Comparison of calculus detection among dental hygienists using an explorer and ultrasonic insert.

INTRODUCTION: Periodontal therapy disrupts the biofilm harbouring calculus that triggers inflammation. The explorer is primarily used for calculus detection, and the ultrasonic instrument is primarily used for calculus removal. The efficiency in dental hygiene care may improve if the ultrasonic instrument could be used in both calculus detection and removal. PURPOSE: The purpose of this study was to validate the effectiveness of calculus detection between the Thinsert® ultrasonic insert and the 11/12 explorer. METHODS: Upon IRB approval, this validation study involved three dental hygiene faculty from the Ohio State University Dental Hygiene Program and 30 patient participants from the Ohio State University community. Using both instruments, calculus was evaluated on Ramfjord index teeth and on four possible surfaces per tooth. Data were analysed to evaluate for interrater reliability, intrarater reliability, sensitivity, and specificity. RESULTS: For interrater reliability, the average measure of intraclass coefficient (ICC) value was 0.782 with a 95% confidence interval (CI) of 0.749-0.810 (F(1439, 2878)  = 4.852, P < 0.01). For intrarater reliability, mean Kappa averages were in the full agreement range (κ = 0.726, n = 2160, P < 0.01). When using the Thinsert® for calculus detection, the sensitivity was 75%, specificity was 97%, PPV was 81%, and NPV was 94%. CONCLUSION: Since calculus evaluation was comparable when using the ODU 11/12 explorer and the Thinsert®, efforts can be focused on developing the tactile sensitivity when using the Thinsert® ultrasonic instrument in the assessment, treatment, and maintenance of periodontal disease and the support of oral health. The efficiency in dental hygiene care may improve by using the Thinsert® ultrasonic instrument in both the detection and removal of calculus.

Clinical and laboratory evaluation of the effects of different treatment modalities on titanium healing caps: a randomized, controlled clinical trial.

OBJECTIVES: The objective of this study is to evaluate the effects of treatment modalities on titanium surface characteristics and surrounding tissues. MATERIALS AND METHODS: Eighteen participants each had four titanium healing caps (HC) attached to four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and periopathogens were recorded before and 3 months following instrumentation. After final assessments, HCs were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24 h; mixed culture, 24 h) and (b) gingival fibroblasts (5 days). HC surfaces were analyzed with a scanning electron microscope (SEM). RESULTS: No significant differences between the groups were evident before or after instrumentation for PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A comparison of the overall mean SEM surface roughness scores showed a significant difference between all groups (p < 0.0001) with the lowest roughness after EP. CONCLUSIONS: All treatments performed yielded comparable outcomes and may be implemented safely. CLINICAL RELEVANCE: Clinicians may fear implant surface damage, but all instrumentation types are safe and non-damaging. They can be implemented as needed upon considering the presence of staining and soft and hard deposits.

Comparison of traditional orthodontic polishing systems with novel non-orthodontic methods for residual adhesive removal.

BACKGROUND: Following the debonding of orthodontic brackets, the removal of residual adhesive from the enamel surface is required. Published adhesive removal protocols present conflicting advice. AIMS: The present study evaluated the surface roughness of enamel after debonding and instrumentation with non-traditional orthodontic polishing systems. METHODS: The facial aspects of 35 extracted human incisor teeth were scanned with a surface profilometer for surface roughness prior to the bonding of orthodontic brackets. After debonding, residual adhesive was removed with a 12-fluted titanium carbide bur. The teeth were randomly divided into seven groups (N = 5 per group) and the enamel surface was polished with one of seven products. All samples were re-scanned for surface roughness and subjectively evaluated via SEM. RESULTS: There was no significant difference in enamel surface roughness between the groups when compared using surface profilometry. Visual observations from the SEM evaluations demonstrated differences in the enamel surface at the microscopic level that were not detected by profilometric analysis. CONCLUSIONS: The present study found no statistically significant difference in mean enamel smoothness change from pretreatment to post-treatment between the seven polishing methods studied via profilometer surface reading measurements. An SEM analysis showed visual differences in enamel striations viewed at 1000x magnification in a comparison of traditional versus non- traditional polishing methods.

