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Objective. To investigate the subsurface degree of conversion (DC) and shrinkage force formation of low-viscosity (flowable) bulk-fill composite materials. Materials and methods. Three flowable bulk-fill resin composites [SureFil SDR flow (SDR; Dentsply DeTrey), Venus Bulk Fill (VB; Heraeus Kulzer) and x-tra base (XB; VOCO)] and one conventional flowable control composite material [EsthetX flow (EX; Dentsply DeTrey)] were tested. The materials were photoactivated for 20 s at an irradiance of 1170 mW/cm2 and the DC ( n = 5) was recorded at 0.1-, 1.5- and 4-mm depth using Fourier transform infrared spectroscopy. Shrinkage forces ( n = 5) of 1.5-mm-thick specimens were continuously recorded for 15 min using a custom-made stress analyzer. Data were statistically analyzed by ANOVA, Tukey's HSD and Bonferroni's post-hoc tests ( α = 0.05). Results. SDR generated the significantly lowest shrinkage forces (22.9 ± 1.4 N), but also attained the significantly lowest DC at 1.5-mm depth (67.5 ± 0.8%). The conventional flowable composite EX generated the significantly highest shrinkage forces (40.7 ± 0.7 N) and reached a significantly higher DC (74.4 ± 1.3%) compared to SDR and XB at 1.5-mm depth. The shrinkage force values of VB (29.4 ± 1.1 N) and XB (28.3 ± 0.6 N) were similar ( p > 0.05). All materials attained significantly higher DC at 4-mm depth than at the near-surface. Conclusion. The tested low-viscosity bulk-fill materials show lower shrinkage force formation than a conventional flowable resin composite at high levels of degree of conversion up to 4-mm incremental thickness. [ABSTRACT FROM AUTHOR]

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Purpose: To test different kinds of mechanical and chemical pre-treatments of previously sealed dentin before re-sealing. Methods: 75 bovine dentin samples were precycled for 3 days (per day: 6x1 minute erosion (HCl; pH 2.3), and kept in artificial saliva in dwell time and overnight. Group 1 samples (n=15) remained untreated (control). Remaining samples were sealed with Seal&Protect (S&P). After thermo-mechanical loading (5,000 cycles, 50/5°C, 11,000 blushing strokes) a first measurement was performed to evaluate permeability of the sealant. Permeability was tested by storing the samples in HCl (pH 2.3; 24 hours) and measuring the calcium release into the acid by atomic absorption spectroscopy. Based on these calcium release values, the previously sealed samples were allocated to four groups (2-5) according to a stratified randomization. Samples of Groups 2-5 were re-sealed with S&P after either being treated with ethanol (Group 3), silane-coupling-agent (Group 4) or sandblasting (Group 5). After re-sealing, all samples had a second measurement of permeability. After another thermo-mechanical loading, a third evaluation of permeability was conducted. Results: At all measurements, calcium release was significantly higher in the untreated control group than in the sealed Groups 2-5 with no significant differences among the sealed groups. Within Groups 2-5, calcium release at the first and third measurement was higher compared with that at the second measurement (P< 0.05). [ABSTRACT FROM AUTHOR]

Objective. To investigate the abrasive wear of surface sealants (Seal&Protect and K-0184 (experimental sealant)) and the influence of pre-treatment with mineral deposit forming prophylaxis pastes (NUPRO Sensodyne and NUPRO) on this wear. Methods. One hundred and eight bovine dentine samples were randomly allocated to nine groups (1-9). Pre-treatment (10 s): groups 1-3: untreated, groups 4-6: NUPRO, groups 7-9: NUPRO Sensodyne. Sealing: groups 1, 4 and 7: unsealed, groups 2, 5 and 8: Seal&Protect, groups 3, 6 and 9: K-0184 (experimental sealer). Samples were then brushed with 12 000 brushing strokes (BS) with toothpaste slurry in an automatic brushing machine (120 BS/min; F = 2.5 N). Surface profiles were recorded at baseline, after pre-treatment and sealing and after each 2000 BS. Results. Total profile change (wear or gain due to pre-treatment, treatment and 12 000 BS): groups 1, 4 and 7 (no surface sealant) showed a not significantly different wear of 18.48 ± 2.63 µm, 24.98 ± 3.02 µm and 21.50 ± 5.47 µm, respectively. Remaining groups (sealed) showed a gain in height with no significant difference among each other. Wear in sealed groups (2, 3, 5, 6, 8 and 9) were not significantly different at all numbers of brushing strokes. Starting with 4000 BS, the wear in unsealed groups (1, 4 and 7) was statistically significantly higher compared to all other groups. Conclusion. Stability and wear resistance of surface sealants are not affected by pre-treatment of dentine with NUPRO Sensodyne. The surface sealants tested provide a stable protective surface layer on dentine, which lasts for at least 12 000 brushing strokes. [ABSTRACT FROM AUTHOR]

