Impact of Quantity of Resin, C-factor, and Geometry on Resin Composite Polymerization Shrinkage Stress in Class V Restorations

Objective: This study evaluated the effect of quantity of resin composite, C-factor, and geometry in Class V restorations on shrinkage stress after bulk fill insertion of resin using two-dimensional finite element analysis.Methods: An image of a buccolingual longitudinal plane in the middle of an upper first premolar and supporting tissues was used for modeling 10 groups: cylindrical cavity, erosion, and abfraction lesions with the same C-factor (1.57), a second cylindrical cavity and abfraction lesion with the same quantity of resin (QR) as the erosion lesion, and then all repeated with a bevel on the occlusal cavosurface angle. The 10 groups were imported into Ansys 13.0 for two-dimensional finite element analysis. The mesh was built with 30,000 triangle and square elements of 0.1 mm in length for all the models. All materials were considered isotropic, homogeneous, elastic, and linear, and the resin composite shrinkage was simulated by thermal analogy. The maximum principal (MPS) and von Mises stresses (VMS) were analyzed for comparing the behavior of the groups.Results: Different values of angles for the cavosurface margin in enamel and dentin were obtained for all groups and the higher the angle, the lower the stress concentration. When the groups with the same C-factor and QR were compared, the erosion shape cavity showed the highest MPS and VMS values, and abfraction shape, the lowest. A cavosurface bevel decreased the stress values on the occlusal margin. The geometry factor overcame the effects of C-factor and QR in some situations.Conclusion: Within the limitations of the current methodology, it is possible to conclude that the combination of all variables studied influences the stress, but the geometry is the most important factor to be considered by the operator.

Influence of Different Surface Treatments on Bond Strength of Resin Composite Using the Intrinsic Characterization Technique

Objective: This study evaluated the influence of different surface treatments on the resin bond strength/light-cured characterizing materials (LCCMs), using the intrinsic characterization technique. The intrinsic technique is characterized by the use of LCCMs between the increments of resin composite (resin/thin film of LCCM/external layer of resin covering the LCCM).Materials and Methods: Using a silicone matrix, 240 blocks of composite (Z350/3M ESPE) were fabricated. The surfaces received different surface treatments, totaling four groups (n=60): Group C (control group), no surface treatment was used; Group PA, 37% phosphoric acid for one minute and washing the surface for two minutes; Group RD, roughening with diamond tip; and Group AO, aluminum oxide. Each group was divided into four subgroups (n=15), according to the LCCMs used: Subgroup WT, White Tetric Color pigment (Ivoclar/Vivadent) LCCM; Subgroup BT, Black Tetric Color pigment (Ivoclar/Vivadent) LCCM; Subgroup WK, White Kolor Plus pigment (Kerr) LCCM; Subgroup BK, Brown Kolor Plus pigment (Kerr) LCCM. All materials were used according to the manufacturer's instructions. After this, block composites were fabricated over the LCCMs. Specimens were sectioned and submitted to microtensile testing to evaluate the bond strength at the interface. Data were submitted to two-way analysis of variance (ANOVA) (surface treatment and LCCMs) and Tukey tests.Results: ANOVA presented a value of p<0.05. The mean values (+/- SD) for the factor surface treatment were as follows: Group C, 30.05 MPa (+/- 5.88)a; Group PA, 23.46 MPa (+/- 5.45)b; Group RD, 21.39 MPa (+/- 6.36)b; Group AO, 15.05 MPa (+/- 4.57)c. Groups followed by the same letters do not present significant statistical differences. The control group presented significantly higher bond strength values than the other groups. The group that received surface treatment with aluminum oxide presented significantly lower bond strength values than the other groups.Conclusion: Surface treatments of composite with phosphoric acid, diamond tip, and aluminum oxide significantly diminished the bond strength between composite and the LCCMs.

