Glass-ionomer and calcium silicate-based cements interactions with human dentine in health and disease: Two-photon fluorescence microscopy and Raman spectroscopy analysis.

OBJECTIVES: To investigate the potential mineralising effects of calcium silicate-based dentine replacement material (Biodentine™) in comparison with glass-ionomer cement (GIC) (Fuji IX™) on different human dentine substrates using a multimodal non-invasive optical assessment. METHODS: Cements were applied on artificially demineralised or naturally carious dentine and stored for 4 weeks in phosphate-rich media +/- tetracycline used for mineralisation labelling. Interfacial dentine was examined from the same sample and location before and after aging using two-photon fluorescence microscopy, fluorescence lifetime imaging (FLIM) and second harmonic generation (SHG) imaging. Additionally, Raman spectroscopy was used to detect changes in the mineral content of dentine. RESULTS: Significant changes in the fluorescence intensity and lifetime were detected in partially demineralised dentine and caries-affected dentine underneath both tested cements, after storage (p < 0.001). This was associated with a significant increase in the mineral content as indicated by the increased intensity of the phosphate Raman peak located at 959 cm-1 (p < 0.0001). Caries-infected dentine showed significant fluorescence changes under Biodentine™ after storage (p < 0.001), but not under GIC (p = 0.44). Tetracycline binding induced a reduction in the fluorescence lifetime with comparable increase in the fluorescence intensity in both cements' groups within the affected dentine (p < 0.001). Significance Two-photon fluorescence microscopy can be used efficiently for non-destructive in-vitro dentine caries characterisation providing a technique for studying the same dentine-cement interface over time and detect changes. Biodentine™ demonstrated comparable remineralising potential to GIC, in addition to inducing remineralisation of caries-infected dentine. This may suggest using Biodentine™ as part of minimally invasive operative dentistry (MID) in caries management.

Chitosan-bioglass complexes promote subsurface remineralisation of incipient human carious enamel lesions.

OBJECTIVES: To test the in vitro subsurface remineralisation efficacy of chitosan-bioglass complex on artificial white spot lesions. METHODS: 64 artificial enamel white spot lesions were created by acidic gel and equally separated for static and 7d pH-cycling models. In each model, samples were assigned to 4 groups: (1) bioglass application on chitosan pre-treated lesions (CB); (2) chitosan-bioglass slurry (CBS); (3) "standard" remineralisation solution (RS - positive control); (4) deionised water (NC - negative control). Before each treatment using remineralising agents, 3-minute pellicle was formed on lesions' surfaces. Mineral content changes, surface and subsurface microhardness and ultrastructure were evaluated by Raman intensity mapping, Knoop microhardness and scanning electron microscopy, respectively. Data were statistically analysed using one-way ANOVA with Tukey's test (p < 0.05 is considered as significant). RESULTS: Chitosan-bioglass complexing was found to exhibit greater mineral regain and recovery of surface and subsurface microhardness compared to "standard" remineralisation solution and control groups, after static and dynamic pH-cycling remineralisation for 7 days (p < 0.05). Specifically, dense precipitations with Ca/P ratios similar to that in pure hydroxyapatite (HA) were observed on surfaces and subsurfaces which filled the porosities in the dynamic pH-cycling group, leaving no prismatic enamel structure exposed. CONCLUSIONS: Chitosan-bioglass complex is positive in promoting subsurface mineral deposition in spite of the presence of a short-term salivary pellicle. Clinical significance chitosan-bioglass complexing may provide an alternative clinical strategy in remineralising early enamel carious lesions as well as desensitizing exposed porous vital dental tissues clinically.

Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial-2-year results.

OBJECTIVES: Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations. MATERIALS AND METHODS: Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24. RESULTS: At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations. CONCLUSIONS: Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria. CLINICAL SIGNIFICANCE: Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years. TRIAL REGISTRATION: NCT02201641.

In-vitro subsurface remineralisation of artificial enamel white spot lesions pre-treated with chitosan.

