Effect of a calcium phosphate-containing desensitizing agent on postoperative sensitivity: A split-mouth, randomized controlled study.

PURPOSE: To evaluate the effectiveness of a calcium phosphate-containing-desensitizer (Teethmate Desensitizer - TD), caries type, subject age, and preoperative hypersensitivity on postoperative sensitivity (POS) after composite restorations on deep or extremely deep lesions. METHODS: 50 subjects, having two teeth with deep or extremely deep caries, participated in this study. TD was applied randomly to one tooth of each participant, and all teeth were restored with composite resin (Filtek Z250). After 1 week, POS was evaluated according to NRS (numerical rating scale) and VAS (visual analogue scale) by using participant diaries. At 6 weeks, POS was assessed considering subjects' reports. The normality of data was analyzed with Shapiro-Wilk test. For analyses, Pearson's chi-squared test, Mann-Whitney U and the Wilcoxon Signed-Rank test were used, and the effect sizes (ES) were calculated (α= 0.05). RESULTS: 47 of the participants completed the 6-week study. There was a small effect size noted for TD for NRS and VAS (P> 0.05, ES < 0.30). Also, there was no statistically significant difference between POS and subject age (P= 0.294, ES= 0.161), type of caries (P= 0.680, ES= 0.042) and preoperative sensitivity (P= 1.000, ES= 0.138) after the first week. CLINICAL SIGNIFICANCE: Teethmate Desensitizer had no significant effect on postoperative sensitivity occurrence with respect to caries type, subject age, and existence of preoperative sensitivity. The application of Teethmate Desensitizer demonstrated no significant relieving effect on postoperative sensitivity in deep or extremely deep cavities.

How does radiotherapy affect the adhesion of universal adhesive to enamel and dentin? A qualitative and quantitative analysis? / Efecto de la radioterapia a la adhesión del adhesivo universal al esmalte y dentina? Un análisis cualitativo y cuantitativo?

Abstract This study investigated the shear bond strength (SBS) of a universal adhesive to enamel/dentin; 1) that had undergone radiotherapy (RT) and 2) that were readily restored and had undergone RT. Enamel and dentin surfaces were obtained from 90 intact human molars. They were randomly divided into six groups according to the presence and timing of irradiation (RT0:no radiotherapy/control, RT1:RT before restoration, RT2:RT after restoration groups) and adhesive application modes (etch&rinse/ER, self-etch/SE)(n=15). A universal adhesive and resin composites were applied. The radiotherapy protocol was conducted with 60 Gy. The SBS test was subjected (1mm/min) and failure type analysis was performed. The resin-enamel/dentin interfaces were examined. Data were statistically analyzed. For enamel and dentin, the presence and timing of irradiation did not significantly influence the SBS values (p>0.05). For enamel, significantly higher SBS values were obtained using etch&rinse mode than self-etch mode (p<0.05). The predominant failure was mixed type. Loss of enamel prisms and obliterated irregular dentinal tubules were found for the radiotherapy-treated specimens. Resin tags were clearer in the irradiated enamel treated with ER than SE. Irradiation with different timings did not influence the bond strength to enamel and dentin, negatively. Irrespective of radiotherapy, the etch&rinse mode caused higher bond strength to enamel than self-etch mode.

Resumen Este estudio investigó la fuerza de unión al cizallamiento (SBS) de un adhesivo universal al esmalte/dentina en piezas que se habían sometido a radioterapia (RT). Se obtuvieron superficies de esmalte y dentina de 90 molares humanos intactos. Se dividieron aleatoriamente en seis grupos según la presencia y el momento de la irradiación (RT0: sin radioterapia/control, RT1: RT antes de la restauración, RT2: RT después de la restauración considerando los modos de aplicación del adhesivo (n=15). Se aplicó un adhesivo universal y resinas compuestas. El protocolo de radioterapia se realizó con 60 Gy. Se sometió a la prueba adhesiva (1mm/min) y se realizó análisis del tipo de falla. Se examinaron las interfases resina-esmalte/dentina. Los datos fueron analizados estadísticamente. Para el esmalte y la dentina, la presencia y el momento de la irradiación no influyeron significativamente en los valores adhesivos (p>0,05). Para el esmalte, se obtuvieron valores adhesivos significativamente más altos utilizando el modo de grabado y enjuague que el modo de autograbado (p<0,05). La falla predominante fue de tipo mixto. Se encontró pérdida de prismas de esmalte y túbulos dentinarios irregulares obliterados en las muestras tratadas con radioterapia. La irradiación con diferentes tiempos no influyó negativamente en la fuerza de unión al esmalte ni a la dentina. Independientemente de la radioterapia, el modo de grabado ácido y enjuague provocó una mayor fuerza de adhesión al esmalte que el modo de autograbado.

