Surface smoothness of resin composites after polishing-A systematic review and network meta-analysis of in vitro studies.

A systematic review and network meta-analysis was performed to provide evidence for the best polishing protocol for different types of resin composites to minimize surface roughness. A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, EMBASE, and Cochrane Library on July 2, 2019 (updated in December, 2020). In vitro studies that included at least two systems for polishing resin composites and analyzed surface roughness were included. The risk of bias was evaluated. A random-effects Bayesian-mixed treatment comparison model was used to compare surface roughness in resin composites with the different types of polishers. Surface under the cumulative ranking curve (SUCRA) analysis was performed to rank the probability for the best polishing system. After removal of duplicates, title and abstract screening yielded 34 studies. Network meta-analysis was not possible for hybrid and microhybrid composites. SUCRA analysis showed that abrasive paper discs allowed greater surface smoothness for nanohybrid and nanofill composites to a probability of between 83% and 91.6%. Silicon carbide brush had a 78.2% probability of being the best system for microfill composites. The use of abrasive paper disc polishers showed a favorable result in nanofill and nanohybrid resin composites. Silicon carbide brush has a greater chance of promoting a smoother surface for microfill resin composites.

Efeito do acabamento e polimento sobre a topografia superficial de uma resina composta convencional e uma bulk fill / Effect of finishing and polishing on the surface topography of a conventional compound resin and a bulk fill / Efecto de acabado y pulido en la topografía superficial de una resina compuesta convencional y un llenado a granel

Introdução:As atuaisresinas Bulk-Fill apresentamcomovantagens e propriedades: menor tempo clínico, baixa contração de polimerização, maior translucidez, entre outros. Objetivo:Avaliar a topografia superficial de restaurações com diferentes tipos de resina composta antes e após submetê-las a diferentes sistemas de acabamento e polimento. Metodologia:Confecção de100 corpos de prova, sendo 50 de cada composto resinoso, apresentando cinco grupos (n=10) sorteados de forma aleatória, de acordo com o sistema de acabamento e polimento empregado. Foram utilizadas as resinas Filtek Z350 XT e a Bulk Fill Filtek One Bulk Fill e os sistemas de acabamento e polimento: Discos de Lixa Sof-Lex Pop On Kit;Discos Diamantado Espiral Sof-Lex; Ponta Enhance e Broca Carbide Multilaminada nº 0283F, que foram comparados com superfície deixada pela Tira de Poliester (Controle Negativo). Após 7 dias de armazenamento em água destilada, os corpos de provaforam submetidos aoMicroscópio Eletrônico de Varredura.Resultados:Os corpos de provada resina Bulk Fill tiveram como melhor resultado o sistema de acabamento e polimentocom broca carbidee resultado não satisfatório com discodiamantado espiral Sof-lex, enquanto a ponta Enhance e lixa Sof-lex Pop Ontiveram resultados semelhantes. Os corpos de prova da resina Filtek Z350 XT tiveram melhor aspecto visual de lisura no grupo controle negativoe pior resultado no grupo com disco diamantado espiral Sof-lex. Conclusões:Dessa forma, o sistema que apresentou melhor resultado foi a broca Carbidena resina Bulk Fill, enquanto a Filtek Z350 XT apresentou-se melhor no grupo controle. Porém, ainda são necessáriosestudos para se chegar em um protocolo de acabamento e polimento mais eficiente (AU).

Introduction:The current Bulk-Fill resins have the following advantages and properties: less clinical time, low polymerization shrinkage, greater translucency, among others.Objective:Toevaluate the topography of restorations with different types of composite resin before and after submitting them to different finishing and polishing systems.Methodology:Manufacture of 100 specimens, 50 of each resin compound, presenting five groups (n = 10) drawn at random, according to the finishing and polishing system employed. Filtek Z350 XT resins and Bulk Fill Filtek One Bulk Fill andfinishing and polishing systems were used: Sof-Lex Pop On Kit Sanding Discs; Diamond Spiral Sof-Lex Discs; Tip Enhance and Multilaminated Carbide Drill nº 0283F, which were compared with the surface left by the Polyester Strip (Negative Control). After 7 days of storage in distilled water, the specimens were submitted to a Scanning Electron Microscope.Results:The Bulk Fill resin specimens had the best result of the finishing and polishing system with carbide drill and unsatisfactory result with Sof-lex spiral diamond disc, while the Enhance tip and Sof-lex Pop On sandpaper had similar results. The Filtek Z350 XT resin specimens had a better visual aspect of smoothness in the negative control group and a worse result in the group with Sof-lex spiral diamond wheel.Conclusions:Thus, the system that showed the best result was the Carbide drill in Bulk Fill resin, while Filtek Z350 XT was better in the control group. However, studies are still needed to arrive at a more efficient finishing and polishing protocol (AU).

