Follow-up of flowable resin composites performed with a universal adhesive system in non-carious cervical lesions: A randomized, controlled 24-month clinical trial.

PURPOSE: This randomized, controlled study evaluated the 2-year clinical performance of two flowable resin composites performed with a universal adhesive in two etching modes for restoring non-carious cervical lesions (NCCLs). METHODS: One hundred NCCLs were restored with two flowable composites ( Charisma Opal Flow and G-aenial Universal Flo) and a universal adhesive (Single Bond Universal) with two etching modes (self-etch and etch&rinse) in a random order. The restorations were evaluated for retention, marginal adaptation, anatomic form, marginal discoloration, surface texture and secondary caries (modified USPHS criteria) at baseline, and after 6, 12 and 24 months. RESULTS: The clinical success for retention, surface texture and secondary caries parameters was scored as 100% for each group after 6, 12 and 24 months. The first acceptable changes (Bravo score) in marginal adaptation, anatomical form and marginal discoloration started to show up after 12 months for all test groups, except for etch&rinse+Charisma Opal Flow. Self-etch+Charisma Opal Flow and self-etch+G-aenial Universal Flo showed progressive marginal discoloration that remained in the clinical acceptability level after 2 years. After 24 months, each resin composite restored with either the etch&rinse mode or the self-etch mode of the universal adhesive showed similar clinical performance. Marginal discoloration was higher in the restorations performed with the self-etch system. Selective-etching can be favorable. CLINICAL SIGNIFICANCE: The clinical performance of flowable composites performed with a universal adhesive in two etching modes was clinically acceptable after 24 months.

Comparison of the marginal adaptation of direct and indirect composite inlay restorations with optical coherence tomography.

OBJECTIVE: The purpose of the study was to use the photonic imaging modality of optical coherence tomography (OCT) to compare the marginal adaptation of composite inlays fabricated by direct and indirect techniques. MATERIAL AND METHODS: Class II cavities were prepared on 34 extracted human molar teeth. The cavities were randomly divided into two groups according to the inlay fabrication technique. The first group was directly restored on cavities with a composite (Esthet X HD, Dentsply, Germany) after isolating. The second group was indirectly restored with the same composite material. Marginal adaptations were scanned before cementation with an invisible infrared light beam of OCT (Thorlabs), allowing measurement in 200 µm intervals. Restorations were cemented with a self-adhesive cement resin (SmartCem2, Dentsply), and then marginal adaptations were again measured with OCT. Mean values were statistically compared by using independent-samples t-test and paired samples t-test (p<0.05), before and after cementation. RESULTS: Direct inlays presented statistically smaller marginal discrepancy values than indirect inlays, before (p=0.00001442) and after (p=0.00001466) cementation. Marginal discrepancy values were increased for all restorations after cementation (p=0.00008839, p=0.000000952 for direct and indirect inlays, respectively). The mean marginal discrepancy value of the direct group increased from 56.88±20.04 µm to 91.88±31.7 µm, whereas the indirect group increased from 107.54±35.63 µm to 170.29±54.83 µm. Different techniques are available to detect marginal adaptation of restorations, but the OCT system can give quantitative information about resin cement thickness and its interaction between tooth and restoration in a nondestructive manner. CONCLUSIONS: Direct inlays presented smaller marginal discrepancy than indirect inlays. The marginal discrepancy values were increased for all restorations that refer to cement thickness after cementation.

Comparison of the marginal adaptation of direct and indirect composite inlay restorations with optical coherence tomography

ABSTRACT Objective The purpose of the study was to use the photonic imaging modality of optical coherence tomography (OCT) to compare the marginal adaptation of composite inlays fabricated by direct and indirect techniques. Material and Methods Class II cavities were prepared on 34 extracted human molar teeth. The cavities were randomly divided into two groups according to the inlay fabrication technique. The first group was directly restored on cavities with a composite (Esthet X HD, Dentsply, Germany) after isolating. The second group was indirectly restored with the same composite material. Marginal adaptations were scanned before cementation with an invisible infrared light beam of OCT (Thorlabs), allowing measurement in 200 µm intervals. Restorations were cemented with a self-adhesive cement resin (SmartCem2, Dentsply), and then marginal adaptations were again measured with OCT. Mean values were statistically compared by using independent-samples t-test and paired samples t-test (p<0.05), before and after cementation. Results Direct inlays presented statistically smaller marginal discrepancy values than indirect inlays, before (p=0.00001442) and after (p=0.00001466) cementation. Marginal discrepancy values were increased for all restorations after cementation (p=0.00008839, p=0.000000952 for direct and indirect inlays, respectively). The mean marginal discrepancy value of the direct group increased from 56.88±20.04 µm to 91.88±31.7 µm, whereas the indirect group increased from 107.54±35.63 µm to 170.29±54.83 µm. Different techniques are available to detect marginal adaptation of restorations, but the OCT system can give quantitative information about resin cement thickness and its interaction between tooth and restoration in a nondestructive manner. Conclusions Direct inlays presented smaller marginal discrepancy than indirect inlays. The marginal discrepancy values were increased for all restorations that refer to cement thickness after cementation.

