An in-vitro study on effects of laser activation on dye penetration in human root dentin.

Objective: To evaluate the penetration of a dye in root dentin after activation with different laser wavelengths. Materials: Palatal roots of 38 human molars were enlarged and disinfected. Irrigation activation was performed with an Er:YAG laser: @50 mJ, 15 Hz (Er:YAG); a 9.3 µm CO2 laser: @40% power (CO2); diode lasers 455 nm/970 nm: @0.8 W, 15 Hz (D455, D970) and 808/980 nm: @1 W (D808, D980) and compared to positive control: etching with 35% H3PO4 (POS); negative control: water (NEG) and conventional needle irrigation: NaOCl and ethylenediaminetetraacetic acid (EDTA) (CONV). Methylene blue solution was introduced in the canal and laser-activated or left untouched for 100 s before the roots were dried and cut into horizontal slices. Dye penetration was automatically calculated by color recognition of two samples per root third (n = 8 per group in each coronal, middle and apical root thirds). The presence and absence of a smear layer was checked in two additional samples of the negative and positive control under scanning electron microscopy (SEM). Results: Full-depth infiltration was not achieved in any group. Dye penetration in CONV was significantly less than in Er:YAG, CO2, POS, D455, D970, D808 and similar to NEG and D980 when results of different root thirds were pooled. Conclusion: Laser activation using certain parameters enhanced dye penetration compared to conventional needle irrigation with NaOCl and EDTA (CONV).

Effect of brushing simulation on the wear behavior of repaired CAD-CAM restorations.

OBJECTIVE: The aim of the present study was to evaluate the influence of multidirectional brushing on the surface roughness, morphology, and bonding interface of resin-repaired CAD-CAM ceramic and composite restorations. MATERIALS AND METHODS: Twelve (N = 12) blocks (4 mm × 4 mm × 2 mm for parallel axis; 5 mm × 4 mm × 2 mm for perpendicular axis) of lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar AG) and CAD-CAM resin composite (Tetric CAD, Ivoclar AG) were obtained and repaired with direct resin composite (Clearfil AP-X, Kuraray). An abrasive slurry was prepared and the brushing was performed according to each restorative material and axis of brushing (n = 6; perpendicular to repair interface and parallel to repair interface) during 3,650 cycles (240 strokes per minute) to simulate 3 years of brushing. The surface roughness (Ra) and the profile variation for each material (restoration and direct repair resin composite) were measured at the baseline condition and after brushing, and the mean roughness and presence of steps at the repair interface were evaluated through factorial analysis of Variance (ANOVA). Scanning Electron Microscopy (SEM) images were taken to evaluate the surface topography of the repaired materials after brushing. RESULTS: The mean roughness of the repaired CAD-CAM restorations was affected by the brushing (P < .05), mainly when evaluating the repair material and the interface (P < .05), while the restorative CAD-CAM materials presented more stable values. The profile evaluation showed higher steps at the interface when repairing lithium disilicate than for CAD-CAM resin composite. CONCLUSION: Repaired CAD-CAM restorations were susceptible to wear after brushing simulation. The surface roughness of the direct resin composite was the most affected leading to step development at the interface, particularly in the repaired lithium disilicate samples. Cinical maintenance recalls and polishing protocols must be considered to enhance the longevity of such restorations.

Activation of endodontic irrigants using a 9.3 µm CO2 and diode lasers: A laboratory proof of concept model.

