Assessment of laminate technique using glass ionomer and resin composite for restoration of root filled teeth

Effect of polyhydroxy-terminated PAMAM dendrimer on dentin matrix metalloproteinases within the hybrid layers

BACKGROUND

Intrafibrillar remineralization within the hybrid layers (HLs) has recently attracted extensive attention in achieving durable resin-dentin bonds. The polyhydroxy-terminated poly(amidoamine) dendrimer (PAMAM-OH) at fourth generation becomes a desirable candidate to induce intrafibrillar remineralization to protect exposed collagen fibrils within HLs based on the size exclusion effect of fibrillar collagen. However, the remineralization process in vivo is time-consuming, during which the exposed collagen fibrils are vulnerable to enzymatic degradation, resulting in unsatisfactory remineralization. Thereby, if PAMAM-OH itself possesses concomitant anti-proteolytic activity during the induction of remineralization, it would be very beneficial to obtain satisfactory remineralization.

METHODS

Binding capacity tests using adsorption isotherm and confocal laser scanning microscopy (CLSM) were performed to assess if the PAMAM-OH had adsorption capacity on dentin. Anti-proteolytic testings were detected by MMPs assay kit, in-situ zymography and ICTP assay. Adhesive infiltration of resin-dentin interface and tensile bond strength before and after thermomechanical cycling were implemented to assess if the PAMAM-OH adversely affected resin-dentin bonds.

RESULTS

Anti-proteolytic testings performed using MMPs assay kit, in-situ zymography and ICTP assay indicated that PAMAM-OH inhibited exogenous soluble MMP-9 as well as had inhibitory effect on the endogenous proteases. Adhesive infiltration of resin-dentin interface and tensile bond strength before and after thermomechanical cycling were implemented to indicate that the PAMAM-OH pretreatment had no adverse effects on immediate dentin bonding and prolonged the durability of resin-dentin bonds.

CONCLUSIONS

PAMAM-OH possesses anti-proteolytic activity and prevents exposed collagen fibrils within HLs from degradation, which lays the foundation for the satisfactory intrafibrillar remineralization induced by PAMAM-OH within HLs to achieve durable resin-dentin bonds in the next work.

The durability of resin-dentine bonds are enhanced by epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica

Biomimetic nanohydroxyapatite (nHAp) has long been used as a biocompatible material for bone repair, bone regeneration, and bone reconstruction due to its low toxicity to local or systemic tissues. Various cross-linkers have been employed to maintain the structure of collagen; these include epigallocatechin-3-gallate (EGCG), which can fortify the mechanical properties of collagen and withstand the degradation of collagenase. We hypothesized that EGCG combined with nHAp may promote resin-dentin bonding durability. Here, we examined the effect of epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica (EGCG@nHAp@MSN) on thermal stability and remineralization capability of dentin collagen. Dentin slices (2 × 2 × 1 mm³ ) were obtained and completely demineralized in a 10% phosphoric acid water solution. The resulting dentin collagen matrix was incubated with deionized water, EGCG, nHAp@MSN, and EGCG@nHAp@MSN. The collagen thermal degradation temperature was assessed utilizing differential scanning calorimetry analysis, which indicated that EGCG, nHAp@MSN, and EGCG@nHAp@MSN reinforced collagen's capability to resist thermal degradation. EGCG@nHAp@MSN resulted in the highest increase in denaturation temperature. Thermogravimetric analysis showed that both nHAp@MSN and EGCG@nHAp@MSN achieved a higher residual mass than the EGCG and control groups. Fourier transform infrared spectroscopy was performed to examine the interaction between EGCG@nHAp@MSN and dentin collagen. The EGCG@nHAp@MSN sample exhibited stronger dentin microhardness and uppermost bond strength after thermocycling. EGCG significantly enhanced collagen's capability to resist thermal degradation. In summary, EGCG and nHAp@MSN may work together to assist the exposed collagen to improve resistance to thermal cycling and promote remineralization while also strengthening the durability of resin-dentin bonds.

