Exploring the efficacy of laser-assisted in-office tooth bleaching: A study on varied irradiation times and power settings utilizing a diode laser (445 nm).

The aim of this study was to evaluate the effectiveness of a laser-assisted in-office tooth bleaching treatment, employing a diode laser (445 nm) using different power and time settings. Two hundred human incisors were collected for evaluating tooth color change (ΔΕ00) and whiteness index in dentistry (ΔWID) following laser-assisted tooth bleaching treatment. The specimens were distributed into 25 groups (n = 8) according to laser output power (0.5-2 W) and duration of irradiation (10-60 s) that was applied. ΔΕ00 and ΔWID were evaluated using a spectrophotometer at three points of time (24 h, 1 week and 1 month after treatments). Three-way ANOVA revealed that power, duration of laser irradiation, and time of measurement after bleaching treatments significantly affected both ΔΕ00 and ΔWID(p < 0.05). Furthermore, laser irradiation increased ΔΕ00 and ΔWID at all applied powers compared to the control group (p < 0.05), but this increase was dependent on the duration of irradiation. Laser irradiation significantly increased ΔΕ00 when the duration of operation was 50-60 s at 0.5-1 W, while at 1.5-2 W was significantly increased when the duration was 30-60 s. ΔWID was significant higher in the laser groups compared to the control group at all powers, except for 0.5 W where it was significant higher when the duration was 50-60 s. The outcomes of the study can help in selecting the suitable power settings and duration of laser exposure to achieve the optimal whitening results while ensuring the safety of the tooth pulp.

Temperature changes in the pulp chamber and bleaching gel during tooth bleaching assisted by diode laser (445 nm) using different power settings.

The aim of this in vitro study was to investigate the safety of using blue diode laser (445 nm) for tooth bleaching with regard to intrapulpal temperature increase operating at different average power and time settings. Fifty human mandibular incisors (n = 10) were used for evaluating temperature rise inside the pulp chamber and in the bleaching gel during laser-assisted tooth bleaching. The change in temperature was recorded using K thermocouples for the five experimental groups (without laser, 0.5, 1, 1.5 and 2 W) at each point of time (0, 10, 20, 30, 40, 50 and 60 s). As the average power of the diode laser increases, the temperature inside the pulp chamber also increases and that of the bleaching gel was significantly higher in all the experimental groups (p < 0.05). However, the intrapulpal temperature rise was below the threshold for irreversible thermal damage of the pulp (5.6 °C). Average power of a diode laser (445 nm) ranging between 0.5-2 W and irradiation time between 10-60 s should be considered safe regarding the pulp health when a red-colored bleaching gel is used. Clinical studies should confirm the safety and effectiveness of such tooth bleaching treatments. The outcomes of the present study could be a useful guide for dental clinicians, who utilize diode lasers (445 nm) for in-office tooth bleaching treatments in order to select appropriate power parameters and duration of laser irradiation without jeopardizing the safety of the pulp.

Effect of air-abrasion pretreatment with three bioactive materials on enamel susceptibility to erosion by artificial gastric juice.

OBJECTIVE: The purpose of the study was to investigate the protective effect of three in-office preventive treatments with bioactive materials against enamel erosion induced by artificial gastric juice similar to that found in gastroesophageal reflux disease (GERD) patients. The treatments included air-abrasion of enamel with a fluoride-containing bioactive glass (BioMinF®), Bioglass 45S5 (ProSylc) and nano-hydroxyapatite (MI Pearls) to test enamel susceptibility following an erosive challenge. METHODS: Enamel surface loss was evaluated using confocal microscopy, while changes in enamel surface roughness and morphology were also investigated after the treatments. SEM and EDS were used to observe formation of apatite crystals on enamel and to detect alterations in mineral composition. In Group 1 (negative control) the specimens did not receive any treatment; Group 2 specimens (positive control) treated with 0.4 % SnF2, while in Groups 3-5 enamel was air-abraded with BioMinF®, ProSylc and MI Pearls, respectively. RESULTS: All the experimental groups reduced significantly enamel surface loss compared to the negative control group (p < 0.05), except for the MI Pearls treatment (p > 0.05). The most protective behavior against erosion presented the treatment with SnF2. BioMinF induced the larger amount of apatite crystals on the enamel surface, followed by ProSylc. SIGNIFICANCE: BioMinF and ProSylc treatments may be beneficial against dental erosion induced by gastric juice in GERD patients, while MI Pearls treatment may not suitable for this indication. Both materials promote formation of apatite crystals on enamel in acidic conditions protecting the surface from the erosion. The tested treatments may be useful in GERD patients who cannot comply with at-home therapies with SnF2.

