A randomised trial comparing the antibacterial effects of dentine primers against bacteria in natural root caries.

As people are living longer and retaining their teeth into old age, root caries is an increasingly significant problem. A minimally invasive treatment strategy, involving sealing the root caries lesion with an antibacterial resin sealant, could be highly beneficial. The aim of this study was to compare the antibacterial properties of the primers of two proprietary dentine bonding agents, Clearfil SE Bond (SE; Kuraray Medical, Japan) and Clearfil Protect Bond (PB; Kuraray Medical), which contains the antibacterial monomer methacryloyloxydodecylpyridinium bromide. Fifty-two root caries lesions were identified and randomly assigned to a primer. The lesion was cleaned, isolated, sampled with a sharp spoon excavator, a primer applied and a second sample taken. Samples were transported in fastidious anaerobe broth, vortex-dispersed and serial dilutions inoculated onto selective agars. Reduction in colony-forming units (CFU, %) after primer application was calculated for both primers for bacterial growth on each selective agar and compared to a hypothesised mean of 100% (one-sample t test, p < 0.05). No significant differences between primers were seen, indicating efficient bacterial elimination by both materials. Comparing percent reduction between SE and PB for each agar (Mann-Whitney test, p < 0.05), a significantly greater CFU reduction by PB was seen for streptococci but not other bacteria. More lesions exhibited bacterial growth and several lesions demonstrated marked bacterial growth after treatment with SE compared with PB. Therefore, PB appears to exhibit superior antimicrobial properties, particularly against streptococci. Both primers are highly antibacterial towards root caries bacteria and may therefore be suitable for minimally invasive treatment.

Quantitative determination of radio-opacity: equivalence of digital and film X-ray systems.

OBJECTIVES: To evaluate the equivalence of a digital X-ray system (DenOptix) to conventional X-ray film in terms of the measured radio-opacity of known filled-resin materials and the suitability of attenuation coefficient for radio-opacity determination. METHODS: Discs of five thicknesses (0.5-2.5mm) and step-wedges of each of three composite materials of nominal aluminum-equivalence of 50%, 200% and 450% were used. X-ray images of a set of discs (or step-wedge), an aluminum step-wedge, and a lead block were taken at 65 kV and 10 mA at a focus-film distance of 400 mm for 0.15s and 1.6s using an X-ray film or imaging plate. Radio-opacity was determined as equivalent aluminum thickness and attenuation coefficient. The logarithm of the individual optical density or gray scale value, corrected for background, was plotted against thickness, and the attenuation coefficient determined from the slope. The method of ISO 4049 was used for equivalent aluminum thickness. RESULTS: The equivalent aluminum thickness method is not suitable for materials of low radio-opacity, while the attenuation coefficient method could be used for all without difficulty. The digital system gave attenuation coefficients of greater precision than did film, but the use of automatic gain control (AGC) distorted the outcome unusably. CONCLUSION: Attenuation coefficient is a more precise and generally applicable approach to the determination of radio-opacity. The digital system was equivalent to film but with less noise. The use of AGC is inappropriate for such determinations.

Effects of temperature on the fluoride release and recharging ability of glass ionomers.

This study investigated the effects of environmental temperature on the fluoride release and recharging ability of glass ionomers. Five disk specimens (15 mm in diameter and 1 mm thick) were made of each of the following materials: a conventional luting glass ionomer, two high viscosity restorative glass ionomers and a restorative resin-modified glass ionomer. The fluoride release of each material was measured at 4 degrees C, 37 degrees C and 55 degrees C. An additional three groups, which were made of the same materials, were stored in distilled and deionized water for 30 days and recharged in 250 ppm fluoride solution at 4 degrees C, 37 degrees C and 55 degrees C for five minutes. The fluoride re-release was measured daily from two days prior to two days after the recharging process. At all temperatures, the luting glass ionomers showed the greatest fluoride release and recharging ability, followed by the resin-modified glass ionomer, then the high viscosity glass ionomers. For each material, the fluoride release increased with increasing temperature and all glass ionomers showed greater recharging ability at higher temperatures. An increase in environmental temperature increased both the fluoride release and recharging of the glass ionomers. This may be important in developing regimes for improving the delivery of topical fluoride products.

