Risk assessment of predicted serum concentrations of bisphenol A in children and adults following treatment with dental composite restoratives, dental sealants, or orthodontic adhesives using physiologically based pharmacokinetic modeling.

Bisphenol A (BPA) is a chemical used to manufacture bisphenol A glycidyl methacrylate (BisGMA). BisGMA has been used for decades in dental composite restoratives, sealants, and adhesives. Based on published studies, exposure to low concentrations of BPA are possible from dental and orthodontic devices. The serum BPA concentrations arising from such devices and oral doses were predicted using a PBPK model in children and adult females based on 1) published extraction data for cured and uncured 3M ESPE Filtek Supreme Ultra Flowable, 3M ESPE Filtek Bulk Fill Restorative, and 3M ESPE Clinpro Sealant and 2) published 20% ethanol/water and water rinsate data following orthodontic application with 3M ESPE Transbond MIP Primer and 3M ESPE Transbond XT Adhesive. Predicted oral exposure to BPA arising from these dental and orthodontic devices is low (median <10 ng/treatment) and predicted serum BPA concentrations were also low (<10-4 nM). Even the maximum predicted exposure in this study (533.2 ng/treatment) yields a margin of exposure of 7.5 relative to the EFSA t-TDI (4 µg/kg-day) and is only 2.8% of the daily BPA exposure for the US population in a 58-kg woman (15,660 ng/day). Therefore, the exposure to BPA arising from the 3M ESPE dental and orthodontic devices evaluated in this study is negligible relative to daily BPA exposure in the general population and these potential BPA sources do not constitute a risk to patients.

SDR® vs traditional composite in class II restorations in primary molars.

This study aims to compare the clinical characteristics of a new flowable resin-based composite with those of a traditional composite when applied to deciduous molars for class II restorations. Twentyeight children between 6-12 years of age, with paired minimal Class II cavities present on their primary molars, were chosen. The paired cavities were restored with either a microhybrid composite or a new flowable resin-based composite. The composites were assigned to cavities in either the right or left side of the mouth, using random allocation tables. Each pair of restorations were clinically assessed at sixmonth intervals following the United States Public Health Service criteria. The prevalence of carious lesions was higher in maxillar molars (53.6%) compared to the mandibular molars (46.4%). At 24 months, Charlie or Delta scores in the paired groups were not seen in any patient, thus demonstrating a clinical success. The statistical analysis using Pearson’s chi-squared test did not reveal significant p-values for any parameter except the proximal contact showing significant p-values for this parameter. SDR appears to be the material of choice for the restoration of deciduous teeth due to its clinical features shown at 24 months as well as its ease and speed of application.

Digital intraoral scanning technique for edentulous jaws.

Few studies have evaluated direct digital scans of edentulous jaws using intraoral scanners because it is difficult to scan edentulous sites that are smooth and devoid of features. A scanning technique is introduced for making direct digital scans of edentulous jaws with intraoral scanners in patients with a broad palate.

Porosity of flowable resin composites is not influenced by applicator tip diameter.

PURPOSE: To assess the influence of applicator tip diameter on the inclusion of porosities in three different flowable resin composites. METHODS: The initial porosity of three syringes [Filtek Supreme XTE Flowable (XTE), Grandio Flow (GRF), Gradia Direct Flo (GDF)] was determined by 3D tomography. 25 samples per syringe, i.e. 75 samples in total, were prepared using five applicator tips of different diameters (n= 5). The porosity of the 75 samples was assessed by 3D tomography. RESULTS: For each of the materials, the applicator tips, irrespective of type, all generated an increase in the average porosity percentage compared to the initial porosity of the syringes. For XTE and GRF, the applicator tips, irrespective of type, all generated a decrease in the average porosity volume compared to the initial average porosity volume in their respective syringes. Conversely, for GDF the average porosity volume of the samples was increased. Furthermore, for each of the materials, varying the diameter of the applicator tips had no significant influence on the porosity percentage and volume. Using the present study conditions, the applicator tip generated a variation in the initial porosity of the materials; however, the diameter of the tip had no influence on said variation. CLINICAL SIGNIFICANCE: It appears that practitioners can choose an applicator tip with a diameter that best suits the size and shape of the cavity to be filled using a syringe of flowable resin composite without this having any impact on the percentage and volume of porosities in the final filling of the cavity.

