Effects of proanthocyanidin-functionalized hydroxyapatite nanoparticles on dentin bonding.

OBJECTIVES: To evaluate the effect of proanthocyanidin-functionalized hydroxyapatite nanoparticles (nHAp_PA) used as pretreatment at different concentrations on the microtensile bond strength (µTBS) and endogenous enzymatic activity (MMPs) on pH-cycled dentin after 24 h and 6 months of artificial aging. MATERIALS AND METHODS: Fifty human sound dentin blocks were randomly assigned to 5 groups (n = 10): (i) negative control (no treatment); (ii) positive control (pH-cycling); (iii) pH-cycling + 2% nHAp_PA for 60s; (iv) pH-cycling + 6.5% nHAp_PA for 60s; (v) pH-cycling + 15% nHAp_PA for 60s. A self-etch adhesive was used for bonding procedures before resin composite build-ups. Specimens were tested with the µTBS test after 24 h and 6 months of laboratory storage. The proteolytic activity in each group was evaluated with gelatin zymography and in situ zymography. Data were statistically analyzed (p < 0.05). RESULTS: At 24 h, the µTBS of the experimental groups were significantly higher than the controls (p ≤ 0.001), and no differences were observed between different concentrations (p > 0.05). Artificial aging significantly decreased bond strength in all groups (p ≤ 0.008); however, nHAp_PA 2% still yielded higher bonding values than controls (p ≤ 0.007). The groups pretreated with nHAp_PA exhibited lower MMP-9 and MMP-2 activities compared to the positive control group and almost the same enzymatic activity as the negative control group. In situ zymography showed that after 6 months of aging, nHAp_PA 2% and nHAp_PA 6,5% decreased enzymatic activity as well as the negative control. CONCLUSIONS: Dentin pretreatment with nHAp_PA increased the bonding performance of a self-etch adhesive and decreased MMP-2 and MMP-9 activities after 6 months.

Influence of de-remineralization process on chemical, microstructural, and mechanical properties of human and bovine dentin.

OBJECTIVES: This study compared the chemical composition, microstructural, and mechanical properties of human and bovine dentin subjected to a demineralization/remineralization process. MATERIALS AND METHODS: Human and bovine incisors were sectioned to obtain 120 coronal dentin beams (6 × 1 × 1 mm3) that were randomly allocated into 4 subgroups (n = 15) according to the time of treatment (sound, pH-cycling for 3, 7, and 14 days). Three-point bending mechanical test, attenuated total reflectance-Fourier transform infrared (ATR-FTIR), thermogravimetric (TG), and X-ray diffraction (XRD) techniques were employed to characterize the dentin samples. RESULTS: Regarding chemical composition at the molecular level, bovine sound dentin showed significantly lower values in organic and inorganic content (collagen cross-linking, CO3/amide I, and CO3/PO4; p = 0.002, p = 0.026, and p = 0.002, respectively) compared to humans. Employing XRD analyses, a higher mineral crystallinity in human dentin than in bovines at 7 and 14 days (p = 0.003 and p = 0.009, respectively) was observed. At the end of the pH-cycling, CI (ATR-FTIR) and CO3/PO4 ratios (ATR-FTIR) increased, while CO3/amide I (ATR-FTIR), PO4/amide I (ATR-FTIR), and %mineral (TG) ratios decreased. The extension by compression values increased over exposure time with significant differences between dentin types (p < 0.001, in all cases), reaching higher values in bovine dentin. However, flexural strength (MPa) did not show differences between groups. We also observed the correlation between compositional variables (i.e., PO4/amide I, CI, and %mineral) and the extension by compression. CONCLUSIONS: Human and bovine dentin are different in terms of microstructure, chemical composition, mechanical strength, and in their response to the demineralization/remineralization process by pH-cycling. CLINICAL RELEVANCE: These dissimilarities may constitute a potential limitation when replacing human teeth with bovines in in vitro studies.

Effect of 30 % hydrogen peroxide on mineral chemical composition and surface morphology of bovine enamel.

