Effects of stannous fluoride on eroded enamel permeability.

This study aimed to evaluate the effect in vitro of a single application of a stannous fluoride- (SnF2-) containing toothpaste on eroded enamel. Forty-eight teeth were subjected to three acid treatments: 15% hydrochloric acid for 120 s (HA group); 1% citric acid (pH=4) for 180 s (CA group); 37% phosphoric acid for 30 s (PA group). They were brushed with an electric toothbrush with pressure control and 1 g of SnF2 (1100 ppm) toothpaste for 2 min. Polyether replicas of buccal enamel surfaces were obtained at baseline, after acid exposure and after brushing, gold sputtered and inspected by SEM for fluid droplets presence. Hydrochloric and citric acid treatments increased enamel permeability while, on the contrary, phosphoric acid reduced enamel fluid release. SnF2 application of ameliorated acid induced permeability in citric and hydrochloric treated samples. Permeability in phosphoric treated enamel was unchanged after topical application of SnF2. Our data show specific acid-dependent effects on enamel permeability and demonstrate that SnF2 application can reverse acid-induced permeability.

In vitro effects of fluoride-based and desensitizing toothpastes on dentine permeability.

This study aims to evaluate the effectiveness in reducing dentine permeability of three different toothpastes comparing with a sodium fluoride one. Dentine permeability was measured by a fluid filtration system. Dentin discs were randomized in four experimental groups and treated with different commercial toothpastes, as it follows. Group A: Sensodyne® Rapid, with strontium acetate; group B: Elmex Sensitive ProfessionalTM, with arginine and 450 ppm monofluoro-phosphate; group C: Colgate Total Advanced®, with 1450 ppm NaF; group D: AZ Pro-Expert®, with 1100 ppm SnF2. After brushing specimens of each groups were assigned to two subgroups and: 1) stored in artificial saliva (2 h) and treated with 6% citric acid for 1 min; 2) stored in artificial saliva for 24 h. SEM analysis was performed to investigate dentinal tubules occlusion of acid treated and stored in artificial saliva samples. Dentin permeability proved affected by dentifrice treatments. The toothpastes specifically formulated for hypersensitivity showed significant effects concerning decrease of dentine permeability. SEM observations demonstrated the presence of dentifrice particles on dentin surface and inside dentin tubules. Stannous fluoride treated samples exhibited the greater tubules occlusion.

Primary enamel permeability: a SEM evaluation in vivo.

AIM: The aim of this study was to evaluate in vivo the occurrence of outward fluid flow on primary tooth sound enamel surface. MATERIALS AND METHODS: Sixty primary upper canines from preadolescent patients (mean age 8.0±1.9) and 24 retained primary upper canines from adult subjects (mean age 35.0±1.8) were analysed. The enamel surface was gently polished and air dried for 10 s. An impression was immediately obtained by vinyl polyxiloxane. Replicas were then obtained by polyether impression material, gold coated and inspected under SEM. The hydrophobic vinyl polyxiloxane material enabled to obtain in situ a morphological image of the presence of droplets, most likely resulting from outward fluids flow through outer enamel. For each sample three different representative areas of 5µ² in the cervical, medium and incisal third were examined and droplets presence values was recorded. All data were analysed by by Fisher's exact test. RESULTS: Primary enamel showed a substantial permeability expressed as droplets discharge on its surface. Droplets distribution covered, without any specific localisation, the entire enamel surface in all the samples. No signs of post-eruptive maturation with changes in droplets distribution were observed in samples from adult subjects. No statistically significant differences (P = 0.955) were noted in the percentage distribution of enamel area covered with droplets among the two group studied. CONCLUSION: SEM evaluation of droplets distribution on enamel surface indicated a substantial enamel permeability in primary teeth, accordingly with histological features, without changes during aging. A relationship between enamel permeability, caries susceptibility and bonding procedures effectiveness could be hypothesised.

The effect of ultrasonic removal of various root-end filling materials.

