Effects of alpha-tocopherol antioxidant on fracture strength and adhesion of endodontically treated teeth restored after dental bleaching.

This study evaluated the effect of different concentrations of alpha-tocopherol in gel form on fracture strength, hybrid layer formation, and microtensile bond strength of endodontically treated teeth bleached with 40% hydrogen peroxide (H2 O2 ). Sixty bovine incisors were randomized into one of six groups (n = 10 incisors per group) defined by the interventions carried out after endodontic treatment. In the control group, no additional intervention was carried out, while all teeth in the five intervention groups were bleached with 40% H2 O2 and subsequently treated with alpha-tocopherol at concentrations of 15% (15AT), 20% (20AT), or 25% (25AT), with 10% sodium ascorbate (10SA), or with nothing (40HP). Fracture strength was evaluated in a mechanical testing machine, hybrid layer formation was assessed using scanning electron microscopy, and bond strength was determined using microtensile bond-strength testing. Data were analyzed using Kruskal-Wallis and Dunn's tests. No statistically significant difference regarding fracture strength was observed among groups. Hybrid layer formation was greater in the 15AT group than in groups 40HP and 10SA. Teeth in groups 15AT, 20AT, and 25AT demonstrated higher bond strength than teeth in groups 40HP and 10SA. Alpha-tocopherol, preferably at 15%, effectively reverses the deleterious effects, of bleaching, on hybrid layer formation and bond strength to dentin.

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 multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness.

OBJECTIVES: To investigate the effect of multiple firings on color, translucency, and biaxial flexure strength of Virgilite-containing (Li0.5Al0.5Si2.5O6) lithium disilicate glass ceramics of varying thickness. MATERIALS AND METHODS: Sixty discs were prepared from Virgilite-containing lithium disilicate blocks. Discs were divided according to thickness (n = 30) into T0.5 (0.5 mm) and T1.0 (1.0 mm). Each thickness was divided according to the number of firing cycles (n = 10); F1 (Control group): 1 firing cycle; F3: 3 firing cycles, and F5: 5 firing cycles. The discs were tested for color change (ΔE00) and translucency (TP00) using a spectrophotometer. Then, all samples were subjected to biaxial flexure strength testing using a universal testing machine. Data were collected and statistically analyzed (α = 0.5). For chemical analysis, six additional T0.5 discs (2 for each firing cycle) were prepared; for each firing cycle one disc was subjected to X-ray diffraction analysis (XRD) and another disc was subjected to Energy dispersive X-ray spectroscopy (EDX) and Scanning electron microscope (SEM). RESULTS: Repeated firing significantly reduced the translucency of F3 and F5 compared to F1 in T0.5 (p < 0.001), while for T1.0 only F5 showed a significant decrease in TP00 (p < 0.001). For ΔE00, a significant increase was recorded with repeated firings (p < 0.05) while a significant decrease resulted in the biaxial flexure strength regardless of thickness. CONCLUSIONS: Repeated firings had a negative effect on both the optical and mechanical properties of the Virgilite-containing lithium disilicate glass ceramics. CLINICAL RELEVANCE: Repeated firings should be avoided with Virgilite-containing lithium disilicate ceramics to decrease fracture liability and preserve restoration esthetics.

Efficacy of denture cleansers on Candida albicans adhesion and their effects on the properties of conventional, milled CAD/CAM, and 3D-printed denture bases.

