Dental Caries diagnosis from bitewing images using convolutional neural networks.

BACKGROUND: Dental caries, also known as tooth decay, is a widespread and long-standing condition that affects people of all ages. This ailment is caused by bacteria that attach themselves to teeth and break down sugars, creating acid that gradually wears away at the tooth structure. Tooth discoloration, pain, and sensitivity to hot or cold foods and drinks are common symptoms of tooth decay. Although this condition is prevalent among all age groups, it is especially prevalent in children with baby teeth. Early diagnosis of dental caries is critical to preventing further decay and avoiding costly tooth repairs. Currently, dentists employ a time-consuming and repetitive process of manually marking tooth lesions after conducting radiographic exams. However, with the rapid development of artificial intelligence in medical imaging research, there is a chance to improve the accuracy and efficiency of dental diagnosis. METHODS: This study introduces a data-driven model for accurately diagnosing dental decay through the use of Bitewing radiology images using convolutional neural networks. The dataset utilized in this research includes 713 patient images obtained from the Samin Maxillofacial Radiology Center located in Tehran, Iran. The images were captured between June 2020 and January 2022 and underwent processing via four distinct Convolutional Neural Networks. The images were resized to 100 × 100 and then divided into two groups: 70% (4219) for training and 30% (1813) for testing. The four networks employed in this study were AlexNet, ResNet50, VGG16, and VGG19. RESULTS: Among different well-known CNN architectures compared in this study, the VGG19 model was found to be the most accurate, with a 93.93% accuracy. CONCLUSION: This promising result indicates the potential for developing an automatic AI-based dental caries diagnostic model from Bitewing images. It has the potential to serve patients or dentists as a mobile app or cloud-based diagnosis service (clinical decision support system).

Effects of curing time and intensity and polishing technique on color stability of bleach-shade composite resins.

Background: Despite the improvements in optical properties of composite resins, their color stability is still a matter of concern. This study aimed to assess the curing time and intensity and polishing technique on color stability of bleach-shade composite resins. Materials and Methods: In this in vitro, experimental study, 128 discs (1 mm × 8 mm) were fabricated from two composite resins. The specimens fabricated from each composite were assigned to 8 subgroups (n = 8) based on the curing time and intensity and polishing with polishing points or discs. After polishing, the color parameters of specimens were measured by EasyShade spectrophotometer according to the CIEL* a*b* color system. The specimens were then immersed in tea solution, and their color parameters were measured again. Color change (ΔE) was calculated and analyzed at 0.05 level of significance. SPSS 25 was used for data analysis. Univariate four-way ANOVA was applied to assess the effects of composite type, curing time, curing intensity, and technique of polishing on ΔE of composite resins. Since the interaction effects were significant, subgroup analysis was performed by t-test. The level of significance for this test was set at 0.05. Results: The effects of curing intensity and polishing technique were significant on ΔE (P < 0.05). Filtek Z350 XBW composite specimens polished by polishing points experienced lower color change than those polished with discs. The minimum ΔE of Gradia XBW composite was recorded in specimens that underwent high-intensity curing for 20 s and were polished with polishing points while the maximum ΔE was recorded in specimens that underwent high-intensity curing for 20 s and were polished with discs. Conclusion: In all groups except on (Filtek, polishing with Disk, curing time = 20 s), high-intensity curing and polishing with polishing points were more effective and caused lower color change compared with low-intensity curing and polishing with discs.

Comparative Efficacy of Four Stain Removal Methods for Bleach-Shade Composite Resins after Immersion in Staining Solutions: An In Vitro Study.

