Clinical evaluation of posterior flowable short fiber-reinforced composite restorations without proximal surface coverage.

The purpose of this clinical trail was to assess the clinical behavior of posterior composite restorations supported by a substantial foundation of flowable short fiber-reinforced composite SFRC (everX Flow, GC, Japan) used without proximal surface coverage with particulate filler resin composite (PFC). Seventy patients (20 males, 50 females; mean age: 30 ± 10 years) were randomly enrolled in this trial. Patients received direct restorations of either SFRC covered only on the occlusal surface (1-2 mm) by conventional PFC composite (G-ænial Posterior, GC), or plain conventional PFC composite without fiber-reinforcement, in Class II cavities in premolar and molar vital teeth. One operator made all restorations using one-step, self-etch bonding agent (G-ænial Bond, GC) according to manufacturers' recommendations. Two blinded trained operators evaluated the restorations at baseline, at 6, 12 and 18 months using modified USPHS criteria. Results indicated that, in both groups and at different follow-up intervals, according to evaluated criteria, restorations were rated mostly with best score (Alpha) (p > 0.05). For the marginal integrity after 6 months, a single case in the intervention [increased to 3 (8.8%) after 18 months] and 3 (9.7%) cases of the control group [increased to 4 (12.9%) after 18 months] had Bravo score but with no significant difference (p > 0.05). For color match measured after 6 and 18 months, three (8.8%) cases had Bravo score in the intervention group. The use of flowable SFRC composite without any PFC surface coverage proximally in Class II restorations demonstrated satisfactory clinical outcome throughout the 18-month follow-up.

Wear behavior at margins of direct composite with CAD/CAM composite and enamel.

OBJECTIVES: The aim was to investigate the two-body wear at the marginal area between direct filling composites and substrate of CAD/CAM composites or enamel. MATERIALS AND METHODS: Flat specimens were prepared from CAD/CAM composites (CERASMART 270 and SFRC CAD) and bovine enamel. A box-shaped cavity cut into CAD/CAM composites and enamel surfaces was made. The prepared cavity in CAD/CAM composites was treated with a primer, while in enamel, the cavity was treated with an adhesive. Three conventional composites (Universal Injectable, G-aenial A'Chord, and Filtek Bulk Fill) and one short fiber composite (everX Flow) were placed and cured in the prepared cavities. A two-body wear test was conducted with 15,000 chewing cycles using a dual-axis chewing simulator. The specimens (n = 5/per group) were positioned to produce wear (load = 20 N) across the marginal area between filling composites and substrates. The wear depth was analyzed using a 3D optical profilometer. SEM was used to evaluate the wear behavior and margins between the filling and substrate materials. RESULTS: All composites used displayed different wear behavior (20-39 µm) (p < 0.05). The highest wear values were recorded for A'Chord and Filtek, while the lowest values were for Injectable and CERASMART 270. The data analysis showed that the wear behavior of substrate materials depends on the filling materials used at margins (p < 0.05). The marginal breakdown was seen only between bovine enamel and filling composites. CONCLUSIONS: The use of the two-body wear simulation method revealed important information about the behavior of the filling composites at the marginal area with CAD/CAM composites or bovine enamel substrates. CLINICAL RELEVANCE: The marginal breakdown related to the material combination at the bonding region.

Fatigue performance of endodontically treated premolars restored with direct and indirect cuspal coverage restorations utilizing fiber-reinforced cores.

