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Background/aim Little is known about the effect of dental trauma and mouthguards (MG) on teeth with ceramic laminate veneers (CLV). The aim was to evaluate the influence of CLV thickness and the presence of a MG with and without antagonist tooth contact on impact stresses during dental trauma. Materials and methods Twelve 2D-finite element models of a head with maxillary structures and upper incisors, six with and six without antagonist tooth, were created in three CLV conditions: sound incisor (no CLV), 0.3 mm CLV, and 1.0 mm CLV. These were evaluated with and without a 4.0-mm ethylene-vinyl acetate MG, with and without an antagonist tooth. An impact analysis was performed in which the head frontally hits a rigid surface at a speed of 1 m/s (3.6 km/h). The results were analyzed using Critical modified von Mises (MPa). The mean of the 10% highest modified von Mises stresses in each structure was collected. Results MG presence substantially reduced impact stresses in the CLV and tooth structures. The contact of the antagonist tooth promoted better stress distribution and reduced the stress levels in the traumatized tooth. Critical stress areas were found in the palatal enamel, incisal enamel, labial cervical area, and enamel under the CLV for all models without MG. In the models with MG, the stresses reduced significantly. Critical modified von Mises stress showed that sound or prepared enamel experienced more critical impact stresses than 0.3 or 1.0-mm thick CLV. Conclusions The use of 4.0 mm EVA mouthguard reduced the impact stress levels in models with 0.3-mm CLV and 1.0-mm CLV, similar to a sound tooth. The contact of an antagonist tooth and the MG better distributed the stresses and reduced the impact stress in the traumatized tooth. more...

Background Complete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument. Methods Mesiolingual and distolingual preparations were prepared in 14 extracted anterior teeth, restored with shade-matched composite, finished, and polished. One restoration was removed with an erbium, chromium:yttrium-scandium-gallium-garnet laser and the other with a rotary instrument (handpiece and carbide burs). Gypsum models made from vinyl polysiloxane impressions of the preparation and removal stages were scanned. The 2 scans were precisely aligned to calculate the amount of tooth structure removed and residual composite, which were statistically compared (t test) between the bur and laser groups. Results Rotary instruments removed significantly more tooth structure than the laser in terms of mean depth (P = .0017) but not maximum depth (P = .0762). Although mean depth of tooth loss was smaller in the laser group, the area of tooth loss was significantly larger (P = .0004) because the rotary instrumentation left significantly more composite than the laser in terms of volume (P = .0104), mean depth (P = .0375), maximum depth (P = .0318), and area (P = .0056). Conclusions and Practical Implications The erbium, chromium:yttrium-scandium-gallium-garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite. Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites. Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument. more...

How the loading rate might affect the mechanical properties of interim materials and interim fixed dental prostheses is unclear.The purpose of this in vitro study was to compare the material stiffness, material strength, and structural strength of interim 3-unit fixed dental prostheses fabricated from 3 interim materials when stressed at different loading rates.Bar-shaped specimens and anatomically correct interim 3-unit fixed dental prostheses with a modified-ridge lap pontic were fabricated from polyethyl methacrylate resin (Trim) and 2 bis-acrylic composite resins (TempSmart; Integrity) (n=10). Flexural modulus and strength of the bar specimens, representing material stiffness and strength, were determined with a 4-point bend test in a universal testing machine. The structural strength of the prosthesis was assessed from the failure load from a vertical force applied on the occlusal surface of the pontic. Three loading rates, 0.5, 5, or 10 mm/min, were evaluated. Results were statistically analyzed with 2-way analysis of variance and multiple comparisons (α=.05).Loading rate and material significantly affected flexural modulus, flexural strength, and structural strength (P.05). Increasing loading rate significantly increased the flexural modulus of all materials (P.05), but the effect of loading rate on the flexural strength of bis-acrylic composite resins was mostly insignificant. Polyethyl methacrylate specimens did not fracture when loaded at 0.5 or 5 mm/min, and the interim fixed dental prostheses made from polyethyl methacrylate did not fracture at the 0.5 mm/min loading rate. Dual-polymerizing bis-acrylic composite resin had significantly higher flexural modulus and strengths than autopolymerizing bis-acrylic composite resin.Polyethyl methacrylate resin had the lowest stiffness among the interim materials tested and did not fracture but excessively deformed at the low loading rate. Dual-polymerizing bis-acrylic composite resin consistently had higher stiffness and material strength and provided higher structural strength than the autopolymerizing bis-acrylic composite resin. Loading rate significantly affected the mechanical properties of polyethyl methacrylate resin (P.05), but the effect was indistinct for the bis-acrylic materials. more...

Objectives:To measure post-gel shrinkage, elastic modulus, and flexural strength of orthodontic adhesives and to predict shrinkage stress using finite element analysis (FEA).Materials and Methods:The following 6 orthodontic adhesives were tested: Transbond XT (3M Unitek, Monrovia, Calif), Transbond Plus Color Change (3M Unitek), Greengloo (Ormco, Brea, Calif), Ortho Connect (GC America, Alsip, Ill), Trulock (RMO, Denver, Colo), GoTo (Reliance, Itasca, Ill). Post-gel shrinkage was measured using a biaxial strain gauge during light curing. Elastic modulus and flexural strength were measured with a 4-point bending test. Analysis of variance and Student-Newman-Keuls post hoc tests were used to compare the shrinkage, elastic modulus, and flexural strengths among the materials (α = .05). Shrinkage stresses caused by the post-gel shrinkage and elastic modulus values were calculated using a cross-sectional FEA of a metallic bracket bonded to an incisor.Results:Properties were highly different among the adhesives (P ≤ .0001). Transbond XT (0.38 ± 0.09 percent volumetric contraction) and GoTo (0.42 ± 0.05 percent volumetric contraction) had the lowest post-gel shrinkage; Transbond Plus Color Change had the highest (0.84 ± 0.08 percent volumetric contraction). OrthoConnect (6.8 ± 0.6 gigapascals) had the lowest elastic modulus; GoTo (28.3 ± 3.1 gigapascals) had the highest. Trulock (64.1 ± 8.2 megapascals) had the lowest flexural strength; Greengloo (139.1 ± 20.7 megapascals) had the highest. FEA showed that the highest shrinkage stresses were generated with Transbond Plus Color Change and the lowest with OrthoConnect.Conclusions:Post-gel shrinkage of orthodontic adhesives was comparable with restorative composites, which are known to create shrinkage stresses in restored teeth. FEA indicated that this shrinkage creates stresses in the adhesive and in the enamel around the brackets. more...

Purpose To determine the effect of substrate on the depth-of-cure determination when using hardness profiles in a covered-slot technique and to introduce a new covered-slot method that uses tooth substrates. Materials and methods Three bulk-fill composites and one conventional composite were tested: Tetric EvoCeram Bulk Fill, Venus Bulk Fill, Filtek Bulk Fill Flowable, Filtek Supreme Ultra. The composites were light-cured in rectangular slots (2 mm deep, 2 mm wide) made in a plaster mold or an extracted tooth. The slots were covered with an orange glass plate during curing, leaving one end exposed for light-curing. After curing, the glass plate was removed and the sample was stored in the dark for 24 hours before Vickers hardness was measured as a function of depth at 0.5-mm intervals. Results were analyzed using two-way analysis of variance (ANOVA) and pairwise comparisons (significance level 0.05). Results The hardness of composites cured in covered-slot molds decreased with increasing depth (p < 0.001). Bulk-filled composites cured in plaster molds had a slightly lower depth-of-cure than those cured in natural tooth substrates. Differences between the tooth and plaster substrates were significant at all depths in the “packable” bulk-fill composite (Tetric EvoCeram Bulk Fill), and were significant at ≥2.5 and ≥3.5 mm in the flowable bulk-fill composites (Filtek Bulk Fill Flowable and Venus Bulk Fill) respectively. Conclusion Using natural tooth substrates in the covered-slot method increased the depth-of-cure of bulk-filled composites in comparison to opaque plaster molds. How to cite this article Church BW, Tantbirojn D, Do T, Wells MH, Versluis A. Depth-of-cure of Bulk-fill Composites Cured in Tooth or Opaque Substrate. Int J Experiment Dent Sci 2017;6(2):68-73. more...

