Failure Of Composite Restorations Research Articles

Engineering Interfacial Integrity with Hydrolytic-Resistant, Self-Reinforcing Dentin Adhesive.

The leading cause of composite restoration failure is secondary caries, and although caries is a multifactorial problem, weak, damage-prone adhesives play a pivotal role in the high susceptibility of composite restorations to secondary caries. Our group has developed synthetic resins that capitalize on free-radical polymerization and sol-gel reactions to provide dental adhesives with enhanced properties. The resins contain γ-methacryloxypropyltrimethoxysilane (MPS) as the Si-based compound. This study investigated the properties of methacrylate-based resins containing methacryloxymethyltrimethoxysilane (MMeS) as a short-chain alternative. The degree of conversion (DC), polymerization kinetics, water sorption, mechanical properties, and leachates of MMeS- and MPS-resins with 55 and 30 wt% BisGMA-crosslinker were determined. The formulations were used as model adhesives, and the adhesive/dentin (a/d) interfaces were analyzed using chemometrics-assisted micro-Raman spectroscopy. The properties of the 55 wt% formulations were comparable. In the 30 wt% BisGMA formulations, the MMeS-resin exhibited faster polymerization, lower DC, reduced leachates, and increased storage and loss moduli, glass transition (Tg), crosslink density, and heterogeneity. The spectroscopic results indicated a comparable spatial distribution of resin, mineralized, and demineralized dentin across the a/d interfaces. The hydrolytically stable experimental short-chain-silane-monomer dental adhesive provides enhanced mechanical properties through autonomous strengthening and offers a promising strategy for the development of restorative dental materials with extended service life.

Synergistic enhancement of hydrophobic dental adhesives: autonomous strengthening, polymerization kinetics, and hydrolytic resistance

The leading cause of composite restoration failure is recurrent marginal decay. The margin between the composite and tooth is initially sealed by a low-viscosity adhesive, but chemical, physical, and mechanical stresses work synergistically and simultaneously to degrade the adhesive, destroying the interfacial seal and providing an ideal environment for bacteria to proliferate. Our group has been developing self-strengthening adhesives with improved chemical and mechanical characteristics. This paper reports a self-strengthening adhesive formulation that resists hydrolysis-mediated degradation by providing intrinsic reinforcement of the polymer network through synergistic stimulation of free-radical polymerization, sol-gel reaction, and hydrophobicity. Hydrophobic resin formulation (NE1) was developed using HEMA/BisGMA 28/55w/w and 15 wt% MPS. Control (NC1) contained HEMA/BisGMA 28/55 w/w and 15 wt% MES. The polymerization kinetics, water sorption, leachates, and dynamic mechanical properties of the resin samples were investigated. The NC1 and NE1 samples showed comparable polymerization kinetics, degree of conversion and water sorption. In contrast, NC1 showed significantly higher levels of HEMA and BisGMA leachate, indicating faster degradation in ethanol. At day 3, cumulative HEMA leachate for NC1 was tenfold greater than NE1 (p < 0.05). Dynamic mechanical properties were measured at 37 and 70°C in both dry and wet conditions. Under dry conditions, the storage moduli of NC1 and NE1 were comparable and the glass transition temperature (Tg) of NC1 was statistically significant lower (p < 0.001) than NE1. Under wet conditions, the storage modulus of NC1 was lower than NE1 and at 70°C there is a threefold difference in storage modulus. At this temperature and under wet conditions, the storage modulus of NC1 is statistically significantly lower (p < 0.001) than NE1. The results indicated that in the wet environment, NE1 provided lower chain mobility, higher crosslink density, and more hydrogen bonds. The newly formulated methacrylate-based adhesive capitalizes on free-radical polymerization, sol-gel reactions, and hydrophobicity to provide enhanced mechanical properties at elevated temperatures in wet environments and hydrolytic stability under aggressive aging conditions.

