Clinical performance of two ion-releasing bulk-fill composites in class I and class II restorations: A two-year evaluation.

OBJECTIVES: This randomized clinical trial evaluated and compared the 2-year clinical performance of two ion-releasing bulk-fill composites (Cention N and Surefil One) with that of a conventional bulk-fill resin composite (Powerfil) in Class I and II cavities. METHODS: Thirty-two patients, each with 3 Class I and/or Class II cavities under occlusion, were enrolled in this trial. A total of 96 restorations were placed, 32 for each material, as follows: a self-adhesive composite; Surefil-one, alkasite; Cention N, and a bulk-fill resin composite; Powerfil. The restorations were placed by a single operator. Clinical evaluation was performed at baseline (1-week), 6-months, 1-year, and 2-years by two independent examiners using the FDI criteria. Intergroup and intragroup comparisons were analyzed using the Kruskal-Wallis and Friedman Tests. Multiple comparisons between groups were analyzed using the Mann-Whitney and Wilcoxon-rank tests. The level of significance was set at α = 0.05. RESULTS: Twenty-seven patients with a total of 81 restorations were evaluated at the end of the 2-years with 84.35% recall rates. Clinical success rates were 100%, 100%, and 96.3% for Powerfil, Surefil-one, and Cention N, respectively. Cention N showed a statistically significant (p < 0.05) decreased marginal integrity in comparison with resin composite at the 2-year evaluation. No recurrent decay was detected in any restoration. CONCLUSIONS: Both ion-releasing bulk-fill composites provided acceptable clinical performance similar to bulk-fill composite in Class I and II restorations over a 2-year period. CLINICAL RELEVANCE: The results of this trial suggests that there is a promising evidence supporting the use of ion-releasing composites.

Effect of various surface coating methods on surface roughness, micromorphological analysis and fluoride release from contemporary glass ionomer restorations.

OBJECTIVE: To evaluate the effect of various surface coating methods on surface roughness, micromorphological analysis and fluoride release from contemporary resin-modified and conventional glass ionomer restorations. MATERIALS & METHODS: A total of 72 permanent human molars were used in this study. The teeth were randomly assigned into 2 groups according to type of restorative materials used; resin modified glass ionomer cement and conventional glass ionomer (SDI Limited. Bayswater Victoria, Australia). Each group was subdivided into 3 subgroups according to the application of coat material; Sub-group1: without application of coat; Sub-group2: manufacturer recommended coat was applied and sub-group3: customized (vaseline) coat was applied. Each group was then subdivided into two divisions according to the time of testing; immediate (after 24 h) and delayed (after 6 months of storage). Three specimens from each sub-group were selected for surface roughness test (AFM) and another 3 specimens for the micromorphological analysis using scanning electron microscope (SEM). For the fluoride release test, a total of 60 cylindrical discs were used (n = 60). The discs were randomly split into 2 groups according to type of restorative materials used (n = 30); resin modified glass ionomer cement and conventional glass ionomer. Each group was subdivided into 3 subgroups (n = 10) according to the application of the coat material; Sub-group1: without application of coat; Sub-group2: with the manufacturer recommended coat and sub-group3: with application of customized (vaseline) coat. Data for each test was then collected, tabulated, were collected, tabulated, and tested for the normality with Shapiro-Wilk test. Based on the outcome of normality test, the significant effects of variables were assessed using appropriate statistical analysis testing methods. RESULTS: Regarding the data obtained from surface roughness test, Shapiro-Wilk test showed normal distribution pattern of all values (p > 0.05). Accordingly, Two-way ANOVA outcome showed that the 'type of restoration' or 'test time' had statistically significant effect on the AFM test (p < 0.05). Regarding Fluoride specific ion electrode test 2-way ANOVA followed by Least Significant Difference (LSD) Post-hoc test revealed significant difference among the groups (p < 0.05). It showed that SDI GIC group after 14 days of measurement had the highest mean of fluoride release (36.38 ± 3.16 PPM) and SDI RMGIC after 30 days of measurement had the second highest mean of fluoride release (43.28 ± 1.89 PPM). Finally, regarding the micromorphological analysis using SEM, a slight difference was observed between the studied groups. CONCLUSIONS: Based on the results of this study, various coatings enhance surface roughness in the initial 24 h of restoration insertion. Different coat types seems that have no influence on fluoride release and the micromorphological features of the restoration/dentin interface.

