Assessment of polymerization contraction stress of three composite resins.

OBJECTIVES: The purpose of this study was to measure the development of contraction stress of three composite resin restorative materials during photo-polymerization: a micro-hybrid composite (Filtek Z250, 3M ESPE, St. Paul, MN, USA); a nano-filled composite (Filtek Supreme, 3M ESPE, St. Paul, MN, USA); and a low-shrinkage composite (AElite LS, Bisco Inc., Schaumburg, IL, USA). METHODS: Curing shrinkage stress was measured using a stress-analyzer. Composites were polymerized with a halogen-curing unit (VIP, Bisco Inc., Schaumburg, IL, USA) for 40 s. The contraction force (N) generated during polymerization was continuously recorded for 150 s after photo-initiation. Contraction stress (MPa) was calculated at 20, 40, 60 and 150 s. Data were statistically analyzed. RESULTS: The low-shrinkage composite AElite LS exhibited the lowest stress values compared to other materials (p<0.05). Statistical analysis did not show significant differences between Filtek Z250 and Filtek Supreme. SIGNIFICANCE: The low-shrinkage composite showed lower contraction stress than micro-hybrid and nano-filled composite. Ideally, non-shrinking resins would represent the ultimate solution to overcome polymerization contraction and stress-related problems.

Influence of thickness on color in multi-layering technique.

OBJECTIVES: The aim of the study was to evaluate the influence of layer thickness on the final color for different shade and opacity composite combinations in a laboratory set-up simulating a 2-layer stratification technique. METHODS: Resin disks of different thicknesses were made. From one composite system (Point4, Kerr Co.), four dentin shades were selected (A1, A2, A3, A4). For each shade, disks were produced of 0.5-3.0mm thickness, with increasing thickness steps of 0.5mm. Moreover, from the three translucent shades of the same system (T1, T2, T3) disks were made of 0.5-2.0mm thickness, again with increasing thickness steps of 0.5mm. For all 288 combinations of base+translucent material color was determined with a spectrophotometer. RESULTS: For a mounting layer thickness from 0.5 to 3.0mm of the base material, differences till to DeltaE=5.1 were recorded. These differences increased when the layer thickness of the translucent material decreased. The translucent shade also influence the final aspect of the samples, whereas each translucent shade acted differently dependent on their shade and their thickness. Their layer thickness played a significant role in color perception. SIGNIFICANCE: Layer thickness and the proportion of thicknesses of the dentin and translucent shade greatly influence the final aspect of a multi-layer composite restoration. Good understanding of the optical behavior of each composite system is essential in order to obtain high quality in aesthetic dentistry.

The effect of application sustained seating pressure on adhesive luting procedure.

OBJECTIVES: To evaluate the effect of short versus long application seating pressure on the bond strength of resin blocks, luted with a dual-cured resin cement (Panavia F) to pre-coated or non pre-coated dentin with an hydrophobic light-cured adhesive (Clearfil Protect Bond). METHODS: Sixteen non-carious human third molars were randomly divided into six Groups (four teeth each). Cylindrical composite blocks were luted with Panavia F (Group Ia) and with Clearfil Protect Bond with Panavia F (Group IIa) and seating pressure was applied for 5s. In Groups Ib and IIb, the two bonding procedures were respectively repeated, but the resin cylinder was maintained under constant pressure during the entire 3min polymerization period for the resin cement. After storing in distilled water for 24h, 0.9mmx0.9mm sticks were produced from these luted specimens for microtensile bond testing and SEM examination. RESULTS: The use of Clearfil Protect Bond with Panavia F produced higher bond strengths than the use of Panavia F (p<0.05). Extending the time of pressure application up to 3min increased the bond strength (p<0.001) and improved the integrity of the interfacial quality. SIGNIFICANCE: The application of sustained seating pressure during luting procedures and the additional use of a hydrophobic light-cured adhesive both improve the final bond strength of the resin cement.

Spectrophotometric and visual shade measurements of human teeth using three shade guides.