Introduction: Bleach-shade composite resins were recently introduced to the market due to the high demand of patients for whiter teeth. This study sought to compare four stain removal methods for bleach-shade composite resins. Materials and Methods: Seventy-two discs were fabricated from each of the Filtek Z350 XT and Gradia XBW composite resins and immersed in coffee or sour cherry juice staining solutions. Each group was then divided into four subgroups to assess the efficacy of four stain removal methods (finishing with soft-lex disk "brush with pumice" bleaching with carbamide peroxide 16%, bleaching with hydrogen peroxide 40%). The color of each specimen was measured by Easyshade spectrophotometer, and data were analyzed using SPSS 25 statistical package for social sciences. Results: The home-bleaching technique was more effective than the office-bleaching and pumice for the removal of sour cherry juice stain (ΔE = 1.93) and coffee stain (ΔE = 3.32) from Gradia composite discs, almost returning the baseline original color. The Sof-Lex discs were more effective than the pumice for the removal of sour cherry juice stain (ΔE = 4.11) and coffee stain (ΔE = 4.93) from Z350 composite discs but not return the baseline original color. Conclusions: Filtek Z350 had more discoloration than Gradia Direct. The different materials and solutions reacted differently to the four stain removal methods. In GCJ group after all stain removal methods, ΔE reduced to a clinically acceptable level.

Dental students' knowledge about protective guidelines for clinical practice during the COVID-19 pandemic.

Objective: The coronavirus disease 2019 (COVID-19) originated in China, in December 2019, spread worldwide promptly and turned into an outbreak which caused an international public health concern. The novel coronavirus which is also called SARS-CoV-2 transmits predominantly by respiratory droplets and the spread pattern of this infection throughout the community became a big challenge encountering the dental profession. Recently several guidelines have been developed for dental clinicians to protect both patients and practitioners, agents this infection. The aim of this study was to estimate the knowledge of dental students about the content of protective guidelines for clinical practice during the COVID-19 pandemic. Methods: An online questionnaire was developed by a team of specialists which were the faculty member of Tehran University of Medical sciences according to the content of the protective guidelines of ADA for dental practice during the COVID-19 pandemic. The questionnaire was validated and its reliability was confirmed by retesting 10 samples after 2 weeks with a cronbach alpha of 0.9. The online questionnaire was sent to 4 dental schools in the city of Tehran and was fill out by 170 dental students. Results: The mean knowledge score for all 170 participants was 16.23 out of 32 (50.72%) with the maximum score of 24 (75.0%) and the minimum score of 1 (3.1%). There was a significant relationship between the gender of participants and their knowledge score (p = 0.032) in the way that male students had significantly higher score than females. Students with more advanced educational level achieved higher knowledge scores. (p = 0.038) However, there were no significant correlation between other variables and the students' knowledge score. (p > 0.05). Conclusion: Dental students had acceptable knowledge about the general protocols against corona virus in terms of hand hygiene, wearing face masks, surface sanitization and diagnostic symptoms of a patient susceptible to be infected by corona virus. However, mostly they were not aware of the details of the guideline's items which makes it crucial to add related content in the dental students' educational curriculum.

Effect of glazing and polishing on opalescence and fluorescence of dental ceramics.

OBJECTIVE: Tooth enamel has opalescence and fluorescence, which should be mimicked by esthetic dental restorations. The purpose of this study was to compare the effects of glazing and polishing on the opalescence and fluorescence of dental ceramics. MATERIALS AND METHODS: Twenty-four discs were fabricated of feldspathic, IPS e.max, zirconia, and Enamic ceramics with 10 mm diameter and 0.5 and 1 mm thicknesses (n = 12). Of the discs fabricated with 0.5 and 1 mm thicknesses, half of them were glazed and the remaining half were polished (n = 6). Opalescence was calculated as the difference in yellow-blue (CIE ∆b*) and red-green (CIE ∆a*) color axes between the transmitted and reflected colors. The fluorescence of specimens was measured by a novel technique. Data were analyzed using two-way analysis of variance at a 0.05 level of significance. RESULTS: In all groups (except for the Enamic ceramic), the mean opalescence of polished specimens (e.max = 2.704, feldspathic = 1.67, zirconia = 3.143) was higher than that of glazed specimens (e.max = 2.163, feldspathic = 1.016, zirconia = 2.690). The mean opalescence of glazed Enamic specimens (2.140) was higher than that of polished specimens (1.308). The fluorescence of glazed and polished specimens was not significantly different. CONCLUSION: Surface treatment (glazing/polishing) affects the opalescence, but not the fluorescence of dental ceramics evaluated in this study.

Direct pulp capping with autologous bone marrow derived stem cells in dogs.

