Richard van Noort

The future of dental devices is digital

OBJECTIVES Major changes are taking place in dental laboratories as a result of new digital technologies. Our aim is to provide an overview of these changes. In this article the reader will be introduced to the range of layered fabrication technologies and suggestions are made how these might be used in dentistry. METHODS Key publications in English from the past two decades are surveyed. RESULTS The first digital revolution took place many years ago now with the production of dental restorations such as veneers, inlays, crowns and bridges using dental CAD-CAM systems and new improved systems appear on the market with great rapidity. The reducing cost of processing power will ensure that these developments will continue as exemplified by the recent introduction of a new range of digital intra-oral scanners. With regard to the manufacture of prostheses this is currently dominated by subtractive machining technology but it is inevitable that the additive processing routes of layered fabrication, such as FDM, SLA, SLM and inkjet printing, will start to have an impact. In principle there is no reason why the technology cannot be extended to all aspects of production of dental prostheses and include customized implants, full denture construction and orthodontic appliances. In fact anything that you might expect a dental laboratory to produce can be done digitally and potentially more consistently, quicker and at a reduced cost. SIGNIFICANCE Dental device manufacturing will experience a second revolution when layered fabrication techniques reach the point of being able to produce high quality dental prostheses. The challenge for the dental materials research community is to marry the technology with materials that are suitable for use in dentistry. This can potentially take dental materials research in a totally different direction.

Bond durability of the resin-bonded and silane treated ceramic surface.

OBJECTIVES The aim of this study was to explore methods for improving the ceramic-silane-resin bond strength of silica-based ceramics, such that it may be possible to eliminate the hazardous process of acid etching these dental ceramics with hydrofluoric acid (HF). METHODS Ni/Cr rods were prepared with ceramic facings, which were polished to a 1 microm finish. A silane coupling agent was applied to the ceramic surface using seven different procedures. Specimens were bonded using a luting resin and the tensile bond strength was measured at a crosshead speed of 1mm/min. One bonding procedure was selected and used for the comparison of four ceramic surface preparations consisting of; 1 microm polish, gritblasted (50 microm alumina), etched with 10% HF, and gritblasted and etched. The durability of the bond was assessed by (1) storing the specimens in water at 37 degrees C for different time periods up to 3 months, (2) thermal cycling, and (3) storing in water at 100 degrees C for 24h. RESULTS The results showed that one bonding procedure to a polished ceramic surface gave better results for the tensile bond strength of the resin to the smooth ceramic surface and that the tensile bond strength was not significantly different from the gritblasted, etched or gritblasted and etched groups (P>0.05). There was no deterioration in the tensile bond strength for any of the groups after water storage for up to 3 months or after thermal cycling (P>0.05). The silane bond was also capable of resisting hydrolytic attack in boiling water. SIGNIFICANCE The results indicate that a durable resin-ceramic tensile bond can be obtained by appropriate silane application without the need for HF acid etching the ceramic surface.

Osteoblastic differentiation of cultured rat bone marrow cells on hydroxyapatite with different surface topography

UNLABELLED Hydroxyapatite (HA) has been used in orthopedic, dental, and maxillofacial surgery as a bone substitute. OBJECTIVE The aim of this investigation was to study the effect of surface topography produced by the presence of microporosity on the response of the rat bone marrow cells, evaluating: cell attachment, proliferation, total protein content, alkaline phosphatase (ALP) activity, and bone-like nodule formation. METHODS Cells were cultured on HA discs manufactured by a combination of uniaxial powder pressing and different sintering conditions, with different percentage of microporosity (<5%-HA5, 15%-HA15, and 30%-HA30). For attachment evaluation, cells were cultured for 2 h. Proliferation was evaluated after 7 and 14 days. After 14 days, total protein content and ALP activity were measured. For bone-like nodule formation, cells were cultured for 21 days. Data were compared by ANOVA and Duncans multiple range test when appropriate. RESULTS Cell attachment was not affected by surface topography (p=0.37). Proliferation (p=0.001), total protein content (p=0.039), ALP activity (p=0.050), and bone-like nodule formation (p=0.00001) were all significantly decreased by the most irregular surface (HA30). SIGNIFICANCE. These results suggest that initial cell events were not affected by the surface topography of the HA. However, intermediary and final events such as proliferation, protein synthesis, ALP activity, and bone-like nodule formation favored surfaces with a more regular topography, such as that presents in HA with 15% or less of microporosity.

The effect of different surface treatments on bond strength between leucite reinforced feldspathic ceramic and composite resin.

