Mechanical properties of conventional versus microwave-polymerized denture base acrylic resins.

STATEMENT OF PROBLEM: New denture base acrylic resins have been introduced that are specifically formulated for microwave polymerization. Microwave polymerization is a time-efficient procedure, but few studies have evaluated how these new acrylic resin formulations compare with conventionally processed acrylic resins. PURPOSE: The purpose of this in vitro study was to compare the stiffness and strength of denture base acrylic resins formulated for microwave polymerization with conventionally processed acrylic resin. MATERIAL AND METHODS: Rectangular beams were fabricated from 2 microwave-polymerized denture base acrylic resins, microwave-specific resin (Nature-Cryl MC), resin with the option of microwave polymerization (Diamond D), and a conventionally processed resin as a control (Lucitone 199). Specimens (n=10) were stored in water for 1 week and subjected to a 3-point bend test to determine the flexural modulus (stiffness) and flexural strength before (initial properties) or after 120 000 load cycles. The load cycles, conducted between 5 and 25 N at 2 Hz, simulated 6 months of mastication. Data were analyzed by using 2-way ANOVA, followed by pairwise comparisons (α=.05). RESULTS: The initial flexural modulus (mean ±standard deviation) was conventionally processed resin, 2.65 ±0.33 GPa; microwave-specific resin, 3.01 ±0.20 GPa; and microwave-option resin, 2.63 ±0.04 GPa. After load cycling, the mean flexural modulus was conventionally processed resin, 2.34 ±0.32 GPa; microwave-specific resin, 2.69 ±0.20 GPa; and microwave-option resin, 1.96 ±0.11 GPa. The initial flexural strength was conventionally processed resin, 77.6 ±11.0 MPa; microwave-specific resin, 83.6 ±3.5 MPa; and microwave-option resin, 78.9 ±2.6 MPa. After load cycling, the mean flexural strength was conventionally processed resin, 68.7 ±9.0 MPa; microwave-specific resin, 73.3 ±3.3 MPa; and microwave-option resin, 65.5 ±3.5 MPa. Resin and loading state significantly affected the stiffness and strength (P<.01); the interaction resin×state was not significant (P≥.558). CONCLUSIONS: Microwave-polymerized denture base acrylic resins were comparable in stiffness and strength with conventionally processed acrylic resin. All acrylic resins decreased in stiffness and strength after load cycling. The microwave-specific resin was significantly stiffer and stronger than the other denture base acrylic resins, initially and after 120 000 load cycles.

A Structural Analysis of 3D Printed Pediatric Space Maintainers.

Purpose: To design, fabricate, and evaluate in vitro 3D printed space maintainers (SMs) and compare their retentive capabilities to tradi- tional stainless-steel (SS) space maintainers. Methods: E-Guard was selected as the printing material based on flexural strength and elastic modulus. SMs with a claw design were printed, cemented to testing blocks, and vertically loaded to determine failure strength and flexure (n equals 10). The intaglio surfaces of SM bands, printed with plain, crosshatched, or horizontal ridges, were cemented to extracted primary teeth. The force needed to dislodge the bands was compared to cemented traditional SS bands (n equals 14). Results: Flexural strength (mean±standard deviation [SD]) of E-Guide, E-Dent, and E-Guard materials was 65±12, 90±13, 134±25 MPa, respectively. Elastic modulus (mean±SD) was 1.54±0.40, 2.49±0.14, 2.65±0.89 GPa, respectively. When subjected to vertical loading, the mean failure load of 3D printed SMs (E-Guard) was 124 N and the mean deflection at fracture was 1.73 mm. Retention strengths (mean±SD) of 3D printed bands were 32±13, 43±13, 43±16 N for the plain printed, cross- hatched, and horizontal ridges designs, respectively. The retention strength of traditional SS bands was 126±27 N. Conclusions: E-Guard had superior mechanical properties among tested printing resins. Strength and deflection under the vertical load of claw-design 3D printed space maintainers may be adequate as a viable alternative to traditional SMs. Retention of 3D printed SMs was significantly lower than for traditional SS bands. Textured intaglio surfaces did not significantly improve the retention of 3D printed bands.

Millennial drinks: acidity, fluoride content, and enamel softening.