Assessment of Prevalence and Causative Factors for Replacement of Composite and Amalgam Restorations: An Observational Study

ABSTRACT Aim: This study intends to evaluate the frequency and causes of replacement for failed amalgam and composite dental restorations. Methodology: A cross-sectional study comprising female patients with failed permanent composite and amalgam restorations aged 15–60 years old was carried out at the dental clinics of Qassim University. Using a self-structured proforma, demographic data and causes for restoration failure were recorded. The effectiveness of the restorations was assessed by using the Ryge criteria after performing clinical and radiographic examinations. The Statistical Package for Social Science was used for the statistical analysis. Results: It is found that 84.6% of the 299 unsuccessful restorations examined were composite, and 15.4% were amalgam. The main reason for dental failure for both amalgam (95.6%) and composite (93.28%) restorations was secondary caries. Failure of amalgam restoration was largely caused by poor marginal adaptation. With varied incidences between amalgam and composite restorations, typical complaints included discomfort, sensitivity, pain, and food impaction with soreness. The main justification for replacement in amalgam restorations was sensitivity. Repair and replacement rates were similar for amalgam, composite, and mandibular/maxillary restorations. Moreover, 21.1% of individuals overall reported no symptoms, with 8.7% in the amalgam group and 23.3% in the composite group with significant differences (χ 2 = 34.28, P = 0.001). Conclusion: According to the current study, secondary caries was found to be the main reason for both amalgam and composite restoration failure. The main problems reported were sensitivity, discomfort, and pain with amalgam showing more sensitivity-related failures.

Clinical Evaluation of Reasons for Immediate Composite Restoration Failure Placed by Dental Students: A Cross-sectional Study in Jordan

Objective: The present study aims to investigate the reasons for the immediate failure of direct anterior and posterior resin composite restorations placed by dental students. Methods: A cross-sectional study on resin composite restorations placed by fourth- and fifth-year dental students (n=436). Variables included in the study were; the operative field isolation method, the time needed to complete the restoration after cavity preparation to polishing and finishing, and the plaque index of the patient. Restoration class distribution according to the type of tooth and cavity classification was examined and recorded. Restorations were clinically evaluated immediately after placement. It involved the assessment of the restoration’s mobility, marginal discoloration, and lack of anatomy. Results: A total of 233 direct anterior and posterior resin composite restorations which were placed by 127 students were diagnosed as failed restorations. The mode of failure was distributed as mobility/debonding (61.80%), marginal discoloration (29.18%), and lack of anatomy (9.02%). Cl III restorations demonstrated the highest failure on tooth type and cavity classification (30%), followed by Cl II restorations in molars (18.45%). Failure-associated factors were proper restoration manipulation, field isolation, and patients’ plaque index. Conclusion: In the current study, the most frequent reason for the immediate failure of resin composite restorations was the quick application of the restoration either as the only associated factor or coupled with other failure-associated factors. Failure to maintain proper field isolation and the poor oral hygiene of the patient were the other two failure-associated factors.

Triclosan to Improve the Antimicrobial Performance of Universal Adhesives.

To solve the proble ms of composite restoration failure caused by secondary caries, this study reports a light curable antibacterial triclosan derivative (TCS-IH), which was synthesized and added to the existing commercial universal adhesive to achieve a long-term antibacterial effect The effect of mixing different mass percentages of TCS-IH on the bond strength of dentin was also investigated.TCS-IH was synthesized by solution polymerization and characterized by nuclear magnetic resonance hydrogen spectroscopy (1H NMR) and Fourier transform infrared (FTIR) spectroscopy. Two commercial universal adhesives, Single Bond Universal and All Bond Universal, were selected and used as the control group, and universal adhesives with different mass percentages (1 wt%, 3 wt%, 5 wt% and 7 wt%) of TCS-IH were used as the experimental group. The antibacterial properties were analysed by means of colony count experiments, biofilm formation detection, plotting of growth curves, biofilm metabolic activity detection, insoluble extracellular polysaccharide measurements and observations by confocal laser scanning microscopy and scanning electron microscopy (SEM). The effect of adhesives on biofilm formation, metabolism, extracellular matrix production, distribution of live and dead bacteria, and bacterial morphology of Streptococcus mutans (S. mutans) was analysed. The mechanical properties were evaluated by the degree of conversion and microtensile bonding strength under different conditions. Its biosafety was tested. We found that the addition of TCS-IH significantly improved the antibacterial performance of the universal adhesive, with the 5 wt% and 7 wt% groups showing the best antibacterial effect and effectively inhibiting the formation of biofilm. In addition, the adhesive strength test results showed that there was no statistical difference (p < 0.05) in the microtensile bond strength measured under various factors in all experimental groups except for the 7 wt% group in the self-etch bonding mode, and all of them had good biosafety. In summary, the 5 wt% group of antibacterial monomer TCS-IH was selected as the optimum addition to the universal adhesive to ensure the antimicrobial properties of the universal adhesive and the stability and durability of the adhesive interface. This study provides a reference for the clinical application of adhesives with antimicrobial activity to improve the stability and durability of adhesive restorations.