A combination of atomic absorption spectroscopy (AAS), Fourier transform infrared spectroscopy (FTIR), scanning electronic microscopy (SEM), and gas adsorption techniques was used to characterize the effect of 30 % hydrogen peroxide (HP) on enamel surface. To perform the analyses of AAS, 1 ml of 30 % HP was added to 30 mg of a bovine enamel powder sample (150-200 µm fractions) for times of 5, 20, 60, 90, and 120 min; then 5 ml of the solution was withdrawn after each time period to measure [Ca(2+)] ions. The remaining powder was recovered and analyzed by FTIR. For SEM and gas adsorption tests, 4 × 4 mm(2) enamel sectioned samples were polished and 30 % HP was applied on the surface for the same time periods. AAS data show that 30 % HP treatment mobilized calcium from the enamel at all times studied. FTIR spectra showed that the total amount of phosphate and carbonate mineral contents such as amide I decreased significantly. SEM revealed that randomly distributed areas throughout the smooth enamel surface treatment became rougher and more irregular. These alterations indicate that surface damage increases with increasing durations of HP treatment. Gas adsorption analysis proved that bleached enamel is a typically non-porous material with a small specific surface area which decreases slightly with the 30 % HP treatment. In sum, 30 % HP induced a significant alteration of the organic and mineral part of the enamel, leading to the release of calcium and a rougher, more irregular enamel surface on randomly distributed areas.

Ferric sulphate alterations on primary dentin and the adhesive interface.

PURPOSE: The purpose of this study was to test the hypothesis that the pulp medication ferric sulphate (FS) may remain on primary dentin, affecting its microchemical structure and the bond strength of adhesives to primary dentin. MATERIALS AND METHODS: The effects of FS and pre-bonding conditioning (37% phosphoric acid [PA] for 15 s or a self-etching primer, with or without the use of 2% chlorhexidine [CHX]) on FS-treated primary dentin were characterized using optical microscopy with Masson's and Perls' stains, variable-pressure SEM/energy-dispersive x-ray spectroscopy (VP-SEM/EDS), Fourier transform infrared spectroscopy (FT-IR), and x-ray diffraction. Ferric sulphate was applied for 30 s or 1 h for microchemical analysis. The adhesive interface and the bond strength were studied by VP-SEM/EDS and the µTBS test (1 mm2 bars, crosshead speed 0.5 mm/min), respectively. The study groups were: etch-and-rinse (E&R, Excite) adhesive (group 1); FS+E&R (group 2); FS+CHX+E&R (group 3); self-etching (SE, Adper Scotchbond) adhesive (group 4); FS+SE (group 5); FS+CHX+SE (group 6). RESULTS: Ferric sulphate application produced demineralization, gypsum formation, and adsorption of Fe on the dentin surface, and it modified the collagen structure of primary dentin. There were no effects of FS on bond strength of the tested etch-and-rinse adhesive system. FS slightly reduced the bond strength between the primary dentin and the SE adhesive, and the values were not restored by CHX (group 4 = 17.58 ± 5.52 MPa > group 5 = 14.26 ± 7.08 MPa = group 6 = 13.96 ± 4.87 MPa). CONCLUSIONS: Ferric sulphate alters the microchemical structure of primary dentin and can impair the adhesive strength of some self-etching adhesives.

Green synthesis of chitosan- and fluoride-functionalized silver nanoparticles using Camellia sinensis: Characterization and dental applications.

The development of new biocompatible and eco-friendly materials is essential for the future of dental practice, especially for the management of dental caries. In this study, a novel and simple method was applied for the green synthesis of silver nanoparticles (AgNPs) from the aqueous extract of Camellia sinensis (WT) and functionalized with chitosan (CHS) and NaF. The effects of WT_AgNPs application on demineralized dentin were evaluated for potential dental applications. The WT_AgNPs showed molecular groups related to organic compounds, potentially acting as reducing and capping agents. All AgNPs presented spherical shapes with crystal sizes of approximately 20 nm. Forty human molars were assigned to control: sound (SD) and demineralised dentine (DD), and experimental groups: WT_AgNPs, WT_AgNPs_NaF, and WT_AgNPs_CHS. Then, the NPs were applied to DD to evaluate the chemical, crystallographic, and microstructural characteristics of treated-dentine. In addition, a three-point bending test was employed to assess mechanical response. The application of WT_AgNPs indicated a higher mineralisation degree and crystallites sizes of hydroxyapatite than the DD group. SEM images showed that WT_AgNPs presented different degrees of aggregation and distribution patterns. The dentine flexural strength was significantly increased in all WT_AgNPs. The application of WT_AgNPs demonstrated remineralising and strengthening potential on demineralised dentine.