Novel dual-functional implants via oxygen non-thermal plasma and quaternary ammonium to promote osteogenesis and combat infections

OBJECTIVE

Implant-related infections are a primary reason for implant failures that affect millions of patients. It is of paramount importance to develop novel implants that possess the dual functions of osteogenesis-promotion and antibacterial activity. The objectives of this study were to: (1) develop novel dual-functional titanium (Ti) implants by combining oxygen non-thermal plasma and covalent bonding of antibacterial organosilicon quaternary ammonium monomers; (2) investigate the physicochemical properties, bioactivity and antibacterial effects of the modified implants for the first time.

METHODS

Surface characteristics of the modified Ti surfaces were tested. Adherence and viability of rat bone marrow-derived stem cells (rBMSCs) on the surface were evaluated. Metabolic activity of biofilm on the surfaces were measured. The stability of the dual-function after 5000 thermal cycles was also evaluated.

RESULTS

The presence of chemical bonding between Ti and organosilicon monomers demonstrated covalent immobilization of the antibacterial agents. The water contact angle of the treated Ti surfaces decreased from 70.98 ± 3.68° to 59.86 ± 4.91°. The adhesion and proliferation of rBMSCs on the modified Ti were increased by 40%, compared to control group (P < 0.05). The metabolic level of biofilms on modified Ti were reduced by more than half, compared to control (P < 0.05). The modified Ti implants exhibited cell-promotion and antibacterial stability after thermal cycles.

SIGNIFICANCE

The new dual-functional Ti implant is promising to promote osteogenesis while simultaneously preventing infections. Furthermore, the novel surface modification and processing methods have applicability to enhancing a wide range of other implants to improve bioactivity and combat infections.

Base Materials' Influence on Fracture Resistance of Molars with MOD Cavities

The aim of this study was to compare fracture resistance of teeth presenting medium-sized mesial-occlusal-distal (MOD) cavities using different base materials. Thirty-six extracted molars were immersed for 48 h in saline solution (0.1% thymol at 4 °C) and divided into six groups. In group A, the molars were untouched, and in group B, cavities were prepared, but not filled. In group C, we used zinc polycarboxylate cement, in group D—conventional glass ionomer cement, in group E—resin modified glass ionomer cement, and in group F—flow composite. Fracture resistance was tested using a universal loading machine (Lloyd Instruments) with a maximum force of 5 kN and a crosshead speed of 1.0 mm/min; we used NEXYGEN Data Analysis Software and ANOVA Method (p < 0.05). The smallest load that determined the sample failure was 2780 N for Group A, 865 N for Group B, 1210 N for Group C, 1340 N for Group D, 1630 N for Group E and 1742 N for Group F. The highest loads were 3050 N (A), 1040 N (B), 1430 N (C), 1500 N (D), 1790 N (E), and 3320 N (F), the mean values being 2902 ± 114 N (A), 972 ± 65 N (B), 1339 ± 84 N (C), 1415 ± 67 N (D), 1712 ± 62 N (E), and 2334 ± 662 N (F). A p = 0.000195 shows a statistically significant difference between groups C, D, E and F. For medium sized mesial-occlusal-distal (MOD) cavities, the best base material regarding fracture resistance was flow composite, followed by glass ionomer modified with resin, conventional glass ionomer cement and zinc polycarboxylate cement. It can be concluded that light-cured base materials are a better option for the analyzed use case, one of the possible reasons being their compatibility with the final restoration material, also light-cured.

The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial

AIM

To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars.

METHODOLOGY

A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score ≥ 3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3-mm gutta-percha was removed and replaced with glass-ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2-mm-thick GIC base followed by final composite resin restoration; base group: received 2-mm-thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow-up was done at 3, 6, 9 and 12 months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal-Wallis, chi-square and Wilcoxon signed-rank tests and logistic regression analysis.

