Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics.

BACKGROUND: Enhancement of students' knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students' and interns' basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections. MATERIALS AND METHODS: A cross-sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019-June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi-square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%. RESULTS: The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri-angles, cotton rolls and saliva ejectors. Dual-cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement-retained implant-supported restorations. CONCLUSIONS: Students' knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.

Impact of different chemical denture cleansers on the properties of digitally fabricated denture base resin materials.

PURPOSE: To compare the impact of three different chemical denture cleansers (CDCs) (Corega, chlorhexidine, and hydrogen peroxide) on the surface roughness, microhardness, and color stability of 3D-printed, computer-aided design and computer-aided manufacturing (CAD-CAM) milled, and heat-polymerized denture base material (DBM). MATERIALS AND METHODS: A total of 420 disc-shaped specimens (10 ± 0.1 × 2 ±0.1 mm) were fabricated using three different construction techniques: three-dimensional (3D) printing (n = 140), CAD-CAM milling (n = 140), and heat-polymerization (n = 140). Sixty specimens (20 of each DBM) were used for baseline (pre-immersion) measurements (T1 ) for the tested surface properties (hardness [n = 10/material] and roughness [n = 10/material]). The remaining 360 specimens (n = 120/material) were investigated for surface roughness, microhardness, and color change after immersion for 1 year (T2 ) in distilled water or CDCs (n = 30/solution and n = 10/test). The data were analyzed using two-way ANOVA, one-way ANOVA followed by post-hoc Tukey's test at a significance level of less than 0.05. RESULTS: Significant differences were observed in the effects of the tested CDCs on the surface roughness, micro-hardness, and color stability of varying DBM specimens (p < 0.05). Corega showed the highest surface roughness and color change in all DBMs while H2 O2 resulted in the lowest microhardness for all DBMs. The lowest changes in all tested properties were seen with distilled water followed by chlorhexidine. A significant effect of type of cleanser, denture base material, and the interaction between the two was seen on all measured properties (p < 0.05). CONCLUSIONS: The tested CDCs significantly affected the surface properties of all DBMs but at varying degrees. Corega produced the highest negative effect on roughness and color change while H2 O2 dramatically affected the microhardness. Prolonged use of CDCs should be cautiously followed.

Evaluation of the Effect of Different Construction Techniques of CAD-CAM Milled, 3D-Printed, and Polyamide Denture Base Resins on Flexural Strength: An In Vitro Comparative Study.

PURPOSE: To compare the flexural strength of computer-aided design and computer-aided manufacturing (CAD-CAM) milled denture base resin (DBR), 3D-printed DBR, polyamide, and conventional compression-molded DBR. MATERIALS AND METHODS: Six denture base resins were used, one conventional heat-polymerized (Vertex), two milled CAD-CAM (AvaDent and Polident), two 3D-printed (Harz and NextDent), and one flexible polyamide (Polyamide). According to ISO 20795-1:2013, 60 specimens (65×10×3 mm) were constructed and divided into six groups (n = 10), according to DBR type. The flexural strength was measured using a universal testing machine and three-point loading test. Data were collected and analyzed using one-way ANOVA and Tukey's pair-wise post hoc tests (α = 0.05). RESULTS: One-way ANOVA results showed significant differences in flexural strengths between the tested DBRs (p˂0.001). Milled denture base resins (AvaDent and Polident) had significantly higher flexural strength values than the other groups (p˂0.001) and were followed by Vertex and NextDent, while Polyamide and Harz had the lowest values. Polyamide and Harz denture base resins had significantly lower flexural strength values than conventional denture base resin (p˂0.001). CONCLUSION: CAD-CAM milled DBRs showed the highest flexural strength when compared with conventional compression-molded or 3D-printed DBRs, while 3D-printed DBRs and polyamide showed the lowest flexural strengths.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials.

