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This article outlines an atraumatic isolation approach and a conservative instrumentation sequence, followed by use of a highly viscous, rapid-setting, capsulated glass ionomer cement to manage a difficult deep proximal-cervical Class V lesion.
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PURPOSE: To investigate the microleakage of cervical cavities restored with flowable composites in conjunction with an all-in-one adhesive system (AQ Bond) and an experimental two-step self-etching primer system (ABF) after thermocycling or flexural load cycling. METHODS: 180 wedge-shaped cervical cavities on the labial surfaces of bovine incisors were treated with AQ Bond or ABF according to the manufacturers' instructions. The treated cavities were filled with one of three flowable composites (AElite Flo, Metafil Flo or Protect Liner F). Ten of 30 specimens for each group were immersed in 0.5% basic fuchsin solution immediately after finishing of the restorations. Specimens to be subjected to thermocycling (5-60 degrees C, 15 seconds dwell time, 5000 cycles) or to flexural load cycling (approximately 0.5 mm labio-lingual displacement at the incisal edge, 10,000 cycles, 1 Hz) prior to immersion in the dye were also prepared. After 24-hour storage in the dye solution, the teeth were sectioned longitudinally through the center of the restorations, and the degrees of dye penetration scored. The microleakage scores of a hybrid composite (Clearfil AP-X) obtained from our previous study were used for comparison. The data were analyzed with the Kruskal-Wallis test and the Mann-Whitney U-test (P < 0.05). RESULTS: No significant differences in the microleakage patterns and scores were found among the flowable composites. On the other hand, significant differences in the microleakage patterns and scores were observed between the flowable and the hybrid composites. Thermocycling caused deterioration of marginal integrity, and the flowable composites showed more microleakage than the hybrid composite. In contrast, flexural load cycling did not cause deterioration of the marginal integrity when the cavities were filled with the flowable composites. Statistical analysis also revealed that the adhesive systems played a large role in the microleakage patterns.
Noncarious, cervical, wedge-shaped, sclerotic lesions are commonly encountered in clinical practice. In such lesions, dentin has been pathologically altered, often resulting in partial or complete obliteration of the dentinal tubules. These lesions are known to respond to etching and bonding differently from normal dentin, leading to complications during clinical treatment. A search of the literature was performed to obtain background information on the most commonly cited etiologic factors, clinical diagnoses, and morphologic and chemical characterizations along with an extensive review of all potential obstacles to bonding the most recent adhesives to such a dentinal substrate. Recent progress in adaptive strategies to render dentin more receptive to resin bonding is emphasized in this article, and the major drawbacks of these strategies are discussed.
PURPOSE: The aim of this in vitro study was to compare the microtensile bond strength (MTBS) between root canal and pulp chamber dentin with two bonding strategies (self-etching primer and total-etch technique). MATERIALS AND METHODS: The pulp chamber of four human canines was accessed and the pulp chamber and root canal prepared with spiral drills. The teeth were cut into halves parallel to the long axis of the tooth and randomly assigned to two groups: Clearfil SE Bond + AP-X(SE) (Kuraray) and SingleBond + Filtek Z250(SB) (3M ESPE). After 24 h in water storage, the specimens were cut perpendicular to the root into 1.0-mm slices with a low-speed diamond saw. Specimens were trimmed to obtain hourglass shapes with a bond area of 1.0 mm2 (n = 12). Three specimens were obtained from the cervical root canal dentin (R) and from the coronal pulp chamber dentin (C). The MTBS was measured in a Bencor device with an Instron machine at a crosshead speed of 0.5 mm/min. The data was analyzed with two-way ANOVA and Tukey LSD post hoc (p < 0.05). RESULTS: MTBS in MPa (mean +/- SD) were: SB.C = 25.3 (+/-6.5)a; SB.R = 16.9 (+/-6.0)b; SE.C = 16.9 (+/-3.4)b; SE.R = 16.8 (+/-5.3)b. Means with the same letter are not statistically different at p < 0.05. When data were pooled for "dentin region", coronal pulp chamber dentin resulted in statistically higher bond strengths than root canal dentin (p < 0.013). CONCLUSION: Bonding to pulp chamber dentin seems to be more predictable than to root canal dentin. In the former region, the total-etch technique may result in a higher bond strength.