Influence of operator experience on bond strength of different adhesives to dentin.

AIM: Application of adhesive systems on dentin is a multistep, technique-sensitive procedure. Thus, the aim was to assess the effect of operator experience on the shear bond strength of an etch-and-rinse adhesive system and a self-etch adhesive system on dentin. MATERIALS AND METHODS: Forty-eight extracted human molar teeth were used in the study. They were embedded in an acrylic resin after cutting off the roots. The mesial and distal enamels of the teeth were removed to expose dentin surfaces. The samples were allocated to four groups (n = 12): Group 1: restorative dentistry specialist with 13 years of experience, Group 2: with 6 years of experience, Group 3: postgraduate operator with 2 years of experience, and Group 4: undergraduate student with 1 year of experience and familiar with adhesive with systems. Each operator applied an etch-and-rinse adhesive system (Adper Single Bond 2) to mesial surface and a self-etch adhesive system (Clearfil SE Bond) to distal surface (n = 12). Then, a composite resin (Filtek Z250) was inserted with the aid of a plastic ring (2 mm × 2 mm) and light polymerized. The specimens were stored in distilled water before shear bond strength test. A two-way ANOVA test was used for statistical analysis. RESULTS: No statistically significant difference was found between each operator type with respect to etch-and-rinse adhesive system (P > 0.05); however, the undergraduate student performed better than 2-year experienced operator with respect to self-etch system application (P < 0.05). CONCLUSION: The shear bond strength of a self-etch system might vary according to the operator's experience.

Awareness about dental amalgam among Turkish dentists and patients: a questionnaire and search engine based cross-sectional study.

OBJECTIVES: There has been considerable controversy concerning the health risks and benefits of using mercury-containing amalgam. This study aimed to evaluate the Turkish dentists' and patients' preference and opinion about amalgam and to assess Internet search trends about amalgam. METHODS: The study consists of three stages. The first two stages of the study are cross-sectional studies to verify both the patients' perception with amalgam restorations and dentists' attitudes regarding the use of dental amalgam. The third stage of the study evaluated the Internet search trends of Turkish people about mercury and amalgam related concerns between 2004 and 2018. RESULTS: A total of 320 patients (180 female, 140 male) and 1,211 dentists (533 female, 678 male) participated in this study. Majority of the patients have no idea about the type of dental restorations and effect of dental materials on their health. 188 (58.8%) participants stated that they would not prefer amalgam restoration in their teeth as amalgam is unaesthetic. A total of 24% (291) of the dentists used amalgam routinely; 9.5% (156) of them used amalgam rarely, and 63.1% (764) did not use amalgam at all. The reason for not using amalgam included the patients' desire and unaesthetic properties. According to the Internet search trends, Turkish people do not know as much about amalgam as people in the rest of the world. CONCLUSION: Awareness about dental amalgam is low among patients studied. Although dentists do not use dental amalgam frequently, they disagree on banning dental amalgam.

Dental students' ability to assess their performance in a preclinical restorative course: comparison of students' and faculty members' assessments.

Dental education consists of both theoretical and practical learning for students to develop competence in treating patients clinically. When dental students encounter practical courses in their first year as a new educational experience, they must also learn to evaluate themselves. Self-evaluation is an essential skill to learn for dental professionals to keep increasing their competence over the course of their careers. The aim of this study was to compare the assessment scores of second- and third-year dental students and the faculty in two consecutive preclinical practical exams in restorative dentistry courses in a dental school in Turkey. Faculty- and student-assigned scores were calculated from two consecutive preclinical examinations on tooth restorations performed on both artificial casts and phantom patients. The students were formally instructed on grading procedures for tooth preparations, base and restoration placement, and polishing criteria. After each step, each item was assessed by faculty members, the student, and another student. The results indicated that the initial differences between second-year students' assessments of their own preclinical practical ability and that of the faculty decreased among the third-year students. Self-evaluation scores did not indicate whether the third-year students tended to over- or underestimate the quality of their own work. However, the second-year students not only overestimated themselves but thought they were above average. The results point to the need to develop students' self-insight with more exercises and practical training.

