Fatigue behavior of resin composites in aqueous environments.

OBJECTIVES: Interaction between mechanical and chemical fatigue of resin composites was investigated. METHODS: Fatigue fracture resistance of composites after (1) water immersion and under (2) dry and (3) aqueous conditions was analyzed using a fatigue crack propagation test. The characteristics of fatigue crack propagation were expressed as the correlation between the fatigue crack growth rate (da/dN) and stress intensity factor range (DeltaK) and by the fatigue crack growth threshold (DeltaKth). Following the fatigue test, a fractographic examination was performed by scanning electron microscopy. RESULTS: Contrary to common perception, fatigue crack propagation was retarded under aqueous conditions but accelerated after water immersion. In addition, fatigue cracks detoured around inorganic macro-fillers, but penetrated organic fillers. SIGNIFICANCE: It was concluded that the inverse effects of water on fatigue resistance of composites are dependent on the experimental conditions. Moreover, inorganic macro-fillers were shown to be functional in retarding fatigue cracks in composites.

Influence of Nonenzymatic Glycation in Dentinal Collagen on Dental Caries.

Advanced glycation end-products (AGEs) are generated via nonenzymatic glycation of dentinal collagen, resulting in accumulation of AGEs in dentin tissue. Since accumulated AGEs cause crosslinking between amino acid polypeptides in the collagen molecule and modify mechanical properties of dentinal collagen, the authors assumed that there would be a significant interaction between the generation of AGEs and progression of caries in dentin. To confirm such an interaction, spectroscopic imaging analyses (i.e., nanosecond fluorescence lifetime imaging and second harmonic generation light imaging) were performed in addition to biochemical and electron microscopic analyses in the present study. Seven carious human teeth were fixed in paraformaldehyde and cut longitudinally into 1-mm sections using a low-speed diamond saw for the following analyses. In transmission electron microscopy (TEM) analysis, nondecalcified specimens were embedded in epoxy resin and sliced into thin sections for observation. For the immunohistochemical analysis, the specimens were paraffin embedded after decalcification for 2 wk and sectioned with a microtome. Resultant sections were stained with anti-AGE and anticollagen antibodies. The demineralized specimens were used for spectroscopic analyses without additional treatment. For Western blotting analysis, specimens were separated into carious and sound dentin. Each specimen was homogenized with a bead crusher and an ultrasonic homogenizer and then treated with hydrochloric acid. In carious dentin, the collagen fibers showed an amorphous structure in the TEM image, and the AGEs were localized in the areas of bacterial invasion in the immunostaining image. The total amount of AGEs in carious dentin was higher than in sound dentin in Western blotting. The ultrastructure of type I collagen and total amount of AGEs varied markedly in the dentinal caries region. The fluorescence lifetime was shorter in the carious area than that in the sound areas, indicating an increase of AGEs in the carious area. The increase of AGEs could influence the progression of dentinal caries.

Comparison of polymerization contraction stresses between self- and light-curing composites.

OBJECTIVES: The objective of this study was to examine the distributions and the magnitudes of the internal stresses in self- and a light-curing composite restorations resulting from polymerization shrinkage. METHODS: Butt-joint box-shaped cavities (5.0 x 2.0 mm2, 2.0 mm in depth) prepared in composite molds were filled with either a self- or light-curing transparent resin composite. The restorations were cross-sectioned perpendicular to the longitudinal axes of the cavities and observed using polarizing microscopes. The principal stresses in the restorations, normal and shear stresses at the cavity wall were evaluated by photoelastic analysis. RESULTS: The distributions of the principal stresses and the stresses generated at the cavity wall in both the self- and the light-curing composite restorations were similar. The maximum stress generated at the cavity wall in the light-curing composite restorations was twice as large as that seen in the self-curing restorations. CONCLUSIONS: The results of this study indicated that the difference in the magnitude of the internal stresses between self- and light-curing composites was not related to the distribution of the stresses. The velocity of polymerization appeared to be the most important factor contributing to the magnitude of the internal stresses generated in the composite restorations in this study.

Analysis of longitudinal marginal deterioration of ceramic inlays.

