Influence of resin-coating techniques on the marginal adaptation and the bond strengths of CAD/CAM-fabricated hybrid ceramic inlays

This study aimed to evaluate the effects of different resin-coating technique strategies and dual-cure resin luting materials on proximal marginal adaptation and the microtensile bond strengths (μTBSs) of CAD/CAM hybrid ceramic inlays. Extracted human molars were classified into four groups, depending on the coating technique: No coating (None), single coating (1-coating), double coating (2-coating), and flowable resin-coating (Combination). The inlays were bonded with one of the three materials: Panavia V5 (V5), Rely X Ultimate (RXU), and Calibra Ceram (CC). The differences with regard to adaptation were not significant. In the case of μTBS data for V5, no significant differences were observed, whereas for RXU, μTBS values for Combination statistically exceeded those for None and 1-coating. For CC, μTBS values for Combination statistically exceeded those for None, 1-coating, and 2-coating. The coating techniques did not influence the adaptation but influenced the bond strength, and Combination performed the best.

Proximal Caries Detection Using Short-Wave Infrared Transillumination at Wavelengths of 1050, 1200 and 1300 nm in Permanent Posterior Human Teeth

This in vitro study aimed to investigate the diagnostic potential of short-wave infrared transillumination (SWIRT) at 1050, 1200 and 1300 nm for the detection of proximal caries in molars and premolars. It was compared to the diagnostic performance of bitewing radiography (BWR) and micro-computed tomography (µCT) as the reference standard. 250 sound or decayed proximal surfaces of permanent posterior extracted teeth were examined using (1) SWIRT at 1050, 1200 and 1300 nm with two camera systems of different resolutions, (2) BWR and (3) µCT. Thresholds were defined for both test methods and the reference standard for caries in general, enamel caries and dentin caries. All images were assessed by two examiners twice, at an interval of two weeks. SWIRT at wavelengths of 1050, 1200 and 1300 nm achieved sensitivity values more than 2.5 times higher than BWR (enamel caries 3.2-4.4 times; dentin caries 3.25-4.25 times) for the detection of proximal caries. Sensitivity values of SWIRT improved with the higher wavelength. No significant difference was found in diagnostic quality between the two camera systems. SWIRT at 1300 nm imaged proximal enamel caries with the highest accuracy, while the physical optimum for transillumination in dentin was located at a lower wavelength (<1000 nm).

Simulating the shrinkage-induced interfacial damage around Class I composite resin restorations with damage mechanics

OBJECTIVES

To investigate the shrinkage-induced damage at the composite-tooth interface by finite element analysis (FEA) using the cohesive zone model (CZM).

METHODS

Axisymmetric models of Class I restorations were created to illustrate the interfacial damage around composite resin restorations of different dimensions, with polymerization shrinkage modeled analogously to thermal shrinkage. The damage to the adhesive interface was determined using a CZM based on the fracture strength and fracture energy. To show the effects of damage, conventional models with perfectly bonded composite resin restorations were created as controls.

RESULTS

The results indicated interfacial damage at the butt-joint cavosurface margin, dentinoenamel junction, and internal line angle. The percentage of damaged interfacial area was found to increase with decreasing diameter for restorations of the same height. For a given diameter, the damage was more severe for restorations of greater depth. The effects of the damage were further illustrated in the model with a restoration of 2-mm diameter and height. The interfacial damage occurred primarily at the internal line angle (83.3 % of all the damaged interfacial area), leading to local stress relief (from 18.3 MPa to 12.8 MPa), but also higher stress at the damage fronts. Greater local shrinkage was found in composites adjacent to the damage.

SIGNIFICANCE

The damage mechanics-based CZM is an essential refinement of the FEA to predict interfacial damage and its implications. The extent of damage was found to be greater around restorations with smaller diameters and greater depths. The entire simulation is available via an open-source platform to facilitate further applications in adhesive dentistry.

Tooth whitening with an experimental toothpaste containing hydroxyapatite nanoparticles

Background

The aim of this study was to evaluate the postbrushing tooth-whitening effect of toothpaste containing hydroxyapatite nanoparticles (nano-HAPs). The impact of the concentration on the whitening performance of nano-HAP toothpaste was also investigated.

Methods

Two concentrations of nano-HAP (10 wt% and 1 wt%) were incorporated in nonabrasive toothpastes. Forty bovine incisors were randomly assigned into four groups: 10 wt% nano-HAP, 1 wt% nano-HAP, toothpaste without nano-HAP as a negative control and water as a blank control. Each tooth was treated with the toothpaste three times and hydrodynamic shear force (HSF) once. The teeth surfaces were observed by SEM after each application. Tooth color (L*, a* and b* values) was measured by a spectrophotometer, and color changes (△E, △L, △a and △b values) were calculated. Two-way mixed ANOVA was performed to evaluate the influence of the concentration and repeated application on the tooth-whitening effect of nano-HAP.

Results

We found that nano-HAP-treated enamel exhibited higher L* values and lower a* and b* values than the control groups (P < 0.05). The 10 wt% nano-HAP group showed significantly higher △E values than the 1 wt% nano-HAP group (P < 0.05). After three applications, the △E mean value of the 10 wt% nano-HAP group was 4.47. The △E and △L values were slightly reduced after HSF (P < 0.05). For both nano-HAP groups, HAP single crystallites and agglomerates were identified, and their sizes grew with nano-HAP reapplication.

Conclusions

In conclusion, nano-HAP toothpaste has a satisfying postbrushing whitening effect and good resistance to mechanical forces. The whitening effect seemed to be concentration-dependent.

Attenuation of near-ultraviolet, visible and near-infrared light in sound and carious human enamel and dentin

Objectives

This in vitro study aimed to investigate the optical attenuation of light at 405, 660 and 780 nm sent through sound and carious human enamel and dentin, including respective individual caries zones, as well as microscopically sound-appearing tissue close to a carious lesion.

Materials and methods

Collimated light transmission through sections of 1000–125-µm thickness was measured and used to calculate the attenuation coefficient (AC). The data were statistically analysed with a MANOVA and Tukey’s HSD. Precise definition of measurement points enabled separate analysis within the microstructure of lesions: the outer and inner halves of enamel (D1, D2), the translucent zone (TZ) within dentin lesions and its adjacent layers, the enamel side of the translucent zone (ESTZ) and the pulpal side of the translucent zone (PSTZ).

Results

The TZ could be distinguished from its adjacent layers and from caries-free dentin at 125 µm. Sound-appearing dentin close to caries lesions significantly differed from caries-free dentin at 125 µm. While sound and carious enamel exhibited a significant difference (p < 0.05), this result was not found for D1 and D2 enamel lesions (p > 0.05). At 405 nm, no difference was found between sound and carious dentin (p > 0.05).

Conclusions

Light optical means enable the distinction between sound and carious tissue and to identify the microstructure of dentin caries partially as well as the presence of tertiary dentin formation. Information on sample thickness is indispensable when interpreting the AC.

Clinical relevance

Non-ionising light sources may be suitable to detect lesion progression and tertiary dentin.

Adhesion and whitening efficacy of P11-4 self-assembling peptide and HAP suspension after using NaOCl as a pre-treatment agent

Background

This study evaluated the adhesion and whitening efficacy of a mixture of hydroxyapatite and P11-4 self-assembling peptide (HAP-peptide) on bovine enamel after pre-treatment with low-concentrated sodium hypochlorite (NaOCl).

Methods

Fifty-two caries-free bovine incisors were selected. 50 teeth were randomly allocated to five groups (n = 10). The first group was treated with a mixture of 6.25 wt% HAP and 5 ml P11-4 peptide, using NaOCl 3% as pre-treatment. Second, third and fourth groups were treated with 6.25 wt% HAP, 5 ml P11-4 peptide, and NaOCl 3%, respectively. In the fifth group, only water was applied (control group). The color of samples was measured using a spectrophotometer (USB4000-VIS-NIR-ES, Ostfildern, Germany). To evaluate color changes, ΔE values were statistically analyzed. Finally, adherence of HAP particles on two enamel surfaces with and without pre-treatment with NaOCl was analyzed with SEM.

Results

It was observed that the ΔE of the HAP-peptide suspension after pre-treatment with NaOCl was significantly stronger than the control group. In contrast, the overall color changes of separate applications of HAP, peptide, and NaOCl did not differ notably from the control group. SEM observations confirmed that pre-treatment with NaOCl resulted in a more pronounced coverage of HAP on the enamel surface.