PURPOSE: To investigate the differences between irrigant propagation and temperature changes using laser-activated irrigation (LAI) at different settings in an artificial root canal model. METHODS: Using an artificial resin root canal model, irrigant activation was achieved in 19 experimental groups with eight samples each. A 9,300 nm CO2 laser, two diode lasers with different settings (wavelengths 455, 808, 970, and 980 nm) were compared to 2,940 nm Er:YAG laser and traditional needle irrigation. Er:YAG and CO2 laser were activated in the pulpal chamber only, while diode lasers and needles were inserted into the main root canal. Lasers were activated for 5x 20 seconds resulting in 100 seconds of activation or rinsing for each sample. After each activation of 20 seconds, a photo was taken of the side canals and the propagation of the dye was measured with a digital measuring tool after calibration. Further, the temperature of the irrigant was reported after activation of 20 seconds and repeated 5 times. Data were checked for normality and statistically compared. RESULTS: All lasers increased the irrigant propagation compared to conventional irrigation. Significant differences were found between groups regarding propagation and temperature (P< 0.0027). Er:YAG and CO2 laser had similar effects on irrigant propagation in middle and apical located side-canals with specific power parameters and were superior to diode lasers and syringe irrigation. The irrigant's temperature increased significantly with the diode and CO2 lasers. CLINICAL SIGNIFICANCE: Diode lasers and CO2 lasers have not been established for irrigant activation. 9,300 nm CO2 lasers absorb well in water and were shown to introduce vapor bubble formation and streaming in water. Diode lasers are highly accepted in periodontics. The laser light is not absorbed in water but interacts with bacteria as well as soft tissues and contributes therefore to infection control. With a modified laser tip it was however possible to introduce cavitation and streaming in irrigants.

Effect of crown retention systems and loading direction on the stress magnitude of posterior implant-supported restorations: A 3D-FEA.

This study aimed to investigate the effect of four retention systems for implant-supported posterior crowns under compressive loading using three-dimensional finite element analysis. A morse-taper dental implant (4.1 × 10 mm) was designed with Computer Aided Design software based on non-uniform rational B-spline surfaces. According to International Organization for Standardization 14,801:2016, the implant was positioned at 3 mm above the crestal level. Then four models were designed with different crown retention systems: screw-retained (A), cement-retained (B), lateral-screw-retained (C), and modified lateral-screw-retained (D). The models were imported to the analysis software and mesh was generated based on the coincident nodes between the juxtaposed lines. For the boundary conditions, two loads (600 N) were applied (axial to the implant fixture and oblique at 30°) totaling 8 conditions according to retention design and loading. The von-Mises stress analysis showed that different retention systems modify the stress magnitude in the implant-supported posterior crown. There is a similar stress pattern in the implant threads. However, models C and D presented higher stress concentrations in the crown margin in comparison with A and B. The oblique loading highly increased the stress magnitude for all models. In the simulated conditions, part of the stress was concentrated at the lateral screw under axial loading for model C and oblique loading for model D. The results indicate a possible new failure origin for crown retained using lateral screws in comparison to conventional cement-retained or screw-retained systems.

Repair protocols for indirect monolithic restorations: a literature review.

Despite the advancements in indirect monolithic restorations, technical complications may occur during function. To overcome this issues, intraoral repair using resin composite is a practical and low-cost procedure, being able to increase the restoration's longevity. This review aimed to evaluate the need for repair and suggest a standardized repair protocol to the main indirect restorative materials. For this, studies were surveyed from PubMed with no language or date restriction, to investigate the scientific evidence of indirect monolithic restoration repair with direct resin composite. A classification to guide clinical decisions was made based on the FDI World Dental Federation criteria about defective indirect restorations considering esthetic and functional standards, along with the patient's view, to decide when polishing, repairing or replacing a defective restoration. Based on 38 surveyed studies, different resin composite intraoral repair protocols, that included mechanical and chemical aspects, were defined depending on the substrate considering resin-based, glass-ceramic or zirconia restorations. The presented criteria and protocols were developed to guide the clinician's decision-making process regarding defective indirect monolithic restorations, prolonging longevity and increasing clinical success.

Effect of Surface Treatment and Resin Cement on the Bond Strength of an Advanced Lithium Disilicate.

