Three-dimensional finite element analysis of the impact of access cavity preparation on first molar fracture resistance: A scoping review.

Access cavity preparation represents the initial step in root canal treatment. Minimally invasive approaches have gained increasing attention and involve advancements in the traditional access cavity preparation. Simultaneously, the development of three-dimensional finite element analysis (3D-FEA) has provided a theoretical foundation for evaluating the merits and drawbacks of various access cavity preparations. Studies using static loading 3D-FEA have suggested that conservative access cavity preparation reduces the concentration of stress in the cervical region, thereby strengthening fracture resistance. However, the lack of support from clinical data raises concerns about the validity of this suggestion. Conversely, studies involving cyclic loading 3D-FEA and dynamic loading 3D-FEA have challenged the prevailing perspectives by taking into account additional factors such as filling materials, thus providing a more comprehensive understanding of the impact of access cavity preparation on fracture resistance. Existing research lacks a comprehensive comparison of the different 3D-FEA methods, and this review fills this gap by providing a systematic assessment of different 3D-FEA methods and their applications in access cavity preparation.

Biaxial flexural strength of 3D-printed 3Y-TZP zirconia using a novel ceramic printer.

OBJECTIVES: To compare the strength and reliability of 3D-printed 3Y-TZP zirconia manufactured with various printing orientations and staining. MATERIALS AND METHODS: A total of one-hundred cylindrical zirconia specimens were designed and fabricated using 3D printing and processed according to ISO 6872 standards. Of these specimens, 80 were 3D printed using the new ZIPRO-D (ZD) 3D ceramic printer. In this ZD group, 60 specimens were printed in a vertical orientation and were either stained after debinding (ZD1, x-orientation, n = 20) or not stained (ZD2, x-orientation, n = 20; ZD3, y-orientation, n = 20) and the remaining 20 specimens out of n = 80 were printed in a horizontal orientation (ZD4). Further 20 specimens out of the entire sample N = 100 were printed vertically with the CeraFab7500 3D ceramic printer (LC). All completed specimens were loaded until fracture using a universal testing machine. Biaxial flexural strengths and Weibull parameters were computed for the ZD groups and for the LC group. Group and sub-group effects were evaluated using Welch ANOVA (alpha = 0.05). RESULTS: The mean (standard deviation, SD) biaxial flexural strengths of vertically oriented ZD samples with (ZD1) and without (ZD2/ZD3) staining were 811 (197) and 850 (152) MPa, respectively (p > 0.05). The ZD4 (horizontally printed), 1107 (144) MPa, and LC (1238 (327)) MPa samples had higher mean (SD) flexural strengths than the ZD1-3 specimens. No difference was observed between the ZD4 and LC group (p > 0.05). Weibull moduli were between m = 4.6 (ZD1) and 9.1 (ZD4) in the ZD group and m = 3.5 in the LC group. CONCLUSIONS: All tested 3D-printed zirconia specimens exceeded the flexural strengths required for class 5 restorations according to ISO 6872 standards. While the flexural strengths of zirconia printed using the novel ZD device in the vertical orientation are lower than those of zirconia printed using the LC printer, the ZD printer shows at least comparable reliability. CLINICAL RELEVANCE: 3D-printing of zirconia is a new technology in dental application. Based on the presented strengths values, clinical application of 3D-printed zirconia for fixed dental protheses can be recommended.

Effect of replacing Bis-GMA with a biobased trimethacrylate on the physicochemical and mechanical properties of experimental resin composites.