OBJECTIVE: To test the null hypothesis that chitosan application has no impact on the remineralisation of artificial incipient enamel white spot lesions (WSLs). METHODS: 66 artificial enamel WSLs were assigned to 6 experimental groups (n=11): (1) bioactive glass slurry, (2) bioactive glass containing polyacrylic acid (BG+PAA) slurry, (3) chitosan pre-treated WSLs with BG slurry (CS-BG), (4) chitosan pre-treated WSLs with BG+PAA slurry (CS-BG+PAA), (5) remineralisation solution (RS) and (6) de-ionised water (negative control, NC). Surface and cross-sectional Raman intensity mapping (960cm-1) were performed on 5 samples/group to assess mineral content. Raman spectroscopy and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) were used to identify the type of newly formed minerals. Surface and cross-sectional Knoop microhardness were implemented to evaluate the mechanical properties after remineralisation. Surface morphologies and Ca/P ratio were observed using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX). Data were statistically analysed using one-way ANOVA with Tukey's test. RESULTS: BG+PAA, CS-BG, RS presented significantly higher mineral regain compared to NC on lesion surfaces, while CS-BG+PAA had higher subsurface mineral content. Newly mineralised crystals consist of type-B hydroxycarbonate apatite. CS-BG+PAA showed the greatest hardness recovery, followed by CS-BG, both significantly higher than other groups. SEM observations showed altered surface morphologies in all experimental groups except NC post-treatment. EDX suggested a higher content of carbon, oxygen and silicon in the precipitations in CS-BG+PAA group. There was no significant difference between each group in terms of Ca/P ratio. SIGNIFICANCE: The null hypothesis was rejected. Chitosan pre-treatment enhanced WSL remineralisation with either BG only or with BG-PAA complexes. A further investigation using dynamic remineralisation/demineralisation system is required with regards to clinical application.

Remineralisation of enamel white spot lesions pre-treated with chitosan in the presence of salivary pellicle.

OBJECTIVE: To investigate the remineralisation of chitosan pre-treated enamel white spot lesions (WSLs) by bioglass in the presence of the pellicle layer. METHODS: 50 artificial enamel white spot lesions were created by acidic gel. Two lesions were used to investigate the formation of the pellicle layer by treating with human whole saliva for 3 min. 48 lesions were assigned to 6 experimental groups (n = 8): (1) bioactive glass slurry, (2) bioactive glass containing polyacrylic acid (BG + PAA) slurry, (3) chitosan pre-treated WSLs with BG slurry (CS-BG), (4) chitosan pre-treated WSLs with BG + PAA slurry (CS-BG + PAA), (5) "standard" remineralisation solution (RS) and (6) de-ionised water (negative control, NC). Remineralisation was carried out using a pH-cycling model for 7 days. Before each treatment using remineralising agents, 3-min pellicle was formed on lesions' surfaces. Mineral content changes, surface and subsurface microhardness and ultrastructure were evaluated by Raman intensity mapping, Knoop microhardness and scanning electron microscopy, respectively. Data were statistically analysed using one-way ANOVA with Tukey's test (p < 0.05 is considered as significant). RESULTS: Despite the heterogeneously formed pellicle layer, all groups showed an increase in surface mineral content after pH-cycling. Chitosan pre-treatment enhanced the subsurface remineralisation of WSLs using bioglass as both pre-treated groups showed greater surface and subsurface microhardness compared to NC. CS-BG exhibited denser subsurface structure than BG, while in CS-BG + PAA the crystals were bigger in size but resemble more enamel-like compared to BG + PAA as shown in SEM observations. Remineralisation of RS was limited to the surface as no significant subsurface changes of mechanical properties and structure were found. CONCLUSIONS: Chitosan pre-treatment can enhance WSL remineralisation with bioglass biomaterials when a short-term salivary pellicle is present. A further investigation using a long-term pH-cycling model with mature pellicle is suggested with regards to clinical application. CLINICAL SIGNIFICANCE: Chitosan pre-treatment has the potential in clinical application to remineralise subsurface lesions to achieve lesion consolidation.

An in vitro investigation of pre-treatment effects before fissure sealing.

