Clinical and radiographic evaluation of high viscosity bulk-fill resin composite restorations.

PURPOSE: To perform a clinical and radiographic evaluation comparing Filtek Bulk Fill high viscosity bulk-fill resins with Filtek Z350 XT nanoparticulate for 1 year. METHODS: 58 restorations were performed for each material (bulk-fill and nanoparticulate), for a total of 116 restorations. Among these, 42 Class I and 16 Class II restorations were performed for each group, in molars and premolars. Clinical evaluation was performed 7 days (baseline), 6 months and 1 year after restorations, using the World Dental Federation (FDI) criteria. Radiographs were obtained at 7 days and 1 year after the restoration was placed and the radiopacity was measured using Image J software at the same time interval. RESULTS: Of the 70 restorations available for evaluation at 1 year, the Mann-Whitney and Friedman tests showed no statistically significant difference for the FDI criteria analyzed. Greater radiopacity was observed for bulk-fill resin compared to nanoparticulate (two-way ANOVA, P= 0.022). This same test showed no difference in radiopacity between the groups in the two evaluation periods (P= 0.062). The high viscosity bulk-fill resin composite presented similar clinical performance to nanoparticulate resin in this evaluation period and higher radiopacity was observed for this material when compared to nanoparticulate resin, in both time periods. CLINICAL SIGNIFICANCE: The high viscosity bulk-fill resin composite showed similar performance to the nanoparticulate resin during the evaluation period of 1 year. Radiopacity showed high values for the bulk-fill resin when compared to nanoparticulate resin. The bulk-fill resin has potential to be used in posterior teeth.

Moist vs over-dried etched dentin: FE-SEM/TEM and bond strength evaluation of resin-dentin interfaces produced by universal adhesives.

OBJECTIVE: To evaluate the influence of the degree of dentin moisture on interfacial ultramorphology and bond strength (µTBS) of universal adhesives. MATERIALS AND METHODS: Futurabond U (FBU), Scotchbond Universal (SBU), Adhese Universal (ADU), and Prime&Bond active (PBA) were used. After acid-etching, moist or over-dried dentin surfaces were tested. Teeth were restored for scanning and transmission electron microscopy (n = 3) and µTBS evaluation (n = 5). µTBS results were analyzed by two-way ANOVA and Tukey. RESULTS: For moist dentin, a well-formed hybrid layer (HL) was observed. However, when applied to over-dried dentin, remarkable differences were observed. Defects, gaps, and reduced HL thickness were observed mainly for ADU and FBU. When applied to wet dentin, µTBS values were similar for all adhesives, except for FBU, which was significantly lower. When applied to over-dried dentin, PBA presented the highest µTBS values, followed by SBU, ADU, and FBU. ADU presented significantly lower µTBS when applied to over-dried dentin. CONCLUSION: PBA, SBU, and FBU µTBS values were not sensitive to the degree of moisture. Even though application to over-dried dentin revealed defects, gaps and reduced HL thickness for SBU, ADU, and FBU, µTBS analysis only revealed a significant reduction for ADU. CLINICAL SIGNIFICANCE: Universal adhesives can be applied in either self-etching or etch-and-rinse mode. However, clinicians are not aware which universal adhesives should be strictly applied on a moist dentin for bonding in the etch-and-rinse mode.

Adhesive/silane application effects on bond strength durability to a lithium disilicate ceramic.

OBJECTIVE: To test the effects of different adhesive protocols and silane application on the adhesive durability to a Lithium Disilicate reinforced glass ceramic. METHODS: Forty disks of 13 mm diameter (E.max Press) were used. After etching with 9.5% HF for 20 seconds, disks were randomly assigned into 4 groups according to the adhesive/silane protocol: silane application only (SIL); silane application followed by adhesive (SILXP-XP Bond); silane-containing adhesive (SBU-ScotchBond Universal); silane application followed by silane-containing adhesive (SILSBU). Four resin composite cylinders of 1-mm diameter and 3-mm height were made on each ceramic disk and tested in shear. Specimens were stored in water for 24 hours or 12 months prior to testing. Results were statistically analyzed by two-way ANOVA and Tukey test. RESULTS: After 24 hours, the highest SBS values were observed for SILXP and SILSBU. However, after 12 months, SILXP and SILSBU presented a significant reduction in SBS, while the highest SBS were observed for SIL. For SBU, no significant reduction in SBS was observed, however, it showed the lowest SBS after 12 months. CONCLUSIONS: Regardless of the presence of silane in the composition of SBU, previous silane application is still recommended prior to cementation of Lithium Disilicate. CLINICAL SIGNIFICANCE: The application of silane as a separate step is recommended prior to cementation of Lithium Disilicate reinforced glass-ceramic, independent of the presence of silane within the universal adhesive solution.