Conclusions

Pre-treatment with a low-concentrated NaOCl enhanced the adherence of the HAP layer on the enamel surface, resulting in a stronger whitening effect.

Trial registration

The peptide-HAP suspension is effective in improving tooth whiteness.

Biomimetic tooth-whitening effect of hydroxyapatite-containing mouthrinses after long-term simulated oral rinsing

PURPOSE

To investigate the tooth-whitening effects of mouthrinses containing different sizes of hydroxyapatite (HAP) particles after prolonged application time and compare them with a commercial whitening mouthrinse.

METHODS

50 bovine incisors were stained and randomly distributed into five groups: the HAP groups with 3 µm, 200 nm and 50 nm particle size, the commercial whitening mouthrinse group and the distilled water group. The teeth underwent prolonged mouthrinse applications that were equivalent to simulated 3- and 6-month mouthrinsing. Tooth color was measured and calculated before and after mouthrinsing. The group and application time effects were analyzed with a nonparametric analysis of longitudinal data using the nparLD package in R and ANOVA-type statistic was reported. Pairwise Wilcoxon rank-sum tests with BH correction were performed to compare the tooth color changes of individual groups. The mouthrinse-treated enamel was observed by SEM.

RESULTS

The whitening effect of HAP mouthrinses after the prolonged application time was confirmed. The HAP mouthrinses exhibited similar whitening effects to the commercial mouthrinses. The particle size and application time could significantly affect the whitening performance of HAP mouthrinses. The 50 nm HAP group exhibited significantly higher ΔE values than the 3 µm group after the 6-month-equivalent application (P= 0.024). A longer period of application increased significantly the ΔE and ΔL values (P< 0.05). The HAP-treated enamel surfaces were entirely covered with HAP after the 6-month-equivalent application.

CLINICAL SIGNIFICANCE

The HAP nanoparticles showed better tooth-whitening performance after a longer period of mouthrinsing than the microsized HAP particles. This should be taken into consideration by dental manufacturers for optimizing the particle size for their HAP-containing products. To achieve a better outcome in tooth-whitening, the patients should apply the mouthrinse regularly for an extended period of time.

Bulk-fill Composites Compared to a Nanohybrid Composite in Class-II Cavities - A Two-year Follow-Up Study

PURPOSE

To compare different concepts of direct composite restorations in class-II cavities using bulk-fill composites and a conventional composite with different layer thicknesses in a clinical study over a period of 2 years.

MATERIALS AND METHODS

A low-viscosity (SDR), a high-viscosity bulk-fill (Tetric EvoCeram Bulk Fill) and a conventional nanohybrid composite (Tetric EvoCeram) were randomly assigned and placed in different layer thicknesses up to 4 mm in 160 class-II cavities in 94 patients. Restorations were clinically examined at baseline (n = 160), after 12 (n = 150) and 24 months (n = 148) and evaluated according to eight selected FDI criteria. In case of complete loss of the restoration or irreversible pulpitic symptoms, the restoration was rated as failure; repair was considered as relative failure.

RESULTS

The materials investigated showed no significant differences regarding the FDI scores and failure rate during the entire follow-up. After 12 months, 7 failures and after 24 months a total of 8 failures were observed. After 2 years, Tetric EvoCeram Bulk Fill with a 4-mm layer thickness and SDR in combination with Tetric EvoCeram Bulk Fill with a 2-mm layer thickness exhibited a non-significant tendency towards increased hypersensitivity (FDI score 5) as compared to the reference material Tetric EvoCeram with a 2-mm layer thickness (p = 0.051; Kruskal-Wallis test).

CONCLUSION

The clinical stability of bulk-fill materials in layers up to 4 mm is comparable to nanohybrid composites after 2 years.

Near-infrared reflection at 780 nm for detection of early proximal caries in posterior permanent teeth in vitro

Objectives:

The aim of this in vitro study was to evaluate the diagnostic potential of near-infrared reflection at 780 nm (NIRR_780nm) for early proximal caries detection on the occlusal, buccal and oral surfaces of molars and premolars under simulated, clinically relevant conditions. The findings were validated by micro-computed tomography (µCT).

Methods:

Bitewing radiography (BWR) was used as a comparative diagnostic method. 250 sound or decayed permanent teeth were examined using NIRR_780nm and BWR. The NIRR_780nm findings were evaluated using yes/no decisions depending on the presence of caries lesions, as the enamel-dentin junction was not detectable in the majority of samples. All NIRR_780nm, BWR and µCT findings were obtained twice by two trained examiners. NIRR_780nm images were evaluated both occlusally alone and combined occlusally, lingually and buccally. All findings were presented in a cross-table. Sensitivity, specificity and area under the curve (AUC) values were calculated. Reliability assessment was performed using κ statistics.

Results:

Underestimation of caries was observed for NIRR_780nm in 26.0% of all surfaces and for BWR in 32.8% of all surfaces. Overestimation was 10.0% for NIRR_780nm and 0.4% for BWR. Trilateral NIRR_780nm assessment exhibited an overall accuracy of 67.2 %, an underestimation of 13.6% and an overestimation of 19.2%. Trilateral NIRR_780nm exhibited 63.0% sensitivity and 69.6% specificity, while BWR exhibited 26.7% sensitivity but 100% specificity for proximal caries detection.

Conclusion:

NIRR_780nm is not suitable for reliable detection of early proximal caries, even with the application of an ideal setup and optimized in vitro conditions.

Three-body wear of luting composites and influence of the ACTA wheel material

The aim of the study was to investigate the wear of luting materials (Variolink Esthetic LC/DC, Multilink Automix, Panavia V5 paste) compared to a resin composite (Tetric EvoFlow) with an ACTA-machine (three-body-wear simulator) using steel and 3D-printed polymer wheels. Wear was measured (software Match3D) and statistically analyzed (ANOVA). Worn surface was examined with a field-emission-scanning-electron-microscope. Finite element analysis was carried out to analyze differences in the mechanical stress of the two different sample wheels. Using the steel wheel, Variolink Esthetic DC exhibited significantly less wear than Tetric EvoFlow after 200,000 cycles (p=0.037). Luting composites on polymer wheels exhibited significantly lower wear values compared to the steel wheels (p<0.001). Finite element analysis showed higher stresses for the steel wheel compared to the polymer wheel. Mechanical properties of the sample wheels had a high influence on wear properties. Dual- or auto-polymerizing materials seem to have a small advantage over the light-curing materials.

Adhesion and whitening effects of P11-4 self-assembling peptide and HAP suspension on bovine enamel

OBJECTIVES

This study evaluated the adhesion and whitening effects of a combination of P11-4 self-assembling peptide and hydroxyapatite (peptide-HAP) on bovine enamel.

METHODS

Forty-six caries-free bovine teeth were selected, and 40 teeth were randomly allocated to one of five groups (n = 8). First, the effects of application frequency, exposure time, and storage in saliva on the whitening effects of an experimental low-concentrated peptide-HAP suspension (0.5 wt% HAP; Curodont, Credentis) were evaluated and compared with a commercial bleaching agent (VivaStyle Paint on Plus, VS, Ivoclar Vivadent). Tooth color was measured using a spectrophotometer (Gretag MacBeth), and color changes ΔE were statistically analyzed. Second, the effects of peptide-HAP concentration (low versus high: 6.25% HAP; Curodont Protect), and its interactions with saliva and postapplication restaining, were investigated. Third, enamel surfaces (n = 2) were treated with low concentration peptide-HAP and high-concentration peptide-HAP in polymeric and monomeric forms (Curodont Protect & Curodont Repair, Credentis) and analyzed by SEM.

RESULTS

The ΔE of the low-concentration peptide-HAP suspension did not differ from that of VS. Application frequency, exposure time, and storage in saliva did not have any significant impact on whitening efficacy of the peptide-HAP suspension. Increasing the concentration of the suspension did not promote overall ΔE. SEM observations confirmed the presence of the newly generated peptide and HAP on the enamel surface.

CONCLUSIONS

The peptide-HAP suspension is a mild tooth whitener, and the adhesion of peptide-HAP to enamel is concentration dependent.

CLINICAL RELEVANCE

This peptide-HAP suspension is effective in offsetting discoloration caused by restaining after treatment.

