Sixty-month comperative evaluation of a glass hybrid restorative and a composite resin in non-carious cervical lesions of bruxist individuals.

OBJECTIVE: To compare the clinical performance of a glass hybrid (GH) restorative and a nano-ceramic composite resin (CR) in the restoration of non-carious cervical lesions (NCCLs) of bruxist individuals in a 60-month randomized clinical trial. MATERIALS AND METHODS: Twenty-five bruxist candidates having NCCLs were recruited in this clinical study. The depth, height (cervico-incisal), width (mesio-distal), internal angles of the NCCLs, degree of tooth wear (TWI) and gingival index (GI) were measured. One hundred-and-forty-eight NCCLs were restored either with a GH restorative (Equia Forte Fil) or a CR (Ceram.X One Universal). Modified USPHS criteria was used to evaluate restorations after 1 week and 12, 24, 36 and 60 months. Pearson's Chi-Square, Fisher's Exact and Cochran Q tests were run for analysis. Survival rates of the restorations were compared with Kaplan-Meier analysis (p < 0.05). RESULTS: After 60 months, 97 restorations in 15 patients were examined. The recall rate was 60.0%. Retention rates were 73.5% for CR and 66.7% for GH. A total of 29 restorations were lost (13CR (26.5%), 16GH (33.3%)). There was not a significant difference between tested restoratives in retention (p = 0.464), marginal adaptation (p = 0.856) and marginal discoloration (p = 0.273). There was no relationship between internal angle, depth, height or width and retention of the GH or CR restorations (p > 0.05). The increase in retention loss and marginal discoloration of both restorations over time were significant (p < 0.001). Sensitivity or secondary caries were not detected after 60 months. CONCLUSION: GH and nano-ceramic CR showed similar clinical performances in NCCLs after 60 months in patients with bruxism. CLINICAL SIGNIFICANCE: After 60 months, CR and GH materials showed clinically acceptable performances in restoration of NCCLs in patients with bruxism.

Which whitening toothpaste with different contents is more effective on color and bond strength of enamel?

OBJECTIVE: To evaluate the effects of six whitening toothpastes with different whitening ingredients as follows: abrasives, polyphosphates, activated charcoal and hydrogen peroxide on the color, and shear bond strength (SBS) of enamel. MATERIALS AND METHODS: Thirty-five extracted human molars were sectioned in mesiodistal direction, providing 70 enamel specimens and randomly divided into seven groups having different whitening ingredients (n = 10). After baseline color measurements, the specimens were brushed three times daily for the 30 s. At the end of 2 weeks, spectrophotometric readings were repeated, and color change parameters were calculated. Then, composite cylinders were built on the enamel surfaces and the specimens were subjected to SBS test. Failure modes were determined under a stereomicroscope (×10). One specimen from each group was examined with scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis, Wilcoxon signed, one-way-ANOVA (p = 0.05). RESULTS: Clinically acceptable color change was observed in all whitening toothpastes. There were no significant differences among the groups for Δa, ΔL, ΔE00 , and ΔWID (p > 0.05). The differences among the groups were not significant regarding SBS and failure mode distributions (p > 0.05). SEM findings were in line with the SBS test and failure mode distribution results. CONCLUSIONS: All the tested whitening toothpastes showed similar and clinically acceptable efficacy on the color change of the enamel and led to comparable SBS values. CLINICAL SIGNIFICANCE: The tested whitening toothpastes had an acceptable whitening efficacy and did not have a negative effect on the bond strength to the enamel.

Six-year clinical evaluation of bulk-fill and nanofill resin composite restorations.

OBJECTIVES: This study aims to compare the performance of a bulk-fill and a nanofill resin composite in class II restorations after 6 years. MATERIALS AND METHODS: Fifty patients having at least two class II carious lesions were recruited for the study. One lesion in each patient was randomly assigned to be restored using either the Tetric EvoCeram Bulk Fill (TB) or Filtek Ultimate (FU) resin composites with their respective adhesives. One hundred four restorations were placed by two calibrated operators. Restorations were evaluated at baseline and annually over the course of 6 years by two examiners using modified USPHS criteria. Data were statistically analyzed using the Chi-square and Cochran Q tests (p < 0.05). RESULTS: Sixty-six restorations in 33 patients were evaluated after 6 years. Only one restoration was lost from FU group at 5 years. At the end of 6 years, marginal discoloration was observed in three (9.1%) TB and eight (36.4%) FU restorations creating a significant difference between the groups (p < 0.05). The FU group showed a significant increase in marginal discoloration at 6 years from the baseline (p < 0.05). Marginal adaptation was rated as Bravo for 9.1% and 24.2% of TB and FU restorations, respectively (p > 0.05). Significant degradation was observed within each group in terms of marginal adaptation (p < 0.05). There were no statistically significant differences between the groups for the other criteria tested (p > 0.05). CONCLUSIONS: Bulk-fill restorations performed better for marginal discoloration. The remaining clinical performance criteria of bulk-fill and nanofill resin composite restorations were similar after 6 years. CLINICAL RELEVANCE: Bulk-fill resin might be a better alternative to incrementally placed restorative in terms of marginal discoloration under clinical conditions.

