Repair of Bulk-Fill and Nanohybrid Resin Composites: Effect of Surface Conditioning, Adhesive Promoters, and Long-Term Aging

The aim of the study was to investigate the effect of different repair procedures on the repair bond strength of bulk-fill and nanohybrid resin composites after different aging periods. The resin composite blocks (8 × 8 × 4 mm$^{3}$) were prepared from a bulk-fill (reliaFIL Bulk) and a nanohybrid (reliaFIL LC) resin composite and grouped according to aging duration (6 months, 1 year, and 2 years). Following aging, the blocks were assigned to different surface treatments; air-abrasion with aluminum oxide powder, roughening with a diamond bur, and no treatment. After cleansing with phosphoric acid, a silane layer (Porcelain Primer) was applied on the surface of half of the specimens in each group. The specimens were subdivided into two groups (n = 5): Scotchbond Universal (3M Oral Care) and All-Bond Universal (Bisco). The blocks were repaired with the nanohybrid composite (8 × 8 × 8 mm $^{3}$). The repaired specimens were stored in distilled water (37 °C/24 h) and segmented into beams. Half of the beams were immediately subjected to microtensile μTBS testing (1 mm/min), while the other half was stored in distilled water (37 °C) for 6 months before testing. Failure modes were analyzed using stereomicroscope and SEM. Statistical analyses were performed with ANOVA and least significant difference tests (LSD) tests (p = 0.05). The extension of aging periods (6 months, 1 year, and 2 years) reduced the repair bond strength in some groups for both resin composites (p < 0.05). The air-abrasion and bur roughening improved the repair bond strength (p < 0.05). The silane application did not influence the repair bond strength and durability (p > 0.05). There was no difference among the universal adhesives in the same surface treatment groups (p > 0.05). The mechanical roughening treatments are necessary for the repair of resin composite. The universal adhesives might be used for the repair of resin composites regardless of silane content without prior silane application

Repair of Bulk-Fill and Nanohybrid Resin Composites: Effect of Surface Conditioning, Adhesive Promoters, and Long-Term Aging.

The aim of the study was to investigate the effect of different repair procedures on the repair bond strength of bulk-fill and nanohybrid resin composites after different aging periods. The resin composite blocks (8 × 8 × 4 mm3) were prepared from a bulk-fill (reliaFIL Bulk) and a nanohybrid (reliaFIL LC) resin composite and grouped according to aging duration (6 months, 1 year, and 2 years). Following aging, the blocks were assigned to different surface treatments; air-abrasion with aluminum oxide powder, roughening with a diamond bur, and no treatment. After cleansing with phosphoric acid, a silane layer (Porcelain Primer) was applied on the surface of half of the specimens in each group. The specimens were subdivided into two groups (n = 5): Scotchbond Universal (3M Oral Care) and All-Bond Universal (Bisco). The blocks were repaired with the nanohybrid composite (8 × 8 × 8 mm 3). The repaired specimens were stored in distilled water (37 °C/24 h) and segmented into beams. Half of the beams were immediately subjected to microtensile μTBS testing (1 mm/min), while the other half was stored in distilled water (37 °C) for 6 months before testing. Failure modes were analyzed using stereomicroscope and SEM. Statistical analyses were performed with ANOVA and least significant difference tests (LSD) tests (p = 0.05). The extension of aging periods (6 months, 1 year, and 2 years) reduced the repair bond strength in some groups for both resin composites (p < 0.05). The air-abrasion and bur roughening improved the repair bond strength (p < 0.05). The silane application did not influence the repair bond strength and durability (p > 0.05). There was no difference among the universal adhesives in the same surface treatment groups (p > 0.05). The mechanical roughening treatments are necessary for the repair of resin composite. The universal adhesives might be used for the repair of resin composites regardless of silane content without prior silane application

Effect of polishing instruments and polishing regimens on surface topography and phase transformation of monolithic zirconia: An evaluation with XPS and XRD analysis