BACKGROUND: Fissure sealants prevent occlusal caries in permanent molars. Enamel preparation methods are used before fissure sealing. AIMS: To investigate effects of bioglass air-abrasion pre-treatment with and without an adhesive, on fissure enamel of permanent teeth, with respect to etchability, microleakage and microtensile bond strength. DESIGN: Half of the occlusal surfaces of 50 extracted premolars underwent bioglass air-abrasion. Dye was applied to the entire occlusal surface. Photographs were taken to score etched surface by dye uptake. Adhesive was applied to 25 of the bioglass-treated areas and all teeth were fissure sealed, sectioned, and evaluated using confocal microscopy. Buccal and lingual surfaces of a further eight premolars were acid-etched and randomly received: air-abrasion, adhesive, both, or none before sealant application for microtensile bond strength measurement in half of the samples immediately and half following 6 months of water immersion. RESULTS: Linear mixed models and multinomial logistic regression were used (P = 0.05). Bioglass air-abrasion significantly improved enamel etchability and reduced microleakage. The addition of an adhesive made no difference to either microleakage or microtensile bond strength. The combination of bioglass abrasion and adhesive led to more cohesive, rather than adhesive, failure. CONCLUSIONS: Bioglass air-abrasion improved enamel etchability and reduced microleakage irrespective of the adhesive use but neither pre-treatment affected the microtensile bond strength.

Root dentine and endodontic instrumentation: cutting edge microscopic imaging.

Cutting of the dental hard tissues is an integral part of restorative dentistry. Cutting of the root dentine is also needed in preparation prior to endodontic treatment, with significant commercial investment for the development of flexible cutting instruments based around nickel titanium (NiTi) alloys. This paper describes the evolution of endodontic cutting instruments, both in materials used, e.g. the transition from stainless steel to NiTi, and the design of the actual instruments themselves and their method of activation-by hand or motor driven. We have been examining tooth-cutting interactions microscopically for over 25 years using a variety of microscopic techniques; in particular, video-rate confocal microscopy. This has given a unique insight into how many of the procedures that we take for granted are achieved in clinical practice, by showing microscopic video images of the cutting as it occurs within the tooth. This technology has now been extended to allow imaging of the endodontic instrument and the root canal wall for the first time. We are able to image dentine distortion and crack propagation during endodontic filing of the root canal space. We are also able to visualize the often claimed, but seldom seen action of contemporary endodontic instruments.

Influence of phosphoproteins' biomimetic analogs on remineralization of mineral-depleted resin-dentin interfaces created with ion-releasing resin-based systems.

OBJECTIVE: The study aimed at evaluating the remineralization of acid-etched dentin pre-treated with primers containing biomimetic analogs and bonded using an ion-releasing light-curable resin-based material. METHODS: An experimental etch-and-rinse adhesive system filled with Ca(2+), PO4(3-)-releasing Ca-Silicate micro-fillers was created along with two experimental primers containing biomimetic analogs such as sodium trimetaphosphate (TMP) and/or polyaspartic acid (PLA). Dentin specimens etched with 37% H3PO4 were pre-treated with two different aqueous primers containing the polyanionic biomimetic analogs or deionized water and subsequently bonded using the experimental resin-based materials. The specimens were sectioned and analyzed by AFM/nanoindentation to evaluate changes in the modulus of elasticity (Ei) across the resin-dentin interface at different AS storage periods (up to 90 days). Raman cluster analysis was also performed to evaluate the chemical changes along the interface. The phosphate uptake by the acid-etched dentin was evaluated using the ATR-FTIR. Additional resin-dentin specimens were tested for microtensile bond strength. SEM examination was performed after de-bonding, while confocal laser microscopy was used to evaluate the interfaces ultramorphology and micropermeability. RESULTS: Both biomimetic primers induced phosphate uptake by acid-etched dentin. Specimens created with the ion-releasing resin in combination with the pre-treatment primers containing either PLA and TMA showed the greatest recovery of the Ei of the hybrid layer, with no decrease in µTBS (p>0.05) after 3-month AS storage. The ion-releasing resin applied after use of the biomimetic primers showed the greatest reduction in micropermeability due to mineral precipitation; these results were confirmed using SEM. SIGNIFICANCE: The use of the ion-releasing resin-based system applied to acid-etched dentin pre-treated with biomimetic primers containing analogs of phosphoproteins such as poly-l-aspartic acid and/or sodium trimetaphosphate provides a suitable bonding approach for biomimetic remineralization of resin-dentin interfaces.