Twenty-four-month clinical performance of a glass hybrid restorative in non-carious cervical lesions of patients with bruxism: a split-mouth, randomized clinical trial.

AIM: The aim of the present study was to evaluate the clinical performance of a glass hybrid restorative compared with a nano-ceramic composite resin in non-carious cervical lesions (NCCLs) of patients with bruxism. MATERIALS AND METHODS: Twenty-five patients with NCCLs and bruxism were enrolled in the present study. Before treatment, the dimensions of the NCCLs (depth, cervico-incisal height, and mesio-distal width) and internal angles were measured. Degree of tooth wear (TWI) and gingival conditions were recorded. A total of 148 NCCLs were randomly restored with a glass hybrid restorative system (GH) (Equia Forte Fil, GC, Tokyo, Japan) or a nano-ceramic composite resin (RBC) (Ceram.X One Universal, Dentsply, DeTrey, Konstanz, Germany). The restorations were evaluated at baseline and after 6, 12, and 24 months according to the modified USPHS criteria. Data were analyzed with Pearson's chi-square, Fisher's exact, Mann-Whitney U, and Cochran's Q tests (P < 0.05). RESULTS: At the 24-month recall, 126 restorations in 22 patients were evaluated. The recall rate was 88.0%. No significant difference was found between the materials for retention (P = 0.285), and no relationships were found between internal angle, depth, cervico-incisal height, or mesio-distal width and retention of the restorations (P > 0.05). A significant difference was observed between the materials for marginal adaptation (P = 0.002), but no relationships were found among depth, cervico-incisal height, and mesio-distal width and marginal adaptation (P > 0.05). RBC showed better results for marginal adaptation. Between marginal adaptation, TWI, and the gingival index, correlations were significant (P < 0.001, P = 0.002). A significant change was found in marginal discoloration in GH and RBC over time (P = 0.039 and P = 0.004, respectively). Neither secondary caries nor tooth sensitivity was observed on any of the restorations at any evaluation. CONCLUSION: Although nano-ceramic RBC showed better marginal adaptation than GH, both tested restoratives showed clinically acceptable performance for the restoration of NCCLs of patients with bruxism after 24 months of clinical service. TRIAL REGISTRATION: This study is registered on http://clinicaltrials.gov under protocol record KA-16020, Clinical Performance of a Glass Hybrid Restorative in NCCL's of Patients With Bruxism.

Comparison of laser- and bur-prepared class I cavities restored with two different low-shrinkage composite resins: a randomized, controlled 60-month clinical trial.

OBJECTIVE: The aim of this study was to compare the clinical performances of two low-shrinkage composite resins (silorane-based and methacrylate-based) in class I cavities prepared by Er,Cr:YSGG laser or conventional diamond bur over 60 months. MATERIALS AND METHOD: Eighteen patients with four similar-sized occlusal lesions in molar teeth were included to the study. A total of 72 class I cavities were prepared either by Er,Cr:YSGG laser or conventional diamond bur. Cavities were restored with Filtek Silorane (3M-ESPE) (silorane-based) or Kalore (GC) (methacrylate-based) according to the manufacturers' instructions. All restorative procedures were performed by one operator, and the restorations were examined by two evaluators according to the FDI criteria at baseline and at 6, 12, 24, 36, 48, and 60 months. Patients' satisfaction about the preparation methods was also evaluated with a questionnaire. Pearson chi-square test was used for statistical analysis (p = 0.05). RESULTS: The 60-month recall rate was 88.8% and the retention rates for experimental groups were 100%. After 60 months, no significant differences were detected among groups, regarding marginal adaptation, marginal staining, surface staining, color match, and translucency. None of the restorations exhibited postoperative sensitivity or recurrence of caries. CONCLUSION: Different preparation techniques had no effect on the longevity of restorations. The two low-shrinkage composite systems tested were both clinically acceptable after 60 months. CLINICAL RELEVANCE: Low-shrinkage composites showed similar clinical performance in class I cavities prepared with a laser or conventional bur after a 60-month observation period.

