Artificial caries formation around fluoride-releasing restorations in roots

Secondary caries is one of the most important factors leading to replacement of dental restorations. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in the buccal and lingual surfaces of 30 extracted premolars. The six materials used were: glass-ionomer cement (Fuji), glass-ionomer cement with silver particles added (Ketac-silver), fluoride-containing composite resin (Tetric), composite resin (Silux plus), fluoride-containing amalgam (Fluor-Alloy) and high-copper amalgam (Dispersalloy). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that repair with glass-ionomer materials of a carious lesion may be of great importance in the prevention of secondary caries around the restorations in roots.     

Dentastic bond strength to dentin

PURPOSE: To evaluate the shear bond strength to the dentin of permanent teeth and failure site of Dentastic hydrophilic dentin bonding agent. MATERIALS AND METHODS: Forty permanent noncarious molar teeth stored in distilled water were obtained. The teeth were cleaned with pumice and a rubber cup. The mesio-buccal surface of the teeth was ground flat with hand pressure with a series of SiC paper ending with the 600 grit to provide a uniform surface on dentin to which the resin composite could be applied. After preparing the tooth surface, the teeth were stored in distilled water for 48 hours. They were then divided at random into four groups of 10 specimens each: Group 1: Dentastic, five coats of primer; Group 2: Dentastic, three coats of primer; Group 3: Dentastic, five coats of primer, light-cured adhesive before resin bonding; Group 4: Dentastic, three coats of primer, light-cured adhesive before resin bonding. All specimens were thermocycled (500x) and sheared in a testing machine. After shear testing, the debonded sites of all samples were examined with a stereomicroscope and a scanning electron microscope. RESULTS: The results in MPa were: Group 1: 22.63 +/- 6.24; Group 2: 23.35 +/- 5.14; Group 3: 23.58 +/- 5.66; Group 4: 27.26 +/- 8.22. ANOVA and Student-Newman-Keuls showed no statistically significant difference between the groups. In all groups, all specimens failed at the dentin (dentin cohesive failure = dentin fracture) or at the resin (resin cohesive failure = resin fracture). This means that the bond strength of the product is stronger than the cohesive strengths of the dentin and the resin.     

Strength of secondary-cured resin composite inlay repairs

A study was designed to simulate the repair of an indirect resin composite restoration with conventionally cured resin composite. Two-part specimens were prepared to test the diametral tensile strength of the repair interface between the base material of an indirectly cured resin composite (Herculite XRV) and repairs carried out with three directly cured materials (Herculite XRV, TPH, and Charisma). The repairs were carried out with and without use of the bonding resin for the repair material. The diametral tensile strengths of all repaired specimens were significantly less than those of bulk unrepaired specimens. There were no significant differences between the diametral tensile strengths of repaired blocks when the repair materials were used without bonding resin. The use of an intermediate layer of bonding resin significantly increased the bond strengths obtained when Herculite XRV and TPH were used for repair. There was no significant difference between the strength values of Herculite XRV and TPH, but Charisma exhibited the lowest strengths of repaired specimens.     

Effect of restored and unrestored non-carious cervical lesions on the fracture resistance of previously restored maxillary premolar teeth

OBJECTIVES: The effect of non-carious cervical lesions (NCCL) on tooth fracture resistance has not previously been investigated. The aims of this in vitro study were to examine the fracture resistance of a group of extracted maxillary premolar teeth with mesio-occlusal-distal (MOD) restorations of amalgam, and restored or unrestored simulated NCCL. METHOD: Forty sound maxillary, premolar teeth were divided at random into four groups, each of 10 teeth, which were fixed crown uppermost and long axis vertical in stainless steel moulds. Groups 1,2,3 and 4 were prepared with standardized parallel-sided MOD cavities, then restored with amalgam. Groups 1, 2 and 3 were further prepared with standardized NCCL. The NCCL in Group 1 were restored using a resin-modified polyalkenoate (glass-ionomer) cement, and the NCCL in Group 2 were restored with an adhesive composite resin system. The NCCL in Group 3 were left unrestored. The specimens were loaded compressively at 1 mm min-1 using a universal testing machine. RESULTS: Mean fracture loads (KN) of 1.08, 1.03, 0.98 and 1.14, respectively, were recorded for Groups 1, 2, 3 and 4. Two-way ANOVA and Scheffe's Multiple Range Test showed no statistically significant difference between the groups. CONCLUSIONS: It is concluded that the presence of a standardized NCCL in an extracted maxillary premolar tooth does not reduce the fracture resistance of the tooth when loaded compressively at 1 mm min-1. The restoration of NCCL with the materials tested did not result in an increase in the fracture resistance of the previously restored premolar teeth, when loaded compressively at 1 mm min-1.     

