Tooth Age Impact on Dental Erosion Susceptibility and Treatment Efficacy.

This laboratory study investigated the impact of tooth age on dental erosion susceptibility and preventive treatment efficacy. Extracted human premolars were selected and had their age estimated (∼10-100 years old) using established dental forensic methods. Enamel and root dentin slabs were prepared, embedded in acrylic blocks, flattened, and polished. The specimens were randomly assigned to one of three treatments (n = 93): Sn+F (800 ppm Sn as SnCl2 and 250 ppm F as NaF, pH 4.5), NaF (250 ppm F, pH 4.5), or deionized water (DIW). Each specimen was subjected for 10 days to a daily cycling protocol consisting of six 5-min erosive challenges (0.3% citric acid, pH 2.6), six 60-min remineralization periods (artificial saliva), and three 2-min treatments with the test solutions. Surface loss (SL) was measured after 3, 5, and 10 days, using optical profilometry. Effects of tooth age, antierosive treatment, and time on SL were evaluated using linear mixed effects regression analysis. SL increased with age for all substrate-treatment-time combinations (p < 0.0001). Sn+F and NaF solutions significantly reduced SL compared to DIW, regardless of substrate, time, or age (p < 0.0001), with best results shown for Sn+F. Efficacy of Sn+F increased with tooth age on enamel, but tooth age did not affect the efficacy of NaF on enamel. For dentin, increased efficacy was observed with age after 5 (for Sn+F) and 10 days (for Sn+F and NaF). In conclusion, increase of tooth age rendered enamel and root dentin more susceptible to dental erosion. NaF preventive efficacy improved with tooth age for dentin, in advanced erosion simulation. Sn+F reduced enamel SL due to erosion regardless of tooth age.

Effect of lithium disilicate ceramic thickness, shade and translucency on transmitted irradiance and knoop microhardness of a light cured luting resin cement.

This in vitro study evaluates the influence of pressed lithium disilicate thickness, shade and translucency on the transmitted irradiance and the Knoop microhardness (KHN) of a light-cured resin cement at two depths. One hundred and thirty-five ceramic discs of IPS e.max Press (Ivoclar Vivadent) were fabricated and divided into twenty-seven groups (n = 5) according to the association between translucency: HT (hight translucency), LT (low translucency), and MO (medium opacity); shade: BL2, A1 and A3.5; and thickness: 0.5 mm, 1.5 mm, and 2.0 mm. One side of each ceramic disc was finished, polished and glazed. The irradiance (mW/cm²) of a multiwave LED light curing unit (Valo, Ultradent) was evaluated with a potentiometer (Ophir 10ª-V2-SH, Ophir Optronics) without (control group) or with interposition of ceramic samples. The microhardness of Variolink Esthetic LC resin cement (Ivoclar Vivadent) was evaluated after 24 h at two depths (100 µm and 700 µm). Data were submitted to ANOVA followed by Tukey's test (α = 0.05). Irradiance and KHN were significantly influenced by ceramic thickness (p < 0.0001), shade (p < 0.001), translucency (p < 0.0001) and depth (p < 0.0001). Conclusions: the interposition of increasing ceramic thicknesses significantly reduced the irradiance and microhardness of resin cement. Increased depth in the resin cement showed significantly reduced microhardness for all studied groups. Increased ceramic opacity reduced the KHN of the resin cement at both depths for all ceramic thicknesses and shades.

In Vitro Evaluation of Translucency and Color Stability of CAD/CAM Polymer-Infiltrated Ceramic Materials after Accelerated Aging.

