Can the hydrogel form of sodium ascorbate be used to reverse compromised resin infiltrant penetration after bleaching?

Aims: The aim of this study was to investigate the effects of an antioxidant on the bleaching-induced reduction in the penetration depth of infiltrant resins. Materials and Methods: White spot lesions (WSLs) were created on 105 bovine tooth samples, each measuring 6 × 4 × 4 mm. Five samples were randomly selected for the examination of lesion characteristics. The remaining 100 samples were then divided into four groups (n = 25). In Group I, the WSLs were treated with resin infiltration (RI) only. RI was performed on Group II immediately after bleaching. In Group III, an antioxidant was applied for 2 h after bleaching, and this was immediately followed by RI. The Group IV samples were treated with RI at the end of a 1-week waiting period after bleaching. The penetration depths were evaluated through confocal laser scanning microscopy. Results: The lowest penetration rate, which was approximately 57%, was observed in Group II. This was followed by Group III (87%), Group IV (90%), and Group I (92%). Group II, in which the samples were infiltrated immediately after bleaching, had the lowest mean penetration percentage. All the bleached groups exhibited significantly lower penetration percentages than the nonbleached group (Group I) (P < 0.05). Antioxidant application increased the penetration significantly (P < 0.05). Conclusion: Application of sodium ascorbate was found to reverse the reduced resin penetration depth and penetration percentages resulting from bleaching. The postponement of adhesive procedures after bleaching yielded similar results.

Microleakage of IPS empress 2 inlay restorations luted with self-adhesive resin cements.

OBJECTIVE: To assess the microleakage of three self-adhesive and one etch-and-rinse resin cements when luting IPS Empress 2 (Ivoclar Vivadent, Liechtenstein) all-ceramic inlay restorations to the prepared cavities in extracted human molars. METHODS: The cylindrical Class V cavities were prepared on the buccal surfaces of 40 extracted human third molars using diamond burs. The IPS Empress 2 ceramic inlays were placed with Multilink Sprint (Ivoclar Vivadent), RelyX Unicem (3M ESPE, USA), G-Cem (GC, Japan), or Variolink II (Ivoclar Vivadent) as the control group. After storage in distilled water at 37°C for 24 hours, samples were subjected to 1000 thermal cycles between baths of 5°C and 55°C, with a dwell time of 30 seconds. The microleakage scores were examined on the occlusal and gingival margins at 30× magnification after each sample was stained with 0.5% basic fuchsin and sectioned into three parts using a thin diamond blade (Isomet, Buehler, USA) (n=40). The extent of microleakage on both occlusal and gingival margins of the restorations was scored and recorded. The microleakage data were analyzed using Kruskall-Wallis and Mann-Whitney U-tests. RESULTS: Statistically significant differences were observed between the groups in both margins according to the Kruskall-Wallis and Mann-Whitney U-tests (p<0.05). Microleakage scores on the occlusal margins were Variolink II < RelyX Unicem < G-Cem = Multilink Sprint. Microleakage scores on the gingival margins are Variolink II = RelyX Unicem < G-Cem < Multilink Sprint. CONCLUSION: Self-adhesive resin cements displayed higher microleakage scores on the occlusal margins, whereas on the gingival margins RelyX Unicem showed comparable microleakage results with the control samples.

Adhesion of resin composite to hydrofluoric acid-exposed enamel and dentin in repair protocols.