Objectives Adding a new layer of material to cured resin-based composite (RBC) or resin-modified glass ionomer (RMGI) restorations is necessary in dental practice. This study investigated strengths of additions to the two materials. Material and methods Beam-shaped specimens were made from monolithic RBC or RMGI, or additions of RBC and RMGI onto RBC or RMGI half-bar substrates. For the additions, the substrates were left undisturbed or were ground with silicon carbide paper followed by the application of a self-etch adhesive. Sample size was 10. Flexural strengths were determined by a 4-point bending test in a universal testing machine. Results were statistically analyzed with one-way ANOVA followed by Student–Newman–Keuls post-hoc test (α=0.05). Results Flexural strength of the monolithic RBC (86.7±21.8 MPa) was significantly higher than RMGI (52.6±13.1 MPa). Addition of RBC to cured RBC significantly reduced flexural strength regardless of the substrate surface conditions (34.1±11.5–45.7±21.1 MPa). Addition of RMGI to cured RMGI did not significantly reduce flexural strength (36.2±8.4–52.7±25.2 MPa). Flexural strength of RBC added onto cured RMGI that was ground and bonded was the lowest (21.5±10.0 MPa). Most specimens from this group exhibited adhesive failure. Conclusions RBC/RBC additions reduced flexural strength whereas flexural strength of RMGI/RMGI additions was not significantly lower than its cohesive strength. RBC added onto RMGI in the sandwich restorative configuration had lowest failure strength. more...

Background/aim Custom-fitted mouthguards are devices used to prevent dental injuries. The aim of this study was to verify the influence of the antagonist contact on the stresses and strains of the anterior teeth, shock absorption and displacement of EVA custom-fitted mouthguards during a horizontal impact. Materials and methods Finite element models of human maxillary central incisors with and without a mouthguard for different occlusion conditions (with and without antagonist contact) were created based on tomography. A nonlinear dynamic impact analysis using the single-step Houbolt method was performed in which a rigid object hit the model at 1 m s-1 . Strain and stress were evaluated by means of Von Mises and Critical modified Von Mises criterion and shock absorption during impact were calculated as well as the mouthguard displacement. Results The model without mouthguard and without antagonist contact showed the highest stress and strain values at the enamel and dentin in the tooth crown on impact compared to the model without mouthguard and with antagonist contact. Mouthguard presence reduced the stress and strain values regardless of the occlusion condition. The mouthguard displacement decreased with the mandibular antagonist contact. Conclusions Mouthguards are efficient at decreasing the stress and strain values on the tooth in front of an impact reaching more than 90% of shock absorption. A mouthguard with balanced occlusion and maximum number of contacts with mandibular anterior teeth should be considered because it reduces mouthguard displacement. more...

Prefabricated zirconia crowns (ZRCs) require a passive fit and more reduction than stainless steel crowns (SSC). To determine the mean and maximum reduction depths in the mesial-buccal and occlusal areas for three ZRC brands and one SSC in posterior primary typodont molars and to compare reduction depths to existing literature to determine the preparation’s proximity to pulpal tissue. Four primary maxillary and mandibular typodont teeth (J and S) were prepared according to the manufacturers’ guidelines for three ZRCs and an SSC. The teeth were scanned before and after preparation with an optical scanner, and the mean and maximum depths of reduction for each tooth were calculated in triplicate with custom software and statistically compared among the types of crown. The results were compared to existing data on primary tooth enamel and dentin thickness. Maximum mesial-buccal and occlusal depth respectively of preparation for any ZRC for tooth J was 1.19 mm and 1.58 mm while for tooth S it was 1.06 and 2.07mm Both EZ Crowns and Kinder Krowns required an additional 0.5mm occlusal reduction beyond the manufacturer’s recommendation for tooth S. Ideal preparations of ZRCs require more reduction than SSCs. Both EZ Crowns and Kinder Krowns require more reduction than the manufacturer’s recommendation for a mandibular first primary molar. more...

SUMMARY Objectives: This study tested whether delayed photoactivation could reduce shrinkage stresses in dual-cure composites and how it affected the depth-of-cure and mechanical properties. Methods and Materials: Two dual-cure composites (ACTIVA and Bulk EZ) were subjected to two polymerization protocols: photoactivation at 45 seconds (immediate) or 165 seconds (2 minutes delayed) after extrusion. Typodont premolars with standardized preparations were restored with the composites, and cuspal flexure caused by polymerization shrinkage was determined with three-dimensional scanning of the external tooth surfaces before restoration (baseline) and at 10 minutes and one hour after photoactivation. Bond integrity (intact interface) was verified with dye penetration. Depth-of-cure was determined by measuring Vickers hardness through the depth at 1-mm increments. Elastic modulus and maximum stress were determined by four-point bending tests (n=10). Results were analyzed with two- or three-way analysis of variance and pairwise comparisons (Bonferroni; α=0.05). Results: Delayed photoactivation significantly reduced cuspal flexure for both composites at 10 minutes and one hour (p≤0.003). Interface was >99% intact in every group. Depth-of-cure, elastic modulus, and flexural strength were not significantly different between the immediate and delayed photoactivation (p>0.05). The hardness of ACTIVA reduced significantly with depth (p Conclusions: Delayed photoactivation of dual-cure restorative composites can reduce shrinkage stresses without negatively affecting the degree-of-cure or mechanical properties (elastic modulus and flexural strength). more...

The purpose of this study was to investigate the relationship between hygroscopic expansion and polymerization shrinkage for compensation of polymerization shrinkage stresses in a restored tooth. One resin-modified glass-ionomer (RMGI) (Ketac Nano, 3M ESPE), 2 compomers (Dyract, Dentsply; Compoglass, Ivoclar), and a universal resin-based composite (Esthet•X HD, Dentsply) were tested. Volumetric change after polymerization (“total shrinkage”) and during 4 wk of water storage at 37°C was measured using an optical method ( n = 10). Post-gel shrinkage was measured during polymerization using a strain gauge method ( n = 10). Extracted human molars with large mesio-occluso-distal slot preparations were restored with the tested restorative materials. Tooth surfaces at baseline (preparation), after restoration, and during 4 wk of 37°C water storage were scanned with an optical scanner to determine cuspal flexure ( n = 8). Occlusal interface integrity was measured using dye penetration. Data were analyzed using analysis of variance and post hoc tests (significance level 0.05). All tested materials shrunk after polymerization. RMGI had the highest total shrinkage (4.65%) but lowest post-gel shrinkage (0.35%). Shrinkage values dropped significantly during storage in water but had not completely compensated polymerization shrinkage after 4 wk. All restored teeth initially exhibited inward (negative) cuspal flexure due to polymerization shrinkage. Cuspal flexure with the RMGI restoration was significantly less (–6.4 µm) than with the other materials (−12.1 to −14.1 µm). After 1 d, cuspal flexure reversed to +5.0 µm cuspal expansion with the RMGI and increased to +9.3 µm at 4 wk. After 4 wk, hygroscopic expansion compensated cuspal flexure in a compomer (Compoglass) and reduced flexure with Dyract and resin-based composite. Marginal integrity (93.7% intact restoration wall) was best for the Compoglass restorations and lowest (73.1%) for the RMGI restorations. Hygroscopic expansion was more effective in compensating shrinkage stress than would be assumed based on total shrinkage, because only post-gel shrinkage needed compensation. Effective expansion is therefore hygroscopic expansion minus post-gel shrinkage. more...

