Dentin erosion simulation by cantilever beam fatigue and pH change.

Exposed root surfaces frequently exhibit non-carious notches representing material loss by abrasion, erosion, and/or abfraction. Although a contribution from mechanical stress is often mentioned, no definitive proof exists of a cause-effect relationship. To address this, we examined dimensional changes in dentin subjected to cyclic fatigue in two different pH environments. Human dentin cantilever-beams were fatigued under load control in pH = 6 (n = 13) or pH = 7 (n = 13) buffer, with a load ratio (R = minimum load/maximum load) of 0.1 and frequency of 2 Hz, and stresses between 5.5 and 55 MPa. Material loss was measured at high- and low-stress locations before and after cycling. Of the 23 beams, 7 withstood 1,000,000 cycles; others cracked earlier. Mean material loss in high-stress areas was greater than in low-stress areas, and losses were greater at pH = 6 than at pH = 7, suggesting that mechanical stress and lower pH both accelerate erosion of dentin surfaces.

Bonded amalgam restorations: current research and clinical procedure.

This paper reviews the history of amalgam bonding; compares the results of recent clinical studies to laboratory results that report reduced microleakage, increased retention, inhibition of secondary caries, reinforcement of tooth structure, and reduced cuspal deflection; discusses conservative preparation guidelines; and presents a step-by-step clinical procedure.

In vitro fatigue behavior of human dentin with implications for life prediction.

Although human dentin is known to be susceptible to failure under repetitive cyclic fatigue loading, there are few reports in the literature that reliably quantify this phenomenon. This study seeks to address the paucity of fatigue data through a systematic investigation of the effects of prolonged cyclical loading on human dentin in an environment of ambient temperature Hank's balanced salt solution (HBSS) at cyclic frequencies of 2 and 20 Hz. The "stress-life" (S/N) data thus obtained are discussed in the context of possible mechanisms of fatigue damage and failure in this material. In addition, stiffness loss data collected in situ during the S/N tests are used to deduce crack velocities and the thresholds for such cracking. These results are presented in a fracture mechanics context as plots of fatigue-crack propagation rates (da/dN) as a function of the stress-intensity range (Delta K). Such S/N and da/dN-Delta K data are discussed in light of the development of a framework for a fracture-mechanics-based methodology for the prediction of the fatigue life of teeth. It is concluded that the presence of small (on the order of 250 microm) incipient flaws in human teeth will not radically affect their useful life.

Dentin shear strength: effect of distance from the pulp.

OBJECTIVE: Dentin structure varies with orientation and location. Ultimate shear strength (USS) has also been found in previous studies to vary with location. The present study further explores this relationship between USS and various locations in coronal dentin as well as distance from the pulp. METHODS: Stick specimens were prepared from coronal dentin located in the center or under cusps of human molar teeth. These were tested in the shear mode at various distances from the pulp. RESULTS: Median values ranged from 52.7 (range 29.0-73.1) MPa near the pulp to 76.7 (range 53.9-104.0) MPa near the dentino-enamel junction. No differences were found among the buccal, central or lingual locations, however, the USS near the pulp was found to be significantly lower. SIGNIFICANCE: The properties of coronal dentin vary with distance from the pulp, which may affect adhesion and other aspects of restorative dentistry.

Bonding of amalgam restorations: existing knowledge and future prospects.

