Advantages and drawbacks of different methods to measure marginal gaps in fixed dental prostheses: A scoping review.

OBJECTIVES: This review aimed to compare traditional and digital methods to assess marginal gaps in fixed dental prostheses. Each method's characteristics, advantages, and limitations were identified and discussed, also addressing the knowledge gaps in the current scientific literature. DATA: Studies comparing currently available techniques for marginal gap examination were investigated. The main techniques analyzed were the Cross-Sectional Method (CSM), Direct View (DV), Silicone Replica Technique (SRT), Dual-Scan Method (DSM), Triple-Scan Method (TSM), Optical Coherence Tomography (OCT), and Micro-Computed Tomography (MCT). SOURCES: Two experienced independent reviewers screened online databases (MEDLINE via PubMed and Scopus) to identify studies published in English up to March 2024. References from primary studies and the main peer-reviewed scientific journals were manually searched. STUDY SELECTION: From an initial pool of 8126 articles, the reviewers meticulously selected 25 in vitro studies on objective comparisons between two or more methods for assessing marginal gaps in fixed dental prostheses on natural teeth. Publications that assessed marginal gaps in implant-supported fixed dental prostheses were excluded. CONCLUSIONS: This study highlights that while traditional methods like CSM and SRT are widely used and validated, they have limitations in comprehensive gap assessment, often neglecting recommended measurement points. The DV technique, focusing solely on external gaps, may be less relevant for modern assessments. Conversely, three-dimensional techniques like TSM, DSM, OCT, and MCT offer a more thorough evaluation of dental restoration fit. Moreover, digital methods such as TSM and DSM have a significant potential for future clinical application. CLINICAL SIGNIFICANCE: This review examined methods for evaluating marginal gaps in fixed dental prostheses. The review aids dental professionals and researchers in choosing the most suitable technique for clinical in vivo or laboratory assessment of the marginal adaptation of dental restorations. This study also indicates the need for an established and standardized assessment protocol for the marginal fit.

Multifactorial Contributors to the Longevity of Dental Restorations: An Integrated Review of Related Factors.

PURPOSE: This integrated review aims to identify and analyze the multifactorial contributors to the longevity of direct restorations, focusing on tooth-, patient-, and dentist-related factors. MATERIALS AND METHODS: A search of the literature was performed using an electronic database, PubMed/Medline, Web of Science, and Scopus, on papers published between 1980 and 2024. The titles and abstracts of papers that evaluated aspects categorized into tooth-related, patient-related, and dentist-related factors influencing restoration failure were selected and screened. Full-text assessments were conducted, and the extracted data were compiled, summarized, and synthesized. The reference lists of the collected papers were also screened, and relevant citations were included in this review. Data were gathered from clinical and laboratorial studies, systematic reviews, and meta-analyses to provide a comprehensive understanding of restoration longevity. RESULTS: Among the tooth-related factors, multiple-surface restorations, deep margins, tooth location, and tooth vitality significantly impact restoration survival. Patient-related factors such as medical conditions, risk predictors of caries, age, sex, parafunctional habits, smoking, periodontal health, number of restorations, and socioeconomic status all play crucial roles. Regarding dentist-related factors, the decision-making process, age, experience, and dentist manual dexterity are vital aspects. Furthermore, the technique used, including isolation methods for moisture control, as well as the type of dental practice (large group vs. small practice), notably influenced the restoration survival. CONCLUSIONS: The longevity of dental restorations is influenced by a complex interplay of tooth-related, patient-related, and dentist-related factors. Strategies to improve restoration outcomes should consider all these multifactorial contributors. Continuing professional education, diligent patient guidance on the factors that influence restoration survival, careful material selection and restorative technique, and tailored individual treatment are crucial factors to reduce failure rates and improve the lifespan of restorations.

Influence of impression method and shoulder design on the marginal adaptation of CAD/CAM nanoceramic resin onlay restorations.

Objective: This in-vitro study investigates the influence of two different impression techniques and two shoulder designs on the marginal adaptation of computer-aided design/computer-aided manufacturing restorations. Methods: Forty mandibular first premolars were cast into dental arch models for this in vitro study. Fragile cusps and concavities on the mesial-buccal-occlusal surfaces were treated, with 2 mm of the occlusal surface removed. Teeth were categorised into two groups based on shoulder preparation. Digital scanning using a 3Shape 3D scanner identified them further for allocation into conventional and digital impression subgroups. The restorations were created from nanoceramic resin blocks using prescribed guidelines. Microscopic evaluation assessed the restoration's marginal adaptation, with data analysed using SPSS 27.0. The level of significance was set at p ≤ 0.05. Results: Digital intraoral scanning consistently demonstrated smaller marginal gaps than the traditional impression method, regardless of shoulder preparation, with the differences being statistically significant (p < 0.05). Furthermore, shoulder preparation significantly reduced the marginal gaps in both the digital and traditional impression groups (p < 0.05). Conclusions: The onlay preparation design with a shoulder led to restorations with improved marginal adaptation compared with the design with no shoulder. Direct digital impression techniques produced restorations within a better marginal discrepancy than traditional impressions.

