Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection

Direct composite resin restorations have become a viable alternative for patients that require anterior restorative procedures to be integrated to the other teeth that compose the smile, especially for presenting satisfactory esthetic results and minimum wear of the dental structure. Technological evolution along with a better understanding of the behavior of dental tissues to light incidence has allowed the development of new composite resins with better mechanical and optical properties, making possible a more artistic approach for anterior restorations. The combination of the increasing demand of patients for esthetics and the capacity to preserve the dental structure resulted in the development of different incremental techniques for restoring fractured anterior teeth in a natural way. In order to achieve esthetic excellence, dentists should understand and apply artistic and scientific principles when choosing color of restorative materials, as well as during the insertion of the composite resin. The discussion of these strategies will be divided into two papers. In this paper, the criteria for color and material selection to obtain a natural reproduction of the lost dental structures and an imperceptible restoration will be addressed.

Effects of Resinous Monomers Used in Restorative Dental Modeling on the Cohesive Strength of Composite Resin

Purpose: The purpose of this study was to evaluate the cohesive strength of the composite using different resinous monomers to lubricate instruments used in the Restorative Dental Modeling Insertion Technique (RDMIT).Materials and Methods: The composite specimens were made by using a prefabricated Teflon device. Different resinous monomers were used at the interface to lubricate the instruments, for a total of 72 specimens divided into 6 groups: 1. control group, no resinous monomer was used; 2. Composite Wetting Resin; 3. C & B Liquid; 4. Scotchbond Multi-Purpose Adhesive; 4. Adper Single Bond Adhesive; 6. Prime & Bond NT. Specimens were submitted to the circular area tensile test to evaluate the cohesive strength at the composite interfaces. Data were analyzed using ANOVA and Tukey's test (alpha = 0.05).Results: ANOVA showed a value of p < 0.0001, which indicated that there were significant differences among the groups. The means (SD) for the different groups were: Adper Single Bond Adhesive: 26 (12) a; control group: 28 (3) ab; Prime & Bond NT: 32 (12) ab; Composite Wetting Resin: 36 (9) abc; C&B Liquid: 38 (7) bc; Scotchbond Multi-Purpose Adhesive: 46 (10) c. Groups denoted with the same letters were not significantly different. Only Scotchbond Multi-Purpose Adhesive, used for direct restorations, had a statistically significantly higher bond strength than the control group, Adper Single Bond Adhesive, and Prime & Bond NT. Adper Single Bond with Adhesive showed a statistically significantly lower mean value than C & B Liquid.Conclusion: The results of this study indicate that the resinous monomers used for lubricating the instruments in the RDMIT did not alter the mechanical properties of the composite, and therefore did not reduce the cohesive bond strength at the composite interfaces.

Comparison of Physicochemical Surface Conditioning Methods for Adhesion of bis-GMA Resin Cement to Particulate Filler Composite and Surface Characterization

This study compared the effect of physicochemical surface conditioning methods on the adhesion of bis-GMA-based resin cement to particulate filler composite (PFC) used for indirect dental restorations. PFC blocks (N (block)=54, n (block)=9 per group) were polymerized and randomly subjected to one of the following surface conditioning methods: a) No conditioning (Control-C), b) Hydrofluoric acid (HF)etching for 60s (AE60), c) HF for 90s (AE90), d) HF for 120s (AE120), e) HF for 180s (AE180), and f) air-abrasion with 30 mu m silica-coated alumina particles (AB). The conditioned surfaces were silanized with an MPS silane, and an adhesive resin was applied. Resin composite blocks were bonded to PFC using resin cement and photo-polymerized. PFC-cement-resin composite blocks were cut under coolant water to obtain bar specimens (1mmx0.8mm). Microtensile bond strength test (mu TBS)was performed in a universal testing machine (1mm/min). After debonding, failure modes were classified using stereomicroscopy. Surface characterization was performed on a set of separate specimen surfaces using Scanning Electron Microscopy (SEM), X-Ray Dispersive Spectroscopy (XDS), X-Ray Photoelectron Spectroscopy (XPS), and Fourier Transform-Raman Spectroscopy (FT-RS). Mean mu TBS (MPa) of C (35.6 +/- 4.9) was significantly lower than those of other groups (40.2 +/- 5.6-47.4 +/- 6.1) (p<0.05). The highest mu TBS was obtained in Group AB (47.4 +/- 6.1). Prolonged duration of HF etching increased the results (AE180: 41.9 +/- 7), but was not significantly different than that of AB (p>0.05). Failure types were predominantly cohesive in PFC (34 out of 54) followed by cohesive failure in the cement (16 out of 54). Degree of conversion (DC) of the PFC was 63 +/- 10%. SEM analysis showed increased irregularities on PFC surfaces with the increased etching time. Chemical surface analyses with XPS and FT-RS indicated 11-70% silane on the PFC surfaces that contributed to improved bond strength compared to Group C that presented 5% silane, which seemed to be a threshold. Group AB displayed 83% SiO2 and 17% silane on the surfaces.

