Fracture resistance of human roots filled with mineral trioxide aggregate mixed with phosphate-buffered saline, with and without calcium hydroxide pre-medication.

AIM: To compare the fracture strength of extracted human roots with apical plugs of mineral trioxide aggregate (MTA) mixed with either Ca- and Mg-free phosphate-buffered saline (PBS) or water, with and without calcium hydroxide (CH) canal pre-medication. METHODOLOGY: A total of 180 single-rooted human teeth were prepared to resemble immature roots and divided into groups (n = 20). The negative control received canal irrigation only, and the positive control received intracanal treatment with CH for either two or twelve weeks. MTA mixed with water was used in Group 1: (i) without CH pre-medication - MTA(W); (ii) after 2 weeks CH pre-medication - 2/52CH + MTA(W); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(W). MTA mixed with PBS was used in Group 2: (i) without CH pre-medication - MTA(PBS); (ii) after 2-week CH pre-medication - 2/52CH + MTA(PBS); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(PBS). A compressive force was applied to each root until the point of fracture. The results were analysed by the Kruskal-Wallis and Dunn's multiple comparisons tests (P < 0.05). RESULTS: There was no significant difference between groups MTA(W), MTA(PBS) and 2/52CH + MTA(PBS), and all three groups were significantly (P < 0.01, P < 0.05 and P < 0.05, respectively) more resistant to fracture than the negative control. Within Group 1, the samples that received two- (P < 0.01) and twelve-week (P < 0.001) CH pre-treatment were more prone to fracture than those which did not. No difference was found amongst the control groups. The roots of the MTA(PBS) group had a higher dependability (P < 0.05) than the MTA(W) group when compared by the Weibull modulus. The difference was also present when a 2-week CH pre-medication was used. CONCLUSIONS: Mineral trioxide aggregate mixed with Ca- and Mg-free phosphate-buffered saline had a significant strengthening effect on the fracture resistance of structurally weak roots, even when short-term calcium hydroxide pre-medication had been used. MTA mixed with water lost its strengthening effect on human roots when 2- or 12-week CH pre-treatment had been used. Use of CH dressing for up to 12 weeks had no negative effect on fracture resistance of human roots.

Effect of saliva and blood contamination on the bi-axial flexural strength and setting time of two calcium-silicate based cements: Portland cement and biodentine.

This study evaluated the effect of contamination with saliva and blood on the bi-axial flexural strength and setting time of pure gray Portland cement and Biodentine (Septodont, Allington, UK). A one-way ANOVA showed that contamination caused no significant difference between the cements in bi-axial flexural strength (P> 0.05). However there was a significant difference in setting time (P

Investigating the addition of collagen and its integrin binding sequence (RGD) to glass polyalkenoate: In terms of material and cellular properties to explore a more biocompatible method of root caries restoration.

AIMS: Placement of a restoration to treat root caries disrupts many tissues. There is scope for the restorative material to interact with these to augment reductions in micro leakage afforded by an adhesive restorative material. OBJECTIVES: 1) To investigate the effects of incorporating bioactive molecules into a glass polyalkenoate (GPA) 2) To quantify the changes in physical properties of the material. METHODS: Biocompatibility of the GPA cement (Chemfil Superior, Dentsply De Trey, Konstanz, Germany) in unmodified and modified forms was ascertained using cell culture techniques. The optimum concentration of bioactive components required to promote cell attachment was determined indirectly by quantification and localisation of the fibroblast marker vimentin. The properties of surface hardness, compressive strength and adhesive bond strength were also determined prior to and following addition of the bio-additives: collagen type I and a pentapeptide containing Arg-Gly-Asp (RGD). RESULTS: Addition of Type I Collagen (100µg/ml) and RGD (5mg/ml) to ChemFil Superior had no statistically significant effect upon the compressive strength and bond strength to bovine enamel but significantly (P<0.05) increased the materials shore hardness. The addition of RGD to ChemFil Superior increased most the expression of vimentin, indicating that the cells had become more fibroblastic. This may be indicative of increased synthesis of extracellular matrix macromolecules with the potential to foster adhesion of the modified glass polyalkenoate to distracted gingival tissues. CONCLUSIONS: The results suggest that addition of bioactive molecules to GPA cement for subgingival restorations has potential clinical applications. CLINICAL SIGNIFICANCE: It is possible to envisage that the additions, as described in this paper, could foster the attachment of displaced gingival tissues to GPA restorative materials placed subgingivally where root caries has been treated. This would offer potential to form a seal around the restoration by the attached gingival tissues avoiding a periodontal pocket and depriving residual cariogenic bacteria of a nutrient supply. Further investigation of the effects upon other similar materials of such additions is warranted.