Effect of a fiber-reinforcing technique for direct composite restorations of structurally compromised teeth on marginal microleakage.

OBJECTIVES: To evaluate if the marginal microleakage of extensive Class I composite resin restorations can be affected by applying ultra-high-molecular-weight polyethylene (UHMWPE) fibers with the wallpapering technique combined with different restorative materials and methods. MATERIALS AND METHODS: A 120 human molars were selected and one extensive Class I cavity was prepared on the occlusal surface of each tooth. The specimens were divided into 12 groups (n = 10) according to the type of restorative material (Filtek Z550, Beautifil II LS or Beautifil Bulk Restorative), the use or not of reinforcing fibers (ribbond) and the applied restorative technique (incremental or bulk). The specimens were subjected to thermocycling and then immersed into a 50 wt% silver nitrate solution following a dying protocol. Subsequently, the teeth were prepared for SEM observations to evaluate the extent of marginal microleakage. RESULTS: Three-way ANOVA revealed that the type of material, the use of ribbond fibers and the type of restorative technique significantly affected marginal microleakage (p < 0.001). Application of ribbond fibers decreased marginal microleakage to all tested restorative materials, regardless of the restorative technique, in a range of 31.2-81.4%. In the groups with no-use of ribbond fibers, among the materials there were no significant differences in microleakage when the teeth were restored with the incremental technique (p > 0.05). CONCLUSIONS: The use of UHMWPE fibers with wallpapering technique in Class I composite restorations may be an effective method to reduce marginal microleakage, regardless of the selected restorative technique or the material. CLINICAL RELEVANCE: Clinicians may be encouraged to utilize reinforcing fiber restorative techniques for direct restorations of structurally compromised teeth as a valid alternative to indirect restorations.

Evaluation of photopolymerization efficacy and temperature rise of a composite resin using a blue diode laser (445 nm).

The purpose of this study was to evaluate the photopolymerization efficacy of a diode laser (445 nm) for use with a composite containing camphorquinone and to estimate the safety of the method related to the temperature rise. Five cylindrical composite specimens were prepared for each thickness: 1, 2, and 3 mm. Three light-curing modes were investigated: a light emitting diode (LED) unit and a diode laser (445 nm) with output powers at 0.7 W or 3 W. Evaluation of the polymerization efficacy was based on Vickers hardness measurements, and the highest temperatures at the bottom of the specimens were recorded using a K-type thermocouple. The highest microhardness was observed after the diode laser curing operating at 3 W. A comparison of the microhardness of the 0.7 W laser cured specimens with the LED cured specimens showed a statistically significant difference in favor of the laser curing. Laser curing operating at 3 W resulted in extremely high temperatures. Laser curing at 0.7 W resulted in statistically significantly higher maximum temperatures than did LED curing for both 1 mm thick (52.9°C against 45.4°C) and 3 mm thick (43.6°C against 40.9°C) specimens. Diode laser (445 nm) may be an alternative for photopolymerization of composite materials and may result in a higher degree of conversion and depth of cure of composites than what has been seen with LED curing units when they emit at the same energy density.

Quantitative and Qualitative Evaluation of Enamel Erosion Following Air Abrasion with Bioactive Glass 45S5.

