Biomechanical consideration in tooth-supported glass-ceramic restorations: A systematic review and meta-analysis of survival rates and irreparable failures.

STATEMENT OF PROBLEM: Knowledge on the biomechanical behavior of glass-ceramics, their survival rate over time, and their potential failures is essential for decision-making in clinical practice. Systematic reviews and meta-analysis of their survival rates and irreparable failures are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the survival rates and irreparable failures of various monolithic glass-ceramic dental restorations to help determine biomechanical indications. MATERIAL AND METHODS: A comprehensive literature search was conducted across the PubMed, Scopus, Web of Science, and EMBASE databases based on the population, intervention, comparison, and outcome (PICO) question, risk of bias assessment, data extraction, subgroup analysis, and meta-analysis. Both randomized and nonrandomized clinical trials that reported survival rate and irreparable failure were screened. The risk, with a 95% confidence interval, was calculated by using the Mantel-Haenszel method. RESULTS: A total of 46 articles met the inclusion criteria: 8 for laminate veneers, 20 for partial coverage restorations, 11 for single crowns, and 6 for fixed partial dentures, encompassing 1715 participants rehabilitated with 4209 restorations. The estimated cumulative survival rate for partial coverage restorations was 90% over an average span of 6.2 years, with an irreparable failure occurrence of n=5.9. Laminate veneers had a survival rate of 90.2% over 6.5 years, with an irreparable failure occurrence of n=8.2. Single crowns had a survival rate of 96% over 4.6 years and an irreparable failure of n=2.7. Conversely, fixed partial dentures had a survival rate of 76.1% over 6.5 years with an irreparable failure of n=5.2. CONCLUSIONS: Glass-ceramic materials demonstrate relatively high survival rates, indicating that they provide a safe and reliable option for partial coverage restorations, laminate veneers, and single crowns. However, fixed partial dentures had a higher proportion of irreparable failures and a lower survival rate, and caution is required.

Influence of thickness and restorative system on the mechanical behavior of CAD/CAM minimally invasive occlusal veneers - in vitro study.

AIM: The aim of this study was to evaluate the physical-mechanical behavior of the occlusal veneers when subjected to thermomechanical cycling. MATERIALS AND METHODS: Sixty specimens were divided into 04 groups (n=15 per group), according with the different restorative materials and thicknesses: material - lithium dissilicate LD (IPS e.max CAD, Ivoclar Vivadent) and nano- ceramic-resins NCR (ESPE Lava Ultimate, 3M); thickness - 0.6 and 1.2mm. The occlusal veneers were bonded over human flattened fresh extracted molars with dual-polymerizing luting agent (Variolink N, Ivoclar Vivadent and RelyX Ultimate 3M) using the respective adhesive system following the selective-etch technique (self-etch in dentin and total etch in enamel). The resin cement was light cured for 40 seconds each face, using a LED light cure equipment (BlueStar II, Microdont, 1100 mW/cm2). The response variables consisted of veneer survival rates (crack formation, catastrophic cracks and debonding) when subjected to thermal cycling from 5° to 55° C and simultaneous mechanical cycling performed at load intensities of 100, 200, 300, 400 and 450N for 20,000 cycles each. RESULT: Data were submitted to the Kruskall Wallis test and Pairwise Comparison, adopting a significance level of 5%. NCRs presented a lower incidence of failures (p<0.05) when compared to LD. According to thickness factor, 1.2mm thick occlusal veneers withstand higher cycling loads. CONCLUSION: NCR occlusal veneers with 1.2mm thickness presented superior physical-mechanical behavior than lithium disilicate and 0.6mm restorations.

Bovine hydroxyapatite/3Y-TZP bioceramic: Aligning 3Y-TZP content with sintering parameters.

