Search Results (111)

Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article

Reliable adaptation in Class II resin-based composite (RBC) restorations with margins on cementum remains challenging. This study compared the internal adaptation (IA) and closed porosity (CP) of three restorative strategies for such cavities, using either total-etch or self-etch adhesive approaches. Standardized box-only cavities were prepared on both proximal surfaces of 30 extracted molars, applying self-etch on mesial and total-etch on distal cavities. Group 1 used a layered microhybrid RBC; Group 2 used a flowable RBC base beneath a layered microhybrid RBC; and Group 3 used a thermoviscous RBC in a 4 mm bulk increment. Micro-computed tomography was employed to assess IA and CP. ANOVA, Tukey post hoc, and univariate analyses were used to evaluate group differences and the effects of adhesive/restorative strategies. Group 2 demonstrated the best adaptation (0.10%), whereas Group 3 exhibited the highest internal gap ratio (0.63%) and the lowest CP (p = 0.006). Total-etch adhesive significantly improved IA compared to self-etch (p < 0.001). These findings emphasize the impact of material selection and adhesive technique on the quality of restorations in cementum-located Class II cavities. Full article

The continuous need for simplified, minimally invasive restorative procedures with a high precision has led to the advancement of highly filled flowable resin-based materials. These materials present excellent initial outcomes in various clinical applications, including the injection molding technique. Given that several clinical reports present signs of wear and staining, this systematic review aims to investigate the mechanical and optical properties of highly filled flowable composite resins. A comprehensive literature research was conducted to identify relevant studies from the PubMed, the Cochrane Library, and Scopus databases. Data extraction and screening was performed by two independent evaluators. Both in vitro studies and clinical trials were included. A total of thirty-one studies were included in this review. A total of 27 in vitro studies investigated highly filled flowable composite resins independently, or in comparison with conventional composite resins, traditional flowable composites, bulk-fill flowable composites, glass ionomer cements, and compomers. Additionally, four randomized controlled clinical trials (RCTs) compared highly filled flowable composite resins with their conventional counterparts. Highly filled flowable composite resins exhibit adequate optical properties. Despite their significant improvements, their mechanical properties remain inferior to those of medium-viscosity composite resins. These materials demonstrate a favorable initial performance in the injection molding technique. Based on a limited number of RCTs, these materials demonstrate an adequate performance in class I and II restorations; however these findings should be interpreted with caution. The reported drawbacks in laboratory studies may contraindicate their clinical application in extensive cavities, load-bearing areas, and in cases of excessive tooth wear and parafunctional activity. A careful clinical case selection is strongly recommended. Full article

Background/Objectives: The introduction of composite attachments has greatly improved orthodontic aligner therapy, through better force delivery, more predictable movements, and enhanced retention. This in vitro study aims to present and investigate an innovative digital protocol for aligner attachment fabrication incorporating the latest 3D technology used in dentistry. Methods: A virtual attachment measuring 2.5 × 2 × 2 mm was designed using computer-aided design (CAD) software (Meshmixer, Autodesk Inc., San Francisco, CA, USA) and exported as an individual STL file. The attachments were fabricated using a digital light processing (DLP) 3D printer (model: Elegoo 4 DLP, Shenzhen, China) and a dental-grade biocompatible resin. A custom 3D-printed placement guide was used to ensure precise positioning of the attachments on the printed maxillary dental models. A flowable resin was applied to secure the attachments in place. Following attachment placement, the models were scanned using a laboratory desktop scanner (Optical 3D Smart Big, Open Technologies, Milano, Italy) and three intraoral scanners: iTero Element (Align Technology, Tempe, AZ, USA), Aoral 2, and Aoral 3 (Shining 3D, Hangzhou, China). Results: Upon comparison, the scans revealed that the iTero Element exhibited the highest precision, particularly in the attachment, with an RMSE of 0.022 mm and 95.04% of measurements falling within a ±100 µm tolerance. The Aoral 2 scanner showed greater variability, with the highest RMSE (0.041 mm) in the incisor area and wider deviation margins. Despite this, all scanners produced results within clinically acceptable limits. Conclusions: In the future, custom attachments made by 3D printing could be a valid alternative to the traditional composite attachments when it comes to improving aligner attachment production. While these preliminary findings support the potential applicability of such workflows, further in vivo research is necessary to confirm clinical usability. Full article

