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.

The Effect of a Deproteinizing Pretreatment on the Bonding Performance and Acid Resistance of a Two-step Self-etch Adhesive on Eroded Dentin

OBJECTIVES

This study evaluated how deproteinization using sodium hypochlorite (6% NaOCl) or hypochlorous acid (50 ppm HOCl) with or without the subsequent use of an arylsulfinate salt-containing agent (Clearfil DC Activator; DCA; Kuraray Noritake Dental) affects the micro-tensile bond strength (μTBS) and formation of an acid-base resistant zone (ABRZ) of a two-step self-etch adhesive on eroded dentin.

METHODS

Coronal dentin surfaces of sound human molars were exposed to 48 cycles of demineralization (1% citric acid; 5 minutes) and remineralization (buffer solution with pH=6.4; 3.5 hours). They were then assigned to experimental groups according to the pretreatment used: none (negative control), NaOCl, NaOCl+DCA, HOCl, and HOCl+DCA. Sound dentin surfaces with no pretreatment were used as a positive control. The dentin surfaces were bonded with Clearfil SE Bond 2 (Kuraray Noritake Dental), and μTBS was measured either after 24 hours or 20,000 thermal cycles (TC). The μTBS data were statistically analyzed using a mixed-model analysis of variance (ANOVA) and t-tests with Bonferroni correction. Failure mode was determined with scanning electron microscopy (SEM), which was also used for the observation of ABRZ.

RESULTS

Among experimental groups, there was no significant difference between the negative control, HOCl, and HOCl+DCA after 24 hours, but the HOCl-pretreated groups exhibited significantly higher μTBS than the negative control after TC (p<0.01). Pretreatment with NaOCl and NaOCl+DCA resulted in significantly higher μTBS (p<0.001), but the highest μTBS was measured on sound dentin (p<0.001). TC decreased μTBS significantly in all groups (p<0.001) except for sound dentin and NaOCl+DCA (p>0.05). Adhesive failures prevailed in eroded groups, whereas cohesive failures were predominant on sound dentin. ABRZ was recognized in all groups but marked morphological differences were observed.

CONCLUSIONS

The combined use of 6% NaOCl and the arylsulfinate salt-containing agent partially reversed the compromised bonding performance on eroded dentin, while the effect of 50 ppm HOCl was negligible.

Influence of Application Modes on Increasing Bond Strength Longevity of Self-etching and Universal Adhesive Systems to Enamel

The present study aimed to evaluate the influence of application mode on the short-term microshear bond strength longevity of self-etching and universal adhesive systems to enamel, the failure mode, and the resulting enamel surface micromorphology. Ninety enamel surfaces were obtained from sound third molars, planed, and randomly assigned to nine groups, according to the application mode and the adhesive system (n=10). There were three primer application modes: according to the manufacturer's recommended application time (control), using double the application time recommended for the primer and selective enamel etching. The adhesive systems used were: Clearfil SE Bond (Kuraray), FL-Bond II (SHOFU), and Futurabond U (Voco). At least two resin-bonded composite cylinders (Grandioso Light Flow, Voco) were placed on each enamel surface, and then evaluated for microshear bond strength at 24 hours and 180 days of storage in solution body fluid (SBF) at pH 7.4. Failure modes were evaluated with a stereoscopic microscope at 20× magnification. A micromorphological analysis of the enamel surface was performed under a scanning electron microscope at 5000× magnification before and after the treatments. Mixed models for repeated measures over time showed significant interaction among application modes, adhesive systems, and time periods (p=0.0331). The bond strength of FL-Bond II adhesive to enamel observed after performing selective enamel etching was significantly higher than that observed after applying the control treatment (p=0.0010) at both 24 hours and 180 days. However, no significant difference was observed between the application of this same adhesive at double the time recommended by the manufacturer and the other two application modes (p>0.05). There was also no significant difference in the microshear bond strength for the enamel treatments applied using Clearfil SE Bond and Futurabond U (p>0.05). A significant reduction in bond strength to enamel was observed at the 180-day storage time for all the adhesive systems when selective enamel etching was performed (p<0.0001). No significant association was observed between the adhesive system failure mode and the enamel treatments (p=0.1402 and p=0.7590 for 24 hours and 180 days, respectively). The most prevalent failure was the adhesive type.

Material of choice for non-invasive treatment of dentin caries: An in vitro study using natural carious lesions

INTRODUCTION

In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non-invasive approach to caries management is critical. To provide information on non-invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride-containing materials, adjunctive to the everyday use of fluoride toothpaste (F-toothpaste), on primary tooth natural dentin caries.

METHODS

Fifty-five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F-varnish), glass-ionomer cement (GIC), deionized water (DW) with F-toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH-cycling using micro-computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t-test, Wilcoxon-Signed-Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data.

RESULTS

SDF application reduced lesion depth from 844.6 to 759.1 μm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F-varnish (2.0%), F-toothpaste (-1.1%) and no-treatment groups (-1.4%).

CONCLUSION

In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F-toothpaste resulted in the highest remineralization compared with other remineralizing materials.

Noninvasive diagnostic method using optical coherence tomography detected a vulnerable dentin enamel junction created by phosphoric acid etching

To investigate the influence of phosphoric acid etching on the dentin enamel junction (DEJ) using optical coherence tomography (OCT). Human teeth were assigned to four groups: 1. control, no additional treatment (CT); 2. The primer of "SE Bond2" was applied (SE), 3. "Enamel Conditioner" was applied (EC), 4. "K-etchant syringe" was applied (KE). After treatment, the DEJ was observed using a laser microscope (CLSM), OCT, and scanning electron microscopy (SEM). Additionally, an ultimate tensile strength (UTS) test at the DEJ was performed. No cracks were observed by CLSM. In contrast, cracks were observed all samples by SEM. Additionally, OCT revealed a white line along the DEJ in all KE specimens and some EC specimens. The UTS test showed a significant difference between CT and KE. This study found that phosphoric acid etching may cause excessive demineralization and weaken the DEJ. This fragility was observed using a non-invasive diagnostic method using OCT.

Comparison of natural and artificial root caries lesions using microcomputed tomography and microhardness test

BACKGROUND

This study compared natural root caries lesions with artificial root caries lesions prepared with one of the two demineralising solutions.

METHODS

Twelve natural root caries lesions on upper incisors and 24 artificial root lesions were prepared on sound root surfaces using 50 mM acetic acid, 1.5 mM CaCl₂ , 0.9 mM KH₂ PO₄ at pH 5.0 or 80 mL/L Noverite K-702 polyacrylate solution, 500 mg/L hydroxyapatite, 0.1 mol/L lactic acid at pH 4.8 (n = 12/group) for 96 hours. Lesions were scanned using micro-CT. Inciso-gingival oriented images were analysed and mineral density calculated at 7.5 μm increments from the surface to 225-μm deep. Sectioned lesions were analysed by Knoop microhardness up to 250 μm from the lesion surface. Data were analysed by the Dunn's test with Bonferroni correction.

RESULTS

Natural and artificial lesion mean mineral densities were not statistically different (P > 0.05). Mineral density from the surface to 75 μm was greater in natural lesions and from 150 to 225 μm was greater in artificial lesions (P < 0.05). Microhardness values were statistically higher in artificial lesions (P < 0.05); no difference was found among artificial lesions produced by the two solutions (P > 0.05). Mineral density and microhardness of natural and artificial root caries are different from each other. A greater mineralized surface layer existed on natural lesions.

Study of Streptococcus mutans in Early Biofilms at the Surfaces of Various Dental Composite Resins

BACKGROUND

Biofilm deposit on the composite restoration is a common phenomenon and bacterial growth follows the deposition. The study aims to evaluate Streptococcus mutans (S. mutans) early biofilm formation on the surfaces of various dental composite resins by using the real-time quantitative polymerase chain reaction (qPCR) technique.

MATERIALS AND METHODS

Thirty-two discs, where eight discs were in each group of Filtek Supreme Ultra (FSU; 3M, St. Paul, MN), Clearfil AP-X (APX; Kuraray Noritake Dental Inc., Tokyo, Japan), Beautifil II (BE2; Shofu, Inc., Kyoto, Japan), and Estelite Sigma Quick (ESQ; Tokuyama Dental, Tokyo, Japan), were fabricated and subjected to S. mutans biofilm formation in an oral biofilm reactor for 12 hours. Contact angles (CA) were measured on the freshly fabricated specimen. The attached biofilms underwent fluorescent microscopy (FM). S. mutans from biofilms were analyzed using a qPCR technique. Surface roughness (Sa) measurements were taken before and after biofilm formation. Scanning electron microscopy (SEM), including energy dispersive X-ray spectrometer (EDS) analysis, was also performed for detecting relative elements on biofilms.

