Effect of elastomeric urethane monomer on physicochemical properties and shrinkage stress of resin composites.

This study aimed to evaluate the effect of an elastomeric urethane monomer (Exothane-24) in different concentrations on physicochemical properties, gap formation, and polymerization shrinkage stress of experimental resin composites. All experimental composites were prepared with 50 wt.% of Bis-GMA and 50 wt.% of TEGDMA, to which 0 wt.% (control), 10 wt.%, 20 wt.%, 30 wt.%, and 40 wt.% of Exothane-24 were added. Filler particles (65 wt.%) were then added to these resin matrixes. Ultimate tensile strength (UTS: n = 10), flexural strength (FS: n = 10), flexural modulus (FM: n = 10), hardness (H: n = 10), hardness reduction (HR: n = 10), degree of conversion (DC: n = 5), gap width (GW: n = 10), and polymerization shrinkage stress in Class I (SS-I: n = 10) and Class II (SS-II: n = 10) simulated configuration. All test data were analyzed using one-way ANOVA and Tukey's test (α = 0.05;  = 0.2). Exothane-24 in all concentrations decreased the H, HR, DC, GW, SS-I, and SS-II (p < 0.05) without affecting the UTS, and FS (p > 0.05). Reduction in FM was observed only in the Exothane 40% and 30% groups compared to the control (p < 0.05). Exothane-24 at concentrations 20% and 30% seems suitable since it reduced GW and polymerization SS without affecting the properties of the composite resins tested, except for H.

Effect of elastomeric urethane monomer on physicochemical properties and shrinkage stress of resin composites

Abstract This study aimed to evaluate the effect of an elastomeric urethane monomer (Exothane-24) in different concentrations on physicochemical properties, gap formation, and polymerization shrinkage stress of experimental resin composites. All experimental composites were prepared with 50 wt.% of Bis-GMA and 50 wt.% of TEGDMA, to which 0 wt.% (control), 10 wt.%, 20 wt.%, 30 wt.%, and 40 wt.% of Exothane-24 were added. Filler particles (65 wt.%) were then added to these resin matrixes. Ultimate tensile strength (UTS: n = 10), flexural strength (FS: n = 10), flexural modulus (FM: n = 10), hardness (H: n = 10), hardness reduction (HR: n = 10), degree of conversion (DC: n = 5), gap width (GW: n = 10), and polymerization shrinkage stress in Class I (SS-I: n = 10) and Class II (SS-II: n = 10) simulated configuration. All test data were analyzed using one-way ANOVA and Tukey's test (α = 0.05; β= 0.2). Exothane-24 in all concentrations decreased the H, HR, DC, GW, SS-I, and SS-II (p < 0.05) without affecting the UTS, and FS (p > 0.05). Reduction in FM was observed only in the Exothane 40% and 30% groups compared to the control (p < 0.05). Exothane-24 at concentrations 20% and 30% seems suitable since it reduced GW and polymerization SS without affecting the properties of the composite resins tested, except for H.

Resumo Este estudo teve como objetivo avaliar o efeito de um monômero elastomérico de uretano (Exothane-24) em diferentes concentrações em propriedades físico-químicas, formação de fenda e tensão de contração de polimerização de resinas compostas experimentais. Todos os compósitos experimentais foram preparados com 50% em peso de Bis-GMA e 50% em peso de TEGDMA, nos quais 0% (controle), 10%, 20%, 30% e 40% em peso de Exothane-24 foram adicionados. Partículas de carga (65% em peso) foram então adicionadas as matrizes resinosas. Resistência coesiva (RC: n = 10), resistência à flexão (RF: n = 10), módulo de flexão (MF: n = 10), dureza (D: n = 10), redução de dureza (RD: n = 10), grau de conversão (GC: n = 5), largura de fenda (LF: n = 10) e tensão de contração de polimerização em simulações de cavidades Classe I (TC-I: n = 10) e Classe II (TC-II: n = 10). Todos os dados do teste foram analisados usando one-way ANOVA e teste de Tukey (α = 0,05; β = 0,2). O Exothane-24 em todas as concentrações diminuiu a D, RD, GC, LF, TC-I e TC-II (p < 0,05) sem afetar o RC e RF (p > 0,05). A redução da MF foi observada apenas nos grupos Exothane 40% e 30% em relação ao controle (p < 0,05). O Exothane-24 nas concentrações de 20% e 30% pareceu ser adequado, pois reduziu LF e TC de polimerização sem afetar as propriedades das resinas compostas testadas, exceto para D.

