Influence of universal adhesives and silane coupling primer on bonding performance to CAD-CAM resin-based composites: A laboratory investigation.

OBJECTIVE: Obtaining strong resin bonds to computer-aided design and computer-aided manufacturing (CAD-CAM) resin-based composites with dispersed fillers (CCRBCs) poses a challenge. Therefore, this study aimed to assess the effect of three universal adhesives and a two-component silane coupling agent on the shear bond strength to three (CCRBCs). MATERIALS AND METHODS: Eight hundred and sixty-four specimens of Brilliant Crios, Lava Ultimate, and Tetric CAD were polished or grit blasted, bonded with Adhese Universal DC, One Coat 7 Universal (OC7), and Scotchbond Universal Plus Adhesive (SBU) with or without a silane primer. Shear bond strength was measured after 24 h and 10,000 thermocycles. Linear regressions were performed (α = 0.05). RESULTS: After thermocycling, bond strengths were similar for the universal adhesives on polished Brilliant Crios and Lava Ultimate (p ≥ 0.408). Grit blasted Tetric CAD showed no significant differences (p ≥ 0.096). The silane primer had minimal impact on grit blasted Tetric CAD (p ≥ 0.384). The silane primer increased the bond strength of OC7 to Brilliant Crios (p = 0.001) but decreased the adhesion of SBU to Brilliant Crios and Lava Ultimate (p ≤ 0.018). CONCLUSIONS: Bond strength of universal adhesives varied with CCRBC type. The two-component silane coupling agent showed mixed effects on adhesive performance. CLINICAL SIGNIFICANCE: Selecting universal adhesives from the same CCRBC product line does not always guarantee superior bond strength. The efficacy of silane coupling agents differs based on the bonding substrate.

The effect of zeolite incorporation on the physical properties of silver-reinforced glass ionomer cement.

Zeolite can impart antibacterial properties to dental materials in the long-term when incorporated with inorganic cations. However, due to its porosity, it may jeopardize the mechanical integrity of the dental material. The aim of this project was to determine the effect on physical properties when zeolite is added to commercially available Ag-reinforced Glass Ionomer Cement (GIC). Sample groups were prepared according to the percentage of zeolite-clinoptilolite (0% - control, 0.5%, 1%, 2%, and 4% wt) added to Ag-GIC. Water sorption, solubility, Vickers hardness, and flexural strength were determined. Specifically, 10 × 2 mm circular disks were fabricated for the Vickers hardness, water sorption, and water solubility tests and 25 × 5 × 2 mm bars were created for the flexural strength test. The results from the surface hardness, water sorption, and flexural strength tests suggested that adding 0.5-4% wt of zeolite to Ag-reinforced GIC did not diminish its physical properties. However, the water solubility results showed that higher concentrations (2-4% wt) of zeolite had a statistically significant increase in water solubility compared to the control. Up to 4% wt zeolite can be incorporated into Ag-reinforced GIC without compromising mechanical properties. Incorporation of 0.5-1% wt zeolite to Ag-reinforced GIC will maintain an adequate surface hardness, water sorption, and flexural strength without compromising water solubility. Further research is needed to determine the effects of higher water solubility on clinical efficacy of zeolite modified Ag-GIC. Graphical abstract.

Five-year clinical performance of two fluoride-releasing giomer resin materials in occlusal restorations.

OBJECTIVE: To evaluate and compare the clinical performance of two nano-hybrid giomer restorative composite materials after 5 years. MATERIALS AND METHODS: Forty-four pairs of restorations (total n = 88) of a flowable giomer (Beautifil Flow Plus F00; Shofu Inc., Kyoto, Japan) and a conventional nano-hybrid giomer restorative material (Beautifil II; Shofu Inc.) were placed in Class I cavities after the application of a dentin adhesive (FL-Bond II; Shofu Inc.) and a flowable liner (Beautifil Flow Plus F03; Shofu Inc). After 5 years, 32 pairs of restorations were assessed using the modified United States Public Health Service criteria. Both tested materials were compared using Fisher's exact test and each tested clinical criterion for each material was analyzed separately with respect to different follow-up periods using Friedman's test (a = 0.05). RESULTS: None of the restorations showed complete retention loss, post-operative sensitivity, secondary caries or color change. There were no significant changes to any of the clinical criteria for each material during the 5-year evaluation period (p > 0.05) and no significant differences between the two materials in all clinical parameters after 5 years (p > 0.05). CONCLUSIONS: Five-year clinical performance of both two nano-hybrid giomer restorative materials was comparably acceptable and not significantly different for any of the parameters evaluated. CLINICAL SIGNIFICANCE: Nano-hybrid giomer-based materials are clinically acceptable for the restoration of occlusal cavities as they demonstrate excellent performance after 5 years.

