Influence of fluoride-releasing materials in the inhibition of enamel and dentin demineralization around restorations / Influência de materiais liberadores de flúor na inibição da desmineralização do esmalte e da dentina ao redor de restaurações

Objective: The aim was to evaluate the influence of fluoride-releasing restorative materials in enamel and dentin microhardness. Material and Methods: 40 blocks (5x5x3 mm) from cervical third of human molars received a cavity preparation between the enamel and dentin, and the restorations were subjected to in vitro caries model. Specimens were randomly restored with (n=10): conventional glass ionomer cement (Ketac Cem, 3M ESPE); polyacid-modified composite resin (Ionoseal, VOCO); resin-modified glass ionomer cement (Ionofast, Biodinâmica); or microhybrid composite resin (Filtek Z250, 3M ESPE). The specimens were sectioned longitudinally and enamel and dentin Knoop microhardness were determined at different distances from the restorative material (100, 200 and 300 µm) and depth of surface (20, 40 and 60 µm). The data were submitted to three-way repeated measures ANOVA and Tukey ́s test ( α =0.05). Results: For enamel, the double interactions between material x distance and material x depth were statistically significant. In all depths and distances, the highest values of enamel microhardness were observed for Ketac Cem. In dentin, the materials differed statistically from each other, and Ionoseal obtained higher microhardness values than those found in Ionofast. Conclusion: Conventional glass ionomer cement is more effective in preventing enamel demineralization around restoration followed by the polyacid-modified composite resin. In dentin, the polyacid-modified composite resin obtained better performance than resin-modified glass ionomer cement. (AU)

Objetivo: O objetivo foi avaliar a influência de materiais restauradores liberadores de flúor na microdureza do esmalte e da dentina. Material e Métodos: 40 blocos (5x5x3 mm) do terço cervical de molares humanos receberam preparo cavitário entre esmalte e dentina, e após a restauração foram submetidas a um modelo in vitro de cárie. As amostras foram restauradas aleatoriamente com (n=10): cimento de ionômero de vidro convencional (Ketac Cem, 3M ESPE); resina composta modificada por poliácidos (Ionoseal, VOCO); cimento de ionômero de vidro modificado por resina (Ionofast, Biodinâmica); ou resina composta microhíbrida (Filtek Z250, 3M ESPE). As amostras foram seccionadas longitudinalmente e a microdureza Knoop de esmalte e dentina foi determinada em diferentes distâncias do material restaurador (100, 200 e 300 µm) e profundidade de superfície (20, 40 e 60 µm). Os dados foram submetidos à ANOVA para medidas repetidas de três fatores e teste de Tukey (α =0,05). Resultados: Para o esmalte, as duplas interações entre material x distância e material x profundidade foram estatisticamente significativas. Em todas as profundidades e distâncias, os maiores valores de microdureza do esmalte foram observados para o Ketac Cem. Na dentina, Ionoseal obteve valores de microdureza superiores aos encontrados no Ionofast. Conclusão:O cimento de ionômero de vidro convencional é mais eficaz na prevenção da desmineralização do esmalte ao redor da restauração, seguido pela resina composta modificada por poliácidos. Na dentina, a resina composta modificada por poliácidos obteve melhor desempenho que o cimento de ionômero de vidro modificado por resina. (AU)

Low- and high-viscosity bulk-fill resin composites / Resinas compostas bulk-fill de baixa e alta viscosidade

ABSTRACT The aim of this study was to compare low- and high-viscosity bulk-fill composites for Knoop microhardness (KHN), microtensile bond strength (MTBS) to dentin in occlusal cavities, and fracture strength (FS) in molars with mesialocclusal- distal restoration. Disk-shaped samples with different thicknesses (2 or 4 mm) of low-viscosity (SDR Flow, Dentsply) and high-viscosity bulk-fill composites (Filtek BulkFill, 3M ESPE; and Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) were prepared for top and bottom KHN analysis (n=10). MTBS to dentin and fracture pattern was evaluated in human molars with occlusal cavities restored with (n=10): conventional nanocomposite (Z350XT, 3M ESPE), low-viscosity (Filtek Bulk-fill Flow, 3M ESPE) or high-viscosity bulk-fill composites (Filtek BulkFill). The FS and fracture pattern of human molar with mesial-occlusal-distal restorations submitted or not to thermomechanical cycling were investigated (n=10) using: intact tooth (control), and restoration based on conventional microhybrid composite (Z250, 3M ESPE), low-viscosity (SDR Flow) or high-viscosity bulk-fill composites (Filtek BulkFill). The data were submitted to split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) followed by Tukey's test (α=0.05). For KHN, there was no significant difference for the resin composites between the top and bottom. For MTBS, no significant differences among the materials were detected; however, the low-viscosity composite presented lower frequency of adhesive failures. For FS, there was no significant difference between composites and intact tooth regardless of thermomechanical cycling. Low- and high-viscosity bulk-fill composites have comparable microhardness and microtensile bond strength when used in occlusal restorations. Likewise, the bulk-fill composites present similar fracture strength in molars with mesio-occlusal-distal restorations.

