Isolated effect of filler particle size on surface properties of experimental resin composites before and after toothbrush abrasion.

OBJECTIVE: This study aimed to isolate the relationship between filler size and the surface properties of roughness and gloss before and after toothbrush abrasion for experimental resin-based composites (RBCs) containing uniform spherical fillers. MATERIALS AND METHODS: Five experimental light-cured RBCs with different spherical filler sizes and three commercial RBCs were studied. Forty specimens were polished using silicon carbide papers. Gloss was measured after 0, 90, 180, and 360 min of simulated toothbrushing, and surface roughness was measured before and after 360 min of toothbrushing. Two-way ANOVA/Tukey's multiple comparison tests were used to compare the RBCs, and the correlation between particle size and surface roughness or gloss was also determined. RESULTS: After polishing and toothbrushing, RBCs with smaller fillers exhibited significantly higher gloss and lower surface roughness, and RBCs with larger fillers exhibited lower gloss and higher surface roughness. A significant correlation was found between filler particle size and gloss and surface roughness both before and after toothbrush abrasion. CONCLUSIONS: Gloss of RBCs containing fillers with larger particle sizes was significantly reduced. After toothbrushing abrasion, the surface roughness increased for all RBCs, except those containing the finest-sized fillers. The particle size of the filler is a critical determinant of the surface roughness and gloss of RBCs, after polishing and after toothbrushing. CLINICAL SIGNIFICANCE: Increased surface roughness caused by toothbrush abrasion reduces the gloss of resin-based composites. Resin-based composites containing finer fillers best maintain glossiness after routine tooth brushing.

Coaxial Placement of Balloon-Expandable and Self-Expanding Stents: Impact on Crush Resistance and Luminal Recovery in a Benchtop Model.

During endovascular interventions, coaxial deployment of stents may be required to preserve luminal gain. This study characterized in vitro the effect on crush resistance and postcompression recovery when 316L stainless steel balloon-expandable (BE) and laser-cut nitinol self-expanding (SE) venous stents were deployed coaxially. Various stent configurations were parallel-plate compressed from a fully expanded state to 50% diameter reduction (Criterion, Model 42; MTS, Eden Prairie, Minnesota) in a 37 °C ± 1 water bath. Coaxial deployments of SE stent inside BE stent and BE stent inside SE stent demonstrated higher crush resistances compared with each stent individually or their mathematical summation (analysis of variance P < .0001; pairwise comparison P < .01). The configuration of SE stent inside BE stent showed higher postcompression luminal recovery at 48.7% compared with that of BE stent inside SE stent at 27.5% (P = .0001). Coaxial deployment of SE stent inside BE stent may improve crush resistance and luminal recovery after compression in the appropriate clinical context.

Thiol Quantification Using Colorimetric Thiol-Disulfide Exchange in Nonaqueous Solvents.

A careful analysis of two (thiol-disulfide exchange) thiol quantification chromophores' behavior (Ellman's reagent and Aldrithiol-4) in nonaqueous solvents is presented. A wide range of kinetic profiles and response factors were measured to exhibit a large variance for nonaqueous systems. We report several robust benchtop and room-temperature methods using different organic solvents compared to aqueous conditions. Validation of analytical analyses in nonaqueous systems and quantification of the cysteine content of ovalbumin are also presented. This work serves as a treatise on the utilization of thiol-disulfide exchange chromophores under nonaqueous conditions for the quantification of thiols.

Real-Time Monitoring of Biofilm Formation Using a Noninvasive Impedance-Based Method.

Biofilms are complex three-dimensional microbial communities that adhere to a variety of surfaces and interact with their surroundings. Because of the dynamic nature of biofilm formation, establishing a uniform technique for quantifying and monitoring biofilm volume, shape, and features in real-time is challenging. Herein, we describe a noninvasive electrochemical impedance approach for real-time monitoring of dental plaque-derived multispecies biofilm growth on a range of substrates. A working equation relating electrochemical impedance to live biofilm volume has been developed that is applicable to all three surfaces examined, including glass, dental filling resin, and Ca2+-releasing resin composites. Impedance changes of 2.5, 35, 50, and 65% correlated to biofilm volumes of 0.10 ± 0.01, 16.9 ± 2.2, 29.7 ± 2.3, and 38.6 ± 2.8 µm3/µm2, respectively. We discovered that glass, dental filling resin, and Ca2+-releasing dental composites required approximately 3.5, 4.5, and 6 days, respectively, to achieve a 50% change in impedance. The local pH change at the biofilm-substrate interfaces also monitored with potentiometry pH microsensor, and pH change varied according to biofilm volume. This impedance-based technique can be a useful analytical method for monitoring the growth of biofilms on a variety of substrates in real-time. Therefore, this technique may be beneficial for examining antibacterial properties of novel biomaterials.

