Mechanical properties of bulk-fill resin composites with single increment up to 4 mm: A novel mechanical strength test.

PURPOSE: To evaluate the mechanical properties of two brands of bulk-fill resin composites placed in a single increment up to 4 mm thickness via a novel mechanical strength test and provide related explanations. METHODS: Light transmission (LT), translucency parameter (TP), color difference (ΔE), Vickers hardness (HV) of two bulk-fill resin composites (Filtek Bulk Fill Posterior, Tetric N-Ceram Bulk Fill) and two conventional resin composites (Z100, Spectrum TPH) were evaluated. A novel flexural strength (FS) test method was applied for bulk-fill resin composite to determine the FS value of the bottom composites at depths of 1, 2, 3, and 4 mm after 24 hours of aging treatment (3 months water storage and 15,000 thermal cycles). The conventional resin composites were also tested for FS and all the FS results were subjected to Weibull analysis. Degree of conversion (DC) in the bulk-fill resin composites, light-cured at depths of 1, 2, 3, and 4 mm and conventional resin composites at depths of 2 and 4 mm, were assessed by FTIR. RESULTS: Both bulk-fill resin composites showed higher light transmission and translucency than that of conventional ones at each of the same thicknesses (1, 2, 3, 4 mm), wherein their flexural strength was not affected by depth. The Weibull analysis suggested both bulk-fill resin composites achieved good reliability and structural integrity under each curing thickness. Vickers hardness was affected by the material type and thickness. Bulk-fill resin composites showed a decrease in degree of conversion between 1 mm and 4 mm, but both were over 55%. CLINICAL SIGNIFICANCE: Filtek Bulk Fill Posterior, Tetric N-Ceram Bulk Fill achieved acceptable mechanical properties when cured at depths of up to 4 mm, which was beneficial from their optical and polymerized properties.

Evaluation of a half-digital technique for fabricating customized post-cores: A pilot study.

Objectives: The current half-digital post-core fabrication technique can replace the conventional methods; however, it does not consider the impact occlusion has on the digital design. This study proposed a half-digital workflow that integrated intracanal impression with dentition scanning, and evaluated the accuracy of the post-cores fabricated by it. Methods: Standard models with three extracted teeth (a central incisor, a premolar, and a molar) were prepared. Eight post-cores were fabricated for each tooth by the half-digital technique and eight by the conventional technique as controls. Scanning was performed with a microcomputed tomography system. The volume of the overall space (VOS) between the post and canal wall, the space areas in three standardized sections (A, B, and C), and the apical gap (AG) were calculated and statistically analyzed using two-way analysis of variance. Statistical significance was set at p < 0.05. Results: The two techniques differed significantly in the VOS (p < 0.05), section B (p < 0.05), and AG (p < 0.05) of all three teeth but not for sections A (p = 0.099) and C (p = 0.636). Conclusions: The half-digital technique investigated in this study could produce better-fitting customized post-cores than the conventional technique.

NOTCH4 Single-Nucleotide Polymorphism Is Associated with Brain Arteriovenous Malformation in a Chinese Han Population.

INTRODUCTION: Brain arteriovenous malformations (BAVMs) are high-flow intracranial vascular malformations characterized by the direct connection of arteries to veins without an intervening capillary bed. They are one of the main causes of intracranial hemorrhage and epilepsy, although morbidity is low. Angiogenesis, heredity, inflammation, and arteriovenous malformation syndromes play important roles in BAVM formation. Animal experiments and previous studies have confirmed that NOTCH4 may be associated with BAVM development. Our study identifies a connection between NOTCH4 gene polymorphisms and BAVM in a Chinese Han population. METHODS: We enrolled 150 patients with BAVMs confirmed by digital subtraction angiography (DSA) in the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from June 2017 to July 2019. Simultaneously, 150 patients without cerebrovascular disease were confirmed by computed tomography angiography/magnetic resonance angiography/DSA. DNA was extracted from peripheral blood and NOTCH4 genotypes were identified by PCR-ligase detection reaction. The χ2 test or Fisher's exact test was used to evaluate the differences in allele and genotype frequencies between the BAVM group, control group, bleeding group, and other complications. RESULTS: Two single-nucleotide polymorphisms (SNPs), rs443198 and rs438475, were significantly associated with BAVM. No SNP genotypes were significantly associated with hemorrhage or epilepsy. SNPs rs443198_AA-SNP and rs438475_AA-SNP may be associated with a lower risk of BAVM (p = 0.011, odds ratio (OR) = 0.459, 95% confidence interval (CI): 0.250-0.845; p = 0.033, OR = 0.759, 95% CI: 0.479-1.204). CONCLUSION: NOTCH4 gene polymorphisms were associated with BAVM and may be a risk factor in a Chinese Han population.

