Biological aspects of modern dental composites.

Biological evaluation of resin-based dental composites has traditionally been based on in vitro endpoint tests with different methods to determine loss of cell viability and cell morphology changes after exposure to the material or monomer constituents. The data reveals a potential for biological effects, but clinical relevance of such data is limited. Positive allergy tests and allergic clinical reactions to dental monomers are observed in dental personnel and patients. The aim of this review is to address newer research on molecular events caused by exposure to resin-based composites to have a better understanding of the potential for clinical adverse effects. A more accurate understanding of the biological aspects of dental composite materials has been found after studying parameters like glutathione depletion, oxidative stress, genotoxicity, and immunomodulatory key effects in various cell culture models. Using omics-based approaches allow for a broader and non-specified search of changes caused by methacrylate exposure. Defense mechanisms and adaption are observed in cells exposed to monomer concentrations relevant to clinical exposure. The above-mentioned methods are the foundations for modified testing strategies. The clinical relevance of most available in vitro endpoint tests is of limited relevance for the patient. Research focusing on molecular mechanisms has given new insight into methacrylate toxicity in exposed cells. Using this knowledge from mechanistic studies to develop standardized in vitro biocompatibility tests will likely improve their clinical relevance.

Shear bond strength of resin bonded zirconia and lithium disilicate - effect of surface treatment of ceramics and dentin.

Objectives:The purpose of the study was to investigate the effect of ceramic surface pretreatment, effect of resin cement and dentin surface roughness on shear bond strength. Methodology: Zirconia rods (n = 140) were randomly assigned to air born particle abrasion with aluminum oxide (Al2O3) or hot etching with potassium hydrogen difluoride (KHF2). Lithium disilicate rods (LDS; n = 50) etched with hydrofluoric acid served as reference material. In Part 1 of the study, ceramic rods were cemented to bovine dentin using 5 dual-polymerizing resin cements (Variolink Esthetic, Multilink Automix (Ivoclar Vivadent), Duo-Link (BISCO Dental), Panavia F2.0 (Kuraray Dental), RelyX Unicem (3 M)). Shear bond strength was tested and fracture morphology determined. In Part 2 of the study, test groups with the highest frequency of adhesive fractures between cement and dentin were selected for further bond strength testing with different surface roughness of dentin; ground with P1200 or P80 silicon carbide paper. Dentin samples were fractured vertically to the cemented surface and the adherence between cement and dentin was studied. Results: The results of Part 1 showed that hot etching of zirconia significantly improved bond strength to Duo-Link cement. In Part 2, RelyX Unicem showed significantly higher bond strength to P1200 compared to P80 ground dentin. For Variolink Esthetic, bond strengths to P1200 and P80 ground dentin were similar. Adhesive fracture between cement and dentin dominated. Conclusions: A smooth dentin surface (P1200) improved bond strength to RelyX Unicem. Surface roughness was not important for Variolink Esthetic.

The effect of minimally invasive sacroiliac joint fusion compared with sham operation: study protocol of a prospective double-blinded multicenter randomized controlled trial.

Background and purpose - The sacroiliac joint is increasingly recognized as a cause of pain in 15-30% of patients with low back pain. Nonoperative management is not always successful and surgical treatment with fusion of the joint is increasingly recommended. According to the literature, minimally invasive fusion reduces pain and improves function compared with nonoperative treatment. It is, however, unclear to what extent the placebo effect influences these results. Patients and methods - The trial is designed as a prospective multi-center, double-blind, randomized shamsurgery controlled trial with 2 parallel groups. 60 patients with a suspected diagnosis of sacroiliac joint pain confirmed with sacroiliac joint injection are included according to the trial inclusion criteria. Patients are randomized with a 1:1 allocation into 2 groups of 30 patients each. The primary end-point is group difference in sacroiliac joint pain intensity on the operated side at 6 months postoperatively, measured by the Numeric Rating Scale. The main objective is to examine whether there is a difference in pain reduction between patients treated with a minimally invasive fusion of the sacroiliac joint compared with patients undergoing a sham operation. Results - Unblinding occurs after the completed 6-month follow-up. The primary analysis will be performed when all patients have completed 6 months' follow-up. Follow-ups are continued to at least 2 years postoperatively. Data from the different groups will be compared based on the "intention to treat" principle.

