Effects of staining and bleaching procedures on the optical and surface properties of CAD-CAM materials.

PURPOSE: To examine the effects of coffee staining and bleaching applications on the optical properties of CAD-CAM blocks, and to provide a three-dimensional visualization of surface changes with atomic force microscope (AFM). METHODS: 80 samples were prepared from four different CAD-CAM blocks: [Cerec (CR), Shofu (SH), Cerasmart (CRS), Lava Ultimate (LU)], and a microhybrid composite resin [Filtek Z250 (Z250)]. After staining, the samples were divided into two subgroups according to bleaching methods: 16% carbamide peroxide (HB), and 40% hydrogen peroxide (OB). Color measurements were performed at baseline (t0), after staining (t1), and after bleaching (t2) to obtain translucency parameters (TP00), color change (ΔE00), and whiteness index (WID) values. Surface roughness analysis (Ra) was performed with AFM after coffee staining and bleaching procedures (at t1 and t2). Data were analyzed with Generalized Linear Model, and Bonferroni correction (P< 0.05). RESULTS: TP00 values increased only in the CRS group after the bleaching application, and the effect of method was again observed only in CRS. While bleaching increased WID values of all groups except CRS, no difference was found between bleaching methods. Regardless of evaluation time, the roughest group is Z250, and the only difference between bleaching methods was observed in the CR group. In conclusion, the effects of staining and bleaching applications on the optical and surface properties of CAD-CAM blocks are material-dependent. CLINICAL SIGNIFICANCE: Effective bleaching of discolored CAD-CAM materials was achieved regardless of the bleaching method used, and without any significant adverse effect on the surface properties of the materials.

The effects of different cavity disinfectants on fracture resistance of tooth fragment reattachments.

Purpose: This study was conducted to investigate the fracture strength of reattached tooth fragments after different cavity disinfection protocols. Materials and methods: Incisal edges of 144 bovine incisors were sectioned and then randomly divided into 4 different groups as follows: Group C: no disinfectant; Group NaOCl: 2.5% sodium hypochlorite solution; Group NaOCl+Asc: 2.5% sodium hypochlorite followed by 10% ascorbic acid solution; Group CHX: 2% chlorhexidine solution. Teeth were further divided into 3 subgroups according to universal adhesive (G-Premio Bond, Scotchbond Universal, Prime and Bond Universal). Fracture resistance was evaluated using a universal testing machine. Data was analyzed using 2-way ANOVA with Bonferroni tests. Results: Cavity disinfectant had a statistically significant effect on bond strength (p<0.05), with the highest bond strength detected in the NaOCl+Asc Group (148.22 ± 51.64) and the lowest in the NaOCl Group (112.84 ± 43.12). Scotchbond Universal exhibited the highest bond strength values (163.59 ± 49.94); however, there were no significant differences between the other adhesive systems (p> 0.05). Conclusion: Application of ascorbic acid following sodium hypochlorite treatment can improve dentin bond strength.

Clinical evaluation of a low-shrinkage resin composite in endodontically treated premolars: 3-year follow-up.

OBJECTIVES: This study compared the 3-year clinical performance of a low-shrinkage silorane-based composite material with that of a methacrylate-based composite material in the restoration of endodontically treated premolar teeth. MATERIALS AND METHODS: A total of 70 patients requiring a Class II composite-resin restoration of a premolar tooth following root-canal treatment participated in the study. Cavities were restored with either a silorane-based restorative (Filtek Silorane + Silorane System Adhesive) or a methacrylate-based restorative (Filtek Z250 + Clearfil SE Bond) system applied according to the manufacturer's instructions. Restorations were evaluated by two blinded observers at five different time intervals (baseline; 6 months; 1, 2, and 3 years) according to modified USPHS criteria. Pearson's chi-square tests were used to examine differences in the clinical performance of the materials (retention, color match, marginal discoloration, secondary caries, anatomical form, marginal adaptation, and surface roughness), and Friedman and Wilcoxon tests were used to compare changes between baseline and each recall time, with a level of 0.05 considered statistically significant. RESULTS: After 3 years, no statistically significant differences in clinical performance were observed between the two materials (p > 0.05). Intra-system comparisons revealed a statistically significant deterioration in color match, marginal discoloration, anatomical form, marginal adaptation, and surface roughness scores after 3 years for both systems. Although the difference was not significant at 3 years of follow-up, the level of deterioration in marginal adaptation and surface roughness was greater for the Filtek Silorane restoration than for the Filtek Z250 restoration at the 1 year follow-up (p > 0.05). CONCLUSION: Restorations of both materials were clinically acceptable after 3 years. The Filtek Silorane system did not appear to offer any clinical advantages over the methacrylate-based system when used in the restoration of Class II cavities in endodontically treated premolars. CLINICAL RELEVANCE: The restoration of endodontically treated premolars with minor or moderate loss of tooth structure can be directly performed either with silorane or methacrylate-based composite resins.

