Effect of the Combination of Restorative Material and the Etching Protocol in Enamel Microleakage in Class II Cavities after Thermocycling.

This study is aimed at evaluating the marginal microleakage of bulk-fill class II restorations after thermocycling. Thirty-two human third molars received class II cavities prepared on mesial and distal faces. The cavities were bonded according to the adhesive protocol (total or self-etching). The cavities were then restored with composite and divided into 8 groups based on the composite combination: layering technique with Filtek Z350XT (G1 and G5), first layer with Filtek Z350 XT Flowable Restorative and then Filtek Z350XT (G2 and G6), bulk-fill technique with Filtek One Bulk Fill (G3 and G7), and first layer with Filtek One Bulk Fill Flow and Filtek Z350 XT (G4 and G8). The restorations were then subjected to thermocycling (2000 cycles, 5°C and 55°C, dwell time of 30 s). After aging, the restored teeth were immersed in methylene blue for 48 hours. The restorations (n = 32) were sectioned in the middle (two sections). The microleakage results were analyzed by two-way ANOVA followed by Tukey's post hoc test (α = 0.05). The groups did not differ statistically from each other in terms of marginal microleakage (p = 0.295). It can be concluded that there is no difference in the percentage of microleakage between conventional and bulk-fill resins on both consistencies, as well as there is also no statistically significant difference when the adhesive system is used in a conventional or self-etching mode.

Resin composite adhesion to dentin using different curing lights and adhesive systems applied under electric current.

OBJECTIVES: To evaluate the effect of electric current application on the resin composite-tooth bond strength and hybrid layer of three adhesive systems light-cured by two light-curing units (LCUs). MATERIALS AND METHODS: Human molar teeth were distributed into 12 groups (n=6). Three adhesive systems were used: two-step etch-and-rinse (SB2; Adper Single Bond 2, 3M ESPE); two-step self-etch (CSE; Clearfil SE Bond, Kuraray); and one-step self-etch (SBU; Single Bond Universal, 3M ESPE) applied with (50µA) and without (control; conventional application) electric current, and light-cured with different LCUs. Resin composite blocks (Filtek Z350XT, 3M ESPE) were produced and cut into sticks (~1mm2) for microtensile bond strength (µTBS). Fracture patterns were analyzed on stereomicroscope and classified as cohesive-dentin, cohesive-resin, adhesive, or mixed. Specimens were prepared for scanning electron microscope observation. The hybrid layer analysis was carried out using a confocal laser scanning microscopy (n=2). Data were submitted to three-way ANOVA followed by Tukey's post hoc test (α=0.05). RESULTS: The electric current increased the µTBS for all adhesive systems light-cured with single-emission peak and multiple-emission peak LCUs. Both LCUs presented similar µTBS values. CSE applied under electric current showed the highest µTBS mean values. The adhesive failure pattern was more frequently observed in all groups. The electric current formed long resin tags for all adhesive systems. CONCLUSIONS: The adhesive systems applied under electric current increased the bond strength using single-emission peak and multiple-emission peak LCUs. CLINICAL RELEVANCE: Electric current at 50µA applied throughout the dentin is a safe mode and results in better impregnation of the adhesive systems.

Biomechanical evaluation of anterior implants associated with titanium and zirconia abutments and monotype zirconia implants.

PURPOSE: The present in silico study evaluated the behavior of titanium dental implants associated with abutments in zirconia and monotype zirconia implant using finite element analysis (FEA). METHODS: A partial image of the anterior region of the maxilla was obtained by computed tomography. Three models of finite element were made using 3D modeling software (SolidWorks): Ti-Ti (control): implant morse cone (3.75 x 11mm; NobelActive) and titanium abutment (Esthetic Abutment); Ti-Zr: cone morse implant in titanium (3.75 x 11mm; NobelActive) and zirconia abutment (Procera Esthetic Abutment #9); Zr: monotype zirconia implant (4.1 x 12mm; Straumann Pure Ceramic). Computerized crowns of element 11 in lithium disilicate (IPS e.max Press, Ivoclar Vivadent) cemented in all groups were created. A load of 100N (45º) was applied simulating the excursion movement of the incisal guide. The von Mises, modified von Mises, maximum (tensile) and minimum (compression) principal stresses were obtained, compared and used for the quantitative and qualitative evaluation of the groups. RESULTS: The Zr presented the lowest values of maximum, minimum, and von Mises tensions than the two pieces systems (Ti-Ti and Ti-Zr). Ti-Zr group had the highest values of tensions evaluated in this study. CONCLUSIONS: The type of material as well as the geometry of implant influenc ed the tension values evaluated.