OBJECTIVES: The aim of this in vitro study was to investigate the fatigue survival and fracture behavior of endodontically treated (ET) premolars restored with different types of post-core and cuspal coverage restorations. MATERIALS AND METHODS: MOD cavities were prepared on 108 extracted maxillary premolars. During the endodontic treatment, all teeth were instrumented with rotary files (ProTaper Universal) to the same apical enlargement (F2) and were obturated with a matched single cone obturation. After the endodontic procedure, the cavities were restored with different post-core and overlay restorations (n = 12/group). Three groups (A1-A3) were restored with either conventional composite core (PFC; control) or flowable short-fiber-reinforced composite (SFRC) core with/without custom-made fiber posts and without overlays. Six groups had similar post-core foundations as described above but with either direct PFC (B1-B3) or indirect CAD/CAM (C1-C3) overlays. Fatigue survival was tested for all restorations using a cyclic loading machine until fracture occurred or 50,000 cycles were completed. Kaplan-Meyer survival analysis was conducted, followed by pairwise post hoc comparisons. RESULTS: None of the restored teeth survived all 50,000. Application of flowable SFRC as luting-core material with fiber post and CAD/CAD overlays (Group C3) showed superior performance regarding fatigue survival (p < 0.05) to all the other groups. Flowable SFRC with fiber post and direct overlay (Group B3) showed superior survival compared to all other direct techniques (p < 0.05), except for the same post-core foundation but without cuspal coverage (Group A3). CONCLUSIONS: Custom-made fiber post and SFRC as post luting core material with or without cuspal coverage performed well in terms of fatigue resistance and survival when used for the restoration of ET premolars. CLINICAL RELEVANCE: The fatigue survival of direct and indirect cuspal coverage restorations in ET MOD premolars is highly dependent on whether the core build-up is fiber-reinforced or not. The combination of short and long fibers in the form of individualized post-cores seems to offer a favorable solution in this situation.

Midline denture base strains of glass fiber-reinforced single implant-supported overdentures.

STATEMENT OF PROBLEM: The fracture incidence of implant-supported overdentures is more frequent in the area of attachment because of stress concentration and denture deformation in this area. How E-glass fiber reinforcement can address this problem is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the influence of unidirectional E-glass fiber reinforcement on the mid-line denture base strains of single implant-supported overdentures. MATERIAL AND METHODS: An experimental acrylic resin cast was constructed with a single implant placed in the mid-line area and a ball attachment screwed to the implant. Twenty-four experimental overdentures were constructed and divided into 4 groups: group AP fabricated from autopolymerizing acrylic resin without fiber reinforcement, group APF fabricated from autopolymerizing acrylic resin with unidirectional E-glass fiber reinforcement running over the residual ridge and the ball matrix, group HP fabricated from heat-polymerized acrylic resin without fiber reinforcement, and group HPF fabricated from heat-polymerized acrylic resin with unidirectional E-glass fiber reinforcement running over the residual ridge and the ball matrix. A biaxial rosette strain gauge was attached to the incisor areas of each overdenture above the attachment level (Ch1, Ch2) and to a multichannel digital strain meter. A static vertical load of 100 N was applied to the first molar area bilaterally by using a universal testing device during strain measurement procedures. The differences in the mean strain and deflection values among the investigated groups were evaluated for statistical significance using 1-way analysis of variance (ANOVA) with the Tukey post hoc multiple comparison (α=.05). RESULTS: The type of acrylic resin did not have a statistically significant effect on the mean strain values among groups (P=.350), while the reinforcement did significantly affect them (P<.001). The interaction between reinforcement and acrylic resin was not statistically significant (P=.552). Both strain gauge channels in group APF and group HPF recorded significantly lower strain values by almost 50% than those of group AP and group HP (P<.05). CONCLUSIONS: Unidirectional E-glass fiber reinforcement placed over the residual ridge and implant attachment significantly reduced denture base strains and deformation of single implant-supported overdentures.

Assessment of CAD-CAM polymers for digitally fabricated complete dentures.

