Oral cancer screening outcomes in the Latin American region with special relevance to Brazil and Cuba: a systematic review.

BACKGROUND:  The Latin American region represents a hotspot for oral cancer incidence and mortality. To reduce oral cancer mortality rates, screening for early detection of subjects with suspicious or innocuous oral lesions has been promoted. A systematic review was performed to assess the outcomes of oral cancer screening in the Latin American region. MATERIAL AND METHODS:  An electronic search was conducted in eight databases and grey literature. The eligibility criteria included screening where adult participants underwent any screening test during an organized screening program. Screening programs were assessed to understand trends in oral cancer diagnosis. Rates of oral cancers diagnosed in screening programs were classified as increase, decrease, or stable based on each year assessed. RESULTS:  Following our searches, twelve studies conducted in Brazil and Cuba were included. The screening tests reported were visual oral examination (VOE) and in one study in addition light-based fluorescence testing. 13,277,608 individuals were screened and a total of 1,516 oral cancers were detected (0.01%). Only two studies aimed to screen high-risk individuals (smokers and drinkers). Oral cancer cases diagnosed during screening programs were proportionately stable over the years 1997 to 2009 but increased from 2010 to 2021. The fluorescence-associated VOE test demonstrated a sensitivity of 100% and a specificity of 90%. Similarly, the VOE test alone exhibited a sensitivity of 100%, with specificity ranging from 75% to 90%. CONCLUSIONS:  Screening studies conducted in Latin American countries had serious limitations both in methodology (lack of examiner training) and in reporting data (lack of description of clinical categories of screen positives). Capacitation of health workers to perform VOE in well-designed screening programs should be implemented.

Microtensile Bond Strength of Self-Etch Adhesives on Dentin Treated with Chlorhexidine.

AIM: To evaluate the microtensile bond strength of self-etching adhesive systems in dentin treated with 2% chlorhexidine digluconate (CHX). MATERIALS AND METHODS: The occlusal surfaces of 20 human molars were removed and divided into eight groups: 1A, Clearfil SE adhesive (SE) with self-etching technique (TS); 1B, SE with TS and previous application of CHX; 2A, Scotchbond Universal (SBU) adhesive with TS; 2B, SBU adhesive with TS and previous application of CHX; 1C, SE with total-etching technique (TT); 1D, SE with TT and previous application of CHX; 2C, SBU with TT; 2D SBU with TT and previous application of CHX. Composite resin (5mm) was applied on the hybridized surface. Samples were subjected to microtensile test and evaluated on Scanning Electron Microscope (SEM) and with energy-dispersive X-ray (EDX). RESULTS: Low values of bond strength were observed in groups 1A (39,77±11,56) and 2A (40,84±12,49) comparing with 1B (22,86±5,18) and 2B (27,02±5,58). TS group presented adhesive type remover fracture while TT groups presented cohesive at the top of hybrid layer. EDX revealed the presence of CHX crystals for TS, which was not found in the TT. CONCLUSION: The previous application of chlorhexidine on dentin decreased the bond strength of adhesive systems on self-etching technique.

The impact of head and neck radiotherapy on the dentine-enamel junction: a systematic review.

BACKGROUND: Radiotherapy is widely used in contemporary head and neck cancer treatment protocols. The ability of head and neck radiotherapy (HNRT) to cause direct radiogenic destruction to the teeth is one of the most controversial topics in the field of oral oncology. Therefore, this systematic review aimed to investigate ionising radiation as an independent factor for physical and chemical changes on the dentine-enamel junction (DEJ), a pivotal dental topography for the onset and progression of radiation-related caries (RRC) and enamel delamination. MATERIAL AND METHODS: Systematic searches were conducted on three databases: Scopus, MEDLINE (Via PubMed) and Embase (Elsevier). Laboratory studies evaluating the effects of simulated or in vivo HNRT on the DEJ were included. The GRADE tool adapted for in vitro studies was used to assess the methodological quality. RESULTS: Of the 154 initially selected studies, eight met the inclusion criteria, from which five studies were graded as high quality of evidence, two studies were graded as moderate quality and one as low quality. Two studies did not demonstrate DEJ alterations following HNRT while the other six articles described several organic and inorganic changes in the DEJ of irradiated teeth samples. These radiogenic events were mostly detected through micro and nanoindentation, Raman micro-spectroscopy, confocal microscopy, Western blotting and optical coherence tomography. CONCLUSIONS: HNRT may have a negative impact on the physical and chemical aspects of the DEJ, predisposing cancer patients to RRC and enamel delamination.