A number of laboratory and clinical studies over the last 15 years have explored the potential advantages of bonding amalgam to tooth surfaces. Bond strengths have been reported to range from 2 to 20 MPa, with higher bond strengths reported for filled adhesives. Most studies agree that the use of bonding results in a considerable reduction of microleakage, when compared with copal varnish or no lining. The use of bonding provides retention in vitro that is equivalent to, or better than, the use of mechanical undercuts. Most studies on strength of restored teeth report an improvement in resistance to fracture or cuspal flexing as measured by strain gauges. Penetration of secondary caries along the interface has been found to be inhibited by bonding. The mode of failure of bonded amalgams has generally been reported to be mixed, but predominantly between the resin and amalgam. In vitro studies have reported one potential problem in the incorporation of resin into amalgam, which may cause a decrease in strength of the restoration. The clinical studies of bonded amalgams that have been published to date are of short duration, indicating that when traditional preparations are used, no problems are seen with bonding, but also no advantages, as measured by clinical assessment criteria. However, some studies show that bonded amalgam may be useful for procedures where non-bonded amalgams would be expected to be lost, namely in preparations with little, if any, mechanical retention. It was concluded that, while there are various in vitro studies demonstrating that bonded amalgams have advantages of improved retention and tooth reinforcement and decreased marginal microleakage and secondary caries, the operative technique is more complicated and there are few advantages yet evident from clinical studies in conventional preparations having mechanical retentive features. However, there is evidence accruing from clinical studies that bonding of amalgam can be favorably used to extend the range of usage of amalgam to non-retentive conservative preparations, and toward the other extreme, as an adjunct to other forms of retention in large compound restorations.

The development of resin-bonding for amalgam restorations.

Adhesive techniques are now used for many dental restorative materials, including amalgam. Several generations of dentine bonding agents have been developed, mainly for bonding composite resins. When bonding is used with amalgam restorations, the need for retention and resistance form is reduced, the seal is improved, and some procedures, such as amalgam sealants, which were not previously possible, can be considered.

Artificial caries removal and inhibition of artificial secondary caries by pulsed CO2 laser irradiation.

PURPOSE: To investigate the inhibition of artifical secondary caries around restorations placed after removal of artificial caries by pulsed CO2 laser irradiation and by mechanical means. MATERIALS & METHODS: Beveled cavities were prepared mechanically on the facial surfaces of extracted human molars. Each cavity was subsequently exposed to an artificial caries (demineralizing) solution (pH 5.0) for 7 d to generate a demineralized zone approximately 100-200 microns thick on the cavity surface. The artificial carious/demineralized zones of the cavities were removed by a pulsed CO2 laser operating at a wavelength of 9.3 microns with pulse duration of 100 microseconds and an irradiation intensity of 5 J/cm2. Artificial control caries were removed mechanically with a carbide bur in a slow speed handpiece. The cavities were slightly undercut and restored with a resin-based composite without etching and bonding and the restored teeth were subjected to pH cycling solutions for 10 d as follows: Demineralization solution, pH 4.5 for 6 hrs, followed by remineralization solution, pH 7.0 for 18 hrs. Cycled teeth were sectioned through the restorations and the resulting lesions were analyzed in thin section using polarized light and Knoop microhardness. RESULTS: Mean microhardness delta Z values, indicating mineral loss were: 549 (SD 191) for control, and 140 (SD 127) N = 11. This difference is significant with t = 5.543 and P = 0.000 (Paired t-test). Caries penetration: Control side--231 microns (SD 71), Laser treated side: 123 microns (SD 79) N = 6. This difference is significant with t = 5.198 and P = 0.003 (Paired t-test). The results show that the laser treatment not only removed artificial caries, but also inhibited decalcification of the cavity wall in a subsequent artificial caries challenge by as much as 81% compared to control samples. No etching and bonding was used in this pilot study, which might have influenced the results. Future studies should address the inhibition effect of the laser treatment as compared to adhesive techniques, fluoride treatments and fluoride release restorative materials. CONCLUSION: Caries removal by a pulsed lambda = 9.3 microns CO2 laser produces a cavity surface morphology with marked resistance to artificial secondary caries as compared to mechanical removal.

Inhibition of carious lesions in vitro around gallium alloy restorations by fluoride releasing resin-ionomer cement.

