Shear bond strength between light polymerized hard reline resin and denture base resin subjected to long term water immersion

Statement of the problemThe effect of long-term water immersion on the shear bond strength between denture base resin and Triad visible-light-polymerized (VLP) direct hard reline resin is not known.PurposeThe aim of this study was to investigate the bonding characteristics of Triad VLP direct hard reline resin to heat-polymerized denture base resin subjected to long-term water immersion.Material and methodsNinety circular disks, 15 mm in diameter and 3 mm thick, of denture base resin were polymerized from a gypsum mold. Sixty specimens were subjected to water immersion and 30 were stored at ambient room temperature for 4 months. Thirty water-immersed specimens were dried with gauze (group 1), while the other 30 water-immersed specimens were dried with a hair dryer (group 2). The dry specimens (n = 30) represented the control group (group 3). All specimens were air abraded and painted with bonding agent before packing Triad VLP direct hard-reline resin. Specimens in each group were subjected to thermal cycling for 50,000 cycles between 4 °C and 60 °C water baths with 1-min dwell time at each temperature. The bond strength at which the bond failed under stress was recorded using a universal testing machine. One-way ANOVA and Tukey post hoc comparison were applied to find significant differences between groups (α = 0.05).ResultsSignificant differences in mean shear bond strength among the specimens existed because of variable water content in the denture base resin (P < 0.05). Group 3 (dry) was higher than group 2 (desiccated), and the lowest was group 1 (saturated).ConclusionThe shear bond strength of Triad VLP direct hard reline resin to denture base resin depended on the water content in the denture base resin. The dry denture base resin demonstrated superior bond strength compared with the desiccated and water-saturated denture base resins.     

Adhesion properties in systems of laminated pigmented polymers,carbon–graphite fiber composite framework and titanium surfaces in implant suprastructures

ObjectiveFor long-term stability the adhering interfaces of an implant-retained supraconstruction of titanium/carbon–graphite fiber-reinforced (CGFR) polymer/opaquer layer/denture base polymer/denture teeth must function as a unity. The aim was to evaluate adhesion of CGFR polymer to a titanium surface or CGFR polymer to two different opaquer layers/with two denture base polymers.Materials and methodsTitanium plates were surface-treated and silanized and combined with a bolt of CGFR polymer or denture base polymer (Probase Hot). Heat-polymerized plates of CGFR polymer (47 wt% fiber) based on poly(methyl methacrylate) and a copolymer matrix were treated with an opaquer (Sinfony or Ropak) before a denture base polymer bolt was attached (Probase Hot or Lucitone 199). All specimens were heat-polymerized, water saturated (200 days) and thermally cycled (5000 cycles, 5/55 °C) before shear bond testing.ResultsSilicatized titanium surfaces gave higher bond strength to CGFR polymer (16.2 ± 2.34 and 18.6 ± 1.32) MPa and cohesive fracture than a sandblasted surface (5.9 ± 2.11) MPa where the fracture was adhesive. The opaquer Sinfony gave higher adhesion values and mainly cohesive fractures than the opaquer Ropak. Different surface treatments (roughened or polished) of the CGFR polymer had no effect on bond strength.SignificanceThe fracture surfaces of silicatized titanium/CGFR polymer/opaquer layer (Sinfony)/denture base polymers were mainly cohesive. A combination of these materials in an implant-retained supraconstruction is promising for in vivo evaluation.     

Pressure transmission area and maximum pressure transmission of different thermoplastic resin denture base materials under impact load

Purposes

The purposes of the present study were to examine the pressure transmission area and maximum pressure transmission of thermoplastic resin denture base materials under an impact load, and to evaluate the modulus of elasticity and nanohardness of thermoplastic resin denture base.

