Influence of in-office whitening on the color matching and surface characteristics of single-shade resin composites.

OBJECTIVE: The color matching of single-shade resin composites after in-office whitening was investigated. MATERIALS AND METHODS: Four single-shade resin composites were used. A total of 35% hydrogen peroxide was used as the whitening agent. The resin composite was placed in a cavity of an artificially discolored bovine tooth. The color differences between the restoration and surrounding enamel before and after whitening were determined based on ΔE*ab, ΔE00, and ΔWID. The color stability, surface roughness (Sa), and surface gloss (GU) of the resin composite alone were also evaluated. Statistical analyses were performed using repeated-measures analysis of variance with the Tukey-Kramer test. RESULTS: Based on the 50:50% of perceptibility and acceptability thresholds of ΔE*ab and ΔE00, none of the resin composite restorations were clinically acceptable before or after whitening. Regarding ΔWID, although all resin composites showed "acceptable match" in the baseline, they showed "mismatch" after the third session of whitening. Most of the resin composites alone were stable in color against whitening. CONCLUSIONS: Although the single-shade resin composites failed to achieve the expected color matching on discolored teeth either before or after the whitening, the impact of the whitening on the color of the resin composite alone may be negligible.

Worsening ambulation in elderly patients with cervical odontoid fractures: A nationwide multicenter study in Japan.

BACKGROUND: Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months. METHODS: This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients' background. RESULTS: Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D'Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation. CONCLUSIONS: Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.

Whitening efficacy and tooth sensitivity in a combined in-office and at-home whitening protocol: A randomized controlled clinical trial.

OBJECTIVE: This controlled randomized clinical trial determined the whitening efficacy and the intensity and absolute risk of tooth sensitivity in dual whitening when prefilled at-home whitening trays were used between in-office whitening intervals. MATERIALS AND METHODS: An in-office whitening agent containing 35% hydrogen peroxide was used. A prefilled tray with a whitening agent containing 6% hydrogen peroxide was used for at-home whitening. Sixty-six subjects were randomly assigned to three groups. Group I: at-home whitening was performed 10 times between the in-office whitening treatments. Group II: at-home whitening was performed five times between the in-office whitening treatments. Group III: only in-office whitening was performed. The tooth color changes were evaluated using a spectrophotometer. A visual analog scale was used to express the pain intensity. RESULTS: All the groups showed increased ΔE*ab, ΔE00 , and ΔWID with increased whitening sessions. Group I at the 3rd whitening session showed significantly higher ΔE*ab, ΔE00 , and ΔWID than group III. Tooth sensitivity showed higher values up to 24 h after whitening. CONCLUSIONS: Although dual whitening with the prefilled tray and in-office whitening had higher whitening ability than in-office whitening alone, the intensity and absolute risk of tooth sensitivity was similar. CLINICAL RELEVANCE: The dual whitening might produce faster and stronger whitening effects than in-office whitening alone.

Influence of bonding agent application method on the dentin bond durability of a two-step adhesive utilizing a universal-adhesive-derived primer.

This study investigated the effect of the bonding agent application method on the dentin bond durability of a two-step adhesive utilizing a universal-adhesive-derived primer. The bonding durability of a universal adhesive was compared with those of two conventional two-step adhesives by shear bond strength testing after thermal cycling. The primer was applied (with or without phosphoric acid pre-etching), and the specimens were divided into three groups based on the bonding agent application method used as follows: (i) strong air-flow application, (ii) gentle air-flow application, and (iii) gentle air-flow + second bonding application. The shear bond strength was determined after thermal cycling. All the factors (bonding agent application method, adhesive system, and storage condition) significantly influenced the dentin shear bond strength both with and without phosphoric acid pre-etching. The specimens exposed to gentle air-flow showed a higher shear bond strength than did those exposed to strong air-flow and gentle air-flow + second bonding. The bond durability of the tested adhesive systems was influenced by the bonding agent application method, and this trend was material dependent. The G2-Bond Universal exhibited the same or greater dentin bond durability to the other two-step adhesive systems.

