Adhesiveness of various glass ionomer cements in cavities treated with Carisolv.

OBJECTIVE: The purpose of this study was to investigate the adhesion of glass ionomer cements to dentin and the effect of pretreatment using Carisolv. STUDY DESIGN: Forty extracted permanent teeth with caries were used for this study. All lesions were removed using the Carisolv system and teeth were divided into eight groups. Groups 1 to 4 were filled with three types of conventional glass ionomer cements and a resin modified glass ionomer cement. Group 8 was restored with composite resin. In the remaining three groups (Groups 5 to 7), several pretreatment procedures, including EDTA and dentin primer application and a combination of these, were performed before restoring with resin modified glass ionomer cement. All restorations were thermocycled, and microleakage tests were performed on all teeth. RESULTS: There were no statistical differences among Groups 1, 2 and 3 or between Groups 4 and 8. However Groups 1 to 3 had higher microleakage levels than Groups 4 and 8. Groups 5 to 7 showed similar leakage levels as Group 4. CONCLUSION: Pretreatment with EDTA or dentin primer did not improve bonding ability. Combination of caries removal using Carisolv and a resin modified glass ionomer cement restoration without pretreatment seems to be an acceptable method for caries treatment.

Histological examination of experimentally infected root canals after preparation by Er:YAG laser irradiation.

The influence of Er:YAG laser irradiation on periodontal tissues along the root surface and apical region during root canal preparation was histologically evaluated using experimentally infected root canals of rats. Eighty experimentally mesial infected root canals of mandibular first molars in rats were divided into four groups. In three groups, root canals were irradiated using an Er:YAG laser at 2 Hz with 34, 68, or 102 mJ/pulse for 30 s. Non-irradiated canals served as controls. The influence of laser irradiation on periodontal tissues along the root surface and apical area was evaluated histologically under light microscopy at 0 (immediately after), 1, 2, 4, and 8 weeks after irradiation. At all periods, no inflammation or resorption on the root surfaces caused by laser irradiation was observed in any cases in the control or 34 mJ/pulse-irradiated groups. However, mild to severe inflammation with resorption of root surfaces was observed in some cases in the 68- and 102-mJ/pulse-irradiated groups. No significant difference was apparent between control and laser-irradiated groups at the apical area for all experimental periods (p > 0.05). These results suggest that thermal influences on periodontal tissues of experimentally infected root canals during root canal preparation by Er:YAG laser irradiation are minimal if appropriate parameters are selected. Er:YAG laser irradiation is thus a potential therapy for human infected root canals.

Effect of glypican-1 gene on the pulp cells during the reparative dentine process.

GPC-1 (glypican-1) is a cell surface heparan sulfate proteoglycan that acts as a co-receptor for heparin-binding growth factors and members of the TGF-ß (transforming growth factor beta-1) family. The function of cell-surface proteoglycans in the reparative dentine process has been under investigation. Gpc-1 was detected with similar frequency as tgf-ß1 in the cDNA library using mRNA from the odontoblast-like cell-enriched pulp of rat incisors. The aim of this study was to test our hypothesis that gpc-1 may be related to reparative dentine formation. We examined the expression of this gene during the reparative dentine process, as well as the effect of gpc-1 on odontoblast-like cell differentiation using siRNA (small interfering RNA) to down-regulate gpc-1 expression. Immunohistological examination showed that GPC-1 was expressed in pulp cells entrapped by fibrodentine and odontoblast-like cells as well as TGF-ß1. The mRNAs for gpc-1, -3 and -4, except for gpc-2, were expressed during odontoblast-like cell differentiation in pulp cells. The relative levels of gpc-1 mRNA were increased prior to the differentiation stages and were decreased during the secretory and maturation stages of pulp cells. Down-regulation of gpc-1 expression resulted in a 3.9-fold increase in tgf-ß1 expression in pulp cells and a 0.3-fold decrease in dspp (dentine sialophosphoprotein) expression compared with control. These results suggested that gpc-1 and tgfß-1 expression are necessary for the onset of differentiation, but should be down-regulated before other molecules are implicated in the formation of reparative dentine. In conclusion, gpc-1 expression in odontoblast-like cells is associated with the early differentiation but not with the formation of reparative dentine.

