Follow-up of flowable resin composites performed with a universal adhesive system in non-carious cervical lesions: A randomized, controlled 24-month clinical trial.

PURPOSE: This randomized, controlled study evaluated the 2-year clinical performance of two flowable resin composites performed with a universal adhesive in two etching modes for restoring non-carious cervical lesions (NCCLs). METHODS: One hundred NCCLs were restored with two flowable composites ( Charisma Opal Flow and G-aenial Universal Flo) and a universal adhesive (Single Bond Universal) with two etching modes (self-etch and etch&rinse) in a random order. The restorations were evaluated for retention, marginal adaptation, anatomic form, marginal discoloration, surface texture and secondary caries (modified USPHS criteria) at baseline, and after 6, 12 and 24 months. RESULTS: The clinical success for retention, surface texture and secondary caries parameters was scored as 100% for each group after 6, 12 and 24 months. The first acceptable changes (Bravo score) in marginal adaptation, anatomical form and marginal discoloration started to show up after 12 months for all test groups, except for etch&rinse+Charisma Opal Flow. Self-etch+Charisma Opal Flow and self-etch+G-aenial Universal Flo showed progressive marginal discoloration that remained in the clinical acceptability level after 2 years. After 24 months, each resin composite restored with either the etch&rinse mode or the self-etch mode of the universal adhesive showed similar clinical performance. Marginal discoloration was higher in the restorations performed with the self-etch system. Selective-etching can be favorable. CLINICAL SIGNIFICANCE: The clinical performance of flowable composites performed with a universal adhesive in two etching modes was clinically acceptable after 24 months.

The improvement of biocompatibility of adhesives : The effects of resveratrol on biocompatibility and dentin micro-tensile bond strengths of self-etch adhesives.

OBJECTIVE: The aim of this in vitro study is to evaluate the effects of resveratrol (RES) addition on the cytotoxicity and microtensile bond strength (µTBS) of different adhesives. MATERIALS AND METHODS: Five self-etching adhesives (G-aenial Bond-GC, Optibond All in One-Kerr, Gluma Self Etch-Kulzer, Clearfil S3 Bond-Kuraray, and Nova Compo-B Plus-Imicryl) were tested. They were applied to L-929 cell culture by the extract method. In the test groups, 0.5 µM RES (Sigma-Aldrich) was added into the medium. Cell viability was assessed by MTT assay after 24 h. Human extracted third molars were used for µTBS test (n = 7). The adhesives with or without 0.5 µM RES addition were applied on dentin surfaces. A composite build-up was constructed. Then, the specimens were sectioned into multiple beams with the non-trimming version of the microtensile test and subjected to microtensile forces. Statistical analysis was performed using ANOVA and post hoc Tukey test (p Ë‚ 0.05). RESULTS: The extracts of all adhesives decreased the cell viability. However, RES addition increased the cell viability in all groups (p Ë‚ 0.05). RES addition did not cause any decrease in µTBS values of the adhesives compared to baseline. Optibond All in One showed the highest µTBS after RES addition. It was followed by Clerafil S3 Bond and Nova Compo-B Plus. No difference was determined between the Optibond All in One and Clearfil S3 Bond. There was difference between Optibond All in One and Nova Compo-B Plus (p Ë‚ 0.05). CONCLUSION: RES addition may improve the biocompatibility without causing negative influence on µTBS of the adhesives. CLINICAL RELEVANCE: RES addition has clinical applicable potential to overcome the adverse biocompatibility of adhesives.

Does post-bleaching fluoridation affect the further demineralization of bleached enamel? An in vitro study.