AIM: To compare residual root-end filling material in apical root-end cavities following their removal with ultrasonic retrotips. METHODOLOGY: Thirty single-rooted teeth were filled with Thermafil and AH Plus sealer. Root-ends were resected at 90 degrees, 3 mm from the apex. Root-end cavities were prepared with diamond burs and ultrasonic retrotips and filled with one of three filling materials: group I: Retro-TC (calcium silicate-based cement), group II: IRM (Dentsply, Germany), group III: Vitrebond (3M ESPE, USA). After 30 days of storage, ultrasonic retrotips were used to remove materials from the root-end cavities. The ultrasonic application time was fixed at 60 s. Polyether impressions and replicas of the root-ends were made. Root apices and replicas were examined by one operator under a scanning electron microscope. Remnants of residual materials were evaluated using a four-level scoring system; fractures, smear layer and exposed dentinal tubules were also examined. RESULTS: Forty per cent of the specimens filled with Retro-TC revealed complete removal of the material with exposure of dentinal tubules, whilst 60% contained residual cement. Twenty per cent of specimens filled with IRM were completely devoid of material, whereas 80% had retained material. Ten per cent of specimens filled with Vitrebond retained a moderate amount of material whilst 90% had substantial retention of the material. Statistically significant differences were found (P < 0.05) amongst the three groups of materials. CONCLUSIONS: Retro-TC was successfully removed in 40% of cases using ultrasonics retrotips for 60 s, whereas IRM and Vitrebond specimens had evidence of retained material in 80% and 90% of all specimens respectively.

Fluoride release and absorption at different pH from glass-ionomer cements.

OBJECTIVE: The aim of this study was to evaluate the fluoride release (release-tests) from two glass-ionomer cements (GIC), before and after NaF solution treatment (fluoride treatment) in different pH environments. MATERIALS AND METHODS: After 21 days, every second sample was submitted to fluoride treatment to simulate a fluoride recharge. After fluoride treatment every second sample was submitted to a further three days of long release-tests. Sample surfaces were analyzed by SEM before and after the release-tests in all pH solutions studied. RESULTS: The present study showed that GICs released fluoride ions for the duration of the examination period. For both materials the amount of F(-) released at low pH was considerably greater than at higher pH. The massive superficial breaking up observed by SEM probably promoted the releasing processes. Recharge is possible at different pH levels using NaF solution. CONCLUSIONS: Fluoride release may depend on GICs surface degradation caused by pH in the solution. The use of this kind of material may be an important issue in patients with with low pH saliva and with a high risks caries.

In vivo fluid movement through dentin adhesives in endodontically treated teeth.

Fluid transudation through simplified dentin adhesives can occur in bonded vital crown dentin, since these adhesives behave as permeable membranes after polymerization. The effect of adhesive permeability in endodontically treated teeth is unknown. This study examined the hypothesis that in vivo fluid movement through simplified adhesives occurs when they are applied to root canals. Dowel spaces were prepared in endodontically treated teeth with single root canals. Six adhesives were applied to the intra-radicular dentin of canal walls. Impressions were obtained with polyvinyl siloxane, and replicas were fabricated with the use of polyether impression material. Replica hemisections were gold-coated for SEM examination. Fluid transudation was evident on the adhesive surfaces of all simplified total-etch and self-etch adhesives. Conversely, most of the specimens bonded with the control three-step total-etch adhesive were devoid of fluid droplets. Permeability of simplified adhesives results in water movement, even in root-treated dentin. This may adversely affect the coupling of auto-/dual-cured resin cements.

A between-patient disinfection method to control water line contamination and biofilm inside dental units.

The aim of the present study was to evaluate the efficacy of a between-patient disinfection procedures to maintain low bacterial counts in dental unit water line (DUWL) effluents, and control dental water line biofilms. Six dental units already in use, that had never been cleaned, were monitored for three weeks. During the first week only baseline contamination levels were assessed with no treatment of the system. In the second week lines were flushed with water for 30 s before treating each patient. During the third week, a disinfection procedure with 0.26% peracetic acid, followed by a water flush, was implemented before treating each patient. DUWL samples were collected both at the beginning and at the end of 216 dental procedures (72 during each period), plated on R2A agar and incubated at room temperature for seven days to obtain total bacterial counts in colony forming units per millilitre. To assess biofilm control, nine dental units (five never used and four old dental units with established biofilm) were used for 30 days in routine dental practice undergoing five between-patient DUWL disinfecting cycles every day. Water line samples were removed at baseline and at the end of the study and examined by scanning electron microscopy to determine the presence or absence of biofilms. A significant difference (P < 0.01) in mean DUWL bacterial counts was found between the three sets of observations. Biofilms were not present in any of the new dental units and a demonstrable reduction in the biofilms from the four dental units with previous presence of established biofilms was observed at the end of the study. In this study, a between-patient disinfection procedure consisting of flushing DUWL with peracetic acid with use of water was efficacious in the control of both microbial contamination of dental treatment water and dental water line biofilms.

