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2 MICROLEAKAGE IN CLASS II COMPOSITE RESTORATIONS BONDED WITH DIFFERENT ADHESIVE SYSTEMS By ZIYAD KAMAL MAHMOUD MOHAMMAD Thesis submitted in fulfillment of the requirements of the degree of Master of Science UNIVERSITI SAINS MALAYSIA August 2008
3 DEDICATION To my mother and my father for their constant support and sacrifice. To my wife and children who spread joy and happiness in my life. To my supervisor whose guidance, encouragement, help and support made this project possible. ii
4 ACKNOWLEDGEMENTS First, I would like to thank my supervisor, Dr. Norhayati Luddin, for being the best mentor any one can ask for. Her scientific perception and friendship are perhaps only surpassed by her courage in allowing her students to explore the vast scientific landscape, in order to train us to be freethinking independent scientists at the end of the journey. She made me realize that apart from knowing your subject and hard work you need passion and imagination to invent and discover. Without her help and support, I would never be here today. I also would like to express my gratitude to Dr. Sam'an Malik Masudi for his endless support and motivation I would like to thank Puan Asiah Abu Baker, Noor Baizura Ab. Ghani, Siti Fadilah Abdullah for their assistant and cooperation and to all the professors and staffs in the School of Dental Sciences, USM for providing me with a great working environment. iii
5 TABLE OF CONTENTS Page DEDICATION... ii ACKNOWLEDGEMENTS... iii TABLE OF CONTENTS... iv LIST OF TABLES... ix LIST OF FIGURES... x ABSTRAK... xii ABSTRACT... xiv CHAPTER ONE... 1 INTRODUCTION Background of the Study Statement of Problem Justification of Study Objective of Study General Objectives Specific Objectives Research Hypothesis... 6 CHAPTER TWO... 7 LITERATURE REVIEW Microleakage Introduction and Definition Factors Contributing to Microleakage Polymerization Shrinkage and Cavity Configuration Factor Hydroscopic Expansion iv
6 Light Polymerization Concepts and Units Thermocycling Microleakage Test Methods and Dyes Methods of Microleakage Detection Fluorescent Dye Adhesive System Introduction and Definition Bonding to Enamel Bonding to Dentin Wet versus Dry Bonding Bond Strength Adhesive System Classification Clinical Approach Classification: Etch and Rinse Based Adhesive Systems Self-Etch Based Adhesive Systems: Chronologically Based Classification Solvent Based Classification Posterior Composite Restorations and Nanotechnology Introduction Composites Posterior Composites and Nanotechnology Confocal Laser Scanning Microscope (CLSM) Introduction Fluorescence Fluorescence Microscopy v
7 2.4.4 Confocal Laser Scanning Microscopy (CLSM) and Dental Applications CHAPTER THREE MATERIALS AND METHODS Study Design Source Population Inclusion criteria: Exclusion criteria: Sample Size Calculation Randomization Data Collection Procedure Teeth Selection Cavity Preparation Experimental Groups Restoration Placement Procedure Finishing & Polishing Specimen Preparation for Microleakage Test Nail Varnish Application Dye Immersion, Sectioning and Labeling Microscopy and Dye Penetration Measurements Data Transfer to Image Analyzer Reproducibility of the Measurements Data Entry and Analysis Ethical Considerations vi
8 CHAPTER FOUR RESULTS Reproducibility of measurements Comparison of microleakage between the self-etch, one-step, one-component (G Bond) and etch and rinse (Adper single bond 2) adhesive systems Comparison of microleakage between nano-composite (Filtek Z350) and microhybrid composite (Filtek Z250) Comparison of microleakage between nano-composite bonded with self-etch, onestep, one-component adhesive system (group 4) and other study groups (group 1 & 2 & 3) CHAPTER FIVE DISCUSSION Adhesive Systems Comparison Resin Composites Comparison Comparison of Nanocomposite Bonded with Self-Etch, One Step, One-Component Adhesive Group with Other Study Groups Confocal Laser Scanning Microscope (CLSM) CHAPTER SIX CONCLUSIONS AND RECOMMENDATIONS Conclusions Recommendations Recommendations for future research Clinical recommendations Limitation of the study vii
9 REFERENCES APPENDIX viii
10 LIST OF TABLES Page Table 3.1: Description of study groups Table 3.2: Composition of adhesive systems employed in this study Table 3.3: Composition of composites employed in this study Table 4.1 Reproducibility of dye penetration measurements Table 4.2: Comparison of microleakage between the G Bond adhesive system (n=52) and Adper single bond 2 adhesive system (n=52) Table 4.3: Comparison of microleakage between nano-composite (Filtek Z350) (n=52) and microhybrid composite ( Filtek Z250) (n=52) Table 4.4: Comparison of microleakage between all study groups ix
11 LIST OF FIGURES Page Fig. 2.1 Adhesive system classification Fig. 2.2 Emission and excitation of fluorescent subject Fig. 2.3 Schematic diagram of the optical pathway and principal components in a CLSM Fig. 2.4 Confocal microscope configuration and information flow schematic diagram. 44 Fig. 3.1: Inclusion criteria Fig. 3.2: Exclusion criteria (a) caries (b) deformities (c) cracks Fig. 3.3: Teeth examination under light microscope Fig.3.4: Scaling procedure Fig.3.5: Thymol preparation process A) weighting 2 g of thymol, B) thymol addition to distilled water and stirring Fig. 3.6: Mesial and distal cavities Fig. 3.7: Cavity measurements Fig. 3.8: Block randomization into four groups Fig.3.9: Matrix retainer with transparent band Fig.3.10: Light curing from buccal and lingual sides Fig.3.11: Distilled water storage after restorative procedure Fig.3.12: Thermocycling process A) Teeth inserted into 4 perforated bottles B) Teeth immersed in hot water bath C) Teeth immersed in cold water bath Fig.3.13: Sealing of the tooth apex Fig.3.14: Nail varnish application Fig.3.15: Distilled water storage of teeth after thermocycling and nail varnish application x