Seven-Year Clinical Performance of Resin Composite Versus Resin-Modified Glass lonomer Restorations in Noncarious Cervical Lesions

Purpose: The purpose of this study was to comparatively assess the seven-year clinical performance of a one-bottle etch-and-rinse adhesive with resin composite (RC) and resin-modified glass ionomer (RMGI) restorations in noncarious cervical lesions.Methods and Materials: One operator placed 70 restorations (35 restorations in each group) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by two independent examiners, using modified US Public Health Service criteria at baseline and 6, 12, 24, 60, and 84 months. The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests. A difference was significant if p<0.05.Results: Twenty patients were available for recall after seven years (66.6%), and 25 RC and 26 RMGI restorations out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (kappa >= 0.85). Alfa and bravo scores were classified as clinically acceptable. The McNemar test detected significant differences within RC restorations between baseline and seven-year evaluations for anatomic form, marginal integrity, and retention (p<0.05). For RMGI restorations, a significant difference was identified for marginal integrity (p<0.05). As to material comparison, the Fisher exact showed a better retention performance for RMGI restorations than for RC restorations (p<0.05). Twelve composite restorations were dislodged (52.0% retention) and three ionomer restorations were lost (88.5% retention). The cumulative success rate for RC and RMGI was 30% and 58.1%, respectively.Conclusions: After seven years of service, the clinical performance of RMGI restorations was superior to that of the adhesive system/resin composite restorations in this study.

Volumetric microleakage assessment of glass-ionomer-resin composite hybrid materials

Objective: This study was intended to quantify the marginal leakage of three glass-ionomer-resin composite hybrid materials and compare it with the leakage exhibited by a glass-ionomer cement and a bonded resin composite system. Method and materials: Standardized Class V cavities were prepared on root surfaces of 105 extracted human teeth, randomly assigned to five groups of 21 each, and restored with either Ketac-Fil Aplicap, Z100/Scotchbond Multi-Purpose Plus, Vitremer, Photac-Fil Aplicap, or Dyract. The teeth were thermally stressed for 500 cycles and stained with methylene blue. The microleakage was quantified spectrophotometrically, and the data were statistically analyzed with Friedman's test. Results: There were no significant differences in microleakage among the five groups. Restorations of all tested materials showed some marginal leakage in Class V cavities. Conclusion: The microleakage performance of glass-ionomer-resin composite hybrid materials was similar to those of a conventional glass-ionomer and a bonded resin composite system.

Effect of random/aligned nylon-6/MWCNT fibers on dental resin composite reinforcement

The aims of this study were (1) to synthesize and characterize random and aligned nanocomposite fibers of multi-walled carbon nanotubes (MWCNT)/nylon-6 and (2) to determine their reinforcing effects on the flexural strength of a dental resin composite.Nylon-6 was dissolved in hexafluoropropanol (10 wt%), followed by the addition of MWCNT (hereafter referred to as nanotubes) at two distinct concentrations (i.e., 0.5 or 1.5 wt%). Neat nylon-6 fibers (without nanotubes) were also prepared. The solutions were electrospun using parameters under low- (120 rpm) or high-speed (6000 rpm) mandrel rotation to collect random and aligned fibers, respectively. The processed fiber mats were characterized by scanning (SEM) and transmission (TEM) electron microscopies, as well as by uni-axial tensile testing. To determine the reinforcing effects on the flexural strength of a dental resin composite, bar-shaped (20 x 2 x 2 mm(3)) resin composite specimens were prepared by first placing one increment of the composite, followed by one strip of the mat, and one last increment of composite. Non-reinforced composite specimens were used as the control. The specimens were then evaluated using flexural strength testing. SEM was done on the fractured surfaces. The data were analyzed using ANOVA and the Tukey's test (alpha=5%).Nanotubes were successfully incorporated into the nylon-6 fibers. Aligned and random fibers were obtained using high- and low-speed electrospinning, respectively, where the former were significantly (p<0.001) stronger than the latter, regardless of the nanotubes'presence. Indeed, the dental resin composite tested was significantly reinforced when combined with nylon-6 fibrous mats composed of aligned fibers (with or without nanotubes) or random fibers incorporated with nanotubes at 0.5 wt%. (C) 2015 Elsevier Ltd. All rights reserved.

