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.

In Vitro Evaluation of Candida albicans Adhesion and Related Surface Properties of CAD/CAM Denture Base Resins.

OBJECTIVE: The aim of this study was to evaluate the surface roughness, contact angle, and adhesion of Candida albicans to computer-aided designing/computer-aided manufacturing (CAD/CAM) and heat-polymerized (HP) denture base materials. MATERIALS AND METHODS: Specimens were allocated to six groups based on the composition of studied denture base materials, HP acrylic resin, milled resins (AvaDent and IvoCad), and 3D-printed resins (ASIGA, FormLabs, and NextDent). Ten specimens per group were used for each test (n = 10/test). Surface roughness and contact angles were analyzed using profilometer and goniometer, respectively. Adhesion of C. albicans was counted using colony-forming unit (CFU/mL). Means and standard deviations were calculated, and then one-way analysis of variance (ANOVA), followed by Tukey's post hoc test. Correlation of Candida adhesion and surface parameters was determined by using Pearson's correlation analysis. RESULTS: No statistically significant difference was noted in surface roughness between HP, milled, and 3D-printed denture base resins except NextDent, which showed significantly higher roughness in comparison to all other resins (p = 0.001). In terms of contact angle, milled resins had the lowest value, followed by HP, ASIGA, and FormLabs, whereas NextDent showed the highest contact angle (p = 0.001). C. albicans adhesion showed no significant difference between all denture base resins. A positive and significant correlation was found between C. albicans adhesion and contact angle (p = 0.003), while no correlation was reported between C. albicans adhesion and surface roughness (p = 0.523). CONCLUSION: Adhesion of C. albicans was similar in all tested specimens. Surface roughness showed no significant difference between all groups except NextDent, which had the highest value. Milled denture base resins had the lowest contact angle among all groups.

Comparative evaluation of the accuracy of 3D-printed denture teeth.

Objective: This in vitro study compares the accuracy and trueness of various 3D-printed denture teeth. Methods: A total of 30 specimens were created using various 3D-printed resins, 10 each using Asiga DentaTOOTH resin (Asiga, Australia), Formlabs Denture Teeth Resin (Formlabs GmbH, Germany), and NextDent C&B MFH (Micro Filled Hybrid) resin (Nextdent B.V., Netherlands), respectively. A prefabricated mandibular first molar was scanned using a desktop laser scanner (E3, 3Shape A/S) to create a standard tessellation language file, which served as a "reference tooth" scan. That file was sent to each corresponding printer for printing according to manufacturer recommendations. The printed teeth were scanned with an intraoral scanner (TRIOS 3, 3shape, Copenhagen, Denmark). Trueness and precision were assessed using 3D morphometric analysis software (Geomagic Control X, 3D Systems, Rock Hill, SC, USA). One-way ANOVA was used to analyze the data (α = 0.05). Root mean square error and mean deviations were also calculated. Data analysis was carried out using SPSS (IBM Corp., New York, NY, USA) software. One-way ANOVA with Tukey's post hoc analysis was used. P-values of<0.05 were regarded as statistically significant. Results: The overall trueness of teeth followed a similar pattern, with the highest trueness recorded with NextDent specimens, while ASIGA specimens had the lowest. When precision was assessed, there were significant differences in occlusal areas between FormLabs and NextDent specimens (p = 0.01) and between FormLabs and ASIGA specimens (p = 0.002). However, ASIGA and NextDent did not differ from one another (p = 0.9). The precision analysis shows that all tested groups had similar values, with no significant differences among them. Conclusion: The trueness values of the tested printing systems varied, although the precision values were similar. All evaluated printing systems achieved printing accuracy falling within the clinically acceptable range.

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.

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.

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.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials.

PURPOSE: To compare flexural strength, elastic modulus, and surface hardness of computer aided design and computer aided manufacturing 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 and then 3D-printed resins (p < 0.001). Within milled groups, flexural strength of AvaDent was significantly higher than IvoCad (p < 0.001), while elastic modulus and hardness didn't show significant difference. Within 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 in flexural strength (p = 0.357), elastic modulus (p = 1.00), or 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 clinically acceptable values.

