Bond strength and marginal adaptation of resin composites and correlations with clinical results.

OBJECTIVES: Due to innumerable confounding factors and a high number of types and brands of dental restorative materials, the clinical performance of restorative materials are sought predicted by various in vitro tests. However, only few such tests have been found to correlate well with clinical findings. Thus, the present study determined the in vitro dentin bond strength and marginal adaptation of Class II restorations and correlated the results to their clinical outcomes. METHODS: Dentin bond strength (µTBS and µSBS) and marginal gap formation of Class II restorations (replica technique and SEM) were measured after 24 h and 6 m water storage using eight combinations of adhesive and resin composite. Clinical outcomes (mean survival time, Hazard Ratio, annual failure rate; n = 10.695) were gained from a data set of a retrospective multicenter study of direct restorations. RESULTS: Significant differences were found for dentin bond strength and marginal gap formation between the restorative material groups, and negative effects of long-term storage were observed. µTBS correlated significantly with certain clinical outcomes of Class I restorations, while µSBS correlated with certain clinical outcomes of Class II, III, IV and V restorations. Marginal gap formation in enamel and number of paramarginal fractures correlated with certain clinical outcomes of Class II restorations. SIGNIFICANCE: Using the same restorative materials in vitro as in vivo, gave significant, but weak correlations between in vitro bond strength or marginal adaptation and clinical outcomes, lending support to the use of in vitro tests in early stages of material selection.

Marginal Gap Formation in Approximal "Bulk Fill" Resin Composite Restorations After Artificial Ageing.

The aim of this in vitro study was to investigate the marginal gap formation of a packable "regular" resin composite (Filtek Supreme XTE [3M ESPE]) and two flowable "bulk fill" resin composites (Filtek Bulk Fill [3M ESPE] and SDR [DENTSPLY DeTrey]) along the approximal margins of Class II restorations. In each of 39 extracted human molars (n=13 per resin composite), mesial and distal Class II cavities were prepared, placing the gingival margins below the cemento-enamel junction. The cavities were restored with the adhesive system OptiBond FL (Kerr) and one of the three resin composites. After restoration, each molar was cut in half in the oro-vestibular direction between the two restorations, resulting in two specimens per molar. Polyvinylsiloxane impressions were taken and "baseline" replicas were produced. The specimens were then divided into two groups: At the beginning of each month over the course of six months' tap water storage (37°C), one specimen per molar was subjected to mechanical toothbrushing, whereas the other was subjected to thermocycling. After artificial ageing, "final" replicas were produced. Baseline and final replicas were examined under the scanning electron microscope (SEM), and the SEM micrographs were used to determine the percentage of marginal gap formation in enamel or dentin. Paramarginal gaps were registered. The percentages of marginal gap formation were statistically analyzed with a nonparametric analysis of variance followed by Wilcoxon-Mann-Whitney tests and Wilcoxon signed rank tests, and all p-values were corrected with the Bonferroni-Holm adjustment for multiple testing (significance level: α=0.05). Paramarginal gaps were analyzed descriptively. In enamel, significantly lower marginal gap formation was found for Filtek Supreme XTE compared to Filtek Bulk Fill ( p=0.0052) and SDR ( p=0.0289), with no significant difference between Filtek Bulk Fill and SDR ( p=0.4072). In dentin, significantly lower marginal gap formation was found for SDR compared to Filtek Supreme XTE ( p<0.0001) and Filtek Bulk Fill ( p=0.0015), with no significant difference between Filtek Supreme XTE and Filtek Bulk Fill ( p=0.4919). Marginal gap formation in dentin was significantly lower than in enamel ( p<0.0001). The percentage of restorations with paramarginal gaps varied between 0% and 85%, and for all three resin composites the percentages were markedly higher after artificial ageing. The results from this study suggest that in terms of marginal gap formation in enamel, packable resin composites may be superior to flowable "bulk fill" resin composites, while in dentin some flowable "bulk fill" resin composites may be superior to packable ones.

Retention of Root Canal Posts: Effect of Cement Film Thickness, Luting Cement, and Post Pretreatment.

