Aim: The aim of this article is to review the literature on the use of antimicrobial additives in glass-ionomer dental cements. Method: An electronic search between 1987 and the end of 2017 was performed using PubMed, Web of Science and Google search engines with the terms glass-ionomer, glass polyalkenoate, antibacterial and antimicrobial as the key words. The search was refined by excluding the majority of references concerned with cement antimicrobial properties only. Extra papers already known to the authors were added to those considered. Results: A total of 92 relevant articles have been cited in the review of which 55 are specifically concerned with the enhancement of antibacterial properties of glass-ionomers, both conventional and resin-modified, with additives. In addition, information is included on the uses of glass-ionomers and the biological properties of the antibacterial additives employed. There are several reports that show that additives are typically released by diffusion, and that a high proportion is usually left behind, trapped in the cement. Additives generally increase setting times of cements, and reduce mechanical properties. However, smaller amounts of additive have only slight effects and the longer-term durability of cements appears unaffected. Conclusion: Modified glass-ionomer cements seem to be acceptable for clinical use, especially in the Atraumatic Restorative Treatment (ART) technique.
Objective: To evaluate anti-demineralization effects of dentin desensitizer containing sodium fluoride and methacrylate-co-p-styrene sulfonic acid (MS polymer) on root dentin using transverse microradiography (TMR). Material and methods: Twenty-four dentin specimens were divided into four groups: MSO (no fluoride), MSF (3000 ppm F), FJL (9000 ppm F), and Control. In MSO and MSF, each desensitizer was rubbed into the dentin surfaces for 10 s then left for 20 s. In FJL, paste containing 9000 ppm F was applied onto the surface for 30 s. All specimens, including the Controls, were rinsed with deionized water, dried and an area of their surface exposed to pH 5.0 acidic solution, refreshed every 24 h, for 4 days. Sections 300-µm-thick were assessed by TMR. Mineral profiles and integrated mineral loss (IML) of lesions were analyzed by dedicated software. IML was analyzed with one-way ANOVA and Tukey’s test. Results: MSF and FJL specimens showed high mineral volume % at the surface and in lesions, and significantly lower IML than the other groups (p < .05). Conclusion: Dentin desensitizer containing 3000 ppm fluoride and MS polymer has the same anti-demineralization effect as does a fluoride paste containing 9000 ppm F.
This study aims to evaluate fracture resistance of simulated immature teeth after treatment with regenerative endodontic procedure (REP) using tricalcium silicate cements (TSCs) as cervical plugs. Bovine incisors were sectioned to standard crown/root ratio. Pulp tissue was removed and canals were enlarged to a standardized diameter. Teeth were then treated with a REP protocol consisting of NaOCl and EDTA irrigation, intracanal medication with triple-antibiotic paste for 14 days followed by a TSC cervical seal and composite restoration. Teeth were divided into groups according to the material used; Mineral-Trioxide-Aggregate (MTA), Biodentine, TotalFill. Teeth filled with guttapercha (GP) and intact teeth served as controls. All teeth subjected to an increasing compressive force (rate of 0.05 mm/s at a 45° angle to the long axis of the tooth) until fracture. All treated teeth exhibited significantly lower resistance to fracture compared to the intact teeth but no difference was found between the TSC groups (Kruskal-Wallis, Dunn’s multiple comparison, p < .05). TSCs applied at the cervical area of simulated immature teeth treated with REP did not reinforce fracture resistance.
To evaluate debonding mechanism of zirconia and lithium disilicate cemented to dentin mimicking what could occur in a clinical setting. A null hypothesis of no difference in tensile bond strength between groups of zirconia and lithium disilicate cemented with resin cements was also tested. Zirconia rods (n = 100) were randomly assigned to two different surface treatment groups; air borne particle abrasion and hot etching by potassium hydrogen difluoride (KHF2). Lithium disilicate rods (n = 50) were surface etched by hydrofluoric acid (HF). Five different dual cure resin cements were used for cementing rods to bovine dentin. Ten rods of each test group were cemented with each cement. Test specimens were thermocycled before tensile bond strength testing. Fracture morphology was visualized by light microscope. Mean surface roughness (Sa value) was calculated for randomly selected rods. Cohesive fracture in cement was the most frequent observed fracture morphology. Combination of adhesive and cohesive fractures were second most common. Fracture characterized as an adhesive between rod and cement was not observed for KHF2 etched zirconia. Highest mean tensile bond strength was observed when cementing air borne particle abraded zirconia with Variolink Esthetic (Ivoclar Vivadent). All surface treatments resulted in Sa values that were significant different from each other. The number of cohesive cement fractures observed suggested that the cement was the weakest link in bonding of zirconia and lithium disilicate.
