified resin) and zirconium dioxide nanoparticle contents of 1, 2.5, and 5 wt%. The specimens were mixed and polymerized according to the manufacturer's instructions and stored in distilled water for 48 ±2 hours at 37 °C. The flexural strength and elastic modulus were evaluated based on the 3-point bend test where data were analyzed by using 1-way analysis of variance and Tukey post hoc tests (α=.05).

RESULTS

The flexural strength of the 1-wt% zirconium dioxide nanoparticle specimens was significantly higher than that of the control group (P<.001) but did not significantly increase further with the higher nanoparticle content (P>.05). Elastic modulus significantly decreased with 2.5-wt% zirconium dioxide nanoparticles (P=.019), while no significant changes were found with other test groups (P>.05).

CONCLUSIONS

The addition of treated zirconium dioxide nanoparticles at low concentrations increased the flexural strength of autopolymerized polymethyl methacrylate resins used in fixed interim restorations.

Fracture Strength of Composite Rest Seats: An In Vitro Comparative Study of Different Composite versus Amalgam Restorations

Occlusal rest provides support for removable partial dentures (RPD). Rest seats are ideally prepared in enamel, but the abutment teeth might be restored or need restorations. This study compared the fracture strength of abutments restored with composite to amalgam restorations after rest seat preparation. Disto-occlusal cavities were prepared in 30 extracted human maxillary premolars. The specimens were allocated in three groups (n = 10) based on the type of restoration. All the specimens were exposed to thermomechanical aging followed by cycling loading. Fracture strength was tested using a universal testing machine, and then, the fracture mode was recorded. The data were analyzed using Kruskal-Wallis test with a significance level set at 0.05. The fracture mode was recorded as catastrophic or non-catastrophic. The fracture strength between all tested groups showed no significant difference. The highest and lowest fracture strength were recorded on amalgam and Tetric N-Ceram groups, respectively. Composite Tetric N-Ceram showed equal distribution of fracture sites on the restorative materials and teeth, it also displayed the highest number of non-catastrophic fractures unlike other groups where the fracture occurred more within the restorations. The fracture strength of composite was comparable to that of amalgam restorations with prepared rest seats.

Impact of international collaboration on dentistry related papers published in Kingdom of Saudi Arabia

Objective

This bibliographic analysis was designed to review all dental publications in the Kingdom of Saudi Arabia (KSA) and evaluate the effect of international collaboration on the impact of published articles.

Methods

The Web of Science (WOS) database was used to extract all related published articles in the KSA from 1982 to 2021. The keywords were connected using Boolean Operators to download related articles. Downloaded articles were screened according to the following inclusion criteria: collaboration journal category, journal discipline, number of citations, number of authors, and impact factor. After applying the inclusion criteria and excluding single-author articles, 5,689 documents were included in the final analysis. The chi-square test and two-independent samples t-test were used to determine the statistical significance between the variables.

Results

A significantly higher proportion of articles with international collaboration (51.4%) were published in dental journals than those published nationally (43.3%) or within the institutional level (41.8%) (P < 0.0001). In addition, the average number of citations (9.28 ± 23.8) ranged from 0 to 749, received by an article and the impact factor of the journal in which the article was published, significantly higher in the case of internationally collaborative work compared with national or within institutional collaboration (P < 0.0001).

Conclusion

International collaboration positively affected the impact factor, number of citations, and quartile rank of published articles. Moreover, the number of co-authors in different countries contributes to the international collaboration effect.

Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics

BACKGROUND

Enhancement of students' knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students' and interns' basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019-June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi-square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%.

RESULTS

The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri-angles, cotton rolls and saliva ejectors. Dual-cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement-retained implant-supported restorations.

CONCLUSIONS

Students' knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.

Denture Adhesive Utilization and Associated Factors among Dental Practitioners in the Eastern Province, Saudi Arabia

BACKGROUND

Denture adhesives (DAs) enhance denture retention and stability, thus improving functions of removable prostheses. However, the adverse effects of DAs on denture foundation area were also reported. The clinical use of DAs among dentists has not been investigated in Saudi Arabia. Therefore, this study aimed to evaluate utilization of DAs and associated factors among dental practitioners in Saudi Arabia.

METHODS

This cross-sectional study included dental professionals practicing in both public and private sectors in the Eastern Province of Saudi Arabia. A self-administered pilot tested questionnaire was distributed among participants. The questionnaire has questions related to demographic information, knowledge and awareness, and the utilization of DAs. Bivariate and multiple logistic regression analyses were performed.

RESULTS

The study included 279 participants with a response rate of 79.03%. The majority of participants (61.6%) were below 35 years of age, males (56.6%), general dentists (57.3%), and worked in the private sector (59.9%). Less than half of the participants (39.4%) used DAs in their dental practice, and 64.5% recommended using DAs when needed. The most reported complications of DAs included inflammation (58.40%), ulcers (35.10%), and whitish color (31.20%) of denture foundation area. A vast majority (83.90%) reported that DAs improve retention of the dentures. About 55.2% of the participants were taught about DAs in their undergraduate programs, 12.5% attended continuing education, and 21.5% updated their knowledge about DAs. Multiple logistic regression showed that those who attended continuing education activities (adjusted OR = 2.41, p = 0.036) and updated their knowledge about DAs (adjusted OR = 4.43, p = < 0.001) were significantly more likely to use DAs in their dental practice.

CONCLUSION

A minority of dental practitioners used DAs in their practices. Attending continuing education programs and updating knowledge of DAs were significantly associated with DAs utilization.

The Toothbrushing Effects on Surface Properties and Color Stability of CAD/CAM and Pressable Ceramic Fixed Restorations-An In Vitro Study

Pressable ceramic restorations have been introduced and investigated, and found comparable to CAD/CAM ceramic in terms of mechanical properties; however, the effect of toothbrushing on the pressable ceramic has not been thoroughly investigated. The objective of the current study was to assess the effect of artificial toothbrushing simulation on the surface roughness, microhardness, and color stability of different ceramic materials. Three lithium disilicate-based ceramics (IPS Emax CAD [EC], IPS Emax Press [EP]; (Ivoclar Vivadent AG), and LiSi Press [LP] (GC Corp, Tokyo, Japan)) were examined. For each ceramic material, eight bar-shaped specimens were prepared and subjected to 10,000 brushing cycles. Surface roughness, microhardness, and color stability (∆E) were measured before and after brushing. Scanning electron microscopy (SEM) was used for surface profile analysis. The results were analyzed using one-way ANOVA, Tukey's post hoc test, and paired sample t-test α = 0.05. The findings revealed a non-significant decrease in the surface roughness of EC, EP, and LP groups (p > 0.05), and both LP and EP have the lowest surface roughness values (0.64 ± 0.13, 0.64 ± 0.08 µm) after brushing, respectively. Toothbrushing showed a decrease in the microhardness of the three groups: EC and LP, p < 0.001; EP, p = 0.012). EP showed the lowest hardness value after brushing (862.45 ± 273.83). No significant changes (∆E) were observed in all groups (p > 0.05); however, the EC group was found to be considerably affected by color changes, in comparison to the EC and LP groups. Toothbrushing had no effect on surface roughness and color stability of all tested materials, but it decreased the microhardness. Material type, surface treatments, and glazing of ceramic materials contributed to the surface changes in the ceramic materials, necessitating further investigations in terms of the toothbrushing effect with different glazing as variables.

Fracture Load of 3D-Printed Interim Three-Unit Fixed Dental Prostheses: Impact of Printing Orientation and Post-Curing Time

The fracture resistance of 3-unit interim fixed dental prostheses (IFDPs) fabricated using digital light processing (DLP) additive technology with different printing parameters is neglected. Therefore, this study investigates the effect of different printing orientations and different post-curing times on the fracture resistance of 3-unit IFDPs fabricated from two three-dimensional (3D) printed resins, NextDent, C&B (CB), ASIGA, and DentaTOOTH. A 3-unit dye was scanned, and an IFDP was designed. A total of 300 specimens (150/materials, n = 10) were printed and divided into three groups according to printing orientations (0°, 45°, 90°) per material. Each orientation was subdivided into five groups (n = 10) considering the post-curing time (green state as control, 30, 60, 90, and 120 min). All specimens underwent thermocycling (5000 cycles). Each specimen was fitted onto the die and loaded until fracture using a universal testing machine with a loading rate of 1 m/min. Data were analyzed using ANOVA and post hoc Tukey test (α = 0.05). The result showed that printing orientation had a significant effect on the fracture load for both ASIGA and NextDent materials (p < 0.05). The highest fracture load was recorded with 45° orientation, followed by 0° orientation and 90° orientation showed the lowest values per respective post-curing time. Post-curing time increased the fracture load (p < 0.05). Post-curing time had a positive effect on the fracture load. As the post-curing time increased, the fracture resistance load increased (p < 0.05), with 90 and 120 min showing the highest fracture load. The 0° and 45° printing orientations have a high fracture load for 3D-printed IFDPs, and an increased post-curing time is recommended.