Intraoral repairs of ceramic fixed-dental-prostheses (FDP) often include cervical recessions that require pretreatment of the exposed tooth surfaces either before or after the ceramic is conditioned with hydrofluoric (HF) acid gel. The sequence of repair protocol may cross-contaminate the exposed etched enamel or dentin surfaces during the application or rinsing process and thereby affect the adhesion. This study evaluated the influence of HF acid gel with two concentrations on bond strengths of composite to enamel and dentin. Human third molars (N=100, n=10 per group) with similar sizes were selected and randomly divided into 10 groups. Flat surfaces of enamel and dentin were created by wet ground finishing. Before or after the enamel (E) or dentin (D) was conditioned with phosphoric acid (P), substrate surfaces were conditioned with either 9.5% HF (HF(9.5)) or 5% HF (HF(5)). Subsequently, a bonding agent (B) was applied. The experimental groups by conditioning sequence were as follows where the first letter of the group abbreviation represents the substrate (E or D) followed by the acid type and concentration: group 1 (EPHF(9.5)), group 2 (EPHF(5)), group 3 (EHF(9.5)P), group 4 (EHF(5)P), group 5 (DPHF(9.5)), group 6 (DPHF(5)), group 7 (DHF(9.5)P), and group 8 (DHF(5)P). Group 9 (EPB) and group 10 (DPB) acted as the control groups. Repair resin was adhered incrementally onto the conditioned enamel and dentin in polyethylene molds. Each layer was photo-polymerized for 40 seconds. All specimens were thermocycled (×1000, 5°-55°C) and subjected to shear test (universal testing machine, 1 mm/min). Specimens that debonded during thermocycling were considered as 0 MPa. The bond strength data were analyzed using Kruskal-Wallis test and failure types using the chi-square test (α=0.05). Overall, the bond results (MPa) were lower on dentin than on enamel (p<0.01). EPB (25.6 ± 6.6) and DPB (20.2 ± 4.9) control groups showed significantly higher results than those of other groups (p<0.05). While higher mean bond strengths were obtained in group 1 (EPHF(9.5)) (11.5 ± 2.1) and group 2 (EPHF(5)) (7.3 ± 0.6), lower results were obtained when HF acid gels were applied prior to phosphoric acid (EHF(9.5)P: 5.0 ± 1.1, EHF(5)P: 3.6 ± 0.1) (p<0.05). On dentin, the results were the lowest in group 8 (DHF(5)P: 1.5 ± 1.6), being significantly lower than those of group 5 (DPHF(9.5)) (p<0.05). Scanning electron microscope (SEM) images revealed predominantly mixed failures with less than half of the composite left on both enamel and dentin surfaces (64 out of 80) (p<0.05), indicating that in general, adhesion was not ideal. Contamination of the enamel or dentin surfaces with HF acid gel impairs the bond strength of composites. Considering both the bond strength results and failure types, when dental tissues are to be repaired next to ceramic, application of phosphoric acid before HF acid gel application can be recommended. HF acid gel concentration did not influence the results except on enamel.

Effect of Er,Cr:YSGG laser on the microtensile bond strength of two different adhesives to the sound and caries-affected dentin.

OBJECTIVE: This study examined the effect of Er,Cr:YSGG laser irradiation on the microtensile bond strength (microTBS) of a three-step etch-and-rinse and a two-step self-etch adhesive to sound and caries-affected dentin. METHODS: Sixteen freshly extracted human molars with occlusal dentin caries were used. The caries lesion was removed by one of the following methods: conventional treatment with burs or Er,Cr:YSGG laser (Waterlase MD, Biolase). The adhesive systems (AdheSE, Ivoclar Vivadent and Scotchbond Multi Purpose, 3M ESPE) were applied to the entire tooth surface according to the manufacturers' instructions. Resin composites were applied to the adhesive-treated dentin surfaces and light-cured. Each tooth was sectioned into multiple beams with the "non-trimming" version of the microtensile test. The specimens were subjected to microtensile forces (BISCO Microtensile Tester, BISCO). The data was analyzed by three-way ANOVA and independent t-tests (p=0.05). RESULTS: Er,Cr:YSGG laser irradiation exhibited similar microTBS values compared to that of conventional bur treatment, regardless of the adhesive system and type of treated dentin. The self-etch system revealed lower microTBS values, both with conventional and laser treatment techniques, compared to the etch-and-rinse adhesive in sound and caries-affected dentin (p<0.05). CONCLUSION: Er,Cr:YSGG laser irradiation did not negatively affect the bonding performance of adhesive systems to sound and caries-affected dentin.

Oxygen release of tetra acetyl ethylene diamine (TAED) and sodium perborate combination.