Bone-marrow derived stem cells (BMSCs) can differentiate into several mesenchymal cell lines that are suitable for bone and dental tissue engineering. This study was aimed to assess the efficacy of cell therapy in direct pulp capping (DPC) of canine teeth using autologous BMSCs along with collagen/hydroxyapatite hybrid scaffold in terms of the quantity and quality of calcified bridge formation. The teeth were randomly divided into three groups of DPC with mineral trioxide aggregate (MTA), hydroxyapatite/collagen hybrid scaffold alone and BMSCs with hydroxyapatite/collagen hybrid scaffold. DPC was performed under general anesthesia in cavities prepared on the buccal surfaces of mandibular and maxillary premolars of the same dogs from which, stem cells had been isolated. All cavities were then restored with light-cure resin modified glass ionomer cement. Histomorphometric assessments after 12 weeks showed formation of dentinal bridge following DPC with BMSCs and MTA. The efficacy of MTA for calcified bridge formation following DPC was significantly higher than that of BMSCs plus hybrid scaffold. According to the present study, we concluded DPC using BMSCs and hybrid scaffold did not provide clinically noticeable results in canine patients.

Efficacy and durability of bleaching with diode lasers: an in vitro study.

The aim of this in vitro study was to compare the efficacy and durability of bleaching with diode lasers over a 9-month period. This study evaluated 27 extracted teeth categorized into 3 bleaching groups (n = 9): 940-nm diode laser, 980-nm diode laser, and 40% hydrogen peroxide whitening gel (control). After the baseline color of the teeth was measured using a spectrophotometer, the teeth underwent dental prophylaxis and their color was measured again. Bleaching treatment was then performed. The color of the teeth was measured immediately after bleaching and 1 day (24 hours), 1 week, 1 month, 3 months, 6 months, and 9 months after bleaching. The Commission Internationale de l'Eclairage (CIE) L*a*b* color change (ΔE*) at each timepoint was calculated and compared using repeated-measures analysis of variance. All bleaching techniques effectively whitened the teeth to a clinically perceptible level (ΔE* > 3.3), and there were no statistically significant differences among the groups (P > 0.05). The mean ΔE* values of the laser groups were not significantly different from the mean value of the control group during the 9-month evaluation period (P > 0.05). However, statistically significant differences among the groups were noted when color measurements at the following timepoints were compared: immediately after bleaching vs 1 day; 1 day vs 1 week; and 3 months vs 6 months (P < 0.05). Use of a 940-nm diode laser, 980-nm diode laser, or conventional hydrogen peroxide gel provided equally effective bleaching. The color change remained clinically perceptible throughout the 9-month period.

Effect of surface treatment with laser on repair bond strength of composite resin to ceramic.

Background: Small chipping or fracture of ceramic restorations may be repaired by composite resin instead of replacing the restoration. This method is faster and cheaper compared to restoration replacement. Several strategies have been suggested to obtain a high repair shear bond strength (SBS). This study aimed to assess the efficacy of some new ceramic surface treatments (laser and universal adhesive) to enhance the repair bond strength of composite resin to ceramic compared to the conventional method. Materials and Methods: This in vitro study evaluated 80 IPS Empress Esthetic ceramic plates in eight groups (n = 10). The ceramic surface was polished with 320-grit silicon carbide paper under running water, rinsed with water spray for 10 s and dried. The samples were then divided into two subgroups for mechanical surface preparation with hydrofluoric (HF) acid and Er: YAG laser (2 W, 200 m J, 10 Hz, 10 s). Each group was divided into two subgroups for use/no use of silane. The conventional or universal adhesive was then applied on the samples in each subgroup. Composite cylinders were bonded to the ceramic surface using plastic tubes. The samples were stored in distilled water at 37°C for 24 h and subjected to an SBS test. Data were analyzed using one-way ANOVA (P < 0.05). Results: The interaction effect of variables on SBS was significant. Maximum SBS was noted in HF acid + silane + conventional adhesive group (mean: 12.0481 MPa). Minimum SBS was noted in the laser + conventional adhesive group (mean: 2.5766 MPa). Surface treatment with HF acid yielded significantly higher SBS than laser (P < 0.001). The interaction effect of conventional/universal adhesive and use/no use of silane on SBS was statistically significant. Conclusion: The repair SBS was higher in groups treated with HF acid compared to laser. Ceramic surface treatment with HF plus silane plus conventional adhesive yielded a higher SBS as well as HF plus Universal adhesive. Thus, the application of silane as a separate step can be omitted in the repair of ceramic restorations with universal adhesives.