PURPOSE: To compare flexural strength, elastic modulus, and surface hardness of computer aided design and computer aided manufacturing CAD-CAM milled, 3D-printed, and heat-polymerized denture base resins. MATERIALS AND METHODS: A total of 120 specimens were fabricated from heat-polymerized acrylic resin (HP), milled resin (Avadent and IvoCad), and 3D-printed resin (ASIGA, FormLabs, and NextDent). The specimens were divided into 6 groups according to the type of denture base material (n = 20/material) (10/flexural properties and 10/hardness). Flexural strength and elastic modulus of the specimens were evaluated by 3-point bending test and surface hardness by Vickers hardness test. To test flexural properties, the specimens were fabricated according to ISO 20795-1:2013 standards (64 × 10 × 3.3 ± 0.2 mm). The dimensions for hardness test were 15 × 10 × 2.5 ± 0.2 mm. Scanning electron microscope was used to evaluate the surface morphology of the fractured specimens. The means and standard deviations were calculated, followed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: Milled resins showed significantly higher values for flexural strength, elastic modulus, and surface hardness, followed by HP and then 3D-printed resins (p < 0.001). Within milled groups, flexural strength of AvaDent was significantly higher than IvoCad (p < 0.001), while elastic modulus and hardness didn't show significant difference. Within 3D-printed resins, ASIGA showed the highest flexural strength and elastic modulus, insignificantly with FormLabs (p = 0.595) and significantly with NextDent (p = 0.008). ASIGA also showed significantly the highest hardness among the 3D-printed groups. No significant difference was found between FormLabs and NextDent in flexural strength (p = 0.357), elastic modulus (p = 1.00), or surface hardness (p = 0.987). CONCLUSION: CAD-CAM milled resins had greater flexural properties and hardness compared to heat-polymerized acrylic resin and 3D-printed resins. Although 3D-printed samples showed the lowest values of tested properties, the flexural strength and modulus were above clinically acceptable values.

Double-layered acrylic resin denture base with nanoparticle additions: An in vitro study.

STATEMENT OF PROBLEM: Whether the addition of different antifungal nanoparticles to denture base materials may affect physical or esthetic properties of the resulting nanocomposite is unclear. PURPOSE: The purpose of this in vitro study was to determine how a new method of adding antifungal nanofiller affects the properties of the processed nanocomposite denture base material. MATERIAL AND METHODS: Heat-polymerized acrylic resin specimens were prepared according to each test specification. Zirconium dioxide nanoparticles (ZrO2NPs) and silver nanoparticles (AgNPs) were added in 0.5, 1.0, and 1.5% of acrylic resin powder. The specimens were divided into 2 groups according to the acrylic resin packing method: 1 layer packed conventionally in one step and 2 layers packed in 2 steps, first with unmodified acrylic resin and then by a thin layer of modified acrylic resin before the final closure. The control group was made of unaltered acrylic resin in 1 step. Flexural strength (FS), translucency, and surface roughness (Ra) were measured. A microbial assay was performed by using the direct culture and slide count methods. Three-way ANOVA and Tukey post hoc tests were used to identify statistical differences among groups (α=.05). RESULTS: The addition of ZrO2NPs and AgNPs in the 1- or 2-layer specimens reduced Candida albicans adhesion (P<.001). In the 1- and 2-layer specimens, FS significantly increased with ZrO2NPs. AgNPs decreased FS only in the 1-layer specimen (P<.001). Surface roughness was not changed for the 1- and 2-layer specimens with ZrO2NPs or the 1-layer specimen with 0.5% AgNPs (P>.05), while other AgNP groups exhibited increased surface roughness (P<.001). AgNPs significantly lowered translucency in the 1- and 2-layer specimens (P<.001), while ZrO2NPs decreased translucency only in the 1-layer specimen (P<.001). CONCLUSIONS: The addition of ZrO2NPs in the double-layer technique decreased Candida adhesion and improved FS without affecting surface roughness, while AgNPs decreased Candida adhesion and FS and increased surface roughness. Both nanofillers decreased the translucency except 0.5% ZrO2NPs, which did not change translucency when applied in 2 layers.

Comparative Study of the Effectiveness of Laboratory-Formulated Polishing Pastes for Two CAD/CAM Ceramic Restorative Materials.