Effect of self-setting α-tricalcium phosphate between segments for bone healing and hypoaesthesia in lower lip after sagittal split ramus osteotomy

AimsThe aim of this study was to evaluate hypoaesthesia of the lower lip and bone formation using self-setting α-tricalcium phosphate (Biopex^®) between the proximal and distal segments following sagittal split ramus osteotomy (SSRO) with bent absorbable plate fixation.Subjects and methodsThe subjects were 40 patients (80 sides) who underwent bilateral SSRO setback surgery. They were divided into a Biopex^® group (40 sides) and a control group (40 sides). The Biopex^® was inserted into the anterior part of the gap between the segments in the Biopex^® group. Trigeminal nerve hypoaesthesia in the region of the lower lip was assessed bilaterally using the trigeminal somatosensory-evoked potential (TSEP) method. Ramus square, ramus length, and ramus width, the square of the Biopex^® at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1 year postoperatively by computed tomography (CT).ResultsThe mean measurable period and standard deviation were 9.3 ± 15.7 weeks in the control group, 5.3 ± 8.3 weeks in the Biopex^® group, and there was no significant difference. Ramus square after 1 year was significantly larger than that prior to surgery and new bone formation was found between the segments in both groups (P < 0.05). In the Biopex^® group, the square of the Biopex^® after 1 year was significantly smaller than that immediately after surgery (P < 0.05).ConclusionThis study suggested that inserting Biopex^® in the gap between the proximal and distal segments was useful for new bone formation and it did not prevent the recovery of lower lip hypoaesthesia after SSRO with bent absorbable plate fixation.     

High-impact strength acrylic denture base material processed by autoclave

PurposeTo investigate the effect of two different cycles of autoclave processing on the transverse strength, impact strength, surface hardness and the porosity of high-impact strength acrylic denture base material.MethodsHigh Impact Acryl was the heat-cured acrylic denture base material included in the study. A total of 120 specimens were prepared, the specimens were grouped into: control groups in which high-impact strength acrylic resins processed by conventional water-bath processing technique (74 °C for 1.5 h then boil for 30 min) and experimental groups in which high-impact strength acrylic resins processed by autoclave at 121 °C, 210 kPa .The experimental groups were divided into (fast) groups for 15 min, and (slow) groups for 30 min. To study the effect of the autoclave processing (Tuttnauer 2540EA), four tests were conducted transverse strength (Instron universal testing machine), impact strength (Charpy tester), surface hardness (shore D), and porosity test. The results were analyzed to ANOVA and LSD test.ResultsIn ANOVA test, there were highly significant differences between the results of the processing techniques in transverse, impact, hardness, and porosity test. The LSD test showed a significant difference between control and fast groups in transverse and hardness tests and a non-significant difference in impact test and a highly significant difference in porosity test; while, there were a highly significant differences between control and slow groups in all examined tests; finally, there were a non-significant difference between fast and slow groups in transverse and porosity tests and a highly significant difference in impact and hardness tests.ConclusionsIn the autoclave processing technique, the slow (long) curing cycle improved the tested physical and mechanical properties as compared with the fast (short) curing cycle. The autoclave processing technique improved the tested physical and mechanical properties of High Impact Acryl.     

Bonding of acrylic denture teeth to MMA/PMMA and light-curing denture base materials: the role of conditioning liquids

ObjectivesThe connection between resin denture teeth and the denture base is essential for the integrity of partial and full dentures. The aim of the present study was to analyse the bond strength of acrylic denture teeth to two light curing denture base materials compared to the gold-standard (MMA/PMMA) using different conditioning liquids.MethodsThe ridge laps of 220 identical denture teeth were ground and pre-treated using different conditioning liquids (MMA, an experimental conditioning liquid as well as the two commercially available liquids Palabond and Versyo.bond). The denture base materials (PalaXpress, Versyo.com, Eclipse) were applied using a split mould to obtain tensile bond strength specimens of identical shape. Ten specimens per test group were either stored in water for 24 h or thermocycled (5000×, 5–55 °C) prior to tensile bond strength testing (cross-head speed 10 mm/min). Data was subjected to parametric statistics (α = 0.05).ResultsThe three-way ANOVA revealed a significant influence of the material, pre-treatment as well as the storage. PalaXpress showed the highest bond strength (24.3 MPa) of all materials tested after TC, whereas the use of MMA led to the most constant results. Lower values were recorded for Versyo.com (17.5 MPa) and Eclipse (10.4 MPa) bonded with Versyo.bond.ConclusionsThe results indicate that MMA/PMMA based denture base resins provide reliable and durable bond strength to acrylic denture teeth. Using light-curing denture base materials requires the application of appropriate conditioning liquids to obtain acceptable bond strength. The use of MMA affects bond strength to light-curing denture base materials.Clinical significanceThe pre-treatment of denture teeth is critical regarding their bond-strength to denture base materials and in turn for the integrity of removable full and partial dentures. Light-curing denture base resins are more sensitive to the correct tooth pre-treatment compared to conventional MMA/PMMA materials, requiring specific conditioning liquids.     