Background/Objectives: A material incompatibility has been established between self-etching adhesives and amine-containing dual-cure resin composite materials used for core buildups. This study aims to compare the dentin bond strength of several amine-containing and amine-free core materials using self-etching adhesives with different pHs. Methods: Extracted human molars were mounted in acrylic and ground flat with 320-grit silicon carbide paper. Next, 520 specimens (n = 10/group) were assigned to a dual-cure core buildup material group (10 amine-containing, 2 amine-free, and 1 reference light-cure only bulk fill flowable composite) and assigned to a self-etching adhesive subgroup (pH levels of approximately 1.0, 3.0, and 4.0). Within 4 h of surface preparation, the adhesive corresponding to the specimen’s subgroup was applied and light-cured. Composite buttons for the assigned dual-cure core material of each group were placed using a bonding clamp apparatus, allowed to self-cure for 2 h at 37 °C, and then unclamped. An additional group with one adhesive (pH = 3.0) was prepared in which the dual-cure core materials were light-cured. The bonded specimens were stored in water at 37 °C for 24 h. The specimens were mounted on a testing clamp and de-bonded in a universal testing machine with a load applied to a circular notched-edge blade at a crosshead speed of 1 mm/min until bond failure. The maximum load divided by the area of the button was recorded as the shear bond strength. The data was analyzed via 2-way ANOVA. Results: The analysis of bond strength via 2-way ANOVA determined statistically significant differences between the adhesives, the core materials, and their interaction (p < 0.01). There was a general trend in shear bond strength for the adhesives, where pH 4.0 > 3.0 > 1.0. The amine-free core materials consistently demonstrated higher shear bond strengths as compared to the other core materials when chemically cured only. Light-curing improved bond strength for some materials with perceived incompatibility. Conclusions: The results of this study suggest that an incompatibility can exist between self-etching adhesives and dual-cure resin composite core materials. A decrease in the pH of the utilized adhesive corresponded to a decrease in the bond strength of dual-cure core materials when self-curing. This incompatibility may be minimized with the use of core materials formulated with amine-free chemistry. Alternatively, the dual-cure core materials may be light-cured. Full article

This study aimed to evaluate the nanomechanical surface properties and water uptake of a flowable short-fiber-reinforced composite (SFRC) using various restorative techniques in order to assess its potential as a standalone restorative material. Nanoindentation and compressive creep testing were employed to characterize material performance. Three resin composites were examined: a flowable SFRC (everX Flow), a bulk-fill particulate filler composite (PFC), and a conventional PFC. Five experimental groups were established based on the restorative technique: layered PFC, layered SFRC, bulk SFRC, bulk PFC, and a bi-structure combining SFRC and PFC. Ninety standardized specimens (n = 18/group) were fabricated. Static and creep nanoindentation tests were conducted to assess surface properties, and water uptake was measured over a 30-day period. Data were analyzed using one-way ANOVA and Bonferroni post hoc tests. Nanoindentation revealed significant differences in hardness, with bulk PFC exhibiting the lowest values (p < 0.001). Creep testing indicated changes in modulus and viscosity following water storage. Notably, bulk SFRC showed the lowest water absorption (p < 0.001). Overall, bulk-applied SFRC demonstrated favorable nanomechanical properties and reduced water uptake, demonstrating its suitability as a standalone restorative material. Further clinical investigations are recommended to validate its long-term performance. Full article