This study aimed to produces and characterize bovine hydroxyapatite (HA) bioceramic with 3Y-TZP addition and analyze different sintering curves. HA was extracted from bovine bones and nanoparticulated. HA discs (0, 1, 5 and 10 wt% 3Y-TZP) were subjected to uniaxial and isostatic pressing. Dilatometry analysis was performed and the groups were sintered using 3 different firing curves (conventional, 1300 °C; 2-step, 1292 °C; 2-step, 1420 °C). The samples were analyzed by X-ray diffraction (XRD), biaxial flexural strength (BFS), Vickers microhardness (VH) and Field emission scanning electron microscopy (FE-SEM). The dilatometry results signaled the need for sintering optimization in groups added with 3Y-TZP. XRD demonstrated the characteristic crystallographic peaks of HA in the pure groups and with 1% 3Y-TZP, and decomposition of HA into ß-TCP and formation of calcium zirconate in the groups with 5 and 10% 3Y-TZP. Considering each composition, the groups of pure HA (131.3 ± 13.5 MPa; 401 ± 12.7 GPa) sintered by the conventional curve and HA+1%3Y-TZP (145 ± 8.6 MPa; 507 ± 47.9 GPa), HA+5%3Y-TZP (68.1 ± 14.2 MPa; 183 ± 9.8 GPa) and HA+10%3Y-TZP (55.6 ± 5.1 MPa; 96.1 ± 7.64 GPa) sintered by the 2-step curve at 1420 °C, combined the best BFS and VH results. The addition of 1 wt% 3Y-TZP and optimization in the sintering process improved the mechanical and microstructural properties of HA bioceramics and maintenance of its crystalline characteristics. Refinement in material processing is necessary for the future use of this bioceramic in dentistry.

The effects of TiO2 nanotubes on bond strength and radiopacity of a self-adhesive resin cement in self-curing mode / Os efeitos de nanotubos de TiO2 na resistência de união e radiopacidade de um cimento resinoso auto-adesivo no modo auto-polimerizável

Objective: The aim of this in vitro study w as t o analyze the influence of the titanium dioxide nanotubes i n a self-cure mode polymerization of a dual resin luting agent through push out bond strength and radiopacity tests. Material and Methods: After mixed with a commercial du al self-adhesive resin cement, three concentrations o f tit anium dioxide nanotubes (0.3, 0.6, and 0.9% by weight) we re analyzed in self-curing mode. T he bond strength to bovine root dentin and fi berglass posts was assessed with the push out bond str ength t est and was evaluated in three thirds (cervical, middle and apical) (n=10), followed by failure mode analysis (SEM), and the ISO standard 9917-2 was followed for radiopacity test (n=10). Data were statistically analyzed by one-way ANOVA test, followed by Tukey's test (α=0.05). Results: Reinforced self-adhesive resin cement with 0.6% titanium dioxide nanotubes showed significant difference compared to the control gr oup for push out test (p=0.00158). The modified groups did not s how significant difference among thirds (p=0.782). Radiopacity sh owed higher value for group w ith 0.9% titanium dioxide nanotubes in comparison w ith control group (p<0.001). Conclusion: The addition of titanium dioxide nanotubes to a self-adhesive resin cement increased the bond strength to dentin and radiopacity values in the self-cure polymerization mode (AU)

Objetivo: O objetivo deste estudo in vitro foi analisar a influência de nanotubos de dióxido de titânio na polimerização química de um agente cimentante resinoso dual através de testes de resistência à união e radiopacidade. Material e Métodos: Após misturado com um cimento resinoso auto-adesivo comercial, três concentrações de nanotubos de dióxido de titânio (0,3, 0,6 e 0,9% em peso) foram analisadas. A resistência da união para a dentina da raiz bovina e os pinos de fibra de vidro foi avaliada pelo teste de push-out e avaliada em três terços (cervical, médio e apical) (n = 10), seguido pelo análise de modo de falha (MEV) e a norma ISO 9917-2 foi seguido para teste de radiopacidade (n = 10). Os dados foram analisados estatisticamente pelo teste ANOVA um fator seguido do teste de Tukey (α = 0,05). Resultados: O cimento resinoso auto-adesivo reforçado com nanotubos de dióxido de titânio a 0,6% mostrou diferença significativa em comparação com o grupo controle para teste de push-out (p=0,00158). Os grupos modificados não mostraram diferença significativa entre os terços (p=0,782). A radiopacidade mostrou maior valor para o grupo com nanotubos de dióxido de titânio 0,9% em comparação com o grupo controle (p<0,001). Conclusão: A adição de nanotubos de dióxido de titânio a um cimento resinoso auto-adesivo aumentou a os valores de resistência de união à dentina e radiopacidade no modo de polimerização química do agente cimentante (AU)

Y-TZP Physicochemical Properties Conditioned with ZrO2 and SiO2 Nanofilms and Bond Strength to Dual Resin Cement.