12 Fig.3.16: Rhodamine B dye immersion of teeth Fig.3.17: Rhodamine B dye preparation and neutralization A) Weighting the dye, B) Dissolving the dye in 100ml deionized water, C) Buffering the dye in 0.05 NaOH solution, D) ph measurment Fig.3.18: Hard tissue cutter machine and sectioning procedure Fig.3.19: Section fixation to slide and labeling procedure Fig.3.20: Confocal Laser Scaning Microscope (CLSM) Fig.3.21: Arrow showing the gingival surface used for microleakage measurements Fig.3.22: Image analyzer (Material Work Station) Fig. 3.23: The study flow chart Fig. 4.1: CLSM image of a section from group 1 viewed at 10x magnification, A) Image of tooth structure and restoration without dye, B) Image of the same section in A showing the dye alone, C) Image showing the microleakage (combination of image A+B) Fig. 4.2: CLSM image of a section from group 1 viewed at 10x magnification, A) Image showing the dye alone, B) Image showing no microleakage Fig. 4.3: CLSM image of a section from group 2 viewed at 10x magnification A) With microleakage, B) Without microleakage Fig. 4.4: CLSM image of a section from group 3 viewed at 10x magnification A) With microleakage, B) Without microleakage Fig. 4.5: CLSM image of a section from group 4 viewed at 10x magnification A) With microleakage, B) Without microleakage xi
13 KEBOCORAN MIKRO DALAM TAMPALAN KOMPOSIT KELAS II YANG DILEKATKAN MENGGUNAKAN SISTEM PERLEKATAN BERBEZA ABSTRAK Objektif: Tujuan kajian ini ialah untuk membandingkan keberkesanan dua sistem perlekatan iaitu sistem perlekatan self-etch, one-step, one-component dan sistem perlekatan etsa dan bilas. Kajian ini juga digunakan untuk membandingkan dua jenis bahan iaitu nanokomposit dan mikrohibrid komposit ke atas kebocoran mikro pada tampalan komposit kelas II dalam dentin. Keberkesanan penggabungan sistem perlekatan self-etch, one-step, one-component dengan nanokomposit keatas kebocoran mikro pada tampalan komposit kelas II dalam dentin juga dikaji. Bahan bahan dan langkah-langkah: Lima puluh dua batang gigi premolar kekal bahagian atas telah digunakan dan 2 lubang kelas II (3 millimeter (mm) lebar x 1.5 mm dalam) dengan pinggir gingiva berada 1 mm di bawah CEJ telah disediakan dan tampalan dilakukan pada setiap gigi. Dua sistem perlekatan self-etch, one-step, onecomponent (G Bond, GC, Japan), sistem perlekatan etsa dan bilas (Adper Single Bond 2, 3M ESPE, USA) dan dua bahan komposit: nanokomposit (Filtek Z350, 3M ESPE, USA) dan mikrohibrid komposit (Filtek Z250, 3M ESPE, USA) telah digunakan dalam kajian ini mengikut arahan daripada pihak pengeluar. Seratus empat kaviti tersebut dibahagi secara rawak kepada 4 kumpulan (n=26). Dua kumpulan yang pertama telah ditampal menggunakan Filtek Z350 (3M ESPE, USA) manakala dua kumpulan terakhir ditampal menggunakan Filtek Z250 (3M ESPE, USA). Selain itu, semua kaviti daripada kumpulan 1 dan 3 dilekatkan menggunakan G Bond (GC, Japan) manakala kumpulan 2 dan 4 dilekatkan menggunakan Adper Single Bond 2 (3M ESPE, USA). Spesimen ditermosikal pada suhu 5-55 C selama 30 saat sebanyak 500 kitaran. Sampel kemudian direndam di dalam 0.5% dakwat Rhodamine B selama 10 jam dan dipotong xii
14 secara longitudinal. Penetrasi dakwat pada pinggir gingiva diukur dalam millimeter menggunakan confocal laser scanning microscope (CLSM) pada 10x magnifikasi. Data dianalisa menggunakan Two-Way ANOVA dan keputusan dengan p<0.05 dianggap signifikan secara statistik. Keputusan: Tiada perbezaan signifikan dijumpai (p>0.05) untuk sistem perlekatan self-etch, one-step, one-component (G Bond) dan sistem perlekatan etsa dan bilas (Adper Single Bond 2). Penetrasi dakwat antara bahan komposit yang digunakan juga menunjukkan tiada perbezaan signifikan (p>0.05). Tiada perbezaan yang signifikan dapat dilihat dalam penetrasi dakwat pada pinggir gingiva dalam semua kumpulan kajian. Kesimpulan: Sistem perlekatan self-etch, one-step, one-component dan bahan tampalan nanokomposit memberi keputusan yang sama dengan sistem perlekatan etsa dan bilas dan mikrohibrid komposit dalam mengurangkan kebocoran mikro pada tampalan komposit kelas II. xiii
15 MICROLEAKAGE IN CLASS II COMPOSITE RESTORATIONS BONDED WITH DIFFERENT ADHESIVE SYSTEMS ABSTRACT Objectives: The purpose of this study was to compare the effect of self-etch, one-step, one-component adhesive system and etch and rinse adhesive system as well as the nanocomposite and microhybrid composite on the microleakage of class II composite restorations located in dentin. The effect of the combination of self-etch, one-step, onecomponent adhesive and nanocomposite on the microleakage of class II composite restorations located in dentin was also investigated. Materials and Methods: Fifty two upper permanent premolar teeth were used and two class II cavities (3 millimeter (mm) width x 1.5 mm depth) with gingival margins ended 1mm below CEJ were prepared and filled in each tooth. Two adhesive systems: self-etch, one-step, one-component adhesive system (G Bond, GC, Japan), etch and rinse adhesive system (Adper Single Bond 2, 3M ESPE, USA) and two composite materials: nanocomposite (Filtek Z350, 3M ESPE, USA), microhybrid composite (Filtek Z250, 3M ESPE, USA) were used and applied in this study according to the manufacturers instructions. The 104 cavities were divided randomly into four groups (n=26). The first two groups were restored with Filtek Z350 (3M ESPE, USA) while the last two groups were restored with Filtek Z250 (3M ESPE, USA). All the cavities in group 1 and 3 were bonded with G Bond (GC, Japan) while the cavities in group 2 and 4 were bonded with Adper Single Bond 2 (3M ESPE, USA). The specimens were thermocycled between 5 to 55 C with 30 second dwell time for 500 cycles. The samples were then immersed in 0.5% Rhodamine B dye for 10 hours and sectioned longitudinally. Dye penetration at the gingival margin was quantified in millimeters under confocal laser scanning microscopy (CLSM) at 10x magnification. Data were analyzed using Two-Way ANOVA and results with p<0.05 were considered xiv
16 statistically significant. Results: No significant difference (p>0.05) in dye penetration was discovered between self-etch, one-step, one-component adhesive system (G Bond) and etch and rinse adhesive system (Adper Single Bond 2). No significant difference (p>0.05) was also found in dye penetration between the composite materials used. No significant difference (p>0.05) in dye penetration was observed on the gingival margin among all study groups. Conclusion: Self-etch, one-step, one-component adhesive system and nanocomposite restorative materials produced similar results to those of etch and rinse adhesive systems and microhybrid composites in microleakage of class II composite restorations. xv
