Critical hydrodynamic force levels for efficient removal of oral biofilms in simulated interdental spaces.

OBJECTIVES: Sonic toothbrushes generate hydrodynamic shear forces for oral biofilm removal on tooth surfaces, but the effective thresholds for biofilm removal remain unexplored. This in vitro study aimed to investigate various threshold values for hydrodynamic biofilm removal in vitro. MATERIALS AND METHODS: A specialized test bench was designed with a known water flow field within a gap, ensuring that hydrodynamic shear forces on the wall were solely dependent on the volume flow, which was quantifiable using an integrated flow meter and proven by a computational fluid dynamics simulation. A young 20 h supragingival six-species biofilm was developed on hydroxyapatite disks (∅ 5 mm) and applied into the test bench, subjecting them to ascending force levels ranging from 0 to 135 Pa. The remaining biofilms were quantified using colony forming units (CFU) and subjected to statistical analysis through one-way ANOVA. RESULTS: Volume flow measures < 0.1 l/s: Error 1% of reading were established with the test bench. Untreated biofilms (0 Pa, no hydrodynamic shear forces) reached 7.7E7 CFU/harvest and differed significantly from all treated biofilm groups. CFU reductions of up to 2.3E6 were detected using 20 Pa, and reductions of two orders of magnitude were reached above wall shear forces of 45 Pa (6.9E5). CONCLUSIONS: Critical hydrodynamic force levels of at least 20 Pa appear to be necessary to have a discernible impact on initial biofilm removal. CLINICAL RELEVANCE: Pure hydrodynamic forces alone are insufficient for adequate biofilm removal. The addition of antiseptics is essential to penetrate and disrupt hydrodynamically loosened biofilm structures effectively.

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study.

OBJECTIVE: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. METHODS: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. RESULTS: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. CONCLUSIONS: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Students' perception of three-dimensionally printed teeth in endodontic training.

INTRODUCTION: In endodontic education, there is a need for thorough training prior to students embarking on clinical treatment. The aim of this study was to use three-dimensional printing technology to create a new model and to compare its suitability for training purposes with resin blocks and extracted teeth. MATERIALS AND METHODS: Multi-jet-modelling (MJM) produced the 3D model replicating a common difficulty in root-canal morphology. An evaluation study comprising 88 students was run in the sixth semester (summer 2018 and winter 2018/2019). A new questionnaire assessed students' perception of training models and educational environment. Welch's t-test analysed significant differences. RESULTS: The most pronounced differences between models were noted when rating material hardness, radiopacity, root-canal configuration and suitability for practising. Students estimated their learning outcome as greater with 3D-printed teeth compared to resin blocks. Three-dimensionally printed teeth received significantly lower ratings with regard to enthusiasm, the learning of fine motor skills and spatial awareness, when compared to human teeth (p ≤ .001). However, 3D-printed teeth were appreciated for additional benefits, such as their cleanliness, availability and standardisation of training opportunities with complex root-canal configurations. CONCLUSION: Students preferred extracted human teeth to 3D-printed teeth with respect to their physical characteristics and training experience. However, educational advantages may compensate for the shortcomings. The new questionnaire proved both adequate and accurate to assess the models and educational environment in endodontic training. The new 3D-printed teeth enhanced the learning opportunities.

Influence of Cavity Margin Design and Restorative Material on Marginal Quality and Seal of Extended Class II Resin Composite Restorations In Vitro.

PURPOSE: To investigate the influence of three cavity designs on the marginal seal of large Class II cavities restored with low-shrinkage resin composite limited to the enamel. MATERIALS AND METHODS: One hundred twenty (120) intact human molars were randomly divided into 12 groups, with three different cavity designs: 1. undermined enamel, 2. box-shaped, and 3. proximal bevel. The teeth were restored with 1. an extra-low shrinkage (ELS) composite free of diluent monomers, 2. microhybrid composite (Herculite XRV), 3. nanohybrid composite (Filtek Supreme XTE), and 4. silorane-based composite (Filtek Silorane). After artificial aging by thermocycling and storage in physiological saline, epoxy resin replicas were prepared. To determine the integrity of the restorations' approximal margins, two methods were sequentially employed: 1. replicas were made of the 120 specimens and examined using SEM, and 2. the same 120 specimens were immersed in AgNO3 solution, and the dye penetration depth was observed with a light microscope. Statistical analysis was performed using the Kruskal-Wallis and the Dunn-Bonferroni tests. RESULTS: After bevel preparation, SEM observations showed that restorations did not exhibit a higher percentage of continuous margin (SEM-analysis; p>0.05), but more leakage was found than with the other cavity designs (p<0.05). The lowest percentage of continuous margin was observed in ELS restorations (p<0.05). More fractured margins were observed in the undermined enamel cavity design groups (p<0.05). CONCLUSION: Bevel preparation failed to improve margin quality in large Class II composite restorations and is no longer recommended. However, undermined enamel should be removed to prevent enamel fractures.

