Delayed vs. immediate placement of restorative materials over Biodentine and RetroMTA: a micro-shear bond strength study.

BACKGROUND: The aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS. METHODS: A total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05). RESULTS: There is a statistically significant difference (p < 0.05) between the µSBS values obtained by applying resin composite on RetroMTA after different setting times (24 h > 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p < 0.05) than the µSBS values at 12 min and 24 h. For both calcium silicate cements, at the end of all time periods, the µSBS obtained when resin composite was applied at the end was higher than the other materials (p < 0.05). CONCLUSIONS: For Biodentine-resin composite bonding, the manufacturer's recommendation of 12 min can be considered an appropriate time, whereas for RetroMTA-resin composite bonding, the µSBS increased as the waiting time increased. Regardless of the waiting time, it is recommended to prefer direct composite resin restoration over Biodentine and RetroMTA.

Shade matching potential of one-shade resin composites used for restoration repair.

To evaluate shade matching ability of one-shade composites used for repair of different resin-based restorative materials. Two one-shade composites or one layering composite of 1 mm thickness were placed over non-aged or aged 3 different base materials of 1 mm thickness to simulate repair. Two millimeters thick base samples were prepared and used for reference (n=12). Shade measurements of reference and repair groups were performed with dental spectrophotometer and color difference (ΔE00) were calculated according to CIEDE2000. Data were analyzed using three-way ANOVA followed by Tukey's test (α=0.05). Regardless of aging and base materials, repairing with layering composite yielded lower ΔE00 than repair of one-shade composites (p<0.05). Repair of non-aged and aged GrandioDisc with any repair composite led to higher ΔE00 values than repair of other base materials (p<0.05). Shade matching performance of one-shade composites for repair of different non-aged or aged resin-based material was not clinically acceptable.

Kinematics of "Adaptive Motion" under Constant Torque Values.

INTRODUCTION: To demonstrate the unknown kinematics of complex adaptive motion with respect to disclosed values, the aim of this study was (1) to analyze the adaptive motion and (2) to compare the effects of constant torque values on kinematics. METHODS: A new endodontic motor (Aseptico AEU-28SYB Elements; SybronEndo, Orange, CA) and 8:1 contra-angle handpiece were used for analysis. A pilot test was conducted for synchronizing the external experimental stress on the shaft of the target object and the built-in torque sensor of the motor source. A load setup was developed by attaching universal precision weights to the shaft of the of the target object. The groups were adaptive motion with no load (TFA-0), adaptive motion with a 100-gcm constant load (TFA-100), and adaptive motion with a 200-gcm constant load (TFA-200). The peak-to-peak-based phase identification method was used to analyze the kinematics. Student t and Mann-Whitney U tests were used where applicable (α = 0.05). RESULTS: A noteworthy observation was the inconsistent kinematics of TFA-100 compared with the kinematics of TFA-0 and TFA-200. TFA-100 presented mixed-phased kinematics, which consisted of both a quaternary phase (n = 33) similar to that of TFA-200 and a dual phase (n = 17) similar to that of TFA-0. The sequence of these quaternary and dual phases of TFA-100 was arbitrarily changing. The kinematic parameters of dual-phase intermittent motion of TFA-0 and TFA-100 and quaternary-phase reciprocating motion of TFA-100 and TFA-200 revealed significant differences (P < .05). CONCLUSIONS: The main conclusions of the present study are the kinematics of adaptive motion was demonstrated, and the 100-gcm load is not sufficient for predictable and constant operation in the reciprocating mode.

Radiopacity of resin-based CAD/CAM blocks assessed by areal grayscale pixel value measurement.