Microcomputed tomographic comparison of posterior composite resin restorative techniques: sonicated bulk fill versus incremental fill.

Sonication technology has recently been touted to decrease composite viscosity during delivery and may allow better cavity preparation adaptation and minimize voids. The purpose of this investigation was to evaluate the difference between conventional, hand-placed, incremental application of a standard hybrid resin-based composite (RBC) and sonicated application of a bulk-fill RBC in box-type and cylindrical cavity preparations. Experimental restorations were fabricated using molds of box-type or cylindrical preparations. For bulk-filled specimens, a single compule of bulk-fill composite was dispensed with a sonic handpiece. The conventional hybrid material was placed in 3 increments (2 mm, 2 mm, and 1 mm). Microfocus x-ray computed tomography was used to analyze voids for percentage and total volume porosity as well as number of actual pores. An analysis of variance indicated that RBC restorations that were applied to cylindrical cavities using a sonicated bulk-filled application method exhibited significantly less porosity (1.42%; P < 0.001) than incrementally placed cylindrical restorations (2.87%); sonicated bulk-filled, cube-shaped restorations (3.12%); and incrementally placed cube-shaped restorations (5.16%). When the groups were subcategorized into the specific characteristics of shape (cube vs cylinder) and application method (bulk vs incremental), the cylindrical group, which included both bulk-filled and incrementally placed specimens, demonstrated significantly less porosity (2.00%; P < 0.001) than other groups. Restorations that were incrementally placed into cube-shaped cavities produced the largest amount of porosity.

Evaluation of marginal integrity of four bulk-fill dental composite materials: in vitro study.

OBJECTIVE: The aim of the study was to compare under in vitro conditions marginal sealing of 4 different bulk-fill materials composite restorations of class II. METHODS: Comparative evaluation concerned 4 composites of a bulk-fill type: SonicFill, Tetric EvoCeram Bulk Fill, Filtek Bulk Fill, and SDR. The study used 30 third molars without caries. In each tooth 4 cavities of class II were prepared. The prepared tooth samples were placed in a 1% methylene blue solution for 24 h, and after that in each restoration the depth of dye penetration along the side walls was evaluated. RESULTS: The highest rating (score 0, no dye penetration) was achieved by 93.33% of the restorations made of the SDR material, 90% of restorations of SonicFill system, 86.66% of restorations of the composite Filtek Bulk Fill, and 73.33% of restorations of the Tetric EvoCeram Bulk Fill. CONCLUSION: The performed study showed that bulk-fill flowable or sonic-activated flowable composite restorations have better marginal sealing (lack of discoloration) in comparison with bulk-fill paste-like composite.

[The experience of using Filtek Bulk Fill (3M ESPE) - the advantages of bulk fill flowable restoratives].

The paper presents clinical cases illustrating the advantages of bulk fill flowable restoratives, such as Filtek Bulk Fill (3M ESPE). The material showed good clinical results for class I and class II restorations.

Effect of composite insertion technique on cuspal deflection using an in vitro simulation model.