Patients´ satisfaction concerning direct anterior dental restoration.

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Patients´ satisfaction concerning direct anterior dental restoration

Abstract The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Resumo O objetivo deste estudo foi observar a satisfação dos pacientes com suas restaurações dentárias anteriores diretas e compará-las com a avaliação clínica do dentista usando os critérios FDI (Federation Dental International). Os pacientes pontuaram suas restaurações dentárias (n=106) anteriores em relação à satisfação (satisfatória / insatisfatória). Quando insatisfatória, ele foi entrevistado sobre a queixa. Na mesma sessão, as restaurações dentárias foram avaliadas clinicamente por dois dentistas utilizando os critérios FDI (escore 1-5) quanto aos aspectos estéticos, funcionais e biológicos. Estatística descritiva foi usada para frequências de escores atribuídos por pacientes e clínicos. Para comparar as frequências dos pacientes e dos clínicos, foi aplicado o teste Qui-quadrado (p ≤ 0,05). Os pacientes relataram suas restaurações como 52,8% satisfatórias e 47,8% insatisfatórias. Os clínicos reportaram as mesmas restaurações, 82,3% satisfatória e 17,6% insatisfatória. As queixas mais frequentes dos pacientes referiam-se à cor, seguida da forma anatômica, fratura e retenção do material e forma anatômica proximal. Comparando os índices de satisfação e insatisfação dos pacientes com os clínicos, não houve diferença em relação à estética. A frequência de restaurações insatisfatórias por dentistas foi significativamente menor quando as propriedades funcionais e biológicas foram comparadas com as opiniões dos pacientes. As restaurações foram mais frequentemente relatadas como satisfatórias pelos pacientes, sendo as principais queixas relacionadas a questões estéticas. Quando as avaliações dos clínicos e dos pacientes foram comparadas, observou-se que as frequências de restaurações satisfatórias por pacientes e clínicos foram semelhantes em relação às propriedades estéticas e significativamente diferentes em relação às propriedades funcionais e biológicas.

Ability of short exposures from laser and quad-wave curing lights to photo-cure bulk-fill resin-based composites.

OBJECTIVE: This study investigated the ability of a laser, and a 'quad-wave' LCU, to photo-cure paste and flowable bulk-fill resin-based composites (RBCs). METHODS: Five LCUs and nine exposure conditions were used. The laser LCU (Monet) used for 1 s and 3 s, the quad-wave LCU (PinkWave) used for 3 s in the Boost and 20 s in the Standard modes, the the multi-peak LCU (Valo X) used for 5 s in the Xtra and 20 s in the Standard modes, were compared to the polywave PowerCure used in the 3 s mode and for 20 s in the Standard mode, and to the mono-peak SmartLite Pro used for 20 s. Two paste consistency bulk-fill RBCs: Filtek One Bulk Fill Shade A2 (3 M), Tetric PowerFill Shade IVA (Ivoclar Vivadent), and two flowable RBCs: Filtek Bulk Fill Flowable Shade A2 (3 M), Tetric PowerFlow Shade IVA (Ivoclar Vivadent) were photo-cured in 4-mm deep x 4-mm diameter metal molds. The light received by these specimens was measured using a spectrometer (Flame-T, Ocean Insight), and the radiant exposure delivered to the top surface of the RBCs was mapped. The immediate degree of conversion (DC) at the bottom, and the 24-hour Vickers Hardness (VH) at the top and bottom of the RBCs were measured and compared. RESULTS: The irradiance received by the 4-mm diameter specimens ranged from 1035 mW/cm2 (SmartLite Pro) to 5303 mW/cm2 (Monet). The radiant exposures between 350 and 500 nm delivered to the top surface of the RBCs ranged from 5.3 J/cm2 (Monet in 1 s) to 26.4 J/cm2 (Valo X), although the PinkWave delivered 32.1 J/cm2 in 20 s 350 to 900 nm. All four RBCs achieved their maximum DC and VH values at the bottom when photo-cured for 20 s. The Monet used for 1 s and the PinkWave used for 3 s on the Boost setting delivered the lowest radiant exposures between 420 and 500 nm (5.3 J/cm2 and 3.5 J/cm2 respectively), and they produced the lowest DC and VH values. CONCLUSIONS: Despite delivering a high irradiance, the short 1 or 3-s exposures delivered less energy to the RBC than 20-s exposures from LCUs that deliver> 1000 mW/cm2. There was an excellent linear correlation (r > 0.98) between the DC and the VH at the bottom. There was a logarithmic relationship between the DC and the radiant exposure (Pearson's r = 0.87-97) and between the VH and the radiant exposure (Pearson's r = 0.92-0.96) delivered in the 420-500 nm range.

