The accuracy and precision of wear testing and wear facet analyses: The two sides of the story.

A critical examination of the literature for dental wear publications highlighted three distinct areas, clinical data, laboratory data and the simulation of the clinical situation data. The imprecision of the clinical data values from direct and indirect in vivo methods renders the clinical data compromised at best. Laboratory data showed a focus on finding a correlation between simplistic laboratory abrasive wear resistance studies and established materials science laboratory techniques, but with no actual correlation identified. Replication of the masticatory cycle in the mouth in the form of an oral wear simulator has focussed more on the wear testing devices rather than the wear quantification methods. As a result, the data acquisition variables in the x- and y-planes need to be examined to consider how they can influence the accuracy and precision of the laboratory wear measurements recorded in the dental literature. The current approach was undertaken using the teaching tool outlined in "The First Three Questions".

Strength-limiting damage in lithium silicate glass-ceramics associated with CAD-CAM.

OBJECTIVE: The fabrication of all-ceramic restorations using Computer Aided Design and Computer Aided Manufacturing (CAD-CAM) most commonly involves subtractive machining which results in strength-limiting, surface and sub-surface damage in the resultant prosthesis. The objective was to explore how clinically relevant machining-process variables, and material variables, affect damage accumulation in lithium silicate glass-ceramics. METHODS: Three commercial lithium silicate glass-ceramics (IPS e.max® CAD, Celtra® Duo and Vita Suprinity®) were selected. For each material, two groups of disk-shaped specimens were fabricated (n=15), using a CAD-CAM process, creating surfaces equivalent to those generated for a dental restoration, or alternatively, using a highly controlled laboratory process generating disk-shaped test specimens with a consistent polished surface. Bi-axial flexure strength (BFS) was determined in a ball-on-ring configuration and fractographic analyses performed. For each material BFS was correlated with machining sequence and with surface roughness. RESULTS: BFS was significantly influenced by material substrate (p<0.01) and by fabrication route (p<0.01). A significant factorial interaction (p<0.01) identified that the magnitude of changes in BFS when comparing the two specimen fabrication routes, was dependent on substrate type. The polished control specimens exhibited a significantly increased BFS when compared with the CAD-CAM counterparts for all materials. IPS e.max® CAD and Celtra® Duo showed a 44 and 46% reduction in mean BFS for the CAD-CAM specimens when compared with the polished counterparts, respectively. In contrast, Vita Suprinity® showed the least disparity in mean BFS (21%) but the greatest variance in BFS data. SIGNIFICANCE: All CAD-CAM specimens showed evidence of machining introduced damage in the form of median and radial cracks at sites either coincident with, or peripheral to the failure origin. Subtractive machining introduced significant strength limiting damage that is not eliminated by heat treatments applied for either microstructure development (IPS e.max® CAD and Vita Suprinity®) or annealing/crack blunting (Celtra® Duo).

Favorable residual stress induction by resin-cementation on dental porcelain.

OBJECTIVES: Despite developments in polycrystalline ceramics, glassy dental-ceramic materials provide the optimum cosmetic option in most clinical situations to mimic the natural dentition. The clinical success of glassy dental-ceramic materials is often attributed to resin-adhesive bonding techniques. In this study we explore whether shrinkage stresses generated on photo-polymerisation of the resin-cement are sufficient to induce ceramic surface defect stabilization, and we quantify the transient nature of the induced stresses. METHODS: Stress-induced changes in a feldspathic ceramic over a range of thicknesses (0.5-2.0mm: n=20 per thickness) were measured using a profilometric technique at baseline for each disc-shaped specimen (mean of the maximum deflection (δbaseline)) and again following polymerisation of a controlled resin-cement thickness on the contra-lateral surface. Measurements were repeated at 30, 60, 90 and 1440min following photo-polymerization (δ30, δ60, δ90 and δ1440, respectively) before bi-axial flexure strength (BFS) determination at 24h. RESULTS: A repeated measures ANOVA and post-hoc Bonferroni tests determined that δ1440 was significantly different from δbaseline (p=0.02), δ30 (p<0.01) and δ60 (p<0.01) but not δ90 (p=0.61). Data exploration revealed that there were differences in directionality of the independent variable (mean of the maximum deflection (δ)) with a proportion of specimens increasing in deflection and others reducing. The directionality of the effect strongly correlated with the BFS values. Where δ1440-δbaseline was low and/or negative, BFS values were also low. High BFS values were observed when δ1440-δbaseline was large and positive (indirectly inferring high shrinkage-stress-induced-deformation). SIGNIFICANCE: A link between shrinkage stresses associated with the photo-polymerization of dental resin-based cements and the reinforcement of dental porcelain has clearly been established.

