Micromorphology of Root Canal Walls After Laser Activated Irrigation.

This study aims to investigate the effects of laser-activated irrigation on root canal dentin using different laser wavelengths. Sixty-six roots were prepared and split longitudinally. First, lasers with different power settings were tested on 34 samples, pre-etched with phosphoric acid, or remaining with a smear-layer to determine the test parameters. Selected parameters were then applied on thirty roots (9 groups) covered with smear layer: 1. Smear-layer removed; 2. Smear-layer untouched; 3. Conventional needle irrigation with NaOCl and EDTA; 4. ER:YAG laser; 5. 9.3 µm CO2 laser; 6-9. Diode lasers. All lasers were applied in ultra-pure water as an irrigant. Root halves were examined by scanning electron microscope to analyze the intracanal dentin micromorphology on 9 consequent photos per specimen @ a magnification of 1000X. The results showed that conventional needle irrigation was effective in removing the smear-layer from coronal and middle root parts, while laser-activated irrigation had two main mechanisms: cleaning and opening of the dentinal tubules by removing the smear layer (Er:YAG laser) and melting of dentin (CO2 and diode lasers) in all root parts. The study concluded that laseractivated irrigation with different wavelengths impacted the smear layer and root canal dentin differently through pure physical/mechanical effects.

Restoration of Severely Damaged Endodontically Treated Premolars: Influence of the Ferrule Effect on Marginal Integrity and Fracture Load of Resin Nano-ceramic CAD-CAM Endocrowns.

OBJECTIVES: To explore the ferrule effect on Resin Nano-Ceramic (RNC) premolar endocrown marginal integrity and fracture resistance. METHODS: Thirty-six root-canal-treated premolars were cut 2 mm above the cemento-enamel junction (CEJ). They were restored with standardized RNC computer-aided design/computer-aided manufacturing (CAD/CAM) restorations (Lava Ultimate, 3M Oral Care, St. Paul, MN, USA) and divided into three groups (n=12): endocrowns with a 3-mm endo-core (Group 1), endocrowns with a 3-mm endo-core and a 2-mm ferrule (Group 2), and conventional post-and-core crowns with a 2-mm ferrule (Group 3). All specimens were submitted to thermo-mechanical cycling loading (TMCL) (1.7 Hz, 49 N, 600 000 cycles, 1500 thermocycles). Margins were analyzed before and after the TMCL. In the second part of the experiment, the surviving specimens were submitted to unidirectional monotonic loading until fracture. Fragments were then analyzed using scanning electron microscopy (SEM) and the fracture mode was established. RESULTS: Endocrowns of Groups 1 and 2 performed better than conventional crowns (Group 3) in terms of marginal continuity. Differences in fracture load values within all groups were not statistically significant. Most of the specimens fractured in a non-repairable way. CONCLUSIONS: The present test failed to provide evidence of any kind of difference between endocrowns with and without a ferrule in terms of load-bearing capacity and marginal integrity after fatigue. Further studies are needed to confirm the role of the ferrule in adhesive restorations of endodontically treated teeth.

Caries Detection with Near-Infrared Transillumination Using Deep Learning.

Dental caries is the most prevalent chronic condition worldwide. Early detection can significantly improve treatment outcomes and reduce the need for invasive procedures. Recently, near-infrared transillumination (TI) imaging has been shown to be effective for the detection of early stage lesions. In this work, we present a deep learning model for the automated detection and localization of dental lesions in TI images. Our method is based on a convolutional neural network (CNN) trained on a semantic segmentation task. We use various strategies to mitigate issues related to training data scarcity, class imbalance, and overfitting. With only 185 training samples, our model achieved an overall mean intersection-over-union (IOU) score of 72.7% on a 5-class segmentation task and specifically an IOU score of 49.5% and 49.0% for proximal and occlusal carious lesions, respectively. In addition, we constructed a simplified task, in which regions of interest were evaluated for the binary presence or absence of carious lesions. For this task, our model achieved an area under the receiver operating characteristic curve of 83.6% and 85.6% for occlusal and proximal lesions, respectively. Our work demonstrates that a deep learning approach for the analysis of dental images holds promise for increasing the speed and accuracy of caries detection, supporting the diagnoses of dental practitioners, and improving patient outcomes.