OBJECTIVES: To analyze the incorporation of cardanol trimethacrylate monomer (CTMA), derived from the cashew nut shell liquid, as a substitute for Bis-GMA in acrylic resins formulations and its effect on experimental resin composites' physicochemical and mechanical properties. MATERIALS AND METHODS: The intermediary cardanol epoxy was synthesized via cardanol epoxidation, followed by the synthesis of CTMA through methacrylic anhydride solvent-free esterification. Experimental resin composites were formulated with an organic matrix composed of Bis-GMA/TEGDMA (50/50 wt %) (control). CTMA was gradually added to replace different proportions of Bis-GMA: 10 wt % (CTMA-10), 20 wt % (CTMA-20), 40 wt % (CTMA-40), and 50 wt % (CTMA-50). The composites were characterized by degree of conversion, water sorption and solubility, viscosity, thermogravimetric analysis, dynamic mechanical analysis, flexural strength and elastic modulus. Data were analyzed with one-way ANOVA and Tukey's post-hoc test (α = 0.05), except for water sorption data, which were analyzed by Kruskall-Wallis and Dunn's method. RESULTS: CTMA-based and control composites did not show statistically significant differences regarding degree of conversion, flexural strength and elastic modulus. CTMA reduced the viscosity and solubility compared to the Bis-GMA-based composite. The CTMA-40 and CTMA-50 exhibited significantly lower water sorption compared to the control. Also, acceptable thermal stability and viscoelastic properties were obtained for safe use in the oral cavity. CONCLUSIONS: Incorporating CTMA into composites resulted in similar chemical and mechanical properties compared to Bis-GMA-based material while reducing viscosity, water sorption and solubility. CLINICAL RELEVANCE: CTMA could be used as a trimethacrylate monomer replacing Bis-GMA in resin composites, thereby minimizing BPA exposure.

Retention of strength and ion release of some restorative materials.

This study aimed to investigate the retention of strength in accelerated aging condition and ion release from an experimental fiber-reinforced bioactive flowable composite resin (Bio-SFRC), comparing it with various commercially available ion-releasing materials. The flexural strength of Bio-SFRC and other materials (Biodentine, TheraCal LC, Fuji II LC and Surefil one) was evaluated (n = 8) before and after hydrothermal accelerated aging. Ion concentrations of silica and phosphorus were measured after 1, 2, 3, 4, 7, 10, 14, and 21 days of specimen immersion in simulated body fluids (SBF) using UV-Vis spectrometry. In addition, ion release and pH change were studied in a continuous dynamic system in SBF over a period of 72 h. SEM and EDS were used to evaluate the microstructure on the top surface of the materials after SBF immersion. Data were statistically analyzed using variance ANOVA analysis (p = 0.05). Bio-SFRC showed higher flexural strength before (134.9 MPa) and after (63.1 MPa) hydrothermal aging compared to other tested materials (p < 0.05). Flexural strength significantly decreased after aging (p < 0.05) except for Fuji II LC which showed no significant differences. Ion release data showed that experimental Bio-SFRC slowly released phosphate ions. Biodentine and TheraCal LC had the strongest ability to form calcium phosphate precipitation on the material surface. Phosphate ion release cannot be detected clearly from these materials. Surefil one and Fuji II LC were more stable materials without any observable ion release. The advantages of fiber containing structure and slow release of ions suggest that experimental Bio-SFRC is a promising bioactive material to provide ions for mineralization of surrounding tissues, and keeping the durability of the materials at higher level than that of other tested materials.

Effects of pre-heating on physical-mechanical-chemical properties of contemporary resin composites.

This research assessed the effects of pre-heating on the physical-mechanical-chemical properties of different resin composites. For this, resin composites were evaluated in 6 levels: Admira/ADM, Vitra/VIT, Filtek Supreme/FS, Filtek Supreme Flowable/FSF, Filtek One/FO, and Filtek Bulk Fill Flowable/FBF; temperature was evaluated in 4 levels using a composite heater: room temperature/22 ºC, 37 ºC, 54 ºC, and 68 ºC. Response variables were: degree of conversion/DC, flexural strength/FS and color stability/ΔE (immediately after light curing/LC, after 7 days of dark-dry-storage, and after 24 h and 3 days of artificial aging in water at 60 ºC). Data were subjected to 2-way ANOVA (DC and FR) and 3-way repeated measurements ANOVA (ΔE), all followed by Tukey's test (α = 5%). DC were similar (FBF, FS, and FSF) or increased (ADM, FO, and VIT) as the temperature increased. Results of FR were unchanged or increased for all composites except VIT and ADM. High-viscosity composites (VIT and FS) showed higher FR values than low-viscosity composite (FSF). For bulk-fill composites, FBF and FO showed similar results, but lower than high-viscosity composites. Results of color stability showed acceptable values up to 3 days aging except for ADM and FSF. ΔE was not influenced by pre-heating and, overall, ΔE: FS < VIT < FO < FSF < ADM < FBF. Only VIT and FS showed ΔE ≤ 3.3 (clinical threshold). Therefore, the effects of pre-heating depend on the material. The tested materials generally showed similar or enhanced properties after pre-heating (except ADM and VIT).