OBJECTIVES: The aim of the study was to evaluate the effect of surface treatment and resin cement on the bond strength of conventional and advanced lithium disilicates (ALDs). MATERIALS AND METHODS: Ceramic slices (2 × 13 × 15 mm) of conventional lithium disilicate (LD) (IPS e.max CAD) and ALD (CEREC Tessera) were sectioned, polished, and divided into 16 groups (n = 10) according to the factors: ceramic, surface treatment, and resin cement (Panavia V5 and Variolink Esthetic DC). Surface treatments consisted of hydrofluoric acid 4.9% etching for 20 seconds (Hf20) or 30 seconds (Hf30), self-etching ceramic primer (Se), and sandblasting (Sb). Then, a resin cement cylinder (Ø = 2.5 mm) was manufactured on each specimen's surface. The specimens were then submitted to a shear bond strength (SBS) test. Surface roughness was evaluated through a contact profilometer, and surface morphology was evaluated under scanning electron microscopy for qualitative analysis. STATISTICAL ANALYSIS: Two-way analysis of variance (ANOVA) was used to analyze the data of SBS and surface roughness. For bond strength, the effects of surface treatment, resin cement, and the interaction were analyzed for each ceramic. For roughness, analyzed factors include ceramic and surface treatment. RESULTS: ANOVA revealed that ceramic (p = 0.047) and surface treatment (p < 0.001) factors affected the bond strength, while the cements performed similarly. Both materials showed adequate bond strength (ALD 19.1 ± 7.7 MPa; LD 17.1 ± 7.9 MPa). Sb protocol showed the lowest mean value (9.6 ± 2.9 MPa) compared with Hf20 (22.0 ± 7.1 MPa), Hf30 (21.7 ± 7.4 MPa), and Se (19.3 ± 6.0 MPa). CONCLUSION: For both ceramics, the highest performance was obtained after applying Se and Hf20 or Hf30. Therefore, longer etching time is unnecessary. Sb protocol must be avoided.

Effect of printing layer orientation and polishing on the fatigue strength of 3D-printed dental zirconia.

OBJECTIVE: The aim of the study was to evaluate the influence of surface polishing and printing layer orientation on the fatigue behaviour of 3 mol% yttria-stabilized zirconia (3Y-TZP) by stereolithography (SLA) in comparison with subtractive manufacturing. MATERIALS AND METHODS: 60 experimental zirconia bar-shaped specimens were 3D-printed (P) via SLA, and 30 specimens were milled (M) from commercial zirconia block (Lava™ Frame, 3 M ESPE AG). All specimens had the same dimensions (1 mm × 1 mm x 12 mm) after sintering. The 3D-printed specimens were randomly divided according to printing orientations: parallel or perpendicular to the tensile surface in the fatigue test. The specimens were subsequently submitted to two surface finishing protocols (n = 15/gr): unpolished or polished. Their phase compositions were analysed by X-ray diffraction. The fatigue behaviour was evaluated by a stepwise approach. RESULTS: The milled and both 3D-printed groups showed similar phase compositions for the as-sintered condition. Considerable amounts of rhombohedral phase were detected after polishing. Milled unpolished samples presented significantly higher fatigue strength than 3D-printed unpolished samples. Polishing did not improve the fatigue strength for milled zirconia but was advantageous for the 3D-printed specimens. 3D-printed specimens with parallel printing-layer orientation were significantly stronger than specimens with perpendicular layers regardless of surface finishing. CONCLUSION: The manufacturing techniques had a significant influence on the fatigue strength of 3Y-TZP, but not on the phase compositions of the surface. The polishing protocol showed different effects on 3Y-TZP fatigue strength and induced phase transition of the 3Y-TZP from Tetragonal to Rhombohedral. The best fatigue strength was achieved through milling using an unpolished surface and SLA-printed layers that were parallel to the tensile surface, followed by polishing.

Mechanical Behavior of Repaired Monolithic Crowns: A 3D Finite Element Analysis.

