Comparison of Er:YAG laser and ultrasonic in root canal disinfection under minimally invasive access cavity.

The disinfection of root canal through minimally invasive access cavity remains questionable. This in vitro study compared the effectiveness of three disinfection measures including conventional irrigation, ultrasonic assisted irrigation, and erbium:yttrium-aluminum-garnet (Er:YAG) laser assisted irrigation through conventionally or minimally invasive access. Sixty-six extracted maxillary first molars were randomly divided into group 1 conventionally invasive access group (CIA) and group 2 computer-guided minimally invasive access group (MIA). Each group was further randomly divided into three subgroups, (A) conventional irrigation (CI), (B) passive ultrasonic agitation (PUI), and (C) Er:YAG laser activated irrigation (LAI). Enterococcus faecalis (E. faecalis) infection model was established inside all root canals after instrumentation was performed up to ProTaper Universal F2. After various disinfection methods, microbial samples were collected from root canals by paper tip method and cultured, and colony forming units (CFU) values of each sample were calculated. Then the root canals were enlarged to the size of F3, after which dentin debris was collected from the F3 file. After dilution and culturing, the CFU value was calculated for each group. Two-way analysis of variance (ANOVA) was performed to test the interaction. The results revealed a significant antagonism (F = 3.394, P = 0.043). The bacterial CFU counts of group B and group C were significantly less than that of group A (P < 0.05), and there was no significant difference between group B and C (P > 0.05). Additionally, group 2A was better than group 1A (P < 0.05); there was no significant difference between group 1B and group 2B, group 1C and group 2C (P > 0.05). Comparison of the bacterial CFU counts in dentin debris after disinfection, the results revealed a significant antagonism (F = 7.224, P = 0.002), and group C had the least. The disinfection effect of Er:YAG laser or ultrasonic assisted computer-guided minimally invasive access is similar to conventionally invasive access, and Er:YAG laser is better than ultrasonic in removing bacteria from dentinal tubules and is easy to operate, which is more suitable for minimally invasive root canal treatment.

Dentin Bonding Durability of Two-step Self-etch Adhesives with Improved of Degree of Conversion of Adhesive Resins.

PURPOSE: To evaluate (1) the initial and long-term microtensile bond strengths of two-step self-etch adhesives with different degrees of conversion (DC); (2) the elastic modulus of the respective adhesive resins; (3) the water sorption of the respective adhesive resins. MATERIALS AND METHODS: Two two-step self-etch adhesives, Clearfil SE Bond (CSE) and Clearfil SE Bond 2 (CSE2) were used in this study. The DC was determined using ATR/FT-IR with a time-based spectrum analysis. Midcoronal flat dentin surfaces of 24 human molars were prepared with 600-grit SiC paper for microtensile bond strength (µTBS) testing. CSE and CSE2 were applied to the dentin surfaces according to the manufacturer's instructions, followed by composite buildups. The µTBS was measured after water storage for 24 h, 6 months, and 1 year. The elastic modulus (before and after 1 month of water immersion) was determined by the three-point flexural bending test and water sorption values by the water sorption test. RESULTS: CSE2 showed significantly higher DC than CSE. The µTBS of CSE2 was significantly higher than that of CSE in all water storage periods. One-year water storage decreased the µTBS of CSE; however, it did not decrease that of CSE2. Regarding the polymerized adhesive resins, the elastic modulus of CSE2 was significantly higher than that of CSE before and after water immersion (p < 0.001), and the water sorption of CSE was higher than that of CSE2. CONCLUSIONS: The higher DC of adhesive resins of two-step self-etch adhesives resists water aging and improves the initial bond strengths and durability of the resin-dentin bond.

[Antibacterial effect of self-etching adhesive systems on Streptococcus mutans].