Indicators of the risk mechanics for Class-I and Class-II amalgam and composite resin restorations

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Esthetic and function improvement by direct composite resins and biomimetic concept

Aim: This case report describe a resin layering restorative technique based on biomimetic concept to improve esthetics in a patient with dental defects that affected both enamel and dentin in anterior teeth. Background: Severe structural defect in anterior teeth compromises esthetics and it is a high challenge to become the defect imperceptible after the restoration. Case description: A clinical sequence of applying different composite resin layers allowed the reproduction of the interaction between hard dental tissues and the restorative material. Conclusion: This technique achieved a satisfactory final esthetic outcome, preserving sound teeth structure and at same time, improved the quality of life of the young patient. Clinical significance: The utilization of the biomimetic concept to increase a disharmonic smile with dental defects is based in a conservative approach, which reached a satisfactory and esthetic outcome.

Effect of different light-curing techniques on hardness of a microhybrid dental composite resin

Coordenação de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)

[The stamp technique for direct composite restoration]

The indications for direct resin composite restorations are nowadays extended due to the development of modern resin materials with improved material properties. However, there are still some difficulties regarding handling of resin composite material, especially in large restorations. The reconstruction of a functional and individual occlusion is difficult to achieve with direct application techniques. The aim of the present publication was to introduce a new "stamp"-technique for placing large composite restorations. The procedure of this "stamp"-technique is presented by three typical indications: large single-tooth restoration, occlusal rehabilitation of a compromised occlusal surface due to erosions and direct fibre-reinforced fixed partial denture. A step-by-step description of the technique and clinical figures illustrates the method. Large single-tooth restorations can be built-up with individual, two- piece silicone stamps. Large occlusal abrasive and/or erosive defects can be restored by copying the wax-up from the dental technician using the "stamp"-technique. Even fiber-reinforced resin-bonded fixed partial dentures can be formed with this intraoral technique with more precision and within a shorter treatment time. The presented "stamp"-technique facilitates the placement of large restoration with composite and can be recommended for the clinical use.

Trends in material choice for direct restorations by final year students from University College Cork 2004-2009

Traditionally, undergraduate students in University College Cork (UCC) have been taught to use amalgam as the first choice material for direct restoration of posterior cavities. Since 2005 the use of composite resins has replaced amalgam as the first choice material. An audit was conducted of all direct restorations placed by final year students from UCC from 2004 until 2009. Results showed that over a six year period, final year UCC dental undergraduate students placed proportionately more direct composite resin restorations and significantly fewer amalgam restorations. The need for and undergraduate exposure to, provision of amalgam restorations may have to be revisited.

Chemical and Morphological Features of Dental Composite Resin: Influence of Light Curing Units and Immersion Media

Aims: The study evaluated the influence of light curing units and immersion media on superficial morphology and chemistry of the nanofilled composite resin Supreme XT (3M) through the EDX analysis and SEM evaluation. Light curing units with different power densities and mode of application used were XL 3000 (480 mW/cm(2)), Jet Lite 4000 Plus (1230mW/cm(2)), and Ultralume Led 5 (790 mW/cm(2)) and immersion media were artificial saliva, Coke(R), tea and coffee, totaling 12 experimental groups. Specimens (10 mm X 2 mm) were immersed in each respective Solution for 5 min, three times a day, during 60 days and stored in artificial saliva at 37 degrees C +/- 1 degrees C between immersion periods. Topography and chemical analysis was qualitative. Findings: Groups immersed in artificial saliva, showed homogeneous degradation of matrix and deposition of calcium at the material surface. Regarding coffee, there was a reasonable chemical degradation with loss of load particles and deposition of ions. For tea, superficial degradation occurred in specific areas with deposition of calcium, carbon. potassium and phosphorus. For Coke(R), excessive matrix degradation and loss of load particles with deposition of calcium, sodium, and potassium. Conclusion: Light curing units did not influence the superficial morphology of composite resin tested, but the immersion beverages did. Coke(R) affected material`s surface more than did the other tested drinks. Microsc. Res. Tech. 73:176-181, 2010. (c) 2009 Wiley-Liss Inc.

