Effects of experimental in-office bleaching gels incorporated with co-doped titanium dioxide nanoparticles on dental enamel physical properties.

To evaluate the physical properties of enamel submitted to hydrogen peroxide (HP) incorporated with titanium dioxide nanoparticles (NP) co-doped with nitrogen and fluorine and irradiated with violet LED light (LT). Enamel-dentin disks were randomly allocated (T0) into groups, according to HP (HP6, HP15, or HP35) and NP (no NP, 5NP, or 10NP) concentrations, and irradiated or not with LT. A negative control (NC) group was set. After three bleaching sessions (T1, T2, and T3), specimens were stored in saliva for 14 days (T4). Enamel surface microhardness number (KHN), surface roughness (Ra), cross-sectional microhardness (ΔS), energy-dispersive spectroscopy (EDS), scanning electron (SEM), and polarized light (PLM) microscopies were performed. Surface KHN was significantly influenced by NP over time, independently of LT irradiation. At T3 and T4, gels with 5NP and 10NP exhibited no KHN differences compared to NC and baseline values, which were not observed under the absence of NP. NP incorporation did not statistically interfere with the ΔS and Ra. PLM images exhibited surface/subsurface darkening areas suggestive of demineralizing regions. SEM demonstrated some intraprismatic affection in the groups without NP. EDS reported a higher enamel calcium to phosphorus ratio following 10NP gels applications. Gels with NP maintained the enamel surface microhardness levels and seemed to control surface morphology, upholding the mineral content. None of the proposed experimental protocols have negatively influenced the enamel surface roughness and the cross-sectional microhardness.

Effectiveness and safety of biosilicate-enhanced bleaching gels on enamel with early erosion lesion.

AIM: This study evaluated the efficacy and cytotoxicity of 35% hydrogen peroxide (HP) gel incorporated with 10% (w/w) biosilicate (BioS) on sound enamel and early-stage enamel erosion lesions. METHODS: Discs of enamel/dentin were selected, subjected to erosive cycles (0.3% citric acid, pH 2.6), and treated with (n = 8): HP (35% HP, positive control); HP_BioS [carboxymethyl cellulose (CMC) + HP + BioS]; BioS (CMC + BioS); CMC (negative control). The discs were adapted to artificial pulp chambers with the enamel exposed for bleaching, and the dentin facing toward the culture medium (Dulbecco's modified Eagle's medium [DMEM]). Bleaching was performed in three 30-min sessions at 7-day intervals. After bleaching, the diffusion product (DMEM extract + diffused HP) was pipetted onto MDPC-23 odontoblastic cell line and inoculated. Color parameters (ΔL, Δa, Δb), color change (ΔE00), and changes in whiteness index (ΔWID) were determined before (T0) and after the last bleaching session (T3). Cell viability (MTT, %), H2O2 diffusion (µg/mL), oxidative cell stress (OxS), and cell fluorescence (live/dead assay, in confocal microscopy) were assessed (ANOVA/Tukey; α = 0.05). RESULTS: No difference in ΔL, Δa, Δb, ΔE00, and ΔWID were found between HP and HP_BioS (p > 0.05). The incorporation of BioS decreased the HP diffusion into the substrates and mitigated oxidative stress in early-stage eroded enamel (p < 0.05). HP_BioS presented significantly higher cell viability compared with HP under erosion conditions. Live/dead assay indicated that BioS_HP maintained viability with larger clusters of viable cells. CONCLUSION: Incorporating BioS into HP maintained bleaching effectiveness, favored cell viability, reduced the oxidative stress, and the cytotoxicity in teeth with early-stage erosion. CLINICAL SIGNIFICANCE: BioS formulation showed promising results for reducing cytotoxicity in patients seeking tooth bleaching and presenting undetectable early-stage erosion.

Effects of experimental bleaching gels containing co-doped titanium dioxide and niobium pentoxide combined with violet light.

