Compressive modulus, translucency, and irradiance transmittance of clear PVS materials used for resin injection molding technique.

OBJECTIVES: To evaluate the compressive modulus, translucency, and light curing irradiance transmittance of four clear polyvinyl siloxane (PVS) materials used for the injection molding technique at varying thicknesses, and to assess the correlation between color parameters and irradiance transmittance. MATERIALS AND METHODS: Four clear PVS materials (Exaclear, Clear Bite Matrix, Affinity Crystal, and Memosil 2) were used in this study. Compressive modulus was measured by compressing cylindrical PVS specimens (n = 9; d = 10 mm; t = 6 mm) up to 30% strain using a universal testing machine. For the translucency analysis and irradiance transmittance, specimens (n = 5) were fabricated with five different thicknesses (d = 12 mm and t = 2, 4, 6, 8 and 10 mm). The L*, a, *b* values of specimens were obtained using a CIELab spectrophotometer (CMD-700, Konica Minolta) with calibrated white and black tiles; the translucency parameter was calculated. The same specimens were placed onto a spectrophotometer (MARC Light Collector) to measure irradiance transmitted through the specimens from a light curing unit (Valo Corded, Ultradent). Data were analyzed using analysis of variance (ANOVA) with Tukey post hoc test and the correlation between translucency and irradiance transmittance of materials for each thickness was evaluated using Pearson's correlation. RESULTS: Compressive modulus differences in PVS materials were significant (one-way ANOVA: df = 3, F = 76.27, p < 0.001); Affinity and Memosil 2 were highest with no significant difference between them (Tukey: t = -1.62; p = 0.382). Clear Bite was higher than Exaclear (Tukey: t = -3.70; p = 0.004). Exaclear was lowest. Translucency decreased with thickness (Two-way ANOVA: df = 3, F = 586.53, p < 0.001; thickness: df = 4, F = 1389.34, p < 0.001). Exaclear was most translucent at all thicknesses. L*, a*, b* values varied by material and thickness (L*: df = 3, F = 1213.32, p < 0.001; a*: df = 3, F = 10766.8, p < 0.001; b*: df = 3, F = 3260.42, p < 0.001). Memosil 2 had lowest b* values. Irradiance transmittance was affected by material and thickness (Two-way ANOVA: df = 4, F = 2388.86, p < 0.001). Exaclear had highest irradiance transmission, surpassing control at >6 mm. Violet/blue irradiance ratio decreased with thickness; Exaclear maintained a constant ratio, indicating preserved violet irradiance. There was a strong positive correlation between translucency and light irradiance (Pearson's r = 0.97, R2 = 0.86-0.96). Radiant exposure analysis suggests adjusting the curing time based on PVS thickness for optimal exposure (10 J/cm2) is achievable within 13-14 s for <2 mm and 21-30 s for 8-10 mm with Clear Bite, Affinity, and Memosil 2; whereas Exaclear requires less time. CONCLUSIONS: Compressive modulus in clear PVS materials varied by type; Affinity and Memosil 2 demonstrate higher modulus, offering more stability of the clear mold. Translucency and irradiance transmission through clear PVS materials decreased as their thickness increased, yet Exaclear exceled in maintaining high translucency and superior light transmission capabilities. Additionally, there is a strong positive linear correlation between translucency and light irradiance transmittance, offering a method to adjust curing times effectively based on material translucency. CLINICAL SIGNIFICANCE: The light curing time to adequately polymerize composite through clear impression material may need to be increased, particularly with thicker matrices or less translucent materials.

The Effect of Die Material on the Crown Fracture Strength of Zirconia Crowns.

BACKGROUND: Determination of the eligibility of several tooth analog materials for use in crown fracture testing. METHODS: A standardized premolar crown preparation was replicated into three types of resin dies (C&B, low modulus 3D printed resin; OnX, high modulus 3D printed resin composite; and highest modulus milled resin composite). 0.8 mm zirconia crowns were bonded to the dies and the maximum fracture load of the crowns was tested. Twelve extracted human premolars were prepared to a standardized crown preparation, and duplicate dies of the prepared teeth were 3D printed out of C&B. Zirconia crowns were bonded to both the dies and natural teeth, and their fracture load was tested. RESULTS: There was no statistical difference between the fracture load of zirconia crowns bonded to standardized dies of C&B (1084.5 ± 134.2 N), OnX (1112.7 ± 109.8 N) or Lava Ultimate (1137.5 ± 88.7 N) (p = 0.580). There was no statistical difference between the fracture load of crowns bonded to dentin dies (1313 ± 240 N) and a 3D-printed resin die (C&B, 1156 ± 163 N) (p = 0.618). CONCLUSIONS: There was no difference in the static fracture load of zirconia crowns bonded to standardized resin dies with different moduli or between a low modulus resin die and natural dentin die.