Influence of masticating cycles and chewing patterns on inadvertent enamel wear caused by zirconia brackets.

Little information is available about enamel wear caused by zirconia brackets, an inadvertent side effect of orthodontic treatment. The purpose of this study was to examine potential enamel damage induced by contact with zirconia brackets. Sliding and impact wear simulations were performed using bovine enamel specimens positioned at a 25° slant to a zirconium ball to determine wear behaviour. Different chewing patterns, tapping and grinding, were simulated. Specimens were profiled using confocal laser scanning microscopy, and the mean maximum depth and surface roughness were measured. Scanning electron microscopy was also performed. The mean maximum depth of wear values differed according to the number of mastication cycles, with a higher number of cycles producing higher depths of wear. The facet wear depth was significantly greater with the tapping pattern than with the grinding pattern. Scanning electron microscopic observation of the wear facets revealed that surface textures at the edges were rougher than those at the centre of all facets. The results of this study indicated that enamel wear was induced by contact with zirconia brackets during the early period of mastication, and that the patterns and number of cycles of mastication affected the wear progression of enamel.

Immediate bond performance of resin composite luting systems to saliva-contaminated enamel and dentin in different curing modes.

The purpose of this study was to evaluate the immediate shear bond strength of resin composite luting systems to tooth with or without saliva contamination in different curing modes. The Knoop hardness number of the resin composite luting agents was measured. Four combinations of resin composite luting systems were used. The shear bond strength to bovine teeth was measured with and without saliva contamination in different curing modes at different storage periods. The Knoop hardness number of the resin composite luting agents was also evaluated. Significantly lower enamel and dentin shear bond strengths and Knoop hardness number values were observed in all resin composite luting systems at 5 min versus 24 h, regardless of the curing mode or saliva contamination. The influence of the curing mode of the resin composite luting systems on shear bond strengths and Knoop hardness number was dependent on material. For the saliva contamination conditions, only G-CEM ONE EM did not show any significant difference in shear bond strength among the groups with and without saliva contamination, regardless of curing mode, storage period, or tooth substrate. All the resin composite luting systems showed lower shear bond strengths and Knoop hardness number values immediately after setting.

Bond durability of universal adhesives to intact enamel surface in different etching modes.

This study aimed at determining the enamel bond durability of universal adhesives to intact enamel (IE) and ground enamel (GE) in different etching modes under thermal cycling (TC) and fatigue stresses. Two universal adhesives and a two-step self-etch adhesive were used. Enamel specimens were divided into four groups by treatment: (i) GE in etch-and-rinse, (ii) IE in etch-and-rinse, (iii) GE in self-etch, and (iv) IE in self-etch. Bonded specimens were subjected to TC, and then shear bond strengths (SBS) were conducted. SBS tests were also conducted after storage in 37°C water for 24 h (baseline). For shear fatigue strength (SFS) testing, bonded specimens were subjected to fatigue stress at a frequency of 10 Hz for 50,000 cycles. At baseline, all adhesives showed significantly higher SBS values with GE than IE in self-etch mode in contrast to in etch-and-rinse mode. After TC, the universal adhesives with IE showed lower SBS values than the baseline, regardless of the etching mode. Universal adhesives showed significantly lower SFS values with IE in etch-and-rinse, but not in self-etch mode. Phosphoric acid pre-etching or grinding of the aprismatic enamel may be helpful in establishing reliable initial and long-term bonds to enamel when using universal adhesives in self-etch mode.

Bonding and wear properties of self-adhesive flowable restorative materials.

The purpose of this study was to evaluate the bonding and wear properties of self-adhesive flowable restorative materials. Five self-adhesive flowable restorative materials were used. The study parameters were: (i) shear bond strengths; (ii) microleakage; (iii) occlusal wear; and (iv) qualitative evaluation of the bonding interface. The range of shear bond strengths of the materials was as follows: 7.4-12.2 MPa to ground enamel, 22.5-32.5 MPa to etched enamel, and 1.3-4.2 MPa to dentin. The microleakage scores of the materials did not show any statistically significant differences regardless of the presence or absence of etching. The wear facets on the materials showed 0.099-0.447 mm3 of volume loss and 148.6-365.3 µm maximum depth, with statistically significant differences between materials. Scanning electron microscopic images of the interfaces of the materials showed good adaptation regardless of substrate. The bonding and wear properties of self-adhesive flowable restorative materials were still limited and showed lower values than previously reported results for nanofilled composites with an adhesive system. Selective enamel etching can improve the bonding performance of these materials.