Microcomputed Tomography Evaluation of Volumetric Shrinkage of Bulk-Fill Composites in Class II Cavities.

PURPOSE: This study aimed to quantify polymerization shrinkage of one conventional and three bulk-fill composites, under bonded and unbonded conditions, in Class II preparations using 3D microcomputed tomography (µCT) and report its location. MATERIALS AND METHODS: Preparations (2.5 mm occlusal depth × 4 mm wide × 4 mm mesial box and 1 mm beyond the CEJ distal box depth) were made in 48 human extracted molars (n = 6). Four composites were tested, one regular (Vitalescence/VIT) and three bulk-fill: SureFil SDR Flow (SDR), Tetric EvoCeram Bulk Fill (TET), and Filtek flowable Bulk Fill (FIL). Teeth were divided into four groups according to restorative material used and subdivided into two subgroups, according to the presence of an adhesive system (XP Bond) application (bonded [-B]) or its absence (unbonded [-U]). Each tooth was scanned three times: (1) after cavity preparation, (2) before and (3) after composite light-curing. Acquired µCT images were imported into 2D and 3D software for analysis. RESULTS: Significantly different volumetric shrinkage between bonded and unbonded conditions was observed only for TET group (p < 0.05), unbonded presenting significantly higher volumetric shrinkage. Among the bonded groups, TET-B presented significantly lower shrinkage than both SDR-B and FIL-B but not significantly different from VIT-B. Generally, shrinkage occurred at occlusal and distal surfaces. CONCLUSIONS: When applied to bonded Class II cavities, TET exhibited significantly lower volumetric shrinkage compared to the other bulk-fill composites. However, it also exhibited the highest difference of volumetric shrinkage values between unbonded and bonded cavities. CLINICAL SIGNIFICANCE: Volumetric polymerization shrinkage occurred with all composites tested, regardless of material type (conventional or bulk-fill) or presence or absence of bonding. However, volumetric shrinkage has been reduced or at least maintained when bulk-fill composites were used compared to a conventional composite resin, which makes them a potential time saving alternative for clinicians. (J Esthet Restor Dent 29:118-127, 2017).

Analysis of interfacial structure and bond strength of self-etch adhesives.

PURPOSE: To determine the bond strength, nanoleakage and interfacial morphology of four self-etch adhesives bonded to superficial dentin. METHODS: Microtensile (MT) (n= 15) and single plane shear (SP) (n= 8) bond tests were performed using human dentin polished through 320-grit SiC paper. Clearfil Protect Bond (PB), Clearfil S3 Bond (S3), Prompt L-Pop (PLP) and G-Bond (GB) were used according to their manufacturers' instructions. Composite was applied as cylinders with a thickness of 4 mm with a 1 mm diameter and stored in water at 370C for 24 hours. Specimens were debonded with a testing machine at a cross-head speed of 1 mm/minute. Means and standard deviations of bond strength were calculated. Data were analyzed using ANOVA. Fisher's PLSD intervals were calculated at the 0.05 level of significance. Failure modes were determined at x100. The hybrid layer was revealed by treatment with 5N HC1/5% NaOCl or fractured perpendicular to the interface and sputter coated with gold. Specimens were viewed at x1,000, x2,500, and x5,000 in a field emission SEM at 15 kV. Teeth (n=2) sectioned into 0.9 mm-thick slabs were immersed in ammoniacal silver nitrate solution for 24 hours, rinsed and immersed in photo-developing solution for 8 hours. Specimens were sectioned (90 nm-thick) and observed under TEM. RESULTS: Means ranged from 25.0 to 73.1 MPa for MT and from 15.5 to 56.4 MPa for SP. MT values were greater than SP, but were highly correlated (R2 = 0.99, P= 0.003) and provided the same order for the systems studied. Fisher's PLSD intervals (P< 0.05) for bond strength techniques and adhesives results were 1.7 and 2.3 MPa, respectively. Failures sites were mixed. TEM showed that hybrid layers were -0.5 pm for PB, GB and S3 and approximately 5 microm for PLP. SEM showed morphologic differences among adhesives. Silver nitrate deposits were observed within the interfaces for all adhesive systems.

Effects of a peripheral enamel margin on the long-term bond strength and nanoleakage of composite/dentin interfaces produced by self-adhesive and conventional resin cements.