RESULTS

The study showed that FSU demonstrated the lowest CA while APX presented the highest values. FM revealed that condensed biofilm clusters were most on FSU. The qPCR results indicated the highest S. mutans DNA copies in the biofilm were on FSU while BE2 was the lowest (p < 0.05). Sa test signified that APX was significantly the lowest among all materials while FSU was the highest (p < 0.05). SEM displayed areas with apparently glucan-free S. mutans more on BE2 compared to APX and ESQ, while FSU had the least. Small white particles detected predominantly on the biofilms of BE2 appeared to be Si, Al, and F extruded from the resin.

CONCLUSION

Differences in early biofilm formation onto various composite resins are dependent on the differences in material compositions and their surface properties. BE2 showed the lowest quantity of biofilm accumulation compared to other resin composites (APX, ESQ, and FSU). This could be attributed to BE2 proprieties as a giomer and fluoride content.

Resin Cement/Enamel Interface: A Morphological Evaluation of the Acid-Base Resistant Zone, Enamel Etching Pattern, and Effect of Thermocycling on the Microshear Bond Strength

PURPOSE

To evaluate the effects of etching mode (self-etch and etch-and-rinse) on acid-base resistant zone (ABRZ) formation at the resin cement/enamel interface and enamel etching pattern, as well as the effects of thermocycling (0, 5000, and 10,000 cycles) on the enamel microshear bond strength (μSBS) mediated by dual-cure resin cements (DCRC).

MATERIALS AND METHODS

Two DCRC were used in 4 groups: Panavia V5 in self-etch (V5NE) and etch-and-rinse mode (V5E); and Estecem II in self-etch (ENE) and etch-and-rinse mode (EE). For ABRZ observation, the bonded interface was subjected to a demineralizing solution. The morphological attributes of the interface and etching patterns were observed using FE-SEM. For μ-SBS, cylinders with a 0.79-mm internal diameter and 0.5-mm height were made with DCRC and tested in shear after 0, 5000, and 10,000 thermal cycles (TC) (5°C and 55°C) (n = 10).

RESULTS

The formation of an enamel ABRZ was observed in all groups with different morphological features between self-etch and etch-and-rinse groups. A funnel-shaped erosion beneath the interface was present using V5NE and ENE modes where enamel was dissolved, while ABRZ formation was confirmed and no funnel-shaped erosion was noticed using V5E and EE. No significant differences in μSBS were observed between resin cements. However, significantly lower µSBSs were recorded when the self-etching mode was used. Thermocycling resulted in a significant reduction in µSBS for all groups.

CONCLUSION

Selective enamel etching should be recommended to improve the interfacial quality when dual-cure resin luting cements are used.

Influence of different tooth etchants on bur-cut and uncut enamel

This study aimed to evaluate the effect of pre-etching for two-step self-etch adhesive bonding to bur-cut and uncut enamel. Bur-cut and uncut enamel surfaces were assigned to surface treatments of no etchant (CT), Enamel Conditioner (EC; Shofu, Kyoto, Japan), or K-etchant syringe (KE; Kuraray Noritake Dental, Tokyo, Japan). The bonded samples were thermal cycled and evaluated by microshear bond strength (μSBS). The adhesive interface after acid-base challenge and the conditioned enamel surfaces were morphologically analyzed using scanning electron microscopy (SEM). For bur-cut enamel, EC and KE pre-etching significantly improved μSBS. For uncut enamel, KE showed higher μSBS than EC. SEM observation revealed that only KE removed the prismless layer of the uncut enamel surface. EC could improve enamel bonding and appears to be a substitute for phosphoric acid, especially for bur-cut enamel. However, uncut enamel could not be effectively conditioned by EC with a lower bond strength than KE.

Analysis of reaction products on hydroxyapatite created by tooth etchants with different compositions

PURPOSE

The purpose of this study was to investigate the reaction products formed by application of three tooth etchants to hydroxyapatite.

METHODS

Tooth etchants with three different compositions, designed for application to teeth before dental adhesive - " K-etchant GEL" (containing phosphoric acid), "Enamel Conditioner" (containing organic acids), and "Multi Etchant" (containing acidic monomer) - were applied to hydroxyapatite plates.

RESULTS

Atomic force microscopy measurements revealed that Multi Etchant formed nano-sized particles on the hydroxyapatite. X-ray diffraction and Fourier transform infrared spectrometer analyses of the powdered hydroxyapatite indicated that Enamel Conditioner produced calcium tartrate whereas K-etchant GEL generated monetite. These results indicated that each etchant reacted with hydroxyapatite in a different way.

CONCLUSION

Not only differences among the etching ability of etchants, but also differences in the reaction compounds they produce may influence bonding performance in clinical practice.

Hydroxyapatite Affects the Physicochemical Properties of Contemporary One-Step Self-Etch Adhesives

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQ_exp) were manipulated on different surfaces: manufacturer's Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives' pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives' properties.

Clinical and primary evidence of silver diamine fluoride on root caries management

Root caries is a growing problem for the worldwide aging population. Silver diamine fluoride (SDF) contains high concentrations of silver and fluoride ions, which prevents and arrests root caries, as well as dentin caries in the primary teeth of young children. Unlike other fluoride products that mainly reduce the formation of new carious lesions, 38% SDF is an effective agent that can efficiently arrest the carious process, remineralize the decayed dental tissues, and protect the tooth structure against the formation of new caries lesions. The use of SDF can result in more caries-resistant tooth structures. Despite these merits, its clinical disadvantages are the deep penetration of silver ions and sequential formation of silver compounds, which cause esthetic concern due to the discoloration and impaired efficacy of dentin bonding after using SDF. Thus, this narrative review, by addressing the primary experimental results and clinical applications of SDF on root caries, proposes management methods for root caries in conjunction with the application of SDF. We propose a two-visit treatment protocol to take advantage of the SDF application for root surface caries and utilize the discoloration caused by SDF.

Effect of Surface Pre-Reacted Glass Ionomer Containing Dental Sealant on the Inhibition of Enamel Demineralization

The effect of a surface pre-reacted glass ionomer (S-PRG)-containing sealant on the demineralization inhibition and remineralization of intact enamel adjacent to the sealant material was investigated. BeautiSealant (BTS, S-PRG sealant, Shofu), Teeth Mate F-12.0 (TMF, fluoride-releasing sealant, Kuraray Noritake Dental), and an experimental silica-filler sealant were investigated. After pH cycling for 10 days, the enamel surface adjacent to the sealant material was observed using confocal laser microscopy and scanning electron microscopy. The polymerized sealant disks were immersed in a demineralized solution (pH: 4.3) to measure pH change. The enamel specimens with polymerized sealant disks were additionally immersed in demineralized solution, followed by energy-dispersive X-ray spectroscopy. The demineralized area of BTS was significantly smaller than that of TMF and SS (p < 0.05). The surfaces adjacent to the sealant of TMF and SS were demineralized, while the surface of BTS was comparatively intact. An increase in pH values were observed in the BTS and TMF groups. Enamel surfaces presented an inhibition of demineralization for BTS and TMF, but not for SS. Fluoride uptake from the polymerized sealant was greater for BTS than for TMF. The S-PRG-containing sealant showed a buffering ability, demineralization inhibition, promotion of remineralization, and it can be advised for clinical applications.

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement

Purpose

The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses.

Methods and Materials

This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe’s test. One-way ANOVA was also performed for comparison of the Vickers hardness results.

Results

Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p&lt;0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p&lt;0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p&lt;0.05).