Maxillary incisor palatal erosion: no correlation with dietary variables?

The objectives of the study were to examine a relationship between tooth erosion affecting the palatal aspects of permanent maxillary central incisors with dietary, behavioral and medical variables. The methods included, 251 schoolchildren aged 11 to 13 years were recruited to participate. Each subject had dental impressions of the palatal aspects of both upper central incisors recorded at baseline, 9 and 18 months intervals. From these, electroconductive replicas were fabricated, mapped and compared using a surface matching technique. At the end of the study all participants underwent a structured interview that sought to assay the level of potential erosive dietary, behavioral and medical risk factors. Correlation analyses of the responses given in the final structured interview with the degrees of palatal tooth substance loss (both previous and measured) were under taken. The results showed: (1) The degree of previous erosion did not predict the level of measured ongoing erosion. (2) Brushing the teeth more frequently with fluoridated toothpaste correlated significantly with lower levels of ongoing erosion (P = 0 011). It was concluded that: (1) Evidence of previous palatal erosion did not predict future erosion. (2) The application of topical fluoride as a by-product of tooth brushing may provide an element of protection against palatal erosion. (3) In view of the lack of correlation between exposure to potential risk factors and the level of ongoing palatal tooth surface loss in this study, other factors (such as an individual's susceptibility and salivary buffering power) may well be more important predictors. The clinical relevance included: Preventive advice to patients with dental erosion should not only include the use of topical fluoride, in the form of toothpaste, but recognize individual susceptibility to this condition.

Informing a realistic laboratory erosion-testing regime--observations.

OBJECTIVES: To measure aspects of fizzy drink consumption in a social environment to inform the development of a laboratory testing regime. METHODS: This was an observational study in which participants were invited to attend one of four pizza and soft drink parties. All such foods and drinks were served in an air conditioned room at a temperature of 24°C. All drinks were at a temperature of 4°C and each participant was asked to spit out, into graduated cups, their first and second sips. Both the temperature and volume of these were measured. Upon completion of the party the volume of drinks consumed was determined. Video footage of the experiment was recorded for subsequent analysis to determine sip count and the elapsed time period between first and last sip. These values were compared to the analogous measured value of expectorated volume in order to assess the usefulness of video observation in the context of this work. RESULTS: The mean expectorated beverage temperature was 14.9±2.0°C. The mean time spent drinking was 44.2±17.4 minutes with a mean consumption rate of 13.3±6.0 ml/min. Only the sip volume and sip count per can values were significantly different between sexes (P<0.05) with females displaying lower values for volume and a higher sip count. There was close agreement between the sip volume values observed and calculated using video observation derived parameters. CONCLUSIONS: Several human drinking behaviour values were reported in this study and these will be of value in the development of more realistic laboratory erosion-testing regimes. It is concluded, within the limitations of this work, that (1) there are differences in the drinking behaviour of males and females with respect to sip volume and count, (2) the intraoral rise in temperature of a 4°C beverage is lower than that used in previous laboratory simulations and (3) the values derived from video observation agree with those measured directly validating this technique for use in further studies. CLINICAL SIGNIFICANCE: The work provides valuable quantitative data on which to base simulated laboratory erosion work. Perhaps the most significant finding is that sipped beverages attain a temperature of only 14.9°C.

The effect of storage media upon the surface microhardness and abrasion resistance of three composites.

The effects of various storage media [distilled water, lactate (pH 4.0), and citrate (pH 6.0) buffers] upon the hardness and wear factor values of three composites [Occlusin (O), P-30 (P), and Fulfil (F)] were studied. Over the one-year storage period, the hardness of all three materials stored in citrate buffer was unchanged. In the case of P in water and all materials stored in lactate buffer, a reduction was observed. There was no significant difference (P greater than 0.05) between the wear factors of specimens after one year or one week of water storage. Specimens of F stored in citrate buffer had a wear factor (P less than 0.01) higher than that of those stored in water. The other materials were not affected by storage in the lactate or citrate buffers. A reduction in surface hardness for some materials did not result in an increase in wear rate. This indicates that the softening effect was limited to a thin surface layer. Although not significant in vitro, this effect would probably increase the rate of in vivo wear, since the softened material would be lost, exposing a fresh surface to further attack. This would adversely prejudice the material's long-term clinical durability by impairing its resistance to abrasion.

Alternative approaches to evaluating the fatigue characteristics of materials.

