Pre-sintering pigmentation techniques do not affect the fatigue behavior of adhesively luted 4YSZ restorations

This study aims to characterize the effect of shading techniques on the fatigue behavior of a 4YSZ ceramic (4 mol% yttrium stabilized zirconia) adhesively bonded to a dentin analogue (fiber-reinforced epoxy resin). 4YSZ ceramic discs (IPS e.max ZirCAD, Ø = 10 mm and 1 mm of thickness) were allocated according to the factor 'shading technique' into 4 groups: Brush- unshaded ceramic disc (IPS e.max ZirCAD BL) pigmented at the pre-sintered stage with pigment solution applied manually using a round liner brush; Immersion- unshaded ceramic disc pigmented through immersion in the solution for 1 s on only one side of the ceramic disc; Manufacturer- specimens already shaded by the manufacturer (IPS e.max ZirCAD MT A2 - Manufacturer group); Control- a control condition with absence of pigment (i.e. non-pigmented specimens). The specimens were sintered and a spectrophotometer (SP60, EX- Rite) was used to ensure that the same perceived color (i.e. pigment saturation) was achieved in the different shading strategies (Manufacturer, Brush or Immersion groups). To do so, the color differences (ΔE00) were calculated using the CIEDE 2000 equation; and an ΔE00 of up to 1.77 was considered as an acceptability threshold. Dentin analogue discs were obtained (Ø = 10 mm and 2.5 mm of thickness) and randomly allocated into pairs with the 4YSZ ceramic discs. Next, the pairs were adhesively bonded using a resin cement (Multilink N). The bonded assemblies (n = 15) were tested for fatigue using the step-stress test method (frequency of 20 Hz; 10,000 cycles per step, initial load 200 N; step-size of 100 N, up to 700 N; and after, step-size of 50 N, until specimen failure/fracture or radial cracks). Fatigue failure load (FFL) and number of cycles for failure (CFF) were recorded for statistical analysis. Fractographic features were accessed, and complementary roughness, topography, grain size and phase content analyses were performed. No statistical differences were observed in the fatigue behavior among the non-shaded condition (Control group - 880 N) and the shaded specimens (Manufacturer - 887 N, Brush - 820 N, and Immersion - 850 N groups; p > 0.05). However, the use of a brush shading technique induced slightly inferior fatigue mechanical behavior of the restorative set compared to the specimens already shaded by the manufacturer (p = 0.027). No differences in Weibull modulus were observed among the tested groups. The specimens pigmented by the brush technique demonstrated a rougher surface, with statistically higher Rz values, in addition to a larger grain size in comparison to all other conditions (p< 0.05). No m-phase content was identified (only t and c phases were detected). Thus, the shading techniques used to provide a Vita classic A2 shade does not negatively affect the mechanical fatigue properties of a bonded 4YSZ ceramic. However, the brush technique has detrimental effect on the fatigue behavior compared to when the ceramic was already provided in a shaded format by its manufacturer.

Resistance fracture of minimally prepared endocrowns made by three types of restorative materials: a 3D finite element analysis

A thin endocrown restoration was often applied in endodontically treated teeth with vertical bite height loss or inadequate clinical crown length. A model of mandibular molars made by endocrown restoration with 1 mm thickness and 2 mm depth of pulp chamber was constructed and imported into FEA ANSYS v18.0 software. The three CAD/CAM materials, feldspathic (Mark2), lithium disilicate (EMAX), and lava ultimate (LU), were assigned, and the five load indenters were loaded on the full occlusal (FO), occlusal center (OC), central fossa (CF), buccal groove (BG), and mesiobuccal cusp (MC) of restoration in the model. The MinPS and MaxPS of the thin endocrown were significantly higher than those of tooth tissue in five types of loads except for the LU endocrown loaded in the FO group. The smaller the contact surface of the load was, the higher MaxPS and MinPS were. MaxPS and MinPS of the MC were the highest, followed by the BG and CF in the restoration. In the stress distribution of tooth tissue, MaxPS in the LU endocrown accumulated at the external edge of enamel and was significantly higher than MaxPS in Mark2 and EMAX endocrown concentrated on the chamber wall of dentin under OC, CF and BG loads. Within the limitations of this FEA study, the LU endocrown transferred more stress to tooth tissue than Mark2 and EMAX, and the maximum principal stress on endocrown restoration and tooth tissue at the mesiobuccal cusp load was higher than that at the central fossa and buccal groove load.

Calcium hydroxyapatite nanoparticles as a reinforcement filler in dental resin nanocomposite

The current study focuses on the fabrication of calcium hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂) (HA) in a nanorange having whiskers- and cubic-shaped uniform particle morphology. The synthesized HA particles hold a promising feature as reinforcement fillers in dental acrylic resin composite. They increase the efficacy of reinforcement by length and aspect ratio, uniformity, and monodispersity. Therefore, the acrylic resin was reinforced with the as-synthesized monodispersed HA filler particles (0.2-1 Wt%). The presence of filler particles in the composite had a noticeable effect on the tribological and mechanical properties of the dental material. The morphological effect of HA particles on these properties was also investigated, revealing that cubic-shaped particles showed better results than whiskers. The as-fabricated composite (0.4 Wt%) of the cubic-shaped filler particles showed maximum hardness and improved antiwear/antifriction properties. Particle loading played its part in determining the optimum condition, whereas particle size also influenced the reinforcement efficiency. The current study revealed that particle morphology, particle size, uniformity, etc., of HA fillers, greatly influenced the tribological and mechanical properties of the acrylic resin-based nanocomposite. Improvement in the tribological properties of HA particle-reinforced acrylic resin composites (HA-acrylic resin) followed the trend as AR < C_mC < WC < CC.

