Volumetric Evaluation of Voids and Gaps of Different Calcium-Silicate Based Materials Used in Furcal Perforations: A Micro-CT Study.

This study aimed at evaluating volumetrically gaps and voids of calcium-silicate based materials of different generations and handling properties (BC­Endosequence BC RRM-Fast Set Condensable Putty, MTA­ProRoot MTA, and BIO­Biodentine) in simulated furcal perforations in an ex vivo setup by microcomputed tomography (Micro-CT) analysis. Thirty-six extracted human mandibular molars with sound furcation areas were selected. Standardized perforations were created in the furcation area of the pulp chamber using #4 diamond burs. The specimens were randomly assigned to three groups (BC, MTA and BIO; n = 12). Samples were then scanned (SkyScan 1172; Bruker-microCT, Kontich, Belgium), and three-dimensional (3D) images reconstructed. The relative volume of gaps (VG%) and voids (VV%) present on each material was calculated. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's HSD test (p < 0.05). Mean VG% for BC, MTA, and BIO groups were, respectively, 0.513%, 1.128%, 1.460%, with BC presenting statistically (p < 0.05) fewer gaps formation than the other groups. Mean VV% were, respectively, 0.018%, 0.037%, and 0.065%. The was no statistical difference regarding VV%. There were no gap-free and void-free samples. BC group had the lowest VG% among the groups with a significant statistical difference (p < 0.05).

Filling ability of three bioceramic root-end filling materials: A micro-computed tomography analysis.

This study aimed at evaluating the volume of gaps and voids, and the total porosity percentage of three calcium-silicate-based materials in mandibular molars apicoectomy by Micro-CT analysis. Thirty-three mesial roots of extracted human mandibular molars were instrumented and obturated. The apical 3mm of each root was resected and prepared. Root-end cavities were filled with EndoSequence BC Putty (BC); ProRoot MTA (MTA) and Biodentine (BIO). Samples were scanned using a Micro-CT scanner and the tridimensional images reconstructed. Percentage of gaps (VG%) and of voids (VV%) were obtained. Porosity percentage (Po%) was also assessed. Data were analysed using Student's t-test (P < 0.05). All materials presented gaps and voids. VG% was 2.006 (BC), 1.882 (MTA) and 1.450 (BIO), and VV% was 0.039 (BC), 0.021 (MTA) and 0.024 (BIO) with no statistical difference. Po% were 56.73 (BC), 51.94 (MTA) and 50.45 (BIO), with BC being statistically (P > 0.05) more porous.

Incorporation of AuNP-PLL nanocomplexes in DPSC: a new tool for 3D analysis in pulp regeneration.

OBJECTIVES: To assess the viability of dental pulp stem cells loaded with gold nanoparticles complexed with poly (L-lysine) (AuNP-PLL) and to track the cellular behavior in a 3D analysis by micro-CT. MATERIALS AND METHODS: DPSC (dental pulp stem cells) were cultured and incorporated with AuNP-PLL (0.2 mg/ml) and assessed for cell viability (24 h, 48 h, and 72 h) using MTS assay. Apoptosis/cell death index and cell cycle were analyzed by propidium iodide. AuNP-PLL-RITC were used for observation in confocal microscopy and quantification of the incorporation rates. Cells were also suspended in agarose and analyzed three-dimensionally in µCT, assessing their radiopacity. Quantitative data (cell viability and apoptosis) were analyzed by t test (p < 0.05). RESULTS: AuNP-PLL labeling did not affect cellular viability in any of the periods analyzed nor interfered with the apoptosis index of DPSC. AuNP-PLL nanocomplexes were identified in the cytoplasm of cells by immunofluorescence, mainly in the perinuclear region. The observed incorporation rate was 98%. Micro-CT analysis has shown that incorporated cells are now visible using x-ray, with a clear increase in radiopacity when compared to the control group (non-incorporated cells). CONCLUSION: These results indicate that it is possible to incorporate AuNP-PLL complex into DPSC and track the cells by using µCT; furthermore, this incorporation of 0.2 mg/ml of AuNP-PLL does not interfere in the DPSC basic behavior. CLINICAL RELEVANCE: This methodology can be a useful tool for cellular labeling to observe cell behavior and their interaction with scaffolds in a 3D manner, opening an array of new approaches in regenerative endodontics.