Water sorption and solubility of bulk-fill composites polymerized with a third generation LED LCU.

The aim of this study was to compare the degree of water sorption and solubility in bulk-fills after curing with a polywave light source. A total of 120 disc-shaped specimens (8 mm diameter; 4 mm depth) were prepared from three regular bulk-fill materials (X-tra Fil, Tetric N-Ceram Bulk Fill, SonicFill), and a control material (Filtek Z250), cured in 3 different modes (standard: 1000 mW/cm2-20 s; high power: 1400 mW/cm2-12 s; xtra power: 3200 mW/cm2-6 s) using a third generation light-emitting diode light curing unit. Water sorption and solubility levels of the specimens were measured according to the ISO 4049:2009 specification after storing in distilled water for 30 days. Data were analyzed using two-way ANOVA and Tukey's post-hoc test (p < 0.05). The Z250 sample exposed to high power presented a higher sorption compared to the X-tra Fil and SonicFill samples. In xtra power mode, the values of Z250 and SonicFill were similar to each other and higher compared to those of X-tra Fil. Only SonicFill exhibited significantly different sorption values depending on the curing mode, the highest of which was achieved when using the xtra power mode. The highest solubility values were obtained for SonicFill. No statistically significant differences were found among other groups. No significant correlation was detected between water sorption and solubility. The traditional composite group exhibited a higher water sorption values than the bulk-fills. The reduction in polymerization time significantly increased the sorption of SonicFill. SonicFill showed the highest water solubility value among the composites tested.

Water sorption and solubility of bulk-fill composites polymerized with a third generation LED LCU

Abstract The aim of this study was to compare the degree of water sorption and solubility in bulk-fills after curing with a polywave light source. A total of 120 disc-shaped specimens (8 mm diameter; 4 mm depth) were prepared from three regular bulk-fill materials (X-tra Fil, Tetric N-Ceram Bulk Fill, SonicFill), and a control material (Filtek Z250), cured in 3 different modes (standard: 1000 mW/cm2-20 s; high power: 1400 mW/cm2-12 s; xtra power: 3200 mW/cm2-6 s) using a third generation light-emitting diode light curing unit. Water sorption and solubility levels of the specimens were measured according to the ISO 4049:2009 specification after storing in distilled water for 30 days. Data were analyzed using two-way ANOVA and Tukey's post-hoc test (p < 0.05). The Z250 sample exposed to high power presented a higher sorption compared to the X-tra Fil and SonicFill samples. In xtra power mode, the values of Z250 and SonicFill were similar to each other and higher compared to those of X-tra Fil. Only SonicFill exhibited significantly different sorption values depending on the curing mode, the highest of which was achieved when using the xtra power mode. The highest solubility values were obtained for SonicFill. No statistically significant differences were found among other groups. No significant correlation was detected between water sorption and solubility. The traditional composite group exhibited a higher water sorption values than the bulk-fills. The reduction in polymerization time significantly increased the sorption of SonicFill. SonicFill showed the highest water solubility value among the composites tested.

Effect of a third-generation LED LCU on microhardness of tooth-colored restorative materials.

OBJECTIVE: To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials. DESIGN: A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05). RESULTS: The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05). CONCLUSION: Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials.

Effect of propolis as a root canal irrigant on bond strength to dentin.