Resin composite repair: Quantitative microleakage evaluation of resin-resin and resin-tooth interfaces with different surface treatments.

OBJECTIVE: The aim was to evaluate the effect of different adhesive systems and surface treatments on the integrity of resin-resin and resin-tooth interfaces after partial removal of preexisting resin composites using quantitative image analysis for microleakage testing protocol. MATERIALS AND METHODS: A total of 80 human molar teeth were restored with either of the resin composites (Filtek Z250/GrandioSO) occlusally. The teeth were thermocycled (1000×). Mesial and distal 1/3 parts of the restorations were removed out leaving only middle part. One side of the cavity was finished with course diamond bur and the other was air-abraded with 50 µm Al2O3. They were randomly divided into four groups (n = 10) to receive: Group 1: Adper Single Bond 2; Group 2: All Bond 3; Group 3: ClearfilSE; Group 4: BeautiBond, before being repaired with the same resin composite (Filtek Z250). The specimens were re-thermocycled (1000×), sealed with nail varnish, stained with 0.5% basic fuchsin, sectioned mesiodistally and photographed digitally. The extent of dye penetration was measured by image analysis software (ImageJ) for both bur-finished and air-abraded surfaces at resin-tooth and resin-resin interfaces. The data were analyzed statistically. RESULTS: BeautiBond exhibited the most microleakage at every site. Irrespective of adhesive and initial composite type, air-abrasion showed less microleakage except for BeautiBond. The type of initial repaired restorative material did not affect the microleakage. BeautiBond adhesive may not be preferred in resin composite repair in terms of microleakage prevention. CONCLUSIONS: Surface treatment with air-abrasion produced the lowest microleakage scores, independent of the adhesive systems and the pre-existing resin composite type. Pre-existing composite type does not affect the microleakage issue. All-in-one adhesive resin (BeautiBond) may not be preferred in resin composite repair in terms of microleakage prevention.

Clinical evaluation of resin-based composites in posterior restorations: a 3-year study.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of a nanohybrid and a microhybrid composite in class I and II restorations after 3 years. SUBJECTS AND METHODS: A total of 82 class I and class II restorations were performed in 31 patients (10 males and 21 females) using Grandio and QuiXfil with self-etch adhesives (Futurabond and Xeno III). The restorations were clinically evaluated by 2 operators 1 week after placement (baseline) and at 6 months and 1, 2, and 3 years using modified United States Public Health Service (USPHS) criteria. At the 3-year follow-up, 62 class I and class II cavities were reevaluated in 23 patients (7 males and 16 females). Statistical analysis was performed using Pearson's χ(2) and Fisher's exact tests (p < 0.05). RESULTS: At the 6-month follow-up, all restorations received Alfa scores with respect to each evaluation criterion. At the 1-year follow-up, 2 QuiXfil restorations had to be replaced and Grandio restorations started to deteriorate in terms of marginal adaptation. At the end of 2 years, 9 Grandio restorations showed significant deterioration of the surface properties, demonstrating Bravo scores. At the end of 3 years, no significant differences were observed regarding color match, marginal adaptation, secondary caries, marginal discoloration, and anatomic form loss between the evaluated materials in 25 class I and 37 class II restorations. At the 3-year follow-up, Grandio restorations had 21% Bravo scores and showed significant deterioration of the surface properties, which were still clinically acceptable according to USPHS criteria. Three QuiXfil and 1 Grandio restorations were replaced because of secondary caries and loss of retention. CONCLUSIONS: Both the nanohybrid (Grandio) and the microhybrid (QuiXfil) composites were clinically functional after 3 years.

1 year clinical evaluation of microhybrid composites used in the restoration of non-carious cervical lesions.

