Effect of Different Liners on Fracture Resistance of Premolars Restored with Conventional and Short Fiber-Reinforced Composite Resins.

PURPOSE: To see whether applying four different liners under short fiber-reinforced composite (SFRC), everX Posterior, compared to conventional composite resin, Z250, affected their strengthening property in premolar MOD cavities. MATERIALS AND METHODS: Mesio-occluso-distal (MOD) cavities were prepared in 120 sound maxillary premolars divided into 10 groups (n = 12) in terms of two composite resin types and 4 liners or no liner. For each composite resin, in 5 groups no liner, resin-modified glass ionomer (RMGI), conventional flowable composite (COFL), self-adhesive flowable composite resin (SAFL), and self-adhesive resin cement (SARC) were applied prior to restoring incrementally. After water storage and thermocycling, static fracture resistance was tested. Data (in Newtons) were analyzed using two-way ANOVA (α = 0.05). RESULTS: Fracture resistance was significantly affected by composite resin type (p = 0.02), but not by the liner (p > 0.05). The interaction of the two factors was not statistically significant (p > 0.05). SFRC exhibited higher fracture strength (1470 ± 200 N) compared to conventional composite resin (1350 ± 290), irrespective of the application of liners. Application of SARC and SAFL liners led to a higher number of restorable fractures for both composite resins. CONCLUSIONS: The four liners can be used without interfering with the higher efficacy of SFRC, compared to conventional composite resins, to improve the fracture strength of premolar MOD cavities.

The Effect of the Application Sequence of Casein Phosphopeptide-Amorphous Calcium Phosphate Paste on the Shear Bond Strength of Etch-and-Rinse Resin Cements to Dentin.

PURPOSE: To evaluate the effect of the application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (MI paste) on shear bond strength (SBS) of 2 etch-and-rinse resin cements to dentin. MATERIALS AND METHODS: Sixty extracted human maxillary premolars were cut to expose the mid-coronal dentin surfaces. The teeth were randomly divided into 6 groups (n = 10), based on the resin cement used and CPP-ACP application. In groups 1-3, Excite DSC/Variolink II and in groups 2-4, One-Step Plus/Duolink was bonded to dentin. There were 3 groups for each cement as follows: with no treatment as a control; 3-minute application of CPP-ACP before acid etching (CPP-ACP/Etching); 3-minute application of CPP-ACP after acid etching (Etching/CPP-ACP). After storage in distilled water at 37°C for 24 hours, SBS test was performed. Data were analyzed with 2-way ANOVA and post-hoc Tukey test (α = 0.05). RESULTS: CPP-ACP application on the dentin before and after acid etching significantly decreased the SBS of OS/Duolink (13.60 and 14.71 MPa, respectively vs. control; 21.21 MPa, p < 0.001); however, it did not influence the SBS of Excite DSC/Variolink II (25.14 MPa) before acid etching (27.37 MPa) or after acid etching (26.41 MPa, p > 0.388). The application sequence of CPP-ACP did not influence the SBS of etch-and-rinse resin cements evaluated. CONCLUSION: CPP-ACP applications may lower the SBS in some etch-and-rinse resin cements, and timing of applications makes no difference.

Effect of fiber inserts on gingival margin microleakage of Class II bulk-fill composite resin restorations.