Removal of organic debris from occlusal fissures: advantage of Carisolv system over sodium hypochlorite.

OBJECTIVE: The purpose of this in vitro study was to evaluate and compare the removal of artificial debris from pits and fissures using the Carisolv system and sodium hypochlorite. STUDY DESIGN: Forty artificial fissures prepared on extracted human teeth were filled with artificial organic debris. Debris was removed using either Carisolv or 10% sodium hypochlorite gel. After stereoscopic observation, samples were filled with a sealant and subjected to microleakage test. RESULTS: Both Carisolv and sodium hypochlorite demonstrated adequate cleaning ability and prevention of microleakage. Although both Carisolv and 10% sodium hypochlorite are effective at removing debris from fissures, Carisolv presents greater advantages in terms of safety and antibacterial properties. CONCLUSION: Fissure cleaning using Carisolv might be an effective approach to improve the retention of fissure sealants.

Analysis of surface roughness and microleakage of fissure sealants following organic debris removal with Carisolv.

OBJECTIVE: The objective of the present study was to improve fissure sealing by pre-treatment with Carisolv in order to remove organic debris. The surface morphology and roughness of fissure cavities and the degree of microleakage after Carisolv application were compared with those after bristle brush treatment in vitro. METHODS: Fifty extracted human teeth were used in this study. The teeth were randomly divided into two groups of 25 each. Artificial fissures were prepared in all teeth into which artificial organic debris was placed. The debris in 25 teeth of one group was removed using Carisolv applied for 30s and excavation was performed with a dental explorer until the gel was clear. The remaining 25 teeth were then cleaned using bristle brush with prophylaxis paste. Surface roughness was analyzed in five samples from each group by color laser three-dimensional (3D) microscopy and by scanning electron microscopic examination. The remaining samples were filled with sealant and subjected to a microleakage test under thermocycling. Statistical analysis was performed using the Mann-Whitney U-test; a value of p<0.05 was considered significant. RESULTS: Morphologically, most of the debris in the fissures was removed by Carisolv treatment, whereas some fissures were not cleaned by bristle brush. Carisolv-treatment with acid-etching resulted in removal of debris-like smear layer leaving enamel prisms open, and 3D laser microscopy demonstrated that the roughness values increased after acid-etching. However, microleakage test of both Carisolv and brush methods showed similar results. CONCLUSIONS: Carisolv-treated surfaces especially when subjected to acid-etching might facilitate good adaptation of sealant to enamel, because of an increase in surface roughness and favorable surface characteristics.

Effects of KTP laser irradiation, diode laser, and LED on tooth bleaching: a comparative study.

OBJECTIVE: This in vitro study examines the whitening efficacy of a light-emitting diode (LED), a diode laser, and a KTP laser irradiation in dental bleaching by analyzing the change in color achieved from the treatment, the temperature increase induced in the pulpal cavity, as well as enamel microhardness measurement after treatment. BACKGROUND DATA: Bleaching techniques achieved significant advances with the use of coherent or incoherent radiation sources to activate the bleaching agents. METHODS: A hydrogen peroxide bleaching agent, Hi-Lite, was stimulated with an LED, a 980-nm diode laser at 0.8 W, or a 532-nm KTP laser at 1.0 W for 30 sec on 64 extracted human incisors. During irradiation, the temperature in the pulpal cavity was monitored. The color change was evaluated using the CIE L*a*b* color space measurement system, and Vikers enamel microhardness was tested after treatment. RESULTS: A mean total color difference value (DeltaE*) greater than 5.0 was obtained in each group. KTP-laser-induced bleaching gave a significantly higher DeltaL* (8.35) after treatment (p < 0.01). Neither LED nor the two lasers produced significant differences in the enamel microhardness after treatment (p > 0.01). Mean maximal pulpal temperature rise was 2.95 degrees C for LED, 3.76 degrees C for KTP laser, and 7.72 degrees C for diode laser, respectively. CONCLUSION: The results of this study suggest that KTP laser is effective at providing brighter teeth. According to the conditions used in this study, the LED and KTP laser induced a safer pulpal temperature increase when assisted with Hi-Lite bleaching gel.