Adhesives and nonshrinking dental resins of the future

Much attention has been directed toward producing dentinal adhesives that withstand the forces involved during polymerization shrinkage of composite resins. Studies have shown that an effective dentin-adhesive bond depends on the wetting and penetration characteristics of the dentinal adhesive system and the reactivity of the treated dentinal surface. The structure of the collagen in the demineralized dentinal layer also seems to influence the behavior of the bond. Adhesive systems that do not completely denature the fibrous collagen and leave interwoven banded collagen in the demineralized layer produce superior bond strengths (greater than 20 MPa). Other research efforts seek to develop a nonshrinking high-performance polymer for use as a matrix material for dental composite resins. Spiroorthocarbonates that expand during polymerization have been developed. In combination with a three-component epoxy comonomer, matrix resins have been produced that expand during polymerization and whose mechanical properties, water sorption, solubility, and degree of polymerization are acceptable for dental use. Further developments of nonshrinking composite resins and improved dentinal adhesives will greatly increase the longevity of 21st-century composite resin restorations and should significantly ease clinical placement.     

The use of liners under amalgam restorations: an in vitro study on marginal leakage

OBJECTIVE: Marginal leakage of amalgam restorations may lead to secondary caries and pulpal damage. The purpose of this study was to determine the effect various cavity liners might have on microleakage. METHOD AND MATERIALS: Mesio-occlusodistal amalgam restorations with margins on enamel and dentin were treated with different liner materials (an adhesive system, a topical fluoride gel, a cavity varnish, and a glass-ionomer cement) in vitro. Following restoration, the teeth were submitted to thermocycling in a stained solution and sectioned to allow assessment of microleakage. RESULTS: On enamel, the control group (no liner) and the glass-ionomer-lined group had equivalent leakage scores and were superior to every other group. On dentin, only the glass-ionomer specimens had superior performance. The cavity varnish and fluoride-lined specimens exhibited the highest leakage scores. CONCLUSION: The use of liners does not reduce microleakage on amalgam restorations when the cavity margins remain on enamel. On dentin margins, a glass-ionomer liner can reduce microleakage.     

Circadian rhythm of breath hydrogen in young women

PURPOSE: The retention forces of a newly developed compomer cement (Dyract Cem), a glass ionomer cement (Ketac Cem Aplicap), and a resin cement (F21) were examined. MATERIAL AND METHODS: Cemented cast gold crowns were removed along the path of insertion with a Zwick universal testing device. The impact of both a cured and a noncured additional bonding layer that were applied to the inner surface of the crowns was examined across the Dyract Cem group. RESULTS: The mean adhesive strength was measured at 2.36 +/- 0.69 N/mm2 in the Ketac Cem group, at 0.60 +/- 0.28 N/mm2 in the F21 group, and at 1.85 +/- 0.94 N/mm2 in the Dyract Cem group, respectively. The application of an additional bonding layer to the inner surface of the crowns did not significantly improve the retentive strength of Dyract Cem; the respective mean strengths were observed at 1.46 +/-0.33 N/mm2 for the uncured and at 1.70 +/- 0.76 N/mm2 for the cured bonding layers. CONCLUSIONS: Dyract Cem and Ketac Cem showed significantly higher retentive strengths than F21 (p < 0.001, Wilcoxon test, 5% level). No significant difference was found in bond strength between Ketac Cem and Dyract Cem.     

Benefits and disadvantages of tooth-coloured alternatives to amalgam

OBJECTIVES: To give the practising dentist scientifically based data to assist him/her in the responsible decision-making process necessary to weigh the options available to the patient if she/he prefers not to have an amalgam placed. DATA SOURCES: Based on the literature and on the research work, which was done in the author's department, the indications and limitations of the known alternatives of amalgam were formulated. DESCRIPTION OF ALTERNATIVES TO AMALGAM: With the exception of cast gold restorations, all alternatives require the strict use of adhesive techniques. When compared with similar amalgam restorations, placing composite restorations (if they are indicated) takes approximately 2.5 times longer because complex incremental techniques are needed. Despite all the efforts, direct composite restorations placed in large cavities still show unacceptable amounts of marginal openings. Tooth-coloured inlays are a better alternative for large restorations. These restorations must be inserted with adhesive techniques. With composite inlays it is difficult to achieve a composite-composite bond. Ceramic inlays may be micromechanically bonded to the luting composite. They all show clinically a good marginal behaviour and the use of ultrasonic energy may further simplify the application technique of aesthetic inlays. STUDY SELECTION: Papers describing the different techniques were used as a base for the corresponding chapter. To assess and compare the longevity of the different restoration types, literature data were used. We limited ourselves to papers reporting at least 5-year clinical data. Longitudinal, clinically controlled studies were preferred. However, to be more complete, retrospective, cross sectional studies were also included. LONGEVITY OF POSTERIOR RESTORATIONS: Amalgam shows excellent longevity data with studies up to 20 years. The average annual failure rate is 0.3-6.9%. Posterior composites are in the same range (0.5-6.6%), however, the study times are much shorter (max. 10 years). For tooth-coloured inlays much less data are available. Longevity is reported up to 6 years with annual failure rates of 0.6-5%. CONCLUSIONS: All aesthetic alternatives to amalgam require more complex procedures and more time. If cost benefit considerations are a concern, amalgam is still the most convenient restorative material for posterior teeth.     