Percentage exposure of root dentin collagen after application of two irrigation protocols with manual or rotary instrumentation and two methacrylate resin-based sealers.

PURPOSE: To compare the percentage of collagen exposed in dentin root thirds after two irrigation protocols with manual or rotary instrumentation using two methacrylate resin-based sealers. MATERIALS AND METHODS: Forty-eight single-root human teeth were prepared with manual (n = 24) or nickeltitanium ProFile rotary (n = 24) instrumentation, using 5% NaOCl between instruments and 5 ml 17% EDTA as final irrigant or 20% citric acid + 2% chlorhexidine (CHX) between instruments and as the final irrigant. RealSeal or EndoREZ were used as filling materials. One 1-mm slice per third was abraded and stained with Masson's trichrome method. Mean exposed collagen values were obtained in four areas from each section (at 60X magnification) and a complete factorial ANOVA was used to analyze the influence of the study variables. Non-parametric Mann-Whitney's test was used to compare groups. Differences with p < 0.05 were considered significant. RESULTS: A significantly higher percentage of collagen was exposed in all thirds with the use of the 20% citric acid + 2% CHX protocol with rotary vs manual instrumentation, but percent collagen exposed did not differ as a function of the filling material. After the 5% NaOCl + 17% EDTA protocol, the percentage of collagen exposed did not differ between rotary and manual instrumentation but was higher with the use of RealSeal. CONCLUSION: The highest percentage exposure of collagen was with 20% citric acid + 2% CHX using rotary instrumentation, regardless of the filling material.

Bond strength of self-adhesive resin cements to different treated indirect composites.

OBJECTIVES: The objective of this study was to determine microtensile bond strength (µTBS) to dentin of three self-adhesive and a total-etch resin cements used for luting different treated indirect composites. MATERIALS AND METHODS: Composite overlays (Filtek Z250) were prepared. Their intaglio surfaces were ground with 600-grit SiC papers and randomly assigned to three different surface treatments: no treatment, silane application (RelyX Ceramic Primer), and silane agent followed by a bonding agent (Adper Scotchbond 1 XT). The composite overlays were luted to flat dentin surfaces of extracted human third molars using the following self-adhesive resin cements: RelyX Unicem, Maxcem Elite and G-Cem, and a total-etch resin cement, RelyX ARC. The bonded assemblies were stored in water (24 h, 37 °C) and subsequently prepared for µTBS testing. Beams of approximately 1 mm(2) were tested in tension at 1 mm/min in a universal tester (Instron 3345). Data were analyzed by two-way ANOVA and Student-Newman-Keuls tests (α = 0.05). RESULTS: A significant influence of the resin cement used was detected. Composite surface treatment and the interaction between the resin cement applied and surface treatment did not affect µTBS. CONCLUSIONS: Surface treatment of indirect resin composite did not improve the µTBS results of dentin/composite overlay complex. Self-adhesive resin cements tested obtained lower µTBS than the total-etch resin cement RelyX ARC. Specimens luted with Maxcem Elite exhibited the highest percentage of pretesting failures. CLINICAL RELEVANCE: Surface treatment of indirect resin composite with silane or silane followed by a bonding agent did not affect bond strength to dentin.

Effect of thermal aging on the tensile bond strength at reduced areas of seven current adhesives.