In-vivo evaluation of the surface roughness and morphology of enamel after bracket removal and polishing by different techniques.

INTRODUCTION: The aim of this study was to evaluate the surface roughness and morphology of enamel with a surface roughness tester and scanning electron microscopy after the removal of metal brackets and polishing. METHODS: Ten orthodontic patients were selected for the study. At the conclusion of orthodontic treatment, their metal brackets were removed. For each patient, teeth on one side of the mouth were randomly chosen for finishing and polishing with aluminum oxide discs (n = 10). Teeth on the other side were finished with multilaminated carbide burs (n = 10). Dental replicas (before and after tooth polishing) were obtained with epoxy resin. Three surface roughness measurements were made in different directions with an angle of 120° among them, and a mean for each dental replica was calculated. The roughness data were statistically evaluated by repeated-measurements analysis of variance. Three specimens from each group were also used for scanning electron microscopy analysis. RESULTS: After resin removal, the average roughness in the carbide bur group (0.31 µm) was significantly greater than that in the aluminum oxide disc group (0.25 µm). CONCLUSIONS: The aluminum oxide disc polishing system resulted in less enamel roughness than did the multilaminated carbide bur system.

In vitro and in vivo evaluation of the effectiveness of three dentin desensitizing treatment regimens.

PURPOSE: To evaluate the in vitro and in vivo effects of three treatment regimens on dentin permeability and reduction of dentin hypersensitivity (DH). METHODS: The desensitization treatments were: Gluma Desensitizer PowerGel (GLU), MS Coat One (MSC), and dentin burnishing with fiber-resin burs (STB). A split-chamber device was used to determine the permeability of dentin slices cut from human molars in vitro. Fluid flow through dentin was recorded with a photochemical method after EDTA cleaning, albumin soaking and desensitization treatment (n = 10). 61 study participants with three severely hypersensitive teeth each were enrolled. Sensitivity was determined with an air stimulus before, immediately after treatment, and after 1, 3 and 6 months, using a verbal rating scale. RESULTS: From the 61 study participants enrolled, 52 completed the trial. Permeability at baseline and after albumin soaking was not significantly different. All treatments produced reduced fluid flow through dentin (P > 0.05). All treatments reduced DH significantly (no or moderate sensitivity). Statistical results revealed significant differences among the treatments (P = 0.03). Mann-Whitney comparisons showed GLU, STB < MSC.

An investigation of the effect of scaling-induced surface roughness on bacterial adhesion in common fixed dental restorative materials.

STATEMENT OF PROBLEM: Bacterial plaque must be routinely removed from teeth, adjacent structures, and prostheses. However, the removal of this plaque can inadvertently increase the risk of future bacterial adhesion. PURPOSE: The purpose of this investigation was to assess the change in the surface roughness of 3 different surfaces after dental prophylactic instrumentation and how this influenced bacterial adhesion. MATERIAL AND METHODS: Forty specimens each of Type III gold alloy, lithium disilicate, and zirconia were fabricated in the same dimensions. The specimens were divided into 4 groups: ultrasonic scaler, stainless steel curette, prophylaxis cup, and control. Pretreatment surface roughness measurements were made with a profilometer. Surface treatments in each group were performed with a custom mechanical scaler. Posttreatment surface roughness values were measured. In turn, the specimens were inoculated with Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus. Bacterial adhesion was assessed by rinsing the specimens with sterile saline to remove unattached cells. The specimens were then placed in sterile tubes with 1 mL of sterile saline. The solution was plated and quantified. Scanning electron microscopy was performed. The statistical analysis of surface roughness was completed by using repeated-measures single-factor ANOVA with a Bonferroni correction. RESULTS: The surface roughness values for gold alloy specimens increased as a result of prophylaxis cup treatment (0.221 to 0.346 Ra) (P<.01) and stainless steel curette treatment (0.264 to 1.835 Ra) (P<.01). The results for bacterial adhesion to gold alloy proved inconclusive. A quantitative comparison indicated no statistically significant differences in pretreatment and posttreatment surface roughness values for lithium disilicate and zirconia specimens. In spite of these similarities, the overall bacterial adherence values for lithium disilicate were significantly greater than those recorded for gold alloy or zirconia (P<.05). Instrumentation of the lithium disilicate and zirconia with the stainless steel curette significantly increased bacterial adhesion compared with the control (P<.05). CONCLUSIONS: The results of this investigation indicate that Type III gold alloy exhibited increased surface roughness values after stainless steel curette and prophylaxis cup treatments. Zirconia was less susceptible to bacterial adhesion than lithium disilicate, and greater bacterial adhesion was found for the stainless steel curette than the other instrumentation methods.