OBJECTIVES The aim of this study was to evaluate the effect of different surface treatments on the microtensile bond strength between a leucite reinforced glass-ceramic and composite resin. METHODS Leucite reinforced ceramic blocks (n=24) were constructed using the hot pressing technique. The blocks were assigned to 4 groups, which received the following surface treatments: G1: hydrofluoric (HF) acid and silane; G2: silane alone; G3: HF acid and silane then dried with warm air (100 degrees C); G4: silane alone then dried with warm air (100 degrees C). Unfilled resin was applied, followed by composite resin. Specimens were prepared and loaded in tension to determine the microtensile bond strength. Failure modes were classified by stereo- and scanning electron microscopy (SEM). Data was analysed using Kruskal-Wallis test followed by the Dunns multiple range test. RESULTS The groups including the warm air step (G3 and G4) achieved a significantly stronger adhesion than G1 and G2. Pre-treatment of the surface with hydrofluoric acid in G1 resulted in significantly higher bond strength than G2. Failures were mostly cohesive in the luting resin for G1, G3 and G4 and mainly adhesive at the ceramic-resin interface in G2. CONCLUSIONS The method of application of silane to the ceramic surface can have a significant influence on the adhesion between the ceramic restoration and the resin cement. Enhancing the condensation reaction by drying the silane with a 100C warm air stream significantly improved the microtensile bond strength, possibly eliminating the need for the hydrofluoric acid etching step.

Effect of resin matrix composition on the translucency of experimental dental composite resins

OBJECTIVES The purpose of this study was to investigate the effect of the resin matrix composition on the translucency of experimental dental composite resins. METHODS Three types of unfilled resin matrices (TEGDMA-, UDMA- and BisGMA-based) were formulated and light cured. In addition, six different experimental dental composite resins with constant filler loading but varying in the type of monomer and the content of BisGMA were fabricated. Discs of each test material with 15.5mm diameter and 1.0mm thickness were prepared (N=3) and light cured. Total and diffuse transmittance values for each sample were measured using a UV/VIS spectrophotometer with the range of readings from 380 to 700nm. Difference in color was measured using the CIE Lab system. RESULTS Statistical analysis by one-way ANOVA followed by Tukeys test showed that there was no statistically significant difference in transmittance values between the three unfilled resins. However, with the addition of filler, BisGMA-containing composite resins showed significantly higher transmittance values than the UDMA- and TEGDMA-based composite resins. Regression analysis revealed that there was a linear correlation between the percentage of BisGMA in the resin matrix and the total and diffuse translucency. SIGNIFICANCE The amount of BisGMA used in the resin matrix has a significant effect on the translucency of silica filler-containing dental composite resins.

Infiltration of demineralized dentin with silica and hydroxyapatite nanoparticles

OBJECTIVES The management of demineralized dentin resulting from dental caries or acid erosion remains an oral healthcare clinical challenge. This paper investigates, through a range of studies, the ability of colloidal silica and hydroxyapatite (HA) nanoparticles to infiltrate the collagen structure of demineralized dentin. METHODS Dentin samples were completely demineralized in 4 N formic acid. The remaining collagen matrix of the dentin samples was subsequently infiltrated with a range of nano-particulate colloidal silica and HA solutions. The effectiveness and extent of the infiltration was evaluated by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDS). RESULTS Silica nanoparticles have the ability to penetrate dentin and remain embedded within the collagen matrix. It is suggested that particle size plays a major role in the degree of dentin infiltration, with smaller diameter particles demonstrating a greater infiltrative capacity. The infiltration of demineralized dentin with sol-gel HA nanoparticles was limited but was significantly increased when combined with the deflocculating agent sodium hexametaphosphate. The use of acetone as a transport vehicle is reported to enhance the infiltration capacity of sol-gel HA nanoparticles. SIGNIFICANCE Collagen infiltrated with HA and silica nanoparticles may provide a suitable scaffold for the remineralization of dentin, whereby the infiltrated particles act as seeds within the collage matrix and given the appropriate remineralizing environment, mineral growth may occur.

Marginal gap, internal fit, and fracture load of leucite-reinforced ceramic inlays fabricated by CEREC inLab and hot-pressed techniques.

