A dual composite resin injection molding technique with 3D-printed flexible indices for biomimetic replacement of a missing mandibular lateral incisor.

PATIENTS: This case report presents a minimally invasive approach to replace a missing mandibular lateral incisor using a dual-injection molding technique with flowable composite resins. Integrated with a comprehensive digital workflow, this method achieves a structurally and esthetically biomimetic, bi-layered prosthetic solution. A 34-year-old woman with congenital absence of a mandibular lateral incisor was successfully rehabilitated using a direct composite resin-bonded fixed partial denture (RBFPD). DISCUSSION: Two specialized three-dimensional (3D)-printed flexible indices stabilized by a custom-designed 3D-printed rigid holder were employed to ensure the meticulous injection molding of flowable composite resins formulated to emulate the inherent chromatic gradations between dentin and enamel. The inherent flexibility of the indices, combined with the holder, facilitated accurate and seamless adaptation to the complex morphological features of the dental arch, thereby mitigating the challenges commonly associated with rigid 3D-printed resin indices. CONCLUSIONS: The bilayered direct composite RBFPD using 3D printed flexible indices prepared with a full digital workflow has several advantages over other dental prosthetic solutions, including noninvasiveness, cost-effectiveness, biomimetic esthetics, repairability, and shortened treatment times. Although the initial results are promising, further longitudinal studies with larger patient cohorts are required to confirm the long-term efficacy of this approach.

Automatic caries detection in bitewing radiographs-Part II: experimental comparison.

OBJECTIVE: The objective of this study was to compare the detection of caries in bitewing radiographs by multiple dentists with an automatic method and to evaluate the detection performance in the absence of a reliable ground truth. MATERIALS AND METHODS: Four experts and three novices marked caries using bounding boxes in 100 bitewing radiographs. The same dataset was processed by an automatic object detection deep learning method. All annotators were compared in terms of the number of errors and intersection over union (IoU) using pairwise comparisons, with respect to the consensus standard, and with respect to the annotator of the training dataset of the automatic method. RESULTS: The number of lesions marked by experts in 100 images varied between 241 and 425. Pairwise comparisons showed that the automatic method outperformed all dentists except the original annotator in the mean number of errors, while being among the best in terms of IoU. With respect to a consensus standard, the performance of the automatic method was best in terms of the number of errors and slightly below average in terms of IoU. Compared with the original annotator, the automatic method had the highest IoU and only one expert made fewer errors. CONCLUSIONS: The automatic method consistently outperformed novices and performed as well as highly experienced dentists. CLINICAL SIGNIFICANCE: The consensus in caries detection between experts is low. An automatic method based on deep learning can improve both the accuracy and repeatability of caries detection, providing a useful second opinion even for very experienced dentists.

Automatic caries detection in bitewing radiographs: part I-deep learning.

OBJECTIVE: The aim of this work was to assemble a large annotated dataset of bitewing radiographs and to use convolutional neural networks to automate the detection of dental caries in bitewing radiographs with human-level performance. MATERIALS AND METHODS: A dataset of 3989 bitewing radiographs was created, and 7257 carious lesions were annotated using minimal bounding boxes. The dataset was then divided into 3 parts for the training (70%), validation (15%), and testing (15%) of multiple object detection convolutional neural networks (CNN). The tested CNN architectures included YOLOv5, Faster R-CNN, RetinaNet, and EfficientDet. To further improve the detection performance, model ensembling was used, and nested predictions were removed during post-processing. The models were compared in terms of the [Formula: see text] score and average precision (AP) with various thresholds of the intersection over union (IoU). RESULTS: The twelve tested architectures had [Formula: see text] scores of 0.72-0.76. Their performance was improved by ensembling which increased the [Formula: see text] score to 0.79-0.80. The best-performing ensemble detected caries with the precision of 0.83, recall of 0.77, [Formula: see text], and AP of 0.86 at IoU=0.5. Small carious lesions were predicted with slightly lower accuracy (AP 0.82) than medium or large lesions (AP 0.88). CONCLUSIONS: The trained ensemble of object detection CNNs detected caries with satisfactory accuracy and performed at least as well as experienced dentists (see companion paper, Part II). The performance on small lesions was likely limited by inconsistencies in the training dataset. CLINICAL SIGNIFICANCE: Caries can be automatically detected using convolutional neural networks. However, detecting incipient carious lesions remains challenging.

