Effectiveness of adhesive containing MDPB: A practice-based clinical trial.

OBJECTIVES: This prospective practice-based trial assessed the longevity of composite restorations made with an adhesive containing an antibacterial monomer compared to a conventional adhesive. METHODS: 9 general practices in the Netherlands were provided with two composite resin adhesives, each for a period of 9 months. Adhesive P contained the quaternary ammonium salt MDPB, and Adhesive S was a control. Patient's age and caries risk, as well as tooth type/number, reason for restoration placement, used restorative material and adhesive, and restored surfaces were recorded. All interventions carried out on these teeth in the 6 years after restoration were extracted from the electronic patient records, along with their date, type, reason, and surfaces. Two dependent variables were defined: general failure, and failure due to secondary caries. All data handling and multiple Cox regression analysis were carried out in R 4.0.5. RESULTS: 11 dentists from 7 practices made 10,151 restorations over a period of two years in 5102 patients. 4591 restorations were made with adhesive P, whereas 5560 were made with adhesive S. The observation period was up to 6.29 years, median observation time was 3.74 years. Cox regression showed no significant difference between the two adhesive materials when corrected for age, tooth type and caries risk, for general failure nor failure due to caries. SIGNIFICANCE: No difference in restoration survival could be shown between composite restorations made using an adhesive containing MDPB and control. Restorations made with the adhesive containing MDPB also did not fail more or less frequently due to secondary caries. This trial is registered on clinicaltrials.gov with identifier NCT05118100.

[The anticaries effect of antibacterial bonding in vitro is lost with aging]. / Het cariësremmende effect van antibacteriële bonding in vitro gaat verloren door veroudering.

This in vitro study investigated whether aging of restorative materials influences secondary caries development. The research question was whether antibacterial bonding maintained its effectiveness after aging. 60 enamel-dentine blocks were restored using 3 different restorative materials (n = 20 per material): composite with conventional bonding, composite with antibacterial bonding and amalgam. Half of the samples in each group (n = 10) were artificially aged through exposure to a sucrose biofilm model. Lesion depth was subsequently measured using transversal microradiography. Aging led to deeper lesions in the composite with antibacterial bonding group (CAB), compared to fresh samples. These fresh samples showed lesions less deep than fresh samples of composite with conventional bonding. After aging, this effect was absent. Within the limitations of this short-term in vitro study, it can be concluded that aging of restorative materials can influence caries progression. Antibacterial bonding materials lose their effectiveness over time.

The effect of occlusal loading on cervical gap deformation: A 3D finite element analysis.

OBJECTIVES: Secondary caries can be accelerated by hydrodynamic flow in a gap between the tooth and restorative material. This study investigated whether occlusal loading can lead to increased hydrodynamic flow by deforming a gap between tooth and restorative material. METHODS: 3D finite element analysis was employed to model a molar containing a restoration with an interfacial gap. The model was loaded using direct cusp-to-restoration contact and using a rubber tube model simulating a food bolus. The object exerting pressure was moved across the molar from buccal to lingual side. The applied forces were 50, 100, 200 and 400N. The elastic modulus of the restoration material was varied between 5, 10, 15.9 and 25GPa to resemble different kinds of composite. The primary outcome parameter was the volume of the gap under occlusal pressure. RESULTS: Occlusal loading resulted in deformation of the gap area. Maximum deformation was seen when loading was applied in the middle of the restoration. Higher forces and lower restoration stiffness led to more deformation of the gap. Maximum deformation with a force of 100N and composite modulus of 15.9GPa was -0.0083mm3 (1.12%). SIGNIFICANCE: Deformation of the gap between tooth and restorative material could lead to increased hydrodynamic flow and faster secondary caries lesion formation. The measured deformation is small. Further research needs to show whether gap compression through occlusal loading affects secondary caries formation to a clinically relevant degree.

A threshold gap size for in situ secondary caries lesion development.

