Three-Dimensional Internal Voids and Marginal Adaptation in Deep Margin Elevation Technique: Efficiency of Highly Filled Flowable Composites.

PURPOSE: To evaluate interfacial three-dimensional adaptation and internal voids of different flowable materials before and after cyclic fatigue in a simulated deep-margin elevation scenario. METHODS: Eighty (n = 80) extracted premolars were selected and two Class II cavities were prepared. The mesial one with cervical margin 1 mm above the cementum-enamel junction (CEJ) and the distal one with cervical margin 1 mm below the CEJ. After performing adhesive procedures, specimens were divided into four groups according to the employed materials for 2 mm horizontal deep-margin relocation: nanohybrid composite (Clearfil ES2, Kuraray); conventional viscosity flowable composite (Tetric Flow, Ivoclar); medium viscosity flowable composite (Majesty ES2 Low Flow, Kuraray); high viscosity flowable composite (Majesty ES2 Super Low Flow, Kuraray). All restorations were finalized by oblique layering with nanohybrid composite (Clearfil ES2, Kuraray). To reveal interfacial and internal gap progression, specimens were scanned with a micro-CT (SkyScan 1172), before and after 500,000 cycles of mechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growing. Only the 2 mm margin relocation volumes were considered. Obtained masks were analyzed for noise removal and volume calculation. At baseline, interfacial gap progression and internal voids, expressed in mm3, were collected and statistically analyzed with two-way ANOVA (α 0.05) for the variables substrate and restorative materials followed by Tukey post-hoc test. An additional two-way ANOVA test, followed by Tukey post-hoc test, was performed to evaluate variation in interfacial gap progression after mechanical aging. RESULTS: At baseline, the ANOVA test showed a significant difference for the variable restorative materials (p = 0.01). More specifically, the Tukey post-hoc test revealed that the highly filled medium viscosity composite performed better than the conventional viscosity composite at baseline for the interfacial gap. The internal voids ANOVA test at baseline reported no significant differences for the variable tested. Analysis of variance for internal gap progression after thermocycling showed no differences for both substrate and restorative material employed. CONCLUSIONS: Highly filled medium viscosity composite performed significantly better than the conventional viscosity flowable composite for what concern baseline interfacial gaps. Artificial aging with a chewing simulator and thermocycling did not affect interfacial gap progression on enamel and dentin. The tested restorative materials performed equally after aging.

Clinical Management of Facemasks for Early Treatment of Class III Malocclusion: A Survey among SIDO Members.

To evaluate whether there are differences among orthodontists in the clinical management of facemask treatment for early treatment of Class III malocclusion, a survey consisting of 16 questions was conducted among members of the Italian Society of Orthodontics (SIDO). Sixty percent of the respondents were Specialists in Orthodontics (S) whereas 40% were General Dentists practicing Orthodontics (GD). Descriptive statistics were calculated to summarize the collected data. Differences in answers between S and GD were assessed with the Fisher's exact test for dichotomous variables, chi-square test for qualitative variables, and Mann-Whitney test for ordinal variables. A total of 151 clinicians participated in this survey. As for treatment timing, about 80% of the participants reported treating Class III patients with RPE and facemask between 5 and 8 years of age. Most of the participants requested the patients to wear the facemask in the afternoon and at night for a period of 9 or 12 months with recommended forces of 500 g per side. Comparisons between S and GD showed that S preferred the Petit facemask whereas GD favored the Delaire's type facemask (Fisher's Exact test, p = 0.0005). S and GD also differed significantly in their judgment of the most critical time of treatment, which for the majority of GD was the initial period but for the S was the final period (Chi-square test p = 0.0188). This survey showed that the facemask is not well received by the patients who, along with their parents, express concerns regarding its tolerability.

3D Printed Materials for Permanent Restorations in Indirect Restorative and Prosthetic Dentistry: A Critical Review of the Literature.