The Effect of Bonding Strategy and Aging on Adhesion to Primary Enamel: An In-Vitro Study.

PURPOSE: Resin composites are commonly used in pediatric dentistry, but there is limited evidence on adhesion to primary teeth, especially primary enamel. In this study, three bonding strategies were assessed - one-step self-etch (1-SE), two-step self-etch (2-SE), and three-step etch-and-rinse (3-ER) - by measuring the immediate and aged microshear bond strength (µSBS) to sound primary enamel. MATERIALS AND METHODS: 120 extracted human primary molars with sound buccal surfaces were used for µSBS testing. Six adhesive protocols (two per bonding strategy) were selected and µSBS was measured either after 24 h or 10,000 thermal cycles (n = 10). Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were used to determine failure modes. Furthermore, 18 primary molars were etched using the different adhesive protocols (n = 3) for the measurement of surface roughness (Sa) using CLSM and morphological analysis using SEM. RESULTS: After 24 h, there was no significant difference in µSBS between 1-SE and 2-SE strategies (p = 0.96), but the 2-SE strategy yielded significantly higher µSBS after thermocycling (p < 0.001). The highest µSBS was obtained using the 3-ER strategy regardless of aging (p < 0.001). The 3-ER strategy clearly exposed enamel prisms and resulted in the highest Sa (p < 0.001). In contrast, if SE strategies were used, enamel prisms were barely recognizable, and Sa was not significantly different from baseline (p > 0.95). CONCLUSION: The 3-ER strategy is optimal for bonding to primary enamel. The etching effect of SE strategies is weaker, resulting in lower µSBS. Thermocycling revealed that the bonding durability of the 1-SE strategy is inferior to that of to multi-step strategies.

Digitally Guided Direct Composite Injection Technique with a Bi-layer Clear Mini-Index for the Management of Extensive Occlusal Caries in a Pediatric Patient: A Case Report.

PURPOSE: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient. MATERIALS AND METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices. RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent. CONCLUSION: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.

The Influence of Various Adhesive Systems and Polishing Methods on Enamel Surface Roughness after Debonding of Orthodontic Brackets: A Three-Dimensional In Vitro Evaluation.

A slight alteration of the enamel surface is inevitable upon debonding of orthodontic brackets, adhesive removal, and finishing/polishing. The aim of this in vitro study was to compare two adhesives and three polishing methods by measuring enamel surface roughness using confocal laser scanning microscopy (CLSM). Brackets were bonded on 42 extracted human premolars using Transbond XT (Transbond group) or Fuji Ortho (Fuji group). After debracketing, adhesives were removed with a tungsten carbide bur, and surfaces were polished using Sof-Lex discs, a rotary brush with a prophylactic paste (Depural), or a prophylactic cup with two polishing pastes (n = 7 in each subgroup). Surface roughness (Sa, Sku, Sq, and Sz) was measured using CLSM and compared before treatment (T1), after debracketing and adhesive removal (T2), and after polishing (T3). The data were statistically analyzed using the Mann-Whitney U and Kruskal-Wallis tests with Bonferroni correction. The time required for adhesive removal was measured and compared using a two-sample t-test. Surface roughness at T2 increased compared to T1, but the difference was significant only for the Fuji group (p < 0.01). The time required to remove Transbond XT (94.1 ± 6.8 s) was significantly higher compared to Fuji (72.1 ± 5.9 s, p < 0.0001). Polishing with Sof-Lex discs resulted in lower surface roughness compared to T1 (p = 0.018). Using Depural and polishing pastes showed no significant difference in surface roughness compared to T1, except for a significant decrease in Sa and Sq for Transbond (p = 0.043) and in Sku for Fuji (p = 0.018) after polishing with Depural. In conclusion, the removal of Transbond took significantly longer, but there were fewer residues of composite resin on the enamel surface. Sof-Lex discs decreased enamel roughness, whereas enamel morphology and roughness were similar to the pre-treatment state after polishing with polishing pastes.