An MMP-inhibitor modified adhesive primer enhances bond durability to carious dentin.

OBJECTIVES: To evaluate the effect of adding a matrix metalloproteinase (MMP) inhibitor (BB94, Batimastat) to the primer of a three-step etch and rinse adhesive system on caries-affected dentin (CaD) MMP activity, and to assess the effect of such an inclusion on the chemical content of the CaD-adhesive interface. METHODS: Caries-infected dentin (CiD) was excavated selectively from freshly extracted human carious teeth using a chemo-mechanical agent. Each tooth was sectioned into three slabs through the CaD retained cavity. These were treated with either Optibond FL "OB" (Kerr, Orange, USA) without MMP inhibitor, or with 500 µM BB94 prior to the application of OB primer and bond, or with OB primer that contained 5 µM BB94. In situ zymography and Raman micro-spectroscopy were used to investigate MMP activity and the changes in the chemical content at the CaD/adhesive interface, respectively. RESULTS: Data showed the use of OB adhesive with BB94 resulted in immediate interfacial MMP inhibition, by direct application (93.3%) and by means of a drug delivery system (80%), as demonstrated by in situ zymography. Raman imaging revealed 33% higher resin infiltration into MMP-inhibited adhesive interfaces (SE 3.88). SIGNIFICANCE: Through competitive inhibition by batimastat (BB94), a proportion of the MMPs found in CaD were inhibited immediately and irreversibly. Such a competitive mechanism brings the adhesive primer close to the collagen matrix and enhances the dental adhesive wettability, which is a proposed mechanism to explain the presence of more resin within the hybrid layer.

Penetration depth of monomer systems into acrylic resin denture teeth used as pontics.

STATEMENT OF PROBLEM: The ways of softening and dissolving the surface of acrylic resin denture teeth need to be specified to obtain more durable prosthetic treatments that include resin denture teeth. PURPOSE: The purpose of this study was to analyze the penetration depth of 4 monomer systems applied during different exposure times on the acrylic resin denture teeth used as pontics of directly fabricated fiber-reinforced composite fixed dental prostheses. The penetration depth contributes to the adhesion of the tooth to the adhesive resin. MATERIAL AND METHODS: Ninety-six specimens were divided into 3 groups according to the acrylic resin denture tooth used: Artic 8 (Heraeus Kultzer), experimental tooth (GC), and Vitapan (Vita). Each group was divided into 4 subgroups according to the monomer system used: methylmethacrylate (99%), composite primer, a flowable composite resin, and a photopolymerizing dimethacrylate resin. The 4 monomer systems were labeled with rhodamine B to determine their penetration depth into the acrylic resin denture teeth. After exposure times of 1, 5, 15, and 60 minutes, the monomers were photopolymerized for 5 minutes, with the exception of methylmethacrylate. The specimens were cut orthogonally from gingival to occlusal in 4 slices (n=8/subgroup). The penetration depths of monomers were measured by a confocal scanning type microscope. Differences in the penetration depths were evaluated with ANOVA. RESULTS: ANOVA (R(2)=.699) revealed significant differences in the penetration depths according to the exposure times (P<.001), monomers (P<.001), brands used (P=.047), and their mutual interaction (P<.001). CONCLUSIONS: The ability of monomers to penetrate the surface of acrylic resin denture teeth was influenced by the monomer systems, which might improve the bond between the pontics and the fiber-reinforced composite frameworks of fixed dental prostheses.

Surface pre-conditioning with bioactive glass air-abrasion can enhance enamel white spot lesion remineralization.