In vitro comparison of an Er:YAG laser-activated bleaching system with different light-activated bleaching systems for color change, surface roughness, and enamel bond strength.

To compare an Er:YAG laser-activated bleaching system with different light-activated in-office bleaching systems for color change, surface roughness, and post-bleaching enamel bond strength. 51 enamel slabs were prepared from the sound buccal enamel of extracted bovine teeth. The teeth were randomly divided into three groups according to different light-activated office bleaching systems (n = 17): diode laser (Epic, Biolase) (940 nm, 7 W, continuous mode), Er:YAG laser (LightWalker, Fotona) (2940 nm, 50 mJ, 10 Hz, 1000 µs), and LED (Radii Plus) (440-480 nm, 1500 mW/cm2). All systems were used with their compatible bleaching agents according to manufacturers' recommendations. The tooth color and surface roughness (Ra) were assessed at baseline and after bleaching using a spectrophotometer and a surface profilometer, respectively. The color change was determined by the CIE L*a*b* system (ΔE, ΔL*, Δa*, Δb*). Kruskal-Wallis test was used for color change whereas Kruskal-Wallis and Wilcoxon tests were used to analyze the roughness data. For shear bond strength test (SBS), composite cylinders were bonded on bleached enamel samples 14 days after bleaching procedures and stored in water (37 °C). Specimens were then debonded with a universal testing machine at 1 mm/min and data were analyzed by using Kruskal-Wallis test. All the tested bleaching systems were effective on color change (ΔE > 3.3) and produced similar color change (p > 0.05). There were no significant differences among the Ra values of the groups neither at baseline nor after bleaching (p > 0.05). However, comparing the baseline and after bleaching Ra values, a significant increase was observed for all tested groups (p < 0.05). Significant differences were also found among all systems for SBS (p < 0.05). The highest values were obtained in Er:YAG group, whereas the LED group revealed the lowest values (p < 0.05). All tested bleaching systems were effective on tooth whitening, whereas they all led to an increase on surface roughness. Although the current Er:YAG laser-activated bleaching system did not differ from other tested bleaching systems according to color change and surface roughness, it appears to provide better results in terms of SBS.

Clinical performance of a glass ionomer restorative system: a 6-year evaluation.

OBJECTIVES: The aim of this study is to evaluate the long-term clinical performance of a glass ionomer (GI) restorative system in the restoration of posterior teeth compared with a micro-filled hybrid posterior composite. MATERIALS AND METHODS: A total of 140 (80 Cl1 and 60 Cl2) lesions in 59 patients were restored with a GI system (Equia) or a micro hybrid composite (Gradia Direct). Restorations were evaluated at baseline and yearly during 6 years according to the modified-USPHS criteria. Negative replicas at each recall were observed under SEM to evaluate surface characteristics. Data were analyzed with Cohcran's Q and McNemar's tests (p < 0.05). RESULTS: One hundred fifteen (70 Cl1 and 45 Cl2) restorations were evaluated in 47 patients with a recall rate of 79.6% at 6 years. Significant differences were found in marginal adaptation and marginal discoloration for both restorative materials for Cl1 and Cl2 restorations (p < 0.05). However, none of the materials were superior to the other (p > 0.05). A significant decrease in color match was observed in Equia restorations (p < 0.05). Only one Cl2 Equia restoration was missing at 3 years and another one at 4 years. No failures were observed at 5 and 6 years. Both materials exhibited clinically successful performance after 6 years. SEM evaluations were in accordance with the clinical findings. CONCLUSIONS: Both materials showed a good clinical performance for the restoration of posterior teeth during the 6-year evaluation. CLINICAL RELEVANCE: The clinical effectiveness of Equia and Gradia Direct Posterior was acceptable in Cl1 and Cl2 cavities subsequent to 6-year evaluation.

Effect of bleaching on mercury release from amalgam fillings and antioxidant enzyme activities: a pilot study.