Introducción:Las actuales resinas Bulk-Fill tienen las siguientes ventajas y propiedades: menor tiempo clínico, baja contracción de polimerización, mayor translucidez, entre otras.Objetivo: Evaluar la topografía de restauraciones con diferentes tipos de resina compuesta antes y después de someterlas a diferentes sistemas de acabado y pulido.Metodología: Fabricación de 100 probetas, 50 de cada resina compuesta, presentando cinco grupos (n = 10) extraídos al azar, según el sistema de acabado y pulido empleado. Se utilizaron resinas Filtek Z350 XT y Bulk Fill Filtek One Bulk Fill y sistemas de acabado y pulido: Discos de lijado Sof-Lex Pop On Kit; Discos Sof-Lex en espiral de diamante; Broca Realce de Punta y Carburo Multilaminado nº 0283F, que fueron comparadas con la superficie dejada por la Tira de Poliéster (Control Negativo). Después de 7 días de almacenamiento en agua destilada, lasmuestras se sometieron a un Las muestras de resina Bulk Fill tuvieron el mejor resultado del sistema de acabado y pulido con broca de carburo y un resultado insatisfactorio con el disco de diamante en espiral Sof-lex, mientras que la punta Enhance y el papel de lija Sof-lex Pop On tuvieron resultados similares. Las muestras de resina Filtek Z350 XT tuvieron un mejor aspecto visual de suavidad en el grupo de control negativo y un peor resultado en el grupo con disco de diamante en espiral Sof-lex.Conclusiones: Así, el sistema que mejor resultado mostró fue la broca Carbide en resina Bulk Fill, mientras que Filtek Z350 XT fue mejor en el grupo control. Sin embargo, aún se necesitan estudios para llegar a un protocolo de acabado y pulido más eficiente (AU).

Influência do uso da proantocianidina em um adesivo autocondicionante: avaliação da resistência de união / Influence of the use of proanthocyanidinin a self-etching adhesive: evaluation of bond strength / Influenciadel uso de proantocianidinaem um adesivo autograbante: evaluación de la fuerza de unión

Introdução:Os sistemas adesivos possibilitama execução de restaurações estéticas e minimamente invasivas, sendo, portanto,objeto de pesquisas para contornar os problemas que se apresentam no procedimento restaurador.Objetivo:Avaliar in vitroa resistência de união de um sistema adesivo autocondicionante, e deste modificado com soluções extrativas de semente de uva.Metodologia:Duas soluções extrativas foram preparadas comextrato de semente de uva em pó dissolvido em acetona e etanol. A partir delas e de umadesivo,seis sistemas adesivos autocondicionantes experimentais foram preparados, diferindo quanto aosolvente utilizado eàsproporções entre adesivo puro e solução extrativa(7,5%, 15% e 30%). Setenta incisivos bovinos hígidos tiveram as raízes removidas com disco de carborundum e as faces vestibulares desgastadas comlixas d'água de granulação 120, 240, 600 e 1200 sob refrigeração até expor a dentina superficial. Os dentes foram distribuídos aleatoriamenteem sete grupos distintos: Controle; A7,5; A15; A30; E7,5; E15; e E30, contendo 10 elementos cada. A aplicação dos adesivos foi executada de acordo com as recomendações do fabricante do adesivo controle. A restauração foi realizada com uma matriz de silicone com dimensões 2mm de altura e 4mm de diâmetro e inserido o material restaurador em incremento único e fotopolimerizado por 40s. Após três meses armazenados em água destilada, os espécimes foram submetidos ao teste de resistência de união. Foi empregado ométodo estatísticoTeste Paramétrico Anova 1 Fator e pós-teste de Tamhane (p<0,05). Resultados:Os grupos A7,5, E7,5 e E30 não apresentaram diferença em relação ao grupo Controle; A15 e A30 mostraram desempenho estatisticamente semelhante entre si; e E15 não apresentou diferença estatística em relação aos outros adesivos.Conclusões:A adição de proantocianidina teve efeitos diferentes,dependendodos solventes e das concentrações utilizadas, mas sem alterar significativamente o desempenho do adesivo (AU).

Introduction:Adhesive systems make it possible to perform aestheticand minimally invasive restorations, being the subject of research to circumvent the problems that arise in the restorative procedure.Objective:Evaluate in vitrothe bond strength of a self-etching adhesive system,and modified with extractive grape seed solutions. Methodology:Two extractive solutions were prepared with powdered grape seed extract dissolved in acetone and ethanol. From them and an adhesive, six experimental self-etching adhesive systems were prepared, differing in terms of the solvent used and the proportions between pure adhesive and extractive solution(7.5%, 15% and 30%). Seventy healthy bovine incisors had their roots removed with carborundum disc and the vestibular faces were worn with sandpaper with granulation water 120, 240, 600 and 1200 under refrigeration until the superficial dentin was exposed. The teeth were randomly assigned to seven different groups: Control; A7.5; A15; A30; E7.5; E15; and E30, containing 10 elements each. The application of the adhesives was carried out according to the recommendations of the manufacturer of the control adhesive. The restoration was performed with a silicone matrix with dimensions 2mm high and 4mm indiameter and the restorative material was inserted in a single increment and light cured for 40s. After three months stored in distilled water, the specimens were submitted to the bond strength test. The statistical method Parametric Test Anova 1 Factor and Tamhane post-test (p<0.05) were used. Results:Groups A7.5, E7.5 and E30 showed no difference in relation to the Control group; A15 and A30 showed a statistically similar performance; and E15 showed no statistical difference in relation to the other adhesives. Conclusions:The addition of proanthocyanidin had different effects, depending on the solvents and concentrations used, but without significantly altering the performance ofthe adhesive (AU).

