Indirect repair of saliva-contaminated materials using veneering ceramics.

PURPOSE: To analyze the in vitro efficacy of a surface conditioning liquid facilitating ceramic repairs of saliva-contaminated metal-ceramic and all-ceramic restorations. MATERIALS AND METHODS: Specimens constructed from nonprecious alloy (NPA), precious alloy (PA), lithium-disilicate (LD), zirconia (ZI), veneering ceramics for zirconia (VZI), veneering ceramics for lithium-disilicate (VLD), and veneering ceramics for metal alloys (VM) were manufactured (total: n = 168; each material n = 24). Veneering ceramic cylinders (thickness: 2 mm) were hand-layered on top of the specimens. Shear bond strength (SBS) tests were performed, measuring the maximum bond strength (MBS) of the cylinders on the specimens. Following this, the specimens were artificially aged and stored in artificial saliva for 30 days at 37°C. After physical cleaning using aluminum oxide air abrasion, a new surface conditioning liquid was applied (test, n = 84) or not (control, n = 84). New ceramic cylinders were hand-layered followed by a second SBS test. Descriptive statistics, linear regression analyses, and a one-sample t-test (α = 0.05) were used to ascertain the differences within (prerepair vs. postrepair) and between the groups. RESULTS: All specimens in the test group could be repaired, whereas 18 repairs in the control group failed. After the repairs, an MBS decrease was observed for the NPA specimens of the control group (-15.5 MPa, p = 0.004) but not among any of the test groups. Comparing the change in MBS between the test and control groups, the reduction was significantly higher in the repaired NPA specimens of the control group (mean difference 11.8 MPa, p = 0.017). CONCLUSIONS: Using the analyzed surface conditioning liquid, metal-ceramic and all-ceramic materials can be repaired, while some repairs failed without the liquid. The initial bond strengths between core and veneering materials could be restored in all specimens when the new surface conditioning liquid was applied.

Long-Term Bond Strength of Self-Etch Adhesives to Normal and Artificially Eroded Dentin: Effect of Relative Humidity and Saliva Contamination.

PURPOSE: To investigate the effect of relative humidity and saliva contamination on short- and long-term bond strength of two self-etch adhesives to normal and artificially eroded dentin. MATERIALS AND METHODS: A total of 480 dentin specimens were produced from extracted human molars. Half of the specimens (n = 240) were left untreated (normal dentin) whereas the other half (n = 240) were artificially eroded. The specimens were treated with Clearfil SE Bond (CSE) or Scotchbond Universal (SBU), and composite (Filtek Z250) was applied to the treated dentin surface under four experimental conditions: at a relative humidity of 45% or 85% without/with human saliva contamination. Shear bond strength (SBS) was measured after storage for 24 h (100% humidity; 37°C) or 1 year (tap water; 37°C). SBS results were statistically analyzed with a nonparametric ANOVA followed by Wilcoxon-Mann-Whitney tests (significance level: α = 0.05). RESULTS: SBS was significantly influenced by the dentin substrate (normal or artificially eroded dentin) and adhesive (p < 0.001) but not by relative humidity, saliva contamination, or storage. SBS significantly differed (all p < 0.001) following the ranking (MPa; medians [pooled]): SBU on normal dentin (21.1) > CSE on normal dentin (19.2) > SBU on artificially eroded dentin (17.1) > CSE on artificially eroded dentin (10.9). CONCLUSION: On normal dentin, the two self-etch adhesives showed stable bond strength over time even under adverse conditions such as high relative humidity and saliva contamination. However, erosively altered dentin had a detrimental effect on the bond strength of both the adhesives investigated.

Effect of artificial toothbrushing and water storage on the surface roughness and micromechanical properties of tooth-colored CAD-CAM materials.