The aim of this study was to investigate the effect of the cement film thickness of a zinc phosphate or a resin cement on retention of untreated and pretreated root canal posts. Prefabricated zirconia posts (CosmoPost: 1.4 mm) and two types of luting cements (a zinc phosphate cement [DeTrey Zinc] and a self-etch adhesive resin cement [Panavia F2.0]) were used. After removal of the crowns of 360 extracted premolars, canines, or incisors, the root canals were prepared with a parallel-sided drill system to three different final diameters. Half the posts did not receive any pretreatment. The other half received tribochemical silicate coating according to the manufacturer's instructions. Posts were then luted in the prepared root canals (n=30 per group). Following water storage at 37°C for seven days, retention of the posts was determined by the pull-out method. Irrespective of the luting cement, pretreatment with tribochemical silicate coating significantly increased retention of the posts. Increased cement film thickness resulted in decreased retention of untreated posts and of pretreated posts luted with zinc phosphate cement. Increased cement film thickness had no influence on retention of pretreated posts luted with resin cement. Thus, retention of the posts was influenced by the type of luting cement, by the cement film thickness, and by the post pretreatment.

Influence of surface roughness on mechanical properties of two computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials.

The aim of this study was to evaluate the influence of surface roughness on surface hardness (Vickers; VHN), elastic modulus (EM), and flexural strength (FLS) of two computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials. One hundred sixty-two samples of VITABLOCS Mark II (VMII) and 162 samples of IPS Empress CAD (IPS) were ground according to six standardized protocols producing decreasing surface roughnesses (n=27/group): grinding with 1) silicon carbide (SiC) paper #80, 2) SiC paper #120, 3) SiC paper #220, 4) SiC paper #320, 5) SiC paper #500, and 6) SiC paper #1000. Surface roughness (Ra/Rz) was measured with a surface roughness meter, VHN and EM with a hardness indentation device, and FLS with a three-point bending test. To test for a correlation between surface roughness (Ra/Rz) and VHN, EM, or FLS, Spearman rank correlation coefficients were calculated. The decrease in surface roughness led to an increase in VHN from (VMII/IPS; medians) 263.7/256.5 VHN to 646.8/601.5 VHN, an increase in EM from 45.4/41.0 GPa to 66.8/58.4 GPa, and an increase in FLS from 49.5/44.3 MPa to 73.0/97.2 MPa. For both ceramic materials, Spearman rank correlation coefficients showed a strong negative correlation between surface roughness (Ra/Rz) and VHN or EM and a moderate negative correlation between Ra/Rz and FLS. In conclusion, a decrease in surface roughness generally improved the mechanical properties of the CAD/CAM ceramic materials tested. However, FLS was less influenced by surface roughness than expected.

Bonding of restorative materials to dentin with various luting agents.

The aim was to compare eight types of luting agents when used to bond six indirect, laboratory restorative materials to dentin. Cylinders of the six restorative materials (Esteticor Avenir [gold alloy], Tritan [titanium], NobelRondo [feldspathic porcelain], Finesse All-Ceramic [leucite-glass ceramic], Lava [zirconia], and Sinfony [resin composite]) were ground and air-abraded. Cylinders of feldspathic porcelain and glass ceramic were additionally etched with hydrofluoric acid and were silane-treated. The cylinders were luted to ground human dentin with eight luting agents (DeTrey Zinc [zinc phosphate cement], Fuji I [conventional glass ionomer cement], Fuji Plus [resin-modified glass ionomer cement], Variolink II [conventional etch-and-rinse resin cement], Panavia F2.0 and Multilink [self-etch resin cements], and RelyX Unicem Aplicap and Maxcem [self-adhesive resin cements]). After water storage at 37°C for one week, the shear bond strength of the specimens (n=8/group) was measured, and the fracture mode was stereomicroscopically examined. Bond strength data were analyzed with two-factorial analysis of variance (ANOVA) followed by Newman-Keuls' Multiple Range Test (α=0.05). Both the restorative material and the luting agent had a significant effect on bond strength, and significant interaction was noted between the two variables. Zinc phosphate cement and glass ionomer cements produced the lowest bond strengths, whereas the highest bond strengths were found with the two self-etch and one of the self-adhesive resin cements. Generally, the fracture mode varied markedly with the restorative material. The luting agents had a bigger influence on bond strength between restorative materials and dentin than was seen with the restorative material.