Osmotic blistering in enamel bonded with one-step self-etch adhesives.

One-step self-etch adhesives behave as permeable membranes after polymerization, permitting water to move through the cured adhesives. We hypothesize that osmotic blistering occurs in bonded enamel when these adhesives are used without composite coupling. Tooth surfaces from extracted human premolars were bonded with 5 one-step self-etch adhesives. They were immersed in distilled water or 4.8 M CaCl(2), and examined by stereomicroscopy, field-emission/environmental SEM, and TEM. Water blisters were observed in bonded enamel but not in bonded dentin when specimens were immersed in water. They collapsed when water was subsequently replaced with CaCl(2). Blisters were absent from enamel in specimens that were immersed in CaCl(2) only. Water trees were identified from adhesive-enamel interfaces. Osmotic blistering in enamel is probably caused by the low water permeability of enamel. This creates an osmotic gradient between the bonded enamel and the external environment, causing water sorption into the interface.

In vivo and in vitro permeability of one-step self-etch adhesives.

Adhesive dentistry should effectively restore the peripheral seal of dentin after enamel removal. We hypothesize that non-rinsing, simplified, one-step self-etch adhesives are effective for minimizing dentin permeability after tooth preparation procedures. Crown preparations in vital human teeth were sealed with Adper Prompt, Xeno III, iBond, or One-Up Bond F. Epoxy resin replicas were produced from polyvinyl siloxane impressions for SEM examination. Dentin surfaces from extracted human teeth were bonded with these adhesives and connected to a fluid-transport model for permeability measurements and TEM examination. Dentinal fluid droplets were observed from adhesive surfaces in resin replicas of in vivo specimens. In vitro fluid conductance of dentin bonded with one-step self-etch adhesives was either similar to or greater than that of smear-layer-covered dentin. TEM revealed water trees within the adhesives that facilitate water movement across the polymerized, highly permeable adhesives. Both in vitro and in vivo results did not support the proposed hypothesis.

Effect of removal of surface collagen fibrils on resin-dentin bonding.

OBJECTIVES: The aim of this study was to evaluate the effects of NaOCl at removing the demineralized layer by examining the morphology of the hybrid layer and measuring shear bond strengths after different dentin treatments. METHODS: Dentin disks were treated with: (1) 35% phosphoric acid (PA) 20 s; (2) PA treatment followed by 1.5% NaOCl, 2 min; (3) PA treatment, followed by a 10% NaOCl immersion for 120 h. SEM was used to analyze the morphology of dentin and its interface with dentin bonding agents (DBAs), while shear bond strength tests were used to measure adhesion. All specimens were then fractured into two halves: One half was inspected under SEM; the other half was sequentially placed in 10% PA followed by 12.5% NaOCl for 70 h, to remove all dentin from the resin replica of the original bonded interface. RESULTS: SEM observations showed that collagen fibrils were completely removed from the acid-etched surface by NaOCl treatment. The diameter and the size of dentinal tubules and the number of lateral branches of the tubules were increased following NaOCl treatment. NaOCl applied on dentin smear layers did not significantly modify their SEM morphology. Resin tags were larger in diameter after phosphoric acid/NaOCl treatment than after only phosphoric acid treatment. Resin-infiltrated dentin-layers were only observed after the single phosphoric acid (i.e. conventional etching) procedure, and were not observed after combined phosphoric acid/NaOCl treatment. Etched/NaOCl samples showed a lower bond strength using Scotchbond MP and 3M Single Bond, but were higher in Optibond FL and unmodified in Prime & Bond 2.0 groups when compared with acid-etched controls. Treatment of etched dentin with NaOCl for 120 h produced an unusual type of resin infiltration of mineralized dentin that could be called a "reverse hybrid layer" which may explain the mechanism of resin bonding to NaOCl treated dentin. SIGNIFICANCE: The use of acidic conditioners for exposure of the collagen matrix exposes a soft delicate mesh that can collapse, thereby interfering with resin infiltration. If acid-etching is followed by NaOCl treatment, high bond strengths can be achieved via "reverse hybrid layer" formation, a proposed new mechanism of micromechanical resin retention. This mechanism is not yet recommended for clinical use but demonstrates a new type of resin retention.