AIM: Microhybrid composite resins are commonly used to treat non-carious cervical lesions. The aim of this double blind study was to compare the 12-month clinical performance of cervical restorations placed with the use of two different microhybrid composite resins. METHODS: 20 patients with at least one pair of non-carious cervical lesion participated in this study. Ninety-seven cervical lesions were restored with either TPH Spectrum (n=48) or Filtek Z250 (n=49) using a two-step etch &rinse adhesive (Single Bond 2) Restorations were evaluated using modified USPHS criteria after 6 and 12 months. The statistical comparison of resin composites for each category was performed with the Pearson chi square test and the performance of restorations at the baseline, 6 months and after 12 month recall time was evaluated by Mc Nemar's test (p<0.05). RESULTS: The recall rate of the patients was 100% at each evaluation period. The retention rates were 100% at six months,89,6% and 91,8% at 12-months for TPH and Z250, respectively and no statistically significant difference was observed with respect to each evaluation criteria (p>0.05). CONCLUSION: Cervical restorations placed with two different microhybrid composites and a two-step etches and rinse system showed satisfactory clinical performance after 12-months.

Effect of haemostatic agent application on the shear bond strength of contemporary/multi-mode adhesive systems.

OBJECTIVES: The aim was to determine the effect of blood contamination and haemostatic agent application on the shear bond strength (SBS) of different adhesives to dentin. MATERIALS AND METHODS: Seventy-two extracted human molars were used in this study. Teeth were mounted acrylic in moulds. Mesial and distal surfaces were removed to obtain flat dentin surfaces (n=144) and grinded with a 600 grit sandpaper. The samples were randomly divided into three main groups (N=48) based on the adhesive system and application procedures. GROUP 1: No contamination (control), GROUP 2: Blood contamination, GROUP 3: Blood Contamination+Haemostatic agent application. Each group was further divided into four subgroups: SUBGROUP I: Single Bond 2 (etch-and-rinse) Subgroup II: Clearfil SE Bond (two-step self-etch) Subgroup III: Single Bond Universal (multimode, etch-and-rinse) subgroup IV: Single Bond Universal (multimode, all-in-one self-etch) (n=12). Resin cylinders (Filtek Z550) were bonded to the dentin surfaces according to the manufacturers' instructions. A shear load was applied to the specimens using universal testing machine at a cross-head speed of 0.5 mm/min until failure. Data were analyzed statistically (p<0.05). RESULTS: Statistically significant differences were observed between no contamination (control) and blood + haemostatic agent contamination groups for both Single Bond 2 (etch-and-rinse) and Single Bond Universal (multimode, all-in-one self-etch) (p<0.05). When the adhesive systems were compared to each other, no statistically significant differences were found in all contamination groups and control group for the mean SBS values (p>0.05). CONCLUSION: When blood contamination is inevitable two step self- etching adhesive systems may be the choice of adhesive system in terms of shear bond strength.

Do adhesive systems leave resin coats on the surfaces of the metal matrix bands? An adhesive remnant characterization.

Reestablishing proximal contacts with composite resins may prove challenging since the applied adhesives may lead to resin coating that produces additional thickness. The aim of this study was to investigate the surface of metal matrix bands after application of adhesive systems and blowing or wiping off the adhesive before polymerization. Seventeen groups of matrix bands were prepared. The remnant particles were characterized by energy dispersive spectrum and scanning electron microscopy. Total etch and two-step self-etch adhesives did not leave any resin residues by wiping and blowing off. All-in-one adhesive revealed resin residues despite wiping off. Prime and Bond NT did not leave any remnant with compomer. Clinicians must be made aware of the consequences of possible adhesive remnants on matrix bands that may lead to a defective definitive restoration. The adhesive resin used for Class II restorations may leave resin coats on metal matrix bands after polymerization, resulting in additional thickness on the metal matrix bands and poor quality of the proximal surface of the definitive restoration when the adhesive system is incorporated in the restoration.

Rehydration of a reattached fractured tooth fragment after prolonged dehydration.