Objective. Application of SnCl2/AmF/NaF containing mouth rinse showed good protection against erosion. The aim of the study was to evaluate if this is due to the amount of KOH-soluble fluoride (KOHsF) formed or its resistance under erosive conditions. Methods. One hundred and fifty bovine enamel samples were allocated to five groups (n = 30) and were once eroded in 0.05 mol/l citric acid (5 min). Samples were stored in artificial saliva for 4 days. Samples of two groups (erosive-SnCl2 + erosive-NaF) were eroded 6 × for 5 min. The remaining samples were stored in aqua dest deionised water. Each day the samples were treated twice for 2 min with 1 ml SnCl2/AmF/NaF-solution (erosive-SnCl2;neutral-SnCl2/AmF/NaF) or NaF-solution (erosive-NaF;neutral-NaF). The fifth group remained untreated (control). On day 5, 10 samples of each group were used for determination of KOHsF (series 1). The remaining samples were again eroded (erosive-SnCl2 + erosive-NaF) or stored in artificial saliva (neutral-SnCl2 + neutral-NaF). KOHsF of another 10 samples of each group was measured (series 2). The last 10 samples of each group were also treated as described above and the amount of KOHsF was measured (series 3). Results. In each series 1-3 KOHsF in group erosive-SnCl2/AmF/NaF were significantly higher. No significant loss of KOHsF between the series 1-3 was observed (except for control). Conclusion. SnCl2/AmF/NaF containing mouth rinse revealed a better formation of KOH-soluble fluoride as the NaF-solution, although the applied fluoride compound has no influence on the stability of the KOHsF under erosive conditions, leading to the conclusion that the resistance of KOHsF is not responsible for the difference in the protection against dental erosion. [ABSTRACT FROM AUTHOR]

Objective. The purpose of the present survey was to evaluate the implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations by private practitioners who attended a hands-on continuing education course on this technique. Materials and methods. In the years 2007 and 2008, 17 1-day continuing education courses on vertical bite reconstruction in the worn dentition by using direct resin composite restorations were attended by 310 participants. A 13-item questionnaire was posted to all course participants in April 2009 seeking information on the acceptance, implementation and experience of the presented technique in the private practice. Results. A total of 97 (31%) questionnaires were returned, whereas 67% of the respondents had used the presented technique. Analysis of the overall experience and satisfaction with the placed resin composite restorations using visual analog scale (VAS) revealed a mean VAS score of 7.2 ± 1.7 (0 = maximal unsatisfied, 10 = maximal satisfied). The direct resin composite restorations were predominantly rated 'good' within the assessed criteria surface texture, anatomical form, marginal integrity, marginal discoloration and color match. Ninety-eight percent of the private practitioners stated that they would continue to carry out vertical bite reconstructions according to this technique. The three most frequently observed clinical problems were related to marginal discolorations, bulk fractures and adhesive failures. Conclusion. The presented restoration method was well accepted by private practitioners who used this treatment approach at least once after course participation, even though some clinical problems were observed. [ABSTRACT FROM AUTHOR]

Objectives. This in-situ study aimed to investigate the potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) crème and fluoride mouth rinse to re-harden erosively softened enamel and to evaluate the influence of an intra-oral or extra-oral application. Methods. Ten volunteers performed five experimental series. Per series, four bovine enamel samples were extra-orally softened by immersion in Sprite light® (2 min) and subsequently worn intra-orally for 5 min in intra-oral appliances. Thereafter, samples were treated (3 min) with either 250 ppm AmF/SnF2 solution (Meridol) (series 1 and 3) or CPP-ACP crème (Tooth Mousse) (series 2 and 4). Application of the substances was performed extra-orally (series 1 and 2) or intra-orally (series 3 and 4). Untreated specimens served as control (series 5). The appliances were worn for 4 h afterwards. Knoop microhardness (KHN) measurement was performed at baseline, after softening and after completing of the respective run. Data were statistically analyzed by ANOVA and Bonferroni/Dunn post-hoc test. Results. No significant difference in baseline microhardness was observed, while immersion in Sprite light reduced the microhardness significantly. Significant re-hardening after intra-oral exposure occurred in all series, but baseline microhardness was not achieved. Microhardness in series 2 was significantly higher than that in series 1 and 5. No significant differences in KHN were detected between series 3, 4 and 5. The re-hardening ΔKHN (final microhardness - microhardness after erosion) was not significant different in all five series. Conclusion. Intra-oral application of CPP-ACP crème or fluoride solution provides no benefit regarding re-hardening of erosively softened enamel. [ABSTRACT FROM AUTHOR]

