Resin-composite blocks for dental CAD/CAM applications.

Advances in digital impression technology and manufacturing processes have led to a dramatic paradigm shift in dentistry and to the widespread use of computer-aided design/computer-aided manufacturing (CAD/CAM) in the fabrication of indirect dental restorations. Research and development in materials suitable for CAD/CAM applications are currently the most active field in dental materials. Two classes of materials are used in the production of CAD/CAM restorations: glass-ceramics/ceramics and resin composites. While glass-ceramics/ceramics have overall superior mechanical and esthetic properties, resin-composite materials may offer significant advantages related to their machinability and intra-oral reparability. This review summarizes recent developments in resin-composite materials for CAD/CAM applications, focusing on both commercial and experimental materials.

Bond strengths of nine current dentine adhesive systems to primary and permanent teeth.

The aim of this study was to compare the shear bond strength (SBS) of nine dentine bonding systems (DBS) of different classes to human primary and permanent dentine. Flat dentine occlusal surfaces were produced on human molars (100 primary, 100 permanent) by wet grinding on a 800-grit SiC paper. Nine DBS were applied following the manufacturers' instructions: One total etch multi-step system: Scotchbond Multipurpose Plus (3M/ESPE); Four total etch one-bottle system: Prime &Bond 2.1 (Dentsply), One Step (Bisco), Scotchbond 1 (3M/ESPE), and OptibondSolo Plus (Kerr); Three two-step self-etching primer systems: Clearfil Liner Bond 2 (Kuraray), Clearfil SE Bond (Kuraray), and Prime &Bond NT with NRC (Dentsply); An 'all-in-one' self-etching system: Prompt L-Pop (3M/ESPE). Composite (Z100; 3M/ESPE) cylinders (2 mm diameter, 3 mm high) were polymerized on the treated dentine surfaces and the specimens were stored at 37 degrees C for 24 h prior to testing. Twenty experimental groups were produced and tested. Statistical analysis revealed both a substrate and a bonding system effect. Two adhesive systems (One Step, Prime &Bond NT) had significantly higher bond strengths on permanent than on primary dentine. There was an effect of dentine bonding system on the mode of fracture. Although eight of the 10 DBS tested exhibited higher median SBS values on permanent dentine than on primary dentine, the dependent pairwise comparison identified a significant difference only for two groups. The use of simplified bonding systems does not necessarily result in improved bond strength to primary or to permanent dentine.

Fatigue crack propagation path across the dentinoenamel junction complex in human teeth.

The human tooth structures should be understood clearly to improve clinically used restorative materials. The dentinoenamel junction (DEJ) plays a key role in resisting crack propagation in teeth. The aim of this study was to determine the fracture toughness of the enamel-DEJ-dentin complex and to investigate the influence of the DEJ on the fatigue crack propagation path across it by characterizing fatigue-fractured enamel-DEJ-dentin complexes using optical and scanning electron microscopy. The results of this study showed that the fracture toughness of the enamel-DEJ-dentin complex was 1.50 +/- 0.28 Mpa x m(1/2). Based on the results of this investigation, it was concluded that the DEJ complex played a critical role in resisting crack propagation from enamel into dentin. The DEJ complex is, approximately, a 100 to 150 microm broad region at the interface between enamel and dentin. The toughening mechanism of the DEJ complex may be explained by the fact that crack paths were deflected as cracks propagated across it. Understanding the mechanism of crack deflection could help in improving dentin-composite as well as ceramic-cement interfacial qualities with the aim to decrease the risk of clinical failure of restorations. Both can be viewed as being composed from a layer of material of high strength and hardness bonded to a softer but tougher substratum (dentin). The bonding agent or the luting cement layer may play the critical role of the DEJ in improving the strength of these restorations in clinical situations.

What is a "compomer"?

"Compomers" are recently introduced products marketed as a new class of dental materials. These materials are said to provide the combined benefits of composites (the "comp" in their name) and glass ionomers ("omer"). Based on a critical review of the literature, the author argues that "compomers" do not represent a new class of dental materials but are merely a marketing name given to a dental composite.