The purpose of this study was to determine the micro-tensile bond strength (MTBS) to dentin of seven adhesive systems (total and self-etch adhesives) after 24 h and 5,000 thermocycles. Dentin surfaces of human third molars were exposed and bonded with two total-etch adhesives (Adper Scotchbond 1 XT and XP Bond), two two-step self-etch adhesives (Adper Scotchbond SE and Filtek Silorane Adhesive System) and three one-step self-etch adhesives (G-Bond, Xeno V and Bond Force). All adhesive systems were applied following manufacturers' instructions. Composite buildups were constructed and the bonded teeth were then stored in water (24 h, 37 °C) or thermocycled (5,000 cycles) before being sectioned and submitted to MTBS test. Two-way ANOVA and subsequent comparison tests were applied at α = 0.05. Characteristic de-bonded specimens were analyzed using scanning electron microscopy (SEM). After 24 h water storage, MTBS values were highest with XP Bond, Adper Scotchbond 1 XT, Filtek Silorane Adhesive System and Adper Scotchbond SE and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. After thermocycling, MTBS values were highest with XP Bond, followed by Filtek Silorane Adhesive System, Adper Scotchbond SE and Adper Scotchbond 1 XT and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. Thermal aging induced a significant decrease in MTBS values with all adhesives tested. The resistance of resin-dentin bonds to thermal-aging degradation was material dependent. One-step self-etch adhesives obtained the lowest MTBS results after both aging treatments, and their adhesive capacity was significantly reduced after thermocycling.

Comparison of the Efficacy of Two Protocol Treatments in Patients with Symptomatic Disc Displacement without Reduction: A Randomized Controlled Trial.

The aim of this study was to compare the effectiveness of arthrocentesis followed by hyaluronic acid infiltration treatment (ASH) and mandibular exercise therapy (MET) in patients with symptomatic disc displacement without reduction (DDwoR) by examining pain intensity (VAS), mandibular range of motion (MO), and quality of life (QoL). Fifty-two patients were randomly allocated into two groups, MET (N = 26) and ASH (N = 26), and therapy was applied at the baseline and one month after. Patients were followed up at 1 and 12 months after the baseline assessment. Clinical and patient-reported outcomes were compared at the baseline, 1-month follow-up, and 12-month follow-up. The study found no significant differences in VAS and MO between the ASH and MET groups at the baseline. However, while not significant, it was noted that the ASH group showed higher values for MO. Regarding OHIP-14 at 1 month of follow-up, the ASH group showed significant improvements in physical pain (p > 0.01), physical and psychological disability (p = 0.043 and p = 0.029), and handicap (p = 0.033). At the 12-month follow-up, the ASH group showed significant improvements in functional limitation, psychological discomfort, psychological disability, and handicap (p = 0.008, p = 0.001, p = 0.001, p = 0.005, respectively). ASH treatment did not reduce pain or improve mandibular range of motion more than physical therapy in patients with symptomatic DDwoR. However, ASH could be preferable given its positive long-term effects on patients' quality of life. The clinician's main objective is to prioritize the treatment plan order with a focus on the patient's quality of life. Accordingly, healthcare professionals should consider ASH as a treatment option for patients with symptomatic DDwoR who desire long-term improvement in their quality of life.

Evaluation of the remineralizing capacity of silver diamine fluoride on demineralized dentin under pH-cycling conditions.

OBJECTIVE: (1) to determine the effects of the silver diamine fluoride (SDF) and sodium fluoride (NaF) in demineralized dentin exposed to an acid challenge by pH-cycling, (2) to evaluate the remineralizing capacity of SDF/NaF products based on the physicochemical and mechanical properties of the treated dentin surfaces. METHODOLOGY: In total, 57 human molars were evaluated in different stages of the experimental period: sound dentin - negative control (Stage 1), demineralized dentin - positive control (Stage 2), and dentin treated with SDF/NaF products + pH-c (Stage 3). Several commercial products were used for the SDF treatment: Saforide, RivaStar, and Cariestop. The mineral composition and crystalline and morphological characteristics of the dentin samples from each experimental stage were evaluated by infrared spectroscopy (ATR-FTIR), X-ray diffraction, and electron microscopy (SEM-EDX) analytical techniques. Moreover, the mechanical response of the samples was analyzed by means of the three-point bending test. Statistics were estimated for ATR-FTIR variables by Wilcoxon test, while the mechanical data analyses were performed using Kruskal-Wallis and Mann Whitney U tests. RESULTS: Regarding the chemical composition, we observed a higher mineral/organic content in the SDF/NaF treated dentin + pH-c groups (Stage 3) than in the positive control groups (Saforide p=0.03; Cariestop p=0.008; RivaStar p=0.013; NaF p=0.04). The XRD results showed that the crystallite size of hydroxyapatite increased in the SDF/NaF treated dentin + pH-c groups (between +63% in RivaStar to +108% in Saforide), regarding the positive control. SEM images showed that after application of the SDF/NaF products a crystalline precipitate formed on the dentin surface and partially filled the dentin tubules. The flexural strength (MPa) values were higher in the dentin treated with SDF/NaF + pH-c (Stage 3) compared to the positive control groups (Saforide p=0.002; Cariestop p=0.04; RivaStar p=0.04; NaF p=0.02). CONCLUSIONS: The application of SDF/NaF affected the physicochemical and mechanical properties of demineralized dentin. According to the results, the use of SFD/NaF had a remineralizing effect on the dentin surface even under acid challenge.

