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PubMed1996

Finite element stress analysis of three filling techniques for class V light-cured composite restorations.

An important disadvantage of current dental resin composites is polymerization shrinkage. This shrinkage has clinical repercussions such as sensitivity, marginal discoloration, and secondary caries. The objective of this study was to compare three filling techniques in terms of the transient stresses induced at the resin composite/tooth interface during polymerization. The techniques were: bulk filling (B), three horizontal increments (HI), and three wedge increments (WI). A simple Class V cavity preparation was modeled in finite element analysis. Polymerization shrinkage was simulated by a thermal stress analogy, thereby causing 1% shrinkage due to an arbitrary coefficient of thermal expansion. Interface normal and shear stresses were calculated at nine steps during polymerization, proceeding from 0% to 100% volume of cured resin. The importance of the interface transient stresses was revealed by the finding that, in most cases, their peak values exceeded the final or residual stress. Also, the WI and B techniques consistently exhibited the highest and lowest maximum transient stresses, respectively. These results from the simple model of a Class V restoration suggest that bulk filling of light-cured resin composites should be used in restorations which are sufficiently shallow to be cured to their full depth.

Chemical Phenomena↗
PubMed1998

Do dental composites always shrink toward the light?

Many of the current light-curing composite restorative techniques are rationalized in compliance with the theory that composite shrinks toward the light. Shrinkage directed toward the margins is believed to be responsible for the observed improved marginal properties. However, the dental literature does not consistently support this theory. Experimental determination of contraction patterns is very difficult. In this study, a finite element technique is used to analyze the direction of composite shrinkage as it cures. The process of polymerization can be characterized by pre- and post-gel phases. The stress developed in a restoration can be relieved quickly by the flow of material still in the pre-gel phase. Residual stresses arise after gelation. Both auto- as well as photo-curing composites were analyzed. In photo-curing composites, the gel-point varies throughout the material with the intensity of the light. Experimentally determined light transmittance data for different materials were used in the simulation. Degree of cure and time-dependent shrinkage properties were also included from experimental measurements. The analysis showed that the shrinkage direction was not significantly affected by the orientation of the incoming curing light, but instead was mostly determined by the bonding of the restoration to the tooth and by the free surfaces. Consequently, differences between the contraction patterns of auto- and photo-cure were minimal. It was concluded that composite does not shrink toward the light, but that the direction is predominantly determined by cavity shape and bond quality. Improved marginal properties should be pursued by the optimization of other factors, such as the polymerization process, the curing procedure, and the bond quality. The direction of shrinkage vectors in response to light position does not seem to be an appropriate criterion for the optimization of marginal quality.

Animals↗
PubMed1999

Three-body wear of a hand-consolidated silver alternative to amalgam.

Recent studies have investigated a mercury-free silver alternative to amalgam, but the silver powders required a relatively high compaction pressure to consolidate. The aim of the present study was to consolidate a precipitated silver powder into a cohesive solid using an air-driven pneumatic condenser fitted with an amalgam plugger at a clinically realistic load, and to study the mechanisms and rates of three-body wear of the consolidated silver in comparison with that of an amalgam. The silver powder was annealed, rinsed with a dilute acid, and consolidated either in a prepared tooth cavity or in a specimen mold at a load of 15 N. A four-station wear machine was used where each specimen was immersed in a slurry containing polymethyl methacrylate beads, then a steel pin was loaded and rotated against the specimen at a maximum load of 76 N. The flexural strength in MPa (mean +/- SD; n = 10) was 86 +/- 20 for amalgam, 181 +/- 45 for silver with a polished surface, and 202 +/- 21 for silver with a burnished surface. After 4 x 10(5) wear cycles, the wear scar depth in microm was 134 +/- 54 for amalgam, 143 +/- 8 for polished silver, and 131 +/- 9 for burnished silver, which were not significantly different (Tukey's multiple comparison test; family confidence coefficient = 0.95). SEM examination revealed cracks and fracture pits in the worn surface of amalgam, in contrast to a smooth surface in silver. Wear and material removal in amalgam occurred by microfracture and dislodgement of cracked segments, while wear in the silver occurred by ductile deformation and flow of materials. To conclude, the consolidated silver possesses a three-body wear resistance similar to that of amalgam, and a higher resistance to wear-induced damage and cracking than amalgam. The mechanism of wear in amalgam is microfracture and material dislodgement, while that in consolidated silver is ductile deformation and flow of material.