Commercial Yttria-tetragonal zirconia polycrystalline (Y-TZP) was subjected to surface treatments, and the bond strength of dual resin cement to Y-TZP and failure modes were evaluated. Disks (12 mm × 2 mm), cylinders (7 mm × 3.3 mm), and bars (25 mm × 5 mm × 2 mm) were milled from Y-TZP CAD-CAM blocks, divided into seven groups, and subjected to different surface treatments; silicatization was used as control. On the basis of the literature, this study evaluated modifications with films containing SiO2 nanoparticles and silane; SiO2+ZrO2­SiO2 (50%) and ZrO2 (50%) nanoparticles, SiO2+ZrO2/Silane-SiO2 (50%) and ZrO2 (50%) nanoparticles, and silane. Specimens were analyzed by wettability (n = 3), surface free energy (n = 3), X-ray diffraction (n = 1), Fourier transform infrared spectroscopy (FTIR) (n = 1), roughness (n = 5), shear bond test (n = 10), and dynamic modulus (n = 3). Specimens treated with hydrofluoric acid­HF 40% presented significantly higher contact angle and lowest surface free energy (p < 0.05). The SiO2/Silane presented crystalline SiO2 on the surface. The surface roughness was significantly higher for groups treated with nanofilms (p < 0.05). Shear bond strength was significantly higher for silicatization, HF 40%/silicatization, SiO2/Silane, and SiO2+ZrO2/Silane groups. The proposed treatments with nanofilms had potentially good results without prejudice to the physicochemical characteristics of zirconia. Generally, groups that underwent silica surface deposition and silanization had better bond strength (p < 0.005).

TiO2 nanoparticles added to dense bovine hydroxyapatite bioceramics increase human osteoblast mineralization activity.

OBJECTIVES: This study evaluated the effect of TiO2 nanoparticles + dense hydroxyapatite (HA) on human osteoblast cells (SAOS-2). METHODS: Particulate bovine HA powder with or without the addition of either 5 or 8 % TiO2 (HA, HA/TiO2Np5 % or HA/TiO2Np8 %) were pressed into disks (Ø = 12.5 mm; thickness = 1.3 mm) uniaxially (100 MPa) and isostatically (200 MPa/1 min) and sintered at 1300 °C. Y-TZP disks were used as control. The following tests were performed: Scanning Electron Microscopy and Dispersive Energy Spectroscopy (SEM/EDS), Atomic Force Microscopy (AFM), cell viability assay (Alamar Blue-AB) and mineralized matrix deposition (Alizarin Red-AR). AB and AR data were submitted to 2-way ANOVA/Tukey tests and ANOVA/Tukey tests, respectively. RESULTS: SEM revealed that the surface of HA/TiO2Np5% resembles DPBHA surface, but also contains smaller granules. HA/TiO2Np8% characteristics resembles HA/TiO2Np5% surface, but with irregular topography. Y-TZP showed a typical oxide ceramic surface pattern. EDS revealed Ca, O, and P in all samples. C, O, and Zr appeared in Y-TZP samples. AFM data corroborates SEM analysis. AB test revealed excellent cellular viability for HA/TiO2Np5% group. AR test showed that all groups containing TiO2np had more mineralized matrix deposition than all other groups, with statistically differences between HA/TiO2Np8% and HA cultivated in non-osteogenic medium. Culture in osteogenic medium exhibited much more mineralized matrix deposition by TiO2np groups. SIGNIFICANCE: In conclusion, the addition of TiO2np showed chemical, superficial, and biological changes in the reinforced materials. HA/TiO2Np5% showed the best results for cell viability and HA/TiO2Np8% for mineralized matrix deposition.