A survey of failed post-retained restorations.

Survival of endodontically treated, post-restored teeth depends on a multitude of factors, all of which are practically impossible to include in a randomized, controlled clinical study. The purpose of this survey was to characterize and analyze reported failures of post-retained restorations to identify factors critical to failure and to type of failure. A questionnaire was mailed to private practitioners in Denmark with a request to complete the questionnaire whenever a patient presented with a failed post-retained restoration. Information was gathered on factors related to the patient, the tooth, the restorative materials, and the techniques. Two-hundred and sixty questionnaires were collected from 171 practitioners over a 3-year period. Functioning time until failure varied between 3 months and 38 years. Mean survival time until failure was 11 years. Of the failed restorations, 61% had functioned for 10 years or less. Fracture of the tooth was the most common type of failure reported, followed by loosening of the post and fracture of the post. Tapered posts implied an increased risk of tooth fracture compared to loosening or fracture of the post, and the relative risk of tooth fracture increased with the functioning time until failure. Fracture of the post was more common among male than female patients. On the basis of this survey of failed post-retained restorations, it was concluded that tapered posts were associated with a higher risk of tooth fracture than were parallel-sided posts.

Influence of curing rate of resin composite on the bond strength to dentin.

This study determined whether the strength with which resin composite bonds to dentin is influenced by variations in the curing rate of resin composites. Resin composites were bonded to the dentin of extracted human molars. Adhesive (AdheSE, Ivoclar Vivadent) was applied and cured (10 seconds @ 1000 mW/cm2) for all groups. A split Teflon mold was clamped to the treated dentin surface and filled with resin composite. The rate of cure was varied, using one of four LED-curing units of different power densities. The rate of cure was also varied using the continuous or pulse-delay mode. In continuous curing mode, in order to give an energy density totaling 16 J/cm2, the power densities (1000, 720, 550, 200 mW/cm2) emitted by the various curing units were compensated for by the light curing period (16, 22, 29 or 80 seconds). In the pulse-delay curing mode, two seconds of light curing at one of the four power densities was followed by a one-minute interval, after which light cure was completed (14, 29, 27 or 78 seconds), likewise, giving a total energy density of 16 J/cm2. The specimens produced for each of the eight curing protocols and two resin composites (Tetric EvoCeram, Ivoclar Vivadent; Filtek Supreme XT, 3M ESPE) were stored in water at 37 degrees C for seven days. The specimens were then either immediately subjected to shear bond strength testing or subjected to artificial aging (6,000 cycles between 5 degrees C and 55 degrees C baths) prior to testing. Failure modes were also assessed. The shear bond strengths were submitted to factorial analysis of variance, and the failure modes were submitted to a Chi-square test (alpha = 0.05). All but power density (curing mode, resin composite material and mode of aging) significantly affected shear bond strength. The curing mode and resin composite material also influenced the failure mode. At the selected constant energy density, pulse-delay curing reduced bonding of the resin composite to dentin.

Resin composite properties and energy density of light cure.

According to the "total energy concept", properties of light-cured resin composites are determined only by energy density because of reciprocity between power density and exposure duration. The kinetics of polymerization is complex, and it was hypothesized that degree of cure, flexural strength, and flexural modulus were influenced not only by energy density, but also by power density per se. A conventional resin composite was cured at 3 energy densities (4, 8, and 16 J/cm(2)) by 6 combinations of power density (50, 100, 200, 400, 800, and 1000 mW/cm(2)) and exposure durations. Degree of cure, flexural strength, and flexural modulus increased with increasing energy density. For each energy density, degree of cure decreased with increasing power density. Flexural strength and modulus showed a maximum at intermediate power density. Within clinically relevant power densities, not only energy density but also power density per se had significant influence on resin composite properties.

Resistance to cyclic loading of teeth restored with posts.

