2-year survival and cost analysis of occlusoproximal ART restorations using encapsulated glass ionomer cement in primary molars: a randomized controlled trial.

BACKGROUND: The survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars. METHODS: Children from public schools in Tietê (Brazil), aged 4-8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation. RESULTS: A total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18). CONCLUSION: After two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Microleakage of Silver-Modified Atraumatic Restorative Technique (SMART) Restorations Using Silver Diammine Fluoride and High-Viscosity Glass Ionomer.

Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage.

Comparing Shear Bond Strength Between Pink Opaquer and Other Tooth-Colored Restorative Materials on Demineralized Dentin Treated with Silver Diammine Fluoride.

Purpose: The purposes of this study were to evaluate the effect of silver diammine fluoride (SDF) on the shear bond strength (SBS) of pink opaquer (PO) compared to resin-modified glass ionomer (RMGI) and conventional composite (COMP) on demineralized dentin, and also to investigate the mode of failure (MOF). Methods: Sixty extracted third molars were prepared, demineralized for 14 days, and divided into four groups: (1) COMP; (2) SDF+PO; (3) SDF+RMGI; and (4) SDF+COMP (restoration size: two by two mm). SBS, MOF, modified adhesive remnant index (MARI), and remnant adhesive volume (RAV) were evaluated using an Instron® machine, light microscopy, 3D digital scanner ( 3Shape©), and GeoMagic Wrap© software. Results: There was no significant difference in SBS (MPa) among the COMP mean??standard deviation (2.5±1.59), SDF+COMP (2.28±1.05), SDF+PO (3.31±2.63), and SDF+RMGI groups (3.74±2.34). There was no significant difference in MOF and MARI among the four groups (P>0.05). There was no significant difference in RAV (mm3) among the COMP (0.5±0.33), SDF+COMP (0.39±0.44), SDF+PO (0.42±0.38), and SDF+RMGI groups (0.42±0.38; P>0.05). A significant correlation existed between MOF and RAV (R equals 0.721; P<0.001). MOF, MARI, and RAV did not show any correlations with SBS (P>0.05). Conclusions: Silver diammine fluoride does not affect shear bond strength between carious dentinal surface and tooth color restorative materials. The amount of material left on the interface is not related to the amount of shear force needed to break the restoration.

The Impact of Repeated Steam Sterilization Cycles on the Efficacy of Chairside Adjustment Kits for Polishing Monolithic Multi-Layered Zirconia Dental Restoration Material.

BACKGROUND Before insertion, chairside adjustment kits are heat sterilized for positioning and polishing dental restorations. This study aimed to evaluate the effects of 2 steam sterilization cycles on the efficacy of polishing highly translucent monolithic zirconia (HTMLZ) dental restoration material. MATERIAL AND METHODS 100 HTMLZ disc-shaped specimens were adjusted (grinding, finishing, polishing) with EVE Diacera kit. Two steam sterilization techniques [standard (Gp S), immediate/flash (Gp (F)] of CAK were further subgrouped based on number of sterilization cycles [cycle 1 (control), cycle 5, 10, 15, and 20 (experimental)] (n=10 each). Each subgroup accordingly was evaluated for average surface roughness (Ra) and root mean square roughness (Rq) using a profilometer. Mean and standard deviation of 5 subgroups were statistically analyzed using one-way ANOVA/post hoc Tukey's test. Scanning electron microscopy complemented Ra, Rq measurements. Statistical differences of P≤0.05 were considered significant. RESULTS HTMLZ specimens in both groups showed increased (Ra/Rq) values after repeated sterilization of EVE Diacera kit, with Gp F showing lesser increase than Gp S (20 cycles). Gp F at 10 cycles and Gp S at 15 cycles showed clinically unacceptable roughness threshold (0.25 µm). Differences between subgroups for Ra and Rq values were significant (P≤0.05) with less differences within groups observed in early cycles (1, 10). Results validate the manufacturer's recommendations of using flash sterilization/10 cycles for EVE Diacera kit. CONCLUSIONS Repeated sterilization reduces efficacy of chairside adjustment kit to produce smooth surfaces on HTMLZ. This study recommends flash sterilization to a maximum of 10 times to get the clinically acceptable results of Ra and Rq.