Biomimetic mineralisation systems for in situ enamel restoration inspired by amelogenesis

Caries and dental erosion are common oral diseases. Traditional treatments involve the mechanical removal of decay and filling but these methods are not suitable for cases involving large-scale enamel erosion, such as hypoplasia. To develop a noninvasive treatment, promoting remineralisation in the early stage of caries is of considerable clinical significance. Therefore, biomimetic mineralisation is an ideal approach for restoring enamel. Biomimetic mineralisation forms a new mineral layer that is tightly attached to the surface of the enamel. This review details the state-of-art achievements on the application of amelogenin and non-amelogenin, amorphous calcium phosphate, ions flow and other techniques in the biomimetic mineralisation of enamel. The ultimate goal of this review was to shed light on the requirements for enamel biomineralisation. Hence, herein, we summarise two strategies of biological minimisation systems for in situ enamel restoration inspired by amelogenesis that have been developed in recent years and compare their advantages and disadvantages.

Water jet as a novel technique for enamel drilling ex vivo

To investigate the usage of a water jet for enamel drilling ex vivo, 210 individual extracted molars without lesions or fillings were collected. Then, the specimens were drilled by a water jet or a high-speed dental drill. The cavities of 50 teeth were reconstructed digitally by micro-computed tomography (micro-CT) to measure the height and width. The cavities of 10 teeth were longitudinally incised and their surfaces were observed by scanning electronic microscopy (SEM). After the cavities were filled, 50 fillings were vertically incised. The bonding interface between tooth and filling was observed by SEM. 50 teeth with fillings were stained in 0.1% rhodamine B solution, and then the dye penetration between tooth and filling was observed under the stereomicroscope and confocal laser scanning microscopy (CLSM). The bonding strength between enamel and filling of 50 teeth was simulated and predicted with finite element analysis (FEA). At 140-150 MPa and for 2-3 s, cavities were made with a depth of approximately 764 μm in each tooth. SEM showed the cavity surface in the water jet group had a more irregular concave and convex structure than that in the high-speed dental drill group. There was a trend that the microleakage and bonding width was smaller in the water jet group than in the high-speed dental drill group. FEA indicated that the stress on the resin surface was greater than on the enamel surface in the water jet group. Compared with the tooth drilled by a high-speed dental drill, the tooth drilled by a water jet gained better retention of the filling material and suffered less bonding strength on the enamel surface. Water jet drilling is effective for enamel drilling.

Surface treatment of RMGIC to composite resin using different photosensitizers and lasers: A bond assessment of closed Sandwich restoration

AIM

The aim of present study was to assess and compare different conditioning methods (laser, PDT and conventional) on shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) bonded to composite (sandwich technique).

MATERIAL AND METHODS

Fifty specimens were prepared from RMGIC and were packed in a teflon mould placed on glass slab. Through each of the glass slab the cement was light cured for 20 s. Now samples were randomly allocated into five groups (n = 10) according to pre-treatment protocols. In group 1 RMGIC were conditioned with MBP using PDT, Samples in group 2 treated with Er,Cr:YSGG (ECYL), group 3 pre-treated with Nd:YAG laser (NYL), samples in group 4 surface conditioned with air abrasion (AA) and group 5 conditioned with 37 % phosphoric acid (PA). Specimens after conditioning were rinsed with distilled water. Adhesive Adper Single Bond 2 was applied on treated surface of RMGIC and cured. Teflon mold was utilized to hold the composite Filtek Z250 in an incremental technique. For SBS testing all specimens were placed under shear knife edge at 1 K N at a speed of 0.5mm2 until bond failure. Optical microscope was used to evaluate failure pattern at 10x magnification. The data of SBS in Megapascal were subjected to statistical test. Analysis of variance was followed by Post hoc test with level of significance at 5 %.

RESULT

The maximum SBS was found in group 5 RMGIC conditioned with 37 % PA (16.45 ± 0.32 MPa). Whereas, group 1 (MBP, PDT) demonstrated significantly lower bond integrity (9.82 ± 1.08 MPa) compared to all experimental groups. Bond integrity of RMGIC surface treated with MBP, PDT (9.82 ± 1.08 MPa), group 3 lased with NYL (11.47 ± 0.53 MPa) and samples in group 4 conditioned with AA (11.23 ± 0.47 MPa) were comparable (p > 0.05).

CONCLUSION

ECYL has a potential to be used for conditioning of RMGIC prior to composite restoration (sandwich technique). MBP at 100 mg/L deteriorates SBS of composite to RMGIC.

Harnessing biomolecules for bioinspired dental biomaterials

Dental clinicians have relied for centuries on traditional dental materials (polymers, ceramics, metals, and composites) to restore oral health and function to patients. Clinical outcomes for many crucial dental therapies remain poor despite many decades of intense research on these materials. Recent attention has been paid to biomolecules as a chassis for engineered preventive, restorative, and regenerative approaches in dentistry. Indeed, biomolecules represent a uniquely versatile and precise tool to enable the design and development of bioinspired multifunctional dental materials to spur advancements in dentistry. In this review, we survey the range of biomolecules that have been used across dental biomaterials. Our particular focus is on the key biological activity imparted by each biomolecule toward prevention of dental and oral diseases as well as restoration of oral health. Additional emphasis is placed on the structure-function relationships between biomolecules and their biological activity, the unique challenges of each clinical condition, limitations of conventional therapies, and the advantages of each class of biomolecule for said challenge. Biomaterials for bone regeneration are not reviewed as numerous existing reviews on the topic have been recently published. We conclude our narrative review with an outlook on the future of biomolecules in dental biomaterials and potential avenues of innovation for biomaterial-based patient oral care.