Effect of preheating on mechanical properties of a resin-based composite containing elastomeric urethane monomer.

This study investigated the effect of preheating an elastomeric urethane monomer (Exothane-24) experimental resin composite on its physicochemical properties. Two resin matrices were formulated: (a) 50 wt% Bisphenol-glycidyl methacrylate (Bis-GMA) and 50 wt% triethylene glycol dimethacrylate (TEGDMA); and (b) 20 wt% Exothane-24, 40 wt% Bis-GMA and 40 wt% TEGDMA. A photoinitiator system (0.25 wt% camphorquinone and 0.50 wt% ethyl-4-dimethylamino benzoate) and 65 wt% of the inorganic filler (20 wt% 0.05 µm silica and 80 wt% 0.7 µm BaBSiO2 glass) were added to both matrices. These formulations were then assigned to four groups: Exothane-24 (E); Exothane-24 plus preheating (EH); no Exothane-24 (NE); and no Exothane-24 plus preheating (NEH). NEH and EH were preheated at 69 °C. The dependent variables were as follows: film thickness (FT); polymerization shrinkage stress (PSS); gap width (GW); maximum rate of polymerization (Rpmax); and degree of conversion (DC). Data were statistically analyzed by two-way ANOVA and Tukey's test (α = 0.05). Preheating reduced FT for both composites. PSS and GW were significantly lower for EH, when compared with E. The DC for EH and NEH and the Rpmax for EH increased significantly. Preheating improved most of the physicochemical properties (FT, PSS, GW, and DC) of the experimental resin composite containing Exothane-24.

Evaluation of a novel restorative protocol to treat non-carious cervical lesion associated with gingival recession: a 2-year follow-up randomized clinical trial.

OBJECTIVE: To compare 2 different resin composites and 2 adhesive systems used in a new restorative protocol (partial restoration) to treat non-carious cervical lesions associated with gingival recession type 1 (RT1). MATERIAL AND METHODS: Eighty combined defects (CDs) were treated with a partial restoration and periodontal plastic surgery for root coverage. The CDs were randomly assigned to one of the following groups: NP + TE (n = 20), nanofilled composite and 2-step total-etch adhesive system; NP + UA (n = 20), nanofilled composite and universal adhesive system; MH + TE (n = 20), microhybrid composite and 2-step total-etch adhesive; MH + UA (n = 20), microhybrid composite and universal adhesive. Restorations were assessed using the United States Public Health Service (USPHS) criteria at 1 week (baseline) and 6, 12, and 24 months. Survival rate, periodontal parameters, dentin hypersensitivity (DH), and aesthetics were also evaluated. RESULTS: After 24 months, only the MH + TE group did not lose any restoration, with no significant differences between groups. For surface roughness parameter, MH presented 83.3% of the restorations scoring Bravo, whereas NP presented 48.5% of the restorations scoring Bravo. All groups presented restorations with marginal discoloration. All periodontal parameters behaved similarly, regardless of the restorative material. All groups presented significant reductions of dentin hypersensitivity and improved aesthetic perceptions (p < 0.05). CONCLUSION: Both resin composites and adhesives tested can be combined for partial restorations to treat CDs. CLINICAL RELEVANCE: This new restorative-surgical protocol to treat CDs presents satisfactory outcomes. The partial restorations can be successfully executed with both combinations of adhesives and resin composites evaluated in this investigation. TRN : ClinicalTrial.gov: NCT03215615; registration date July 12, 2017.

