Can a Self-etching Primer be Effective in Bonding Aligner Attachments to Different Types of Ceramics?

Objective: This in vitro study aimed to evaluate the effectiveness of pretreatment with a self-etching primer for bonding aligner attachments to lithium disilicate (LD) and monolithic zirconia (MZ) ceramics. Methods: Forty ceramics, including LD (n=20) and MZ (n=20), were divided into four study groups according to the surface pretreatments: LD specimens pretreated with universal primer (Monobond Plus, MP) after hydrofluoric acid etching (Group 1); MZ ceramics pretreated with MP after sandblasting (Group 2); LD ceramics pretreated with self-etching ceramic primer (Monobond etch & prime, MEP) (Group 3); and MZ ceramics pretreated with MEP after sandblasting (Group 4). The aligner composite (GC Aligner Connect) and universal adhesive (GPremio Bond) were used to prepare the resin attachments. The bond strength was evaluated by micro-shear bond strength (SBS) testing (0.1 mm/min) after thermocycling, and the remnant adhesive was scored according to the resin attachment remnant index (RARI). The SBS data were analyzed using ANOVA and Tukey tests, and the RARI scores were analyzed using the chi-square test. Results: Group 1 had the lowest SBS, and group 2 had the highest SBS. There were significant differences between the groups in terms of bond strength (p<0.05). The RARI scores showed no significant differences, regardless of the pretreatment and ceramic type. Conclusion: The use of a self-etching primer increased the bond strength of resin attachments on LD ceramics. For zirconia ceramics, both ceramic primers are recommended for aligner attachment bonding.

Oral Rehabilitation with Implant-Retained Overdenture in a Patient with Down Syndrome.

Down syndrome, known as trisomy 21, is the most common chromosomal disorder. The disorder affects mental and systemic development as well as oral structure, including dental anomalies, high susceptibility of periodontal disease, and poor quality of alveolar bone. This report presents a case of dental rehabilitation by means of dental implants of a patient with Down syndrome. Two titanium dental implants were placed in the maxilla, and three titanium dental implants were installed in the mandible. One implant was lost during the osseointegration period. The prosthetic rehabilitation was performed with implant-retained maxillary and mandibular overdentures with the Locator attachment system. After a 2-year follow-up period, the patient was doing well, and all implants were clinically stable with no signs of bone loss or inflammation. The present study emphasizes that implant-retained overdentures with Locator attachment system could be a therapeutic option even for patients with Down syndrome. This therapy prevents crestal bone loss around the implants, improves functional and esthetic outcomes, and provides optimum oral hygiene for patients with mild mental impairment. Careful patient selection and education of patients and caregivers are essential considerations for a successful and safe treatment with dental implants in Down syndrome patients.

Evaluation of residual monomer release and toxicity of self-adhesive resin cements.

The aim of this study was to evaluate the amount of leached residual monomers from self-adhesive resin cements and evaluate their toxicity in-vitro. A total of 60 disk-shaped specimens (5 mm in diameter and 0.5 mm in thickness) were prepared from each cement (RelyX U200, SpeedCEM, G-Cem) (n=20). Specimens were immersed in artificial saliva and the amount of released monomers [urethane dimethacrylate (UDMA) and triethyleneglycol dimethacrylate (TEGDMA)] was identified. Then, the cytotoxicity and genotoxicity effect on cells were evaluated using the defined amounts of released monomers from cements. The highest monomer release was detected in G-Cem (p<0.05). The highest cytotoxicity value was identified from SpeedCEM (p<0.01) and the highest genotoxicity values were calculated from RelyX U200 (p<0.05). Released UDMA and TEGDMA from self-adhesive resin cements induced cytotoxicity and genotoxicity effect on cells.

Six-Year Survival of a Mini Dental Implant-Retained Overdenture in a Child with Ectodermal Dysplasia.