Tissue engineering: from research to dental clinics.

UNLABELLED: Tissue engineering is an interdisciplinary field that combines the principles of engineering, material and biological sciences toward the development of therapeutic strategies and biological substitutes that restore, maintain, replace or improve biological functions. The association of biomaterials, stem cells, growth and differentiation factors has yielded the development of new treatment opportunities in most of the biomedical areas, including Dentistry. The objective of this paper is to present the principles underlying tissue engineering and the current scenario, the challenges and the perspectives of this area in Dentistry. SIGNIFICANCE: The growth of tissue engineering as a research field has provided a novel set of therapeutic strategies for biomedical applications. Indeed, tissue engineering may lead to new strategies for the clinical management of patients with dental and craniofacial needs in the future.

Dental pulp tissue engineering.

Dental pulp is a highly specialized mesenchymal tissue that has a limited regeneration capacity due to anatomical arrangement and post-mitotic nature of odontoblastic cells. Entire pulp amputation followed by pulp space disinfection and filling with an artificial material cause loss of a significant amount of dentin leaving as life-lasting sequelae a non-vital and weakened tooth. However, regenerative endodontics is an emerging field of modern tissue engineering that has demonstrated promising results using stem cells associated with scaffolds and responsive molecules. Thereby, this article reviews the most recent endeavors to regenerate pulp tissue based on tissue engineering principles and provides insightful information to readers about the different aspects involved in tissue engineering. Here, we speculate that the search for the ideal combination of cells, scaffolds, and morphogenic factors for dental pulp tissue engineering may be extended over future years and result in significant advances in other areas of dental and craniofacial research. The findings collected in this literature review show that we are now at a stage in which engineering a complex tissue, such as the dental pulp, is no longer an unachievable goal and the next decade will certainly be an exciting time for dental and craniofacial research.

Pulp capping materials exert an effect on the secretion of IL-1ß and IL-8 by migrating human neutrophils.

Pulp repair is a complex process whose mechanisms are not yet fully understood. The first immune cells to reach the damaged pulp are neutrophils that play an important role in releasing cytokines and in phagocytosis. The objective of this study was to analyze the effect of different pulp-capping materials on the secretion of interleukin-1 beta (IL-1ß) and interleukin-8 (IL-8) by migrating human neutrophils. Neutrophils were obtained from the blood of three healthy donors. The experimental groups were calcium hydroxide [Ca(OH)(2)], an adhesive system (Single Bond), and mineral trioxide aggregate (MTA). Untreated cells were used as control. Transwell chambers were used in performing the assays to mimic an in vivo situation of neutrophil chemotaxis. The pulp-capping materials were placed in the lower chamber and the human neutrophils, in the upper chamber. The cells were counted and the culture medium was assayed using ELISA kits for detecting and quantifying IL-1ß and IL8. The data were compared by ANOVA followed by Tukey's test (p < 0.05). The secretion of IL-8 was significantly higher in all groups in comparison to the control group (p < 0.05). The adhesive system group showed higher IL-8 than the MTA group (p < 0.05). The secretion of IL-1ß was significantly greater only in the MTA group (p < 0.001). It was concluded that only MTA is able to improve the secretion of IL-1ß, and all materials tested increased IL-8 secretion. These results combined with all the other biological advantages of MTA indicate that it could be considered the material of choice for dental pulp capping.