Two-body wear resistance and fatigue survival of new Y-TZP and ATZ ceramics made with a new slip-casting method.

BACKGROUND: Dental zirconium oxide restorations are milled from pre-sintered blocks or disks which are produced either with high isostatic pressure (HIP) or, simpler, a slurry technique. The objective was to perform a fatigue test and an in vitro wear simulation of two ceramics, yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) ceramic and a hybrid zirconium oxide-aluminum oxide ceramic, (ATZ) both produced either the classical way using high isostatic pressure (HIP, control) or with a slurry technique. MATERIALS AND METHODS: Ten discs/group were subjected to a cyclic biaxial fatigue test using a staircase approach under water at 37 °C in a dynamic universal testing machine. The 2-body wear test was performed on eight lapped 12 mm thick cylindrical samples subjected to spherical (ø 6 mm) leucite ceramic antagonists in a CS-4 chewing simulator at 49 N force and 0.7 mm lateral movement for 600 k cycles and 4167 thermal cycles (5-55 °C). Volumetric wear was calculated based on laser-scanned surfaces. Selected samples of both tests were viewed in SEM. RESULTS: All the ceramic specimens produced using the HIP method survived up to 1.2 M cycles with the maximum load of the equipment (1000 N) loading the specimens up to 1527 MPa. The fatigue limit stress at 1.2 M cycles for the Slurry ATZ samples was 946 MPa. For the Slurry Y-TZP samples the fatigue limit stress at 1.2 M cycles was 658 MPa. At 600 k cycles, all zirconium oxide ceramics showed no measurable wear and had a highly polished appearance. The leucite ceramic antagonists wear developed in a linear way. There was no difference between the materials produced with the slurry and the HIP process. ATZ ceramic produced significantly more wear than 3Y- TZP ceramic. CONCLUSIONS: The HIP method provided higher fatigue strength than the Slurry manufacturing method. All HIP ceramics surpassed the limit threshold (1527 MPa) of the testing machine. The tested ceramics did not show any measurable wear but had worn the leucite reinforced glass ceramic antagonists for a considerable amount.

Depth of cure of 10 resin-based composites light-activated using a laser diode, multi-peak, and single-peak light-emitting diode curing lights.

OBJECTIVES: To evaluate the depth of cure (DOC) of ten contemporary resin-based composites (RBCs), light-cured using different LCUs and exposure times. METHODS: The power, radiant emittance, irradiance, radiant exposure (RE), and beam profiles from a laser (M, Monet), a multi-peak (V, Valo Grand), and single-peak (S, SmartLite Pro) LCU were measured. The DOC was measured using a 6-mm diameter metal mold and a solvent dissolution method to remove the uncured RBC. The length of the remaining RBC was divided by 2. The exposure times were: 1 s and 3 s for M, 10 s and 20 s for V, and 10 s and 20 s for S. Data were analyzed using: Bland-Altman distribution, Pearson's Correlation, and an artificial neural network (ANN) to establish the relative importance of the factors on the DOC (α=0.05; ß=0.2). RESULTS: Significant differences were found in the DOC achieved by the different LCUs and composites. The laser LCU emitted the highest power, radiant emittance is used above and in the tables and delivered the highest irradiance. However, this LCU used for 1 s delivered the lowest RE and produced the shortest DOC in all ten RBCs. The ANN demonstrated that the RE is the most critical factor for the DOC. Bland-Altman comparisons showed that the DOCs achieved with the laser LCU used for 1 s were between 17 and 34% shorter than the other conditions. CONCLUSIONS: Although the laser LCU cured all 10 RBCs when used for 1 s, it produced the shallowest DOC, and some RBCs did not achieve their minimum DOC threshold. The RE and not the irradiance was the most important factor in determining the DOC of these 10 RBCs. CLINICAL SIGNIFICANCE: Despite delivering high power and irradiance, the laser used for l s delivered a lower radiant exposure than the conventional LCUs used for 10 s. This resulted in a shorter DOC.