Crown fractures of the anterior teeth are one of the most common outcomes of trauma to the orofacial region. The reattachment of dental fragments is a conservative treatment and should be considered a primary treatment choice in the restoration of anterior tooth fractures. This article presents a clinical technique for the restoration of a fractured maxillary lateral incisor by reattaching the tooth fragment that was kept in dry conditions for five days with the aid of adhesive dentistry. The esthetic compromise of white color (due to excessive dehydration of the segment) was reconciled after one month of service in the mouth by regaining the natural color by rehydration. The one-year clinical evaluation revealed a successful outcome for this technique, and the patient was pleased with the esthetic results of the conservative treatment modality.

The effects of prophylactic ozone pretreatment of enamel on shear bond strength of orthodontic brackets bonded with total or self-etch adhesive systems.

OBJECTIVES: The aim of this in vitro study is to determine (1) shear bond strength (SBS) of brackets bonded with self-etch and total-etch adhesive after ozone treatment (2) bond failure interface using a modified Adhesive Remnant Index (ARI). METHODS: 52 premolars were randomly assigned into four groups (n=13) and received the following treatments: Group 1: 30 s Ozone (Biozonix, Ozonytron, Vehos Medikal, Ankara, Turkey) application + Transbond Plus Self-Etching Primer (SEP) (3M) + Transbond XT (3M), Group 2: Transbond Plus SEP + Transbond XT, Group 3: 30 s Ozone application + 37% orthophosphoric acid + Transbond XT Primer (3M) + Transbond XT, Group 4: 37% orthophosphoric acid + Transbond XT Primer + Transbond XT. All samples were stored in deionised water at 37°C for 24 hours. Shear debonding test was performed by applying a vertical force to the base of the bracket at a cross-head speed of 1 mm/min. RESULTS: The mean SBS results were Group 1: 10.48 MPa; Group 2: 8.89 MPa; Group 3: 9.41 MPa; Group 4: 9.82 MPa. One-Way Variance Test revealed that the difference between the groups was not statistically significant (P=0.267). Debonded brackets were examined by an optical microscope at X16 magnification to determine the bond failure interface using a modified ARI. The results were (mean) Group 1: 2.38; Group 2: 1.31; Group 3: 3.00; Group 4: 1.92. Multiple comparisons showed that Groups 1 and 2, 2 and 3, 3 and 4 were statistically different (P=0.014, P<.001 and P=0.025). CONCLUSIONS: Ozone treatment prior to bracket bonding does not affect the shear bond strength.

Clinical evaluation of resin-based composites in posterior restorations: two-year results.

OBJECTIVE: This study evaluated the clinical performance of a nanohybrid and a low shrinkage posterior composite in Class I and II restorations after two years. METHODS AND MATERIALS: A total of 82 Class I and Class II cavities were restored in 31 patients (10 male, 21 female) by one clinician using Grandio and Quixfil and the manufacturers' self-etch adhesives (Futura Bond and Xeno III) according to the manufacturers' instructions. Two previously calibrated operators clinically evaluated the restorations one week after placement (baseline) and six months, one year and two years after placement using modified USPHS criteria. Statistical analysis was completed using the Pearson Chi-square and Fisher's Exact Test (p<0.05). RESULTS: All patients attended the 12-month recall and no lack of retention was observed. With respect to color match, marginal adaptation, secondary caries and surface texture, no significant differences have been found between the two restorative materials that were tested after 12 months (p>0.05). None of the restorations had shown any marginal discoloration and anatomic form loss until the end of the 12-month period. Two-year recall data demonstrated an 83.87% recall rate (26 patients). Grandio restorations showed a significant deterioration of the surface properties that demonstrated 26% Bravo scores, which are still clinically acceptable. None of the restorations exhibited postoperative sensitivity at any evaluation period. CONCLUSIONS: It was concluded that nanofill (Grandio) and posterior composite (Quixfil) demonstrated acceptable clinical performance after two years. However, further evaluations are necessary for the long-term clinical performance of these materials.

Amalgam repair: quantitative evaluation of amalgam-resin and resin-tooth interfaces with different surface treatments.

