Cytotoxicity and genotoxicity of a low-shrinkage monomer and monoacylphosphine oxide photoinitiator: Comparative analyses of individual toxicity and combination effects in mixtures.

OBJECTIVE: To compare cytotoxicity and genotoxicity of novel urethane-based monomer FIT-852 and monoacylphosphine oxide photoinitiator (Lucirin TPO) with conventional Bisphenol A-glycidyl-methacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) monomers and camphorquinone (CQ)/amine photoinitiator system, respectively. Moreover, we quantified and analyzed the combinatorial effects of individual substances in resin-based mixtures concerning the nature of the combinatorial effects. METHODS: Cytotoxic and genotoxic effects of BisGMA, FIT, TEGDMA, CQ, DMAEMA and TPO and their combined toxicity in four clinically relevant mixtures (FIT/TPO, FIT/CQ, BisGMA/TPO, BisGMA/CQ) were tested on human fetal lung fibroblasts MRC-5 using MTT and Comet assays. We assessed combination effects of monomers and photoinitiators on overall toxicity from the measured concentration-effect relationships. Combination index (CI) was calculated on the basis of the median-effect equation derived from the mass-action law principle. RESULTS: Individual substances showed decreasing cytotoxic effects in the following order: BisGMA>TPO>FIT>CQ>DMAEMA>TEGDMA. Experimental mixtures showed decreasing cytotoxic effects in the order BisGMA/TPO>BisGMA/CQ>FIT/CQ>FIT/TPO. FIT-based mixtures exhibited antagonistic cytotoxic effects between components while BisGMA-based mixtures demonstrated synergistic effects at ED50. TPO amplified both antagonistic and synergistic cytotoxic effects in mixtures. Pure substances showed genotoxicity in the following order: TPO>BisGMA>FIT>CQ>TEGDMA. We did not detect the genotoxic potential of DMAEMA. The rank of genotoxic concentrations of the mixtures was: BisGMA/TPO>BisGMA/CQ>FIT/CQ>FIT/TPO. SIGNIFICANCE: Lower cytotoxicity and genotoxicity of FIT than BisGMA suggests its greater biocompatibility. Conversely, photoinitiator TPO was significantly more cytotoxic and genotoxic than both CQ and DMAEMA. CI values showed that components of FIT-based mixtures exhibit an antagonistic cytotoxic effect, while compontents of BisGMA-based mixtures show synergism.

Refractive indices of unfilled resin mixtures and cured composites related to color and translucency of conventional and low-shrinkage composites.

This study correlated the refractive indices (RIs) of unfilled resin mixtures and resin-based composites (RBCs) with color and translucency of conventional and low-shrinkage RBCs. Unfilled resin mixtures based on different ratios of conventional monomers Bisphenol A-glycidyl-methacrylate (BisGMA)/triethyleneglycol-dimethacrylate (TEGDMA) and urethane-dimethacrylate (UDMA)/TEGDMA and a low-shrinkage monomer FIT-852 (FIT, Esstech Inc.)/TEGDMA were used to prepare model RBCs, containing 30 wt % of the organic matrix and 70 wt % of silanated barium-glass fillers (n = 1.553, Esstech Inc.). The RIs of resins were measured on an ABBE refractometer, those of cured RBCs using the Becke-line method in immersion oils. Color and translucency were determined using an AvaSpec-2048 (Avantes BV) spectrometer. The RIs of unfilled resin mixtures decreased with increasing amounts of TEGDMA. Cured RBCs had higher RIs than their respective resin mixtures. BisGMA-based composites were more translucent with significantly lower L* values than FIT- and UDMA-based RBCs. The RIs of unfilled resins positively correlated with cured RBCs (p = 0.001), as did the RIs with translucency (p = 0.001) and color (p = 0.008). Resin mixtures and corresponding RBCs based on UDMA and its modified low-shrinkage version, FIT, showed similar optical properties. The RIs of unfilled resins appeared to be good predictors of the RIs of cured RBCs. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 7-13, 2017.

Local deformation fields and marginal integrity of sculptable bulk-fill, low-shrinkage and conventional composites.

