Bonding of the silane containing multi-mode universal adhesive for lithium disilicate ceramics

OBJECTIVES: This study evaluated the influence of a multi-mode universal adhesive (MUA) containing silane (Single Bond Universal, 3M EPSE) on the bonding of resin cement to lithium disilicate. MATERIALS AND METHODS: Thirty IPS e.max CAD specimens (Ivoclar Vivadent) were fabricated. The surfaces were treated as follows: Group A, adhesive that did not contain silane (ANS, Porcelain Bonding Resin, Bisco); Group B, silane (S) and ANS; Group C, hydrofluoric acid (HF), S, and ANS; Group D, MUA; Group E, HF and MUA. Dual-cure resin cement (NX3, Kerr) was applied and composite resin cylinders of 0.8 mm in diameter were placed on it before light polymerization. Bonded specimens were stored in water for 24 hours or underwent a 10,000 thermocycling process prior to microshear bond strength testing. The data were analyzed using multivariate analysis of variance (p < 0.05). RESULTS: Bond strength varied significantly among the groups (p < 0.05), except for Groups A and D. Group C showed the highest initial bond strength (27.1 ± 6.9 MPa), followed by Group E, Group B, Group D, and Group A. Thermocycling significantly reduced bond strength in Groups B, C, and E (p < 0.05). Bond strength in Group C was the highest regardless of the storage conditions (p < 0.05). CONCLUSIONS: Surface treatment of lithium disilicate using HF and silane increased the bond strength of resin cement. However, after thermocycling, the silane in MUA did not help achieve durable bond strength between lithium disilicate and resin cement, even when HF was applied.

Elemental analysis of caries-affected root dentin and artificially demineralized dentin

OBJECTIVES: This study aimed to analyze the mineral composition of naturally- and artificially-produced caries-affected root dentin and to determine the elemental incorporation of resin-modified glass ionomer (RMGI) into the demineralized dentin. MATERIALS AND METHODS: Box-formed cavities were prepared on buccal and lingual root surfaces of sound human premolars (n = 15). One cavity was exposed to a microbial caries model using a strain of Streptococcus mutans. The other cavity was subjected to a chemical model under pH cycling. Premolars and molars with root surface caries were used as a natural caries model (n = 15). Outer caries lesion was removed using a carbide bur and a hand excavator under a dyeing technique and restored with RMGI (FujiII LC, GC Corp.). The weight percentages of calcium (Ca), phosphate (P), and strontium (Sr) and the widths of demineralized dentin were determined by electron probe microanalysis and compared among the groups using ANOVA and Tukey test (p < 0.05). RESULTS: There was a pattern of demineralization in all models, as visualized with scanning electron microscopy. Artificial models induced greater losses of Ca and P and larger widths of demineralized dentin than did a natural caries model (p < 0.05). Sr was diffused into the demineralized dentin layer from RMGI. CONCLUSIONS: Both microbial and chemical caries models produced similar patterns of mineral composition on the caries-affected dentin. However, the artificial lesions had a relatively larger extent of demineralization than did the natural lesions. RMGI was incorporated into the superficial layer of the caries-affected dentin.

Epigenetics: general characteristics and implications for oral health

Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.

How to design in situ studies: an evaluation of experimental protocols

OBJECTIVES: Designing in situ models for caries research is a demanding procedure, as both clinical and laboratory parameters need to be incorporated in a single study. This study aimed to construct an informative guideline for planning in situ models relevant to preexisting caries studies. MATERIALS AND METHODS: An electronic literature search of the PubMed database was performed. A total 191 of full articles written in English were included and data were extracted from materials and methods. Multiple variables were analyzed in relation to the publication types, participant characteristics, specimen and appliance factors, and other conditions. Frequencies and percentages were displayed to summarize the data and the Pearson's chi-square test was used to assess a statistical significance (p < 0.05). RESULTS: There were many parameters commonly included in the majority of in situ models such as inclusion criteria, sample sizes, sample allocation methods, tooth types, intraoral appliance types, sterilization methods, study periods, outcome measures, experimental interventions, etc. Interrelationships existed between the main research topics and some parameters (outcome measures and sample allocation methods) among the evaluated articles. CONCLUSIONS: It will be possible to establish standardized in situ protocols according to the research topics. Furthermore, data collaboration from comparable studies would be enhanced by homogeneous study designs.