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

OBJECTIVES: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

Polishing methods for composites restoration: the influence on human gingival fibroblasts behaviour.

BACKGROUND: Carious/Non-carious cervical lesions with gingival recessions may require both dental and periodontal reconstructive therapy, where flaps/grafts may be placed in contact with a dental filling material. Human Gingival Fibroblasts (HGF-1) response during the early phase of healing could vary according to the procedures employed to cure the dental composite. Moreover, oxygen diffusion into dental composite inhibits the polymerization reaction, creating an oxygen-inhibited layer (OIL) that presents residual unreacted monomers. The aim of this study was to assess the effect of different polishing techniques and OIL on HGF-1. METHODS: Composite discs polished with different techniques (diamond rubber, abrasive discs and tungsten carbide burr) were used. An additional not polished smooth group obtained with and without OIL was used as control. Samples were physically characterized through the analysis of their hydrophilicity and surface topography through contact angle measurement and SEM, respectively; afterwards the biologic response of HGF-1 when cultured on the different substrates was analyzed in terms of cytotoxicity and gene expression. RESULTS: The finishing systems caused alterations to the wettability, even if without a proportional relation towards the results of the proliferation essay, from which emerges a greater proliferation on surfaces polished with one-step diamond rubber and with abrasive discs as well as a direct effect of the glycerin layer, confirming that surface roughness can heavily influence the biological response of HGF-1. CONCLUSIONS: Surfaces wettability as well as cellular behavior seem to be affected by the selection of the finishing system used to lastly shape the restoration. Especially, the presence of OIL act as a negative factor in the regards of human gingival fibroblasts. The present study may provide the first clinical instruction regarding the best polishing system of composite material when the restoration is placed directly in contact with soft tissue cells. Understanding HGF-1 behavior can help identifying the polishing treatment for direct restoration of carious/non-carious cervical lesions associated with gingival recessions.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study.

BACKGROUND: An optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars. METHODS: Thirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test. RESULTS: Marginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%). CONCLUSIONS: Direct restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn't significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations. CLINICAL SIGNIFICANCE: Indirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

EFFECT OF LOW-LEVEL DIODE LASER ON DENTIN TOPOGRAPHY AND SYMPTOMATIC NONCARIOUS CERVICAL LESIONS PRIOR TO COMPOSITE RESTORATIONS: A SPLIT-MOUTH RANDOMIZED CONTROLLED TRIAL.

OBJECTIVES: This study assessed alterations in sensitivity among symptomatic noncarious cervical lesions (NCCLs) following the application of 3 low-level diode laser wavelengths before composite restoration. It analyzed the changes in dentin topography using a scanning electron microscope (SEM). MATERIALS AND METHODS: Nine patients with 36 NCCLs were randomly assigned intra-individually to 4 groups based on the laser wavelength: laser simulation, 445 nm, 660 nm, and 970 nm. Cavity preparation, irradiation, and composite restoration were performed for each lesion. Sensitivity to cold stimuli was recorded using a visual analog scale (VAS) before the intervention (baseline) and at 1 day, 14 days, 1-, 3-, and 6-month. Pulp sensibility was recorded using an electrical pulp tester (EPT) at baseline, before treatment, and at 3- and 6-month. Additionally, an in vitro examination was performed on 12 extracted human molars to yield 12 dentin discs. Each disc was randomly divided into 4 quadrants to receive the same laser wavelengths to determine the diameters of the tubules using SEM. Results were analyzed statistically for clinical studies by the Friedman test, while ANOVA (RM-ANOVA) was conducted in-vitro, followed by the Bonferroni test in the case of significance (P < .05). RESULTS: VAS readings decreased across all groups, with a significant decrease observed for 660 nm and 970 nm from 14 days to 6-month, while at 445 nm there was a significant decrease at 6-month compared to the control (P < .05). EPT showed a significant decrease in pain threshold levels at 660 nm and 970 nm at 3- and 6-month, while 445 nm showed a significant decrease at 6-month compared to the control (P < .05). The mean tubular diameter at 445 nm decreased, with no significant difference from the control, whereas a significant decrease was found at 660 nm and 970 nm compared to the control (P < .05). CONCLUSIONS: Prior to composite restoration in symptomatic NCCLs, diode lasers with a wavelength of 660 nm showed the highest reduction in sensitivity, followed by 970 nm, whereas 445 nm diode lasers showed the least reduction. Additionally, diode lasers with wavelengths of 660 and 970 nm reduced the width of the dentinal tubules (DT) without inducing melting, as viewed under SEM.