Flexural strength and translucency of barium-silicate-filled resin nanoceramics for additive manufacturing.

OBJECTIVE: This in vitro study aimed to evaluate the flexural strength (FS) and translucency parameter (TP) of resin nanoceramics (RNCs) with barium silicate for additive manufacturing. MATERIALS AND METHODS: An RNC slurry was prepared by mixing a barium silicate filler and resin monomer. For the FS tests, specimens with three filler contents (0, 50, and 63 wt%) were designed according to ISO6872 for dental ceramics and ISO10477 for dental polymers. These specimens were then formed into discs with thicknesses of 1 and 2 mm for TP measurement. RESULTS: In the specimens prepared according to ISO6872, the FS increased significantly depending on the filler content. However, in the case of ISO10477, there was no significant difference between the FSs of the specimens with 0 and 50 wt% filler contents. The increase in thickness affected translucency, and the lowest translucency was obtained at a filler content of 63 wt%. The filler distribution was dense in the specimen with 63 wt% filler and uniform but relatively sparse in the specimen with 50 wt% filler. More voids were observed in the specimen with 63 wt% filler. The thickness and filler content of the specimen affected its TP. The TP of the specimen with 63 wt% filler was similar to that of human enamel. CONCLUSION: The FS was significantly higher at a filler content of 63 wt%. The lowest translucency was obtained at a filler content of 63 wt% for all tested thicknesses. CLINICAL SIGNIFICANCE: Increasing the filler content was advantageous for the mechanical properties of the RNCs. A high filler content led to low translucency in the RNCs. Therefore, the esthetics of human teeth can be reproduced if layering according to the filler content is performed in areas where esthetic characteristics are required.

Evaluation of mechanical, optical, and fluoride-releasing properties of a translucent bulk fill glass hybrid restorative dental material.

OBJECTIVE: Measure and compare the mechanical properties, translucency, and fluoride-releasing capabilities of EQUIA Forte HT against Fuji IX GP and ChemFil Rock. MATERIALS AND METHODS: Ten specimens of each material were fabricated for compressive strength (CS), flexural strength (FS), and surface hardness analysis at 24 h and 7 days. The L*a*b* values were measured against a black-and-white background using a spectrophotometer to analyze the translucency parameter (TP). Fluoride release was recorded after 2 months of immersion in distilled water. The mean data was analyzed by 1- and 2-way ANOVA (α = 0.5). RESULTS: EQUIA Forte HT showed higher CS, surface hardness, and FS values (p < 0.05) compared with Fuji IX GIC, while no significant difference was found in FS values between EQUIA Forte HT and Chemfil Rock (p > 0.05). The EQUIA Forte HT exhibited significantly higher translucency in comparison to both ChemFil Rock (p < 0.001) and Fuji IX GICs (p < 0.05). An increase (p > 0.05) of fluoride release was observed for EQUIA Forte HT. CONCLUSION: The EQUIA Forte HT Glass-ionomer cements (GIC) offers enhanced translucency, improved strength, and enhanced fluoride-releasing properties compared to the traditionally used Fuji IX GIC and ChemFil Rock GICs. This material might have a wide range of clinical applications due to its improved strength and optical properties. CLINICAL SIGNIFICANCE: Glass-ionomer dental restorative materials possess unique advantageous characteristics. However, its poor mechanical and optical properties have typically limited its clinical applications. Efforts to improve these properties have resulted in enhanced GICs. EQUIA Forte HT GIC offers enhanced mechanical and optical properties with potential applications in posterior and anterior restorative procedures.

Mechanical properties of 3D-printed and milled composite resins for definitive restorations: An in vitro comparison of initial strength and fatigue behavior.