Hyaluronic acid on collagen membranes: An experimental study in rats

ObjectiveThe aim of this study was to evaluate the effect of hyaluronic acid (HA) in the structure and degradation patterns of BioGide^® and OsseoGuard™ collagen membranes. HA mediates inflammation and acts in cell migration, adhesion, and differentiation, benefitting tissue remodeling and vascularization. These are desirable effects in guided regeneration procedures, but it is still unknown whether HA alters the barrier properties of absorbable membranes.DesignBone defects were created in the calvaria of rats, which were treated with HA gel 1% (HA group) or simply filled with blood clot (control group), and covered with BioGide^® or OsseoGuard™. The animals were euthanized after 1, 30, and 60 days, and their calvarias were processed for histological analysis.ResultsBioGide^®, in both HA and control groups, showed vascularization, intense cell colonization, bone formation, and tissue integration at 30 and 60 days. In contrast, Osseoguard™ presented minimal cellular colonization, and inflammatory reaction associated to foreign body reaction in both time points and groups. The HA group of BioGide^® showed higher cell colonization (574.9 ± 137.6) than the control group (269.1 ± 70.83) at 60 days (p < 0.05). Despite this finding, the structure and degradation pattern were similar for BioGide^® and Osseoguard™ in the HA and control groups.ConclusionThe results suggest that HA did not interfere with tissue integration and structural degradation of BioGide^® and Osseoguard™ membranes.     

Esterases affect the physical properties of materials used to seal the endodontic space

Materials used to seal the endodontic space are subjected to enzymatic degradative activities of body fluids and bacteria.ObjectivesTo assess effects of simulated human salivary, blood and bacterial esterases (SHSE) on physical properties of typical restorative material and root canal sealers.MethodsSpecimens of set methacrylate-based resin composite (Bisfil^TM2B; RC), calcium-silicate sealer (EndoSequence^®; BC) or epoxy-resin sealer (AH-Plus^®; ER) were tested after up to 28 Days exposure to phosphate buffered saline (PBS) or SHSE, using ANSI/ADA-57:2000 and ISO-6876:2012.ResultsRegardless of media, microhardness increased with time for BC remained unchanged for ER and decreased for RC (p < 0.05). SHSE moderated the increase for BC compared to PBS (28.0 ± 4.8 vs. 38.1 ± 7.9 KHN) at 7 Days, and enhanced the decrease for RC at 7 Days (55.6 ± 7.1 vs. 66.3 ± 6.5 KHN) and 28 Days (52.3 ± 9.2 vs. 62.6 ± 8.5 KHN). Compressive strength was enhanced only for BC by either media. BC expanded with time for both incubation conditions; SHSE moderated the expansion compared to PBS at 7 Days (0.026 ± 0.01% vs. 0.049 ± 0.007%). Shrinkage of ER was similar for both incubation media and was lower than that for RC (p < 0.05). Shrinkage of RC was enhanced by SHSE compared to PBS at 7 Days (0.5 ± 0.07% vs. 0.38 ± 0.08%). Weight loss was lowest for ER and highest for BC (p < 0.05). It was enhanced by SHSE compared to PBS for BC at 28 Days (2.40 ± 0.2 vs. 2.96 ± 0.19 W L%), and for RC at 7 Days (0.54 ± 0.09 vs. 0.80 ± 0.1 W L%).SignificanceSimulated body fluids and bacterial esterases affected the physical properties of test materials, suggesting potential impacts on sealing ability and resistance to bacterial ingress, and tooth strength ultimately affecting their clinical performance.     