PURPOSE: To evaluate the effect of different polishing pastes with different particle sizes on the surface finish of two different CAD/CAM ceramics. MATERIALS AND METHODS: A total of 128 specimens were prepared of two CAD/CAM ceramics: lithium disilicate (12.4 × 14.5 × 2 mm) and monolithic zirconia (17.5 × 12.5 × 2.5 mm). They were divided randomly into 8 groups according to surface treatment (n = 8). Group 1 (control) was left as received after crystallization or sintering with no further surface treatment; Group 2 (glazed); Group 3 (positive control), where specimens were polished using standardized surface treatment (medium grit silicon carbide discs, rubber cup and pumice slurry, then rubber cup and toothpaste). For groups 4 to 8, in addition to silicon carbide and pumice slurry polishing, specimens were further polished using a diamond paste (DP), and polishing pastes of microzirconia (MZ), nanosilica (NS), nanodiamond (ND), and nanozirconia (NZ), respectively. Surface roughness (Ra ) was measured using noncontact profilometer. The mean values were compared using ANOVA and Post Hoc Tukey's test (α = 0.05). Specimens' surfaces were studied using a scanning electron microscope (SEM). RESULTS: Positive control group and MZ exhibited significant Ra of lithium disilicate compared to control (p ˂ 0.001), glazed (p = 0.001), DPs (p = 0.002), NS (p ˂ 0.001), ND (p ˂ 0.001), and NZ (p = 0.002). In the case of zirconia, positive control showed a significantly higher Ra compared to all other groups (p ˂ 0.001). No statistical difference was found between all other polishing techniques (positive control, glazed, DPs, NS, ND, MZ, and NZ) (p > 0.05). CONCLUSION: Polishing with ND, NZ, and NS lab-formulated pastes produced surfaces with comparable smoothness to control and glazed specimens for lithium disilicate and zirconia ceramic materials.

Strength and Surface Properties of a 3D-Printed Denture Base Polymer.

PURPOSE: This in vitro study evaluated the flexural strength, impact strength, hardness, and surface roughness of 3D-printed denture base resin subjected to thermal cycling treatment. MATERIALS AND METHODS: According to ISO 20795-1:2013 standards, 120 acrylic resin specimens (40/flexural strength test, 40/impact strength, and 40/surface roughness and hardness test, n = 10) were fabricated and distributed into two groups: heat-polymerized; (Major.Base.20) as control and 3D-printed (NextDent) as experimental group. Half of the specimens of each group were subjected to 10,000 thermal cycles of 5 to 55°C simulating 1 year of clinical use. Flexural strength (MPa), impact strength (KJ/m2 ), hardness (VHN), and surface roughness (µm) were measured using universal testing machine, Charpy's impact tester, Vickers hardness tester, and profilometer, respectively. Data were analyzed by ANOVA and Tukey honestly significant difference (HSD) test (α = 0.05). RESULTS: The values of flexural strength (MPa) were 86.63 ± 1.0 and 69.15 ± 0.88; impact strength (KJ/m2 )-6.32 ± 0.50 and 2.44 ± 0.31; hardness (VHN)-41.63 ± 2.03 and 34.62 ± 2.1; and surface roughness (µm)-0.18 ± 0.01 and 0.12 ± 0.02 for heat-polymerized and 3D-printed denture base materials, respectively. Significant differences in all tested properties were recorded between heat-polymerized and 3D-printed denture base materials (P < 0.001). Thermal cycling significantly lowered the flexural strength (63.93 ± 1.54 MPa), impact strength (2.40 ± 0.35 KJ/m2 ), and hardness (30.17 ± 1.38 VHN) of 3D-printed resin in comparison to thermal cycled heat-polymerized resin, but surface roughness showed non-significant difference (p = 0.262). CONCLUSION: 3D-printed resin had inferior flexural strength, impact strength, and hardness values than heat-polymerized resin, but showed superior surface roughness. Temperature changes (thermal cycling) significantly reduced the hardness and flexural strength and increased surface roughness, but did not affect the impact strength.

Closed Repair Technique: Innovative Surface Design for Polymethylmethacrylate Denture Base Repair.

PURPOSE: This study aimed to evaluate the repair strength of a newly introduced repair technique involving zero-gap repair width. MATERIALS AND METHODS: A total of 36 rectangular prism specimens with dimensions of 64 × 10 × 3.3 mm were prepared from heat-polymerized acrylic resin. Nine specimens were kept intact. The other specimens were sectioned into halves and modified to create repair gaps of 2.5-mm beveled (2.5B) as control, 0-mm beveled (ZB), and 0-mm inverse bi-beveled (ZIBB). The ZIBB group was prepared with a V-shaped internal groove on both halves (repair tunnel), while the intaglio and cameo surfaces were kept intact except for two small holes at the cameo surface for repair resin injection. The 2.5B and ZB groups were repaired conventionally while the ZIBB group was repaired by injecting repair resin into the tunnel through one of the holes until excess material oozed from the other hole. Repaired specimens were thermally cycled at 5 and 55°C for 10,000 cycles with 1 min dwell time. A 3-point bending test was conducted using a universal testing machine for flexural strength and elastic modulus measurement. Kruskal-Wallis/Mann-Whitney tests and ANOVA/post hoc Tukey tests were applied for data analysis (α = 0.05). RESULTS: The flexural strength of repaired specimens was substantially lower than that of intact specimens, and significant differences were present between repaired groups (p ˂ 0.05). ZB and ZIBB had higher flexural strength (p ˂ 0.001) and elastic modulus (p ˂ 0.05) than 2.5B. Among the ZB and ZIBB groups, ZB showed the highest flexural strength, and ZIBB had the highest elastic modulus. CONCLUSION: The closed repair technique improved the flexural strength and elastic modulus of repaired acrylic denture base.

