Morphometric micro-CT study of contralateral mandibular incisors.

OBJECTIVES: This study aimed to determine the degree of similarity and symmetry in the anatomy of contralateral mandibular incisors. Three-dimensional (3D) models of extracted teeth were obtained from microtomography (micro-CT) scans. Qualitative and quantitative assessments of the morphology and comparison of contralateral pairs were made. The null hypothesis was that contralateral mandibular incisors could not be considered identical in simple morphometric measurements. METHODS: Sixty pairs of mandibular incisors were extracted from 30 patients and scanned with micro-CT. Virtual models of the cemento-enamel junction to the root apex were rendered. Parameters such as length, canal width, dentinal thicknesses, tortuosity, centerline length, accessory canals, root canal configurations, and root canal orifice cross-sections were used to compare the teeth. Width and thickness comparisons between paired teeth in the same individual were made by paired t-test (Wilcoxon signed-rank test for variables not normally distributed). An online randomization tool generated randomized pairs (independent of the individual/patient). Subsequently, an unpaired t-test (or Mann-Whitney U test for non-normally distributed parameters) and a correlation analysis were conducted. Canal configurations were classified according to preexisting classification schemes. The number and location of accessory canals and apical foramina were registered and compared. RESULTS: Utilizing advanced imaging techniques and quantitative analyses, our study establishes that contralateral mandibular incisors exhibit a remarkable degree of symmetry in multiple morphological parameters, including length, canal width, and dentinal thicknesses. The apical third showed a high degree of inter-variability for the contralateral pairs. The rigorous statistical analysis of the normalized parameters by Z-score showed no statistically significant differences between the contralateral mandibular incisors. Comparisons between central and lateral teeth revealed differences in root length but no significant disparity in the distribution of accessory canals. Central teeth, on average, were longer, while accessory canals were distributed relatively evenly between central and lateral teeth. CONCLUSIONS: The findings of this study further establish the significant similarities between contralateral mandibular incisors, reinforcing their suitability as a reliable substrate for root canal comparison studies. CLINICAL RELEVANCE: The absence of statistically significant differences between contralateral pairs in normalized parameters underscores their potential as a reliable reference point for root canal comparison studies in clinical dentistry. Furthermore, our findings emphasize the importance of individualized treatment planning, considering the natural symmetry in mandibular incisors to enhance clinical decision-making. This research contributes valuable insights to the field of endodontics, offering a standardized approach to sample selection and enriching the understanding of dental anatomy.

Bulk Fill Composites Have Similar Performance to Conventional Dental Composites.

The aim of the study was to perform comprehensive characterization of two commonly used bulk fill composite materials (SDR Flow (SDR) and Filtek™ Bulk Fill Flowable Restorative (FBF) and one conventional composite material (Tetric EvoCeram; TEC). Eleven parameters were examined: flexural strength (FS), flexural modulus (FM), degree of conversion, depth of cure, polymerisation shrinkage (PS), filler particle morphology, filler mass fraction, Vickers hardness, surface roughness following simulated toothbrush abrasion, monomer elution, and cytotoxic reaction of human gingival fibroblasts, osteoblasts, and cancer cells. The degree of conversion and depth of cure were the highest for SDR, followed by FBF and TEC, but there was no difference in PS between them. FS was higher for bulk fill materials, while their FM and hardness were lower than those of TEC. Surface roughness decreased in the order TEC→SDR→FBF. Bisphenol A-glycidyl methacrylate (BisGMA) and urethane dimethacrylate were found in TEC and FBF eluates, while SDR released BisGMA and triethylene glycol dimethacrylate. Conditioned media accumulated for 24h from FBF and TEC were cytotoxic to primary human osteoblasts. Compared to the conventional composite, the tested bulk fill materials performed equally or better in most of the tests, except for their hardness, elastic modulus, and biocompatibility with osteoblasts.

Methodology for Morphometric Analysis of Modern Human Contralateral Premolars.

