Cost-Effectiveness of Expanding National Health Insurance Coverage for Composite Resin Restorations in Cancer Patients in South Korea.

OBJECTIVES: Cancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients. METHODS: Data from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses. RESULTS: Between the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded. CONCLUSIONS: The expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients. CLINICAL SIGNIFICANCE: Timely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding National Health Insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases.

Wear and roughness analysis of two highly filled flowable composites.

This in vitro study aimed to evaluate surface roughness and wear of highly filled flowables and traditional packable composites. Additionally, the effect of polymerization time on these parameters was evaluated. Two flowable higly filled composites (CMf-Clearfil Majesty ES flow-low viscosity, Kuraray and GUf-Gaenial Universal Injectable, GC) and two packable composites (CM-Clearfil Majesty ES-2, Kuraray and GU-Gaenial A'CHORD, GC) were used to create 160 specimens (n = 40;8 × 6 × 4mm). For each tested material, two subgroups were considered according to the polymerization time (n = 20): 10 s or 80 s. After setting, the specimens were subjected to chewing simulations (240.000 cycles, 20N), and wear was measured by the laser integrated in the chewing simulator. The surface roughness was measured using a rugosimeter, before and after chewing cycles. Two representative specimens per group were observed under scanning electron microscope (SEM). Data were collected and statistically analyzed (p < 0.05). Wear analysis highlighted statistically significant differences between the groups: CMf10-CMf80 (p = 0.000), CMf10-CM10 (p = 0.019), CMf10-GUf10 (p = 0.002), CM10-CM80 (p = 0.000), CM80-GUf80 (p = 0.02), GUf10-GUf80 (p = 0.000), GUf10-GU10 (p = 0.043) and GU10-GU80 (p = 0.013). Statistically significant differences in surface roughness were highlighted between the groups: CMf10-CMf80 (p = 0.038), CMf80-CM80 (p = 0.019), CMf80-GU80 (p = 0.010), CM80-GUf80 (p = 0.34) and GUf80-GU80 (p = 0.003). Surface roughness and wear of highly filled flowable composites were comparable to that of traditional paste composites. Furthermore, a longer curing time leads to an improvement in the mechanical properties of the composites. Highly filled flowables can be a valid alternative to paste composites in occlusal areas due to its similar surface roughness and wear values, especially when overcured.

Comprehensive Evaluation of Long-Term Dentin Bond Strength, Water Sorption, Solubility, and Degree of Conversion of Self-Adhesive Resin Composites.

PURPOSE: To evaluate the long-term microtensile bond strength (µTBS) to dentin, water sorption (WSP) and solubility (WSL), and degree of conversion (DC) of self-adhesive resin composites (SACs). MATERIALS AND METHODS: The mid-coronal dentin of human molars was exposed, and teeth were randomly assigned to five groups according to the SACs (n = 10): 1. FIT SA F03 (FIT); 2. Experimental (EXP); 3. Fusio Liquid Dentin (FLD); 4. Vertise Flow (VER); 5. Constic (CON). The µTBS was evaluated after 24 hours (24 h) and 6 months (6 m) storage. A scanning electron microscope examined failure modes and resin-dentin interfaces. The WSP and WSL (n = 5) were evaluated following ISO 4049:2019 specifications, and DC (n = 3) was measured using Raman spectroscopy. The statistical analyses were performed accepting a significance level of p = 0.05. RESULTS: FIT, EXP, and FLD produced significantly higher µTBS median values than VER and CON after 24 h and 6 m (p 0.05). After 6m, the µTBS median of FIT and EXP significantly decreased (p 0.05), while FLD, VER, and CON showed no significant difference (p > 0.05). FLD and CON exhibited lower WSP than FIT, EXP, and VER (p 0.05). FLD presented the lowest (p 0.05), and VER revealed the highest WSL (p 0.05). FIT and EXP showed the highest (p 0.05), and VER demonstrated the lowest DC (p 0.05). CONCLUSIONS: Following the present study's design, SACs' bonding performance and physical properties remained restricted. Therefore, the application should be considered cautiously, and further clinical trials are necessary to evaluate their long-term performance.

Diversity of short-term DC outcomes in bulk-fill RBCs subjected to a 3 s high-irradiance protocol.