Antibiofilm Activity of 3D-Printed Nanocomposite Resin: Impact of ZrO2 Nanoparticles

Poly(methyl methacrylate) (PMMA) is a commonly used material, as it is biocompatible and relatively cheap. However, its mechanical properties and weak antibiofilm activity are major concerns. With the development of new technology, 3D-printed resins are emerging as replacements for PMMA. Few studies have investigated the antibiofilm activity of 3D-printed resins. Therefore, this study aimed to investigate the antibiofilm activity and surface roughness of a 3D-printed denture base resin modified with different concentrations of zirconium dioxide nanoparticles (ZrO₂ NPs). A total of 60 resin disc specimens (15 × 2 mm) were fabricated and divided into six groups (n = 10). The groups comprised a heat-polymerized resin (PMMA) group, an unmodified 3D-printed resin (NextDent) group, and four 3D-printed resin groups that were modified with ZrO₂ NPs at various concentrations (0.5 wt%, 1 wt%, 3 wt%, and 5 wt%). All specimens were polished using a conventional method and then placed in a thermocycler machine for 5000 cycles. Surface roughness (Ra, µm) was measured using a non-contact profilometer. The adhesion of Candida albicans (C. albicans) was measured using a fungal adhesion assay that consisted of a colony forming unit assay and a cell proliferation assay. The data were analyzed using Shapiro-Wilk and Kruskal-Wallis tests. A Mann-Whitney U test was used for pairwise comparison, and p-values of less than 0.05 were considered statistically significant. The lowest Ra value (0.88 ± 0.087 µm) was recorded for the PMMA group. In comparison to the PMMA group, the 3% ZrO₂ NPs 3D-printed group showed a significant increase in Ra (p < 0.025). For the 3D-printed resins, significant differences were found between the groups with 0% vs. 3% ZrO₂ NPs and 3% vs. 5% ZrO₂ NPs (p < 0.025). The highest Ra value (0.96 ± 0.06 µm) was recorded for the 3% ZrO₂ NPs group, and the lowest Ra values (0.91 ± 0.03 µm) were recorded for the 0.5% and 5% ZrO₂ NPs groups. In terms of antifungal activity, the cell proliferation assay showed a significant decrease in the C. albicans count for the 0.5% ZrO₂ NPs group when compared with PMMA and all other groups of 3D-printed resins. The group with the lowest concentration of ZrO₂ NPs (0.5%) showed the lowest level of C. albicans adhesion of all the tested groups and showed the lowest Candida count (0.29 ± 0.03). The addition of ZrO₂ NPs in low concentrations did not affect the surface roughness of the 3D-printed resins. These 3D-printed resins with low concentrations of nanocomposites could be used as possible materials for the prevention and treatment of denture stomatitis, due to their antibiofilm activities.

Wear and Fracture Resistance of 3D-Printed Denture Teeth: An In Vitro Comparative Study

PURPOSE

The longevity of removable prostheses is mostly influenced by the properties of the used materials. The ability of the material to withstand high occlusal loads without deformation can enhance patient satisfaction and quality of life. This in vitro study aimed to investigate the wear and fracture resistance of three-dimensional (3D)-printed teeth compared with commercially available acrylic resin teeth.

MATERIALS AND METHODS

A total of 40 prefabricated acrylic teeth and 40 3D-printed teeth were prepared in two forms: anatomical for fracture resistance or flat for wear resistance (n = 10). For wear evaluation, specimens were scanned at baseline and then subjected to thermal cycling (10,000 cycles). This was followed by a chewing simulator (60,000 cycles) against either metal or natural tooth. Then, the specimens were scanned again. Wear analysis was performed by superimposing the standard tessellation language (STL) files from baseline and the final scans with the aid of GOM Inspect 2020 software. Fracture resistance was assessed with a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling. Data were analyzed with two-independent t-test and two-way ANOVA (α = 0.05).

RESULTS

The 3D-printed teeth showed significantly lower wear resistance than the prefabricated ones with both antagonists (metal, p = 0.049; natural tooth, p = 0.021). The fracture resistance of the 3D-printed teeth was significantly higher than that of the prefabricated teeth before thermocycling (p = 0.042). After thermal cycling, the fracture resistance of both groups was decreased with no significant differences between them (p = 0.266).

CONCLUSIONS

The 3D-printed teeth showed lower wear resistance and higher fracture resistance than the prefabricated ones. Thermal cycling negatively affected the fracture resistance of 3D-printed teeth.

Factors affecting flexural strength of 3D-printed resins: A systematic review

PURPOSE

The strength of 3D-printed resins is affected by different factors, but review articles clarifying these factors are limited. This review lists the factors affecting the strength of 3D-printed resins and the possible correlations between them to answer the study question: What are the factors affecting the flexural strength of 3D-printed resins?

METHODS

A database search (PubMed, Google Scholar, and Scopus) was performed, limited to English-language publications between 2010 and February 1, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for study selection. The modified Consolidated Standards of Reporting Trials (CONSORT) checklist was used to determine the risk of bias of the included studies in this review. The data analysis was descriptive due to the presence of many variables in the included studies.

RESULTS

Out of 123 studies, 26 were reviewed for full-text analysis, and 19 met the inclusion criteria and were thus included in this systematic review. The included studies were divided according to the investigated resin: 5 studies tested provisional restorations, seven tested denture base resins, 2 tested occlusal devices, 3 tested orthodontic appliances, 1 tested denture teeth, and 1 tested surgical guide resins. These studies investigated the flexural strength of 3D-printed resins, with different factors, such as reinforcement with fillers or nanofillers; printing orientation, angulation, and directions; post-polymerization time and temperature; third-party printing (switching between printers and materials); printing layer thickness; and post-printing rinsing time. Most factors significantly affected the flexural strength of 3D-printed resin.

CONCLUSIONS

The strength of 3D-printed resins could be improved with one or more of the following factors: filler or nanofiller addition; printing orientation, angulation, or directions; printing layer thickness; and post-polymerization time and temperature. However, further studies combining these factors are recommended.

Evaluation of the Effect of Different Construction Techniques of CAD-CAM Milled, 3D-Printed, and Polyamide Denture Base Resins on Flexural Strength: An In Vitro Comparative Study

PURPOSE

To compare the flexural strength of computer-aided design and computer-aided manufacturing (CAD-CAM) milled denture base resin (DBR), 3D-printed DBR, polyamide, and conventional compression-molded DBR.

MATERIALS AND METHODS

Six denture base resins were used, one conventional heat-polymerized (Vertex), two milled CAD-CAM (AvaDent and Polident), two 3D-printed (Harz and NextDent), and one flexible polyamide (Polyamide). According to ISO 20795-1:2013, 60 specimens (65×10×3 mm) were constructed and divided into six groups (n = 10), according to DBR type. The flexural strength was measured using a universal testing machine and three-point loading test. Data were collected and analyzed using one-way ANOVA and Tukey's pair-wise post hoc tests (α = 0.05).

RESULTS

One-way ANOVA results showed significant differences in flexural strengths between the tested DBRs (p˂0.001). Milled denture base resins (AvaDent and Polident) had significantly higher flexural strength values than the other groups (p˂0.001) and were followed by Vertex and NextDent, while Polyamide and Harz had the lowest values. Polyamide and Harz denture base resins had significantly lower flexural strength values than conventional denture base resin (p˂0.001).

CONCLUSION

CAD-CAM milled DBRs showed the highest flexural strength when compared with conventional compression-molded or 3D-printed DBRs, while 3D-printed DBRs and polyamide showed the lowest flexural strengths.

Influence of Denture Cleansers on the Retention Loss of Attachment Systems Retained Implant Overdenture

Background

This study aimed to evaluate the effects of different denture cleansing solutions (DCSs) on the retention of Locator and Locator R-Tx attachment systems of implant retained overdentures (IRO).