OBJECTIVE: This study aimed at developing a standard methodology for morphometric analysis and comparison of contralateral human premolar pulp space using microcomputed tomography (micro-CT) and semiautomated software. The primary objective was to establish a method to compare the complex and minute morphological internal volumes of contralateral premolar pulp spaces and determine their degree of similarity. The secondary aim was to introduce new methodology for selecting contralateral premolars for the study of biomaterials and techniques. METHODS: Forty-one intact human premolar pairs (n = 82) extracted from 28 patients were scanned with micro-CT. Quantitative comparative evaluation was performed through geometric morphometric deviation analysis of the pulp spaces after mirroring, automatic alignment, and coregistration with semiautomated software. Geometric parameters compared included volume, surface, and surface over volume. Shape deviation analysis of transformed mean distances and root mean square errors was conducted. RESULTS: The geometric parameters of the contralateral premolar pulp spaces had significantly higher similarity coefficients than random pairs (P < 0.001). The shape deviation analysis and transformed mean distances had significantly lower values for contralaterals compared with random pairs (P < 0.001). The contralateral geometries had a statistically significant narrower distribution in deviation when compared with random pairs (P < 0.001). CONCLUSIONS: We present a methodology that sets a new standard for internal validation of the teeth to be used in ex vivo testing of endodontic materials and techniques. It also shows that the resolution of the CT scan is crucial and that studies using cone beam CT cannot be used for such studies.

Assessment of the Root Canal Similarity in Contralateral Mandibular Incisors.

INTRODUCTION: The purpose of this study was to determine the degree of similarity between contralateral mandibular incisors utilising 3-dimensional (3D) models obtained from micro-computed tomographic (micro-CT) scans of extracted human teeth. The null hypothesis was that contralateral mandibular incisors do not exhibit matching symmetry. METHODS: Sixty pairs (n = 120) of extracted mandibular incisors were obtained from 30 patients and scanned with micro-CT with a voxel size of 15.0 µm. 3D virtual models of the pulpal cavities were rendered. Geometric morphometric deviation analysis was performed after mirroring, automatic alignment, and co-registration of the models of contralateral teeth root mean square (RMS) errors were calculated. The quantitative analysis of the 3D models included 6 different geometric parameters. Data sets were examined with a 2-sample Kolmogorov-Smirnov test. Post hoc retrospective power analysis was performed to find statistical power (α = 0.05). RESULTS: Contralateral pairs had a narrower distribution in deviation than random pairs. Also, contralateral pairs showed a statistically higher similarity coefficient (5 out of 6 geometric parameters) compared to random pairs (P < .001); no difference was found when comparing central to lateral pairs or between Vertucci type I configurations compared to non-type I. RMS errors had significantly lower Contralateral premolars (CPs) values than random pairs (P < .001). CONCLUSIONS: A high degree of similarity was demonstrated for pairing contralateral mandibular incisors using 3D models. The similarity between contralateral central and lateral incisors suggests that when screened and matched, these 4 teeth might be used in endodontic research where similar root canal anatomy is crucial.

Discrepancy in alloy composition of imported and non-imported porcelain-fused-to-metal (PFM) crowns produced by Norwegian dental laboratories.

Purpose: Even though the use of full ceramic crowns have become a well-established practice in dental clinics compare to the last decade, the use of imported casted porcelain-fused-to-metal (PFMs) crowns is still prevalent. The use of imported PFMs is often economically driven; however, when dentists order PFMs, they do not have capabilities to examine its true alloy content. Therefore, we raise the questions whether cheaper imported PFMs have more discrepancies in alloy content compared to domestically produced PFMs? Materials and Methods: This study included 62 porcelain-fused-to-metal crowns: 41 produced in Norway and 21 imported. Their alloy-composition was determined non-destructively by EDX and SEM. Results and Conclusions: Imported PFMs demonstrated larger deviations compared with non-imported PFMs. Significant deviation was found in key metallic elements in the different alloys (W, In, Pd, Ag). The detected deviations in key element such as Wolfram and Indium could influence the PFMs service time. These finding may be of international concern.

Anatomic Comparison of Contralateral Premolars.