Accelerated Fatigue Model for Predicting Composite Restoration Failure

An empirical method is proposed to predict the clinical performance of resin composite dental restorations by using laboratory data derived from simple specimens subjected to chemical degradation and accelerated cyclic fatigue. Three resin composites were used to fill dentin disks (2-mm inner diameter, 5-mm outer diameter, and 2 mm thick) made from bovine incisor roots. The specimens (n = 30 per group) were aged with different durations of a low-pH challenge (0, 24, and 48 h under pH 4.5) before being subjected to diametral compression with either a monotonically increasing load (fast fracture) or a cyclic load with a continuously increasing amplitude (accelerated fatigue). The data from 1 material were used to establish the relationship between laboratory time (number of cycles) and clinical time to failure (years) via the respective survival probability curves. The temporal relationship was then used to predict the clinical rates of failure for restorations made of the other 2 materials, and the predictions were compared with the clinical data to assess their accuracy. Although there were significant differences in the fast fracture strength among the groups of materials or durations of chemical challenge, fatigue testing was much better at separating the groups. Linear relationships were found between the laboratory and clinical times to failure for the first material (R2 = 0.90, 0.90, and 0.62 for the 0-, 24-, and 48-h low-pH groups, respectively). The clinical life of restorations made of the other 2 materials was best predicted with data from the 48-h low-pH groups. In conclusion, an accelerated fatigue model was successfully calibrated and applied to predict the clinical failure of resin composite restorations, and the predictions based on data obtained from chemically aged specimens provided the best agreement with clinical data.

Dual-functional adhesive containing amorphous calcium phosphate nanoparticles and dimethylaminohexadecyl methacrylate promoted enamel remineralization in a biofilm-challenged environment

ObjectiveThe cariogenic biofilm on enamel, restoration, and bonding interface is closely related to dental caries and composite restoration failure. Enamel remineralization at adhesive interface is conducive to protecting bonding interface and inhibiting secondary caries. This study intended to assess the remineralization efficiency of adhesive with dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) on initial caries lesion of biofilm-coated enamel. MethodsArtificial initial carious lesion was created via 72-hour immersion in demineralization solution and cariogenic biofilm was formed after 24-hour culture of Streptococcus mutans (S. mutans). Specimens were then divided into 4 groups: enamel control, enamel treated with NACP, DMAHDM and NACP+DMAHDM respectively. Samples next underwent 7-day cycling, 4 h in BHIS (brain heart infusion broth containing 1 % sucrose) and 20 h in AS (artificial saliva) per day. The pH of BHIS was tested daily. So did the concentration of calcium and phosphate in BHIS and AS. Live/dead staining, colony-forming unit (CFU) count, and lactic acid production of biofilms were measured 7 days later. The enamel remineralization efficiency was evaluated by microhardness testing and transverse microradiography (TMR) quantitatively. ResultsEnamel of NACP+DMAHDM group demonstrated excellent remineralization effectiveness. And the NACP+DMAHDM adhesive released a great number of Ca2+ and PO43- ions, increased pH to 5.81 via acid neutralization, decreased production of lactic acid, and reduced CFU count of S. mutans (P < 0.05). SignificanceThe NACP+DMAHDM adhesive would be applicable to preventing secondary caries, strengthening enamel-adhesive interface, and extending the lifespan of composite restoration.

Comparative Evaluation of Microleakage in Premolars after Placement of Microhybrid and Nanohybrid Composite Using Snow Plow Technique