The motivational effect of multicolored dental restoration on dental behavior of first preliminary school children

Objectives

To assess the motivational effect of multi-colored restoration on the anxiety level of pediatric patients at thedental clinic and its motivational effect on their oral hygiene status.

Material and methods

A total of 30 participants.

Results

Both groups revealed reduction in the anxiety level and improvement in their behavior at the dental office but did not reach significance. Plaque index showed a significant reduction per group and a near significance as compared between test groups.

Conclusions

The use of the multicolored restoration could provide a potential advantage to improve the oral health status of children and might aid in enhancing their behavior at dental clinic particularly younger age groups.

Elastic Modulus Maturation Effect on Shrinkage Stress in a Primary Molar Restored with Tooth-Colored Materials

Purpose: Polymerization shrinkage stress is determined by shrinkage as well as elastic modulus. Elastic modulus develops during polymerization. This study evaluated how elastic modulus affects shrinkage stresses in a primary molar for three types of restorative materials. Methods: Elastic modulus of resin composite, compomers, and resin-modified glass ionomer (RMGI) were determined using four-point bending of rectangular beams at 10 minutes, 24 hours, and after one to four weeks storage in water (n equals 10). Results were analyzed using twoway analysis of variance and pairwise comparisons (α equals 0.05). The elastic moduli were used with published shrinkage data to calculate stresses at the tooth-restoration interface in finite element models of a cross-sectioned restored primary molar. Results: The elastic modulus ranged between 5.6 to 19.9 gigapascal. Elastic modulus values were lowest at 10 minutes, regardless of material, and increased significantly (43 to 95 percent) in 24 hours; RMGI continued to increase (64 percent) for one week. Shrinkage stresses increased nonproportionally (resin composite 31 percent, compomer 35 percent, RMGI 52 percent) with increasing elastic modulus for sustained volumetric shrinkage. Conclusions: Elastic modulus development is material dependent and an important factor in polymerization shrinkage stress. Maturation of restorative materials can cause long-lasting stress increases if shrinkage is not alleviated by hygroscopic expansion.

Depth of cure of proximal composite resin restorations using a new perforated metal matrix

The purpose of this study was to compare the depths of cure of a proximal box preparation filled in bulk with various approaches: filled with a bulk-fill or conventional composite; placed with a new perforated metal matrix, a traditional metal matrix, or a clear matrix; and polymerized with either occlusal-only or tri-sited light curing. After tri-sited curing, the use of the new perforated metal matrix band resulted in a depth of cure that was not significantly different from that achieved with the use of metal bands (removed during curing) or transparent matrix bands. Adequate polymerization was obtained at depths of more than 5.0 mm for the bulk-fill composite and more than 4.0 mm for the conventional composite when tri-sited light curing was used. Tri-sited light curing resulted in a significantly greater depth of cure than occlusal-only curing. The perforated metal band may be used as an alternative to the use of solid metal bands or transparent matrix bands to provide similar depths of cure for composite resins, with the possible benefits of malleability and the ability to leave the band in place during tri-sited light curing.

Use of a Modified Matrix Band Technique to Restore Subgingival Root Caries

Given the increasing incidence of root caries in the elderly population, clinicians frequently must isolate and restore subgingival preparations. This article demonstrates a technique utilizing a modified Tofflemire matrix band that creates a preparation free of crevicular fluid and blood for restoration with resin-modified glass ionomer cement.

Metal-free materials for fixed prosthodontic restorations

BACKGROUND

Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth structure. Traditionally full metal or metal frameworks veneered with ceramic (metal-ceramic (MC)) have been used. In recent years several different metal-free systems have become available to clinicians and patients. In general, metal-free restorations should allow practitioners to better reproduce natural tooth colour, avoiding shortcomings of MC restorations. The comparative in service clinical performance of fixed prosthodontic treatments of different materials is unclear.

OBJECTIVES

To assess the effects of metal-free materials for prosthodontic restorations compared to metal-ceramic or other conventional all-metal materials.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (searched 3 May 2017), Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4) in the Cochrane Library (searched 3 May 2017), MEDLINE Ovid (1946 to 3 May 2017), and Embase Ovid (1980 to 3 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (searched 3 May 2017). No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which the clinical performance of metal-free fixed prosthodontic restorations was compared with metal-ceramic (MC) or other conventional restorations in adult patients requiring prosthodontic treatment. RCTs in which the clinical performance of different kinds of metal-free systems were compared among themselves were also considered.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for missing information. Available results for the outcomes of interest of the systematic review of the studies included were tabulated as they could not be included in a formal meta-analysis.