Diffuse Reflectance Spectroscopy as a Novel Method of Caries Detection-An In Vitro Comparative Study in Permanent Teeth.

This in vitro study aimed to compare outcomes of dental caries detection using visual inspection classified according to the International Caries Detection and Assessment System (ICDAS) with objective assessments using a well-established laser fluorescence system (Diagnodent pen) and a novel diffuse reflectance spectroscopy (DRS) device. One hundred extracted permanent premolars and molars were utilized, including sound teeth, teeth with non-cavitated caries, or teeth with small cavitated lesions. A total of 300 regions of interest (ROIs) were assessed using each detection method. Visual inspection, being a subjective method, was performed by two independent examiners. The presence and extent of caries were histologically verified according to Downer's criteria, serving as a reference for other detection methods. Histological results revealed 180 sound ROIs and 120 carious ROIs, categorized into three different extents of caries. Overall, there was no significant difference between the detection methods in sensitivity (0.90-0.93) and false negative rate (0.05-0.07). However, DRS exhibited superior performance in specificity (0.98), accuracy (0.95), and false positive rate (0.04) compared to other detection methods. Although the tested DRS prototype device exhibited limited penetration depth, it shows promise as a method, particularly for the detection of incipient caries.

Polymerization shrinkage of light-cured conventional and bulk-fill composites -The effect of cavity depth and post-curing.

Volumetric shrinkage (VS) of conventional, bulk-fill, and core build-up resin-based composites (RBCs) of various thickness (1-5 mm) was measured using the modified bonded-disk method with confocal laser scanning microscopy. Additionally, the bottom-to-top ratio of Vickers hardness (%VH) was measured. Conventional RBCs exhibited significantly higher VS than bulk-fill and core build-up RBCs (p<0.05). As specimen thickness increased, VS relative to volume (%VS) and difference in VS at each depth (VSdepth) decreased. For conventional RBCs, there was a significant drop in VSdepth between 1 mm and 2 mm (p<0.05), and another drop was observed between 3 mm and 4 mm (p<0.05) where %VH decreased below 90%. For bulk-fill and core build-up RBCs, VSdepth decreased significantly between 2 mm and 3 mm (p<0.05), but %VH exceeded 90% even in 5 mm deep cavities. These results indicated that post-curing contributed to lower shrinkage in deeper layers, and that conventional RBCs were not adequately polymerized at the depth of over 3 mm.

Effect of filler load on structural coloration and color adjustment potential of resin composites.

The color-matching ability of single-shade composites Omnichroma (OMN) and Omnichroma Flow (OCF) is ensured by structural color, which arises from monodisperse 260 nm spherical fillers. This study evaluated how filler load influences the color adjustment potential of composite restorations to human teeth of various shades. The performance of composites containing the 260 nm spherical fillers -OMN (79 wt%), OCF (71 wt%), and experimental composites R1 (65 wt%), and R2 (60 wt%)- was compared to two conventional A2-shade composites and a transparent composite. Additionally, the translucency parameter, spectral reflectance, and light transmission properties were assessed. Composites with a lower load of the 260 nm spherical fillers exhibited lower light diffusion and lower reflectance in the yellow-to-red range (580-650 nm), which is characteristic for the structural color of OMN and OCF. The best color adjustment was achieved with OCF, presumably due to its high translucency and uniform spectral reflectance.

Does the thickness of universal-shade composites affect the ability to reflect the color of background dentin?

The recently introduced resin composites with a universal shade are claimed to match any tooth color. In this study, it was examined how composite thickness affects the color adjustment of conventional and universal-shade composites to background dentin. Thirty sound human central incisors of various shade were used, and color differences between their intact labial surfaces, exposed dentin surfaces and composite restorations (thickness 1-3 mm) were evaluated. In addition, the translucency, light transmission characteristics, and spectral reflectance of the composites were measured. The results showed that universal-shade composites outperformed conventional composites of A2 shade in the adjustment of hue and chroma (p<0.05) but not in lightness (p>0.05). The color adjustment potential of all composites significantly decreased as their thickness increased (p<0.05). The effect of thickness on Omnichroma and Omnichroma Flow was less marked, presumably because of their higher translucency (p<0.05) and structural coloration which induces light reflectance in the yellow-to-red range.