The influence of the resin-based cement layer on ceramic-dentin bond strength.

The purpose of the study was to measure the cement thickness obtained when ceramic rods were luted to dentin and to analyze the relation between cement thickness and the previously published tensile bond strength of similar test specimens. In addition, the ISO standard 4049:2019 method was used to determine the film thickness of the used cements. Zirconia (n = 100) and lithium disilicate (n = 50) rods were cemented to bovine dentin using one of five different resin-based cements. The ceramic-dentin test specimens were cut into two slices and the cement thickness was measured using a scanning electron microscope and compared to the bond strength values of similar specimens already published. The mean cement thickness recorded for ceramic rods cemented to dentin was in the range 20-40 µm, which was larger than the cement film thickness found by the ISO method. The cement film thickness determined according to ISO standard methods did not concur with the results obtained when cementing ceramic rods to dentin. For cementing ceramic restorations, a cement thickness in the range 25-35 µm seems to be favorable for the bond strength.

Dentin to dentin adhesion using combinations of resin cements and adhesives from different manufacturers - a novel approach.

AIMS: The aims of this study were to present a novel method to analyse dentin bond strength and to evaluate the bond strength of combining adhesive systems and resin cement from different manufacturers. METHODS: Human wisdom teeth were ground flat to the dentin on parallel surfaces and axially cut into two parts. Dentin cylinders (Ø 3 mm) were drilled from one half of each tooth. The other half from each tooth was embedded in epoxy resin with the dentin surface exposed. The specimens were ground with silicone carbide paper and the dentin cylinders were cemented onto the dentin surface of the other half of the same tooth.Materials: Resin cement and adhesive systems from three different manufacturers were used in various combinations (n = 8 per group). Cement and adhesive from the same manufacturer served as control. Shear bond strength (SBS) was measured and fracture modes were registered.Results and conclusions: The highest median SBS value was found in a bonding combination between cement and a non-corresponding adhesive (33.1 MPa) and one of the lowest values was found in one of the controls (15.3 MPa). Cohesive fractures were most frequent. The results indicated that combining adhesive and cement from different manufacturers did not compromise the dentin bonding. The novel test method is recommended for evaluating dentin bonding.

Effect of thermal cycling on temperature changes and bond strength in different test specimens.

Objectives: To investigate temperature changes in various test specimens during thermal cycling and to evaluate difference in micro-tensile repair bond strength in specimens cut from the inner or the outer area of composite blocks after thermal cycling. Materials and methods: Four rectangular composite blocks of various sizes were fabricated, and thermocouples placed in the centre of the specimens or halfway from the surface to the centre. Composite cylinders were made on ground flat extracted molars, as intended for micro-tensile and shear bond testing, with a thermocouple placed at the centre of the cylinder radius between composite and dentin. The specimens were thermal cycled between 5 °C and 55 °C with 20-60 s dwell times. The highest and lowest temperatures in the test specimens were recorded. Composite blocks were fabricated and stored in water for a week and then repaired with the same composite. After thermal cycling (5000×, 5 °C and 55 °C with a 20 s dwell time), test specimens were cut for micro-tensile testing. Results: None of the specimens tested reached the cold and warm water bath temperatures after a 20 s dwell time. In the smallest composite block, the centre core temperature reached 5 °C and 55 °C after 40 s dwell time, but lacked 1 °C after 60 s in the largest block. None of the specimens involving teeth reached water temperatures. The micro-tensile repair strength was significantly different between the outer and the central cut rods (p < .05). Conclusions: The most commonly used dwell times for thermal cycling are insufficient to create a homogeneous temperature change.

Does radiopaque cement conceal periprosthetic bone loss around femoral stems?