Effect of Incorporation of Bioactive Glass-Ceramic into Self-etch Adhesives.

PURPOSE: This study evaluated the effect of incorporating different concentrations of biosilicate in an experimental self-etch adhesive (SE). MATERIALS AND METHODS: Biosilicate microparticles (0, 2, 5, and 10 wt%) were incorporated into the primer, and degree of conversion (DC) and wettability were tested (one-way ANOVA, Tukey's test, p < 0.05). The two best concentrations were selected (2% and 5%) for µTBS evaluation. Sound human molars (n=20) were sectioned into quarters and randomly assigned to 4 experimental groups: 1. experimental SE + 0% biosilicate (Exp0%; negative control); 2. experimental SE + 2% biosilicate (Exp2%); 3. experimental SE + 5% biosilicate (Exp5%); 4. AdheSE (Ivoclar Vivadent, positive control). After adhesive application, Filtek Z350 (3M Oral Care) composite was built up incrementally to 5 mm. Each quarter tooth was sectioned into sticks (0.9 mm2) and stored in distilled water (37°C) for 24 h, 6 months, or 1 year. After storage, sticks were submitted to µTBS (0.75 mm/min). The Ca:P ratio was analyzed using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Data were analyzed using two-way ANOVA with Bonferroni's correction, with statistical siginificance set at p < 0.05. Fracture patterns were observed under a digital microscope and adhesive interfaces with transmission electron microscopy (TEM). RESULTS: Exp2% presented the highest DC (p < 0.05), Exp5% exhibited the lowest µTBS (p < 0.05), and adhesive failures were predominant in all groups. TEM suggested remineralized areas in Exp2% and to a lesser degree in Exp5%. Exp2% and Exp5% showed a higher Ca:P ratio after aging (p < 0.05). CONCLUSION: The incorporation of biosilicate microparticles can improve the properties of self-etch adhesives. It increased the DC of the experimental adhesive as well as mineral deposition. However, the adhesive properties are concentration dependent, as a higher concentration of microparticles can adversely affect the mechanical properties of an adhesive.

Physicochemical properties of experimental resin-based composites using tris(trimethylsilyl)silane associated with diphenyl iodonium hexafluorophosphate (DPIHP) salt.

The purpose was to evaluate the effect of tris(trimethylsilyl)silane (TTMSS) associated with diphenyl iodonium hexafluorophosphate (DPIHP) on the polymerization shrinkage stress (PSS), mechanical properties, color change (CC), and degree of conversion (DC) of resin-based composites (RBCs). Experimental RBCs containing 35 wt% of organic matrix (10.2 wt% BisGMA, 11.1 wt% BisEMA10 and UDMA and 2.1 wt% TEGDMA) and 65 wt% filler (13 wt% fumed silica and 52 wt% BaBSiO2) were assigned to six groups: control (0.2 wt% CQ, 0.5 wt% DMAEMA); TD05 (0.2 wt% CQ, 0.5 wt% TTMSS, 0.5 wt% DPIHP); TD10 (0.2 wt% CQ, 1 wt% TTMSS, 0.5 wt% DPIHP); DTD (0.2 wt% CQ, 0.25 wt% of DMAEMA, 0.25 wt% TTMSS, 0.5 wt% DPIHP); DT (0.2 wt% CQ, 0.25 wt% DMAEMA, 0.25 wt% TTMSS); and T05 (0.2 wt% CQ, 0.25 wt% TTMSS). The experimental formulations were submitted to the following tests: DC; PSS; CC; rate of polymerization (Rp); depth of cure by Knoop hardness; flexural strength; and flexural modulus. TTMSS showed no effect on the DC, Rp, and mechanical properties of the RBCs. DMAEMA reacted with TTMSS and reduced the Rp; the RBCs containing no DMAEMA showed no reduction in CC. DT showed the lowest PSS mean value among the groups. TTMSS differed from DMAEMA only when used in combination with DPIHP, which significantly improved the DC, maximum Rp, and mechanical properties of the RBCs tested. Based on the artificial ageing results, TTMSS was ineffective in reducing CC in the RBCs tested.

