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Advances in restorative materials.

This article has presented basic up-to-date information concerning the selection, properties, and clinical uses of current restoratives that are tooth colored and adhesive. This area in dentistry is advancing at an exponential rate, and it is essential that all practitioners pay constant attention to the information about all materials as they appear on the market. Coupled with a thorough knowledge of treatment planning and case design, results such as seen in Figure 4 make restorative practice a rewarding endeavor for clinicians and patients. Interest in the scientific background, development, and performance of restorative materials must be at a high level to avoid being snared by advertising promises.

Adhesives↗

Long-term resin bond strength to zirconia ceramic.

PURPOSE: The aim of this in vitro study was to evaluate the long-term bond strength of adhesive bonding systems to yttrium-oxide-partially-stabilized zirconia ceramic (YPSZ). MATERIALS AND METHODS: Plexiglas tubes filled with resin composite were bonded to industrially manufactured zirconia ceramic disks (96% ZrO2 stabilized by 4% Y2O3). After air abrading the ceramic and ultrasonic cleansing, groups of 16 samples were bonded in an alignment apparatus using 7 different bonding methods. Subgroups of 8 bonded samples were tested for tensile strength following storage in distilled water at 37 degrees C either for 3 days or 2 years. In addition, the 2-year samples were thermocycled 37,500 times. The statistical analyses were conducted with the Kruskal-Wallis test followed by multiple pair-wise comparison of the groups using the Wilcoxon rank sum test. RESULTS: A moderate to relatively high initial bond strength was achieved by air abrasion alone, the additional use of a silane, or acrylizing the YPSZ surface in combination with a conventional bis-GMA resin composite. However, these methods failed spontaneously over storage time. The use of the bis-GMA resin composite after tribochemical silica coating of YPSZ and the use of a polyacid-modified resin composite after air abrasion of YPSZ resulted in a high initial bond strength which decreased significantly over storage time. A durable resin bond strength to YPSZ was achieved only after air abrasion of YPSZ and using one of two resin composites containing a special phosphate monomer. CONCLUSION: A durable bond strength to YPSZ was achieved only by using resin composites containing a special adhesive monomer.

Acrylates↗

Dentin bonding agents and resin cements--current status.

Contemporary restorative dentistry is a rapidly evolving science which challenges the progressive clinician with a plethora of "new and improved" products. Sound product choices should be couched in the prudent consideration of well conducted in vitro and in vivo product research. This review shall list the most recent product developments in dentin bonding agents (fifth generation agents), resin-containing dental cements and the newest generation of dental cements i.e., resin-ionomer dental cements.

Acid Etching, Dental↗

Effect of bonding variables on the shear bond strength and interfacial morphology of a one-bottle adhesive.

This study's objectives were: 1) to determine the combination of bonding procedures (with or without acid etching, moist or dry substrate, one or two applications of primer/adhesive) that would produce the highest shear bond strength of Prime & Bond and Dyract AP and 2) to characterize the resin-dentin/enamel interface produced by these bonding procedures. Ninety-six bovine incisors were randomly assigned to eight groups for shear bond testing to enamel (n = 6) and dentin (n = 6). Prime & Bond and Dyract AP were applied and cured following manufacturers' instructions. Shear bond testing was conducted in a Universal Testing Machine. Thirty-two bovine incisors were sectioned to produce blocks with enamel and dentin, then bonded in pairs for evaluation of interfacial morphology. They were polished and argon ion-etched using a high-speed argon ion-etching machine and examined by SEM. The groups where enamel was etched, kept moist or dry and received a single application of Prime & Bond produced the highest shear bond strength. Dentin bond strengths were high in the groups where dentin was etched and kept moist. The number of Prime & Bond applications had no effect on dentin bond strength. Acid etching results in better adaptation of Prime & Bond to enamel and dentin regardless of whether moisture is present.

Acid Etching, Dental↗

Radiopacity of glass-ionomer/composite resin hybrid materials.

This study visually compared the radiopacity of seven restorative materials (3 resin-modified glass-ionomer cements, 3 polyacid-modified composite resins, and 1 conventional glass-ionomer cement) to a sound tooth structure sample, and an aluminium stepwedge. All hybrid materials were more radiopaque, except for one resin-modified glass-ionomer cement, than both the tooth structure and conventional glass-ionomer cement.

Acrylic Resins↗

[Effect of wire ligature splint reinforced with preparing groove and employing composite materials on the teeth with severe periodontitis].