Effect of a new remineralizing biomaterial on the color of dental enamel.

The aim of this research was to describe the effects of altering the composition of a modified remineralizing agent (MRA) and the osmotic pressure on tooth color by using spectrophotometric analysis. One hundred and four (104) human premolars and molars were randomly divided into 2 groups of 52 specimens each. Group 1 was treated with the remineralizing agent MRA 55, (remineralizing agent 1), a 50% - 50% by weight mixture of coarse-grain and fine-grain generating minerals, and group 2 was treated with the remineralizing agent MRA 91 (remineralizing agent 2), containing the same minerals in a 90% - 10% proportion. Each group was divided into 2 subgroups with 26 specimens each, which were stored as follows: subgroups A were stored in synthetic saliva with isotonic osmotic pressure (IP), and subgroups B in hypotonic osmotic pressure saliva (HP). The initial and final readings were taken with a Vita Easy Shade spectrophotometer. Color parameters (L*, a*, b*) and whiteness indices (WIC, WIO, W) were calculated from the readings. The color changes (deltaL, deltaA, deltaB, and deltaE) and whiteness indices were compared and analyzed with descriptive analyses. The variables deltaL, deltaA, deltaB, deltaE, and the whiteness index W were analyzed with an analysis of variance (ANOVA), and the indices WIC and WIO were analyzed with a nonparametric Kruskal-Wallis ANOVA. The results indicate that combination A2 (MRA 91 and IP) affected variables deltaB and deltaE, while combination B1 (MRA 55 and HP) affected variables deltaA, deltaB and the whiteness index WIO. Only MRA 91 affected the variable deltaL. The osmotic pressure of saliva and the remineralizing agent used affect the color of dental enamel.

In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii following root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes.

OBJECTIVES: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro. MATERIALS AND METHODS: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72 h and adhesion of S. gordonii ATCC 10558 for 2 h have been determined. RESULTS: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36 µm/after: 0.25 µm; p < 0.001; median Rz before: 2.34 µm/after: 1.61 µm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31 µm/Rz of 2.06 µm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria. CONCLUSIONS: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion. CLINICAL RELEVANCE: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healing.

Use of high-magnification loupes or surgical operating microscope when performing prophylaxes, scaling or root planing procedures.

The use of high-level magnification (6-8x loupes magnification, or higher degrees of magnification provided by the surgical operating microscope), combined with head-mounted, coaxial lighting, may improve the ability of a dentist or dental hygienist to perform prophylaxis or scaling and root planing procedures, compared to the performance of these tasks using unaided vision or entry-level (2.5x) magnification, combined with overhead operatory lighting. A magnified view of the supragingival contours of a tooth surface facilitates visualizing the dimensions and curvature of the unseen sub-gingival tooth surfaces, which facilitates detection and removal of calculus that is located on these subgingival surfaces. Improved calculus removal ability may lead to better periodontal disease outcomes.

Effect of different methods for decontaminating tooth enamel after contact with blood before bonding orthodontic buttons.