PURPOSE: To investigate and compare the translucency and color stability of a newly introduced polymer-infiltrated ceramic network (PICN) material (Crystal Ultra) to those of clinically well-established restorative materials. MATERIALS AND METHODS: A total of 80 specimens measuring (12 × 14 × 1 mm ± 0.05 mm) were prepared from five CAD/CAM (IPS e.max (IPS), Lava Ultimate (LU), Cerasmart (CS), Vita Enamic (VE), Crystal Ultra (CU)) high translucency (HT) blocks in A2 or equivalent shades. Specimens were randomly allocated into two groups (A and B) (n = 8), and were subjected to 5,000 thermal-cycles (TC). This was followed by one-week immersion of group A specimens in coffee (staining) solution and group B specimens in distilled water. Following immersion, the specimens from both groups were further subjected to 5,000 TC. A spectrophotometer was used to measure the translucency parameter (TP) and color change (ΔE00 ) of the samples using CIELAB color coordinates at baseline, after 5,000 TC, following immersion, and after further 5,000 TC. Color stability was evaluated using the CIEDE2000 formula. Data were analyzed by non-parametric tests (α = 0.05). RESULTS: The TP values of the CAD/CAM materials ranged from 18.0-22.0. Following the initial TC, the changes in TP values were significant for VE (p = 0.012). Coffee immersion and further TC significantly impacted the TP values of PICN (VE and CU) materials compared to glass- ceramics (IPS), and resin nanoceramic (CS and LU) materials (p = 0.012). The comparison between CAD/CAM materials at different intervals showed a significant difference in the TP values (p < 0.01). The materials showed perceptible color changes following the initial TC except for PICN materials which demonstrated acceptable color changes. The major color difference was noticed for the resin nanoceramic specimens immersed in coffee; LU and CS showed higher color changes (ΔE00 = 2.45 and 2.09, respectively) than VE and CU (ΔE00 < 1.8). CONCLUSIONS: The translucency of the newly introduced Crystal Ultra PICN material was low compared to the resin nanoceramics and lithium disilicate glass-ceramic. The Crystal Ultra material exhibited better color stability compared to resin nanoceramics, but higher color change when compared with Vita Enamic PICN and lithium disilicate glass-ceramic CAD/CAM materials.

Clinical evaluation of a universal adhesive in non-carious cervical lesions.

OBJECTIVES: To compare the clinical performance of a universal adhesive in class V non-carious cervical lesions (NCCLs) using two surface treatment protocols (self-etch [SfE] vs selective-enamel-etch [SelE]). MATERIAL AND METHODS: Thirty-three adults, each with ≥2 NCCLs, received one resin composite restoration utilizing a SfE universal adhesive and another utilizing the adhesive and SelE with 37% phosphoric acid. Restorations were evaluated for sensitivity, retention, marginal discoloration, marginal adaptation, and clinical acceptability through 24 months using Cochran-Mantel-Haenszel tests for stratified, ordered categorical outcomes. RESULTS: Sixty-six restorations (35 SfE, 31 SelE; 27 volunteers) were evaluated at 24 months. There were no significant differences between SfE and SelE for sensitivity, retention, marginal adaptation, or clinical acceptability. One SfE restoration was lost. Marginal adaptation was significantly worse at 24 months than baseline for SelE (P = 0.01), but not for SfE. Marginal discoloration was significantly worse for SfE (P = 0.02), but not for SelE. Sensitivity improved from baseline to 24 months for both groups (SelE P = 0.004, SfE P = 0.002). CONCLUSIONS: Twenty-four-month data indicated significantly reduced sensitivity for both groups, worse marginal discoloration for SfE, and worse marginal adaptation for SelE. No changes in retention or clinical acceptability were observed in either group. All retained restorations were clinically acceptable at 24 months. CLINICAL SIGNIFICANCE: Both self-etch and selective enamel etch techniques with a universal adhesive produced clinically acceptable results in resin composite restorations for NCCLs over 2 years.

Polymerization pattern characterization within a resin-based composite cured using different curing units at two distances.

OBJECTIVES: To investigate the relationship of the irradiance-beam-profile areas from six different light-curing units (LCUs) with the degree of conversion (DC), microhardness (KH), and cross-link density (CLD) throughout a resin-based composite (RBC) cured at two clinically relevant distances, and to explore the correlations among them. MATERIALS AND METHODS: A mapping approach was used to measure DC using micro-Raman spectroscopy, KH using a Knoop indentor on a hardness tester, and %KH reduction after ethanol exposure, as an indicator for CLD within a nano-hybrid RBC increment (n = 3) at various depths. These sample composites were cured from two distances while maintaining the radiant exposure, using six different light-curing units: one quartz-tungsten-halogen; two single and three multiple-emission-peak light-emitting-diode units. Irradiance beam profiles were generated for each LCU at both distances, and localized irradiance values were calculated. Points across each depth were analyzed using repeated measures ANOVA. Correlations across multiple specimen locations and associations between beam uniformity corresponding with polymerization measurements were calculated using linear mixed models and Pearson correlation coefficients. RESULTS: Significant non-uniform polymerization patterns occurred within the specimens at various locations and depths. At 2-mm curing distance, the localized DC = 52.7-76.8%, KH = 39.0-66.7 kg/mm2, and %KH reduction = 26.7-57.9%. At 8-mm curing distance, the localized DC = 50.4-78.6%, KH = 40.3-73.7 kg/mm2, and %KH reduction = 28.2-56.8%. The localized irradiance values were weakly correlated with the corresponding DC, KH, and %KH reduction, with only a few significant correlations (p < 0.05). CONCLUSIONS: Although significant differences were observed at each depth within the specimens, the localized irradiance values for all LCUs did not reflect the polymerization pattern and did not seem to have a major influence on polymerization patterns within the RBC, regardless of the curing distance. CLINICAL RELEVANCE: Commonly used LCUs do not produce uniform polymerization regardless of the curing distance, which may contribute to the risk of RBC fracture.