This study quantitatively and morphologically analyzed and clarified the longitudinal marginal changes of ceramic inlays and determined the mechanism for those changes. Epoxy replicas of 15 Class II ceramic inlays in permanent premolars prepared at baseline, 6, 12, 24, 48, 72 and 96 months after placement were selected. A CCD optical laser scanner was employed to measure quantitative changes in the occlusal surfaces of restored teeth. Longitudinal cross-sections of marginal areas of a ceramic inlay were computed, and two profiles of the same location obtained at different periods were superimposed using software. The area enclosed by the two profiles obtained at different periods was defined as the quantitative marginal change, and both the area and maximum depth in the area enclosed were calculated with picture analysis software. The marginal deterioration pattern was analyzed by drawing a longitudinal curve of quantitative change for each restoration. Morphological observation was carried out by scanning electron microscopy at magnifications from 20x to 75x. Quantitative measurement and morphological observation identified a sequential three-stage pattern of marginal deterioration; initial rapid progress of wear of resin composite cement in the first stage, followed by a second stage without any remarkable visible change, then rapid progression of microfractures of ceramics and/or enamel in the third stage. Boundaries between the first and second stage were found in the six and 21-month period, and those between the second and third stage at 72 months. It was concluded that longitudinal marginal deterioration of fired ceramic inlays progressed in a sequential three-stage pattern.

Effects of cavity form and setting expansion of refractory dies on adaptability of Class II (MO and MOD) fired ceramic inlays.

This study investigated the effects of cavity divergence and setting expansion of refractory die material on the adaptability of Class II (MO and MOD) fired ceramic inlays. Standardized Class II (MO and MOD) cavities with two kinds of lateral wall divergence (10 and 20 degrees) were prepared in epoxy resin blocks. A refractory die was prepared from an impression of the epoxy resin cavity in which the setting expansion ranged from 0.04 to 1.14%. A ceramic inlay was fired on each die. The fabricated inlay was inserted into the epoxy resin cavity, and the interfacial distance between the ceramic inlay and the cavity wall at the margin was measured using a reflecting microscope at x100 magnification. The internal fit was measured after sectioning the specimen longitudinally. The results indicate that the setting expansion of the refractory die materials and the divergence of the lateral walls had significant effects on the adaptability of Class II (MO and MOD) fired ceramic inlays. The inlays fabricated on the refractory dies with small setting expansion showed small internal gaps in Class II (MO) cavities. Significantly good adaptation was achieved when the setting expansion was 0.32% or less (p < 0.05). The inlays fabricated on the refractory dies with large setting expansion showed small internal gaps in Class II (MOD) cavities. Significantly good adaptation was achieved when the setting expansion was 0.87% and greater (p < 0.05).

6-year clinical evaluation of fired ceramic inlays.

The purpose of the present study was to evaluate the quality of fired ceramic inlay restorations consisting of a feldspathic porcelain system (G-Cera Cosmotech II) after 6 years in vivo. A total of 49 fired ceramic inlays (for 27 premolars and 22 molars: class 1 in 11 teeth, class 2 in 36 teeth, and onlays in two teeth) were placed in 29 patients, and all restorations were evaluated at the time of placement, at 6 months, and 1, 2, 4, and 6 years after placement using modified USPHS criteria. Replicas made of the restorations were observed using a scanning electron microscope (SEM) to assess the state of the marginal area and wear of the restoration. Favorable color match was noted, and no bulk fracture, tooth fracture, or missing restorations were detected. Longevity was observed in 92% of the fired ceramic inlay restorations at 6 years (Kaplan-Meier method); however, marginal fracture was detected in six restorations (13%) and marginal discoloration in 11 (23%). SEM evaluation disclosed marginal microfracture in 49% of the restorations, wear in 19%, and wear of resin cement along margins in 36% at 6 years. No significant difference was observed in the incidence of each of these three characteristics between molars and premolars. This longitudinal 6-year clinical observation suggested that fired ceramic inlay restorations made by the G-Cera Cosmotech II system are aesthetic, durable, and clinically acceptable. Further follow-up is needed for the restorations showing marginal degradation and fracture from a microscopic and macroscopic perspective.

Effect of cavity form and setting expansion of refractory dies on adaptability of fired ceramic inlays.

The purpose of this study was to investigate the effect of cavity form and setting expansion of refractory die materials on the adaptability of fired ceramic inlays. Standardized Class I cavities with three kinds of lateral wall divergences (10 degrees, 20 degrees, and 30 degrees) and three kinds of surface roughness were prepared in epoxy resin blocks. A refractory die was prepared from an impression of the epoxy resin cavity, whose setting expansion ranged from 0.01 to 1.13%. A ceramic inlay was fired on each die. The fabricated inlay was inserted into the epoxy resin cavity, and the interfacial distance between the ceramic inlay and the cavity wall at the margin was measured using a reflecting microscope at X100 magnification. The internal fit was measured after sectioning the specimen longitudinally. The results were analyzed by ANOVA and Sheffé's F test. Good adaptation was achieved with the smooth-surface cavity. The adaptability depended on the angle of the cavity divergence, and small gaps were observed in 20 degrees and 30 degrees cavities (P < 0.05). The inlays fabricated on the refractory dies with a small setting expansion demonstrated small internal gaps. Significantly good adaptation was achieved when the setting expansion was less than 0.2% (P < 0.05). The results indicated that the cavity form and the setting expansion of the refractory die material had significant effects on the adaptability of fired ceramic inlays.