PURPOSE: To evaluate the best method for decontaminating tooth enamel contaminated by contact with blood before bonding orthodontic buttons. MATERIALS AND METHODS: The labial surfaces of 195 bovine incisors initially received prophylaxis, followed by 37% phosphoric acid etching, adhesive application, and light polymerization. After this, the labial surfaces of all teeth were contaminated with blood. The teeth were then randomly divided into 13 groups (n = 15), comprising the control group (treated according to the manufacturer's recommendations) and 12 experimental groups treated by the following decontamination methods: group 1, no decontamination; group 2, washing with distilled water; group 3, washing with physiologic solution; group 4, jets of air; group 5, gauze; group 6, cotton wool; group 7, distilled water plus jets of air; group 8, distilled water plus gauze; group 9, distilled water plus cotton wool; group 10, physiologic solution plus jets of air; group 11, physiologic solution plus gauze; and group 12, physiologic solution plus cotton wool. RESULTS: No statistical differences were shown between the control group and groups 4, 7, 10, and 11 (P > .05). The lowest bond strength values were shown in group 1, in which no decontamination was performed, and groups 6 and 12, which were decontaminated with cotton wool and physiologic solution plus cotton wool, respectively. CONCLUSIONS: The best method of decontaminating enamel contaminated with blood is washing with physiologic solution, followed by drying with jets of air and gauze or drying with jets of air only.

Evaluation of fluoride varnish and its comparison with pumice prophylaxis using self-etching primer in orthodontic bonding--an in vivo study.

The aim of this study was to evaluate the use of fluoride varnish as a prophylaxis method with self etching primer (SEP) and its comparison with pumice before orthodontic bonding. Thirty seven orthodontic patients participated in a prospective clinical trial. A split mouth technique was used in each patient, one quadrant was assigned to fluoride varnish and the contralateral quadrant to pumice prophylaxis. A total of 684 teeth were bonded with SEP (Transbond plus; 3M Unitek) and monitored for 6 months for bond failures. A total of 42 (6.1%) failures were recorded, 9 (2.6%) in the pumice group and 33 (9.6%) in the fluoride varnish group. Chi-square analysis was used to compare the number of bracket failures between the pumice and fluoride varnish groups and the number of patients in each group experiencing at least one bond failure. Statistically significant differences were found both in total number of bond failures (P < 0.001) and in the number of patients with bond failures (P < 0.05) between both groups. A significantly lower and clinically acceptable bond failure rate was observed with Transbond Plus self etching primer after pumice prophylaxis.

Enamel loss and adhesive remnants following bracket removal and various clean-up procedures in vitro.

This study evaluated the enamel loss and composite remnants after debonding and clean-up. The tested null hypothesis is that there are no differences between different polishing systems regarding removing composite remnants without damaging the tooth surface. Brackets were bonded to 75 extracted human molars and removed after a storage period of 100 hours. The adhesive remnant index (ARI) was evaluated. The clean-up was carried out with five different procedures: 1. carbide bur; 2. carbide bur and Brownie and Greenie silicone polishers; 3. carbide bur and Astropol polishers; 4. carbide bur and Renew polishers; and 5. carbide bur, Brownie, Greenie and PoGo polishers. Silicone impressions were made at baseline (T0) and after debonding (T1) and polishing (T2) to produce plaster replicas. The replicas were analysed with a three-dimensional laser scanner and measured with analytical software. Statistical analysis was performed with the Kruskal-Wallis test and pairwise Wilcoxon tests with Bonferroni-Holm adjustment (α = 0.05). Enamel breakouts after debonding were detectable in 27 per cent of all cases, with a mean volume loss of 0.02 mm(3) (±0.03 mm(3)) and depth of 44.9 µm (±48.3 µm). The overall ARI scores was 3 with a few scores of 1 and 2. The composite remnants after debonding had a mean volume of 2.48 mm(3) (±0.92 mm(3)). Mean volume loss due to polishing was 0.05 mm(3) (±0.26 mm(3)) and the composite remnants had a mean volume of 0.22 mm(3) (±0.32 mm(3)). There were no statistically significant differences in volumetric changes after polishing (P = 0.054) between the different clean-up methods. However, sufficient clean-up without enamel loss was difficult to achieve.