PURPOSE: The purpose of this in vitro study was to evaluate the effect of propolis on bond strength to dentin of a self-etch adhesive when used as a final irrigant. METHODS: 126 human third molars were sectioned 3 mm below the occlusal level and then randomly divided into 7 groups (n = 18). The exposed dentin surfaces were treated with irrigation solutions as follows: Group 1: 5.25% NaOCl; Group 2: 5.25% NaOCl followed by 17% EDTA; Group 3: 5.25% NaOCl followed by Tubulicid Plus (Temrex, Freeport, NY, USA); Group 4: 5.25% NaOCl followed by MTAD; Group 5: 5.25% NaOCl followed by 20% propolis; Group 6: 5.25% NaOCl followed by 2% CHX; Group 7: distilled water (control). Irrigated specimens were bonded using Clearfil SE Bond (Kuraray, Osaka, Japan) with Tygon (Saint-Gobain, Saint-Gobain Performance Plastics, France), tubes for microshear bond strength testing. Data was analyzed using a one-way ANOVA and Tukey test. RESULTS: Among the tested groups, although the lowest bond strength values were detected in Group 1 (11.25 ± 1.97), a significant statistical difference was detected only between this group and Group 4 (18.70 ± 1.82) and Group 5 (16.75 ± 3.70) (p = 0.0012). CONCLUSIONS: 20% propolis solution as a final irrigant was found to have a favorable effect on the dentin bond strength of the tested self-etch adhesive to coronal dentin when compared with other irrigation solutions.

Water Sorption, Solubility, and Color Stability of Giomer Restoratives.

OBJECTIVES: This study compared the color stability, water sorption, and solubility of a giomer composite and two nanohybrid composite resins. MATERIALS AND METHODS: Disc-shaped specimens (1-mm thickness × 15-mm diameter) of a giomer (Beautifil II, Shofu, Kyoto, Japan) and two nanohybrid (Filtek Z550, 3M ESPE, St. Paul, MN, USA; Tetric N-Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) composites (N = 10) were prepared. Baseline color measurements were taken, and specimens were immersed in water for 28 days. Following immersion, color values were remeasured, and color-change values (ΔE) were calculated. Water sorption and solubility were assessed by mass gain or loss after storage in water for 28 days. Data were analyzed with one-way analysis of variance and Tukey's post-hoc tests (p = 0.05). Pearson's correlation test was used to assess possible correlations between water sorption and solubility, water sorption and color stability, and solubility and color stability (p = 0.05). RESULTS: Water sorbtion (%) and color change (ΔE) varied significantly among groups, with Beautifil II exhibiting the highest values (p < 0.001). No statistically significant differences were observed in water solubility values among the groups (p = 0.661); however, a linear, positive correlation was detected between solubility and discoloration (r = 0.368, p = 0.046). CONCLUSION: Water sorption and discoloration values of the giomer composite group were significantly higher than those of the nanohybrids tested. CLINICAL SIGNIFICANCE: The high levels of water sorption and discoloration of giomer composites are likely to have an adverse effect on esthetic restorations.

Does the light source affect the repairability of composite resins?

The aim of this study was to examine the effect of the light source on the microshear bond strength of different composite resins repaired with the same substrate. Thirty cylindrical specimens of each composite resin--Filtek Silorane, Filtek Z550 (3M ESPE), Gradia Direct Anterior (GC), and Aelite Posterior (BISCO)--were prepared and light-cured with a QTH light curing unit (LCU). The specimens were aged by thermal cycling and divided into three subgroups according to the light source used--QTH, LED, or PAC (n = 10). They were repaired with the same substrate and a Clearfil Repair Kit (Kuraray). The specimens were light-cured and aged for 1 week in distilled water at 37 °C. The microshear bond strength and failure modes were assessed. There was no significant difference in the microshear bond strength values among the composite resins, except for the Filtek Silorane group that showed significantly lower bond strength values when polymerized with the PAC unit compared to the QTH or LED unit. In conclusion, previously placed dimethacrylate-based composites can be repaired with different light sources; however, if the composite to be repaired is silorane-based, then using a QTH or LED device may be the best option.