SUMMARY Objectives To evaluate the effect of the restorative protocol on cuspal strain, fracture resistance, residual stress, and mechanical properties of restorative materials in endodontically treated molars. Methods Forty-five molars received mesio-occlusal-distal (MOD) Class II preparations and endodontic treatment followed by direct restorations using three restorative protocols: composite resin (CR) only (Filtek Supreme, 3M-ESPE), resin modified glass ionomer cement in combination with CR (Vitremer, 3M-ESPE in pulp chamber and Filtek Supreme in MOD cavity), conventional glass ionomer cement in combination with composite resin (CGI-CR) (Ketac Fil, 3M-ESPE in pulp chamber and Filtek Supreme in MOD cavity). Cuspal strain was measured using strain gauges, and fracture resistance was tested with an occlusal load. Elastic modulus (EM) and Vickers hardness (VH) of the restorative materials were determined at different depths using dynamic microhardness indentation. Curing shrinkage was measured using the strain gauge technique. The restorative protocols were also simulated in finite element analysis (FEA). The shrinkage strain, cuspal strain, EM, VH, and fracture resistance data were statistically analyzed using split-plot analysis of variance and Tukey test (p=0.05). Residual shrinkage stresses were expressed in modified von Mises equivalent stresses. Results Shrinkage strain values (in volume %) were Ketac Fil (0.08±0.01) < Vitremer (0.18±0.01) < Filtek Supreme (0.54±0.03). Cuspal strain was higher and fracture resistance was lower when using CR only compared with the techniques that used glass ionomer. The EM and VH of the materials in the pulp chamber were significantly lower for glass ionomer. The FEA showed that using CR only resulted in higher residual stresses in enamel and root dentin close to the pulp chamber than the combinations with glass ionomers (RMGI-CR and CGI-CR). Conclusions The choice of restorative protocol significantly affected the biomechanical behavior of endodontically treated molars. Using glass ionomer to fill the pulp chamber is recommended when endodontically treated molars receive direct composite restorations because it reduces cuspal strain and increases fracture resistance. more...

Objectives A simple optical method for measuring polymerization shrinkage of dental composites is compared with an established dilatometer. Methods Five restorative composites were used to test the methods: Filtek Supreme Ultra (3M ESPE), Filtek LS (3M ESPE), Premise (Kerr), Gradia Direct (GC), and GC Kalore (GC). Uncured composites were attached to sandblasted silane-treated glass slides. The slides were placed sample side inside a mercury-filled dilatometer (ADAF). The mercury levels were recorded as the materials were light-cured through the glass-slides (40 s). Mercury levels, which correlated with volumetric shrinkage, were recorded for 60 min ( N = 6). For the optical method, uncured composite was placed on a smooth silicone platform. A pre-polymerization image was captured under a stereomicroscope, and the specimen was light-cured (40 s). Post-polymerization images were captured at 2, 10, 60, and 90 min ( N = 10). Composite outlines were traced to obtain projected surface areas (ImageJ) and volumetric shrinkage was calculated. Results were analyzed using two-way ANOVA ( α = 0.05) and Pearson Correlation tests. Shrinkage deformation for both methods was modeled using finite element analysis. Results Volumetric shrinkage at 60 min ranged between 1.24% and 2.24% for dilatometer and 1.35–2.68% for optical methods. Optical method shrinkage was consistently higher than the dilatometer ( P = .0001), but the ranking of the composites was the same (Pearson Correlation Coefficient 0.9997). Finite element analysis showed that lower shrinkage values of the dilatometer method could be attributed to bonding of its samples. Significance The optical method using a general-purpose stereomicroscope and public-domain software is a simple and accurate alternative to measure free shrinkage. more...

SUMMARY Objectives This study tested the hypothesis that photoactivation timing and resin cement affect mechanical properties and bond strength of fiberglass posts to root dentin at different depths. Methods Fiberglass posts (Exacto, Angelus) were luted with RelyX Unicem (3M ESPE), Panavia F 2.0 (Kuraray), or RelyX ARC (3M ESPE) using three photoactivation timings: light curing immediately, after three minutes, or after five minutes. Push-out bonding strength, PBS (n=10) was measured on each root region (coronal, middle, apical). The elastic modulus (E) and Vickers hardness (VHN) of the cement layer along the root canal were determined using dynamic indentation (n=5). A strain-gauge test was used to measure post-gel shrinkage of each cement (n=10). Residual shrinkage stress was assessed with finite element analysis. Data were analyzed with two-way analysis of variance in a split-plot arrangement and a Tukey test (α=0.05). Multiple linear regression analysis was used to determine the influence of study factors. Results The five-minute delay photoactivation timing significantly increased the PBS for all resin cements evaluated. The PBS decreased significantly from coronal to apical root canal regions. The mean values for E and VHN increased significantly with the delayed photoactivation for RelyX Unicem and decreased from coronal to apical root regions for all resin cements with the immediate-curing timing. Conclusions The PBS of fiber posts to root dentin, E, and VHN values were affected by the root canal region, photoactivation timing, and resin cement type. Shrinkage stress values decreased gradually with delayed photoactivation for all the cements. more...

Objective: To evaluate adhesive performance in terms of debonding forces of precoated metal and ceramic brackets 4 years after expiration. Materials and Methods: Buccal and lingual surfaces of embedded extracted maxillary premolars were etched with 34% Tooth Conditioner Gel (Dentsply Caulk, Milford, Del), rinsed, and dried. Transbond MIP (3M Unitek, Monrovia, Calif) was applied prior to placing adhesive precoated brackets (APC II Victory stainless steel and APC Plus Clarity ceramic brackets, 3M Unitek). The preexpiration brackets had 29–35 months before, and the postexpiration brackets were 45–52 months past, their expiration dates. Sample size was 17–21 per group. Debonding forces were determined by subjecting the bonded brackets to a shear force in a universal testing machine. Debonding forces were compared using two-way ANOVA. Debonded surfaces were examined under a stereomicroscope to determine failure modes, which were compared using the chi-square test. Results: No statistically significant difference was found in debonding forces (P = .8581) or failure modes (P = .4538) between expired and unexpired brackets. Metal brackets required statistically significantly higher debonding forces than did ceramic brackets (P = .0001). For both expired and unexpired brackets, failure modes were mostly cohesive in the adhesive layer for ceramic brackets, and mixed between adhesive and cohesive failure in the adhesive layer for metal brackets. Conclusions: Adhesive precoated brackets did not have any reduction in enamel-adhesion properties up to 4 years after their expiration date. Extended shelf life testing for precoated dental brackets may be worth considering. more...

Background/Aim Custom-fitted mouthguards are devices used to decrease the likelihood of dental trauma. The aim of this study was to develop an experimental bovine dentoalveolar model with periodontal ligament to evaluate mouthguard shock absorption, and impact strain and stress behavior. Methods A pendulum impact device was developed to perform the impact tests with two different impact materials (steel ball and baseball). Five bovine jaws were selected with standard age and dimensions. Six-mm mouthguards were made for the impact tests. The jaws were fixed in a pendulum device and impacts were performed from 90, 60, and 45° angles, with and without mouthguard. Strain gauges were attached at the palatal surface of the impacted tooth. The strain and shock absorption of the mouthguards was calculated and data were analyzed with 3-way anova and Tukey's test (α = 0.05). Two-dimensional finite element models were created based on the cross-section of the bovine dentoalveolar model used in the experiment. A nonlinear dynamic impact analysis was performed to evaluate the strain and stress distributions. Results Without mouthguards, the increase in impact angulation significantly increased strains and stresses. Mouthguards reduced strain and stress values. Conclusions Impact velocity, impact object (steel ball or baseball), and mouthguard presence affected the impact stresses and strains in a bovine dentoalveolar model. Experimental strain measurements and finite element models predicted similar behavior; therefore, both methodologies are suitable for evaluating the biomechanical performance of mouthguards. more...

a b s t r a c t Purpose: This study compared the fracture strengths and failure modes of ultrathin (0.3-mm) occlusal composite or hybrid ceramic veneers. Methods: Sixty extracted maxillary molars were sectioned to remove the entire coronal structure 4 mm occlusal to the cementoenamel junction (CEJ), leaving a flat area of exposed dentin and peripheral enamel. Standardized occlusal veneers with a central fossa thickness of 0.3 mm were milled from a computer-aided design (CAD)/computer-aided manufacturing (CAM) composite (Paradigm MZ100), a resin nanoceramic (Lava Ultimate), and a hybrid ceramic (Vita Enamic) (N = 20). Each occlusal veneer was cemented with a self-adhesive resin cement (RelyX Unicem) on the prepared teeth. The restored teeth were loaded vertically to determine the fracture strength. Strength values were statistically analyzed using one-way analysis of variance (ANOVA) and Scheffe's post hoc test (significance level 0.05). The mode of failure of each specimen was classified and the correlation between fracture strength and failure mode was analyzed using Spearman's rank-order test. Results: The fracture strengths (mean ± standard deviation) were 2416 ± 640, 1752 ± 676, and 1777 ± 697 N for Lava Ultimate, Paradigm MZ100, and Vita Enamic, respectively. Lava Ultimate had signif- icantly higher fracture strength than the other two materials (p < 0.05); the fracture strengths of Paradigm MZ100 and Vita Enamic were not significantly different. No correlation between fracture strengths and failure modes was found within each material. Most specimens (48 out of 60) fractured in the restoration without involving tooth structures. Conclusions: The fracture strength of ultrathin occlusal veneers made from the novel ceramic hybrid matched the strength of CAD/CAM composite. The highest strength was found with the resin nanoceramic material. more...