Lessons learned from the Cracked Tooth Registry: A 3-year clinical study in the Nation's Network.

BACKGROUND: This article reviews the most salient lessons learned from a large, multisite, 3-year observational study of posterior teeth with cracks conducted by The National Dental Practice-Based Research Network. TYPES OF STUDIES REVIEWED: Eight articles published over a 6-year period (2017-2022) describing clinical characteristics of posterior teeth with cracks and their treatment and outcomes are reviewed and discussed to answer 3 common questions faced by oral health care clinicians: Which cracked teeth will get worse? When should practitioners intervene? What is the best treatment? RESULTS: Although cracks in teeth are prevalent, few will fracture (3%) or show crack progression in 3 years (12%). Characteristics that guide the clinician to treatment include active caries, biting pain, and to a lesser degree, having a crack detectable with an explorer, connecting with a restoration, or blocking transilluminated light; the main treatment chosen is a complete crown. Of those teeth treated (36%), few (14%) will need retreatment but will still survive, despite having an internal crack as well. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Although cracked teeth often pose a dilemma to clinicians, clincians are generally good at deciding which teeth to treat and when and which to monitor.

3D-printed microgels supplemented with dentin matrix molecules as a novel biomaterial for direct pulp capping.

OBJECTIVES: To develop a 3D-printed, microparticulate hydrogel supplemented with dentin matrix molecules (DMM) as a novel regenerative strategy for dental pulp capping. MATERIALS AND METHODS: Gelatin methacryloyl microgels (7% w/v) mixed with varying concentrations of DMM were printed using a digital light projection 3D printer and lyophilized for 2 days. The release profile of the DMM-loaded microgels was measured using a bicinchoninic acid assay. Next, dental pulp exposure defects were created in maxillary first molars of Wistar rats. The exposures were randomly capped with (1) inert material - negative control, (2) microgels, (3) microgels + DMM 500 µg/ml, (4) microgels + DMM 1000 µg/ml, (5) microgels + platelet-derived growth factor (PDGF 10 ng/ml), or (6) MTA (n = 15/group). After 4 weeks, animals were euthanized, and treated molars were harvested and then processed to evaluate hard tissue deposition, pulp tissue organization, and blood vessel density. RESULTS: All the specimens from groups treated with microgel + 500 µg/ml, microgel + 1000 µg/ml, microgel + PDGF, and MTA showed the formation of organized pulp tissue, tertiary dentin, newly formed tubular and atubular dentin, and new blood vessel formation. Dentin bridge formation was greater and pulp necrosis was less in the microgel + DMM groups compared to MTA. CONCLUSIONS: The 3D-printed photocurable microgels doped with DMM exhibited favorable cellular and inflammatory pulp responses, and significantly more tertiary dentin deposition. CLINICAL RELEVANCE: 3D-printed microgel with DMM is a promising biomaterial for dentin and dental pulp regeneration in pulp capping procedures.

Effect of S. mutans biofilm on the hybrid ceramic-resin cement bond strength assessed by different methods