STATEMENT OF PROBLEM: Information on the mechanical properties of the materials used for manufacturing computer-engineered complete dentures is scarce. PURPOSE: The purpose of this in vitro study was to evaluate the mechanical properties of 3 prepolymerized polymethyl methacrylate (PMMA) resins used in the fabrication of computer-aided design and computer-aided manufacturing (CAD-CAM) milled complete dentures (CDs), as well as 2 denture base polymers used for conventionally fabricated CDs. MATERIAL AND METHODS: Three CAD-CAM materials were evaluated: Degos Dental L-Temp, IvoBase CAD, and Zirkonzahn Temp Basic Tissue. Two materials used for conventionally manufactured dentures were also included as controls (Palapress and Paladon 65). Each material type was sectioned into bars for flexural strength, nanohardness, elastic modulus, and surface microhardness evaluation (n=8/material). Half of the specimens were stored in water for 30 days, while the other half was dry-stored. A 2-way ANOVA was conducted to detect the effect of material and storage on the evaluated properties (α=.05). Linear contrasts were conducted to compare the differences among the 3 types of CAD-CAM material and the conventional ones. RESULTS: Material type and storage had a significant influence on the flexural strength, nanohardness, elastic modulus, and surface hardness of the materials investigated (P<.001). The post hoc Scheffé test for flexural strength revealed a nonsignificant difference in the interaction between Degos L-Temp and Paladon (P=1.000). In terms of nanohardness, no difference was found when comparing Palapress with Paladon, as well as IvoBase CAD with Zirkonzahn Temp Basic (P=1.000). A nonsignificant interaction in terms of surface hardness was also found between IvoBase CAD and Palapress (P=.575). CONCLUSIONS: The tested materials showed variation in their mechanical properties, with satisfactory behavior of the CAD-CAM materials. However, the results obtained when testing the materials used for the conventional fabrication of complete dentures suggest that their use might still be advisable.

Incorporation of cellulose fiber in glass ionomer cement.

This study investigated the effect of discontinuous cellulose microfibers with various loading fractions on selected physical properties of glass polyalkenoate (glass ionomer) cement (GIC). Fiber-reinforced GIC (Exp-GIC) was prepared by adding discontinuous cellulose microfiber (with an average length of 500 µm) at various mass ratios (1, 2, 3, 4, and 5 mass%) to the powder of conventional GIC (GC Fuji IX) using a high-speed mixing device. Fracture toughness, work of fracture, and compressive strength were determined for each experimental and control material. The specimens (n = 6) were wet stored (37°C for 1 d) before testing. A scanning electron microscope equipped with an energy dispersive spectroscope was used to examine the surface of fibers after treatment with cement liquid. Data were analyzed using ANOVA. The Exp-GIC (5 mass%) specimen had statistically significantly higher fracture toughness (0.9 MPa.m1/2 ) than unreinforced material (0.4 MPa.m1/2 ). On the other hand, Exp-GIC with 1 mass% displayed the highest compressive strength (116 MPa) among all tested groups. The use of discontinuous cellulose microfibers with conventional GIC matrix considerably increased the toughening performance compared with the particulate GICs used.

Fracture resistance and marginal gap formation of post-core restorations: influence of different fiber-reinforced composites.

OBJECTIVES: The aim was to explore the fracture behavior and marginal gap within the root canal of endodontically treated (ET) premolars restored with different fiber-reinforced post-core composites (FRCs). Further aim was to evaluate the composite curing at different depths in the canal. MATERIALS AND METHODS: Eighty-seven intact upper premolars were collected and randomly divided into six groups. After endodontic procedure, standard MOD cavities were prepared and restored with their respective fiber-reinforced post-core materials: group 1: prefabricated unidirectional FRC-post + conventional composite core; group 2: prefabricated unidirectional FRC-post + short fiber composite (SFRC) core; group 3: individually formed unidirectional FRC-post + conventional composite core; group 4: randomly oriented SFRC directly layered as post and core; group 5: individually formed unidirectional FRC + randomly oriented SFRC as post and core. After restorations were completed, teeth (n = 3/group) were sectioned and then stained. Specimens were viewed under a stereo microscope and the percentage of microgaps within the root canal was calculated. Fracture load was measured using universal testing machine. RESULTS: SFRC application in the root canal (groups 4 and 5) showed significantly higher fracture load (876.7 N) compared to the other tested groups (512-613 N) (p < 0.05). Post/core restorations made from prefabricated FRC-post (group 1) exhibited the highest number of microgaps (35.1%) at the examined interphase in the root canal. CONCLUSIONS: The restoration of ET premolars with the use of SFRC as post-core material displayed promising performance in matter of microgap and load-bearing capacity. CLINICAL SIGNIFICANCE: Fracture resistance of ET premolar restored by bilayered composite restoration that includes both SFRC as post-core material and surface conventional resin seems to be beneficial.