BACKGROUND: Topical fluoride agents have been shown to be the most effective method in treating demineralized enamel after in-office bleaching treatments. Thus, this study aimed to examine the effects of two different post-bleaching fluoridation agents: 1.5% titanium tetrafluoride (TiF(4)) (9200 ppm) and 2.1% sodium fluoride (NaF) (9500 ppm), on the calcium loss of enamel after an acidic challenge. METHODS: Ten maxillary premolars were sectioned into four pieces and then divided into the following four groups: Group 1: Control, kept in artificial saliva, no treatment; Group 2: 38% hydrogen peroxide (HP); Group 3: 38% HP followed by 1.5% TiF(4); Group 4: 38% HP followed by 2.1% NaF solution. The specimens were subjected to demineralization for 16 days, refreshing the solution every 4 days; that is, on the 4th, 8th, 12th, and 16th days. Calcium ion (Ca(2+)) concentration was determined by an atomic absorption spectrophotometer. Data were analyzed using Friedman and Wilcoxon tests (p = 0.05). RESULTS: The loss of Ca(2+) in each of the test groups was compared with that of the control group, depicting that there was a statistically significant difference among the groups after 4, 8, 12, and 16 days and in total (p < 0.05). The calcium released from the fluoride-applied groups was lower when compared with the 38% HP and control group. At the end of the 16th day, the total amount of calcium released from the TiF(4-)treated samples (9.12 mg/mL) was less than from the NaF-treated samples (13.67 mg/mL) (p < 0.05). CONCLUSIONS: Regarding the results of our in vitro study, the risk of further demineralization was significantly reduced with the use of TiF(4) and NaF after bleaching with 38% HP. TiF(4) was found to be more effective in preventing Ca2+ release owing to acid attack when compared with NaF. In the case of an intra-oral acidic exposure, the use of topical 1.5% TiF(4) and 2.1% NaF agents might be beneficial after bleaching with 38% HP.

The Use of Toothpastes Containing Different Formulations of Fluoride and Bioglass on Bleached Enamel.

OBJECTIVES: To investigate the application of toothpaste either containing calcium sodium phospho-silicate bioglass (NovaMin) or calcium fluorosilicate bioglass (BioMinF) on the surface mineral composition and morphology of enamel after bleaching procedure. Methods: Thirty extracted noncarious human teeth were allocated into five groups (n = 6). Group 1: Bleaching using 40% hydrogen peroxide (HP) and fluoridated toothpaste containing bioactive glass (1450 ppm fluoride). Group 2: Bleaching using 40%HP and toothpaste containing calcium fluorosilicate bioglass (540 ppm fluoride). Group 3: Bleaching using 40%HP and fluoridated toothpaste (1450 ppm fluoride). Group 4: Bleaching alone using 40%HP. Group 5: Negative control with distilled water alone. The surface morphology was evaluated using Scanning Electron Microscope (SEM) and Scanning Probe Microscope (SPM). The concentration of elements as atomic percentages were determined by X-ray Photoelectron Spectroscopy (XPS) and Energy-Dispersive X-ray Spectroscopy (EDS). Results: This laboratory-based study reported that SPM and SEM detected minor changes on the surfaces of all toothpaste-treated enamel samples (Groups 1-3) after 45 days. Bioactive glass deposits were observed on enamel surfaces in Groups 1 and 2, whilst the bleaching-alone samples (Group 4) had rough enamel surfaces. XPS reported that toothpaste containing calcium fluorosilicate bioglass (Group 2) had a high atomic% of calcium and phosphate, whilst silicon values were high in the toothpaste containing bioactive glass and 1450 ppm fluoride (Group 1) after bleaching procedure when compared to other groups (p < 0.05). In addition, EDS detected the highest %F in Groups 1, 2 and 5. Conclusions: Within the limitations of this laboratory-based study, there was no significant decrease in the Ca%, P% values and surface properties of enamel after the bleaching procedure following the use of different formulations of toothpastes for a period of 45 days. However, the Ca% and P% values were significantly high for the toothpaste containing calcium fluorosilicate bioglass (BioMinF) on the bleached enamel. Clinical relevance: The bleaching process can provide optimum aesthetic outcomes, but the effect of peroxides on hard tissues is still in question. Toothpastes containing different formulations of fluoride and bioactive glass might have the potential to prevent mineral loss on bleached enamel. However, further laboratory-based studies and controlled double-blind randomised clinical trials are required to interpret the effects of toothpastes with different fluoride and bioactive glass formulations on enamel surfaces following bleaching procedures.