Patients with ectodermal dysplasia (ED) experience several problems caused by abnormal development and functioning of the head and neck region. In addition to developmental nasal cartilage abnormalities and absence of sweat glands, hair, and eyebrows, edentulism or developmental disorders of teeth (cone-shaped teeth) are commonly observed in these types of patients. ED is also characterized by underdeveloped alveolar ridges, a decreased occlusal vertical dimension, reduced salivary secretion, and dry oral mucosa, which make prosthetic rehabilitation difficult. Few studies of intraosseous dental implant-retained prostheses have described adverse effects on craniofacial growth and esthetic and functional disadvantages, while some researchers have described the advantages of this treatment option as an alternative option in these cases. Due to the associated alveolar bone deficiency, dental mini-implant therapy may be a treatment option for these patients; however, there are isolated cases in the literature regarding the rehabilitation of ED patients with mini-implant-supported overdentures. This clinical report describes the rehabilitation of a 6-year-old child with ED using a maxillary removable partial prosthesis and a mini-implant-retained mandibular overdenture. The clinical and radiographic findings of this prosthetic rehabilitation during the 6-year follow-up are also presented.

Is a Fixed Hybrid Prosthesis with Distal Cantilever Appropriate for Maxillofacial Defects? A Report of Two Patients.

The most important objectives in restoring the maxillofacial patient are the restoration of function and psychological improvement through esthetics. Acquired maxillary and mandibular defects due to significant trauma or surgery represent a major challenge for the clinician and patient. Dental implant-retained prostheses represent a well-documented and reliable treatment option and can also help patients with maxillofacial defects by eliminating denture instability and improving function. Full-arch fixed dental hybrid prostheses provide functional and psychological advantages and also reduce the load on vulnerable soft and hard tissues in the reconstruction area. Two clinical reports are presented describing the prosthetic rehabilitation using dental implant-supported fixed hybrid prostheses with clinical and radiographic follow-up of 3 years.

Color stainability of CAD/CAM and nanocomposite resin materials.

STATEMENT OF PROBLEM: The color stainability of recently introduced computer-assisted design/computer-assisted manufacturing (CAD/CAM) hybrid ceramic and resin nanoceramic is unknown. PURPOSE: The purpose of this in vitro study was to compare the effect of coffee staining on the color of 3 different CAD/CAM restorative materials and a nanocomposite resin. MATERIAL AND METHODS: Specimens from a hybrid dental ceramic (VITA Enamic), a resin nanoceramic (Lava Ultimate), a lithium disilicate glass ceramic (IPS e.max CAD), and a nanocomposite resin (Filtek Supreme Ultra Universal) were evaluated for color change due to thermocycling in coffee (n=5). Specimens 0.5 to 0.7 mm and 1 to 1.2 mm in thickness were thermocycled for 5000 cycles. CIEDE2000 color differences (ΔE00) due to thermocycling in coffee were calculated using the color coordinates obtained from a spectroradiometer. ANCOVA was used to analyze the color differences among the materials with thickness as the covariate. Significant differences at average thickness were analyzed with the Tukey-Kramer test. RESULTS: For color difference due to staining, thickness was a significant covariate (P<.001). Regarding the analysis of color differences, every pair of the tested materials was significantly different (P<.001). Least squares means of color differences (ΔE00) at mean thickness were 4.34 for the nanohybrid composite resin, 3.66 for the resin nanoceramic, 1.35 for the hybrid ceramic, and 0.43 for the lithium disilicate ceramic. CONCLUSION: When exposed to hot and cold coffee, the color change was beyond clinical acceptability for the tested resin nanoceramic and nanocomposite resin materials. The average color change of the hybrid ceramic was clinically perceivable over the tested thickness values. The color change of lithium disilicate ceramic was not clinically perceivable at any tested thickness.

Effects of cigarette smoke and denture cleaners on the surface roughness and color stability of different denture teeth.

