Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis.

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

MIH-Affected Substrate: An Overview of Adhesive Challenges to the Dental Structures.

Based on the current state of the art regarding molar incisor hypomineralisation (MIH)-affected enamel, bonding systems are expected to play a relevant role on the restorative procedures when required. MIH-affected enamel is often subjected to posteruptive breakdown combined or not with carious lesions, predominantly on molars, and may also affect the aesthetics of anterior teeth. As unbalanced mineral and protein contents occur, understanding these alterations is essential before selecting the most appropriate adhesive systems, while bearing in mind their limitations. In particular, when dentin is involved due to enamel breakdown, the use of functional monomer-based bonding systems present in self-etching and universal systems produce a chemical interaction that enhance the bonding. So far, the overall recommendation relies on placing the margin of the restoration on clinically sound enamel, regardless of the category of the adhesive system.

INFLUENCE OF ABUTMENT MATERIAL, CEMENT THICKNESS, AND CROWN TYPE ON THE FINAL COLOR OF IMPLANT-SUPPORTED RESTORATIONS.

PURPOSE: To evaluate the influence of abutment material, cement thickness, and crown type on the esthetics of implant supported restorations. MATERIAL AND METHODS: In total, 60 specimens were prepared to represent six abutment groups: Group PA = pink-anodized Ti; Group GA = gold-anodized Ti; Group T = nonanodized Ti; Group H = hybrid (Ti + zirconia); Group P = PEEK (Ti + PEEK); and Group C = composite resin (control). Crown specimens (n = 120) were obtained from Vita Enamic (VE) and Vita Suprinity (VS). Two cement thicknesses (0.1 and 0.2 mm) were used. The color values of crown configura:ons were measured and ΔE00* values were calculated. Statistical analyses included were Shapiro Wilk, three-way ANOVA, and Tukey HSD tests (P ≤ .05). RESULTS: Abutment (P < .001) and crown materials (P = .001) had a significant effect on ΔE00* values, while cement thickness did not. Groups PA and H resulted in significantly lower mean ΔE00* values than other abutments, whereas Group T revealed the highest. Unlike VS, cement thicknesses created a significant difference on the ΔE00* values for VE (P ≤.05). CONCLUSIONS: Pink-anodized Ti or hybrid abutments for VE and pink- or goldanodized Ti for VS seem to be better options, in terms of color change. Cement thickness of 0.1 mm resulted in higher ΔE00* value than 0.2 mm for VE (P ≤ .05).

Effect of cementation protocols on the fracture load of bilayer ceramic crowns manufactured by the Rapid Layer Technology.

To evaluate the fracture load of bilayer ceramic crowns manufactured by Rapid Layer Technology (RLT) after different cementation protocols of the veneering ceramic to the zirconia infrastructures. Sixty epoxy resin preparations simulating a molar tooth were obtained and 60 zirconia infrastructures and feldspathic crowns were manufactured by RLT and divided into 6 groups according to the cementation protocol at the interface to veneering ceramic (n=10): Ctr- control: conventional resin cement; Al- Al2O3 sandblasting 50µm + conventional resin cement; Al/MDP- Al2O3 sandblasting (50µm) + resin cement with MDP; Sil- silicatization 30µm + conventional resin cement; Gl/HF- glaze + hydrofluoridric acid (5%,60s) + silane + conventional resin cement; Gl- glazing as bonding agent. The feldspathic ceramic internal surface was etched with fluoridric acid (5%) + silane followed by cementation according to respective protocols. All samples were mechanically cycled (200N and 4.5x105 Pa, 37°C, 2x106 cycles, 3.4Hz) and submitted to axial compressing fracture load test (10kN, 0.5mm/min). The results(N) were submitted to descriptive and analytical statistical analysis with 1-way ANOVA, Weibull, and the Tukey test (α=0.05). ANOVA revealed that there was a significant difference among the tested groups (p<0.0001). The group Al/MDP presented the higher resistance to fracture (1972.46A N), followed by the Ctr group (1584.41B N). The characteristic strength(σ0) was significantly different (p=0.000). The crack and chipping were the predominant failures. The air-abrasion at the external surface of zirconia with Al2O3 followed by cementation with MDP resin cement, should be selected to Rapid Layer Technique when felspathic ceramic is used as veneer ceramic.

