Twelve-Month Follow-Up of Different Dentinal Hypersensitivity Treatments by Photobiomodulation Therapy, Nd:YAG and Nd:YAP Lasers.

In this retrospective study, data for three different laser-assisted approaches for the management of dentinal hypersensitivity (DH) was collected (n = 920 teeth). In total, 387 teeth were treated with photobiomodulation (PBM) therapy with 660 nm red light laser (PBM group), 327 were treated with the Nd:YAG laser (1064 nm) and 206 were treated with the Nd:YAP laser (1340 nm). To assess the effectiveness of each treatment, a visual analogue scale (VAS) was used, where zero represented no pain at all and ten represented the greatest pain. VAS was used before (T0), immediately after (T1), one week after (T2), four weeks after (T3), six months after (T4) and one year after treatment (T5). Means and standard deviations of VAS at different follow-up times were calculated. Values were compared within and between groups. Statistical significance was considered to be achieved when p-value was less than 0.05. Confidence level was proposed to be 99% with a P value lower than 0.001. Within groups, a statistically significant reduction was obtained when the mean value of VAS at T0 was compared with T5. At T5, the PBM group had the highest reduction of VAS (with mean value of 0), while the Nd:YAG and Nd:YAP groups had scores of 1.065 ± 0.674 and 4.665 ± 0.674, respectively. Conclusion: this retrospective study showed that PBM therapy and irradiation with Nd:YAG and Nd:YAP lasers are effective in managing DH pain. However, PBM therapy was the only procedure that showed complete pain relief at six and twelve months after treatment.

Dentinal Hypersensitivity Treatment Using Diode Laser 980 nm: In Vivo Study.

The discomfort of patients due to dentinal hypersensitivity (DH) is one of the main challenges that dentists face in daily practice. Difficulties in DH treatment gave rise to many protocols which are currently used. The aim of this clinical study is to evaluate the effectiveness of a new protocol on the reduction of dentinal hypersensitivity with diode laser 980 nm and the application of a graphite paste. 184 patients enrolled in the study, the degree of pain was evaluated by visual analog scale (VAS), graphite paste was applied on the exposed dentine before irradiation, the application of diode laser 980 nm with continuous mode, backward motion, tangential incidence of the beam in non-contact mode and a delivery output of 1 W. Fiber's diameter was 320 µm and total exposure time depended on the time necessary to remove the graphite paste from the teeth. Statistical analyses were performed with Prism 5® software. Pain in post-operative significantly decreased immediately after the treatment. Mean values stayed stable until a 6-month follow-up. The application is considered to be safe with long-term effectiveness.

No post-no core approach to restore severely damaged posterior teeth: An up to 10-year retrospective study of documented endocrown cases.

OBJECTIVES: The objectives of the present study were to (1) retrospectively evaluate documented cases of ceramic and composite endocrowns performed using immediate dentin sealing (IDS); (2) correlate failures with clinical parameters such as tooth preparation characteristics and occlusal parameters. METHODS: 99 documented cases of endocrowns were evaluated after a mean observation period of 44.7±34.6months. A classification of restorations was established in function of the level of damage of residual tooth tissues after preparation, from 1 to 3. Evaluation was performed according to FDI criteria and endodontic outcomes were analyzed. Occlusal risk factors were examined and fractographic analysis was performed in case of fracture. RESULTS: 48.4% of patients were shown to present occlusal risk factors. 75.8% of restorations were Class 3 endocrowns. 56.6% were performed on molars, 41.4% on premolars and 2.0% on canines. 84.8% were performed in lithium-disilicate glass-ceramic and 12.1% in Polymer-Infiltrated Ceramic Network (PICN) material. The survival and success rates of endocrowns were 99.0% and 89.9% respectively, while the 10-year Kaplan-Meier estimated survival and success rates were 98.8% and 54.9% respectively. Ten failures were detected: periodontal disease (n=3), endocrown debonding (n=2), minor chipping (n=2), caries recurrence (n=2) and major fractures (n=1). Due to the reduced amount of failures, no statistical correlation could be established with clinical parameters. CONCLUSIONS: Endocrowns were shown to constitute a reliable approach to restore severely damaged molars and premolars, even in the presence of extensive coronal tissue loss or occlusal risk factors, such as bruxism or unfavorable occlusal relationships. CLINICAL SIGNIFICANCE: Practitioners should consider the endocrown instead of the post and core approach to restore severely damaged non-vital posterior teeth. This minimally invasive solution reduces the risk of catastrophic failures and is easily performed. The use of IDS procedure and lithium-disilicate glass-ceramic as prosthesis material gave very good results.

An in vitro evaluation of leakage of two etch and rinse and two self-etch adhesives after thermocycling.