Bonding of universal adhesives to bur-cut dentin: Effect of double application and dentin moisture level.

This study investigated how the double application of adhesives and dentin moisture level influence the microtensile bond strength (µTBS) of universal adhesives containing different hydrophilic monomers to bur-cut dentin. Four universal adhesives (Scotchbond Universal, Clearfil Universal Bond Quick, Prime&Bond Universal, BeautiBond Universal) were applied to wet and dry bur-cut dentin either in one or two layers. The µTBS test was performed after 25,000 thermal cycles, and scanning electron microscopy was used for the analysis of failure mode and interfacial ultrastructure. Double application significantly improved µTBS on wet dentin (p<0.001), but the effect was not significant on dry dentin (p>0.050). Double application also enhanced the formation of resin tags and limited voids within the adhesive layer of BeautiBond Universal. Dentin moisture had a significant effect on µTBS only if the adhesives were applied in a single layer (p=0.007). Except for Prime&Bond Universal, the tested universal adhesives performed better on dry dentin.

Addition of metal chlorides to a HOCl conditioner can enhance bond strength to smear layer deproteinized dentin.

OBJECTIVES: To evaluate the effect of smear layer deproteinization using hypochlorous acid (HOCl) with/without metal chlorides (SrCl2 and ZnCl2) on the microtensile bond strength (µTBS) of two simplified adhesives to dentin. METHODS: Human dentin surfaces with a standardized smear layer were pretreated using a 105 ppm HOCl solution with/without SrCl2 (0.05 M, 0.1 M, 0.2 M, 0.4 M) or ZnCl2 (0.05 M, 0.1 M, 0.2 M) for 5 s, 15 s, or 30 s. After the deproteinizing solution was washed out with water for 5 s, 15 s, or 30 s, pretreated surfaces were bonded with one-step self-etch adhesive Bond Force II or universal adhesive Clearfil Universal Bond Quick, and µTBS was measured after 24 h. Additionally, the deproteinizing effects of HOCl solutions with/without the metal chlorides were compared by measuring changes in the amide:phosphate ratio using attenuated total reflection Fourier transform infrared spectroscopy. Statistical analysis was performed using multifactor ANOVA, Tukey's post hoc tests and t-tests (p < 0.05). RESULTS: Pretreatment with pure HOCl for 15 s and 30 s significantly decreased the amide:phosphate ratio (p < 0.05), indicating effective deproteinization, but the µTBS of both adhesives increased significantly only if HOCl was washed out for 30 s (p < 0.05). Increasing the concentrations of metal chlorides enabled shortening of the wash-out time down to 5 s while maintaining the improved µTBS (p < 0.05). The deproteinizing effect of HOCl was not significantly altered by the addition of metal chlorides (p > 0.05). SIGNIFICANCE: The effectiveness of smear layer deproteinization using HOCl can be improved by the addition of metal chlorides, as their increasing concentration allowed to shorten the wash-out time from 30 s down to 5 s.

Application of Sulfinate Agent in Conjunction with HOCl Smear-Layer Deproteinization Improves Dentin Bonding Durability of One-step Self-etch Adhesives.