Pulp capping materials exert an effect on the secretion of IL-1β and IL-8 by migrating human neutrophils

Pulp repair is a complex process whose mechanisms are not yet fully understood. The first immune cells to reach the damaged pulp are neutrophils that play an important role in releasing cytokines and in phagocytosis. The objective of this study was to analyze the effect of different pulp-capping materials on the secretion of interleukin-1 beta (IL-1β) and interleukin-8 (IL-8) by migrating human neutrophils. Neutrophils were obtained from the blood of three healthy donors. The experimental groups were calcium hydroxide [Ca(OH)2], an adhesive system (Single Bond), and mineral trioxide aggregate (MTA). Untreated cells were used as control. Transwell chambers were used in performing the assays to mimic an in vivo situation of neutrophil chemotaxis. The pulp-capping materials were placed in the lower chamber and the human neutrophils, in the upper chamber. The cells were counted and the culture medium was assayed using ELISA kits for detecting and quantifying IL-1β and IL8. The data were compared by ANOVA followed by Tukey's test (p < 0.05). The secretion of IL-8 was significantly higher in all groups in comparison to the control group (p < 0.05). The adhesive system group showed higher IL-8 than the MTA group (p < 0.05). The secretion of IL-1β was significantly greater only in the MTA group (p < 0.001). It was concluded that only MTA is able to improve the secretion of IL-1β, and all materials tested increased IL-8 secretion. These results combined with all the other biological advantages of MTA indicate that it could be considered the material of choice for dental pulp capping.

Dental pulp tissue engineering

Dental pulp is a highly specialized mesenchymal tissue that has a limited regeneration capacity due to anatomical arrangement and post-mitotic nature of odontoblastic cells. Entire pulp amputation followed by pulp space disinfection and filling with an artificial material cause loss of a significant amount of dentin leaving as life-lasting sequelae a non-vital and weakened tooth. However, regenerative endodontics is an emerging field of modern tissue engineering that has demonstrated promising results using stem cells associated with scaffolds and responsive molecules. Thereby, this article reviews the most recent endeavors to regenerate pulp tissue based on tissue engineering principles and provides insightful information to readers about the different aspects involved in tissue engineering. Here, we speculate that the search for the ideal combination of cells, scaffolds, and morphogenic factors for dental pulp tissue engineering may be extended over future years and result in significant advances in other areas of dental and craniofacial research. The findings collected in this literature review show that we are now at a stage in which engineering a complex tissue, such as the dental pulp, is no longer an unachievable goal and the next decade will certainly be an exciting time for dental and craniofacial research.

A polpa dental é um tecido conjuntivo altamente especializado que possui uma restrita capacidade de regeneração, devido à sua disposição anatômica e à natureza pós-mitótica das células odontoblásticas. A remoção total da polpa, seguida da desinfecção do canal radicular e seu preenchimento com material artificial proporciona a perda de uma significante quantidade de dentina deixando como sequela um dente não vital e enfraquecido. Entretanto, a endodontia regenerativa é um campo emergente da engenharia tecidual, que demonstrou resultados promissores utilizando células-tronco associadas à scaffolds e moléculas bioativas. Desta forma, esse artigo revisa os recentes avanços obtidos na regeneração do tecido pulpar baseado nos princípios da engenharia tecidual e fornece aos leitores informações compreensivas sobre os diferentes aspectos envolvidos na engenharia tecidual. Assim, nós especulamos que a combinação ideal de células, scaffolds e moléculas bioativas pode resultar em significantes avanços em outras áreas da pesquisa odontológica. Os dados levantados em nossa revisão demonstraram que estamos em um estágio no qual, o desenvolvimento de tecidos complexos, tais como a polpa dental, não é mais inatingível e que a próxima década será um período extremamente interessante para a pesquisa odontológica.

Cytotoxicity of substances leached from a conventional and a self-etching adhesive system on human pulp fibroblasts / Citotoxicidade de substâncias liberadas de sistemas adesivos convencional e auto-condicionante sobre fibroblastos de polpa humana