Conclusion

Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

Evaluation of Incipient Enamel Caries at Smooth Tooth Surfaces Using SS-OCT

(1) Background: Dental caries, if diagnosed at the initial stage, can be arrested and remineralized by a non-operative therapeutic approach preserving tooth structure. Accurate and reproducible diagnostic procedure is required for the successful management of incipient caries. The aim of this study was to evaluate the diagnostic accuracy of 3D swept-source optical coherence tomography (3D SS-OCT) for enamel caries at smooth tooth surface if the lesion was with remineralization. (2) Methods: Forty-seven tooth surfaces of 24 extracted human teeth visibly with/without enamel caries (ICDAS code 0−3) were selected and used in this study. The tooth surfaces of investigation site were cleaned and visually examined by four dentists. After the visual inspection, SS-OCT scanning was performed onto the enamel surfaces to construct a 3D image. The 2D tomographic images of the investigation site were chosen from the 3D dataset and dynamically displayed in video and evaluated by the examiners. A five-rank scale was used to score the level of enamel caries according to the following; 1: Intact enamel. 2: Noncavitated lesion with remineralization. 3: Superficial noncavitated lesion without remineralization. 4: Deep nonvacitated lesion without remineralization. 5: Enamel lesion with cavitation. Sensitivity and specificity for 3D OCT image and visual inspection were calculated. Diagnostic accuracy of each diagnostic method was calculated using weighted kappa. Statistical significance was defined at p = 0.05. (3) Results: 3D SS-OCT could clearly depict enamel caries at smooth tooth surface as a bright zone, based on the increased backscattering signal. It was noted that 3D SS-OCT showed higher sensitivity for the diagnosis of remineralized lesions and deep enamel lesions without cavitation, as well as cavitated enamel lesions (p < 0.05). No significant difference of specificity was observed between the two diagnostic methods (p > 0.05). Furthermore, 3D SS-OCT showed higher diagnostic accuracy than visual inspection (p < 0.05). (4) Conclusions: Within the limitations of this in vitro study, 3D SS-OCT showed higher diagnostic capacity for smooth surface enamel caries than visual inspection and could also discriminate lesion remineralization of enamel caries.

Surface Roughness and Bond Strength of Resin Composite to Additively Manufactured Zirconia with Different Porosities

PURPOSE

To investigate the bond strength of resin cement to additively manufactured (AM) zirconia with different porosities when compared to milled zirconia.

MATERIALS AND METHODS

A 12 × 5 mm disk virtual design file was used to fabricate a total of 48 disks divided into 4 groups: 3 groups were AM with different porosities including 0%-porosity (AMZ0 group), 20%-porosity (AMZ20 group), and 40%-porosity (AMZ40 group), and 1 milled zirconia (control or CNCZ group). The dimensions of all specimens were measured using a digital caliper. A 3D- confocal laser scanner was used to analyze surface morphology and measure the surface roughness (Sa), followed by SEM analysis. Tensile bond strength of composite resin cement to specimens was measured before and after aging procedures using a universal testing machine (n = 10). Failure modes were evaluated under a light microscope. Volumetric change data was analyzed using one-way ANOVA, and two-way ANOVA was used to compare bond strength values (α = 0.05).

RESULTS

There was a significant difference in volumetric changes among the groups. The CNCZ group showed the least changes in diameter 0.027 ± 0.029 mm and thickness 0.030 ± 0.012 mm and AM zirconia with 40% porosity showed the most volumetric changes in diameter 5.237 ± 0.023 mm. ANOVA test indicated an overall significant difference in surface roughness across all groups (F = 242.6, p < 0.001). The CNCZ group showed the highest mean Sa of 1.649 ± 0.240 µm, followed by AMZ40 group with Sa of 0.830 ± 0.063 µm, AMZ20 group with Sa of 0.780 ± 0.070 µm, and the AMZ0 group with Sa of 0.612 ± 0.063 µm. Two-way ANOVA showed significant difference in bond strength between the CNCZ group 12.109 ± 3.223 MPa and the AMZ0 group 8.629 ± 0.914 MPa, with significant pretest failures in specimens with porosities. Thermal cycling methods reduced the bond strength non-significantly in CNCZ group with no effect in the AMZ0 group.

CONCLUSION

Milled zirconia had a higher surface roughness and bond strength to composite resin cement than AM zirconia, and porosities in AM zirconia decreased the bond strength with significant pretest failures.

MDP Salts: A New Bonding Strategy for Zirconia

Durable resin-ceramic adhesion may influence the clinical success of ceramic restorations, which has been one of the challenging issues in dentistry. The present study assessed the bond strength and chemical interaction of 10-methacryloxydecyl dihydrogen phosphate (MDP), MDP+silane, and MDP-salt primers to alumina-blasted zirconia ceramic by tensile bond strength test, surface elemental composition with x-ray photoelectron spectroscopy analysis, contact angle measurement, surface morphology with scanning electron microscopy, and surface topography with 3-dimensional confocal laser scanning microscope analyses. MDP-salt showed the highest tensile bond strength before and after thermocycling when compared with MDP and MDP+silane (P < 0.05). The measured contact angle values differed significantly (P < 0.001) in the order of MDP-salt > control (no chemical pretreatment) > MDP+silane > MDP. There was no difference in surface roughness (P = 0.317) and surface topography among all tested groups. Zirconia treated with MDP-salt showed phosphorus peaks in addition to zirconia and alumina peaks. MDP-salt has zirconia priming properties, which improves bonding performance to resin cement.

Bonding performance of self-etch adhesives to enamel bleached with different peroxide concentrations

The aim of this study was to evaluate the micro-shear bond strength (µSBS) of one and two steps self-etch adhesive systems after enamel bleaching with photo-activated bleaching systems of different hydrogen peroxide (HP) concentration. Occlusal enamel of forty intact human molars were flattened and assigned into four groups. GI Unbleached, GII, GIII, and GIV were bleached with Pyrenees (3.5% HP), GC TiON (20% HP), and Hi-Lite (35% HP) respectively. Enamel treatment with one and two steps self-etch adhesives (Clearfil S3 Bond- S3, and Clearfil SE Bond-SE) then micro-tubes were fixed on enamel and filled with AP-X composite (n=5). Bond was tested with the universal testing machine. Data were analyzed using two-way ANOVA and Tukey's tests at 5 % level of significance. The µSBS was significantly different between adhesives (F=154.46; p<0.05) and bleaching systems (F=77.33; p<0.05) with significant interaction. Specimens bonded with S3 shows a significantly lower μSBS than those bonded with SE (p<0.05) in all groups. For both adhesives the bleached groups demonstrate lower µSBS than unbleached except specimens bleached with Pyrenees and bonded with SE (p>0.05). A significant difference was observed between groups of the bleaching systems (p<0.05). Different peroxide concentrations photo-activated bleaching systems adversely affect μSBS of one and two steps self-etch adhesives. Low concentration system (Pyrenees) does not influence the bond strength of two steps adhesive.

The effects of different silicatization and silanization protocols on the bond durability of resin cements to new high-translucent zirconia

OBJECTIVE

The aim of this study was to assess the influence of different silicatization protocols with various silane treatment methods on the bond performance to high-translucent zirconia.

MATERIALS AND METHODS

High-translucent zirconia specimens were assigned to five groups according to mechanical surface pretreatment: as-sintered (Con), 0.2 MPa alumina sandblasting (AB2), tribochemical silica coating (TSC), 0.2 and 0.4 MPa glass bead air abrasion (GB2) and (GB4). Each group was subjected to 4 different cementation protocols: Panavia SA Universal (SAU), Panavia SA plus (SAP), silane + SAP (S-SAP), and Universal adhesive + SAP (U-SAP). Tensile bond strength (TBS) was measured after 24 h and 10,000 thermocycling (TC). Surface topography, surface energy, and elemental composition of the abraded zirconia surface analyses were completed. TBS data was analyzed using the Weibull analysis method. Surface roughness and surface energy were compared by one-way ANOVA analysis of variance (α = 0.05).

RESULTS

After 24 h, higher TBS was achieved with all cementation protocols in AB2 and TSC, also, in GB2 with all protocols except U-SAP, and in GB4 with SAU and S-SAP. After aging, GB4/S-SAP, GB2/S-SAP, AB2/U-SAP, and TSC/S-SAP showed the highest bond strength. GB groups showed the lowest surface roughness and highest surface energy.

CONCLUSION

Glass bead abrasion achieved the durable bond strength to high-translucent zirconia using a separate silane coupling agent while altered surface chemistry, surface energy, and roughness without effect on morphology.

CLINICAL RELEVANCE

Glass bead air abrasion is an alternative to alumina sandblasting and tribochemical silica coating and improves bond strength to high translucent zirconia.