The protective effect of resveratrol against dentin bonding agents-induced cytotoxicity.

This study was designed to evaluate the cytotoxicity of four dentin bonding agents and the effects of an antioxidant addition. Group A: G-aenial Bond, Group B: Optibond All in One, Group C: Gluma Self Etch and Group D: Clearfil S(3) Bond were added to the medium using extract method. The cells were cultured with or without resveratrol (RES) addition. MTT, reactive oxygen species (ROS), DCF, Comet and 8-OHdG measurements were performed. The agents had a dose-dependent (1:1>1:10>1:20) cytotoxic effect. Considering 1:10 concentration; Group D at 1 h (p<0.01) and Group B and D at 24 h had the weakest cytotoxic effect (p<0.05). After RES addition, the highest cell viability was determined in Groups B+RES and D+RES at 1 h and in Groups A+RES and B+RES at 24 h (p<0.01). The dentin bonding agents induced ROS production and DNA damage regarding to their composition. However, RES addition decreased the indicated parameters.

Comparative clinical evaluation of the efficacy of a new method for caries diagnosis and excavation.

AIM: The purpose of this study is to compare the efficiency of fluorescence-aided caries excavation (FACE) to remove carious dentin primary teeth with that of conventional methods. METHODS AND MATERIALS: After caries excavation was carried out, dentin surfaces were conventionally inspected using visual tactile criteria and 415 cavities which were classified as caries-free, re-inspected with Face-Light and caries detector dye (CDD) methods. Orange-red fluorescing areas classified as carious dentin, as well as stained carious dentin. All the data were recorded according to localization of the caries and determination efficiency of the methods. X(2) test was used to compare the mean values of both Face-Light and dye applications, while Wilcoxon test performed to evaluate the effectiveness for each diagnostic method. RESULTS: A total of 273 patients with 415 Class II (OM/OD) cavities (1.65 ± 0.52 teeth per patient) with carious lesions in molar and premolar teeth, were examined. Out of 415 teeth, in 149 teeth (35.9%) no caries findings had been illustrated. While FACE detected remaining carious or partially removed areas in 237 teeth (57.2%), CDD stained only 29 teeth by itself (P < 0.05). CONCLUSION: In conclusion, FACE has a higher detectability compared to visual inspection and caries detector dye in diagnosis and removal of carious dentin.

The prevalence and consequences of burnout on a group of preclinical dental students.

OBJECTIVE: The aim of this study is to investigate the prevalence of burnout among a group of Turkish preclinical dental students, to compare the level of burnout and to determine the consequences in structural equation model. MATERIALS AND METHODS: Preclinical dental students (n = 329, 50.5% of females and 49.5% of males) aged between 18 and 24 took part in the study. Maslach burnout inventory student version, academic satisfaction scale, and personal information sheet were used to gather data. Pearson correlation analyses, t-test, and one-way ANOVA were used for statistical analysis. The proposed theoretical model was tested via observed variable path analysis using maximum likelihood parameter estimation with AMOS 7.0. RESULTS: About 22.3% of students had high level of emotional exhaustion, 16.7% of students had high level of cynicism, and 17.9% of students suffered from high level of reduced academic efficacy. While the students attending the first grade reported higher level of reduced academic efficacy, the students in the third grade reported higher level of emotional exhaustion. Academic workload played an important role in the development of burnout. As consequences of burnout, students with high levels of burnout intended to change their current major and did not to plan to continue to postgraduate education. Students with high level of burnout reported less level of academic satisfaction and academic achievement. CONCLUSIONS: Creating awareness on the burnout of dental students from the preclinical period may be useful for prevention and more compatible dental education environment.

Clinical evaluation of three desensitizing agents in relieving dentin hypersensitivity.

OBJECTIVES: This in vivo study determined whether the application of three different desensitizing agents on exposed dentin surfaces was effective in reducing dentin hypersensitivity in subjects with slight-to-moderate sensitivity. METHODS: Sixty patients with a history of sensitivity were included in this study. At baseline visit, the initial sensitivity levels were recorded using a visual analog scale (VAS). In order to activate the sensitivity, evaporative (air-blast) and thermal (chloraethyl) stimuli were applied to each subject. The subjects' responses to the stimuli were marked on the VAS. Then, the subjects were assigned to one of the treatment groups or to a placebo. The agents used were Seal&Protect (Dentsply DeTrey GmbH, Konstanz, Germany), Vivasens (Ivoclar Vivadent AG, Schaan, Liechtenstein) and BisBlock (BISCO, Schaumburg, IL, USA); whereas, distilled water was used as the placebo. The subjects were recalled after four weeks, and their responses were again recorded. RESULTS: The VAS scores of the treatment and placebo groups were not different from each other at baseline (p > 0.05), and thermal stimuli caused higher patient discomfort than evaporative stimuli (p < 0.05). Alleviation effects of the desensitizing agents were not significantly different from each other; however, the placebo was an exception (p < 0.05). The differences between the VAS scores at baseline and after four weeks were significant for all three desensitizing agents (p < 0.05). However, in the placebo group, the evaporative stimuli led to insignificant pain variations (p > 0.05). CONCLUSION: It was concluded that the desensitizing agents used in this clinical study were effective in alleviating dentin hypersensitivity. Meanwhile, the placebo response was shown to play a significant role.