Implications of resin-based composite (RBC) restoration on cuspal deflection and microleakage score in molar teeth: Placement protocol and restorative material.

OBJECTIVE: To assess the cuspal deflection of standardised large mesio-occluso-distal (MOD) cavities in third molar teeth restored using conventional resin-based composite (RBC) or their bulk fill restorative counterparts compared with the unbound condition using a twin channel deflection measuring gauge. Following thermocycling, the cervical microleakage of the restored teeth was assessed to determine marginal integrity. METHODS: Standardised MOD cavities were prepared in forty-eight sound third molar teeth and randomly allocated to six groups. Restorations were placed in conjunction with (and without) a universal bonding system and resin restorative materials were irradiated with a light-emitting-diode light-curing-unit. The dependent variable was the restoration protocol, eight oblique increments for conventional RBCs or two horizontal increments for the bulk fill resin restoratives. The cumulative buccal and palatal cuspal deflections from a twin channel deflection measuring gauge were summed, the restored teeth thermally fatigued, immersed in 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage score. RESULTS: The one-way analysis of variance (ANOVA) identified third molar teeth restored using conventional RBC materials had significantly higher mean total cuspal deflection values compared with bulk fill resin restorative restoration (all p<0.0001). For the conventional RBCs, Admira Fusion (bonded) third molar teeth had significantly the lowest microleakage scores (all p<0.001) while the Admira Fusion x-tra (bonded) bulk fill resin restored teeth had significantly the lowest microleakage scores compared with Tetric EvoCeram Bulk Fill (bonded and non-bonded) teeth (all p<0.001). SIGNIFICANCE: Not all conventional RBCs or bulk fill resin restoratives behave in a similar manner when used to restore standardised MOD cavities in third molar teeth. It would appear that light irradiation of individual conventional RBCs or bulk fill resin restoratives may be problematic such that material selection is vital in the absence of clinical data.

The impact of resin-coating on sub-critical crack extension in a porcelain laminate veneer material.

OBJECTIVES: Characterisation of the interaction between crack extension, crack stabilisation and stress/strain relaxation in the polymeric matrix, the interplay between stress corrosion cracking and the mechanical response of a resin-based luting adhesive within a surface defect population could extend PLV restoration longevity by optimising cementation protocols. The aim was to investigate the influence of stress corrosion cracking and the viscoelastic behaviour of a resin-based luting adhesive independently by controlling the environmental conditions operative during test specimen fabrication. METHODS: The effects of stress corrosion at ceramic crack tips and potential viscoelastic responses to loading of the resin-coated impregnating cracks were isolated. Resin-coated feldspathic ceramic test specimens were fabricated in ambient humidity or following moisture exclusion. Bi-axial flexure strengths of groups (n = 20) were determined at constant loading rates of 2.5, 10, 40, 160 or 640 N/min and data was compared with uncoated controls. Fractographic analyses were performed on all fractured test specimens. RESULTS: Resin-cement coating resulted in significant ceramic strengthening in all conditions tested (p < 0.01). A two-way ANOVA demonstrated that the exclusion of moisture during resin- coating significantly increased mean BFS (p<0.01) but post-hoc Tukey tests identified that moisture exclusion resulted in significant increases in BFS values only at intermediate loading rates with no significant differences observed at either the fastest or slowest loading rates (640 and 2.5 N/min, respectively). SIGNIFICANCE: Mechanical reinforcement of PLV materials by resin-cement systems is yet to be optimized. The viscoelastic behavior of the resin-cement itself can influence the magnitude of reinforcement observed and sub-critical crack growth.

An approach to understanding tribological behaviour of dental composites through volumetric wear loss and wear mechanism determination; beyond material ranking.

