Three-year clinical evaluation of universal adhesives in non-carious cervical lesions.

PURPOSE: To compare the performance of universal adhesives containing different monomers, namely 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate monophosphate (PENTA), in the restoration of non-carious cervical lesions (NCCLs). METHODS: This was a randomized controlled clinical trial involving 63 subjects in need of restorations of 203 NCCLs. Notch-shaped lesions were restored with Kalore (GC Corporation) after application of Scotchbond Universal (SU) or Prime&Bond Elect (PBE) following the etch-and-rinse (ER) or self-etch (SE) technique. Restorations were assessed after 1 week, 18 and 36 months. Logistic regression was performed for each outcome separately with compound symmetric variance-covariance structure assumed to consider a correlation of restorations within subjects. All analyses were conducted using SAS 9.4 (SAS). RESULTS: 150 teeth in 41 subjects were assessed at 36 months. Three restorations in the PBE_SE group failed the retention criterium. Statistically significant differences were reached for the following comparisons: restorations with SU_SE were 75% less likely to maintain a score of Alfa for marginal discoloration than PBE_SE; restorations with PBE_SE were 83% less likely to maintain a score of Alfa for marginal adaptation than PBE_ER. CLINICAL SIGNIFICANCE: More than 20% of restorations restored with universal adhesives developed marginal degradation after 36 months. The impact of phosphoric acid on the restoration seems to be material-dependent.

CAD/CAM ceramic fragments in anterior teeth: A clinical report.

OBJECTIVE: The treatment of fractured teeth has become a great opportunity to investigate new approaches in the field of restorative dentistry. Restoring teeth with ceramic fragments is a great challenge, however, the computer aided design/computer aided manufacturing (CAD/CAM) technology allows the fabrication of both laminate veneers and ceramic fragments. MATERIALS AND METHODS: Thus, the aim of this article was to report a clinical case where anterior teeth, fractured due to a sport practice, were restored with CAD/CAM ceramic fragments. CONCLUSIONS: It was observed that with this kind of restoration optimum esthetic results might be achieved when treating anterior fractured teeth. CLINICAL SIGNIFICANCE: Ceramic fragments using CAD/CAM systems are a viable clinical alternative to composites for the reconstruction of fractured teeth. Function and esthetics can be restored with the use of this treatment quickly and efficiently.

Shear bond strength of acetone-based one-bottle adhesive systems.

The aim of this study was to assess the shear bond strength of four acetone-based one-bottle adhesive systems to enamel and dentin, and compare to that of an ethanol-based system used as control. Fifty human molars were bisected mesiodistally and the buccal and lingual surfaces were embedded in acrylic resin using PVC cylinders. The buccal surfaces were ground to obtain flat dentin surfaces, while the lingual surfaces were ground to obtain flat enamel surfaces. All specimens were polished up to 600-grit sandpapers and randomly assigned to 5 groups (n=20; 10 dentin specimens and 10 enamel specimens), according to the adhesive system used: One-Step (Bisco); Gluma One Bond (Heraeus Kulzer); Solobond M (Voco); TenureQuik w/F (Den-Mat) and OptiBond Solo Plus (Kerr) (control). Each adhesive system was applied according to the manufacturers' instructions. The respective proprietary hybrid composite was applied in a gelatin capsule (d=4.3 mm) and light-cured for 40 s. The specimens were tested in shear strength with an Instron machine at a crosshead speed of 5 mm/min. Bond strengths means were analyzed statistically by one-way ANOVA and Duncan's post-hoc (p< or =0.05). Shear bond strength means (MPa) (+/-SD) to enamel and dentin were: Enamel: One-Step=11.3(+/-4.9); Gluma One Bond=16.3(+/-10.1); Solobond M=18.9(+/-4.5); TenureQuik w/F=18.7(+/-4.5) and OptiBond Solo Plus=16.4(+/-3.9); Dentin: One-Step=6.4(+/-2.8); Gluma One Bond=3.0(+/-3.4); Solobond M=10.6(+/-4.9); TenureQuik w/F=7.8(+/-3.9) and OptiBond Solo Plus=15.1(+/-8.9). In enamel, the adhesive systems had statistically similar bond strengths to each other (p>0.05). However, the ethanol-based system (OptiBond Solo Plus) showed significantly higher bond strength to dentin than the acetone-based systems (p< or =0.0001). In conclusion, the solvent type (acetone or ethanol) had no influence on enamel bond strength, but had great influence on dentin bonding, which should be taken into account when choosing the adhesive system.

Thermal-induced residual stresses affect the lifetime of zirconia-veneer crowns.

