Assessment of a highly-filled flowable composite for the repair of indirect composites.

PURPOSE: To compare the shear-bond-strength (SBS) of a highly-filled-flowable composite (HFFC) and a paste-type composite for indirect composite repair and to evaluate the effect of different surface treatments (ST), concerning the composite repair protocol. METHODS: Eighty-four 5 × 5 × 2 mm cylindrical specimens were prepared using Gradia Plus and SR Nexco indirect composite materials. The samples were thermocycled 5,000 times. According to the ST, the samples were divided into three groups (control, bur, and air-abrasion). After ST, the sample subgroups were divided into two sub-groups according to the repair material: paste-type composite and HFFC (n = 7). Another 5,000 cycles of aging were performed. SBS values were measured with a universal testing machine (Shimadzu, Japan). Shapiro-Wilk, 3-way ANOVA, and Tukey HSD test were used to evaluate data (P < 0.05). RESULTS: ST was considered significant for SBS (P < 0.001). The mean values were (13.9 ± 5.7), (17.0 ± 6.4), (20.4 ± 4.9) MPa for the control, bur and phosphoric acid, and air-abrasion groups, respectively. The surface treatment and repair material interaction was considered significant for SBS (P = 0.044). The highest mean bond strength (24.5 ± 4.5 MPa) was observed for the interaction of SR Nexco, air-abrasion ST, and HFFC repair. CONCLUSION: Repairing with HFFC following air abrasion might enhance the SBS for indirect composite restorations.

Clinical assessment of various imaging systems for dental plaque scoring after the use of 3 different toothpastes.

Purpose: This study was conducted to compare dental plaque scores obtained through clinical examinations and various imaging techniques, as well as to assess the effectiveness of herbal and conventional toothpastes for plaque removal. Material and Methods: Thirty volunteers were divided into 3 groups. Each group was given a different toothpaste (from 2 herbal toothpastes and a conventional toothpaste) with which to brush their teeth for 21 days. Both initially and after brushing, dental plaque samples were collected, and plaque on the buccal surfaces of anterior teeth was scored using several imaging systems after staining with a disclosing agent. Specifically, digital dental photography, intraoral digital scanning, and FluoreCam imaging were employed to capture intraoral images. The Turesky Modified Quigley-Hein Plaque Index was used for clinical examination and image analysis. Quantitative polymerase chain reaction analyses and correlational assessments between clinical examination and imaging scores were conducted before and after toothpaste use. The Shapiro-Wilk test and Pearson correlations were utilized. Results: The lowest mean value was observed in the clinical examination without staining, while the highest was obtained using the FluoreCam method. No significant change was found in the level of any microorganism assessed following toothpaste use (P<0.05), with the exception of a decrease in S. mutans levels after using conventional toothpaste (P<0.05). Conclusion: Herbal toothpaste demonstrated plaque-removal effectiveness comparable to that of conventional toothpaste. The use of imaging methods for measuring plaque index has been suggested as a means to educate patients about plaque control and promote ongoing oral care.

Metagenomic analysis of black-stained plaques in permanent dentition.

OBJECTIVES: We aimed to determine the aetiologic agent responsible for black staining of permanent dentition using next-generation sequencing and determine the relationship between caries and black stains. MATERIALS AND METHODS: A total of 52 systemically healthy patients with black-stained and caries-free (n = 13), black-stained and carious (n = 13), black stain-free and caries-free (n = 13), and black stain-free and carious (n = 13) teeth were enrolled in the study. The International Caries Detection and Assessment System (ICDAS II) was used for caries classification. Between 08:00 and 10:00, supragingival plaque samples were collected after a minimum of 8-12 h of accumulation and DNA samples were isolated. The samples were processed using the ZymoBIOMICS™ Service. Bioinformatics analysis was performed using mothur at usegalaxy.org. Data were analysed statistically using the Pearson chi-square and Fisher tests. RESULTS: The number of caries-free teeth (ICDAS 0, 1, and 2) was significantly higher in patients with black stains (p = 0.007).Capnocytophaga (4.8 %), Corynebacterium (3.9 %), and Neisseria (5.4 %) species were the most abundant among all black-stained plaques (carious and caries-free) (p < 0.05). Capnocytophaga (10.8 %), Cardiobacterium (3.6 %), and Rothia (1.72 %) species were detected in the black-stained plaques of caries-free patients (p < 0.05). CONCLUSION: This study is one of the first studies examining the microbial composition of dental plaques with black staining in carious and caries-free adult patients using next generation sequencing technology. In the presence of black staining, plaques have an ultimate complex microbial structure. A lower caries burden was noted in the presence of black staining.