BACKGROUND: Periprosthetic bone remodelling may increase fracture risk and deplete bone stock around hip implants. These changes are in part caused by implant design, advocating an early evaluation of bone remodelling properties of new implants. This can be done by repeated dual-energy x-ray absorptiometry (DXA) measurements. We know that radiopaque cement falsely elevates bone mineral density (BMD) in single measurements, however, its impact on repeated measurements, i.e. BMD changes is unexplored. We have therefore investigated whether the presence of radiopaque cement affect repeated BMD measurements. METHODS: 33 patients eligible for total hip replacement were randomly assigned to either radiopaque or radiolucent cement. BMD changes up to 12 months were measured by DXA, in addition to Harris Hip Score, plain radiographs and radiostereometric analysis (RSA). RESULTS: Periprosthetic BMD declined during the first 3-6 months in all zones in both groups. The greatest reduction (14%) was seen in the proximal Gruen zones (1 and 7). We found a significant difference in Gruen zones 1 and 2, where the measured bone loss was higher in the radiolucent cement group. CONCLUSIONS: The presence of radiopaque agents in bone cement may influence DXA measurements of bone remodelling.ClinicalTrials.gov identifier NCT00473421.

The dental monomer HEMA causes proteome changes in human THP-1 monocytes.

Resin-based biomaterials are widely used in medical and dental treatment, and both clinicians and patients are exposed to the materials. The knowledge of toxicity is mainly based on in vitro studies at exposure concentrations that induce cell death. However, severe cell damage and cell death signaling may overshadow essential cellular events caused by a possible toxicant. For dental resins, the knowledge of interaction with living cells at more clinical relevant exposure doses is sparse. 2-Hydroxyethylmethacrylate (HEMA) is a commonly used monomer in dental resins. Measuring cellular adaptation to HEMA at concentrations that did not reduce cell viability was the main focus of this study. Stable isotope labeling with amino acids in cell culture was used to measure proteome changes in cultured THP-1 cells exposed to HEMA. Western blotting verified the results. Cells exposed to HEMA increased their level of several cytoprotective proteins. The observed adaptation is compatible with increased oxidative burden caused by GSH depletion and the electrophilic characteristic of HEMA. The present approach to analyzing the toxic potential of HEMA yielded information on interactions with living cells is not previously reported. This detailed information is of great value to make better predictions of possible side effects in the clinic. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 851-859, 2019.

Digital evaluation of marginal and internal fit of single-crown fixed dental prostheses.

The present study used a new, digitized version of the impression replica technique, namely the dual-scan technique, to evaluate the adaptation of single-crown fixed dental prostheses (FDPs). Scans of the bare master model and of the master model with a silicone layer representing the cement layer were superimposed and analyzed using designated software. Single crowns produced using the lost-wax metal casting technique were included. The cement space of the band width, 0.5-1.0 mm from the preparation margin (marginal fit), was smallest for crowns made from laser-sintered cobalt-chromium. The internal fit in both mesial-distal and buccal-palatal directions was statistically significantly better for crowns made using the conventional lost-wax metal casting technique than for crowns produced using computer-aided design/computer-aided manufacturing (CAD/CAM). Fixed dental prostheses produced by milled cobalt-chromium had the loosest internal fit. The results agree with those of our previous study of the same test specimens, in which the triple-scan method was used, and imply that the dual-scan method is well suited for adaptation studies.

Optimizing quality and safety of dental materials.

This paper discusses aspects of quality and safety improvement of the most commonly used dental restorative materials, the resin-based composites. From a patient's perspective, long-lasting resin-based restorations without complications are important. Recurrent caries and fracture are the most common causes for restoration failures. Proper handling and curing of the composites improve the mechanical properties of the restorations and increase safety by reducing exposure to residual methacrylate monomers. A number of compounds have been introduced in restorative materials to reduce the risk of recurrent caries, even though a real breakthrough has not yet been achieved. It is concluded that simple measures may improve the quality and safety of resin-based composite restorations.