The objective of this study was to review the scientific evidence currently available on 3D printable materials and 3D printing technologies used for the fabrication of permanent restorations, focusing on material properties that are clinically relevant. A literature search was performed on four databases (MEDLINE/PubMed, Scopus, Cochrane Library, Web of Science) for articles published from January 2013 until November 2023, using a combination of free words: (restorative dentistry OR prosthetic dentistry) AND (3D printing OR additive manufacturing OR rapid prototyping) AND materials. Two reviewers screened titles and/or abstracts of 2.468 unique studies. In total, 83 studies were selected for full-text reading, from which 36 were included in the review. The assessed variables were mechanical properties, reporting in most of the cases positive results, dimensional accuracy and fit, reporting conflicting results with a predominance of positive, aesthetic properties, with positive reports but scarcely addressed, and biological properties, almost unexplored in independent studies. Despite numerous studies with positive results in favor, papers with negative outcomes were also retrieved. Aesthetic and biological properties are conversely still mostly unexplored. There remains a lack of conclusive evidence for viable 3D printable restorative and prosthodontic materials for permanent restorations. Research should be strengthened by defining international standards for laboratory testing and, where pre-clinical data are promising, conducting clinical trials.

Clinically Relevant Properties of 3D Printable Materials for Intraoral Use in Orthodontics: A Critical Review of the Literature.

The review aimed at analyzing the evidence available on 3D printable materials and techniques used for the fabrication of orthodontic appliances, focusing on materials properties that are clinically relevant. MEDLINE/PubMed, Scopus, and Cochrane Library databases were searched. Starting from an initial retrieval of 669 citations, 47 articles were finally included in the qualitative review. Several articles presented proof-of-concept clinical cases describing the digital workflow to manufacture a variety of appliances. Clinical studies other than these case reports are not available. The fabrication of aligners is the most investigated application of 3D printing in orthodontics, and, among materials, Dental LT Clear Resin (Formlabs) has been tested in several studies, although Tera Harz TC-85 (Graphy) is currently the only material specifically marketed for direct printing of aligners. Tests of the mechanical properties of aligners materials lacked homogeneity in the protocols, while biocompatibility tests failed to assess the influence of intraoral conditions on eluents release. The aesthetic properties of 3D-printed appliances are largely unexplored. The evidence on 3D-printed metallic appliances is also limited. The scientific evidence on 3D printable orthodontic materials and techniques should be strengthened by defining international standards for laboratory testing and by starting the necessary clinical trials.

An Insight into Enamel Resin Infiltrants with Experimental Compositions.

Resin infiltration is a conservative treatment of initial enamel carious lesions. Only one infiltrant material is available on the market (Icon, DMG), and research is now investigating new chemical compositions so as to further exploit the benefits of the resin infiltration technique. A literature search of the articles testing the effects of different formulations on mechanical properties, resin penetration ability, remineralizing, and antibacterial activities was conducted. Of 238 articles, 29 resulted in being eligible for the literature review. The formulations investigated were all different and consisted in the inclusion of hydrophobic monomers (i.e., BisEMA, UDMA), solvents (ethanol, HEMA), alternative etchants (PAM) or molecules with antibacterial or bioactivity features (i.e., AgNP, YbF3, MTZ, chitosan, DMAMM, HAp, MC-IL, NACP, PUA, CHX) and microfilled resins. Information on the long-term performances of the tested experimental materials were scarce. The combination of TEGDMA with hydrophobic monomers and the inclusion of a solvent alternative to ethanol reinforced mechanical properties of the materials. Hybrid-glass materials demonstrated an enhanced remineralization capacity. Techniques such as tunnelization increased the penetration depth and preserved the recourse to less-conservative treatments. Combining the min-invasive infiltrant approach with remineralizing and bacteriostatic properties would be beneficial for therapeutic and economical aspects, according to the principles of minimally invasive dentistry.

Factory Crystallized Silicates for Monolithic Metal-Free Restorations: A Flexural Strength and Translucency Comparison Test.

