Towards a better understanding of the adhesion mechanism of resin-modified glass-ionomers by bonding to differently prepared dentin.

OBJECTIVES: The purpose of this study was to evaluate the bonding effectiveness of a resin-modified glass-ionomer (RMGI) to differently prepared dentin and how this restorative material interacts with these distinct substrates. Also the potential adhesion-promoting role of a polyalkenoic-acid conditioner was assessed. METHODS: Forty-eight dentin surfaces were prepared from sound human molars and randomly distributed among 6 experimental groups. Fuji II LC (GC) was applied on bur-cut (100 µm diamond), fractured and Er:YAG laser-irradiated (200mJ, 10Hz, 31.4J/cm(2)) dentin with or without the beforehand application of the aqueous polyalkenoic-acid conditioner, Cavity Conditioner (GC). After 7 days of storage in water at 37 °C, specimens were prepared for microtensile bond strength testing (µTBS), as well as for TEM characterization of the resultant RMGI-dentin interface. Statistical analysis of the µTBS results was performed using ANOVA and Tukey's test (p<0.05). RESULTS: The use of conditioner resulted in a significantly higher bond strength only when dentin was prepared by diamond bur (p<0.05). Laser irradiation induced micro-cracks on the dentin surface and led to the lowest bond strength, irrespective of the use of conditioner (p<0.05). Fuji II LC was able to partially demineralise (up to 2.0µm) and infiltrate bur-cut and fractured dentin, but no evident interaction was observed at the interface between the RMGI and laser-irradiated dentin. CONCLUSIONS: Laser-induced surface modifications impaired the interaction of the RMGI with dentin, thereby negatively influencing its bonding effectiveness. The use of a polyalkenoic-acid conditioner remains crucial for the RMGI to bond effectively to bur-cut dentin.

Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: part 2. present-day adhesion to erbium-lased tooth structure in permanent teeth.

With the introduction of the Er:YAG laser, it has become possible to remove enamel and dentin more effectively and efficiently than with other lasers. Thermal damage is reduced, especially in conjunction with water spray. Since FDA (Federal Drug Administration) approval of the Er:YAG laser in 1997--for caries removal, cavity preparation and conditioning of tooth substance - there have been many reports on the use of this technique in combination with composite resins. Moreover, cavity pretreatment with Er:YAG laser (laser etching) has been proposed as an alternative to acid etching of enamel and dentin. Reports evaluating the adhesion of glass-ionomer cements to Er:YAG-lased tooth substance are scarce. This article reviews the literature regarding adhesion and sealing efficacy using different (pre)treatment protocols in association with Er:YAG laser preparation. Recent research has shown that lasing of enamel and dentin may result in surface and subsurface alterations that have negative effects on both adhesion and seal. It is concluded that at present, it is advisable to respect the conventional pretreatment procedures as needed for the respective adhesive materials. Although the majority of present day reports show that microleakage and bond strength are negatively influenced by laser (pre)treatment (compared with conventional preparation), there is ongoing discussion of how adhesion is best achieved on Er:YAG-lased surfaces.

Microleakage of glass ionomer formulations after erbium:yttrium-aluminium-garnet laser preparation.

The aim of this study was to investigate the microleakage in class V cavities restored with four conventionally setting glass ionomers (CGIs) and one resin-modified glass ionomer (RMGI) following erbium:yttrium-aluminium-garnet (Er:YAG) laser or conventional preparation. Four hundred class V cavities were assigned to four groups: A and B were prepared by an Er:YAG laser; C and D were conventionally prepared. In groups B and D, the surface was additionally conditioned with Ketac conditioner. Each group was divided into five subgroups according to the glass ionomer cement (GIC) used: groups 1 (Ketac Fil), 2 (Ketac Molar), 3 (Ionofil Molar), 4 (Ionofil Molar Quick) and 5 (Photac Fil Quick). After thermocycling, a 2% methylene blue solution was used as dye. Scanning electron microscope (SEM) photographs were taken to show the conditioner's effect. Complete marginal sealing could not be reached. PhotacFil showed less microleakage than the conventionally setting glass ionomer cements (CGICs) investigated. Conditioning laser-prepared cavities did not negatively influence microleakage results except for Ionofil Molar Quick.

Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: part 1. Laser-assisted cavity preparation.

The use of the ruby laser (693.4 nm) was first described in 1960, and it was applied for hard tissue ablation in 1964. Different wavelengths [Nd:YAG (1.065 microm), CO2 (9.6 microm), Ho:YAG (2.12 microm)] were consequently explored. Due to massive thermal side effects, these wavelengths caused increased temperature in dental pulp, as well as microcracks and carbonization. The use of this laser for dental hard tissue preparation was eventually abandoned. At the end of the 1980s, excimer lasers (ultraviolet) and the erbium laser (infrared) were developed, with the advantages of improved temperature control and smaller penetration depths. With the development of smaller devices and improved knowledge of how to limit damage to the surrounding tissues, new ablation techniques were established in the 1990s. There is still contradiction in the current literature, however, in that different wavelengths are advocated for hard tissue removal, and heterogeneity in laser parameters and power densities remain. In this review, the effects of the wavelengths presently used for cavity preparation are evaluated. We conclude that erbium lasers (Er:YAG and Er,Cr:YSGG) are most efficient and, with the right parameters, the thermal side effects are small. There is a substantial need for "gold standards", although this is difficult to establish in practice owing to different laser parameters (including pulse repetition rate, amount of cooling, energy delivered per pulse, and types of pulses) and target specificity (tissue interaction with sound or decayed enamel or dentin, and the extent of (de)mineralization) which influence tissue interaction.

Transmission electron microscopic examination of the interface between a resin-modified glass-ionomer and Er:YAG laser-irradiated dentin.

OBJECTIVE: The aim of this study was to analyze the ultrastructural characteristics of the interface between a resin-modified glass ionomer (RMGI) and Er:YAG laser-irradiated dentin. BACKGROUND DATA: The Er:YAG laser has been considered as a possible alternative for cavity preparation, but the interaction between glass ionomers and Er:YAG-lased dentin still needs further investigation. MATERIALS AND METHODS: Five dentin surfaces were prepared by diamond bur (120,000 rpm) as controls or for Er:YAG laser irradiation (31.45 J/cm(2), 200 mJ, 10 Hz, 100 micros). The RMGI Fuji II LC (GC) was then applied to their surfaces, which were previously conditioned with a 20% polyalkenoic acid conditioner. The samples were sealed with an unfilled resin, stored in distilled water for 1 wk at 37 degrees C, and then processed for transmission electron microscopic (TEM) examination. RESULTS: When applied to bur-cut dentin (controls), Fuji II LC was able to partially demineralize the dentin surface, resulting in the formation of a hybrid layer, on top of which a sub-micron gel-phase was observed. In the laser-irradiated samples, the RMGI was in close contact with the irregular dentin substrate, but no hybrid layer or gel-phase formation could be detected, nor were there signs of dentin demineralization or collagen melting. Horizontal cracks were clearly seen in the sub-surface layer of dentin. CONCLUSION: Although presenting horizontal micro-cracks in its sub-surface, the irregular laser-irradiated dentin showed close contact with the RMGI. However, no hybrid layer or gel-phase could be detected, and there were no signs of dentin demineralization and collagen melting.

Microleakage of four different restorative glass ionomer formulations in class V cavities: Er:YAG laser versus conventional preparation.

