Scaffolding competence-based learning design in the dental simulation curriculum.

INTRODUCTION: Learning in a clinical domain in dentistry is complex and learners may face uncertain clinical scenarios. A simulation curriculum can be designed to have simple clinical scenarios and learning activities which progress in complexity and employ competence assessments of simulated clinical practice before students can undertake authentic practice on patients. This paper presents how scaffolding of competence can be used for designing learning with simulators (haptics and phantom head) demonstrated in a specific domain in restorative dentistry. METHODS: A collaborative workshop as a research approach was undertaken to inform the iterative analysis, development, and discussion on scaffolding the learning design with respect to competence assessments of learning cavity preparation with simulation-based learning technologies. A workshop was conducted, which was collaborative and involved design negotiations between researchers, technologists, and teachers/practitioners in developing the simulation curriculum. RESULTS: A competence assessment with feedback in a specific domain in preparing interproximal caries was used as a context to describe how the learning activities and outcomes were designed to meet assessment of competence with varied levels of simple to complex learning activities and structured sessions. CONCLUSION: Simulation curriculum can be designed and implemented by scaffolding the level of competence that can be learned using simulation between haptics and phantom-head. This brings impetus to the need in meeting the relevant competence criteria in context to a specific affordance of the simulation-based learning technologies to provide optimal patient-centred holistic care.

Involvement of Angiopoietin 2 and vascular endothelial growth factor in uveitis.

PURPOSE: Angiopoietin (Ang) 2 is released from vascular endothelial cells by the stimulation of vascular endothelial growth factor (VEGF)A. Ang2 increases the expression of leukocyte adhesion molecules on endothelial cells via nuclear factor κB. The aim of this study was to evaluate the effects of Ang2 and VEGFA on ocular autoimmune inflammation. METHODS: We measured the concentrations of Ang2 and VEGFA in vitreous samples among patients with uveitis. Vitreous samples were collected from 16 patients with idiopathic uveitis (uveitis group) and 16 patients with non-inflammatory eye disease (control group). Experimental autoimmune uveoretinitis (EAU) was induced in B10.BR mice with a human interphotoreceptor retinoid-binding protein-derived peptide. The retinochoroidal tissues of the EAU mice were removed, and the mRNA levels of Ang2 and VEGFA were examined. EAU mice treated with anti-Ang2, anti-VEGFA, a combination of anti-Ang2 and anti-VEGFA, anti-Ang2/VEGFA bispecific, or IgG control antibodies were clinically and histopathologically evaluated. RESULTS: The protein levels of Ang2 and VEGFA were significantly higher in the vitreous samples of patients with uveitis than in controls (P<0.05). The retinochoroidal mRNA levels of Ang2 and VEGFA were significantly upregulated in EAU mice compared to controls (n = 6, P<0.05). Although there was no significant difference, treatment with anti-VEGFA antibody reduced the clinical and histopathological scores. However, treatment with anti-Ang2 antibody reduced the clinical and histopathological scores (n = 18-20, P<0.05). Furthermore, these scores were further decreased when treated by inhibiting both Ang2 and VEGFA. CONCLUSIONS: Based on these results, VEGFA and Ang2 were shown to be upregulated locally in the eye of both uveitis patients and models of uveitis. Dual inhibition of Ang2 and VEGFA is suggested to be a new therapeutic strategy for uveitis.

Digitally Guided Direct Composite Injection Technique with a Bi-layer Clear Mini-Index for the Management of Extensive Occlusal Caries in a Pediatric Patient: A Case Report.

PURPOSE: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient. MATERIALS AND METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices. RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent. CONCLUSION: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.

Effect of surface topography and wettability on shear bond strength of Y-TZP ceramic.