In vitro comparison of bonding to zirconia- or glass- based ceramics between flowable resin composites and composite resin cements.

PURPOSE: To evaluate and compare the bonding of flowable resin composites and light-cured resin cements to dental ceramics. METHODS: Grit-blasted zirconia plates were primed with MDP-containing adhesive. Lithium disilicate glasses plates were etched with HF and primed with silane. Two flowable resin composites with high (CM: 75 wt%/62 vol%) and low (BF: 67.3 wt%/47 vol%) filler contents, and two resin cements, again with high (C: 72 wt%/69 vol%) and low (R: 66 wt%/47 vol%) filler contents, were bonded to both types of pretreated ceramics. Shear bond strength (SBS) was measured after 24 hours water storage or 10,000 times thermocycling between 5 and 55°C. The viscosities and film thicknesses of the four resin-based luting agents (RBLAs) were also explored by rotational rheometer and metallurgical microscope severally. RESULTS: Different RBLAs provided statistically different SBS values, with the high-filler specimens exhibiting higher SBS values than the low-filler specimens. The viscosities decreased in the order C > R > BF > CM. The film thicknesses for the BF and C groups were higher than those of the CM and R groups. CLINICAL SIGNIFICANCE: This study provides evidence that flowable resin composites with high filler contents and low viscosities may serve as an alternative to light-cured resin cements for luting zirconia or lithium disilicate glass. This expands the range of light-cured luting agents available for bonding of veneers or other thin restorations, which is of great benefit to clinical practice.

Identification and Potential Mechanisms of a 7-MicroRNA Signature That Predicts Prognosis in Patients with Lower-Grade Glioma.

Background: Lower-grade glioma is an intracranial cancer that may develop into glioblastoma with high mortality. The main objective of our study is to develop microRNA for LGG patients which will provide novel prognostic biomarkers along with therapeutic targets. Methods: Clinicopathological data of LGG patients and their RNA expression profile were downloaded through The Cancer Genome Atlas Relevant expression profiles of RNA, and clinicopathological data of the LGG patients had been extracted from the database of "The Cancer Genome Atlas." Differential expression analysis had been conducted for identification of the differentially expressed microRNAs as well as mRNAs in LGG samples and normal ones. ROC curves and K-M plots were plotted to confirm performance and for predictive accuracy. For the confirmation of microRNAs as an independent prognostic factor, an independent prognosis analysis was conducted. Moreover, target differentially expressed genes of these identified prognostic microRNAs that were extracted and protein-protein interaction networks were developed. Moreover, the biological functions of signature were determined through Genome Ontology analysis, genome pathway analysis, and Kyoto Encyclopedia of Genes. Results: 7-microRNA signature was identified that has the ability of categorization of individuals with LGG into high- and low-risk groups on the basis of significant difference in survival during training and testing cohorts (P < 0.001). The 7-microRNA signature had appeared to be robust in predictive accuracy (all AUC> 0.65). It was also approved with multivariate Cox regression along with some traditional clinical practices that we can use 7-microRNA signature for therapeutic purposes as a self-regulating predictive OS factor (P < 0.001). KEGG and Gene Ontology (GO) analyses reported that 7-microRNAs had mainly developed in important pathways related with glioma, e.g., the "cAMP signaling pathway," "glutamatergic synapses," and "calcium signaling pathway". Conclusion: A newly discovered 7-microRNA signature could be a potential target for the diagnosis and treatment for LGG patients.

Identification of an N6-methyladenosine (m6A)-related signature associated with clinical prognosis, immune response, and chemotherapy in primary glioblastomas.

BACKGROUND: N6-methyladenosine (m6A) RNA methylation regulators play crucial role in tumorigenicity and progression. However, their biological significance in primary glioblastomas (GBM) has not been fully elucidated. METHODS: In the present study, we evaluated the 22 m6A RNA regulators using the integrated data of primary GBM samples from The Cancer Genome Atlas and Chinese Glioma Genome Atlas databases. The different m6A modification patterns and m6A-related gene signature in primary GBM were distinguished by using principal component analysis. Single-sample gene set enrichment analysis was introduced to assess the relative level of immune infiltration. Gene set variation analysis was performed to calculate the enrichment score of the signaling pathways for different clusters. An m6A scoring scheme was established to evaluate the m6A modification pattern in individual tumors in order to predict prognosis and evaluate tumor microenvironment (TME) cell infiltration, immune response, and chemotherapy effect in primary GBM. RESULTS: Two distinct m6A modification subgroups associated with different clinical features and biological pathways were identified among the 371 primary GBM. Based on 132 prognostic m6A phenotype-related differentially expressed genes (DEGs) between 2 m6A cluster subgroups, an m6A scoring model was constructed to assess the m6A modification pattern in individual tumors. The high-m6A score group was associated with better prognosis and immune response and worse chemotherapy effect. CONCLUSIONS: The findings of the present study indicate the potential role of m6A modification in primary GBM, which will help enhance our understanding of TME characteristics, predict clinical prognosis, and provide important insight into effective immunotherapy and chemotherapy.