MAIN RESULTS

Nine trials involving a total of 448 participants were included. We judged two trials to be at unclear risk of bias and seven to be at high risk of bias. The majority of items of risk of bias were evaluated to be at unclear or high risk level in more than 50% of the included trials. Each trial except two was addressing a different type of intervention. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results, the latter being due to very small sample sizes, low event rates, 95% confidence intervals including the possibility of benefit for both the test and control groups, or combinations of these problems. This means that we are very uncertain about all of the results presented in this review.One trial compared metal-free single crowns (full contour zirconia) to cast gold single crowns in 224 participants and found insufficient evidence of a difference in failure rate after one year, but after five years there was some evidence of a benefit for the gold crowns. There was insufficient evidence of a difference for crown complications at either time of assessment.One trial compared three-unit metal-free FDPs (lithium disilicate) to three-unit metal-ceramic FDPs in 37 participants. There was insufficient evidence of a difference in bridge failure at one and six years, but some evidence of a benefit for the lithium disilicate group in terms of bridge complications at six years. One trial compared zirconia-ceramic FDPs to metal-ceramic FDPs in 34 participants but found insufficient evidence of a difference in bridge failures (i.e. no failures in either treatment group), bridge complications or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free cantilevered FDPs to metal-ceramic cantilevered FDPs in 21 participants. There was insufficient evidence of a difference for any primary outcome: bridge failures (i.e. no failures in either treatment group), bridge complications, or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free implant-supported screw retained single crowns (zirconia veneered with feldspathic ceramic) to metal-ceramic implant-supported screw-retained single crowns in 20 participants. There was insufficient evidence of a difference for any primary outcome: crown failures (i.e. no failures in either treatment group), crown complications, or satisfaction/aesthetic evaluation at any time of assessment up to two years.Two trials compared metal-free implant abutments (zirconia) to metal implant abutments both supporting single crowns in 50 participants. There was insufficient evidence of a difference in abutment failure at one year.One trial compared metal-free implant-supported FDPs made of two different types of zirconia ceramic in 18 participants. There was insufficient evidence of a difference in failures at any time of assessment up to 10 years (i.e. no failures in either treatment group). There was some evidence of a benefit for the zirconia-toughened alumina group in terms of complications (chipping).One trial compared metal-free tooth-supported FDPs made with two different veneering techniques (pressed versus layered) in 40 participants. There was insufficient evidence of a difference for failures (i.e. no failures in either treatment group) or complications at any time of assessment up to three years.

AUTHORS' CONCLUSIONS

There is insufficient evidence to support or refute the effectiveness of metal-free materials for fixed prosthodontic treatment over metal-ceramic or other type of standard restorations. The overall quality of existing evidence was very low, therefore great caution should be exercised when generalising the results of the included trials. Until more evidence becomes available clinicians should continue to base decisions on which material to use for fixed prosthodontic treatment on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients. There is urgent need of properly designed RCTs.

Retrospective Study to Determine Patient Satisfaction of Immediately Placed and Provisionalized Implants in the Esthetic Zone From a US Private-Practice Research Network

BACKGROUND

Immediately placed/immediately restored dental implants in the esthetic zone are judged by not only their functional success but also the appearance and acceptance of the restorative outcome. The purpose of this study was to retrospectively evaluate in a private-practice setting the satisfaction of both patients and doctors regarding immediately placed/immediately restored implants in the esthetic zone.

METHODS

The author group consists of nine board-certified periodontists. Each private practice contributed to the patient population of this study through a primarily referral-based source. In a 6-month period, practices evaluated patients who were candidates for dental implant replacement with teeth Nos. 5 through 12 scheduled for extraction. All patients received informed consent and were asked if their data could be used with a visual analog scale (VAS) they graded. Pretreatment and 6-month post-final restoration loading was compared for statistically significant changes in reference to crestal bone changes, papilla index score (PIS), facial gingival margin stability (FGMS), and investigator/patient esthetic evaluations using a VAS.

RESULTS

Thirty-five patients were included in the study with a total of 35 implants placed and 32 restored with a final restoration. Implants were followed for an average of 15.4 months prior to reporting. A total of three failures were encountered. The PIS resulted in an average score of 2.7. VAS resulted in an average score of 9.3 by the surgeons and 9.5 by the patients. The FGMS accounted for 76% of the implants with no change, 15% demonstrating recession, and 9% demonstrating coronal migration.

CONCLUSIONS

Immediately placed and immediately temporized implants in the esthetic zone demonstrated a successful outcome that was highly acceptable to patients in private-practice settings from a diverse group of private periodontal practices.

Precision and security in restorative dentistry: the synergy of isolation and magnification

It is often presumed that, since its introduction in 1864, the use of rubber dam in multiple dental procedures has increased. However, its use is not as widespread as one might expect. There still seem to be many obstacles that prevent clinicians from adopting it as a standard of care. Furthermore, it appears very difficult to scientifically prove the impact of its use on the final outcome of a given procedure. The fundamental idea of isolating the operatory field and preventing contamination is simple; the practical execution of it is more demanding. In this article, the authors not only focus on the essential criteria for predictable isolation, they also present an isolation strategy that can be translated into a step-by-step procedure. It is suggested that by adopting this strategy, clinicians can eliminate the most commonly experienced obstacles and optimize the full potential of isolation, even in extremely difficult clinical situations.

[Not Available]

The restorative rehabilitation of the severe loss of dental hard tissue due to dental erosion or abrasion is a challenging situation for the dentist. The following article presents the case of applying direct adhesive composite restorations as one possible approach to reconstruct erosively-induced severe dental hard tissue loss.

Key Parameters of Hybrid Materials for CAD/CAM-Based Restorative Dentistry

Hybrid materials are a recent addition to the dental armamentarium for computer-assisted design/ computer-assisted manufacturing (CAD/CAM)-based restorative dentistry. They are intended to provide dentists with the capability of restoring single teeth in one appointment with a material that emulates the structure and physical properties of natural teeth. This article aims to provide an overview of currently available hybrid materials and offer the reader further understanding of their key clinical parameters and possible limitations.