This in vitro study evaluated the effect of presence of post, presence of core, and of shape, type, and surface treatment of posts on resistance to cyclic loading of crowned human teeth. For all teeth, crowns designed without ferrule were cast in sterling silver and luted with resin cement (Panavia F). Each tooth underwent cyclic loading of 600 N at two loads per second until failure. Teeth that had only been crowned showed significantly higher resistance to cyclic loading than teeth with cores or with post and cores. No significant differences were found between teeth restored with cores only or with post and cores, irrespective of surface-treatment of the posts. Teeth restored with parallel-sided cast post (ParaPost XP) and cores showed significantly higher resistance to cyclic loading than teeth with either tapered cast posts or untreated prefabricated posts of titanium alloy (ParaPost XH) or glass fiber composite (ParaPost Fiber White). No significant difference was found between teeth restored with parallel-sided cast post and cores and teeth restored with untreated prefabricated posts of zirconia (Cerapost). Surface treatment of posts significantly increased the resistance to cyclic loading compared with untreated posts. When posts are used, surface treatment is recommended.

Soft-start polymerization and marginal gap formation in vitro.

PURPOSE: To determine the effect of soft-start polymerization of resin-based composites on the marginal gap formation in dentin cavities. MATERIALS AND METHODS: Cylindrical cavities were prepared in dentin in extracted human molars. The cavities were distributed into 8 groups. The teeth in groups 1-4 were treated with Scotchbond Multi-Purpose and restored with Z100, and the teeth in groups 5-8 were treated with OptiBond FL and restored with Herculite XRV. The restorations were light-cured for 40 s by four different curing modes. The marginal gap formation was measured in a light microscope after a 20 min water-storage, and the wall-to-wall contraction was calculated as the widest gap in percent of the cavity diameter. RESULTS: Soft-start light curing did not influence wall-to-wall contraction in dentin cavities. OptiBond FL and Herculite XRV showed less wall-to-wall contraction than did Scotchbond Multi-Purpose and Z100. CLINICAL SIGNIFICANCE: The soft-start polymerization procedures studied did not improve the marginal adaptation of two resin composites bonded to dentin cavities compared with conventional polymerization.

Influence of selected components on crosslink density in polymer structures.

Bifunctional methacrylates polymerize to form crosslinked polymer structures which may be characterized by the quantity of remaining double bonds and by the crosslink density. This study investigated the influence of composition variation on the crosslink density of model methacrylate polymers. It was hypothesized that addition of a monofunctional monomer would reduce crosslink density and that compositions giving rise to many centers of polymer growth would result in increased crosslink density. Unfilled resins with varying content of BisGMA, TEGDMA, a monofunctional monomer, camphoroquinone, and amine were polymerized by visible light irradiation. After polymerization, the quantity of remaining double bonds and the Wallace hardness were determined. Polymer softening upon storage in ethanol was taken as a measure of the crosslink density. After ethanol storage, the relationship between hardness number and amount of monofunctional monomer showed a minimum. At same quantity of remaining double bonds, a high content of camphoroquinone compared to amine resulted in reduced softening in ethanol. Composition influenced not only remaining double bonds but also the crosslink density of the resulting polymer structures.

The influence of relative humidity on the effect of dentin bonding systems.

PURPOSE: The aim of the study was to measure the influence of relative humidity of the ambient air on bond strength to enamel and dentin of six different bonding systems. In this manner, the role of the primer solvent was assessed. MATERIALS AND METHODS: The bonding systems selected were Prime & Bond 2.1, One Step, Scotchbond MP, Syntac Single Component, Optibond Solo, and Perma Quick. The primers of these systems are based on either acetone, water or ethanol. Plane enamel and dentin surfaces were placed at relative humidities of 18%, 45%, 80% or 99% RH and then treated in accordance with the recommendations of the respective manufacturers. A resin composite was then bonded to the treated surfaces. After storage in water at 37 degrees C for 1 day, the bonded specimens were broken in shear. RESULTS: The bonds to enamel were either unaffected or in one case moderately increased by increasing ambient humidity. The bonds to dentin were either unaffected or in four cases strongly reduced by increasing humidity. CONCLUSIONS: The response of the bonding systems to differences in ambient humidity were not related to the solvent of the primer in a simple way. To exclude the damaging effect of high humidity on dentin bonding, the use of rubber-dam is recommended.