PURPOSE: To evaluate the efficacy of two adhesive systems in reducing microleakage when applied with three different adhesive placement techniques. MATERIALS AND METHODS: Sixty freshly extracted caries-free human premolars and molars were used. MO/DO Class II standardized preparations were performed with the gingival margin placed 1 mm above the CEJ. Teeth were randomly divided into 2 groups (group I: Prime& Bond NT, Dentsply/Caulk; group II: Single Bond, 3M Espe). Each group was divided into 3 subgroups: (A) application of 2 coats and one cure: IA-IIA; (B) 2 coats and 2 cures of each adhesive system: IB-IIB; and (C) one coat of each adhesive along with the manufacturers' B1 flowable resin (0.5-mm thick layer) cured together at once: IC-IIC. Each coat was cured for 20 s at 800 mW/cm2 using a quartz-tungsten halogen light (Elipar Trilight, 3M ESPE). Teeth were then restored using 2-mm increments of an A2 microhybrid composite (Esthet-X, Dentsply/Caulk). All teeth were stored in distilled water at 37 degrees C for 24 h, thermocycled (500x, 5 degrees to 55 degrees C, 30 s dwell) and then placed in a 0.5% methylene blue dye solution for 24 h at 37 degrees C. Samples were sectioned longitudinally and evaluated for microleakage at the gingival margin under a stereomicroscope at 20x magnification. Dye penetration was scored using an ordinal scoring system, where 0: no penetration; 1: enamel penetration; 2: gingival dentin penetration; 3: axial dentin penetration. Kruskal-Wallis and Mann-Whitney tests were used. RESULTS: A Mann-Whitney U-Test revealed no statistically significant difference between subgroups. Although not statistically significant, P&B NT (two coats and one cure) revealed the lowest microleakage scores. CONCLUSION: In the experimental model adopted for this study, microleakage was not affected either by the adhesive or its placement technique.
PURPOSE: To place four restorative materials, including two resin-based composites (Pertac III and Synergy), an improved resin-modified glass-ionomer (Fuji II LC Improved), and a compomer (Dyract AP), in Class 5 non-carious cervical lesions and to evaluate and compare those restorations for marginal discoloration, anatomic form, surface texture, secondary caries, retention, and marginal adaptation at baseline and annually for 3 years. METHODS: The tested materials were used to restore moderate-size Class 5 non-carious cervical lesions. All materials were used following the manufacturers' directions for etching, bonding, curing, and finishing. Thirty restorations of each material were placed. After rubber-dam isolation, a bevel was placed on the occlusal margin of all preparations except the Fuji II LC Improved, and all preparations were cleaned with pumice. Each restorative material was placed and cured in increments except Fuji II LC Improved. All restorations were evaluated at baseline, 6 months, 1, 2, and 3-year recalls using a modified USPHS scale. RESULTS: Analysis with Chi Square and Logit Analysis revealed that, at 3 years, Pertac III and Fuji II LC Improved were significantly rougher than all other materials. Pertac III had significantly poorer marginal adaptation than all other materials. All other comparisons were not significant. At 3-year recall, most restorations were satisfactory.
PURPOSE: To compare the morphology of experimentally induced cervical toothbrush abrasion lesions to teeth demonstrating non-carious cervical lesions in vivo. METHODS: Eighteen premolars extracted for orthodontic reasons were each subjected to 80 hours (1.4 million strokes) of horizontal brushing in a custom fabricated toothbrushing machine. Toothpaste slurry was applied continuously and specimens were subjected to 300 gms of toothbrushing force. Denture base resin was used to simulate gingival recession of 1 mm and a sulcus width of 0.1 mm. Cervical abrasions were analyzed by optical and scanning electron microscopy and classified as either V-shape/wedged vs. U-shape/rounded lesions. When lesions exhibited both shapes, they were classified as mixed. Shapes of experimentally induced lesions then were compared to naturally occurring ones found on extracted premolars. RESULTSts: Experimentally induced toothbrush abrasion duplicated the classical clinical shapes. Half (9/18) of the experimentally induced toothbrush abrasions exhibited wedged lesions, 28% (5/18) showed a mixed wedged/rounded lesion, and 22% (4/18) showed rounded lesions. Serial photography showed progression of the morphology of the lesions. Toothbrush abrasion apparently begins apical to the cemento-enamel junction, progresses to dentin, and then undermines enamel with loss of the original cemento-enamel junction. Wedged lesions may appear with the apex oriented coronal or apical, or may be symmetrical.