Two models of fatigue failure (designated type 1 and type 2) have been investigated by use of a total of seven materials. For type 1 behavior, there is a clear relationship between fatigue life and fatigue stress, whereas for type 2 behavior no such relationship exists. For materials exhibiting type 2 behavior, failure occurs at a level of stress below the ultimate strength of the material, but the values of fatigue life appear to be distributed randomly when several specimens of the same material are tested. A value of fatigue limit can be calculated for these materials which is independent of fatigue life. It is likely that, for these materials, resistance to fatigue is primarily dependent upon the presence or absence of flaws such as porosities. For the dental materials investigated in this study, it appears that brittle materials such as dental plaster and heavily filled composites are likely to exhibit type 2 behavior, whereas less brittle materials, such as more likely filled composites, are more likely to exhibit type 1 behavior.

Close range photogrammetry--a clinical dental research tool.

Photogrammetry is the art, science and technology of obtaining reliable information about physical objects through processes of recording and interpreting photographic images. This review outlines the principles of the technique and summarizes the various methodologies and applications in clinical dental research.

Strength-probability-time (SPT) diagram--an adjunct to the assessment of dental materials?

This investigation sought to construct and compare strength-probability-time (S-P-T) diagrams for four dental materials. Three of these were resin composites and one was dental plaster. In the case of dental plaster a total of 90 compressive specimens as fabricated whereas for each of the other materials a total of 75 specimens was prepared. The compressive strength of equal sized groups of each material was then determined at the crosshead (XHD) speeds of 1, 5 and 10 mm min-1 respectively. The data was subjected to Weibull analysis to relate the probability of failure to the applied stress. Where strong correlations were found between the (i) mean compressive strength and crosshead speed, (ii) individual compressive strengths and failure times, the data was used to determine the crack velocity exponent (n) and produce a S-P-T diagram. Although only one of the materials (P-50) evaluated fulfilled all the necessary criteria and yielded a value of n = 16.13 (7.22), it is suggested that this method may enable comparisons to be made amongst other materials satisfying the required conditions. As such diagrams are based upon a crack growth law they may be of value in assessing the likely clinical wear resistance of new formulations. Consideration, however, should always be given to what levels are deemed acceptable for the intended clinical application of the material. Thus, before this technique can be employed fully, to the evaluation of new restorative materials, further work is necessary to determine appropriate design criteria.

A comparison of the shear bond strengths to a resin composite of two conventional and two resin-modified glass polyalkenoate (ionomer) cements.

The inability of resin composite to bond directly to dentine has compromised the clinical success of this restorative material. This problem may be overcome by the so-called laminate technique in which glass polyalkenoate cement is placed upon dentine and then covered with a resin composite. The cement both adheres to dentine and affords micromechanical attachment to the composite. The introduction of the resin-modified glass polyalkenoate cements (RMCs) offers the potential for chemical union between cement and composite. This investigation examined the shear bond strengths of P-50 resin composite to four glass polyalkenoate lining materials, with and without the application of an intermediate bonding agent (Scotchbond 2). Two of the cements were RMCs (Vitrebond, XR-Ionomer) and the others were conventional base materials (Baseline, Ketac-Bond). The bond between P-50 and Vitrebond with or without Scotchbond 2 was significantly (P < 0.01) stronger and more consistent (P < 0.05) than that observed for all other materials. The treatment of the conventional materials and XR-Ionomer with Scotchbond 2 significantly (P < 0.01) improved the bond strengths to P-50. It is concluded that Vitrebond formed the most favourable cement-resin composite bond and that the other materials studied should be used in conjunction with an effective intermediate bonding agent, such as Scotchbond 2.

Effects of a commercial orthodontic debonding agent upon the surface microhardness of two orthodontic bonding resins.

The bonding techniques employed in orthodontic practice differ from those used in restorative dentistry for, upon the completion of treatment, the appliance is removed. This necessitates breaking the resin/enamel bond. Ideally a smooth, undamaged enamel surface free from all traces of bonding agent should result. Regrettably, however, this ideal is rarely achieved. This investigation assessed the effects of a commercial debonding agent (P-de-A, Oradent Ltd, Eton, Berks, UK), derived from peppermint oil, upon the surface microhardness of two orthodontic resins (Orthodontic Concise and Transbond, both 3M, St Paul, MN, USA). Twenty discs (10 mm diameter x 1.25 mm deep) of each resin were fabricated and, following 1 week's storage in distilled water at 37 degrees C, were allocated to application groups composed of four specimens. The mean initial surface hardness of each group was then determined prior to the application of P-de-A for one of: 30, 60, 90, 120 and 180 s. The hardness was then remeasured. One-way analyses of variance were performed upon the mean initial and final hardness data and revealed only a significant (P < 0.05) reduction in surface hardness following the 180 s application of P-de-A to Orthodontic Concise. We were therefore unable to find little evidence to suggest that the agent facilitates debonding by a softening mechanism and further work is required to elucidate the means whereby orthodontic debonding and 'clean-up' of residual composite, as reported by others, is facilitated.