OBJECTIVES: The objective of the study is to evaluate the bleaching potential of 6% hydrogen peroxide (6% HP) gels containing NF_TiO2 or Nb2O5 irradiated with a violet LED light and the effects on enamel mineral content and surface morphology. METHODS: Particles were synthesized, and experimental gels were chemically analyzed by preliminary and accelerated stability tests, pH, and HP decomposition rate. Bovine enamel blocks were treated with 6% HP gels containing (n = 10): 5% NF_TiO2, 5% Nb2O5, 2.5% NF_TiO2 + 2.5% Nb2O5 or without particles (6% HP), irradiated or not with LED, and the control was treated with 35% HP. Color (∆E00) and whitening index (∆WID) variations, surface microhardness (SH), average roughness (∆Ra), Ca-P concentration (EDS), and enamel morphology (SEM) were assessed. Bleaching was performed in 3 sessions of 30 min and 7-day intervals. Data were submitted to two- (pH, decomposition rate, ∆E00, and ∆WID) or three-way ANOVA and Bonferroni (SH), Kruskal-Wallis (∆Ra), and Dunnet tests (α = 0.05). RESULTS: No changes in the gel's color, odor, or translucency were observed. The pH (6 to 6.5) remained stable over time, and light irradiation boosted the HP decomposition rate. NF_TiO2 and Nb2O5-containing gels displayed higher ∆E00 and ΔWID when light-irradiated (p < 0.05). Nb2O5 and Nb2O5 + NF_TiO2 decreased enamel SH (p < 0.05), but no SH changes were found among groups (p > 0.05). No differences among groups were noted in ∆Ra, Ca-P content, and enamel morphology after treatments (p > 0.05). CONCLUSION: Experimental light-irradiated 6% HP gels containing NF_TiO2 or Nb2O5 were chemically stable and exhibited bleaching potential comparable with 35% HP. CLINICAL RELEVANCE: Low-concentrated HP gels containing NF_TiO2 or Nb2O5 and light-irradiated stand as a possible alternative to in-office bleaching.

The potential of conventional and bulk-fill bioactive composites to inhibit the development of caries lesions around restorations.

PURPOSE: To determine caries inhibition potential of conventional and bulk-fill bioactive composites around restorations. METHODS: Enamel and dentin blocks were prepared using a diamond saw under water irrigation, finished (SiC, 600- and 800-grit) and polished (SiC 1,200, final polish= 0.2 µm). Blocks were then selected through enamel surface microhardness, and enamel and dentin standard cavities were restored (n=10/group) with conventional bioactive composite (Beautifil II, BTF), bulk-fill bioactive composite (Activa BioACTIVE, ACT), glass-ionomer cement (Ionofil Plus, ION), conventional composite (GrandioSO, GSO), and bulk-fill composite (Admira Fusion X-TRA, ADM). Afterwards, the blocks were subjected to pH cycling: 4 hours in demineralization and 20 hours in remineralization solutions for 7 days, before being cut in the middle. One half was used to calculate the carious lesion area (ΔS) using values obtained by cross-sectional microhardness (CSMH) testing. The other half was submitted to polarized light microscopy (PLM) and scanning electron microscopy (SEM). The % of internal gap formation (GAP) of restorations' replicas were analyzed under SEM. Data were analyzed by ANOVA and Tukey test (α= 5%). RESULTS: In terms of CSMH, ION group exhibited the lowest ΔS values, with no significant difference to ADM. The composites BTF and ACT were similar to each other (P< 0.05) and to their negative controls (GSO and ADM), respectively. ION showed lower caries formation under PLM, whereas the GSO group presented a greater demineralized area. ION presented the highest % of internal GAP formation. Bioactive composites (BTF and ACT) were similar to their corresponding conventional ones (GSO and ADM) in terms of GAP formation. CLINICAL SIGNIFICANCE: The glass-ionomer cement was more effective in inhibiting the formation of caries lesions around restorations. Because of the glass-ionomer cement's limited application in high load-bearing areas, the conventional bioactive composite would be a promising clinical choice.

Colorimetric evaluation after in-office tooth bleaching with violet LED: 6- and 12-month follow-ups of a randomized clinical trial.

OBJECTIVES: To evaluate the long-term outcomes of in-office bleaching with violet LED light (LED) alone or combined with carbamide (CP) or hydrogen (HP) peroxides. METHODS: Volunteers of a previous short-term study were recalled for 6- and 12-month follow-ups, according to the following interventions (n = 18/group): LED, CP, LED/CP, HP, and LED/HP. The objective color (ΔEab, ΔE00) and whiteness index (ΔWID) changes were calculated applying the CIELab coordinates' values obtained using a spectrophotometer. A visual shade guide determined the tooth's subjective color change (ΔSGU). Data were submitted to one-way ANOVA or Welch's ANOVA, following appropriate post hoc tests (α = 5%). RESULTS: The LED and CP groups exhibited the lowest ΔEab, ΔE00, and ΔSGU (p < 0.05), but the LED group displayed a significantly lower ΔWID. After 12 months, the LED/CP group presented a higher ΔEab and ΔE00 than the CP group (p < 0.05). ΔEab, ΔE00, ΔSGU, or ΔWID means did not differ statistically between the LED/CP and HP groups. The LED/HP group presented a higher ΔE00 than the HP group, regardless of the time. CONCLUSIONS: The bleaching efficacy of LED alone was significantly lower compared to the LED/CP and HP-containing protocols. After 12 months, the LED/CP and HP groups did not differ in bleaching efficacy. LED irradiation only increased the objective color change of bleaching gels. CLINICAL RELEVANCE: LED alone promoted a long-term perceptible bleaching, but not compatible with that of high-concentrated HP. The bleaching outcomes of violet irradiation to 37% CP were maintained over time, with LED/CP demonstrating comparable results to HP even after 12 months. NATIONAL CLINICAL TRIALS REGISTRY (REBEC): RBR-5t6bd9.