Objective. To investigate the influence of time delay and duration of photo-activation on subsurface microhardness of a dual-cured resin composite. Material and methods . A commercially available dual-cured core build-up resin composite (Rebilda DC) was filled in cavities (diameter: 4.0 mm; height: 6.0 mm) of polystyrene molds and light-cured for 20 or 60 s either immediately after the filling procedure (time delay 0 s) or after a time delay of 30, 90, 180 or 300 s. Non-irradiated self-cured specimens served as a control group ( n = 15). Specimens were stored in complete darkness and at 100% relative humidity at 37°C for 2 weeks and cross-sectioned. Knoop Hardness Numbers (KHNs) were measured six times per depth and averaged at distances of 0.25, 0.50, 1.00, 2.00, 3.50 and 5.50 mm from the light-exposed surface. Data were statistically analyzed using one- and two-way ANOVA followed by Scheffé's post-hoc test at a level of significance of 0.05. Results . Mean hardness values in all experimental groups ranged between 54.3 ± 2.1 and 58.1 ± 2.3 KHN. Light-curing did not significantly increase composite KHN at any depth measured. Delaying light exposure had no influence on KHN, irrespective of depth. A longer light-exposure time (60 versus 20 s) resulted in significantly higher KHN only at depths of 3.50 and 5.50 mm. Conclusion. Photo-activation of the tested dual-cured resin composite provided no clinically relevant benefit compared to self-curing regarding the degree of hardening. [ABSTRACT FROM AUTHOR]

The restorative treatment of dental hard tissue loss, e.g., due to erosion, and the rehabilitation of the original vertical bite dimension confronts the dentist with problems when implementing the therapy. Traditionally, this therapy is conducted with laboratory-fabricated workpieces made of ceramics which usually require a preparation of the remaining tooth substance and also causes high costs for the patient. Therefore, alternative methods should be considered. This article presents the use of direct adhesive composite restorations as a way of reconstructing a dentition severely altered by erosion. To reconstruct the occlusal surfaces, transfer splints are used that are made on the basis of individual wax-up models. The procedure described is a well-researched and proven method for restoring teeth with erosion-related loss of hard tooth substance. As with all new procedures, there will be a certain learning curve for the practical dentist after which high-quality restorations can be implemented with this technique.

Purpose: To investigate the effect of over-etching and subsequent use of different adhesive application approaches including active, double, preheated, and ultrasonic application on dentin bond strength., Methods: Dentin specimens from sound human third molars were prepared and allocated into six groups (n= 10 per group). In Group 1 (negative control), the dentin specimens were over-etched with phosphoric acid for 30 seconds, and a two-step etch-and-rinse adhesive (Prime & Bond XP; Dentsply Sirona) was applied for 20 seconds according to the manufacturer's instructions. In test Groups 2-5, the application of the adhesive varied: In Group 2, the adhesive was actively rubbed into the dentin surface, whereas in Group 3, a second adhesive layer was applied after light-curing of the first one. In Group 4, the adhesive was heated to 68°C prior to application, and in Group 5, the adhesive was ultrasonically activated. Acid-etching for 15 seconds and adhesive application for 20 seconds was performed in the positive control group (Group 6) according to the manufacturer's instructions. After light-curing and composite build-up [Ceram.x Spectra ST (HV); Dentsply Sirona], microtensile bond strength and fracture types were determined. Data were statistically analyzed by Kruskal-Wallis rank test, followed by post-hoc pairwise comparisons using Conover tests and P-value adjustment according to Holm (α= 0.05)., Results: Active, double, preheated, or ultrasonic adhesive application showed no significant effect on dentin bond strength when compared to the control groups. Predominantly adhesive failures were observed in all groups., Clinical Significance: A modification of adhesive application by using active, double, preheated, or ultrasonic application does not improve bonding to accidentally over-etched dentin., Competing Interests: The authors declared that they had no conflict of interest. The paper is partly based on the undergraduate theses of S. Simoni and P. Zwicky, University of Zurich, supervised by P. Burrer and T.T. Tauböck., (Copyright©American Journal of Dentistry.)

Self-adhesive composites promise simplified application and reliable adhesion to dental hard tissues without prior conditioning or application of an adhesive system. Their working principle is based on specific functional monomers. Although they may reach acceptable sealing capability in minimally invasive cavities, study results showed significantly reduced bond strength to enamel and dentin compared to conventional adhesive systems. Thus, the use of self-adhesive composites requires critical individual consideration.