OBJECTIVE: To evaluate the flexural strength and fatigue behavior of a novel 3D-printed composite resin for definitive restorations. MATERIALS AND METHODS: Fifty disc-shaped specimens were manufactured from each of a nanohybrid composite resin (NHC), polymer-infiltrated ceramic network (PICN), and 3D-printed composite resin (3D) with CAD-CAM technology. Biaxial flexural strength (σin ) (n = 30 per group) and biaxial flexural fatigue strength (σff ) (n = 20 per group) were measured using piston-on-three-balls method, employing a staircase approach of 105 cycles. Weibull statistics, relative-strength degradation calculations, and fractography were performed. The results were analyzed with 1-way ANOVA and Games-Howell post hoc test (α = 0.05). RESULTS: Significant differences in σin and σff among the groups (p < 0.001) were detected. The NHC group provided the highest mean ± standard deviation σin and σff (237.3 ± 31.6 MPa and 141.3 ± 3.8 MPa), followed by the PICN (140.3 ± 12.9 MPa and 73.5 ± 9.9 MPa) and the 3D (83.6 ± 18.5 MPa and 37.4 ± 23.8 MPa) groups. The 3D group exhibited significantly lower Weibull modulus (m = 4.7) and up to 15% higher relative strength degradation with areas of nonhomogeneous microstructure as possible fracture origins. CONCLUSIONS: The 3D-printed composite resin exhibited the lowest mechanical properties, where areas of nonhomogeneous microstructure developed during the mixing procedure served as potential fracture origins. CLINICAL SIGNIFICANCE: The clinical indications of the investigated novel 3D-printed composite resin should be limited to long-term provisional restorations. A cautious procedure for mixing the components is crucial before the 3D-printing process, since nonhomogeneous areas developed during the mixing could act as fracture origins.

The influence of the addition of titanium oxide nanotubes on the properties of 3D printed denture base materials.

INTRODUCTION: In this study, the effects of adding titanium dioxide nanotubes (TiO2) to 3D-printed denture base resin on the mechanical and physical properties of denture bases were examined for the first time. METHODS: The specimens were digitally created using 3D builder software from Microsoft Corporation through computer-aided design. In accordance with the test specifications for transverse strength, impact strength, hardness, surface roughness, and color stability, specimens were designed and printed with certain dimensions following relevant standards. TiO2 nanotubes (diameter: 15-30 nm and length: 2-3 µm) were added to the 3D-printed denture base resin (DentaBase, Asiga, Australia) at 1.0% and 1.5% by weight. Flexural strength, impact strength (Charpy impact), hardness, surface roughness, and color stability were evaluated, and the collected data were analyzed with ANOVA followed by Tukey's post hoc test (α = 0.05). Field emission scanning electron microscopy (FESEM) and energy dispersive x-ray spectroscopy (EDX) mapping were used to evaluate the dispersion of the nanotubes. RESULTS: Compared with those of the control group (0.0 wt.% TiO2 nanotubes), the average flexural, impact, and hardness values of the 1.0 and 1.5 wt.% TiO2 nanotube reinforcement groups increased significantly. Both nanocomposite groups showed significant color changes compared to that of the pure resin, and there was a considerable reduction in the surface roughness of the nanocomposites compared to that of the control group. CONCLUSION: Adding TiO2 nanotubes to 3D-printed denture base materials at 1.0 and 1.5 wt.% could enhance the mechanical and physical properties of the material, leading to better clinical performance. CLINICAL SIGNIFICANCE: In terms of clinical applications, 3D-printed denture base material has been shown to be a viable substitute for traditional heat-cured materials. By combining this with nanotechnology, existing dentures could be significantly enhanced, promoting extended service life and patient satisfaction while addressing the shortcomings of the current standard materials.

Comparison of the flexural strength of printed and milled denture base materials.

BACKGROUND: To evaluate the flexural strength of digitally milled and printed denture base materials. METHODS: The materials tested were Lucitone 199 denture base disc (Dentsply Sirona), AvaDent denture base puck (AvaDent), KeyMill denture base disc (Keystone), Lucitone digital print denture base resin (Dentsply Sirona), Formlab denture base resin (Formlabs), and Dentca base resin II (Dentca). Sixty bar-shaped specimens of each material were prepared for flexural strength testing and were divided into five groups: control, thermocycled, fatigue cycled, and repair using two different materials. The flexural strength and modulus were tested using a 3-point bend test performed on an Instron Universal Testing Machine with a 1kN load cell. The specimens were centered under a loading apparatus with a perpendicular alignment. The loading rate was a crosshead speed of 0.5 mm/min. Each specimen was loaded with a force until failure occurred. A one-way ANOVA test was used to analyze the data, followed by Tukey's HSD test (α = 0.05). RESULTS: The milled materials exhibited higher flexural strength than the printed materials. Thermocycling and fatigue reduce the flexural strengths of printed and milled materials. The repaired groups exhibited flexural strengths of 32.80% and 30.67% of the original flexural strengths of printed and milled materials, respectively. Nevertheless, the type of repair material affected the flexural strength of the printed materials; the composite resin exhibited higher flexural strength values than the acrylic resin. CONCLUSIONS: The milled denture base materials showed higher flexural strength than the printed ones.