Influence of NaHCO(3) Powder on Translucency of Microfilled Composite Resin Immersed in Different Mouthrinses

The regular use of mouthrinses, particularly when combined with the use of air-powder polishing, could affect the appearance of tooth-colored restorations. The current study sought to evaluate the effect of NaHCO(3) powder on translucency of a microfilled composite resin immersed in different mouthrinses, at distinct evaluation periods. Eighty disk-shaped specimens of composite resin (Durafill VS, Heraeus Kulzer GmbH & Co. KG, Hanau, Germany) were prepared. The composite specimens were then randomly allocated into two groups according to the surface treatment: exposure to NaHCO(3) powder (10 seconds) or nonexposure, and they were randomly assigned into four subgroups, according to the mouthrinses employed (N = 10): Periogard (Colgate/Palmolive, Sao Bernardo do Campo, SP, Brazil), Cepacol (Aventis Pharma, Sao Paulo, SP, Brazil), Plax (Colgate/Palmolive), and distilled water (control group). The samples were immersed for 2 minutes daily, 5 days per week, over a 4-month test period. Translucency was measured with a transmission densitometer at seven evaluation periods. Statistical analyses (analysis of variance and Tukey`s test) revealed that: distilled water presented higher translucency values (86.72%); Periogard demonstrated the lowest translucency values (72.70%); and Plax (74.05%) and Cepacol (73.32%) showed intermediate translucency values, which were statistically similar between them (p > 0.01). NaHCO(3) air-powder polishing increased the changes in translucency associated with the mouthrinses. Air-powder polishing alone had no effect on material translucency. Translucency percent was gradually decreased from 1 week of immersion up to 4 months. It may be concluded that the NaHCO(3) powder and the tested mouthrinses have affected the translucency of microfilled composite resin, according to the tested time. CLINICAL SIGNIFICANCE During the last decade, the demand for composite resin restorations has grown considerably, however, controversy persists regarding the effect of surface roughness on color stability.

Measurement of shrinkage of composite resin by laser speckle contrast analysis

The aim of this study was to evaluate the shrinkage of a microhybrid dental composite resin photo-activated by one LED with different power densities by means of speckle technique. The dental composite resin Filtek (TM) Z-250 (3M/ESPE) at color A(2) was used for the samples preparation. Uncured composite was packed in a metallic mold and irradiated during 20 s from 100 to 1000 mW cm(-2). For the photo-activation of the samples, it was used a LED prototype (Light Emission Diode) with wavelength centered at 470 nm and adjustable power density until 1 W cm(-2). The speckle patterns obtained from the bottom composite surfaces were monitored using a CCD camera without lens. The speckle field is recorded in a digital picture and stored by CCD camera as the carrier of information on the displacement of the tested surface. The calculated values were obtained for each pair of adjacent patterns and the changes in speckle contrast as a function of time were obtained from six repeated measurements. The speckle contrasts obtained from the bottom surface with 100 mW cm(-1) were smaller than those than the other power densities. The higher power densities provided the higher shrinkage.

Influence of Er:YAG laser on surface treatment of aged composite resin to repair restoration

The purpose of this study was to investigate the effect of Er:YAG laser on surface treatment to the bond strength of repaired composite resin after aged. Sixty specimens (n = 10) were made with composite resin (Z250, 3M) and thermocycled with 500 cycles, oscillating between 5 to 55A degrees C. The specimens were randomly separated in six groups which suffered the following superficial treatments: no treatment (GI, control), wearing with diamond bur (GII), sandblasted with aluminum oxide with 27.5 A mu m particles (GIII) for 10 s, 200 mJ Er:YAG laser (GIV), 300 mJ Er:YAG laser (GV), and 400 mJ Er:YAG laser (GVI), with the last 3 groups under a 10 Hz frequency for 10 s. Restoration repair was done using the same composite. The shear test was done into the Universal testing machine MTS-810. Analyzing the results through ANOVA and Tukey test, no significant differences were found (p-value is 0.5120). Average values analysis showed that superficial treatment with aluminum oxide presented the highest resistance to shear repair interface (8.91MPa) while 400 mJ Er:YAG laser presented the lowest (6.76 MPa). Fracture types analysis revealed that 90% suffered cohesive fractures to GIII. The Er:YAG laser used as superficial treatment of the aged composite resin before the repair showed similar results when used diamond bur and sandblasting with aluminum oxide particles.

Influence of pre-heat treatment and different light-curing units on Vickers hardness of a microhybrid composite resin

The aim of this study was to evaluate the hardness of a dental composite resin submitted to temperature changes before photo-activation with two light-curing unite (LCUs). Five samples (4 mm in diameter and 2 mm in thickness) for each group were made with pre-cure temperatures of 37, 54, and 60A degrees C. The samples were photo-activated with a conventional quartz-tungsten-halogen (QTH) and blue LED LCUs during 40 s. The hardness Vickers test (VHN) was performed on the top and bottom surfaces of the samples. According to the interaction between light-curing unit and different pre-heating temperatures of composite resin, only the light-curing unit provided influences on the mean values of initial Vickers hardness. The light-curing unit based on blue LED showed hardness mean values more homogeneous between the top and bottom surfaces. The hardness mean values were not statistically significant difference for the pre-cure temperature used. According to these results, the pre-heating of the composite resin provide no influence on Vickers hardness mean values, however the blue LED showed a cure more homogeneous than QTH LCU.