Antimicrobial and physicochemical properties of experimental light curing composites with alkali-substituted calcium phosphate fillers.

OBJECTIVE: The antimicrobial and physicochemical properties of experimental light curing composites prepared with fillers made of mechanically activated alkali-substituted calcium phosphates like CaKPO(4), CaNaPO(4) or Ca(2)KNa(PO(4))(2) were compared with a commercial silane-modified cristobalite filler. METHODS: The antimicrobial properties were tested using Streptococcus mutans, Staphylococcus aureus and a clinically isolated plaque mixture. The potential for reducing bacteria growth on modified composites was determined using the proliferation reagent WST-1, which enables the measurement of metabolic activity and therefore the colonization with living bacteria. Investigated material properties included the degree of conversion and a test of flexural strength. RESULTS: All alkali-substituted composites provide a changed, mainly basic micro-milieu leading to a reduction of bacteria population with respect to the non-modified composite of about 25-70% with a flexural strength of cured composites in the range of 55-77 MPa complying with the clinical standard and a degree of conversion of 44-66%. SIGNIFICANCE: This study suggests that the modified composites increase antimicrobial properties while basic composite characteristics are not influenced by the filler.

Development of 3D Force Sensors for Nanopositioning and Nanomeasuring Machine.

In this contribution, we report on different miniaturized bulk micro machined three-axes piezoresistive force sensors for nanopositioning and nanomeasuring machine (NPMM). Various boss membrane structures, such as one boss full/cross, five boss full/cross and swastika membranes, were used as a basic structure for the force sensors. All designs have 16 p-type diffused piezoresistors on the surface of the membrane. Sensitivities in x, y and z directions are measured. Simulated and measured stiffness ratio in horizontal to vertical direction is measured for each design. Effect of the length of the stylus on H:V stiffness ratio is studied. Minimum and maximum deflection and resonance frequency are measured for all designs. The sensors were placed in a nanopositioning and nanomeasuring machine and one point measurements were performed for all the designs. Lastly the application of the sensor is shown, where dimension of a cube is measured using the sensor.

Influence of endodontic post type (glass fiber, quartz fiber or gold) and luting material on push-out bond strength to dentin in vitro.

OBJECTIVES: To determine the influence of post type and luting material on bond strength to dentin. METHODS: The root canals of extracted human upper central incisors were instrumented and post space was prepared using the respective drills for each post system. Glass fiber posts (Luscent Anchor, Dentatus [LA]) were luted using three dual-curing adhesive systems (Excite DSC/Variolink II, Vivadent [VL2]; EnaBond/EnaCem, Micerium [ENA]; Prime & Bond NT/Calibra, DentSply DeTrey [CAL]). A different brand of glass fiber post (EasyPost, DentSply Maillefer [EP]) and quartz fiber post (DT Light Post, VDW [DT]) were luted using CAL. Gold posts (Perma-dor, VDW) were luted either adhesively following tribo-chemical silicate coating (Rocatec, ESPE-Sil, 3M ESPE; CAL) or conventionally using glass ionomer cement (Ketac Cem, 3M ESPE). Three slices of 2mm height were cut perpendicular to the post from each restored root. Bond strength was determined by pushing out the post using a universal testing machine (/1449, Zwick). RESULTS: For all experimental groups combined, bond strength increased from the coronal to the apical section (Friedman test: P<0.001). Significant differences were observed among the fiber posts (DT/CAL>LA/CAL; Mann-Whitney U-test with Bonferroni-Holm adjustment: P<0.05; EP/CAL ranging in between) but not among luting materials (LA/VL2, LA/ENA, LA/CAL: n.s.). The gold posts were equivalent to DT/CAL with both luting procedures. SIGNIFICANCE: Selection of post type may be more important for bond strength than luting material. Bond strength of fiber posts was equivalent but not superior to adhesively or conventionally luted gold posts.

Antimicrobial properties of nanocrystalline tetracalcium phosphate cements.