PURPOSE: To evaluate the effect of pre-treatment air abrasion of surfaces using bioactive glass 45S5 on the progression of erosion in bovine enamel induced by a common soft drink. MATERIALS AND METHODS: Twelve intact bovine incisors were selected and 24 enamel samples were prepared and randomly assigned to two groups (n = 12): 1. control group, no anti-erosive treatment; 2. experimental group: samples were air abraded with bioglass 45S5 before the erosive challenge. The enamel samples were submitted to erosive cycling using a common soft drink. Enamel surface loss was evaluated using optical profilometry; surface microhardness and roughness changes were determined using Vickers method and Vertical Scanning Interferometry, respectively. In addition, SEM observations and EDS analysis were performed to detect any alterations in surface morphology and mineral content. The data were statistically analysed using one-way ANOVA and Tukey's post-hoc test at a significance level of α = 0.05. RESULTS: The experimental group exhibited less (18.7%) surface loss than did the control group (p < 0.05), while also presenting a statistically significantly smaller decrease in surface microhardness compared to the control group after erosive cycling (p < 0.05). However, neither group showed a statistically significant change in surface roughness (p > 0.05). After the treatments, changes in surface morphology and mineral content of enamel were observed. CONCLUSIONS: Surface pre-treatment using air abrasion bioglass 45S5 may help prevent enamel erosion induced by excessive consumption of soft drinks. Further clinical trials are needed to confirm the effectiveness of this method and its clinical significance.

Digital subtraction radiography in detection of vertical root fractures: accuracy evaluation for root canal filling, fracture orientation and width variables. An ex-vivo study.

OBJECTIVE: Ex-vivo evaluation of the detectability of vertical root fractures (VRFs) using digital subtraction radiography (DSR) and conventional digital periapical radiography (CDPR); investigation of the effect of root canal filling, x-ray angulation, and thickness of the VRF in the diagnostic accuracy. MATERIALS AND METHODS: Sixty root canals were mechanically prepared and radiographed either with a gutta-percha root canal filling or without, at 0o and ± 10o. VRFs were introduced with a universal testing machine. The width and angulation of the fracture line with the radiographic beam were calculated. DSR was performed comparing radiographs obtained prior to and after the VRF induction. Five examiners evaluated the resultant images and analysis was performed using receiver operator characteristic (ROC) statistics and binary logistic regression tests. RESULTS: No significant differences in sensitivity, specificity, and the areas under the ROC curves (AUC) between the CDPR and DSR were detected (p > 0.05), except for root canal filled teeth where the AUC for DSR was higher (p < 0.05). Using DSR, a VRF was 1.3 times more likely to be diagnosed [95% confidence intervals (CI): 1.045-1.59; p = 0.018]. A correct diagnosis was 2.399 times more likely to occur in non-filled teeth regardless of the radiographic technique (95% CI 1.940-2.965; p = 0). The regression coefficients were positive for width and negative for angle. CONCLUSIONS: DSR showed a better diagnostic accuracy of VRFs compared with CDPR, in single root canal filled teeth. The angulation, the width, and the presence of a root canal filling affected the diagnostic potential. CLINICAL RELEVANCE: DSR is a cost- and time-effective imaging technique that could contribute in early diagnosis of VRFs.

Influence of material and surface treatment on composite repair shear bond strength.

OBJECTIVES: The aim of this study is to investigate the influence of the composite material and surface treatment to the bond strength when repairing an aged composite surface with new composite. MATERIALS AND METHODS: One hundred and sixty resin blocks of methacrylate composite and silorane composite prepared and aged in artificial saliva for 6 months. Specimens treated either with a diamond bur (DB) or air abrasion (AA), conditioned with orthophosphoric acid (OA) or sodium hypochloride (SH) and repaired with methacrylate or silorane composite using the corresponding adhesive system. Repaired composites underwent thermocycling fatigue (×5000), and bond strength was measured at shear. RESULTS: Methacrylate achieved the highest bond strengths as repair material, in all combinations (26.54-55.56 MPa). Silorane only reached 8.12 MPa when repairing silorane treated with DB and OA. For all other treatment combinations repairing with silorane led to pretest failures. The most susceptible to repair composites/surface treatment combination is when repairing methacrylate treated with AA and SH and methacrylate composite (55.56 MPa). CONCLUSIONS: Silorane composites are not suitable to be used when repairing an old composite restoration. The repair material is the most critical factor, while aged surface treatment has only a minor influence to the shear bond strength.