Effect of thermal cycling on the flexural strength of 3-D printed, CAD/CAM milled and heat-polymerized denture base materials.

BACKGROUND: This study compared the impact of thermal cycling on the flexural strength of denture-base materials produced through conventional and digital methods, using both subtractive and additive approaches. METHODS: In total, 60 rectangular specimens were fabricated with specific dimensions for flexural strength tests. The dimensions were set according to the International Organization for Standardization (ISO) guideline 20795-1:2013 as 64 × 10 × 3.3 ± 0.2 mm. Specimens from each material group were divided into two subgroups (thermal cycled or nonthermal cycled, n = 10/group). We used distinct methods to produce three different denture-base materials: Ivobase (IB), which is a computer-aided-design/computer-aided-manufacturing-type milled pre-polymerized polymethyl methacrylate resin disc; Formlabs (FL), a 3D-printed denture-base resin; and Meliodent (MD), a conventional heat-polymerized acrylic. Flexural strength tests were performed on half of the samples without a thermal-cycle procedure, and the other half were tested after a thermal cycle. The data were analyzed using a two-way analysis of variance and a post hoc Tukey test (α = 0.05). RESULTS: Based on the results of flexural-strength testing, the ranking was as follows: FL > IB > MD. The effect of thermal aging was statistically significant for the FL and IB bases, but not for the MD base. CONCLUSIONS: Digitally produced denture bases exhibited superior flexural strength compared with conventionally manufactured bases. Although thermal cycling reduced flexural strength in all groups, the decrease was not statistically significant in the heat-polymerized acrylic group.

Impact of repeated heat-pressing on the microstructure and flexural strength of lithium disilicate glass-ceramics.

BACKGROUND: The leftover material from the heat-pressing of IPS e.max Press ceramic is often discarded, despite some laboratories exploring its potential for reuse. However, there is a lack of data on the performance of IPS e.max Press ceramic when combined with the button portions. This study investigated the impact of repeated heat-pressing on the crystal structure and flexural strength of lithium disilicate glass-ceramic (LDGC). METHODS: Specimens (N = 30, n = 10 per group) were categorized based on the number of heat-pressing cycles: G0 (control group, no heat-pressing), G1 (one cycle of heat-pressing), and G2 (two cycles of heat-pressing). The crystal structure of LDGC bars was characterized using X-ray diffraction (XRD). Flexural strength was tested, and microstructures were analyzed via scanning electron microscopy (SEM) and the ImageJ processing program. Data were analyzed using one-way analysis of variance (ANOVA), and multiple pairwise comparisons of means were performed with Tukey's post-hoc test. RESULTS: G2 exhibited significantly lower flexural strength and crystallinity, as well as larger crystal size, compared to G1 and G0 (p < 0.05). Flexural strength values decreased significantly with an increased number of heat-pressing cycles. CONCLUSIONS: The mechanical properties of LDGC significantly degraded after repeated heat pressing. Therefore, it is not clinically advisable to repeatedly press the lithium disilicate ingot together with the leftover material.

Modification of polymethylmethacrylate bone cement with halloysite clay nanotubes.

