Comparison of the physical properties of glass ionomer modified with silver phosphate/hydroxyapatite or titanium dioxide nanoparticles: in vitro study.

Glass ionomer cements (GICs) are the common materials employed in pediatric dentistry because of their specific applications in class I restorations and atraumatic restoration treatments (ART) of deciduous teeth in populations at high risk of caries. Studies show a limited clinical durability of these materials. Attempts have thus been made to incorporate nanoparticles (NPs) into the glass ionomer for improving resistance and make it like the tooth structure. An in vitro experimental study was conducted using the required samples dimensions and prepared based on the test being carried out on the three groups with or without the modification of light-cured glass ionomer. Samples were grouped as follows: control group (G1_C), 2% silver phosphate/hydroxyapatite NPs group (G2_SPH), and 2% titanium dioxide NPs group (G3_TiO2). The physical tests regarding flexural strength (n = 10 per group), solubility (n = 10 per group), and radiopacity (n = 3 per group) were performed. The data were analyzed by Shapiro Wilks test, and one-way analysis of variance (one-way ANOVA), and multiple comparisons by post hoc Tukey's test. The p-value of < 0.05 was considered significant. No statistically significant difference was observed between the control group (G1_C) and (G2_SPH) (p = 0.704) in the flexural strength test, however differences were found between G2_SPH and G3_TiO2 groups, ANOVA (p = 0.006); post hoc Tukey's test (p = 0.014). Pertaining to the solubility, G2_SPH obtained the lowest among the three groups, ANOVA (p = 0.010); post hoc Tukey's test (p = 0.009). The three study groups obtained an adequate radiopacity of >1 mm Al, respectively. The resin-modified glass ionomer cement (RMGIC) was further modified with 2% silver phosphate/hydroxyapatite NPs to improve the physical properties such as enhancing the solubility and sorption without compromising the flexural strength and radiopacity behavior of modified RMGIC. The incorporation of 2% titanium dioxide NPs did not improve the properties studied.

Relationship between the polymerization distance of monowave and polywave light-curing units and the irradiance and physical properties of dental resin-based composites.

PURPOSE: To evaluate the influence of the polymerization distance of monowave and polywave light curing units (LCUs) on the measured irradiance relative to the value reported by the manufacturer in relation to the physical properties of resin-based composites (RBCs). METHODS: Four LCUs were used: one monowave and three polywave. The irradiance was measured with a digital radiometer. Depth of cure (DC) and flexural strength (FS) tests were performed according to ISO 4049:2019 at polymerization distances of 0 mm and 5 mm. RESULTS: The irradiance of all LCUs was higher than that reported by the manufacturer (>25-64%). The irradiance of the four LCUs was reduced when polymerization was performed at between 0 to 5 mm (paired t-test, P < 0.001). The DC at 0 mm was similar in all groups but was significantly decreased at 5 mm distance (ANOVA P < 0.001). FS showed differences among the LCUs at 0 mm (ANOVA P < 0.001) and was affected by the polymerization distance. The elastic modulus was unaffected by the LCU used or the distance (ANOVA P > 0.001). CONCLUSIONS: The LCU must be positioned as near as possible to RBCs during the polymerization process, as increased distance negatively affects the depth of cure and flexural strength.

Is a White Diet Necessary for Tooth Bleaching Procedures? A Systematic Review and Meta-Analysis.

The aim of this investigation was to conduct a systematic review and meta-analysis to determine the necessity of a white diet during or following a bleaching procedure. This systematic review and meta-analysis followed the PRISMA guidelines meticulously. The research question was: Is a white diet necessary during and/or after a bleaching treatment? In vitro studies or clinical trials reporting the color change in bleached enamel after the use of a free-staining diet were considered for full-text review. For the analyses, a random-effects model was employed. Statistical significance was defined as a p-value < 0.05. A total of 17 documents were eligible for qualitative analysis: 5 clinical trials and 12 in vitro studies. Only data from the clinical trials were included in the meta-analysis. For at-home bleaching, differences in the color among the subjects were not statistically significant during the first (p = 0.64), second (p = 0.26) or third (p = 0.43) weeks of treatment. Also, the color difference one month after finishing the bleaching treatment were not statistically significant (p = 0.27). The color difference one month after finishing an in-office treatment showed that the restrictions on diet did not significantly improve the bleaching outcomes (p = 0.90). According to the findings of this review, dietary restrictions are not necessary during or after bleaching procedures.