Effect of implant support on mandibular distal extension removable partial dentures: Relationship between denture supporting area and stress distribution

PurposeThis study explored the relationship between implant support and the denture-supporting area by comparing the stability of an implant-supported distal extension removable partial denture and a conventional distal extension removable partial denture.MethodsA model simulating a mandibular bilateral distal extension missing (#34–37 and #44–47) was fabricated using silicone impression material as soft tissue (2 mm thick) on an epoxy resin bone model. The denture base was reduced by 5 mm cutting part of both the retromolar pad and the lingual border. Loads of up to 5 kg were applied, and the pressure and displacement of the RPDs were simultaneously measured and analyzed using the Wilcoxon test (α < 0.05).ResultsThe pressure on the bilateral first molar and the middle areas of the implant-supported distal extension removable partial denture (ISRPD) was significantly less than on the conventional RPD (CRPD). As the supporting area of the denture base decreased, the pressure and the denture displacement of the CRPD were greater than for the ISRPD.ConclusionThis study indicated that implant placement at the distal edentulous ridge can prevent denture displacement of the distal extension bases, regardless of the supporting area of the denture base.     

Curing efficiency of four self-etching,self-adhesive resin cements

ObjectivesTo evaluate the degree of cure (%DC) of four self-etching, self-adhesive resin cements, and one conventional resin cement, in their self- and dual-curing mode.MethodsThe self-etching, self-adhesive resin cements studied were RelyX? Unicem (3M? ESPE? AG), Maxcem? (Kerr Corporation), Biscem? (Bisco, Inc.) and Multilink^® Sprint (Ivoclar Vivadent^® AG) and the classic resin cement was Multilink^® Automix (Ivoclar Vivadent^® AG). Twelve specimens of each material (1.8 mm × 4 mm × 4 mm) were prepared in room temperature (23 ± 1) °C following the manufacturers’ instructions. Six of them were treated as dual-cured, thus irradiated for 20 s with a halogen light curing unit and left undisturbed for 5 min. The other six were treated as self-cured and were not irradiated, but left in dark and dry conditions for 10 min. The assessment of the %DC was made using micro-ATR FTIR spectrometry.ResultsThe %DC in their self-curing mode was very low (10.82–24.93%), with Multilink Sprint exhibiting the highest values among the five. In the dual-curing mode the values obtained were also low (26.40–41.52%), with the exception of Multilink Automix (61.36%). Maxcem was found to have the lowest DC.SignificanceThe low %DC found raises questions as to whether these materials can be successfully used in clinical applications, where light attenuation takes place. Increased irradiation times could potentially lead to higher %DC, in applications where light is not completely blocked by the overlying restoration.     

Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: A comparative study in beagles

ObjectiveThe aim of the study was to evaluate the effects of the combined use of dentin matrix protein-1 (DMP1) gene-modified bone marrow stromal cells (BMSCs) and Bio-Oss^® for maxillary sinus floor augmentation (MSFA) implant placement in dogs.Materials and methodsBMSCs were derived from bone marrow of six beagles and cultured. The cells were transduced with a lentiviral vector overexpressing the DMP1 gene and enhanced green fluorescent protein (EGFP) gene (Lenti-DMP1/EGFP) in test group, and with a lentiviral vector encoding EGFP gene (Lenti-EGFP) in control group. Six dogs received sinus augmentations using the bilateral approach with a simultaneous implant placement at each site respectively. At the same concentration, 2 × 10⁷ cells/ml, one sinus was grafted using a mixture of autologous DMP1/EGFP gene-modified BMSCs and Bio-Oss^® (DMP1 group), and the contralateral sinus was grafted with autologous EGFP gene-modified bMSCs and Bio-Oss^® (EGFP group). After a 3 month healing period, bone regeneration and osseointegration were evaluated using histologic and histomorphometric methods.ResultsThe bone-implant contact (BIC) and the bone area fraction in the DMP1 group (BIC: 34.67% ± 8.23%, bone area fraction: 35.16% ± 3.32%) were significantly greater compared with the EGFP group (BIC: 26.06% ± 5.16%, bone area fraction: 20.74% ± 1.63%) (P < 0.05). No significant difference between the residual bone substitute material volume (BSMV) in the DMP1 group (35.86 ± 7.35) and the EGFP group (32.16 ± 9.16) was found in our study (P > 0.05).ConclusionBMSCs modified with the DMP1 gene can be used as an adjunct to Bio-Oss^® to enhance new bone formation and the osseointegration of dental implants in MSFA of dogs.     

Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea

AimThe aim of this study was to assess the effectiveness of the two-part semi-rigid oral appliance, Silensor^® (Erkodent, Tuttlingen, Germany) which prevents the mandible from retracting during mouth opening.Materials and methodsTen patients with mild or moderate obstructive sleep apnea (2 males and 8 females; mean age = 62.5 ± 10.0 years) were recruited and lateral cephalometric radiographs were taken. The patients underwent polysomnography before and after 3 months of receiving treatment with the Silensor^®. The relationship between the improvement in the polysomnographic variables after the therapy and the cephalometric features was analyzed.ResultsA significant difference was observed in the apnea–hypopnea index after 3 months of Silensor^® therapy (1st (baseline), 17.1 ± 5.5; 2nd (therapy of Silensor^®), 11.0 ± 7.2, p = 0.011). Furthermore there was a significant positive correlation between the improvement in the degree of slow wave sleep (%) and the mandibular plane angle (R = 0.662, p = 0.037), as well as between the improvement in degree of slow wave sleep (%) and the lower face height (R = 0.845, p = 0.002). A significant negative correlation was observed between the improvement in degree of sleep efficiency (%) and the soft palate area (R = ?0.809, p = 0.005).ConclusionThese results suggested that keeping the nasopharyngeal airway space during mouth opening improves apnea–hypopnea index of some patients with mild or moderate obstructive sleep apnea and quality of sleep in obstructive sleep apnea patients with a long lower face height and a small soft palate.     

Maxillary sensory nerve responses induced by different types of dentures

PurposeThe purpose of this study was to investigate whether different types of dentures induced different responses to stimulations in sensory nerve underlying the denture-supporting mucosa using current perception threshold (CPT).Materials and methodsThe study population comprised 45 complete denture wearers with a mean age of 69.7 years (CD), 30 partial denture wearers (PD) with a mean age of 67.1 years, and 40 dentulous participants with a mean age of 69.0 years (Dent). Current perception threshold (CPT) on the greater palatine nerve at 2000 Hz, 250 Hz, and 5 Hz, corresponding to A-beta, A-delta, and C fibers respectively, were measured by the Neurometer^® NS3000 device. The differences CPTs among CD, PD, and Dent groups were analyzed by Kruskal–Wallis test and Mann–Whitney U test with adjusting the multiple comparisons’ inflation of type 1 error rate by a Bonferroni correction.ResultsCPTs of CD, PD, and Dent group at 2000 Hz were 61.5 ± 45.8, 53.5 ± 25.3, 33.0 ± 11.4 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 250 Hz were 29.2 ± 28.2, 20.1 ± 13.2, 14.3 ± 5.9 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 5 Hz were 28.9 ± 23.4, 17.8 ± 12.2, 12.2 ± 5.6 (10^?2 mA) respectively. The CPTs at all frequencies increased in the following order: Dent < PD < CD wearer. The statistical analyses showed that the different types of dentures significantly affected CPTs at 2000 Hz (p < 0.0001), 250 Hz (p < 0.0001), and 5 Hz (p < 0.0001).ConclusionThe different types of dentures induce different responses to stimulations in the sensory nerve underlying the denture-supporting mucosa.     