RESUMO O objetivo deste estudo foi comparar resinas compostas bulk- -fill de baixa e alta viscosidade quanto à microdureza Knoop (KHN), resistência de união a microtração (MTBS) em cavidades oclusais e carga à fratura (FS) em molares com restauração mesio-oclusal-distal. Amostras em forma de disco com diferentes espessuras (2 ou 4 mm) de resinas bulk-fill de baixa viscosidade (SDR Flow, Dentsply) e alta viscosidade (Filtek BulkFill, 3M ESPE; e Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) foram obtidas para análise de KHN no topo e na base (n = 10). A MTBS em dentina e o padrão de fratura foram avaliados em molares humanos com cavidades oclusais restauradas com (n = 10): resina composta nanoparticulada convencional (Z350XT, 3M ESPE), resinas bulk-fill de baixa viscosidade (Filtek Bulk-fill Flow, 3M ESPE) ou alta viscosidade (Filtek BulkFill). Foram investigados a FS e o padrão de fratura de molares humanos em restaurações mesial-ocluso-distais sub metidas ou não à ciclagem termomecânica (n = 10), sendo: dente íntegro (controle), e restaurações baseadas em resina composta microhíbrida convencional (Z250, 3M ESPE); resinas bulk-fill de baixa viscosidade (SDR Flow) ou alta viscosidade (Filtek BulkFill). Os dados foram submetidos a split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) seguidos do teste de Tukey (α = 0,05). Para KHN, não houve diferença significativa entre o topo e a base para as resinas compostas. Para MTBS, não foram detectadas diferenças significativas entre os materiais; entretanto, a resina bulk-fill de baixa viscosidade apresentou menor frequência de falhas adesivas. Para FS, não houve diferença significativa entre os materiais e o dente íntegro, independentemente da ciclagem termomecânica. As resinas bulk-fill de baixa e alta viscosidade têm microdureza e resistência à microtração comparáveis quando usados em restaurações oclusais. Da mesma forma, as resinas bulk-fill apresentam resistência à fratura semelhante em molares com restaurações mesio-oclusal-distais.

Effect of sucralfate against hydrochloric acid-induced dental erosion.

OBJECTIVE: Devising effective measures for the prevention of hydrochloric acid (HCl)-induced erosion is of great significance. This is even more important in dentine, in which products have limited diffusion. Therefore, agents that can bind to proteins forming an acid-resistant gel-like coat, such as sucralfate, may stand out as a promising alternative. This study investigated the protective effect of sucralfate suspensions against HCl-induced dental erosion. MATERIALS AND METHODS: In the first experiment, hydroxyapatite (HAp) crystals were pre-treated with a commercial sucralfate suspension (CoSS, pH 5.9), a stannous-containing sodium fluoride solution (NaF/SnCl2 pH 4.5), two prepared sucralfate suspensions (PrSS, pH 5.9 and 4.5), or deionized water (DI, control). HAp dissolution was measured using a pH-stat system. In a subsequent experiment, embedded/polished enamel and root dentine slabs were allocated into five groups to be treated with one of the tested substances prior to and during erosion-remineralization cycles (HCl-2 min + artificial saliva 60 min, two times per day, 5 days). Surface loss was assessed profilometrically. Data were analyzed by ANOVA and Tukey's tests. RESULTS: HAp dissolution was as follows: NaF/SnCl2 < CoSS < PrSS/pH 4.5, while PrSS/pH 5.9 = DI and both did not differ from CoSS and PrSS/pH 4.5. In enamel, surface loss did not differ between CoSS and PrSS/pH 4.5, with both having lower surface loss than PrSS/pH 5.9 and DI and NaF/SnCl2 differing only from DI. In root dentine, surface loss was as follows: CoSS < PrSS/pH 5.9 < (NaF/SnCl2 = DI), while PrSS/pH 4.5 = CoSS = PrSS/pH 5.9. CONCLUSION: Sucralfate suspension provided anti-erosive protection to HCl-induced erosion. CLINICAL RELEVANCE: Sucralfate may protect teeth against erosion caused by gastric acid.