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation.

BACKGROUND: This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent. METHODS: Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy. RESULTS: Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization. CONCLUSIONS: It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

In vitro elemental and micromorphological analysis of the resin-dentin interface of bioactive and bulk-fill composites.

PURPOSE: To evaluate the bonding interface and the remineralization potential of a bioactive restorative material on demineralized dentin compared to a conventional bulk-fill resin composite restoration. METHODS: Twelve caries-free human molars were used in this study. Specimens were randomly divided into two groups according to the type of restorative material used (n=12); an injectable resin-modified glass-ionomer restorative [Activa BioActive-Restorative (ABR) ] and a bulk-fill composite [3M Filtek One Bulk Fill Restorative, (BFC) ]. Each restored specimen was sectioned in two semi-equal halves along the long axis of the teeth perpendicular to the resin dentin interface with a water-cooled diamond disk at low speed. The restoration-dentin interfaces were scanned under SEM to observe micromorphological analysis; then an elemental analysis of the interface was performed using an energy dispersive X-ray (EDX) spectroscopy. RESULTS: Quantitative data were described using median (minimum and maximum) after testing normality using the Shapiro-Wilk test. Mann-Whitney U test was used to compare the BFC and ABR. Higher mean values of Ca were identified and related to the ABR material, which provided more Ca ions than BFC. The comparison of Ca and P between materials showed a significant difference in the amount of Ca provided by ABR versus BFC. ABR restorations presented a thicker, and superior remineralization interface compared to the bulk-fill resin composite. CLINICAL SIGNIFICANCE: Activa BioActive Restorative restorations presented a thicker and superior remineralization interface compared to the bulk-fill resin composite.

Effect of shelf-storage temperature on degree of conversion and microhardness of composite restorative materials.

BACKGROUND: The pre-cure temperature is considered an important parameter that affects the polymerization kinetics and the properties of composite restoration. As dissension exists about the effect of storing composite restorative materials in refrigerator, this study aimed to assess the effect of shelf-storage temperature on degree of conversion (DC) and microhardness of three composite restorative materials with different matrix systems. METHODS: Three commercially-available composite restorative materials were used in this study; an Ormocer-based composite (Admira Fusion, Voco GmbH), a nanoceramic composite, (Ceram.X SphereTEC One, Dentsply Sirona GmbH), and a nanohybrid composite (Tetric N-Ceram, Ivoclar Vivadent AG). Regarding DC and microhardness tests, 60 disc-shaped composite specimens for each test were randomly divided into 3 groups (n = 20) according to the restorative material used. Each group was divided into 2 subgroups (n = 10) according to the composite storage temperature; stored at room temperature or stored in the refrigerator at 4°-5 °C. DC was evaluated using a Fourier-transform infrared spectrometer coupled to an attenuated total reflectance accessory. Microhardness was evaluated using micro-Vickers hardness tester under a load of 50 g with a dwell time of 10 s. The results were analyzed by ANOVA, post-hoc LSD, and independent t-tests at a significance level of p < 0.05. RESULTS: Regarding DC test all groups showed statistically significant differences at both storage temperature. The Ormocer-based composite had the highest mean values. There was a statistically significant difference between all room-stored groups and their corresponding groups stored at refrigerator (p < 0.05). For microhardness test, all groups exhibited also statistically significant differences at both storage temperatures with the Ormocer-based composite having the highest mean values. A statistically significant difference between both room-stored and refrigerator-stored groups has been observed also (p < 0.05). CONCLUSIONS: Refrigeration of resin-composite might have a deleterious effect on DC and microhardness of the tested composite restorative materials with different matrix systems. Moreover, the differences in the formulations of composite matrix have a potential impact on DC and microhardness.