PURPOSE: To evaluate the effect of a sulfinate agent on the bonding durability of one-step self-etch adhesives (1-SEAs) to smear-layer-covered dentin deproteinized with hypochlorous acid (HOCl). MATERIALS AND METHODS: Human coronal dentin disks with a standardized smear layer were deproteinized with 100 ppm HOCl solution for 0 s (control), 15 s or 30 s. After rinsing with water for 30 s and air drying, half of the specimens were treated with a sulfinate agent (Scotchbond Universal Dual Cure Activator; SDA) prior to the application of a 1-SEA (Bond Force II [Tokuyama Dental] or Clearfil Universal Bond Quick [Kuraray Noritake]). Microtensile bond strength (µTBS) was measured after 24 h or 10,000 thermal cycles (TC). The data were analyzed by three-way ANOVA with Tukey's post-hoc tests and t-tests at the 0.05 significance level. RESULTS: The 24-h µTBS of both adhesives increased statistically significantly with the HOCl pretreatment for 15 s or 30 s (p < 0.05), but it was not statistically significantly affected by the application of SDA (p > 0.05). However, after TC, the groups treated with the combination of HOCl and SDA maintained their µTBS (p > 0.05), as opposed to untreated dentin and dentin treated with either HOCl or SDA, whose µTBS decreased significantly (p < 0.05). CONCLUSION: The application of the sulfinate agent did not statistically significantly affect the immediate bond strength of 1-SEAs, and it could not prevent a significant decrease in the bond strength to untreated dentin after thermocycling. However, the sulfinate agent significantly improved the bonding durability of 1-SEAs to HOCl smear-layer deproteinized dentin.

Smear layer deproteinization with NaOCl and HOCl: Do application/wash-out times affect dentin bonding of one-step self-etch adhesives?

This study investigated the influence of application/wash-out times of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) on dentin bond strength of one-step self-etch adhesives (1-SEAs). Human coronal dentin discs with a standardized smear layer were pretreated with 6% NaOCl or 100 ppm HOCl for 5 s, 15 s, or 30 s, and washed out with water for 5 s, 15 s or 30 s with or without the application of Clearfil DC Activator (CDA). No pretreatment was used as a control. The discs were bonded with a 1-SEA (Bond Force II or Clearfil Universal Bond Quick) and microtensile bond strength (µTBS) was measured after 24 h. Pretreatment with NaOCl for 15 s and 30 s significantly decreased µTBS (p<0.05), irrespective of wash-out time. The application of CDA recovered µTBS but did not outperform the control group. Conversely, pretreatment with HOCl for 15 s and 30 s followed by 30 s wash-out time significantly increased µTBS of 1-SEAs (p<0.05), regardless of CDA application.

Additive effects of touch-activated polymerization and extended irradiation time on bonding of light-activated adhesives to root canal dentin.

STATEMENT OF PROBLEM: The bonding of light-activated adhesives to root canal dentin with an additional touch-polymerization activator has been insufficiently examined. PURPOSE: The purpose of this in vitro study was to investigate the effect of touch-polymerization activators and extended light-irradiation time on the microtensile bond strength (µTBS) of light-activated adhesives. MATERIAL AND METHODS: Post cavities were prepared in 50 extracted mandibular premolars and bonded using Prime&Bond Universal (PBU); PBU+Self Cure Activator (SCA); Clearfil SE Bond 2 (SEB); SEB+Clearfil DC Activator (DCA); or Clearfil Universal Bond Quick ER (UBQ). After light-irradiation for 10 or 20 seconds, the post cavities were filled with dual-activated resin core materials. Eight beams were prepared per specimen and subjected to the µTBS test. The µTBS data were analyzed by using 3-way ANOVAs with the Bonferroni correction (α=.05). RESULTS: The 3-way ANOVAs indicated that the use of touch-polymerization activators (SCA and DCA) significantly increased the µTBS of PBU and SEB in both the coronal (P=.015) and apical (P=.001) regions. The extension of light-irradiation time to 20 seconds significantly improved their µTBS in the apical region (P<.001), but not in the coronal region (P=.09). Light-irradiation for 20 seconds increased the µTBS of UBQ significantly in the coronal region (P=.014). CONCLUSIONS: Touch-polymerization activators improved the bond strength of light-activated adhesives to root canal dentin, especially when combined with an extended light-irradiation time.

Sodium p-Toluenesulfinate Enhances the Bonding Durability of Universal Adhesives on Deproteinized Eroded Dentin.