The Effect of Restoration Thickness on the Fracture Resistance of 5 mol% Yttria-Containing Zirconia Crowns.

BACKGROUND: To determine what thickness of 5 mol% yttria zirconia (5Y-Z) translucent crowns cemented with different cements and surface treatments would have equivalent fracture resistance as 3 mol% yttria (3Y-Z) crowns. METHODS: The study included 0.8 mm, 1.0 mm, and 1.2 mm thickness 5Y-Z (Katana UTML) crowns and 0.5 and 1.0 mm thickness 3Y-Z (Katana HT) crowns as controls. The 5Y-Z crowns were divided among three treatment subgroups (n = 10/subgroup): (1) cemented using RMGIC (Rely X Luting Cement), (2) alumina particle-abraded then luted with the same cement, (3) alumina particle-abraded and cemented using a resin cement (Panavia SA Cement Universal). The 3Y-Z controls were alumina particle-abraded then cemented with RMGIC. The specimens were then loaded in compression at 30° until failure. RESULTS: All 5Y-Z crowns (regardless of thickness or surface treatment) had a similar to or higher fracture force than the 0.5 mm 3Y-Z crowns. Only the 1.2 mm 5Y-Z crowns with resin cement showed significantly similar fracture force to the 1 mm 3Y-Z crowns. CONCLUSION: In order to achieve a similar fracture resistance to 0.5 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns may be as thin as 0.8 mm. To achieve a similar fracture resistance to 1.0 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns must be 1.2 mm and bonded with resin cement.

Wear of lithium disilicate opposed by various ceramic materials.

OBJECTIVES: To compare volumetric wear of lithium disilicate against different ceramic (3 mol% yttria-stabilized (3Y) zirconia, 5 mol% yttria-stabilized (5Y) zirconia, lithium disilicate, porcelain and enamel antagonists). MATERIALS AND METHODS: Forty lithium disilicate (e.max CAD) specimens (n = 8/antagonist) were wet sanded to 1200grit SiC and mounted into a UAB wear device. Antagonist spheres (diameter = 4.75 mm) were made from polished 3Y zirconia, 5Y zirconia, lithium disilicate, porcelain and human enamel. A two-body wear test was performed with 20 N load and 1.5 mm slide for 400,000 cycles at 1 Hz. 33% glycerin was used as a lubricant. Wear facets were measured with optical profilometry. Wear scar areas of antagonists were measured with digital microscopy. Scanning electron microscopy was performed on wear facets and scars. Vicker's microhardness was measured of all antagonist materials. All data were compared with 1-way ANOVA and Tukey post-hoc analysis. RESULTS: Significant differences in lithium disilicate volumetric wear (mm3 ) occurred with various antagonist materials: 0.38 ± 0.01a (3Y zirconia), 0.33 ± 0.01b, (5Y zirconia), 0.16 ± 0.01c (lithium disilicate), 0.11 ± 0.03d, (enamel), and 0.07 ± 0.01e (porcelain). The lithium disilicate antagonist demonstrated a larger wear scar than other materials. Zirconia was the hardest material and enamel the least hard. CONCLUSIONS: Zirconia causes significant wear on lithium disilicate and lithium disilicate causes significant wear against itself. CLINICAL SIGNIFICANCE: When selecting a material to oppose an existing lithium disilicate crown, a porcelain or lithium disilicate surface would cause significantly less wear to the existing crown. If an existing zirconia crown exists opposed to a prepared tooth, lithium disilicate may not be an ideal material selection to restore the tooth.

Characterization of materials used for 3D printing dental crowns and hybrid prostheses.