Antifungal Activity of Denture Base Resin Containing Nanozirconia: In Vitro Assessment of Candida albicans Biofilm.

OBJECTIVE: To evaluate the antimicrobial effects of different concentrations of zirconium dioxide nanoparticles (nano-ZrO2) reinforcement of poly(methyl) methacrylate (PMMA) on surface roughness and C. albicans biofilm. METHODS: 20 heat-polymerized acrylic resin discs were conventionally made and divided into 4 groups (n = 5) according to nano-ZrO2 concentration: control (0% filler) and 3 experimental groups (2.5% (Z2.5), 5.0% (Z5.0), and 7.5% (Z7.5)). An optical profilometer was used for surface roughness evaluation, followed by Candida adherence assay. Specimens were sterilized, then immersed in cultured yeast (C. albicans), and incubated at 37°C for 48 hours. After that, discs were rinsed before extracting the clustered pellets of Candida. The attached C. albicans was counted using the direct method after spreading on agar media and incubating for 48 hours. Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test at α = 0.05. RESULTS: Surface roughness was significantly increased with all modified groups compared with control (P < 0.01), which showed the lowest roughness value (0.027 ± 0.004 µm). There was no significant difference in the roughness value among reinforced groups (2.5, 5.0, and 7.5%) (P > 0.05), with Z7.5 showing the highest roughness value (0.042 ± 0.004 µm). Candida count was reduced as the nano-ZrO2 increased but not significantly (P=0.15). CONCLUSIONS: The addition of different concentrations of nano-ZrO2 particles to PMMA increased the surface roughness compared with control; in contrast, insignificant reduction of C. albicans biofilm was detected.

Effects of Denture Cleansers on the Flexural Strength of PMMA Denture Base Resin Modified with ZrO2 Nanoparticles.

PURPOSE: The additions of zirconium oxide nanoparticles (nano-ZrO2 ) to denture base materials have produced nanocomposites with satisfactory properties, although there is a lack of research investigating the effects of denture cleansers on these materials. This study aimed to evaluate the effect of denture cleansers on the flexural strength of denture base materials modified with nano-ZrO2 . MATERIALS AND METHODS: A total of 270 specimens were fabricated from pure and nano-ZrO2 reinforced acrylic resins at 2.5% and 5%, resulting in 3 main groups. The groups were further divided into subgroups (n = 10) according to immersion solution (distilled water, Corega, sodium hypochlorite, and Renew) and immersion duration. Flexural strength was measured at baseline (T0 ) in distilled water and after 180 and 365 days of immersion (T1 and T2 ) in denture cleansers. Data were collected and analyzed using repeated measure ANOVA and Bonferroni post hoc tests (α = 0.05). RESULTS: The flexural strength of the nano-ZrO2 modified denture base material decreased significantly after immersion in different denture cleansers at different immersion durations in comparison to baseline (T0 ) (p < 0.001). Sodium hypochlorite showed the highest reduction in flexural strength followed by Corega, while Renew cleansing solution resulted in the least change. CONCLUSION: Denture cleansers can significantly affect the flexural strength of nano-ZrO2 modified denture base materials and thus should be used cautiously.

Influence of Addition of Different Nanoparticles on the Surface Properties of Poly(methylmethacrylate) Denture Base Material.