17 CHAPTER ONE INTRODUCTION 1.1 Background of the Study Good adhesion between dentin and restorative resins is of primary importance in clinical practice. The search for improved adhesive and resin composite materials has received considerable interest in the recent years. The improved properties of adhesive materials, resin-based composite restorations have been made more reliable and longstanding. New approaches to bonding restorative resins to tooth substrates without acid etching step, such as self-etching systems, have recently been introduced. These simplified systems aim to reduce technique sensitivity by reducing the number of clinical steps involved (Van Meerbeek et al., 2003). As a result, their popularity is increasing. One of the advantages of using single-step, self-etch, one-component adhesives is, it can prevent discrepancies occurring between the depth of etching and resin monomer penetration. This is because the single-step, self-etch, one-component adhesive systems form a continuous layer by simultaneous demineralization with acidic monomers, followed by resin monomer penetration into the dentin substrate (Van Meerbeek et al., 2003). Unfortunately, the first evaluations of the sixth (6 th ) generation system showed sufficient bond to conditioned dentin but, the bond to enamel was less effective (Kugel and Ferrari, 2000). This may be due to insufficient etching to enamel. In addition, they are available in two bottles by which one drop of liquid from each will be mixed together before application to the tooth structure. This can cause error to occur due to unequal ratio of liquid mixed or mishandling of the bottles. As a result, some 1
18 manufacturers introduced the 7 th generation one bottle adhesive systems which simplifies the procedure further. Although there have been reports regarding the performance of total-etch and selfetch (5 th and 6 th generations) adhesive systems, studies and reported data on the capability of the newly introduced self-etch, one-step, one-component adhesive system (7 th generation) in sealing the margins of restorations in class II cavities is very limited. Moreover, most of the previously conducted studies on self etch adhesives tested these materials on Class V preparations (Deliperi et al., 2007, Brackett et al., 2004, Owens and Johnson, 2007). This is because studies on class V are easy to control and standardize while, studies performed on class II restorations are more difficult to execute and normally have a greater standard deviation. This is due to the significant influences of dentin structures, the operative procedure and the origin of dentin (caries affected, sclerotic, sound, superficial or deep) (Ernst, 2004). Since the presence of open margins around restorations causes teeth to be susceptible to secondary caries, a restoration should provide a good adhesion to the tooth. Resin shrinkage due to polymerization has been reported as one of the factors associated with marginal leakage and gap formation at the tooth-restoration interface (Cenci et al., 2005). The polymerization shrinkage can create significant stress in the surrounding tooth structure and may lead to bond failure (Amaral et al., 2004). This problem can be minimized by using different restorative techniques and different materials such as nanocomposite. These composites are characterized by using nano particles that increase in the filler loading with the consequences of reducing polymerization shrinkage and increased the mechanical properties (Beun et al., 2007). Araujo Fde et al. (2006) and Fruits et al. (2006) reported that major marginal microleakage occurs on the gingival surfaces located in dentin or cementum. Generally, 2
19 data regarding microleakage of nanocomposites, as well as, nanocomposites bonded with self-etch compared to total etch adhesive systems in class II restorations is still limited. Therefore, it is useful to determine the effect of self-etch, one-step, onecomponent adhesive materials and nanocomposite at the gingival surface microleakage in class II restorations. This raises the question whether self-etch, one-step, one-component, adhesive systems and nanofilled composites are efficient in preventing or reducing microleakage in class II cavities and whether the combination of nanofilled composites with the selfetch, one-step, one-component, adhesive systems add an advantage in preventing or reducing microleakage. Microleakage testing conducted by previous studies (Kim et al. 1992, Brunton et al. 2004) using normal low-resolution optical microscopy with fluorescent dyes since these dyes present a very visible, strong color. However, with the introduction of confocal laser scanning microscope, microleakage testing starts to rely on the fluorescence criteria of the dye rather than the color, which give us a new advantage over conventional microscopy. Confocal laser scanning microscope offers several other advantages over conventional optical microscopy. This includes the ability to control depth of field, elimination or reduction of background information away from the focal plane (that leads to image degradation) and the capability to collect serial optical sections from thick specimens. This technique generates significant improvement in resolution, lying somewhat between that of conventional light microscope and scanning electron microscope (SEM). Moreover, this type of microscopy enables high-resolution images to be made of samples with minimum requirements for specimen preparation (Watson, 1997). Therefore, CLSM may provide more accurate detection of 3
20 microleakage (D'Alpino et al., 2006a). For all these reasons, this technology was utilized to detect microleakage in this study. 1.2 Statement of Problem Due to increase patient s demand for aesthetic, the use of adhesive restorations for posterior teeth is becoming very popular these days (Mjor and Gordan, 2000). Due to this there is a tendency to simplify bonding procedure to reduce the clinical time and improve the longevity of the restoration. Over time, several changes have been made in formulation to produce materials that enhance clinical success. The latest innovations are the development of dental composites based on nanotechnology. However, problems, such as wear, technique sensitivity and microleakage still the concern when resin-based composite restorations are placed in teeth. Since the nanocomposite materials have been around for only a short period, no independent research data is yet available (Ure and Harris, 2003). Therefore, the aim of this in vitro study was to investigate the microleakage in Class II restorations restored with self-etch, one-step adhesives and nanocomposites. 1.3 Justification of Study Due to increased patients demand for aesthetic restorations and the many availability of products in the market, it is necessary to evaluate the quality and reliability of the new adhesive systems and new nano-composite materials in reducing the microleakage of composite restorations through laboratory investigation. Since the self-etch, one-step, adhesive systems and nanocomposite materials are used on patients by the students and the clinicians at the dental school of Universiti Sains 4