Effect of antimicrobial photodynamic therapy with different photosensitizers and adhesion protocol on the bond strength of resin composite to sound dentin.

OBJECTIVES: The aim of this study is to evaluate the influence of the antimicrobial photodynamic therapy with phycocyanin and toluidine blue on the bond strength of resin composite to the sound dentin. MATERIALS AND METHODS: The samples include 120 tooth blocks taken from 60 human extracted sound third molar teeth. They were randomly divided into 12 groups and disinfected with two different photosensitizers (Phycocyanin and Toluidine blue) activated by 635 nm diode laser for aPDT procedure. Then two different protocols (total-etch and self-etch) of universal adhesive system (G-Premio BOND, GC Dental Products CORP. Japan) were applied. The samples then filled with resin composite (Gradia® Direct, GC Dental Products CORP. Japan). After 10000 cycles of thermocycling, all samples were subjected to the micro shear bond strength (µSBS) test using a universal testing machine (1 mm/min). The data were analyzed with One Way ANOVA. RESULTS: The effect of aPDT using both photosensitizers (phycocyanin and toluidine blue O) on the bonding strength to dentin was not significant (P>0.05). However, the bonding strength of total etch groups was reduced significantly (P<0.05) after aPDT using both photosensitizers. Phycocyanin self-etch group showed the greatest bonding strength (19.48 ± 3.89 MPa) in comparison to other aPDT groups. No significant reduction after thermocycling in dentin bond strength was observed in all groups (P>0.05), with exception of control total etch groups, which showed significant difference (P<0.05). CONCLUSION: aPDT using toluidine blue O and phycocyanin has no adverse effect on bonding to sound dentin when using universal adhesive in self-etch protocol. CLINICAL RELEVANCE: Phycocyanin is more recommended to be used in aPDT in comparison to toluidine blue as a natural photosensitizer.

Effect of Thickness on Fluorescence of Some Clinical Dental Ceramics.

Objectives: This study aimed to develop a new method for measurement of florescence and compare the fluorescence of some clinical dental ceramics in different thicknesses. Materials and Methods: Forty-eight samples of feldspathic (Vita VM9, A2), IPS e.max (Ivoclar HT, A2), zirconia (Korox Zircostar, A2) and Enamic (Vita A2) ceramics were used in this study in 0.5 and 1 mm thicknesses. The fluorescence of the samples was measured by using a developed technique. The results were analyzed by two-way ANOVA and Duncan post-hoc test. P<0.05 was considered significant. Results: Enamic, feldspathic and e.max ceramics had significantly different fluorescence in descending order (P=0.000). Fluorescence of ceramics increased with an increase in their thickness from 0.5 to 1 mm (P=0.007). Conclusion: The results confirmed the applicability of the presented method for measurement of fluorescence of dental ceramics. While, the thickness of restoration determines the concentration of the fluorescent agent, some additional technical information is required for justification of the observed trend in the studied ceramics.

Surface microhardness of a self-adhesive composite in comparison with conventional composite resins.

BACKGROUND: The surface microhardness of dental composites greatly affects the durability of restorations. OBJECTIVES: The aim of this study was to compare the surface microhardness of a self-adhesive composite with that of other conventional composites. The effect aging has on surface microhardness was also evaluated. MATERIAL AND METHODS: In this in vitro experimental study, the composite resins were poured into molds measuring 3 mm × 3 mm × 6 mm and cured for 40 s. The samples were then immersed in distilled water at 37°C for 24 h. After polishing, the surface microhardness of the samples was measured using the Vickers hardness tester. For this purpose, a 100-gram load was applied to 3 points on the surface of each composite sample for 20 s, and the mean value of surface microhardness was used as the Vickers hardness number. The samples were then subjected to 30,000 thermal cycles at 5-55°C in order to age them; after that, their surface microhardness was measured again. The one-way analysis of variance (ANOVA) was used for the statistical analysis. RESULTS: The maximum hardness value before and after aging belonged to Filtek® Z250, followed by Premise™ Flow and Vertise™ Flow, with significant differences between them (p < 0.001). After aging, the surface microhardness of all composites decreased significantly (p < 0.001). The effect of aging on surface microhardness was the same in all groups (p > 0.05). CONCLUSIONS: The surface microhardness of composites was significantly different before and after aging. All composites experienced a reduction in their surface microhardness after aging.