OBJECTIVES: To determine the short-term (5 min) initial effects of a high-irradiance light-curing (LC) protocol on light transmission (LT%), radiant exposure (RE) and degree of conversion (DC%) of different bulk-fill resin-based composites (RBCs). MATERIALS AND METHODS: Six bulk-fill composites with different viscosities were investigated: OBF (One Bulk Fill, 3 M), EB (Estelite bulkfill,Tokuyama), PFill, PFlow, ECeram and EFlow (PowerFill, Poweflow, Tetric EvoCeram bulkfill, Tetric Evoflow bulkfill, Ivoclar), subjected to different LC protocols: one ultra-high-intensity (3 W/cm2 -3 s via PowerCure LCU) and two conventional (1.2 W/cm2 -10 s and 20 s via PowerCure and Elipar S10 LCUs). Specimens (n = 5) were polymerized within their molds (ϕ5 mm × 4 mm depth) to determine LT% and RE at 4 mm using a MARC-LC spectrometer. For real-time DC% measurements by FTIR, similar molds were utilized. Data were analyzed by one-way ANOVA and Tukey post-hoc tests at 5 % significance. RESULTS: Regardless of the applied LC protocols, OBF and low-viscosity RBCs (EB, PFlow and EFlow) had the lowest and highest LT%, RE, DC% and RPmax, respectively. RE results of all RBCs were in the same sequence: Elipar-20 s > PCure-10 s > PCure-3 s. DC% of PFill and PFlow displayed no significant difference between the applied LC protocols (p > 0.05). The polymerization kinetic in all materials was well described by an exponential sum function (r2 varied between 0.85 and 0.98), showing a faster polymerization with the PCure-3 s protocol. SIGNIFICANCE: The measurement of LT% and DC% at 5 min gave an insight into the developing polymerization process. The initial response of these bulk-fill composite to a high-irradiation protocol varied depending on their composition and viscosity, being faster for low viscosity materials. Nevertheless, even though multiple resin composites are designed to be efficient during photopolymerization, care should be taken when selecting materials/curing protocol.

Is use of flowable resin composite an option for occluso-proximal restorations in primary teeth? A fracture strength analysis.

BACKGROUND: Use of flowable resin composites for ocluso-proximal restorations in primary molars could improve cervical adaptation, and reduce the failure risk. AIM: To investigate the fracture strength of occluso-proximal restorations in primary teeth using different flowable resin composites (as an intermediate layer or entire cavity) and a conventional resin composite (incremental technique). DESIGN: Two standardized occluso-proximal cavities were prepared on mesial and distal surfaces of 50 sound primary molars. The teeth were randomly assigned into five groups (n = 10): 2 mm Filtek Bulk Fill Flow + Z350 XT; 4 mm Filtek Bulk Fill Flow; 2 mm Z350 XT Flow + Z350 XT; 4 mm Z350 XT Flow; and Z350 XT inserted by incremental technique. All restored teeth were subjected to cariogenic challenge and then submitted to fracture strength test. The failure pattern of each specimen was categorized as reparable or irreparable/need for replacement based on the World Dental Federation (FDI) criteria. Fracture strength means were submitted to one-way ANOVA and Tukey's post hoc tests. Failure pattern was analyzed descriptively. RESULTS: There was no statistically significant difference on fracture strength among groups (p = .48). A similar distribution of reparable (35%-40%) and irreparable (60%-65%) failures was observed among groups. CONCLUSION: Based on a laboratorial setting, the use of different flowable resin composites (as an intermediate layer or entire cavity) may be an option to restore occluso-proximal cavities in primary molars.

Investigation of experimental resin composites containing different boron compounds incorporated into mesoporous and nonporous hydroxyapatite nanocarriers.