Customized Post and Cores Fabricated with CAD/CAM Technology: A Literature Review.

Post and core restorations are a widely accepted method to restore endodontically treated teeth with compromised tooth structure. The use of computerized technology to fabricate customized post and cores is a simple and quick alternative to conventional methods. A literature search was conducted, and a summary of articles describing fabrication techniques and materials used to fabricate post and cores with computer-aided design and computer-aided manufacturing (CAD/CAM) has been provided. Several techniques have been reported to restore endodontically treated teeth with CAD/CAM post and cores, including direct and indirect methods. Zirconia, composite resin, and hybrid ceramic were the most commonly reported materials. Published reports on CAD/CAM post and core are limited; however, further studies are needed to investigate the long-term outcome of this treatment.

Printing Accuracy and Flexural Properties of Different 3D-Printed Denture Base Resins.

Digital dentures can be fabricated by subtractive milling or, more recently, by 3D-printing technology. Several different 3D-printing technologies and materials are commercially available, and the differences in printing accuracy and mechanical behavior among them are unknown. AIM: This study evaluated the printing accuracy of 3D-printed denture base resins and assessed their flexural properties when compared with conventional heat-polymerized ones. METHODS: A total of 40 acrylic specimens were prepared with four different materials: three 3D-printed resins, and a conventional heat polymerized resin was used as a control. The printing accuracy was evaluated by calculating the error rate of 3D-printed specimens compared with dimensions of the virtual design. Flexural strength and elastic modulus were assessed with a universal testing machine. One-way ANOVA and Kruskal-Wallis tests were used for analysis. RESULTS: Printing accuracy across the tested materials was statistically different. Specimen length showed error rates between 1.3% and 2.4%, specimen width had error rates between 0.2% and 0.7%, and specimen thickness had error rates between 0.2% and 0.6%. Three-dimensional-printed specimens had lower flexural strength and elastic modulus values when compared with heat-polymerized specimens. CONCLUSIONS: The choice of material seems to influence printing accuracy, and to a lesser extent, flexural strength. However, it has no effect on the elastic modulus.

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 resin. 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 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.

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.

Reducing the need to maintain fixed complete dentures by providing gold occlusal surfaces: A clinical report.

The excessive occlusal wear of complete-arch implant-supported prostheses made with metal and acrylic resin is a clinical complication that can require repeated maintenance in certain patients. A patient who presented with moderate occlusal wear of the prosthetic teeth and substantial fracture of the maxillary anterior acrylic resin base only 2 years after a previous replacement of the acrylic resin base and denture teeth is described. Because of the patient's history and existing wear, both the maxillary and mandibular prostheses were repaired by replacing the acrylic resin bases and resin denture teeth but with the addition of cast gold occlusal surfaces on the posterior prosthetic teeth. The provided treatment helped this patient, who was likely to need more frequent maintenance visits in the future because of his history of accelerated occlusal wear and increased occlusal force.

Effect of Ageing Process and Brushing on Color Stability and Surface Roughness of Treated White Spot Lesions: An in vitro Analysis.