Background: Microleakage is the significant reason for composite restoration failure. The type of composite material utilized should reduce polymerization shrinkage and hence avoid micro-leakage.&#x0D; Objectives:&#x0D; &#x0D; To evaluate microleakage in Class I cavity using microhybrid composite in snow plow placement technique.&#x0D; To evaluate microleakage in Class I cavity using nanohybrid composite in snow plow placement technique&#x0D; To compare microleakage in Class I cavity with microhybrid composite and nanohybrid composite using snow plow placement technique.&#x0D; &#x0D; Methodology: Prepared Class I cavities in 22 human premolars will be divided randomly into 2 groups based on the restorative material used. These cavity preparations will be restored using the snow plow technique. All the specimens will be thermocycled and stained with 50% silver nitrate solution. We will wash the specimens in the distilled water, store them in the developing solution and for 24 hours exposed to sunlight. The samples will be sectioned longitudinally from the middle of cavity into two parts and will be then evaluated for microleakage on the basis of silver nitrate penetration under stereomicroscope (20X). To compare the microleakage, data will be subjected to statistical analysis.&#x0D; Expected Results: Nanohybrid composite placement using snow plow technique is expected to have less micro-leakage than microhybrid composite placement using the same technique.&#x0D; Conclusion: If this study proves correct, this would be helpful for the clinicians to choose the most efficient restorative material with the best technique and minimal microleakage which will aid in the success of the root canal treatment.

Metal Oxide Nanoparticles and Nanotubes: Ultrasmall Nanostructures to Engineer Antibacterial and Improved Dental Adhesives and Composites.

Advances in nanotechnology have unlocked exclusive and relevant capabilities that are being applied to develop new dental restorative materials. Metal oxide nanoparticles and nanotubes perform functions relevant to a range of dental purposes beyond the traditional role of filler reinforcement—they can release ions from their inorganic compounds damaging oral pathogens, deliver calcium phosphate compounds, provide contrast during imaging, protect dental tissues during a bacterial acid attack, and improve the mineral content of the bonding interface. These capabilities make metal oxide nanoparticles and nanotubes useful for dental adhesives and composites, as these materials are the most used restorative materials in daily dental practice for tooth restorations. Secondary caries and material fractures have been recognized as the most common routes for the failure of composite restorations and bonding interface in the clinical setting. This review covers the significant capabilities of metal oxide nanoparticles and nanotubes incorporated into dental adhesives and composites, focusing on the novel benefits of antibacterial properties and how they relate to their translational applications in restorative dentistry. We pay close attention to how the development of contemporary antibacterial dental materials requires extensive interdisciplinary collaboration to accomplish particular and complex biological tasks to tackle secondary caries. We complement our discussion of dental adhesives and composites containing metal oxide nanoparticles and nanotubes with considerations needed for clinical application. We anticipate that readers will gain a complete picture of the expansive possibilities of using metal oxide nanoparticles and nanotubes to develop new dental materials and inspire further interdisciplinary development in this area.

Novel low-shrinkage-stress bioactive nanocomposite with anti-biofilm and remineralization capabilities to inhibit caries

Background/purposeA common reason for dental composite restoration failure is recurrent caries at the margins. Our objectives were to: (1) develop a novel low-shrinkage-stress, antibacterial and remineralizing resin composite; (2) evaluate the effects of dimethylaminohexadecyl methacrylate (DMAHDM) on mechanical properties, biofilm inhibition, calcium (Ca) and phosphate (P) ion release, degree of conversion, and shrinkage stress on the new low-shrinkage-stress resin composite for the first time.Material and methodsThe resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE) with high resistance to salivary hydrolytic degradation. Composites were made with 0%–8% of DMAHDM for antibacterial activity, and 20% of nanoparticles of amorphous calcium phosphate (NACP) for remineralization. Mechanical properties and Streptococcus mutans biofilm growth on composites were assessed. Ca and P ion releases, degree of conversion and shrinkage stress were evaluated.ResultsAdding 2–5% DMAHDM and 20% NACP into the low-shrinkage-stress composite did not compromise the mechanical properties (p > 0.05). The incorporation of DMAHDM greatly reduced S. mutans biofilm colony-forming units by 2–5 log and lactic acid production by 7 folds, compared to a commercial composite (p < 0.05). Adding 5% DMAHDM did not compromise the Ca and P ion release. The low-shrinkage-stress composite maintained a high degree of conversion of approximately 70%, while reducing the shrinkage stress by 37%, compared to a commercial control (p < 0.05).ConclusionThe bioactive low-shrinkage-stress composite reduced the polymerization shrinkage stress, without compromising other properties. Increasing the DMAHDM content increased the antibacterial effect in a dose-dependent manner.