PURPOSE: To evaluate and compare the surface properties (roughness and hardness) of poly(methylmethacrylate) denture base material modified with zirconium dioxide (ZNPs), silicon dioxide (SNPs), and diamond (DNPs) nanoparticles. MATERIALS AND METHODS: Two hundred sixty heat-polymerized acrylic resin disks (15 × 2 mm) were prepared. ZNPs, SNPs, and DNPs were added in concentrations of 0%, 0.5%, 1.0%, 2.5%, and 5.0% by weight of acrylic powder. This yielded a total of 13 groups for each test according to filler type and concentration (n = 10/group). The control group was made of pure acrylic. A mechanical polisher was used to standardize specimens' surfaces before testing. A profilometer and Vickers hardness indenter were used to test the surface roughness and hardness, respectively. ANOVA and Tukey post hoc tests were used for data analysis (α = 0.05). RESULTS: In comparison to control, results showed a nonsignificant increase in surface roughness (Ra ) of acrylic material after the addition of 0.5% nanoparticles (ZNPs p = 0.168, SNPs p = 0.166, and DNPs p = 0.177), while a significant increase was seen with all other concentrations (p ˂ 0.05). Ra values of ZNP and DNP groups were significantly higher than those of the SNPs group (p < 0.001). The addition of any of the fillers to acrylic denture base materials significantly increased the hardness (p ˂ 0.05), with ZNPs and DNPs having values lower than those of the SNPs group (p < 0.001). CONCLUSIONS: Although nanofiller addition increased the hardness of denture base material, Ra was adversely affected when the concentration exceeded 0.5%. Therefore, 0.5% is suggested to be the most appropriate ratio to improve hardness with acceptable Ra .

Effect of Protective Coating on Surface Properties and Candida albicans Adhesion to Denture Base Materials.

PURPOSE: To evaluate the effect of protective coatings on the surface roughness, contact angle, and Candida albicans (C. albicans) adhesion to polymethyl methacrylate (PMMA) denture base materials. MATERIAL AND METHODS: A total of 560 rectangular heat- and autopolymerized acrylic resin specimens were fabricated and divided into 5 groups (n = 14/group) according to coating agent. Uncoated specimens were used as control. Coating materials were: nano-coat, Optiglaze, nano-silica, or cyanoacrylate. Surface roughness (Ra ) was evaluated using a profilometer. Contact angle measurements were performed using the sessile drop method. C. albicans adhesion was evaluated using direct culture and slide count methods. ANOVA and Tukey's post hoc tests were used for data analysis (α = 0.05). RESULTS: Nano-coat and Optiglaze coating of heat-polymerized acrylic significantly decreased Ra (p < 0.001). No significant effect was seen with nano-silica coating while Ra significantly increased with cyanoacrylate (p < 0.001). For autopolymerized acrylic, nano-coat, Optiglaze, and nano-silica coatings significantly decreased Ra in comparison to control group (p < 0.001) while no significant difference was seen between control and cyanoacrylate coating (p = 0.45). In comparison to control group, nano-coat, Optiglaze, and nano-silica coating for both denture base materials significantly decreased contact angle, and C. albicans adhesion (p < 0.001) while cyanoacrylate significantly increased C. albicans adhesion (p = 0.002) with no effect on contact angle for heat- (p = 1.00) and autopolymerized resins (p = 0.83). CONCLUSION: Coating of removable prosthesis with nano-coat, Optiglaze, or nano-silica is an effective method to reduce C. albicans adhesion.

Comparative Effect of Glass Fiber and Nano-Filler Addition on Denture Repair Strength.

PURPOSE: To evaluate and compare the effects of glass fiber (GF), Zirconium oxide nanoparticles (nano-ZrO2 ), and silicon dioxide nanoparticles (nano-SiO2 ) addition on the flexural strength and impact strength of repaired denture base material. MATERIALS AND METHODS: Heat-polymerized acrylic resin specimens were fabricated. All specimens were sectioned centrally and beveled creating 2.5 mm repair gap except for 10 controls. Specimen grouping (n = 10/group) was done according to filler concentration of 0%, 0.25%, 0.5%, and 0.75% of auto-polymerized acrylic powder. Modified resin was mixed, packed in the repair gap, polymerized, finished and polished. Three-point bending test and Charpy type impact testing were done. Data were analyzed using one-way-ANOVA and Post-Hoc Tukey test (α = 0.05). RESULTS: All additives significantly increased flexural strength and impact strength (p < 0.05). Within the modified subgroups, no significant differences were found for GF. Significant increase for nano-ZrO2 and significant decrease for nano-SiO2 as the concentration of additive increased were noted for both flexural strength and impact strength. Highest flexural strength was found with 0.75%-nano-ZrO2 (69.59 ± 2.52MPa) and the lowest was found with 0.75%-nano-SiO2 (53.82 ± 3.10MPa). The 0.25%-nano-SiO2 showed the highest impact strength value (2.54 ± 0.21 kJ/m2 ) while the lowest impact strength value was seen with 0.75%-nano-SiO2 (1.54 ± 0.17 kJ/m2 ). CONCLUSION: Nano-filler effect was concentration dependent and its addition to repair resin increased the flexural and impact strengths. The incorporation of 0.75%-ZrO2 or 0.25%-SiO2 into repair resin proved to be a promising technique to enhance repair strength and avoid repeated fractures.