This in vitro study aimed to evaluate the acidity and fluoride content of beverages commonly consumed by millennials and the enamel-softening effect of these drinks on tooth enamel. The study included 13 beverages in 4 categories: energy (sports) drink, flavored sparkling water, kombucha, and other (an unsweetened iced tea, a vegetable-fruit juice blend, and a soft drink). The acidity was measured with a pH/ion meter, and the fluoride concentration was measured with a combined fluoride electrode coupled to the meter (n = 10 measurements per beverage). The Vickers hardness number of extracted molars was measured before and after a 30-minute immersion in 4 representative beverages via 2 immersion protocols (n = 10 per beverage per protocol): (1) immersion in the beverage only and (2) immersion alternating between the beverage and artificial saliva every other minute. The pH and fluoride concentrations of the beverages ranged from 2.652 to 4.242 and from 0.0033 to 0.6045 ppm, respectively. One-way analysis of variance (ANOVA) revealed that all differences between beverages in pH values were statistically significant, as were the majority of differences in fluoride concentrations (P < 0.001). The beverages and the 2 immersion methods significantly affected enamel softening (2-way ANOVA, P = 0.0001 to 0.033). The representative energy drink (pH 2.990; 0.0102 ppm fluoride) caused the greatest enamel softening followed by the representative kombucha (pH 2.820; 0.2036 ppm fluoride). The representative flavored sparkling water (pH 4.066; 0.0098 ppm fluoride) caused significantly less enamel softening than the energy drink and kombucha. A root beer (pH 4.185; 0.6045 ppm fluoride) had the least enamel softening effect. All tested beverages were acidic and had a pH below 4.5; only some contained fluoride. Flavored sparkling water, likely due to its higher pH, caused less enamel softening than the tested energy drink and kombucha. The fluoride content of kombucha and root beer lower their enamel-softening effects. It is imperative that consumers be aware of the erosive potential of beverages they consume.

Does a black light lens aid in composite removal?

OBJECTIVE: To evaluate the effectiveness of a black light lens as visual aid in composite restoration removal. Lost tooth structure, residual composite, and removal time were compared for operators with different levels of experience. METHODS: Occlusal preparations in 24 matched-pair extracted molars were etched, bonded, restored with composite, and thermocycled. The restored teeth were radiographed and two faculty and two student doctors removed the restorations with or without a black light lens while time was recorded. Digital scans of the cavity before and after restoration removal were used to calculate lost tooth structure and residual composite. RESULTS: Removal of restorations resulted in tooth structure loss and left residual composite. The use of the black light lens had no significant effect (two-way ANOVA; p value >0.05). However, operator experience significantly affected operating times and average depth of tooth structure loss (two-way ANOVA; p value <0.05). Student doctors assisted by the black light lost less tooth structure than experienced operators and improved their operating times (multiple comparisons; p value <0.05). CONCLUSIONS: The black light lens did not conserve tooth structure or avoid composite remnants compared to routine operation, nor affected the operating time. However, less-experienced operators did benefit from the black light in conserving tooth structure and time. CLINICAL SIGNIFICANCE: Replacement of defective composite restorations is a regular practice in restorative dentistry. When existing composite restorations are removed, loss of tooth structure is unavoidable. A black light lens might improve the ability of operators with less experience to conserve tooth structure even though it did not provide benefits for the experienced operators.

Strength and flexibility of lithium disilicate bonded to polyetherketoneketone.

STATEMENT OF PROBLEM: Polyetherketoneketone (PEKK) is a high-performance polymer gaining popularity in dentistry for the fabrication of crowns, fixed partial dentures, removable partial denture frameworks, and frameworks for implant-supported fixed complete dentures. Despite a lack of performance data, lithium disilicate crowns have been bonded to retentive elements in PEKK frameworks. PURPOSE: The purpose of this in vitro study was to compare the bond strengths and flexibility of lithium disilicate to PEKK or zirconia. MATERIAL AND METHODS: Forty-five PEKK, 15 zirconia, and 60 lithium disilicate beam-shaped specimens (12.5×2×2 mm) were fabricated. The ends of the PEKK beams were subjected to 3 different surface treatments before the application and light polymerization of a primer: 50-µm aluminum oxide airborne-particle abrasion, nonthermal air plasma, and argon-oxygen plasma. The zirconia specimen bonding surfaces were prepared with 50-µm aluminum oxide airborne-particle abrasion and the application of primer. Lithium disilicate specimens were etched with 4.5% hydrofluoric acid, and primer was applied. The lithium disilicate specimens were luted with an adhesive resin cement to the PEKK and zirconia specimens by using light-activated and chemically activated polymerization. Fifteen monolithic specimens of PEKK, lithium disilicate, and zirconia (25×2×2 mm) were also fabricated. All specimens were incubated overnight in 100% humidity before testing. Bonded and monolithic specimens were loaded in a universal testing machine, and 4-point bend tests were conducted until failure (n=15). The flexural modulus and strength were calculated and statistically analyzed with 1-way analysis of variance and Student-Newman-Keuls post hoc tests (α=.05). RESULTS: All bonded specimens failed at the adhesive interface. The zirconia-lithium disilicate bond strength was approximately twice that of the strongest group of PEKK (airborne-particle abrasion group) bonded to lithium disilicate (42 ±12 MPa and 24 ±13 MPa, respectively) and was approximately 9 times more rigid (71 ±19 GPa and 8 ±2 GPa, respectively). Monolithic PEKK fractured at 238 ±22 MPa, monolithic zirconia at 771 ±128 MPa, and monolithic lithium disilicate at 173 ±26 MPa. Monolithic PEKK was approximately 30 times more flexible than monolithic zirconia (6 ±1 GPa and 178 ±16 GPa, respectively). All values were statistically significantly different (P<.05), except for the bond strength between lithium disilicate and PEKK treated with airborne-particle abrasion and nonthermal air plasma and the flexural moduli of PEKK to lithium disilicate. CONCLUSIONS: Bond strength between PEKK and lithium disilicate was significantly weaker than that between zirconia and lithium disilicate. Monolithic PEKK was significantly more flexible than monolithic zirconia.