OBJECTIVE: To evaluate the effect of pre-conditioning enamel white spot lesion (WSL) surfaces using bioactive glass (BAG) air-abrasion prior to remineralization therapy. METHODS: Ninety human enamel samples with artificial WSLs were assigned to three WSL surface pre-conditioning groups (n=30): (a) air-abrasion with BAG-polyacrylic acid (PAA-BAG) powder, (b) acid-etching using 37% phosphoric acid gel (positive control) and (c) unconditioned (negative control). Each group was further divided into three subgroups according to the following remineralization therapy (n=10): (I) BAG paste (36 wt.% BAG), (II) BAG slurry (100 wt.% BAG) and (III) de-ionized water (negative control). The average surface roughness and the lesion step height compared to intra-specimen sound enamel reference points were analyzed using non-contact profilometry. Optical changes within the lesion subsurface compared to baseline scans were assessed using optical coherence tomography (OCT). Knoop microhardness evaluated the WSLs' mechanical properties. Raman micro-spectroscopy measured the v-(CO3)(2-)/v1-(PO4)(3-) ratio. Structural changes in the lesion were observed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX). All comparisons were considered statistically significant if p<0.05. RESULTS: PAA-BAG air-abrasion removed 5.1 ± 0.6 µm from the lesion surface, increasing the WSL surface roughness. Pre-conditioning WSL surfaces with PAA-BAG air-abrasion reduced subsurface light scattering, increased the Knoop microhardness and the mineral content of the remineralized lesions (p<0.05). SEM-EDX revealed mineral depositions covering the lesion surface. BAG slurry resulted in a superior remineralization outcome, when compared to BAG paste. SIGNIFICANCE: Pre-conditioning WSL surfaces with PAA-BAG air-abrasion modified the lesion surface physically and enhanced remineralization using BAG 45S5 therapy.

Impact of hydrophilicity and length of spacer chains on the bonding of functional monomers.

OBJECTIVES: 10-Methacryloyloxy-decyl-dihydrogen-phosphate (10-MDP) is currently considered as one of the most effective functional monomers for dental bonding, this in part thanks to its long and relatively hydrophobic spacer chain, adequately separating the polymerizable from the phosphate functionalities. This study compared functional monomers with different spacer chains' length and hydrophilicity to 10-MDP on their dentin and enamel bonding performance. METHODS: Atomic absorption spectroscopy (AAS) was used to characterize the chemical interaction. Micro-tensile bond strength (µTBS) and fractographic analyses were performed after 24h and one year. Confocal micro-permeability and SEM nanoleakage assessments were also undertaken. The tested functional monomers were 2-MEP (2-carbon spacer), 10-MDP (10-carbon), 12-MDDP (12-carbon), MTEP (high hydrophilic polyether spacer chain) and CAP-P (intermediate hydrophilic ester spacer). RESULTS: AAS revealed clear differences (p<0.05) in monomer-calcium salt formation in this order: 12-MDDP=10-MDP>CAP-P>MTEP>2-MEP. The highest initial dentin µTBS was obtained using 10-MDP or 12-MDDP. After 1-year aging, a significant drop (p<0.05) in µTBS was observed for the adhesives with MTEP (enamel and dentin), 2-MEP (enamel) and CAP-P (enamel). MTEP presented the highest micro-permeability, while 2-MEP, CAP-P and MTEP showed increased nanoleakage after aging. SIGNIFICANCE: These outcomes showed that more hydrophilic and shorter spacer chains may compromise the chemical interaction with calcium and the dentin/enamel bonding performance.

Polycarboxylated microfillers incorporated into light-curable resin-based dental adhesives evoke remineralization at the mineral-depleted dentin.

This study aimed at evaluating the remineralizing properties of three experimental light-curable resin-based dental adhesives containing tailored polycarboxylated microfillers. A co-monomers blend was firstly formulated and then mixed with each of the following microfillers: polycarboxylated bioactive glass (PBAG), polycarboxylated calcium silicates (PCS), and polycarboxylated calcium silicates-doped brushite (PDP). The three experimental and a filler-free control resins were applied onto 10% orthophosphoric acid treated dentin discs and light cured. The specimens were soaked in artificial saliva (AS) for 3, 7, and 14 days. Dentin mineral variation was monitored using attenuated total reflection-Fourier transform infrared (ATR-FTIR) and Raman spectroscopy. Confocal laser scanning microscopy (CLSM) was employed to observe the ultra-morphology/nanoleakage along the resin-dentin interface. The bonding ability and the durability of the resin-dentin bonds were investigated through microtensile bond strength (µTBS) test. ATR-FTIR and Raman showed a significant increase of the mineral matrix area ratio and phosphate peak intensity in specimens treated with the experimental resins within 14 days (p < 0.05). No significant increment of minerals was found in untreated specimens or specimens treated using the control filler-free resin (p > 0.05). Dentin treated using PBAG or PCS exhibited higher level of remineralization than the specimens in PDP group. CLSM showed reduction in nanoleakage, although the remineralization of the hybrid layer induced a significant drop in the µTBS after 3-month storage (p < 0.05). The experimental resin-based dental adhesives containing bioactive microfillers remineralize the resin-dentin interfaces when in intimate contact with biological fluids.