Antibacterial and Physical Properties of PVM/MA Copolymer- Incorporated Polymethyl Methacrylate as a Novel Antimicrobial Acrylic Resin Material.

Polymethyl methacrylate (PMMA), an acrylic resin used in orthodontic appliances and removable dentures for its biocompatibility and esthetics, may harbor bacteria on its surface. The present study investigated a new PMMA formula with Gantrez: an antibacterial copolymer of methyl vinyl ether and maleic acid (PVM/MA). Samples were tested for mechanical properties (surface hardness, flexural strength, water sorption, and water solubility) and effects against Streptococcus mutans. Six groups (0%-control, 5%, 10%, 15%, 20%, and 25% Gantrez) of n = 12 were fabricated for physical property tests and analyzed with one-way ANOVA and Prism 6. From these results, three groups (0%, 5%, and 10% Gantrez) were selected for antibacterial tests, and data were analyzed with one-way ANOVA and Tukey's multiple comparison test. Adding 5% and 10% Gantrez into PMMA significantly decreased S. mutans adhesion. There was no significant difference between the control vs. 5%, 10%, 15%, and 20% Gantrez (p > 0.05) for surface hardness, the control vs. 5% Gantrez (p > 0.05) for flexural strength, and the control vs. 5 and 10% Gantrez for water sorption and water solubility. Overall, incorporating 5% Gantrez into PMMA may be a promising solution to reduce bacterial adhesion without changing the acrylic resin's physical properties.

Effect of surface treatment and cleaning on the bond strength to polymer-infiltrated ceramic network CAD-CAM material.

STATEMENT OF PROBLEM: Optimal composite resin bonds to polymer-infiltrated ceramic network (PICN) computer-aided design and computer-aided manufacturing (CAD-CAM) materials are essential for clinical success. However, comparative bond strength studies on the influence of different etching and cleaning methods on these materials are lacking. PURPOSE: The purpose of this in vitro study was to measure and compare the microshear bond strength (µSBS) of a composite resin cement with that of a PICN material after different surface treatment and cleaning methods. MATERIAL AND METHODS: Seventy specimens of a CAD-CAM PICN were divided into 7 groups (n=10): no treatment (control), hydrofluoric acid etching for 20 seconds (HF20), 60 seconds (HF60), 120 seconds (HF120), HF20 + phosphoric acid for 60 seconds and ultrasonic bath for 5 minutes, HF60 + PH, and HF120 + PH. After surface treatment, a silane coupling agent and composite resin cement were applied. Microshear bond strength was determined, and data were analyzed with 1-way ANOVA and Tukey post hoc multiple comparison tests (α=.05). RESULTS: All HF acid treatments resulted in a significant increase in bond strength to the polymer-infiltrated ceramic network material (P=.02). Bond strength values for HF etching for 20 seconds were significantly lower than those for 60 seconds and 120 seconds (P=.034). No difference was found between 60 seconds and 120 seconds of HF etching time (P=.986). Additional surface treatment with phosphoric acid 60 seconds and ultrasonic bath 5 minutes did not improve the bond strength beyond values obtained by hydrofluoric acid treatment only (P=.834). Most failures were cohesive. CONCLUSIONS: Acid etching and surface treatment have significant effects on composite resin bond strength to a PICN CAD-CAM material. HF etching for 60 seconds or 120 seconds provides the highest bond strengths. Cleaning methods after etching did not have any significant effect on bond strength.

Influence of cleaning methods on bond strength to saliva contaminated zirconia.