This study evaluated the effect of fiber inserts combined with composite resins on enamel and dentin margin microleakage. The fiber inserts were used with high- (x-tra fil) and low-viscosity (x-tra base) bulk-fill composite resins and as well as conventional composite resins (Grandio and Grandio Flow). In 96 sound, recently extracted molars, 2 standardized Class II cavities were prepared. The teeth were randomly divided into 8 groups of 12 teeth each, based on composite resin type and presence or absence of fiber inserts: groups 1 and 2, x-tra fil with and without fiber inserts, respectively; groups 3 and 4, x-tra base with and without fiber inserts; groups 5 and 6, Grandio with and without fiber inserts; and groups 7 and 8, Grandio Flow liner (gingival floor)/Grandio (remainder of cavity) with and without fiber inserts. In all the groups, a 2-step etch-and-rinse adhesive was used. The specimens were processed in a dye penetration technique to determine microleakage percentages. Data were analyzed with analysis of variance, Tukey, and t tests. There was significantly less leakage at the enamel margins than the dentin margins. Fiber reinforcement significantly decreased enamel microleakage in all the groups, with no significant differences among the groups. Concerning dentin microleakage, there were no significant differences among the 4 groups without fiber inserts, while a significant difference was detected in groups 2 (x-tra fil plus fiber) and 8 (Grandio Flow plus fiber/Grandio). Fibers significantly improved dentin sealing in groups 2 and 8. These findings suggest that a fiber insert reinforcing bulk-fill and conventional composite resins might improve enamel sealing in shallow Class II cavi-ties. The effect of fiber reinforcement on the dentin margins of deep cavities depended on the viscosity of the composite resins; fiber reinforcement was effective for flowable bulk-fill and conventional composite resin restorations.

Microleakage of Class II composite resin restorations with self-adhesive composite resin liners.

This study investigated the microleakage of Class II composite restorations with composite resin liners. Standardized box cavities were prepared on the mesial and distal surfaces of 84 extracted intact human molars. Proximal margins were located in enamel (occlusal) and 1.0 mm apical to the cementoenamel junction (gingival). The teeth were randomly divided into 6 groups (n = 28 cavities) and restored with Filtek Z350 nanohybrid composite resin (FZ). The test groups were lined with a conventional flowable composite resin, Premise Flowable (PF), or 1 of 2 self-adhesive composites (SACs): Vertise Flow (VF) or Clearfil SA luting cement (CSA) with or without their respective self-etching adhesives: Optibond All-in-One (OB) or Clearfil SE Bond (CSE). The adhesive/lining procedure was performed as follows: OB/FZ (control), OB/PF/FZ, VF/FZ, OB/VF/FZ, CSA/FZ, or CSE/CSA/FZ. Microleakage was evaluated at the occlusal and gingival margins using a dye penetration technique and quantitative assessment. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the data at the significance level of α = 0.05. None of the restorative techniques was capable of preventing microleakage completely. The greatest amount of microleakage was detected in the VF/FZ and CSA/FZ groups at both margins (P < 0.02). Among the groups placed with a bonding agent, OB/VF/FZ showed significantly greater values of microleakage at the occlusal margins than did OB/FZ, OB/PF/FZ, and CSE/CSA/FZ (P < 0.05). At the gingival margins, the OB/PF/FZ group exhibited the least leakage compared with the OB/VF/FZ and CSE/CSA/FZ groups (P < 0.001). The results indicated that the additional application of bonding agents improved the marginal sealing of SACs in Class II composite restorations.

Comparison of Cytotoxicity of New Nanohybrid Composite, Giomer, Glass Ionomer and Silver Reinforced Glass Ionomer using Human Gingival Fibroblast Cell Line.

AIM: The objective of this study was to investigate the cytotoxic effects of new nanohybrid composite, giomer, conventional and resin modified and silver reinforced glass ionomer cements and compare the biocompatibility of these dental materials in cell culture. STUDY DESIGN: Five cylindrical specimens were made of each material, using a mold (2mm. thick and 5 mm in diameter). For HGF, cells were cultured in RPMI-1640 medium. After attaining 80% confluence, cells were treated with different doses of five tested materials for 24h. Then cell cytotoxicity was assessed using MTT assay. The data were analyzed using Kruskal-Wallis and Dunn test. RESULTS: The materials evaluated on HGF cells, showed significantly more cytotoxicity in silver reinforced glass ionomer but nanohybrid composite shows mild cytotoxic effect. However, giomer shows no significant cytotoxicity and conventional and resin modified glass ionomer enhance cell proliferation. CONCLUSIONS: Silver reinforced glass ionomer induced a significant high cytotoxic effect over a wide range of concentration. Therefore, higher attention should be focused on this restorative dental material, which should be chosen for further investigations.