OBJECTIVE: To investigate the antibacterial effect of different self-etching adhesive systems against Streptococcus mutans (S. mutans). METHODS: Six reagents Clearfil(TM) SE Bond primer (SP), Clearfil(TM) SE Bond adhesive (SA),Clearfil(TM) Protect Bond primer (PP), which contained antibacterial monomer methacryloyloxydodecylpyridinium bromide (MDPB), ClearfilTM Protect Bond adhesive (PA), positive control chlorhexidine acetate [CHX, 1% (mass fraction)], and negative control phosphate buffer solution (PBS) were selected. They were mixed with S. mutans for 30 s respectively, then colony-forming units (CFU) were counted after incubated for 48 h on brain heart infusion (BHI) agar medium. The 6 reagents were applied to the sterile paper discs, and distributed onto the BHI agar medium with S. mutans and incubated for 24 h, then the inhibition zones were observed. CHX, PBS, PP, and SP were added on the dentin with artificial caries induced by S. mutans and kept for 30 s, then confocal laser scanning microscope (CLSM) was used to observe the live and dead bacteria after staining. The ratio of live to dead bacteria was calculated. PP+PA and SP+SA were applied on the dentin according to the manual and light cured. S. mutans were incubated on the samples for 2 h, ultrasonically treated and incubated on BHI agar medium for 48 h, then CFU was counted. The data were analyzed by non-parametric analysis and one-way ANOVA. RESULTS: Compared with PBS, the PP, SP, PA, SA and CHX showed the antibacterial effect on free S. mutans (P<0.05); SP and PP showed stronger antibacterial effect than PA, SA and CHX (P<0.05). CHX, SP and PP presented inhibition zones, while PBS, SA and PA did not. Compared with PBS, the CHX, SP and PP could lower the ratio of the live to dead bacteria significantly (P<0.05). Cured self-etching adhesive systems did not show any antibacterial effect on the free S. mutans. CONCLUSION: The primer of self-etching adhesives Clearfil(TM) SE Bond and Clearfil(TM) Protect Bond showed significant antibacterial effect on free and attached S. mutans. The adhesive only showed antibacterial effect on free S. mutans before light-cured polymerization. After being cured, the self-etching adhesive systems did not show antibacterial effect anymore.

[Influence of thermalcycling on bonding durability of self-etch adhesives with dentin].

OBJECTIVE: To investigate influence of thermalcycling on the bonding durability of two one-step products [Adper Prompt (AP) and G-bond (GB)] and one two-step self-etching adhesive [Clearfil SE bond (SE)] with dentin in vitro. METHODS: Forty-two extracted human molars were selected. The superficial dentin was exposed by grinding off the enamel. The teeth were randomly distributed into six groups with varied bonding protocols. The adhesives were applied to the dentin surface. Composite crowns were built up, then the samples were cut longitudinally into sticks with 1.0 mm×1.0 mm bonding area [for microtensile bond strength (MTBS) testing] or 1.0 mm thick slabs (for nanoleakage observation). Bonding performance was evaluated with or without thermalcyling. For the MTBS testing, the strength values were statistically analysed using One-Way ANOVA. Four slabs in each group were observed for nanoleakage by SEM with a backscattered electron detector. RESULTS: Thermalcycling procedures affected MTBS. In the two one-step groups, the MTBS decreased significantly (P<0.05) after thermalcycling [AP group from (19.06±1.50) MPa to (12.62±2.10) MPa; GB group from (17.75±1.10) MPa to (6.24±0.42)MPa]. But in SE groups, MTBS did not significantly affect [(45.80±2.97) MPa compared with(40.60±5.76) MPa]. As a whole, one-step self-etching adhesives showed lower MTBS than two-step bonding system after aging.For AP and GB, continuous nanoleakage appearance was notable and more obvious than for SE. CONCLUSION: Thermalcycling can affect the bonding performance of self-etch adhesives including decrease of bond strength and nanoleakage pattern. one-step self-etch adhesives showed more obvious change compared with their two-step counterparts.

[Clinical evaluation of a two-step etch-and-rinse adhesive and a one-step self-etch adhesive in non-carious cervical lesion].

OBJECTIVE: To compare the clinical effectiveness of the two-step etch-and-rinse with the one-step self-etch adhesive in non-carious cervical lesions. METHODS: Fifty patients were selected, each with at least two wedge-shaped defects in the mouth. The paired defects were randomly bonded either with the two-step etch-and-rinse adhesive α or the one-step self-etch adhesive ß and then restored with resin composite. The treatment was carried out by one practitioner according to standard procedures. The evaluation was performed by another practitioner according to modified United States Public Health Service (USPHS) criteria at one week, six months and eighteen months after treatment. Chi-square test was used for statistical analysis. RESULTS: Fifty restorations were placed for each group. Forty-eight patients attended the six months recall, with two restorations loss for each group. Forty-four patients attended the eighteen months recall, with accumulative four restorations loss for adhesive α and six restorations loss for adhesive ß. The retention rate was 90.0% for group α and 86.4% for group ß. Marginal adaptation of three restorations in group α and five restorations in group ß were scored Bravo; while for marginal discoloration, two restorations in group α and three restorations in group ß were scored Bravo respectively. No secondary caries and post-operative sensitivity occurred for any of the restorations after eighteen months. No significant difference was detected between the groups for any evaluation criteria (P > 0.05). CONCLUSION: Within the observation period of this study, the two-step etch-and-rinse adhesive and the one-step self-etch adhesive showed similar clinical performance. The long term follow-up is still warranted.