Effects of Tribochemical Silica Coating and Alumina-Particle Air Abrasion on 3Y-TZP and 5Y-TZP: Evaluation of Surface Hardness, Roughness, Bonding, and Phase Transformation.

PURPOSE: To determine and compare the effects of tribochemical silica coating and alumina-particle air abrasion on 3 mol% and 5 mol% yttria-stabilized tetragonal zirconia polycrystals (Y-TZP). MATERIALS AND METHODS: Two different 3Y-TZP samples (Lava Plus, 3M Oral Care; Ceramill Zolid, Amann Girrbach) and one 5Y-TZP sample (Katana Zirconia UTML, Kuraray Noritake) were prepared and treated with alumina-particle air abrasion and a 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP)-containing self-adhesive composite cement or with tribochemical silica coating followed by silanization (n = 30). Resin columns were cemented onto the treated ceramic surfaces to form specimens. After 24-h water storage or aging with 10,000 thermocycles plus 60-day water storage, shear bond strength (SBS) testing was conducted. Surface roughness, surface Vickers hardness, and crystallographic phase analyses were also performed. RESULTS: The SBS of tribochemically silica-coated 5Y-TZP before and after aging were 13.8 ± 1.4 and 13.2 ± 1.5 MPa, resp., for Lava Plus (3Y-TZP) 14.4 ± 1.4 and 13.9 ± 1.6 MPa, respectively, and for Ceramill Zolid (3Y-TZP) 14.8 ± 1.1 and 13.9 ± 1.5 MPa, respectively. There was no statistical difference between tribochemical silica coating and alumina air abrasion treatments (p = 0.21) on the bonding performance (SBS) of the 3Y-TZPs and 5Y-TZP (p = 0.25) before and after aging (p = 0.50). After alumina air abrasion, 5Y-TZP showed higher surface roughness (Ra = 1.7 ± 0.1) than did the 3Y-TZPs (Ra = 1.2 ± 0.1 for Lava Plus; Ra = 1.2 ± 0.1 for Ceramill Zolid), while the Vickers hardness was similar among the three materials (p = 0.70). Monoclinic zirconia was not detected in 5Y-TZP irrespective of treatment, with the zirconia being mainly cubic phase. However, the 3Y-TZPs were mainly tetragonal phase with some monoclinic zirconia; the latter increased after being alumina-particle air abraded. CONCLUSION: The bond strength to 5Y-TZP is similar to those of the 3Y-TZPs under the same bonding strategies. Durable bonding can be achieved both by alumina air abrasion combined with a 10-MDP-containing self-adhesive composite cement and by tribochemical silica coating followed by silanization for both the 3Y-TZPs and 5Y-TZP.

Bond durability when applying phosphate ester monomer-containing primers vs. self-adhesive resin cements to zirconia: Evaluation after different aging conditions.

PURPOSE: This study aimed to evaluate bond durability when applying 2 phosphate ester monomer-containing self-adhesive resin cements alone, versus a combination of phosphate ester monomer-containing primer conditioning plus 2 conventional resin cements requiring primers, to zirconia after different artificial aging methods. METHODS: We cemented air-abraded zirconia plates to composite resin cylinders with self-adhesive resin cements (MS; RU) alone or cemented them with traditional resin cements (ZRV; ZVN) after pre-conditioning with a zirconia primer. A shear bond strength (SBS) test were performed after subjecting them to 19 different aging conditions (n = 15) comprising 30,000× thermocycles, air storage at room temperature (RT), water storage at RT, or at 37 °C for 24 h, 1 week, 1, 3, 6, and 12 months. Zirconia powders mixed with zirconia primer or 2 self-adhesive resin cements were characterized by X-ray photoelectron spectroscopy. RESULTS: Groups MS and ZVN obtained the highest SBS after all of aging methods. SBS after 6 months of storage was similar to SBS after 24 h of storage, while both were higher than SBS after 1 year of storage. Water storage at 37 °C provided higher SBS than RT water storage did. We detected a Zr-O-P bond in both self-adhesive resin cement/zirconia powder mixtures. CONCLUSIONS: Application of self-adhesive resin cements alone could be an alternative to pre-conditioning with a zirconia primer followed by the application of conventional resin cements. Formation of Zr-O-P bonds contributed to the bonding improvement of self-adhesive resin cements. Different aging conditions affected SBS values.