OBJECTIVE: The objective of this study was to investigate, by simulation, the effect of conventional composite resin insertion techniques on cuspal deflection using bonded typodont artificial teeth. The deflection produced by a new low-shrinkage composite was also determined. MATERIALS AND METHODS: Sixty standardized MOD preparations on ivorine maxillary premolars were prepared: group A at 4 mm depth and group B at 6 mm depth. Each group was further subdivided according to composite insertion technique (n=6), as follows: 1) bulk insertion, 2) horizontal increments, 3) tangential increments, and 4) a modified tangential technique. Preparations were microetched, acid-cleaned, and bonded with adhesive resin to provide micromechanical attachment before restoration with a conventional composite (Spectrum TPH( 3 ), Dentsply). Two additional subgroups at 4 mm and 6 mm depth (n=6) were restored in bulk using low-shrinkage composite (Filtek LS, 3M/ESPE). All groups received the same total photo-polymerization time. Cuspal deflection was measured during the restorative procedure using two Linear Variable Differential Transformers attached to a data acquisition system. RESULTS: The average cuspal deflections for group A were 1) 40.17 ± 1.18 µm, 2) 25.80 ± 4.98 µm, 3) 28.27 ± 5.12 µm, and 4) 27.33 ± 2.42 µm. The deflections in group B were 1) 38.82 ± 3.64 µm, 2) 50.39 ± 9.17 µm, 3) 55.62 ± 8.16 µm, and 4) 49.61 ± 8.01 µm. Cuspal flexure for the low-shrinkage composite was 11.14 ± 1.67 µm (group A: 4 mm depth) and 16.53 ± 2.79 µm (group B: 6 mm depth). CONCLUSIONS: All insertion techniques using conventional composite caused cuspal deformation. In general, deeper preparations showed increased cuspal deflection-except in the case of bulk insertion, which was likely affected by decreased depth of cure. Cuspal movement using low-shrinkage composite was significantly reduced.

Penetration depths of an infiltrant into proximal caries lesions in primary molars after different application times in vitro.

BACKGROUND: Caries infiltration aims to inhibit lesion progression, by occluding the porosities within the lesion body with low-viscosity resins. The ability in hampering lesion progression is correlated with the penetration depth (PD) of the infiltrant. AIM: This study aimed to compare the infiltration depths into proximal lesions in primary molars after different application times. DESIGN: Noncavitated natural caries lesions (n = 83) were etched with 15% HCl for 2 min and infiltrated for 0.5, 1, 3, or 5 min. Specimens were sectioned and PD at the maximum lesion depth (LD(max)) were analysed using dual fluorescence confocal microscopy. RESULTS: Percentage penetrations (PD/LD(max)) were significantly higher after 3 or 5 min compared with 0.5-min application (P < 0.05; Mann-Whitney test). For LD(max) <400 µm, no significant differences were observed between application times (P > 0.05). For LD(max) ≥400 µm, 3- and 5-min application resulted in significantly deeper infiltration compared with 0.5 min (P < 0.05). After 1-min application, PD was significantly lower than 5 min (P < 0.05), PD/LD(max) did not differ from all other groups (P > 0.05). CONCLUSIONS: Natural noncavitated proximal lesions in primary molars were deeply infiltrated after 1-min application in vitro. For deeper lesions, however, more consistent results were obtained after 3 min.

Modern high powered led curing lights and their effect on pulp chamber temperature of bulk and incrementally cured composite resin.

Pulpal temperature changes induced by modern high powered light emitting diodes (LEDs) are of concern when used to cure composite resins. This study showed an increase in pulp chamber temperature with an increase in power density for all light cure units (LCU) when used to bulk cure composite resin. Amongst the three LEDs tested, the Elipar Freelight-2 recorded the highest temperature changes. Bulk curing recorded a significantly larger rise in pulp chamber temperature change than incrementally cured resin for all light types except for the Smartligh PS. Both the high powered LED and the conventional curing units can generate heat. Though this temperature rise may not be sufficient to cause irreversible pulpal damage, it would be safer to incrementally cure resins.

Integrated risk assessment of a hydroxyapatite-protein-composite for use in oral care products: a weight-of-evidence case study.