Characterization and effectiveness of a violet LED light for in-office whitening.

OBJECTIVES: This study characterized a violet LED light (V-LED; bright max whitening) tooth whitening device and evaluated its efficacy on stained enamel compared to hydrogen peroxide (HP). MATERIALS AND METHODS: Characterization of the V-LED beam profile was performed using a laser beam-profiler. The irradiance was measured throughout an exposure cycle at 0- and 8-mm distances using an integrating sphere and a spectral radiometer. Bovine enamel/dentin blocks stained with black tea (BT), cigarette smoke (CS), or without staining (CONT) were subjected to V-LED or 40% HP (n = 10/group). Color parameters (ΔL, Δa, Δb, and ΔE00) were measured using a digital spectrophotometer. Light transmission was estimated through 1-mm-thick bovine enamel slices (n = 5). ΔL, Δb, ΔE00, and irradiance were analyzed by two-way ANOVAs and Tukey's tests, Δa by Kruskal-Wallis and Mann-Whitney tests, and light transmission by t-test (α = 5%). RESULTS: Heterogeneous beam distribution was observed for the emitting V-LED chips. After 20 sequential exposures, irradiance levels were reduced 25-50%, regardless of the distance from V-LED. Localized irradiance values were statistically different between beam locations and different distances from the target. V-LED produced lower ΔE00, ΔL, Δa, and Δb values than HP for CONT and BT, with no differences for CS. Light transmittance decreased approximately 98% through 1-mm thick enamel. CONCLUSIONS: V-LED irradiance was heterogeneous and decreased throughout the exposure cycles and was also greatly reduced with increasing tip distance. V-LED produced a significantly lower whitening effect on BT and control teeth. CLINICAL RELEVANCE: This study contributes to the knowledge of V-LED and its clinical use.

Effect of extended light activation and increment thickness on physical properties of conventional and bulk-filled resin-based composites.

OBJECTIVES: To evaluate the biaxial flexural strength (BFS), flexural modulus (BFM), and Knoop microhardness (KHN) of incremental and bulk-filled resin-based composites (RBCs) using extended curing exposure times. MATERIALS AND METHODS: Disc specimens (n = 8; 6-mm diameter) were fabricated using three stacked molds (0.5-mm thick for the top and bottom molds, and a 1-mm-thick center mold for the conventional and 3-mm thick for the bulk-fill RBCs). Conventional (Tetric EvoCeram/TCE and Filtek Z250/FIZ) and bulk-fill RBCs (Tetric EvoCeram Bulk Fill/TBF and Filtek One Bulk Fill Restorative/FOB) were evaluated. The stacked RBC-filled molds were light-cured for (1) the manufacturer-recommended exposure (MRE) duration; (2) 50%, and (3) 100% extension of the MRE. The BFS, BFM, and KHN of the top and bottom discs were measured. BFS and BFM were analyzed by three-way ANOVA (material*curing time*depth) and Tukey's post hoc (α = 0.05). KHN was analyzed by two-way ANOVA (curing time*depth) and Tukey's post hoc (α = 0.05). RESULTS: Extending the exposure duration did not change the BFS and BFM on the top of the RBCs, but the BFS and KHN increased at the bottom of bulk-fill RBCs. For the conventional RBCs, TCE showed the highest increase on BFS at the bottom, going from 53.6 MPa at T1 to 69.9 at T3. Among the bulk-fill RBCs, FOB presented the highest increase on the bottom BFS (T1: 101.0 ± 19.9 MPa, T3: 147.6 ± 12.9 MPa). For all RBCs and exposure times, BFS and KHN were lower at the bottom. Only FIZ and FOB reached a bottom-to-top hardness ratio of 80%, at T3 and T2. CONCLUSION: A significant increase on the BFS and KHN on the bottom of bulk-fill RBCs can be observed when the time of exposure to the curing light is double the MRE. However, extended exposure does not eliminate differences on the BFS and KHN between the shallow and deep regions of RBCs. TCE and TBF failed to reach an acceptable B/T hardness ratio at all evaluated exposure times. CLINICAL RELEVANCE: Mechanical properties of RBCs can be affected by insufficient polymerization, specially at deeper regions of the increment. Therefore, clinicians should consider applying twice the MRE to curing-light to polymerize the maximal increment thickness of bulk-fill RBCs.