Microtensile bond strength of self-etch adhesives in different surface conditionings.

AIM: Self-etch bonding systems have been introduced recently and have the advantage of reduced operating time. Because of patient management and isolation difficulties in children, the present study aimed to evaluate microtensile bond strength of two self-etch bonding systems (AdheSE and Xeno® III) on cleaned only, ground and sandblasted enamel. MATERIALS AND METHODS: Thirty intact primary molars were selected and randomly divided into two groups according to the type of bonding used (Xeno® III and AdheSE). The teeth were divided into three subgroups according to enamel surface conditioning method: prophylaxis with pumice, grinding with coarse finishing and polishing disc, and sandblasting with aluminum oxide particles. Tetric Ceram composite then was applied. Samples were sectioned coronally and axially. The interface area of dental sticks was measured and specimens were subjected to a tensile force of 0.5 mm/min until failure. RESULTS: Microtensile bond strength of Xeno® III-sandblasting, AdheSE-sandblasting, AdheSE-grinding, and AdheSE- cleaned only were 25.5±7.7, 21.2±2.3, 12.9±2.2, and 9.1±1.1, respectively. During sectioning, all specimens of Xeno® III-cleaned only and Xeno® III-grinding groups were fractured. CONCLUSIONS: Two step AdheSE yields higher mTBS in comparison to one step Xeno ® III. In regard to surface conditioning, sandblasting increases the mTBS relative to grinding with finishing and polishing disc, and the cleaned-only enamel has the lowest mTBS.

Laboratory evaluation of extrinsic stain removal by a specially engineered sonic powered toothbrush with unique sensing and control technologies.

OBJECTIVE: The purpose of this laboratory study was to evaluate extrinsic stain removal from teeth by a specially engineered sonic powered toothbrush with unique sensing and control technologies, using the Triple Clean and the Sensitive refill brush heads, in comparison to a manual flat-trim toothbrush. METHODS: Twelve (12) artificially stained bovine teeth were tested with each product. The percentage of stain removed by each product was calculated by taking the ratio of the amount of stain removed by brushing for 800 strokes to the total amount of stain removed by subsequent application of a dental prophylaxis. The stain was quantified by measuring the light reflected by the stained teeth with a spectrophotometer. Data were reported as L*, lightness of the stain, and as W*, a whiteness index comprising the lightness, hue, and chroma of reflected light. Statistical analyses were performed separately for the AL* and AW* scores. Comparisons of the toothbrushes with respect to baseline-adjusted deltaL* and deltaW* scores were performed using an analysis of covariance (ANCOVA). Post-ANCOVA pair-wise comparisons of the study toothbrushes were performed using Tukey's test for multiple comparisons. All statistical tests of hypotheses were two-sided, and employed a minimum level of significance of 0.05. RESULTS: The percentage of stain removed by the sonic powered toothbrush, using either the Triple Clean brush head or the Sensitive brush head under laboratory test conditions, is superior (p < 0.05) to the percentage of stain removed by the manual flat-trim toothbrush when analyzed for both the deltaL* and deltaW* scores. The mean percentage of stain removed was 62.10 for the power toothbrush with the Triple Clean brush head, 49.01 for the power toothbrush with the Sensitive brush head, and 30.56 for the manual flat-trim toothbrush when calculated using deltaL* scores. The mean percentage of stain removed was 59.89 for the power toothbrush with the Triple Clean brush head, 46.83 for the power toothbrush with the Sensitive brush head, and 29.25 for the manual flat-trim toothbrush when calculated using deltaW* scores. CONCLUSIONS: This new specially engineered sonic powered toothbrush with unique sensing and control technologies effectively removes extrinsic stains from the surface of teeth under laboratory test conditions with both the Triple Clean and the Sensitive brush heads. The effectiveness of stain removal with either brush head is significantly greater than the effectiveness of stain removal of a manual flat-trim toothbrush under these conditions.

Qualitative and quantitative evaluation of enamel after various post-stripping polishing methods: an in vitro study.