Risk assessment of cosmetic ingredients represents a regulatory standard requirement in Europe and other regions. An integrated approach was designed to assess the safety of HPC, a particulate composite of hydroxyapatite and protein (gelatin) for use in oral care products, employing a weight-of-evidence assessment and considering specific physico-chemical properties and exposure conditions. An initial evaluation of the constituents suggested that their chemical nature does not represent a particular health hazard per se. Hydroxyapatite is the main component of teeth and bones in mammals; gelatin is used in food and assumed to be safe once a BSE/TSE risk has been excluded. In vitro screening tests were chosen to further evaluate the biocompatibility: Hen's egg test-chorioallantoic membrane (HET-CAM) to assess irritating effects towards mucous membranes; MTT cytotoxicity test with 3T3 fibroblasts; human corneal epithelial models to investigate inflammatory mediators and cytotoxicity; macrophage assays to measure cytotoxicity, inflammatory mediators and oxidative stress. Together with results from clinical studies, exposure estimates and analyses of kinetic properties, the presented information provides sound evidence to support the safe use of HPC. This is an example of a risk assessment for cosmetic use of small particles without the need for additional animal studies.

Microleakage of repaired class V silorane and nano-hybrid composite restorations after preparation with erbium:yttrium-aluminum-garnet laser and diamond bur.

The aim of this in vitro study was to compare the microleakage of repaired class V resin composite restorations prepared either by Er:YAG laser or a diamond bur. Ninety-six intact human molar teeth were randomly distributed into eight groups. In the first four groups, class V cavities (3 × 3 × 3 mm) prepared on the buccal and lingual surfaces of the teeth using an erbium:yttrium-aluminum-garnet laser (VersaWave, HOYA ConBio, Japan). Similar class V cavities were prepared in the second four groups using a diamond bur (S-Class, Komet, UK). Teeth in groups 1, 2, and 5, 6 were restored with a nano-ceramic composite (Ceram.X duo, DENTSPLY), whereas a silorane material (Filtek Silorane, 3M ESPE) was used to restore cavities in groups 3, 4, and 7, 8. Two different adhesive systems (XP Bond, DENTSPLY, and Silorane System Adhesive, 3M ESPE) were also used. All specimens were aged for 7 days. New cavities (3 × 3 × 3 mm) were prepared adjacent to the old restorations with Er:YAG laser (groups I-IV) or diamond bur (groups V-VIII). Different repair materials were then applied to the new cavities using the previous two restorative materials and two adhesive systems. All teeth were subjected to thermocycling (5,000 cycles between 5 and 55°C) and axial loadcycling (30 N, 1 Hz, 2,000 cycles). Specimens were immersed in 50% w/w silver nitrate solution. Teeth were sectioned longitudinally in buccolingual direction. Stereomicroscope (Nikon SMZ 800) and SEM (JEOL JSM 5600) were used to evaluate the microleakage that existed at the interface between the old restorations and the repair materials. Data were analyzed statistically with one-way ANOVA and Tukey tests (p < 0.05). Even though no statistically significant differences were found between any of the groups, the cavities repaired with different restoratives showed slight microleakage, especially those prepared by Er:YAG laser (p > 0.05). No microleakage scores were obtained in the groups repaired with Filtek Silorane/Filtek Silorane and Ceram.X/Ceram.X. All the substances tested can be used as repair materials for immediate repair after Er:YAG laser and diamond bur. All substances tested in this study can be used as immediate repair materials after cavity preparations with Er:YAG laser or diamond bur.

Effect of low fluency dentin conditioning on tensile bond strength of composite bonded to Er:YAG laser-prepared dentin: a preliminary study.

Several studies in the literature have previously shown that the bond strength of a composite bonded to dentin is almost equivalent as when dentin is prepared by either bur or Er:YAG laser. The aim of this preliminary study is to assess the hypothesis that dentin conditioning at low fluency by means of Er:YAG laser can improve the value of adhesion of composites resin to dentin. Sixty surfaces of caries-free human third molars extracted for orthodontic purposes were randomly divided into five groups of 12 teeth. The bur group was the control, prepared using bur, group L was prepared using Er:YAG 200 mJ, SSP (50 µs), 20 Hz, 15 seconds of sweeping, for groups L80, L100, L120, they were prepared first, with the same parameters of the group L 200, and then they received a conditioning, which is, respectively, 15 s of irradiations at: 80 mJ (SSP, 10 Hz), 100 mJ (SSP, 10 Hz), and 120 mJ (SSP, 10 Hz). All samples were restored in a single-component adhesive system: Xenon (DENTSPLY), and ceramX (DENTSPLY) as the resin composite. The specimens were submitted to tensile bond strength test using a universal testing machine. Data were submitted to statistical analysis using ANOVA coupled to a Tukey-Kramer test at the 95% level. The mean values in MPa were 33.3 for group B, 36.73 for group L 200, 41.7 for group L80, 37.9 for group L100, and 39.1 for group L120. Our results showed that dentin conditioning at a low fluency of 12.58 J/cm(2) per pulse, with 80 mJ output energy and 50-µs pulse duration can significantly improve tensile bond strength of a composite bonded to Er:YAG laser-prepared dentine.

