Effect of ethylene oxide unit number in bis-EMA on the physical properties of additive-manufactured occlusal splint material.

PURPOSE: To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints. METHODS: Seven experimental materials containing bis-EMAs with three and 10 ethylene oxide units (BE3 and BE10, respectively) were prepared at different BE10 content rates (BE10-0%, -20%, -30%, -40%, -50%, -60%, and -80%). Half the specimens of each material were aged in boiling water. Flexural strength (FS), flexural modulus (FM), fracture toughness (FT), microwear depth (MD), degree of conversion (DC), water sorption (WSP), water solubility (WSL), color difference between non-aged and aged series (ΔE), and translucency (TP) were evaluated. All the evaluated properties other than FS and MD were analyzed by 1-way ANOVA and Tukey's post hoc analysis, while FS and MD were analyzed by Kruskal-Wallis's test and Bonferroni correction (α=0.05). RESULTS: BE10-80% revealed the lowest FS (P < 0.01 for BE10-0%, -20%, and -30%) and FM (P < 0.01, for all), while revealing the highest DC, WSP, WSL (P < 0.01 for all) and TP (P < 0.01 for all other than BE10-60%). BE10-50% showed the highest FT (P < 0.01 for all). BE10-50%, -60%, and -80% revealed significantly lower ΔE than others (P < 0.01) and lower MD than BE10-0% (P < 0.05). Regardless of the BE10 content, FS, FM, and FT decreased with aging. CONCLUSIONS: The number of ethylene oxide units affects the physical properties of additively manufactured occlusal splints. The higher number of ethylene oxide units in bis-EMA enhanced the microwear resistance, DC, WSP, WSL, color stability, and translucency, whereas it deteriorated the FS and FM.

Effect of 3D printing system and post-curing atmosphere on micro- and nano-wear of additive-manufactured occlusal splint materials.

Although additive manufacturing has been widely applied for occlusal splint (OS) fabrication, it is still unclear whether 3D printing system and post-curing atmosphere would play a role in the wear resistance of additive-manufactured OS. Therefore, the aim of this study was to evaluate the effect of 3D printing system (liquid crystal display (LCD) and digital light processing (DLP)) and post-curing atmosphere (air and nitrogen gas (N2)) on the wear resistance of hard and soft OS materials for additive-manufactured OSs (KeySplint® Hard and Soft). The evaluated properties were microwear (by two-body wear test) and nano-wear resistances (by nanoindentation wear test) as well as flexural strength and flexural modulus (by three-point bending test), surface microhardness (by Vickers hardness test), and nanoscale elastic modulus (reduced elastic modulus) and nano surface hardness (by nanoindentation test). For the hard material, the surface microhardness, microwear resistance, reduced elastic modulus, nano surface hardness, and nano-wear resistance were significantly affected by the printing system (p < 0.05), while all the evaluated properties except flexural modulus were significantly affected by the post-curing atmosphere (p < 0.05). Meanwhile, both the printing system and post-curing atmosphere significantly affected all the evaluated properties (p < 0.05). The specimens additive-manufactured by DLP printer tended to show higher wear resistance in the hard material groups and lower wear resistance in the soft material groups when compared to those by LCD printer. The post-curing at N2 atmosphere significantly enhanced the microwear resistance of hard material groups additive-manufactured by the DLP printer (p < 0.05) and soft material groups additive-manufactured by the LCD printer (p < 0.01), while it significantly enhanced the nano-wear resistance of both hard and soft material groups regardless of the printing system (p < 0.01). It can be concluded that 3D printing system and post-curing atmosphere affect the micro- and nano-wear resistance of tested additively manufactured OS materials. In addition, it can be also concluded that the optical printing system providing higher wear resistance depends on the material type, and using nitrogen gas as a protection gas during post-curing enhances the wear resistance of tested materials.

Effect of splinting material type and location on resistance against deflection force of splinted periodontally compromised teeth with hypermobility.