Can a New HEMA-free Two-step Self-etch Adhesive Improve Dentin Bonding Durability and Marginal Adaptation?

PURPOSE

A new two-step self-etch adhesive (2-SEA) free of hydrophilic monomers was evaluated. Its microtensile bond strength (µTBS) to dentin under various aging conditions, interfacial gap formation, water sorption/solubility, and formation of an acid-base resistant zone (ABRZ) were evaluated and compared with a gold-standard 2-SEA.

MATERIALS AND METHODS

The new 2-SEA G2-Bond Universal (G2; GC) was compared to Clearfil SE Bond 2 (CSE2, Kuraray Noritake). Their µTBS to sound coronal dentin was tested after 1 week, 10,000 thermal cycles (TC), 20,000 TC, 6 months and 1 year. Failure mode was determined using scanning electron microscopy (SEM). Gap formation at the interface of 2-mm deep tapered cavities with an enamel border was observed using swept-source optical coherence tomography after 1 day, 1 week, 10,000 TC, and 20,000 TC. In addition, water sorption and solubility of the bonding agents was measured, and ABRZ formation was evaluated using SEM.

RESULTS

There was no significant difference in µTBS between G2 and CSE2 (p > 0.05), and the aging conditions had no significant effect on µTBS (p > 0.05). In all groups, cohesive failures prevailed (55%-95%). Interfacial gap formation was initially similar for both adhesives (p > 0.05), but G2 exhibited a significantly lower gap formation than CSE2 after TC (p < 0.05). The water sorption of G2 was significantly lower compared to CSE2 (p < 0.05), and their solubility was statistically similar (p > 0.05). ABRZ of similar thickness was observed with both adhesives.

CONCLUSION

The new 2-SEA exhibited stable dentin bonding and increased hydrophobicity resulting from the absence of hydrophilic monomers.

Surface analysis of dental caries using a wireless pH sensor and Raman spectroscopy for chairside diagnosis

A chairside tool for quantitative analysis of dental caries would improve clinical dental inspections. The wireless caries sensing tool with dental-explorer size has been developed comparing two sensing methods, Raman reading and pH reading for evaluating dental caries. The Raman spectra at 575 cm^-1 and 960 cm^-1 for in inorganic compounds, as well as 1450 cm^-1 and 2940 cm^-1 for organic compounds reinforced and supported the pH results. An Iridium/Iridium oxide (Ir/IrOx) pH sensing probe and wireless pH sensor (comprising an ESP8266 ESP-01 wireless module and ADS1115 analog digital converter) has been developed to quantitatively evaluate dental caries. All the operations of the wireless pH sensor were performed with a developed LabVIEW-based real-time data monitoring program. The slope and the linear fitting regression value (R²) of the wireless pH sensor using seven standards were -54.9 mV/pH and 0.999, respectively, showing high accuracy and stability for the pH measurements. The pH on the dental caries surface was measured with the wireless pH sensor, and the pH mapping results in the non-caries and caries areas were 6.9 and 5.7, respectively. The developed wireless pH sensor would be useful to understand the condition of dental caries and support dentists' inspection to remove only the caries part while keeping the non-caries structure.

Optical Coherence Tomography for Patients with Developmental Disabilities: A Preliminary Study

Dental radiographs are essential for diagnosis and treatment planning, but are sometimes difficult to acquire for patients with developmental disabilities (PDD). Optical Coherence Tomography (OCT) is a non-ionizing imaging modality that has the potential application as an alternative to dental radiographs for PDD. This study aimed to determine the feasibility of intraoral OCT imaging for PDD. Ten participants were recruited in the Dental Education in the Care of Persons with Disabilities (DECOD) Clinic to explore the utility of dental OCT. The prototype system (Yoshida Dental) creates in-depth and three-dimensional images of teeth. The participants indicated their degree of pain during imaging on the Wong-Baker FACES Pain Rating Scale, and the degree of discomfort after imaging on a visual analog scale. OCT can be used for patients with developmental disabilities with minimal levels of pain and discomfort, without ionizing radiation.

Effect of smear layer removal agents on the microhardness and roughness of radicular dentin

Purpose

To evaluate the effect of phytic acid (IP6) on the surface roughness and microhardness of human root canal dentin and compare it to other smear layer removal agents.

Materials and methods

Fifty extracted human maxillary incisors were sectioned longitudinally into a total of 100 specimens followed by embedding in auto-polymerizing acrylic resin. The specimens were polished and then randomly divided into five groups (n = 20) according to the test solution used to condition root canal dentin: 17% ethylenediaminetetraacetic acid (EDTA); 10% citric acid (CA); 1% IP6; 37% phosphoric acid (PA); or distilled water (control group). Each specimen was treated with a total volume of 1 ml of each solution for 1 min with agitation. Each group was then divided into two subgroups of 10 specimens each. The specimens of the first subgroup were used to determine microhardness, using Vickers hardness tester, and the specimens of the second subgroup were used to measure surface roughness, using a confocal laser scanning microscope. The results were analyzed statistically using one-way ANOVA and Tukey tests, α = 0.05.

Results

All the tested groups exhibited microhardness and surface roughness values that were statistically significantly different when compared with the control group (P < 0.05). The microhardness value obtained with IP6 was significantly lower when compared to EDTA, CA, and the control group, whereas its roughness value was significantly higher compared to the aforementioned groups. However, there was no significant difference between IP6 and PA (P > 0.05).

Conclusions

IP6 and PA showed the lowest microhardness and the highest surface roughness values.

Eight-year Microtensile Bond Strength to Dentin and Interfacial Nanomechanical Properties of a One-step Adhesive

PURPOSE

To evaluate the microtensile bond strength (µTBS) of a one-step self-etch adhesive (1-SEA) to dentin and its interfacial nanomechanical properties after 8 years of water storage.

MATERIALS AND METHODS

Flat coronal dentin surfaces of extracted human third molars were bonded with a 1-SEA (Clearfil S3 Bond Plus, CS3+) and built up with a hybrid resin composite (Clearfil AP-X). After storage in water for 24 h or 8 years, non-trimmed stick-shaped specimens were fabricated from the central part of each bonded tooth and subjected to the µTBS test at a crosshead speed of 1.0 mm/min. Failure modes and the morphology of debonded interfaces were analyzed using a scanning electron microscope (SEM). In addition, the elastic modulus (E) and hardness (H) of the adhesive layer and the resin composite were determined by an instrumented nanoindentation test. The acquired µTBS, E, and H data were statistically analyzed using t-tests to examine the effect of storage time (α = 0.05).

RESULTS

The 8-year µTBS was slightly lower than that after 24 h, but the difference was not significant (p = 0.123). The SEM observation of debonded surfaces after 8 years revealed extrusions and lacunas. E and H of the adhesive layer and the resin composite significantly decreased over the 8-year water storage (p < 0.001).

CONCLUSIONS

Although 8 years of water storage did not decrease the µTBS of CS3+ significantly, the observed failure mode patterns and significantly decreased nanomechanical properties indicated resin degradation of the adhesive and the resin composite.

Pulpal response to mineral trioxide aggregate containing phosphorylated pullulan-based capping material

This study aimed to evaluate the pulpal responses of monkey's pulp after direct pulp capping (DPC) with the novel mineral trioxide aggregate containing phosphorylated pullulan-based material (MTAPPL). Seventy-two teeth were randomly divided into four groups: MTAPPL; Nex-Cem MTA (NX); TheraCal LC (TH); and Dycal (DY). Histopathological changes in the pulps were observed at days 3, 7 and 70. On day 3, mild inflammatory responses were observed in the MTAPPL, no to moderate inflammatory responses in the TH, whereas moderate inflammatory responses in the NX and DY. No mineralized tissue formation (MTF) was observed in all groups. On day 7, no or mild inflammatory responses were observed in all groups. Initial MTF was observed except for DY. No inflammation with complete MTF including presence of odontoblast-like cells was observed in the MTAPPL, NX and TH groups at day 70. These findings indicate that MTAPPL could be an efficient DPC material.

Surface roughness and shear bond strength to composite resin of additively manufactured interim restorative material with different printing orientations

STATEMENT OF PROBLEM

Additive manufacturing (AM) is a technology that has been recently introduced into dentistry for fabricating dental devices, including interim restorations. Printing orientation is one of the important and influential factors in AM that affects the accuracy, surface roughness, and mechanical characteristics of printed objects. However, the optimal print orientation for best bond strength to 3D-printed interim restorations remains unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of printing orientation on the surface roughness, topography, and shear bond strength of AM interim restorations to composite resin.

