Preheating and "snow-plow" composite application technique affect double bond conversion but not bond strength to dentine.

OBJECTIVE: To measure degree of conversion (DC) of a flowable composite, microtensile bond strength (MTBS) to dentine in the snow-plow technique with/without preheating and temperature in the preheated composite. MATERIALS AND METHODS: For DC, snow-plow specimens of Filtek Ultimate Flowable (Flow) and Filtek Bulk Fill (Bulk) (3M) were prepared by light-curing composites simultaneously in standardized molds while in control groups light-curing was separate. DC of Flow was measured using micro-Raman spectroscopy. For MTBS, specimens were prepared on dentine of human extracted molars by simultaneous (snow-plow) or separate (control) light-curing. MTBS was measured using a universal testing machine after 24 h and 6 months. Data were analyzed using ANOVA with Tukey's post hoc (α = 0.05). RESULTS: Increased curing time significantly increased DC in snow-plow from 13.4% ± 11.6% (10 s) to 31.8% ± 4.4% (40 s) albeit significantly lower than controls (p < 0.05). Preheated Bulk improved conversion in snow-plow (44.3% ± 1.7%) and control (50.5% ± 2.6%) (p < 0.05). No significant differences occurred in MTBS between groups (p > 0.05). MTBS values ranged between 66.7 ± 8.4 MPa (snow-plow group_21°C_baseline) and 54.1 ± 15.8 MPa (control_21°C_long-term). Temperature in the preheated Bulk dropped to ~38°C after 30 s. CONCLUSIONS: Snow-plow technique, irrespective of preheating, resulted in lower DC of Flow than separate light-curing of composite increments. Snow-plow, irrespective of preheating, resulted in similar initial and long-term MTBS to dentine. CLINICAL SIGNIFICANCE: Clinicians with preference for flowable composite liners in Class II restorations should be aware that the snow-plow technique of simultaneous light-curing of flowable and bulk-fill composite increments affects monomer-to-polymer conversion, albeit no effect on immediate, and long-term bonding to dentine was detected. Preheating sculptable bulk-fill composite improves conversion of the flowable liner in the snow-plow technique but has no detectable effect on bond strength to dentine.

Effect of different finishing and polishing procedures on surface roughness and microbial adhesion on highly-filled composites for injectable mold technique.

OBJECTIVE: To evaluate the effect of different finishing and polishing procedures on surface roughness and microbial adhesion and viability of Streptococcus mutans on novel highly-filled composites for injectable mold technique. MATERIALS AND METHODS: One hundred sixty specimens were divided into four material groups: FSF (Filtek Supreme Flowable Restorative), TE (Tetric EvoFlow), GUI (G-aenial Universal Injectable) and GUF (G-aenial Universal Flo). Within each group, specimens were split regarding finishing and polishing (F/P) procedures into: SLD (Sof-Lex Discs), SLS (Sof-Lex Spirals), OG (OneGloss) and PG (PoGo). Surface roughness was analyzed using profilometer (Ra and Rz) and scanning electron microscopy (SEM) and Strep. mutans biofilm formation was analyzed using colony forming unit (CFU) and cell viability assay. Two-way analysis of variance (ANOVA) followed by Tukey's post hoc test were used for comparison among groups, Pearson's coefficient was applied for the correlation between Ra and CFU/ml and all data were presented as mean ± SD. RESULTS: Both materials and F/P procedures affect Ra, Rz and Strep. mutans CFU/ml values (p ≤ 0.05). Considering the Ra and Rz, GUI and GUF revealed lower values, compared to FSF and TE and SLD and SLS revealed lower values, compared to OG and PG. Considering the Strep. mutans CFU/ml and viability, GUI and TE presented lower values, compared to GUF and FSF and SLD and SLS presented lower values, compared to OG and PG. Moderate positive correlation was found between Ra and CFU/ml (r = 0.552). CONCLUSIONS: The smoothest surfaces possess GUI and GUF, among materials and SLD and SLS, among F/P procedures. GUI adhered the lowest amount of Strep. mutans, due to the smoothest surfaces. FSF and GUF revealed the highest amount of Strep. mutans, due to bis-GMA, bis-MEPP and TEGDMA in their composition. CLINICAL SIGNIFICANCE: The findings of the present study may be beneficial for the proper selection of highly-filled composites and an adequate finishing and polishing procedure when performing the injectable mold composite resin veneer technique.

