Progressive Tooth Wear Against Resin-Based Restorative Composites.

PURPOSE: The composition and properties of resin-based composite materials could affect tooth wear and lead to clinical problems. Therefore, the study objective was to characterize human tooth wear behavior against a bulk-fill restorative (BF) compared to a conventional resin composite (RC) and a CAD/CAM resin nano ceramic (RN). METHODS: Square-shaped specimens of each material were prepared and sub-divided according to the number of testing cycles (n=8): 100,000, 250,000, and 500,000 cycles. An occlusal wear test was performed using a chewing machine with 49 N, 2 Hz, in 37°C distilled water. Human premolar cusps were used as antagonists. Micro-CT and laser scanner were used to scan antagonists and specimens, respectively. Wear volume was assessed using a software and the wear pattern was examined with SEM. Softening in solvent analysis was performed by measuring the materials' Knoop microhardness (KHN) before and after immersion in ethanol. Wear volume data were analyzed with two-way ANOVA and Student-Neuman-Keuls test (α=0.05). RESULTS: For tooth and specimen wear volume, there was statistical significance for material and number of cycles, but not for the interaction between factors. BF resulted in less tooth (p=0.008) and specimen (p=0.030) wear than RN and RC, which were similar (p⟩0.05). Volume loss increased from 100,000 to 500,000 cycles. BF showed the lowest microhardness (KHN1); and %ΔKHN similar to RC, but greater than RN. CONCLUSION: BF induced less volume loss to the tooth than RC and RN, while presenting greater wear resistance. The tooth wear pattern and damage progression were mild for all materials. CLINICAL SIGNIFICANCE: Resin composites show favorable wear behavior, leading to low volume loss and mild structural damage of the tooth. Regular bulk-fill resin composite stands out for its efficient restorative technique, low wear susceptibility and reduced capacity to wear down the tooth.

The Influence of a Flexible Model on the Marginal Adaptation of Inlay Composite Restorations: A MicroCT Analysis.

The aim of this study was to evaluate the influence of flexible models on the marginal adaptation of indirect resin composite restorations. Thirty-six cavity preparations were made for class II restorations in permanent molar teeth. Three groups (n=12) were defined following three impressions/model material combinations: G(STONE), polyvinylsiloxane, and type IV stone model, as a control group; G(IMPRESSIONPVS), alginate and flexible polyvinylsiloxane; G(MODELPVS), alginate and flexible polyvinylsiloxane for models. All restorations were positioned on their respective teeth and evaluated by micro-computed tomography. Absolute marginal discrepancies were measured digitally (ImageJ). The results were compared using one-way ANOVA (p⟨ 0.05). The mean ± SD absolute marginal discrepancy of indirect resin composite restorations made from flexible and rigid stone models was as follows: G(STONE), 206 (±79.95) µm; G(IMPRESSIONPVS), 221.50 (±61.73) µm; G(MODELPVS), 203.25 (±65.93) µm. Absolute marginal discrepancies were not significantly influenced by the flexible and rigid stone models (p=0.78). The flexible or rigid stone model did not influence the marginal adaptation of the indirect resin composite restorations.

CAD/CAM Milled Glass Fiber Posts: Adaptation and Mechanical Behavior in Flared Root Canals.

This study aimed to evaluate the cementation and mechanical behavior of flared root canals restored with CAD/CAM milled glass fiber post-and-core systems. Sixty-six endodontically treated human canines with a flared root canal were divided into three different groups according to the type of post: GPF received prefabricated posts; GREL received relined glass fiber posts, and GMILLED received CAD/CAM milled glass fiber posts. Cementation was performed with self-adhesive resin cement. The samples were submitted to x-ray microcomputed tomography analysis for the analysis of voids and gaps. The roots were sectioned and submitted to the push-out bond strength test. The load-to-fracture was evaluated in post-and-core systems. GMILLED presented lower void and lower gap volumes when compared to GPF and GREL. On the load-to-fracture test, GREL presented statistically significant higher values than GMILLED. GPF values had no statistically significant difference from the two other groups. On the push-out bond strength test, GPF presented statistically significant lower values when compared to GREL and GMILLED. The most common failure pattern was between dentin and cement in all groups. CAD/CAM milled glass fiber post-and-core systems presented an enhanced adaptation of glass fiber posts to flared root canal systems. Their results were comparable to relined posts in bond strength, while load-to-fracture-results for GMILLED were lower than those for GPF.

Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report.

Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.

Bifunctional Composites for Biofilms Modulation on Cervical Restorations.

Cervical composites treating root carious and noncarious cervical lesions usually extend subgingivally. The subgingival margins of composites present poor plaque control, enhanced biofilm accumulation, and cause gingival irritation. A potential material to restore such lesions should combine agents that interfere with bacterial biofilm development and respond to acidic conditions. Here, we explore the use of new bioresponsive bifunctional dental composites against mature microcosm biofilms derived from subgingival plaque samples. The designed formulations contain 2 bioactive agents: dimethylaminohexadecyl methacrylate (DMAHDM) at 3 to 5 wt.% and 20 wt.% nanosized amorphous calcium phosphate (NACP) in a base resin. Composites with no DMAHDM and NACP were used as controls. The newly formulated 5% DMAHDM-20% NACP composite was analyzed by micro-Raman spectroscopy and transmission electron microscopy. The wettability and surface-free energy were also assessed. The inhibitory effect on the in vitro biofilm growth and the 16S rRNA gene sequencing of survival bacterial colonies derived from the composites were analyzed. Whole-biofilm metabolic activity, polysaccharide production, and live/dead images of the biofilm grown over the composites complement the microbiological assays. Overall, the designed formulations had higher contact angles with water and lower surface-free energy compared to the commercial control. The DMAHDM-NACP composites significantly inhibited the growth of total microorganisms, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum by 3 to 5-log (P < 0.001). For the colony isolates from control composites, the composition was typically dominated by the genera Veillonella, Fusobacterium, Streptococcus, Eikenella, and Leptotrichia, while Fusobacterium and Veillonella dominated the 5% DMAHDM-20% NACP composites. The DMAHDM-NACP composites contributed to over 80% of reduction in metabolic and polysaccharide activity. The suppression effect on plaque biofilms suggested that DMAHDM-NACP composites might be used as a bioactive material for cervical restorations. These results may propose an exciting path to prevent biofilm growth and improve dental composite restorations' life span.

Niobium silicate particles promote in vitro mineral deposition on dental adhesive resins.

OBJECTIVE: This study aims to analyze the addition of niobium silicate particles to dental adhesive resins and evaluate its physicomechanical and biological properties. METHODS: The SiNb particles were produced by the sol-gel route and presented a mean particle size of 2.1 µm and a specific surface area of 616,96m2/g. An experimental adhesive resin was formulated with 66 wt% Bisphenol A-Glycidyl Methacrylate and 33 wt% Hydroxyethyl methacrylate with diphenyl(2,4,6-trimethyl benzoyl)phosphine oxide as the photoinitiator. The SiNb particles were incorporated into the adhesive resins in 1 wt% (SiNb1%) and 2 wt% (SiNb2%) concentration. A control group (SiNb0%) without the addition of particles was used. The developed adhesives were evaluated by their polymerization kinetics, refractive index, softening in solvent, cytotoxicity, mineral deposition, ultimate tensile strength, and micro shear bond strength. RESULTS: The refractive index range was increased by the addition of niobium silicate particles. No statistically significant difference was found between groups in the degree of conversion,.softening in solvent analysis, cytotoxicity and ultimate tensile strength. The deposition of minerals increased after immersion of specimens in SBF after 14 days on the SiNb2%. The SiNb2% group showed high micro shear bond strength values, reaching 33.87 MPa. CONCLUSION: In the present study, the addition of 2 wt% of niobium silicate into dental adhesive resins promoted the mineral deposition with increased bond strength without affecting other material properties. CLINICAL SIGNIFICANCE: Bioactive fillers must maintain the physical-chemical properties of dental adhesives, guaranteeing their clinical performance. Niobium silicate particles could promote the remineralization of dentin hard tissues without compromising the physico-mechanical properties on these materials.

Ionic Liquid-Stabilized Titania Quantum Dots Applied in Adhesive Resin.