MATERIAL AND METHODS

Disk-shaped specimens (Ø20×10 mm) were designed by a computer-aided design software program (Geomagic freeform), and a standard tessellation language (STL) file was obtained. The STL file was used for the AM of 60 disks in 3 different printing orientations (0, 45, and 90 degrees) by using E-Dent 400 C&B material. An autopolymerizing interim material (Protemp 4) was used as a control group (CNT), and specimens were fabricated by using the injecting mold technique (n=20). Surface roughness (Sa, Sz parameters) was measured by using a 3D-laser scanning confocal microscope (CLSM) at ×20 magnification. For shear bond testing, the specimens were embedded in polymethylmethacrylate autopolymerized resin (n=20). A flowable composite resin was bonded by using an adhesive system. The specimens were stored in distilled water at 37 °C for 1 day and thermocycled 5000 times. The shear bond strength (SBS) was measured at a crosshead speed of 1 mm/min. The data were analyzed by 1-way ANOVA, followed by the Tukey HSD test (α=.05).

RESULTS

The 45-degree angulation printing group reported the highest Sa, followed by the CNT and the 90-degree and 0-degree angulations with significant difference between them (P<.001). The CNT showed the highest Sz, followed by the 45-degree, 90-degree, and 0-degree angulations. The mean ±standard deviation SBS was 28.73 ±5.82 MPa for the 90-degree, 28.21 ±10.69 MPa for the 45-degree, 26.21 ±11.19 MPa for the 0-degree angulations and 25.39 ±4.67 MPa for the CNT. However, no statistically significant difference was found in the SBS among the groups (P=.475).

CONCLUSIONS

Printing orientation significantly impacted the surface roughness of 3D-printed resin for interim restorations. However, printing orientation did not significantly affect the bond strength with composite resin.

Anti-Demineralization Effects of Dental Adhesive-Composites on Enamel-Root Dentin Junction

Oral biofilm reactor (OBR) and pH cycling (pHC) artificial caries model were employed to evaluate the anti-demineralization effects of four composite filling systems on enamel-root dentin junction. Sixty-four enamel-root dentin blocks (6 mm × 6 mm × 2 mm) each with a cylindrical cavity were randomly assigned to the pHC and OBR group, then four subgroups (n = 8) and filled with either the Beautifil II (BEF, SPRG-filler-containing) or Estelite (EST) composite after the adhesive (either Single Bond Universal (SBU) or FL Bond II (FL, SPRG-filler-containing)). The demineralization lesions of filling interface were examined by micro-computerized tomography (μCT) and swept-source-optical coherence tomography (SS-OCT). According to the degree of interface damage, the caries lesions were sorted into four types: Type A and B (no attachment loss); Type C and D (attachment loss). EST/SBU showed the worst demineralization lesion and attachment loss (100% Type D), while BEF/FL exhibited the shallowest lesion depth (p < 0.05, 145 ± 45 μm on enamel, 275 ± 35 μm on root dentin) and no attachment loss (75% Type A and 25% Type B). Using FL adhesive alone does not effectively reduce enamel demineralization. BEF plays a leading role in acid resistance. The combination of BEF and FL showed a cumulative synergistic effect on anti-demineralization.

Influence of the resin-coating technique on the bonding performance of self-adhesive resin cements in single-visit computer-aided design/computer-aided manufacturing resin restorations

OBJECTIVE

This in vitro study investigated the influence of resin coating on the bonding performance of self-adhesive resin cements in single-visit computer-aided design (CAD)/computer-aided manufacturing (CAM) resin restorations.

MATERIALS AND METHOD

CAD/CAM resin (1.5-mm thick) was mounted on 20 noncoated and 20 resin-coated human dentin surfaces using dual-cured self-adhesive resin cements (Panavia SA Cement Plus or Panavia SA Cement Universal, Kuraray Noritake Dental) in either self-curing or dual-curing mode. These specimens were sectioned into beam-shaped sticks and subjected to microtensile bond strength tests after 24 h of water storage. The obtained data were statistically analyzed with three-way analysis of variance (ANOVA) and t tests (α = 0.05).

RESULTS

The three-way ANOVA results revealed the significant influence of resin coating, resin cement, and curing mode. Resin coating and light curing led to higher bond strengths in almost all groups. Resin-coated dentin with Panavia SA Cement Plus exhibited a mean bond strength greater than 35 MPa in both self-curing and dual-curing modes.

CONCLUSIONS

In single-visit CAD/CAM resin restorations, resin coating, resin cement selection, and curing mode influenced the bonding performance of self-adhesive resin cements. In addition, resin coating and light curing increased the bond strength of self-adhesive resin cements. Resin coating and light curing are encouraged for predictable bonding performance of dual-cured self-adhesive resin cements in single-visit CAD/CAM resin restorations.

Influence of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) incorporated experimental cleaners on the bonding performance of saliva-contaminated zirconia ceramic

OBJECTIVES

To assess the efficacy of experimental cleaners containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) on the saliva decontamination of ceramic and their influence in restoring zirconia's adherence to resin cement.

MATERIALS AND METHODS

Four hundred sixty alumina-blasted zirconia specimens were categorized into saliva-contaminated and uncontaminated groups which were treated with ceramic primer (P), experimental cleaner 1 (C1), C1 followed by P (C1P), experimental cleaner 2 (C2), and C2 followed by P (C2P). Stainless-steel rods were then attached to the specimens using PanaviaV5 cement (Kuraray Noritake Dental; Tokyo, Japan). Tensile bond strength (TBS) test was performed after 24 h and 5000 thermocycling processes. X-ray photoelectron spectroscopy (XPS) analysis and contact angle measurement of the specimen were performed. The TBS data were analyzed by Weibull analysis and three-way ANOVA. Contact angle data were analyzed by two-way ANOVA (α = 0.05).

RESULTS

C2P groups showed the highest TBS in all conditions among tested groups. Saliva contamination led to a significant reduction of TBS in primer- and cleaner-treated groups, with no significant impact on C2P. Adhesive failure was predominant in contaminated groups except with the C1P and C2P groups. XPS revealed that a nitrogen peak was observed on contaminated groups but not in primed groups. The contact angle was significantly affected by saliva contamination, the cleaners, and/or ceramic primer usage (p < 0.001).

CONCLUSIONS

The MDP cleaner followed by the MDP primer protocol may overcome the effect of saliva contamination and improve the resin-ceramic bond strength.

CLINICAL RELEVANCE

It is recommended to use a combination of MDP-containing cleaner 2 and ceramic primer as a chair-side chemical pretreatment for zirconia substrate with or without saliva contamination.

Dentin anti-demineralization potential of surface reaction-type pre-reacted glass-ionomer filler containing self-adhesive resin cement

OBJECTIVE

To investigate the anti-demineralization potential of a newly developed surface reaction-type pre-reacted glass-ionomer (S-PRG) filler containing self-adhesive resin cement against acidic attacks on the dentin surface.

MATERIALS AND METHODS

A total of 32 bovine teeth were used. Cavities were prepared on crown dentin slaps and filled with three self-adhesive resin cement: (1) S-PRG-based cement, (2) Si-based cement, and (3) RelyX cement. Specimens were then subjected to pH cycling for 28 days, and the depth of demineralization was assessed using swept-source optical coherence tomography (SS-OCT) after 7, 14, 21, and 28 days. Sixty-four root dentin blocks were divided into four groups and then subjected to a pH cycling procedure with the aforementioned three material blocks and one negative control. The mineral loss was observed using transverse microradiography (TMR), and the surface microhardness (SMH) test was conducted to investigate the mechanical properties of treated dentin surfaces.

RESULTS

The depth of demineralization for the S-PRG-based cement was significantly lower than that of the Si-based cement after 7, 21, and 28 days. Conversely, the RelyX cement was not significantly different from the Si-based cement after 7, 14, and 21 days (p < 0.05). Regarding the TMR and SMH test, the S-PRG-based cement showed the least mineral loss with the highest resistance to acidic challenge.

