Effect of a cross-linking antioxidant agent on the bond strength of adhesive resin to irradiated dentin.

It has been shown that irradiation can cause structural changes in dentin that may reduce the bond strength of adhesives to dentin. Applying cross-linking or antioxidant agents may help reverse this detrimental effect and improve adhesion to dentin. This in vitro study aimed to evaluate the effects of epigallocatechin-3-gallate (EGCG) pretreatment and the time of adhesive bonding (24 hours vs 1 month) on the shear bond strength (SBS) of All-Bond Universal (ABU) to irradiated dentin using etch-and-rinse (ER) and self-etching (SE) modes. Flat dentin surfaces prepared from 96 extracted intact human molars were divided into 8 groups (n = 12) and bonded with ABU. In the control (CO) groups (CO/ER and CO/SE), bonding was performed on nonirradiated dentin; in the irradiated (IR) groups (IR/ER and IR/SE), bonding was performed on irradiated dentin; in the irradiated pretreated groups (IR/EGCG/ER and IR/EGCG/SE), irradiated dentin received a 0.1% EGCG pretreatment before bonding; and in the irradiated delayed bonding (DL) groups (IR/DL/ER and IR/DL/SE), bonding on irradiated dentin was performed 1 month after completion of radiotherapy. The irradiation protocol consisted of a total dose of 60 Gy with 2-Gy exposure applied 5 days per week for a period of 6 weeks. After bonding procedures were completed, the specimens were stored in 100% humidity at 37°C for 24 hours and then the SBS was tested in a universal testing machine. Data were analyzed using 1-way analysis of variance and Tukey tests. There was a statistically significant difference among the 8 groups (P < 0.001). Irradiation diminished the SBS in the IR/ER and IR/SE groups compared with their controls (P < 0.001). Pretreatment with EGCG significantly increased the SBS in the IR/EGCG/ER group only (P < 0.001). The difference between the IR/ER and IR/DL/ER groups was not statistically significant, and the difference between the IR/SE and IR/DL/SE groups was marginally significant (P = 0.056). Pretreatment with EGCG after acid etching restored the SBS of ABU to irradiated dentin, resulting in an adhesive performance equivalent to that observed with nonirradiated dentin. A 1-month delay between irradiation and bonding did not improve the SBS.

Cytotoxic effect of silorane and methacrylate based composites on the human dental pulp stem cells and fibroblasts.

OBJECTIVES: The aim of this study was to compare the cytotoxic effect of a methacrylate-based and a silorane-based composite on the human dental pulp stem cells (DPSCs) versus human dental pulp fibroblasts (DPFs). STUDY DESIGN: Samples of the Filtek Z250 and P90 were polymerized and immersed in the culture medium to obtain extracts after incubation for one, seven and 14 days. Magnetic cell sorting based on the CD146 expression was performed to purify DPSCs and DPFs. After incubation of both cells with the extracts, cytotoxicity was determined using the MTT test. RESULTS: For the extracts of first and seventh day, both composites showed significantly lower cytotoxicity on DPSCs than DPFs (p=0.003). In addition, there was a significant difference in the time-group interaction of both materials indicating different cytotoxic behaviours (p=0.014). In contrast to Z250, exposure to the 14th day extract of P90 resulted in higher cell viability compared to that of day seven. CONCLUSIONS: DPSCs are less susceptible to the cytotoxic effect of the composites than DPFs. Compared to Z250, the cytotoxic effect of silorane-based composite decreases as the time passes on. This difference should be considered, particularly in deep cavities, in order to preserve the regenerative capacity of the pulp.

Pre-Sealing of Endodontic Access Cavities for the Preservation of Anterior Teeth Fracture Resistance.