Resin composite thickness' influence on L*a*b* coordinates and translucency.

OBJECTIVES: To evaluate if material thickness can influence the L*a*b* coordinates and translucency of different composite shades. MATERIALS AND METHODS: Twelve composite disc specimens made of three different resin composite materials (dentin A2, Essentia, GC; body shade A2, Brillant Everglow, Coltene-Whaledent; enamel skin neutral, Inspiro, Edelweiss DR) and of three different thicknesses 0.5, 1.0, and 1.5 mm were readied. L*a*b* coordinates of the 118 specimens were assessed by a calibrated reflectance spectrophotometer over a black as well as a white background. RESULTS: Over the black background, median ΔE00 values varied from 0.7 (Brilliant Everglow) to 1.5 (Inspiro SN) for 0.5-mm composite thickness (intrinsic color variation) and from 3.2 (Essentia) to 7.5 (Inspiro SN) for 1.0 mm, respectively 6.1 (Essentia) to 11.1 (Inspiro SN) for 1.5-mm composite thickness (color variation related to thickness). Over the white background, median ΔE00 values varied from 0.6 (Essentia) to 1.6 (Inspiro SN) for 0.5-mm composite thickness and from 2.9 (Inspiro SN) to 4.3 (Essentia) for 1.0 mm, respectively 4.9 (Inspiro SN) to 7.0 (Essentia) for 1.5-mm composite thickness. Transparency varied from 25.2% (Essentia) to 34.6% (Inspiro SN) for 0.5-mm composite thickness, from 20.3% (Essentia) to 27.5% (Inspiro SN) for 1.0-mm thickness and from 14.8% (Essentia) to 22.9% (Inspiro SN) for 1.5-mm thickness. CONCLUSIONS: Material thickness can influence the L*a*b* coordinates and translucency of different composite shades. CLINICAL RELEVANCE: L* a* b* coordinates are influenced by composite thickness.

Correction to: Color stability of different composite resins after polishing.

In the original publication of the article, the author's name "Prof. René Daher" was inadvertently missed in the author group. This has been updated in this erratum. Also, the original article has been corrected.

Color stability of different composite resins after polishing.

The goals of the present study were to evaluate, in vitro, the staining of different composite resins submitted to different common beverages, and to compare the staining effect of each of these solutions. A total of 288 specimens were randomly divided into six groups and immersed for 4 weeks in five staining solutions represented by red wine, orange juice, coke, tea and coffee or in artificial saliva as a control group. When analyzed over a black background, mean ΔE00 values varied from 0.8 for Venus Diamond, Saremco Microhybrid and ELS in saliva and Estelite Posterior in coke to 37.6 for Filtek Supreme in red wine. When analyzed over a white background, mean ΔE00 values varied from 0.5 for Saremco Microhybrid in saliva to 51.1 for Filtek Supreme in red wine. All materials showed significant changes in color after 4 weeks of immersion in staining solutions. Significant differences were found between the tested composite resins and also between the staining solutions.

Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns.

OBJECTIVES: To explore fatigue limits of ceramic endocrowns for premolars. METHODS: Forty-eight devitalized premolars were cut at the CEJ. They were restored with standardized CAD-CAM lithium disilicate reinforced ceramic restorations (IPS e.max CAD, Ivoclar-Vivadent) and divided into four Groups (n=12): overlays (Group A, no endo-core, negative control), endocrowns with an endo-core of 2mm (Group B), 4mm (GroupC) and crowns with post and core (Group D, positive control). All specimens were first submitted to thermo-mechanical cyclic loading (TCML)(1.7Hz, 49N, 600000 cycles, 1500 thermo-cycles). Margins were analysed before and after the loading. Survived specimens were then submitted to cyclic isometric stepwise loading (5Hz, 200N to 1200N) until completion of 105000 cycles or failure. In case of fracture, fragments were analysed using SEM and failure mode was determined. Results of stepwise loading were statistically analysed by Kaplan-Meier life survival analysis and log rank test (p=0.05). RESULTS: All the specimens survived the TCML test except four specimens of Group A (early restorations' debonding). No difference in percentages of closed margins was found between endocrowns (Groups B, C) and crowns (Group D). After the stepwise test, differences in survival within the groups were not statistically significant. Most of restorations experienced non-reparable fracture. CONCLUSIONS: Endocrowns with both 2-mm and 4-mm long endo-cores displayed outcomes after fatigue equivalent to classical crowns. Results of this study discourage the use of flat overlays with only adhesive retention. CLINICAL SIGNIFICANCE: When restoring extremely destroyed devitalized premolars, adhesive strategies should be coupled to a macro-mechanical retention in the root.

