Fracture strength of extended class I composite restorations with different restorative techniques.

To evaluate the fracture strength of extended Class I restorations with different restorative techniques using nanofilled and nanohybrid composites. Sixty extracted human third molars were prepared with extended Class I cavities and divided into six groups: groups FS-F (Filtek bulk-fill Flow + Filtek Supreme Ultra, 3 M) and GR-F (X-tra base + GrandioSO, VOCO), restored with a flowable bulk-fill composite as a base covered by a nanofilled or nanohybrid composite; groups FB (Filtek One Bulk-Fill, 3 M) and AF (Admira Fusion X-tra, VOCO), restored with a bulk-fill resin composite; and groups FS (Filtek Supreme Ultra, 3 M) and GR (GrandioSO, VOCO), restored incrementally with a nanofilled or nanohybrid composite. Sound extracted teeth (n = 10) were used as a control group (CTL). The specimens were axially loaded until failure. Data were analyzed using one-way ANOVA and Games Howell test (α = 0.05). Groups CTL and GR-F demonstrated significantly higher mean fracture strength when compared to FS, AF, and GR (p < 0.05). Group AF obtained more repairable fractures than the other groups. Restorations made with a nanofilled bulk-fill composite or with conventional resin composites associated with a flowable bulk-fill base were able to reestablish the fracture strength to that of sound teeth.

One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions.

OBJECTIVE: The aim of this double-blind, randomized trial was to evaluate the 1-year clinical performance of a bulk-fill flowable and a regular nanofilled composite in non-carious cervical lesions (NCCLs). METHODS: Twenty-two subjects with at least two NCCLs were enrolled in the study. A total of 89 restorations were performed by a single operator using Filtek Supreme (FS) Ultra Universal or Filtek Bulk (FB) Fill Flowable. A universal adhesive (Scotchbond™ Universal Adhesive) was used with a self-etching approach in dentin. The restorations were evaluated by two independent and previously calibrated examiners at baseline (7 days), 6 months and 1 year, according to the USPHS modified criteria. Mann-Whitney U test was used to analyze the differences between composites and Wilcoxon signed rank test for comparisons between the baseline and follow-ups (α = 5%). RESULTS: One restoration was considered clinically unacceptable due to loss of retention after 6 months in the FS group. FS presented statistically high scores for surface roughness when compared to FB after 1 year (p < 0.05), but both were considered clinically acceptable. After 1 year, the frequency of clinically unacceptable rates was 3.3% for anatomical form in the FB group, 1.1% for retention in the FS group, and 2.2% for marginal adaptation in both groups. All restorations, in both groups, presented score 0 over the 1-year period for marginal staining, postoperative sensitivity, and secondary caries. CONCLUSION: Both composite resins showed acceptable clinical performances for the restoration of NCCLs after 1 year. CLINICAL RELEVANCE: Both bulk-fill flowable and regular nanofilled composites showed good clinical performances for the restoration of NCCLs after 1 year.

Clinical efficacy of resin-based materials for dentin hypersensitivity treatment.

PURPOSE: To evaluate the effect of three resin-based materials in the treatment of dentin hypersensitivity (DH) up to a 6-month follow-up. METHODS: 30 participants (179 teeth) with DH were enrolled in this randomized, double-blind, controlled clinical study. The teeth were randomly allocated into one of three groups: CV (resin-modified glass ionomer varnish - Clinpro XT Varnish), CP (fluoride-containing self-etch adhesive - Clearfil SE Protect) and GB (glutaraldehyde-containing etch-and-rinse adhesive - Gluma 2 Bond). The materials were applied according to the manufacturer's instructions. DH was evaluated by subjects' perception measured on a 0-10 visual analog scale (VAS) after evaporative (air blast) stimuli. The scores were recorded at baseline, immediately and at 1, 3 and 6 months after treatment. The data were analyzed by a two-way ANOVA with repeated measures for "time" and Games-Howell test (α = 0.05). RESULTS: ANOVA detected statistically significant differences among the time intervals, but not among the materials or interactions. There was a significant decrease in sensitivity scores from baseline to all the time points (P< 0.05). However, the differences were not statistically significant among the follow-ups, from immediately until 6 months after treatment (P> 0.05). All the resin-based materials were able to reduce DH up to 6 months after treatment. CLINICAL SIGNIFICANCE: Resin-based materials used as desensitizing agents were effective in reducing DH after a 6-month period and so could be recommended as a safe treatment for sensitive teeth.