Evaluation and comparison of four types of bio-ceramic materials AGM MTA, Ortho MTA, pro root MTA and Cem cement in oral and dental health.

BACKGROUND AND OBJECTIVES: Mineral Trioxide Aggregate (MTA) is one of the main retrograde filling materials that is used today as a root end filling material and perforation repair material. This study was conducted with the aim of investigating the antibacterial and antifungal properties of four types of bio-ceramic materials, AGM MTA, Ortho MTA, Pro root MTA and Cem cement for oral and dental health. METHODS: In this study, the antibacterial activity of four types of bio-ceramic materials against two bacterial strains of Enterococcus faecalis (ATTC 29212), Escherichia coli (ATTC 35318) and antifungal activity against Candida albicans (ATTC 10231) were investigated using the well diffusion method. RESULTS: In the context of the relationship between the type of microorganism and the diameter of the growth inhibitory zone for each type of bio-ceramic material, there was no significant difference for Enterococcus faecalis, and a significant difference was observed for Escherichia coli and Candida albicans (p < 0.05). CONCLUSION: The results show that each of the bio-ceramic materials AGM, Pro root, Cem cement and Ortho have antibacterial and antifungal properties. AGM MTA bio-ceramic material on Candida albicans fungus and Ortho MTA bio-ceramic material had the most effect on Escherichia coli bacteria. Therefore, the mentioned bio-ceramic materials can play a significant role in oral and dental health by providing a suitable material for restoration.

Chemical and physical properties of radiopaque Portland cement formulation with reduced particle size.

This study compared the chemical and physical properties of an experimental radiopaque white Portland cement (REPC) with reduced particle size to ProRoot white mineral trioxide aggregate (WMTA). The particle size distribution of experimental Portland cement (EPC) was examined, and then nano-zirconium oxide (nano-ZrO) was added to produce REPC. Chemical analysis, initial setting time, pH values, and push-out bond strength were evaluated. Results showed that REPC had smallest particle size (354.5±26.45 nm), while PC had the largest (1,309.67±60.54 nm) (p<0.05). Differences in chemical composition were observed. REPC exhibited shorter setting time (32.7±0.58 min) compared to WMTA (131.67±2.89 min) and PC (163.33±2.89 min) (p<0.05). All groups showed alkaline pH (p<0.05). REPC demonstrated the highest push-out bond strength (22.24±4.33 MPa) compared with WMTA (15.53±3.26 MPa) and PC (16.8±5.43 MPa) (p<0.05). This cost-effective PC formulation reduced the setting time and increased the push-out bond strength while maintaining the alkaline properties of the original cements.

Immediate and Long-Term Pull-Out Bond Strength of 3D-Printed Provisional Crowns.

Background: Over the past decade, 3D printing technology has revolutionized various fields, including dentistry. Provisional restorations play a crucial role in prosthetic rehabilitation, necessitating the evaluation of their bond strength with different provisional cement agents. Aims: This study is aimed at assessing the immediate and long-term bond strength of 3D-printed dental crowns using three provisional cement agents. Materials and Methods: Provisional crowns (N = 36) were manufactured using 3D modeling software and cemented in dentin analogues (G10 Nema resin). After the crowns' fabrication, they were randomly divided into three groups (n = 12) for cementation with Relyx Temp 3M ESPE, Provicol-VOCO, and Meron-VOCO. Tensile strength tests were conducted using a universal testing machine, with half of the specimens subjected to 2000 thermal cycles before testing. Finite element analysis was employed to assess tensile stress distribution. Results: Statistical analysis (two-way ANOVA and Tukey's test at a 95% confidence level) revealed significant effects of cement type (p = 0.006) and thermal aging (p = 0.001) on bond strength. Glass ionomer cement exhibited the highest immediate resistance, while all types of cement were adversely affected by thermal aging, resulting in decreased bond strength. Conclusion: Thermal aging significantly alters the properties of 3D printing resin and affects the bond strength of provisional cement with 3D-printed crowns. Despite the adverse effects of thermal aging, glass ionomer cement demonstrated the highest immediate resistance. Clinicians should carefully consider these findings when selecting provisional cements for 3D-printed crowns.