Beam Profiling of Dental Light Curing Units Using Different Camera-Based Systems.

OBJECTIVE: This study aimed to perform the beam profile of dental light-curing units (LCUs) using mirrorless and smartphone cameras and correlate it to a camera-based laser beam profiling system. MATERIALS AND METHODS: Three LCUs were evaluated (Radii Plus; Bluephase G2; and VALO Cordless). The spectral power of the LCUs was measured by using a spectrophotometer. The light emitted from the LCUs was projected onto a glass diffuser, and the images were recorded by using a mirrorless camera (NEX-F3), a smartphone (iPhone) and a camera-based beam profiler. Bandpass optical-filters were used, and for each LCU, the total spectral power output was integrated to calibrate the images. Statistical analysis was performed by digital image correlation (pixel by pixel) using Pearson's correlation (α = 0.05; ß = 0.2). RESULTS: The beam profile images showed nonuniform radiant emittance and spectral emission distributions across all the LCUs light tip. A strong correlation was found among cameras (Pearson's r = 0.91 ± 0.03 with 95% confidence interval [CI]: 0.88-0.94 for the NEX-F3 and Pearson's r = 0.88 ± 0.04 with 95% CI: 0.84-0.92 for the iPhone). CONCLUSION: The standard Ophir beam profile system presented the most accurate distribution, but the mirrorless and smartphone cameras presented a strong correlation in the irradiance distribution of the beam profile images. Alternative cameras can be used to perform light beam profile of dental LCUs, but caution is needed as the type of sensor, image bit depth, and image processing are important to obtain accurate results.

Effect of an elastomeric urethane monomer on BisGMA-free resin composites containing different co-initiators.

OBJECTIVES: The aim of this study was to investigate the mechanical, chemical, optical, and adhesive properties of BisGMA-free experimental resin composites containing Exothane-24-an elastomeric urethane monomer-and different co-initiators. MATERIALS AND METHODS: A blend of urethane dimethacrylate (UDMA), extended dimethacrylate urethane (PEG 400), triethylene glycol dimethacrylate (TEGDMA), and camphorquinone was prepared. Two different co-initiators-dimethyl aminoethyl methacrylate (DMAEMA) or 4-N alcohol, N-dimethylamine phenylethyl (DMPOH)-were added to the blend. Exothane-24 monomer was added to the blend for each co-initiator and four groups were established as follows: DMAEMA; DMAEMA + Exothane; DMPOH; and DMPOH + Exothane. Specimens were photo-activated using a multi-wave LED light-curing unit (VALO; 954 mW/cm2 of irradiance). Mechanical (ultimate tensile strength, flexural strength, flexural modulus and hardness), chemical (degree of conversion, hardness reduction, water sorption and solubility), optical (color change), and adhesive (microtensile bond strength) properties were analyzed. Data were submitted to two-way ANOVA and Tukey's test (α = 0.05). RESULTS: The resin composite containing DMPOH and Exothane-24 showed similar or superior performance to those of the other experimental composites for mechanical and chemical properties, except for flexural strength. It also showed less color change and greater micro-tensile bond strength. CONCLUSIONS: Among the combinations tested, the BisGMA-free resin composite containing Exothane-24 combined with the DMPOH co-initiator showed the best mechanical, chemical, optical, and adhesive properties. Clinical relevance Exothane-24 monomer and DMPOH co-initiator could be useful in the formulation of BisGMA-free resin composites in order to minimize exposure to BPA.