Methods

Two part acrylic resin blocks were fabricated, upper part contained metal housing and plastic inserts and lower part contained implant analogs and abutments. Eighty pink plastic inserts (40/attachment, 10/solution) were immersed in Corega, Fittydent, sodium hypochlorite, and water for a time simulating upto 1-year of clinical usage. Acrylic blocks were held on a universal testing machine for a pull-out test to record the dislodgement force. Measurements were conducted after 6 months (T1) and 12 months (T2). One-way ANOVA followed by Tukey's HSD test was used to analyze the results (α = 0.05).

Results

For both attachments, retention significantly decreased after immersion in different solutions at T2 (P < 0.001). Locator R-Tx attachment in NaOCl showed a significant decrease in retention compared with other solutions at T1. At T2, there was a significant decrease in retention for all DCS compared with water (P < 0.001). Locator R-TX showed higher retention values per solution compared to Locator attachment (P < 0.001). In terms of retention loss %, NaOCl recorded the highest (61.87%) loss, followed by Corega (55.54%) and Fittydent (43.13%), whereas water demonstrated the best retention (16.13%) in both groups.

Conclusion

Locator R-TX has better retention with different DCS immersion. The loss of retention varied with different types of DCS and NaOCl recorded the highest retention loss. Therefore, denture cleanser selection must be guided by the type of IRO attachment.

Repair Bond Strength of Conventionally and Digitally Fabricated Denture Base Resins to Auto-Polymerized Acrylic Resin: Surface Treatment Effects In Vitro

Denture base fracture is one of the most annoying problems for both prosthodontists and patients. Denture repair is considered to be an appropriate solution rather than fabricating a new denture. Digital denture fabrication is widely spreading nowadays. However, the repair strength of CAD-CAM milled and 3D-printed resins is lacking. This study aimed to evaluate the effect of surface treatment on the shear bond strength (SBS) of conventionally and digitally fabricated denture base resins. One l heat-polymerized (Major base20), two milled (IvoCad, AvaDent), and three 3D-printed (ASIGA, NextDent, FormLabs) denture base resins were used to fabricate 10 × 10 × 3.3 acrylic specimens (N = 180, 30/resin, n = 10). Specimens were divided into three groups according to surface treatment; no treatment (control), monomer application (MMA), or sandblasting (SB) surface treatments were performed. Repair resin was bonded to the resin surface followed by thermocycling (5000 cycles). SBS was tested using a universal testing machine where a load was applied at the resin interface (0.5 mm/min). Data were collected and analyzed using ANOVA and a post hoc Tukey test (α = 0.05). SEM was used for failure type and topography of fractured surfaces analysis. The heat-polymerized and CAD-CAM milled groups showed close SBS values without significance (p > 0.05), while the 3D-printed resin groups showed a significant decrease in SBS (p < 0.0001). SBS increased significantly with monomer application (p < 0.0001) except for the ASIGA and NextDent groups, which showed no significant difference compared to the control groups (p > 0.05). All materials with SB surface treatment showed a significant increase in SBS when compared with the controls and MMA application (p < 0.0001). Adhesive failure type was observed in the control groups, which dramatically changed to cohesive or mixed in groups with surface treatment. The SBS of 3D-printed resin was decreased when compared with the conventional and CAD-CAM milled resin. Regardless of the material type, SB and MMA applications increased the SBS of the repaired resin and SB showed high performance.

CAD-CAM Fabricated Denture Base Resins: In Vitro Investigation of the Minimum Acceptable Denture Base Thickness

PURPOSE

To investigate the influence of reducing material thickness on flexural properties of computer-aided design and computer-aided manufacturing (CAD-CAM) denture base resins.

MATERIALS AND METHODS

Four CAD-CAM denture base acrylic resin materials were selected; two were made via the subtractive method (AvaDent and IvoCad) and two were made with the additive method (FormLabs and NextDent). One heat-polymerized denture base material was used as a control. Specimens were fabricated with varying thicknesses (n = 10/group): 3.3 mm, 2.5 mm, 2 mm, or 1.5 mm. Flexural strength was evaluated via a three-point bending test. One- and two-way ANOVA were used for data analysis along with Tukey's post hoc comparison (α = 0.05).

RESULTS

Reducing the thickness of materials made via the subtractive method did not influence flexural strength up to 2 mm (p > 0.05). However, the difference was significant at a 1.5 mm thickness (p ˂ 0.001). For materials made via the additive method, NextDent specimens had no significant decrease in flexural strength when the thickness was reduced to 2 mm (p = 0.58). FormLabs specimens showed a significant decrease (p ˂ 0.001), although the values of flexural strength were clinically acceptable. During testing, specimens manufactured via the additive method at a 1.5 mm thickness bent without fracturing and were therefore excluded. All materials showed a reduction in elastic modulus as the thickness decreased (p ˂ 0.001).

CONCLUSION

Heat-polymerized, AvaDent, and IvoCad materials may be used for denture base fabrication at a minimum thickness of 1.5 mm. FormLabs and NextDent may be fabricated at a 2 mm minimum thickness, with clinically acceptable flexural properties.

3D-Printable Denture Base Resin Containing SiO2 Nanoparticles: An In Vitro Analysis of Mechanical and Surface Properties

PURPOSE

To evaluate the flexural strength (FS), impact strength (IS), surface roughness (Ra), and hardness of 3D-printed resin incorporating silicon dioxide nanoparticles (SNPs).

MATERIALS AND METHODS

A total of 320 acrylic specimens were fabricated with different dimensions according to test specifications and divided into a control group of heat denture base resin, and 3 test groups (80/test (n = 10) of unmodified, 0.25 wt%, and 0.5 wt% SNPs modified 3D-printed resin. 10,000 thermal cycles were performed to half of the fabricated specimens. FS, IS (Charpy impact), Ra, and hardness were evaluated and the collected data was analyzed with ANOVA followed by Tukey's post hoc test (α = 0.05).

RESULTS

Incorporating SNPs into 3D-printed resin significantly increased the FS, IS (at 0.5%) and hardness compared to unmodified 3D-printed resin (p < 0.001). However, the FS of pure 3D-printed and 3D/SNP-0.50% resin and IS of all 3D-printed resin groups were significantly lower than the control group (p < 0.0001). Hardness of 3D/SNP-0.25% and 3D/SNP-0.50% was significantly higher than control and unmodified 3D-printed resin (p < 0.0001), with insignificant differences between them. The Ra of all 3D-printed resin groups were significantly higher than control group (p < 0.001), while insignificant difference was found between 3D-printed groups. Thermal cycling significantly reduced FS and hardness for all tested groups, while for IS the reduction was significant only in the control and 3D/SNP-0.50% groups. Thermal cycling significantly increased Ra of the control group and unmodified 3D-printed resin (p < 0.001).

CONCLUSION

The addition of SNPs to 3D-printed denture base resin improved its mechanical properties while Ra was not significantly altered. Thermal cycling adversely affected tested properties, except IS of unmodified 3D-printed resin and 3D/SNP-0.25%, and Ra of modified 3D-printed resin.

Evaluation of the effectiveness of bioactive glass fillers against Candida albicans adhesion to PMMA denture base materials: An in vitro study

Background

Dentures with antimicrobial properties are desirable for preventing Candida albicans adhesion. This study was to assess the effectiveness of bioactive glass (BAG) on C. albicans adhesion, surface roughness, and hardness of denture base materials.

Methods

Heat-polymerized (HP) and autopolymerized (AP) acrylic resins were used to fabricate 240 disk specimens (120/material, 60/C. albicans, 60/surface roughness and hardness). Specimens were divided into five groups (n = 10) based on the BAG concentration: 0.5, 1.5, 3, 5, and 7.5 wt% of the acrylic powder, with a control group comprised of unmodified specimens. Direct culture method was used to assess C. albicans adhesion. A profilometer and Vickers hardness test were used to measure surface roughness and hardness respectively. Analysis of variance (ANOVA) and post hoc Tukey's test were used for data analysis (α = 0.05).

Results

BAG addition significantly decreased the C. albicans count when compared with the control group (P < 0.001) for both HP and AP. Regarding surface roughness, there was no change in the HP acrylic resins (P > 0.05), while the AP acrylic resins exhibited significantly higher surface roughness with BAG addition (P < 0.001). The hardness of the HP and AP acrylic resins were significantly higher with the addition of BAG (P < 0.001).