Clinical evaluation of Giomer and self-etch adhesive compared with nanofilled resin composite and etch-and-rinse adhesive - Results at 8 years.

OBJECTIVE: This study aimed to evaluate the long-term clinical performance of Giomer and a self-etch adhesive system compared with a nanofilled resin composite and etch-and-rinse adhesive system in Class I and Class II restorations. METHOD: The study was designed to be double-blinded with intra-individual control. 48 patients with 54 pairs of cavities (class I or class II) were recruited. Each pair of restorations was placed with either BEAUTIFIL II (BF) and FL-BOND II (FL) or Filtek Z350 (Z350) and Scotchbond Multi-Purpose (SMP). Clinical evaluation was performed at baseline, 6-month, 18-month, 4-year and 8-year after placement according to modified USPHS criteria. Kaplan-Meier survival analysis and log rank tests were performed (SPSS 20.0, IBM Corporation, US) to compare the survival probability of different restorations.A generalized linear mixed model (GLMM) was adopted to assess the performance of the materials. The McNemar test was used to show significant changes for all the evaluation criteria and difference between them. RESULTS: At the eight-year recall, 32 patients with 67 restorations were present. There were twelve restorations in total recorded as failure due to loss of retention, restoration fracture, secondary caries, tooth fracture or endodontic treatment due to pulp necrosis. The survival probabilities and calculated annual failure rate(AFR) of BF and Z350 restorations at 8-year were 87.2 % vs 87.8 % and 1.6 % vs 1.5 % respectively with no significant difference (p > 0.05)between the two materials. Over the recall time range of eight years, decreased possibility of alpha rating was observed for retention, marginal adaptation, marginal staining and surface roughness for both materials (p < 0.05). Decreased possibility of alpha rating was observed for surface staining and secondary caries for Z350 (p < 0.05) and restoration fracture for BF (p < 0.05), respectively. Comparing the two restorative systems over eight years, no significant difference was seen for linear decline of the possibility of alpha rating for any of the criteria evaluated (p > 0.05). CONCLUSION: Giomer material and the self-etch adhesive system had comparable clinical performance with nanofilled resin composite and etch-and-rinse adhesive system over the observation period of eight years.

Effects of polishing press-on force on surface roughness and gloss of CAD-CAM composites.

PURPOSE: The aim of this study was to determine the effect of polishing press-on force on surface roughness and gloss of computer-aided design-computer-aided manufacturing (CAD-CAM) composites. METHODS: The materials evaluated included a CAD-CAM ceramic, a polymer-infiltrated ceramic, and three filler-based CAD-CAM composites. The CAD-CAM blocks were sectioned, embedded in self-cured resin, finished with abrasive papers and ultrasonically cleaned. Specimens were subsequently polished using the Sof-Lex disk system with 0.5, 1.0, 1.5, and 2.0 N press-on force by means of a custom-made apparatus. Contour arithmetic mean deviation (Ra) and gloss value (GU) data were acquired with a profilometer and glossmeter, respectively, and analyzed using ANOVA/Bonferroni post hoc test and Pearson's correlation (α = 0.05). Representative samples of the various materials at baseline and after each polishing step were examined under scanning electron microscope. RESULTS: Mean Ra and GU values ranged from 0.096 ± 0.004 µm to 0.295 ± 0.045 µm and 13.4 ± 1.9 to 67.6 ± 11.3 correspondingly for the various material-force combinations. Surface roughness and gloss were found to be press-on force and material dependent. A moderately strong and negative correlation (rs = -0.69) existed between Ra and GU values. CONCLUSION: For optimal smoothness and gloss, ceramic and polymer-infiltrated ceramic CAD-CAM materials must be polished with a 2.0 N force, while filler-based CAD-CAM composites should, in general, be polished using a 1.0 to 1.5 N force.

Effectiveness of different cleaning measures on the bonding of resin cement to saliva-contaminated or blood-contaminated zirconia.