Tensile bond strength of an aged resin composite repaired with different protocols.

PURPOSE: To evaluate the effect of different surface treatments and bonding procedures on the tensile bond strength (TBS) of resin composites repaired 6 months after polymerization. MATERIALS AND METHODS: Resin composite sticks were aged in distilled water at 37°C for 6 months. They were divided into 12 groups (n = 10) according to the combination of surface treatment/bonding procedures [none, only bur treatment, XP Bond (XPB/Dentsply/DeTrey) with/without bur, AdheSE (A-SE/Ivoclar/Vivadent) with/without bur, Composite Primer (CP/GC) with/without bur, CP after bur and acid-etching, XPB after acid etching and CP with bur, A-SE after bur and CP]. The ultimate tensile bond strength (UTS) of the resin composites was tested in intact but aged specimens. Tensile bond strengths were tested with a universal testing machine (Shimadzu). Data were analyzed using one-way ANOVA and Duncan Multiple Comparisons tests (p < 0.05). RESULTS: All repaired groups showed significantly higher TBS than the group without any sureface treatment (p < 0.05). Four groups resulted in TBS similar to those of intact resin composite UTS: A-SE, A-SE with bur, A-SE after CP with bur, and XPB after acid etching+CP with bur. CONCLUSION: Bur treatment, silane primer or etch-and-rinse adhesive application alone were not successful in the repair process of aged resin composite, whereas self-etching adhesive alone showed similar performance to the intact specimens. Combined procedures generally showed better performance: A-SE with bur, A-SE after CP with bur, and XPB after acid etching +CP with bur showed TBS similar to those of the intact specimens. It was concluded that bur roughening of the surfaces and rebonding procedures were essential for repairing aged resin composites.

Comparative radiopacity of six flowable resin composites.

OBJECTIVE: This study investigated the radiopacity of six commercially available flowable composites by using a digital image analysis method to determine the mean gray values of the materials. METHODS: The flowable resin composites evaluated in this study were Clearfil Majesty Flow, Estelite Flow Q, Tetric N Flow, Esthet X Flow, Filtek Supreme XT Flow and Gradia Direct LoFlo. Ten sample discs (6 x 1 mm) for each group were prepared and 1-mm thick slices were obtained from freshly-extracted teeth for the control group. The mean gray values (MGVs) of each specimen and aluminum (Al) stepwedge were measured by using the histogram function of a computer graphics program. Analysis of variance (ANOVA) was used to investigate the significance of the differences among the groups. For pairwise comparisons, the Tukey test was applied (alpha=0.05). RESULTS: The radiopacity values of Gradia Direct LoFlo, dentin and Estelite Flow Q were close to that of 1 mm Al. Tetric N Flow and Cl Majesty Flow were more radiopaque than enamel, whereas Filtek Supreme XT Flow had a similar radiopacity to enamel. CONCLUSION: The radiopacity of flowable composites varies considerably, and care must be taken when selecting an appropriate material to enable secondary caries detection under posterior composite restorations.

Color stability of nanocomposites polished with one-step systems.

OBJECTIVE: This study compared the color changes of five novel resin composites polished with two one-step polishing systems when exposed to coffee solution. METHODS: The resin composites tested were Filtek Supreme XT, Grandio, CeramX, Premise and Tetric EvoCeram. A total of 150 discs (30/resin composites, 10 x 2 mm) were fabricated. Ten specimens/resin composites cured under Mylar strips served as the control. The other samples were polished with PoGo and OptraPol discs for 30 seconds using a slow speed handpiece and immersed in coffee (Nescafé) for seven days. Color measurements were made with Vita Easyshade at baseline and after one and seven days. Repeated Measures ANOVA and Bonferroni tests were used for statistical analyses (p< or =0.05). RESULTS: The differences between the mean DeltaE* values for the resin composites polished with two different one-step systems were statistically significant (p<0.05). After one week, all materials exhibited significant color changes compared to baseline. All Mylar finished specimens showed the most intense staining (p<0.05). There were no significant differences between the OptraPol and PoGo polished groups. Mylar-finished specimens of CeramX, Tetric EvoCeram, Premise and Filtek Supreme XT presented the greatest staining (p<0.05). For Grandio, there were no significant differences between the Mylar and PoGo groups, while the most stain resistant surfaces were attained with OptraPol. CONCLUSION: Removing the outermost resin layer by polishing procedures is essential to achieving a stain resistant, more esthetically stable surface. One-step polishing systems can be used successfully for polishing nanocomposites.