Degree of Conversion and Temperature Increase of a Composite Resin Light Cured with an Argon Laser and Blue LED

Different light sources and power densities used on the photoactivation process may provide changes in the degree of conversion (DC%) and temperature ( T) of the composite resins. Thus, the purpose of this study was to evaluate the DC (%) and T (degrees C) of the microhybrid composite resin (Filtek (TM) Z-250, 3M/ESPE) photoactivated with one argon laser and one LED (light-emitting diode) with different power densities. For the KBr pellet technique, the composite resin was placed into a metallic mould (2-mm thickness, 4-mm diameter) and photoactivated as follows: a continuous argon laser (CW) and LED LCUs with power density values of 100, 400, 700, and 1000 mW/cm(2) for 20 s. The measurements for DC (%) were made in a FTIR spectrometer Bomen ( model MB 102, Quebec, Canada). Spectroscopy ( FTIR) spectra for both uncured and cured samples were analyzed using an accessory of the reflectance diffusion. The measurements were recorded in absorbance operating under the following conditions: 32 scans, 4 cm(-1) resolution, 300 to 4000-cm(-1) wavelength. The percentage of unreacted carbon double bonds (% C=C) was determined from the ratio of absorbance intensities of aliphatic C=C (peak at 1638 cm(-1)) against an internal standard before and after the curing of the specimen: aromatic C-C (peak at 1608 cm(-1)). For T (degrees C), the samples were created in a metallic mould (2-mm thickness, 4-mm diameter) and photoactivated for 20 s. The thermocouple was attached to the multimeter allowing temperature readings. The DC (%) and T (degrees C) were submitted to ANOVA and Tukey`s test (p < 0.05). The degree of conversion values varied from 35.0 to 50.0% ( 100 to 1000 mW/cm(2)) for an argon laser and from 41.0 to 49% (100 to 1000 mW/cm(2)) for an LED. The temperature change values varied from 1.1 to 13.1 degrees C (100 to 1000 mW/cm(2)) for an argon laser and from 1.9 to 15.0 degrees C (100 to 1000 mW/cm(2)) for an LED. The power densities showed a significant effect on the degree of conversion and changes the temperature for both light-curing units.

Effect of power densities and irradiation times on the degree of conversion and temperature increase of a microhybrid dental composite resin

The different parameters used for the photoactivation process provide changes in the degree of conversion (DC%) and temperature rise (TR) of the composite resins. Thus, the purpose of this study was to evaluate the DC (%) and TR of the microhybrid composite resin photoactivated by a new generation LED. For the KBr pellet technique, the composite resin was placed into a metallic mould (1-mm thickness and 4-mm diameter) and photoactivated as follows: continuous LED LCU with different power density values (50-1000 mW/cm(2)). The measurements for the DC (%) were made in a FTIR Spectrometer Bomen (model MB-102, Quebec-Canada). The spectroscopy (FTIR) spectra for both uncured and cured samples were analyzed using an accessory for the diffuse reflectance. The measurements were recorded in the absorbance operating under the following conditions: 32 scans, 4-cm(-1) resolution, and a 300 to 4000-cm(-1) wavelength. The percentage of unreacted carbon-carbon double bonds (% C=C) was determined from the ratio of the absorbance intensities of aliphatic C=C (peak at 1638 cm(-1)) against an internal standard before and after the curing of the specimen: aromatic C-C (peak at 1608 cm-1). For the TR, the samples were made in a metallic mould (2-mm thickness and 4-mm diameter) and photoactivated during 5, 10, and 20 s. The thermocouple was attached to the multimeter to allow the temperature readings. The DC (%) and TR were calculated by the standard technique and submitted to ANOVA and Tukey`s test (p < 0.05). The degree of conversion values varied from 35.0 (+/- 1.3) to 45.0 (+/- 2.4) for 5 s, 45.0 (+/- 1.3) to 55.0 (+/- 2.4) for 10 s, and 47.0 (+/- 1.3) to 52.0 (+/- 2.4) for 20 s. For the TR, the values ranged from 0.3 (+/- 0.01) to 5.4 (+/- 0.11)degrees C for 5 s, from 0.5 (+/- 0.02) to 9.3 (+/- 0.28)degrees C for 10 s, and from 1.0 (+/- 0.06) to 15.0 (+/- 0.95)degrees C for 20 s. The power densities and irradiation times showed a significant effect on the degree of conversion and temperature rise.