Alternative Direct Restorative Materials for Dental Amalgam: A Concise Review Based on an FDI Policy Statement.

Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.

Microhardness and Gloss of a New CAD/CAM Hybrid Material Following Accelerated Aging and Coffee Immersion.

PURPOSE: To evaluate and compare the effect of accelerated aging and coffee immersion on the microhardness and gloss of a new computer-aided design and computer-aided manufacturing (CAD/CAM) hybrid material (Crystal Ultra) to those of contemporary restorative materials. MATERIALS AND METHODS: A total of 160 specimens (12 × 14 × 1 mm ± 0.05 mm) were obtained from IPS e.max (IPS), VITA Enamic (VE), Crystal Ultra (CU), Lava Ultimate (LU), and CeraSmart (CS) high-translucency CAD/CAM blocks. The Vickers microhardness and gloss of the specimens were determined after thermocycling and coffee immersion. Data analysis was performed using SPSS (α = .05). RESULTS: IPS and CS specimens exhibited the highest (572.66 ± 11.30) and lowest (61.92 ± 3.91) microhardness, respectively. The highest gloss was observed with IPS specimens (3.31 ± 0.32), and LU specimens showed the lowest gloss (2.33 ± 0.06). A significant difference in gloss was observed between the materials at all measurement intervals (P < .01), except at T0 (P = .43). IPS specimens showed no significant changes in either group at any measurement interval. CONCLUSIONS: The microhardness and gloss of the new CU material were comparable to those of the tested contemporary hybrid restorative materials. Glass-ceramic showed superior hardness and gloss compared to hybrid restorative materials. Accelerated aging with thermocycling and staining significantly affected the microhardness and gloss of all tested CAD/CAM materials.

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association.

BACKGROUND: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED: The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS: The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS: The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.

Release and MMP-9 Inhibition Assessment of Dental Adhesive Modified with EGCG-Encapsulated Halloysite Nanotubes.

Degradation of the collagen fibrils at the dentin-resin interface by the enzymatic activity of matrix metalloproteinases (MMPs) has been known to permit some dental restoration complications, such as microleakage, secondary caries, and, ultimately, restoration failures. This study aimed to evaluate a modified adhesive by adding an MMP inhibitor from green tea extract with and without nanotube encapsulation to sustain the drug release. Epigallocatechin-3-gallate (EGCG) and Halloysite nanotubes (HNTs) were prepared to produce three variant combinations of modified adhesive (EGCG, EGCG-encapsulated HNT, and EGCG-free HNT). The drug loading efficiency and EGCG release over time were evaluated using UV-vis spectrometry. MMP-mediated ß-casein (BCN) cleavage rate assays were used to determine the ability of the EGCG in eluates of the adhesive to inhibit MMP-9 activities. For up to 8 weeks, HNT encapsulation reduced release to a statistically significant level. MMP-mediated ß-casein cleavage rate assays showed a significant decrease for the EGCG groups compared to the non-EGCG adhesive groups. Furthermore, the use of HNT for EGCG encapsulation to modify a dental adhesive helped slow down the rate of EGCG release without impacting its MMP inhibitory capabilities, which may help to maintain the dentin-resin interface's integrity over the long term after dental restoration placement.

Effect of a modified adhesive system with encapsulated arginine and calcium carbonate on dentin permeability.