PURPOSE: To compare spectrophotometric vs. visual color identification of tooth shade on the basis of three different commercially available shade guides. METHODS: On 54 subjects, two operators (with >10 years experience) independently selected the best match of the middle third of one of the patient's upper central incisors, using consecutively three shade guides (Vita Lumin Vacuum, Chromascop, Vita 3D Master). After each individual shade match, the same operator performed a shade measurement with a SpectroShade spectrophotometer. RESULTS: The Vita Lumin shade guide appeared to provide the most consistent results between human and spectrophotometrical evaluation, although Vita 3D Master offered a greater variety of colors. In approximately 47% of the cases, the spectrophotometer provided more accurate results than visual selection. From a clinical point of view, this is a noteworthy improvement in the complex process of color match for indirect restoration.

A clinical trial of Empress II porcelain inlays luted to vital teeth with a dual-curing adhesive system and a self-curing resin cement.

PURPOSE: The aim of the study was to clinically evaluate Empress II inlays cemented with a dual-curing bonding agent and a self-curing luting system. MATERIALS AND METHODS: Forty patients were selected to receive one Empress II inlay. Empress II is a heat-pressed glass ceramic containing lithium disilicate and lithium orthophosphate crystals, purported to provide higher stress resistance and improved strength. The restorations were placed between March and May 2000. Recalls were performed after 6, 12, 24, and 36 months. At the 3-year recall, 7 patients were lost to follow-up. Inlays were evaluated for postoperative sensitivity, marginal integrity, marginal leakage, color stability, surface staining, retention, and surface crazing (microcracks). RESULTS: At the 3-year recall, all the restorations were in place and only one showed postoperative sensitivity (at the first recall, 1 week after placement). Only 3 inlays showed slight marginal staining, and 4 inlays showed gaps, with little surface staining or microcracks. CONCLUSIONS: No inlay debonded or fractured during theobservation period. All the evaluated inlays were in place and acceptable.

Effect of the seating pressure on the adhesive bonding of indirect restorations.

PURPOSE: To evaluate the effect of two different techniques of seating pressure application on the adhesive-dentin bond of indirect restorations. METHODS: Eight non-carious human third molars were randomly divided in two treatment groups (four teeth each). Cylindrical composite blocks were luted with a resin cement (Panavia F). In Group 1, the seating pressure was applied for 5 seconds. In Group 2, the resin cylinder was maintained under constant pressure during the entire 3-minute polymerization period of the resin cement. After storing in distilled water for 24 hours, 0.9 x 0.9 mm sticks were produced from these luted specimens for microtensile bond testing and SEM examination. RESULTS: The Student t-test showed a significant difference (P < 0.05) in bond strength between Groups 1 and 2. SEM revealed the presence of structural defects and resin globules on the seating surface of the composites. These features were exclusively identified from Group 1 specimens and were probably caused by fluid transudation from the underlying dentin through the simplified self-etch adhesive (ED primer).

Effect of adhesive layer properties on stress distribution in composite restorations--a 3D finite element analysis.

OBJECTIVES: Teeth, adhesively restored with resin-based materials, were modeled by 3D-finite elements analysis that showed a premature failure during polymerization shrinkage and occlusal loading. METHODS: Simulation of Class II MOD composite restorations with a resin bonding system revealed a complex biomechanical behavior arising from the simultaneous effects of polymerization shrinkage, composite stiffness and adhesive interface strain. Due to a polymerization contraction, shrinkage stress increases with the rigidity of the composites utilised in the restoration, while the cusp movements under occlusal loading are inversely proportional to the rigidity of the composites. The adhesive layer's strain also plays a relevant role in the attenuation of the polymerization and occlusal loading stresses. RESULTS: The choice of an appropriately compliant adhesive layer, able to partially absorb the composite deformation, limits the intensity of the stress transmitted to the remaining natural tooth tissues. For adhesives and composites of different rigidities, FEM analysis allows the determination of the optimal adhesive layer thickness leading to maximum stress release while preserving the interface integrity. Application of a thin layer of a more flexible adhesive (lower elastic modulus) leads to the same stress relief as thick layers of less flexible adhesive (higher elastic modulus).

Energy dependent polymerization of resin-based composite.