In vitro comparison of two types of digital X-ray sensors for proximal caries detection validated by micro-computed tomography

OBJECTIVES

We aimed to compare the diagnostic accuracy of two intraoral digital X-ray sensors-the charged-coupled device (CCD) and complementary metal-oxide-semiconductor (CMOS)-for proximal caries detection in permanent molar and premolar teeth. Micro-CT served as the reference standard.

METHODS

250 samples were mounted in three-dimensional (3D)-printed phantoms, and their proximal surfaces were evaluated by ICDAS criteria directly to create a balanced sample. Bitewing radiography was conducted using 3D-constructed X-ray phantoms with a CCD sensor at a 0.08 s and a CMOS sensor at 0.12 and 0.16 s exposure time. Two examiners determined the diagnostic decisions twice at appropriate intervals. Three diagnostic thresholds for sound surfaces and enamel and dentin caries were defined and presented in a cross-table. Sensitivity and specificity values and overall accuracy were calculated, and receiver operating curves were generated and compared. Reliability assessment was performed using linear weighted κ statistics.

RESULTS

The overall accuracies between the reference standard and different sensors and exposure times were 63.1% (CCD), 67.1% (CMOS sensor at 0.12 s) and 70.7% (CMOS sensor at 0.08 s). High specificity but low sensitivity values were found for all examination conditions at all thresholds. The area under the curve comparison values revealed no significant difference between sensor types and exposure times. Linear-weighted κ analysis revealed almost perfect agreement for all assessments.

CONCLUSION

No significant difference was found for diagnostic performance of proximal caries detection between the different sensors and exposure times. The increased exposure time did not lead to a significant diagnostic benefit.

Effects of flowable liners on the shrinkage vectors of bulk-fill composites

Objectives

This investigation evaluated the effect of flowable liners beneath a composite restoration applied via different methods on the pattern of shrinkage vectors.

Methods

Forty molars were divided into five groups (n = 8), and cylindrical cavities were prepared and bonded with a self-etch adhesive (AdheSe). Tetric EvoCeram Bulk Fill (TBF) was used as the filling material in all cavities. The flowable liners Tetric EvoFlow Bulk Fill (TEF) and SDR were used to line the cavity floor. In gp1-TBF, the flowable composite was not used. TEF was applied in a thin layer in gp2-fl/TEF + TBF and gp3-fl/TEF + TBFincremental. Two flowable composites with a layer thickness of 2 mm were compared in gp4-fl/TEF + TBF and gp5-fl/SDR + TBF. TEF and SDR were mixed with radiolucent glass beads, while air bubbles inherently present in TBF served as markers. Each material application was scanned twice by micro-computed tomography before and after light curing. Scans were subjected to image segmentation for calculation of the shrinkage vectors.

Results

The absence of a flowable liner resulted in the greatest shrinkage vectors. A thin flowable liner (gp2-fl/TEF + TBFbulk) resulted in larger overall shrinkage vectors for the whole restoration than a thick flowable liner (gp4-fl/TEF + TBF). A thin flowable liner and incremental application (gp3-fl/TEF + TBFincremental) yielded the smallest shrinkage vectors. SDR yielded slightly smaller shrinkage vectors for the whole restoration than that observed in gp4-fl/TEF + TBF.

Conclusions

Thick flowable liner layers had a more pronounced stress-relieving effect than thin layers regardless of the flowable liner type.

Clinical relevance

It is recommended to apply a flowable liner (thin or thick) beneath bulk-fill composites, preferably incrementally.

A detailed report on the measures taken in the Department of Conservative Dentistry and Periodontology in Munich at the beginning of the COVID-19 outbreak

Objectives

The corona disease (COVID-19) is developing into one of the greatest challenges for healthcare professionals around the world. In this article, we report the detailed actions taken in the Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany, during the early phase of the COVID-19 pandemic.

Material and methods

After a joint on-site inspection of the dental clinic with the Department of Clinical Microbiology and Hospital Hygiene, existing clinical and hygiene protocols were adapted for COVID-19 patients.

Results

A comprehensive summary of the preparation of the facilities as well as pre- treatment, treatment and posttreatment protocols are described and arising problems are being discussed.

Conclusions

The importance of rigorous hygiene and treatment protocols as well as a sufficient supply of PPE for dental offices and hospitals is highlighted. The measures reported may be subject to change due to the dynamics of the pandemic.

Clinical relevance

The modes of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (e.g., droplets, aerosols, and fomites) can pose a risk for dental healthcare professionals and patients alike. The presented measures may guide dental faculties and dental practices during the early stage of the COVID-19 crisis.

The influence of storage temperature on fracture behavior of cryopreserved teeth-An in vitro study

Objectives

Cryopreservation is discussed as a viable method of preserving teeth for determined autogenous tooth transplantation. Unchanged physical properties of hard tooth tissues are crucial for functional healing. Due to different thermal expansion coefficients of enamel and dentin or the crystallization process, the freezing process may lead to crack formation, which could adversely impact the long‐term prognosis of the teeth.

Material and methods

Twenty third molars (n = 20) were frozen slowly using a conservative cryopreservation protocol and stored at −80°C (group 1) and −196°C (group 2). After a storage time of 2 weeks, the samples were thawed to a temperature of +36°C and embedded in polymethyl methacrylate blocks. Cyclic loading was carried out using a spherical steel test specimen with 50,000 mechanical load cycles, followed by load to failure testing for determination of critical load.

Results

No significant difference in the first load drop could be detected during the load to failure test under different storage conditions. The values until fracture correlated very closely in contralateral tooth pairs, which emphasizes the importance of crown geometry in load to failure tests.

Conclusions

Conclusions: Cryopreservation, specifically the storage temperature, does not appear to have a significant effect on the physical properties of tooth transplants.

In-vitro validation of near-infrared reflection for proximal caries detection

The aim of this study was the in-vitro validation of VistaCam iX HD, which uses near-infrared reflection (NIRR), for proximal caries detection. It was compared with digital bitewing radiography (BWR), and micro-computed tomography (µCT) was used as the reference standard. One-hundred teeth with either sound (n = 54) or carious (n = 46) proximal surfaces were selected using visual-tactile criteria. Images of these surfaces were generated using BWR and NIRR. Evaluation was performed by two examiners, twice, at an interval of 2 weeks. All samples were scanned with a micro-computed tomograph. Thresholds were defined for sound surfaces, and for enamel and dentin lesions, for all methods. Both BWR and NIRR showed moderate sensitivity for the detection of any caries (0.50 for NIRR and 0.53 for BWR). For enamel lesions, sensitivity was lower (0.13 for NIRR and 0.31 for BWR). Specificity was high (≥0.94) in all categories for both methods. Inter-rater reliability ranged from 0.89 to 0.93 and intra-rater reliability from 0.80 to 0.89. Surface evaluation of images generated using NIRR was complicated by overexposed areas; approximately 25% of the images were not clearly interpretable. In conclusion, NIRR and BWR were found to be reproducible methods with comparable diagnostic accuracy. However, NIRR cannot be recommended as a complementary diagnostic method for assessing proximal caries in permanent molars because of problems with image quality and artefacts.

Three-body wear of 3D printed temporary materials

OBJECTIVE

The aim of this study was to investigate the three-body wear of different additively manufactured temporary materials, one temporary PMMA material for CAD/CAM milling and one resin-based composite for direct restorations as a control group by using an ACTA machine.

METHODS

Specimens (n=8) of the 3D printing materials 3Delta temp, NextDent C&B, Freeprint temp were additively manufactured by DLP 3D printer. Postprocessing was carried out according to the manufacturer's specifications. Telio CAD were cut out of blocks, Tetric EvoCeram was applied directly and light cured. Three-body wear was simulated with an ACTA machine. Data were statistically analysed (ANOVA, post hoc test: Tukey, p<0.05). The worn surfaces of the specimens were examined with a FE-SEM.

RESULTS

The average mean wear was 50±15μm for Tetric EvoCeram<62±4μm for 3Delta temp<236±31μm for Telio CAD<255±13μm for NextDent C&B<257±24μm for Freeprint temp. After 200,000 cycles, the wear and wear rates for Tetric EvoCeram and 3Delta temp were significantly lower than those for the other materials. SEM revealed that 3Delta temp has a higher filler proportion than the other 3D printing materials but less than Tetric EvoCeram.