AIM: The purpose of this study was to evaluate the ultramorphology and surface roughness of permanent tooth enamel after various post-stripping polishing methods. METHODS: Sixty extracted, permanent lower incisors were randomly assigned to two groups (Group A and Group B). Group A was morphologically assessed by a scanning electron microscopy (SEM) and Group B was assessed by a stylus profilometer which applied a surface roughness test. Each group was divided into five subgroups of six incisors. Four of the subgroups were subjected to interpoximal enamel reduction, followed by various polishing methods; the fifth subgroup served as a control. The polishing methods comprised; Subgroup 1, diamond disk followed by a fine Sof-lex disc; Subgroup 2, diamond disk and fine diamond bur; Subgroup 3, diamond disk and fine tungsten carbide bur; Subgroup 4, diamond disk and chemical stripping using 37% orthophosphoric acid in conjunction with a fine 3M finishing strip and Subgroup 5 (control), no stripping nor polishing. Qualitative (scanning electron microscopy) and quantitative (surface roughness test) assessments were performed. Surface roughness values (Ra) for permanent enamel were evaluated using the Welch analysis of variance (ANOVA). RESULTS: Subgroup 1 (diamond disk and fine Sof-lex disc) produced the smoothest enamel surface and Subgroup 4 (chemical stripping) produced the roughest enamel surface. CONCLUSIONS: All proximal stripping and polishing methods significantly roughened the enamel surfaces. The best results were obtained when the stripped enamel surfaces were polished and finished with fine Sof-lex discs.

Comparison of shear bond strength of hydrophilic bonding materials: an in vitro study.

AIM: The aim of this study was to evaluate and compare the shear bond strength of hydrophilic materials like Transbond MIP with Assure-fluoride releasing light cure sealant paste system (Reliance orthodontic product), Enhance Lc-adhesion booster (Reliance Orthodontics) Prime and Bond NT-one step adhesive with nanotechnology (Dentsply Product India) with Transbond XT as the control group. MATERIALS AND METHODS: The study was conducted on 180 extracted human premolar teeth which were divided into five main groups. Each group contained 36 teeth, which were further subdivided into three subgroups containing 12 teeth. The teeth were bonded in three different surface environments namely dry, contaminated with artificial saliva and reprimed after contamination with artificial salvia. The brackets were bonded and cured. The shear bond strength was tested using Instron universal testing machine (4501). RESULTS: The results were subjected to statistical analysis like 3 factorial ANOVA and compared to post-hoc using the Student Newman levels test. The residual resin on the tooth surface after debonding was evaluated with adhesive remnant index. CLINICAL SIGNIFICANCE: The results revealed that in situations in which moisture contamination is critical there is distinct advantage in using hydrophilic primers.

Glass ionomer cement as an orthodontic bonding agent.

AIM: To find an alternative to popular orthodontic bonding agent composite resin and elimination of acid etching. To assess GC Fuji Ortho as an orthodontic bonding agent under different enamel conditions and evaluate the shear bond strength. Enamel surfaces intentionally contaminated with saliva, conditioned enamel using Fuji dentin conditioner and conventional 37% phosphoric acid/60 seconds. To evaluate and compare shear bond strength to a 'gold standard' composite bonding agent--Rely-a-Bond. MATERIALS AND METHODS: The sample consisted of 50 human premolar teeth collected and stored in formalin. Out of 50 samples, 38 were upper premolars and 12 were lower second premolars. The total sample divide into 10 each. Stainless steel contour bracket with bondable mesh measured about 3.42 mm in length and 3.31 mm in width. Each tooth sample was embedded in a cylindrical acrylic block of polymethyl methacrylate (PMMN). The buccal surfaces of all the samples were polished with fluoride-free pumice and rinsed thoroughly. Group 1 bonded with GC Fuji Ortho after getting etched with 37% phosphoric acid/60 seconds. Group 2 was contaminated with saliva. Group 3 was conditioned with Fuji dentin condition. Group 4 unetched, uncontaminated, and Group 5 was treated with rely bond composite resin after getting etched with 37% phosphoric acid. The shear bond strength was tested using Instron universal testing machine. The force at which bond failed was recorded on XY recorder as shear/peel bond strength of the material used for bonding. The reading obtained were statistically analyzed. RESULT: Rely bond showed highest bond strength of 64.70 N (Newtons). The next highest value was that of Group 1. The lowest bond strength in the Group 4. CONCLUSION: GC Fuji Ortho can be used as a bonding agent on etched enamel. Unetched, uncontaminated enamel surfaces were inadequate for bracket bonding. CLINICAL SIGNIFICANCE: Potential benefits of glass ionomer cements can be utilized in orthodontic bonding.