Clinical performance of resin-matrix ceramic partial coverage restorations: a systematic review.

OBJECTIVE: To evaluate clinical performance of the new CAD/CAM resin-matrix ceramics and compare it with ceramic partial coverage restorations. MATERIALS AND METHODS: An electronic search of 3 databases (The National Library of Medicine (MEDLINE/PubMed), Scopus, and the Cochrane Central Register of Controlled Trials) was conducted. English clinical studies published between 2005 and September 2020 that evaluated the clinical performance of CAD/CAM resin-matrix ceramics inlays, onlays, or overlays were selected. The primary clinical question was applied according to PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). The included studies were individually evaluated for risk of bias according to the modified Cochrane Collaboration tool criteria. RESULTS: A total of 7 studies were included according to the established inclusion and exclusion criteria. From the included studies, 6 were randomized clinical trials while one study was longitudinal observational study without control group. According to the results of the included studies, the success rate of CAD/CAM resin-based composite ranged from 85.7 to 100% whereas the success rate reported for ceramic partial coverage restorations ranged from 93.3 to 100%. Fractures and debondings are found to be the most common cause of restorations failure. CONCLUSION: CAD/CAM resin-based composite can be considered a reliable material for partial coverage restorations with clinical performance similar to glass ceramic restorations. However, this result needs to be confirmed in long-term evaluations. CLINICAL RELEVANCE: CAD/CAM resin-based composites provide a potential alternative to ceramic indirect restorations. However, clinicians must be aware of the lake of knowledge regarding long-term outcome.

Accuracy of an electrical impedance device in estimation of remaining dentin thickness vs cone beam computed tomography.

The objective of this study is to compare the estimated values of remaining dentin thickness (RDT) recorded by a newly introduced electrical impedance device (Prepometer) with cone beam computed tomography (CBCT) and histological in situ measurement. A total number of thirty human molars were used in this study. A deep class I cavity was prepared. The RDT for each cavity was measured with Prepometer in three different points (mesial, middle, and distal). Same specimens were imaged with high-resolution Cone Beam Computed Tomography CBCT (0.1 mm voxel size) using I CAT next Generation Machine (Imaging Science International, Hatfield, PA, USA), to provide the highest possible accuracy of linear measurements. Finally, the specimens were vertically sectioned parallel to the long axis of the tooth in a mesiodistal direction splitting the cavity into two halves through its center. Then, the actual RDT of each half will be measured in the same three points using a digital caliper. The outcome of one-way ANOVA revealed that there was no significant difference in RDT values measured by prepometer device, CBCT, or histological sectioning methods (p > 0.05). Within the limitations of this laboratory study, prepometer seems to be a potential non-invasive accurate measuring tool for RDT. Based on the findings of this study, the Prepometer can be considered as an easily handled and less-expensive method compared to CBCT to evaluate the RDT. Also, it can be used in dental schools and with less-experienced operators to avoid traumatic exposures of the dental pulp.

Long-term evaluation of early-enamel lesions treated with novel experimental tricalcium silicate paste: A 2-year randomized clinical trial.