File Breakage in Conventional Versus Contracted Endodontic Cavities.

OBJECTIVE: To compare rotations to failure and tip separation length of a nickel-titanium (Ni-Ti) rotary in- strument within a simulated mesio-buccal canal of a mandibular molar with a conventional or contracted endodontic cavity. METHODS: Two identical lithium disilicate #30 crowns were milled. A conventional or contracted endodontic cavity was prepared. A custom glass tube was fabricated with taper and length replicating a mesio-buccal canal, including buccal and lingual curvature, and placed at the mesio-buccal orifice of each crown, held in a silicone mold. Instrumentation was simulated using 30/.04 Ni-Ti rotary files following manufacturer recommended 1.8 Nm torque and 500 RPM (n=20 per access type). Instrumentation was video recorded to determine time (sec- onds) and rotations to failure. The length of broken tips was measured. The experimental data were compared using a t-test (significance level 0.05). Stresses in the instruments were examined using finite element analysis. RESULTS: Number of rotations to failure (mean±standard deviation) was 599±126 for conventional and 465±65 and for contracted access; tip separation lengths (mean±standard deviation) were 3.99±0.29 for conventional and 4.90±1.02 mm for contracted access. Number of rotations to failure and tip separation lengths were signifi- cantly different between the two access openings (p<0.001). Finite element analysis confirmed higher file curva- ture and accompanying higher stress levels with contracted access and the maximum stress further from the tip. CONCLUSION: Within the limitations of this study, the contracted access caused earlier failure of the Ni-Ti in- strument with longer tip separation lengths than the conventional access due to higher stresses towards the middle section of the instrument. (EEJ-2022-11-143).

Do composite resin polishing systems damage enamel?

Finishing and polishing of composite resin restorations may cause damage to the bordering enamel. Although many studies have investigated the effect of polish on restorative materials, few have quantified the effect on bordering enamel. The objective of this study was to compare enamel loss surrounding composite restorations after finishing and polishing sequences. The null hypothesis was that there would be no difference in enamel loss between different finishing and polishing sequences. Class V preparations on the buccal and lingual surfaces of 15 extracted human molars were restored with a composite resin and assigned to 1 of 2 finishing and polishing sequences, so that each tooth underwent both sequences (n = 15 per sequence). In sequence 1, a tungsten carbide finishing bur and aluminum oxide polishing discs were used; in sequence 2, a diamond finishing bur, aluminum oxide-impregnated finishing cup, and diamond-impregnated polishing cup were used. Tooth surfaces were scanned with an optical scanner after preparation, finishing, initial polishing, and final polishing. The finishing and polishing scans were aligned to the preparation scan using Cumulus software. The depth of enamel surface loss was calculated and statistically analyzed (α = 0.05; paired t test). Most enamel loss (mean [SD]) resulted from the finishing step with the tungsten carbide bur (51.8 [21.3] µm) or diamond bur (43.3 [12.6] µm). Each polishing step increased mean enamel loss by only a few microns. There was no statistically significant difference between the 2 finishing and polishing sequences. The majority of enamel damage during finishing and polishing of composite resin restorations resulted from the finishing burs. Little enamel was removed by either of the tested composite resin polishing systems.