OBJECTIVE: This study explores the relationship between the extent of polymerization and the radiant energy (dose) applied during the photopolymerization of resin-based composites. METHOD: FTIR was used to measure the 5-min and 24-h conversion of four resin-based composites prepared in a thin film and polymerized under conditions of decreasing intensity and a constant exposure time (30s) using a tungsten halogen curing light. The measured conversion was obtained over a wide range of applied radiant energy. Additionally, samples for two of the materials were polymerized at various intensities and exposure times such that the dose remained constant. This process was performed at four dose levels representing approximately 75% of the conversion range. RESULTS: The curing profiles (percent conversion versus applied radiant energy) depict a gradual decrease in conversion with decreasing energy followed by a rapid descent. Though there are differences in the maximum conversion attained between the materials, when conversion is represented as a fractional conversion relative to the maximum 24-h value, their 5-min and 24-h curing profiles appear quite similar. Additionally, very similar conversion was measured when the films were exposed using equivalent doses providing evidence for a reciprocal relationship between irradiance (power density) and exposure time. For the 24-h measurements, statistical equivalence (Fishers protected LSD at the 0.05 level) was noted for most of the combinations of exposure time and power density within a given dose. Generally, the exceptions occurred with the shortest exposure times. SIGNIFICANCE: A reciprocal relationship between exposure time and power density adds significance to the study of conversion as a function of the total applied dose. This relationship establishes the curing profile as a universal correlation between exposure time and power density.

Effect of surface treatments on the bond strength of glass ionomers to enamel.

OBJECTIVES: The objective of this study was to evaluate the effect of various surface treatments on the bond strength of several glass ionomers to enamel, and to examine the resulting bond interface. METHODS: Ground bovine enamel specimens were divided into groups which were pretreated with one of the following: (1) no pretreatment, (2) Vitremer primer, (3) 10% polyacrylic acid or (4) 35% phosphoric acid. A conventional glass ionomer and two resin-modified glass ionomers (RMGI's) were bonded to the pretreated enamel surfaces, stored in water for 24h and shear bond strengths measured. RMGI's were tested as light-cured and self-cured materials. Transverse sections of similarly prepared samples were etched with phosphoric acid for 60s to partially remove enamel and expose the enamel/glass-ionomer interface. The interface morphology was examined by SEM. RESULTS: Polyacrylic acid and phosphoric acid conditioning resulted in significantly increased bond strength to enamel for all three glass ionomer materials, compared to no pretreatment (p<0.01). Light-cured bond strengths were in most cases, significantly greater than when self-cured (p<0.01). Examination of the bonded interfaces revealed the presence of polymer tags in the enamel conditioned with polyacrylic acid and phosphoric acid. SIGNIFICANCE: Conditioners significantly improved the bond to enamel for the conventional glass ionomer and RMGI's that were examined in this study. Micromechanical bonding may play a role in the mechanism of bonding glass ionomer to enamel.

An SEM evaluation of several adhesive systems used for bonding fiber posts under clinical conditions.

OBJECTIVES: The objective of this investigation was to evaluate the effectiveness of three 'one-bottle' and two 'three step' adhesive systems (as controls) in the formation of resin tags, adhesive lateral branches and a resin dentin interdiffusion zone (RDIZ) when used to bond fiber posts under clinical conditions. This study was performed using standardized SEM observations and scoring resin tag formation and density. METHODS: Fifty root canal treated teeth, already scheduled for extraction for endodontic or periodontal reasons, were selected for this study. The patients were informed and their written consent was obtained. The samples were randomly allocated to five groups of ten samples each. Group 1: All Bond 2 with C & B (Bisco); Group 2: Scotchbond Multipurpose Plus with Opal Luting Composite (3M); Group 3: Scotchbond 1 in combination with Rely X ARC resin cement (3M); Group 4: One-step with C & B resin cement (Bisco); Group 5: All Bond Experimental with Post Cement HI-X (Bisco). The adhesive systems and resin cements were used strictly according to the manufacturers' instructions. The priming-adhesive solution of each 'one-bottle' system was light-cured before placing the resin cement and the post. Fifty Aestheti-Plus posts (white quartz fiber posts, RTD, France) were used. A week later, the roots were extracted and processed for SEM observations. RESULTS: All the adhesive systems showed a RDIZ and resin tag and adhesive lateral branch formation. Microscopic examination of the restored interfaces of Groups 1 and 2 showed a higher percent of RDIZ than those found in samples of Groups 3, 4 and 5. RDIZ morphology was easily detectable and uniform in the first two thirds of the root canals, whilst in the apical third the RDIZ was not uniformly present. Resin tag morphology and formation were significantly more detectable in the cervical and middle areas than in the apical zone. No statistically significant differences were found among the five groups coronally, while in the apical and middle thirds two 'one-bottle' systems (Groups 3 and 4) showed significantly less resin tags than the control Groups 1, 2 and the experimental Group 5. No statistically significant differences were found among the three 'one-bottle' systems in the three evaluated areas. The standardization of SEM observations and scoring resin tag formation allowed statistical evaluation. CONCLUSIONS: The 'three step' adhesive systems can create a wider micromechanical interlocking between adhesive materials and etched dentin than 'one-step' systems.

