Survival of occlusal ART restorations using high-viscosity glass-ionomer with and without chlorhexidine: A 2-year split-mouth quadruple-blind randomized controlled clinical trial.

The study question was whether the use of high-viscosity glass-ionomer with chlorhexidine (HVGIC/CHX) for the Atraumatic Restorative Treatment (ART) prepared cavities could achieve a higher restoration survival percentage and be more effective for preventing dentine carious lesions adjacent to the restoration than the use of HVGIC without CHX. The study followed a split-mouth, quadruple-blind, randomized controlled clinical design and lasted 2 years. Patients with at least two small- to medium-sized occlusal cavities were included. The occlusal cavities were prepared according to the ART method and restored with HVGIC/CHX (test) and HVGIC (control). A replica of all restorations available and digital photographs were fabricated at baseline and after 0.5, 1, 1.5 and 2 years and evaluated by two examiners using the ART and Federation Dentaire International (FDI) restoration assessment criteria. Survival curves were constructed using the Kaplan-Meier method, and the log-rank test was used to test for significance between the survival percentages. A total of 100 subjects with an average age of 14.4 years participated. According to the ART restoration assessment criteria, the 2-year survival percentages of ART/HVGIC/CHX (96.8%) and ART/HVGIC (94.8%) did not differ significantly and no significant difference was found between the test (97.9%) and control (96.9%) groups according to the FDI restoration assessment criteria. Eight and five occlusal restorations failed according to the ART and FDI restoration criteria, respectively. No dentine carious lesions along the restoration margin were observed. The 2-year survival of ART restorations in both groups was high. The development of carious dentine lesions adjacent to the restoration was not observed in either treatment group. There is no evidence for modifying HVGIC by incorporating chlorhexidine in order to prevent dentine carious lesion development or to improve the survival of ART restorations in occlusal surfaces in permanent teeth. HVGIC without chlorhexidine can be used successfully to restore occlusal 'ART-prepared' cavities in permanent teeth.

Bond Strength Durability of Different Adhesives to Dentin After Aging in Two Different Solutions.

PURPOSE: To determine the influence of aging in artificial saliva compared to distilled water on the dentin microtensile bond strength (µTBS) of different adhesive systems. MATERIALS AND METHODS: Occlusal enamel and superficial dentin of 42 teeth were removed and roots were sectioned to expose the pulp chamber for connecting the tooth segments to an intrapulpal pressure assembly. According to the tested adhesives, tooth segments were allocated to three groups (n = 14): an etch-and-rinse adhesive (Adper Scotchbond Multi-Purpose, SBMP), a two-step self-etching adhesive (Clearfil SE Bond, CSE), and a singlestep self-etching adhesive (Clearfil S3 Bond, S3). Each adhesive system was applied to the dentin surface according to its manufacturer's instructions, while intrapulpal pressure was simulated. Resin composite (3M ESPE) was built up in two increments of 2 mm each. Each bonded specimen was sectioned to obtain eight sticks (0.8 ± 0.01 mm2). Sticks of each group were divided equally (n = 56) according to the storage solution, either distilled water or artificial saliva. For each storage solution, half of the sticks of each subgroup (n = 28) was stored for 24 h at 37°C and the other half was thermocycled for 10,000 cycles between 5°C and 55°C. Sticks were then subjected to µTBS testing. Data were statistically analyzed using multifactor ANOVA with repeated measures and Bonferroni's post-hoc test (p < 0.05). Student's t-test was used for pairwise comparison. Failure modes were determined for all tested sticks using scanning electron microscopy. RESULTS: The decrease in bond strength of the three adhesives was significantly higher in distilled water than in artificial saliva. The predominant failure modes were adhesive and mixed. CONCLUSION: The decrease in bond strength was more pronounced for specimens stored in distilled water than in artificial saliva.

Repair bond strength of dual-cured resin composite core buildup materials.