Selective removal of mineral and organic components of bovine enamel by phosphoric acid.

PURPOSE: To follow the chemical composition of bovine enamel during phosphoric acid-induced demineralization. MATERIALS AND METHODS: Enamel samples were ground into a fine powder, selecting the 150- and 200-µm fractions in order to obtain a more homogeneous study material. They were immersed in diluted phosphoric acid (0.1%) for increasing durations ranging from 1 to 1440 min. The chemical composition of the solution and enamel powder was determined after each sequential treatment by means of atomic absorption (AA) and Fourier transform infrared (FTIR) spectroscopy. RESULTS: AA data revealed that the amount of calcium mobilized to the solution by the acid treatment was higher at shorter exposure times. However, FTIR data showed that the degree of mineralization of the enamel remained constant during the treatment, indicating that the mineral and organic components were lost at the same rate. Interestingly, poorly crystalline phosphate and carbonate-rich mineral components were preferentially removed and were presumably the main source of calcium released by the acid exposure. FTIR results also demonstrated that organic components rich in hydrophobic groups were preferentially removed during acid treatment. CONCLUSION: Etching with phosphoric acid produces a nonhomogeneous demineralization of bovine enamel, with the selective removal of poorly crystalline mineral and hydrophobic organic components.

Gender and Leadership Positions in Spanish Dentistry.

Dentists in Spain reached equal gender representation in 2012 and the number of female dentists has continued to grow (until 57.3% in 2020). This study aims to increase evidence about the gender distribution on the high responsibility positions and opinion leaders of the dental profession and academia. Composition of the executive comities of the main dental institutions of Spain (regional professional associations, national dental association, and scientific societies), members of the Faculty of Dentistry of the University of Granada in 2020 and speakers of the main dental congresses of 2019 (due to the lack of congress in 2020) were recorded and analyzed by genders using chi-squared test (P < .05). Mean representation of female dentists in executive committees of professional associations was 35.6%. More than 70% of presidents and vice-presidents of professional colleges and more than 60% of these positions in scientific societies were occupied by male dentists. None of dental congresses of 2019 reached equal gender participation, being 81.3% of lecturers presenting on main auditoriums male dentists. Although dental workforce in Spain is slightly overrepresented by females, leadership positions and figures among Spanish dentists doesn't seem to reflect the gender distribution of the collective. There is a lack of women occupying high-level positions in dentistry that proves the existence of the so-called "glass ceiling effect" on the profession. Further studies about sociodemographic aspects of dental workforce are needed to develop evidence-based policies for the collective.

Demineralization effects of phosphoric acid on surface and subsurface bovine enamel bleached with in-office hydrogen peroxide.