Quantum dots (QDs; 1 to 10 nm) were recently synthesized by sol-gel and used as nonagglomerated nanoparticles in adhesive resin. The sol-gel process presented a low yield and resulted in a liquid product without stability. In this study, an imidazolium ionic liquid (IL; 1- n-butyl-3-methylimidazolium tetrafluoroborate, BMI.BF4) was used as stabilizing agent to synthesize titanium dioxide QDs (TiO2QDs/BMI.BF4) via a chemical route. The product was isolated as powder after washing, centrifuging, and drying. An experimental adhesive resin was formulated by mixing methacrylate monomers and a photoinitiator system. The TiO2QDs/BMI.BF4 powder was incorporated at 2.5 (G2.5%) and 5 (G5%) wt% in the adhesive resin, and one group remained without TiO2QDs/BMI.BF4 powder as the control (Gctrl). The TiO2QDs/BMI.BF4 powder was analyzed by micro-Raman spectroscopy, thermogravimetry, and transmission electron microscopy. The dispersion of TiO2QDs/BMI.BF4 powder was analyzed in the polymerized adhesive resin with transmission electron microscopy and fluorescence microscopy. The adhesive resins were evaluated for immediate and long-term antibacterial activity, cytotoxicity, polymerization behavior, degree of conversion, softening in solvent, immediate and long-term microtensile bond strength, and fracture pattern. The TiO2QDs/BMI.BF4 powder showed peaks of anatase and rutile and 26 wt% of BMI.BF4. TiO2QDs/BMI.BF4 presented a minimum size of 1.19 nm, a maximum size of 7.11 nm, and a mean ± SD size of 3.54 ± 1.08 nm. TiO2QDs/BMI.BF4 was dispersed in the adhesive resin without agglomeration, presenting intermittent luminescence by blinking. The addition of any tested concentration of TiO2QDs/BMI.BF4 powder provided immediate and long-term antibacterial activity without cytotoxic effect against the pulp fibroblasts. Furthermore, compared with Gctrl, G2.5% showed reliable polymerization behavior and degree of conversion without differences for softening in solvent with maintenance of bond adhesion to tooth immediately and over time. Thus, the incorporation of 2.5 wt% of TiO2QDs/BMI.BF4 in adhesive resin showed reliable physical, chemical, and biological properties.

Quantum Dots as Nonagglomerated Nanofillers for Adhesive Resins.

Nanoparticles used in adhesive resins are prone to agglomeration, turning the material susceptible to physical failure. Quantum dots are nonagglomerated inorganic nanoparticles (1 to 10 nm) when in equilibrium. The aim of the present study was to synthesize and characterize zinc oxide quantum dots (ZnOQDs) and to develop and evaluate an adhesive resin with the addition of ZnOQDs. ZnOQDs were formulated by self-organization in chemical reaction with isopropanol and added to 2-hydroxyethyl methacrylate (HEMA). HEMA containing ZnOQDs was used for the experimental group and neat HEMA for the control group. Mean ZnOQD diameter was evaluated in isopropanol and in HEMA by ultraviolet-visible spectroscopy. The adhesives were evaluated for degree of conversion ( n = 5), softening in solvent ( n = 5), ultimate tensile strength ( n = 5), microtensile bond strength ( n = 20) at 24 h and after 6 mo, SEM-EDS (scanning electron microscopy-energy-dispersive x-ray spectroscopy; n = 3), and superresolution confocal microscopy ( n = 3). Data of microtensile bond strength after 6 mo and Knoop hardness after solvent immersion were evaluated by paired t test with a 0.05 level of significance. The other data were evaluated by independent t test with a 0.05 level of significance. Ultraviolet-visible spectroscopy indicated that the mean ZnOQD diameter remained stable in isopropanol and in HEMA (1.19 to 1.24 nm). Fourier transform infrared spectroscopy analysis showed the peak corresponding to zinc and oxygen bond (440 cm-1). The experimental group achieved a higher degree of conversion as compared with the control group and presented dentin/adhesive interface stability after 6 mo without altering other properties tested. SEM-EDS indicated 1.54 ± 0.46 wt% of zinc, and the superresolution confocal microscopy indicated nonagglomerated nanoparticles with fluorescence blinking in the polymerized adhesive. The findings of this study showed a possible and reliable method to formulate composites with nonagglomerated nanoscale fillers, shedding light on the nanoparticle agglomeration concern.

