Does the addition of chlorhexidine to glass ionomer cements influence its antimicrobial effect and survival rate? A systematic review.

PURPOSE: To evaluate the influence of the addition of chlorhexidine on the antimicrobial effect and on the survival of restorations performed with glass ionomer cement. METHODS: Nine databases were used to search for randomized clinical trials that compared the survival rate and the antimicrobial effect of glass ionomer cement (GIC) restorations with and without the incorporation of chlorhexidine (CHX), without restrictions on year or language. Cochrane Collaboration's Risk of Bias 2 was used to assess the risk of bias. The GRADE approach was used to assess the certainty of evidence. RESULTS: From 593 studies found, seven met the inclusion criteria. The concentration of CHX varied between 0.5 and 2%. In general, the addition of CHX to GIC promoted reductions in Streptococcus mutans and Lactobacillus acidophilus burdens when compared to those without CHX. No study showed a difference in the survival of restorations between GIC with CHX and conventional GIC. Individual risk of bias varied from low to high and the certainty of evidence was classified as very low. CONCLUSIONS: Based on a very low level of certainty, the evidence suggests that the incorporation of CHX in GIC might improve the antimicrobial effects for a short time, in addition to having little influence on the survival of the restoration.

Effect of root morphology on biomechanical behaviour of premolars associated with abfraction lesions and different loading types.

The aim of this study was to investigate the biomechanical behaviour of maxillary premolar teeth regarding root morphology and abfraction depth, submitted to axial and oblique occlusal load. The investigation was conducted using 3D finite element analysis and strain gauge test. Sound maxillary premolar single and double root were selected for 3D model generation. The teeth were scanned for external morphology data acquisition. The 3D geometry was stored in *.STL and exported to Bio-CAD software (Rhinoceros-3D) to model generation. Mesh generation, mechanical properties and boundary conditions were performed in finite element software (Femap, Noran Engineering, USA). Twelve models were generated: sound tooth, 1.25 and 2.5 mm abfraction teeth. 100N compressive static load was applied: axially and 45° angle to the long axis on the palatine surface of the buccal cusp. Two strain gauges were bonded on the teeth mounted in a mechanical testing machine. Von Mises criterion showed that the double-root teeth associated with 2.5 mm abfraction and oblique loading presented higher stress values. Axial loading associated with single-root teeth propitiated the lowest stress rates. Double root sound 1.25 and 2.5 mm abfraction teeth associated with oblique loading showed the highest strain values (µS): 692.6, 1043.31 and 1236.14, respectively. Single root sound 1.25 and 2.5 mm abfraction teeth associated with oblique loading showed 467.10, 401.51 and 420.98 strain values, respectively. Axial loading showed lower strain rates, ranging from 136.12 to 366.91. The association of deep lesions, oblique loading and double-root tooth promoted higher stress and strain concentration.

Non-carious cervical lesions: influence of morphology and load type on biomechanical behaviour of maxillary incisors.

BACKGROUND: The aim of this study was to measure the effect of simulating two different loads on maxillary incisors displaying eight morphological types of non-carious cervical lesions, unrestored and restored with an adhesive restoration, by quantifying the stress distributions generated using finite element analysis. METHODS: Virtual models of maxillary incisors were generated using the CAD software (RhinoCeros). After composing virtual dental and supporting structures with and without non-carious cervical lesions, each model was meshed using a control mesh device (ANSYS Finite Element Analysis Software). All of the virtual models were subjected to two load types, oblique load and vertical load, to simulate occlusal forces of 100 N each. Comparisons were made between simulated teeth with non-carious cervical lesions, with and without composite resin restorations, and a simulated sound tooth. Data summarizing the stress distributions were obtained in MPa using von Mises criteria. RESULTS: Oblique loading on simulated non-carious cervical lesions resulted in greater stress concentration compared with vertical loading, and non-carious cervical lesions with acute angles displayed higher stress concentrations at the depth of the lesion. Restoring the lesions with an adhesive restoration, such as composite resin, appeared to overcome this stress concentration. CONCLUSIONS: Restoring NCCLs with adhesive restorative materials, such as a nanohybrid composite resin, appears to recover the biomechanical behaviour similar to sound teeth.

Fracture resistance and mode of failure of various types of root filled teeth.

AIM: To investigate ex vivo the influence of the post system on fracture resistance and failure mode of root filled incisor, canine, premolar and molar teeth. METHODOLOGY: Eighty human teeth were divided into eight groups (n = 10) resulting from the interaction between the two study factors: post system (glass fibre post; cast Ni-Cr alloy post and core) and type of tooth (maxillary incisors, maxillary canines, maxillary premolars and mandibular molars). All roots were prepared with a 2-mm ferrule and restored with metal crown. Fracture resistance (N) was assessed in a mechanical testing device, and the data were analysed by two-way anova (4 × 2) followed by Tukey's test (α = 0.05). The failure mode was evaluated using an optical stereomicroscope and classified according to the location of the failure. Failure mode data were analysed by two-factor anova and Student-Newman-Keuls (SNK) tests (α = 0.05). Correlation between fracture resistance and failure mode was analysed by linear regression. RESULTS: Glass fibre and cast posts and cores had similar fracture resistance, regardless of the type of tooth. Canines and molars had significantly higher fracture resistance (P < 0.001) than premolars. Incisors teeth had significantly lower fracture resistance (P < 0.001) than premolars. The fracture mode for incisors, premolars and molars was more amenable to restoration when the teeth were restored with glass fibre posts. Fracture resistance had no correlation with fracture mode, regardless of the post system and type of tooth analysed. CONCLUSIONS: Post system had no significant effect on fracture resistance, regardless of the type of tooth. The mode of fracture was more restorable with glass fibre posts.

