The effect of thermocyclic aging on color stability of high translucency monolithic lithium disilicate and zirconia ceramics luted with different resin cements: an in vitro study.

BACKGROUND: High-translucency monolithic zirconia were developed to combine the esthetics of all ceramic restorations with the strength properties of zirconia. The purpose of this study was to compare the color stability of high-translucency monolithic zirconia ceramics with lithium disilicate luted using light-cure versus dual-cure resin cements following thermocyclic aging. METHODS: Forty specimens, each composed of 10 × 10 × 1 mm ceramic slice luted to dentin surface of an extracted tooth, were prepared and assigned into four groups (n = 10) as follows; LiDi/LC: lithium disilicate luted by light-cure resin cement; LiDi/DC: lithium disilicate luted by dual-cure resin cement; Zr/LC: zirconia luted by light-cure resin cement; and Zr/DC: zirconia luted by dual-cure resin cement. Color analysis of the specimens was performed before and after 3000 thermal cycles by means of spectrophotometry. The CIE L*a*b* values of the specimens were measured, and data were analyzed statistically at a significance value of p < 0.05. RESULTS: Thermocycling resulted in a significant change in color coordinates of specimens with an overall ΔE = 3.59 ± 1.60, but there was no statistically significant difference in the color change value among all tested groups (P = 0.756). CONCLUSIONS: At 1 mm restoration thickness, the color stability of high-translucency monolithic lithium disilicate and zirconia ceramics were not significantly different irrespective of the cement type used. Clinical implication Understanding the difference in color stability of dental ceramics may help in determining long-term esthetic result.

Repair bond strength of dental computer-aided design/computer-aided manufactured ceramics after different surface treatments.

OBJECTIVE: To evaluate the microtensile bond strength of four dental computer-aided design/computer-aided manufactured (CAD/CAM) ceramics after application of four different surface treatments. MATERIALS AND METHODS: Four dental CAD/CAM ceramics were tested: feldspathic ceramic (VITABLOCKS-Mark II), polymer-infiltrated ceramic network (VITA ENAMIC), zirconia-reinforced lithium silicate (VITA SUPRINITY), and yttria-stabilized zirconia (VITA YZ T). Four surface treatments were applied: no treatment, 5% hydrofluoric acid-etching, airborne particle abrasion, and tribochemical silica coating. The ceramic blocks were repaired with nanohybrid composite (Tetric N-Collection). Sixteen test groups of 12 specimens were prepared. After thermocycling, microtensile bond testing was performed. The microtensile strengths values were statistically analyzed using two-way analysis of variance and Tukey's post-hoc test. RESULTS: Repaired feldspathic and resin polymer-infiltrated ceramic network ceramics demonstrated superior microtensile bond strengths compared to zirconia-reinforced lithium silicate and yttria-stabilized zirconia. Etched feldspathic and polymer-infiltrated ceramic network ceramics had higher bond strength than the untreated groups. Surface treatments did not affect the bond strength of zirconia-reinforced lithium silicate and yttria-stabilized zirconia with the exception of etching, which reduced the bond strength of yttria-stabilized zirconia. CONCLUSION: Feldspathic ceramic and polymer-infiltrated ceramic network were repaired with dental composite after surface etching with hydrofluoric acid. Repair of zirconia-reinforced lithium silicate and yttria-stabilized zirconia did not demonstrate promising results. CLINICAL SIGNIFICANCE: Repair of feldspathic ceramic and polymer-infiltrated ceramic network restorations may be a cost-effective means to promote the longevity of dental restorations. However, zirconia and zirconia-reinforced lithium disilicate restorations do not offer such an option.

Enhanced Antimicrobial Properties of Polymeric Denture Materials Modified with Zein-Coated Inorganic Nanoparticles.