OBJECTIVE: To compare strain and displacement of sculptable bulk-fill, low-shrinkage and conventional composites as well as dye penetration along the dentin-restoration interface. METHODS: Modified Class II cavities (N=5/group) were filled with sculptable bulk-fill (Filtek Bulk Fill Posterior, 3M ESPE; Tetric EvoCeram Bulk Fill, Ivoclar Vivadent; fiber-reinforced EverX Posterior, GC; giomer Beautifil Bulk, Schofu), low-shrinkage (Kalore, GC), nanohybrid (Tetric EvoCeram, Ivoclar Vivadent) or microhybrid (Filtek Z250, 3M ESPE) composites. Strain and displacement were determined using the 3D digital image correlation method based on two cameras with 1µm displacement sensitivity and 1600×1200 pixel resolution (Aramis, GOM). Microleakage along dentin axial and gingival cavity walls was measured under a stereomicroscope using a different set of teeth (N=8/group). Data were analyzed using analyses of variance with Tukey's post-test, Pearson correlation and paired t-test (α=0.05). RESULTS: Strain of TEC Bulk, Filtek Bulk, Beautifil Bulk and Kalore was in the range of 1-1.5%. EverX and control composites showed 1.5-2% strain. Axial displacements were between 5µm and 30µm. The least strain was identified at 2mm below the occlusal surface in 4-mm but not in 2-mm layered composites. Greater microleakage occurred along the gingival than axial wall (p<0.05). No correlation was found between strain/displacements and microleakage axially (r2=0.082, p=0.821; r2=-0.2, p=0.605, respectively) or gingivally (r2=-0.126, p=0.729, r2=-0.278, p=0.469, respectively). SIGNIFICANCE: Strain i.e. volumetric shrinkage of sculptable bulk-fill and low-shrinkage composites was comparable to control composites but strain distribution across restoration depth differed. Marginal integrity was more compromised along the gingival than axial dentin wall.

Changes of Color and Fluorescence of Resin Composites Immersed in Beer.

OBJECTIVE: The aim of this study was to evaluate changes of color and fluorescence of resin based composite exposed to beer. MATERIALS AND METHODS: 84 samples (13 mm in diameter and 1.5 mm thick) of microhybrid composite Gradia DirectTM extra bleach white were immersed in 5 different beers (dark and light) or distilled water. Color and fluorescence were measured prior and after 1-, 7-, and 14-day immersion by Spectrophotometer Thermo Evolution 600 and Fluorolog-3-221 spectrofluorometer. RESULTS: Resin based composites changed color after immersion in beers of different types. Beers with higher optical absorption induced greater color changes. The fluorescence intensity of composites was decreased after immersion in beer, but the shape of fluorescence spectra was not changed. 14-day immersion in Bernard dark beer caused the greatest changes in optical properties of composite: ΔE*=9.0 and 57.6% reduced fluorescence. CONCLUSION: Dark and light beers changed optical properties of resin based composite. The color change come exclusively from the change of chroma. CLINICAL SIGNIFICANCE: To fully meet esthetic criteria when using dental materials in restoration it is crucial to match optical properties of teeth and dental restoration at the moment of placement, but also to keep the match over the time. Considering that staining in beer causes changes in color and fluorescence of composites and that discoloration is a frequent reason for replacement of composite restorations, the data and conclusions on discoloration of dental restorations caused by beer consumption should aid dental professionals when reaching for high esthetics of modern dentistry.(J Esthet Restor Dent 28:330-338, 2016).

Effect of resin and photoinitiator on color, translucency and color stability of conventional and low-shrinkage model composites.

OBJECTIVE: To study the effect of a low-shrinkage methacrylate monomer and monoacylphosphine oxide photoinitiator on color, translucency, and color stability of model resin-based composites (RBCs). METHODS: Four micro-hybrid RBCs were prepared containing barium-glass fillers in bisphenol A-glycidyl-methacrylate (BisGMA) and triethyleneglycol-dimethacrylate (TEGDMA) or urethane-based low-shrinkage monomer FIT-852 (FIT; Esstech Inc.) and TEGDMA matrix. Camphorquinone (CQ)/amine or Lucirin TPO were used as photoinitiators. Commercial low-shrinkage RBCs (Charisma Diamond, Heraeus Kulzer and N'Durance, Septodont) and conventional RBCs (Tetric EvoCeram, Ivoclar Vivadent and Filtek Z250, 3M ESPE) were used as controls. Color and translucency were measured using Thermo Scientific Evolution (Thermo Fisher Scientific) and SpectroShade™ Micro (MHT Optic Research) spectrophotometers. Color stability was evaluated after immersion in black tea (pure, with milk or lemon) and distilled water. Data were analyzed using analyses of variance with Tukey's post-test (α=0.05). RESULTS: Photoinitiators had no significant effect on baseline color. Initially whiter FIT-based RBCs showed greater staining in all staining solutions than BisGMA-based RBCs. TPO-containing RBCs showed better color stability than CQ-containing RBCs irrespective of the base monomer. Tea and tea with lemon induced greatest color changes. Adding milk to tea significantly reduced material staining. SIGNIFICANCE: Urethane-based low-shrinkage monomer FIT and conventional BisGMA affected color, translucency and color stability of their respective RBCs. Despite being used in posterior teeth, low-shrinkage RBCs are expected to have favorable optical and esthetic properties. Manufacturers are urged to provide information on optical properties of monomers and monomer mixtures in their low-shrinkage RBCs to allow understanding of interaction with fillers and photoinitiators.