PURPOSE: This study assessed radiopacity of resin-based computer-aided-design/computer-aided-manufacturing (CAD/CAM) materials by areal grayscale pixel value measurement. METHODS: Radiopacities of six resin-based CAD/CAM block materials and resin composite were evaluated and compared to that of enamel and dentin. Specimens of 1-mm thickness were placed on photostimulable phosphor plate and irradiated with digital x-ray unit. On the radiographic image, regions of interests were determined for each specimen and areal grayscale pixel values were measured. Elemental analysis was performed with energy-dispersive x-ray spectroscopy (EDS) on field emission scanning electron microscope (FESEM) images of the specimens. Data were analyzed statistically (α = 0.05). RESULTS: Radiopacity values of the restorative materials were significantly different from each other (P < 0.05). Radiopacity values of two resin-based CAD/CAM materials were significantly lower than that of dentin (P < 0.05). All tested restorative materials contain zirconium, three materials contain barium, and only resin composite contains lanthanum. CONCLUSION: Four CAD/CAM materials with higher amounts of zirconia or barium (>18%) had radiopacity values significantly higher than the dentin; while two materials with lower amounts of zirconia (<4%) and/or no-barium, had radiopacity values significantly lower than the dentin. EDS analysis suggests materials containing elements with higher atom numbers such as zirconia and barium could exhibit higher radiopacity.

Radiopacity quantification and spectroscopic characterization of OrthoMTA and RetroMTA.

The aim of this article was to investigate the unknown radiopacity performances of OrthoMTA and RetroMTA via means of a contemporary image analyzing methods and energy dispersive X-ray spectroscopy. Three commercial hydraulic calcium silicate-based cements and a calcium hydroxide-based paste were used. Pure-grade zirconium oxide, bismuth oxide, zinc oxide, barium sulfate, and calcium hydroxide were as references. An energy-dispersive X-ray spectroscopy instrument was used for the elemental analysis. Radiographic image data was obtained according to the International Organization for Standardization 6876-2012 specifications. The region of interest was determined for each specimen. Mean (±SD) grey values of the X-ray image data was measured with an image analyzing software. The calibration curve was created by curve-plotting software and the mean grey-values were matched versus Al values (mm Al). Data were analyzed with one-way ANOVA followed by Tukey's multiple comparison test. Spectroscopic characterization of the commercial materials was shown with assigned Carbon, oxygen, aluminum, silicon, calcium, zinc, zirconium, barium, tungsten, bismuth, and sulfur elements. The major radiopacifier/s of OrthoMTA is Bi, of RetroMTA is Zr, of BioDentine are Ba and Zr, and of ProCal is Ba. The radiopacity values of all commercial materials are significantly different (p < .05). The rank of the radiopacity values: RetroMTA (3.36 ± 0.29mmAl) > OrthoMTA (2.56 ± 0.19mmAl) > BioDentine (2.02 ± 0.12mmAl) > ProCal (1.46 ± 0.60mmAl). The study reported that the radiopacity values and spectral characterization of RetroMTA and OrthoMTA cements. The pixel-based and reproducible method could be used universally to the quantification of the radiodensity of digitally collected X-ray data.

Micro-computed tomographic evaluation of the effects of pre-heating and sonic delivery on the internal void formation of bulk-fill composites.

The aim of this study was to compare the effects of conventional, sonic or pre-heating insertion techniques on internal void formation of bulk-fill composites with micro-computed tomography. Standardized cylindrical cavities were prepared in 160 human third molars. Four groups received different paste-like bulk-fill composites: SonicFill 2 (SF2); VisCalor Bulk (VCB); Filtek One Bulk-fill restorative (FBF); Tetric EvoCeram Bulk Fill (TEB); and a conventional posterior composite, Clearfil Majesty Posterior (CMP). A hybrid CAD/CAM block was selected as a control (n=10). Composite restorations were built according to each resin composite type and insertion technique (n=10). Micro-CT was used to assess internal void rates. Data was analyzed with two-way ANOVA and Tukey's multiple comparisons test (α=0.05). CAD/CAM blocks were free of voids. For each composite, the highest void rates were observed for the sonic delivery method (p<0.05) except for SF2. SF2 was not affected by insertion techniques (p>0.05). Other composites showed the lowest void rates with pre-heating technique.