Background: Polymeric denture materials can be susceptible to colonization by oral microorganisms. Zein-coated magnesium oxide nanoparticles (zMgO NPs) demonstrate antimicrobial activity. The aim of this study was to investigate the antimicrobial effect and adherence of different oral microorganisms on hybrid polymeric denture materials incorporated with zMgO NPs. Methods: Five types of polymeric denture materials were used. A total of 480 disc-shaped specimens were divided by material type (n=96/grp), then subdivided by zMgO NPs concentration: control with no nanoparticles and other groups with zMgO NPs concentrations of 0.3%, 0.5% and 1% by weight. Characterization of the polymeric denture materials incorporating zMgO NPs was done, and the antimicrobial activity of all groups was tested against four types of microorganisms: 1) Streptococcus mutans, 2) Staphylococcus aureus, 3) Enterococcus faecalis and 4) Candida albicans. The samples underwent an adherence test and an agar diffusion test. Experiments were done in triplicates. Results: The characterization of the hybrid samples revealed variation in the molecular composition, as well as a uniform distribution of the zMgO NPs in the polymeric denture materials. All hybrid polymeric denture materials groups induced a statistically significant antimicrobial activity, while the control groups showed the least antimicrobial activity. The agar diffusion test revealed no release of the zMgO NPs from the hybrid samples, indicating the NPs did not seep out of the matrix. Conclusion: The zMgO NPs were effective in reducing the adherence of the tested microorganisms and enhancing the antimicrobial activity of the polymeric denture materials. This antimicrobial effect with the polymeric dentures could aid in resisting microbial issues such as denture stomatitis.

Effect of Repressing Lithium Disilicate Glass Ceramics on The Shear Bond Strength of Resin Cements.

The aim of this study was to investigate the effect of repeated pressing of lithium disilicate ceramic on the shear bond strength (SBS) of three types of resin cement. METHODOLOGY: A lithium disilicate ceramic (IPS e.max® Press) was first heat-pressed to form rectangular disk specimens. Then, leftovers were used for the second and third presses. A total of 90 specimens were prepared and separated, according to the number of pressing cycles, into three groups: 1st, 2nd, and 3rd presses (n = 30). Each group was further subdivided into three groups (n = 10) according to the type of resin cement used, as follows: Multilink N (MN), Variolink Esthetic DC (VDC), and Variolink Esthetic LC (VLC). All the cement was bonded to the ceramic surface, which was etched with hydrofluoric acid and primed with Monobond Plus. All samples were light-cured and stored for 24 h. Shear bond strength was tested on a universal testing machine. RESULTS: A two-way ANOVA was used to evaluate the influence of repeated pressing cycles and cement type as well as their interaction. The results indicated that cement type has a significant impact (p < 0.001) but not the number of pressing cycles (p = 0.970) or their interaction (p = 0.836). The Bonferroni post-hoc test showed that the SBS of MN was significantly higher than that of VDC and VLC in the first press and second press cycles, respectively. The SBS of MN was significantly higher than that of VDC and VLC cements in the third pressing cycle. There was no significant difference in the SBS between VLC and VDC in all three pressing cycles. CONCLUSION: The results of the current study did not report a detrimental effect of repeated pressing up to three cycles on the shear bond strength of the IPS e.max® Press. Multilink resin cement showed the highest SBS to IPS e.max® Press at the third pressing cycle. For all types of cement and heat pressing cycles, the majority of cement failures were adhesive. No cohesive failures occurred in any of the tested resin cements, regardless of the cement type or the number of heat pressing cycles tested.

The Effect of Repeated Pressing on the Flexural Strength, Color Stability, Vickers Hardness, and Surface Topography of Heat-Pressed Lithium Disilicate.