BACKGROUND: Polymethylmethacrylate (PMMA) bone cement is used in orthopedics and dentistry to get primary fixation to bone but doesn't provide a mechanically and biologically stable bone interface. Therefore, there was a great demand to improve the properties of the PMMA bone cement to reduce its clinical usage limitations and enhance its success rate. Recent studies demonstrated that the addition of halloysite nanotubes (HNTs) to a polymeric-based material can improve its mechanical and thermal characteristics. OBJECTIVES: The purpose of the study is to assess the compressive strength, flexural strength, maximum temperature, and setting time of traditional PMMA bone cements that have been manually blended with 7 wt% HNT fillers. METHODS: PMMA powder and monomer liquid were combined to create the control group, the reinforced group was made by mixing the PMMA powder with 7 wt% HNT fillers before liquid mixing. Chemical characterization of the HNT fillers was employed by X-ray fluorescence (XRF). The morphological examination of the cements was done using a scanning electron microscope (SEM). Analytical measurements were made for the compressive strength, flexural strength, maximum temperature, and setting time. Utilizing independent sample t-tests, the data was statistically assessed to compare mean values (p < 0.05). RESULTS: The findings demonstrated that the novel reinforced PMMA-based bone cement with 7 wt% HNT fillers showed higher mean compressive strength values (93 MPa) and higher flexural strength (72 MPa). and lower maximum temperature values (34.8 °C) than the conventional PMMA bone cement control group, which was (76 MPa), (51 MPa), and (40 °C), respectively (P < 0.05). While there was no significant difference in the setting time between the control and the modified groups. CONCLUSION: The novel PMMA-based bone cement with the addition of 7 wt% HNTs can effectively be used in orthopedic and dental applications, as they have the potential to enhance the compressive and flexural strength and reduce the maximum temperatures.

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.

Evaluating flexure properties, hardness, roughness and microleakage of high-strength injectable dental composite: an in vitro study.

BACKGROUND: Recently, a new generation of high-strength flowable dental composites has been introduced by manufacturers. The manufacturers claim that these materials have enhanced mechanical and physical properties and are suitable for use in a wide range of direct anterior and posterior restorations, even in high-stress bearing areas. AIM: The objective of this study was to assess certain physical and mechanical properties of these recently introduced high-strength flowable composites in comparison to conventional multipurpose dental composites. METHODS: Four types of high-strength flowable composites (Genial Universal FLO, Gaenial Universal Injectable, Beautifil Injectable, and Beautifil Flow Plus) were tested in experimental groups, while a nanohybrid conventional composite (Filtek Z350 XT) was used as the control. For flexure properties, ten rectangular samples (2 × 2 × 25 mm) were prepared from each composite material and subjected to 5000 cycles of thermocycling. Samples were then subjected to flexural strength testing using the universal testing machine. Another twenty disc-shaped specimens of dimensions (5 mm diameter × 2 mm thickness) were fabricated from each composite material for surface roughness (Ra) (n = 10) and hardness (VHN) test (n = 10). All samples underwent 5000 cycles of thermocycling before testing. Additionally, microleakage testing was conducted on 60 standardized class V cavities prepared on molar teeth and divided randomly into five groups (n = 12). Cavities were then filled with composite according to the manufacturer's instructions and subjected to thermocycling for 1000 cycles before testing using methylene blue solution and a stereomicroscope. RESULTS: All tested materials were comparable to the control group in terms of flexural strength and surface roughness (p > 0.05), with Gaenial Universal FLO exhibiting significantly higher flexural strength compared to the other flowable composite materials tested. However, all tested materials demonstrated significantly lower elastic modulus and surface hardness than the control group (p < 0.05). The control group exhibited higher microleakage scores, while the lowest scores were observed in the Gaenial Universal FLO material (p < 0.05) CONCLUSION: The physical and mechanical behaviors of the different high-strength flowable composites investigated in this study varied. Some of these materials may serve as suitable alternatives to conventional composites in specific applications, emphasizing the importance of dentists being familiar with material properties before making material selections.

Evaluation of flexural strength, impact strength, and surface microhardness of self-cured acrylic resin reinforced with silver-doped carbon nanotubes.