The effects of deproteinization using sodium hypochlorite (NaOCl) and the subsequent application of an antioxidant (sodium p-toluenesulfinate, STS) onto the bonding durability of universal adhesives on eroded dentin were investigated. Untreated sound dentin served as the control, whereas eroded dentin, which had been prepared by pH-cycling in 1% citric acid and a remineralization solution, was either untreated, deproteinized with a 10% NaOCl gel or deproteinized with the 10% NaOCl gel and subsequently treated with an STS-containing agent. The dentin surfaces were bonded using a universal adhesive (Clearfil Universal Bond Quick, Scotchbond Universal or G-Premio Bond), and the micro-tensile bond strength (µTBS) test was performed after 24 h or 10,000 thermal cycles. The µTBS data were statistically analyzed using a three-way ANOVA and Tukey's HSD post hoc tests. The lowest µTBS was measured on untreated eroded dentin (p < 0.001). Deproteinization of eroded dentin resulted in µTBS similar to untreated sound dentin (p > 0.05), but the highest µTBS was obtained if deproteinization was followed by the application of STS. Thermocycling significantly decreased µTBS in all groups (p < 0.001), except for STS-treated deproteinized eroded dentin (p > 0.05). This indicated that deproteinization, followed by the application of STS, could enhance the bonding durability of universal adhesives on eroded dentin.

Can a New HEMA-free Two-step Self-etch Adhesive Improve Dentin Bonding Durability and Marginal Adaptation?

PURPOSE: A new two-step self-etch adhesive (2-SEA) free of hydrophilic monomers was evaluated. Its microtensile bond strength (µTBS) to dentin under various aging conditions, interfacial gap formation, water sorption/solubility, and formation of an acid-base resistant zone (ABRZ) were evaluated and compared with a gold-standard 2-SEA. MATERIALS AND METHODS: The new 2-SEA G2-Bond Universal (G2; GC) was compared to Clearfil SE Bond 2 (CSE2, Kuraray Noritake). Their µTBS to sound coronal dentin was tested after 1 week, 10,000 thermal cycles (TC), 20,000 TC, 6 months and 1 year. Failure mode was determined using scanning electron microscopy (SEM). Gap formation at the interface of 2-mm deep tapered cavities with an enamel border was observed using swept-source optical coherence tomography after 1 day, 1 week, 10,000 TC, and 20,000 TC. In addition, water sorption and solubility of the bonding agents was measured, and ABRZ formation was evaluated using SEM. RESULTS: There was no significant difference in µTBS between G2 and CSE2 (p > 0.05), and the aging conditions had no significant effect on µTBS (p > 0.05). In all groups, cohesive failures prevailed (55%-95%). Interfacial gap formation was initially similar for both adhesives (p > 0.05), but G2 exhibited a significantly lower gap formation than CSE2 after TC (p < 0.05). The water sorption of G2 was significantly lower compared to CSE2 (p < 0.05), and their solubility was statistically similar (p > 0.05). ABRZ of similar thickness was observed with both adhesives. CONCLUSION: The new 2-SEA exhibited stable dentin bonding and increased hydrophobicity resulting from the absence of hydrophilic monomers.

Release of Bisphenol A from Milled and 3D-Printed Dental Polycarbonate Materials.

Polycarbonates are polymers of bisphenol A (BPA), a well-known endocrine disruptor. This study evaluated the release of BPA from polycarbonate crowns that were (1) milled from Temp Premium Flexible (ZPF, Zirkonzahn, Italy) or Tizian Blank Polycarbonate (TBP, Schütz Dental, Germany), or (2) 3D-printed (Makrolon 2805, Covestro, Germany). Commercial prefabricated polycarbonate crowns (3M, USA) and milled poly(methyl methacrylate) (PMMA) crowns (Temp Basic, Zirkonzahn, Italy) were included for comparison. The crowns were stored at 37 °C in artificial saliva (AS) or methanol, which represented the worst-case scenario of BPA release. Extracts were collected after 1 day, 1 week, 1 month and 3 months. BPA concentrations were measured using liquid chromatography-tandem mass spectrometry. The amounts of released BPA were expressed in micrograms per gram of material (µg/g). After 1 day, the highest amounts of BPA were measured from milled polycarbonates, TBP (methanol: 32.2 ± 3.8 µg/g, AS: 7.1 ± 0.9 µg/g) and ZPF (methanol 22.8 ± 7.7 µg/g, AS: 0.3 ± 0.03 µg/g), followed by 3D-printed crowns (methanol: 11.1 ± 2.3 µg/g, AS: 0.1 ± 0.1 µg/g) and prefabricated crowns (methanol: 8.0 ± 1.6 µg/g, AS: 0.07 ± 0.02 µg/g). Between 1 week and 3 months, the average daily release of BPA in methanol and AS decreased below 2 µg/g and 0.6 µg/g, respectively. No BPA was released from PMMA in AS, and the cumulative amount released in methanol was 0.2 ± 0.06 µg/g. In conclusion, polycarbonates could be a relevant source of BPA, but the current tolerable daily intake of BPA (4 µg/kg body weight) should not be exceeded.

