Use of Artificial Neural Network in Determination of Shade, Light Curing Unit, and Composite Parameters' Effect on Bottom/Top Vickers Hardness Ratio of Composites.

OBJECTIVE: To assess the influence of light emitting diode (LED) and quartz tungsten halogen (QTH) light curing unit (LCU) on the bottom/top (B/T) Vickers Hardness Number (VHN) ratio of different composites with different shades and determination of the most significant effect on B/T VHN ratio of composites by shade, light curing unit, and composite parameters using artificial neural network. METHOD: Three composite resin materials [Clearfil Majesty Esthetic (CME), Tetric N Ceram (TNC), and Tetric Evo Ceram (TEC)] in different shades (HO, A2, B2, Bleach L, Bleach M) were used. The composites were polymerized with three different LED LCUs (Elipar S10, Bluephase 20i, Valo) and halogen LCU (Hilux). Vickers hardness measurements were made at a load of 100 g for 10 sec on the top and bottom surfaces and B/T VHN ratio calculated. The data were statistically analyzed with three-way ANOVA and Tukey test at a significance level of 0.05. The obtained measurements and data were then fed to a neural network to establish the correlation between the inputs and outputs. RESULTS: There were no significant differences between the B/T VHN ratio of LCUs for the HO and B shades of CME (p>0.05), but there were significant differences between the B/T VHN ratio of LCUs for shade A2 (p<0.05). No significant difference was determined between the B/T VHN ratio of LCUs for all shades of TNC (p>0.05). For TEC, there was no significant difference between the B/T VHN ratio of halogen and LED LCUs (p>0.05), but a significant difference was determined among the LED LCUs (p<0.05). The artificial neural network results showed that a combination of the curing light and composite parameter had the most significant effect on the B/T VHN ratio of composites. Shade has the lowest effect on the B/T VHN ratio of composites. CONCLUSION: The B/T VHN ratio values of different resin-based composite materials may vary depending on the light curing device. In addition, the artificial neural network results showed that the LCU and composite parameter had the most significant effect on the B/T VHN ratio of the composites. Shade has the lowest effect on the B/T VHN ratio of composites.

The effect of different adhesive system applications on push-out bond strengths of glass fiber posts.

PURPOSE: Over the past years, the adhesion of fiber posts luted with simplified adhesive systems has been a matter of great interest. The aim of this study was to assess the post retentive potential of a self-adhesive resin cement using different adhesive systems to compare the push-out bond strengths of fiber posts. MATERIALS AND METHODS: The post spaces of 56 mandibular premolar roots were prepared and divided into 4 experimental groups and further divided into 2 subgroups according to testing time (n=7). The fiber posts (Rely X Fiber Post) were luted with a self-adhesive resin cement (RelyX Unicem) and one of the following adhesive systems: no adhesive, a total-etch adhesive resin (Single Bond), a two-step self-etch adhesive resin (Clearfil SE Bond) and a one-step self-etch adhesive resin (Clearfil S3 Bond). Each root was cut horizontally, and 1.5 mm thick six root segments were prepared. Push-out tests were performed after one week or three months (0.5 mm/min). Statistical analysis were performed with three-way ANOVA (α=.05). RESULTS: Cervical root segments showed higher bond strength values than middle segments. Adhesive application increased the bond strength. For one week group, the total-etch adhesive resin Single Bond showed higher bond strength than the self-adhesive resin cement RelyX Unicem applied without adhesive resin at middle region. For 3 months group, the two-step self-etch adhesive resin Clearfil SE Bond showed the highest bond strength for both regions. Regarding the time considered, Clearfil SE Bond 3 months group showed higher bond strength values than one week group. CONCLUSION: Using the adhesive resins in combination with the self-adhesive resin cement improves the bond strengths. The bond strength values of two-step self-etch adhesive resin Clearfil SE Bond improved as time passes.

Comparison of time-dependent changes in the surface hardness of different composite resins.