Marginal hybrid layer in Class V restorations.

The aim of this study was to evaluate the morphology of the hybrid layer (identified as marginal hybrid layer) along the cervical margins of Class V restorations using several bonding systems. Class V restorations were prepared in vitro at the CEJ in extracted third molars. Three different bonding systems were selected: Scotchbond 1 (Single Bond), Scotchbond MP, and Clearfil Liner Bond 2V. After finishing each restoration with disks, each margin was polished for one minute with polishing paste. The margins of half of the restorations were then treated with 10% phosphoric acid for five seconds, washed in deionized water, and then stored in water for 24 hours before SEM analysis. The margins of the other half of the restorations were treated with 10% phosphoric acid for five seconds, then with 1.5% NaOCl gel for two minutes to remove noninfiltrated collagen, then washed and stored in water for 24 hours. Each sample was gold coated and observed under SEM. A one-way ANOVA was performed to determine if there were any statistically significant differences in hybrid layer thicknesses. The thickness of the marginal hybrid layer measured under SEM was 1.5-2.5 microns thick in Scotchbond MP and Scotchbond 1 but varied from 0.0 to 12.0 microns in Clearfil Liner Bond 2V when observed after NaOCl postpolishing procedures. Far more porosities were seen in the marginal hybrid layer of Clearfil Liner Bond 2V. Enamel margins were free from a hybrid layer in both groups. This study demonstrated that collagen fibrils are not completely infiltrated by adhesive resin at the CEJ level along the cavorsurface margin of the restorations. The presence of noninfiltrated collagen along the external margins may reduce the sealing capability of bonding systems, leaving many open spaces and gaps, which may jeopardize the durability of the bond over time.

Thickness and morphology of resin-infiltrated dentin layer in young, old, and sclerotic dentin.

The purpose of the present study was to evaluate the morphology of the resin tags and the resin-infiltrated dentin layer (RIDL) of several bonding systems in superficial vs deep young, old, and sclerotic human dentin. Dentin was obtained after the removal of occlusal enamel from extracted molars. Phosphoric acid gels (35-37%) were used to etch dentin before the application of bonding systems (OptiBond FL; Prime & Bond 2.0; Scotchbond Multi-Purpose Plus and Scotchbond 1; One Step). Each bonded specimen was then sectioned into two halves. One half was polished using a standard procedure to evaluate RIDL thickness and morphology by SEM. The other half was demineralized and deproteinized to evaluate the presence and the morphology of resin tags. RIDL was thinner in superficial dentin than in deeper dentin for all the materials tested regardless of the type of dentin. Sclerotic and old dentin showed thinner RIDL, with short resin tags, and fewer lateral branches than normal dentin.

Resin-infiltrated dentin layer formation of new bonding systems.