An evidence-based review of dental matrix systems

The restoration of proximal surface cavities, originating from Class II carious lesions, to "normal" anatomical specifications is a fundamental objective for the dental practitioner. Cognitive interpretation of tooth morphology attained from evidence-based resources, together with the necessary psychomotor skills for correct design and completion, are considered essential strategies for restoration success. Also, the visualization of the original tooth structure, if present, should substantially benefit the dentist in the creation of a clinically satisfactory restoration. The purpose of this evidence-based review is to define the cause and effect of decisions based on optimum treatment standards of care for the patient. The concepts of form and function, as related to the oral environment, and the consequences of unsatisfactory dental restorative care will be scrutinized. This article will identify and explain the different challenges and solutions for restoration of dental proximal lesions and provide an overview of past, present, and future procedures.

Interfacial Adaptation of Composite Restorations Before and After Light Curing: Effects of Adhesive and Filling Technique

PURPOSE

To investigate the effects of placement technique and adhesive material on adaptation of composites before and after light curing.

MATERIALS AND METHODS

Cylindrical cavities (3 mm diameter, 1.7 mm depth) in extracted human molars were restored in 6 groups (n=5) using 2 adhesives--two-step self-etching Clearfil SE Bond 2 (SE2) and all-in-one Clearfil Tri-S Bond Plus (TSP) (Kuraray Noritake Dental)--and 2 composites--Estelite Sigma Quick (ESQ) and Estelite Flow Quick (FLQ) (Tokuyama Dental)--placed with three different techniques: ESQ bulk placed, FLQ lining followed by ESQ and FLQ bulk placed. Specimens were scanned twice using swept-source optical coherence tomography (SS-OCT) before and after photopolymerization of the composite. Gap formation during polymerization or the difference in floor interface (DFI%) and final unsealed interface (USI%) were measured by image coregistration and subtraction on 6 diametrical planes across each scan.

RESULTS

Two-way ANOVA suggested that both factors (adhesive and filling technique) and their interaction were significant (p<0.001). SE2 showed significantly lower DFI% than did TSP when the composites were placed in bulk, but no difference was found when flowable lining was applied (p<0.05). Within TSP, all filling techniques were significantly different and the lining group showed the lowest values, followed by ESQ-bulk. Overall, SE2 always showed lower UFI% than did TSP, while there was no difference among different techniques within SE2.

CONCLUSION

SS-OCT is a unique method to observe the pre-existing interfacial defects and gaps developed during polymerization, which were found to depend on both placement technique and applied adhesive.

The Simultaneous Modeling Technique: closing gaps in posteriors

Direct posterior restorations represent a widespread procedure in daily practice. Occlusal layering is often considered a complex task, generally not predictable and often requiring several occlusal adjustments. Moreover, direct posterior restorations are time consuming, as many small increments must be applied and cured individually to control shrinkage stress. Several authors have proposed different material layering techniques for posteriors. The authors of this article propose a simplified approach, which primarily aims to help the clinician perform quick, simple, predictable, and natural-looking occlusal modeling, reducing the need for occlusal adjustments.

Posterior Vertical Bite Reconstructions of Erosively Worn Dentitions and the "Stamp Technique" - A Case Series with a Mean Observation Time of 40 Months

PURPOSE

In the present case series, the authors report on seven cases of erosively worn dentitions (98 posterior teeth) which were treated with direct resin composite.

MATERIALS AND METHODS

In all cases, both arches were restored by using the so-called stamp technique. All patients were treated with standardized materials and protocols. Prior to treatment, a waxup was made on die-cast models to build up the loss of occlusion as well as ensure the optimal future anatomy and function of the eroded teeth to be restored. During treatment, teeth were restored by using templates of silicone (ie, two "stamps," one on the vestibular, one on the oral aspect of each tooth), which were filled with resin composite in order to transfer the planned, future restoration (ie, in the shape of the waxup) from the extra- to the intraoral situation. Baseline examinations were performed in all patients after treatment, and photographs as well as radiographs were taken. To evaluate the outcome, the modified United States Public Health Service criteria (USPHS) were used.

RESULTS

The patients were re-assessed after a mean observation time of 40 months (40.8 ± 7.2 months). The overall outcome of the restorations was good, and almost exclusively "Alpha" scores were given. Only the marginal integrity and the anatomical form received a "Charlie" score (10.2%) in two cases.

CONCLUSION

Direct resin composite restorations made with the stamp technique are a valuable treatment option for restoring erosively worn dentitions.

The use of incinerated pig head in dental identification simulation

PURPOSE

The aim of this exercise was to simulate a disaster victim identification scenario to allow training in documentation of postmortem incinerated remains and reconciliation of dental data.

METHOD

Varying number of restorations were placed in ten pig heads. The teeth and restorations were charted, with the restorations radiographed and documented, creating an ante-mortem data set. The following day the heads were cremated. Following cooling and recording they were transported for a post-mortem examination by trained specialist odontologists who were not involved in the initial antemortem phase. Recordings included the charting of teeth, restorations, lost teeth, and radiographs to simulate a post-mortem examination. A reconciliation of postmortem to antemortem information was attempted.

RESULTS

There was an unacceptable amount of error in the postmortem examination of the heads. The errors related mainly to avulsed teeth and incorrect opinion of which charted surfaces the restorations were placed upon. Also noted were a considerable number of root fractures occurring beneath the crestal bone. This observation does not mimic the evidence observed in human incinerated teeth where the crowns tend to fracture off the roots at the dentin-enamel junction.

