Marginal adaptation of two-step self-etch versus universal adhesives for Class V restorations: Effect of Er:YAG laser vs. bur prepared cavities.

PURPOSE: To compare the in vitro effect of laser and bur preparation on marginal adaptation of Class V cavities restored with a 2-step self-etch and distinct universal one-component universal adhesives used in self-etching mode. METHODS: 96 Class V cavities were prepared with conventional burs or with an Er:YAG laser. Four universal self-etch (Unibond Extra Low Shrinkage, All Bond Universal, SKB-100 and Prime&Bond active) and a 2-step self-etch adhesive (Clearfil SE Bond) that served as control were used to restore the cavities with direct composite. The percentages of continuous margins were evaluated by quantitative SEM analysis before and after a fatigue test consisting of 240,000 occlusal loads and 600 warm/cold thermal cycles. RESULTS: The marginal adaptation of bur prepared restorations was statistically superior to laser-prepared ones. Class V cavities restored with Clearfil SE Bond and the one-component self-etching universal adhesives All Bond Universal and Prime&Bond active presented the highest and statistically similar percentages of continuous margins before and after loading under both bur and laser cavity preparation. The lowest percentages of continuous margins were observed in the groups restored with the low shrinking adhesive (Unibond ELS), with medians of 49 and 21 for bur and laser prepared cavities after loading. CLINICAL SIGNIFICANCE: Class V cavities presented smoother and higher percentages of continuous margins when prepared by bur rather than by laser. The 2-step self-etch adhesive Clearfil SE Bond and 1-step self-etch universal adhesives All Bond Universal and Prime&Bond active showed a comparable marginal performance.

Activation of endodontic irrigants using a 9.3 µm CO2 and diode lasers: A laboratory proof of concept model.

PURPOSE: To investigate the differences between irrigant propagation and temperature changes using laser-activated irrigation (LAI) at different settings in an artificial root canal model. METHODS: Using an artificial resin root canal model, irrigant activation was achieved in 19 experimental groups with eight samples each. A 9,300 nm CO2 laser, two diode lasers with different settings (wavelengths 455, 808, 970, and 980 nm) were compared to 2,940 nm Er:YAG laser and traditional needle irrigation. Er:YAG and CO2 laser were activated in the pulpal chamber only, while diode lasers and needles were inserted into the main root canal. Lasers were activated for 5x 20 seconds resulting in 100 seconds of activation or rinsing for each sample. After each activation of 20 seconds, a photo was taken of the side canals and the propagation of the dye was measured with a digital measuring tool after calibration. Further, the temperature of the irrigant was reported after activation of 20 seconds and repeated 5 times. Data were checked for normality and statistically compared. RESULTS: All lasers increased the irrigant propagation compared to conventional irrigation. Significant differences were found between groups regarding propagation and temperature (P< 0.0027). Er:YAG and CO2 laser had similar effects on irrigant propagation in middle and apical located side-canals with specific power parameters and were superior to diode lasers and syringe irrigation. The irrigant's temperature increased significantly with the diode and CO2 lasers. CLINICAL SIGNIFICANCE: Diode lasers and CO2 lasers have not been established for irrigant activation. 9,300 nm CO2 lasers absorb well in water and were shown to introduce vapor bubble formation and streaming in water. Diode lasers are highly accepted in periodontics. The laser light is not absorbed in water but interacts with bacteria as well as soft tissues and contributes therefore to infection control. With a modified laser tip it was however possible to introduce cavitation and streaming in irrigants.

Efficacy of one-time application of low-level laser therapy in the management of complications after third molar surgery: A retrospective practice-based study.

PURPOSE: To evaluate in a retrospective practice-based clinical study, the effects of additional laser therapy on side effects following the removal of all four impacted third molars. The secondary objective was, based on those results, to rationalize a protocol for low-level laser therapy (LLLT) in terms of irradiation settings. METHODS: 96 subjects requiring simultaneous surgical removal of the four third molars were treated from 2017 to 2019. For each subject, one side was randomly assigned to laser treatment, the other receiving the placebo. LLLT was performed by applying an infrared diode laser of 810 nm. In the LLLT irradiated side of the mouth, three groups were randomly assigned to a specific protocol of irradiation. Controllable settings include power, energy density and also scanning technique. The main outcome was pain, registered on a visual analog scale (VAS) performed by the patients. RESULTS: There was a statistically significant difference for one of the tested protocols. Self-reported annoyance and pain scores were lower for the side submitted to a 30-second laser radiation at a power of 0.3 W with the slow scanning technique (P< 0.05). CLINICAL SIGNIFICANCE: The present treatment approach, using a one-time low-level laser therapy intra-oral application, showed a beneficial effect of LLLT reducing pain after third molar surgery, which should be confirmed through further study.