STATEMENT OF PROBLEM: Because of the different composition of resin-ceramic computer-aided design and computer-aided manufacturing (CAD-CAM) materials, their polishability and their micromechanical properties vary. Moreover, depending on the composition of the materials, their surface roughness and micromechanical properties are likely to change with time. PURPOSE: The purpose of this in vitro study was to investigate the effect of artificial toothbrushing and water storage on the surface roughness (Ra and Rz) and the micromechanical properties, surface hardness (Vickers [VHN]) and indentation modulus (EIT), of 5 different tooth-colored CAD-CAM materials when polished with 2 different polishing systems. MATERIAL AND METHODS: Specimens (n=40 per material) were cut from a composite resin (Paradigm MZ100; 3M ESPE), a feldspathic ceramic (Vitablocs Mark II; Vita Zahnfabrik), a resin nanoceramic (Lava Ultimate; 3M ESPE), a hybrid dental ceramic (Vita Enamic; Vita Zahnfabrik), and a nanocomposite resin (Ambarino High-Class; Creamed). All specimens were roughened in a standardized manner and polished either with Sof-Lex XT discs or the Vita Polishing Set Clinical. Surface roughness, VHN, and EIT were measured after polishing and after storage for 6 months (tap water, 37°C) with periodic, artificial toothbrushing. The surface roughness, VHN, and EIT results were analyzed with a nonparametric ANOVA followed by Kruskal-Wallis and exact Wilcoxon rank sum tests (α=.05). RESULTS: Irrespective of polishing system and of artificial toothbrushing and storage, Lava Ultimate generally showed the lowest surface roughness and Vitablocs Mark II the highest. As regards micromechanical properties, the following ranking of the CAD-CAM materials was found (from highest VHN/EIT to lowest VHN/EIT): Vitablocs Mark II > Vita Enamic > Paradigm MZ100 > Lava Ultimate > Ambarino High-Class. Irrespective of material and of artificial toothbrushing and storage, polishing with Sof-Lex XT discs resulted in lower surface roughness than the Vita Polishing Set Clinical (P≤.016). However, the polishing system generally had no influence on the micromechanical properties (P>.05). The effect of artificial toothbrushing and storage on surface roughness depended on the material and the polishing system: Ambarino High-Class was most sensitive to storage, Lava Ultimate and Vita Enamic were least sensitive. Artificial toothbrushing and storage generally resulted in a decrease in VHN and EIT for Paradigm MZ100, Lava Ultimate, and Ambarino High-Class but not for Vita Enamic and Vitablocs Mark II. CONCLUSIONS: Tooth-colored CAD-CAM materials with lower VHN and EIT generally showed better polishability. However, these materials were more prone to degradation by artificial toothbrushing and water storage than materials with higher VHN and EIT.

Effect of salivary contamination and decontamination on bond strength of two one-step self-etching adhesives to dentin of primary and permanent teeth.

PURPOSE: To evaluate the effects of human saliva contamination and two decontamination procedures at different stages of the bonding procedure on the bond strength of two one-step self-etching adhesives to primary and permanent dentin. MATERIALS AND METHODS: Extracted human primary and permanent molars (210 of each) were ground to mid-coronal dentin. The dentin specimens were randomly divided into 7 groups (n = 15/group/molar type) for each adhesive (Xeno V+ and Scotchbond Universal): no saliva contamination (control); saliva contamination before or after light curing of the adhesives followed by air drying, rinsing with water spray/air drying, or by rinsing with water spray/air drying/reapplication of the adhesives. Resin composite (Filtek Z250) was applied on the treated dentin surfaces. The specimens were stored at 37°C and 100% humidity for 24 h. After storage, shear bond strength (SBS) was measured and data analyzed with nonparametric ANOVA followed by exact Wilcoxon rank sum tests. RESULTS: Xeno V+ generated significantly higher SBS than Scotchbond Universal when no saliva contamination occurred. Saliva contamination reduced SBS of Xeno V+, with the reduction being more pronounced when contamination occurred before light curing than after. In both situations, decontamination involving reapplication of the adhesive restored SBS. Saliva contamination had no significant effect on Scotchbond Universal. There were no differences in SBS between primary and permanent teeth. CONCLUSION: Rinsing with water and air drying followed by reapplication of the adhesive restored bond strength to saliva-contaminated dentin.

Bond Strength of Resin Composite to Dentin with Different Adhesive Systems: Influence of Relative Humidity and Application Time.

