The effect of artificial aging on Martens hardness and indentation modulus of different dental CAD/CAM restorative materials

OBJECTIVES To determine the Martens hardness parameters for five different classes of CAD/CAM restorative materials after storage in water and thermo-cycling. MATERIALS AND METHODS Lithium disilicate ceramic IPS e.max CAD (EX), silicate ceramic IPS Empress CAD (EC), a polymer infiltrated interpenetrating network material (hybrid material) VITA Enamic (VE), two compact filled composites Lava Ultimate (LU), experimental material (EM), two low filled resin composites Katana Avencia (KA), Ambarino High-Class (AH) and ultra-low/unfilled acrylic polymers CAD-Temp (CT), Telio CAD (TC), breCAM.HIPC (BC) were tested. Specimens were stored in water at 37 °C for 30, 60, 90, 120 days and afterwards thermo-cycled (30,000×, 5 °C/55 °C). Martens hardness (HM) and indentation modulus (E$_{IT}$) were longitudinally investigated after each storage time. For structural analysis, each material was analyzed by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). RESULTS The groups of unfilled polymers/ultra-low filled composite (CT, TC, BC) followed by low (KA, AH) and compact filled resin composites (LU, EM) showed the lowest HM and E$_{IT}$ values (p < 0.001). The highest values presented ceramics (EX, EC) followed by hybrid material (VE) (p < 0.001). High influence on the Martens hardness parameters was exerted by the aging duration (HM: η$_{P}$$^{2}$ = 0.108, p < 0.001; E$_{IT}$: η$_{P}$$^{2}$ = 0.074, p < 0.001). Structural analyses of resin composites revealed big differences in shape, size and distribution of filler particles. CONCLUSIONS The tested CAD/CAM materials showed differences in Martens hardness and indentation modulus pursuant to the material class. Ceramics showed highest values, followed by the hybrid material. For resin composites the Martens hardness and indentation modulus increased with the filler content. Artificial aging affected CAD/CAM materials differently. Some materials tested are prone to aging, the Martens hardness and indentation modulus decreased after thermo-cycling

In vitro tooth cleaning efficacy of manual toothbrushes around brackets

The purpose of this laboratory study was to assess the potential cleaning efficacy of nine different toothbrushes around brackets in vitro. Standard and Mini Diamond™ brackets were fixed on coloured teeth in a special model, coated with white titanium oxide, brushed in a machine with different manual toothbrushes (three different types: planar, staged, and v-shaped bristle field), and tested with a horizontal motion for 1 minute. After brushing, the teeth were scanned and the black surfaces were planimetrically assessed using a grey scale. Tooth areas which were black again after brushing indicated tooth surface contact of the filaments. The remaining white tooth areas around the brackets indicated ‘plaque-retentive' niches. Statistical analysis was carried out using the Kruskal-Wallis one-way test of variance for individual comparison. Bonferroni adjustment was used for multiple testing, and comparison of bracket size with Wilcoxon signed rank test. In the most critical area of 2 mm around the brackets, there was no statistically significant difference between the different toothbrushes evaluated. The untouched area ranged from 11 to 26 per cent of the initially whitened tooth surface. By pooling the toothbrushes according to their design, the median cleaning efficacy of the v-shaped (73.1 per cent) and staged (75.6 per cent) toothbrushes resulted in significantly superior cleaning efficacy than planar toothbrushes (60.7 per cent) for standard brackets. For mini bracket type, staged toothbrushes showed a significantly better mean cleaning efficacy (77.8 per cent) than planar (65 per cent) and v-shaped (72.4 per cent) toothbrushes. Staged and v-shaped brush designs resulted in superior cleaning efficacy of teeth with fixed orthodontic attachments than toothbrushes with a planar bristle field. None of the tested toothbrushes showed a consistent, significantly higher cleaning efficacy than the others in this in vitro experimen

Impact of different pretreatments and aging procedures on the flexural strength and phase structure of zirconia ceramics