Cytotoxicity evaluation of eluates from universal adhesives by real-time cell analysis.

The aim of this study was to evaluate the cytotoxicity of universal adhesives on L929 mouse fibroblast cell line by using a real-time cell analysis. In order to obtain extract, six different cured dental adhesives were immersed in Dulbecco's Modified Eagle's Medium (DMEM) at 37°C for 24 h. A real-time cell analysis system was used to assess cytotoxicity of the dental adhesives. After seeding 25,000 cells/300 µL/well cell suspensions into the wells of an e-plate, fibroblasts were exposed to extracts of tested adhesives at varying dilutions (1:1, 1:2, and 1:10) and observed at every 30 min intervals for 72 h. Three-way ANOVA one factor repeated measures were used to analyze the results (α=0.05). All tested adhesives induced cell viability loss, cell morphology alteration, and cell death depending on extract concentration and time. Cell viability of L929 cells to between 44 and 10% for 1:1 diluted extracts, at 72 h, when compared to the negative control.

Outcomes of visual tooth shade selection performed by operators with different experience.

OBJECTIVE: To evaluate the effect of professional experience and lighting conditions on visual shade selection on natural teeth and comparing the visual-shade-selection results with those of instrumental methods. MATERIALS AND METHODS: Shade selection was performed on five maxillary central incisors. The 25 observers were divided into five groups according to their professional experience. Observers performed visual-shade-selection using shade guide (Vita 3D Master, Vita Zahnfabrik, Bad Säckingen, Germany) under two lighting conditions (4000 and 6500 K) from the cervical, middle and incisal thirds of the teeth. Same teeth were measured using an intraoral scanner (Trios 3Shape, Copenhagen, Denmark) and spectrophotometer (Vita Easyshade Compact, Vita Zahnfabrik, Bad Säckingen, Germany), under the same two lighting conditions. RESULTS: Visual-shade-selection outcomes were not affected by professional experience under both lighting conditions (P < .05). Outcomes of visual-shade-selection and intraoral scanner were not significantly different than that of spectrophotometer (P > .05). Lighting conditions had no effect on the shade measurement outcomes of visual shade selection, Vita Easyshade Compact, and Trios 3Shape (P > .05). CONCLUSIONS: Shade measurement outcomes were not affected by the lighting conditions (4000 and 6500 K). The shade measurement feature of the T-3S could be an alternative to V-ES and VSS. CLINICAL SIGNIFICANCE: This study suggests professional experience and lighting conditions has no effect on visual shade selection. Trios 3Shape could be used for shade determination as an alternative to a Vita Easyshade Compact spectrophotometer.

Influence of cleaning methods on bond strength to saliva contaminated zirconia.

OBJECTIVE: To evaluate the influence of saliva contamination and cleaning procedures on shear bond strength (SBS) of a self-adhesive resin cement (SAC) to zirconia surfaces. MATERIALS AND METHODS: A total of 160 sandblasted zirconia blocks were randomly divided into eight groups as follows: No saliva contamination, no cleansing (NC-NC); contamination with saliva, no cleansing (SC-NC); no saliva contamination, cleansing with a zirconia primer (ZP; Z-Bond, Danville Materials, Inc., S. Ramon, California) (NC-ZP); contamination with saliva, cleansing with ZP (SC-ZP); no saliva contamination, cleansing with hydrofluoric acid (HF; Ultradent Porcelain Etch; Ultradent Products, South Jordan, Utah) followed by cleansing with ZP (NC-HF-ZP); contamination with saliva, cleansing with HF followed by cleansing with ZP (SC-HF-ZP); cleansing with ZP, contamination with saliva, cleansing with ZP (ZP-SC-ZP); application of ZP, contamination with saliva, cleansing with HF followed by cleansing with ZP (ZP-SC-HF-ZP). Cylindrical resin composite blocks were luted to the zirconia surfaces with SAC (Clearfil SA Cement Automix, Kuraray, Inc., Tokyo, Japan). Specimens were subjected to shear forces at a cross-head speed of 0.5 mm/min. Data were analyzed with Analysis of Variance and Tukey tests (α = 0.05). RESULTS: The bond strength values to zirconia were significantly influenced by saliva contamination (P < .05). The SC-NC group showed the lowest bond strength values (5.6 ± 1.4 MPa; P < .05). All cleansing or pretreatment agents improved the bond strengths when compared to noncleansing groups, NC-NC and SC-NC. CONCLUSION: In situations where saliva contamination is deemed unavoidable, application of ZP after try-in of the zirconia restoration could be beneficial for the accurate cementation. CLINICAL SIGNIFICANCE: During try-in sessions of fixed dental prostheses, zirconia ceramic restoration may come into contact with saliva and surfaces should be cleansed to obtain an optimal surface for adhesion. Application of zirconia primer to the sandblasted zirconia surface is recommended whether the surface is contaminated with saliva or not.