OBJECTIVE: The aim of this pilot clinical study was to determine the mercury release from amalgam fillings and antioxidant enzyme activities (Superoxide Dismutase [SOD] and Catalase[CAT] ) in body fluids after exposure to two different vital tooth bleaching systems. MATERIAL AND METHODS: Twenty eight subjects with an average age of 25.6 years (18-41) having at least two but not more than four Class II amalgam fillings on each quadrant arch in the mouth participated in the study. Baseline concentrations of mercury levels in whole blood, urine, and saliva were measured by a Vapor Generation Accessory connected to an Atomic Absorption Spectrometer. Erythrocyte enzymes, SOD, and CAT activities in blood were determined kinetically. Subjects were randomly assigned to two groups of 14 volunteers. Group 1 was treated with an at-home bleaching system (Opalescence PF 35% Carbamide Peroxide, Ultradent), and Group 2 was treated with a chemically activated office bleaching system (Opalescence Xtra Boost 38% Hydrogen Peroxide, Ultradent) according to the manufacturer's recommendations. Twenty-four hours after bleaching treatments, concentrations of mercury and enzymes were remeasured. RESULTS: There were no significant differences on mercury levels in blood, urine, and saliva before and after bleaching treatments (p > 0.05). No differences were also found in the level of antioxidant enzyme activities (SOD and CAT) before and after treatments (p > 0.05). Mercury release did not affect the enzyme activities (p > 0.05). CONCLUSION: Bleaching treatments either office or home did not affect the amount of mercury released from amalgam fillings in blood, urine, and saliva and the antioxidant-enzyme activities in blood. CLINICAL SIGNIFICANCE: Bleaching treatments with the systems tested in this pilot study have no deleterious effect on the mercury release from amalgam fillings and antioxidant enzymes in body fluids.

Evaluation of ER;CR:YSGG Laser and Remineralization Agents on Mineral Density and Ion Levels of Primary and Permanent Enamel.

Objective: The aim of this study is to evaluate the efficacy of two different fluoride varnishes used alone or in combination with laser treatment on permanent and primary tooth enamel. Methods: Ninety-six primary and 96 permanent molar samples were divided into six groups. The levels of calcium, phosphorus, fluoride, and silver ions of each sample were analyzed using energy-dispersive X-ray spectroscopy (EDS). Six different treatments were applied to 12 different groups (n = 15) as control (g1/G1), fluoride varnish (g2/G2), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-fluoride varnish (g3/G3), laser (g4/G4), laser+fluoride varnish (g5/G5), and laser+CPP-ACP-fluoride varnish (g6/G6). After the procedures, ion levels were reanalyzed with EDS. The teeth were subjected to the artificial caries-forming procedure and ion levels were again evaluated by EDS. One sample from each group was prepared separately for the focused ion beam-scanning electron microscope measurement; initial and final images were recorded. The obtained data were statistically analyzed with the SPSS 23.0 program. Results: Compared with the initial measurement, phosphorus percentages increased in most of the groups in the last measurement. Calcium percentages of primary teeth increased in the last measurement, except for the g1 group, but in permanent teeth, there was an increase only in the G6 group. There was a statistically significant difference between g1/G1 and g6/G6 groups in the last measurement of phosphorus and calcium percentages. Conclusions: The combined use of laser with CPP-ACP-fluoride varnish enhanced remineralization in the primary and permanent teeth. However, in permanent teeth, the use of laser alone was not as effective as in primary teeth. Therefore, combined usage with CPP-ACP-fluoride varnish can enhance its efficacy. This in vitro study was approved by the local ethics committee of Hacettepe University (Project No.: GO 20/441).

Clinical Performance of a "No Wait" Universal Adhesive in Noncarious Cervical Lesions: A Two-year Randomized Controlled Clinical Trial.