Postoperative sensitivity of composites using novel Bacillus subtilis nanofortified adhesives: a triple-blind study.

NANOTECHNOLOGY: is the art and science of dealing with nanoscale particles. This has transformed contemporary dental practices through myriad contributions to biomaterial science. Titanium dioxide nanoparticles procured from Bacillus subtilis, an eco-friendly and biogenic source, can significantly magnify the physiochemical attributes of dental materials. However, postoperative sensitivity is a major drawback of composite restorations. The incorporation of these nanoparticles into dental adhesives can greatly benefit clinical dentistry by resolving this issue. This trial aimed to evaluate the effectiveness of a novel titanium dioxide nanofortified adhesive on the postoperative sensitivity of composite restorations. METHODS: This triple-blind, parallel-group randomized controlled trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Islamabad, from May 15, 2023, to November 25, 2023. Participants (n = 60) with Class I and II primary carious lesions with a minimum cavity depth of 3-5 mm were randomly assigned to two groups (n = 30). After obtaining informed consent, the restorative procedure was accomplished using a minimally invasive approach and etch-and-rinse adhesive strategy. In group A, a nanofortified adhesive was used for composite restoration, whereas in group B, an adhesive without nanoparticles was used. Postoperative sensitivity was evaluated using the Visual Analog Scale (VAS) score at follow-up periods: of one day, one week, two weeks and one month. A Chi-square test was used to compare postoperative sensitivity between the two groups. The level of significance was set at p < 0.05. RESULTS: A noteworthy association was observed between sensitivity and the group variable at all four evaluation periods: after one day (p = 0.002), 1 week (p = 0.002), 2 weeks (p = 0.007) and one month. In conclusion, participants who underwent restorative intervention using titanium dioxide nanoreinforced adhesives reported a notable reduction in sensitivity at all time intervals. Hence, the occurrence and severity of postoperative sensitivity are significantly reduced using Bacillus subtilis-procured nanofortified adhesives as compared to conventional adhesives without nanoparticles. TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov (ID: NCT06242184) on 03/02/2024. All procedures involving human participants were performed in conformance with this protocol.

Effect of adding sodium fluoride and nano-hydroxyapatite nanoparticles to the universal adhesive on bond strength and microleakage on caries-affected primary molars.

Evaluation of micro tensile bond strength (µTBS) and marginal leakage of sodium fluoride (NaF) and nano-hydroxyapatite (n-HA) modified universal adhesives (UAs) bonded using etch-and-rinse (ER) and self-etch (SE) bonding technique to the carious affected dentin (CAD). One hundred and twenty primary molars were prepared for CAD on the occlusal surface. The occlusal CAD surface was flattened and underwent a polishing procedure. The specimens were divided into six groups using a random allocation method based on the UAs applied and the mode of etching used (n = 20) Group A1: UAs (ER), Group B1: UAs (SE), Group A2: UAs (NaF) + ER, Group B2: UAs (NaF) + SE, Group A3: UA (n-HA) + ER and Group B3: UAs (n-HA) + SE. Composite restoration was placed and samples were thermocycled. Microleakage, µTBS, and failure mode assessment were performed using a dye penetration test, universal testing equipment, and stereomicroscope respectively. The µTBS and microleakage results (mean ± SD) were examined using analysis of the variance (ANOVA) and Tukey post hoc tests. Group B1 (UAs + SE) demonstrated the maximum scores of microleakage (25.14 ± 9.12 nm) and minimum recorded value of µTBS (14.16 ± 0.55 MPa). In contrast, Group A3 (UAs (n-HA) + ER) displayed a minimum value of marginal leakage (12.32 ± 6.33 nm) and maximum µTBS scores (19.22 ± 0.92 MPa). The outcomes of the intergroup comparison analysis showed that Group A2 (UAs (NaF) + ER), Group B2 (UAs (NaF) + SE), Group A3 (UA (n-HA) + ER) and Group B3 (UAs (n-HA) + SE) presented comparable outcomes of marginal seal outcomes and µTBS scores (p > 0.05). NaF and n-HA-modified UAs displayed favorable bond strength and minimum marginal leakage to the deciduous affected dentin surface.