Dental trauma splints for the mixed dentition - A finite element analysis of splint material, splint extension, missing teeth, and PDL representation.

BACKGROUND/AIMS: Dental traumatic injuries are common in children during the mixed dentition stage. These injuries usually require splinting for stabilization, which is complicated by the various stages of the permanent tooth development and primary tooth exfoliation. The aim of this study was to evaluate the effect on mobility of splint materials and extensions for an avulsed central incisor, stabilized with and without the adjacent incisor under intrusive and extrusive loading with different periodontal ligament (PDL) conditions. MATERIALS AND METHODS: Seventeen 3D model variations were created from a CBCT scan of a 7-year-old patient without erupted permanent upper lateral incisors. A 1000 N palatal load on the right central incisor simulated the avulsion injury and created an increased alveolus and bone deformation, resulting in an increased PDL thickness of 0.45 mm. Wire-resin composite splints with 0.9 mm cross-section (WCS) or 1.0 mm diameter nylon-resin composite splints (NCS) were created. The models simulated conditions with and without the adjacent upper central incisor. Two PDL conditions were investigated, simulating detached PDL or PDL with polyether impression material-like properties. Mobility was calculated under simulated biting loads in horizontal and vertical (intrusive and extrusive) directions. RESULTS: The NCS allowed greater tooth mobility of the avulsed incisor than the WCS, irrespective of splint extension, PDL condition, or load application. During horizontal loading, polyether-like properties for the PDL allowed around 0.2 mm mobility of the avulsed tooth with the WCS, similar to the intact tooth, whereas a simulated detached PDL allowed 25% more mobility with a WCS than with a NCS. CONCLUSIONS: Based on the FEA analysis, a 1.0 mm NCS may be suitable for splinting avulsion injuries during the mixed dentition stage compared to the considerably more rigid WCS. The NCS models provided flexibility for PDL healing while maintaining stability, even when missing adjacent teeth increased span widths. Extensions beyond directly adjacent teeth did not alter the mobility with the NCS but should still be considered an extra protection in case of bond failure or exfoliation.

Dual-cure dental composites: can light curing interfere with conversion?

Dual-cure composites used for dental restorations offer photo- and self-activation, promising unlimited curing depth. This study examined depth of cure with respect to light- and self-cure capabilities. Four dual-cure composites (BulkEZ; Activa; HyperFIL; Injectafil) were tested, with bulk fill (Tetric) and universal (TPH) light-cure composites as comparison. Composites were irradiated from one direction in molds. Additionally, dual-cure composites were left to self-cure without irradiation. Vickers hardness was measured up to 6 mm deep. Results were analyzed with two-way ANOVA and pairwise comparisons (α = 0.05). Hardness dropped significantly with depth in light- and dual-cured composites, except BulkEZ. Self-cured dual-cure composites achieved constant hardness throughout their depth. Only BulkEZ was unaffected by curing mode. Irradiation significantly decreased hardness in middle sections of Hyperfil and Injectafil compared with self-cured samples. Dual-cure composites cured substantially through 6 mm depths but curing behaviors differed. Whereas irradiation did not affect one dual-cure composite, in two other dual-cure composites low-density light levels interfered with the self-polymerization aspect.

Tooth Structure Removed in Primary Molar Prefabricated Crown Preparations of Typodont Teeth.

PURPOSE: Esthetic prefabricated pediatric crowns require more tooth reduction than stainless steel crowns due to their passive fit. The purpose of this study was to determine tooth reduction in primary molar preparations for various pediatric prefabricated crowns. METHODS: Fifty primary maxillary and fifty mandibular typodont molars were scanned with an optical scanner. The teeth were mounted in a typodont, and 10 experienced pediatric clinicians prepared them for five types of pediatric prefabricated crowns: (1) stainless steel (SS); (2) zirconia EZCrowns™ (EZ); (3) NuSmile ® ZR (NS); (4) Zirconia Kinder Krowns ® (KD); and (5) an experimental composite crown (PS). The prepared teeth were rescanned, and the pre- and postpreparation scans were precisely aligned. Mean and maximum reduction depths were calculated for occlusal and mesio- buccal surfaces. Differences in reduction among crown types were compared using one-way analysis of variance followed by the Student-Newman- Keuls post hoc test (α equals 0.05). RESULTS: Reduction depths were not significantly different among the esthetic crowns but were significantly higher than SS crowns. Maximum reduction exceeded two mm in some of the KD and NS crown preparations, with KD consistently showing the highest reduction. CONCLUSIONS: Preparations for esthetic prefabricated molar crowns were more extensive than SS crowns, especially at occlusal and mesiobuccal surfaces. Clinicians should carefully follow manufacturer preparation guidelines to avoid encroaching the mesiobucccal pulp horn.

