The glass-ionomer phase in resin-based restorative materials.

Glass-ionomer (GI) fillers are added to restorative materials, but it is unclear if they truly react with these materials. This TEM study evaluated the existence of the GI phase in a conventional GIC (ChemFlex), a resin-modified GIC (Fuji II LC), a giomer (Reactmer Paste), a compomer (Dyract AP), and a composite (SpectrumTPH), before and after water uptake. Wafers were stored at 100% RH for 24 hrs, or in water for 7 or 84 days. ChemFlex glass particles were surrounded by 300-nm-thick silica gel layers. In Fuji II LC, we found thinner hydrogel layers (100 nm) that became thicker upon water storage. No appreciable change occurred in Reactmer Paste. Only a very thin hydrogel layer occurred in Dyract AP, and none was seen in SpectrumTPH after water storage for 84 days. We conclude that the variable extent of the GI phase is determined by differences in the resin composition of the restoratives.

An ultrastructural study of the influence of acidity of self-etching primers and smear layer thickness on bonding to intact dentin.

PURPOSE: The objectives of this study were (1) to determine the depth of demineralization into intact dentin using several self-etching primer systems with different pH values, and (2) to evaluate whether hybridization of intact dentin in Clearfil SE Bond may be affected by variation in the thickness of the smear layers. MATERIALS AND METHODS: Dentin disks were created from mid-coronal dentin in extracted, human third molars. Three self-etching primer systems (Clearfil Liner Bond II, Liner Bond 2V, and SE Bond) were applied separately to these disks to evaluate how deep self-etching systems penetrate through smear layers into intact dentin. Dentin treated with All-Bond 2 using the "no-etch" technique was used as a control group. In the second part of the study, dentin disks with different smear-layer thicknesses were produced. The cryofractured control group was devoid of a smear layer. The experimental teeth were ground with 60-, 180-, or 600-grit SiC paper and bonded using SE Bond. Dentin disks were bonded together and examined with TEM. RESULTS: All-Bond 2 did not etch beyond the smear layer. The three self-etching primers etched beyond the smear layer to form true hybrid layers within intact dentin. This layer was thickest with Liner Bond 2 (ca 1.2 to 1.4 microns), but very thin (0.5 micron) using both Liner Bond 2V and SE Bond. Application of SE Bond to dentin of different surface roughness produced hybridized smear layers of variable thickness. However, the thickness of the underlying true hybrid remained consistent for the four groups (ca 0.4 to 0.5 micron). CONCLUSION: Self-etching primers create thin hybrid layers that incorporate the smear layer. The suspicion that thick smear layers may interfere with the diffusion of self-etching primers into the underlying intact dentin was not confirmed.

Regional measurement of resin-dentin bonding as an array.

During the development of the microtensile bond-testing method, large variations in bond strengths were noted among serial sections. The reason for these variations is unknown. The purpose of this work was to determine the consistency of resin-dentin bond strengths across the occlusal surface of coronal dentin by dividing composite resin buildups into an array of 1x1 mm beams, the top half consisting of composite resin, and the bottom half consisting of dentin. Extracted human third molars had the occlusal enamel removed as a single section by means of a diamond saw. Resin composite buildups were made after the dentin was bonded with either One-Step or MacBond. After being stored in 37 degrees C water for 1 day, the teeth were vertically sectioned at 1-mm increments into slabs of bonded teeth. Each slab was further subdivided by vertical sections into 1x1x8 mm beams. Each beam was assigned an x-y coordinate and tested for tensile bond strength. Two different clinicians (A and B) performed the same procedures using One-Step in a parallel study. Using One-Step, clinician A obtained a large number of zero bonds in superficial dentin but fewer in deep dentin. This resulted in a very large standard deviation in bond strengths (mean +/- SD of 22+/-20 MPa in superficial dentin and 27+/-14 MPa in deep dentin). Clinician B obtained much higher (p<0.001) and more uniform bond strengths with One-Step (56+/-13 MPa in superficial dentin and 57+/-12 MPa in deep dentin). With MacBond, there were no zero bonds and hence less variation, with a mean of 41+/-13 MPa in superficial dentin and 27+/-12 MPa (x +/- SD) in deep dentin. When pairs of Z100 resin composite cylinders were bonded together with One-Step and then sectioned into an array, there was little variation in regional bond strength (37 +/-1 MPa). Dividing bonded resin composite buildups into an array of 20 to 30 1x1x8 mm beams allows for the evaluation of uniformity of resin-dentin bonds. The method used in this study detected local regional differences in resin-dentin bond strengths. The largest differences were shown to be related to technique rather than to material. The results indicate that resin-dentin bonds may not be as homogenous as was previously thought.