SIGNIFICANCE

The filler content influences the wear behaviour of additively manufactured materials as well as dental restorative composite materials. While most 3D printing materials have a low inorganic filler load, which qualifies the materials for temporary use only, one 3D printing material has an optimized composition that would qualify the material for longer clinical service time if wear is considered as the outcome variable.

Effect of Thermo-mechanical Load Cycling on Microleakage in Class II Ormocer Restorations

Objectives: The objective of this in vitro study was to evaluate the marginal sealing ability of an ormocer in comparison with a hybrid composite when using thermocycling and load cycling procedures together in the study design.

Methods: Modified proximal Class II cavities were prepared on the mesial and distal surfaces of twenty-two human premolars. Each tooth was restored with Admira and contralaterally with TPH Spectrum. Half of all of the teeth were subjected to thermo-mechanical load cycling. After dye penetration, longitudinal sections in mesio-distal direction were prepared and examined under a stereomicroscope. Data were analyzed with Mann Whitney U test.

Results: The results showed that the thermo-mechanical load cycling caused a statistically significant increase in gingival microleakage when compared with the non-thermocycled and nonloaded restorations for both the materials Admira (P=0.006) and TPH Spectrum (P=0.023).

Conclusions: Simultaneous load cycling and thermocycling are decisive factors in the in vitro assessment of gingival microleakage, which still remains to be a clinical problem even with the ormocer system Admira. (Eur J Dent 2009;3:200-206)

Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: A randomized, controlled 6-month trial

Aim

The aim of the present randomized, controlled trial was to compare the impact of the regular use of a fluoride‐free microcrystalline hydroxyapatite (HAP) dentifrice and a 1400 ppm fluoride control dentifrice on caries progression in 150 highly caries‐active orthodontic patients.

Methods

The primary outcome was the occurrence of lesions with International Caries Detection and Assessment System (ICDAS) ≥code 1 on the vestibular surfaces of teeth 15‐25 within 168 days after fixation of orthodontic brackets. Secondary outcomes were lesion development ICDAS ≥code 2, the plaque index, and the gingival index.

Results

In total, 147 patients were included in the intent‐to‐treat (ITT) analysis; 133 finished the study per protocol (PP). An increase in enamel caries ICDAS ≥code 1 was observed in 56.8% (ITT) and 54.7% (PP) of the HAP group participants compared with 60.9% (ITT) and 61.6% (PP) of the fluoride control group. Non‐inferiority testing (ITT and PP) demonstrated the absence of a significant difference between the groups. No significant differences in secondary outcomes were observed between the groups.

Conclusion

In highly caries‐active patients, the impact of the regular use of a microcrystalline HAP dentifrice on caries progression is not significantly different from the use of a 1400 ppm fluoride toothpaste (ClinicalTrials.gov: NCT02705456).

Effects of boundary condition on shrinkage vectors of a flowable composite in experimental cavity models made of dental substrates

OBJECTIVES

Bond strength to enamel and dentin depends on the bonding approach or condition. This study investigated the effects of the boundary conditions, in terms of the bonding substrate and the bonding condition, on the shrinkage vectors of a flowable composite.

MATERIALS AND METHODS

An experimental cylindrical cavity (diameter = 6 mm, depth = 3 mm) consisting of the enamel floor and the surrounding dentin cavity walls was prepared for the "enamel-floor" group. Cylindrical cavities of the same dimensions were prepared with access from the occlusal enamel into dentin and served as controls. Each cavity model group was divided and bonded with two bonding conditions (n = 9): a self-etch (Adper Easy Bond, 3M ESPE) and a total-etch approach (OptiBond FL, Kerr). The composite (Tetric EvoFlow, Ivoclar Vivadent) was mixed with glass beads, applied to the cavity, scanned twice by micro-CT (uncured and cured states). The scans were evaluated by rigid registration, sphere segmentation, and registration for computing shrinkage vectors.

RESULTS

The free surface of all restorations moved downward. The shrinkage vectors in the experimental cavity model pointed downward towards the enamel cavity floor, and the net axial movement was downward. In the control group, shrinkage vectors additionally moved upward, away from the cavity floor. The effect of the bonding substrate and the bonding condition was investigated for the shrinkage vectors and the axial movement (univariate ANOVA).

CONCLUSION

The bonding substrate, enamel, influenced the shrinkage vectors' direction, while the bonding condition caused only variations in the magnitude.

CLINICAL RELEVANCE

Bonding to enamel influences shrinkage vectors' direction, while the bonding condition plays only a minor role. Graphical abstract ᅟ.

Hydroxyapatite and Self-Assembling Peptide Matrix for Non-Oxidizing Tooth Whitening

OBJECTIVES

The aim of this combined in vitro and in vivo study was to evaluate the efficacy of tooth whitening using a mixture of Self- Assembling Peptide Matrix (SAPM) and hydroxyapatite (HA).

METHODS

The mixture was applied on stained bovine teeth, and the tooth color was measured using a spectrophotometer; mean changes in L*a*b values between measurements were expressed as DE. Additionally, the nature of the surface layer was investigated by ATRFTIR and EDX. The optical changes due to the additional surface layer were measured using a goniometer. Finally, a proof-of-concept clinical study was performed investigating the mixture of SAPM+HA.

RESULTS

The results verified that the SAPM remained on the tooth surface and acted as a temporary adhesive to attach the HA particles to the tooth surface. Further, the optical changes due to the additional surface layer indicated a diffuse reflection to be the origin of the optical whitening. Lastly, the mixture of SAPM+HA showed significant and visible whitening after one application, increasing throughout the first week of home application (DE = 4.9 ± 3.3) and remaining stable for 30 days (DE = 4.8 ± 3.6).

CONCLUSIONS

The combination of SAPM+HA particles caused optical whitening based on diffuse reflection by the HA particles on the tooth surface. The whitening effect and its magnitude observed in vitro were also seen in vivo.

Degradation Potential of Bulk Versus Incrementally Applied and Indirect Composites: Color, Microhardness, and Surface Deterioration

This study investigated the color stability and microhardness of five composites exposed to four beverages with different pH values. Composite discs were produced (n=10); Filtek Z250 (3M ESPE) and Filtek P90 (3M ESPE) were applied in two layers (2 mm, 20 seconds), and Tetric N-Ceram Bulk Fill (TetricBF, Ivoclar Vivadent) and SonicFill (Kerr) were applied in bulk (4 mm) and then light cured (40 seconds, Ortholux-LED, 1600 mW/cm²). Indirect composite Sinfony (3M ESPE) was applied in two layers (2 mm) and cured (Visio system, 3M ESPE). The specimens were polished and tested for color stability; ΔE was calculated using spectrophotometer readings. Vickers microhardness (50 g, dwell time=45 seconds) was assessed on the top and bottom surfaces at baseline, 40 days of storage, subsequent repolishing, and 60 days of immersion in distilled water (pH=7.0), Coca-Cola (pH=2.3), orange juice (pH=3.75), or anise (pH=8.5) using scanning electron microscopy (SEM). The materials had similar ΔE values (40 days, p>0.05), but TetricBF had a significantly greater ΔE than P90 or SF (40 days). The ΔE was less for P90 and TetricBF than for Z250, SonicFill, and Sinfony (60 days). Repolishing and further immersion significantly affected the ΔE (p<0.05) except for P90. All composites had significantly different top vs bottom baseline microhardnesses. This was insignificant for the Z250/water, P90/orange juice (40 days), and Sinfony groups (40 and 60 days). Immersion produced variable time-dependent deterioration of microhardness in all groups. Multivariate repeated measures analysis of variance with post hoc Bonferroni tests were used to compare the results. ΔE and microhardness changes were significantly inversely correlated at 40 days, but this relationship was insignificant at 60 days (Pearson test). SEM showed degradation (40 days) that worsened (60 days). Bulk-fill composites differ regarding color-stability and top-to-bottom microhardness changes compared with those of other composites. P90 showed better surface degradation resistance. In conclusion, bulk-fill composites are not promising alternatives to incremental and indirect composites regarding biodegradation.