Zirconia toughened fluorosilicate glass-ceramics for dental prosthetic restorations.

Background: Dental glass-ceramics have limited strength and are unsuitable for high-stress-bearing areas. Zirconia stands out as a popular choice for reinforcing dental glass-ceramics due to its biocompatibility and high fracture toughness. Objectives: The objective of the study is to investigate the effect of an increase in zirconia (25, 30, 35 and 50 wt%) on microstructure, chemical solubility, hardness, fracture toughness, and brittleness index of fluorosilicate glass systems for dental restorative applications. Material and methods: The fluorosilicate glass frit was obtained through the melt-quench technique. The glass frit was ball-milled with 25, 30, 35 and 50 wt % of 3 mol% yttria-stabilized zirconia (G-25Z, G-30Z, G-35Z, and G-50Z). The composites were sintered to 1000 °C for 48h at a heating rate of 5 °C/min. The glass frit was subject to differential scanning calorimetry. Phase analysis and microstructural characterization were carried out. The crystallite size of zirconia and glass-ceramics, micro-hardness, indentation fracture toughness, brittleness index, and chemical solubility were evaluated. Results: Phase analysis reveals tetragonal and monoclinic zirconia with minor peaks of forsterite, fluorphlogopite, norbergite, and spinel. Their microstructures reveal the characteristic house-of-cards arrangement of fluorophlogopite crystals with dispersed zirconia. The results of hardness and fracture toughness show a statistically significant improvement with an increase in zirconia content. The crystallite size of zirconia and fluorophlogopite crystals with aspect ratio, brittleness index, and chemical solubility declined as the zirconia content increased. Conclusions: Increase in zirconia content from 25 wt % to 50 wt % in heat-treated fluorosilicate glass systems reveals non-reactive zirconia with a stable glass matrix and limits the growth of fluorphlogopite crystals with a house-of-cards microstructure. This results in a range of properties suitable for dental restorations of enhanced hardness, and improved fracture toughness. Despite these improvements, the material maintains its machinability with reduced chemical solubility.

Mini-review: Pathways of postural disturbances tracing to the stomatognathic system.

Postural alignment is strongly shaped by inborn anatomical and nonvolitional neural factors, whereas postural stability is dynamic in nature and driven by both automatic and volitional sensorimotor processes. The sensory and motor systems responsible for these functions are tightly integrated with the central nervous system, several vital structures of which are in close proximity to the stomatognathic system. Interventions in the oral cavity have therefore been stipulated to provide sensory feedback, which may then be translated into motor function. Since the early 90 s, numerous intervention studies have provided evidence of this correlation, with traditional views advocating that causative factors are mainly indirect. Dynamic postural responses were thus predominantly considered manifestations of head displacement, with most studies identifying potential connections along active and passive muscular interactions. The consideration however, that neuromuscular adaptations of whole-body dynamics might extend beyond biomechanical responses and involve direct pathways as well, has led to a recent paradigm shift, challenging conventional perspectives. Among the suggested pathways are central projections of trigeminal afferents, providing inputs for the oculomotor system, as well as active and passive muscular interactions. Further intervention studies indicate a sensory integration of the stomatognathic system to proprioception, likely through neural networks that work in concert with visual cues and the vestibular organs. Building on this accumulating pool of evidence, a timely perspective is provided on a critical yet underexplored aspect of neurophysiology: the intricate interplay between the cranio-cervico-mandibular system and the broader framework of body posture.

Comparative Evaluation of Mechanical Properties and Color Stability of Dental Resin Composites for Chairside Provisional Restorations.