Zirconia ceramics have been widely used as dental restorations due to their esthetic appearance and high flexural strength. The bonding of zirconia with resin cement should rely on both mechanical and chemical bonds. This study was performed to investigate the effect of zirconia surface topography and its wettability after surface pretreatments on the microshear bond strength (µSBS) of a resin cement. Zirconia slabs were prepared and randomly divided into 5 groups based on the surface treatment as follows: no treatment (control), air abrasion (AB), etching with hydrofluoric acid (F), the mixture of hydrofluoric acid and nitric acid (FN), or the mixture of hydrochloric acid and nitric acid (CN) for 10 min. The specimens were subjected to investigation of surface roughness characteristics [average roughness (Ra), peak-to-valley average distance (Rpv), skewness (Rsk), and kurtosis (Rku)] using atomic force microscopy (AFM) and measurements of surface contact angle (θc) and µSBS of a resin cement. In addition, the area % of the nanoscale surface irregularity (nSI%) was calculated from the AFM images. The effects of nSI%, Ra and θc on the µSBS were analyzed by multiple linear regression analysis (p < 0.05). Multiple regression analysis revealed that the nSI% was the most predominant factor for the µSBS (p < 0.001). A surface with larger nSI%, higher Ra and relatively lower θc was essential for establishing a reliable resin-zirconia bond.

Delineating effects of angiopoietin-2 inhibition on vascular permeability and inflammation in models of retinal neovascularization and ischemia/reperfusion.

Introduction: Clinical trials demonstrated that co-targeting angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF-A) with faricimab controls anatomic outcomes and maintains vision improvements, with strong durability, through 2 years in patients with neovascular age-related macular degeneration and diabetic macular edema. The mechanism(s) underlying these findings is incompletely understood and the specific role that Ang-2 inhibition plays requires further investigation. Methods: We examined the effects of single and dual Ang-2/VEGF-A inhibition in diseased vasculatures of JR5558 mice with spontaneous choroidal neovascularization (CNV) and in mice with retinal ischemia/reperfusion (I/R) injuries. Results: In JR5558 mice, Ang-2, VEGF-A, and dual Ang-2/VEGF-A inhibition reduced CNV area after 1 week; only dual Ang-2/VEGF-A inhibition decreased neovascular leakage. Only Ang-2 and dual Ang-2/VEGF-A inhibition maintained reductions after 5 weeks. Dual Ang-2/VEGF-A inhibition reduced macrophage/microglia accumulation around lesions after 1 week. Both Ang-2 and dual Ang-2/VEGF-A inhibition reduced macrophage/microglia accumulation around lesions after 5 weeks. In the retinal I/R injury model, dual Ang-2/VEGF-A inhibition was statistically significantly more effective than Ang-2 or VEGF-A inhibition alone in preventing retinal vascular leakage and neurodegeneration. Discussion: These data highlight the role of Ang-2 in dual Ang-2/VEGF-A inhibition and indicate that dual inhibition has complementary anti-inflammatory and neuroprotective effects, suggesting a mechanism for the durability and efficacy of faricimab in clinical trials.

Real-time measurements of vascular permeability in the mouse eye using vitreous fluorophotometry.

Breakdown of blood-retinal barrier integrity underpins pathological changes in numerous ocular diseases, including neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Whilst anti-vascular endothelial growth factor (VEGF) therapies have revolutionised disease treatment, novel therapies are still required to meet patients' unmet needs. To help develop new treatments, robust methods are needed to measure changes in vascular permeability in ocular tissues in animal models. We present here a method for detecting vascular permeability using fluorophotometry, which enables real-time measurements of fluorescent dye accumulation in different compartments of the mouse eye. We applied this method in several mouse models with different increased vascular leakage, including models of uveitis, diabetic retinopathy and choroidal neovascularization (CNV). Furthermore, in the JR5558 mouse model of CNV, we observed with anti-VEGF post-treatment a longitudinal reduction in permeability, in the same animal eyes. We conclude fluorophotometry is a useful method for measuring vascular permeability in the mouse eye, and can be used over multiple time points, without the need to sacrifice the animal. This method has the potential to be used in both basic research for studying the progression and factors underlying disease, but also for drug discovery and development of novel therapeutics.