AIM: The successful addition of new restorative materials to an existing restoration may be the most conservative course of treatment. Repairing amalgam restorations with resin materials remains a viable clinical alternative to amalgam replacement. This in vitro study evaluated the effect of different adhesive systems and surface treatments on the integrity of amalgam-resin and resin-tooth interface after partial removal of pre-existing amalgam. MATERIALS AND METHODS: Fifty defect-free human molars were restored with amalgam occlusally. The teeth were thermocycled (1,000x) between 5 degrees C and 55 degrees C, with a dwell time of 30 seconds. The mesial and distal parts of the amalgam fillings were removed, leaving only the middle part of amalgam. One side of the cavity was finished with a coarse diamond bur, while the other part of the amalgam was finished with a fine diamond bur. The samples were then randomly divided into five groups (n = 10/group) and received the following adhesive systems: Group 1: All Bond 3 (BISCO, Inc); Group 2: Clearfil SE Bond+Alloy Primer (Kuraray); Group 3: Kuraray DC Bond (Kuraray); Group 4: Xeno V (Dentsply); Group 5: XP Bond (Dentsply). All the cavities were restored with resin composite (TPH Spectrum, Dentsply). All the materials were used according to the manufacturer's directions. The specimens were re-thermocycled (1,000x), sealed with nail varnish, stained with 0.5% basic fuchsin for 24 hours, sectioned mesiodistally and photographed digitally. The extent of dye penetration on the tooth-sealant interface was measured by image analysis software (ImageJ, Scion Image, Frederick, Maryland, USA) for both coarse-finished and fine-finished surfaces at the resin-tooth and resin-amalgam interface. The data were analyzed statistically with one-way ANOVA and post hoc Tukey tests (alpha = 0.05). RESULTS: All Bond 3 and XP bond (etch & rinse) produced the best results at each section. All the materials exhibited more microleakage at the amalgam interface than the tooth interface. Surface finishing with different burs did not statistically affect microleakage. CONCLUSION: In terms of microleakage reduction, etch & rinse adhesives may be preferred over self-etch adhesives for amalgam repair.

Clinical evaluation of resin-based composites in posterior restorations: 12-month results.

OBJECTIVES: The purpose of this study was to evaluate and compare the 12 month clinical performances of two different posterior composites in Class I and Class II restorations. METHODS: Thirty-one patients (10 male, 21 female) were recruited into the study. A total of 82 Class I and Class II cavities were restored with either a nanohybrid composite (Grandio) or a low-shrinkage composite (Quixfil), using their self etch adhesives (Futura Bond and Xeno III) according to manufacturers' instructions. The restorations were clinically evaluated 1 week after placement as baseline, and after 6 and 12 months post-operatively using modified USPHS criteria by two previously calibrated operators. Statistical analysis were performed using Pearson Chi-square and Fisher's Exact Test (P<.05). RESULTS: All patients attended the 12-month recall. Lack of retention was not observed in any of the restorations. With respect to color match, marginal adaptation, secondary caries and surface texture, no significant differences were found between two restorative materials tested after 12 months (P>.05). None of the restorations had marginal discoloration and anatomic form loss on the 12 month follow-up. Restorations did not exhibit post-operative sensitivity at any evaluation period. CONCLUSIONS: Clinical assessment of nanohybrid (Grandio) and low-shrinkage posterior composite (Quixfil) exhibited good clinical results with predominating alpha scores after 12 months. However; further evaluations are necessary for the long-term clinical performance of these materials.

Effect of LED curing on marginal integrity of an ormocer-based sealant.

PURPOSE: The purpose of this study was to investigate the microleakage of a light cured, ormocer-based fissure sealant when photopolymerized with 2 different light emitting diode (LED) curing units and a conventional quartz-tungsten halogen (QTH) light-curing unit. METHODS: Thirty freshly extracted, unerupted human third molars from 9 adolescent were randomly assigned into 3 groups (N=10/group). Pits and fissures were acid etched for 30 seconds, rinsed for 15 seconds with an air-water spray, and air-dried. An ormocer-based fissure sealant material (Admira Seal) was applied to all fissures. In group 1, the sealant was photopolymerized with a Smart Light LED curing unit (Dentsply) for 10 seconds. Another LED curing unit (Elipar II) and a conventional QTH curing unit (Hilux) were used in groups 2 and 3 for 10 and 30 seconds, respectively. Specimens were immersed in 0.5% basic fuchsin for 24 hours, sectioned and examined under a stereomicroscope, and scored for marginal microleakage. RESULTS: Statistical analysis of microleakage scores revealed no significant difference among the groups tested (P>.05, Kruskal-Wallis test). CONCLUSION: The tested LED curing units may provide reduction in total application time without comprising marginal integrity of the ormocer-based sealant.