PURPOSE: To evaluate the effect of ageing process and brushing on the color stability and surface roughness of white spot lesions treated with resin infiltration or remineralization. PATIENTS AND METHODS: Artificial white spot lesions were created on the facial surface of extracted bovine teeth. Specimens were divided into three main groups based on treatment received: resin infiltration (Icon), MI Paste Plus (MI) or no treatment (control). Specimens underwent pH cycling for 7 days, followed by brushing with toothbrush simulator. Specimens were then immersed in three different solutions (water, cranberry juice, or coffee) for 7 days. Surface roughness (SR) and color stability (CS) assessments were performed at baseline and after each test. One-way and two-way ANOVA were used to calculate the statistical comparisons between the groups and significance considered at P <0.05. RESULTS: Icon group had the least color change after pH cycling, while MI showed the least color change after brushing test. Immersion in coffee produced the highest color change in all groups, followed by cranberry juice. Icon group had the best color stability when immersed in cranberry juice or coffee. Control and the MI treated specimens showed gradual increase of SR after pH cycling and brushing test, while Icon group had improved surface properties. Brushing test alone produced less color change in comparison with immersion in cranberry juice and coffee; however, brushing increased SR. CONCLUSION: Icon treatment showed superior color stability and surface roughness, compared to the control and the MI treated teeth. Brushing had less influence on color change compared to the immersion in cranberry juice or coffee.

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.

Knowledge of dentists, dental auxiliaries, and students regarding the COVID-19 pandemic in Saudi Arabia: a cross-sectional survey.

BACKGROUND: This study aimed to assess the knowledge of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. RESULTS: A total of 1,033 questionnaires were collected (273 dental students, 193 dental auxiliary personnel, 544 dentists). In all, 63.4% of the respondents worked in hospitals. Of all the respondents, 44.9%, 33.4%, and 21.7% worked in governmental clinics, academia, and the private sector, respectively. Overall knowledge of the incubation period and route of transmission of SARS-CoV-2 was consistent across all dental professions. Knowledge of hand-soap cleaning time was significantly different among dental professionals (p < 0.001). Dental professionals displayed significant disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of the respondents were reluctant to treat a suspected COVID-19 patient, and 92% of the participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of the participants. CONCLUSIONS: Dental professionals seem to be consistent regarding their knowledge of the incubation period of SARS-CoV-2. However, knowledge of viral survivability and recommended hand-soap washing time was significantly variable among the professionals. A high degree of apprehension toward suspected COVID-19 patients existed among all dental professionals. Pandemic-awareness campaigns are essential among healthcare providers.

Stainability of acrylic resin materials used in CAD-CAM and conventional complete dentures.

STATEMENT OF PROBLEM: The effect of staining beverages on the color of dentures made with computer-aided design and computer-aided manufacturing (CAD-CAM) is unknown. PURPOSE: The purpose of this in vitro study was to evaluate the stainability of acrylic resins used in CAD-CAM-fabricated complete dentures compared with conventional materials. MATERIAL AND METHODS: Acrylic resin denture teeth from 3 different manufacturers (2 conventional and 1 milled) were obtained (N=45). Denture base acrylic resin specimens were made with 3 different techniques (compression molding, injection molding, and milling) (N=45). Conventional and/or milled acrylic resins were used to make specimens comprising both denture teeth and denture base acrylic resins (4 conventional, 2 milled denture bases with bonded teeth, and 1 all-milled) (N=105). All specimens were then immersed in coffee, red wine, or distilled water as control. The CIELab color differences between before and after immersion were determined by using a VITA Easyshade spectrophotometer. The tooth-denture base interface of the denture blocks was evaluated visually for the presence of stain. The CIELab data were analyzed by using ANOVA, and chi-square test was used for visual assessment (α=.05). RESULTS: Significant interactions were found between each acrylic resin material and each staining solution immersion when compared with distilled water immersion (P<.001). Denture teeth had similar color change after immersion in coffee (P=.149), while the most pronounced color change was observed with Portrait teeth upon immersion in wine (P<.001). Injection-molded denture base specimens exhibited less color change upon staining in wine than compression-molded or milled specimens (P<.001). Upon staining in coffee, milled specimens were not significantly different from injection- (P=.053) and compression-molded specimens (P=.180). The chi-square test showed a significant association between processing technique and stain accumulation at the tooth-denture base interface when evaluated visually (P<.001). Stain accumulation was greatest with compression-molded specimens (58%), followed by injection-molded (43%) and milled specimens with bonded teeth (8%). Monolithic teeth with milled denture base had no stain deposits at the tooth-denture base interface. CONCLUSIONS: The stainability of milled acrylic resins was no better than that of conventional materials. However, CAD-CAM milled denture blocks with teeth and base acrylic resins had greater resistance to stain accumulation at the tooth-denture base interface than those of conventional processing methods.