A comparison of the aspirating abilities of re-usable and partly disposable dental cartridge syringes in vitro.

OBJECTIVES: To compare the ability of re-usable and partly disposable dental cartridge syringes to aspirate in vitro. METHODS: A laboratory investigation comparing two re-usable (Astra and Rotor) and one partly disposable (Ultra Safety-plus) dental cartridge syringes. Forces needed to move the cartridge plunger and forces required to produce aspiration of Bonney's Blue dye were measured using an Instron testing machine. RESULTS: There were significant differences in the forces needed to produce aspiration in the different systems (F = 194, p<0.001). The Astra system needed the least force to produce aspiration. The forces required to aspirate in the Rotor and Ultra Safety-plus systems did not differ. Each system aspirated effectively in vitro at the initial aspiration manoeuvre. The forces available for subsequent aspiration attempts varied with the speed of cartridge plunger movement. The volume of local anaesthetic cartridge used did not affect the force needed to produce aspiration in the Ultra Safety-plus syringe. The method of testing free-flow of solution through the needle affected the force generated at subsequent plunger movements. CONCLUSIONS: The re-usable and partly disposable syringes investigated aspirated effectively at the initial aspiration manoeuvre. The force available to produce aspiration at subsequent attempts varies with the speed of injection. The method of testing free-flow of solution through the needle in a loaded syringe affects the force available at the first aspiration manoeuvre.

Recording surface detail on moist surfaces with elastomeric impression materials.

The objective was to assess the ability to accurately record detail on moist surfaces for three elastomeric impression materials derived from different polymers. One polyvinylsiloxane, one polyether and one hybrid material containing a copolymer of siloxane and polyether polymers were used. Impressions were recorded of moist gypsum casts having both a shallow (approximately 20 microm) and deep (approximately 180 microm) groove reproduced on their surface. The grooves in the casts and in the impressions were profiled using a non-contacting laser profilometer Comparisons were made between the groove depths in the casts and impressions (paired t-test). The results indicated that all of the tested materials accurately recorded dimensions in the x-y plane. However, there was evidence that the polyether and hybrid materials were more accurate than the polyvinylsiloxane in recording the true depths of the deep grooves (z plane) under moist conditions. It was concluded that the more hydrophilic nature of the polyether and hybrid materials enabled them to record more accurate impressions of moist surfaces, particularly in areas of difficult access as modelled by the deep grooves.

Viscoelasticity of dental tissue conditioners during the sol-gel transition.

Formation of tissue conditioners is a process of polymer chain entanglements. This study evaluated the influence of composition and structure on dynamic viscoelasticity of concentrated polymer solutions based on poly(ethyl methacrylate) (PEMA) used as tissue conditioners through the sol-gel transition. The hypothesis was that the ethanol content is the most influential factor in determining gelation speed. Rheological parameters were determined with the use of a controlled-stress rheometer. Analysis of variance by orthogonal array L(16)(4(5)) indicated that the strong polar bonding of ethanol (contribution ratio rho = 53.8%; confirming the hypothesis) and molecular weight of polymer powders (rho = 26.7%) had a greater influence on the gelation times of PEMA-based systems than did the molar volume of plasticizers (rho = 9.0%) and concentration of polymers (i.e., powder/liquid ratio) (rho = 4.5%). The results suggest that the gelation of tissue conditioners based on PEMA can be controlled over a wide range by varying the polymer molecular weight, and especially ethanol content.

Salivary contamination and bond strength of glass-ionomers to dentin.