OBJECTIVE: To investigate microleakage in class V cavities following restoration with conventional glass-ionomer cements (CGICs) or resin-modified glass-ionomer cements (RMGICs), following Er:YAG laser or conventional preparation. BACKGROUND DATA: The sealing ability of GICs in Er:YAG-lased cavities has not been studied extensively. METHODS: Three hundred and twenty class V cavities were assigned to four groups: those in groups A and B were prepared using an Er:YAG laser, and those in groups C and D were conventionally prepared. In groups B and D the surface was additionally conditioned with cavity conditioner. Each group was subdivided according to the GIC used: groups 1 (Fuji II), 2 (Fuji IX), 3 (Fuji II LC) and 4 (Fuji VIII). After thermocycling, the specimens were immersed in a 2% methylene blue solution, sectioned oro-facially, and analyzed for leakage. The effect of the conditioner was analyzed using a scanning electron microscope (SEM). RESULTS: Significant differences between occlusal and gingival margins were found in all groups (p < 0.05) except B4, D3, and D4. Comparison of preparation methods (groups A-D) revealed significant differences at the occlusal margin in groups 1 and 3, but in all groups at the gingival margin (p < 0.05). Laser preparation without conditioning allowed more leakage (p < 0.05). Comparison of filling materials (groups 1-4) revealed significant differences in groups B and C at the occlusal margin, and in all groups at the gingival margin (p < 0.05). In these groups, laser-prepared cavities (with or without conditioning) restored with Fuji II LC and Fuji VIII showed the least leakage at both margins. CONCLUSION: RMGICs allowed less microleakage than CGICs. Complete marginal sealing was not achieved and conditioning is recommended.

[Black or white--is amalgam 'out'? Part 1. Amalgam or composite: which of these 2 materials is the most deleterious?]. / Noir ou blanc--L'amalgame est-il 'out'? 1ère partie. Amalgame ou composite: lequel de ces deux matériaux est le plus délétère ?

Dental amalgam containing mercury has been condemned because of its toxicity and hence to be damaging of harmful to the general health. It must be clear that many sensational, confusing and misleading reports have been published. Today there is evidence that dental amalgam in the oral cavity does not harm anyone's health. For those who are condemning amalgam there an abundant number of alarming reports taking into consideration the biologic effects of resin composites: methacrylate allergy for dentists and dental technicians, the three-finger-syndrome due to contact with liquid resin, allergic reactions at the level of the airways and breathing problems caused by dust particles (esp. composite particles after polishing procedures) have been described. It can be concluded that dental amalgam is not more toxic than resin composite in light of both patients' and dental care providers' health. Recent investigations demonstrated higher than expected health risks with resin composites.

[Black or white--Which choice for the molars? Part 2. Which does one choose for the restoration of posterior teeth: amalgam or composite?]. / Noir ou blanc--Quel choix pour les molaires? 2ème partie. Que choisir pour la restauration des dents postérieures: amalgame ou composite?

The two direct dental restorative materials most commonly used today are silver-mercury amalgam and resin-based composite. The survival of dental amalgam restorations is twice as high than for composite fillings: polymerisation shrinkage, deficient marginal adaptation, higher wear rates, defective contact points leading to food impaction, insufficiently converted composite at the bottom of the cavity are problems that cannot be underestimated when using resin-composite. This does not imply that there is no weakness for amalgam: the need for retentive cavities at the cost of healthy tooth substance, weakening of the tooth's strength by cutting through the tooth crown's ridges, the risk of fracture of remaining tooth substance (mostly buccal and lingual surfaces) as the result of the cavity design, and the lack of adhesion between amalgam and tooth substance. Retaining a tooth's strength by the replacement of amalgam by resin-composites is not always the correct solution. In this respect, it can be questioned whether it is not appropriate to repair failing (extensive) amalgam restorations as to replace them with resin-composites. Research in this respect has demonstrated that dentists still are not convinced of this treatment option. Restoring a tooth in its original build-up or structure and function within the oral cavity is the basis of the biomimetic principle: the use of composite appears to be more obvious than restoring with amalgam. In the present survey pro's and con's of amalgams and resin-composites for the restoration of posterior teeth are weighted. The conclusion demonstrates that there is still a place for dental amalgam in modern restorative dentistry when plastic filling materials are used for the direct tooth repair or restoration.

Scanning electron microscopic evaluation of enamel and dentin surfaces after Er:YAG laser preparation and laser conditioning.