PURPOSE: To investigate the influence of relative humidity and application time on bond strength to dentin of different classes of adhesive systems. MATERIALS AND METHODS: A total of 360 extracted human molars were ground to mid-coronal dentin. The dentin specimens were treated with one of six adhesive systems (Syntac Classic, OptiBond FL, Clearfil SE Bond, AdheSE, Xeno Select, or Scotchbond Universal), and resin composite (Filtek Z250) was applied to the treated dentin surface under four experimental conditions (45% relative humidity/application time according to manufacturers' instructions; 45% relative humidity/reduced application time; 85% relative humidity/application time according to manufacturers' instructions; 85% relative humidity/reduced application time). After storage (37°C, 100% humidity, 24 h), shear bond strength (SBS) was measured and data analyzed with nonparametric ANOVA followed by Kruskal-Wallis tests and Mann-Whitney U-tests with Bonferroni-Holm correction for multiple testing (level of significance: α = 0.05). RESULTS: Increased relative humidity and reduced application time had no effect on SBS for Clearfil SE Bond and Scotchbond Universal (p = 1.00). For Syntac Classic, OptiBond FL, AdheSE, and Xeno Select there was no effect on SBS of reduced application time of the adhesive system (p ≥ 0.403). However, increased relative humidity significantly reduced SBS for Syntac Classic, OptiBond FL, and Xeno Select irrespective of application time (p ≤ 0.003), whereas for AdheSE, increased relative humidity significantly reduced SBS at recommended application time only (p = 0.002). CONCLUSION: Generally, increased relative humidity had a detrimental effect on SBS to dentin, but reduced application time had no effect.

Two pre-treatments for bonding to non-carious cervical root dentin.

PURPOSE: To investigate the effect of airborne-particle abrasion or diamond bur preparation as pre-treatment steps of non-carious cervical root dentin regarding substance loss and bond strength. METHODS: 45 dentin specimens-produced from crowns of extracted human incisors by grinding the labial surfaces with silicon carbide papers (control) were treated with one of three adhesive systems (Group 1A-C; A: OptiBond FL, B: Clearfil SE Bond, or C: Scotchbond Universal; n= 15/adhesive system). Another 135 dentin specimens (n = 15/group) produced from the labial, non-carious cervical root part of extracted human incisors were treated with one of the adhesive systems after either no pre-treatment (Group 2A-C), pre-treatment with airborne-particle abrasion (CoJet Prep and 50 µm aluminum oxide powder; Group 3A-C), or pre-treatment with diamond bur preparation (40 µm grit size; Group 4A-C). Substance loss caused by the pre-treatment was measured in Groups 3 and 4. After treatment with the adhesive systems, resin composite was applied and all specimens were stored (37°C, 100% humidity, 24 hours) until measurement of micro-shear bond strength (µSBS). Data were analyzed with a nonparametric ANOVA followed by Kruskal-Wallis and Wilcoxon rank sum tests (level of significance: α = 0.05). RESULTS: Overall substance loss was significantly lower in Group 3 (median: 19 µm) than in Group 4 (median: 113 µm; P < 0.0001). There were no significant differences in µSBS between the adhesive systems (A-C) in Group 1, Group 3, and Group 4 (P 0.133). In Group 2, OptiBond FL (Group 2A) and Clearfil SE Bond (Group 2B) yielded significantly higher µSBS than Scotchbond Universal (Group 2C; P ≤ 0.032). For OptiBond FL and Clearfil SE Bond, there were no significant differences in µSBS between the ground crown dentin and the non-carious cervical root dentin regardless of any pre-treatment of the latter (both P = 0.661). For Scotchbond Universal, the µSBS to non-carious cervical root dentin without pre-treatment was significantly lower than to ground crown dentin and to non-carious cervical root dentin pre-treated with airborne-particle abrasion or diamond bur preparation (P ≤ 0.014).

Light curing through glass ceramics: effect of curing mode on micromechanical properties of dual-curing resin cements.

OBJECTIVES: The aim of this study was to investigate micromechanical properties of five dual-curing resin cements after different curing modes including light curing through glass ceramic materials. MATERIALS AND METHODS: Vickers hardness (VH) and indentation modulus (Y HU) of Panavia F2.0, RelyX Unicem 2 Automix, SpeedCEM, BisCem, and BeautiCem SA were measured after 1 week of storage (37 °C, 100 % humidity). The resin cements were tested following self-curing or light curing with the second-generation light-emitting diode (LED) curing unit Elipar FreeLight 2 in Standard Mode (1,545 mW/cm(2)) or with the third-generation LED curing unit VALO in High Power Mode (1,869 mW/cm(2)) or in XtraPower Mode (3,505 mW/cm(2)). Light curing was performed directly or through glass ceramic discs of 1.5 or 3 mm thickness of IPS Empress CAD or IPS e.max CAD. VH and Y HU were analysed with Kruskal-Wallis tests followed by pairwise Wilcoxon rank sum tests (α = 0.05). RESULTS: RelyX Unicem 2 Automix resulted in the highest VH and Y HU followed by BeautiCem SA, BisCem, SpeedCEM, and finally Panavia F2.0. Self-curing of RelyX Unicem 2 Automix and SpeedCEM lowered VH and Y HU compared to light curing whereas self-curing of Panavia F2.0, BisCem, and BeautiCem SA led to similar or significantly higher VH and Y HU compared to light curing. Generally, direct light curing resulted in similar or lower VH and Y HU compared to light curing through 1.5-mm-thick ceramic discs. Light curing through 3-mm-thick discs of IPS e.max CAD generally reduced VH and Y HU for all resin cements except SpeedCEM, which was the least affected by light curing through ceramic discs. CONCLUSIONS: The resin cements responded heterogeneously to changes in curing mode. The applied irradiances and light curing times adequately cured the resin cements even through 1.5-mm-thick ceramic discs. CLINICAL RELEVANCE: When light curing resin cements through thick glass ceramic restorations, clinicians should consider to prolong the light curing times even with LED curing units providing high irradiances.