OBJECTIVE: The aim of this study was to evaluate the change in surface hardness of silorane-based composite resin (Filtek Silorane) in time and compare the results with the surface hardness of two methacrylate-based resins (Filtek Supreme and Majesty Posterior). MATERIALS AND METHODS: From each composite material, 18 wheel-shaped samples (5-mm diameter and 2-mm depth) were prepared. Top and bottom surface hardness of these samples was measured using a Vicker's hardness tester. The samples were then stored at 37°C and 100% humidity. After 24 h and 7, 30 and 90 days, the top and bottom surface hardness of the samples was measured. In each measurement, the rate between the hardness of the top and bottom surfaces were recorded as the hardness rate. Statistical analysis was performed by one-way analysis of variance, multiple comparisons by Tukey's test and binary comparisons by t-test with a significance level of P = 0.05. RESULTS: The highest hardness values were obtained from each two surfaces of Majesty Posterior and the lowest from Filtek Silorane. Both the top and bottom surface hardness of the methacrylate based composite resins was high and there was a statistically significant difference between the top and bottom hardness values of only the silorane-based composite, Filtek Silorane (P < 0.05). The lowest was obtained with Filtek Silorane. The hardness values of all test groups increased after 24 h (P < 0.05). CONCLUSION: Although silorane-based composite resin Filtek Silorane showed adequate hardness ratio, the use of incremental technic during application is more important than methacrylate based composites.

Effect of different disinfectant methods on the initial microtensile bond strength of a self-etch adhesive to dentin.

The aim of this in vitro study was to evaluate the effect of different disinfection methods on the initial microtensile bond strength of a two-step, self-etch adhesive to dentin. Twenty mandibular molars were sectioned parallel to the occlusal plane to expose the mid-coronal dentin. All of the teeth were divided into four groups (n = 5 per group): (1) in group OZ, the dentin surfaces were exposed to ozone gas from the Ozonytron X delivery system (OzonyTron X-Bioozonix, Munich, Germany), (2) in group ND, the dentin surfaces were irradiated with an Nd:YAG laser (Pulsmaster 600 IQ, American Dental Technologies, U.S.), (3) in group CHX, the dentin surfaces were treated with a 2% chlorhexidine solution, and (4) in the control group, no treatment was applied. In all of the groups, the teeth were restored with Clearfil SE Bond (Kuraray, Tokyo, Japan) and Clearfil Majesty Posterior (Kuraray, Tokyo, Japan), according to the manufacturer's instructions. The teeth were sectioned perpendicular to the bonded surface (surface area of approximately 1 mm(2)). Thus, six to seven specimens were obtained from each tooth, and a total of 34 specimens were analyzed in each group. The specimens were attached to the microtensile test machine (Micro Tensile Tester, T-61010 K, Bisco, U.S.). The data was analyzed using the one-way analysis of variance (ANOVA) and Tukey test (p < 0.05). Fracture modes of each specimen were determined using a stereomicroscope (SZ-PT Olympus, Tokyo, Japan) and a scanning electron microscope (SEM). The lowest bond strength occurred in the OZ group. Significant differences were determined only between group OZ and the other groups (group ND, group CHX, and control group) (p < 0.05). In conclusion, although ozone decreased the microtensile bond strength of the self-etch adhesive system to dentin, the Nd:YAG laser and 2% chlorhexidine did not change the microtensile bond strength so in context of the present study it would appear that the Nd:YAG laser and 2% chlorhexidine may be used as pre-restorative sterilization procedures on the dentin prior to the application of a two-step, self-etch adhesive.

Effect of desensitizing agents on the microtensile bond strength of a two-step self-etch adhesive to dentin.