Bond strengths and SEM evaluation of Clearfil Liner Bond 2

PURPOSE: To evaluate a dental adhesive system that uses a single conditioning/primer agent. MATERIALS AND METHODS: Twenty-five flat enamel and dentin bonding sites were prepared to 600 grit on human molar teeth. The Clearfil Liner Bond 2 adhesive system was used to bond Clearfil AP-X composite to both enamel and dentin. After 24 hours of water storage, shear bond strengths were determined using an Instron testing machine. Fifty V-shaped cavity preparations were prepared in human molar teeth with an enamel and cementum margin. Composite restorations were placed using the new adhesive system. The teeth were stored for 24 hours, thermocycled, stained with AgNO3 , sectioned and examined for microleakage. SEM examinations were also completed to evaluate the effects of the treatment steps on enamel and dentin surfaces. RESULTS: Mean shear bond strengths for the experimental adhesive to enamel and dentin were 28.2 +/- 4.9 and 19.4 +/- 3.1 MPa. A t-test revealed that the enamel bond strength was significantly greater (P<0.05) than the dentin strength. No marginal leakage was observed from the enamel margins of the restorations. Three restorations showed minimal leakage from the cementum margins. SEM examinations showed resin penetration into both the conditioned enamel and dentin surfaces. The adhesive system produced high bond strengths to both enamel and dentin, exhibited very minimal microleakage and was easy to use.     

Electrochemical study of insulating properties of dental amalgam bonding polymers

The standard techniques used for amalgam restorations often result in a lack of adhesion to mineralized dental tissues. The bonding of amalgam with polymer has been suggested to improve its adaptation to dental tissues. Moreover the polymer involved in the bonding should inhibit the corrosion and the diffusion of metallic ions. The aim of this study was to evaluate in vitro the capacity of bonded amalgam to prevent ionic diffusion and migration. In this respect, an original method employing electrochemical techniques was used to determine the leakage current of bonded amalgam restorations. The electrochemical behaviour of conventional and bonded amalgam restorations was compared using a potentiostat driven by a computerized system (Voltamaster, Radiometer Analytical) with software for specific applications such as chronoamperometry or cyclic voltammetry. Samples of recently extracted teeth of young patients were first examined, and then the results were checked by other experimental assays using protected and unprotected copper sticks. The measurements obtained with chronoamperometry (E = +300 mV/SCE) in Ringer's solution at 37 degrees C showed that after polarization for 30 h the oxidation current decreased threefold for bonded samples (10 microA cm(-2)) as compared with the unprotected samples (35 microA cm(-2)). These results, as well as those obtained with the copper wires, demonstrated that even with two layers of adhesive the bonded joint is permeable to ions probably as a result of the hydrophylic properties of HEMA, a component of the adhesive. However, using five layers of adhesive reduced the ionic current by a factor as large as 10(6).     

New England eye care survey

Amalgambond Plus with a high-performance additive was evaluated for its ability to bond a resin composite or an amalgam alloy to deep dentin in primary teeth with nonretentive cavity preparations. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was evaluated at 15 months and 2 and 3 years. There was no statistically significant difference in the retention, marginal adaptation, secondary caries, and post-operative sensitivity over the times of the evaluation or between amalgam and resin composite restorations. After 3 years, most of the teeth were extracted because it was their exfoliation time, and 29 restorations limited within buccal and lingual cusps were evaluated for marginal leakage. There were no significant differences in microleakage between amalgam and resin composite restorations lined with Amalgambond Plus. Amalgambond Plus has the potential for serving successfully as a cavity liner with either amalgam or resin composite restorations.     