Using a professional DSLR camera to measure total shrinkage of resin composites.

This study evaluated the optical method for measuring free total shrinkage using a Digital Single Lens Reflex (DSLR) camera. Eight composites were evaluated, conventional, bulk fill and low-shrinkage: Z100 (3M Oral Care), Gradia Direct Anterior (GC corporation), Spectra Smart (Dentsply), Filtek Z350 XT (3M Oral Care), Aura Bulk Fill (SDI), Vittra APS (FGM), Opus Bulk Fill APS (FGM), and Beautifil II LS (Shofu Inc.). The samples (6 mm diameter and 1.5 mm thick, n = 10) were placed on a polyvinylsiloxane impression material. An image of the uncured sample was captured using a DSLR camera with 105 mm macro lens and a ring flash. Samples were light cured with a 700 mW/cm2 LED light-cure unit for 40s. Post-polymerization images were captured at 2, 10 and 60 min. Projected circumferential areas of the specimens were drawn using the ImageJ software. Volumetric total shrinkage was calculated from the ratio of the areas obtained from pre- and post-curing. Results were analyzed using One-way ANOVA (α = 0.05) and Tukey test. Volumetric total shrinkage values were significantly different among the composite materials (p < .001). The volumetric shrinkage (%) mean and results of Tukey test at 60 min were: Z100: 3.45±0.30 (A); Gradia Direct Anterior: 3.00 ± 0.23 (B); Spectra Smart 2.89 ± 0.35 (B); Filtek Z350 XT: 2.65 ± 0.37 (BC); Aura Bulk Fill: 2.42 ± 0.25 (CD); Vittra APS: 2.14 ± 0.35 (DE); Opus Bulk Fill APS: 1.91 ± 0.24 (E); Beautifil II LS: 1.18 ± 0.16 (F). The optical method using a DSLR camera, was suitable for total shrinkage evaluation and will allow assessment of total shrinkage without the need for specialized equipment.

Failure load of milled, 3D-printed, and conventional chairside-dispensed interim 3-unit fixed dental prostheses.

STATEMENT OF PROBLEM: New techniques and materials for the laboratory fabrication of interim fixed dental prostheses have gained in popularity, yet how their failure strengths compare with conventional chairside materials is unclear. PURPOSE: The purpose of this in vitro study was to compare the strength of computer-aided design and computer-aided manufacturing (CAD-CAM) milled polymethylmethacrylate (PMMA) or 3-dimensionally (3D) printed bis-acryl interim fixed dental prostheses with a traditional chairside-dispensed autopolymerizing bis-acryl prosthesis while taking into account the effect of loading rate and storage time. MATERIAL AND METHODS: A dentiform mandibular second premolar and second molar with a first molar pontic were prepared and scanned. Three groups of 3-unit interim fixed dental prostheses were fabricated: milled PMMA, 3D-printed bis-acryl, and chairside-dispensed autopolymerizing bis-acryl. The interim prostheses were evaluated for fit with a silicone disclosing material and cemented onto 3D-printed resin dies. The specimens were stored in 100% humidity at 37 °C. After 1 or 30 days of storage, the cemented interim prostheses were loaded to failure in a universal testing machine at 1 or 10 mm/min (n=15/group). Failure loads were analyzed by 3-way analysis of variance and multiple comparisons (α=.05). RESULTS: Mean ±standard deviation failure loads ranged from 363 ±93 N (3D-printed bis-acryl, 30 days, 1 mm/min) to 729 ±113 N (milled PMMA, 24 hours, 1 mm/min). Loading rate did not significantly affect failure load of the interim prostheses (P=.306). After 30 days of storage in 100% humidity, the failure load of milled PMMA and 3D-printed bis-acryl interim prostheses decreased significantly, but the chairside autopolymerizing bis-acryl prostheses were not affected. After 30 days of storage, the failure loads of milled PMMA and chairside autopolymerizing bis-acryl were not significantly different. CONCLUSIONS: Regardless of loading rate, interim fixed dental prostheses from milled PMMA had the highest initial strength 1 day after storage. Thirty days of exposure to humidity, however, reduced the strength of the CAD-CAM-manufactured interim prostheses, whereas the traditional chairside prostheses retained their strength.

Strength and stiffness of interim materials and interim fixed dental prostheses when tested at different loading rates.