OBJECTIVES: Evaluate the efficacy of denture cleaners on the adhesion of Candida albicans and their effects on the surface, optical, and mechanical properties of resins for conventional, milled, and 3D-printed denture bases. MATERIALS AND METHODS: A total of 240 resin samples were made, 120 for testing Candida albicans adhesion, optical stabilities (ΔE00), roughness (Ra), hydrophilicity (°), surface free energy (Owens-Wendt) and 120 samples for testing Candida albicans adhesion, surface microhardness (Knoop), flexural strength and modulus of elasticity in a three-point test, in which they were divided into 3 groups of denture resin (n = 40) and subdivided into 5 cleaners of dentures (n = 8). Data were evaluated by two-way ANOVA and Tukey's test for multiple comparisons (α = 0.05). RESULTS: Denture cleaners with an alkaline solution and dilute acid composition were those that showed the greatest effectiveness in reducing Candida albicans (P < 0.001), however 1% NaOCl significantly affected the properties of the resins (P < 0.05). Denture 3D-printed showed that the surface microhardness was significantly lower for all cleansers (P < 0.05). CONCLUSIONS: Listerine demonstrated superior efficacy in reducing Candida albicans with minimal effect on denture properties, whereas 1% NaOCl had a significant negative impact on the properties. The mechanical properties were significantly lower in 3D-printed resin than in other resins for all denture cleansers. CLINICAL RELEVANCE: Denture base materials are being sold to adapt to the CAD/CAM system, increasing the number of users of dentures manufactured with this system. Despite this, there is little investigation into denture cleaners regarding the adhesion capacity of microorganisms and the optical, surface and mechanical properties of dentures, thus requiring further investigation.

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.

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 fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth.

INTRODUCTION: Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS: Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS: Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION: No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

Comparative analysis of flexural strength of 3D printed and milled 4Y-TZP and 3Y-TZP zirconia.

STATEMENT OF PROBLEM: The mechanical properties of 3 dimensionally (3D) printed zirconia have been reported to be comparable with those of milled zirconia, except for the flexural strength. However, most previous studies tested 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP), making it necessary to study 3D printed zirconia with 4 mol% yttria content (4Y-TZP). PURPOSE: The purpose of this in vitro study was to compare the flexural strength of 3D printed 4Y-TZP with 3Y-TZP materials and milled 4Y-TZP. MATERIAL AND METHODS: A total of 80 disk specimens (Ø15×1.5 mm) were fabricated and divided into 4 groups (n=20) using the fabrication method and yttria content: milled 3Y-TZP (Katana HT; Kuraray Noritake), 3D printed 3Y-TZP (TZ-3Y-E; Tosoh), milled 4Y-TZP (Katana STML; Kuraray Noritake), and 3D printed 4Y-TZP (3DMAT; Genoss). The biaxial flexural strength was determined with a piston-on-3-ball test (n=15). The flexural strength of each specimen was measured, and the Weibull modulus (m) and characteristic strength (σ0) were estimated from the fracture load distribution. Two intact and fractured specimens were examined with scanning electron microscopy (SEM). The crystalline phase of the specimens in each group was identified through X-ray diffraction (XRD) analysis (n=5). A 1-way ANOVA was used to compare the flexural strength among different groups. Subsequently, pairwise comparisons were conducted with the Tukey post hoc method (α=.05). RESULTS: The flexural strength of 3D printed 4Y-TZP was significantly higher than that of milled 4Y-TZP (P<.001). In contrast, the flexural strength of 3D printed 3Y-TZP was significantly lower than that of milled 3Y-TZP (P<.001). X-ray diffraction (XRD) analysis revealed that the tetragonal phase was the dominant phase in all groups, with the identification of some cubic phase peaks. CONCLUSIONS: Three dimensionally printed 4Y-TZP showed significantly higher flexural strength than milled 4Y-TZP and exhibited a clinically acceptable flexural strength exceeding 800 MPa.

Effect of the coloring liquid shade and dipping time on the color, transparency, and flexural strength of monolithic zirconia.