Effect of tin-chloride pretreatment on bond strength of two adhesive systems to dentin.

OBJECTIVES: To determine the effect on resin composite-to-dentin bond strength of incorporation of an acidic tin-chloride pretreatment in two adhesive systems. MATERIALS AND METHODS: Human molars were ground to expose mid-coronal dentin. For microtensile bond strength (µTBS) testing, dentin was treated with Optibond FL or Clearfil SE according to one of six protocols (n = 22/group). Group 1: Phosphoric acid etching, Optibond FL Prime, Optibond FL Adhesive (manufacturer's instructions; control); Group 2: Tin-chloride pretreatment, Optibond FL Prime, Optibond FL Adhesive; Group 3: Phosphoric acid etching, tin-chloride pretreatment, Optibond FL Prime, Optibond FL Adhesive; Group 4: Clearfil SE Primer, Clearfil SE Bond (manufacturer's instructions; control); Group 5: Phosphoric acid etching, Clearfil SE Primer, Clearfil SE Bond; and Group 6: Tin-chloride pretreatment, Clearfil SE Primer, Clearfil SE Bond. The molars were then built up with resin composite (Clearfil Majesty Esthetic). After storage (1 week, 100 % humidity, 37 °C) the µTBS was measured and failure mode was determined. Additionally, pretreated dentin surfaces were evaluated using SEM and EDX. The µTBS results were analyzed statistically by a Welch Two Sample t-test and a Kruskal-Wallis test followed by exact Wilcoxon rank sum tests with Bonferroni-Holm adjustment for multiple testing (α = 0.05). RESULTS: When Optibond FL was used, partial or total replacement of phosphoric acid with tin-chloride decreased µTBS significantly. In contrast, when Clearfil SE was used, inclusion of a tin-chloride pretreatment in the adhesive procedure increased µTBS significantly. CONCLUSIONS: Tin-chloride pretreatment had a beneficial influence on the bond promoting capacity of the MDP-containing adhesive system Clearfil SE.

Temporary zinc oxide-eugenol cement: eugenol quantity in dentin and bond strength of resin composite.

Uptake of eugenol from eugenol-containing temporary materials may reduce the adhesion of subsequent resin-based restorations. This study investigated the effect of duration of exposure to zinc oxide-eugenol (ZOE) cement on the quantity of eugenol retained in dentin and on the microtensile bond strength (µTBS) of the resin composite. The ZOE cement (IRM Caps) was applied onto the dentin of human molars (21 per group) for 1, 7, or 28 d. One half of each molar was used to determine the quantity of eugenol (by spectrofluorimetry) and the other half was used for µTBS testing. The ZOE-exposed dentin was treated with either OptiBond FL using phosphoric acid (H3PO4) or with Gluma Classic using ethylenediaminetetraacetic acid (EDTA) conditioning. One group without conditioning (for eugenol quantity) and two groups not exposed to ZOE (for eugenol quantity and µTBS testing) served as controls. The quantity of eugenol ranged between 0.33 and 2.9 nmol mg⁻¹ of dentin (median values). No effect of the duration of exposure to ZOE was found. Conditioning with H3PO4 or EDTA significantly reduced the quantity of eugenol in dentin. Nevertheless, for OptiBond FL, exposure to ZOE significantly decreased the µTBS, regardless of the duration of exposure. For Gluma Classic, the µTBS decreased after exposure to ZOE for 7 and 28 d. OptiBond FL yielded a significantly higher µTBS than did Gluma Classic. Thus, ZOE should be avoided in cavities later to be restored with resin-based materials.