PURPOSE: This study evaluated the effects of peripheral enamel margins on the long-term bond strength (µTBS) and nanoleakage in resin/dentin interfaces produced by self-adhesive and conventional resin cements. MATERIALS AND METHODS: Five self-adhesive [RelyX-Unicem (UN), RelyX-U100 (UC), GCem (GC), Maxcem (MC), Set (SET)] and 2 conventional resin cements [RelyX-ARC(RX), Panavia F(PF)] were used. An additional group included the use of a two-step self-etching adhesive (SE Bond) with Panavia F (PS). One hundred ninety-two molars were assigned to 8 groups according to luting material. Five-mm-thick composite disks were cemented and assigned to 3 subgroups according to water-exposure condition (n = 6): 24-h peripheral exposure (24h-PE-enamel margins), or 1 year of peripheral (1 yr-PE) or direct exposure (1 yr-DE-dentin margin). Restored teeth were sectioned into beams and tested in tension at 1 mm/min. Data were analyzed by two-way ANOVA and Tukey's test. Two additional specimens in each group were prepared for nanoleakage evaluation. Nanoleakage patterns were observed under SEM/TEM. RESULTS: Except for RX, no significant reduction in µTBS was observed between 24h-PE and 1 yr-PE. 1 yr-DE reduced µTBS for RX, PF, GC, MC, and SET. No significant reduction in µTBS was observed for PS, UC, and UN after 1 year. After 1 yr-DE, RX and PS presented the highest µTBS, and SET and MC the lowest. Nanoleakage was reduced when there was a peripheral enamel margin. SET and MC presented more silver deposition than other groups. CONCLUSION: The presence of a peripheral enamel margin reduced the degradation rate in resin/dentin interfaces for most materials. The µTBS values produced by the multi-step luting agents RX and PS were significantly higher than those observed for self-adhesive cement.

Low- and high-viscosity bulk-fill resin composites: a comparison of microhardness, microtensile bond strength, and fracture strength in restored molars.

The aim of this study was to compare low- and high-viscosity bulk-fill composites for Knoop microhardness (KHN), microtensile bond strength (MTBS) to dentin in occlusal cavities, and fracture strength (FS) in molars with mesialocclusal- distal restoration. Disk-shaped samples with different thicknesses (2 or 4 mm) of low-viscosity (SDR Flow, Dentsply) and high-viscosity bulk-fill composites (Filtek BulkFill, 3M ESPE; and Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) were prepared for top and bottom KHN analysis (n=10). MTBS to dentin and fracture pattern was evaluated in human molars with occlusal cavities restored with (n=10): conventional nanocomposite (Z350XT, 3M ESPE), low-viscosity (Filtek Bulk-fill Flow, 3M ESPE) or high-viscosity bulk-fill composites (Filtek BulkFill). The FS and fracture pattern of human molar with mesial-occlusal-distal restorations submitted or not to thermomechanical cycling were investigated (n=10) using: intact tooth (control), and restoration based on conventional microhybrid composite (Z250, 3M ESPE), low-viscosity (SDR Flow) or high-viscosity bulk-fill composites (Filtek BulkFill). The data were submitted to split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) followed by Tukey's test (α=0.05). For KHN, there was no significant difference for the resin composites between the top and bottom. For MTBS, no significant differences among the materials were detected; however, the low-viscosity composite presented lower frequency of adhesive failures. For FS, there was no significant difference between composites and intact tooth regardless of thermomechanical cycling. Low- and high-viscosity bulk-fill composites have comparable microhardness and microtensile bond strength when used in occlusal restorations. Likewise, the bulk-fill composites present similar fracture strength in molars with mesio-occlusal-distal restorations.

O objetivo deste estudo foi comparar resinas compostas bulk- -fill de baixa e alta viscosidade quanto à microdureza Knoop (KHN), resistência de união a microtração (MTBS) em cavidades oclusais e carga à fratura (FS) em molares com restauração mesio-oclusal-distal. Amostras em forma de disco com diferentes espessuras (2 ou 4 mm) de resinas bulk-fill de baixa viscosidade (SDR Flow, Dentsply) e alta viscosidade (Filtek BulkFill, 3M ESPE; e Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) foram obtidas para análise de KHN no topo e na base (n = 10). A MTBS em dentina e o padrão de fratura foram avaliados em molares humanos com cavidades oclusais restauradas com (n = 10): resina composta nanoparticulada convencional (Z350XT, 3M ESPE), resinas bulk-fill de baixa viscosidade (Filtek Bulk-fill Flow, 3M ESPE) ou alta viscosidade (Filtek BulkFill). Foram investigados a FS e o padrão de fratura de molares humanos em restaurações mesial-ocluso-distais sub metidas ou não à ciclagem termomecânica (n = 10), sendo: dente íntegro (controle), e restaurações baseadas em resina composta microhíbrida convencional (Z250, 3M ESPE); resinas bulk-fill de baixa viscosidade (SDR Flow) ou alta viscosidade (Filtek BulkFill). Os dados foram submetidos a split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) seguidos do teste de Tukey (α = 0,05). Para KHN, não houve diferença significativa entre o topo e a base para as resinas compostas. Para MTBS, não foram detectadas diferenças significativas entre os materiais; entretanto, a resina bulk-fill de baixa viscosidade apresentou menor frequência de falhas adesivas. Para FS, não houve diferença significativa entre os materiais e o dente íntegro, independentemente da ciclagem termomecânica. As resinas bulk-fill de baixa e alta viscosidade têm microdureza e resistência à microtração comparáveis quando usados em restaurações oclusais. Da mesma forma, as resinas bulk-fill apresentam resistência à fratura semelhante em molares com restaurações mesio-oclusal-distais.