Surface pH of resin-modified glass polyalkenoate (ionomer) cements.

The recently developed group of materials known as light-activated, or resin-modified, glass polyalkenoate (ionomer) cements have been produced in response to clinical demands for a command set cavity base material. This study monitored the surface pH of three commercially available resin-modified glass ionomer cements over a 60-min period following either mixing alone or mixing followed by a 30-s exposure to a curing lamp. The results indicate that each material behaves in a unique manner. For all materials and conditions the pH reached after a 60-min period was significantly (P < 0.001) higher than the initial value. Light curing the materials significantly increased (P < 0.01) the surface pH of two of the materials (Baseline VLC and Vitrebond) as compared to the same materials in the uncured state. In the case of XR-Ionomer, however, no significant (P > 0.05) effect of light curing upon the surface pH was apparent. The precise clinical consequences of a low surface pH are unclear but may be an aetiological factor in postoperative pulpal sensitivity. It is therefore recommended that a sublining of a proprietary calcium hydroxide lining material should be placed routinely beneath these materials and every effort made to ensure effective light curing.

The permeability of dental gloves following exposure to certain dental materials.

OBJECTIVES: This investigation sought to study the permeability of three commonly used clinical gloves when exposed to chemical agents. METHODS: A total of 35 gloves of each type were selected at random and were assigned to one of seven equally sized treatment groups. The effective barrier properties were investigated following treatment for 15 min with one of: acid etchant, Trim, cavity varnish, Hibiscrub, Hydrex and Vitremer using a dye permeability test. Following the chemical insult a 0.02% solution of erythrosine dye was introduced into each glove and the outer glove surface was washed with 10 ml of distilled water at intervals of 30, 60, 90 and 120 min. The percentage absorption of the collected washings, at 530 nm, was determined using a spectrophotometer. The results were compared with those values obtained from untreated gloves. RESULTS: Acid etchant and Hydrex had little effect on any of the gloves. Trim caused an increase in permeability of the vinyl gloves but had little or no effect upon those made of latex. Cavity varnish increased the permeability of both Biogel D and Tru-Touch but had no effect on Featherlite. The integrity of the latex gloves was diminished by Hibiscrub but little effect was observed in the case of the vinyl based glove. The permeability of all three gloves was increased by exposure to Vitremer liquid. CONCLUSIONS: Manufacturers should provide details of potential glove chemical interactions to assist dentists in glove selection.

The effect of placement technique upon the compressive strength and porosity of a composite resin.

This paper examines the effect of two placement techniques upon the compressive strength and level of porosity of specimens of a composite resin. Those specimens prepared by a condensation technique had a significantly lower mean compressive strength (P less than 0.05) and value of Weibull modulus (P less than 0.05) than specimens prepared using a smearing technique. No significant differences in the overall mean percentage area occupied by porosity and mean number of pores were demonstrated (P greater than 0.05) between the two placement techniques. Specimens prepared using the smearing technique, however, had significantly smaller mean maximum pore diameters (P less than 0.05) than those prepared using the condensation technique. It is therefore desirable when placing composite resins to reduce to a minimum handling procedures that are likely to influence the levels of porosity within the material.

Comparison of a novel photogrammetric technique and modified USPHS criteria to monitor the wear of restorations.

This paper describes monitoring the wear of restorations borne by partial dentures over a 12 months period using a novel photogrammetric technique and modified United States Public Health Service (USPHS) criteria. The performance of Class II restorations of Dispersalloy was compared with that of similar restorations of either KetacFil or Occlusin. The photogrammetric technique highlighted differences in performance not detected by the modified USPHS criteria. It is concluded that the photogrammetric technique should prove valuable in the in vivo assessment of the performance of restorative materials but that further refinement of the method is required particularly with regard to the orientation of replicas for sequential measurements.

Development of a novel system for assessing tooth and restoration wear.