OBJECTIVE: To investigate the effectiveness of different cleaning measures on the bonding of resin cement to saliva- or blood-contaminated zirconia. METHODS: One hundred and forty-one specimens (10 × 10 × 1.5 mm3) were fabricated from KATANATM zirconia blocks and contaminated with human saliva or sheep blood. Six cleaning measures were examined: water-rinse, H3PO4, 5.25% NaOCl, ZirCleanTM, Ivoclean and KATANATM Cleaner. Tensile bond strength was evaluated for 13 groups (N=10): six cleaning measures against two contaminations (12 experimental groups) and one uncontaminated control group. Scanning electron microscopy was used to observe the control and water-rinsed specimen surfaces. X-ray photoelectron spectroscopy (XPS) was conducted to identify carbon (C1s), nitrogen (N1s), phosphorous (P2p) and zirconium (Zr3d) peaks, from which the elemental ratios C/Zr, N/Zr and P/Zr were calculated. RESULTS: Although water-rinsing removed most of the contaminants from the zirconia surface, bond strength of resin cement was significantly lower compared with the control. Phosphoric acid was ineffective and NaOCl was less reliable in restoring bond strength. The three commercial cleaners (ZirCleanTM, Ivoclean, KATANATM Cleaner) out-performed the other cleaning measures and restored the bond strength of resin cement to zirconia except for the use of ZircleanTM on blood-contaminated surfaces. N/Zr decreased for all cleaned specimens and P/Zr ratio increased for phosphoric acid and KATANATM Cleaner groups. Differences in elemental ratios could indicate different cleaning mechanisms for the zirconia cleaners. CONCLUSION: All three commercial zirconia cleaners are effective in decontaminating saliva-contaminated or blood-contaminated zirconia and increasing the bond strength of resin cement to contaminated zirconia. CLINICAL SIGNIFICANCE: The use of water, phosphoric acid or concentrated sodium hypochorite for cleaning saliva- or blood-contaminated dental zirconia is not recommended. ZirCleanTM works well on decontamination of saliva-contaminated zirconia. Ivoclean or KATANATM Cleaner are useful for decontamination of both saliva- and blood-contaminated zirconia during the intraoral try-in stage to recover the original bond strength of cementation.

Effects of dentine surface cleaning on bonding of a self-etch adhesive to root canal sealer-contaminated dentine.

OBJECTIVES: To compare the effectiveness of different sealer cleaning methods on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. METHODS: Forty-nine extracted molars were divided into seven groups. Dentine surfaces were exposed and cotaminated with a thin layer of epoxy resin-based sealer (AH Plus (AHP)) or zinc oxide eugenol-based sealer (Pulp Canal Sealer (PCS)). Three cleaning protocols were examined: dry cotton pellet, 70% ethanol-saturated cotton pellet or a surfactant-based cleaner (KatanaTM Cleaner (KC), Kuraray Noritake Dental Inc.). Uncontaminated dentine served as control. The dentine surfaces were bonded with a two-step self-etch adhesive and restored with resin composite. Bond strength testing was performed using a microtensile approach. Two teeth from each group were used for scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). The pulpal floor of the teeth was covered with sealer and cleaned. The percentage of zinc/zirconium on the dentine surface was detected to indicate the amount of remnant sealer. RESULTS: Tensile bond strength for uncontaminated dentine control was 46.4±7.3 MPa; bond strength decreased significantly for the dry cotton group (29.6±4.2 MPa for AHP, 24.7±4.7 MPa for PCS, p<0.05). Both ethanol and KC restored bonding performance after cleaning, with no significant difference from the control. Significantly lower MTBS was observed for the ZOE/ethanol subgroup (38.9±5.1 MPa). Cleaner surfaces and less zinc/zirconium elements were identified by SEM/EDX after cleaning with ethanol or KC. CONCLUSIONS: KatanaTM Cleaner decontaminates root canal sealer-smeared dentine surfaces effectively and restores the bonding performance of a self-etch adhesive to dentine. CLINICAL SIGNIFICANCE: The surfactant-based KatanaTM Cleaner, originally designed for cleaning zirconia surfaces prior to adhesive bonding, may be used as for cleaning dentine that has been contaminated with unset root canal sealers after root canal treatment to restore the bonding strength of a self-etch adhesive to sealer-contaminated dentine.

In vitro evaluation of efficacy of two endodontic sonic-powered irrigant agitation systems in killing single-species intracanal biofilms.

