Bio-active cements-Mineral Trioxide Aggregate based calcium silicate materials: a narrative review.

Recent advances in the field of endodontics have greatly improved the outcome and success rate of dental materials. For last three decades, there has been great interest in the development of bioactive dental material with the ability to interact and induce surrounding dental tissues to promote regeneration of pulpal and periradicular tissues. As these bioactive materials are mainly based on calcium silicates, they are also referred to as Calcium Silicate materials. The first material introduced was Mineral Tri-oxide Aggregate, which, due to its favourable biological properties, gained importance initially. However, later, due to its drawbacks, liked is colouration, long setting time and difficult manipulation, several modifications were done and newer bioactive materials, such as Biodentine, BioAggregate, Endosequence, Calcium-Enriched Mixture etc., were developed. The main applications of these materials are for pulp capping (direc t/indirec t), pulpotomy, perforation repair, resorption defects, apexogenesis and as retrograde filling materials, apexification and endodontic sealers. This review discusses the various types of bioactive materials, their composition, setting mechanism, and literature evidence for current applications.

Study of Two-Body Wear Performance of Dental Materials.

INTRODUCTION: The purpose of this study was to evaluate the two-body wear resistances of natural enamel and four dental materials in vitro. METHODS: The testing machine was modified to form a type of pin-on-disk wear test apparatus. Four dental material specimens (Au-Pd alloy, Ag-Pd alloy, FiltekTMP60 and FiltekTMZ350 composite resins) and enamel were used as the pins, and a steatite ceramic grinding wheel was used as the abrasive counter face. The wear volume loss and the rigidity value was measured. The worn surface and the element analysis of the debris were analyzed. RESULT: The wear volume loss of Au-Pd alloy and its steatite antagonists were the nearest to those of the dental enamel. SEM microphotographs showed that, the main wear mechanism of the dental materials was abrasive and adhesive wear. CONCLUSIONS: Au-Pd alloy had good wear resistance and was more suitable for dental applications than other three dental materials.

Hybrid materials offer new perspectives.

Dental materials, especially in restorative dentistry, must not only be cost-effective, they must also meet many other requirements: biocompatibility, durability, excellent shade and light effects, abrasion resistance, hardness, mechanical strength under pressure, chemical resistance, surface density, ease of manufacture, and easy intraoral maintenance.

Root Caries in Older Adults.

Older adults are retaining an increasing number of natural teeth, and nearly half of all individuals aged 75 and older have experienced root caries. Root caries is a major cause of tooth loss in older adults, and tooth loss is the most significant negative impact on oral health-related quality of life for the elderly. The need for improved preventive efforts and treatment strategies for this population is acute.

Repair of dental resin-based composites.

OBJECTIVES: The study analyzed the reparability and compatibility of light-curing resin-based composites (RBCs) of the categories "microhybrid," "nanohybrid," and "packable." MATERIALS AND METHODS: Six RBCs with different matrix and filler formulation--purely methacrylate-based composites (MBCs), ormocer-based composites (OBCs), and silorane-based composites (SBCs)--were used for the specimens. Every material was combined with itself and with the other five RBCs, resulting in a total of 36 combination groups (n = 20). The specimens were polymerized, aged for 8 weeks in distilled water at 37 °C, and then repaired by means of a repair kit. Shear bond strength and fracture mode were measured after aging of the specimens, undergoing storage for 24 h in distilled water at 37 °C followed by thermocycling (5,000 cycles, 5-55 °C) and an additional 4-week storage in distilled water at 37 °C. RESULTS: Data were statistically analyzed using ANOVA with TUKEY HSD post hoc test (α = 0.05). On average, the OBC Admira reached the highest value as a substrate material (30.41 MPa), and the SBC Filtek Silorane reached the lowest value (8.14 MPa). Filtek Silorane was identified as the repair material with the highest bond strength value (28.70 MPa), while a packable composite reached the lowest bond strength value (15.55 MPa). The analysis of the break modes showed that adhesive breaks are typical when strength is at its lowest (6.27 MPa). A large number of cohesive fractures are conspicuous when identical materials are used for repair, except Filtek Silorane (2 % cohesive fractures). CONCLUSIONS: The study demonstrated that the effect of the different materials on bond strength varies strongly, depending on whether the material is used as filling or as repair material. CLINICAL RELEVANCE: It is generally advisable but not compulsory to combine identical RBCs.

