Effect of pH of In-Office Bleaching Gels and Timing of Fluoride Gel Application on Microhardness and Surface Morphology of Enamel.

Objective: To assess microhardness (VH) of enamel treated with two in-office bleaching agents with different pH and to study the effect of post- and prebleaching fluoride therapy. Materials and Methods: Eighty bovine incisors were divided into eight groups: G1-Unbleached group; G2-2% NaF; G3-Pola Office (pH = 3.8); G4-Pola Office+ (pH = 7); G5-Pola Office followed by 2% NaF; G6-2% NaF followed by Pola Office; G7-Pola Office+ followed by 2% NaF; G8-2% NaF followed by Pola Office+. Bleaching was conducted 3x with 1-week intervals (T1/T7/T14). Specimens were kept in artificial saliva. VH was measured at T1, T7, and T14. Data were analyzed using repeated measure ANOVA. Surface morphology was assessed using scanning electron microscopy. Result: There was no significant difference among the groups at T1. No significant difference was found between G3 and G4 at all intervals. 2% NaF (G5/G6 vs. G3) significantly prevented softening at T7 and T14. Some nonsignificant hardening was observed for 2% NaF for G7/G8 vs. G4. At T14, G3 showed the lowest VH values. G5 showed higher VH values compared to other groups apart from G6-G7. No relationship between bleaching protocols and surface morphology was observed. Conclusion: Pola Office caused the most softening. 2% NaF gel application after Pola Office bleaching was effective in recovering enamel hardness. Fluoride application after Pola Office+ bleaching provided little benefit.

The role of lead and cadmium in deciduous teeth and saliva on dental caries in children residing in Tehran, Iran.

BACKGROUND: Lead (Pb) and Cadmium (Cd) are important environmental contaminants. There is no biological monitoring of exposure to these heavy metals and their potential effect on dental caries in children in Tehran, Iran, a polluted megacity. Therefore, the present study investigated the potential association between Pb and Cd levels in primary teeth and saliva and dental caries. METHODS: In a cross-sectional design, 211 children aged 6-11 years referred to Tehran University of Medical Sciences, School of Dentistry and residing in Tehran were examined. Pb and Cd levels of exfoliated primary teeth and stimulated saliva were determined by atomic absorption spectrophotometry (AAS). Dental caries prevalence was evaluated according to WHO criteria. Socioeconomic status, oral hygiene behavior, snacking frequency and salivary pH data were acquired as confounding factors. Frequency and percentages were reported for categorical variables, mean and standard deviation (SD) for continuous variables, and geometric mean for skewed continuous variables. A simple linear regression and Pearson correlation tests were used for statistical analyses. P-values < 0.05 were considered as significant. RESULT: The mean (95 % confidence interval) Pb and Cd levels in teeth were 213.26 ppb (164.29-274.84) and 23.75 ppb (20.86-27.05), respectively. The mean Pb and Cd levels in saliva were 11.83 ppb (10.71-13.06) and 3.18 ppb (2.69-3.75), respectively. Furthermore, Pb and Cd in primary teeth and saliva were not associated (p > 0.05) with socioeconomic status, oral hygiene behavior and snacking frequency CONCLUSION: This study showed no association between Pb and Cd concentrations in primary teeth and in saliva with dental caries prevalence.

Effect of Photobiomodulation Therapy with 915 nm Diode Laser on Pain Perception during Local Anesthesia of Maxillary Incisors: A Randomized Controlled Trial.

This study aimed to evaluate the effect of photobiomodulation therapy (PBMT) with 915 nm wavelength on pain reduction during maxillary incisors' local infiltration in a randomized clinical trial study. A prospective triple-blinded split-mouth clinical trial was designed to assess pain perception during needle insertion and local anesthetic injection in 32 healthy patients required operative caries management on contralateral maxillary incisors. After laser treatment (915 nm, power of 1.5 W, duty cycle of 60% and energy density of 72 J cm^-2 ) in active group and no irradiation in sham group, the injection was performed. Patients' perception of pain was immediately assessed using numerical rating scale (NRS) for pain. Washout period between two appointments was one week. Wilcoxon signed-rank and Pearson correlation statistical analyses were used to assess the comparison of pain score between two appointments and the effect of anxiety level of previous dental injections. The mean scores of pain for the active laser and sham laser groups were 2.5 ± 2.19 and 4.34 ± 2.52, respectively, with a statistically significant higher NRS in the sham laser group (P ˂ 0.05). In this study's condition, diode PBMT reduced pain during infiltration on maxillary incisors. Anxiety experience of dental injection had no significant effect on pain perception scale (P ˃ 0.05).