Assessment of dentists' opinions on the cause of failure of adhesive composite restorations

Aim of this study was to get an overview of what dentists estimate to be the reason for failure of adhesive composite restorations and to gain knowledge about potential future foci for targeted further education. Therefore, a survey about the fabrication of composite restorations was conducted in the course of seven dental conferences with the main topic tooth-prevention. A total of 577 dentists participated in the survey. The most often called estimated factor for failure of composite restorations was the "dentist" (70.7%), followed by "indication" (32.2%), "material" (8.5%) and "patient" (8.1%). Participants estimated insufficient drying and fluid management (67.9%), incorrect application of the adhesive system (41.8%), insufficient lightpolymerisation (31.2%) and errors in incremental technique (27.6%) to be the main mistakes. The participating dentists claimed to attach great importance to careful drying and fluid management (60.8%), thorough adhesive application (37.3%), adequate incremental technique (32.6%) and sufficient lightpolymerisation (28.8%) while placing their own restorations. According to the survey participants, the treating dentist has the greatest influence on the quality and longevity of composite restorations. Drying and fluid management was the most often called estimated reason for failure but at the same time the step which is given the greatest caution.

Novel low-shrinkage-stress nanocomposite with remineralization and antibacterial abilities to protect marginal enamel under biofilm

ObjectivesPolymerization shrinkage stress may lead to marginal damage, microleakage and failure of composite restorations. The objectives of this study were to : (1) develop a novel nanocomposite with low-shrinkage-stress, antibacterial and remineralization properties to reduce marginal enamel demineralization under biofilms; (2) evaluate the mechanical properties of the composite and calcium (Ca) and phosphate (P) ion release; and (3) investigate the cytotoxicity of the new low-shrinkage-stress monomer in vitro. MethodsThe low-shrinkage-stress resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), and 3 % dimethylaminohexadecyl methacrylate (DMAHDM) and 20 % calcium phosphate nanoparticles (NACP) were added. Mechanical properties, polymerization shrinkage stress, and degree of conversion were evaluated. The growth of Streptococcus mutans (S. mutans) on enamel slabs with different composites was assessed. Ca and P ion releases and monomer cytotoxicity were measured. ResultsComposite with DMAHDM and NACP had flexural strength of 84.9 ± 10.3 MPa (n = 6), matching that of a commercial control composite. Adding 3 % DMAHDM did not negatively affect the composite ion release. Under S. mutans biofilm, the marginal enamel hardness was 1.2 ± 0.1 GPa for the remineralizing and antibacterial group, more than 2-fold the 0.5 ± 0.07 GPa for control (p < 0.05). The polymerization shrinkage stress of the new composite was 40 % lower than that of traditional composite control (p < 0.05). The new monomers had fibroblast viability similar to that of traditional monomer control (p > 0.1). ConclusionA novel low-shrinkage-stress nanocomposite was developed with remineralizing and antibacterial properties. This new composite is promising to inhibit recurrent caries at the restoration margins by reducing polymerization stress and protecting enamel hardness.

Antimicrobial Peptide-Polymer Conjugates for Dentistry.

Bacterial adhesion and growth at the composite/adhesive/tooth interface remain the primary cause of dental composite restoration failure. Early colonizers, including Streptococcus mutans, play a critical role in the formation of dental caries by creating an environment that reduces the adhesive's integrity. Subsequently, other bacterial species, biofilm formation, and lactic acid from S. mutans demineralize the adjoining tooth. Because of their broad spectrum of antibacterial activity and low risk for antibiotic resistance, antimicrobial peptides (AMPs) have received significant attention to prevent bacterial biofilms. Harnessing the potential of AMPs is still very limited in dentistry-a few studies have explored peptide-enabled antimicrobial adhesive copolymer systems using mainly nonspecific adsorption. In the current investigation, to avoid limitations from nonspecific adsorption and to prevent potential peptide leakage out of the resin, we conjugated an AMP with a commonly used monomer for dental adhesive formulation. To tailor the flexibility between the peptide and the resin material, we designed two different spacer domains. The spacer-integrated antimicrobial peptides were conjugated to methacrylate (MA), and the resulting MA-AMP monomers were next copolymerized into dental adhesives as AMP-polymer conjugates. The resulting bioactivity of the polymethacrylate-based AMP conjugated matrix activity was investigated. The antimicrobial peptide conjugated to the resin matrix demonstrated significant antimicrobial activity against S. mutans. Secondary structure analyses of conjugated peptides were applied to understand the activity differential. When mechanical properties of the adhesive system were investigated with respect to AMP and cross-linking concentration, resulting AMP-polymer conjugates maintained higher compressive moduli compared to hydrogel analogues including polyHEMA. Overall, our result provides a robust approach to develop a fine-tuned bioenabled peptide adhesive system with improved mechanical properties and antimicrobial activity. The results of this study represent a critical step toward the development of peptide-conjugated dentin adhesives for treatment of secondary caries and the enhanced durability of dental composite restorations.