Bleaching of simulated stained-remineralized caries lesions in vitro.

OBJECTIVE: Non-invasive esthetic treatment options for stained arrested caries lesions have not been explored. This study aimed to develop laboratory models to create stained-remineralized caries-like lesions (s-RCLs) and to test the efficacy of bleaching on their esthetic treatment. MATERIALS AND METHODS: One hundred twelve enamel/dentin specimens were prepared from human molars, embedded, and had their color measured spectrophotometrically at baseline and after demineralization. They were randomly divided into four groups (n = 14) based on the staining/remineralization protocols for a total of 5 days: G1, no staining/no remineralization; G2, no staining/remineralization in artificial saliva (AS); G3, non-metallic staining/remineralization with sodium fluoride/AS; and G4, metallic staining/remineralization with silver diamine fluoride/AS. The lesion mineral loss (ΔZ) and depth (L) were measured using transverse microradiography along with color change (ΔE). Specimens were bleached and color was re-evaluated. Data were analyzed using ANOVA models followed by Fisher's PLSD tests (α = 0.05). RESULTS: s-RCLs in G4 were significantly (p < 0.001) darker than G3, G2, and G1 regardless of substrate type and condition. s-RCLs in G2, G3, and G4 showed significantly lower ΔZ and L than G1 (all p < 0.001), confirming occurrence of remineralization. G4 exhibited significantly lower ΔZ and L compared to G2 (p < 0.001). Bleaching was more effective in non-metallic than in metallic stained lesions regardless of substrate type (p < 0.001). CONCLUSION: The proposed models created distinct s-RCLs. Non-metallic s-RCLs were lighter and more responsive to bleaching compared to metallic s-RCLs. CLINICAL RELEVANCE: The developed experimental models allow the further investigation of the efficacy and safety of different clinical strategies for the esthetic management of s-RCLs.

Doxycycline-loaded nanotube-modified adhesives inhibit MMP in a dose-dependent fashion.

OBJECTIVES: This article evaluated the drug loading, release kinetics, and matrix metalloproteinase (MMP) inhibition of doxycycline (DOX) released from DOX-loaded nanotube-modified adhesives. DOX was chosen as the model drug, since it is the only MMP inhibitor approved by the U.S. Food and Drug Administration. MATERIALS AND METHODS: Drug loading into the nanotubes was accomplished using DOX solution at distinct concentrations. Increased concentrations of DOX significantly improved the amount of loaded DOX. The modified adhesives were fabricated by incorporating DOX-loaded nanotubes into the adhesive resin of a commercial product. The degree of conversion (DC), Knoop microhardness, DOX release kinetics, antimicrobial, cytocompatibility, and anti-MMP activity of the modified adhesives were investigated. RESULTS: Incorporation of DOX-loaded nanotubes did not compromise DC, Knoop microhardness, or cell compatibility. Higher concentrations of DOX led to an increase in DOX release in a concentration-dependent manner from the modified adhesives. DOX released from the modified adhesives did not inhibit the growth of caries-related bacteria, but more importantly, it did inhibit MMP-1 activity. CONCLUSIONS: The loading of DOX into the nanotube-modified adhesives did not compromise the physicochemical properties of the adhesives and the released levels of DOX were able to inhibit MMP activity without cytotoxicity. CLINICAL SIGNIFICANCE: Doxycycline released from the nanotube-modified adhesives inhibited MMP activity in a concentration-dependent fashion. Therefore, the proposed nanotube-modified adhesive may hold clinical potential as a strategy to preserve resin/dentin bond stability.