Effect of interface surface design on the fracture behavior of bilayered composites.

This study aimed to evaluate the effect of different interface designs on the load-bearing capacity of bilayered composite structures (BLS). Cylindrical specimens of BLS were prepared from base composite of 3.5 mm thickness and surface composite of 1.5 mm thickness (n = 80). Two different base composites - flowable bulk-fill (FBF) [smart dentin replacement (SDR)] and short fiber-reinforced (FRC) (everX Posterior) - were evaluated, and conventional composite (G-aenial Posterior) was used as the surface layer. Four different interface designs were used: (i) pyramidal; (ii) mesh; (iii) linear grooves; and (iv) flat surface (control). Three-dimensional printed molds were fabricated to standardize the interface design between the surface and the base composites. The specimens were then statically loaded with a steel ball until fracture using a universal testing machine. Fracture types were classified into catastrophic, complete, and partial bulk. ANOVA revealed that both the material and the interface design had a statistically significant effect on the load-bearing capacity. Flowable bulk-fill showed lower mean load-bearing capacity than FRC in all the interface designs tested, except for the flat surface design. Fracture analysis showed that FRC demonstrated up to 100% partial bulk fractures with the pyramid interface design, but no incidence of catastrophic bulk fracture. By contrast, FBF demonstrated up to 84.6% and 40% catastrophic bulk fractures with the flat interface design but no incidence of partial bulk fracture. Consequently, the interface designs studied enhanced the fracture behavior of BLS.

Scattering of therapeutic radiation in the presence of craniofacial bone reconstruction materials.

PURPOSE: Radiation scattering from bone reconstruction materials can cause problems from prolonged healing to osteoradionecrosis. Glass fiber reinforced composite (FRC) has been introduced for bone reconstruction in craniofacial surgery but the effects during radiotherapy have not been previously studied. The purpose of this study was to compare the attenuation and back scatter caused by different reconstruction materials during radiotherapy, especially FRC with bioactive glass (BG) and titanium. METHODS: The effect of five different bone reconstruction materials on the surrounding tissue during radiotherapy was measured. The materials tested were titanium, glass FRC with and without BG, polyether ether ketone (PEEK) and bone. The samples were irradiated with 6 MV and 10 MV photon beams. Measurements of backscattering and dose changes behind the sample were made with radiochromic film and diamond detector dosimetry. RESULTS: An 18% dose enhancement was measured with a radiochromic film on the entrance side of irradiation for titanium with 6 MV energy while PEEK and FRC caused an enhancement of 10% and 4%, respectively. FRC-BG did not cause any measurable enhancement. The change in dose immediately behind the sample was also greatest with titanium (15% reduction) compared with the other materials (0-1% enhancement). The trend is similar with diamond detector measurements, titanium caused a dose enhancement of up to 4% with a 1 mm sample and a reduction of 8.5% with 6 MV energy whereas FRC, FRC-BG, PEEK or bone only caused a maximum dose reduction of 2.2%. CONCLUSIONS: Glass fiber reinforced composite causes less interaction with radiation than titanium during radiotherapy and could provide a better healing environment after bone reconstruction.

Fatigue resistance of a simulated single LOCATOR overdenture system.