This study aimed to investigate the surface hardness, monomer conversion, surface roughness, boron release, and water sorption-solubility properties of experimental resin composites (RC) containing hydroxyapatite nanocarriers (HAP) loaded with different boron compounds, in comparison to a conventional RC. In this study, boron nitride and 4-borono-L-phenylalanine were loaded into mesoporous and nonporous HAP. 1% boron-nanocarrier complexes were added to a conventional resin-composite content. The study groups were designated based on the boron compound and nanocarrier type: Group 1 (Control): (a conventional RC), Group 2: Experimental RC containing mesoporous HAP loaded with boron nitride (BN@MHAP), Group 3: Experimental RC containing nonporous HAP loaded with boron nitride (BN@HAP), Group 4: Experimental RC containing mesoporous HAP loaded with 4-borono-L-phenylalanine (BPA@MHAP), Group 5: Experimental RC containing nonporous HAP loaded with 4-borono-L-phenylalanine (BPA@HAP). Vickers microhardness, surface roughness, degree of monomer conversion, water sorption-solubility, and boron release analyses were conducted on the RC samples. The nanoparticles were characterized using the Energy Dispersive X-ray Spectroscopy (EDX) for elemental analysis and mapping, X-ray Diffraction (XRD) for examining crystal structure, Fourier-Transform Infrared Spectroscopy (FTIR) for evaluating molecular bond structure, and Scanning Electron Microscopy (SEM) for observing surface morphology of mesoporous and non-porous HAP. No statistically significant difference was found between the experimental RC materials containing boron-nanocarrier complexes and the control group in terms of monomer conversion, surface hardness, surface roughness, water sorption and solubility (p > 0.05). However, all experimental groups demonstrated significantly higher boron release rates over time (p < 0.05), with BN@HAP and BPA@MHAP groups exhibiting the highest release rates at all timepoints (p < 0.05). The addition of 1% BN@HAP/MHAP or BPA@HAP/MHAP to the RC is promising for developing an antibacterial RC capable of releasing boron without compromising the tested physico-chemical properties of the material.

Comparison of Bulk Polymeric Resin Composite and Hybrid Glass Ionomer Cement in Adhesive Class I Dental Restorations: A 3D Finite Element Analysis.

This study aimed to investigate the mechanical behavior of resin composites and hybrid glass ionomer cement in class I adhesive dental restorations under loading and shrinkage conditions. Three CAD models of a mandibular first molar with class I cavities were created and restored with different techniques: a bi-layer of Equia Forte HT with Filtek One Bulk Fill Restorative composite (model A), a single layer of adhesive and Filtek One Bulk Fill Restorative (model B), and a single layer of Equia forte HT (model C). Each model was exported to computer-aided engineering software, and 3D finite element models were created. Models A and B exhibited a similar pattern of stress distribution along the enamel-restoration interface, with stress peaks of 12.5 MPa and 14 MPa observed in the enamel tissue. The sound tooth, B, and C models showed a similar trend along the interface between dentine and restoration. A stress peak of about 0.5 MPa was detected in the enamel of both the sound tooth and B models. Model C showed a reduced stress peak of about 1.2 MPa. A significant stress reduction in 4 mm deep class I cavities in lower molars was observed in models where non-shrinking dental filling materials, like the hybrid glass ionomer cement used in model C, were applied. Stress reduction was also achieved in model A, which employed a bi-layer technique with a shrinking polymeric filling material (bulk resin composite). Model C's performance closely resembled that of a sound tooth.

The Impact of Modeling Liquids on Surface Roughness and Color Properties of Bulkfill Resin Composites After Simulated Tooth Brushing: An in Vitro Study. Part I.

OBJECTIVE: To evaluate the effect of different modeling agents on color changes, surface roughness, and translucency parameters over time in Bulkfill resin composites. MATERIAL AND METHODS: Sixty specimens were prepared using three Bulkfill resin composites (Tetric N-Ceram Bulkfill, Filtek One Bulkfill and Opus Bulkfill) and three modeling agents (Wetting Resin, Optibond FL and Ambar APS). All specimens were subjected to a simulated tooth-brushing (Baseline, 50.000 cycles, 100.000 cycles), and surface roughness was measured at each interval. Surface topography was evaluated. The translucency parameter and color changes were assessed after 24-h, 7-, 14- and 30-day immersion in water, wine, and coffee. Data was analyzed using ANOVA and Bonferroni test. RESULTS: All specimens increased roughness after simulated tooth-brushing (p < 0.05). Wetting Resin decreased roughness on Tetric N-Ceram Bulkfill (p < 0.05). The translucency parameter remained unaltered for all groups. All groups changed color after 30-days of immersion in wine and coffee (p < 0.05). Ambar APS and Wetting Resin on Tetric N-Ceram Bulkfill showed higher color changes when immersed in coffee (p < 0.05). CONCLUSION: The use of modeling agents does not jeopardize translucency properties but may affect surface roughness and color properties of Bulkfill resin composites depending on their composition. CLINICAL SIGNIFICANCE: The findings of this study suggest that surface roughness and color properties are affected by the differences in the composition between modeling agents and Bulkfill resins composites.

