Dimensional changes of CAD/CAM polymer crowns after water aging - An in vitro experiment

Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) polymers can potentially replace traditional materials used for manufacturing indirect restorations. In 2012, Lava Ultimate (LU) was introduced as a highly suitable material for implant-supported single crowns. Three years after its introduction, the manufacturer issued a change in indication for the material, implying that they no longer considered the material to be suitable for crown indications due to debonding issues. A clinical trial with implant-borne Lava Ultimate crowns bonded to zirconia abutments revealed that 80 percent of the LU crowns showed debonding from the abutment within one year, whereas no debonding occurred when an alternative full-ceramic restoration material was used. These results suggest that the material itself had been the cause of the debonding. However, the exact reason for the debonding remained unclear. Water uptake in resin methacrylates like LU is known to cause dimensional changes resulting in mechanical stress on the RelyX Ultimate (RU) cement. The purpose of this study is to quantify the dimensional changes in LU caused by water uptake and relate these dimensional changes to the failure of the RU cement. Twenty-five identical LU-crowns were divided into three groups. 10 LU-crowns with abutment and 10 crowns without abutments were stored in water for 23 days and were only removed for measurement. Five crowns served as a control to calibrate the measurements. The internal diameter was measured eight times with a TS 460 Heidenhain touch probe. For visualization purposes, one crown was also 3D scanned before and after water treatment. The results showed that after 23 days in water the mean increase in diameter for the groups with and without abutment was 36.6 μm (SD = 35,1) and 36.7 μm (SD = 26,5) respectively. Mixed effects modelling indicated no significant between-group differences at any time point. Exposure of LU to water results in dimensional changes causing mechanical stress on the crown-abutment complex. It can be estimated that RU cement fails after an expansion of more than 4 μm. Within the limitations of this in vitro study, it can be concluded that the dimensional changes induced by water uptake can cause debonding issues. As more CAD/CAM polymers for restorative purposes are expected to be developed, the results of this study should stimulate manufacturers to quantify their products' dimensional changes in a wet environment before market release

Review of nanomaterials in dentistry: interactions with the oral microenvironment, clinical applications, hazards, and benefits.

Interest in the use of engineered nanomaterials (ENMs) as either nanomedicines or dental materials/devices in clinical dentistry is growing. This review aims to detail the ultrafine structure, chemical composition, and reactivity of dental tissues in the context of interactions with ENMs, including the saliva, pellicle layer, and oral biofilm; then describes the applications of ENMs in dentistry in context with beneficial clinical outcomes versus potential risks. The flow rate and quality of saliva are likely to influence the behavior of ENMs in the oral cavity, but how the protein corona formed on the ENMs will alter bioavailability, or interact with the structure and proteins of the pellicle layer, as well as microbes in the biofilm, remains unclear. The tooth enamel is a dense crystalline structure that is likely to act as a barrier to ENM penetration, but underlying dentinal tubules are not. Consequently, ENMs may be used to strengthen dentine or regenerate pulp tissue. ENMs have dental applications as antibacterials for infection control, as nanofillers to improve the mechanical and bioactive properties of restoration materials, and as novel coatings on dental implants. Dentifrices and some related personal care products are already available for oral health applications. Overall, the clinical benefits generally outweigh the hazards of using ENMs in the oral cavity, and the latter should not prevent the responsible innovation of nanotechnology in dentistry. However, the clinical safety regulations for dental materials have not been specifically updated for ENMs, and some guidance on occupational health for practitioners is also needed. Knowledge gaps for future research include the formation of protein corona in the oral cavity, ENM diffusion through clinically relevant biofilms, and mechanistic investigations on how ENMs strengthen the tooth structure

Calcium release and pH-characteristics of calcium hydroxide plus points

Aim To evaluate calcium ion release and pH-characteristics of calcium hydroxide plus points (CHPP), conventional calcium hydroxide points (CHP, both Coltene/Whaledent, Langenau, Germany) and aqueous calcium hydroxide suspension (CHS) (Calxyl, OCO, Dirmstein, Germany). Methodology Ten CHPP or CHP of size 50 were immersed into 5 mL isotonic sodium chloride solution. Conventional Ca(OH)(2)-free gutta-percha points served as negative control. Calcium release was measured up to 44 days by means of complexometric titration. Time dependent pH behaviour of all points in comparison with CHS was determined immersing 30 points of size 50 into 2.3 mL 0.9% wt NaCl-solution at time intervals of 0.5-72 h by a microelectrode measuring chain and a pH-meter. The surface morphologies of new and used gutta-percha points were evaluated qualitatively under a scanning electron microscope. Statistical evaluation was carried out using Kolmogorov-Smirnov-tests, Mann-Whitney-tests and multifactorial ANOVA. Results For CHPP, a threefold greater calcium release was measured compared with CHP. Both types of points as well as CHS showed a maximum pH of approximately 12. Differences between groups were statistically significant for calcium release and pH (multifactorial ANOVA; P 11 within 3 min. CHPP had a greater release of Ca2+ compared with CHP

The effect of different light-curing units on fatigue behavior and degree of conversion of a resin composite

The aim of this study was to investigate the effect of different light-curing units and irradiation modes on the mechanical fatigue strength and degree of conversion of a restorative resin composite. Conventional halogen, plasma arc and blue LED light-curing units were used for polymerization of a resin composite (Tetric® Ceram, Ivoclar, Vivadent, Liechtenstein). Initial fracture strength (FS) and flexural fatigue limit (FFL) as well as degree of conversion (DC) were measured. The FFL was determined under cyclic loading for 105 cycles in terms of a staircase approach. The specimens were stored for 14 days in 37 °C distilled water prior to testing. The curing efficiency was observed with Fourier transform infrared micromultiple internal reflectance spectroscopy. The measurements were carried out at 0.5 and 2.5 mm distance from the directly irradiated surface after 14 days storage in dark and dry conditions at 37 °C. The highest FS, FFL and DC were observed from high energy curing devices and from extended curing intervals. The conventional halogen light exhibited the most homogenous in-depth curing efficiency along with a low loss of mechanical resistance under cyclic fatigue. Evaluation of flexural fatigue limit and curing efficiency correlate in terms of decreased mechanical strength due to insufficient light-curing intervals or light intensities. Initial promising fracture strengths do not correlate with a clinically more relevant fatigue loading and with the in-depth degree of conversion, both accounting for a significantly reduced strength performance. © 2004 Academy Dental Materials. Published by Elsevier Ltd. All rights reserved