The influence of the renewal or the single application of the peroxide gel on the efficacy and tooth sensitivity outcomes of in-office bleaching-A systematic review and meta-analysis.

OBJECTIVE: To answer the question: "Does the peroxide gel application regimen (single application vs. renewal) influence the efficacy and the tooth sensitivity outcomes of in-office tooth bleaching?" METHODS: The search was done in Pubmed, Cochrane, LILACS, Scopus, Web of Science, and EMBASE in February 2021 (updated in July 2021). Randomized clinical trials (RCT) comparing the single application vs. the renewal protocols of HP were included. The meta-analyses were performed for the objective (ΔEab ), subjective (ΔSGU) color changes, and absolute risk of tooth sensitivity (TS). Heterogeneity was evaluated using Q test (I2 ). Cochrane Collaboration tool assessed the risk of bias (RoB). The GRADE evaluated the certainty of evidence. RESULTS: Five RCT studies remained. Two studies showed high RoB, and three presented some concerns. No significant differences were observed between the protocols in terms of the ΔEab , ΔSGU, and TS. ΔEab exhibited substantial heterogeneity (I2  = 87%), while ΔSGU (I2  = 60%) and the TS (I2  = 62%) presented a moderate one. The certainty of evidence was considered low or very low, depending on the variable response and the evaluation time. CONCLUSION: The application regimen (single vs. renewal of HP) did not impact color change or the absolute risk of TS. CLINICAL SIGNIFICANCE: The renewal of bleaching gel during the in-office appointment may not be necessary. However, there is at least a low certainty of evidence. Because of this, further randomized clinical trials with appropriate methodology on this topic are encouraged.

DOES TITANIUM TETRAFLUORIDE PROMOTE A PROTECTIVE EFFECT ON ERODED TOOTH? A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: This systematic review and meta-analyses aimed to evaluate the potential protective effect of titanium tetrafluoride (TiF4) compound compared to sodium fluoride (NaF) on eroded enamel or dentin. METHODS: Two independent reviewers searched PubMed, Scopus, Web of Science, LILACS, Cochrane, EMBASE, and Open gray Literature up to June 2020. MeSH terms, supplementary concepts, synonyms, and free terms were applied based on PICOS strategy (P- population: eroded enamel or dentin; I- intervention: eroded teeth treated with solution or varnish of TiF4; C- comparison: eroded teeth treated with a solution or varnish of NaF; O- outcome: mineral loss measurement; S- study design: in vitro studies). Seven distinct parameters evaluated the risk of bias, and all studies were submitted to 4 meta-analyses (first and second meta-analyses related to enamel loss treated with fluoride solution or varnish, respectively; third and fourth meta-analyses related to dentin loss treated with fluoride solution or varnish, respectively). A sensitivity test was performed by the RevMan software, based on standard mean difference calculation (P < .05). RESULTS: A total of 10,260 studies were retrieved, from which 22 studies were included in systematic review through eligibility criteria, of which 1 study was classified as low risk of bias, 19 as medium, and 3 as high. Seventeen studies were included in 4 different meta-analyses, presenting considerable overall heterogeneity (I2 = 95; 92; 95; and 93%, respectively) with statistical significance for TiF4 on the first meta-analysis, and no statistical significance for second, third, and fourth meta-analyses. CONCLUSIONS: Titanium tetrafluoride compound delivered as solution provided significant effective protection for erosion lesions on the enamel surface compared to sodium fluoride. However, when TiF4 or NaF were applied on enamel or dentin surfaces as varnish, both provided the same effective protection, based on in vitro studies with considerable heterogeneity.

Use of antioxidants to restore bond strength after tooth bleaching with peroxides.

This review compiles the literature on the antioxidants used after tooth bleaching with either low or high-concentrated carbamide and hydrogen peroxide to recover the bond strength. Antioxidants used in bleached teeth are mainly natural and non-enzymatic, except for catalase. Commonly, antioxidants are applied to remove any reactive oxygen species (ROS) residues left from bleaching gels, which adversely affect adhesive procedures, such as restorations or orthodontic brackets bonding. Even though sodium ascorbate, the most thoroughly investigated antioxidant, showed the most efficient bond strength recovery at 10% concentration, its performance depends on the type of solution and the application time. Natural extracts, such as proanthocyanidins and green tea, showed satisfactory results in the reversal of bond strength at 5% and 10% concentrations, respectively. Sodium ascorbyl phosphate, α-tocopherol, and catalase exhibited promising results, but further research is required. The adhesive system type plays an important role in the outcome of enamel bond strength after the antioxidant application. The postponement of either restorations or orthodontic brackets cementation following bleaching procedures seems to be efficiently replaced by antioxidant application prior to bonding procedures. However, the efficacy of using an antioxidant to recover bond strength depends on its type and application time.