Bond strengths of silorane- and methacrylate-based composites to various underlying materials.

OBJECTIVE: To evaluate shear bond strength (SBS) values of a methacrylate (FZ 250) and a silorane-based (FS) resin composite to various underlying materials. MATERIALS AND METHODS: A total of 80 samples were prepared with four different underlying materials; a flowable (FLC) and a bulk-fill flowable composite (BFC), and a conventional (CGIC) and resin modified glass-ionomer cement (RMGIC). These underlying materials were laminated plus to methacrylate or silorane-based resin composites (n = 10). To evaluate the specimens SBS values were evaluated with a universal testing machine (cross-head speed; 1.0 mm/min). Statistical comparisons were carried out using two-way ANOVA and Tukey's post hoc test with a significance level of P < 0.05. RESULTS: SBS values for FZ250 were significantly higher than for FS for all of the underlying materials tested (P < 0.05). SBS values of FZ250 to BFC were significantly higher than to all other materials (P < 0.05), whereas SBS values of FS did not vary significantly according to underlying material (P > 0.05). CONCLUSION: The use of FS in conjunction with any of the tested materials showed lower SBS than the FZ 250. Also, new low elastic modulus liner BFC presented slightly good interfacial adhesion so, the usage of BFC as an underlying material may be preferable for FZ 250.

Effect of sodium ascorbate on the bond strength of silorane and methacrylate composites after vital bleaching.

We investigated the effect of sodium ascorbate (SA) on the microtensile bond strengths (MTBSs) of different composites to bovine enamel after vital bleaching with hydrogen peroxide (HP) or carbamide peroxide (CP). Thirty bovine incisors were randomly divided into five groups and treated with no bleaching application (control), 35% HP alone, 35% HP+10% SA for 10 minutes (HP+SA), 16% CP alone, or 16% CP+10% SA for 10 minutes (CP+SA). Specimens were restored with Silorane adhesive and Filtek Silorane composite (designated as S/group) or with Clearfil SE bond and Filtek Supreme XT (designated as F/group). Composite build-up was created on the enamel. Sectioned specimens (n=10 per group; 1 mm2; cross-sectional area) were created and stressed in a universal testing machine at 1 mm/min crosshead speed. The application of 10% SA immediately after bleaching with 16% CP or 35% HP increased the enamel MTBS, regardless of the adhesive/composite resin used. The resulting MTBS values were similar to those of the control groups. Use of 16% CP and 35% HP alone decreased the enamel MTBS, regardless of the adhesive/composite resin used, with F/CP+SA=F/HP+SA=F/CP=S/CP+SA=S/HP+SA=S/C>S/CP=S/HP=F/CP=F/HP (p<0.05). We concluded that the application of SA for 10 minutes immediately after vital bleaching increases the enamel BS for dimethacrylate- and silorane-based composites.

Endodontic treatment of a taurodontic premolar with five canals.

Taurodontism is a morpho-anatomical abnormality in the shape of a tooth. An enlarged pulp chamber, apical displacement of the pulpal floor and no constriction at the level of the cemento-enamel junction are the characteristic features. Special care is required in all aspects of endodontic treatment of a taurodontal tooth, including identifying the orifice, canal exploration, cleaning, shaping and obturation of the root canal. This case report describes the successful endodontic treatment of a taurodontic mandibular second premolar with five root canals.

Effect of sodium ascorbate on the bond strength of silorane and methacrylate composites after vital bleaching