STATEMENT OF PROBLEM: Denture teeth have the most effect on the esthetics of complete dentures. However, extrinsic factors can change their roughness and color. PURPOSE: The purpose of this study was to investigate the effects of smoking and denture cleaners on the roughness and color (CIE [Commission International de I'Eclairage] L*a*b*) of denture teeth. MATERIAL AND METHODS: Maxillary central incisors made of acrylic resin, high-strength acrylic resin, and porcelain (Acrylux, SR, Orthosit PE-O, and Enta) were divided into 4 groups (n=10): control, denture cleaner, cigarette smoke, and cigarette smoke and denture cleaner. The dental cleaner group and cigarette smoke and dental cleaner group were immersed in denture cleaner (Protefix; Queisser Pharma) for 15 minutes; the cigarette smoke group and cigarette smoke and dental cleaner group were exposed to smoke from 20 cigarettes for 10 minutes per cigarette. The roughness was measured with a profilometer, and the color was measured with a colorimeter. The CIE L*a*b* values were recorded. The data were analyzed with a 3-way ANOVA and the Fisher least significant difference test (α=.05). RESULTS: The roughness of Acrylux, SR Orthosit PE-O (P<.001), and Enta (P<.01) was significantly higher in the cigarette smoke group and dental cleaner group than in the control group. Immersion in denture cleaner after exposure to cigarette smoke decreased the roughness of Acrylux, SR Orthosit PE-O (P<.001), and Enta (P<.01). The greatest color change (7.94) was observed in Acrylux in the cigarette smoke group, whereas the smallest color change (0.24) was in Enta in the control group. The color change of all of the teeth in the cigarette smoke group decreased after exposure to denture cleaner (P<.05). The L* decreased, and the a* and b* increased after exposure to smoke (P<.05). CONCLUSIONS: Smoking and denture cleaner increased the roughness and discolored the teeth, whereas denture cleaners after exposure to smoke decreased the roughness.

Residual HEMA and TEGDMA release and cytotoxicity evaluation of resin-modified glass ionomer cement and compomers cured with different light sources.

The purpose of this study was first to evaluate the elution of 2-hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) monomers from resin-modified glass ionomer cement (RMGIC) and compomers cured with halogen and light-emitting diode (LED) light-curing units (LCUs). The effect of cured materials on the viability of L929 fibroblast cells was also evaluated. One RMGIC (Ketac N100) and two compomers (Dyract Extra and Twinkystar) were tested. Materials were prepared in teflon disks and light-cured with LED or halogen LCUs. The residual monomers of resin materials in solution were identified using high-performance liquid chromatography. The fibroblast cells' viability was analyzed using MTT assay. The type of LCU did not have a significant effect on the elution of HEMA and TEGDMA. A greater amount of HEMA than TEGMDA was eluted. The amount of TEGDMA eluted from Twinkystar was greater than Dyract Extra (P < 0.05) when cured with a halogen LCU. All material-LCU combinations decreased the fibroblast cells' viability more than the control group (P < 0.01), except for Dyract Extra cured with a halogen LCU (P > 0.05). Curing with the LED LCU decreased the cells' viability more than curing with the halogen LCU for compomers. For Ketac N100, the halogen LCU decreased the cells' viability more than the LED LCU.

Discoloration of provisional restorations after oral rinses.

PURPOSE: Oral rinses are widely used to promote periodontal health with provisional restorations during the interim period. The aim of this study was to compare the discoloration of provisional restoration materials with different oral rinses. MATERIAL AND METHODS: A total of 140 disc-shaped specimens (shade A2) (10 mm x 2 mm) were prepared from one PMMA-based (TemDent Classic(®)) and three different bis-acrylic-based (Protemp II(®), Luxatemp(®) and Fill-In(®)) provisional restoration materials (n=7). The color values (L*, a*, and b*) of each specimen were measured before and after exposure with a colorimeter, and the color changes (∆E) were calculated according to the CIE L*a*b* system. The specimens were immersed in each of the 4 oral rinses (alcohol-containing mouthwash, chlorhexidine, benzydamine HCl, benzydamine HCl and chlorhexidine) twice a day for 2 minutes. After 2 minutes of immersion in the oral rinses, the specimens were immersed in artificial saliva. The specimens were exposed to the oral rinses and the artificial saliva for 3 weeks. Two-way ANOVA, the Bonferroni test and the paired sample t-test were used for statistical analyses (p<0.05). RESULTS: Comparison of the discoloration from the oral rinses after immersion for three weeks revealed no significant differences (p>0.05). The lowest color change was observed in PMMA-based Temdent in all oral rinses (p<0.05). There were no significant differences between the bis-acryl composites after immersion in saliva or the mixture of benzydamine HCl and chlorhexidine and the alcohol-containing mouthwash for 3 weeks (p>0.05). After immersion in chlorhexidine, the color change values of Protemp II and Fill-in showed significant differences (p=0.018). Protemp II also showed less discoloration than the other bis-acryl composites, and this color change was statistically significant (p <0.05). For all oral rinses, the L* value decreased while b* values increased, and this color change was found to be statistically significant (p <0.05). A* values were found to be significantly higher with oral rinses (p<0.05), except Protemp II immersed in benzydamine HCl or alcohol-containing mouthwash. CONCLUSIONS: The type of the oral rinse did not affect the discoloration process. For long-term esthetic results, choosing MMA-based materials for provisional restorations appears to be more effective.