Time-and cost-effective 3-dimensional-printing workflow to rehabilitate worn dentitions: A clinical report.

Current restorative methods of restoring worn or eroded dentition present drawbacks that may deter dentists or patients from pursuing complete mouth rehabilitation. A novel additive manufacturing approach using 3D-printed definitive composite resin restorations is described as a less technique-sensitive and more cost-effective alternative. These restorations are straightforward to repair, modify, or replace.

Effect of light-curing time and direction on microhardness of a light-cured resin composite to cement CAD-CAM restorations.

PURPOSE: To evaluate the effect of light-curing exposure time and location on polymerization of a restorative bulk-fill resin composite to lute endocrowns. METHODS: A light-cured restorative bulk-fill resin composite (Filtek One Bulk Fill) was submitted to direct light-curing by a high-power LED light-curing unit for 20 seconds as the positive control group (n= 10). Five more groups (n= 10) were light-cured in a natural tooth mold from two sites (labial and lingual) through a nanohybrid resin composite CAD-CAM restoration (Lava Ultimate A2 LT), for different irradiation times: 90 seconds per site, 40 seconds per site, 30 seconds per site, 20 seconds per site and 10 seconds per site. Vickers microhardness measurements were made at two different depths and test/control ratios were calculated. Ratios of 0.8 were considered as an adequate level of curing. A quantile regression was run to identify the minimally sufficient time of light-curing, and a two-way ANOVA was used to compare the results to previous findings and evaluate the effect of curing location. RESULTS: Analysis showed that 40 seconds x 2 is the minimal irradiation time that presents a test/control ratio above 0.8. Quantile regressions showed that the required irradiation time to reach a test/control ratio of 0.8 at a confidence level of 95% is 41.5 seconds and 39.2 seconds at 200 µm and 500 µm depths in the luting agent, respectively. There was no statistically significant difference between microhardness of the two depths except for the irradiation time of 10 seconds. The two-site to three-site light curing comparison showed no statistically significant difference except for the 90-second time. CLINICAL SIGNIFICANCE: Systematic light-curing through the labial, lingual and occlusal surfaces of thick indirect restorations is not always required for sufficient polymerization and can even waste valuable clinical time especially in the case of multiple restorations luted with resin composites.

Efficiency of 3D-printed composite resin restorations compared with subtractive materials: Evaluation of fatigue behavior, cost, and time of production.

STATEMENT OF PROBLEM: Three-dimensionally (3D)-printed composite resins have been marketed as materials for definitive restorations. However, limited information is available regarding the stability of the adhesive interface and the efficiency of 3D-printed composite resins. PURPOSE: The purpose of this in vitro study was to evaluate the integrity of the marginal adhesive interface before and after thermal and mechanical fatigue of an initial formulation of a 3D-printed composite resin and to evaluate the efficiency of this manufacturing method. MATERIAL AND METHODS: Freshly extracted molars were prepared for onlays and adhesively restored with either 3D-printed composite resin (VarseoSmile Crown Plus) (Group 3D), milled composite resin (Tetric CAD) (Group MCOMP), milled PMMA (Telio CAD) (Group PMMA), and milled lithium disilicate (IPS e.max CAD) (Group EM). Marginal analysis was performed under a scanning electron microscope before and after fatigue by thermomechanical cyclic loading, and initial and terminal percentages of continuous margin (%CM) were compared. The time required for the production of each type of restoration was recorded, and the production costs were also compared. RESULTS: Before aging, 3D, MCOMP, and EM presented comparable values of %CM (69.8%, 75.9%, and 63.1%, respectively) that were statistically significantly higher (P<.05) than those of PMMA (45.1%). After aging, 3D and EM had comparable results (44.7% and 43.7%, respectively), which were lower than those of the MCOMP group (68.5%) but higher than those of the PMMA group (20.5%). Regarding time efficiency, 3D printing took less time than MCOMP or PMMA if more than 8 restorations were fabricated. For the production costs, 3D printing was 5.5, 8.7, and 10.2 times less expensive than PMMA, MCOMP, and EM, respectively. The initial equipment cost was also lower for the additive manufacturing method. However, 3D printing did not always considerably reduce waste. CONCLUSIONS: In terms of marginal adaptation, the evaluated initial formulation of a 3D-printed composite resin behaved similarly to other well-established definitive restoration materials and better than milled PMMA, both before and after fatigue. Three-dimensionally printed resins present advantages in terms of equipment and consumable costs, even for a single restoration, but also for production time when more than 8 restorations were fabricated.