This study aimed to evaluate the effect of splinting material type and material location on the force resistance of splinted periodontally compromised teeth with hypermobility. Extracted teeth including the target tooth (maxillary second premolar) and its adjacent teeth were placed into the alveolar sockets of a dental arch model via artificial periodontal ligaments made of elastic impression material. Three different experimental models with varied target tooth mobility including Periotest® values (PTVs) of 20, 30, and 40 were fabricated (named models #20, #30, and #40, respectively). For each experimental model, the force resistance of tooth splinting was tested using the following four materials: everStick PERIO (glass fiber reinforcement: GFR), FORESTAFLEX (braided stainless steel: BSS), Ortho-FlexTech (stainless steel chain: SSC), and Super-Bond (MMA-based resin cement: MRC). The evaluated measures were the PTV after tooth splinting and the required load to cause tooth displacements of 0.05 mm and 0.10 mm in the vertical and lateral directions, respectively. The splinting material type and material location as well as the original PTV of target the tooth significantly affected all the evaluated measures (p < 0.001). MRC revealed the significantly highest force resistance of tooth splinting regardless of material location in each experimental model and was followed by GFR. The PTVs of splinted teeth were comparable to those of adjacent anchor teeth in models #20 and #30 when using GFR, while that was comparable in model #40 when using MRC. Meanwhile, the load causing certain tooth displacement showed a similar tendency to previous-reported data with healthy teeth in model #20 when using GFR, while that showed a similar tendency in models #30 and #40 when using MRC. Overall results concluded that splinting material type and location play a role in the resistance against the deflection force of splinted periodontally compromised hypermobile tooth. It was noted that MRC provided the highest resistance against the deflection force of splinted teeth regardless of material location whereas GFR maintained the physiologically considered tooth mobility.

Effect of Surface Polishing on Physical Properties of an Occlusal Splint Material for Additive Manufacturing under Protection Gas Post-Curing Condition.

The aim of this study was to evaluate the effect of surface polishing as well as the post-curing atmospheres (air and nitrogen gas) on the physical properties of an occlusal splint material for additive manufacturing. Flexural strength, flexural modulus, Vickers hardness number (VHN), degree of carbon double bond conversion (DC), water sorption (WSP), and water solubility (WSL) were evaluated. Surface polishing significantly affected the evaluated properties. Regardless of the post-curing atmosphere, flexural strength, flexural modulus, VHN, and DC showed significantly higher values for the polished specimens when compared with the unpolished ones, while WSP and WSL were significantly lower for the polished specimens. Unpolished specimens post-cured at nitrogen gas showed significantly higher VHN and DC values. However, the effect of the post-curing at a nitrogen gas atmosphere was non-significant in polished specimens. The current results suggested that surface polishing plays a role in the physical properties of the evaluated occlusal splint material and can enhance all the evaluated properties regardless of the post-curing atmosphere. Meanwhile, the post-curing at a nitrogen gas atmosphere can enhance the VHN and DC but its effect is confined only to the surface layers, which can be removed during surface polishing.

Three-dimensional microscopic comparison of wear behavior between immature and mature enamel: an in vitro study.

BACKGROUND: Dental enamel, the hardest outermost layer of a human tooth, is subjected to occlusal forces throughout life during different oral function as talking, mastication etc. Due to this continuous stress, wear causes the loss of this protective shell. This study aimed to detect microscopic differences in enamel's wear behavior among different age groups of adolescents and adults. AIMS AND METHODS: Enamel specimens from immature open-apex and mature closed-apex premolars were subjected to simulated occlusal wear of impact and sliding wear test ISWT. Upper and lower enamel specimens were made to come in contact under controlled conditions. The enamel specimens' surfaces were examined using different microscopes. The upper and lower specimens were subjected to the following tests; pre-test light microscopy examination, enamel specimens' preparation for ISWT, scanning laser confocal microscopy of upper specimens, three-dimensional (3D) colored laser microscope and a Profilometer imaging of the lower specimens. RESULTS: Wear characteristics, including wear areas, crater depths, and relation to enamel microstructures, differed among different age groups. Immature enamel from the upper specimens was more resistant to chipping than mature enamel with no statistically significant wear area difference. The immature enamel craters from the lower specimens were wider and deeper than those in the mature enamel; the wear areas in the mature enamel in the lower specimens were almost flat and smooth. The wear areas in the immature enamel in the lower specimens were significantly larger than those in the mature enamel. CONCLUSIONS: Wear characteristics of the immature enamel are different from those of the mature enamel. Hence, it should be repaired using restorative materials with compatible wear properties.