Resin-based materials to control human dentin permeability under erosive conditions in vitro: A hydraulic conductance, confocal microscopy and FTIR study.

OBJECTIVES: To characterize the behavior of three different polymeric agents before and after an erosive challenge on dentin permeability, to analyze their degradation in both conditions, and to analyze their degree of conversion (DC). METHODS: The permeability of human dentin disks (1.0 ± 0.2 mm) was measured with smear layer, after its removal, after treatment (LpTreat) with Gluma Desensitizer, PRG Barrier Coat (PBC) or Icon infiltrant (n = 11/group) and after exposure to citric acid (LpEro) (6%, pH 2.1, 1 min). The specimens were analyzed under a Laser Scanning Confocal Microscope (n = 2/group) and the products' DC were calculated. Data were subjected to 2-way repeated measures ANOVA and post-hoc Bonferroni (permeability analysis), to paired t-test (for specimens treated with Icon) and to t-test (DC analysis) (α < 0.05). RESULTS: Icon showed the lowest LpTreat and LpEro values, while PBC and Gluma did not differ from each other under these conditions. Icon and PBC showed LpEro similar to a dentin with smear layer. Under the Laser Scanning Confocal Microscope, more deposits were noticeable on dentin after treating with PBC. Gluma presented the deepest penetration in dentin. The DC of PBC was the highest. SIGNIFICANCE: Icon caused the highest reduction on permeability values, followed by PBC and Gluma. PBC generated more deposits covering dentin and seemed to be more efficient after an erosive challenge. The association of a polymeric resin with inorganic ion-releasing fillers seem to be a great strategy to manage dentin hypersensitivity under erosive conditions.

A new technique for incorporation of TiO2 nanotubes on a pre-sintered Y-TZP and its effect on bond strength as compared to conventional air-borne particle abrasion and silicatization TiO2 nanotubes application on pre-sintered Y-TZP.

OBJECTIVE: This study evaluated the microshear bond strength of a resin cement to Y-TZP after different methods of TiO2 nanotubes (nTiO2) incorporation on pre-sintered Y-TZP surfaces. METHODS: nTiO2 were synthesized and incorporated on Y-TZP slices as follows (n = 15): 1) nTiO2 mixed with isopropyl alcohol/manual application (MAl); 2) nTiO2 mixed with acetone/manual application (MAc); 3) nTiO2 mixed with isopropyl alcohol/high-pressure vacuum application (HPVAl); 4) nTiO2 mixed with acetone/high-pressure vacuum application (HPVAc). As controls, surfaces were sandblasted with Al2O3 (OX) or Rocatec silicatization (ROC). All ceramics were sintered after nTiO2 incorporation. Surface treatments of OX and ROC were made after sintering. Surfaces were characterized by confocal laser microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Resin composite cylinders (1.40 mm diameter and 1 mm height) were cemented with a resin cement, stored in water at 37 °C for 24 h and thermocycled for 10 000 cycles before microshear bond strength evaluation. Data were analyzed with one-way ANOVA and Games-Howell (α = 0.05), and fracture analysis was performed using a stereomicroscope. RESULTS: EDS confirmed the presence of TiO2 on treated Y-TZP. The confocal analysis showed higher roughness for HPVAc and OX. There were significant differences between surface treatments (p < 0.001). HPVAl (22.96 ± 10.3), OX (34.16 ± 7.9) and ROC (27.71 ± 9.4) showed higher microshear bond strengths and were statistically similar (p > 0.05). MAC showed intermediary values, and HPVAc and MAl presented decreased bond strength, with a high percentage of premature debonding. CONCLUSION: High-pressure vacuum application of nTiO2 mixed with isopropyl alcohol was able to produce bond strength values compared to conventional air abrasion and Rocatec silicatization. SIGNIFICANCE: The infiltration of TiO2 nanostructures on the pre-sintered Y-TZP is an interesting approach that can improve bond strength without the need of sandblasting methods.

Determination of chemical species of fluoride during uptake mechanism of glass-ionomer cements with NMR spectroscopy.