Transillumination and HDR Imaging for Proximal Caries Detection

The purpose of this study was to develop an in vitro model for the validation of near-infrared transillumination (NIRT) for proximal caries detection, to enhance NIRT with high-dynamic-range imaging (HDRI), and to compare both methods, using micro-computed tomography (µCT) as a reference standard. Both proximal surfaces of 53 healthy or decayed permanent human teeth were examined using the Diagnocam (DC) (KaVo) and NIRT with HDRI (NIRT-HDRI). NIRT was combined with HDRI to improve the diagnostic performance by reducing under- and overexposed image areas. For NIRT-HDRI, an exposure series was captured and merged into a single HDR image. A classification was applied according to lesion depth. All surfaces were assessed twice by 2 trained examiners, and additionally with µCT for validation. The Kappa statistic was used to calculate inter-rater reliability and agreement between DC and NIRT-HDRI. Inter-rater reliability (weighted Kappa, wκ) showed very good agreement for the DC (0.90) and NIRT-HDRI (0.96). The overall agreement (wκ) was almost perfect (0.85). In the individual categories (0 to 4), the agreement (simple Kappa) ranged from almost perfect (category 4) to moderate (1 and 2) to substantial (categories 0 and 3). Sensitivity and specificity of sound surfaces, enamel, and dentin caries ranged from 0.57 to 0.99 and were similar for both methods in the different categories. NIRT-HDRI had a higher sensitivity for sound surfaces and enamel caries, as well as a higher specificity for dentin caries. Regarding the obtained images, HDRI allowed for the detection of caries within a greater range of luminance levels, resulting in a more detailed visualization of structures without under- or overexposure. However, HDRI this did not improve the diagnostics significantly. Distinguishing between a processed demineralized enamel and dentin lesions appears to be a problem specific to NIRT and cannot be balanced using HDRI.

Shrinkage vectors of a flowable composite in artificial cavity models with different boundary conditions: Ceramic and Teflon

Polymerization shrinkage of dental resin composites leads to stress build-up at the tooth-restoration interface that predisposes the restoration to debonding. In contrast to the heterogeneity of enamel and dentin, this study investigated the effect of boundary conditions in artificial cavity models such as ceramic and Teflon. Ceramic serves as a homogenous substrate that provides optimal bonding conditions, which we presented in the form of etched and silanized ceramic in addition to an etched, silanized and bonded ceramic cavity. In contrast, the Teflon cavity presented a non-adhesive boundary condition that provided an exaggerated condition of poor bonding as in the case of contamination during the application procedure or a poor bonding substrate such as sclerotic or deep dentin. The greatest 3D shrinkage vectors and movement in the axial direction were observed in the ceramic cavity with the bonding agent followed by the silanized ceramic cavity, and smallest shrinkage vectors and axial movements were observed in the Teflon cavity. The shrinkage vectors in the ceramic cavities exhibited downward movement toward the cavity bottom with great downward shrinkage of the free surface. The shrinkage vectors in the Teflon cavity pointed towards the center of the restoration with lateral movement greater at one side denoting the site of first detachment from the cavity walls. These results proved that the boundary conditions, in terms of bonding substrates, significantly influenced the shrinkage direction.

Surface properties and color stability of incrementally-filled and bulk-fill composites after in vitro toothbrushing

PURPOSE

To evaluate the effect of simulated toothbrush abrasion on the surface gloss, the surface roughness and the color stability of incrementally-filled and bulk-fill composites.

METHODS

48 dimensionally standardized composite specimens (n= 8/group) were made from four incrementally-filled composites (Tetric EvoCeram, IPS Empress Direct Enamel, Ceram X mono and Arabesk) and two bulk-fill composites (Quix fil and Tetric EvoCeram Bulk). Before and after toothbrushing simulation the surface gloss was measured by a glossmeter, the surface roughness was evaluated with a profilometer, and the color was measured using a spectrophotometer.

RESULTS

Before and after the toothbrush abrasion, IPS Empress Direct Enamel yielded the highest gloss value, while Ceram X mono exhibited the lowest gloss value. Quix fil showed the highest Ra value before the toothbrushing simulation, however, it showed similar Ra value with Ceram X mono and Arabesk after the toothbrushing simulation. IPS Empress Direct Enamel showed the lowest ΔE after the simulated toothbrushing. Tetric EvoCeram Bulk showed similar gloss value, Ra value, and ΔE to Tetric EvoCeram after the toothbrushing simulation. Simple regression analysis showed no correlation between the roughness and the gloss, but it showed a positive linear relationship between ΔE and ΔRa. (R2= 0.863, P= 0.027).

CLINICAL SIGNIFICANCE

The evaluated bulk-fill composites did not exhibit significantly worse surface properties and color stability than incrementally-filled materials after toothbrush abrasion. Color changes of composites caused by toothbrush abrasion were acceptable on the premise that 3.3ΔE units were considered as acceptable threshold values.

Polishing mechanism of light-initiated dental composite: Geometric optics approach

BACKGROUND/PURPOSE

For light-initiated dental hybrid composites, reinforcing particles are much stiffer than the matrix, which makes the surface rugged after inadequate polish and favors bacterial adhesion and biofilm redevelopment. The aim of the study was to investigate the polishing mechanism via the geometric optics approach.

METHODS

We defined the polishing abilities of six instruments using the obtained gloss values through the geometric optics approach (micro-Tri-gloss with 20°, 60°, and 85° measurement angles). The surface texture was validated using a field emission scanning electron microscope (FE-SEM). Based on the gloss values, we sorted polishing tools into three abrasive levels, and proposed polishing sequences to test the hypothesis that similar abrasive levels would leave equivalent gloss levels on dental composites.

RESULTS

The three proposed, tested polishing sequences included: S1, Sof-Lex XT coarse disc, Sof-Lex XT fine disc, and OccluBrush; S2, Sof-Lex XT coarse disc, Prisma Gloss polishing paste, and OccluBrush; and S3, Sof-Lex XT coarse disc, Enhance finishing cups, and OccluBrush. S1 demonstrated significantly higher surface gloss than the other procedures (p < 0.05). The surface textures (FE-SEM micrographs) correlated well with the obtained gloss values.

CONCLUSION

Nominally similar abrasive abilities did not result in equivalent polish levels, indicating that the polishing tools must be evaluated and cannot be judged based on their compositions or abrasive sizes. The geometric optic approach is an efficient and nondestructive method to characterize the polished surface of dental composites.

Shear bond strength of two adhesives to bovine dentin contaminated with various astringents

PURPOSE

To investigate the in vitro shear bond strength of two adhesives to bovine dentin contaminated with various astringents.

METHODS

120 adult bovine incisors were collected and cut to obtain 240 specimens. The specimens were randomly divided into a self-etch adhesive group (N = 120) and a total-etch adhesive group (N = 120). Both of the groups were divided into the following six subgroups: the non-contamination group and the contamination groups 25% Al2(SO4)3 (Orbat sensitive), 25% AlCl3 (Racestyptine), 10% AlCl3 (Roeko Gingiva Liquid), 15.5% Fe2(SO4)3 (Astringedent) and AlCl3 Paste (Astringent Retraction Paste, N = 20 in each subgroup). Each astringent was applied for 1 minute to the dentin surface before rinsing with water spray for 20 seconds. The respective adhesive was then applied according to the manufacturer's instructions. Two composite cylinders were shaped with a mold, cured on the dentin surface of each specimen and sheared off after 1 day and 1 week storage. The shear bond strengths (MPa) were recorded and analyzed with ANOVA. Results: In the self-etching adhesive group, all astringents showed negative effects on dentin bonding (P < 0.05). Astringent contamination did not have a negative effect on dentin bonding in the total-etch adhesive group (P > 0.05).

Surface properties of universal and flowable nanohybrid composites after simulated tooth brushing

PURPOSE

To evaluate gloss and surface roughness (Ra-value) of four universal nanohybrid composites and four flowable nanohybrid composites before and after toothbrush abrasion.

METHODS

64 dimensionally standardized specimens (n= 8/group) were prepared from four universal nanohybrid composites (i.e. Filtek Supreme XTE Universal, Grandio, Tetric EvoCeram, Venus Diamond) and four flowable nanohybrid composites (i.e. Filtek Supreme XTE Flow, Grandio Flow, Tetric EvoFlow, Venus Diamond Flow). All of the specimens were polished with up to 4000-grit silicon carbide papers. Gloss was measured with a glossmeter and Ra-value was measured with a contact profilometer before and after powered toothbrush abrasion with 70 RDA toothpaste slurry at 12,000 strokes while applying a vertical force of 100 g.