Artificial plaque removal with Carisolv system: a clinical approach.

In the present study, removal of artifcial plaque in pits and fissures with the Carisolv system was compared with that of conventional bristle brush methoda in vitro. The results indicate that in the dental clinic, complete plaque removal with the Carisolv is possible, and in addition to acid etching, treated cavity was almost free of debris which might increase sealant retention.

Effects of diode laser irradiation on smear layer removal from root canal walls and apical leakage after obturation.

OBJECTIVE: The objective of this study was to investigate the rise in temperature in root surfaces during and immediately after diode laser irradiation, to observe morphological changes of root canal wall after irradiation, and to evaluate the apical leakage after irradiation and obturation in vitro. BACKGROUND DATA: There have been very few reports on root canal treatment by 980-nm wavelength diode laser. METHODS: Sixty-six extracted human single-rooted teeth were instrumented up to size 60 K-file, and then randomly divided into three groups of 22 teeth each. Groups 1 and 2 were irradiated with a diode laser at 5 W for 7 sec using fibers of diameters 550 and 365 microm, respectively. Group 3 was not irradiated, and served as a control. The rise in temperature on root surfaces of the teeth in groups 1 and 2 were measured by thermography. Six teeth in each group were bisected longitudinally and observed morphologically. Other teeth were obturated and immersed in rhodamine B solution, and the degree of apical leakage was evaluated longitudinally and transversally. RESULTS: A maximum temperature rise of 8.1( degrees )C was recorded in group 1. The smear layer in the laser-treated groups was evaporated and removed, resulting in clean root canal walls, which was significantly superior to the control group (p < 0.05). After obturation, the laser-treated groups showed significantly less apical leakage than the control group (p < 0.05). CONCLUSIONS: These results indicate that the diode laser is useful for removing smear layer and debris from root canal walls, and reducing apical leakage after obturation in vitro, and suggest that it would be useful for root canal treatment in clinic.

Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers.

OBJECTIVE: The purpose of this study was to evaluate morphologically the dental hard tissue ablation at the class V cavity preparation by two types of laser devices: Er:YAG and Er,Cr:YSGG lasers in vitro. BACKGROUND DATA: There have been no reports on the comparative study of dental tissue ablation at cavity preparation by Er:YAG and Er,Cr:YSGG lasers. METHODS: Twenty-two extracted human mature molar teeth were used in this study and divided into two groups of 11 teeth each. The teeth of the Er:YAG laser-irradiated group were irradiated at the parameters of 250 mJ/pulse and 15 Hz with water spray, and those of the Er,Cr:YSGG laserirradiated group were irradiated at the parameters of 5 Wand 20 Hz with water spray. After cavity preparation, the teeth were dehydrated, coated with platinum, and examined by scanning electron microscopy. RESULTS: Both of the laser devices were capable of ablating dental hard tissues, but similar, irregular, and rugged surface aspects with different depths were observed. Open dentinal tubules at the cavities prepared by Er,Cr:YSGG laser were more clearly visible than those prepared by Er:YAG laser. Smaller width and stripped surfaces were observed on the cavities prepared by Er,Cr:YSGG laser. CONCLUSION: The results suggested that there is little difference between the two types of lasers-Er:YAG and Er,Cr:YSGG lasers-morphologically for class V cavity preparation, because both lasers were capable of preparing class V cavities, and the morphological features of the irradiated surfaces were very similar.

Caries removal with Carisolv system: criteria evaluation and microleakage test.

In the present study, cavities prepared by Carisolv were verified as being caries-free by two methods; by conventional visual and tactile criteria, and by DIAGNOdent. The results indicate that in the dental clinic, the efficiency of complete carious dentin removal with Carisolv is no longer difficult when a proper clinical guide is used. Furthermore, treatment of dentin surfaces with Carisolv is capable of decreasing marginal microleakage after composite resin restorations.

Mineral trioxide aggregate induces osteoblastogenesis via Atf6.