The use of adhesives for direct dental pulp capping is not advisable, due to its harmful effects to the tissue. However, new adhesive systems are often released, and self-etching systems seem to be less toxic than conventional ones. The purpose of this study was to compare the in vitro cytotoxicity of substances leached from calcium hydroxide and two adhesive systems on human dental pulp fibroblasts. Cell culture media conditioned by Calcium Hydroxide (CH), Single Bond (SB), Clearfill Protect Bond primer (CP) or Clearfill Protect Bond resin (CB) were applied to human pulp fibroblasts. Fresh cell culture medium was used in the Control group. The number of viable cells was obtained through the MTT reduction assay. Data were compared by ANOVA and Tukey’s test (p≤0.05). The mean number of viable cells was 3.9x103(±0.75) for the control group, which was similar to those found in the CH group (4.31x103±0.87). Statistical differences were found among the groups (p<0.001), with the cell viability decreasing significantly with SB (0.09x103±0.06) and CP (0.28x103±0.08) when compared to CH and control groups. CB (2.37x103±0.72) was significantly less cytotoxic than CP and SB, but more cytotoxic than CH. It was concluded that Single Bond and Clearfill Protect Bond primer release substances that decrease cell viability of human dental pulp cells in culture. According to this study the use of bonding systems for direct pulp capping is not recommended, since they are cytotoxic

O uso de adesivos dentinários sobre a polpa não é recomendável, devido aos efeitos deletérios provocados sobre o tecido. Entretanto, novos sistemas adesivos são frequentemente lançados, e sistemas autocondicionantes parecem ser menos tóxicos que os sistemas convencionais. O objetivo deste estudo foi comparar in vitro, a citotoxicidade de substâncias liberadas pelo hidróxido de cálcio e dois sistemas adesivos utilizando fibroblastos de polpa humana. Meios de cultura celular condicionados por Hidróxido de cálcio (CH), Single Bond (SB), Clearfill Protect Bond primer (CP) ou Clearfill Protect Bond resin (CB) foram testados em fibroblastos de polpa humana. Meio fresco de cultivo celular foi utilizado no grupo centrole. O número de células viáveis foi obtido através do teste da redução do MTT. Os dados foram comparados por ANOVA e teste de Tukey (p≤0,05). O número médio de células viáveis foi de 3,9x103(±0,75) para o grupo controle, que foi similar ao encontrado para o grupo CH (4,31x103±0,87). Houve diferenças estatísticas entre os grupos (p<0.001), sendo que a viabilidade celular decresceu significantemente com SB (0,09x103±0,06) e CP (0,28x103±0,08), quando comparados ao CH e controle. CB (2,37x103±0,72) foi menos citotóxico que CP e SB, mas mais citotóxico que CH. Conclui-se que o Single Bond e o Clearfill Protect Bond primer liberam substâncias que diminuem a viabilidade celular de fibroblastos humanos em cultura. De acordo com este estudo, o uso de sistemas adesivos para capeamento direto não é recomendado, uma vez que são citotóxicos.

Interleukin-1 beta and interleukin-8 in healthy and inflamed dental pulps.

UNLABELLED: After aggression to the dental pulp, some cells produce cytokines in order to start and control the inflammatory process. Among these cytokines, interleukin-1 beta (IL-1beta) and interleukin-8 (IL-8) emerge as important ones. OBJECTIVE: The purpose of this study was to analyze the location, distribution and concentration of these cytokines in healthy and inflamed dental pulps. MATERIAL AND METHODS: Twenty pulps, obtained from healthy third molars (n=10) and from pulpectomies (n=10) were used for the study, with half of each group used for immunohistochemistry and half for protein extraction and ELISA assays. Fibroblasts obtained from healthy dental pulps, stimulated or not by Escherichia coli lipopolysaccharide (LPS), in order to simulate aggression on the cell cultures, were also used and analyzed by ELISA for IL-1beta and IL-8 as complementary information. Data obtained from immunohistochemistry were qualitatively analyzed. Data obtained from ELISA assays (tissue and cells) were statistically treated by the t-test (p<0.05). RESULTS: Immunohistochemically, it was observed that inflamed pulps were strongly stained for both cytokines in inflammatory cells, while healthy pulps were not immunolabeled. ELISA from tissues quantitatively confirmed the higher presence of both cytokines. Additionally, cultured pulp fibroblasts stimulated by LPS also produce more cytokines than the control cells. CONCLUSIONS: It may be concluded that inflamed pulps present higher amounts of IL-1beta and IL-8 than healthy pulps and that pulp fibroblasts stimulated by bacterial LPS produce higher levels of IL-1beta and IL-8 than the control group.