RESULTS

The median gloss values ranged from 80.6 to 93.6 GU before toothbrush abrasion and from 32.8 to 80.0 GU after toothbrush abrasion. The median Ra-value ranged from 0.065 to 0.088 microm before toothbrush abrasion and from 0.076 to 0.277 mirom after toothbrush abrasion. After toothbrush abrasion, Tetric EvoCeram yielded the lowest median gloss value and the highest Ra-value among all eight composites. Filtek Supreme XTE Flowable yielded the highest median gloss value before and after toothbrush abrasion and the lowest Ra-value after toothbrush abrasion. Spearman's rank correlation test revealed that there was negative correlation between the gloss and Ra-value including both before and after toothbrush abrasion (r = -0.681, P < 0.001).

MicroCT-based comparison between fluorescence-aided caries excavation and conventional excavation

PURPOSE

To evaluate and compare the use of micro-computed tomography (microCT) to investigate the mineral concentration of the treated dentin surface after caries removal with fluorescence-aided caries excavation (FACE) and conventional excavation.

METHODS

20 extracted human teeth with dentin caries were bisected through the lesion center into two halves which were distributed to a FACE and a conventional excavation group. Tungsten-carbide round burs were used for both groups. Each specimen was investigated with microCT after excavation. The obtained images of all the specimens were evaluated using Image J. Based on the grey values, the linear attenuation coefficients were calculated. Four resin-embedded solid hydroxyapatite phantoms with the gradually increased mineral concentration were used to obtain a calibration curve and equation. Finally, the mineral concentration values of the superficial dentin of each specimen after removal and sound dentin were calculated. The data were compared with the Student's t-test.

RESULTS

The statistical results showed that the linear attenuation coefficient (LAC) of the treated surface was significantly lower (P < 0.0001) in the FACE group with a mean value of 2.13 +/- 0.33 cm9-1). The value of the conventional excavation group was 2.98 +/- 0.19 cm(-1). The LAC of sound dentin was 3.89 +/- 0.10 cm(-1). By using the calibration equation, the calculated mineral concentration of the superficial dentin after caries removal were 0.68 +/- 0.14 g/cm3 in the FACE group and 1.05 +/- 0.08 g/cm3 in the conventional excavation group. The mineral concentration of sound dentin was 1.44 +/- 0.04 g/cm3. The mineral concentration of the superficial dentin after caries removal in the FACE group was about 47% of that of sound dentin, while the value in the conventional excavation group was approximately 73% of that of sound dentin. Under the conditions of this in vitro study, the results of the microCT evaluation may imply that FACE was more conservative than conventional excavation.

Efficacy of tooth whitening with different calcium phosphate-based formulations

The aim of this in-vitro study was to evaluate the efficacy of tooth whitening using different calcium phosphate-based formulations. Teeth were treated with three different hydroxyapatite preparations at different concentrations and with two control preparations; each tooth was treated a total of three times. After application of the last material, hydrodynamic shear force was applied to mimic mechanical loading. After each treatment, tooth color was measured using a dental spectrophotometer, and the mean changes in L*a*b* values between different measurements were expressed as ∆E. The results indicated significant differences between the materials, but neither dose- nor time-dependent associations were found. The suspension containing tricalcium phosphate (10 wt%) showed the most obvious color change (∆E = 2.20 ± 0.90), while the suspension containing zinc-carbonate-apatite (20 wt%) showed the least obvious color change (∆E = 0.91 ± 0.50). Calcium phosphate-based formulations that can adhere to the enamel surface and contribute to tooth whitening have promising tooth-whitening potential.

Surface characterization of current composites after toothbrush abrasion

The present study was designed to evaluate the surface roughness and the gloss of current composites before and after toothbrush abrasion. We assessed forty dimensionally standardized composite specimens (n=8/group) from five composites: two nanohybrids (i. e., IPS Empress Direct Enamel and IPS Empress Direct Dentin), two microhybrids (i. e., Clearfil AP-X and Filtek Z250) and one organically modified ceramics (Admira). All of the specimens were polished with 4000-grid silicon carbide papers. Surface roughness was measured with a profilometer and gloss was measured with a glossmeter before and after powered toothbrush abrasion with a 1:1 slurry (dentifrice/tap water) at 12,000 strokes in a toothbrush simulator. There was a significant increase in the surface roughness and a reduction in gloss after toothbrush abrasion in all of the composites except Clearfil AP-X (p<0.05). Simple regression analysis showed that there was not an association between the surface roughness and the gloss (R(2)=0.191, p<0.001).

The prevalence of tooth hypersensitivity following periodontal therapy with special reference to root scaling. A systematic review of the literature

PURPOSE

To provide a current status of the art, answering the question whether a certain procedure of periodontal treatment is more reliable than another and where innovative developments could improve on the incidence of hypersensitivity by a systematic literature review.

METHODS

Pubmed, Embase and Cochrane library were considered for the study. 2,656 articles of the PubMed search were found, from the beginning of 1945 until April 2011. 99 articles from PubMed were evaluated for this review. From Embase, 60 articles were selected and one was included in this review. From the Cochrane library, 182 were found, of which two contributed to the review. Included were all studies dealing with periodontal treatment followed by hypersensitivity and all studies dealing with the loss of attachment, followed by hypersensitivity. Excluded were any treatments of tooth hypersensitivity with pathogenesis not related to dentin exposure, genetically caused disorders, and fractures. Ultimately, 102 papers were evaluated, included and referred to in the review.

RESULTS

The term "tooth hypersensitivity" is most often used. Common causes of loss of hard substance are listed and updated. Mechanical loss of hard tissue formed one group of etiological factors; gingival recession and loss of attachment another. Surgical interventions, scaling and root planing were considered and in most cases performed as combined procedures. The different methods were evaluated and critically discussed. There were no properly randomized studies in the literature. The weak point of all epidemiological studies is the lack of any objective measurement. With respect to periodontal therapy, further research and developmental work on medical devices is needed, as well as ongoing applied research with laser technologies, continuing education and training programs for professionals.

Irregularities below the enamel-dentin junction may predispose for fissure caries

This study investigated the structure of the fissure fundus on occlusal surfaces with respect to the detection of possible irregularities below the enamel-dentin junction (EDJ). Occlusal surfaces were examined by micro-computed tomography (µCT). In total, 203 third molars with clinically sound occlusal fissures or non-cavitated lesions were selected. All specimens were scanned with µCT. Subsequently, each tooth was sectioned, and each slice was investigated by stereomicroscopy. In 7 of 203 molars (3.4%), demarcated radiolucencies below the EDJ were detected by µCT. These defects were obviously of non-carious origin, because the µCT images revealed no gradient of demineralization in the dentin. In all cases, a direct pathway between the oral cavity and the dentin was evident. The comparison of the µCT sites with conventional histological images also revealed defects in the dentin. These results demonstrate that demarcated radiolucencies below the EDJ may not necessarily be caries lesions according to µCT images and may be classified as possible developmental irregularities. To avoid misinterpreting µCT data, dental researchers should carefully consider this condition when analyzing µCT images. The clinical significance of this finding is that these defects may predispose molar teeth to early-onset caries in occlusal pits and fissures.

Contemporary adhesives: marginal adaptation and microtensile bond strength of class II composite restorations

PURPOSE

To evaluate the marginal adaptation (in terms of % continuous margin) and microtensile bond strength (microTBS) of the enamel and dentin of direct class II composite restorations.

METHODS

32 standardized class II cavities were prepared with the gingival margin of one box occlusal to the cementum-enamel junction (CEJ) and one gingival floor extended beyond the CEJ. The teeth (n= 8) were restored using one of four adhesive systems [Adper Scotchbond Multi Purpose (SMPP), Adper Scotchbond 1 XT (S1XT), Clearfil SE Bond (CSEB), or Clearfil Tri-S Bond (CTSB)] with incrementally placed composite restorations before being stored in water (24 hours), thermocycled (2,000 cycles, 5 to 55 degrees C) and mechanically loaded (50,000 cycles, 50 N). Marginal adaptation was evaluated by SEM. Additionally, the teeth were sectioned and trimmed to obtain specimens for microTBS testing.

RESULTS

All adhesive systems exhibited "continuous margins" in enamel over 95.4%, whereas "continuous margins" in dentin ranged from 60.2 to 84.8%. CSEB and CTSB yielded significantly more "continuous margins" between the adhesive restoration and dentin than SMPP or S1XT (P< 0.05). The mean microTBSs (MPa) for enamel were 40.5 (SMPP), 37.3 (S1XT), 30.8 (CSEB) and 23.2 (CTSB), and for dentin, they were 37.7 (SMPP), 33.0 (S1XT), 37.3 (CSEB) and 29.0 (CTSB).