The two-year clinical performance of esthetic restorative materials in noncarious cervical lesions.

BACKGROUND: Materials used in restoration of cervical lesions include resin-modified glass ionomer cements, polyacid-modified resin-based composites and resin-based composites. In this study, the authors evaluated the clinical performance of these materials over a two-year period. METHODS: Thirty patients were enrolled in this study. The authors placed in these patients 130 restorations, 24 of which were Vitremer (3M Dental Products, St. Paul, Minn.), 38 were F2000 Compomer (3M Dental Products), 46 were Dyract AP (Dentsply DeTrey, Konstanz, Germany) and 22 were Valux Plus (3M Dental Products). Enamel margins were not beveled, and no mechanical retention was placed. Two independent, calibrated examiners evaluated the restorations baseline and at one and two years after placement using modified U.S. Public Health Service criteria. RESULTS: Retention rates at the end of two years were 100 percent for Vitremer, 67 percent for F2000 Compomer, 68 percent for Dyract AP and 70 percent for Valux Plus. The retention rate of Vitremer was significantly higher than that of the others (P < .05). In other categories, however, Valux Plus had the most favorable performance (P < .05). No secondary caries was detected around any restoration. CONCLUSION: Vitremer, with its high retention rate, seems to be the most appropriate material for restoration of noncarious cervical lesions, though it does not have the esthetic properties of resin-based composites. All materials used in this study were in need of improvements. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement, polyacid-modified resin-based composite and resin-based composite behaved differently in the restoration of noncarious cervical lesions. Therefore, clinicians should take factors such as esthetic needs and localization into account in selecting materials for such restorations.

Clinical evaluation of indirect resin composite and ceramic onlays over a 24-month period.

The purpose of this study was to compare the clinical performance of ceramic and indirect resin composite onlays over a 24-month period. A total of 94 onlay restorations in 47 patients were included in this study. Cavities were prepared, full-arch impressions were taken, and onlays were fabricated in the laboratory. All restorations were placed with a dual-cured luting resin composite system. Restorations were evaluated at baseline and at 6, 12, 18, and 24 months. Differences between Alpha scores were analyzed statistically. The recall rate of this study was 93.6%. At the six-month evaluation, one onlay failed due to pulpitis. Other than the color match, there was no significant difference between indirect resin composite and ceramic onlays (p > 0.05). For indirect resin composites, Alpha score differences pertaining to color match, marginal adaptation, and surface texture were found to be statistically significant (p < 0.05) between the baseline and the 24-month recall. For ceramic restorations, marginal adaptation criteria was the only significant difference over the 24-month period (p < 0.05). At the end of 24 months, both indirect resin composite and ceramic onlays were considered to be successful clinically.

Shear bond strengths of three different resin luting cements to bovine teeth.

This study evaluated the shear bond strengths of dentin/porcelain and enamel/ porcelain specimens bonded with three different dual-cure cements. The specimens were prepared using the heat-pressed ceramic technique. Three different dual-cure cements were used to bond samples to previously prepared bovine enamel and dentin surfaces. The specimens were thermocycled and tested in shear until failure. The shearbond data was subjected to one-way ANOVA, followed by Duncan's multiple range test at a significance level of p < 0.05. The shear bond strengths of Variolink II were significantly higher than those of Rely-X ARC and Panavia F for enamel and dentin (p < 0.05). Bond strenghts in enamel were higher than those of dentin in all materials (p < 0.05).

Effects of topical fluoride agents on artificial enamel lesion formation in vitro.

OBJECTIVE: The purpose of this study was to assess the effects of topical fluoride agents on enamel erosion in vitro. METHOD AND MATERIALS: Ten premolars extracted for orthodontic purposes were sectioned buccolingually and then longitudinally into two parts, so that four specimens were obtained from each tooth. The specimens were randomly assigned to one of four groups. The following topical fluoride agents were applied to the specimens: 1% titanium tetrafluoride (0.32 MF) for 1 minute; Duraphat (2.26% F) and Elmex (1.25% F) for 4 minutes. In the control group, no solution was applied. The specimens were treated with an artificial caries solution for 4, 8, 12, and 16 days. Calcium (Ca++) concentration was determined by an atomic absorbtion spectrophotometer, while fluoride (F-) concentration was determined with an ion-selective electrode. One-way analysis of variance tests were performed on cumulative concentrations of calcium and fluoride at days 4, 8, 12, and 16. RESULTS: Specimens treated with titanium tetrafluoride lost significantly less calcium than did specimens in the other two test groups at all time periods. Titanium tetrafluoride-treated specimens released significantly less fluoride than did Duraphat- or Elmex-treated specimens at day 16. CONCLUSION: Titanium tetrafluoride was found to be more effective than the other fluoride agents in preventing artificial enamel lesion formation.