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.

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.

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.

Time-lasting ceramic stains and glaze: A toothbrush simulation study.

OBJECTIVE: To evaluate and compare color stability and gloss retention of ceramic stains and glaze under simulated toothbrushing using dentifrices with different relative dentin abrasion (RDA). MATERIALS AND METHODS: Feldspathic porcelain, lithium disilicate, 3 mol% yttria partially stabilized zirconia, and 5 mol% yttria partially stabilized zirconia were evaluated. Ceramics were externally stained, glazed and mounted in the toothbrush simulator. A toothbrush with 300 g force was applied. Regular toothpaste (72 RDA) and charcoal toothpaste (RDA <200) were used. Linear brushing motion with cycle intervals: 5 k, 10 k, 30 k, and 50 k was achieved. Change in color (CIEΔE2000) and gloss measurements were collected using a reflection spectrophotometer (Ci 7600, X-rite) at baseline and cycle intervals. Repeated measures analysis of variance within specimen factors (ceramic type, toothpaste and cycles) was performed. RESULTS: ΔE00 was significantly different at 50 k cycles and with zirconia ceramics (P < .0001). Charcoal toothpaste was significantly different in ΔE00 compared to regular toothpaste (P > .0001). Loss of gloss was observed at 5 k and 30 k (charcoal and regular toothpaste respectively) regardless type of ceramic (P > .0001). CONCLUSION: Glass-phase ceramics retain stains longer than zirconia ceramics. Charcoal toothpaste affect color and gloss stability. Ceramic glaze maybe lost within the first 6 months in patients' mouth. CLINICAL SIGNIFICANCE: Long-term color and gloss stability of externally stained and glazed ceramics maybe a clinical concern. Charcoal toothpastes enhance loss of color and gloss of ceramic restorations.

Effect of Thickness of Ceramic Veneers on Color Stability and Bond Strength of Resin Luting Cements Containing Alternative Photoinitiators.

PURPOSE: To evaluate the light transmittance of ceramic veneers of different thicknesses and verify their influence on the degree of conversion, color stability, and dentin bond strength of light-curing resin cements containing different photoinitiator systems. MATERIALS AND METHODS: Experimental resin cements were fabricated containing camphorquinone and amine (CQ-amine), TPO, Ivocerin (IVO), or TPO and Ivocerin (TPO-IVO). All photoinitiators were characterized by UV-Vis spectrophotometry. Disk-shaped lithium disilicate ceramic specimens that were 0.4, 0.7, and 1.5 mm in thickness were prepared using IPS e.max Press (Ivoclar Vivadent, shade LT/A2). Light transmittance through each specimen was measured using spectrophotometry. Specimens of each cement (n = 10) were made in a custom-designed mold and were light cured through each glass-ceramic disk using a multiwave LED (Bluephase G2, Ivoclar Vivadent). CS was evaluated using spectrophotometry before and after artificial aging with UV light. DC was evaluated using FTIR-spectroscopy. Dentin µSBS was evaluated using 0.75-mm-thick specimens that were light cured under the same protocol (n = 10). All data were submitted to two-way ANOVA and Tukey's test (α = 0.05; ß = 0.2). RESULTS: CQ-amine cements showed the highest color changes (p < 0.05) due to increased yellowing when compared to the amine-free cements (p < 0.05). However, all cements showed a significant color change after aging when cured through ceramics up to 1.5 mm thick (p < 0.05). The TPO-IVO cement showed the highest DC and the IVO cement showed a similar DC when compared to the CQ-amine cement. The TPO cement presented the lowest DC (p = 0.0377). No differences in mean dentin µSBS were found among the cements, except for the TPO cement, which presented a lower mean dentin µSBS (p = 0.0277). CONCLUSION: Amine-free cements containing Ivocerin and TPO seem to be a better alternative to CQ-amine cements, while not reducing either DC or dentin µSBS of amine-free cements. However, CQ-amine and amine-free cements still seem to change color over time.

The effect of diamond toothpastes on surface gloss of resin composites.

PURPOSE: To evaluate the effect of diamond toothpastes on the gloss surface of five resin composites. METHODS: 30 discs of each resin composite in A2 shade [Filtek Supreme Ultra (FS), Tetric EvoCeram (TE), IPS Empress Direct (ED), Charisma (CC), Venus Diamond (VD)] were made. The samples were divided into three groups according to the toothpaste: Colgate Total Clean Mint (control) (CTC), Candida White Diamond (CWD) and Emoform-F Diamond (EFD). After standardized polishing, the samples were brushed using a toothbrushing simulator, and gloss measurements were assessed at baseline and 15, 30, 45, 60, 75, 90, 105 and 120 minutes. RESULTS: Diamond toothpastes behaved dif-ferently from each other: the CWD and CTC groups presented the lowest values compared to EFD (P< 0.05). Nanofilled composites presented higher gloss values than other composites when brushed with various toothpastes (P< 0.05). The addition of diamond particles as abrasives in toothpastes can affect resin composites' surface gloss. CLINICAL SIGNIFICANCE: The various types of abrasive particles present in toothpastes may harm resin-composite restorations.