Effects of lactic acid etching on immediate and aged bond strength of resin-dentin bonding interface.

To investigate the effects of lactic acid etching on the immediate and aged bond strength of the resin-dentin bonding interface, the resin-dentin bonding interface was evaluated 24 hours and 6 months later. A total of 42 isolated third molars were randomly divided into 6 experimental groups according to different lactate concentration (35%, 40%, 45%) and acid etching time (30 s, 45 s), with 37% phosphoric acid etching 15 s as a control. In each group, dentin samples were etched under different acidic conditions and bonded with Adper Single Bond 2 (3M ESPE) as directed. The immediate group was immediately stored in deionized water at 37 °C for 24 h, and the aging group was stored in artificial saliva at 37 °C for 6 months. Immediate and aged bond strengths were measured by a micro-tensile tester, and the specimen fracture surface was observed under a microscope. 14 isolated third molars were randomly divided into 7 groups, and each group was etched with acid. Collagen fibers morphology in dentin was examined after gradient dehydration with ethanol by scanning electron microscopy (SEM). Statistically, there was no difference between the resin-dentin immediate bonding strength of 35% lactic acid for 30 s and 37% phosphoric acid for 15 s, but the aged bond strength was greater than that of the phosphoric acid group. According to scanning electron microscope observations, the collagen fiber morphology in 35% and 40% lactate etching dentin 30 s groups was relatively intact compared with other groups. In conclusion, 35% lactic acid etching of dentin 30 s ensures both immediate and aged resin-dentin bond strength.

Exploring Zirconia Adhesion: Pre and Postsintering Physical Surface Treatment, Chemical Treatment, and Cement Interactions.

Background: Adhesion to zirconia remains a significant dental challenge. This study is aimed at assessing the bond strength of zirconia based on surface treatment with pre or postsintering sandblasting associated with different chemical treatments and resin cements. Methods: Zirconia blocks were divided into 12 experimental groups based on the surface treatment (presintering sandblasting or postsintering sandblasting/tribochemical abrasion treatment), chemical treatment (none, Single Bond Universal, or Signum Zirconia Bond), and choice of cement (Panavia F or RelyX™ U200). The bond strength was measured by shear tests using a universal testing machine. The fracture analysis was performed using stereomicroscopy. Data were analyzed using three-way ANOVA and Tukey's test (α = 5%). Results: Triple and double factor's interactions were not significant (p > 0.05). Regarding the surface treatment factor, the bond strength following postsintering sandblasting treatment associated with tribochemical abrasion (9.15 ± 3.62 MPa) was significantly higher than presintering sandblasting treatment (5.24 ± 3.53 MPa). Concerning the chemical treatment factor, bond strengths were ranked as follows: Signum Zirconia Bond > Single Bond Universal > no treatment. The bond strength of the resin cements did not differ among them. Most fractures (67%) were classified as adhesive, and 32% were categorized as mixed fractures. Conclusion: Surface treatment via postsintering sandblasting combined with tribochemical abrasion demonstrated superior efficacy than in presintering sandblasting. Additionally, chemical treatment with zirconia primer increased the bond strength of zirconia irrespective of the surface physical treatment.