OBJECTIVE: Sodium hypochlorite solution (NaOCl) is an effective canal irrigant but interferes with the mechanical features of dentin and the bonding capability of adhesives when restoring endodontically treated teeth. This study evaluated whether access cavity resin sealing before using canal irrigant would augment the resistance of endodontically treated anterior teeth against fracture. METHODS: Sixty maxillary incisors underwent endodontic treatment in five groups (n = 12). Irrigation with 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was performed in all groups except for Group 5. After root canal obturation, in Group 1, the access cavity was kept unrestored. In Group 2, immediate restoration after obturation was achieved. For Group 3, delayed restoration after 1 week was provided. In Group 4 (pre-sealed), before canal irrigation, the dentin surface of access cavities was sealed using self-adhesive composite resin (Vertise Flow) and then restored after obturation. In Group 5, which was saline irrigated, immediate restoration was performed. After storage and thermal cycling for 5000 cycles at 5°C-55°C with a dwell time of 15 s and a transfer time of 5 s, teeth were statically loaded by a universal testing machine until a fracture occurred. Data were collected as the fracture resistance (FR) and analyzed using the one-way analysis of variance and Tukey's tests. RESULTS: FR significantly differed between all groups (p < 0.001). The lowest FR was recorded in the unrestored group (284 ± 86 N), which was not statistically different from the immediately restored group (p = 0.065). The pre-sealed group exhibited the highest FR value (810 ± 127 N, p ≤ 0.02 vs. other groups). The FR of the saline-irrigated and delayed restored groups was almost similar (p = 0.13). CONCLUSIONS: NaOCl/EDTA irrigation resulted in an adverse effect on FR. Delayed restoration could reduce this adverse effect. Access cavity pre-sealing with flowable composites led to a higher FR than conventional methods and may be considered an effective step during treatment procedures.

Effect of natural antioxidants on bond strength recovery of resin-modified glass ionomers to the NaOCl-affected pulp chamber dentin.

OBJECTIVE: This study evaluated the effect of two natural antioxidants on the compromised bond strength of a resin-modified glass ionomer (RMGI) to the sodium hypochlorite (NaOCl)-affected pulp chamber dentin. METHODS: Forty-two sound third molars were split into halves. The exposed pulp chamber dentin was ground to provide the flat dentin surfaces and divided into seven groups (n = 12), according to the solutions used for immersion: (1) Control, distilled water; (2) NaOCl, 5.25% NaOCl for 20 min; (3) NaOCl/Ethylenediaminetetraacetic acid (EDTA); 5.25% NaOCl for 20 min + 17% EDTA for 1 min; (4) NaOCl/TA, 5.25% NaOCl + 10% tanic acid (TA) for 5 min; (5) NaOCl/EDTA/TA, 5.25% NaOCl + 17% EDTA + 10% TA for 5 min; (6) NaOCl/PA, 5.25% NaOCl+ 10% proanthocyanidin for 5 min; and (7) NaOCl/EDTA/PA, 5.25% NaOCl+ 17% EDTA + 10% PA for 5 min. The RMGI was bonded on the treated dentin using a Tygon tube. After 24 h of storage, microshear bond strength (µSBS) was tested. Data in MPa were submitted to one-way analysis of variance and Tamhane test. RESULTS: NaOCl significantly decreased the µSBS; NaOCl/EDTA and NaOCl/TA significantly increased the µSBS, higher than the control group (p < .05); and in the NaOCl/EDTA/TA group, the increased bond strength was at the level of the control group (p > .05). NaOCl/PA and NaOCl/EDTA/PA and NaOCl groups had comparable µSBS. CONCLUSION: TA could be suggested to provide effective bonding of RMGI and immediate sealing of the pulp chamber dentin after NaOCl irrigation.

Reconstruction of Natural Smile and Splinting with Natural Tooth Pontic Fiber-Reinforced Composite Bridge.

