Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Restauração em resina composta semidireta em dente posterior: relato de caso / Semi-direct composite restoration in posterior toth: a case report

A escolha da técnica restauradora desempenha papel fundamental na eficácia e duração de um tratamento reabilitador. O objetivo deste relato de caso foi descrever a utilização da técnica semidireta para a confecção de uma restauração em resina composta em um primeiro molar inferior. A paciente apresentava uma restauração insatisfatória no dente 36, que necessitava ser substituída devido à infiltração por cárie. Optou-se pela técnica semidireta devido à amplitude da cavidade, que envolvia estruturas de suporte, e pela combinação das vantagens das abordagens direta e indireta. O procedimento envolveu a remoção de tecido cariado, a aplicação de hidróxido de cálcio pasta, seguida da aplicação de uma fina camada de ionômero de vidro e, posteriormente, resina fluída para realizar o selamento dentinário. O preparo foi realizado seguindo os princípios necessários. O elemento em questão foi moldado com silicone de adição e o arco antagonista, com alginato. Ambos modelos foram vertidos com silicone para modelos semirrígidos e montados em oclusor de peças de brinquedo. A restauração semidireta foi confeccionada em resina composta Filtek Z350 XT, respeitando a anatomia do dente 36. Pigmentos foram utilizados para aprimorar detalhes estéticos. Após acabamento e polimento, a peça foi condicionada e cimentada com cimento dual Relyx Ultimate. Pode-se concluir que a abordagem restauradora por meio da técnica semidireta construída em modelo semirrígido é uma opção terapêutica conservadora e vantajosa para dentes com extensa destruição coronária. Essa técnica possibilita a restauração de forma eficaz, garantindo tanto a estética quanto a função adequada do dente afetado(AU)

The choice of restorative technique plays a fundamental role in the effectiveness and duration of rehabilitation treatment. The objective of this case report was to describe the use of the semi-direct technique to create a composite resin restoration in a lower first molar. The patient had an unsatisfactory restoration on tooth 36, which needed to be replaced due to cavity infiltration. The semi-direct technique was chosen due to the amplitude of the cavity, which involved support structures, and the combination of advantages of the direct and indirect approaches. The procedure involved the removal of carious tissue, and the application of calcium hydroxide paste, followed by the application of a thin layer of glass ionomer and, subsequently, fluid resin to seal the dentin. The preparation was carried out following the necessary principles. The element in question was molded with addition silicone and the antagonist arch was molded with alginate. Both models were poured with silicone for semi-rigid models and mounted on toy parts occluders. The semi-direct restoration was made in Filtek Z350 XT composite resin, respecting the anatomy of tooth 36. Pigments were used to improve aesthetic details. After finishing and polishing, the piece was conditioned and cemented with Relyx Ultimate dual cement. It can be concluded that the restorative approach using the semi-direct technique built on a semi-rigid model is a conservative and advantageous therapeutic option for teeth with extensive coronal destruction. This technique allows for effective restoration, ensuring both the aesthetics and adequate function of the affected tooth(AU)

In Vitro Microleakage and Fracture Resistance of "Infinity Edge" and Cusp Reduction Preparation Designs for Moderate-sized Class II Composites.

AIM: This study aimed to evaluate the marginal microleakage and maximum occlusal fracture loads and fracture modes of two novel class II preparation designs, "infinity edge" and the "2.5 mm cusp reduction" preparations as compared to a traditional class II preparation without cuspal involvement. MATERIALS AND METHODS: Thirty extracted human mandibular molars were prepared for moderate-sized class II restorations with extensions into all occlusal grooves. Of these, ten class II preparations served as control. Ten were modified for a 2.5 mm even reduction of the cusps adjacent to the interproximal box. An additional 10 preparations were modified with an "infinity edge" bevel on the interproximal and occlusal portions. All teeth were restored utilizing a flowable bulk-fill composite in the apical portion of the interproximal box and 2-4 mm of heated bulk-fill composite in one increment for the remainder. All groups were cyclic loaded and thermocycled, then imaged with microcomputed tomography (µCT) before and after infiltration with a silver nitrate solution. Images were subtracted to obtain volumetric measurements of microleakage and reported as a percentage of the total volume from the apical extent of the proximal box. All groups were loaded to failure and fracture load and mode were recorded. RESULTS: No significant differences were found in microleakage volume as a percentage of total tooth volume; however, the "infinity edge" group had significantly greater microleakage in the proximal box compared to the traditional class II group. No significant differences were found in fracture load or mode between the groups. CONCLUSION: Traditional class II, 2.5 mm cuspal reduction, and "infinity edge" preparation designs have similar fracture loads as well as volumes of microleakage; however, an "infinity edge" preparation has a higher ratio of microleakage in the proximal box. CLINICAL SIGNIFICANCE: Clinicians should carefully consider the use of "infinity edge" margins, particularly on dentin in the apical extent of the proximal box. How to cite this article: Watson JC, Lien W, Raimondi JC, et al. In Vitro Microleakage and Fracture Resistance of "Infinity Edge" and Cusp Reduction Preparation Designs for Moderate-sized Class II Composites. J Contemp Dent Pract 2024;25(1):3-9.

Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study.

AIM: The aim of the current investigation was to evaluate the marginal microleakage of various esthetic restorative materials applied to primary teeth. MATERIALS AND METHODS: A total of 75 noncarious primary molars that were removed for orthodontic intervention and teeth nearing exfoliation were chosen. One millimeter (mm) above the cementoenamel junction, on the buccal surface of the teeth, Class V cavities were prepared. William's graded periodontal probe was used to standardize cavity preparation on all teeth. 3 mm was the cavity's length, 2 mm in width, and 2 mm in depth. The teeth were then divided into three groups (25 samples in each group) according to the type of esthetic restorative material used. Group I: Resin-modified glass ionomer cement, Group II: Ormocer, Group III: Giomer. The samples underwent 500 cycles of thermocycling, with an immersion time of 60 seconds and a well time of 15 seconds, between 5 and 55°C. The samples were submerged in methylene blue dye for 24 hours at room temperature and dried. The samples were then divided into sections and examined with a stereomicroscope. Data was recorded and statistically analyzed. RESULTS: The least marginal microleakage was found in the ormocer group (1.22 ± 0.01) followed by resin-modified glass ionomer cement group (1.31 ± 0.07) and the giomer group (1.78 ± 0.03). There was a highly statistically significant difference found between resin-modified glass ionomer cement group and the ormocer group, resin-modified glass ionomer cement group and giomer group. And no significant difference was found between the ormocer group and the giomer group. CONCLUSION: The present study concluded that there was some amount of microleakage in primary teeth in all restorative materials examined in this in-vitro investigation. However, the marginal sealing ability of ormocer was found highest compared to resin-modified glass ionomer cement and Giomer materials. CLINICAL SIGNIFICANCE: The primary reason dental restorations fail, particularly in Class V cavities, is microleakage since the margins of these restorations are typically found in the dentin or cementum. Assessing microleakage is a crucial step in determining the marginal integrity of restorative materials. Developing methods and resources that reduce the adverse effects caused by the restorative marginal seal failing would benefit from this. How to cite this article: Al Ghwainem A, Alqarni AS. Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study. J Contemp Dent Pract 2024;25(1):58-61.

Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Maxillary First Premolar: In Vitro.

This study was designed to investigate the impact of access cavity designs on fracture resistance of endodontically treated maxillary first premolars. The study sample consisted of 72 intact maxillary first premolars, randomly divided into six groups (n = 12). A standardized proximal cavity preparation was prepared for all samples using standard bur. Groups I: control group with only standard proximal cavity and no endodontic access, group II: Truss access cavity, group III: Separated access to buccal and palatal canals without removal of dentine in between, group IV: Access to buccal and palatal canals with removal of dentine in between, group V: Traditional access cavity, group VI: Mesio-occlusal-distal cavity (MOD). For groups I and VI, only composite restoration was used to restore the proximal cavity, while for groups II- V, the access was prepared and endodontic treatment was performed on all teeth, then composite restoration was placed. The root canals were instrumented using nickel-titanium files, irrigated with sodium hypochlorite, and filled with AH plus sealer and gutta-percha using warm vertical condensation. All samples were then placed in an acrylic mold and underwent thermal aging for 10,000 cycles between 5 and 55°C. The samples were fixed in a universal testing machine with the long axis of the roots positioned at 20° to a load applied at a crosshead speed of 1 mm/min using a stainless steel semi-spherical indenter (Ø = 3 mm) until fracture occurred to determine the fracture resistance force in Newton. The normality test (Shapiro-Wilk) showed that data are normally distributed. Group II exhibited the highest mean fracture resistance, and group VI was the least likely to resist the fracture. No statistically significant differences between tested groups (p-value = 0.237). The MOD group showed a more unfavorable mode of fracture compared to other groups. No significant difference in fracture resistance between conservative and traditional access cavities. The missing marginal ridges, such as in MOD cavities played an important role in decreasing the fracture resistance of endodontically treated teeth.