A Novel Approach to Improve Repair Bond Strength of Repaired Acrylic Resin: An in Vitro Study on the Shear Bond Strength.

PURPOSE: To evaluate the combined effect of mechanical surface treatment with intermediate bonding agents (methyl methacrylate [MMA] and silane coupling agents) and ZrO2 nanoparticle (nano-ZrO2 ) addition to repair material on the shear bond strength (SBS) of repaired denture bases. MATERIALS AND METHODS: Heat-polymerized acrylic resin was used to fabricate 130 cylindrical blocks (15 mm × 10 mm) and divided into a control group without treatment (C, n = 10), and 3 repair groups (n = 40/group) divided into specimens treated with alumina blasting alone (AB), specimens blasted with alumina combined with silane coupling agent (AB + SCA), or combined with MMA-based composite bonding agent (AB + MA). Treated groups were further subdivided according to nano-ZrO2 concentrations into 0 wt%, 2.5 wt%, 5 wt%, and 7.5 wt% added to repair resin powder. Repair resin monomer and polymer were combined and packed on the repair area and then placed in a pressure pot at 37°C for 15 minutes for polymerization. Shear bond test was performed using a universal testing machine. Scanning electron microscopy (SEM) was used to examine the effect of surface modifications on repair surfaces and to evaluate the topography of fracture surfaces. Tukey-Kramer multiple-comparison test was used to detect significant differences between groups (p ≤ 0.05). RESULTS: SBS (MPa) of specimens treated with alumina blasting and application of intermediate agents were significantly higher than the control group (p < 0.05), while no significant differences were found between AB and control group (p > 0.05). Nano-ZrO2 addition significantly increased SBS except for AB, and 5%, 7.5% MA (p > 0.05). SEM evaluation showed that alumina blasting created rougher and more porous surfaces, while SCA and MA reduced the irregularities and fissures. CONCLUSION: Application of bonding agents to repair surfaces after alumina blasting improved the repair bond strength and proved to be a possible new adhesive method for denture repair. Moreover, nano-ZrO2 addition in combination with surface treatment improved the repair bond strength.

Effect of Repair Gap Width on the Strength of Denture Repair: An In Vitro Comparative Study.

PURPOSE: To evaluate the effect of repair gap width on the flexural strength and impact strength of a repaired acrylic denture with and without thermal cycling. MATERIALS AND METHODS: A total of 240 heat-polymerized acrylic resin specimens were fabricated in dimensions of 65 × 10 × 2.5 ± 0.2 mm and 55 × 10 × 10 ± 0.2 mm for flexural strength and impact strength testing, respectively. All specimens were sectioned into halves then divided into 6 groups according to repair gap width (n = 10). The repair gap of the control group was 2.5 mm at the base, while the repair gaps of the test groups were prepared as 2.0, 1.5, 1.0, 0.5, and 0 mm at the base. All specimens were prepared with a 45° bevel joint. Each specimen was placed into the mold that retained the original length of the specimen and modified only the repair gap, which was packed with repair resin. After polymerization, specimens were finished and polished, and half of the specimens were thermal cycled for 5000 cycles. Three-point bending test and Charpy impact test were used to determine the flexural strength and impact strength, respectively. ANOVA and Tukey's HSD test were used for statistical analysis, where α was set at 0.05. RESULTS: Decreasing repair gap significantly increased the flexural strength in comparison to control group (p < 0.05); 0.5-mm repair gap showed the highest flexural strength values. Changing the repair gap significantly increased the impact strength of groups 2.0- and 1.5-mm (p < 0.05). Thermal cycling significantly decreased the flexural strength of all tested groups as well as impact strength for groups with wide repair gaps (2.5-, 2.0-, and 1.5-mm) (p < 0.05), while other tested groups had nonsignificant effect on impact strength (p > 0.05). CONCLUSION: Decreasing repair gap increased the flexural and impact strengths of repaired acrylic resin. A repair gap of 0-, 0.5-, or 1.0-mm with beveled repair surface is recommended to improve repair strength and overcome the drawbacks of increased amounts of autopolymerized repair resin.