Objectives: Trauma to maxillary incisors is frequent, and requires timely, conservative management for optimal prognosis. This in vitro study evaluated the fracture resistance (FR) and orthodontic bracket bond strength (BS) of incisors following incisal fragment reattachment using various restorative techniques. Materials and Methods: Two independent tests—FR testing (Newtons) and BS testing (megapascals)—were conducted. Eighty intact human maxillary central incisors (n = 40/test), standardized in size and shape using a digital caliper (Mitutoyo, ±0.01 mm), were embedded in acrylic resin and numbered. An uncomplicated crown fracture was induced in 64 teeth (n = 32/test), and the teeth were randomly assigned (simple randomization using Excel’s RAND function) to five groups (n = 8/group/test): (1) intact teeth (negative control, NC); (2) nanohybrid composite buildup using Filtek Z250 and Single Bond 2 (positive control, CB); (3) fragment reattachment using flowable composite (Filtek Supreme, FL); (4) reattachment with a palatal veneer using a nanohybrid composite (PV); and (5) reattachment reinforced with a polyethylene fiber band (Ribbond Inc., RB). In BS testing groups, stainless steel orthodontic brackets (PINNACLE) were bonded using Transbond XT, centered over the fracture line. Light curing was performed using an LED unit (Mini LED Standard, Acteon, 1250 mW/cm², 20 s/bond, 40 s/composite, 2 mm curing tip distance). Specimens were stored in distilled water at room temperature for 24 h before reattachment. FR and BS were evaluated using a universal testing machine (Instron) until failure. Failure modes were analyzed, and data were statistically evaluated using one-way ANOVA, Tukey’s post hoc test, and Pearson’s correlation analysis. Results: Significant differences were observed among groups for both FR and BS (p < 0.05). The NC group exhibited the highest FR (514.4 N) and BS (17.6 MPa). The RB group recorded the second-highest FR (324.6), followed by the PV (234.6), CB (224.9), and FL (203.7) groups. The CB group demonstrated the second-best BS (16.6), followed by the RB (15.2), FL (13.4), and PV (6.5) groups. FR and BS were negatively correlated. Mixed failures predominated in the reattachment groups, except for the PV group, which showed mainly adhesive failures. In BS testing, mixed failures dominated in the NC and CB groups, while adhesive failures predominated in the PV and FL groups. Conclusions: Ribbond reinforcement improves the mechanical performance of reattached incisal fragments, and composite buildup may provide more reliable bracket bonding than fragment reattachment. Clinical Relevance: In cases where biomimetic, minimally invasive reattachment is indicated, Ribbond fiber reinforcement appears to offer a reliable restorative solution. Full article

The purpose of this study was to measure the filler content by weight and volume of universal shade flowable resin-based composites and analyze the correlation between polymerization shrinkage and filler content. The filler content by weight of six universal shade flowalble resin-based composites (Bulk Base Hard II Medium Flow, A-Uno Flow Basic, Clearfil Majesty ES Flow Low, Gracefill Low Flow, Omnichroma Flow, Omnichroma Flow Bulk) was measured in accordance with ISO 17304. The filler content by volume of each flowable resin-based composite was determined by measuring the density of the filler using a dry density meter, and the filler content by volume of the composite was calculated from the densities obtained. The correlations between filler content by weight or volume, polymerization shrinkage and filler content by weight ratio, and polymerization shrinkage and filler content by volume were analyzed. The filler content of the universal flowable resin-based composites ranged from 59.40 to 69.81% (by weight) and from 40.61 to 54.84% (by volume), and the correlations between the values for filler content of the composites by weight and volume were weakly negative and not statistically significant. The correlations between polymerization shrinkage (3.15–4.48%) and filler content by weight or volume were also not statistically significant. Full article

The aim of this in vitro study is to evaluate the effect of resin type and placement technique on the hardness of resin-based composites (RBCs). A total of 300 samples consisting of five RBCs (Filtek Z250 microhybrid, Filtek P60 packable, Tetric Ceram hybrid, Admira ORMOCER, and Tetric Flow flowable RBCs) were prepared. Each RBC was placed into Teflon molds with a 4 mm diameter and 2 or 8 mm depths with standard, bulk and incremental techniques and was polymerized by second-generation LED (Hilux Ledmax 1055, 229.153 mW/cm²) and UV (ELC-410, 26.106 mW/cm²) light-curing units (LCUs) in standard mode (n = 10). The Vickers hardness number (VHN) was measured from the top and bottom surfaces of the RBCs. Data were statistically analyzed with a one-way ANOVA. Multiple comparisons were made using the Tukey, Scheffe, and t-tests (p < 0.05). The VHN of the RBCs polymerized with LED and UV LCUs varied between 110.33 and 25.16 and between 104.86 and 34.20, respectively. The Tetric Flow RBC did not polymerize with the LCUs on either surface. The RBCs placed using the bulk technique could not polymerize with the UV LCU on the top surface, except for the Filtek P60 RBC, but showed a higher VHN on the bottom surface. These significant findings highlight that the hardness is specific to the RBC material and placement technique. Full article