CONCLUSION

The use of incinerated pig (Sus Scrofa) heads is not an ideal model for forensic odontology training in disaster victim identification. Differences in both anatomy and behavior following exposure to heat were shown to hamper documentation and subsequent comparison to antemortem data.

A new methodology for fluorescence analysis of composite resins used in anterior direct restorations

The aim of this study was to use a new methodology to evaluate the fluorescence of composite resins for direct restorations. Microhybrid (group 1, Amelogen; group 2, Opallis; group 3, Filtek Z250) and nanohybrid (group 4, Filtek Z350 XT; group 5, Brilliant NG; group 6, Evolu-X) composite resins were analyzed in this study. A prefabricated matrix was used to prepare 60 specimens of 7.0 × 3.0 mm (n = 10 per group); the composite resin discs were prepared in 2 increments (1.5 mm each) and photocured for 20 seconds. To establish a control group of natural teeth, 10 maxillary central incisor crowns were horizontally sectioned to create 10 discs of dentin and enamel tissues with the same dimensions as the composite resin specimens. The specimens were placed in a box with ultraviolet light, and photographs were taken. Aperture 3.0 software was used to quantify the central portion of the image of each specimen in shades of red (R), green (G), and blue (B) of the RGB color space. The brighter the B shade in the evaluated area of the image, the greater the fluorescence shown by the specimen. One-way analysis of variance revealed significant differences between the groups. The fluorescence achieved in group 1 was statistically similar to that of the control group and significantly different from those of the other groups (Bonferroni test). Groups 3 and 4 had the lowest fluorescence values, which were significantly different from those of the other groups. According to the results of this study, neither the size nor the amount of inorganic particles in the evaluated composite resin materials predicts if the material will exhibit good fluorescence.

Effect of High Irradiance on Depth of Cure of a Conventional and a Bulk Fill Resin-based Composite

OBJECTIVES

This study evaluated the effect of using three commercial light curing units (LCUs) delivering a range of irradiance values, but delivering similar radiant exposures on the depth of cure of two different resin-based composites (RBCs).

METHODS

A conventional hybrid RBC (Z100 shade A2, 3M ESPE) or a bulk fill RBC (Tetric EvoCeram Bulk Fill shade IVA, Ivoclar Vivadent) was packed into a 10-mm deep semicircular metal mold with a 2-mm internal radius. The RBC was exposed to light from a plasma-arc-curing (PAC) light (Sapphire Plus, DenMat) for five seconds, a quartz-tungsten-halogen (QTH) light (Optilux 501, Kerr) for 40 seconds, or a light-emitting-diode (LED) light (S10, 3M ESPE) for 20 seconds and 40 seconds (control). The Knoop microhardness was then measured as soon as possible at the top surface and at three points every 0.5 mm down from the surface. For each RBC, a repeated measures analysis of variance (ANOVA) model was used to predict the Knoop hardness in a manner analogous to a standard regression model. This predicted value was used to determine at what depth the RBC reached 80% of the mean hardness achieved at the top surface with any light.

RESULTS

The PAC light delivered an irradiance and radiant exposure of 7328 mW/cm(2) and 36.6 J/cm(2), respectively, to the RBCs; the QTH light delivered 936 mW/cm(2) and 37.4 J/cm(2) and in 20 seconds the LED light delivered 1825 mW/cm(2) and 36.5 J/cm(2). In 40 seconds, the control LED light delivered a radiant exposure of 73.0 J/cm(2). For Z100, using 80% of the maximum hardness at the top surface as the criteria for adequate curing, all light exposure conditions achieved the 2.0-mm depth of cure claimed by the manufacturer. The LED light used for 40 seconds achieved the greatest depth of cure (5.0 mm), and the PAC light used for five seconds, the least (2.5 mm). Tetric EvoCeram Bulk Fill achieved a 3.5-mm depth of cure when the broad-spectrum QTH light was used for 40 seconds delivering 37.4 J/cm(2). It required a 40-second exposure time with the narrow-spectrum LED, delivering approximately 73 J/cm(2) to reach a depth of cure of 4 mm.

CONCLUSIONS

When delivering a similar radiant exposure of 37 J/cm(2), the QTH (40 seconds) and LED (20 seconds) units achieved a greater depth of cure than the PAC (five seconds) light. For both resins, the greatest depth of cure was achieved when the LED light was used for 40 seconds delivering 73 J/cm(2) (p<0.05).

In vivo Evaluation of Proximal Resin Composite Restorations performed using Three Different Matrix Systems

OBJECTIVE

The aim of this in vivo study was to radiographically evaluate the proximal contour of composite resin restorations performed using different matrix systems.

MATERIALS AND METHODS

Patients with premolars needing class II type resin composite restorations involving the marginal ridge were selected. Thirty premolars were selected and randomly divided into three groups (n = 10 each) to receive restorations using different matrix systems: group 1: metal matrix coupled to a carrier matrix and wood wedge (G1-MMW); group 2: sectioned and precontoured metal matrix and elastic wedge (G2-SME); and group 3: a polyester strip and reflective wedge (G3-PMR). After the restorative procedure, bitewing radiographs were performed and analyzed by three calibrated professionals. The quality of the proximal contact and marginal adaptation of the proximal surfaces was classified as either correct or incorrect (undercontour/overcontour).