OBJECTIVE: The aim of the present study was to determine the chemical species formed inside glass-ionomer cements after fluoride uptake and to investigate the depth of penetration of fluoride ions within the cement matrix. METHODS: An experimental fluoride-free glass with composition 2SiO2-AlO3-CaO was produced. The glass powder was mixed with aqueous poly(acrylic acid) (PAA), and allowed to set. The resulting specimens were stored in 20ml KF solution with 1000ppm fluorine for 24h and then placed into the same amount of water as for 24h. A fluoride selective electrode was used to give the F concentration of the respective solutions. 19F MAS-NMR spectra were recorded on powdered cement specimens using a Bruker AVANCE-NEO 600 spectrometer. In addition, SEM observation and EDX chemical analysis were conducted on the cross-section of a carefully fractured specimen. RESULTS: Fluoride was shown to be mainly present in the surface layers of the specimen after placement in the KF solution, and only a small fraction was re-released into water. 19F NMR spectroscopy showed that AlF complexes were formed within the cement. SIGNIFICANCE: The fluoride taken up by a free-fluoride glass ionomer cement mostly occupies surface layers and is retained because it bonds to aluminum within the matrix. This finding explains why the majority of fluoride taken up by conventional glass ionomer cements is retained.

Consensus on glass-ionomer cement thresholds for restorative indications.

OBJECTIVE: The aim of this paper is to present the results of a consensus meeting on the threshold property requirements for the clinical use of conventional glass-ionomer cements (GICs) for restorative indications. METHODS: Twenty-one experts on GICs evaluated the results of tests on mechanical and optical properties of 18 different brands of restorative GICs: Bioglass R [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z [IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [MA], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. All experiments were carried out by a team of researchers from Brazil and England following strict protocols, under the same laboratory conditions throughout, and maintaining data integrity. RESULTS: There was consensus on: determining as primary properties of the material: compressive strength, microhardness, acid erosion and fluoride release, and as secondary properties: contrast ratio and translucency parameter, in order to rank the materials. Seven brands were below the thresholds for restorative indications: IZ, IM, IG, MA, VF, B and MG. CONCLUSIONS: Based on the primary properties adopted as being essential for restorative indications, the conventional restorative GICs that met the thresholds and could be considered suitable as long-term restorative materials were: EF, GI, GL9, KM, IP, GL2, IS, CR, V, VM and R. A decision-making process to select the best GIC must also include results from clinical trials. CLINICAL SIGNIFICANCE: This study provides a ranking of GICs that could be considered suitable as long-term restorative materials based on their main properties.

Effect of TiF4 varnish after pre-treatment with proanthocyanidin or chlorhexidine on the progression of erosive dentin loss in the presence or absence of the demineralized organic matrix.

This study evaluated the protective effect of TiF4 varnish, after pre-treatment with proantocyanidin or chlorhexidine, on the progression of erosive dentin loss (EDL), under the presence or absence of the demineralized organic matrix (DOM). Bovine root dentin samples were eroded for 30 min (0.1% citric acid, pH 2.5) and the loss was measured by profilometry. Half of them were subjected to the DOM removal using collagenase for 4 days, while the other half remained immersed in water. The removal of DOM was checked by profilometry. Samples were divided into 24 groups (n = 15) according to the factors: 1- With or without DOM; 2- Pre-treatment with 0.012% chlorhexidine gel, 10% proanthocyanidin gel or untreated for 1 min; 3-Final Treatment with TiF4 varnish, NaF varnish, placebo varnish or untreated for 6 h. The samples were submitted to a pH cycling for 5 days: 0.1% citric acid (4 × 90s/day) and artificial saliva between the challenges. The final profile was obtained for the calculation of EDL (µm, three-way ANOVA/Tukey test). When DOM was preserved, the EDL was lower compared to the condition without DOM (7.08 ± 4.03 µm and 9.80 ± 3.79 µm, p < 0.001, respectively), regardless of the treatments. The pre-treatment had no influence on the progression of EDL (p = 0.637), while the final treatment (TiF4 varnish only, 6.77 ± 4.08 µm) was effective in reducing the progression of EDL (NaF varnish: 9.52 ± 4.02 µm; Placebo varnish: 8.64 ± 4.06 µm and no treatment: 8.80 ± 3.95 µm). It can be concluded that DOM has important protective effect on the progression of EDL. TiF4 was the unique treatment capable of reducing EDL progression, regardless of the pre-treatment of DOM.