Mecanismos preventivos de la degradación de la capa híbrida / Preventive mechanisms of the degradation of the hybrid layer

Uno de los mayores retos de la odontología actual es lograr una adhesión duradera y estable entre los materiales de restauración y los tejidos dentales. Los protocolos adhesivos han ido cambiando a lo largo del tiempo para cumplir con dicho objetivo, tratando de mantener la integridad de la capa hibrida, por lo que se revisaron los factores que provocan la degradación de la capa hibrida y los mecanismos propuestos para prevenir esta degradación. Se realizó una investigación y recopilación de información bibliográfica especializadas en el tema, en buscadores científicos como PubMed, Scielo, Redalyc, Medigraphic y Scopus. Para los criterios de inclusión se consideraron años de publicación entre el año 2002 al 2022, enfocados en trabajos de investigación relacionados con la degradación de la interfaz de unión resina-dentina y mecanismos para prevenir esta degradación en la capa híbrida. El mecanismo mas estudiado a corto y largo plazo es la aplicación de clorhexidina, la cual se utiliza después del ácido fosfórico y antes del adhesivo, inhibe la actividad proteolítica de las metaloproteinasas de la matriz (MMPs) y retarda la degradación de las fibras colágenas, consiguiendo de esta manera una mayor vida de las restauraciones adhesivas.

One of the biggest challenges in dentistry is to achieve a long-lasting and stable bond between restorative materials and dental tissues. The adhesive protocols have been changing over time to meet this objective, trying to maintain the integrity of the hybrid layer, so the factors that cause the degradation of the hybrid layer and the mechanisms proposed to prevent this degradation were reviewed. An investigation and compilation of specialized bibliographic information on the subject was carried out, in scientific search engines such as PubMed, Scielo, Redalyc, Medigraphic, Scopus, among others, as well as books. For the inclusion criteria, years of publication between 2002 and 2022 were considered, focused on research works related to the degradation of the resin-dentin bonding interface and mechanisms to prevent this degradation in the hybrid layer. The placement of CHX is used after the application of phosphoric acid and before the adhesive, it inhibits the proteolytic activity of matrix metalloproteinases (MMPs) and the degradation of collagen fibers, thus achieving a longer life of resin dental restorations.

Subgingival Microbiota and Periodontal Clinical Status in Patients with Plaque Psoriasis: A Cross-Sectional Study.

Plaque Psoriasis (PP) and periodontitis are inflammatory disorders with a bidirectional association. They both have a qualitatively similar immune-modulatory cascade, cytokine profile, and a recently described dysbiosis. Different oral bacterial species compositions in the periodontal pocket might play a role in the development of PP. To describe the subgingival microbiota of the Mexican population with PP and the periodontal conditions. Subjects were divided into two groups: periodontal health (PH) (PH-non-PP, PH-PP) and periodontitis (PD) (P-non-PP, PD-PP). Following clinical examination, the patients were classified into three groups according to the degree of psoriasis as measured by the Psoriasis Area Severity Index (PASI) and the periodontal status according to the parameters of the American Academy of Periodontology (AAP). Subgingival microbiota samples of each patient were used to determine 40 species of periodontal bacteria by checkerboard DNA-DNA hybridization. IL-2 and IL-6 were measured by ELISA. Of the forty-eight patients with PP, 21 patients had PH and 27 patients had PD. PD-PP group has a significant increase in the percentage of plaque, gingival redness, pocket probing depth, and clinical attachment loss (P<0.001) compared to PH-PP group. Microbiologically PD-PP exhibited significantly higher mean counts for A. georgiae, A. israelii, A. naeslundii from blue complex (P<0.001) than PD-non-PP. Moreover, the counts of these Actinomyces in PD-PP increased according to the severity of index PASI. The concentration of IL-2 and IL-6 were increased in saliva from PH-PP and PD-PP patients compared to PH non-PP. PP individuals harbored a particular sub-gingival microbiota profile different from non-PP. The severity of psoriasis was related to dysbiosis of microbiota -PASI > 5 related to periodontitis with the predominance of Actinomyces periodontal, irrespective of their periodontal condition. Finally, the severity of psoriasis could be unbalanced in subgingival microbiota and increase the risk to develop periodontitis.