CONCLUSION

The S-PRG filler containing resin cement can reduce mineral loss and promote remineralization of dentin substrate and has the potential to preserve dentin integrity and resist acidic attack. Clinical significance Self-adhesive resin cement containing S-PRG fillers maintained the surface integrity of dentin after exposure to 28 days of acidic challenge with a significant anti-demineralization effect.

Retention of posterior resin bonded fixed dental prostheses with different designs after chewing simulation

The aim of this study was to evaluate the effect of different preparation and framework designs on the retention of posterior resin bonded fixed dental prostheses (RBFDPs) made from monolithic zirconia ceramic. Forty-eight caries-free upper premolars and forty-eight upper third molars were used in this study. The teeth were randomly divided into six main groups (n = 8 each) according to the preparation design of two-retainer RBFDPs: narrow or wide rest, combined with 0, 1 or 2 retainer wings. All RBFDPs were milled from monolithic zirconia (KATANA Zirconia ML). They were bonded using Panavia V5 with its corresponding primer, and underwent thermodynamic loading (98 N, 1,200,000 cycles). Retention was evaluated for the surviving RBFDPs in a universal testing machine by means of a debonding test. Failure modes were evaluated using a light microscope. Data was statistically analyzed by Kruskal-Shapiro-Wilk followed by Mann-Whitney with Bonferroni correction for multiple testing. The survival rates after the chewing simulation were 75% (group narrow rest/no retainer wing), 62.5% (group wide rest/no retainer wing) and 100% (the other groups). The mean retention ranged from 31 N to 766 N. Designs with two retainer wings showed significantly higher bond strength than the other designs (p ≤ 0.05). The rest width did not show a significant effect on the retention. Posterior RBFDPs with a modified design (occlusal rest and two retainer wings) exhibited promising durability and retention. Designs with two additional retainer wings should be preferred over designs with one or no retainer wing, irrespectively of the rest width.

Progression of non-carious cervical lesions: 3D morphological analysis

OBJECTIVES

This longitudinal study aimed to investigate morphologically and quantitatively the progression of non-carious cervical lesions (NCCLs) using a confocal laser scanning microscope (CLSM) and replica models.

MATERIALS AND METHODS

The samples examined comprised sets of replicas annually obtained from 83 lesions in 16 participants over 3 to 5 years. All lesions were visually categorized as wedge-shaped, saucer-shaped, or mixed-shaped lesions. CLSM images of the replicas were analyzed in terms of axial depth, occlusogingival width (height) in the buccolingual cross-section, and estimated volume using a custom code of the image analysis software to estimate the progression of the NCCLs over time. The morphological characteristics of the NCCLs were also objectively divided into three groups according to the depth to height ratio (D/H ratio). Fisher's exact test and the Cochran-Armitage trend test were used for statistical analysis.

RESULTS

Saucer-shaped lesions progressed mainly in height, whereas wedge-shaped lesions increased both in height and depth. Annual progression in depth and volume significantly increased as the D/H ratio increased. More than half of the NCCLs with a small D/H ratio progressed 50 μm or more in height, whereas none of them progressed more than 50 μm in depth. Annual progression in depth significantly increased as the lesion depth at baseline increased.

CONCLUSIONS

Progression patterns significantly differed between NCCLs of different shapes. Most NCCLs progressed slowly in depth regardless of their shape. Moreover, NCCLs may progress through active and inactive stages.

Effect of Surface Moisture on Bur-cut Dentin on Bonding of HEMA-free and HEMA-containing Universal Adhesives with or without Methacrylamide Monomer

PURPOSE

The effect of surface moisture on bur-cut dentin on the microtensile bond strength (μTBS) of universal adhesives with various contents of 2-hydroxyethyl methacrylate (HEMA) and methacrylamide monomers was evaluated.

MATERIALS AND METHODS

Flat mid-coronal dentin surfaces of human molars were exposed, and a standardized smear layer was prepared using a fine-grit diamond bur. The surfaces were either left wet or air dried for 10 s before bonding with Clearfil Universal Bond Quick (UBQ), experimental UBQ without an amide monomer (UBQexp), Scotchbond Universal (SBU), Prime&Bond Universal (PBU), or BeautiBond Universal (BBU). The specimens were built up with resin composite, sectioned into sticks and subjected to the μTBS test after 24 h or 10,000 thermal cycles. The μTBS data were analyzed using three-way ANOVA followed by pairwise comparisons with Bonferroni's correction (α = 0.05).

RESULTS

The level of dentin moisture did not significantly affect μTBS of UBQ and BBU (p > 0.05). HEMA-containing UBQ, UBQexp, and SBU exhibited higher μTBS to dry dentin, while HEMA-free PBU and BBU showed higher μTBS to wet dentin. Thermocycling significantly decreased the μTBS of UBQexp (p < 0.01) and BBU (p < 0.001) irrespective of dentin moisture level, while SBU was significantly affected only on dry dentin (p < 0.001). Thermocycling had no significant effect on UBQ and PBU containing methacrylamide monomers (p > 0.05).

CONCLUSION

Dry surfaces enabled obtaining optimal bonding for HEMA-containing adhesives to bur-cut dentin, while wet surfaces enabled optimal bonding for HEMA-free adhesives. Methacrylamide monomers could contribute to the improvement of the initial and long-term bonding performance of universal adhesives to bur-cut dentin.

The effect of in-office bleaching materials with different pH on the surface topography of bovine enamel

This study evaluated the alterations of surface topography of the bovine enamel caused by different pH of in-office bleaching agents. 23% H₂O₂ with pH 5.5, 7.0 and 8.5 were applied on the bovine tooth specimens (n=10) and photo-irradiated for 10 min. The bleaching procedure was repeated three times and specimens were subjected to linear surface roughness (Ra) and Vickers microhardness test (VHN) at baseline and after three consecutive applications. The morphological alterations were observed before and after third bleaching application. Data were analyzed by two-way ANOVA followed by Tukey's HSD. The pH of the bleaching agent significantly affects the Ra and VHN (p<0.05). Low pH yielded a significant increase in Ra and decrease in VHN. All the groups showed morphological alterations and profound effect was found in pH 5.5 group. It was concluded that the pH of the bleaching agent can affect Ra, VHN and surface morphology.

Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes.

Effect of fluoride-releasing 4-META/MMA-TBB resin on enamel demineralization around orthodontic brackets: An in vitro µCT analysis

This study aimed to evaluate the impact of fluoride-releasing 4-META/MMA-TBB resin on the degree of enamel demineralization typically detected around orthodontic brackets using μCT. Enamel-dentin blocks were prepared from bovine teeth. Brackets were attached with either 4-META/MMA-TBB resin (SBC), fluoride-releasing 4-META/MMA-TBB resin (SBF), or fluoride-releasing RMGIC (FLC). The specimens were subjected to demineralization (pH 4.5, 21 days) and scanned by μCT (0, 7, and 21 days). Fluoride ion release under the experimental conditions was measured. The degree of demineralization detected in SBF and FLC was significantly lower than that in SBC; there were no significant differences in the degree of demineralization detected in SBF and FLC. The level of fluoride ion detected in FLC was significantly higher than that detected in SBC. Fluoride-releasing 4-META/MMA-TBB resin protected against enamel demineralization around orthodontic brackets when compared to the results from the fluoride-free resin.

Effects of Different Tooth Conditioners on the Bonding of Universal Self-etching Adhesive to Enamel

PURPOSE

To investigate the effects of several etching products prior to the application of a one-step self-etch adhesive (1-SEA) or two-step self-etch adhesive (2-SEA) on enamel by microshear bond strength (µSBS) testing and observation of the adhesive-enamel interface.

MATERIALS AND METHODS

Ground human enamel surfaces were randomly assigned to one of eight groups according to the combination of surface treatments (either no conditioner [NC], ME [Multi Etchant], EC [Enamel Conditioner], or KE [K-etchant Gel]) and adhesive (ADU [Adhese Universal] or SE2 [Clearfil SE Bond 2]). All groups were further divided into two subgroups: 0 or 10,000 thermal cycles (TC). Then, the µSBS test was performed. The adhesive-enamel interface after acid-base challenge and the surface structure after conditioner application were also observed.