PURPOSE: To measure the demineralization capacity of 37% phosphoric acid on surface and subsurface bovine enamel after bleaching with hydrogen peroxide (H2O2). MATERIALS AND METHODS: Three equally-sized sections with 16 mm2 of exposed enamel surface were obtained from the enamel of 10 bovine incisors. One specimen sample from each crown was assigned to one of three groups (n = 10): group I, no bleaching agent; group II, bleached with 38% H202 for 20 min; or group III, 30% H202 for 60 min. After 24 h, the thickness of specimens was measured and they were immersed in 37% phosphoric acid solution, of which 5-ml aliquots were collected at 30 s and 60 s. Specimens were then ground to a depth of 25 µm and again immersed in 37% phosphoric acid solution. This procedure was repeated for enamel depths of 50 and 100 µm. Ca2+ concentrations in the phosphoric acid aliquots were measured by atomic absorption spectroscopy. RESULTS: No significant differences were found in the total amounts of extracted Ca2+ between bleached and unbleached specimens (F = 0.142; p = 0.869). The amount of Ca2+ extracted was similar among the four depth levels in the unbleached and in the 30% H202 bleached specimens. A significantly larger amount of Ca2+ was obtained at 25 µm depth (subsurface) from specimens treated with 38% H202. CONCLUSIONS: Pre-bleaching with 38% H202 significantly increased the decalcifying effect of phosphoric acid on subsurface enamel at a depth of 25 µm compared to 100 µm, whereas pre-bleaching with 30% H202 did not modify this effect at any level.

Regional bond strength to lateral walls in class I and II ceramic inlays luted with four resin cements and glass-ionomer luting agent.

PURPOSE: To investigate regional shear bond strength to lateral walls of ceramic inlays in occlusal and occlusoproximal cavities using etch-and-rinse and self-adhesive resin cements and a glass-ionomer luting agent. MATERIALS AND METHODS: IPS e.max Press ceramic inlays were made in 50 Class I and 50 Class II standardized cavities in intact extracted human molars and divided into 5 luting agent subgroups (n = 10): Variolink II (VL); Multilink Sprint (MLS); Multilink Automix (MLA); RelyX Unicem (RLX), and Ketac Cem Aplicap (KC). Inlays were pre-etched with IPS Ceramic etching gel for 60s. After 48 h, two disks of ca 1.0 mm thickness, one of superficial and the other of deep dentin, were push-out tested in a universal testing machine at a crosshead speed of 1.0 mm/min. The mode of failure was determined under a stereomicroscope at 20X. Data were analyzed with one way ANOVA, and Scheffé's test was used for post-hoc comparisons (α = 0.05). RESULTS: There were no significant differences in shear bond strength between Class I and Class II cavities for the dual-curing system in light-curing mode (VL=MLS=RLX), except that RLX demonstrated greater bond strength to deep dentin in Class II cavities. Bond strength values were significantly higher on deep than on superficial dentin. KC showed the worst result. Failures were mixed (adhesive/cohesive) for the resin luting cements and solely adhesive (cement/ceramic) for the glass-ionomer luting agent. CONCLUSION: Dual-curing etch-and-rinse or self-etching self-adhesive resin luting cements achieved greater bond strength when light curing was applied, with no differences between Class I and Class II cavities but higher values for deep vs superficial dentin. The weakest adhesion was obtained with glass-ionomer luting agent in both cavity types.

A gender- based approach to the current situation of Spanish dentists.

BACKGROUND: To determine the perception of Spanish dentists about the situation of the profession nowadays and how the changes occurred in dental workforce (in number and gender of the past twenty years) have affected their personal and professional lives, under a gender-based approach. MATERIAL AND METHODS: An online survey comprising of 51 opinion and socio-economic questions, divided into 9 sections of different topics, which was administered between the members of 13 professional associations. Chi-squared tests were calculated (p<0.05). RESULTS: Valid responses were received from 422 participants with a mean age of 41 years old and 66% of female dentists. Most dentists considered their selves in a "good" position, however, 72.3% of them said the profession "has had worsened". Opinions significantly differed between women and men in gender equity and the pay gap between them could be observed (29.4% of males earned more of 4000 euros a month, while only 15.1% female dentists did). Also, 49.5% of female dentists felt underrepresented in the highest association of Spanish dentists (General Council of Dentist - Consejo General de Dentistas) and 38.4% declared they have had suffered verbal violence coming from patients repeatedly. CONCLUSIONS: A generally negative perception of dentists' work quality was found among respondents. Also, opinions between males and females differed in important aspects of professional development. Further research projects are needed to have growing evidence on problems and disparities in the dental workforce which would help the institutions to make improvement actions. Key words:Dentists, Health Workforce, Survey, Gender, Spain.

Effect of Two Immediate Dentin Sealing Approaches on Bond Strength of Lava™ CAD/CAM Indirect Restoration.