OBJECTIVES: To compare the filler weight percentage (wt%), filler and resin composition, flexural strength, modulus, and hardness of several 3D-printed resins to direct and indirect restorative materials. MATERIALS AND METHODS: Four 3D-printed resins (C&B MFH, Ceramic Crown, OnX, and OnX Tough), one milled resin composite (Lava Ultimate), one conventional composite (Filtek Supreme), and one ceramic (IPS e.max CAD) were evaluated. Filler wt% was determined by the burned ash technique, and filler particle morphology and composition were analyzed by scanning electron microscopy and energy-dispersive spectroscopy, respectively. Organic resin composition was analyzed by Fourier transform infrared spectroscopy. Three-point bend flexural strength and modulus of the materials were determined by ISO 4049 or ISO 6872. Vickers microhardness was measured. Data were compared with a one-way analysis of variance (ANOVA) and Tukey post hoc analysis. Linear regression analysis was performed for filler wt% versus flexural strength, modulus, and hardness. RESULTS: 3D-printed resins were composed of various sized and shaped silica fillers and various types of methacrylate resins. Significant differences were found among filler wt% with some materials around 3% (C&B MFH), others between 33% and 38% (OnX Tough and OnX), others around 50% (Ceramic Crown), and some around 72% (Filtek Supreme and Lava Ultimate). All 3D-printed resins had significantly lower flexural strength, modulus, and hardness than the conventional and milled resin composites and ceramic material (p < 0.001). Filler wt% demonstrated a linear relationship with modulus (p = 0.013, R2 = 0.821) and hardness (p = 0.018, R2 = 0.787) but not flexural strength (p = 0.056, R2 = 0.551). CONCLUSIONS: 3D-printed resins contain from 3% to 50% filler content. Filler wt% alone does not affect flexural strength, but strength may be affected by resin composition as well. Although the 3D-printed resins had lower flexural strength, modulus, and hardness than milled and conventional composite and ceramic, they demonstrated nonbrittle plastic behavior. CLINICAL SIGNIFICANCE: The properties of 3D-printed resins vary based on their composition, which affects their clinical applications.

Bond Strength of Reline Materials to 3D-Printed Provisional Crown Resins.

(1) Purpose: The aim of the present study was to compare the bond strength between two 3D-printed resins designed for long-term provisional crowns and three different reline materials. (2) Materials and Methods: Rectangular specimens were prepared from two 3D-printed resins (Envision Tech and NextDent C&B) and a conventional self-cure PMMA. Transparent tubes filled with three different reline materials including composite resin, Bis-acryl, and PMMA were bonded to the 3D-printed specimens (n = 11 per group, total of 6 study groups). Tubes filled with PMMA were bonded to the prepared PMMA specimens which served as the control group (n = 11, control group). The specimens were subjected to a shear bond strength (SBS) test, and mode of failure was recorded using light microscopy. Statistical analysis was performed using a one-way ANOVA and post hoc Tukey's tests (alpha = 0.05). (3) Results: The highest SBS value was achieved to both 3D-printed materials with the PMMA reline material. The bond to both 3D-printed materials was lower with Bis-acrylic or composite resin relines in comparison to that with PMMA (p-value < 0.05). No significant difference was found between the control PMMA group and either 3D-printed material when relined with PMMA (p-value > 0.05). (4) Conclusion: The tested 3D-printed resins achieved a clinically acceptable bond strength when relined with PMMA.

Fracture resistance of zirconia surveyed crowns with four different occlusal rest seat designs.

PURPOSE: To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. MATERIALS AND METHODS: Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1 Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. RESULTS: The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). CONCLUSIONS: Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.

Chemical and Physical Properties of Contemporary Pulp Capping Materials.