Marginal adaptation of two-step self-etch versus universal adhesives for Class V restorations: Effect of Er:YAG laser vs. bur prepared cavities.

PURPOSE: To compare the in vitro effect of laser and bur preparation on marginal adaptation of Class V cavities restored with a 2-step self-etch and distinct universal one-component universal adhesives used in self-etching mode. METHODS: 96 Class V cavities were prepared with conventional burs or with an Er:YAG laser. Four universal self-etch (Unibond Extra Low Shrinkage, All Bond Universal, SKB-100 and Prime&Bond active) and a 2-step self-etch adhesive (Clearfil SE Bond) that served as control were used to restore the cavities with direct composite. The percentages of continuous margins were evaluated by quantitative SEM analysis before and after a fatigue test consisting of 240,000 occlusal loads and 600 warm/cold thermal cycles. RESULTS: The marginal adaptation of bur prepared restorations was statistically superior to laser-prepared ones. Class V cavities restored with Clearfil SE Bond and the one-component self-etching universal adhesives All Bond Universal and Prime&Bond active presented the highest and statistically similar percentages of continuous margins before and after loading under both bur and laser cavity preparation. The lowest percentages of continuous margins were observed in the groups restored with the low shrinking adhesive (Unibond ELS), with medians of 49 and 21 for bur and laser prepared cavities after loading. CLINICAL SIGNIFICANCE: Class V cavities presented smoother and higher percentages of continuous margins when prepared by bur rather than by laser. The 2-step self-etch adhesive Clearfil SE Bond and 1-step self-etch universal adhesives All Bond Universal and Prime&Bond active showed a comparable marginal performance.

Analyzing working time and efficient caries removal using a novel bioactive caries detecting dye and air polisher prophy for caries excavation: randomised clinical trial.

OBJECTIVES: This study aims to analyze the working time consumed during caries excavation and pain perception while using a novel Bioactive caries-detecting dye solution (BCD), an Air Polisher Prophy and a combination. MATERIALS AND METHODS: Four groups (in each group, n = 20 permanent teeth) were selected from 60 people between 17 and 40 years of age. The study included teeth with occlusal dentinal caries in the molars with cavity entrance sizes of less than 2 mm (clinically and radiographically). Randomization software was used to assign patients to various groups. Group A: Conventional Rotary Drilling, Group B: BCD + Mechanical Excavation (Spoon Excavator), Group C: Air Polisher Prophy, and Group D: BCD + Air Polisher Prophy 0.5 mL BCD was applied with a micro brush to the carious tooth surface for 40 s in groups B and D. After that, radiographs were performed to see if the radiopaque extension was visible. For mechanical caries extraction, a spoon excavator was used for group B, and an air polisher prophy was employed for group D. For mechanical caries extraction, a spoon excavator was utilized for group B. An air polisher prophy was employed for group D. Multiple applications of the BCD were used in the event of residual caries. Working time and pain experienced during caries excavation were registered using the Verbal Pain Scale (VPS) (score 0-4), and caries removal was clinically graded using the modified Scale (score 0-5). RESULTS: The time taken was Group A, Group D, Group B, and Group C, according to statistical analysis using ANOVA and the Post Hoc Test (275.02, 403.8, 461.98, 615.41 s, respectively). Group A had the highest mean VPS (1.85), whereas Group B had the most minor pain (0.6), followed by Group D (1.2) and Group C (0.6). (1.45). Group C (2.35), followed by groups D (1.75), B (1.30), and A (1.30), had ineffective caries eradication (0.90). (p < 0.05). CONCLUSIONS: compared to group C, groups B and D took less time and had less/no pain while excavating caries. Compared to traditional mechanized caries removal methods, the chemo-chemical BCD can diagnose and aid in successful caries removal with minimal pain. CLINICAL RELEVANCE: The outcomes of the present study demonstrated that the chemo-chemical bioactive caries detecting dye solution has the potential to identify and help in effective caries removal before mechanized caries removal methods.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study.