AIM: To evaluate the effect of tetra acetyl ethylene diamine (TAED) on oxygen release from sodium perborate and to compare it with sodium perborate-hydrogen peroxide (H(2)O(2)) and sodium perborate-distilled water mixtures. METHODOLOGY: Six groups were evaluated: control groups (groups I-III), sodium perborate was mixed with distilled water or 3% or 30% H(2)O(2); experimental groups (groups IV-VI), sodium perborate was mixed with TAED in different ratios and then distilled water was added to these mixtures. The amount of oxygen released from the samples was measured with a digital oxygen meter at room temperature (25 degrees C) and body temperature (37 degrees C) after 1 min, 1-6 h and 12 h and on each day up to 1 week. The results were statistically evaluated by one-way analysis of variance and post hoc Tukey's tests. RESULTS: The TAED groups demonstrated significantly higher amounts of released oxygen after 1 min and 1 h at 25 degrees C and 1 min at 37 degrees C (P < 0.05). At all other measurement times, the amount of TAED in each mixture did not alter the amount or speed of oxygen release (P > 0.05). CONCLUSIONS: Tetra acetyl ethylene diamine groups achieved their maximum oxygen release 2 h earlier at 25 degrees C and 1 h earlier at 37 degrees C than the other groups. Thus, TAED accelerated oxygen release from sodium perborate-distilled water mixtures regardless of its proportions up to 24 h.

Stability of various sodium hypochlorite solutions.

Although the manufacturers use at least a 2-yr expiration date for sealed undiluted NaOCl solutions, chemical stability of NaOCl may be adversely affected by many factors. The purpose of this study was to investigate the effects of storage temperature, concentration, and time on the stability on three different brands of commercial household bleaching agents as a source of NaOCl, and to compare the stability of these brands. All solutions showed degradation versus time; however, this degradation occurred very slowly except for the group of solutions containing 5% available chlorine stored at 24 degrees C. Solutions containing 0.5% available chlorine stored at 4 degrees C and 24 degrees C and 5% solutions stored at 4 degrees C showed satisfactory stability at 200 days. No significant difference was found among three brands in respect to their chemical stability.

Delayed replantation of avulsed mature teeth with calcium hydroxide treatment.

Three avulsed teeth that were replanted and splinted after approximately a 200-min dry extraoral period in two patients are presented. In case 1 calcium hydroxide treatment was performed 1 month after replantation, because the patient did not come for endodontic treatment on the day after replantation as requested. In case 2, calcium hydroxide treatment was initiated on the day after replantation. Calcium hydroxide treatment was used to prevent or treat inflammatory root resorption. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position and did not reveal clinical ankylosis or replacement resorption.

Root canal morphology of human permanent teeth in a Turkish population.

An in vitro study was performed to determine the number and the type of root canals, their ramifications, transverse anastomoses, apical foramina locations, and frequency of apical deltas in a Turkish population. One thousand four hundred human permanent teeth were injected with India ink, decalcified, and cleared after the length of each was measured. The examination of root canal systems of the teeth was based on Vertucci's classification. The findings were used to classify the teeth into four groups. Variable root canal configurations were found in the second premolar and the mesiobuccal roots of first and second molars among the maxillary teeth and in all of the mandibular teeth, except the mandibular second premolar.

Periapical repair and apical closure of a pulpless tooth using calcium hydroxide.

A case with a wide-open apex and a large cystlike periapical lesion in an adult is presented. The lesion formed as a result of necrosis from trauma to a maxillary central incisor 12 years ago. After nonsurgical endodontic treatment with calcium hydroxide paste and a calcium hydroxide-containing root canal sealer, apical closure and significant healing of the periapical lesion within 15 months were observed. This report suggests that even large periapical lesions (likely cystic) could respond favorably to nonsurgical treatment.

Surgical extrusion of intruded immature permanent incisors: case report and review of the literature.

This report presents a case of intrusive luxation of immature maxillary central incisors with concomitant uncomplicated crown fractures in an 8-year-old boy. The intruded teeth with open apices were repositioned with surgical extrusion and endodontically treated through use of calcium hydroxide paste. Six months after initiation of apexification, definitive apical stops had formed. The canals were then permanently obturated, and the crowns were restored with composite resin. Clinical and radiographic examination 24 months after the surgical extrusion revealed satisfactory apical healing and healthy supporting tissues.