Fibr-reinforced composites (FRC) have been used successfully for decades in many fields of science and engineering applications. Benefits of FRCs relate to physical properties of FRCs and versatile production methods, which can be utilized. Conventional hand lamination of prefabricated FRC prepregs is utilized still most commonly in fabrication of dental FRC devices but CAD-CAM systems are to be come for use in certain production steps of dental constructions and medical FRC implants. Although metals, ceramics and particulate filler resin composites have successfully been used as dental and medical biomaterials for decades, devices made out of these materials do not meet all clinical requirements. Only little attention has been paid to FRCs as dental materials and majority of the research in dental field has been focusing on particulate filler resin composites and in medical biomaterial research to biodegradable polymers. This is paradoxical because FRCs can potentially resolve many of the problems related to traditional isotropic dental and medical materials. This overview reviews the rationale and status of using biostable glass FRC in applications from restorative and prosthetic dentistry to cranial surgery. The overview highlights also the critical material based factors and clinical requirement for the succesfull use of FRCs in dental reconstructions.
Desensitising agents are added to dentifrices to occlude exposed dentine tubules and reduce pain associated with dentine hypersensitivity. In occluding the tubules these agents may alter the surface layer of the dentine and consequently affect bacterial biofilm formation. This research sought to examine the effects of desensitising agents on dentinal biofilms using an in vitro model. A constant depth film fermenter (CDFF) was selected to mimic the oral environment and human dentine with exposed tubules was analysed. Calcium sodium phosphosilicate (CSPS) was selected as a model desensitising agent. Dentine discs were treated with pumice or CSPS-containing dentifrices with or without fluoride, or left untreated (control). Dual-species biofilms of Streptococcus mutans and Streptococcus sobrinus were grown in artificial saliva and analysed by viable counts, polymerase chain reaction (PCR) and scanning electron microscopy (SEM). SEM images confirmed the presence of occluded tubules after CSPS application and demonstrated the formation of biofilms containing extracellular matrix material. Analysis of PCR and viable count data using a one-way ANOVA showed no significant differences for bacterial composition for any of the four treatments. There were, however, trends towards increased numbers of bacteria for the pumice and CSPS treated samples which was reversed by the addition of fluoride to CSPS. In conclusion, CSPS was not found to have a significant effect on biofilms and an in vitro model for testing desensitising agents has been developed, however, further work is required to improve the reproducibility of the biofilms formed and to explore the trends seen.
The aim of this study was to compare conventional and digital additive manufacturing of hard occlusal stabilization splints (SS) using technical and clinical parameters. 14 subjects were subjected to DC/TMD Axis I clinical examination protocol and Axis II questionnaire. The subjects underwent treatment with splints over a period of 12 weeks. All subjects underwent both conventional alginate impression and intraoral digital scanning. Seven subjects received conventional manufactured stabilization splints (CM-SS), and seven subjects received CAD-CAM additive manufactured stabilization splints (AM-SS). 12 subjects completed the 12 weeks follow-up period. The subjects significantly preferred digital intraoral scanning compared to conventional alginate impression. There was a significant difference in VAS between CM-SS and AM-SS. The mean VAS result was 15 for AM-SS and 42 for CM-SS, 0 represented excellent comfort and 100 very uncomfortable. This was significant. Splint manufacturing method had no influence on treatment outcome. There was no significant difference in mean delta change for unassisted jaw opening from baseline to 12 weeks between the two groups, for CM-SS it was 2 mm difference and for AM-SS the difference was 3 mm. All subjects in both treatment groups showed improved oral function. In this study, the scanning procedure is more accepted by the subjects than alginate impressions, however the first procedure was more time consuming.