Light curing through glass ceramics with a second- and a third-generation LED curing unit: effect of curing mode on the degree of conversion of dual-curing resin cements.

OBJECTIVES: The aim of this study was to measure the degree of conversion (DC) of five dual-curing resin cements after different curing modes with a second- and a third-generation light-emitting diode (LED) curing unit. Additionally, irradiance of both light curing units was measured at increasing distances and through discs of two glass ceramics for computer-aided design/manufacturing (CAD/CAM). MATERIALS AND METHODS: Irradiance and spectra of the Elipar FreeLight 2 (Standard Mode (SM)) and of the VALO light curing unit (High Power Mode (HPM) and Xtra Power Mode (XPM)) were measured with a MARC radiometer. Irradiance was measured at increasing distances (control) and through discs (1.5 to 6 mm thickness) of IPS Empress CAD and IPS e.max CAD. DC of Panavia F2.0, RelyX Unicem 2 Automix, SpeedCEM, BisCem, and BeautiCem SA was measured with an attenuated total reflectance-Fourier transform infrared spectrometer when self-cured (negative control) or light cured in SM for 40 s, HPM for 32 s, or XPM for 18 s. Light curing was performed directly (positive control) or through discs of either 1.5- or 3-mm thickness of IPS Empress CAD or IPS e.max CAD. DC was analysed with Kruskal-Wallis tests followed by pairwise Wilcoxon rank sum tests (α = 0.05). RESULTS: Maximum irradiances were 1,545 mW/cm(2) (SM), 2,179 mW/cm(2) (HPM), and 4,156 mW/cm(2) (XPM), and all irradiances decreased by >80 % through discs of 1.5 mm, ≥95 % through 3 mm, and up to >99 % through 6 mm. Generally, self-curing resulted in the lowest DC. For some cements, direct light curing did not result in higher DC compared to when light cured through ceramic discs. For other cements, light curing through ceramic discs of 3 mm generally reduced DC. CONCLUSIONS: Light curing was favourable for dual-curing cements. Some cements were more susceptible to variations in curing mode than others. CLINICAL RELEVANCE: When light curing a given cement, the higher irradiances of the third-generation LED curing unit resulted in similar DC compared to the second-generation one, though at shorter light curing times.

The effect of a tin-containing fluoride mouth rinse on the bond between resin composite and erosively demineralised dentin.

OBJECTIVES: To evaluate the effect of a tin-containing fluoride (Sn/F) mouth rinse on microtensile bond strength (µTBS) between resin composite and erosively demineralised dentin. MATERIALS AND METHODS: Dentin of 120 human molars was erosively demineralised using a 10-day cyclic de- and remineralisation model. For 40 molars, the model comprised erosive demineralisation only; for another 40, the model included treatment with a NaF solution; and for yet another 40, the model included treatment with a Sn/F mouth rinse. In half of these molars (n = 20), the demineralised organic matrix was continuously removed by collagenase. Silicon carbide paper-ground, non-erosively demineralised molars served as control (n = 20). Subsequently, µTBS of Clearfil SE/Filtek Z250 to the dentin was measured, and failure mode was determined. Additionally, surfaces were evaluated using SEM and EDX. RESULTS: Compared to the non-erosively demineralised control, erosive demineralisation resulted in significantly lower µTBS regardless of the removal of demineralised organic matrix. Treatment with NaF increased µTBS, but the level of µTBS obtained by the non-erosively demineralised control was only reached when the demineralised organic matrix had been removed. The Sn/F mouth rinse together with removal of demineralised organic matrix led to significantly higher µTBS than did the non-erosively demineralised control. The Sn/F mouth rinse yielded higher µTBS than did the NaF solution. CONCLUSIONS: Treatment of erosively demineralised dentin with a NaF solution or a Sn/F mouth rinse increased the bond strength of resin composite. CLINICAL RELEVANCE: Bond strength of resin composite to eroded dentin was not negatively influenced by treatment with a tin-containing fluoride mouth rinse.

In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii following root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes.

OBJECTIVES: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro. MATERIALS AND METHODS: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72 h and adhesion of S. gordonii ATCC 10558 for 2 h have been determined. RESULTS: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36 µm/after: 0.25 µm; p < 0.001; median Rz before: 2.34 µm/after: 1.61 µm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31 µm/Rz of 2.06 µm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria. CONCLUSIONS: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion. CLINICAL RELEVANCE: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healing.