Introducción: Sistemas adhesivos permiten realizar restauraciones estéticas y mínimamente invasivas, siendo objeto de investigación para sortear problemas que surgen en elprocedimiento restaurador. Objetivo: Evaluar in vitrola fuerza de unión de un sistema adhesivoautograbante y modificado con soluciones extractivas de semilla de uva. Metodología: Se prepararon dos soluciones extractivas con extracto de semilla de uva en polvo disuelto en acetona y etanol. A partir de ellos y de un adhesivo, se prepararon seis sistemas experimentales de adhesivos autograbantes, que se diferencian en cuanto al solvente utilizado y las proporciones entre adhesivo puro y solución extractiva (7,5%, 15% y 30%). Setenta incisivos bovinos sanos fueron removidos con un disco de carborundo y las caras vestibulares fueron usadas com lija de agua de granulación 120, 240, 600 y 1200 bajo refrigeración hasta que la dentina superficial quedo expuesta. Los dientes se asignaron aleatoriamente a siete grupos diferentes: Control; A7,5; A15; A30; E7,5; E15; y E30, que contiene 10 elementos cada uno. La aplicación de los adhesivos se realizó siguiendo las recomendaciones del fabricante del adhesivo de control. La restauración se realizó con matriz de silicona con 2mm de altura y 4mm de diámetro y el material restaurador se insertó en un solo incremento y se fotopolimerizó durante 40s. Tres meses después, almacenados em agua destilada, las muestras se sometieron a la prueba de resistencia de la unión. Se utilizó el método estadístico Prueba Paramétrica Factor Anova 1 y post-prueba de Tamhane (p<0,05). Resultados: Los grupos A7,5, E7,5 y E30 no mostraron diferencias em relación con el grupo Control; A15 y A30 mostraron un desempeño estadísticamente similar; y E15 no mostró diferencia estadística en relación con los otros adhesivos. Conclusiones: La adición de proantocianidina tuvo diferentes efectos, dependiendo de los disolventes y concentraciones utilizadas, pero sin alterar significativamente el rendimiento del adhesivo (AU).

Quantitative measurements of aerosols from air-polishing and ultrasonic devices: (How) can we protect ourselves?

AIM: To assess the distribution and deposition of aerosols during simulated periodontal therapy. METHODS: A manikin with simulated fluorescein salivation was treated by four experienced dentists applying two different periodontal treatment options, i.e. air-polishing with an airflow device or ultrasonic scaling in the upper and lower anterior front for 5 minutes, respectively. Aerosol deposition was quantitatively measured on 21 pre-defined locations with varying distances to the manikins mouth in triplicates using absorbent filter papers. RESULTS: The selected periodontal interventions resulted in different contamination levels around the patient's mouth. The highest contamination could be measured on probes on the patient's chest and forehead but also on the practitioner's glove. With increasing distance to the working site contamination of the probes decreased with both devices. Air-polishing led to greater contamination than ultrasonic. CONCLUSION: Both devices showed contamination of the nearby structures, less contamination was detected when using the ultrasonic. Affirming the value of wearing protective equipment we support the need for universal barrier precautions and effective routine infection control in dental practice.

Effect of Two Polishing Systems on Surface Roughness, Topography, and Flexural Strength of a Monolithic Lithium Disilicate Ceramic.

PURPOSE: To evaluate the effect of overglazing and two polishing procedures on flexural strength and quality and quantity of surface roughness of a monolithic lithium disilicate ceramic computer-aided design (CAD) after grinding. MATERIALS AND METHODS: This in vitro study was conducted on 52 partially crystalized bar-shaped specimens (16 × 4 × 1.6 mm) of monolithic lithium disilicate ceramic. The specimens were wet polished with 600-, 800-, and 1200-grit silicon carbide papers for 15 seconds using a grinding/polishing machine at a speed of 300 rpm. Then, the specimens were crystalized and glaze-fired in one step simultaneously and randomly divided into four groups of 13: (I) Glazing group (control); (II) Grinding-glazing group, subjected to grinding with red band finishing diamond bur (46 µm) followed by glazing; (III) Grinding-D+Z group, subjected to grinding and then polishing by coarse, medium, and fine diamond rubber points (D+Z); and (IV) Grinding-OptraFine group, subjected to grinding and then polishing with a two-step diamond rubber polishing system followed by a final polishing step with an OptraFine HP brush and diamond polishing paste. The surface roughness (Ra and Rz) values (µm) were measured by a profilometer, and the mean values were compared using one-way ANOVA and Tamhane's test (post hoc comparison). One specimen of each group was evaluated under a scanning electron microscope (SEM) for surface topography. The three-point flexural strength values of the bars were measured using a universal testing machine at a 0.5 mm/min crosshead speed and recorded. The data were analyzed using one-way ANOVA and Tamhane's test (α = 0.05). RESULTS: Statistically significant differences were noted among the experimental groups for Ra, Rz (p < 0.0001), and flexural strength values (p < 0.009). The lowest Ra and Rz values were found in the grinding-OptraFine group (0.465 ± 0.153), which were significantly lower than those in glazing (p < 0.03) and grinding-glazing (p < 0.001) groups. The Ra and Rz values were not significantly different between the two polishing systems (p = 0.23 and p = 0.25, respectively). The highest flexural strength was found in the glazing group (283.350 ± 49.854 MPa) without significant differences compared to grinding-glazing (p = 0.98) and grinding-OptraFine groups (p = 0.86). The lowest flexural strength was found in grinding-D+Z group (225.070 ± 17.299), which was significantly different from the value in glazing (p < 0.03) and grinding-glazing (p < 0.04) groups. SEM analysis of polished surfaces revealed regular morphology with some striations. CONCLUSIONS: The OptraFine system created smoother and more uniform surfaces in terms of quantity (p < 0.03 for Ra, p < 0.01 for Rz) and quality of roughness compared to glazing. The flexural strength of lithium disilicate ceramic after polishing with the OptraFine system was similar to that after glazing (p = 0.86). Despite similar surface roughness after polishing with the two systems, the D+Z system reduced the flexural strength of ceramic (p < 0.03).