OBJECTIVE: To investigate the fundamental wear mechanisms of six resin-based composite (RBC) formulations during short-term in vitro wear testing. MATERIALS: RBC materials were condensed into rectangular bar-shaped specimens and light irradiated using the ISO 4049 specimen manufacture and irradiation protocol. Wear testing (n=10 specimens for each RBC) was performed on a modified pin-on-plate wear test apparatus and wear facets were analysed for wear volume loss using a white light profilometer. The wear tested RBC specimens and their corresponding antagonists were analysed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS), respectively to determine the wear mechanism. RESULTS: Data generated using the profilometer showed variations in the mean total wear volume (mm3) between the RBCs tested (p<0.05). Abrasive wear was evident in all RBCs investigated with varying degrees of damage. Material transfer/deposition of the filler particles on the corresponding antagonists was evident in two RBC materials (Filtek Supreme and Kalore) indicative of a further adhesive wear mechanism. CONCLUSION: It is proposed that the approach employed to use a combination of measurement and analytical techniques to quantify the wear facet volume (profilometry), wear trough (SEM) and material transfer (EDS) provides more useful information on the wear mechanism and the tribology of the system rather than relying on a simple wear ranking for the RBC materials as is routinely the case in dental research studies.

Data acquisition variability using profilometry to produce accurate mean total volumetric wear and mean maximum wear depth measurements for the OHSU oral wear simulator.

OBJECTIVE: To identify the minimum data acquisition variables in the x- and y-planes required when using three-dimensional (3D) profilometry to produce accurate mean total volumetric wear and mean maximum wear depth measurements for a range of wear facets produced by an oral wear simulator. METHODS: The Oregon Health Science University (OHSU) oral wear simulator was employed to wear an experimental resin-based composite formulation from 25,000 to 400,000 wear cycles. Mean total volumetric wear and mean maximum wear depth were determined using a contact profilometry at a measurement speed of 1mm/s. An area (8mm length and 4mm width) was profiled on each wear facet comprising 8001 horizontal traces (y-axis at 1µm intervals) with 4001 measurement points (x-axis at 1µm intervals) resulting in 32,012,001 measurement points with a z-axis resolution of 40nm. The minimum x- and y-axis spacing data acquisition requirement were assessed using the TalyMap software by reducing the number of measurement points in the original scanned wear facets and normalized data were converted to percentage values. RESULTS: Minimum x- and y-axis spacing to achieve an accuracy of 99, 95 and 90% of the mean total volumetric wear value for the wear facets produced (25,000-400,000 wear cycles) were 20µm×20µm, 100µm×100µm and 200µm×200µm, respectively but for maximum wear depth data normalized with respect to the 'true value or gold standard' the x- and y-axis spacing requirement varied with the size of the wear facet. SIGNIFICANCE: The study emphasizes the difficulty in employing mean maximum wear depth measurements when assessing the in vitro wear facets produced by an OHSU oral wear simulator and accurate quantification of the mean total volumetric wear of a wear facet is a prerequisite to informing the profession about dental restorative wear performance.

The Histone-Deacetylase-Inhibitor Suberoylanilide Hydroxamic Acid Promotes Dental Pulp Repair Mechanisms Through Modulation of Matrix Metalloproteinase-13 Activity.

Direct application of histone-deacetylase-inhibitors (HDACis) to dental pulp cells (DPCs) induces chromatin changes, promoting gene expression and cellular-reparative events. We have previously demonstrated that HDACis (valproic acid, trichostatin A) increase mineralization in dental papillae-derived cell-lines and primary DPCs by stimulation of dentinogenic gene expression. Here, we investigated novel genes regulated by the HDACi, suberoylanilide hydroxamic acid (SAHA), to identify new pathways contributing to DPC differentiation. SAHA significantly compromised DPC viability only at relatively high concentrations (5 µM); while low concentrations (1 µM) SAHA did not increase apoptosis. HDACi-exposure for 24 h induced mineralization-per-cell dose-dependently after 2 weeks; however, constant 14d SAHA-exposure inhibited mineralization. Microarray analysis (24 h and 14 days) of SAHA exposed cultures highlighted that 764 transcripts showed a significant >2.0-fold change at 24 h, which reduced to 36 genes at 14 days. 59% of genes were down-regulated at 24 h and 36% at 14 days, respectively. Pathway analysis indicated SAHA increased expression of members of the matrix metalloproteinase (MMP) family. Furthermore, SAHA-supplementation increased MMP-13 protein expression (7 d, 14 days) and enzyme activity (48 h, 14 days). Selective MMP-13-inhibition (MMP-13i) dose-dependently accelerated mineralization in both SAHA-treated and non-treated cultures. MMP-13i-supplementation promoted expression of several mineralization-associated markers, however, HDACi-induced cell migration and wound healing were impaired. Data demonstrate that short-term low-dose SAHA-exposure promotes mineralization in DPCs by modulating gene pathways and tissue proteases. MMP-13i further increased mineralization-associated events, but decreased HDACi cell migration indicating a specific role for MMP-13 in pulpal repair processes. Pharmacological inhibition of HDAC and MMP may provide novel insights into pulpal repair processes with significant translational benefit. J. Cell. Physiol. 231: 798-816, 2016. © 2015 Wiley Periodicals, Inc.