Micromorphology and adhesive performance of Er:YAG laser-treated dentin of primary teeth.

This study evaluated (1) the micromorphology by scanning electron microscopy (SEM) and (2) the adhesive performance by microtensile bond strength (µTBS) of diamond bur-treated dentin compared to Er:YAG laser-treated dentin of human primary teeth. (1) For qualitative SEM evaluation, dentin of 18 second primary molars (n = 3/method) was treated with either diamond bur as a control (group 1a: 40 µm diamond bur only (clinical situation); group 1b: grinding + 40 µm diamond bur) or with Er:YAG laser (group 2a (clinical situation, manufacturer's settings): 200 mJ/25 Hz (5 W) + 100 mJ/35 Hz (3.5 W) laser only; group 2b (experimental setting "high"): grinding + 400 mJ/20 Hz (8 W); group 2c (manufacturer's setting "finishing"): grinding + 100 mJ/35 Hz (3.5 W); group 2d (experimental setting "low"): grinding + 50 mJ/35 Hz (1.75 W)). (2) For evaluation of adhesive performance, 64 second primary molars were divided into four groups and treated as described for group 1b and groups 2b/c/d (n = 16/method), and µTBS of Clearfil SE/Clearfil Majesty Esthetic to dentin was measured. The SEM micrographs were qualitatively analyzed. The µTBS values were compared with a Kruskal-Wallis test. The significance level was set at α = 0.05. SEM micrographs showed the typical micromorphologies with a smear layer for the diamond bur groups and open dentin tubules for all laser-treated groups. However, in group 2d, the laser beam had insufficiently irradiated the dentin area, rendering the underlying ground surface partly visible. There were no statistically significant differences between µTBS values of the four groups (p = 0.394). This suggests that Er:YAG laser treatment of dentin of primary molars provides bond strengths similar to those obtained following diamond bur treatment.

The influence of toothbrushing and coffee staining on different composite surface coatings.

The aim of our study is to evaluate the performance of surface sealants and conventional polishing after ageing procedures. Eighty circular composite restorations were performed on extracted human molars. After standardised roughening, the restorations were either sealed with one of three surface sealants (Lasting Touch (LT), BisCover LV (BC), G-Coat Plus (GP) or a dentin adhesive Heliobond (HB)) or were manually polished with silicon polishers (MP) (n = 16). The average roughness (Ra) and colourimetric parameters (CP) (L*a*b*) were evaluated. The specimens underwent an artificial ageing process by thermocycling, staining (coffee) and abrasive (toothbrushing) procedures. After each ageing step, Ra and CP measurements were repeated. A qualitative surface analysis was performed with SEM. The differences between the test groups regarding Ra and CP values were analysed with nonparametric ANOVA analysis (α = 0.05). The lowest Ra values were achieved with HB. BC and GP resulted in Ra values below 0.2 µm (clinically relevant threshold), whereas LT and MP sometimes led to higher Ra values. LT showed a significantly higher discolouration after the first coffee staining, but this was normalised to the other groups after toothbrushing. The differences between the measurements and test groups for Ra and CP were statistically significant. However, the final colour difference showed no statistical difference among the five groups. SEM evaluation showed clear alterations after ageing in all coating groups. Surface sealants and dentin adhesives have the potential to reduce surface roughness but tend to debond over time. Surface sealants can only be recommended for polishing provisional restorations.

Enamel loss and adhesive remnants following bracket removal and various clean-up procedures in vitro.

This study evaluated the enamel loss and composite remnants after debonding and clean-up. The tested null hypothesis is that there are no differences between different polishing systems regarding removing composite remnants without damaging the tooth surface. Brackets were bonded to 75 extracted human molars and removed after a storage period of 100 hours. The adhesive remnant index (ARI) was evaluated. The clean-up was carried out with five different procedures: 1. carbide bur; 2. carbide bur and Brownie and Greenie silicone polishers; 3. carbide bur and Astropol polishers; 4. carbide bur and Renew polishers; and 5. carbide bur, Brownie, Greenie and PoGo polishers. Silicone impressions were made at baseline (T0) and after debonding (T1) and polishing (T2) to produce plaster replicas. The replicas were analysed with a three-dimensional laser scanner and measured with analytical software. Statistical analysis was performed with the Kruskal-Wallis test and pairwise Wilcoxon tests with Bonferroni-Holm adjustment (α = 0.05). Enamel breakouts after debonding were detectable in 27 per cent of all cases, with a mean volume loss of 0.02 mm(3) (±0.03 mm(3)) and depth of 44.9 µm (±48.3 µm). The overall ARI scores was 3 with a few scores of 1 and 2. The composite remnants after debonding had a mean volume of 2.48 mm(3) (±0.92 mm(3)). Mean volume loss due to polishing was 0.05 mm(3) (±0.26 mm(3)) and the composite remnants had a mean volume of 0.22 mm(3) (±0.32 mm(3)). There were no statistically significant differences in volumetric changes after polishing (P = 0.054) between the different clean-up methods. However, sufficient clean-up without enamel loss was difficult to achieve.