Aim: The purpose of this study was to investigate the biofilm effect on the hybrid ceramic-resin cement bond strength (BS) by comparing two methods. Methods: Teeth were distributed into groups (n=5), according to the resin cement (Maxcem Elite-(MC) or NX3 Nexus-(NX)) and degradation method (24h or 7 days in distilled water; 7 or 30 days incubated with biofilm and 30 days in sterile media). Treated surfaces of Vita Enamic blocks (5x6x7mm) were luted to treated or no treated dentin surfaces and light-cured. After 24h, beams were obtained (1x1x10mm) and stored accordingly. The flexural bond strength (FBS) was assessed by four-point bending test. Additional beams were obtained from new teeth (n=5), stored for 24h or 7 days in distilled water, and submitted to a microtensile bond strength (µTBS) assay. Failure modes were determined by scanning electron microscopy (100X). The flexure strength of the cements (n=10) was assessed by a four-point bending test. Data were analyzed by 1 and 2-ways ANOVA, and Tukey's test (α=0.05). Results: There was no significant difference between the degradation methods for the FBS groups. For the µTBS, the significant difference was as follows: NX 7days > NX 24h > MC 7days = MC 24h. Failure mode was mainly adhesive and mixed, but with an increase of cohesive within cement and pre-failures for the MC groups assessed by µTBS. NX had better performance than MC, regardless of the method. Conclusions: The biofilm had no effect on the materials BS and FBS test was a useful method to evaluate BS of materials with poor performance

RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews.

OBJECTIVES: To develop a risk of bias tool for pre-clinical dental materials research studies that aims to support reporting of future investigations and improve assessment in systematic reviews. METHODS: A four-stage process following EQUATOR network recommendations was followed, which included project launch, literature review, Delphi process and the tool finalization. With the support of the European Federation of Conservative Dentistry (EFCD) and the Dental Materials Group of the International Association for Dental Research (DMG-IADR), a total of 26 expert stakeholders were included in the development and Delphi vote of the initial proposal. The proposal was built using data gathered from the literature review stage. During this stage, recent systematic reviews featuring dental materials research, and risk of bias tools found in the literature were comprehensively scanned for bias sources. The experts thus reached a consensus for the items, domains and judgement related to the tool, allowing a detailed guide for each item and corresponding signalling questions. RESULTS: The tool features nine items in total, spread between 4 domains, pertaining to the following types of bias: bias related to planning and allocation (D1), specimen preparation (D2), outcome assessment (D3) and data treatment and outcome reporting (D4). RoBDEMAT, as presented, features signalling questions and a guide that can be used for RoB judgement. Its use as a checklist is preferred over a final summary score. CONCLUSION: RoBDEMAT is the first risk of bias tool for pre-clinical dental materials research, supported and developed by a broad group of expert stakeholders in the field, validating its future use. CLINICAL SIGNIFICANCE: This new tool will contribute the study field by improving the scientific quality and rigour of dental materials research studies and their systematic reviews. Such studies are the foundation and support of future clinical research and evidence-based decisions.

"Fatigue-Crack Propagation Behavior in Microcapsule-Containing Self-Healing Polymeric Networks".

Over the last years, research on the design of dental self-healing polymers has grown dramatically. It is related to the promising potential of maximizing the clinical lifespan of dental restorations that this strategy holds. In this manuscript, the microcapsule-based strategy is innovated by incorporating the high toughness component N,N-Dimethylacrylamide (DMAM) into the healing agent systems and analyzing in-depth the change in crack propagation behavior induced by the addition of microcapsules into the highly crosslinked polymeric network. In general, the addition of the hydrophilic and high vapor pressure DMAM into the healing agent systems imposed a challenge for the microencapsulation, which highlighted the importance of tailoring the properties of the capsules' shells according to the core composition. The addition of DMAM as cushioning agent proved to be a successful strategy since it resulted in increased G'/G" crossover time from 0.06 (control) to 0.57 s and decreased storage modulus from 8.0 (control) to 0.5GPa. In addition, the incorporation of microcapsules within the polymerized networks provided obstacles to crack propagation, which translated to an overall reinforcement of the polymeric network, as evidenced by the increase in toughness up to 50 % and energy required to propagate cracks up to 100 % in systems containing DMAM at 20 wt%.

Effect of thickness on the degree of conversion of two bulk-fill and one conventional posterior resin-based composites at high irradiance and high temporal resolution.