RESULTS

At the end of 12 months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow-up period (P > 0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing.

CONCLUSION

The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12 months. However, its influence in the long term requires further evaluation.

The inhibitory effect of carboxyl-terminated polyamidoamine dendrimers on dentine host-derived matrix metalloproteinases in vitro in an etch-and-rinse adhesive system

The biomimetic remineralization of collagen fibrils has increased interest in restoring the demineralized dentine generated by dental caries. Carboxyl-terminated polyamidoamine dendrimers (PAMAM-COOH), hyperbranched polymeric macromolecules, can act as non-collagenous proteins to induce biomimetic remineralization on a dentine organic matrix. However, in vivo remineralization is an extremely time-consuming process; before complete remineralization, demineralized dentine collagen fibrils are susceptible to degradation by host-derived matrix metalloproteinases (MMPs). Therefore, we examined the effect of fourth-generation PAMAM-COOH (G4-PAMAM-COOH) on the collagenolytic activities of endogenous MMPs, the interaction between G4-PAMAM-COOH and demineralized dentine collagen and the influence of G4-PAMAM-COOH pre-treatment on resin-dentine bonding. G4-PAMAN-COOH not only inhibited exogenous soluble rhMMP9 but also hampered the proteolytic activities of dentine collagen-bound MMPs. Cooperated with the results of G4-PAMAM-COOH absorption and desorption, FTIR spectroscopy provided evidence for the exclusive electrostatic interaction rather than hydrogen or covalent bonding between G4-PAMAM-COOH and dentine collagen. Furthermore, G4-PAMAM-COOH pre-treatment showed no damage to resin-dentine bonding because it did not significantly decrease the elastic modulus of the demineralized dentine, degree of conversion, penetration of the adhesive into the dentinal tubules or ultimate tensile strength. Thus, G4-PAMAM-COOH can effectively inactivate MMPs, retard the enzymolysis of collagen by MMPs and scarcely influence the application of resin-dentine bonding.

Fracture resistance, gap and void formation in root-filled mandibular molars restored with bulk-fill resin composites and glass-ionomer cement base

AIM

To evaluate fracture resistance and gap/void presence of root-filled mandibular molars restored with 2 bulk-fill and 1 conventional resin composites, with or without a glass-ionomer cement (GIC) base.

METHODS

Coronal access and mesio-occlusal (MO) cavities were prepared, then root canal treatment was performed on 30 mol/L. The teeth were randomly divided, according to the cavity volume, into 6 experimental groups (N = 5) and restored with conventional/light-cured (Ceram-X), bulk-fill/light-cured (SureFil SDR) or bulk-fill/dual-cured (Core-X Flow) with/without a 2-mm thick GIC base. Gaps and voids (%) were determined using microcomputed tomography. Intact teeth and unrestored teeth were used as negative and positive controls. Fracture load (N) was determined using a universal testing machine.

RESULTS

No significant difference in fracture resistance or gap/void formation was found among the 3 resin composites. GIC-base groups revealed significantly lower fracture strength than intact teeth, while fracture strengths of no GIC-base groups were not significantly different from intact teeth. GIC-base groups revealed significantly more gaps and voids in the area of the GIC than the resin composite.

CONCLUSION

Conventional and bulk-fill resin composites provided similar fracture resistance and gaps/voids in root-filled molars with MO cavities. Placing a GIC base decreased fracture resistance and increased gap/void formation.