Influence of pulse-delay curing on softening of polymer structures.

Resin composites may be polymerized according to one of several light-curing modes. These modes include variations in intensity of the curing lights and time delay before final cure. The so-called pulse-delay method has earlier been found to reduce the formation of gaps due to polymerization contraction, without mechanical properties of the resin composite being compromised. It was hypothesized that the slow pre-cure of this method would give rise to a different polymer structure than results when the polymer is cured in one step at high intensity. It was found that although the quantity of remaining double bonds was unaffected, the pulse-delay technique led to polymers of increased susceptibility to softening in ethanol. The softness increased with the intensity of the pre-cure and with the waiting time before final cure. The increased softening may be interpreted as the manifestation of a polymer structure having fewer crosslinks.

A survey of the use of dentin-bonding systems in Denmark.

OBJECTIVES: Dentin-bonding systems, which usually involve multistep procedures, are relatively new in dentistry. This study was conducted to survey dental practitioners in Denmark concerning their use of dentin-bonding systems. METHODS: A questionnaire regarding dentin-bonding systems was distributed to dentists at an annual dental conference, and 462 dentists were included in the survey. RESULTS: Dentin-bonding systems were used by 99% of the dentists. Twenty-one different dentin-bonding systems were being used, with six of the systems being used by 78% of the dentists. Of the 456 dentists who used a dentin-bonding system, 77% recalled a clinical procedure for their dentin-bonding system that was in accordance with the written instructions of the manufacturer. The degree to which the dentists complied with the instructions for use, was influenced by the number of operating steps involved for a given dentin-bonding system, by the frequency with which the dentin-bonding system was used, and by the degree to which the dentist was satisfied with the instructions for use provided by the manufacturer. The frequency with which dentin-bonding systems were used, was influenced by year of graduation, place of work, and gender of the dentist. SIGNIFICANCE: Further studies, which focus on the adherence of dental practitioners to instruction manuals are warranted as are investigations of the potential clinical consequences of incorrect use of dentin-bonding systems.

Effect of pulse-delay curing on in vitro wall-to-wall contraction of composite in dentin cavity preparations.

PURPOSE: To determine the effect of pulse-delay curing of resin composite on marginal gap formation in dentin cavity preparations. MATERIALS AND METHODS: Cylindrical cavities were prepared in extracted human molar dentin and were distributed into 8 groups (A-H). The cavity preparations were treated with a dentin-bonding agent (Prime & Bond NT) and filled with a light-cured resin composite (Z100). The restorations were irradiated initially for 1, 2 or 3 seconds at a power density of 425 mW/cm2. Following water storage for varying time intervals, the restorations were re-exposed for 10 seconds at 750 mW/cm2. Marginal gap formation was measured by light microscopy after 20 minutes of water-storage, and the wall-to-wall contraction was calculated as the widest gap in percent of cavity diameter. RESULTS: Pulse-delay curing in combination with a waiting time of at least 1 minute between exposures reduced wall-to-wall contraction in dentin cavities compared to continuous-cure control.

The effect of different polishing techniques on the surface roughness of acrylic resin materials.

This study evaluated three methods of surface polishing on acrylic denture base materials. Specimens of three commercial heat-cured acrylic resin materials were finished using burs, sandpaper discs and rubber wheels, and polished with polishing soap, paste, or by application of a UV-light-activated resin sealant. The resulting surface roughness was examined by scanning electron microscopy as well as measured by means of a stylus profile Perthometer. Surface roughness was reduced by polishing. Polishing paste and UV-light-activated resin sealant were more, and equally, effective in reducing surface roughness compared to polishing soap. Polishing paste or UV-light-activated resin sealant may be used to create a smoother surface on acrylic dentures.

Substitutes for methylene chloride as dental softening agent.