In vitro remineralization assessment of enamel subsurface lesions using different percentages of surface reaction-type pre-reacted glass-ionomer containing gum-based material.

OBJECTIVE: To identify the remineralization activity of enamel subsurface lesions using different percentages of surface pre-reacted glass-ionomer (S-PRG) filler containing gum-base material. METHODS: Gum extracts from gum-base materials containing 0wt%, 5wt%, and 10wt% S-PRG filler were prepared as GE0, GE5, and GE10, respectively. A total of 50 bovine enamel specimens were used, and the polished enamel surface of a 3 × 3 mm2 window area was exposed. The specimens were then subjected to a demineralization solution for seven days to create a subsurface enamel lesion. Remineralization was then conducted for seven days using a protocol whereby the specimens were immersed three times a day in prepared gum extracts (0wt%, 5wt%, and 10wt%) and artificial saliva of pH 7 (Control) for 20 min at 37 °C. Thereafter, remineralization assessment was performed by using Swept Source Optical Coherence Tomography (SS-OCT) and micro-computed tomography (µCT). Surface morphology and elemental analysis were conducted by scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS). RESULTS: The depths of the demineralized lesions in the GE5 and GE10 groups were significantly lower than those of the Control and the GE0 groups. SEM observations of the enamel surface morphology of the GE5 and GE10 groups indicated remineralization with S-PRG filler-related elements present. CONCLUSION: The GE5 and GE10 S-PRG filler containing gum-base materials showed significantly improved surface remineralization and reduced demineralization of the enamel lesions. EDS analysis suggested that the released ions from the S-PRG filler might be responsible for surface remineralization. CLINICAL SIGNIFICANCE: The S-PRG filler containing gum-base material may have a significant remineralization effect and improve the surface morphology of enamel subsurface lesions.

Polymerization shrinkage of light-cured conventional and bulk-fill composites -The effect of cavity depth and post-curing.

Volumetric shrinkage (VS) of conventional, bulk-fill, and core build-up resin-based composites (RBCs) of various thickness (1-5 mm) was measured using the modified bonded-disk method with confocal laser scanning microscopy. Additionally, the bottom-to-top ratio of Vickers hardness (%VH) was measured. Conventional RBCs exhibited significantly higher VS than bulk-fill and core build-up RBCs (p<0.05). As specimen thickness increased, VS relative to volume (%VS) and difference in VS at each depth (VSdepth) decreased. For conventional RBCs, there was a significant drop in VSdepth between 1 mm and 2 mm (p<0.05), and another drop was observed between 3 mm and 4 mm (p<0.05) where %VH decreased below 90%. For bulk-fill and core build-up RBCs, VSdepth decreased significantly between 2 mm and 3 mm (p<0.05), but %VH exceeded 90% even in 5 mm deep cavities. These results indicated that post-curing contributed to lower shrinkage in deeper layers, and that conventional RBCs were not adequately polymerized at the depth of over 3 mm.

Fostering globally competent dental students through virtual team-working, problem-solving and person-centred multi-disciplinary care planning.

Background/purpose: : Development and acquisition of communication, logical thinking, team-building, critical appraisal, critical thinking and person-centred multi-disciplinary care planning must be considered as skill sets and global core competencies for a dental professional. Therefore, an international online study course to foster undergraduate dental students' skill sets in these areas was established and this study aimed to report the perceptions of participants. Materials and methods: An international online course consisting of three levels pertaining to the school year was delivered to dental undergraduates of Japan and Thailand from September to December in 2021. An online questionnaire survey was conducted to obtain feedback from the participants and assess the implementation of the course. Results: In total, 64 responses were obtained from students who participated in all the assigned online sessions and completed the questionnaire (a response rate of 88%). More than 95% of students from each level felt that the programme increased their motivation to study clinical dentistry, and was beneficial for their future and made them appreciate the importance of participating in international exchange. The ratio of favourable respondents was more than 90% with a 95% confidence interval. Conclusion: Fostering globally competent dental students is important and the acquisition of necessary skill sets could be enhanced through international virtual team-working, problem-solving and person-centred multi-disciplinary care planning activities. These are beneficial for undergraduate dental student training so that they graduate with a broader global perspective and an appreciation of the importance of delivering person-centred culturally sensitive dental care.