Equivalence study of the resin-dentine interface of internal tunnel restorations when using an enamel infiltrant resin with ethanol-wet dentine bonding.

This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth's marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.

The fracture resistance of pulpotomized primary molars restored with zirconia crowns, lithium disilicate or resin based ceramic endocrowns.

BACKGROUND: Endocrown in pediatric dentistry was rooted in the fundamental principles of preserving healthy dental tissues, leveraging contemporary adhesive methodologies. AIM: This research aimed on assessing and comparing the fracture resistance of pulpotomized primary molars when rehabilitated with zirconia crowns and two distinct types of endocrowns, namely E-Max and Brilliant Crios. METHODS: The study involved thirty, anonymized, freshly extracted second primary molars that underwent pulpotomy. These teeth were then evenly divided into three groups, each consisting of ten specimens: the zirconia crown, the E-Max endocrown, and the Brilliant Crios endocrown groups. Post-pulpotomy, the teeth were prepared for their respective restorations. Subsequent to this preparation, the zirconia crowns, E-Max endocrowns, and Brilliant Crios endocrowns were secured. To evaluate the fracture resistance using a computer-controlled testing machine (Instron), a progressively increasing load was applied to each group until fracture occurred. The gathered data were then analyzed for outliers and subjected to normality testing using the Shapiro-Wilk and/or Kolmogorov-Smirnov tests, with a significance threshold set at 0.05. RESULTS: There was no statistically significant difference in fracture resistance of pulpotomized primary molars among lithium disilicate (E-Max) group (mean=1367.59N), Brilliant Crios group (mean=1349.73N) and zirconia group (mean=1240.82N). CONCLUSION: Endocrowns can be considered a promising restoration for pulpotomized primary molars.

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation.

BACKGROUND: This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent. METHODS: Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy. RESULTS: Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization. CONCLUSIONS: It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

The chemical and optical stability evaluation of injectable restorative materials under wet challenge.

OBJECTIVES: To investigate and compare the chemical and optical stability of four restorative composite materials: two injectable resins, one flowable resin and one compomer. METHODS: Two injectable nano-filled composite resins: G-aenial Universal (GU) and Beautifil Injectable XSL (BI), a flowable composite resin: Filtek Supreme Flowable (FS) and a compomer: Dyract Flow (DF), in A2 shade were tested and compared. Water sorption and solubility were conducted according to ISO4049:2019 standard; ICP-OES and F-ion selective electrode were used to test the elemental release; Degree of conversion (DC) was obtained by using FTIR; water contact angle was obtained by static sessile drop method, and a spectrophotometer was used for optical properties (ΔE⁎, ΔL⁎ and TP). SPSS 28.0 was used for statistical analysis and the significant level was pre-set as α = 0.05. RESULTS: GU performed the best in water sorption and solubility, FS had the lowest elemental release, the best colour stability, and the highest DCIM and DC24-h. DF, the compomer had the lowest, and GU and BI, the injectable composites had the largest water contact angle, respectively. Correlations were found between water sorption and water solubility. CONCLUSIONS: The four composite restorative materials showed different chemical and optical behaviours. Overall, composite resins performed better than compomer, while additional laboratory and in vivo tests are necessary to obtain a more comprehensive comparison between injectable and flowable composite resins. Wsp and Wsl are influenced by many common factors, and the values are highly positively related. CLINICAL SIGNIFICANCE: A comprehensive understanding of materials is crucial before selecting materials for clinical practice. Composite resins rather than compomers are recommended because of their exceptional properties, which make them eligible for a wide range of clinical applications and an elongated lifespan.

Remineralizing pretreatment using casein phosphopeptide-amorphous calcium phosphate fluoride, self-assembling peptide, and nanohydroxyapatite gel activation via invisible infrared light on the dentin microhardness and micro shear bond strength to the composite restoration.