Nuclear magnetic resonance spectroscopy and infrared spectroscopy analysis of precipitate formed after mixing sodium hypochlorite and QMix 2in1.

BACKGROUND: Mixing sodium hypochlorite (NaOCl) with chlorhexidine (CHX) forms a brown precipitate. QMix-2in1 (QMix) was introduced as a final irrigant. Manufacturer recommends interim flushing with saline between the application of NaOCl and QMix to prevent formation of precipitation. This study assessed whether para-chloroaniline (PCA) is formed after mixing NaOCl with QMix. METHODS: Commercially available, 5.25% NaOCl solution, 2% CHX, QMix, 15% ethylenediaminetetraacetic acid (EDTA) and 98% PCA in powder form were used. Groups were prepared at room temperature. Group 1, 98% PCA in powder form; Group 2, 2% chlorhexidine (CHX); Group 3, QMix; Group 4, 5.25% sodium hypochlorite (NaOCl) mixed with QMix; Group 5, 5.25% NaOCl mixed with CHX; Group 6, 15% EDTA mixed with CHX. The precipitates were extracted and analysed with Proton Nuclear Magnetic Resonance (1H-NMR) and Infrared (IR) Spectroscopy, using PCA as an internal standard. RESULTS: No PCA was found in any of the irrigant-mixture groups tested. CONCLUSIONS: This study used the interpretation of spectral results for the amino signals of precipitate formed after mixing QMix with 5.25% NaOCl using different nondestructive analysis methods, with PCA as an internal standard (control). We conclude that mixing QMix or 2%CHX with 5.25% NaOCl does not yield free PCA.

Flexural strength of fiber reinforced posts after mechanical aging by simulated chewing forces.

This study evaluated the effect of simulated chewing forces on the flexural strength of fiber reinforced posts (FRPs). Four different brands of FRPs were selected as main group for the study: RelyX Fiber Post (RX), IceLight (ICE), Unicore Posts (UC), FlouroPost (FP). Ten posts in each main group didn't receive any aging process and tested as baseline (BL), other ten posts were subjected to simulated chewing forces/mechanical aging (MA) as follows: Post spaces were prepared in acrylic with drill. Depth of preparation was adjusted to leave 4-mm coronal part of posts protruding from canals. Coronal parts were incrementally restored with resin-composite (Clearfil Majesty Posterior A2, Kuraray, Osaka, Japan). Prepared samples were subjected to chewing cycles in a chewing simulator (Chewing Simulator CS-4, Mechatronik, Germany). Flexural strengths of all groups were measured with three-point bending test. Data were analyzed by two-way ANOVA and Tukey's test (α = 0.05). After MA, flexural strengths of all posts were significantly decreased when compared with BL for all FRPs tested (p < 0.05). At BL, highest flexural strength values were obtained for ICE. After MA, similar to BL, highest flexural strength values were obtained for ICE. Only RX showed statistically significant difference when compared with ICE (p < 0.05). UC and FP showed similar flexural strength values with ICE (p > 0.05). It may be concluded that chewing forces on post-core systems may reduce the flexural strengths of FRPs.