The effect of filler and silane content on conversion of resin-based composite.

OBJECTIVE: This study examines the influence of filler loading and silane content on the conversion of photoactivated, resin-based composites as determined using Fourier transform infrared spectroscopy (FTIR). METHOD: Zirconia/silica filler was processed with a silane coupling agent (gamma-methacryloxypropyltrimethoxysilane) to achieve a range of silane-to-filler compositions. Treated fillers were compounded with a photoactivated BisGMA/TEGDMA resin to yield a series of pastes all containing 72 wt% total solids. Diffuse reflectance FTIR was used to characterize methacrylate unsaturation of the silane on the filler particles while paste conversion was determined using transmission FTIR. A resin matrix conversion was determined by adjusting the paste conversion for silane unsaturation. Two additional series of pastes were compounded to achieve variable filler-to-resin ratios using non-treated filler and filler processed with 8 wt% silane. Paste conversion was determined using transmission FTIR. RESULTS: Pastes compounded from fillers containing variable percent silane demonstrated linearly decreasing conversion (R(2)=0.986) with increasing silane content and ranged from 52.7 to 62.8%. Adjusting paste conversion for silane unsaturation yielded similar resin matrix conversion for all cured pastes (65.1+/-0.8%). Pastes compounded with increasing filler-to-resin ratios had progressively decreasing conversion. Correcting for silane unsaturation suggests this effect was independent of whether the filler was silane-treated or not. SIGNIFICANCE: Composite resin matrix conversion as determined via FTIR can be underestimated by the presence of unreacted methacrylate from silane on the filler. A corrected resin matrix conversion can be estimated by adjusting for silane unsaturation. Additionally, increasing filler-to-resin ratio progressively decreases conversion independent of the presence of silane on the filler.

Stress distributions in adhesively cemented ceramic and resin-composite Class II inlay restorations: a 3D-FEA study.

OBJECTIVES: The purpose of this study was to investigate the effect of differences in the resin-cement elastic modulus on stress-transmission to ceramic or resin-based composite inlay-restored Class II MOD cavities during vertical occlusal loading. METHODS: Three finite-element (FE) models of Class II MOD cavity restorations in an upper premolar were produced. Model A represented a glass-ceramic inlay in combination with an adhesive and a high Young's modulus resin-cement. Model B represented the same glass-ceramic inlay in combination with the same adhesive and a low Young's modulus resin-cement. Model C represented a heat-cured resin-composite inlay in combination with the same adhesive and the same low Young's modulus resin cement. Occlusal vertical loading of 400 N was simulated on the FE models of the restored teeth. Ansys FE software was used to compute the local von Mises stresses for each of the models and to compare the observed maximum intensities and distributions. Experimental validation of the FE models was conducted. RESULTS: Complex biomechanical behavior of the restored teeth became apparent, arising from the effects of the axial and lateral components of the constant occlusal vertical loading. In the ceramic-inlay models, the greatest von Mises stress was observed on the lateral walls, vestibular and lingual, of the cavity. Indirect resin-composite inlays performed better in terms of stress dissipation. Glass-ceramic inlays transferred stresses to the dental walls and, depending on its rigidity, to the resin-cement and the adhesive layers. For high cement layer modulus values, the ceramic restorations were not able to redistribute the stresses properly into the cavity. However, stress-redistribution did occur with the resin-composite inlays. SIGNIFICANCE: Application of low modulus luting and restorative materials do partially absorb deformations under loading and limit the stress intensity, transmitted to the remaining tooth structures.