Intra-pulpal and subsurface temperature rise during tooth irradiation with 808 nm diode laser: an in vitro study.

AIM: This in vitro study evaluated the pulpal and subsurface temperatures during proximal tooth surface irradiation with different settings of an 808 nm diode laser. MATERIALS AND METHODS: The elevation of pulpal and subsurface temperature during irradiation was measured using thermocouples positioned in the centre of the pulp chamber (n=30) and in the centre of a prepared 1.5 mm deep coronal cavity (n=30). Each sample was irradiated 3 times within one-week interval using different exposure settings. A temperature increase of 3.5°C was regarded as critical value for pulpal heath. Results were analysed with one-way ANOVA and Duncan post hoc tests. Micromorphological investigation by digital microscopy was carried out for the irradiated and non-irradiated tooth surface. RESULTS Measurable temperature increase within the pulp chamber (delta PT) and the subsurface (delta ST) were observed with all laser settings tested. The highest recorded delta PT and delta ST were 3.1°C and 8.5°C, respectively. Delivery mode, beam diameter, and exposure time influenced the temperature rise. No alterations on the enamel surface were observed when inspected by the digital microscope after undergoing irradiation with the tested parameters. Cconclusion: From the thermal point of view, under the conditions of the present study the application of an 808 nm diode laser on the outer surface of the tooth at 1W in the continuous mode and at 5W in the pulsed mode for two cycles of 30 s each proved to be safe.

In Vitro Evaluation of Marginal Adaptation of Direct Class II Composite Restorations Made of Different "Low-Shrinkage" Systems.

The present study evaluated the influence of various low-shrinkage restorative systems in class II direct composite restorations following simulated occlusal loading. Forty MOD class II cavities were prepared on freshly extracted human lower third molars with proximal margins located mesially 1.0 mm coronal to and distally 1 mm apical to the cementoenamel junction. The samples were randomly distributed into five experimental groups corresponding to the following restorative systems: a conventional resin composite (Tetric) as active control group, a low-shrinkage composite (Extra Low Shrinkage [ELS]) alone or combined with its corresponding flowable version (ELSflow) used as a 1- to 1.5-mm liner, a bulk-filling flowable composite (Surefil SDR) covered by a 1-mm layer of restorative composite (Ceram-X), and a restorative bulk-filling composite (SonicFill). All specimens were submitted to 1,000,000 cycles with a 100N eccentric load into saline. Tooth restoration margins were analyzed semiquantitatively by scanning electron microscopy before and after loading. The percentage of perfect adaptation to enamel varied from 94.15% (SonicFill) to 100% (ELS) before loading and from 69.22% (SonicFill) to 93.61% (ELS and ELSflow) after loading. Continuous adaptation to cervical dentin varied from 22.9% (Tetric) to 79.48% (SDR/Ceram-X) before loading and from 18.66% (Tetric) to 56.84% (SDR/Ceram-X) after loading. SDR/CeramX and SonicFill showed the best cervical dentin adaptation.

Color stability of recent composite resins.

