Effect of surface topography and wettability on shear bond strength of Y-TZP ceramic.

Zirconia ceramics have been widely used as dental restorations due to their esthetic appearance and high flexural strength. The bonding of zirconia with resin cement should rely on both mechanical and chemical bonds. This study was performed to investigate the effect of zirconia surface topography and its wettability after surface pretreatments on the microshear bond strength (µSBS) of a resin cement. Zirconia slabs were prepared and randomly divided into 5 groups based on the surface treatment as follows: no treatment (control), air abrasion (AB), etching with hydrofluoric acid (F), the mixture of hydrofluoric acid and nitric acid (FN), or the mixture of hydrochloric acid and nitric acid (CN) for 10 min. The specimens were subjected to investigation of surface roughness characteristics [average roughness (Ra), peak-to-valley average distance (Rpv), skewness (Rsk), and kurtosis (Rku)] using atomic force microscopy (AFM) and measurements of surface contact angle (θc) and µSBS of a resin cement. In addition, the area % of the nanoscale surface irregularity (nSI%) was calculated from the AFM images. The effects of nSI%, Ra and θc on the µSBS were analyzed by multiple linear regression analysis (p < 0.05). Multiple regression analysis revealed that the nSI% was the most predominant factor for the µSBS (p < 0.001). A surface with larger nSI%, higher Ra and relatively lower θc was essential for establishing a reliable resin-zirconia bond.

Polymerization shrinkage of light-cured conventional and bulk-fill composites -The effect of cavity depth and post-curing.

Volumetric shrinkage (VS) of conventional, bulk-fill, and core build-up resin-based composites (RBCs) of various thickness (1-5 mm) was measured using the modified bonded-disk method with confocal laser scanning microscopy. Additionally, the bottom-to-top ratio of Vickers hardness (%VH) was measured. Conventional RBCs exhibited significantly higher VS than bulk-fill and core build-up RBCs (p<0.05). As specimen thickness increased, VS relative to volume (%VS) and difference in VS at each depth (VSdepth) decreased. For conventional RBCs, there was a significant drop in VSdepth between 1 mm and 2 mm (p<0.05), and another drop was observed between 3 mm and 4 mm (p<0.05) where %VH decreased below 90%. For bulk-fill and core build-up RBCs, VSdepth decreased significantly between 2 mm and 3 mm (p<0.05), but %VH exceeded 90% even in 5 mm deep cavities. These results indicated that post-curing contributed to lower shrinkage in deeper layers, and that conventional RBCs were not adequately polymerized at the depth of over 3 mm.

How long does it take for the occlusion to re-establish following the placement of restorations at an increased occlusal vertical dimension? A literature review.

Purpose This literature review aimed to investigate predictability of re-establishment of the occlusion following placement of restorations at an increased OVD, duration and to assess the quality of the available evidence.Methods An electronic search of articles using MEDLINE (1946-01/2019), EMBASE (1974-01/2019) and the Cochrane databases was undertaken. Search terms included dental restoration, vertical dimension and time. Studies involving placement of restorations at an increased OVD and recorded the time taken for the occlusion to re-establish were included. Eligibility assessments were carried out independently by two reviewers who also undertook independent extraction of predefined data fields, including study quality indicators.Results The search provided 61 results with 11 being relevant. A further 5 papers were identified for full text analysis. 4 papers used similar data from previous studies and 3 were excluded after full text assessment.. A final total of 9 papers were included in the review. It was indicated that the technique of placing restorations at an increased OVD appears to be clinically predictable in terms of re-establishment of occlusion and appears to occur most rapidly in younger patients.Conclusions The time taken for the occlusion to re-establish was between 15 days to 24 months. However, there is a need for prospective studies to evaluate the process in terms of success, predictive variables and specifically how long the process takes and this information would be helpful for both clinicians and patients, so that they know what to expect before embarking on a treatment.

Should new operating procedures arising from COVID-19 make us re-think our management of deep caries?