Flexural strength (FS) and translucency (Contrast Ratio-CR) of three different factory crystallized silica-based glass ceramics, Celtra Duo (CD), N!ce (NI) and Li-Si Block, a lithium disilicate, IPS e.max CAD (LD), and a leucite-reinforced feldspathic ceramic, Empress CAD (EM), in two different translucencies (HT and LT) for use in chairside dental restorations have been compared. CAD blocks of the materials were cut into beams and tiles and processed following manufacturers' instructions. The beams were tested (3-PBT) to determine flexural strength, Weibull characteristic strength, and Weibull modulus; and tiles were tested to determine CR. All data were statistically analyzed. In addition, SEM analysis of the materials was performed. Differences in flexural strength (FS) and translucency (CR) between the materials were found to be statistically significant. FS decreased as follows (MPa): LDHT 350.88 ± 19.77 (a) = LDLT 343.57 ± 18.48 (a) > LSLT 202.15 ± 17.41 (b) = LSHT 196.93 ± 8.87 > NIHT 186.69 ± 13.06 (c) = CDLT 184.73 ± 13.63 (c) = CDHT 174.15 ± 21.76 (c) = NILT 172.12 ± 11.98 (c) > EMHT 131.16 ± 13.33 (e) = EMLT 127.65 ± 11.09. CR decreased as follows (mean ± sd): CDLT 74.1 ± 1.1 (a); LSLT 74.0 ± 1.1 (ab); NILT 73.3 ± 0.8 (ab); EMLT 73.0 ± 1.5 (ab); NIHT 72.4 ± 1.0 (bc); LDLT 71.3 ± 1.1 (bc); LTHT 65.2 ± 0.9 (de); LSHT 63.8 ± 1.1 (def); EMHT 636 ± 1.2 (ef); CDHT 62.2 ± 0.8 (f). Our findings show that factory-crystallized lithium silicate glass ceramics fulfill ISO standards for Classes 1 and 2. Therefore, they can be considered viable alternatives to produce single-unit restorations with a chairside procedure not requiring thermal treatment.

3D Printed Customized Facemask for Maxillary Protraction in the Early Treatment of a Class III Malocclusion: Proof-of-Concept Clinical Case.

In order to improve fit and comfort, a maxillary protraction facemask customized to the patient's anatomy was produced by means of 3D face scanning, digital design and additive manufacturing. An 8-year-old patient in need of early treatment for the Class III malocclusion received a rapid palatal expander and a Petit-type facemask, whose components were digitally designed on a 3D scan of the patient's face. For face scanning, the iPad Pro 2018 tablet (Apple, Cupertino, CA, USA) with the Bellus3D DentalPro application (Bellus3D, Campbell, CA, USA) was used. Facemask components were modelled with 3D Blender software. The rests were 3D printed in BioMed Clear biocompatible resin (Formlabs, Somerville, MA, USA), and the bar in stainless steel. For greater comfort, the internal surface of the rests was lined with a polymer gel pad (Silipos, Niagara Falls, NY, USA). The manufacturing procedure of the customized facemask is patented. The patient wore the facemask at night for a period of 9 months. The patient's experience was evaluated with a questionnaire at 1 week, 3, 6, and 10 months of treatment. The customized facemask was well accepted by the patient and obtained the expected treatment outcome. Furthermore, 3D face scanning, 3D modelling and 3D printing allow for the manufacturing of customized facemasks with improved fit and comfort, favoring patient compliance and treatment success.

Effects of Substrate and Cement Shade on the Translucency and Color of CAD/CAM Lithium-Disilicate and Zirconia Ceramic Materials.

The aim of this in vitro study was to evaluate the effects of substrate and cement shades on the translucency and color of lithium-disilicate and zirconia CAD/CAM materials. Two light-cured resin cements (RelyX Veneer Cement; 3M; Choice 2 Veneer Cement; Bisco Dental) with a standardized thickness (0.1 mm) were tested in combination with two different monolithic CAD/CAM materials (E-Max CAD (LI2SI2O5); Ivoclar Vivadent; Katana (ZrO2); Kuraray-Noritake Dental) on two different colored composite substrates used as a dentin (Filtek Supreme XTE; 3M); for a total of 12 combinations (n = 10). The specimens' color was measured with a spectrophotometer (Spectroshade; MHT). Measurements were taken using the CIELAB color coordinate system (L*a*b*) against black and white backgrounds. L*a*b* values were statistically analyzed for the variables Substrate, Ceramic, and Cement by applying a Three-Way ANOVA followed by the Tukey Test for post-hoc comparison (p < 0.05). Translucency Parameter (TP) and Constant Ratio (CR) were assessed to evaluate translucency; acceptability and perceptibility thresholds (ΔE00 1.8 and 0.8) were used. Statistically significant influence was found for factors ceramic material, cement shade, and substrate color (p < 0.05). Unacceptable color differences were reported for Li2Si2O5. Opacity was significantly higher when white opaque cement shade was employed. Ceramic type and cement shade significantly influenced L*a*b* color coordinates. The final translucency and color of ceramic restorations can, therefore, be influenced by ceramic material, cement shade, and substrate color.