Teeth with severe periodontitis exhibit alveolar bone loss, teeth mobility and even teeth loss. The author made groove along the buccal and labial surfaces of teeth, twisted the stainless steel wire and placed ultraviolet light polymerized composite resin over the wire. Teeth with mobility 2-3 degree from 39 patients were treated and the effect was evaluated in the period of 2 to 4 years. The results demonstrated that the treatment had advantages of stabiliting very loose teeth and forming a firm unit. It minimized teeth mobility and improved greatly teeth occlusal function. When occlusing, the device could redirect force to other teeth, thereby reduced traumatism and facilitated periodontal tissue repairing and regeneration and protected loose teeth.

Adult↗

Clinical evaluation of glass-ionomer/resin-based hybrid materials used as pit and fissure sealants.

OBJECTIVE: The objective of the present study was to clinically evaluate the hybrid materials Vitremer and Dyract when used as pit and fissure sealants. METHOD AND MATERIALS: The materials were applied in pairs on the mandibular permanent first molars of 100 children, 7 to 8 years old. RESULTS: After 12 months of sealing, the clinical evaluation presented rates of 95.9% and 85.7% of complete retention for Dyract and Vitremer, respectively, indicating a statistically significant difference. The hybrid materials presented a statistically significant protective effect against caries compared with the control group at 6 and 12 months. CONCLUSION: The hybrid materials were able to control occlusal caries.

Acid Etching, Dental↗

Effect of fluoride gels on micromorphology of resin-modified glass-ionomer cements and polyacid-modified resin composites.

OBJECTIVE: The purpose of this study was to evaluate the surface micromorphology of resin-modified glass-ionomer cements and polyacid-modified resin composites subjected to a neutral sodium fluoride (NNaF) and an acidulated phosphate fluoride (APF) gel application. METHOD AND MATERIALS: Thirty standardized cylindric specimens were randomly obtained from each of two resin-modified glass-ionomer cements-Fuji II LC Improved and Photac-Fil Aplicap-and two polyacid-modified resin composites--Dyract and F2000-amounting to 120 samples. After 1 week, the specimens were finished and polished with aluminum oxide disks. Surface treatments with fluoride gels, or distilled water as a control, were performed four times, interspersed with eight pH cycles, simulating high cariogenic challenges. Five calibrated evaluators assessed the surface micromorphology through photomicrographs. RESULTS: The Kruskal-Wallis test showed no significant difference between the control and experimental groups for Fuji II LC Improved and Dyract. Photac-Fil Aplicap showed less micromorphologic change as a result of distilled water application, unlike the NNaF and APF treatments, which revealed no significant difference from each other. For F2000, there was no significant difference between the surfaces treated by NNaF and distilled water; the highest degradation occurred with the APF. CONCLUSION: Both the resin-modified glass-ionomer cements and the polyacid-modified resin composites showed erratic behaviors concerning their micromorphology when subjected to fluoride gel application.

Acidulated Phosphate Fluoride↗

Microleakage of adhesive restorative materials.

PURPOSE: To compare the marginal sealing ability of two conventional and one polyacid-modified resin-based composite, and two conventional and three resin-modified glass-ionomers in conventional cylindrical box cavities following a silver-staining microleakage evaluation method. MATERIALS AND METHODS: In 80 freshly extracted and caries-free human third molars, three standardized cylindrical butt-joint cavities were prepared: the first cavity in coronal enamel, the second at the cemento-enamel junction (CEJ) and the third completely in root cementum. A control group of 10 additional teeth was chosen. After the cavities were restored randomly using the eight restorative materials tested, the specimens were first stored in distilled water at 37 degrees C for 7 days and then thermocycled (500 cycles). Thereafter, the specimens were centrifuged for 10 min in plastic bottles containing 50 wt% silver nitrate aqueous solution. The degree of microleakage was recorded at four different depths along the restoration margins using an optical stereomicroscope equipped with a measuring gauge. RESULTS: None of the tested systems prevented microleakage completely, but the extent of leakage decreased towards the bottom of the restorations. The resin-modified glass-ionomers performed better than the conventional resin-based composites and conventional glass-ionomers. CLINICAL SIGNIFICANCE: Distinct leakage patterns were recorded among all materials investigated. Complete marginal sealing could still not be reached with the new adhesive restorative materials.

Analysis of Variance↗

Microleakage of Class II composite restorations.