Purpose: The purpose of this study was to compare the chemical and physical properties of eight contemporary direct pulp capping materials. Methods: Materials included: calcium hydroxide-based (Dycal®, Lime-LiteTM, and Ultra-BlendTM plus), bioceramic-based (MTA Angelus®, Biodentine®, TheraCal LC®, Ceramir® Protect LC), and resin ionomer-based materials (Bio-Cap®). Calcium release and pH changes were measured after one, seven, 28, and 90 days in 36.8 degrees Celsius of deionized water. Water sorption and solubility were calculated with weight loss after 90 days. Results: Biodentine® (965.5 ppm) and MTA Angelus® (921.2 ppm) released significantly more cumulative calcium ions (P<0.05), followed by Ceramir® Protect LC (450.8 ppm) and Dycal® (268.1 ppm); Lime-LiteTM had the least amount of calcium ions. After 90 days, Biodentine® and MTA Angelus® showed significantly higher pH (P<0.05), while Bio-Cap® and Lime-LiteTM had limited effects in raising the pH to alkaline. Dycal® presented the most weight loss (26 percent, P<0.05) after 90 days. Conclusions: Biodentine® and MTA Angelus® demonstrated more favorable in vitro characteristics for clinical pulp capping purposes, while Lime-LiteTM had no effect in releasing calcium ions and limited influence in raising pH value.

Preventing Porcelain Fractures During Endodontic Treatment.

Attempting endodontic access through ceramic or veneering porcelain can be wrought with challenges. Clinicians must take every precaution to assist patients who are in pain without causing harm through chipping or fracturing the restoration. This article discusses strategies clinicians can consider when facing the task of achieving endodontic access through an all-ceramic crown.

Fracture strength of zirconia and lithium disilicate restorations following endodontic access.

OBJECTIVES: To compare the fracture load of zirconia and lithium disilicate crowns prepared with endodontic access with fine and coarse diamond instruments. MATERIALS AND METHODS: 0.8 mm (3Y zirconia) or 1 mm (lithium disilicate) crowns were luted to resin composite dies with resin-modified glass ionomer (zirconia) or self-adhesive resin (lithium disilicate) cement. A 2.5 mm endodontic access hole was placed in each crown with fine (8369DF.31.025FOOTBALL) or coarse (6379 DC.31.023FOOTBALL) diamond instruments and restored with composite. A control group was prepared without access holes. Crowns were thermocycled for 10,000 cycles (5-55°C) and tested in compression with a steel indenter until failure (n = 8/group). A one-way ANOVA and Dunnett 2-sided test (alpha = 0.05) compared differences in fracture load between groups. RESULTS: For zirconia, there was no statistical difference between the control group (2335 ± 160 N) and coarse diamond group (2345 ± 246 N); however, the fine diamond group (2077 ± 216 N) was significantly lower. For lithium disilicate, there was no statistical difference between the control group (2113 ± 183 N) and the fine (2049 ± 105 N) or coarse (2240 ± 118 N) groups. CONCLUSIONS: 3Y zirconia crowns became weaker when accessed with a fine diamond instrument. There was no negative effect of the endodontic access with bonded lithium disilicate crowns. CLINICAL SIGNIFICANCE: Conservative endodontic access openings in high-strength ceramic restorations do not have a negative effect on their static fracture load. The coarse zirconia-cutting diamond rotary instrument is more efficient and has a less detrimental effect on the strength of the crowns than a fine diamond rotary instrument.

Methods to Clean Residual Resin Cement from Lithium-Disilicate Glass-Ceramic.

PURPOSE: To compare the effect of different methods of cleaning residual composite cement from the surface of lithium-disilicate glass-ceramic on its bond strength. MATERIALS AND METHODS: Blocks of lithium-silicate glass-ceramic (e.max CAD) were coated with composite cement. Blocks in a positive control (CO+) group received no cement; negative controls (CO-) received composite cement. After water storage (24 h), specimens were cleaned as follows (n = 20/group): BUR: grinding with a fine-grit diamond bur (20 s); ALUM: air abrasion with 50-µm alumina (10 s); GLASS: air abrasion with 50-µm glass beads (10 s); FURN: firing in ceramic furnace and cleaning with ethanol; SULF: immersion in sulfonic acid solution (1 h); HYFL: no additional treatment. All specimens were etched with hydrofluoric acid, aside from the CO- group, and treated with silane. A 1.5-mm diameter cement-filled tube was affixed to the specimens and light polymerized. Specimens were stored in 37°C water for 24 h (n = 10) or 90 days (n = 10). Shear bond strength was tested. Two-way ANOVA and post-hoc Tukey tests were performed. Specimens from each group were examined with SEM. RESULTS: Bond strength significantly differed according to surface cleaning method (p < 0.01) and storage time (p < 0.01), but their interaction was not significant (p = 0.264). Longer storage time decreased the bond strength. BUR, ALUM, GLASS, and FURN did not differ statistically significantly from CO+, but were significantly greater than CO-. SULF and HYFL did not differ statistically significantly from CO- and were significantly lower than CO+. CONCLUSIONS: Cleaning composite cement with BUR, ALUM, GLASS, and FURN restored bond strengths to that of the positive control. However, only GLASS and FURN did not roughen the surface of the underlying lithium-silicate glass-ceramic.