Teeth replacement is challenging in old patients with severe periodontal disease, limiting prosthetics treatment options. Here, we report a fiber-reinforced composite (FRC) resin bridge using natural tooth pontic in a patient with severe periodontitis. A 60-year-old lady complaining of teeth mobility was diagnosed with severe periodontitis, recession, bone loss, and crowding in the anterior maxillary teeth. Due to a hopeless periodontal prognosis, lateral incisors were extracted and sectioned using a cylindrical diamond bur. The pulp chamber was debrided and filled with self-adhesive flowable composite resin. After three weeks, the pontics were fixed in proximal contact areas, and the FRC bridge was fabricated directly using the resin fiber strip followed by occlusion adjustment, finishing, and polishing. Esthetic, occlusion, and periodontal status were re-evaluated after six months. Here, FRC using natural pontic could successfully reconstruct a natural smile, splint the adjacent teeth, eliminate crowding, and provide stable occlusion. Therefore, this method may be considered for similar cases.

Evaluating the shear bond strength and remineralization effect of calcium silicate-based and conventional self-adhesive resin cements to caries-affected dentin.

OBJECTIVE: Given the importance of preserving caries-affected dentin (CAD) in conservative dentistry, the shear bond strength (SBS) of different resin cements to CAD has been investigated. Here, we aimed to compare the SBS and remineralizing effect of a calcium silicate (TheraCem) and conventional self-adhesive cement (Panavia SA) on the SBS of CAD. MATERIALS AND METHODS: Forty-eight extracted third molars (24 sound and 24 CAD) were used. In each group, 12 teeth were prepared for bonding to TheraCem or Panavia SA. After removal of the enamel and caries, resin composite cylinders were luted on the prepared dentin. After 28 days of storage in the artificial saliva, SBS was measured and the failure mode analysis was investigated. The images of fractured sections were analyzed using scanning electron microscopy and energy-dispersive X-ray to evaluate the Ca/P weight ratio. RESULTS: SBS of CAD and sound dentin was not different when cemented with TheraCem (9.56 ± 4.51 vs. 9.17 ± 2.76, p = .806), but the CAD showed significantly lower SBS to Panavia SA (9.4 ± 2.36 vs. 7.39 ± 2.18, p = .015). The Ca/P ratio in CAD was significantly higher when bonded to both TheraCem and Panavia-SA than that of the controls (p = .001); however, this ratio was not different for those bonded to TheraCem compared to Panavia SA. CONCLUSIONS: Based on our results, TheraCem as a calcium silicate cement shows better SBS to attach the restoration to CAD as compared to Panavia SA. Obliteration and mineralization of the dentinal tubules in TheraCem were also higher than in Panavia SA. However, their ability to improve the amount of the Ca/P ratio in CAD was similar.

The effect of bleaching on the optical and physical properties of externally stained monolithic zirconia.

OBJECTIVE: This study aimed to investigate the effects of bleaching on the color, translucency, surface roughness, and surface hardness of monolithic zirconia with external stainin . METHODS: In this experimental study, 32 specimens of monolithic zirconia (1 × 1 mm; shade A2) were divided into two groups based on random permuted blocks. Overglaze and staining procedures were performed with a yellow stain or a value stain (GC Stain). Baseline color, translucency, roughness, and surface hardness were measured. The specimens were then randomly bleached with hydrogen peroxide (HP) 40% (20 min, twice with a 1-week interval in between) as office bleaching or carbamide peroxide (CP) 20% (4 h per day for 14 days) as home bleaching. Finally, the color, translucency, surface roughness, and surface hardness were measured again. RESULTS: Bleaching with CP and HP caused a perceptible change in the color of the specimens (ΔE > 2), although this change was within the clinically acceptable range (ΔE < 3.3). HP significantly reduced the surface hardness of the specimens (p = 0.043). Changes in surface roughness of the specimens were neither statistically nor clinically significant (p = 0.19 and p = 0.25 for office and home bleaching, respectively). CONCLUSION: The effects of home and office bleaching on the surface characteristics of monolithic zirconia were almost the same. It is not necessary to exchange or even to polish the surfaces of zirconia restorations after exposure to bleaching agents. Further studies are recommended to confirm the color stability of externally stained monolithic zirconia.