Our experiment evaluated the microleakage in resin composite restorations bonded to dental tissues with different adhesive systems. 40 class V cavities were prepared on the facial and lingual surfaces of each tooth with coronal margins in enamel and apical margins in cementum (root dentin). The teeth were restored with Z100 resin composite bonded with different adhesive systems: Scotchbond Multipurpose (SBMP), a 3-step Etch and Rinse adhesive, Adper Scotchbond 1 XT (SB1), a 2-step Etch and Rinse adhesive, AdheSE One (ADSE-1), a 1-step Self-Etch adhesive, and AdheSE (ADSE), a 2-step Self-Etch adhesive. Teeth were thermocycled and immersed in 50% silver nitrate solution. When both interfaces were considered, SBMP has exhibited significantly less microleakage than other adhesive systems (resp., for SB1, ADSE-1 and ADSE, P = 0.0007, P < 0.0001 and P < 0.0001). When enamel and dentin interfaces were evaluated separately, (1) for the Self-Etch adhesives, microleakage was found greater at enamel than at dentin interfaces (for ADSE, P = 0.024 and for ADSE-1, P < 0.0001); (2) for the Etch and Rinse adhesive systems, there was no significant difference between enamel and dentin interfaces; (3) SBMP was found significantly better than other adhesives both at enamel and dentin interfaces. In our experiment Etch and Rinse adhesives remain better than Self-Etch adhesives at enamel interface. In addition, there was no statistical difference between 1-step (ADSE-1) and 2-step (ADSE) Self-Etch adhesives.

Relationship between Operator Skill and In Vitro Microleakage of Different Adhesive Systems in Class V Restorations.

Objectives. The aim of this study was to evaluate the influence of operator skill on microleakage in class V composite restorations. Materials and Methods. A total of 16 dentists and 25 dental students were enrolled, and 123 extracted teeth were allocated according to the adhesive being tested: Scotchbond Multipurpose, Adper Scotchbond 1 XT, and AdheSE. Each operator was asked to restore one tooth from each experimental group: two class V cavities were cut on each tooth and each adhesive was used on the same tooth before and after instructions for its use. After filling cavities with composite (Z100), the teeth were thermocycled. Results. For all of the tested adhesives, the mean microleakage score was lower for the dentists than for the students. The mean scores for the three tested adhesives were statistically similar before and after instructions for use. Conclusion. Our results indicate that the skill of the operator has a significant influence on microleakage.

Microleakage after Thermocycling of Three Self-Etch Adhesives under Resin-Modified Glass-Ionomer Cement Restorations.

This study was designed to evaluate microleakage that appeared on Resin-Modified Glass-Ionomer Cement (RMGIC) restorations. Sixty class V cavities (h x w x l = 2 mm x 2 mm x 3 mm) were cut on thirty extracted third molars, which were randomly allocated to three experimental groups. All the buccal cavities were pretreated with polyacrylic acid, whereas the lingual cavities were treated with three one-step Self-Etch adhesives, respectively, Xeno III (Dentsply Detrey GmbH, Konstanz, Germany), iBond exp (Heraeus Kulzer gmbH & Co. KG, Hanau, Germany), and Adper Prompt-L-Pop (3M ESPE AG, Dental products Seefeld, Germany). All cavities were completely filled with RMGIC, teeth were thermocycled for 800 cycles, and leakage was evaluated. Results were expressed as means +/- standard deviations (SDs). Microleakage scores were analysed by means of generalized linear mixed models (GLMMs) assuming an ordinal logistic link function. All results were considered to be significant at the 5% critical level (P < .05). The results showed that bonding RMGIC to dentin with a Self-Etch adhesive rather than using polyacrylic acid did not influence microleakage scores (P = .091), except for one tested Self-Etch adhesive, namely, Xeno III (P < .0001). Nevertheless, our results did not show any significant difference between the three tested Self-Etch adhesive systems. In conclusion, the pretreatment of dentin with Self-Etch adhesive system, before RMGIC filling, seems to be an alternative to the conventional Dentin Conditioner for the clinicians as suggested by our results (thermocycling) and others (microtensile tests).

Further evidence of the association between periodontal conditions and coronary artery disease.