Resin composites have become the preferred choice for chairside provisional dental restorations. However, these materials may undergo discoloration, changes in surface roughness, and mechanical properties with aging in the oral cavity, compromising the aesthetics, functionality, and success of dental restorations. To investigate the color and mechanical stability of chairside provisional composite resins, this study evaluated the optical, surface, and mechanical properties of four temporary restoration resin materials before and after aging, stimulated by thermal cycling in double-distilled water. Measurements, including CIE LAB color analysis, three-point bending test, nanoindentation, scanning electron microscopy (SEM), and atomic force microscopy (AFM), were conducted (n = 15). Results showed significant differences among the materials in terms of optical, surface, and mechanical properties. Revotek LC (urethane dimethacrylate) demonstrated excellent color stability (ΔE00 = 0.53-Black/0.32-White), while Artificial Teeth Resin (polymethyl methacrylate) exhibited increased mechanical strength with aging (p < 0.05, FS = 68.40 MPa-non aging/87.21 MPa-aging). Structur 2 SC (Bis-acrylic) and Luxatemp automix plus (methyl methacrylate bis-acrylate) demonstrated moderate stability in optical and mechanical properties (Structur 2 SC: ΔE00 = 1.97-Black/1.38-White FS = 63.20 MPa-non aging/50.07 MPa-aging) (Luxatemp automix plus: ΔE00 = 2.49-Black/1.77-White FS = 87.72 MPa-non aging/83.93 MPa-aging). These results provide important practical guidance for clinical practitioners, as well as significant theoretical and experimental bases for the selection of restorative composite resins.

Fracture resistance of CAD/CAM milled versus direct hand-made interim laminate veneers.

Background: Comparative studies of interim veneer restorations crafted using subtractive computer-aided manufacturing (s-CAM) milling technology and traditional direct hand-made approaches are needed. Purpose: This comparative in vitro study evaluated the fracture resistance of two types of provisional veneer restorations for maxillary central incisors: milled (s-CAM) and traditional direct hand-made bis-acryl veneers. Materials and methods: Fifty maxillary right central incisor veneers (25 specimens per group) were fabricated and divided according to the fabrication method: (1) s-CAM milled (Structure CAD, VOCO Dental); and (2) hand-made (Protemp Plus, 3M). The restorations were cemented onto 3D-printed resin dies using temporary cement and subjected to 1000 cycles of thermal cycling between 5° and 55 °C. These restorations subsequently were subjected to compressive loading until fracture occurred. Images of the fractured samples were captured using a scanning electron microscope (SEM). Statistical analysis was performed using the one-way ANOVA test and the Mann-Whitney U test. Results: Significant differences (p < 0.001) in the fracture resistance were observed between the two groups. s-CAM milled interim veneers displayed higher fracture resistance values (439.60 ± 26 N) compared to the traditional method (149.15 ± 10 N). Conclusion: The manufacturing method significantly influences the fracture resistance of interim veneer restorations. s-CAM interim laminate veneer restorations for maxillary central incisors exhibit a fracture resistance superior to that of the traditional method using bis-acryl.Clinical relevanceClinicians should consider CAD/CAM milled veneers for scenarios demanding long-term interim restoration and the withstanding of high occlusal forces.

Mechanistic study of the stabilization of dentin-bonded restorative interfaces via collagen reinforcement by multi-acrylamides.

Hydrolytically and enzymatically-stable multi-acrylamides have been proposed to increase the long-term durability of dental adhesive interfaces as alternatives to methacrylates. The aim of this study was to investigate the mechanical and biochemical properties of experimental adhesives containing multi-functional acrylamides concerning collagen reinforcement and metalloproteinases (MMP) activity. Multi-functional acrylamides, TMAAEA (Tris[(2-methylaminoacryl) ethylamine) and DEBAAP (N,N-Diethyl-1,3-bis(acrylamido) propane), along with the commercially available DMAM (N,N-dimethylacrylamide) (monofunctional acrylamide) and HEMA (2-Hydroxyethyl methacrylate) (monofunctional methacrylate - control) were tested for stability against enzymatic hydrolysis by cholesterol esterase/pseudocholinesterase (PC/PCE) solutions for up to 30 days. Collagen-derived substrate and gelatin zymography were performed to examine the effect of the compounds on the biological activity of human recombinant and dentin-extracted gelatinases MMP-2 and MMP-9. In situ zymography was carried out by fluorescent collagen degradation combined with confocal microscopy analysis. Hydroxyproline content was measured in collagen derived from dentin extracts though reaction with Ehrlich's reagent p-dimethylaminobenzaldehyde (DMAB), generating a stable chromophore measured at 550 nm. Storage shear modulus of demineralized dentin discs treated with the tested compounds was measured by oscillatory rheometry, in order to investigate potential collagen reinforcement. FT-IR was performed to determine qualitative differences in collagen based on observed changes in amide bands. The results were analyzed by ANOVA/Tukey's test (α = 0.05). Multi-acrylamides survived 30 days of incubation in cholinesterase/pseudo-cholinesterase (PC/PCE) solutions, while HEMA showed approximately 70 % overall degradation. Incubation with multi-acrylamides reduced collagen degradation as evidenced by the reduced hydroxyproline levels and by the 30 % increase inshear storage modulus. Biochemical and zymography assays showed no noticeable inhibition of recombinant and extracted MMPs enzymatic activity. The infra-red spectroscopy results for multi-functional acrylamides treated samples demonstrated shifts of the amide II bonds and marked increase in intensity of the bands 1200 cm-1, which may indicate partial collagen denaturation and some degree of cross-linking of the compounds with collagen, respectively. The multi-acrylamides exhibited not only comparable mechanical properties but also demonstrated significantly enhanced biochemical stability when compared to the widely used methacrylate control. Clinical relevance: These findings highlight the potential of multi-acrylamides to increase the bonding stability to tissues and, ultimately, contribute to the longevity of dental restorations.

