Effect of polyethylene fiber orientation on fracture resistance of endodontically treated premolars.

STATEMENT OF PROBLEM: Polyethylene fibers have been reported to improve the fracture resistance of endodontically treated teeth, but their optimal orientation is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effects of different fiber positions and orientations on the fracture resistance of endodontically treated premolar teeth. MATERIAL AND METHODS: One hundred endodontically treated maxillary premolars were divided into 2 groups according to the cavity design, mesio-occluso-distal and occluso-buccal, and each group was divided into 5 subgroups (n=10) according to the polyethylene fiber orientation on the pulpal floor: unidirectional horizontal (from mesial to distal), unidirectional vertical (from buccal to palatal), bidirectional (buccopalatal and mesiodistal), circular (around the walls), and without fibers (control group). The cavities were restored with fiber-reinforced composite resin and conventional composite resin. All the teeth were fractured with a universal testing machine and analyzed as catastrophic failure or reparable failure. A 1-way ANOVA was used to compare fracture strength values (α=.05). RESULTS: The tested groups with different fiber orientations showed significantly higher fracture load than the control group (P<.05). No statistically significant difference was observed among the fiber orientations (P>.05). Most of the favorable fractures were occlusal to the cemento-enamel junction, and adhesive failure were seen in the mesio-occluso-distal and occluso-buccal cavities. The highest percentage of unfavorable fractures and mixed failures was observed in the control group. CONCLUSIONS: The fiber orientation pattern in the mesio-occluso-distal and occluso-buccal cavities did not differ significantly in the fracture resistance of endodontically treated maxillary premolar teeth.

Multispecies oral biofilm and identification of components as treatment target.

Endodontic infections involve a multispecies biofilm, making it difficult to choose an antimicrobial treatment. Characteristics such as the pathogens involved and number of microorganisms, nutrients, material surface to develop the biofilm, flow and oxygenation conditions are important for biofilm development using in vitro models. OBJECTIVE: To develop a standardized biofilm model, which replicates the main features (chemical, microbiological, and topographical) of an infected root canal tooth to detect components as treatment target. DESIGN: Clinical strains of Enterococcus faecalis, Candida albicans, and Actinomyces israelii were isolated, and a multispecies biofilm was developed using continuous laminar flow reactors under anaerobic conditions in human dental roots. The microbiological composition was determined by counting colony-forming units and scanning electron microscope micrographs. In addition, the chemical composition of the exopolymeric matrix was determined by vibrational Raman spectroscopy and liquid chromatography of biofilm supernatant treated with enzyme. RESULTS: E. faecalis turned out to be the main microorganism in mature biofilm, this was related to the presence of ß-galactosidase detected by vibrational Raman spectroscopy. After the enzymatic treatment of the extracellular polymeric substance, the presence of mannose and glucose was established. CONCLUSIONS: The present work contributes to better understanding of standard conditions to develop a multispecies biofilm in human dental roots, which could have an impact on the generation of new root canal disinfection techniques in endodontic pathologies.

Effect of short fiber-reinforced composite combined with polyethylene fibers on fracture resistance of endodontically treated premolars.

STATEMENT OF PROBLEM: Whether direct coronal restorations of endodontically treated teeth with short fiber-reinforced composite combined with polyethylene fibers provide adequate mechanical strength is unclear. PURPOSE: The purpose of this in vitro study was to compare the fracture strength of endodontically treated premolars with standardized mesio-occluso-distal (MOD) preparations restored with short fiber-reinforced composite (SFRC) combined with polyethylene Ribbond fibers (PRFs). MATERIAL AND METHODS: A total of 40 premolars were selected and distributed into 4 groups (n=10) as follows: group restored with SFRC (EverX Posterior), group restored with PRF (Ribbond fibers), and group restored with the combination PRF+SFRC, all followed by a conventional composite resin (IPS Empress Direct). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). Specimens were loaded using a universal testing machine until fracture occurred at a crosshead speed of 0.5 mm/min, and the failure type and fracture patterns was reported descriptively. The mean values of the groups were analyzed by using the Shapiro-Wilk test and 1-way ANOVA tests (α=.05). RESULTS: Restoration with PRF+SFRC provided the highest mean ±standard deviation fracture resistance (288.2 ±73.5 N). Restoration with just PRF had the lowest values (192.4 ±25.4 N), which were statistically different from those of SFRC and PRF+SFRC (P<.05). The predominant mode of failure was mixed, and all fracture patterns were favorable. CONCLUSIONS: Reinforcing endodontically treated premolars with MOD cavities with Ribbond fibers followed by a conventional composite resin enhanced fracture resistance and may be suitable for the direct coronal restoration of large posterior cavities in stress-bearing areas.