AIM:This study investigated the reinforcing effect of discontinuous glass microfibers with various loading fractions on selected mechanical properties of self-cure glass ionomer cement (GIC). METHOD:Experimental fiber reinforced GIC (Exp-GIC) was prepared by adding discontinuous glass microfiber (silane/non-silane treated) of 200-300 µm in length to the powder of self-cure GIC (GC Fuji IX) with various mass ratios (15, 20, 25, 35, and 45 mass%) using a high speed mixing device. Flexural strength, flexural modulus, work of fracture, compressive strength and diametral tensile strength were determined for each experimental and control materials. The specimens (n = 8) were wet stored (37 °C for one day) before testing. Scanning electron microscopy equipped with energy dispersive spectrometer was used to analysis the surface of silanized or non-silanized fibers after treated with cement liquid. The results were analyzed with using multivariate analysis of variance MANOVA. RESULTS:Fiber-reinforced GIC (25 mass%) had significantly higher mechanical performance of flexural modulus (3.8 GPa), flexural strength (48 MPa), and diametral tensile strength (18 MPa) (p < .05) compared to unreinforced material (0.9 GPa, 26 MPa and 8 MPa). No statistical significant difference in tested mechanical properties was recorded between silanized and non-silanized Exp-GIC groups. Compressive strength did not show any significant differences (p > .05) between the fiber-reinforced and unreinforced GIC. CONCLUSION:The use of discontinuous glass microfibers with self-cure GIC matrix considerably increased the all of the studied properties except compressive strength.
BPA has been reported to leach from some resin based dental restorative materials and materials used for orthodontic treatment. To confirm and update previous findings, especially in light of the new temporary lower threshold value for tolerable daily BPA intake, we have investigated the leaching of BPA from 4 composite filling materials, 3 sealants and 2 orthodontic bonding materials. The materials were either uncured and dissolved in methanol or cured. The cured materials were kept in deionized water for 24 hours or 2 weeks. Samples were subsequently analyzed by ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS-MS). The composite filling material Tetric EvoFlow® and the fissure sealant DELTON® showed significantly higher levels of BPA leaching compared to control samples for all test conditions (uncured, 24 h leaching and 2 weeks leaching). There were no significant differences in amount of leached BPA for any of the tested materials after 24 hours compared to 2 weeks. These results show that BPA is still released from some dental materials despite the general concern about potential adverse effects of BPA. However, the amounts of BPA were relatively low and most likely represent a very small contribution to the total BPA exposure.
Aim: The use of colored translucent zirconia may enable restorations of a more natural tooth-like appearance than previous opaque white zirconia. The shift from non-colored to colored zirconia may however entail a risk of reduced strength. The aim of the present study was to compare fracture load and fracture mode of fixed dental prostheses frameworks made of colored translucent zirconia to that of non-colored controls. Methods: A total of forty three-unit FDP frameworks were manufactured from two different high translucent zirconia materials (Zenostar, Wieland Dental, and DD cubeX2, Dental Direkt). Each group contained two subgroups, one colored and one non-colored. Coloring was performed before final sintering using two different infiltration techniques. All FDPs underwent an artificial aging process in the form of heat treatment, thermocycling and preloading whereafter the specimens were subjected to load until fracture. Fracture load and mode was registered. Results: For one of the zirconia materials, Zenostar, the non-colored frameworks showed significantly higher fracture loads (p < .0001) compared to its colored counterpart. No significant difference (p > .05) was found between colored and non-colored frameworks in the other zirconia material, DD cubeX2. All FDPs fractured through the connector. Some fractures ran through the mesial and some through the distal side of the connector but there were no significant differences in fracture mode between groups. Conclusion: Coloring before sintering of high-translucent zirconia may decrease the fracture load of FDP frameworks for certain materials and techniques. Fracture mode however, does not appear to be affected.
Aim: The purpose of the study was to assess the marginal adaptation and discrepancy of SSC’s. Differences in adaptation and discrepancy between the four surfaces (mesial, lingual, distal, and buccal) were evaluated. Methods: The placement of stainless steel crowns were completed on a phantom head in accordance with the clinical technique. The ideal tooth preparation was made and this ‘master tooth’ duplicated to achieve a sample size of 15. The stainless steel crowns were placed, trimmed, and cemented as per the clinical technique. The cemented stainless crowns were analyzed under 100× stereomicroscope magnification. The marginal adaptation and discrepancy of each specimen was measured every 2 µm. Results: All the specimens showed marginal adaptation and discrepancy. The lingual margin had a significantly better adaptation (p < .0001) over the other surfaces. The buccal surface was the only surface that had an appropriate supra-CEJ level with a significance of p < .0001. Conclusion: The marginal discrepancies occur during the trimming procedure and assessment of the gingival approximation of the SSC margin. The inspection of stainless steel crown adaptation and discrepancy is an essential clinical step.