Statement of problem Denture tooth fracture may limit the longevity of dental prostheses. Whether the strength of the denture tooth material is affected by the denture processing technique is unclear. Purpose The purpose of this in vitro study was to investigate whether the denture processing technique affects the mechanical properties of denture tooth materials. Material and methods Two denture processing techniques, injection and compression molding, were tested for 3 types of denture teeth: nanohybrid composite (NHC), interpenetrating network (IPN), and microfiller-reinforced polyacrylic (MRP). Denture teeth were processed by using an injection-molded resin or a compression-molded resin. Unprocessed denture teeth served as the control. After teeth were processed, they were sectioned into rectangular beams for 3-point bend testing (n=20 to 24). Elastic moduli were determined from load deflection and maximum stress from maximum bending load. The results were statistically analyzed by using 2-way ANOVA and multiple comparisons (α=.05). Results The processing technique and the type of denture tooth affected both the elastic modulus and the maximum stress. The injection-molded technique resulted in significantly higher (24% to 26%) elastic modulus for NHC and IPN (12% higher in MRP, but not statistically significant) and higher (12% to 17%) maximum stresses for IPN and MRP (3% lower in NHC, but not statistically significant). Compression-molded technique increased the elastic modulus of IPN and NHC by 10% to 17% (3% lower in MRP but not statistically significant), but maximum stresses were not statistically significantly different in any of the tested teeth. Regardless of processing, MRP teeth had the highest elastic modulus (8.0 to 9.2 GPa) but the lowest maximum stresses (97 to 124 MPa), whereas IPN teeth had the lowest elastic modulus (5.5 GPa) but high or highest maximum stress (171 to 192 MPa). Conclusions The injection-molded technique significantly increased the elastic modulus of NHC and IPN teeth and significantly increased the maximum stress of IPN teeth. The compression-molded technique did not significantly affect mechanical properties of denture teeth. more...

The relationship between post-gel shrinkage, total shrinkage, and cuspal flexure was examined. Cuspal flexure was measured on restored typodont teeth, which offered a standardized tooth shape for comparison of shrinkage stress effects among restorative composites.Six restorative composites were compared (Filtek LS, Venus Flowable, Tetric EvoCeram, Filtek Flowable, Esthet-X, and Filtek Supreme). Total shrinkage was determined from changes in projected surface area before and after polymerization (n=10). Post-gel shrinkage was determined with a biaxial strain gauge that measured strain development during polymerization (n=10). Cuspal flexure was determined using typodont maxillary second premolars with standard MOD slot preparation (n=10). Flexure was determined by comparing the three-dimensionally scanned cuspal surfaces before and after restoration. Restoration bonding to the typodont cavity was achieved by sandblasting and adhesive application. Bond integrity was verified by measuring dye penetration. Results were analyzed using ANOVA and Student-Newman-Keuls post hoc test (significance level 0.05). Pearson was used for correlations.Total and post-gel shrinkage were significant different for all composites (t-test; P0.001). Depending on the composite, only 9-41% of the total shrinkage was recorded as post-gel shrinkage. Bond integrity of restored typodont teeth was 96-99%. Cuspal flexure correlated strongly with post-gel shrinkage, but there was no correlation with total shrinkage.Cuspal flexure of restored typodont teeth showed the effect of shrinkage stress caused by polymerizing composite restorations, ensuring standardization while maintaining the effects of tooth/cavity geometry. Post-gel shrinkage gave a good indication to screen composites for the stress they may generate; total shrinkage had no direct correlation with stress. more...

Polymerization shrinkage stress of resin-based materials have been related to several unwanted clinical consequences, such as enamel crack propagation, cusp deflection, marginal and internal gaps, and decreased bond strength. Despite the absence of strong evidence relating polymerization shrinkage to secondary caries or fracture of posterior teeth, shrinkage stress has been associated with post-operative sensitivity and marginal stain. The latter is often erroneously used as a criterion for replacement of composite restorations. Therefore, an indirect correlation can emerge between shrinkage stress and the longevity of composite restorations or resin-bonded ceramic restorations. The relationship between shrinkage and stress can be best studied in laboratory experiments and a combination of various methodologies. The objective of this review article is to discuss the concept and consequences of polymerization shrinkage and shrinkage stress of composite resins and resin cements. Literature relating to polymerization shrinkage and shrinkage stress generation, research methodologies, and contributing factors are selected and reviewed. Clinical techniques that could reduce shrinkage stress and new developments on low-shrink dental materials are also discussed. more...

Objective: To measure enamel surface changes after ceramic bracket debonding and after cleanup. Materials and Methods: Forty extracted teeth were scanned in three dimensions using an optical scanner (baseline). Two ceramic bracket systems were placed (19 metal-reinforced polycrystalline ceramic brackets; 21 monocrystalline ceramic brackets). Seven days later, brackets were debonded and teeth scanned (post-debond). Adhesive remnants and bracket fragments were recorded. Tooth surfaces were cleaned using a finishing carbide bur and scanned again (post-cleanup). Post-debond and post-cleanup scans were aligned with the baseline, and surface changes were quantified. Results were statistically compared using t-tests and Mann-Whitney tests (α = .05). Results: The depth of enamel loss (mean ± standard deviation) post-debond was 21 ± 8 µm and 33 µm and post-cleanup was 28 ± 14 µm and 18 ± 8 µm (P = .0191); the post-debond remnant thickness was 188 ± 113 µm and 120 ± 37 µm (P = .2381) and post-cleanup was 16 ± 5 µm and 15 µm for polycrystalline and monocrystalline ceramic brackets, respectively. The monocrystalline ceramic brackets predominantly left all adhesive on the tooth; the polycrystalline ceramic brackets were more likely to leave bracket fragments attached. Conclusion: Both systems allowed successful removal of the brackets with minimal enamel loss. However, the polycrystalline ceramic brackets left more fragments on the tooth, which complicated cleanup efforts. more...

Purpose To determine the effect of material type and restoration thickness on the fracture strength of posterior occlusal veneers made from computer-milled composite (Paradigm MZ100) and composite-ceramic (Lava Ultimate) materials. Methods 60 maxillary molars were prepared and restored with CAD/CAM occlusal veneer restorations fabricated from either Paradigm MZ100 or Lava Ultimate blocks at minimal occlusal thicknesses of 0.3, 0.6, and 1.0mm. Restorations were adhesively bonded and subjected to vertical compressive loading. The maximum force at fracture and mode of failure were recorded. 2-Way ANOVA was used to identify any statistically significant relationships between fracture strength and material type or thickness. Spearman's rank correlation coefficient was used to analyze mode of failure with regard to fracture strength. Results The average maximum loads (N) at fracture for the Paradigm MZ100 groups were 1620±433, 1830±501, and 2027±704 for the material thicknesses of 0.3, 0.6, and 1.0mm, respectively. The Lava Ultimate groups fractured at slightly higher loads (N) of 2078±605, 2141±473, and 2115±462 at the respective 0.3, 0.6, and 1.0mm thickness. Statistical analyses revealed that, while no significant difference existed among the various restoration thicknesses in terms of fracture strength ( P >0.05), the material type was found to be influential ( P =0.04). The maximum load at fracture (N) for Lava Ultimate averaged over all thicknesses (2111±500) was significantly higher than that of the Paradigm MZ100 (1826±564). No correlation between mode of failure and fracture strength was found. Conclusions Under the conditions of this study, the maximal loads at fracture for these "non-ceramic" occlusal veneer restorations were found to be higher than human masticatory forces. Occlusal veneers made from the two materials tested are likely to survive occlusal forces regardless of restoration thickness, with those fabricated from the composite-ceramic hybrid material being more likely to survive heavier loads. more...