Xenoestrogenicity and dental materials.

This paper discusses the xenoestrogenicity of dental materials due to 2,2-bis(4-hydroxyphenyl) propane (Bisphenol-A or BPA) and/or its derivatives. Based on a critical review of the pertinent published literature, the author concludes that there is no reason to change the indications for the clinical application of these dental materials.

Novel fracture toughness test using a notchless triangular prism (NTP) specimen.

The aim of this study was to develop and validate a new method for determining the fracture toughness of materials and adhesive interfaces. The new test specimen is a notchless triangular prism (NTP) which, when placed in the testing holder, achieves a configuration similar to that of the standard chevron-notched short rod (CNSR) specimen. It can be cast, ground, or simply machined easily and reproducibly without cutting an initial notch. Finite element analysis of a modeled NTP specimen loaded in tension showed a stress distribution similar to a CNSR specimen. A very good correlation was obtained between the NTP and CNSR fracture toughness values of poly(methyl methacrylate) during a calibration study. Fracture toughness values similar to those reported in the literature were obtained for several dental materials and one adhesive interface using the NTP test. The fracture patterns were indicative of plane strain conditions during testing. All bulk specimens and most of the adhesive specimens showed crack arrest, which suggested a stable, well-controlled testing procedure. These results suggest that the NTP fracture toughness test can be used to determine the fracture mechanics of bulk materials and adhesive interfaces.

Apical root strain as a function of post extension into a composite resin core.

This study tested the hypothesis that there is no difference in the amount of strain measured in the root of an extracted tooth at the apical end of a prefabricated post, whether a composite resin core completely covers the head of the post or the post is exposed at the occlusal surface of the core. Twenty extracted teeth were measured (1) after endodontic treatment (baseline), (2) after a composite resin core was fabricated over a prefabricated post, and (3) after a cast crown was cemented. The teeth were randomly divided into two groups after baseline testing. In group 1, the post was buried within the core, and in group 2, the head of the post was exposed on the occlusal surface of the core. Analysis of results indicated a statistically significant decrease in strain from the baseline to the crown when 1 mm of composite resin covered the head of the post. However, based on the small strain values measured, the difference may not be clinically significant.

In vitro changes in clips and bars used to retain implant overdentures.

Although implant-retained overdentures are a less expensive alternative to fixed implant-supported prostheses in certain situations, problems with retentive clips fracturing and needing frequent replacement have been reported. This study compared baseline and posttest retention of metal and plastic clip-retained overdenture analogs and monitored surface changes in bars and clips throughout the testing process. A laboratory model was made with two implant analogs processed into an acrylic resin platform to which three bars were fitted. Two overdenture analogs were made and retained on the model with metal or plastic clips. Each bar-clip assembly was subjected to 5500 insertion and removal cycles to simulate 3 years of in vivo insertion and removal. Although the differences in retention between metal and plastic clips and between clips before and after testing were statistically significant, it is questionable whether they are clinically significant. Neither clip fracture nor loss occurred during this study, which suggests that it may be functional or parafunctional loading and not repeated insertion and removal of an implant overdenture that may cause the stated problems.

The effect of amalgam surface preparation on the shear bond strength between composite and amalgam.

The aim of this study was to investigate the effect of amalgam surface preparation on the short-and long-term in vitro shear bond strength between a dental amalgam (Valiant) and two dental composites (Herculite, Z100) mediated by three universal bonding agents (All-Bond 2, Amalgambond, and Scotchbond Multi-Purpose). Cylinders of dental composite resin were formed on, and bonded to flat amalgam surfaces. Prior to bonding, the amalgam surfaces were: a) ground flat, with the grinding lines oriented parallel to the direction of the shear stress; b) ground flat, with the grinding lines oriented perpendicular to the direction of the shear stress; or c) ground flat and then sandblasted using 50 micrometer Al2O3. A computerized Universal Testing Machine was used to determine the 1-, 7-, and 30-day shear bond strength of 162 samples (six per group) that were stored in distilled water at 37 degrees C. The results, which were statistically analyzed by performing a three-way analysis of variance (ANOVA) and 27 one-way ANOVA followed by modified (Bonferroni) t-tests for between-group comparisons (alpha = 0.05), have shown that: 1) sandblasting resulted in higher shear bond strength than grinding, except for 1-day All-Bond 2, where no differences were identified; 2) there was no difference in the shear bond strength between samples with parallel or perpendicular ground surfaces for a given bonding system and storage time; 3) for All-Bond 2, the 7-day shear bond strength of parallel and perpendicular ground samples dropped to half of the 1-day values, while the sandblasted samples showed a constant, high shear bond strength over 30 days, 4) for Amalgambond, the shear bond strength of parallel, perpendicular, and sand blasted samples was constant over 30 days; and 5) for Scotchbond Multi-Purpose, a sharp drop in the 7-day shear bond strength was recorded for all the samples, irrespective of amalgam surface preparation.