The role of spacer carbon chain in acidic functional monomers on the physicochemical properties of self-etch dental adhesives.

OBJECTIVES: To evaluate the effects of acidic functional monomers with different hydrophilicity and spacer carbon chain length on the degree of conversion (DC), wettability (contact angle), water sorption (WS) and ultimate tensile strength (UTS) of experimental one-step self-etch adhesives (1-SEAs). METHODS: A series of standard resin blends was prepared with each formulation containing 15mol% of each acidic monomer. The structural variations of the acidic monomers were MEP (spacer chain with 2 carbons), MDP (10-carbons), MDDP (12-carbons), MTEP (more hydrophilic polyether spacer) and CAP-P (intermediate hydrophilicity ester spacer). Dumbbell-shaped and disc specimens were prepared and tested for UTS and WS, respectively. DC was assessed by FTIR, while the wettability of each 1-SEA was evaluated on glass slides and flat dentine surfaces. Results were analysed with one-way ANOVA and Tukey's test (p<0.05). RESULTS: The outcomes showed lower UTS for CAP-P, control blend and MEP than MTEP, MDDP and MDP (p<0.05). The degree of conversion was statistically similar for all resins (p=0.122). On dentine, the wettability was higher (lower contact angle) with the most hydrophilic monomer MTEP. Higher WS was attained using MTEP. Different lengths of the spacer chains did not result in different wettability and WS (p>0.05). CONCLUSION: At similar molar percentage, different acidic functional monomers induced similar degree of conversion and different UTS when included in a 1-SEA. However, the inclusion of highly hydrophilic monomer may increase the wettability on dentine and the WS.

The physical characteristics of resin composite-calcium silicate interface as part of a layered/laminate adhesive restoration.

OBJECTIVES: To compare in-vitro micro-shear bond strengths (µSBS) of resin composite to calcium silicate cement (Biodentine™) vs. glass ionomer cement vs. resin modified glass ionomer cement (RM-GIC) using an adhesive in self-etch (SE)/total etch (TE) mode after aging three substrates and bond and characterizing their failure modes. METHODS: Resin composite was SE/TE bonded to 920 standardized disks of Biodentine™, GIC & RM-GIC. Dividing samples into two groups, the first underwent early (t=0min, 5min, 20min, 24h) or delayed (t=2wk, 1 month, 3 months, 6 months) substrate aging before bonding and µSBS (t=24h) testing. In the second, adhesive was applied after either early (t=5min) or delayed (t=2wk) substrate aging and then tested after bond aging (t=2wk, 1 month, 3 months, 6 months). The failure modes were identified using stereomicroscope. SEM images of selected samples were analyzed. RESULTS: No significant differences were observed between (SE)/(TE) bonding modes (P=0.42). With substrate aging, a significant reduction in µSBS occurred between early and delayed time intervals for Biodentine™ (P=0.001), but none for the GIC/RM-GIC (P=0.465, P=0.512 respectively). With bond aging, there was no significant difference between time intervals for all groups, except at 6 months for the GIC (P<0.05). Modes of failure were primarily cohesive within all the substrates (68.82%) followed by adhesive failure at the resin-substrate interface (21.71%). SIGNIFICANCE: Biodentine™ is a weak restorative material in its early setting phase. Placing the overlying resin composite as part of the laminate/layered definitive restoration is best delayed for >2wk to allow sufficient intrinsic maturation to withstand contraction forces from the resin composite. A total-etch or self-etch adhesive may be used.

Present and future of glass-ionomers and calcium-silicate cements as bioactive materials in dentistry: biophotonics-based interfacial analyses in health and disease.