COVID-19 has impacted heavily on the delivery of dental services within the UK, particularly in regards to aerosol generating procedures (AGPs). However, it has created an opportunity to reflect on how operative dental procedures, such as the management of dental caries, are undertaken. In light of recent evidence in favour of speed increasing contra-angle handpieces in combination with an electric micromotor to eliminate the generation of aerosols at certain speeds while still allowing the cutting of hard tooth tissue, albeit at a slower rate than the traditional air-turbine, this article explores the evidence for partial caries removal using the electric micromotor system. Aspects of maintaing the health of the pulpal tissue using this system and adopting a logical approach to placing adhesive direct resin composites to faciliate an optimum outcome for the patient are also explored.

Long-term observation of periodontal condition following placement of removable partial dentures with rigid retainers and major connector in patients with/without diabetes: A retrospective study.

PURPOSE: This retrospective study evaluated the periodontal tissues of the abutment teeth of removable partial dentures (RPDs) with rigid retainers and major connectors in patients with and without type 2 diabetes mellitus (T2D). METHODS: A total of 313 patients who had been treated with RPDs, including rigid retainers and major connectors, were divided into two groups: T2D and non-T2D. The periodontal parameters and radiographic bone heights of the abutment teeth were evaluated at baseline and at a 5-year examination during supportive periodontal therapy (SPT). For patients with accessible standardized radiographs, bone density was analyzed based on the gray level (GL) using digital subtraction radiography (n = 83). RESULTS: Overall, 739 abutment teeth (86 in the T2D group) of 235 patients (25 in the T2D group) were analyzed, and 95.0% (94.2% in the T2D group, and 95.2% in the non-T2D group) were maintained. The mean probing pocket depth significantly increased in both groups (p < 0.001). There were significant changes in the radiographic bone height (p = 0.038) and GL on the side of the denture base area (p = 0.048) in the T2D group compared to those in the non-T2D group. CONCLUSION: Regardless of T2D, RPDs with rigid retainers and major connectors could prevent the progression of periodontal disease and successfully maintain most of the abutment teeth during 5-years of SPT. However, T2D may be significantly associated with loss of bone height reduction and density on the side of the denture base area.

Long-term evaluation of warm-air treatment effect on adaptation of silane-containing universal adhesives to lithium disilicate ceramic.

The effect of warm air-blowing on the sealing ability of two one-bottle and one two-bottle silane-containing universal adhesives (UAs) applied to lithium disilicate ceramics (LDS) was evaluated. Tapered cavities prefabricated in LDS blocks (IPS e.max CAD) were treated by the adhesives, air-blown either with normal air (23±1°C) or warm air (60±5°C), and filled with a flowable resin composite. Interfacial gap formation was observed using swept-source optical coherence tomography immediately after filling, after 24 h, 5,000 and 10,000 thermal cycles, and an additional 1-year water storage. Specimens bonded using normal air-blown one-bottle UAs exhibited a significantly higher gap formation than the two-bottle UA (p<0.001), and detached within 24 h. Warm air-blowing significantly decreased the gap formation of one-bottle UAs (p<0.001), but the specimens dislocated within 24 h or during thermocycling. The two-bottle UA withstood all aging procedures and warm air-blowing significantly decreased its 1-year gap formation compared to normal air-blowing (p=0.002).

Bond strengths of three-step etch-and-rinse adhesives to silane contaminated dentin.

This study aimed to evaluate the effect of silane coupling agent contamination on the microtensile bond strength (µTBS) of 3-step etch-and-rinse adhesives on dentin. Flat occlusal dentin surfaces were prepared and randomly divided into 8 groups (n=20) based on the tested adhesives; Scotchbond Multi-purpose or Optibond FL, with contamination of an experimental silane (2 vol% of 3-m ethacryloxypropyltrimethoxysilane at pH 4.5) before acid-etching, after-etching or after-priming; while the groups without silane contamination served as controls. µTBS data were analyzed by two-way ANOVA and Tukey's HSD tests at a significance level of 0.05. Additional specimens of contaminated dentin were used to analyze changes in the organic molecules by Fourier transform infrared spectroscopy (FTIR). Silane contamination before acid-etching did not significantly change µTBS (p>0.05), but contamination after-etching and after-priming significantly decreased µTBS of both adhesives (p<0.05). Silane contamination had an adverse effect on the dentin bond strength of 3-step etch-and-rinse adhesives especially after-priming.

Current perspectives on dental adhesion: (2) Concepts for operatively managing carious lesions extending into dentine using bioactive and adhesive direct restorative materials.