Oval Versus Circular-Shaped Root Canals: Bond Strength Reached with Varying Post Techniques.

The aim of this study was to compare the bond strength (BS) of glass fiber posts (GFP) luted to oval and circular-shaped root canals rehabilitated using varying post techniques, at different intraradicular levels. Ninety 16-mm-long roots of human mandibular premolars, classified either as having oval or circular-shaped canals, were endodontically treated and prepared for restoration using one of three different post techniques (n=15): 1) single GFP; 2) resin-relined GFP; 3) main GFP associated with accessory posts. GFPs were luted with a dual polymerizing resin cement (RelyX ARC) after the canal had been treated with a 3-step etch-and-rinse adhesive system (Adper Scothbond Multipurpose). The samples were sectioned into three 1-mm-thick sections, which were differentiated by the root level (cervical, middle and apical) and tested for push-out BS. Assessment of failure mode was made under a stereomicroscope. Data were analyzed using repeated measures three-way ANOVA and Tukey's test. The root canal cross-section had a significant influence on BS (p<0.001), with the lowest values being observed in oval-shaped canals. The post technique also significantly affected the BS (p=0.018), with the resin-relined GFPs providing the highest BS values in both oval and circular-shaped canals. Irrespective of the cross-section of the root canal and post technique, there was no significant difference in BS in the cervical, middle and apical third of the root canal (p=0.084). In oval-shaped canals, the BS to intraradicular dentin at cervical, middle or apical level could be increased when the GFPs posts were relined.

Oval versus circular-shaped root canals: bond strength reached with varying post techniques

Abstract The aim of this study was to compare the bond strength (BS) of glass fiber posts (GFP) luted to oval and circular-shaped root canals rehabilitated using varying post techniques, at different intraradicular levels. Ninety 16-mm-long roots of human mandibular premolars, classified either as having oval or circular-shaped canals, were endodontically treated and prepared for restoration using one of three different post techniques (n=15): 1) single GFP; 2) resin-relined GFP; 3) main GFP associated with accessory posts. GFPs were luted with a dual polymerizing resin cement (RelyX ARC) after the canal had been treated with a 3-step etch-and-rinse adhesive system (Adper Scothbond Multipurpose). The samples were sectioned into three 1-mm-thick sections, which were differentiated by the root level (cervical, middle and apical) and tested for push-out BS. Assessment of failure mode was made under a stereomicroscope. Data were analyzed using repeated measures three-way ANOVA and Tukey's test. The root canal cross-section had a significant influence on BS (p<0.001), with the lowest values being observed in oval-shaped canals. The post technique also significantly affected the BS (p=0.018), with the resin-relined GFPs providing the highest BS values in both oval and circular-shaped canals. Irrespective of the cross-section of the root canal and post technique, there was no significant difference in BS in the cervical, middle and apical third of the root canal (p=0.084). In oval-shaped canals, the BS to intraradicular dentin at cervical, middle or apical level could be increased when the GFPs posts were relined.

Resumo O objetivo deste estudo foi comparar a resistência de união (RU) de pinos de fibra de vidro (PFV), cimentados a condutos com secção transversal ovalada ou circular reabilitados com diferentes técnicas de restauração com PFVs, em função do nível intrarradicular. Noventa raízes de pré-molares inferiores humanos, com 16 mm de altura, classificadas como possuindo canais ovais ou circulares, foram tratadas endodonticamente e preparadas para serem reabilitadas com uma das três técnicas de restauração com PFVs (n=15): 1) PFV único, 2) PFV reembasado com resina composta, e 3) PFV principal associado a pinos acessórios. Os PFVs foram cimentados com um agente resinoso de polimerização dupla (RelyX ARC), após o canal ter sido tratado com um sistema adesivo de condicionamento total de três passos (Adper Scothbond Multiuso). As amostras foram seccionadas em três fatias de 1 mm de espessura, de acordo com o nível da raiz (cervical, médio e apical)e foram submetidas ao teste de RU por push-out. A análise do modo de falha foi realizada com auxílio de um estereomicroscópio. Os dados foram analisados utilizando-se a ANOVA a três critérios para medidas repetidas e o teste de Tukey. A secção do conduto apresentou influência na RU (p<0,001), com os menores valores sendo observados nos condutos ovalados. A técnica de restauração com PFVs afetou significativamente a RU (p=0,018), tendo o PFV reembasado proporcionado os maiores valores de RU, tanto em condutos ovais quanto circulares. Independentemente da secção transversal do conduto radicular e da técnica de restauração com PFV, não houve diferença significativa na RU nos terços cervical, médio e apical (p=0,084). Nos canais de secção transversal ovalada, a RU à dentina intrarradicular nos níveis cervical, médio ou apical aumentou com o emprego de PFVs reembasados.