Color stability of resin-based composites: Staining procedures with liquids-A narrative review.

OBJECTIVE: The objective of this study was to review the experimental staining procedures performed in in-vitro studies for evaluating color stability of resin-based composites used for direct restorations. OVERVIEW: A review was performed with the purpose to identify in vitro procedures carried out to establish staining and color stability of resin-based composites used for direct restorations. A literature search was performed on four online databases (PubMed, Scopus, Embase and Web of Science) for articles published from January 1st 2001 till March 20th 2021, using a combination of free words and Medical Subject Headings (MESH) terms: "Composite Resins" AND "Color Stability" OR "Staining." Two reviewers screened titles and/or abstracts of 1728 unique studies. In total, 208 studies were selected for full-text reading, from which 178 were included in the review. The assessed variables were specimen dimensions, shape, and surface finishing; time before immersion; staining media type, dwell time, temperature and renewal interval; type of composite; color and translucency assessment parameters and measuring system. One hundred and seventy-eight articles analyzed color stability with staining liquids. Coffee was the most used staining medium (n = 102), followed by tea (n = 61), and red wine (n = 55). A disc-shaped specimen was used in most studies (n = 170) with a 2 mm thickness (n = 116). Spectrophotometers were the most used color assessment devices (n = 154), followed by colorimeters (n = 17). Color differences were quantified with ΔE (n = 154), ΔE00 (n = 23). Acceptability and or perceptibility thresholds were also taken into consideration (n = 126). CONCLUSIONS: The large variety of staining procedure suggests the need for standardization. CLINICAL SIGNIFICANCE: Aesthetic failure due to discoloration is a relevant clinical problem. Evaluating benefits and drawbacks of resin based composites artificial staining procedures will improve to predict materials clinical performances.

Bracket Bonding to All-Ceramic Materials with Universal Adhesives.

The need for bracket bonding to ceramic restorations is increasing. The aim of this study was to evaluate the effect of universal adhesives on bracket adhesion to polished or glazed lithium disilicate (LDS) and monolithic zirconia (MZ) surfaces. One hundred and twenty brackets (N = 10) were bonded to either polished or glazed LDS (e.max CAD B32, Ivoclar Vivadent, Schaan, Liechtenstein) and MZ (In-Ceram® YZ, VITA, Bad Sackingen, Germany) blocks using three different adhesives combined with Transbond™ XT Paste (3M Unitek, Monrovia, CA, USA). Tested universal adhesives were Scotchbond™ Universal Adhesive (SU, 3M St. Paul, MN, USA) and Assure Plus (AP, Reliance, Itasca, IL, USA). Transbond™ XT Primer (XTP, 3M Unitek, Monrovia, CA, USA) served as a control adhesive. Bracket bond strength was measured in shear mode (SBS). Failure type was determined by the Modified Adhesive Remnant Index (ARI). Data were statistically analyzed. On polished LDS, SU yielded bracket SBS significantly superior to those of AP and XTP. On polished MZ, the use of SU and AP significantly enhanced bracket retention as compared with XTP. Low SBS values, below the threshold of clinical acceptability, were reached by all tested adhesives on glazed LDS and MZ specimens. SBS measurements corresponded with failure type observations. Universal adhesives SU and AP could be considered for use on polished LDS and MZ surfaces.

Cross-Sectional Study on Lateral Skull Radiographs to Design a New Nasopharyngeal Swab for Simplified COVID-19 and Respiratory Infections Diagnostic Testing in Children.

