Preventive and restorative alternatives to caries by irradiation: a scoping review.

PURPOSE: This study is to conduct a comprehensive scoping review to map scientific evidence and clarify concepts regarding the commonly recommended preventive and restorative dental treatments for patients diagnosed with head and neck cancer (HNC) and subjected to radiotherapy. MATERIAL AND METHODS: This systematic scoping review was performed under the PRISMA-ScR guidelines. The study's experimental design was registered in the Open Science Framework. In vitro studies that evaluated preventive and restorative dental treatment over 50 Gy radiation doses were included. The search was conducted in November 2023 in five electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) without language or date restriction. A search strategy was applied based on keywords, MeSh terms, or synonyms. A descriptive analysis was conducted. RESULTS: A total of 49 studies, out of 3679 original articles identified, were included and reviewed. Of the included studies, three evaluated saliva stimulants and 35 evaluated fluoride-based preventive materials: gel (n = 18) toothpaste (n = 11) mouth rinse (n = 8) and varnish (n = 5) while 14 evaluated restorative materials: resin composite (n = 12) glass ionomer cement (n = 6) and amalgam (n = 1) Of those studies, 36 were clinical trials and 13 were in vitro studies. CONCLUSION: Fluoride gel was the most frequently recommended preventive material for preventing radiation caries with supportive clinical evidence. Resin composite and glass ionomer were the most frequently used restorative materials, respectively. However, there is not yet clinical evidence to support the use of resin composite in irradiated teeth.

Effects of simulation-based flipped classroom in developing head and neck examination skills in dental students.

OBJECTIVES: To evaluate the effectiveness of a simulation-based flipped classroom in developing dental students' head and neck examination skills. METHODS: Second-year dental students (n = 118) participated in a simulation-based flipped classroom experience. A pre-class recorded lecture and video were posted online one week before the simulation date. In class, students completed a pre-quiz assessing pre-class coursework understanding of head and neck examination content. Then, students attended a question-and-answer session before the patient simulation. A formative assessment of head and neck examination simulation on a patient in the clinic was completed. Lastly, students completed an in-class post-quiz assessing understanding of head and neck examination content after the simulation, classroom simulation discussion, and open-response survey. RESULTS: Student post-quiz scores were significantly higher than pre-quiz scores, with an average improvement of 4.8 ± 7.2 percentage points. There was no difference between male and female improvement in scores. Student survey responses indicated that students liked combining simulation and flipped classroom methodology, flexibility with their schedules, learning at their pace, and opportunities for a deeper level of learning. Students reported wanting more practice sessions for their technical skills and more accessibility to faculty. CONCLUSIONS: According to this study's results, students had significantly higher post-quiz scores than pre-quiz scores and reported positive perceptions of this combined teaching technique. A simulation-based flipped classroom might be an effective teaching approach for developing head and neck examination skills that can be applied at other dental facilities with potentially similar results.

Effect of artificial aging on optical properties and crystalline structure of high-translucency zirconia.

PURPOSE: To investigate the effect of different in vitro aging protocols on the optical properties and crystalline structure of high-translucency (HT) zirconia. MATERIALS AND METHODS: Thirty-six specimens of HT and extra-high translucency (XT) zirconia were divided into three groups: control (CO)-no treatment; hydrothermal aging (HA)-autoclave aging for 12.5 h at 134°C, 2 bar; clinically related aging (CRA)-aging in the chewing simulator for 1.2 million cycles, followed by 50,000 thermocycles (5-55°C) and immersion in HCl (pH 1.2) for 15 h. Optical properties, crystalline structure, and surface roughness were analyzed and compared using analysis of variance (5% significance level). RESULTS: There was no statistically significant effect of aging on translucency (p = 0.10), but CRA promoted the development of a high contrast ratio (p = 0.03). Aging did not cause significant color changes for HT (p = 0.65) or XT (p = 0.36). The proportion of monoclinic crystals increased to 40% for HT-zirconia after HA and 5% after CRA. No monoclinic crystals were detected for XT groups. There was no effect of aging on surface roughness (p = 0.77). CONCLUSIONS: Although hydrothermal aging has been widely used to verify zirconia crystalline stability, it did not generate an effect similar to clinically related aging on the optical properties and crystalline structure of zirconia. HA affected the crystalline structure of HT-zirconia, and CRA compromised the optical properties of XT zirconia.