The objective of the study was to evaluate the color stability of 8 recently developed resin composites when exposed to various staining agents. Six disc-shaped specimens made out of 8 resin composite materials were immersed in artificial saliva, coffee, coke, tea, orange juice and red wine. The initial color (T0) of the 288 specimens was assessed by a calibrated reflectance spectrophotometer (SpectroShade, MHT) over a black as well as a white background. All specimens were kept in an incubator (INP-500, Memmert GmbH) at 37 °C for 4 weeks. Colorant solutions were changed every 7 days to avoid bacteria or yeast contamination. After 4 weeks of storage in the colorants (T1), spectrophotometric measurements were repeated and ΔE00 was calculated. When analyzed over a white background, the mean ΔE00 values varied from 1.5 (Venus Diamond) to 52.4 (Miris 2). When analyzed over a black background, the mean ΔE00 values varied from 0.8 (Venus Diamond) to 40.0 (ELS). Significant differences were detected when comparing values at T0 and T1 (ΔE00) for both backgrounds (Anova and Fisher's LSD post hoc test). Resin composite materials do behave in a significantly different way (p value < 0.01) when exposed to various staining solutions.

Fatigue behavior of resin-modified monolithic CAD-CAM RNC crowns and endocrowns.

OBJECTIVE: To evaluate the influence of different types of modifications with resin on fatigue resistance and failure behavior of CAD-CAM resin nano ceramic (RNC) restorations for maxillary first premolars. METHODS: Sixty standardized resin composite root dies received CAD-CAM RNC endocrowns (n=30) and crowns (n=30) (Lava Ultimate, 3M Espe). Restorations were divided into six groups: full anatomic endocrowns (group A) and crowns (group D), buccal resin veneered endocrowns (group B) and crowns (group E) and buccal resin veneered endocrowns (group C) and crowns (group F) with a central groove resin filling. A nano-hybrid resin composite was used to veneer the restorations (Filtek Supreme, 3M Espe). All specimens were first submitted to thermo-mechanical cyclic loading (1.7Hz, 49N, 600000 cycles, 1500 thermo-cycles) and then submitted to cyclic isometric stepwise loading (5Hz) until completion of 105000 cycles or failure after 5000 cycles at 200N, followed by 20000 cycles at 400N, 600N, 800N, 1000N and 1200N. In case of fracture, fragments were analyzed using SEM and modes of failure were determined. Results were statistically analyzed by Kaplan-Meier life survival analysis and log rank test (p=0.05). RESULTS: The differences in survival between groups were not statistically significant, except between groups D and F (p=0.039). Endocrowns fractured predominantly with a mesio-distal wedge-opening fracture (82%). Partial cusp fractures were observed above all in crowns (70%). Analysis of the fractured specimens revealed that the origin of the fracture was mainly at the occlusal contact points of the stepwise loading. SIGNIFICANCE: Veneering of CAD-CAM RNC restorations has no influence on their fatigue resistance except when monolithic crowns are modified on their occlusal central groove.

The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations.

OBJECTIVES: To evaluate the fracture strength and the mode of failure of endodontically treated molars restored with CAD/CAM overlays with fiber reinforced composite build-up of the pulp chamber. METHODS: 40 Devitalized molars were cut over the CEJ and divided into five groups (n=8). The pulp chamber area was filled with: group 0 (control), no resin build-up; group 1, hybrid composite build-up (G-aenial posterior, GC); group 2, as in group 1 but covered with 3 nets of bi-directional E-glass fibers (EverStickNET, Stick Tech Ltd.); group 3, a FRC resin (EverX posterior, GC); group 4, as in group 3 but covered by the bi-directional fibers. The crowns were restored with CAD-CAM composite restorations (Lava Ultimate, 3M ESPE). Maximum fracture loads were recorded in Newton and data were analyzed using Kruskal-Wallis test (p<0.05). Fragments were analyzed using SEM. RESULTS: The mean static loads in Newton were: group 0: 2448 (546); group 1: 2817 (873); group 2: 2128 (952); group 3: 2429 (1091); group 4: 2577 (833). No significant differences were found between the groups (p>0.05). All specimens fractured in a catastrophic way, under the CEJ. The main crack evolved in the corono-apical direction. In groups 2 and 4 secondary fracture paths with apico-coronal direction were detected close to the bi-directional fibers' layer. CONCLUSIONS: For the restoration of endodontically treated molars, the incorporation of FRCs did not influence the load-bearing capacity of the tooth-restoration complex. The SEM analysis showed a low ability of the bi-directional fibers net in deviating the fracture but this effect was not sufficient to lead more favorable fracture patterns, over the CEJ. CLINICAL SIGNIFICANCE: The use of FRCs to reinforce the "core" of devitalized molars against vertical fractures under static loads seems useless when the thickness of the CAD/CAM composite overlay restoration is high.