An effective technique to posterior resin composite restorations

AIM: The aim of this study is to present a clinical case in which an occlusal matrix device was used in a patient who needed to restore a posterior tooth. MATERIAL AND METHODS: A direct duplicate occlusal appliance was used (biteperf) in a patient who needed an occlusal restoration in two posterior teeth. RESULTS: Using the matrix helps having fast and accurate reproduction of the original anatomical details of the occlusal surface. The final result surprised with the presented restoration in terms of esthetic quality, despite the simplicity of the technique. CONCLUSION: Posterior teeth with initial lesions were confined to the occlusal surface of anatomically complex or fissured anatomy with or without signs of proximal caries wich are ideal candidates for this technique. The overlying enamel surface must be relatively intact; lesions of hidden or occult caries. CLINICAL SIGNIFICANCE: The aesthetic and time-saving benefits of the occlusal device (biteperf) are immediately clear. The matrix allows the fast and accurate reproduction of the anatomic details of the original occlusal surface of the tooth. The professionals who lack an artistic penchant and marked manual ability will be able to carry out excellent posterior resin composite restorations.

In vitro reduction of Streptococcus mutans biofilm on silver nanoparticle-modified resin composite

Introduction: Currently, new methods to reduce biofilm formation on biomaterials are very studied, for example the use of silver nanoparticles, which were bactericidal. However, there are few studies investigating the benefits of these particles in dental restorative materials. Objective: This study aimed to compare in vitro the Streptococcus mutans biofilm formation on conventional light-cured composite resin with that on experimental light-cured composite resin, modified with silver nanoparticles. Material and methods: Discs were produced with either conventional resin (control group) and resin modified with different concentrations of silver nanoparticles, 0.1%, 0.3% and 0.6 % wt. (groups 1, 2 and 3, respectively). The samples were incubated in bacterial suspension (S. mutans) enriched with 20% sucrose to promote biofilm growth on the surfaces. Incubation times were 1, 4 and 7 days. After each period, adherent biofilms were disaggregated by ultrasound. Then, the numbers of viable cells recovered from the biofilms were counted through the serial dilution method. A morphological analysis of biofilm was also performed by Scanning Electron Microscopy. The data were subjected to Anova and Tukey’s test (α = 0.05). Results: The number of viable cells was statistically lower in groups 2 and 3 than in group 1 and control group, after the three incubation periods, without statistical difference between groups 2 and 3. The number of viable cells was statistically lower in group 1 than in control group, after 4 and 7 days of incubation. Conclusion: Resins modified with silver presented reduction of S. mutans biofilm on their surfaces, according to the conditions of this study.

The influence of "C-factor" and light activation technique on polymerization contraction forces of resin composite

Objectives: This study evaluated the influence of the cavity configuration factor ("C-Factor") and light activation technique on polymerization contraction forces of a Bis-GMA-based composite resin (Charisma, Heraeus Kulzer). Material and Methods: Three different pairs of steel moving bases were connected to a universal testing machine (Emic DL 500): groups A and B - 2x2 mm (CF=0.33), groups C and D - 3x2 mm (CF=0.66), groups E and F - 6x2 mm (CF=1.5). After adjustment of the height between the pair of bases so that the resin had a volume of 12 mm(3) in all groups, the material was inserted and polymerized by two different methods: pulse delay (100 mW/cm(2) for 5 s, 40 s interval, 600 mW/cm(2) for 20 s) and continuous pulse (600 mW/cm(2) for 20 s). Each configuration was light cured with both techniques. Tensions generated during polymerization were recorded by 120 s. The values were expressed in curves (Force(N) x Time(s)) and averages compared by statistical analysis (ANOVA and Tukey's test, p<0.05). Results: For the 2x2 and 3x2 bases, with a reduced C-Factor, significant differences were found between the light curing methods. For 6x2 base, with high C-Factor, the light curing method did not influence the contraction forces of the composite resin. Conclusions: Pulse delay technique can determine less stress on tooth/restoration interface of adhesive restorations only when a reduced C-Factor is present.