This study evaluated the mechanical behavior and risk of failure of three CAD-CAM crowns repaired with different resin composites through a three-dimensional (3D) finite element analysis. Three-dimensional models of different cusp-repaired (conventional nanohybrid, bulk-fill, and flowable resin composites) crowns made of zirconia, lithium disilicate, and CAD-CAM resin composite were designed, fixed at the cervical level, and loaded in 100 N at the working cusps, including the repaired one. The models were analyzed to determine the Maximum Principal and Maximum Shear stresses (MPa). Complementary, an in vitro shear bond strength test (n = 10) was performed to calculate the risk of failure for each experimental group. The stress distribution among the models was similar when considering the same restorative material. The crown material affected the stress concentration, which was higher for the ceramic models (±9 MPa for shear stress; ±3 MPa for tensile stress) than for the CAD-CAM composite (±7 MPa for shear stress; ±2 MPa for tensile stress). The shear bond strength was higher for the repaired CAD-CAM resin composite (±17 MPa) when compared to the ceramics (below 12 MPa for all groups), while the repair materials showed similar behavior for each substrate. The stress distribution is more homogenous for repaired resin composite crowns, and a flowable direct resin composite seems suitable to repair ceramic crowns with less risk of failure.

Does glaze firing affect the strength of advanced lithium disilicate after simulated defects?

OBJECTIVE: To study the influence of glazing on strength repair of lithium disilicate glass-ceramics after defect incorporation in different production processing phases. MATERIALS AND METHODS: Bar-shaped specimens (1 × 1 × 12 mm, n = 280; 20/group) made from different lithium disilicate ceramics (IPS e.max CAD, Ivoclar, "LD" or advanced lithium disilicate CEREC Tessera, Dentsply Sirona, "ALD") were exposed to 7 different protocols: crystallized without (c) and with glaze layer (cg), with a defect incorporated before crystallization without (ic) and with glaze layer (icg), with a defect after crystallization without (ci) or with glaze layer (cig), and defect incorporated after the glaze layer (cgi). The flexural strength was determined using the three-point bending test. Analysis of indented areas and fractured specimens was performed by scanning electron microscopy. Flexural strength data were evaluated by two-way ANOVA followed by Tukey tests (α = 5%). RESULTS: Two-way ANOVA revealed a significant influence of ceramic (p < 0.001; F = 55.45), protocol (p < 0.001; F = 56.94), and the interaction protocol*ceramic (p < 0.001; F = 13.86). Regardless of ceramics, defect incorporation as final step resulted in the worst strength, while defects introduced before crystallization did not reduce strength. Glaze firing after defect incorporation led to strength repair for ALD, whereas such an effect was not evident for LD. CONCLUSIONS: The advanced lithium disilicate must receive a glaze layer to achieve its highest strength. Defects incorporated in the pre-crystallized stage can be healed during crystallization. Defects should not be incorporated after glazing. CLINICAL RELEVANCE: Clinical adjustments should be performed on pre-crystallized or crystalized restorations that receive a glazer layer afterwards.

Endocrown fixed partial denture: Is it possible?

STATEMENT OF PROBLEM: Whether the replacement of a missing tooth with a fixed partial denture supported by an endodontically treated abutment could be improved with endocrowns is unclear. PURPOSE: The purpose of the study was to evaluate the mechanical behavior of a fixed partial denture (FPD) according to the preparation of the abutment teeth (endocrown or complete crown) in terms of stress magnitude in the prosthesis, cement layer, and tooth. MATERIAL AND METHODS: A posterior model with 2 abutment teeth (first molar and first premolar) was modeled with a computer-aided design (CAD) software program for conducting a 3-dimensional finite element analysis (FEA). To replace the missing second premolar, the model was replicated in different possible FPDs according to the abutment preparation design (complete crown [Conventional], 2 endocrowns [EC]) or an endocrown on one of the abutment teeth (first molar [ECM] and first premolar [ECP]) for a total of 4 designs. All FPDs were in lithium disilicate. The solids were imported to an analysis software program (ANSYS 19.2) in the standard for the exchange of product data (STEP) format. The mechanical properties were considered isotropic and the materials to show linear elastic and homogeneous behavior. An axial load (300 N) was applied at the occlusal surface of the pontic. The results were evaluated by colorimetric stress maps of von Mises and maximum principal stress in the prosthesis, maximum principal stress and shear stresses on the cement layer, and maximum principal stress in the abutment teeth. RESULTS: The von Mises stresses revealed that all FPD designs behaved similarly and that, considering the maximum principal stress criteria, the pontic was the most stressed region. For the cement layer, the combined designs presented an intermediate behavior, with the ECM more suitable to reducing the stress peak. The conventional preparation allowed less stress concentration in both teeth, and higher stress concentration in the premolar was observed with an endocrown. The endocrown decreased the risk of fracture failure. Considering the risk of debonding failure for the prosthesis, the endocrown preparation was only able to decrease the failure risk when the EC design was used and when only the shear stress was considered. CONCLUSIONS: Performing endocrown preparations to retain a 3-unit lithium disilicate FPD is an alternative to conventional complete crown preparations.

