Failure Strengths of Composite Additions and Repairs

SUMMARY Purpose When adding composite to a cured composite restoration, the intent is to achieve the same failure strength as the original restorative material. This study evaluated the failure strengths of added or repaired composite using various chemical and/or mechanical surface treatments. Methods Failure strengths were determined using a four-point bending test. Beam-shaped specimens were fabricated by adding new composite to cured composite (Filtek Supreme Ultra). The cured composites were either fresh or aged seven days (N=10-14). The composite surfaces were left unground or were ground before treatment with various combinations of roughening, acid etching, silane, and dental adhesives (conventional Adper SingleBond Plus or new multimode Scotchbond Universal) and/or tribochemistry (CoJet system). Monolithic composite specimens were the control. Failure strengths were statistically analyzed using one-way analysis of variance and the Fisher protected least significant difference (α=0.05). Results Failure strengths (mean ± standard deviation) when composite was added to unground freshly cured composites (111±25 MPa) and aged composites using a new multimode adhesive with (102±22 MPa) or without (98±22 MPa) tribochemical treatment were not significantly lower than the monolithic specimens (122±23 MPa). Grinding the surfaces of freshly cured composite significantly reduced failure strength, either with (81±30 MPa) or without (86±31 MPa) use of conventional adhesive. Failure strengths of aged composites were also significantly lower (51±21 MPa with SingleBond Plus), even after tribochemical treatment (71±29 MPa with SingleBond Plus; 73±35 MPa with Silane-Visiobond). Conclusions Using a new multimode adhesive when adding composite to freshly cured or aged composite substrates recovered the failure strength to that of the original monolithic composite. </jats:sec

Effective Expansion

The purpose of this study was to investigate the relationship between hygroscopic expansion and polymerization shrinkage for compensation of polymerization shrinkage stresses in a restored tooth. One resin-modified glass-ionomer (RMGI) (Ketac Nano, 3M ESPE), 2 compomers (Dyract, Dentsply; Compoglass, Ivoclar), and a universal resin-based composite (Esthet•X HD, Dentsply) were tested. Volumetric change after polymerization (“total shrinkage”) and during 4 wk of water storage at 37°C was measured using an optical method ( n = 10). Post-gel shrinkage was measured during polymerization using a strain gauge method ( n = 10). Extracted human molars with large mesio-occluso-distal slot preparations were restored with the tested restorative materials. Tooth surfaces at baseline (preparation), after restoration, and during 4 wk of 37°C water storage were scanned with an optical scanner to determine cuspal flexure ( n = 8). Occlusal interface integrity was measured using dye penetration. Data were analyzed using analysis of variance and post hoc tests (significance level 0.05). All tested materials shrunk after polymerization. RMGI had the highest total shrinkage (4.65%) but lowest post-gel shrinkage (0.35%). Shrinkage values dropped significantly during storage in water but had not completely compensated polymerization shrinkage after 4 wk. All restored teeth initially exhibited inward (negative) cuspal flexure due to polymerization shrinkage. Cuspal flexure with the RMGI restoration was significantly less (–6.4 µm) than with the other materials (−12.1 to −14.1 µm). After 1 d, cuspal flexure reversed to +5.0 µm cuspal expansion with the RMGI and increased to +9.3 µm at 4 wk. After 4 wk, hygroscopic expansion compensated cuspal flexure in a compomer (Compoglass) and reduced flexure with Dyract and resin-based composite. Marginal integrity (93.7% intact restoration wall) was best for the Compoglass restorations and lowest (73.1%) for the RMGI restorations. Hygroscopic expansion was more effective in compensating shrinkage stress than would be assumed based on total shrinkage, because only post-gel shrinkage needed compensation. Effective expansion is therefore hygroscopic expansion minus post-gel shrinkage. </jats:p

Microleakage of Resin-Modified Glass Ionomer Restorations With Selective Enamel Etching

SUMMARY Aim Bonding of resin-modified glass ionomers to enamel is an important quality, especially when saliva contamination is inevitable. This study evaluated if microleakage of a resin-modified glass ionomer improves with selective enamel etching, with or without saliva contamination. Methods Class V cavities with the occlusal margin in enamel and the gingival margin on the root were prepared in extracted human permanent teeth and filled with a resin-modified glass ionomer using an acidic primer according to the manufacturer's recommendation or with an additional selective enamel etching step. Preparations were contaminated with saliva before primer application or before restoration placement (n=10). Restored teeth were thermocycled between 5°C and 55°C for 1000 cycles, stained with basic fuchsin, and sectioned. Microleakage distance was measured and analyzed with analysis of variance followed by Duncan post hoc test at a significance level of 0.05. Results Enamel microleakage was highest when saliva contamination occurred before the placement of resin-modified glass ionomer. Microleakage distances were significantly reduced in the selective etching groups regardless of saliva contamination. However, selective etching of enamel increased microleakage in cementum. The increase in cementum leakage was significantly higher when saliva contamination occurred before restoration placement. Conclusion Selective etching reduces enamel microleakage of a resin-modified glass ionomer even with saliva contamination, but it may increase microleakage at the cementum. The severity of microleakage is affected by the timing of saliva contamination. </jats:sec