Threats to adhesive/dentin interfacial integrity and next generation bio-enabled multifunctional adhesives.

Nearly 100 million of the 170 million composite and amalgam restorations placed annually in the United States are replacements for failed restorations. The primary reason both composite and amalgam restorations fail is recurrent decay, for which composite restorations experience a 2.0-3.5-fold increase compared to amalgam. Recurrent decay is a pernicious problem-the standard treatment is replacement of defective composites with larger restorations that will also fail, initiating a cycle of ever-larger restorations that can lead to root canals, and eventually, to tooth loss. Unlike amalgam, composite lacks the inherent capability to seal discrepancies at the restorative material/tooth interface. The low-viscosity adhesive that bonds the composite to the tooth is intended to seal the interface, but the adhesive degrades, which can breach the composite/tooth margin. Bacteria and bacterial by-products such as acids and enzymes infiltrate the marginal gaps and the composite's inability to increase the interfacial pH facilitates cariogenic and aciduric bacterial outgrowth. Together, these characteristics encourage recurrent decay, pulpal damage, and composite failure. This review article examines key biological and physicochemical interactions involved in the failure of composite restorations and discusses innovative strategies to mitigate the negative effects of pathogens at the adhesive/dentin interface. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2466-2475, 2019.

Polymerization Shrinkage of Five Bulk-Fill Composite Resins in Comparison with a Conventional Composite Resin

The polymerization shrinkage of methacrylate-based composites is among the most important causes of failure of composite restorations. The manufacturers claim that bulk-fill composites have a lower polymerization shrinkage than conventional composites. This study aimed to assess the polymerization shrinkage of five bulk-fill composites in comparison with a conventional composite. In this in-vitro experimental study, composite discs (n=30) were fabricated using everX Posterior (EXP), Filtek Bulk-Fill Posterior (FBP), SonicFill 2 (SF2), Tetric N-Ceram Bulk-Fill (TNB), X-tra fil (XF), and Filtek Z250 conventional composite at the center of a metal ring bonded to a microscope slide and were covered with a coverslip. This assembly was transferred to a linear variable differential transformer (LVDT). Light-curing (1200 mW/cm2) was performed from underneath the slide for 30 seconds. The deflecting disc method and LVDT were used to assess the dimensional changes of the samples (indicative of polymerization shrinkage) at 1, 30, 60, and 1800 seconds following the onset of light irradiation. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's test. The groups were significantly different regarding polymerization shrinkage (P<0.002). The polymerization shrinkage of the tested composites following the onset of light irradiation ranged from 0.19 to 3.03. EXP showed a significantly higher polymerization shrinkage than other composites at 30, 60, and 1800 seconds after light irradiation, while XF showed the lowest polymerization shrinkage at the aforementioned time points. The tested bulk-fill composites had a polymerization shrinkage similar to that of the conventional composite.

New silyl-functionalized BisGMA provides autonomous strengthening without leaching for dental adhesives