SUMMARY Objectives To evaluate the effect of composite resins (one conventional and two low-shrink composites) and filling techniques on cuspal strains (CS), microtensile bond strength (μTBS), composite ultimate tensile strength (UTS), and mechanical properties of the composites at various depths in molars with large Class II restorations. Materials and Methods One hundred seventeen human molars received standardized Class II mesio-oclusal-distal cavity preparations and restorations with three composites (Filtek LS [3M-ESPE]; Aelite LS [BISCO]; and Filtek Supreme [3M-ESPE]) using three filling techniques (bulk, eight increments, and 16 increments). CS was measured using strain gauges, after which the same restored teeth were used to assess μTBS and UTS. The elastic modulus (E) and Vickers hardness (VH) at different depths were determined from microhardness indentations. The CS, μTBS, UTS, E, and VH data were statistically analyzed using split-plot analysis of variance and Tukey test (p=0.05). Results The CS was higher when using 16 increments. The ‘low-shrink' composites caused lower CS. The μTBS and UTS were similar for eight- and 16-increment techniques and higher when compared to the bulk filling in all composites. E and VH were constant through the depth when applied in eight or 16 increments. Conclusions Type of composite and filling technique affected the CS, μTBS, UTS, and mechanical properties of large Class II restorations. The eight-increments filling technique resulted in generally less CS with the same μTBS and UTS than was obtained with 16 increments, without affecting E and VH through the depth of the composites. more...

SUMMARY Objective: The aim of this study was to investigate the effect of delayed photo-activation on elastic modulus, Knoop hardness, and post-gel shrinkage of dual cure resin cements and how this affects residual shrinkage stresses in posterior teeth restored with ceramic inlays. Methods and Materials: Four self-adhesive (RelyX Unicem, 3M ESPE; GCem, GC; MonoCem, Shofu; and seT, SDI) and two conventional (RelyX ARC, 3M ESPE; and AllCem, FGM) dual cure resin cements for cementing posterior ceramic inlays were tested. Strain gauge and indentation tests were used to measure the post-gel shrinkage (Shr), elastic modulus (E), and Knoop hardness (KHN) when photo-activated immediately and 3 and 5 minutes after placement (n=10). Shr, E, and KHN results were analyzed using two-way analysis of variance followed by Tukey honestly significant difference post hoc tests (α=0.05). The experimentally determined properties were applied in a finite element analysis of a leucite ceramic inlay (Empress CAD, Ivoclar Vivadent) cemented in a premolar. Modified von Mises stresses were evaluated at the occlusal margins and cavity floor. Results: Shr, E, and KHN varied significantly among the resin cements (p Conclusions: KHN and E values varied among the different resin cements. Residual shrinkage stress levels decreased with increasing photo-activation delay with all resin cements. more...

Endodontic treatment procedures induce changes in tooth structure and may shift stress distributions in treated roots that make them more prone to fracture. This chapter discusses mechanical properties and changes in dentin characteristics and shape of the root canal caused by root canal therapy. Moisture, irrigants, medicaments, obturation materials, temperature rise, and canal taper may induce these changes. more...

Adding a post affects the biomechanical response of root canal-treated teeth. This chapter discusses the biomechanical performance of anterior and posterior root canal-treated teeth restored with fiber-reinforced resin posts and the effects of post systems, post lengths, luting procedures, ferrule design, and coronal restorations. The chapter includes discussion of anatomic glass fiber posts for severely weakened endodontically treated teeth and adhesive endocrown restorations. more...

Denture tooth fracture or debonding remains a common problem in removable prosthodontics.The purpose of this in vitro study was to explore factors determining failure strengths for combinations of different denture tooth designs (shape, materials) and injection or compression molded denture base resins.Three central incisor denture tooth designs were tested: nanohybrid composite (NHC; Ivoclar Phonares II), interpenetrating network (IPN; Dentsply Portrait), and microfiller reinforced polyacrylic (MRP; VITA Physiodens). Denture teeth of each type were processed on an injection molded resin (IvoBase HI; Ivoclar Vivadent AG) or a compression molded resin (Lucitone 199; Dentsply Intl) (n=11 or 12). The denture teeth were loaded at 45 degrees on the incisal edge. The failure load was recorded and analyzed with 2-way ANOVA (α=.05), and the fracture mode was categorized from observed fracture surfaces as cohesive, adhesive, or mixed failure.The following failure loads (mean ±SD) were recorded: NHC/injection molded 280 ±52 N; IPN/injection molded 331 ±41 N; MRP/injection molded 247 ±23 N; NHC/compression molded 204 ±31 N; IPN/compression molded 184 ±17 N; MRP/compression molded 201 ±16 N. Injection molded resin yielded significantly higher failure strength for all denture teeth (P.001), among which IPN had the highest strength. Failure was predominantly cohesive in the teeth, with the exception of mixed mode for the IPN/compression group.When good bonding was achieved, the strength of the structure (denture tooth/base resin combination) was determined by the strength of the denture teeth, which may be affected by the processing technique. more...

Background/aim The aim of this study was to evaluate the tooth stresses and strains, shock absorption, and displacement during impact of custom-fitted mouthguards with different thicknesses. Methods Six bar-shaped specimens of the EVA were made and subjected to tensile test for elastic modulus assessment. Two-dimensional plane-strain models of a human maxillary central incisor, periodontal ligament, bone support, soft tissue, and mouthguard (MTG) were created. The mouthguards were modeled in five different thicknesses (2, 3, 4, 5, and 6 mm). One model was created without mouthguard. A nonlinear dynamic impact analysis was performed in which a rigid object hit the model at 1 m s(-1). Strain and stress (von Mises and Critical modified von Mises) distributions were evaluated, and the displacement of the mouthguard with respect to the tooth was calculated. Results The mean [SD] for the EVA elastic modulus was 18.075 [0.457] MPa. The model without mouthguard showed the highest stress values at the enamel and dentin structures in the tooth crown during the impact. For the MTG models, the location of the stress concentrations changed to the root, regardless of the MTG thickness, but maximum stresses in the enamel and dentin were lower compared with the model without MTG. Increasing the mouthguard thickness did not notably decrease the stress-strain values. Conclusion It was concluded that the use of a mouthguard promoted lower stresses and strains in teeth during an impact with a rigid object. There was no substantial difference in peak stresses and strains and in shock absorption among the different mouthguard thicknesses. more...