OBJECTIVE: To evaluate the efficacy of two sonic-powered irrigation systems, EDDY and EndoActivator, in killing intracanal biofilms. METHODS: Eighty-three instrumented, autoclaved single-rooted human premolars were inoculated with Enterococcus faecalis (ATCC-29212) for 21 days to generate mature, single-species biofilms. The teeth were devided into four groups: irrigation with saline (N = 11); irrigation with 2% NaOCl without agitation (N = 24); irrigation with 2% NaOCl with agitation by the EndoActivaor (N = 24); irrigation with 2% NaOCl with agitation by the EDDY (N = 24). Colony-forming unit (CFU) counts and XTT assay were used to evaluate bacterial load. Additional teeth were split into root-halves for fluorescence staining to examine the percentages of live/dead bacteria in the dentinal tubules present in different canal locations (coronal, mid-root and apical portions). RESULTS: Agitation of 2% NaOCl by EDDY or EndoActivator reduced bacteria load more proficiently than the use of 2%NaOCl without agitation (p < 0.05). No significant difference was detected between the two sonic-powered irrigant agitation systems (p > 0.05). Confocal laser scanning microscopy indicated that both devices had better intratubular bacteria killing efficacy than the use of 2% NaOCl only in all parts of the canal space (p < 0.05), with no significant difference detected between EDDY and EndoActivator (p > 0.05). Elimination of intracanal and intratubular bacteria were less efficient in the apical portion of the canal space for all experimental groups. CONCLUSION: The two sonic-powered irrigant activation systems demonstrated comparable intracanal bacteria reduction efficacy when 2% NaOCl was used for disinfecting E. faecalis biofilms in single-rooted teeth. CLINICAL SIGNIFICANCE: With the use of 2% NaOCl as irrigant, the EDDY and EndoActivator sonic-powered irrigant agitation systems have improved and equivalent intracanal bacteria reduction efficacy but are incapable of completely killing all bacteria that resided within the dentinal tubules of root canals.

Effects of pre-mixed hydraulic calcium silicate putties on osteogenic differentiation of human dental pulp stem cells in vitro.

OBJECTIVES: An experimental tricalcium silicate and dicalcium silicate-containing endodontic putty has been designed to overcome the issue of reduced shelf life after exposure to atmospheric moisture during repeated opening of the container for clinical retrieval. The present study examined the effects of this experimental hydraulic putty on the mineralogenic characteristics of osteogenic lineage-committed human dental pulp stem cells (hDPSCs), by comparing the cellular responses with a commercially available putty (EndoSequence BC RRM Putty). METHODS: The osteogenic potential of hDPSCs that had been exposed to the putties was examined using quantitative reverse-transcription polymerase chain reaction for osteogenic gene expressions and western blot for osteogenic protein expressions. Alkaline phosphatase activity assay and alizarin red S staining were performed to detect changes in production of the intracellular enzyme and extracellular matrix mineralization respectively. RESULTS: Osteogenic differentiation of the hDPSCs was significantly enhanced after exposure to the pre-mixed hydraulic putties, with no significant difference between these two examined putties. CONCLUSIONS: The experimental hydraulic tricalcium silicate putty enhances osteogenic differentiation of hDPSCs to the same extent as a commercially available tricalcium silicate putty. CLINICAL SIGNIFICANCE: The experimental hydraulic putty appears to be an alternative to the commercial putty when used for applications involving the regeneration of bone in endodontics. Animal models are required for validating its potential in enhancing osteogenesis in vivo.

[Effect of filler content of composite resins on polymerization shrinkage measured by a video imaging apparatus (Acuvol)].

OBJECTIVE: To investigate the effect of filler content on the polymerization shrinkage of resins and to evaluate whether Acuvol is a simple and easy method in volumetric shrinkage measurement. METHODS: Six experimental resins with filler contents of 80%, 78%, 76%, 70%, 60%, and 50% were made. Three commercial resins were Syn D6 with 80% filler content, Syn Compact Nano with 74% filler content and Syn Flow with 55% filler content(using the mass fraction to express the filler content). Small semi-sphere samples of these composites were manually formed and light cured for 40 s using a quartz tungsten halogen unit at 650 mW/cm2 (n=10). The volumetric shrinkage was measured in both SVVR and MVVR modes using Acuvol. RESULTS: The volumetric shrinkage of the three commercial resins were: Syn Flow > Syn Compact Nano > Syn D6. The shrinkage values of the six experimental resins with different filler contents were: 50% > 60% > 70% > 76% > 78% > 80%. The negative correlation between filler content and volumetric shrinkage of commercial and experimental resins were strongly (-0.982 and -0.968 respectively, P<0.001). No significant difference between SVVR and MVVR modes (t=0.385, P>0.05). CONCLUSION: The present results support the view that filler content is one of the most important factors influencing polymerization shrinkage of composites. Acuvol provides an easy method for measuring polymerization shrinkage of composites. Both SVVR and MVVR modes of Acuvol give reproducible results.

