Complete versus incomplete caries removal procedures and their effects on dental pulp in primary teeth - An in vivo study.

INTRODUCTION: Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child's discomfort. AIM: The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures. MATERIALS AND METHODS: The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically. RESULTS: The proportion was compared using Fisher's exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%. CONCLUSION: The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.

The Selective Enamel Etch Technique.

Adhesive dentistry is an essential component in the delivery of direct and indirect restorations. Ongoing discussions among scientists and clinicians have focused on whether or not current self-etch and universal adhesives adequately prepare enamel surfaces to achieve optimal bond strengths. To address these concerns, a selective enamel etch technique has been recommended. The definition of a selective enamel etch technique is as its name suggests. The clinician selectively etches the enamel of a cavity preparation by applying phosphoric acid etchant to the enamel surfaces of the preparation while refraining from applying the etchant to the dentin. This article explores the current research to help guide clinicians to achieve ideal outcomes when using dental adhesives. With few exceptions, the current scientific evidence recommends a selective enamel etch technique in conjunction with the clinician's adhesive system of choice.

The effect of different deep margin elevation methods on the fracture strength of CAD-CAM restorations.

PURPOSE: To evaluate the effect of two resin composites (with different viscosities) and the elevation amount on fracture strength and fracture behavior of molars with and without deep margin elevations (DME). METHODS: 70 extracted, caries-free human molars were selected. All teeth were prepared as MOD onlay cavities with a margin 2 mm below the cemento-enamel junction (CEJ) on the mesial and buccal sides and 2 mm above the CEJ on the distal side. The teeth were divided into two groups according to the type of resin composite used in margin elevation, elevated with flowable composite (Universal Flo) or condensable composite (G-Aenial Posterior). These two groups were further subdivided into subgroups in which the elevation was 2, 3, or 4 mm, and a control group in which the non-elevated indirect restoration was directly bonded to the subgingival margin, making a total of seven groups (n= 10). After elevations, the restorations were completed using a nanoceramic CAD-CAM block (Cerasmart A3 HT) and as adhesive cement, G-Cem Link Force. Static force was applied to the restored teeth using a universal testing machine at an angle of 15° until fracture occurred. Fracture strength values were recorded, and fracture types were examined under 6x magnification. One-way ANOVA was carried out to determine the effect of DME on the fracture strength. A two-way ANOVA was conducted to investigate main and interaction effects of the material type used in the elevation and the amount of elevation made on the fracture strength (P< 0.05). RESULTS: Using flowable or condensable composite as elevation material did not affect the fracture strength of CAD-CAM restorations. Flowable and condensable composites of 2, 3, or 4 mm did not significantly affect fracture strength values for either material. Specimen margins with and without elevation exhibited similar fracture strength values. The type of material used in the elevation and the amount did not affect the fracture strength of teeth. CLINICAL SIGNIFICANCE: The deep margin elevation technique for teeth with carious lesions extending subgingivally, may be useful in routine practice.

Clinical guidelines for posterior semidirect composite resin restorations: a case report with a 17-month follow-up.

Patients are always looking for conservative, esthetic, and long-lasting dental restorations, and the technique used directly influences the longevity of the treatment. The location of the restoration in the mouth and the extent of the decay influence the treatment choice. The larger the dimensions of the cavity preparation, the greater the difficulties in restoring the tooth using direct techniques. The semidirect technique, when indicated, can achieve satisfactory results. It is a relatively easy procedure, consisting of tooth preparation to receive an indirect restoration, fabrication of an alginate impression, fabrication of the composite resin restoration on a flexible cast, cementation, removal of excess cement, and occlusal adjustment. The aim of this case report is to present a viable alternative to direct and indirect restorations for posterior teeth with extensive decay. The article describes the extraoral semidirect technique for fabricating a composite resin restoration, highlighting its indications and discussing advantages and disadvantages.

Deep margin elevation in restorative dentistry: A scoping review.

OBJECTIVES: Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA: Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES: This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION: The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS: DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE: With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.

Effect of fiber-reinforced direct restorative materials on the fracture resistance of endodontically treated mandibular molars restored with a conservative endodontic cavity design.