The purpose of this study was to evaluate the resin-dentin interfacial morphology and shear bond strength of several new and experimental dentin bonding systems classified as single-bottle/total etch, multi-step/total etch, and self-etching. Class 1 and 5 cavities were prepared from freshly extracted permanent molars and restored with composite resin. Each bonded sample was cross sectioned and one-half was completely demineralized and deproteinized, while the other half was polished along the cut surface to permit measurement of the thickness of resin-infiltrated dentin layer (RIDL) within intertubular dentin (iRIDL) and around the peritubular walls (pRIDL) of resin tags by SEM. Shear bond strength was measured for all the systems 2 minutes after photocuring. SEM showed iRIDL and resin tags of different morphology depending on material and dentin location. The iRIDL was thinner in superficial dentin and thicker in deep dentin. Peritubular RIDL (pRIDL) was thinner than intertubular RIDL. Bond strength measurements varied from 12 to 21 MPa, depending on the materials used. Self-etching primer systems exhibited the highest bond strength, although one of the one-step/total etch systems also yielded very high values. The contribution of pRIDL to adhesion onto superficial dentin is limited by the small number of tubules. Single-component bonding agents produced SEM morphology and bond strengths similar to those of multi-step systems. Self-etching systems, despite their limited RIDL thickness, produced the highest immediate bond strengths. Bond strength did not correlate well with the thickness and morphology of RIDL.

Effect of air, dentin and resin-based composite thickness on light intensity reduction.

PURPOSE: To evaluate the effect of air, dentin and resin-based composite thickness on light intensity reduction. MATERIALS AND METHODS: Two different light-units were used in the study. Light intensity was measured using a curing radiometer. RESULTS: There was an exponential decrease in light intensity with distance. The light-intensity value at a specific distance from the tip during passage through a specific dental material was calculated. Both composite and dentin caused a dramatic reduction in light intensity rate, e.g. 2.0 mm of composite are sufficient to reduce the light-intensity to 6% of its initial value.

Marginal morphology of Class V composite restorations.

PURPOSE: To evaluate the morphology of enamel and dentin margins of Class V restorations filled with different resin composites and glass ionomer cements by SEM examination of replicas. Microleakage was also evaluated between the restorative materials and dentin and enamel at different levels. MATERIALS AND METHODS: Non-retentive Class V cavities were prepared in extracted third molars on buccal and lingual surfaces at the CEJ level. Each material was used according to manufacturer's directions. Immediately after finishing, an impression of each restoration was made using a polyvinylsiloxane material to obtain an epoxy resin replica. Each replica was inspected under SEM to evaluate the morphology of the margin along the cervical-dentin and incisal-enamel junctions. Each tooth was then stored in dye solution (erythrosin B) for 24 hours. First an evaluation was made along the restoration margins to evaluate circumferential leakage. After longitudinal sectioning, leakage was calculated along the cavity wall in dentin and at the enamel interface (longitudinal leakage). RESULTS: Enamel margins were characterized (SEM) by prism fractures around restorations along with enamel chips and overhangs. These lesions were observed in about 30% of the samples. Dentin margins showed gaps along the dentin-bonding agents and fractures in the bonding agent/composite interface. Glass ionomers showed similar but fewer lesions both at enamel and dentin interfaces.

Laboratory evaluation of compomers in Class V restorations.

PURPOSE: To evaluate the in vitro microleakage, marginal morphology and resin tags configuration of a compomer restorative material (Dyract) alternatively used with two different bonding systems (Dyract-PSA and Prime & Bond 2.0). A hybrid resin composite (Prisma TPH) used with two different bonding systems (Universal Bond 3 and ProBond) was evaluated as control material. MATERIALS AND METHODS: Class V non-retentive restorations were made in vitro at CEJ and divided at random in four groups: Dyract/PSA, Dyract/P&B 2.0, Prisma TPH/UB3, and Prisma TPH/ProBond. The latter two groups were as controls. After finishing the restorations, an impression material was used to obtain an epoxy resin replica for SEM analysis of margin alterations. Percentage of perfect margin was evaluated under SEM and calculated comparing it with the width/length of restoration margin. The presence of gaps, enamel fractures and other marginal alterations was also recorded inspecting under SEM replicas. Each tooth was then immersed for 24 hours in erythrosin B dye solution at room temperature and evaluated at superficial margins as marginal leakage (ML) for dye penetration. Each sample was then longitudinally sectioned, and leakage was expressed as % dye penetration of the total cavity wall, longitudinal leakage (LL). Finally, each tooth was dissolved (10%H3PO4 for 48 hours and NaOCl solution for additional 24 hours) to leave only the resin restoration. The internal walls of each restoration were then inspected by SEM at x1,000-15,000 to evaluate the presence of resin-dentin infiltrated layer (hybrid layer) and to calculate the ability of primer/bonding to infiltrate peritubular dentin and to form resin tags. RESULTS: Gap widths were 2-6 microns at dentin and lower at enamel. Several enamel fractures along the margin were observed. Resin tags were observed only in deeper dentin. Only Prime & Bond 2.0/Dyract formed resin tags at medium-superficial dentin. The length of resin tags ranged from 1-6 microns for Dyract-PSA primer to 100 microns for Prime & Bond 2.0. Marginal and longitudinal leakage was observed both at dentin and enamel levels. The best dentin seal was obtained with Prime & Bond 2.0/Dyract, while enamel seals were equivalent with both bonding systems (P > 0.05). No correlations were demonstrated between leakage and SEM observations.