The objective of this work was to compare the micro-tensile bond strength (µTBS) of CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) specimens cemented with different pairing of adhesives and resin-cements using two Immediate Dentin Dealing (IDS) approaches in comparison with Delay Dentin Sealing (DDS). Coronal dentin from 108 molars were divided into nine groups (n = 12) depending on the adhesive/resin-cement (A-C) assigned. Lava™ Ultimate (4 × 10 × 10 mm) was cemented according to different strategies: IDS1(cementation after dentin sealing), DDS (dentin sealing and cementation at 2-weeks), IDS2 (immediate dentin sealing and cementation at 2-weeks). Samples were sectioned and tested until failure to determine the µTBS. Failure mode was categorized as dentin/cement (DC), at Lava™ Ultimate/cement (LC) and hybrid (H). Kruskal-Wallis and Mann-Whitney U tests and influence of the type of failure on the µTBS by survival analysis with competing risk was explored. Mostly, µTBS values were equal or higher in IDS2 than DDS. In general, A-Cs that showed higher µTBS, have high percentages of LC failure. Survival analysis with competing risk between DC + H and LC values showed that some A-Cs would significantly increase the µTBS values for IDS2. A-Cs with the highest adhesion values showed a high percentage of fractures at the LC interface, suggesting that the adhesion at the adhesive/dentin interface would be higher.

Proanthocyanidin-functionalized hydroxyapatite nanoparticles as dentin biomodifier.

OBJECTIVE: This study evaluated the potential combined effects of nanohydroxyapatite and proanthocyanidin on the remineralization and collagen stabilization of demineralized dentin. METHODS: Seventy-five coronal dentin beams (6 × 1 × 1 mm3) were randomly allocated into five experimental groups (n = 15): Sound (no treatment), Control (pH-cycling), nHAp (nanohydroxyapatite), nHAp_PA (Proanthocyanidin-functionalized nanohydroxyapatite), and PA (proanthocyanidin) treatments. The sound group (negative control) were immersed in distilled water over the experimental period. The remaining groups were submitted to a pH-cycling process for 14 days. Following the de-re mineralization process, specimens corresponding to the control group (positive control) were immersed in distilled water whereas the test groups were immersed in 1 mL of respective solution treatment (nHAp, nHAp_PA, or PA) for 1 min. The dentin samples were analyzed to determine their chemical composition (ATR-FTIR and Thermogravimetric) and mineralogical (XRD) characteristics as well as their mechanical response, obtained by three-point bending test. RESULTS: Higher phosphate content (v4 PO4: ATR-FTIR) and amount of mineral (XRD) was observed in the nHAp_PA group. Furthermore, a larger induction of collagen cross-links (ATR-FTIR) and %Organic Matter (TGA) would indicate the PA incorporation and the achievement of dentin matrix stability. These effects on dentin properties were related to increasing flexural strength (MPa), demonstrating that 15% w/v nHAp_PA treatment improved the mechanical properties of the samples. SIGNIFICANCE: nHAp_PA shows significant potential for promoting remineralization while improving collagen stability into demineralized dentin in a clinically feasible period of 1 min.

Physicochemical and Mechanical Effects of Commercial Silver Diamine Fluoride (SDF) Agents on Demineralized Dentin.

PURPOSE: To investigate the effects of four commercial silver diamine fluoride (SDF) agents on the chemical composition and microstructural properties of dentin, and its relation to the bond strength of two adhesives. MATERIALS AND METHODS: Ninety human molars were randomly divided into sound dentin (negative control), demineralized dentin (positive control), and four experimental groups (n = 15) according to the SDF treatments (Cariestop [Biodinamica Quimica y Farmaceutica], RivaStar 1 [SDI], RivaStar 2 [SDI], and Saforide [Tokyo Seiyaku Kasei]). ATR-FTIR, x-ray diffraction, and SEM techniques were employed to characterize the compositional, crystalline, and microstructural properties of the samples. The microtensile bond strength test evaluated the bonding performance of two adhesives in demineralized dentin treated with SDF agents. RESULTS: Regarding the chemical composition, all SDF-treated groups showed a significantly higher phosphate:organic matrix ratio than the demineralized dentin group (p < 0.05). The XRD analyses revealed that the crystallite size for hydroxyapatite crystals increased on the surface areas (deep, medium, and superficial dentin) for all experimental groups compared to demineralized dentin (p < 0.05). SEM images showed that the behavior of the agents used differs on each surface treated. Bond strength values were adversely affected with both adhesive systems in the four experimental groups (p < 0.05). CONCLUSIONS: The application of SDF agents resulted in the formation of different crystalline phases of silver salts and the increase of mineralization of the pretreated demineralized dentin. However, SDF application showed a negative effect on the bond strength of the adhesives.