Conclusions

The addition of BAG to HP and AP acrylic resins effectively decreases C. albicans adhesion. The roughness of AP acrylic resins increases with the addition of BAG, while the hardness of both HP and AP acrylic resins increase with the addition of BAG.

Influence of ZrO2 Nanoparticle Addition on the Optical Properties of Denture Base Materials Fabricated Using Additive Technologies

This study investigated the translucency of 3D-printed denture base resins modified with zirconium dioxide nanoparticles (ZrO₂NPs) under thermal cycling. A total of 110 specimens were fabricated and divided into 3 groups according to the materials, i.e., heat-polymerized resin, and 3D-printed resins (NextDent, and ASIGA). The 3D-printed resins were modified with 0, 0.5, 1, 3, and 5 wt.% of ZrO₂NPs. All the specimens were subjected to 5000 thermal cycles. The translucency was measured using a spectrophotometer. The results showed that the heat-polymerized resin had considerably higher translucency than the 3D-printed resins. Compared to the unmodified group, the translucency decreased significantly after adding 5% ZrO₂NPs to NextDent and 3% ZrO₂NPs to ASIGA resins. The highest translucency was achieved for NextDent by adding 0.5% ZrO₂NPs and for ASIGA without any ZrO₂NPs. It was found that the average concentration level in ASIGA was significantly higher than that in NextDent. These findings revealed that 3D-printed resins have lower translucency than heat-polymerized acrylic resin, and adding ZrO₂NPs at low concentrations did not affect the translucency of the 3D-printed resins. Therefore, in terms of translucency, 3D-printed nanocomposite denture base resins could be considered for clinical applications when ZrO₂NPs are added at low concentrations.

Effect of Occlusal Splint Therapy on Condylar Movements Recorded Using an Electronic Pantograph: A Prospective Clinical Study

AIMS AND OBJECTIVE

The effect of occlusal splint therapy on the muscle activity has been addressed in the literature. However, its effect on condylar movements in subjects with normal and abnormal occlusions has not yet been investigated. This prospective clinical study addressed the effect of occlusal splint therapy on condylar movements in subjects with normal and abnormal occlusions using an electronic pantograph.

MATERIALS AND METHODS

Two groups of subjects were included in this study. The first group included subjects with normal occlusion, whereas the subjects in the other group were diagnosed with abnormal occlusion. The occlusal splint was fabricated, adjusted clinically, and delivered for each subject. Condylar movements were recorded using a Cadiax Compact II electronic pantograph at baseline, 2-, 4-, and 6-month follow-up periods to assess sagittal condylar inclination (SCI), immediate mandibular lateral translation (IMLT), and progressive mandibular lateral translation (PMLT). The t-test, one-way analysis of variance (ANOVA), and two-way ANOVA were used to compare the parameters between the groups and to assess the time effect on these parameters (α = 0.05).

RESULTS

Twenty subjects were recruited for this study (n = 10). Among them, 12 were women and eight were men, with a mean age of 34 years. In each group, insignificant differences were reported for each tested parameter at baseline and during the follow-up periods (P > 0.05). However, when comparing the two groups, the only significant difference was found in the SCI during the 6-month follow-up period (P = 0.014).

CONCLUSIONS

Occlusal splints had an insignificant effect on the parameters SCI, IMLT, and PMLT up to 6 months of follow-up for subjects with normal or abnormal occlusion. SCI increased substantially in normal occlusion subjects compared with abnormal occlusion subjects during the 6-month follow-up period.

Physiomechanical and Surface Characteristics of 3D-Printed Zirconia: An In Vitro Study

The objective of this study is to examine the physiomechanical and surface properties of 3D-printed zirconia in comparison to milled zirconia. A total of 80 disc-shaped (14 × 1.5 ± 0.2 mm) specimens (20 milled and 60 3D-printed (at three different orientations; horizontal, vertical, and tilted)) were manufactured from 3-mol% yttria-stabilized tetragonal zirconia. Five specimens per group were evaluated for crystalline phase, grain size, density, porosity, surface roughness, wettability, microhardness, and SEM analysis of the surface. Biaxial flexural strength (BFS) was measured (n = 15) followed by Weibull analysis and SEM of fractured surfaces. Statistical analysis was performed using one-way ANOVA and Tukey’s post hoc test at α = 0.05. All groups showed a predominant tetragonal phase, with a 450 nm average grain size. There was no significant difference between groups with regards to density, porosity, and microhardness (p > 0.05). The tilted group had the highest surface roughness (0.688 ± 0.080 µm), significantly different from the milled (p = 0.012). The horizontal group presented the highest contact angle (89.11 ± 5.22°), significantly different from the milled and tilted (p > 0.05). The BFS of the milled group (1507.27 ± 340.10 MPa) was significantly higher than all other groups (p < 0.01), while vertical and tilted had a similar BFS that was significantly lower than horizontal (p < 0.005). The highest and lowest Weibull modulus were seen with tilted and milled, respectively. Physical properties of all groups were comparable. The surface roughness of the tilted group was higher than milled. The horizontal group had the highest hydrophobicity. Printing orientations influenced the flexural strength of 3D-printed zirconia. Clinical implications: This study demonstrates how the printing orientation affects the physiomechanical characteristics of printed zirconia.

Comparative Evaluation of Surface Roughness and Hardness of 3D Printed Resins

The effect of printing parameters on the surface characteristics of three-dimensional (3D)-printed denture base resins (DBRs) is neglected. Therefore, this study investigated the effect of printing orientation and post-curing time on the surface roughness and hardness. One conventional heat-polymerized (HP) resin and two 3D-printing resins (NextDent (ND) and ASIGA (AS)) were used to fabricate a total of 250-disc (10 × 2.5 mm) specimens. ND and AS specimens were printed with different orientations (0-, 45-, and 90-degree) and each orientation group was subjected to four post-curing times (30, 60, 90, 120 min). Printed specimens were thermo-cycled (10,000 cycles) followed by the measuring of surface roughness (Profilometer (Ra)) and hardness (a Vickers hardness (VH)). ANOVA and post hoc tests were used for data analysis (α = 0.05) at significant levels. AS and ND showed no significant changes in Ra when compared with HP (p ˃ 0.05), except the 45-degree orientation (AS/90 min and AS/120 min) significantly increased surface roughness (p ˂ 0.001). There was no significant difference in Ra with different orientations and post-curing time for both materials AS and ND (p ˃ 0.05). Compared with HP, 3D-printed DBRs showed low VH values (p ˂ 0.001). For AS, 90-degree orientation showed a significant decrease in VH at 60, 90, and 120 min when compared with 0- and 45-degree orientation (p ˂ 0.001), while ND showed no significant difference in VH with different printing orientations (p ˃ 0.05). The VH of AS and ND improved when increasing post-curing time to 120 min (p ˂ 0.001), and the printing orientations and post-curing time did not affect the Ra of 3D-printed DBRs.

Effect of printing orientation and post-curing time on the flexural strength of 3D-printed resins

PURPOSE

To evaluate the effect of printing orientation combined with different post-curing times on the flexural strength of 3D-printed resins.

MATERIALS AND METHODS

A total of 480 rectangular specimens with the dimensions of 64×10×3.3 mm were designed and fabricated from two 3D printed acrylic resins and one heat-polymerized resin (HP). 3D-printed groups were divided into 3 groups according to printing orientations (0-, 45-, 90-degree); each group was subdivided into 4 groups according to post-curing time (30, 60, 90, 120 min.). All specimens were subjected to thermal cycling (10,000 cycles) before testing flexural strength. Fractured surfaces were examined under scanning electron microscope (SEM). ANOVA and Tukey's post hoc test were used for data analysis (α = 0.05).

RESULTS

The result of this study showed that the highest flexural strength values of 3D-printed resin (NextDent, and ASIGA) were in 0-degree groups. Also, the flexural strength values increased when post-curing time was increased regardless of the printing orientation and the highest flexural strength was recorded at 120 min post-curing time in all orientations. SEM analysis showed rougher surface with irregular lamellae which represented a ductile fracture confirming that high energy is required for crack propagation and these features markedly increased as post-curing time increased.

CONCLUSION

The results showed that the 0-degree orientation groups showed higher flexural strength compared to other groups. Similarly, with increased post-curing time, the flexural strength increased. This article is protected by copyright. All rights reserved.