PURPOSES: (1) To evaluate the in vitro sealing ability of several Class II resin restorations whose gingival extension of the proximal margin was apical to the cemento-enamel junction and in dentin and (2) to determine the effect of thermocycling on leakage into the resin-tooth interface. MATERIALS AND METHODS: Mesio-occlusal and distoocclusal preparations were made in extracted human molars. The gingival floor of the proximal box, was placed 1.0mm apical to the CEJ, and was prepared to a width of 1.5mm from the cavosurface margin to the axial wall. The teeth were restored with one of seven restorations (Z100 control, Z100, Wave, F2000, Surefil, Z100 and Vitrebond Sandwich A, Z100 and Vitrebond Sandwich B) using multiple incremental placement and materials. Following storage, half the samples were thermocycled. All 70 samples were stained using silver nitrate. The entire resin restoration was then removed from the proximal box ,and starting at the cavosurface margin the gingival floor was divided into three zones of 0.5 mm each and analyzed for dye penetration, using a novel technique which utilized the aid of computer imaging software and assessed both quantitatively and qualitatively. RESULTS: There was no statistical difference in leakage for all groups in Zone 1. For Zones 2 and 3, the groups utilizing glass-ionomer liner on the cavosurface margin had significantly less microleakage (P>0.05). Although the compomer/hybrid combination had low leakage values on average, the wide range of values led to unpredictable results. The flowable/hybrid combination and the packable composite performed less favorably. CLINICAL SIGNIFICANCE: This study demonstrated the difficulty in sealing a proximal dentin margin. However, the glass-ionomer/hybrid restorative techniques is the most likely to give successful clinical results.

Analysis of Variance↗

Surface roughness assessment of resin-based materials during brushing preceded by pH-cycling simulations.

This study evaluated the surface roughness pattern of resin-based restorative materials during brushing preceded by a regimen that simulated a dynamic pH-cycling. Restoratives included two resin composites (Renamel Microfill and Charisma), two polyacid-modified composite resins (Compoglass-F and Dyract AP) and one resin-modified glass ionomer cement (Fuji II LC Improved). Twenty standardized cylindrical specimens of each material were prepared according to a randomized complete block design. After finishing and polishing, the average surface roughness (Ra) and profile-length ratio (LR) of the specimens were determined. The experimental units were subjected to a pH-cycling regimen, and then to 10,000 brushing strokes. New readings of both the Ra and LR parameters were obtained. The same protocol of pH-cycling, brushing simulation and surface roughness measurements were repeated 10 times. Data was analyzed using ANOVA according to split-plot design and Tukey's test. Results showed the pH-cycling followed by 10,000 brushing strokes provided a remarkable increase in Ra for all restorative materials except for Renamel. Throughout the brushing simulation, Renamel, Charisma, Compoglass-F and Dyract AP showed steady textures, whereas Fuji II LC Improved exhibited a progressive increase in surface roughness. Among the materials tested, Renamel presented the smoothest surface, followed by Charisma and Compoglass-F, which did not differ from each other except at the baseline. Dyract AP was different from both these materials except at the baseline. Fuji II LC Improved had the roughest surface texture.

Analysis of Variance↗

Color stability of glass-ionomers and polyacid-modified resin-based composites in various environmental solutions.

PURPOSE: To evaluate the degree of color stability of glass-ionomers (GIs) and polyacid modified resin-based composites (PMRBCs) in various environmental solutions. MATERIALS AND METHODS: Seven polyacid-based esthetic restorative materials were used: three chemical-cured GIs, one resin-modified GI and three polyacid-modified RBCs. A light-cured resin-based composite (RBC) (Z 100) was used as a control. Disk type specimens were prepared and were aged in four different solutions (deionized water, 0.1 mole acetic acid solution, 75% ethanol, and 10% hydrogen peroxide solution) for 1, 7, 14, 21, 28, and 56 days. The specimens were kept at 37 degrees C throughout the study. Color coefficients (CIE L*a*b*) were measured by a reflection spectrophotometer with SCE mode, and the surface of specimens was examined by a stereo zoom microscope. RESULTS: In deionized water, all specimens showed an acceptable color stability. All of the GIs and PMRBCs showed significant color change in 0.1 mole acetic acid solution. The light-cured resin-modified GI showed a significant color change in 75% ethanol solutions. 10% hydrogen peroxide solution resulted in degradation and a high degree of color change for chemical-cured GIs. The light-cured resin-modified GI and PMRBCs showed high color change in 10% hydrogen peroxide solution. The light-cured RBC (Control), showed excellent color stability in all experimental solutions.

Acetic Acid↗

Effect of conditioning times on resin-modified glass-ionomer bonding.

