Rafael Yagüe Ballester

Can Fiber Posts Increase Root Stresses and Reduce Fracture

The clinical success of fiber posts has been attributed to their lower elastic modulus. The tested hypothesis was that fiber posts could lead to lower risk of post debonding and lower risk of root fracture, despite an increase in root stresses. Stress analyses were carried out with a 3D finite element model of a premolar restored with a metallic or a fiber post. Bonded and non-bonded post/cement interface conditions were simulated. We calculated risk-of-fracture indices by determining the highest principal stress values divided by the tensile strength. Shear stresses along the post/cement interface were analyzed for the bonded models. Compared with the premolar restored with a metallic post, the fiber post generated lower stresses along the interface and higher stresses in the root. However, with the fiber post, fracture was less likely to occur in the root, since its core and post fracture indices were higher.

Polymerization shrinkage: effects of constraint and filling technique in composite restorations

OBJECTIVES To evaluate the linear polymerization shrinkage (LPS) and its effect upon mean gap width, bond strength and cohesive strength of a composite placed under different constraints (C-factors--CF) and filling techniques. METHODS Composite was placed in cavities sized 4 x 4 x 2 mm3 (CF = 3) or on flat dentin surfaces (CF = 0.3) of bovine incisors, after adhesive application. They were inserted in one or three increments, and light cured (600 mW/cm2) for 80 s. The LPS was measured by placing a probe on the top surface of the composite in order to measure its dislodgment in the top-bottom direction. Half of the sample was sectioned to obtain composite resin sticks subjecting them to tensile forces at 0.5 mm/min. The other half of the sample was sectioned and the mean gap width was measured in both sides of the sections. Then the sections were sliced again to obtain composite/dentin sticks. The mean gap width in the sticks was performed before subjecting them to tensile forces at 0.5 mm/min. Data was analyzed by a two-way ANOVA and the correlation between the bond strength and gap width was analyzed by simple linear regression. RESULTS (1) Linear polymerization shrinkage: significant differences were observed for the interaction (p < 0.05). Under the low constraint, the LPS were similar for both filling techniques. Under higher constraint, polymerization shrinkage was lower for the incremental technique. (2) Gap width and bond strength: no difference was detected either for interaction, or for technique (p > 0.05). Under higher constraint, the gap width was higher and the bond strength lower. (3) The cohesive strength of composite resin was similar for all groups (p > 0.05). No correlation between bond strength and gap width was found (p = 0.17). SIGNIFICANCE The effects of polymerization shrinkage were not reduced by the filling technique under the different cavity constraints tested.

Sequential software processing of micro-XCT dental-images for 3D-FE analysis

OBJECTIVES The aim was to describe a sequential software processing of mu-XCT molar-images for 3D-FE tooth/restoration model geometries based on a representative molar tooth, giving attention on each step of data-processing. This paper first gives an overview of a sequential processing and then applies the resulting model to the particular case. METHODS An intact mandibular molar was scanned using a micro-XCT instrument (1072, SkyScan, Belgium) in which 960 slices were obtained. Sixty-three non-adjacent bitmap slices were then optimally selected for model-creation. Enamel/dentin boundaries were clarified, for each slice, using image control-system software (ScanIP, Simpleware), generated a file which was sequentially converted into a mesh in a reconstruction software (ScanFE, Simpleware) and posteriorly converted into a STL-file (triangulated-2D-stereolithography). This was imported into a FE-software package (Patran, MSC.Software, USA) and all elements were re-meshed. From these elements, surfaces were created and exported to another FE-software (Hypermesh, Altair Hyperworks) to build the dental-cavities. Finally, the volumetric-mesh was created and the model was imported back to FE-software to apply the boundary-conditions, material-properties and initiate post-processing (using Patran and Marc, MSC Software). To demonstrate the use of the resulting model, this was applied to the particular case of a Class I restoration subjected to distributed loading. The analysis was performed as linear and structural and outputs of maximum principal (MP) and maximum shear (MS) stresses were then evaluated. RESULTS A 3D-model of a mandibular molar was processed without generating errors in the FE-package used. The maximum deviation between the tooth and the model was less than 0.1%. Stress concentrations were found at the surface where the load was applied and in the vicinity of the tooth-composite interface. SIGNIFICANCE The described procedure is a successful method able to produce a highly detailed 3D finite element model of restored molar teeth with any cavity configuration and combination of restorative materials and this method can also be used for other biological or biomaterials applications.