AIM: Different remineralizing pretreatments Casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), self-assembling peptide (SAP) P11-4 and 10 % Nanohydroxyapatite (nHA) gel activation via invisible infrared light on the dentin microhardness (MH) and micro shear bond strength (µSBS) of composite restoration. METHODS: Seventy-five human molar teeth were collected and the dentinal surface of all the samples was exposed to different demineralizing solutions. (n = 15) Group 1 (demineralized dentin), Group 2 (CPP ACP), Group 3 (TCP-F), Group 4 (SAP P11-4), Group 5 (nHA gel activation via invisible infrared light). MH assessment was performed using Vickers hardness. Each group of 10 samples was subjected to composite restoration buildup and µSBS were tested. The debonded samples were then observed under a stereo-microscope for failure analysis. ANOVA was conducted, along with Tukey's post hoc analysis, to examine the µSBS of composite and MH of the remineralized surface. RESULTS: nHA gel activation via invisible infrared light pretreated specimens showed the maximum outcomes of surface hardness (331.2 ± 77.3) and bond strength (10.38 ± 2.77). However, Group 4 (SAP P11-4) (148.3 ± 29.2) remineralized dentin displayed minimum scores of MH and µSBS (5.88 ± 1.01). CONCLUSION: Remineralizing pretreatment nHA gel activation via invisible infrared light and casein phosphopeptide-amorphous calcium phosphate fluoride seem to improve the dentin MH and µSBS of the composite restoration.

Dental restorative materials and halitosis: a preliminaryin-vitrostudy.

Despite the widespread use of dental restorative materials, little information exists in the literature regarding their potential impact on bad breath. This in vitro study aims to fill this gap by investigating the influence of different restorative materials on the release of hydrogen sulfide (H2S). Thirteen diverse dental restorative materials, including composites, flowable composites, glass ionomer restorative materials, high-copper amalgam, and CAD-CAM blocks, were examined. Cellulose Sponge models were used as negative and positive control. All samples were prepared with a diameter of 5 mm and a height of 2 mm. Except for the negative control group, all samples were embedded into Allium cepa L., and the emitted H2S was measured using the Wintact W8802 hydrogen sulfide monitor. Surface roughness's effect on emission was explored by roughening the surfaces of CAD-CAM material samples, and gas emission was measured again. The data were statistically analyzed using the Kruskal-Wallis test and DSCF pairwise comparison tests. Fiber-reinforced flowable composite (EverX Flow), amalgam (Nova 70-caps), and certain composite materials (IPS Empress Direct, Tetric Evoceram, Admira Fusion X-tra) released higher H2S concentrations compared to the negative control. The H2S release period lasted longer in the same materials mentioned above, along with G-aenial Universal Injectable. Indirectly used materials, such as GC Cerasmart, Vita Enamic, and Vita YZ HT, demonstrated significantly lower emissions compared to other direct restoratives. Importantly, the surface roughness of indirect materials did not significantly affect peak H2S concentrations or release times. The study reveals variations in H2S release among restorative materials, suggesting potential advantages of indirect restorative materials in reducing H2S-induced halitosis. This comprehensive understanding of the relationship between restorative materials and halitosis can empower both dental professionals and patients to make well-informed treatment choices. Notably, there is evidence supporting the enhanced performance of indirect restorative materials for individuals affected by halitosis.

Enhancement of mineral density and mechanical properties in root caries treated with silver diammine fluoride and glass ionomer cement, with emphasis on silver ion distribution.