OBJECTIVES: The purposes of this study were to investigate the effects of thermal residual stresses on the reliability and lifetime of zirconia-veneer crowns. METHODS: One hundred and twenty eight second upper premolar zirconia-veneer crowns were manufactured for testing the initial strength (n=64) and under cyclic fatigue (n=64). Zirconia copings (YZ Cubes, VITA Zahnfabrik, CTE: alphac=10.5 ppm/°C) were milled using a Cerec3 InLab (Sirona) machine and sintered to a final thickness of 0.7 mm. Sixty-four copings were sandblasted with 105 µm alumina particles (15 s, 3 cm distance, 45° angle, 0.4 MPa pressure) in order to trigger a tetragonalmonoclinic transformation and to produce a rough surface. The copings were veneered using two different porcelains (VM9, VITA Zahnfabrik, CTE: alphaVM9=9.1 ppm/°C, Lava Ceram, 3M ESPE, CTE: alphaLava=10.2 ppm/°C) so to result in crowns with either high thermal mismatch (+1.4 ppm/°C with VM9) and low thermal mismatch (+0.3 ppm/°C with Lava Ceram). The porcelains were applied by the same operator and fired (VITA Vacumat 4000) according to the firing schedules defined by the manufacturers to a final thickness of 1.4mm (total crown thickness=2.1mm, core/veneer ratio=0.5). After the last glaze firing the crowns were cooled following a fast (600°C/min) or a slow (30°C/min) cooling protocol. The glazed crowns were submitted to a sliding-motion (0.7 mm lateral movement) cyclic fatigue in a chewing simulator (SD Mechatronik) under 20 kg (~200 N load) weight until failure (chipping) (n=16). The other half of the crowns were subjected to a compressive loading test in an universal testing machine (Instron model 4240) until failure at a cross-head speed of 0.75 mm/min (n=16). The failure probability for initial strength and cyclic fatigue was performed using a Weibull distribution approach at a scale factor of n=16. RESULTS: The compressive strength test showed a low sensitivity to detect reliability variations regarding thermal stresses created within the veneer layer of tested crowns. For cyclic fatigue, slow cooling resulted in statistically higher cycles to failure only for the crowns that presented a high thermal mismatch between core and veneer (VM9 group). Comparisons between veneers with high or low thermal mismatches showed statistically higher sigma0 for Lava Ceram-veneered crowns only when the groups were fast-cooled. SIGNIFICANCE: Minimizing the thermal residual stresses within the veneer through the use of a veneer with a closer CTE to the zirconia delays the failure of zirconia-veneer crowns. Slow-cooling increases the lifetime of crowns presenting large differences in CTE between the zirconia core and the veneering porcelain.

Bond strength and fracture analysis between resin cements and root canal dentin.

The aim of this research is to evaluate bond strength between translucent fibre posts (White Post DC, FGM or FRC Postec Plus, Ivoclar/Vivadent) and intraradicular dentin at three different levels (cervical, middle and apical) using a dual-cure (AllCem, FGM) or self-curing (Multilink, Ivoclar/Vivadent) resin cement. Also, the fracture type after push-out test was analysed under SEM. Thirty-two extracted single-root teeth were selected. After undergoing endodontic therapy, they were randomly divided into four groups according to their post type and resin cement. Root canals were etched using 37% phosphoric acid, and Excite DSC adhesive (Ivoclar/Vivadent) was applied in all groups. The root was sectioned to obtain nine 1-mm-thick slices (three per third: coronal, middle, apical). All slices were subjected to push-out tests. Data were analysed using two-way anova. The mean bond strengths vary from 6.6 (4.6) MPa [apical] to 11.9 (5.9) MPa [cervical]. There were no significant differences between groups. Pearson χ(2)-test revealed significant differences in fracture types for all groups (P < 0.0001). The apical third had the lowest bond strengths and it was also shown to be the most critical region for luting fibre posts.

Wear and morphology of infiltrated white spot lesions.