This article reviews the current concepts for operatively managing carious lesions extending into dentine with minimal removal of tooth structure and restoring with dentine adhesives and direct composite resin. It looks sequentially at the operative steps involved including remineralisation with bioactive cements, bonding to caries-affected dentine including smear-layer modification using HOCl, creation of an acid-base resistance zone,steps to optimise the performance of all-in-one adhesives, and incremental placement of direct composite resin to improve bond strengths to cavity floor dentine. It explores how understanding the phenomenon of colour-shifting at the composite resin-enamel/dentine restoration borders can help in creating near "invisible" restoration margins through a "chameleon" effect. With the increased risks of transmission of Covid-19 when aerosol generating procedures are carried out in Dentistry, following a minimally invasive approach to managing dental caries should be given serious consideration.

Effect of smear layer deproteinization with chemo-mechanical caries removal agents on sealing performances of self-etch adhesives.

OBJECTIVES: To evaluate the sealing performance of self-etch adhesives (SEA) after smear layer deproteinization with chemo-mechanical caries removal agents (CRA) to enamel and dentin cavity walls in comparison with 6% NaOCl smear layer deproteinizing. METHODS: Eighty extracted bovine incisors with tapered cylindrical cavities (2.5 mm upper diameter, 1.5 mm lower diameter, 2 mm depth) at the cemento-enamel junction were randomly divided into four pre-treatment groups; no treatment (control), Papacarie (papain enzyme-based CRA), Carisolv (NaOCl-based CRA), and 6% NaOCl. After pretreatment, G-Bond Plus (GBP, one-step SEA) or Clearfil SE Bond 2 (CSE, two-step SEA) was applied to the pre-treated cavity, and then filled with a flowable resin composite (Clearfil Majesty ES Flow). Gap formations at the enamel and dentin lateral walls, and on the dentin cavity floor were investigated using swept-source optical coherence tomography (SS-OCT) after 24-h water storage at 37 °C. Deproteinizing effects of the tested agents on smear layer-covered enamel and dentin were quantified by changes in the amide:phosphate ratio using ATR-FTIR analysis. RESULTS: Papacarie significantly reduced gap formation with both self-etch adhesives at all locations, compared to the control group (p < 0.05). In contrast, increased gap formation was observed with Carisolv and NaOCl. In most groups, CSE exhibited significantly lower gap formation than GBP (p < 0.05). ATR-FTIR revealed a significant decrease in the amide:phosphate ratio for all the deproteinizing agents (p < 0.05). CONCLUSIONS: Chemo-mechanical CRAs could effectively remove the organic phase of enamel and dentin smear layer. The papain enzyme-based gel Papacarie could improve the sealing performance of the self-etch adhesives to both enamel and dentin.

The combined effect of light-illuminating direction and enamel rod orientation on color adjustment at the enamel borders of composite restorations.

OBJECTIVES: To investigate the effect of light-illuminating direction (from composite or enamel side) on color adjustment at the coronal and cervical enamel borders in composite restorations. MATERIALS AND METHODS: Forty cylindrical holes (3.0-mm diameters) were prepared in bovine enamel disks (1.0-mm thickness). After application of a one-step self-etch adhesive, one of four resin composites (Estelite Asteria, EA; Estelite Pro, EP; Kalore, KA; Clearfil Majesty ES-2 Premium, MJ) was restored in the holes. After 24-h storage, the colors (L*, C*, or h* values) at the restored enamel disks over a black background were measured in a black box using a CIE XYZ camera, spotted with D65 standard illuminant either from coronal or cervical side at 45°/0° geometry. The color shifting rate was calculated at the coronal and cervical enamel borders of the composite restorations, and analyzed by three-way ANOVA with Dunnett's T3 and t test for post hoc analysis (p < 0.05). RESULTS: The light-illuminating directions significantly affected the L* shifting rate at the cervical enamel border in EP and MJ (p < 0.05), and the C* shifting rate at the coronal enamel border in EA, EP, and MJ (p < 0.05). CONCLUSIONS: The color appearance at the border of the composite restoration was influenced by the light-illuminating direction in conjunction with the enamel rod orientation in the coronal or cervical enamel border. CLINICAL RELEVANCE: The line-of-vision angle would affect the perception of color adaptation at the enamel borders in the composite restorations.