OBJECTIVE: To evaluate the influence of saliva contamination and cleaning procedures on shear bond strength (SBS) of a self-adhesive resin cement (SAC) to zirconia surfaces. MATERIALS AND METHODS: A total of 160 sandblasted zirconia blocks were randomly divided into eight groups as follows: No saliva contamination, no cleansing (NC-NC); contamination with saliva, no cleansing (SC-NC); no saliva contamination, cleansing with a zirconia primer (ZP; Z-Bond, Danville Materials, Inc., S. Ramon, California) (NC-ZP); contamination with saliva, cleansing with ZP (SC-ZP); no saliva contamination, cleansing with hydrofluoric acid (HF; Ultradent Porcelain Etch; Ultradent Products, South Jordan, Utah) followed by cleansing with ZP (NC-HF-ZP); contamination with saliva, cleansing with HF followed by cleansing with ZP (SC-HF-ZP); cleansing with ZP, contamination with saliva, cleansing with ZP (ZP-SC-ZP); application of ZP, contamination with saliva, cleansing with HF followed by cleansing with ZP (ZP-SC-HF-ZP). Cylindrical resin composite blocks were luted to the zirconia surfaces with SAC (Clearfil SA Cement Automix, Kuraray, Inc., Tokyo, Japan). Specimens were subjected to shear forces at a cross-head speed of 0.5 mm/min. Data were analyzed with Analysis of Variance and Tukey tests (α = 0.05). RESULTS: The bond strength values to zirconia were significantly influenced by saliva contamination (P < .05). The SC-NC group showed the lowest bond strength values (5.6 ± 1.4 MPa; P < .05). All cleansing or pretreatment agents improved the bond strengths when compared to noncleansing groups, NC-NC and SC-NC. CONCLUSION: In situations where saliva contamination is deemed unavoidable, application of ZP after try-in of the zirconia restoration could be beneficial for the accurate cementation. CLINICAL SIGNIFICANCE: During try-in sessions of fixed dental prostheses, zirconia ceramic restoration may come into contact with saliva and surfaces should be cleansed to obtain an optimal surface for adhesion. Application of zirconia primer to the sandblasted zirconia surface is recommended whether the surface is contaminated with saliva or not.

Effect of thickness and surface modifications on flexural strength of monolithic zirconia.

STATEMENT OF PROBLEM: A recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential. PURPOSE: The purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses. MATERIAL AND METHODS: Monolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-µm Al2O3 particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05). RESULTS: The 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05). CONCLUSIONS: The mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.

Effect of fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate on the acid resistance of the primary enamel.

BACKGROUND: This study aimed to investigate the effects of a fluoride varnish with added Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) treatments on acid resistance of primary teeth enamel. METHODS: Enamel specimens obtained from 40 primary incisors (for surface microhardness testing) and 40 primary molars (for demineralization depth measurement) were randomly divided into four groups (n = 10 incisors and 10 molars) each according to surface treatment: no treatment (control), MI varnish (1-8 % sodium fluoride and 1-5 % CPP-ACP), Clinpro White (1-5 % sodium fluoride and <5 % modified tricalcium phosphate), Duraphat (<5 % sodium fluoride). Specimens were stored for 24 h in a moist environment. After varnish residues were removed, specimens were subjected to pH cycling. The effects of fluoride varnishes were evaluated according to surface microhardness, lesion depth and structural changes. Results were analyzed by ANOVA and Tukey's tests. RESULTS: The lowest changes in surface microhardness and lesion depth occurred in MI varnish group, followed by the Clinpro White, Duraphat and no treatment (control) group (for percentage of loss surface microhardness -20.80, -34.60, -57.80 and -73.40; for lesion depth values 23.60 µm ± 3.36, 29.85 µm ± 3.27, 40.37 µm ± 3.41 and 54.56 µm ± 4.16, respectively). Statistically significant differences in both surface microhardness and lesion depth were observed among all groups (P < 0.05). CONCLUSIONS: Within the limitations of this in vitro study, fluoride varnish containing CPP-ACP was more effective in increasing the acid resistance of primary enamel than other fluoride varnishes. However, further clinical research is needed to confirm these in vitro results.

Effect of Storage Temperature on the Shelf Life of Self-adhesive Resin Cements.