Study on the surface properties of different commercially available CAD/CAM materials for implant-supported restorations.

OBJECTIVE: To determine if there are any differences in surface characteristics (surface roughness and contact angle) among different CAD/CAM materials indicated for fabricating implant-supported restorations, following all the material preparation protocols provided by the manufacturer. MATERIALS AND METHODS: One-hundred forty-four specimens were divided into six groups: RBC (resin-based composite), PMMA (polymethyl methacrylate), PEEK (polyether ether ketone), ZP (zirconia polished), ZG (zirconia glazed) and CoCr4 (CoCr4 alloy). The experimental part included surface roughness (SR) and contact angle of water (WCA) analyses, fulfilled with Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM) view of surface topography. The data were analyzed using Kruskal-Wallis test with a Dunn's post hoc analysis, the correlation between measurements was tested using Spearman's rank correlation coefficient and all data were presented as mean ± SD. RESULTS: ZG specimens were significantly rougher compared to other groups (p ≤ 0.05). The WCA measurements revealed significantly lower mean values in ZG group (p ≤ 0.05), contrary to PEEK and CoCr4 , where significantly higher mean values were observed, compared to other groups (p ≤ 0.05). There exist a moderate negative correlation between the SR and WCA (ρ = -0.41). AFM 3D and SEM 2D images presented more or less heterogeneous surface of all materials. CONCLUSIONS: There were statistically significant differences in surface roughness and contact angle among tested material groups. Moderate negative correlation was found between surface roughness and contact angle of tested material groups. CLINICAL SIGNIFICANCE: The study gives us a better understanding of influence of physicochemical characteristics of investigated materials on their surface properties and provides useful knowledge for future researches in a view of material's behavior under in vivo conditions, when it comes to a question of features related to surface quality, such as microbial adhesion, corrosion, wear, biocompatibility and esthetics.

Effects of non-thermal atmospheric plasma on dentin wetting and adhesive bonding efficiency: Systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis evaluated the effects of non-thermal atmospheric plasma (NTAP) treatment on dentin wetting and adhesive-dentin bond strength. DATA/SOURCES: This report followed the PRISMA 2020 statement. Two reviewers conducted literature search of MEDLINE, Web of Science and Scopus databases up to the end of November 2020. Included in vitro studies compared the effect of NTAP on treated dentin of non-carious, intact, extracted human third molar teeth with different control groups. Studies with no adequate methods, missing data, lack of control group, or those using animal teeth were excluded. The random effects model was used to summarize the treatment effect with standardized mean difference (SMD) and 95% CI. Risk of bias was assessed using the custom Cochrane Collaboration's tool. STUDY SELECTION/RESULTS: Seventeen studies met inclusion criteria. The effects on dentin wetting were reported in favor of NTAP (SMD -5.38; 95% CI [-6.97, -3.78]; p<0.00001; I2=81%). Regarding adhesive-dentin bond strength, statistically significant differences between the NTAP and control group were in favor of NTAP in the short-term (SMD 1.92; 95%CI [1.35, 2.50]; p<0.00001; I2=97%), and long-term (SMD 3.28; 95%CI [2.46, 4.09]; p<0.00001; I2=97%). A limitation of meta-analysis is moderate heterogeneity caused by methodological differences and lack of data, which was evaluated through risk of bias and sensitivity analysis. CONCLUSIONS: NTAP substantially improves dentin wetting and adhesive-dentin bond strength with 30 seconds exposure time and up to 10 mm tip-to-surface distances being sufficient for positive NTAP effects on bonding efficiency. FUNDING: ON172207 and III41008 from the Ministry of Education, Science and Technological Development, Republic of Serbia. NP is funded by MESTD grant number 451-03-68/2020-14/200024. CLINICAL SIGNIFICANCE: This systematic review and meta-analysis substantiate potential applicability of NTAP treatment of dentin in improving adhesive bonding clinically. Further research should be based on the optimized parameters such as time and distance with additional refinement of NTAP power.

Effects of whitening gels on color and surface properties of a microhybrid and nanohybrid composite.