The effect of one-step polishing system on the surface roughness of three esthetic resin composite materials.

Proper finishing of restorations is desirable not only for aesthetic considerations but also for oral health. The primary goal of finishing is to obtain a restoration that has good contour, occlusion, healthy embrasure forms and a smooth surface. This study investigated: 1) analyzing the surface roughness of three resin composites finished and polished with a new one-step and two conventional multi-step polishing systems and 2) evaluating the effectiveness of one-step polishing system and surface morphology using scanning electron microscope analysis (SEM). Specimens (N = 72) measuring 8-mm in diameter x 2-mm in thickness were fabricated in a plexiglass mold covered with a Mylar strip using three esthetic resin composites. After polymerization six specimens per resin composite received no finishing treatment and served as a control. Fifty-four specimens were randomly polished with Sof-Lex discs, Enhance disc with polishing paste or PoGo for 30 seconds after being ground wet with a 1200 grit silicon carbide paper. The average surface roughness of each polished specimen was determined with a profilometer (Surtronic 4). The data were analyzed using repeated measures ANOVA and Scheffe's post-hoc test of multiple comparisons (p < or = 0.01). Representative samples of the mentioned finishing procedures were selected and examined using a scanning electron microscope (SEM). There was no surface roughness in all resin composites tested against Mylar strip. The results showed no difference between the surfaces of Clearfil ST and Esthet-X polished with PoGo and the Mylar group (p > or = 0.01). Among all the polishing systems tested, PoGo exhibited the smoothest finish for all resin composites. The combination of Enhance and Prisma Gloss polishing paste exhibited the highest roughness values for Filtek A110 and Clearfil ST; however, it gave the same Ra values as PoGo for Esthet-X (p < or = 0.01). SEM analysis of Esthet-X samples confirmed the profilometer's results. The surfaces of the Clearfil ST discs polished with PoGo resemble that of Mylar, while Enhance and Sof-Lex exposed and dislodged the filler particles. PoGo scratched in some places Filtek A110's surface, while Enhance produced mostly a Mylar-like surface with dislodged fillers in some places.

Permeability of protective gloves used in dental practice.

Two brands of latex rubber gloves and one brand of polyvinyl chloride glove were examined for their permeability. New and used gloves were included. All of the gloves were examined visually and then subjected to an air leakage test, an electrical test, and a microbiologic test. Permeability was evaluated independently by two researchers in a blind manner. Statistical analysis showed that there were no significant differences among the three brands of gloves or with respect to the usage periods, according to visual inspection and the air leakage test. Conversely, there were significant differences among each of the three brands of gloves and with respect to usage periods, according to the electrical and microbiologic tests.

Tensile bond strength of brackets after antioxidant treatment on bleached teeth.

Various studies have reported a significant reduction in tensile bond strength of brackets when bonding is carried out immediately after bleaching. The purpose of this investigation was to determine the effect of an antioxidant agent on the tensile bond strength values of metal brackets bonded with composite resin to human enamel after bleaching with carbamide peroxide (CP). A total of 80 extracted premolar teeth were randomly divided into three bleaching groups of 10 per cent CP and an unbleached control group. The specimens in group 1 were bonded immediately after bleaching; group 2 were stored in an artificial saliva solution for 7 days after bleaching; group 3 were treated with 10 per cent sodium ascorbate, immediately before bonding, whereas the unbleached specimens in group 4 had no treatment before bonding. Tensile bond strengths were established in MPa. To evaluate the amount of resin left on the enamel surfaces after debonding, the adhesive remnant index (ARI) scores were used. The tensile bond strength data were analyzed with the Kruskal-Wallis test and pairwise comparisons were made by the Mann-Whitney U test at a significance level of P < 0.05. The brackets bonded immediately after bleaching revealed significantly lower tensile bond strengths than those of unbleached enamel (P = 0.000). No statistically significant differences in tensile bond strength were noted when the delayed-bonding (P = 6.000) and antioxidant-treated (P = 0.2757) groups were compared with the control group. The antioxidant treatment immediately after bleaching was effective in reversing the tensile bond strength of brackets.