OBJECTIVE: This study aimed to evaluate the fracture strength of teeth restored using fiber-reinforced direct restorative materials after endodontic treatment with a conservative mesio-occlusal access cavity design. MATERIALS AND METHODS: A total of 100 extracted intact mandibular first molars were selected and distributed into a positive control group where teeth left intact and the following four test groups comprised of teeth with conservative mesio-occlusal access cavities that had undergone root canal treatment (n = 20/group): access cavity without restoration (negative control), bulk-fill resin composite with horizontal glass fiber post reinforcement, fiber-reinforced composite with bulk-fill resin and bulk-fill resin composite. Following thermocycling (10,000 cycles), fracture resistance was measured using a universal testing machine. Statistical analyses (one-way analysis of variance and the Tamhane test) were performed, and statistical significance was set at p < 0.05. RESULTS: Groups with minimally invasive access cavities had lower fracture strength than intact teeth, regardless of the restoration material (p < 0.05). Fiber-reinforced composite groups demonstrated higher fracture strength than bulk-fill resin composite alone (p < 0.05). Fracture types varied among groups, with restorable fractures predominant in the fiber-reinforced composite groups. CONCLUSION: This study suggests that using fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, can effectively enhance the fracture strength of endodontically treated teeth with conservative access cavities. However, using only bulk-fill resin composite is not recommended based on the fracture strength results. CLINICAL SIGNIFICANCE: When teeth that undergo endodontic treatment are restored using a conservative access cavity design and fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, the fracture strength of the teeth can be effectively increased.

In-vitro evaluation of fracture resistance of teeth restored with different high-viscosity glass ionomer restorative materials and bulk-fill composite resins.

OBJECTIVES: This study aimed to evaluate the effect of restorations made with a glass-hybrid restorative system (GHRS), a high-viscosity glass ionomer restorative material (HVGIC), a high-viscosity bulk-fill composite resin (HVB), a flowable bulk-fill composite resin (FB), and a nanohybrid composite resin (NH), which are commonly preferred in clinical applications on the fracture resistance of teeth in-vitro. MATERIALS AND METHODS: One hundred intact human premolar teeth were included in the study. The teeth were randomly divided into ten groups (n = 10). No treatment was applied to the teeth in Control group. Class II cavities were prepared on the mesial surfaces of the remaining ninety teeth in other groups. For restoration of the teeth, a GHRS, a HVGIC, a HVB, a FB, and a NH were used. Additionally, in four groups, teeth were restored using NH, GHRS, and HVGIC with open and closed-sandwich techniques. After 24 h, fracture resistance testing was performed. One-way ANOVA and Tukey HDS tests were used for statistical analysis of the data. RESULTS: The fracture resistance values of Control group were statistically significantly higher than those of GHRS, HVGIC, FB, NH, HVGIC-CS, GHRS-OS, and HVGIC-OS groups(p < 0.05). There was no statistically significant difference observed between the fracture resistance values of Control, HVB, and GHRS-CS groups (p > 0.05). CONCLUSION: It can be concluded that the use of HVB and the application of GHRS with a closed-sandwich technique may have a positive effect on the fracture resistance of teeth in the restoration of wide Class II cavities. CLINICAL RELEVANCE: The use of high-viscosity bulk-fill composite resin and the application of glass-hybrid restorative system with the closed-sandwich technique in the restoration of teeth with wide Class II cavities could increase the fracture resistance of the teeth.

Assessments of polymerization shrinkage by optical coherence tomography-based digital image correlation analysis-Part I: Parameter identification.

OBJECTIVE: To investigate the feasibility of optical coherence tomography (OCT)-based digital image correlation (DIC) analysis and to identify the experimental parameters for measurements of polymerization shrinkage. METHODS: Class I cavities were prepared on bovine incisors and filled with Filtek Z350XT Flowable (Z350F). One OCT image of the polymerized restoration was processed to generate virtually displaced images. In addition, the tooth specimen was physically moved under OCT scanning. A DIC software analyzed these virtual and physical transformation sets and assessed the effects of subset sizes on accuracy. The refractive index of unpolymerized and polymerized Z350F was measured via OCT images. Finally, different particles (70-80 µm glass beads, 150-212 µm glass beads, and 75-150 µm zirconia powder) were added to Z350F to inspect the analyzing quality. RESULTS: The analyses revealed a high correlation (>99.99%) for virtual movements within 131 pixels (639 µm) and low errors (<5.21%) within a 10-µm physical movement. A subset size of 51 × 51 pixels demonstrated the convergence of correlation coefficients and calculation time. The refractive index of Z350F did not change significantly after polymerization. Adding glass beads or zirconia particles caused light reflection or shielding in OCT images, whereas blank Z350F produced the best DIC analysis results. SIGNIFICANCE: The OCT-based DIC analysis with the experimental conditions is feasible in measuring polymerization shrinkage of RBC restorations. The subset size in the DIC analysis should be identified to optimize the analysis conditions and results. Uses of hyper- or hypo-reflective particles is not recommended in this method.

Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study.

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation.

BACKGROUND: This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent. METHODS: Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy. RESULTS: Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization. CONCLUSIONS: It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

Assessment of the efficiency of dental excavation methods using laser speckle imaging.

This paper introduces a novel application of the laser speckle technique in dentistry, focusing on assessing the efficiency of dental excavation methods used to remove decayed tooth structure. The aim is to evaluate the efficiency of two chemo-mechanical agents and the high-speed drill using the laser speckle technique, which offers objective, non-invasive, and real-time evaluation capabilities. Extracted human primary molars with active occlusal carious lesions were sectioned into three parts, with each part allocated to one of three groups: Group 1 (Brix3000®), Group 2 (Papacarie DUO®), and Group 3 (High-speed drill mechanical caries removal). Caries removal was performed using the designated agent or method for each group. After caries excavation, speckle imaging using a 632.8 nm laser was conducted. Additionally, SEM was used to acquire micro-photographs of the surface morphology of the treated samples. The findings reveal insights into the comparative efficiency of the three dental excavation agents and methods using the laser speckle technique. The speckle parameters extracted from speckle patterns generated by treated teeth provide valuable information for evaluating the performance of the excavation methods. The scanning electron microscopy images also offer detailed visual evidence to support the analysis. This paper demonstrates the potential of the laser speckle technique for assessing the efficiency of dental excavation methods. The objective, non-invasive, and real-time evaluation provided offers advantages over subjective visual assessment and manual measurements.

Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course.

BACKGROUND: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. METHODS: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. RESULTS: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). CONCLUSION: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

Simulated Hydrostatic Pulpal Pressure Effect on Microleakage-An Initial Study.

PURPOSE: This study's purpose was to evaluate the effect of simulated in vitro hydrostatic pulpal pressure (HPP) on microleakage. METHODS AND MATERIALS: Extracted third molars (n=12) were sectioned 5 mm below the cementoenamel junction, pulp tissue removed, and the sectioned crowns mounted on a Plexiglas plate penetrated by an 18-gauge stainless steel tube. The mounted specimen mesial surface received a 2×4×6 mm Class V preparation followed by restoration with a strongly acidic, one-step dental adhesive and a flowable microfilled resin, following all manufacturers' instructions. Restorations were finished to contour, and tubing was attached to a 20-cm elevated, 0.2% rhodamine G reservoir to the specimen steel tube for 48 hours. Specimens then received a nail polish coating to within 1 mm of the restoration margins and were placed in 2% methylene blue (MB) dye for 24 hours, followed by rinsing, embedding in epoxy resin, and sectioning into 1 mm slices using a diamond saw. Controls were intact molars (n=12) processed as above but without HPP. Specimen slices were evaluated using laser confocal microscopy with images exported to ImageJ software with microleakage assessed as the MB linear penetration as a percentage of the total interfacial wall length. Mean values were evaluated with the Kruskal Wallis/Dunn test at a 95% confidence level. RESULTS: The control specimens demonstrated significantly greater (p<0.0001) MB penetration than experimental specimens with simulated HPP. Under this study's conditions, simulated HPP significantly decreased MB dye penetration. CONCLUSION: Studies accomplished without simulated HPP may overestimate microleakage results.

Analyzing working time and efficient caries removal using a novel bioactive caries detecting dye and air polisher prophy for caries excavation: randomised clinical trial.

