Investigation on the effect of antimicrobial photodynamic therapy as an adjunct for management of deep caries lesions-study protocol for a randomized, parallel groups, controlled clinical trial.

BACKGROUND: Alternatively to conventional treatments, chemo-mechanical caries removal agents can be used. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana is being researched for application in aPDT. This protocol aims to determine the effectiveness of aPDT with Bixa orellana extract in deep caries lesions. METHODS: A total of 160 teeth with deep occlusal dental caries will be selected and divided into 4 groups: G1 - control group (Caries removal with a low-speed drill); G2 - Partial Caries Removal with Papacarie™ (Fórmula e Ação, São Paulo, SP, Brazil); G3 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) (Fórmula e Ação, São Paulo, SP, Brazil); G4 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) with LED (Valo Cordless Ultradent®, South Jordan, UT, USA) (aPDT). After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at immediately, 1 week, and 1, 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The efficacy of treatments will be assessed with microbiological (colony-forming units, before and after carious tissue removal), radiographic (integrity of the periapical area and eventual changes in the radiolucent zones), and clinical examinations (retention of the restorative material in the cavity and occurrence of secondary caries), as well as with the time required for the procedures and the need for anesthesia during the procedures. In case data distribution is normal, analysis of variance (ANOVA) will be used for both the dependent and independent variables. In case the data distribution is not normal, the Friedman test will be used for the dependent variables. For independent variables, the Kruskal-Wallis test will be used. DISCUSSION: Procedures using aPDT have been developed for the treatment of dental caries, but there are few controlled clinical trials in the literature confirming its efficacy. TRIAL REGISTRATION: This protocol is registered at ClinicalTrials.gov under the number NCT05236205 and it was first posted on 01/21/2022 and last updated on 05/10/2022.

Impact of silanization of different bioactive glasses in simplified adhesives on degree of conversion, dentin bonding and collagen remineralization.

OBJECTIVE: To analyze simplified adhesive containing pure or silanized bioglass 45S5 (with calcium) or Sr-45S5 (strontium-substituted) fillers applied on dentin and to evaluate the microtensile bond strength (µTBS), interface nanoleakage, degree of conversion of adhesive, collagen degradation and remineralization. METHODS: Ambar Universal adhesive (FGM) was doped with 10 wt% bioactive glasses to form following groups: Control (no bioglass), 45S5 (conventional bioglass 45S5), Sr-45S5 (Sr-substituted bioglass 45S5), Sil-45S5 (silanized bioglass 45S5) and Sil-Sr-45S5 (silanized bioglass Sr-45S5). Adhesives were applied after dentin acid-etching using phosphoric acid at extracted human molars. Resin-dentin sticks were obtained and tested for µTBS, nanoleakage at 24 h or 6 months. Degree of conversion was measured using micro-Raman spectroscopy. Dentin remineralization was assessed by FTIR after 6-month storage in PBS. Hydroxyproline (HYP) release was surveyed by UV-Vis spectroscopy. Statistical analysis was performed using ANOVA and Tukey's test (p < 0.05). RESULTS: Regarding µTBS, Sr-45S5 and 45S5 presented higher and stable results (p > 0.05). Control (p = 0.018) and Sil-Sr-45S5 (p < 0.001) showed µTBS reduction after 6-month aging. Sil-Sr-45S5 showed higher HYP release than that obtained in the 45S5 group. Sil-45S5 showed mineral deposition and increase in µTBS (p = 0.028) after 6-months. All experimental adhesives exhibited higher degree of conversion compared to Control group, except for 45S5. All adhesives created gap-free interfaces, with very low silver impregnation, except for Sil-Sr-45S5. SIGNIFICANCE: The incorporation of silanized 45S5 bioglass into the universal adhesive was advantageous in terms of dentin remineralization, bonding performance and adhesive polymerization. Conversely, Sil-Sr-45S5 compromised the µTBS, interface nanoleakage and had a negative impact on HYP outcomes.

The Allogenic Dental Pulp Transplantation from Son/Daughter to Mother/Father: A Follow-Up of Three Clinical Cases.

The study investigated allogenic pulp transplantation as an innovative method of regenerative endodontic therapy. Three patients were selected for the endodontic treatment of single-root teeth, who also had a son/daughter with deciduous teeth or third molars scheduled for extraction. Receptor teeth were endodontically instrumented and irrigated using a tri-antibiotic solution. During the transplant procedures, the teeth from the son/daughter were extracted, sectioned, and the pulp was carefully removed. The harvested pulp from the donor was inserted into the root canal of the host tooth (father/mother), followed by direct pulp capping and resin composite restoration. The teeth were followed-up with for 2 years and were surveyed with computed tomography, the electric pulp vitality test, and Doppler ultrasound examination. At the 6-month follow-up, positive pulp vitality and the formation of periapical lesions were verified in cases 1 and 2. Case 3 showed remarkable periapical radiolucency before transplantation, but after 1 year, such lesions disappeared and there was positive vitality. All teeth were revascularized as determined by Doppler imaging after 2 years with no signs of endodontic/periodontal radiolucency. In conclusion, although this was a case series with only three patients and four teeth treated, it is possible to suppose that this allogenic pulp transplantation protocol could represent a potential strategy for pulp revitalization in specific endodontic cases.