Higher cartilage wear in unipolar than bipolar hemiarthroplasties of the hip at 2 years: A randomized controlled radiostereometric study in 19 fit elderly patients with femoral neck fractures.

Background and purpose - The use of unipolar hemi-arthroplasties for femoral neck fractures is increasing in some countries due to reports of higher reoperation rates in bipolar prostheses. On the other hand, it has been proposed that bipolar hemiarthroplasties have clinical advantages and less cartilage wear than unipolar hemiarthroplasties. We compared cartilage wear between bipolar and unipolar hemiarthroplasties using radiostereometric analyses (RSA), in patients aged 70 years or older. Patients and methods - 28 ambulatory, lucid patients were randomized to treatment with a unipolar or a bipolar hemiarthroplasty for an acute femoral neck fracture. Migration of the prosthetic head into the acetabulum was measured using RSA. Secondary outcomes were Harris Hip Score (HHS), and EQ-5D scores. Patients were assessed at 3, 12. and 24 months. Results - 19 patients were available for follow-up at 2 years: mean proximal penetration was 0.83 mm in the unipolar group and 0.24 mm in the bipolar group (p = 0.01). Mean total point movement was 1.3 mm in the unipolar group and 0.95 mm in the bipolar group (p = 0.3). Median HHS was 78 (62-96) in the unipolar group and 100 (70-100) in the bipolar group (p = 0.004). Median EQ-5D Index Score was 0.73 (0.52-1.00) in the unipolar group and 1.00 (0.74-1.00) in the bipolar group (p = 0.01). Median EQ-5D VAS was 70 (50-90) in the unipolar group and 89 (70-95) in the bipolar group (p = 0.03) Interpretation - Patients with unipolar hemiarthroplasties had higher proximal cartilage wear and lower functional outcomes. Unipolar hemiarthroplasties should be used with caution in ambulatory, lucid patients.

Internal fit of three-unit fixed dental prostheses produced by computer-aided design/computer-aided manufacturing and the lost-wax metal casting technique assessed using the triple-scan protocol.

Suboptimal adaptation of fixed dental prostheses (FDPs) can lead to technical and biological complications. It is unclear if the computer-aided design/computer-aided manufacturing (CAD/CAM) technique improves adaptation of FDPs compared with FDPs made using the lost-wax and metal casting technique. Three-unit FDPs were manufactured by CAD/CAM based on digital impression of a typodont model. The FDPs were made from one of five materials: pre-sintered zirconium dioxide; hot isostatic pressed zirconium dioxide; lithium disilicate glass-ceramic; milled cobalt-chromium; and laser-sintered cobalt-chromium. The FDPs made using the lost-wax and metal casting technique were used as reference. The fit of the FDPs was analysed using the triple-scan method. The fit was evaluated for both single abutments and three-unit FDPs. The average cement space varied between 50 µm and 300 µm. Insignificant differences in internal fit were observed between the CAD/CAM-manufactured FDPs, and none of the FPDs had cement spaces that were statistically significantly different from those of the reference FDP. For all FDPs, the cement space at a marginal band 0.5-1.0 mm from the preparation margin was less than 100 µm. The milled cobalt-chromium FDP had the closest fit. The cement space of FDPs produced using the CAD/CAM technique was similar to that of FDPs produced using the conventional lost-wax and metal casting technique.

Effect of curing and silanizing on composite repair bond strength using an improved micro-tensile test method.