Effects of calcium-phosphate, laser and adhesive on dentin permeability and bond strength.

OBJECTIVES: The present study examined a technique for reducing dentin permeability through the application of a calcium phosphate (CaP)-based desensitiser with a laser-assisted process and evaluated adhesive-dentin bond strength. Methods: Thirty dentin discs were divided into two groups according to whether the selected desensitiser (TeethMate; Kuraray Noritake) was used prior to dentin bonding. Each group was subdivided into three subgroups (n = 5): A- Adhesive (Single Bond Universal, 3M ESPE), AL- Adhesive + Laser (Nd:YAG 60 mJ) and LAL- Laser + Adhesive + Laser. Dentin permeability values (%) were recorded before and after desensitiser application. Resin composites were placed over the bonded specimens; the latter were aged prior to microtensile bond strength evaluation. Gelatinolytic activity within the hybrid layers was examined with in-situ zymography using confocal laser scanning microscopy. Data were analysed with ANOVA and Tukey test (α = 0.05). RESULTS: Significant differences in dentin permeability were identified for all groups (p = 0.00). Both laser treatment (p = 0.182) and desensitiser application (p = 0.687) did not significantly improve dentin bond strength. Ultrastructure of the resin-dentin interface identified presence of calcium phosphate within dentinal tubules. Laser treatment did not affect hybrid layer ultrastructure. Both treatment modalities (intratubular CaP occlusion and laser) had no influence on gelatinolytic activity within hybrid layers. CONCLUSION: Although intratubular CaP occlusion and laser treatment were effective in reducing dentin permeability, they did not affect bond strength, interfacial ultrastructure and gelatinolytic activity within hybrid layers. CLINICAL RELEVANCE: Treatment of etched dentin with Nd:YAG Laser at 60 mJ does not adversely affect collagen ultrastructure and gelatinolytic activity within the hybrid layer. The application of a calcium phosphate-based desensitiser to etch dentin does not affect dentin bond strength.

Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature.

The purpose of this study was to report the clinical efficacy of decompression for 3 cases with large periapical lesions and to review technique details. Three cases with large periapical cystic lesions were treated with decompression after root canal treatment. A traditional decompression technique was used for the first case. After aspiration, mucogingival incision, irrigation, and incisional biopsy, a pediatric endotracheal tube was sutured in place and kept for 3 weeks for lesion debridement. An aspiration/irrigation technique was adopted for the second case. An 18-G needle with a syringe was used to aspirate the cystic lesion. Two needles were then inserted into the lesion; copious saline irrigation was delivered from 1 needle and until clear saline was expressed from the other. For the third case, decompression was accomplished with a surgical catheter that was subsequently replaced with a gutta-percha plug after 1 month. None of the 3 cases underwent complete enucleation and root-end surgery. Healed lesions or lesions in healing were observed after 1 to 2 years. Based on the presented cases and published case reports on decompression, a literature review was provided covering indications, technique details, modification, and prognosis of decompression in endodontics. For large periapical cystic lesions, conservative decompression may be used for certain cases before or in lieu of apical surgery. Decompression enables healing of large, persistent periapical lesions after root canal treatment.

Janus Nanoparticles for Improved Dentin Bonding.

The amphiphilic monomer 2-hydroxyethyl methacrylate (HEMA) is widely used in dental adhesives as a priming component, especially for dentin bonding. It behaves as a compatibilizer between hydrophilic and hydrophobic components and stabilizes the multicomponent adhesive system. However, there are several drawbacks associated with using HEMA, such as water retention within the adhesive layer, hydrolysis in oral environments, and cytotoxicity. These drawbacks lead to the failure of tooth restoration and represent a heavy medical burden. Thus, it is imperative to find a new compatibilizer to substitute for HEMA. Because of their superior compatibilization capabilities as functional solid surfactants, amphiphilic Janus particles are chosen as candidates for an alternative to HEMA in dental adhesives. Reactive amphiphilic Janus nanoparticles are synthesized by selectively etching and modifying at the interface of a Pickering emulsion. This approach could be extended to the synthesis of a series of other Janus nanoparticles. The Janus nanoparticles were verified to be better for the reduction of the phase separation and stabilization of dentin adhesives than HEMA. It is also demonstrated that these reactive Janus nanoparticles can strongly enhance the dentin bonding interface without cytotoxicity. It is clearly illustrated by this study that Janus nanoparticles may be promising materials to substitute for HEMA in dental adhesives.