Cytotoxicity effects and differentiation potential of ormocer-based and nanohybrid composite resins on human dental pulp stem cells.

OBJECTIVE: to compare conventional nanohybrid (Ceram.x Spectra) and ormocer-based (Admira fusion) dental composite resins effects on human dental pulp stem cells (hDPSCs) in terms of cytotoxicity, self-renewal, migration and osteogenic differentiation. METHODS: hDPSCs were cultured in presence of different dilutions (undiluted, form 1:2 to 1:100) of CeramX (CX) and Admira fusion (AD) eluates and viability assay in standard or osteogenic conditions were performed. Samples and eluates were prepared according to ISO 10993-12. In addition, apoptosis, self-renewal and migration activity evaluations were carried out. Osteogenic differentiation potential was tested by Alkaline Phosphatase Activity, alizarin red staining and gene expression of specific markers (ALP, RUNX2, OCN, OPN and COL1α1). Statistical analysis was performed by means of a One-way analysis of variance (One-way ANOVA) followed by a Tukey's test for multiple comparison; results were presented as mean ± standard error of mean (SEM). RESULTS: Admira Fusion demonstrated to be highly biocompatible and showed positive effects on hDPSCs proliferation and differentiation; on the contrary, conventional nanohybrid composite showed to be more cytotoxic and without any notable effect on stem cells differentiation. Moreover, the obtained results were further corroborated by a significant upregulation of osteogenic differentiation markers obtained in presence of ormocer-based composite resin eluate. Specifically, in AD 1:50 group expression levels of ALP, Runx2, Col1α1 were double than control (ALP, p = 0.045; Runx2, p = 0.003; Col1α1, p = 0.001) and CX 1:50 (ALP, p = 0.006; RUNX2, p = 0.029; Col1α1, p = 0.005). Moreover, in the same group, OPN and OCN resulted about 5 times more expressed as compared to control (OPN, p = 0.009; OCN, p = 0.0005) and CX 1:50 (OPN, p = 0.012; OCN, p = 0.0006). SIGNIFICANCE: The less cytotoxicity obtained by AD than conventional nanohybrid composite may be attributed to a reduced monomers release in the oral environment, supporting the hypothesis of limited adverse effect and enhanced healing potential, mainly when the material is positioned in close contact with pulp tissue.

Post-failure analysis of model resin-composite restorations subjected to different chemomechanical challenges.

OBJECTIVE: The current study aimed to evaluate the effects of different combinations of chemical and mechanical challenges on the failure load, failure mode and composition of the resulting fracture surfaces of resin-composite restorations. METHODS: Three resin composites were used to fill dentin disks (2 mm inner diameter, 5 mm outer diameter, and 2 mm thick) made from bovine incisor roots. The model restorations, half of which were preconditioned with a low-pH buffer (48 h under pH 4.5), were subjected to diametral compression with either a monotonically increasing load (fast fracture) or a cyclic load with a continuously increasing amplitude (accelerated fatigue). The load or number of cycles to failure was noted. SEM was performed on the fracture surfaces to determine the proportions of dentin, adhesive, and resin composite. RESULTS: Both cyclic fatigue and acid preconditioning significantly reduced the failure load and increased the proportion of interfacial failure in almost all the cases, with cyclic fatigue having a more pronounced effect. Cyclic fatigue also increased the amount of adhesive/hybrid layer present on the fracture surfaces, but the effect of acid preconditioning on the composition of the fracture surfaces varied among the resin composites. SIGNIFICANCE: The adhesive or hybrid layer was found to be the least resistant against the chemomechanical challenges among the components forming the model restoration. Increasing such resistance of the tooth-restoration interface, or its ability to combat the bacterial actions that lead to secondary caries following interfacial debonding, can enhance the longevity of resin-composite restorations.