STATEMENT OF PROBLEM: The impact of different coloring liquid shades and dipping times on the color, transparency, and flexural strength of monolithic zirconia ceramics is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effects of different coloring liquid shades (A2, 3M2, and 5M2) and dipping times (no dipping, 30 seconds, 60 seconds, and 90 seconds) on the color difference (ΔE00), relative translucency parameter (ΔRTP00), and 3-point flexural strength (σ) of monolithic zirconia ceramics. MATERIAL AND METHODS: Yttria-stabilized zirconia (3Y-TZP, 3 mol%) was cut into Ø16×1.2-mm plates (n=10) and 25×4×1.2-mm bars (n=15), which were colored using 3 shades of coloring liquid at 4 dipping times. Color coordinates were measured on a gray background by using a digital spectrophotometer with an integrating sphere attachment. The color and translucency differences were evaluated using 50:50% perceptibility (PT00 and TPT00) and acceptability (AT00 and TAT00) thresholds. The 3-point flexural strengths of the bar-shaped specimens were measured using a universal testing machine and analyzed using the Weibull distribution to calculate the Weibull modulus (m) and characteristic fracture strength (σ0). The data were analyzed with the 2-way ANOVA, Kruskal-Wallis, and LSD post hoc tests (α=.05). RESULTS: Both shade and dipping time significantly affected the color and translucency of monolithic zirconia (P<.001). The ΔE00 was above the PT00 for all groups, with only 3M2-90 and A2-60 being below the AT00. The main cause of color differences was the difference in lightness. Only A2 showed ΔRTP00 below the TPT00 (A2-30 (ΔRTP00=0.26), A2-60 (ΔRTP00=0.29), and A2-90 (ΔRTP00=0.46)). All experimental groups showed translucency differences below TAT00. In addition, only the dipping time had a significant effect on the flexural strength of zirconia (P<.001). CONCLUSIONS: The optical properties of monolithic zirconia ceramics were affected by the shade and dipping time of the coloring liquid. The mismatch in lightness was the main reason for the color difference. The dipping time affects the flexural strength of monolithic zirconia, whereas the shade of the coloring liquid did not seem to influence flexural strength.

Mechanical properties of conventional versus microwave-polymerized denture base acrylic resins.

STATEMENT OF PROBLEM: New denture base acrylic resins have been introduced that are specifically formulated for microwave polymerization. Microwave polymerization is a time-efficient procedure, but few studies have evaluated how these new acrylic resin formulations compare with conventionally processed acrylic resins. PURPOSE: The purpose of this in vitro study was to compare the stiffness and strength of denture base acrylic resins formulated for microwave polymerization with conventionally processed acrylic resin. MATERIAL AND METHODS: Rectangular beams were fabricated from 2 microwave-polymerized denture base acrylic resins, microwave-specific resin (Nature-Cryl MC), resin with the option of microwave polymerization (Diamond D), and a conventionally processed resin as a control (Lucitone 199). Specimens (n=10) were stored in water for 1 week and subjected to a 3-point bend test to determine the flexural modulus (stiffness) and flexural strength before (initial properties) or after 120 000 load cycles. The load cycles, conducted between 5 and 25 N at 2 Hz, simulated 6 months of mastication. Data were analyzed by using 2-way ANOVA, followed by pairwise comparisons (α=.05). RESULTS: The initial flexural modulus (mean ±standard deviation) was conventionally processed resin, 2.65 ±0.33 GPa; microwave-specific resin, 3.01 ±0.20 GPa; and microwave-option resin, 2.63 ±0.04 GPa. After load cycling, the mean flexural modulus was conventionally processed resin, 2.34 ±0.32 GPa; microwave-specific resin, 2.69 ±0.20 GPa; and microwave-option resin, 1.96 ±0.11 GPa. The initial flexural strength was conventionally processed resin, 77.6 ±11.0 MPa; microwave-specific resin, 83.6 ±3.5 MPa; and microwave-option resin, 78.9 ±2.6 MPa. After load cycling, the mean flexural strength was conventionally processed resin, 68.7 ±9.0 MPa; microwave-specific resin, 73.3 ±3.3 MPa; and microwave-option resin, 65.5 ±3.5 MPa. Resin and loading state significantly affected the stiffness and strength (P<.01); the interaction resin×state was not significant (P≥.558). CONCLUSIONS: Microwave-polymerized denture base acrylic resins were comparable in stiffness and strength with conventionally processed acrylic resin. All acrylic resins decreased in stiffness and strength after load cycling. The microwave-specific resin was significantly stiffer and stronger than the other denture base acrylic resins, initially and after 120 000 load cycles.