Effect of different laser devices on the composition and microhardness of dentin.

This study determined the compositional changes and microhardness of the cavity floor prepared by Er,Cr:YSGG and Er:YAG lasers and compared the results with the conventional method of bur preparation. Fifteen non-carious human molars were used in this study. On the buccal and lingual surfaces of each tooth, two cavities (mesio-distal 3 mm, inciso-gingival 3 mm, depth 2 mm) were prepared with two different laser devices (Er,Cr:YSGG laser; Waterlase MD and Er:YAG laser; KaVo Key Laser 3) and a high-speed turbine. The teeth were embedded into polyester resin and cross-sectioned. The microhardness measurements from the floor of each half cavity were recorded with the Vickers surface hardness tester. The remaining halves of the cavities were subjected to SEM-EDS atomic analysis. The results were statistically evaluated by one-way ANOVA and Kruskal Wallis tests (p = 0.05). No significant differences were observed among the microhardness values, quantities of Ca (Ca weight %), P (P weight %) and Ca/P ratio of the lased and conventionally prepared cavities (p > 0.05). The cavity preparation techniques and differences in laser devices did not significantly alter the composition and microhardness of dentin tissue. Both laser devices used in this study were observed to lead to minimal thermal damage in the dentin tissue and minimal thermally-induced changes in dentinal compositions.

Can different chlorhexidine agents be used as cavity disinfectants?

This study used the agar well method to compare the antimicrobial effect of cavity disinfectants containing chlorhexidine with other chlorhexidine agents (such as mouthrinses and antiseptics) and to determine whether there was a difference in composite bond strength when these chlorhexidine agents were applied to the dentin surface. All tested solutions showed antimicrobial effect against Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans (p < 0.05). However, Savlex was found to be the most effective antibacterial agent against all microorganisms (p < 0.05). There were no significant differences between the bond strengths obtained from the cavity disinfectants and those of the control group (p > 0.05). However, the mouthrinse and the antiseptic decreased the shear bond strength compared with the control group (p < 0.05).

Clinical performance of novel resin composites in posterior teeth: 18-month results.

PURPOSE: The aim of this study was to evaluate the clinical success potential of two nanocomposites placed in posterior teeth using an antibacterial adhesive system over 18 months. METHODS: A total of 49 Class I and 47 Class II restorations were placed in the permanent teeth of thirty adult patients. The carious lesions were restored with Grandio (Voco) or Filtek Supreme (3M ESPE) using a two-step self-etching antibacterial adhesive system Clearfil Protect Bond (Kuraray). The restorations were finished with fine-grit diamond burs, Enhance polishing system, and Sof-Lex finishing brushes. The restorations were evaluated at baseline, 6, 12, and 18 months after placement using modified Ryge criteria for color stability, marginal discoloration, marginal adaptation, caries formation, anatomic form, postoperative sensitivity, surface roughness, and retention. RESULTS: The changes in the parameters were assessed using the Cochran Q test and the McNemar test at a significance level of p < 0.05. All restorations were classified as clinically satisfactory after 18 months. Statistical analysis demonstrated differences only in superficial roughness, with Grandio exhibiting more surface roughness than Filtek Supreme (p < 0.05). CONCLUSION: Posterior restorations built up with the novel nanocomposites using an antibacterial self-etching system showed satisfactory results at the 18-month recall appointment relative to all criteria except the surface texture in the case of Grandio. Further evaluations are necessary for a more in-depth analysis.

Microleakage study of different adhesive systems in Class V cavities prepared by Er,Cr:YSGG laser and bur preparation.