In Vitro Analysis of Outcome Differences Between Repairing and Replacing Broken Dental Restorations.

Objective In light of several advancements and considerations in endodontic dentistry, there still remains a need to comprehensively evaluate the outcome disparities between repairing and replacing broken dental restorations. This study aims to compare the effectiveness of repairing dental restorations versus replacing them, focusing on how each method affects the structural strength and longevity of the restorations. Methods The study included 60 freshly removed human maxillary premolars. Initial processing involved rigorous washing, descaling, and polishing of the teeth. To ensure preservation, the specimens were stored in sterile, distilled water. To occlude the root canals, a self-hardening composite resin was used, and the roots were coated with two coats of clear nail polish to prevent moisture penetration. A 245 carbide bur attached to a high-speed dental handpiece with air and water spray cooling produced standardized Class II cavities on the occluso-proximal surfaces. Each cavity had a buccolingual breadth of 2 mm, an occluso-cervical length of 4 mm, and a gingival boundary that was 1 mm coronal to the cement-enamel junction. Following this preparation, the teeth were randomly separated into three groups (Group A, Group B, and Group C), each containing 20 teeth. Results Our analysis showed that teeth with entirely replaced restorations had a higher average fracture resistance than those with repaired restorations. However, the difference in fracture resistance between the repair and replacement groups for each type of material was not statistically significant. Conclusion Based on the findings, repairing a dental restoration can be a conservative and less invasive alternative to a full replacement without a significant compromise in the restoration's ability to withstand fracture. Therefore, dental professionals might consider full restoration as a viable option, taking into account the need to preserve dental tissue as well as the restoration's durability and structural integrity.

Evaluating the Effect of NanoFilled Composite Restorations on the Wear Resistance of Posterior Teeth: An RCT.

Background: Dental restorations play a crucial role in preserving the structural integrity and function of posterior teeth. However, wear resistance remains a significant concern for these restorations. Materials and Methods: In this RCT, 120 participants with posterior tooth restoration needs were randomly assigned to two groups. Group A received conventional composite restorations, while Group B received NanoFilled Composite restorations. The restorations were placed according to standardized protocols. Wear resistance was assessed using a custom-designed chewing simulator, and the material wear was quantified using a profilometer. Patient-reported outcomes and clinical evaluations were also recorded at regular intervals over a 24-month follow-up period. Results: The wear resistance of the NanoFilled Composite restorations (Group B) was significantly higher than that of the conventional composite restorations (Group A) after 24 months of follow-up (P < 0.05). Profilometer measurements revealed that Group B had an average wear depth of 0.15 mm, while Group A had an average wear depth of 0.25 mm. Patient-reported outcomes indicated higher satisfaction and comfort in Group B. Clinical evaluations also demonstrated that Group B restorations had better retention and marginal integrity. Conclusion: This RCT demonstrates that NanoFilled Composite restorations exhibit superior wear resistance compared to conventional composite restorations when used in posterior teeth.

A Comprehensive Narrative Review of Nanomaterial Applications in Restorative Dentistry: Demineralization Inhibition and Remineralization Applications (Part I).

Nanotechnology is extensively employed in various aspects of dentistry, including restorative dentistry, because of its substantial improvement and promising potential in the clinical efficacy of restorative materials and procedures. The main purpose of this review is to explore the different uses of nanomaterials in restorative dentistry. The review is divided into two parts: the current review (Part 1) focuses on the prevention of demineralization and promotion of remineralization, while the upcoming review (Part 2) will discuss the reinforcement of restorative materials and their therapeutic applications. Nanofillers are added to dental materials to boost their antibacterial, anticaries, and demineralization inhibitory capabilities. Additionally, they improve remineralization and enhance both mechanical properties and therapeutic features. The nanoparticles (NPs) used to increase antibacterial and remineralization inhibitions can be classified into two main groups: inorganic and organic NPs. Examples of inorganic NPs include silver, zinc oxide, titanium oxide, and gold. Examples of organic NPs include silica, quaternary ammonium salt monomers, and chitosan NPs. Furthermore, the nanofillers utilized to enhance the process of remineralization include various types such as metals, nano-hydroxyapatite, nano-amorphous calcium phosphate (ACP), dicalcium phosphate NPs, casein phosphopeptide-ACP (CPP-ACP), and calcium fluoride NPs. These uses underscore the potential applications of NPs in restorative dentistry, although there are still some limitations to address.