Collagen Cross-Linking Lignin Improves the Bonding Performance of Etch-and-Rinse Adhesives to Dentin.

To evaluate the biomodification ability of lignin used as pre-treatment in human dentin before the application of an etch-and-rinse adhesive. Experimental hydroethanolic solutions with different cross-linking agents were used: 6.5% proanthocyanidins (PAC, from grape-seed extract); 2% cardanol (CARD, from cashew-nut shell liquid); lignin (LIG, from eucalyptus) at 1, 2 or 4% concentrations. The negative control (NC) was ethanol 50 v%. Extracted molars were prepared, and dentin microtensile bond strength (µTBS) was evaluated after 24 h water storage or 10,000 thermocycling aging. Further specimens were processed for SEM nanoleakage, micropermeability confocal microscopy evaluation and in situ degree of conversion (DC) through micro-Raman spectroscopy. Demineralized dentin sticks were submitted to a three-point bending test to evaluate the elastic modulus (E) before and after 1 min biomodification using the tested solutions. Moreover, it was also evaluated the mass changes and hydroxyproline (HYP) release after 4-weeks of water storage. Vibrational collagen crosslinking identification was evaluated through micro-Raman spectroscopy. The results were analyzed by analysis of variance (ANOVA) and Tukey's test (α = 0.05). A significant reduction in µTBS was observed in groups NC (p < 0.001) and CARD (p = 0.026). LIG-4% showed no significant reduction in µTBS after aging (p = 0.022). Nanoleakage micrographs showed hybrid layer protection with all agents, but reduced micropermeability was attained only with lignin. Polymerization was negatively affected in the presence of all tested cross-linking agents, except LIG-1%. Lignin and cardanol increased the dentin E values, but only lignin reduced the mass loss in dentin specimens. Effective collagen crosslinking (1117 cm−1 and 1235 cm−1) was detected for all agents. HYP release was significantly lower with LIG-1% than NC (p < 0.001). Lignin was able to perform collagen cross-linking and prevent the degradation of unprotected dentin collagen, thereby improving the bonding performance of the composite restorations performed in this study.

Dental Pulp Autotransplantation: A New Modality of Endodontic Regenerative Therapy-Follow-Up of 3 Clinical Cases.

The aim of this study was to develop a novel method of endodontic therapy, which we refer to as dental pulp autotransplantation. Three patients (2 males and 1 female) were selected for endodontic treatment of a uniradicular premolar and extraction of a third molar (without odontosection). Electric assessment of pulp vitality and computed tomographic imaging were undertaken followed by endodontic access and instrumentation using triantibiotic solution for irrigation in the host tooth. A few minutes before the transplant procedure, the third molar was extracted, the tooth was sectioned with a diamond blade in a low-speed handpiece, and the pulp was carefully removed. After premolar instrumentation, the harvested and preserved pulp tissue was reinserted into the root canal followed by direct pulp capping performed using Biodentine (Septodont, Saint-Maur-des-Fossés, France), a liner of resin-modified glass ionomer cement and composite resin restoration. The teeth were followed up for at least 12 months after the procedures and were analyzed using computed tomographic imaging, electric pulp vitality testing, and Doppler ultrasound examination. At the 3- and 6-month follow-ups, positive pulp vitality and regression of periapical lesions were verified. After 9-12 months, all teeth were revascularized as determined by Doppler imaging, and the tooth vitality was reestablished with no signs of endodontic/periodontal radiolucency or complications. Within the limitations of the study, considering that it was a case series with only 3 patients, we described a highly innovative procedure of pulp autotransplantation, which appears to be feasible, highlighting the potential for clinical application of pulp regeneration using this new modality of endodontic therapy.

Intraradicular Dentin Biomodification with Natural Agents for Bonding Glass-fiber Posts.

PURPOSE: To evaluate the effects of pretreatment with different crosslinking agents on glass-fiber-post adhesive luting. MATERIALS AND METHODS: Single-rooted human teeth (n = 20) were randomly assigned to four groups: proanthocyanidins (PA) from grape-seed extract, cardol and cardanol (separated from cashew nut-shell liquid) and negative control (hydroethanolic solution). The solutions were applied on 37% phosphoric acid-etched dentin for 60 s. Glass-fiber posts were cemented using a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M Oral Care) and composite cement (RelyX ARC, 3M Oral Care). Slices for the push-out bond strength test were cut and tested after 24-h or 6-month storage in distilled water. The dentin underlying the adhesive layer was analyzed by micro-Raman spectroscopy to evaluate vibrational formation of collagen crosslinks. Three additional slices per group were also made and the adhesive in-situ degree of conversion (DC) was analyzed by micro-Raman spectroscopy. The results were analyzed using two-way ANOVA and Tukey's test (p < 0.05). RESULTS: No statistically significant changes in bond strength were found over time for any of the groups, except with cardol, which increased bond strength (8.4 ± 3.9 MPa at 24 h to 15.0 ± 2.9 MPa after 6 months, p < 0.001) after aging. The formation of peaks at 1117 cm-1 and 1235 cm-1 showed the presence of collagen crosslinks for all three biomodification agents. The DC outcomes showed no statistically significant differences between groups (p = 0.514). CONCLUSION: Biomodification agents did not impair adhesive polymerization. Cardol demonstrated a positive influence on intraradicular dentin bonding for glass-fiber post luting.