Evaluation of the radiopacity of luting cements by digital radiography.

PURPOSE: The aim of this study was to evaluate the radiopacity of eight contemporary luting cements using direct digital radiography. MATERIALS AND METHODS: Ten specimens, (5 mm diameter, 1 mm high) were prepared for each material tested (RelyX ARC, RelyX U100, RelyX Unicem, Nexus 2, Nexus 3, Metacem, Breeze, Adhesor zinc phosphate). The specimens were stored in a moist chamber at 37°C until completely set, then radiographed using a Kodak digital sensor and an aluminum step wedge with variable thicknesses (1 to 13 mm in 1-mm increments) used for reference. A Kodak 2100 intraoral X-ray unit was operated at 60 kV, 7 mA, and 0.20 seconds. According to international standards, the radiopacity of the specimens was compared with that of the aluminum step wedge using the equal-density area tool of the Kodak Dental Imaging software (ver. 6.7). Data were analyzed by ANOVA and Tukey's test. RESULTS: Adhesor zinc phosphate cement showed the highest radiopacity of all materials and dentin. Breeze showed the lowest radiopacity (p < 0.05). No significant difference in radiopacity was observed between dentin and RelyX ARC, Nexus 2, or Metacem (p > 0.05). The radiopacities of Nexus 3 and RelyX Unicem were significantly higher than those of other resin cements and dentin (p < 0.05). CONCLUSIONS: All materials showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association. Breeze had less radiopacity than dentin.

Evaluation of TEGDMA leaching from four resin cements by HPLC.

OBJECTIVE: The aim of this study was to evaluate the elution of TEGDMA from dual cured resin cements, used for bonding of ceramic restoration by high performance liquid chromatography (HPLC). METHODS: Forty freshly extracted caries and restoration free molar teeth used in this study. Standardized Class I preparations were prepared in all teeth. Ceramic inlays were cemented with one of the dual cured resin cements (Variolink II, Rely X ARC, Rely X Unicem and Resilute). After cementation, specimens were stored in 75% ethanol solution. HPLC was used to analyze the amounts of TEGDMA in different time intervals. Two-way ANOVA and Tukey HSD tests were used to evaluate the results (P<.05). RESULTS: The amount of TEGDMA eluted from Resilute was the highest and the amount of TEG-DMA eluted from Rely X Unicem was the lowest (P<.05). The total amount of monomers was the highest after 21 days (P<.05). CONCLUSION: In the case of resin cements, elution of TEGDMA was the highest in Resilute and lowest in Rely X Unicem. The amount of TEGDMA eluted from resin cements was influenced by the time.

Effect of provisional cements on shear bond strength of porcelain laminate veneers.

OBJECTIVES: The purpose of this study was to evaluate the effect of three provisional cements and two cleaning techniques on the final bond strength of porcelain laminate veneers. METHODS: The occlusal third of the crowns of forty molar teeth were sectioned and embedded in autopolymerizing acrylic resin. Dentin surfaces were polished and specimens were randomly divided into four groups (n=10). Provisional restorations were fabricated and two provisional restorations were cemented onto each tooth. Restorations were fixed with one of three different provisional cements: eugenol-free provisional cement (Cavex), calcium hydroxide (Dycal), and light-cured provisional cement (Tempond Clear). Provisional restorations were removed with either a dental explorer and air-water spray, or a cleaning bur (Opticlean). In the control group, provisional restorations were not used on the surfaces of specimens. IPS Empress 2 ceramic discs were luted with a dual-cured resin cement (Panavia F). Shear bond strength was measured using a universal testing machine. Data were statistically analyzed by ANOVA, Tukey's HSD and Dunnett tests. Surfaces were examined by scanning electronic microscopy. RESULTS: Significant differences were found between the control group and both the light-cured provisional cement groups and the eugenol-free provisional cement-cleaning bur group (P<.05). Groups that had received light-cured provisional cement showed the lowest bond strength values. CONCLUSIONS: Selection of the provisional cement is an important factor in the ultimate bond strength of the final restoration. Calcium hydroxide provisional cement and cleaning with a dental explorer are advisable.