RESULTS

With 10,000 TCs, there was no statistically significant difference between ME-ADU and NC-ADU. On the other hand, the µSBS of EC-ADU or KE-ADU was significantly higher than that of NC-ADU, while that of ME-SE2 was significantly lower than NC-SE2. There was no significant difference between EC-SE2, NC-SE2, and KE-SE2. Formation of an acid-base resistance zone (ABRZ) was confirmed in all groups. However, funnel-shaped erosion, which indicates interfacial defects, was observed in the NC-ADU, ME-ADU, and ME-SE2 groups.

CONCLUSION

For enamel bonding, application of EC or KE prior to ADU increased the bond strength and created a stable adhesive-enamel interface. On the other hand, SE2 also had stable shear bond strength and interface without the use of conditioners. However, ME decreased the bonding performance of SE2.

The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo

OBJECTIVES

To evaluate the prevalence of non-carious cervical lesions (NCCLs) on teeth with or without erosive etiological factors across a broad range of ages of Japanese adults.

MATERIALS AND METHODS

The study sample consisted of a total of 1108 subjects aged 15 to 89 years in Tokyo, Japan. Two examiners evaluated NCCLs and dental erosion (DE) during a full-mouth examination. Subjects were asked to complete a self-administered daily diet, habits, and health condition questionnaire. Subjects who had frequent acid consumption or gastric reflux and at least one tooth with initial enamel wear were placed in the erosion present (EP) group, and the remainder of subjects were placed in the erosion not present (EN) group. Logistic regression analyses were carried out to identify etiological factors of NCCLs associated with DE.

RESULTS

Overall prevalence of NCCLs was 60.2%; the prevalence increased with age. There were no statistical differences in the prevalence of NCCLs between the EP and EN groups, except for the 60-69 years group. Multiple logistic regression analysis showed the frequency of consumption of carbonated soft drinks, citrus juice, and acidic fruits such as oranges; tooth brushing pressure; and bruxism were associated with the presence of NCCLs.

CONCLUSION

There were no statistical differences in the prevalence of NCCLs with or without erosive etiological factors except for the 60-69 years group.

CLINICAL RELEVANCE

NCCL distribution increased with age, and erosive risk factors caused by change in dietary habits might affect the incidence of NCCLs for elders.

TRIAL REGISTRATION

UMIN000041982.

Effect of photo-thermal acceleration on in-office bleaching

The purpose is to evaluate the effect of photo-thermal acceleration on in-office bleaching efficiency using a bleaching agent without photocatalysts in vitro. Artificially discolored bovine lower incisors were prepared, and the mixed in-office bleaching material contained hydrogen peroxide 23% was applied by following treatment for 10 min: high-(HI group) and low-intensity LED lights (LI group), oven at 38 °C (OV group), and room temperature at 23 °C (RT group). Color was measured before and after bleaching and color difference (∆E*) was calculated. The data were statistically analyzed using a two-way ANOVA and Tukey’s post hoc test. The temperature change (∆T) of applied bleaching agent in HI and LI groups was measured using a thermography and was analyzed using a T test. The bleaching procedures were repeated 6 times. Irradiation in the HI group resulted in the highest ΔE, followed by the LI group whose ΔE was significantly lower. Both irradiated modes exhibited higher ΔE compared to non-irradiated OV and RT groups which were not significantly different from each other. The average temperature rise of bleaching agents in HI and LI groups after 10 min irradiation was 15.00 °C and 11.80 °C, respectively. The effect of photo-thermal acceleration was proved for an in-office bleaching agent without photocatalysts in vitro.

Evaluation of Mechanical and Physical Properties of Light and Heat Polymerized UDMA for DLP 3D Printer

The aims of this study were to investigate the feasibility of using a DLP 3D printer to fabricate a crown using scan data before tooth preparation, and to investigate the effect of additional heat curing on the mechanical properties of the urethane dimethacrylate (UDMA)-based 3D printed crown. A silicone fitting test was used to evaluate the internal adaptation of the crown. For ultimate tensile strength (UTS), the specimens were tested after 24 h storage in water at 37 °C or after 10,000 thermal cycles (TC) between 5–55 °C. For shear bond strength (SBS), a PMMA self-curing resin was filled into a Teflon ring mounted onto the polished UDMA specimens. The internal adaptation of the crowns fabricated with cement space was better than those with no cement space. There was no significant difference in UTS between light-curing and additional heat-curing groups after TC. As for the SBS, there was a significant difference after TC between the two groups. Crowns can be fabricated by a DLP 3D printer using pre-preparation scans with a cement space defined in the software. Additional heat curing of the UDMA-based crown reduced residual monomer and improved its mechanical properties.

Effect of a temporary sealing material on the bond strength of CAD/CAM inlay restorations with resin-coating technique

This study aimed to assess the effects of a temporary sealing material and cleaning method of resin-coated dentin on the bond strength of computer-aided design/computer-aided manufacturing (CAD/CAM) inlay restorations. Resin-coated dentin surfaces were unsealed or temporarily sealed for 1 h or 1 week. For the temporarily sealed group, a hydraulic temporary sealing material was removed and further divided into four groups: without cleaning, cleaned with a rotational brush, a universal cleaner or an air-polishing device. Some specimens were investigated with energy dispersive X-ray spectroscopy and the others were used for microtensile bond strength (MTBS) test. A sealing material could not be removed with a rotational brush, which resulted in pretest failures in all specimens after 1 h and which resulted in low MTBS after 1 week. An air-polishing device can clean resin-coated dentin temporarily sealed with a hydraulic temporary sealing material and resulted in the similar MTBS as in the unsealed group.

Characteristics of biofilm-induced degradation at resin-dentin interfaces using multiple combinations of adhesives and resins

OBJECTIVE

We aimed to evaluate morphological, mechanical and chemical characteristics at resin-dentin interfaces using multiple combinations of adhesives and resins after a short-term biofilm-induced degradation.

METHODS

Cervical cavities were prepared in bovine incisors, treated by Clearfil SE Bond 2 (SE) or FL-Bond II (FL), restored by Clearfil Majesty ES Flow (ES) or Beautifil Flow Plus (BFP) and grouped into SE-ES, SE-BFP, FL-ES and FL-BFP. After biofilm challenge, interfacial gaps and dentin wall lesions were examined by optical coherence tomography (OCT). Gap depth (GD), gap pattern scale (GPS) and dentin wall lesion depth (WLD) were evaluated from confocal laser scanning microscope. Microhardness of dentin lesions was measured with a Vickers microhardness tester. Chemical elements in resins and dentin wall lesions were analyzed by scanning electron microscopy and energy dispersive X-ray spectrometry (SEM/EDS). Morphological structures of interfacial gaps were observed by SEM.

RESULTS

OCT could detect adhesive-dentin-bonded and adhesive-dentin-debonded gaps. SE-containing groups showed significantly lower GPS than FL-containing groups. FL-BFP showed significantly lower WLD than FL-ES. Microhardness of dentin wall lesions was higher than that of outer lesions and they showed significant differences in FL-BFP. SE-BFP showed a lower GPS curve and higher intensities of Ca and P in the upper half of dentin wall lesions than other groups. From SEM, microgaps between filler and matrix, break and loss of matrix, separation of adhesive matrix with hybrid layer occurred at interfacial gaps.

SIGNIFICANCE

The morphological, mechanical and chemical characteristics of resin-dentin interfacial degradation depend on the component and chemistry of restorative materials.

Effect of Air-Particle Abrasion Protocol and Primer on The Topography and Bond Strength of a High-Translucent Zirconia Ceramic

PURPOSE

To evaluate effect of air-particle abrasion protocol and primer on surface topography and bond strength of resin cement to high-translucent zirconia ceramics.

MATERIALS AND METHODS

Two hundred disk-shaped high-translucent zirconia specimens of 5Y-PSZ were prepared. The specimens were assigned to 5 groups in terms of particle type and air-particle abrasion pressure: (1) control, (2) alumina with 0.2 MPa-air pressure [AB-0.2], (3) alumina with 0.4 MPa-air pressure [AB-0.4], (4) glass beads with 0.2 MPa-air pressure [GB-0.2], and (5) glass beads with 0.4 MPa-air pressure [GB-0.4]. Two different primers 1% MDP (Experimental) and MDP-silane primer (Clearfil Ceramic Primer Plus) was also tested. Stainless steel rods were bonded to the 5Y-PSZ specimens with PANAVIA V5. For each group, the tensile bond strength (TBS) was measured after 24-hour water storage (n = 10) and after 5000 thermal-cycling (n = 10) at crosshead speed of 2 mm/min. The data were statistically analyzed using Weibull analysis. Surface roughness (Sa) was measured using a 3D-Laser Scanning Confocal Microscope (n = 5) and analyzed by t-test with Bonferroni correction. Surface topography using scanning electron microscopy (SEM) and surface elemental analysis using energy dispersion spectroscopy (EDX), and cross-section SEM at the interface with composite cement were also investigated.