The ability of mouthguards to protect veneered teeth: A 3D finite element analysis.

BACKGROUND/AIMS: Professional and amateur athletes might have veneer restorations. The aim of this study was to investigate the protective effect of mouthguards on veneered anterior restorations. METHODS: A nonlinear dynamic analysis was performed to simulate conditions during an impact with or without a custom-made mouthguard. Using a computer-aided design (CAD) software, a slice of a human maxilla was designed containing an upper right central incisor. The model was composed of mucosa, cortical bone, trabecular bone, periodontal ligament, dentin, enamel, and pulp tissue. The enamel was prepared (feather design), restored with an indirect veneer (1.0 mm thickness), and duplicated to simulate both conditions with or without a mouthguard (4 mm thickness). Both models were subdivided into finite elements using the computer-aided engineering (CAE) software. Frictionless contacts were used, and an impact was simulated in which a rigid sphere hit the model at 1 m s-1 . Fixation was defined at the base of the bone. The elastic modulus of the veneer was assessed by using five different restorative materials (resin composite, hybrid ceramic, zirconia-reinforced lithium silicate, lithium disilicate, and zirconia). Von Mises stress, minimal principal stress, and maximum principal stress (in MPa) were obtained and plotted for visual comparison. RESULTS: Von-Mises results showed higher stress concentrations in the veneer's cervical labial region for models without a mouthguard. Observing the quantitative results for each model, the highest compressive (709 MPa) and tensile (58 MPa) stresses occurred in the situation without a mouthguard with a zirconia veneer, while the lowest occurred in resin composite veneer with a mouthguard (8 and 5 MPa). The mouthguard was able to reduce the stresses in the tooth structure and it also reduced the risk of fracture in all conditions. CONCLUSIONS: Mouthguards were beneficial in reducing the effects of dental trauma regardless of the restorative material used to manufacture the indirect veneer, since they act by dampening the generated stresses during the trauma event. Equal impact stresses on a mouthguard will lead to higher stresses in veneered teeth with more rigid restorative materials leading to a less protective effect.

Nickel allergy is associated with a broad spectrum cytokine response.

BACKGROUND: Nickel-induced proliferation or cytokine release by peripheral blood mononuclear cells may be used for in vitro diagnosis of nickel allergy. OBJECTIVES: Aim of this study was to explore the nickel-specific cytokine profile to further elucidate the pathogenesis of nickel allergic contact dermatitis (ACD) and to identify potential new biomarkers for nickel ACD. METHODS: Peripheral blood mononuclear cells from patients and controls were cultured with T-cell skewing cytokine cocktails and/or nickel. Cytokine and chemokine concentrations were assessed in culture supernatants using validated multiplex assays. Specific cytokine production was related to history of nickel allergy and patch-test results. RESULTS: Twenty-one of the 33 analytes included in the analysis were associated with nickel allergy and included type1 (TNF-α, IFN-γ, TNF-ß), type 2 (IL-3, IL-4, IL-5, IL-13), type 1/2 (IL-2, IL-10), type 9 (IL-9), type 17/1 (IL-17A[F], GM-CSF, IL-21) and type 22 (IL-22) derived cytokines as well as the T-cell/antigen presentation cell derived factors Thymus and activation regulated chemokine (TARC), IL-27 and IP-10. Receiver operator characteristics (ROC) analysis showed that IL-5 was the strongest biomarker for nickel allergy. CONCLUSIONS: A broad spectrum of 33 cytokines and chemokines is involved in the allergen-specific immune response in nickel allergic patients. IL-5 remains, next to the lymphocyte proliferation test, the strongest biomarker for nickel allergy.