An in vitro comparison of four intra-oral ceramic repair systems

ObjectivesThis study evaluated the effect of different surface conditioning methods on the tensile bond strength (TBS) and integrity of the leucite-reinforced glass ceramic (Cerana^® inserts)–resin composite interface, using four commercially available ceramic repair systems.MethodsTwo hundred extra-large Cerana^® inserts were mechanically treated and stored in artificial saliva for 3 weeks and subsequently randomly assigned to one of the following ceramic repair systems (n = 40/group): Group 1, Ceramic Repair^® (Ivoclar Vivadent, Liechtenstein); Group 2, Cimara^® (Voco, Germany); Group 3, Clearfil Repair^® (Kuraray, Japan); Group 4, CoJet system^® (3M ESPE, Germany); and Group 5, no surface conditioning and no adhesive system applied: the control group. Subsequently, resin composite material was added to the substrate surfaces and the ceramic–resin composite specimens were subjected to TBS testing. Representative samples from the test groups were subjected to scanning electron microscopy (SEM) to determine the mode of failure. The data were analysed statistically using a one-way multivariate analysis of variance and Kruskal–Wallis test at a 95% confidence interval level.ResultsSurface conditioning with the CoJet^® system resulted in significantly higher bond strength values (5.2 ± 1.1 MPa) than surface conditioning with the other repair systems (p = 0.03). The SEM examination of the failed interfaces revealed that all the specimens examined failed adhesively.SignificanceWhilst highest bond strength values were observed with the CoJet^® system all tested repair systems resulted in relatively weak TBS values and, as a consequence, these repair systems may be indicated only as interim measures.     

Patient satisfaction and preference with thermoplastic resin removable partial dentures: a randomised cross-over trial

PurposeThis randomised cross-over trial aimed to comparatively investigate patient preference and satisfaction with thermoplastic resin removable partial dentures (TR-RPDs) and conventional metal clasp-retained removable partial dentures (MC-RPDs).MethodsTwenty-eight partially dentate subjects were enrolled and randomised to receive MC-RPDs followed by TR-RPDs or vice versa (n = 14, each group). The subjects were asked to score overall satisfaction and denture-related parameters 3 months after delivery of each denture. Additionally, they were asked to choose their preferred denture type at the end of the trial.ResultsOf the 28 subjects, 24 (86%; mean age, 67.3 years) completed the trial. The overall satisfaction scores and ratings for oral appearance with TR-RPDs were significantly higher than those with MC-RPDs (P < 0.05). Moreover, 75% (18/24) and 83% (20/24) of the subjects reported greater overall satisfaction and better oral appearance with TR-RPDs than with MC-RPDs (P < 0.001, both). Scores for mucosal pain and food impaction were significantly better with TR-RPDs than with MC-RPDs (P < 0.05). Relative to MC-RPDs, TR-RPDs provided slightly better oral comfort and speech, although the differences were not statistically significant (P > 0.05). Scores for chewing ability, denture stability, and ease of denture cleaning were almost identical for both types of dentures.ConclusionsThese results suggest that TR-RPDs hold an advantage over MC-RPDs in terms of oral appearance and can offer greater satisfaction than MC-RPDs in partially dentate arches with at least an occluding pair in the posterior region.Clinical trial registrationUMIN Clinical Trials Registry (UMIN000007310).     

Effect of storage in artificial saliva and thermal cycling on Knoop hardness of resin denture teeth