RESULTS

The Pearson Chi-square statistical test (α = 5%) revealed a statistically difference between frequencies of correct and incorrect restorations (α(2) = 6.787, p < 0.05). The group G2 SME produced a higher frequency of correct proximal contours (90%), while G1-MMW and G3-PMR had a ratio of 40% correct and 60% incorrect contours respectively.

CONCLUSION

None of the matrix systems was able to prevent the formation of incorrect proximal contours; however, the sectioned and precontoured metal matrix/elastic wedge configuration provided better results as compared to the other groups.

Preparing and Restoring Composite Resin Restorations. The Advantage of High Magnification Loupes or the Dental Surgical Operating Microscope

Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

Simplifying Direct Composite Veneer Placement

Several clinical uses for the Uveneer system have been described in the case examples presented herein, demonstrating how this technique can help the dentist more easily create aesthetic facial surfaces of maxillary anterior teeth. This template system can be used to create direct composite veneers as definitive restorations, and in a variety of diagnostic situations that help the dentist and patient get on the "same page" when designing an aesthetic restorative case to meet a patient's individual goals.

Translucency of human teeth and dental restorative materials and its clinical relevance

The purpose was to review the translucency of human teeth and related dental materials that should be considered for the development of esthetic restorative materials. Translucency is the relative amount of light transmission or diffuse reflection from a substrate surface through a turbid medium. Translucency influences the masking ability, color blending effect, and the degree of light curing through these materials. Regarding the translucency indices, transmission coefficient, translucency parameter, and contrast ratio have been used, and correlations among these indices were confirmed. Translucency of human enamel and dentine increases in direct proportion to the wavelength of incident light in the visible light range. As for the translucency changes by aging, limited differences were reported in human dentine, while those for enamel proved to increase. There have been studies for the adjustment of translucency in dental esthetic restorative materials; the size and amount of filler and the kind of resin matrix were modified in resin composites, and the kind of ingredient and the degree of crystallization were modified in ceramics. Based on the translucency properties of human enamel and dentine, those of replacing restorative materials should be optimized for successful esthetic rehabilitation. Biomimetic simulation of the natural tooth microstructure might be a promising method.

Matrixing for MID success

The proper use of matrices can lead to successful, stable dental restorations. Their importance is further advanced in MID restorations. The 3 Cs of contour, contact, and control properly exercised with correct placement of matrices can enhance the long-term success of any restoration. Matrices create healthy gingival contours, mimic natural tooth contours, and also create good healthy contacts. All of these benefits can be achieved while controlling the flow of bonding products from the gums and keeping sulcular fluids from contaminating the bonding surfaces.

Increased frequency of delayed type hypersensitivity to metals in patients with connective tissue disease

BACKGROUND

Connective tissue disease (CTD) is a group of inflammatory disorders of unknown aetiology. Patients with CTD often report hypersensitivity to nickel. We examined the frequency of delayed type hypersensitivity (DTH) (Type IV allergy) to metals in patients with CTD.

METHODS

Thirty-eight patients; 9 with systemic lupus erythematosus (SLE), 16 with rheumatoid arthritis (RA), and 13 with Sjögren's syndrome (SS) and a control group of 43 healthy age- and sex-matched subjects were included in the study. A detailed metal exposure history was collected by questionnaire. Metal hypersensitivity was evaluated using the optimised lymphocyte transformation test LTT-MELISA(®) (Memory Lymphocyte Immuno Stimulation Assay).

RESULTS

In all subjects, the main source of metal exposure was dental metal restorations. The majority of patients (87%) had a positive lymphocyte reaction to at least one metal and 63% reacted to two or more metals tested. Within the control group, 43% of healthy subjects reacted to one metal and only 18% reacted to two or more metals. The increased metal reactivity in the patient group compared with the control group was statistically significant (P<0.0001). The most frequent allergens were nickel, mercury, gold and palladium.

CONCLUSIONS

Patients with SLE, RA and SS have an increased frequency of metal DTH. Metals such as nickel, mercury and gold are present in dental restorative materials, and many adults are therefore continually exposed to metal ions through corrosion of dental alloys. Metal-related DTH will cause inflammation. Since inflammation is a key process in CTDs, it is possible that metal-specific T cell reactivity is an etiological factor in their development. The role of metal-specific lymphocytes in autoimmunity remains an exciting challenge for future studies.

Rubber dam isolation--key to success in diastema closure technique with direct composite resin

The use of direct composite resin for diastema closure has technique advantages, including that the restorative procedure can be carried out in one appointment at a reasonable cost and without the removal of sound tooth structure. The use of a rubber dam for closing diastemas with composite resin is of paramount importance as it prevents moisture contamination and ensures increased gingival retraction compared to other techniques. This provides better access to the cervical area of the tooth, facilitating proper placement of resin to recreate the natural anatomical contours and contact point. Thus, there is a more natural adaptation of the restoration to the gingival tissue, avoiding a space between the papilla and the restored tooth. To illustrate the advantages of this technique, two diastema closure cases are presented using direct composite resin with rubber dam isolation.

Use of a resin-modified glass-ionomer (RMGI) liner in conservative direct treatment of deep caries

Liners and bases are a class of dental materials that provide added protection for the health and well-being of a tooth being restored. They help prevent postoperative sensitivity resulting from an incomplete dentinal seal. Some practitioners use them, while others choose not to. In this case report, a resin-modified glass-ionomer (RMGI) liner was utilized in deep restorations on premolars that had old, existing amalgam restorations and were experiencing microleakage and sensitivity problems. The materials and technique used allowed for conservative treatment while delivering an esthetic and functionally pleasing result.