BACKGROUND: Poly-methyl methacrylate (PMMA) is a type of polymer mostly used to make denture bases. Self-cured acrylic resin (PMMA) can be used to repair a fractured acrylic denture base; however, even after repair, this area remains vulnerable. Carbon nanotubes (CNTs) could be used as a filler for polymer reinforcement. Furthermore, silver nanoparticles are efficient agents for the prevention of dental biofilm and improving their mechanical properties. The doping of CNTs with silver nanoparticles may lead to a synergistic interaction that is predicted to enhance the mechanical characteristics of the fillers. OBJECTIVES: The aim of the study was to assess the influnce of manual incorporation of 0.5% weight percent (%wt.) of silver doped carbon nanotubes (Ag-doped CNTs) into commercial self-cured PMMA on its flexural strength, impact strength, and surface microhardness. METHODS: In this investigation, a total of 60 specimens comprised of acrylic resin were employed. They are divided into two main groups: (a) the control group, which was made by using liquid monomer and commercial self-cured PMMA powder; and (b) the modified group, prepared by hand mixing the purchased silver-doped CNTs powder (0.5% wt.) to self-cured PMMA powder (99.5%wt.), and then the blended powder was incorporated into the liquid monomer. Flexural strength, flexural modulus, impact strength, and surface microhardness were evaluated. Independent sample t-tests were used to statistically analyze the data and compare the mean values of flexural strength, flexural modulus, impact strength, and surface microhardness (p-value ≤ 0.05). RESULTS: The flexural strength of the modified groups with Ag-doped CNTs (132.4 MPa) was significantly greater than that of the unmodified (control) groups (63.2 MPa). Moreover, the flexural modulus of the modified groups with Ag-doped CNTs (3.067 GPa) was significantly greater than that of the control groups (1.47 GPa). Furthermore, the impact strength of the modified groups with Ag-doped CNTs (11.2 kJ/mm2) was significantly greater than that of the control groups (2.3 kJ/mm2). Furthermore, the microhardness of the modified groups with Ag-doped CNTs (29.7 VHN) was significantly greater than that of the control groups (16.4 VHN), (p-value = 0.0001). CONCLUSION: The incorporation of 0.5% wt. silver doped CNTs fillers to the self-cured acrylic resin enhanced its flexural strength, flexural modulus, impact strength, and surface microhardness.

Flexural strength of novel glass infiltrated monochrome and multilayer high yttrium oxide containing zirconia upon various sintered cooling rates.

PURPOSE: The sintering technique and cooling strategy influence the strength of zirconia. This study examined the impact of altering the cooling rate of glass-infiltrated monolayer and multilayer 5 mol% yttria-partially stabilized zirconia (5Y-PSZ) on their strength. MATERIALS AND METHODS: One-hundred eighty (180) specimens (width × length × thickness = 10 × 20 × 2 mm) were prepared using monolayer (Mo: Cercon-xt) and multilayer (Mu: Cercon-xt ML) 5Y-PSZ. Randomly distributed specimens (n = 15/group) were sintered with traditional (T) versus glass infiltrated (G) technique and cooled down with different cooling rates: slow (S: 5°C/min), normal (N: 35°C/min), and fast (F: 70°C/min). Four-point bending test was used to measure flexural strength (σ). Microstructures were investigated by scanning electron microscope (SEM), energy dispersive spectroscopy (EDS), and X-ray diffraction (XRD). Three-way ANOVA and Tamhane comparisons were determined for a significant difference of σ (p < 0.05). Weibull analysis was determined for Weibull modulus (m). RESULTS: The highest σ (MPa) was seen for GMuS (696.8 ± 69.8). Mo-PSZ and Mu-PSZ showed no significant difference in σ. G-sintering presented significantly higher σ (659.9 ± 79.3) than T-sintering (426.0 ± 63.7). S-cooling (560.9 ± 126.1) had the highest σ. The highest m-value was observed in GMuN (12.1 ± 3.8). A significant difference in σ was indicated due to cooling rates and sintering techniques (p < 0.05). CONCLUSIONS: Glass infiltration significantly enhanced strength through elastic gradience. F-cooling reduced grain size, impaired grain boundary integration, and increased the tetragonal to monoclinic phase transition, significantly decreasing flexural strength in traditional sintering. Nevertheless, F-cooling was recommended for glass-infiltrated 5Y-PSZ to enhance strength while reducing processing time.

Effect of different surface treatments and adhesive cementation on the surface topography and flexural strength of translucent and ultra-translucent monolithic zirconia.