56-month clinical performance of Class I and II resin composite restorations

Objective: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. Material and Methods: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (alpha=0.05). Results: After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. Conclusions: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.

Microtensile bond strength of resin composite to dentin treated with Er:YAG laser of bleached teeth

The objective of this study was to evaluate the influence of Er:YAG laser (lambda = 2.94 mu m) on microtensile bond strength (mu TBS) and superficial morphology of bovine dentin bleached with 16% carbamide peroxide. Forty bovine teeth blocks (7 x 3 x 3 mm(3)) were randomly assigned to four groups: G1- bleaching and Er:YAG irradiation with energy density of 25.56 J/cm(2) (focused mode); G2 - bleaching; G3 - no-bleaching and Er:YAG irradiation (25.56 J/cm(2)); G4 - control, non-treated. G1 and G2 were bleached with 16% carbamide peroxide for 6 h during 21 days. Afterwards, all blocks were abraded with 320 to 600-grit abrasive papers to obtain flat standardized dentin surfaces. G1 and G3 were Er:YAG irradiated. Blocks were immediately restored with 4-mm-high composite resin (Adper Single Bond 2, Z-250-3 M/ESPE). After 24 h, the restored blocks (n = 9) were serially sectioned and trimmed to an hour-glass shape of approximately 1 mm(2) at the bonded interface area, and tested in tension in a universal testing machine (1 mm/ min). Failure mode was determined at a magnification of 100x using a stereomicroscope. One block of each group was selected for scanning electron microscope (SEM) analysis. mu TBS data was analyzed by two-way ANOVA and Tukey test (alpha = 0.05). Mean bond strengths (SD) in MPa were: G1- 32.7 (5.9)(A); G2- 31.1 (6.3)(A); G3- 25.2 (8.3)(B); G4- 36.7 (9.9).(A) Groups with different uppercase letters were significantly different from each other (p < .05). Enamel bleaching procedure did not affect mu TBS values for dentin adhesion. Er:YAG laser irradiation with 25.56 J/cm(2) prior to adhesive procedure of bleached teeth did not affect mu TBS at dentin and promoted a dentin surface with no smear layer and opened dentin tubules observed under SEM. On the other hand, Er:YAG laser irradiation prior to adhesive procedure of non-bleached surface impaired mu TBS compared to the control group.

Kinetic of water diffusion and color stability of a resin composite as a function of the curing tip distance

The influence of curing tip distance and storage time in the kinetics of water diffusion (water sorption-W SP, solubility-W SB, and net water uptake) and color stability of a composite were evaluated. Composite samples were polymerized at different distances (5, 10, and 15 mm) and compared to a control group (0 mm). After desiccation, the specimens were stored in distilled water to evaluate the water diffusion over a 120-day period. Net water uptake was calculated (sum of WSP and WSB). The color stability after immersion in a grape juice was compared to distilled water. Data were submitted to three-way ANOVA/Tukey's test (α = 5%). The higher distances caused higher net water uptake (p < 0.05). The immersion in the juice caused significantly higher color change as a function of curing tip distance and the time (p < 0.05). The distance of photoactivation and storage time provide the color alteration and increased net water uptake of the resin composite tested.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

Influence of curing rate on softening in ethanol, degree of conversion, and wear of resin composite