Antibacterial activity in adhesive dentistry: a literature review.

This literature review summarizes the published research regarding the antibacterial agents used in adhesive dentistry. This article provides information about the clinical applications, beneficial effects, and possible disadvantages of antibacterials when used in various bonding situations.

Composite resin: a versatile, multi-purpose restorative material.

Introduced more than some 50 years ago, composite resin technology has simplified the manner in which clinicians practice restorative dentistry, offering greater predictability and improved physical properties. Decades of material science and laboratory development along with clinical trials in human subjects have culminated in composite resin being validated as a reliable, multifunctional restorative material. With a wide range of composite resins available today, clinicians can benefit from knowing the infrastructure of a given material in order to determine which type will work best in a particular clinical situation.

Prosthetic treatments for patients with oronasal communication.

The prosthetic treatments play a role in the rehabilitation of patients with congenital and acquired cleft palate. To prepare the surgical field and/or correct inevitable sequelae of the surgery, the rehabilitation with obturator prosthesis is an auxiliary or complementary treatment to surgical treatments. In cases where the surgical treatment is contraindicated, the prosthetic rehabilitation becomes a definitive treatment. The denture is planned and fabricated according to each patient. Therefore, the aim of this study was to discuss the prosthetic rehabilitation performed in patients with oronasal communication.

Strategies to overcome polymerization shrinkage--materials and techniques. A review.

UNLABELLED: Stress generation at tissue/resin composite interfaces is one of the important reasons for failure of resin-based composite (RBC) restorations owing to the inherent property of polymerization shrinkage. Unrelieved stresses can weaken the bond between the tooth structure and the restoration, eventually producing a gap at the restoration margins. This can lead to postoperative sensitivity, secondary caries, fracture of the restorations, marginal deterioration and discoloration. As polymerization shrinkage cannot be eliminated completely, various techniques and protocols have been suggested in the manipulation of, and restorative procedures for, RBCs to minimize the shrinkage and associated stresses. Introduction of various newer monomer systems (siloranes) may also overcome this problem of shrinkage stress. This review emphasizes the various material science advances and techniques advocated that are currently available or under trial/testing phase to deal with polymerization shrinkage in a clinical environment. CLINICAL RELEVANCE: Minimizing the shrinkage stresses in RBC restorations may lead to improvement in the success rate and survival of restorations. Thus, it is important for dental practitioners to be aware of various techniques and materials available to reduce these shrinkage stresses and be updated with the current knowledge available to deal with this issue.

Confocal examination of subsurface cracking in ceramic materials.