The antimicrobial properties of cements prepared from mechanically activated tetracalcium phosphate (maTTCP) were tested with the agar diffusion test using Streptococcus salivarius, Staphylococcus epidermidis, and a clinically isolated plaque mixture. All maTTCP cements showed a significantly higher antimicrobial potency as revealed by inhibition zones of approximately 3-5 mm width, compared with a commercial Ca(OH)(2)//salicylate cement which only produced small inhibition zones around the cement specimens of 1.5 mm or less. This behavior was explained by the formation of amorphous Ca(OH)(2) during setting of maTTCP cements, which is thought to have a higher solubility and may release more OH(-) ions than conventional Ca(OH)(2)//salicylate cements. In fact, the pH value in the agar gel around the specimens was higher in the case of maTTCP cements (7.8-8.7) compared with the Ca(OH)(2)//salicylate control (7.0-8.0). The maTTCP cements did not affect the photoactivation of resin-based composites, and their antimicrobial activity is making them interesting candidates for the use as pulp-capping agents, endodontic sealers, or cavity liners in dentistry.

Influence of curing methods and matrix type on the marginal seal of class II resin-based composite restorations in vitro.

This study determined the influence of light curing protocols and matrix type on the margin quality and marginal seal of Class II resin-based composite restorations. In extracted human molars, box-shaped MOD cavities with 1 mm wide interproximal bevels were prepared with cervical margins located at least 1 mm coronal to the cemento-enamel junction. The prepared teeth were mounted in a jig featuring artificial training teeth that served as adjacent teeth. A contoured sectional metal matrix band was placed in one interproximal area, and a section of a contoured transparent matrix band was placed in the opposite interproximal area. Both were kept in position using wooden wedges. After etching (35% H3PO4 gel) and the application of a three-step etch & rinse dentin adhesive (Optibond FL, Kerr), a thin layer of flowable resin-based composite (Revolution, Kerr) was applied to the interproximal margins. The cavities were restored by placing one horizontal and two oblique increments of a fine hybrid resin-based composite (Herculite XRV, Kerr). The curing protocols included one standard halogen protocol (Elipar Trilight, 3M ESPE, 40 seconds @ 800 mW/cm2), 3 halogen soft-start protocols (Step: Elipar HiLight, 3M ESPE; 10 seconds @ 150 mW/cm2, 30 seconds @ 850 mW/cm2; Ramp: Elipar TriLight, 3M ESPE, 5 seconds @ 100 mW/cm2, exponential increase for 10 seconds, 25 seconds @ 800 mW/cm2; Pulse delay: VIP Light, BISCO, cervical increment: 10 seconds @ 500 mW/cm2, occlusal increments: 3 seconds @ 200 mW/cm2, final irradiation after a 5 minute interval: 30 seconds @ mW/cm2) and 2 plasma arc high intensity protocols (PAC: Lightning Cure, ADT, 10 seconds @ 1400 mW/cm2; APO: Apollo 95E, DMDS, 2 x 3 seconds @ 1570 mW/cm2). The restored teeth were stored in 0.9% saline at 37 degrees C for 4 weeks and submitted to thermal cycling [TC] with 2500 cycles between 5 degrees C and 55 degrees C after 2 weeks. The margin quality before and after TC was analyzed in SEM using the replica technique, and the marginal seal was determined using the dye penetration test (50% AgNO3, 2 hours) at the end of the study. The matrix type did not significantly influence the quality and seal of the respective margins. For the complete restoration margin, one of the high intensity protocols (APO) produced a higher percentage of "continuous margin" compared to pulse delay irradiation after TC and lower percentages of "marginal opening" compared to halogen standard irradiation before and after TC. Halogen step irradiation produced a superior marginal seal compared to pulse delay curing at the occlusal margins; equivalent results were observed for all curing modes at the cervical margins. Neither a general advantage of soft-start irradiation nor a general disadvantage of high intensity curing was confirmed.

Effect of high intensity vs. soft-start halogen irradiation on light-cured resin-based composites. Part II: Hardness and solubility.