In vitro fatigue testing of a dental bonding system on enamel.

The aim of this study was to investigate the in vitro fatigue behavior of a dental bonding system [ScotchBond Multi Purpose (SBMP)] by using a cyclic shear loading test. Cylinders of a light-cured hybrid composite resin (Z100) were formed on, and bonded with SBMP to, the flattened, acid-etched enamel surface of human teeth. Thirty-two samples (eight per group) were used to determine the 1-h, 1-day, 7-day, and 30-day shear bond strengths. For the shear fatigue test, the stress was cycled, at a rate of 1 Hz, between 0 and a present value in the 12-28 MPa range (from -3 SD to +1 SD around the 24-MPa mean bond strength of the 1-h specimens). The applied stress and the number of cycles to failure were recorded for each of the 75 samples tested (15 samples per set-stress). Three stress versus number of cycles curves (low, median, and high S-N curves) were obtained and an approximate endurance limit of 10 MPa was identified for the SBMP bonding system. The data obtained explain, in part, the discrepancy between in vitro and in vivo results and underline the difficulty of predicting the in vivo behavior based on results of in vitro bond strength tests alone. Shear fatigue test data, however, could provide a better insight into the long-term in vivo behavior of a dental bonding system.

Adhesion of a resin composite to bleached and unbleached human enamel.

Cylinders of a visible light-cured microfil resin were formed on and bonded to the flattened enamel surface of 15 human hemisected premolar teeth which had previously been subjected to three different treatments: (a) immersion in 35% hydrogen peroxide (HP) for 60 min, (b) immersion in 35% HP for 60 min followed by storage in distilled water for 1 day prior to resin application, and (c) immersion in saline (S) for 60 min. Specimens were stored in distilled water at 37 degrees C for 7 days prior to shear bond strength testing. A total of 30 specimens were tested. Statistical analysis of the data indicated that there was a highly significant reduction in shear bond strength between HP- and saline-treated specimens. Water storage of HP-treated specimens for 1 day prior to resin application appeared to restore the adhesiveness but not to a point that was statistically significant. Scanning electron microscopic examination of randomly selected, fractured test specimens indicated that the reduction in bond strength may be related to alterations in the ability of the resin to attach itself to the HP-treated surface and to possible effects of the HP on the resin itself.

The effect of carbamide-peroxide gel on the shear bond strength of a microfil resin to bovine enamel.

Cylinders of a visible-light-cured microfil resin were formed on, and bonded to, the flattened labial enamel surfaces of young bovine incisor teeth which had previously been subjected to four different treatments: (1) immersion in 10% carbamide-peroxide gel, pH 4.7, for three h; (2) immersion in 10% carbamide-peroxide gel, pH 4.7, for six h; (3) immersion in 10% carbamide-peroxide gel, pH 7.2, for three h; and (4) immersion in 10% carbamide-peroxide gel, pH 7.2, for six h. For each experimental group, a control group of resin-bonded to saline-immersed teeth was prepared. In addition, two groups, prepared according to treatment 4, were leached in distilled water for one and seven d, respectively, prior to resin application. Specimens were stored in distilled water at 37 degrees C for seven d prior to shear-bond-strength testing. A total of 90 teeth was tested. Statistical analysis of the results indicated that there was a highly significant reduction in the shear bond strength to carbamide-peroxide-treated enamel as compared with that to saline-treated enamel. The effects of duration of peroxide treatment and pH, as well as the interaction term, were not statistically significant. Leaching of the peroxide-treated enamel in water for either one or seven d prior to resin application restored the adhesiveness of the enamel. Scanning electron microscopic examination of randomly selected, fractured test specimens indicated that the peroxide-induced reduction in enamel adhesiveness was related to alterations in both attachment-surface area at the resin-enamel interface and resin quality.