3D-Printed Nanocomposite Denture-Base Resins: Effect of ZrO2 Nanoparticles on the Mechanical and Surface Properties In Vitro

Due to the low mechanical performances of 3D-printed denture base resins, ZrO2 nanoparticles (ZrO2NPs) were incorporated into different 3D-printed resins and their effects on the flexure strength, elastic modulus, impact strength, hardness, and surface roughness were evaluated. A total of 286 specimens were fabricated in dimensions per respective test and divided according to materials into three groups: heat-polymerized as a control group and two 3D-printed resins (NextDent and ASIGA) which were modified with 0.5 wt.%, 1 wt.%, 3 wt.%, and 5 wt.% ZrO2NPs. The flexure strength and elastic modulus, impact strength, hardness, and surface roughness (µm) were measured using the three-point bending test, Charpy’s impact test, Vickers hardness test, and a profilometer, respectively. The data were analyzed by ANOVA and Tukey’s post hoc test (α = 0.05). The results showed that, in comparison to heat-polymerized resin, the unmodified 3D-printed resins showed a significant decrease in all tested properties (p < 0.001) except surface roughness (p = 0.11). In between 3D-printed resins, the addition of ZrO2NPs to 3D-printed resins showed a significant increase in flexure strength, impact strength, and hardness (p < 0.05) while showing no significant differences in surface roughness and elastic modulus (p > 0.05). Our study demonstrated that the unmodified 3D-printed resins showed inferior mechanical behavior when compared with heat-polymerized acrylic resin while the addition of ZrO2NPs improved the properties of 3D-printed resins. Therefore, the introduced 3D-printable nanocomposite denture-base resins are suitable for clinical use.

The Effect of Salivary pH on the Flexural Strength and Surface Properties of CAD/CAM Denture Base Materials

OBJECTIVES

 This study aimed to evaluate the influence of different salivary pH on flexural strength, hardness, and surface roughness of computer-aided design and computer-aided manufacturing (CAD/CAM) milled and three-dimensional (3D)-printed denture base resins.

METHODS

 One heat-polymerized, two CAD/CAM milled (IvoCad, AvaDent), and two 3D-printed (FormLabs, NextDent) denture base resins were fabricated and divided into five groups (n = 10) according to the solutions: three groups were immersed in different salivary pH (5.7, 7.0, or 8.3), one group was immersed in distilled water (DW) as a positive control, and one group had no immersion (negative control). All immersions were performed at 37°C for 90 days. Flexural strength, hardness, and surface roughness were measured before and after immersion. Data was analyzed with analysis of variance and post hoc Tukey's test (α = 0.05).

RESULTS

 After immersion, all specimens had lower flexural strength values when compared with those with no immersion. Comparing the immersion groups, the highest flexural strength value (93.96 ± 3.18 MPa) was recorded with IvoCad after immersion in DW while the lowest value (60.43 ± 2.66 MPa) was recorded with NextDent after being immersed in 7.0 pH saliva. All specimens had significant decrease in hardness except IvoCad and AvaDent specimens where both presented the highest surface hardness (53.76 ± 1.60 Vickers hardness number [VHN]) after immersion in DW while NextDent showed the lowest hardness value (24.91 ± 2.13 VHN) after being immersed in 8.3 pH saliva. There was statistically significant difference between the baseline and different artificial salivary pH solutions in terms of surfaces roughness, with the highest surface roughness were found in 3D-printed resin materials.

CONCLUSION

 After exposure to artificial saliva with different salivary pH, the milled CAD/CAM denture base resins showed higher flexural strength, hardness, and lesser surface roughness than conventional and 3D-printed denture base resins.

Polymethylmethacrylate denture base layering as a new approach for the addition of antifungal agents

PURPOSE

To introduce a new technique, denture base layering, for the addition of titanium dioxide nanoparticles (TiO₂ NPs) to polymethylmethacrylate (PMMA) and to investigate the effects of the layering technique on Candida albicans (C. albicans) adhesion and on surface roughness, hardness, translucency, and flexural strength.

MATERIALS & METHODS

In total, 210 heat-polymerized acrylic resin specimens were prepared as discs (15 × 2 mm) for testing C. albicans adhesion (n = 70) and surface roughness, hardness, and translucency (n = 70); and as acrylic plates (65 × 10 × 2.5 mm) for testing flexural strength (n = 70). Specimens were divided into 4 groups: control (n = 30), one-layer (n = 60), double-layer (n = 60), and dotted-layer (n = 60) according to the packing and layering technique. Each group was divided according to the concentration of TiO₂ NPs 1% and 2.5% (n = 10). The control group comprised one layer of unmodified resin. The one-layer group comprised one layer of a mixture of PMMA/TiO₂ NPs packed conventionally. The double-layer group consisted of two different layers packed in two steps, as follows: unmodified resin first, followed by a continuous thin layer of the PMMA/TiO₂ NPs mixture. Similarly, the dotted-layer group consisted of two different layers packed in two steps, as follows: unmodified resin first, followed by a thin layer of the PMMA/TiO₂ NPs. However, the second mixture was added in a dotted manner. The direct culture method for C. albicans adhesion before and after ultraviolet light activation, and surface roughness, hardness, translucency, and flexural strength were measured. An analysis of variance and Tukey's post hoc test were used for data analysis (α = 0.05).

RESULTS

The addition of TiO₂ NPs reduced C. albicans adhesion (P ˂.001). However, no significant difference was found between both concentrations within the same group before and after ultraviolet light activation (P >0.05), except in the 1% dotted-layer (P = .022). Surface roughness and hardness were not affected by the additions of different concentrations of TiO₂ NPs (P = .905) and (P = .059), respectively. Translucency was significantly reduced in all the groups (P ˂.001) except in the 1% dotted-layer (P = .332). Flexural strength decreased as the TiO₂ NPs concentration increased, with the greatest reduction in strength observed in the one-layer group (P ˂.001).

CONCLUSIONS

The double and dotted layering techniques were effective in reducing C. albicans adhesion, without affecting surface roughness, hardness, or flexural strength. However, translucency was reduced in all the groups, except the 1% dotted-layer group. This article is protected by copyright. All rights reserved.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials

PURPOSE

To compare flexural strength, elastic modulus, and surface hardness of CAD-CAM milled, 3D-printed, and heat-polymerized denture base resins.

MATERIALS AND METHODS

A total of 120 specimens were fabricated from heat-polymerized acrylic resin (HP), milled resin (Avadent and IvoCad), and 3D-printed resin (ASIGA, FormLabs, and NextDent). The specimens were divided into 6 groups according to the type of denture base material n = 20/material, (10/flexural properties and 10/hardness). Flexural strength and elastic modulus of the specimens were evaluated by 3-point bending test and surface hardness by Vickers hardness test. To test flexural properties, the specimens were fabricated according to ISO 20795-1:2013 standards (64×10×3.3 ±0.2 mm). The dimensions for hardness test were 15×10×2.5 ±0.2 mm. Scanning electron microscope was used to evaluate the surface morphology of the fractured specimens. The means and standard deviations were calculated, followed by one-way ANOVA and Tukey post-hoc test (α = 0.05).

RESULTS

Milled resins showed significantly higher values for flexural strength, elastic modulus, and surface hardness, followed by HP then 3D-printed resins (P<0.001). In between milled groups, flexural strength of AvaDent was significantly higher than IvoCad (P<0.001), while elastic modulus and hardness didn't show significant difference. In between 3D-printed resins, ASIGA showed the highest flexural strength and elastic modulus, insignificantly with FormLabs (P = 0.595) and significantly with NextDent (P = 0.008). ASIGA also showed significantly the highest hardness among the 3D-printed groups. No significant difference was found between FormLabs and NextDent flexural strength (P = 0.357), elastic modulus (P = 1.00) and surface hardness (P = 0.987).

CONCLUSION

CAD-CAM milled resins had greater flexural properties and hardness compared to heat-polymerized acrylic resin and 3D-printed resins. Although 3D-printed samples showed the lowest values of tested properties, the flexural strength and modulus were above the clinically acceptable values. This article is protected by copyright. All rights reserved.