OBJECTIVE: The aim of the current study is to evaluate the remineralization potential of experimental tricalcium silicate (TCS) paste in comparison with more popular remineralizing agents like silver diamine fluoride potassium iodide (SDF-KI) and casein phosphopeptide amorphous calcium phosphate (CPP-ACP) on early enamel lesions. MATERIALS AND METHODS: Forty-five patients in the age range of 15-50 years had early enamel lesions on the buccal surface of molar teeth. The patients were randomly divided into three treatment groups (SDF-KI, CPP-ACP, and TCS group) with 15 patients per group. Lesions were evaluated clinically by DIAGNOdent pen immediately and after 3,6,12, and 24 months of treatment. RESULTS: The study was completed with 45 patients and 92 teeth. Twice-daily application of CPP-ACP and TCS paste showed a significant remineralization effect on early enamel lesions after 24 months (p < 0.001). Also, annual application of SDF-KI showed a significant remineralization effect after 24 months (p < 0.001). There was a significant difference between (SDF-KI and CPP-ACP) and (SDF-KI and TCS) at the different follow-up periods 3,6,12, and 24 months (p < 0.001). Meanwhile, there was no significant difference between CPP-ACP and TCS at the mentioned follow-up periods (p > 0.05). CONCLUSION: TCS showed potential remineralization for early enamel lesions. CLINICAL RELEVANCE: Experimental TCS is a promising remineralizing agent for management of early enamel lesions.

Effect of different surface treatments on resin-matrix CAD/CAM ceramics bonding to dentin: in vitro study.

BACKGROUND: Evaluating the effect of different surface treatment methods on the micro-tensile bond strength (µTBS) of two different resin-matrix computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics (RMCs). METHODS: A standardized inlay preparations were performed on 100 intact maxillary premolars. According to the type of the restorative material, the teeth were randomly divided into two equally sized groups (n = 50): (polymer-infiltrated ceramic (Vita Enamic) and resin-based composites (Lava Ultimate)). The inlays were fabricated using CAD/CAM technology. In each group, the specimens were randomly assigned to five subgroups (n = 10) according to the surface treatment method: group 1 used was the control group (no surface treatment); group 2, was treated with air abrasion with 50 µm Al2O3 (A) and universal adhesive (UA); group 3, was treated with air abrasion with 50 µm Al2O3 (A) and silane coupling agent (S); group 4, was treated with hydrofluoric acid (HF) and universal adhesive (UA) and group 5, was treated with Hydrofluoric acid (HF) + silane coupling agent (S). The inlays were then cemented to their respective preparations using dual-cure self-adhesive resin cement (RelyX U200, 3 M ESPE) according to the manufacturer's instructions. The µTBS test was conducted in all groups, and stereomicroscope and scanning electron microscope were used to inspect the failure mode. The data were statistically analyzed using a two-way analysis of variance (ANOVA) and Tukey's post-hoc multiple comparison tests at a significance level of p < 0.05. RESULTS: Surface treatments significantly increased the µTBS of the materials compared to the control group (p < 0.05). For CAD/CAM RBCs, the µTBS value highest in group 2 whereas, for PICN, the µTBS value was highest in group 3. Cohesive failure of CAD/CAM restorative material was the most predominant mode of failure in all treated groups, whereas adhesive failure at restoration-cement interface was the most predominant failure mode in the control group. CONCLUSION: Surface treatments increase the µTBS of resin-matrix CAD/CAM ceramics to tooth structure. Air abrasion followed by universal adhesive and hydrofluoric acid followed by silane application appears to be the best strategies for optimizing the bond strength of CAD/CAM RBCs and PICN respectively.

The effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment: systematic review of prospective randomized clinical trials.

BACKGROUND: Endodontic surgical procedures, when performed, require retrograde filling materials that are biocompatible, non-toxic, non-irritant, dimensionally stable, and ideally promote bone formation. Precise evaluation of retrograde filling materials in clinical trials is necessary to give holistic view for properties of material and potential outcome from its use. The purpose of this review is to evaluate the effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment. METHODS: An electronic search was performed in the time frame between 1st of January 2000 to 1st of September 2020 using database. Sources Web of Science, PubMed and redundant hand searches through their references. Seven inclusion-exclusion criteria were set for the selection and identification of relevant articles. Risk of bias was conducted for the included studies. RESULTS: Nine randomized clinical trials (RCTs) fulfilled the inclusion criteria for this systematic review. The outcome of this review revealed that none of the reviewed trials totally-fulfilled CONSORT 2010 criteria. CONCLUSIONS: In light of the outcome of this review, there is no enough evidence to support the superiority of certain retrograde filling material or surgical technique over another in the success rate of surgical endodontics retreatment. The variety of methodologies and strategies, such as patient selection, the method of treatment and study analysis, led to doubtful credibility of the obtained clinical evidence. Further prospective randomized controlled clinical trials evaluating the specific effect of the various used materials are needed.