OBJECTIVE To test the impact of zirconia pretreatment and aging on flexural strength and phase structure. METHODS For flexural strength measurements, 180 3Y-TZP$_{0.25}$ specimens were fabricated and pretreated: (i) air-abraded (105-μm alumina, 0.25MPa), (ii) air-abraded (50-μm alumina, 0.25MPa), (iii) air-abraded (30-μm silica-coated alumina, 0.28MPa) (iv) non-pretreated. Each pretreated group (n=15) was aged: (a) hydrothermal (134°C, 0.23MPa, 2h) (b) in a mastication simulator (1,200,000×, 5/55°C) and (c) not aged. The fractured specimens were stored dry for 5 years (23°C) for analysis of phase transformation. Additionally, specimens were fabricated from 3Y-TZP$_{0.25}$ (n=12) and 3Y-TZP$_{0.05}$ (n=8), pretreated (i, ii, iii, iv), and hydrothermally aged. Each air-abrasion method was alternated using 0.05, 0.25 and 0.4MPa pressure. The phase transformation was examined by Raman spectroscopy and surface topography by scanning electron microscope. Data were analyzed using univariate ANOVA with the Scheffé post hoc test and partial-eta-squared (ƞ$_{p}$²) (α=0.05). RESULTS The highest impact on flexural strength was exerted by the pretreatment (η$_{P}$²=0.261, p<0.001), followed by interactions between pretreatment and aging (η$_{P}$²=0.077, p=0.033). Non-pretreated and non-aged specimens showed the lowest monoclinic percentage. Hydrothermal aging and 5 years of storage at room temperature increased the monolithic percentage of 3Y-TZP$_{0.25}$. The highest phase transformation was observed in groups air-abraded with 105-μm alumina particles. Increasing pressure during the air-abrading process increased the content of the monoclinic phase in zirconia surfaces. SIGNIFICANCE Air-abrasion with 30-μm silica-coated alumina powder can be recommended for pretreatment of 3Y-TZP$_{0.25}$ and 3Y-TZP$_{0.05}$. For air-abrasion using alumina powder lower pressure should be used

Cleaning ability and induced dentin loss of a magnetostrictive ultrasonic instrument at different power settings

Some laboratory studies have evaluated the oscillation mode of ultrasonic scalers. None of them recorded its influence on calculus removal and quantified dental hard tissue loss. This study aimed to compare the performance of a magnetostrictive ultrasonic instrument at different power settings in vitro in relation to the tip oscillation activity. The oscillation activity of the straight Slimline® insert in the Cavitron® ultrasonic scaling device was analyzed at five different power settings with the help of two laser vibrometers. The performance of this instrument was tested on 60 roots of human single-rooted teeth. Twelve roots each were randomly assigned to be instrumented at a given power setting. Every root was instrumented for 120s at a standardized instrumentation force of 0.1 ± 0.05N. In addition, another 30 periodontally involved roots with subgingival calculus were instrumented accordingly to assess the calculus removal potential. The surface characteristics after instrumentation were analyzed under scanning electron microscope. The instrumentation at minimum power setting resulted in an mean increase of the root surface roughness of 0.18 ± 0.28 compared to 0.51 ± 0.48 at maximum power setting (P = 0.0327). The loss of dental hard tissue amounted to 11.37 ± 3.64 at minimum compared to 23.37 ± 15.76 at maximum power (P = 0.0010). The higher the power setting, the more calculus was removed. The values of the latter ranged between 4.04 ± 1.87 and 11.26 ± 4.66mm2 of cleaned dentin surface area (P = 0.0065). At lower power settings, a more favorable relation between cleaning ability, loss of dentine, and surface roughness was foun

Zirconia ceramics, their contrast ratio and grain size depending on sintering parameters

This study investigated the contrast ratio and grain size depending on sintering parameters of twelve different zirconia materials and compared with glass-ceramic (N=156, n=12 per group). Contrast ratio of all ceramics was measured using a spectrophotometer according to ISO 2471: 2008. Grain sizes of zirconia were determined by SEM. Data was analyzed using one-way ANOVA followed by post-hoc Scheffé-test, Kruskal-Wallis-H-test and Spearman correlation (p<0.05). The area under the sintering curve up 25°C (AUC25) and 1200°C (AUC1200) of zirconia was calculated. Glass-ceramic showed significantly lowest contrast ratio compared to zirconia. Final sintering temperature and AUC1200 influenced contrast ratio. Grain size was affected by final sintering temperature, sintering duration and AUC. Contrast ratio and grain size showed an association

Influence of dentin and enamel pretreatment with acidic sulfur compounds on adhesive performance