Effects of Simulated Gastric Juice on CAD/CAM Resin Composites-Morphological and Mechanical Evaluations.

PURPOSE: To evaluate the effects of simulated gastric juice on CAD/CAM resin composites by means of morphological and mechanical (i.e., hardness) evaluations. MATERIALS AND METHODS: Fourteen specimens of each resin composite (Lava Ultimate and Paradigm MZ100) were prepared according to the manufacturer's instructions. They were submitted to erosive challenges in a simulated gastric juice (pH = 1.2) solution for 6 and 24 hours. Vickers microhardness and surface roughness (Ra , Rq ) evaluations were taken before (baseline) and after acid exposure. Morphological analysis was obtained using scanning electron microscopy (SEM). Statistical analysis was performed using two-way repeated measures ANOVA and Student-Newman-Keuls's test (α = 0.05). RESULTS: Paradigm MZ100 demonstrated higher microhardness than Lava Ultimate regardless of the storage time period (p ≤ 0.001), and microhardness was not affected by the acidic challenge (p = 0.58). After 6 hours of acid exposure, a significant decrease in Ra and Rq was seen for Paradigm MZ100 when compared to the baseline (Ra p = 0.032; Rq p = 0.013); however, for Lava Ultimate only Rq decreased (p = 0.021), while Ra remained unchanged (p = 0.38). After 24 hours of acid exposure, while Paradigm MZ100 exhibited no additional changes in surface roughness (p ≥ 0.75), Lava Ultimate became rougher (Ra p = 0.041; Rq p = 0.014), as confirmed by SEM imaging. CONCLUSIONS: The acidic scenario tested in the present study changed the surface roughness of the resin composites but not their Vickers microhardness. Moreover, both resin composites seem suitable for use under acidic scenarios, although Paradigm MZ100 showed enhanced stability compared to Lava Ultimate.

Evaluation of selected properties of a new root repair cement containing surface pre-reacted glass ionomer fillers.

OBJECTIVE: This study evaluated selected properties of a prototype root repair cement containing surface pre-reacted glass ionomer fillers (S-PRG) in comparison to mineral trioxide aggregate (MTA) and intermediate restorative material (IRM). MATERIALS AND METHODS: The antibacterial effect of S-PRG, MTA, and IRM cements was tested against Porphyromonas gingivalis and Enterococcus faecalis after 1 and 3 days of aging of the cements. The set cements were immersed in distilled water for 4 h to 28 days, and ion-releasing ability was evaluated. Initial and final setting times of all cements were evaluated using Gilmore needles. The push-out bond strength between radicular dentin and all cements was tested at different levels of the roots. RESULTS: S-PRG and IRM cements, but not MTA cement, demonstrated significant antibacterial effect against P. gingivalis. All types of cements exhibited significant antibacterial effect against E. faecalis without being able to eliminate the bacterium. S-PRG cement provided continuous release of fluoride, strontium, boron, sodium, aluminum, and zinc throughout all tested time points. Both initial and final setting times were significantly shorter for S-PRG and IRM cements in comparison to MTA. The push-out bond strength was significantly lower for S-PRG cement in comparison to MTA and IRM at coronal and middle levels of the roots. CONCLUSIONS: S-PRG cement demonstrated significant antibacterial effects against endodontic pathogens, multiple ion-releasing ability, relatively short setting time, and low bonding strength. CLINICAL RELEVANCE: S-PRG cement can be used as a one-visit root repair material with promising antibacterial properties and ion-releasing capacity.

A Systematic Review of Recall Regimen and Maintenance Regimen of Patients with Dental Restorations. Part 2: Implant-Borne Restorations.