PURPOSE: To compare the bonding performance of three new self-adhesive resin cements to human dentin after storage under two different conditions. MATERIALS AND METHODS: Buccal, lingual, mesial, and distal dentin surfaces of 36 human molars were abraded to directly below the enamel with #600 SiC papers. The teeth were divided into two main test groups. In the first test group (FT), the cements were kept in a refrigerator (6 ± 2°C) for three months and then used for the test. The remainder of the cements was kept at a constant room temperature of 19 ± 2°C for an additional three months, and then used again for the second test group (ST). Each test group comprised 6 teeth and 24 dentin sections. The cements Clearfil SA (CSA), G-Cem (GC), and Bis-Cem (BC) were applied to the surfaces according to the manufacturers' recommendations. After application of the cements to the flat dentin surfaces and light curing, shear bond strengths were determined at a crosshead speed of 0.5 mm/min. Bond strengths were then calculated and expressed in MPa. Data were analyzed with Kruskal-Wallis and Wilcoxon Signed Rank tests. To investigate the cement/ dentin interfaces using SEM, the buccal surfaces of three additional teeth were used for each test group. RESULTS: The bond strength values of cement groups were significantly different for the FT and ST groups (p < 0.01). GC showed the highest bond strength values of all materials. There was a difference between the bond strength values of the two testing periods for all materials (p < 0.01). Bond strengths significantly decreased after storage at room temperature. CONCLUSION: Storage temperatures considerably affect the shelf life of self-adhesive resin cements.

Microtensile bond strength to enamel affected by hypoplastic amelogenesis imperfecta.

PURPOSE: This study compared the microtensile bond strengths (µTBS) of two different self-etching (SE) and etchand- rinse (ER) adhesive systems to enamel affected by hypoplastic amelogenesis imperfecta (HPAI) and analyzed the enamel etching patterns created by the two adhesive systems using scanning electron microscopy (SEM). MATERIALS AND METHODS: Sixteen extracted HPAI-affected molars were used for the bond strength tests and 2 molars were examined under SEM for etching patterns. The control groups consisted of 12 healthy third molars for µTBS tests and two molars for SEM. Mesial and distal surfaces of the teeth were slightly ground flat. The adhesive systems and composite resin were applied to the flat enamel surfaces according to the manufacturers' instructions. The tooth slabs containing composite resin material on their mesial and distal surfaces were cut in the mesio-distal direction with a slow-speed diamond saw. The slabs were cut again to obtain square, 1-mm-thick sticks. Finally, each stick was divided into halves and placed in the µTBS tester. Bond strength tests were performed at a speed of 0.5 mm/min. Data were analyzed with two-way ANOVA and Tukey's tests. RESULTS: There was no significant difference between the bond strength values of ER and SE adhesives (p > 0.05). However, significant differences were found between HPAI and control groups (p < 0.05). HPAI-affected enamel surfaces exhibited mild intra- and inter-prismatic enamel etching patterns after orthophosphoric acid application, while conditioning of HPAI-affected enamel with SE primer created a slightly rough and grooved surface. CONCLUSION: SE and ER adhesive systems provide similar bond strengths to HPAI-affected enamel surfaces.

Effect of thermomechanical aging on bond strength and interface morphology of glass fiber and zirconia posts bonded with a self-etch adhesive and a self-adhesive resin cement to natural teeth.

STATEMENT OF PROBLEM: Information regarding the effect of thermomechanical aging (TMA) on the bond strength of luting cements to root canal dentin and endodontic posts is limited. PURPOSE: The purpose of this study was to investigate the effect of TMA on the bond strength of fiber and zirconia posts bonded to root canal dentin with 2 different resin cements with microtensile and scanning electron microscopic evaluation. MATERIAL AND METHODS: Eighty extracted single-rooted human premolars were endodontically treated and restored with either a glass fiber post (FP) or a zirconia post (ZP) with 2 commercially available resin luting cements. The teeth were divided into 2 main groups. In the first group, posts (n=40) were bonded with a self-etch adhesive cement (SEAC). In the second group (n=40), posts were bonded using a self-adhesive cement (SAC). During the first aging phase, all specimens in each group were stored in distilled water for 30 days at 37°C. During the second phase, half of the specimens in each group were subjected to the TMA. The test groups were as follows: FP/SEAC, FP/SEAC+TMA, ZP/SEAC, ZP/SEAC+TMA, FP/SAC, FP/SAC+TMA, ZP/SAC, and ZP/SAC+TMA. The bond strength was measured with a microtensile test. Data were analyzed by 3-way analysis of variance and the Tukey honest significant different test (α=.05). RESULTS: FP/SEAC at 30 days was higher than in the other groups. However, bond strength values were significantly reduced in this group after TMA (P<.001). CONCLUSIONS: Bond strength values and physical properties of SEAC with higher filler content were more affected by the TMA than those of SALC. According to scanning electron microscopic observation, TMA also affected the micromorphologic interface between the posts and the resin cements as well as between the resin cements and the root canal dentin.