Water Sorption, Solubility, and Translucency of 3D-Printed Denture Base Resins

This study aimed to evaluate the water sorption, solubility, and translucency of 3D-printed denture base resins (NextDent, FormLabs, and Asiga), compare them to heat-polymerized acrylic denture base resins, and assess their performance under the effects of thermal cycling. A total of 80 acrylic disc specimens were used in the current study, categorized into four groups (n = 10); in one group, the samples were fabricated conventionally with a heat-polymerizing process (control), while the other three groups were fabricated digitally from different 3D-printed reins (NextDent, FormLabs, and Asiga). Specimens were fabricated according to the manufacturers’ recommendations and immersed in distilled water for 48 h at 37 °C. Data on water sorption, solubility, and translucency measurements (T1) were obtained. All the specimens were subjected to 5000 thermal cycles, and then the measures were repeated using the same method (T2). Data analysis was attained via ANOVA and the post hoc Tukey test (α = 0.05). The type of resin significantly affected the values of water sorption, solubility, and translucency (p < 0.001). The water sorption of 3D-printed resins was increased significantly in comparison to control with or without a thermal cycling effect. In terms of solubility, a significant increase in 3D-printed resins before thermocycling was observed; however, after thermocycling, Asiga had a significantly low value compared to the other groups (p < 0.001). Thermal cycling increased the water sorption and solubility of all tested materials. In comparison to control, the translucency of the 3D-printed resins was significantly decreased (p < 0.001). The translucency was significantly decreased per material in terms of the thermal cycling effect (before and after). NextDent showed significantly low translucency values (p < 0.001) compared to the other groups. All 3D-printed resin groups had higher water sorption and solubility and lower translucency values in comparison to the heat-polymerized resin group. Regardless of resin types, thermal cycling adversely affected all tested properties.

Effect of denture cleansers on the surface properties and color stability of 3D Printed denture base materials

OBJECTIVES

To evaluate the effect of denture cleansers on surface roughness, hardness and color stability of 3D-printed resins compared to heat-polymerized resins.

METHODS

Acrylic specimens (N=160) were prepared using one heat-polymerized (HP) and three 3D-printed denture base resins. Specimens per material were randomly divided into four groups (n = 10) according to immersion solutions as follows: distilled water (DW), sodium hypochlorite (NaOCl), effervescent tablet 1 or effervescent tablet 2. Color changes (∆E) were measured using a spectrophotometer. Surface roughness (Ra, µm) and microhardness were evaluated. The results were analyzed using one- and three-way ANOVA with Tukey's post hoc test (α = 0.05).

RESULTS

After 360 days of cleaning protocols, we observed a significant increase in the surface roughness of tested materials (P<0.001). Hardness values significantly decreased in all groups (P<0.001), except HP and ND specimens, cleaned with effervescent tablet 1 (P>0.05) and AS specimens with effervescent tablet 2 (P=0.051). According to the National Bureau of Standards (NBS) score, all denture base specimens had 'perceivable' to 'extremely marked' color change after immersion in NaOCl, while immersion in effervescent tablets 1 and 2 resulted in a 'slight' to 'marked' color change.

CONCLUSION

3D-printed denture bases exhibited changes in surface roughness, hardness and color of 3D-printed dentures similar to HP denture base material. The use of denture cleansers resulted in a time-dependent increase in surface roughness and a decrease in hardness. The color change was significant with NaOCl, while effervescent denture cleansers produced a minimal color difference.

CLINICAL SIGNIFICANCE

Denture cleansers seem to influence surface properties over time. The degree of impact is mainly dependent on the type of cleanser selected, regardless of the type of denture base material.

The post-pandemic era: will physical distancing be a perceived way of life?

Background: This study aimed to determine whether people living in the Eastern Region of Saudi Arabia would prefer to continue the practice of physical distancing after the coronavirus disease 2019 (COVID-19) pandemic or to return to their previous way of life. Methods: This cross-sectional study was conducted from August 2020 to October 2020 in the Eastern Region of Saudi Arabia. A pre-tested questionnaire was sent electronically through social media. Data on participants' demographics and their perspectives regarding post-pandemic physical distancing were collected. The calculated sample size was 1,066; however, the total number of responses included in the analysis was 989. Results: The average age of the participants was 31.15±11.93 years. There were 435 men and 554 women in the study. Participants showed significantly high levels of disagreement with statements indicating that they were willing to use public transportation (61%), attend social gatherings (36%), and hug relatives or colleagues (40%) after the pandemic ( p<0.001); however, 43% agreed that they would spend time with family or friends ( p<0.001). The level of education was also found to be significantly related to the responses, and the level of disagreement increased as the level of education increased ( p<0.001). Conclusions: One-third of the study participants planned to continue engaging in physical distancing even after the current pandemic and if the COVID-19 related restriction will remain in place for longer, there is chance to increase in this proportion. However, it cannot be concluded whether or not this behavior will prevail in the long run, after the ease in restrictions. If so, it may greatly affect some businesses and perhaps some social norms and values as well.

In-vitro Comparative Evaluation for the Surface Properties and Impact Strength of CAD/CAM Milled, 3D Printed, and Polyamide Denture Base Resins

Objective

There is a paucity of data regarding the effect of fabrication techniques and compositions of CAD/CAM milled, 3D-printed, and polyamide flexible denture base resin materials (DBRMs) on the surface roughness (SR), surface hardness (SH), and impact strength (IS). Therefore, this study aimed to evaluate the SR, SH, and IS of CAD/CAM milled, 3D-printed, and polyamide flexible DBRMs.

Materials and Methods

Ninety specimens were constructed from different DBRMs and divided into three groups (CAD/CAM, 3D-printed, and polyamide DBRMs; n = 30) with specific measurements: 15 × 10 × 2.5 mm for SR and H tests and 80 × 10 × 4 mm notched specimen for IS test. SR meter and Vickers micro SH tester were used to measure SR and SH, respectively, whereas the IS was evaluated using Charpy's impact testing machine. Data were collected and statistically analyzed using one-way analysis of variance and post hoc Tukey's tests (α=0.05).

Results

There were significant differences between the tested materials (P< 0.05). The CAD/CAM milled showed lowest SR when compared with 3D-printed resin and polyamide flexible resin (P< 0.05); however, there was a significant increase in SH of CAD/CAM milled and 3D-printed DBRMs when compared with polyamide materials (P< 0.05). There was a significant increase in IS of polyamide and CAD/CAM milled resins when compared with 3D-printed DBRMs (P < 0.05).

Conclusion

CAD/CAM milled resins showed high IS and SH with lower SR.

Antifungal Activities and Some Surface Characteristics of Denture Soft Liners Containing Silicon Dioxide Nanoparticles

Objective

This study aimed at determining the influence of adding silicon dioxide nanoparticles (nano-SiO₂) to soft relining materials on C. albicans adhesion, surface roughness, and contact angle.

Materials and Methods

Eighty heat-polymerized acrylic resin disks were constructed and relined by using auto-polymerized acrylic soft liners (COE-SOFT, GC Co., Tokyo, Japan). The specimens were categorized into two groups according to the tests conducted. Group A was composed of 40 specimens for evaluating antifungal activity, and Group B was composed of 40 specimens for testing surface roughness and contact angle. Each group was subcategorized into four subgroups (n = 10) according to the concentration of nano-SiO₂ added to the soft-liner powder: control, 0.25%, 0.5%, and 1.0% by weight. The colony forming unit (CFU) was used to assess C. albicans count. A profilometer was used to measure the surface roughness values (Ra; μm). The sessile drop method was used to evaluate the contact angle (^o) by using a goniometer. Analysis of variance and Tukey's post hoc tests (α = 0.05) were used for the data analysis.

Results

In comparison with the unmodified group, the 0.25% and the 0.5% nano-SiO₂ groups exhibited significantly lower C. albicans counts (P < 0.001), surface roughness (P < 0.001), and contact angles (P < 0.001). The exception was the 1% group, which exhibited higher C. albicans count, surface roughness, and contact angles than lower-concentration nano-SiO₂ groups; however, these values in the 1% group were still less than their respective values in the control group.

Conclusion

The addition of 0.25% and 0.5% nano-SiO₂ to an auto-polymerized acrylic soft liner decreased C. albicans adhesion, surface roughness, and contact angle.

Effect of silicon dioxide nanoparticles on the flexural strength of heat-polymerized acrylic denture base material: A systematic review and meta-analysis

Objective

This study evaluated the influence of silicon dioxide (SiO₂) nanoparticles on the flexural strength of heat-polymerized denture base materials.

Background

Nanoparticles have been incorporated into the denture base materials in different proportions to enhance the mechanical properties. Recently, the incorporation of SiO₂ nanoparticles at low concentrations has shown promising outcomes.