The effect of ceramic thickness on opalescence.

OBJECTIVES: Creating a tooth-like appearance by use of dental ceramics is still a challenge. Opalescence is a unique property of dental enamel, attempted to be mimicked by dental restorative materials. This study aimed to assess the effect of ceramic thickness on opalescence. MATERIALS AND METHODS: Twenty-four discs were fabricated of feldspathic ceramic, IPS e.max, zirconia and Enamic ceramics with 10 mm diameter and 0.5 and 1 mm thicknesses (n = 12). The opalescence of ceramic specimens was calculated by measuring the difference in yellow-blue axis (CIE ∆b*) and red-green axis (CIE ∆a*) between the transmitted and reflected spectra. One-way ANOVA was applied to compare the opalescence of different ceramic specimens with variable thicknesses at .05 level of significance. RESULTS: The opalescence of feldspathic, IPS e.max, zirconia and Enamic ceramic specimens with 0.5 mm thickness was 1.06 ± 0.15, 3.39 ± 0.15, 1.98 ± 0.15 and 1.44 ± 0.15, respectively. By increasing the thickness to 1 mm, the opalescence of feldspathic, IPS e.max, zirconia and Enamic ceramics changed to 1.12 ± 0.15, 1.47 ± 0.15, 3.85 ± 0.15 and 2.00 ± 0.15, respectively. In all groups except for IPS e.max, the mean opalescence of 1-mm-thick specimens was higher than that of 0.5-mm-thick specimens. CONCLUSION: Type and thickness of ceramic affect its opalescence. The opalescence of all ceramic specimens tested in this study with 0.5 and 1 mm thicknesses was lower than that of the enamel.

Effect of an Optical Whitening Toothpaste on Color Stability of Tooth-Colored Restorative Materials.

OBJECTIVES: This study aimed to assess the effect of an optical whitening toothpaste on color stability of microhybrid, nanofilled, and microfilled composite resins and resin-modified glass ionomer (RMGI) cement in comparison of two other toothpastes. MATERIALS AND METHODS: In this experimental study, disc-shaped composite samples were fabricated. The samples were then polished using silicon carbide papers. Twenty-seven samples of each material were fabricated and subjected to colorimetry using a spectrophotometer. Each group of material was then divided into three subgroups for the application of conventional whitening and whitening containing blue covarine toothpastes. One operator brushed the samples with an electric soft toothbrush with circular motion twice a day, each time for 30 seconds. Colorimetry was performed at 0, 1, 7, 30, and 90 days. STATISTICAL ANALYSIS: Two-way analysis of variance (ANOVA), one-way ANOVA, and Tukey's honestly significant difference (HSD) test were used for statistical analysis. RESULTS: The interaction effect of type of restorative material and time on ∆E was not significant at baseline or 1 day (p > 0.05). The effect of type of toothpaste on ∆E was not significant at baseline or 1 day (p = 0.78) but the effect of type of material was significant (p < 0.05). The toothpastes had significantly different effects on ∆E of Z250 at all time points (p < 0.05) except for ∆E0-30 (p = 0.106). The toothpastes had significantly different effects on ∆E of Z350 and Gradia at all time points (p < 0.05). The same was true for RMGI except for ∆E0-7 (p = 0.43) and ∆E0-90 (p = 0.52). The majority of color changes caused by toothpastes were not clinically perceivable (∆E < 3.3), except for ∆E0-90 by the whitening toothpaste (∆E = 9), ∆E0-90 by the conventional toothpaste for Z350 (∆E = 3.9), and ∆E0-1 by the whitening toothpaste for RMGI (∆E = 3.7). CONCLUSION: The color change of all composite samples was not clinically perceivable (<3.3) at all time points, which shows that the tested toothpastes do not cause a significant change in color of composite materials.