In Vitro Evaluation of Experimental Self-Adhesive Orthodontic Composites Used to Bond Ceramic Brackets.

The aim of this study was to evaluate the degree of conversion (DC), flexural strength (FS), and shear bond strength (SBS) of ceramic brackets bonded to enamel with experimental self-adhesive orthodontic composites. Functional monomers 10-methacryloyloxy-decyl-dihydrogen-phosphate (MDP) and glycerol-dimethacrylate-phosphate (GDMA-P) were used in experimental composites. They were compared to the same composite without an acidic monomer (negative control) and with enamel acid-etching prior to adhesive application (positive control). DC was evaluated by Raman micro-spectroscopy. Flexural three-point bending testing was performed in a universal testing machine. Ceramic brackets were bonded to bovine enamel and SBS was evaluated before and after 2000 thermal-cycles. Fracture patterns were surveyed with manual removal with specific pliers and analyzed by SEM. Statistics was performed using ANOVA and Tukey's test (p < 0.05). DC of the control composite was significantly higher (p < 0.001) than that of GDMA-P and MDP. FS showed no significant difference between composites (p = 0.451). Regarding adhesion, the positive control (8.47 ± 0.88 MPa) and MDP (7.07 ± 2.69 MPa) obtained higher overall results. The predominant fracture pattern of the positive control and MDP was mixed while it was adhesive for further groups. The MDP-containing orthodontic composite attained similar adhesion to a conventional three-step orthodontic bonding system, with a similar fracture pattern and mechanical properties. Nevertheless, the presence of acidic functional monomers reduced the DC.

Dentin bonding and physicochemical properties of adhesives incorporated with epigallocatechin-3-gallate.

The aim was to assess dentin adhesion and physicochemical properties of experimental etch-and-rinse and self-etch adhesives doped with epigallocatechin-3-gallate (EGCG), a well-known collagen crosslinker obtained from green tea (Camellia sinensis). Experimental adhesives were prepared without (0 wt%), with 0.1 or 0.5 wt% EGCG addition. Their degree of conversion was surveyed by FTIR, and bar-shaped specimens were tested to obtain flexural strength and modulus initially and after 1-week ethanol storage. Extracted human molars were prepared, bonded, and cut into resin-dentin sticks for microtensile bond strength test, which was conducted after 24 h or 6-month water storage. Statistical analyses were performed with two-way ANOVA and Tukey's test (p < 0.05). Degree of conversion outcomes depicted a significant polymerization reduction by the addition of EGCG in self-etch adhesive in both concentrations. However, only 0.1% reduced the conversion of etch-and-rinse adhesive. Flexural modulus and strength were significantly diminished (p < 0.05) by the addition of both concentrations of EGCG for the two model adhesives. Dentin-bond strength was reduced after aging with the addition of EGCG to self-etch adhesive. Nevertheless, 0.5% EGCG increased the bond strength of etch-and-rinse adhesive after aging, conversely to the significant reduction for EGCG-free control adhesive. In conclusion, EGCG at 0.5% provides optimal improvements on dentin bonding without altering final polymerization of a model etch-and-rinse adhesive.

Micro-Raman Vibrational Identification of 10-MDP Bond to Zirconia and Shear Bond Strength Analysis.

So far, there is no report regarding the micro-Raman vibrational fingerprint of the bonds between 10-methacryloyloxy-decyl dihydrogen phosphate (10-MDP) and zirconia ceramics. Thus, the aim of this study was to identify the Raman vibrational peaks related to the bonds of 10-MDP with zirconia, as well as the influence on microshear bond strength. Micro-Raman spectroscopy was employed to assess the vibrational peak of 10-MDP binding to zirconia. Microshear bond strength of the dual-cure resin cement to zirconia with the presence of 10-MDP in composition of experimental ceramic primer and self-adhesive resin cement was also surveyed. Statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). Peaks at 1545 cm-1 and 1562 cm-1 were found to refer to zirconia binding with 10-MDP. The presence of 10-MDP in both experimental ceramic primer and self-adhesive resin cement improved microshear bond strength to zirconia ceramic. It can be concluded that the nondestructive method of micro-Raman spectroscopy was able to characterize chemical bonds of 10-MDP with zirconia, which improves the bond strengths of resin cement.