Pilot study on the early shear strength of porcelain-dentin bonding using dual-cure cements ☆ ☆☆

STATEMENT OF PROBLEM One of the most critical steps of the porcelain restoration technique is cementation. Mechanical stress before the resin cement reaches a certain degree of polymerization can displace or even fracture the restoration. Dual-cure materials are intended to be more effective at early stages of polymerization because they contain both photoinitiator and components for chemically activated reaction. PURPOSE This study evaluated the early shear strength of bonding between porcelain and dentin, using dual-cure cements. MATERIAL AND METHODS Sixty nonrestored human molars and premolars were randomly divided in 12 groups. The dual-cure cements tested were Porcelite and Dual. A chemically activated cement was also tested (C&B luting composite). Ceramic pieces, 3 mm high, were etched with hydrofluoric acid, silane-coated, and then bonded to flat dentin surfaces with each of the cements, associated with Optibond adhesive system. Photoactivation was made by using a light unit with 450 mW/cm2. The specimens were stored in water at 37 degrees C. Testing times were 10, 30, 90 minutes, and 7 days (referred to as maximum strength). RESULTS Both Porcelite and Dual dual-cure cements show statistically similar shear strength for the same time interval. The chemically activated material showed statistically lower values when compared with both dual-cure cements, regardless of the time interval. Results at 7 days were much higher than those obtained at 90 minutes for the 3 cements tested. CONCLUSIONS Both dual-cure cements tested presented similar results. The bond strength of dual-cure cements to dentin was higher at all time intervals than that obtained for chemically activated material. The high values for the coefficient of variation confirmed the technique-sensitive nature of the porcelain/dentin bonding procedure. Although dual-cure cements reach higher bonding strength values faster than the chemically activated material, it is not recommended to stress the bonding until 90 minutes after cementation, because the strength at that time is much lower than the maximum.

Influence of time and adhesive system on the extrusion shear strength between feldspathic porcelain and bovine dentin

OBJECTIVES The behavior of dual-cure cements over time remains unclear. This study evaluated the extrusion shear strength of the bond between feldsphatic porcelain and bovine dentin at different time intervals, using three adhesive systems based on dual-cure cements and one based on a self-cure cement. METHODS The adhesive systems evaluated included: C&B/One-Step, Enforce/Prime&Bond NT Dual-Cure, RelyX ARC/Single Bond and Variolink II/Syntac SC. Discs of bovine root dentin, 2.5 mm thick, had the root canal prepared with a standardized taper. Porcelain truncated cones etched with 4% hydrofluoric acid and silanized were bonded into the perforations. The extrusion shear test was performed after 15 min, 4 h, 12 h, 24 h, and 7 days. Data were analyzed using the Weibull distribution. The failure mode was accessed by stereomicroscope and SEM. RESULTS Statistical differences were found between 15 min and 7 days for Variolink II/Syntac SC and RelyX ARC/Single Bond, and between 15 min and 24 h for Enforce/Prime&Bond NT Dual-Cure. For C&B/One-Step, difference was found between 15 min and 4 h. Between 24 h and 7 days, only the system RelyX ARC/Single Bond showed a significant increase in the characteristic strength. SEM analysis revealed that the failure involved the hybrid layer/dentin or the hybrid layer/adhesive interfaces, regardless of the time interval and adhesive system. SIGNIFICANCE High characteristic strengths were observed after 15 min when dual-cure cements were used. In general, the values found at 24 h or 7 days were higher than at 15 min. However, there was always a considerable probability of bonding failure at low stress levels for all the systems tested.

Vertical root fracture in upper premolars with endodontic posts: finite element analysis.

Upper premolars restored with endodontic posts present a high incidence of vertical root fracture (VRF). Two hypotheses were tested: (1) the smaller mesiodistal diameter favors stress concentration in the root and (2) the lack of an effective bonding between root and post increases the risk of VRF. Using finite element analysis, maximum principal stress was analyzed in 3-dimensional intact upper second premolar models. From the intact models, new models were built including endodontic posts of different elastic modulus (E = 37 or E = 200 GPa) with circular or oval cross-section, either bonded or nonbonded to circular or oval cross-section root canals. The first hypothesis was partially confirmed because the conditions involving nonbonded, low-modulus posts showed lower tensile stress for oval canals compared to circular canals. Tensile stress peaks for the nonbonded models were approximately three times higher than for the bonded or intact models, therefore confirming the second hypothesis.

Does Adhesive Thickness Affect Resin-dentin Bond Strength After Thermal/Load Cycling?