OBJECTIVE: Since their introduction, calcium silicate cements have primarily found use as endodontic sealers, due to long setting times. While similar in chemistry, recent variations such as constituent proportions, purities and manufacturing processes mandate a critical understanding of service behavior differences of the new coronal restorative material variants. Of particular relevance to minimally invasive philosophies is the potential for ion supply, from initial hydration to mature set in dental cements. They may be capable of supporting repair and remineralization of dentin left after decay and cavity preparation, following the concepts of ion exchange from glass ionomers. METHODS: This paper reviews the underlying chemistry and interactions of glass ionomer and calcium silicate cements, with dental tissues, concentrating on dentin-restoration interface reactions. We additionally demonstrate a new optical technique, based around high resolution deep tissue, two-photon fluorescence and lifetime imaging, which allows monitoring of undisturbed cement-dentin interface samples behavior over time. RESULTS: The local bioactivity of the calcium-silicate based materials has been shown to produce mineralization within the subjacent dentin substrate, extending deep within the tissues. This suggests that the local ion-rich alkaline environment may be more favorable to mineral repair and re-construction, compared with the acidic environs of comparable glass ionomer based materials. SIGNIFICANCE: The advantages of this potential re-mineralization phenomenon for minimally invasive management of carious dentin are self-evident. There is a clear need to improve the bioactivity of restorative dental materials and these calcium silicate cement systems offer exciting possibilities in realizing this goal.

Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders.

OBJECTIVE: To evaluate the potential of bio-active glass (BAG) powder and BAG containing polyacrylic acid (PAA-BAG) to remineralise enamel white spot lesions (WSL). METHODS: 32 human enamel samples with artificial WSLs were assigned to 4 experimental groups (n=8); (a) BAG slurry, (b) PAA-BAG slurry, (c) "standardised" remineralisation solution (positive control) and (d) de-ionised water (negative control). Mechanical properties of enamel were assessed using surface and cross-section Knoop microhardness. Micro-Raman spectroscopy in StreamLine™ scan mode was used to scan lesion cross-sections. The intensity of the Raman phosphate peak at 959 cm(-1) was fitted and measured producing depth profiles analysed using a double-step fitting function. A further 20 samples (n=5) were used to obtain 3D images of surfaces using non-contact white light profilometry permitting measurement of lesion step height in relation to the sound enamel reference level, and to scan the lesion surface using scanning electron microscopy (SEM). Data were analysed statistically using one-way ANOVA with Tukey's HSD post-hoc tests. RESULTS: BAG, PAA-BAG and the remineralisation solution exhibited statistically significantly higher surface and cross-section Knoop microhardness compared to the negative control. Micro-Raman spectroscopy detected significantly higher phosphate content within the treated groups compared to the negative control group. Lesions' depth was not significantly reduced. SEM images revealed mineral depositions, with different sizes and shapes, within BAG, PAA-BAG and the positive control groups. CONCLUSION: BAG and PAA-BAG surface treatments enhance enamel WSL remineralisation, assessed by the resultant improved mechanical properties, higher phosphate content and morphological changes within the artificial lesions.

Dicalcium phosphate (CaHPO4·2H2O) precipitation through ortho- or meta-phosphoric acid-etching: effects on the durability and nanoleakage/ultra-morphology of resin-dentine interfaces.