PURPOSE: Polishing procedures might alter monolithic zirconia (MZ) surface resulting in phase changes that can be deleterious for clinical performance and antagonist tooth wear. This study investigated the topographical features and phase transformation in MZ after polishing with different regimens simulating the clinical workflow. ​ MATERIALS AND METHODS: MZ specimens (Katana Zirconia HT, Kuraray-Noritake) (12×12×1.8 mm(3)) were grinded and polished using one of the five systems assessed: BG: Silicone carbide polishers (Brownie, Greenie, Super Greenie); CG: Diamond impregnated ceramic polisher kit (Ceragloss); EV: Synthetically bonded grinder interspersed with diamond (EVE Kit); SL: Urethane coated paper with aluminium oxide grits (Soflex Finishing and Polishing System Kit) and DB: Diamond bur (8 µm). Polished specimens were initially roughened with 220 µm diamond burs (Grinding Bur-GB) (10 s, 160.000160,000 rpm) and considered for baseline measurements. Polishing regimens were performed for 10 s using a slow-speed hand piece under water-cooling except for SL, in a custom made device (750 g; 5000 and 75,000 rpm). Surface roughnesses, phase changes (XRD) were assessed, surface characterization was performed (SEM, EDS). RESULTS: The highest roughness was obtained with the EV system (1.11 µm) compared to those of other systems (0.13-0.4 µm) (pθ and minor peak at 34.94°2θ. While GB, CG, EV, SL and DB exhibited a peak shift to the left, BG demonstrated a right peak shift on the 2θ scale. Monoclinic phase change was not noted in any of the groups. CONCLUSION: All polishing methods, except BG, exhibited a peak shift towards the lower angles of the 2-theta scale. Since the peak shifts were in the order of fractions of an angle they are attributed to stress formation rather than a phase change in the material. Thus, all polishing systems tested may not be detrimental for the phase transformation of MZ. EV system resulted in the highest roughness and none of the polishing regimens restored the polishability to the baseline level

Color Change after 25% Hydrogen Peroxide Bleaching with Photoactivation: A Methodological Assessment Using Spectrophotometer versus Digital Photographs.

This study aimed to evaluate the color change of teeth bleached with light activation using two different objective color measurement approaches after two years of clinical follow-up. A cross-sectional retrospective clinical study according to STROBE was followed including 30 participants. The 25% hydrogen peroxide gel (Philips Zoom) was applied with a supplementary LED light for 15 min in four cycles. Tooth color was assessed based on CIEL*a*b* values using a spectrophotometer (Spectroshade) at different time points (baseline, post bleaching, 1 week, 1 year, and 2 years). Standardized digital photographs were taken at each time point. The L*, a*, and b* values were measured from the digital photographs using Adobe Photoshop software. The color difference (ΔE) was separately calculated using the L*, a*, and b* values obtained with spectrophotometric and photographic analyses at each evaluation time. Data were analyzed with non-parametric tests (p < 0.05). A color regression was detected by both measurement approaches after 1 and 2 years (p < 0.05). Greater ΔE values were acquired with the spectrophotometer compared to the digital photographic analysis (p < 0.05). Although a greater color change was observed with the spectrophotometer, both approaches were able to detect the color rebound using the 25% hydrogen peroxide light-activated in-office system. Digital photographic analysis might therefore be used to assess color change after bleaching

Adhesion of Different Resin Cements to Zirconia: Effect of Incremental versus Bulk Build Up, Use of Mould and Ageing.

Bonding to zirconia presents a great challenge, as the clinical guidelines for predictable adhesion are not sufficiently validated. The aim of this study was to assess the influence of various bonding methodologies of various resin cements on zirconia, using different aging protocols. Manufactured zirconia specimens (N = 300 and n = 20 per group) were randomly assigned to three luting protocols: 1-in mould incremental build up; 2-in mould incremental build up with mould removal; 3-in mould non-incremental bulk build up. Five dual, photo- and chemical-cure resin cements were used, namely, Variolink Esthetic (Ivoclar), Tetric (Ivoclar), Panavia (Kuraray), TheraCem (Bisco), and RelyX UniCem (3M ESPE), and were applied on primed zirconia using photopolymerization protocols. Thereafter, the specimens were subjected to the following three ageing methods: 1-dry; 2-thermocycling (×5000; 5-55 °C); 3-3-6 months of water storage. Using a universal testing machine, the specimens were loaded under shear, at 1 mm/min crosshead speed. An analysis of the data was performed using three-way ANOVA and the Bonferroni method. The moulding type, ageing and luting cement significantly affected the results (p < 0.05). Among all the protocols under dry conditions, TheraCem (16 ± 3; 11 ± 1; 16 ± 3) showed the best bond strength, while, after thermocycling, TheraCem (7 ± 2) and Tetric (7 ± 2) performed the best with Protocol 1. In Protocol 2, RelyX (7 ± 3) presented the highest result, followed by TheraCem (5 ± 3) and Tetric (5 ± 1) (p < 0.05). Using Protocol 3, RelyX (10 ± 6) showed the highest result, followed by TheraCem (7 ± 2) and Panavia21 (7 ± 2) (p < 0.05). Six months after water storage, TheraCem presented the highest result (10 ± 2) in Protocol 1, while, in Protocols 2 and 3, Tetric (10 ± 2; 15 ± 5) presented the highest result, followed by TheraCem (6 ± 2; 8 ± 3). Adhesion tests using the incremental or bulk method, using moulds, showed the highest results, but removing the mould, and the subsequent ageing, caused a decrease in the adhesion of the resin cements tested on zirconia, probably due to water absorption, with the exclusion of Tetric