Demineralization effects of hydrogen peroxide on bovine enamel and relation to shear bond strength of brackets.

PURPOSE: To measure the demineralization capacity of 37% phosphoric acid and shear bond strength (SBS) of brackets attached on bovine enamel at different times after bleaching with 30% hydrogen peroxide. MATERIALS AND METHODS: Four equally-sized pieces of each crown from 18 bovine incisors were randomly distributed among 7 groups (n = 10). After bleaching with 30% hydrogen peroxide for 1 h, specimens were stored in artificial saliva for 0 h, 24 h, or 1, 2, 3, or 4 weeks before bonding specimens to brackets. An unbleached group of specimens served as controls. Shear bond strength (SBS in MPa) was measured with a universal testing machine. Adhesive Remnant Index (ARI) scores were determined after failure of bracket bonds. To measure demineralized Ca2+, four 4 x 4 mm sections from each of 15 bovine incisors were randomly distributed among 4 groups (n = 15). Specimens were stored in artificial saliva for 0 h, 24 h or 7 days after bleaching and then immersed in 37% phosphoric acid solution. After 15 s, 30 s, and 60 s, 5-ml aliquots of solution were removed for spectrophotometry. Unbleached specimens served as controls. RESULTS: Larger amounts of Ca2+ were extracted from the enamel by phosphoric acid up to 24 h after application of hydrogen peroxide, when there was also a significant decrease in bracket-enamel SBS. After 1 week, there were no changes in amounts of Ca2+ extracted, and SBS values returned towards unbleached values. CONCLUSION: Lower bracket-enamel SBS values at 24 h after bleaching are closely correlated with the larger amounts of Ca2+ extracted from the enamel.

Changes with age (from 0 to 37 D) in tibiae bone mineralization, chemical composition and structural organization in broiler chickens.

Broiler chickens have an extreme physiology (rapid growth rates) that challenges the correct bone mineralization, being an interesting animal model for studying the development of bone pathologies. This work studies in detail how the mineralization, chemistry, and structural organization of tibiae bone in broiler chickens change with age during the first 5 wk (37 D) from hatching until acquiring the final weight for slaughter. During the early growth phase (first 2 wk), the rapid addition of bone tissue does not allow for bone organic matrix to fully mineralize and mature, and seems to be a critical period for bone development at which bone mineralization cannot keep pace with the rapid growth of bones. The low degree of bone mineralization and large porosity of cortical bone at this period might be responsible of leg deformation and/or other skeletal abnormalities commonly observed in these birds. Later, cortical bone porosity gradually decreases and the cortical bone became fully mineralized (65%) at 37 D of age. At the same time, bone mineral acquires the composition of mature bone tissue (decreased amount of carbonate, higher crystallinity, Ca/P = 1.68). However, the mineral part was still poorly organized even at 37 D. The oriented fraction was about 0.45 which means that more than half of apatite crystals within the mineral are randomly oriented. Mineral organization (crystal orientation) had an important contribution to bone-breaking strength. Nevertheless, locally determined (at tibia mid-shaft) bone properties (i.e., cortical thickness, crystal orientation) has only a moderate correlation (R2 = 0.33) with bone breaking strength probably due to large and highly heterogeneous porosity of bone that acts as structural defects. On the other hand, the total amount of mineral (a global property) measured by total ash content was the best predictor for breaking strength (R2 = 0.49). Knowledge acquired in this study could help in designing strategies to improve bone quality and reduce the incidence of skeletal problems in broiler chickens that have important welfare and economic implications.