[Ergonomic analysis of the handle of manual instruments for dental hygiene]. / Analisi ergonomica del manico di strumenti manuali per igiene dentale.

Work-related musculoskeletal disorders of upper limbs are very common among dental hygienists. To minimize the risk of their occurrence, it is essential that attention be paid to proper ergonomics in the workplace, including the selection of instrumentation. At present there are no specific guidelines but only some indications for the selection of the different hand tools. The main purpose of this study was to make a comparative analysis of different types of handles of hand tools used for root planing (Gracey curettes). Nine dental hygienists were interviewed with a questionnaire aimed to assess three different types of curette handle. The results showed that lightness, being of solid steel, having a cylindrical non-uniform shape with full enlarged cross-section, and being silicon coated with non-slip ends are the preferred characteristics for a curette handle. These considerations may assist both manufacturers in designing new hand instruments and clinicians in selecting the most ergonomic ones to buy.

Professional brushing study comparing the effectiveness of sonic brush heads with manual toothbrushes: a single blinded, randomized clinical trial.

The aim of this study was to evaluate the plaque removal efficacy of four toothbrushes: the Philips Sonicare Elite with medium and mini brush heads, the Elmex Sensitive, and the American Dental Association (ADA) reference toothbrush. This study was a randomized, controlled, investigator-blinded, four-brush crossover design study, which examined plaque removal following a consecutive repeated use. All brushes were used on each participant in a randomly assigned quadrant of the mouth. A total of 90 subjects participated in the study. Prior to the experiment, they received a professional prophylaxis and were requested to refrain from toothbrushing for 48 h. Teeth were professionally brushed consecutively for 10 to 90 s per quadrant. A Turesky-modified Quigley Hein Index score was assessed at baseline and after each brushing interval by one blinded investigator. Results showed reduction of mean plaque scores for all brushes with time from 10 to 90 s. After 30 s (2-min whole mouth equivalent) of brushing, the Sonicare brushes cleaned 19, the ADA brush 16, and the Elmex Sensitive 10 of in average 28 tooth surfaces. With time, the number of additional cleaned surfaces decreased. Time is an important variable in the evaluation of plaque-removing efficacy since absolute efficacy increases with time and differs per toothbrush. No differences could be found between the two brush heads of the Sonicare.

In vivo effects of fluoride on enamel permeability.

This in vivo study evaluated the effects of topical fluoride application on enamel by repeated scanning electron microscopy analysis of replicas. Baseline fluid droplets were employed as qualitative indication of enamel permeability. CaF(2)-like globules were detected in vivo after fluoride application and were not found after professional brushing, ultrasound action, or chemical extraction. Absence of water permeability of enamel was demonstrated even after removal of CaF(2)-like globules. Droplets reappeared within 1 h in sodium fluoride-treated teeth, but they did not reappear even after 1 week following topical enamel treatment with acidulated phosphate fluoride. Teeth treated with an acidulate fluoride-free solution showed lack of CaF(2)-like globules and no droplets for at least 1 week as detected in acidulate phosphate fluoride-treated teeth. The caries-preventing action of fluoride may be due to its ability to decrease permeability and diffusion pathways. CaF(2)-like globules seem to be indirectly involved in enamel protection over time maintaining an impermeable barrier, and phosphoric acid seemed to play an unexpected fluoride-independent preventive role.