A new fluoride releasing resin-ionomer cement was used for bonding of gallium alloy restorations in vitro. Etching, priming, and fluoride releasing resin-ionomer cement were used in the experimental group (ARG), prior to placement of the gallium alloy restorations. Three different controls were used: gallium alloy only (G), no etching, fluoride releasing resin-ionomer cement, gallium alloy (RG), etching, priming, non-fluoride cement and gallium alloy (ACG). The mean shear bond strengths of ARG group to enamel and dentin were higher than those of the three control groups. Artificial secondary caries lesions around the restorations in the experimental group and the control groups were produced, using a strep. mutans culture. The microradiographs were examined for presence of a caries inhibition zone near the restoration. Caries inhibition zones were clearly detected around RG and ARG, but not around G and ACG. The results indicate that the fluoride releasing resin-ionomer cement provided good adhesion and caries inhibition in enamel and dentin.

A two-year randomized, controlled clinical evaluation of bonded amalgam restorations.

PURPOSE: The clinical performance of adhesively bonded dental amalgam restorations was compared with that of traditionally placed non-bonded control amalgams in a randomized prospective study. MATERIALS AND METHODS: One-hundred thirteen Class II Dispersalloy amalgams were placed in permanent molars and premolars of 31 (21 males, 10 females) human subjects with their informed consent. By random assignment, 60 amalgam restorations were adhesively bonded using ED Primer and Panavia 21 TC (both Kuraray Co, Japan), and 53 traditional non-bonded restorations were placed. Most preparations involved replacement of defective amalgam restorations. Clinical recalls were conducted by experienced evaluators using modified USPHS criteria for occlusal and proximal anatomic form, occlusal and proximal marginal adaptation, and occlusal and proximal surface roughness. RESULTS: For the categories of anatomic form, marginal adaptation, surface quality, and temperature sensitivity, there were no significant differences between bonded and non-bonded amalgam restorations (chi-square analysis, p > 0.05). Three non-bonded restorations were lost at 4, 7, and 24 months from preparations with no deliberate retention. CONCLUSION: After two years' clinical service, there were no failures among the amalgam restorations adhesively bonded using ED Primer and Panavia 21 TC, but three non-bonded restorations failed due to lack of retention. For traditional preparations, adhesively bonded amalgams of the type investigated perform as well as non-bonded amalgams over two years' clinical service.

Bonded amalgam sealants: two-year clinical results.

The authors used bonded amalgams as pit and fissure sealants without mechanical preparation. They compared the two-year retention of the bonded amalgams with that of resin-based pit and fissure sealants. Clinical examinations at six months, one year and two years revealed no difference between the retention of the two sealants. This technique opens up the possibility of using bonded amalgam in pits and fissures surrounding very conservative preparations in a preventive amalgam restoration.

Effect of resin-modified glass ionomer cements on secondary caries.

PURPOSE: To evaluate the in vitro secondary caries inhibitory effect of two resin-modified glass ionomer cements (R-GICs). MATERIALS AND METHODS: Class V cavities were prepared at the cementoenamel junction on facial and lingual surfaces of 32 extracted upper premolars. The facial cavities were restored with a conventional glass ionomer cement (GIC) (Fuji II), while the lingual cavities were restored with either one of the R-GICs (Fuji II LC, Photac Fil, Vitremer), or a resin composite (Z-100). The margins of the restorations were subjected to a 20-day in vitro cariogenic challenge and the degree of demineralization was analyzed by microradiography. The amounts of fluoride released into distilled water from disc specimens of the materials tested were also measured for immersion time up to 161 days. RESULTS: The R-GICs and GIC's released similar cumulative amounts of fluoride over 161 days. Photac-Fil showed significantly higher amounts of fluoride release over the same period. The depth of the outer lesion and the thickness of the acid-resistant layer showed no significant difference among the R-GICs and GIC's. Moreover, the residual fluoride and calcium in the dentin adjacent to the R-GICs and GIC's were correlated with the thickness of acid-resistant layers in the dentin adjacent to the R-GICs and GIC's by electron probe microanalysis. However, the inhibitory effect of the R-GICs was not directly related to the fluoride concentrations eluted from them.