Temperature Rise during Resin Composite Polymerization under Different Ceramic Restorations.

OBJECTIVES: The purpose of this study was to measure temperature increase induced by various light polymerizing units during resin composite polymerization beneath one of three types of ceramic restorations. METHODS: The resin composite (Variolink II) was polymerized between one of three different ceramic specimens (zirconium oxide, lithium disilicate, feldspathic) (diameter 5 mm, height 2 mm) and a dentin disc (diameter 5 mm, height 1 mm) with a conventional halogen light, a high intensity halogen light, or an LED unit. The temperature rise was measured under the dentin disc with a J-type thermocouple wire connected to a data logger. Ten measurements were carried out for each group. The difference between the initial and highest temperature readings was taken and the 10 calculated temperature changes were averaged to determine the mean value in temperature rise. Two way analysis of variance (ANOVA) was used to analyze the data (polymerizing unit, ceramic brand) for significant differences. The Tukey HSD test was used to perform multiple comparisons (α=.05). RESULTS: Temperature rise did not vary significantly depending on the light polymerizing unit used (P=.16), however, the type of ceramic system showed a significant effect on temperature increases (P<.01). There were no statistically significant differences between lithium disilicate and feldspathic ceramic systems (P >.05); in comparison, the resin composite polymerized under the zirconium oxide ceramic system induced a significantly lower temperature increase than the other ceramic systems tested (P<.05) CONCLUSIONS: The resin composite polymerized beneath zirconium oxide ceramic system induced significantly smaller temperature changes. The maximal temperature increase detected in all groups in this study was not viewed as critical for pulpal health.

Effects of food-simulating liquids on the mechanical properties of a silorane-based dental composite.

The purpose of this study was to investigate the effects of food-simulating liquids (FSL) on the hardness and flexural strength (FS) of a new silorane-based composite and to compare it with methacrylate-based composites (MBCs). Four restorative materials (Filtek Silorane, P60, Z250, and Supreme XT) were used. Specimens for the FS and hardness measurements were fabricated in customized molds. Immediately after polymerization, the materials were stored in the following dietary simulating solvents at 37 degrees C for 1 week: distilled water, 0.02 N citric acid, heptane, and 75% aqueous ethanol solution. After conditioning, the FS and hardness values were measured. Data were subjected to ANOVA/Scheffé's test at a significance level of 0.05. The hardness and FS of Filtek Silorane were not significantly affected by FSL (p>0.05). Conversely, the hardness of MBCs significantly decreased after conditioning in water and ethanol (p<0.05). Similarly, the FS values of MBCs were significantly affected after conditioning in ethanol.

HPLC analysis of HEMA released from two different adhesive systems.

OBJECTIVES: The aim of this study was to evaluate in vitro elution of 2-Hydroxyethyl methacrylate (HEMA) from two different adhesive systems, used in two dual polymerized resin cements for bonding of ceramic restoration by high performance liquid chromatography (HPLC). METHODS: Twenty freshly extracted caries and restoration free molar teeth used in this study. Standardized Class I preparations were prepared in all teeth. A lithium disilicate based (IPS Empress Esthetic; Ivoclar) ceramic inlays were cemented with one of the dual polymerized resin cements (RelyX ARC; 3M ESPE or Nexus 2; Kerr) that have two different adhesive systems (Single Bond; 3M ESPE, Optibond Solo Plus; Kerr). After cementation, specimens were stored in 75% ethanol solution. HPLC was used to analyze the amount of HEMA in the solution (after 10 min, 1 h, 24 h, 3, 7, 14, and 21 days). Two-way analysis of variance and Tukey HSD tests were used to evaluate the results (p < 0.05). RESULTS: There were statistically significant differences between adhesive systems according to the amount of released HEMA (p < 0.01) and also among time periods (p < 0.01). The amount of HEMA eluted from Optibond Solo Plus was significantly higher than Single Bond. The total amount of monomers was the highest after 21 days (p < 0.01). CONCLUSIONS: In the case of adhesive systems, Optibond Solo Plus showed the highest amount of HEMA. The amount of HEMA eluted from adhesive systems influenced by the time.