Mineral trioxide aggregate (MTA) has been recommended for various uses in endodontics. To understand the effects of MTA on alveolar bone, we examined whether MTA induces osteoblastic differentiation using MC3T3-E1 cells. MTA enhanced mineralization concomitant with alkaline phosphatase activity in a dose- and time-dependent manner. MTA increased production of collagens (Type I and Type III) and matrix metalloproteinases (MMP-9 and MMP-13), suggesting that MTA affects bone matrix remodeling. MTA also induced Bglap (osteocalcin) but not Bmp2 (bone morphogenetic protein-2) mRNA expression. We observed induction of Atf6 (activating transcription factor 6, an endoplasmic reticulum (ER) stress response transcription factor) mRNA expression and activation of Atf6 by MTA treatment. Forced expression of p50Atf6 (active form of Atf6) markedly enhanced Bglap mRNA expression. Chromatin immunoprecipitation assay was performed to investigate the increase in p50Atf6 binding to the Bglap promoter region by MTA treatment. Furthermore, knockdown of Atf6 gene expression by introduction of Tet-on Atf6 shRNA expression vector abrogated MTA-induced mineralization. These results suggest that MTA induces in vitro osteoblastogenesis through the Atf6-osteocalcin axis as ER stress signaling. Therefore, MTA in endodontic treatment may affect alveolar bone healing in the resorbed region caused by pulpal infection.

Histopathological study of dental pulp tissue capped with enamel matrix derivative.

The purpose of this study was to examine the histopathological response of dental pulp tissue to enamel matrix derivative (EMD) used as a pulp capping material. Thirty-two teeth from two mongrel dogs were divided into four equal groups. One group served as controls, and the others were used for deep Class V cavity preparation followed by direct pulp capping with enamel matrix derivative. The treated teeth were extracted after 1, 4, and 8 weeks and prepared for histopathological examination by light microscopy. All teeth prepared after 4 and 8 weeks demonstrated an increase in tertiary dentin, suggesting that enamel matrix derivative exerts a considerable influence on odontoblasts and endothelial cells of capillaries in dental pulp tissue. These results imply that enamel matrix derivative used as a pulp capping material may play a role in the calcification of dental pulp tissue.

Root surface temperature increase during Er:YAG laser irradiation of root canals.

The authors measured the temperature of the root surface during root canal preparation using Er:YAG laser irradiation and evaluated the thermal effect on the periodontal region. Twenty extracted human teeth with single roots were divided into two groups of 10. These were irradiated using an Er: YAG laser at 2 Hz and 136 to 184 or 170 to 230 mJ/pulse for 1 min with a water spray. The temperature of the root surface was monitored using thermocouples throughout the procedure. The teeth were longitudinally bisected and observed by stereoscopy and scanning electron microscopy. The temperature on the root surface increased by less than 6 degrees C at the apical area and by less than 3 degrees C at the central area. A morphological evaluation revealed no carbonization or melting. These results suggest that the thermal effect on periodontal tissues during root canal preparation using an Er: YAG laser at less than 230 mJ/pulse for 1 min is minimal.

An immunohistochemical study of the effects of pulsed neodymium:yttrium-aluminium-garnet laser irradiation in root canals on the eruption of rat incisors.

The incisors of 21 Wistar rats were transected, pulp tissue was extirpated for 10mm from the level of the gingival margin and each canal was prepared with files. The fibre tip of a pulsed neodymium:yttrium-aluminium-garnet laser was inserted into the root canal for 10mm and laser irradiation delivered at 2 W and 20 pulses/s for 10s. After 6 weeks the mandibles were removed and sectioned. Sections were stained either with haematoxylin and eosin or immunohistochemically using polyclonal antibodies against keratin/cytokeratin, amelogenin and type I collagen. The inner epithelial cells on the labial side differentiated into ameloblasts in animals where eruption had recovered. The pulp cells differentiated into odontoblast-like cells and staining for type I collagen was evident in pulp cells, odontoblast-like cells and inside dentinal tubules. In animals where eruption had ceased, the inner epithelial cells on the labial side did not differentiate into ameloblasts. Staining for type I collagen was observed in the mineralized nodules and tubules of dentine-like hard tissues in the pulp cavity. These results suggest that differentiation of epithelial cells on the labial side into ameloblasts is involved in the re-eruption process.