Effect of rotation frequency of polishing discs on the surface roughness of resin composite material.

The aim of this study was to evaluate the effect of rotation frequency (rpm) of different polishing discs on the surface roughness of a nanohybrid resin composite material. 126 specimens were prepared in metal molds of 10 mm diameter and 2 mm depth using a nanohybrid resin composite material. The prepared specimens were kept in distilled water for 24 hours. Polishing treatments at 5k, 10k, 15k, and 20k rpm were applied to the nanohybrid resin composite material by grouping different brand polishing discs: Sof-Lex Contouring and Polishing Discs (3M Espe, USA) (3M Group), Optidisc (Kerr Corporation, USA) (Kerr Group), Super-Snap Rainbow Technique Kit (Shofu Dental, Japan) (Shofu Group), Finishing Disc (Bisco Dental, USA) (Bisco Group). The surface roughness was evaluated at three different points by atomic force microscopy for all specimens and scanning electron microscopy was used for visual assessment. Data were evaluated by Two Way ANOVA and Tukey's HSD Test. The mean surface roughness (Ra, µm) of all prepared samples showed significant differences (α = 0.05). According to Two-Way ANOVA, there is a statistically significant relationship between the rpm values and the discs. The 3M group showed the highest roughness value at all rpm speeds. Shofu group at 15k, 20k rpm, Bisco group at 10k, 15k, 20k rpm, the Kerr group at 15k, 20k rpm showed the lowest roughness value and had roughness close to the surfaces finished with a mylar strip. The smoothest surfaces were obtained at 15k rpm, even though polishing discs from different brands were used. It was also observed that 5k and 20k rpm polishing speeds can increase the surface roughness of the nanohybrid resin composite material.

Effect of Zeolite Incorporation on the Ion Release Properties of Silver-Reinforced Glass Ionomer Cement.

BACKGROUND: Zeolite can release antimicrobial silver ions in a targeted and controlled manner for an extended time, selectively inhibiting the growth of pathogenic oral bacteria when added to dental materials. The objective of this study was to investigate the effect of the addition of zeolite to silver-reinforced glass ionomer cement on the release of silver ions over time. METHODS: Five concentrations of silver-zeolite (0%, 0.5%, 1%, 2%, 4% wt) were incorporated into silver-reinforced GIC in the form of 10 mm × 2 mm circular disks (n = 5). The disks were incubated in deionized water at 37 °C and ion release from the samples was measured at 1, 2, 7, and 30 days after immersion by inductively coupled atomic emission spectroscopy. RESULTS: Incorporating silver-zeolite increased silver ion release from silver-reinforced GIC disks compared to the control disks (p < 0.05), while incorporating zeolite alone had no effect. Higher concentrations of added silver-zeolite resulted in increased silver ion release. Sustained silver ion release was observed for up to 30 days. CONCLUSION: Adding silver-zeolite to silver-reinforced GIC may enhance its extended antibacterial effect in the oral cavity.

Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review.

The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength is affected by the type of aging conditions, bonding agents, flowable resin composites, impression materials, temporary materials, and/or resin cement used within the IDS procedure. A comprehensive database search of PubMed, Embase, Scopus, Ovid Medline, Web of Sciences, Cochrane Library, Dentistry & Oral Sciences Source, and ProQuest was carried out up to 30 January 2024 without publication year or language limitations. Only in vitro full-texts regarding the effect of IDS on bond strength were included, and the quality of their methods was assessed via a Risk of Bias (RoB) test. In total, 1023 pertinent studies were initially found, and 60 articles were selected for review after screening for the title, abstract, and full texts. IDS application improves the bond strength of indirect restorations to dentin and reduces the negative effects of temporary materials on the bond durability of final indirect restorations. Filled dentin bonding agents or combinations with flowable resin composite are preferred to protect the IDS layer from conditioning procedures.

Postoperative tooth sensitivity with a new self-adhesive resin cement--a randomized clinical trial.