Inhibition of the activity of matrix metalloproteinase 2 by triethylene glycol dimethacrylate.

The aim of this study was to evaluate the effect of different concentrations of triethylene glycol dimethacrylate (TEGDMA) on the inhibition of matrix metalloproteinase 2 (MMP-2). Mouse gingival explants were cultured overnight in DMEM and the expression of secreted enzymes was analyzed by gelatin zymography in buffers containing 5 mM CaCl(2) (Tris-CaCl(2)) in 50 mM Tris-HCl buffer with the addition of TEGDMA at different concentrations (0.62%, 1.25%, 2.5%, or 5.0% (v/v)). The gelatinolytic proteinase present in the conditioned media was characterized as matrix metalloproteinase by means of specific chemical inhibition. The matrix metalloproteinases present in the conditioned media were characterized as MMP-2 by immunoprecipitation. The eletrophoretic bands were scanned and the transmittance values were analyzed. Data was plotted and submitted to linear regression to investigate MMP-2 inhibition as a function of TEGDMA concentration. Three major bands were detected in the zymographic assays. These bands were characterized as MMP-2. Zymogene (72 kDa), intermediate (66 kDa) and active forms of MMP-2 (62 kDa) were inhibited by TEGDMA in a dose-dependent way. These findings suggest that TEGDMA could inhibit MMP-2 expression even at small concentrations.

In Vitro and In Vivo Efficacy of New Composite for Direct Pulp Capping.

OBJECTIVES: To investigate physicochemical properties, dentin bonding, cytotoxicity, and in vivo pulp response of experimental self-adhesive composites tailored to direct pulp capping. MATERIALS AND METHODS: Experimental composites were prepared with beta-tricalcium phosphate and hydroxyapatite nanoparticles adsorbed with simvastatin and glutathione added at 0% (control resin), 1 wt% (Res 1%), and 10 wt% (Res 10%). A commercial light-curable calcium hydroxide (Ca(OH)2) (Ultra-Blend Plus) was used as control material. The physicochemical properties investigated were flexural strength and modulus, calcium release, and degree of conversion. Dentin bonding was assessed by the push-out test. Proliferation and cell counting assays were performed to evaluate in vitro cytotoxicity using fluorescence microscopy. In vivo pulp capping was performed on molars of Wistar rats, which were euthanized after 14 days and evaluated by histological analysis. RESULTS: No statistical difference was observed in flexural strength and cell viability (p > 0.05). Res 10% presented higher modulus than control resin and Ca(OH)2. Also, Res 10% attained statistically higher degree of conversion when compared to other experimental composites. Ca(OH)2 showed higher calcium release after 28 and 45 days of storage, with no statistical difference at 45 days to Res 10%. All experimental composites achieved significantly higher bond strength when compared to Ca(OH)2. While no significant difference was observed in the cell proliferation rates, resins at lower concentrations showed higher cell viability. In vivo evaluation of pulp response demonstrated no pulp damage with experimental composites. CONCLUSIONS: The experimental composite investigated in this study achieved adequate physicochemical properties with minor in vivo pulpal inflammation and proved to be a valuable alternative for direct pulp capping.

Effect of the insertion and polymerization technique in composite resin restorations: analysis of marginal gap by atomic force microscopy.