Clinical Quantitative Evaluation of Tooth Wear: A 4-year Longitudinal Study.

PURPOSE: This study investigated the progression of incisal tooth wear clinically for 4-years, using various diagnostic methods. Effectiveness of occlusal splints (night guards) for patients with nocturnal bruxism was also evaluated. MATERIALS AND METHODS: Forty maxillary incisors from 10 patients with nocturnal bruxism were selected. Group 1 (n=5) wore occlusal splints for 6 months, whereas group 2 (n=5) didn't. Ultrasound, cast-model analysis (control), digital radiography, FluoreCam and colorimeter were used for measurements. Clinical progression of incisal wear monitored at baseline, 3, 6, 12, 24 and 48 months, respectively. RESULTS: Ultrasound, cast-model analysis and FluoreCam readings gradually and statistically significantly decreased during the overall evaluation period for both groups (p<0.001). Regarding colorimeter, statistically significant differences in periodical measurements were observed from 24 months and 12 months, for group 1 and group 2, respectively (p<0.001). There were no statistically significant differences in readings at evaluation periods, between the groups, for ultrasound, digital radiography and cast-model analysis (p≥0.05); however, statistically significant differences were observed for colorimeter at 24 months (p=0.010) and 48 months (p<0.001), and for FluoreCam at 12, 24, 48 months (p<0.001). Annual decrease in mean crown length was determined as 20-30 µm for group 1 and 40-50 µm for group 2. The decreases in mean crown length were statistically significantly lower for group 1 compared to group 2, regarding the assessments for 1 year, 2 years and 4 years (p<0.001). Positive and good correlations were observed between ultrasound, cast-model analysis and FluoreCam measurements (p<0.001). CONCLUSIONS: Ultrasound, FluoreCam and colorimeter showed promising results for monitoring any change and progression of incisal tooth wear clinically. Ultrasound might be considered as a quantitative, reliable and repeatable method. Precision of the measurements varied among the diagnostic methods used. Occlusal splints may have a potential preventive effect for progressive tooth wear.

Diagnostic Performance of ICDAS II, FluoreCam and Ultrasound for Flat Surface Caries with Different Depths.

The use of ultrasound for the diagnosis of natural caries lesions with different depths on flat surfaces of permanent molar teeth was studied. A total of 200 freshly extracted permanent molar teeth with natural caries lesions were included. After evaluation with International Caries and Detection Assessment System II (ICDAS II), mineral loss and lesions in the teeth were detected with a fluorescence device, FluoreCam and lesion depths were measured using ultrasound. The teeth were sectioned and examined histologically using a microscope. The intraclass correlation coefficient was 0.97 for the ultrasound system, 0.65 for the ICDAS II classification and 0.59 for FluoreCam (p < 0.001 for all). With an increase in ICDAS II scores, mean ultrasound values, FluoreCam-Size and microscope measurements increased numerically, while FluoreCam-Intensity and FluoreCam-Impact measurements inversely decreased (p < 0.001). There was a high level of agreement between histologic diagnosis and ultrasound. Ultrasound and FluoreCam can be used to detect enamel caries on flat surfaces.

Clinical assessment of demineralization and remineralization surrounding orthodontic brackets with FluoreCam

Objective:To determine quantitatively the amount of demineralization and the ability of commercially available products and an experimental cream to inhibit or reverse orthodontic related demineralization.Methods:A total of 20 patients who were 25-35 years old and having orthodontic treatment for 6-8 months were chosen.Caries risk assessments were done for each patient and ones with moderate risk were included.Patients with fixed orthodontic appliances were divided into 4 groups (5 patients each) including one control and 3 study groups.All patients used same toothpaste 2 times a day during the 3 weeks study period.Additional to the toothpaste first study group used MI Paste Plus (GC,Tokyo,Japan),second study group used Remin Pro (Voco,Cuxhaven,Germany) and third group used an experimental rcmineralizing cream per day for 3 weeks.Maxillary central and lateral incisors of each patient were examined by FluoreCam (Daraza Therametric Technologies,USA) device.The examinations were performed at baseline and at the end of 1 st,2nd and 3rd weeks.Results:According to the FluoreCam measurements the control group showed significant amount of demineralization at the end of 3 weeks,moreover the amount of demineralization has gradually increased in time.At the end of the study all 3 study groups showed significant amount of remineralization and the amount of remineralization for all the 3 study groups has gradually increased in time.However the amount of remineralization for 3rd study group was lesser than the 1 st and 2nd study groups.The remineralization amounts for the 1 st and 2nd study groups were determined to be identical.Conclusions:This study demonstrated that demineralization is measurable around orthodontic brackets and the demineralization can be completely inhibited and/or reversed by the use of commercially available remineralization products.