Bond strengths of the adhesive resin-amalgam interface.

PURPOSE: To evaluate the tensile and shear bond strengths of eight adhesives and two amalgams (spherical and lathe cut). MATERIALS AND METHODS: Two high-copper amalgams (Tytin, spherical; and ANA-2000, dispersed phase) and seven adhesives (Panavia EX, C&B Metabond, Chameleon Metal Resin Cement, All-Bond 2, All-Bond C&B, Photo-Bond and Imperva Dual) were evaluated. An epoxy resin (Stycast 1266) was included as a control for comparison because it was an adhesive material of similar viscosity but different chemistry from the dental adhesives. The aluminum surfaces were sandblasted with 50 microns aluminum oxide just prior to coating with adhesive resins. The testing area was defined with a 4 mm circular adhesive Mylar mask. All adhesives were mixed and handled according to manufacturers' instructions. Freshly mixed amalgam was condensed into the test cavity and onto the surface immediately after coating with adhesive. After 24 hours storage, the bond strengths were determined in an Instron testing machine at a crosshead speed of 2 mm/minute. The debonded surfaces were examined in an optical microscope for site of failure. The few samples which showed failure at the aluminum-resin interface were not included in the study. Selected debonded surfaces were examined by SEM. A 2-way ANOVA (General Levin Models-GLM) was used to analyze the data from both the tensile and shear bond strength tests. GLM was used instead of standard ANOVA because of the unbalanced design. The lack of balance occurred because some of the bonding resin/amalgam groups had different sample numbers. RESULTS: A wide variation in bond strengths was obtained with adhesive resin cements and not all appeared suitable for adhesive amalgam restorations. Panavia EX, C&B Metabond, Chameleon Metal Resin Cement and All-Bond C&B showed the best potential for amalgam bonding, with shear and tensile bond strengths greater than 8 MPa. Viscous, filled versions of adhesives appeared to be more effective. Choice of amalgam appeared to be less important than choice of adhesive.

Clinical research on bonded amalgam restorations. Part 1: SEM study of in vivo bonded amalgam restorations.

Exfoliated deciduous teeth, in which bonded or nonbonded amalgams had been placed two to three years previously, were examined directly and indirectly with the use of a scanning electron microscope (SEM). Bonding resin was found in the interface between the amalgam and the tooth structure, frequently obliterating the microspace. Several materials now are available that bond amalgam to tooth surfaces with bonding strength exceeding 10 MPa. Amalgam can be retained in preparations without undercuts, or in pits and fissures without any tooth preparation. The article consists of two parts: in part 1, results of a pilot study on bonded amalgam-tooth interfaces is presented. In part 2, the authors discuss further studies and clinical technique. Commercial products are compared; and other clinical trials now in progress, concerning amalgam bond strength adhesion and ability to eliminate microspace, are discussed.

Clinical research on bonded amalgam restorations. Part 2: Further studies and clinical technique.

In vitro studies show that the adhesive amalgam technique is superior to the nonadhesive technique. Also, early clinical results indicate that the adhesive technique can eliminate the microspace between amalgam and tooth. And, it can retain amalgam on unprepared occlusal surfaces of molars and premolars, sealing the fissures. Moreover, amalgam can be retained in preparations without undercuts. Early results indicate in traditional preparations, the adhesive technique appears to be at least equivalent to nonadhesive technique.

Bond strength, interfacial characterization, and fracture surface analysis for a new stress-breaking bonding agent.