The flexural strength of 3D-printed provisional restorations fabricated with different resins: a systematic review and meta-analysis.

BACKGROUND: Three-dimensional (3D) printing technology has revolutionized dentistry, particularly in fabricating provisional restorations. This systematic review and meta-analysis aimed to thoroughly evaluate the flexural strength of provisional restorations produced using 3D printing while considering the impact of different resin materials. METHODS: A systematic search was conducted across major databases (ScienceDirect, PubMed, Web of Sciences, Google Scholar, and Scopus) to identify relevant studies published to date. The inclusion criteria included studies evaluating the flexural strength of 3D-printed provisional restorations using different resins. Data extraction and quality assessment were performed using the CONSORT scale, and a meta-analysis was conducted using RevMan 5.4 to pool results. RESULTS: Of the 1914 initially identified research articles, only 13, published between January 2016 and November 2023, were included after screening. Notably, Digital Light Processing (DLP) has emerged as the predominant 3D printing technique, while stereolithography (SLA), Fused Deposition Modeling (FDM), and mono-liquid crystal displays (LCD) have also been recognized. Various printed resins have been utilized in different techniques, including acrylic, composite resins, and methacrylate oligomer-based materials. Regarding flexural strength, polymerization played a pivotal role for resins used in 3D or conventional/milled resins, revealing significant variations in the study. For instance, SLA-3D and DLP Acrylate photopolymers displayed distinct strengths, along with DLP bisacrylic, milled PMMA, and conventional PMMA. The subsequent meta-analysis indicated a significant difference in flexure strength, with a pooled Mean Difference (MD) of - 1.25 (95% CI - 16.98 - 14.47; P < 0.00001) and a high I2 value of 99%, highlighting substantial heterogeneity among the studies. CONCLUSIONS: This study provides a comprehensive overview of the flexural strength of 3D-printed provisional restorations fabricated using different resins. However, further research is recommended to explore additional factors influencing flexural strength and refine the recommendations for enhancing the performance of 3D-printed provisional restorations in clinical applications.

Delayed vs. immediate placement of restorative materials over Biodentine and RetroMTA: a micro-shear bond strength study.

BACKGROUND: The aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS. METHODS: A total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05). RESULTS: There is a statistically significant difference (p < 0.05) between the µSBS values obtained by applying resin composite on RetroMTA after different setting times (24 h > 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p < 0.05) than the µSBS values at 12 min and 24 h. For both calcium silicate cements, at the end of all time periods, the µSBS obtained when resin composite was applied at the end was higher than the other materials (p < 0.05). CONCLUSIONS: For Biodentine-resin composite bonding, the manufacturer's recommendation of 12 min can be considered an appropriate time, whereas for RetroMTA-resin composite bonding, the µSBS increased as the waiting time increased. Regardless of the waiting time, it is recommended to prefer direct composite resin restoration over Biodentine and RetroMTA.

Multi-response optimisation analysis of material properties in dental restorative composites under the influence of thermal and thermomechanical stimuli - A 3D finite element study.

OBJECTIVES: Restored teeth undergo more damage than intact teeth. Therefore, the scientific investigation of their mechanical and physical behaviour under varying oral conditions is vital. The current study is to numerically investigate the stresses on a class-II mesio-occluso-distal (MOD) restored molar due to thermal and thermomechanical stimuli with varying input properties such as coefficient of thermal expansion and elastic properties. This is performed to optimise the dental restoration material, thereby reducing the stresses and failure of the restoration. METHODS: An upper molar was scanned using µ-CT for segmenting and modelling the enamel and dentine. A class-II MOD cavity was then prepared on the model, after which non-manifold meshing was generated. The coefficient of thermal expansion (CTE) and elastic modulus (E) properties of the restoration were varied from 20 × 10-6 °C-1 to 55 × 10-6 °C-1 and 5 GPa-20 GPa, respectively. After the material properties and boundary conditions were set for the finite element (FE) analysis, the thermal and thermomechanical loading analyses were performed to demonstrate the influence of input parameters on the stress. The maximum values of principal stresses on the restoration-enamel junction and the restoration were evaluated. The results were statistically processed using analysis of variance, response surface methodology (RSM) and optimisation analysis to estimate the most optimum inputs for minimising principal stresses. RESULTS: The study reveals that the location of principal stress occurs at the restoration-enamel junction (REJ) and the restoration changes based on the composite material value of E and CTE due to thermal and thermomechanical stimuli. The REJ showed higher principal stress than restoration during the application of both thermal and thermomechanical stimuli, making it more vulnerable to fracture and failure. Moreover, the study showed non-linear variations in the values and locations of principal stresses due to thermal and thermomechanical stimuli with the change in the property of the restoration composite used. Finally, this study derived an optimised restorative value for CTE and E due to the application of thermal and simultaneous thermal and mechanical stimuli. CONCLUSION: This study highlights the importance of choosing the suitable material properties of the restoration composite by dental clinicians to repair a large class MOD cavity. The findings from this study also suggest that the difference in the values of E and CTE in a dental restoration composite when compared with the enamel causes a lack of uniformity in mechanical and thermal properties, thereby forming stress concentrations at the interfaces. The study establishes two optimised CTE and E values for the MOD restoration composite as 25 × 10-6 °C-1 and 20 GPa and 37 × 10-6 °C-1 and 5 GPa, respectively.