The influence of pre-heating the restoration and luting agent on the flexural strength of indirect ceramic and composite restorations.

Background: This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites. Materials and Methods: 400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated. Results: There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations. Conclusion: Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations.

Different luting procedures significantly impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations, with light-curing cement demonstrating superior performance for specific thicknesses.Pre-heated resin composites, either with or without pre-heated restorations, offer a viable alternative to conventional dual-curing cement for bonding indirect restorations, presenting potential clinical advantages.Restoration thickness plays a crucial role in the mechanical response of restorations, with thinner resin composite restorations benefiting from dual- or light-curing, while thicker ones are less sensitive to luting procedure variations.

Evaluating the use of self-conditioning adhesive combined with dual curing resin cement as an endodontic sealer: An in vitro study.

Objectives: To compare infiltration, sealing and microleakage in root dentin with a self-conditioning adhesive system combined with dual curing resin (resin-based cement) to a conventional epoxy-resin-based sealer using confocal microscopy imaging. Methods: 26 roots were enlarged and disinfected. Dentin tubules of 24 teeth were labelled with a red fluorophore (Rhodamine B) (two samples served as controls). Root canal samples were sealed in group AH (n = 11) with a conventional sealer (AH Plus Root Canal Sealer, Dentsply DeTrey) and in group RC (n = 11) with a resin-based cement (Parabond combined with Paracore, Coltène). Roots were then sectioned horizontally and immersed in H2O2 to remove the Rhodamine B not fixed by the sealers. The empty dentin spaces were labeled with a green fluorophore (Fluorescein) enabling the evaluation of infiltration as well as microleakage by confocal microscopy. Two additional samples were fractured in vertical direction for observation under SEM. Results: Group RC presented significantly more infiltration in the middle third than in the middle and apical thirds of group AH. Microleakage was significantly higher in group AH than in group RC. SEM images revealed more dentin plugs and a homogenous resin layer in group RC in contrast to group AH. Conclusion: The resin-based cement revealed promising outcomes compared to a traditional epoxy resin based sealer.

Infiltration and microleakage in infiltrated and sealed root dentin samples are higher in middle than apical root thirds. Root dentin infiltration and sealing with a self-conditioning adhesive system and a dual-curing resin cement revealed less microleakage than with an epoxy-resin-based sealer.

Biomechanics of implant-supported restorations / Biomecânica das restaurações implantossuportadas

The rehabilitation of patients with dental implant-supported restorations is an ideal treatment option in contemporary dentistry. The aim of this review was to compile and to demonstrate the mechanical response during loading condition, on the stress distributions of implant-supported prostheses. The findings show that the majority of stresses were concentrated in the cervical region of the implant/abutment interface and that they can be affected by several clinical parameters and loading conditions. Finally, the final prosthetic design should combine superior mechanical response, long-term survival rate and allow patient satisfaction. (AU)

A reabilitação de pacientes com restaurações implanto-suportadas é uma opção de tratamento ideal na odontologia contemporânea. O objetivo desta revisão foi compilar e demonstrar a resposta mecânica durante a aplicação de carga, na distribuição de tensão de próteses implanto-suportadas. Os achados mostram que a maioria das tensões se concentram na região cervical da interface implante/pilar e pode ser afetada por diversos parâmetros clínicos e condições de carregamento. Por fim, o desenho protético final deve combinar uma melhor resposta mecânica, taxa de sobrevida a longo prazo e permitir a satisfação do paciente. (AU)

Cytotoxicity and anti-biofilm properties of novel hybrid-glass-based caries infiltrant.