Effects of Polishing Bur Application Force and Reuse on Sintered Zirconia Surface Topography.

OBJECTIVE: Limited information is available on how to polish and finish zirconia surfaces following computer-aided design/computer-aided manufacturing (CAD/CAM), specifically, how differing application forces and reuse of zirconia polishing systems affect zirconia topography. PURPOSE: To determine the effect of differing, clinically relevant, polishing application forces and multiple usages of polishing burs on the surface topography of CAD/CAM zirconia. METHODS: One hundred twenty 220-grit carbide finished zirconia disks were sintered according to manufacturer's directions and divided into two groups for the study of two coarse polishing bur types. Each group was divided into subgroups for polishing (15,000 rpm) at 15 seconds for 1.0 N, 4.5 N, or 11 N of force using a purpose-built fixture. Subgroups were further divided to study the effects of polishing for the first, fifth, 15th, and 30th bur use, simulating clinical procedures. Unpolished surfaces served as a control group. Surfaces were imaged with noncontact optical profilometry (OP) and atomic force microscopy (AFM) to measure average roughness values (Ra). Polishing burs were optically examined for wear. Scanning electron microscopy (SEM) was performed on burs and zirconia surfaces. One-way ANOVA with post hoc Tukey HSD (honest significant difference) tests (α=0.05) were used for statistical analyses. RESULTS: AFM and OP Ra values of all polished surfaces were significantly lower than those of the unpolished control. Different polishing forces and bur reuse showed no significant differences in AFM Ra. However, significant differences in OP Ra were found due to differing application forces and bur reuse between the first and subsequent uses. SEM and optical micrographs revealed notable bur wear, increasing with increasing reuse. SEM and AFM micrographs clearly showed polished, periodic zirconia surfaces. Nanoscale topography, as analyzed with kurtosis and average groove depth, was found dependent on the specific polishing bur type. CONCLUSIONS: These in vitro results suggest changes in OP Ra due to bur reuse and polishing application force. Within the parameters of this study, the resultant topography of zirconia polishing is force-dependent and the reuse of coarse polishing burs is possible without statistically significant differences in Ra values after initial use. Nanoscale and microscale topography were shown to depend on specific polishing bur type.

A randomised controlled study on the use of finishing and polishing systems on different resin composites using 3D contact optical profilometry and scanning electron microscopy.

OBJECTIVES: The aim of this study was to evaluate theeffects of different finishing and polishing techniques on the surface roughness of microhybrid and nanofilled resin composites. METHODS: The resin composites included were Filtek Z250 (a universal microhybrid resin composite) and Filtek Supreme XTE (a universal nanofill resin composite). Ninety cylindrical-shaped specimens were prepared for each composite resin material. The polishing methods used included tungsten carbide bur (TC); diamond bur (Db); Sof-Lex discs (S); Enhance PoGo discs (PG); TC + S; Db + S; TC + PG; Db + PG. Polymerisation against a Mylar strip without finishing and polishing acted as the control group. Surface roughness was measured using a 3D contact optical profilometer and surface morphology was examined by scanning electron microscope examination. RESULTS: The results showed that the Mylar-formed surfaces were smoothest for both composites. Finishing with the 20 µm diamond finishing bur caused significantly greater surface irregularity (P < 0.0001) and damage than finishing with the tungsten carbide finishing bur. The Enhance PoGo polishing system produced smoother surfaces than the Sof-Lex disc polishing system; this difference was statistically highly significant (P < 0.0001). CONCLUSION: For both composites, the Mylar-formed surfaces were smoothest. Where indicated clinically, finishing is better conducted using a tungsten carbide bur- rather than a diamond finishing bur. The Enhance PoGo system was found to produce a smoother surface finish than the Sof-Lex system. CLINICAL SIGNIFICANCE: If finishing and polishing is required the use a tungsten carbide finishing bur followed by Enhance PoGo polishing may be found to result in the smoothest surface finish.

Preservation of root cementum: a comparative evaluation of power-driven versus hand instruments.