Effect of Laser Irradiance and Fluoride Varnish on Demineralization Around Dental Composite Restorations.

Introduction: This study aimed to assess the effects of CO2 and erbium-doped yttrium aluminum garnet (Er:YAG) lasers with and without fluoride varnish on demineralization around composite restorations. Methods: This in vitro experimental study evaluated 96 extracted human premolars. After preparation and restoration of class V cavities in the buccal surface of the teeth with composite resin, they were randomly divided into 8 groups of control, CO2 laser (L1), CO2 laser-NaF (L1F), NaF-CO2 laser (FL1), Er:YAG laser (L2), Er:YAG laser-NaF (L2F), NaF-Er:YAG laser (FL2) and NaF (F). The entire surface of the teeth, except for the restored cavity in the buccal surface and 1 mm around the margin, was coated with two layers of nail varnish. The teeth then underwent pH cycling for 10 days (3 hours in demineralizing solution and 21 hours in remineralizing solution) to artificially induce demineralization. The amount of calcium and phosphorous released into the cariogenic solution was quantified using atomic absorption spectroscopy and spectrophotometry. The Vickers hardness tester was used to measure the hardness of the tooth structure adjacent to composite restoration. Data were analyzed using one-way ANOVA and Tukey's test. Results: The four groups of L1F, FL1, FL2 and L2F showed minimum loss of calcium and phosphorous ions, and the mean hardness of FL1 and FL2 groups was higher than that of other groups. Conclusion: The CO2 and Er:YAG lasers alone have no significant effect on the resistance of tooth structure to cariogenic solution. However, they can exert a synergistic effect when used along with NaF varnish. Fluoride varnish applied prior to laser irradiation confers further resistance to the tooth structure and positively affects its hardness.

Fluorescence and Opalescence of Two Dental Composite Resins.

OBJECTIVE: Lifelike esthetic appearance of dental restorations is among the main goals in restorative dentistry. This study aimed to assess and compare the opalescence and fluorescence of two dental composite resins. MATERIALS AND METHODS: This in vitro experimental study evaluated the A2 shade of Filtek Z350 XT Enamel, Filtek Z350 XT Dentin, Aelite Aesthetic Enamel, and Aelite All Purpose Body composite resins. Composite discs were fabricated with 10 mm diameter and 0.5 and 1 mm thicknesses (n = 2) using a plexiglass mold and subjected to colorimetry. The color parameters were determined according to the International Commission on Illumination (CIE) L*a*b* system using a spectrophotometer. The fluorescence and opalescence were also measured and reported separately for 0.5 and 1 mm thicknesses of Z350, Aelite Body, and Enamel composite resins. To determine the opalescence, the color of samples in the reflectance mode was measured using a calibration cylinder and in the transmittance mode in presence of 100% ultraviolet (UV) light. To determine the fluorescence, the color of samples against a white background in the reflectance mode in presence or absence of 100% UV light was measured. STATISTICAL ANALYSIS: Data were analyzed using SPSS via three-way analysis of variance and independent t-test. RESULTS: The fluorescence of 0.5 mm thickness of all composites was higher than that of 1 mm thickness (p < 0.05). The fluorescence of Aelite was higher than that of Z350 (p < 0.05). The fluorescence of Aelite Enamel was higher than that of Aelite Body irrespective of their thickness, but the results were opposite for Z350 (p < 0.05). In Aelite composite, opalescence increased by an increase in thickness (p < 0.05). The opalescence of Aelite was significantly higher than that of Z350 (p < 0.05). The opalescence of 0.5 mm thickness of Aelite Enamel was higher than that of Aelite Body, while the opalescence of 1 mm thickness of Z350 Body was higher than that of Z350 Enamel (p < 0.05). CONCLUSION: Thickness, type, and brand of composite resins affected their fluorescence and opalescence.

Repair bond strength of composite: Effect of surface treatment and type of composite.

