Do nanofilled/nanohybrid composites allow for better clinical performance of direct restorations than traditional microhybrid composites? a systematic review

This systematic review was carried out to assess the clinical effectiveness of nanofilled and nanohybrid composites used for direct restorations in comparison with microhybrid composites. The guidelines for the preferred reporting items for systematic reviews and meta-analyses were followed. A search of articles published from July 1996 to February 2017 was performed in PubMed, SciVerse Scopus, Latin American and Caribbean Health Sciences, the Scientific Electronic Library Online, and the Cochrane Library. The present review selected only randomized controlled trials comparing the clinical performance of a nanofilled or nanohybrid composite for direct restorations with that of a microhybrid composite. The research found 201 studies. Twenty-one articles fulfilled the criteria of the present review. However, the included studies were characterized by great methodological diversities. As a general trend, nanofilled and nanohybrid composites were found to be capable of clinical performance, marginal quality, and resistance to wear similar to that of traditional composites without showing improved surface characteristics. The risk of bias of included studies was judged unclear or high. The clinical performance of nanofilled/nanohybrid composites was found to be comparable to that of traditional composites in the posterior area. The data concerning anterior and cervical restorations were insufficient. With regard to the esthetic properties, there is a compelling need for studies on anterior teeth in which the operators are kept unaware of the restorative material. Nanofilled/nanohybrid composites seem to be a valid alternative to traditional microhybrid composites, and at the moment, there is low-level evidence attesting a lack of their superiority

Evaluation of degree of conversion, rate of cure, microhardness, depth of cure and contraction stress of three nano hybrid composites containing pre-polymerized spherical filler

Aim: Manufacturers aim at improving filler technology to enhance the properties of the restorative materials, thus maximising the aesthetic and functional outcome of the restored tooth. The present study tested the degree of conversion (DC), rate of cure (RC), microhardness (VHN), depth of cure (VHR) and contraction stress (CS) of three new nano hybrid composites with pre-polymerized spherical filler. Methods: Three commercially available composite resin were characterised in the present study, namely the Ceram.X\uae universal shade A3 (CXUA3), Ceram.X\uae duo enamel shade E2, and Ceram.X\uae duo dentin shade D3 (CXDE2 and CXDD3). The materials were light-cured with a LED light (SmartLite Focus, measured output 1301 mW/cm2) following the protocol recommended by the manufacturer. DC was assessed by means of Fourier-transform infrared spectroscopy, calculating RC from a second-grade polynomial fitting of the kinetic curve. A microhardness testing machine equipped with a Vickers indenter served to measure the top and bottom VHN of 2 mm-high disc-shaped specimens, using the bottom/top surface values ratio (VHR) as indirect evaluation of the depth of cure. CS vs time was evaluated by a universal testing machine provided with an extensometer as feedback system, CS was normalized for the specimen bonding area. All data sets underwent statistical analysis with dedicated software and tested for the assumptions for the use of parametric tests. Multiple analyses of variance with Scheff\ue9 post hoc test were carried out to compare the dependent variables of interest among the tested materials. Results: All tested materials exhibited a DC lower than 50%, with CXUA3 reaching the lowest DC value after 10 s. RC of CXUA3 at 5 s was comparable to that of CXDE2, while after 10s RC of CXUA3 decreased to a value proportional to that of CXDD3. For all the tested materials, top-VHN was greater than bottom-VHN. Top-VHN of CXDE2 was lower than CXUA3 and CXDD3. CXDD3 was the only material achieving VHR>80%. The main differences in CS among the tested materials were found during the irradiation with curing-light: CXDE2 displaying the lowest CS after 10 s and CXDD3 the highest after 30 s. Conclusion: The present study proved that the light curing protocol suggested by the manufacturer for the three composites might be improved: 10 s of irradiation seemed insufficient to adequately cure CXUA3 and CXDE2. Longer curing times for these materials appear advisable

In vitro and in vivo evaluation of T and B lymphocyte functions in AKR mice.

To investigate whether AKR spontaneous leukaemogenesis is associated with a reduction in functional activity of T lymphocytes, the PHA response of AKR blood cells at different ages up to and including the preleukaemic period was studied. No significant differences were observed among young, adult and preleukaemic donors. In addition, the in vitro and in vivo AKR lymphocyte functions were compared with those of CBA lymphocytes by means of their response to stimulation with T and B lymphocyte selective mitogens (PHA, Con A and LSP respectively), and their response to immunization with thymus dependent (SRBC) or independent (LPS) antigens. We observed in vitro that while the B lymphocytes responded normally to mitogen, an intrinsic hyporeactivity to mitogens characterizes the T lymphocytes. Moreover, AKR mice exhibited a reduced in vivo response to both thymus dependent and independent antigens

Use of reciproc instruments with different motions: cyclic fatigue testing with simulation of the body temperature

Aim: To assess the influence of different motions on the cyclic fatigue resistance of Reciproc instruments simulating the temperature of the clinical conditions. Methods: The sample size was determined using statistical software set with the following parameters: \u3b1=0.05, \u3b2=0.20, \u3b4=30.0, \u3c3=28.0. The experiment required 54 Reciproc files. Brand new R25 files were randomly allocated to three groups defined by the tested motion: continuous rotation at 300 rpm (n=18), \u201cRECIPROC\u201d mode (n=18), and \u201cWAVEONE\u201d mode (n=18). The same endodontic motor was used for all groups (X-Smart IQ). All files were rotated/reciprocated until fracture inside a custom-designed artificial canal with 60\ub0 angle and 5-mm radius of curvature milled in a stainless-steel block. The testing device was electrically heated to keep its internal temperature at 35\ub11\ub0C, which was constantly monitored with a thermometer. After file separation, the time to failure was registered with a digital chronometer and the length of the fractured fragment measured with a digital calliper. The fracture surface of each file was observed at the scanning electron microscope to perform a qualitative fractographic analysis. The collected data (time to fracture and fracture length) were tested for the normality of the distribution and the equality of variances with a Shapiro-Wilk and a Levene test, respectively. The dependent variables were compared amongst groups by means of a multivariate analysis of variance and Tuckey post-hoc test (p=0.05). Results: The continuous rotation group exhibited the shortest lifespan among the considered groups (85.4\ub19.5 s to failure). Both reciprocating motions were associated with a significant improvement of fatigue resistance (p<0.001). The \u201cRECIPROC\u201d mode allowed for longer time to failure than the \u201cWAVEONE\u201d mode, with 141.6\ub119.4 s and 117.2\ub111.2 s to failure, respectively. The absence of differences among the considered groups in terms of fracture length confirmed the correct positioning of the files inside the artificial canal. The scanning electron microscopic analysis showed signs of file separation ascribable to cyclic fatigue. Conclusion: The present study preliminary demonstrated that the native \u201cRECIPROC\u201d motion use of R25 Reciproc files should be preferred over other types of motions to prevent file separation in the clinical setting