Modified Epoxy Resin on the Burning Behavior and Mechanical Properties of Aramid Fiber Composite.

Aramid fiber/epoxy resin (AF/EP) composite has been heavily used as an impact protection material due to its excellent mechanical properties and lightweight merits. Meanwhile, it is also necessary to concern the flammability of matrix resin and the wick effect of aramid fiber, which would constitute a fire risk in harsh environments. In this work, a multifunctional flame-retardant modifier (EAD) was incorporated into the AF/EP system to improve the flame retardation. The addition of 5 wt% EAD made the AF/EP composite exhibit a high limiting oxygen index (LOI) value of 37.5%, self-extinguishment, as well as decreased total heat release and total smoke release. The results from thermogravimetric analysis (TGA) and dynamic mechanical analysis (DMA) demonstrated that the treated composites maintained good thermal stability. Due to the combined action of covalent and noncovalent bonds in the matrix-rich region, the interfacial bonding improved, which endowed AF/EP composite with strengthening and toughening effects. Compared with the control sample AF/EP, the tensile strength and ballistic parameter (V50) of the sample with 5 wt% EAD increased by 17% and 10%, accompanied with ductile failure mode. Furthermore, the flame-retardant mechanism was obtained by analyzing the actions in condensed and gaseous phases. Thanks to good compatibility and interfacial adhesion, the incorporation of EAD solved the inconsistent issue between flame retardancy and mechanical properties, which further expanded the application of AF/EP composite in the protection field.

Can energy drinks affect the surface quality of bioactive restorative materials?

BACKGROUNDS: This study aimed to compare the effects of different energy drinks on the surface roughness, weight loss, and color change of various bioactive restorative materials. METHODS: Charisma Diamond One, Activa™ BioActive Restorative, Activa™ Presto™ and Equia Forte HT Fil samples were prepared using plastic molds (8 × 2 mm) (n = 10/groups). After polishing, the samples were weighed, their colors were recorded using a spectrophotometer according to the CIEDE2000 system, and their surface roughness was measured using a profilometer. The samples were immersed in Powerade, Burn, Monster and distilled water for 7 days. After immersion, all the measurements were repeated. Statistical analyses were performed using the Wilcoxon signed-rank test and the Mann‒Whitney U test (p < 0.05). RESULTS: All energy drinks roughened the surface of Equia Forte HT Fil (p < 0.05). Powerade and Monster increased the Ra of all materials after 7 days (p < 0.05). Burns affected all materials except the Activa Bioactive (p < 0.05). Significant weight loss was observed in the Equia Forte group after immersion in all the energy drinks, whereas no weight loss was observed in the other groups. According to the color measurements, ΔE00 values were greater in the Burn and Monster groups, except for the Equia Forte HT Fil group (p < 0.05). CONCLUSION: Energy drinks affected bioactive materials to varying degrees. The glass hybrid material was the most affected, and the bioactive restorative materials based on the resin matrix were the least.

Impact of combining dental composite brushes with modeling resins on the color stability and topographic features of composites.

This study explores the effect of using dental brushes with or without metacrylate-based modeling resins on long-term color stability and surface topographies of resin-based composites. This study examined the effects of two variables: (1) the type of brush used (Art brush, Micro-brush, or Mylar strip) and (2) the application of a modeling resin (applied or not applied). The specimens were artificially aged through 10,000 cycles of thermocycling and subsequently immersed in coffee for 30 days. Measurements of color and surface roughness were taken at baseline and after the aging, using a non-contact profilometer for surface roughness and a spectrophotometer for color. Data were analyzed using paired t-tests and one-way ANOVA. Resin-based composites smoothed with dental brushes or micro brushes without modeling resins exhibited lower color change (ΔE) than other groups. Paired t-tests revealed significant differences in average surface roughness (Ra) and valley depth (Rv) for each surfacing technique before and after aging (p ⩽ 0.01). The root means square average of the profile heights (Rq) significantly increased in the control and micro-brush groups (p ⩽ 0.01). In conclusion, the use of brushes in resin-based composites placement does not increase the susceptibility to staining. Instead, the inclusion of resin modeling contributes to discoloration over time.