This in vitro study evaluated the marginal gap at the composite tooth/resin interface in class V cavities under the influence of two insertion techniques and a curing system by means of atomic force microscopy (AFM). Forty enamel and dentin cavities were prepared on the buccal surface in bovine teeth with quadratic forms measuring 2 mm × 2 mm and depth of 1.5 mm. The teeth were then divided into four groups: group A, 10 cavities were restored in one increment, light cured by halogen light; group B, 10 cavities filled with bulk filling, light cured by the light emitting diodes (LED); group C, 10 cavities were restored by the incremental technique, light cured by halogen light; group D, 10 cavities were restored by the incremental technique, light cured by the LED. The teeth underwent the polishing procedure and were analyzed by AFM for tooth/restoration interface evaluation. The data were compared between groups using the nonparametric Kruskall-Wallis and Mann-Whitney tests (p < 0.05). The results showed a statistically significant difference between groups A and B and groups A and C. It was concluded that no insertion and polymerization technique was able to completely seal the cavity.

Comparison of conventional versus colored compomers for class II restorations in primary molars: a 12-month clinical study.

OBJECTIVE: To evaluate the 12-month clinical performance of conventional (Compoglass F) and colored (Twinky Star) compomer restorative materials in class II restorations of primary molars. MATERIALS AND METHODS: A total of 196 restorations were placed in 98 children aged between 5 and 10 years (mean age: 7.43 +/- 1.31 years) who had bilateral matched pairs of carious posterior class II primary molars. A split-mouth design was used in which 2 materials (Compoglass F, Twinky Star) were randomly placed on contralateral sides by 3 dentists. At baseline, after 6 and after 12 months, the restorations were evaluated using modified US Public Health Service criteria for: secondary caries, marginal integrity, marginal discoloration, anatomic form and surface texture. The Alpha and Bravo scores were considered as clinical success. The data were subjected to statistical analysis by the Wilcoxon and McNemar tests (p < 0.05). The Kaplan-Meier survival method was applied to estimate survival percentages. RESULTS: No significant difference was found among the groups at all recalls regarding marginal integrity, marginal discoloration, anatomic form, secondary caries and surface texture. The 12-month mean cumulative survival rate of Compoglass F was 95.7%, while in the Twinky Star group, the survival rate was 93% in class II restorations with no significant difference between the groups for either material. CONCLUSION: Both conventional and colored compomer materials are suitable restorative materials for primary teeth for at least 12 months. Colored compomers could also be a good alternative to tooth-colored compomers in the restoration of primary molars.

Comparing microleakage and the layering methods of silorane-based resin composite in wide Class II MOD cavities.

OBJECTIVE: This in vitro study compared the effects of different layering techniques and different monomer-based composites on microleakage. METHOD AND MATERIALS: Thirty-two freshly extracted caries-free human third molars were used. A wide mesio-occlusal-distal (MOD) cavity was prepared in each third molar, with the occlusal dimension being approximately two-thirds of the intercuspal dimension, and the cervical limit of one proximal box was stopped 1 mm below and the other 1 mm above the cementoenamel junction. The cavities were filled with a methacrylate-based nanohybrid composite (Grandio, VoCo) and a silorane-based microhybrid composite (Filtek Silorane, 3M ESPE). All samples were subjected to 1000 thermal cycles of 5 degrees C/55 degrees C in water with a 30-second dwell time and, after the procedure, the teeth were immersed in a 0.5% basic fuchsin dye at 23 degrees C for 24 hours. Sectioned samples were examined under a stereomicroscope (Leica MZ12, Leica Microsystems), and microleakage scores were statistically analyzed using the Kruskal-Wallis and the Mann-Whitney U tests. RESULTS: No microleakage was observed for silorane-based resin composite restorations. The nanohybrid-based resin composite restorations showed different levels of leakage. Statistical analysis of microleakage scores showed differences only at the enamel margins for nanohybrid material for both layering techniques (p < 0.05). The nanohybrid-based resin composite restorations showed better results with the vertical layering technique for enamel margins.