Effect of Tribochemical Coating on Composite Repair Strength.

CLINICAL RELEVANCE: Tribochemical treatment of existing composite surfaces is highly effective for composite repair. When repairing an old composite restoration, the clinician should try to use the same composite originally used for the restoration. If the information about the original restoration is not known, a composite with strong mechanical properties should be used for the repair restoration. SUMMARY: This study evaluated the effect of tribochemical coating on composite-to-composite repair interfacial fracture toughness (iFT). Sixty beam-shaped specimens (21×4×3 ± 0.2 mm) were prepared with a nanofill composite (Filtek Supreme Ultra [FSU]) and a nanohybrid composite (Clearfil Majesty ES-2 [CME]) and aged for 50,000 thermocycles (5°C-55°C, 20-second dwell time) and then sectioned in half. The resulting 120 hemispecimens (60 for each composite) were randomly assigned to different repair methods (n=10): universal adhesive (Clearfil Universal Bond Quick [CUB]), sand-blasting followed by CUB, or tribochemical coating (CoJet, CoJet sand, Espe-Sil, and Visio-Bond). The repair surface was prepared with a diamond bur (Midwest #471271), rinsed, and dried. Each aged composite brand (FSU, CME) was repaired with either the same composite or the opposite composite. All adhesives and composites were light cured with a high-irradiance LED curing light (Elipar DeepCure-S). After postrepair storage in 100% humidity and at 37°C for 24 hours, iFT was measured as KIc (MPa m½). Data were analyzed for statistical significance using two-way analysis of variance (ANOVA) and the Tukey honest significant difference post hoc test (α=0.05). Regardless of the substrate composite, ANOVA showed significant differences for surface treatment (p<0.0001) and repair composite (p<0.0001). Mean iFT values (SD) ranged from 0.91 (0.10) MPa·m½ to 2.68 (0.12) MPa·m½. Repairs made with FSU after CoJet resulted in significantly higher iFT (FSU: 2.68 MPa·m½; CME: 2.21 MPa·m½) when compared to the other experimental groups. The repair iFT was higher with CoJet treatment and when the nanofill composite FSU was used as the repair composite.

Composite-composite Adhesion as a Function of Adhesive-composite Material and Surface Treatment.

OBJECTIVE: To evaluate the composite-to-composite repair interfacial fracture toughness (iFT) as a function of adhesive and composite repair material. METHODS AND MATERIALS: Beam-shaped composite specimens (21×4×3±0.2 mm) were prepared for each substrate material (Filtek Supreme Ultra [FSU] or Clearfil Majesty ES-2 [CME]) and artificially aged for 50,000 thermocycles (5-55°C, 20-second dwell time). Aged specimens were sectioned in half, and the resulting hemispecimens were randomly assigned to one of the different repair methods (n=10) based on the following variables: type of substrate composite (FSU or CME), acid etch (yes or no), adhesive type (Scotchbond Universal or Clearfil SE Bond 2), and type of repair composite (FSU or CME). The repair surface was prepared with a course diamond bur (Midwest #471271). When used, 37% phosphoric acid was applied for 20 seconds, rinsed, and dried. All adhesives and composites were applied according to manufacturers' instructions. After postrepair storage (100% humidity, 37°C, 24 hours), iFT was measured and expressed as MPa. Data were analyzed for statistical significance using a three-way analysis of variance and Tukey post hoc tests (α=0.05). RESULTS: iFT values ranged from 0.64 ± 0.19 MPa to 1.28 ± 013 MPa. Significantly higher iFT values were achieved when FSU was used as the repair composite resin regardless of the substrate composite resin (p<0.001). Clearfil SE Bond 2 adhesive was associated with significantly higher iFT values for FSU substrate (p<0.001). The etching procedure had no significant effect on the iFT values of the repair procedures (p>0.05). CONCLUSIONS: Composite repair strength is adhesive and composite dependent. Repair strength appears to be higher when FSU is the repair composite regardless of the adhesive used.

Tooth-surface-specific effects of xylitol: randomized trial results.

The Xylitol for Adult Caries Trial was a three-year, double-blind, multi-center, randomized clinical trial that evaluated the effectiveness of xylitol vs. placebo lozenges in the prevention of dental caries in caries-active adults. The purpose of this secondary analysis was to investigate whether xylitol lozenges had a differential effect on cumulative caries increments on different tooth surfaces. Participants (ages 21-80 yrs) with at least one follow-up visit (n = 620) were examined at baseline, 12, 24, and 33 months. Negative binomial and zero-inflated negative binomial regression models were used to estimate incidence rate ratios (IRR) for xylitol's differential effect on cumulative caries increments on root and coronal surfaces and, among coronal surfaces, on smooth (buccal and lingual), occlusal, and proximal surfaces. Participants in the xylitol arm developed 40% fewer root caries lesions (0.23 D2FS/year) than those in the placebo arm (0.38 D2FS/year; IRR = 0.60; 95% CI [0.44, 0.81]; p < .001). There was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries (p = .100), occlusal-surface caries (p = .408), or proximal-surface caries (p = .159). Among these caries-active adults, xylitol appears to have a caries-preventive effect on root surfaces (ClinicalTrials.gov NCT00393055).