STATEMENT OF PROBLEM: How the loading rate might affect the mechanical properties of interim materials and interim fixed dental prostheses is unclear. PURPOSE: The purpose of this in vitro study was to compare the material stiffness, material strength, and structural strength of interim 3-unit fixed dental prostheses fabricated from 3 interim materials when stressed at different loading rates. MATERIAL AND METHODS: Bar-shaped specimens and anatomically correct interim 3-unit fixed dental prostheses with a modified-ridge lap pontic were fabricated from polyethyl methacrylate resin (Trim) and 2 bis-acrylic composite resins (TempSmart; Integrity) (n=10). Flexural modulus and strength of the bar specimens, representing material stiffness and strength, were determined with a 4-point bend test in a universal testing machine. The structural strength of the prosthesis was assessed from the failure load from a vertical force applied on the occlusal surface of the pontic. Three loading rates, 0.5, 5, or 10 mm/min, were evaluated. Results were statistically analyzed with 2-way analysis of variance and multiple comparisons (α=.05). RESULTS: Loading rate and material significantly affected flexural modulus, flexural strength, and structural strength (P<.05). Increasing loading rate significantly increased the flexural modulus of all materials (P<.05), but the effect of loading rate on the flexural strength of bis-acrylic composite resins was mostly insignificant. Polyethyl methacrylate specimens did not fracture when loaded at 0.5 or 5 mm/min, and the interim fixed dental prostheses made from polyethyl methacrylate did not fracture at the 0.5 mm/min loading rate. Dual-polymerizing bis-acrylic composite resin had significantly higher flexural modulus and strengths than autopolymerizing bis-acrylic composite resin. CONCLUSIONS: Polyethyl methacrylate resin had the lowest stiffness among the interim materials tested and did not fracture but excessively deformed at the low loading rate. Dual-polymerizing bis-acrylic composite resin consistently had higher stiffness and material strength and provided higher structural strength than the autopolymerizing bis-acrylic composite resin. Loading rate significantly affected the mechanical properties of polyethyl methacrylate resin (P<.05), but the effect was indistinct for the bis-acrylic materials.

Bond strength of lithium disilicate to polyetheretherketone.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) is a high-performance polymer that is increasingly used in dentistry, for example, as a framework for implant-supported fixed complete dentures. One protocol calls for individual lithium disilicate crowns to be cemented on preparation-shaped retentive elements on the framework. However, the flexibility and strength of the bonded system is unclear. PURPOSE: The purpose of this in vitro study was to compare the flexibility and strength of bonded lithium disilicate to PEEK with the bond between lithium disilicate and zirconia. MATERIAL AND METHODS: Fifteen PEEK (JUVORA Dental Disc), 15 zirconia (ArgenZ HT+), and 30 lithium disilicate (IPS e.max CAD) beam-shaped specimens (12.5×2×2 mm) were prepared. The ends of the PEEK beams were conditioned with 50-µm aluminum oxide airborne-particle abrasion, followed by primer (visio.link) and light-activated polymerization. Zirconia specimens were prepared with airborne-particle abrasion and primer (Monobond Plus). Lithium disilicate specimens were etched with 4.5% hydrofluoric acid (IPS Ceramic Etching Gel) and primed (Monobond Plus). The lithium disilicate specimens were cemented (Multilink Automix) to the PEEK and zirconia specimens. Light- and chemical-activated polymerization were used. Monolithic specimens of PEEK and zirconia (25×2×2 mm) were also prepared. All specimens were stored overnight in distilled water and submitted to a 4-point bend test in a universal testing machine at 0.5 mm/min crosshead speed until fracture, and the flexural modulus and strength were calculated. Differences among groups were statistically tested by using 1-way analysis of variance followed by the Student-Newman-Keuls post hoc test (α=.05). RESULTS: All bonded specimens fractured at their adhesive interface. Zirconia bonded to lithium disilicate specimens (29.7 ±8.8 MPa) were approximately 3 times stronger than PEEK bonded to lithium disilicate specimens (10.4 ±2.7 MPa) and approximately 12 times more rigid (78.5 ±6.7 GPa and 6.5 ±1.8 GPa, respectively). The flexure of monolithic PEEK was such that it did not fracture when loaded at 0.5 mm/min, while zirconia fractured at 413.9 ±38.5 MPa. Monolithic PEEK was approximately 37 times more flexible than monolithic zirconia (4.3 ±0.3 GPa and 157.2 ±7.2 GPa, respectively). All values were statistically significantly different except between the flexural moduli of monolithic PEEK and PEEK bonded to lithium disilicate. CONCLUSIONS: The bond strength between PEEK and lithium disilicate was significantly weaker than between zirconia and lithium disilicate. Monolithic zirconia was significantly stiffer than monolithic PEEK.