Scoping review: Effect of surface treatments on bond strength of resin composite repair.

OBJECTIVE: to evaluate the existing evidence on surface treatment techniques employed in resin composite repair and their effect on the repair short- and long-term bond strength. DATA AND SOURCE: This scoping review was performed under the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform. STUDY SELECTION: A systematic search was conducted in PubMed, Embase, and Scopus and grey literature up to September 2022 without language or date restriction. In vitro studies comparing mechanical surface and/or chemical treatments on repair bond strength of resin composite were included. Studies evaluating experimental adhesive systems or resin composites were excluded. Selection of studies and data extraction were performed. Data from selected studies was qualitatively analyzed. RESULTS: A total of 76 studies were included in the qualitative analysis. Among the mechanical treatments, alumina blasting was the most frequently used, followed by silica coating and diamond bur. As for chemical treatments, dentin bonding systems were the most frequently evaluated, followed by universal adhesive systems and silane/ceramic primer. The combination of mechanical and chemical pre-treatments increased the repair bond strength of resin composite in both short- and long-term simulated aging scenarios. The evidence obtained from the included studies was classified as moderate quality, mainly due to the medium risk of bias observed across most of the studies. CONCLUSION: The techniques used to treat the surface of resin composites for repair are diverse. Incorporating a combination of mechanical and chemical pre-treatments resulted in superior repair bond strength of resin composite materials under both short- and long-term simulated aging conditions. CLINICAL SIGNIFICANCE: The analysis of evidence revealed significant variability among protocols for repairing resin composites. Utilizing both mechanical and chemical pre-treatment methods is important for enhancing the bond strength of resin composites during both short- and long-term simulated aging situations.

A survey of amalgam use to guide dental education curriculums.

OBJECTIVES: To identify behavioral, preferential, and professional factors influencing the use of amalgam in private practices; and to compare the incidence of the placement of amalgam versus composite resin restorations in the province of Ontario and its pedagogical implications on dental curricula. METHODS: Participants responded anonymously to a 23-question online survey about their current use of dental amalgam and composite resins as well as their opinions regarding both dental materials. The explanatory variables were associated bivariately with the outcome variables, and the most significant predictors were identified using the multivariate analysis. RESULTS: Higher percentages of amalgam use were reported among clinicians who trained in Canada only (P = .009), who graduated before 1980 (p = <.001) and who work outside private practice (p = <.001). Familiarity with amalgam was higher among clinicians who are female (p = <.001), older (p = <.001), trained only in Canada (p = .017), who graduated prior to 2000 (p = <.001), and who work in locations with populations over 100,000 (p = .042). Familiarity with composite resin was higher among clinicians who graduated more recently (p = .002). A higher percentage of females (p = <.001), younger clinicians (p = <.001), recent graduates (p = <.001), and clinicians who work in private practice (p = .043) suggested that over 50% of dental student training time be allocated to amalgam. CONCLUSIONS: Decreased amalgam use was reported by later dental graduates and private practitioners; this may be impacted by familiarity with dental amalgam. As amalgam remains a safe and effective dental material, its removal may not be prudent. Dental educators play a crucial role in the future of amalgam opinion and use.

Bonding Efficacy of Universal Resin Adhesives to Zirconia Substrates: Systematic Review and Meta-Analysis.

PURPOSE: To provide an overview of the in-vitro bond strength of universal adhesives to zirconia and analyze whether these adhesives are a reliable alternative to conventional zirconia primers. MATERIALS AND METHODS: A systematic search was conducted in PubMed/Medline, Scopus, and ISI Web of Science databases up to August 2021. Investigations published in English, assessing resin-mediated bond to zirconia using universal adhesives compared to phosphate/silane-based primer or phosphate-based primer were included. After study selection and data extraction, risk of bias analysis was performed. Statistical analyses were performed using RevMan 5.4, with a random effects model, at a significance level of 0.05. RESULTS: In total, 23 studies were included for qualitative and quantitative analysis. Universal adhesives showed higher bond strengths than did phosphate-based primers (p < 0.00001) to aged zirconia without airborne alumina-particle abrasion. Similar results were observed when the zirconia surface was airborne-particle abraded at baseline and after dynamic aging (p < 0.0001). When universal adhesives and phosphate-silane based primers were compared, similar bond strengths (p ≥ 0.001) were observed after surface abrasion, regardless of storage condition. CONCLUSION: The results showed that universal adhesives generate higher bond strengths when compared to conventional zirconia primers.