PURPOSE: The original ceramic surface finish and its microstructure may have an effect on crack propagation. The purpose of this study was to investigate the relation between crack propagation and ceramic microstructure following cyclic fatigue loading, and to qualitatively evaluate and quantitatively measure the surface and subsurface crack depths of three types of ceramic restorations with different microstructures using a Confocal Laser Scanning Microscope (CLSM) and Scanning Electron Microscope (SEM). MATERIALS AND METHODS: Twenty (8 x 4 x 2 mm(3)) blocks of AllCeram (AC), experimental ceramic (EC, IPS e.max Press), and Sensation SL (SSL) were prepared, ten glazed and ten polished of each material. Sixty antagonist enamel specimens were made from the labial surfaces of permanent incisors. The ceramic abraders were attached to a wear machine, so that each enamel specimen presented at 45 degrees to the vertical movement of the abraders, and immersed in artificial saliva. Wear was induced for 80K cycles at 60 cycles/min with a load of 40 N and 2-mm horizontal deflection. The specimens were examined for cracks at baseline, 5K, 10K, 20K, 40K, and 80K cycles. RESULTS: Twenty- to 30-microm deep subsurface cracking appeared in SSL, with 8 to 10 microm in AC, and 7 microm close to the margin of the wear facets in glazed EC after 5K cycles. The EC showed no cracks with increasing wear cycles. Seventy-microm deep subsurface cracks were detected in SSL and 45 microm in AC after 80K cycles. Statistically, there was significant difference among the three materials (p < 0.05). Bonferroni multiple comparison of means test confirmed the ANOVA test and showed that there was no statistical difference (p > 0.05) in crack depth within the same ceramic material with different surface finishes. CONCLUSIONS: The ceramic materials with different microstructures showed different patterns of subsurface cracking.

Adhesion of Streptococcus mutans NCTC 10449 to artificial teeth: an in vitro study.

STATEMENT OF PROBLEM: Plaque on dentures may foster the occurrence of denture stomatitis and periodontal diseases in gingival tissues adjacent to partial dentures. Thus, it is beneficial for dental materials to have a low susceptibility to plaque adhesion. PURPOSE: The purpose of this study was to evaluate the susceptibility of commonly used artificial teeth to adhesion of the oral bacterium Streptococcus mutans. MATERIAL AND METHODS: Fifteen specimens each of 12 different artificial teeth were prepared by cutting standardized slabs from the buccal tooth surfaces. After normalizing size (round specimens, diameter of 5 mm, 2 mm thick), polishing (grinding paper, grain 1000 and 4000; universal polishing paste), and assessing surface roughness with a profilometric contact surface measurement device, specimens were incubated with Streptococcus mutans NCTC 10449 suspension for 2.5 hours at 37 degrees C. A veneering composite resin (Sinfony) was used as a control. Adherent bacteria were quantified using a fluorometric assay (Resazurin reduction); relative fluorescence intensity correlates linearly with the number of adherent bacteria. Medians and 25%/75% percentiles were calculated, and statistical analysis was performed using the Kruskal-Wallis test and the Bonferroni-adjusted Mann-Whitney U test. RESULTS: The highest values, indicating high adhesion of streptococci, were observed for filler-supplemented teeth with median relative fluorescence values ranging from 6356 to 18,770. Similar values were recorded for a double cross-linked resin tooth (6444). Significantly lowest values, ranging from 1173 to 3974, were found for unfilled PMMA acrylic resin teeth and acrylic resin teeth with an interpenetrating network (1436). CONCLUSIONS: Within the limitations of this study, it can be concluded that the adhesion of Streptococcus mutans to unfilled PMMA teeth and teeth with an interpenetrating network is lower than adhesion to artificial teeth supplemented with fillers or double cross-linked acrylic resin teeth.

Clinical, morphological, and ultrastructural aspects with the use of Er:YAG and Er,Cr:YSGG lasers in restorative dentistry.

The Er:YAG laser has an active medium of Yttrium-Aluminium-Garnet doped with Erbium ions and emits free-running pulsed laser energy at a wavelength of 2940 nm. The Er,Cr:YSGG laser has an active medium of Yttrium-Scandium-Gallium-Garnet doped with Erbium and Chromium ions and emits free-running pulsed laser energy at a wavelength of 2780 nm. These wavelengths have a high absorption in water, which makes their application appropriate for ablating oral soft tissue as well as dental hard tissue. This article examines the principles of use for the Er:YAG and Er,Cr:YSGG lasers in clinical restorative dentistry and reviews the literature regarding different aspects of the use of laser energy on hard tissues.

Adhesive procedures in daily practice: essential aspects.