PURPOSE: To evaluate the effect of different surface treatments and adhesive cementation on the miniflexural strength (MFS) of monolithic zirconia. MATERIALS AND METHODS: Two-hundred and forty (240) sintered bars of translucent zirconia (ZT) and ultra-translucent zirconia (ZUT) were obtained (8 mm ×2 mm ×1 mm). The bars were divided into 16 groups (n = 15) according to the factors "Zirconia" (ZT and ZUT), "Cementation" (Cem) and "surface treatment" (Ctrl:Control, Al:Aluminum oxide/Al2O3 50 µm, Si:Silica/SiO2 coated alumina particles oxide 30 µm, Gl:Glazing+hydrofluoric acid). Half of the bars received an adhesive layer application, followed by application of resin cement and light curing. The surface roughness was measured in non-cemented groups. All the bars were subjected to the MFS test (1.0 mm/min; 100 kgf). Scanning electron microscopy was used for qualitative analyses. MFS data (MPa) and roughness (µm) were statistically evaluated by three-way and two-way ANOVA respectively and Tukey's test (5%). RESULTS: The surface treatment and the interaction were significant for roughness. Glazing promoted less roughness compared to silicatization. Regarding MFS, only the zirconia and surface treatment factors were significant. For ZT, the sandblasted groups had an increase in MFS and glazing reduced it. There was no difference between the groups without cementation for the ZUT; however, ZUT.Si/Cem, and ZUT.Al/Cem obtained superior MFS among the cemented groups. CONCLUSIONS: Sandblasting increases the flexural strength for ZT, while glaze application tends to reduce it. Applying resin cement increases the flexural strength of ZUT when associated with sandblasting. Sandblasting protocols promote greater surface roughness.

Microstructural and flexural strength of various CAD-CAM lithium disilicate ceramics.

PURPOSE: To analyze the microstructural and mechanical properties of various commercial trademarks of lithium disilicate ceramics for CAD-CAM systems. MATERIALS AND METHODS: Specimens of different lithium disilicate ceramics were obtained and randomized into 5 groups (n = 14): EM: e.max CAD; RT: Rosetta SM; EV: Evolith; PM: Smile-Lithium CAD; and, HS: HaHaSmile. The microstructural analysis was performed by X-ray diffraction (XRD) and scanning electron microscopy (SEM); for flexural strength, the three-point bending flexure test was used. XRD and SEM data were qualitatively evaluated. Data from flexural strength were assessed with one-way ANOVA test (α = 0.05) and Weibull analysis. RESULTS: High peaks corresponding to the lithium metasilicate and lithium disilicate pattern with similar intensities were observed in all ceramics in the XRD analysis. SEM images showed similar patterns of crystalline structure in the EM and RT ceramics, while the other three groups presented different crystal morphologies than the previous ones and were similar to each other. No differences were found in flexural strength among the groups (p = 0.28). CONCLUSIONS: The CAD-CAM lithium disilicate ceramics showed comparable crystalline intensities. The microstructure of the EM and RT ceramics were different from the other groups. Flexural strength was similar among all ceramics.

Effect of incisal preparation design on the fracture strength of monolithic zirconia-reinforced lithium silicate laminate veneers.

PURPOSE: This study aimed to assess the fracture resistance of monolithic zirconia-reinforced lithium silicate laminate veneers (LVs) fabricated on various incisal preparation designs. MATERIALS AND METHODS: Sixty maxillary central incisors with various preparation designs were 3D-printed, 15 each, including preparation for: (1) LV with feathered-edge design; (2) LV with butt-joint design; (3) LV with palatal chamfer; and (4) full-coverage crown. Restorations were then designed and manufactured from zirconia-reinforced lithium silicate (ZLS) following the contour of a pre-operation scan. Restorations were bonded to the assigned preparation using resin cement and following the manufacturer's instructions. Specimens were then subjected to 10,000 thermocycles at 5 to 55°C with a dwell time of 30 s. The fracture strength of specimens was then assessed using a universal testing machine at a crosshead speed of 1.0 mm/min. One-way ANOVA and Bonferroni correction multiple comparisons were used to assess the fracture strength differences between the test groups (α = 0.001). Descriptive fractographic analysis of specimens was carried out with scanning electron microscopy images. RESULTS: Complete coverage crown and LV with palatal chamfer design had the highest fracture resistance values (781.4 ± 151.4 and 618.2 ± 112.6 N, respectively). Single crown and LV with palatal chamfer had no significant difference in fracture strength (p > 05). LV with feathered-edge and butt-joint designs provided significantly (p < 05) lower fracture resistance than complete coverage crown and LV with palatal chamfer design. CONCLUSION: The fracture resistance of chairside milled ZLS veneers was significantly influenced by the incisal preparation designs tested. Within the limitation of this study, when excessive occlusal forces are expected, LV with palatal chamfer display is the most conservative method of fabricating an indirect restoration.