Comparison of marginal adaptation and internal fit of monolithic lithium disilicate crowns produced by 4 different CAD/CAM systems.

OBJECTIVES: To evaluate the marginal adaptation and internal space of crowns produced by 4 CAD/CAM systems using microcomputed tomography (µCT) and replica technique (RT). MATERIALS AND METHODS: Monolithic lithium disilicate crowns were milled (Ceramill, Cerec, EDG, and Zirkonzahn) (n = 10). The cement film obtained with low viscosity silicone was scanned by the µCT system and captured by a stereomicroscope, according to RT. Two-way ANOVA followed by Tukey's test were used for statistical analysis (α = 0.05). A uniformity index (UI) was idealized to describe the distribution of crowns' internal space and submitted to the Kruskal-Wallis and Tukey's test (α = 0.05). The correlation between µCT and RT was performed by Pearson's Correlation Coeficient (α = 0.05). RESULTS: Marginal adaptation and internal space were statistically significant different between the experimental groups for the µCT and RT (p < 0.05). The medians of the 4 systems tested were within clinically acceptable range and the mean (± SD) highest marginal discrepancy was recorded in the Ceramill group at 133.0 ± 71.5 µm (µCT) and 90.6 ± 38.5 µm (RT). For internal fit, the UI disclosed a better distribution of the internal space for the Zirkonzahn group (p < 0.001). There was a strong correlation between the methods (p = 0.01 and r = 0.69). CLINICAL RELEVANCE: Because of the variability of the CAD/CAM systems available, evaluating their accuracy is of clinical interest. The 4 systems are capable to produce restorations adaptated within clinically appropriate levels. The µCT and RT are efficient adaptation methodologies.

Translucency parameter of conventional restorative glass-ionomer cements.

OBJECTIVE: To evaluate the translucency parameter (TP) and contrast ratio (CR) of different conventional restorative glass-ionomer cements (GICs). MATERIALS AND METHODS: Eighteen brands of GICs were evaluated. Five disks of each material were made following ISO 9917-1. The luminous reflectance and Central Bureau of the International Commission on Illumination parameters of disks were evaluated using a colorimeter, against backings of white and black, to obtain the translucent parameter and contrast ratio of different brands of glass-ionomer cements. The correlation between translucency parameter and contrast ratio was assessed with the Pearson correlation test. The translucent and contrast ratio parameters values were submitted to the one-way ANOVA and Tukey test for multiple comparisons (p < 0.05). RESULTS: There was a strong inverse relationship between CR and TP (r2  = 0.94, p < 0.001). The contrast ratio decreased as translucency increased. There were significant differences in TP and CR among brands (p < 0.001). CONLUSIONS: GICs exhibit different translucency and contrast ratio behavior. Some brands of GICs presented very low TP and this condition would be unacceptable for areas with esthetic demands. In addition, TP and CR showed a strong linear relationship. CLINICAL SIGNIFICANCE: The results found in this study demonstrated that the knowledge of the translucency and CR of different conventional restorative GICs is important in order to guide clinicians in the selection of restorative GICs for anterior teeth.

Effect of the addition of functionalized TiO2 nanotubes and nanoparticles on properties of experimental resin composites.