Effect of three types of light-curing units on 5-year colour changes of light-cured composite.

The purpose of this study was to determine colour changes in a composite cured with tungsten-halogen, light-emitting diode (LED) or a plasma arc after 5 years. Five specimens 10 mm in diameter and 2 mm in height were prepared using Hybrid (Clearfil AP-X) composite for each test group. The corresponding specimens were cured with a tungsten-halogen curing light, a LED unit or with a plasma arc. Specimens were stored in light-proof boxes for 5 years after the curing procedure to avoid further exposure to light and stored in 37 degrees C in 100% humidity. Colorimetric values of the specimens immediately after curing and after 5 years were measured using colorimeter. The DeltaE*( ab ) values varied significantly depending on the curing unit used (p < 0.001). Curing time did not affect the colour changes of the specimens (p = 0.4). The results of this study suggest that composite materials undergo measurable changes due to the curing unit exposure.

Evaluation of monomer leaching from a dual cured resin cement.

PURPOSE: An increasing number of inlay cavities is restored with tooth-colored materials, especially ceramics are cemented with resin cements. The comonomer TEGDMA and other monomers Bis-GMA and UDMA have been identified as the main compounds released from polymerized resin cements into aqueous media. The present investigation was conducted to clarify the leaching behavior of the monomers of dual polymerized resin cement. MATERIAL AND METHODS: Ten freshly extracted caries and restoration free molar teeth were used in this study. Standardized Class I preparations were prepared in all teeth. Lithium disilicate based (IPS Empress Esthetic) ceramic inlays were cemented with dual polymerized resin cement (Variolink II). After cementation, specimens were stored in 75% ethanol solution. High-performance liquid chromatography (HPLC) was used to analyze the amounts of three monomers in the solution (after 10 min, 1 h, 24 h, 3, 7, 14, and 21 days). Two-way ANOVA and Tukey HSD tests were used to evaluate the results (p < 0.05). RESULTS: There were statistically significant differences among the amounts of the monomers (p < 0.01) and also among time periods (p < 0.01). While the TEGDMA resulted in significantly higher amount than Bis-GMA and UDMA, there were no statistically significant differences between amounts of Bis-GMA, UDMA (p = 0.06). The cumulative amount of monomers was the highest after 21 days (p < 0.01). CONCLUSION: In the case of resin cement, leaching of TEGDMA was the highest and the cumulative amount of leaching monomers from resin cement was influenced by the time.

Temperature rise during polymerization of three different provisional materials.

The purpose of this study was to evaluate the temperature rise during polymerization of three different provisional materials by direct method on two different dentin disc thicknesses. Two autopolymerizing; bis-acrylic composite (Fill-in; Kerr), polymethyl methacrylate (Temdent; Weil Dental), and one light polymerizing composite (Revotek LC; GC) provisional restoration materials were used in this study. Sixty dentin discs were prepared from extracted molars (diameter, 5 mm; height, 1 or 2 mm). These dentin discs (1 or 2 mm) were placed on apparatus developed to measure temperature rise. The temperature rise during polymerization was measured under the dentin disc with a J-type thermocouple wire that was connected to a data logger. Statistical analysis was performed with two-way analysis of variance followed by Tukey HSD test (alpha=0.05). Temperature rise values statistically varied according to the provisional restoration material used (light polymerized, auto polymerized; P<0.001) and the dentin thickness (1 and 2 mm; P<0.001). The polymethyl methacrylate based provisional material induced significantly higher temperature rise than other provisional restoration materials at 2-mm dentin thickness (P<0.01). At 1-mm dentin thickness, polymethyl methacrylate and composite induced significantly higher temperature increase than bis-acrylic composite provisional material (P<0.05). The risk for heat-induced pulpal damage should be taken into consideration during polymerization of provisional materials in deep cavities in which dentin thickness is less than 1 mm.