The effects of Pain-Free Desensitizer on dentine permeability and tubule occlusion over time, in vitro.

The purpose of this in vitro study was to evaluate the efficacy of a new resin emulsion (Pain-Free Desensitizer) treatment for dentine hypersensitivity, for its ability to decrease dentine permeability. Crown segments were prepared from extracted, unerupted human 3rd molars by horizontal sectioning to remove occlusal enamel and the roots. The specimens were allocated in one of two groups: In group 1, the dentine surface was acid-etched to simulate the patent tubules of hypersensitive dentine. In group 2, the mineralized dentine surface was polished free of smear layer using a hydroxyapatite paste and ultrasonication. The hydraulic conductance of each specimen was then measured to obtain a pretreatment of control value. After a single treatment with resin desensitizer, the permeability was remeasured at 5 min, 1 day, 1 week and 1 month. Between measurements, the specimens were stored in buffer solution to simulate the solubilizing effects of saliva. Parallel specimens were followed by SEM examination. The results showed that a single treatment with resin desensitizer produced large, immediate, reductions in dentine permeability in both acid-etched and mineralized surfaces. In the acid-etched (group 1) specimens, the permeability returned to control values within 7 days, while the permeability of the group 2 specimens remained low even after 30 days of soaking. This simple treatment for occluding dentinal tubules may provide sufficient temporary reduction in dentine permeability to permit the development of natural desensitization.

Effects of HEMA on water evaporation from water-HEMA mixtures.

OBJECTIVES: The aims of this research were: (1) to determine the relative rates of evaporation of water and HEMA, and (2) to determine the effects of increasing concentrations of HEMA on the rate of evaporation of water from water and HEMA mixtures. METHODS: Ten microliters of each solution (100% H2O, 75% H2O-25% HEMA, 50% H2O-50% HEMA, 25% HEMA, 100% HEMA) were placed on the pan of a thermogravimetric analysis instrument held at 37 degrees C. The rate of spontaneous weight loss was measured as a function of time and relative humidity (RH) and compared statistically using ANOVA and Scheffé F test. RESULTS: The rate of evaporation of pure water was 32-fold higher than that of 100% HEMA. Addition of HEMA to water lowered the rate of evaporation of water from the water-HEMA mixtures in a manner that was proportional to its effect on lowering the vapor pressure of water (p < 0.05 comparing 50% HEMA with 75% HEMA). The rate of evaporation of water from water-HEMA mixtures was higher (p < 0.05) when the ambient gas was at 0% RH than when it was at 51% RH. SIGNIFICANCE: The results indicate that as water evaporates from water-HEMA mixtures, the concentration of HEMA rises because it is relatively non-volatile. This rise in HEMA concentration lowers the vapor pressure of water making it more difficult to remove the last amounts of water. This residual water may interfere with polymerization of adhesive monomers, thereby lowering the quality of the hybrid layer.

Effects of cross-sectional area on resin-enamel tensile bond strength.

OBJECTIVE: It was hypothesized that there is an inverse relationship between resin-enamel bond strength and bonded cross-sectional area, and that there are regional differences in resin-enamel bond strength. METHODS: The facial and lingual surfaces of extracted human third molars were ground down 0.3 mm using 240 grit abrasive paper and were then bonded with either Clearfil Liner Bond 2 or Scotchbond Multi-Purpose Plus adhesive systems using the manufacturer's instructions. The bonded surfaces then received a resin composite build-up. After 24 h of storage in water, the bonded teeth were vertically serially sectioned into 1.0 mm thick slabs using a diamond saw, and the bonded surface area at the resin-enamel interface was varied from 0.5 to 3.0 mm2 using a diamond saw under microscopic observation. The trimmed region was varied from the occlusal third of the facial or lingual enamel to the middle third, to the cervical third. The trimmed specimens were then glued to a Bencor Multi-T device, placed in an Instron testing machine and stressed to failure at 1 mm/min. A three-factor ANOVA was used to compare bond strengths (buccal vs. lingual, occlusal vs. middle vs. cervical-third, vs. materials). Regression analysis was used to examine the relationship between bond strength and bonded cross-sectional area for each material on occlusal enamel. RESULTS: For both bonding systems, there was a highly significant (p < 0.001) inverse exponential relationship between tensile bond strength (y axis) and bonded cross-sectional area (x axis) with y intercepts of 51 and 59 MPa for Clearfill Liner Bond 2 and Multi-Purpose Plus, respectively. Using both materials, the highest bond strengths were measured in the occlusal third, which were significantly higher (p < 0.05) than those made to cervical enamel. SIGNIFICANCE: Like resin-dentin bonds, resin-enamel bonds exhibit an inverse relationship with cross-sectional area. This relationship becomes more apparent at bonded surface areas below 2 mm2 and is probably due to reductions in the number of interfacial stress-raisers as samples are made smaller.