This study evaluated the influence of adhesive layer thickness (ADL) on the resin-dentin bond strength of two adhesive systems (AS) after thermal and mechanical loading (TML). A flat superficial dentin surface was exposed with 600-grit SiC paper on 40 molars. After primer application, the adhesive layer of Scotchbond Multipurpose (SBMP) or Clearfil SE Bond (CSEB) was applied in one or two layers to a delimited area (52 mm2) and resin blocks (Filtek Z250) were built incrementally. Half of the sample was stored in distilled water (37 degrees C, 24 hours) and submitted to thermal (1,000; 5 degrees -55 degrees C) and mechanical cycles (500,000; 10kgf) [TML]. The other half was stored in distilled water (72 hours). The teeth were then sectioned to obtain sticks (0.8 mm2) to be tested under tensile mode (1.0 mm/minute). The fracture mode was analyzed at 400x. The BS from all sticks from the same tooth was averaged for statistical purposes. The data was analyzed by three-way ANOVA. The chi2 test was used (p < 0.05) to compare the frequency of pre-testing failure specimens. Higher BS values were observed for SBMP regardless of the ADL. The TML reduced the BS values irrespective of the adhesive employed and the ADL. A higher frequency of pre-testing failure specimens was observed for the cycled groups. A thicker adhesive layer, acting as an intermediate flexible layer, did not minimize the damage caused by thermal/mechanical load cycling for a three-step etch-and-rinse and two-step self-etch system.

Understanding Contradictory Data in Contraction Stress Tests

The literature shows contradictory results regarding the role of composite shrinkage and elastic modulus as determinants of polymerization stress. The present study aimed at a better understanding of the test mechanics that could explain such divergences among studies. The hypothesis was that the effects of composite shrinkage and elastic modulus on stress depend upon the compliance of the testing system. A commonly used test apparatus was simulated by finite element analysis, with different compliance levels defined by the bonding substrate (steel, glass, composite, or acrylic). Composites with moduli between 1 and 12 GPa and shrinkage values between 0.5% and 6% were modeled. Shrinkage was simulated by thermal analogy. The hypothesis was confirmed. When shrinkage and modulus increased simultaneously, stress increased regardless of the substrate. However, if shrinkage and modulus were inversely related, their magnitudes and interaction with rod material determined the stress response.

Morphological characterization of the tooth/adhesive interface

The purpose of this study was to assess the morphological characteristics of the tooth/adhesive interface using different adhesive systems in MOD restorations under scanning electron microscopy (SEM). The tested hypothesis was that the morphology of the bonding interface would vary in different areas of MOD restorations for the three adhesive systems. MOD cavities were prepared in 12 sound extracted human third molars and restored with Filtek Z250 composite resin and one of the following adhesive systems: Experimental ABF (n=4), Clearfil SE Bond (n=4) self-etching primers and Single Bond etch-and-rinse adhesive system (n=4). After 24-h storage in distilled water at 37 degrees C, teeth were sectioned and prepared for SEM. The interfacial morphology varied depending on the adhesive system and also on the evaluated area. The null hypothesis was accepted because the morphology of the tooth/adhesive interface reflected the characteristics of both the dental substrate and the adhesive systems.

Clinical, biochemical and histological study of the effect of antimicrobial photodynamic therapy on oral mucositis induced by 5-fluorouracil in hamsters

Oral mucositis (OM) is a debilitating side effect of chemotherapy, which can be relieved by phototherapy. Antimicrobial photodynamic therapy (aPDT) may be used for the treatment of OM, when infection is present. However, there are no studies showing that aPDT affects tissue repair process when used in the treatment of lesions caused by OM. This work aims to evaluate the effect of aPDT in healing OM induced by 5-Fluorouracil (5-FU). Two hundred forty-five hamsters were divided into two groups, control (C) and experimental, which were subdivided into 4 subgroups (Ch, ChP, ChL, aPDT). C group received only the vehicle of chemotherapy and anesthesia, whereas all animals of the experimental groups received anesthesia and chemotherapy agent 5-FU to induce OM. Ch group received no OM treatment; ChP group received an application of methylene blue (MB) 0.01%; ChL received irradiation with low-power-laser (LPL-660 nm/120 J /cm(2)/40 mW/4.4 J per point); and aPDT received MB and LPL irradiation. OM Clinical severity were daily assessed by a blinded examiner. The animals were sacrificed after 5, 7 and 10 days of experiment and their oral mucosa were removed for biochemical (enzymatic activity of SOD and catalase) and histological analyzes (light microscopy). After statistical analysis was performed, results showed that aPDT reduced the severity of OM on the tenth day of the experiment, when compared to the initial OM score (p < 0.05), as well as increased keratinization with organized collagen deposition in the lamina propria. In conclusion, aPDT can be safely used in animals with infected OM because it does not affect lesion-repairing processes.