The effect of antimicrobial agents on bond strength of orthodontic adhesives: a meta-analysis of in vitro studies.

Antimicrobial orthodontic adhesives aim to reduce white spot lesions' incidence in orthodontic patients, but they should not jeopardizing its properties. Systematic review and meta-analysis were performed to answer the question whether the association of antimicrobial agents with orthodontic adhesives compromises its mechanical properties and whether there is a superior antimicrobial agent. PubMed and Scopus databases. In vitro studies comparing shear bond strength of conventional photo-activated orthodontic adhesives to antimicrobial photo-activated orthodontic adhesives were considered eligible. Search terms included the following: orthodontics, orthodontic, antimicrobial, antibacterial, bactericidal, adhesive, resin, resin composite, bonding agent, bonding system, and bond strength. The searches yielded 494 citations, which turned into 467 after duplicates were discarded. Titles and abstracts were read and 13 publications were selected for full-text reading. Twelve studies were included in the meta-analysis. The global analysis showed no statistically significant difference between control and experimental groups. In the subgroup analysis, only the chlorhexidine subgroup showed a statistically significant difference, where the control groups had higher bond strength than the experimental groups. Many studies on in vitro orthodontic bond strength fail to report test conditions that could affect their outcomes. The pooled in vitro data suggest that adding an antimicrobial agent to an orthodontic adhesive system does not influence bond strength to enamel. It is not possible to state which antimicrobial agent is better to be associated.

The influence of methodological variables on the push-out resistance to dislodgement of root filling materials: a meta-regression analysis.

The aim of this systematic review was to evaluate the influence of several methodological variables on the push-out resistance to dislodgment of root filling materials by a meta-regression analysis of the literature. A systematic review was performed by searching the PubMed database using the terms 'push-out' and 'pushout'. Laboratory studies published before March 2015 were included. Two reviewers extracted data regarding country of origin, year of publication, tooth type, smear layer removal, root canal sealer, core material, obturation technique, sample storage, tooth portion, test machine load velocity and slice thickness. Pooled mean resistance to dislodgement of all groups from the included studies was used in a linear meta-regression of random effects (α = 0.05). Of the 850 identified studies, 53 met the inclusion criteria. A meta-regression of the 341 groups extracted from these articles was performed to analyse the influence of each variable on resistance to dislodgement (in MPa). The sealer, core material, obturation technique, slice thickness, storage time, load velocity and tooth portion significantly influence the results (P < 0.05). Irrigant solution and smear layer removal did not influence the resistance to dislodgement of the root filling materials (P > 0.05). Methodological variables such as sealer, core material, root filling technique, tooth type, tooth portion, slice thickness, storage time and load velocity influenced the resistance to dislodgment. The inclusion and standardization of all related variables could lead to a more comparable and reproducible analysis of the resistance to dislodgment of the root canal sealers.

Synthesis and characterization of a glycerol salicylate resin for bioactive root canal sealers.

AIM: To develop and characterize a salicylate resin with potential use in bioactive endodontic sealers. METHODOLOGY: Methyl salicylate, glycerol and titanium isopropoxide were added in a closed system for the transesterification reaction. The resin obtained was characterized by proton nuclear magnetic resonance spectroscopy (1H NMR) and size exclusion chromatography (SEC). To verify the applicability of the resin to the development of endodontic sealers, experimental cements were prepared by mixing glycerol salicylate resin, calcium hydroxide and methyl salicylate in the ratios of 2 : 1 : 1, 1 : 2 : 1, 1 : 1 : 2, 1 : 1 : 1, 4 : 1 : 1, 1 : 4 : 1 and 1 : 1 : 4. Setting times were measured according to ISO 6876. Features of the hardening reaction were described by micro-RAMAN spectroscopy. RESULTS: The transesterification reaction had a 72% efficiency. The (1) H NMR analysis revealed the presence of the expected functional groups (hydroxyls and aromatic rings), and the SEC confirmed the molar mass of the resin produced. The setting times of experimental sealers ranged from 70 min (ratio 1 : 1 : 1) to 490 min (ratio 1 : 1 : 4). The conversion of the salicylic groups (1 613 cm(-1) ) to salicylate salt (1 543 cm(-1) ) and the reduction in calcium hydroxide peaks (1084 and 682 cm(-1) ) were confirmed by micro-RAMAN spectroscopy, which showed the calcium chelation by the resin. CONCLUSION: The new glycerol salicylate resin was successfully synthesized and revealed a potential application in the development of endodontic sealers.