Assessment of wear facets produced by the ACTA wear machine.

OBJECTIVE: To investigate the use of a three-dimensional (3D) digital scanning method in determining the accuracy of the wear performance parameters of resin-based composites (RBCs) determined using a two-dimensional (2D) analogue methodology following in-vitro testing in an Academisch Centrum for Tandheelkunde Amsterdam (ACTA) wear machine. METHODS: Specimens compatible with the compartments of the ACTA wear machine specimen wheel (n=10) were prepared from one commercial and four experimental RBCs. The RBC specimens were rotated against an antagonist wheel in a food-like slurry for 220,000 wear cycles. The mean wear depth was measured using the traditionally employed 2D and compared with the 3D profilometric (digital) techniques. Data were submitted to analyses of variance, Tukey's post hoc tests and Independent Samples Student's t-tests (where appropriate) at p<0.05. RESULTS: The RBC rank achieved for mean wear depth calculations were similar whether the 2D or 3D techniques were employed. However, the mean wear depth values obtained from the 3D digital technique were significantly increased for two of the five RBC materials compared with the 2D methodology. The total volumetric wear data provided an assessment of the potential of the experimental RBC formulations for clinical usage. CONCLUSION: The 3D technique allowed for the assessment of mean maximum wear depth and mean total volumetric wear which enables tribological analyses of the wear facet and therefore the wear mechanisms operative. Employing the 2D profile technique ranks RBC materials in terms of in-vitro wear performance. CLINICAL SIGNIFICANCE: Confidence in the wear volume measurements can only be achieved if the wear facet is analysed with sufficient resolution using a 3D digital measurement technique. However, the employment of 2D profilers is useful when screening potential new RBC formulations for the restoration of posterior dentition.

Transcriptional profiling of suberoylanilide hydroxamic acid (SAHA) regulated genes in mineralizing dental pulp cells at early and late time points.

Dental pulp tissue can be damaged by a range of irritants, however, if the irritation is removed and/or the tooth is adequately restored, pulp regeneration is possible (Mjör and Tronstad, 1974 [1]). At present, dental restorative materials limit healing by impairing mineralization and repair processes and as a result new biologically-based materials are being developed (Ferracane et al., 2010 [2]). Previous studies have highlighted the benefit of epigenetic modification by histone deacetylase inhibitor (HDACi) application to dental pulp cells (DPCs), which induces changes to chromatin architecture, promoting gene expression and cellular-reparative events (Duncan et al., 2013 [3]; Paino et al., 2014 [4]). In this study a genome-wide transcription profiling in epigenetically-modified mineralizing primary DPC cultures was performed, at relatively early and late time-points, to identify differentially regulated transcripts that may provide novel therapeutic targets for use in restorative dentistry. Here we provide detailed methods and analysis on these microarray data which has been deposited in Gene Expression Omnibus (GEO): GSE67175.

In vitro comparison of polymerisation kinetics and the micro-mechanical properties of low and high viscosity giomers and RBC materials.