OBJECTIVES: This study investigated the influence of very small gaps in secondary caries (SC) development and additionally linked the threshold gap size with the caries activity level from volunteers. METHODS: For 21 days, 15 volunteers wore a modified occlusal splint loaded with dentin-composite samples restored with different interfaces: bonded (B = samples restored with complete adhesive procedure), no-bonded (NB = restored with composite resin without adhesive procedure), and 30, 60 and 90 µm (no adhesive procedure and with intentional gap). The splint was dipped in a 20% sucrose solution (10 min) 8 x per day. Samples were imaged with transversal wavelength independent microradiography (T-WIM) and lesion depth and mineral loss were calculated. Average wall lesion depth from each volunteer was determined and according to the values the volunteers were grouped as high, mid and low caries activity levels. RESULTS: No wall lesion formation was observed in B and NB groups. In general, intentional gaps led to SC lesion depth progression independent of caries activity level of volunteers. No substantial wall lesions were found for two volunteers. A trend for deeper lesion in larger gaps was observed for the high activity group. CONCLUSION: Very small gaps around or wider than 30 µm develop SC independent of the caries activity level of the patient and SC wall lesion progression seemed to be related to individual factors even in this standardized in situ model. SIGNIFICANCE: Independently of caries activity level of the patient, the threshold gap size for secondary caries wall lesion seems to be 30 µm at most.

Secondary caries development and the role of a matrix metalloproteinase inhibitor: A clinical in situ study.

OBJECTIVES: This in situ study aimed to investigate whether the dentin treatment with MMPs inhibitor (CHX 2%) could influence the development of secondary caries wall lesions in different dentin-composite interfaces. MATERIAL AND METHODS: For 21 days, 15 volunteers wore a modified-occlusal splint loaded with dentin-composite samples treated or not with CHX and restored according 4 different interface conditions: Bonding (B = samples restored with complete adhesive procedure), no bonding (NB = restored with composite resin without adhesive procedure), 100 µm (no adhesive procedure and with intentional gap) and 100 µm + B (adhesive material on composite side and intentional gap). Eight times per day, the splint with samples was dipped in a 20% sucrose solution for 10 min. Before and after caries development, samples were imaged with T-WIM and lesion depth (LD) and mineral loss (ML) were calculated. RESULTS: Linear mixed effect analysis showed that dentin treatment with CHX did not significantly affect the caries lesion progression (LD and ML; p ≤ 0.797). Dentin wall lesions were observed in the 100 µm and 100 µm + B groups independently of MMP inhibitor treatment. CONCLUSION: The treatment of dentin with MMP inhibitor was not able to slow down the secondary caries wall lesion development in this in situ study. SIGNIFICANCE: The dentin treatment with 2% CHX did not prevent secondary caries wall lesion initiation.

[Preventive dentistry 5. Secondary caries]. / Preventieve tandheelkunde 5. Secundaire cariës.

Secondary caries is reported as one of the most important reasons for replacing restorations. The patient's general caries risk plays an important role in the development of secondary caries. The connection, at the patient level, between various factors, the risk of caries and restoration factors, such as the presence of a gap and the kind of restoration material, deserves additional investigation. The minimum gap width in which secondary caries can develop is most likely less than 100 µm and could depend on the patient's caries risk. Composite restorations seem more susceptible to secondary caries than amalgam restorations in patients with high caries risk. So far, there is no unambiguous explanation for this difference. The prevention of secondary caries is comparable to that of primary caries and stresses the importance of fluoride, diet and oral hygiene.

Restoration materials and secondary caries using an in vitro biofilm model.

This in vitro study investigated whether restoration materials and adhesives influence secondary caries formation in gaps using a short-term in vitro biofilm model. Sixty enamel-dentin blocks were restored with 6 different restoration materials with or without adhesives (n = 10 per group) with a gap: 1) Clearfil AP-X composite, 2) Clearfil AP-X composite + SE Bond, 3) Clearfil AP-X composite + ProtectBond, 4) Filtek Silorane composite, 5) Filtek Silorane composite + Silorane System adhesive, or 6) Tytin amalgam. Specimens were subjected to an intermittent 1% sucrose biofilm model for 20 days to create artificial caries lesions. Lesion progression in the enamel-dentin next to the different materials was measured in lesion depth (LD) and mineral loss (ML) using transversal wavelength independent microradiography (T-WIM). A regression analysis was used to compare the LD and ML of the different restoration materials at 4 measurement locations: 1 location at the surface of the enamel, 1 location at the wall of the enamel, and 2 locations at the wall of the dentin. A statistically significant effect of AP-X composite with Protect Bond was found for LD and ML at the WallDentin1 location, leading to less advanced wall lesions. An additional finding was that gap size was also statistically significant at the 2 wall locations in dentin, leading to increasing lesion progression with wider gaps. In conclusion, adhesives can influence wall lesion development in gaps. Protect Bond showed significantly less caries progression compared to bare restoration materials or other adhesives in this short-term in vitro biofilm model.