Fiber-reinforced technology in multidisciplinary chairside approaches.

There is an increasing demand to improve dentofacial esthetics in the adult population. This demand usually requires a close collaboration within the various disciplines of dentistry and the patient at every stage of the therapy. The materials and techniques used by these interdisciplinary clinicians must be conservative and minimally invasive. Fiber-reinforced composite technology offers such solutions for chairside applications. This case report presents two cases where fiber-reinforced ribbon and composite complex was used in a multidisciplinary approach to improve esthetics.

A comparison of white spot lesion formation between a self-ligating bracket and a conventional preadjusted straight wire bracket.

AIM: Demineralization following removal of orthodontic appliances is a common problem. Presence of archwires, especially those with loops and different types of ligatures, complicate cleaning around bands and brackets during orthodontic treatment. These factors led clinicians to develop self-ligating brackets. The purpose of this study was to compare the incidence of white spot lesion formation with the use of a self-ligating bracket with conventional preadjusted straight wire brackets. METHODS: Twenty patients were randomly divided into 2 groups. In the first group (aged 13.4 ± 2.5 years), the teeth were bonded with In-ovation brackets; the second group's (aged 14 ± 3.34 years) teeth were bonded with conventional preadjusted straight wire brackets. The patients were followed throughout treatment, and the number of white spot lesions was noted at debonding. RESULTS: The results revealed no statistically significant differences in white spot lesion development between conventional straight wire and self-ligating brackets. CONCLUSION: No differences in terms of white spot lesion formation were found between conventional straight wire and self-ligating brackets, and white spot lesion formation does depend largely on patients' oral hygiene status, not the type of bracket or ligation used.

The influence of Er:YAG laser conditioning versus self-etching adhesives with acid etching on the shear bond strength of orthodontic brackets.

OBJECTIVE: The aim of this study was to compare the shear bond strength (SBS) of orthodontic brackets after acid etching, laser ablation, self-etching primer application, and combined treatments. METHODS: One hundred defect-free premolars were randomly assigned to five groups. The teeth received the following treatments: group 1: phosphoric acid + Transbond XT primer; group 2: Transbond Plus Self-Etching Primer (TPSEP); group 3: Er:YAG laser ablation + Transbond XT primer; group 4: Er:YAG laser ablation + phosphoric acid + Transbond XT primer; and group 5: Er:YAG laser ablation + TPSEP. Transbond XT Adhesive Paste was used in all groups for bracket bonding. Samples were stored in deionized water at 37 degrees C for 24 h. The shear debonding test was performed at a crosshead speed of 5 mm/min. Failed brackets were examined by a stereomicroscope at 16 x magnification to determine the bond failure interface using a modified adhesive remnant index (ARI). SBS values were compared using one-way analysis of variance (ANOVA). The Kruskal-Wallis test was used for ARI scores and pairwise comparisons were done using the Mann-Whitney U test with Bonferroni correction. RESULTS: Mean SBS values (MPa) and standard deviations for the groups were: group 1, 13.18 +/- 3.45; group 2, 13.52 +/- 4.38; group 3, 10.33 +/- 4.74; group 4, 13.00 +/- 3.47; and group 5, 12.46 +/- 6.31. No significant differences were observed in the SBS of all the groups evaluated, but there was a significant difference in ARI scores, with group 3 showing higher ARI scores than groups 1 and 4. CONCLUSIONS: Er:YAG laser ablation and self-etching primer application showed similar SBS values as conventional acidetching for bonding brackets.

Re-attachment of a fractured tooth: a case report.

A 16-year-old patient who fractured her maxillary central incisors is presented. One of the original tooth fragments was available. The fracture was clean and there was no pulpal exposure. Juxtaposition of the fragment to the tooth showed that the margins of each fitted well against each other and no interfragmentary space was present. The fragment was re-attached with an adhesive bonding agent and the other tooth was restored with a resin composite. The esthetic result achieved in a single appointment was excellent. The tooth was vital and there was no change in the color of the tooth in 1-year recall.