PurposeThis study aimed to evaluate the effect of different storage periods in artificial saliva and thermal cycling on Knoop hardness of 8 commercial brands of resin denture teeth.MethodsEigth different brands of resin denture teeth were evaluated (Artplus group, Biolux group, Biotone IPN group, Myerson group, SR Orthosit group, Trilux group, Trubyte Biotone group, and Vipi Dent Plus group). Twenty-four teeth of each brand had their occlusal surfaces ground flat and were embedded in autopolymerized acrylic resin. After polishing, the teeth were submitted to different conditions: (1) immersion in distilled water at 37 ± 2 °C for 48 ± 2 h (control); (2) storage in artificial saliva at 37 ± 2 °C for 15, 30 and 60 days, and (3) thermal cycling between 5 and 55 °C with 30-s dwell times for 5000 cycles. Knoop hardness test was performed after each condition. Data were analyzed with two-way ANOVA and Tukey's test (α = .05).ResultsIn general, SR Orthosit group presented the highest statistically significant Knoop hardness value while Myerson group exhibited the smallest statistically significant mean (P < .05) in the control period, after thermal cycling, and after all storage periods. The Knoop hardness means obtained before thermal cycling procedure (20.34 ± 4.45 KHN) were statistically higher than those reached after thermal cycling (19.77 ± 4.13 KHN). All brands of resin denture teeth were significantly softened after storage period in artificial saliva.ConclusionStorage in saliva and thermal cycling significantly reduced the Knoop hardness of the resin denture teeth. SR Orthosit denture teeth showed the highest Knoop hardness values regardless the condition tested.     

In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes

ObjectiveTo investigate the erosion and abrasion inhibiting effect of CPP-ACP/NaF and xylitol/NaF varnishes.MethodsBovine enamel samples (n = 40) were exposed to the following treatments (n = 10): NaF varnish (Duraphat^®, positive control); CPP-ACP/NaF varnish (MI varnishTM); xylitol/NaF (Profluorid^®) or distilled and deionized water (MilliQ^®, negative control). The samples were submitted for 3 days to 4 cycles/day of erosion (5 min in Sprite Zero) and 2 cycles of abrasion/day after the first and last erosive challenge, with a toothbrush machine and slurries of a placebo toothpaste for 15 s (50 strokes/s). Among the cycles and after the last daily cycle, the specimens remained in artificial saliva. The change in the enamel surface was evaluated by using 3D non-contact optical profilometry with surface roughness (Ra and Sa values) and tooth structure loss (TSL) measurements. Scanning electron microscopy (SEM) assessed the enamel topographic characteristics. Differences in the Ra, Sa and TSL among treatments were tested using one-way ANOVA followed by the Tukey test.ResultsAll varnishes promoted better results for Ra and Sa values than the negative control (p = 0.0001), without difference among them (p > 0.05). However, CPP-ACP/NaF varnish stimulated fewer TSL (7.09 ± 0.70 μm) compared to NaF varnish (10.33 ± 1.36 μm, p = 0.002), xylitol/NaF varnish (9.96 ± 0.41 μm, p = 0.007) and the negative control (18.38 ± 3.32 μm, p = 0.0001).ConclusionA single-application of fluoride topical varnishes was effective in reducing enamel wear. The CPP-ACP/NaF varnish had the best effect against enamel loss from an erosion-abrasion challenge.     

Initial fracture resistance and curing temperature rise of ten contemporary resin-based composites with increasing radiant exposure

ObjectivesThe principal objective of this study was to determine whether the bulk fracture resistance of ten light activated composites varied over a clinically realistic range of radiant exposures between 5 and 40 J/cm².MethodsTen operators were tested for clinically simulated radiant exposure delivery from a Bluephase^® (Ivoclar Vivadent, Schaan, Liechtenstein) LED light to an occlusal cavity floor in tooth 27 in a mannequin head using a MARC^®-Patient Simulator (Bluelight Analytics Inc., Halifax, NS) device. Notch disc test samples were prepared to determine the torque resistance to fracture (T) of the composites. Samples were irradiated with the same monowave Bluephase^® light for 10 s, 20 s or 40 s at distances of 0 mm or 7 mm. After 24 h, storage samples were fractured in a universal testing machine and torque to failure was derived.ResultsRadiant exposure delivered in the clinical simulation ranged from 14.3% to 69.4% of maximum mean radiant exposure deliverable at 0 mm in a MARC^®-Resin Calibrator (Bluelight Analytics Inc., Halifax, NS) test device. Mean torque to failure increased significantly (P < 0.05) with radiant exposure for 8 out of 10 products. The micro-fine hybrid composite Gradia Direct anterior (GC) had the lowest mean (S.D.) T between 10.3 (1.8) N/mm and 13.7 (2.2) N/mm over the tested radiant exposure range. Three heavily filled materials Majesty Posterior, Clearfil APX and Clearfil Photo-Posterior (Kuraray) had mean T values in excess of 25 N/mm following 40 J/cm² radiant exposure. Mean T for Z100 (3MESPE) and Esthet-X (Dentsply) increased by 10% and 91% respectively over the tested range of radiant exposures.ConclusionsIndividual products require different levels of radiant exposure to optimize their fracture resistance. Light activated composites vary in the rate at which they attain optimal fracture resistance.Clinical significanceUnless the clinician accurately controls all the variables associated with energy delivery, there is no way of predicting that acceptable fracture resistance will be achieved intra-orally.     