Adhesion to bovine dentin--surface characterization.

X-ray photo-electron spectroscopy (XPS) and secondary ion mass spectrometry (SIMS) were used to characterize the dentin surface, to determine the effects of different pre-conditioning procedures on the elemental composition of the dentin surface, and to investigate the interaction between dentin and a dentin bonding agent (ScotchBond) by studying the changes in the elemental composition of dentin as a result of the interaction. Scanning electron microscopy (SEM) was used to characterize sample surface morphology, which was then correlated with surface elemental composition. The results showed that: (a) the elemental composition of the smear layer was similar to that of the underlying dentin; (b) cleaning with hydrogen-peroxide did not produce any modification in the elemental composition of the dentin surface; and (c) acid-etching led to an almost complete demineralization of the dentin, leaving behind an organic-rich surface. The results suggest that bonding systems that use acid-etching as a pre-conditioning procedure should be based on agents able to interact with the organic components of dentin, since bonding agents that rely on a chelation-to-calcium reaction are unlikely to be successful. The investigation of the interaction between the bonding agent and dentin led to a postulated adhesive-bonding reaction mechanism and suggested a partially cohesive failure in the bonding agent during fracturing of a dentin-bonding-agent-bonded assembly.

Preliminary surface analysis of etched, bleached, and normal bovine enamel.

X-ray photoelectron spectroscopic (XPS) and secondary ion-mass spectroscopic (SIMS) analyses were performed on unground un-pumiced, unground pumiced, and ground labial enamel surfaces of young bovine incisors exposed to four different treatments: (1) immersion in 35% H2O2 for 60 min; (2) immersion in 37% H3PO4 for 60 s; (3) immersion in 35% H2O2 for 60 min, in distilled water for two min, and in 37% H3PO4 for 60 s; (4) immersion in 37% H3PO4 for 60 s, in distilled water for two min, and in 35% H2O2 for 60 min. Untreated unground un-pumiced, unground pumiced, and ground enamel surfaces, as well as synthetic hydroxyapatite surfaces, served as controls for intra-tooth evaluations of the effects of different treatments. The analyses indicated that exposure to 35% H2O2 alone, besides increasing the nitrogen content, produced no other significant change in the elemental composition of any of the enamel surfaces investigated. Exposure to 37% H3PO4, however, produced a marked decrease in calcium (Ca) and phosphorus (P) concentrations and an increase in carbon (C) and nitrogen (N) concentrations in unground un-pumiced specimens only, and a decrease in C concentration in ground specimens. These results suggest that the reported decrease in the adhesive bond strength of resin to 35% H2O2-treated enamel is not caused by a change in the elemental composition of treated enamel surfaces. They also suggest that an organic-rich layer, unaffected by acid-etching, may be present on the unground un-pumiced surface of young bovine incisors. This layer can be removed by thorough pumicing or by grinding. An awareness of its presence is important when young bovine teeth are used in a model system for evaluation of resin adhesiveness.

Acidity of glass ionomer cements during setting and its relation to pulp sensitivity.

Recent findings regarding pulp sensitivity to luting glass ionomer cements have aroused controversy as to the cause of the problem. Contributing factors may include chemical irritation from the material and leakage. The pH changes during setting were determined for three glass ionomer cements, a zinc phosphate cement, and a polycarboxylate cement. The data showed that the glass ionomer luting cements may show lower pH values for longer times than the other cements. This initial acidity, involving a prolonged period at pH below 3, coupled with cytotoxicity of other ingredients, may lead to damaging effects on the pulp when manipulation of the material and tooth preparation and cementation procedures are less than ideal.