OBJECTIVES: To assess the cytotoxicity of an experimental hybrid-glass-based infiltrant and its effect on biofilm attachment, growth and metabolic activity, and to compare it to the resin-based infiltrant Icon. METHODS: Cytotoxicity of hybrid-glass-based material (EXP) and resin-based infiltrant Icon (Icon) was tested in direct contact tests on freshly cured (direct_mat) and on materials kept for 24 h in cell culture medium (direct_exmat), and extract test with materials 24-h extracts (extract). Cell viability of L929 mouse fibroblast cell line was measured with MTT assay, according to ISO10993-5:2009. Biofilm attachment (5 h), growth (24 h and 48 h) and lactic-acid production (24 h and 48 h) on glass-disk specimens coated with EXP or Icon, or uncoated (control), were assessed using a microcosm biofilm model and Amsterdam Active Attachment system. At indicated time points, biofilms were harvested, plated, and CFU counts were determined, while lactic-acid production was measured colorimetrically. RESULTS: Cell viability reduction by EXP was below 30%-threshold in direct contact tests, while in extract test an increased cell viability was observed. Icon reduced cell viability substantially in all three tests. Significantly less bacteria attached to the surface of EXP after 5 h compared to Icon and control. Biofilm growth was significantly lower on EXP than on Icon and control after 24 h, but this difference was smaller and statistically insignificant after 48 h. There was no difference in lactic-acid production among groups. SIGNIFICANCE: Novel hybrid-glass-based infiltrant seems to have a better biocompatibility and accumulates on its surface less bacteria than resin-based infiltrant, which makes it an attractive resin-free alternative.

Dental biomechanics of root-analog implants in different bone types.

STATEMENT OF PROBLEM: When implants are applied to restore oral function, the masticatory load on the crown will lead to stress development in all parts of the crown-abutment-implant-bone system. An optimal design of the whole system will be important for sustained function. PURPOSE: The purpose of this 3-dimensional (3D) finite element analysis (FEA) study was to evaluate the influence of the root-analog implant (RAI) design in molar rehabilitation and bone type. MATERIAL AND METHODS: Twelve 3D models of single posterior implant-supported restorations were created according to the zirconia implant design (monotype, 2-piece, or RAI) and bone type (D1, D2, D3, and D4, according to the Misch classification). The models were composed of cortical bone, cancellous bone, implant, cement layers, and a monolithic ceramic crown. For the 2-piece zirconia implant model, the titanium base, prosthetic screw, and framework were also designed. All materials were assumed to behave elastically throughout the entire analysis. The bone was fixed, and an axial loading of 600 N was applied to the contacts on the occlusal surface of the crowns. Results for the crown and implant were obtained in maximum principal stress, as well as the von Mises stress for the model and bone microstrain. RESULTS: High stress concentration was observed at the intaglio surface of the crowns near the loading region. Regardless of the design, the stress trend in the implant was similar, increasing proportionally to the bone type (D1>D2>D3>D4). RAI showed a homogeneous stress field near the values calculated for the conventional designs, but with lower magnitudes. The 2-piece zirconia model showed the highest stress magnitude regardless of the bone type and, therefore, the highest failure risk. All models showed a higher strain in the cortical bone than in the cancellous bone, located predominantly in the cervical region. A strain analysis showed that both conventional implant models presented similar behavior for D1 and D2 bone types, with an increasing difference for D3 and D4. RAI showed the lowest strain regardless of the bone type. CONCLUSIONS: Root-analog zirconia implants present a promising biomechanical behavior for dissipating the masticatory load in comparison with conventional screw-shaped implants.

Effect of hydrothermal aging on the microhardness of high- and low-viscosity conventional and additively manufactured polymers.