Patient demands for aesthetic orthodontic brackets (OBs) has increased since orthodontic treatments are of long duration. Clinicians encounter old composite restorations frequently, against which OBs need to be bonded. This study aims to determine the shear bond strength (SBS) of two aesthetic OBs (ceramic and resin) against aged composite resins (flowable and packable) after standard surface treatment. A total of 96 disk-shaped specimens of two aged (A) composite resins [flowable (F) and packable (P)] were divided into eight groups, using ceramic (C) and plastic (P) brackets, out of which four subgroups served as the control [non-aged (N)FC, NPC, NFR, NPR] and four as experimental [AFC, APC, AFR, APR]. Surface treatment included mechanical [air abrasion] and chemical [Assure Plus and Transbond XT]. After 24 h of storage, the specimens were tested for SBS and observed for failure mode using adhesive remnant index scores. Mean values of SBS in each subgroup were analyzed statistically using a one-way analysis of variance test and Tukey post hoc test. All probability ‘p’ differences were significant at a value of 0.05 and less. All aged composite resin subgroups had decreased bond strength than controls, with all subgroups bonded with plastic brackets having the least bond strengths that were clinically nonacceptable [≤7 to 10 MPa]. Flowable composites when bonded with either ceramic or plastic brackets had higher strength than packable composites. Ceramic brackets had higher SBS than plastic brackets for both flowable and packable composites. Significant differences in bond strength were observed among subgroups of plastic brackets. Ceramic brackets were associated with a higher residue of adhesives on the composite surface. Aged composite resins exhibit significantly lower SBS than fresh composites, with ceramic brackets and flowable composites producing better bond strength values than plastic brackets and packable composites. Full article

The adhesive–resin composite pair has been the cornerstone of direct restorations in dentistry for many years. Resin composites are traditionally classified in three ways based on their inorganic structure, their organic composition and their viscosity. While these classifications have long been associated with the optical, mechanical, and clinical properties of resin composites, recent studies indicate that this classification is not always valid. In recent years, a significant expansion of the range of clinical resin composite families has occurred, each with varying degrees of validation through in vitro and clinical studies. As a result, new resin composites with distinct structures, viscosities, and clinical indications have emerged. Despite this progress, a formal classification of the clinical features of all resin composites is still lacking, leading to terminological inconsistencies in research and potential confusion among clinicians. This brief review, supported by an exhaustive search of the dental literature, proposes a new clinical classification system for resin composites based on their key clinical features to help clinicians and researchers easily identify the key clinical characteristics of formulations. This modular classification, encompassing eight main families and 14 characteristics, is particularly suited to future developments, as current trends aim to simplify procedures by integrating multiple formulations into single products. Full article

The widespread implementation of new CAD/CAM materials has led to the necessity of establishing an adequate luting protocol. The aim of this study was to evaluate the microtensile bond strength (μTBS) and the film thickness of different luting methods on CAD/CAM resin blocks. Five Brilliant Crios CAD/CAM blocks (Coltene/Whaledent) were sequentially sectioned into two halves, air abraded with 50 µm aluminum oxide, and luted according to five different cementation protocols: Brilliant EverGlow (BEG), Brilliant EverGlow with ultrasound application (BEG-US), preheated Brilliant EverGlow (BEG-H), Brilliant EverGlow Flow (BEGF), and Duo Cem^® Trans (DC). Subsequently, the blocks were sectioned to obtain rods, which were then submitted to a microtensile bond strength test (n = 20). The surfaces were examined with optical microscopy to determine the failure mode and the bonding interface was assessed with scanning electron microscope (SEM) analysis. Bond strength values were analyzed using one-way ANOVA and Tukey’s post hoc tests (α = 0.05). The bond strength values varied with the different cementation protocols (p < 0.001): BEG (45.48 ± 18.14 MPa), BEG-US (42.15 ± 14.90 MPa), BEG-H (41.23 ± 15.15 MPa), BEGF (58.38 ± 15.65 MPa), and DC (81.07 ± 8.75 MPa). Regarding bond strength, DC presented significantly higher values than all other experimental groups (p < 0.050), whereas all luting methods using BEG presented similar values (p = 0.894). Adhesive failures were the predominant type. On SEM evaluation, all the luting materials presented a tight and homogeneous cement–block interface with variable film thicknesses. In conclusion, among the cementation protocols, the resin cement (DC) rendered the highest bond strength values. SEM analysis revealed that the lowest film thickness was associated with the flowable composite (BEGF). Full article