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents.

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers' application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Performance of Dental Students in Shade Matching: Impact of Training.

OBJECTIVE: The present study evaluated the effect of training on dental students' ability for matching two different shade guides. MATERIALS AND METHODS: The study was conducted in 2012. The participants were 88 male and female undergraduate dental students from Brazil and Portugal, with or without previous color education and vision refractive errors (response rate of 73.33%). They were asked to match a pair set of the shade guides Vita Classical (VC) and Vitapan 3D Master (3DM), with a 20-minutes' rest between each match. The sets were assembled over a neutral gray background and under controlled light. About 7-10 days later, all participants watched a video lecture on color education and repeated the matching procedure. The percentage of matches was calculated and submitted to statistical analysis for the variables gender, geographic region, shade guide and previous color education (Mann-Whitney tests), vision refractive errors (Kruskal-Wallis), and training (Wilcoxon signed rank). All tests were performed at a confidence level of 95%. RESULTS: Training increased the percentage of matches for all groups, except for Portuguese and hyperopic individuals (VC and 3DM) and men (3DM). Previous color education affected VC shade matching before training. Gender, refractive errors, and geographic region did not affect shade matching ability. CONCLUSIONS: Previous education and training in color positively affected shade-matching ability of dental students on shade guide pairing tests. CLINICAL SIGNIFICANCE: The subjectivity of the visual method might not be a clinical concern in daily practice. The human eye can detect small differences in color and visualize the tooth with all its complex geometry, multilayered tissues, and secondary color parameters. Therefore, any color-matching task will be judged by the patient and/or other observers with consideration to this complexity. In other words, visual assessment is paramount to the success/failure of esthetic restorative procedures. The efficiency of the visual color method may be improved by color education through the development of professional color discrimination ability. This would make the students responsible for color selection, reproduction, and evaluation and lead to increased capability over a layperson observer receiving the restorative treatment. (J Esthet Restor Dent 29:E24-E32, 2017).

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers’ application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Resumo O objetivo do estudo foi avaliar a permeabilidade da dentina (Lp) usando diferentes agentes dessensibilizantes antes e depois de um desafio abrasivo/erosivo. Discos de dentina foram obtidos a partir 42 terceiros molares humanos. Lp mínima foi medida após uma simulação de smear layer usando lixa de SiC # 600 e a Lp máxima foi medida após imersão em EDTA 0,5 M. As amostras foram tratadas com diferentes dessensibilizantes: dois vernizes (Fluor Protector-FP, Clinpro XT Varnish-CV), uma pasta (Desensibilize Nano P-NP) e um gel (Oxa Gel-OG). A Lp de cada amostra foi medida imediatamente após a aplicação dos dessensibilizantes. Os discos foram submetidos a um ciclo de erosão/abrasão durante 7 dias, com uma solução de 0,5% de ácido cítrico (6x/dia) e escovação (3x/dia). Lp foi medida do primeiro ao sétimo dia do desafio. Os dados foram analisados por ANOVA a 3 critérios com medidas repetidas e teste de Games-Howell (α=5%). FP e CV demonstraram Lp semelhante imediatamente depois da aplicação até 7 dias (p<0,05). OG apresentou um aumento significativo na Lp depois do 4º e 7º dias. NP resultou numa permeabilidade significativamente mais elevada comparada com a dos outros materiais imediatamente após a aplicação e após o primeiro dia de desafio. Todos os dessensibilizantes reduziram a permeabilidade da dentina imediatamente após a aplicação. No entanto, apenas os vernizes foram capazes de manter o efeito oclusivo após o desafio da erosão/abrasão.