OBJECTIVES: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial.

AIM: This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions. METHODS: Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria. RESULTS: Comparison of age, time and volume with study groups were made using Independent Sample' t' test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen's Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups. CONCLUSION: Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Effect of cervical margin relocation on marginal adaptation and microleakage of indirect ceramic restorations.

PURPOSE: This study evaluated the effect of cervical margin relocation (CMR) with two different materials and contamination with hemostatic agents on the margin adaptation and microleakage of ceramic restorations. MATERIALS AND METHODS: Mesial-occlusal-distal cavities were prepared in 60 human first molars and distributed to 3 groups (n = 20) according to the margin relocation procedure. The groups were: group F; flowable composite applied in two 2 mm increments, group B; bulk-fill flowable composite applied as a bulk increment of 4 mm thickness and group C (control); no CMR was done. Each group was subdivided into two subgroups (subgroup N; no hemostatic agent applied and subgroup H; hemostatic agent was applied). In all groups, ceramic inlays were prepared and cemented. The samples were subjected to thermocycling (10,000 cycles). The adaptation of the cervical margin was evaluated with scanning electron microscopy (200×). Samples were then assessed for microleakage analysis with the dye penetration method. Marginal adaptation data were normally distributed and analyzed using two-way ANOVA followed by Tukey's post hoc test. Ordinal microleakage score data were analyzed using cumulative link models followed by the analysis of deviance using Wald chi-square tests. RESULTS: Both CMR and contamination with a hemostatic agent had significant effects on the margin adaptation of the cervical margin. Group C showed the highest adaptation with no significant difference from group F. The lowest adaptation was revealed in group B with a significant difference from group C. Subgroup N (in all groups) showed a statistically higher adaptation than subgroup H. Regarding microleakage assessment, CMR had no significant effect but hemostatic agent application showed a significantly higher microleakage score for all groups. CONCLUSIONS: Both the CMR procedure and contamination with AlCl3 hemostatic agent had a negative effect on marginal adaptation. For microleakage assessment, only contamination with hemostatic agent negatively affected the microleakage with no effect on the margin relocation procedure.

Co-Influence of Restoration Bonding and Inlay Cavity Design on Fracture Load of Restored Tooth.

INTRODUCTION: The aim of this study was to investigate the co-influence of indirect mesio- occlusal-distal (MOD) cavity geometry and inlay restoration bonding on quasi-static fracture load of the restored tooth. METHODS: Forty-eight intact human molar teeth were selected and prepared for standardized edge-shaped or round-shaped MOD cavities. The resin composite (Cerasmart, GC) inlays were bonded with the state-of-the-art inlay bonding protocol or with intentionally deteriorated bonding using n-hexane-wax solution for preconditioning. Restored teeth were loaded along the long axis of the tooth. Ultimate fracture load was recorded, and the type of fracture was visually determined and classified. Statistical analysis of load values was performed by Kruskal-Wallis test. RESULTS: Round-shaped cavity design with bonded restoration presented the highest fracture load (1658N). Bonding had significant influence on the fracture load of roundshaped cavity design (p=0.0003), whereas cavity design had no influence when the bonding was deteriorated (p=0.8075). In the case of deteriorated bonding, either the inlay or tooth fractured separately whereas in the bonded inlays fractures were commonly found both in the tooth and inlay. CONCLUSIONS: According to this study, bonded inlay restoration increased fracture resistance, while cavity design had no statistical difference on fracture resistance of the restored tooth.

Evaluation of the microleakage of class V composite restoration after cavity treatment with Erbium, CO2 lasers, Papain, and Bromelain enzymes.

OBJECTVES: Different surface preparation and treatment methods may have dissimilar effects on the microleakage of composite resin. This study was conducted to determine the deproteinizing effect of 10% bromelain enzyme, 10% papain enzyme, CO2 , and erbium-YAG laser in regard to decrease in the microleakage of composite restorations. MATERIALS AND METHODS: Thirty teeth were selected and 60 class V cavities were prepared on the lingual and buccal sides. They were divided into six groups (n = 10): Group 1, phosphoric acid gel; Group 2, bromelain enzyme 10%; Group 3, papain enzyme 10%; Group 4, mixed papain and bromelain enzymes 10%; Group 5, CO2 laser; and Group 6, erbium-YAG laser. They were stored in basic fuchsine and dye penetration was evaluated. Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis, p < 0.05 RESULTS: In both occlusal and gingival margins, comparison of microleakage between groups 1, 2, 3, 4, and 5 showed no significant differences (p = 1) and group 6 had a significant difference with other groups (p ˂ 0.001). CONCLUSIONS: Microleakage of composite resin in the dentin surface was not affected significantly using either bromelain or papain 10% enzymes or erbium laser. However, CO2 laser had a negative effect on the enamel and dentin margins and increased the microleakage. Erbium laser showed a better effect than enzymes on microleakage.