Direct Midline Diastema Closure with Composite Layering Technique: A One-Year Follow-Up.

Objective. Maxillary anterior spacing is a common aesthetic complaint of patients. Midline diastema has a multifactorial etiology such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Appropriate technique and material for effective treatment are based on time, physical, psychological, and economical limitations. Direct composite resins in diastema cases allow dentist and patient complete control of these limitations and formation of natural smile. Clinical Considerations. In this case report a maxillary midline diastema was closed with direct composite resin restorations in one appointment without any preparation. One bottle total etch adhesive was used and translucent/opaque composite resin shades were layered on mesial surfaces of the teeth that were isolated with rubber dam and Teflon bands. Finishing and polishing procedures were achieved by using polishing discs. Patient was informed for recalls for every 6 months. Conclusions. At one-year recall no sensitivities, discolorations, or fractures were detected on teeth and restorations. Direct composite resins seemed to be highly aesthetic and durable restorations that can satisfy patients as under the conditions of case presented.

Direct composite laminate veneers: three case reports.

Re-establishing a patient's lost dental esthetic appearance is one of the most important topics for contemporary dentistry. New treatment materials and methods have been coming on the scene, day by day, in order to achieve such an aim. Most dentists prefer more conservative and aesthetic approaches, such as direct and indirect laminate veneer restorations, instead of full-ceramic crowns for anteriors where aesthetics is really important. Laminate veneers are restorations which are envisioned to correct existing abnormalities, esthetic deficiencies and discolo-rations. Laminate veneer restorations may be processed in two different ways: direct or indirect. Direct laminate veneers have no need to be prepared in the laboratory and are based on the principle of application of a composite material directly to the prepared tooth surface in the dental clinic. Indirect laminate veneers may be produced from composite materials or ceramics, which are cemented to the tooth with an adhesive resin. In this case report, direct composite laminate veneer technique used for three patients with esthetic problems related to fractures, discolorations and an old prolapsed restoration, is described and six-month follow-ups are discussed. As a conclusion, direct laminate veneer restorations may be a treatment option for patients with the esthetic problems of anterior teeth in cases similar to those reported here.

Clinical evaluation of demineralization and remineralization of intact root surface lesions in the clinic by a quantitative light-induced fluorescence system.

Detection of demineralization of root surface caries is an important issue since preventive approaches prolong tooth life. Quantitative light-induced fluorescence (QLF) has been shown to be useful for the laboratory assessment of demineralization of root surfaces. The aim of this study was to determine the demineralization and remineralization of root surface intact and cavitated caries lesions using a QLF system as a nondestructive in vivo method. Noncavitated and demineralized root surface lesions were detected and scored using the QLF system. Oral hygiene education was given and periodontal cleaning was completed before the remineralization treatment. After obtaining baseline QLF data, the patients were informed about the remineralization treatment. Fluoride varnish was applied to the carious lesions at the baseline visit, and the patients were then reviewed after 1, 2, 3 and 4 weeks, with QLF assessment and fluoride varnish application repeated at each review. Repeated-measures ANOVA (α = 0.05) showed significant differences between ΔQ values at each visit (p < 0.001); ΔQ showed marked decreases at all the cut-off values (15, 20, 25, 30). The changes in ΔQ were not affected by the cut-off value. The ΔQ values of QLF showed differences at all visits. The QLF system was able to detect early root surface caries lesions in vivo. Bifluoride 12 varnish improved mineral levels as shown by the QLF system. The treatment response to chemicals of intact noncavitated root surface carious lesions could be followed nondestructively in the clinic using QLF to quantify remineralization at recall visits. Teeth with root surface caries can be kept by controlling their remineralization.

Clinical evaluation of a gingiva-coloured material, Comp Natur: a 3-year longitudinal study.

OBJECTIVE: To report on a three-year clinical evaluation of the gingiva-coloured compomer (Comp Natur, Voco, Germany). METHODS: Twelve patients with cervical lesions as a result of either gingival recession or worn root dentine were included in this study. In total, 106 restorations were evaluated by two examiners at baseline, 6-month and 3-year recalls. RESULTS: Ninety-nine restorations (99/106, 93.4%) were reported with having a good retention in the oral cavity at the 3-year recall. Ninety-two of the 99 restorations were evaluated as excellent for colour match. Marginal discoloration was slightly higher at the 3-year recall, while surface texture and anatomic form were significant. Marginal adaptation was not statistically important at the 3-year recall. There was no problem related to caries and postoperative sensitivity. CONCLUSION: Comp Natur is an acceptable treatment choice for cervical defects with recessed gingiva.