Illuminant metameric effects on interbrand and intrabrand color differences of direct composite resins.

STATEMENT OF PROBLEM: Information on the illuminant metameric effects on the intrabrand and interbrand differences in color of direct composite resins is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effects of different illuminations on the color differences of the same or different brands of composite resins. MATERIAL AND METHODS: Sixty-four disks were prepared from 8 different direct dental composite resins of A3 shade, and, after polymerization and hydration for 48 hours, their color coordinates were measured in the Commission Internationale de I'Eclairage (CIE) L∗a∗b∗ color space with a portable colorimeter on a black and white background under D65 (daylight), F2 (cool white fluorescence), and A (incandescence) illuminations. Translucency parameters (TP) and fluorescence intensities (FI) of the brands were also measured to assist in the interpretation of brand behavior under the illuminations. The Kruskal-Wallis and Friedman nonparametric tests with post hoc multiple comparisons tests were applied to analyze the data for differences within and between brands under all illuminations (α=.05), while regression analysis was used to estimate the relationship between D65 and F2 or A illumination data. RESULTS: Statistical analysis showed significant differences among brands (P<.05) for all color coordinates under all illuminations, with a strong linear relationship between them (R2=0.72-0.97). Intrabrand differences were significantly different across brands (P<.05) and ranged from 0.06 to 3.1 across illuminations in ΔE∗ab units (0.05 to 2.4 in ΔΕ00 units). Interbrand differences were also significantly different (P<.05), with a range of 0.15 to 8.7 ΔE∗ab units or 0.14 to 5.7 ΔΕ00 units. CONCLUSIONS: Primary color coordinates of composite resins were affected by A or F2 illumination and were strongly associated with D65 values. Redder or yellower composite resins were affected more under A or F2 illumination. Intrabrand differences, although small, may contribute to clinical mismatches under A or F2 illuminations. Clinicians should be aware that certain brand pairs may present acceptable differences under D65 illumination but could become unacceptable under A or F2 illumination.

Prevalence of Molar Incisor Hypomineralization in over 30,000 Schoolchildren in Switzerland.

OBJECTIVES: To quantify the prevalence of Molar Incisor Hypomineralization (MIH) in the canton of Geneva, Switzerland. STUDY DESIGN: Thirty-eight dentists of the state school dental services were trained to detect and classify MIH cases. All children (32,142) from age 4 to 12 were examined during the annual dental screening offered by the state. Cases were scored as mild, moderate or severe. RESULTS: The prevalence of hypomineralizations was found to be 7.45% when all hypomineralized teeth were taken into consideration. MIH cases were found to be at 6.6%. Out of the MIH cases, 51% scored as mild, 36% as moderate and 13% as severe. CONCLUSION: The mean prevalence of MIH in Geneva school children was found to be 6.6%. This seems to be lower than the European and the global average. However, with almost half cases being moderate or severe, asserting a proper management protocol is necessary.

Influence of 9.3 µm CO2 and Er:YAG laser preparations on marginal adaptation of adhesive mixed Class V composite restorations with one component universal adhesive.