Niobium pentoxide as a new filler for methacrylate-based root canal sealers.

AIM: To evaluate the influence of several niobium pentoxide (Nb(2) O(5) ) concentrations on the radio-opacity, flow, film thickness, microhardness and degree of conversion of an experimental root canal sealer. METHODOLOGY: An experimental dual-cured root canal sealer was produced with a methacrylate-based comonomer blend. Nb(2) O(5) was added at four different concentrations: 0, 80, 100 and 120 wt%. Radio-opacity was evaluated according to ISO 6876 using a digital system (n = 5). Flow and film thickness were determined in accordance with ISO 6876 (n = 3). Microhardness was evaluated with 50 g for 15 s (n = 5). Degree of conversion was evaluated with FTIR immediately after photocuring and after 1, 7 and 14 days. The data were analysed using anova and Tukey's test. The degree of conversion over time was evaluated using RM-anova (α = 0.05). RESULTS: The groups with 80 wt% and 100 wt% of filler showed no significant difference in radio-opacity from that of equivalent 2 mmAl (P > 0.05). The addition of 120 wt% resulted in radio-opacity values higher than 2 mmAl (P < 0.05). The flow was not significantly different amongst the different groups (P > 0.05). All groups had a film thickness of <50 µm (ISO 6876). All groups with Nb(2) O(5) were associated with higher values of microhardness than the control group. The group with 0 wt% was associated with a higher degree of conversion at all times. All groups except those with 80 wt% had higher values for degree of conversion after 14 days than immediately after photocuring. CONCLUSION: The addition of Nb(2) O(5) increases radio-opacity and microhardness; this material may be a promising filler for the production of a new endodontic sealer.

Nanostructured hydroxyapatite as filler for methacrylate-based root canal sealers.

AIM: To evaluate the effect of different concentrations of nanostructured hydroxyapatite on the radiopacity, flow and film thickness of an experimental root canal sealer. METHODOLOGY: An experimental dual-cured root canal sealer was produced with a methacrylate-based co-monomer blend. Nanostructured hydroxyapatite/calcium tungstate solutions (ratios 10:90, 20:80, 30:70 and 40:60) were added to produce the sealer. Radiopacity was evaluated using a digital system and an aluminium step wedge (n=5). Flow and thickness tests were conducted in accordance with ISO 6876 (n=3). The data were analysed using one-way anova and Tukey's test (α=0.05). RESULTS: All groups had levels of radiopacity in accordance with ISO 6876. The flow of the experimental sealers was not significantly different (P=0.204). All groups had a film thickness in accordance with ISO 6876 and with no statistical difference (P = 0.654). CONCLUSION: The addition of up to 40% HA(nano) to root canal sealers did not alter their radiopacity and film thickness.

Ytterbium trifluoride as a radiopaque agent for dental cements.

AIM: To evaluate the radiopacity, degree of conversion (DC) and flexural strength of an experimental dental cement, with several added radiopaque substances. METHODOLOGY: Titanium dioxide, quartz, zirconia, bismuth oxide, barium sulphate and ytterbium trifluoride were added to the experimental cement in five different concentrations. Radiopacity was evaluated with a phosphor plate system, and the radiodensity of specimens was compared with an aluminium step-wedge. DC was evaluated with FT-infrared spectroscopy following 20 s of photo-activation. Specimens with dimensions of 12 x 2 x 2 mm were used for the flexural strength test. Data were analysed with two-way anova and Tukey's post hoc test. RESULTS: Radiopacity of the experimental dental cements with barium sulphate and bismuth oxide at 40% and ytterbium fluoride at 30% and 40% showed no significant differences in comparison with 3 mm of Al (181, 96). CONCLUSIONS: The experimental dental cements with at least 30% added ytterbium trifluoride had satisfactory radiopacity without influencing other properties.