STATEMENT OF PROBLEM: The incidence of fracture in a single-implant overdenture base increases in the region adjacent to the fulcrum implant. PURPOSE: The purpose of this in vitro study was to evaluate the effect of bidirectional woven electrical glass (E-glass) fiber reinforcements on the fatigue resistance of a simulated single LOCATOR-retained overdenture. MATERIAL AND METHODS: Test specimens with a centrally positioned metal housing for a LOCATOR stud attachment were fabricated from autopolymerizing acrylic resin. Specimens for the control group were fabricated without glass fiber reinforcements. The 4L group specimens had 4 layers of E-glass fiber weaves and were divided according to the fiber location into the following 3 subgroups: 4L-A with 4 fiber layers above the metal housing; 4L-N with 4 fiber layers adjacent to the metal housing; and 4L-A+4L-N with 4 fiber layers above and 4 fiber layers adjacent to the housing. Specimens were stored in distilled water for 1 week at 23 °C before cyclic fatigue testing at 10 000 cycles by using a staircase approach (n=12). The results were analyzed with 1-way ANOVA and the Tukey multiple comparisons post hoc analysis (α=.05). A 2-way ANOVA (α=.05) was conducted to detect the effect of fatigue cyclic loading and the position of the fiber layers and their interaction on the fatigue resistance. RESULTS: The results of the investigated compressive fatigue limits for the test groups were 190 ±15.9 N for the control group, 265 ±15.9 N for the 4L-A subgroup, 220 ±15.9 N for the 4L-N subgroup, and 275 ±15.9 N for the 4L-A+4L-N subgroup. A nonsignificant difference was found for creep values between the control group and reinforced subgroups (P>.05). The postfatigue flexural strength values in the 4L-A and 4L-A+4L-N subgroups were significantly higher than those in the control group (P<.001) and the 4L-N subgroup (P=.004 and P=.005). However, no significant difference was found in postfatigue flexural strength between the control group and the 4L-N subgroup (P=.828). CONCLUSIONS: Placing 4 layers of bidirectional E-glass fiber weaves above the metal housing can increase the fatigue resistance and the postfatigue flexural strength of single LOCATOR-retained overdentures.

From body-on-frame to unibody constructions and designs mimicking biological structures - an overview.

In dentistry, isotropic materials, such as metals, ceramics, and polymers, are used. Their properties are not related to any specific direction of the material microstructure. There is a trend toward non-metallic, adhesive, and minimally invasive dentistry. This is in line with the conceptual change seen in the automobile industry, in which the basis of car structures has changed from body-on-frame designs to unibody designs. In unibody designs, all structural parts of the body of the car mechanically form a single structural entity. In modern adhesive dentistry, remaining tooth substance and the dental material form unibody designs, enabling preservation of tooth substance. Biological structures are created to withstand loading and are light in weight. The structural designs of elements in these biological materials are, to a large extent, based on fibrous material. More attention has been paid to mimicking fibrous structures of dental hard tissues by synthetic fiber-reinforced composites. This overview reports key features of natural fibrous elements and how they are utilized in dentistry. Special emphasis is placed on the aspects of interfacial adhesion of restorative materials, especially ceramics to resin-based materials and their role in the unibody design of the tooth-restoration system.

Immediate Repair Bond Strength of Fiber-reinforced Composite after Saliva or Water Contamination.

PURPOSE: This in vitro study aimed to evaluate the shear bond strength (SBS) of particulate filler composite (PFC) to saliva- or water-contaminated fiber-reinforced composite (FRC). MATERIALS AND METHODS: One type of FRC substrate with semi-interpenetrating polymer matrix (semi-IPN) (everStick C&B) was used in this investigation. A microhybrid PFC (Filtek Z250) substrate served as control. Freshly cured PFC and FRC substrates were first subjected to different contamination and surface cleaning treatments, then the microhybrid PFC restorative material (Filtek Z250) was built up on the substrates in 2-mm increments and light cured. Uncontaminated and saliva- or water-contaminated substrate surfaces were either left untreated or were cleaned via phosphoric acid etching or water spray accompanied with or without adhesive composite application prior applying the adherent PFC material. SBS was evaluated after thermocycling the specimens (6000 cycles, 5°C and 55°C). RESULTS: Three-way ANOVA showed that both the surface contamination and the surface treatment signficantly affected the bond strength (p < 0.05). Saliva contamination reduced the SBS more than did the water contamination. SBS loss after saliva contamination was 73.7% and 31.3% for PFC and FRC, respectively. After water contamination, SBS loss was 17.2% and 13.3% for PFC and FRC, respectively. The type of surface treatment was significant for PFC (p < 0.05), but not for FRC (p = 0.572). CONCLUSION: Upon contamination of freshly cured PFC or semi-IPN FRC, surfaces should be re-prepared via phosphoric acid etching, water cleaning, drying, and application of adhesive composite in order to recover optimal bond strength.

Creep Behavior of Resin Composite Interface Between Orthodontic Brackets and Enamel.