Eight-year clinical evaluation of fired ceramic inlays.

This study evaluated the quality of fired ceramic inlay restorations consisting of a feldspathic porcelain system (G-Cera Cosmotech II, GC Co, Tokyo, Japan) after eight years in vivo. Forty-five fired ceramic inlays (for 26 premolars and 19 molars; Class I in 12 teeth, Class II in 31 teeth and onlay in two teeth) were placed in 25 patients. All restorations were evaluated at the time of placement and at 6 months, 1, 2, 4, 6 and 8 years after placement using modified USPHS criteria. Replicas of the restorations were observed with a scanning electron microscope (SEM) to evaluate the degradation of the marginal area and wear loss of the restoration. Longevity was observed in 80% of the fired ceramic inlay restorations at eight years (Kaplan-Meier method), although it was 92% at the six-year observation. Marginal fracture was detected in 11 restorations (22%), including bulk fracture in five (11%), which had first occurred during the last two years. Recurrent caries was observed in three (7%) cases and marginal discoloration in 14 (31%). SEM evaluation disclosed marginal microfractures in 77% of the restorations, wear in 36% and wear of the resin cement along the margin in 74% at eight years. No significant difference was observed in each of these three characteristics between molars and premolars. This longitudinal eight-year clinical observation suggested that fired ceramic inlay restorations made by the G-Cera Cosmotech II system are clinically acceptable. However, critical failure as bulk fracture may become a future problem since marginal disintegration was detected in 77% of the restorations from microscopic and macroscopic perspectives.

Additional heat-curing of light-cured composite resin for inlay restoration.

The purpose of this study was to evaluate the effect of heat application after light curing on some physical properties of composite resin for dental inlay. Specimens each were additionally dry heat-cured at various temperatures for 15 min after initial light curing, and other specimens were not heat-cured as a control. Fracture toughness, bending strength, bending elastic modulus, coefficient of thermal expansion, hygroscopic expansion, microhardness, water absorption and solubility were determined. Fracture toughness, bending strength and bending elastic modulus were significantly higher when heated at 80-120 degrees C than the control. The coefficient of thermal expansion, hygroscopic expansion, microhardness and solubility were significantly improved than those of the control when heated, while water absorption was not significantly altered by dry heat-curing. These results indicate that the physical properties of composite resin, except water absorption, were improved significantly when heated after initial cure.

Polymerization contraction stress of resin composite restorations in a model Class I cavity configuration using photoelastic analysis.

PURPOSE: An important factor that contributes to deterioration of resin composite restorations is contraction stress that occurs during polymerization. The purpose of this article is to familiarize the clinician with the characteristics of contraction stress by visualizing the stresses associated with this invisible and complex phenomenon. MATERIALS AND METHODS: Internal residual stresses generated during polymerization of resin composite restorations were determined using micro-photoelastic analysis. Butt-joint preparations simulating Class I restorations (2.0 mm x 5.0 mm, 2.0 mm in depth) were prepared in three types of substrates (bovine teeth, posterior composite resin, and transparent composite resin) and were used to examine contraction stress in and around the preparations. Three types of composite materials (a posterior composite, a self-cured transparent composite, and a light-cured transparent composite) were used as the restorative materials. The self-cured composite is an experimental material, and the others are commercial products. After treatment of the preparation walls with a bonding system, the preparations were bulk-filled with composite. Specimens for photoelastic analysis were prepared by cutting sections perpendicular to the long axis of the preparation. Fringe patterns for directions and magnitudes of stresses were obtained using transmitted and reflected polarized light with polarizing microscopes. Then, the photoelastic analysis was performed to examine stresses in and around the preparations. RESULTS: When cavity preparations in bovine teeth were filled with light-cured composite, a gap was formed between the dentinal wall and the composite restorative material, resulting in very low stress within the restoration. When cavity preparations in the posterior composite models were filled with either self-cured or light-cured composite, the stress distribution in the two composites was similar, but the magnitude of the stress was greater in the light-cured material. When preparations in the transparent composite models were filled with posterior composite and light-cured transparent composite material, significant stress was generated in the preparation models simulating tooth structure, owing to the contraction of both restorative materials. CLINICAL SIGNIFICANCE: Polymerization contraction stress is an undesirable and inevitable characteristic of adhesive restorations encountered in clinical dentistry that may compromise restoration success. Clinicians must understand the concept of polymerization contraction stress and realize that the quality of composite resin restorations depends on successful management of these stresses.