Biocompatibility of new bioactive resin composite versus calcium silicate cements: an animal study.

BACKGROUND: The purpose of this study was to compare the biocompatibility of three bioactive materials, namely ACTIVA bioactive restorative resin composite, iRoot BP plus and Mineral Trioxide Aggregate (MTA) Angelus-HP. METHODS: Seventy-five Wistar male rats were subjected to subcutaneous implantation of four polyethylene tubes; one empty tube was used as control (Group 1), and the other tubes were filled with ACTIVA (Group 2), iRoot BP (Group 3) and MTA-HP (Group 4). Then, the rats were subdivided into 3 groups according to the sacrification time into one, two and 4 weeks (n = 25 rats). Tissue specimens were submitted to histopathological and immunohistochemical analysis of α-SMA and caspase 3. RESULTS: The one-way Anova test revealed that ACTIVA group exhibited minimal inflammation in comparison to calcium silicate cements (iRoot BP and MTA-HP groups). iRoot BP group significantly revealed a more severe degree of chronic inflammation in comparison to other groups (P < 0.05). ACTIVA group showed marked regression of inflammation and fibrosis comparable to the control, while iRoot BP group revealed remarkable fibrosis and calcification, with less degrees in MTA-HP group (P < 0.05). Immunostaining of both α-SMA and caspase 3 revealed lower indexes in ACTIVA group consistent with the control (P < 0.05). CONCLUSIONS: ACTIVA showed a higher degree of biocompatibility to subcutaneous tissues in comparison to both iRoot BP and MTA-HP cements in regard to decrease the intensity of inflammation, with subsequent fibrous connective tissue remodeling and better healing patterns. CLINICAL SIGNIFICANCE: Preliminary data suggests that the application of ACTIVA in retrograde fillings.

Antimicrobial activity and pH measurement of calcium silicate cements versus new bioactive resin composite restorative material.

BACKGROUND: The purpose of this in vitro study is to compare the antimicrobial effect and pH of two calcium silicate cements Mineral trioxide aggregate high plasticity (Angelus PR, Brazil) and iRoot BP Plus (BioCeramix Inc., Vancouver, BC, Canada) and new bioactive restorative resin composite restorative material (ACTIVA, MA, Pulpdent, USA) against aerobic bacteria, strictly anaerobic bacteria and a yeast by using an agar diffusion test. METHODS: The materials were tested immediately after manipulation and were applied to the agar plates. Sodium hypochlorite (NaOCl) 5.25% was used as a positive control group. The dry filter paper acted as a negative control group for this study. The size of the inhibition zone for each material was measured after 12, 24 and 48 h. At the time of pH measurement; materials were prepared, crushed then dispersed in distilled water. RESULTS: The one-way Anova test revealed that iRoot BP Plus significantly showed superior antimicrobial efficacy compared to MTA-HP against the following species; Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, Enterococcus faecium, Peptostreptococcus anaerobius and Candida albicans (P < 0.05). All of the tested materials did not show any antimicrobial effect against Porphyromonas gingivalis and Actinomyces israelii. The new bioactive resin composite material (ACTIVA) showed the least antimicrobial activity against the previously mentioned microorganisms except E. faecalis. NaOCl significantly showed the highest antimicrobial activity among the test group (P < 0.05). iRoot BP Plus was more alkaline (pH 12.1 ± 0.14/ 11.9 ± 0.25) in comparison to MTA-HP (pH 11.6 ± 0.16/ 11.2 ± 0.10) while ACTIVA was slightly acidic (pH 5.4 ± 0.09/ 6.5 ± 0.08). CONCLUSIONS: According to the findings of this study, it was concluded that calcium silicate- based cements showed a potential antimicrobial activity mainly due to its high alkalinity. The new bioactive resin composite restorative material exhibits less antimicrobial activity due to its resinous ingredients and slightly acidic nature. Antimicrobial effect of calcium silicate cements against strictly anaerobic bacterial species is still questionable.