Immediate endodontic access cavity sealing: fundamentals of a new restorative technique.

Endodontic access cavity sealing is conventionally performed after endodontic irrigation, referred to as delayed endodontic sealing (DES). Evidence shows that endodontic irrigation with NaOCl decreases dentinal bond quality and could cause coronal leakage. Access cavity sealing before endodontic irrigation is a new restorative approach, referred to as immediate endodontic sealing (IES). The primary aim of this in vitro study was to investigate whether IES improved internal adaptation. The secondary aim was to investigate the influence of the viscosity of the composite used to seal the dentine, on the internal adaptation in both IES and DES groups. Third molars (n= 40) with fully developed apices were used. The teeth were prepared into standard Class II MO cavities, and divided in 4 groups according to the approach, and composite viscosity was used for sealing. Group 1: IES + low viscosity composite; group 2: IES + high viscosity composite; group 3: DES + low viscosity composite; and group 4: DES + high viscosity composite. Samples were then sectioned axially for observation using scanning electron microscopy. Outcome was evaluated by determining the internal adaptation of the samples, which was judged based on the percentage of a continuous margin at the tooth-composite interface. The results were analyzed using a two-way analysis of variance and Mann-Whitney test. IES groups exhibited significantly greater internal adaptation (p = 0.000) as compared with DES groups. Composite viscosity did not significantly affect internal adaptation in either IES or DES groups (p > 0.005).

Micro-CT evaluation of cavities prepared with with different Er:YAG handpieces.

AIM: The aim of the study was to compare several cavity shapes after application using different handpieces and tips of Er:YAG laser. MATERIALS AND METHODS: Firstly, this in vitro investigation was performed on two upper molars. Their crowns were cut horizontally underneath the occlusal fissures in order to obtain a flat dentin surface. Afterwards, minimal cavities were prepared by using an Er:YAG laser device with a variety of handpieces and tips (Kavo KEY Laser Plus). All cavities were prepared using the following parameters: 250 mJ and 10 Hz during 30s, and were scanned using Micro-CT. Secondly, thirteen caries-free, human upper molars were prepared according to the same protocol. Five cavities were prepared on each tooth, using five different tips and the same laser settings as step one. The cavities' depths were measured with a digital micrometer. The width and morphology were controlled under scanning electron microscope (SEM). RESULTS: Noticeable differences in the dimensions of the cavities were observed, even if the same laser parameters were used for all preparations. Two main shapes were registered: triangle and rectangle. CONCLUSION: None of the cavities presented an adhesive configuration, rounded shape often found in hidden caries; they were straighter (rectangle) or focusing (triangle). For the moment, there is no ideal Er:YAG laser handpiece/tip in order to prepare conservative adhesive cavity.

Caries diagnosis using light fluorescence devices: VistaProof and DIAGNOdent.

The modern concept of minimally invasive dentistry encompasses early detection of incipient carious lesions and their treatment. Due to the low sensitivity of visual inspection and radiography in the detection of occlusal hidden carious lesions under a macroscopically sound surface, several devices have been developed to increase detection accuracy. DIAGNOdent is one of the tools used for that purpose and VistaProof is a new device recently introduced into the market. They both use light fluorescence to detect incipient carious lesions. DIAGNOdent is based on the fact that carious lesions show higher level of fluorescence than sound tissues when excited by light at specific wavelength. Vistaproof is based on the same principle, but it uses a different wavelength of excitation than DIAGNOdent and a video camera for the detection of fluorescence. The aim of this article was to compare these two devices and present their clinical use.