The effect of vitality and dentin depth on resin tags length of resin-dentin interface in dogs' teeth

The aim of this study was to evaluate the effect of pulpal pressure and dentin depth on the quality of hybrid layer of bonded composite. Four healthy dogs, aged between 12 and 18 months, with intact dentitions were used for the experimental work. A total of 24 teeth were available for the study by using the six upper anterior teeth of each of the four dogs used in the study. The 24 teeth included in the study were divided according to presence or absence of pulpal pressure (P) into two groups with 12 teeth in each group. P₁ teeth with positive pulpal pressure and P₂ teeth with no pulpal pressure. Each of these two groups was further divided into two subgroups, according to the cavity depth (D) they received, where in D₁ a class V cavity with depth of 1 mm was performed, while in D₂ a class V cavity with depth of 2 mm was performed. The cavities were restored with micro hybrid composite restorative material and the samples were then left in the dogs’ mouth for 30 days. At the end of the experimental period, the dogs were euthanized by injecting an overdose of thiopental sodium. The anterior part of the upper jaw was sawed out of each dog’s mouth and the teeth were sectioned to evaluate the resin–dentin interface using Environmental Scanning Electronic Microscope. Results of the study showed that the mean resin tag length value was significantly affected by vitality and dentin depth. The presence of pulpal pressure together with depth of dentin could adversely affect the quality of hybridization.

In vitro fracture strength and patterns in root-filled teeth restored with different base materials

BACKGROUND

There is little research on the effects of an intermediate base on the fracture strength of root-filled teeth. This study compared the fracture strengths and patterns of root-filled teeth restored with intermediate bases of glass-ionomer cement (GIC), zinc polycarboxylate cement (ZPC), dual-cured resin composite (DCRC) and Biodentine^® under resin composite.

METHODS

Standardized cavities were prepared in 100 extracted human maxillary and mandibular premolars, and root canal treatment was performed. The teeth were stratified and randomly allocated to five groups (n = 20): (i) GIC; (ii) ZPC; (iii) DCRC; (iv) Biodentine; and (v) prepared but unrestored (control). The teeth were subjected to an oblique, ramped load until fracture. The fracture loads, level, mode and location were recorded.

RESULTS

Mean fracture strengths of all restored groups were not significantly different amongst the groups. There were significant overall effects on mean fracture strength for tooth type (P = 0.002) and buccolingual width of the crown (P = 0.001).

CONCLUSIONS

The four materials were appropriate intermediate bases. The laminate restorative technique promoted fracture strengths that are likely to withstand normal and maximum masticatory function. The base material can influence failure mode, which may have implications for the clinical presentation of fractures of root-filled teeth.

Restoration of the Root-Filled Tooth

Root-filled teeth are weakened by loss of strategic tooth structure through restorative procedures and caries, rather than by the endodontic procedures. Therefore, prompt restoration is required to minimise coronal leakage and the risk of tooth fracture. However, restorability should be confirmed before root canal treatment begins, by removing caries and existing restoration to evaluate the residual tooth structure. Based on the remaining tooth structure, the restoration is planned to maximise the longevity of root-filled teeth as a functional unit. This review considers risk factors for survival of root-filled teeth and principles of restoration, rather than detailed techniques, including direct and indirect restorations.

Shear Bond Strength of Two Types of Glass Ionomer to Bleached Dentin: Effect of Delayed Bonding and Antioxidant Agent

BACKGROUND

Studies have shown a reduction in bond strength of composites and glass ionomer to bleached enamel and dentin. Several methods have been proposed to reverse compromised bond strength.

OBJECTIVE

The aim of this study was to evaluate the effect of delayed bonding and application of antioxidant agent on the bond strength of reinforced self-cured (Fuji IX) and light-cured glass ionomers (Fuji II LC) to bleached dentin.

MATERIAL

Eighty extracted third molars were randomly divided into 8 groups. Buccal dentin surfaces received different treatments: Two control groups: no treatment + bonding Fuji IX or Fuji II LC. Two immediate bonding groups: bleaching + bonding Fuji IX or Fuji II LC. Two delayed bonding groups: bleaching + 7 days delay + bonding Fuji IX or Fuji II LC. Two sodium ascorbate application groups: Bleaching + application of 10% sodium ascorbate + bonding Fuji IX or Fuji II LC. All samples were tested for shear bond strength. Two-way analysis of variance (ANOVA) was used to compare the mean and standard deviations among groups, followed by the Tukey's test for significant interaction.