The use of an elastomeric methacrylate monomer (Exothane 24) to reduce the polymerization shrinkage stress and improve the two-body wear resistance of bulk fill composites.

OBJECTIVES: Characterize the chemical structure of an elastomeric monomer (Exothane 24) and evaluate the degree of conversion (DC), polymerization shrinkage stress (PSS), rate of polymerization (Rp), flexural strength (FStrenght), flexural modulus (FModulus), Vickers hardness (VHardness) and two-body wear resistance of dental bulk fill composites (BFCs) containing Exothane 24. METHODS: The Exothane 24 was characterized using mass spectroscopy, elemental analysis, 13C- and 1H NMR. BFCs were formulated containing Exothane 24 (E10, E25, and E50). Similar BFCs containing regular UDMA (U10, U25, and U50), commercial conventional, and BFCs were used as control groups. ATR-FTIR spectroscopy was used to measure DC and the Rp of the composites. The PSS was measured using the universal testing machine method. Specimen bars were used to assess the FStrenght, FModulus, and VHardness. RBCs were submitted to a two-body wear test using a chewing simulator machine; the rate and volumetric wear loss were evaluated using an optical scanner. Data were analyzed statistically with α = 0.05 and ß = 0.2. RESULTS: Exothane 24 is a urethane isophorone tetramethyl methacrylate monomer with polymerization stress-relieving properties. No differences were found in the DC up to 4 mm in depth for E25. All BFCs had similar FStrenght, except for E50. E25 had the lowest volumetric wear loss and wear rate. E25 had approximately 30% lower PSS and slower Rp than commercial BFCs with similar wear resistance to conventional commercial composites. SIGNIFICANCE: The Exothane 24 reduced the PSS and increased the wear resistance of BFCs; however, the formulation is important to optimize the properties of the BFCs.

How Reliable a Bonding Strategy Is the Use of Universal Adhesives?

Universal adhesives (UAs) were introduced about 10 years ago as alternative bonding systems to clinicians' demand for versatility and user-friendly clinical techniques. Clinical studies have shown that the performance of UAs is dependent on the bonding strategy used.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation.

OBJECTIVE: This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators. METHODS: Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers. RESULTS: The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers. CONCLUSIONS: In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly. CLINICAL SIGNIFICANCE: Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Light Transmittance and Depth of Cure of a Bulk Fill Composite Based on the Exposure Reciprocity Law.

The objective of this study was to evaluate the effect of the exposure reciprocity law of a multi-wave light-emitting diode (LED) on the light transmittance (LT), depth of cure (DOC) and degree of conversion in-depth (DC) of a bulk fill composite. A bulk fill composite (EvoCeram® bulk fill, Ivoclar Vivadent) was photoactivated using the multi-wave LED (VALO™ Cordless, Ultradent). The LED was previously characterized using a spectrophotometer to standardize the time of exposure when using the Standard or Xtra-Power modes with the same radiant exposure of 20J/cm2. LT was evaluated through samples of the bulk fill composite every millimeter till 4 mm in-depth. DOC was evaluated according to the ISO 4049. DC of the central longitudinal cross-section from each sample of the DOC test was mapped using FT-NIR microscopy. Data were statistically analyzed according to the experimental design (α=0.05; ß=0.2). The radiant exposure in the violet wavelength range for Standard and Xtra-Power was 4.5 and 5.0 J/cm2, respectively; for the blue wavelength range the radiant exposure for Standard and Xtra-Power was 15.5 and 15.0 J/cm2, respectively. There was no statistical difference in the DOC using Standard or Xtra-Power light-curing modes, but the DOC was lower than the claimed by the manufacturer (4 mm). The DC was not significantly affected by the light-curing mode up to 4 mm in depth (p>0.05). According to exposure reciprocity law, the reduction in exposure time using the same radiant exposure did not affect the depth of cure of the bulk fill composite.

Biaxial flexural strength, crystalline structure, and grain size of new commercially available zirconia-based ceramics for dental appliances produced using a new slip-casting method.