The effect of polymerization procedure on Vickers hardness of dual-curing resin cements.

PURPOSE: To investigate the surface hardness (Vickers hardness, HVN) of one light-curing flowable resin composite and five dual-curing resin cements after different polymerization procedures. METHODS: The HVN was measured with a hardness-indentation device on one light-curing flowable resin composite (Tetric EvoFlow) and five dual-curing resin cements (Panavia F2.0, SpeedCEM, RelyX Unicem Clicker, SmartCem2 and iCEM) after the resin material had been cured at constant 30 degrees C according to one of five polymerization procedures (n = 30/procedure and material): (1) 5-minute light-curing (positive control; prolonged light-curing), (2) 40-second light-curing (immediate light-curing), (3) 6-minute auto-curing (negative control; dual-curing resin cements only), (4) 6-minute auto-curing followed by 40-second light-curing (delayed light-curing), and (5) 5-second light-curing, 1-minute auto-curing and 40-second light-curing (instructions for removal of excess cement). A Kruskal Wallis test followed by pairwise Wilcoxon ranksum tests with Bonferroni-Holm adjustment was applied for each material and procedure (level of significance: alpha = 0.05). RESULTS: For each material, Procedure 1 showed the significantly highest HVN and Procedure 3 the significantly lowest HVN. Procedure 4 showed significantly increased HVN for each material compared to Procedure 3. With Procedure 1, Panavia F2.0 and RelyX Unicem yielded significantly higher HVN than the other resin materials. With Procedure 3, no significant differences in HVN were found between Panavia F2.0, SpeedCEM and SmartCem2 which all showed significantly higher HVN than RelyX Unicem and iCEM.

[Dentin bonding of cements. The bonding of cements with dentin in combination with various indirect restorative materials]. / Dentinhaftung von Zementen. Der Haftverbund von Zementen mit Dentin in Kombination mit verschiedenen indirekten Restaurationsmaterialien.

The number of both luting agents and restorative materials available on the market has rapidly increased. This study compared various types of luting agents when used to bond different indirect, laboratory restorative materials to dentin. Cylinders were produced of six restorative materials (gold alloy, titanium, feldspathic porcelain, leucite-glass ceramic, zirconia, and an indirect resin composite). Following relevant pretreatment, the end surface of the cylinders were luted to ground, human dentin with eight different luting agents (DeTrey Zinc [zinc phosphate cement], Fuji I [conventional glass ionomer cement], Fuji Plus [resin-modified glass ionomer cement], Variolink II [conventional etch-and-rinse resin cement], Panavia F2.0 and Multilink [self-etch resin cements], RelyX Unicem Aplicap and Maxcem [self-adhesive resin cements]). After water storage at 37 °C for one week, the shear bond strength of the specimens was measured and the fracture mode was examined stereo-microscopically. Restorative material and luting agent both had a significant effect on bond strength and there was a significant interaction between the two variables. The zinc phosphate cement and the glass ionomer cements resulted in the lowest bond strengths, whereas the highest bond strengths were found with the two self-etch and one of the self-adhesive resin cements.

Restoration of teeth affected by molar-incisor hypomineralisation: a systematic review.