Thermal irritation of teeth during dental treatment procedures

While it is reasonably well known that certain dental procedures increase the temperature of the tooth's surface, of greater interest is their potential damaging effect on the pulp and tooth-supporting tissues. Previous studies have investigated the responses of the pulp, periodontal ligament, and alveolar bone to thermal irritation and the temperature at which thermal damage is initiated. There are also many in vitro studies that have measured the temperature increase of the pulp and tooth-supporting tissues during restorative and endodontic procedures. This review article provides an overview of studies measuring temperature increases in tooth structures during several restorative and endodontic procedures, and proposes clinical guidelines for reducing potential thermal hazards to the pulp and supporting tissues.

Flexural strength and microstructure of two lithium disilicate glass ceramics for CAD/CAM restoration in the dental clinic

OBJECTIVES: There has been a growing interest in glass ceramic systems with good esthetics, high fracture resistance and bonding durability, and simplified fabrication techniques using CAD/CAM. The aim of this study is to compare flexural strength before and after heat treatment of two lithium disilicate CAD/CAM blocks, IPS e.max CAD (Ivoclar Vivadent) and Rosetta SM (Hass), and to observe their crystalline structures. MATERIALS AND METHODS: Biaxial flexural strength was tested according to ISO 6872 with 20 disc form specimens sliced from each block before and after heat treatment. Also, the crystalline structures were observed using field-emission scanning microscopy (FE-SEM, Hitachi) and x-ray diffraction (XRD, Rigaku) analysis. The mean values of the biaxial flexural strength were analyzed by the Mann-Whitney U test at a significance level of p = 0.05. RESULTS: There were no statistically significant differences in flexural strength between IPS e.max CAD and Rosetta SM either before heat treatment or after heat treatment. For both ceramics, the initial flexural strength greatly increased after heat treatment, with significant differences (p < 0.05). The FE-SEM images presented similar patterns of crystalline structure in the two ceramics. In the XRD analysis, they also had similar patterns, presenting high peak positions corresponding to the standard lithium metasilicate and lithium disilicate at each stage of heat treatment. CONCLUSIONS: IPS e.max CAD and Rosetta SM showed no significant differences in flexural strength. They had a similar crystalline pattern and molecular composition.

Effects of matrix metallproteinases on dentin bonding and strategies to increase durability of dentin adhesion

The limited durability of resin-dentin bonds severely compromises the longevity of composite resin restorations. Resin-dentin bond degradation might occur via degradation of water-rich and resin sparse collagen matrices by host-derived matrix metalloproteinases (MMPs). This review article provides overview of current knowledge of the role of MMPs in dentin matrix degradation and four experimental strategies for extending the longevity of resin-dentin bonds. They include: (1) the use of broad-spectrum inhibitors of MMPs, (2) the use of cross-linking agents for silencing the activities of MMPs, (3) ethanol wet-bonding with hydrophobic resin, (4) biomimetic remineralization of water-filled collagen matrix. A combination of these strategies will be able to overcome the limitations in resin-dentin adhesion.

Color and hardness changes in artificial white spot lesions after resin infiltration

OBJECTIVES: The purpose of this study was to determine the effect of resin infiltration technique on color and surface hardness of white spot lesion (WSL) with various degrees of demineralization. MATERIALS AND METHODS: Ten human upper premolars were cut and divided into quarters with a 3 x 4 mm window on the enamel surface. Each specimens were separated into four groups (n = 10) and immersed in demineralization solution to create WSL: control, no treatment (baseline); 12 h, 12 hr demineralization; 24 h, 24 hr demineralization; 48 h, 48 hr demineralization. Resin infiltration was performed to the specimens using Icon (DMG). CIEL*a*b* color parameters of the enamel-dentin complex were determined using a spectroradiometer at baseline, after caries formation and after resin infiltration. Surface hardness was measured by Vickers Micro Hardness Tester (Shimadzu, HMV-2). The differences in color and hardness among the groups were analyzed with ANOVA followed by Tukey test. RESULTS: Resin infiltration induced color changes and increased the hardness of demineralized enamel. After resin infiltration, there was no difference in color change (DeltaE*) or microhardness among the groups (p < 0.05). CONCLUSION: There was no difference in the effect of resin infiltration on color and hardness among groups with different extents of demineralization.