Cytokine production from human primary teeth pulp fibroblasts stimulated by different pulpotomy agents.

PURPOSE: After exposing the pulp tissue, cytokines are produced that regulate the pulp inflammatory response. The dental literature, however, lacks information on the participation of primary tooth fibroblasts in this process. The purpose of this study was to verify the participation of human primary tooth pulp fibroblasts in the inflammatory process, evaluate the production of interleukin 1 beta (IL-l beta) and interleukin 8 (IL-8) from these cells. METHODS: Pulpotomy agents were applied as conditioned media on cell cultures in the following groups: (1) negative control; (2) positive control (Lipopolysaccharide -LPS); (3) calcium hydroxide (powder); (4) mineral trioxide aggregate (MTA); (5) adhesive resin; and (6) formocresol. After 24 hours in contact with the cells, the conditioned media were removed, the proteins were extracted from the cells and IL-l beta and IL-8 were quantified by ELISA (Enzyme linked immuno-sorbent assay). RESULTS: Data were analyzed by analysis of variance (P<0.05) and Tukey's test (P<0.05). It was observed that calcium hydroxide has stimulated the production of IL-l beta, without stimulating IL-8. Conversely, the adhesive resin and formocresol stimulated the production of IL-8, and did not stimulate IL-l beta. MTA stimulated both cytokines in an intermediate level when compared to the other materials. CONCLUSION: Primary tooth fibroblasts can respond immunologically, and different pulp capping materials can help in this process.

Interleukin-1 beta and interleukin-8 in healthy and inflamed dental pulps

After aggression to the dental pulp, some cells produce cytokines in order to start and control the inflammatory process. Among these cytokines, interleukin-1 beta (IL-1β) and interleukin-8 (IL-8) emerge as important ones. OBJECTIVE: The purpose of this study was to analyze the location, distribution and concentration of these cytokines in healthy and inflamed dental pulps. MATERIAL AND METHODS: Twenty pulps, obtained from healthy third molars (n=10) and from pulpectomies (n=10) were used for the study, with half of each group used for immunohistochemistry and half for protein extraction and ELISA assays. Fibroblasts obtained from healthy dental pulps, stimulated or not by Escherichia coli lipopolysaccharide (LPS), in order to simulate aggression on the cell cultures, were also used and analyzed by ELISA for IL-1β and IL-8 as complementary information. Data obtained from immunohistochemistry were qualitatively analyzed. Data obtained from ELISA assays (tissue and cells) were statistically treated by the t-test (p<0.05). RESULTS: Immunohistochemically, it was observed that inflamed pulps were strongly stained for both cytokines in inflammatory cells, while healthy pulps were not immunolabeled. ELISA from tissues quantitatively confirmed the higher presence of both cytokines. Additionally, cultured pulp fibroblasts stimulated by LPS also produce more cytokines than the control cells. CONCLUSIONS: It may be concluded that inflamed pulps present higher amounts of IL-1β and IL-8 than healthy pulps and that pulp fibroblasts stimulated by bacterial LPS produce higher levels of IL-1β and IL-8 than the control group.

Ultrasonic versus high-speed cavity preparation: analysis of increases in pulpal temperature and time to complete preparation.