This study sought to compare the microleakage of composite resin restorations using two different dentin adhesive systems and two different modes of cavity preparation: a high-speed handpiece and an Er,Cr:YSGG laser. Twenty-five caries-free permanent human premolars were assigned randomly into five groups of five. A high-speed handpiece was used to prepare Class V cavities on the buccal and lingual surfaces of 10 randomly selected teeth. Class V cavities were cut on the buccal and lingual surfaces of the remaining 15 teeth using the Er,Cr:YSGG laser system. Fifty cavities were prepared with enamel and dentin margins 1.0 mm below the cemento-enamel junction and assigned into five groups: I, II, and III by the Er,Cr:YSGG laser and IV and V by the high-speed handpiece. In all groups, the differences between gingival and occlusal leakage scores were statistically significant (p < 0.05). The occlusal and gingival scores of groups I and IV demonstrated statistically significant differences (p < 0.05). The lased group with additional acid etching revealed less microleakage than groups III and IV (p < 0.05). Both self-etch and total-etch adhesive systems demonstrated acceptable microleakage scores when used on Er,Cr:YSGG laser-prepared cavities; however, additional acid etching after Er,Cr:YSGG laser preparation is recommended.

Shear bond strength of different adhesives to Er:YAG laser-prepared dentin.

PURPOSE: The aim of this study was to examine the influence of Er:YAG laser on the shear bond strength of three different adhesives to lased dentin. MATERIALS AND METHODS: Seventy specimens obtained from 35 extracted human molars were embedded in polyester resin and ground with silicon carbide papers. The samples were divided into seven groups. 1. Er:YAG laser (Key Laser 3, KaVo) + Clearfil Protect Bond (Kuraray); 2. Er:YAG laser + Clearfil tri-S Bond (Kuraray); 3. Er:YAG laser + 37% H3PO4 + Single Bond 2 (3M-ESPE); 4. Er:YAG laser + Single Bond 2; 5. conventional method + Clearfil Protect Bond; 6. conventional method + Clearfil tri-S Bond; 7. conventional method + 37% H3PO4 + Single Bond 2. The samples were subjected to shear bond testing 24 h after bonding. Statistical analyses were carried out by two-way ANOVA, t-test, one-way ANOVA, post-hoc Tukey's and Dunnett C test (p = 0.05). RESULTS: Only the Er:YAG laser + Clearfil tri-S Bond group demonstrated significantly higher bond strengths vs conventionally prepared specimens (p < 0.05). There were no significant differences between the shear bond strengths of Single Bond 2 adhesive applied to laser- vs bur-treated specimens (p > 0.05). In laser prepared samples, Clearfil Protect Bond showed the highest scores (p < 0.05), whereas in conventionally prepared groups, no statistical differences were observed between Clearfil Protect Bond and Clearfil tri-S Bond (p > 0.05). CONCLUSION: Er:YAG laser irradiation did not adversely affect the shear bond strength of Single Bond 2 and Clearfil Protect Bond to dentin, whereas it increased the shear bond strength values of Clearfil tri-S Bond.

Is an antibacterial adhesive system more effective than cavity disinfectants?

PURPOSE: To compare the antibacterial activity of an adhesive system containing an antibacterial monomer MDPB, Clearfil Protect Bond with three different cavity disinfectants, chlorhexidine gluconate-based Consepsis, benzalkonium chloride-based Tubulicid Red and 3% hydrogen peroxide. METHODS: Materials were tested using agar well technique and a tooth cavity model. The test materials were filled in the agar wells of plates inoculated with Streptococcus mutans. After 48 hours of incubation, the zones of inhibitions were measured in millimeters. For the tooth cavity model test, cylindrical cavities were prepared in the flat occlusal dentin of human extracted molars. The teeth were left in a broth culture of Streptococcus mutans at 37 degrees C for 72 hours allowing bacteria to invade. Teeth were then randomly assigned into five groups of five teeth (10 cavity preparations) each. In the first four groups test materials were applied into the cavities following the manufacturer's instructions and the cavities in the fifth group were left untreated for control. The teeth were kept in saline for 72 hours. Standard amounts of dentin chips were obtained from the cavity walls and the number of bacteria recovered was counted. RESULTS: The results were analyzed by ANOVA, Dunnett C and Bonferroni tests. For the agar well technique, Clearfil Protect Bond primer exhibited greater inhibition zones than all three cavity disinfectants (P< 0.05). When tested by the cavity method, the application of Clearfil Protect Bond system resulted in significantly less bacterial recovery than all disinfectants (P< 0.05). For both microbiological methods, there were no significant differences between the antibacterial activities of Consepsis and Tubulicid Red (P> 0.05). They were superior to hydrogen peroxide in the cavity test method (P< 0.05).