Management of bilateral invasive cervical resorption lesions in maxillary incisors using a novel calcium silicate-based cement: A case report.

Invasive cervical resorption is a pathologic process leading to progressive and usually destructive loss of tooth structure. The pathogenic mechanism is not completely understood and the diagnosis may be challenging. The aim of this article is to present an unusual case of bilateral presence of invasive cervical resorption lesions in maxillary central incisors and to discuss the treatment procedures using a novel repair material. The management of the present case was carried out in three phases. The first stage of the treatment aimed at curetting the active tissue from the resorption cavity and restoring the defect with the novel calcium silicate-based cement (Biodentine, Septodont). In the maxillary left central incisor it was not possible to remove the resorptive tissue without exposing the pulp, and therefore root canal treatment was performed. At the second phase, a full-thickness flap was raised in order to expose and repair the defect that was extending subgingivally. At the third phase teeth were restored with composite resin. The patient was kept under review and after a follow-up period of 2 years neither signs of periradicular lesion nor recurrence of resorption were observed. The teeth were asymptomatic, and restorations appeared to be in excellent condition. In conclusion, Biodentine seems to be a promising material for the treatment of invasive cervical resorption lesions.

The reparability of contemporary composite resins.

OBJECTIVE: The objective was to investigate the way that various surface treatments could influence the bond strength of the repair of methacrylate (MC) and silorane (SIL) composites. MATERIALS AND METHODS: A total of 160 MC and SIL cylindrical specimens were polymerized and aged in artificial saliva solution for 7 days. Depending on the following surface treatment (diamond bur or air abrasion), and the conditioning procedure (orthophosphoric acid or sodium hypochlorite), 16 groups were formed and repaired either with MC, either with SIL composite. Repaired specimens were subjected to an additional aging procedure in artificial saliva for 7 days, followed by thermo-cycling and then stressed in shear at a rate of 0.5 mm/min until failure. Failure patterns were analyzed using stereomicroscope and scanning electron microscopy. RESULTS: MC composite showed statistically significant higher bond strength both as a base or repair material than SIL (P < 0.001). Statistically significant differences were not observed, when grinding and conditioning procedures was compared. Pretest failures were observed when aged MC-based composite was repaired with SIL-based. CONCLUSIONS: Type of composite seems to be the main factor influencing the bond strength of the repair. MC-based composite showed better repairability than SIL composite. Optimum repair conditions should include knowledge of the composite's composition.

Shear bond strength of a "solvent-free" adhesive versus contemporary adhesive systems

AIM: To compare the shear bond strength (SBS) of a solvent free self-etch adhesive with solvent containing adhesives. METHODS: Forty-five human teeth were sectioned longitudinally to expose superficial dentin and substrates polished with 600-grit SiC paper. The adhesive area was isolated with a cylindrical Teflon mold 3x4 mm. Fifteen specimens were prepared for each material. Were evaluated a solvent free self-etch adhesive (Bond 1 SF), an ethanol self-etch adhesive (Futurabond M), and a water-acetone-ethanol self-etch adhesive (Optibond All-In-One). All specimens were subjected to an aging procedure by thermo-cycling (5000 cycles). Thirty-six specimens were stressed in shear at a rate of 0.5mm/min. Mean data values were analyzed statistically using the Welch robust analysis of variance and the Games-Howell statistic. Failure patterns were analyzed using stereomicroscope and scanning electron microscopy (SEM). Additional more dentin specimens were prepared for SEM. RESULTS: The Bond 1 SF showed the statistically significant lowest SBS to dentin (Welch statistic p<0.001). Failures for Bond 1 SF were mainly adhesive failures with partial cohesive failures in the adhesive resin, while for Futurabond M and Optibond All-In-One were mainly mixed. SEM findings confirm the results. CONCLUSIONS: Eliminating solvents from self-etch adhesive systems may decrease the bonding strength to dentin.

Temperature rise during photo-polymerization under ceramic restorations.