Tracing of Microbes in Prepared Cavity Following Different Minimally Invasive Caries Removal Protocols.

AIMS: The conventional caries removal technique has been replaced with minimally invasive (MI) techniques to preserve healthy natural teeth and to provide durable dental restorations. Each of these MI caries removal protocols is reported to be favorable in dealing with different caries conditions. The current study aimed to trace the residual bacteria that may remain in a prepared cavity following a visual-tactile (VT), caries detection dye (CDD), and chemo-mechanical caries removal (CMCR) protocol. MATERIALS AND METHODS: A total of 29 extracted human molar teeth with visible caries lesions were randomly divided into three groups. The cavity preparation and caries removal of each group was accomplished following one of the MI caries removal protocols. Swab samples (one from each specimen) were taken and inoculated onto a blood agar plate and incubated for 48 hours. The growth of the bacterial colony was observed under a microscope and the specific genome of the bacteria was identified by polymerase chain reaction (PCR) test. RESULTS: The maximum number of traceable bacteria was observed following the chemo-mechanical caries removal group followed by the caries detection dye group and the least in the visual-tactile group. The PCR test revealed the presence of Streptococcus mutans in all the observed colonies; however, Streptococcus sobrinus was absent completely. The Chi-square test reveals a statistically insignificant (p = 0.646) difference among the tested groups. CONCLUSION: All of the MI caries removal protocols used in this study showed a trace of microbes in certain teeth. The cavity prepared following a visual tactile protocol showed the least amount of traceable bacteria in the prepared cavity. CLINICAL SIGNIFICANCE: Cavity that is prepared following individual MI protocol has a risk of leaving microbes in it.

Evaluation of the proximal contact tightness in class II resin composite restorations using different contact forming instruments: a 1-year randomized controlled clinical trial.

BACKGROUND: Proper proximal contact in direct composite restorations is crucial for periodontal health. Over a one-year period, this study was conducted to assess successive biological changes in proximal contact tightness PCT in class II direct composite restorations and the adjacent teeth by applying sectional matrix system along with different contact forming instruments. METHODS: 72 direct compound class II composite restorations were performed in patients aged 18-40 years and divided into 4 groups: Group I (n = 18): proximal contact was restored with Palodent plus sectional matrix system, Group II (n = 18): Trimax as contact forming instrument, Group III (n = 18): Perform as contact forming instrument and Group IV (n = 18): Contact pro as contact forming instrument. All contact forming instruments were used along with Palodent plus matrix system. PCT was measured using a digital force gauge before (T0), immediate post operative (T1) and at 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after restorative treatment. Using One-Way ANOVA, Tukey's post hoc test, and Bonferroni correction, PCT values were compared between groups before and after the intervention restoration. Meanwhile, for comparisons within groups, a paired t-test was conducted (p ≤ 0.05). RESULTS: Contact forming instruments combined with Palodent plus sectional matrix system achieved better PCT. Trimax led to a statistically considerable tighter proximal contacts than the other groups (p < 0.05). No statistically significant difference was found in PCT between Contact pro-2, Perform and Palodent plus sectional matrix system. By means of multivariate analysis, the PCT between both T0 and T1 were increased (p < 0.001) and then it decreased till T5. CONCLUSIONS: The use of transparent contact forming instruments achieved greater PCT compared to Palodent sectional matrix system alone that gradually decreased throughout 12 months and reached the PCT between the natural teeth. Using Trimax system provided the tightest proximal contacts. Additionally, digital force gauge was confirmed as an inclusive and accurate method to quantify PCT. TRIAL REGISTRATION: ClinicalTrials.gov NCT05749640: 24/5/2022.

Restorations of Class II Cavities Evaluated for Marginal Leakage When Restored with Composites or a Giomer Using Different Bonding Agents.