PURPOSE: To examine the marginal adaptation in enamel and dentin of mixed Class V saucer shaped restorations where cavities were prepared by two different lasers. METHODS: A handpiece-integrated Er:YAG laser @ 4.5 W, 300 mJ, 15 Hz (LiteTouch III) and a novel CO2 laser @ 12.95 W, 19.3 mJ, 671 Hz (Solea 9.3 µm). Diamond bur preparation with a 25 µm diamond bur (Intensiv) in a red contra angle at high speed under water spray cooling served as the control. Eight cavities per group were readied and restored under simulation of dentin fluid with a one bottle universal adhesive (One Coat 7 Universal) and a nanohybrid resin composite (Everglow), applied in two layers. For every preparation technique, the adhesive system was applied in the selective-etch and the self-etch mode, resulting in six experimental groups. Marginal analysis was performed immediately after polishing and after simultaneous thermal (5-50°C, 2 minutes each) and mechanical (max. 49 N; 200,000 cycles) loading by using a SEM (x200 magnification). RESULTS: Significant differences were found for all groups - except groups 2 and 5 - between initial and terminal results and between the groups as well (P< 0.05, 2-way ANOVA with Fisher's post-hoc test). The bur prepared group with selective-etch technique showed the best overall results after loading, followed by Er:YAG prepared self-etch group and CO2-prepared selective-etch group. CLINICAL SIGNIFICANCE: By using a universal one-component adhesive system, marginal adaptation in enamel and in dentin depended on the preparation method and on the adhesive's application technique as well. When using lasers, Er:YAG in self-etch mode and CO2 9.3 µm in selective-etch mode total marginal adaptation showed results which were comparable to conventional bur preparation with selective-etch technique.

Fluorescence intensities of composite resins on photo images.

Recording fluorescence using flash photography, may help reduce time of capture and apply effectively in clinical practice. To test methods for visualizing composite resins fluorescence by direct digital photography. Sixty-four specimen discs (1.5 × 10 mm) were prepared from 8 different composite resin brands. Their CIELAB color coordinates (L*, a*, b*) and fluorescence were measured using a portable colorimeter and a fluorescence spectrophotometer. The mean of three measurements was recorded and then specimens were photographed by a DSLR camera with two different filters (365 nm and 405 nm) mounted on a commercial macro flash. RGB values of all specimens on the photographs were measured by using Photoshop software and converted to CIELab. Data were then analyzed using Kruskal-Wallis and Dunn's multiple comparisons tests. Correlation and regression analyses were also used to relate fluorescence and color parameters on the photographs at α = 0.05. Fluorescence and color data indicated significant differences among the materials (p < 0.05). L* a* and b* color coordinates from both photographs were highly correlated to fluorescence intensities found by the reference method (r365 - 0.95, r405 - 0.94), while regression analysis indicated a strong linear relationship (R2365 - 0.88, R2405 - 0.89). The study showed that filtered flash photography either by the use of a 365 nm or a 405 nm band pass filter can directly visualize fluorescence of composite resin materials and differences in fluorescence between them.

Fracture strength of non-invasively reinforced MOD cavities on endodontically treated teeth.

The purpose of this in-vitro study was to evaluate the fracture resistance and failure mode of non-invasively reinforced endodontically treated mandibular molars. Sixty freshly extracted defect-free mandibular molars were divided into four experimental groups with extensive MOD cavities on endodontically treated teeth with different restoration types and one control group with intact teeth (n = 12). The groups were as follows: "Normal": direct resin composite; "Ring": glass fiber-reinforced strip (Dentapreg) wrapped around buccal and lingual walls followed by direct resin composite; "Inlay": indirect CAD/CAM resin composite inlay; "Onlay": indirect CAD/CAM resin composite onlay; "Intact": Intact teeth (Control). Tetric EvoCeram and Adhese Universal (Ivoclar Vivadent) were used for direct restorations and Tetric CAD (Ivoclar Vivadent) adhesively luted with Adhese Universal and Variolink Esthetic LC (Ivoclar Vivadent) were used for indirect restorations. All teeth were submitted to thermo-mechanical cyclic loading. All samples were then submitted to a compressive load until fracture. Fracture load was noted and teeth were analyzed to classify the failure mode as either catastrophic (C) or non-catastrophic (NC). No statistically significant difference was found between fracture strength of the five groups when all specimens were considered (p = 0.1461). Intact group showed the lowest percentage of catastrophic failures (41.67%). Ring group presents less catastrophic failures (75%) than Normal group (83.34%), and failures of indirect restorations-Inlay and Onlay-were almost all catastrophic (91.67% and 100%, respectively).

Surface degradation of composite resins for direct restorations: effects on wear and gloss retention.