The aim of this study was to investigate the effect of repressing leftover heat-pressed lithium disilicate material on its mechanical and optical properties. A lithium disilicate ingot (IPS e.max® Press, IvoclarVivadent, Schaan, Liechtenstein) shade (A1) low translucency was first heat-pressed to yield ceramic bars and disks. Then, the second and third presses were fabricated from the leftovers of the previous pressing cycles. A total of 36 bars and 15 disk specimens were fabricated and divided into three groups according to the number of pressing cycles (n = 12 bars and n = 5 disks): P1: first press (control), P2: second press, and P3: third press. The specimens were tested for flexural strength, color change, Vickers hardness, and surface topography under scanning electron microscopy. One-way ANOVA testing was used to evaluate flexural strength and hardness, while an independent t-test was performed to evaluate color change. There was no significant difference in flexural strength as the number of heat-pressed cycles increased (p = 0.283). Similarly, there was no significant difference in the microhardness values between all groups (p = 0.220). The overall color change ∆E between P1-P2 and P1-P3 were 2.01 and 2.14, respectively. The SEM images showed evenly distributed and densely packed lithium disilicate crystals in the P1 group. However, larger and less densely packed crystals were noticeable in P2 and P3. The IPS e.max Press could be repressed up to two times without an adverse effect on mechanical properties or color stability. These results may support the reuse of pressed lithium disilicate for economical purposes, but further clinical evaluation should be conducted to confirm these findings.

Rebonding of orthodontic brackets. Part II, an XPS and SEM study.

OBJECTIVE: The hypothesis of this two-part study is that adhesive systems for bonding orthodontic brackets (ie, two self-etch primers [Transbond and M-Bond] and a conventional phosphoric acid etch [Rely-a-Bond]) would show a difference with respect to rebonded enamel surface morphology and chemical composition. MATERIALS AND METHODS: This study examined the enamel surface before and after debonding with scanning electron microscopy and the enamel surface chemical composition for the elements Ca, P, O, F, Si, and C using x-ray photoelectron spectroscopy. RESULTS: The etching of the two self-etch groups is less aggressive and less uniform than that of phosphoric acid. The change in the concentration of C indicated that the separation of the bracket from the enamel surface is at the resin-enamel interface for the phosphoric acid-etched adhesive and a mixed mode involving the enamel-resin-bracket interfaces for the self-etching systems. F release appears to occur for Transbond but not for M-Bond. CONCLUSIONS: The results confirm the original hypothesis that differences in adhesive systems are manifested in less aggressive etches and less adhesive left on the enamel surface for the self-etching adhesive systems.

Contact versus flexure fatigue of a fiber-filled composite.

OBJECTIVE: The intent of this project was to examine the effect of two different modes of fatigue loading, contact and flexure, on the flexure strength of a dental composite. METHODS: The composite was Restolux (a fiber-filled composite) formed as bars 3 mm x 3 mm x 25 mm in size. The cyclic loading ranges were 30-50, 60-80, and 90-110 N for contact loading and 20-40 and 40-60 N for the flexure loading. Number of cycles completed was 1, 1000 or 100,000 in four different media: air, water, artificial saliva, and a 50/50 mixture of water and ethanol. Specimens were aged in sealed polyethylene containers in their respective media for 4 months at 37 degrees C. RESULTS: Statistical analysis indicated a significantly lower flexure strength for the specimens flexure loaded versus contact loaded. For the flexure loaded specimens, the number of cycles had no significant effect, but the aging, load, and the media were all significant. For the contact loaded specimens, a significant effect was observed for the media, aging, and cycles completed, but no effect for the different cycling loads. SIGNIFICANCE: In summary, the decrease in flexure strength from flexure loading was mainly affected by the aging media, whereas, the decrease from contact loading was attributed mainly to the number of cycles.

Variables affecting darbepoetin resistance index in hemodialysis patients.

Erythropoietin resistance index calculation has been used as a tool to evaluate anemia response to erythropoietin therapy. Very little has been reported in its use when using darbepoetin and factors influencing in Arab patients. Darbepoetin resistance index (DRI) was calculated in all our patients using darbepoetin. This was correlated to demographic, clinical, and laboratory parameters. Of the 250 patients, 40.4% were diabetic, 71.1% on hemodialysis, and 28.6% on hemodiafiltration), 23.9% with PermCaths (PC), and 76.1 % with arteriovenous fistula (AVF). The mean DRI was 10.96 ± 12.9 I. Females had 45% higher DRI than males (P = 0.005), and patients with PC had a 66% higher DRI than those with AVF (P = 0.029). Patients with Vitamin D level below the 50th percentile had 55.9% higher DRI than those above it (P = 0.05). DRI was negatively correlated with age (P = 0.018), dialysis vintage (P = 0.039), interdialytic weight gain P = 0.007), Vitamin D level, and serum albumin (P = 0.005) and positively correlate with parathyroid hormone (PTH) level (P = 0.000). No impact was seen by the mode of dialysis, being diabetic, using anti-hypertensive therapy, body mass index, Kt/V, serum iron, total iron binding capacity, transferrin saturation, ferritin, C-reactive protein, Ca, or P. DRI in our Arab patients was comparable to erythropoietin resistance indices reported in other communities. Higher DRI was observed in females, PC users, lower serum albumin, lower Vitamin D, and shorter dialysis vintage. A negative correlation existed between DRI and age, dialysis vintage, interdialytic weight, and serum albumin and a positive correlation with PTH level.