PURPOSE: To evaluate the marginal leakage of three different types of bonding agents used with two posterior composites and a giomer, available commercially. MATERIAL AND METHODS: Class II box-only cavities were prepared on 90 mandibular first molars with margins extending 1 mm beyond the cementoenamel junction. The samples were divided into nine groups based on three different bonding agents, two different composites, and a giomer. Cavities were restored per the manufacturer's description. Teeth were subjected to a thermocycling procedure (500×, 5°C to 55°C) and dye penetration by immersing in a 2% methylene blue solution (Merck Specialties) for 24 hours. The marginal adaptation was evaluated as a continuous margin at the gingival level under a stereomicroscope. The results were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The results of the groups with the total-etch technique showed no statistical difference between the nanohybrid Filtek Z250 XT (3M ESPE) and fine hybrid SwissTEC composite (Coltène\Whaledent AG). The groups with the self-etch technique showed no statistical difference when used with either of the two composites. The acid-etch technique showed better marginal adaptation than the self-etch technique. When the giomer (Beautifil II, Shofu) was used with the total-etch technique, it showed better adaptation than when used with the self-etch technique but overall showed more marginal leakage than the composites. CONCLUSION: The total-etch technique provided better marginal adaptation for the composites and giomer compared to the self-etch technique. CLINICAL SIGNIFICANCE: The demand for esthetic restorations continues to increase, and composite restorations are now considered the material of choice for Class II cavities. There are various concerns with composite restorations, one of them being good marginal adaptation to increase the life of the restoration. This study evaluated marginal leakage with the nanohybrid composite Filtek Z250 XT, fine hybrid composite SwissTEC, and a giomer when used with the total-etch technique and self-etch technique and reported satisfactory adaptation with the total-etch technique.

The in-vitro development of novel enzyme-based chemo-mechanical caries removal agents.

OBJECTIVES: Bromelain is a potent proteolytic enzyme that has a unique functionality makes it valuable for various therapeutic purposes. This study aimed to develop three novel formulations based on bromelain to be used as chemomechanical caries removal agents. METHODS: The novel agents were prepared using different concentrations of bromelain (10-40 wt. %), with and without 0.1-0.3 wt. % chloramine T or 0.5-1.5 wt. % chlorhexidine (CHX). Based on the enzymatic activity test, three formulations were selected; 30 % bromelain (F1), 30 % bromelain-0.1 % chloramine (F2) and 30 % bromelain-1.5 % CHX (F3). The assessments included molecular docking, Fourier-transform infrared spectroscopy (FTIR), viscosity and pH measurements. The efficiency of caries removal was assessed by DIAGNOdent pen, measuring the excavation time and number of applications, followed by a morphological evaluation of the remaining dentine using scanning electron microscopy (SEM). The results were compared to Brix 3000 as a control. RESULTS: The chloramine and chlorhexidine were chemically compatible with bromelain without compromising the enzyme activity. All experimental formulations showed higher viscosity and pH in comparison to Brix 3000. The DIAGNOdent readings were <20 in all groups, and the lowest readings were observed in F2. The excavation time and number of applications were lowest in F2 and F1. Both F2 and F3 produced smooth dentine surfaces with less tissue debris, but more patent dentine tubules were observed in F1 and F2. CONCLUSIONS: The bromelain-contained formulations showed a potential to be used as chemomechanical caries removal agents in vitro. Further laboratory and clinical studies are needed to validate this claim. CLINICAL SIGNIFICANCE: The bromelain from pineapple stem has broad specificity for cleavage the peptide bonds in denatured protein to facilitate their removal. The study proved the efficiency of this enzyme to remove the dental caries chemomechanically when used alone or conjugated with chloramine and/or chlorhexidine to enhance the disinfecting and cleansing properties.

Impact of matrix systems on proximal contact tightness and surface geometry in class II direct composite restoration in-vitro.