Impact of Silane-containing Universal Adhesive on the Biaxial Flexural Strength of a Resin Cement/Glass-ceramic System.

The aim of this study was to determine whether using a silane-containing universal adhesive as a silane primer in glass-ceramic/resin cement systems affects biaxial flexural strength (BFS) and bonded interface integrity after loading. Glass-ceramic (IPS e.max CAD, Ivoclar/Vivadent, Schaan, Liechtenstein) disc-shaped specimens (6.5±0.1mm in diameter, 0.5±0.1mm thick) were etched with 5% hydrofluoric acid (HF) for 20 seconds and divided into four groups of 30 specimens, to be treated as follows: 1) One bottle silane primer (RCP); 2) Separate application of silane and adhesive (RCP+SB); 3) Silane-containing universal adhesive (SBU); 4) No treatment (C). After silanization, all specimens were resin cement- coated and polymerized for 40 seconds. Each specimen layer was measured, as well as each assembly's thickness, using a digital caliper and scanning electron microscope (SEM). Specimens were stored for 24 hours and submitted to a BFS test (1.27 mm/min). BFS values were calculated using the bilayer disc-specimen solution. Bonded interfaces were analyzed on fractured fragments using SEM. One-way ANOVA and Tukey tests (α=0.05) were applied, as well as the Weibull analysis. Factor "silane treatment" was statistically significant ( p<0.0001). RCP+SB (372.2±29.4 MPa) and RCP (364.2±29.5 MPa) produced significantly higher BFS than did the C (320.7±36.3 MPa) or SBU (338.0±27.1 MPa) groups. No differences were found in the Weibull modulus ( m: RCP: 10.1-17.3; RCP+SB: 10.1-17.0; SBU: 12.3-22.4; C: 7.4-12.9). Bonded interface analysis exhibited ceramic-cement separation (SBU, C) and voids within the resin cement layer (all groups). Neither the ceramic/cement system's BFS nor its bonded interface stability were improved by SBU after loading.

Short- and Long-Term Bond Strength Between Resin Cement and Glass-Ceramic Using a Silane-Containing Universal Adhesive.

This study aimed to evaluate the effect of various silane-containing solutions on bonding between resin cement and glass ceramic after 24 hours and after six months of water storage. Glass-ceramic plaques (IPS e.max CAD) were sandblasted with aluminum oxide, etched with 10% hydrofluoric acid (HF), and divided into five "silane treatment" groups: RelyX Ceramic Primer (RCP), RelyX Ceramic Primer and Single Bond Plus (RCP+SB), Scotchbond Universal (SBU), Clearfil Ceramic Primer (CP), and no solution (HF-only control). Each group was divided into two "storage time" subgroups: 24 hours or six months in 37°C water. Eighteen resin cement cylinders (RelyX Ultimate) were bonded to each treatment group substrate (n=18) and then subjected to microshear testing. Failure mode was analyzed using scanning electron microscopy. Debond data were analyzed using a two-way analysis of variance and the Tukey post hoc test (α=0.05) as well as Weibull distributions. The factors "silane treatment," "storage time," (p<0.0001), and their interaction were statistically significant (p<0.0010). Group means (MPa±SD), RCP (24 hours: 27.2±3.1; six months: 18.0±4.9), and HF-only control (24 hours: 21.1±3.4; six months: 15.7±5.8) showed a reduced bond strength after six months of water storage, while RCP + SB (24 hours: 23.4±4.4; six months: 22.2±5.4), SBU (24 hours: 18.8±3.0; six months: 17.2±3.6), and CP (24 hours: 21.7±4.3; six months: 17.4±4.8) remained constant. Weibull analysis revealed that more reliable bond strengths were obtained after six months for SBU and RCP + SB. Evaluation by scanning electron microscopy revealed that all groups demonstrated hydrolytic degradation at six months of storage, but RCP + SB and SBU indicated less. Use of a separate application of silane and adhesive system improved short and long-term ceramic/resin cement bond strength.