OBJECTIVES: This study aims to analyze the working time consumed during caries excavation and pain perception while using a novel Bioactive caries-detecting dye solution (BCD), an Air Polisher Prophy and a combination. MATERIALS AND METHODS: Four groups (in each group, n = 20 permanent teeth) were selected from 60 people between 17 and 40 years of age. The study included teeth with occlusal dentinal caries in the molars with cavity entrance sizes of less than 2 mm (clinically and radiographically). Randomization software was used to assign patients to various groups. Group A: Conventional Rotary Drilling, Group B: BCD + Mechanical Excavation (Spoon Excavator), Group C: Air Polisher Prophy, and Group D: BCD + Air Polisher Prophy 0.5 mL BCD was applied with a micro brush to the carious tooth surface for 40 s in groups B and D. After that, radiographs were performed to see if the radiopaque extension was visible. For mechanical caries extraction, a spoon excavator was used for group B, and an air polisher prophy was employed for group D. For mechanical caries extraction, a spoon excavator was utilized for group B. An air polisher prophy was employed for group D. Multiple applications of the BCD were used in the event of residual caries. Working time and pain experienced during caries excavation were registered using the Verbal Pain Scale (VPS) (score 0-4), and caries removal was clinically graded using the modified Scale (score 0-5). RESULTS: The time taken was Group A, Group D, Group B, and Group C, according to statistical analysis using ANOVA and the Post Hoc Test (275.02, 403.8, 461.98, 615.41 s, respectively). Group A had the highest mean VPS (1.85), whereas Group B had the most minor pain (0.6), followed by Group D (1.2) and Group C (0.6). (1.45). Group C (2.35), followed by groups D (1.75), B (1.30), and A (1.30), had ineffective caries eradication (0.90). (p < 0.05). CONCLUSIONS: compared to group C, groups B and D took less time and had less/no pain while excavating caries. Compared to traditional mechanized caries removal methods, the chemo-chemical BCD can diagnose and aid in successful caries removal with minimal pain. CLINICAL RELEVANCE: The outcomes of the present study demonstrated that the chemo-chemical bioactive caries detecting dye solution has the potential to identify and help in effective caries removal before mechanized caries removal methods.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study.

OBJECTIVES: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

In Vitro Microleakage and Fracture Resistance of "Infinity Edge" and Cusp Reduction Preparation Designs for Moderate-sized Class II Composites.

AIM: This study aimed to evaluate the marginal microleakage and maximum occlusal fracture loads and fracture modes of two novel class II preparation designs, "infinity edge" and the "2.5 mm cusp reduction" preparations as compared to a traditional class II preparation without cuspal involvement. MATERIALS AND METHODS: Thirty extracted human mandibular molars were prepared for moderate-sized class II restorations with extensions into all occlusal grooves. Of these, ten class II preparations served as control. Ten were modified for a 2.5 mm even reduction of the cusps adjacent to the interproximal box. An additional 10 preparations were modified with an "infinity edge" bevel on the interproximal and occlusal portions. All teeth were restored utilizing a flowable bulk-fill composite in the apical portion of the interproximal box and 2-4 mm of heated bulk-fill composite in one increment for the remainder. All groups were cyclic loaded and thermocycled, then imaged with microcomputed tomography (µCT) before and after infiltration with a silver nitrate solution. Images were subtracted to obtain volumetric measurements of microleakage and reported as a percentage of the total volume from the apical extent of the proximal box. All groups were loaded to failure and fracture load and mode were recorded. RESULTS: No significant differences were found in microleakage volume as a percentage of total tooth volume; however, the "infinity edge" group had significantly greater microleakage in the proximal box compared to the traditional class II group. No significant differences were found in fracture load or mode between the groups. CONCLUSION: Traditional class II, 2.5 mm cuspal reduction, and "infinity edge" preparation designs have similar fracture loads as well as volumes of microleakage; however, an "infinity edge" preparation has a higher ratio of microleakage in the proximal box. CLINICAL SIGNIFICANCE: Clinicians should carefully consider the use of "infinity edge" margins, particularly on dentin in the apical extent of the proximal box. How to cite this article: Watson JC, Lien W, Raimondi JC, et al. In Vitro Microleakage and Fracture Resistance of "Infinity Edge" and Cusp Reduction Preparation Designs for Moderate-sized Class II Composites. J Contemp Dent Pract 2024;25(1):3-9.

Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study.