In vitro study on the dimensional changes of human dentine after demineralization.

Dentine rods measuring approximately 0.7 x 0.7 x 5.0 mm were prepared from dentine of extracted human third molars stored in saline containing 0.5% sodium azide at 4 degrees C until used. Forty specimens were demineralized in 10% citric acid plus 3% ferric chloride (w/w) solution for 8 h, then assigned to four groups (A, B, C and D) of 10 specimens each. Groups A and B were used to investigate volumetric changes after air-drying and further immersion in either water, an aqueous solution of 50% 2-hydroxymethylmethacrylate (HEMA) or 100% HEMA, followed by air-drying. Groups C and D were used to investigate the ability of 100% HEMA or 100% ethylene glycol to prevent shrinkage of demineralized dentine during exposure to air. Demineralization caused a small, non-significant (1.9%) reduction in dentine volume. Air-drying further reduced the volume by 65.6%. When demineralized, shrunken specimens were immersed in water for 24 h, they recovered their original demineralized volume. Immersion in 100% HEMA did not re-expand demineralized shrunken dentine. Specimens immersed in 50% HEMA yielded a 50% volume shrinkage when exposed to air for 24 h. Both 100% HEMA and 100% ethylene glycol were effective in preventing shrinkage of demineralized dentine. The technique used provided useful information about maximal dimensional changes that may occur at a microscopic level during adhesive dental restorative procedures.

Sterilization of human teeth: its effect on permeability and bond strength.

Extracted human teeth were randomly divided into three groups. Group 1 teeth were untreated and served as controls. Group 2 teeth were sterilized in a steam autoclave. Group 3 teeth were sterilized by exposure to ethylene oxide gas. Crown segments were then prepared from these teeth by resection of the roots at the CEJ and the occlusal enamel to expose a flat occlusal plane of dentin. The permeability of the dentin was determined to be similar in all three groups. The shear bond strength of Prisma Universal Bond 3 and C&B Metabond was also similar in all groups indicating that sterilization of teeth does not alter dentin permeability or bond strength.

Effects of oxalate on dentin bonding.

The purpose of this study was to determine how much topical treatment of dentin with potassium oxalate would interfere with subsequently placed dentin bonding resins. The results indicated that oxalate lowered the bond strengths of Superbond, All Bond and Scotchbond 2, but that normal bond strengths could be obtained for Superbond and All Bond after pumicing the oxalate-treated dentin.

Bond strengths to superficial, intermediate and deep dentin in vivo with four dentin bonding systems.

The shear bond strength of four dentin bonding systems which remove or modify the smear layer were measured in vivo in dog canine and molar teeth as a function of dentin depth. Dentin bond strengths were higher with cuspid teeth compared to molar teeth. Most bonding systems gave higher bonds to superficial dentin and progressively lower bond strengths deeper dentin. The highest bond strengths were obtained with Clearfil Liner Bond, followed by Superbond C&B, Scotchbond 2 and Tenure. The former two bonding systems achieved shear bond strengths to cuspids that were > 10 MPa regardless of dentin depth while the latter two systems produced bond strengths < 10 MPa. In molars, the same ranking of bonding systems was noted but the value that separated the high from the low bonds was 5 MPa.

Analyzing dental procedures performed by an HIV-positive dental student.

No evidence of HIV transmission was found between an HIV-positive dental student and 163 treated patients.

Effects of CO2 laser energy on dentin permeability.

The effect of a CO2 laser on the structure and permeability of smear layer-covered human dentin was evaluated in vitro. Three different energy levels were used (11, 113, and 566 J/cm2). The lowest exposure to the laser energy increased dentin permeability, measured as a hydraulic conductance, due to partial measured as a hydraulic conductance, due to partial loss of the superficial smear layer and smear plugs. The intermediate energy level also increased dentin permeability by crater formation, making the dentin thinner. The lack of uniform glazing of the surface of the crater, leaving its surface porous and in communication with the underlying dentinal tubules also contributed to the increase in dentin permeability seen with the intermediate laser energy. The highest laser energy produced complete glazing of the crater surfaces and sealed the dentinal tubules beneath the crater. However, it also completely removed the smear layer in a halo zone about 100-microns wide around each crater which increased the permeability of the pericrater dentin at the same time it decreased the permeability of the dentin within the crater. The combined use of scanning electron microscopy and permeability measurements provides important complementary information that is essential in evaluating the effects of lasers on dentin.