OBJECTIVES: The purpose of this study was to evaluate the effects of three distinct periodontal treatment methods in comparison with hand instrumentation on residual cementum of periodontal diseased teeth. Cementum can influence the activities of periodontal cells and may play an important regulatory role in periodontal treatment. The ideal method for periodontal therapy involves removal of biofilm, calculus and endotoxin while preserving root cementum. MATERIAL AND METHODS: Forty-eight caries free, single-rooted teeth in patients diagnosed with severe chronic periodontitis were treated using four different methods prior to extraction. The teeth were instrumented subgingivally at one approximal site either by hand curettes (HC), piezoelectric ultrasonic scalers (U), piezoelectric ultrasonic scalers following air polishing (U + AP) or air polishing (AP) alone. Following extraction of teeth, instrumented and non-instrumented sites were analysed with a dissecting microscope and SEM for measurement of the amount of and surface characteristics of residual cementum. RESULTS: The percentage of coronal cementum remaining following subgingival instrumentation was 84% for U, 80% for U + AP, 94% for AP and 65% for HC. Although subgingival instrumentation of apical portions of the cementum demonstrated 6% less retained cementum in comparison with coronal portions, the amount of retained cementum with AP was still significantly greater than with HC. SEM results found the smoothest root surfaces were produced by the HC followed by the AP, while root surfaces instrumented by U or U + AP presented grooves and scratches. CONCLUSIONS: This study demonstrated that AP was superior to U devices in preserving cementum, whereas HC were the most effective instruments in removing cementum.

A Study on Topographical Properties and Surface Wettability of Monolithic Zirconia after Use of Diverse Polishing Instruments with Different Surface Coatings.

PURPOSE: To investigate the surface topography parameters and wettability of monolithic zirconia (MZ) using polishing instruments with different coatings. MATERIALS AND METHODS: MZ specimens (N = 50, n = 10 per group) (12 × 12 × 1.8 mm3 ) were highly polished. Five polishing systems were studied: BG: silicon carbide polishers; CG: diamond-impregnated ceramic polisher kit; EV: synthetically bonded grinder interspersed with diamond; SL: urethane-coated paper with aluminum oxide grits; and DB: diamond bur (8 µm). Specimens were initially roughened with 220 µm grit diamond burs (10 seconds, 160,000 rpm). After baseline measurements, they were further polished for 10 seconds using a slow-speed handpiece under water coolant, except for SL using a custom-made device (7.5 N), with speed ranging between 5000 and 30,000 rpm. Topographical changes were evaluated considering (a) weight (digital scale), (b) volume loss (digital microscope), (c) vertical height loss (digital microscope), (d) surface roughness (Ra) (profilometer), and (e) surface wettability (goniometer, water). RESULTS: Compared to baseline, material loss from the surface after polishing (ΔW) ranged between 0.00 ± 0.0001×10-1 and -0.03 ± 0.008×10-1 g (SLa < CGa < BGa < DBb < EVc ) and the volume loss (ΔV) between 900 ± 3×10-5 and 2459 ± 7×10-5 µm3 (SLa < BGa < CGa,b < DBb < EVc ). The vertical height loss (∆VH) was highest for SL (-18.911 ± 3.5) and lowest for EV 55.19 ± 6.3 µm (SLa < BGa < CGa,b < DBb < EVc ). The surface roughness (µm) difference (∆Ra) was lowest for DB (-0.14 ± 0.02) and the highest for EV (0.86 ± 0.42) (DBa < BGa < SLa < CGa < EVb ). BG showed the lowest contact angle difference (∆SW) -2.79 ± 0.8° and EV the highest (3.93 ± 3.1°) (BGa < DBa < SLa < CGa < EVa ). CONCLUSIONS: All polishing instruments performed similarly when ∆Ra values were considered. SL, BG, and CG produced the least material loss. Synthetically bonded rubber bur interspersed with diamond (EV) could not be suggested for polishing MZ.

Effects of small-grit grinding and glazing on mechanical behaviors and ageing resistance of a super-translucent dental zirconia.

OBJECTIVES: The purpose of this study is to elucidate the effects of small-grit grinding on the mechanical behaviors and ageing resistance of a super-translucent dental zirconia and to investigate the necessity of glazing for the small-grit ground zirconia. METHODS: Small-grit grinding was performed using two kinds of silicon carbide abrasive papers. The control group received no grinding. The unground surfaces and the ground surfaces were glazed by an experienced dental technician. Finally, the zirconia materials were thermally aged in water at 134°C for 5h. After aforementioned treatments, we observed the surface topography and the microstructures, and measured the extent of monoclinic phase, the nano-hardness and nano-modulus of the possible transformed zone and the flexural strength. RESULTS: Small-grit grinding changed the surface topography. The zirconia microstructure did not change obviously after surface treatments and thermal ageing; however, the glaze in contact with zirconia showed cracks after thermal ageing. Small-grit grinding did not induce a phase transformation but improved the flexural strength and ageing resistance. Glazing prevented zirconia from thermal ageing but severely diminished the flexural strength. The nano-hardness and nano-modulus of the surface layer were increased by ultrafine grinding. CONCLUSIONS: The results suggest that small-grit grinding is beneficial to the strength and ageing resistance of the super-translucent dental zirconia; however, glazing is not necessary and even impairs the strength for the super-translucent dental zirconia. CLINICAL SIGNIFICANCE: This study is helpful to the researches about dental grinding tools and maybe useful for dentists to choose reasonable zirconia surface treatments.