OBJECTIVES: This study evaluated and compared sensitivity of teeth after cementation of full-coverage crowns with a new self-adhesive resin cement (SARC). A resin-modified glass ionomer cement (RMGIC) served as control. MATERIALS AND METHODS: Eighty-eight full-coverage crowns were cemented to vital teeth with either the self-adhesive cement iCem (Heraeus Kulzer; n = 44) or the RMGIC GC Fuji PLUS (GC, n = 44). Before preparations, patients were questioned for sensitivity (patient sensitivity, PS). In addition, air was blown for 2 s onto the buccal cementoenamel junction (air sensitivity, AS), and ice spray was applied in the cementoenamel junction area (ice sensitivity, IS). Patient responses were recorded with a visual analog scale. After cementation of the crowns, patients were recalled for follow-up (f/u) visits at 1 day, 1 week, and 3 weeks. PS, AS, and IS were recorded during each visit. Data were analyzed with Mann-Whitney U tests. RESULTS: The two groups revealed comparable sensitivity scores at baseline. SARC showed significantly lower PS sensitivity scores at 1 day (p = 0.02) and significantly lower AS scores at 1-week follow-up (p = 0.01). IS generally produced the highest sensitivity scores with SARC revealing significantly lower scores at all follow-up visits. CONCLUSION: Cementation of crowns with the SARC tested in this study resulted in overall lower postoperative sensitivity than with the RMGIC. CLINICAL RELEVANCE: Among other clinical advantages, some self-adhesive resin cements seem to lower postoperative sensitivity of crowned teeth.

Self-etch and etch-and-rinse adhesive systems in clinical dentistry.

Current adhesive systems follow either an "etch-and-rinse" or "self-etch" approach, which differ in how they interact with natural tooth structures. Etch-and-rinse systems comprise phosphoric acid to pretreat the dental hard tissues before rinsing and subsequent application of an adhesive. Self-etch adhesives contain acidic monomers, which etch and prime the tooth simultaneously. Etch-and-rinse adhesives are offered as two- or three-step systems, depending on whether primer and bonding are separate or combined in a single bottle. Similarly, self-etch adhesives are available as one- or two-step systems. Both etch-and-rinse and self-etch systems form a hybrid layer as a result of resins impregnating the porous enamel or dentin. Despite current trends toward fewer and simpler clinical application steps, one-step dentin bonding systems exhibit bonding agent lower bond strengths and seem less predictable than multi-step etch-and-rinse and self-etch systems. The varying evidence available today suggests that the choice between etch-and-rinse and self-etch systems is often a matter of personal preference. In general, however, phosphoric acid creates a more pronounced and retentive etching pattern in enamel. Therefore, etch-and-rinse bonding systems are often preferred for indirect restorations and when large areas of enamel are still present. Conversely, self-etch adhesives provide superior and more predictable bond strength to dentin and are, consequently, recommended for direct composite resin restorations, especially when predominantly supported by dentin.

Neurotoxic effect of povidone-iodine on the rat spine using a laminectomy-durotomy model.

OBJECTIVE: The efficacy and safety of povidone-iodine in wound dressing and irrigation of some operative cavities were established by many in vitro and in vivo experimental reports and clinical series. However, its use in defective tissue in neural structures has not been confirmed yet. The aim of the present study was to histopathologically investigate its effect on neural tissues when applied on the upper side of defective dura. METHODS: Wistar rats were randomly divided into two experimental groups: control and povidone-iodine groups. In the control group, durotomy was performed following laminectomy, and the spinal cord was covered with a dry sponge. In the study group, the same procedure was performed, but open duras were covered with a sponge that had been wetted with 0.1 % povidone-iodine solution. Three weeks after surgery, all experimental animals were sacrificed, and histopathological evaluations were conducted. RESULTS: Myelin changes were absent or minimal in all cases of the control group but were present as markedly increased myelin degeneration in nearly all cases in the study group. Axonal degeneration and hypoxic neuronal damage were absent in the control group, whereas they were marked in half of the study group. No statistically significant differences were established in Schwann cell proliferation, venous congestion, and lymphocytic proliferation between the two groups. CONCLUSIONS: Based on the present study, 0.1 % povidone-iodine solution cannot be recommended for wound dressing for neural structures such as myelomeningocele cases because of possible damage to underlying neural tissues.

Influence of operator experience on in vitro bond strength of dentin adhesives.