OBJECTIVES: The study aims to characterise a low and high viscosity giomer bulk fill resin restorative with established low and high viscosity resin-based composite (RBC) restoratives at simulated clinical relevant specimen depths. METHODS: The irradiance of a light curing unit (Bluephase 20i) was measured on a laboratory-grade spectrometer at distances up to 10mm from the light tip (in 1mm increments). Polymerization kinetics (real-time decrease of CC double bond and degree of cure, DC) and micro-mechanical properties (Vickers hardness/HV; Depth of cure/DOC; Indentation modulus/E) were assessed at varying specimen depths (0.1-6mm in 100µm steps for E, DOC and HV and 0.1, 2, 4 and 6mm for DC) for a 20s irradiation. RESULTS: One and two-way ANOVA (α=0.05) were performed. The parameter material has a significant (p<0.001) effect on DC (ηP(2)=0.839), HV (ηP(2)=0.683), and E (ηP(2)=0.536), whereas the specimen depth influenced only DC (ηP(2)=0.584) but not HV (p=0.093) or E (p=0.133). The polymerisation kinetic could be described by an exponential sum function, distinguishing between the gel and the glass phase. The hardness drop out was lower than 20%, indicated a depth of cure of 6mm for all materials. CONCLUSIONS: The low and high viscosity giomer bulk-fill restoratives fulfil the requirements of bulk-fill placement, since under the analysed irradiation conditions an adequate depth of cure of >4mm was identified. Variation of DC with specimen depth was low, with little variation at specimen depths of <4mm. The micro-mechanical properties of the giomer materials were higher compared with the conventional RBC materials.

Fracture toughness testing: A discriminatory mechanical testing performance indicator for glass-ionomer restoratives?

OBJECTIVES: To investigate the single-edge notched (SEN) bend fracture toughness (KIC) testing methodology as a reproducible and discriminatory mechanical testing protocol for encapsulated and hand-mixed glass-ionomers (GI). METHODS: SEN bend test-pieces (35.0±0.1mm length, 6.0±0.1mm width, 3.0±0.1mm thickness with a sharp notch formed at mid-length by embedding a scalpel blade) were prepared for KIC testing using three encapsulated GI products (Chemfil Rock, Fuji IXGP Fast Capsule and Ionofil Molar AC). In addition, test-pieces were prepared from a hand-mixed GI product (Ionofil Molar) which contained between 100% and 20% of the manufacturer's recommended powder content (in 10% decrements) for a constant weight of liquid. Groups of 20 test-pieces were prepared for each encapsulated GI product (n=3) and hand-mixed GI powder:liquid mixing ratio (n=9). Data were statistically analyzed and the coefficients of variation (CoV) determined for each encapsulated GI product and hand-mixed GI powder:liquid mixing ratio. RESULTS: The KIC testing methodology failed to discriminate between the encapsulated GI products that were investigated (p=0.225). For the hand-mixed GI, the KIC testing methodology also failed to discriminate between the powder:liquid mixing ratios investigated (R(2)=0.576). The pooled CoV (10%) for the encapsulated GI products and for the powder:liquid mixing ratio groups (12%) identified the reproducibility of the test for this experiment. For the hand-mixed GI mixing ratio groups with between 100% to 50% of the recommended powder content, no trend could be discerned. SIGNIFICANCE: The KIC testing methodology failed to discriminate between different encapsulated GI products and hand-mixed GI powder:liquid mixing ratio groups investigated, despite KIC being an intrinsic material property and the coefficient of variation being acceptable.

Conventional glass-ionomer materials: A review of the developments in glass powder, polyacid liquid and the strategies of reinforcement.