The aim of this study was to compare color changes, surface roughness and gloss of a microhybrid and nanohybrid composite whitened in a simulated in-office or at-home procedure using 40% hydrogen peroxide or 16% carbamide peroxide, respectively. CIELab coordinates were measured before, during and after treatment using VITA EasyShade V (VITA) and ∆E00 calculated. Surface roughness was measured using a surface roughness tester (SJ210; Mitutoyo). Gloss was measured using a gloss checker (IG-331; Horiba). At-home whitening resulted in ∆E00 of 1.23±0.49 (microhybrid) and 1.01±0.76 (nanohybrid). In-office exposure resulted in ∆E00 of 0.69±0.38 (microhybrid) and 0.72±0.50 (nanohybrid). There were no significant differences in ∆E00, surface roughness and gloss between whitening protocols (p>0.05). Color changes of a microhybrid and nanohybrid composite following simulated in-office or at-home whitening reached CIEDE2000 50:50% perceptibility but not acceptability threshold. Surface roughness and gloss of the microhybrid and nanohybrid composite were not affected by whitening.

Multifactorial analysis of optical properties, sorption, and solubility of sculptable universal composites for enamel layering upon staining in colored beverages.

OBJECTIVE: To analyze the effects of factors 'composite,' 'medium,' and 'time' on color, translucency, and sorption/solubility of sculptable universal composites for enamel layering upon immersion in colored beverages. MATERIALS AND METHODS: Disk-shaped specimens, 10 mm in diameter and 2 mm thick (n = 5/group), of ultrafine, hybrid composite Essentia (GC), microhybrid Gaenial Anterior (GC), nanofilled Filtek Ultimate Enamel and Body ( 3M ESPE) were immersed in red wine, coffee, or distilled water for 15 days. CIELab color coordinates were measured and CIEDE2000 (∆E00 ) and Translucency Parameter differences (∆TP00 ) were calculated. Sorption and solubility were determined according to ISO 4049:2009. Data were analyzed using the analyses of variance and Tukey's post-hoc test (α = 0.05). RESULTS: Essentia and Gaenial exhibited the lowest and the highest staining-dependent color differences, with mean ∆E00 range of 1.7-6.1 and 5.1-11.3, respectively (p < 0.05). ∆TP00 was more pronounced in wine than in coffee (p < 0.05). Sorption and solubility varied between 9.8 and 15.3 µg/mm3 and -1.6 and -5.4 µg/mm3 , respectively, with positive correlation between ∆TP00 and sorption (p = 0.005). CONCLUSIONS: Total color and translucency differences of sculptable composites for enamel layering were material-, time- and medium-dependent. Translucency differences positively correlated with sorption. Overall, the ultrafine, hybrid composite exhibited the best results in terms of color stability, sorption and solubility. CLINICAL SIGNIFICANCE: Clinicians should be aware of differences in color stability of sculptable composites for enamel layering as these are directly exposed to discoloration in the oral environment and are directly related to patients' long-term satisfaction and restoration longevity. Ultrafine, hybrid composite may be preferred due to better color stability, lower sorption and solubility compared to nanofilled and microhybrid composites evaluated in this study.

Color stability of bulk-fill and universal composite restorations with dissimilar dentin replacement materials.

OBJECTIVE: To determine color changes in bulk-fill composite and universal composite restorations with dissimilar dentin replacement materials in extracted teeth after staining in red wine. MATERIALS AND METHODS: Cylindrical, 4 mm deep, class I cavities were prepared in 140 human molars. Bottom 2 mm was restored with Biodentine (Septodont), everX posterior (GC) or experimental HAP inserts. Each dentin replacement material was covered with a 2-mm layer of a universal composite Filtek Z250 or Z550 (3M ESPE) or Gradia Posterior (GC). Groups combining top composite layer and the underlying dentin replacement were designated as "composite_dentin replacement." Filtek Bulk Fill (3M ESPE) and Tetric EvoCeram Bulk Fill (Ivoclar Vivadent) were placed as a single 4-mm layer. Color measurements were performed using Vita Easyshade 4.0 (Vita Zahnfabrik) initially and after 48-hours storage in red wine at 37°C. RESULTS: Color differences (ΔEoo ) ranged between 2.1 ± 0.7 (Z250_HAP) and 7.8 ± 1.1 (Z550_everX). EverX resulted in higher ΔEoo of the overlying composite than HAP (P < .001) and Biodentine (P = .006). Generally, ΔEoo was affected more by decreasing lightness (ΔL') than changes in chroma (ΔC'). CONCLUSIONS: EverX resulted in higher ΔEoo of the restoration than Biodentine and experimental HAP after staining in red wine. No significant differences in ΔEoo may be expected in different composites with the same underlying dentin replacement material. The same was generally true for bulk-fill and universal composites. CLINICAL SIGNIFICANCE: Similar extent of color changes may be expected in bulk-fill and universal composites. Highly translucent everX might exhibit greater color differences irrespective of the capping composite than non-translucent materials. Clinicians have a wider choice of composite materials to cover a particular dentin replacement material, for example, everX or Biodentine, as similar color differences may be expected in various overlying composite brands.