PURPOSE This in vitro study was designed to evaluate and compare the marginal gap, internal fit, and fracture load of resin-bonded, leucite-reinforced glass ceramic mesio-occlusal-distal (MOD) inlays fabricated by computer-aided design/manufacturing (CAD/CAM) or hot pressing. MATERIALS AND METHODS Fifty caries-free extracted human molars were prepared for standardized MOD inlays. Impressions of each specimen were made and poured using type IV dental stone. Dies were randomly divided into two equal groups. Twenty-five ceramic inlays were fabricated by the hot-pressed technique using IPS Empress leucite-reinforced glass ceramics, and the other 25 ceramic inlays were produced by CAD/CAM technology using ProCAD leucite-reinforced ceramic blocks and CEREC inLab facilities. Inlays were bonded to the teeth using a dual-cured resin cement. The specimens were stored in distilled water at 37°C for 24 hours and then thermocycled for 5000 cycles. The marginal gap measurements were taken with a stereomicroscope. Specimens in each group of inlay systems were randomly divided into two subgroups of 10 and 15 specimens each. Ten specimens in each subgroup were sectioned mesiodistally for evaluation of the internal fit. The fracture load of specimens in the second subgroup (n = 15) of the two inlay systems was determined under compressive load in a universal testing machine. Data were analyzed using Students t-test at a significance level of p < 0.05. RESULTS The mean marginal and internal gap size in both IPS Empress and ProCAD inlays were less than 100 μm; however, the marginal gap for the IPS Empress restorations was significantly higher than that of ProCAD restorations (p < 0.05). There was no significant difference in the mean internal fit or the fracture load between the two glass ceramic inlays (p > 0.05). CONCLUSIONS The leucite-reinforced glass ceramic inlay restorations fabricated by CEREC inLab (CAD/CAM) and the hot-pressed technique provided clinically acceptable marginal and internal fit with comparable fracture loads after luting.

Biocompatibility of Resin-based Dental Materials

Oral and mucosal adverse reactions to resin-based dental materials have been reported. Numerous studies have examined the biocompatibility of restorative dental materials and their components, and a wide range of test systems for the evaluation of the biological effects of these materials have been developed. This article reviews the biological aspects of resin-based dental materials and discusses the conventional as well as the new techniques used for biocompatibility assessment of dental materials.

Evaluation of the marginal integrity of ceramic copings with different marginal angles using two different CAD/CAM systems

OBJECTIVES To investigate and compare the marginal integrity of ceramic copings constructed with the CEREC3 and the EVEREST system employing three different margin angle designs and explore to what extent these CAD/CAM machines can produce acute marginal angles creating restorations with acceptable margins. MATERIALS AND METHODS Three brass models were prepared with a different marginal finish line, namely a 0° bevel (or 90° shoulder), a 30° bevel and a 60° bevel. Ten restorations were produced for each finishing line and CAD/CAM system, respectively. The copings were milled from lithium disilicate glass ceramic blocks (IPS e.max(®) CAD). An impression was taken for each model to fabricate a series of 10 replica dies for each marginal design. Quantitative analysis of the margins of each coping was performed using digital photography and image analysis software. The marginal integrity of the restorations was evaluated by detecting and measuring any signs of marginal chipping and the Chipping Factor (CF) was calculated. Statistical analysis was performed using Univariate Analysis of Variance and multiple comparisons (Tukey HSD). RESULTS The average Chipping Factor (CF) of the CEREC copings was: 2.8% for the 0° bevel angle, 3.5% for the 30° bevel angle and 10% for the 60° bevel angle. For the EVEREST copings the average CF was: 0.6% for the 0° bevel angle, 3.2% for the 30° bevel angle and 2.0% for the 60° bevel angle. Univariate Analysis of Variance and multiple comparisons showed that there was a statistically significant difference in the quality of margins between the two systems for the 0° and 60° bevel finishing line. CONCLUSIONS The results of this study indicated that the introduction of a marginal angle of the restoration increases the potential for marginal chipping. Different CAD/CAM systems which employ different milling processes produce restorations with different amount of marginal chipping, although this only became apparent for a marginal angle of a 60°.

Biologic Assessment of Antiseptic Mouthwashes Using a Three-Dimensional Human Oral Mucosal Model

BACKGROUND The biologic safety profile of oral health care products is often assumed on the basis of simplistic test models such as monolayer cell culture systems. We developed and characterized a tissue-engineered human oral mucosal model, which was proven to represent a potentially more informative and more clinically relevant alternative for the biologic assessment of mouthwashes. The aim of this study was to evaluate the biologic effects of alcohol-containing mouthwashes on an engineered human oral mucosal model. METHODS Three-dimensional (3D) models were engineered by the air/liquid interface culture technique using human oral fibroblasts and keratinocytes. The models were exposed to phosphate buffered saline (negative control), triethylene glycol dimethacrylate (positive control), cola, and three types of alcohol-containing mouthwashes. The biologic response was recorded using basic histology; a cell proliferation assay; 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tissue-viability assay; transmission electron microscopy (TEM) analysis; and the measurement of release of interleukin (IL)-1beta by enzyme-linked immunosorbent assay. RESULTS Statistical analysis showed that there was no significant difference in tissue viability among the mouthwashes, cola, and negative control groups. However, exposure to the positive control significantly reduced the tissue viability and caused severe cytotoxic epithelial damage as confirmed by histology and TEM analysis. A significant increase of IL-1beta release was observed with the positive control and, to a lesser extent, with two of the tested mouthrinses. CONCLUSIONS The 3D human oral mucosal model can be a suitable model for the biologic testing of mouthwashes. The alcohol-containing mouthwashes tested in this study do not cause significant cytotoxic damage and may slightly stimulate IL-1beta release.