A new method of evaluation of fracture patterns following microtensile bond strength testing using polarized light microscopy.

PURPOSE: This work describes a new method using polarized light microscopy to determine the failure modes of fractured beams following microtensile bond strength testing. The outcomes were validated using SEM and EDX elemental analysis. MATERIALS AND METHODS: Resin adhesives and resin composites bonded to caries-free dentin samples as well as disks of adhesive and composite were observed with reflected polarized light microscopy (PLM) to obtain standard images. A set of beams fractured in the microtensile bond test were observed with PLM and compared with the standard images to determine failure mode through PLM color matching with the standard dentin, adhesive, or composite images. Samples were analyzed by EDX under SEM and compared with the PLM outcomes. RESULTS: Reflected PLM images showed that the fractured surfaces covered with resin-based materials (adhesives or composite) appeared pink in color, in contrast to dentin surfaces, which appeared yellow. EDX mapping together with SEM observation confirmed the results obtained by PLM. CONCLUSION: The results of EDX mapping and SEM observation showed that the use of polarized light microscopy is a simple, viable method for differentiation between the resin-covered dentin surfaces for determining fracture pattern analysis after bond testing.

Effect of chemomechanical caries removal on bonding of self-etching adhesives to caries-affected dentin.

PURPOSE: To evaluate the effect of enzyme-based (Papacárie) and sodium-hypochlorite-based (Carisolv) chemomechanical caries removal methods on bonding of self-etching adhesives to caries-affected dentin, in comparison to the standard rotary-instrument caries removal method. MATERIALS AND METHODS: Seventy-eight carious permanent molars exhibiting frank cavitation into dentin were used. Forty-eight teeth were randomly divided into three groups, according to the caries excavation methods: (i) Papacárie, (ii) Carisolv and (iii) a round steel bur. After caries removal, each group was subdivided into two groups for two-step (Clearfil SE Bond) or one-step (Clearfil S3 Bond) self-etching adhesive application and resin composite buildups. Bonded specimens were sectioned into beams for microtensile bond strength testing. Bond strength data were analyzed using three-way ANOVA and Tukey's test. For interfacial nanoleakage evaluation using a field-emission scanning electron microscope, caries was similarly removed from the remaining thirty carious molars, bonding was performed as for bond strength testing, and the teeth were sectioned. RESULTS: RESULTS of three-way ANOVA revealed that bond strength was significantly affected by "adhesive" (p<0.001) and "dentin" (p<0.001), but not "caries excavation methods" (p>0.05). The bond strength of the two-step self-etching adhesive was significantly higher than that of the one-step self-etching adhesive (p<0.001). Conversely, the bond strength of self-etching adhesives to sound dentin was significantly higher than to residual caries-affected dentin (p<0.001). Greater silver penetration was observed in the bonded interfaces of residual caries-affected dentin and in interfaces bonded with the one-step self-etching adhesive vs those bonded with the two-step self-etching adhesive. CONCLUSION: Chemomechanical caries removal did not affect the bonding of self-etching adhesives to caries-affected dentin as compared to caries excavation with rotary instruments.

Introduction of "qpdb" teeth numbering system.

This manuscript introduces a new method for teeth numbering system. The primary rationale of lunching this system was to solve previous numbering systems' drawbacks. Furthermore, to keep simplicity and ease of reading and inputting data. The outcome of a questionnaire disseminated among 66 personnel showed the confusion existing among currently used tooth numbering systems. The 'qpdb' system divided the oral cavity into four quadrants, each quadrant represented by alphabetical English letter (q, p, d & b). In spite of being a promising system, this new system lacks the real usage and application, and need more future studies to prove its validity.

3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials.