The aim of this in vitro study was to evaluate the effect of cervical hypersensitivity treatments (neodymium yttrium aluminum garnet [Nd:YAG] laser and conventional techniques) on the microtensile bond strengths of adhesives to treated dentin. The buccal cervical enamel of 42 freshly extracted human mandibular third molars was ground flat to expose the cervical dentin. The dentin surfaces were polished with a series of silicon carbide papers, and the smear was removed with an ethylenediamine tetra-acetic acid solution. The teeth were randomly divided into six groups as follows: group 1, Vivasens; group 2, BisBlock; group 3, fluoride gel; group 4, Nd:YAG laser; group 5, Clearfil SE + Nd:YAG laser; and group 6, no treatment (control). The specimens were then restored with a two-step self-etch adhesive, with the exception of group 5. Five specimens from each group were restored with a nanohybrid composite resin. The adhesive interface of two specimens from each group was examined using scanning electron microscopy. The specimens were sectioned perpendicularly to the adhesive interface to produce beams (adhesive area 1 mm(2)). The beams were then attached to a microtensile tester and stressed to failure at 1 mm/min. The data were compared using one-way analysis of variance at a significance level of 0.05. The microtensile bond strengths of the control group were significantly higher than those found for group 1, group 2, group 3, and group 4 (p< 0.05). No significant difference was found between group 5 and the control group. Most of the premature failures were seen in group 2 (80%), and the fewest premature failures were seen in group 5 (13.3%). The SEM findings verified the microtensile test findings. In conclusion, desensitizing treatment procedures (with the exception of Clearfil SE + Nd:YAG laser) reduced the microtensile bond strength of a two-step self-etch adhesive to dentin.

Effect of multiple consecutive adhesive coatings on microleakage of class v cavities.

OBJECTIVES: The purpose of this in vitro study was to evaluate the effect of multiple consecutive adhesive coatings of a one-step self-etch adhesive on microleakage of Class V cavities. METHODS: Standardized box shaped Class V cavities were prepared onto the buccal side of forty five non-carious human premolar teeth. The teeth were randomly divided into three groups of fifteen teeth in each and restored as: Group I- one-step self-etch adhesive resin (Clearfil S3, Kuraray Co. Ltd., Osaka, Japan) was applied according to the manufacturer's instructions, Group II- two consecutive same one-step self-etch adhesive application was performed, and Group III- three consecutive same one-step self-etch adhesive application was performed. After the adhesive applications light curing unit was activated for 20 seconds and the cavities were restored with a composite resin. The restorations were finished with aluminum oxide discs and the specimens were stored in water at room temperature for 24 hours before they were immersed in 2% methylene blue for 48 hours. The dye penetration was examined under a stereomicroscope and the asymtotic significance were analysed with Kruskall Wallis and Mann Whitney U tests and dentin-enamel margins were compared with each other with Wilcoxon Signed Rank test. RESULTS: The microleakage at the dentinal margins of Class V cavities were significantly decreased with two (Group II) and three (Group III) consecutive adhesive applications (P<.05). There was no significant difference between Group I, Group II and Group III at the enamel margins (P<.05). The microleakage at the dentinal margins were significantly higher than the enamel margins in Group I and Group II but in Group III there was no statistically significant difference (P<.05). CONCLUSIONS: Within the limitations of this in vitro study, it may be concluded that three consecutive applications of the one-step self-etch adhesive resin provided better sealing than the one coat of adhesive resin at the dentinal margins of Class V cavities.

Effect of multiple consecutive applications of one-step self-etch adhesive on microtensile bond strength.

AIM: The aim of this study was to evaluate the effects of multiple consecutive coatings of a one-step self-etch adhesive system (Clearfil Tri-S Bond) on the microtensile bond strength (MBS) to dentin. METHODS AND MATERIALS: Nine caries-free human lower third molars were sectioned perpendicular to the long axis to expose the mid-coronal dentin. The teeth were separated into three experimental groups (n=3) according to the number of adhesive resin coats applied. In Group 1 one layer of Clearfil Tri-S Bond was applied according to the manufacturer's instructions. In Group 2 and Group 3 the adhesive was applied in two and three layers, respectively. In these two groups the first layer was applied according to the manufacturer's instructions but the second and third layers of adhesive were not light cured after application. After the placement of the composite, the teeth were sectioned to obtain approximately 1 mm2 beams for testing. Eighteen beams were prepared for each group using the 'non-trimming' method. The MBS values of all specimens were tested, and fracture modes were then determined using a stereomicroscope. RESULTS: The mean MBS values (in MPa) of Group 1 (one coat of the adhesive) was significantly lower (p=0.04) than those of Group 3 (three applied coats of the adhesive). There were no statistically significant differences between Groups 1 and 2 and Groups 2 and 3. CONCLUSION: Within the limitations of this in vitro study the application of multiple coats of a one-step self-etch adhesive may provide an increase in bond strength compared to the application of only one coat of adhesive. CLINICAL SIGNIFICANCE: Three consecutive coats of one-step self-etching adhesive application can improve MBS.