Preheating of dental composite resins: A scoping review.

OBJECTIVE: The aim of this scoping review was to analyze the available evidence on the preheating process and its effects on physicochemical properties of composite resins. MATERIALS AND METHODS: A systematic search was performed in August 2021 using PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and gray literature without language or date restriction. Inclusion criteria were in vitro studies that assessed the physicochemical properties and marginal adaptation of preheated composite. Exclusion criteria were studies with experimental composite, literature reviews, clinical studies. Data from selected studies were qualitatively analyzed. RESULTS: In total, 104 studies were found from which 39 were included. The most used composite resin was Filtek Z350 XT (3 M/ESPE), preheated at 68°C in a Calset device (AdDent Inc., Danbury, CT, USA) for 5 or 15 min. Most studies showed decreased viscosity, increased conversion degree and microhardness of composite resins, and better marginal adaptation of direct and indirect restorations. Also, flexural strength was not affected, and data about bond strength were inconclusive due to heterogeneity among studies. CONCLUSION: The parameters used for preheating composite resins are heterogeneous. Preheating decreased viscosity, increased the conversion degree and microhardness of composite resins, and improved the marginal adaptation of direct and indirect restorations. CLINICAL SIGNIFICANCE: The analysis of evidence showed a high heterogeneity among preheating protocols. Preheating may benefit the handling and physicochemical properties of composite resins.

Effect of Simulated Gastric Acid on the Interface Between Zirconia and Resin Cement

PURPOSE: To evaluate the effect of simulated gastric acid solution (SGAS) and resin cement composition on the shear bond strength (SBS) of zirconia-based materials with different levels of translucency to composite resin. MATERIALS AND METHODS: A total of 40 medium-opacity (MO; 3Y-TZP) and 40 medium-translucency (MT; 4Y-PSZ) zirconia slabs were distributed into four groups according to the composition of the resin luting system (MDP free or with MDP [primer + Panavia V5]) and storage method (distilled water or SGAS [5% hydrochloric acid]). Composite resin cylinders were cemented on the zirconia surface and stored for 91 hours. SBS, failure mode, and surface characterization analyses via scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were performed. SBS data were analyzed using three-way ANOVA and Tukey test, and failure mode was assessed using one-way ANOVA (P < .05). RESULTS: Storage media (P = .180), resin cement (P = .110), zirconia (P = .404), and their interactions did not affect SBS values. Bond strength ranged from 21.41 to 26.11 MPa. SEM images showed that SGAS modified the surface topography of zirconia and resin cement. The presence of chlorine and silicon (wt%) were higher after SGAS storage than after water storage in both cements used, while barium was higher only for the MDP cement. There was a prevalence of mixed failures for most of the groups. CONCLUSION: The SBS between both types of zirconia and resin cement was not affected by SGAS, although changes in zirconia topography were observed after SGAS exposure. The presence of MDP in the cement layer had no effect on the SBS challenged by SGAS.

Perception of COVID-19 pandemic restrictions on dental researchers.

BACKGROUND/OBJECTIVES: Historical evidence shows a gender-based disproportionate effect of pandemics across different populations. In 2020, the coronavirus disease 2019 (COVID-19) pandemic began spreading its devastating effects worldwide. The goal of the present study was to investigate the effect of the COVID-19 pandemic on research productivity, work-life arrangements, and mental health of dental professionals worldwide with focus on gender differences. METHODS: A 38-item survey, concerning demographics, career stage, employer support, family structure, mental health, and relationships, was distributed to 7692 active members of the International Association for Dental Research. Bivariate associations between independent variables and the primary outcome variable were tested using Spearman's correlation test. A logistic regression model was used to assess the simultaneous, independent associations between each variable and researcher productivity. RESULTS: A total of 722 responses were obtained, indicating a 9.4% response rate. Higher productivity was reported by male respondents (p = 0.021), and by those in senior career stages (p = 0.001). Institutional support was associated with higher productivity (p < 0.0001). Lower productivity was reported by younger researchers (p = 0.003). Remote work negatively affected productivity (p < 0.0001) and female respondents reported working more hours, regardless of work location (p = 0.004). Poor mental health was associated with low productivity (p < 0.0001). CONCLUSIONS: Our results showed that the COVID-19 pandemic significantly affected dental professionals' perceived productivity and mental health around the globe. Younger individuals and women were disproportionally affected, and institutional support had a significant influence to mitigate effects of the pandemic for dental researchers.