PURPOSE: The present study investigated the creep of adhesive resin under constant loading at the orthodontic bracket/enamel interface with an orthodontic bracket-tooth model (shear creep) and three-point bending test (bending creep). MATERIALS AND METHODS: For the bracket-tooth model, sixty premolars were assigned to 4 groups (n = 15). Orthodontic brackets were bonded onto the enamel surface using four different bonding agents: conventional, homogeneous Transbond XT orthodontic composite (group 1/TBC); Transbond XT composite reinforced with photopolymerized glass-fiber-reinforced composite (FRC with bidirectional fibers) (group 2/TBE); Transbond XT reinforced with FRC of vertically oriented unidirectional fibers (group 3/TBV); and Transbond XT reinforced with FRC of horizontally oriented fibers (group 4/TBH). Load was applied at the bracket/tooth interface and from the bracket wire slot. In the three-point bending test, the creep and recovery of the rectangular interface materials were tested by a dynamic mechanical analyzer. The data obtained were statistically analyzed with ANOVA and a post-hoc test using SPSS v20 statistical software. RESULTS: The groups exhibited significant differences in strain % and time for bracket deflection at the interface (p < 0.05). The interface loading with unidirectional fibers (groups TBV and TBH) were statistically significantly different compared to the interface with bidirectional fibers and control group (groups TBE and TBC). The three-point test showed the least creep compliance (ie, creep deformation occurring at each time point [J]) with group TBC, followed by groups TBV and TBE. Group TBC showed the highest nanohardness and elastic modulus; the lowest values were seen in group TBE, reflecting differences in polymer matrix composition. CONCLUSION: The creep and time for debonding the bracket increased with incorporation of glass fibers at the interface between bracket and enamel.

Load-bearing capacity of simulated Locator-retained overdenture system.

STATEMENT OF PROBLEM: Acrylic resin overdenture bases usually fracture because of stress concentrations at the area of the abutments. PURPOSE: The purpose of this study was to evaluate the reinforcing effect of bidirectional woven electrical glass (E-glass) fiber weaves with a different number of layers and different locations on the load-bearing capacity of simulated Locator-retained overdenture specimens. MATERIAL AND METHODS: Test specimens with a centrally located metal housing for a Locator stud attachment were fabricated from autopolymerizing acrylic resin (polymethylmethacrylate based) and reinforced with bidirectional woven E-glass fiber layers. The control group specimens were fabricated without fiber reinforcement. The 2L group had 2 layers of E-glass fiber weaves and was divided according to the fiber location within the specimens as follows: 2L-A subgroup with 2 fiber layers above the metal housing; 2L-N subgroup with 2 fiber layers adjacent to the housing; and 2L-A+2L-N subgroup with 2 fiber layers above and 2 fiber layers adjacent to the housing. The 4L group had 4 layers of E-glass fiber weaves and was divided according to the fiber location as follows: 4L-A subgroup with 4 fiber layers above the housing; 4L-N subgroup with 4 fiber layers adjacent to the housing; and 4L-A+4L-N subgroup with 4 fiber layers above and 4 fiber layers adjacent to the housing. Dry specimens were submitted to a 3-point static loading test, and the mean flexural strength, flexural modulus, and strain values were analyzed with 1-way ANOVA and Tukey post hoc tests (α=.05). Two-way ANOVA was conducted to detect the influence of the number and location of the reinforcing layers (α=.05). RESULTS: The results revealed a significant difference (P<.001) in flexural strength values between the control group (92.4 ±14 MPa) and the 2 subgroups, 4L-A (116 ±7.3 MPa) and 4L-A+4L-N (117.1 ±6 MPa), with a significant effect only from the number of the reinforcing layers (P<.001) and not the location (P=.153). No significant differences were found with flexural modulus (P=.195) and strain values (P=.174) among the tested groups. CONCLUSIONS: The load-bearing capacity of a Locator-retained overdenture can be significantly increased by placing 4 layers of bidirectional woven E-glass fiber weaves either only above the metal housing or in both locations above and adjacent to the metal.

The effect of smear layer removal on E. faecalis leakage and bond strength of four resin-based root canal sealers.