The effects of sodium hypochlorite and calcium hydroxide on tissue dissolution and root canal cleanliness.

In this in vitro study, we investigated the efficacy of sodium hypochlorite (NaOCl) and calcium hydroxide (Ca(OH)2) in dissolving necrotic tissue and cleaning root canals. In the first part of the study, 0.5% NaOCl solution and Ca(OH)2 paste and solution were tested with samples of necrotic bovine muscle in different treatment modes and for different periods. The necrotic tissue was weighed before and after the test and the percentage of weight change calculated. In the second part of the study, 40 extracted single-rooted human teeth were hand instrumented and then subjected to different irrigation regimens. The cleansing efficacy in root canals of 0.5% NaOCl with Ca(OH)2 pretreatments and ultrasonics was examined using scanning electron microscopy. A solution of 5% NaOCl was significantly more effective than 0.5% NaOCl as a solvent of necrotic tissue. Calcium hydroxide was an effective solvent for necrotic tissue as a paste but not as a solution. Pretreatment of necrotic tissue with Ca(OH)2 increased its solubility in 0.5% NaOCl. While 5% NaOCl plus ultrasonic irrigation produced cleaner root-canal walls at the middle and apical thirds, 0.5% NaOCl used with the same technique achieved no root-canal cleaning. However, pretreatment of root canals with Ca(OH)2 paste increased the effectiveness of 0.5% NaOCl plus ultrasonic irrigation, except in the coronal third of the root canal.

Effect of nonvital bleaching with 10% carbamide peroxide on sealing ability of resin composite restorations.

AIM: To (i) determine the effect of nonvital bleaching with 10% carbamide peroxide on the sealing ability of resin composite restorations bonded with a self-etching adhesive system; and (ii) compare the effects of antioxidant treatment and delayed restoration after bleaching on marginal seal. METHODOLOGY: Forty-eight noncarious maxillary incisors were divided into four groups (n=12) after conventional root canal treatment was completed. In group 1, access cavities were restored with a self-etching adhesive system and resin composite. In the remaining three groups, 10% carbamide peroxide bleaching gel was placed into the access cavities for periods of 8 h per day for 1 week. They were then restored in the same manner as group 1. Group 2 consisted of specimens restored immediately after bleaching. Group 3 specimens were treated with the antioxidant, 10% sodium ascorbate, whereas group 4 specimens were immersed in artificial saliva for 1 week before restoration. Ten specimens in each group were then subjected to dye leakage; the remaining 2 specimens were examined in a SEM (Jeol/JSM 5200, Tokyo, Japan). The dye penetration was assessed with the standard scoring system. Statistical analysis was carried out using the Kruskal-Wallis and the Mann-Whitney tests. RESULTS: Groups 1, 3 and 4 exhibited similar leakage patterns and significantly less leakage than group 2 (P<0.0083). SEM examination of groups 1, 3 and 4 specimens demonstrated close adaptation of resin composite to cavity walls, whereas group 2 specimens did not. CONCLUSION: Nonvital bleaching with 10% carbamide peroxide adversely affected the immediate sealing ability of resin composite restoration; both 10% sodium ascorbate treatment and a 1-week delay in restoration following bleaching improved the reduced sealing ability of resin composite.

Prognosis of permanent teeth with internal resorption: a clinical review.

This study was performed in order to report the clinical features of internal resorption cases and evaluate their prognosis after endodontic treatment. Twenty-seven patients with 28 teeth with internal resorption were referred to our clinic and 20 teeth were treated endodontically. Sixteen teeth had non-perforating internal resorption and were treated by conventional root canal therapy. The remaining 4 teeth had perforating internal resorption and were initially treated by remineralization therapy with calcium hydroxide. The teeth treated by conventional root canal therapy showed clinical and radiographic evidence of healing. However, the remineralization therapy was successful in only one case. The three failed cases were subsequently treated by endodontic surgery. The surgical therapy was unsuccessful in one case due to extensive loss of marginal alveolar bone and increased tooth mobility.

Root canal treatment of a root-fractured incisor tooth with internal resorption: a case report.

A case is described in which root canal treatment with calcium hydroxide was used successfully to repair a fracture site with internal resorption of the tooth.