OBJECTIVES: The development of glass-ionomers (GIs) from the earliest experimental GI formulations to the modern day commercially available GIs was reviewed. The aim of the review was to identify the developments in the glass powder and polyacid liquid constituents of GIs since their inception in the late 1960s. DATA: The glass powder has undergone major changes from the earliest GI powder formulation (G200) in an effort to enhance the reactivity with the polyacid liquid. The GI liquids have also been optimised by the manufacturers in terms of polyacid composition, molecular weight and concentration to improve the handling characteristics. Despite these developments in the glass powder and polyacid liquid constituents, GIs cannot 'truly' be advocated for the restoration of posterior dentition due to the poor mechanical properties when compared with dental amalgam and resin-based composites (RBCs). SOURCES: Various attempts to improve the mechanical properties of GIs through substitution of reinforcing fillers to the GI powder or modification of the GI liquid were identified in the dental literature. Despite the claimed improvements in mechanical properties of the modified GIs, a wide variation in mixing and testing conditions was identified which prevented a valid assessment of the reported reinforcement strategies. When investigating a GI reinforcement strategy it is crucial that the mixing and testing conditions are standardised to allow a valid comparison between studies. STUDY SELECTION: The dental literature reporting the earliest experimental GIs to modern day commercially available GIs (1969-2015) was reviewed. In addition, full-text publications and abstracts published in English reporting various GI reinforcement strategies were included. CONCLUSION: Nevertheless, major improvements in GI formulations through a reinforcement strategy have yet to be made to enable clinical usage of GIs for the restoration of posterior dentition. CLINICAL SIGNIFICANCE: GIs chemically are inherently weak but bond to sound tooth structure without the need for preconditioning or removal of sound tooth structure such that improvements in the mechanical properties of GIs would be desirable. Although advances have been made through different GI glass powder and polyacid liquid formulations over the past 40 years, further improvements in the mechanical properties of the current GIs are required to be indicated for the restoration of posterior dentition. The literature is replete with reports on GI reinforcement, however, improved reporting and control of mixing and testing conditions are required for a valid assessment of the reinforcement strategies.

Laminated ceramics with elastic interfaces: a mechanical advantage?

OBJECTIVES: As CAD/CAM technologies improve we question whether adhesive lamination of ceramic materials could offer mechanical advantages over monolithic structures and improve clinical outcomes. The aim was to identify whether an adhesive interface (a chemically cured resin-cement) would influence the biaxial flexure strength (BFS) and slow-crack growth in a machinable dental ceramic. METHODS: Monolithic and adhesively laminated (with a chemically cured dimethacrylate resin-cement) feldspathic ceramic discs of identical dimensions were fabricated. BFS testing was performed on the Group A monolithic specimens (n = 20), on Group B laminated specimens with the adhesive interface positioned below the neutral bending axis (n = 20) and Group C laminated specimens with the adhesive interface positioned above the neutral bending axis (n = 20). To study subcritical crack growth additional laminated specimens received controlled indentations and were exposed to thermo-mechanical fatigue. BFS data was analysed using parametric statistics (α = 0.05). Fractographic analyses were qualitatively assessed. RESULTS: No significant differences between the mean BFS data of Groups A and B were observed (p = 0.92) but the mean BFS of Group C was slightly reduced (p < 0.01). Lamination reduced the stiffness of the structure and fractographic analysis demonstrated that energy consuming crack deflection occurred. Thermo-mechanical fatigue caused subcritical extension of radial cracks associated with indentations adjacent to the adhesive interface. Crack growth was limited to parallel to the interface and was arrested or deflected in a direction normal to the interface. CONCLUSIONS: Ceramic lamination increased the damage tolerance of the structure and could limit or arrest subcritical crack growth at regions near the 'interlayer'. CLINICAL SIGNIFICANCE: Lamination of a dental ceramic with a polymeric 'interlayer' could offer toughening effects which could potentially delay or arrest sub-critical crack growth at regions near the interface and thereby improve restoration longevity.

Bulk fill restoratives: to cap or not to cap--that is the question?

OBJECTIVES: To assess the cuspal deflection and cervical microleakage scores of standardised large mesio-occlusal-distal (MOD) cavities filled with different restoration protocols: (1) conventional resin restoratives, (2) bulk fill flowable base materials 'capped' with a conventional dimethacrylate resin-based composite (RBC) or (3) bulk fill resin restorative materials. METHODS: Standardised MOD cavities were prepared in sixty-four sound maxillary premolar teeth and randomly allocated to eight groups. Restorations were placed in conjunction with a universal bonding system and resin restorative materials were irradiated with a quartz-tungsten-halogen light-curing-unit. Restoration protocol (eight oblique increments of conventional resin restorative, bulk fill flowable base and two occlusal 'capping' RBC increments (three increments in total) or bulk fill resin restorative (two increments)) was the dependent variable. A twin channel deflection measuring gauge measured the buccal and palatal cuspal deflections. Teeth were thermally fatigued, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage score. RESULTS: Post hoc Tukey's tests highlighted significant differences in the mean total cuspal deflection values between resin restoratives (p < 0.0001) and restoration protocol (p < 0.005). In general (albeit product dependently), an increase in mean total cuspal deflection and concomitant decrease in cervical microleakage score was evident for bulk fill flowable base materials with occlusal 'capping' RBC increments (restoration protocol 2) compared with bulk fill resin restoratives (restoration protocol 3). CONCLUSIONS: Not all bulk fill flowable materials or bulk fill resin restoratives behave in a similar fashion when used to restore standardised MOD cavities in maxillary premolar teeth and material selection is vital in the absence of clinical data. CLINICAL SIGNIFICANCE: Poorly performing bulk fill flowable materials or bulk fill restoratives can be identified using the cuspal deflection and cervical microleakage protocol which could save the complications encountered clinically when restoring Class II restorations.