Effect of different dental burs for experimental induction of pulpitis in mice.

OBJECTIVE: To evaluate the effect of using different dental burs on the development of pulpal inflammation after pulpal exposure in mice. DESIGN: Eighty-eight C57BL/6 mice were randomly assigned to group A (n=40), group B (n=40) and control group (n=8). The pulps of the maxillary first molars were occlusally exposed using » round burs and polishing burs in group A and B respectively. Animals were sacrificed randomly at 0h, 4h, 8h, 12h and 24h after pulpal exposure. Micro-CT scanning was used to determine the success rate of sample preparation. Pulpal tissue changes were evaluated by histopathologic and immunohistochemical analyses. RESULTS: The success rates of sample preparations were 85% in group A and 90% in group B. The mean maximum diameter of pulpal exposure area was 625.6±30.6µm in group A and 402.7±18.0µm in group B (p<0.05). In addition, the mean of the minimum remaining dentine thickness at the marked region of interest was 133.2±29.9µm in group A and 261.4±16.3µm in group B (p<0.05). Histopathologic staining demonstrated more signs of inflammation in both groups, as the duration of pulpal exposure increases. However, the rate of inflammatory progress was higher in group A, even spreading to the root pulp tissue within a few hours. For group B, the progress was relatively slow. CONCLUSIONS: Pulpal exposure with different sizes of dental burs affects changes in the development of pulpal inflammation in mice.

In vitro biofilm formation on resin-based composites after different finishing and polishing procedures.

OBJECTIVES: To evaluate the influence of surface treatments of different resin-based composites (RBCs) on S. mutans biofilm formation. METHODS: 4 RBCs (microhybrid, nanohybrid, nanofilled, bulk-filled) and 6 finishing-polishing (F/P) procedures (open-air light-curing, light-curing against Mylar strip, aluminum oxide discs, one-step rubber point, diamond bur, multi-blade carbide bur) were evaluated. Surface roughness (SR) (n=5/group), gloss (n=5/group), scanning electron microscopy morphological analysis (SEM), energy-dispersive X-ray spectrometry (EDS) (n=3/group), and S. mutans biofilm formation (n=16/group) were assessed. EDS analysis was repeated after the biofilm assay. A morphological evaluation of S. mutans biofilm was also performed using confocal laser-scanning microscopy (CLSM) (n=2/group). The data were analyzed using Wilcoxon (SR, gloss) and two-way ANOVA with Tukey as post-hoc tests (EDS, biofilm formation). RESULTS: F/P procedures as well as RBCs significantly influenced SR and gloss. While F/P procedures did not significantly influence S. mutans biofilm formation, a significant influence of RBCs on the same parameter was found. Different RBCs showed different surface elemental composition. Both F/P procedures and S. mutans biofilm formation significantly modified this parameter. CONCLUSIONS: The tested F/P procedures significantly influenced RBCs surface properties but did not significantly affect S. mutans biofilm formation. The significant influence of the different RBCs tested on S. mutans biofilm formation suggests that material characteristics and composition play a greater role than SR. CLINICAL SIGNIFICANCE: F/P procedures of RBCs may unexpectedly play a minor role compared to that of the restoration material itself in bacterial colonization.

Effect of Finishing Procedures on the Surface Roughness of Resin-modified Glass-Ionomer Materials.

This study examined the influence of finishing procedures on the surface roughness of different formulations of resin-modified glass ionomers (RMGIs) available in capsules compared with standard resin composites (RCs). Disc samples of three RMGIs and two RCs were fabricated using a metal mold (5 mm x 1.5 mm). Samples were randomly divided into seven groups (N = 10) and subjected to finishing and polishing procedures using a combination of carbide or diamond burs, followed by either rubber points or aluminum-oxide discs. Three different regions of each sample were analyzed using a contact profilometer to determine the average roughness (Ra). The main surface roughness was calculated using a two-way analysis of variance (ANOVA) and the Bonferroni correction for multiple comparisons. A dual-stage combination of a fine carbide bur followed by the use of the finest two grits of aluminum-oxide discs was found to produce the smoothest finished and polished surface. the smoothest surfaces were found to be on the two RCs and one of the RMGIs.

Subcutaneous emphysema related to air-powder tooth polishing: a report of three cases.

Subcutaneous emphysema is a rare complication of dental procedures and can occasionally give rise to potentially life-threatening complications. We describe three cases of subcutaneous emphysema diagnosed in the same dental clinic. All cases occurred during tooth or implant cleaning using air polishing (KavoProphyflex® ) with a sodium bicarbonate powder (Air-N-Go Classic® ). The diagnosis was based on clinical findings and was confirmed radiologically. The cervical and facial regions were affected in all three cases, and spread to the mediastinum occurred in one case. All the episodes resolved within 3-5 days. Tooth cleaning using air polishing combined with an abrasive powder is a risk factor for subcutaneous emphysema, especially when the powder and device are from different manufacturers. Radiological assessment must be performed to rule out involvement of deep tissue planes.

Efficacy of polishing kits on the surface roughness and color stability of different composite resins.