STATEMENT OF PROBLEM: Studies on the microhardness of novel additively manufactured polymers compared with well-established low- and high-viscosity composite resins with regard to chemical composition are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of hydrothermal aging on the microhardness of various conventional and additively manufactured polymers. MATERIAL AND METHODS: Cylindrically shaped specimens (N=240, n=10 per group) (Ø10×2 mm) were either additively manufactured (6 groups) or conventionally (6 groups) manufactured by using 3D (Optiprint Temp [OP; Dentona]; C&B MFH [ND; NextDent]; Saremco print CROWNTEC [SA; Saremco Dental AG]; Temp Print [TP; GC]; 3DELTA ETEMP [DM; Deltamed]; MED690 [ST; Stratasys, Ltd]) or conventional low (Gradia Direct [GR; GC]; Clearfil Majesty [CM; Kuraray Noritake]; Tetric EvoCeram [TE; Ivoclar AG]) and high (Gradia Direct Flo [GR-F; GC]; Clearfil Majesty Flow [CM-F; Kuraray Noritake]; Tetric EvoFlow [TE-F; Ivoclar AG]) viscous materials. All specimens were randomly allotted to 2 different aging methods (no-aging [dry] or aging by thermocycling [TC], ×6000, 5 °C-55 °C) and Vickers hardness (VH) tested (ZHV30; Zwick). Three indentations were made on each specimen (0.98-N load, duration 15 seconds). The calculated average microhardness value of each specimen was statistically analyzed by using 2-way ANOVA and Tukey post hoc tests (α=.05). Two-parameter Weibull distribution was calculated to predict the reliability of material type and aging method on VH. RESULTS: The mean ±standard deviation VH ranged between 17 ±0.5 VHN and 68 ±0.5 VHN in the following ascending order: group STa.05). The mean ±standard deviation of HV for aged (37 ±1 VHN) and nonaged (35 ±1 VHN) specimens were statistically similar (P>.05). The Weibull distribution values presented the highest shape for the aged group SA (37.81). CONCLUSIONS: The choice of the material had a significant effect and resulted in lower hardness for the 3-dimensionally printed materials than for the conventional composite resins. Under fatigue conditions, the choice of the material showed no significant difference when the Vickers microhardness was evaluated.

Effect of light-curing time and direction on microhardness of a light-cured resin composite to cement CAD-CAM restorations.

PURPOSE: To evaluate the effect of light-curing exposure time and location on polymerization of a restorative bulk-fill resin composite to lute endocrowns. METHODS: A light-cured restorative bulk-fill resin composite (Filtek One Bulk Fill) was submitted to direct light-curing by a high-power LED light-curing unit for 20 seconds as the positive control group (n= 10). Five more groups (n= 10) were light-cured in a natural tooth mold from two sites (labial and lingual) through a nanohybrid resin composite CAD-CAM restoration (Lava Ultimate A2 LT), for different irradiation times: 90 seconds per site, 40 seconds per site, 30 seconds per site, 20 seconds per site and 10 seconds per site. Vickers microhardness measurements were made at two different depths and test/control ratios were calculated. Ratios of 0.8 were considered as an adequate level of curing. A quantile regression was run to identify the minimally sufficient time of light-curing, and a two-way ANOVA was used to compare the results to previous findings and evaluate the effect of curing location. RESULTS: Analysis showed that 40 seconds x 2 is the minimal irradiation time that presents a test/control ratio above 0.8. Quantile regressions showed that the required irradiation time to reach a test/control ratio of 0.8 at a confidence level of 95% is 41.5 seconds and 39.2 seconds at 200 µm and 500 µm depths in the luting agent, respectively. There was no statistically significant difference between microhardness of the two depths except for the irradiation time of 10 seconds. The two-site to three-site light curing comparison showed no statistically significant difference except for the 90-second time. CLINICAL SIGNIFICANCE: Systematic light-curing through the labial, lingual and occlusal surfaces of thick indirect restorations is not always required for sufficient polymerization and can even waste valuable clinical time especially in the case of multiple restorations luted with resin composites.