AIM: The aim of the current investigation was to evaluate the marginal microleakage of various esthetic restorative materials applied to primary teeth. MATERIALS AND METHODS: A total of 75 noncarious primary molars that were removed for orthodontic intervention and teeth nearing exfoliation were chosen. One millimeter (mm) above the cementoenamel junction, on the buccal surface of the teeth, Class V cavities were prepared. William's graded periodontal probe was used to standardize cavity preparation on all teeth. 3 mm was the cavity's length, 2 mm in width, and 2 mm in depth. The teeth were then divided into three groups (25 samples in each group) according to the type of esthetic restorative material used. Group I: Resin-modified glass ionomer cement, Group II: Ormocer, Group III: Giomer. The samples underwent 500 cycles of thermocycling, with an immersion time of 60 seconds and a well time of 15 seconds, between 5 and 55°C. The samples were submerged in methylene blue dye for 24 hours at room temperature and dried. The samples were then divided into sections and examined with a stereomicroscope. Data was recorded and statistically analyzed. RESULTS: The least marginal microleakage was found in the ormocer group (1.22 ± 0.01) followed by resin-modified glass ionomer cement group (1.31 ± 0.07) and the giomer group (1.78 ± 0.03). There was a highly statistically significant difference found between resin-modified glass ionomer cement group and the ormocer group, resin-modified glass ionomer cement group and giomer group. And no significant difference was found between the ormocer group and the giomer group. CONCLUSION: The present study concluded that there was some amount of microleakage in primary teeth in all restorative materials examined in this in-vitro investigation. However, the marginal sealing ability of ormocer was found highest compared to resin-modified glass ionomer cement and Giomer materials. CLINICAL SIGNIFICANCE: The primary reason dental restorations fail, particularly in Class V cavities, is microleakage since the margins of these restorations are typically found in the dentin or cementum. Assessing microleakage is a crucial step in determining the marginal integrity of restorative materials. Developing methods and resources that reduce the adverse effects caused by the restorative marginal seal failing would benefit from this. How to cite this article: Al Ghwainem A, Alqarni AS. Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study. J Contemp Dent Pract 2024;25(1):58-61.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial.

AIM: This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions. METHODS: Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria. RESULTS: Comparison of age, time and volume with study groups were made using Independent Sample' t' test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen's Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups. CONCLUSION: Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Co-Influence of Restoration Bonding and Inlay Cavity Design on Fracture Load of Restored Tooth.

INTRODUCTION: The aim of this study was to investigate the co-influence of indirect mesio- occlusal-distal (MOD) cavity geometry and inlay restoration bonding on quasi-static fracture load of the restored tooth. METHODS: Forty-eight intact human molar teeth were selected and prepared for standardized edge-shaped or round-shaped MOD cavities. The resin composite (Cerasmart, GC) inlays were bonded with the state-of-the-art inlay bonding protocol or with intentionally deteriorated bonding using n-hexane-wax solution for preconditioning. Restored teeth were loaded along the long axis of the tooth. Ultimate fracture load was recorded, and the type of fracture was visually determined and classified. Statistical analysis of load values was performed by Kruskal-Wallis test. RESULTS: Round-shaped cavity design with bonded restoration presented the highest fracture load (1658N). Bonding had significant influence on the fracture load of roundshaped cavity design (p=0.0003), whereas cavity design had no influence when the bonding was deteriorated (p=0.8075). In the case of deteriorated bonding, either the inlay or tooth fractured separately whereas in the bonded inlays fractures were commonly found both in the tooth and inlay. CONCLUSIONS: According to this study, bonded inlay restoration increased fracture resistance, while cavity design had no statistical difference on fracture resistance of the restored tooth.

Evaluation of the microleakage of class V composite restoration after cavity treatment with Erbium, CO2 lasers, Papain, and Bromelain enzymes.

OBJECTVES: Different surface preparation and treatment methods may have dissimilar effects on the microleakage of composite resin. This study was conducted to determine the deproteinizing effect of 10% bromelain enzyme, 10% papain enzyme, CO2 , and erbium-YAG laser in regard to decrease in the microleakage of composite restorations. MATERIALS AND METHODS: Thirty teeth were selected and 60 class V cavities were prepared on the lingual and buccal sides. They were divided into six groups (n = 10): Group 1, phosphoric acid gel; Group 2, bromelain enzyme 10%; Group 3, papain enzyme 10%; Group 4, mixed papain and bromelain enzymes 10%; Group 5, CO2 laser; and Group 6, erbium-YAG laser. They were stored in basic fuchsine and dye penetration was evaluated. Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis, p < 0.05 RESULTS: In both occlusal and gingival margins, comparison of microleakage between groups 1, 2, 3, 4, and 5 showed no significant differences (p = 1) and group 6 had a significant difference with other groups (p ˂ 0.001). CONCLUSIONS: Microleakage of composite resin in the dentin surface was not affected significantly using either bromelain or papain 10% enzymes or erbium laser. However, CO2 laser had a negative effect on the enamel and dentin margins and increased the microleakage. Erbium laser showed a better effect than enzymes on microleakage.