Color- and strength-graded zirconia: Strength, light transmission, and composition.

STATEMENT OF PROBLEM: Natural teeth are graded in terms of translucency and strength. Graded zirconia materials are now available with a higher yttria content on the top or in the enamel zone to increase surface translucency and a lower yttria content on the bottom or in the dentin zone to increase strength. Such materials could provide multiple advantages over uniform materials and reduce the need for porcelain veneering in anterior artificial crowns; however, studies on the properties of these materials are lacking. PURPOSE: The purpose of this in vitro study was to measure and compare the biaxial flexural strength, percentage light transmission, elemental content, and phase content of zones within and among color graded zirconia blocks and color- and strength-graded zirconia blocks. MATERIAL AND METHODS: Disks of a color graded material (Katana STML) and a strength- and color-graded material (IPS e.max ZirCAD Prime) were fabricated (Zircom Furnace). Biaxial flexural strength was measured using a piston-on-3-ball test in a universal testing machine (n=10). Absolute light transmission was measured with a spectrophotometer. Elemental compositions were quantified for 3 zones in each of the 2 zirconia materials using X-ray fluorescence analysis. Zirconia phase fractions were quantified for 3 zones using X-ray diffraction analysis (XRD). Where appropriate, 2-way ANOVA, 1-way ANOVA, and Tukey multiple pairwise comparison testing were used to determine which of the 6 zones differed from one another (α=.05). RESULTS: The color-graded zirconia exhibited gradients in light transmission and differences in phase content in the 3 zones measured. The color- and strength-graded zirconia exhibited gradients in light transmission, biaxial flexural strength, elemental composition, and phase content in the 3 zones measured. The bottom, dentin, or intaglio layer of a strength graded zirconia material was substantially stronger than all other zones of either material (P<.05). The top, enamel, zones of both materials possessed high light transmissibility (P<.05). The 2 materials differed with respect to biaxial strength (P<.001), light transmission (P<.02), elemental composition, and phase composition overall, as well as in most zone-by zone comparisons (P<.05). The performance and composition of the color graded material was consistent with it being a 5Y material throughout. The performance and composition of the color and strength graded material was consistent with it having a 3Y bottom zone and a 5Y top zone. CONCLUSIONS: A strength-graded and color-graded zirconia material offers potential advantages in both strength and translucency.

Effects of simulated long-term exposure to bottled, neutral pH electrolyzed oxidizing water on the properties of denture base resins.

STATEMENT OF PROBLEM: Denture stomatitis can pose serious health risks, especially to older people. Chemical denture cleaning agents must be effective, yet not adversely affect the longevity of removable dentures. Ready-to-use (RTU) neutral pH electrolyzed oxidizing water (EOW) is an effective biocide against Candida albicans biofilms on denture resins, but the effects of daily disinfection with EOW on the physical and mechanical properties of resins have not been established. PURPOSE: The purpose of this in vitro study was to investigate the effects of simulated long-term exposure to RTU EOW on the color, surface characteristics, and flexural strength of denture base resins. MATERIAL AND METHODS: Heat-polymerized (HP), 3D printed (3D) and computer-aided design and computer-aided manufacture (CAD-CAM)-milled (CC) denture resin specimens (square: 20×20×3.3 mm; beam: 64×10×3.3 mm) were immersed in tap water (TW), RTU EOW (Neutral Anolyte ANK; Envirolyte; EOW), or a commercial denture cleaning tablet solution (Polident 3-Minute; Glaxo SmithKline; PD), mimicking a 5-minute once daily disinfection routine performed up to 3.0 years. Color and surface roughness were recorded (n=3, squares), and changes in color (∆E00) and surface roughness (∆Ra) were calculated. Flexural strength (n=12, beams) and surface hardness (n=18, beams) were measured with a universal testing machine. The fractured surfaces of specimens were examined by scanning electron microscopy and energy dispersive spectroscopy. Data were assessed by performing the Shapiro-Wilk or D'Agostino and Pearson normality tests. Two-way ANOVA or the Kruskal-Wallis test with a post hoc Tukey HSD or Dunn multiple comparisons (α=.05) was used for statistical analyses. RESULTS: No significant changes were found in either color or surface roughness for HP, 3D, and CC resins after 1.5-year and 3.0-year immersion in any of the agents (P>.05). The surface hardness of 3D resins reduced by 14% with TW and by 23% with EOW and PD at 3.0 years. The flexural strengths of all 3 resins were unaffected by 3.0-year immersion (P>.05). CONCLUSIONS: Simulated long-term immersion disinfection with RTU neutral pH EOW did not adversely affect the physical and mechanical properties of HP or CC denture resins.