OBJECTIVE: The aim of this study was to observe and evaluate the micro-morphology of enamel and dentin surfaces after Er:YAG laser preparation and conditioning. BACKGROUND DATA: Information regarding micro-morphologic changes of tooth substance as a result of a change of Er:YAG laser parameters for cavity preparation is limited. METHODS: Human enamel and dentin surfaces were irradiated with an Er:YAG laser with the following parameters : (1) energy output: 200 mJ, 250 mJ, 300 mJ, 350 mJ, and 400 mJ; (2) repetition rate: 5 Hz and 10 Hz; (3) pulse duration: 100 mus/VSP (very short pulse); (4) 5 and 10 passes over the surface at a distance of 7 mm, speed: 4 mm/s using a non-contact delivery tip; (5) water cooling: 5 mL/min. The hand piece was fixed in a power driven x-y moving table. Subsequently, half of the samples were laser-conditioned at 100 mJ, 10 Hz, 250 mus/SP (short pulse) for enamel, and 80 mJ, 10 Hz, SP for dentin at a distance of 10 mm. Surface morphology and surface alterations were evaluated using scanning electron microscopy (SEM). RESULTS AND CONCLUSION: SEM evaluation showed the characteristics of Er:YAG-lased enamel and dentin surfaces: irregular enamel surfaces with typical keyhole shaped prisms and rods, and protrusion of dentinal tubules with a cuff-like appearance. Laser conditioning rounded off the sharp edges on the enamel irregularities and dentin surface structures. First signs of vitrification were seen at 250 mJ for enamel samples and 300 mJ for dentin samples. Increase of the pulse repetition rate from 5 Hz to 10 Hz did not result in changes of surface morphology. Laser conditioning did not result in additional vitrification.

[Dental and buccal complications of lip and tongue piercing]. / Complications dentaires et buccales des piercings labiaux et linguaux.

Oral and facial piercing with different kinds of body art are being observed more frequently in medical and dental practices. Principally, piercing is not a new form of body art and is traditional in different geographical areas. In this review, the possible risks and complications are described. Postprocedural complications are oedema, haemorrhage and infection. Other adverse outcomes include mucosal or gingival trauma, chipped or fractured teeth, increased salivary flow, calculus build-up, and interference with speech, mastication and swallowing. Dentists, and oral- and maxillofacial surgeons should be in the position to advise patients with orofocial piercings or those who plan to have this type of body art performed.

Microleakage of class V glass ionomer restorations after conventional and Er:YAG laser preparation.

OBJECTIVE: The aim of this study was to investigate the microleakage in class V cavities following Er:YAG laser or conventional preparation restored with two conventional glass ionomer cements (cGIC) and to evaluate the effect of conditioning on laser-prepared surfaces. BACKGROUND DATA: Information on this topic related to cGIC is scarce. METHODS: Sixty class V cavities were assigned to six groups: I and IV were Er:YAG-lased, II and V Er:YAG-lased and conditioned, and III and VI conventionally prepared and conditioned. Groups I, II, and III, were restored with Ketac Fil Plus Applicap; groups IV, V, and VI were restored with Fuji IX GP Capsule. Then, teeth were stored in distilled water (37 degrees C, 24 h), thermal cycled 1500 times (5-55 degrees C), placed in a 2% aqueous solution of methylene blue (37 degrees C, 24 h), embedded in acrylic resin, sectioned oro-facially, and analyzed for leakage. RESULTS: Statistically significant differences between occlusal and cervical regions were observed (p < 0.05). Group III showed significantly more microleakage at the occlusal margin compared to group II (p = 0.022). Group V showed significantly more microleakage at the gingival margin than group VI (p = 0.022). Leakage on the occlusal margins was significantly higher in group III than in group VI (p = 0.038). Scanning electron microscopy indicated that conditioning of laser-prepared dentin with Ketac conditioner partially closed the tubules' orifices, whereas the use of GC conditioner completely obliterated the tubules. CONCLUSION: The application of Ketac Fil Plus to laser-prepared enamel and dentin resulted in a better and more reproducible seal compared to conventionally prepared tooth surfaces. When using the more viscous Fuji IX application, Er:YAG lasing did not improve marginal adaptation.