Effects of non-thermal atmospheric plasma treatment on dentin wetting and surface free energy for application of universal adhesives.

OBJECTIVES: The study aims to evaluate the effects of non-thermal atmospheric plasma (NTAP) treatments on dentin wetting and surface free energy (SFE) and compare the effects of NTAP treatment, etch-and-rinse, and self-etch protocols for application of universal adhesives. MATERIALS AND METHODS: Mid-coronal dentin of intact third molars was used to measure contact angles of distilled water, ethylene-glycol, and diiodomethane and calculate SFE following different NTAP preset treatments (feeding gas consisting of pure He, He + 1% O2, He + 1.5% O2), power input (1 or 3 W), and tip-to-surface distance (2, 4, or 8 mm). Contact angles of reference liquids and SFE of dentin following He + 1.5% O2 at 3-W and 4-mm treatment was compared to phosphoric acid etching. Contact angles of Single Bond Universal (SBU; 3M ESPE) and Clearfil Universal Bond (CUB; Kuraray Noritake) were measured following NTAP, etch-and-rinse, and self-etch protocols. RESULTS: NTAP significantly reduced contact angles of reference liquids and increased dentin SFE compared to untreated dentin (p < 0.05). O2 intensified the effect of He NTAP (p < 0.05). NTAP and phosphoric acid increased dentin polarity and Lewis base surface characteristics. Phosphoric acid increased contact angles of adhesives compared to the self-etch protocol (p < 0.05). NTAP resulted in lower adhesive contact angles than phosphoric acid, the difference being statistically significant for CUB (p < 0.05). Compared to the self-etch protocol, NTAP slightly reduced CUB contact angle but not that of SBU (p > 0.05). CONCLUSIONS: He NTAP with and without O2 increased dentin wetting and SFE, surpassing the effect of phosphoric acid and lowering adhesive contact angles. NTAP produced no apparent micro-morphological changes on dentin surface comparable to acid etching. CLINICAL SIGNIFICANCE: NTAP treatment of dentin prior to adhesive application increases dentin wetting and surface free energy facilitating better adhesive distribution on dentin surface compared to phosphoric acid etching and similar to the "self-etch" application protocol.

Optical properties of composite restorations influenced by dissimilar dentin restoratives.

OBJECTIVES: To evaluate optical properties (color and translucency) of 'sandwich' restorations of resin-based composites and esthetically unfavorable dentin restoratives. METHODS: Cylindrical 'dentin' specimens (8mm in diameter and 2mm thick, N=5/group) were prepared using EverX Posterior (GC), Biodentine (Septodont), experimental hydroxyapatite (HAP) or conventional composites (Gradia Direct Posterior, GC; Filtek Z250 and Filtek Z500, 3M ESPE). Capping 'enamel' layers were prepared using composites (Gradia Direct Posterior, Filtek Z250 or Z550) of A1 or A3 shade and the following thickness: 0.6, 1 or 2mm. Color (ΔE) and translucency parameter (TP) were determined using a spectrophotometer (VITA Easyshade Advance 4.0, VITA Zahnfabrik). Data were statistically analyzed using analysis of variance with Tukey's post-hoc tests (α=0.05). RESULTS: TP was greatly affected by layer thickness, whilst ΔE depended on shade and layer thickness of the capping composite. HAP and Biodentine showed significantly lower TP and higher ΔE (deviation from 'ideal white') than composites (p<0.05). Greater TP was seen in EverX_composite groups than in corresponding control groups of the same shade and thickness. TP of composites combined with Biodentine or HAP was below 2, lower than the corresponding control groups (p<0.05). Within-group differences of ΔE were greatest in HAP_composite groups. EverX_Gradia and EverX_FiltekZ250 combinations showed the most comparable ΔE with the control groups. SIGNIFICANCE: A 2mm thick layer of composite covering dentin restoratives with unfavorable esthetics is recommended for a final 'sandwich' restoration that is esthetically comparable to a conventional, mono-composite control restoration.