Dental bleaching with ozone: effects on color and enamel microhardness / Clareamento dental com ozônio: efeitos na cor e na microdureza do esmalte

The aim of this in vitro study was to evaluate the effects of dentalbleaching with ozone (O3) on color change and enamelmicrohardness. Enamel blocks (3 x 3 x 3mm) were randomlydistributed for treatments (n=10). Color change (ΔE) and Knoopmicrohardness of the enamel blocks were evaluated before andafter the following treatments: C – deionized water (control); HP– 37.5% hydrogen peroxide (Pola Office+/ SDI); PLA – placebogel; O3– ozone; and O2– oxygen. Four 8-minute applicationswere used for HP and PLA, and one 19-minute application for O3and O2.One-way ANOVA revealed that ΔE was not significantlyinfluenced by the treatment (p = 0.112). For the treatments withHP, PLA, O3 and O2, ΔE was greater than 3.3. The paired t testshowed significant decrease in microhardness after treatments (p< 0.001) but no significant difference between treatments(ANOVA; p = 0.313). Dental bleaching treatments with O3, HP,O2and PLA induced enamel color changes that may be clinicallydiscernible, although enamel microhardeness decreased.

O objetivo deste estudo in vitro foi avaliar os efeitos doclareamento dental com ozônio (O3) quanto à alteração de core microdureza do esmalte. Blocos de esmalte (3 x 3 x 3mm)foram aleatoriamente distribuídos entre os tratamentos(n=10). Alteração de cor (ΔE) e microdureza Knoop foramavaliados antes e após cada um dos seguintes tratamentos: C– água deionizada (controle); PH – peróxido de hidrogênio a37,5% (Pola Office+/ SDI); PLA – gel placebo; O3– ozônio;O2– oxigênio. Quatro aplicações de PH e PLA foramrealizadas por 8 minutos cada e uma aplicação de O3e O2foram realizados por 19 minutos em cada bloco de esmalte.ANOVA a um critério mostrou que os valores de ΔE não foramsignificativamente influenciados pelo tratamento (p = 0,112).Para os tratamentos com PH, PLA, O3 e O2, o ΔE foi maior que3,3. O teste t pareado mostrou diminução significativa dosvalores de microdureza no final do tratamento quandocomparado com o tempo baseline (p < 0,001), mas não houvediferença significativa entre os tratamentos (ANOVA; p =0,313). O tratamento com O3, PH, O2e PLA levou a alteraçãode cor do esmalte clinicamente perceptível, embora tenha sidoobservada diminuição da microdureza do esmalte com arealização dos tratamentos.

Calcium lactate pre-rinse increased fluoride protection against enamel erosion in a randomized controlled in situ trial.

OBJECTIVES: This in situ trial study was designed to evaluate whether calcium (Ca) pre-rinse would increase the fluoride (F) rinse protection against enamel erosion. METHODS: Fifteen volunteers participated in this split-mouth, 3-phase, crossover design study wearing a palatal appliance containing four sterilized bovine enamel slabs, for 10 days. In the 1st phase, five participants followed protocol A: daily rinse with a Ca lactate (CaL, 150mmol/L, 1min), followed by F (NaF 12mmol/L, 1min). Other five participants followed protocol B: daily rinse only with F, while the remainders followed protocol C: no rinse (negative control). Appliances were removed from the mouth and one side of the palatal appliance was exposed to a daily erosive challenge (0.05M citric acid, 90s); the other side served as control (deionized water - no erosion). In the 2nd phase volunteers were crossed over to other protocol and in the 3rd phase volunteers received the remaining protocol not yet assigned. Specimens were evaluated for surface loss using an optical profilometer. RESULTS: Repeated-measures three-way ANOVA (p=0.009) and Tukey's test showed that CaL pre-rinse followed by NaF rinse significantly decreased surface loss of enamel when performed prior to an erosive challenge in comparison with the condition in which NaF only was used. CONCLUSIONS: Pre-rinse with CaL may increase the protection exerted by NaF against erosive wear.

