Demineralization Inhibition by Two Calcium-releasing Restorative Materials.

OBJECTIVE: To compare the ability of two calcium-releasing restorative materials to inhibit root dentin demineralization in an artificial caries model. METHODS AND MATERIALS: Preparations were made at the cementum-enamel junction of extracted human molars (40, n=10/material) and restored with two calcium-releasing materials (Experimental composite, Pulpdent Corporation and Cention N, Ivoclar Vivadent), a resin composite (Filtek Supreme Ultra, 3M Oral Care), and a resin-modified glass ionomer (RMGI) (Fuji II LC, GC). All materials (other than the RMGI) were used with an adhesive (Scotchbond Universal Adhesive, 3M Oral Care) in the self-etch mode, which was light cured for 10 seconds. All restorative materials were light cured in 2-mm increments for 20 seconds and then finished with a polishing disc. Teeth were incubated (37°C) for 24 hours in water. An acid-resistant varnish was painted onto the teeth around the restoration, leaving a 2-mm border of uncovered tooth. A demineralization solution composed of 0.1 M lactic acid, 3 mM Ca3(PO4)2, 0.1% thymol, and NaOH (to adjust pH=4.5), and a remineralization solution composed of 1.5 mM Ca, 0.9 mM P, and 20 mM Tris(hydroxymethyl)-aminomethane (pH=7.0) were prepared. Specimens were placed in the demineralization solution for 4 hours, followed by the remineralization solution for 20 hours and cycled daily for 30 days. The specimens were embedded, sectioned into 100-µm sections, and the interface between the restorative material and root dentin was viewed with polarized light microscopy. A line was drawn parallel with the zone of demineralization for each tooth. The area of "inhibition" (defined as the area external to the line) or "wall lesion" (defined as the area internal to the line) was measured with image evaluation software. Areas of inhibition were measured as positive values, and areas of wall lesions were measured as negative areas. RESULTS: A one-way analysis of variance (ANOVA) found significant differences between materials for "inhibition/wall lesion" areas in root dentin (p<0.001). Tukey post hoc analysis ranked materials (µm2, mean ±SD): Fuji II LC (5412±2754) > Cention N (2768±1576) and experimental composite (1484±1585) > Filtek Supreme Ultra (-1119±1029). CONCLUSION: The experimental composite and Cention N materials (used with an adhesive) showed net areas of inhibition greater than a reference resin composite, albeit at a lower level than a reference RMGI material (used with no adhesive).

Two-year Randomized, Controlled Clinical Trial of a Flowable and Conventional Composite in Class I Restorations.

OBJECTIVES: This study evaluated the two-year clinical performance and volumetric wear of a flowable resin composite compared to a conventional highly filled composite resin in Class I restorations. METHODS AND MATERIALS: In this single-center, single-blinded, comparator-controlled clinical study (Institutional Review Board approved), 120 carious teeth distributed in 60 patients were randomly assigned to four calibrated practitioners who placed occlusal restorations (n=60 flowable and n=60 conventional composite). Direct and indirect assessment at baseline, six months, one year, and two years occurred during which the modified Cvar and Ryge criteria were evaluated. Volumetric wear was determined by superimposition of profilometer scans of baseline and two-year casts. RESULTS: At two years, there was no significant difference in anatomic form (p=0.80), color match (p=0.08), marginal adaptation (p=0.89), marginal discoloration (p=0.79), surface integrity (p=0.18), secondary caries (p=0.66), cold sensitivity (p=0.522), occlusal sensitivity (p=0.818), or volumetric wear (p=0.661) between materials. Both materials showed a decrease in all criteria except secondary caries (p=0.95) over time. Two-year mean volumetric wear was 3.16 ± 2.38 mm(3) for the flowable composite and 3.43 ± 2.50 mm(3) for the conventional composite. CONCLUSIONS: The flowable and conventional composites used in this study have similar clinical efficacy after two years of service when placed as Class I occlusal restorations having isthmus widths less than one-half the intercuspal distance.

Influence of Etching Protocol and Silane Treatment with a Universal Adhesive on Lithium Disilicate Bond Strength.