Splint stiffness and extension effects on a simulated avulsed permanent incisor-A patient-specific finite element analysis.

BACKGROUND/AIM: Splinting is an important procedure after avulsion. However, the role of splint stiffness and extension is not fully understood. The aim of this study was to evaluate the effect of splint stiffness and extensions on the mobility and stress on an injured tooth under physiological biting load. MATERIALS AND METHODS: Three-dimensional (3D) finite element models were created from a cone beam computer tomogram of a patient with normal occlusion. An avulsion injury of the right central incisor was created with a 1000 N load application on the palatal of the injured tooth, causing increased socket width. Splints made from four materials were tested: 0.9 mm diameter wire-composite splint (WCS1), 0.4 mm diameter wire-composite splint (WCS2), 1.0 mm diameter nylon-composite splint (NCS), and a 2 mm high by 0.2 mm thick plastic strip composite splint (PSS). Three splint extensions (involving 6, 5, and 3 teeth) were evaluated. Mobility of the avulsed tooth and the maximum principal stress distributions in the adjacent teeth were calculated. RESULTS: The injured incisor tooth mobility was not affected by the splint extensions. The NCS and PSS stabilized the avulsed incisor but allowed, respectively, 10 and 20 times more mobility under horizontal loading than the WCS1, which inhibited most mobility, while the WCS2 allowed double the mobility compared with WCS1. The NCS and PSS allowed more tooth mobility, mainly in the extrusion direction. Splints were 2-3 times more effective in limiting mobility under intrusive loads than extrusive loads. High levels of stress were found at the base of the composite attachments in the adjacent incisors. CONCLUSION: Splinting an avulsed tooth to one or two teeth bilaterally using a nylon splint or a plastic strip is appropriate for tooth stabilization and should be recommended over the 0.4mm wire-composite splint, while the 0.9 mm orthodontic wire is too rigid and not recommended.

Using a professional DSLR camera to measure total shrinkage of resin composites

Abstract This study evaluated the optical method for measuring free total shrinkage using a Digital Single Lens Reflex (DSLR) camera. Eight composites were evaluated, conventional, bulk fill and low-shrinkage: Z100 (3M Oral Care), Gradia Direct Anterior (GC corporation), Spectra Smart (Dentsply), Filtek Z350 XT (3M Oral Care), Aura Bulk Fill (SDI), Vittra APS (FGM), Opus Bulk Fill APS (FGM), and Beautifil II LS (Shofu Inc.). The samples (6 mm diameter and 1.5 mm thick, n = 10) were placed on a polyvinylsiloxane impression material. An image of the uncured sample was captured using a DSLR camera with 105 mm macro lens and a ring flash. Samples were light cured with a 700 mW/cm2 LED light-cure unit for 40s. Post-polymerization images were captured at 2, 10 and 60 min. Projected circumferential areas of the specimens were drawn using the ImageJ software. Volumetric total shrinkage was calculated from the ratio of the areas obtained from pre- and post-curing. Results were analyzed using One-way ANOVA (α = 0.05) and Tukey test. Volumetric total shrinkage values were significantly different among the composite materials (p < .001). The volumetric shrinkage (%) mean and results of Tukey test at 60 min were: Z100: 3.45±0.30 (A); Gradia Direct Anterior: 3.00 ± 0.23 (B); Spectra Smart 2.89 ± 0.35 (B); Filtek Z350 XT: 2.65 ± 0.37 (BC); Aura Bulk Fill: 2.42 ± 0.25 (CD); Vittra APS: 2.14 ± 0.35 (DE); Opus Bulk Fill APS: 1.91 ± 0.24 (E); Beautifil II LS: 1.18 ± 0.16 (F). The optical method using a DSLR camera, was suitable for total shrinkage evaluation and will allow assessment of total shrinkage without the need for specialized equipment.

Effect of luting materials, presence of tooth preparation, and functional loading on stress distribution on ceramic laminate veneers: A finite element analysis.