Compressive Strength↗
PubMed1997

Modeling the mechanical behavior of the jaws and their related structures by finite element (FE) analysis.

In this paper, we provide a review of mechanical finite element analyses applied to the maxillary and/or mandibular bone with their associated natural and restored structures. It includes a description of the principles and the relevant variables involved, and their critical application to published finite element models ranging from three-dimensional reconstructions of the jaws to detailed investigations on the behavior of natural and restored teeth, as well as basic materials science. The survey revealed that many outstanding FE approaches related to natural and restored dental structures had already been done 10-20 years ago. Several three-dimensional mandibular models are currently available, but a more realistic correlation with physiological chewing and biting tasks is needed. Many FE models lack experimentally derived material properties, sensitivity analyses, or validation attempts, and yield too much significance to their predictive, quantitative outcome. A combination of direct validation and, most importantly, the complete assessment of methodical changes in all relevant variables involved in the modeled system probably indicates a good FE modeling approach. A numerical method for addressing mechanical problems is a powerful contemporary research tool. FE analyses can provide precise insight into the complex mechanical behavior of natural and restored craniofacial structures affected by three-dimensional stress fields which are still very difficult to assess otherwise.

Anatomy, Cross-Sectional↗
PubMed1998

Determinants of quality in operative dentistry.

The definition of quality in operative dentistry has often, at least in part, been related to how well a cut preparation compares with an ideal preparation. The ideal preparation follows well-defined design principles. These design principles have their roots in empirical dentistry and scientific evaluations, the latter often being conducted in vitro. Because of the complexity of following these design principles practically, a large portion of dental education consists of perfecting cavity preparations. By focusing on how to cut these cavity preparations as closely as possible to the ideal preparation, dentists with high psycho-motor skills have been able to provide the public with restorative procedures of high standards over the years. However, because of the tendency of relating quality in operative dentistry to the ideal preparation, we found it justifiable to review the literature dealing with the cavity design principles of the Class II amalgam preparation. What triggered this review was a request from the International Dental Federation (FDI) to start a process leading to a scientifically based quality definition of dental restorations, a definition that determines how different factors, including cavity design principles, affect the longevity of both tooth and restoration. From our review, we conclude that patient response and restoration performance over time, rather than how closely a cavity preparation compares with the ideal preparation, will be of more significance in determining the longevity of a Class II amalgam restoration.

Dental Amalgam↗
PubMed2005

A critical review of the durability of adhesion to tooth tissue: methods and results.

The immediate bonding effectiveness of contemporary adhesives is quite favorable, regardless of the approach used. In the long term, the bonding effectiveness of some adhesives drops dramatically, whereas the bond strengths of other adhesives are more stable. This review examines the fundamental processes that cause the adhesion of biomaterials to enamel and dentin to degrade with time. Non-carious class V clinical trials remain the ultimate test method for the assessment of bonding effectiveness, but in addition to being high-cost, they are time- and labor-consuming, and they provide little information on the true cause of clinical failure. Therefore, several laboratory protocols were developed to predict bond durability. This paper critically appraises methodologies that focus on chemical degradation patterns of hydrolysis and elution of interface components, as well as mechanically oriented test set-ups, such as fatigue and fracture toughness measurements. A correlation of in vitro and in vivo data revealed that, currently, the most validated method to assess adhesion durability involves aging of micro-specimens of biomaterials bonded to either enamel or dentin. After about 3 months, all classes of adhesives exhibited mechanical and morphological evidence of degradation that resembles in vivo aging effects. A comparison of contemporary adhesives revealed that the three-step etch-and-rinse adhesives remain the 'gold standard' in terms of durability. Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits.