STATEMENT OF PROBLEM: The use of ultrasonic tips has become an alternative for cavity preparation. However, there are concerns about this type of device, particularly with respect to intrapulpal temperatures and cavity preparation time. PURPOSE: The purpose of this study was to analyze pulpal temperature increases generated by an ultrasonic cavity preparation with chemical vapor deposition (CVD) tips, in comparison to preparation with a high-speed handpiece with a diamond rotary cutting instrument. The time required to complete the cavity preparation with each system was also evaluated. MATERIAL AND METHODS: Thermocouples were positioned in the pulp chamber of 20 extracted human third molars. Slot-type cavities (3 x 3 x 2 mm) were prepared on the buccal and the lingual surfaces of each tooth. The test groups were: high-speed cavity preparation with diamond rotary cutting instruments (n=20) and ultrasonic cavity preparation with CVD points (n=20). During cavity preparation, the increases in pulpal temperature, and the time required for the preparation, were recorded and analyzed by Student's t test for paired samples (alpha=.05). RESULTS: The average pulpal temperature increases were 4.3 degrees C for the high-speed preparation and 3.8 degrees C for the ultrasonic preparation, which were statistically similar (P=.052). However, significant differences were found (P<.001) for the time expended (3.3 minutes for the high-speed bur and 13.77 minutes for the ultrasound device). CONCLUSIONS: The intrapulpal temperatures produced during cavity preparation by ultrasonic tips versus high-speed bur preparation were similar. However, the use of the ultrasonic device required 4 times longer for the completion of a cavity preparation.

Increases in intrapulpal temperature during polymerization of composite resin.

STATEMENT OF PROBLEM: The polymerization of dental composite resins can generate increases in intrapulpal temperature that may damage the pulp. The development of new polymerization devices such as the argon laser makes the assessment of these temperatures important. PURPOSE: This study compared increases in temperature generated by argon laser and halogen light when polymerizing a bonding system and a composite resin, and also sought to determine whether both types of polymerization lights generate temperature increases below the safe limit of 5.5 degrees C. MATERIAL AND METHODS: Thermocouples linked to a temperature reading system were positioned in the pulp chamber of 10 extracted bovine incisors. Class V cavities were prepared, etched, and filled with a 1-bottle bonding system (Single Bond) and composite resin (Z-100). The test groups were as follows (n = 5 for all groups): halogen light for bonding system (HB); halogen light for composite resin (HC); argon laser for bonding system (LB), and argon laser for composite resin (LC). The polymerization parameters were halogen light operated at 600 mW/cm2 for 40 seconds, which served as control, and argon laser operated at 200 mW for 10 seconds. Data were analyzed by a 2-way (light versus material) analysis of variance (ANOVA) (alpha = .05). RESULTS: The average temperature increases were 2.35 degrees C (HB), 2.69 degrees C (HC), 1.25 degrees C (LB), and 1.5 degrees C (LC). Significant differences between halogen light and argon laser (P = .002), but not between composite and bonding system, were demonstrated. CONCLUSIONS: The argon laser produced significantly lower increases in pulpal temperature than the halogen light, independent of the thickness of the polymerized material.

Thermal curves of acrylic resins in microwave curing / Curvas térmicas de resinas acrílicas polimerizadas por energia de microondas

The use of microwave polymerization on acrylic resins is a clean and easy method to make complete dentures. It is observed that this kind of process may cause a higher porosity when compared to the conventional heated water bath, probably because of the excessive temperature increase. The objective of this study was the qualitative observation of the thermal curves generated on acrylic by the application of microwave energy in different polymerization cycles. Wax model dentures were reproduced, resulting in four specimens, within each one 7 thermocouples were positioned, havingdifferent reading sites of the specimens while the resin was polymerized in a conventional microwave oven. Four cycles were used: 1) three minutes at 475W; 2) 13 minutes at 95W + 1,5 minute at 475W; 3) three minutes at 475W with 150ml of water; and 4) seven minutes at 95W + seven minutes at 95W. The thermocouples were linked to data acquisition equipment, resulting in time-versus-temperature charts. It was concluded that lower power settings led to lower temperature increases. The use of minimum water load caused lower temperature peaks. The used method has a great value for temperature readings when polymerizing microwave acrylic resins

Water flow in high-speed handpieces.