OBJECTIVE: Different polishing kits may have different effects on the composite resin surfaces. The aim of this study was to evaluate the surface roughness and color stability of four different composites which was applied different polishing technique. MATERIALS AND METHODS: Thirty specimens were made for each composite resin group (nanohybrid, GrandioSo-GS; nanohybrid, Clearfil Majesty Esthetic-CME; hybrid, Valux Plus-VP; micro-hybrid, Ruby Comp-RC; [15 mm in diameter and 2 mm height]), with the different monomer composition and particle size from a total of 120 specimens. Each composite group was divided into three subgroups (n = 10). The first subgroup of the each composite subgroups served as control (C) and had no surface treatment. The second subgroup of the each composite resin groups was polished with finishing discs (Bisco Finishing Discs; Bisco Inc., Schaumburg, IL, USA). The third subgroup of the each composite resin was polished with polishing wheel (Enhance and PoGo, Dentsply, Konstanz, Germany). The surface roughness and the color differences measurement of the specimens were made and recorded. The data were compared using Kruskal-Wallis test, and regression analysis was used in order to examine the correlation between surface roughness and color differences of the specimens (α = 0.05). RESULTS: The Kruskal-Wallis test indicated significant difference among the composite resins in terms of ΔE (P < 0.05), and there was no statistically significant difference among composite resins in terms of surface roughness (P > 0.05). Result of the regression analysis indicated statistically significant correlation between Ra and ΔE values (P < 0.05, r2 = 0.74). CONCLUSION: The findings of the present study have clinical relevance in the choice of polishing kits used.

Novel Microscalpels for Removing Proximal Composite Resin Overhangs on Class II Restorations.

INTRODUCTION: Limited access to interdental spaces complicates removal of excess material when placing class II composite resin restorations. Evidence-based recommendations on interproximal finishing are rare. We present novel microscalpels for this indication. The aim of the study was to test their fracture strength and cutting ability and to compare microscalpels with the use of a scaler, oscillating devices (G5-ProShape, G5-Proxocare), finishing strips and scalpels of sizes 12, 15, and 21 in a standardized in vitro model. METHODS AND MATERIALS: Fracture strength (LOAD) and cutting forces (CUT) of microscalpels were evaluated at different angles (15, 30, 60, and 75 degrees; n=30 each) in a universal testing machine. Devices were compared in vitro using standardized composite overhangs. Marginal quality (QUAL; n=30) and quantity of excess/deficit (QUAN; n=30) were evaluated using scanning electron microscopy (SEM) for each device (explorative data analysis, Student t-test or analysis of variance; post hoc Scheffé). RESULTS: Microscalpels showed the highest LOAD (95.8 [5.0] N) (mean [standard deviation]) and easiest cutting (CUT) (7.6 [1.5]) at 15 degrees. At all angles, LOAD was significantly higher than CUT (p<0.001). Perfect margins were seen most often with scalpel size 12 (QUAL: 37% relative frequency), while most excess (73.4%) was observed with finishing strips. QUAN was lowest with microscalpels (19.3 [4.4] µm) and highest with finishing strips (116.0 [18.8]). Use of scalers led to fractures and crack formation. CONCLUSION: Microscalpels are able to cut composite at a lower force than necessary to fracture the blades at all angles. Small and/or curved scalpels yield the best-quality margins.

Atomic force microscopy analysis of enamel nanotopography after interproximal reduction.

INTRODUCTION: Interproximal reduction (IPR) removes enamel and leaves grooves and furrows on the tooth surface, which may increase the risk of caries. The aims of this study were to assess the nanotopography of enamel surfaces produced by the most commonly used IPR instruments and to evaluate the effect of polishing after IPR. METHODS: Enamel slabs were cut from the interproximal surfaces of healthy premolars and then treated with diamond burs, strips, or discs, or Sof-Lex polishing discs (3M ESPE, St Paul, Minn). All samples were cleaned by sonication in distilled water. The control group had no IPR performed and was subjected only to cleaning by sonication. The enamel surfaces were assessed using atomic force microscopy. RESULTS: The IPR instruments all produced surfaces rougher than the control sample; however, the samples that received polishing with Sof-Lex discs after enamel reduction were smoother than untreated enamel (P <0.05 for all comparisons). The larger grit medium diamond burs and medium strips generated rougher enamel surfaces than their smaller grit counterparts: fine diamond burs and fine strips (P <0.001). The difference in roughness generated by mesh and curved disks was not statistically significant (P = 0.122), nor was the difference caused by fine strips and mesh discs (P = 0.811) or by fine strips and curved discs (P = 0.076) (surface roughness values for medium bur, 702 ± 134 nm; medium strip, 501 ± 115 nm; mesh disc, 307 ± 107 nm; fine bur, 407 ± 95 nm; fine strip, 318 ± 50 nm; curved disc, 224 ± 65 nm). The smoothest surfaces were created by use of the entire series of Sof-Lex polishing discs after the enamel reduction (surface roughness, 37 ± 14 nm), and these surfaces were significantly smoother than the control surfaces (surface roughness, 149 ± 39 nm; P = 0.017). CONCLUSIONS: Different IPR instruments produced enamel surfaces with varied nanotopography and different degrees of roughness. Enamel surfaces treated with diamond-coated burs were the roughest, followed by diamond-coated strips and diamond coated discs. Polishing with Sof-Lex polishing discs after IPR reduced the enamel surface roughness, and this surface was even smoother than untreated enamel.