PURPOSE: To examine the influence of operator experience level on shear bond strength (SBS) of a self-etching adhesive (Clearfil SE Bond [CSE], Kuraray) and an etch-and-rinse adhesive (Single Bond [SB], 3M ESPE). MATERIALS AND METHODS: Flat dentin surfaces were created on 120 extracted human third molars. Bonding agents and composite resin were applied and light cured according to manufacturers' directions (n = 15). Four operators with different levels of experience in operative dentistry performed the same specimen preparation steps independently: group 1: specialist in operative dentistry; group 2: post-graduate student; group 3: undergraduate dental student; group 4: private general practitioner. Specimens were stored in distilled water for 24 h at 37°C before SBS testing. Statistical analyses were carried out with Mann-Whitney U- and Kruskall-Wallis tests. RESULTS: For CSE, mean SBS and standard deviations were: (1) 54.4 ± 15.6(a), (2) 55.3 ± 7.6(a), (3) 49.4 ± 10.5(ab), (4) 41.6 ± 13.1(b). For SB, they were: (1) 28.6 ± 10.3(c), (2) 32.7 ± 11.2(c), (3) 17.5 ± 5.6(d), (4) 24.4 ± 9.5(cd). Groups with the same superscript letters are not significantly different. CSE showed higher bond strengths than SB in all groups (p < 0.05). There was no significant difference in mean bond strengths between groups 1 and 2 for each adhesive (p > 0.05). Depending on the adhesives, groups 3 and 4 were significantly different from groups 1 and 2, but not different from each other. CONCLUSION: Operator experience influences dentin bond strength values of dentin adhesives. An increased level of experience with a specific adhesive system and the associated application procedures correlates with higher SBSs.

The effect of nonthermal argon plasma surface treatment on the fracture resistance of monolithic zirconia restorations containing tetragonal and cubic grains.

PURPOSE: The aim of this study was to investigate the effect of nonthermal argon plasma (NP) surface treatment on the fracture resistance of monolithic zirconia restorations with different microstructures. METHODS: Twenty restorations were prepared from each of two tetragonal and two cubic zirconia materials (80 restorations in total). The restorations were then divided into two subgroups (n = 10) for each material according to the surface treatment applied: air abrasion or NP. The surface topography of the treated groups was examined using a scanning electron microscope. All restorations were fixed to metal dies with resin cement, subjected to thermal cycling, and then underwent fracture resistance testing with a universal testing device. Two-way ANOVA and Bonferroni tests were used for statistical analysis of the data (α = 0.05). RESULTS: The type of surface treatment and the type of zirconia material were shown to significantly affect the fracture resistance of the restorations. The air-abraded groups showed significantly higher fracture resistance (N) than the NP groups (P < 0.001). CONCLUSION: The results of this study suggest that air abrasion surface treatment has a more favorable effect on the fracture resistance of tetragonal and cubic zirconia restorations than NP surface treatment.

Influence of Surface Modifications on Bacterial Adherence to Implant Abutment Materials.

The purpose of this study was to investigate the effects of various titanium and zirconia polishing protocols on the colonization of oral bacteria. Titanium and zirconia discs were divided into five groups: unpolished (control, UNP) and polished with Brownie only (BRO), Brownie plus Greenie (BPG), Brownie plus Greenie plus Supergreenie (BGS), and CeraMaster Coarse plus CeraMaster polishing tips (CER). The samples were sterilized and immersed in unstimulated saliva, then incubated in a liquid suspension of Streptococcus gordonii (S gordonii). The number of attached bacteria were counted 48 hours after the diluted suspensions were inoculated. Data were analyzed with ANOVA and Tukey test (P < .05). For titanium discs, the average number of bacteria from each group (CFU/mm2) was 1.51 x 103 for UNP; 3.71 x 103 for BRO; 5.65 x 103 for BPG; 8.99 x 102 for BGS; and 8.49 x 102 for CER. For zirconia, the averages were 2.87 x 102 for UNP; 3.16 x 102 for BRO; 3.50 x 102 for BPG; 1.83 x 102 for BGS; and 8.73 x 101 for CER. Inadequate polishing roughens surfaces and promotes microbial adhesion to titanium and zirconia. Sequential polishing to the finest-finish polishing tips minimizes bacterial adherence to abutment surfaces. Zirconia exhibited less bacterial adhesion than titanium.