Leaching and mechanical properties characterization of dental composites.

The objective of this study was to determine the leaching of Ba, Si, and Sr from four dental composites: Restolux (RX), Micronew (M), Renew (RW), and Choice (C) and to correlate the effects of such leaching with flexure strength and modulus of elasticity. The specimens were 3 x 3 x 25-mm bars, polished with 120- and 240-grit SiC paper, and were aged for 4, 6, and 8 months in artificial saliva, distilled water, and a 50/50 mixture of ethanol and distilled water. Inductively coupled plasma with mass spectroscopy (ICP/MS) was used to determine the ion concentrations after aging. The greatest release of Ba and Sr occurred after aging in 50/50 volume fraction mixture of ethanol/water and for Si in artificial saliva. The 50/50 solution caused a breakdown of the resin and glass matrix, resulting in an increase of Ba and Sr, whereas aging in artificial saliva resulted in an ion charge balance, which allowed an elevated and continuous release of Si. The flexure strength and the elastic modulus showed a gradual decrease over time, with the greatest decreases occurring following aging in the 50/50 water/ethanol solution, but little correlation with the leaching of the filler ions.

Fatigue behaviour of dental composite materials.

OBJECTIVE: The intent of the project was to evaluate the fatigue behavior of particle and fiber filled dental composites that are fabricated either directly or indirectly using a notched specimen with respect to the number of cycles until failure. METHODS: The materials were five dental composites, three normally cured in the oral cavity (Restolux, Renew and Filtek Supreme), direct processing, and two laboratory produced (BelleGlass, and Tescera), indirect processing. The specimens were 3mmx3mmx25mm bars with a 0.75 or 1.0mm notch in the mid-span of the bars, polished with 320 grit SiC paper and aged for 6 months in air, distilled water, artificial saliva, and a 50/50 mixture of ethanol and distilled water. Testing was performed with a stress mean range of 5-49MPa, the maximum number of cycles was 100,000, and the number of cycles to failure was recorded. RESULTS: For the specimens that failed, BelleGlass, Restolux, and Tescera were able to withstand a higher cyclic loaded stress than Renew and Filtek. The 50/50 by volume mixture of water and ethanol resulted in the lowest resistance to fatigue for all materials. CONCLUSIONS: Of the dental composite materials investigated, the indirect processed and those with large particle fillers (higher weight percent filler) had better cyclic fatigue resistance than micro- and nano-particle fillers (lower weight percent filler).

Changes in prosthetic screw stability because of misfit of implant-supported prostheses.

PURPOSE: The effect of two levels of prosthesis misfit on prosthetic screw stability was evaluated. MATERIALS AND METHODS: Two levels of vertical discrepancies--100 and 175 microns--were introduced between an implant-supported complete denture and the terminal abutment. An implant-supported complete denture without vertical discrepancy served as a control. Cyclic load was delivered vertically on the cantilever portion of the prosthesis next to the terminal abutment for 48 hours for each trial. A total of seven sets of new screws were tested for each level of fit. RESULTS: The results revealed significant prosthetic screw instability at both the 100- and 175-micron levels of discrepancy. CONCLUSION: Vertical discrepancies of 100 and 175 microns introduced between an implant-supported fixed complete denture and the terminal abutment resulted in significant prosthetic screw instability.