This study evaluated the effect of salivary contamination on the shear bond strength of two highly viscous glass ionomer cements (Fuji IX GP Fast and Ketac-Molar Maxicap) to conditioned dentin and assessed the effect of cleaning the contaminated field prior to bonding. The buccal surfaces of 90 human molars and premolars were ground to expose dentin and the teeth were then set in resin. The specimens were divided into two groups for each material, then further subdivided into three groups of 15 teeth each: Group 1--uncontaminated (control), Group 2--dentin contaminated with saliva, Group 3--dentin contaminated, washed and air dried. The specimens were made by bonding the test material to dentin using a 4 mm diameter gelatin capsule. All specimens were protected with varnish and placed in distilled water at 37 degrees C for seven days prior to measuring bond strength in shear. Fractured surfaces were examined visually and by using SEM to assess mode of failure. There were no significant differences in mean shear bond strength among the three test groups for either material (ANOVA). However, shear bond strength of Fuji IX to dentin was significantly greater than Ketac-Molar (p=0.019) for all groups. Weibull analysis showed that contaminated (Group 2) specimens had a greater probability of failure at low stresses. Modes of failure were mostly cohesive for Fuji IX and adhesive/cohesive for Ketac-Molar. In conclusion, salivary contamination did not affect the mean shear bond strength of Fuji IX GP Fast and Ketac-Molar Maxicap to conditioned dentin; however, it increased the probability of failure at low stresses.

Resin-modified glass-ionomers.

This paper reviews the current status of resin-modified glass-ionomers and presents the results of recent findings of research in some key areas. The debate on nomenclature pertaining to these products is perceived as being pointless and the need for application-based ISO standards is raised. Setting characteristics are similar in many respects to those of light-activated composites, although some products have limited working time due to the influence of the acid-base setting reaction and sensitivity to ambient light. Water absorption and swelling are generally very high. The clinical significance of swelling after water exposure is unknown. Mechanical properties of most materials lie between those of the composites and conventional glass-ionomers depending upon the resin content of the matrix phase of the set material. Some products demonstrate an inherent adhesion to enamel, although etching may be required in order to make the bond clinically effective. Bonding to dentine is probably through a more complex mechanism than that involved with conventional glass-ionomers. Conditioning and priming of dentine is often advocated. Fluoride release rates and their clinical significance is an area which requires clarification and standardization. The key factor appears to be the frequency with which the storage water is changed. Equilibration is reached within minutes for some materials and their true fluoride-releasing potential can only be judged under dynamic test conditions.

Dynamic viscoelastic properties and the age changes of long-term soft denture liners.

The dynamic viscoelastic properties of long-term soft denture liners were measured over a wide range of frequencies using a dynamic viscoelastometer based on a non-resonance-forced vibration principle. Changes in properties over a 3 yr period have also been monitored. One acrylic material, one fluoroelastomer, one heat cured silicone and one self-curing addition silicone were used. Complex dynamic tensile modulus (E*), tensile storage modulus (E'), tensile loss modulus (E") and loss tangent (tan delta) were determined over the frequency range from 0.01 to 100 Hz on administration of a 0.27% strain at 37 degrees C. The dynamic viscoelasticity of the acrylic and fluoroelastomer products was more sensitive to changes in frequency than that of silicone products. The acrylic material and fluoroelastomer exhibited viscoelastic behaviour whilst silicones exhibited elastic behaviour. The silicone products remained unchanged after soaking for 3 yr whilst the acrylic and fluoroelastomer products underwent significant change.

Output from visible-light activation units and depth of cure of light-activated composites.

A simple and reproducible method for monitoring the intensity of radiation from composite light-activation units has been developed. The method depends upon the use of a cadmium sulfide photo-conductive cell, the electrical resistance of which varies with the amount of light falling upon its surface. Filters were used for selection of the wavelength of light that is thought to be most effective in activating polymerization. The use of broad-band wavelength filters failed to give results for light intensity that correlated with depth of cure. Narrow-band interference filters, having a band width of only 10 nm and being selective within the wavelength range of from 460 to 480 nm, produced results for light intensity that correlated with depth of cure. The depths of cure for various types of composite material were measured with use of a penetrometer that enabled the thickness of unpolymerized material at the base of the test mould to be determined. The depth of cure was inversely proportional to the attenuation of light caused by the composite resin at 470 nm. The relationship between depth of cure and light intensity at 470 nm was not a simple linear one over all intensity values. Above a certain critical value of intensity (about 550 lux for a 3.5-mm aperture in these experiments), the depth of cure appeared to be almost independent of intensity. Below this critical value, depth of cure fell markedly with decreasing intensity.

Dynamic creep of dental amalgam as a function of stress and number of applied stress cycles.