We investigated the effect of sodium ascorbate (SA) on the microtensile bond strengths (MTBSs) of different composites to bovine enamel after vital bleaching with hydrogen peroxide (HP) or carbamide peroxide (CP). Thirty bovine incisors were randomly divided into five groups and treated with no bleaching application (control), 35% HP alone, 35% HP + 10% SA for 10 minutes (HP + SA), 16% CP alone, or 16% CP + 10% SA for 10 minutes (CP + SA). Specimens were restored with Silorane adhesive and Filtek Silorane composite (designated as S / group) or with Clearfil SE bond and Filtek Supreme XT (designated as F / group). Composite build-up was created on the enamel. Sectioned specimens (n = 10 per group; 1 mm2; cross-sectional area) were created and stressed in a universal testing machine at 1 mm/min crosshead speed. The application of 10% SA immediately after bleaching with 16% CP or 35% HP increased the enamel MTBS, regardless of the adhesive / composite resin used. The resulting MTBS values were similar to those of the control groups. Use of 16% CP and 35% HP alone decreased the enamel MTBS, regardless of the adhesive / composite resin used, with F / CP + SA = F / HP + SA = F / CP = S / CP + SA = S / HP + SA = S / C > S / CP = S / HP = F / CP = F / HP (p < 0.05). We concluded that the application of SA for 10 minutes immediately after vital bleaching increases the enamel BS for dimethacrylate- and silorane-based composites.

The effects of finishing and polishing techniques on surface roughness and color stability of nanocomposites.

OBJECTIVES: The aim of this in vitro study was to evaluate the effects of different finishing and polishing techniques on the surface roughness and color stability of nanocomposites. METHODS: Two nanohybrid (Grandio, Aelite Aesthetic Enamel), two nanofill (Filtek Supreme XT Dentin and Translucent), and a microhybrid (Filtek Z250) composites were used. Two hundred and eighty disc-shaped specimens were cured under a mylar strip. Seven specimens of each resin composite were randomly assigned to one of the seven polishing systems. A profilometer was used for assessing surface roughness. ΔE was calculated with a colorimeter at baseline and 48 h after storage in a coffee solution. The results were analysed by two-way ANOVA and Tukey's HSD test (α=0.05). Regression analysis was used to examine the correlation between surface roughness and color stability (α=0.01). RESULTS: There was no significant difference in R(a) values between mylar strips and Sof-Lex polishing discs (p>0.05). The highest ΔE and R(a) values were obtained from Grandio (p<0.05), and Aelite Aesthetic Enamel had the lowest ΔE values (p<0.05). The Enhance system showed the lowest color differences among all the finishing systems. The highest ΔE values were found in the composite resin groups under mylar strips and finished with diamond burs (p<0.05). CONCLUSIONS: While the Sof-Lex discs provided the lowest surface roughness, the Enhance Polishing system provided the most stain-resistant groups. Grandio presented the highest surface roughness and staining susceptibility after storage in coffee solution. Aelite Aesthetic Enamel, which did not include TEGDMA in its composition, showed the least discoloration. CLINICAL SIGNIFICANCE: The composites with smaller filler size did not necessarily show low surface roughness and discoloration. Staining of composite resins was dependent on monomer structure, as well as surface irregularities.

Deformation and fracture of Mtwo rotary nickel-titanium instruments after clinical use.

INTRODUCTION: In recent years, a number of rotary nickel titanium (NiTi) systems have been developed to provide better, faster, and easier cleaning and shaping of the root canal system. Although the NiTi instruments are more flexible than the stainless steel files, the main problem with the rotary NiTi instruments is the failure of the instruments. The aim of this study was to evaluate the deformation and fracture rate of Mtwo rotary nickel-titanium instruments (VDW, Munich, Germany) discarded after routine clinical use. METHODS: A total of 593 Mtwo rotary NiTi instruments were collected after clinical use from the clinic of endodontics over 12 months. The length of the files was measured using a digital caliper to determine any fracture, and then all the files were evaluated under a stereomicroscope for defects such as unwinding, curving, or bending and fracture. The fracture faces of separated files were also evaluated under a scanning electron microscope. The data were analyzed using a chi-square and z test. RESULTS: A percentage of all files (25.80%) showed defects, and the major defect was fracture (16.02%). The most frequently fractured file was #10.04 (30.39%). Deformations without fracture were mostly observed on #15.05 files (25.47%). CONCLUSIONS: A higher rate of deformation was observed for #10.04 and #15.05 files. Therefore, these files should be considered as single-use instruments. Because cyclic fatigue was the cause of 71.58% of the instrument fractures, it is also important not to exceed the maximum number of usage recommended by the manufacturer and discard the instruments on a regular basis.