21 Malaysia, it is important to study its efficacy in reducing the microleakage in class II composite restorations. In addition, the result of the study will provide the dental health service providers with some knowledge that will help them select better treatment modalities in order to provide longer lasting restorations to their patients. 1.4 Objective of Study General Objectives The purpose of this in vitro experimental study is to evaluate the efficacy of self-etch, one-step, one-component adhesive systems and nanocomposites in reducing the microleakage of class II composite restorations, in relation to the total-etch adhesives and microhybrid composites using confocal laser scanning microscope (CLSM) Specific Objectives First objective: To compare the microleakage of self-etch, one-step, one-component adhesive systems (G Bond, GC, Japan) in class II composite restorations with the totaletch adhesive systems (Adper Single Bond 2, 3M ESPE, USA). Second objective: To compare the microleakage of class II composite restorations restored with nano-composite material (Filtek Z350, 3M ESPE, USA) and microhybrid composite material (Z250, 3M ESPE, USA). Third objective: To compare the microleakage of the nano-composite material (Filtek Z350, 3M ESPE, USA) bonded with self-etch, one-step, one-component adhesive system (G Bond, GC, Japan) with other study groups (1,2,and 3). 5
22 1.5 Research Hypothesis 1) Self-etch, one-step, one-component adhesive system has lower microleakage as compared to the total etch system in class II restorations. 2) Nano-composite has lower microleakage as compared to the microhybrid composite material in class II restorations. 3) Nano-composite material bonded to self-etch, one-step, one-component adhesive system exhibit the lowest microleakage as compared to other study groups 6
23 CHAPTER TWO LITERATURE REVIEW 2.1 Microleakage Introduction and Definition The integrity and durability of the marginal seal has always been of prime concern in the investigation of dental restorative materials performance. One of the key functions of a dental restoration is to seal the exposed dentin from the oral environment, to prevent pulpal damage and further decay. Therefore, the microleakage at the toothrestorative interface is a major concern influencing the clinical longevity of composite resin restorations (Gwinnett et al., 1995). The marginal integrity of the tooth and restoration interface is dependent upon several factors. It is dependent upon type of restorative material, the physical properties of the material, interactions between materials, physical properties of the tissue interface, and the interaction of the oral environment (Rossomando and Wendt, 1995) The clinical symptoms associated with the occurrence of microleakage are breakdown and discoloration of margins, secondary caries, increase in postoperative sensitivity, pulpal pathology, and reduction in the longevity of the restoration (Peutzfeldt, 2000). Leakage of water and other products can occur along the interface through voids created during insertion or function. Based upon the size of these voids, two types of leakage can be distinguished: Microleakage: occurs when large voids are present causing water, large molecules, and even bacteria to migrate along the restoration. Microleakage is defined as the 7
24 clinically undetectable passage of bacteria, fluids, molecules, or ions between a cavity wall and the restorative material applied to it (Kidd, 1976). Nanoleakage: occurs when the voids are so small that only water and some small molecules can pass. The difference between both types is somewhat arbitrary, since both may occur simultaneously (Dorfer et al., 2000). Many different laboratory techniques have been used to demonstrate microleakage. These techniques include the use of bacteria, compressed air, chemical and radioactive tracers, neutron activation analysis, artificial caries technique, scanning electron microscope, and perhaps the most common of all, dye penetration. Investigation of leakage has been carried out both in vivo and in vitro, but the latter is more common. In vitro experiments can be divided into two categories, one that uses a clinical simulation and the other one that is purely a test of the behavior of materials (Kidd, 1976) Factors Contributing to Microleakage Several factors can affect the integrity of the tooth-restoration interface and can contribute to microleakage. Among these are: Polymerization shrinkage and cavity configuration factor Hydroscopic expansion Light polymerization concepts and units Thermal cycling and occlusal stresses Polymerization Shrinkage and Cavity Configuration Factor Photo-polymerization is now a widely accepted initiation mode for the clinical hardening processes with a wide range of biomaterials including dental adhesives and restorations. The polymerization of dental composite resins is inevitably accompanied by shrinkage. Due to this, molecular densification during the polymerization process of 8