Effect of 10% sodium ascorbate on the shear bond strength of composite resin to bleached bovine enamel.

The purpose of this study was to comparatively investigate the effect of antioxidant treatment and delayed bonding after bleaching with three different concentrations of carbamide peroxide (CP) on the shear bond strength of composite resin to enamel. One hundred flat buccal enamel surfaces obtained from bovine incisors were divided into three bleaching groups of 10, 16 and 22% CP (n = 30) and a control group. Each bleaching group was then divided into three subgroups (n = 10). Group 1 consisted of specimens bonded immediately after bleaching. Group 2 specimens were treated with antioxidant agent, 10% sodium ascorbate, while Group 3 specimens were immersed in artificial saliva for 1 week after bleaching. Specimens in the control group were not bleached. After the specimens were bonded with Clearfil SE Bond and Clearfil AP-X, they were thermocycled and tested in shear until failure. Fracture analysis of the bonded enamel surface was performed using scanning electron microscope. The shear bond strength data was subjected to one-way analysis of variance followed by Duncan's multiple range test at a significance level of P < 0.05. Shear bond strength of composite resin to enamel that was bonded immediately after bleaching with 10, 16 and 22% CP was significantly lower than that of unbleached enamel (P < 0.05). For all three bleaching groups, when the antioxidant-treated and delayed bonding (1 week) subgroups were compared with the control group, no statistically significant differences in shear bond strength were noted (P < 0.05).

Clinical investigation of traumatic injuries of permanent incisors in Izmir, Turkey.

470 injured teeth of 370 patients who consulted the Dental Clinic of Ege University, Izmir, Turkey for examination or treatment between 1981-1993 were evaluated. Information concerning sex, age of patients at the time of injury, cause of trauma, number of injured teeth, type of tooth and type of trauma were recorded. More boys suffered traumatic injuries (64.8%) than girls (35.2%). Patients aged 11-15 years old exhibited the highest number of injuries (34.4%) followed by the 6-10 years old group (24.5%). Most injuries involved one tooth (60%) and maxillary central incisors were the most often affected teeth (66.2%). The leading cause of injury was undefined falls (45.1%). At the initial examination, cases seen after a long posttraumatic period showed more complications than those presented within a short time period. Educational programs about the importance of dental trauma, the benefits of immediate attendance and conservation of avulsed and fractured teeth would be very helpful for patients. Additionally improving the knowledge of the dental practitioner about trauma would be another important point in solving the problem.

Effect of calcium hydroxide as an intracanal dressing on apical leakage.

In this in vitro study, we investigated the effects of the use of two different calcium hydroxide (Ca(OH)2) preparations as an intracanal dressing on the sealing ability of two different sealers were investigated. Eighty-eight freshly extracted, single-rooted maxillary anterior teeth were used. After the root canals were hand-instrumented, they were divided into six groups of 10 each. The root canals were dressed with Ca(OH)2 paste, either mixed with sterile water (in groups 1 and 2) or with glycerine (in groups 3 and 4). The dressed root canals were incubated in 100% humidity at 37 degrees C for 7 days. In groups 5 and 6, the root canals were not dressed. After the root canal dressings were removed by irrigation with 5.25% NaOCl and reaming with a K-type file, all canals of the experimental groups were obturated with sealer and gutta-percha using a cold lateral condensation technique. Calciobiotric Root Canal Sealer, (CRCS), (in groups 1, 3 and 5) and Diaket (in groups 2, 4 and 6) were used as sealers. All specimens were placed in India ink for 7 days, and the amount of apical leakage was scored. Eight further prepared specimens were dressed with Ca(OH)2 plus water or Ca(OH)2 plus glycerine and examined with scanning electron microscopy (SEM) following the removal of dressings. There was a statistical difference in the leakage patterns amongst the 6 experimental groups (P < 0.05). Specimens in group 2 exhibited less leakage than the other experimental groups, except group 4 (P < 0.05). There were no other significant interactions. SEM examination revealed that Ca(OH)2 crystals were present on the surface of smear layer in both groups where Ca(OH)2 paste had been placed, but they did not penetrate into the dentinal tubules.