Nasopharyngeal swab sample collection is the first-line testing method for diagnosing COVID-19 infection and other respiratory infections. Current information on how to properly perform nasopharyngeal swabbing in children is largely defective. This study aimed at collecting nostril to nasopharynx distance measurements on lateral skull radiographs of children and adolescents to design a nasopharyngeal swab meant to standardize and facilitate the sample collection procedure. A total of 323 cephalograms of 152 male and 171 female children aged 4-14 years taken for orthodontic reasons were selected. On each cephalogram, the shortest distance between the most anterosuperior point of the nostril contour and the nasopharynx outline was measured in mm parallel to the palatal plane. Descriptive statistics of the measurements were calculated for each age group. The lower limit of the 95% confidence intervals of the measurements was taken as a reference to design a swab shaft with marks that, at each age, delimitate a safety boundary for swab progression up to the posterior nasopharyngeal wall. The simplification of the procedure enabled by the newly designed nasopharyngeal swab is valuable to help healthcare providers perform specimen collection on children in a safe and effective way, perhaps under the less-than-ideal conditions possibly occurring in 'point-of-need' contexts.

Three-dimensional evaluation of maxillary second molar position in untreated patients with normal occlusion : Implications for preadjusted appliance prescriptions.

PURPOSE: The study was aimed at evaluating the sagittal and transversal inclinations of upper second molars in untreated adolescents with normal occlusion. METHODS: A sample of 41 subjects (16 females, 25 males) was selected from the University of Michigan Growth Study (UMGS). Digital dental casts with fully erupted second molars in occlusion were chosen (mean age 14.9 ± 1.3 years). Digital measurements were recorded with the open source software 3D Slicer ( www.slicer.org ). The digital measurements of the UMGS sample were compared with the manual measurements collected by Andrews from his sample of untreated class I subjects with normal overbite and overjet. Two mixed effect models (sagittal and transversal inclinations) were performed. The "random effect" was represented by the subjects, while the "fixed effects" were the two compared groups, the side of the arch (right and left), and the groupâ€¯× side interaction. Outcome variables were sagittal and transversal inclinations of the upper second molars. RESULTS: The UMGS group showed a significantly greater distal crown angulation (-18.9°) with respect to the Andrews sample (0.4°, P < 0.0001). As for the transversal inclination, the UMGS group exhibited significantly greater lingual crown inclination (-10.6° versus -8.0°, P = 0.0118). CONCLUSIONS: Fully erupted maxillary second molars in a sample of adolescent subjects with normal occlusion showed significantly greater distal and lingual inclinations when compared with Andrews' values. The finding of a distal crown inclination in contrast with Andrews' observation of a mesial crown inclination suggests that revision in tip prescription for preadjusted brackets may be considered.

Variations in maxillary second molar position of untreated subjects with normal occlusions: A long-term observational study.

INTRODUCTION: The purpose of the present study was to evaluate the long-term variations in maxillary second molar position in untreated subjects with normal occlusion. SETTING AND SAMPLE POPULATION: A sample of 39 subjects (18 females and 21 males) selected from the University of Michigan Growth Study (UMGS) was followed longitudinally with digital dental casts at 3 observation times: T1, when the maxillary permanent second molars were fully erupted, T2, last observation available in the longitudinal series (38 subjects), and T3, at least 20 years after T2 (12 subjects). MATERIALS AND METHODS: Digital measurements were recorded with an open-source software. Outcome variables were sagittal and transverse inclinations of the upper second molars. Two mixed-effect models were performed. RESULTS: The maxillary second molars had a distolingual inclination at T1, T2 and T3. Sagittal and transverse inclination showed progressive significant uprighting from T1 through T3 (P < .001). From T1 to T2, the adjusted difference in sagittal crown inclination was 8.0° (95% CI from 6.5° to 9.6°; P < .001). From T2 to T3, the adjusted difference was 5.5° (95% CI from 3.0° to 8.1°; P < .001). From T1 to T2, the adjusted difference in transverse crown inclination was 1.9° (95% CI from 0.4° to 3.5°; P = .011). From T2 to T3, the adjusted difference was 6.0° (95% CI from 3.4° to 8.5°; P < .001). CONCLUSIONS: Along with age, maxillary second molars showed a progressive significant uprighting with a decrease in the distal and lingual inclinations.