Race, life style and renal disease in South Africa

PURPOSE: Clinical evaluation of repairing old amalgam restorations using composite inlays cemented with two different bonding agents. MATERIALS AND METHODS: Occluso-proximal Class II inlay cavities were prepared in 50 old defective amalgam restorations. Extra oral system (EOS) composite inlays were cemented with two different bonding agents (All-Bond 2 or Geristore). After final finishing and polishing of each restoration, evaluation was carried out at baseline, 6 months, 12 months, and 24 months using US Public Health Service criteria. The data were collected and statistically analyzed using Chi-square test. RESULTS: No significant difference was found between the two bonding materials at any time interval.     

Selection of restorative materials, reasons for replacement, and longevity of restorations in Florida

The purpose of the present study was to obtain information relating to the types of restorative materials used, the main reason for replacement of restorations, and the age of failed restorations. Dentists in general dental practice in Florida were invited to record details from their own work pertaining to restorations. The diagnostic criteria were described and coded. The clinicians were not calibrated in the use of the criteria but they could call in for further explanation if needed. The 27 clinicians involved placed 2,035 restorations of which 53% were replacements of failed restorations. The increased use of resin based restorative material was clearly evident including posterior composites. The clinical diagnosis secondary caries was the most common reason for replacement of amalgam (56%) and composite (59%) restorations. Only discoloration showed a statistically significant difference in the reason for replacement of the two types of materials. The median age of the replaced amalgam restoration was 15 years and that of composite restoration was 8 years.     

Effects of moxonidine and clonidine on renal function and blood pressure in anesthetized rats

OBJECTIVES: This study was conducted 1) to characterize through SEM analysis the resin-dentin interface produced by single-bottle primer/adhesives and a three-component system [Scotchbond Multi-Purpose (3M Dental)] and 2) to evaluate the shear bond strength to dentin of these adhesive systems. METHODS: Single-bottle primer/adhesives [Bond 1 (Jeneric/Pentron), Single Bond, (3M Dental Products); One Step (Bisco Inc.), OptiBond Solo (Kerr Corp.), Prime & Bond 2.1 (L.D. Caulk-Dentsply), Syntac Single-Component (Ivoclar-Vivadent), Tenure Quilk with Fluoride (Den-Mat)] were used according to manufacturers' instructions to bond resin composite to flat dentinal surfaces of extracted human third molars (n = 15). All samples were thermocycled 300x. Twelve specimens per group were used to measure shear bond strength and three specimens were used to evaluate the interfacial morphology under SEM. A one-way ANOVA and Turkey's test were used to assess the results. RESULTS: Mean shear bond strengths in MPa +/- SD for the groups ranged from 22.27 +/- 4.5 MPa for Single Bond to 7.6 +/- 3.9 MPa for Syntac Single-Component. The statistical analysis indicated that Single Bond produced significantly higher (p < 0.001) bond strengths than Syntac Single-Component, Prime & Bond 2.1, Bond 1 and Tenure Quik With Fluoride. Bond strengths for Syntac Single-Component were significantly lower than One-Step, OptiBond Solo, Scotchbond Multi-Purpose Plus and Single Bond. SEM examination clearly revealed the formation of a distinct hybrid layer for all adhesive systems; however, minor variations in ultrastructure existed among products. SIGNIFICANCE: Some single-bottle primer/adhesive present in vitro bond strengths and hybrid layer formation similar to those found for the conventional three-component adhesive system tested.     

The epidemiology of Neisseria gonorrhoeae isolates in Greenland 1979-1990: the emergence, spread and disappearance of non-PPNG strains carrying the conjugative 38.9 kb plasmid

The aim of this study was to compare the clinical performance of an amalgam, a glass polyalkenoate (ionomer) cerment material and a resin-based composite material used in small Class II cavities in permanent teeth. All restorations were inserted under rubber dam. They were examined yearly for 3 years. One clinician continued the study up to 5 years. The clinical examination focused on two criteria: clinically acceptable and failure. In addition, impressions were taken of the prepared cavities immediately before restoration and at each clinical examination using an elastomeric material. The study comprised 274 Class II restorations (88 amalgams, 95 cerments and 91 resin composites) placed in 142 adolescent patients. One hundred and sixty-seven restorations were in molar and 107 in premolar teeth. Patient dropout after 5 years resulted in the loss of 161 restorations, evenly distributed for restorative material and type of tooth involved. Four amalgam restorations, 22 glass ionomer cerment and nine resin composite restorations failed. The glass ionomer cerment and amalgam restorations failed primarily due to bulk fractures, while the resin composite restorations failed due to secondary caries and bulk fractures.     