Surface treatments on CAD/CAM glass-ceramics: Influence on roughness, topography, and bond strength.

OBJECTIVE: To evaluate the influence of surface treatment on roughness (SA), topography, and shear bond strength (SBS) of computer-aided designer and manufacture (CAD/CAM) zirconia-reinforced lithium silicate (ZLS) and feldspathic (FEL) glass-ceramics. MATERIALS AND METHODS: FEL and ZLS specimens were submitted to 5% or 10% hydrofluoric acid (HF) or self-etching ceramic primer (MEP) and different application times (20, 40, and 60 s), or to sandblasting (Control, 20 s). Resin cement cylinders were bonded to the specimens and tested in shear (n = 10) after 24 h and 16-months of water storage. SA and topography were evaluated by atomic force (AFM, n = 10) and scanning electron microscopy. Data were analyzed by ANOVA and Bonferroni test (α = 0.05). RESULTS: Sandblasting promoted the highest SA for ZLS, but 10% HF (40, 60 s) promoted higher SBS at 16 months. 10% HF produced the highest SA for FEL, but sandblasting and 5% HF (20 s) maintained SBS after 16 months, without differences from 10% HF (20 s) (p > 0.05). Overall, MEP produced lower SA and SBS among groups (p < 0.05). HF displayed greater morphological changes on FEL. CONCLUSION: 10% HF (40 s) provided better results for ZLS, while 5% or 10% HF (20 s) was suitable for FEL. CLINICAL SIGNIFICANCE: Surface treatments influenced SA, topography, and SBS of materials. HF etching is the surface treatment of choice for both CAD/CAM glass-ceramics.

Effects of activated charcoal powder combined with toothpastes on enamel color change and surface properties.

AIM: To evaluate the effects of activated charcoal powder (COAL) combined with regular (RT) or whitening (WT) toothpastes on enamel color and surface in comparison to carbamide peroxide (CP). METHODS: Dental blocks (n = 10/group) were randomly divided into COAL, COAL/RT, COAL/WT, CP, CP/RT, CP/WT, RT, WT, and CONT (without treatment). Simulated toothbrushing and whitening treatments were followed by colorimetric (ΔE00 , L*, a*, b*), surface roughness (Ra), and enamel topography assays. ΔE00 was submitted to two-way ANOVA and Tukey test. Color coordinates and Ra were tested with three-way repeated measures ANOVA (α = 5%). RESULTS: COAL exhibited greater ΔE00 than CONT (P = .048), but it did not enhance ΔE00 promoted by RT or WT (P > .05). COAL alone increased Ra (P < .001) and altered enamel topography. COAL did not increase Ra caused by RT and WT (P > .05). CP exhibited the highest ΔE00 (P < .05), but it raised Ra and changed enamel topography to a less extent than COAL. CONCLUSION: Even though charcoal powder did not increase enamel Ra when combined with toothpastes, the topography was negatively impacted by COAL. Also, COAL was unable to enhance the color change of RT and WT, or reach the effectiveness of CP. CLINICAL SIGNIFICANCE: The use of activated charcoal-based product, claimed as a natural whitener, before brushing with toothpastes is not only ineffective to change the color of teeth, but also it might result in alterations on the enamel surface. Whitening with CP, instead, was effective during the same period of treatment, which still represents a more appropriate technique to whiten teeth.

Color change, diffusion of hydrogen peroxide, and enamel morphology after in-office bleaching with violet light or nonthermal atmospheric plasma: An in vitro study.