PURPOSE: To evaluate the 24-month clinical performance of a "no wait" universal adhesive with different application modes in comparison with an etch-and-rinsew and two-step self-etch adhesive in non-carious cervical lesions (NCCLs). MATERIALS AND METHODS: A total of 234 non-carious cervical lesions in 34 patients were restored following 5 different adhesive approaches: 1. Clearfil Universal Bond Quick, self-etch mode (CUQ-SE); 2. Clearfil Universal Bond Quick, selective etch mode (CUQ-SLE); 3. Clearfil Universal Bond Quick, etch-and-rinse mode (CUQ-ER); 4. Clearfil SE Bond (self-etch adhesive) (CSEB); 5. Tetric N-Bond Universal, etch-and-rinse mode (TBU-ER). All NCCLs were restored with a nanohybrid composite (Tetric N-Ceram). The restorations were evaluated at baseline, 6, 12, and 24months of clinical service regarding retention, marginal adaptation, marginal discoloration, secondary caries, post-operative sensitivity, color match, surface texture using modified United States Public Health Service (USPHS) criteria. RESULTS: The patient recall rate at 24 months was 73.5%. Eleven restorations, 6 of the CUQ-SE group, 4 of the CSEB group and 1 of the TBU-ER group, were clinically unacceptable due to retention loss. Regarding marginal adaptation and discoloration, CUQ-SE and CSEB groups exhibited higher bravo scores than other groups after 24 months (p < 0.05). At the end of 24-month examinations, no significant differences were detected among the groups regarding secondary caries, post-operative sensitivity, color match and surface texture. CONCLUSION: The clinical survival rates of the "no wait" universal adhesive at self-etch mode after 24 months were not acceptable. The "no wait" universal adhesive showed clinically acceptable performance in selective-etch and etch-and-rinse mode according to the evaluated USPHS criteria.

Professional motivations and perceptions of senior dental students in the distance education period during the first year of the Covid-19 pandemic.

Purpose: Dental students are particularly prone to be affected by the global emergency of Coronavirus-19 (Covid-19) pandemic. The aim of this study was to evaluate the professional motivations and perceptions of senior dental students during the distance education period due to pandemic. Materials and methods: The data was collected via an online questionnaire, including questions related to students' professional motivation and perceptions, and views about preventive dentistry. For identifying the distress levels, Turkish version of Depression Anxiety Stress Scale (DASS)-21 was used. Descriptive statistics and marginal homogeneity test were used for statistical analysis. Results: A total of 114 (83 female, 31 male) students, with the mean age of 23.7±1.03 participated the study. Statistically significant changes were observed on the students' career plans (p<0.001); fear about getting and transmitting infectious diseases (p<0.001); and satisfaction about their profession (p<0.001) during the Covid-19 pandemic. Motivation loss was determined on the participants. Conclusion: There is an urgent need for revision on dental education in order to ensure the students be competent to provide oral health service that can meet the latest needs and achieve professional self-confidence without deterioration on their professional motivation and perceptions. Crisis-oriented psychological support programs should be provided for students. Some improvements should be structured in terms of preventive dentistry issues, both for dental education and dental health service aspects.

A randomized controlled 10 years follow up of a glass ionomer restorative material in class I and class II cavities.

OBJECTIVE: To evaluate the durability of a glass ionomer restorative material in Class I and Class II cavities during 10 years compared with a micro filled composite resin. METHODS: Fifty-nine participants (mean age 24 years) received 140 (80 Class I and 60 Class II) glass ionomer (GI) or composite resin (CR) restorations. Evaluation was performed with slightly modified USPHS criteria at baseline, and yearly during the 10 years. Data were analyzed with Cohran's Q and McNemar's tests. RESULTS: Fifty-one patients and 124 restorations (61 GI / 38 Class I - 23 Class II, 63 CR / 38 Class I, 25 Class II) were evaluated after 10 years. The recall rate was 86.4%. The overall clinical recall rate of restorations was 88.6%. The success rate of Class I and II restorations were calculated as 100% for both materials. The cumulative failure rate (CRF) of all Cl I and Cl II GI restorations was 3.17% in total, but CFR was 8 % for Cl II GI restorations. A significant difference was observed between the marginal discoloration scores of restorations at 10 years (p = 0.022). No significant difference was seen between two restorative materials in terms of marginal adaptation (p > 0.05). A significant change was seen in color match of GI restorations at 10 years (p < 0.05). No significant change was found for the anatomical form, secondary caries, postoperative sensitivity, surface texture, and retention for either restorative material (p > 0.05). CONCLUSIONS: Both tested restorative materials showed an acceptable success rate in the restoration of Class I and Class II cavities during the 10-year follow up.

One-year evaluation of a new restorative glass ionomer cement for the restoration of non-carious cervical lesions in patients with systemic diseases: a randomized, clinical trial.