In vitro comparison of wear of three orthodontic bite materials and opposing enamel.

OBJECTIVE: Orthodontic bite turbos are used to separate the maxillary and mandibular arch when disocclusion is needed for brackets placement or extrusion of teeth. Bite turbos should have adequate wear resistance to maintain disocclusion but also avoid abrasion of the opposing enamel. The objective of this study was to measure the wear of three materials used as bite turbos and opposing enamel wear. MATERIALS AND METHODS: 10mm×8mm×4mm specimens (n=8) of Transbond™LR (3M™) Transbond™ Plus (3M™) and Triad®gel (Dentsply) were prepared in silicone molds. Cusps of extracted premolars were prepared to a standard cone shape. Extracted maxillary incisors were used as reference for flat enamel surfaces. The experiments were performed on the modified UAB wear testing device at 20N for 200,000 cycles at 1Hz. All surfaces were scanned with a non-contact profilometer at 10micron resolution. Volumetric wear was measured with superimposition software and data analysed with one-way ANOVA and Tukey post-hoc. RESULTS: Significant differences were seen in the wear of materials and opposing enamels (P<.01). Material wear ranked: Triad®gel (.878±.196mm3)>Transbond™ Plus (.317±.062mm3)>Transbond™ LR (.136±.027mm3)>Enamel (.053±.04mm3). Opposing enamel ranked: Transbond™ LR (.158±.086mm3)=Enamel (.128±.035mm3)=Transbond™ Plus (.126±.025mm3)>Triad®gel (.039±.008mm3). CONCLUSIONS: All bite turbo materials wore more than natural enamel but caused equal or less wear to opposing enamel than tooth-tooth contact. Triad®gel underwent 2.5× and 6× the wear of Transbond™ Plus and Transbond™ LR respectively. The bite turbo material used may be selected based on preference for longevity.

2021 Trends in Restorative Dentistry: Composites, Curing Lights, and Matrix Bands.

Composite materials remain a mainstay as a restorative option in dentistry. This article reviews some of the most recent updates and projected future trends in dental composites, along with curing lights and matrix systems.

In vitro inhibition of demineralization from bioglass-containing adhesive and composite.

PURPOSE: To measure and compare the area of inhibition around a bioglass-containing adhesive and resin-based composite following an in vitro artificial caries model in human extracted teeth. METHODS: Preparations were made at the CEJ of extracted human molars (40, n=10/material) and restored with combinations of a bioglass-containing adhesive (BA, Regen), a reference adhesive which served as a negative control (RA), a bioglass-containing composite (BC, Regen), and a reference composite which served as a negative control (RC): BABC, RABC, BARC, RARC. All materials were light-cured and then finished with a polishing disc. Teeth were incubated (37°C) for 24 hours in water. A demineralization solution composed of 0.1 M lactic acid, 3 mM Ca3(PO4)2, 0.1% thymol, and NaOH (to adjust pH= 4.5) and a remineralization solution composed of 1.5 mM Ca, 0.9 mM P, and 20 mM Tris(hydroxymethil)-aminomethane (pH= 7.0) were prepared. Specimens were placed in the demineralization solution for 4 hours followed by a remineralization solution for 20 hours and cycled daily for 30 days. The specimens were embedded, sectioned into 100 µm sections, and the interface between the adhesive/composite and root dentin margin was viewed with polarized light. A line was drawn parallel with the zone of demineralization for each tooth. The area of "inhibition" (defined as the area external to the line) or "wall lesion" (defined as the area internal to the line) was traced with internal image evaluation software and measured. Areas of inhibition were measured as positive values and areas of wall lesions were measured as negative values. RESULTS: A one-way ANOVA found significant differences between materials for "inhibition/wall lesion" areas in root dentin (P< 0.001). Tukey post-hoc analysis ranked materials (µm2, mean± SD): BABC (3590± 2847)a RABC (1903± 1025)a, BARC (-792± 850)b, RARC (-2544± 1760)b. CLINICAL SIGNIFICANCE: The use of bioglass-containing resin-based composite with or without a bioglass-containing adhesive demonstrated inhibition of demineralization at the restoration margin.