A discriminatory mechanical testing performance indicator protocol for hand-mixed glass-ionomer restoratives.

OBJECTIVES: To identify a reproducible and discriminatory mechanical testing methodology to act as a performance indicator for hand-mixed glass-ionomer (GI) restoratives. METHODS: Groups of 20 (five batches of four) cylinders (6.0±0.1 mm height, 4.0±0.1 mm diameter) for compressive fracture strength (CFS) and compressive modulus (CM) testing, bars (25.0±0.1 mm length, 2.0±0.1 mm width, 2.0±0.1 mm thickness) for three-point flexure strength (TFS) and tensile flexural modulus (TFM) testing, discs (13.0±0.1 mm diameter, 1.0±0.1 mm thickness and 10.0±0.1 mm diameter, 3.10±0.03 mm thickness) for biaxial flexure strength (BFS) and Hertzian indentation (HI) testing, respectively, were prepared using a hand-mixed GI restorative manipulated with 100-20% (in 10% increments) of the manufacturers recommended powder content for a constant weight of liquid. Data were statistically analyzed at p<0.05, the coefficient of variation (CoV) was assessed for the four tests at each powder:liquid mixing ratio investigated (n=9) and a Weibull analysis performed on the CFS, TFS and BFS data to assess the reliability of the data sets. The failure mode and fracture origin of the HI specimens was assessed by fractography. RESULTS: For the hand-mixed GI restorative, a progressive reduction in the powder content (by 10% for a constant weight of liquid) resulted in a progressive linear deterioration (p<0.001) in the CFS (R2=0.957), CM (R2=0.961) and TFM (R2=0.982) data. However, no linear deterioration (p>0.05) was identified for the TFS (R2=0.572), BFS (R2=0.81) and HI (R2=0.234). The CoV and Weibull data identified distinct regions--three for the CFS and TFS data and two for the BFS data sets, within the range of powder:liquid mixing ratios investigated. Fractographic analysis of HI specimens revealed a transition in failure mode from bottom-initiated radial cracking to top-initiated cone cracking on reducing the powder content for a constant weight of liquid. SIGNIFICANCE: The CFS test is the only discriminatory performance indicator for hand-mixed GIs from amongst the four mechanical testing approaches (CFS, TFS, BFS and HI) investigated. The CM and TFM represent an intrinsic material property independent of specimen dimensions and may be used as an adjunct to a mechanical testing approach when investigating hand-mixed GIs.

Advances in dental materials.

The dental market is replete with new resorative materials marketed on the basis of novel technological advances in materials chemistry, bonding capability or reduced operator time and/or technique sensitivity. This paper aims to consider advances in current materials, with an emphasis on their role in supporting contemporary clinical practice.

The adhesive potential of dentin bonding systems assessed using cuspal deflection measurements and cervical microleakage scores.