Dentin µTBS and Hardness of Bulk-fill and Conventional Composites Placed in a Box-shaped Cavity Preparation.

PURPOSE: To compare the dentin microtensile bond strength (µTBS) and the Knoop hardness of bulk-fill and conventional restorative composites in box-shaped Class I cavities using different insertion techniques. MATERIALS AND METHODS: Forty box-shaped Class I preparatons 4 mm deep were performed in the pulp chamber of sound human third molars. The restorations were made using either a conventional microhybrid (Z250, 3M ESPE) or bulk-fill (Tetric EvoCeram Bulk-fill, TCBF) composite using two incremental thicknesses: 2 mm or 4 mm (n = 10). After 24-h water storage, the restorations were sectioned. The first slice (0.7 mm thick) taken from a proximal surface was submitted to the Knoop hardness (KHN) test at five depths from the occlusal cavosurface to the pulpal line angle. Sticks were fabricated from the remaining sections and tested for dentin microtensile bond strength (µTBS). Means were analyzed using two-way ANOVA and Tukey's test (p < 0.05). RESULTS: Higher (p < 0.05) µTBS resulted when both composites were restored with 2-mm increments, with no significant difference between materials (p > 0.05). Higher (p < 0.05) KHN means were found when 2-mm increments were used, with no significant differences (p > 0.05) between the materials. When the teeth were restored with one bulk increment (4 mm), the deeper layers presented lower KHN means (p < 0.05) starting at 2 mm for Z250 and 3 mm for TCBF. CONCLUSION: The 2-mm increment restorations in box-shaped cavities yielded higher µTBS and microhardness for conventional and bulk-fill composites.

Acrylic Reinforcement with Off the Shelf Perforated Metal Plates.

To evaluate the effect of Dentaurum Grid Strengthener on flexural strength and modulus of two types of PMMA, 24 beams (75 mm x 10 mm x 2.5 mm) containing bonded and flattened Grid Strengthener and 24 beams without Grid Strengthener were subjected to a 3-point bending test at 5 mm/min. Flexural strength and modulus were calculated. Data were analyzed with a 2-way ANOVA. The highest mean strength and flexural modulus was measured for reinforced high impact resin (96.2±14.3 MPa and 3425±779 MPa, respectively). For flexural strength and modulus, resin and reinforcement had a significant effect. CLINICAL RELEVANCE: Independent of the resin used, the incorporation of a grid strengthener increases the strength and modulus, thus the fracture probability of dentures is reduced.

Bond Strength of a Flowable Bulk-fill Resin Composite in Class II MOD Cavities.

PURPOSE: To evaluate the microtensile bond strength (µTBS) of a bulk-fill low-stress resin-based composite to dentin from gingival walls of Class II MOD cavities. MATERIALS AND METHODS: Class II MOD cavities were prepared in 44 human molars with the distal and mesial proximal boxes 4 and 6 mm deep, respectively. Eight experimental groups (n = 11) were obtained by a factorial design including 1. "composite" in two levels: a bulk-fill low-stress composite (SureFil SDR Flow, Dentsply Caulk) and a conventional composite (Filtek Z350 XT, 3M ESPE); 2. "filling technique" in two levels: bulk-fill (Bf) and incremental (In); and 3. "depth" in two levels: 4 mm and 6 mm in order to create different polymerization conditions. Twenty-four hours after placement of restorations, teeth were sectioned into beams with a cross-sectional bonded area of approximately 1 mm2. Bonded beams obtained from the gingival walls of the proximal boxes were tested in tension at a crosshead speed of 1 mm/min. Data were submitted to a 3-way ANOVA followed by a post-hoc Tukey's test (p < 0.05). RESULTS: ANOVA failed to identify significant differences for the triple and double interaction between factors. However, significant differences were observed for the factors "composite" and "filling technique" (p < 0.05). SDR presented significantly higher µTBS values for bulk and incremental filling techniques (p < 0.05), and the incremental filling technique presented significantly higher µTBS values for both composites (p < 0.05). CONCLUSION: It can be concluded that the bulk-fill flowable composite SDR may improve the bond strength to the gingival walls of Class II MOD cavities.

Evaluation of microshear bond strength of orthodontic resin cement to monolithic zirconium oxide as a function of surface conditioning method.