Effectiveness of pre-silanization in improving bond performance of universal adhesives or self-adhesive resin cements to silica-based ceramics: Chemical and in vitro evidences.

OBJECTIVES: To examine effectiveness of pre-silanization in improving bond performance of multipurpose products such as universal adhesives or self-adhesive resin cements to silica-based ceramics. METHODS: The present study investigated reactions between silanol groups of γ-methacryloxypropyltrimethoxysilane (γ-MPS) and silica, dehydration self-condensation of γ-MPS, and condensation polymerization between γ-MPS and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) by using thermodynamic calculations. Shear bond strength (SBS) tests were used to evaluate the influence of pre-silanization on resin bonding when a silane-containing universal adhesive, a silane-unknown universal adhesive, or two self-adhesive resin cements were applied for bonding lithium disilicate to resin. In addition, reactions between silane and lithium disilicate were analyzed using X-ray photoelectric spectroscopy (XPS) and Fourier transform infrared spectroscopy (FTIR). RESULTS: Acquired thermodynamic data indicated formation of siloxane between γ-MPS and silica. However, self-condensation of γ-MPS and reaction between γ-MPS and 10-MDP consumed the silanol. Pre-silanization enhanced SBS for self-adhesive resin cements or universal adhesives when applied for bonding silica-based ceramics. Thermocycling and aging decreased SBS in most groups. XPS and FTIR supported formation of siloxane between the employed silane coupling agent and two universal adhesives and lithium disilicate. SIGNIFICANCE: Pre-silanization is beneficial in further enhancing bond performance of universal adhesives or self-adhesive resin cements to silica-based ceramics.

Shear bond strength of zirconia to resin: The effects of specimen preparation and loading procedure.

PURPOSE: Shear bond strength (SBS) test is the most commonly used method for evaluating resin bond strength of zirconia, but SBS results vary among different studies even when evaluating the same bonding strategy. The purpose of this study was to promote standardization of the SBS test in evaluating zirconia ceramic bonding and to investigate factors that may affect the SBS value of a zirconia/resin cement/composite resin bonding specimen. MATERIALS AND METHODS: The zirconia/resin cement/composite resin bonding specimens were used to simulate loading with a shear force by the three-dimensional finite element (3D FE) modeling, in which stress distribution under uniform/non-uniform load, and different resin cement thickness and different elastic modulus of resin composite were analyzed. In vitro SBS test was also performed to validate the results of 3D FE analysis. RESULTS: The loading flat width was an important affecting factor. 3D FE analysis also showed that differences in resin cement layer thickness and resin composite would lead to the variations of stress accumulation area. The SBS test result showed that the load for preparing a SBS specimen is negatively correlated with the resin cement thickness and positively correlated with SBS values. CONCLUSION: When preparing a SBS specimen for evaluating bond performance, the load flat width, the load applied during cementation, and the different composite resins used affect the SBS results and therefore should be standardized.

Effect of tribochemical silica coating or multipurpose products on bonding performance of a CAD/CAM resin-based material.

OBJECTIVES: Nanocomposite ceramics have been widely used in clinical practice; however, a standard, recommended bonding protocol has not been determined yet. The present study aimed to evaluate application of tribochemical silica coating or multipurpose products on bonding performance of a CAD/CAM resin-based material (known as nanocomposite ceramic). MATERIALS AND METHODS: Nanocomposite ceramic specimens were fabricated and assigned into 11 groups to build bonded specimens (n = 15) according to surface treatments (none; air particle abrasion with 50-µm alumina followed by application of a silane coupling agent or a universal adhesive; tribochemical silica coating followed by application of a silane coupling agent or a universal adhesive) and resin luting cements (conventional resin cement, RelyX Veneer; self-adhesive resin cement RelyX Unicem) used. Micro-shear bond strength (µ-SBS) was measured after 24-h water storage or ageing with 10,000 thermocycles plus additional 90-d water storage. Surface roughness after alumina air abrasion and tribochemical silica coating were determined using a profilometer. Surface morphology and element variation were observed by using a scanning electron microscope (SEM)/energy dispersion spectrum (EDS). X-ray photoelectron spectroscopy (XPS) was used to characterize nanocomposite ceramic powders conditioned with silane coupling agent or the universal adhesive used in the µ-SBS test. The nanocomposite ceramic plates received alumina air abrasion, tribochemical silica coating, or without, were determined using X-ray diffraction (XRD). RESULTS: Nanocomposite ceramic treated with alumina air abrasion achieved the highest surface roughness, followed by those treated with tribochemical silica coating. Newly formed Si-O-Si bonds on the nanocomposite ceramic surface were detected by XPS after treatment with silane coupling agent or universal adhesive, and a Zr-O-P bond was detected after treating with universal adhesive. µ-SBS was significantly affected by bond strategies and ageing. Ageing by thermocycling and water storage significantly decreased µ-SBS. µ-SBS values derived by use of a universal adhesive or self-adhesive resin cement alone were no lower than the values derived by use of a silane coupling agent alone. Pre-silanization further enhanced the bonding improvement of universal adhesive or self-adhesive resin cement. However, tribochemical silica coating failed to provide higher µ-SBS compared with alumina air abrasion. XRD detected no monoclinic zirconia phase after alumina air abrasion or tribochemical silica coating, suggesting that these two roughening methods did not lead to phase transformation of zirconia fillers. CONCLUSIONS: Combination of presilanization and universal adhesives improve resin bonding of nanocomposite ceramics. Tribochemical silica coating is not superior to alumina air abrasion for pretreated nanocomposite ceramics.

