To etch or not to etch, Part III: On the hydrophobic-rich content and fatigue strength of universal adhesives after long-term ageing.

OBJECTIVES: To examine whether dentin-etching extension and/or the hydrophobic-rich content of hybrid layers would affect fatigue strengths of a mild universal adhesive after long-term aging. METHODS: Twin-bonded resin-dentin interfaces were produced by etching sound midcoronal dentin beams with 32 % ortho-phosphoric acid for 15 s (OPA15s), 3 s (OPA3s) or 10 % meta-phosphoric acid for 15 s (MPA15s). Samples were bonded with a mild universal adhesive with or without additional coating using a solvent-free bisGMA-based bonding resin. Self-etch application served as control. Composite buildups were made with a nanofilled composite. Bar-shaped twin-bonded interfaces (0.9 × 0.9 × 12 mm) were aged for two years in artificial saliva at 37 â„ƒ and tested under 4-point flexure at quasi-static (n = 16) and cyclic loads (n = 35) until failure. The stress-life fatigue behavior was evaluated using the staircase method at 4 Hz. Crack initiation and fracture patterns were evaluated by SEM. Cyclic-loaded data was analyzed by Kruskal-Wallis on Ranks (α = 0.05). RESULTS: Significantly higher fatigue life distributions and higher endurance limits were observed for less aggressive etch-and-rinse protocols (OPA3s and MPA15s) after long-term ageing. Hydrophobic-rich coating produced 20-32 % higher endurance limits, prevented micrometer-sized porosities at bonded interfaces, reduced etching-associated variability and lowered crack formation. Significance Long-term hydrolysis produces detrimental effects on the fatigue strength of resin-dentin interfaces. The bond-promotion effect of less aggressive etch-and-rinse protocols and the creation of hybrid layers with higher hydrophobic-rich content are critical to extend the durability of mild universal adhesives. Therefore, current oversimplification trends in adhesive dentistry may limit resin-dentin bonding performance.

VR-haptic and phantom head dental training: Does the order matter? A comparative study from a preclinical fixed prostho-dontics course.

Learning tooth preparation techniques and the finesse required is an important part of preclinical dental education. Being able to practice surgical skills without loss of Frasaco® teeth while being provided with performance analysis data is a boon to students and educators. We investigated the combination of haptics-enhanced virtual reality (Simodont®) and conventional phantom head practice in a preclinical dental course, evaluating the students' performances and perceptions. Forty students were randomized into two groups: Group One began within a VR-haptic setting while Group Two worked with Frasaco® teeth. Halfway through the course the scenarios were switched. A crown preparation test on Frasaco® teeth was conducted at the end of the course. Students' performances and satisfaction were assessed anonymously. Analysis of the students' performances included clinical metrics (occlusal and axial reduction, convergence angle, damage to adjacent teeth). The perceived usefulness of VR-haptic and phantom head simulations was assessed. In Group One, the tooth preparation metrics were more in line with the requested parameters compared to Group Two. All students ranked VR-haptics highly regarding manual dexterity improvement. In conclusion, this study shows that by combining VR-haptics with conventional dental procedures, it is possible to improve important preparation metrics in fixed prosthodontics tooth preparation.

To etch or not to etch, Part II: On the hydrophobic-rich content and fatigue strength of universal adhesives.

OBJECTIVE: To determine whether smear layer management, via conservative etching protocols, and the hydrophobic-rich content of hybrid layers would affect the fatigue strength of resin-dentin interfaces. METHODS: Bar-shaped dentin beams obtained from sound third molars were wet-polished for 30 s. Dentin was etched with 32 % ortho-phosphoric acid for 3 or 15 s, 10 % meta-phosphoric acid for 15 s or by a prime-and-rinse application using a mild universal adhesive (Scotchbond Universal, 3M ESPE). Self-etch application served as control. Coating was performed with a solvent-free bisGMA-based resin. Composite buildups were made with a nanofilled composite. Resin-dentin beams with twin-bonded interfaces were sectioned and stored in deionized water for 24 h at 37 â„ƒ before 4-point flexural quasi-static monotonic testing (n = 16). Stress-life fatigue behavior was evaluated under cyclic loading (n = 35) by the staircase method at 4 Hz. The tension side of cyclic-loaded unfractured beams were evaluated under SEM, along with the micro-morphology of etched dentin surfaces. Monotonic data was analyzed by two-way ANOVA followed by the Tukey Test and cyclic-loaded data by Kruskal-Wallis on Ranks (α = 0.05). RESULTS: Etching protocols and higher hydrophobic-rich content produced significantly higher fatigue life distributions (p < 0.05). Dentin demineralization was ranked as OPA 15 s > MPA 15 s > OPA 3 s > P + R > SE. Less aggressive etching and coating reduced crack formation at hybrid layers. SIGNIFICANCE: Current oversimplification trends in resin-dentin bonding constitute a trade-off between hybridization quality and easier adhesive handling. Controlled dentin etching and increasing the hydrophobic-rich content of hybrid layers may be necessary to extend the longevity of mild universal adhesives.