Influence of luting strategies on dentin bond performance of self-adhesive resin luting cement in combination with a universal adhesive.

OBJECTIVES: This study aimed to evaluate the dentin bond performance of various resin luting cement (RLC) systems combined with universal adhesives in different luting strategies. MATERIALS AND METHODS: Three self-adhesive resin luting cements (SRLCs) were used with universal adhesives as primers. Twelve specimens per group were prepared to measure shear bond strength (SBS) under distinct luting strategies in etch-&-rinse and self-etch modes. Regarding luting strategies, the bonded specimens were categorized into four groups based on tooth primer application and the curing mode of the SRLC paste: (i) with light irradiation of the tooth primer (wL) + dual-cure mode (DC) of the SRLC paste, (ii) wL + self-cure mode (SC) of the SRLC paste, (iii) without light irradiation of the tooth primer (woL) + DC mode of the SRLC paste, and (iv) woL + SC mode of the SRLC paste. Specimens were also subjected to different storage conditions: 24 h in water (baseline condition) and 10,000 cycles of thermal cycling. RESULTS: Luting strategy, storage condition, and SRLC system type significantly influenced dentin SBS values in both etching modes. Notably, certain SRLCs exhibited significantly higher dentin SBS when the primer was light-irradiated compared with no primer irradiation. CONCLUSION: Most SRLCs demonstrated higher dentin bond strength with light-irradiated primers, suggesting potential enhancement of dentin bond performance via primer light irradiation.

Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Stability of the Dentin-Bonded Interface Using Self-Etching Adhesive Containing Diacrylamide after Bacterial Challenge.

Purpose/Aim: Acrylamides are hydrolytically stable at pH lower than 2, and were shown to preserve bonded interface integrity with two-step, total etch adhesives. The objective of this study was to leverage those two characteristics in self-etching primers containing the acidic monomer 10-MDP and test the microtensile bond strength before and after incubation with S. mutans incubation. Materials and Methods: Acidic primers (10 wt % 10-methacryloyloxydecyl dihydrogen phosphate─10-MDP; 45 wt % N,N-diethyl-1,3-bis(acrylamido)propane─DEBAAP, or 2-hydroxyethyl methacrylate─HEMA; 45 wt %, glycerol-dimethacrylate─GDMA) and adhesives (DEBAAP or HEMA/10-MDP/UDMA 45/10/45 wt %) were made polymerizable by the addition of 0.2 wt % camphorquinone, 0.8 wt % ethyl-4-dimethylaminobenzoate, 0.4 wt % diphenyliodonium hexafluorophosphate, and 0.1 wt % butylhydroxytoluene. Nonsolvated materials were characterized for flexural strength (FS), modulus (E), toughness, water sorption/solubility (WS/SL), contact angle, and vinyl conversion (DC). Viscosity was evaluated after adding 20 and 40 vol % ethanol to the primer and adhesive, respectively. The experimental materials or Clearfil SE Bond (CC─commercial control) were used to bond a commercial composite (Filtek Supreme) to the flat surface of human dentin. Microtensile bond strength (MTBS) was tested in 1 mm2 sticks for the 5 primer/bond combinations: CC (Clearfil Bond Primer and Bond), HH (HEMA/HEMA), DD (DEBAAP/DEBAAP), HD (HEMA/DEBAAP), and DH (DEBAAP/HEMA). Prior to testing, sticks were stored in water or biofilm-inducing culture medium with S. mutans for 1 week. Confocal images and FTIR-ATR evaluation evaluated the hybrid layer of the adhesives. Results were analyzed using Student's t-test (WS, SL, DC, contact angle, FS, E, toughness), one-way ANOVA/Tukey's test for viscosity, and two-way ANOVA/Tukey's test for MTBS (95%). Results: HEMA-based materials had lower contact angle (p = 0.004), higher WS (p < 0.001), and similar SL values compared to DEBAAP (p = 0.126). FS (p = 0.171) and E (p = 0.065) dry values were similar, but after one week of water storage, FS/E dropped more significantly for HEMA materials. Dry and wet toughness was greater for DEBAAP (p < 0.001), but it also had the greatest drop (46%). Clearfil bonds had the highest viscosity, followed by DEBAAP and HEMA, respectively (p = 0.002). For the primers, HEMA had the lowest viscosity (p = 0.003). As far as MTBS, all groups tested in water were statistically different when compared with HH (p < 0.001). After storage in biofilm, DH had the highest MTBS value, being statistically different from HH (p = 0.002), CC (p = 0.015), and DD (p = 0.027). Conclusions: The addition of a diacrylamide and its association with HEMA in self-etching adhesive systems provided greater bonding stability after bacterial challenge.