To modify an adhesive system with halloysite clay nanotubes (HNTs) containing arginine and calcium carbonate and to evaluate their cytocompatibility, viscosity and efficacy in reducing dentin permeability. HNTs containing arginine and calcium carbonate were incorporated into the primer and adhesive of a three-step adhesive system (SBMP), and their viscosity was measured. Discs (n = 4/group) were prepared: SBMP (control), HNT-PR (modified primer), HNT-ADH (modified adhesive) and HNT-PR + ADH (modified primer and adhesive) were evaluated regarding cell death and viability. Dentin discs were prepared and randomly assigned into the following treatments (n = 10): NC (no treatment), SBMP, HNT-PR, HNT-ADH, HNT-PR + ADH and COL (Colgate® Sensitive Pro-relief™ prophylaxis paste). After, they were submitted to an erosive-abrasive cycling. Dentin permeability (hydraulic conductance) was evaluated at baseline, 24 h after treatment and after cycling. Both the modified primer and adhesive showed significantly higher viscosity than their controls. Group HNT-PR resulted in significantly higher cytotoxicity when compared to SBMP and HNT-PR + ADH groups. Group HNT-ADH resulted in the highest cell viability compared to all other groups. All groups showed significantly lower dentin permeability when compared to the NC group. Post-cycling, SBMP and HNT-ADH groups showed significantly lower permeability when compared to COL group. The addition of encapsulated arginine and calcium carbonate did not affect the cytocompatibility of the materials nor their ability to reduce dentin permeability.

Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs. RESULTS: Thirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass isomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Owing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.

Bioactivity of Dental Restorative Materials: FDI Policy Statement.

The term bioactivity is being increasingly used in medicine and dentistry. Due to its positive connotation, it is frequently utilised for advertising dental restorative materials. However, there is confusion about what the term means, and concerns have been raised about its potential overuse. Therefore, FDI decided to publish a Policy Statement about the bioactivity of dental restorative materials to clarify the term and provide some caveats for its use in advertising. Background information for this Policy Statement was taken from the current literature, mainly from the PubMed database and the internet. Bioactive restorative materials should have beneficial/desired effects. These effects should be local, intended, and nontoxic and should not interfere with a material's principal purpose, namely dental tissue replacement. Three mechanisms for the bioactivity of such materials have been identified: purely biological, mixed biological/chemical, or strictly chemical. Therefore, when the term bioactivity is used in an advertisement or in a description of a dental restorative material, scientific evidence (in vitro or in situ, and preferably in clinical studies) should be provided describing the mechanism of action, the duration of the effect (especially for materials releasing antibacterial substances), and the lack of significant adverse biological side effects (including the development and spread of antimicrobial resistance). Finally, it should be documented that the prime purpose, for instance, to be used to rebuild the form and function of lost tooth substance or lost teeth, is not impaired, as demonstrated by data from in vitro and clinical studies. The use of the term bioactive dental restorative material in material advertisement/information should be restricted to materials that fulfil all the requirements as described in the FDI Policy Statement.

Microhardness and gloss of a new CAD-CAM hybrid material following accelerated aging and coffee immersion.

PURPOSE: To evaluate and compare the effect of accelerated aging and coffee immersion on the microhardness and gloss of a new CAD/CAM hybrid material (Crystal Ultra) to those of contemporary restorative materials. MATERIALS AND METHODS: A total of 160 specimens (12 x 14 x 1 mm ± 0.05 mm) were obtained from (IPS e.max [IPS], VITA Enamic [VE], Crystal Ultra [CU], Lava Ultimate [LU], and CeraSmart [CS]) high-translucency CAD/CAM blocks. The Vickers microhardness and gloss of the specimens were determined following thermocycling and coffee immersion. Data analysis was performed using SPSS (α = .05). RESULTS: IPS and CS specimens exhibited the highest (572.66 ± 11.30) and lowest (61.92 ± 3.91) microhardness, respectively. The highest gloss was observed with IPS specimens (3.31 ± 0.32), and LU specimens showed the lowest gloss (2.33 ± 0.06). A significant difference in gloss was observed between the materials at all measurement intervals (P < .01), except at T0 (P = .43). IPS specimens showed no significant changes in either group at any measurement interval. CONCLUSION: The microhardness and gloss of the new CU material were comparable to those of the tested contemporary hybrid restorative materials. Glass-ceramic showed superior hardness and gloss compared to hybrid restorative materials. Accelerated aging by thermocycling and staining significantly affected the microhardness and gloss of all the tested CAD/CAM materials.

Effect of hydrogel-based antibiotic intracanal medicaments on crown discoloration.