PURPOSE: To evaluate the current scientific evidence on patient recall and maintenance of implant-supported restorations, to standardize patient care regimens and improve maintenance of oral health. An additional purpose was to examine areas of deficiency in the current scientific literature and provide recommendations for future studies. MATERIALS AND METHODS: An electronic search for articles in the English language literature from the past 10 years was performed independently by multiple investigators using a systematic search process. After application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed to meet the objectives of this review. RESULTS: The initial electronic search resulted in 2816 titles. The systematic application of inclusion and exclusion criteria resulted in 14 articles that satisfied the study objectives. An additional 6 articles were added through a supplemental search process for a total of 20 studies. Of these, 11 were randomized controlled clinical trials, and 9 were observational studies. The majority of the studies (15 out of 20) were conducted in the past 5 years and most studies were conducted in Europe (15), followed by Asia (2), South America (1), the United States (1), and the Middle East (1). Results from the qualitative data on a combined 1088 patients indicated that outcome improvements in recall and maintenance regimen were related to (1) patient/treatment characteristic (type of prosthesis, type of prosthetic components, and type of restorative materials); (2) specific oral topical agents or oral hygiene aids (electric toothbrush, interdental brush, chlorhexidine, triclosan, water flossers) and (3) professional intervention (oral hygiene maintenance, and maintenance of the prosthesis). CONCLUSIONS: There is minimal evidence related to recall regimens in patients with implant-borne removable and fixed restorations; however, a considerable body of evidence indicates that patients with implant-borne removable and fixed restorations require lifelong professional recall regimens to provide biological and mechanical maintenance, customized for each patient. Current evidence also demonstrates that the use of specific oral topical agents and oral hygiene aids can improve professional and at-home maintenance of implant-borne restorations. There is evidence to demonstrate differences in mechanical and biological maintenance needs due to differences in prosthetic materials and designs. Deficiencies in existing evidence compel the forethought of creating clinical practice guidelines for recall and maintenance of patients with implant-borne dental restorations.

A Systematic Review of Recall Regimen and Maintenance Regimen of Patients with Dental Restorations. Part 1: Tooth-Borne Restorations.

PURPOSE: To evaluate the current scientific evidence on patient recall and maintenance of dental restorations on natural teeth, standardize patient care regimens, and improve maintenance of oral health. An additional purpose was to examine areas of deficiency in the current scientific literature and provide recommendations for future studies. MATERIALS AND METHODS: An electronic search for articles in the English language literature from the past 15 years was performed independently by multiple investigators using a systematic search process. After application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed in depth to meet the objectives of this review. RESULTS: The initial electronic search resulted in 2161 titles. The systematic application of inclusion and exclusion criteria resulted in 12 articles that met the objectives of the study. An additional 4 articles were added through a supplemental search process for a total of 16 studies. Out of these, 9 were randomized controlled clinical trials and 7 were observational studies. The majority of the studies (14 out of 16) were conducted in the past 5 years, and most of the studies were conducted in Europe (10). Results from the qualitative data, on a combined 3569 patients, indicated that outcome improvements in recall and maintenance regimen were related to (1) patient/treatment characteristics (adherence to recall appointments, type of restoration and type of restorative material); (2) agent (chlorhexidine, fluoride, triclosan); and (3) professional interventions (repeated oral hygiene instruction, regular oral hygiene intervention). CONCLUSIONS: There is minimal evidence related to recall regimens in patients with removable and fixed tooth-borne restorations; however, there is considerable evidence indicating that patients with tooth-borne removable and fixed restorations require lifelong dental professional maintenance to provide repeated oral hygiene instruction and regular oral hygiene intervention customized to each patient's treatment. Current evidence also indicates that use of specific oral topical agents like chlorhexidine, fluoride, and triclosan can aid in reducing risk for gingival inflammation, dental caries, and candidiasis. Therefore, these agents may aid in improvement of professional and at-home maintenance of various tooth-borne dental restorations. Furthermore, due to the heterogeneity of patient populations, restorations, and treatment needs, the evidence compels forethought of creating clinical practice guidelines for recall and maintenance of patients with tooth-borne dental restorations.

Clinical Practice Guidelines for Recall and Maintenance of Patients with Tooth-Borne and Implant-Borne Dental Restorations.

PURPOSE: To provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne removable and fixed restorations. MATERIALS AND METHODS: The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association (ADA), Academy of General Dentistry (AGD), and American Dental Hygienists Association (ADHA) who critically evaluated and debated recently published findings from two systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a round table discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained. RESULTS: A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised (1) patient recall, (2) professional maintenance, and (3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations. CONCLUSIONS: The clinical practice guidelines presented in this document were initially developed using the two systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility, and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations.