Objectives To compare bulk-fill with incremental filling techniques for restoring large mesio-occlusal-distal (MOD) restorations. Methods Seventy-five molars with MOD preparations were divided into five groups: Z350XT, incrementally filled with Filtek Z350XT and four bulk-fills—FBF/Z350XT, Filtek Bulk Fill/Filtek Z350XT; VBF/CHA, Venus Bulk Fill/Charisma Diamond; SDR/EST-X, SDR/Esthet-X HD; TEC, TetricEvoCeram Bulk Fill. Cuspal strains were measured using strain-gauges ( n = 10): CSt-Re, during restorative procedure; CSt-100N, during 100N occlusal loading; CSt-Fr, at fracture load. Before fracture load, teeth were load-cycled. Fracture resistance, fracture mode, and enamel cracks were recorded. The other five teeth were used for Elastic modulus (E) and Vickers hardness (VH). Post-gel shrinkage (Shr), diametral tensile strength (DTS) and compressive strength (CS) were determined ( n = 10). Shrinkage stresses were analyzed using finite element analysis. Results SDR had similar CS values as TEC, lower than all other composites. CHA had similar DTS values as Z350XT, higher than all other composites. Z350XT had the highest mean Shr and SDR the lowest Shr. New enamel cracks and propagation was observed after the restoration, regardless of filling technique. Z350XT had lower fracture resistance than bulk-fill composite techniques. No significant differences in failure modes were found. E and VH were constant through the depth for all techniques. Bulk-filling techniques had lower stresses compared to Z350XT. Conclusions Flowable bulk-fill composites had lower mechanical properties than paste bulk-fill and conventional composites. All bulk-fill composites had lower post-gel shrinkage than conventional composite. Bulk-fill filling techniques resulted in lower cusp strain, shrinkage stress and higher fracture resistance. Clinical significance Using bulk-fill composites cause lower CSt wich indicates lower stress in restored tooth. Furthermore, bulk-fill composites have a higher fracture resistance. Therefore, clinicians may choose the bulk-fill composite to decrease undesirable effects of restoration while simplifying filling procedure. more...

Objectives . Chipping and bulk fracture are major contributors in clinical failures of composite restorations. Fracture toughness ( K Ic ) quantifies susceptibility for fracture, but experimental determination is complicated. It would be beneficial for the dental community if a relatively simple experiment, such as microhardness (HK), could be used to screen composites for fracture resistance. This study explores a possible correlation between K Ic and HK. Methods . Composite cylinders (4 mm diameter and ∼7 mm long) were cured for five combinations of light intensity ( I , mW/cm 2 ) and curing time ( T , s) to achieve a range of different total light energy densities ( I × T =100×10, 100×20, 300×20, 300×40, and 700×60 mW s/cm 2 ). A chevron-notch was cut in the median plane of the cylinders for the fracture toughness test, which was executed in a displacement control mode at 6 μm/s cross-head speed (sample size 4). Knoop hardness was determined at the median plane of the cylinders (sample size 6). The tests were performed 15 min and 24 h after curing. Results . Both the K Ic and HK increased with increased light energy density and storage time. Linear regression analysis indicated a strong correlation between HK and K Ic tested at the same time period ( R 2 =0.97 and 0.90 for 15 min and 24 h, respectively). The correlation became weaker between the different storage times ( R 2 =0.71), indicating a change in fracture toughness and/or microhardness mechanisms. Conclusion . Fracture toughness of a composite cannot be simply extrapolated from microhardness. more...

A nanofilled, resin-based light-cured coating (G-Coat Plus, GC America, Alsip, Ill.) may reduce water absorption by glass ionomers. The authors investigated this possibility by measuring cuspal flexure caused by swelling of glass ionomer-restored teeth.The authors cut large mesio-occlusodistal slots (4-millimeter wide, 4-mm deep) in 12 extracted premolars and restored them with a glass ionomer cement (Fuji IX GP Extra, GC America). Six teeth were coated, and the other six were uncoated controls. The authors digitized the teeth in three dimensions by using an optical scanner after preparation and restoration and during an eight-week storage in water. They calculated cuspal flexure and analyzed the results by using an analysis of variance and Student-Newman-Keuls post hoc tests (significance level .05). They used dye penetration along the interface to verify bonding.Inward cuspal flexure indicated restoration shrinkage. Coated restorations had significantly higher flexure (mean [standard deviation], -11.9 [3.5] micrometers) than did restorations without coating (-7.3 [1.5] μm). Flexure in both groups decreased significantly (P.05) during water storage and, after eight weeks, it changed to expansion for uncoated control restorations. Dye penetration along the interfaces was not significant, which ruled out debonding as the cause of cuspal relaxation.Teeth restored with glass ionomer cement exhibited shrinkage, as seen by inward cuspal flexure. The effect of the protective coating on water absorption was evident in the slower shrinkage compensation.The study results show that teeth restored with glass ionomers exhibited setting shrinkage that deformed tooth cusps. Water absorption compensated for the shrinkage. Although the coating may be beneficial for reducing water absorption, it also slows the shrinkage compensation rate (that is, the rate that hygroscopic expansion compensates for cuspal flexure from shrinkage). more...

A new bond strength test method proposed by Lin et al. (Lin CP, Douglas WH, Fields RP. J Dent Res 1992;71(IADR Abstracts #74):524) is presented to overcome the shortcomings of traditional bond strength measurements, which are based on nominal stress concepts. This paper is a theoretical analysis based on a linear elastic fracture mechanics approach. The analytical relationship between the elastic energy release rate G Ic and the critical load is derived approximately as a function of specimen shape and material properties. more...

Many of the current light-curing composite restorative techniques are rationalized in compliance with the theory that composite shrinks toward the light. Shrinkage directed toward the margins is believed to be responsible for the observed improved marginal properties. However, the dental literature does not consistently support this theory. Experimental determination of contraction patterns is very difficult. In this study, a finite element technique is used to analyze the direction of composite shrinkage as it cures. The process of polymerization can be characterized by pre- and post-gel phases. The stress developed in a restoration can be relieved quickly by the flow of material still in the pre-gel phase. Residual stresses arise after gelation. Both auto- as well as photo-curing composites were analyzed. In photo-curing composites, the gel-point varies throughout the material with the intensity of the light. Experimentally determined light transmittance data for different materials were used in the simulation. Degree of cure and time-dependent shrinkage properties were also included from experimental measurements. The analysis showed that the shrinkage direction was not significantly affected by the orientation of the incoming curing light, but instead was mostly determined by the bonding of the restoration to the tooth and by the free surfaces. Consequently, differences between the contraction patterns of auto- and photo-cure were minimal. It was concluded that composite does not shrink toward the light, but that the direction is predominantly determined by cavity shape and bond quality. Improved marginal properties should be pursued by the optimization of other factors, such as the polymerization process, the curing procedure, and the bond quality. The direction of shrinkage vectors in response to light position does not seem to be an appropriate criterion for the optimization of marginal quality. more...

SUMMARY Objectives Finite element analysis (FEA) was used to study polymerization shrinkage stress in molars restored with composites and to correlate those stresses with experimentally measured tooth deformation. Methods Three composites (Filtek LS, Aelite LS Posterior, Filtek Supreme) and three filling techniques (bulk, 2.0-mm increments, and 1.0-mm increments) for restoring a molar were simulated in a two-dimensional FEA. Polymerization shrinkage was modeled using post-gel shrinkage, which was measured using the strain gauge technique (n=10). Cuspal tooth deformation, measured at the buccal and lingual surfaces with strain gauges in a laboratory study, was used to validate the analysis. Residual shrinkage stresses were expressed in modified von Mises equivalent stresses. Linear Pearson correlations were determined between the laboratory and FEA results. Results Post-gel shrinkage values (in volume %) were: Filtek LS (0.11 ± 0.03) < Aelite LS Posterior (0.51 ± 0.02) < Filtek Supreme (0.62 ± 0.09). The 1.0-mm increment filling caused substantially higher stresses and strains in the cervical enamel region. Significant correlations were found between: elastic modulus and FEA strain, elastic modulus and FEA stress, post-gel shrinkage and FEA strain, post-gel shrinkage and FEA stress, FEA strain and cuspal deformation by strain gauge, and FEA stress and cuspal deformation by strain gauge (p Conclusions Increasing the number of increments and high post-gel shrinkage and/or elastic modulus values caused higher stresses in the remaining tooth structure and tooth/restoration interface. Cuspal deformation measured with the strain gauge method validated the finite element analyses. more...