Effects of a low-shrinkage methacrylate monomer and monoacylphosphine oxide photoinitiator on curing efficiency and mechanical properties of experimental resin-based composites.

This study investigated the degree of conversion, depth of cure, Vickers hardness, flexural strength, flexural modulus and volumetric shrinkage of experimental composite containing a low shrinkage monomer FIT-852 (FIT; Esstech Inc.) and photoinitiator 2,4,6-trimethylbenzoyldiphenylphosphine oxide (TPO; Sigma Aldrich) compared to conventional composite containing Bisphenol A-glycidyl methacrylate (BisGMA) and camphorquinone-amine photoinitiator system. The degree of conversion was generally higher in FIT-based composites (45-64% range) than in BisGMA-based composites (34-58% range). Vickers hardness, flexural strength and modulus were higher in BisGMA-based composites. A polywave light-curing unit was generally more efficient in terms of conversion and hardness of experimental composites than a monowave unit. FIT-based composite containing TPO showed the depth of cure below 2mm irrespective of the curing light. The depth of cure of FIT-based composite containing CQ and BisGMA-based composites with either photoinitiator was in the range of 2.8-3.0mm. Volumetric shrinkage of FIT-based composite (0.9-5.7% range) was lower than that of BisGMA-based composite (2.2-12% range). FIT may be used as a shrinkage reducing monomer compatible with the conventional CQ-amine system as well as the alternative TPO photoinitiator. However, the depth of cure of FIT_TPO composite requires boosting to achieve clinically recommended thickness of 2mm.

Bond strength of restorative materials to hydroxyapatite inserts and dimensional changes of insert-containing restorations during polymerization.

OBJECTIVE: To determine the shear bond strength (SBS) between synthetic controlled porous hydroxyapatite (HAP) inserts and restorative materials and dimensional changes of insert-containing restorations during curing. METHODS: Cylinder-shaped HAP inserts (4mm in diameter, 1.6mm thick) were cemented in dentin discs (5mm×1.6mm), cut mid-coronally from human third molars, using one of the following materials: universal microhybrid composite Filtek Z250, flowable composite Filtek Ultimate or glass-ionomer Vitrebond (all 3M ESPE). SBS of the same materials to HAP inserts was tested in a universal testing machine. Three-dimensional digital image correlation system Aramis (GOM) was used to measure strains and displacements. Data were statistically analyzed using one-way ANOVA with Tukey's post-test (α=0.05). RESULTS: SBS of restorative materials to HAP inserts ranged between 12.2±2.1MPa (Filtek Z250) and 0.7±0.4MPa (Filtek Z250 without an adhesive). The 'total-etch' approach of adhesive application significantly increased SBS of both Filtek Z250 (12.2±2.1MPa) and Filtek Ultimate flowable (9.5±2.5MPa) compared to the 'self-etch' approach (8.2±1.6MPa and 4.4±0.9MPa, respectively) (p<0.05). HAP inserts reduced polymerization shrinkage to below 0.5% as well as displacements in the central region of the restorations. Peripheral shrinkage of restorative materials was similar with and without HAP inserts as were displacements of Filtek Z250 and Vitrebond. SIGNIFICANCE: Replacing major part of dentin clinically, especially in large cavities, HAP inserts may shorten clinical working time, improve dimensional stability of the restoration by reducing central shrinkage and displacements and provide adhesive bonding to universal composites following a 'total-etch' approach.