OBJECTIVES: This study aimed to measure the distribution of silver ion (Ag+), mineral recovery, and nanohardness in carious lesions and comprehensively evaluate the degree of dentin restoration. METHODS: Sixty human teeth with root caries were randomly assigned to the control, silver diammine fluoride (SDF) [Safo], and SDF+Glass ionomer cement (GIC) treatment [Safo+Fuji] groups. Micro-computed tomography (micro-CT) was performed at five time points for each sample before/after treatment to evaluate mineral density within and around carious lesions. Three months following treatment, 12 samples were selected for synchrotron radiation X-ray fluorescence analysis to evaluate Ag+ distribution, while 15 samples were selected for nanoindentation. Data were analyzed using Dunnett's T3 test for micro-CT and Wilcoxon rank sum test with Bonferroni correction (p = 0.017) for nanoindentation. The correlation between hardness and mineral change was analyzed using the Spearman rank correlation coefficient. RESULTS: The Safo and Safo+Fuji groups showed significantly higher mineral recovery rates than did the control group (p < 0.001). In the Safo group, Ag+ accumulated in the deeper layers rather than the superficial layer of caries. In the Safo+Fuji group, Ag+ was found evenly distributed throughout caries, with only a few Ag+ detected in the GIC layer. Hardness in the Safo+Fuji group was significantly higher compared with the Safo group at depths in the range of 10-50 µm. CONCLUSION: In the presence of GICs, SDF exhibited high remineralization capacity when diffusing throughout carious lesions over time. Combined treatment with SDF and GIC could strengthen root dentin even in the presence of caries. CLINICAL SIGNIFICANCE: We found that combination treatment with SDF and GIC could increase mineral density in caries and improve the hardness of the tooth structure compared with fluoride-based agents alone. These findings might pave the way for future clinical trials to determine the therapeutic potential of nanotechnology-based restorative materials.

In-vitro evaluation of fracture resistance of teeth restored with different high-viscosity glass ionomer restorative materials and bulk-fill composite resins.

OBJECTIVES: This study aimed to evaluate the effect of restorations made with a glass-hybrid restorative system (GHRS), a high-viscosity glass ionomer restorative material (HVGIC), a high-viscosity bulk-fill composite resin (HVB), a flowable bulk-fill composite resin (FB), and a nanohybrid composite resin (NH), which are commonly preferred in clinical applications on the fracture resistance of teeth in-vitro. MATERIALS AND METHODS: One hundred intact human premolar teeth were included in the study. The teeth were randomly divided into ten groups (n = 10). No treatment was applied to the teeth in Control group. Class II cavities were prepared on the mesial surfaces of the remaining ninety teeth in other groups. For restoration of the teeth, a GHRS, a HVGIC, a HVB, a FB, and a NH were used. Additionally, in four groups, teeth were restored using NH, GHRS, and HVGIC with open and closed-sandwich techniques. After 24 h, fracture resistance testing was performed. One-way ANOVA and Tukey HDS tests were used for statistical analysis of the data. RESULTS: The fracture resistance values of Control group were statistically significantly higher than those of GHRS, HVGIC, FB, NH, HVGIC-CS, GHRS-OS, and HVGIC-OS groups(p < 0.05). There was no statistically significant difference observed between the fracture resistance values of Control, HVB, and GHRS-CS groups (p > 0.05). CONCLUSION: It can be concluded that the use of HVB and the application of GHRS with a closed-sandwich technique may have a positive effect on the fracture resistance of teeth in the restoration of wide Class II cavities. CLINICAL RELEVANCE: The use of high-viscosity bulk-fill composite resin and the application of glass-hybrid restorative system with the closed-sandwich technique in the restoration of teeth with wide Class II cavities could increase the fracture resistance of the teeth.

Preventive and restorative alternatives to caries by irradiation: a scoping review.

PURPOSE: This study is to conduct a comprehensive scoping review to map scientific evidence and clarify concepts regarding the commonly recommended preventive and restorative dental treatments for patients diagnosed with head and neck cancer (HNC) and subjected to radiotherapy. MATERIAL AND METHODS: This systematic scoping review was performed under the PRISMA-ScR guidelines. The study's experimental design was registered in the Open Science Framework. In vitro studies that evaluated preventive and restorative dental treatment over 50 Gy radiation doses were included. The search was conducted in November 2023 in five electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) without language or date restriction. A search strategy was applied based on keywords, MeSh terms, or synonyms. A descriptive analysis was conducted. RESULTS: A total of 49 studies, out of 3679 original articles identified, were included and reviewed. Of the included studies, three evaluated saliva stimulants and 35 evaluated fluoride-based preventive materials: gel (n = 18) toothpaste (n = 11) mouth rinse (n = 8) and varnish (n = 5) while 14 evaluated restorative materials: resin composite (n = 12) glass ionomer cement (n = 6) and amalgam (n = 1) Of those studies, 36 were clinical trials and 13 were in vitro studies. CONCLUSION: Fluoride gel was the most frequently recommended preventive material for preventing radiation caries with supportive clinical evidence. Resin composite and glass ionomer were the most frequently used restorative materials, respectively. However, there is not yet clinical evidence to support the use of resin composite in irradiated teeth.