Elemental analysis of the fluoride varnish effects on root caries initiation / 대한치과보존학회지

OBJECTIVES: The usage of fluoride varnish for a moderate to low caries-risk group has not been well validated. This study aimed to evaluate the preventive and therapeutic efficacies of fluoride varnish on the initiated root caries. MATERIALS AND METHODS: Ten premolars were sectioned into quarters, further divided into two windows, one of which was painted with Fluor Protector (1,000 ppm fluoride, Ivoclar Vivadent). An initial lesion with a well-preserved surface layer was produced by pH cycling. Scanned line analysis using energy dispersive spectrometry determined the weight percentages of Ca and P in the demineralized layer. Scanning Electron microscopy and confocal laser scanning microscopy (CLSM) evaluated the varnish-applied root surfaces. RESULTS: The mean lesion depth (SD) was 12.3 (2.6) microm (single cycling) and 19.6 (3.8) microm (double cycling). Double cycling extended the lesion depth, but induced no more mineral loss than single cycling (p < 0.05). The mean weight percentages of Ca and P between groups with and without varnish were not significantly different (p < 0.05). A CLSM showed varnish remained within 15 microm of the surface layer. CONCLUSIONS: When a mild acid challenge initiated root tissue demineralization, the application of low-concentration fluoride varnish did not influence the lesion depth or the mineral composition of the subsurface lesion.

Influence of rebonding procedures on microleakage of composite resin restorations / 대한치과보존학회지

During a composite resin restoration, an anticipating contraction gap is usually tried to seal with low-viscosity resin after successive polishing, etching, rinsing and drying steps, which as a whole is called rebonding procedure. However, the gap might already have been filled with water or debris before applying the sealing resin. We hypothesized that microleakage would decrease if the rebonding agent was applied before the polishing step, i.e., immediately after curing composite resin. On the buccal and lingual surfaces of 35 extracted human molar teeth, class V cavities were prepared withthe occlusal margin in enamel and the gingival margin in dentin. They were restored with a hybrid composite resin Z250 (3M ESPE, USA) using an adhesive AdperTM Single Bond 2 (3M ESPE). As rebonding agents, BisCover LV (Bisco, USA), ScotchBond Multi-Purpose adhesive (3M ESPE) and an experimental adhesive were applied on the restoration margins before polishing step or after successive polishing and etching steps. The infiltration depth of 2% methylene blue into the margin was measured using an optical stereomicroscope. The correlation between viscosity of rebonding agents and mciroleakage was also evaluated. There were no statistically significant differences in the microleakage within the rebonding procedures, within the rebonding agents, and within the margins. However, when the restorations were not rebonded, the microleakage at gingival margin was significantly higher than those groups rebonded with 3 agents (p < 0.05). The difference was not observed at the occlusal margin. No significant correlation was found between viscosity of rebonding agents and microleakage, except very weak correlation in case of rebonding after polishing and etching at gingival margin (r = -0.326, p = 0.041).