The Simultaneous Effect of Extended Etching Time and Casein Phosphopeptide-Amorphous Calcium Phosphate containing Paste Application on Shear Bond Strength of Etch-and-rinse Adhesive to Caries-affected Dentin.

AIM: This study evaluated the simultaneous effect of extended etching time and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing paste application on shear bond strength (SBS) of etch-and-rinse adhesive to caries-affected-dentin (CAD). MATERIALS AND METHODS: Fifty human third molars were used; 10 normal in group 1 and 40 caries-affected teeth in groups 2 to 5. In the CAD groups, teeth were randomly assigned into four groups (n = 10). In groups 2 and 4, phosphoric acid etching for 15 and 45 seconds was used and in groups 3 and 5, after 15 or 45 seconds etching respectively, CPP-ACP containing paste (MI paste) was applied for 3 minutes. After rinsing, single bond adhesive system and Z250 composite were used for resin composite build-up in all groups. After storage, SBS test was measured at cross head speed of 0.5 mm/min. Data were analyzed using one/two-way ANOVA and Tukey HSD test (α = 0.05). RESULTS: Normal dentin groups showed the highest SBS among different groups. There was a statistically significant difference between different etching times in CAD groups (p < 0.05), but there were no significant differences between SBS of SB adhesive to CAD with or without CPP-ACP pretreated in both etching times. Most of the failure modes were adhesive except in groups 1 and 5 which cohesive failure in composite was also observed. CONCLUSION: The results of our study indicated that extended etching time up to 45 seconds could enhance the SBS of CAD and approach nearly to SBS of normal dentin. Moreover, MI paste pretreatment had not significant effect on SBS of etch-and-rinse adhesive in CAD. CLINICAL SIGNIFICANCE: Simultaneous application of extended etching time and CPP-ACP containing paste may be a suggested method in increasing the SBS of adhesive to CAD.

Effect of resin coating and chlorhexidine on the microleakage of two resin cements after storage.

PURPOSE: This study evaluated the effect of resin coating and chlorhexidine (CH) on microleakage of two resin cements (Panavia F2.0, Nexus 2) after water storage. MATERIALS AND METHODS: Class V cavities were prepared on the facial and lingual surfaces of 120 intact human molars with gingival margins placed 1 mm below the cementoenamel junction. Indirect composite inlays were fabricated. The specimens were randomly assigned into six groups (n = 40). Indirect composite inlays (Gradia) were cemented as follows: Group 1 (control): inlays were cemented with Panavia F2.0 according to the manufacturer's instructions. Group 2: the ED-primed (ED Primer, Kuraray Dental, Tokyo, Japan) dentin was coated with a resin layer before cementation of the inlays with Panavia F2.0. Group 3: a 2% CH solution was applied before bonding with Panavia F2.0. Group 4: after CH application, the primed dentin was coated with a resin layer before cementation with Panavia F2.0. Group 5: (control) after applying Optibond Solo Plus, the inlays were cemented with Nexus 2. Group 6: after etching, CH was applied, and cementation was performed similarly to group 5. Half the specimens in each group were stored in distilled water for 24 hours, while the other half were stored in distilled water for 6 months. After storage, the teeth were placed in 1% methylene blue dye for 24 hours, sectioned, and evaluated under a 20× stereomicroscope. Dye penetration was scored using 0 to 3 criteria. Data were analyzed using nonparametric tests. RESULTS: Resin coating of ED primer for Panavia F2.0 significantly reduced microleakage at the gingival margins after 6 months (p < 0.05). CH application in Panavia F2.0 did not lead to a significant difference in the microleakage at both margins, after 24 hours and 6 months (p > 0.05). The application of CH showed significantly less microleakage than that of the control group at the gingival margins of Nexus 2 after 6 months. In general, gingival margins showed more microleakage than occlusal margins. CONCLUSION: An additional resin layer applied to a self-etch cement can improve long-term dentinal sealing for indirect restorations, while CH cannot; however, CH reduces gingival microleakage in an etch-and-rinse cement after aging.