The objective was to systematically analyse clinical studies on restorative procedures for teeth affected by molar-incisor hypomineralisation (MIH). The databases PubMed, Embase, and Cochrane Library were searched. Only retrospective and prospective clinical studies dealing with sealing or restoration of MIH-affected teeth were included. The language was restricted to English or German. Thirteen of 36 potentially eligible studies were included focusing on the following subjects: extension of enamel preparation, adhesive procedures prior to restoration, application of fissure sealants as well as restoration with conventional glass ionomer cements (GIC), resin modified glass ionomer cements (RMGIC), resin composites, and indirect restorations. Seven clinical studies were controlled trials. However, only two included MIH-unaffected teeth as control. No meta-analysis was performed due to the heterogeneity of study designs (e.g. severity of MIH or the restorative materials investigated). Based on the present analysis, the annual failure rates were in average 21% for fissure sealants, 22% for GIC, 1-6% for RMGIC, 13-32% for resin composites, and 0-7% for indirect restorations. In summary, only few tendencies can be deduced from this review at a low level of evidence (number of studies): 1) preparation margins in sound enamel seem to be superior to preparations in hypomineralised enamel (1 study), 2) RMGIC seems to be superior to GIC (3 studies), 3) resin composites may be used for restoring all severities of MIH (7 studies) with self-etch and etch-and-rinse adhesive systems generally not performing differently (3 studies), and 4) in cases of severe MIH, indirect restorations showed a good clinical success (4 studies).

Performance of different polishing techniques for direct CAD/CAM ceramic restorations.

This in vitro study evaluated the performance of three ceramic and two commonly used polishing methods on two CAD/CAM ceramics. Surface roughness and quality were compared. A glazed group (GLGR) of each ceramic material served as reference. One-hundred and twenty specimens of VITABLOCS Mark II (VITA) and 120 specimens of IPS Empress CAD (IPS) were roughened in a standardized manner. Twenty VITA and 20 IPS specimens were glazed (VITA Akzent Glaze/Empress Universal Glaze). Five polishing methods were investigated (n=20/group): 1) EVE Diacera W11DC-Set (EVE), 2) JOTA 9812-Set (JOTA), 3) OptraFine-System (OFI), 4) Sof-Lex 2382 discs (SOF) and 5) Brownie/Greenie/Occlubrush (BGO). Polishing quality was measured with a surface roughness meter (Ra and Rz values). The significance level was set at alpha=0.05. Kruskal Wallis tests and pairwise Wilcoxon rank sum tests with Bonferroni-Holm adjustment were used. Qualitative surface evaluation of representative specimens was done with SEM. On VITA ceramics, SOF produced lower Ra (p<0.00001) but higher Rz values than GLGR (p=0.003); EVE, JOTA, OFI and BGO yielded significantly higher Ra and Rz values than GLGR. On IPS ceramics, SOF and JOTA exhibited lower Ra values than GLGR (p<0.0001). Equivalent Ra but significantly higher Rz values occurred between GLGR and EVE, OFI or BGO. VITA and IPS exhibited the smoothest surfaces when polished with SOF. Nevertheless, ceramic polishing systems are still of interest to clinicians using CAD/CAM, as these methods are universally applicable and showed an increased durability compared to the investigated silicon polishers.

Caries-preventive efficacy and retention of a resin-modified glass ionomer cement and a resin-based fissure sealant: a 3-year split-mouth randomised clinical trial.

PURPOSE: This prospective clinical trial compared the retention rate and caries-preventive efficacy of two types of sealant modalities over a 3-year period. MATERIALS AND METHODS: Using a split-mouth randomised design, 1280 sealants were randomly applied on sound permanent second molars of 320 young patients aged between 12 and 16 years. Half of the teeth (n = 640) were sealed with a resin-modified glass ionomer cement (RMGIC) (Vitremer™, 3M ESPE) and the other half (n = 640) with a conventional light-cure, resin-based fissure sealant (LCRB) (Fluoroshield®, Dentsply Caulk). Teeth were evaluated at baseline, 6-, 12-, 18-, 24-, 30- and 36-month intervals with regard to retention and new caries development. RESULTS: On the sealed occlusal surfaces after 3 years, 5.10% of RMGIC and 91.08% of LCRB sealants were totally intact and 6.37% of RMGIC and 7.65% of LCRB sealants were partially intact. New caries lesions were found in 20.06% of RMGIC sealed occlusal surfaces, compared to 8.91% for LCRB sealants. CONCLUSIONS: The findings of the present clinical study suggest that RMGIC should be used only as a transitional sealant that can be applied to newly erupting teeth throughout the eruptive process, whereas LCRB sealants are used to successfully prevent occlusal caries lesions once an effective rubber dam can be achieved. It can be concluded that there are differences between the RMGIC and LCRB sealants over a 3-year period in terms of the retention rate and caries-preventive efficacy. RMGIC can serve as a simple and economic sealing solution, however provisional. Due to its poor retention rate, periodic recalls are necessary, even after 6 months, to eventually replace the lost sealant.