AIM: The aim of this study was to measure the temperature increase induced by various light-curing units during photo-polymerization beneath ceramic restorations. METHODS: Three light-curing units were used; a high intensity QTH unit Elipar 2500 and two LED units: Translux Power Blue and Excelled 1400. The 15 ceramic specimens (CEREC Blocks) used in this study were of 2.5 mm thickness, 5 mm wide and 6 mm long and made using a slow speed saw. Using the same slow speed saw the occlusal enamel portion of 15 mandibular third molars was removed and 15 dentin discs of 1 mm height were prepared. The thickness of the luting cement was delimited to 0.5 mm, using a Teflon mold and then brought into contact with the dentin disc. Light-curing time for all the groups was 20 sec. The temperature rise was measured placing underneath the dentin disc a K-type thermocouple wire connected to a data logger. Five measurements were carried out for each group. Statistical analysis was performed using ANOVA (a=0.05). RESULTS: The results indicated that there was a lower temperature rise induced from Translux Power Blue than from the other two light-curing units, which did not present statistically significant difference (p<0.05). However, temperature rise from the light-curing units used in this study is lower than 5.5°C, which is the limit of pulpal damage. CONCLUSIONS: Within the limitations of this study, although the type and characteristics of light-curing units may affect temperature rise under ceramic restorations, this influence is possibly not of clinical significance.

Pulp response to dentine adhesives: A study on mature human pulps.

OBJECTIVE: To clinically investigate the antibacterial effects of a commercially available self-etch 12-methacryloyloxy- dodecylpyridinium bromide (MDPB)-containing adhesive system in comparison with its respective non-MDPB-containing adhesive and to evaluate the pulp responses when in use on human teeth. MATERIALS AND METHODS: Sixty-two viable human teeth scheduled for extraction were used. Class V cavities were prepared on the buccal surfaces of the teeth and filled with the tested materials (Protect Bond/Clearfil AP-X, SE Bond/Clearfil AP-X and Dycal/Ketac Fill Plus) as a control group, according to manufacturer's recommendations. Randomly divided to two groups teeth remained intra-orally for 4 and 8 weeks. After extraction, teeth were decalcified, sectioned and stained using the Mayer's hematoxylin and eosin, and modified Brown-Brenn's technique. Pulp responses were evaluated microscopically under a microscope and remaining dentine thickness measured under a stereomicroscope. RESULTS: No statistically significant differences regarding pulp inflammation or bacterial infiltration were found either for the materials tested or for periods of post-operative evaluation. CONCLUSIONS: The results suggested that for a short period of evaluation there are no quantitative differences, regardless to restoring material used.

Bonding of adhesives to Er:YAG laser-treated dentin.

OBJECTIVE: The shear bond strength of adhesives applied to dentin was investigated after irradiation with an erbium-doped yttrium aluminum garnet (Er:YAG) laser. METHODS: Superficial and deep dentin specimens from human molars were treated either with carbide bur or an Er:YAG laser. Two etch and rinse adhesives (Single Bond and XP Bond) and two self-etch adhesives (Prompt L-Pop and Xeno III) were employed to bond the composite. Shear bond strength (SBS) was determined after storage in water for 24 h using a universal testing machine with a crosshead speed of 0.5 mm/min. Failure patterns and modes were analyzed and evaluated using a stereomicroscope. In addition, samples were processed for Scanning Electron Microscopy SEM evaluation. A linear mixed model was used, and pairwise comparisons were made using the Bonferroni test. RESULTS: Results showed significant differences between the levels of dentin treatment (p=.01) in carbide bur-cut dentin and lased dentin, as well as significant interaction effects due to the depth of dentin and the bonding system used. The etch and rinse adhesives bonded less effectively with lased dentin than with carbide bur-cut dentin, while self-etch adhesives bonded equally well with lased and bur-cut superficial dentin but much less effectively with lased deep dentin than with bur-cut deep dentin. SEM revealed a predominantly adhesive failure mode in laser-ablated fractured specimens, while a mixed failure mode was apparent in the bur-cut fractured specimens. CONCLUSIONS: Cavities prepared by laser seem less receptive to adhesive procedures than conventional bur-cut cavities.