Effects of phosphoric acid and glutaraldehyde-HEMA on dentin collagen.

The purpose of this study was to evaluate the effects of phosphoric acid (PA) and a proprietary glutaraldehyde-HEMA aqueous solution (Gluma Desensitizer; GD) on dentin collagen. Specimens of demineralized bovine dentin collagen were treated with either 37% or 50% PA for 1 or 5 min. An additional set of specimens was treated with 37% PA for 1 min followed by GD for 1 min. All specimens were washed with distilled water, lyophilized. reduced with standardized NaB3H4, hydrolyzed with 6 M HCl and subjected to amino acid and cross-link analyses. The results demonstrated that the treatment of demineralized dentin with PA under the conditions tested did not significantly alter the collagen cross-links. The GD-treated samples showed reduction of free lysine (Lys) and hydroxylysine (Hyl) residues, as well as a decrease in the levels of collagen reducible cross-links. In addition, unidentified reducible compounds were detected by high-performance liquid chromatography (HPLC) analysis. These compounds may be derived from cross-links formed between GD-derived aldehyde and Lys/Hyl of collagen. The findings indicate that PA treatment does not significantly affect dentin collagen amino acid and cross-link composition, and that GD treatment affects dentin collagen amino acid and cross-link composition.

Dentin bond strengths as a function of solvent and glutaraldehyde content.

PURPOSE: To evaluate the effect of the inclusion of glutaraldehyde on the shear bond strength of new ethanol-based adhesives (Gluma Comfort Bond & Desensitizer, GCBD and Gluma Comfort Bond, GCB) versus acetone-based Gluma One Bond (GOB) and a conventional three-step adhesive as a control. MATERIALS AND METHODS: Forty bovine incisors were mounted in acrylic, polished to 600-grit, and randomly assigned to four groups (n=10). Dentin was etched for 15 s using 35% phosphoric acid, rinsed, and lightly dried. After adhesive application and curing, Charisma composite was applied in a #5 gelatin capsule and light-cured. Specimens were loaded in shear using an Instron at 5 mm/min. Shear bond strengths were calculated by dividing failure load by bonded surface area. ANOVA showed a significant difference in means at P< 0.01, so Tukey's test was used for pairwise comparisons. RESULTS: Mean SBS (+/- SD, MPa) were: GOB: 8 (4.4)ab; GCB: 10 (4.4)ab; GCBD: 14 (6)bc; SBMP: 17.7 (6.4)c. Superscript letters indicate Tukey's homogeneous subsets (P< 0.05).

Posterior resin-based composite restorations: clinical recommendations for optimal success.

Resin-based composites are increasingly used for the restoration of defects in posterior teeth. This review describes, illustrates and discusses important clinical aspects of the posterior composite technique. A relatively new stratification concept oriented to the development of functional and anatomic restorations is proposed.

Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique.

PURPOSE: To report the 4-year clinical performance of posterior resin-based composite restorations placed using the total-etch technique. MATERIALS AND METHODS: Over a period of 1 year, 726 restorations (248 molars, 478 premolars; 260 Class I, 466 Class II; 540 replacements, 186 primary decay) were placed on conservative preparations, using the incremental placement technique in a clinical environment. Baseline data were collected, and the restorations were evaluated after 4 years. Z100 and Scotchbond Multi-Purpose (SBMP) (3M Dental Products, St. Paul, Minnesota) were used as the restorative system. The criteria evaluated were color match, marginal adaptation, anatomic form, cavosurface marginal discoloration, axial contour, interproximal contact, secondary caries, postoperative sensitivity, and tooth vitality. RESULTS: At baseline, 24% of the teeth restored presented postoperative sensitivity; 86% of the sensitive teeth were from the replacement group. At 4 years, all teeth were vital to cold test. Eighteen restorations (2.5%) presented clinically detectable marginal fracture. The shade was acceptable in all restorations. Cavosurface marginal discoloration was observed in 47 restorations (6.5% bravo scores). Axial contour, interproximal contact, and marginal adaptation received 100% alfa scores. No secondary caries was diagnosed in any of the teeth examined. None of the examined restorations required replacement. CLINICAL SIGNIFICANCE: Under controlled clinical conditions, posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years. None of the examined restorations required replacement, and there was no clinically detectable wear in any of the restorations. Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations.