Wear behavior of materials for additive manufacturing after simulated occlusion of deciduous dentition.

OBJECTIVES: To evaluate wear characteristics of materials for additive manufacturing (AM) after a simulated occlusal test in primary teeth. Wear was simulated by means of impacting - sliding wear testing (ISWT) between specimens prepared from materials for AM against enamel derived from deciduous teeth. METHODS: The prepared hemispherical upper specimens were subjected to impacting-sliding wear test (ISWT) machine against the flattened enamel of deciduous molars on lower specimens. The samples were subjected to 20,000 load cycles using a contact force of 30 N between the opposing surfaces under controlled conditions. In the upper specimens, five groups (n=9): four types of additively manufactured materials Dima, Zenith, Detax, Veltz and a deciduous enamel groups were tested in this study. The enamel-to-enamel group was used as the control. Wear characteristics comprised wear surface area, wear depth, wear volumetric loss, and surface roughness were measured with a confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Data obtained were statistically analyzed by Kruskal-Wallis test and Dunn's test with Bonferroni correction (p < 0.05). RESULTS: Dima showed significantly higher worn surface area (p = 0.009, 0.001, and < 0.001 for Zenith, Detax, and control enamel, respectively), volumetric loss (p = 0.027, 0.007, and < 0.001 for Zenith, Detax, and control enamel, respectively), and damaged opposing enamel (p = 0.002, 0.001, and 0.01 for Detax, Veltz, and control enamel, respectively). There was no significant difference among the volumetric loss in Zenith and Detax. However, SEM revealed that Zenith showed rough worn surfaces and chipping, Detax showed rather a smooth circular worn surface. The worn area of Veltz was smaller than Detax and Zenith at 5,000 cycles, but higher at 15,000 and 20,000 cycles, and SEM showed detachment. CONCLUSION: Wear behavior was different among different materials for AM. In the upper specimens, DM and VZ showed large wear. In the lower specimens, DM caused largest enamel wear and damage. In contrast, ZT and DX showed lower wear and caused less damage to the antagonistic primary enamel. SEM image of ZT showed large losses due to chipping, whereas DX showed the rather smooth. DX was confirmed to have lowest wear and caused least damage to the opposing deciduous enamel, which might be applicable as restorative treatments in deciduous dentition. SIGNIFICANCE: Additive manufactured dental materials could be considered as a treatment modality in deciduous teeth.

Effect of 3D Printer Type and Use of Protection Gas during Post-Curing on Some Physical Properties of Soft Occlusal Splint Material.

Despite the fact that three-dimensional (3D) printing is frequently used in the manufacturing of occlusal splints, the effects of the 3D printer type and post-curing methods are still unclear. The aim of this study was to investigate the effect of the printer type (digital light processing: DLP; and liquid crystal display: LCD) as well as the post-curing method with two different atmospheric conditions (air and nitrogen gas (N2)) on the mechanical and surface properties of 3D-printed soft-type occlusal splint material. The evaluated properties were flexural strength, flexural modulus, Vickers hardness (VHN), fracture toughness, degree of double bond conversion (DC%), water sorption, water solubility, and 3D microlayer structure. The printer type significantly affected all the evaluated properties. Flexural strength, flexural modulus, and fracture toughness were significantly higher when specimens were printed by a DLP printer, while VHN and DC% were significantly higher, and a smoother surface was noticeably obtained when printed by an LCD printer. The post-curing at an N2 atmosphere significantly enhanced all of the evaluated properties except water sorption, 3D microlayer structure, and fracture toughness. The current results suggested that the printer type and the post-curing methods would have an impact on the mechanical and surface properties of the evaluated material.