Effects of potassium oxalate on knoop hardness of etch-and-rinse adhesives.

The objective of this study was to determine whether the hardness of etch-and-rinse adhesives may be affected by the pretreatment of acid-etched dentin with potassium oxalate desensitizer. Unerupted human third molars were cut into crown segments by removing the occlusal enamel and roots. The pulp chamber of these crown segments was connected to a syringe barrel filled with phosphate-buffered saline so that the moisture of dentin was maintained during the bonding procedures. Three etch-and-rinse adhesives-two two-step systems (Adper Single Bond 2 [SB], One-Step [OS]) and one three-step system (Adper Scotchbond Multi-Purpose [MP])-were applied to acid-etched dentin that had been treated (experimental groups) or not (control groups) with potassium oxalate (BisBlock). The Knoop hardness (KHN) of adhesives was taken at different sites of the outer surface of the adhesive-bonded dentin. The KHN of the three tested adhesives applied to acid-etched dentin treated with potassium oxalate was significantly lower than that exhibited by the respective controls (not treated with oxalate; p<0.05). Regardless of the adhesive, the treatment with potassium oxalate reduced the adhesives' KHN (p<0.05), with the OS system exhibiting the lowest KHN compared with the MP and SB systems.

Patterns of demineralization and dentin reactions in radiation-related caries.

Radiation-related caries is a unique form of rampant decay and is a complication of head and neck radiotherapy that frequently causes generalized dental destruction and impairs quality of life in cancer patients. The aim of this study was to investigate the patterns of demineralization of caries in irradiated patients and to establish whether direct radiogenic damage to the dentition might be important in the progression of radiation-related caries. Teeth from patients who had concluded radiotherapy were examined histologically by polarized light microscopy, and the ultrastructure was examined by scanning backscattered electron microscopy. Cervical caries and incisal caries, a very unusual sort of lesion, were widely detected. Additionally, diffuse brown discoloration of the smooth surface of enamel was frequently observed. Polarized light microscopy suggested that these areas were incipient caries. Evidence of normal odontoblast function was observed in the detection of reactionary dentin and intratubular dentin deposition. In conclusion, radiation-related caries seems to have the same morphological and demineralization pattern as ordinary caries, with the presence of demineralized dentin, a translucent zone, dentin dead tracts, reactionary dentin and intratubular dentin deposition. Based on these findings, direct radiogenic destruction of the teeth seems to be not essential to the microscopic progression of radiation-related caries.

In vivo preservation of the hybrid layer by chlorhexidine.

Host-derived proteases have been reported to degrade the collagen matrix of incompletely-resin-infiltrated dentin. This study tested the hypothesis that interfacial degradation of resin-dentin bonds may be prevented or delayed by the application of chlorhexidine (CHX), a matrix metalloproteinase inhibitor, to dentin after phosphoric acid-etching. Contralateral pairs of resin-bonded Class I restorations in non-carious third molars were kept under intra-oral function for 14 months. Preservation of resin-dentin bonds was assessed by microtensile bond strength tests and TEM examination. In vivo bond strength remained stable in the CHX-treated specimens, while bond strength decreased significantly in control teeth. Resin-infiltrated dentin in CHX-treated specimens exhibited normal structural integrity of the collagen network. Conversely, progressive disintegration of the fibrillar network was identified in control specimens. Auto-degradation of collagen matrices can occur in resin-infiltrated dentin, but may be prevented by the application of a synthetic protease inhibitor, such as chlorhexidine.

Chlorhexidine preserves dentin bond in vitro.