The purpose of this article is to provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne removable and fixed restorations. The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association, Academy of General Dentistry, and American Dental Hygienists Association, who critically evaluated and debated recently published findings from 2 systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a roundtable discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained. A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised (1) patient recall, (2) professional maintenance, and (3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations. The clinical practice guidelines presented in this document were initially developed using the 2 systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility, and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

Halloysite nanotube incorporation into adhesive systems­effect on bond strength to human dentin.

OBJECTIVES: This study aimed to evaluate the effect of Halloysite® aluminosilicate clay nanotube (HNT) incorporation into a two-step etch-and-rinse (ER) and a one-step self-etch (SE) adhesive on human dentin shear bond strength (SBS). MATERIALS AND METHODS: Ten groups (n = 12) were prepared according to the adhesive system (i.e., ER or SE) and amount of HNT incorporated (5-20%, w/v), as follows: commercial control (i.e., the adhesive was used as purchased, 0% HNT); experimental control (i.e., the adhesive was processed through mixing/stirring and sonication similarly to the HNT-incorporated experimental groups, but without HNT); and 5, 10, and 20% HNT. SBS testing was performed after 24 h of storage in deionized water at 37 °C. Failure modes were examined using a stereomicroscope (×40). Scanning electron microscopy (SEM) of the resin-dentin interface of selected specimens was carried out. RESULTS: Two-way ANOVA revealed that incorporation of HNT up to 20% (w/v) in ER and up to 10% (w/v) in SE demonstrated an increased SBS compared to their experimental controls. Compared to the commercial control, SBS of HNT-modified dentin adhesives was not significantly different for ER adhesives (p > 0.05) but was significantly higher with 5% HNT in the SE adhesive (p < 0.05). Failure modes were predominantly adhesive and mixed failures. SEM micrographs of resin-dentin interfaces for ER-commercial control and ER-10% showed a similar morphology. A thicker adhesive layer and the presence of agglomerated HNT on the resin tags were seen in ER-10%. An increased number of short resin tags in SE-5% compared with SE-commercial control were observed. CONCLUSIONS: HNT addition up to 20% in ER and up to 10 % in SE showed increased SBS to dentin compared with the experimental control. CLINICAL RELEVANCE: HNT can be used not only to reinforce adhesive resins but also hold potential for the development of bioactive adhesives by the encapsulation of matrix metalloproteinase (MMP) inhibitors or anticariogenic agents.

The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm.

OBJECTIVES: To investigate the effect of various dilutions of antibiotic medicaments used in endodontic regeneration on the survival of human dental pulp stem cells (DPSCs) and to determine their antibacterial effect against established Enterococcus faecalis biofilm. MATERIALS AND METHODS: The cytotoxic and antibacterial effects of different triple (TAP) and double antibiotic paste (DAP) dilutions (0.125, 0.25, 0.5, 1, and 10 mg/ml) were tested against Enterococcus faecalis established biofilm and DPSC. Established bacterial biofilm were exposed to antibiotic dilutions for 3 days. Then, biofilms were collected, spiral plated, and the numbers of bacterial colony forming units (CFU/ml) were determined. For the cytotoxic effect, lactate dehydrogenase activity assays (LDH) and cell viability assays (WST-1) were used to measure the percentage of DPSC cytotoxicity after 3-day treatment with the same antibiotic dilutions. A general linear mixed model was used for statistical analyses (α = 0.05). RESULTS: All antibiotic dilutions significantly decreased the bacterial CFU/ml. For WST-1 assays, all antibiotic dilutions except 0.125 mg/ml significantly reduced the viability of DPSC. For LDH assays, the three lowest tested concentrations of DAP (0.5, 0.25, 0.125 mg/ml) and the two lowest concentrations of TAP (0.25 and 0.125 mg/ml) were non-toxic to DPSC. CONCLUSIONS: All tested dilutions had an antibacterial effect against E. faecalis. However, 0.125 mg/ml of DAP and TAP showed a significant antibacterial effect with no cytotoxic effects on DPSCs. CLINICAL RELEVANCE: Using appropriate antibiotic concentrations of intracanal medicament during endodontic regeneration procedures is critical to disinfect root canal and decrease the adverse effects on stem cells.

The effects of radicular dentine treated with double antibiotic paste and ethylenediaminetetraacetic acid on the attachment and proliferation of dental pulp stem cells.