OBJECTIVE: This randomized and clinical trial aimed to evaluate the performance of a new restorative Glass Ionomer Cement (GIC) for the restoration of non-carious cervical lesions (NCCLs) of patients with systemic diseases compared with a posterior resin composite after 12 months. METHODOLOGY: 134 restorations were placed at 30 patients presenting systemic diseases by a single clinician. NCCLs were allocated to two groups according to restorative system used: a conventional restorative GIC [Fuji Bulk (GC, Tokyo Japan) (FB)] and a posterior resin composite [G-ænial Posterior (GC, Tokyo Japan) (GP)] used with a universal adhesive using etch&rinse mode. All restorative procedures were conducted according to manufacturer's instructions. Restorations were scored regarding retention, marginal discoloration, marginal adaptation, secondary caries, surface texture, and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after 1 week (baseline), 6, and 12 months. Descriptive statistics were performed using chi-square tests. Cochran Q and Mc Nemar's tests were used to detect differences over time. RESULTS: After 12 months, recall rate was 93% and the rates of cumulative retention failure for FB and GP were 4.9% and 1.6% respectively. Both groups presented similar alpha rates for marginal adaptation (FB 86.2%, GP 95.5%) and marginal discoloration (FB 93.8%, GP 97%) at 6-month recall, but FB restorations showed higher bravo scores than GP restorations for marginal adaptation and marginal discoloration after 12 months (p<0.05). Regarding surface texture, 2 FB restorations (3.1%) were scored as bravo after 6 months. All restorations were scored as alpha for secondary caries and postoperative sensitivity after 12 months. CONCLUSION: Although the posterior resin composite demonstrated clinically higher alpha scores than the conventional GIC for marginal adaptation and discoloration, both materials successfully restored NCCLs at patients with systematic disease after a year. CLINICAL RELEVANCE: Due to its acceptable clinical results, the tested conventional restorative GIC can be used for the restoration of NCCLs of patients with systemic diseases.

Comparison of Resin Infiltration Technique with Conventional Preventive Applications on Occlusal Fissures in Terms of Chemical Analysis and SEM.

OBJECTIVE: To compare the subsurface mineral loss preventing capability of resin infiltration technique with topical fluoride and fissure sealant applications to demineralized occlusal fissures under simulated oral conditions. MATERIALS AND METHODS: Occlusal surfaces of 64 extracted intact human third molars were demineralized. Next, the teeth were classified into four groups according to preventive applications (n = 16): G1, Specimens used as the control group with no preventive treatment; G2, Topical fluoride application (APF Gel/ DEEPAK); G3, Fissure sealant application (ClinproTMSealant/ 3M ESPE); and G4, Resin infiltration technique (Icon/ DMG). Chemical compositions before pH cycling were evaluated for eight specimens from each group. The remaining eight teeth from each group were subjected to pH cycling for 15 days to simulate the oral conditions. Subsequently, the specimens were fractured after immersion in liquid nitrogen and the subsurface fluoride (F), calcium (Ca), phosphorus (P) levels, and Ca/P ratio of each specimen were measured using energy dispersive x-ray spectrometer (EDS). The data were subjected to statistical analysis (p = 0.05). The effects of preventive applications to surface topography of specimens were evaluated using scanning electron microscope (SEM). RESULTS: There were no significant differences among the groups in subsurface F, Ca, and P levels and Ca/P ratios before or after pH cycling (p > 0.05). All three preventive applications were effective during pH cycling according to SEM observations. CONCLUSIONS: The subsurface mineral loss preventing capability of resin infiltration technique applied to occlusal fissures was comparable to topical fluoride and fissure sealant applications. CLINICAL SIGNIFICANCE: The resin infiltration technique could represent a valid alternative to traditionally used both preventive and restorative treatments for treating initial carious lesions on occlusal fissures, offering the advantages of better resin penetration and retention.

Clinical Evaluation of a Self-Adhering Flowable Resin Composite in Minimally Invasive Class I Cavities: 5-year Results of a Double Blind Randomized, Controlled Clinical Trial.