Evaluation of adhesive properties and enzymatic activity at the hybrid layer of a simplified adhesive loaded with 0.2 % Cu and 5 % ZnO nanoparticles: A Randomized Clinical Trial and ex vivo analysis.

OBJECTIVE: The aim of this study was to evaluate the effect of an adhesive loaded with 0.2 % copper (Cu) and 5 % zinc oxide (ZnO) nanoparticles (Nps) on its adhesive properties and enzymatic activity at the hybrid layer ex vivo in a randomized clinical model. METHODS: Fifteen patients participated in this study, and a total of 30 third molars were used. Occlusal cavities (4 × 4 × 2 mm) were made in each tooth, and randomly divided into 2 groups: (i) Experimental group: commercial adhesive loaded with 0.2wt % CuNps and 5wt % ZnONps; and (ii) Control Group: non-loaded commercial adhesive. Teeth were restored with resin composite. Thirty days later, extractions were performed. Extracted teeth were longitudinally sectioned. Nps in powder were characterized by field emission scanning electron microscope (FE-SEM) and energy dispersive X-ray (EDX) analysis. Microtensile bond strength (µTBS), degree of conversion (DC), and nanoleakeage (NL) tests were executed. In situ zymography (Zym) was performed to evaluate the gelatinolytic activity at the hybrid layer. Student's t-test (α = 0.05) was applied for all tests. RESULTS: µTBS and DC did not show significant differences (p > 0.05) between both groups. However, NL and gelatinolytic activity at the hybrid layer showed significant values (p < 0.05) for experimental group in comparison with control group. CONCLUSION: The addition of 0.2 % CuNps and 5 % ZnONps to a universal adhesive decreases NL and gelatinolytic activity at the hybrid layer, without jeopardizing its adhesive properties. SIGNIFICANCE: This randomized clinical trial with ex vivo analysis demonstrate that a commercial adhesive modified with 0.2wt % Cu and 5wt % ZnO Nps that does not affect its adhesive properties, reducing gelatinolytic activity and nanoleakage at the hybrid layer, which should contribute to an improvement of long term bonding-dentine clinical performance.

The influence of neutral MDP-Na salt on dentin bond performance and remineralization potential of etch-&-rinse adhesive.