OBJECTIVES: To evaluate the toothbrush wear resistance of infiltrated artificial white spot lesions following two infiltration strategies, and to assess their ultramorphology. METHODS: Flat enamel surfaces from freshly extracted bovine teeth were polished and immersed in a Buskes demineralising solution for 30 days to create incipient caries-like lesions (white spots). Two experimental regions on the surface of each tooth were infiltrated with an infiltrant and a commercial etch-and-rinse adhesive. Toothbrush abrasion was applied for 20,000 cycles. Vertical wear loss of the infiltrated areas was measured after 10,000 and 20,000 cycles against unabraded and abraded enamel using confocal laser scanning microscopy (CLSM; multiple t-tests, α=0.05). Each lesion's surface and cross-section were evaluated under CLSM and scanning electron microscopy after etching and infiltration to assess ultramorphology. RESULTS: After 20,000 abrasion cycles, a statistically non-significant difference in vertical wear loss was measured for the infiltrant versus the adhesive compared with the original enamel (42.6±20.7 µm vs. 40.4±18.5 µm, p>0.05). Irregular surface profiles were common for the adhesive-infiltrated group as a result of peeling and blistering of the resin-covering layer. Ultramorphology of the infiltrated lesions revealed different patterns of penetration regarding density and depth. CONCLUSIONS: Although both infiltration strategies had equivalent wear resistance to toothbrush abrasion, surface and morphological aspects pointed to improved surface stability and infiltration quality for the infiltrant material.

Clinical effectiveness and tooth sensitivity associated with different bleaching times for a 10 percent carbamide peroxide gel.

BACKGROUND: The daily application time for 10 percent carbamide peroxide (CP) typically is between four and eight hours. However, to the authors' knowledge, no investigators in clinical studies have compared different application times; this is the aim of this study. METHODS: The authors recruited 60 patients and categorized each of them into one of four groups. All participants used 10 percent CP in a bleaching tray. The daily application times were 15 minutes, 30 minutes, one hour or eight hours. Participants bleached their teeth for 16 days and those who were not satisfied with the results extended the bleaching time until they were satisfied. Patients recorded their tooth sensitivity on a 0 to 4 scale. The authors measured the shade changes by using a digital spectrophotometer and shade guide. They performed appropriate statistical analysis of the data (α = .05). RESULTS: Participants in the one- and eight-hour groups bleached their teeth for 18 and 16 days, respectively (P > .05), while statistically longer periods were required for participants in the other two groups (P < .001) to be satisfied with the results. Participants' tooth sensitivity ratings were similar for the 15-minute, 30-minute and one-hour application times (P > .05), and they were statistically lower than those for participants in the eight-hour group. CONCLUSIONS: The eight-hour bleaching protocol yielded faster bleaching; however, participants experienced higher sensitivity levels. The one-hour group most closely approached the eight-hour group with regard to bleaching speed, while those in the one-hour group experienced lower sensitivity levels. CLINICAL IMPLICATIONS: In this study, the difference in bleaching speed between the eight- and one-hour application times after 16 days was small, and the results showed less tooth sensitivity for patients in the one-hour group.

Critical appraisal. To bevel or not in anterior composites.

Composites are widely used for the functional and esthetic restorations of anterior teeth. The placement of a cavosurface margin bevel on the enamel margins of anterior composite preparations traditionally has been recommended to enhance retention and for esthetic reasons, as bevels result in a gradual transition between the restoration and the tooth. However, advances in adhesive and composite technology, as well as careful composite selection and application techniques, have made it possible to place adequate anterior composites without a bevel. Elimination of bevels results in more conservative cavity preparations, a simpler technique, a reduced restored surface area, and the preservation of tooth structure when the restoration is replaced. This Critical Appraisal summarizes clinical reviews and laboratory publications related to the influence of cavity preparation and, more specifically, cavosurface bevels on the performance of anterior composite restorations.

In situ effect of 10% carbamide peroxide on resin-dentin bond strengths: a novel pilot study.

PURPOSE: This pilot study used a novel study design to evaluate the effect of a 10% carbamide peroxide bleaching gel on the bond strength of a resin-based composite system to dentin. MATERIALS AND METHODS: Dentin disks were obtained from human third molars, polished to 600 grit, and mounted on the palatal aspect of a removable orthodontic retainer. Two disks were exposed to a 10% carbamide peroxide bleaching gel for 2 h/d for 21 days, whereas two disks were not treated and served as controls. A retainer was worn by the participant regardless of whether bleaching was used, simulating the action of the saliva/oral fluids on the dentin specimens. After the treatment phase, the dentin disks were retrieved and a resin-based composite system was applied to the specimens following manufacturer's instructions. Composite dentin "sticks" were obtained and tested in microtensile mode. Bond strength values were obtained for treated (n = 20) versus nontreated (n = 26) dentin and were analyzed statistically. RESULTS: Mean bond strengths values (SD) were 29.9 MPa (6.2) and 39.2 MPa (5.8) for treated and nontreated dentin specimens, respectively (p < .001). CONCLUSION: The results of this study suggest that nightguard (home) bleaching with 10% carbamide peroxide for 2 h/d for 21 days significantly affects resin-dentin bond strengths when dentin is exposed to bleaching material. CLINICAL SIGNIFICANCE The findings of this novel pilot study imply that dentin bonding, such as to exposed root surfaces and cervical areas of the teeth, should not be performed immediately after bleaching with 10% carbamide peroxide.