PURPOSE: To evaluate the microshear bond strength (µSBS) of orthodontic resin cement to monolithic zirconium oxide ceramic (MZ) after different surface conditioning methods. MATERIALS AND METHODS: Two types of MZ (BruxZir Solid Zirconia, n = 60; Prettau-Zirkon, n = 60) with two types of surface finish (glazed, n = 30 per group; polished, n = 30 per group) were tested after two surface conditioning methods: 1. air abrasion with 30-µm silica coated aluminum oxide (Al2O3) particles (CoJet), or 2. air abrasion with 50-µm Al2O3particles. The non-conditioned group acted as the control. A universal primer (Monobond-Plus) and an orthodontic primer (Transbond-XT Primer) were applied to all specimen surfaces. Orthodontic resin composite (Transbond-XT) was bonded using a mold and photopolymerized. The bonded specimens were subjected to µSBS testing (0.5 mm/min). Data were analyzed statistically using three-way ANOVA and the Sidac adjustment post-hoc test (α = 0.05). Failure modes were analyzed using a stereomicroscope (30X). RESULTS: Mean µSBS values (MPa) did not show a significant difference between the two brands of MZ (p > 0.05). In both glazed (44 ± 6.4) and polished (45.9 ± 4.8) groups, CoJet application showed the highest µSBS values (p < 0.001). The control group (34.4 ± 6) presented significantly better results compared to that of Al2O3(30 ± 3.8) (p < 0.05) on glazed surfaces, but it was the opposite in the polished groups (control: 20.3 ± 4.7; Al2O3: 33.8 ± 4.7; p < 0.001). Adhesive failure was the dominant type in all groups. Conditioning MZs with Al2O3and CoJet increased the percentage of mixed failure type. CONCLUSION: Air abrasion with CoJet followed by the application of universal primer improved the µSBS of orthodontic resin to both the polished and glazed monolithic zirconium oxide materials tested.

Effect of butylated hydroxytoluene (BHT) concentrations on polymerization shrinkage stress and other physicochemical properties of experimental resin composites.

The present study examined different concentrations of the butylated hydroxytoluene (BHT) inhibitor on the kinetics of conversion, polymerization shrinkage stress, and other correlated physicochemical properties of experimental resin composites (ERC). A model composite was formulated with 75 wt% filler containing 0.5 wt% camphorquinone and 1 wt% amine with BHT concentrations of 0.01 wt% (BHT-0.01); 0.1 wt% (BHT-0.1); 0.25 wt% (BHT-0.25); 0.5 wt% (BHT-0.5); 1 wt% (BHT-1), and control (no BHT). They were tested on polymerization shrinkage stress (PSS; n = 5), degree of conversion (DC; n = 3), maximum polymerization rate (RpMAX; n = 5), water sorption (Wsp; n = 0), and solubility (Wsl; n = 10), flexural strength (FS; n = 10), flexural modulus (FM; n = 10), Knoop microhardness (KH; n = 10), and microhardness reduction (HR; n = 10). Data concerning these tests were submitted to one-way ANOVA and Tukey's test (α = 0.05; ß = 0.2). BHT-0.25, BHT-0.5, and BHT-1 showed a gradually significant decrease in PSS (p = 0.037); however, BHT-1 demonstrated a decrease in the physicochemical properties tested. Thus, within the limitations of this study, it was possible to conclude that BHT concentrations between 0.25 and 0.5 wt% are optimal for reducing shrinkage stress without affecting other physicochemical properties of ERCs.

Physicochemical properties of flowable composites using isobornyl methacrylate as diluent monomer.

OBJECTIVE: this study sought to evaluate the effect of isobornyl methacrylate (IBOMA) as a diluent monomer on the physicochemical properties of experimental flowable resin composites. METHODOLOGY: the organic resin matrix of a modal flowable resin composite was formulated with 50 wt.% of bisphenol-A-glycidyl methacrylate (Bis-GMA) and 50 wt.% of a diluent monomer, in which IBOMA was used as a combining or substituent diluent monomer to triethylene glycol dimethacrylate (TEGDMA). The resin matrices were filled with 55 wt.% particles, of which 10 wt.% was 0.05-µm fumed silica, and 45 wt.% was 0.7-µm BaBSiO2 glass. Polymerization shrinkage stress (PSS; n=10), degree of conversion (DC; n=3), maximum rate of polymerization (Rpmax; n=3), film thickness (FT; n=10), sorption (Wsp; n=10), solubility (Wsl; n=10), flexural strength (FS; n=10), flexural modulus (FM; n=10), Knoop microhardness (KH; n=10), and microhardness reduction after chemical softening (HR; n=10) were evaluated. Data were analyzed using one-way ANOVA, followed by Tukey's test (α=0.05; ß=0.2). RESULTS: the results showed that the substitution or addition of IBOMA reduced FT (p=0.001), PSS (p=0.013), Rpmax (p=0.001), DC (p=0.001), FM (p=0.006) Wsp (p=0.032), and Wsl (p=0.021). However, when used as a complete substituent, IBOMA demonstrated significantly lower FS (p=0.017) and KH (p=0.008), while TEGDMA demonstrated significantly lower HR (p=0.022). CONCLUSION: the flowable composite containing IBOMA combined with TEGDMA showed no effect in KH and FS and effectively reduced the PSS, RP, FT, Wsp, and Wsl. However, it showed a reduction in DC, FS, and an increase in HR.

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 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.

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.

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.

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.

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.

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.

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.