OBJECTIVE: The aim of this study was to evaluate the long-term clinical performance of a self-adhering flowable resin composite compared to a conventional flowable resin composite used with an etch&rinse adhesive system in minimally invasive Class I cavities. MATERIALS AND METHODS: Twenty-five patients received at least one pair of Class I restorations (n=65). After class I cavities had been prepared, they were randomly restored either with a self-adhering flowable resin composite (VertiseFlow/Kerr-VR) [Group-1 (n=33)], or with a flowable resin composite (Luxaflow/DMG-LX) in combination with an etch&rinse adhesive (Teco/DMG) [Group-2 (n=32)] according to the manufacturers' instructions. The restorations were evaluated at baseline and yearly during 5 years according to the FDI criteria by two evaluators. A statistical analysis was carried out using the Pearson Chi-Square test and the Cochran Q-test followed by the Mc Nemar's test (p=0.05). RESULTS: After 5 years a total of 47 restorations were evaluated with a recall rate of 68%. At 4-year, 3 (11.5%) VR and 2 LX (7.6%) restorations exhibited a cumulative retention loss. Seventeen (73.9%) VR and 14 LX (58.3%) restorations exhibited clinically acceptable (2) scores for marginal adaptation. At 5-year evaluations VR and LX showed similar results regarding all evaluated criteria (p > 0.05). The cumulative retention loss rates of VR and LX were 15.3% and 7.6%, respectively. None of the restorations demonstrated a recurrence of caries and post operative sensitivity. Both materials showed significant changes at 4 and 5 years regarding marginal staining when compared to baseline (p<0.001). Furthermore, significant changes were observed for VR and LX at 1, 2, 3, 4 and 5 years for marginal adaptation according to baseline (p<0.001). CONCLUSION: The use of both materials for the restoration of Class-I cavities demonstrated clinically acceptable performance at the end of 5-year. The self-adhering flowable composite exhibited a clinical performance similar to the conventional flowable applied with an etch&rinse adhesive.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial.

OBJECTIVE: The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). MATERIAL AND METHODS: Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). RESULTS: The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. CONCLUSION: GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Microhardness and shear bond-strength of carious dentin after fluorescence-aided or conventionally excavation: (An in-vitro comparison).

BACKGROUND: To compare the fluorescence-aided and conventionally excavated dentin with microhardness and shear bond strength(SBS) tests. MATERIAL AND METHODS: Twenty-four teeth with dentin caries were bisected through the center of the lesion into two halves. Forty-eight dentin specimens were embedded and mounted in an acrylic resin. All carious tissue was removed and classified as caries free using conventional visual tactile criteria. Then half of the specimens(n=24) were reinspected with fluorescence-aided caries excavation light(FACE) (FaceLight, W&H Dentalwerk, Bürmoos GmbH, Austria). Specimens were subjected to microhardness and shear bond strength testings. The fracture mode analysis was also performed. The data were compared with Student's t test and Chi-square test. RESULTS: Residual caries was observed in 2 out of 24 conventionally excavated specimens with FACE inspection(p>0.05). Mean Vickers hardness of the dentin was 61.5±5 in the FACE group and 70.3±3 kg/mm2 in the conventionally excavated group(p>0.05). The mean SBS value of FACE group was 11.42±1.63 MPa and 18.27±1.43 MPa in conventionally excavated group. There was no statistically significant difference between conventional and FACE groups for microhardness and SBS tests(p>0.05). There were also no significant differences on the fracture mode distributions of the groups(p>0.05). CONCLUSIONS: FACE method could be considered as a promising technique for removing infected dentin. Key words:FACE, conventional excavation, residual caries detection, shear bond strength, microhardness.

Comparison of Er,Cr:YSGG Laser Handpieces for Class II Preparation and Microleakage of Silorane- or Methacrylate-Based Composite Restorations.

OBJECTIVE: The aim of this study was to evaluate the influence of cavity preparation with different Er,Cr:YSGG laser handpieces on microleakage of different posterior composite restorations. METHODS: Fifty-four extracted intact human premolars were randomly assigned to three groups according to cavity preparation method: Bur Group: high-speed diamond bur (Diatech), MD Group: Er,Cr:YSGG laser Waterlase MD handpiece (Biolase Millennium II), and Turbo Group: Er,Cr:YSGG laser Waterlase MD TURBO handpiece (Biolase Millennium II). One hundred eight Class II slot cavities were prepared on the mesial and distal proximal surfaces of each tooth, and the cavity preparation times required were determined. The groups were then subdivided according to the restorative systems used (n = 12): a conventional methacrylate-based microhybrid composite (Filtek P60+Adper Single Bond 2/3M); a silorane-based resin composite (Filtek Silorane+Silorane System Adhesive/3M); and a nanohybrid methacrylate-based composite (Kalore+G-Bond/GC). The restorative systems were applied according to the manufacturers' recommendations. Following thermocycling (X5000; 5°C-55°C), the teeth were coated with nail varnish except the restoration margins, immersed in 0.5% basic fuchsin dye solution, and sectioned in a mesiodistal direction. Dye penetration was evaluated under a light microscope for occlusal and cervical margins. Data were analyzed with one-way ANOVA and chi-square tests (p < 0.05). RESULTS: The cavity preparation time (mean ± SD) required for Bur, MD, and Turbo group was 31.25 ± 3.82, 222.94 ± 15.85, and 92.5 ± 7.42 sec, respectively, and the differences among the groups were statistically significant (p < 0.05). Comparing the occlusal and cervical microleakage scores, no statistically significant differences were found among the groups and subgroups (p > 0.05). CONCLUSIONS: Er;Cr:YSGG laser cavity preparation with the Turbo handpiece needed shorter time than the MD handpiece, although it needed longer time than the conventional diamond bur. The use of different handpieces of Er,Cr:YSGG laser did not differ from conventional preparation with diamond bur in terms of microleakage with the tested methacrylate- and silorane-based posterior composite restorative systems.