Polymerization efficiency of curing lamps: a universal energy conversion relationship predictive of conversion of resin-based composite.

A universal energy-conversion relationship (ECRu) predictive of conversion of a resin-based composite (RBC) polymerized with any light source has been described. This relationship was derived from an energy conversion relationship for RBC polymerized with a tungsten-halogen lamp and the lamp's efficiency relative to a hypothetical standard lamp. The ECRu was then used to predict conversion throughout RBC polymerized with an LED lamp using the lamp's relative efficiency compared to the standard lamp. The universal energy scale has also been described as predictive of scrape-back lengths for this RBC family when polymerized with any light source. Despite a 31% greater relative efficiency, scrape-back lengths from RBC polymerized using the LED lamp were predicted to be only 6% greater than those polymerized with the tungsten-halogen lamp when RBC is polymerized on an equal energy basis. This result was experimentally verified.

An energy conversion relationship predictive of conversion profiles and depth of cure for resin-based composite.

Predicting the polymerization throughout resin-based composite (RBC) has been reduced to a set of variables involving irradiance of the light source, exposure duration and RBC transmission properties, together with an energy-conversion relationship (ECR) derived from Fourier Transform Infrared Spectroscopic analysis (FTIR) of a single shade of photo-polymerized RBC. The ECR describes the localized energy density required to achieve a desired conversion independent of shade. Using this ECR, conversion was predicted and experimentally verified throughout different opacities of RBC based on knowledge of their transmission properties and the incident radiant energy density (irradiance times exposure time). Also, using RBC transmission properties, a critical scrape-back energy of approximately 32 mJcm(-2) was determined from cylindrical samples of photo-polymerized RBC in which the poorly polymerized material was removed. This value correlates to approximately 22% conversion. The critical scrape-back energy was then used to predict scrape-back lengths obtained from samples polymerized at various energy densities. These results confirm the logarithmic relationship between depth of cure and energy of exposure and the reciprocal relationship between irradiance and time of exposure.

In situ transformation of glass-ionomer into an enamel-like material.

PURPOSE: To assess the nature of clinically detectable alterations in glass-ionomer after long-term clinical service. METHODS: In addition to clinical macro pictures, SEM was carried out on replicas and on two sectioned primary molars SEM-EDAX analysis was performed to determine chemical transformation in the glass-ionomer. Also with SEM-EDAX, the composition was determined of a partially removed half-year old sealant. RESULTS: The clinically observed altered optical aspect and increased hardness could be related with surface structure changes as identified by SEM. The changed glass-ionomer showed a continuous integration with the adjacent enamel. The SEM-EDAX analysis revealed an increase of calcium and phosphorus in the surface layer, tentatively suggesting a sort of additional "mineralization" of the material. This phenomenon was only observed for restorations that had minimally 2-3 years in vivo dwell time.

Inter-operator variability in light curing.

OBJECTIVE:To test the hypothesis that operator experience influences the efficacy of light curing in a typical posterior intra-oral location. To investigate whether short cure cycles affect performance. DESIGN:A cross-sectional single-centre study designed to assess the efficacy of experienced and inexperienced operators when undertaking simulated intra-oral curing. SETTING:An in vitro laboratory based investigation conducted in a dental school during 2001. MATERIALS AND METHODS:A computer-based technique was used to monitor light intensity in a clinical simulation. Dentists and student operators were tested for their ability to cure a posterior restoration effectively. Relative light intensity was assessed against time for each operator and test run. RESULTS:Experienced (qualified) operators produced more effective and consistent cure results than less experienced undergraduate students. Operator performance was not affected by variations in irradiation time. CONCLUSIONS:This cross-sectional pilot investigation demonstrates that operator experience is a factor in successful clinical photo-curing of posterior restorations. Stable and accurate light guide positioning are required throughout the entire irradiation cycle to optimise intra-oral cure of light-activated restorations. Further investigations are planned to assess the potential of this novel method of assessment for use as a routine teaching aid in clinical practice.