RESULTS

No statistically significant difference was detected in shear bond strength of Fuji IX to bleached or normal dentin. Although a significant reduction was found shear bond strength values of Fuji II LC to bleached dentin, no significant difference was observed between no bleaching group and those treated with 10% sodium ascorbate or 7 days of delay in bonding for both types of glass ionomer.

CONCLUSION

Bleaching had no significant effect on shear bond strength of Fuji IX to dentin; this type of GI can be used immediately after bleaching.

The Effect of Resin-modified Glass-ionomer Cement Base and Bulk-fill Resin Composite on Cuspal Deformation

Objectives: This study investigated cuspal deformation in teeth restored with different types of adhesive materials with and without a base.

Methods: Mesio-occluso-distal slot cavities of moderately large dimension were prepared on extracted maxillary premolars (n=24). Teeth were assigned to one of four groups and restored with either a sonic-activated bulk-fill resin composite (RC) (SonicFill), or a conventional nanohybrid RC (Herculite Ultra). The base materials used were a flowable nanofilled RC (Premise Flowable) and a high-viscosity resin-modified glass-ionomer cement (RMGIC) (Riva Light-Cure HV). Cuspal deflection was measured with two direct current differential transformers, each contacting a buccal and palatal cusp. Cuspal movements were recorded during and after restoration placement. Data for the buccal and palatal cusp deflections were combined to give the net cuspal deflection.

Results: Data varied widely. All teeth experienced net inward cuspal movement. No statistically significant differences in cuspal deflection were found among the four test groups.

Conclusions: The use of a flowable RC or an RMGIC in closed-laminate restorations produced the same degree of cuspal movement as restorations filled with only a conventional nanohybrid or bulk-fill RC.

Evaluation of marginal leakage of different temporary restorative materials in Endodontics

Aim:

The aim of this study is to assess the coronal marginal leakage of three temporary restorative materials used for root canal sealing after endodontic treatment.

Materials and Methods:

A total of 88 single-rooted teeth were submitted to biomechanical preparation and filled by lateral condensation technique. After obturation process, the teeth were randomly separated into four groups, being two teeth of each group used as positive and negative control. Temporary sealing was performed as follows: GI - Clip F (VOCO); GII - Bioplic (Biodinβmica); GIII - Vitremer (3M ESPE) and GIV - Ketak N100 (3M ESPE). Next, the specimens were immersed into Indian ink for 30 and 60- days, being 10 specimens for each time interval and then submitted to diaphanization to verify the amount of coronal leakage using a measuring microscope.

Results:

Leakage mean values within the 30-day period were as follows: Vitremer (0.3 mm), Ketak N100 and Clip F (0.6 mm) and Bioplic (1.7 mm). Within the 60-day period, leakage means were 1.1 mm, 1.5 mm, 2.2 mm and 2.6 mm, respectively.

Conclusions:

None of the materials was capable of preventing marginal leakage within the 30- and 60-day period. In both time intervals, Bioplic presented the highest mean of leakage and Vitremer the lowest.

Effect of antiasthmatic medication on the surface roughness and color stability of dental restorative materials

OBJECTIVE

This study evaluated the effect of antiasthmatic medication on the surface roughness and color stability of dental restorative materials.

MATERIALS AND METHODS

A total of 60 disc-shaped specimens were fabricated from glass ionomer (n = 20), composite resin (n = 20) and feldspathic porcelain (n = 20). Each material group was randomly divided into two subgroups (n = 10): (1) control group and (2) test group. Control groups of the specimens were kept in artificial saliva. Test groups were exposed to salbutamol sulfate (Ventolin Nebules) using an inhaler machine. Surface roughness measurements were done using a profilometry and color measurements were done with digital colorimetry at baseline and after inhalation and storing in artificial saliva. A two-way analysis of variance (ANOVA) and post-hoc Fisher's least significant difference test were used to compare the change in surface roughness and color. The confidence level was set at 95%.