Knowledge of Patients Regarding Infection Control in Dentistry: Development and Validation of a New Questionnaire.

Objectives: Assessment of patients' knowledge regarding infection control in dentistry can help professionals in the development of protocol planning to minimize the risk of disease transmission through dental procedures. The aim of this paper is to assess the knowledge level about infection control of patients presenting to the dental clinic of the School of Dentistry, Tehran University of Medical Sciences in 2020. Materials and Methods: The draft of the questionnaire was designed with eight domains regarding infection control in dentistry including the coronavirus disease-2019 (COVID-19). The content validity of the questionnaire was assessed by six experts and 10 laypersons. The reliability of the questionnaire was assessed by the test-retest method. Two-hundred and forty-four patients (over 20 years of age) were selected based on non-random convenience sampling method, and participated in this study in July 2020. According to the difficulty coefficient, differential coefficient, and the opinion of the experts about the questionnaire filled out by the participants, 24 questions were selected out of 43 for the final version. Results: The intra-rater reliability indices were ≥75% and the scale-content validity indices for relevance, simplicity, and clarity were 87.80%, 93.75% % and 93.33%, respectively. The knowledge score of patients was 76.83%±11.58% which was not correlated with the level of education, age or gender (P>0.05). Conclusion: The knowledge level of patients presenting to the dental clinic of Tehran University of Medical Scineces measured by a valid and reliable researcher-made questionnaire was acceptable about infection control.

Comparison of microleakage of an alkasite restorative material, a composite resin and a resin-modified glass ionomer

Aim: To compare the microleakage of Cention N, a subgroup of composite resins with a resin-modified glass ionomer (RMGI) and a composite resin. Methods: Class V cavities were prepared on the buccal and lingual surfaces of 46 extracted human molars. The teeth were randomly assigned to four groups. Group A: Tetric N-Bond etch-and-rinse adhesive and Tetric N-Ceram nanohybrid composite resin, group B: Cention N without adhesive, group C: Cention N with adhesive, and group D: Fuji II LC RMGI. The teeth were thermocycled between 5°-55°C (×10,000). The teeth were coated with two layers of nail vanish except for 1 mm around the restoration margins, and immersed in 2% methylene blue (37°C, 24 h) before buccolingual sectioning to evaluate dye penetration under a stereomicroscope (×20). The data were analyzed by the Kruskal-Wallis and Wilcoxon tests (α=0.05). Results: Type of material and restoration margin had significant effects on the microleakage (p<0.05). Dentin margins showed a higher leakage score in all groups. Cention N and RMGI groups showed significant differences at the enamel margin (p=0.025, p=0.011), and for the latter group the scores were higher. No significant difference was found at the dentin margins between the materials except between Cention N with adhesive and RMGI (p=0.031). Conclusion: Microleakage was evident in all three restorative materials. Cention N groups showed similar microleakage scores to the composite resin and displayed lower microleakage scores compared with RMGI

Effect of ceramic material type on the fracture load of inlay-retained and full-coverage fixed dental prostheses.

Objective: Ceramic inlay-retained fixed partial denture (IRFPD) is a conservative prosthetic option but the mechanical durability of new high strength zirconia reinforced glass ceramic FPDs is not investigated. The purpose of this study was to compare fracture load of 3-unit ceramic FPDs. Materials and methods: Extracted premolars and molars (N = 64) were used to create three test groups (IRFPDs) and one control group (full coverage FPD) (n = 8). The teeth were embedded in PMMA resin with a mesiodistal distance of 6 mm. Premolars had a distal and molars had a mesial inlay preparation (width: 3 mm; height: 4 mm) in the test groups. IRFPDs were made from a zirconia reinforced lithium silicate (VS) or a monolithic zirconia. Zirconia IRFPDs received 2 types of surface treatments: sandblasting (Zr-IRFPD) or internal coating with feldspathic porcelain (ZrC-IRFPD). Control group was made from monolithic zirconia with the same connector size and zirconia surfaces were sandblasted (Zr-FPD). All restorations were cemented using a resin luting cement. After 5000 thermo-cycles, fracture load values (N) were determined with a universal testing machine at a crosshead speed of 0.75 mm/min. Data were analyzed using 1-way ANOVA and Tukey`s post hoc test (p ˂ .05). Result: Fracture load (mean ± SD) of Zr-FPDs, Zr-IRFPDs and ZrC-IRFPDs were 672 ± 183, 672 ± 123 and 638 ± 59, respectively, being not statistically different (p > .05). VS-IRFPD exhibited statically lower values (391 ± 136). The predominant mode of failure was fracture at the connector area in all groups. Conclusion: The fracture load of 3-unit IRFPD was significantly affected by types of ceramics but the retainer design and surface treatment in Zr groups did not show a significant effect.