In situ effect of 10% carbamide peroxide on microhardness of human enamel: function of time.

PURPOSE: This study evaluated the effect of two home bleaching regimens (1 h/day versus 7 h/day for a total of 21 days) on the microhardness of superficial enamel treated with 10% carbamide peroxide gel. MATERIALS AND METHODS: Rectangular enamel specimens (2.5 x 2.5 x 1 mm) were obtained from human third molars and mounted on the palatal aspect of removable orthodontic retainers. Nine enamel specimens were mounted in each of 10 retainers, used by 10 volunteers during the active phase of the study. Modified 0.089 cm thick bleaching trays were fabricated for each participant. Each bleaching tray fit a participant's arch and the retainer containing the enamel specimens. Enamel specimens were treated with a 10% carbamide peroxide bleaching gel (Nite White Excel 2Z, Discus Dental, Culver City, CA, USA) for either 1 h/day (n = 30) or 7 h/day (n = 30), both for 21 days. Three enamel specimens in each retainer were never treated and served as controls. The retainers were worn by the participants whether or not they underwent bleaching. This simulated the natural action of the saliva/oral fluids on the enamel specimens. Enamel specimens were subjected to pre- and post-treatment microhardness measurements. Post-treatment Knoop hardness numbers were compared with baseline values and analyzed statistically. RESULTS: Bleaching treatment resulted in a nonsignificant reduction in microhardness values when compared with values of the control nontreated specimens (1.7% and 2.5% reduction in hardness for 1 h/day and 7 h/day, respectively). There was no difference in microhardness between the different treatment regimens. CONCLUSION: Home bleaching with 10% carbamide peroxide for up to 7 h/day for 21 days does not significantly affect enamel microhardness. CLINICAL SIGNIFICANCE: Bleaching with 10% carbamide peroxide for 1 h/day or 7 h/day for a total of 21 days is safe for human enamel.

Shear bond strength of acetone-based one-bottle adhesive systems

O objetivo deste estudo foi avaliar a resistência ao cisalhamento de quatro sistemas adesivos de frasco único com solvente acetona e um sistema com solvente etanol em esmalte e à dentina. Cinqüenta molares humanos foram seccionados ao meio no sentido mesiodistal e incluídos com resina acrílica em tubos de PVC. As superfícies vestibulares foram desgastadas até atingir dentina plana, enquanto as superfícies linguais foram desgastadas até atingir esmalte plano. Os espécimes foram polidos até lixa d'água de granulação 600 e divididos aleatoriamente entre os 5 grupos (n=20; 10 espécimes de dentina e 10 espécimes de esmalte), de acordo com o sistema adesivo utilizado: One-Step (Bisco); Gluma One Bond (Heraeus Kulzer), Solobond M (Voco), TenureQuik w/F (Den-Mat) and OptiBond Solo Plus (Kerr) (controle). Os adesivos foram aplicados conforme as instruções dos fabricantes. Uma cápsula cilíndrica gelatinosa (d=4,5mm), preenchida com compósito híbrido de cada fabricante foi posicionada sobre a superfície dental e fotopolimerizada durante 40 s. Após 24 h, os corpos-de-prova foram submetidos a ensaios de cisalhamento em uma máquina de ensaios Instron com velocidade de 5 mm/min. Os dados foram analisados estatisticamente pela ANOVA a um critério e teste de Duncan post hoc (p£0.05). As médias de resistência ao cisalhamento resistência em esmalte e dentina (MPa) (±SD) foram: Esmalte: One-Step=11,3(±4,9); Gluma One Bond=16,3(±10,1); Solobond M=18,9(±4,5); TenureQuik w/F=18,7(±4,5) e OptiBond Solo Plus=16,4(±3,9); Dentina: One-Step=6,4(±2,8); Gluma One Bond=3,0(±3,4); Solobond M=10,6(±4,9); TenureQuik w/F=7,8(±3,9) e OptiBond Solo Plus=15,1(±8,9). Em esmalte, todos os agentes adesivos tiveram resultados estatisticamente semelhantes entre si (p>0.05). Entretanto, em dentina, o sistema adesivo a base de etanol apresentou maior resistência de união que todos os sistemas a base de acetona (p£0.0001). O tipo de solvente presente nos sistemas adesivos de frasco único não exerceu influência na sua capacidade de união ao esmalte, mas se mostrou um componente importante na adesão dentinária, o que deve ser levado em conta quando da escolha de um sistema adesivo.