OBJECTIVES: To investigate the effect of neutral 10-methacryloyloxydecyl dihydrogen phosphate salt (MDP-Na) on the dentin bond strength and remineralization potential of etch-&-rinse adhesive. METHODS: Two experimental etch-&-rinse adhesives were formulated by incorporating 0 wt% (E0) or 20 wt% (E20) neutral MDP-Na into a basic primer. A commercial adhesive, Adper Single Bond 2 (SB, 3 M ESPE), served as the control. Sixty prepared teeth were randomly allocated into three groups (n = 20) and bonded using either one of the experimental adhesives or SB. Following 24 h of water storage, the bonded specimens were sectioned into resin-dentin sticks, with four resin-dentin sticks obtained from each tooth for microtensile bond strength (MTBS) test. Half of the sticks from each group were immediately subjected to tensile loading using a microtensile tester at a crosshead speed of 1 mm/min, while the other half underwent tensile loading after 6-month incubation in artificial saliva (AS). The degree of conversion (DC) of both the control and experimental adhesives (n = 6 in each group) and the adsorption properties of MDP-Na on the dentin organic matrix (n = 5 in each group) were determined using Fourier-transform infrared spectrometry. Furthermore, the effectiveness of neutral MDP-Na in promoting the mineralization of two-dimensional collagen fibrils and the adhesive-dentin interface was explored using transmission electron microscopy and selected-area electron diffraction. Two- and one-way ANOVA was employed to assess the impact of adhesive type and water storage on dentin bond strength and the DC (α = 0.05). RESULTS: The addition of MDP-Na into the primer increased both the short- and long-term MTBS of the experimental adhesives (p = 0.00). No difference was noted in the DC between the control, E0 and E20 groups (p = 0.366). The MDP-Na remained absorbed on the demineralized dentin even after thorough rinsing. The intra- and extra-fibrillar mineralization of the two-dimensional collagen fibril and dentin bond hybrid layer was confirmed by transmission electron microscopy and selected-area electron diffraction when the primer was added with MDP-Na. CONCLUSIONS: The use of neutral MDP-Na results in high-quality hybrid layer that increase the dentin bond strength of etch-&-rinse adhesive and provides the adhesive with remineralizing capability. This approach may represent a suitable bonding strategy for improving the dentin bond strength and durability of etch-&-rinse adhesive.

Historical Perspectives on the Use Plastic-Based Cements in Endodontics and Prosthodontics: Part 1 - Oxychlorides.

Oxychloride of zinc was used for years to treat teeth by different approaches and procedures. The success of material usage depended on how well the procedures were conducted and largely on the mix of the material. This article aims to review the evolutionary history of this material with a view to its clinical uses, properties, procedures, applications, and successes when used in the management of decayed tooth structure. Perspectives proffered within focus cover 110 years from 1850 to 1960."Who has not mentally asked the question, as he has taxed himself and his patient to almost complete exhaustion in some dental operation of unusual magnitude or length, Is there not some way either to prevent this destruction of tissue or to restore these organs when attacked, unattended by the severe mental and physical strain upon the operator, and the shrinking, dread, and suffering to the patient which the present general practice and teaching involve?…If the profession would avert this evil, observation must be extended and accurate; new remedies must be sought and applied; investigation by experiment made popular, and the employment of other than mere mechanical remedies encouraged."

Historical Perspectives and Comparisons on the Use Plastic-Based Cements in Endodontics and Prosthodontics: Part 2 - Oxyphosphates.

Oxyphosphate of zinc was used for years to treat teeth by different approaches and procedures. Like oxychloride of zinc, success of the material depended on how well the procedures were conducted and largely on the mix of the material. This article aims to review the evolutionary history of this material with a view to its clinical uses, properties, procedures, applications, and successes when used in the management of decayed tooth structure and rebuilding of teeth. Perspectives proffered within focus cover 110 years from 1850 to 1960.

Assessment of MMP levels in reversible and irreversible pulpitis and a randomized controlled trial comparing clinical success of two different calcium-silicate cements in pulpotomy treatment of primary molars with an 18-month follow-up.