OBJECTIVE: To evaluate the influence of the addition of functionalized and non-functionalized TiO2 nanostructures on properties of a resin composite. METHODS: TiO2 nanostructures were synthesized and functionalized, using 3-(aminopropyl)triethoxysilane (APTMS) and 3-(trimethoxysilyl)propyl methacrylate (TSMPM). Characterizations were performed with XRD, EDS, TEM, and TGA. Resin composites containing Bis-GMA/TEGDMA, CQ, DABE, and barium-aluminum silicate glass were produced according to TiO2 nanostructure (nanotube or nanoparticle), concentration (0.3 or 0.9 wt%), and functionalization (APTMS or TSMPM). The resin composite without nanostructures was used as control. The amount of fillers was kept constant at 78.3 wt% for all materials. The degree of conversion (DC - at 0 h and 24 h), maximum polymerization rate (Rpmax), and Knoop microhardness (KHN before and after ethanol softening) were evaluated. Data were analyzed with two-way ANOVA with repeated measures and Tukey's HSD (α = 0.05). RESULTS: TGA results demonstrated that functionalizations were effective for both nanostructures. For DC, resin composites, time and interaction effect were significant (p < 0.001). Higher DC was found for 0.3-wt%-functionalized-nanotubes at 24 h. For nanoparticles, only 0.9-wt%-non-functionalized and 0.3-wt%-APTMS-functionalized showed DC similar to the control and all other groups showed higher DC (p < 0.05). Rpmax was higher for 0.3-wt%-APTMS-nanotubes, which corresponded to higher DC after 24 h. The lowest Rpmax occurred for 0.9-wt%-TSMPM-nanotubes, which showed smaller DC at 0 h. For KHN, resin composites, ethanol softening and interaction effect were significant (p < 0.001). KHN decreased after ethanol softening all groups, except for 0.3-wt%-TSMPM-nanotubes, 0.9-wt%-TSMPM-nanotubes, and 0.3-wt%-non-functionalized-nanoparticles. CONCLUSION: The resin with 0.3-wt%-TSMPM-nanotubes showed higher DC after 24 h, while being the most stable material after the ethanol softening. SIGNIFICANCE: The addition of functionalized TiO2 nanostructures in resin-based materials may improve the properties of the material.

Indirect evaluation of pit and fissure sealants: A 3D-based method validation.

BACKGROUND: The aim of the present study was to compare indirect methods to assess the clinical performance of pit and fissure sealants and validate the use of 3D scanners. MATERIAL AND METHODS: Sample consisted of 58 plaster models of upper and lower first permanent molars, sealed with resin sealants, as well as photographs obtained during the 18-month follow-up. Pre-established criteria were applied to categorize the sealant presence/absence and marginal integrity. Two calibrated examiners performed the evaluations, independently, using Scanning Electron Microscopy (SEM; gold-standard), Photography, 3D (CEREC In Lab) and Stereomicroscope analysis. RESULTS: The intra-examiner Spearman correlation was 94% e 97%, respectively, and the inter-examiner was 96%. Data was submitted to Kappa test, Spearman correlation and Receiver Operating Characteristic Curve (ROC). 3D and SEM presented good concordance; Stereomicroscope showed regular concordance with SEM and 3D (p<0.001). There was no concordance among Photography and the other methods (p>0.05). SEM had a significant positive correlation with 3D and Stereomicroscope (r=0.76 and 0.71, respectively; p<0.01). There was significant positive correlation (r=0.65) between 3D and Stereomicroscope (p<0.01). The ROC estimated curve areas for Stereomicroscope and 3D were 0.90 (IC:0.81-0.99) and 1.0 (IC:1.0-1.0), respectively (p<0.001). CONCLUSIONS: Photography presented lower sensitivity and specificity (area=0.59). 3D method showed the best performance when compared to gold standard, exhibiting high sensitivity and specificity, therefore, it was validated as a reliable method to evaluate pit and fissure sealants. Key words:Photography, stereomicroscope, SEM, diagnostic, sealants.

Influence of thickness and aging on the mechanical properties of provisional resin materials.