Effect of nanomodified 3D printed photopolymerizable resin on flexural strength, color, and antimicrobial efficacy: An in vitro study.

STATEMENT OF PROBLEM: Three-dimensional (3D) printing has become popular in dentistry, but studies on the influence of incorporating organic and inorganic nanofillers on 3D printed materials are lacking. PURPOSE: The purpose of this in vitro study was to assess the flexural strength, color, and antimicrobial efficacy of 3D printed photopolymerizable resin upon adding titanium dioxide nanoparticles (TiO2 NPs) and silanized chitosan nanoparticles (sCS NPs). MATERIAL AND METHODS: A stereolithographic material (VarseoSmile Crown plus; Bego) was used as a control group (VSC resin), and 3 nanocomposite resin groups were prepared by adding nanoparticles as follow: titanium dioxide group (VSC resin + 0.4% wt. TiO2 NPs), chitosan group (VSC resin + 0.4% wt. sCS NPs), and hybrid group (VSC resin + 0.2% wt. TiO2 NPs + 0.2% wt. sCS NPs). A total of 132 specimens were designed by using a free computer-aided design software program, printed, postpolymerized, and divided into 4 groups. The nanocomposite resins were characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and Fourier-transform infrared spectroscopy (FTIR). Bar shaped specimens (n=44) were tested for 3-point flexural strength using a universal testing machine followed by the color measurement of disk-shaped specimens (n=44) with a spectrophotometer. Antimicrobial capacity was measured with Streptococcus mutans, and absorbance was measured using a microplate reader (n=44). Statistical assessments were made with 1-way ANOVA followed by the Tukey post hoc test with Bonferroni adjustment (α=.05). RESULTS: The hybrid group recorded the highest mean value of flexural strength 135.51 MPa, showing a significant difference compared with that of the control group (P=.022). Regarding color, the mean ∆E00 for titanium was 1.18, for chitosan was 4.26, and for the hybrid group was 3.23 (P<.001). The optical density of the chitosan (2.42) was significantly higher than that of the titanium 1.36 (P=.007) and that of the control 1.63 (P=.042). CONCLUSIONS: The incorporation of nanofillers resulted in an increase in flexural strength, but it adversely affected the color of nanocomposite resins. Antimicrobial efficacy was improved by incorporating titanium nanofillers.

Flexural strength, flexural modulus and microhardness of milled vs. fused deposition modeling printed Zirconia; effect of conventional vs. speed sintering.