PURPOSE: To determine hardness and solubility of light-cured resin-based composites after high intensity vs. soft-start quartz tungsten halogen irradiation. METHODS: Knoop hardness of resin-based composite specimens was measured at 1.5 mm depth after dry storage for 24 hours at 37 degrees C so as to indirectly evaluate degree of cure. Solubility was determined gravimetrically by extraction of post-cured (24 hours, 37 degrees C) specimens in 50 wt% methanol for 72 hours. Four hybrid (Filtek Z250, Herculite, Solitaire 2, Tetric Ceram), an inhomogeneously filled hybrid (InTen-S) and a microfilled (Filtek A110, formerly Silux Plus) composite were cured using the quartz tungsten halogen units Astralis 10 and Optilux 501 in the high intensity (Astralis 10 High Power: 10 seconds @ 1300 mW/cm2; Optilux Boost: 10 seconds @ 1140 mW/cm2) or soft-start modes (Astralis 10 Pulse: increase to 700 mW/cm2 within 10 seconds, three periods of 2 seconds @ 1300 mW/cm2 alternating with two periods of 2 seconds @ 700 mW/cm2; Optilux Ramp: exponential increase within 10 seconds, followed by 10 seconds @ 1140mW/cm2). RESULTS: For the fast curing composites Z250, Tetric Ceram and InTen-S, equivalent hardness was observed after 10 seconds of high intensity and 20 seconds of soft-start irradiation. For the slower curing composites Herculite, Solitaire 2 and A110, the soft-start protocols produced higher hardness values. Regarding solubility however, the superiority of soft-start irradiation was also seen for Tetric Ceram and InTen-S. The lowest solubility was observed for InTen-S, followed by Z250, whereas Herculite and Solitaire 2 scored highest for this parameter.

The influence of plasma arc vs. halogen standard or soft-start irradiation on polymerization shrinkage kinetics of polymer matrix composites.

OBJECTIVES: To determine polymerization shrinkage kinetics and hardness of photo-activated polymer matrix composites (PMC) after plasma arc vs. halogen standard or soft-start irradiation. METHODS: Polymerization shrinkage was measured using the 'deflecting disk technique', and Knoop hardness was measured at the bottom of 1.5 mm thick specimens stored for 24 h at 37 degrees C. The materials comprised one micro-filled (Silux Plus) and four fine hybrid PMC (Definite, Herculite XRV, Solitaire 2 and Z250). The irradiation protocols included halogen standard irradiation at three intensities (TriLight, ESPE), ramp curing (dito), step curing (HiLight, ESPE), pulse polymerization (VIP Light, BISCO) and plasma curing (Apollo 95E, DMDS; PAC Light, ADT). RESULTS: Standard halogen irradiation at reduced intensity delayed the start and slowed down the progression of shrinkage strain, but (except for Z250) as well produced lower hardness. Soft-start halogen curing produced similar kinetics but maintained hardness. Plasma arc irradiation resulted in an immediate start and a rapid progression of polymerization contraction, but produced low hardness values in Definite (cured by the ADT unit) and in Solitaire 2 (both units). Z250 featured the highest, Silux Plus the lowest maximum rate of contraction. Despite soft-start irradiation, contraction of Z250 progressed faster than that of Silux Plus with halogen standard irradiation at high intensity. CONCLUSIONS: Soft-start halogen irradiation protocols provide better chances for compensation of shrinkage stress by flow within PMC without compromising hardness and may contribute to a better marginal integrity of the restorations. Irradiation protocols should be individually adjusted to compensate for the different curing characteristics of PMC.

Influence of curing methods and materials on the marginal seal of class V composite restorations in vitro.

The study tests the hypothesis that soft-start irradiation improves, whereas, high intensity irradiation compromises the margin quality and marginal seal of Class V resin based composite [RBC] restorations. Box-shaped Class V cavities were prepared in extracted, human third molars with cervical margins located apical to the CEJ. Cavities were restored using a multi-step bonding agent (Optibond FL, Kerr), a thin layer of flowable resin composite and two increments of fine hybrid resin composite (Filtek Flow/Filtek Z250, 3M ESPE; Revolution f2/Herculite XRV, Kerr). Light irradiation was performed using either the standard (40 seconds) or the soft-start mode (40 seconds with exponential increase) of a quartz tungsten halogen or an LED curing light (Elipar Trilight, Elipar Freelight, 3M ESPE); for high intensity irradiation, a Plasma Are curing unit was used with three irradiations of three seconds (Apollo 95E, DMDS). After 30 days of water storage and thermal cycling (n = 2500, 5-55 degrees C), margin quality was assessed in the SEM using the replica technique and marginal seal was evaluated using dye penetration (AgNO3 50%). Few differences were observed between the light curing protocols. However, less leakage was observed in the case of the lower shrinking RBC Filtek Z250.

Effect of high intensity vs. soft-start halogen irradiation on light-cured resin-based composites. Part I. Temperature rise and polymerization shrinkage.