Evaluation of the sealing capability and morphological fit of prefabricated dowels and fiber-reinforced composite resin: An in vitro study.

STATEMENT OF PROBLEM: Prefabricated dowels do not always provide intraradicular sealing in the root canal dentin, and the lack of sealing predisposes the dowel to adhesive failure and debonding. It is unclear if fiber-reinforced composite resin dowels provide better sealing. PURPOSE: The purpose of this in vitro study was to evaluate the intraradicular sealing and morphological fit of prefabricated dowels and fiber-reinforced composite resin dowels in root canal dentin. The thickness of the resin cement layer and push-out bond strength were determined to assess their effects on the sealing of the dowels. MATERIAL AND METHODS: A total of 50 permanent maxillary central incisors were endodontically treated and divided into 2 subgroups (n=25). In one group, prefabricated dowels were cemented; in the second group, fiber-reinforced composite resin dowels were placed. The thickness of the resin cement layer was assessed in 3 different locations: coronal, middle, and apical of the root canal dentin with fluorescence confocal laser microscopy. The push-out bond strength was then determined, and intraradicular sealing observed by using scanning electron microscopy. RESULTS: Fiber-reinforced composite resin dowels showed a closer intraradicular fit and seal in the root canal dentin, and the morphology of the apical portion of the fiber-reinforced composite resin dowels showed a sealing area with the gutta percha in the apical portion. The mean thickness of the resin cement layer was significantly reduced for the fiber-reinforced composite resin dowels compared with the prefabricated dowels (P<.05) in the cervical area (197.0 µm versus 311.0 µm) and in the apical portion of the root canal (57.3 µm versus 131.6 µm). The mean push-out strength was higher for the fiber-reinforced composite resin dowels (22.98 N/mm2) than that for the prefabricated dowels (16.49 N/mm2) (P<.05). CONCLUSIONS: The morphological fit of fiber-reinforced composite resin dowels provides better intraradicular sealing in the cervical and apical portions, reducing the resin cement thickness. The increased push-out strength can therefore be assumed to result from increased frictional retention compared with prefabricated dowels.

Surface degradation and biofilm formation on hybrid and nanohybrid composites after immersion in different liquids.

PURPOSE: This study evaluated the association of surface degradation and formation of Streptococcus mutans (S. mutans) biofilm in resin-based composites (RBCs) after storage in different acidic liquids. METHODS: To evaluate microhardness and surface micromorphology, hybrid and nanohybrid RBC discs were stored in artificial gastric acid, cola drink, orange juice, artificial saliva, and distilled water for three intervals of 15 min per day for 7, 15, and 30 days. After 30 days of storage, surface roughness was analyzed, and the RBC discs were placed in a biofilm reactor inoculated with S. mutans to evaluate surface biofilm formation. RESULTS: As compared with nanohybrid RBCs, roughness and surface microhardness values were significantly lower (P < 0.05) for hybrid RBCs stored in artificial gastric acid, followed by specimens stored in cola drink and orange juice. Artificial gastric acid caused greater surface degradation, which increased the biomass of S. mutans on the surface of both RBC types. CONCLUSION: Surface degradation of hybrid and nanohybrid RBCs correlated with the pH of the liquid, while S. mutans biofilm formation was associated with increased surface roughness in hybrid RBCs.

Hydroxyapatite decreases cytotoxicity of a glass ionomer cement by calcium fluoride uptake in vitro.