PURPOSE: To investigate the effect of curing rate on softening in ethanol, degree of conversion, and wear of resin composites. METHOD: With a given energy density and for each of two different light-curing units (QTH or LED), the curing rate was reduced by modulating the curing mode. Thus, the irradiation of resin composite specimens (Filtek Z250, Tetric Ceram, Esthet-X) was performed in a continuous curing mode and in a pulse-delay curing mode. Wallace hardness was used to determine the softening of resin composite after storage in ethanol. Degree of conversion was determined by infrared spectroscopy (FTIR). Wear was assessed by a three-body test. Data were submitted to Levene's test, one and three-way ANOVA, and Tukey HSD test (alpha = 0.05). Results: Immersion in ethanol, curing mode, and material all had significant effects on Wallace hardness. After ethanol storage, resin composites exposed to the pulse-delay curing mode were softer than resin composites exposed to continuous cure (P< 0.0001). Tetric Ceram was the softest material followed by Esthet-X and Filtek Z250 (P< 0.001). Only the restorative material had a significant effect on degree of conversion (P< 0.001): Esthet-X had the lowest degree of conversion followed by Filtek Z250 and Tetric Ceram. Curing mode (P= 0.007) and material (P< 0.001) had significant effect on wear. Higher wear resulted from the pulse-delay curing mode when compared to continuous curing, and Filtek Z250 showed the lowest wear followed by Esthet-X and Tetric Ceram.

Influence of beveling and ultrasound application on marginal adaptation of box-only Class II (slot) resin composite restorations

A laboratory study was performed to assess the influence of beveling the margins of cavities and the effects on marginal adaptation of the application of ultrasound during setting and initial light curing. After minimal access cavities had been prepared with an 80 microm diamond bur, 80 box-only Class II cavities were prepared mesially and distally in 40 extracted human molars using four different oscillating diamond coated instruments: (A) a U-shaped PCS insert as the non-beveled control (EMS), (B) Bevelshape (Intensiv), (C) SonicSys (KaVo) and (D) SuperPrep (KaVo). In groups B-D, the time taken for additional bevel finishing was measured. The cavities were filled with a hybrid composite material in three increments. Ultrasound was also applied to one cavity per tooth before and during initial light curing (10 seconds). The specimens were subjected to thermomechanical stress in a computer-controlled masticator device. Marginal quality was assessed by scanning electron microscopy and the results were compared statistically. The additional time required for finishing was B > D > C (p < or = 0.05). In all groups, thermomechanical loading resulted in a decrease in marginal quality. Beveling resulted in higher values for "continuous" margins compared with that of the unbeveled controls. The latter showed better marginal quality at the axial walls when ultrasound was used. Beveling seems essential for good marginal adaptation but requires more preparation time. The use of ultrasonic vibrations may improve the marginal quality of unbeveled fillings and warrants further investigation.

Determination of caries risk at resin composite margins

PURPOSE: To design an artificial mouth in order to evaluate if a new diagnostic tool (Clinpro Cario Diagnosis) can be used for early detection of secondary caries at resin composite margins in vitro. METHODS: 32 intact human third molars received standardized Class-V resin composite restorations (Tetric Ceram bonded with Syntac SC). After storage for 4 weeks at 37 degrees C, teeth were subjected to 5,000 or 10,000 thermocycles (+/- 5 degrees C and +/- 55 degrees C) and polysiloxane impressions were taken. Streptococcus mutans 10449 (SM) was used in a nutrition medium to initiate a secondary caries process. Daily, the teeth were incubated for 2 x 2.5 hours in SM containing nutrition medium followed by 2 x 9.5 hours incubation in artificial saliva. Teeth were investigated after total incubation periods of 4, 6, and 8 weeks. After the different incubation protocols, the restoration margins were evaluated for infection and secondary caries processes in using Clinpro Cario Diagnosis which measures site-specifically the lactic acid production of SM in response to a sucrose challenge. The color signal was read 5 minutes after removal of the diagnostic impression. After thermocycling and biological load cycling, precision polysiloxane impressions were taken and replicas were investigated under a light microscope for gap widths at enamel and dentin margins. Demineralization was evaluated by fluorescence microscopy in using a special FITC filter. The demineralization depths at the cavity margin were calculated with Xpert for Windows using a pixel distance of 5 microm. RESULTS: After the different thermocycling protocols, no differences in gap widths and demineralization depths were found (P > 0.05). After SM incubation, gap widths and demineralization depths were significantly dependent on SM incubation time and previous number of thermocycles (P < 0.05). Lactic acid formations of SM were detectable by Clinpro Cario Diagnosis at dentin cavosurface margins formed after 6 weeks of incubation with SM (P < 0.05).