Effect of polymerization method and fabrication method on occlusal vertical dimension and occlusal contacts of complete-arch prosthesis.

PURPOSE: This study evaluated the dimensional stability of a complete-arch prosthesis processed by conventional method in water bath or microwave energy and polymerized by two different curing cycles. MATERIALS AND METHODS: Forty maxillary complete-arch prostheses were randomly divided into four groups (n = 10): MW1 - acrylic resin cured by one microwave cycle; MW2 - acrylic resin cured by two microwave cycles: WB1 - conventional acrylic resin polymerized using one curing cycle in a water bath; WB2 - conventional acrylic resin polymerized using two curing cycles in a water bath. For evaluation of dimensional stability, occlusal vertical dimension (OVD) and area of contact points were measured in two different measurement times: before and after the polymerization method. A digital caliper was used for OVD measurement. Occlusal contact registration strips were used between maxillary and mandibular dentures to measure the contact points. The images were measured using the software IpWin32, and the differences before and after the polymerization methods were calculated. The data were statistically analyzed using the one-way ANOVA and Tukey test (α = .05). RESULTS: he results demonstrated significant statistical differences for OVD between different measurement times for all groups. MW1 presented the highest OVD values, while WB2 had the lowest OVD values (P<.05). No statistical differences were found for area of contact points among the groups (P=.7150). CONCLUSION: The conventional acrylic resin polymerized using two curing cycles in a water bath led to less difference in OVD of complete-arch prosthesis.

Wear at the Implant-Abutment Interface of Zirconia Abutments Manufactured by Three CAD/CAM Systems.

PURPOSE: To evaluate the changes in the external-hexagon surface of the titanium (Ti) implant before and after mechanical cycling, when coupled with zirconia (Zr) abutments (A) manufactured by three computer-aided design/computer-aided manufacturing (CAD/CAM) systems (Neodent Digital, Zirkonzahn, and AmannGirrbach) and the ZrTi abutment manufactured by Neodent. MATERIALS AND METHODS: Four groups were formed (n = 6): titanium implant with Zr AmannGirrbach abutment (AZrAG), with Zr Zirkonzahn abutment (AZrZ), with Zr Neodent abutment (AZrN), and with Zr abutment with infrastructure in Ti Neodent (AZrTiN). Standardized abutments were made from three identical abutments milled in wax. Images of the surface of each side of the hexagons of the implant were obtained by scanning electron microscopy, before and after mechanical cycling, to evaluate the parameters: (1) scratches in the hexagon face; (2) hexagon superior shoulder kneading; (3) hexagon shoulder wear; (4) alterations on the hexagon base; and (5) scratches on the hexagon top. The abutments were coupled with the implants, and Cr-Co crowns were cemented. The implant/abutment/crown assemblies were submitted to mechanical cycling (400 N, 8.0 Hz) for 1 million cycles. The observed changes were classified as follows: absence (0), mild (1), moderate (2), and severe (3). The results were analyzed using the Mann-Whitney, Kruskal-Wallis, and Dunn tests (P < .05). RESULTS: For parameter 1, a significant difference (P = .008) was observed between AZrZ and AZrAG, with more scratches in AZrZ; and between AZrN and AZrTiN (P = .006), with more scratches in AZrN. For parameter 2, a significant difference (P < .05) was observed between AZrZ and AZrAG and between AZrZ and AZrN, with greater kneading in AZrZ; among AZrN and AZrTiN, there was no significant difference (P = .103). For parameter 3, a significant difference (P < .05) was observed between AZrZ and the other groups of Zr, with more wear in AZrZ; between AZrN and AZrTiN, there was no significant difference (P = .107). For parameter 4, a significant difference (P < .05) was observed between AZrZ and AZrN, with more scratches in AZrZ; a significant difference (P = .002) was also observed between AZrN and AZrTiN, with more scratches in AZrN. For parameter 5, a significant difference (P < .05) was observed between AZrZ and AZrAG and between AZrZ and AZrN, with the fewest scratches in AZrZ; a significant difference (P = .006) was also observed between AZrN and AZrTiN, with more alterations in AZrN. Considering all the alterations, the AZrZ group showed more surface alteration, 1.74 (0.99); followed by AZrN, 1.43 (0.92); AZrAG, 1.32 (0.96); and AZrTiN, 0.88 (0.94). CONCLUSION: Among the Neodent abutments, the AZrN group had shown more surface alterations. Among the Zr groups, AZrZ samples had shown the most altered surfaces, suggesting that alterations on the implant/Zr abutment hexagon surfaces are related to the abutment milled hexagon shape.