Advanced Material Strategy for Restoring Damaged Endodontically Treated Teeth: A Comprehensive Review.

The restoration of endodontically treated teeth (ETT) remains a significant challenge in modern dentistry. These teeth often suffer from substantial structural damage due to both the original pathology and the invasive nature of endodontic procedures. Consequently, ETT are more susceptible to fractures compared to vital teeth, necessitating restorative strategies that can effectively restore both function and aesthetics while minimizing the risk of failure. In recent years, advances in adhesive dentistry and the development of high-strength ceramics have further expanded the restorative options for ETT. Bonded restorations have gained popularity as they preserve more tooth structure and enhance the overall strenght of the tooth-restoration complex. The choice of restorative material and technique is influenced by numerous factors, including the amount of remaining tooth structure, the functional requirements of the tooth, and the aesthetic demands of the patient. Despite the plethora of available materials and techniques, the optimal approach to restoring ETT remains a topic of ongoing research and debate. In this comprehensive review, the current state of and recent advances in restoring damaged endodontically treated teeth are explored. Numerous therapeutic options exist, involving a wide range of materials. This article aims to present the biomaterial advancements of the past decade and their applications, offering alternative approaches to treating damaged ETT with the goal of prolonging their retention on the dental arch and serving as a valuable resource for dental practitioners who face this issue daily.

Tribological Research of Resin Composites with the Fillers of Glass Powder and Micro-Bubbles.

This study investigates the tribological properties of resin composites reinforced with the fillers of glass powder and micro-bubbles. Resin composites were prepared with varying concentrations from 1% to 5% wt of fillers. Tribological tests were conducted using a block-on-ring scheme under dry friction conditions. The measurements of friction coefficient and wear values were performed under variable rotation speeds and loading conditions. The study showed that resin composites with 2-3% glass powder fillers and resin composites with 3-4% micro-bubbles exhibited optimal tribological properties. The resin glass powder modifications reduce the wear by 63% and resin micro-bubbles reduce wear by 32%. SEM analysis of the surfaces revealed surface imperfections and structural damage mechanisms, including abrasive and fatigue wear. The study concludes that specific filler concentrations improve the friction and wear resistance of resin composites, highlighting the importance of material preparation and surface quality in tribological performance. The increased wear resistance on both composites would hopefully expand the usage of additive manufactured composite, namely industrial moving components such as polymer gear, wheel, pulley, etc.

In Vitro Assessment of a New Block Design for Implant Crowns with Functional Gradient Fabricated with Resin Composite and Zirconia Insert.

This study aims to evaluate and compare the mechanical resistance, fatigue behavior and fracture behavior of different CAD/CAM materials for implant crowns. Eighty-eight implant crowns cemented-screwed with four sample groups: two monolithic G1 Zirconia (control) and G3 composite and two bi-layered G2 customized zirconia/composite and G4 prefabricated zirconia/composite. All static and dynamic mechanical tests were conducted at 37 °C under wet conditions. The fractographic evaluation of deformed and/or fractured samples was evaluated via electron microscopy. Statistical analysis was conducted using Wallis tests, which were performed depending on the variables, with a confidence interval of 95%, (p < 0.05). The Maximum Fracture Strength values displayed by the four groups of samples showed no statistically significant differences. The crown-abutment material combination influenced the failure mode of the restoration, transitioning from a fatigue fracture type located at the abutment-analog connection for monolithic materials (G1 and G3) to a brittle fracture located in the crown for bi-layered materials (G2 and G4). The use of layered crown materials with functional gradients appears to protect the crown/abutment connection area by partially absorbing the applied mechanical loads. This prevents catastrophic mechanical failures, avoiding long chairside time to solve these kinds of complications.

Microscopic and Color Changes in Direct Dental Restorative Composite Resins upon Immersion in Beverages: Characterization by Scanning Electron Microscopy (SEM) and Energy-Dispersive X-ray Spectroscopy (EDS).