Zirconia restorations: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Zirconia is a relatively new dental material used for indirect dental restorations. Little is known about how dental practitioners are using this material in their practice. METHODS: A survey on zirconia restorations was developed and administered electronically through e-mail communications to the American Dental Association Clinical Evaluators (ACE) Panel on August 31, 2020. Reminders were sent to nonrespondents, and the survey closed 2 weeks after the launch date. RESULTS: When using zirconia for a restoration, respondents choose it to restore natural teeth (99%) more often than implants (76%). Almost all respondents (98%) use it for posterior crowns, whereas approximately two-thirds (61%) use it for anterior crowns. Restoration removal or replacement and shade matching and translucency were the top 2 cited disadvantages of zirconia, whereas most of the respondents (57%) cited flexural strength or fracture resistance as the biggest advantage. Fine diamonds and ceramic polishers are used most often to polish and adjust zirconia restorations, whereas coarse diamond rotary instruments and those made specifically for zirconia are most frequently used for removing these restorations. Compared with metal ceramic restorations, more than 50% of respondents experience debonding more often with zirconia restorations. CONCLUSIONS: Dentists recognize the favorable fracture resistance and flexural strength properties of zirconia, and most use similar techniques when adjusting and removing this material. Removing these restorations and shade matching are a struggle for many. PRACTICAL IMPLICATIONS: Dentists may benefit from tips on the best methods to remove, shade match, and adhesively bond zirconia restorations.

Probing the hierarchy of evidence to identify the best strategy for placing class II dental composite restorations using current materials.

OBJECTIVE: The objective of this review is to present a synopsis of the existing clinical and in vitro evidence regarding placement of direct class II restorations with dental composites of varying viscosities, focusing on the marginal integrity achievable. OVERVIEW: The literature on class II composites placed with various techniques was searched through PubMed, Scopus, and the citations of identified articles, focusing on aspects related to adaptation and clinical performance. Studies comparing layering of conventional composite to layering with a flowable liner, including the "snow plow technique," use of warmed composite, flowable bulk-fill liners with a conventional composite capping layer, and bulk-fill restorative in a single or incremental fill (including placement with sonic energy and dual-curing) CONCLUSIONS: In vitro and clinical evidence does not support any one specific method or material type for achieving optimal performance when restoring class II cavity preparations with current dental composites. CLINICAL SIGNIFICANCE: Although there are many available placement methods and types of composite materials on the market for use in class II restorations, the reasonable success presented in the clinical and laboratory literature for the various approaches suggests that the most important factor for achieving success is likely careful and proper placement and light-curing technique, independent of the approach.

Material Selection for Single-Unit Crown Anterior Restorations.

Lithium disilicate and layered zirconia appear to be the most prevalent materials used for single-unit anterior crowns. These materials offer the necessary mechanical properties as well as sufficient optical characteristics needed in this type of restoration. There now are also more translucent versions of zirconia available that can be used for monolithic anterior restorations. This article discusses the factors that clinicians must take into account when determining a restorative material for single-unit anterior crowns. Considerations for lithium-disilicate crowns, 4 and 5 mol% yttria-containing (4Y and 5Y) zirconia materials, and layered 3Y zirconia restorations are provided.