Does clinical experience affect occlusal caries diagnosis and sealant recommendation? An in vitro study.

The purpose of this in vitro study was to evaluate the effect of the length of clinical experience on clinician's diagnosing caries and recommending sealants on the occlusal surfaces of permanent/caries free third molars. The third molars involved in this study had been extracted prior to eruption. There were three study groups: dental students, clinicians with five to ten years experience, and clinicians with fifteen to twenty years of practice. Twenty-four percent of the entire sample diagnosed caries. Clinicians with five to ten years of practice diagnosed occlusal caries significantly more than clinicians with fifteen to twenty years of practice, but not significantly differently than senior dental students. Clinicians recommended sealants significantly more than dental students. The most frequent reason for sealant indication was prevention. The results indicate that clinical experience alone does not impart better caries diagnosis and sealant recommendation criteria.

Unique enamel phenotype associated with amelogenin gene (AMELX) codon 41 point mutation.

Different mutations in the amelogenin gene (AMELX) result in the markedly different enamel phenotypes that are collectively known as amelogenesis imperfecta (AI). We hypothesize that unique phenotypes result from specific genetic mutations. The purpose of this study was to characterize the enamel compositional and structural features associated with a specific AMELX mutation in three families with X-linked AI. We performed mutational analysis by amplifying AMELX exons and sequencing the products. Permanent and primary affected (N = 6) and normal (N = 3) teeth were collected and examined by light, scanning, and transmission electron microscopy. Enamel proteins were evaluated by immunolocalization of amelogenin and amino acid analysis. AI-affected individuals all shared a common AMELX point mutation (C to A change at codon 41). The dental phenotypic findings were remarkably consistent in all affected individuals. The AI enamel was opaque, with numerous prism defects or holes encompassing the entire prism width. Affected crystallites appeared more radiolucent and morphologically less uniform, compared with that of normal enamel. Immunogold labeling with anti-amelogenin antibodies localized amelogenin to the crystallites but not to the inter-crystalline spaces. No immunogold labeling was seen in normal enamel. There was an increased and amelogenin-like protein content in AI enamel (0.95%) compared with normal enamel (0.13%). We conclude that this codon 41 C to A missense point mutation, in a highly conserved region of the AMELX gene, results in a remarkably consistent phenotype.

Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite.

STATEMENT OF PROBLEM: Veneer preparations are considered to weaken endodontically treated maxillary incisors. Prefabricated posts have been controversially indicated to reinforce endodontically treated teeth before final restoration. PURPOSE: This in vitro study evaluated whether (1) veneer preparation in enamel or in enamel/dentin weakens endodontically treated maxillary incisors, (2) bonding of direct composite veneer restores the original strength of the unprepared teeth, and (3) use of prefabricated metal posts increases fracture resistance of prepared and restored teeth. MATERIAL AND METHODS: Ninety extracted human maxillary central incisors were submitted to conventional root canal treatment. Specimens were randomly divided into 8 experimental groups (veneer preparation in enamel or dentin with/without post and with/without direct composite veneer restoration) and a control group (n = 10). Specimens were loaded to fracture, and the data were analyzed statistically. RESULTS: Statistical analysis revealed that a conservative veneer preparation does not significantly reduce maxillary incisors' fracture resistance. For prepared incisors, bonding of direct composite veneer restored their original strength, and the use of posts did not increase their fracture resistance. CONCLUSION: Conservative veneer preparations involving enamel and enamel/dentin did not significantly reduce the fracture resistance of endodontically treated maxillary incisors. In addition, restoration of the intraenamel preparations with direct composite resulted in teeth more resistant to fracture than teeth having restorations in dentin. The use of posts did not improve fracture resistance of endodontically treated maxillary incisors reduced and veneered with direct composite.

Shear bond strengths of one-bottle adhesives to oil-contaminated enamel.