OBJECTIVES: This study evaluated the effects of low and moderate concentrations of triple antibiotic paste (TAP) and double antibiotic paste (DAP) loaded into a hydrogel system on crown discoloration and explored whether application of an adhesive bonding agent prevented crown discoloration. MATERIALS AND METHODS: Intact human molars (n = 160) were horizontally sectioned 1 mm apical to the cementoenamel junction. The crowns were randomized into 8 experimental groups (calcium hydroxide, Ca[OH]2; 1, 10, and 1,000 mg/mL TAP and DAP; and no medicament. The pulp chambers in half of the samples were coated with an adhesive bonding agent before receiving the intracanal medicament. Color changes (ΔE) were detected by spectrophotometry after 1 day, 1 week, and 4 weeks, and after 5,000 thermal cycles, with ΔE = 3.7 as a perceptible threshold. The 1-sample t-test was used to determine the significance of color changes relative to 3.7. Analysis of variance was used to evaluate the effects of treatment, adhesive, and time on color change, and the level of significance was p < 0.05. RESULTS: Ca(OH)2 and 1 and 10 mg/mL DAP did not cause clinically perceivable tooth discoloration. Adhesive agent use significantly decreased tooth discoloration in the 1,000 mg/mL TAP group up to 4 weeks. However, adhesive use did not significantly improve coronal discoloration after thermocycling when 1,000 mg/mL TAP was used. CONCLUSIONS: Ca(OH)2 and 1 and 10 mg/mL DAP showed no clinical discoloration. Using an adhesive significantly improved coronal discoloration up to 4 weeks with 1,000 mg/mL TAP.

Tooth Age Impact on Dental Erosion Susceptibility and Treatment Efficacy.

This laboratory study investigated the impact of tooth age on dental erosion susceptibility and preventive treatment efficacy. Extracted human premolars were selected and had their age estimated (∼10-100 years old) using established dental forensic methods. Enamel and root dentin slabs were prepared, embedded in acrylic blocks, flattened, and polished. The specimens were randomly assigned to one of three treatments (n = 93): Sn+F (800 ppm Sn as SnCl2 and 250 ppm F as NaF, pH 4.5), NaF (250 ppm F, pH 4.5), or deionized water (DIW). Each specimen was subjected for 10 days to a daily cycling protocol consisting of six 5-min erosive challenges (0.3% citric acid, pH 2.6), six 60-min remineralization periods (artificial saliva), and three 2-min treatments with the test solutions. Surface loss (SL) was measured after 3, 5, and 10 days, using optical profilometry. Effects of tooth age, antierosive treatment, and time on SL were evaluated using linear mixed effects regression analysis. SL increased with age for all substrate-treatment-time combinations (p < 0.0001). Sn+F and NaF solutions significantly reduced SL compared to DIW, regardless of substrate, time, or age (p < 0.0001), with best results shown for Sn+F. Efficacy of Sn+F increased with tooth age on enamel, but tooth age did not affect the efficacy of NaF on enamel. For dentin, increased efficacy was observed with age after 5 (for Sn+F) and 10 days (for Sn+F and NaF). In conclusion, increase of tooth age rendered enamel and root dentin more susceptible to dental erosion. NaF preventive efficacy improved with tooth age for dentin, in advanced erosion simulation. Sn+F reduced enamel SL due to erosion regardless of tooth age.

Evaluation of the Water Sorption and Solubility Behavior of Different Polymeric Luting Materials.