This study aimed to evaluate the flexural strength (FS) and modulus of elasticity (ME) of 2 provisional resins at different thicknesses and after different storage periods. A total of 80 specimens were made of 2 provisional restorative materials (n = 40): Dencôr (DC) or Protemp 4 (PT). The specimens in each material group were prepared in 2 different thicknesses (n = 20): 1.5 mm or 2.0 mm. The groups were further subdivided by storage time (n = 10 per material thickness per time): 7 days or 3 months. A 3-point bending test was performed with a universal testing machine. Data were submitted to 3-way analysis of variance followed by a post hoc Tukey test (α = 0.05). Regarding the interaction of material and thickness, the 2.0-mm-thick DC specimens presented a significantly lower mean FS (41.08 MPa) than the other groups (P < 0.05). Regarding the interaction of material and storage time, PT after 3 months presented a significantly higher mean FS (75.51 MPa) than the other groups and periods (P < 0.05). Regardless of the material, the highest mean ME was found in the 1.5-mm-thick group after 3 months (2.24 GPa) (P < 0.05). The lowest ME values were found in the 2.0-mm-thick specimens after both storage times (7 days, 0.88 GPa; 3 months, 1.09 GPa), which were not significantly different from each other (P > 0.05). The correlation between FS and ME was direct and positive (R2 = 0.51; P < 0.001), independently of the variables (material, thickness, and time). Therefore, 2.0-mm-thick PT specimens presented the highest values of FS, mainly after 3 months. The ME was higher after 3 months (1.5-mm-thick specimens), regardless of the material. In addition, the higher the FS, the higher the ME of the material.

Aging resistant ZTA composite for dental applications: Microstructural, optical and mechanical characterization.

OBJECTIVE: To synthesize a zirconia toughened alumina (ZTA) composite with 70% alumina reinforced by 30% zirconia for dental applications and to characterize its microstructure and optical properties for comparison with the isolated counterpart materials and a first-generation 3Y-TZP. METHODS: Disc-shaped specimens were divided in four groups (n = 70/material): (1) 3YSB-E (first generation 3Y-TZP), (2) Zpex (second generation 3Y-TZP), (3) alumina, and (4) ZTA-Zpex 70/30. After synthesis, ceramic powders were pressed, and green-body samples sintered following a predetermined protocol. Specimens were polished to obtain a mirror surface finish. Apparent density was measured by Archimedes principle. X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to characterize the crystalline content and microstructure. Reflectance tests were performed to determine the contrast-ratio (CR) and translucency-parameter (TP). Mechanical properties were assessed by biaxial flexural strength (BFS) test. All analyses were conducted before and after artificial aging (20 h, 134 °C, 2.2 bar). Optical parameters were evaluated through repeated-measures analysis of variance and Tukey tests (p < 0.05). BFS data were analyzed using Weibull statistics (95% CI). RESULTS: High density values (95-99%) were found for all ceramic materials and SEM images exhibited a dense microstructure. While XRD patterns revealed the preservation of crystalline content in the ZTA composite, an increase in the monoclinic peak was observed for pure zirconias after aging. Significantly higher CR and lower TP values were observed for the ZTA composite, followed by alumina, 3YSB-E, and Zpex. The highest characteristic stress was recorded for 3YSB-E, followed by intermediate values between ZTA and Zpex, and the lowest for alumina. Aging affected the optical and mechanical properties of both zirconias, while remained stable for ZTA composite and alumina. SIGNIFICANCE: The synthesis of experimental 70-30% ZTA composite was successful and its relevance for dental applications relies on its higher masking ability, aging resistance, and strength similar to zirconia.

Wettability and pre-osteoblastic behavior evaluations of a dense bovine hydroxyapatite ceramics.

In this study, the wettability, cell viability, and roughness of an experimental dense bovine hydroxyapatite [Ca10(PO4)6(OH)2] ceramic block were evaluated so that, in the future, it could be used as a base material for dental implants. The results to commercial zirconia and a commercially pure titanium (Ti) alloy were compared. The surface roughness and contact angles were measured. An in vitro evaluation was conducted by means of tests in which pre-osteoblastic MC3T3-E1 cells were placed in indirect and direct contact with these materials. For cell viability, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and crystal violet test were conducted. A qualitative analysis was conducted using variable pressure scanning electron microscopy (SEM). No statistically significant differences were observed in wettability and roughness tests among the groups. In both the MTT assay and crystal violet test, all groups demonstrated satisfactory results without cytotoxicity. SEM showed cell adhesion and cell proliferation results on the material surfaces after 24 h and 48 h. In conclusion, this dense Ca10 (PO4)6(OH)2 ceramic can be considered as a potential biocompatible material.