Effects of in-office bleaching agent combined with different desensitizing agents on enamel.

OBJECTIVE: To analyze color change, microhardness and chemical composition of enamel bleached with in-office bleaching agent with different desensitizing application protocols. MATERIALS AND METHODS: One hundred and seventeen polished anterior human enamel surfaces were obtained and randomly divided into nine groups (n = 13). After recording initial color, microhardness and chemical composition, the bleaching treatments were performed as G1: Signal Professional White Now POWDER&LIQUID FAST 38% Hydrogen peroxide(S); G2: S+Flor Opal/0.5% fluoride ion(F); G3: S+GC Tooth Mousse/Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) paste(TM); G4: S+UltraEZ/3% potassium nitrate&0.11% fluoride(U); G5: S+Signal Professional SENSITIVE PHASE 1/30% Nano-Hydroxyapatite (n-HAP) suspension(SP); G6: S-F mixture; G7: S-TM mixture; G8: S-U mixture; G9: S-SP mixture. Color, microhardness and chemical composition measurements were repeated after 1 and 14 days. The percentage of microhardness loss (PML) was calculated 1 and 14 days after bleaching. Data were analyzed with ANOVA, Welch ANOVA, Tukey and Dunnett T3 tests (p<0.05). RESULTS: Color change was observed in all groups. The highest ΔE was observed at G7 after 1 day, and ΔE at G8 was the highest after 14 days (p<0.05). A decrease in microhardness was observed in all groups except G6 and G7 after 1 day. The microhardness of all groups increased after 14 days in comparison with 1 day after bleaching (p>0.05). PML was observed in all groups except G6 and G7 after bleaching and none of the groups showed PML after 14 days. No significant changes were observed after bleaching at Ca and P levels and Ca/P ratios at 1 or 14 days after bleaching (p>0.05). F mass increased only in G2 and G6, 1 day after bleaching (p<0.05). CONCLUSIONS: The use of desensitizing agents containing fluoride, CPP-ACP, potassium nitrate or n-HAP after in-office bleaching or mixed in bleaching agent did not inhibit the bleaching effect. However, they all recovered microhardness of enamel 14 days after in-office bleaching.

Comparison of two different methods of detecting residual caries.

OBJECTIVES: The aim of this study was to investigate the ability of the fluorescence-aided caries excavation (FACE) device to detect residual caries by comparing conventional methods in vivo. MATERIALS AND METHODS: A total of 301 females and 202 males with carious teeth participated in this study. The cavity preparations were done by grade 4 (Group 1, 154 teeth), grade 5 (Group 2, 176 teeth), and postgraduate (Group 3, 173 teeth) students. After caries excavation using a handpiece and hand instruments, the presence of residual caries was evaluated by 2 investigators who were previously calibrated for visual-tactile assessment with and without magnifying glasses and trained in the use of a FACE device. The tooth number, cavity type, and presence or absence of residual caries were recorded. The data were analyzed using the Chi-square test, the Fisher's Exact test, or the McNemar test as appropriate. Kappa statistics was used for calibration. In all tests, the level of significance was set at p = 0.05. RESULTS: Almost half of the cavities prepared were Class II (Class I, 20.9%; Class II, 48.9%; Class III, 20.1%; Class IV, 3.4%; Class V, 6.8%). Higher numbers of cavities left with caries were observed in Groups 1 and 2 than in Group 3 for all examination methods. Significant differences were found between visual inspection with or without magnifying glasses and inspection with a FACE device for all groups (p < 0.001). More residual caries were detected through inspection with a FACE device (46.5%) than through either visual inspection (31.8%) or inspection with a magnifying glass (37.6%). CONCLUSIONS: Within the limitations of this study, the FACE device may be an effective method for the detection of residual caries.