To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers' instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann-whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann-whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.

Effect of ethanolic extract of propolis on antibacterial and microshear bond strength of glass-ionomer restorations to dentin.

Objectives: This study was conducted to evaluate the effect of ethanolic extract of propolis on antibacterial and microshear bond strength of glass ionomer restorations to dentin. Materials and methods: Conventional glass ionomer cement (Equia forte, GC Tokyo, Japan), resin-modified glass ionomer (Fuji II LC, GC Tokyo, Japan) and propolis powder (dried extract from honey bees) materials were used in this study. Both conventional glass ionomer and resin-modified glass ionomer were modified by two different concentrations of ethanolic extract of propolis (10 % and 25 % EEP). For antibacterial test, Streptococcus mutans strain was spread on agar petri dishes using a sterile swab. Discs of both glass ionomer restorative materials (without adding EEP, with 10 % EEP and with 25 % EEP) were fabricated within the agar plates. Antibacterial activity was evaluated by measuring the inhibition zones around each disc. For microshear bond strength test, 60 healthy human permanent molars were prepared by cutting occlusal surface and expose the dentin at the height of contour of all teeth then conditioned using poly acrylic acid conditioner, both glass ionomer restorative materials (without adding EEP, with 10 % EEP and with 25 % EEP) were mixed and applied on conditioned dentin surface by using tygon tube. Microshear bond strength was evaluated by the universal testing machine. Results: Two-way ANOVA test revealed that both glass ionomer type and different concentrations of EEP had significant effect on the antibacterial test results and microshear bond strength values (p < 0,05). Glass ionomer restorative material with 25%EEP had the highest antibacterial values whereas glass ionomer restorative material without modifications (control groups) had the lowest values. Resin-modified glass ionomer without any modification (control group) had the highest bond strength while resin-modified glass ionomer with 25%EEP had the lowest bond strength. Conclusions: Incorporation of ethanolic extract of propolis to glass ionomer restorative material increases the antibacterial effects of both conventional GIC and RMGI. Inspite of this advantage, it seems that it has deleterious effect on microshear bond strength to dentin.

Microshear Bond Strength of Bioactive Materials to Dentin and Resin Composite.

OBJECTIVES: The aim of this study was to comparatively evaluate microshear bond strength (µSBS) of bioactive ionic resin composite and resin-modified glass ionomer liner (RMGI) to dentin and resin composite. MATERIALS AND METHODS: The enamel of 11 posterior molar teeth was removed to expose dentin and then placed in acrylic blocks. Each specimen received three microcylindrical Tygon tubes filled with bioactive ionic resin composite (Activa Bioactive base/liner (PULPDENT: , MA, USA)), RMGI (Riva light cure SDI LTD, Bayswater, Australia), and resin composite (Filtek Z350xt, MN, USA). Composite discs (n = 11) were fabricated from nanofilled resin composite (Filtek Z350xt) and then fixed in acrylic blocks. Each specimen received two microcylindrical Tygon tubes filled with Activa Bioactive base/liner and Riva RMGI. All specimens were mounted individually to universal testing machine for µSBS test. Failure modes were analyzed using stereomicroscope and scanning electron microscope. RESULTS: Filtek Z350xt nanofilled resin composite showed the highest µSBS values. No statistical significant difference was found between Activa Bioactive and Riva RMGI (p > 0.05). CONCLUSION: Bioactive ionic resin composite liner exhibited similar bond strength as RMGI to dentin and resin composite.

Intramedullary bone tissue reaction of ion-releasing resin-modified glass-ionomer restoration versus two calcium silicate-based cements: an animal study.