INTRODUCTION: The comparative anatomy of contralateral premolars has not been previously studied. The purpose of this micro-computed tomography investigation was to qualitatively and quantitatively assess and compare the morphology of contralateral premolars in terms of length, canal width, dentinal thicknesses, accessory canals, root canal configurations, isthmi, C-shapes, root canal orifices, and apical foramina. The null hypothesis (H0) is that contralateral premolars are more morphologically similar than randomly assigned pairs for simple morphometric measurements (lengths, canal widths, and dentinal thickness). METHODS: Forty-one intact premolar pairs (n = 82) extracted from 28 patients were scanned with micro-computed tomography and reconstructed. Quantitative comparative assessment of measurements was performed by pairwise statistical analysis of contralateral and random pairs with Student t test and one-sample t test. All measured parameters (lengths, widths, and thicknesses) were normalized by Z score so that they could all be compared on a common scale. A correlation study was also performed. Canal configurations and isthmi were classified according to preexisting classification schemes. The number and location of accessory canals and apical foramina were registered and compared. RESULTS/CONCLUSIONS: Contralateral premolar pairs demonstrated a high degree of similarity in terms of the linear measurements (lengths, widths, and thicknesses). The apical portion (foramina, C-shapes, and accessory canals) did not demonstrate bilateral symmetry. The comprehensive statistical analysis of the normalized parameters by Z score showed no statistically significant differences between the contralateral premolar pairs. The null hypothesis (H0) was accepted.

Can CAD/CAM resin blocks be considered as substitute for conventional resins?

OBJECTIVE: Dentists are facing a myriad of new CAD/CAM product for dental filling therapies. Are the new materials any worthwhile using? Are they succeeding the standard filling materials? Here we compare for the first time the new resin-composite blocks (RCBs) with conventional materials (Filtek Z250 and Tetric EvoCeram). METHODS: The material were tested for residual monomer elution by HPLC, thermogravimetric analysis (TG) was used to determine the percentage of fillers by weight, hardness was evaluated by Vickers method, morphology of fillers and distribution in the matrix were examined by scanning electron microscopy (SEM), elemental analysis for elemental determination of the filler particles was performed by energy-dispersive X-ray spectroscopy (EDX) cytotoxicity using human gingival fibroblasts and an epithelial cell line. RESULTS: The RBC outperformed conventional composite regarding mechanical characteristics (hardness) and monomer eluation, but showed some worrisome results regarding cytotoxicity. SIGNIFICANCE: The cost benefit is not in favour of RBCs in comparison to conventional composites, as the cytotoxicity was found higher for RBCs.

Own brand label restorative materials-A false bargain?

OBJECTIVES: This study aims at evaluating and comparing mechanical, chemical, and cytotoxicological parameters of a commercial brand name composite material against two 'own brand label' (OBL) composites. METHODS: Parameters included depth of cure, flexural strength, degree of conversion, polymerization shrinkage, filler particle morphology and elemental analyzes, Vickers hardness, surface roughness parameters after abrasion, monomer elution, and cytotoxicity. RESULTS: The conventional composite outperformed the OBLS in terms of depth of cure (p<0.001), degree of cure at the first and last time intervals (p<0.001), hardness (p<0.001), and post-abrasion roughness (p<0.05). The polymerization volumetric shrinkage ranged from 2.86% to 4.13%, with the highest shrinkage seen among the OBLs. Both Monomer elution from the OBLs was statistically significantly higher (p<0.001). Statistically significantly higher cytotoxicity combined with altered morphology and loss of confluence was detected in the cells exposed to extracts from the OBLs. CONCLUSIONS: The OBLs were in general outdone by the conventional composite. CLINICAL SIGNIFICANCE: OBLs restorative materials have become pervasive in the dental market. Manufacturers often promise equal or better characteristics than existing brand-name composites, but at a lower price. Dentists are highly recommended to reconsider utilization of OBLs lacking sound scientific scrutiny, and our findings underscore this recommendation.

Wear model simulating clinical abrasion on composite filling materials.

The aim of this study was to establish a wear model for testing composite filling materials with abrasion properties closer to a clinical situation. In addition, the model was used to evaluate the effect of filler volume and particle size on surface roughness and wear resistance. Each incisor tooth was prepared with nine identical standardized cavities with respect to depth, diameter, and angle. Generic composite of 3 different filler volumes and 3 different particle sizes held together with the same resin were randomly filled in respective cavities. A multidirectional wet-grinder with molar cusps as antagonist wore the surface of the incisors containing the composite fillings in a bath of human saliva at a constant temperature of 37°C. The present study suggests that the most wear resistant filling materials should consist of medium filling content (75%) and that particles size is not as critical as earlier reported.