RESULTS

Inhaler treatment significantly increased the surface roughness and color change of glass ionomer and composite resin materials (p < 0.05), while the surface roughness and color of feldspathic porcelain was not changed after inhaler treatment (p > 0.05).

CONCLUSION

The antiasthmatic inhaler medication (salbutamol sulfate) affected the surface roughness and color of composite resin and glass ionomer restorative materials.

Investigation of Biodentine as dentine replacement material

OBJECTIVE

Biodentine was compared to glass ionomer and resin modified cements in an "open sandwich" restoration.

METHODS

Fuji IX, Vitrebond and Biodentine were characterised using various techniques. The effect of etching with 35% phosphoric acid was investigated by assessment of surface topography, Fourier transform infrared (FT-IR) spectroscopy, surface micro-hardness and micro-leakage using tagged carboxylated-modified fluorescent microspheres and tracing the presence of these particles with a confocal microscope.

RESULTS

Acid etching resulted in erosion of the material surface with exposure of the glass particles in the glass ionomer-based materials. Biodentine exhibited a reduction in the chlorine peak and the calcium-silicon ratio. There was no difference in the micro-hardness in etched and un-etched materials. The FT-IR plots did not show any chemical changes caused by etching for all the materials investigated. Both Vitrebond and Fuji IX exhibited no leakage at the dentine to material interface while Biodentine exhibited leakage both when it was etched and also when the surface was left unprepared. The sandwich technique was effective and prevented micro-leakage with glass ionomer-based materials but micro-leakage occurred with Biodentine.

CONCLUSIONS

Biodentine demonstrated both structural and chemical changes when etched with 37% phosphoric acid. Biodentine exhibited a lower calcium to silicon ratio and a reduction in the chloride peak height when etched. When used as a dentine replacement material in the sandwich technique overlayed with composite, significant leakage occurred at the dentine to material interface. On the other hand materials based on glass ionomer cement were etched successfully and no chemical and physical changes or micro-leakage were detected when the materials were used as bases under composite restorations. The micro-hardness of all the materials was unaffected by etching.

Hertzian indentation testing of glass-ionomer restoratives: A reliable and clinically relevant testing approach

OBJECTIVES

To investigate the load to failure of encapsulated posterior glass-ionomer (GI) restoratives tested under Hertzian indentation and to explore the validity and reproducibility of the test results achieved for consideration of inclusion as an ISO testing protocol.

METHODS

Groups of 20 disc-shaped specimens (10.0±0.1mm diameter, 3.10±0.03mm thickness) were prepared (in batches of four) from three encapsulated posterior GI restoratives. Discs were tested while resting freely on a dentine analogue material at 24h under Hertzian indentation at a rate of 1mm/min delivered through a 20mm diameter hard steel ball. The failure mode and fracture origin of the GI specimens was assessed by fractography. Statistical analyses of the load to failure data were conducted using SPSS software (p<0.05) with the normality and homogeneity of variance of the load to failure data assessed using the Shapiro-Wilk and Levene's test, respectively. Data was also analysed using regression analyses to identify trends within the load to failure data sets.

RESULTS

The load to failure data for the GI restorative groups investigated were normally distributed (p>0.05), homogenous (p>0.05) and not significantly influenced by batch (p>0.780) or specimen number (p>0.447) although significant differences (p<0.05) between the GI restorative materials were evident. Fractographic analysis identified smooth fracture surfaces parallel to the loading axis where the failure mode was bottom initiated radial cracking. The mean coefficient of variation (CoV) for the GI restorative load to failure data sets achieved using Hertzian indentation testing was 7%.

SIGNIFICANCE

The failure mode and fracture origin of the GI restoratives tested using Hertzian indentation is representative of the clinical situation in vivo. The reliability of the load to failure data sets produced were improved compared with routinely employed mechanical testing approaches suggesting the possibility of inclusion as an ISO testing protocol.