PURPOSE: To evaluate in vitro the effect of different polyacrylic acid conditioning times on the shear bond strength of a resin-modified glass-ionomer bonded either to enamel to dentin surfaces. MATERIALS AND METHODS: 36 flat enamel and 36 dentin bond sites were prepared to 600 grit on human incisors. Five groups (n = 6 per group) for each substrate (enamel or dentin) were conditioned using 20% polyacrylic acid and 3% aluminum chloride for either 10, 20, 40, 80, or 160 s before bonding with the resin-modified glass-ionomer. A non-conditioning group per substrate group was used as a control. A hybrid composite was placed in two increments in a 3 mm diameter matrix on the treated surfaces. The specimens were stored for 4 weeks in distilled water at 37 degrees C. Shear bond strengths were determined using an Instron testing machine with a load rate of 0.5 mm/min. Additionally, 15 enamel and 15 dentin samples were tested with a profilometer to quantify changes in surface roughness during the different conditioning times. RESULTS: Dentin shear bond strength values were not significantly different among the different groups, including the unconditioned control group. For enamel, the unconditioned group was significantly weaker than any of the conditioned groups. No significant differences (P > 0.05) were found among the conditioned enamel specimens. No significant differences in surface roughness were found for either enamel or dentin.

Acrylic Resins↗

Biocompatibility of a resin-modified glass-ionomer cement applied as pulp capping in human teeth.

PURPOSE: to evaluate the human pulp response following pulp capping with calcium hydroxide (CH, Group 1), and the resin-modified glass-ionomer Vitrebond (VIT, Group 2). MATERIALS AND METHODS: Intact teeth with no cavity preparation were used as control Group (ICG, Group 3). Buccal Class V cavities were prepared in 34 sound human premolars. After exposing the pulps, the pulp capping materials were applied and the cavities were filled using Clearfil Liner Bond 2 bonding agent and Z100 resin-based composite. The teeth were extracted after 5, 30, and from 120 to 300 days, fixed in 10% buffered formalin solution, and prepared according to routine histological techniques. 6-microm sections were stained with hematoxylin and eosin, Masson's trichrome, or Brown & Brenn technique for bacterial observation. RESULTS: At 5 days, CH caused a large zone of coagulation necrosis. The mononuclear inflammatory reaction underneath the necrotic zone was slight to moderate. VIT caused a moderate to intense inflammatory pulp response with a large necrotic zone. A number of congested venules associated with plasma extravasation and neutrophilic infiltration was observed. Over time, only CH allowed pulp repair and complete dentin bridging around the pulp exposure site. VIT components displaced into the pulp tissue triggered a persistent inflammatory reaction which appeared to be associated with a lack of dentin bridge formation. After 30 days a few histological sections showed a number of bacteria on the lateral dentin walls. In these samples the pulp response was similar to those samples with no microleakage. VIT was more irritating to pulp tissue than CH, which allowed pulp repair associated with dentin bridge formation. These results suggested that VIT is not an appropriate dental material to be used in direct pulp capping for mechanically exposed human pulps.

Adolescent↗

Direct and indirect adhesive restorative materials: a review.

Esthetic restorative materials require a bonding procedure in order to be durable and reliable. In order to accomplish this ideal, the bonding system must be biocompatible, bond indifferently to enamel and dentin, have sufficient strength to resist masticator forces, have mechanical properties close to those of tooth structures, be resistant to degradation in the oral environment and easy to use. This paper reviews the published literature on direct and indirect adhesive restorative materials.

Biocompatible Materials↗

Clinical evaluation of a polyacid-modified resin used as a fissure sealant: 48-month results.

PURPOSE: To evaluate the incidence of occlusal caries and the rates of retention using Variglass VLC (polyacid-modified resin) as an occlusal sealant. MATERIALS AND METHODS: The sample consisted of 185 school children (6-8 yr-old), with sound unsealed permanent first molars. Sealants were applied on the upper and lower first molars from a randomly chosen hemiarch (N=370 teeth). The follow-up was conducted at 6, 12 and 48 months examining 343 (93%), 290 (78%) and 187 (51%) teeth, respectively. RESULTS: After 48 months, total retention of the material was noted in only 5% of the teeth. The presence of sealant in 2/3 and 1/3 of the pit extension was verified in 8% and 14% of the teeth, respectively, while 73% of the sealed teeth had no sealant present on the occlusal surface. Caries incidence, measured by the presence of dental caries and restorations, was 16% representing an annual increase of 4%.

Acrylic Resins↗