Resin-based composite has overtaken dental amalgam as the most popular material for direct restorative dentistry. In spite of this popularity the clinical lifetime of composite restorations is threatened by recurrent decay. Degradation of the adhesive leads to gaps at the composite/tooth interface–bacteria, bacterial by-products and fluids infiltrate the gaps leading to recurrent decay and composite restoration failure. The durability of resin-dentin bonds is a major problem. We address this problem by synthesizing silyl-functionalized BisGMA (e.g., silyl-BisGMA), formulating dental adhesives with the new monomer and determining the physicochemical properties and leaching characteristics of the silyl-BisGMA adhesives. Silyl-BisGMA was synthesized by stoichiometric amounts of BisGMA and 3-isocyanatopropyl trimethoxysilane (IPTMS). The control adhesive was a mixture based on HEMA/BisGMA (45/55, w/w). In the experimental formulations, BisGMA was partially or completely replaced by silyl-BisGMA. Water miscibility, polymerization behavior (Fourier transform infrared spectroscopy, FTIR), thermal property (modulated differential scanning calorimetry, MDSC), mechanical properties in dry and wet conditions (dynamic mechanical analysis, DMA), and leached species (HPLC) were investigated. Data from all tests were submitted to appropriate statistical analysis (α = 0.05). Silyl-BisGMA-containing adhesives exhibited comparable water miscibility, lower viscosities, and significantly improved degree of conversion of CC bond as compared to the control. After 4 weeks aqueous aging, the glass transition temperature and rubbery moduli of the experimental copolymers were significantly greater than the control (p < 0.05). HPLC results indicated a substantial reduction of leached HEMA (up to 99 wt%) and BisGMA (up to 90 wt%). By introducing silyl-functional group, the new BisGMA derivative exhibited potential as a monomer that can lead to dental adhesives with improved mechanical properties and reduced leaching under conditions relevant to the oral environment. Statement of SignificanceThe low-viscosity adhesive that bonds the composite to the tooth (enamel and dentin) is intended to seal and stabilize the composite/tooth interface, but it degrades leading to a breach at the composite/tooth margin. As the most popular crosslinking monomer in adhesives, Bisphenol A-glycerolate dimethacrylate (BisGMA) has limitations, e.g. susceptible to hydrolysis and concomitant property degradation. A methoxysilyl-functionalized BisGMA derivative (silyl-BisGMA) was introduced in this work to respond to these limitations. Our results indicated that by introducing silyl-BisGMA, higher crosslinked networks were obtained without sacrificing the homogeneity, and the leached amount of HEMA was reduced up to 99%. This novel resin offers potential benefits including prolonging the functional lifetime of dental resin materials.

Performance of resin composite restorations in the primary dentition: a retrospective university-based study.

Limited data is available on variables influencing the survival of composite restorations in primary teeth. This retrospective university-based study assessed the survival and risk factors associated with failures of resin composite restorations performed in primary teeth. The sample was composed of 961 restorations from records of 337 patients (178 girls and 159 boys) attended in a university dental clinic. The restorations' longevity up to 48months of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P<0.05). Mean survival time was 41.5months (95% CI: 39.7-43.3), with 70.6% of the restorations surviving after 48months of evaluation. The overall annual failure rate up to 48months follow-up was 8.3%. Restorations placed in lower arch had lower survival rate than those in upper arch (HR: 1.82, 95% CI: 1.02-3.28). Restorations involving two or more surfaces had more risk offailure than restorations placed in cavities involving only one surface (HR: 2.55 95% CI: 1.34- 4.83). Girls had less risk of failure in their restorations (HR: 0.43, 95% CI: 0.19-0.96). Individual and dental variables such as gender, arch type and number of restored surfaces were associated with failure of composite restorations performed in children under daily life clinical environment.

A Pragmatic Study Shows Failure of Dental Composite Fillings Is Genetically Determined: A Contribution to the Discussion on Dental Amalgams.

Composite resins for posterior tooth restorations have become a viable alternative to dental amalgam. Failures sometimes cannot be easily explained, and we hypothesize that a genetic component may influence longevity of restorations. We aimed to determine if there is any evidence for a difference in the performance of amalgams versus composite resin in extensive posterior restorations. We also aimed to determine if risk factors such as age, sex, smoking tobacco, alcohol drinking, diabetes status, and periodontal health status may have a role in the failures of extensive anterior composite restorations. Finally, we investigated if genetic variation in matrix metalloproteinases that are present in the mineralized dentin is associated with failure of composite resin. The data used to perform this research were obtained from the Dental Registry and DNA Repository project after screening 4,856 patients. All restorations were evaluated at times of 1, 2, and 5 years after the restoration placement. 6,266 amalgam and 2,010 composite restorations were analyzed in a total of 807 patients in a period of approximately 10 years (period corresponding to the database existence). An additional 443 extensive direct composite resin restorations in anterior teeth were also studied. Failure rates of amalgam and composite restorations are similar, and by the end of 5 years, composites outperformed amalgams slightly. Failures of anterior composite restorations occurred more often in males who smoked tobacco (p = 0.05), despite a similar number of females and males that smoked tobacco in the sample (116 individuals smoked tobacco, 54 females and 62 males). Alcohol drinking increased failure rate within 2 years (p = 0.03). We found a statistically significant association between matrix metalloproteinase 2 rs9923304 and failure of composite restorations (p = 0.007). Composite resins can replace amalgam restorations. Smoking tobacco and drinking alcohol will increase the chance of restoration failure.