Dentin permeability after toothbrushing with different toothpastes.

PURPOSE: To evaluate the interaction of smear layer produced during brushing and dentifrice particles. MATERIALS AND METHODS: Dentin disks were obtained from extracted human third molars. Dentin permeability was evaluated using a hydraulic pressure apparatus working at 1 psi of pressure. After preparation, each sample was connected to the hydraulic pressure apparatus to evaluate the permeability of dentin with the smear layer produced during specimen preparation. After 5 min of measurements dentin was etched with 37% phosphoric acid gel for 2 min, washed and gently dried with cotton to measure the permeability after smear layer removal. This was done to measure the maximum permeability of each specimen (expressed as 100%). Then a second smear layer was produced using a #400 carbide paper under water for 1 min. Dentin permeability of the smear layer covered dentin was then measured, and expressed as a percent of the maximum permeability of that specimen, permitting each specimen to serve as its own control. The three toothpastes used (Merfluan powder, Merfluan paste and Fluorigard) were applied on dentin surfaces using a small sponge to completely cover the dentin surface. After 5 s, each sample was connected to a mechanical device and brushed under water for 3 min with constant pressure of 250 gr using a Colgate medium toothbrush. After this treatment, each sample was gently washed with tap water, gently air dried for 3-5 s and connected with the pressure apparatus to remeasure the permeability after brushing. For SEM examination of dentin before and after treatment with toothpaste and brushing, each dentin and enamel sample was fixed in 2% buffered glutaraldehyde. RESULTS: Dentin permeability proved unaffected by dentifrice treatments. SEM observations demonstrated the presence of dentifrice particles on dentin surface and inside dentin tubules. Smear plugs produced during dentin brushing were not removed by dentifrices.

[Sternocleidomastoid-mandibular interaction and the rest position]. / Interazione sternocleidomastoideo mandibolare (ISM) e postura.

BACKGROUND: The aim of this study was to evaluate the functional role of the interaction between the sternocleidomastoid muscles and the mandibular corners (ISM) in the context of the stomatognathic apparatus. METHODS: Registrations were effected about opening and closing movements of the mandible from the rest position with two different postures of the head. For the evaluations four volunteer subjects unaffected by functional anomalies of stomatognathic apparatus were selected. RESULTS: The resulting graphics allowed the elaboration of a theory about the way of setting up the mandibular rest position. The interactions between the sternocleidomastoid muscles and mandibular corners might be the supports where the strengths, which work on the mandible to avoid any stresses to masticatory muscles, are spread. The knowledge of determining factors for the rest position is considered basic for both diagnosis and rehabilitation purposes. CONCLUSIONS: Furthermore this study allows us to explain the already known relationships between the stomatognathic apparatus and cervical rachis with a new method.

[Mandibular movements and the position of the head]. / Movimenti mandibolari e posizione del capo.

The aim of this study was to evaluate the relation between head position and mandibular movements. The movements of the incisal point were evaluated on a sagittal plane in a group of 4 subjects unaffected by anomalies of the masticatory system. It was observed that there was a marked increase in rotary movement along the hinge axis when the head was extended and vise versa. The author attribute this to interference between the sternocleidomastoid muscles and the mandibular corners (ISM). ISM limits rotary movement, activates mandibular translation and might be the cause of some deviations during opening, malocclusion and ATM disorders. The present study does not establish whether or not ISM plays a functional role.