High refractive index monofunctional monomers as promising diluents for dental composites

ObjectivesTo evaluate high refractive index methacrylates as diluents for the formulation of radiopaque esthetic bulk-fill composites.Methods2-(4-Cumylphenoxy)ethyl methacrylate 1, 2-(2-phenylphenoxy)ethyl methacrylate 2 and 2-[2-(2-phenylphenoxy)ethoxy]ethyl methacrylate 3 were synthesized and characterized by ¹H NMR spectroscopy. The reactivity of each monomer was studied using photo-DSC. Bulk-fill composites based on monomers 1–3 were formulated. Translucency (before and after light cure) was measured using a spectrophotometer. The depth of cure and the water sorption of these materials were determined according to ISO 4049. The flexural strength and modulus of elasticity were measured using a three-point bending setup, according to ISO 4049. The shrinkage force was assessed based on a method described by Watts et al. using a universal testing machine.ResultsMonomers 1–3 were easily synthesized in two steps. They exhibit a low viscosity and a high refractive index (1.553–1.573). Monofunctional methacrylates 1–3 were found to be more reactive than triethylene glycol dimethacrylate (TEGDMA). Bulk-fill composites based on these monomers were successfully prepared. They exhibit a high depth of cure and excellent esthetic properties (low transparency). These composites provide higher flexural modulus as well as lower water sorption than a corresponding material based on TEGDMA. Methacrylates 1 and 3 are particularly interesting as they led to composites showing lower shrinkage force.SignificanceMethacrylates 1–3 are promising diluents for the formulation of highly esthetic radiopaque bulk-fill composites.     

Thiol-ene-methacrylate composites as dental restorative materials

Objectives

The objective of this study was to evaluate composite methacrylate-thiol-ene formulations with varying thiol:ene stoichiometry relative to composite dimethacrylate control formulations. It was hypothesized that the methacrylate-thiol-ene systems would exhibit superior properties relative to the dimethacrylate control resins and that excess thiol relative to ene would further enhance shrinkage and conversion associated properties.

Methods

Polymerization kinetics and functional group conversions were determined by Fourier transform infrared spectroscopy (FTIR). Volume shrinkage was measured with a linometer and shrinkage stress was measured with a tensometer. Flexural modulus and strength, depth of cure, water sorption and solubility tests were all performed according to ISO 4049.

Results

All of the methacrylate-thiol-ene systems exhibited improvements in methacrylate conversion, flexural strength, shrinkage stress, depth of cure, and water solubility, while maintaining equivalent flexural modulus and water sorption relative to the dimethacrylate control systems. Increasing the thiol to ene stoichiometry resulted in further increased methacrylate functional group conversion and decreased volume shrinkage. Flexural modulus and strength, shrinkage stress, depth of cure, water sorption and solubility did not exhibit statistically significant changes with excess thiol.

Significance

Due to their improved overall functional group conversion and reduced water sorption, the methacrylate-thiol-ene formulations are expected to exhibit improved biocompatibility relative to the dimethacrylate control systems. Improvements in flexural strength and reduced shrinkage stress may be expected to result in composite restorations with superior longevity and performance.     

Evaluation of commercial and newly-synthesized amine accelerators for dental composites.

The characteristics of newly synthesized tertiary aromatic amines as accelerators for restorative resins have been evaluated. Comparison of the composites prepared with these and presently used accelerators indicate that resins formulated with 4-N,N-dimethylaminophenylacetic acid, its methyl ester or N,N-dimethylaminoglutethimide have properties generally better than comparable resins prepared with commercially used amines.     

Size-controllable synthesis of dendritic porous silica as reinforcing fillers for dental composites

ObjectivePorous materials, especially porous silica particles are of great interest in different areas, and have applied in dental composites as inorganic fillers, due to their potential in constructing micromechanical interlocking at the filler-resin matrix interfaces. However, the facile and precise synthesis of hierarchical porous silica with graded sizes is still a great challenge.MethodsHere, we synthesized dendritic porous silica (DPS) with center-radial hierarchical pores and controllable size ranging from 75 to 1000 nm by varying simultaneously the amounts of silica precursor and template in the microemulsion. A plausible nucleation-growth mechanism for the structural formation and the size tunability of the DPS particles was further put forward. These DPS particles were then formulated with Bis-GMA/TEGDMA resin.ResultsThe particle size and morphology influenced the mechanical properties of dental composites. Particularly, DPS-500 particles (average size: 500 nm) exhibited the superior reinforcing effect, giving large improvements of 32.0, 96.7, 51.9, and 225.6% for flexural strength (S_F), flexural modulus (E_Y), compressive strength (S_C), and work of fracture (WOF), respectively, over the DPS-75 filled composite. All DPS filler sized exhibited similar degree of conversions and curing depths. Furthermore, the DPS-500 filled composite presented better cytocompatibility than commercial Z250 XT.SignificanceThe facile synthesis of DPS particles developed here and the understanding of the influence of the filler size and morphology on the composite properties provide a shortcut to design porous silica with precise size control and dental composites with superior performance. These DPS particles could also have promising applications in biomedicine, catalysis, adsorption, and cancer therapy.     