Antibacterial activity of various self-etching adhesive systems against oral streptococci.

The antibacterial properties of self-etching adhesive systems constitute an important issue in operative dentistry, since viable bacteria can still be present after cavity preparation. The current study evaluated the antibacterial activity of five one-step self-etching adhesives (SEAs) and four self-etching primers (SEPs) against oral streptococci. Clearfil S3 (S3), One-Up Bond F Plus (OU), Futurabond NR (FB), GBond (GB), Xeno IV (X4), Clearfil SE Bond (SE), Clearfil Protect Bond (PB), Adper SE Plus (AS) and AdheSE (AD) were tested for antibacterial activity against five streptococci species: S oralis, S sanguinis, S cricetus, S mutans and S sobrinus. Chlorhexidine (0.12%) and phosphoric acid (37%) gel were used as control. The agar diffusion test method was used. Plates containing BHI agar and 300 uL of bacterial cell suspension (0.5 MacFarland) were prepared. Holes 6 mm in diameter were made and partially filled with bacteriological agar. Then, 10 uL of each SEA or SEP was dropped and the plates were incubated under microaerophilic atmosphere at 37 degrees C for 48 hours and the diameter of each halo was registered. The results were analyzed by two-way ANOVA and Tukey test. PB exhibited the most effective antibacterial activity against oral streptococci. The performances of SE and FB were similar or better than chlorhexidine for all bacteria. S3, X4, AS, AD, OU and GB showed significantly lower inhibition values. Among the species tested, S oralis was the most sensitive to all self-etching adhesive systems; on the other hand, S cricetus, S mutans and S sobrinus were more resistant. Among the self-etching adhesive systems evaluated, Clearfil Protect Bond exhibited the most effective antibacterial activity against oral streptococci.

Monolithic CAD/CAM laminate veneers: Reliability and failure modes.

OBJECTIVES: to evaluate the probability of survival and failure modes of lithium-disilicate, feldspathic-ceramic, and resin-nanoceramic anterior veneers cemented on dentin analog substrates after sliding-contact step-stress accelerated life testing (SSALT). METHODS: A virtual incisor tooth preparation was produced with a reduction of 1.5mm at the incisal edge and of 0.7mm buccally. A .STL file of the preparation was generated and CAD/CAM based G10 dentin-analog material was used for testing. Laminate veneers were milled in three different materials: lithium-disilicate (LDS, E.max CAD), resin-nanoceramic (RN, Lava Ultimate), and feldspathic-ceramic (FELDS, Vita Blocks). SSALT was employed where a spherical indenter contacted the veneer, slided along its interface with G10 to lift off and start a new cycle at 2Hz in water. Qualitative fractography was performed. The probability of survival (90% confidence-bounds) was calculated for several load/cycle missions. RESULTS: The probability of survival for a mission of 50,000 cycles decreased from 50 up to 150N equally for all groups and were not different between them. At 200N, the probability of survival was significantly lower for FELDS (10%) compared to RN veneers (41%), whereas LDS presented intermediate values (22%). The characteristic strength of RN (247N) was significantly higher than LDS (149N), and FELDS (151N). In FELDS and LDS, hackles, wake hackles and twist hackles indicated the direction of crack propagation. In RN, hackles were observed. CONCLUSIONS: Differences in probability of survival were observed only at 180 and 200N between groups. Failure modes were similar with veneer fracture down to the tooth-analog substrate.

Microtensile bond strength of new self-adhesive luting agents and conventional multistep systems.