Materials and Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, this study was designed with the following focused question: “Does the addition of SiO₂ nanoparticles improve the flexural strength of heat-polymerized acrylic resins?” The inclusion criteria included in-vitro studies that assessed the flexural strength of SiO₂ nanoparticle-reinforced heat-polymerized acrylic denture base resins tested according to American Dental Association specifications. The database search involved articles published from 2005 to 2020 on PubMed/MEDLINE, Web of Science, Google Scholar, and Scopus using the following keywords: SiO₂, nanosilica, silica oxide, nanoparticles, denture base resin, acrylic resin, polymethyl methacrylate, PMMA, flexural strength, and mechanical properties.

Results

Among 167 studies, five papers fulfilled the inclusion criteria and were added for the data analysis and meta-analysis. Proportions of incorporated SiO₂ nanoparticles ranged from 0.25% to 15% and the reported flexural strength values for the reinforced acrylic resin ranged from 41.25 MPa to 124.56 MPa. The meta-analysis revealed no significant effect on the flexural strength between the unmodified and the SiO₂ nanoparticle-reinforced acrylic resin.

Conclusion

Therefore, No particular concentration of SiO₂ nanoparticles could be recommended for heat-polymerized denture base reinforcement.

Effect of Low Nanodiamond Concentrations and Polymerization Techniques on Physical Properties and Antifungal Activities of Denture Base Resin

Background: Denture base resin has some drawbacks. This study investigated the impact of nanodiamonds (ND) and autoclave polymerization on the surface characteristics, translucency, and Candida albicans adherence in polymethyl methacrylate (PMMA) denture base resin after thermocycling. Methods: Heat-polymerized PMMA discs (15 × 2 mm) with a total sample size n = 160 were studied. Specimens were categorized into two main groups (N = 80): conventional water-bath-polymerized PMMA (CP/PMMA) and autoclave-polymerized PMMA (AP/PMMA). Each group was subdivided according to the ND concentration into four groups (n = 20): unmodified PMMA as a control, and 0.1%, 0.25%, and 0.5% ND–PMMA. Scanning electron microscopy (SEM) was used to inspect the morphology of the ND and the ND–PMMA mixtures before heat polymerization. The specimens were exposed to thermal cycling (5000 cycles at 5 and 55 °C), then surface roughness was measured with a non-contact optical interferometric profilometer, contact angle with an automated goniometer, and translucency using a spectrophotometer. Colony-forming units (CFU) were used to determine the adherence of Candida albicans cells to the specimens. ANOVA and Tukey post hoc tests for pairwise comparison were utilized for the statistical analysis (α = 0.05). Results: Surface roughness was significantly reduced with ND addition to CP/PMMA (p ˂ 0.001), while the reduction was not statistically significant in AP/PMMA (p = 0.831). The addition of ND significantly reduced the contact angle, translucency, and Candida albicans count of CP/PMMA and AP/PMMA (p ˂ 0.001). The incorporation of ND in conjunction with autoclave polymerization of PMMA showed significant reduction in all tested properties (surface roughness, contact angle and Candida albicans adherence) except translucency (p = 0.726). Conclusions: ND addition to PMMA and autoclave polymerization improved the surface properties with respect to antifungal activities, while the translucency was adversely affected.

Influence of Different Beverages on the Color Stability of Nanocomposite Denture Base Materials

BACKGROUND

The effect of beverages on nanocomposite denture base materials is neglected. Therefore, this study aimed to investigate the influence of different beverages (coffee, tea, cola, and mineral water) on the color stability of nanoparticles-modified denture base materials (DBMs).

MATERIALS AND METHODS

A total of 280 specimens (n = 10/group) were prepared from heat-polymerized acrylic resin modified with different concentrations (3% and 7%) of zirconium dioxide (nano-ZrO2), titanium dioxide (nano-TiO2), and silicon dioxide (nano-SiO2) nanoparticles, while 0% was taken as a control. Color change (∆E) of the specimens was evaluated after simulating 6-month immersion time in four commonly used beverages, coffee, tea, cola, and mineral water, as experimental groups. Color stability was measured using a spectrophotometer, and then values were converted to National Bureau of Standards units (NBS units). The one-way ANOVA test was applied to compare color change (ΔE) results followed by Bonferroni's post hoc test (α = 0.05).

RESULTS

The results showed that the heat-polymerized acrylic resin modified with different types of nanoparticles showed lower color changes after being immersed in beverage solutions compared to the unmodified group (P < 0.001), so the color stability of heat-polymerized acrylic resin was significantly enhanced by the addition of several nanoparticles; nano-ZrO2 showed the lowest ΔE followed by nano-TiO2 and then nano-SiO2. Regardless of the filler type, 3% concentration showed lower mean ΔE than 7% concentration. Regarding the beverage solutions, the greatest color change was found in the coffee group followed by tea and cola, while water showed the least changes.

CONCLUSION

Modification of heat-polymerized acrylic resin with certain amounts of nano-ZrO2, nano-TiO2, and nano-SiO2 may be useful in improving color stability.

The impact of nanoparticles-modified repair resin on denture repairs: a systematic review

This study aimed to evaluate the effect of nanoparticles on the mechanical properties of acrylic denture repairs. The review was designed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Database search was conducted involving articles published from 2000 to 2020 using the following keywords: PMMA/nanoparticles, denture repair/nanoparticles, and repair strength/nanoparticles. PubMed/MEDLINE, Embase, Google Scholar, Scopus, and EBSCOhost were used to find only those studies used repair resin reinforced with nanoparticles for denture repairs. Due to variations between nanoparticles types, sizes, and testing properties, the quantitative statistical meta-analysis couldn't be conducted. Therefore, a descriptive data analysis was applied. Out of 379 articles, 8 articles were included; three nanoparticles, zirconium oxide (nano-ZrO2), silicon oxide (nano-SiO2), and aluminum oxide (nano-Al2O3) nanoparticles were used as reinforcements to repair resin. Seven studies investigated the effects of 0.25-7.5 wt.% nano-ZrO2 on the mechanical properties of repaired denture bases and reported positive effects with high concentrations. Two studies study investigated 0.25-0.75 wt% nano-SiO2 and found that low % nano-SiO2 concentrations improved repair strength while, one study showed that 1 and 1.5 wt.% nano-Al2O3 increased the flexural strength. Although nanoparticles offer positive effects on the properties of denture repair, inadequate studies exist. Therefore, further investigations are required. Scientific field of dental Science: Prosthodontics.

Comparative Study of the Effectiveness of Laboratory-Formulated Polishing Pastes for Two CAD/CAM Ceramic Restorative Materials

PURPOSE

To evaluate the effect of different polishing pastes with different particle sizes on the surface finish of two different CAD/CAM ceramics.

MATERIALS AND METHODS

A total of 128 specimens were prepared of two CAD/CAM ceramics: lithium disilicate (12.4 × 14.5 × 2 mm) and monolithic zirconia (17.5 × 12.5 × 2.5 mm). They were divided randomly into 8 groups according to surface treatment (n = 8). Group 1 (control) was left as received after crystallization or sintering with no further surface treatment; Group 2 (glazed); Group 3 (positive control), where specimens were polished using standardized surface treatment (medium grit silicon carbide discs, rubber cup and pumice slurry, then rubber cup and toothpaste). For groups 4 to 8, in addition to silicon carbide and pumice slurry polishing, specimens were further polished using a diamond paste (DP), and polishing pastes of microzirconia (MZ), nanosilica (NS), nanodiamond (ND), and nanozirconia (NZ), respectively. Surface roughness (R_a ) was measured using noncontact profilometer. The mean values were compared using ANOVA and Post Hoc Tukey's test (α = 0.05). Specimens' surfaces were studied using a scanning electron microscope (SEM).

RESULTS

Positive control group and MZ exhibited significant R_a of lithium disilicate compared to control (p ˂ 0.001), glazed (p = 0.001), DPs (p = 0.002), NS (p ˂ 0.001), ND (p ˂ 0.001), and NZ (p = 0.002). In the case of zirconia, positive control showed a significantly higher R_a compared to all other groups (p ˂ 0.001). No statistical difference was found between all other polishing techniques (positive control, glazed, DPs, NS, ND, MZ, and NZ) (p > 0.05).

CONCLUSION

Polishing with ND, NZ, and NS lab-formulated pastes produced surfaces with comparable smoothness to control and glazed specimens for lithium disilicate and zirconia ceramic materials.