Effect of anti-rotation devices on biomechanical behaviour of teeth restored with cast post-and-cores.

AIM: To test the hypothesis that the presence of an anti-rotation device (ARD) and its location can influence the biomechanical behaviour of root filled teeth restored with cast post-and-cores and metallic crowns. METHODOLOGY: Fifth two bovine incisor roots were selected and divided into four groups (n = 13): Nd- without ARD; Bd- buccal ARD; Ld- lingual ARD; BLd- buccal and lingual ARD. The specimens were restored with cast post-and-cores and metallic crowns. After a fatigue process (3 x 10(5) 50 N), three strain gauges were attached on the buccal, lingual and proximal surfaces and the samples of each group (n = 3) were submitted to a 0-100 N load. Fracture resistance was assessed in a mechanical testing machine (n = 10). Strain values and fracture resistance data were analysed by one-way anova and Tukey Honestly Significant Difference (HSD) test (alpha = 0.05). The failure mode was then evaluated under an optical stereomicroscope. Bidimensional models of each group were generated for finite element analysis (FEA) and analysed using the von Mises criteria. RESULTS: No significant difference in fracture resistance values and fracture modes occurred between the four groups. The BLd group had higher stress concentrations in the buccal dentine and higher strain values on the proximal surfaces. CONCLUSIONS: The anti-rotation devices did not influence significantly the fracture resistance and fracture mode. However, the stress-strain values were increased when the anti-rotation device was prepared on the buccal and lingual faces concomitantly.

Effect of gamma irradiation on ultimate tensile strength of enamel and dentin.

The effect of gamma irradiation therapy on the ultimate tensile strength (UTS) of enamel and dentin in relation to prism orientation, dentin tubule orientation, and location is unknown. It was hypothesized that tubule and prism orientation, location, and irradiation have an effect on the UTS of dental structures. Forty human third molars were used, half of which were subjected to 60 Gy of gamma irradiation, in daily increments of 2 Gy. The specimens were evaluated by microtensile testing. Results showed that irradiation treatment significantly decreased the UTS of coronal and radicular dentin and of enamel, regardless of tubule or prism orientation. With or without irradiation, enamel was significantly stronger when tested parallel to its prismatic orientation. Coronal and radicular dentin of non-irradiated specimens presented significantly higher UTS when tested perpendicularly to tubule orientation. However, when the teeth were irradiated, the influence of tubule orientation disappeared, demonstrating that irradiation is more harmful to organic components.

Effects of post system and length on the strain and fracture resistance of root filled bovine teeth.

AIM: To investigate ex vivo the effects of different post systems and lengths on the strain and fracture resistance of root-filled teeth. METHODOLOGY: One hundred and thirty-five bovine incisors were sectioned 15 mm from their apices, root-filled and divided into three groups (n = 45): fibreglass post; prefabricated steel post; cast post and core. Each group was divided into three subgroups (n = 15) according to the post length: 5.0 mm; 7.5 mm; 10.0 mm. All teeth were restored with metal crowns. For strain-gauge measurement, two strain gauges per sample were used. The fracture resistance (N) was measured and the data were analysed with two-way analyses of variance, followed by the Tukey's HSD test (alpha = 05). RESULTS: For all posts, decreased lengths resulted in increased microstrain values. However, the fibreglass posts were associated with lower increases when compared with cast post and cores and prefabricated steel posts, which showed microstrain values two times higher when the post length was 5.0 mm. The two-way analyses of fracture resistance values revealed that post length was statistically significant for the metal posts and not significant for the fibreglass post. The fracture mode analysis indicated that all groups tended to demonstrate root fractures in groups restored with metal posts and resin core fractures in groups restored with fibreglass posts. CONCLUSIONS: The cast post and core when the length was 10.0 mm had the highest fracture resistance; however, the fibreglass post was effective with the three post lengths, with higher fracture resistance than metal posts when the length was 5.0 mm.

Microtensile specimen attachment and shape--finite element analysis.

Microtensile bond strength values are influenced by specimen shape and attachment method to the gripping device during testing. We hypothesized that stress distribution inside the testing specimen is affected by microtensile specimen shape and attachment method. Rectangular, hourglass-, and dumbbell-shaped specimens, all with a 1 mm(2) cross-sectional testing region, were modeled as indirect ceramic restorations luted to dentin. Three specimen attachments were investigated: (1) posterior surface; (2) posterior, superior, and lateral surfaces; and (3) all surfaces. Qualitative and quantitative analyses were carried out according to von Mises' criteria. Stress analysis showed a direct correlation between attachment modes and stress distribution, with shear stresses observed in models with less surface attachment. Increasing the number of faces for specimen attachment to the metallic gripping device resulted in a more homogeneous and regular distribution of stress, with tensile stress concentrated at the adhesive interface. Dumbbell-shaped specimens showed improved stress distribution compared with rectangular and hourglass-shaped specimens.