OBJECTIVES: This investigation sought to develop a mapping apparatus for use in the assessment of both tooth and restoration wear. METHODS: A computer controlled mapping device, capable of scanning a suitably prepared electroconductive tooth replica by means of an electrical feedback mechanism, was constructed and its accuracy assessed by measuring the thicknesses of four engineers' slip gauges 12 times each. The reproducibility of three potential methods of rendering a die stone replica electroconductive was also investigated. Finally, tooth replicas were surface profiled and compared empirically with the originals using a commercial surface mapping program. RESULTS: The overall mean accuracy of the mean thicknesses of the slip gauges was 4.4 (2.8) microns. Surface deposition of either nickel spray or gold leaf, upon a ready formed replica, did not give a reproducible thickness. Precoating silicone impressions with nickel spray prior to replica production overcame this problem. On an empirical basis the instrument yielded accurate digital terrain models of tooth replicas. CONCLUSIONS: A surface mapping device has been developed which is both accurate and reproducible. A satisfactory electroconductive surface may be produced upon a tooth replica by precoating a silicone impression with nickel spray before casting the replica. The technique should prove invaluable for monitoring both tooth and restoration wear but further work is necessary to examine how such an approach will perform clinically.

Linear interpolation error in measured surfaces in a dental erosion study.

An extensive palatal erosion study, which is currently being undertaken at the University of Dundee, aims to detect erosion through the precise mapping of replicas of children's incisors. All perceived sources of error are being scrutinised closely. The error due to the interpolation of surface positions from discrete point measurements has been investigated so that its contribution to the erosion estimates can be gauged. The calculation of the error statistics made use of covariance functions to express the undulation of the tooth surfaces. It has been found that, for the measurement point spacing of 150 microm being used in the current project, the interpolation error for an incisor is typically about 25 microm, to be compared with the root-mean-square error due to tooth impression and replication procedures, assessed as being in the order of +/- 3 microm, and replica measurement, assessed as being in the order of +/- 5 microm. The interpolation error constitutes a surprisingly large proportion of the overall system error. The same error estimation technique can be applied usefully and without difficulty to other research studies concerning erosion or wear in natural or restorative dental surfaces.

Assessment of a procedure for detecting minute levels of tooth erosion.

Over a period of some years, the components of a system for discerning erosion on children's teeth have been progressively developed, for use in an extensive project seeking correlations between erosion and various perceived risk factors. The aim was the detection of minute levels of erosion, based on mappings of the palatal surfaces of the maxillary central incisors in children. Significant challenges were encountered, the primary problem being the impracticality of placing control marks that would aid the realignment of successive measurements. The paper describes the erosion detection system and initial experiences based on the results of the first 100 subjects measured after 9 months. The procedures detected the occurrence of erosion of 50 microm magnitude on about one-quarter of the teeth over the 9 month period, at a precision estimated to be +/- 15 microm. The occurrence of some anomalous incidents prevented the procedure from being fully automatic, and it necessitated human examination of a graphical diagram derived from the surface matching program, but it was nevertheless superior to current practices of examining impressions or replicas entirely by eye.

A retrospective observational study of the effect of surface treatments and cementing media on the durability of gold palatal veneers.

This paper reports on the results of a retrospective observational study that sought to determine both the longevity and effects of surface treatments of gold palatal veneers used to restore tooth surface loss. Details of all gold palatal veneers fabricated from Mattident 60 were sourced from hospital records spanning 11 years and 9 months. The case notes of each individual were accessed and, for each restoration, a note was made of the date and method of cementation, together with the period of patient follow-up. When patients continued their routine checkups, the records were scrutinized closely for evidence of restoration failure. This yielded a data set of 151 palatal gold veneer cementations for which the surface treatments and/or cementing media were known. Survival analysis by the Kaplan-Meier method of alumina blasted veneers revealed median survival times of 4,663 days when cemented with Panavia 21 and 687 days if cemented with Aquacem. Veneers that were alumina blasted, oxidized and cemented with Panavia 21 had a survival probability of 1.0. A Logrank test revealed highly statistically significant differences between the survival curves (p<0.0001). It was concluded that: (1) Alumina blasting the fit surface of a gold veneer prior to cementation with Panavia 21 resulted in a significantly more durable restoration compared to alumina blasting and cementation with Aquacem and no etching of tooth substance. (2) Due to low MST cementing, gold palatal veneers with a conventional glass polyalkenoate cement are not recommended. (3) Pre-treatment of gold palatal veneers by alumina blasting and oxidation prior to cementing with Panavia 21 appears to improve the chances of obtaining a dependable restoration. A greater number of restorations would be required to statistically test this trend.