Critical thinking education for dental schools in Asia: Perceptions of educators.

Teaching competence in critical thinking is an important element of undergraduate dental curricula. The pedagogy for critical thinking education in Asia requires further discussion and neither the current situation nor the possible challenges are widely known from the perspectives of dental educators. Therefore, seven educators from four countries gathered online in the summer of 2021 to share the current situation and possible challenges. All the participants considered "critical thinking" was "important" (43%) or "very important" (57%), however, 86% mentioned that they faced challenges in delivering education in critical thinking. The challenges to delivering critical thinking education were insufficient time in the curriculum and lack of human resources; lack of information on appropriate teaching methods for the student population; and no established methods of assessment. How to teach and assess critical thinking therefore requires more brainstorming, and raising the awareness of educators to implement this education might be necessary.

How long does it take for the occlusion to re-establish following the placement of restorations at an increased occlusal vertical dimension? A literature review.

Purpose This literature review aimed to investigate predictability of re-establishment of the occlusion following placement of restorations at an increased OVD, duration and to assess the quality of the available evidence.Methods An electronic search of articles using MEDLINE (1946-01/2019), EMBASE (1974-01/2019) and the Cochrane databases was undertaken. Search terms included dental restoration, vertical dimension and time. Studies involving placement of restorations at an increased OVD and recorded the time taken for the occlusion to re-establish were included. Eligibility assessments were carried out independently by two reviewers who also undertook independent extraction of predefined data fields, including study quality indicators.Results The search provided 61 results with 11 being relevant. A further 5 papers were identified for full text analysis. 4 papers used similar data from previous studies and 3 were excluded after full text assessment.. A final total of 9 papers were included in the review. It was indicated that the technique of placing restorations at an increased OVD appears to be clinically predictable in terms of re-establishment of occlusion and appears to occur most rapidly in younger patients.Conclusions The time taken for the occlusion to re-establish was between 15 days to 24 months. However, there is a need for prospective studies to evaluate the process in terms of success, predictive variables and specifically how long the process takes and this information would be helpful for both clinicians and patients, so that they know what to expect before embarking on a treatment.

Should new operating procedures arising from COVID-19 make us re-think our management of deep caries?

COVID-19 has impacted heavily on the delivery of dental services within the UK, particularly in regards to aerosol generating procedures (AGPs). However, it has created an opportunity to reflect on how operative dental procedures, such as the management of dental caries, are undertaken. In light of recent evidence in favour of speed increasing contra-angle handpieces in combination with an electric micromotor to eliminate the generation of aerosols at certain speeds while still allowing the cutting of hard tooth tissue, albeit at a slower rate than the traditional air-turbine, this article explores the evidence for partial caries removal using the electric micromotor system. Aspects of maintaing the health of the pulpal tissue using this system and adopting a logical approach to placing adhesive direct resin composites to faciliate an optimum outcome for the patient are also explored.

Long-term observation of periodontal condition following placement of removable partial dentures with rigid retainers and major connector in patients with/without diabetes: A retrospective study.