Over the last years, bioactive glass particles have been successfully incorporated in dental restorative materials. Remineralizing effects on dental hard tissue and antibacterial properties are promising properties of these customized composites. A few materials doped with bioactive fillers are already available on the dental market. Nevertheless, further research is required to fine-tune bioactive composites for biomimetic restorative approaches.

Purpose: To investigate the influence of pretreating demineralised enamel with an infiltrant on the margin integrity of Class V like composite restorations on primary teeth bonded with different adhesives., Materials and Methods: Forty specimens from primary molars were demineralised and circular class-V-like cavities were prepared. The cavities were treated with a universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care), applied either in self-etch (SE) or etch-and-rinse mode (ER) mode. In groups SE-I and ER-I, the demineralised margins were pretreated with a caries infiltrant (Icon, DMG) prior to adhesive application. The cavities were restored with a nanofilled composite material and thermocycled. Marginal integrity was evaluated using SEM, and the percentage of continuous margin was statistically analysed., Results: Specimens treated with the caries infiltrant followed by the adhesive showed similar marginal continuity as the adhesive alone., Conclusions: Pretreatment of demineralised primary enamel with a caries infiltrant before applying a universal adhesive does not influence the marginal integrity of composite fillings.

This study aimed to investigate polymerization kinetics and curing light transmittance of two series of experimental dental resin composites filled with 0-40 wt% of either 45S5 bioactive glass (BG) or a customized low-Na F-containing BG. Polymerization kinetics in 0.1-mm and 2-mm thick layers were investigated through real-time degree of conversion measurements using a Fourier transform infrared (FTIR) spectrometer. FTIR spectra were continuously collected at a rate of 2 s -1 during light-curing (1340 mW/cm 2 ). Light transmittance through 2-mm thick composite specimens was measured using a UV-Vis spectrometer at a rate of 20 s -1 . Unlike BG 45S5, which led to a dose-dependent reduction in the rate and extent of polymerization, the customized low-Na F-containing BG showed a negligible influence on polymerization. The reduction in light transmittance of experimental composites due to the addition of the low-Na F-containing BG did not translate into impaired polymerization kinetics. Additionally, the comparison of polymerization kinetics between 0.1-mm and 2-mm thick layers revealed that polymerization inhibition identified for BG 45S5 was not mediated by an impaired light transmittance, indicating a direct effect of BG 45S5 on polymerization reaction. A customized low-Na F-containing BG showed favourable behaviour for being used as a functional filler in light-curing dental resin composites., (© 2021. The Author(s).)

The objective of this study was to investigate the effect of individual instructions and training of dental students on the amount of applied light irradiance before and after training using a patient simulator with integrated visual feedback. Furthermore, the effect on the degree of conversion of composite restorations placed by the dental students was assessed. Forty-two dental students, split into two groups, light-cured a simulated restoration in tooth 27 of a dental patient simulator for 20 s. The irradiance (mW/cm 2 ) received by the detector was measured in real-time before and after individual instructions and training, and the energy delivered (J/cm 2 ) was calculated for each student. The degree of conversion at the bottom of incrementally placed composite restorations prior to individual instructions (group 1) and after individual instructions (group 2) was assessed using Fourier-transform infrared (FTIR) spectroscopy. The irradiance and degree of conversion measurements were re-assessed after all students received individual instructions. Data were analyzed using Wilcoxon signed-rank test and Mann-Whitney U-test at an overall level of significance of α = 0.05. A significant increase ( p < 0.001) in applied light irradiance could be observed after individual instructions for both groups, with notably reduced data scattering. However, no significant difference was detected for the degree of conversion of placed composite restorations before or after instruction and training. Neither gender nor age of the dental students affected the obtained results. Consistent light energy delivered by dental students could be achieved through individual instructions and training with a patient simulator, also leading to less scattered irradiance results. However, the improved light-curing performance after the training did not affect the degree of conversion of the placed class II composite restorations.