Adhesives↗
PubMed2005

Ultrastructural correlates of in vivo/in vitro bond degradation in self-etch adhesives.

The morphologic correlates of bond degradation in self-etching primers have not been fully elucidated. We hypothesized that there is no difference between the mechanism of degradation of self-etching primers in vivo and in vitro. Class I cavities prepared in vivo in 24 caries-free human molars were bonded with Clearfil SE Bond or Clearfil Protect Bond, and restored with resin composites. Eight teeth were extracted after 24 hrs, and the rest after 1 yr. The same protocol was repeated in vitro with extracted molars. Degradation of resin-dentin bonds was assessed by microtensile bond testing and TEM of interfaces after tracer immersion. Both in vivo and in vitro bond strengths decreased with time for SE Bond but not for Protect Bond, with more pronounced water treeing observed in the former adhesive under both aging conditions. There is no difference between the mechanism of degradation of self-etch adhesives in vivo or in vitro.

Analysis of Variance↗
PubMed2006

Nano DCPA-whisker composites with high strength and Ca and PO(4) release.

The main challenges facing composite restorations are secondary caries and bulk fracture. The objective of this study was to develop nano DCPA (dicalcium phosphate anhydrous)-whisker composites with high strength and Ca and PO(4) ion release to combat caries. Flexural strength for the nano DCPA-whisker composites at a nano DCPA:whisker mass ratio of 1:2 ranged from (148 +/- 9) MPa to (167 +/- 23) MPa, significantly higher than the (103 +/- 32) MPa of an inlay/onlay commercial control composite without Ca-PO(4) release. The nano DCPA-whisker composite released PO(4) to a concentration of (1.95 +/- 0.13) mmol/L and Ca of (0.68 +/- 0.05) mmol/L. Compared with previous conventional Ca- and PO(4)-releasing composites, the nano DCPA-whisker composites had strengths two-fold higher, and released comparable or higher levels of Ca and PO(4). In conclusion, combining nano-DCPA with whiskers yielded novel composites that released high levels of Ca and PO(4) requisite for remineralization. These high-strength composites may provide a unique combination of stress-bearing and caries-inhibiting capabilities.

Analysis of Variance↗
PubMed2006

Residual stress in composites with the thin-ring-slitting approach.

During polymerization, dental composites develop residual stresses that may compromise the marginal integrity and properties of the restorative. The objective of this study was to use the thin-walled ring-slitting method to measure and compare residual stresses. The hypotheses to be tested were that composites would generate different levels of residual stress based on their specific formulations and slitting times. Rings made from composites (Z100, Herculite, and Heliomolar) were cut at different times (10 min, 1 and 24 hrs) after being light-cured, and stress was measured. Residual stress was higher at the earlier cutting times, except for Heliomolar (alpha < 0.05). For the 10-minute and one-hour cutting groups, stress followed this order: Z100 > Herculite > Heliomolar. Early slitting was better to capture residual stress, and the thin-walled rings showed higher values than thick-walled rings and were better able to discriminate residual stress in composites.

Acrylic Resins↗
PubMed2006

Minimizing dentinal fluid flow associated with gap formation.

The relationship between gap formation and outward fluid flow and procedures to minimize both phenomena were investigated in extracted human premolars restored in vitro with MOD composite restorations. We hypothesized that either glass-ionomer cement (GIC) liners or low-shrinkage composite could reduce fluid flow related to gap formation. Two groups restored with bonding agents with either high- or low-shrinkage resin composites, and 2 groups restored by either conventional or light-cured GIC liner plus resin composite were compared (8 teeth/group). Fluid flow was measured with an automated apparatus. Baseline fluid flow was low and unchanged after bonding, but increased sharply (though transiently) after teeth were lined with GIC. Outward flow was significantly greater with conventional than with light-cured GIC. Inward fluid flow occurred during light-curing, followed by extensive, prolonged outward flow after curing. Low-shrinkage composite or GIC liners reduced gap formation and limited outward fluid flow. GIC liners promoted outward fluid flow during their setting reactions.