Effect of double-layer application on the early enamel bond strength of universal adhesives.

OBJECTIVES: The present study aimed to investigate the changes in the enamel bond strengths of universal adhesives in the early phase of specimen creation and evaluate the effect of double-layer application on enamel bond effectiveness using different etching modes. METHOD: Four universal adhesives, namely Clearfil Universal Bond Quick, G-Premio Bond, Scotchbond Universal, and Tokuyama Universal Bond, were used. Clearfil SE Bond two-step self-etch adhesive system was used as a comparison. Fifteen specimens per group were used for determining the shear bond strength (SBS) to bovine enamel in the etch-and-rinse or self-etch mode. The adhesive was applied to specimens in accordance with the manufacturers' instructions (single-layer application), or the adhesive was applied twice (double-layer application). The bonded specimens were stored in distilled water at 37 °C for 5 min or 1, 6, 12, or 24 h before SBS testing. The flexural properties of the resin composite Clearfil AP-X were measured for the same storage periods. RESULTS: All universal adhesives exhibited increased SBS values with prolonged storage periods regardless of the application technique or etching mode used. Double-layer application was associated with higher SBS values than single-layer application for most universal adhesives over the same storage period. CONCLUSION: Phosphoric acid pre-etching and double-layer application of universal adhesives resulted in increased enamel bond strength in the early phase of specimen bonding. CLINICAL RELEVANCE: Care should be taken when using universal adhesives in the self-etch mode for enamel bonding because the enamel adhesion is sensitive to the duration after filling.

Influence of light irradiation for in-office tooth whitening: A randomized clinical study.

PURPOSE: To evaluate the influence of light irradiation on the clinical efficiency of an in-office whitening agent. METHODS: The in-office whitening agent (Opalescence Boost 35%) was used in this study. Two whitening regimens were evaluated on maxillary anterior teeth: (1) with light irradiation; and (2) without light irradiation. The ΔE*, changes of L*, a*, b*, and the best shade match on the central incisor before, immediately after, and 6 months after whitening procedures were evaluated using a dental spectrophotometer. RESULTS: The ΔE and shade had no significant differences with or without light irradiation. In addition, the ΔE, changes of L*, a*, b*, and shade did not change over 6 months after bleaching at a level detectable to the naked eye. The results suggested that the in-office whitening agent using 35% hydrogen peroxide without photocatalysts can improve tooth color with or without light irradiation for 6 months after whitening. CLINICAL SIGNIFICANCE: In office whitening using 35% hydrogen peroxide without photocatalysts should be considered as a good treatment option for vital teeth whitening.

Ultrasonic measurement of dentin remineralization effects of dentifrices and silver diamine fluoride.

OBJECTIVE: This study investigated the dentin remineralization effect of the application of a functionalized tri-calcium phosphate (fTCP) dentifrice and a silver diamine fluoride (SDF) solution. MATERIAL AND METHODS: The materials used were: a fluoride-containing dentifrice with fTCP (fTCP＋), a fluoride-containing dentifrice without fTCP (fTCP-) and a 38% SDF solution. Following treatment, the dentin slabs were immersed in a 0.1-M lactic acid buffer solution and then placed in artificial saliva. This procedure was repeated three times daily for 28 days. The propagation time of longitudinal ultrasonic velocities (UV) and the Knoop hardness (KH) of the samples were measured. The samples were also observed using scanning electron microscopy. RESULTS: The SDF and fTCP＋ groups showed higher UV than the fTCP - group regardless of the application method. The F-SDF group at 28 days showed significantly higher UV (4121 ± 102 m/s) than the F-fTCP + group (3731 ± 65 m/s) (p < .05). The F-SDF group at 28 days showed significantly higher KH (47.4 ± 2.2) than the F-fTCP＋ group (43.3 ± 1.0) and the F-fTCP - group (42.9 ± 2.1) (p < .05). Closure of the dentinal tubules and crystal precipitation was detected on the surface of the fTCP＋ group to a greater extent than the fTCP - group. CONCLUSIONS: The fTCP-containing dentifrice and SDF solution effectively enhanced bovine dentin remineralization.