Effect of Universal Adhesives on Long-term Bond Strength to Zirconia.

PURPOSE: To evaluate the effect of universal adhesives on the long-term bond strength to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). MATERIALS AND METHODS: Polyethylene tubes filled with composite cement containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) were adhesively luted to 60 fully sintered Y-TZP slabs (7 x 7 x 2 mm) with or without (control) previous application of a 10-MDP-based adhesive (All Bond Universal, Bisco) - ABU; Clearfil Universal Bond Quick, Kuraray Noritake - CUB; Scotchbond Universal Adhesive, 3M Oral Care - SUA) on the zirconia surface. The bonded specimens were stored in water for 24 h, 6 months, or 1 year and subjected to microshear bond strength testing. The data were analyzed by one-way ANOVA and Tukey's test (p < 0.05). The contact angle was measured after adhesive application to evaluate surface wettability. The adhesive-treated specimens were analyzed with x-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) for chemical characterization. RESULTS: The application of a 10-MDP-based adhesive significantly improved bond strength of composite cement to zirconia when compared to the control group (no adhesive application) (p < 0.05). One-year water storage significantly decreased bond strength for ABU- and CUB-bonded specimens, but not for SUA-bonded specimens. The analysis by XPS and ToF-SIMS showed peaks of carbon, phosphorus, and silicon in all adhesive-treated specimens. CONCLUSIONS: One-year water storage affected the bond strength of composite cement to zirconia when All Bond Universal or Clearfil Universal Bond Quick were used.

Room-temperature atomic layer deposition of SiO2 on microcracked ZrO2 layers.

Yttria-stabilized zirconia (Y-SZ) has become a reliable material option to restore severely compromised teeth. Y-SZ materials are prone to low-temperature degradation (LTD), which generates a tetragonal-to-monoclinic (t-m) transformed, porous layer. We suggest that room-temperature atomic layer deposition (RT-ALD) could be used for the infiltration and deposition of nanoscale SiO2 film over this layer, creating a protective hybrid surface against further degradation by LTD. This study investigated the potential of developing a Y-SZ transformed layer under controlled conditions for the infiltration of silica using RT-ALD, aiming to develop a hybrid zirconia-silica interface, and to investigate the effect of silica deposition/infiltration via RT-ALD on the surface roughness and wettability of zirconia-based materials. Sintered specimens (14 mm × 4 mm x 2 mm) were prepared from four different Y-SZ materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid, FX white). Specimens were exposed to hydrothermal treatment (HTT) to develop similar depths of crystalline changes. RT-ALD was used to deposit a thin film of silica (SiO2). Surface roughness and wettability analyses were performed to investigate the effect of treatment (HTT and RT-ALD) and material on Y-SZ surface properties, and data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). RT-ALD and HTT-RT-ALD treated specimens of 3Y-LT and 5Y-HT materials were exposed to further hydrothermal aging (HA) and the surface was characterized by time-of-flight secondary ion mass spectrometry (ToF-SIMS). There was a significant interaction effect of material and treatment (HTT and RT-ALD) on roughness (p = 0.02), and surface wettability (p < 0.001). Silica deposition via RT-ALD resulted in a significant increase in surface roughness of all materials tested, while surface wettability was either improved or not changed based on the material type and HTT exposure. Nanofilms of SiO2 were successfully deposited on Y-SZ materials and infiltrated 3Y-LT zirconia.

Promoting mineralization at biological interfaces Ex vivo with novel amelotin-based bio-nano complexes.