PURPOSE: To determine polymerization shrinkage kinetics and temperature rise of light-cured resin-based composites after high intensity vs. soft-start quartz tungsten halogen irradiation. METHODS: Shrinkage kinetics was evaluated using the "deflecting disk technique", modified for simultaneous measurement of temperature within the resin-based composite using a thermocouple. Additional irradiations after 60 and 65 minutes allowed the determination of temperature rises caused by radiation or by reaction heat. Four hybrids (Filtek Z250, Herculite, Solitaire 2, Tetric Ceram), an inhomogeneously filled hybrid (InTen-S) and a microfill (Filtek A110, formerly Silux Plus) were cured using the quartz tungsten halogen units Astralis 10 and Optilux 501 in the high intensity (A10 HiPo: 10 seconds at 1300 mW/cm2; OL Boost: 10 seconds at 1140 mW/cm2) or soft-start modes (A10 Pulse: increase to 700 mW/cm2 within 10 seconds, three periods of 2 seconds at 1300 mW/cm2 alternating with two periods of 2 seconds at 700 mW/cm2; OL Ramp: exponential increase within 10 seconds, followed by 10 seconds at 1140 mW/cm2). RESULTS: The soft-start protocols produced less contraction, and polymerization shrinkage started later and progressed slower (or: more slowly), compared to high intensity irradiation [correction]. The lowest shrinkage was observed for InTen-S, followed by Filtek Z250 and A110, whereas Solitaire 2, Herculite and Tetric Ceram scored highest for this parameter. Temperature rise was caused more or less equally by radiation and by reaction heat and reached values of up to 28.9 degrees C relative to a baseline of 37 degrees C. For some combinations of curing modes and resin-based composites, less heat was generated by the soft-start protocols and by Optilux 501.

Elution of leachable components from resin composites after plasma arc vs standard or soft-start halogen light irradiation.

OBJECTIVES: To determine the release of leachable components from resin based composites (RBC) after plasma arc vs. standard or soft-start halogen curing. METHODS: The tested RBC were the fine hybrids Herculite XRV (Kerr), Solitaire 2 (Kulzer) and Z250 (3M), the micro-fill Silux Plus (3M) and the polysiloxane-containing Definite (Degussa). The irradiation protocols included halogen standard irradiation at three different intensities (TriLight, ESPE), ramp curing (dito), step curing (HiLight, ESPE), pulse polymerization (VIP Light, BISCO) and plasma curing (Apollo 95E, DMDS; PAC Light, ADT). Initial solubility was determined applying RBC into simulated cavities (molds of 6mm inner diameter and 2mm height fabricated from pressed ceramics) and eluting 24h in demineralized water at 37 degrees C. Medium-term solubility was evaluated using plain RBC specimens of equivalent dimensions stored dark (37 degrees C, 24h) and extracted in 50% CH(3)OH (37 degrees C, 72 h). After drying the specimens to constant weight, solubility and sorption were determined gravimetrically. RESULTS: Medium-term solubility/sorption were higher than initial ones. Irradiation at reduced intensity increased solubility and sorption, whereas ramp curing, step curing and pulse polymerization (for most materials) maintained low values. Plasma arc curing worked well for Z250 and Herculite XRV, compared to medium or low intensity halogen irradiation for Silux Plus and Definite and produced moderately (PAC Light) or very (Apollo 95E) high solubility for Solitaire 2. CONCLUSIONS: Reducing irradiation intensity does and soft-start protocols do not compromise solubility and sorption. The efficiency of plasma arc curing depends markedly on the types of photo-initiators used.

Effect of irradiation type (LED or QTH) on photo-activated composite shrinkage strain kinetics, temperature rise, and hardness.

This study compares commercially available light-emitting diode (LED) lights with a quartz tungsten halogen (QTH) unit for photo-activating resin-based composites (RBC). Shrinkage strain kinetics and temperature within the RBC were measured simultaneously using the 'deflecting disc technique' and a thermocouple. Surface hardness (Knoop) at the bottom of 1.5-mm thick RBC specimens was measured 24 h after irradiation to indicate degree of cure. Irradiation was performed for 40 s using either the continuous or the ramp-curing mode of a QTH and a LED light (800 mW cm(-2) and 320 mW cm(-2), respectively) or the continuous mode of a lower intensity LED light (160 mW cm(-2)). For Herculite XRV and Filtek Z250 (both containing only camphoroquinone as a photo-initiator) the QTH and the stronger LED light produced similar hardness, while in the case of Definite (containing an additional photo-activator absorbing at lower wavelength) lower hardness was observed after LED irradiation. The temperature rise during polymerization and heating from radiation were lower with LED compared to QTH curing. The fastest increase of polymerization contraction was observed after QTH continuous irradiation, followed by the stronger and the weaker LED light in the continuous mode. Ramp curing decreased contraction speed even more. Shrinkage strain after 60 min was greater following QTH irradiation compared with both LED units (Herculite, Definite) or with the weaker LED light (Z250).