BACKGROUND: Various methods can be used for creating zirconia dental restorations, including 3-dimensional (3D) printing and computer-aided design/ computer-aided manufacturing (CAD/CAM) milling. The fused deposition modeling (FDM) printing method for zirconia presents numerous advantages, albeit research on the mechanical properties of these materials and resultant restorations remains scarce. Such developments are undeniably intriguing and warrant further investigation. The objective of the present study was to evaluate the impact of the sintering firing cycle (Conventional vs. Speed sintering) on the flexural strength, flexural modulus, and Vickers Microhardness of milled vs. FDM printed zirconia. METHODS: A total of 60 bars (2 × 5 × 27 mm) were fabricated for flexural strength testing, along with 40 discs (12 × 1.5 mm) for Vickers microhardness testing. Half of the specimens underwent conventional sintering, while the other half underwent a speed sintering cycle. The flexural strength and modulus were determined by a three-point bending test in a universal testing machine. The microhardness of the specimens was evaluated using a Vickers microhardness tester. Statistical analysis was performed using a two-way ANOVA test with a post-hoc Tukey test (p < 0.05). RESULTS: CAD/CAM milled zirconia had significantly higher flexural strength and modulus than FDM-printed zirconia. The sintering process did not significantly affect the flexural strength or modulus of milled or FDM-printed zirconia. The milled speed sintering group had significantly higher values in the Vickers microhardness test compared to the other groups. CONCLUSIONS: The mechanical properties of FDM-printed zirconia specimens were not found to be comparable to those of milled zirconia. Speed sintering cycle may produce milled zirconia restorations with similar flexural strength and modulus to conventional sintering, and even higher Vickers Microhardness values.

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.

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.

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.

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.

Effect of E-glass fibers addition on compressive strength, flexural strength, hardness, and solubility of glass ionomer based cement.

BACKGROUND: In dentistry, glass-ionomer cements (GICs) are extensively used for a range of applications. The unique properties of GIC include fluoride ion release and recharge, chemical bonding to the tooth's hard tissues, biocompatibility, a thermal expansion coefficient like that of enamel and dentin, and acceptable aesthetics. Their high solubility and poor mechanical qualities are among their limitations. E-glass fibers are generally utilized to reinforce the polymer matrix and are identified by their higher silica content. OBJECTIVES: The purpose of the study was to assess the impact of adding (10 wt% and 20 wt%) silane-treated E-glass fibers to traditional GIC on its mechanical properties (compressive strength, flexural strength, and surface hardness) and solubility. METHODS: The characterization of the E-glass fiber fillers was achieved by XRF, SEM, and PSD. The specimens were prepared by adding the E-glass fiber fillers to the traditional GIC at 10% and 20% by weight, forming two innovative groups, and compared with the unmodified GIC (control group). The physical properties (film thickness and initial setting time) were examined to confirm operability after mixing. The evaluation of the reinforced GIC was performed by assessing the compressive strength, flexural strength, hardness, and solubility (n = 10 specimens per test). A one-way ANOVA and Tukey tests were performed for statistical analysis (p ≤ 0.05). RESULTS: The traditional GIC showed the least compressive strength, flexural strength, hardness, and highest solubility. While the GIC reinforced with 20 wt% E-glass fibers showed the highest compressive strength, flexural strength, hardness, and least solubility. Meanwhile, GIC reinforced with 10 wt% showed intermediate results (P ≤ 0.05). CONCLUSION: Using 20 wt% E-glass fiber as a filler with the traditional GIC provides a strengthening effect and reduced solubility.

In vitro antifungal and physicochemical properties of polymerized acrylic resin containing strontium-modified phosphate-based glass.

Acrylic resins are widely used as the main components in removable orthodontic appliances. However, poor oral hygiene and maintenance of orthodontic appliances provide a suitable environment for the growth of pathogenic microorganisms. In this study, strontium-modified phosphate-based glass (Sr-PBG) was added to orthodontic acrylic resin at 0% (control), 3.75%, 7.5%, and 15% by weight to evaluate the surface and physicochemical properties of the novel material and its in vitro antifungal effect against Candida albicans (C. albicans). Surface microhardness and contact angle did not vary between the control and 3.75% Sr-PBG groups (p > 0.05), and the flexural strength was lower in the experimental groups than in the control group (p < 0.05), but no difference was found with Sr-PBG content (p > 0.05). All experimental groups showed an antifungal effect at 24 and 48 h compared to that in the control group (p < 0.05). This study demonstrated that 3.75% Sr-PBG exhibits antifungal effects against C. albicans along with suitable physicochemical properties, which may help to minimize the risk of adverse effects associated with harmful microbial living on removable orthodontic appliances and promote the use of various materials.