Incorporation of a hydrophilic amide monomer into a one-step self-etch adhesive to increase dentin bond strength: Effect of application time.

The purpose was to evaluate the effect of a hydrophilic amide monomer on µTBS of one-step adhesive to dentin at different application times. Clearfil Universal Bond Quick (UBQ), experimental adhesive (UBQexp; same compositions as UBQ but hydrophilic amide monomer was replaced with 2-hydroxyethyl methacrylate), Clearfil SE ONE and Clearfil SE Bond were applied to midcoronal dentin prepared with 600-grit SiC at different application time (0, 10, 20 and 40 s). Water sorption (Wsp) and the ultimate tensile strength (UTS) of polymerized adhesives were also measured. UBQ showed significantly lower Wsp and higher UTS than UBQexp. At each application time, UBQ exhibited significantly higher µTBSs than UBQexp. UBQ showed the highest µTBS at 0 s application time among all the adhesives. When the application time was prolonged from 0 s to 10 s, only UBQ showed no significant difference. The hydrophilic amide monomer increased µTBS with reduction in Wsp and increase in the UTS and may allow a shortened application time.

Effect of light-curing time on light-cure/post-cure volumetric polymerization shrinkage and regional ultimate tensile strength at different depths of bulk-fill resin composites.

The aim of this study was to investigate volumetric polymerization shrinkage (VS), using swept-source optical coherence tomography (SS-OCT), of bulk-fill composites with different light-curing strategies; immediately after light-irradiation and after 24 h, and to evaluate their regional ultimate tensile strength (UTS) at different curing depths. The immediate VS after photo-polymerization decreased when the curing light-curing time was reduced from 20 to 10 to 5 s. On the other hand, their VS values after 24 h significantly increased due to the post-cure polymerization, resulting in similar VS values at all the light-curing times. Five seconds light-curing decreased the regional UTS of resin composites after the 24 h period compared with the 10 and 20 s light-curing regimes; therefore, the remarkable progress of post-cure polymerization after light-curing for a short time would not lead to an improvement in the mechanical properties of resin composites. The influence of the light-curing time on the curing depth was dependent upon the bulk-fill composite material.

Effect of Polymerization Accelerator on Bond Strength to Eugenol-Contaminated Dentin.

PURPOSE: To evaluate the effect of a polymerization accelerator on the microtensile bond strength (µTBS) of etch-and-rinse and self-etch adhesives to eugenol-contaminated dentin. MATERIALS AND METHODS: Sixty flat dentin surfaces were prepared from human molars. Half of the specimens were restored with zinc oxide eugenol temporary cement (IRM) (eugenol-contaminated group) and the other half remained without restoration (control group). After 24-h storage, the cement was mechanically removed. Then the specimens in each group were further divided into three subgroups based on the application procedure of a polymerization accelerator (p-toluenesulfinic acid sodium salt; Accel): no application, 10-s application, or 30-s application. After air drying, the dentin surfaces were bonded with either a three-step etch-and-rinse adhesive (OptiBond FL) or a two-step self-etch adhesive (Clearfil SE Bond) and restored with composite. After 24-h water storage, the bonded specimens were subjected to the µTBS test. Data were analyzed by three-way ANOVA and Dunnett's T3 test (p < 0.05). RESULTS: The eugenol-contaminated groups had significantly lower µTBS than the control groups with both types of adhesives (p < 0.05), and the application of Accel significantly increased the compromised µTBS to eugenol-contaminated dentin. Optibond FL presented significantly higher µTBS to eugenol-contaminated dentin than did Clearfil SE Bond (p < 0.05). CONCLUSION: The application of a polymerization accelerator on eugenol-contaminated dentin prior to adhesive resin application increased the µTBS of both the three-step etch-and-rinse and two-step self-etch adhesive.

Effect of Water Aging of Adherend Composite on Repair Bond Strength of Nanofilled Composites.