Evaluation of crack propagation in dental composites by optical coherence tomography

ObjectivesThe purpose of this study was to image the sites of fracture initiation and slow crack propagation in a fiber reinforced composite, using the optical coherence tomography (OCT) technique.MethodsBar specimens (2 mm × 3 mm × 25 mm) of fiber reinforced composite were mechanically and thermally cycled to emulate oral conditions. The interior of these samples was analyzed prior to and after loading, using OCT. The device used was a home-built Fourier domain OCT setup working at 800 nm with 6 μm spatial resolution.ResultsIntact specimens after load cycling were analyzed. It was clearly seen that OCT images provide an insight into crack propagation, which is not seen by the naked eye.SignificanceBy using OCT the possibility of analyzing the fracture propagation quantitatively, and in depth, was added, opening up possibilities to quantitative studies.     

Evaluation of dental restorative composites containing polyhedral oligomeric silsesquioxane methacrylate.

OBJECTIVES: The aim of this study was to explore novel polymeric dental restorative composites, in which polyhedral oligomeric silsesquioxane methacrylate monomer (POSS-MA) was used to partially (or completely) replace the commonly used base monomer 2,2'-bis-[4-(methacryloxypropoxy)-phenyl]-propane (Bis-GMA). METHODS: The composites were cured (hardened) by photo-initiated free radical polymerization. Mechanical properties (i.e. flexural strength, Young's modulus and diametral tensile strength) of the composites were tested by a universal mechanical testing machine; photopolymerization induced volumetric shrinkage was measured using a mercury dilatometer; and near infrared (NIR) technique was used to study the degree of methacrylate double bond conversion and photopolymerization rate. RESULTS: Small percentage POSS-MA substitution of Bis-GMA (i.e. mass fraction of 10% or less) in the resin system improved the mechanical properties of the composites; while large amount substitution led to less desirable mechanical properties, lower methacrylate double bond conversion, and slower photopolymerization rate. Statistical examinations showed the maximum flexural strength of the composites occurred when 10% (mass fraction) of Bis-GMA was replaced by POSS-MA, while the highest modulus occurred when the mass fraction of POSS-MA was 2%. SIGNIFICANCE: Polymeric dental restorative composites with improved mechanical properties may be designed by judicious choice of monomer (POSS-MA, Bis-GMA and TEGDMA) compositions.     

Pre-warming of dental composites

Objectives

Cavity lining with flowable composites have been proposed to improve initial marginal adaptation and minimize shrinkage stresses. The purpose of this study was to evaluate if prewarming of composites would influence the flow and enhance marginal adaptation thus the effect of pre-warming different types of composites on their properties are reported.

Methods

Six different composites were used in this study including a flowable and a polyacid modified composite. Uncured composites were pressed between two glass plates with a known load and the film thickness was measured to determine flow. Polymerization shrinkage was measured by means of a one-dimension contacting transducer. Flexural strength was determined using a three-point bend test. Microleakage was determined in human lower third molars on both enamel and dentin restoration interfaces. Cytocompatibility was analyzed with an Alamar Blue redox cell proliferation assay. The flow properties, linear shrinkage, flexural strength, microleakage and cytocompatibility were evaluated at 22 °C and 60 °C.

Results

The results indicated that the film thickness for each of the materials was significantly lower at 60 °C and the linear shrinkage was greater as a result of the higher degree of polymerization. The flexural strength of Spectrum TPH and Wave were found to be statistically significantly higher with pre-warming, however the other composites did not exhibit any differences. Microleakage studies showed that pre-warming had no significant bearing on the results and alamarBlue^® results showed that the pre-heating did not have an effect on the cytotoxicity however the levels of cytotoxicity varied between the composites that can be attributed to the composition.

Significance

Pre-warming of the composites studied enhanced flow as observed by measuring film thickness and did not significantly affect other properties.     