STATEMENT OF PROBLEM: Several self-adhesive luting agents have recently been introduced on the market. It is crucial to know the effectiveness of such luting agents prior to their clinical application. PURPOSE: The purpose of this study was to evaluate the microtensile bond strengths (microTBS) produced by different self-adhesive cements and compare them with conventional luting agents. MATERIAL AND METHODS: Six self-adhesive cements (RelyX Unicem (UN), RelyX U100 (UC), SmartCem 2 (SC), G-Cem (GC), Maxcem (MC), and SeT (SET), and 2 conventional luting agents, one that uses a 2-step etch-and-rinse adhesive (RelyX ARC (RX)), and one that uses a 1-step self-etching adhesive (Panavia F (PF)), were used in this study. An additional group included the use of a 2-step self-etching primer adhesive system (Clearfil SE Bond) prior to the application of Panavia F (PS). Fifty-four human molars were abraded to expose occlusal surfaces and were assigned to 9 groups according to the luting material (n=6). Five composite resin (Filtek Z250) discs (12 mm in diameter, 5 mm thick) were cemented on the teeth according to manufacturers' instructions. After 24 hours of water storage, restored teeth were serially sectioned into beams with a cross-sectional area of approximately 1 mm2 at the bonded interface and were tested in tension with a crosshead speed of 1 mm/min. Failure mode was determined using scanning electron microscopy. Data were statistically analyzed by 1-way ANOVA and Tukey's studentized range HSD test (alpha =.05). RESULTS: Mean bond strengths (SD) in MPa were: RX, 69.6 (16.6)A; PS, 49.2 (9.7)A; PF, 33.7 (13.9)AB; GC, 16.9 (10.3)BC; UC, 15.3 (3.4)BC; UN, 12.5 (2.4)C; MC 11.5 (6.8)CD; SC, 8.5 (4.9)CD; SET, 4.6 (0.5)D. Groups with different uppercase letters were significantly different from each other (P<.05). The predominant failure mode of the self-adhesive cements was adhesive between the resin cement and dentin. CONCLUSIONS: The bond strengths produced by the multistep luting agents were significantly higher than those observed for most self-adhesive cements.

Micro-computed tomography evaluation of volumetric polymerization shrinkage and degree of conversion of composites cured by various light power outputs.

This study evaluated the influence of different light-curing modes on the volumetric polymerization shrinkage and degree of conversion of a composite resin at different locations using micro-computed tomography and Fourier transform infrared spectroscopy (FTIR). Specimens were divided into 4 groups based on the light-curing mode used (Bluephase 20i): 1 -High (1,200 mW/cm2); 2 -Low (650 mW/cm2); 3 -Soft-start (650-1,200 mW/cm2); and 4 -Turbo (2,000 mW/cm2). Degree of conversion was calculated by the measurement of the peak absorbance height of the uncured and cured materials at the specific wavenumbers, and was performed by FTIR 48 h after curing resin samples. Degree of conversion was analyzed using two-way ANOVA. No significant differences were observed independent of the region of the restoration investigated (p>0.05). Different curing modes did not influence volumetric shrinkage neither degree of conversion of class I composite resin restorations.

Long-term TEM analysis of the nanoleakage patterns in resin-dentin interfaces produced by different bonding strategies.

OBJECTIVES: The aim of this study was to evaluate the ability of etch-and-rinse and self-etching adhesive systems to prevent time- and water-induced nanoleakage in resin-dentin interfaces over a 6-month storage period. METHODS: Five commercial adhesives were tested, which comprise three different strategies of bonding resins to tooth hard tissues: one single-step self-etching adhesive (One-up Bond F (OB), Tokuyama); two two-step self-etching primers (Clearfil SE Bond (SE) and an antibacterial fluoride-containing system, Clearfil Protect Bond (CP), Kuraray Inc.); two two-step etch-and-rinse adhesives (Single Bond (SB), 3M ESPE and Prime&Bond NT (PB), Dentsply). Restored teeth were sectioned into 0.9 mm thick slabs and stored in water or mineral oil for 24 h, 3 or 6 months. A silver tracer solution was used to reveal nanometer-sized water-filled spaces and changes that occurred over time within resin-dentin interfaces. Characterization of interfaces was performed with the TEM. RESULTS: The two two-step self-etching primers showed little silver uptake during the 6-month experiment. Etch-and-rinse adhesives exhibited silver deposits predominantly within the hybrid layer (HL), which significantly increased for SB after water-storage. The one-step self-etching adhesive OB presented massive silver accumulation within the HL and water-trees protruding into the adhesive layer, which increased in size and quantity after water-storage. After storage in oil, reduced silver deposition was observed at the interfaces for all groups. SIGNIFICANCE: Different levels of water-induced nanoleakage were observed for the different bonding strategies. The two-step self-etching primers, especially the antibacterial fluoride-containing system CP, showed the least nanoleakage after 6 months of storage in water.