Loss of hybrid layer integrity compromises resin-dentin bond stability. Matrix metalloproteinases (MMPs) may be partially responsible for hybrid layer degradation. Since chlorhexidine inhibits MMPs, we hypothesized that chlorhexidine would decelerate the loss of resin-dentin bonds. Class I preparations in extracted third molars were sectioned into two halves. One half was customarily restored (etch-and-rinse adhesive/resin composite), and the other was treated with 2% chlorhexidine after being acid-etched before restoration. Specimens were stored in artificial saliva with/without protease inhibitors. Microtensile bond strengths and failure mode distribution under SEM were analyzed immediately after specimens' preparation and 6 months later. With chlorhexidine, significantly better preservation of bond strength was observed after 6 months; protease inhibitors in the storage medium had no effect. Failure analysis showed significantly less failure in the hybrid layer with chlorhexidine, compared with controls after 6 months. In conclusion, this in vitro study suggests that chlorhexidine might be useful for the preservation of dentin bond strength.

Polymerization kinetics of pre-heated composite.

Temperature affects the polymerization behavior of dimethacrylate-based materials. This study describes the influence of pre-polymerization temperature and exposure duration on polymerization kinetics of a commercial dental photo-activated composite at the top and at 2-mm depth. We used the temperature-controlled stage of a diamond-attenuated-total-reflectance unit to pre-set composite temperature between 3 degrees and 60 degrees C. Composite was light-exposed by a conventional quartz-tungsten-halogen curing unit for 5, 10, 20, or 40 sec. Real-time conversion, maximum conversion rate (R(p)(max)), time to achieve R(p)(max), and conversion at R(p)(max) were calculated from infrared spectra. Composite pre-warming enhanced maximal polymerization rate and overall monomer conversion (top significantly greater than 2 mm). Time when R(p)(max) occurred did not change with temperature, but occurred sooner at the top than at 2-mm depth. Conversion at R(p)(max) increased with temperature, allowing more of the reaction to occur prior to vitrification than at room temperature.

Monomer conversion of pre-heated composite.

The potential for maximizing conversion of room-temperature, photoactivated resin composite in the oral environment is limited. Pre-heating composite prior to light-curing is hypothesized to increase monomer conversion and reduce the duration of light exposure. Composite temperature was controlled at between 3 degrees C and 60 degrees C prior to exposure with a conventional quartz-tungsten-halogen curing unit: 5, 10, 20, or 40 sec. Monomer conversion was calculated from infrared spectra at 0 mm (top) and 2-mm-deep surfaces 5 min after light initiation. A strong, positive correlation existed between temperature and monomer conversion: top r(2) = 0.999, 2 mm r(2) = 0.998. Conversion ranged from 31.6% (3 degrees C) to 67.3% (60 degrees C). The duration of light exposure, reduced by 50 to 75% with pre-heated composite, yielded the same or significantly higher conversion (p = 0.001) than with control (22 degrees C, 20 sec). Both hypotheses were accepted: Pre-heating composite prior to photoactivation provides greater conversion requiring reduced light exposure than with room-temperature composite.

Effect of the photo-activation method on polymerization shrinkage of restorative composites.

This study measured the gap that resulted from polymerization shrinkage of seven restorative resin composites after curing by three different methods. Contraction behavior, according to the specimen region, was also characterized. The materials used for this study were Alert (Jeneric/Pentron, Wallingford, CT 06492, USA), Surefil (Dentsply Caulk, Milford, DE 19963, USA), P60 (3M Dental Products, St Paul, MN 55144, USA), Z250 (3M), Z100 (3M), Definite (Degussa-Hüls, Hanau, Germany) and Flow-it (Jeneric/Pentron). The composite was placed in a circular brass mold 7 mm in diameter and 2 mm in height. Photo-activation was performed by a) continuous light (500 mW/cm2) for 40 seconds; b) stepped light with low intensity (150 mW/cm2) for 10 seconds and high intensity (500 mW/cm2) for 30 seconds and c) intermittent light (450 mW/cm2) for 60 seconds. The top and bottom surfaces were then polished and after 24 +/- 1 hours, the contraction gap was measured by SEM at variable pressure (LEO 435 VP, Cambridge, England). Results were analyzed by ANOVA and the means compared by Tukey's test (5%). The results demonstrated 1) the continuous light method presented the greatest gap values (15.88 microm), while the other methods demonstrated lower polymerization shrinkage values (stepped light, 13.26 microm; intermittent light, 12.79 microm); 2) restorative composites shrunk more at the bottom surface (15.84 microm) than at the top surface (12.11 microm) and (3) the composites Alert (12.02 microm), Surefil (11.86 microm), Z250 (10.81 microm) and P60 (10.17 microm) presented the least contraction gaps, followed by Z100 (15.84 microm) and Definite (14.06 microm) and finally Flow-it (23.09 microm) low viscosity composite, which had the greatest mean value.