Comparison of operative techniques between female and male dentists in class 2 and class 5 resin composite restorations / 대한치과보존학회지

This study aimed to assess whether the gender of the dental practitioner affects operative techniques in class 2 and class 5 resin composite restorations. In 2008, a nationwide survey was given to Korean dentists. Total 12,193 e-mails were distributed, 2,632 were opened by recipients, and 840 responses were collected. Of the respondents, 78.9% were male and 21.1% were female. The gender distribution in the age groups between respondents and the total population did not differ (p > 0.05). A chi-square test was used to compare technical differences between female and male dentists. A multiple logistic regression analysis was performed to assess the association between gender and operative techniques in resin composite restoration. For class 2 resin composite restoration, female dentists were 1.87 times more likely than male dentists to do multiple incremental fillings (four layers or more) and 2.72 times more likely than males to spend 30 minutes or more for the treatment (p < 0.05). For class 5 resin composite restoration, female dentists were 2.69 times more likely than their male counterparts to use a cavity base or liner, 1.83 times more likely to do multiple incremental fillings (four layers or more) and 1.63 times more likely to spend 20 minutes or more for the procedure (p < 0.05). The gender factor was influential to individual operative techniques in restorative treatment.

Effect of the exponential curing of composite resin on the microtensile dentin bond strength of adhesives / 대한치과보존학회지

OBJECTIVES: Rapid polymerization of overlying composite resin causes high polymerization shrinkage stress at the adhesive layer. In order to alleviate the shrinkage stress, increasing the light intensity over the first 5 seconds was suggested as an exponential curing mode by an LED light curing unit (Elipar FreeLight2, 3M ESPE). In this study, the effectiveness of the exponential curing mode on reducing stress was evaluated with measuring microtensile bond strength of three adhesives after the overlying composite resin was polymerized with either continuous or exponential curing mode. METHODS: Scotchbond Multipurpose Plus (MP, 3M ESPE), Single Bond 2 (SB, 3M ESPE), and Adper Prompt (AP, 3M ESPE) were applied onto the flat occlusal dentin of extracted human molar. The overlying hybrid composite (Denfil, Vericom, Korea) was cured under one of two exposing modes of the curing unit. At 48h from bonding, microtensile bond strength was measured at a crosshead speed of 1.0 mm/min. The fractured surfaces were observed under FE-SEM. RESULTS: There was no statistically significant difference in the microtensile bond strengths of each adhesive between curing methods (Two-way ANOVA, p > 0.05). The microtensile bond strengths of MP and SB were significantly higher than that of AP (p < 0.05). Mixed failures were observed in most of the fractured surfaces, and differences in the failure mode were not observed among groups. CONCLUSION: The exponential curing method had no beneficial effect on the microtensile dentin bond strengths of three adhesives compared to continuous curing method.

Pulp tissue regeneration and root formation of permanent teeth with pulpal/periapical deseases / 대한치과보존학회지

Numerous cases about additional growth of roots or pulp tissue regeneration by using various intracanal medicaments in immature permanent teeth with periapical or pulpal disease have been reported. The underlying mechanism has not been clearly delineated, but it has been widely accepted that undifferentiated mesenchymal cells and stem cells are involved. Moreover, the growth and deposition of osteoid or cementoid tissues have been observed in regenerated pulp and roots. This new and non-invasive treatment has brightened the future of endodontics, and enlarged the vision of regenerative root canal treatment with multi-potent stem cells and various tissue engineering techniques.

The effect of priming etched dentin with solvent on the microtensile bond strength of hydrophobic dentin adhesive / 대한치과보존학회지

Deterioration of long-term dentin adhesion durability is thought to occur by hydrolytic degradation within hydrophilic domains of the adhesive and hybrid layers. This study investigated the hypothesis that priming the collagen network with an organic solvent displace water without collapse and thereby obtain good bond strength with an adhesive made of hydrophobic monomers and organic solvents. Three experimental adhesives were prepared by dissolving two hydrophobic monomers, bisphenol-A-glycidylmethacrylate (Bis-GMA) and triethyleneglycol dimethacrylate (TEGDMA), into acetone, ethanol or methanol. After an etching and rinsing procedure, the adhesives were applied onto either wet dentin surfaces (wet bonding) or dentin surfaces primed with the same solvent (solvent-primed bonding). Microtensile bond strength (MTBS) was measured at 48 hrs, 1 month and after 10,000 times of thermocycles. The bonded interfaces were evaluated using a scanning electron microscope (SEM). Regardless of bonding protocols, well-developed hybrid layers were observed at the bonded interface in most specimens. The highest mean MTBS was observed in the adhesive containing ethanol at 48 hrs. With solvent-primed bonding, increased MTBS tendencies were seen with thermocycling in the adhesives containing ethanol or methanol. However, in the case of wet bonding, no increase in MTBS was observed with aging.