Analysis of Variance↗
PubMed2002

Fracture mechanics analysis of the dentine-luting cement interface.

The objectives of this study were to determine the fracture toughness of adhesive interfaces between dentine and clinically relevant, thin layers of dental luting cements. Cements tested included a conventional glass-ionomer, F (Fuji 1), a resin-modified glass-ionomer, FP (Fuji Plus) and a compomer cement, D (DyractCem). Ten miniature short-bar chevron notch specimens were manufactured for each cement, each comprising a 40 microm thick chevron of lute, between two 1.5 mm thick blocks of bovine dentine, encased in resin composite. The interfacial K(IC) results (MN/m3/2) were median (range): F; 0.152 (0.14-0.16), FP; 0.306 (0.27-0.37), D; 0.351 (0.31-0.37). Non-parametric statistical analysis showed that the fracture toughness of F was significantly lower (p <0.05) than those of FP or D, and all were significantly lower than values for monolithic cement specimens. Scanning electron microscopy of the specimens suggested crack propagation along the interface. However, energy dispersive X-ray analysis indicated that failure was cohesive within the cement. It is concluded that the fracture toughness of luting cement was lowered by cement-dentine interactions.

Animals↗
PubMed2000

The orthodontic restorative management of the peg-lateral.

There are usually two orthodontic options in dealing with the peg-lateral. First, the lateral incisor can be extracted and the resultant space closed. However, this will often give a narrow unaesthetic smile. The canine is too yellow and the gingival margin is too high. The second, preferred, option is often to open the space mesial and distal to the peg-lateral and create a proper space for a normal-sized lateral incisor. The restorative dentist has to build up the peg-lateral to simulate a normal-sized lateral incisor.

Acrylic Resins↗
PubMed2002

Assessing restorative dental materials: 2. Questions for a dental sales representative.

Many methodologies are used during the testing of dental materials, although different tests are suitable for different materials and clinical situations. This paper discusses factors relevant to the choice of a dental material, and suggests questions that a practitioner would find helpful to ask a dental sales representative, such as ease of use, effect on the environment and the relevance of fluoride release.

Advertising↗
PubMed2002

Restorative management of the worn dentition: 4. Generalized toothwear.

This is the final paper of a four part series on the management of worn dentition. The factors affecting the selection of restorative techniques for generalized toothwear, such as pulpal vitality, jaw relationship and occlusal guidance are discussed. The practical steps of oral rehabilitation using fixed prostheses are illustrated with two clinical cases.

Aged↗
PubMed2003

Use of tooth-coloured restorations in the management of toothwear.

The problem of toothwear appears to be increasing in both children and adults. Recent developments in bonding and aesthetic restorations have added to the dentist's armamentarium for restoring worn teeth. Bonded ceramic and composite restorations offer the possibility of conservative restoration of teeth already damaged by toothwear. Despite this, concern still remains regarding the durability and clinical performance of these restorations. This paper reviews the currently available techniques for providing tooth-coloured restorations in toothwear cases.

Adult↗
PubMed2006

Amelogenesis imperfecta--clinical presentation and management: a case report.

Amelogenesis imperfecta (AI) is an inherited disorder which results in enamel defects. The presentation of AI can vary depending on the type and severity of AI. The management of this condition is important for the patient, both functionally and aesthetically. This report describes the management of a young man who was referred to Birmingham Dental Hospital with AI. The patient's primary complaint was the appearance of his front teeth and the sensitivity he was experiencing from his worn molar teeth.

Adolescent↗