The effect of occlusal loading on the microleakage of class V restorations.

OBJECTIVE: This in vitro study evaluated the microleakage of Class V cavities restored with a resin composite and different adhesive systems after occlusal loading. METHODS & MATERIALS: Standardized box-shaped Class V cavities were prepared on the buccal side of 135 non-carious human premolars. The teeth were randomly divided into three groups of 45 premolars each and restored as follows: Group 1-two-step total-etch adhesive (Single Bond, 3M) + resin composite (Supreme, 3M ESPE); Group 2-two-step self-etch adhesive (Clearfil SE, Kuraray) + resin composite and Group 3-one-step self-etch adhesive (Xeno III, Dentsply) + resin composite. The restorations were finished with aluminum oxide discs (Sof-Lex, 3M). Fifteen teeth in each group received 10,000 x 100 N and 250 N occlusal loads, respectively, and the remaining 15 teeth served as the control. The premolars were immersed in 2% methylene blue for 24 hours. The dye penetration was examined under a stereomicroscope, and the results were statistically analyzed by Kruskal Wallis, Mann-Whitney U and Wilcoxon Signed Rank tests to determine differences between the groups. RESULTS: Gingival margins showed more dye penetration than occlusal margins in all the tested groups (p<0.05). In all the tested adhesive systems, 100 N occlusal loading did not change dye penetration; however, Groups 1 and 2 exhibited better marginal sealing than Group 3 at the enamel margins under 250 N occlusal loading. CONCLUSION: Within the limitations of this in vitro study, it may be concluded that enamel margins provided better marginal sealing than dentin/cementum margins and the two-step self-etch adhesive exhibited better marginal sealing than an all-in-one adhesive at the enamel margins under 250 N occlusal loading.

Effect of preheating on the mechanical properties of resin composites.

OBJECTIVES: The purpose of this study was to compare the flexural strength and modulus of two commercial resin composites, at room temperature and 40, 45 and 50 degrees C prior to light polymerization with standard and step-cure protocols. METHODS: One nanohybrid (Grandio, VOCO, Cuxhaven, Germany), and microhybrid composite resin (Filtek Z250, 3M ESPE, St. Paul, MN, USA) were used. The materials were inserted into rectangular moulds at room temperature or preheated to a temperature of 40, 45 or 50 degrees C and cured with standard or step-cure protocols with high intensity halogen (Elipar Highlight, 3M-ESPE, St. Paul, MN, USA). Ten specimens were prepared for each preheating and light curing protocol. A three-point bending test was performed using a universal testing machine at a crosshead speed of 1 mm/min. The data were analyzed by one-way analysis of variance and Tukey's post hoc tests (P<.05) to examine the effect of curing protocol and preheating. Pearson's correlation test was used to determine the correlation between tested mechanical properties and preheating. RESULTS: There were no statistically significant difference between tested mechanical properties of the materials, curing protocols and temperature of the materials. No significant correlation was found between preheating and tested mechanical properties. CONCLUSIONS: The mechanical properties of the tested materials did not changed by preheating so the tested materials could be preheated because of the other potential clinical advantages like more adaptation to the cavity walls.

The effect of different finishing and polishing systems on the surface roughness of different composite restorative materials.