This comparative study was conducted to assess the intramedullary bone tissue reaction of an ion-releasing resin modified glass-ionomer cement with claimed bioactivity (ACTIVA bioactive resin) restorative material versus Mineral Trioxide Aggregate High Plasticity (MTA HP) and bioceramic putty iRoot BP Plus. Fifty-six adult male Wistar rats were assigned into 4 equal groups (14 rats each). A surgical intramedullary bi-lateral tibial bone defects were performed in rats of the control group I (GI) and left without any treatment to be considered as controls (n = 28). The rats of groups II, III and IV were handled as group I except that the tibial bone defects were filled with ACTIVA, MTA HP and iRoot BP, respectively. In all groups, rats were euthanized after one month and specimens were processed to histological investigation, SEM examination and EDX elemental analysis. In addition, semi-quantitative histomorphometric scoring system was conducted for the following parameters; new bone formation, inflammatory response, angiogenesis, granulation tissue, osteoblasts and osteoclasts. The clinical follow-up outcome of this study revealed the recovery of rats after 4 days post-surgical procedure. It was observed that the animal subjects returned to their routine activities, e.g., walking, grooming and eating. The rats showed normal chewing efficiency without any weight loss or postoperative complications. Histologically, the control group sections showed scanty, very thin, new bone trabeculae of immature woven type located mostly at the peripheral part of the tibial bone defects. These defects exhibited greater amount of thick bands of typically organized granulation tissue with central and peripheral orientation. Meanwhile, bone defects of ACTIVA group showed an empty space surrounded by thick, newly formed, immature woven bone trabeculae. Moreover, bone defects of MTA HP group were partially filled with thick newly formed woven bone trabeculae with wide marrow spaces presented centrally and at the periphery with little amount of mature granulation tissue at the central part. The iRoot BP Plus group section exhibited an observable woven bone formation of normal trabecular structures with narrow marrow spaces presented centrally and at the periphery showed lesser amount of well-organized/mature granulation tissue formation. Kruskal Wallis test revealed total significant differences between the control, ACTIVA, MTAHP and iRoot BP Plus groups (p < 0.05). Meanwhile, Mann-Whitney U test showed significant difference between control and ACTIVA groups, Control and MTA HP groups, control and iRoot BP Plus groups. ACTIVA and MTA HP groups, ACTIVA and iRoot BP Plus (p Ë‚ 0.05) with no significant difference between MTA HP and iRoot BP Plus (p > 0.05). The elemental analysis outcome showed that the lesions of the control group specimens were filled with recently created trabecular bone with limited marrow spaces. EDX tests (Ca and P analysis) indicated a lower degree of mineralization. Lower amounts of Ca and P was expressed in the mapping analysis compared with other test groups. Calcium silicate-based cements induce more bone formation when compared to an ion-releasing resin modified glass-ionomer restoration with claimed bioactivity. Moreover, the bio-inductive properties of the three tested materials are likely the same. Clinical significance: bioactive resin composite can be used as a retrograde filling.

Inhibition of Caries around Restoration by Ion-Releasing Restorative Materials: An In Vitro Optical Coherence Tomography and Micro-Computed Tomography Evaluation.

The objective of this study was firstly to assess the demineralization inhibitory effect of ion-releasing restorations in enamel adjacent to restoration using a biofilm caries model and secondly to compare the effect to that in a chemical caries model. Fifty-six bovine incisors were filled with either Surefil one (SuO), Cention N (CN) (both ion-releasing materials), Ketac-Molar (GIC) or Powerfill resin composite (RC). The restored teeth were then randomly divided into 2 groups according to the used caries model (biofilm or chemical caries model). The micro-computed tomography (MicroCt) and optical coherence tomography (OCT) outcome measures used to evaluate demineralization inhibition effects were lesion depth, LD and increase in OCT integrated reflectivity, ΔIR, at five different depths. It was observed that all outcome measures of CN were statistically the same as those of GIC and conversely with those of RC. This was also the case for SuO except for LD, which was statistically the same as RC. When comparing the two caries models, LD of the biofilm model was statistically deeper (p < 0.05) than the chemical model for all four materials. In conclusion, CN and SuO have similar demineralization inhibitory effects as GIC, and the biofilm caries model is more discriminatory in differentiating demineralization inhibitory effects of ion-releasing restorative material.