Degree of conversion and water sorption of self-adhesive and conventional flowable composites: an in vitro study

Aim: Self-adhesive flowable composite resins have been recently introduced to the market. Degree of conversion (DC) and water sorption (WS) are two important parameters affecting the properties of restorative materials. This study aimed to assess the DC and WS of a self-adhesive flowable composite resin in comparison with two conventional flowable composite resins. Methods: Vertise Flow (VF) self-adhesive and Tetric-N Flow (TF) and Grandio Flow (GF) conventional flowable composites were evaluated in this in vitro, experimental study. The DC (n=3) was determined by attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR). The WS (n=7) was measured after 7 days of immersion in artificial saliva accordingto ISO 4049specifications. Data were analyzed by one-way ANOVA and a post-hoc test (p<0.05). Results: VF showed the highest DC percentage (84.3%) followed by GF (72.79%) and TF (68.7%). The latter two had no significant difference (p=0.8). WS was the highest in VF (55.2 µg/mm3), and the two conventional flowable composites had a significant difference in WS (19.5 µg/mm3 in TF and 11 µg/mm3 in GF; p<0.001). Conclusions: Flowable composite resins had significant differences in DC and WS, and VF demonstrated the highest DC and WS

In Vitro Evaluation of the Effect of Different Surface Treatments of a Hybrid Ceramic on the Microtensile Bond Strength to a Luting Resin Cement.

Introduction: The aim of the present study was to investigate the effect of different surface treatments of a hybrid ceramic, Vita Enamic, on the micro-tensile bond strength (µ-TBS) to resin cement. Methods: Ten blocks (3×10×8 mm) were retrieved from the original blocks and divided into 5 groups according to the different surface treatments performed: Groups 1: 35% acid phosphoric for 60 seconds (PA); group 2: Sandblasting with 50 µm Al2 O3 particles for 10 seconds (SB); groups 3: 9.5% hydrofluoric acid for 60 seconds (HF), group 4: The Er:YAG laser (2 W, 10 Hz) (ER1), group 5: The Er:YAG laser (3 W, 10 Hz) (ER2). All treated surfaces were salinized and the blocks with similar surface treatments were bonded together using a dual-cured resin cement and light-cured. After 24-hour storage in water, the blocks were cut into beams (1 mm2). Half of the specimens in each group (n=16) were tested immediately and the rest were subjected to thermocycling between 5°C and 55°C for 6000 cycles before the µ-TBS test at a crosshead speed of 0.5 mm/min. The data were analyzed using two-way analysis of variance (ANOVA) and Tukey HSD tests and the significance level was set at 0.05. The failure mode was evaluated by using a stereomicroscope. Results: The µ-TBS was clearly influenced by surface treatment methods (P < 0.001) and thermocycling significantly decreased the bond strength values in all groups (P = 0.007). The highest value (66.07 MPa ± 11.3) was obtained for the HF groups with no thermocycling and the lowest values were observed in the laser groups with no significant difference among different irradiation parameters. Adhesive failure was mainly observed in the PA and SB groups while mixed failure was predominantly shown in the laser and HF groups. Conclusion: This study demonstrated that surface treatment of VE with HF and salinization could improve the bond strength to a dual-cured resin cement, and Er:YAG laser irradiation with the evaluated parameters did not promote the adhesion of the resin cement to VE.

The Micro-Shear Bond Strength of Various Resinous Restorative Materials to Aged Biodentine.