Influence of water-storage time on the sorption and solubility behavior of current adhesives and primer/adhesive mixtures.

This study evaluated the effects of water-storage on the water sorption and solubility behavior of five commercially available dental adhesive systems and two primer/adhesive mixtures. The adhesives comprised three different approaches to bonding to hard tooth tissues: a one-step self-etching adhesive (One-up Bond F), two two-step self-etching primers (Clearfil SE Bond and Clearfil Protect Bond) and two etch-and-rinse systems: a water/ethanol-based (Single Bond) and an acetone-based filled adhesive (Prime&Bond NT). The bonding agents and primers of the two-step self-etching systems were mixed in a 1:1 volume ratio. Water sorption and solubility values were determined after 1, 7, 30, 90 and 180 days. The results showed that, except for SB, all adhesives presented increased water sorption with increased storage time. The one-step self-etching adhesive and self-etching primer/adhesive mixtures presented the highest water sorption and solubility values. Equilibrium in the water sorption values was observed for all adhesives after 90 days of water-storage. However, solubility values continued to increase for some materials until 180 days. The sorption and solubility behavior of the materials tested seem to be related to hydrophilicity of the adhesive resin solution and might influence the long-term performance of resin-based composite restorations.

Low- and high-viscosity bulk-fill resin composites / Resinas compostas bulk-fill de baixa e alta viscosidade

ABSTRACT The aim of this study was to compare low- and high-viscosity bulk-fill composites for Knoop microhardness (KHN), microtensile bond strength (MTBS) to dentin in occlusal cavities, and fracture strength (FS) in molars with mesialocclusal- distal restoration. Disk-shaped samples with different thicknesses (2 or 4 mm) of low-viscosity (SDR Flow, Dentsply) and high-viscosity bulk-fill composites (Filtek BulkFill, 3M ESPE; and Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) were prepared for top and bottom KHN analysis (n=10). MTBS to dentin and fracture pattern was evaluated in human molars with occlusal cavities restored with (n=10): conventional nanocomposite (Z350XT, 3M ESPE), low-viscosity (Filtek Bulk-fill Flow, 3M ESPE) or high-viscosity bulk-fill composites (Filtek BulkFill). The FS and fracture pattern of human molar with mesial-occlusal-distal restorations submitted or not to thermomechanical cycling were investigated (n=10) using: intact tooth (control), and restoration based on conventional microhybrid composite (Z250, 3M ESPE), low-viscosity (SDR Flow) or high-viscosity bulk-fill composites (Filtek BulkFill). The data were submitted to split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) followed by Tukey's test (α=0.05). For KHN, there was no significant difference for the resin composites between the top and bottom. For MTBS, no significant differences among the materials were detected; however, the low-viscosity composite presented lower frequency of adhesive failures. For FS, there was no significant difference between composites and intact tooth regardless of thermomechanical cycling. Low- and high-viscosity bulk-fill composites have comparable microhardness and microtensile bond strength when used in occlusal restorations. Likewise, the bulk-fill composites present similar fracture strength in molars with mesio-occlusal-distal restorations.

RESUMO O objetivo deste estudo foi comparar resinas compostas bulk- -fill de baixa e alta viscosidade quanto à microdureza Knoop (KHN), resistência de união a microtração (MTBS) em cavidades oclusais e carga à fratura (FS) em molares com restauração mesio-oclusal-distal. Amostras em forma de disco com diferentes espessuras (2 ou 4 mm) de resinas bulk-fill de baixa viscosidade (SDR Flow, Dentsply) e alta viscosidade (Filtek BulkFill, 3M ESPE; e Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) foram obtidas para análise de KHN no topo e na base (n = 10). A MTBS em dentina e o padrão de fratura foram avaliados em molares humanos com cavidades oclusais restauradas com (n = 10): resina composta nanoparticulada convencional (Z350XT, 3M ESPE), resinas bulk-fill de baixa viscosidade (Filtek Bulk-fill Flow, 3M ESPE) ou alta viscosidade (Filtek BulkFill). Foram investigados a FS e o padrão de fratura de molares humanos em restaurações mesial-ocluso-distais sub metidas ou não à ciclagem termomecânica (n = 10), sendo: dente íntegro (controle), e restaurações baseadas em resina composta microhíbrida convencional (Z250, 3M ESPE); resinas bulk-fill de baixa viscosidade (SDR Flow) ou alta viscosidade (Filtek BulkFill). Os dados foram submetidos a split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) seguidos do teste de Tukey (α = 0,05). Para KHN, não houve diferença significativa entre o topo e a base para as resinas compostas. Para MTBS, não foram detectadas diferenças significativas entre os materiais; entretanto, a resina bulk-fill de baixa viscosidade apresentou menor frequência de falhas adesivas. Para FS, não houve diferença significativa entre os materiais e o dente íntegro, independentemente da ciclagem termomecânica. As resinas bulk-fill de baixa e alta viscosidade têm microdureza e resistência à microtração comparáveis quando usados em restaurações oclusais. Da mesma forma, as resinas bulk-fill apresentam resistência à fratura semelhante em molares com restaurações mesio-oclusal-distais.