Effect of desensitizing agents on the microtensile bond strength of two-step etch-and-rinse adhesives to dentin.

Desensitizers can be used to control postoperative sensitivity in adhesive restorations. The aim of this study was to evaluate the effect of desensitizing agents on the bond strength of two-step etch-and-rinse adhesive systems to dentin. Forty-two human molars were sectioned to obtain 3-mm-thick dentin discs. The discs were divided into three groups (n = 14 in each) - no-treatment control group (CT), and oxalic acid [BisBlock (BB)] and calcium phosphate [Desensibilize Nano-P (NP)] desensitizers - before the application of two adhesive systems [Adper Single Bond Plus (SB) and One-Step Plus (OSP)]. A nanoparticle composite resin was used to create a 3-mm-thick build-up. The specimens were stored in distilled water for 24 h before a microtensile bond-strength test was performed. The failure modes were determined using a stereomicroscope at 100 × magnification. Specimens were sectioned perpendicular to the interface for scanning electron microscopy analyses. The CT-SB group exhibited the highest bond strength, differing significantly from BB-SB and BB-OSP groups. Mixed failures were prevalent for all groups. Scanning electron microscopy revealed a continuous hybrid layer and resin tags in all groups. Dentin bond strength of etch-and-rinse adhesive systems was reduced by an oxalic acid desensitizer but was not affected by a calcium phosphate-containing desensitizer.

Effect of open-sandwich vs. adhesive restorative techniques on enamel and dentine demineralization: an in situ study.

OBJECTIVES: To assess in situ the effect of different restorative techniques used with fluoride-releasing materials on enamel and dentine demineralization in the presence of a cariogenic challenge. METHODS: Thirty human molars were prepared for 60 Class V cavities, with enamel and dentine margins. The teeth were divided into four groups (n=15): L1 - open sandwich technique with a conventional glass ionomer cement (GIC), L2 - open sandwich technique with a resin-modified GIC, A1 - total-etch bonding with a fluoride-containing adhesive, A2 - total-etch bonding with a nonfluoride-containing adhesive. All the cavities were restored with a nanofilled composite. Fifteen volunteers used appliances containing one specimen from each group. The cariogenic challenge was carried out with a 20% sucrose solution 8×/day for 7 days. The specimens were sectioned for microhardness test and EDS analysis at different depths below the enamel and dentine margins (25, 50 and 100µm) and distances from the tooth-restoration interfaces (25 and 75µm). The data were analyzed by ANOVA and Games-Howell test (α=5%). RESULTS: Both GICs produced higher hardness in enamel at all depth-and-distance combinations, but only L1 produced higher hardness in dentine (p<0.05). L2 and A1 exhibited similar dentine hardness at 25µm distance for all depths (p>0.05). L1 demonstrated significantly higher amounts of calcium in dentine than the other groups, but had similar amounts in enamel to L2 and A1. CONCLUSIONS: The open sandwich technique using conventional GIC proved more effective in reducing enamel and dentine demineralization at depths of up to 100µm under a cariogenic challenge. CLINICAL SIGNIFICANCE: Conventional GICs should be considered the materials of choice for lining of cavities not having all margins in enamel, particularly using the open sandwich technique.

Microhardness of dentin underneath fluoride-releasing adhesive systems subjected to cariogenic challenge and fluoride therapy.