Effect of Nitrogen Gas Post-Curing and Printer Type on the Mechanical Properties of 3D-Printed Hard Occlusal Splint Material.

Although three-dimensional (3D) printing is clinically convenient to fabricate occlusal splints, it is still unclear how the post-curing method and the printer type can affect 3D-printed splints. This study aimed to evaluate the effect of stroboscopic post-curing at a nitrogen gas (N2) atmosphere versus post-curing in an air atmosphere, as well as the printer type (liquid crystal display (LCD) and digital light processing (DLP)) on the mechanical properties of a 3D-printed hard-type occlusal splint material. Flexural strength, flexural modulus, Vickers hardness number (VHN), fracture toughness, degree of double bond conversion (DC), 3D microlayer structure, water sorption, and water solubility were evaluated. The post-curing method significantly affected all evaluated properties except fracture toughness and 3D microlayer structure, while the printer type significantly affected all evaluated properties except flexural strength and flexural modulus. VHN and DC were significantly higher, and the smoother surface was noticeably obtained when printed by LCD printer and post-cured at an N2 atmosphere. The current results suggested that the post-curing method and the printer type would play a role in the mechanical properties of the evaluated material and that the combination of post-curing at an N2 atmosphere and LCD printer could enhance its mechanical properties and surface smoothness.

Replica-based inspection of enamel wear microfeatures.

BACKGROUND: Surface replication is a nondestructive evaluation technique applied in examining surface wear by recording surface irregularities, especially in conditions when surfaces of interest cannot be further manipulated to fit directly under a microscope to be examined. Enamel is the outermost protective layer of the human teeth and is constantly stressed by mastication forces which results in enamel wear. OBJECTIVE: To date, a procedure combining the clinical and microscopic examination of enamel surfaces is absent, which hinders the early diagnosis and comprehension of the wear process. METHODS: This study investigated the role of replication sheets in registering microscopic wear on human enamel surfaces by both negative and positive replication techniques. RESULTS: The sheets replicated wear features successfully. Sheets were compatible to use with multiple microscopes, with proper preparation, including high resolution microscopes such as the scanning electron microscope and transmitting electron microscope.

The application of cellulose acetate replication sheets in enamel wear investigations.

Surface replication is a nondestructive evaluation technique applied in examining surfaces' cracks/wear. This is quite valuable when the surface of interest cannot be further manipulated by cutting or polishing to fit directly under a microscope. Replication by acetate sheets is one of the techniques applied in industrial, metallographic and anthropological wear/examination. Enamel is the outermost protective layer of human teeth and is subjected to mechanical stresses due to the masticatory function; thus, wear is inevitable in human teeth. This relatively inert hard tissue has been reported to possess some properties of both metals and glasses due to its unique delicate microstructure. This study investigated the applicability of replication sheets in registering wear induced features on human enamel surfaces. The sheets replicated wear features successfully with compatibility to use with multiple microscopes. Acetate sheets have a potential in enamel wear replication.

Enamel Microcracks Induced by Simulated Occlusal Wear in Mature, Immature, and Deciduous Teeth.