Protein-repelling adhesive resin containing calcium phosphate nanoparticles with repeated ion-recharge and re-releases.

OBJECTIVES: The objectives were to develop a calcium (Ca) and phosphate (P) ion-rechargeable and protein-repellent adhesive containing nanoparticles of amorphous calcium phosphate (NACP) and 2-methacryloyloxyethyl phosphorylcholine (MPC), and investigate the MPC effects on ion recharge and re-releases for the first time. METHODS: Pyromellitic glycerol dimethacrylate and ethoxylated bisphenol-A dimethacrylate were used to fabricate adhesive PEHB. Six adhesives were tested: (1) Scotchbond (SBMP); (2) PEHB, (3) PEHB + 20%NACP; (4) PEHB + 30%NACP; (5) PEHB + 20%NACP+3%MPC; (6) PEHB + 30%NACP+3%MPC. Dentin shear bond strength, Ca/P ion release, recharge and re-release, and protein adsorption were measured. A microcosm biofilm model was tested for lactic-acid production and colony-forming units (CFU). RESULTS: Adding NACP + MPC did not negatively affect dentin bond strength (p > 0.1). With increasing the number of recharge/re-release cycles, the Ca/P ion re-release reached similarly higher levels (p > 0.1), indicating long-term remineralization capability. One recharge enabled the adhesives to have continued re-releases for 21 days. Incorporation of 3% MPC yielded 10-fold decrease in protein adsorption, and 1-2 log decrease in biofilm CFU. CONCLUSIONS: The new rechargeable adhesive with MPC + 30%NACP greatly reduced protein adsorption, biofilm growth and lactic acid. Incorporation of MPC did not compromise the excellent Ca/P ion release, rechargeability, and dentin bond strength. CLINICAL SIGNIFICANCE: Novel bioactive adhesive containing MPC + NACP is promising to repel proteins and bacteria, and inhibit secondary caries at the restoration margins. The method of NACP + MPC to combine CaP-recharge and protein-repellency is applicable to the development of a new generation of materials including composites and cements to suppress oral biofilms and plaque formation and protect tooth structures.

Nanostructured Polymeric Materials with Protein-Repellent and Anti-Caries Properties for Dental Applications.

Dental caries is prevalent worldwide. Tooth cavity restorations cost more than $46 billion annually in the United States alone. The current generation of esthetic polymeric restorations have unsatisfactory failure rates. Replacing the failed restorations accounts for 50⁻70% of all the restorations. This article reviewed developments in producing a new generation of bioactive and therapeutic restorations. This includes: Protein-repellent and anti-caries polymeric dental composites, especially the use of 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminododecyl methacrylate (DMAHDM); protein-repellent adhesives to greatly reduce biofilm acids; bioactive cements to inhibit tooth lesions; combining protein-repellency with antibacterial nanoparticles of silver; tooth surface coatings containing calcium phosphate nanoparticles for remineralization; therapeutic restorations to suppress periodontal pathogens; and long-term durability of bioactive and therapeutic dental polymers. MPC was chosen due to its strong ability to repel proteins. DMAHDM was selected because it had the most potent antibacterial activity when compared to a series of antibacterial monomers. The new generation of materials possessed potent antibacterial functions against cariogenic and periodontal pathogens, and reduced biofilm colony-forming units by up to 4 logs, provided calcium phosphate ions for remineralization and strengthening of tooth structures, and raised biofilm pH from a cariogenic pH 4.5 to a safe pH 6.5. The new materials achieved a long-term durability that was significantly beyond current commercial control materials. This new generation of bioactive and nanostructured polymers is promising for wide applications to provide therapeutic healing effects and greater longevity for dental restorations.