Objective: The study evaluated the water sorption (WSP) and water solubility (WSL) characteristics of different luting agents over a 180-day water storage period. Materials and Methods: Nine luting materials, i.e., conventional resin cement: Panavia F (PF), Rely X ARC (RA), self-adhesive resin cement: Rely X Unicem (RU), Breez (BZ), Maxcem Elite (MX), BisCem (BC) and resin-modified glass ionomer cement: FujiCem (FC), FujiPlus (FP) Rely X luting plus (RL) were assessed and fifty-two-disc specimens of each material were fabricated. All specimens were desiccated until a constant weight (W0) was reached. Thirteen specimens for each luting material were then randomly assigned to one of the four water immersion periods (7, 30, 90, and 180 days). After each period, the specimens were removed from the water and weighed to get W1. The samples were again desiccated for a second time and W2 was measured. Both WSP and WSL were determined by the following equations: WSP (%) = (W1 - W2) × 100/W0 and WSL (%) = (W0 - W2) × 100/W0. Assessments were performed following ISO standards. ANOVA was used to assess the effect of luting agent and time period on water sorption and solubility. Pair-wise comparisons were adjusted using Tukey's multiple comparison procedure. A significance level of 0.05 was used for all statistical tests. Results: The highest mean WSP and WSL (WSP/WSL) were demonstrated by resin-modified glass-ionomers (RL 18.32/3.25, FC 17.08/4.83, and FP 14.14/1.99), while resin luting agents showed lower WSP and WSL results (PF 1.6/0.67 and RA 1.76/0.46), respectively. The self-adhesive agents exhibited a wide range of WSP and WSL values (RU 1.86/0.13, BZ 4.66/0.93, and MX 3.68/1.11). Self-adhesive cement showed lower WSP and WSL compared with the resin-modified glass-ionomers (p < 0.05). All the materials reached equilibrium after 90-days. Conclusions: Resin-based luting materials have the lowest sorption and solubility. Rely X Unicem self-adhesive luting materials were comparable to resin luting materials for WSL and WSP. Resin-modified glass-ionomer showed the highest water sorption and solubility compared with both resin and self-adhesive materials.

Effect of lithium disilicate ceramic thickness, shade and translucency on transmitted irradiance and knoop microhardness of a light cured luting resin cement.

This in vitro study evaluates the influence of pressed lithium disilicate thickness, shade and translucency on the transmitted irradiance and the Knoop microhardness (KHN) of a light-cured resin cement at two depths. One hundred and thirty-five ceramic discs of IPS e.max Press (Ivoclar Vivadent) were fabricated and divided into twenty-seven groups (n = 5) according to the association between translucency: HT (hight translucency), LT (low translucency), and MO (medium opacity); shade: BL2, A1 and A3.5; and thickness: 0.5 mm, 1.5 mm, and 2.0 mm. One side of each ceramic disc was finished, polished and glazed. The irradiance (mW/cm²) of a multiwave LED light curing unit (Valo, Ultradent) was evaluated with a potentiometer (Ophir 10ª-V2-SH, Ophir Optronics) without (control group) or with interposition of ceramic samples. The microhardness of Variolink Esthetic LC resin cement (Ivoclar Vivadent) was evaluated after 24 h at two depths (100 µm and 700 µm). Data were submitted to ANOVA followed by Tukey's test (α = 0.05). Irradiance and KHN were significantly influenced by ceramic thickness (p < 0.0001), shade (p < 0.001), translucency (p < 0.0001) and depth (p < 0.0001). Conclusions: the interposition of increasing ceramic thicknesses significantly reduced the irradiance and microhardness of resin cement. Increased depth in the resin cement showed significantly reduced microhardness for all studied groups. Increased ceramic opacity reduced the KHN of the resin cement at both depths for all ceramic thicknesses and shades.

Effect of a chlorhexidine-encapsulated nanotube modified pit-and-fissure sealant on oral biofilm.

The purpose of this study was to characterize a chlorhexidine-encapsulated nanotube modified pit-and-fissure sealant for biofilm development prevention. HS (commercial control); HNT (HS+15wt%Halloysite®-clay-nanotube); CHX10% (HS+15wt% HNT-encapsulated with chlorhexidine 10%); and CHX20% (HS+15wt% HNT-encapsulated with CHX20%) were tested. Degree-of-conversion (DC%), Knoop hardness (KHN), and viscosity were analyzed. The ability of the sealant to wet the fissures was evaluated. Specimens were tested for zones of inhibition of microbial growth. S. mutans biofilm was tested by measuring recovered viability. Data were statistically analyzed (p<0.05). DC% was significantly higher for the HNT-CHX groups. For KHN, CHX10% presented a lower mean value than the other groups. Adding HNT resulted in higher viscosity values. The biofilm on CHX10% and CHX20% sealants presented remarkable CFU/mL reduction in comparison to the HS. The experimental material was able to reduce the biofilm development in S. mutans biofilm without compromising the sealant properties.