Comparison between Hydrofluoric Acid and Single-Component Primer as Conditioners on Resin Cement Adhesion to Lithium Silicate and Lithium Disilicate Glass Ceramics.

This study aimed at evaluating the effects of different surface conditionings on the microshear bond strength (µSBS) of a self-adhesive resin cement to VITA Suprinity (ZLS) and IPS e.max CAD (LD). Three surface conditioning protocols were performed on ZLS and LD before luting with a self-adhesive resin cement (RelyX Unicem 2, RXU): hydrofluoric acid (HF), HF + silane (HF + S), or Monobond Etch & Prime (EP). In each group, 15 cylindrical buildups of RXU were prepared on five milled bars and submitted to a µSBS test. Data were statistically analyzed with two-way ANOVA and Tukey's post hoc test (p < 0.05). Failure modes were recorded and classified as adhesive, mixed, cohesive in resin, or ceramic, and statistically analyzed with Fisher's exact test (p = 0.05). One additional bar per group was used for the morphological characterization of the conditioned surface by means of SEM. The material per se did not significantly influence adhesion (p = 0.744). Conditioning protocol was a significant factor: EP yielded significantly higher µSBS than HF (p = 0.005), while no significant differences emerged between EP and HF + S (p = 0.107), or HF + S and HF (p = 0.387). The material-conditioning protocol interaction was not statistically significant (p = 0.109). Significant intergroup differences were found in distribution of failure modes: mixed failures were predominant in the ZLS/EP group, while the other groups showed a prevalence of adhesive failures. The self-etching primer showed promising results in terms of immediate bond strength of a self-adhesive resin cement to lithium-silica-based glass ceramics, suggesting its alternative use to hydrofluoric acid and silane conditioning protocols.

Influence of Low-pH Beverages on the Two-Body Wear of CAD/CAM Monolithic Materials.

The aim of this in vitro study is to evaluate the effect of different acidic media on volumetric wear and surface roughness of CAD/CAM monolithic materials. Forty-eight rectangular specimens were prepared using different CAD/CAM monolithic materials: nanohybrid composite (Grandio Blocks, Voco), resin-based composite (Cerasmart, GC), lithium disilicate (E-Max, Ivoclar), and high-translucency zirconia (Katana STML, Kuraray Noritake). After storage in distilled water at 37 °C for two days, the specimens were tested using a chewing machine with a stainless-steel ball as an antagonist (49N loads, 250,000 cycles). Testing was performed using distilled water, Coca-Cola, and Red Bull as abrasive media. Wear and surface roughness analyses of the CAD/CAM materials were performed using a 3D profilometer and analyzed with two-way analysis of variance and post hoc pairwise comparison procedures. Worn surfaces were examined using scanning electron microscopy. Resin-based materials suffered higher volumetric wear than ceramics (p = 0.00001). Water induced significantly less volumetric wear than the other tested solutions (p = 0.0014), independent of the material tested. High-translucency zirconia showed less surface roughness than all the other materials tested. The selection of monolithic CAD/CAM materials to restore worn dentition due to erosive processes could impact restorative therapy stability over time. Resin-based materials seem to be more influenced by the acidic environment when subjected to a two-body wear test.

External Marginal Gap Variation and Residual Fracture Resistance of Composite and Lithium-Silicate CAD/CAM Overlays after Cyclic Fatigue over Endodontically-Treated Molars.

The purpose of this in vitro study was to evaluate the external marginal gap variation with a 3D quantitative method and the residual fracture resistance after cyclic fatigue in endodontically treated molars restored with overlays of different materials, with and without fiber posts-supported buildups. Forty-eight human maxillary molars were selected, endodontically treated, prepared with standardized MOD cavities and randomly allocated into 6 study groups considering the "core strategy" (build-up with composite resin; build-up with composite resin supported by a fiber post); and the "restorative material" of the indirect adhesive overlay (GrandioBlocks, Voco; Cerasmart, GC; CeltraDuo, Dentsply). All procedures were executed according with manufacturers guidelines. Micro-CT analysis prior and after cyclic fatigue were executed, followed by scanning electron microscope analysis and fracture resistance test. The Two-Way ANOVA analysis showed that interfacial gap progression was significantly influenced by the "core strategy" (p < 0.01) but not of "restorative material" (p = 0.59). Concerning fracture resistance, "restorative material" was statistically significant (p < 0.01), while "core strategy" (p = 0.63) and the interaction (p = 0.84) were not. In conclusion, the fiber post presence within the build-up promoted a lower interfacial gap opening after fatigue, evaluated through micro-CT scans. In terms of fracture resistance, teeth restored with Cerasmart and Celtra Duo were statistically similar, but superior to GrandioBlocks.