BACKGROUND: Poor contact tightness and contour in class II composite restorations are significant problems in clinical practice. They affect occlusal stability and periodontal health. The aim of this study was to evaluate proximal contact tightness and contour established after completing class II direct composite restorations using two pre-contoured matrix systems. METHODS: Standardized mesio-occlusal cavities were prepared in twenty typodont lower right first permanent molar teeth. Prepared teeth were randomly divided into two groups according to matrix system: Group 1, Sectional matrix system with a separation ring (Palodent V3); and Group 2, Circumferential matrix system with integrated tightener (Palodent 360). Contact tightness was evaluated using universal testing machine. Area, depth and curvature radius of proximal surface concavity in the restoration were evaluated using contact stylus profilometer. T-test was used for comparison between groups. RESULTS: Sectional matrix showed higher contact tightness than circumferential matrix system. The results of proximal surface concavity in the restoration showed significantly higher area and depth of concavity with lower radius of curvature in circumferential matrix compared to sectional matrix. CONCLUSIONS: The use of separation ring with sectional matrix provides superior contact tightness compared to circumferential matrix. However, both matrix systems presented some deficiency regarding proximal contour of direct class II resin composite restoration.

Teaching of posterior composites for the restoration of permanent teeth in undergraduate dental training programmes: Systematic review and meta-analysis.

OBJECTIVES: To systematically assess aspects of teaching of posterior composite restorations (PCRs) in permanent teeth in dental schools. STUDY SELECTION: Quantitative studies reporting on dental schools' teaching regarding the placement of PCRs in permanent teeth. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed based on the Medical Education Research Study Quality Instrument (MERSQI). SOURCES: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in January 2023. DATA: Forty sources reporting on 34 studies having surveyed 1,286 dental schools were included. Overall, 92.7% (95%-CI: 88.2-95.5) of dental schools reported to teach PCRs. PCRs in three-surface Class II cavities are taught by 82.0% (95%-CI: 70.4-89.7). The mandatory use of liners in deep cavities is taught by 78.3% (95%-CI: 68.9-85.5), and 44.0% (95%-CI: 34.3-54.2) reported to teach bulk-fill composites. While most posterior restorations placed by students were composites (56.1%; 95%-CI: 46.0-65.8), 94.7% (95%-CI: 86.6-98.0) of dental schools (still) teach posterior amalgam restorations. The proportion of dental schools teaching PCRs in three-surface Class II cavities increased and the mean proportion of PCRs among all posterior restorations increased over time (padj.≤0.003). CONCLUSIONS: The teaching of PCRs in dental schools around the world reflects the increased use of resin composite in clinical practice, with students in countries where dental amalgam continues to be used, placing more posterior composites than restorations of dental amalgam. The teaching of PCRs, which is anticipated to increase, will continue to be refined with further developments in adhesive materials, devices, instrumentation, and techniques. CLINICAL SIGNIFICANCE: Graduating dentists can be expected to be familiar with the use of resin composites for the restoration of posterior teeth.

A novel dice-inspired multifunctional 3D printing guided splint for minimally invasive access cavity preparation and canal orifice identification.

BACKGROUND: The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation. OBJECTIVE: This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification. METHOD: Data were collected from an outpatient with dens invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast). RESULTS: The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly. CONCLUSION: This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator's experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field.

Investigating the impact of flowable composite liner on the fracture strength and microleakage of large composite resin restorations of primary anterior teeth.

PURPOSE: To investigate the effect of pre-cured and co-cured flowable composite liner on fracture strength and microleakage of primary anterior teeth with extended composite resin restorations. METHODS: In the current in vitro experimental study, the crowns of 54 extracted primary canine teeth were cut 1 mm above the CEJ, and a pulpectomy procedure was performed. The samples were randomly divided into three groups to restore the coronal part up to 4 mm above the CEJ. In group 1, the samples were built up with Filtek Z250 packable composite resin. In group 2 (pre-cure), first, 1 mm of Filtek Z350 XT flowable liner was applied to the sample, and after curing, the restoration process continued using packable composite resin. In group 3 (co-cure), the flowable composite liner was cured while the first layer of packable composite resin was applied; then, the same restorative procedure similar to the other groups was followed. The samples' cross-sectional area in the fracture strength test was calculated by AutoCAD software. Subsequently, the samples were subjected to a force in a universal testing machine. The samples related to the microleakage experiment were cut vertically, and then, the dye penetration percentage (10% methylene blue) was measured under a stereomicroscope. ANOVA was used to analyze the data. RESULTS: Mean fracture strength in group 2 was significantly higher than in group 1 (P = 0.016). The microleakage mean in group 3 was significantly lower than in groups 1 (P = 0.000) and 2 (P = 0.026). CONCLUSION: The flowable composite liner and its relevant separate curing increased the fracture strength of composite resin restorations. However, less microleakage was reported in the group where the liner was applied as a co-cure.