A histochemical study of the regeneration process after injury by pulsed Nd:YAG laser irradiation of root canals.

Histological changes of rat dental pulp cells were followed after injury. The regeneration process after 3, 6 and 10 days was monitored. Mandibular incisors were irradiated with a pulsed Nd:YAG laser at 2 W and 20 pulses per sec (pps) for 5 sec and the pulp was examined histologically and immunohistochemically for TGF-beta1. Eruption of the developing tooth was disturbed for a short period only. Rapid formation of osteodentin was observed. After 3 days, a zone of fibrodentin matrix as well as newly formed vessels were found. Afterwards, regenerative dentin formation was observed accompanied by the formation of a layer of odontoblast-like cells in the damaged area. Immunohistochemical staining of TGF-beta1 showed that positivity was present in small tissue areas beneath the mantle dentin, the zone of fibrodentin matrix and odontoblast-like cells. These results indicate that pulsed Nd:YAG laser irradiation of rat incisor pulp induces formation of osteodentin, and TGF-beta1 plays a role during regeneration.

Effects on periradicular periodontal tissues of root canal irradiation with Er:YAG laser in rats.

OBJECTIVE: The effects of Er:YAG laser irradiation on the periodontal region during root canal preparation were evaluated using rats histopathologically. BACKGROUND DATA: The effects on periodontal tissues along the root surface and apical area during root canal preparation using Er:YAG laser irradiation in vivo are not clear. METHODS: One hundred mesial root canals of mandibular first molars in rats were divided into four groups. In three of these groups, root canals were irradiated using an Er:YAG laser at 2 Hz and 34, 68, and 102 mJ/pulse for 30 sec. Non-irradiated canals served as controls. The effects of laser irradiation on the periodontal tissues along the root surface and apical area were evaluated at 0, 2 days, 1, 2, and 4 weeks after irradiation under light microscopy. RESULTS: At 4 weeks after treatment, no inflammation or resorption was observed in any cases in the control or 34 mJ/pulse-irradiated groups. However, moderate to severe inflammation with resorption of root surface was observed in four of five cases (80%) in the 102 mJ/pulse-irradiated group, which was significantly different from the control (p < 0.01). CONCLUSIONS: These results suggest that the effects on periodontal tissues during root canal preparation by Er:YAG laser irradiation after pulpectomy are minimal, if appropriate parameters are selected, and this is a potential therapy for human root canals of teeth.

Thermographical and morphological studies of Er,Cr:YSGG laser irradiation on root canal walls.

OBJECTIVE: This study was performed to investigate the temperature rises on root surfaces and morphological changes on root canal walls of extracted human teeth after irradiation by erbium, chromium: yttrium, scandium, gallium, garnet (Er, Cr:YSGG) laser and to evaluate the efficiency in removing smear layer and debris from the prepared root canal walls in vitro. BACKGROUND DATA: No report on Er, Cr:YSGG laser effects under various conditions and specific tips for endodontic treatments has been reported. METHODS: Sixty extracted human teeth with single and straight root were used in this study. The teeth were prepared at 1 mm short of the apical foramen by a conventional technique using K-files. Fifty-four specimens were irradiated by Er, Cr:YSGG laser at the output powers of 2 W, 3 W, and 5 W for 7 sec with three fiber tips (200, 320, and 400 microm diameters). Temperature changes were recorded thermographically. All teeth were examined by light microscopy or scanning electron microscopy (SEM). RESULTS: Thermographic study showed that the average temperature rises on root surfaces were less than 8 degrees C. Observation by light microscopy revealed the ablation at the apical stop, and that by SEM indicated that laser irradiation at 5 W using a fiber tip with 400 microm diameter was efficient for removing smear layer and debris without carbonization or melting. CONCLUSIONS: The results of this study suggested that the temperature rises during Er, Cr:YSGG laser irradiation at the parameters used in this study are minimal to cause the damage on periodontal and bone tissues. Moreover, it was suggested that it is efficient to remove smear layer and debris without causing any carbonization and melting.