The reparability of dual-cured resin composite core buildup materials using a light-cured one following one week or three months storage, prior to repair was evaluated. Two different dual-cured resin composites; Cosmecore™ DC automix and Clearfil™ DC automix core buildup materials and a light-cured nanofilled resin composite; Filtek™ Z350 XT were used. Substrate specimens were prepared (n = 12/each substrate material) and stored in artificial saliva at 37 °C either for one week or three months. Afterward, all specimens were ground flat, etched using Scotchbond™ phosphoric acid etchant and received Single Bond Universal adhesive system according to the manufacturers' instructions. The light-cured nanofilled resin composite (Filtek™ Z350 XT) was used as a repair material buildup. To determine the cohesive strength of each solid substrate material, additional specimens from each core material (n = 12) were prepared and stored for the same periods. Five sticks (0.8 ± 0.01 mm(2)) were obtained from each specimen (30 sticks/group) for microtensile bond strength (µTBS) testing. Modes of failure were also determined. Two-way ANOVA revealed a significant effect for the core materials but not for the storage periods or their interaction. After one week, dual-cured resin composite core buildup materials (Cosmecore™ DC and Clearfil™ DC) achieved significantly higher repair µTBS than the light-cured nanofilled resin composite (Filtek™ Z350 XT). However, Clearfil™ DC revealed the highest value, then Cosmecore™ DC and Filtek™ Z350 XT, following storage for 3-month. Repair strength values recovered 64-86% of the cohesive strengths of solid substrate materials. The predominant mode of failure was the mixed type. Dual-cured resin composite core buildup materials revealed acceptable repair bond strength values even after 3-month storage.

Effect of preheating of low shrinking resin composite on intrapulpal temperature and microtensile bond strength to dentin.

The effect of preheating of the silorane-based resin composite on intrapulpal temperature (IPT) and dentin microtensile bond strength (µTBS) was evaluated. For the IPT, teeth (n = 15) were sectioned to obtain discs of 0.5 mm thickness (2 discs/tooth). The discs were divided into three groups (n = 10/group) according to the temperature of the Filtek LS™ silorane-based resin composite during its placement, either at room temperature (23 ± 1 °C) or preheated to 54 °C or 68 °C using a commercial Calset™ device. Discs were subjected to a simulated intrapulpal pressure (IPP) and placed inside a specially constructed incubator adjusted at 37 °C. IPT was measured before, during and after placement and curing of the resin composite using K-type thermocouple. For µTBS testing, flat occlusal middentin surfaces (n = 24) were obtained. P90 System Adhesive was applied according to manufacturer's instructions then Filtek LS was placed at the tested temperatures (n = 6). Restorative procedures were done while the specimens were connected to IPP simulation. IPP was maintained and the specimens were immersed in artificial saliva at 37 °C for 24 h before testing. Each specimen was sectioned into sticks (0.9 ± 0.01 mm(2)). The sticks (24/group) were subjected to µTBS test and their modes of failure were determined using scanning electron microscope (SEM). For both preheated groups, IPT increased equally by 1.5-2 °C upon application of the composite. After light curing, IPT increased by 4-5 °C in all tested groups. Nevertheless, the IPT of the preheated groups required a longer time to return to the baseline temperature. One-way ANOVA revealed no significant difference between the µTBS values of all groups. SEM revealed predominately mixed mode of failure. Preheating of silorane-based resin composite increased the IPT but not to the critical level and had no effect on dentin µTBS.

Influence of different intrapulpal pressure simulation liquids on the microtensile bond strength of adhesive systems to dentin.

PURPOSE: To evaluate the effect of three different liquids used for intrapulpal pressure (IPP) simulation on the microtensile bond strength (µTBS) of three adhesive systems to dentin. MATERIALS AND METHODS: The occlusal surfaces of sound human molars were ground flat down to mid-dentin depth. The teeth were bonded under 15 mmHg simulated IPP using distilled water, phosphate buffered saline, or human plasma as a simulating liquid. Three adhesive systems were tested: a single-bottle etch-and-rinse adhesive (SingleBond, 3M ESPE), and two single-step self-etching adhesives (G-Bond, GC) and (iBond, Heraeus Kulzer). Resin composite (Tetric EvoCeram, Ivoclar Vivadent) buildups were made in 2 increments, each 2 mm in height. Specimens were stored in artificial saliva under 20 mmHg IPP at 37°C for 24 h prior to testing. µTBS (n = 15) was tested using a universal testing machine, and failure modes were determined. Data were statistically analyzed using ANOVA and Bonferroni post-hoc tests at p <= 0.05. RESULTS: With SingleBond adhesive, distilled water showed significantly higher µTBS compared to plasma and phosphate buffered saline. With G-Bond, no significant difference was found between distilled water and phosphate buffered saline, whereas plasma showed significantly lower µTBS values. In contrast, no significant difference was encountered between the three IPP liquids for iBond adhesive. Predominant modes of failure were adhesive and mixed. CONCLUSION: A difference in intrapulpal pressure simulating liquids influences the bonding of adhesives to dentin. Etch-and-rinse adhesives are more sensitive to intrapulpal simulating liquids than are self-etching adhesives. Adhesives containing protein-coagulating components perform better with plasma perfusion than those lacking such components.