Effects of Luting Cements and Surface Conditioning on Composite Bonding Performance to Zirconia.

PURPOSE: This study compared bond strength, durability, and mechanical properties of luting cements for bonding zirconia: a resin-modified glass ionomer cement (RMGIC), a conventional composite cement, and two self-adhesive composite cements. MATERIALS AND METHODS: The air-abraded zirconia specimens were assigned to 12 groups (n = 30) to prepare bonded specimens. Classification was based on the pre-conditioning selection: none; primers containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP); universal adhesives containing MDP. Further classification was done according to the type of luting cement: RMGIC; conventional composite cement; MDP-free self-adhesive composite cement; MDP-containing self-adhesive composite cement. The shear bond strength (SBS) was measured after 24 h of water storage or aging with 20,000 thermocycles plus an additional 60 days of water storage at 37°C. The elastic modulus and three-point bending strength were determined, and a related Weibull analysis of the four luting cements was performed. RESULTS: The choice of luting cement and aging significantly affected the SBS. Aging decreased the SBS in most groups, except for those that used MDP-containing primers plus conventional composite cements. RMGIC had SBS (before and after aging) that were similar to the MDP-free self-adhesive composite cement. Use of MDP-containing products prior to conventional composite cements provided the highest initial SBS. However, pre-conditioning with MDP-containing products failed to increase the SBS of RMGIC. RMGIC showed lower elastic modulus and three-point bending strength than did the three composite cements. CONCLUSIONS: RMGIC is an alternative to composite cements for luting zirconia restorations. Conditioning with a primer containing MDP combined with conventional composite cement is more reliable.

Effects of multiple firings on mechanical properties and resin bonding of lithium disilicate glass-ceramic.

OBJECTIVES: This study aimed to evaluate the effects of different firing cycles on surface hardness, fracture toughness, and roughness of lithium disilicate glass-ceramic, as well as their bond strength to resin. MATERIALS AND METHODS: A total of 320 polished lithium disilicate glass-ceramic plates were assigned to four main groups (n = 60) to receive one, two, three, or four firing cycles, respectively. Ceramic plates of the four groups were conditioned with HF acid followed by silanization. The pre-treated ceramic plates were cemented with composite resin cylinders using conventional or self-adhesive resin cements to build bonded specimens, and submitted to shear-bond-strength (SBS) testing after water storage for 24 h or 3 mo at 37 °C. The ceramic received different firing cycles after polishing or HF etching was observed using a scanning electron microscope, and their surface roughnesses were determined by a profilometer. The surface Vickers hardness, fracture toughness, and related Weibull analysis results of the polished ceramics after undergoing different firing-cycle times were compared. RESULTS: One sintering significantly increased fracture toughness of lithium disilicate glass-ceramic; however, multiple firing cycles failed to increase it further. Weibull analysis revealed a significant difference in terms of structural reliability among the specimens receiving 0-4 firing cycles. Specimens that received no firing cycle showed the highest surface hardness. Multiple firing cycles had no significant influence on the surface Vickers hardness and surface roughness. HF etching increased surface roughness, and the roughened surface improved the resin SBS of lithium disilicate glass-ceramic. Multiple firing cycles had no significant effect on surface roughness. Furthermore, multiple firing cycles and 3-mo water storage had no significant effect on the SBS. CONCLUSIONS: The mechanical properties of lithium disilicate glass-ceramics would be partially affected by multiple firing cycles, while their resin bonding would not be.