The purpose of this in vitro study was to compare the 2-body wear resistance of 7 direct composite resin materials (Synergy, Filtek Supreme XTE, GrandioSO, Tetric EvoCeram, G-ænial Anterior, Venus Pearl, and Ceram.X Duo) following thermomechanical loading as well as their gloss stability following toothbrushing. For measurement of resistance to wear, 8 specimens of each material were thermomechanically challenged under 200,000 load cycles at a maximum force of 49 N and 500 thermal cycles between 5°C and 50°C simultaneously. Wear was analyzed by measuring the volume and vertical loss of the contact point area using a high-speed 3-dimensional scan. For gloss measurements, 8 additional specimens of each material were evaluated using a glossmeter after being subjected to 15 minutes of brushing with an electric toothbrush at a 200-N application force. Filtek Supreme XTE had the least volumetric wear, while G-ænial Anterior and Ceram.X Duo had the greatest. The greatest vertical loss was recorded for G-ænial Anterior and Ceram.X Duo. Ceram.X Duo also had the greatest loss of gloss units, together with Venus Pearl. The universal composite Filtek Supreme XTE demonstrated the lowest wear rates and the best gloss retention.

Influence of mechanical and chemical degradation on surface gloss of direct and CAD-CAM resin composite materials.

PURPOSE: To compare the gloss retention of four resin based materials, two direct resin composites (Tetric EvoCeram and Filtek Supreme) and two indirect resin composite CAD-CAM blocks (Tetric CAD and Lava Ultimate). METHODS: 36 samples of 1 mm thickness were readied of each test material and manually polished with polishing discs (Sof-Lex) up to the finest grit size. Three gloss measurements per sample were taken (one every 120 degrees of sample rotation) by means of a glossmeter (Novo-Curve) for a total of 60 values obtained per tested material. Samples of each material were then randomly divided into three equal groups and aged with 75% alcohol (Group 1), amine fluoride gel (Elmex gelée) (Group 2) or mechanical brushing (Group 3). Another set of gloss measurements was performed on all samples after 1 hour of aging. Gloss values were statistically evaluated by means of repeated measures ANOVA and Fisher's LSD post-hoc tests. RESULTS: Gloss retention values ranged from 59.0 (Tetric EvoCeram) to 70.9 (Lava Ultimate) for alcohol, from 59.3 (Filtek Supreme) to 67.5 (Lava Ultimate) for Elmex gelèe and from 33.3 (Tetric EvoCeram) to 53.4 (Lava Ultimate) for mechanical brushing. Statistical analysis revealed: (1) significant difference between intial and final gloss values for all materials and groups; (2) significant difference between final gloss values of all the materials in the alcohol group; (3) significant difference between final gloss values of Lava Ultimate and all the other materials in the Elmex gelèe group; (4) significant difference between final gloss values of Lava Ultimate and Tetric CAD with the other tested materials in the brushing group. CLINICAL SIGNIFICANCE: Direct resin composites in general are widely used, and CAD-CAM resin composite materials are becoming progressively more accessible. Making the choice between direct and indirect techniques is still a challenge, and understanding the advantages of CAD-CAM resin composites in the form of higher gloss retention, which translates into higher durability of esthetics, may be one the parameters facilitating the decision.

Effect of light-curing time on microhardness of a restorative bulk-fill resin composite to lute CAD-CAM resin composite endocrowns.

PURPOSE: To evaluate the minimal irradiation time to reach a sufficient polymerization of a photopolymerizable restorative bulk-fill resin composite to lute endocrowns. METHODS: A photopolymerizable restorative bulk-fill resin composite (Filtek One Bulk Fill) was submitted to direct light-curing by a high power LED light-curing unit for 20 seconds as the positive control group (n = 10). Five more test groups (n= 10) were light-cured in a natural tooth mold from three sites (buccal, palatal and occlusal) under a 9.5 mm thick nanohybrid resin composite CAD-CAM endocrown (Lava Ultimate A2 LT), for different irradiation times: 90 seconds per site, 40 seconds per site, 30 seconds per site, 20 seconds per site and 10 seconds per site. Vickers microhardness measurements were made at two different depths and test/control ratios were calculated. Ratios of 0.8 were considered as an adequate level of curing. RESULTS: Analysis shows that 30 seconds x 3 was the minimal irradiation time that presented a test/control ratio above 0.8. Quantile regressions showed that the required irradiation time to reach a test/control ratio of 0.8 at a confidence level of 95% was 38 seconds and 37 seconds for 200 µm and 500 µm, respectively. There was no statistically significant difference between microhardness of the two depths except for the irradiation time of 10 seconds. A 120-second (40 seconds per buccal, palatal and occlusal site) light-curing of photopolymerizable bulk-fill resin composite to lute a resin composite CAD-CAM endocrown restoration can be considered sufficient to reach adequate polymerization.

Coating of enamel and dentin with bioactive materials: Effect on adhesive interface of class V restorations.