RESULTS

In MDP-silane groups, the highest TBS was observed in AB-0.4 after 24 hours and GB-0.4 after thermal-cycling (p < 0.05). In MDP groups, AB groups resulted in the significantly higher TBS than GB groups (p < 0.05). AB-0.4 group showed the highest Sa value compared to all groups (p < 0.005), meanwhile GB groups did not show different Sa compared to control (p > 0.005).

CONCLUSION

Air-abrasion with different particle and blasting pressure can improve bonding to zirconia with proper primer selection. Particularly, glass beads abrasion followed by MDP-silane primer and alumina abrasion followed by MDP primer alone provided stable bond strength of resin cement to high-translucent zirconia after aging. High-translucent zirconia abraded with glass beads achieves a desirable bonding performance without creating surface microcracks which may hinder zirconia's mechanical properties.

The effect of different ceramic surface treatments on the repair bond strength of resin composite to lithium disilicate ceramic

This study aimed to evaluate the bonding abilities and long-term durability of different repair agents when applied to lithium disilicate ceramics (LDS). Blocks of IPS e.max CAD were prepared and divided into four groups according to the surface treatment: Monobond Etch & Prime (ME), K-etchant GEL+Clearfil Universal Bond (UB), Bondmer Lightless (BL), and K-etchant GEL+G-Multi Primer (GMP). All treated ceramic specimens were bonded to resin composite and light-cured. The micro-shear bond strength was measured after 24 h of water storage or 5,000 thermocycles. ME and BL showed significantly higher initial bond strengths than UB and GMP (p<0.05). After 5,000 thermocycles, there was no significant difference in ME (p>0.05), but BL and GMP showed considerable reduction in bond strength (p<0.05); moreover, the samples of UB were all de-bonded before testing. ME and BL proved to be effective surface treatment materials for LDS.

Color adjustment potential of single-shade resin composite to various-shade human teeth: Effect of structural color phenomenon

This study evaluated the effect of the structural color phenomenon in resin composites (RCs) on the color adjustment of restorations by investgating their color reproduction performance in human incisors of various shade. Cervical cavities were filled with a single-shade RC with 260 nm spherical fillers (Omnichroma (OMN)), conventional A2-shade RCs (Estelite Σ Quick or Clearfil AP-X), or experimental RCs with 5-50 nm fumed silica fillers (R1) and 100 nm spherical fillers (R2). Color parameters (L*C*h*) were measured using a CIE XYZ camera along the centerline of the restorations, and the color difference (∆E₀₀) between corresponding areas of intact and restored teeth was calculated. Additionally, the reflectance spectra of OMN, R1, and R2 were investigated. OMN exhibited significantly lower ∆E₀₀ than other tested RCs (p<0.05) and its reflection spectrum ranged from blue to red, while a blue peak was observed with R1 and R2, indicating a higher color adjustment potential of OMN.

Influence of primer contamination on the bonding interface of enamel pre-etched with phosphoric acid

In this study, the influence of primer contamination on enamel bonding was analyzed. Adper Scotchbond Multi-Purpose (SMP), CLEARFIL SE Bond 2 (SE2), Scotchbond Universal (SBU) Adhesive, and Scotchbond Etchant (35% phosphoric acid; PA) were used. Ground bovine enamels were divided into eight groups based on the bonding protocols. The bonding interfaces after an acid-base challenge were observed via scanning electron microscopy to determine the acid-base resistant zone (ABRZ). Moreover, the bonding interfaces after the nanoleakage challenge were analyzed via energy-dispersive X-ray spectroscopy. ABRZ was observed in all the samples except PA_ONLY (applied PA etching, No primer and No adhesive resin). The funnel-shaped erosion was detected only in X_SBU (applied SBU without PA etching). The nanoleakage test revealed silver patterns in some groups. The nanoleakage, i.e., the penetration of the silver ions, was detected in the groups wherein primer was applied on PA-pre-etched enamel.

The effect of reduced glutathione on the toxicity of silver diamine fluoride in rat pulpal cells

Introduction

Due to its ability to arrest untreated dental caries, silver diamine fluoride (SDF) has been advocated for indirect pulp capping procedures. However, the high concentrations of silver and fluoride in SDF raise concerns about its biocompatibility to pulpal tissues.

Objectives

This study aimed to investigate the effect of SDF on the viability, alkaline phosphatase (ALP) activity, and morphology of pulpal-like cells (RPC-C2A) and to evaluate the influence of reduced glutathione (GSH) on SDF-induced cytotoxicity and deposit formation on dentin.

Methodology

The cytotoxicity of diluted 38% SDF solutions (10-4 and 10-5), with or without the addition of 5 mM or 50 mM GSH, was evaluated at 6 and 24 hours. Cell viability was detected using WST-8 and the effect on ALP activity was performed using an ALP assay kit. Cell morphology was observed using a phase-contrast microscope. Scanning electron microscopy analysis was conducted to evaluate the effect of GSH incorporation or conditioning on SDF-induced deposit formation on dentin discs. Cytotoxicity data were analyzed by two-way analysis of variance (ANOVA) and Tukey post hoc tests (p<0.05).

Results

There were significant differences between the groups. The results demonstrated that all tested SDF dilutions caused a remarkable cytotoxic effect, while the addition of GSH prevented SDF-induced damage at 6-hour exposure time in the higher dilution of SDF. Dentin treated with plain SDF or GSH-incorporated SDF solution showed deposit formation with occluded dentinal tubules, unlike the other groups.

Conclusion

SDF severely disturbed the viability, mineralization-ability, and morphology of pulpal-like cells, while controlled concentrations of GSH had a short-term protective effect against SDF-induced damage. GSH showed an inhibitory effect on SDF-induced dentinal deposit formation. Further research is warranted to evaluate the effect of GSH on caries-arresting, anti-hypersensitivity, and antibacterial functions of SDF.

Deproteinization of caries-affected dentin with chemo-mechanical caries removal agents and its effect on dentin bonding with self-etch adhesives

OBJECTIVES

To evaluate the micro-tensile bond strength (μTBS) of self-etch adhesives (SEA) to normal and caries-affected dentin after smear layer deproteinization with papain enzyme-based and NaOCl-based chemo-mechanical caries removal agents (CRAs) and to compare their efficacy to a 6 % NaOCl solution.

METHODS

Forty extracted human molars with occlusal carious lesions were randomly divided into four pretreatment groups: no treatment (control), Papacarie for 60 s, Carisolv for 60 s, and 6 % NaOCl for 15 s. After pretreatment, Universal Bond Quick ER (UBQ, one-step, 1-SEA) or Clearfil SE Bond 2 (CSE, two-step, 2-SEA) was applied to the pre-treated surface, and built-up with resin composite (Clearfil AP-X). The μTBS test was performed after 24 h water storage of the specimens at 37 °C, and the modes of failure were determined under SEM. Deproteinizing effects of the tested agents on smear layer-covered dentin was quantified by changes in the amide:phosphate ratio using attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR) analysis.

RESULTS

On caries-affected dentin the μTBS improved significantly after pretreatment with Papacarie, Carisolv, and 6 % NaOCl with both SEAs (p < 0.05). Papacarie pretreatment significantly improved the μTBS of UBQ on normal dentin compared to NaOCl pretreatment (p < 0.05). ATR-FTIR revealed that all agents significantly decreased the amide:phosphate ratio on the smear layer-covered normal and caries-affected dentin (p < 0.05).

CONCLUSIONS

Smear layer deproteinizing with papain enzyme-based and NaOCl-based gel CRAs was effective in improving the micro-tensile bond strength of self-etch adhesives to caries-affected dentin.

CLINICAL SIGNIFICANCE

Smear layer deproteinization with Papacarie (a papain enzyme-based gel) or Carisolv (a NaOCl-based gel) can improve the μTBS to normal and caries-affected dentin bonded with 2-step self-etch adhesives.