Fracture resistance of endodontically treated premolars restored with bulk-fill composite resins: The effect of fiber reinforcement.

BACKGROUND: Coronal restoration of endodontically treated teeth (ETT) with mesio-occluso-distal (MOD) cavities is of a great importance in long-term success of the treatment. This study evaluated the effect of fiber reinforcement on the fracture resistance (FR) of ETT restored with flowable or paste bulk (PB)-fill composite resin compared to conventional composite (CC) resin. MATERIALS AND METHODS: In this in vitro experimental study, eighty maxillary premolars were divided into eight groups (n = 10). The first group was left intact (G1) and the other groups received MOD cavities along with endodontic treatment. G2: Remained unrestored while the other experimental groups were restored with three types of composite resin with or without fiber insertion. G3: CC resin, G4: PB fill, G5: Flowable bulk fill (FB). G6: Fiber + CC, G7: Fiber + PB, and G8: Fiber + FB. FR was tested at crosshead speed of 1 mm/min and recorded in Newton. Data were analyzed using one-way analysis of variance and Tukey's tests at significance level of P < 0.05. RESULTS: G1 and G2 revealed the highest and the lowest FR, respectively. The mean FR of the testing groups in Newton was as follows: G1 = 1204.8 A, G2 = 352.1 C, G3 = 579.6 BD, G4 = 596.7 BD, G5 = 624.9 BDE, G6 = 858.3 E, G7 = 529.6 CB, and G8 = 802.5DE. Different uppercase letters indicate the significant difference between the groups. CONCLUSION: The effect of fiber insertion on FR depended on the type of composite resin; the highest reinforcing effect was obtained in the CC resin + fiber, followed by bulk-fill flowable + fiber, and flowable bulk (FB)-fill composite resin. The strength of the former was significantly higher than the conventional and PB fill with and without fiber.

Three-year clinical evaluation of cuspal coverage with combined composite-amalgam in endodontically-treated maxillary premolars.

This clinical study evaluated the clinical performance of cuspal coverage with combined composite-amalgam restorations in endodontically-treated maxillary premolars over a three-year period. Thirty-six maxillary premolars, each with a Class II cavity in 36 patients ranging in age between 28 and 52 years, were selected after endodontic treatment. After reduction of the buccal and palatal cusps, internal coverage and veneering of the reduced buccal cusp was performed with composite. The remaining cavity and reduced palatal cusp were restored with high-copper amalgam. The restorations were evaluated at baseline and in one-, two- and three-year recalls with USPHS criteria. Changes in characteristics of the restorations were analyzed with the Cochran Q-test at a significance level of p < 0.05. Most of the restorations received an overall score of alpha, except two restorations, which showed a slight discrepancy at the composite-amalgam interface after one year (p > 0.05). Four restorations exhibited slight discoloration of the composite veneering after three years (p < 0.05). No restoration exhibited fracture after three years. It was concluded that combined composite-amalgam cusp coverage of endodontically-treated maxillary premolars showed acceptable clinical performance after three years.

Effect of composite/amalgam thickness on fracture resistance of maxillary premolar teeth, restored with combined amalgam-composite restorations.