This study was conducted to determine whether novel experimental low-shrinkage dimethacrylate co-monomers could provide low polymerization shrinkage composites without sacrifice to degree of conversion, and mechanical properties of the composites. Experimental composites were prepared by mixing 28.6 wt% of bisphenol-A-glycidyl dimethacrylate based resin matrix (bis-GMA) with various weight-fractions of co-monomers; tricyclo decanedimethanol dacrylate (SR833s) and isobornyl acrylate (IBOA) to 71.4 wt% of particulate-fillers. A composite based on bis-GMA/TEGDMA (triethylene glycol dimethacrylate) was used as a control. Fracture toughness and flexural strength were determined for each experimental material following international standards. Degree of monomer-conversion (DC%) was determined by FTIR spectrometry. The volumetric shrinkage in percent was calculated as a buoyancy change in distilled water by means of the Archimedes’ principle. Polymerization shrinkage-strain and -stress of the specimens were measured using the strain-gage technique and tensilometer, respectively with respect to time. Statistical analysis revealed that control group had the highest double-bond conversion (p < .05) among the experimental resins tested. All of the experimental composite resins had comparable flexural strength, modulus, and fracture toughness (p > .05). Volumetric shrinkage and shrinkage stress decreased with increasing IBOA concentration. Replacing TEGDMA with SR833s and IBOA can decrease the volumetric shrinkage, shrinkage strain, and shrinkage stress of composite resins without affecting the mechanical properties. However, the degree of conversion was also decreased.
Glass-ionomer cements are used for a variety of tooth-repair functions in clinical dentistry. They are formed by reaction of a basic glass powder with a solution of polymeric water-soluble acid, usually polyacrylic acid. After the initial neutralization reaction, by which the cement hardens, various maturation reactions occur. Changes induced by these maturation reactions are identified as: increase in strength; reduction in plasticity; improvement in opacity; and increase in proportion of tightly bound water. In addition, in contact with the tooth, an ion-exchange interfacial layer is gradually formed. This is mechanically strong and chemically-resistant. These changes are described in the current paper, which reviews the extent to which they occur, and reports what is know about the chemistry that underlies them. Processes involving slow diffusion of various ions and of water through the set cement bring about these changes. They include a secondary setting reaction to form a phosphate-based phase, binding of water to co-ordination sites around metal cations and to a hydration sheath around the polymer molecules, and possibly reaction of water with glass particle surfaces to form silanol groups. Evidence from a wide range of literature sources is used to be build up a detailed picture of the chemistry of the maturation processes, and gaps in our understanding are highlighted. The article concludes that, given the importance of glass-ionomers in contemporary dentistry, it is important to know the extent to which such maturation processes occur in current cement formulations, and also to determine how rapidly they take place.
Objective: To investigate the repair bond strength of fresh and aged nanohybrid and hybrid composite resins using a universal adhesive (UA). Materials and methods: Fresh and aged substrates were prepared using two nanohybrid (Venus Pearl, Heraus Kulzer; Filtek Supreme XTE, 3 M ESPE) and one hybrid (Z100, 3 M ESPE) composite resin, and randomly assigned to different surface treatments: (1) no treatment (control), (2) surface roughening with 320-grit (SR), (3) SR + UA (iBOND, Heraus Kulzer), (4) SR + Silane (Signum, Ceramic Bond I, Heraeus Kulzer) + UA, (5) SR + Sandblasting (CoJet, 3 M ESPE) + Silane + UA. After surface treatment, fresh composite resin was added to the substrates at 2 mm layer increments to a height of 5 mm, and light cured. Restored specimens were water-stored for 24 h and sectioned to obtain 1.0 × 1.0 mm beams (n = 12), and were either water-stored for 24 h at 37 °C, or water-stored for 24 h, and then thermocycled for 6000 cycles before microtensile bond strength (µTBS) testing. Data were analyzed with ANOVA and Tukey's HSD tests (p = .05). Results: Combined treatment of SR, sandblasting, silane and UA provided repair bond strength values comparable to the cohesive strength of each tested resin material (p < .05). Thermocycling significantly reduced the cohesive strength of the composite resins upto 65% (p < .05). Repair bond strengths of UA-treated groups were more stable under thermocycling. Conclusions: Universal adhesive application is a reliable method for composite repair. Sandblasting and silane application slightly increases the repair strength for all substrate types.