BACKGROUND: The aim of the study was to assess bacterial sealability and bonding ability of methacrylate-based Resilon (RS, SybronEndo), Endo Rez (ER, Ultradent Products Inc), and epoxy-based AH Plus (AH, Dentsply/DeTrey), MTA Fill Apex (MTAF, Angelus Soluções Odontológicas) root canal sealers, and the effect of the smear layer removal on the sealability. METHODS: One hundred thirty root segments were instrumented up to apical size #60 and rinsed with 2.5% NaOCl. Half of the roots were rinsed with 5ml 17% EDTA to remove the smear layer. All the roots were filled with AH, ER, MTAF sealers and gutta-percha, or RS with Resilon cones. After storage at 37°C for 7 days the samples were mounted into bacterial leakage assay for 50 days. Another 100 roots were instrumented and rinsed as described above, split longitudinally, cut into the cervical, middle and apical parts. The sealers were injected through the plastic mould on the dentin surface. After 7 days of incubation at 37°C, bond strength was tested using a notched-edge test fixture (Crosshead, Ultradent Products Inc.) and a universal testing machine (Lloyd Instruments). RESULTS: AH revealed the longest mean time for bacterial resistance by 29.4 and 36.8 days (with and without smear layer, respectively) followed by RS (15.1 and 24.7 days, respectively). The difference between materials was significant (p<0.001). Bond strength values ranged from 0.2± 0.1 to 3.5± 0.7 MPa and increased from the apical to the cervical third. In the apical third, AH showed the highest mean (SD) bond values 1.4 (0.4) MPa and 1.7 (0.6) MPa (with and without smear, respectively, followed by RS, 0.5 (0.1) MPa and 0.8 (0.1) MPa, respectively. The difference between materials was significant (p=0.001). CONCLUSION: The effect of the smear layer removal on the sealability was material-dependent.

In vitro cytotoxicity and surface topography evaluation of additive manufacturing titanium implant materials.

Custom-designed patient-specific implants and reconstruction plates are to date commonly manufactured using two different additive manufacturing (AM) technologies: direct metal laser sintering (DMLS) and electron beam melting (EBM). The purpose of this investigation was to characterize the surface structure and to assess the cytotoxicity of titanium alloys processed using DMLS and EBM technologies as the existing information on these issues is scarce. "Processed" and "polished" DMLS and EBM disks were assessed. Microscopic examination revealed titanium alloy particles and surface flaws on the processed materials. These surface flaws were subsequently removed by polishing. Surface roughness of EBM processed titanium was higher than that of DMLS processed. The cytotoxicity results of the DMLS and EBM discs were compared with a "gold standard" commercially available titanium mandible reconstruction plate. The mean cell viability for all discs was 82.6% (range, 77.4 to 89.7) and 83.3% for the control reconstruction plate. The DMLS and EBM manufactured titanium plates were non-cytotoxic both in "processed" and in "polished" forms.

Light Transmission of Novel CAD/CAM Materials and Their Influence on the Degree of Conversion of a Dual-curing Resin Cement.

PURPOSE: To evaluate the light transmission characteristics of different types, shades, and thicknesses of novel CAD/CAM materials and their effect on the degree of conversion (DC) of a dual-curing resin cement. MATERIALS AND METHODS: Square specimens (12 × 12 mm2) of three CAD/CAM materials - GC Cerasmart, Lava Ultimate, Vita Enamic - of different thicknesses (1.00, 1.50, and 2.00 mm, n = 5 per thickness) were irradiated with an LED unit. The amount of transmitted light was quantified. Thereafter, the DC% of the dual-curing resin cement (RelyX Ultimate) was recorded after 15 min using Fourier transform infrared spectroscopy. Statistical analysis was performed using two-way ANOVA followed by the Tukey's HSD post-hoc test at a significance level of p < 0.05. Regression analysis was performed to investigate the correlation between the DC and radiant energy, and the DC and thickness. RESULTS: Although the type and shade of CAD/CAM material significantly affect transmitted light irradiation (p < 0.0001), degrees of conversion are similar when the CAD/CAM material or material shade were taken into consideration (p > 0.05). Conversely, material thickness significantly affected light transmission (p < 0.0001) and DC (p < 0.0001). Multiple effects of material, shade, and thickness did not significantly affect the evaluated parameters (p = 0.638 for light irradiation; p = 0.637 for DC). Linear regression analysis showed a correlation between delivered energy and DC% results of the Vita Enamic (R²â€¯= 0.4169, p < 0.0001). CONCLUSION: Reduced light transmission in 2-mm-thick specimens of all CAD/CAM materials indicates that proper curing of the cement beneath CAD/CAM materials should be ensured.