Photocalorimetry of light-cured dental composites

The reactivity of six light-curable dental composite materials has been examined by a novel technique, photocalorimetry, which permits in situ analysis of photoreactions in opaque cross-linking systems. According to photocalorimetry, the rates of reaction of dental composites decrease in the following order: Uvio Fil, Scintilux 2, Visio Dispers, Visio Fil, Silux, and Prisma Fil. By comparing the heats of reaction of the composites and of the resins, one may assume that at least two types of reactive resins are used in these dental composites: one with a heat of reaction of about 35 cal/g, and others with considerably less reactivity, ranging from 14 cal/g to 25 cal/g. Photocalorimetry allows for a rapid assessment of the rate of polymerization (photospeed) of light-curing dental composites and is ideally suited for the study of kinetics and for optimization of formulations.     

Repair of dental resin-based composites

Objectives

The study analyzed the reparability and compatibility of light-curing resin-based composites (RBCs) of the categories “microhybrid,” “nanohybrid,” and “packable.”

Materials and methods

Six RBCs with different matrix and filler formulation—purely methacrylate-based composites (MBCs), ormocer-based composites (OBCs), and silorane-based composites (SBCs)—were used for the specimens. Every material was combined with itself and with the other five RBCs, resulting in a total of 36 combination groups (n?=?20). The specimens were polymerized, aged for 8 weeks in distilled water at 37 °C, and then repaired by means of a repair kit. Shear bond strength and fracture mode were measured after aging of the specimens, undergoing storage for 24 h in distilled water at 37 °C followed by thermocycling (5,000 cycles, 5–55 °C) and an additional 4-week storage in distilled water at 37 °C.

Results

Data were statistically analyzed using ANOVA with TUKEY HSD post hoc test (α?=?0.05). On average, the OBC Admira reached the highest value as a substrate material (30.41 MPa), and the SBC Filtek Silorane reached the lowest value (8.14 MPa). Filtek Silorane was identified as the repair material with the highest bond strength value (28.70 MPa), while a packable composite reached the lowest bond strength value (15.55 MPa). The analysis of the break modes showed that adhesive breaks are typical when strength is at its lowest (6.27 MPa). A large number of cohesive fractures are conspicuous when identical materials are used for repair, except Filtek Silorane (2 % cohesive fractures).

Conclusions

The study demonstrated that the effect of the different materials on bond strength varies strongly, depending on whether the material is used as filling or as repair material.

Clinical relevance

It is generally advisable but not compulsory to combine identical RBCs.     

Properties of packable dental composites

The introduction of many new packable composites suggests that these products are rapidly gaining popularity. The purpose of this study was to evaluate the in vitro properties of a variety of packable composites and to determine if significant enhancements in physical and mechanical properties have been achieved for these materials compared with two popular nonpackable posterior composites. For the five packable and two regular composites tested (ALERT, Pyramid-Dentin, Pyramid-Enamel, Solitaire, SureFil, Heliomolar, and Z100), the values for fracture toughness, flexure strength, flexure modulus, hardness, and volumetric polymerization shrinkage were determined. In general, although the packable composites were of heavier consistency, they had mechanical properties that were intermediate to (ALERT, Pyramid, and SureFil) or lower than (Solitaire) those of the nonpackable materials. These results could have been predicted based on the similar methacrylate resin chemistry and filler volumes of the various composites. No composite had adequate depth-of-cure when tested in increments greater than 2 mm thick. Polymerization contraction of the packable composites was similar to or higher than that of the nonpackable composites. In addition, the radiopacity of at least one material, Solitaire, was not considered to be adequate (less than 2 mm of aluminum). The results of this study suggest that these packable composites are unlikely to offer improved clinical performance over well-placed nonpackable composites.     

Cyclopolymerizable monomers for use in dental resin composites

The simple reaction of conventional monofunctional acrylate monomers with paraformaldehyde has yielded a new class of difunctional monomers. The unique proximity of the double bonds within these compounds allows a facile cyclopolymerization to incorporate a cyclic ether structure into the polymer backbone. The external position of the acrylate esters means that these pendant groups can be varied for alteration of the physical properties of the monomers and the corresponding polymers. A series of the new monomers has been prepared and polymerized under dilute solution and bulk conditions to yield non-crosslinked and crosslinked polymers, respectively. The polymers exhibited high degrees of conversion and significantly reduced polymerization shrinkage, compared with polymers obtained from conventional diacrylate or dimethacrylate monomers. These properties appear to be a direct result of an efficient cyclopolymerization process. The combination of improved conversion to polymer with less contraction makes these monomers ideal candidates for use in dental resin composites. A preliminary evaluation of their potential in this application has shown that with suitable ester functionality, they can be formulated to provide composites with excellent mechanical strength properties.     