25 dental restoratives, and the macroscopic effects of shrinkage strain and/or shrinkage stress, continue to attract widespread international research interest (Watts and Silikas, 2005). Resin shrinkage due to polymerization has been reported as one of the factors directly responsible for marginal staining, fractures, debonding, microleakage, secondary caries and postoperative sensitivity. The present generation of flowable composites undergoes a free volumetric shrinkage of 4-9% (Watts and Silikas, 2005). For condensable composites, volumetric shrinkage is in the range of 2-6%, with most values near 3.5%. Sixty five to 75% of this shrinkage occurs within the first 10 minutes of placement, irrespective of curing mode. Polymerization stresses in a bonded structure may cause adhesive or cohesive failure and interfacial gap formation or, if adhesion is maintained, deformation of residual tooth structure may occur (Watts and Silikas, 2005). The effect of tooth structure deformation to accommodate potential stress is unknown. However, light cured composites develop higher stress than auto-cured analogues, and the use of higher energy curing lights further exacerbate the situation. Shrinkage stresses are very dependent upon the cavity geometry as well as the underlying chemistry. This is often discussed in terms of C-factor. C-factor is defined as the ratio of the bonded surface area to the free unbonded surface area of the cavity (Albers, 2002). C-factors for dental restorations typically range from 0.1 to 5.0 with higher values (>1.5) indicating more likelihood of higher interfacial stresses. A key effect on actual stress is dependent on the complexity of a dental restoration. For example, Class I and deep Class V cavities have high C-factor values with possible high contraction stresses. However, the presence of a high C-factor is a risk for bonding because the polymerization stresses may be too great to be counteracted by the bond strength of the 9
26 dentine bonding agent. Immediate bond strength of approximately 17 MPa may be necessary to resist the contraction stresses to prevent marginal debonding (Bayne et al., 2002). Because of its simplicity, the C-factor theory has been an attractive explanation for potential clinical problems. However, the real importance of these effects for current clinical systems may be much less. Many composites are highly filled, placed incrementally, and cured with appropriate techniques. In addition, newer adhesive systems are much better bonded (Bayne et al., 2002). (Braga et al., (2006) demonstrated that shrinkage stress and microleakage were higher in restorations with larger diameters and depths. In addition, they stated that high stresses may be translated into a more severe microleakage or low bond strength, depending on the variable tested. However, microleakage seemed to be related to restorations volume, but not to its C factor. (Cara et al., (2007) examined the effect of polymerization contraction stress (manifested as cuspal deflection) during polymerization of the resin based composites. They demonstrated that a precured intermediary flowable layer reduced the associated cuspal deflection resulting from the polymerization shrinkage of the incrementally applied resin based composites. Nevertheless, this precured intermediary flowable layer did not affect the microleakage Hydroscopic Expansion Polymerization reaction and subsequent interaction with the aqueous oral environment may result in a series of physical changes in the resin-based composite restorative materials. Resin-based composite restorative materials may absorb significant amounts of water when exposed to the oral environment. Water sorption may produce some undesirable effects such as dissolution, hydrolysis, expansion, 10
27 plasticization, microcrack formation and fatigue. This degradation of its physical properties decreases the life expectancy of dental restorative materials (Robenson et al., 2002). Most polymer-based materials absorb water through a diffusion controlled process. A number of factors including type of resin, filler fraction, filler size, reactivity of the glass and the presence of silane and non-silane coupling agents, determine the diffusion coefficient of dental composite restorative materials (Eliades et al., 2005). Of these, the nature of the resin matrix has the most significant bearing on the amount and rate of hydroscopic expansion for any given resin-based composite restorative material. Water sorption by the resin may compensate for the effect of the polymerization shrinkage. This is because; the resin may expand and seal off marginal gaps. However, it occurs only over a relatively long period of time and it is directly proportional to resin content (Perdigao and Swift, 2002; Robenson et al., 2002). Unfortunately, swelling is much more marked for restorations with a low C-factor, in which shrinkage stress is not as a great problem. In the case of high C-factor restorations, the surface of the restoration which is exposed to the oral cavity will initially gain in volume. This gain produces a gradient from the outer surface to the bulk of the restoration, thus adding additional stress. On the other hand, owing to the slow process of water sorption from saliva, stress relief may come too late, after fractures have already formed. Although water sorption is generally recognized as a stressrelieving mechanism, there are only a few quantitative data available to assess its true impact. After a prolonged period of swelling, nonshrinking composite materials may encounter major problems related to expansion stress in some types of restorations for example, in mesioocclusodistal (MOD) restorations (Dauvillier et al., 2000). 11
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An event every month that begins at 7:30pm on day First of the month, repeating indefinitely
One of the many ways to get connected at TORCC NY is through our "Dipping Nights". On Dipping Nights, visitors and their friends can simply come and be encouraged and refreshed. How? Most of our frustrations come from confusion. We know what the Scriptures say about God and His will and how He truly wants to bless and mature us, but sometimes we may need something more specific that will bring the pieces of the 'puzzle' together to reveal what the outcomes will be. Our ministry team has been anointed with gifts that enable them to discern present and future events that may "join some of the dots" of your life together for clarity! These gifts are what are commonly called "prophecy" and the "word of knowledge". Our well proven ministers and their words have been the source of encouragement and direction to thousands of people over 25 years of ministry. It's time for your Isaiah 55:11 season.Find out more »

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These earrings are not heavy and are medium size, measuring 2 inches total length and 1inch across. With oval blue turquoise stone in the center and silver charms have a turquoise patina on the silver in a southwestern pattern. With sterling silver ear wires.