To etch or not to etch, Part I: On the fatigue strength and dentin bonding performance of universal adhesives.

OBJECTIVE: To characterize whether the bonding performance and fatigue strength of resin-dentin interfaces created by a universal adhesive would be affected by different H3PO4-application times to more accurately assess long-term durability. METHODS: Mid-coronal flat dentin surfaces with standardized smear-layers were produced on sound third molars, etched with 32% H3PO4 for 0, 3 and 15 s, bonded with a mild universal adhesive (3M-ESPE) and restored with a nanofilled composite. Bonded specimens (0.9 × 0.9 mm) were stored in deionized water for 24 h and sectioned into beams for microtensile testing (n = 10). Resin-dentin beams were tested under tension until failure (0.5 mm/min) after 24 h or 6 month storage in artificial saliva at 37 ̊C. Bar-shaped resin-dentin beams (0.9 × 0.9 × 12 mm) were tested under 4-point-flexure initially at quasi-static loads (n = 22) and then under cyclic loads (n > 50). The stress-life fatigue behavior was evaluated using the twin-bonded interface approach by the staircase method at 4 Hz. Fractured interfaces and the tension side of unfractured beams were evaluated under SEM, along with the micro-morphology of the etched dentin surfaces and hybrid layers. Data were analyzed by ANOVA and Tukey test and Wilcoxon Rank Sum Test (α = 0.05). RESULTS: Quasi-static loads were limited to discriminate the bonding performance of resin-dentin interfaces. Application modes significantly affected etching patterns, fatigue strength, endurance limits and hybrid layer morphology (p < 0.001). SIGNIFICANCE: Reductions in fatigue strength of self-etched bonded interfaces raise concerns about the true ability of universal adhesives to properly bond to dentin.

Incorporation of dimethyl sulfoxide into experimental hydrophilic and hydrophobic adhesive resins: evaluation of cytotoxic activities.

This study evaluated the cytotoxicity of methacrylate-based resins containing dimethyl sulfoxide (DMSO). DMSO was incorporated into hydrophobic (R2) and hydrophilic (R5) resins at weight concentrations of 0, 0.01, 0.1, 1, 5, or 10 w/w %. Resin discs (n = 10/group) were prepared. Human gingival fibroblasts (HGF-1) were exposed to resin eluates for 24 h. Furthermore, dentin barrier test was performed using 3-D cultures of odontoblast-like cells (SV40 transfected pulp derived cells) with dentin slices of 400 µm thickness (n = 8). After acid etching of dentin, DMSO-modified resins were applied into the cavity part of the device and light-cured for 20 s. Cell viability (%) was assessed by MTT and analyzed spectrometrically. Data were analyzed by ANOVA and Tukey test (α = 0.05). Resin eluates showed statistically significantly lower % cell viability for all neat and DMSO-modified resins than seen for the negative control. Moreover, DMSO-R5 eluates resulted in significantly lower % cell viability than DMSO-R2 emulates. The dentin barrier test showed that DMSO-R2 did not result in significantly lower % cell viability, whereas incorporation of 1-10 w/w % DMSO into R5 resulted in significantly lower % of cell viability. Incorporating DMSO into hydrophilic self-etching resins may increase cytotoxicity. The biocompatibility is not influenced by the addition of DMSO into hydrophobic resin.