Objective: This study tested the potential hampering effects of acidic sulfur compounds (ASC) containing hydroxybenzene sulfonic acid, hydroxymethoxybenzene sulfonic acid, and sulfuric acid, prior to self-etch and etch-and-rinse bonding procedures on enamel and dentin. According to the manufacturer, ASC should be applied after cavity preparation and prior to application of a primer in order to reduce the remaining biofilm in the preparation cavity. Despite promoted marketing, data on the investigated liquid are almost completely lacking. Material and methods: One hundred and fifty-two extracted mandibular bovine incisors were embedded and polished to expose either enamel (E) or dentin (D). Then, specimens were randomly divided and conditioned as follows (n = 12/group): ASC and consecutive phosphoric acid application (E1/D1), ASC (E2/D2; E5/D5), phosphoric acid (E3/D3), and no conditioning (E4/D4; E6/D6). Groups were then treated with either Optibond FL® (etch-and-rinse; 1-4) or Clearfil SE Bond® (self-etch; 5-6). Hollow acrylic cylinders were bonded with a hybrid composite resin (Filtek Supreme XTE®) to the specimens, and the shear bond strength was measured (1mm/min). In addition, failure types were assessed. Descriptive statistics and statistical analyses were performed with one-way ANOVA followed by the Scheffé post hoc test. Results: For enamel, the highest shear bond strength values were obtained applying routine bonding procedures (23.5 ± 5.6MPa for etch-and-rinse and 26.0 ± 6.0MPa for self-etch, respectively). In contrast, dentin pretreatment with a combination of ASC and phosphoric acid led to the highest shear bond values (22.8 ± 4.1MPa). Conclusion: This study shows that ASC prior to dental restoration placement cannot be recommended for etch-and-rinse procedures on enamel but is appropriate for dentin without interfering with routine bonding procedures. Clinical relevance: The application of acidic sulfur compounds prior to adhesive restoration placement should be restricted to dentin only as it may negatively influence shear bond strength on sound ename

Long-term protective effect of surface sealants against erosive wear by intrinsic and extrinsic acids

OBJECTIVE: To test sealants to prevent erosive tooth wear caused by extrinsic and intrinsic acids under long-term exposition. METHODS: 144 bovine enamel samples were randomly allocated to twelve groups (1-12). Samples of groups 1, 5 and 9 remained unsealed (positive controls), 2, 6 and 10 were sealed with Silicon Seal Nano Mix and 3, 7 and 11 with Seal&Protect. Groups 4, 8 and 12 were sealed with flowable composite (negative controls). Groups 1-4 were immersed in artificial saliva, 5-8 in hydrochloric acid and groups 9-12 in citric acid for 28 days, respectively. After 1, 2, 4, 7, 11, 14, 21 and 28 days, solutions were renewed and enamel wear was quantified by assignation of (32)P in the solutions. RESULTS: In all immersion solutions, lowest mineral loss was observed for the negative controls whilst highest loss was observed for unsealed positive controls. In artificial saliva and citric acid, the loss from samples sealed with Seal&Protect was not significantly different compared with negative controls whilst loss in groups sealed with Silicon Seal Nano Mix was significantly higher. In hydrochloric acid, loss from samples sealed with Seal&Protect was not different compared with that of negative controls up to 4 days. Except day 1, the mineral loss in the Seal&Protect group was significantly lower compared with that of the Silicon Seal Nano Mix group. CONCLUSION: The tested resin based surface sealant is able to significantly reduce the erosive demineralisation of enamel caused by hydrochloric and citric acid even under long-term exposition

Effect of Aging on Stained Monolithic Resin-Ceramic CAD/CAM Materials: Quantitative and Qualitative Analysis of Surface Roughness