Trends in restorative composites research: what is in the future?

Clinical trials have identified secondary caries and bulk fracture as the main causes for composite restoration failure. As a measure to avoid frequent reinterventions for restoration replacement, composites with some sort of defense mechanism against biofilm formation and demineralization, as well as materials with lower susceptibility to crack propagation are necessary. Also, the restorative procedure with composites are very time-consuming and technically demanding, particularly concerning the application of the adhesive system. Therefore, together with bulk-fill composites, self-adhesive restorative composites could reduce operator error and chairside time. This literature review describes the current stage of development of remineralizing, antibacterial and self-healing composites. Also, an overview of the research on fiber-reinforced composites and self-adhesive composites, both introduced for clinical use in recent years, is presented.

Novel self-strengthening hybrid dentin adhesive via a facile visible-light irradiation triple polymerization

Event Abstract Back to Event Novel self-strengthening hybrid dentin adhesive via a facile visible-light irradiation triple polymerization Qiang Ye1, Linyong Song1, Xueping Ge1, Anil Misra1, 2 and Paulette Spencer1, 3 1 University of Kansas, Bioengineering Research Center, United States 2 University of Kansas, Department of Civil Engineering, United States 3 University of Kansas, Department of Mechanical Engineering, United States Introduction: In vivo biodegradation of the bond between the composite and tooth, i.e. the composite restoration’s adhesive bond layer, is considered a major contributor to premature failure of composite restorations[1]. The structure of methacrylate-based dentin adhesives suggests a general mechanism for their chemical and enzymatic degradation in oral fluids. In our previous study[2], the crosslink density of dentin adhesives can be improved with the addition of epoxide monomers. The objective of this work was to further develop a self-strengthening methacrylate-based dentin adhesive system by introducing an epoxy cyclohexyl trimethoxysilane (TS) containing both epoxy and methoxysilyl functional groups and cured by visible-light photopolymerization. Materials and Methods: Neat methacrylate monomer mixture (Scheme 1) of HEMA/BisGMA at 45/55 wt% was used as the control (C0). Experimental formulation with HEMA/BisGMA/TS (22.5/27.5/50, wt%) was used to investigate the free radical polymerization of methacrylate, ring-opening cationic polymerization of epoxy, and photoacid-induced sol-gel reaction. The polymerization behavior was monitored in-situ using real-time Fourier transform infrared spectroscopy (FTIR). The properties of copolymers at TS concentration from 5 to 35 wt% were determined using dynamic mechanical analysis (DMA). The leachables from polymer discs were determined by HPLC using a reverse phase C18 column and UV/diode array detectors. Results and Discussion: In this triple polymIn this triple polymerization system, free radical polymerization rate was the highest and the hydrolysis-condensation reaction was the slowest. In acidic environments, the fast hydrolysis reaction and the limited condensation gave rise to the self-strengthening process, which significantly improved the mechanical properties. When the TS concentration was 10-20 wt%, the copolymers became more homogeneous and the storage modulus at 70 0C reached maximum. The cumulative amounts of leached monomers were reduced significantly (Figure 1). Conclusion: With the introduction of both epoxy and trimethoxysilyl functional groups, a self-strengthening hybrid system has been developed for application as a dentin adhesive. During visible-light irradiation, a triple polymerization mechanism was involved (Figure 2). Supported by grant NIH/NIDCR R01 DE022054. Scheme 1. Chemical structures of monomers used in the formulations. Figure 1. Cumulative release of HEMA from the dentin adhesive copolymers as a function of incubation time in ethanol at 23±2 0C Figure 2. Proposed polymethacrylate-based matrix network structure and the autonomic self-strengthening process with different TS concentrations. (A1 and A2) Polymethacrylate-based network formed by free radical polymerization, cationic ring-opening polymerization, and limited photoacid-induced sol-gel reaction in dry conditions after 40 s irradiation; (B1 and B2) photoacid-induced ring-opening polymerization and sol-gel reaction after 24 h; (C1 and C2) self-strengthening process via sol-gel reaction and ring-opening polymerization in wet environment. Supported by grant R01DE022054 (PS, JSL), from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892.