Objectives Polymerization of composite restorations causes shrinkage, which deforms and thus stresses restored teeth. This shrinkage deformation, however, has been shown to decrease over time. The objective was to investigate whether this reduction was caused by hygroscopic expansion or stress relaxation of the composite/tooth complex. Methods Extracted molars were mounted in rigid stainless steel rings with four spherical reference areas. Twelve molars were prepared with large mesio-occluso-distal slots, etched, bonded, and restored with a composite material (Filtek Supreme, 3M ESPE) in two horizontal layers. Ten intact molars were the controls. The teeth were stored either in deionized water or silicone oil. They were scanned after preparation (baseline), restoration (0-week), and after 1, 2, and 4 weeks storage. Scanned tooth surfaces were aligned with the baseline using the unchanged reference areas. Cuspal flexure was calculated from lingual and buccal surface deformation. To verify that the restorations had remained bonded, dye penetration at the interfaces was assessed using basic fuchsin dye. Statistical assessment was done by ANOVA followed by Student–Newman–Keuls post hoc test (p = 0.05). Results Substantial cuspal contraction was found for restored teeth after the composite was cured (13–14 μm cuspal flexure). After 4 weeks cuspal contraction decreased significantly for restored teeth stored in water (7.3 ± 3.2) but not for those stored in silicone oil (11.4 ± 5.0). Dye penetration of the occlusal interface was minimal in both groups (106 ± 87 and 21 ± 28 μm in water and silicone oil, respectively). Significance The results suggest that hygroscopic expansion was the main mechanism for shrinkage stress compensation. more...

Background Restoration techniques affect shrinkage stress and depth of cure. The authors tested cuspal deflection and depth of cure resulting from the use of different techniques (bulk, incremental, bulk/transtooth illumination) and two resin-based composites (deep curing and conventional). Methods The authors restored extracted teeth with deep-curing X-tra fil (VOCO, Cuxhaven, Germany) (by using bulk and incremental techniques) and Filtek Supreme Plus (3M ESPE, St. Paul, Minn.) (by using bulk, incremental and bulk/transtooth-illumination techniques). The sample size for each technique was five. They determined cuspal deflections as changes in buccal and lingual surfaces before and after restoration. To determine the extent of cure, they measured hardness 0.5 to 3.5 millimeters deep on the sectioned restorations. Results The authors found no difference in cuspal deflection between filling techniques within the same materials ( P > .05). They found no difference in hardness for X-tra fil at any depth with either the bulk or the incremental technique ( P > .05). Filtek Supreme Plus had higher hardness values at depths of less than 1.5 mm with the bulk/transtooth-illumination technique, whereas the bulk technique resulted in lower hardness values at depths of 2.0 mm and below ( P Conclusions Cuspal deflection was not affected by filling techniques. X-tra fil cured up to a depth of at least 3.5 mm; Filtek Supreme Plus had lower curing values below a depth of 2 mm. The transtooth-illumination technique improved curing depth for restorations placed in bulk. Clinical Implications When using resin-based composite restorative materials, clinicians should be more concerned about the effect of filling techniques on curing depth than about how these techniques affect shrinkage stresses. more...

Progress in polymer science has led to continuous reduction of polymerization shrinkage, exemplified by a new generation of “low-shrink composites”. The common inference that shrinkage stress effects will be reduced in teeth restored with such restoratives with lower shrinkage was tested in extracted human premolars. Mesio-occluso-distal slot-shaped cavities were cut and restored with a conventional (SupremePlus) or low-shrink (RefleXions, Premise, Kalore, and LS) composite (N = 5). We digitized the coronal surfaces before and 10 min after restoration to determine cuspal deflection from the buccal and lingual volume change/area. We also determined the main properties involved (total shrinkage, post-gel shrinkage, degree of conversion, and elastic modulus), as well as microleakage, to verify adequate bonding. It was shown that, due to shrinkage stresses, buccal and lingual surfaces pulled inward after restoration (9-14 microns). Only Kalore and LS resulted in significantly lower tooth deformation (ANOVA/Student-Newman-Keuls post hoc, p = 0.05). The other two low-shrink composites, despite having the lowest and highest total shrinkage values, did not cause significant differences in cuspal deflection. Deflection seemed most related to the combination of post-gel shrinkage and elastic modulus. Therefore, even for significantly lower total shrinkage values, shrinkage stress is not necessarily reduced. more...

Objective Restorative materials exhibit contraction and expansion due to polymerization and water absorption. Each process deforms and stresses a restored tooth structure in opposite direction. This study evaluated the tooth deformations during these competing processes. Methods Large MOD cavities were prepared in 10 extracted molars. Five were restored with a hydrophobic resin composite (Filtek Supreme, 3M ESPE) and the others with a hydrophilic resin-modified glass-ionomer (Ketac Nano, 3M ESPE). The restored molars and two unrestored controls were stored in water for 24 weeks. The molars were digitized with an optical scanner at baseline, after preparation, restoration, and at 1, 2, 4, 8, 16, and 24 weeks water immersion. The digitized buccal, lingual, and restoration surfaces were analyzed to determine their deformation patterns. The results were statistically analyzed using ANOVA followed by Student–Newman–Keuls post hoc tests ( p = 0.05). Results The buccal and lingual tooth surfaces moved 13–14 μm inward after restoration. After water immersion, cuspal deformation in the resin composite group gradually decreased, reversing the shrinkage deformation within four weeks. The immersed resin-modified glass ionomer group reversed shrinkage deformation within one week, and continued to expand further to 28 μm after 24 weeks. Cuspal deformations after water immersion were significantly different with the two restoratives. Restoration surfaces also expanded after water immersion, while the control teeth showed no significant deformation. Significance Polymerization shrinkage deformation was compensated by hygroscopic expansion within 4 weeks in teeth restored with a hydrophobic resin composite, while a hydrophilic restorative over-compensated polymerization shrinkage within 1 week causing tooth expansion. more...

Residual stress due to polymerization shrinkage of restorative dental materials has been associated with a number of clinical symptoms, ranging from post-operative sensitivity to secondary caries to fracture. Although the concept of shrinkage stress is intuitive, its assessment is complex. Shrinkage stress is the outcome of multiple factors. To study how they interact requires an integrating model. Finite element models have been invaluable for shrinkage stress research because they provide an integration environment to study shrinkage concepts. By retracing the advancements in shrinkage stress concepts, this chapter illustrates the vital role that finite element modeling plays in evaluating the essence of shrinkage stress and its controlling factors. The shrinkage concepts discussed in this chapter will improve clinical understanding for management of shrinkage stress, and help design and assess polymerization shrinkage research. more...

Objectives The contribution of chemical bonding of the polycarboxylic acid in classical powder/liquid conventional glass ionomers (GI) and resin-modified glass-ionomers (RMGI) has been attributed to the excellent long-term bond strengths and clinical retention. RMGIs have been recently introduced as paste/liquid systems for convenience of clinical usage. The objective of this study was to investigate the long-term bond strengths and mechanism of adhesion of paste-liquid RMGI in order to ascertain whether similar characteristics are retained. Methods Long-term shear adhesion to dentin and enamel was measured on two paste-liquid RMGIs and one powder/liquid RMGI. Scanning electron microscopy (SEM), Fourier-transformed infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) analyses were carried out on the paste-liquid RMGI Vitrebond Plus (VBP) and compared with the classical powder/liquid RMGI Vitrebond (VB). Results VBP maintains adhesion to dentin and enamel over long times; its long-term adhesive performance is equivalent to VB. FTIR data confirm that VBP exhibits the carboxylate crosslinking reaction of a true glass ionomer. SEM images show evidence of micromechanical bonding at the interface between VBP and the tooth. XPS and FTIR data show that the methacrylated copolyalkenoic acid component present in VB and VBP chemically bonds to the calcium in HAP. Significance The new paste-liquid RMGI liner, VBP, shows equivalent adhesion to its powder-liquid predecessor, VB. The adhesion mechanism was attributed to micromechanical and chemical bonding. This chemical bond is a significant factor in the excellent long-term adhesion of these materials. more...