PURPOSE The aim of this in vitro study was to measure the effect of staining and artificial aging on the surface roughness of commercially available resin-ceramic computer-aided design and computer-aided manufacturing (CAD/CAM) materials both quantitatively and qualitatively and to compare it to feldspathic material. MATERIALS AND METHODS Test specimens (n = 15 per material) were prepared of CAD/CAM ingots from a resin nanoceramic (Lava Ultimate, LVU), a polymer-infiltrated ceramic (Vita Enamic, ENA), and a resin nanoceramic (Cerasmart, CER). In the staining protocol, test specimens were (i) roughened in a standardized manner and (ii) stained with the manufacturer's recommended staining kit by means of photo-polymerization (Bluephase Polywave). The control specimens were prepared out of a feldspathic ceramic (Vita Mark II,VM2) and stained in a ceramic furnace. As negative control of each group, 15 specimens were prepared and polished in a standardized manner. Surface roughness (Ra) was measured after finishing procedures and after simulation of clinical service up to 5 years by means of toothbrushing. After each year of aging, one specimen per group was randomly selected for scanning electron microscopy (SEM) analysis. Kruskal-Wallis test and paired post-hoc test were applied to detect differences between treatment groups (alpha = 0.05). RESULTS The mean roughness measurements of the stained CAD/CAM materials were 0.14 ± 0.04 μm (ENA), 0.15 ± 0.03 μm (LVU), 0.22 ± 0.03 μm (VM2), and 0.26 ± 0.12 μm (CER). In the polished CAD/CAM materials the measurements were 0.01 ± 0.01 μm (CER), 0.02 ± 0.01 μm (LVU), 0.02 ± 0.00 μm (VM2), and 0.03 ± 0.01μm (ENA). Irrespective of the restoration material, the applied staining protocol resulted in a higher surface roughness compared to the polished specimens (p < 0.001). After 5 years of simulated aging the mean surface roughness in the stained CAD/CAM materials were 0.22 ± 0.03 μm (VM2), 0.24 ± 0.09 μm (ENA), 0.25 ± 0.06 μm (CER), and 0.37 ± 0.09 μm (LVU). Aging had a significant effect on surface roughness in groups ENA and LVU (p < 0.001). SEM analysis showed that the staining layer on resin-ceramic CAD/CAM materials was partially removed over time. CONCLUSIONS The applied staining protocol significantly increased surface roughness of CAD/CAM materials. Instability of the staining layer on resin-ceramic CAD/CAM materials could be anticipated over time as a consequence of toothbrushing, whereas feldspathic ceramic did not suffer from such aging effect

Application of cerium chloride to improve the acid resistance of dentine

OBJECTIVE: To investigate the effect of cerium chloride, cerium chloride/fluoride and fluoride application on calcium release during erosion of treated dentine. METHODS: Forty dentine samples were prepared from human premolars and randomly assigned to four groups (1-4). Samples were treated twice a day for 5 days, 30s each, with the following solutions: group 1 placebo, group 2 fluoride (Elmex fluid), group 3 cerium chloride and group 4 combined fluoride and cerium chloride. For the determination of acid resistance, the samples were consecutively eroded six times for 5 min with lactic acid (pH 3.0) and the calcium release in the acid was determined. Furthermore, six additional samples per group were prepared and used for EDS analysis. SEM pictures of these samples of each group were also captured. RESULTS: Samples of group 1 presented the highest calcium release when compared with the samples of groups 2-4. The highest acid resistance was observed for group 2. Calcium release in group 3 was similar to that of group 4 for the first two erosive attacks, after which calcium release in group 4 was lower than that of group 3. Generally, the SEM pictures showed a surface coating for groups 2-4. No deposits were observed in group 1. CONCLUSION: Although fluoride showed the best protective effect, cerium chloride was also able to reduce the acid susceptibility of dentine significantly, which merits further investigation

Influence of chemical activation of a 35% hydrogen peroxide bleaching gel on its penetration and efficacy--in vitro study

OBJECTIVES: The aim of this study was to evaluate the effects of chemical activation of hydrogen peroxide (HP) gel on colour changes and penetration through the tooth structure. METHODS: One hundred and four bovine incisors were used. One dentine (CD) disc and one enamel-dentine (ED) disc were prepared from each tooth. They were positioned over artificial pulpal chambers and the bleaching was performed with an experimental 35% HP gel. Two control and six experimental groups were prepared. In the positive control group (PC) no chemical activator was used. In the negative control group (NC) the specimens did not receive any bleaching. Each experimental group received a different chemical activator (manganese gluconate-MG; manganese chlorite-MC; ferrous sulphate-FS; ferrous chlorite-FC; and mulberries root extract-MRE). After the bleaching procedure a sample of solution was collected from the artificial pulpal chamber and the HP concentration was measured. The data were analysed using ANOVA, Tukey's, and Dunnett's tests. RESULTS: The groups MG and FS showed a significantly lower penetration of HP than the PC group. For the parameter Delta E, all the groups, with the exception of the group MRE, showed a significantly higher means in relation to the PC group in ED colour. For dentine colour, just the groups MG and FS had significant differences in relation to PC. CONCLUSIONS: The addition of MG and FS decreases the penetration of HP. The chemical activation using metal salts tested was effective in increasing the bleaching effect