BACKGROUND: Glass ionomer cements (GICs) are widely used in dentistry because of their remineralizing and cariostatic potential induced by fluoride. In vitro studies have reported cell toxicity triggered by GICs; however, the influence of hydroxyapatite (HAp) must be considered. The aim of this study was to evaluate the effect of HAp in decreasing the cytotoxicity of the GIC 3M Vitrebond in vitro. METHODS: Samples of 3M Vitrebond (powder, liquid and light-cured) were incubated in Dulbecco's modified Eagle's medium-Ham's F12 (DMEM-F12) for 24 hours at 37°C. Subsequently, the light-cured medium was treated with 100 mg/mL of HAp overnight. Toxicity of conditioned media diluted 1:2, 1:4, 1:8 and 1:20 was analyzed on human gingival fibroblasts (HGFs) using light microscopy and the fluorometric microculture cytotoxicity assay. The amounts of calcium fluoride (CaF2) were determined by the alizarin red S method. RESULTS: The exposure of HGFs to light-cured induced cell death and morphological changes such as chromatin condensation, pyknotic nuclei and cytoplasmic modifications. Exposure to light-cured treated with HAp, significantly increased cell viability leading to mostly spindle-shaped cells (p<0.001). The concentration of CaF2 released by the light-cured was 200 ppm, although, in the light-cured/HAp conditioned medium, this quantity decreased to 88 ppm (p<0.01). CONCLUSIONS: These data suggest that HAp plays a protective role, decreasing the cytotoxic effect of 3M Vitrebond induced by CaF2.

Biologic monitoring and causes of failure in cycles of sterilization in dental care offices in Mexico.

BACKGROUND: Biologic indicator tests (BIs) are considered the most meaningful way to verify sterilization. OBJECTIVE: To monitor the cycles of sterilization using BIs in dry heat sterilizers and steam autoclaves and to identify the causes of failures in the cycles of sterilization in dental offices in San Luis Potosí, México. METHODS: An invitation to participate was sent to 400 dental offices, and 206 practitioners of 200 dental offices were included. A questionnaire was given to each of the participants, asking for the following information: sterilizer type, operational parameters used (eg, temperature, pressure, and length of exposure), frequency of sterilization cycles per day, use of BIs, and maintenance procedures of the sterilizer. Two hundred thirty sterilizers were monitored using BIs. The sterilizers with positive results were monitored a second and third time to identify the cause of the failure. RESULTS: Twenty-two percent of practitioners (n = 46) used BIs, and 17% (n = 39) of the sterilizers reported positive results (bacterial growth). The detected failures were a mistake in the procedure (eg, temperature, time, or pressure), an absence of supervision of the procedure performed by the assistant, and improper maintenance. CONCLUSIONS: There are opportunities to increase information on infection control, to improve the adoption of standard quality control methods for sterilization as a routine process, to improve training on proper testing, and standardize processes.

Predictive values of thermal and electrical dental pulp tests: a clinical study.

INTRODUCTION: For a diagnostic test to be useful, it is necessary to determine the probability that the test will provide the correct diagnosis. Therefore, it is necessary to calculate the predictive value of diagnostics. The aim of the present study was to identify the sensitivity, specificity, positive and negative predictive values, accuracy, and reproducibility of thermal and electrical tests of pulp sensitivity. METHODS: The thermal tests studied were the 1, 1, 1, 2-tetrafluoroethane (cold) and hot gutta-percha (hot) tests. For the electrical test, the Analytic Technology Pulp Tester (Analytic Technology, Redmond, WA) was used. A total of 110 teeth were tested: 60 teeth with vital pulp and 50 teeth with necrotic pulps (disease prevalence of 45%). The ideal standard was established by direct pulp inspection. RESULTS: The sensitivities of the diagnostic tests were 0.88 for the cold test, 0.86 for the heat test, and 0.76 for the electrical test, and the specificity was 1.0 for all 3 tests. The negative predictive value was 0.90 for the cold test, 0.89 for the heat test, and 0.83 for the electrical test, and the positive predictive value was 1.0 for all 3 tests. The highest accuracy (0.94) and reproducibility (0.88) were observed for the cold test. CONCLUSIONS: The cold test was the most accurate method for diagnostic testing.