Objectives: To investigate the effect of rapid high-intensity light-curing on the marginal integrity of four bulk-fill composites, including two materials specifically designed for high-intensity curing., Methods: Class V cavities were prepared on buccal surfaces of intact human molars with simulated pulpal pressure, filled in a single increment and light-cured using a conventional (10 s @ 1,340 mW/cm 2 ) or high-intensity (3 s @ 3,440 mW/cm 2 ) protocol. The restorations were subjected to thermo-mechanical loading (TML) comprising 1,200,000 mechanical loading cycles and 3,000 thermocycles. Quantitative margin analysis was performed before and after TML using a scanning electron microscope, and the marginal integrity was expressed as percentage of continuous margin (PCM)., Results: All PCM values measured before TML were statistically similar regardless of the material and curing protocol (p>0.05). A statistically significant effect of the curing protocol (p = 0.021) was identified only after TML for one material. PCM was significantly diminished by TML (p<0.001) for most combinations of material and curing protocol. The PCM values of the sculptable composites after TML were statistically similar regardless of the curing protocol (p>0.05). Compared to these values, significantly lower PCM after TML was identified for the flowable composites cured with the high-intensity protocol (p = 0.001-0.045)., Conclusion: In most cases, high-intensity and conventional curing generally led to similar marginal integrity. Although all of the investigated composites initially performed similarly well, the flowable composites light-cured using the high-intensity protocol showed a significantly inferior marginal integrity compared to the sculptable composites after loading., Clinical Significance: Rapid high-intensity light-curing cannot be recommended for flowable bulk-fill composites since it may compromise the tooth-restoration interface., (Copyright © 2021. Published by Elsevier Ltd.)

This study investigated the short- and long-term effects of dental adhesives doped with nano-sized bioactive glass 45S5 (BAG) on the resin-dentin interfacial bond strength. Two etch-and-rinse adhesives (Adper Scotchbond Multi-Purpose (ASB) and Solobond Plus (SB)) and one self-etch adhesive (Clearfil SE Bond (CF)) were doped with different concentrations of BAG (5, 10, and 20 wt%). The unmodified (0 wt% BAG) commercial adhesives served as control groups. Dentin of 120 molars (n = 10 per group) was treated with the different adhesives, followed by buildups with a conventional composite restorative material. From each tooth, 14 sticks were prepared for micro-tensile bond strength (µTBS) testing. The sticks were stored in simulated body fluid at 37 °C and tested after 24 h or six months for µTBS and failure mode. Data were analyzed using Kruskal-Wallis tests in combination with post-hoc Conover-tests and Wilcoxon signed-rank tests at a level of significance of α = 0.05. After 24 h and six months, both etch-and-rinse adhesives with a low BAG content (up to 10 wt% for ASB and 5 wt% for SB) showed similar µTBSs as their respective control groups (0 wt% BAG). CF showed a significant decrease in µTBS even after addition of 5 wt% BAG. At a high concentration of added BAG (20 wt%), all three adhesives showed a significant decrease in µTBS compared to the unmodified controls. The CF control group showed significantly lower µTBS after 6 months of storage than after 24 h. In contrast, the µTBS of all CF groups modified with BAG was unaffected by aging. In conclusion, the tested etch-and-rinse adhesives can be modified with up to 5 wt% (SB), or 10 wt% (ASB) of BAG without reducing their short- and long-term dentin bond strength. Moreover, the addition of nano-sized BAG may prevent long-term bond strength deterioration of a self-etch adhesive.

The aim of this study was to investigate whether experimental and commercial dental restorative materials with functional fillers can exert a protective anti-demineralizing effect on enamel that is not immediately adjacent to the restoration. Four experimental resin composites with bioactive glass and three commercial restorative materials were investigated. Enamel blocks were incubated in a lactic acid solution (pH = 4.0) at a standardized distance (5 mm) from cured specimens of restorative materials. The lactic acid solution was replenished every 4 days up to a total of 32 days. Surfaces of enamel blocks were periodically evaluated by Knoop microhardness measurements and scanning electron microscopy. The protective effect of restorative materials against acid was identified as enamel microhardness remaining unchanged for a certain number of 4-day acid addition cycles. Additionally, the pH of the immersion medium was measured. While enamel microhardness in the control group was maintained for 1 acid addition cycle (4 days), restorative materials postponed enamel softening for 2-5 cycles (8-20 days). The materials capable of exerting a stronger alkalizing effect provided longer-lasting enamel protection. The protective and alkalizing effects of experimental composites improved with higher amounts of bioactive glass and were better for conventional bioactive glass 45S5 compared to a fluoride-containing bioactive glass. Scanning electron micrographs evidenced the protective effect of restorative materials by showing a delayed appearance of an etching pattern on the enamel surface. A remotely-acting anti-demineralizing protective effect on enamel was identified in experimental composites functionalized with two types of bioactive glass, as well as in three commercial ion-releasing restorative materials.