Three commercial dentin bonding systems were analyzed by tensile bond testing, area analysis of fractured surfaces, and SEM analysis of the tooth-resin interfaces. Tensile bond strengths in megapascals(SD) were Tenure-Marathon V ([T-M]; 8.86[3.02]), new system with low-viscosity resin ([K-LVR-P]; 6.50[2.01]), and new system without low-viscosity resin ([K-P] = 7.28[1.75]), which were significantly greater than Scotch-bond 2-P50 ([SB-P50]; 3.96[1.02]). Gaps that ranged up to 5.6 microns (mean for the group) were observed around most of the restorations at dentin surfaces and less so at enamel surfaces, where some of the restorations remained free of gaps. The gaps near the dentin margin were significantly smaller for K-LVR-P than for SB-P50. The tensile test revealed mixed failure modes in all systems, and in the cross sections of class V restorations, the gaps were confined to the dentin-resin junction.

Mechanical retention versus bonding of amalgam and gallium alloy restorations.

The retention of amalgam and gallium alloy restorations in proximal box forms was measured in vitro, and three different adhesives to conventional undercuts were compared. For control, restorations were placed without undercuts or adhesives. No significant difference was found between amalgam and gallium alloys with each of the five methods of retention used. Alloys placed without retention or adhesives were significantly less retentive than all other groups. When Tytin alloy was used, no difference was found in retention among the restorations retained with Panavia or All-Bond adhesive or an occlusal dovetail and retention grooves, but Amalgambond adhesive was less retentive than all three of these methods. When gallium alloy was used, both Panavia and All-Bond adhesive were more retentive than undercuts, but the effect of Amalgambond adhesive was more retentive than undercuts, but the effect of Amalgambond adhesive was comparable to that of undercuts. The results of this study indicate that adhesives could be used in place of traditional undercuts to retain amalgam and gallium alloys, thus saving a considerable amount of tooth structure.

Shear bond strength of amalgam adhesives to dentin.

This study compared the bond strength of resinous adhesives used to bond amalgam to dentin. The adhesives were: All-Bond 2 (AB), Liner-F (LF), SuperBond C&B (SB), Amalgambond (AM), Photo Bond (PB), and Panavia (PA). Occlusal surfaces of non-carious molars were ground wet to 600 grit finish, exposing dentin. The dentin surfaces were conditioned and the adhesives were applied according to manufacturers' instructions. Dispersalloy amalgam (D) was condensed onto the adhesive immediately. For comparison, resin composite, Photo Posterior (PO) and Bis-Fil (BIS) were used. After 24 hours of storage in 100% humidity at room temperature, shear bond strengths were determined with a shear testing jig in an Instron testing machine at a crosshead speed of 0.5 mm/minute. The data were compared using ANOVA, P < 0.01. AB, LF, D had significantly higher bond strengths than other amalgam adhesives. There was no significant difference between SB, D and PB, PO. Bond strength of PB, PA, D was significantly higher than PA, D. Thus, there were significant differences among adhesives for bonding amalgams. Amalgam to dentin and composite to dentin bond strength were comparable except for the All-Bond groups. Fracture patterns at the dentin/restoration interfaces were examined by scanning electron microscopy (SEM).

Adhesion and microleakage tests of a new dentin bonding system.

Adhesion to dentin and microleakage of a new dentin bonding system was studied. The new system includes a low viscosity lightly filled Bis-GMA based resin liner which is placed between the phosphate ester-containing adhesive layer and the composite. This system was compared to dentin bonding agents based on: 1) HEMA and Bis-GMA and 2) PMDM and NTG-GMA. The phosphate ester system was used with and without the low viscosity resin. Each system was used with its corresponding posterior composite. All groups were tested by shear and tensile bond testing immediately and up to 6 mon after bonding. Microleakage of the three systems was tested in Class V restorations by dye penetration. The results of the shear and tensile tests indicated that significant changes within groups occurred with time, and significant differences appeared between groups at various times. The use of low viscosity resin with the phosphate ester system resulted in decreased leakage. The amount of leakage observed was related to early shear bond strength. This study suggests that the properties of the layer immediately adjacent to the adhesive may affect the performance of the system.