OBJECTIVES: This study: 1) measures the effect of sample thickness and high irradiance on the depth-dependent time delay before photopolymerization reaction onset; 2) determines if exposure reciprocity exists; 3) measures the conversion rate at four irradiance levels; 4) determines the time, t0, at which the maximum DC rate is reached for two bulk-fill and one conventional posterior resin-based composites (RBCs). METHODS: Tetric PowerFill IVA shade (Ivoclar Vivadent) and Aura bulk-fill ultra universal restorative (SDI), and one conventional posterior resin-based composite (RBC), Heliomolar A3 (Ivoclar Vivadent), that were either 0.2 mm, 2 mm, or 4 mm thick were photocured using a modified Bluephase G4 (Ivoclar Vivadent) light-curing unit (LCU) that delivered a single emission band (wavelength centered at 449 nm). The same radiant exposure of 24 J/cm2 was delivered at irradiances ranging from 0.5 to 3 W/cm2 by adjusting the exposure time. PowerFill was also photocured for 3 s or 6 s using a Bluephase PowerCure LCU (Ivoclar Vivadent) on the 3 s mode setting. The degree of conversion (DC) was measured in real-time at a high temporal resolution at 30 °C using Attenuated Total Reflection (ATR) FTIR spectroscopy with a sampling rate of 13 DC data points per second. The DC data were analyzed using a phenomenological autocatalytic model. The RBC viscosity was measured at 21 °C and 30 °C. Light transmission through the RBC samples at 22 °C was monitored with time to calculate the extinction coefficients of the RBCs. RESULTS: The time delay before photopolymerization started increased as the RBC thickness increased and the irradiance decreased. An autocatalytic model described the DC data. The time t0 was less than 77 ms for the 0.2 mm thick samples of PowerFill irradiated using the highest irradiance of 3 W/cm2. Among the three RBCs for each sample thickness and irradiance level, the PowerFill had the smallest time t0. There was a time delay of 0.59 s and 1.25 s before the DC started to increase at the bottom of 4 mm thick samples for the PowerFill and Aura, respectively, when an irradiance of 1 W/cm2 was delivered. The time delay increased to 3.65 s for the Aura when an irradiance of 0.5 W/cm2 was delivered. The extinction coefficients near 449 nm were 0.78 mm-1, 0.76 mm-1, and 1.55 mm-1 during the first 2 s after the start of photocuring of PowerFill, Aura, and Heliomolar, respectively. Only PowerFill followed exposure reciprocity. At T = 30 °C, the viscosity was 3400, 17000, and 5200 Paˑs for PowerFill, Aura, and Heliomolar, respectively. SIGNIFICANCE: The time delay between when photopolymerization starts at the top and bottom of 2- or 4-mm thick RBC restorations may affect the structural integrity of the bond between the tooth and the bottom of the restoration. Only PowerFill followed exposure reciprocity between irradiance levels of 0.5 to 3 W/cm2. Exposure reciprocity did not occur for Aura or Heliomolar, neither of which are optimized for short light exposure or high irradiance conditions.

In-vitro models of biocompatibility testing for restorative dental materials: From 2D cultures to organs on-a-chip.

Dental caries is a biofilm-mediated, diet-modulated, multifactorial and dynamic disease that affects more than 90% of adults in Western countries. The current treatment for decayed tissue is based on using materials to replace the lost enamel or dentin. More than 500 million dental restorations are placed annually worldwide, and materials used for these purposes either directly or indirectly interact with dentin and pulp tissues. The development and understanding of the effects of restorative dental materials are based on different in-vitro and in-vivo tests, which have been evolving with time. In this review, we first discuss the characteristics of the tooth and the dentin-pulp interface that are unique for materials testing. Subsequently, we discuss frequently used in-vitro tests to evaluate the biocompatibility of dental materials commonly used for restorative procedures. Finally, we present our perspective on the future directions for biological research on dental materials using tissue engineering and organs on-a-chip approaches. STATEMENT OF SIGNIFICANCE: Dental caries is still the most prevalent infectious disease globally, requiring more than 500 million restorations to be placed every year. Regrettably, the failure rates of such restorations are still high. Those rates are partially based on the fact that current platforms to test dental materials are somewhat inaccurate in reproducing critical components of the complex oral microenvironment. Thus, there is a collective effort to develop new materials while evolving the platforms to test them. In this context, the present review critically discusses in-vitro models used to evaluate the biocompatibility of restorative dental materials and brings a perspective on future directions for tissue-engineered and organs-on-a-chip platforms for testing new dental materials.