PURPOSE: This retrospective study evaluated the periodontal tissues of the abutment teeth of removable partial dentures (RPDs) with rigid retainers and major connectors in patients with and without type 2 diabetes mellitus (T2D). METHODS: A total of 313 patients who had been treated with RPDs, including rigid retainers and major connectors, were divided into two groups: T2D and non-T2D. The periodontal parameters and radiographic bone heights of the abutment teeth were evaluated at baseline and at a 5-year examination during supportive periodontal therapy (SPT). For patients with accessible standardized radiographs, bone density was analyzed based on the gray level (GL) using digital subtraction radiography (n = 83). RESULTS: Overall, 739 abutment teeth (86 in the T2D group) of 235 patients (25 in the T2D group) were analyzed, and 95.0% (94.2% in the T2D group, and 95.2% in the non-T2D group) were maintained. The mean probing pocket depth significantly increased in both groups (p < 0.001). There were significant changes in the radiographic bone height (p = 0.038) and GL on the side of the denture base area (p = 0.048) in the T2D group compared to those in the non-T2D group. CONCLUSION: Regardless of T2D, RPDs with rigid retainers and major connectors could prevent the progression of periodontal disease and successfully maintain most of the abutment teeth during 5-years of SPT. However, T2D may be significantly associated with loss of bone height reduction and density on the side of the denture base area.

Strain analysis of anterior resin-bonded fixed dental prostheses with different thicknesses of high translucent zirconia.

BACKGROUND/PURPOSE: High translucent zirconia has been used as a new monolithic zirconia prosthesis, which has the potential to make anterior resin-bonded fixed dental prostheses (RBFDPs) without veneering porcelain. However, it is unclear whether the RBFDPs retainer can be thinned as much as conventional zirconia RBFDPs. The aim of this study was to assess the usability of high translucent zirconia RBFDPs with a thin retainer thickness by evaluating differences in retainer thickness on the surface strain. MATERIALS AND METHODS: A model with a missing upper lateral incisor was used. The abutment teeth were upper central incisor and canine. Three types of RBFDPs were fabricated as follows: metal RBFDPs with a retainer thickness of 0.8 mm (0.8M), and high translucent zirconia RBFDPs with a retainer thicknesses of 0.8 and 0.5 mm (0.8Z, 0.5Z) (n = 10). The fitness of the margins was evaluated by the silicone replica technique. The surface strain of each retainer under static loading was measured and statistically analyzed using a t-test with Bonferroni correction. RESULTS: The marginal fitness of all RBFDPs was under 76.1 µm, which was clinically acceptable. Each strain of the 0.8Z and 0.5Z groups was significantly lower than that of the 0.8M (p < 0.05). There was no difference in strain of the zirconia RBFDPs even if the retainer thickness was changed. CONCLUSION: Our results suggest that the high translucent zirconia RBFDPs can be manufactured with a retainer thickness of 0.5 mm, which reduces the amount of tooth preparation compared to the metal RBFDPs.

Long-term evaluation of warm-air treatment effect on adaptation of silane-containing universal adhesives to lithium disilicate ceramic.

The effect of warm air-blowing on the sealing ability of two one-bottle and one two-bottle silane-containing universal adhesives (UAs) applied to lithium disilicate ceramics (LDS) was evaluated. Tapered cavities prefabricated in LDS blocks (IPS e.max CAD) were treated by the adhesives, air-blown either with normal air (23±1°C) or warm air (60±5°C), and filled with a flowable resin composite. Interfacial gap formation was observed using swept-source optical coherence tomography immediately after filling, after 24 h, 5,000 and 10,000 thermal cycles, and an additional 1-year water storage. Specimens bonded using normal air-blown one-bottle UAs exhibited a significantly higher gap formation than the two-bottle UA (p<0.001), and detached within 24 h. Warm air-blowing significantly decreased the gap formation of one-bottle UAs (p<0.001), but the specimens dislocated within 24 h or during thermocycling. The two-bottle UA withstood all aging procedures and warm air-blowing significantly decreased its 1-year gap formation compared to normal air-blowing (p=0.002).

Bond strengths of three-step etch-and-rinse adhesives to silane contaminated dentin.