Influence of increment thickness on dentin bond strength and light transmission of composite base materials.

OBJECTIVES: Bulk-fill resin composites (BFCs) are gaining popularity in restorative dentistry due to the reduced chair time and ease of application. This study aimed to evaluate the influence of increment thickness on dentin bond strength and light transmission of different BFCs and a new discontinuous fiber-reinforced composite. MATERIALS AND METHODS: One hundred eighty extracted sound human molars were prepared for a shear bond strength (SBS) test. The teeth were divided into four groups (n = 45) according to the resin composite used: regular particulate filler resin composite: (1) G-ænial Anterior [GA] (control); bulk-fill resin composites: (2) Tetric EvoCeram Bulk Fill [TEBF] and (3) SDR; and discontinuous fiber-reinforced composite: (4) everX Posterior [EXP]. Each group was subdivided according to increment thickness (2, 4, and 6 mm). The irradiance power through the material of all groups/subgroups was quantified (MARC® Resin Calibrator; BlueLight Analytics Inc.). Data were analyzed using two-way ANOVA followed by Tukey's post hoc test. RESULTS: SBS and light irradiance decreased as the increment's height increased (p < 0.05), regardless of the type of resin composite used. EXP presented the highest SBS in 2- and 4-mm-thick increments when compared to other composites, although the differences were not statistically significant (p > 0.05). Light irradiance mean values arranged in descending order were (p < 0.05) EXP, SDR, TEBF, and GA. CONCLUSIONS: As increment thickness increased, the light transmission decreased for all tested resin composites. Discontinuous fiber-reinforced composite showed the highest value of curing light transmission, which was also seen in improved bonding strength to the underlying dentin surface. CLINICAL RELEVANCE: Discontinuous fiber-reinforced composite can be applied safely in bulks of 4-mm increments same as other bulk-fill composites, although, in 2-mm thickness, the investigated composites showed better performance.

Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC) and Metallic Retainers.

Fiber reinforced Composite (FRC) retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot-) resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis.

The effect of cycling deflection on the injection-molded thermoplastic denture base resins.

OBJECTIVE: The aim of this study was to evaluate the effect of cycling deflection on the flexural behavior of injection-molded thermoplastic resins. MATERIALS AND METHODS: Six injection-molded thermoplastic resins (two polyamides, two polyesters, one polycarbonate, one polymethyl methacrylate) and, as a control, a conventional heat-polymerized denture based polymer of polymethyl methacrylate (PMMA) were used in this study. The cyclic constant magnitude (1.0 mm) of 5000 cycles was applied using a universal testing machine to demonstrate plasticization of the polymer. Loading was carried out in water at 23ºC with eight specimens per group (n = 8). Cycling load (N) and deformation (mm) were measured. RESULTS: Force required to deflect the specimens during the first loading cycle and final loading cycle was statistically significantly different (p < 0.05) with one polyamide based polymer (Valplast) and PMMA based polymers (Acrytone and Acron). The other polyamide based polymer (LucitoneFRS), polyester based polymers (EstheShot and EstheShotBright) and polycarbonate based polymer (ReigningN) did not show significant differences (p > 0.05). None of the materials fractured during the loading test. One polyamide based polymer (Valplast) displayed the highest deformation and PMMA based polymers (Acrytone and Acron) exhibited the second highest deformation among the denture base materials. CONCLUSION: It can be concluded that there were considerable differences in the flexural behavior of denture base polymers. This may contribute to the fatigue resistance of the materials.