Evaluation of structural coloration of experimental flowable resin composites.

OBJECTIVE: To examine the effect of filler contentTo examine the effect of filler content on structural coloration of experimental flowable resin composites. OVERVIEW: Experimental composites containing spherical fillers and different filler contents (30, 40, 50, 60 and 70 wt%), a structural colored resin composite (Omnichroma), and a nanohybrid flowable resin composite (Gracefil LoFlo) were used. The optical characteristics of the specimens were measured on standard black and white backgrounds using a spectrophotometer under CIE D65 illuminant and the L*a*b* values were determined. The color matching abilities to artificial teeth were evaluated using the ΔE*ab and ΔE00 color difference formulas. One-way analysis of variance and Tukey's post hoc test were used. The spectral reflectance of experimental composites showed different trends in different backgrounds, plate thickness, and filler contents. In particular, higher spectral reflectance was observed on the white background at wavelengths ranging from 450 to 700 nm in both 1.5 and 3.0 mm plates when compared to the black background. The percent reflectivity tended to decrease with a decrease of the filler contents. The color matching abilities of the experimental composites improved with the increase in the filler contents. CONCLUSIONS: Structural coloration of the flowable resin composites were affected by the filler contents. CLINICAL SIGNIFICANCE: Clinical Significance: Higher filler contents might be needed to achieve the optimal color properties of structural colored flowable resin composites, thereby improving the restoration esthetics.

Comparison of dentin bond durability of a universal adhesive and two etch-and-rinse adhesive systems.

OBJECTIVE: This study aimed to compare dentin bond durability under different degradation conditions between two etch-and-rinse (ER) systems and a universal adhesive in ER mode. METHOD: This study used a universal adhesive [Scotchbond Universal (SU)], a three-step ER adhesive [Scotchbond Multi-Purpose Plus (SM)], and a two-step ER adhesive [Single Bond Plus (SB)]. A phosphoric acid-etching agent was applied to bovine dentin prior to the application of either a primer or the adhesive. After acid etching, bonding procedures were conducted. The specimens were divided into three group classes: (1) subjected to 10,000, 30,000, or 50,000 thermal cycles (TC); (2) stored in distilled water at 37 °C for 6 months or 1 year (WS); and (3) stored in distilled water for 24 h (baseline). Shear bond strength (SBS) tests were conducted. RESULTS: SB showed a higher baseline SBS than the other adhesives. Defining the baseline SBS value for each adhesive system as 100%, TC groups ranged from 56.1 to 70.3% for SM, from 98.4 to 103.7% for SB, and from 120.3 to 126.7% for SU. WS groups ranged from 66.2 to 71.4% for SM, from 98.1 to 103.3% for SB, and from 102.5 to 118.1% for SU. CONCLUSIONS: Although SB showed relatively stable dentin bond performance under all degradation conditions, SM showed decreased dentin SBS with prolonged degradation. SU did not show any significant decrease in SBS from the baseline under any degradation condition. CLINICAL RELEVANCE: The universal adhesive showed comparable adhesive performance with the two-step ER adhesive.

Ultrasonic measurement of remaining dentin thickness using a pencil-type transducer.