Eight-year Microtensile Bond Strength to Dentin and Interfacial Nanomechanical Properties of a One-step Adhesive.

PURPOSE: To evaluate the microtensile bond strength (µTBS) of a one-step self-etch adhesive (1-SEA) to dentin and its interfacial nanomechanical properties after 8 years of water storage. MATERIALS AND METHODS: Flat coronal dentin surfaces of extracted human third molars were bonded with a 1-SEA (Clearfil S3 Bond Plus, CS3+) and built up with a hybrid resin composite (Clearfil AP-X). After storage in water for 24 h or 8 years, non-trimmed stick-shaped specimens were fabricated from the central part of each bonded tooth and subjected to the µTBS test at a crosshead speed of 1.0 mm/min. Failure modes and the morphology of debonded interfaces were analyzed using a scanning electron microscope (SEM). In addition, the elastic modulus (E) and hardness (H) of the adhesive layer and the resin composite were determined by an instrumented nanoindentation test. The acquired µTBS, E, and H data were statistically analyzed using t-tests to examine the effect of storage time (α = 0.05). RESULTS: The 8-year µTBS was slightly lower than that after 24 h, but the difference was not significant (p = 0.123). The SEM observation of debonded surfaces after 8 years revealed extrusions and lacunas. E and H of the adhesive layer and the resin composite significantly decreased over the 8-year water storage (p < 0.001). CONCLUSIONS: Although 8 years of water storage did not decrease the µTBS of CS3+ significantly, the observed failure mode patterns and significantly decreased nanomechanical properties indicated resin degradation of the adhesive and the resin composite.

Effect of Surface Moisture on Bur-cut Dentin on Bonding of HEMA-free and HEMA-containing Universal Adhesives with or without Methacrylamide Monomer.

PURPOSE: The effect of surface moisture on bur-cut dentin on the microtensile bond strength (µTBS) of universal adhesives with various contents of 2-hydroxyethyl methacrylate (HEMA) and methacrylamide monomers was evaluated. MATERIALS AND METHODS: Flat mid-coronal dentin surfaces of human molars were exposed, and a standardized smear layer was prepared using a fine-grit diamond bur. The surfaces were either left wet or air dried for 10 s before bonding with Clearfil Universal Bond Quick (UBQ), experimental UBQ without an amide monomer (UBQexp), Scotchbond Universal (SBU), Prime&Bond Universal (PBU), or BeautiBond Universal (BBU). The specimens were built up with resin composite, sectioned into sticks and subjected to the µTBS test after 24 h or 10,000 thermal cycles. The µTBS data were analyzed using three-way ANOVA followed by pairwise comparisons with Bonferroni's correction (α = 0.05). RESULTS: The level of dentin moisture did not significantly affect µTBS of UBQ and BBU (p > 0.05). HEMA-containing UBQ, UBQexp, and SBU exhibited higher µTBS to dry dentin, while HEMA-free PBU and BBU showed higher µTBS to wet dentin. Thermocycling significantly decreased the µTBS of UBQexp (p < 0.01) and BBU (p < 0.001) irrespective of dentin moisture level, while SBU was significantly affected only on dry dentin (p < 0.001). Thermocycling had no significant effect on UBQ and PBU containing methacrylamide monomers (p > 0.05). CONCLUSION: Dry surfaces enabled obtaining optimal bonding for HEMA-containing adhesives to bur-cut dentin, while wet surfaces enabled optimal bonding for HEMA-free adhesives. Methacrylamide monomers could contribute to the improvement of the initial and long-term bonding performance of universal adhesives to bur-cut dentin.