PURPOSE: To evaluate resin bond strength to enamel contaminated with handpiece oil. MATERIALS AND METHODS: Bovine teeth were randomly assigned to six groups of 20 teeth each for treatment with one of six different bonding systems (five one-bottle and one multibottle). For each system, 10 enamel specimens were contaminated with handpiece oil before acid-etching and 10 were contaminated after acid-etching. The enamel was etched for 15 seconds using 35% phosphoric acid. Following adhesive application, composite resin was bonded using a gelatin capsule technique. Shear bond strengths from the two contaminated groups were compared to bond strengths to uncontaminated enamel obtained from a previous study that was performed by the same group of investigators, using the same facility, materials, and methods. RESULTS: Two-way analysis of variance (ANOVA) showed that the factor "surface contamination" did not have a significant effect on bond strength (p > .542). The type of adhesive and the interaction of adhesive and surface contamination were significant (p < .0001 and p < .003, respectively). When oil was applied before etching, mean bond strengths ranged from 18.0 +/- 4.8 MPa for OptiBond SOLO (Kerr Corp., Orange, California) to 25.3 +/- 5.6 MPa for Tenure Quik with Fluoride (Den-Mat Corp., Santa Maria, California). With oil applied after etching, bond strengths ranged from 18.4 +/- 8.0 MPa for Tenure Quik with Fluoride to 27.4 +/- 5.4 MPa for Single Bond (3M Dental Products, St. Paul, Minnesota). For the same adhesive, comparing uncontaminated and "oil-before-etch" contaminated groups, the only statistically significant difference in bond strengths was for OptiBond SOLO: 21.8 +/- 4.0 MPa (uncontaminated) versus 18.0 +/- 4.8 MPa (oil before etch). Comparing uncontaminated and "oil-after-etch" groups, the only statistically significant difference was for Tenure: 24.5 +/- 5.7 MPa (uncontaminated) and 18.4 +/- 8.0 MPa (oil after etch).

Effects of different re-wetting techniques on dentin shear bond strengths.

PURPOSE: For contemporary hydrophilic resin adhesive systems, bonding to dentin is improved if the substrate is maintained in a hydrated state following acid-etching. The purpose of this study was to compare the dentin shear bond strengths of two single-bottle adhesives (one acetone-based and one ethanol-based) applied under different etched-dentin conditions: dry, wet, or dry and re-wetted with different solutions. MATERIALS AND METHODS: Bovine incisors (N = 120) were mounted in acrylic, polished to 600-grit, and randomly assigned to 12 groups (n = 10). Dentin was etched for 15 seconds using 35% phosphoric acid, rinsed, and either blot-dried, air-dried, or air-dried and re-wetted with different solutions (distilled water, Gluma Desensitizer, Aqua-Prep, and 5% glutaraldehyde in water). Two adhesives (Single Bond and Prime & Bond NT) were applied to each of the surface conditions following manufacturers' instructions. After adhesive application and curing, composite was applied in a No. 5 gelatin capsule and light-cured. Specimens were loaded in shear, using an Instron at 5 mm per minute. Shear bond strengths were calculated by dividing the failure load by the bonded surface area. Data were subjected to analysis of variance (ANOVA) and a post hoc Tukey test. RESULTS: Mean shear bond strengths ranged from 12.5 to 26.6 MPa for Single Bond and from 5.6 to 14.7 MPa for Prime & Bond NT. Significant differences were found in both groups of materials (p < .001). The three highest mean bond strengths were obtained (in order) on dentin that was re-wetted with Gluma Desensitizer, re-wetted with Aqua-Prep, or never dried. Differences between these surface conditions were not statistically significant for either material.

Teaching of posterior resin-based composite restorations in Brazilian dental schools.

OBJECTIVE: The purpose of this study was to evaluate the teaching program of Class I and Class II resin-based composite (RBC) restorations in Brazilian dental schools and to observe if any differences were found from similar surveys conducted in North American, European, and Japanese dental schools. METHOD AND MATERIALS: A questionnaire containing 15 questions was distributed to 92 Brazilian dental schools, and 64 (70%) schools returned the questionnaire. The questions inquired the amount of time the curriculum dedicated to teaching of posterior RBC restorations, future expectation regarding the teaching time, limitation in extension of the occlusal width and the proximal box in Class II, contraindications for placing posterior RBC restorations, protocol for using bases and liners, brand of bonding agents and RBC used, instruments and techniques employed for finishing, cost relative to amalgam restorations, and biologic reactions related to the use of posterior RBC. The responses were calculated as percentages based on the number of schools that responded to the questionnaire. Where appropriate, the Chi-squared test and the Fisher exact test were used for statistical analysis. RESULTS: Of the dental schools that responded, 88% dedicated 10% to 50% of the teaching time in operative dentistry to posterior RBC restorations. A significant correlation (P = 0.041) was found between the percentage of time dedicated to the teaching of posterior RBC restorations and the higher cost of posterior RBC compared to amalgam restorations. Resin-based composite restorations cost 30% to 70% more than amalgam restorations in the 40% of dental schools that charged a fee. Posterior composites for large restorations in molars were used by 14% of the dental schools. Base and liner were not placed by 10% of dental schools in deep Class I or Class II RBC restorations. One school did not recommend acid etching of the dentin. CONCLUSION: No major differences were found in the teaching philosophy of posterior RBC restorations by comparing the Brazilian data to the data from similar surveys done in North America, Japan, and Europe.