Repair of silorane-based dental composites: influence of surface treatments

OBJECTIVE

The purpose of our study was to evaluate the effects of surface treatment on the microtensile bond strength (MTBS) of repaired silorane-based composites (Filtek Silorane (Silorane), 3M ESPE).

METHODS

The surfaces of the aged Silorane blocks (6 mm × 6 mm × 5 mm) were ground with 320-grit SiC paper. The subsequent surface treatments were: no treatment, bonding agent, acetone, acetone+bonding agent, ethanol, ethanol+bonding agent, silane and silane+bonding agent. Another group made from Silorane without repair served as positive control. New Silorane was bonded onto the treated samples. The MTBS test was performed (1mm/min) with beam-shaped sticks (1.0 mm × 1.0 mm × 10 mm) before and after fatigue simulation (FS). The Weibull moduli for the MTBS data were also calculated. The fracture modes were examined with an optical microscope. The aged specimens after grinding were observed in a SEM and the percentage of uncovered filler surface in relation to the whole surface was calculated.

RESULTS

There were no significant differences between the no treatment group and the acetone only or ethanol only groups. Bonding agent improved the MTBS and the Weibull modulus. Although the SEM image revealed only 5.1% of uncovered filler surface, silane improved the MTBS. The groups with silane and bonding agent had the highest strength values except two groups and showed a fairly large number of cohesive failures. However, after FS, the differences between almost all groups were insignificant. FS increased the MTBS of almost all groups.

SIGNIFICANCE

The application of silane and bonding agent enhanced the initial repair strength.

In vitro assessment of human dentin wear resulting from toothbrushing

It is well-recognized that toothbrushing is the most widely used method for daily oral hygiene maintenance. This in vitro study examines dentin surface wear resulting from the use of an oral hygiene device in a controlled oral condition. Powered toothbrushes produce less wear than manual brushes. However, depending on their design and applied forces, they can also produce varying levels of dentin wear.

Polymerization composite shrinkage evaluation with 3D deformation analysis from microCT images

OBJECTIVES

The aim of this study was to develop a method to experimentally determine and visualize the direction and amount of polymerization shrinkage.

METHODS

We modified a composite to include 1.5 wt% traceable glass beads. A cylindrical cavity (6mm diameter, 3mm height) was restored with this traceable composite, with and without dentin adhesive, and digitized with high-resolution micro-computed tomography (microCT). Image segmentation was performed to extract the glass beads from the acquired 3D microCT images (uncured and cured). Afterwards, each glass bead was subjected to local rigid registration. The resulting displacement vectors were used to examine and calculate the changes.

RESULTS

In unbonded restorations, the displacement vectors were oriented inwards to the center of mass, although not perfectly. Bonded restorations exhibited two contraction patterns: either toward one side of the cavity or toward the top-surface of the restoration. The displacement vector length values (mean/SD) for the bonded group (46.8 microm/10.0 microm) was significantly higher (p<0.01) than unbonded group (31.3 microm/8.5 microm), and the histogram curve was flatter (skew/kurtosis: 0.10/-0.56) as compared to the unbonded group (skew/kurtosis: 0.03/-0.26).

SIGNIFICANCE

The proposed method can visualize real 3D displacement vectors generated by polymerization shrinkage. The bonding quality and cavity geometry are critical for the direction of polymerization contraction. This method has the potential to validate current models concerning the amount and orientation of shrinkage vectors.

Effect of Thermo-mechanical Load Cycling on Microleakage in Class II Ormocer Restorations

OBJECTIVES

The objective of this in vitro study was to evaluate the marginal sealing ability of an ormocer in comparison with a hybrid composite when using thermocycling and load cycling procedures together in the study design.

METHODS

Modified proximal Class II cavities were prepared on the mesial and distal surfaces of twenty-two human premolars. Each tooth was restored with Admira and contralaterally with TPH Spectrum. Half of all of the teeth were subjected to thermo-mechanical load cycling. After dye penetration, longitudinal sections in mesio-distal direction were prepared and examined under a stereomicroscope. Data were analyzed with Mann Whitney U test.

RESULTS

The results showed that the thermo-mechanical load cycling caused a statistically significant increase in gingival microleakage when compared with the non-thermocycled and non-loaded restorations for both the materials Admira (P=0.006) and TPH Spectrum (P=0.023).

CONCLUSIONS

Simultaneous load cycling and thermocycling are decisive factors in the in vitro assessment of gingival microleakage, which still remains to be a clinical problem even with the ormocer system Admira.

Effect of different bonding agents on prevention of enamel demineralization around orthodontic brackets

INTRODUCTION

Demineralization around the bracket is an undesired side effect of orthodontic treatment. The aim of this in-vitro study was to evaluate the efficacy of 5 bonding agents to prevent enamel demineralization. Two quantification methods were used.

METHODS

Eighty-five extracted teeth were randomly allocated to 5 groups: (1) Transbond Plus SEP and Transbond XT (both, 3M Unitek, Seefeld, Germany), (2) 37% phosphoric acid, Pro Seal (Reliance Orthodontic Products, Itasca, Ill) and Transbond XT, (3) Clearfil Protect Bond (Kuraray Medical, Okayama, Japan) and Transbond XT, (4) 37% phosphoric acid and Light Bond (Reliance Orthodontic Products), and (5) Ortho Conditioner and Fuji Ortho LC (both, GC, Tokyo, Japan). In-vitro caries was created by pH cycling for 30 days. After demineralization, the teeth were scanned with a commercial cone-beam microtomographic system. Then the teeth were examined by polarized light microscopy.

RESULTS

The 2 methods of examination showed significant differences among the 5 groups according to lesion depth and mineral loss (P < 0.01). The resin-modified glass ionomer cement (group 5) had the lowest values for lesion depth and mineral loss.

CONCLUSIONS

Fuji Ortho LC showed a significantly smaller lesion depth and less mineral loss compared with the other materials. The cone-beam microtomographic system is suitable for evaluation of subsurface lesions and has considerable advantages.

Whitening effect and morphological evaluation of hydroxyapatite materials

PURPOSE

To measure the efficacy of the whitening effect of non-oxidizing and non-acidic nano- and micro-hydroxyapatite materials on the enamel surface and to evaluate the surface changes after treatment.

METHODS

Three hydroxyapatite suspensions and two hydroxyapatite mixtures in dissolvable polymer films were applied to a total of 30 extracted caries-free human premolars. After the last material application, a hydrodynamic shear force was generated and applied for 2 minutes to all teeth to simulate mechanical loading of the surface. The tooth color was measured with a dental spectrophotometer. The mean changes of the L*a*b* values between different measurements in each group were expressed as delta E and were analyzed with ANOVA and the Tukey's post-hoc test.

RESULTS

The groups of the nano-hydroxyapatite, the hydroxyapatite-nanocrystals and the tricalcium-phosphate exhibited significant delta E values between baseline and after hydrodynamic shear force application (P<0.05). In conclusion, the materials used in the study are very promising alternatives to oxidizing bleaching agents.

Self-limiting caries therapy with proteolytic agents

PURPOSE

To determine the extent to which artificial carious dentin can be removed by agents that do not seem to attack sound dentin such as pepsin, trypsin, collagenase and NaOCl, and to evaluate the effect of the enzyme pepsin and a new enzymatic solution SFC-V (pepsin in mild acidic buffer) as a self-limiting caries therapy in deep dentin carious lesions using our new model for artificial dentin caries.

METHODS

Artificial dentin caries was used to investigate different proteolytic agents which have the potential to remove carious tissue. 408 slices of coronal dentin were subjected to a demineralization regime which produces dentin caries very similar to natural lesions: acetic acid (pH 5) or lactic acid (pH 4) were used (7 days). Subsequently, sodium hypochlorite, collagenase, trypsin and pepsin were dissolved each in a suitable buffer and the demineralized dentin was treated for 10 minutes or 24 hours with these solutions. To differentiate the influence of the acidic buffer in case of pepsin, a second experiment was performed. 192 slices were exposed to lactic acid for 1 week. Subsequently the demineralized dentin surfaces were treated with either the enzyme pepsin in its acidic buffer, the acidic buffer alone, and in addition a neutral buffer as a control. In addition a fourth group was added where a new enzyme-based solution SFC-V was used. This second experiment differentiated further the influence of "diffusion enhanced by agitation" versus "diffusion" alone. The application time of the solutions was 3 minutes with and without agitation using a stiff nylon brush. To obtain information on the morphology of the pre- and post-treatment dentin surfaces, high resolution FE-SEM was used. Descriptive statistics were used based on cross tabulation of the morphological criteria.