OBJECTIVE: The aim is to evaluate the effect of violet light (VL) and nonthermal atmospheric plasma (NTAP) combined with or without 35% hydrogen peroxide (HP) and 37% carbamide peroxide (CP). METHODS: Bovine crowns were divided into (n = 10) VL, VL/HP, VL/CP, NTAP, NTAP/HP, NTAP/CP, HP, CP, and C (control) groups. Color and whiteness change (CIELAB-Δ Eab, CIEDE2000-Δ E00 , whiteness index-ΔWID ), color parameters (ΔL, Δa, and Δb), and intrapulpal concentration (µL/mL) of HP were assessed by spectrophotometry. Scanning electron microscopy evaluated the morphology of enamel surface. Data were analyzed by two-way analysis of variance and Tukey (Δ Eab , ΔE00 , ΔWID , ΔL, and µL/mL) and Kruskal-Wallis and Mann-Whitney tests (Δ a and Δ b, α = 5%). RESULTS: VL increased ΔEab and ΔWID of CP (P < .05). VL and NTAP alone resulted in perceptible color and whiteness change, but lower than those in the gel-treated groups (P < .05). Activation modes increased ΔL compared with that of C, but only VL enhanced Δb when applied alone or combined with CP. VL and NTAP did not increase HP diffusion (P > .05) or cause alterations in enamel morphology. However, HP and CP promoted topographical changes. CONCLUSION: VL and NTAP changed color to a lesser extent than bleaching gels. VL produced supplementary effectiveness only for CP (ΔEab and ΔWID ), without increasing HP diffusion or changing enamel morphology. CLINICAL SIGNIFICANCE: Although violet LED light and nonthermal atmospheric plasma (NTAP) promoted in vitro perceptible bleaching without compromising enamel morphology, bleaching gels (hydrogen peroxide and carbamide peroxide) were more effective than VL or NTAP. VL or NTAP did not increase intrapulpal diffusion of peroxide.

Enamel and dentin bond strength, interfacial ultramorphology and fluoride ion release of self-etching adhesives during a pH-cycling regime.

PURPOSE: This study evaluated the effects of pH cycling on fluoride release and bond strength of two self-etching adhesive systems to both enamel and dentin. The ultramorphology of the interfaces produced by the adhesive systems were also analyzed. MATERIALS AND METHODS: The buccal surfaces of bovine incisors were flattened to expose enamel and dentin, which were bonded with either Clearfil Protect Bond (CPB) or One-Up Bond F Plus (OBP). The bonded samples were prepared for microtensile bond strength (µTBS) testing, fluoride ion release, and transmission electron microscopy. pH cycling comprised demineralization (8 h/day) and remineralization (16 h/day) cycles for 8 days. The µTBS data were analyzed by two-way ANOVA, while fluoride release was analyzed using the Friedman and Wilcoxon tests. RESULTS: The adhesives presented similar bond strengths to enamel. However, the dentin bond strength of CPB was higher than that of OBP. pH cycling did not influence enamel or dentin µTBS. The amount of fluoride released from the bonded enamel and dentin was low and varied among the groups. The morphological evaluation showed that the thickness of the dentin hybrid layers was similar for both adhesives. CONCLUSION: The pH-cycling regime did not affect enamel or dentin bond strengths. In enamel, both the self-etching adhesives tested presented similar bond strengths, but in dentin, Clearfil Protect Bond showed higher dentin bonding than One-Up Bond F Plus.

In situ antimicrobial activity and inhibition of secondary caries of self-etching adhesives containing an antibacterial agent and/or fluoride.

PURPOSE: To evaluate the in situ effect of fluoride and MDPB-containing adhesives on antibacterial activity around restorations in conditions of high caries risk. METHODS: Bovine enamel and dentin blocks were restored with a fluoride-containing (One-up Bond F Plus - OP) or a MDPB and fluoride-containing adhesive (Clearfil Protect Bond - PB). Volunteers (n = 17) wore an intra-oral appliance containing three enamel and three dentin blocks, aligned side-by-side and restored with OP or PB and one enamel and dentin block (controls). The cariogenic challenge was carried out in two phases of 14 days each. The counts of total streptococci (TM), mutans streptococci (MS) and lactobacilli (LB) were analyzed in the biofilm formed. Cross-sectional microhardness (CSM) and polarized light microscopy (PLM) evaluated caries lesions around the restorations and the demineralization extension. Data obtained by CSM testing was analyzed by Split-Split Plot ANOVA (P < 0.05). PLM and microbiota results were analyzed by Wilcoxon test (P < 0.05). RESULTS: TM and MS counts were highest for the OP enamel restorations, and these presented higher lesion depths than PB in both the enamel and dentin. The CSM in dentin was the lowest at 60 µm from the restoration wall. None of the adhesives prevented demineralization and bacteria growth, but PB reduced the amount of oral pathogens in enamel and demineralization around restorations in enamel and dentin.