AIM: This study explored the effects of dentine treated with two concentrations of double antibiotic paste (DAP) and ethylenediaminetetraacetic acid (EDTA) on the attachment and proliferation of dental pulp stem cells (DPSCs). MATERIALS AND METHODS: Radicular dentine samples were prepared with identical dimensions and randomized into six groups (n = 4). Four groups were treated with double antibiotic paste (DAP) at concentrations of 500 mg ml(-1) or 1 mg ml(-1) with or without EDTA. The other two groups were treated with EDTA only or received no treatment. DPSCs were seeded on each dentine sample (10 000 cells per sample). Lactate dehydrogenase activity assays were used to calculate the attached DPSCs after 1 day of incubation. Water soluble tetrazolium assays were performed to investigate DPSCs proliferation on the treated dentine samples after three additional days of incubation. Two-way anova followed by Tukey-Kramer tests was used for statistical analyses (α = 0.05). RESULTS: Dentine treated with 1 or 500 mg ml(-1) of DAP followed by EDTA caused significant increases in DPSCs attachment compared to the dentine treated with the DAP alone. The 500 mg ml(-1) of DAP with or without EDTA caused significant reductions in DPSCs proliferation. However, the treatment of dentine with 1 mg ml(-1) of DAP did not have significant negative effects on DPSCs proliferation regardless of the use of EDTA. CONCLUSION: The use of 1 mg ml(-1) of DAP followed by 10 min of irrigation with EDTA in endodontic regeneration procedure may have no negative effects on the attachment and proliferation of DPSCs.

A novel approach to evaluate the effect of medicaments used in endodontic regeneration on root canal surface indentation.

OBJECTIVES: The aim of this study was to investigate the capability of a novel reference point indentation apparatus to test the indentation properties of root canal surface dentine treated with three intracanal medicaments used in endodontic regeneration. MATERIALS AND METHODS: Immature human premolars were selected (n = 22). Four specimens were obtained from each root and randomly assigned to three treatment groups and a control group. Each specimen was exposed to one of the three treatment pastes (triple antibiotic (TAP), double antibiotic (DAP), or calcium hydroxide (Ca(OH)2)) or neutral deionized water (control) for 1 or 4 weeks. After each time interval, the indentation properties of the root canal dentine surfaces were measured using a BioDent reference point indenter. Two-way ANOVA and Fisher's protected least significant differences were used for statistical analyses. RESULTS: Significant differences in indentation parameters and estimated hardness between all groups at both time points were found. TAP-treated dentine had the highest significant indentation parameters, followed by DAP-treated dentine, untreated control dentine, and Ca(OH)2-treated dentine, respectively. Furthermore, TAP-treated dentine had the lowest significant estimated hardness, followed by DAP-treated dentine, untreated control dentine, and Ca(OH)2-treated dentine, respectively. CONCLUSION: BioDent reference point indenter was able to detect significant differences in indentation properties of root canal dentine treated with various medicaments. CLINICAL RELEVANCE: The use of a reference point indenter is a promising approach to characterize the indentation properties of root canal surfaces without any surface modification. This might provide an in vitro mechanical measurement that is more representative of the actual clinical situation.

Influence of zirconia surface treatment on veneering porcelain shear bond strength after cyclic loading.

STATEMENT OF PROBLEM: The influence of yttria-stabilized tetragonal zirconia polycrystal surface treatment on veneering porcelain shear bond strength after cyclic loading is not fully understood. PURPOSE: The purpose of this study was to investigate the influence of yttria-stabilized tetragonal zirconia polycrystal surface treatment on veneering porcelain shear bond strength and cyclic loading on the shear bond strength between the 2 materials. MATERIAL AND METHODS: A total of 48 cylinder-shaped yttria-stabilized tetragonal zirconia polycrystal specimens were fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM), sintered for 8 hours at 1500°C, ground with 320-grit diamond paper, and divided into 4 groups (n = 12) according to surface treatment as follows: no treatment/control; heat treatment of 650°C to 1000°C at 55°C/min; airborne-particle abrasion with 50-µm alumina at 0.4 MPa pressure for 10 seconds; or heat treatment after abrasion. A veneering porcelain cylinder was built and fired on the prepared yttria-stabilized tetragonal zirconia polycrystal specimens. The shear bond strength was tested with a universal testing machine. Six specimens from each group were subjected to cyclic loading (10000 cycles, 1.5 Hz, 10 N load) before testing. RESULTS: The mean ± SD ranged from 10.7 ± 15.4 to 34.1 ± 10.0. Three-way ANOVA found no statistically significant (P > .05) effect of surface treatment and cyclic loading on shear bond strength. The Sidak multiple comparisons procedure found that cyclic loading specimens had significantly lower shear bond strength than noncyclic loading specimens after airborne-particle abrasion without heat treatment (P = .013). CONCLUSIONS: Within the limitations of this study, the shear bond strength between yttria-stabilized tetragonal zirconia polycrystal and veneering porcelain was not significantly affected by surface treatment. Airborne-particle abrasion without subsequent heat treatment should be avoided as a surface treatment in fabrication methods.