Polyhydroxybutyrate (PHB) is a biopolymer produced by bacteria. This study aimed to implement the production process of experimental medical-grade PHB and to evaluate its morphology and biocompatibility compared to conventional resin-based composites (RBCs). PHB raw material was produced via biological process and then the membrane was generated via electrospinning specifically for this study and imaged with Micro-Computed Tomography (Micro-CT) and scanning electron microscopy (SEM). MTS assay was used to assess the cytotoxicity of PHB compared to other materials. Test groups included two packable resin composites (Point 4-Kerr, G-aenial anterior-GC), two flowable resin composites (Filtek Ultimate Flowable-3M ESPE, Nova Compo HF-Imicryl), a compomer (Nova Compomer-Imicryl), a fissure-sealant (Fissured Nova Plus-Imicryl), and the PHB membrane (Innovaplast Biotechnology Inc., Eskisehir, Turkey). A control group consisting of cells without any test material was also produced. To perform the MTS assay, disc-shaped specimens of the aforementioned materials were prepared and then incubated with mouse fibroblast cells (L929) for 24 and 48 h. Micro-CT and SEM images revealed a homogeneous and fibrillary structure of the PHB. MTS assay revealed the highest cell viability in the PHB, Nova Compomer, and Fissured Nova Plus groups after 24 h. PHB and Nova Compomer showed the highest viability rates at 48 h while other RBCs had rates below 25% (p < 0.05). Considering the cell viability data and its fibrillary structure, from a biological point of view, PHB seems a promising biopolymer that might have applications in the field of dental restorative materials. Full article

Background/Objectives: This study aimed to investigate the microtensile bond strength (µTBS) of composite-based (Cerasmart), polymer-infiltrated (Vita Enamic), and feldspathic (Cerec) CAD/CAM blocks luted to dentin using a dual-cure resin cement (LinkForce), as well as micro-hybrid (G-aenial) and flowable composites (G-aenial Universal Flo), and evaluate the microhardness (HV) of luting materials through the CAD/CAM blocks. Methods: Cerasmart, Enamic, and Cerec were luted to dentin using three luting materials; LinkForce, G-aenial, and Universal Flo (n = 5). For HV, 117 disk-shaped specimens from LinkForce, G-aenial, and Universal Flo (n = 13) were polymerized through 3 mm thick CAD/CAM. Thirty-nine light-cured specimens without CAD/CAM were used as control. Following 24 h storage, the µTBS and HV were evaluated. Data were analyzed using the two-way ANOVA and post hoc Tukey tests (p < 0.05). Results: The µTBS to dentin and HV were significantly influenced by the type of luting material and CAD/CAM material. With all the CAD/CAM materials, LinkForce and Universal Flo exhibited a significantly similar µTBS to that of dentin (p > 0.05). Compared with the control group, all the HV values of the luting materials decreased significantly (p < 0.05). Conclusions: Heavily filled flowable composites exhibit a bonding effectiveness similar to that of dual-cure resin cements. All the luting materials showed similar HV when polymerized through the polymer-infiltrated CAD/CAM material. Full article

Background/Objectives: The success of treatment and prevention for secondary caries hinges significantly on the techniques employed in Class II composite restoration. Additionally, the location of the restored tooth within the oral cavity has emerged as a potential factor determining the quality of the restoration. A comprehensive understanding of these interrelated variables is crucial for advancing the efficacy and durability of dental composite restorations. The aim of this study was to assess how various restoration techniques and the specific location of the tooth restoration in the oral cavity affect marginal sealing, verified by the gap created in the tooth–restoration interface. Methods: Sixty extracted human teeth that had been indicated for orthodontic extraction were collected and embedded into a custom-made holder that was located in one of the four quadrants of a laboratory phantom head. Class II resin composite restorations, using flowable and packable composites, were performed on all teeth using two techniques: Pre-cure and Co-cure. The aging of the restored teeth was conducted using cyclic loading and thermocycling. After aging, the teeth were examined under a scanning electron microscope to measure the gap within the tooth–composite interface. Kolmogorov–Smirnov tests were used to assess the data distribution. Unpaired T-tests were employed to compare the mean gaps between the Pre-cure and Co-cure techniques. Additionally, unpaired T-tests were utilized to compare the mean gaps between the mesial and distal parts of the teeth. The Kruskal–Wallis test was used to compare the mean gaps among the four quadrants. The statistical significance was set at p = 0.05. Results: No significant difference in the gaps between the Pre-cure and Co-cure techniques was found (p = 0.212). The tooth’s location did not generally affect the restoration’s gap interface (p = 0.136). Conclusions: Flowable composites aid in restoring the deep margins of Class II composite restoration. Thus, the potential for further microleakage is similar for both the Pre-cure and Co-cure restoration techniques. The marginal seal of Class II composite restorations is effective when using both Pre-cure and Co-cure techniques, and the restoration site within the oral cavity does not significantly influence the tooth–composite interface seal. Full article