Objectives: To evaluate the micro-tensile repair bond strength between aged and new composite, using silane and adhesives that were cured or left uncured when new composite was placed. Methods: Eighty Filtek Supreme XLT composite blocks and four control blocks were stored in water for two weeks and thermo-cycled. Sandpaper ground, etched and rinsed specimens were divided into two experimental groups: A, no further treatment and B, the surface was coated with bis-silane. Each group was divided into subgroups: (1) Adper Scotchbond Multi-Purpose, (2) Adper Scotchbond Multi-Purpose adhesive, (3) Adper Scotchbond Universal, (4) Clearfil SE Bond and (5) One Step Plus. For each adhesive group, the adhesive was (a) cured according to manufacturer's instructions or (b) not cured before repair. The substrate blocks were repaired with Filtek Supreme XLT. After aging, they were serially sectioned, producing 1.1 × 1.1 mm square test rods. The rods were prepared for tensile testing and tensile strength calculated at fracture. Type of fracture was examined under microscope. Results: Leaving the adhesive uncured prior to composite repair placement increased the mean tensile values statistically significant for all adhesives tested, with or without silane pretreatment. Silane surface treatment improved significantly (p < 0.001) tensile strength values for all adhesives, both for the cured and uncured groups. The mean strength of the control composite was higher than the strongest repair strength (p < 0.001). Conclusions: Application of freshly made silane and a thin bonding layer, rendered higher tensile bond strength. Not curing the adhesive before composite placement increased the tensile bond strength.

Internal fit of single crowns produced by CAD-CAM and lost-wax metal casting technique assessed by the triple-scan protocol.

STATEMENT OF PROBLEM: Whether single crowns produced by computer-aided design and computer-aided manufacturing (CAD-CAM) have an internal fit comparable to crowns made by lost-wax metal casting technique is unknown. PURPOSE: The purpose of this in vitro study was to compare the internal fit of single crowns produced with the lost-wax and metal casting technique with that of single crowns produced with the CAD-CAM technique. MATERIAL AND METHODS: The internal fit of 5 groups of single crowns produced with the CAD-CAM technique was compared with that of single crowns produced in cobalt-chromium with the conventional lost-wax and metal casting technique. Comparison was performed using the triple-scan protocol; scans of the master model, the crown on the master model, and the intaglio of the crown were superimposed and analyzed with computer software. The 5 groups were milled presintered zirconia, milled hot isostatic pressed zirconia, milled lithium disilicate, milled cobalt-chromium, and laser-sintered cobalt-chromium. RESULTS: The cement space in both the mesiodistal and buccopalatal directions was statistically smaller (P<.05) for crowns made by the conventional lost-wax and metal casting technique compared with that of crowns produced by the CAD-CAM technique. CONCLUSIONS: Single crowns made using the conventional lost-wax and metal casting technique have better internal fit than crowns produced using the CAD-CAM technique.

Silanising agents promote resin-composite repair.

OBJECTIVE: The aim of this study was to investigate the effect of silane in the repair of old and new resin-composite restorations. METHOD: Part 1: repair of old composite was performed on 60 resin-composite substrates that were 6 years old and were made of six different brands of composite. Three experiments were performed. In the first experiment, the substrates were ground flat and composite was fixed to the surface with bonding agent without silane (i.e. Clearfil Bond SE only, the control). Shear bond strength (SBS) was tested according to ISO/TS 11405 after thermocycling. In the second experiment, the same 60 substrates were ground again and treated with bis-silane a 2-part silane mixed shortly before application before applying bonding agent (Clearfil Bond SE plus silane) and repair composite before SBS testing. In the third experiment, the same substrates were ground again and a one-step bonding product containing silane (Scotchbond Universal bond containing silane) was used for the repair procedure before SBS testing. Part 2: to evaluate the repair of newly made composite restorations, 66 composite substrates were made and stored in water for 2 months. The specimens were divided into three groups and were tested using the same protocols as used to evaluate repair of old composite. RESULTS: Mean SBS (± standard deviation), in MPa, for repair of old composite was 6.2 ± 4.0 (Clearfil Bond SE only, control), 14.8 ± 7.8 (Clearfil Bond SE plus silane) and 15.3 ± 5.6 (Scotchbond Universal bond with silane), whereas for new composite mean SBS was 15.4 ± 8.6 (Clearfil Bond SE only, control), 23.4 ± 8.3 (Clearfil Bond SE with silane) and 23.7 ± 5.8 (Scotchbond Universal containing silane). A significant difference was observed between the control and the test groups with silanising agents, both in Part 1 (P < 0.001) and in Part 2 (P < 0.005). CONCLUSION: Silanising agents increase the bond strength of the resin composite repair.