Consensus Conference Findings on Supragingival and Subgingival Air Polishing.

A consensus conference was convened to evaluate and address issues of safety and efficacy when using glycine powder in an air-powder jet device for supra- and subgingival applications during dental prophylaxis and periodontal maintenance. The conference reported the following conclusions: 1) Supra- and subgingival air polishing using glycine powder is safe and effective for removal of biofilms from natural tooth structure and restorative materials; 2) there is no evidence of soft-tissue abrasion when using glycine powder in an air-polishing device; 3) in periodontal probing depths of 1 mm to 4 mm, glycine-powder air polishing, using a standard air-polishing nozzle, is more effective at removing subgingival biofilm than manual or ultrasonic instruments; and 4) at probing depths of 5 mm to 9 mm, using a subgingival nozzle, glycine powder air polishing is more effective at removing subgingival biofilm than manual or ultrasonic instrumentation. This conference statement, supported by an industry grant, was drafted by a panel of distinguished dental professionals.

Use of a continual sweep motion to compare air polishing devices, powders and exposure time on unexposed root cementum.

Low abrasive air polishing powders are a viable method for subgingival biofilm removal. This in vitro study evaluated the effects of air polishing using a standard tip on cementum following clinically recommended protocols. Forty-eight teeth were randomly divided into eight groups with six teeth per group. Teeth were treated using either a Hu-Friedy EMS or DENTSPLY Cavitron® air polishing device. One of three glycine powders (Air-flow 25 µm, Clinpro 45 µm, Clinpro+TCP 45 µm) or a sodium bicarbonate powder (NaHCO3  85 µm) was sprayed on cementum using a clinically relevant sweeping motion. Volume and depth of cementum removed after 5 and 90 s exposures were calculated. Surface texture was evaluated using SEMs taken following the last exposure. After 5 s exposures, neither unit nor powder had a substantial effect on volume loss or defect depth. After 90 s exposures, differences between powders existed only for the DENTSPLY unit (p < 0.0001). Pairwise comparisons for this unit revealed mean volume loss and maximum defect depth were greater for NaHCO3 85 µm than the glycine powders (p < 0.0001). The 90 s exposure produced greater mean volume loss and defect depth for all powders (p < 0.0001). SEM images revealed dentinal tubule exposure with all powders; however, exposed tubules were larger and more prevalent for NaHCO3 85 µm. Root surface loss was similar for glycine powders evaluated in this study. Differences in powder performance between units may be related to tip apertures and spray patterns. Additional research is needed to determine if cementum loss is greater than what occurs with conventional biofilm removal methods, such as curets and ultrasonic scalers.

Effect of various polishing systems on the surface roughness and phase transformation of zirconia and the durability of the polishing systems.

STATEMENT OF PROBLEM: Although many systems are used to polish zirconia, a comparison of the performance of zirconia and feldspathic porcelain polishing systems is lacking. PURPOSE: The purpose of this in vitro study was to compare the effects of 3 polishing systems on surface roughness, zirconia phase transformation, and durability of the polishing systems when applied to zirconia and feldspathic porcelain. MATERIAL AND METHODS: Three polishing systems were evaluated: Z1, a zirconia polishing system; Z2, a zirconia polishing system, and F1, a feldspathic porcelain polishing system. Three ceramic systems were evaluated: PR and ZM zirconia specimens (diameter 15 mm, height 2 mm; 23 specimens each) and CB feldspathic porcelain specimens of the same size (15 specimens). A rough surface was created on the 3 types of specimens (15 specimens each) to model an occlusal adjustment under the same conditions. Polishing was carried out with the 3 polishing systems for 2 minutes each. Surface roughness was measured with a 3-dimensional (3D) optical profiler. The surface was also observed with a scanning electron microscopy. X-ray diffraction analysis was performed for 8 PR or ZM zirconia specimens polished by using the Z1 and Z2 systems for 8 minutes to evaluate the phase transformation of zirconia before, during, and after polishing. These specimens were compared and analyzed for phase transformation that might have occurred during the polishing of the specimens. After finishing the surface roughness experiment and the phase transformation experiment, the volumes of the polishers were measured with a 3D volume scanner and compared with those before the experiments to evaluate the durability of the polishing system. A statistical analysis of all data was performed using 2-way ANOVA and the Tukey honest significant difference test (α=.05). RESULTS: The 2 zirconia polishing systems (Z1, Z2) created a significantly (P<.001) smoother surface, regardless of the type of specimens used for polishing, than the feldspathic porcelain polishing system (F1). When polishing treatment was carried out on zirconia specimens for 8 minutes, the maximum percentages of monoclinic phase increased by 0.03% in the Z1 system and by 0.09% in the Z2 system. The volume change for the durability evaluation of the polishing system was 13.35 and 29.37% in the Z1 system, 2.05 and 5.92% in the Z2 system, and 3.60 and 4.95% in the F1 system, respectively. CONCLUSIONS: Zirconia polishing systems created a smoother surface on zirconia than the feldspathic porcelain polishing system. No significant changes in the phase transformation of zirconia were found before and after polishing. Each polishing system showed different levels of wear resistance.