Effect of ethyl cellulose coating as an evaluation agent against contamination on the bond strength of zirconia restorations: An in vitro study.

STATEMENT OF PROBLEM: During the trial placement of zirconia restorations, contamination of the bonding surface is inevitable. Although cleaning methods for contaminated surfaces have been described, a method of preventing saliva contamination of the bonding surface of zirconia restorations is lacking. PURPOSE: The purpose of this in vitro study was to investigate an ethyl cellulose coating as an evaluation agent to mitigate the effects of saliva contamination on the bond strength of zirconia restorations. MATERIAL AND METHODS: Experimental groups representing different cleaning methods of tetragonal yttria-stabilized tetragonal zirconia polycrystal (4Y-TZP) surfaces were investigated for shear bond strength with a resin luting agent, and the failure mode was analyzed. The 9.0×7.0×5.0-mm zirconia blocks (n=72) were assigned as follows: Group N: uncontaminated control; Group CU: contaminated with saliva, followed by ultrasonic cleaning with ethanol; Group CI: contaminated with saliva, followed by application of a zirconia cleaner; Group PCW: preapplication of a zirconia primer, contaminated with saliva, followed by cleaning with water spray; Group ECU: precoating with the ethyl cellulose agent, contaminated with saliva, followed by removal of the agent in an ultrasonic bath with ethanol. Each group was divided into 3 subgroups (immediate, short-term aging, and long-term aging), and the shear bond strength was measured (n=24). To analyze the bonding surface characteristics, the contact angle was measured (n=5). The surfaces of the zirconia specimens in each experimental group were evaluated by using a field emission scanning electron microscope (n=5). Time-of-flight secondary ion mass spectroscopy was used for the chemical analysis of the conditioned surfaces (n=3). A 2-way analysis of variance (ANOVA) with main effect model for shear bond strength results and a 1-way ANOVA for contact angle data were performed as statistical analysis, followed by the Bonferroni post hoc test (α=.05). RESULTS: The shear bond strength was significantly higher in the ECU group than in the groups with the other cleaning methods (P<.05). After the removal of ethyl cellulose with ethanol, the contact angle and surface topography were found to be similar to those of the control group, and no saliva contaminants were identified in the spectroscopy analysis. CONCLUSIONS: Coating with ethyl cellulose may protect the bonding surface of zirconia restorations from salivary contamination better than cleaning a contaminated surface.

Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network.

OBJECTIVE: Cracked teeth may be associated with pain, especially biting pain, and to a lesser degree cold and spontaneous pain.  Described are how commonly these pains remain constant, develop, or resolve over time, none of which have been well-described, especially among untreated cracked teeth. METHODS: Cracked teeth from the Cracked Tooth Registry (CTR) study were followed for 3 years.  Assessments of cold, biting, and spontaneous pain and treatments performed were completed at enrollment (Y0) and at each annual recall visit. RESULTS: 209 practitioners enrolled 2,858 patients, each with a visible crack on a posterior tooth; 2601 (91%) patients attended at least one recall visit. Overall, 960 (37%) were treated, primarily with crowns. Among both treated and untreated cracked teeth with biting pain or spontaneous pain at Y0, the vast majority (92-99%) had their pain resolved by the time of a recall visit and 85-93% remained pain-free after initial resolution. The observations for cold pain were similar: 68% (untreated) and 78% (treated) became free of cold pain at some point during follow-up, and 84% of these stayed free of cold pain after initial resolution. Few teeth developed biting or spontaneous pain (4-8%) and 44-67% of these had pain resolution during the follow-up period. CONCLUSION: In this study, treatment resolved a preponderance of pain associated with a cracked tooth.  Pain was also resolved for most untreated cracked teeth, especially biting pain, and to a lesser degree spontaneous and cold pain, although not to the same degree as with the treated cracked teeth.

Real-time monitoring of the pH microenvironment at the interface of multispecies biofilm and dental composites.