Effect of repair and surface treatments on the strength of digitally fabricated resin-based dental prostheses: A systematic review of in vitro studies.

OBJECTIVE: This review investigated the current literature pertaining to the repairability of computer-aided design-computer-aided manufacturing (CAD-CAM) milled and three-dimensional (3D) printed resin-based dental prostheses (RBDPs) as well as the appropriate surface treatment for each repair material that will produce adequate repair bond strength. DATA/SOURCES: PubMed, Web of Science, and Scopus databases were searched for published articles involving repair of CAD-CAM RBDPs between January 2010 and June 2023. Data were collected and analyzed to reveal the surface treatment effects, suggested repair materials, and strength of repaired RBDPs. STUDY SELECTION: Out of 164 retrieved titles, 11 studies were included, of which five investigated the repair of 3D-printed RBDPs, three investigated the repair of CAD-CAM milled resins, and three investigated both materials. Additionally, of the included studies, seven investigated denture base resins, three studied provisional restoration resins, and one evaluated 3D-printed intraoral splints. Various surface treatments were suggested, with air-abrasive methods being the most commonly used. Different materials for resin repair were proposed and used, including auto-polymerized, reline, and composite resins. For 3D-printed resins, repair with Bis-acrylic/Bis-GMA composites improved repair strength. CONCLUSION: Surface treatments positively affected the repair strength of conventional and milled RBDPs. However, challenges remain relevant to the repair of 3D-printed resins owing to composition mismatches and fabrication techniques. Therefore, further investigation is required to develop new 3D-printed resins. CLINICAL SIGNIFICANCE: CAD-CAM milled resins have satisfactory repair strength, which increases with surface treatment. The repair of 3D-printed resins has proven challenging even with surface treatments. However, composite resins are the materials of choice.

Impact of Nanoparticle Addition on the Surface and Color Properties of Three-Dimensional (3D) Printed Polymer-Based Provisional Restorations.

This study aimed to evaluate and compare the impact of additives such as ZrO2 and SiO2 nanoparticles (ZrO2NP or SiO2NP) on the hardness, surface roughness, and color stability of 3D printed provisional restorations. Two hundred samples in total were printed using 3D printed resins (ASIGA, and NextDent). Each resin was modified with ZrO2NPs or SiO2NPs in two different concentrations (0.5 wt% and 1 wt%), while one group was kept unmodified (n = 10). Disc-shaped (15 × 2.5 mm) samples were designed and printed in accordance with the manufacturer's recommendation. Printed discs were evaluated for color changes through parameters CIELAB 2000 system (ΔE00), hardness using Vickers hardness test, and surface roughness (Ra) using a noncontact profilometer. After calculating the means and standard deviations, a three-way ANOVA and Tukey post hoc test were performed at α = 0.05. The addition of ZrO2NPs or SiO2NPs to ASIGA and NextDent resins significantly increased the hardness at a given level of concentration (0.5% or 1%) in comparison with pure (p < 0.001), with no significant difference between the two modified groups per resin type (p > 0.05). The highest hardness value was detected in 1% ZrO2NPs with 29.67 ± 2.3. The addition of ZrO2NPs or SiO2NPs had no effect on the Ra (p > 0.05), with 1% ZrO2NPs showing the highest value 0.36 ± 0.04 µm with NextDent resin. ZrO2NPs induced higher color changes (∆E00), ranging from 4.1 to 5.8, while SiO2NPs showed lower values, ranging from 1.01 to 1.85, and the highest mean ∆E00 was observed in the 1% ZrO2NPs group and NextDent resin. The incorporation of ZrO2NPs and SiO2NPs in 3D printed provisional resins increased the hardness without affecting the surface roughness. The optical parameters were significantly affected by ZrO2NPs and less adversely affected by SiO2NPs. Consequently, care must be taken to choose a concentration that will improve the materials' mechanical performance without detracting from their esthetic value.

In Vitro Evaluation of Candida albicans Adhesion and Related Surface Properties of CAD/CAM Denture Base Resins.