OBJECTIVE: The aim of this study was to evaluate the biaxial flexural strength, the crystalline structure, and the grain size of zirconia-based ceramics produced using a new slip-casting method. MATERIALS AND METHODS: Yttria-stabilized Tetragonal Zirconia Polycrystal (Y-TZP) and Alumina Toughened Zirconia (ATZ) ceramics were purchased from different manufactures. For the experimental group, ceramics produced using a patent pending slip-casting method (Slurry, Decema GmbH) was used. Slurry ceramics (n = 42) with a diameter of 14 ± 0.2 mm were produced by a proprietary colloidal shaping process, sintered, and subsequently polished with a lapping process using 15 µm diamond particles to a thickness of 1.2 ± 0.2 mm. For the control group, ceramics produced using the hot isostatic pressure method (HIP, Metoxit AG) were used. HIP ceramics discs (n = 42) with a diameter of 15.5 ± 0.02 mm were produced by classical HIP method and subsequently machined to a thickness of 1.99 ± 0.04 mm 32 discs of each ceramic were submitted to a biaxial flexural strength test using an universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analyses using two-way ANOVA and Weibull distribution were performed. 2 discs of each ceramic were analyzed using X-ray diffraction for grain crystalline phase quantification. 2 discs of each ceramic were thermally etched and scanning electron microscopy images were obtained for grain size analysis (ISO 13383-1:2012). 6 discs of each ceramic were used for density measurement using the Archimedes' method. RESULTS: For both ATZ and Y-TZP ceramics, the biaxial flexural strength and the characteristic strength of ceramics produced using the Slurry method were significantly higher than ones of the ceramic produced using HIP. The structure analysis confirmed the superiority of the Slurry ceramics which had only 1.2% tetragonal phase compared to 11-16% for the HIP ceramics. Grain size distributions covered a wide range 50-800 nm; the ZrO2 grains of the Slurry ceramics were significantly smaller than the ones of the control ceramics, while the Al2O3 grain distributions were not affected by the manufacturing process. The manufacturing process had no influence on the density of both materials. CONCLUSIONS: The Slurry method using a new proprietary slip-casting method to produce Y-TZP and ATZ dental ceramics presented higher biaxial flexural strength, less monoclinic phase and smaller ZrO2 grains.

In vitro wear of dual-cured bulkfill composites and flowable bulkfill composites.

OBJECTIVES: The objective of this study is to test the wear of dual-cured bulkfill and flowable bulkfill composites. MATERIALS AND METHODS: Six dual-cured bulkfill composites, Cention, Cention-Exp, Activa, Fill-up, Hyperfil Injectafill, and two flowable bulkfill composites Tetric Evoflow BulkFill and G-aenial Universal Flo were tested in this study (n = 8). Each composite was applied into an aluminum sample holder and cured with a Valo Grand (1230 mW/cm2 ) or self-cured according to manufacturer's recommendations, and stored in water for 3 weeks. The samples were subjected to 120 000 load cycles of 49 N (CS-4) against spherical steatite antagonists and simultaneously subjected to 4440 thermocycles (5°C-55°C). At intervals between load cycles, polyvinyl siloxane impressions were taken and scanned with a True Definition Laser Scanner. The volumetric wear was calculated using image software (Geomagic). Microscopic images of selected wear facets and their corresponding worn antagonists were obtained using SEM. All data were analyzed using analysis of variance (ANOVA) and Tukey post hoc test for multiple comparison (α = .05; ß = .2). RESULTS: The load cycles volumetric wear-increase was linear. Two-way ANOVA showed significant main effects (material and light-cured) and significant interactions. Self-cured materials (mean = 0.38 mm3 ) showed more wear than light-cured materials (mean = 0.35mm3 ). CONCLUSIONS: The bioactive materials except Activa light-cured showed significantly more wear than the flowable composites. CLINICAL SIGNIFICANCE: This study demonstrated that most of the dual-cured composites, if light-cured, showed the same wear as the flowable composites used as control. Therefore, to obtain adequate wear resistance the dual-cured composites should be routinely light-cured.