Chlorhexidine-Loaded Amorphous Calcium Phosphate Nanoparticles for Inhibiting Degradation and Inducing Mineralization of Type I Collagen.

A major shortcoming of contemporary dentin adhesives is their limited durability. Exposed collagen fibrils within the bonding interface are degraded by matrix metalloproteinases (MMPs), resulting in aging of the resin-dentin bond. In this study, chlorhexidine-loaded amorphous calcium phosphate (ACP) nanoparticles were synthesized to induce the mineralization of collagen fibrils. The nanoparticles sustainably released chlorhexidine to inhibit MMPs during mineralization. Three types of ACP nanoparticles were prepared: N-ACP containing no chlorhexidine, C-ACP containing chlorhexidine acetate, and G-ACP containing chlorhexidine gluconate, which had a higher drug-loading than C-ACP. Scanning and transmission electron microscopy indicated that the synthesized nanoparticles had diameters of less than 100 nm. Some had diameters of less than 40 nm, which was smaller than the width of gap zones in the collagen fibrils. Energy dispersive X-ray spectroscopy, Fourier-transform infrared spectroscopy, and high performance liquid chromatography confirmed the presence of chlorhexidine in the nanoparticles. X-ray diffraction confirmed that the nanoparticles were amorphous. The drug loading was 0.11% for C-ACP and 0.53% for G-ACP. In vitro release profiles indicated that chlorhexidine was released sustainably via first-order kinetics. Released chlorhexidine inhibited the degradation of collagen in human dentine powder, and its effect lasted longer than that of pure chlorhexidine of the same concentration. The ACP could induce the mineralization of self-assembled type I collagen fibrils. The chlorhexidine-loaded ACP nanoparticles sustainably released chlorhexidine and ACP under appropriate conditions. This is useful for inhibiting degradation and inducing the mineralization of dentine collagen fibrils.

Comparison of efficacy and outcome satisfaction between in-office and home teeth bleaching in Chinese patients.

This in vivo study aimed to evaluate the efficacy of in-office and home teeth bleaching in Asian patients. Moreover, the correlation between tooth color change and patient's outcome satisfaction was investigated. Overall, 40 Chinese patients were randomly divided into two groups and prescribed in-office (OB) or take-home bleaching (HB). The color of the maxillary central incisor and canine were recorded at baseline, immediately after first treatment, 1 week, and 3 months after treatment by using a spectrophotometer. Bleaching sensitivity and outcome satisfaction were assessed using Likert and visual analogue scale (VAS), and the results were analyzed using independent t-test and Pearson correlation (P < 0.05). ΔL*, Δa*, Δb*, and ΔE* values of HB were greater than those of OB. Color changes observed in canines were generally greater than those in incisors. Moreover, HB was generally associated with less tooth sensitivity than OB. Patients were satisfied with both treatments, but VAS scores were greater for HB. Furthermore, the correlation between ΔE* and VAS was significant for canines immediately after the first treatment and 1 week after HB. In conclusion, HB was more effective in lightening teeth and reducing chromacity in Chinese patients. The correlation between tooth color change and outcome satisfaction was generally insignificant and weak.

Extrafibrillar collagen demineralization-based chelate-and-rinse technique bridges the gap between wet and dry dentin bonding.

Limitations associated with wet-bonding led to the recent development of a selective demineralization strategy in which dentin was etched with a reduced concentration of phosphoric acid to create exclusive extrafibrillar demineralization of the collagen matrix. However, the use of acidic conditioners removes calcium via diffusion of very small hydronium ions into the intrafibrillar collagen water compartments. This defeats the purpose of limiting the conditioner to the extrafibrillar space to create a collagen matrix containing only intrafibrillar minerals to prevent collapse of the collagen matrix. The present work examined the use of polymeric chelators (the sodium salt of polyacrylic acid) of different molecular weights to selectively demineralize extrafibrillar dentin. These polymeric chelators exhibit different affinities for calcium ions (isothermal titration calorimetry), penetrated intrafibrillar dentin collagen to different extents based on their molecular sizes (modified size-exclusion chromatography), and preserve the dynamic mechanical properties of mineralized dentin more favorably compared with completely demineralized phosphoric acid-etched dentin (nanoscopical dynamic mechanical analysis). Scanning and transmission electron microscopy provided evidence for retention of intrafibrillar minerals in dentin surfaces conditioned with polymeric chelators. Microtensile bond strengths to wet-bonded and dry-bonded dentin conditioned with these polymeric chelators showed that the use of sodium salts of polyacrylic acid for chelating dentin prior to bonding did not result in significant decline in resin-dentin bond strength. Taken together, the findings led to the conclusion that a chelate-and-rinse conditioning technique based on extrafibrillar collagen demineralization bridges the gap between wet and dry dentin bonding. STATEMENT OF SIGNIFICANCE: The chelate-and-rinse dental adhesive bonding concept differentiates from previous research in that it is based on the size-exclusion characteristics of fibrillar collagen; molecules larger than 40kDa are prevented from accessing the intrafibrillar water compartments of the collagen fibrils. Using this chelate-and-rinse extrafibrillar calcium chelation concept, collagen fibrils with retained intrafibrillar minerals will not collapse upon air-drying. This enables adhesive infiltration into the mineral-depleted extrafibrillar spaces without relying on wet-bonding. By bridging the gap between wet and dry dentine bonding, the chelate-and-rinse concept introduces additional insight to the field by preventing exposure of endogenous proteases via preservation of the intrafibrillar minerals within a collagen matrix. If successfully validated, this should help prevent degradation of resin-dentine bonds by collagenolytic enzymes.