RESULTS

Lactic acid produced demineralized dentin covered with a surface layer removable by proteolytic enzymes while acetic acid produced only demineralized dentin. The amount of tissue removed with the current proteolytic agents ranked as follows: trypsin < pepsin < collagenase < NaOCl. The neutral and the acidic buffers did not affect the surface precipitates while the enzyme pepsin and the solution SFC-V were effective in removing the degraded organic matrix.

Three-body-wear resistance of the experimental composites containing filler treated with hydrophobic silane coupling agents

This paper evaluated the wear resistance of resin composite materials with fillers which were modified with a novel hydrophobic silane coupling agent. The novel silane coupling agent containing hydrophobic phenyl group 3-(3-methoxy-4-methacryloyloxyphenyl)propyltrimethoxysilane (p-MBS) was synthesized. The experimental light-cure hybrid composites containing 85wt% of filler modified with this silane were formulated. Twelve specimens were prepared for the three-body-wear test with the ACTA machine and the collected data were analyzed statistically using a one-way ANOVA and Tukey's multiple comparison test as the post hoc test. The wear of the composites containing fillers treated with p-MBS was significantly lower compared with the composite materials containing fillers pretreated with 3-methacryloyloxypropyltrimethoxysilane or the commercially composites (AP-X and ELS extra low shrinkage) after a wear test for 200,000 cycles (p<0.05). It is suggested that the resin composites containing fillers modified with the novel hydrophobic silane has high wear resistant, because of the coupling layers treated with this silane had an excellent affinity with the base resin and formed a highly hydrophobic layer on the filler surface.

Determination of caries risk at resin composite margins

PURPOSE

To design an artificial mouth in order to evaluate if a new diagnostic tool (Clinpro Cario Diagnosis) can be used for early detection of secondary caries at resin composite margins in vitro.

METHODS

32 intact human third molars received standardized Class-V resin composite restorations (Tetric Ceram bonded with Syntac SC). After storage for 4 weeks at 37 degrees C, teeth were subjected to 5,000 or 10,000 thermocycles (+/- 5 degrees C and +/- 55 degrees C) and polysiloxane impressions were taken. Streptococcus mutans 10449 (SM) was used in a nutrition medium to initiate a secondary caries process. Daily, the teeth were incubated for 2 x 2.5 hours in SM containing nutrition medium followed by 2 x 9.5 hours incubation in artificial saliva. Teeth were investigated after total incubation periods of 4, 6, and 8 weeks. After the different incubation protocols, the restoration margins were evaluated for infection and secondary caries processes in using Clinpro Cario Diagnosis which measures site-specifically the lactic acid production of SM in response to a sucrose challenge. The color signal was read 5 minutes after removal of the diagnostic impression. After thermocycling and biological load cycling, precision polysiloxane impressions were taken and replicas were investigated under a light microscope for gap widths at enamel and dentin margins. Demineralization was evaluated by fluorescence microscopy in using a special FITC filter. The demineralization depths at the cavity margin were calculated with Xpert for Windows using a pixel distance of 5 microm.

RESULTS

After the different thermocycling protocols, no differences in gap widths and demineralization depths were found (P > 0.05). After SM incubation, gap widths and demineralization depths were significantly dependent on SM incubation time and previous number of thermocycles (P < 0.05). Lactic acid formations of SM were detectable by Clinpro Cario Diagnosis at dentin cavosurface margins formed after 6 weeks of incubation with SM (P < 0.05).

The influence of curing times and light curing methods on the polymerization shrinkage stress of a shrinkage-optimized composite with hybrid-type prepolymer fillers

OBJECTIVES

The aim of the study was to determine the influence of different light curing units (LCU) and regimes on the polymerization shrinkage stress (PSS) and the mechanical properties of a nano-hybrid composite.

MATERIAL AND METHODS

The polymerization shrinkage force (PSF) was measured continuously with compliance compensation for 300s after photo-initiating the composite, Tetric EvoCeram (Ivoclar Vivadent, Schaan, FL, Shade A3) in a Stress-Strain Analyser. Astralis 10, Bluephase and MiniL.E.D LCU with exposure times 10, 20 and 40s were used (C-factor=0.33, n=8 per group). Immediately after the PSF measurements, mechanical properties of the samples were measured at the top and the bottom using a Fischerscope H100C (Helmut Fischer GmbH, Sindelfingen, Germany). Statistical analyses were done using one-way ANOVA (p<0.05) and Tukey post hoc test.

RESULTS

Significant differences in the PSS for 10, 20 and 40s polymerization using Astralis 10 were found. The MiniL.E.D recorded low stress values. Modulus of elasticity is high after curing the composite with Astralis 10 at 10, 20 and 40s and for Bluephase 40s. Low moduli of elasticity were recorded for the MiniL.E.D and for the Bluephase 20 and 10s. The hardness values (HV) followed the same pattern as the modulus of elasticity. The Ramping mode of the MiniL.E.D had prolonged gel point.

CONCLUSIONS

High intensity LCU produce not just high HV but also high shrinkage, making it important to balance both the effects by choosing the appropriate curing time. Soft-start regimes have no paramount benefit in a LED regarding stresses in the clinical situation.

Evaluation of micro-tensile bond strengths of composite materials in comparison to their polymerization shrinkage

OBJECTIVE

The present study determined the influence of polymerization shrinkage of eight commercially available hybrid, micro-filled and nano composites (Z100 and Filtek Supreme, 3M-ESPE; Charisma and Durafill, Heraeus Kulzer; Tetric and InTen-S, Ivoclar Vivadent; Enamel plus HFO, GDF; Palfique Estelite Low Flow, Tokuyama) placed in large class 1 cavities on the bond strength to dentin.

METHODS

Polymerization shrinkage was recorded for 300 s at room temperature with a Stress-Strain-Analyzer (C(FACTOR)=0.3). The maximum contraction stresses after 300 s, the time until gelation (t(0.5 N)) and the coefficient of near linear fit of contraction force/time (gradient) were analysed. For the evaluation of the micro-tensile-bond-strength (micro-TBS), hourglass shape samples obtained from a total of 32 no carious extracted human third and second molars, randomly divided into 8 groups, were used. Micro tensile bond strengths were determined by computing the ratio of maximum load by the adhesion area of the hourglass shape. In order to analyze the quality of the polymerization within fillings, hardness profiles of a surface cut thought the middle of the restored tooth and along the tooth axis were made. Further, the modulus of elasticity, determined in a three-point-bending test, as well as the variation of the modulus of elasticity and of the hardness within a filling were considered. The statistical analyses were conducted by ANOVA (alpha=0.05) and post-hoc Tukey's test.

RESULTS

A significant correlation between polymerization shrinkage and micro-TBS was found (Pearson; -0.44). The correlation between modulus of elasticity in bending test and shrinkage stress (Pearson; 0.77), coefficient of near linear fit m (Pearson; 0.72), time until gelation (Pearson; -0.52) and micro-tensile-bond-strength (Pearson; -0.45) was also significant. A high polymerization tension and modulus of elasticity negatively affected the adhesion of the composite to the tooth hard substance. Further, the number of samples lost during the slice cutting and the hourglass shape preparation was found to correlate highly significantly with the shrinkage stress (Pearson; 0.97), coefficient of near linear fit m (Pearson; 0.94) and modulus of elasticity (Pearson; 0.82). All materials showed sufficient polymerization within the filling in comparison to the filling surface, the hardness at the bottom of the filling was greater than 80% of the maximum hardness value. The modulus of elasticity was not considerably reduced within the filling.

SIGNIFICANCE

High contraction stress and modulus of elasticity, fast development of contraction force and an early start of stress build-up of materials placed in restrictive cavities cause tension in the material with a possible subsequent distortion of the bond to the tooth structure. A low modulus of elasticity is not necessarily associated with high bond strength. However, it causes a more uniform stress distribution at the restorative composite-tooth interface. This is also evident in a reduced sample loss during the different stages of sample preparation.