OBJECTIVES: This study measured the water flow commonly used in high-speed handpieces to evaluate the water flow's influence on temperature generation. Different flow speeds were evaluated between turbines that had different numbers of cooling apertures. METHOD AND MATERIALS: Two water samples were collected from each high-speed handpiece at private practices and at the School of Dentistry at São José dos Campos. The first sample was collected at the customary flow and the second was collected with the terminal opened for maximum flow. The two samples were collected into weighed glass receptacles after 15 seconds of turbine operation. The glass receptacles were reweighed and the difference between weights was recorded to calculate the water flow in mL/min and for further statistical analysis. RESULTS: The average water flow for 137 samples was 29.48 mL/min. The flow speeds obtained were 42.38 mL/min for turbines with one coolant aperture; 34.31 mL/min for turbines with two coolant apertures; and 30.44 mL/min for turbines with three coolant apertures. There were statistical differences between turbines with one and three coolant apertures (Tukey-Kramer multiple comparisons test with P < .05). CONCLUSION: Turbine handpieces with one cooling aperture distributed more water for the burs than high-speed handpieces with more than one aperture.

Pulpal temperature increases with Er:YAG laser and high-speed handpieces.

STATEMENT OF PROBLEM: During tooth preparation, both high-speed handpieces and lasers generate heat, which, if not controlled, can cause pulpal necrosis. PURPOSE: The aim of this study was to compare temperature increases produced by a high-speed dental handpiece with those produced by a relatively new instrument, the Er:YAG (erbium: yttrium-aluminum-garnet) laser. MATERIALS AND METHODS: Thirty bovine mandibular incisors were reduced to an enamel/dentin thickness of 2.5 mm. Class V preparations were completed to a depth of 2.0 mm, measured with a caliper or by a mark on the burs. A thermocouple was placed inside the pulp chamber to determine temperature increases (degrees C). Analysis was performed on the following groups (n=10): Group I, high-speed handpiece without water cooling, Group II, high-speed handpiece with water cooling (30 mL/min), and Group III, the noncontact Er:YAG laser (2.94 microm at 350 mJ/10 Hz) with water cooling (4.5 mL/min). The temperature increases were recorded by a computer linked to the thermocouples. The data were analyzed using the Kruskal-Wallis test. The Dunn multiple comparison test was used as post hoc test (alpha=.05). RESULTS: The average temperature rises were: 11.64 degrees C (+/- 4.35) for Group I, 0.96 degrees C (+/- 0.71) for Group II, and 2.69 degrees C (+/- 1.12) for Group III. There were no statistical differences between Groups II and III; both II and III differed from Group I significantly (P=.000 and P=.002, respectively). CONCLUSION: The preparations made with the high-speed and the laser instrument generated similar heat increases under water cooling. Water cooling was essential to avoid destructive temperature increases when using both the high-speed handpiece and laser.

High-speed cavity preparation techniques with different water flows.

STATEMENT OF PROBLEM: Cavity and tooth preparations generate heat because the use of rotary cutting instruments on dental tissues creates friction. Dental pulps cannot survive temperature increases greater than 5.5 degrees C. PURPOSE: This study evaluated the efficiency of 3 different water flows for 2 different tooth preparation techniques to determine which are safe for use. MATERIAL AND METHODS: Thermocouples were placed in the pulpal chambers of 30 bovine teeth, and 1 of 2 tooth preparation techniques was used: a low-load intermittent tooth preparation technique or a high-load tooth preparation technique without intervals. Water flows of 0, 30, and 45 mL/min were associated with each technique, for a total of 6 different groups. The results were analyzed with a 2-factor analysis of variance (P<.05). RESULTS: Temperature increases with the high-load technique were 16.40 degrees C without cooling (group I), 11.68 degrees C with 30 mL/min air-water spray cooling (group III), and 9.96 degrees C with 45 mL/min cooling (group V). With the low-load tooth preparation technique, a 9.54 degrees C increase resulted with no cooling (group II), a 1.56 degrees C increase with 30 mL/min air-water spray cooling (group IV), and a 0.04 degrees C decrease with 45 mL/min cooling (group VI). The low-load technique was associated with more ideal temperature changes. CONCLUSION: The results of this study confirm the necessity of using a low-load technique and water coolants during cavity and tooth preparation procedures.