Late Clinical and Hemodynamic Outcomes in patients with degenerated bioprosthetic aortic valves undergoing transcatheter valve-in-valve implantation

Background

Clinical studies have shown promising early outcomes for valve-in-valve transcatheter aortic valve implantation (ViV-TAVI); however, the late outcomes of this procedure remain under-investigated.

Purpose

We performed the present analysis to assess the late clinical and hemodynamic outcomes of ViV-TAVI in patients with degenerated bioprosthetic aortic valves.

Methods

A comprehensive chart review was performed for eligible patients to retrieve data on procedural characteristics, admission details following the procedure, and echocardiographic parameters. Clinical outcomes included all-cause mortality, heart failure hospitalization and structural valve deterioration (SVD), as defined by VARC-II criteria, up to 5 years of follow-up. To assess the trends in mean and peak transvalvular gradients, data from the follow-up echocardiographic reports were analyzed using Syngo Dynamics imaging software.

Results

A total of 188 patients were included with a mean age of 75.8±10.4 years. Balloon- and self-expandable valves were used in 155 (82.4%) and 33 (17.6%) patients, respectively. At 30 days, 3 (1.6%) patients died and 8 (4.2%) required hospitalization for heart failure, while at 5 years, both events were recorded in 29 (15.4%) and 37 (19.7) patients, respectively. Kaplan-Meier survival analysis showed that patients with smaller surgical valves (internal diameter ≤21 mm) had a significantly higher mortality rate (log-rank p=0.021) than those with larger valves; however, no significant difference (log-rank p=0.59) was detected between different transcatheter valves (self vs. balloon-expandable). Three patients underwent re-intervention, performed via a transcatheter approach. Further, assessment of follow-up echocardiographic reports revealed 9 (4.8%) cases of SVD, as well as stable mean (16.3±6.9 at discharge and 16.9±11.3) and peak (30.3±12.1 at discharge and 30.7±18.4 at 5 years) transvalvular gradients. No difference (p&gt;0.05) was observed based on transcatheter valve type or surgical valve internal diameter in terms of mean and peak transvalvular gradients throughout the follow-up period.

Conclusion

The present study showed good clinical outcomes among patients undergoing VIV-TAVI, with stable VIV performance over a five-year period. Future long-term studies are warranted to analyze the predictors of outcomes following ViV-TAVI and explore the role of this treatment option in the life-long management of aortic stenosis.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jennifer and Robert McNeil Donation to the Heart, Thoracic, and Vascular Institute at Cleveland Clinic. Figure 1

The Bond Strength of a Universal Adhesive System with Silane to Lithium Disilicates in Comparison with an Isolated Silane Coupling Agent

PURPOSE

The aim of this in vitro study was to evaluate the effects of different durations of silane coupling agent application compared to a universal adhesive system regarding the shear bond strength of two ceramic materials.

MATERIALS AND METHODS

A total of 120 human molars were ground to the dentinal coronal third and then fixed into an acrylic resin holder. Lithium disilicate specimens were divided into two main groups according to the ceramic type: computer-aided design/computer-aided manufacturing IPS e.max CAD and heat-pressed Initial LiSi Press GC (dimensions of 4 × 3× 3 mm). Each main group was subdivided into 6 subgroups (n = 10) according to the duration of the silane and universal adhesive system application (20, 60, or 120 seconds) on the ceramic surface before cementation; then, the cementation procedures were performed. All specimens were subjected to 5000 thermal cycles at 5 and 55°C before testing. The shear bond strength was measured using a universal testing machine. ANOVA and Scheffe post hoc test multiple comparisons tests were conducted (α = 0.05).

RESULTS

The shear bond strength increased as the duration of the silane and universal adhesive system application increased. The highest bond value for each material was found for the silane application at 120 seconds, with a significant difference between 120 and 60, and 20 seconds for both e. max CAD and Initial LiSi materials (p = 0.029 and p ˂ 0.001, respectively). No significant difference was found between 60 and 20 seconds when silane and universal adhesive system were applied for both e. max CAD and Initial LiSi materials (p = 0.169 and p = 0.120, respectively). All groups treated with the silane primer showed significantly higher values than the universal adhesive system for each application time (p ˂ 0.001).

CONCLUSION

Increasing the duration of the silane coupling agent and universal adhesive system application to 120 seconds on the ceramic surface before cementation improved the shear bond strength of the ceramic-cement interface. Ceramic pretreatment with silane could be an essential step for bonding ceramic to dentin regardless of silane presence in the universal adhesive system.

Impact of ZrO2 nanoparticles addition on flexural properties of denture base resin with different thickness

PURPOSE

This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO₂) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses.

MATERIALS AND METHODS

Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO₂ concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey's post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions.

RESULTS

Groups with 0% nano-ZrO₂ showed no significant difference in the flexural strength as thickness decreased (P = .153). The addition of nano-zirconia significantly increased the flexural strength (P < .001). The highest value was with 5% nano-ZrO₂ and 2 mm-thickness (125.4 ± 18.3 MPa), followed by 5% nano-ZrO₂ and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness (P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant (P = .10).

CONCLUSION

Reinforcement of denture base material with nano-ZrO₂ significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO₂ was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMA/nano-ZrO₂ could be used with minimum acceptable thickness of 1.5 mm.

Comparative Effect of Different Surface Treatments on the Shear Bond Strength of Two Types of Artificial Teeth Bonded To Two Types of Denture Base Resins

PURPOSE

This in vitro study aims to assess the impact of various surface treatments on the shear bond strength (SBS) of two types of artificial teeth and denture base resins (DBRs).

MATERIALS AND METHODS

Two types of DBRs (CAD/CAM-milled and heat-polymerized) and two types of denture teeth (acrylic and composite) were investigated. Teeth were cut into slices (5 × 5 × 2 mm) and divided according to surface treatment into four subgroups (n = 10): no treatment (control), air abrasion (Alumina-blasting; AB), bur roughening, and dichloromethane (DCM) subgroups. According to manufacturer recommendations, the treated tooth slices were bonded to the acrylic disk of DBRs. The SBS test was performed using a universal testing machine. ANOVA was used for results analysis followed by Tukey's post hoc tests (α = 0.05).

RESULTS

DCM and AB increased the SBS of acrylic teeth to heat-polymerized DBR compared with other groups (p < 0.001). All surface treatments showed no significant difference in CAD/CAM DBR with acrylic teeth (p = 0.059; AB, p = 0.319; bur roughening, p = 0.895; DCM), while there was a significant decrease in SBS with composite teeth (p ˂ 0.001). Between teeth, acrylic teeth showed a statistically significant increase in SBS compared to composite teeth (p < 0.001).

CONCLUSION

AB and DCM application improved the SBS for acrylic teeth with the heat-polymerized DBR when compared with the untreated group, but none of the surface treatment agents showed significant improvement with CAD/CAM DBR. All surface treatment agents reduced the SBS for composite teeth with CAD/CAM DBR while AB only increased the SBS with heat-polymerized DBR.

Effects of SiO2 Incorporation on the Flexural Properties of a Denture Base Resin: An In Vitro Study

Objective  The aim of this study was to evaluate the effects of the addition of low-silicon dioxide nanoparticles (nano-SiO ₂ ) on the flexural strength and elastic modulus of polymethyl methacrylate (PMMA) denture base material.

Materials and Methods  A total of 50 rectangular acrylic specimens (65 × 10 × 2.5 mm ³ ) were fabricated from heat-polymerized acrylic resin. In accordance with the amount of nano-SiO ₂ , specimens were divided into the following five groups ( n = 10 per group): a control group with no added SiO ₂ , and four test groups modified with 0.05, 0.25, 0.5, and 1.0 wt% nano-SiO ₂ of acrylic powder. Flexural strength and elastic modulus were measured by using a 3-point bending test with a universal testing machine. A scanning electron microscope was used for fracture surface analyses. Data analyses were conducted through analysis of variance and Tukey’s post hoc test (α = 0.05).

Results  Compared with the control group, flexural strength and modulus of elasticity tended to significantly increase ( p ˂ 0.001) with the incorporation of nano-SiO ₂ . In between the reinforced groups, the flexural strength significantly decreased ( p ˂ 0.001) as the concentrations increased from 0.25 to 1.0%, with the 1.0% group showing the lowest value. Furthermore, the elastic modulus significantly increased ( p ˂ 0.001) at 0.05% followed by 1.0%, 0.25%, 0.5%, and least in control group.

Conclusion  A low nano-SiO ₂ addition increased the flexural strength and elastic modulus of a PMMA denture base resin.