Conventional, Speed Sintering and High-Speed Sintering of Zirconia: A Systematic Review of the Current Status of Applications in Dentistry with a Focus on Precision, Mechanical and Optical Parameters.

The aim of this systematic review was to provide an overview of the technical and clinical outcomes of conventional, speed sintering and high-speed sintering protocols of zirconia in the dental field. Data on precision, mechanical and optical parameters were evaluated and related to the clinical performance of zirconia ceramic. The PICOS search strategy was applied using MEDLINE to search for in vitro and in vivo studies using MeSH Terms by two reviewers. Of 66 potentially relevant studies, 5 full text articles were selected and 10 were further retrieved through a manual search. All 15 studies included in the systematic review were in vitro studies. Mechanical, precision and optical properties (marginal and internal fit, fracture strength and modulus, wear, translucency and opalescence, aging resistance/hydrothermal aging) were evaluated regarding 3-, 4- and 5-YTZP zirconia material and conventional, high- and high-speed sintering protocols. Mechanical and precision results were similar or better when speed or high-speed sintering methods were used for 3-, 4- and 5-YTZP zirconia. Translucency is usually reduced when 3 Y-TZP is used with speed sintering methods. All types of zirconia using the sintering procedures performed mechanically better compared to lithium disilicate glass ceramics but glass ceramics showed better results regarding translucency

Effect of Cumulative Ionizing Radiation on Flexural Strength, Flexural Modulus, and Elasticity Modulus of Dentin in Unerupted Human Third Molars

Purpose: This in vitro study aimed to investigate the changes in mechanical properties in dentin of third molars after radiation therapy using variable doses and frequencies. Methods and Materials: Rectangular cross sectioned dentin hemisections (N = 60, n = 15 per group; >7 × 4 × 1.2 mm) were prepared using extracted third molars. After cleansing and storage in artificial saliva, random distribution was performed to 2 irradiation settings, namely AB or CD (A, 30 single doses of irradiation [2 Gy each] for 6 weeks; B, control group of A; C, 3 single doses of irradiation [9 Gy each]; and D, control group of C). Various parameters (fracture strength/maximal force, flexural strength, and elasticity modulus) were assessed using a universal Testing Machine (ZwickRoell). The effect of irradiation on dentin morphology was evaluated by histology, scanning electron microscopy, and immunohistochemistry. Statistical analysis was performed using 2-way analysis of variance and paired and unpaired t tests at a significance level of 5%. Results: Significance could be found considering the maximal force applied to failure when the irradiated groups were compared with their control groups (A/B, P < .0001; C/D, P = .008). Flexural strength was significantly higher in the irradiated group A compared with control group B (P < .001) and for the irradiated groups A and C (P = .022) compared with each other. Cumulative radiation with low irradiation doses (30 single doses; 2 Gy) and single irradiation with high doses (3 single doses; 9 Gy) make the tooth substance more prone to fracture, lowering the maximal force. The flexural strength decreases when cumulative irradiation is applied, but not after single irradiation. The elasticity modulus showed no alteration after irradiation treatment. Conclusions: Irradiation therapy affects the prospective adhesion of dentin and the bond strength of future restorations, potentially leading to an increased risk of tooth fracture and retention loss in dental reconstructions

Durability of cantilever inlay-retained fixed dental prosthesis fabricated from multilayered zirconia ceramics with different designs.