Whitening efficacy of activated charcoal-based products: A single-blind randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial evaluated the whitening efficacy, tooth sensitivity (TS), and volunteers' satisfaction following the use of activated charcoal powder and toothpaste. METHODS: Fifty-six volunteers were randomly allocated into 4 groups (n = 14) according to a 14-day toothbrushing or whitening treatment with activated charcoal powder (ACPW), activated charcoal toothpaste (ACT), regular fluoridated toothpaste (RT), and 10 % carbamide peroxide (CP). Objective (ΔE00) and subjective (ΔSGU) color and whiteness index (ΔWID) changes were calculated. Patients self-reported the risk and intensity of TS using a visual analogue scale and the volunteer's satisfaction was determined by a questionnaire. Color assessments were analyzed by Kruskal-Wallis followed by Dwas-Steel-Crithlow-Fligner, and absolute TS risk and volunteer's satisfaction by Fisher exact test (p < 0.05). RESULTS: ACPW and ACT promoted similar effects in ΔE00, ΔSGU, and ΔWID to that observed for RT. No significant difference was found in terms of TS risk intensity. TS risk became high after 7 and 14 days, with higher TS prevalence in CP. Volunteers reported that ACPW exhibited the lowest ease-of-use, comfort, and whitening satisfaction among groups (p < 0.05). CONCLUSION: Activated charcoal-based products presented a minor and unsatisfactory whitening effect while CP resulted in optimal tooth whitening and the highest level of satisfaction among volunteers. Risk was higher from 7 days onwards and was more pronounced in the CP. CLINICAL RELEVANCE: Based on the whitening effect and patient satisfaction, this controlled-randomized clinical evidence supports that the use of activated charcoal-based products should be discouraged.

Influence of violet LED and fluoride-containing carbamide peroxide bleaching gels on early-stage eroded/abraded teeth.

PURPOSE: This study evaluated enamel with early-stage erosion/abrasion following bleaching with 20% and 45% carbamide peroxide (CP) gels containing fluoride (F) and irradiated with violet LED (LED). METHODS: Enamel blocks were immersed in 1% citric acid (5 min) and artificial saliva (120 min) three times to produce early-stage enamel erosion. Simulated toothbrushing was performed only after the first saliva immersion, to provoke enamel abrasion. The erosive/abraded enamel samples were submitted to (n=10): LED/CP20, CP20, LED/CP20_F, CP20_F, LED/CP45, CP45, LED/CP45_F, CP45_F, LED, and control (without treatment). The pH of the gels was assessed, and color (ΔE00) and whiteness index (ΔWID) changes were calculated after cycling (T1), and 7 days from bleaching (T2). Enamel surface roughness average (Ra) and Knoop microhardness (kg/mm2, %SHR) were evaluated at baseline (T0) at T1 and T2. Scanning electron microscopy evaluated the enamel surface morphology at T2. RESULTS: The gels' pH was neutral and CP20 and CP45 exhibited no differences in ΔE00 and ΔWID (p>0.05) but LED increased these parameters for CP20_F and CP45. Erosion/abrasion significantly decreased mean kg/mm2, and the LED group was the only one not increasing microhardness after bleaching (p>0.05). None of the groups fully recovered the initial microhardness. All groups exhibited %SHR similar to the control (p>0.05) and the increase in Ra was detected only after erosion/abrasion. CP20_F groups exhibited a more preserved enamel morphology. CONCLUSION: Light irradiation combined with low-concentrated CP gel promoted a bleaching effect comparable to the high-concentrated CP. The bleaching protocols did not adversely impact the surface of early-stage eroded/abraded enamel.

Effects of gastric acid and mechanical toothbrushing in CAD-CAM restorative materials: Mechanical properties, surface topography, and biofilm adhesion.

OBJECTIVE: To evaluate the effects of simulated gastric acid erosion combined with mechanical toothbrushing abrasion on the mechanical properties, surface topography, and biofilm adhesion of different CAD/CAM materials. MATERIAL AND METHODS: Specimens of zirconia-reinforced lithium silicate glass-ceramic (ZLS), polymer-infiltrated ceramic network (PICN), feldspathic glass-ceramic (FE), and two nanoceramic resins (RK, RG), were submitted to the following challenges: erosion (E), abrasion (A), erosion combined with abrasion (E + A), or remained untreated (control - C). After challenges, flexural strength was evaluated, while microhardness (KHN) and surface roughness (Ra) were tested before and after treatments. The biofilm adhesion (Streptococcus mutans ATCC 700610, Streptococcus sanguinis ATCC 10556 e Candida albicans MYA 2876) was determined by the counting of colonies forming units per milliliters (UFC/mL) after erosive and abrasive challenges. RESULTS: FE showed the lowest flexural strengths, while ZLS and RG exhibited the highest, while PICN and RK, had intermediate values. PICN, ZLS, and FE showed lower microhardness after E and E + A challenges than polymer-based materials (RG and RK). FE surface roughness increased after E and E + A challenges and after A and E + A challenges for RK. Biofilm formation after erosive/abrasive challenges was higher on ZLS than FE, RK, and RG, but no different than PICN. RK and RG exhibited the lowest biofilm formation among the groups. Furthermore, E + A challenges held significant changes in the surface of the materials, which were more severe on the surface of glass ceramics and hybrid materials. CONCLUSION: Erosive challenges combined with abrasion negatively influenced the mechanical properties and surface topography of most CAD/CAM materials and increased the biofilm adhesion on ZLS. Besides, the severity of the damage is related to the type and composition of each material.