BACKGROUND: Combined amalgam-composite restorations have been used through many years to benefit from the advantages of both dental amalgam and composite resin. Two variations have been mentioned for this technique, this study investigated the fracture resistance of maxillary premolar teeth with extended mesio-occluso-distal (MOD) cavities, restored with the two variations of combined amalgam-composite restorations. MATERIAL AND METHODS: Sixty intact extracted premolar teeth were randomly divided into 6 groups (G1-G6) of 10 teeth. G1; consisted of intact teeth and G2; consisted of teeth with MOD preparations were assigned as the positive and negative control groups respectively. Other experimental groups after MOD preparations were as follows: G3, amalgam restoration; G4, composite restoration; G5 combined amalgam-composite restoration with amalgam placement only on 1mm of the gingival floor of the proximal boxes; G6, combined amalgam-composite restoration with amalgam placement to the height of contact area of the proximal surface of the tooth. Fracture strength of the specimens was measured and the data were analyzed using one-way analysis of variance (ANOVA). The level of significance was P<0.05. Fracture mode of the specimens was also recorded. RESULTS: G1 had the highest value of fracture resistance (1736.90 N). G2 and G3 had the lowest fracture resistance (775.70 N and 874.70 N, respectively). The difference between G 4, 5 and 6 was not statistically significant. However, G4, G5 and G6 showed significantly higher resistance to fracture compared to G2 and G3. Fracture modes were favorable in all of the study groups except in G6. CONCLUSIONS: Fracture resistance of the premolars restored with the two variations of combined amalgam-composite restoration was similar to that achieved with composite restoration alone and more than that of amalgam restoration alone. It can be concluded that the thickness of amalgam in combined amalgam-composite restorations did not affect fracture resistance of the teeth. KEY WORDS: Amalgam, composite, fracture resistance, restoration.

Flexural Strength Comparison of Silorane- and Methacrylate-Based Composites with Pre-impregnated Glass Fiber.

STATEMENT OF THE PROBLEM: Sufficient adhesion between silorane/methacrylate-based composites and methacrylate impregnated glass fiber increases the benefits of fibers and enhances the mechanical and clinical performance of both composites. PURPOSE: The aim of this study was to evaluate the compatibility of silorane and methacrylate-based composites with pre-impregnated glass fiber by using flexural strength (FS) test. MATERIALS AND METHOD: A total of 60 bar specimens were prepared in a split mold (25×2×2 mm) in 6 groups (n=10). In groups 1 and 4 (control), silorane-based (Filtek P90) and nanohybrid (Filtek Z350) composites were placed into the mold and photopolymerized with a high-intensity curing unit. In groups 2 and 5, pre-impregnated glass fiber was first placed into the mold and after two minutes of curing, the mold was filled with respective composites. Prior to filling the mold in groups 3 and 6, an intermediate adhesive layer was applied to the glass fiber. The specimens were stored in distilled water for 24 hours and then their flexural strength was measured by 3 point bending test, using universal testing machine at the crosshead speed of 1 mm/min. Two-way ANOVA and post-hoc test were used for analyzing the data (p< 0.05). RESULTS: A significant difference was observed between the groups (p< 0.05). The highest FS was registered for combination of Z350 composite, impregnated glass fiber, and application of intermediate adhesive layer .The lowest FS was obtained in Filtek P90 alone. Cohesive failure in composite was the predominant failure in all groups, except group 5 in which adhesive failure between the composite and fiber was exclusively observed. CONCLUSION: Significant improvement in FS was achieved for both composites with glass fiber. Additional application of intermediate adhesive layer before composite build up seems to increase FS. Nanohybrid composite showed higher FS than silorane-based composite.

Microleakage of Three Types of Glass Ionomer Cement Restorations: Effect of CPP-ACP Paste Tooth Pretreatment.