Bonding crowns and bridges with resin cement: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Bonding crowns and bridges with resin cement can improve retention and reinforcement of the restoration. However, there is variation in the steps taken by different practitioners to achieve this goal. METHODS: The authors developed a survey on bonding dental crowns and bridges with resin cement and distributed it electronically to the American Dental Association Clinical Evaluators (ACE) Panel on May 22, 2020. The survey remained open for 2 weeks. Descriptive data analysis was conducted using SAS Version 9.4. RESULTS: A total of 326 panelists responded to the survey, and 86% of respondents who place crowns or bridges use resin cements for bonding. When placing a lithium disilicate restoration, an almost equal proportion of respondents etch it with hydrofluoric acid in their office or asked the laboratory to do it for them, and more than two-thirds use a silane primer before bonding. For zirconia restorations, 70% reported their restorations are sandblasted in the laboratory, and 39% use a primer containing 10-methacryloyloxydecyl dihydrogen phosphate. One-half of respondents clean their lithium disilicate or zirconia restorations with a cleaning solution. Resin cements used with a primer in the etch-and-rinse mode are the most widely used. The technique used to cure and clean excess resin cement varies among respondents. CONCLUSIONS: The types of resin cements used, tooth preparation, crown or bridge preparation, and bonding technique vary among this sample. PRACTICAL IMPLICATIONS: Although many dentists bond crowns and bridges on the basis of best practices, improvement in the process may be achieved by dentists communicating with their laboratory to confirm the steps performed there, ensuring an effective cleaning technique is used after try-in and verifying that the correct primer is used with their chosen restorative material.

Inhibition of root dentin demineralization by ion releasing cements.

OBJECTIVES: To compare the ability of resin-modified glass ionomer (RMGI) and bioactive cements to prevent root dentin demineralization. MATERIALS AND METHODS: Fifty molars were prepared at the cementum-enamel junction (n = 10) and restored with three bioactive cements (Activa Bioactive Cement, ACT; Ceramir Crown and Bridge, CER; and Theracem, THE), a self-adhesive resin cement (Rely X Unicem 2, UNI), and a RMGI cement (Rely X Luting Plus, LUT). Specimens were cycled for 30 days between a demineralization solution (pH = 4) composed of 0.1 M lactic acid and 3 mM Ca3 (PO4 )2 for 4 hours and a remineralization solution (pH = 7.0) composed of 1.5 mM Ca, 0.9 mM P, and 20 mM Tris(hydroxymethyl)-aminomethane for 20 hours. Specimens were sectioned to 100 µm and evaluated with polarized light microscopy. A line was drawn parallel with the zone of demineralization for each tooth. The areas of "inhibition" (external to the line) were measured as positive values and "wall lesions" (pulpal to the line) were measured as negative areas. RESULTS: Significant differences were found between materials for "inhibition/wall lesion" areas in root dentin (P < .001) and ranked as (µm2 , mean ± SD): LUT (7700 ± 2500) > CER (3800 ± 1900), THE (2100 ± 2600), and ACT (1400 ± 700) > UNI (-2000 ± 1700). CONCLUSIONS: Bioactive cements showed net areas of demineralization inhibition albeit at a lower level than a reference RMGI cement. CLINICAL SIGNIFICANCE: RMGI or bioactive cements may be indicated for patients at risk of secondary caries around crown margins.

Dental light-curing units: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: The ability to polymerize light-activated dental materials with dental light-curing units (DLCUs) has revolutionized dentistry. However, proper DLCU use is essential for ensuring the effectiveness and performance of these materials. METHODS: The authors developed an electronic cross-sectional survey in the American Dental Association Qualtrics Research Core platform. The survey included questions about DLCU use, unit type and selection, training, maintenance, technique, and safety measures. The authors deployed the survey to 809 American Dental Association Clinical Evaluators (ACE) panelists on October 9, 2019, and sent reminder links to nonrespondents 1 week later. They conducted exploratory and descriptive analyses using SAS software Version 9.4. RESULTS: Of the 353 ACE panelists who completed the survey, most used a DLCU in their practices (99%), and light-emitting diode multiwave units were the most common type of DLCU units (55%). Dentists use DLCUs for over one-half of their appointments each day (mean [standard deviation], 59% [22%]). Regarding technique, respondents reported that they modify their curing technique on the basis of material thickness (79%) and material type or light tip-to-target distances (59%). Maintenance practices varied, with two-thirds of respondents reporting that they periodically check their DLCUs' light output. CONCLUSIONS: DLCUs are an integral part of a general dentist's daily practice, but maintenance, ocular safety, and technique varied widely among this sample. PRACTICAL IMPLICATIONS: Because clinical effectiveness requires delivery of an adequate amount of light energy at the appropriate wavelength, variation in DLCU maintenance, safety, and techniques suggest that dentists could benefit from additional guidance and training on DLCU operation.