Effect of rubbing force magnitude on bond strength of universal adhesives applied in self-etch mode.

This study investigated the effect of rubbing force magnitude on dentin bond strengths of multi-mode adhesives applied in self-etch mode. Seventy-two extracted human molar teeth were used. Two different universal adhesives Single Bond Universal (SB) and Clearfil Universal (CL) were applied onto dentin surfaces in three different modes: without rubbing (NR), rubbing with 40 gf (gram-force) (40) or 80 gf (80) load. Teeth were restored with a resin composite. Half of the specimens were subject to thermal aging (10,000 cycles). Microtensile bond strength was measured and data were statistically analyzed with two-way analysis of variance and Tukey's test (α=0.05). Baseline bond strength values for CL adhesive were improved by rubbing (40 and 80 gf) as compared to no rubbing (p<0.05). Rubbing did not significantly improve bond strength values for SB, regardless of aging (p>0.05). Rubbing improves bonding performance of some universal adhesives to dentin when applied in self-etch mode.

Adhesive system affects repair bond strength of resin composite.

PURPOSE: This study evaluated the effects of different adhesive systems on repair bond strength of aged resin composites. MATERIALS AND METHODS: Ninety composite discs were built and half of them were subjected to thermal aging. Aged and non-aged specimens were repaired with resin composite using three different adhesive systems; a two-step self-etch adhesive, a two-step total-etch adhesive and a one-step self-etch adhesive; then they were subjected to shear forces. Data were analyzed statistically. RESULTS: Adhesive type and aging significantly affected the repair bond strengths (p<0.0001). No statistical difference was found in aged composite groups repaired with two-step self- etch or two-step total-etch adhesive. One-step self-etch adhesive showed lower bond strength values in aged composite repair (p<0.0001). CONCLUSION: In the repair of aged resin composite, two-step self-etch and two-step total-etch adhesives exhibited higher shear bond strength values than that of one-step self-etch adhesive.

Kinematic analysis of new and used reciprocating endodontic motors in 2 different modes.

PURPOSE: The actual reciprocating angles of endodontic motors might differ from the manufacturers' set values. This study analyzed the effect of clinical usage on the kinematics of reciprocating endodontic motors with 2 different reciprocal modes. METHODS: 1 new and 3 used reciprocating endodontic motors (X-Smart Plus, Dentsply Maillefer) with 2 different reciprocating modes, WaveOne mode (W-mode) or Reciproc mode (R-mode), were analyzed. An angle measurement disc was inserted into a contra-angle. Reciprocating motions were recorded with a high-speed camera at 1,200 fps and analyzed on a computer. The following kinematic parameters were calculated: duration of each reciprocating motion, engaging and disengaging angles, cycle rotational speeds, engaging and disengaging rotational speeds, net cycle angle, total cycle angle, and number of cycles to complete full rotation. One-way ANOVA and Kruskal-Wallis test followed by multiple comparison tests were used for statistical analysis (p = 0.05). RESULTS: In W-mode, the actual engaging angles of all used and new motors were different from the manufacturer's set values (p<0.0001), whereas there was no difference between actual engaging angles among the motors (p>0.05). In R-mode, the actual engaging angles of all used and new motors were similar to the manufacturers' set values (p>0.05). There was no difference between the actual engaging angles among motors (p>0.05). Both the W-mode and R-mode showed statistically different values of actual disengaging angles for all used and new motors when compared with the manufacturers' set value (p<0.0001). CONCLUSIONS: This study confirmed that the actual kinematics of reciprocating endodontic motors differ from the manufacturers' set values. Some kinematic parameters were influenced by the clinical usage of the motors.

Endodontic Outcomes in Mandibular Second Premolars with Complex Apical Branching.