BACKGROUND: By an increase in use of composite restorations, some defects are also seen in these restorations, which need to be repaired. Since complete replacement of an old restoration may compromise the tooth structure, repair of defect is a more practical approach if there is no caries recurrence. Risk of pulp injury also decreases as such. One major challenge in restoration repair is to obtain a durable bond between the new and old composite. Laser irradiation has been suggested for surface preparation of old composite. This study aimed to assess the effect of composite surface preparation with Er,Cr:YSGG laser on microtensile bond strength to new composite. MATERIAL AND METHODS: A total of 18 blocks were fabricated in three groups of nanohybrid, microhybrid and Beautiful II giomer measuring 4x7x7 mm and subjected to 10,000 thermal cycles between 5-55°C with 30 seconds of dwell time. The samples were randomly assigned to no surface treatment (etching and bonding) or laser plus etching and bonding groups. Composite cylinders measuring 4x7x7 mm were fabricated of Beautiful, nanohybrid and microhybrid composites on old composite surfaces and subjected to 500 thermal cycles for 50 seconds between 5-55°C with 30 seconds of dwell time. Each block was sectioned into 10 samples and they were subjected to microtensile bond strength test. Data were analyzed using ANOVA and Tukey's test. RESULTS: In all composites, the mean bond strength in laser subgroups was higher than that in control subgroups except for giomer, which showed lower bond strength in laser subgroup. The lowest mean bond strength was noted in repair of Z350XT with Z350XT when the surface of old composite was etched (10.92 MPa). The highest mean bond strength was noted in repair of Z250 with giomer when the old composite surface was irradiated with laser (30.55 MPa). CONCLUSIONS: Er,Cr:YSGG laser plus etching increased the bond strength in all groups except for giomer group, which showed a reduction in bond strength. Key words:Composite resins, surface treatment, tensile bond strength, laser, er,cr:ysgg, giomer.

Bond Strength of Fiber Posts to Composite Core: Effect of Surface Treatment With Er,Cr:YSGG Laser and Thermocycling.

Introduction: This study aimed to determine the bond strength of fiber post to composite core following surface treatment with Er,Cr:YSGG laser at different powers and sandblasting with and without thermocycling. Methods: In this experimental study, 30 fiber posts (Glassix, Nordin, Switzerland) were randomly divided into 5 groups of sandblasting, no treatment and laser irradiation at 1, 1.5 and 2 W powers. Following composite filling and mounting, 1-mm thick sections were made for pushout bond strength testing. Half of the samples in each group were subjected to thermocycling (n=15). Two-way analysis of variance (ANOVA) was used to analyze the bond strength values. Pairwise comparisons were made using Tukey test (P<0.05). Results: Effect of treatment method on push-out bond strength of fiber post to composite core was significant (P=0.017), while thermocycling had no significant effect on bond strength (P=0.964). Pairwise comparison of surface treatment methods revealed no significant difference in groups with and without thermocycling (P>0.05), but Er,Cr:YSGG laser irradiation with 1 W power yielded significantly higher bond strength than the control group (P=0.01). Conclusion: Irradiation of Er,Cr:YSGG laser at 1 W power increased the bond strength of fiber post to composite core. Thermocycling slightly decreased the bond strength at the fiber postcore interface.

Effect of thermocycling and surface treatment on repair bond strength of composite.