Differential expression of drug resistance genes in CD146 positive dental pulp derived stem cells and CD146 negative fibroblasts.

INTRODUCTION: The stem cell portion of the dental pulp derived cultures (DPSCs) showed a higher resistance to cytotoxic effect of restorative dental materials compared to pulpal fibroblasts (DPFs). Here, we aimed to compare the expression of some drug resistant genes between these cells. METHODS AND MATERIALS: To separate DPSCs from DPFs, we used magnetic cell sorting technique based on CD146 expression. To assess the stem cell properties, the positive and negative portions underwent colony forming assays and were induced to be differentiated into the adipocytes, osteoblasts, hepatocytes, and neural cells. Cell surface antigen panels were checked using immune fluorescence and flow-cytometry techniques. The mRNA expression of 14 ABC transporters including ABCA2, ABCB1, ABCB11, ABCC1, ABCC2, ABCC3, ABCC4, ABCC5-2, ABCC5-4,ABCC5-13, ABCC6, ABCC10, ABCC11, and ABCG2 genes was assessed, using quantitative RT-PCR technique. RESULTS: Only the CD146 positive portion could be differentiated into the desired fates, and they formed higher colonies (16.7 ± 3.32 vs. 1.7 ± 1.67, p < .001). The cell surface antigen panels were the same, except for CD146 and STRO-1 markers which were expressed only in the positive portion. Among the ABC transporter genes studied, the positive portion showed a higher expression (approximately two-fold) of ABCA2, ABCC5-13, and ABCC5-2 genes. CONCLUSION: Dental pulp stem cells which can be separated from dental pulp fibroblasts based on CD146 expression, express higher levels of some drug resistance genes which probably accounts for their features of more resistance to cytotoxic effects of some dental materials. This needs to be more validated in future.

Dental pulp polyps contain stem cells comparable to the normal dental pulps.

OBJECTIVES: Few studies investigated the isolation of stem cells from pathologically injured dental tissues. The aim of this study was to assess the possibility of isolation of stem cells from pulp polyps (chronic hyperplastic pulpitis), a pathological tissue produced in an inflammatory proliferative response within a tooth. STUDY DESIGN: Pulp polyp tissues were enzymatically digested and the harvested single cells were cultured. Cultured cells underwent differentiation to adipocytes and osteoblasts as well as flowcytometric analysis for markers such as: CD90, CD73, CD105, CD45, and CD14. In addition we tried to compare other characteristics (including colonigenic efficacy, population doubling time and the cell surface antigen panels) of these cells to that of healthy dental pulp stem cells (DPSCs). RESULTS: Cells isolated from pulp polyps displayed spindle shape morphology and differentiated into adipocytes and osteoblasts successfully. These cells expressed CD90, CD73, and CD105 while were negative for CD45, CD14. Number of colonies among 104 tissue cells was higher in the normal pulp tissue derived cells than the pulp polyps (P=0.016); but as polyp tissues are larger and contain more cells (P=0.004), the total number of the stem cell in a sample tissue was higher in polyps but not significantly (P=0.073). CONCLUSIONS: The cells isolated from pulp polyps fulfill minimal criteria needed for MSC definition; hence, it can be concluded that pulp polyps contain stem cells. Although pulp polyps are rare tissues in daily practice but when they are present, may serve as a possible new non-invasively acquired tissue resource of stem cells for affected patients. List of abbreviations: APC = allophycocyanin, BM = Bone Marrow, CFU-F = Colony Forming Unit Fibroblast, DPSC = Dental Pulp Stem Cell, FITC = fluorescein isothiocyanate, MNC = mononuclear cells, MSC = Multipotent Mesenchymal Stromal Cell, PE = Phycoerythrin, PerCP = Peridinin chlorophyll protein, PPSC = Pulp Polyp Stem Cell. Key words:Adult stem cell, chronic hyperplastic pulpitis, dental pulp stem cell, pulp polyp.