PURPOSE: To evaluate the effect of water aging of adherend composite on repair bond strength to nanofilled composites with specific fillers using different bonding agents. MATERIALS AND METHODS: Three nanofilled composites - Beautifil II with S-PRG filler (BE) / Filtek Supreme ultra with nanocluster filler (SP) / Estelite Σ Quick (ES) - and one microhybrid composite, Clearfil APX (AP), were used in this study. The composite disks were immersed in water for different durations (immediate, 1 week, 2 weeks or 1 month), and then the polished surfaces were treated with one of three bonding agents - no treatment (control), application of Clearfil SE One (SE), application of Clearfil SE One plus Clearfil Porcelain Bond Activator (PB) - then filled with a repair composite. The bonded composite disks were subjected to the microshear bond strength (µSBS) test. Additionally, water sorption (Wsp) and solubility (Wsl) of the resin composite were measured. The µSBS data were was statistically analyzed using a three-way ANOVA and t-test with Bonferroni correction for multiple comparisons. RESULTS: Water aging of adherend composite affected the repair bond strength (p < 0.05). For BE, SP, and ES, application of an adhesive agent improved repair bond strengths to water-aged composites (p < 0.05), but adding a silane coupling agent could not (p > 0.05). For AP, the µSBS significantly increased, with control group < SE group < PB group (p < 0.05). CONCLUSION: Microhybrid composite was a more suitable material for composite repair than nanofilled composite, due to adhesion to exposed, larger silica fillers. S-PRG filler and nanocluster filler in the nanofilled composites played a slight role in improving their repair bonding performances with the bonding agents tested.

Stress distribution in tooth resin core build-ups with different post-end positions in alveolar bone level under two kinds of load directions.

This study aimed to evaluate influence of different post-end positions in alveolar bone level on stress distributions in resin-core build-up tooth under different load directions. Three-dimensional mathematical models of a root-filled mandibular premolar tooth were constructed. Resin post and core were built-up with six post lengths: 0, 1, 2, 3, 4, and 6 mm. Finite element analysis calculated stress distributions with oblique load of 400 N to buccal cusp 45 degree from buccal side or from lingual side. The 3 mm-post length (post-end position equal to cancellous bone level) caused highest equivalent stress of post-end compared with the shorter or longer post length. When change of load direction, the direction of maximum shear stress became completely opposite at mesiodistal cervical edge of core-part without a change of the magnitude. Changing shear stress direction would increase risk of debonding at mesiodistal cervical edge.

Influence of enamel prism orientations on color shifting at the border of resin composite restorations.

This study aimed to investigate the influence of enamel prism orientations on color adjustment of resin composite restoration. The color measurements (L*, C*, or h* values) at the restored bovine enamel disk (1.0 mm-thick) with resin composite (Estelite Asteria, Estelite Pro, Kalore, Clearfil Majesty) were performed using a CIE XYZ camera (RC500). The color shifting rate and range at the coronal and cervical border were calculated. The coronal border was significantly lower L* and C* color shifting rate than the cervical border (p<0.05). The L* color shifting range was significantly affected by regions in the 3-mm cavity group (p<0.05), but not in the 1-mm cavity group (p>0.05), while the C* color shifting range was not significantly affected by regions (p>0.05). The coronal enamel border with diagonal-cut of enamel prisms would have an advantage for color adjustment of resin composite restorations compared to the cervical border with longitudinal-cut of enamel prisms.

Smear layer-deproteinizing improves bonding of one-step self-etch adhesives to dentin.

OBJECTIVES: Smear layer deproteinizing was proved to reduce the organic phase of smear layer covered on dentin surface. It was shown to eliminate hybridized smear layer and nanoleakage expression in resin-dentin bonding interface of two-step self-etch adhesive. This study aimed to investigate those effects on various one-step self-etch adhesives. METHODS: Four different one-step self-etch adhesives were used in this study; SE One (SE), Scotchbond™ Universal (SU), BeautiBond Multi (BB), and Bond Force (BF). Flat human dentin surfaces with standardized smear layer were prepared. Smear layer deproteinizing was carried out by the application of 50ppm hypochlorous acid (HOCl) on dentin surface for 15s followed by Accel® (p-toluenesulfinic acid salt) for 5s prior to adhesive application. No surface pretreatment was used as control. Microtensile bond strength (µTBS) and nanoleakage under TEM observation were investigated. The data were analyzed by two-way ANOVA and Tukey's post-hoc test and t-test at the significant level of 0.05. RESULTS: Smear layer deproteinizing significantly improved µTBS of SE, SU, and BB (p<0.001). Hybridized smear layer observed in control groups of SE, BB, and BF, and reticular nanoleakage presented throughout the hybridized complex in control groups of BB and BF were eliminated upon the smear layer deproteinizing. SIGNIFICANCE: Smear layer deproteinizing by HOCl and Accel® application could enhance the quality of dentin for bonding to one-step self-etch adhesives, resulting in the improving µTBS, eliminating hybridized smear layer and preventing reticular nanoleakage formation in resin-dentin bonding interface.