This study aimed to evaluate the staining sensitivity and surface changes in recent composite resins (Herculite Ultra XRV (Kerr, Bolzano, Italy), G-ænial A'CHORD (GC Corp, Tokyo, Japan), and Omnichroma (Yamaguchi, Japan)) when exposed to common beverages such as coffee, red wine, and Coca-Cola. A total of 60 disk-shaped specimens were prepared from three different resin composites (n = 20 each). The specimens were exposed to coffee, red wine, and Coca-Cola for 10 days. Color measurements were taken using a spectrophotometer, and surface morphology and elemental composition were analyzed using SEM and EDS. The SEM and EDS analyses revealed significant changes in the surface morphology and elemental composition of the composites after immersion. Coffee and wine caused significant surface degradation, whereas Coca-Cola resulted in the greatest degree of surface and elemental variations. Color changes (ΔE = 4 ± 0.52) were most notable in Coca-Cola for Herculite Ultra XRV (Kerr, Italy), in red wine for G-ænial A'CHORD (GC Corp, Japan) (ΔE = 12.51 ± 0.38), and in coffee for Omnichroma (Yamaguchi, Japan) (ΔE = 10.85 ± 1.03). The tested beverages significantly affected both the surface condition and the chemical composition of the resin at the surface level. These findings highlight the importance of understanding the effects of common dietary beverages on dental composites.

Enhancing Esthetics in Direct Dental Resin Composite: Investigating Surface Roughness and Color Stability.

Dental restorations must replicate the natural appearance of teeth while ensuring biocompatibility and durability. This study evaluated the surface characteristics and color stability of three dental composites-Herculite Ultra XRV, G-ænial A'CHORD, and Omnichroma-exposed to acidic beverages (red wine, black coffee, and Coca-Cola). Sixty disk-shaped specimens were prepared, polished, and immersed in these beverages. Surface roughness was assessed using profilometry and SEM analysis, hydrophobicity via contact angle analysis, and surface charge through streaming potential measurements. Color stability was evaluated using a spectrophotometer, and the pH levels of the solutions were recorded. Results showed that Herculite Ultra XRV had the highest mean contact angle (79.46° ± 6.52), indicating superior hydrophobicity, while Omnichroma had the lowest (64.94° ± 3.08), indicating more hydrophilicity. Significant color changes were observed, especially in black coffee, with ∆E values indicating notable discoloration. The acidic pH of the solutions increased surface roughness and color changes. Statistical analyses confirmed significant increases in surface roughness and color change for all composites, with the nanohybrid resin composite showing the greatest variability. These findings highlight the need for dental restorative materials with enhanced resistance to acidic environments to improve the longevity and esthetics of dental treatments.

Surface roughness of different types of resin composites after artificial aging procedures: an in vitro study.

BACKGROUND: The temperature changes, chemical agents, and brushing activity that resin composite restorations are exposed to in the oral environment can cause changes in surface roughness. In this study, the aim was to investigate in vitro the clinical one-year surface roughness changes of different types of composites (flowable or conventional) from the same companies by subjecting them to immersion in solutions, brushing, and thermal cycling procedures to simulate intraoral conditions. METHODS: Four different resin composite brands were included in the study using both their conventional (Charisma Smart, 3M Filtek Ultimate Universal, Omnichroma, Beautifil II) and flowable resin composites (Charisma Flow, 3M Filtek Ultimate Flowable, Omnichroma Flow, Beautifil Flow Plus F00), giving 4 groups with 2 types of resin composite in each. 40 samples were prepared for each group/resin type, for a total of 320 samples. After initial surface roughness measurements by a mechanical profilometer, the samples were divided into 4 subgroups (n = 10) and immersed in solutions (distilled water, tea, coffee, or wine) for 12 days. The samples were then subjected to 10,000 cycles of brushing simulation and 10,000 cycles of thermal aging. Surface roughness measurements were repeated after the procedures. For statistical analysis, the 3-way analysis of variance and the Tukey test were used (p < 0.05). RESULTS: It was concluded that composite groups and types had an effect on surface roughness at time t0 (p < 0.001). At time t1, the highest surface roughness value was obtained in the Beautifil-conventional interaction. When the surface roughness values between time t0 and t1 were compared, an increase was observed in the Beautifil II and Beautifil Flow Plus F00, while a decrease was observed in the other composite groups. CONCLUSION: Composite groups, types, and solutions had an effect on the surface roughness of resin composites. After aging procedures, it was concluded that the Beautifil group could not maintain the surface structure as it exceeded the threshold value of 0.2 µm for bacterial adhesion.