Nacre-like ceramic composites: Properties, functions and fabrication in the context of dental restorations.

Dental restorations are in increasing demand, yet their success rate strongly decreases after 5-10 years post-implantation, attributed in part to mismatching properties with the surrounding buccal environment that causes failures and wear. Among current research to address this issue, biomimetic approaches are promising. Nacre-like ceramic composites are particularly interesting because they combine multiple antagonistic properties making them more resistant to failure in harsh environment than other materials. With the rapid progress in 3D printing producing nacre-like structures has open up new opportunities not yet realised. In this paper, nacre-like composites of various compositions are reviewed in the context of hypothetical biomimetic dental restorations. Their structural, functional and biological properties are compared with those of dentin, enamel, and bone to determine which composition would be the most suitable for each of the 3 mineralized regions found in teeth. The role of complex microstructures and mineral orientations are discussed as well as 3D printing methods that allow the design and fabrication of such complex architectures. Finally, usage of these processes and anticipated prospects for next generation biomimetic dental replacements are discussed to suggest future research directions in this area. STATEMENT OF SIGNIFICANCE: With the current ageing population, dental health is a major issue and current dental restorations still have shortcomings. For the next generation of dental restorations, more biomimetic approaches would be desirable to increase their durability. Among current materials, nacre-like ceramic composites are interesting because they can approach the various structural properties found in the different parts of our teeth. Furthermore, it is also possible to embed self-sensing functionalities to enable monitoring of oral health. Finally, new recent 3D printing technologies now permit the fabrication of complex shapes with local compositions and local microstructures. With this current status of the research, we anticipate new dental restorations designs and highlight the remaining gaps and issues to address.

Degradation products of resin-based materials detected in saliva in vivo.

OBJECTIVES: Dental composites remain under scrutiny regarding their (long-term) safety. In spite of numerous studies on the release of monomers both in vitro and in vivo, only limited quantitative data exist on the in vivo leaching of degradation products from monomers and additives. The aim of this observational study was for the first time to quantitatively and qualitatively monitor the release of parent compounds and their degradation products in saliva from patients undergoing multiple restorations. MATERIALS AND METHODS: Five patients in need of multiple large composite restorations (minimally 5 up to 28 restorations) due to wear (attrition, abrasion, and erosion) were included in the study, and they received adhesive restorative treatment according to the standard procedures in the university clinic for Restorative Dentistry. Saliva was collected at different time points, starting before the restoration up until 24 h after the treatment with composite restorations. Saliva extracts were analyzed by liquid chromatography-mass spectrometry. RESULTS: Leaching of monomers and degradation products was highest within 30 min after the placement of the restorations. The highest median concentrations of monomers were recorded for UDMA, BisEMA-3, and TEGDMA; yet, besides BisEMA-3 and TEGDMA, no monomers could be detected after 24 h. Mono- and demethacrylated degradation products remained present up to 24 h and concentrations were generally higher than those of monomers. In patients with multiple restorations, degradation products were still present in the sample taken before the next operation, several weeks after the previous operation. CONCLUSIONS: Exposure to residual monomers and degradation products occurs in the first hours after restoration. Monomers are present in saliva shortly after restoration, but degradation products can be detected weeks after the restoration confirming a long-term release. CLINICAL SIGNIFICANCE: Future research should focus more on the release of degradation products from monomers and additives from resin-based materials given their prolonged presence in saliva after restoration.