Influence of Surface Treatment on the Physical Properties and Biofilm Formation of Zirconia- Reinforced Lithium Silicate Ceramics: In Vitro Trial.

PURPOSE: To evaluate the performance of fully crystallized zirconia-reinforced lithium silicate (Celtra Duo, ZLS-CD), partially crystallized zirconia-reinforced lithium silicate (Vita Suprinity, ZLS-VS), and partially sintered lithium disilicate-based (IPS e.max CAD, LD) glass-ceramics submitted to polishing, glazing, or no surface treatment after aging. MATERIAL AND METHODS: Samples of each glass-ceramic material were subjected to polishing with rubber cups (POL), glazing (GL), or no treatment (control: unpolished) and afterward aged with 18,000 thermal cycles (5.C to 55.C). The average roughness, 2D and 3D morphology, contact angle, multispecies biofilm formation (Streptococcus mutans and Candida albicans), and mechanical strength were evaluated with atomic force microscopy (AFM, n = 5), sessile-drop goniometry (n = 5), spectrophotometry (n = 5), and the flexural strength test (n = 10), respectively. Data were analyzed using two-way ANOVA and Tukey test (α = 5%). RESULTS: POL produced lower surface roughness than GL, and ZLS-CD presented higher roughness than LD (P < .05). Surfaces without polishing displayed higher roughness than the POL group (P < .001), greater contact angle (P < .001), and significant morphologic changes, regardless of the glass-ceramic material. Irrespective of the treatment, the contact angle was higher in the ZLS-CD group, and regardless of the material, there was higher biofilm formation and lower flexural strength of the unpolished compared to the POL or GL ceramics. CONCLUSIONS: POL promoted lower roughness and minor morphologic surface alterations, but biofilm formation and flexural strength were similar to the GL group. In general, ZLS-CD and ZLS-VS showed more similar behavior than LD, which makes ZLS glass-ceramic a good option for indirect restorations.

Fracture load and failure mode of semi-direct resin composite occlusal veneers: Influence of design and mechanical cycling.

AIMS: To evaluate the influence of the type of preparation and mechanical cycling on the fracture load and failure mode of semi-direct posterior resin composite restorations. METHODS: In total, 70 healthy third molars were used; 10 belonging to the control group (C - unprepared teeth) and 60 teeth prepared and restored with nanoparticle resin composite, divided into 3 groups (n = 20): O - exclusively occlusal preparation (Table Top); OV - occlusal preparation with buccal extension (Veneerlay); OVP - Occlusal preparation with chamfer on the proximal and buccal-lingual/palatal surfaces (Overlay). The preparations were performed with diamond burs with a thickness of 1 mm. The restorations were made with nanoparticulate resin composite (Filtek Z350 XT) and subsequently received additional polymerization (thermoprocessing). Cementation was performed with the use of universal adhesive system (Single Bond Universal) on dental substrate and dual resin cement (RelyX ARC). Half of the teeth in each group (n = 10) were submitted to mechanical cycling, simulating 6 months of clinical service (5 × 105 fatigue cycles), under dynamic loading of 130 N, at a frequency of 2Hz. Fracture load tests were performed in a universal testing machine with a 200 kgf load cell. Failure mode was classified using scores. Generalized linear models and Fisher Exact tests were applied to the data (significance level of 5%). RESULTS: There were no significant differences between the types of preparation (p = 0.9435), or relative to cycling (p = 0.3764). The Fisher Exact Test showed a significant association between the groups and the type of failure (p = 0.0006), with preparations O (with cycling) and OVP (with and without cycling) exhibiting most failures with restoration fractures without involvement of the dental remnant. CONCLUSIONS: Semi-direct restorations showed resistance to fracture load similar to that of healthy teeth and were capable of withstanding functional masticatory loads. The type of preparation influenced the failure mode of teeth. The Table Top and Overlay types of preparations were those had fewer catastrophic failures, suggesting that since they are more conservative preparations, they made it possible for the tooth to receive a new restorative procedure in the future in cases of failures.