Methylene chloride is used as softening agent for guttapercha and as adhesion promotor for polymethylmethacrylate (PMMA). However, methylene chloride has been found to be carcinogenic. It was the aim of the present work to search for harmless substitutes for methylene chloride in these situations. A number of possible candidates with structural similarities to guttapercha or PMMA were selected. The efficacy in softening of guttapercha of these compounds was measured by the depth of penetration of a needle under the load of 2 N. The effect of the compounds on the adhesion between PMMA and an acrylic rebasing material was measured in shear. It was found that a number of alkenes or dialkenes of moderate molecular weight (1,3-pentadiene, cyclopentene, isoprene, 2-methyl-2-butene, and 1,5-hexadiene) were as effective as methylene chloride as softening agent for guttapercha. As adhesion promotor in bonding to PMMA, it was found that low molecular weight methyl esters (methyl formate and methyl acetate) were as effective as methylene chloride. Because of the variation in polarity, the calculated solubility parameter was not a reliable predictor of softening efficacy of the investigated compounds.

Elution of TEGDMA and BisGMA from a resin and a resin composite cured with halogen or plasma light.

Plasma arc light units for curing resin composites have been introduced with the claim of relatively short curing times. The purpose of the present study was to measure and compare elution of monomers from an experimental BisGMA-TEGDMA resin and a commercial resin composite when cured with a halogen unit and when cured with a plasma arc unit. Specimens of the materials were immersed in methanol, and the amounts of monomers released with time were analyzed by HPLC. By use of Fick's laws of diffusion, the amount of eluted monomers from the specimen at infinity was estimated. The elution from resin specimens and from resin composite specimens cured with the plasma arc light unit was 7 and 4 times higher, respectively, compared to the elution from specimens cured with the halogen unit. It was concluded that the plasma arc light curing unit did not provide optimal cure when used as recommended by the manufacturer.

Characterization of resin composites polymerized with plasma arc curing units.

OBJECTIVES: Newly developed curing units (plasma arc curing units) operate at relatively high intensity and are claimed to result in optimum properties of resin composites in a short cure time. This study was conducted to determine a number of characteristics of resin composites polymerized by plasma arc curing units. METHODS: The investigated polymerization characteristics were quantity of remaining double bonds, depth of polymerization, flexural strength and modulus, and wall-to-wall polymerization contraction. The investigated plasma arc curing units were Apollo 95E and 1000 PAC. The conventional curing unit XL 3000 was used as baseline. RESULTS: Irradiation with Apollo 95E resulted in a higher quantity of remaining double bonds than did XL 3000, whereas the results obtained with 1000 PAC depended on the resin composite. The depth of cure with the plasma arc units was equal to or less than that obtained with the conventional unit, depending on the resin composite. The flexural strength did not depend on the curing unit. The flexural modulus resulting from curing with Apollo 95E was less than that resulting from curing with XL 3000 in 3 out of 4 comparisons. The wall-to-wall polymerization contraction was equal to or less with the plasma arc units than with the conventional unit. SIGNIFICANCE: Plasma arc curing units make it possible to polymerize resin composite in much shorter times than conventional curing units. However, the polymerization characteristics associated with the units may be less than optimal.

The effect of postcuring on quantity of remaining double bonds, mechanical properties, and in vitro wear of two resin composites.

OBJECTIVES: To determine the effect of different postcuring methods on degree of conversion, mechanical properties, and in vitro wear of two resin composites (Z100 and Charisma). The postcuring methods involved devices for inlay curing as well as devices present for other purposes in many dental laboratories or dental offices. METHODS: Specimens of the resin composites were initially light cured and then postcured according to one of the following methods: Translux EC handheld curing unit (10min), Translux EC light box (10min), Triad II (10min), 40 degrees C (10min), 70 or 110 degrees C for 10min, 1, 6, or 24h. The properties were determined following storage of the specimens for 1week in water at 37 degrees C. The degree of conversion was determined using transmission IR. The mechanical properties tested were diametral tensile strength, flexural strength, and flexural modulus. In vitro wear was induced by a three-body wear simulator. RESULTS: Most postcuring methods increased degree of conversion of both materials. Postcuring increased the mechanical properties and in vitro wear resistance of Charisma, whereas no effect of postcuring was found on these properties of Z100. CONCLUSION: Postcuring with the use of devices readily available in the dental laboratory and dental office increased the degree of conversion of Z100 and Charisma as well as the mechanical properties and in vitro wear resistance of Charisma. A heat treatment at 110 degrees C for 10-60min was found to be the most promising postcuring method.