A restorative approach for class II resin composite restorations: a two-year follow-up

This clinical report describes a restorative technique used to replace two Class II resin composite restorations on the upper premolars. A sectional matrix band was used in conjunction with an elastic ring (Composi-Tight) to obtain tight proximal contact. A nanofilled resin composite (Filtek Supreme Ultra) was incrementally applied using oblique layers to reduce the C-factor, each layer being no more than 2 mm thick, and then light cured for 20 seconds with a light-emitting diode lamp (EliparFreeLight 2 LED Curing Light) with a power density of 660 mW/cm(2). A centripetal technique was used to restore the lost tooth structure from the periphery toward the center of the cavity in order to achieve a better contour and anatomy with less excess, thereby minimizing the use of rotary instruments during the finishing procedures. Finally, the resin composite restorations were finished and polished, and a surface sealer (Perma Seal) was applied to fill small gaps and defects that may have been present on the surfaces and margins of the restorations after the finishing and polishing procedures.

The effect of interincisal opening, cavity location and operator experience on the energy delivered by a light-curing unit to a simulated dental restoration

BACKGROUND

Curing of resin-based composites depends on the delivery of adequate total energy, which may be operator dependent. Aim To determine the effect of interincisal opening, cavity location and operator experience on the total energy delivered to simulated cavity preparation sites.

DESIGN

Three cohorts were included: junior dental nurses, senior dental nurses and qualified dentists (N=5, each cohort). Each operator (participant) followed the same procedure and light-cured two simulated restorations in a MARC patient simulator using a Demi light-curing unit for 20 seconds in each of the following situations: left upper second molar (UL7), interincisal opening at both 25 mm and 45 mm; upper central incisor (UR1), interincisal opening at 45mm. The light energy delivered by each operator in each situation was recorded. Five readings for each operator were taken at each interincisal distance. Statistical comparisons of delivered energy (J/cm2) between interincisal openings, location and groups in the total energy delivered were performed using the Kruskal-Wallis nonparametric test: alpha = 0.05.

RESULTS

Less total energy was delivered to the posterior cavity at 25mm (12.0 +/- 5.3 J/cm2) than at 45mm (16.9 +/- 5.6 J/cm2) by all operators (P < 0.05). At 45 mm, less total energy was delivered to the posterior cavity compared to the anterior cavity (25.1 +/- 7.4 J/cm2; P < 0.05). There was no statistically significant difference between junior nurses and qualified dentists (P > 0.05) but there was a significant difference in the total energy delivered between senior nurses (20.1 +/- 7.8 J/cm2) and junior nurses (17.5 +/- 7.6 J/cm2) and between senior nurses and qualified dentists (16.6 +/- 8.7 J/cm2) (P < 0.05).

CONCLUSIONS

Interincisal mouth opening, location of the cavity and operator experience affected the total energy delivered to cavities in a simulated clinical environment.

[Loading and strength of single- and multi-unit fixed dental prostheses. 1. Retention and resistance]

The degree to which single- and multi-unit fixed dental prostheses are able to withstand loading forces is dependent, among other things, on the quality of their retention and resistance. The quality of the retention and resistance of the configuration of an abutment tooth prepared for a metal and metal-ceramic single-unit fixed dental prosthesis is determined by the configuration's convergence angle, the height, the volume, the interocclusal space, the cervical outline design, the additional preparations, the quality of the (build-up) restoration, and the surface roughness. A silicate ceramic single-unit fixed dental prosthesis is attached through adhesion using a composite cement, but the retention and resistance of an oxide ceramic single-unit fixed dental prosthesis is dependent on the abutment tooth configuration. Most types of multi-unit fixed dental prosthesis have the following additional retention and resistance determining factors: the position in the occlusal system, the number of abutment teeth and their mutual configurations, and the length of (cantilever) pontics. A resin-bonded fixed partial denture's retention and resistance are determined by its bonding as well as its enamel surface coverage and its resistance preparations.

Evaluation of mercury contamination in patients and water during amalgam removal

AIM

The aim of this study was to evaluate mercury levels in wastewater and in patients during the removal of dental amalgam restorations.

MATERIALS AND METHODS

To test for mercury levels, patients were tested before and after amalgam restoration removal. To test for mercury emissions, samples of constant volume of wastewater from high-speed drills were collected before and during amalgam restoration removal.

RESULTS

Although the systemic mercury levels were lower than the limit of biological tolerance, all patients had increased levels after dental restorations. All samples of wastewater had increased mercury levels too.

CONCLUSION

The urinary levels of mercury increased with dental amalgam removal using a high-speed drill. During the process of amalgam removal, water used for cooling the dental drill was contaminated with mercury.

CLINICAL SIGNIFICANCE

The mercury released by the physical action of the drill, the replacement material and especially the final destination of the amalgam waste can increase contamination levels that can be a risk for human and environment health.

Direct composite restorations in anterior teeth. Managing symmetry in central incisors

In direct restorations of anterior teeth, particularly central incisors, symmetry plays an important role. The clinician can take advantage of silicone indexes based on a wax-up to build palatal and incisal walls; however, when he has to reproduce free-hand chair-side symmetrical items like interproximal emergence profiles, macro- and microsurface textures, and chromatic characteristics, the result can often be unpredictable. A step-by-step class IV restoration treatment will be described, as well as a simple procedure to help reproduce, check and correct symmetrically interproximal wall contours and chromatic characteristics.