Leadership diversity in prosthodontics: Number of women and nonwhite individuals serving as President of selected prosthodontic organizations in the last 20 years.

STATEMENT OF PROBLEM: As a measure of the leadership diversity in prosthodontics, the number and percentage of women and nonwhite Presidents of prosthodontics organizations is unknown. PURPOSE: The purpose of this observational study was to calculate and compare the number and percentage of women and nonwhite Presidents of 10 selected prosthodontic organizations over the past 20 years and to determine whether the number of women and nonwhite Presidents has changed over the time frame of 2000-2019 in comparison to male and white Presidents. MATERIAL AND METHODS: The number of women and nonwhite Presidents of the Academy of Prosthodontics (AP), American Academy of Fixed Prosthodontics (AAFP), American Academy of Maxillofacial Prosthetics (AAMP), American College of Prosthodontists (ACP), American Prosthodontic Society (APS), European Prosthodontic Association (EPA), International Association of Dental Research - Prosthodontics group (IADR-P), International College of Prosthodontists (ICP), Greater New York Academy of Prosthodontics (GNYAP), and Pacific Coast Society for Prosthodontics (PCSP) was recorded. The chi-square test was used to determine differences in the percentage of women and nonwhite Presidents over time and between organizations. RESULTS: The range of women Presidents in the selected years was 20% (EPA) to 0% (APS) with a mean of 10%. No statistically significant differences over time and between organizations were observed. The range of nonwhite Presidents in the selected years was 25% (ICP) to 0% (AAFP, AAMP, ACP, and GNYAP) with a mean of 7.5%. No statistically significant difference over time was observed while a statistically significant difference between organizations was observed (P=.015). Multiple comparisons revealed the ICP had significantly more nonwhite Presidents in the selected years. CONCLUSIONS: The relatively low numbers of women and nonwhite Presidents in the organizations studied is compelling evidence that there are an insufficient number of women and nonwhite role models in prosthodontics and that important voices representing the diversity of members of the prosthodontic community remain unheard.

Leadership diversity in prosthodontics: Recommendations for the representation of women speakers at scientific prosthodontic meetings.

STATEMENT OF PROBLEM: Leadership platforms in the professions include invitations to speak at the meetings of major organizations. However, the percentage of women speakers at prosthodontic meetings is lower than that of women prosthodontists overall. Recommendations or reporting requirements to address this deficiency are lacking. PURPOSE: The purpose of this observational study was to determine the probability of the number of women speakers at any scientific meetings of 6 different prosthodontic organizations over the past decade occurring by chance alone and to make recommendations for scientific program committees and organizations regarding the number of women speakers at future meetings. MATERIAL AND METHODS: The number of men and women speakers at the 2009-2018 annual meetings of the Academy of Prosthodontics (AP), American Academy of Fixed Prosthodontics (AAFP), American College of Prosthodontics (ACP), American Prosthodontic Society (APS), Greater New York Academy of Prosthodontics (GNYAP), and Pacific Coast Society for Prosthodontics (PCSP) was recorded. The chi-square test was used to determine differences in the percentage of women speakers over time and between organizations. The BINOM.DIST function was used to calculate the probability of selecting the exact number of women speakers at each meeting (α=.05). RESULTS: The mean percentage of women speakers across all organizations and all years was 10.80%. The percentage ranged from 0.00% (AAFP 2013; ACP 2013; APS 2012, 2015; GNYAP 2009, 2014; and PCSP 2009, 2010, 2011) to 42.86% (AP 2013). No change in women speaker presence was observed over the time frame investigated. The AP had significantly more women speakers than the other organizations. Of the 60 meetings included, 25 meetings had a statistically significantly low number of women speakers, and 1 meeting had a statistically significantly high number of women speakers. CONCLUSIONS: The number of women speakers at the scientific meetings of the organizations analyzed was significantly low and has not changed significantly over the years from 2009 to 2018. There were significantly more women speakers at the scientific meetings of the Academy of Prosthodontics than in the 5 other major prosthodontic organizations over the years 2009 to 2018. A recommendation is made that prosthodontic organizations include more women speakers on scientific programs. Specifically, a minimum of 25% of speakers should be women (rolling 3-year average) or 25% of podium time should be for women speakers (rolling 3-year average).