Interfacial failure at the resin-dentin interface is a significant disadvantage of resin-based dental restoration. In this study, we created bio-inspired bio-nano complexes using the enamel protein amelotin (AMTN) or AMTN with an engineered collagen-binding site (AMTN-Col) to coat hydroxyapatite nanoparticles (HANP). The resulting nano-bio complexes, AMTN-HANP and AMTN-Col-HANP, were evaluated for their ability to promote collagen mineralization. Our study comprises three separate phases.In phase I, developing a method for functionalizing HANP with AMTN/AMTN-Col was explored. HANP were synthesized and characterized using TEM, SAED-TEM, XRD and ATR-FTIR. The nanoparticles were functionalized with AMTN or AMTN-Col. The successful coating of the nanoparticles with the proteins was confirmed using a TEM image of immunogold-labelled samples.In phase II of the study, the mineralization potential of the synthesized bio-nano complexes was studied using model systems consisting of simulated body fluid (SBF), polymerized collagen gels, and dentin disks prepared from human extracted molars. Mineral formation in SBF was recorded with a light scattering assay using a microplate reader on 8 replicates of each sample per study time point. Statistical analysis was performed using one-way ANOVA and the Tukey test. Significance was assigned at P â€‹< â€‹0.01. The extent of mineral formation on collagen gel and remineralization of demineralized dentin was studied with SEM. Accelerated mineral formation collagen mineralization of bio-nano complexes treated samples were observed in all model systems.In phase III of the study, the clinical utilization of AMTN/AMTN-Col coated HANP in bio-integration and enhancing the bond strength of a resin-based dental restoration and the dentin interface was investigated. The bio-nano complexes were applied as a pretreatment on dentin disks prepared from human extracted molars prior to the composite resin restoration. The micro-shear bond strength test was done on 8 samples per treatment group (a total of 32 samples). Statistical analysis on shear bond strength was performed using one-way ANOVA and the Tukey test. Significance was assigned at P â€‹< â€‹0.01. Shear bond strength values indicated that pretreatment of dentin with the bio-nano complexes before adhesive application significantly improved shear bond strength. Conclusion: We have shown that AMTN based bio-nano complexes promote mineral formation on collagenous interfaces. Our findings can be the basis of new bio-inspired, bio-nano materials that may improve dental restoration longevity by enhancing the stability and integrity of the dentin-composite resin interface.

Silica deposition on zirconia via room-temperature atomic layer deposition (RT-ALD): Effect on bond strength to veneering ceramic.

PURPOSE: To develop and to characterize a hybrid interface between yttria-stabilized zirconia (Y-TZP) transformed layer and silica-based nanofilm to enable a better bonding between Y-TZP and a veneering ceramic. MATERIAL AND METHODS: Sixty-six fully-sintered rectangular Y-TZP specimens were distributed into 6 groups, according to the surface treatment applied: C (control): no treatment; Al: 27 µm-alumina particle abrasion; Ht: hydrothermal treatment in autoclave for 15h; Si20: 20 cycles of silica deposition using room-temperature atomic layer deposition (RT-ALD); Si40: 40 cycles of RT-ALD; Ht + Si40: hydrothermal treatment followed by 40 cycles of RT-ALD. RT-ALD was performed by the sequential exposure of specimens to vapor of tetramethoxysilane orthosilicate (TMOS) and ammonium hydroxide (NH4OH). Y-TZP surface wettability and shear bond strength (SBS) between Y-TZP and the veneering ceramic were analyzed for all groups after surface treatments. One-way ANOVA and Tukey's HSD test were used for data analysis (p ≤ 0.05). RESULTS: The highest contact angle was observed for the control group (64.46 ± 6.09 θ), while the lowest values (p < 0.001) were presented after Si20 (29.85 ± 4.23 θ) and Si40 (30.37 ± 5.51 θ) treatments. Hydrothermal treatment (49.3 ± 2.69 θ) and alumina abrasion (45.84 ± 4.12 θ) resulted in intermediate contact angle values. The highest SBS values were observed for Al (16.74 ± 1.68 MPa) and Ht (15.27 ± 2.11 MPa) groups (p < 0.018). Groups Si20 (9.66 ± 1.22 MPa), Si40 (9.33 ± 2.11 MPa), Ht + Si40 (9.37 ± 1.02 MPa) and C (12.54 ± 2.64 MPa) all resulted in similar SBS results (p > 0.998). CONCLUSION: The experimental treatments proposed enhanced surface wettability, but shear bond strength between Y-TZP and veneering ceramic was not improved. Alumina particle-abrasion improved SBS values while a decrease in wettability was observed.