A morphological and tensile bond strength evaluation of an unfilled adhesive with low-viscosity composites and a filled adhesive in one and two coats.

OBJECTIVE: The purpose of this study was to measure the tensile bond strength (TBS) testing of resin composite to dentin of three low-viscosity composites, in association with an unfilled adhesive, and a filled adhesive one and two coats respectively, and to evaluate and compare the SEM morphological observations. METHODS: The labial surface of 120 bovine lower incisors were ground to obtain a flat dentin surface allowing demarcation of a 4 mm diameter area with adhesive tape. The teeth were randomly divided in six groups of 20 each. The dentin of each ground surface was etched with 35% H(3)PO(4) for 15s, followed by application of the respective adhesive: Single Bond (SB) for Groups 1, 2, 3 and 6; Optibond Solo (OS) for Groups 4 and 5. In Groups 1 and 4, a resin composite rod with a wire loop was luted directly to the adhesive surface with Z100. Group 2 received an intermediate layer of Flow It (FI) composite; Group 3 received an intermediate layer of Protect Liner F (PLF) composite; Group 5 received a second coat of OS; and Group 6 received an intermediate layer of an experimental low-viscosity composite (EM). A resin composite rod was luted to the surface of each specimen with Z100 resin composite. All specimens were stored in distilled water at 37 degrees C for 24h prior to TBS testing. Each specimen was inspected by SEM and classified according to adhesive or cohesive failure mode. One specimen of each group was cut longitudinally, polished and prepared for SEM observation. RESULTS: The TBS values were: Group 1 (7.86MPa+/-2.28), Group 2 (7.62MPa+/-1.85), Group 3 (7.60MPa+/-2.14), Group 4 (7.96MPa+/-2.36), Group 5 (7.50MPa+/-2.70) and Group 6 (7.18MPa+/-2.40). No significant statistical differences were observed among the groups. However, the analyses of the failure mode presented a considerable variation. SIGNIFICANCE: The use of a filled adhesive or an unfilled adhesive along with a low-viscosity composite as an intermediate layer may provide a stress absorbing layer, whereby improving the preservation of the bonded interface area.

Effect of antimicrobial agents on the micromorphology of primary dentin.

The use of disinfectants on the dentin surface contributes to superficial cleaning and removal of remaining microorganisms of the carious process. However, the effect of these agents on the adhesion of resin materials to the dentin surface of primary teeth has not been established. This study evaluated the dentin micromorphological effects due to the use of antimicrobial agents in the different depths of dentin. Twenty-five buccal surfaces of primary molars were prepared from the sectioned teeth, ground flat and polished with silicon carbide paper of different grits. The surfaces were treated with 32% phosphoric acid with benzalkonium chloride (Bisco), 35% phosphoric acid gel (3 M), 3% benzalkonium chloride solution by itself or 10% maleic acid. All agents were applied for 15 seconds on the dentin surface. The samples were washed with distilled water, dried and coated with gold for observation of the dentin surface with the scanning electron microscope. The samples were subdivided according to the dentin depth in upper, middle and lower areas. The following was observed: presence of smear layer, opening of the dentin tubules, and inter and intratubular dentin morphology. The effects of the antimicrobial agents were compared in the different depths of the dentin. The results demonstrated that the surface conditioned with 3% benzalkonium chloride solution presented few disclosed dentin tubules. The use of the 32% phosphoric acid with benzalkonium chloride completely removed the smear layer and increased the diameter of the dentin tubule openings. The 35% phosphoric acid totally exposed the tubules in the upper area of the analyzed surface but partially exposed them in the middle and lower areas. The 10% maleic acid totally removed the smear layer, left all the tubules opened and conditioned the intertubular dentin. It was concluded that in the different depths of the dentin surface, conditioning with 10% maleic acid in primary teeth showed the most consistent micromorphological characteristics compared to the other agents used in this study.