Physical properties, marginal adaptation and bioactivity of an experimental mineral trioxide aggregate-like cement modified with bioactive materials.

PURPOSE: To evaluate the effect of adding wollastonite and bioactive glass to an experimental mineral trioxide aggregate-like cement (MTA) on the dimensional stability, compressive strength, solubility, bioactivity, and marginal adaptation by scanning electron microscopy (SEM) and X-ray diffraction (XRD). METHODS: Four groups were evaluated at 7, 14, and 21 days: MTA Angelus, experimental MTA-like cement (MTA Exp), BG10 (MTA Exp+10 wt% bioactive glass), and WO20 (MTA Exp+20 wt% wollastonite). To evaluate marginal adaptation, extracted teeth were endodontically obturated and root-end cavities were prepared and filled with the tested materials. RESULTS: Cements with bioactive materials showed minimal dimensional changes. Adding wollastonite or bioactive glass to MTA Exp reduces the compressive strength but does not affect solubility. Bismite (Bi2O3), larnite (Ca2SiO4), calcite (CaCO3) and carbonated hydroxyapatite (Ca5[PO4,CO3]3[OH]) were identified in the four cements; ettringite (Ca6Al2[SO4]3[OH]12·26H2O) and bismutite ([BiO]2CO3) were only observed in MTA Exp, BG10, and WO20. Cement-dentin interfaces were not observed after 14 days on the BG10 and WO20 cement composites due to the ettringite formation. CONCLUSION: Acicular growing crystals typical of hydroxyapatite were found on the surfaces of all cements. An improved marginal adaptation was observed with the addition of wollastonite or bioactive glass.

Theoretical method for a radiopacifier proportion calculation in MTA type cements.

This article deals with the problem of determining the proportion by weight of radiopacifying material needed to add to a cement clinker of mineral trioxide aggregated (CE) to comply with ISO 6876/2001 and ANSI-ADA 57 regulations for radiopacity. With this aim, CE was synthesized and mixed experimentally with 5, 10, 15, and 20 wt% of ZrO2 as radiopacifying material. Radiographic images were taken so that radiographic density was obtained and related to the mmAl scale by using an aluminum step wedge. From a theoretical point of view, absorbed intensity given by the Lambert-Beer law was calculated using mass attenuation coefficients (NIST database) for each chemical element included in each component of the cement samples. In this way, we predicted that by adding above 10 wt% of ZrO2 to the CE, the requirements stipulated by ISO 6876 for radiopacity were satisfied with discrepancies around 1 mmAl. This theoretical method gives an excellent approximation to determine the amount of radiopacifying material needed to meet the requirements stipulated by ISO.

Cell viability and physicochemical effects of different concentrations of bismuth trioxide in a mineral trioxide aggregate cement.

PURPOSE: To evaluate the effect of three concentrations of bismuth trioxide (Bi2O3) on the biological and physicochemical properties of an experimental mineral trioxide aggregate-type (MTA-type) cement at different time points. METHODS: Three experimental groups with white Portland cement containing 15, 20, or 25 wt% of Bi2O3 were assessed. Cellular proliferation in human periodontal ligament fibroblasts was evaluated with an MTT assay. Radiopacity, dimensional stability, pH, and compressive strength were evaluated at different time points. RESULTS: Bismuth trioxide induced cell proliferation in the Bi15 and Bi25 groups in a time-dependent manner; pH was similar in all groups. Compressive strength was associated with time and bismuth concentration. Bi25 had significantly contracted at day 7 and expanded at day 14 (ANOVA P < 0.05, post hoc Tukey test P < 0.05). CONCLUSION: A higher Bi2O3 concentration had a negative effect on the physical properties of the cement at all time points.