Adhesive procedures are essential to most restorative protocols used in modern dentistry. Increasing demand and constant interest in new products have stimulated dental manufacturers to produce new adhesive systems and marketing campaigns that announce fast and easy bonding. However, laboratorial and clinical studies show that, usually, ease of application of an adhesive system does not relate to its competence in creating a quality, long-term adhesive interface. This article will present relevant data from the scientific literature to help clinicians understand quality adhesion and achieve excellent results with the current adhesion systems.

Does Classification of Composites for Network Meta-analyses Lead to Erroneous Conclusions?

OBJECTIVES: Composites can be classified differently, according to manufacturer information, filler particle size, resin-monomer base, or viscosity, for example. Using clinical trial data, network meta-analyses aim to rank different composite material classes. Dentists then use these ranks to decide whether to use specific materials. Alternatively, annual failure rates (AFRs) of materials can be assessed, not requiring any classification for synthesis. It is unclear whether different classification systems lead to different rankings of the same material (ie, erroneous conclusions). We aimed to evaluate the agreement of material rankings between different classification systems. METHODS: A systematic review was performed via MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. Randomized controlled trials published from 2005-2015 that investigated composite restorations placed in load-bearing cavitated lesions in permanent teeth were included. Network meta-analyses were performed to rank combinations of composite classes (according to manufacturer, filler particle size, resin-monomers, viscosity) and adhesives. Material combinations were additionally ranked using AFRs. RESULTS: A total of 42 studies (6088 restorations, 2325 patients) were included. The ranking of most material class combinations showed significant agreement between classifications ( R2 ranged between 0.03 and 0.56). Comparing material combinations using AFRs had low precision and agreement with other systems. AFRs were significantly correlated with follow-up periods of trials. CONCLUSION: There was high agreement between rankings of identical materials in different classification systems. Such rankings thus allow cautious deductions as to the performance of a specific material. Syntheses based on AFRs might lead to erroneous results because AFRs are determined by follow-up periods and have low precision.

[Photoelastic analysis of the influence of prosthetic material on the stress distribution in bone around implant].

Objective: To provide a reference for a suitable alternative treatment choice for implant-supported prostheses, and to explore the influence of 3 types of prosthetic material on the stress distribution around implant. Methods: The implant-abutment analogs were embedded individually into photoelastic resin blocks, which were medical pure titanium castings reproducing the surface and outline of implant (diameter 4.3 mm, length 11.5 mm) and esthetic abutment (regular profile, 1 mm). The prostheses were divided into 3 groups according to the type of prosthetic material. Each group consisted of 5 samples. The samples of composite resin ceramic and zirconia group were milled by chair-side computer aided design and computer aided manufacture (CAD/CAM) system. The samples of porcelain-fused-to-metal crown group were made manually and a pre-arranged silicone rubber impression of CAD/CAM crown would guide to shape the veneer porcelain. Each set was submitted to a 300 N compressive load axially or obliquely (75°). The stress value in the peri-implant bone at the level of the neck, neck1/3, middle1/3 and root1/3 of the sections (0.5, 1.5, 2.5, 3.5 mm) from implant was analyzed by digital photoelasticity, and the stress cushioning effect of 3 types of prosthetic material was comprehensively evaluated. Results: The time spent reaching the stress peak of composite resin ceramic group [(1.58±0.08) s, axially; (2.75±0.21) s, obliquely] was larger than that of the zirconia group [(1.40±0.12) s, axially; (2.30±0.25) s, obliquely] (P<0.05) under the same download mode. Although there were no significant differences in equivalent stress values of the measurement points among the three groups (P>0.05), a downward trend of equivalent stress values of composite resin ceramic group was observed compared to zirconia group, regardless of load type. When loaded obliquely, the highest degree of stress concentration at the level of the neck of implant were found in the porcelain-fused-to-metal crown group. Conclusions: Within the limitations of this study, composite resin ceramic was more beneficial to the biomechanical behavior of implant in stress buffer compared to zirconia.