Dynamic creep tests on specimens of dental amalgam gave a relationship between creep (epsilon), applied dynamic stress (sigma), and number of applied stress cycles (N) as epsilon = AN (m sigma + c) where A, m, and c are constants. This equation can be used to predict creep of amalgam at low levels of stress and extended times. The pattern of results produced for different types of amalgam indicates that the creep process is multifactorial in nature.

Rheological properties of elastomers during setting.

A controlled stress rheometer has been used to monitor the changes in rheological properties occurring in five elastomeric impression materials during setting. The rheometer differs from conventional rotary viscometers in that the torque is the controlled variable, and the resulting deformation is measured. The use of such an instrument in oscillatory mode enables a range of rheological parameters--including viscosity, rigidity, and elasticity--to be monitored during setting. The polyvinylsiloxane impression materials develop elasticity at a rate that would not be apparent from measurements of viscosity or rigidity alone. This highlights the potential danger of basing the evaluation of clinically important properties, such as working time, on simple measurements of viscosity or rigidity.

Influence of incorporation of antibacterial monomer on curing behavior of a dental composite.

A newly developed monomer, methacryloyloxdodecylpyridinium bromide (MDPB), has an antibacterial activity against oral streptococci, and this monomer can be active even after being immobilized as one component of a cured composite. The purpose of this study was to investigate the influence of incorporation of MDPB on the curing behavior of Bis-GMA-based composites. Depth of cure, degree of cure, light-attenuating effect, and surface hardness of composites incorporating 0.4 or 0.5% MDPB were measured and compared with those of a control material without MDPB. Depth of cure of composites with MDPB, measured by means of a penetrometer, was greater than for the control (p < 0.05). Differential thermal analysis showed that composites with MDPB had a significantly greater degree of cure than the control (p < 0.05). The light-attenuating effect of MDPB composites was less than for the control (p < 0.05). No significant difference between experimental and control was obtained with respect to Vickers hardness after both one day's and seven days' storage in water. These results indicate that the incorporation of small quantities of MDPB into Bis-GMA-based composites did not adversely affect the cure performance. On the contrary, a significant, though small, improvement was observed.

Rheological properties of elastomeric impression materials before and during setting.

In this study, we examined the rheological properties of elastomeric impression materials, both before and during setting, to assess the clinical significance of certain key characteristics such as viscosity, pseudoplasticity, and the rate of development of elasticity. The hypothesis to be tested was that monitoring the change in tan delta is the most appropriate means of monitoring the setting characteristics of elastomers. The loss tangent (tan delta) and the dynamic viscosity (eta') for five impression materials (both unmixed pastes and mixed/setting materials) were measured by means of a controlled-stress rheometer in a cone/plate configuration. For unmixed pastes, tests were performed at various frequencies (0.1 to 10 Hz) and torques (from 1 to 50 x 10(-4) Nm), while testing on setting materials was performed at constant frequency (1 Hz) and torque (3 x 10(-3) Nm). Most base and catalyst pastes were pseudoplastic before being mixed. Immediately after being mixed, the polyether (tan delta = 9.85) and polysulfide (tan delta = 9.54) elastomers showed tan delta markedly higher than those of other mixed materials (tan delta = 4.96 to 3.01). The polyvinylsiloxane elastomers showed lower initial tan delta, which rapidly reduced even further with time. This suggests that these materials should be used as soon as possible after being mixed. The polyether elastomer had a comparatively long induction period during which the tan delta remained at a high value. These characteristics are thought to be key factors in controlling clinical efficacy and therefore support the hypothesis that monitoring tan delta is an appropriate method for evaluating the setting characteristics of elastomers. One limitation was that the controlled-stress rheometer was unable to monitor rheological properties through to completion of setting.

Onset of elasticity in setting elastomers.

A controlled stress-rheometer used in creep/recovery mode was used for detection of the onset of elasticity in setting elastomers. The time for the materials to develop 5-20% elastic recovery corresponded with the time to reach a phase angle of 60 degrees in an oscillatory test.

The effects of cross-linking agents on some properties of HEMA-based resins.