The effect of five kinds of surface treatment agents on the bond strength to various ceramics with thermocycle aging.

This study evaluated the effects of ceramic surface treatment agents on shear bond strengths to ceramic materials with and without thermocycling. Ceramic plates were prepared from feldspathic ceramic; AAA, lithium disilicate ceramic material; IPS e.max Press, zirconia ceramic; Lava. Ceramic surfaces were pretreated with one of five surface treatment agents (Clearfil PhotoBond mixed with Porcelainbond activator (PB), Clearfil SE One mixed with Porcelainbond activator (SO), Ceramic Primer (CP), Universal Primer (UP), Scotchbond Universal (SU)), and then a resin cement (Clapearl DC) was filled. After 0, 5,000, and 10,000 thermocycles, micro-shear bond strengths between ceramic-cement interfaces were determined. SU exhibited significantly lower initial bond strength to AAA and e.max than PB, SO, CP, and UP. For Lava, PB, SO, CP and SU exhibited higher initial bond strengths than UP. Thermocycles reduced bond strengths to all the ceramic materials with any surface treatment.

Bonding Durability of a Self-etch Adhesive to Normal Versus Smear-layer Deproteinized Dentin: Effect of a Reducing Agent and Plant-extract Antioxidant.

PURPOSE: To evaluate the effect of a reducing agent and plant-extract antioxidant on the bonding durability of a self-etch adhesive to normal and NaOCl-treated, smear-layer-deproteinized dentin. MATERIALS AND METHODS: Flat smear-layer-covered dentin surfaces from 60 extracted human molars were prepared by removing the occlusal enamel. The teeth were divided into two groups with or without NaOCl-deproteinizing treatment for 30 s, and further divided into three subgroups as follows: no application of antioxidant, application of Accel (p-toluenesulfinic acid sodium salt solution) for 5 s, or application of rosmarinic acid solution for 5 s. All treated dentin surfaces were bonded with a two-step self-etch adhesive (Clearfil SE Bond) and restored with composite (Clearfil AP-X). The bonded teeth were sectioned into a hourglass-shaped sticks with a composite-dentin bonded interface area of 1.0 mm2. After storage in artificial saliva for 24 h or 1 year, the specimens were subjected to the microtensile bond strength test (n = 15). Data were statistically analyzed with three-way ANOVA, Tukey's post-hoc test, and the t-test (p < 0.05). RESULTS: Without an antioxidant, 1-year storage significantly reduced the bond strengths of the self-etch adhesive to normal and smear-layer-deproteinized dentin compared with those after 24-h storage (p < 0.05). Application of Accel and rosmarinic acid restored the compromised initial bond strengths to smear-layer-deproteinized dentin (p < 0.05), and prevented long-term deterioration of bond strengths to both normal and smear-layer-deproteinized dentin (p > 0.05). CONCLUSION: Application of Accel and rosmarinic acid improved bonding durability of the self-etch adhesive to both normal and smear-layer-deproteinized dentin.

Effect of enamel margin configuration on color change of resin composite restoration.

This study aimed to investigate the effect of enamel margin configuration on color change of resin composite restoration. Enamel disks of 1.0 mm-thick were sliced from sixty bovine anterior teeth and divided into three groups by margin configuration (non-bevel, 45-degree bevel and 45-degree reverse-bevel). The color measurements (L*C*h* values) at the restored bovine enamel disk with resin composite (Estelite Asteria, Estelite Pro, Kalore, Clearfil Majesty) were performed using a digital camera with CIE XYZ color gamut (RC500). All the resin composite restorations with non-beveled and beveled cavities significantly increased L* values compared with the control composite disks (p<0.05). The bevel preparation increased L* values toward the enamel-composite border with gentle inclination, while the reverse-bevel preparation was significantly lower L* values at the enamel-composite border than the non-bevel preparation (p<0.05). Enamel margin configuration affected color shifting of resin composite restoration and color adjustment of the border.