Dentin permeability: sealing the dentin in crown preparations.

Provisional restorations of full crown preparations may permit more microleakage of bacteria and their products than the final castings do. However, most investigations of the sealing qualities of cemented castings have reported that they too permit dye leakage. One approach to the problem is to seal the dentin with dentin bonding agents at the completion of the crown preparation. This study evaluated the ability of six different dentin bonding agents to seal the dentin of crown preparations of human teeth in vitro using two independent techniques. The first technique quantitated fluid filtration across dentin before and after treatment with dentin bonding agents at one hour, one day, one week, and one month and after thermocycling. The second method measured silver nitrate penetration of the thin veneers of dentin bonding agents into the dentin. Both methods correlated well with each other. The best seals were obtained with Prisma Universal Bond 2 or Superbond powder plus liquid. The worst seals were found using Gluma and Superbond liquid only. Clearfil PhotoBond, Amalgambond, and Scotchbond 2 gave intermediate results. Although the dentin bonding agents tend to accumulate on chamfers, thereby increasing their thickness to 200-300 microns, the method looks promising as a simple way to protect the pulp from the consequences of microleakage.

Permeability of normal versus carious dentin.

Although a number of reports have been published demonstrating that carious dentin is less permeable than normal dentin, these reports have been qualitative rather than quantitative. The purpose of this in vitro study was to apply a quantitative technique to the study of the permeability of carious human teeth before and after excavation, before and after removal of the smear layer and before and after preparation of a control cavity of similar size and depth in normal dentin subjected to the same measurements, for comparative purposes. Dentin permeability was measured as a hydraulic conductance. The permeability values measured at each step in the protocol were expressed as a percent of the maximum permeability of both cavities, permitting each tooth the serve as its own control. Carious lesions exhibited a slight degree of permeability (2.3 +/- 0.6% of controls) which remained unchanged after excavation of the lesions. Removal of the smear layer in the excavated carious lesions increased the permeability significantly to 6.9 +/- 3.2%. Preparation of a control cavity of the same area and depth increased the permeability slightly. Removal of its smear layer increased the permeability of the dentin 91%. These results confirm previous qualitative studies that carious dentin, even after excavation and removal of the smear layer has a very low permeability.

Amalgam buildups: shear strength and dentin sealing properties.

The retentive strength and sealing properties of amalgam buildups were compared in vitro in three groups of specimens. All teeth were prepared with flat, nonretentive surfaces. In the first group, the amalgam buildups were retained by four self-threading Minim pins. In the second group, retention was provided by a circumferential slot prepared in the dentin just inside the DEJ. The third group utilized an adhesive resin for retention. Dentin permeability was measured as a hydraulic conductance before and after placement of the amalgam buildups and before and after thermocycling. All methods of retention sealed dentin very well even in the absence of cavity varnish. The 90 degree retentive strength was: pins, 10.3 +/- 0.9 MPa; slots, 4.1 +/- 0.5 MPa; resin, 3.1 +/- 0.8 MPa (mean +/- SEM).

Dentin permeability and restorative dentistry: a status report for the American Journal of Dentistry.

Most dental materials permit of microleakage because oral fluids and bacteria commonly gain access to dentin surfaces. Dentin is permeable and allows the bidirectional movement of materials from the oral cavity, across dentin to the pulp and vice versa. The pupal irritation associated with microleakage is often dictated by the permeability of dentin. Thick dentin covered with a smear layer is a better barrier than thin dentin with the smear layer removed, while coronal dentin is more permeable than root dentin. Carious dentin is less permeable than normal dentin, but freshly cut dentin is more permeable than previously prepared dentin. This is partly due to the movement of large plasma proteins from the pulpal blood vessels into dentin. The pulpal circulation contributes to the health of the pulp by supplying nutrients and by removing toxic material that diffuses across dentin via the microcirculation. Thus, there is a delicate balance involving the rate bacterial products diffuse around microgaps between restorative materials and dentin, the rate these materials permeate across dentin and the rate they are removed during pulpal circulation.

Protective effects of cavity liners on dentin.

Smear layers are very soluble in acidic solutions. Removal of smear layers increases dentin permeability and the potential for pulpal irritation. In this study, smear layers were treated with either saline, Barrier, Copalite, LC-Scotchbond, Hydroxyline, or DDS 1 & 2 to determine how well they protected the dentin from subsequent acid attack with 37% phosphoric acid for two minutes. Using both SEM and permeability measurements, the materials were ranked from least to most effective as: Saline less than Barrier = Copalite less than Hydroxyline = Scotchbond = DDS 1 & 2.