OBJECTIVES: To assess the cuspal deflection and cervical microleakage of standardized mesio-occluso-distal (MOD) cavities restored with a dimethacrylate resin-based-composite (RBC) placed with one 3-step, one 2-step and three 1-step bonding systems and compared with the unbound condition. METHODS: Forty-eight sound maxillary premolar teeth with standardized MOD cavities were randomly allocated to six groups. Restoration was performed in eight oblique increments using a quartz-tungsten-halogen (QTH) light curing unit (LCU) with the bonding condition as the dependent variable. Buccal and palatal cuspal deflections were recorded post-irradiation using a twin channel deflection measuring gauge at 0, 30, 60 and 180s. Following restoration, the teeth were thermocycled, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage assessment. RESULTS: The mean total cuspal deflection measurements with the one 3-step, one 2-step and three 1-step bonding systems were 11.26 (2.56), 10.95 (2.16), 10.03 (2.05) (Futurabond(®) DC SingleDose), 6.37 (1.37) (Adper™ Prompt™ L-Pop™), 8.98 (1.34) µm (All-Bond SE(®)), respectively when compared with the unbound condition (6.46 (1.88) µm) The one-way ANOVA of the total cuspal deflection measurements identified statistical differences (p<0.001) between groups. Cervical microleakage scores significantly increased (p<0.001) for the negative control (unbound condition) when compared with teeth restored with a bonding system although differences between the bonding systems were evident (p<0.001). SIGNIFICANCE: The cuspal deflection and cervical microleakage protocol reported offers an opportunity to test the bonding technologies available to practitioners for RBCs. Poorly performing adhesives can be identified which indicated the technique may be useful as a screening tool for assessing existing and new bonding technologies which offers the potential to limit complications routinely encountered with Class II RBC restorations.

The reliability of Little's Irregularity Index for the upper dental arch using three dimensional (3D) digital models.

AIM: To investigate the inter-examiner variability of contact point displacement measurements (used to calculate the overall Little's Irregularity Index (LII) score) from digital models of the maxillary arch by four independent examiners. METHODS: Maxillary orthodontic pre-treatment study models of ten patients were scanned using the Lava(tm) Chairside Oral Scanner (LCOS) and 3D digital models were created using Creo(®) computer aided design (CAD) software. Four independent examiners measured the contact point displacements of the anterior maxillary teeth using the software. Measurements were recorded randomly on three separate occasions by the examiners and the measurements (n=600) obtained were analysed using correlation analyses and analyses of variance (ANOVA). RESULTS: LII contact point displacement measurements for the maxillary arch were reproducible for inter-examiner assessment when using the digital method and were highly correlated between examiner pairs for contact point displacement measurements >2mm. The digital measurement technique showed poor correlation for smaller contact point displacement measurements (<2mm) for repeated measurements. The coefficient of variation (CoV) of the digital contact point displacement measurements highlighted 348 of the 600 measurements differed by more than 20% of the mean compared with 516 of 600 for the same measurements performed using the conventional LII measurement technique. CONCLUSIONS: Although the inter-examiner variability of LII contact point displacement measurements on the maxillary arch was reduced using the digital compared with the conventional LII measurement methodology, neither method was considered appropriate for orthodontic research purposes particularly when measuring small contact point displacements.

Cuspal deflection and cervical microleakage scores to determine the adhesive potential of universal bonding systems.

OBJECTIVES: To assess the adhesive performance of three universal bonding systems (self-etch and total-etch protocols) with cuspal deflection and cervical microleakage score. METHODS: Fifty-six standardised sound maxillary premolar teeth with uniform mesio-occlusal-distal (MOD) cavities were randomly allocated to six groups. Restoration with resin-based composite (RBC) was performed in conjunction with a universal bonding system facilitated by a quartz-tungsten-halogen light-curing-unit. The dependent variable was the universal bonding protocol (self-etch or total-etch). Buccal and palatal cuspal deflections were recorded at 0, 30, 60 and 180s post-irradiation using a twin channel deflection measuring gauge. Following restoration, the teeth subjected to 500 thermocycles, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage. RESULTS: Comparing between bonding protocol (self-etch or total-etch), a decrease in total cuspal deflection and a concomitant increase in cervical microleakage were evident when employing the total-etch compared with the self-etch protocol for two of the three universal dental adhesives. CONCLUSIONS: The 'Adhesion-Decalcification concept' suggests a trend towards 'mild self-etch' adhesives. Differences in adhesive performance (cuspal deflection and cervical microleakage) between the teeth restored using the self-etch or total-etch protocols is suggested to be a result of the pH of the self-etch solutions. 'Mild self-etch' (pH∼2.0) adhesives out-performed ultra-mild (pH>2.5) or strong (pH<1.5) self-etch solutions. CLINICAL SIGNIFICANCE: Poorly performing adhesives could be identified using the cuspal deflection and cervical microleakage protocol reported which could save the complications encountered clinically with Class II RBC restorations.