Clinical application of stress-breaking ball attachment for implant overdenture

PatientThe patient was a 62-year-old partially edentulous woman with missing bilateral premolars and molars in the mandibular jaw. The patient selected implant supported-removable partial denture rehabilitation. Implants were placed bilaterally at the distal extension of the denture base in order to minimize denture displacement. The stress-breaking ball (SBB) attachment consists of a flat-top ball head male and O-ring rubber female. The female was covered by a silicone housing with three amounts of space to allow three kinds of settlement (0.3 mm, 0.5 mm, and 0.7 mm); they were selected by thickness or pressure displacement of the mucosa and occlusal force. After the healing period, the SBB attachments (0.3 mm) were placed on the implants, and the implant-supported removable partial denture was then conventionally fabricated. The delivered denture had sufficient retention and appropriate stress breaking.DiscussionThe advantages of SBB attachments over conventional attachments are as follows: (1) they prevent the implant from excessive occlusal force, (2) they are ready-made, (3) they show appropriate retention, and (4) they can be easily mounted on the denture base. The disadvantages of these attachments are as follows: (1) they are approximately 1 mm higher than conventional ball attachments and (2) the retentive force cannot be adjusted.ConclusionThe use of a stress-breaking attachment for implant overdenture rehabilitation should be considered so that the occlusal force is equally distributed between the alveolar ridge and the implants.     

Influence of various irradiation processes on the mechanical properties and polymerisation kinetics of bulk-fill resin based composites

ObjectivesTo assess the effect of irradiation time and distance of the light tip on the micro-mechanical properties and polymerisation kinetics of two bulk-fill resin-based composites at simulated clinically relevant filling depth.MethodsMicro-mechanical properties (Vickers hardness (HV), depth of cure (DOC) and indentation modulus (E)) and polymerisation kinetics (real-time increase of degree of cure (DC)) of two bulk-fill resin-based composites (Tetric EvoCeram^® Bulk Fill, Ivoclar Vivadent and x-tra base, Voco) were assessed at varying depth (0.1–6 mm in 100 μm steps for E and HV and 0.1, 2, 4 and 6 mm for DC), irradiation time (10, 20 or 40 s, Elipar Freelight2) and distances from the light tip (0 and 7 mm). Curing unit's irradiance was monitored in 1 mm steps at distances up to 10 mm away from the light tip on a laboratory-grade spectrometer.ResultsMultivariate analysis (α = 0.05), Student's t-test and Pearson correlation analysis were considered. The influence of material on the measured mechanical properties was significant (η² = 0.080 for E and 0.256 for HV), while the parameters irradiation time, distance from the light tip and depth emphasise a stronger influence on Tetric EvoCeram^® Bulk Fill. The polymerisation kinetics could be described by an exponential sum function, distinguishing between the gel and the glass phase. The above mentioned parameters strongly influenced the start of polymerisation (gel phase), and were of less importance for the glass phase.ConclusionsBoth materials enable at least 4 mm thick increments to be cured in one step under clinically relevant curing conditions.Clinical significanceThe susceptibility to variation in irradiance was material dependent, thus properties measured under clinically simulated curing conditions might vary to a different extent from those measured under ideal curing conditions.