Bacterial-mediated local pH change plays an important role in altering the integrity of resin dental composite materials in a dynamic environment such as the oral cavity. To address this, we developed a 300-µm-diameter, flexible, solid-state potentiometric pH microsensor capable of detecting and quantifying the local pH microenvironment at the interface of multispecies biofilm and dental resin in real time over 10 days. We used fluorinated poly(3,4-ethylenedioxythiophene) as the back contact in our newly developed pH sensor, along with a PVC-based ion-selective membrane and PTFE-AF coating. The high temporal resolution pH data demonstrated pH changes from 7 to 6 and 7 to 5.8 for the first 2 days and then fluctuated between 6.5 to 6 and 6 to 5.5 for the remaining 8 days with the resin composite or glass slide substrate respectively. We could observe the fluctuations in pH mediated by lactic acid production within the biofilm and the re-establishment of pH back to 7. However, acid production started to overwhelm buffering capacity with the continuous feed of sucrose cycles and reduced the local pH nearer to 5.5. No such changes or fluctuations were observed above the biofilm, as the pH remained at 7.0 ± 0.2 for 10 days. The localized real-time monitoring of the pH within the biofilm showed that the pH shift underneath the biofilm could lead to damage to the underlying material and their interface but cannot be sensed external to the biofilm.

Impact of Postthrombotic Vein Wall Biomechanics on Luminal Flow during Venous Angioplasty and Stent Placement: Computational Modeling Results.

This study characterized the impact of vein wall biomechanics on inflow diameter and luminal flow during venous angioplasty and stent placement, using postthrombotic and healthy biomechanical properties from an ovine venous stenosis and thrombosis model. Finite element analysis demonstrated more pronounced inflow channel narrowing in the postthrombotic vein compared with the healthy control vein during angioplasty and stent placement (relative inflow diameter reduction of 42% versus 13%, P < .0001). Computational fluid dynamics modeling showed increased relative areas of low wall shear rate in the postthrombotic vein compared with the normal vein (0.46 vs 0.24 for shear rate < 50 s-1; 0.13 vs 0.07 for shear rate < 15 s-1; P < .05), with flow stagnation and recirculation. Since inflow narrowing and low wall shear rate are associated with in-stent restenosis and reintervention, these computational results based on experimentally obtained biomechanical values highlight the significance of postthrombotic venous properties in optimizing venous intervention outcomes.

Development and maintenance of surface gloss of dental composites after polishing and brushing: Review of the literature.

OBJECTIVE: To describe the effect of the composites' composition to produce high surface smoothness/gloss using finishers/polishers, and to assess maintained smoothness/gloss under toothbrush abrasion. MATERIALS AND METHODS: PubMed papers published from January 01, 2000 to September 01, 2021 were included, and keywords used were: filler particle size, shape, amount of dental composites; finishing/polishing, gloss/roughness, and toothbrush abrasion of composites. Seventy-five in-vitro studies were included in this literature review. Forty-six articles assessed filler particle size/composition/shape and distribution to obtain high gloss/smoothness on different formulations; and the finishers/polishers effect on these materials. Twenty-nine papers assessed toothbrush abrasion of composites. RESULTS: Suprananofill/nanofill/microfills typically showed the smoothest and glossiest surfaces compared to nanohybrid, microhybrid and hybrid composites. Microfill (0.04-0.07 µm, 71-88 GU); suprananofill (0.001-0.8 µm, 52-92 GU), microhybrids (0.05-0.35 µm, 35-95 GU) and nanohybrids (0.05-0.21 µm, 66-97 GU). Composites with small, spherical particles tend to show smoother, glossier surfaces and more wear resistant compared to resin composites with larger or irregular particles. Several studies showed higher roughness and reduced gloss after toothbrush abrasion. CONCLUSIONS: Within the limitations of this study, suprananofill/nanofill/microfill composites tended to show the smoothest/glossiest surfaces due to smaller particle size. Composites with small, spherical particles tended to show smoother/glossier surfaces. Overall, toothbrush abrasion showed higher surface roughness and reduced gloss. CLINICAL SIGNIFICANCE: Suprananofills/nanofills/microfills had good polishability and polish retention due to their smaller particle size. The effectiveness of a polishing system is material-dependent. In general, Enhance-PoGo, Sof-Lex discs, and Sof-Lex Spiral wheels showed similar level of smoothness.