OBJECTIVES: To measure the effects of hydrofluoric acid (HF) etching and silane prior to the application of a universal adhesive on the bond strength between lithium disilicate and a resin. METHODS AND MATERIALS: Sixty blocks of lithium disilicate (e.max CAD, Ivoclar Vivadent) were sectioned into coupons and polished. Specimens were divided into six groups (n=10) based on surface pretreatments, as follows: 1) no treatment (control); 2) 5% HF etch for 20 seconds (5HF); 3) 9.5% HF etch for 60 seconds (9.5HF); 4) silane with no HF (S); 5) 5% HF for 20 seconds + silane (5HFS); and 6) 9.5% HF for 60 seconds + silane (9.5HFS). All etching was followed by rinsing, and all silane was applied in one coat for 20 seconds and then dried. The universal adhesive (Scotchbond Universal, 3M ESPE) was applied onto the pretreated ceramic surface, air thinned, and light cured for 10 seconds. A 1.5-mm-diameter plastic tube filled with Z100 composite (3M ESPE) was applied over the bonded ceramic surface and light cured for 20 seconds on all four sides. The specimens were thermocycled for 10,000 cycles (5°C-50°C/15 s dwell time). Specimens were loaded until failure using a universal testing machine at a crosshead speed of 1 mm/min. The peak failure load was used to calculate the shear bond strength. Scanning electron microscopy images were taken of representative e.max specimens from each group. RESULTS: A two-way analysis of variance (ANOVA) determined that there were significant differences between HF etching, silane treatment, and the interaction between HF and silane treatment (p<0.01). Silane treatment provided higher shear bond strength regardless of the use or concentration of the HF etchant. Individual one-way ANOVA and Tukey post hoc analyses were performed for each silane group. Shear bond strength values for each etch time were significantly different (p<0.01) and could be divided into significantly different groups based on silane treatment: no silane treatment: 0 HF < 5% HF < 9.5% HF; and RelyX silane treatment: 0 HF < 5% HF and 9.5% HF. CONCLUSIONS: Both HF and silane treatment significantly improved the bond strength between resin and lithium disilicate when used with a universal adhesive.

Enamel wear opposing polished and aged zirconia.

Aging of dental zirconia roughens its surface through low temperature degradation. We hypothesized that age-related roughening of zirconia crowns may cause detrimental wear to the enamel of an opposing tooth. To test our hypothesis, we subjected artificially aged zirconia and reference specimens to simulated mastication in a wear device and measured the wear of an opposing enamel cusp. Additionally, the roughness of the pretest surfaces was measured. The zirconia specimens, artificially aged by autoclave, showed no significant increase in roughness compared to the nonaged specimens. Furthermore, no significant difference in material or opposing enamel wear between the aged and nonaged zirconia was seen. All zirconia specimens showed less material and opposing enamel wear than the enamel to enamel control or veneering porcelain specimens. Scanning electron micrographs showed relatively smooth surfaces of aged and nonaged zirconia following wear testing. The micrographs of the veneering ceramic showed sharp fractured edges and fragments of wear debris. Zirconia may be considered a wear-friendly material for restorations opposing enamel, even after simulated aging.

Effect of light activation on resin-modified glass ionomer shear bond strength.

OBJECTIVE: Recent studies confirmed that resin-modified glass ionomers (RMGIs) set on the basis of two competing mechanisms, an acid-base reaction and a light-activated resin polymerization. This study evaluated the effect of the setting mechanism on bond strength by measuring the shear bond strength of three RMGIs to dentin with and without light activation. METHODS: Sixty human molars were ground to midcoronal dentin and randomly divided into six even groups: 1) Ketac Nano (KN), 2) KN without light cure (woLC), 3) Fuji Filling LC (FF), 4) FF woLC, 5) Fuji II LC (FII), and 6) FII woLC. The dentin surfaces of the specimens were conditioned/primed according to the manufacturers' instructions. A 1.54-mm diameter plastic tube was filled with RMGI material and affixed to the dentin surface. Groups 1, 3, and 5 were light cured for 20 seconds, and groups 2, 4, and 6 were immediately placed in a damp dark box with no light curing at 37°C for 24 hours. Shear bond strength testing was performed in an Instron device at 1 mm/min. Data were analyzed with a one-way analysis of variance (ANOVA) and Tukey/Kramer test (α=0.05). RESULTS: Mean ± standard deviation shear bond strength values (MPa) are: 7.1 ± 4.2 (KN), 11.7 ± 3.9 (FF), 10.2 ± 3.2 (FF woLC), 12.5 ± 5.1 (FII), and 0.3 ± 0.4 (FII woLC). Two KN, all KN woLC, and seven FII woLC specimens debonded before testing. Tukey/Kramer analysis revealed no significant differences in bond strength between the three light-cured RMGIs. KN and FII showed significantly lower bond strength without light cure, but no significant difference was observed between FF and FF woLC. CONCLUSIONS: The results of this study strongly suggest that light activation is necessary to obtain optimal bond strength between RMGI and dentin. FF may contain components that chemically activate resin polymerization. Clinically, KN and FII need to be light cured after placement of these RMGIs.