Effect of Finishing Systems on Surface Roughness and Gloss of Full-Body Bulk-Fill Resin Composites.

BACKGROUND: In this study, we assess the effect produced on roughness and gloss of full-body bulk-fill materials by different finishing and polishing systems. METHODS: Four full-body bulk-fill materials were tested: SonicFill2 (SF), Filtek Bulk Fill Posterior Restorative (FB), Tetric EvoCeram bulk-fill (EC), and Fill-Up! (FU). Sixty discs per material (2 mm in thickness and 7 mm in diameter) were obtained and randomly assigned (n = 15) to four finishing and polishing methods: Sof-Lex Spiral Wheels (SW), HiLusterPLUS (HL), Astropol (AP), and Opti1Step (OS). Surface roughness and gloss were then measured. RESULTS: For roughness, material and surface treatment were significant factors (p < 0.001) with SF = FB = EC < FU and AP < SW < HL = OS. Material and surface treatment had a significant effect also on gloss (p < 0.001), with SF > FB = EC > FU and SW > AP > HL > OS. CONCLUSIONS: The tested combinations of bulk-fill and polishing systems provided clinically acceptable results with regard to roughness, while the outcome was poor for gloss. Multistep finishing/polishing systems were able to produce smoother surfaces on full-body bulk-fill materials compared to simplified ones.

Flexural resistance of CAD-CAM blocks. Part 3: Polymer-based restorative materials for permanent restorations.

PURPOSE: Concurrently with the growing interest in CAD-CAM systems, several new materials of different chemical nature have become available. As an alternative to ceramics, numerous polymer-based materials have recently been proposed for permanent prosthetic restorations. Aim of this study was to test the CAD-CAM polymer-based materials available on the market, comparing mean flexural strength, Weibull characteristic strength and Weibull modulus. METHODS: Seven types of polymer-based blocks were tested: Lava Ultimate, 3M; Brilliant Crios, Coltene; Cerasmart, GC; Block HC, Shofu; Katana Avencia, Noritake; Grandio Blocs, Voco; Tetric CAD, and Ivoclar-Vivadent. Specimens were cut out from blocks, finished, polished, and tested in a three-point bending test apparatus until failure (n=30). Flexural strength, Weibull characteristic strength, and Weibull modulus were calculated. Flexural strength data were statistically analyzed. ANOVA on Ranks was applied, followed by the Dunn's test for post hoc comparisons (P= 0.05). RESULTS: Flexural strength values (MPa) were measured (mean±standard deviation). Different letters in parentheses label statistically significant differences: Grandio Blocs 266±24(a), Brilliant Crios 259±21(ab); Tetric CAD 254±15(ab); Katana Avencia 241±29(bc); Cerasmart 221±24(cd); Lava Ultimate 196±23(de); Block HC 139±10(e). All the tested materials had flexural strengths greater than 100 MPa, thereby satisfying the requirements of ISO standards for polymer-based materials. For all the tested materials the Weibull characteristic strength was greater than 100 MPa. Weibull modulus ranged between 21.20 (Tetric CAD) and 9.09 (Katana Avencia). CLINICAL SIGNIFICANCE: Even though all the CAD-CAM polymer-based materials marketed in blocks tested in the present study satisfy the requirements of ISO standard for polymer-based materials, their flexural resistance differs significantly. The data presented in the study may be helpful to clinicians for selecting the most appropriate materials for each clinical case.

Influence of Acid Concentration and Etching Time on Composite Cement Adhesion to Lithium-silicate Glass Ceramics.