Influence of loading types on the shear strength of the dentin-resin interface bonding.

Small differences in the shear bond test can make critical differences in the bonding strength values. The purpose of this study was to compare the influence of the orthodontic-looped wire, stainless steel tape and chisel systems used in shear bonding tests to verify the resistance in the dentin-resin interface. Forty-eight human teeth were used and divided in three groups. The teeth were ground until a flat smooth surface was achieved, that was delimited with an adhesive tape containing a hole of 4 mm diameter. After, the dentine surface was treated with Scotchbond Multi Purpose and the composite Z-100 was applied in layers, through a stainless steel mold. The samples were stored at 37 degrees C and 100% of relative humidity for 24 h and, then, submitted to 500 thermal cycles. After, they were taken to an universal test machine (Otto Wolpert) with crosshead speed of 6 mm/min. The results were statistically analyzed using a Tukey's test (p\lt 0.05). The orthodontic-looped wire determined the highest values of shear bond (13.33 MPa), following by chisel (7.81 MPa) and stainless steel tape (4.87 MPa). The debonding values depend on a complex stress combination produced during the loading of the samples. Small variations in test methodologies give statistically different values for shear bond strength. Different shear strength methods in vitro make the comparative clinical performance of the resin filling materials difficult.

How wet should dentin be? Comparison of methods to remove excess water during moist bonding.

PURPOSE: The aim of this study was to evaluate the shear bond strength of two adhesive systems when applied on dentin surfaces with different degrees of wetness. MATERIALS AND METHODS: Two-hundred ten dentin specimens were used. After conditioning with 35% phosphoric acid gel and washing, seven methods of drying dentin were used: 30 s air spray (groups 1 and 2), 5 s air spray (groups 3 and 4), dry cotton pellets (groups 7 and 8), wet cotton pellets (groups 9 and 10), microbrush (groups 11 and 12), absorbent paper (groups 13 and 14). The last group was not dried; the dentin surfaces were left overwet (groups 5 and 6). Prime & Bond 2.1 adhesive was applied on the odd-numbered groups and Scotchbond Multi Purpose on the even-numbered groups. Z100 composite cylinders were bonded to the adhesive and the specimens were subjected to a shear bond test. RESULTS: The Least-Squares Means test was used to compare the following results, where different letters indicate significantly different mean values: Group 9 (G9) = 23.2 MPa (a), G3 = 21.3 MPa (ab), G2 = 19.5 MPa (bc), G10 = 18.6 MPa (bc), G14 = 16.3 MPa (cd), G8 = 16.1 MPa (cd), G4 = 14.6 MPa (de), G13 = 14.0 MPa (de), G11 = 13.9 MPa (de), G7 = 13.5 MPa (de), G12 = 12.1 MPa (e), G1 = 8.2 MPa (f), G5 = 2.7 MPa (g), G6 = 2.4 MPa (g). CONCLUSION: The adhesion values were affected both by the degree of dentin wetness and by the adhesive systems.

Correlation between light intensity and exposure time on the hardness of composite resin.

This study evaluated the correlation between light intensity emitted by the curing units and exposure time on the of degree polymerization of dental composites by measured Knoop hardness. Specimens with 5 mm diameter and 2 mm height were prepared in a copper mold, covered with a mylar strip and polymerized for 30 sec by curing units with 50, 130, 180, 220, 280 and 520 mW/cm(2), respectively. The output for all units was measured using a Curing Radiometer (Demetron). Other specimens were polymerized for 45, 60, 75, 90, 105, 120, 135, 150, 165 and 180 sec utilizing units of 130, 220 and 280 mW/cm(2). Knoop hardness values of the top and bottom surfaces were measured after 24 h. The results indicate that the curing units with higher light intensity presented improved values of Knoop hardness on the top and bottom regions. As expected, the top surface always presented improved Knoop hardness values in relation to the bottom, after exposure for 30 sec. The values obtained on the surface were statistically superior compared to the values on the bottom (p<0.05) for the intensity of 130, 220 and 280 mW/cm(2) after 30, 45 and 60 sec of exposure.