INTRODUCTION: The type of materials and application time of veneering restorations on calcium silicate cements are important factors which influence the interfacial properties. The aim of this study was to measure the micro-shear bond strength of a resin composite (RC) using several adhesive systems and a resin-modified glass ionomer cement (RM-GIC) to different aged Biodentine specimens. METHODS AND MATERIALS: A total of 15 Biodentine blocks were prepared and assigned to three aging periods: 12 min, one week and one month. Then they were subdivided into five sub-groups to receive cylinders of resinous materials. RC was applied using different adhesive systems: A) no adhesive B) etch and rinse C) two-step self-etch and D) universal adhesive in self-etch mode and E) RM-GIC applied directly over Biodentine. Micro-shear bond strength was measured and the data were analyzed using one-way and two-way ANOVA. The level of significance was set at 0.05. RESULT: There was significant interaction between Biodentine aging periods and resinous materials (P<0.05). The highest value was obtained in group D bonded to the recently set Biodentine. Increasing the aging period to one week resulted in increased micro-shear bond strength in all groups expect for group D. One-month incubation time led to reduced shear bond strength in group A, C and D. Micro-shear bond strength values of group E increased to the longer aged Biodentine. CONCLUSION: Group D showed the highest bond strength to freshly mixed Biodentine.

Adherence of Streptococcus Mutans to Microhybrid and Nanohybrid Resin Composites and Dental Amalgam: An In Vitro Study.

OBJECTIVES: Streptococcus mutans (S. mutans) is a cariogenic microorganism. The restorative materials which harbor a biofilm with high levels of S. mutans can accelerate the occurrence of dental caries. The purpose of this study was to evaluate the influence of different restorative materials on S. mutans colonization in a simple in-vitro biofilm formation model. MATERIALS AND METHODS: Thirteen discs of each material (nanohybrid resin composite, microhybrid resin composite, and amalgam) were prepared, polished, and sterilized in a gamma radiation chamber. The saliva-free specimens were exposed to the S. mutans bacterial suspension (0.5 McFarland) and were incubated for 4 hours. Afterwards, the specimens were rinsed and sonicated in normal saline. 10µl of the obtained suspension was cultured in a sterile blood agar medium. After 24 hours, the number of colony forming units (CFU) of S. mutans was counted. A sterility test control was considered for each group of materials. The data were analyzed by one-way ANOVA at 5% significance level. RESULTS: The means and standard deviations of the logarithmic values of the colonies on the surfaces of amalgam, microhybrid, and nanohybrid resin composites were equal to 3.76±0.64, 3.91±0.52 and 3.34±0.74, respectively. CONCLUSIONS: There were no significant differences between the restorative materials in terms of S. mutans adhesion rate. The evaluated resin composites showed comparable numbers of CFUs, which could imply the importance of the polishing procedures.

Immediate tooth replacement using fiber-reinforced composite and natural tooth pontic.

The loss and replacement of anterior maxillary teeth poses several challenges. In patients refusing implant surgery, when minimal tooth reduction is desired, a fiber-reinforced composite fixed-partial denture may be used as a conservative alternative to a conventional fixed-partial denture for replacement of a single missing tooth. This article describes a clinical technique and six-year follow-up. The patient presented with a missing maxillary central incisor due to localized juvenile periodontitis. The abutment teeth were clinically stable. The advantage of supragingival margins and minimal tooth structure removal made the bonded bridge with a natural tooth pontic a viable procedure for this compromised restorative situation.

Temperature rise and degree of photopolymerization conversion of nanocomposites and conventional dental composites.

The aim of the study was to investigate the temperature rise of a nanocomposite and a conventional hybrid dental composite during photopolymerization when cured with halogen curing lamp (QHT) and light-emitting diode (LED). Temperature rise during photopolymerization of two commercially available composites (Filtek Supreme(R) and TetricCeram) were measured using a K-type thermocouple and a digital thermometer. Different curing modes were utilized to cure the composites: a high-intensity QHT unit (Optilux 501) in two different modes (standard and ramp), a low-intensity QHT unit (Coltolux 50), and an LED unit (Ultralume-2). Total temperature rise, polymerization reaction exotherm, and irradiation-induced temperature rise of the composites were determined. Degree of conversion of the specimens was measured using FTIR spectroscopy. The results revealed that the Filtek Supreme nanocomposite showed lower temperature rise and degree of conversion in comparison with the hybrid composite (p < 0.05). It was also found that the LED curing unit induced considerable total and irradiation temperature rise without any improvement in the degree of conversion. Ramp curing mode showed lower temperature rise and delayed gel point and was found to be more effective than QHT standard mode and LED units. Although it is claimed that the LED curing units exhibit lower temperature rise during the photopolymerization, the present study showed that the curing units have no advantage over the conventional QHT units regarding the temperature rise and degree of polymerization conversion.