I want each purchase to be a pleasant experience and for you to be a happy customer. All of my items are carefully packaged in gift boxes with tie ribbon shipped in bubble envelopes to protect them and from a smoke free home. Thank you for shopping hand made and Thanks for visiting! Let's visit some more on Facebook, I'd love to be your friend! www.facebook.com/pages/McKee-Jewelry-Designs/247578775324008


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Description: Mike met this girl online, what he didn't know was that she's a real kinky girl. He wanted to fuck her really bad, but she had some other things in mind. Mike is 18 years old, his tight asshole is 100% virgin, and here he is with this blondy that wants to fuck his ass with a 10 inch very thick strap on. He gives in and she starts off by spanking his cute tight butt, then she bends him over and gives him a very hard rough fucking. A must see, very hot.
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Marine microbiology, a monograph on hydrobacteriology1 edition - first published in 1946 Read
Survey of microbial degradation of asphalts with notes on relationship to nuclear waste management1 edition - first published in 1978
My mother, Stella Davis ZoBell, 1881-19581 edition - first published in 1959
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Admire the most beautiful places of Cividale del Friuli and add them to your basket. YAMGU will create your trip considering distances, opening hours and weather.
The Fàrie is a workshop Geretti from Smith and fits in the tradition of family-run workshops in which the secrets of the craft were handed down from father to son. His father Peter, Antonio Geretti (Cividale del Friuli 1904-1982) inherits the business and learn the art of initially work with creativity and attention to technique, tradition and then hone his skills by attending the school of Arts and crafts Working society of mutual help and education of Cividale del Friuli.
The Fàrie preserves Geretti preparatory sketches, hammers, punches, chisels, clamps, anvils, plaster casts up to the stand
A short walk from via Major Monastery, at no. 2 is the Celtic Hypogeum. Consists of various rooms underground, carved into the rock with primordial technique, which grow at different levels, roughly shaped branches K.
A stairway leads into the Central Chamber, from which depart three corridors. There are niches in the walls and rough wooden pallets, but the greatest mystery is represented by three crude mascheroni.
The original function of this unique monument, which is not reflected in Friuli, is still an unresolved question. Apart from the fanciful interpretations mix of legend, it has been su
The Museum was founded in 1817 by the Earl Michele Valsassina della Torre (1757-1844), a scholar who led early in the 800, with subsidies of the Emperor of Austria Francis I, important excavated in Cividale and the territory. Today is headquartered in the Palazzo dei Provveditori Veneti, constructed in the 16th century by Andrea Palladio. The ground floor is located the lapidary with finds dating section from Roman times to the Renaissance age.
In the foreground, after a section regarding Julium Carnicum (Casiee), the section is dedicated to the Lombards, with important evidence of this civili
The Christian museum-founded in 1946, but renovated and expanded by the current Archpriest of the Cathedral, mons. Guido Son-in-law – hosts two important sections: the Lombard Heritage and the treasure of the Cathedral. The first is given by two famous monuments included in the UNESCO candidature: the altar of Ratchis (recently restored with the rediscovery of the original polychrome) and the baptistery of Callisto.