Objective . Residual stresses from polymerization shrinkage in composite restorations deform a tooth. This may cause debonding, enamel crack propagation, and post-operative sensitivity. Deformation due to shrinkage has been measured previously at a few discrete points. The purpose of this study was to analyze cuspal deformation pattern of the occlusal portion of molars for various cavity types and sizes after restoration with a light-initiated composite. Methods . Five extracted human molars were successively prepared as Class I, Class II OM, large Class II OM, and large Class II MOD. The cavities were filled with a light-curing composite using a dentin adhesive system. The occlusal portion of the unrestored cavity and the restoration were digitized with a profilometer. The digitized data of the unrestored and restored tooth were used to calculate the cuspal contour change with Cumulus software. Deformation was visualized as a color contour map. Results . Cuspal deformation showed up in the contour map as a reduction of buccal and lingual contour perpendicular to the surface. Large Class II MODs exhibited the highest cuspal deformation, followed by large OM restorations. Cuspal deformations in Class I and small Class II OM restorations were not significantly different. Significance . When a composite restoration was cured, the surrounding tooth deformed due to polymerization shrinkage. Cavity type and size affected how much cusps moved inward as a result of polymerization shrinkage. This study quantified and visualized the pattern of cuspal deformation. more...

Objectives. To assess residual shrinkage stress, transient properties must be defined that describe the composite transformation during polymerization. The purpose of this study was to determine the development and distribution of properties that affect the creation of residual stresses in a light-initiated restorative composite. Methods. Microhardness and shrinkage strain were experimentally measured during and/or after light-initiated polymerization. The data was acquired for different combinations of light intensities and light exposure times. Light attenuation experiments were used to derive local light intensities inside the composite samples. Results. For the microhardness, a nonlinear correlation was found with the administered light energy, defined as the product of light intensity and exposure time. However, shrinkage strain depended on the initiation intensity rather than the light energy. Higher initiation intensities resulted in higher shrinkage strain rates and values. Microhardness and strain values continued to increase after the light initiation. Significance. Similar microhardness values, and hence degree of cure and mechanical properties, can be achieved by application of comparable light energy. Therefore, microhardness as a function of light energy can be used to describe transient elastic properties during polymerization. Shrinkage strain, and therefore post-gel shrinkage and residual stress, depends primarily on initiation light intensity. Although mechanical properties achieved at a certain light energy level may be similar, residual stresses may differ depending on initiation intensity. more...

Objective. Experimental measurements on various restoration configurations have shown that restored teeth deform under the influence of polymerization shrinkage, but actual residual stresses could not be determined. The purpose of this study was to calculate and validate shrinkage stresses associated with the reported tooth deformations. Methods. Three different restoration configurations were applied in a finite element model of a molar. The composite properties were based on experimentally determined composite behavior during polymerization. The occlusal deformation pattern and the residual stress states of the tooth, restoration, and tooth-restoration interface were calculated using a polymerization model based on the post-gel shrinkage concept. Reported strain gauge measurements and occlusal deformation patterns were used for validation. Results. The shrinkage stresses depended on the configuration and size of the restorations. The tooth's resistance against polymerization shrinkage diminished with loss of dental hard tissue. Larger restorations resulted in lower stress levels in the restoration and tooth-restoration interface, but increased stresses in the tooth. The maximum stress values found for different configurations were not decisively different. Significance. The validated model indicated that shrinkage stress cannot be based on composite properties or restoration configuration alone, but has to be approached as a distributed pattern that depends on the location and on the properties of tooth and restoration, geometry, constraints, and restoration procedures. Tooth deformation was indicative of stresses in the tooth rather than in the restoration or across the tooth-restoration interface. more...

This study addresses the anticipated problem of discriminating among high-performing dentin adhesives. The simplicity of the nominal shear bond test, despite being heavily criticized, has made it a routine procedure for the determination of bonding efficacy. A fracture mechanics approach has been suggested as a better assessment of bonding efficacy (Versluis et al., 1997). However, experimental complexity is a major limitation. It is hypothesized that a new, simplified interfacial fracture toughness test (Lin, 1994) will evaluate bonding agents differently if compared with the traditional shear bond test. Therefore, the objective of this study was to compare the performances of six dentin bonding agents subjected to the interfacial fracture toughness test (critical plane strain energy release rate) or to the nominal shear bond test (shear bond strength). Their performances were also characterized by scanning electron micrography of the fracture surfaces for evidence of dentin cohesive failure. Statistical analyses showed only marginal differences between these determinants of the two tests. However, when the analysis was applied only to the materials that had 100% frequency of dentin cohesive failure in shear testing, which also had high bonding efficacy, the difference in adhesive strengths between the two tests became significant. The reliability of the nominal shear test is questioned when dentin cohesive failure occurs, which usually is associated with high bonding efficacy. Since it is expected that bonding efficacy will increase further, the interfacial fracture toughness test is the preferred methodology to distinguish among high-performing dentin adhesives. more...

SUMMARY Aim Bonding of resin-modified glass ionomers to enamel is an important quality, especially when saliva contamination is inevitable. This study evaluated if microleakage of a resin-modified glass ionomer improves with selective enamel etching, with or without saliva contamination. Methods Class V cavities with the occlusal margin in enamel and the gingival margin on the root were prepared in extracted human permanent teeth and filled with a resin-modified glass ionomer using an acidic primer according to the manufacturer's recommendation or with an additional selective enamel etching step. Preparations were contaminated with saliva before primer application or before restoration placement (n=10). Restored teeth were thermocycled between 5°C and 55°C for 1000 cycles, stained with basic fuchsin, and sectioned. Microleakage distance was measured and analyzed with analysis of variance followed by Duncan post hoc test at a significance level of 0.05. Results Enamel microleakage was highest when saliva contamination occurred before the placement of resin-modified glass ionomer. Microleakage distances were significantly reduced in the selective etching groups regardless of saliva contamination. However, selective etching of enamel increased microleakage in cementum. The increase in cementum leakage was significantly higher when saliva contamination occurred before restoration placement. Conclusion Selective etching reduces enamel microleakage of a resin-modified glass ionomer even with saliva contamination, but it may increase microleakage at the cementum. The severity of microleakage is affected by the timing of saliva contamination. more...

It is widely accepted that a dentin shear bond test which pulls out dentin must mean that the adhesive strength is superior to the cohesive strength of the dentin. Using numerical modeling techniques, Van Noort et al. (1988,1989) and DeHoff et al. (1995) alerted the scientific community that there were massive stress concentrations in the familiar dentin bond test. It is not inconceivable that these localized high tensile stresses could initiate cracks which diverge monolithically into dentin, leaving the interface unchallenged. To test this hypothesis, we developed a failure accumulation simulation program which determined localized failure interactively "on the fly" with a finite element solver, and also included brittle behavior, adhesive and cohesive failure, stochastic response, and dynamic remeshing. All of the familiar dentin bond variables were included in the simulation. A parallel experimental dentin bond test validation was run, and the fractography was examined in the scanning electron microscope for mode of failure. The simulation confirmed the tensile monolithic fracture hypothesis. It is also confirmed that dentin pull-out was partly due to the biomechanics of the test and did not necessarily mean superior adhesive strength or even that the cohesive strength of the dentin was reduced. There is clear need for a new technology for the evaluation of biological interfaces, and the present work has shown the vital role of numerical modeling in the interpretation of such experimental procedures. more...

Glass ionomer cements (GICs) demonstrate the inhibition of caries lesions formed immediately adjacent to the restoration. This in vitro study was conducted to evaluate the distance at which a resin-modified GIC is able to exert its cariostatic effect on artificial enamel lesions ('remote effect'). Resin-modified GIC or bis-GMA resin was applied on the cervical third of the labial surface of 10 paired halves of bovine incisors. Specimens were separately immersed for 3 weeks in lactic acid gel which was changed every other day to reduce fluoride accumulation. Artificial lesions were examined by the cross-sectional microhardness (MHN) method. Volume percent mineral, mineral loss (delta Z value) and change in mineral content (delta M) were computed for each MHN profile, performed at distances of 0.2, 0.5, 1.0, 2.0, 4.0 and 7.0 mm from the edge of the materials. delta Z values of the resin-modified GIC group were significantly lower than those of the bis-GMA control group at all remote sites (t test, p0.05). The delta M caused by resin-modified GIC was more pronounced within 1.0 mm from the material which suggested that the demineralization inhibition can be divided into the near effect (1.0 mm). In this in vitro study, resin-modified GIC provided caries resistance in bovine enamel located at a considerable distance from the margin of the material. more...