Role of lubricants on friction between self-ligating brackets and archwires.

OBJECTIVE: To evaluate the effect of different lubricants on friction between orthodontic brackets and archwires. MATERIALS AND METHODS: Active (Quick, Forestadent) and passive (Damon 3MX, Ormco) self-ligating brackets underwent friction tests in the presence of mucin- and carboxymethylcellulose (CMC)-based artificial saliva, distilled water, and whole human saliva (positive control). Dry friction (no lubricant) was used as the negative control. Bracket/wire samples (0.014 × 0.025 inch, CuNiTi, SDS Ormco) underwent friction tests eight times in a universal testing machine. RESULTS: Two-way analysis of variance showed no significant interaction between bracket type and lubricant (P  =  .324). Friction force obtained with passive self-ligating brackets was lower than that for active brackets (P < .001). Friction observed in the presence of artificial saliva did not differ from that generated under lubrication with natural human saliva, as shown by Tukey test. Higher friction forces were found with the use of distilled water or when the test was performed under dry condition (ie, with no lubricant). CONCLUSION: Lubrication plays a role in friction forces between self-ligating brackets and CuNiTi wires, with mucin- and CMC-based artificial saliva providing a reliable alternative to human natural saliva.

Counteractive effect of antacid suspensions on intrinsic dental erosion.

This in vitro study aimed to investigate the anti-erosive effect of antacid suspensions applied to enamel after exposure to hydrochloric acid (HCl). Ninety bovine enamel slabs were embedded, flattened, and polished. Reference areas were created and specimens were divided into six groups. They were exposed to 0.01 M HCl (pH 2) for 2 min, followed by immersion for 1 min in one of the following test suspensions: magnesium hydroxide, aluminum hydroxide, magnesium hydroxide/aluminum hydroxide, sodium alginate/sodium bicarbonate/calcium carbonate, or hydrated magnesium aluminate. Artificial saliva was used as a negative control. Specimens were subjected to a total of five cycles of erosion/antacid treatment. Enamel surface loss was measured (in micrometers) by optical profilometry. In addition, baseline and final surface microhardness (SMH) values of enamel were obtained. It was found that antacid suspensions significantly reduced enamel loss, and that similar protection was afforded by all formulations. No differences were observed between the final enamel SMH values among groups. Antacid suspensions counteracted HCl-induced enamel loss, although they were not effective in reducing enamel softening. Mouth rinsing with antacid suspensions after vomiting can potentially represent a promising strategy to counteract enamel loss caused by erosion.

Assessment of in vitro methods used to promote adhesive interface degradation: a critical review.

UNLABELLED: One factor that has a great influence on clinical performance of dental restorations is their resistance to degradation. Morphological changes in the structure of tooth-restoration interface aged in the oral environment have been reported. However, even though the in vivo performance is the ultimate testing environment for predicting the behavior of restorations because of the complexity of intraoral conditions, in vitro models such as thermocycling, mechanical loading, pH cycling, and aging of materials in distilled water, NaOCl, and food-simulating solutions may provide important information about the fundamental mechanisms involved in resin-tooth interface degradation. Most recently, the effect of host-derived enzymes and the storage in deproteinizing solutions (such as aqueous NaOCl) on the degradation of resin-dentin bonds has also been described. This review considers the importance of these in vitro methods on bond durability interface in an attempt to understand the behavior of restoratives over time. The first section is focused on the mechanism of in vivo biodegradation, whereas the second looks at studies that have described the influence of water storage, NaOCl storage, host-derived matrix metalloproteinases, thermocycling, mechanical loading, pH cycling, and food-simulating solutions on the degradation of the adhesive interface. It is obvious that these methodologies do not occur separately in the oral cavity, but that each one has a specific importance in the mechanisms of bond degradation. CLINICAL SIGNIFICANCE: The in vitro methods used to simulate bond degradation may describe important points related to the clinical performance of restorations. This article evaluates the mechanism of the in vivo biodegradation of adhesive interfaces as well as the influences that various testing methods have on these bonds.