Leadership diversity in prosthodontics: The number and percentage of women speakers at recent annual scientific meetings of prosthodontic organizations.

STATEMENT OF PROBLEM: Leadership platforms in the professions include invitations to speak at major organization meetings. However, speaker profiles from underrepresented groups at annual scientific meetings of prosthodontic organizations have not been reported. PURPOSE: The purpose of this observational study was to determine the percentage of women invited to speak at selected prosthodontic organization meetings. MATERIAL AND METHODS: The number of men and women speakers at the 2009, 2014, 2015, 2016, 2017, and 2018 annual meetings of the Academy of Prosthodontics, American Academy of Fixed Prosthodontics, American College of Prosthodontics, American Prosthodontic Society, Greater New York Academy of Prosthodontics, and Pacific Coast Society for Prosthodontics were recorded. The chi-square test was used to determine differences in the percentage of women speakers over time and between organizations. RESULTS: A total of 781 speakers in the years 2009 and 2014 to 2018 from the scientific meetings of the 6 prosthodontic organizations reviewed met the inclusion criteria. Of the 781 speakers, 693 (88.7%) were men and 88 (11.3%) were women. No significant differences were noted between organizations nor did the number of women speakers change significantly over time. CONCLUSIONS: The number of women speakers at scientific meetings is lower than that of women prosthodontists and has not changed significantly over the past decade.

Incorporation of dimethyl sulfoxide to model adhesive resins with different hydrophilicities: Physico/mechanical properties.

OBJECTIVE: To understand dimethyl sulfoxide (DMSO) interaction with distinct methacrylate monomer blends and the impact on polymer formation by investigating the combined relationship among degree of resin hydrophilicity, presence of DMSO and specific physico/mechanical properties. METHODS: One hydrophobic (R2) and one hydrophilic (R5) methacrylate-based resins with different monomer compositions were solvated in ascending DMSO concentrations (0, 0.01, 0.1, 1, 5, and 10 w/w %). Neat resins (0 w/w % DMSO) were used as controls. The degree of conversion was determined by Fourier-transform infrared spectroscopy. Polymer crosslinking density was indirectly measured by a modified ethanol-water two-stage solvation technique and the biaxial flexural strength was measured after 24 h and 30 days of water storage at 37 ̊C. Water sorption and solubility were gravimetrically assisted during 28 days of water storage to determine the kinetics of water-polymer interactions. Data were analyzed by ANOVA and Tukey test (α = 0.05). RESULTS: Incorporation of high DMSO-concentrations significantly increased the degree of conversion of all tested formulations, specifically for the hydrophobic resin (p < 0.05). Despite the increase in degree of monomer conversion, higher water sorption/solubility values and lower biaxial flexure strengths were detected as a result of reductions in polymer crosslink density (p < 0.05). In general, low DMSO-concentrations had no impact on the biaxial flexural strength, crosslinking density and water sorption/solubility (p < 0.05). CONCLUSION: DMSO-monomer ratio and monomer composition are critical for new dental methacrylate-based adhesive formulations. High DMSO incorporation hampers physico/mechanical properties of methacrylate bonding resins, albeit to a lesser extend when hydrophilic resins are employed. Nonetheless, DMSO-solvated hydrophobic adhesives extensively outperform their hydrophilic correspondents. DMSO incorporation of 1w/w % may constitute a secure threshold regardless of monomer composition.

Inhibition of dentin matrix-bound cysteine cathepsins by potassium fluoride.

Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) can break down unprotected type I collagen fibrils in dentin matrix. This study investigated the use of potassium fluoride (KF) as a potential inhibitor of MMPs and CCs in dentin. Demineralized dentin beams were divided into groups (n = 10 in each group) and incubated in artificial saliva (AS, control), either alone or with one of seven concentrations of KF (6-238 mM fluoride) for 1, 7, and 21 d. After 21 d, all groups were further aged in AS for 6 months. Total MMP activity was screened using the colorimetric MMP assay. The activities of MMP-2 and MMP-9 were investigated using gelatin zymography. At the end of each incubation, changes in loss of dry mass and CC-mediated or total dissolution of collagen peptides were measured via precision weighing, C-terminal crosslinked telopeptide of type I collagen (CTX), and hydroxyproline (HYP) assays. The beams were examined using scanning electron microscopy. After 21 d, total MMP activities, dry mass loss, and CTX release for the groups exposed to 179 and 238 mM fluoride were significantly lower compared with the control group. After 6 months, all groups showed similar total MMP activity, dry mass loss, and HYP release, and CTX levels were significantly lower when the fluoride concentration was ≥24 mM. Calcium fluoride (CaF2 )-like precipitates were observed over the beams. In summary, KF significantly inhibited the catalytic activity of dentin matrix-bound CCs but did not seem to be effective for MMP-mediated activity.

Effect of calcium fluoride on the activity of dentin matrix-bound enzymes.

OBJECTIVE: Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) are two distinct enzymatic pathways responsible for the degradation of collagen fibrils in demineralized dentin. NaF and KF have been shown to inhibit salivary MMP-2, -9 and CCs. This study investigated the inhibitory effect of calcium fluoride (CaF2) on the dentin matrix-bound MMPs and CCs. DESIGN: Phosphoric acid (10%)-demineralized dentin beams (1 × 2×6 mm) were incubated at 37 °C in an 1 ml of artificial saliva (AS, control), or AS with 6, 12, 24, 48, 120. 179 and 238 mM F containing CaF2 (n = 10/group) for 1, 7 and 21 days. All groups were further incubated in AS only for 6 months. Total MMP activity, dry mass loss, CTX and hydroxyproline (HYP) analyses were performed after each incubation. The beams were examined under scanning electron microscopy (SEM). MMP-2 and MMP-9 activities were screened with gelatin zymography. Data were analyzed by using ANOVA and Tukey HSD tests (p = .05). RESULTS: The total MMP activity was similar for all groups after 21 days and 6 months. After 21 days, the cumulative mass loss and CTX levels were lower compared to control for the CaF2 ≥48 and CaF2≥120 mM, respectively (p < .05). After 6 months, no significant difference was detected in the dry mass loss and CTX compared to the control (p > .05), whereas HYP level was higher with F 24 and 238 mM groups. CaF2-like minerals were observed on the beams under SEM. There was no gelatinase inhibition in zymography. CONCLUSION: CaF2 does not prevent the degradation of demineralized dentin matrices due to the catalytic activity of MMPs and CCs.

Effect of various dimethyl sulfoxide concentrations on the durability of dentin bonding and hybrid layer quality.

The objective was to evaluate effect of dimethyl sulfoxide (DMSO) on microtensile bond strength (µTBS) and nanoleakage (NL). Superficial dentin was acid-etched and pretreated with DMSO. Etch-and-rinse adhesive was applied and restored with resin composite incrementally. After 24 h, teeth were sectioned, stored in artificial saliva for 24-h or 6-months before µTBS evaluation. Failure modes were examined. Six beams per group were submitted to nanoleakage evaluation using SEM. Data were analyzed using ANOVA and Tukey's test (α=0.05). Pretreatment had no significant effect on µTBS after 24 h (p>0.05). After 6 months storage, µTBS of control decreased significantly, more than with the groups treated with 0.01% or higher (p<0.05). DMSO-pretreated groups preserved µTBS in all groups. After 6-months, all groups except 0.001% showed significantly lower nanoleakege compared to control (p<0.05). DMSO (0.01-20%) may improve the hybrid layer integrity and bonding durability. The best results were seen with low (1-5%) of DMSO concentrations.

Antimicrobial efficacy and mechanical properties of BAC-modified hard and soft denture liners.