STATEMENT OF PROBLEM: How the polymerization shrinkage, loading, and mechanical properties of luting materials affect the shrinkage and functional stresses in ceramic laminate veneers (CLVs) with and without tooth preparation is unclear. PURPOSE: The purpose of this finite element analysis (FEA) study was to evaluate the effect of the polymerization shrinkage, functional loading, and mechanical properties of different luting materials on the stresses in ultrathin 0.3-mm CLVs with and without tooth preparation. MATERIAL AND METHODS: Three resin cements, RelyX Veneer (RV), Allcem Veneer APS (AV), Variolink Esthetic LC (VE), and 1 flowable composite resin, Tetric N-Flow (TF), were tested for post-gel shrinkage (Shr), Knoop hardness (KHN), elastic modulus (E), compressive strength (CS), and diametral tensile strength (DTS). IPS e.max CAD disks of 0.3-mm thickness were made for simulating the effects of light attenuation. Eight 2-dimensional finite element models (Marc-Mentat) of a maxillary central incisor were generated to evaluate the polymerization shrinkage stress of different materials for luting 0.3-mm CLVs with or without tooth preparation and the stress during functional loading by using a modified von Mises criterion (mvm). Collected data from Shr, KHN, and E were submitted to 2-way ANOVA and the Tukey HSD test (α=.05). RESULTS: Light attenuation by the 0.3-mm ceramic disk did not significantly affect the E values, but Shr was significantly lower in VE (26%) and TF (35%). TF had lower volumetric Shr (%) when interposing a ceramic disk (0.31%). Both tested tooth preparation options showed similar stress distributions from polymerization shrinkage or functional loading, with higher stress concentration on the incisal edge and also on the cervical surface. The model featuring tooth preparation and RV resin cement had the highest and VE the lowest stress levels. CONCLUSIONS: The flowable composite resin had similar mechanical properties as the resin cements. The stress distribution from shrinkage and functional loading was similar for both techniques with or without tooth preparation.

Numeric Evaluation of Innovate Spring Machined Nickel-Titanium Rotary Instruments: A 3-dimensional Finite Element Study.

INTRODUCTION: The purpose of this study was to investigate if machined springs in nickel-titanium (NiTi) rotary instruments can improve their mechanical properties. The bending and torsion properties were assessed using finite element (FE) model analysis. METHODS: A basic 3-dimensional file model without a spring was created with apical size #25, 25-mm full length, and 16-mm cutting flutes. Three other models were created with a spring machined into their shaft portion with different numbers of spring coils: standard (STspr), 10% more (INspr), and 10% less (DEspr). To compare the mechanical responses among the 4 FE models, file bending and torsion were simulated using FE analysis. RESULTS: Spring machined NiTi rotary instruments showed higher torsional resistance and less bending stiffness than the same instrument without. The spring machined models required more torque to bend or rotate the DEspr model than was required for the STspr and INspr models; however, the STSpr and INSpr models were similar. CONCLUSIONS: Within the limitations of this study, the FE analysis indicated that machining a spring into the shaft of NiTi rotary instruments improved torsional resistance and bending flexibility. Therefore, spring machining has the potential to increase the durability of the NiTi rotary instruments.

Influence of ceramic veneer thickness and antagonist on impact stresses during dental trauma with and without a mouthguard assessed with finite element analysis.

BACKGROUND/AIM: Little is known about the effect of dental trauma and mouthguards (MG) on teeth with ceramic laminate veneers (CLV). The aim was to evaluate the influence of CLV thickness and the presence of a MG with and without antagonist tooth contact on impact stresses during dental trauma. MATERIALS AND METHODS: Twelve 2D-finite element models of a head with maxillary structures and upper incisors, six with and six without antagonist tooth, were created in three CLV conditions: sound incisor (no CLV), 0.3 mm CLV, and 1.0 mm CLV. These were evaluated with and without a 4.0-mm ethylene-vinyl acetate MG, with and without an antagonist tooth. An impact analysis was performed in which the head frontally hits a rigid surface at a speed of 1 m/s (3.6 km/h). The results were analyzed using Critical modified von Mises (MPa). The mean of the 10% highest modified von Mises stresses in each structure was collected. RESULTS: MG presence substantially reduced impact stresses in the CLV and tooth structures. The contact of the antagonist tooth promoted better stress distribution and reduced the stress levels in the traumatized tooth. Critical stress areas were found in the palatal enamel, incisal enamel, labial cervical area, and enamel under the CLV for all models without MG. In the models with MG, the stresses reduced significantly. Critical modified von Mises stress showed that sound or prepared enamel experienced more critical impact stresses than 0.3 or 1.0-mm thick CLV. CONCLUSIONS: The use of 4.0 mm EVA mouthguard reduced the impact stress levels in models with 0.3-mm CLV and 1.0-mm CLV, similar to a sound tooth. The contact of an antagonist tooth and the MG better distributed the stresses and reduced the impact stress in the traumatized tooth.