Caries detection with DIAGNOdent and ultrasound.

OBJECTIVE: The objective of this study was to evaluate the repeatability of 2 nondestructive caries detection methods, ultrasound (ULS) and DIAGNOdent, for the detection of approximal caries lesions, and to evaluate 2 tips provided for the DIAGNOdent. STUDY DESIGN: White/brown-spot lesions (n = 42) were captured by a digital camera, and measured by test methods and confocal laser scanning microscope (CLSM). Intra- and inter-observer reliability, accuracy, and Cohen's kappa and Spearman's rho statistics were used. RESULTS: At DIAGNOdent, intra-observer agreements were 78.5%, 66.7% for A tip and 59.5%, 47.6% for B for 2 examiners, respectively. Accuracy of both tips was 50% for the first examiner; 45.3% for A and 47.6% for the B tip for the second examiner. All ULS measurements were accurate, reliable, and positively and significantly correlated between examiners. CONCLUSION: The A tip of the DIAGNOdent was found to be better than the B tip for the detection of enamel caries. All DIAGNOdent and ULS measurements were positive and significantly correlated for both examiners. Both methods demonstrated high repeatability and accuracy.

Accuracy of ultrasound measurement of progressive change in occlusal enamel thickness.

OBJECTIVE: To evaluate the effectiveness of ultrasound on measuring the thickness of enamel in abrasion. STUDY DESIGN: Flat areas on occlusal surfaces of 20 premolar teeth were marked. Two initial ultrasonic measurements on marked areas were obtained by the first researcher. Then the tooth was measured in the axial direction with a compass. The cusp tips were abraded by an abrasive paper, then the second and third ultrasonic measurements were taken. The second researcher repeated the third ultrasonic measurement to evaluate the interobserver variation. All specimens were sectioned and the remaining enamel thickness was measured under polarized light microscope. RESULTS: Pearson's correlation analysis showed a high level of intraobserver agreement for the ultrasonic measurements of the first researcher (r = .891, P < .000 initial; r = .690, P < .001 first abrasion; r = .885, P < .000 second abrasion). Third ultrasonic measurements of the first and second researchers were positively and significantly correlated with histological readings (r = .966, P < .000; r = .466, P = .039). CONCLUSIONS: The ultrasonic system used in this study was reliable in measuring enamel thickness.

Selected characteristics of an Ormocer and a conventional hybrid resin composite.

OBJECTIVES: The objective of this in vitro study was to evaluate surface roughness, hardness and wear resistance of an Ormocer (Admira), polymerized by a plasma arc system. A secondary objective was to investigate two placement technique bulk or incremental layers. METHODS: Blocks from Admira and Amelogen (a microhybrid composite) were prepared in cylinders, 3 mm in diameter, and 2 and 5 mm in thickness (bulk or incrementally placed) and polymerized by a plasma arc and a conventional light system. Surface roughness measurements were taken by a Surface Profilometer on the top of the specimens. Vickers hardness measurements, with a load of 600mN were taken on the top and bottom of 2 mm and top, intermediate and bottom of 5 mm thick specimens. For the wear test, specimes (8 mm in diameter and 2 mm in thickness) of Admira, Amelogen and amalgam were tested in a ball-on design, by circular movements of the antagonist (alumina ball; diameter 10 mm) under 10 N load. For the statistical evaluation of the results of surface roughness, microhardness and wear test; a paired samples t-test and Kruskal-Wallis analysis of variance test, were performed. RESULTS: Admira showed highest hardness values in all polymerization types at the top surface and this was statistically significant (p < 0.05). These highest hardness values were obtained with conventional polymerization (81.84 +/- 1.167 VHN). Meanwhile, the wear resistance of Admira was found to be higher than Amelogen (Wd(admira) = 0.024 +/- 0.00149 mm3; Wd(amelogen) = 0.032 +/- 0.00075 mm3). However, Admira demonstrated the highest surface roughness value compared to Amelogen, with plasma arc 5 s (0.65 +/- 0.023 microm). Amelogen was found to have the lowest surface roughness value with conventional 40 s (0.45 +/- 0.012 microm). SIGNIFICANCE: The results indicated that Ormocer, which was developed by Ormocer technology, demonstrated higher microhardness and wear resistance when compared to a hybrid composite; however, the polishability of Ormocer needs further investigation. Also the selection of visible light activated composite resins exhibited higher surface microhardness values when polymerized with conventional rather than with plasma arc.