BACKGROUND: Repair of composite restorations is a conservative method that can increase the longevity and durability of restorations while preserving the tooth structure. Achieving a suitable bond between the old and new composite is difficult. To overcome this problem, some methods have been recommended to increase the repair bond strength of composite.This study aimed to assess the effect of aging by thermocycling (5,000 and 10,000 cycles) and mechanical surface treatments (Er,Cr:YSGG laser and bur) on repair shear bond strength of composite resin. MATERIAL AND METHODS: Totally, 120 composite blocks measuring 6x4x4 mm were fabricated of Filtek Z250 composite and were randomly divided into three groups (n=40) based on initial aging protocol: (a) no aging: storage in distilled water at 37°C for 24 hours, (b) 5,000 thermal cycles, (c) 10,000 thermal cycles. Each group was then randomly divided into two subgroups (n=20) based on mechanical surface treatment (laser and bur). The laser and bur-prepared surfaces were silanized and Adper Single Bond 2 was then applied. The repair composite was bonded to surfaces. Half of the samples in each subgroup (n=10) were subjected to 5,000 thermal cycles to assess durability of bond. The remaining half were stored in distilled water at 37°C for 24 hours and all samples were then subjected to shear bond strength testing in a universal testing machine with a crosshead speed of 1mm/min. Data (in megapascals) were subjected to one-way ANOVA and Tukey's test (P=0.05). Mode of failure was determined under a stereomicroscope. RESULTS: Bur preparation significantly improved the bond strength compared to laser (P<0.001). Aging by 10,000 thermal cycles significantly decreased the repair bond strength of composite (P<0.001). No significant difference was noted in this regard between distilled water and 5,000 thermal cycles groups (P=0.699). Primary bond strength and bond strength after 5,000 thermal cycles in the same subgroups were not significantly different either (P=0.342). CONCLUSIONS: Aging by 10,000 thermal cycles significantly decreases the repair bond strength of composite and surface preparation by bur provides a higher bond strength compared to laser. Key words:Thermocycling, Composite, Repair, Laser.

Microshear bond strength of self-adhesive composite to ceramic after mechanical, chemical and laser surface treatments.

OBJECTIVES: This study aimed to assess the microshear bond strength of a repairing self-adhesive flowable composite to ceramic after mechanical, chemical and laser treatment of the ceramic surface. MATERIALS AND METHODS: Forty zirconia and forty feldspathic ceramic blocks measuring 8 x 8 x 2 mm were fabricated. Feldspathic blocks were divided into four groups of control (1), laser (2780 nm) (2), sandblasting + hydrofluoric (HF) acid + silane (3) and laser (2780 nm) + HF acid + silane (4). Zirconia blocks were also divided into four groups of control (1), laser (2780 nm) (2), sandblasting + Z-Prime Plus (3) and laser (2780 nm) + Z-Prime Plus (4). Vertise Flow composite was bonded to treated ceramic surfaces as a repairing material, then the samples were subjected to 1000 thermal cycles. Repair bond strength was measured by Instron machine and data were analyzed using one-way ANOVA and post hoc test (P < 0.05). RESULTS: Maximum and minimum bond strength values were observed in zirconia-control (22.57 ± 4.76 MPa) and feldspathic-control (8.65 ± 6.41 MPa) groups, respectively. There was no significant differences between subgroups within the zirconia or feldspathic groups (P > 0.05), however the bond strength of zirconia subgroups was significantly higher than that of feldspathic subgroups. CONCLUSION: Vertise Flow provides relatively good bond strength to ceramic even with no surface treatment.

Efficacy of E-Learning via the Website of Tehran University of Medical Sciences for Diagnosing Tooth Discolorations and Treatment Planning by Senior Dental Students.

The efficacy of methods like e-learning as a supplement to traditional face-to-face instruction needs to be evaluated in dental courses. This study aimed to assess the efficacy of posting case presentations on one of the educational websites of  the virtual school of Tehran University of Medical Sciences called "SARMAD" to enhance the ability of senior dental students to diagnose tooth discolorations and offer treatment plans. This experimental study had a pre-test/post-test control group design and was conducted on 63 senior dental students. After filling out the primary questionnaire and obtaining a written informed consent, students participated in a pre-test and were then randomly divided into two groups of intervention and control. Fifteen case presentations were posted on the university website (SARMAD) during 6 weeks and discussed. Then, students participated in a post-test. Students' perspectives and their satisfaction with the website were assessed by a questionnaire. For ethical purposes, the same program was also offered to the controls. The post-test score was significantly higher than the pre-test score in the intervention group (P<0.001); but in the control group, the post-test score was only slightly higher than the pre-test score (P=0.128). In the intervention group, 70% stated that they would suggest this method as an efficient educational modality; 93.3% stated that this method would be beneficial as a supplement to conventional education; 16.7% ranked the SARMAD website excellent, 30% ranked it good, 33.3% acceptable, 16.7% moderate and 3.3 poor. It appears that this instructional modality may be efficiently used as a supplement to traditional instruction in undergraduate dental curricula.