A 12-month clinical evaluation of a light-activated glass polyalkenoate (ionomer) cement for the direct bonding of orthodontic brackets

Glass polyalkenoate cements have the unique properties of physicochemically bonding to enamel and base metals and to leach fluoride over prolonged periods. These cements have been modified to provide a dual setting with both light activation and chemical cure to produce a more rapid set. This article reports a 12-month clinical trial of a light-activated glass polyalkenoate cement for the direct bonding of orthodontic brackets, compared with a standard composite bonding adhesive. There was no significant difference in failure rates of direct bonded orthodontic brackets cemented with Fuji II LC light-activated glass polyalkenoate cement (GC Industrial Co., Tokyo, Japan) (3.3%) compared with System I+ composite bonding resin (Ormco Corp., Glendora, Calif.) (1.6%).     

Three-year clinical evaluation of the Clearfil Liner Bond system

Modern dental adhesive systems have improved the bond of restorative materials to mineralized tooth structures. The purpose of this study was to evaluate the clinical performance of composite restorations placed in abrasion and erosion lesions using the Clearfil Liner Bond dental adhesive system. Following ADA clinical guidelines for dentin and enamel adhesive materials, 62 facial class 5 smooth surface erosion or abrasion lesions with no undercuts and involving primarily root surfaces were restored in 25 adult male and female patients. The teeth were restored without preparations using Clearfil Liner Bond and Clearfil Photo Anterior composite resin. The clinical performance of the restorations was assessed by two examiners at baseline, 6 months, 1, 2, and 3 years using the following evaluative parameters: color match, marginal discoloration, and marginal integrity according to modified Ryge criteria; the presence or absence of recurrent decay; pre- and postoperative sensitivity; and restoration failure due to loss of retention or other causes. At the end of 3 years, four of the 55 restorations remaining in the study failed due to lack of retention (92.7% retention rate). The evaluations of the other clinical parameters demonstrated excellent performance by this system.     

Dual NF1-requiring effect of human neurotropic JC virus composite pentanucleotide repeat elements on early and late viral gene expression

OBJECTIVE: The purpose of this study was to prepare a light-cured adhesive applicable for orthodontics by mixing monomers and a polymerized reactive organic composite filler (prepolymerized trimethylolpropane trimethacrylate-filler, TMPT-filler). METHODS: The monomer component was a mixture of 3.0 wt% 2-hydroxy-3-(2-naphthoxy)propyl methacrylate (HNPM) in triethylene glycol dimethacrylate. This was applied to extracted bovine tooth enamel after acid etching with 65 wt% phosphoric acid for 30 s. After 24 h in 37 degrees C water, the tensile bond strength was measured, and the data were analyzed with Duncan's new multiple range test (p < 0.01 or 0.05). RESULTS: The tensile bonding strength to enamel etched with 65 wt% phosphoric acid was 13.1 +/- 0.5 MPa, and the thermal stability of the bond was excellent. SEM examination of the cross-sectioned specimens modified with HCl demineralization showed that when the diffusion time prior to light irradiation was only 1 min, a well-developed resin honeycomb-like structure was created in the enamel surface in the formulation containing HNPM. SIGNIFICANCE: Monomer impregnation beyond the etched enamel surface was important for resin-enamel bonding, increasing bonding strength and thermal stability. HNPM was effective in enhancing monomer diffusion and impregnation of the etched enamel surface.     

Handling characteristics of resin composites in posterior teeth

In the last 10 years, tremendous improvements in strength and shade selection for resin composites have been achieved. Also, a new generation of enamel-dentin bonding systems has been developed, and patient expectations of esthetic treatment have risen. Several techniques are available for restoring posterior teeth. When a caries lesion is limited, a direct esthetic restoration is indicated. Essential elements for obtaining good, long-term clinical results for direct esthetic restorations of posterior teeth are: (1) cavity preparation; (2) knowledge of the characteristics of the three dental substrates; (3) rubber dam use and matrix and wedge placement; (4) correct use of the enamel-dentin bonding system; (5) proper selection of the resin composite material; (6) use of the multilayering technique; (7) finishing and polishing procedures; and (8) maintenance of the restoration.     

Posterior composite resin restorations: operative innovations

The adhesive revolution is alleviating reservations regarding posterior composite resin restorations, established by past experience with outdated materials and techniques. Improved materials, instrumentation, and placement techniques have enhanced the performance of current formulations of posterior composite resins over their predecessors. However, it is a clinician's operative skill that ultimately determines the quality of a restorative option. The learning objective of this article is to share the author's experience in attaining adhesive excellence with posterior tooth-colored restorations as well as aesthetic anatomic form, minimal postoperative sensitivity, and a bond which can weather the true test of success-durability. Optimal applications, dental dam requirement, importance of the first increment of composite resin, restitution of occlusal morphology, and the clinical application are discussed.