Three-dimensional finite element analysis of occlusal splint and implant connection on stress distribution in implant-supported fixed dental prosthesis and peri-implantal bone.

The aim of this study was to investigate the influence of occlusal splint therapy on the stress distribution of implant-supported fixed dental prosthesis (FDP) and peri-implantal bone structures using three-dimensional (3D) finite element analysis (FEA). The system consisted of two implants (positioned on region of second premolar and second molar) as retainers of fixed porcelain-fused-to-metal 3-unit FDP (first molar as pontic element). Two implant connections systems (external and internal hexagon) were tested. Static axial loads simulating functional (100N) and overloaded (300N) chewing were applied on the occlusal surface of the FDP covered or not with the occlusal splint. Maximum von Mises stress and bioperformance were accessed for the implants and bone tissues (cortical and cancellous) models. Analytic results indicated that independently of the load condition, implant region, and connection type, the presence of the occlusal splint decreased the stress developed in the implants. Both bone tissues showed increased levels of von Mises stress, and the bioperformance index was far from their maximum yield strength. The internal hexagon implants presented lower stress on premolar and molar regions than external hexagon implants under functional load and overload. The presence of the occlusal splint device over implant-supported FDP may be clinically useful for forwarding stresses towards the bone structure to maintain implants for long term.

Comparative photoelastic study of dental and skeletal anchorages in the canine retraction.

OBJECTIVE: To compare dental and skeletal anchorages in mandibular canine retraction by means of a stress distribution analysis. METHODS: A photoelastic model was produced from second molar to canine, without the first premolar, and mandibular canine retraction was simulated by a rubber band tied to two types of anchorage: dental anchorage, in the first molar attached to adjacent teeth, and skeletal anchorage with a hook simulating the mini-implant. The forces were applied 10 times and observed in a circular polariscope. The stresses located in the mandibular canine were recorded in 7 regions. The Mann-Whitney test was employed to compare the stress in each region and between both anchorage systems. The stresses in the mandibular canine periradicular regions were compared by the Kruskal-Wallis test. RESULTS: Stresses were similar in the cervical region and the middle third. In the apical third, the stresses associated with skeletal anchorage were higher than the stresses associated with dental anchorage. The results of the Kruskal-Wallis test showed that the highest stresses were identified in the cervical-distal, apical-distal, and apex regions with the use of dental anchorage; and in the apical-distal, apical-mesial, cervical-distal, and apex regions with the use of skeletal anchorage. CONCLUSIONS: The use of skeletal anchorage in canine retraction caused greater stress in the apical third than the use of dental anchorage, which indicates an intrusive component resulting from the direction of the force due to the position of the mini-implant and the bracket hook of the canine.

Evaluation of castable and premachined metal base abutment/implant interfaces before and after cyclical load.

PURPOSE: The purpose of this study was to compare the vertical fit of the castable abutment/implant and premachined base metal abutment/implant interface, before and after cyclic loading. MATERIALS AND METHODS: Ten UCLA abutments were distributed in 2 groups: castable and premachined with a cobalt-chromium metal base. The abutments were cast in cobalt-chromium alloy and were screwed onto implants (3.75 × 13 mm, external hexagon) with a 32 N·cm torque. The vertical gap (in micrometers) at the interface abutment/implant was evaluated by linear microscope 2 times: after torque and after cyclic load (1 million cycles, 400 N). RESULTS: The mean values of the vertical gap at the castable abutment/implant and premachined abutment/implant interfaces before and after cyclic load were 5.33 to 6.64 µm and 7.36 to 8.16 µm, respectively. The mean values of the vertical gap were statistically analyzed (ANOVA and t test, P ≤ 0.05). Vertical gap values of the castable abutment/implant interface were not significantly different from those of the premachined abutment/implant interface, before (P = 0.154) and after (P = 0.471) cyclical loading. CONCLUSION: Castable and premachined base metal abutments showed similar gaps at the implant/abutment interface, both after applying torque and after cyclic loading.

Influence of diamondlike carbon-coated screws on the implant-abutment interface.