PURPOSE: To evaluate the ability of a pencil-type transducer connected to a pulser-receiver to measure remaining dentin thickness (RDT). METHODS: A total of 24 freshly extracted bovine incisors were used to prepare dentin disks with certain thicknesses (0.5, 1.0, 1.5 and 2.0 mm). The thicknesses of the specimens were measured with an ultrasonic technique using a pencil-type transducer, and the data obtained were compared with the direct measurement obtained using a micrometer. The Bland-Altman comparison method and paired t-test were performed at a 0.05 significance level. RESULTS: The agreement between different measurement methods was analyzed to evaluate the inter-methodology variation. The Bland-Altman comparison method revealed a mean difference of 0.0098 ± 0.724 mm between the ultrasonic technique and the direct measurement, with the 95% Bland-Altman limits of agreement ranging from 0.1322 to 0.1517 mm. CLINICAL SIGNIFICANCE: Ultrasonic measurement using the pencil-type transducer may be a promising method to evaluate remaining dentin thickness.

Comparison of occlusal wear between bulk-fill and conventional flowable resin composites.

PURPOSE: To investigate the occlusal wear of bulk-fill and conventional flowable resin composites. METHODS: Four bulk-fill flowable resin composites: (1) Filtek Bulk Fill Flowable Restorative (FB); (2) G-ænial Bulk Injectable (GB); (3) SDR Flow+ (SD); and (4) Tetric EvoFlow Bulk Fill (TB), and four conventional flowable resin composites: (1) Clearfil Majesty IC (CM); (2) Filtek Supreme Ultra Flow (FF); (3) G-ænial Universal Flow (GF); and (4) Herculite XRV Ultra Flow (HF) were evaluated. Localized wear was simulated using 400,000 cycles in a Leinfelder-Suzuki (Alabama) device with a stainless-steel ball bearing antagonist. Volume loss and maximum depth of wear facets were measured using a Proscan 2100 noncontact profilometer in conjunction with analyzing software. Scanning electron microscopy observations were also conducted on the wear specimens. RESULTS: Simulated occlusal wear was significantly different (P< 0.05) among the materials tested. FF, GB and GF showed significantly less wear than the other tested resin composites. The rank order of volume loss and maximum depth was GF-GB-FF-FB-CM-HF-TB-SD. CLINICAL SIGNIFICANCE: Bulk-fill flowable resin composites showed a much wider range of wear properties than conventional flowable resin composites. Some composites of each type may be suitable for use in occlusal contact areas of posterior restorations, but care must be taken when selecting such a resin.

Influence of surface wetness on bonding effectiveness of universal adhesives in etch-and-rinse mode.

The purpose of this study was to evaluate whether surface wetness would influence the bonding effectiveness of universal adhesives in etch-and-rinse mode. All-Bond Universal (AB), G-Premio Bond (GP), Prime & Bond Active (PB), and Scotchbond Universal Adhesive (SU) were evaluated. Initial bond strengths and bond-fatigue strengths of universal adhesives to both wet and dry enamel and dentin in etch-and-rinse mode were determined. Scanning electron microscopy observations of the adhesive interfaces were also conducted. The bond-fatigue durability of universal adhesive to enamel in etch-and-rinse mode was influenced by the surface wetness, unlike that to dentin. The bond fatigue durability of AB and GP to dentin in etch-and-rinse mode was different depending on the surface wetness, unlike that of PB and SU. The thicknesses of the adhesive or hybrid layer of resin-dentin interfaces were not influenced by the surface wetness, but the length of resin tags in the wet group was longer than in the dry group. Some universal adhesives with the addition of specific components and optimization of water content can achieve stable bonds regardless of surface wetness, but the surface wetness of dentin is still a significant factor for universal adhesive bonding in etch-and rinse mode, unlike that of enamel.

Immediate enamel bond strength of universal adhesives to unground and ground surfaces in different etching modes.