The treasure of the Cathedral has in absolutely unprecedented and coordinated form items of jewellery and liturgical use, pictorial works of art (the "Noli me tangere" by Pordenone
This is the most important and best preserved architectural testimony of Lombard times and is particularly important because it marks the coexistence of purely reasons Lombards (in friezes, for example) and a revival of classical models, creating a sort of uninterrupted continuity between the pompous classical art, art Carolingian art and Lombard (in which the shipyard workers often worked, as Lombard in Brescia) and Ottonian. The collection is part of the serial site "Longobards in Italy: the places of power", comprising seven places full of architectural testimonies, pictorial and sculptural
Historical building of the noble family De ' Nordis-former seat of the Museum-sec. Recently restored XVIII exhibition of historic-artistic gallery under construction
The artistic and historical re-enactment of the Ursuline Sisters, placed since its origins within the monastery of Santa Maria in Valle, consists of figurines with head and hands in wax and body in tow. The oral tradition gives the valuable work of folk crafts to the eighteenth century, but studies on the costumes belong to the second half of the 19th century. The statues, made in the silence of the cloister, revive people that animated the streets and markets of Cividale also through Friulian names with which the sisters had baptized them: Robert, Jamil, Checo, Min, Zef, Nadal, Tin, year's Ev


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I know what you're thinking, "What the hell is going on with Babs and this movie gig?" I don't know the answer, except, since I got the bright idea of downloading movies, it has become my "Comfort Zone." Yes, it takes me away from my own insanity for uno momento and I get to watch someone else's version of insanity. So, last night, I watched the 2003 version of Texas Chainsaw Massacre. By far, not the best movie I've seen, it did smack you with that inbred feeling that we all know and love. This is most certainly NOT a true movie but it is based on the schematics of Ed Gein, one of my all time favorite Serial Killers. I say all this, knowing that you guys are all more progressive than me and have already seen this movie, so I'm not spoiling anything. I put the warning at the top for those who've not but do intend to see this movie. I did fall for a lot, hook, line and sinker, enough to research it. There are links at the bottom, just a couple of sites that give info, one of which has video's, story's of Eileen Wurnous, Ed Gein and more. Very interesting. I studied this subject at length and just adore Criminal Psychology, it was and is my Major.
This link will take you to a site that's pretty damn good. It's about Ed Gein, who was a very incredible fella. I mean after all, it's talent to make stuff out of people's skin. I'm lucky I can sew a button on.
This link will take you to a site that has Biography video's of such Serial Killers as Ed Gein, Eilleen Wuornos and more. Very Interesting!


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|Overall rating
From Newport South Wales DIY
- Overall it looks the part, although not as robust as the one it replaced on my gate.
Although I stipulated the gate thickness and was assured that it would fit it came with a short bar, on phoning a new longer bar was sent out without any problems, but it should have come with it in the first place.
It has a fairly flimsy arrangement with the handle, on taping gently to secure onto the bar the handle fell apart. I had to deepen the circlip groove and fit a new circlip.
Yes I could have returned it, but a new one would have been the same.
It is all working now if what a bit rusty. My fault for trying to save a few pounds, should have gone with my original supplier.
I am sorry you had a problem with this product. The spindle of this latch is designed for standard gates up to 45mm thick, I have added the maximum gate thickness to the product specification to avoid future confusion.
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You've got a winner of a school for your son. There hasn't been a sexual molestation scandal there for several years, making it a good time to dissolve the gender binary.
If Trump wants to reduce the corporate income tax, he should cut at least some of the $147 billion the government spends on research grants.
President Trump must manage several crises if he is to make America great again. One of the most important: taming so-called independent regulatory agencies.
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The soft socialism of Hillary Clinton tends to grow up into the rabid Cold War socialism of Russia and Eastern Europe, and China.
We need to behave like adults and ask ourselves which of the two — and only two — candidates on offer would we rather have as president.
The trans bathroom bills are flooding us because we've destroyed the truth that people should be free to choose with whom to associate.
Drew Barrymore may have the money to dissolve her family repeatedly. The rest of society does not.
The left-wing media's attack on Donald Trump is also an attack on anyone who doesn't hew the progressive line.
What was really going on at Harvard was not about the seal or even about money. The whole seal business was really about identity politics.
We must be of good cheer. We are not yet old and fragile. Constitutional governance is, Justice Scalia himself said, 'worth fighting for, win or lose.'
A man who gives you an opportunity to rethink bad ideas isn't necessarily a good candidate for president.
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What do you get when you cross Bill Buckley and Stan Evans? The conservative movement.
Will The Washington Post investigate how a woman with a drinking problem and a steady male companion got to be an Episcopal bishop?
It's time for Republicans to channel their inner Jafar and get sneaky about Democrat attempts to buy votes through never-ending college subsidies.
Secretary of State John Kerry decides he must pander to transsexuals. All two of them at the State Department.
You might think that, today, the battle that changed the course of Western Civilization would have a bit more resonance.
This is the moment Republicans have been waiting for. They have a historic opportunity to free the current indentured former students from their debts .
- Elon Musk Is Right: Our Population Problem Is Too Few Kids, Not Too ManyA disturbing number of the world's nations will not bcontinue reading >
- Ultra-Rich Gay Activist On Targeting Christians: It's Time To 'Punish The Wicked'In a recent interview with Rolling Stone magazine, teccontinue reading >
- Why Conservative Women Are So PrettyThe women of the Right are allowed to believe things thcontinue reading >


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Heathrow expansion opponents face eviction from squat
A group of squatters who have spent the last four years living on land close to Heathrow airport are facing eviction.
The Grow Heathrow group in Sipson village moved onto the derelict site, which had originally been earmarked for airport expansion. Bailiffs are expected to evict the squatters but have yet to turn up.
BBC reporter Karl Mercer talked to John McDonnell, Labour MP for Hayes and Harlington, and local resident Tracy Howard.
15 Aug 2014
- From the section London


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We're sure that you're fed up with these so-called "best ever" or "most amazing" FIFA goals. We are too!
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Also Check: Footballer Kisses Opponent, Gets a Yellow Card


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Hi I'm planning on studying mech eng at uni and was just wondering how my career would be effected if i decided to get tattoos and piercings. Thanks for any help.
