Advancing Discontinuous Fiber-Reinforced Composites above Critical Length for Replacing Current Dental Composites and Amalgam

摘要

Clinicians have been aware that posterior dental particulate-filled composites (PFCs) have many placement disadvantages and indeed fail clinically at an average rate faster than amalgam alloys. Secondary caries is most commonly identified as the chief failure mechanism for both dental PFCs and amalgam. In terms of a solution, fiber-reinforced composites (FRCs) above critical length (Lc) can provide mechanical property safety factors with compound molding packing qualities to reduce many problems associated with dental PFCs. Discontinuous chopped fibers above the necessary Lc have been incorporated into dental PFCs to make consolidated molding compounds that can be tested for comparisons with PFC controls on mechanical properties, wear resistance, void-defect occurrence and packing ability to reestablish the interproximal contact. Further, imaging characterizations can aid in providing comparisons for FRCs with other materials using scanning electron microscopy, atomic force microscopy and photographs. Also, the amalgam filling material has finally been tested by appropriate ASTM flexural bending methods that eliminate shear failure associated with short span lengths in dental standards for comparison with dental PFCs to best explain increased longevity for the amalgam when compared to dental PFCs. Accurate mechanical tests also provide significant proof for superior advantages with FRCs. Mechanical properties tested included flexural strength, yield strength, modulus, resilience, work of fracture, critical strain energy release and critical stress intensity factor. FRC molding compounds with fibers above Lc extensively improve all mechanical properties over PFC dental paste and over the amalgam for all mechanical properties except modulus. The dental PFC also demonstrated superior mechanical properties over the amalgam except modulus to provide a better explanation for increased PFC failure due to secondary caries. With lower PFC modulus, increased adhesive bond breakage is expected from greater interlaminar shearing as the PFC accentuates straining deflections compared to amalgam at the higher modulus tooth enamel margins during loading. Preliminary testing for experimental FRCs with fibers above Lc demonstrated three-body wear even less than enamel to reduce the possibility of marginal ditching as a factor in secondary caries seen with both PFCs and amalgam. Further, FRC molding compounds with chopped fibers above Lc properly impregnated with photocure resin can pack with condensing forces higher than the amalgam to eliminate voids in the proximal box commonly seen with dental PFCs and reestablish interproximal contacts better than amalgam. Subsequent higher FRC packing forces can aid in squeezing monomer, resin, particulate and nanofibers deeper into adhesive mechanical bond retention sites and then leave a higher concentration of insoluble fibers and particulate as moisture barriers at the cavity margins. Also, FRC molding compounds can incorporate triclosan antimicrobial and maintain a strong packing condensing force that cannot be accomplished with PFCs which form a sticky gluey consistency with triclosan. In addition, large FRC packing forces allow higher concentrations of the hydrophobic ethoxylated bis phenol A dimethacrylate (BisEMA) low-viscosity oligomer resin that reduces water sorption and solubility to then still maintain excellent consistency. Therefore, photocure molding compounds with fibers above Lc appear to have many exceptional properties and design capabilities as improved alternatives for replacing both PFCs and amalgam alloys in restorative dental care.