Effects of Tooth Coating Material and Finishing Agent on Bleached Enamel Surfaces by KTP Laser.

OBJECTIVE: The purpose of this study was to evaluate the effect of tooth coating material and finishing agent on bleached enamel surfaces after using KTP laser with 27% hydrogen peroxide. BACKGROUND DATA: There have been few reports on the effects of tooth coating materials and finishing agents after bleaching. METHODS: After 40 crowns of human extracted maxillary incisors were bleached by KTP laser, bleached enamels were finished with fluoride only or both of fluoride and nano-hydroxyapatite as a finishing agent. After application(s) of fluoride and/or finishing agent, the enamel surfaces were divided into 2 groups, which were covered with the coating material or without coating material. After application of coating materials, all specimens were kept for 2 weeks at 37°C of 100% humidity. After removing the coating material, color changing was measured and enamel surfaces were examined by scanning electron microscopy (SEM). RESULTS: SEM observation of enamel surfaces treated the fluoride gel, finishing agent and coating material showed the most flattered surface compared to other groups. By measuring the color changing, few color changing was observed on the enamel surfaces treated the fluoride gel, finishing agents and coating material. CONCLUSION: These results suggested that applications of fluoride gel, finishing agent and coating material made the enamel-surfaces flattered and kept effects of bleaching, could prevent the re-coloration. After applications of fluoride gel and finishing agent, covering the bleached-enamel surfaces with the coating material enhanced the keeping whiteness. It would give the patients satisfaction of whiteness.

In vitro guidance of dental pulp cells by Nd:YAG laser-irradiated endothelial cells.

OBJECTIVE: After endothelial cells were ablated by neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation, we investigated the response of pulp cells by examining the expression of transforming growth factor beta-1 (TGF-ß1). BACKGROUND DATA: The reaction of stimulated blood vessels is related to the initiation of dentinogenesis. After artificial injury of endothelial cells, pulp cells migrate to the site of the injured endothelial cells. MATERIALS AND METHODS: Rat aortic endothelial cells were cultured in the lower compartment of the experimental assembly, and a pulsed Nd:YAG laser was used to ablate these cells. Pulp cells were fluorescence labeled and cultured in the upper compartment. After 7-14 days of laser irradiation, total RNA was extracted from the cells in the lower chamber, and RT-PCR was performed to examine the expression of TGF-ß1 and osteocalcin mRNA. TGF-ß1 was also examined with immunohistochemistry. RESULTS: Seven days after laser irradiation, migrating pulp cells that expressed TGF-ß1 were observed in the lower compartment, and the expression of TGF-ß1 mRNA and osteocalcin mRNA was altered. Without laser irradiation, few migrating pulp cells were observed, and the expression of TGF-ß1 mRNA and osteocalcin mRNA was weak. These results suggested that TGF-ß1 mRNA expression is detected earlier in pulp cells rather than in endothelial cells following injury to endothelial cells. CONCLUSIONS: Using the Nd:YAG laser as an ablative stimulant, this study model was useful for investigating pulp-endothelial cell interactions in reparative dentinogenesis.

Effects of mineral trioxide aggregate on the differentiation of rat dental pulp cells.

The effect of mineral trioxide aggregate (MTA) on the odontoblast-like differentiation of pulp cells was evaluated using heat-shock protein 25 (hsp25) as a marker for odontoblast differentiation. The cells were cultured with tooth-colored MTA or calcium hydroxide-containing cement (Dycal). The effects of the materials on the pulp cells were observed using a confocal laser scanning microscope. The cells were labelled immunocytochemically using polyclonal antibodies against hsp25 and actin. The mRNA expression of hsp25 and dspp in the pulp cells at 2 days were examined by quantitative reverse transcription-polymerase chain reaction (RT-PCR). Most of the cells cultured with MTA showed an intense immunolabelling for hsp25 and the mRNA expressions of hsp25 and dspp at 2 days were higher than those cultured with Dycal. These findings indicate that MTA is an effective pulp capping material and is able to induce the differentiation of odontoblast-like cells and the formation of reparative tertiary dentin with minimum apoptosis.