Bond Strength of Adhesive Systems to Calcium Silicate-Based Materials: A Systematic Review and Meta-Analysis of In Vitro Studies.

Since the adhesion of resin composites to calcium silicate-based cement is considered challenging. Therefore, the best adhesion strategy should be indicated. This review aimed to assess the effect of different adhesive systems on the bond strength of resin composite to calcium silicate-based cement through a systematic review and meta-analysis. The subsequent PICOS framework used was: population, calcium silicate-based cement; intervention, use of self-etch adhesive systems; control, use of total-etch adhesive systems; outcome, bond strength; study design, in vitro studies. The literature search was conducted independently by two reviewers up to 18 February 2021. Electronic databases (PubMed, ISI Web of Science, SciELO, Scopus, and Embase) were searched for applicable articles. In vitro manuscripts studying the effect of adhesive systems on the bond strength of calcium silicate-based cement were considered. The meta-analyses were performed using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Bond strength comparisons were made considering the type of calcium silicate-based cement (Mineral Trioxide Aggregate (MTA), Biodentine™, or TheraCal LC®). A p-value < 0.05 was considered statistically significant. A total of 7321 studies were retrieved in databases searched. After full-text evaluation, 37 eligible papers were assessed for qualitative analysis, leaving a total of 22 papers for the quantitative analysis. According to the meta-analysis, the bond strength values of resin composite materials to MTA and TheraCal LC® cement were favored when a total-etch adhesive system was used (p ≤ 0.02). On the other hand, the meta-analysis of the bond strength of resin-based materials to Biodentine™ calcium silicate-based cement was similar between both approaches (p = 0.12). The in vitro evidence suggests that the bond strength of resin-based materials to both MTA and TheraCal LC® cement was preferred by using the total-etch adhesive strategy. However, when bonding to Biodentine™, the use of self-etch or total-etch strategies displayed promising results. Given the lack of evidence related to the chemical interaction of self-etch adhesive materials with the bioceramics, if self-etch adhesives are used for bonding resin-based restorations to calcium silicate-based cement, a pretreatment with phosphoric acid could be recommended.

Correlation between dental enamel chemical composition and bracket debonding, comparing adhesive systems through a scanning electron microscope.

Literature reports indicate that during bracket removal there can be enamel damage. We compare the shear bond strength (SBS) and tooth enamel loss of four adhesive systems and identify the Ca/P ratio. Then a total of 20 premolars were divided into four groups of five each. After prophylaxis, photographs were taken at 35× with a scanning electron microscope (SEM) and analyzed with X-ray spectroscopy (EDS) at 250×. Brackets were bonded with Transbond™ MIP(G1), Transbond™ PLUS SEP(G2), Enlight(G3) and Stylus®(G4) adhesives, 24 h after were debonded with a Instron universal testing machine at 1 mm/min. All the brackets were photographed with the SEM. The amount of lost enamel was measured with AutoCad. All the results were measured with a significance level p < .05. The SBS general average at debonding was 7.94 ± 2.26 MPa, meanwhile the SBS for G1, G2, G3 and G4 was 9.38 ± 1.46, 6.28 ± 0.69, 9.08 ± 2.45 and 7.04 ± 2.64 MPa respectively. 90% of the samples had no enamel loss, 10% had enamel loss. Only two samples in G1 presented an enamel loss area of 0.34mm2 and 0.80mm2 respectively. From EDS analysis, the Ca/P ratio was 1.6 ± 0.05, 1.61 ± 0.03, 1.64 ± 0.83 and 1.59 ± 0.07 for G1, G2, G3 and G4 respectively; no statistically significant differences were found. We conclude that no association was found between the Ca/P ratio and enamel damage when brackets are removed. HIGHLIGHTS: Where enamel is lost, we observe fractures, steps, horizontal and vertical enamel loss. There is a loss of tooth enamel from 0.34 to 0.80 mm2 with Transbond PLUS SEP. Structural loss of enamel is almost inevitable during the separation of the bracket.