Biomimetic Mechanical Robust Cement-Resin Composites with Machine Learning-Assisted Gradient Hierarchical Structures.

Biological materials relying on hierarchically ordered architectures inspire the emergence of advanced composites with mutually exclusive mechanical properties, but the efficient topology optimization and large-scale manufacturing remain challenging. Herein, this work proposes a scalable bottom-up approach to fabricate a novel nacre-like cement-resin composite with gradient brick-and-mortar (BM) structure, and demonstrates a machine learning-assisted method to optimize the gradient structure. The fabricated gradient composite exhibits an extraordinary combination of high flexural strength, toughness, and impact resistance. Particularly, the toughness and impact resistance of such composite attractively surpass the cement counterparts by factors of approximately 700 and 600 times, and even outperform natural rocks, fiber-reinforced cement-based materials and even some alloys. The strengthening and toughening mechanisms are clarified as the regional-matrix densifying and crack-tip shielding effects caused by the gradient BM structure. The developed gradient composite not only endows a promising structural material for protective applications in harsh scenarios, but also paves a new way for biomimetic metamaterials designing.

Tooth autotransplantation and resin composite reshaping as a multidisciplinary approach for treating dental agenesia: A 10-year follow-up.

CASE REPORT: This case report describes the multidisciplinary approach performed in a 9-year-old male patient with dental agenesia affecting teeth 21 and 22. Autotransplantation of the right upper second premolar with incomplete rhizogenesis to the missing area was combined with coronary reshaping with resin composite and orthodontic therapy. The treatment began with the extraction of the deciduous upper left central incisor, bone preparation for the recipient site of the donor tooth, atraumatic extraction of the right upper second premolar and immediate autotransplantation in the surgically prepared recipient site. Subsequently, sutures to reposition the flap and a rigid splint were performed. After 12 months, coronary reshaping of the autotransplanted tooth with resin composite was carried out. Orthodontic treatment involving the use of a fixed appliance was used to correct the interdental spaces and achieve adequate occlusion. Clinical and radiographic follow-up 10 years after tooth autotransplantation and 9 years after reshaping revealed partial obliteration of the pulp chamber, root resorption, ankylosis and the presence of endodontic treatment. CONCLUSIONS: The long-term outcomes highlighted that tooth autotransplantation represents a biologically and cost-effective procedure for replacing missing teeth in young patients, particularly in cases of incomplete rhizogenesis of the autotransplanted tooth. CLINICAL SIGNIFICANCE: This case report discusses tooth autotransplantation and resin composite reshaping as viable and long-term clinical options for treating young patients with dental agenesis.

The effect of whitening toothpastes on the color stability and surface roughness of stained resin composite.

BACKGROUND: This study aimed to investigate the effect of whitening toothpastes on the color stability and surface roughness of resin composites stained with coffee and cigarette smoke. METHODS: Seventy-two disk-shaped specimens (6 × 2 mm) of suprananohybrid resin composite were randomly divided into two groups and exposed to coffee and cigarette smoke (n = 36). After staining, the samples randomly divided into four groups according to whitening toothpastes and were brushed for 4 min: Opalescence Whitening (OW); Colgate Optic White (COW); Curaprox Black is White (CPX) and, distilled water (control) (n = 9). Color was measured with spectrophotometer at the initial, after staining, and after brushing, and surface roughness was measured with profilometer at the initial and after brushing. A surface morphology analysis was examined using scanning electron microscopy and atomic force microscopy. The obtained data were statistically analyzed. (p < 0.05). RESULTS: Cigarette smoke caused a significantly higher color change than coffee in the resin composite (p < 0.05). Brushing with hydrogen peroxide and silica-containing whitening toothpaste showed significant differences in color change (p < 0.05). The lowest whitening effect was found in activated charcoal-containing toothpaste. While all toothpastes increased the degree of surface roughness of resin composites, the highest roughness was caused by whitening toothpastes containing activated charcoal. (p < 0.05). CONCLUSIONS: The color stability and surface properties of resin composites can be affected by brushing them with whitening toothpaste. The utilization of whitening toothpaste containing hydrogen peroxide can be considered a safe method for increasing the whiteness of discolored resin composites.