PURPOSE: To evaluate the effect of coating enamel and dentin with a calcium phosphate powder, a calcium fluoride silicon polymer, an oxalate and a functionalized tricalcium phosphate, on marginal adaptation of class V cavities restored with a universal adhesive containing the adhesive monomer with chemical bonding potential 10-MDP (Clearfil Universal Bond) and a hybrid composite (Clearfil APX). METHODS: Class V cavities with margins located in enamel and dentin were coated with the different bioactive materials prior to the application of the adhesive and composite. After restoration polishing, the samples were subjected to a thermo-mechanical fatigue test. Gold coated resin-based replicas were readied to analyze the percentages of continuous margins (%CM) before and after loading to evidence differences between different enamel/dentin pre-treatments (Kruskal-Wallis, Duncan post hoc test). RESULTS: The highest %CM was observed in the group in which enamel and dentin were coated with calcium phosphate powder prior to the application of the 10-MDP-containing adhesive. This was also the most stress-resistant group. CLINICAL SIGNIFICANCE: The adhesive interface formed between 10-MDP-containing universal one component adhesive and enamel/dentin with enriched mineral content may improve the quality of restoration margins.

Influence of pulse duration when performing Er:YAG laser irradiation on dental tissues.

PURPOSE: To evaluate the marginal adaptation of mixed Class V composite restorations in cavities prepared with the Quantum Square Pulse (QSP) mode Er:YAG laser, compared to Super Short Pulse (SSP) and diamond bur. The impact of Er:YAG laser finishing with low pulse energy and two irradiation distances was also evaluated. METHODS: Class V cavities were prepared in enamel and dentin by varying the above parameters, and then restored with Clearfil SE Bond and Clearfil AP-X composite under dentin fluid simulation. The control groups were prepared and finished using conventional diamond burs (80 and 25 µm respectively). Scanning electron microscope (SEM) marginal adaptation analysis at x200 magnification was performed on replicas before and after thermo-mechanical cyclic loading in order to determine the percentage of continuous margins (i.e. from 0 to 100% of gap free margins). The differences between groups were analyzed with one-way ANOVA and Duncan post hoc test. RESULTS: Dentin treated with SSP showed significantly lower percentages of "continuous margin" than the QSP and control groups. QSP was as effective as bur preparation. CLINICAL SIGNIFICANCE: The preparation and finishing protocol may no longer be necessary when using the QSP mode, reducing clinical time without compromising marginal adaptation.

Staining susceptibility of resin composite materials.

PURPOSE: To evaluate the color stability of three resin-based materials continuously exposed to various staining agents. METHODS: 144 disc-shaped specimens were made of each of the three tested composites (Essentia, Brillant, Inspiro). Half of them were 1 mm thick, the other half 1.2 mm thick. The thicker group was then polished up to 4,000 grit and reduced to 1 mm thickness, also. All specimens, after 24-hour dry storage in an incubator, received an initial color measurement by means of a calibrated reflectance spectrophotometer (SpectroShade). Specimens were then divided into six groups (n=6) and immersed in five staining solutions or artificial saliva (control). All specimens were kept in an incubator at 37°C for 28 days. Staining solutions (red wine, curry mixed in water, curry mixed in oil, tea and coffee) were changed every 7th day to avoid bacteria or yeast contamination. After 28 days of storage, spectrophotometric measurements were repeated and L*a*b* scores once more recorded to determine the color (ΔE00) changes. RESULTS: All tested materials showed significant color changes after 28 days staining immersion. ΔE00 of polished samples varied from 1.1 (Essentia/distilled water measured over a white background as well as Essentia, Inspiro/distilled water measured over a black background) to 32.5 (Inspiro/wine measured over a white background). CLINICAL SIGNIFICANCE: Staining of restorative materials seems to be dependent on the composition of the product itself. Unpolished samples were more prone to staining than the polished ones.

What should we expect from Switzerland's compulsory dental insurance reform?