Our aim was to evaluate the clinical performance of direct composite restorations placed in patients with severely worn dentitions at an increased vertical dimension of occlusion, after up to 11 years. One hundred and sixty-four teeth in 13 patients with severely worn dentitions had been reconstructed with either microhybrid (first cohort; n = 59) or nanofilled (second cohort; n = 105) composite restorations at increased vertical dimension of occlusion using a wax-up-based template-aided placement technique. From the dental records, information about repair and replacement of restorations was obtained. Patients were clinically examined after a mean follow-up time of 10.7 years (first cohort) or 5.2 years (second cohort) using United States Public Health Service (USPHS) criteria. Subjective patient satisfaction was also recorded using visual analogue scales (VAS). The overall quality of the restorations was good with predominantly 'Alpha' and 'Bravo' scores, respectively. Nanofilled composite showed less surface degradation and better margin qualities than microhybrid composite. Of the 59 restored teeth in the first cohort, 13 restorations showed unfavorable events after 10.7 years, of which ten could be repaired. In the second cohort, 23 of 105 restorations showed unfavorable events, which could all be repaired. VAS scores revealed high patient satisfaction with the treatment approach. In conclusion, direct composite restorations placed at an increased vertical dimension of occlusion show good clinical long-term performance in patients with severe tooth wear.

The shearing off of a cement fragment can cause localised periodontal attachment loss. Typical signs are an isolated periodontal pocket, possibly with gingival swelling, a positive CO2 test and a radiographically detectable radio-opaque fragment parallel to the root surface. We use two cases to show how the treatment of cementum shearing can look.

Rapid high-intensity light-curing of dental resin composites is attractive from a clinical standpoint due to the prospect of time-savings. This study compared the effect of high-intensity (3 s with 3,440 mW/cm 2 ) and conventional (10 s with 1,340 mW/cm 2 ) light-curing on micromechanical properties of conventional and bulk-fill resin composites, including two composites specifically designed for high-intensity curing. Composite specimens were prepared in clinically realistic layer thicknesses. Microhardness (MH) was measured on the top and bottom surfaces of composite specimens 24 h after light-curing (initial MH), and after subsequent immersion for 24 h in absolute ethanol (ethanol MH). Bottom/top ratio for initial MH was calculated as a measure of depth-dependent curing effectiveness, whereas ethanol/initial MH ratio was calculated as a measure of crosslinking density. High-intensity light-curing showed a complex material-dependent effect on micromechanical properties. Most of the sculptable composites showed no effect of the curing protocol on initial MH, whereas flowable composites showed 11-48% lower initial MH for high-intensity curing. Ethanol/initial MH ratios were improved by high-intensity curing in flowable composites (up to 30%) but diminished in sculptable composites (up to 15%). Due to its mixed effect on MH and crosslinking density in flowable composites, high-intensity curing should be used with caution in clinical work.

Purpose: To investigate the reparability of aged and fresh resin composite after different mechanical surface pretreatments., Materials and Methods: Sixty composite specimens (Filtek Supreme XTE, 3M Oral Care) were either aged by thermal cycling (5000 cycles, 5-55°C) and six months of water storage, or immediately processed within 5 min after polymerization. Both aged and fresh specimens were either ground with fine (46-µm) or coarse (100-µm) diamond burs and then silanized or sandblasted with aluminum oxide (Al2O3) and silanized. In the negative control group, no mechanical surface pretreatment or silanization was performed. Specimens (n = 6 per group) were repaired with an adhesive (OptiBond FL, Kerr) and a resin composite (Filtek Supreme XTE). Directly adhered composite-to-composite increments served as the positive control group. After thermoycling, microtensile repair bond strength was assessed and statistically analyzed (α = 0.05)., Results: Aged composite surfaces revealed significantly lower repair bond strength than immediately repaired composite. The negative control group demonstrated the significantly lowest microtensile bond strength of all groups. No significant differences in repair bond strength were observed between the different mechanical pretreatments for both aged and fresh specimens. The repair bond strength of fresh composite pretreated with a fine diamond bur + Al2O3 + silane or a coarse diamond bur with/without Al2O3 + silane did not differ significantly from the positive control group., Conclusion: The age of the repaired composite has a greater influence on repair bond strength than does the type of composite surface pretreatment.

Resin composites containing reinforcing inert glass fillers combined with bioactive glass (BG) can aid in the prevention of secondary caries, which is a major cause of failure of contemporary composite restorations. A series of previous studies on experimental resin composites filled with BG 45S5 has demonstrated that methacrylate resin polymerization can be impaired by the addition of unsilanized BG, leading to lower degrees of conversion (DC). In order to distinguish whether the polymerization inhibition is caused by a direct (temperature-independent) effect of BG or an indirect (temperature-dependent) effect of restricted mobility of reactive species, this study used Raman spectroscopy to evaluate the DC values of experimental composites post-cured at 37 °C and 150 °C. The potential of BG to adversely affect DC was highly dependent on the resin system. The highest DC reduction was observed in the resin system based on ethoxylated bisphenol A dimethacrylate (Bis-EMA), followed by bisphenol A glycidyl methacrylate (Bis-GMA). In contrast, the DC for urethane dimethacrylate (UDMA) was not compromised by BG. Increasing the mobility of reactive species by heating at 150 °C showed limited potential for increasing the DC in the Bis-EMA and Bis-GMA resin systems, indicating a direct inhibitory effect of BG on polymerization.