Effect of etching agent on dentinal adhesive interface in primary teeth.

The purpose of this study was to evaluate in vitro the effect of a phosphoric acid etchant containing benzalkonium chloride on the dentin/adhesive interface in primary teeth. The teeth had caries lesions involving enamel and dentin, and were stored in a 2% glutaraldehyde solution for 2-4 hours. The teeth were divided into five groups of five teeth each: Group 1: Etching for 15 seconds with a semigel 32% phosphoric acid containing benzalkonium chloride; Group 2: Etching with 35% phosphoric acid for 15 seconds; Group 3: Treated with a 2% benzalkonium chloride in a alcoholic solution; Group 4: Conditioned with a 3% benzalkonium chloride in a alcoholic solution (control group); Group 5: The teeth were untreated (control group). The carious tissue was removed with a carbide bur in high-speed and copious air water spray. The overall dimensions and depths of the cavities were determined by the carious tissue removal. After the caries lesion was removed, the cavity was cleaned with an air-water spray and the dentin was treated according to the specific group. The teeth were then restored with Scotchbond Multi-Purpose Plus (3M, St. Paul, MN) and Z-100 resin-based composite (3M, St. Paul, MN) according to the manufacturer's instructions. After the teeth were restored they were stored in water for 24 hours at room temperature and the restorations polished. After storage the teeth were thermally challenged for 500 cycles in temperatures of 50 C and 550 C and then stored in 100% humidity until the sectioning procedures. The teeth were cut into two sections along the longitudinal axis through the center of the teeth and passed the mesial-distal surfaces through the restoration by using a double-face diamond disc with water coolant. The specimens were ground with 320 up to 600 grit silicon carbide paper and polished with 6 mm and 1 mm diamond paste and 0.25 pm alumina solution. The specimens were etched with 10% citric acid for 1 minute and washed with deionized water. After that, they were deproteinized with 10% NaOCl for 5 seconds. The specimens were dried at room temperature sputter-coated with gold and observed with an SEM for assessment of the morphology of the bonded interface. The interface was observed to determine the presence/absence of hybrid layer formation, resin tags, and gaps. In the groups treated only with benzalkonium chloride solutions, spaces were observed in the resin/dentin interface. Similar findings were observed in the control group, which received no treatment on the dentin before primer application. In these groups neither resin tags or hybrid layer formation was observed. The presence of an amorphous layer, which was unremoved smear layer, was noted. The group treated with 35% phosphoric acid showed a hybrid layer formation (8.15 microns). This layer was linked intimately with the peritubular and intertubular dentin. Tags formation was observed towards the pulp under the hybrid layer. In these specimens the gaps were not observed between the dentin layer and bonding materials. The total removal of the smear layer was observed using 37% phosphoric acid with benzalkonium chloride. A hybrid layer (+/- 7.32 microns) and resin-tags attached to this layer were observed similar to the group in which the 35% phosphoric acid was used. The samples showed total removal of the smear layer and no gaps were observed in the dentin/adhesive interface.

Effect of storage and acid etching on the tensile bond strength of composite resins to glass ionomer cement.

This in vitro study evaluates the effect of storage time and acid etching on the tensile bond strength of glass ionomer cement to composite resins. The bonded assemblies were stored at 100% relative humidity and 37 degrees C for 1 hour, 1 day, 1 week, 1 month and 3 months. The test specimen was loaded at tension to failure on an Otto Wolpert-Werke testing instrument with a crosshead speed of 6 mm/min. The results showed a significant statistical difference for etched Vidrion F when compared to etched Ketac Bond at all storage periods. The unetched samples were statistically similar at 3 months, with the highest values for Vidrion F.