BACKGROUND: A vast and heated debate is arising in Switzerland as a result of some recent citizens' initiatives aimed at introducing compulsory dental health care insurance. The Grand Conseils of the Vaud, Geneva, and Neuchâtel cantons recently approved three public initiatives and their citizens are expected to vote on the proposal in 2018. The process of collecting signatures has begun in several other cantons and the discussion has now moved to a national level. DISCUSSION: At present, there is no scientific research that can help policy-makers and citizens to understand the main economic implications of such reform. We attempt to fill this gap by analysing three critical issues: the level and determinants of unmet needs for dental care in Switzerland; the protection of vulnerable individuals; and the economic sustainability of reform. RESULTS AND SHORT CONCLUSIONS: The results show that income is not a unique determinant of barriers to access to dental care but rather, cultural and socio-demographic factors impact the perceived level of unmet dental care needs. The reform might only partially, if at all, improve the equity of the current system. In addition, the results show that the 1% wage-based contribution that the reform promoters suggest should finance the insurance is inadequate to provide full and free dental care to Swiss residents, but is merely sufficient to guarantee basic preventive care, whereas this could be provided by dental hygienists for less.

Non-invasive proximal adhesive restoration of natural non-cavitated proximal lesions.

PURPOSE: To investigate the infiltration potential of different self-etch adhesives into natural non-cavitated proximal lesions and the effect of dehydration protocol on the infiltration of a self-etch adhesive. METHODS: 29 extracted molars and premolars with natural proximal lesions (ICDAS 1-2) were sectioned through the lesion providing two samples from each lesion. To compare the different adhesives, three groups of eight lesions were abraded with fine metallic strips and then etched with 37% H3PO4 acid for 120 seconds. All teeth were stained with rhodamine isothiocyanate. After drying with compressed air and ethanol application, lesions were infiltrated with Scotchbond Universal, Clearfil SE Protect or OneCoat 7 Universal for 180 seconds and then coated with a thin layer of flowable composite (Tetric Flow). To compare the effect of dehydration protocol on infiltration, two groups of nine paired lesions were pretreated as described above. One group was dried using compressed air alone and the second group was dried using compressed air and ethanol, both groups were then infiltrated with Scotchbond Universal then coated with a thin film of flowable composite. After light curing, un-encapsulated dye was bleached by immersion in hydrogen peroxide. Remaining lesion pores were stained with sodium fluorescein solution. Thin cuts of the teeth were observed with confocal microscopy and computer image analysis was performed (ImageJ). RESULTS: ANOVA and Duncan post-hoc tests showed no significant differences of the infiltrated area between the three adhesives (P= 0.835), no significant difference was found between the group dried with air compared to the one dried with air and ethanol. It can be concluded that the tested adhesives may be used for infiltration of natural lesions following the described pretreatment. CLINICAL SIGNIFICANCE: Enamel pretreatment with metallic strip and 37% H3PO4 acid promotes the infiltration of different adhesives into natural non-cavitated caries lesions.

Non-invasive proximal adhesive restoration (NIPAR) compared to resin infiltration for treating initial proximal carious lesions.

PURPOSE: To compare a new technique of non-invasive proximal adhesive restoration (NIPAR) to the infiltration concept technique (ICON). METHODS: Extracted human posterior teeth with non-cavitated proximal carious lesions (ICDAS code 1-2) were cut vertically to obtain two symmetrical lesions. Group 1 (NIPAR):Half of the paired lesions surfaces (n=13) were abraded with metallic strips and etched with 37% H3PO4 for 120 seconds. Group 2 (ICON):The other half of the paired lesions' surfaces (n=13) were etched with 15% HCl gel for 120 seconds. All samples were then stained with rhodamine isothiocyanate (RITC). After ethanol drying and isolation of the cut surface, Group 1 samples were infiltrated with Scotchbond Universal for 180 seconds and coated with a thin film of Tetric flow. Group 2 samples were infiltrated with ICON infiltrant following manufacturer's instructions. After light curing, unbound rhodamine was bleached by immersion in 30% hydrogen peroxide for 12 hours. Remaining lesion pores were stained with sodium fluorescein solution. Samples were observed with confocal microscopy (CLSM) and the percentage of infiltration (area of resin infiltration/area of total demineralization ×100) was calculated using ImageJ. RESULTS: 11 samples out of 13 showed larger infiltrated area of the lesions in Group 1 (NIPAR) compared to Group 2 (ICON). Statistical analysis revealed a significant difference between the two groups (P< 0.05). Within the limitations of this study, NIPAR allowed for better infiltration of non-cavitated proximal carious lesions when compared to ICON. CLINICAL SIGNIFICANCE: The combination of infiltration and sealing using non-invasive proximal adhesive restoration (NIPAR) offers a suitable non-invasive treatment option for non-cavitated proximal lesions combining the advantages of sealing and infiltration.