PURPOSE: To evaluate the influence of hydrofluoric acid (HF) concentration and etching time on the microshear bond strength (µSBS) of RelyX Unicem 2 (3M Oral Care) to VITA Suprinity (Vita Zahnfabrik; zirconia-reinforced lithium-silicate glass ceramic: ZLS) and IPS e.max CAD (Ivoclar Vivadent; lithium-disilicate glass ceramic: LD). MATERIALS AND METHODS: Forty-eight bars each were fabricated of ZLS and LD with Cerec InLab MC-XL. For each material, 8 groups were formed with respect to etching time (20, 40, 60, 120 s) and HF concentration (4.9% and 9.5%). In each group, after etching and silanization, 15 cylindrical specimens of RelyX Unicem 2 were built up for µSBS testing with a special device. Data were analyzed using three-way ANOVA. Failure modes were assessed using an optical stereomicroscope, classified as adhesive, cohesive in resin or ceramic, or mixed. Failure modes were statistically analyzed using Fisher's Exact Test. One bar per group was prepared for SEM observation of the etched surface. RESULTS: ZLS showed significantly higher bond strengths than LD (p < 0.001). Etchant concentration was an influential factor with superior strengths after 4.9% HF etching (p = 0.009). Etching time did not significantly affect adhesion (p = 0.066). The material-etching interaction was statistically significant (p = 0.004). Particularly for ZLS, 4.9% HF etching obtained significantly higher bond strengths than did 9.5%. By using 4.9% HF, adhesion was significantly higher on ZLS than on LD. CONCLUSION: Material and HF concentration influenced the adhesion between RelyX Unicem 2 composite cement and lithium-silicate glass ceramics. Etching time was not an influential factor. The use of 4.9% HF for 20 s proved to be the most effective etching treatment of the intaglio surface.

A pilot trial on lithium disilicate partial crowns using a novel prosthodontic functional index for teeth (FIT).

BACKGROUND: Lithium disilicate is now a well accepted material for indirect restorations. The aim of this trial was to evaluate two lithium disilicate systems using a novel prosthodontic Functional Index for Teeth (FIT). METHODS: Partial adhesive crowns on natural abutment posterior teeth were made on sixty patients. Patients were divided into two groups: Group 1 IPS e.max press (Ivoclar-Vivadent, Schaan, Liecthestein), and Group 2 Initial LiSi press (GC Co., Tokyo, Japan). The restorations were followed-up for 3 years, and the FIT evaluation was performed at last recall. The FIT is composed of seven variables (Interproximal, Occlusion, Design, Mucosa, Bone, Biology and Margins), each of them are evaluated using a 0-1-2 scoring scheme, and is investigated by an oral radiograph and occlusal and buccal pictures. More in details, three variables have the three scores made on the presence or not of major, minor or no discrepancy (for 'Interproximal', 'Occlusion' and 'Design'), presence or not of keratinized and attached gingiva ('Mucosa'), presence of bone loss > 1.5 mm, < 1.5 mm or not detectable ('Bone'), presence or not of Bleeding on Probing and or Plaque Index ('Biology'), presence of detectable gap and marginal stain or not ('Margins'). The Mann-Whitney 'U' test was used and the level of significance was set at p < 0.05. Also, "success" of the crowns (restoration in place without any biological or technical complication) and "survival" (restoration still in place with biological or technical complication) were evaluated. RESULTS: Regarding FIT scores, all partial crowns showed a stable level of the alveolar crest without detectable signs of bone loss in the radiographic analysis. All other evaluated parameters showed a high score, between 1.73 and 2. No statistically significant difference emerged between the two groups in any of the assessed variables (p > 0.05). All FIT scores were compatible with the outcome of clinical success and no one restoration was replaced or repaired and the success rate was 100%. CONCLUSIONS: The results showed that it is possible to evaluate the clinical performance of partial crowns using FIT. The FIT proved to be an effective tool to monitor the performance of the restorations and their compatibility with periodontal tissues at the recall. The FIT can be really helpful for a standardized evaluation of the quality of the therapy in prosthodontic dentistry. The two lithium disilicate materials showed similar results after 3 years of clinical service. TRIAL REGISTRATION: The study protocol was approved by the Ethical Committee of University of Siena (clinicaltrial.gov # NCT01835821), 'retrospectively registered'.