Mathematical modeling of cross-linking monomer elution from resin-based dental composites.

Elution of potentially toxic substances, including monomers, from resin-based dental composites may affect the biocompatibility of these materials in clinical conditions. In addition to the amounts of eluted monomers, mathematical modeling of elution kinetics reveals composite restorations as potential chronic sources of leachable monomers. The aim of this work was to experimentally quantify elution of main cross-linking monomers from four commercial composites and offer a mathematical model of elution kinetics. Composite samples (n = 7 per group) of Filtek Supreme XT (3M ESPE), Tetric EvoCeram (Ivoclar Vivadent), Admira (Voco), and Filtek Z250 (3M ESPE) were prepared in 2-mm thick Teflon moulds and cured with halogen or light-emitting diode light. Monomer elution in ethanol and water was analyzed using high-performance liquid chromatography up to 28 days postimmersion. The mathematical model was expressed as a sum of two exponential regression functions representing the first-order kinetics law. Elution kinetics in all cases followed the same mathematical model though differences in rate constants as well as the extent of monomer elution were material-, LCU-, medium-dependent. The proposed mechanisms of elution indicate fast elution from surface and subsurface layers and up to 100 times slower monomer extraction from the bulk polymer.

Analysis of local shrinkage patterns of self-adhering and flowable composites using 3D digital image correlation.

OBJECTIVE: To analyze local shrinkage patterns in terms of surface shrinkage strains and z-axis displacements in a novel self-adhering composite and a conventional flowable composite using three-dimensional digital image correlation. METHOD AND MATERIALS: Seven samples of each material were prepared in cylindrical Teflon molds 5 mm in diameter and 2 mm thick. The surface of the composites facing the cameras was sprayed with a fine layer of black paint. The unsprayed surface of each sample, opposite the one facing the cameras, was light cured for 40 seconds using a light-emitting diode unit. Digital images were taken immediately before and after light curing. Shrinkage was calculated as von Mises strains, and z-axis displacements were measured in microns. The data were statistically analyzed using two-way ANOVA at a = .05. RESULTS: No significant difference in strain was observed between the two materials (P > .05). Strain distribution was nonhomogenous--the outer segments showed significantly higher strains than central parts in each material (P < .05). The opposite was observed for z-axis displacements-significantly greater displacements were found in central parts compared to the outer segments (P < .05). CONCLUSION: Different shrinkage vectors across the surface of the tested flowable composites showed predominant in-plane shrinkage of the outer surface segments and out-of-plane shrinkage of the inner segments. These complex local deformation patterns in composite materials indicate zones of different types of forces exerted on the tooth-restoration interface in situ.

Monomer elution from nanohybrid and ormocer-based composites cured with different light sources.

OBJECTIVES: To study monomer elution from four resin-based composites (RBCs) cured with different light sources. METHODS: Twenty-eight premolars were randomly allocated to four groups. Standardized cavities were prepared and restored with a nanohybrid (Filtek Supreme XT or Tetric EvoCeram), an ormocer (Admira) or a microhybrid RBC (Filtek Z250) which served as control. Buccal restorations were cured with a halogen and oral restorations with an LED light-curing unit. Elution of diurethane dimethacrylate (UDMA), Bisphenol A diglycidylether methacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA) and 2-hydroxyethyl methacrylate (HEMA) was analyzed using high-performance liquid chromatography (HPLC) 1h to 28 days post-immersion in 75% ethanol. Data were analyzed using multivariate and repeated measures analysis of variance (α = 0.05). RESULTS: The greatest elution of UDMA and BisGMA occurred from Tetric EvoCeram and the least from Filtek Z250 (p < 0.05). LED and halogen light-curing units gave similar results for all RBCs (p > 0.05) except Tetric EvoCeram which showed greater elution for the LED unit (p < 0.05). TEGDMA was below the limit of quantification. HEMA eluted in similar concentrations from Filtek Supreme and Tetric EvoCeram (p > 0.05). SIGNIFICANCE: The two nanohybrid RBCs eluted more cross-linking monomers than the ormocer and the control microhybrid RBC. Continuous elution over 28 days indicates that RBCs act as a chronic source of monomers in clinical conditions. Light source may affect monomer elution since differences were found for one out of four RBCs. Mathematical models for elution kinetics of UDMA and BisGMA indicated two elution mechanisms.