Enamel wear, which is inevitable due to the process of mastication, is a process in which the microcracking of enamel occurs due to the surface contacting very small hard particles. When these particles slide on enamel, a combined process of microcutting and microcracking in the surface and subsurface of the enamel takes place. The aim of this study was to detect microscopic differences in the microcrack behavior by subjecting enamel specimens derived from different age groups (immature open-apex premolars, mature closed-apex premolars, and deciduous molars) to cycles of simulated impact and sliding wear testing under controlled conditions. Our findings indicated that the characteristics of the microcracks, including the length, depth, count, orientation, and relation to microstructures differed among the study groups. The differences between the surface and subsurface microcrack characteristics were most notable in the enamel of deciduous molars followed by immature premolars and mature premolars whereby deciduous enamel suffered numerous, extensive, and branched microcracks. Within the limitations of this study, it was concluded that enamel surface and subsurface microcracks characteristics are dependent on the posteruptive age with deciduous enamel being the least resistant to wear based on the microcrack behavior as compared to permanent enamel.

Management of developmental enamel defects in the primary dentition.

This study attempted to identify appropriate materials for restoration of enamel defects in the primary dentition, which were classified by severity and region with the modified developmental defects of enamel index. To identify the most appropriate materials, we used restorative materials to protect teeth and evaluated clinical outcomes of restoration. Three materials were used for restoration or repair after dislodgement of restorations. Our findings in this case suggest that, because of its durability and esthetic advantages, adhesive resin is beneficial for patients with enamel defects, particularly for restorations of less than two-thirds of the extent of the defect.

Wear characteristics of trimethylolpropane trimethacrylate filler-containing resins for the full crown restoration of primary molars.

Although the demand for aesthetic restoration of primary molars has increased, the full-crown restorations using resin and the details of the wear characteristics of trimethylolpropane trimethacrylate (TMPT) filler containing resins for primary molars are not well understood. This study was conducted to determine whether new light-cured composite resin (Fantasista) and 4-META/MMATBB resin (Bondfill SB) are appropriate for full crown restoration of primary molars by evaluating their wear characteristics. Both resins products contain TMPT filler. The properties of the resins were evaluated through in vitro impacting-sliding wear tests; the wear properties of the opposing enamel specimens used in the tests were also studied. The properties of the resins were compared with those of Litefill, MetafilC, and Clearfil FII, which had been evaluated previously. Fantasista exhibited simple shape of wear that was suggestive of a higher wear resistance than that of Litefill. Fantasista caused the least damage to the antagonistic primary enamel.

Wear of resin composites and primary enamel and their applicability to full crown restoration of primary molars.

PURPOSE: To determine whether resin composites are appropriate for full crown restoration of primary molars by evaluating their wear characteristics. Specifically, the wear properties of resin composite specimens and the opposing enamel surfaces were characterized by means of impacting-sliding wear testing. METHODS: Three types of light-cured resin composites (Estelite Sigma quick, Litefill IIP, and Metafil C), one type of chemical-cured resin composite (Clearfil FII), and a hybrid composite (Estenia C&B) were tested in this study. The enamel sample was used as the control. The hemispherically prepared specimens were subjected to impacting-sliding wear testing against the flattened enamel of primary molars. The worn surfaces were examined by laser scanning microscopy and scanning electron microscopy. The volumetric loss was estimated by using micro-CT images. The areas of worn enamel surfaces were measured by 3D color laser microscopy. On most of the worn enamel surfaces, cracks appeared. Scatter plot analyses between their width and depth were carried out. Data for each specimen were statistically analyzed by multiple comparisons among the means of treatment by Bonferroni's method (P< 0.01). RESULTS: Clearfil showed significantly higher surface area wear, volumetric loss, and worn enamel surface area than did the other resin composites and the control enamel (P< 0.01). There was no significant difference among the worn surface areas ofEstelite, Litefill, Metafil, and Estenia (P< 0.01). The control enamel showed significantly lower worn surface area than did the resin composites (P< 0.01). There was no significant difference in volumetric loss and worn enamel surface areas among Estelite, Litefill, Metafil, Estenia, and the control enamel (P< 0.01). Cracks larger than that on the control enamel were seen on the worn enamel surface opposing Estenia.