Resin-based dental materials containing 3-aminopropyltriethoxysilane modified halloysite-clay nanotubes for extended drug delivery.

OBJECTIVE: To synthesize and characterize a novel resin-based dental material containing 3-aminopropyltriethoxysilane (APTES) surface-modified halloysite-clay nanotubes (HNTs) for long-term delivery of guest molecules. METHODS: The optimal concentrations of HNT (10, 15, 20 wt.%) and silane (0, 2, 4 vol.%sil) to be incorporated into the resin-based materials were determined (15 wt.%HNT, 4 vol.%sil) after assessment of the mechanical properties (DC%, degree of conversion; FS, flexural strength; FM, flexural modulus; and UTS, ultimate tensile strength). The HNTsil-powder was loaded with chlorhexidine (CHX) to evaluate the effect of the silanization on drug release. Resin-discs were prepared for the following groups: RES (resin), HNT (resin+15 wt.%HNT), HNTsil (resin+15 wt.%HNT silanized), HNT-CHX (resin+15 wt.%HNT loaded with chlorhexidine), HNTsil-CHX (resin+15 wt.%HNTsil-CHX), and 0.2 vol.%CHX (resin+0.2 vol.%CHX solution). Specimens were stored in water for 1, 3, 5, 10, and 15 days at 37 °C. Aliquots from each time point and the final 15-day specimens were evaluated for the zone of inhibition (ZOI) against Streptococcus mutans. CHX release was analyzed using spectrophotometry at absorbance of 300 nm. Data were statistically analyzed (α = 0.05). RESULTS: All materials presented similar DC%. Reduced FS but increased FM was detected for 20 wt.%HNT-4%APTES. Groups with 15 wt.% and 20 wt.%HNT with/without APTES presented higher values of UTS. Agar diffusion data indicates that the HNTsil-CHX had a greater ZOI than all other groups over 15 days. HNTsil-CHX had the highest absorbance for day 1 but presented similar values to other groups every time point after. SIGNIFICANCE: Silanization of nanotubes followed by encapsulation of chlorhexidine is a promising technique for long-term delivery of guest molecules.

In Vitro Evaluation of Translucency and Color Stability of CAD/CAM Polymer-Infiltrated Ceramic Materials after Accelerated Aging.

PURPOSE: To investigate and compare the translucency and color stability of a newly introduced polymer-infiltrated ceramic network (PICN) material (Crystal Ultra) to those of clinically well-established restorative materials. MATERIALS AND METHODS: A total of 80 specimens measuring (12 × 14 × 1 mm ± 0.05 mm) were prepared from five CAD/CAM (IPS e.max (IPS), Lava Ultimate (LU), Cerasmart (CS), Vita Enamic (VE), Crystal Ultra (CU)) high translucency (HT) blocks in A2 or equivalent shades. Specimens were randomly allocated into two groups (A and B) (n = 8), and were subjected to 5,000 thermal-cycles (TC). This was followed by one-week immersion of group A specimens in coffee (staining) solution and group B specimens in distilled water. Following immersion, the specimens from both groups were further subjected to 5,000 TC. A spectrophotometer was used to measure the translucency parameter (TP) and color change (ΔE00 ) of the samples using CIELAB color coordinates at baseline, after 5,000 TC, following immersion, and after further 5,000 TC. Color stability was evaluated using the CIEDE2000 formula. Data were analyzed by non-parametric tests (α = 0.05). RESULTS: The TP values of the CAD/CAM materials ranged from 18.0-22.0. Following the initial TC, the changes in TP values were significant for VE (p = 0.012). Coffee immersion and further TC significantly impacted the TP values of PICN (VE and CU) materials compared to glass- ceramics (IPS), and resin nanoceramic (CS and LU) materials (p = 0.012). The comparison between CAD/CAM materials at different intervals showed a significant difference in the TP values (p < 0.01). The materials showed perceptible color changes following the initial TC except for PICN materials which demonstrated acceptable color changes. The major color difference was noticed for the resin nanoceramic specimens immersed in coffee; LU and CS showed higher color changes (ΔE00 = 2.45 and 2.09, respectively) than VE and CU (ΔE00 < 1.8). CONCLUSIONS: The translucency of the newly introduced Crystal Ultra PICN material was low compared to the resin nanoceramics and lithium disilicate glass-ceramic. The Crystal Ultra material exhibited better color stability compared to resin nanoceramics, but higher color change when compared with Vita Enamic PICN and lithium disilicate glass-ceramic CAD/CAM materials.