[Effect of base layer thickness of a self-adhesive resin on dentin bonding strength].

OBJECTIVE: To evaluate the effect of base layer thickness of DyadFlow(DF) self-adhesive resin on dentin bonding strength. METHODS: Twenty extracted intact human molars were randomly selected and the occlusal surface of each molar was prepared by removing the enamel and exposing the dentin surface. The prepared molars were divided, randomly and equally, into 4 groups. For groups G0.5, G1.0 and G2.0, DF was applied directly on the dentin surfaces following the manufacturer's instruction, and for group GOB, OptiBond All-in-One(OB) self etching adhesive was applied on the dentin surface before using DF. The base layer thickness of DF was 0.5 mm, 1.0 mm, 2.0 mm, 2.0 mm for groups G0.5, G1.0, G2.0 and GOB, respectively. Composite crown were built up on each tooth, then the samples were sectioned longitudinally into sticks with proximately 1.0 mm2 bonding area(for microtensile bond strength[MTBS] testing) or slabs (for bonding interface observation with SEM). Fifteen sticks were obtained for each group. The fracture surface was also observed using SEM and the fracture type of each specimen was determined. RESULTS: The MTBS were: GOB (20.19±3.11) MPa>G0.5 (8.65±1.58) MPa>G1.0 (6.65±1.13) MPa>G2.0 (5.70±0.60) MPa(P<0.05). Bonding interface fracture B2 was most frequently observed for all groups: G0.5: 14/15, G1.0: 13/15, G2.0: 14/15 and GOB: 13/15. CONCLUSIONS: The MTBS decreased when the base layer thickness of DF increased. Direct application of DF self-adhesive resin on dentin surface adhesive restorations should be concerned.

Defying ageing: An expectation for dentine bonding with universal adhesives?

OBJECTIVES: The present study evaluated the long-term dentine bonding effectiveness of five universal adhesives in etch-and-rinse or self-etch mode after 12 months of water-ageing. METHODS: The adhesives evaluated included All-Bond Universal, Clearfil Universal Bond, Futurabond U Prime&Bond Elect and Scotchbond Universal. Microtensile bond strength and transmission electron microscopy of the resin-dentine interfaces created in human coronal dentine were examined after 24h or 12 months. RESULTS: Microtensile bond strength were significantly affected by bonding strategy (etch-and-rinse vs self-etch) and ageing (24h vs 12 months). All subgroups showed significantly decreased bond strength after ageing except for Prime&Bond Elect and Scotchbond Universal used in self-etch mode. All five adhesives employed in etch-and-rinse mode exhibited ultrastructural features characteristic of collagen degradation and resin hydrolysis. A previously-unobserved inside-out collagen degradation pattern was identified in hybrid layers created by 10-MDP containing adhesives (All-Bond Universal, Scotchbond Universal and Clearfil Universal Bond) in the etch-and-rinse mode, producing partially degraded collagen fibrils with intact periphery and a hollow core. In the self-etch mode, all adhesives except for Prime&Bond Elect exhibited degradation of the collagen fibrils along the thin hybrid layers. The three 10-MDP containing universal adhesives did not protect surface collagen fibrils from degradation when bonding was performed in the self-etch mode. CONCLUSIONS: Despite the adjunctive conclusion that bonds created by universal adhesives in the self-etch bonding mode are more resistant to decline in bond strength when compared with those bonds created using the etch-and-rinse mode, bonds created by universal adhesives are generally incapable of defying ageing.