Influence of dentin on the effectiveness of antibacterial agents.

The influence of dentin on the effectiveness of three antibacterial agents (triclosan, glutaraldehyde, NaOCl) on Streptococcus mutans, S. sobrinus, and Lactobacillus acidophilus was tested using the agar diffusion method with and without bovine dentin discs (200 mum and 500 mum thickness) placed between bacteria and test substances. The effect of 0.3% triclosan on all tester strains (100%) was reduced after passage through 500 mum dentin discs to 0% (L. acidophilus) and to 22% and 28% (S. mutans and S. sobrinus). Seal&Protect (Dentsply, Konstanz, Germany), a triclosan containing dental bonding agent, produced inhibition zones only against S. mutans, but no zone when applied on 200 mum dentin discs. The inhibition zones for 1% NaOCl and 5% glutaraldehyde against all tester strains were significantly increased up to 230% (glutaraldehyde) and 236% (NaOCl) when applied on dentin discs, compared to direct application (100%). Dentin may either decrease or increase the inhibitory effect of antibacterial agents.

The protective effect of resveratrol against dentin bonding agents-induced cytotoxicity.

This study was designed to evaluate the cytotoxicity of four dentin bonding agents and the effects of an antioxidant addition. Group A: G-aenial Bond, Group B: Optibond All in One, Group C: Gluma Self Etch and Group D: Clearfil S(3) Bond were added to the medium using extract method. The cells were cultured with or without resveratrol (RES) addition. MTT, reactive oxygen species (ROS), DCF, Comet and 8-OHdG measurements were performed. The agents had a dose-dependent (1:1>1:10>1:20) cytotoxic effect. Considering 1:10 concentration; Group D at 1 h (p<0.01) and Group B and D at 24 h had the weakest cytotoxic effect (p<0.05). After RES addition, the highest cell viability was determined in Groups B+RES and D+RES at 1 h and in Groups A+RES and B+RES at 24 h (p<0.01). The dentin bonding agents induced ROS production and DNA damage regarding to their composition. However, RES addition decreased the indicated parameters.

Effects of topical fluoride agents on artificial enamel lesion formation in vitro.

OBJECTIVE: The purpose of this study was to assess the effects of topical fluoride agents on enamel erosion in vitro. METHOD AND MATERIALS: Ten premolars extracted for orthodontic purposes were sectioned buccolingually and then longitudinally into two parts, so that four specimens were obtained from each tooth. The specimens were randomly assigned to one of four groups. The following topical fluoride agents were applied to the specimens: 1% titanium tetrafluoride (0.32 MF) for 1 minute; Duraphat (2.26% F) and Elmex (1.25% F) for 4 minutes. In the control group, no solution was applied. The specimens were treated with an artificial caries solution for 4, 8, 12, and 16 days. Calcium (Ca++) concentration was determined by an atomic absorbtion spectrophotometer, while fluoride (F-) concentration was determined with an ion-selective electrode. One-way analysis of variance tests were performed on cumulative concentrations of calcium and fluoride at days 4, 8, 12, and 16. RESULTS: Specimens treated with titanium tetrafluoride lost significantly less calcium than did specimens in the other two test groups at all time periods. Titanium tetrafluoride-treated specimens released significantly less fluoride than did Duraphat- or Elmex-treated specimens at day 16. CONCLUSION: Titanium tetrafluoride was found to be more effective than the other fluoride agents in preventing artificial enamel lesion formation.