PURPOSE The purpose of this in-vitro study was to investigate the effect of framework design on fracture resistance and failure modes of cantilever inlay-retained fixed partial dentures (IRFDPs) fabricated from two multilayered monolithic zirconia materials. MATERIALS AND METHODS Seventy-two natural premolar teeth were prepared as abutments for cantilever IRFDPs using three designs: mesial-occlusal (MO) inlay with short buccal and palatal wings (D1), MO inlay with long palatal wing (D2), MO inlay with long palatal wing and occlusal extension (D3). Full-contoured IRFDPs were fabricated from two monolithic zirconia materials; IPS e.max ZirCAD Prime and Zolid Gen-X. Adhesive surfaces were air-abraded and bonded with MDP-containing resin cement. Specimens were subjected to thermocycling (5-55 °C, 5000 cycles); then, mechanical loading (1.2 × 10⁶ cycles, 49 N). Surviving specimens were loaded until failure in the universal testing machine. All specimens were examined under stereomicroscope, and two samples from each group were evaluated using Scanning Electron Microscope. RESULTS Mean failure loads were not significantly different between different framework designs or between two materials. However, IPS e.max ZirCAD Prime showed significantly higher failure rate than Zolid Gen-X during dynamic fatigue (p = 0.009). Samples with D1 design showed higher debonding rate, D2 failed mainly by fracture of the palatal wing and debonding, and D3 failed mainly by fracture of the abutment tooth. Debonded restorations showed mainly mixed failures. CONCLUSION Cantilever IRFDPs with framework designs that maximize adhesion to enamel exhibited promising results. IPS e.max ZirCAD Prime was more susceptible to fractures with the long palatal wing design

Effect of polishing procedures and hydrothermal aging on wear characteristics and phase transformation of zirconium dioxide

Statement of problem. Yttria-stabilized zirconia used for the fabrication of crowns and fixed prostheses may require intraoral adjustments after placement and cementation. Grinding and polishing methods may result in changes in the surface characteristics of zirconia. Purpose. The purpose of this in vitro study was to assess the effect of polishing procedures on surface roughness, topographical and phase changes of zirconia, and wear of the opposing dentition. Material and methods. Presintered and precut yttria-stabilized zirconia specimens (10×10×1 mm) were divided into 4 groups (control, Intensiv, Shofu, 3M ESPE) depending on the polishing method used to prepare the specimens. All tests were carried out in triplicate. The specimens were polished depending on the polishing regimen, while the control was left untreated. The specimens were thermocycled for 3000 cycles, with a temperature range of 5C to 55C. The surface roughness, elemental, and phase changes caused by polishing before and after thermocycling were assessed with surface profilometry, energy-dispersive spectroscopy, and X-ray diffraction analysis. The wear on antagonist steatite balls was also measured after mastication simulation. Statistical analysis was performed using 1-way ANOVA and the Tukey post hoc test to perform multiple comparison tests (a=.05). Results. The polishing procedures increased surface roughness (Ra) of yttria-stabilized zirconia from 0.52 for the control specimen to 0.73 for Intensiv, 0.70 for Shofu, and 0.70 for 3M ESPE (P<.05), which was reduced by thermocycling to 0.44 (control), 0.58 (Intensiv), and 0.58 (Shofu) (P<.001), while roughness remained unchanged for 3M ESPE specimens (0.75; P=.452). The deposition of aluminum when using Shofu abrasives and nickel in Intensiv was demonstrated. Phase changes were observed on the zirconia surface with formation of the monoclinic phase in all polishing methods. Specimen aging enhanced the surface phase changes and also induced compressive stresses in zirconia polished with Intensiv. The different polishing protocols did not affect the wear to the antagonist (P>.05). Conclusions. Polishing zirconia increased surface roughness and led to surface phase changes, but wear to the antagonist was not affected.peer-reviewe

Stress Distribution on Various Implant-Retained Bar Overdentures.

The purpose of this study was to evaluate the effects of various fabrication techniques and materials used in implant-supported mandibular overdentures with a Hader bar attachment over added stress distribution. Three-dimensional geometric solid models, consisting of two implants (3.3 mm × 12 mm) placed at the bone level on both mandibular canine regions and a Hader bar structure, were prepared. Model 1 simulated a bar retentive system made from Titanium Grade 5 material by Computer Numerical Control (CNC) milling technique without using any converting adapter/multi-unit element on the implants, while Model 2 simulated the same configuration, but with converting adapters on the implants. Model 3 simulated a bar retentive system made from Cobalt-Chromium material, made by using conventional casting technique with converting adapters on the implants. Static loads of 100 Newton were applied on test models from horizontal, vertical and oblique directions. ANSYS R15.0 Workbench Software was used to compare Von Mises stress distribution and minimum/maximum principal stress values, and the results were evaluated by using Finite Element Analysis method. As a result, the highest stress distribution values under static loading in three different directions were obtained in Model 1. Stress was observed intensely around the necks of the implants and the surrounding cortical bone areas in all models. In scope of the results obtained, using converting adapters on implants has been considered to decrease transmission of forces onto implants and surrounding bone structures, thus providing a better stress distribution. It has also been observed that the type of material used for bar fabrication has no significant influence on stress values in those models where converting adapters were used