This study aimed to evaluate the effect of silane coupling agent contamination on the microtensile bond strength (µTBS) of 3-step etch-and-rinse adhesives on dentin. Flat occlusal dentin surfaces were prepared and randomly divided into 8 groups (n=20) based on the tested adhesives; Scotchbond Multi-purpose or Optibond FL, with contamination of an experimental silane (2 vol% of 3-m ethacryloxypropyltrimethoxysilane at pH 4.5) before acid-etching, after-etching or after-priming; while the groups without silane contamination served as controls. µTBS data were analyzed by two-way ANOVA and Tukey's HSD tests at a significance level of 0.05. Additional specimens of contaminated dentin were used to analyze changes in the organic molecules by Fourier transform infrared spectroscopy (FTIR). Silane contamination before acid-etching did not significantly change µTBS (p>0.05), but contamination after-etching and after-priming significantly decreased µTBS of both adhesives (p<0.05). Silane contamination had an adverse effect on the dentin bond strength of 3-step etch-and-rinse adhesives especially after-priming.

Current perspectives on dental adhesion: (2) Concepts for operatively managing carious lesions extending into dentine using bioactive and adhesive direct restorative materials.

This article reviews the current concepts for operatively managing carious lesions extending into dentine with minimal removal of tooth structure and restoring with dentine adhesives and direct composite resin. It looks sequentially at the operative steps involved including remineralisation with bioactive cements, bonding to caries-affected dentine including smear-layer modification using HOCl, creation of an acid-base resistance zone,steps to optimise the performance of all-in-one adhesives, and incremental placement of direct composite resin to improve bond strengths to cavity floor dentine. It explores how understanding the phenomenon of colour-shifting at the composite resin-enamel/dentine restoration borders can help in creating near "invisible" restoration margins through a "chameleon" effect. With the increased risks of transmission of Covid-19 when aerosol generating procedures are carried out in Dentistry, following a minimally invasive approach to managing dental caries should be given serious consideration.

Can surface protection prevent the loss of hardness on dentin and composite resin surfaces exposed to erosive challenges? / ¿Puede la protección de la superficie prevenir la pérdida de dureza en las superficies de dentina y resina compuesta expuestas a erosión?

Objective: This study investigated the effect of endogenous erosion on the microhardness of dentine and a nanofilled composite resin. Procedures for preventing erosion were also studied. Materials and Methods: 90 bovine dentine specimens were divided into three groups in accordance with the method for preventing: negative control, topical application of fluoride and resin-modified glass ionomer varnish. 120 composite resin specimens were distributed into four groups, which also included a resin sealant, among the preventive procedures. Specimens were then randomly divided into three sub-groups according to the exposure to simulate gastric acid solution and subsequent remineralization: negative control, 9 and 18 cycles. Surface analysis was carried out by measuring the Knoop hardness. The data obtained were statistically analyzed using 2-way ANOVA and Tukey test. Result: The mean hardness of dentine and of the composite specimens resin exhibited lower hardness after 18 cycles. However, the resin-modified glass ionomer varnish resulted in greater values compared to the other preventive procedures. Conclusion: A resin-modified glass ionomer varnish seems to be a promising method for minimizing the damage caused by endogenous acid, but its protection can be reduced depending on the intensity of the erosive challenge.

Objetivo: Este estudio investigó el efecto de la erosión endógena sobre la microdureza de la dentina y una resina compuesta de nanorrelleno. También se estudiaron los procedimientos para prevenir la erosión. Materiales and Métodos:90 muestras de dentina bovina se dividieron en tres grupos de acuerdo con el método para prevenir: control negativo, aplicación tópica de fluoruro y barniz de ionómero de vidrio modificado con resina. Se distribuyeron 120 muestras de resina compuesta en cuatro grupos, que también incluían un sellador de resina, entre los procedimientos preventivos. Las muestras se dividieron al azar en tres subgrupos de acuerdo con la exposición para simular la solución de ácido gástrico y la remineralización posterior: control negativo, 9 y 18 ciclos. El análisis de la superficie se realizó midiendo la dureza Knoop. Los datos obtenidos se analizaron estadísticamente mediante ANOVA de 2 vías y prueba de Tukey. Resultados: La dureza media de la dentina y de la resina de muestras compuestas exhibió una dureza más baja después de 18 ciclos. Sin embargo, el barniz de ionómero de vidrio modificado con resina resultó en valores mayores en comparación con los otros procedimientos preventivos. Conclusión: Un barniz de ionómero de vidrio modificado con resina parece ser un método prometedor para minimizar el daño causado por el ácido endógeno, pero su protección puede reducirse dependiendo de la intensidad del desafío erosivo.