Effect of light-curing distance and curing time on composite microflexural strength.

This study investigated the influence of curing distance on µ-flexural strength (µ-FS) of a nano-hybrid composite, cured using the manufacturer-recommended curing time (MCT), compared to a consistent radiant exposure (CRE) using three different light-curing units (LCUs). Beams (6×2×1 mm) were cured using the MCT or CRE with a quartz-tungsten-halogen (QTH); a single-emission-peak light-emitting-diode (SLED), or a multiple-emission-peak light-emitting-diode (MLED) LCU. Specimens were cured at 0-, 2- or 8-mm distances (n=10) and the bottom irradiance and CRE were measured using a Managing Accurate Resin Curing-Resin Calibrator spectrometer. µ-FS testing was performed, and data analyzed using two-way ANOVA and Tukey multiple comparison tests (α=0.05). Mean bottom irradiance was (25.4-99.7 mW/cm2) and CRE (0.31-1.11 J/cm2). µ-FS was 422.1-516.6 MPa (MCT) and 440.4-490.4 MPa (CRE). Comparing CRE to MCT showed that µ-FS significantly decreased using the CRE at 2-mm (QTH) or the MCT at 2- and 8-mm (SLED). µ-FS may be significantly impacted by the curing protocol.

Clinical evaluation of a universal adhesive in non-carious cervical lesions.

OBJECTIVES: To compare the clinical performance of a universal adhesive in class V non-carious cervical lesions (NCCLs) using two surface treatment protocols (self-etch [SfE] vs selective-enamel-etch [SelE]). MATERIAL AND METHODS: Thirty-three adults, each with ≥2 NCCLs, received one resin composite restoration utilizing a SfE universal adhesive and another utilizing the adhesive and SelE with 37% phosphoric acid. Restorations were evaluated for sensitivity, retention, marginal discoloration, marginal adaptation, and clinical acceptability through 24 months using Cochran-Mantel-Haenszel tests for stratified, ordered categorical outcomes. RESULTS: Sixty-six restorations (35 SfE, 31 SelE; 27 volunteers) were evaluated at 24 months. There were no significant differences between SfE and SelE for sensitivity, retention, marginal adaptation, or clinical acceptability. One SfE restoration was lost. Marginal adaptation was significantly worse at 24 months than baseline for SelE (P = 0.01), but not for SfE. Marginal discoloration was significantly worse for SfE (P = 0.02), but not for SelE. Sensitivity improved from baseline to 24 months for both groups (SelE P = 0.004, SfE P = 0.002). CONCLUSIONS: Twenty-four-month data indicated significantly reduced sensitivity for both groups, worse marginal discoloration for SfE, and worse marginal adaptation for SelE. No changes in retention or clinical acceptability were observed in either group. All retained restorations were clinically acceptable at 24 months. CLINICAL SIGNIFICANCE: Both self-etch and selective enamel etch techniques with a universal adhesive produced clinically acceptable results in resin composite restorations for NCCLs over 2 years.