Quantitative comparison of permeability in the adhesive interface of four adhesive systems / 대한치과보존학회지

The purpose of this study was to perform quantitative comparisons of water permeable zones in both the adhesive and the hybrid layer before and after thermocycling in order to assess the integrity of the bonding interface. Twenty eight flat dentin surfaces were bonded with a light-cured composite resin using one of four commercial adhesives [OptiBond FL (OP), AdheSE (AD), Clearfil SE Bond (CL), and Xeno III (XE)]. These were sectioned into halves and subsequently cut to yield 2-mm thick specimens; one specimen for control and the other subjected to thermocycling for 10,000 cycles. After specimens were immersed in ammoniacal silver nitrate for 24 h and exposed to a photo developing solution for 8 h, the bonded interface was analyzed by scanning electron microscopy (SEM) and wavelength dispersive spectrometry (WDS) at five locations per specimen. Immediately after bonding, the adhesive layer of OP showed the lowest silver uptake, followed by CL, AD, and XE in ascending order (p < 0.0001); the hybrid layer of CL had the lowest silver content among the groups (p = 0.0039). After thermocycling, none of the adhesives manifested a significant increase of silver in either the adhesive or the hybrid layer. SEM demonstrated the characteristic silver penetrated patterns within the interface. It was observed that integrity of bonding was well maintained in OP and CL throughout the thermocycling process. Adhesive-tooth interfaces are vulnerable to hydrolytic degradation and its permeability varies in different adhesive systems, which may be clinically related to the restoration longevity.

A survey on the use of composite resin in Class II restoration in Korea / 대한치과보존학회지

The purpose of this study was to assess the current materials, methods and difficulties according to the year of licence and educational background of Korean dentists in Class II direct composite resin restorations. Total 17 questions were included in the questionnaire. Questions were broadly divided into two parts; first, operator's information, and second, the materials and methods used in Class II posterior composite restoration. The questionnaire was sent to dentists enrolled in Korean Dental Association via e-mail. Total 12,193 e-mails were distributed to dentists, 2,612 e-mails were opened, and 840 mails (32.2%) were received from respondents. The data was statically analyzed by chi-square test using SPSS(v. 12.0.1, SPSS Inc, Chicago, IL, USA). Male dentists among respondents was 79%. 60.3% of the respondents acquired their licences recently (1998-2007), and 77% practiced in private offices. 83.4% have acquired their knowledge through school lectures, conferences and seminars. For the Class II restorations, gold inlays were preferred by 65.7% of respondents, while direct composite resin restorations were used by 12.1% amalgam users were only 4.4% of respondents. For the restorative technique, 74.4% of respondents didn't use rubber dam as needed. For the matrix, mylar strip (53.4%), metal matrix (33.8%) and Palodent system (6.5%) were used. 99.6% of respondents restored the Class II cavity by incremental layering. Obtaining of the tight interproximal contact was considered as the most difficult procedure (57.2%) followed by field isolation (21%). Among various bonding systems, 22.6% of respondents preferred SE Bond and 20.2% used Single Bond. Z-250 was used most frequently among a variety of composite resins.

Shear bond strength of dentin bonding agents cured with a Plasma Arc curing light / 대한치과보존학회지

The objective of this study was to compare dentin shear bond strength (DSBS) of dentin bonding agents (DBAs) cured with a plasma arc (PAC) light curing unit (LCU) and those cured with a light emitting diode (LED) LCU. Optical properties were also analyzed for Elipar freelight 2 (3M ESPE); LED LCU, Apollo 95E (DMT Systems); PAC LCU and VIP Junior (Bisco); Halogen LCU. The DBAs used for DSBS test were Scotchbond Multipurpose (3M ESPE), Singlebond 2 (3M ESPE) and Clearfil SE Bond (Kuraray). After DSBS testing, fractured specimens were analyzed for failure modes with SEM. The total irradiance and irradiance between 450 nm and 490 nm of the LCUs were different. LED LCU showed narrow spectral distribution around its peak at 462 nm whereas PAC and Halogen LCU showed a broad spectrum. There were no significant differences in mean shear bond strength among different LCUs (P > 0.05) but were significant differences among different DBAs (P < 0.001).