BACKGROUND: Matrix metalloproteinases (MMPs) are critical enzymes involved in the remodeling and defense mechanisms of dental pulp tissue. While their role in permanent teeth has been extensively studied, research focusing on MMPs in primary teeth remains limited. This gap highlights the need for further investigations to understand the specific contributions of MMPs to pulpal defense in primary teeth. Moreover, the clinical efficacy of Biodentine as a pulpotomy material in primary teeth warrants further exploration through well-designed studies to establish its success and long-term outcomes in pediatric dentistry. AIM: This study aims to compare the expression levels of MMP-2, MMP-8, and MMP-9 in cases of reversible and irreversible pulpitis. Additionally, it seeks to evaluate the clinical success of Mineral Trioxide Aggregate (MTA) and Biodentine when used as pulpotomy agents in primary molars. By analyzing the differential expression of these MMPs, the study will contribute to a better understanding of their role in pulpal inflammation and the potential therapeutic outcomes of MTA and Biodentine in primary molars. DESIGN: In this parallel randomized controlled trial, 63 mandibular primary second molars were assigned to two main groups: Group 1, consisting of 42 teeth diagnosed with reversible pulpitis, and Group 2, consisting of 21 teeth diagnosed with irreversible pulpitis. Group 1 was further divided into two randomized subgroups, each containing 21 teeth. The expression levels of MMP-2, MMP-8, and MMP-9 were evaluated in all samples. Pulpotomy treatments were performed using MTA and Biodentine in Group 1. Clinical and radiographic evaluations were conducted over an 18-month follow-up period. Statistical analyses were carried out using The Kolmogorov-Smirnov test, t-test and Fisher's exact test (p < 0.05). RESULTS: The study revealed that MMP-2 and MMP-9 expression levels were significantly elevated in specimens with irreversible pulpitis (p = 0.01), indicating a potential correlation between these matrix metalloproteinases and the severity of pulpal inflammation. However, no significant difference was observed in the clinical success rates of pulpotomies performed with MTA and Biodentine, suggesting that both materials are equally effective in the treatment of primary molars with reversible pulpitis. CONCLUSIONS: The expression of MMP-2 and MMP-9 in pulpal blood presents a promising biomarker for assessing the degree of pulpal inflammation in primary teeth, offering a potentially valuable diagnostic tool. Additionally, the clinical success of Biodentine in pulpotomy procedures supports its viability as an effective alternative to MTA, providing a reliable option. CLINICAL TRIAL REGISTRATION ID: The study protocol has been registered with an ID: NCT05145686. Registration Date: 9th November 2021.

Influence of provisional cementation on the stability of adhesively bonded resin-based composite crowns.

PURPOSE: To investigate the influence of temporary cementation and subsequent bonding on the durability during in-vitro aging-simulation and fracture force of resin-based composite crowns. METHODS: Identical molar crowns (n=48, n=8 per group) were milled from resin-based composites and temporarily cemented and finally bonded to human molars. To simulate temporary application, crowns were cemented either with zinc-oxide-eugenol-cement (Tempbond) or with eugenol free zinc-oxide-cement (Tempbond NE). For a first simulation of a long-term provisional clinical application, thermal cycling, and mechanical loading (TCML 2 x 600 x 5°C-55°C, 2 minutes each cycle, distilled water, 240,000 cycles at 50N) was performed. After TCML all crowns were removed, cleaned, and luted either by using etch-and-rinse technique (Vococid, Futurabond U, Bifix QM) or a self-adhesive (Bifix SE) cementation system. A second thermal cycling and mechanical loading (TCML 2 x3,000 x 5°C/55°C, 2 minutes each cycle, distilled water, 1.2 x 106 at 50N) was accomplished to simulate 5 years of clinical application. To assess the survival of the crowns, the failure rates during TCML were documented. As controls, crowns were included without prior provisional cementation. After TCML all crowns were loaded to failure. Failure was categorized as fracture of the crown and partial loosening of the crown. RESULTS: All crowns survived both TCML procedures without any failures. The fracture values after TCML varied between 3,538.0 ± 1,041.2 N and 4,612.0 ± 801.5 N without significant (P= 0.146) differences between the individual groups. No correlation was found between fracture force and type of provisional cementation (zinc-oxide-eugenol vs. zinc-oxide: Pearson: -0.063/P= 0.672) or type of bonding (adhesive vs. self-adhesive: Pearson: -0.151/ P= 0.307). No different failure pattern was observed between the tested systems. CLINICAL SIGNIFICANCE: Regardless of the type of temporary cementation, there was no effect on the in-vitro performance or strength of the final permanently bonded crowns. Resin-based crowns might be bonded with adhesive or self-adhesive systems even after previous temporary cementation.