The use of 2-hydroxyethyl methacrylate (HEMA)-based polymer as a biocompatible material has been well-established. HEMA-based resins containing cross-linking agents have several potential clinical applications. It is hypothesized that the incorporation of cross-linking agent will improve the mechanical properties of HEMA-based polymers while reducing water absorption and solubility. The purpose of the work reported here was to test this hypothesis and to determine the most effective cross-linking agent. A relationship among flexural strength, modulus, water absorption and solubility, and concentration of cross-linking agent was demonstrated. Strength and modulus tend to increase as the cross-linking agent concentration is increased, up to about 50%, after which the values level out or begin to fall. Water absorption drops with increasing cross-linking agent over the whole range of concentrations. Solubility tends to show a small decrease initially (up to 40%), followed by a noticeable increase as cross-linking agent concentration is increased. The trends were similar for all cross-linking agents, although there were differences in the absolute values in all properties depending upon the type of cross-linking agent used.

The effect of using layered specimens for determination of the compressive strength of glass-ionomer cements.

Compressive strength is widely used as the criterion of strength of glass-ionomer dental cements, despite the difficulties in interpretation of the findings. With the introduction of light-cured glass-ionomer cements, which can be used only in thin layers, the question arises of how test specimens should be prepared for the measurement of compressive strength. A suggested method has been to prepare test pieces by building them up in layers, an approach which is examined critically in the current paper. Two different conventional (acid-base) glass-ionomers were studied with the use of layered and unlayered specimens of dimensions 6 mm (height) x 4 mm (diameter) and 12 mm (height) x 6 mm (diameter). While smaller samples gave the same value of compressive strength as larger specimens, layered specimens gave significantly lower values of compressive strength for both sizes. In view of these findings, and since the layered specimens are tedious to prepare, we conclude that compressive strength is unsatisfactory as a criterion of strength for light-cured glass-ionomer cements.

A two-body frictional wear test.

Enamel abraders used in two-body wear tests suffer the disadvantage that standardization is difficult or impossible to obtain. The aim of this study was to test whether steatite (a ceramic material with a Vickers Hardness similar to that of enamel) could be used as a satisfactory human enamel analogue. The friction and wear characteristics of 'spherical' abraders made from these two materials against composite and amalgam specimens were therefore compared. A two-body wear test for restorative materials was devised which could be carried out in a Universal Testing Machine and which allowed for continuous monitoring of the frictional forces during wear. The results showed that steatite and enamel abraders produced similar coefficients of friction (correlation coefficient, r = 0.98). A linear relationship was found between depth (and volume) of wear and number of cycles (r = 0.98 to 0.99). Wear rate was not affected by the increase in abrader facet area. The wear rate against the steatite abrader was slightly greater than that against enamel, but the two abraders were reasonably correlated (r = 0.94). Friction and wear were correlated for the steatite abrader (P < 0.05, r = 0.88) but not the enamel abrader. The hybrid composites had a high wear rate and wore both the abraders more than did the microfilled composites or amalgam. These findings suggest that steatite is a suitable substitute for enamel in this type of test.

The bond strength of composite laminate veneers.

An in vitro model has been developed simulating a composite laminate veneer restoration, along with methods to mimic the environmental conditions to which these restorations are subjected in vivo. Fifty composite laminate specimens were prepared: Ten were left untreated as controls, and 40 were exposed to simulated environmental conditioning. The tensile bond strength of the veneer-to-composite interface was significantly reduced by both thermal and humidity cycling, which may explain the increasing prevalence of marginal failure and staining which occurs as these restorations age in vivo.

Dynamic viscoelasticity of soft liners and masticatory function.

Soft denture liners are used for edentulous patients to cushion functional forces. We hypothesized that the application of soft liners having viscoelastic properties would lead to the most marked improvement in masticatory function. The shear storage modulus (G'), shear loss modulus (G''), and loss tangent (tan delta) were determined for 6 materials by means of a dynamic viscoelastometer. Masticatory function of ten subjects was evaluated by measurements of maximum bite forces and chewing times and frequencies for 2 food samples, and by the use of visual analogue scales. The acrylic materials exhibited viscoelastic behavior, while the silicones exhibited elastic behavior. The improvement in masticatory function compared with hard resin was found to be in the order: acrylic permanent materials > silicone > acrylic temporary materials. The results suggest that the use of materials with higher tan delta and G' provides the most optimum masticatory function for patients requiring the provision of soft liners on their dentures.