BACKGROUND: There is increasing evidence that chronic infections, such as periodontal diseases, could play a role in the initiation and development of coronary artery disease (CAD). The present study was intended to test for a possible association between presence and severity of periodontitis and coronary artery disease in a Belgian population. METHODS: A total of 108 CAD patients (mean age 59.2 +/- 11 years) and 62 presumably healthy controls (mean age 57.7 +/- 9 years) were enrolled in the study. Probing depth, periodontal pocket bleeding index (PPBI), plaque index, furcation involvements, and tooth mobility were evaluated to compare periodontal health in both groups. The subjects were also ranked according to a novel index of periodontitis severity, the periodontal index for risk of infectiousness (PIRI), aimed at quantifying the risk of release of proinflammatory mediators from the periodontal sites. RESULTS: Periodontitis was significantly more frequent in CAD patients than in controls (CAD patients: 91%; controls: 66%). The mean number of pockets was 18 +/- 17.1 in cardiac patients versus 7.6 +/- 12.7 in controls (P < 0.0001), despite the fact that the mean number of missing teeth was significantly greater in cases than in controls (14 +/- 7.1 versus 9 +/- 5.2; P < 0.0001). Furthermore, proportions of mobile teeth, bleeding sites, periodontal pockets, and involved furcations were significantly higher in CAD patients than in controls. In addition, the extent of the periodontal disease present was also greater in cases than in controls. A logistic model, adjusted for known cardiovascular risk factors, showed a strong association between CAD and periodontitis (odds ratio [OR] = 6.5). Moreover, there was a significant dose-response relationship between increasing scores of the periodontal risk of infectiousness and the presence of CAD (adjusted OR = 1.3 per PIRI unit). CONCLUSION: In the present study, periodontitis was revealed to be a significant risk factor for CAD after adjusting for other confounding factors, with the level of association increasing with the individual extent of the periodontal lesions.

Experimental comparison of cavity sealing ability of five dental adhesive systems after thermocycling.

PURPOSE: To evaluate the cavity sealing obtained after thermocycling with five adhesive systems in which one all-in-one adhesive was compared to three one-bottle adhesives, and to observe the effect of a low-charged resin layer added to a one-bottle adhesive. MATERIALS AND METHODS: Twenty-five recently extracted teeth were randomly allocated to five experimental adhesive systems (n = 5 each): Optibond Solo (OS), Scotchbond 1 (SB1), PQ 1, Prompt-L-Pop (PLP), SB1+Revolution (R). On each tooth, two rectangular cavities at the cementoenamel junction were filled with a microhybrid composite (Z100) and the tested adhesives. Teeth were thermocycled and stained with AgNO3 + vitamin C. Leakage was evaluated on a 6-point (0-5) severity scale and the highest score was selected for each restoration. Results were treated by ordinal logistic regression and considered to be significant at p < 0.05. RESULTS: No significant difference was found between leakage values for enamel and dentin interfaces. Leakage scores never exceeded 2 for OS, SB1 and SB1+R, while they reached a maximum of 5 in 20% of PLP cases. OS was significantly better than the other adhesive systems, which were statistically equivalent. The addition of a flowable composite layer on SB1 did not yield a significant difference, but tended to give better results mainly at the dentin interface. CONCLUSION: The all-in-one adhesive PLP, because of quite variable results, seems less reliable than the one-bottle adhesives, of which OS provides significantly the best results. Addition of a flowable composite on SB1 appears to yield slightly better results.

Systemic release of endotoxins induced by gentle mastication: association with periodontitis severity.

BACKGROUND: Periodontitis has recently been identified as a potential risk factor for systemic pathologies such as cardiovascular disease, the hypothesis being that periodontal pockets could release pro-inflammatory bacterial components, for instance endotoxins, into the bloodstream. It is known that the oral cavity can be a source of circulating bacteria, but this has never been shown for bacterial endotoxins, and no evidence exists so far that the risk of systemic injury is related to the severity of periodontitis. The aim of the present study was to test the influence of gentle mastication on the occurrence of endotoxemia in patients with or without periodontal disease. METHODS: A total of 67 subjects were periodontally examined and grouped according to their periodontal status. This classification was based on an original index of severity of periodontal disease (periodontal index for risk of infectiousness, PIRI) aimed at reflecting the individual risk of systemic injury from the periodontal niches. Thus, the patients were classified into 3 risk groups: low, PIRI = 0; n = 25; moderate, 1 < or = PIRI < or = 5, n = 27; and high 6 < or = PIRI < or = 10, n = 15. Blood samples were collected before and 5 to 10 minutes after a standardized session of gentle mastication for detection of circulating endotoxins. Blood samples were tested with a chromogenic limulus amoebocyte lysate assay. RESULTS: Overall, blood levels of endotoxin after mastication were found to be significantly higher than before mastication (0.89 +/- 3.3 pg/ml versus 3.0 +/- 5.8 pg/ml; P= 0.0002). Likewise, the incidence of positive endotoxemia rose from 6% before mastication to 24% after mastication (P = 0.001). When accounting for the PIRI index, endotoxin levels and positive endotoxemia proved to be significantly higher in patients with severe periodontal disease than in the subjects with low or moderate periodontitis. CONCLUSIONS: Gentle mastication is able to induce the release of bacterial endotoxins from oral origin into the bloodstream, especially when patients have severe periodontal disease. This finding suggests that a diseased periodontium can be a major and underestimated source of chronic, or even permanent, release of bacterial pro-inflammatory components into the bloodstream.