Effect of universal adhesives and self-etch ceramic primers on bond strength to glass ceramics: A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: To simplify dental procedures, multicomponent products such as universal adhesives and self-etch ceramic primers have been recommended for glass-ceramic bonding; however, studies have shown a wide range of results. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the in vitro bond strength promoted by hydrofluoric acid+silane-containing universal adhesives and a self-etch ceramic primer to glass-ceramics and compare it with that of conventional treatments. MATERIAL AND METHODS: A systematic search was conducted in the PubMed/Medline, Scopus, LILACS, and ISI Web of Science databases up to April 2021. In vitro studies assessing the resin-mediated bond to glass-ceramics by using a self-etch ceramic primer and hydrofluoric acid+silane-containing universal adhesives and/or compared with traditional hydrofluoric acid+glass-ceramic primers were included. Selection of studies, data extraction, and risk-of-bias analysis were performed. Statistical analysis was performed by using a review management software program using a random effects model (α=.05). RESULTS: A total of 33 studies were included in the qualitative analysis and 26 studies in the quantitative analysis. Bond strength to lithium disilicate ceramic was higher when a hydrofluoric acid+glass-ceramic primer was used than when using a hydrofluoric acid+silane-containing universal adhesive (P<.05), except when 9% to 10% acid concentration was used in combination with static aging (P=.100). A self-etch ceramic primer promoted bond strength values to lithium disilicate that were similar to those of the hydrofluoric acid+glass-ceramic primer (P>.100). CONCLUSIONS: Hydrofluoric acid+silane-containing universal adhesive was not as effective as the hydrofluoric acid+glass-ceramic primer in promoting bond strength to glass-ceramic. Bond strength values generated by a self-etch ceramic primer to glass-ceramic were similar to those generated by the conventional treatment.

Surface and bulk properties of zirconia as a function of composition and aging.

Yttria-stabilized zirconia (Y-SZ) materials with different levels of translucency have been used for indirect dental restorations. Y-SZ composition and microstructure are modified to improve translucency, and it is not clear how these materials respond to aging. This study evaluated the effect of hydrothermal aging (HA) performed in an autoclave on the properties of four dental Y-SZ materials with different compositions. Sintered bar-shaped specimens (14 x 4 x 2 mm) were prepared from four different zirconia-based materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid FX). Fully sintered specimens were exposed to HA for different times (control - 0 h, 5 h, 10 h, or 15 h at 134 °C, 2 bar pressure) and characterized for surface roughness, flexural strength (three-point bending), hardness and elastic modulus (nanoindentation), surface wettability (sessile drop technique) and crystalline content (x-ray diffraction, XRD). Data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). Zirconia composition significantly affected roughness (p = 0.016). Zirconia*aging interaction affected flexural strength (p = 0.012), surface wettability (p < 0.001), and hardness (p = 0.002). Zirconia composition (p = 0.011) and aging (p = 0.001) affected elastic modulus, while the interaction effect was not significant (p = 0.94). HA affects zirconia-based materials in different degrees. For 3Y-LT and 4Y-HT, surface and bulk properties were affected by aging to a similar extent. However, surface and bulk properties may change during clinical use as a result of prolonged degradation of Y-SZ.

Surface characterization of different surface treatments associations with plasma and bonding analysis of Y-TZP and the veneering ceramic.