Ultramorphological analysis of resin-dentin interfaces produced with water-based single-step and two-step adhesives: nanoleakage expression.

This study evaluated the nanoleakage patterns in bonded interfaces using two single-step, self-etching adhesives (Adper Prompt-AD, and One-up Bond F-OB), two two-step, self-etching primers (Clearfil SE Bond-CF, and Unifil Bond-UB), and one two-step, total-etch adhesive (Single Bond-SB). Dentin surfaces were bonded with the adhesive systems and stored in water at 37 degrees C for 1 week and 6 months. After storage periods, teeth were sectioned into 0.8 mm-thick slabs, coated with nail varnish except for the bonded interfaces, and immersed in ammoniacal AgNO(3) for 24 h. After immersion in photodeveloping solution, bonded sections were prepared and observed under a SEM using the backscattered electron mode. Undemineralized, unstained, epoxy resin-embedded sections were prepared for TEM. Nanoleakage patterns were qualitatively compared between periods. Nanoleakage was observed in all bonded specimens at both periods. CF and UB presented silver deposits predominantly restricted to the thin (0.5 microm) hybrid layer (HL) at both periods. Although no evident differences were observed in the nanoleakage pattern of UB at 7 days and 6 months, CF presented enlarged areas of silver impregnation after 6 months. SB presented accumulation of silver particles mostly within the HL at 7 days, which was intensified after 6 months. AD and OB presented massive silver accumulation within the HL and the overlying adhesive layer. No evident differences were noticed between storage periods. Silver impregnation increased for all adhesive systems from 7 days to 6 months, except for UB.

Effects of various finishing systems on the surface roughness and staining susceptibility of packable composite resins.

OBJECTIVES: The purpose of the present study was to investigate the influence of various finishing systems on the surface roughness and staining of three packable resin composites and a conventional microhybrid one. METHODS: Three packable composites (Solitaire-Heraeus-Kulzer, ALERT-Jeneric-Pentron, SureFil-Dentsply) and a conventional microhybrid (Z250-3M-ESPE) were used. Composite specimens were prepared and polished with Poli I and Poli II aluminum oxide pastes, Ultralap diamond paste, Enhance finishing points, Politip rubber polishers, fine and extra fine diamond burs, and 30-blade tungsten carbide burs according to the manufacturers' instructions. The polished surfaces were evaluated with a profilometer, and then immersed in 2% methylene blue for 24h. Afterwards, the specimens were prepared for the spectrophotometric analysis. Results were statistically analyzed by ANOVA and Tukey test. RESULTS: Significant differences were found for the surface roughness and staining recorded, with interaction among composite resins and the finishing systems used. No correlation was found between surface roughness and staining susceptibility (p=0.5657). SIGNIFICANCE: For most of the polishing agents used, Z250 presented the smoothest surfaces and the least dye uptake. ALERT presented the roughest surfaces, and Solitaire, the highest dye concentration. The smoothest surfaces were not necessarily the most stain resistant. Staining is highly influenced by each composite monomer and filler composition.

Comparison of microtensile bond strength to enamel and dentin of human, bovine, and porcine teeth.

PURPOSE: To determine the bond strengths promoted by an adhesive system to human, bovine, and porcine enamel and dentin, and compare their etched micromorphology by scanning electron microscopy. MATERIALS AND METHODS: Thirty sound freshly extracted teeth were used in this study: ten human third molars, ten bovine incisors, and ten porcine molars. The crowns of human (H), bovine (B), and porcine (P) teeth were ground with 600-grit SiC paper to expose either enamel (E) or mid-depth dentin (D) surfaces. After application of the adhesive resin, composite crowns approximately 8 mm high were built up with TPH Spectrum composite. After 24 h of water storage, specimens were serially sectioned in the buccal-lingual direction to obtain 0.8 mm slabs, which were trimmed to an hourglass shape of approximately 0.8 mm2 at the bonded interface. Specimens were tested in tension in a universal testing machine (0.5 mm/min). Results were statistically analyzed with ANOVA and Tukey's test at the 95% confidence level. RESULTS: Tukey's test showed significant differences between bond strengths obtained on enamel and dentin (p < 0.05). However, there were no statistically significant differences in microTBS between human, bovine, and porcine teeth. SEM observations revealed a similar dentinal morphology for the three species. However, porcine enamel specimens presented a very different distribution of enamel prisms. CONCLUSION: Bovine teeth proved to be possible substitutes for human teeth in either dentin or enamel bond testing. However, even though porcine teeth provided enamel and dentin bond strengths similar to human and bovine teeth, enamel morphology presented a very different configuration.

Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial.

BACKGROUND: Excessive gingival display (EGD) has a negative impact on a pleasant smile. Minimally invasive therapeutic modalities have become the standard treatment in many dentistry fields. Therefore, the aim of this study is to compare the clinical outcomes of open-flap (OF) and minimally invasive flapless (FL) esthetic crown lengthening (ECL) for the treatment of EGD. METHODS: A split-mouth randomized controlled trial was conducted in 28 patients presenting with EGD. Contralateral quadrants received ECL using OF or FL techniques. Clinical parameters were evaluated at baseline and 3, 6, and 12 months post-surgery. The local levels of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) were assessed by enzyme-linked immunosorbent assay at baseline and 3 months. Patients' perceptions regarding morbidity and esthetic appearance were also evaluated. Periodontal tissue dimensions were obtained by computed tomography at baseline and correlated with the changes in the gingival margin (GM). RESULTS: Patients reported low morbidity and high satisfaction with esthetic appearance for both procedures (P >0.05). RANKL and OPG concentrations were increased in the OF group at 3 months (P <0.05). Probing depths were reduced for both groups at all time points, compared with baseline (P <0.05). There were no differences between groups for GM reduction at any time point (P >0.05). CONCLUSIONS: FL and OF surgeries produced stable and similar clinical results up to 12 months. FL ECL may be a predictable alternative approach for the treatment of EGD.

Effects of ultramorphological changes on adhesion to lased dentin-Scanning electron microscopy and transmission electron microscopy analysis.

Dentin irradiation with erbium lasers has been reported to alter the composite resin bond to this treated surface. There is still a lack of studies reporting the effect of erbium lasers on dentin organic content and elucidating how laser treatment could interfere in the quality of the resin-dentin interface. This study aimed to evaluate the effect of erbium laser irradiation on dentin morphology and microtensile bond strength (µTBS) of an adhesive to dentin. Seventy-two dentin disks were divided into nine groups (n = 8): G1-Control (600-grit SiC paper); Er:YAG groups: G2- 250 mJ/4 Hz; G3- 200 mJ/4 Hz; G4- 180 mJ/10 Hz; G5- 160 mJ/10 Hz; Er,Cr:YSGG groups: G6- 2 W/20 Hz; G7- 2.5 W/20 Hz; G8- 3 W/20 Hz; G9- 4 W/20 Hz. Specimens were processed for cross-sectional analysis by scanning electron microscopy (SEM) (n = 3), transmission electron microscopy (TEM) (n = 2), and adhesive interface (n = 3). Forty-five dentin samples (n = 5) were restored and submitted to µTBS testing. ANOVA (α = 5%) revealed that G1 presented the highest µTBS values and irradiated groups did not differ from each other. TEM micrographs showed a superficial layer of denatured collagen fibrils. For SEM micrographs, it was possible to verify the laser effects extending to dentin subsurface presenting a rough aspect. Cross-sectional dentin micrographs of this hybridized surface revealed a pattern of modified tags with ringlike structures around it. This in vitro study showed that erbium laser irradiation interacts with the dental hard tissue resulting in a specific morphological pattern of dentin and collagen fibrils that negatively affected the bond strength to composite resin.

Effects of water-storage on the physical and ultramorphological features of adhesives and primer/adhesive mixtures.

The aims of this study were to evaluate the ultimate tensile strength (UTS) and elastic modulus (E) of adhesives, and primer/adhesive mixtures after aging for 6 months in water or oil; and to compare silver uptake patterns under the TEM. A one-step self-etching adhesive (One-up Bond F: OB), two two-step self-etching primers (SE Bond: SE and Protect Bond: CP), and two etch-and-rinse systems (Single Bond: SB and Prime&Bond NT: PB) were used. Bonding and primer solutions of self-etching systems were also mixed (SE+P and CP+P). Most adhesives presented decreased UTS after water-storage. Similar or increased UTS was observed after oil storage. Except for SB, E values did not change after water-storage, but they increased after storage in oil. OB, CP+P and SE+P presented more silver uptake. The effects of water-storage were material-dependent, and significantly affected the mechanical properties and silver uptake patterns of adhesives.