INTRODUCTION: Mandibular premolars that have rare and complex anatomies may have the highest failure rate in nonsurgical endodontic treatment. Awareness of rare and complex anatomies of mandibular second premolars would aid in better outcomes of the treatment. This study aimed to evaluate the success of nonsurgical root canal treatment of mandibular second premolar teeth with complex apical branching. METHODS: Twenty-six mandibular second premolar teeth with complex apical branching treated with multiple-visit nonsurgical root canal treatment or nonsurgical retreatment were retrospectively evaluated. RESULTS: For the clinical outcomes, 9 subjects had complete healing, 1 subject had functional healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had functional healing, and 2 subjects had no healing scores out of 16 retreatment subjects. For the radiographic outcomes, 7 subjects had complete healing, 3 subjects had incomplete healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had incomplete healing, and 2 subjects had no healing scores out of 16 retreatment subjects. The clinical outcome of root canal treatment subjects was significantly different than retreatment subjects (P < .05). Similarly, the radiographic outcome of root canal treatment subjects was also significantly different than retreatment cases (P < .05). CONCLUSIONS: The outcome of endodontic treatment of mandibular second premolars may be influenced by treatment type.

Solvent type influences bond strength to air or blot-dried dentin.

BACKGROUND: Air-drying of etched and rinsed dentin surface may force the exposed collagen fibrils to collapse. Blot-drying is an alternative method to wipe the excess water from the dentin surface without compromising the monomer penetration. Contemporary total etch adhesives contain ethanol/water or acetone as solvent in which resin monomers are dissolved. Solvent type of the adhesive system has an important role in bonding to dentin. An adhesive containing tertiary butanol as an alternative solvent has been in the market. Purpose of this study is to determine the shear bond strengths of three total-etch adhesives with different solvents (acetone, ethanol or tertiary butanol) applied to air or blot dried moist dentin. METHODS: Sixty extracted non-carious human third molars were divided into three main groups according to solvent content of the adhesives [acetone based - One Step (OS, Bisco, IL, USA); ethanol/water based - Optibond Solo Plus (OB, Kerr, CA, USA); and tertiary butanol based - XP Bond (XP, Caulk/Dentsply, DE, USA)]. Each main group was divided into two groups according to drying methods (blot or air) (n = 10). Shear bond strengths (SBS) were measured. Data were analyzed by Student's t test and Tukey HSD test (p < 0,05). RESULTS: XP showed highest SBS values in both drying methods applied (p < 0.05). Drying method did not influence the SBS in OS and OB (p > 0.05). XP-blot produced significantly higher SBS than XP-air (p < 0.05). CONCLUSIONS: Tertiary butanol based adhesive showed higher bond strength values than ethanol or acetone based adhesives. Blot drying of dentin improved the bond strength values of tertiary butanol based adhesive. Further research is necessary to determine in vivo and in vitro performance of tertiary butanol based adhesives.

Does Para-chloroaniline Really Form after Mixing Sodium Hypochlorite and Chlorhexidine?

INTRODUCTION: Mixing sodium hypochlorite (NaOCl) with chlorhexidine (CHX) forms a brown-colored precipitate. Previous studies are not in agreement whether this precipitate contains para-chloroaniline (PCA). Tests used for analysis may demonstrate different outcomes. Purpose of this study was to determine whether PCA is formed through the reaction of mixing NaOCl and CHX by using high performance liquid chromatography, proton nuclear magnetic resonance spectroscopy, gas chromatography, thin layer chromatography, infrared spectroscopy, and gas chromatography/mass spectrometry. METHODS: To obtain a brown precipitate, 4.99% NaOCl was mixed with 2.0% CHX. This brown precipitate was analyzed and compared with signals obtained from commercially available 4.99% NaOCl, 2% solutions, and 98% PCA in powder form. RESULTS: Chromatographic and spectroscopic analyses showed that brown precipitate does not contain free PCA. CONCLUSIONS: This study will be a cutoff proof for the argument on PCA formation from reaction of CHX and NaOCl.