Evaluation of outgassing, tear strength, and detail reproduction in alginate substitute materials.

OBJECTIVE: To compare three alginate substitute materials to an alginate impression material for cast surface porosity (outgassing), tear strength, and detail reproduction. MATERIALS AND METHODS: Detail reproduction tests were performed following American National Standards Institute/American Dental Association (ANSI/ADA) Specification No. 19. To measure tear strength, 12 samples of each material were made using a split mold, placed in a water bath until testing, and loaded in tension until failure at a rate of 500 mm/min using a universal testing machine. For cast surface porosity testing, five impressions of a Teflon mold with each material were placed in a water bath (37.8°C) for the in-mouth setting time and poured with vacuum-mixed Silky Rock die stone at 5, 10, 30, and 60 minutes from the start of mixing. The gypsum samples were analyzed with a digital microscope for surface porosity indicative of hydrogen gas release by comparing the surface obtained at each interval with four casts representing no, little, some, and significant porosity. Data analysis was performed using parametric and Kruskal-Wallis analysis of variance (ANOVA), Tukey/Kramer post-hoc tests (α=0.05), and individual Mann-Whitney U tests (α=0.0167). RESULTS: All alginate substitute materials passed the detail reproduction test. Tear strength of the alginate substitute materials was significantly better than alginate and formed three statistically different groups: AlgiNot had the lowest tear strength, Algin-X Ultra had the highest tear strength, and Position Penta Quick had intermediate tear strength. Significant variation in outgassing existed between materials and pouring times (p<0.05). All alginate substitute materials exhibited the least outgassing and cast porosity 60 minutes after mixing. CONCLUSIONS: Detail reproduction and tear strength of alginate substitute materials were superior to traditional alginate. The outgassing effect was minimal for most materials tested. Alginate substitute materials are superior replacements for irreversible hydrocolloid.

Significant events in the rehabilitation process: the spinal cord patient's point of view.

The purpose of this study was to identify and evaluate significant events in the hospital phase of rehabilitation. Ten patients with high-level spinal cord injuries were studied 5 days a week for the entire length of their hospital stays (mean stay--109 days). Methods of identifying significant events through tape-recorded, daily logs were developed and found reliable at a level of 0.08 or higher. These events, with a net of days surrounding them, were grouped into categories, and evaluated against a control group of days--in which no significant events were identified. Four measures of depressive affect were evaluated: (1) a self report measure, (2) ratings by the hospital staff, (3) behavioral measure of verbal output, and (4) an endocrine measure, the 24-hour output of urinary tryptamine. Seventy-three percent of reactions on the dependent measures of depressive-elative affect were in the direction predicted by patient evaluations. Significant events were rank ordered according to their average rank on the 4 measures of depressive affect. There are advantages to a longitudinal, multimeasure approach to the rehabilitation career of chronically ill or injured patients.

Inverted writing in right- and left-handers in relation to lateralization of face recognition.

In a study with 157 right-handed and 69 left-handed college students, Gilbert's two-face choice task, which was used as an indicator of cerebral lateralization for face recognition, distinguished left-handers from right-handers. Right-handers primarily attended to the right side of the face (left visual field), while the group of left-handers had no visual field preference. Levy's hypothesis that inverted-writing left-handers are cortically lateralized like right-handers, and that inverted-writing right-handers are lateralized like left-handers found some support among the males. However, the females in both handedness groups performed in an opposite manner to that predicted by Levy's hypothesis.