Intraoral wear of PICN CAD-CAM composite restorations used in severe tooth wear treatment: 5-year results of a prospective clinical study using 3D profilometry.

OBJECTIVES: To evaluate, in a prospective clinical study over 5 years with ex vivo 3D profilometry analyses, the intraoral wear of Polymer-Infiltrated Ceramic Network (PICN) CAD-CAM composite restorations used in severe tooth wear treatment with the One-Step No-Prep technique. METHODS: 192 PICN (Vita Enamic) restorations on molars and premolars were included in a prospective clinical study involving patients treated according to the One-step No-prep protocol (n = 7). All patients showed clinical signs of bruxism. Replicas of restorations on molars and premolars were realized at each evaluation time (baseline and then every year up to 5 years) and scanned to perform 3D profilometry. Baseline and recall scans were superimposed with Geomagic Control software. The mean material wear was calculated for the full occlusal area (FOA) and for the occlusal contact area (OCA), respectively. Clinical evaluation of restorations was performed at recall. RESULTS: At 5 years, the estimated mean material wear for FOA was inferior to the accuracy threshold of the profilometry measurement chain. For OCA, the estimated mean wear of the material was - 27.97 µm. This material wear was shown to be significantly influenced by time (p < 0.0001) and patient (p = 0.026), while the type of tooth (molar or premolar) had no influence. At 5 years, the survival and the success rates of restorations were 99.48% and 90.62%, respectively. SIGNIFICANCE: The PICN material exhibits a low wear process in the treatment of severe tooth wear despite the presence of clinical signs of bruxism, and it constitutes a suitable material for the One-step No-prep technique.

Deep margin elevation in restorative dentistry: A scoping review.

OBJECTIVES: Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA: Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES: This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION: The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS: DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE: With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.

Effect of Bonding Agents on the Shear Bond Strength of Tooth-colored Restorative Materials to Dentin: An In Vitro Study.

AIM: The aim of the study is to determine the difference in the shear bond strengths to dentin among dental composite (Filtek Z350®, 3M), compomer (Dyract Flow®, Dentsply) and Giomer (Beautifil®, Shofu) with 3MTM Single BondTM Universal Adhesive (SBU) (7th generation, self-etch, single solution adhesive) and AdperTM Single Bond 2 Adhesive (ASB) (5th generation, total-etch, two solution adhesive). MATERIALS AND METHODS: Sixty extracted human permanent teeth were collected, cleansed of debris, and placed in distilled water. The samples were segregated into two groups depicting the two bonding agents-AdperTM (ASB) and 3MTM Single Bond Universal (SBU) and sub-grouped into three groups depicting the three restorative materials (Composite, Giomer, and Compomer) used. Groups were respresented as follows: Group I-ASB + Composite; Group II-ASB + Giomer; Group III-ASB + Compomer; Group IV-SBU + Giomer; Group V-SBU + Compomer; Group VI-SBU + Composite. After applying the bonding agent as per the manufacturer's instructions, following which the restorative material was placed. A Universal Testing Machine (Instron 3366, UK) was employed to estimate the shear bond strength of the individual restorative material and shear bond strengths were calculated. RESULTS: Composite bonded with SBU (group VI) displayed the greatest shear strength (11.16 ± 4.22 MPa). Moreover, Giomers and flowable compomers displayed better bond strengths with ASB compared with their SBU-bonded counterparts. CONCLUSION: These results mark the importance of careful material selection in clinical practice and the bonding agent used to achieve optimal bond strength and enhance the clinical longevity and durability of dental restorations. CLINICAL SIGNIFICANCE: From a clinical perspective, to avoid a compressive or a shear failure, it would be preferrable to use a direct composite restorative material with SBU (Single bond universal adhesive, 7th generation) to achieve maximum bond strength. How to cite this article: Kuchibhotla N, Sathyamoorthy H, Balakrishnan S, et al. Effect of Bonding Agents on the Shear Bond Strength of Tooth-colored Restorative Materials to Dentin: An In Vitro Study. J Contemp Dent Pract 2024;25(3):245-249.