The direct cytotoxic effects of medicaments used in endodontic regeneration on human dental pulp cells.

AIM: The purpose of this in vitro study was to evaluate the effects of intracanal medicaments commonly used in endodontic regeneration on the survival of human dental pulp cells (DPCs). METHODS: DPCs were cultured and exposed to either no medicament treatment or low concentrations (0.3-5 mg ml(-1) ) of calcium hydroxide [Ca(OH)2 ], triple antibiotic paste (TAP), or double antibiotic paste (DAP) for 3 days. After that, toxicity to the DPCs was determined by lactate dehydrogenase activity assays (LDH) and cell proliferation was measured by colorimetric assays (WST-1). Two-way anova followed by Fisher's protected least significant differences was used for statistical analyses (α = 0.05). RESULTS: The group-by-concentration interactions were significant for the LDH and WST-1 assays (P < 0.0001). For the LDH assays, only the highest tested concentration (5 mg ml(-1) ) of Ca(OH)2 and TAP caused significant toxicity to the DPCs compared with the untreated control, while four tested concentrations of DAP (0.5, 1, 2.5, and 5 mg ml(-1) ) caused significant toxicity to the DPCs compared with the untreated control. For the WST-1 assays, the highest concentrations that did not negatively affect the proliferation rate of DAP, TAP and Ca(OH)2 were 0.3, 2, and 2.5 mg ml(-1) , respectively. CONCLUSION: The low concentrations of intracanal medicaments tested in this study were not cytotoxic in cultured cells. However, these concentrations are much lower than the concentrations that have been advocated in endodontic regeneration. Furthermore, the negative effects of TAP on DPCs were detected at lower concentrations by using the WST-1 assays than by measuring the LDH release.

A comparative study of the accuracy between plastic and metal impression transfer copings for implant restorations.

PURPOSE: A precise transfer of the position and orientation of the antirotational mechanism of an implant to the working cast is particularly important to achieve optimal fit of the final restoration. This study evaluated and compared the accuracy of metal and plastic impression copings for use in a full-arch mandibular edentulous simulation with four implants. MATERIALS AND METHODS: Metal and plastic impression transfer copings for two implant systems, Nobel Biocare™ Replace and Straumann SynOcta®, were assessed on a laboratory model to simulate clinical practice. The accuracy of producing stone casts using these plastic and metal impression transfer copings was measured against a standard prosthetic framework consisting of a cast gold bar. A total of 20 casts from the four combinations were obtained. The fit of the framework on the cast was tested by a noncontact surface profilometer, the Proscan 3D 2000 A, using the one-screw test. The effects of implant/system and impression/coping material on gap measurements were analyzed using repeated measures ANOVA. RESULTS: The findings of this in vitro study were as follows: plastic copings demonstrated significantly larger average gaps than metal for Straumann (p = 0.001). Plastic and metal copings were not significantly different for Nobel (p = 0.302). Nobel had significantly larger average gaps than Straumann for metal copings (p = 0.003). Nobel had marginally smaller average gaps than Straumann (p = 0.096) for plastic copings. The system-by-screw location interaction was significant as well (p < 0.001), indicating significant differences among the four screw locations, but the location differences were not the same for the two systems. A rank transformation of the data was necessary due to the nonnormal distribution of the gap measurements. No adjustments were made for multiple comparisons. CONCLUSIONS: The metal impression copings were more accurate than plastic copings when using the Straumann system, and there was no difference between metal and plastic copings for the Nobel Replace system. The system-by-screw location was not conclusive, showing no correlation within each system.