The aim of this study was to investigate margin integrity of Class V composite restorations in demineralized and sound enamel after bonding with different etch-and-rinse and self-etch adhesive systems. Out of a total of 60 specimens from bovine incisors, 30 specimens were demineralized (21 days, acid buffer, pH 4.95) to create artificial enamel lesions. Circular Class V cavities were prepared in all 60 specimens and treated with either an unfilled etch-and-rinse adhesive (Syntac Classic; Ivoclar Vivadent), a filled etch-and-rinse adhesive (Optibond FL; Kerr), or a self-etch adhesive (iBond Self Etch; Heraeus) (n = 10 per group). The cavities were restored with a nanofilled resin composite and thermocycled (5000×, 5-55 °C). Scanning electron microscopy was used to evaluate margin integrity of the composite restorations, and the percentage of continuous margin was statistically analyzed (α = 0.05). Demineralized enamel led to a significantly lower margin integrity when the self-etch adhesive iBond Self Etch was applied, but did not affect margin integrity when the etch-and-rinse adhesives Optibond FL (filled) or Syntac Classic (unfilled) were used. No significant differences in margin integrity in sound and demineralized enamel were observed between the different adhesives. Demineralized enamel reduces margin integrity of composite restorations when bonded with a self-etch adhesive, but does not affect margin integrity when an etch-and-rinse approach is used.

The aim of the present study was to investigate polymerization shrinkage, shrinkage force development, and degree of monomer conversion of high- and low-viscosity dimethacrylate- and ormocer-based bulk-fill resin composites. Two flowable bulk-fill composites (SDR, x-tra base), two high-viscosity bulk-fill composites (Bulk Ormocer, SonicFill), and two conventional composite materials (Esthet X flow, Esthet X HD) were photoactivated for 20 s at 1275 mW/cm 2 . Linear polymerization shrinkage and shrinkage force were recorded in real time using custom-made devices, and the force rate and time to achieve maximum force rate were determined. Degree of conversion was measured using Fourier-transform infrared spectroscopy. Data were analyzed with one-way ANOVA and Tukey's HSD post-hoc test, and bivariate correlations were computed (α = 0.05). The category of high-viscosity bulk-fill resin composites showed the significantly lowest polymerization shrinkage and force development. Within the tested flowable composite materials, SDR bulk-fill generated the significantly lowest shrinkage forces during polymerization and attained the significantly highest degree of conversion. Strong positive correlations were revealed between shrinkage force and both linear polymerization shrinkage (r = 0.902) and maximum force rate (r = 0.701). Linear shrinkage and shrinkage force both showed a negative correlation with filler volume content (r = - 0.832 and r = - 0.704, respectively). Bulk-fill resin composites develop lower shrinkage forces than their conventional flowable and high-viscosity counterparts, respectively, which supports their use for restoring high C-factor posterior cavities. Overall, bulk-fill composites with high filler amount and low force rate showed the most favorable shrinkage force characteristics.

Objectives: This study aimed to analyse loss of enamel worn against composite, leucite glass ceramic or enamel antagonists under non-erosive and alternating or simultanuous erosive-attritive conditions., Materials and Methods: Flat human enamel specimens were loaded (1 Hz, 300 g loading weight, each subgroup n = 12) with antagonists made from a hybrid-composite (Z250, 3 M Espe), a nano-composite (Filtek Supreme XTE, 3 M Espe), leucite glass ceramic (IPS Empress CAD LT, Ivoclar Vivadent) or enamel. Specimens were either submitted to mechanical loading in mineral solution (60 s) or to loading under alternating or simultaneous erosive conditions. For alternating erosion-attrition, specimens were eroded by citric acid (pH 2.6, 60 s) and then loaded with the respective antagonist for 60s. For simultaneous erosion-attrition, specimens were loaded with the respective antagonist while being immersed in citric acid (pH 2.6, 60 s). After each cycle, specimens were stored in water for 1 h. After 18 cycles, enamel loss was calculated profilometrically and statistically analysed by two-way ANOVA and Tukey's post-hoc tests (p < 0.05)., Results: Enamel loss (μm, mean ± standard deviation) was significantly highest for simultaneous erosion-attrition (ceramic 9.4 ± 1.1, hybrid-composite 8.3 ± 0.7, nano-composite 7.8 ± 1.2, enamel 7.4 ± 0.8) followed by alternating erosion-attrition (ceramic 3.5 ± 0.5, hybrid-composite 2.1 ± 0.8, nano-composite 1.0 ± 0.2, enamel 2.5 ± 0.7) and attrition in mineral solution (ceramic 0.5 ± 0.3, hybrid composite 0.3 ± 0.1, nano composite 0.1 ± 0.2, enamel 0.1 ± 0.1). Ceramic antagonists resulted in significantly higher loss than the remaining antagonistic materials when alternating or simultaneous erosion-attrition was performed., Conclusion: Erosive conditions had a massive impact on enamel worn against different antagonistic materials, with simultaneous erosive-attritive conditions being more detrimental than alternating erosive-attritive conditions., Clinical Relevance: Enamel wear by antagonistic restorative materials is significantly influenced by erosive conditions.