OBJECTIVES: To compare the effects of two etching procedures using meta-phosphoric (MPA) or ortho-phosphoric acid (OPA) on dentine demineralisation, resin-dentine bonds durability and interface nanoleakage/ultra-morphology. METHODS: Middle-dentine specimens were etched using 37% OPA (15s) or 40% MPA (60s) and submitted to infrared spectroscopy (FTIR) or ultra-morphology dye-assisted (calcium-staining) confocal microscopy (Ca-CLSM). A three-step etch-and-rinse adhesive was formulated, applied onto dentine and light-cured for 30s before composite build-up. After 24h, the dentine-bonded specimens were cut into 1mm(2) beams; half were immediately submitted to microtensile bond strength (µTBS) and half stored in DW for six months. The µTBS results were analysed with repeated-measures ANOVA and Tukey's test (p<0.05). Further teeth were bonded and prepared for interface nanoleakage/ultra-morphology confocal evaluation. RESULTS: FTIR and Ca-CLSM analyses showed dicalcium phosphate dihydrate (Brushite) precipitation in MPA-etched dentine and on the bottom (front of demineralisation) of the OPA-etched dentine. Statistical analysis showed similar µTBS for both etching procedures after 24h. The µTBS of specimens in OPA-group dropped significantly (p<0.05) after six month; the specimens in the MPA group showed no statistically difference (p>0.05). CLSM depicted no evident sign of nanoleakage within the resin-dentine interface of the MPA-treated specimens, while the specimens in OPA-group presented intense nanoleakage and interface degradation. CONCLUSION: The use of MPA (60s) as an alternative dentine conditioning agent in etch-and-rinse bonding procedures may be a suitable strategy to create more durable resin-dentine bonds.

Novel light-curable materials containing experimental bioactive micro-fillers remineralise mineral-depleted bonded-dentine interfaces.

This study aimed at evaluating the therapeutic remineralising effects of innovative light-curable materials (LCMs) containing two experimental calcium silicate-based micro-fillers (TCS) modified with ß-TCP only or ß-TCP, zinc oxide (ZnO)/polyacrylic acid (PAA) on mineral-depleted bonded-dentine interfaces in simulated body fluids (SBFS). Three experimental LCMs were formulated: (1) resin A, containing a ß-TCP-modified TCS (ßTCS) micro-filler; (2) resin B, containing a polycarboxylated ß-TCP/ZnO-modified TCS (ßZn-TCS) micro-filler; and 3) resin C, containing no filler (control). Acid-etched (35% H3PO4) dentine specimens were bonded using the three LCMs and submitted to atomic force microscope (AFM)/nano-indentation analysis to evaluate the modulus of elasticity (Ei) and hardness (Hi) across the interface after SBFS storage (24 h/1 m/3 m). The ultramorphology and micropermeability of the resin-dentine interface were evaluated using confocal laser microscopy. Resin-dentine sticks were created and submitted to microtensile bond strength (µTBS) test (SBFS: 24 h/3 m). Scanning electron microscopy (SEM) was performed after de-bonding. The LCMs containing the experimental bioactive micro-fillers reduced the micropermeability and induced a significant increase of the Ei and Hi along the bonding interface. The specimens created using the resin B (ßZn-TCS) attained the highest µTBS values both after 24 h and 3 m of SBFS storage. In conclusion, the innovative bioactive light-curable materials tested in this study are able to induce a therapeutic remineralising effect on the nano-mechanical properties and on the sealing ability of mineral-depleted resin-dentine interfaces. The contemporary idea of minimally invasive operative treatment, where therapeutic restorations are performed to combat the carious process and remineralise the dental hard tissues, may be satisfied by using such resin-base systems, containing ßTCS or ßZn-TCS bioactive micro-fillers.

An in vitro comparison of the accuracy of measurements obtained from high- and low-resolution cone-beam computed tomography scans.

INTRODUCTION: This study aimed to investigate in an ex vivo model the reduction in patient radiation dose while maintaining accurate linear measurements by comparing cone-beam computed tomography (CBCT) scans taken at 360° versus 180° rotation, with porcine jaw specimens as a reference standard. METHODS: CBCT scans of 12 sectioned porcine hemimandibles at 360° and 180° rotations were taken with standardized clinical exposure parameters. To assess interobserver variability, 6 assessors who were blinded to the degree of rotation took linear measurements of anatomic structures on each scan. The measurements were repeated after 2 weeks to assess intraobserver variability. Accuracy of measurement was judged against the corresponding measurements taken from the porcine jaw specimens. RESULTS: Intraclass correlations signaled good-to-excellent intraobserver and interobserver agreement (0.65-0.98 and 0.79-0.98), respectively. Mixed regression analysis found no significant difference between the measurements from 180° or 360° rotations and no difference between the 2 rotations and porcine jaw specimens. CONCLUSIONS: A CBCT image sufficient to make accurate clinical measurements with a reduced radiation exposure may be obtained by using 180° rotation of the CBCT tube head.