This study investigated the antimicrobial efficacy and mechanical strength of hard and soft denture liners modified with benzalkonium chloride (BAC). The specimens (1 mm thickness, 8 mm diameter) were prepared by mixing 0.5, 1, 2 and 5 wt% BAC with soft (Sofreliner Medium, Tokuyama) and hard (Rebase II, Tokuyama) denture liners (n = 5/group). BAC was not added to the controls. Candida albicans ATCC 28366 (A 550 = 0.5) and Streptococcus mutans Ingbritt suspensions (A 550 = 0.35) were pipetted onto the specimens, and incubated for 4 h. The viable cells were collected, and determined by plate-culturing (CFU). The tests were repeated after the specimens were soaked in distilled water for 7 days. The mechanical strengths were evaluated by tear and 4-point flexural strength tests for soft and hard liners, respectively. The data were analyzed with ANOVA and Tukey's HSD tests at p = 0.05. C. albicans viability was lost in all groups of BAC-modified soft liners (p < 0.001), and S. mutans viability was reduced (p < 0.01), except of soaked BAC 0.5 wt% group (p > 0.05). For the hard liner, BAC 5 wt% killed the C. albicans and S. mutans cells both before and after soaked in water (p < 0.001). BAC 2 wt% showed comparable tear strength with the soft liner control (p > 0.05). BAC did not reduce the flexural strength of the hard liner (p > 0.05), except of BAC 5 wt% group (p < 0.01). BAC can be a promising agent reducing the C. albicans and S. mutans viability on the soft and hard denture liner surfaces.

Repair bond strength of nanohybrid composite resins with a universal adhesive.

Objective: To investigate the repair bond strength of fresh and aged nanohybrid and hybrid composite resins using a universal adhesive (UA). Materials and methods: Fresh and aged substrates were prepared using two nanohybrid (Venus Pearl, Heraus Kulzer; Filtek Supreme XTE, 3 M ESPE) and one hybrid (Z100, 3 M ESPE) composite resin, and randomly assigned to different surface treatments: (1) no treatment (control), (2) surface roughening with 320-grit (SR), (3) SR + UA (iBOND, Heraus Kulzer), (4) SR + Silane (Signum, Ceramic Bond I, Heraeus Kulzer) + UA, (5) SR + Sandblasting (CoJet, 3 M ESPE) + Silane + UA. After surface treatment, fresh composite resin was added to the substrates at 2 mm layer increments to a height of 5 mm, and light cured. Restored specimens were water-stored for 24 h and sectioned to obtain 1.0 × 1.0 mm beams (n = 12), and were either water-stored for 24 h at 37 °C, or water-stored for 24 h, and then thermocycled for 6000 cycles before microtensile bond strength (µTBS) testing. Data were analyzed with ANOVA and Tukey's HSD tests (p = .05). Results: Combined treatment of SR, sandblasting, silane and UA provided repair bond strength values comparable to the cohesive strength of each tested resin material (p < .05). Thermocycling significantly reduced the cohesive strength of the composite resins upto 65% (p < .05). Repair bond strengths of UA-treated groups were more stable under thermocycling. Conclusions: Universal adhesive application is a reliable method for composite repair. Sandblasting and silane application slightly increases the repair strength for all substrate types.

NaF Inhibits Matrix-Bound Cathepsin-Mediated Dentin Matrix Degradation.

Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) degrade the collagen fibrils of demineralized dentin. Sodium fluoride (NaF) has previously been shown to inhibit recombinant MMP-2 and MMP-9. This study aimed to evaluate the efficacy of NaF on the inhibition of dentin-bound MMPs and CCs. Dentin beams were completely demineralized in 10% phosphoric acid. The baseline total MMP activity and dry masses were measured. Beams were assigned to test groups based on similar MMP activity and dry mass (n = 10/group), and incubated in artificial saliva (control) or artificial saliva with NaF containing 6-238 mM fluoride for 1, 7 and 21 days. The dry mass loss and MMP activities were reassessed at each time point. The proteolytic activity was screened by gelatin zymography. ICTP and CTX released to the incubation medium were analyzed as indices of MMP and cathepsin K activity, respectively. The beams were examined under scanning electron microscopy. All NaF doses reduced the dry mass loss after 21 days (p < 0.05). NaF inhibition of the total MMP activity ranged between 5 and 80%. In gelatin zymography, the bands of MMP-2 and MMP-9 became less prominent with increasing NaF levels. NaF did not decrease the released ICTP (p > 0.05). Less CTX release was detected with F ≥179 mM (p < 0.05). CaF2-like minerals were observed on the beams. High levels of NaF may slow the degradation of the dentin matrix due to the inhibition of cathepsin K. Fluoride does not seem effective in the direct inhibition of proteolysis by dentin matrix-bound MMPs.