OBJECTIVES: To characterize the surface of zirconia (Y-TZP) submitted to different surface treatments (with and without plasma associations) and to evaluate the shear bond strength (SBS) between veneering ceramic (VC) and Y-TZP after different aging methods. METHODS: 301 Y-TZP specimens were fabricated and distributed into 7 groups: C (control): no treatment; Al: airborne abrasion with 27 µm Al2O3 particle; L: liner; P: plasma; Al + L: airborne + liner; Al + P: airborne + plasma; P + L: plasma + liner. The Y-TZP surface was characterized by SEM, EDS, AFM, surface profilometry, surface-free energy (SFE), and XRD. SBS between Y-TZP and VC was verified after three aging protocols: initial, after hydrothermal aging (autoclave for 5 h), or thermal fatigue (30,000 baths - 5-55 °C). One- (profilometry, SFE) and two-way ANOVA (SBS), and Tukey's HSD test were used. RESULTS: For the plasma groups, a full globular surface coverage was observed (SEM, AFM). Si was found for Al, L, Al + L, and P + L. Roughness was lower for C, P, and Al + P. For SFE, the highest values were found when the liner was applied (>74.59 nm/Nm). The highest monoclinic content was observed for Al + L (6.96%) and Al + P (5.86%). For the initial period, Al and P + L presented the lowest SBS values (<5.85 MPa; P > 0.331). The highest SBS values were found for L, P, and P + L (hydrothermal aging) and for P, L, Al + L, and Al + P (thermal fatigue). SIGNIFICANCE: Changes in Y-TZP topography and the SBS with the VC were found, according to treatments performed. Plasma treatment improved SBS and did not cause phase transformation.

Mechanical performance of a hybrid zirconia developed through hydrothermal treatment and Room-Temperature Atomic Layer Deposition (RT-ALD).

OBJECTIVE: A silica-based nanofilm has been successfully deposited via Room-Temperature Atomic Layer Deposition (RT-ALD) on the surface of a glass. The purpose of this study was to evaluate the mechanical performance of a hybrid interface created between yttria-stabilized zirconia (Y-PSZ) transformed layer and silica-based nanofilm via RT-ALD. MATERIAL AND METHODS: Fully-sintered Y-PSZ (14 × 4.0 × 1.5 mm) specimens in different translucencies (MO, MT, LT; IPS e.max Zircad, Ivoclar Vivadent) were distributed in 5 groups: control (C - no treatment); hydrothermal treatment (HT- 15h, 134°C, 2 bar); alumina blasting (B - 50 µm Al2O3); RT-ALD silica deposition (S); HT followed by silica deposition (HTS). RT-ALD cycles consisted of the sequential exposure of specimens to tetramethoxysilane orthosilicate (TMOS - 60s) and ammonium hydroxide (NH4OH - 10 min) vapors in 40 cycles. Mechanical performance was analyzed by flexural strength (FS) (n = 10) and fatigue failure load (staircase method; n = 20) tests. Surface hardness (H) and Young's modulus (YM) were analyzed by nanoindentation. For surface chemical and topographical characterization, X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) were performed. Data from surface H, YM, FS, and fatigue limit (FL) were analyzed by two-way analysis of variance (ANOVA). RESULTS: The interaction between material and treatment had a significant effect on FS (p < 0.001). The FS values ranged from 436.23 MPa to 856.65 MPa. HT resulted in the highest FS (856.65 MPa) for LT and the lowest FS (436.23 MPa) for MO zirconia. For all materials, S and B treatments resulted in similar FS values (p > 0.410). S did not affect FL when compared to the C group (p > 0.277) for any material investigated. HTS resulted in higher FL than S for LT and MO materials (p < 0.001). Surface hardness and modulus were similar between control and S-treated specimens for all materials analyzed. XPS analysis showed homogeneous silica content after 20 and 40 RT-ALD cycles, and SEM did not show significant changes in surface morphology between C and S-treated specimens. CONCLUSION: RT-ALD resulted in effective silica deposition without any deleterious effect on zirconia-based materials mechanical properties. Alumina blasting promoted higher alteration on surface topography. HT prior to S resulted in superior FL (for MO and MT) and flexural strength (MO) for some of the materials investigated.

Review of nano-technology applications in resin-based restorative materials.