AIM: The purpose of this in vitro study was to examine the effect of two different finishing systems on the surface roughness of different types of composite restorative materials. METHODS AND MATERIALS: Thirty specimens, 8 mm in diameter and 3 mm in depth, were prepared using a microfill composite (Clearfil ST, Kuraray Co. Ltd., Osaka, Japan), a hybrid composite (Clearfil AP-X, Kuraray Co. Ltd., Osaka, Japan), and a packable composite (Clearfil Photo Posterior, Kuraray Co. Ltd., Osaka, Japan) cured against a Mylar matrix strip to create a baseline surface. The average surface roughness was measured using a surface profilometer (Surftest 211, Mitutoyo, Japan) in five different positions on each sample before and after finishing with one of the two finishing systems [Sof-Lex discs (3M) and Po-Go (Dentsply)]. The obtained data were analyzed by two-way analysis of variance (ANOVA) at a p=0.05 significance level. RESULTS: There were statistically significant differences in the average surface roughness (Ra, microm) between the Mylar matrix strip, Sof-Lex discs, and Po-Go discs (p<0.05). For all tested materials, the Mylar matrix strip provided smoother surfaces than both of the finishing systems (p<0.05). When the finishing discs were compared, Sof-Lex discs produced a smoother surface than Po-Go discs for all tested materials (p<0.05). CONCLUSION: The Mylar matrix strip provided a smoother surface than Sof-Lex and Po-Go discs. Furthermore, Sof-Lex discs produced smoother surfaces than Po-Go discs. Sof-Lex and Po-Go systems produced clinically acceptable surface roughness for microfill, hybrid, and packable composite resin materials. The effect of finishing and polishing systems on surface roughness was dependent on both the system and the composite resin restorative material.

Restorative treatment decision making with unaided visual examination, intraoral camera and operating microscope.

This study assessed the restorative treatment options of the occlusal surfaces of teeth examined with unaided visual assistance, an intraoral camera and an operating microscope. Sixty-eight extracted human molars were mounted to perform mouth models with a premolar in contact on both sides. Four observers examined the models in a phantom head, which simulated clinical conditions, using three techniques: unaided visual examination, intraoral camera and operating microscope. The observers were asked to assess the occlusal surface of each tooth and make a treatment decision based on the following scale: 1) the occlusal surface being sound and "not needing a restoration," 2) the occlusal surface having a subsurface or enamel lesion. No operative treatment was needed at this visit, but special attention was given to this surface at recall visits: "preventive care-defer treatment" and 3) the surface had a carious lesion and "needed a restoration." The teeth were then sectioned in the mesio-distal direction and examined under a stereomicroscope with 10x magnification to determine the true extent of caries. Statistical analysis was conducted by calculating percentages and kappa values of the restorative treatment scores based on examinations by four observers. According to all the observers' treatment decisions, the kappa values were found to be 0.341 (p<0.001), 0.471 (p<0.001) and 0.345 (p<0.001) for unaided visual examination, intra-oral camera and operating microscope, respectively. There was a statistically significant difference between the intraoral camera and the other two methods (p<0.05), while there was no significant difference between the unaided visual examination and operating microscope (p>0.05). As a result of a comparison between the unaided visual examination and operating microscope, the use of an intraoral camera improved the restorative treatment decisions of the occlusal surfaces on posterior teeth.

Coronal microleakage of temporary restorations in previously restored teeth with amalgam and composite.

AIM: This study evaluated microleakage at the interface between various temporary restorative materials and existing amalgam or composite restorations, and dental tissues in previously restored teeth after partial removal of the restoration. MATERIALS AND METHODS: The distal half of amal gam (Ag) and composite restorations (Co) in 45 teeth were removed, then filled with temporary restorative materials (IRM, Coltosol and CLIP). After thermal cycling, microleakage was measured microscopically as the penetration of basic fuchsine according to a four-unit-scale: The data were evaluated with Friedman and Kruskal-Wallis tests using Bonferroni correction (p < 0.05). RESULTS: In almost all groups except the Co-IRM and Ag-CLIP interface, lower microleakage values were observed in temporary restoration-permanent restoration interfaces compared to temporary restoration-tooth interfaces. For the Ag and Co groups except for the Ag-IRM-b interfaces, the highest microleakage values were observed with IRM for b and c interfaces followed by Coltosol and CLIP. Interestingly, although CLIP was a temporary restoration, CLIP-tooth interface (Ag-CLIP-c) values were lower than amalgam-tooth interface (Ag-CLIP-a) values. CONCLUSIONS: CLIP provided a better seal against microleakage at amalgam and especially composite interfaces. This material also provided a better seal against microleakage at the tooth tissue interface. The use of a resin based temporary restorative material over partially removed resin composite restorations could be beneficial in achieving better resistance to marginal leakage. Within the limitations of this study, maintaining partially removed permanent restorations does not seem to cause a problem with achieving marginal seal.