Aim: The aim of this study was to compile the usage of Co-Cr alloys in fixed prosthodontics (FP) among dental laboratories in Sweden. Methods: From March to October 2015, questionnaires were sent to 542 registered dental laboratories in Sweden. The questionnaires were divided in two parts, one for fixed dental-supported prosthodontics (FDP) and one for fixed implant-supported prosthodontics (FIP). Reminders were sent three times. Results: In total of 542 dental laboratories, 55% answered the questionnaires. Most dental laboratories use Co-Cr in FP, 134 (74%) in FDP and 89(66%) in FIP. The laboratories used Co-Cr alloys of various compositions in the prostheses, 35 for FDP and 30 for FIP. The most commonly used Co-Cr alloys for tooth-supported FDPs were (a) Wirobond® 280, (b) Cara SLM and (c) Wirobond® C. For implant-supported frameworks the frequently used alloys were: (a) Cara SLM, (b) Cara Milled and (c) Wirobond® 280. Except for the difference in composition of these alloys, they were also manufactured with various techniques. In tooth-supported prostheses the dominating technique was the cast technique while newer techniques as laser-sintering and milling were more commonly reported for implant-supported constructions. A fourth technique; the 'pre-state' milling was reported in FDP. Conclusion: More than 30 different Co-Cr alloys were reported as being used in FP. Thus, there is a need for studies exploring the mechanical and physical behavior and the biological response to the most commonly used Co-Cr alloys.
Objective: To evaluate fracture strength of veneered translucent zirconium dioxide crowns designed with different porcelain layer thicknesses. Materials and Methods: Sixty crowns, divided into six groups of 10, were used in this study. Groups were divided according to different thicknesses of porcelain veneer on translucent zirconium dioxide cores of equal thickness (0.5 mm). Porcelain thicknesses were 2.5, 2.0, 1.0, 0.8, 0.5 and 0.3 mm. Crowns were artificially aged before loaded to fracture. Determination of fracture mode was performed using light microscope. Results: Group 1.0 mm showed significantly (p ≤ .05) highest fracture loads (mean 1540 N) in comparison with groups 2.5, 2.0 and 0.3 mm (mean 851, 910 and 1202 N). There was no significant difference (p>.05) in fracture loads among groups 1.0, 0.8 and 0.5 mm (mean 1540, 1313 and 1286 N). There were significantly (p ≤ .05) more complete fractures in group 0.3 mm compared to all other groups which presented mainly cohesive fractures. Conclusions: Translucent zirconium dioxide crowns can be veneered with minimal thickness layer of 0.5 mm porcelain without showing significantly reduced fracture strength compared to traditionally veneered (1.0–2.0 mm) crowns. Fracture strength of micro-veneered crowns with a layer of porcelain (0.3 mm) is lower than that of traditionally veneered crowns but still within range of what may be considered clinically sufficient. Porcelain layers of 2.0 mm or thicker should be used where expected loads are low only.
Objective: Oral rehabilitation success is enhanced by an accurate and reproducible final impression. The purpose of this study is to evaluate the dimensional changes of a polyether and addition silicone subjected to disinfection and/or sterilization after a long storage period. Material and methods: Ninety samples were obtained from polyether ImpregumTM PentaTM (3M ESPETM, Seefeld, Germany) and 90 of addition silicone ImprintTM 4 PentaTM Putty (3M ESPETM, Seefeld, Germany) according to ISO 4823:2000. The samples of each material were split to form three groups with 30 samples each: a control group, a hypochlorite group (disinfection) and an autoclave group (sterilization). Samples were stored in the Portuguese Institute for Quality for six months at 23 °C. Samples were measured by laser interferometry, according to the Michelson technique before calculating dimensional stability according ISO 4823:2000. A statistical analysis via a three-way mixed ANOVA was performed. Results: Significant shrinkage of ImpregumTM PentaTM was 0.77 ± 0.17% in the control group, 0.42 ± 0.19% in the hypochlorite group and 0.52 ± 0.28% in the autoclave group. For ImprintTM 4 PentaTM Putty, the control group had a shrinkage of 0.42 ± 0.12%, the hypochlorite group 0.36 ± 0.09% and the autoclave group 0.59 ± 0.13%. Conclusions: The long-term storage of samples subjected to disinfection with 5.25% hypochlorite or autoclave sterilization can be used in a clinical setting as the dimensional changes are below the maximum permitted by the ISO 4823:2000, since there are no clinically significant changes in the dimension of the samples during the storage period.