STATEMENT OF THE PROBLEM: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) increases the mineral content of tooth structure. This may enhance the chemical bonding of glass ionomer cements (GIC) and marginal sealing of their restorations. PURPOSE: The aim of this study was to evaluate the effect of CPP-ACP paste pretreatment on the microleakage of three types of GIC. MATERIALS AND METHOD: In this study, 72 Class V cavities were prepared on the buccal and lingual surfaces of molars with occlusal margins in enamel and gingival margins in root. The cavities were divided into 6 groups. Cavities in group 1 and 2 were restored with Fuji II, group 3 and 4 with Fuji II LC, and group 5 and 6 with Ketac N100 with respect to the manufacturers' instructions. In groups 2, 4 and 6, CPP-ACP containing paste (MI paste) was placed into the cavities for 3 minutes before being filled with GIC. The teeth were thermocycled, stained with dye, sectioned, and scored for microleakage under stereomicroscope. Kruskall-Wallis and Chi-Square tests were used to analyze the data. RESULT: There were no statistically significant differences between the control and the CPP-ACP pretreatment groups in enamel and dentin margins. In pairwise comparisons, there were no significant differences between the control and the experimental groups in enamel margin, and in dentin margins of G1 and 2, G5 and 6; however, a significant differences was detected in dentin margins between G3 and 4 (p= 0.041). CONCLUSION: CPP-ACP paste pretreatment did not affect the microleakage of Fuji II and Ketac N100 in enamel or dentin, but decreased the microleakage in dentine margins of Fuji II LC when cavity conditioner was applied before surface treatment.

Impact of oxalate desensitizer combined with ethylene-diamine tetra acetic acid-conditioning on dentin bond strength of one-bottle adhesives during dry bonding.

BACKGROUND: Elimination of water entrapment in hybrid layer during bonding procedure would increase bonding durability. AIMS: This study evaluated the effect of oxalate desensitizer (OX) pretreatment on bond strength of three one-bottle adhesives to ethylene-diamine tetra acetic acid (EDTA)-conditioned dentin under dry bonding. MATERIALS AND METHODS: Three adhesive systems, One-Step Plus (OS), Optibond Solo Plus (OP) and Adper Single Bond (SB) were bonded on dentin surfaces under four bonding conditions: (1) Wet-bonding on acid-etched dentin, (2) wet bonding on EDTA-conditioned dentin, (3) dry bonding on EDTA-conditioned dentin, (4) dry bonding associated with OX on the EDTA-conditioned dentin. After storage and thermo cycling, shear bond strength test was performed. Data were analyzed using two-way analysis of variance and Tukey tests. RESULTS: Wet bonding with EDTA or acid etching showed similar bond strength for test adhesives. Dry bonding with EDTA significantly decreased the bond strength of OS, but it had no effect on the bonding of OP and SB. OX application in the forth bonding condition, in comparison with the third condition, had a negative effect on the bond strength of OP, but not influence on OS and SB. CONCLUSIONS: The use of an OX on EDTA-conditioned dentin compromised the bonding efficacy of OS and OP under dry bonding but compatible for SB.

Effect of oxalate desensitizer on the bonding durability of adhesive resin cements to dentin.

PURPOSE: This study investigated whether the tubular occluding effect of oxalate desensitizer (OX) during adhesive cementation improved bonding of a self-etch and two etch-and-rinse resin cements to dentin after 6 months. METHODS: A flat dentin surface was prepared on 120 extracted premolars, which were randomly divided into six groups of 20 teeth each according to the adhesive resin cement system used: ED primer II/Panavia F2.0, Excite DSC (Ex DSC)/Variolink II, and One-Step Plus (OS Plus)/Duolink, with or without OX (BisBlock) application. After cementation of an indirect composite rod, two subgroups (n=10) were tested after 24 h and 6 months of water storage plus thermocycling, and shear bond strengths were recorded in MPa. RESULTS: Statistical tests showed that although oxalate had a borderline significant negative effect on initial bonding of ED primer II/Panavia F2.0, it significantly improved bonding durability (p<0.05). OX severely compromised the initial bond strength of Ex DSC/Variolink II (p<0.001) but had no effect on the reduction in bonding after aging. OX was compatible with OS Plus/Duolink and did not affect the loss of bonding strength after 6 months (p>0.05). CONCLUSION: Combining an oxalate desensitizer with three types of resin cements had different effects on bond strength to dentin after aging, depending on the interaction of oxalate with the adhesive system associated to the resin cement.