The assessment of unaided visual examination, intraoral camera and operating microscope for the detection of occlusal caries lesions.

This study compared the efficiency of unaided visual examination, intraoral camera and operating microscope according to a visual scoring system (ERK) at occlusal caries detection. A total of 84 extracted human molars were mounted to create mouth models with a premolar in contact on both sides. The models were examined in a phantom head simulating clinical conditions by four observers using the three techniques: unaided visual examination, an intraoral camera and on operating microscope according to the ERK scale. The teeth were than sectioned in a mesio-distal direction and examined under a stereomicroscope with 10x magnification for histological validation. The sensitivity, specificity, positive predictive and negative predictive values were calculated for the four observers with three techniques and statistical analyses were performed using Friedman and DUNN tests, while strength of agreement was determined by calculating Kappa values. From the data, mean sensitivity values were cal. culated as 0.26, 0.43, 0.49 and mean specificity values as 0.87, 0.80 and 0.73 for unaided visual examination, intraoral camera and operating micro scope, respectively. The Kappa values ranged between 0.187 and 0.301 for visual examination, 0.328 and 0.459 for intraoral camera and 0.363 and 0.516 for operating microscope. As a result, the use of an intraoral camera and operating microscope improved occlusal caries detection according to the ERK scale.

Barcoll hardness of different resin-based composites cured by halogen or light emitting diode (LED).

The clinical performance of light curing resin composites is greatly influenced by the quality of the light-curing unit (LCU). Halogen LCUs are commonly used for curing composite materials. However, they have some drawbacks. The development of new, blue, super bright light emitting diodes (LED LCU) of 470-nm wavelength with high light irradiance comes as an alternative to standard halogen LCUs of 450-470-nm wavelengths. This study evaluated the surface hardness of the different resin-based composites (flowable, hybrid and packable resin composites) cured by LED LCU or halogen LCU. A Teflon mold 10-mm in diameter and 2-mm in depth was made to obtain five disk-shaped specimens for each experimental group. Then, the specimens were cured by an LED LCU or halogen LCU for 40 seconds. The hardness of the upper and lower surfaces was measured with a Barcoll hardness-measuring instrument. The statistical analysis was performed using one-way analysis of variance (ANOVA) and Duncan test at a p=0.05 significance level. The results of the hardness test indicated that the hardness of resin composites cured by an LED LCU were greater than those cured by a halogen LCU. Additionally, for all resin-based composites, the hardness values for the upper surfaces were higher than the lower surfaces. However, for both results no statistically significant differences were observed (p>0.05).

The leakage of Class II cavities restored with packable resin-based composites.

Recently, new resin-based composites, called "packable" or "condensable" resin composites, are being promoted as amalgam alternatives. The purpose of this study was to evaluate leakage in Class II cavities restored with the five packable resin-based composites. On 45 freshly extracted human molars, cavities were prepared following a standardized pattern in which the Class II cavity had a length of 3.0 mm, width of 2.0 mm, and depth of 1.5 mm occlusally. The proximal box had an axial depth of 1.5 mm and a buccolingual width of 4.0 mm. The cervical margin was located 1.0 mm below the cement enamel junction (CEJ). The teeth were randomly divided into five groups of 8 each. The cavity surface was conditioned with 36% phosphoric acid, rinsed, excess water removed, and a dental bonding adhesive (Prime&Bond NT) was used for all the cavities. The teeth were then restored according to the manufacturer's instructions: Group 1, Surefil; Group 2, Solitaire; Group 3, Alert; Group 4, Filtek P60; and Group 5, Prodigy Condensable. After the restorations were completed, the specimens were finished and polished with an aluminum-oxide-coated disc, thermocycled, stained, sectioned, and viewed under a stereomicroscope for leakage at occlusal/enamel and gingival/dentin margins. All test groups showed that leakage of gingival/dentin margins were greater when compared with leakage of occlusal/enamel margins. At the occlusal/enamel margins, there were no significant differences between the materials; however, at gingival/dentin margins, Filtek P60 and Prodigy Condensable demonstrated less leakage, while Solitaire demonstrated greater leakage.