PURPOSE: To evaluate the implant-abutment interface area and the abutment screw loosening value when diamondlike carbon (DLC)-coated or titanium screws were used before and after cyclic loading. MATERIALS AND METHODS: Thirty-six implants were divided into four groups according to the type of connection (external hexagon [EH] or internal hexagon [IH]) and the type of abutment screw (with [EHD/IHD] or without [EHT/IHT] DLC coating). The implants were placed in epoxy resin-glass fiber composite, and crowns cast in a metal alloy were screwed to the implants. The implant-abutment interface was measured before (VG1) and after (VG2) cyclic loading. The removal torque values were recorded. RESULTS: In groups with titanium screws, there was an increase in the implant-abutment interface area from VG1 to VG2, whereas in groups with DLC-coated screws, the interface area was reduced (EHT = 4.49%, IHT = 24.32%, EHD = -1.05%, IHD = -9.95%). In the IHT group only, the implant-abutment interface area showed a statistically significant difference between VG1 and VG2. The Pearson correlation indicated no significant differences among the studied factors, where r = -0.11 for EHT, 0.14 for EHD, 0.07 for IHT, and 0.43 for IHD. CONCLUSIONS: The implant-abutment interface areas in groups with an EH connection were larger than those in groups with an IH connection, regardless of the type of screws used. The screw loosening values decreased in all groups after cyclic loading. No correlation between the implant-abutment interface area and the screw loosening value was seen.

Influence of loading and use of occlusal splint in implant-supported fixed prostheses.

The aim of the study was to assess the tensions generated in the long axis of the implants and the interimplants in the cervical, middle, and apical regions when subjected to different loads with or without interposition of the flat occlusal plane splint. A photoelastic model was made with 2 external hexagon implants located in the space corresponding to the second premolar and molar inferiors. A screw-retained metal superstructure was installed on the implants with a torque of 20 N·cm, and the set (photoelastic model with superstructure) were positioned in the circular polariscope in the dark-field configuration to observe the distribution of isochromatic fringes around the implants and interimplant areas. Photographic records were obtained before the application of the occlusal load with the following loading conditions: 300, 600, and 900 N, with and without interposition of the occlusal plane splint. The decrease in stress with the application of the flat occlusal plane splint became more evident after the application of the 600-N load. Generally, the major stress magnitude occurred in the cervical region for interimplant areas and in the apical region around implants. Use of occlusal splint in the loading of 300, 600, and 900 N reduced tension 33.22%, 66.66%, and 73.33%, respectively, in the samples. It can be concluded that the interposition of the occlusal plane splint caused a reduction in tension resulting from the simulation of occlusal overload.

Concurrence between interpupillary line and tangent to the incisal edge of the upper central incisor teeth.

OBJECTIVE: Dento-facial harmony is essential to obtain adequate esthetics and a successful treatment. Therefore, the aim of the present study was to analyze the existence of polar symmetry, obtained by two parallel lines, one along the pupils and another along the incisal edge of the upper central incisor teeth of 102 dental students distributed across five Brazilian dental schools. MATERIALS AND METHODS: One hundred and two students with no missing teeth, who had never been subjected to any kind of dental treatment, not even orthodontic treatment, were selected and photographed using a dental eye II camera (Yashica-Kyocera Optics Inc., Somerset, NJ, USA) with a macro-objective lens of 100 mm and using a scale of 1:10 of the natural size. All the individuals were positioned parallel to the plane of Frankfurt and to the ground, and were photographed smiling in order to expose the central incisors. The pictures were transformed into digital images (1,840 x 1,252 pixels) and analyzed later using Microsoft Office Power Point 2007 software. Two lines (along the pupils and another along the maxillary incisive teeth) were drawn, and the inclination obtained was generated by the program itself. Symmetrical cases were classified as "yes" (Y), and the remainder as "no" (N). Cases were also divided according to gender. Results were statistically assessed by analysis of variance and Student's t-test (alpha = 0.05). RESULTS: There was a statistically significant correlation between the line parallel with the pupils and the tangent of the incisal edge of the incisors, irrespective of gender. CONCLUSION: Regardless of gender, there is a correlation between the pupils and the tangent with the incisal edge of the maxillary central incisors. CLINICAL SIGNIFICANCE Despite diversity in individuals, facial and anatomic measurements may aid in the execution and planning of rehabilitation treatments. (J Esthet Restor Dent 21:318-323, 2009).