Understanding MIH: definition, epidemiology, differential diagnosis and new treatment guidelines.

AIM: Molar-Incisor Hypomineralisation (MIH) is a congenital disease which increases in prevalence. It affects permanent first molars and, often to a lesser degree, permanent incisors with variable severity. The aetiology is unknown, but different hypotheses have been advanced. Differential diagnosis is mandatory not to confound MIH with other diseases. Treatment consists in a minimally invasive approach by reinforcing and protecting the existing dental structure. In more severe cases, restorative treatment may be indicated.

Cutting and coagulation during intraoral soft tissue surgery using Er: YAG laser.

AIM: To find the optimal techniques and parameters that enables Er:YAG laser to be used successfully for small intraoral soft tissue interventions, in respect to its cutting and coagulation abilities. CASE REPORT: In vitro pre-tests: 4 different Er:YAG laser units and one CO2 unit as the control were used for incision and coagulation on porcine lower jaws and optimal parameters were established for each type of intervention and each laser unit: energy, frequency, type, pulse duration and distance. CASE SERIES: 3 different types of intervention using Er:YAG units are presented: crown lengthening, gingivoplasty and maxillary labial frenectomy with parameters found in the in vitro pre-tests. RESULTS: The results showed a great decrease of the EMG activity of masseter and anterior temporalis muscles. Moreover, the height and width of the chewing cycles in the frontal plane increased after therapy. CONCLUSION: Er:YAG is able to provide good cutting and coagulation effects on soft tissues. Specific parameters have to be defined for each laser unit in order to obtain the desired effect. Reduced or absent water spray, defocused light beam, local anaesthesia and the most effective use of long pulses are methods to obtain optimal coagulation and bleeding control.

In vitro performance of Class I and II composite restorations: a literature review on nondestructive laboratory trials--part I.

Posterior adhesive restorations are a basic procedure in general dental practices, but their application remains poorly standardized as a result of the number of available options. An abundant number of study hypotheses corresponding to almost unlimited combinations of preparation techniques, adhesive procedures, restorative options, and materials have been described in the literature and submitted to various evaluation protocols. A literature review was thus conducted on adhesive Class I and II restorations and nondestructive in vitro tests using the PubMed/Medline database for the 1995-2010 period. The first part of this review discusses the selected literature related to photoelasticity, finite element analysis (FEM), and microleakage protocols. Based on the aforementioned evaluation methods, the following parameters proved influential: cavity dimensions and design, activation mode (light or chemical), type of curing light, layering technique, and composite structure or physical characteristics. Photoelasticity has various limitations and has been largely (and advantageously) replaced by the FEM technique. The results of microleakage studies proved to be highly inconsistent, and the further use of this technique should be strictly limited. Other study protocols for adhesive Class II restorations were also reviewed and will be addressed in part II of this article, together with a tentative relevance hierarchy of selected in vitro methods.

In vitro performance of Class I and II composite restorations: a literature review on nondestructive laboratory trials--part II.

A literature review was conducted on adhesive Class I and II restorations and nondestructive in vitro tests using the PubMed/Medline database for the 1995-2010 period. The first part of this review has presented and critically appraised selected literature dealing with the quality and in vitro behavior of adhesive Class II restorations using photoelasticity, finite element analysis, and microleakage study protocols. This second part reviews additional parameters, which are deformation and fracture resistance to cyclic loading, shrinkage stress and tooth deformation following restoration placement, bond strength (microtensile, tensile, and shear tests), and marginal and internal adaptation. In addition, a "relevance score" has been proposed that aims to classify the different study protocols according, firstly, to the resulting quality, quantity, and consistency of the evidence and then, secondly, to their potential clinical relevance, as estimated by their ability to simulate oral and biomechanical strains. The highest clinical relevance was attributed to marginal and internal adaptation studies, following cyclic loading in a moist environement. However, a combination of in vitro protocols will have an even greater predictive potential and has to be considered as a crucial preclinical research approach with which to investigate the numerous restorative configurations that cannot be efficiently and rapidly tested in vivo.