OBJECTIVE: Nanotechnology has progressed significantly and particles as small as 3 nm are being employed in resin-based restorative materials to improve clinical performance. The goal of this review is to report the progress of nanotechnology in Restorative Dentistry by reviewing the advantages, limitations, and applications of resin-based restorative materials with nanoparticles. MATERIALS AND METHODS: A literature review was conducted using PubMed/Medline, Scopus and Embase databases. In vitro, in vivo and in situ research studies published in English between 1999 and 2020, and which focused on the analysis of resin-based restorative materials containing nanoparticles were included. RESULTS: A total of 140 studies were included in this review. Studies reported the effect of incorporating different types of nanoparticles on adhesive systems or resin composites. Mechanical, physical, and anti-bacterial properties were described. The clinical performance of resin-based restorative materials with nanoparticles was also reported. CONCLUSIONS: The high surface area of nanoparticles exponentially increases the bioactivity of materials using bioactive nanofillers. However, the tendency of nanoparticles to agglomerate, the chemical instability of the developed materials and the decline of rheological properties when high ratios of nanoparticles are employed are some of the obstacles to overcome in the near future. CLINICAL SIGNIFICANCE: In spite of the recent advancements of nanotechnology in resin-based restorative materials, some challenges need to be overcome before new nano-based restorative materials are considered permanent solutions to clinical problems.

Effect of ionizing radiation and chewing simulation on human enamel and zirconia.

PURPOSE: To evaluate the effect of ionizing irradiation on human enamel and zirconia after chewing simulation. METHODS: Twenty enamel and twenty translucent Yttria-stabilized zirconia (Y-PSZ) specimens were divided in 4 groups: Co (control) - no irradiation on enamel cusps/opposing zirconia slabs; E70 - irradiated (70 Gray) enamel cusps/opposing irradiated enamel slabs; Z70 - irradiated zirconia cusps/opposing irradiated zirconia slabs; EZ70 - irradiated enamel cusps/opposing irradiated zirconia slabs. Cusps were abraded against slabs in a chewing simulator (CS - one million cycles, 80 N, artificial saliva, 37˚C). Wear and roughness of zirconia and enamel were analyzed using a stylus profilometer. The abraded enamel was analyzed by Electron probe micro-analyzer (EPMA) and zirconia was characterized by nanoindentation and X-ray diffraction. One-way analysis of variance (ANOVA) and Tukey test were used for analysis of wear, Repeated Measures and Bonferroni test for roughness, and hardness and modulus values were compared using Wilcoxan Mann Whitney rank sum test (overall 5% significance). RESULTS: Significantly higher volume loss was presented by cusps in the E70 group (p<0.001). Wear was similar between Co and EZ70 groups. There was no significant effect of irradiation on roughness of enamel or zirconia slabs (p=0.072). Irradiated Y-PSZ slabs had significantly higher hardness and modulus than non-irradiated ones and a 7% increase in m phase content was detected after irradiation. CONCLUSIONS: The opposing surface characteristics played a more significant role on enamel wear than did ionizing radiation. However, radiation affects Y-PSZ crystalline composition, hardness and modulus of elasticity.

Irradiation therapy and chewing simulation: effect on zirconia and human enamel.

PURPOSE: Ionizing radiation therapy (RT) is the main option for head and neck cancer treatment, but it is associated with multiple side effects. This study aimed to evaluate the effect of RT associated with chewing simulation on the surface of human enamel and Yttria-partially stabilized zirconia (Y-TZP). METHODS: Maxillary premolar cusps and Y-TZP slabs were divided in 7 experimental groups: CO: no RT (control); EZ groups had irradiation applied to both, enamel and zirconia samples (simulating restoration prior to RT); E groups had irradiation applied to enamel only (simulating restoration after RT). RT doses were either 30, 50 or 70 Gray (Gy). Enamel cusps were abraded against zirconia slabs in a chewing simulator (CS - one million cycles/ 80 N/ 60 mm/min, 2 mm horizontal path, artificial saliva, 37˚ C). Zirconia hardness was evaluated before CS; zirconia roughness and enamel volume (wear) were evaluated before and after CS. Hardness and wear data were analyzed by one-way Analysis of Variance and Tukey post hoc test. Roughness was analyzed by Repeated Measures test and Bonferroni test (p=0.05). RESULTS: There was no significant effect of enamel or zirconia irradiation on enamel cusp wear (p=0.226), regardless of the irradiation dose used - up to 70 Gy. Irradiation also did not affect Y-TZP surface roughness (p=0.127) and hardness (p=0.964). CONCLUSIONS: RT does not promote significant changes to the surface characteristics of zirconia. Irradiated enamel abraded against zirconia does not show higher wear volume when compared to non-irradiated enamel.