The purpose of this study was to determine the immediate bond effectiveness of universal adhesives to unground and ground enamel surfaces in different etching modes, through shear bond strength (SBS) tests and scanning electron microscopy observations. Three universal adhesives, a conventional two-step self-etch adhesive, and a conventional single-step self-etch adhesive were compared. Human enamel specimens from lower anterior teeth were divided into four groups and subjected to the following treatments: (i) unground enamel in self-etch mode; (ii) ground enamel in self-etch mode; (iii) unground enamel in etch-&-rinse mode; and (iv) ground enamel in etch-&-rinse mode. Bonded assemblies were subjected to SBS testing. All the adhesives showed significantly higher SBS values in etch-&-rinse mode than in self-etch mode, regardless of whether enamel was unground or ground. The influence of the enamel surface condition on SBS was different in different etching modes. Without pre-etching, all tested materials showed lower SBS values in unground enamel than in ground enamel. In etch-&-rinse mode, no significant differences in SBS values were observed between unground enamel and ground enamel for any of the adhesives tested. Phosphoric acid pre-etching before application of self-etch adhesives to an unground enamel surface is essential to enhance initial enamel bond effectiveness.

Surface moisture influence on etch-and-rinse universal adhesive bonding.

PURPOSE: To evaluate whether surface moisture would influence the bonding effectiveness of universal adhesives in etch-and-rinse mode. METHODS: All-Bond Universal (AB), G-Premio Bond (GP) Prime&Bond Active (PB) and Scotchbond Universal Adhesive (SU) were evaluated. Shear bond strengths after 24 hours and 10,000 thermal cycles of universal adhesives to moist and dry enamel and dentin in etch-and-rinse mode were determined. Scanning electron microscopy observations of the adhesive interfaces were conducted. RESULTS: The bond durability of universal adhesive to dentin in etch-and-rinse mode was influenced by the surface moisture, unlike bond durability to enamel. The bond durability of AB and GP, but not PB and SU, to dentin in etch-and-rinse mode was different depending on the surface moisture. Surface moisture did not influence the thicknesses of the adhesive or hybrid layer of resin-dentin interfaces, but the length of resin tags in the moist group was longer than in the dry group. CLINICAL SIGNIFICANCE: Some universal adhesives, with the addition of specific components and optimization of water content, can achieve stable bonds regardless of surface moisture, but the surface moisture of dentin, although not enamel, is still a significant factor for universal adhesive bonding in etch-and rinse mode.

Relationship between enamel bond fatigue durability and surface free-energy characteristics with universal adhesives.

The relationship between enamel bond fatigue durability and surface free-energy characteristics with universal adhesives was investigated. The initial shear bond strengths and shear fatigue strengths of five universal adhesives to enamel were determined with and without phosphoric acid pre-etching. The surface free-energy characteristics of adhesive-treated enamel with and without pre-etching were also determined. The initial shear bond strength and shear fatigue strength of universal adhesive to pre-etched enamel were higher than those to ground enamel. The initial shear bond strength and shear fatigue strength of universal adhesive to pre-etched enamel were material dependent, unlike those to ground enamel. The surface free-energy of the solid (γS ) and the hydrogen-bonding force (γSh) of universal adhesive-treated enamel were different depending on the adhesive, regardless of the presence or absence of pre-etching. The bond fatigue durability of universal adhesives was higher to pre-etched enamel than to ground enamel. In addition, the bond fatigue durability to pre-etched enamel was material dependent, unlike that to ground enamel. The surface free-energy characteristics of universal adhesive-treated enamel were influenced by the adhesive type, regardless of the presence or absence of pre-etching. The surface free-energy characteristics of universal adhesive-treated enamel were related to the results of the bond fatigue durability.

Shear fatigue strength of resin composite bonded to dentin at physiological frequency.

The purpose of this study was to examine the shear fatigue strengths of a resin composite bonded to dentin. Three adhesive systems - a two-step self-etch adhesive (OptiBond XTR; Kerr) and two universal adhesives [Scotchbond Universal (3M ESPE) and G-Premio Bond (GC)] - were used in self-etch mode to bond a resin composite to dentin at a physiologic frequency of 2 Hz over 50,000, 100,000, and 1,000,000 cycles. A staircase method of fatigue testing was used. Twenty specimens were used for each test condition. There was no significant difference in shear fatigue strength across the cycling periods for the three individual adhesives. Differences in shear fatigue strength were found among the three adhesives within each cycling period. Regardless of the adhesive used in self-etch mode for bonding a resin composite to dentin, shear fatigue strength was not influenced by the number of cycles used for testing.