The restorative rehabilitation of the severe loss of dental hard tissue due to dental erosion or abrasion is a challenging situation for the dentist. The following article presents the case of applying direct adhesive composite restorations as one possible approach to reconstruct erosively-induced severe dental hard tissue loss.

Bulk-fill resin composites represent an innovative class of dental composite materials, developed to simplify and expedite the restoration process. They can be adequately photopolymerized up to 4–5mm composite thickness and therefore permit a more economical restorative approach as compared to conventional resin composites. The current paper summarizes the most important facts on bulk-fill composite materials and provides recommendations for the successful use of these materials in daily practice based on upto-date in vitro and in vivo research.

Bulk-fill resin composites represent an innovative class of dental composite materials, developed to simplify and expedite the restoration process. They can be adequately photopolymerized up to 4–5mm composite thickness and therefore permit a more economical restorative approach as compared to conventional resin composites. The current paper summarizes the most important facts on bulk-fill composite materials and provides recommendations for the successful use of these materials in daily practice based on up-to-date in vitro and in vivo research.

This study investigated the influence of modulated photo-activation on axial polymerization shrinkage, shrinkage force, and hardening of light- and dual-curing resin-based composites. Three light-curing resin composites (SDR bulk-fill, Esthet X flow, and Esthet X HD) and one dual-curing material (Rebilda DC) were subjected to different irradiation protocols with identical energy density (27 J cm(-2) ): high-intensity continuous light (HIC), low-intensity continuous light (LIC), soft-start (SS), and pulse-delay curing (PD). Axial shrinkage and shrinkage force of 1.5-mm-thick specimens were recorded in real time for 15 min using custom-made devices. Knoop hardness was determined at the end of the observation period. Statistical analysis revealed no significant differences among the curing protocols for both Knoop hardness and axial shrinkage, irrespective of the composite material. Pulse-delay curing generated the significantly lowest shrinkage forces within the three light-curing materials SDR bulk-fill, Esthet X flow, and Esthet X HD. High-intensity continuous light created the significantly highest shrinkage forces within Esthet X HD and Rebilda DC, and caused significantly higher forces than LIC within Esthet X flow. In conclusion, both the composite material and the applied curing protocol control shrinkage force formation. Pulse-delay curing decreases shrinkage forces compared with high-intensity continuous irradiation without affecting hardening and axial polymerization shrinkage., (© 2014 Eur J Oral Sci.)

Introduction: The temperature and related shrinking kinetics of gutta-percha injected from heat guns are not known; therefore, we investigated them in this study., Methods: The temperatures of 3 different backfill gutta-percha brands extruded from 3 commercially available heat guns set to 200°C were studied. To validate the results, temperature development of 1 gutta-percha brand injected from a heat gun during a simulated backfilling procedure was assessed in single-rooted human teeth containing thermocouples in a water bath of 37°C. These values were compared with the counterparts obtained in a tabletop testing device for shrinkage at an ambient temperature of 37°C. Using this device, linear shrinkage upon cooling was assessed for all 3 gutta-percha brands under investigation. Results were compared by parametric statistics (alpha = .05)., Results: The temperatures of extruded gutta-percha differed significantly (P < .05) between heat guns and gutta-percha brands. Mean temperatures ranging between 57.6° ± 4.5°C and 103.9° ± 7.8°C could be observed with different combinations. The temperature of extruded gutta-percha in tabletop experiments equaled that observed in the root canals. However, the cooling of gutta-percha was (P < .05) faster in the tabletop measuring device compared with the root canal environment. Within the controlled temperature drop from 75°C to 37°C, the total shrinkage differed significantly (P < .05) between the 3 gutta-percha brands under investigation and ranged between 0.96% ± 0.20% and 2.31% ± 0.26% after 10 minutes (P < .05). Shrinking kinetics showed different patterns between the gutta-percha brands., Conclusions: Gutta-percha designed for thermoplastic application shrinks quickly and extensively upon cooling., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)