OBJECTIVES: The aim of this study was to evaluate the microhardness of dentin subjacent to the bonding interface of composite restorations using fluoride-releasing adhesive systems submitted to pH-cycling regimen associated or not to fluoride therapies. METHODS: Thirty human third molars were prepared with class V cavities with dentin cervical margins. The adhesive systems One-Up Bond F Plus (OU), Prime&Bond NT (NT), Clearfil Protect Bond (CF), Optibond Solo Plus (OP) and also the controls [-] Single Bond 2 (SB) and [+] Ketac Molar (KM) were used previously to composite resin restorations. The restorations were sectioned into four slabs and submitted to different storage media for 15 days: distilled water, pH-cycling, pH-cycling associated to NaF 0.05% and associated to NaF 1.23%. The Knoop microhardness test was performed in dentin at 50, 100, 150 and 300 microm from the adhesive interface. Data was analyzed by three-way ANOVA and Tukey HSD test (p<0.05). RESULTS: KM resulted in significantly higher microhardness when compared to all the adhesive systems at 50 microm, with the exception of OU, that was similar to KM when submitted to pH-cycling alone or associated to 1.23% NaF. Microhardness of dentin was significantly higher with all the tested materials, when pH-cycling was associated to NaF 0.05%, at 50 microm and 100 microm depths. OU resulted in similar dentin hardness at all depths and storage media. CONCLUSIONS: The incorporation of NaF 0.05% fluoride therapy to the cariogenic challenge was capable to recover the original microhardness of dentin at 50 and 100 microm with all the tested materials.

Effect of different surface treatments on the repair bond strength of indirect composites.

PURPOSE: To evaluate the tensile bond strength of indirect composites repaired with different surface treatments and direct composites. METHODS: 180 specimens were prepared with Targis, belleGlass HP and Sculpture indirect composites, light-activated and post-cured according to the manufacturers' recommendations. The specimens were stored in distilled water for 24 hours at 37 degrees C. The bonding surfaces were prepared with air abrasion, hydrofluoric acid or hydrofluoric acid followed by a neutralizing solution. All the treated surfaces were subject to the application of a silane and a bonding agent before the repair procedures with Tetric Ceram and Tetric Flow for the Targis specimens, Herculite XRV and Revolution for the belleGlass HP specimens and Sculp-It and Flow-It for Sculpture specimens. The tensile bond strength tests were carried out using a universal testing machine at cross-head speed of 0.5 mm/minute. The type of fracture was observed under a light microscope at x40 magnification. Data were analyzed by a two-way ANOVA and Tukey's post-hoc tests (P < 0.05). RESULTS: Targis showed a statistically higher repair bond strength than belleGlass HP and Sculpture, which were not significantly different from each other. Air abrasion increased the repair bond strength of belleGlass HP and Sculpture. For Targis, all the surface treatments resulted in similar repair bond strength. The different viscosity of repair composites did not affect the repair of indirect composites. Fractured surfaces showed mostly adhesive failures, mainly with hydrofluoric acid treatment.

Sorption and solubility of composites cured with quartz-tungsten halogen and light emitting diode light-curing units.

AIM: The objective of this study was to evaluate the effect of light polymerization on water sorption and solubility of hybrid composites. METHODS AND MATERIALS: Three composite resins were used to make discs cured with either quartz-tungsten halogen (QTH) or light emitting diode (LED) curing units. The specimens were stored in a desiccator at 37 degrees C and weighted to a constant mass, then immersed in deionized water for different periods of time, and reconditioned until achieving a constant mass. Sorption and solubility were calculated and subjected to analysis of variance (ANOVA) and Tukey tests (p<0.01). RESULTS: There were no statistically significant differences between the light sources. Water sorption increased with storage time for all the composites. The lowest sorption was observed for Herculite XRV, followed by Tetric Ceram, and Filtek Z250. Increased storage times reduced the solubility of Filtek Z250 but did not affect the solubility of Herculite XRV and Tetric Ceram. CONCLUSION: Water sorption and solubility of composites are not affected by the type of polymerization when the same intensity and exposure times are used. Thus, the differences found are probably related to the composition of the materials. CLINICAL SIGNIFICANCE: Water sorption and solubility of composites can lead to a shortened service life. However, these properties are not correlated to the type of polymerization.