Evaluation of enamel loss by scanning electron microscopy after debonding brackets place with four different adhesives.

The clinically adequate shear bond strengths (SBS) should be from 2.8 to 10 MPa. The aim of this research is to observe tooth enamel loss through a scanning electron microscope (SEM) during the debonding of braces of four adhesive systems. Then, 100 premolars were used in 4 groups of 25 specimens each, for Transbond MIP (G1), Enlight (G2), Stylus (G3), and Transbond Plus SEP (G4). The research was done under the NOM ISO/TS 11405:2015. Gemini 3M were placed under the manufacturer's recommendations. The SBS test was done at 24 hr in an Instron electromechanical universal testing machine at 1 mm/1 min. Adhesive remnant index (ARI) was measured, all of the brackets where examined in the SEM. For the shear bonding strength G1 = 10.09 ± 2.73 MPa, G2 = 9.27 ± 3.99 MPa, G3 = 7.83 ± 4.46 MPa, and G4 = 6.40 ± 2.85 MPa statistically significant differences were found when comparing the four groups (p = .002). In the Tukey post hoc test, G1 versus G4 and G2 versus G4, statistically significant differences were found. For the ARI a value of 1 in 46%, followed by a value of 2 in 38%, a value of 3 in 13% and a value of 0 in 3% of the total samples, finding statistically significant differences (p < .001). In relation to the tooth enamel loss due to SBS, statistically significant differences were found (p = .326). G1 and G4 had not statistically significant differences. Even though our results concur with the appropriate clinical values, we observed tooth enamel loss with Transbond Plus SEP and Stylus.

Microfiltración en un cemento dental tipo MTA modificado con wollastonita y vidrio bioactivo / Microleakage in MTA-type dental cement modified with wollastonite and bioactive glass

Resumen Un material de retroobturación como el MTA (Mineral Trioxide Aggregate) debe de ser de fácil manejo, biocompatible, tener baja o nula solubilidad y ser dimensionalmente estable para evitar filtraciones asociadas a los cambios volumétricos. Objetivo: Medir la filtración en un cemento dental tipo MTA modificado con wollastonita y vidrio bioactivo. Material y métodos: Se establecieron ocho grupos: MTA Angelus (control), MTA Exp (cemento Portland blanco más 20 wt% de trióxido de bismuto), otros seis grupos se formaron con la adición de 10, 20 y 30 wt% de wollastonita y vidrio bioactivo al MTA Exp. Dientes permanentes uniradiculares, raíz recta y con ápice cerrado fueron preparados con técnica crown-down con fuerzas balanceadas para obtener un diámetro estandarizado a lima apical maestra #40. Se cortaron 3 mm del ápice se prepararon retrocavidades de 3 mm de profundidad con punta de ultrasonido donde fueron colocados los cementos, el extremo apical fue sumergido en solución de azul de metileno al 2% durante 24 horas. Resultados: MTA Exp fue el que presentó menor filtración con un promedio de 0.66 mm, mientras que el grupo de WO10 fue el de mayor con 1.61 mm. MTA Angelus usado como control presentó 0.71 mm de microfiltración, se encontraron diferencias estadísticamente significativas con WO10, (ANOVA p < 0.001, Dunett p < 0.001). Conclusiones: Se observa que en el caso de los cementos con los agregados de wollastonita y vidrio bioactivo la microfiltración disminuye conforme aumenta el porcentaje del agregado, se sugiere el uso de otras técnicas complementarias para medir la microfiltración.