Color reproduction trueness of 3D-printed full-color dental casts with scans derived from an intraoral scanner.

PURPOSE: To investigate the effects of shade tab color variations (tooth-colored vs. gingiva-colored) and surface treatment (application of mineral oil) on the trueness of color reproduction from dental shade tabs to 3D-printed full-color dental casts, using digital scans obtained from an intraoral scanner. MATERIALS AND METHODS: Pristine tooth-colored (with 16 shade tabs) and gingiva-colored (with five shade tabs) shade guides were digitally scanned using an intraoral scanner, and subsequently, 3D-printed replicas were created using a full-color material jetting 3D printer. Three color measurements using a contact type digital spectrophotometer were recorded, including actual shade tabs (R0), dried 3D-printed study samples (RP1 ), and study samples with mineral oil application (RP2 ), in this study to calculate color differences between the actual shade tabs and 3D-printed ones. The CIEDE2000 formula was used to calculate the color differences (color reproduction trueness) between reference shade tabs and 3D-printed full-color study samples-without and with mineral oil, ∆E00 (RP1 ), and ∆E00 (RP2 ). ∆E00 (RP1 ) and ∆E00 (RP2 ) were compared with a 50:50% accessibility threshold (AT) and a 50:50% perceptibility threshold (PT). A grading system, based on the relative ranges of AT and PT, was employed. The percentage of samples falling into each color-matching category was then recorded. The data collected were subjected to statistical analysis, utilizing a mixed model ANOVA to evaluate the effects of shade tab color and mineral oil application on color differences, α = 0.05. RESULTS: The application of mineral oil significantly affected the ∆E00 [F(1, 378) = 19.1, p = < 0.0001]. However, this effect was only significant for the gingiva-colored study samples; the mineral oil application significantly decreased color difference, showing ∆E00 (RP1 ) of 8.71 ± 3.78 and ∆E00 (RP2 ) of 6.55 ± 2.14 (p < 0.0001). For the tooth-colored groups, the mineral oil application did not yield any color difference, showing ∆E00 (RP1 ) of 7.05 ± 2.35 and ∆E00 (RP2 ) of 6.94 ± 2.35 (p = 0.497). In the absence of mineral oil, gingiva-colored samples revealed a significantly larger ∆E00 (RP1 ) of 8.71 ± 3.78 compared to tooth-colored samples at 7.05 ± 2.35 (p = 0.017). Conversely, mineral oil application rendered comparable ∆E00 (RP2 ) values between gingiva-colored (6.55 ± 2.14) and tooth-colored (6.94 ± 2.35) samples (p = 0.558). All 3D-printed full-color samples showed Grade 1 (extremely unacceptable mismatch) and Grade 2 (clearly unacceptable mismatch), regardless of the shades or the presence of mineral oil. CONCLUSIONS: Utilizing an intraoral scanner to gather digital color data, along with an MJ 3D printer, offers the potential for producing 3D-printed full-color dental casts for prosthesis characterization in the dental laboratory. While mineral oil improves the color reproduction trueness of gingiva-colored objects, all 3D-printed full-color samples exhibited unacceptable mismatches when compared to their target objects. This underscores the need for future improvement in the digital color data acquisition process and color optimization protocols in 3D printing processes.

Fluorescence and Near-Infrared Light for Detection of Secondary Caries: A Systematic Review.

BACKGROUND: Early detection of secondary caries near dental restorations is essential to prevent further complications. This systematic review seeks to evaluate the sensitivity of fluorescence and near-infrared (NIR) imaging techniques for detecting secondary caries and to provide insight into their clinical utility. METHODS: A comprehensive search strategy was used to select studies from seven databases, emphasizing diagnostic accuracy studies of secondary caries detection using fluorescence and NIR imaging techniques. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) instrument assessed bias risk and practicality. Two evaluators performed data extraction, screening, and quality assessment independently. RESULTS: From 3110 initial recordings, nine studies were selected for full-text analysis. Wide variations in sensitivity (SE) and specificity (SP) values were reported across the studies. These studies exhibited variable SE and SP values, and the findings highlighted the importance of method selection based on clinical context. This systematic review underlines the potential for fluorescence and NIR imaging to detect secondary caries. However, results from different studies vary, indicating the need to consider additional variables such as restoration materials. CONCLUSIONS: Although these technologies exhibit potential for detecting caries, our research underscores the complex procedure of identifying secondary caries lesions. It is a continuous necessity for progress in dental diagnostics to promptly identify secondary caries lesions, particularly those in proximity to tooth-colored ones.