Gap size and wall lesion development next to composite.

This in situ study investigated whether there is a relationship between gap size and wall lesion development in dentin next to 2 composite materials, and whether a clinically relevant threshold for the gap size could be established. For 21 days, 14 volunteers wore a modified occlusal splint containing human dentin samples with 5 different interfaces: 4 gaps of 50 µm, 100 µm, 200 µm, or 400 µm and 1 non-bonded interface without a gap. Eight times a day, the splint with samples was dipped in a 20% sucrose solution for 10 minutes. Before and after caries development, specimens were imaged with transversal wavelength-independent microradiography (T-WIM), and lesion depth (LD) and mineral loss (ML) were calculated at the 5 different interfaces. After correction for the confounder location (more mesial or distal), a paired t test clustered within volunteers was performed for comparison of gap widths. Results showed no trend for a relationship between the corrected lesion depth and the gap size. None of the differences in lesion depth for the different gap sizes was statistically significant. Also, the composite material (AP-X or Filtek Supreme) gave no statistically significant differences in lesion depth and mineral loss. A minimum gap size could not be established, although, in a non-bonded interface without a measurable gap, wall lesion development was never observed.

Hydrodynamic flow through loading and in vitro secondary caries development.

This in vitro study investigated the effect of hydrodynamic flow through mechanical loading on development of secondary caries lesions. Forty-eight bovine tooth specimens (enamel and dentin; sizes 3.2 x 3.2 x 2.0 mm) were restored with resin-composite on polystyrene bars; 18 samples were bonded, and 30 were not bonded. Specimens were suspended in a lactic acid solution (pH = 5; 14 days) in a modified brushing machine, and artificial caries lesions were formed. During caries development, specimens were mechanically loaded at the surface of the polystyrene bar, bent so that the tooth- composite interfaces were subjected to opening forces (16x/min). Loads applied were either none (Control Bonded, CB, n = 6; and Control Non-bonded, CNB, n = 6), 200 gr (NB200, n = 12), or 350 gr (NB350 and B350, both n = 12). Before and after caries development, specimens were imaged with transverse wavelength-independent microradiography (T-WIM), and lesion depth (LD) and mineral loss (ML) were calculated at 4 different locations. An independent t test was used to compare the LD and ML at the 4 different locations. A statistically significant effect of the level of loading (comparing groups NB200 and NB350) and of bonding (comparing groups NB350 and B350) could be observed, with a higher load and absence of bonding leading to more advanced lesions.

The influence of approximal restoration extension on the development of secondary caries.

OBJECTIVES: To evaluate whether occlusoproximal restorations with cervical margins apical to the cemento-enamel junction (CEJ) are more prone to failure than restorations with margins coronal to the CEJ, in particular failure due to secondary caries. METHODS: A method was developed for scoring cervical margin extension on bitewings, and validated in vitro. Records from patients with at least one occlusoproximal restoration replaced due to secondary caries were selected from an existing database. Cervical margins of approximal restoration sites were scored on bitewings in relation to the CEJ (supra vs. sub CEJ). For all restorations dates of placement, replacement and reason for failure were recorded. Survival times were calculated and Cox-regression analysis was applied to assess influence of selected variables on survival of restorations: extension of cervical margins, number of restored surfaces, restoration material and age of the patient. RESULTS: Records of 84 patients with 1912 restoration sites were examined, 655 failed; 399 supra CEJ and 256 sub CEJ. 257 restorations failed because of secondary caries. Restorations ending below the CEJ showed significantly increased risk for failure (HR=1.28, p=0.020), however, no relation with secondary caries was found (p=0.130). Amalgam restorations showed decreased risk for secondary caries (HR=0.51, p<0.001). CONCLUSION: Occlusoproximal restorations with cervical margins apical to the CEJ do not fail more often due to secondary caries. However, those restorations did show larger risk of failure overall compared to restorations with margins coronal to the CEJ. Resin composite restorations showed increased risk for secondary caries compared to amalgam restorations. CLINICAL SIGNIFICANCE: Within the limitations of this study, no association was found clinically between extension of restoration margins below the CEJ and the occurrence of secondary caries.