Guidelines for the treatment of highly anxious dental patients

Treatment of extreme or pathological forms of dental anxiety requires specific skills. This paper is an attempt to formulate a number of treatment strategies, based on the available literature and effectiveness studies. It is suggested that based upon the assessment information three types of problem areas can be identified, namely, 1. a phobia of specific dental procedures or situations; 2. long overdue requiring acute dental treatment; and 3. intrusive or interfering psychiatric symptoms. In this article these problem situations are reviewed and several appropriate treatment options are discussed.     

Post-curing in dental resin-based composites

Objective

To determine the post-curing in six commercial contemporary resin-based composites (RBCs) using axial shrinkage, the degree of conversion, and Vickers hardness.

Effects of monomer ratios and highly radiopaque fillers on degree of conversion and shrinkage-strain of dental resin composites

ObjectivesThe degree of conversion (DC) and polymerization shrinkage of resin composites are closely related manifestations of the same process. Ideal dental composite would show an optimal degree of conversion and minimal polymerization shrinkage. These seem to be antagonistic goals, as an increase in monomer conversion leads to a high polymerization shrinkage. This paper aims to determine the effect of opaque mineral fillers and monomer ratios on the DC and the shrinkage-strain of experimental composites based on (BisGMA/TEGDMA) monomers (traditionally used monomers). A relationship between the shrinkage-strain and the degree of conversion values was also investigated. The radiopacity of these experimental composites has been investigated in a previous paper.MethodsExperimental resin composites were prepared by mixing different monomer ratios of (BisGMA/TEGDMA) with Camphoroquinone and dimethyl aminoethyl methacrylate (DMAEMA) as photo-initiator system. Five different radiopacifying filler agents: La₂O₃, BaO, BaSO₄, SrO and ZrO₂ at various volume fractions ranging from 0 to 80 wt.% were added to the mixture. The degree of conversion of experimental composites containing different opaque fillers contents was measured using FTIR/ATR spectroscopy. The shrinkage-strain of specimens, photopolymerized at circa 500 mW/cm², was measured using the bonded-disk technique at room temperature with respect to time.ResultsThe result revealed that the DC and the shrinkage-strain decrease slightly with the increasing of opaque fillers loadings, but this decrease is not significant. However, these two properties are closely related to the monomer concentration of the organic matrix. The results have also showed a linear correlation between the shrinkage-strain and DC of experimental composites investigated.SignificanceThe nature and the volume effects of the opaque fillers on the DC and shrinkage of the experimental composites investigated were not significant. However, this study has confirmed the importance of viscosity in the system and shrinkage behavior of dimethacrylate monomers studied. Then we confirmed that direct relationships linked the shrinkage and the DC of filled dental resin composites.     

Siloranes in dental composites.

OBJECTIVE: The purpose of this study was to compare the product profile of a Silorane based composite which polymerizes by a cationic ring opening process with the product profile of different methacrylate based restoratives. METHODS: Four methacrylate based materials Filtek Z250, Filtek P60,Tetric ceram, Spectrum TPH and a Silorane based material were investigated with regard to their compressive strength, flexural strength, E-Modulus and ambient light stability. The data were analyzed by 1-way ANOVA and 2 sample t test (p<0.05). Shrinkage data were determined by the Archimedes method and the bonded disk method. The reactivity of the Silorane and Tetric ceram were derived from the time resolved shrinkage behaviour and the development of the E-Modulus over time. RESULTS: The Silorane Composite revealed with 0.94 vol% (bonded disk method) and 0.99 vol% (Archimedes method) the lowest polymerization shrinkage among all tested composites. Its reactivity was comparable to the reactivity of Tetric Ceram. However, the ambient light stability of >10 min for Silorane was higher than the ambient light reactivity of the other tested methacrylates (55-90 s). SIGNIFICANCE: The ring opening chemistry of the Siloranes enables at the first time shrinkage values lower than 1 vol% and mechanical parameters as E-Modulus and flexural strength comparable to those of clinically well accepted methacrylate based composites.     

Fatigue of packable dental composites.

OBJECTIVE: The purpose of the study was to measure the fatigue properties of four dental resin composites using a dynamic mechanical analysis and to relate the results with viscoelastic properties. METHODS: Dynamic torsional loading was conducted at resonance at 30-50Hz. Specimens were thoroughly cured and tested dry at 21 degrees C. RESULTS: All of the specimens showed a loss of strength following repeated stress, due to material fatigue. The material with the highest shear modulus had the lowest damping and the highest fatigue strength. SIGNIFICANCE: Dental composites exhibit a modest loss of strength due to fatigue. Since mastication involves many cycles of stress during the life of a restoration, fatigue properties should be taken into account in restoration design.