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- 27-11-2013 23:18
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(Original post by mattheywood94)
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- 28-11-2013 13:42
Hi I'm planning on studying mech eng at uni and was just wondering how my career would be effected if i decided to get tattoos and piercings. Thanks for any help.
I know it does not make any difference to your academic ability. As an engineer though, depending on the path of your career after you leave uni, you will come into contact with many people from different cultural backgrounds.
Whilst the UK is quite liberal, there will be people who do not understand and will be quite judgemental. That may limit your career opportunities and you will have difficulty asserting your rights. (A foreign client may say they do not want you on the team for instance).
Piercings are also be a safety hazard. Chemicals (cleaning agents, oils, etching compounds etc.) getting trapped may cause irritation or infection. They risk getting caught in moving parts. Metal objects increase the risk of electrocution when working on high voltage electrical installations/ high power RF installations etc.
It raises all kinds of issues with emplyers liability, insurances etc.
Companies want people, who in their opinion, have good career prospects/management potential and display an attitude aligned with those aims. To that end they are more likely to play safe and err on the side of caution.
Displaying tattoos and piercings may eliminate you from any interview selection processes.
Of course their will be some companies who have a progressive attitude and will not mind.
But......can you afford to take that chance in todays let alone future job markets?Last edited by uberteknik; 28-11-2013 at 13:50.
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A lot of companies will want "blank canvas" individuals. Someone who has their own personality, but is able to adopt the characteristics of the company. Having tattoos and piercings may make this difficult, especially as your role may involve providing presentations to prospective customers whom may not appreciate your style.
As mentioned, piercings can be a potential hazard, but there's nothing wrong with having a sense of identity at university and outside of work. Just make sure they can be easily removed (I would avoid tunnels as they are still highly visible when removed). Tattoos should ideally not be visible and you may wear a short-sleeved shirt or polo as part of your uniform, so be prepared for that. Don't assume that wrists or forearms will be covered all the time at work.
I don't think I've seen the topic be raised in interviews or online applications (if they did, I probably skimmed past because it didn't concern me much), but obviously try to make sure they won't be inappropriate now or in the future. Whatever you end up doing, wear it smartly.
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I'll second this. there is no problem with them per se, but having obvious ones will limit your options. Piercings can be a hazard, particularly in this day and age where you can be asked to wear a hard hat if there is some overhead work happening a mile from your location. It's not just "what if they got caught in a machine with you still attached" but also "what could they mess up if they fell out into a product." We don't accept watches, rings, earings, anything on the aero side of the business I work in. Don't underestimate the importance some companies will attach to health and safety - even if it means the job will take 3x longer and cost 8x more, they'll probably do it to avoid being sued.
Down in manufacturing and the shop floor where I work, tattoos are two a dozen. Come up to the design offices, and you'll be the odd one out. It's an industry with predominantly traditional values - there are companies out there who wont care, but for every one of those there will be 4 who do and may count it against you. You're not going to get "Piercings and Tattoos" as a reason on your rejection letter, but first impressions make a big deal in interviews and you can easily deflect the attention to your appearance rather than your ability which is what we're actually interested in. Interviews in my firm are generally done by senior management who represent the epitome of middle aged, conservative voting, whats-wrong-with-todays-youth type individuals. They're not going to discriminate because they can't by law, but that isn't going to stop them finding a legitimate reason not to consider you and weighting it heavily due to preconcieved ideas. Interview techniques and guides are all about presenting yourself in a way that doesn't draw out bias in the interviewers - and all too often in large companies, the person who interviews you will be nothing to do with the people you end up working for. No one said it was fair, it's just the real world.
So echo the above -go for it at uni, but ensure that you can revert to a professional appearance if you don't want to limit your options.
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Louisiana's most successful high school football coach is headed to the Hall of Fame.
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Really bad news today that our former goalkeeper Pavel Srnicek has suffered a heart attack while running in the Czech Republic and he is now fighting for his life in an induced coma and is said to be in critical condition.
Pavel was at Newcastle only last week to publicize his new autobiography – Pavel is a Geordie – so this has come as a real shock to one of the most popular players ever to play for Newcastle.
Pavel Srnicek while at Newcastle United
It looks like it's very serious and it seems that the 47 year-old collapsed while he was running in the town of Bohumin.
Srnicek was at Newcastle from 1991 until 1998.
Srnicek has also recently expressed an interest in coming back to Newcastle at some time in the future as a coach.
Our thoughts and prayers are with Pavel at this tragic time and we hope he can pull through.
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Our best wishes go to @PavelSrnicekUK, who has been taken to hospital today. Get well soon, Pav. #NUFC pic.twitter.com/g7SgNOX35U
— Newcastle United FC (@NUFC) December 21, 2015


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Did you know..
Did you know that you can get a 3d print out of your baby's ultrasound while they are in the womb so that you can get to hold them before they are even born.
3D babies: Expectant parents offered 3D-printed model of unborn child by American couple Gerard and Katie Bessette | Metro News
Expectant parents are being offered the chance to hold their baby before it is even born - with a 3D-printed replica of the foe…
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I think a lot of it was designed to discover any major problems with the baby before hand. But they said it would be a good way for first time parents who are nervous about having a baby. It gives them a chance to hold and look at their baby before its here to help them relax and get more comfortable handling the baby before the baby actually comes.
Ummmm interesting.. Hm.. definitely not for me.. but probably for some.
I had no idea! I think it's a little creepy though...lol. :)
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