OBJECTIVE: The aim of this study was to evaluate the surface roughness, contact angle, and adhesion of Candida albicans to computer-aided designing/computer-aided manufacturing (CAD/CAM) and heat-polymerized (HP) denture base materials. MATERIALS AND METHODS: Specimens were allocated to six groups based on the composition of studied denture base materials, HP acrylic resin, milled resins (AvaDent and IvoCad), and 3D-printed resins (ASIGA, FormLabs, and NextDent). Ten specimens per group were used for each test (n = 10/test). Surface roughness and contact angles were analyzed using profilometer and goniometer, respectively. Adhesion of C. albicans was counted using colony-forming unit (CFU/mL). Means and standard deviations were calculated, and then one-way analysis of variance (ANOVA), followed by Tukey's post hoc test. Correlation of Candida adhesion and surface parameters was determined by using Pearson's correlation analysis. RESULTS: No statistically significant difference was noted in surface roughness between HP, milled, and 3D-printed denture base resins except NextDent, which showed significantly higher roughness in comparison to all other resins (p = 0.001). In terms of contact angle, milled resins had the lowest value, followed by HP, ASIGA, and FormLabs, whereas NextDent showed the highest contact angle (p = 0.001). C. albicans adhesion showed no significant difference between all denture base resins. A positive and significant correlation was found between C. albicans adhesion and contact angle (p = 0.003), while no correlation was reported between C. albicans adhesion and surface roughness (p = 0.523). CONCLUSION: Adhesion of C. albicans was similar in all tested specimens. Surface roughness showed no significant difference between all groups except NextDent, which had the highest value. Milled denture base resins had the lowest contact angle among all groups.

Fit, Precision, and Trueness of 3D-Printed Zirconia Crowns Compared to Milled Counterparts.

Precise fit of a crown and accurate reproduction of the digital design are paramount for successful treatment outcomes and preservation of clinician and technician time. The study aimed to compare the internal fit, marginal adaptation, precision, and trueness of 3D-printed zirconia crowns compared to their milled counterpart. A total of 20 monolithic 3 mol% yttria stabilized-zirconia crowns (n = 10) were made using computer-assisted design (CAD) followed by additive (3D-printed) and subtractive (milled) manufacturing. Digital scanning of the master die with and without a fit checker followed by image superimposition, and analysis was performed to evaluate internal and marginal adaptation in four areas (occlusal, axial, marginal, and overall). ISO 12836:2015 standard was followed for precision and trueness evaluation. Statistical analysis was achieved using a t-test at α = 0.05. Internal fit and marginal adaptation revealed no significant difference between the two test groups (p > 0.05). The significant difference in trueness (p < 0.05) was found between the two groups in three areas (occlusal, axial, and internal). The best and worst trueness values were seen with 3D-printed crowns at occlusal (8.77 ± 0.89 µm) and Intaglio (23.90 ± 1.60 µm), respectively. The overall precision was statistically better (p < 0.05) in the 3D-printed crowns (9.59 ± 0.75 µm) than the milled (17.31 ± 3.39 µm). 3D-printed and milled zirconia crowns were comparable to each other in terms of internal fit and marginal adaptation. The trueness of the occlusal and axial surfaces of 3D-printed crowns was better, whereas the trueness of fitting surface of milled crowns was better. 3D-printed crowns provided a higher level of precision than milled crowns. Although the internal and marginal fit of both production techniques were comparable, 3D printing of zirconia produced more precise crowns.

Flexural Strength of CAD/CAM Denture Base Materials: Systematic Review and Meta-analysis of In-vitro Studies.

Introduction: Digital complete dentures fabrication techniques are expanding. This study aimed to review flexural strength (FS) of milled and 3D-printed denture base materials to answer the study question: is FS of computer-aided designing/computer-aided manufacturing (CAD/CAM) denture base comparable to conventional heat-polymerized materials? Materials and Methods: Search was done within different databases for articles published between January 2010 and June 2021 using specific keywords. Articles of in-vitro studies in English language with methods following International Standards Organization standardization/ADA specifications for flexural testing of conventional and CAD/CAM (milled or printed) polymethyl methacrylate (PMMA) materials were included. Results: Out of the 61 studies, 9 were processed for data extraction and only 7 underwent meta-analysis. Two, six, and one study showed high, moderate, and low risk of bias, respectively. Random-effects model was used for analysis and resulted in the average FS of 120.61 MPa [95% confidence interval (CI): 109.81-131.41] and 92.16 MPa (CI: 75.12-109.19) for CAD/CAM milled and heat-polymerized PMMA, respectively. Conclusion: Subtractive CAD/CAM technique of denture fabrication showed satisfactory FS values, whereas additive CAD/CAM method was comparable to conventional heat-polymerized technique with lower value, requiring further investigations and improvement. The clinical use of milled denture bases is an acceptable substitution to heat-polymerized PMMA, making the denture fabrication an easier and faster process.