Effect of smear layer deproteinization with chemo-mechanical caries removal agents on sealing performances of self-etch adhesives.

OBJECTIVES: To evaluate the sealing performance of self-etch adhesives (SEA) after smear layer deproteinization with chemo-mechanical caries removal agents (CRA) to enamel and dentin cavity walls in comparison with 6% NaOCl smear layer deproteinizing. METHODS: Eighty extracted bovine incisors with tapered cylindrical cavities (2.5 mm upper diameter, 1.5 mm lower diameter, 2 mm depth) at the cemento-enamel junction were randomly divided into four pre-treatment groups; no treatment (control), Papacarie (papain enzyme-based CRA), Carisolv (NaOCl-based CRA), and 6% NaOCl. After pretreatment, G-Bond Plus (GBP, one-step SEA) or Clearfil SE Bond 2 (CSE, two-step SEA) was applied to the pre-treated cavity, and then filled with a flowable resin composite (Clearfil Majesty ES Flow). Gap formations at the enamel and dentin lateral walls, and on the dentin cavity floor were investigated using swept-source optical coherence tomography (SS-OCT) after 24-h water storage at 37 °C. Deproteinizing effects of the tested agents on smear layer-covered enamel and dentin were quantified by changes in the amide:phosphate ratio using ATR-FTIR analysis. RESULTS: Papacarie significantly reduced gap formation with both self-etch adhesives at all locations, compared to the control group (p < 0.05). In contrast, increased gap formation was observed with Carisolv and NaOCl. In most groups, CSE exhibited significantly lower gap formation than GBP (p < 0.05). ATR-FTIR revealed a significant decrease in the amide:phosphate ratio for all the deproteinizing agents (p < 0.05). CONCLUSIONS: Chemo-mechanical CRAs could effectively remove the organic phase of enamel and dentin smear layer. The papain enzyme-based gel Papacarie could improve the sealing performance of the self-etch adhesives to both enamel and dentin.

The combined effect of light-illuminating direction and enamel rod orientation on color adjustment at the enamel borders of composite restorations.

OBJECTIVES: To investigate the effect of light-illuminating direction (from composite or enamel side) on color adjustment at the coronal and cervical enamel borders in composite restorations. MATERIALS AND METHODS: Forty cylindrical holes (3.0-mm diameters) were prepared in bovine enamel disks (1.0-mm thickness). After application of a one-step self-etch adhesive, one of four resin composites (Estelite Asteria, EA; Estelite Pro, EP; Kalore, KA; Clearfil Majesty ES-2 Premium, MJ) was restored in the holes. After 24-h storage, the colors (L*, C*, or h* values) at the restored enamel disks over a black background were measured in a black box using a CIE XYZ camera, spotted with D65 standard illuminant either from coronal or cervical side at 45°/0° geometry. The color shifting rate was calculated at the coronal and cervical enamel borders of the composite restorations, and analyzed by three-way ANOVA with Dunnett's T3 and t test for post hoc analysis (p < 0.05). RESULTS: The light-illuminating directions significantly affected the L* shifting rate at the cervical enamel border in EP and MJ (p < 0.05), and the C* shifting rate at the coronal enamel border in EA, EP, and MJ (p < 0.05). CONCLUSIONS: The color appearance at the border of the composite restoration was influenced by the light-illuminating direction in conjunction with the enamel rod orientation in the coronal or cervical enamel border. CLINICAL RELEVANCE: The line-of-vision angle would affect the perception of color adaptation at the enamel borders in the composite restorations.