In the present study, amount of titanium (Ti) released into the surrounding bone during placement of implants with different surface structure was investigated. Quantification of Ti released during insertion from three different implants was performed in this ex vivo study. Jaw bone from pigs was used as model for installation of the implants and Inductively Coupled Plasma Atomic Emission Spectroscopy (ICP-AES) was used for analysis of the released Ti. Implant surface were examined with scanning electron microscopy (SEM), before and after the placement into the bone. Ti was abraded to the surrounding bone upon insertion of a dental implant and the surface roughness of the implant increased the amount of Ti found. Diameter and total area of the implant were of less importance for the Ti released to the bone. No visible damages to the implant surfaces could be identified in SEM after placement.
Objective: Leakage of monomers from dental fillings due to incomplete curing is very common. The objective of the present study was to examine the cytokine profile in cells exposed to triethyleneglycol dimethacrylate (TEGDMA) and the adjuvant properties of TEGDMA.Materials and methods: Human peripheral blood mononuclear cells were exposed to TEGDMA (500 and 1000 μM) for 24 h in vitro. Bio-Plex Pro™ assays were used for analysis and detection of cytokines. In vivo, BALB/c mice were immunized subcutaneously in the base of the tail with TEGDMA in combination with ovalbumin (OVA).Results: The cytokine levels of IL-8, IL-18, GRO-α and MCP-1 were significantly increased for both concentrations. IL-1β, IL-6 and TNF-α was only significantly increased in cultures exposed to 500 μM TEGDMA. The concentration of TNF-α was significantly decreased in cultures exposed to 1000 μM TEGDMA. Animals immunized with OVA co-administrated with TEGDMA had a significantly higher IgE and IgG anti-OVA antibody levels in blood than animals immunized with OVA only.Conclusions: TEGDMA affects production of proinflammatory cytokines IL-1β, IL-6, IL-8, IL-18 and TNF-α. This inflammatogenic capacity renders TEGDMAs adjuvant properties, which may interfere with the homeostasis between the immune system and the indigenous microflora in the oral cavity.
Objective: This study evaluated the effect of food-simulating media associated with brushing and coffee staining on color stability of different composite resins. Materials and methods: Eighty specimens were prepared for each composite: Grandio SO (Voco), Amaris (Voco), Filtek Z350XT (3M/ESPE), Filtek P90 (3M/ESPE). They were divided into four groups according to food-simulating media for 7 days: artificial saliva (control), heptane, citric acid and ethanol. The composite surface was submitted to 10,950 brushing cycles (200 g load) in an automatic toothbrushing machine. The specimens were darkened with coffee solution at 37 °C for 24 h. After each treatment, color measurements were assessed by spectrophotometry, using CIE L*a*b* system. The overall color change (ΔE) was determined for each specimen at baseline (C1) and after the treatments (food-simulating media immersion/C2, brushing/C3 and dye solution/C4). Data were analyzed by two-way repeated measures ANOVA and Tukey’s tests (p < .05). Results: The results of RM-ANOVA showed significant differences for composites (p = .001), time (p = .001) and chemical degradation (p = .002). The mean of ΔE for composites were: Z350XT (5.39)a, Amaris (3.89)b, Grandio (3.75)bc, P90 (3.36)c. According to food-simulating media: heptane (4.41)a, citric acid (4.24)a, ethanol (4.02)ab, artificial saliva (3.76)b. For the treatments: dye solution (4.53)a, brushing (4.26)a, after food-simulating media (3.52)b. Conclusions: The composite resin Filtek Z350XT showed significantly higher staining than all other composite resin tested. The immersion in heptane and citric acid produced the highest color alteration than other food-simulating media. The exposure of samples to brushing protocols and darkening in coffee solution resulted in significant color alteration of the composite resins.