The nanoleakage patterns of experimental hydrophobic adhesives after load cycling / 대한치과보존학회지

The purpose of this study was: (1) to compare nanoleakage patterns of a conventional 3-step etch and rinse adhesive system and two experimental hydrophobic adhesive systems and (2) to investigate the change of the nanoleakage patterns after load cycling. Two kinds of hydrophobic experimental adhesives, ethanol containing adhesive (EA) and methanol containing adhesive (MA), were prepared. Thirty extracted human molars were embedded in resin blocks and occlusal thirds of the crowns were removed. The polished dentin surfaces were etched with a 35% phosphoric acid etching gel and rinsed with water. Scotchbond Multi-Purpose (MP), EA and MA were used for bonding procedure. Z-250 composite resin was built-up on the adhesive-treated surfaces. Five teeth of each dentin adhesive group were subjected to mechanical load cycling. The teeth were sectioned into 2 mm thick slabs and then stained with 50% ammoniacal silver nitrate. Ten specimens for each group were examined under scanning electron microscope in backscattering electron mode. All photographs were analyzed using image analysis software. Three regions of each specimen were used for evaluation of the silver uptake within the hybrid layer. The area of silver deposition was calculated and expressed in gray value. Data were statistically analyzed by two-way ANOVA and post-hoc testing of multiple comparisons was done with the Scheffe's test. Silver particles were observed in all the groups. However, silver particles were more sparsely distributed in the EA group and the MA group than in the MP group (p < .0001). There were no changes in nanoleakage patterns after load cycling.

Comparison of the elastic modulus among three dentin adhesives before and after thermocycling / 대한치과보존학회지

The purpose of this study was to determine the effects on the elastic moduli of the adhesive and the hybrid layer from thermocycling. Twenty one human molars were used to create flat dentin surfaces. Each specimen was bonded with a light-cured composite using one of three commercial adhesives (OptiBond FL [OP], Clearfil SE Bond [CL], and Xeno III [XE]). These were sectioned into two halves and subsequently cut to yield 2-mm thickness specimens; one specimen for immediate bonding test without thermocycling and the other subjected to 10,000 times of thermocycling. Nanoindentation test was performed to measure the modulus of elasticity of the adhesive and the hybrid layer, respectively, using an atomic force microscope. After thermocycling, XE showed a significant decrease of the modulus in the adhesive layer (p < 0.05). Adhesives containing hydrophilic monomers are prone to hydrolytic degradation. It may result in the reduced modulus of elasticity, which leads to the mechanically weakened bonding interface.

Development of nano-fluid movement measuring device and its application to hydrodynamic analysis of dentinal fluid / 대한치과보존학회지

This study was aimed to develop an instrument for real-time measurement of fluid conductance and to investigate the hydrodynamics of dentinal fluid. The instrument consisted of three parts; (1) a glass capillary and a photo sensor for detection of fluid movement, (2) a servo-motor, a lead screw and a ball nut for tracking of fluid movement, (3) a rotary encoder and software for data processing. To observe the blocking effect of dentinal fluid movement, oxalate gel and self-etch adhesive agent were used. BisBlock (Bisco) and Clearfil SE Bond (Kuraray) were applied to the occlusal dentin surface of extracted human teeth. Using this new device, the fluid movement was measured and compared between before and after each agent was applied. The instrument was able to measure dentinal fluid movement with a high resolution (0.196 nL) and the flow occurred with a rate of 0.84 to 15.2 nL/s before treatment. After BisBlock or Clearfil SE Bond was used, the fluid movement was decreased by 39.8 to 89.6%.