Abstract Retro-filling material such as MTA (mineral trioxide aggregate) should be biocompatible, easy to handle, with low or nil solubility as well as dimensionally stable in order to avoid filtrations associated to volumetric changes. Objective: To measure filtration in a MTA-type dental cement modified with wollastonite and bioactive glass. Material and methods: Eight groups were established: MTA Angelus (control), MTA Exp (white Portland cement plus 20% wt of bismuth trioxide), another six groups were formed with the addition to MTA Exp of 10, 20 and 30% wt of wollastonite and bioactive glass . Single rooted teeth, with straight root and closed apex were prepared with crown-down technique with balanced forces in order to obtain standardized diameter to fit a number 40 master apical file; 3 mm from the apex were excised, 3 mm deep retro-cavities were prepared with ultrasound point, where cements were placed, apical end was submerged in a 2% methylene blue solution for 24 hours. Results: MTA Exp exhibited least filtration with an average of 0.66 mm, WO10 group exhibited the greatest leakage with average of 1.61 mm. MTA Angelus, used as control exhibited 0.71 mm microleakage. Statistically significant differences were found with WO10, (ANOVA p < 0.001), Dunett p < 0.001). Conclusions: It was observed that in the case of cements with aggregate of wollastonite and bioactive glass, microleakage decreased according to the aggregate's percentage. For microleakage measurement, use of other supporting techniques is advised.

Análisis químico elemental y de fases por medio de PIXE, DSC, TGA y DRX en MTA Angelus® y un cemento Portland blanco / Elemental chemical composition and phase analysis by means of PIXE, DSC, TGA, and DRX of MTA Angelus® and a white Portland cement

Resumen: El mineral trióxido agregado (MTA) es un cemento usado principalmente para sellar perforaciones en órganos dentales debido a que endurece en presencia de humedad, está compuesto por cemento Portland y trióxido de bismuto. Objetivo: Analizar y comparar por medio de PIXE, DSC, TGA y DRX la composición química elemental y de fases del cemento MTA Angelus® y de un cemento Portland blanco (CPB-CA). Material y métodos: MTA Angelus® blanco y un cemento Portland blanco fueron analizados con PIXE en un acelerador de partículas; el análisis de fases cristalinas se realizó por medio de DRX y contrastado los picos con los de base de datos del ICDD, el DSC se realizó en un calorímetro hasta 900 °C. Resultados: PIXE detectó como elementos de mayor porcentaje fueron aluminio, silicio y calcio para ambos cementos; habiendo diferencias en los porcentajes de azufre; el bismuto sólo se detectó en MTA Angelus®. Se detectaron como elementos traza cobre y estroncio en el MTA Angelus®, además de zirconio en CPB-CA. La relación entre silicio-calcio y silicio-aluminio en los dos cementos es similar. Se identificaron tres fases cristalinas en ambos cementos, silicato dicálcico, silicato tricálcico y aluminato tricálcico; sin embargo, se identificó Bismita en el MTA Angelus® y sulfato de calcio en forma de yeso en CPB-CA, que se logró corroborar con la ayuda de la técnica DSC. Conclusiones: Se logró observar la baja cantidad de yeso en MTA Angelus® por medio de la calorimetría. Tanto las fases cristalinas como la composición química elemental son similares en ambos cementos.

Abstract: Mineral trioxide aggregate (MTA) is a cement mainly used to seal tooth perforations; this is due to the fact that it hardens when in presence of humidity. It is composed of Portland cement and Bismuth trioxide. Objective: To analyze and compare with PIXE, DSC, TGA and DRX elementary chemical and phase composition of MTA Angelus® cement with a white Portland cement (WPC). Material and methods: MTA Angelus® white and a white Portland cement were analyzed with PIXE in a particle accelerator, phase analyses were conducted with XRD contrasting peaks with those in the ICDD database. DSC was conducted in a calorimeter up to 900 oC. Results: PIXE detected the following as greater percentage elements: aluminum, silica and calcium for both cements. Differences were found with sulfur percentages; Bismuth was only detected in MTA Angelus®. Trace elements of copper and strontium were detected in MTA Angelus® and zirconium in WPC. Relationship between silica-calcium and silica-aluminum was similar in both cements. In both cements, three crystalline phases were detected: dicalcium silicate, tricalcium silicate and tricalcium aluminate. Nevertheless, Bismite was identified in MTA Angelus® and calcium sulfate in the form of gypsum in WPC, this was corroborated with DSC technique. Conclusions: In MTA Angelus®, low gypsum amounts were observed by means of calorimetry. In both cements, crystalline phases and elemental chemical composition were similar.