PURPOSE: To evaluate the effects of 1) wall grinding status, 2) thermal stress, and 3) time of polishing on sealing performance of two one-step bonding systems in cervical cavities. MATERIALS AND METHODS: Semicircular cavities with dimensions of 3 x 3 x 1.5 mm were prepared along the CEJ of extracted human premolars. In experiment 1, the cavity walls were additionally ground with round steel diamond burs (regularly ground) or finished with superfine diamond burs. The cavities were treated with AQ Bond (AQ) or One-up Bond F (OB) and filled with a resin composite. Then thermocycling (5 degrees C to 55 degrees C, 1000 x) was performed. In experiment 2, the regularly ground cavities were used. After restoration, the teeth were subjected to thermocycling (1,000 to 5,000 x). In experiment 3, the restorations in the regularly ground cavities were polished immediately or 24 h after filling. No thermocycling was carried out in this group. All specimens were immersed in a dye solution for 2 h. Microleakage at coronal and apical walls was evaluated on the longitudinal sections of the restorations. RESULTS: For OB, the cavities finished with superfine burs exhibited more microleakage at the coronal wall than the regularly ground cavity (p < 0.05). The leakage at the coronal walls increased with the number of thermal cycles for both systems (p < 0.05). The delayed polishing generated better adaptation at the apical wall of AQ and at the coronal wall of OB (p < 0.05). CONCLUSION: Grinding status, thermocycling, and time of polishing had influences on the sealing performance of the two one-step adhesive systems.
PURPOSE: To evaluate the effect of thermal and mechanical cycling on the degree and pattern of nanoleakage on cervical margins of Class II restorations. MATERIALS AND METHODS: Forty box-type Class II cavities were prepared on bovine incisors. The cavities were restored with Single Bond and Z-250 composite resin (3M-ESPE) according to manufacturer's instructions. The teeth were randomly assigned to 4 groups: G1, control; G2, thermal cycling (2000 cycles, 5 to 55 degrees C); G3, mechanical load cycling (100,000 cycles, 50 N); G4, thermal and mechanical load cycling group (2000 cycles 5 to 5 degrees C/100,000 cycles, 50 N). The specimens were then sealed leaving a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for 24 h, and exposed to a photodeveloping solution for 8 h. Specimens were sectioned longitudinally, embedded in epoxy resin, polished and mounted on stubs, gold sputter coated, and examined under SEM using backscattered electron mode. Silver particle penetration length was measured directly on the SEM monitor and calculated as the percentage of the total length of cut dentin surface that was penetrated by silver nitrate. The data were analyzed with ANOVA and Fisher's PLSD test (p < 0.05). RESULTS: The degree of nanoleakage significantly increased when thermal and mechanical cycling was performed on the same specimens, as compared to the other groups (p < 0.05). No differences were observed between the control, thermal cycling, and mechanical cycling groups. No difference in nanoleakage pattern was observed between the groups. CONCLUSION: Thermal and mechanical cycling combined adversely affected nanoleakage values. Simulation of the oral condition might be crucial to better evaluate and understand the performance of adhesive materials.
Clinical effects of forces applied by dental occlusion on the periodontium have been evaluated for decades. Historically, trauma from occlusion has been considered as a major etiologic factor of inflammatory periodontal diseases, while some researchers have interpreted it to be of less importance or without any detectable importance in periodontics. In this study, five three-dimensional models of a maxillary central incisor were created using ANSYS 5.40. The only difference in each model was the height of the alveolar bone that showed from normal height (13 mm of alveolar bone height) to 8 mm of alveolar bone loss (5 mm of alveolar bone height). Five-point forces of 0.3 N summing up to 1.5 N were applied in a parallel line, 1 mm apical to the incisal edge on the palatal side in a palatolabial direction. The maximum (S1) and minimum (S3) principal stresses in the nodes of the labial side of the periodontal ligament (apical to the alveolar crest) were assessed. Analysis was done using the finite element method. An increase of S1 (up to 16 times in the cervical and 11.25 times in the apical area) and S3 (up to 17.13 times in the cervical and 9.9 times in the apical area) in comparison to the normal model was shown. The highest stress levels were traced in the subcervical area, except for the last model (8 mm of the alveolar bone loss). According to the results of this study, 2.5 mm of alveolar bone loss can be considered as a limit beyond which stress alterations were accelerated. Based on the FEM analysis, alveolar bone loss increases stress (S1 and S3) produced in the PDL, in spite of applying the same force vector.
This in vitro study evaluated the influence of two flowable resin composites on marginal microleakage and internal voids in Class II composite restorations with the margins below the cementoenamel junction (CEJ). Class II cavities randomly divided into four groups: Group I-Filtek with Filtek Flow lining; Group II-Filtek; Group III-Tetric Ceram with Tetric Flow lining; Group IV-Tetric Ceram. After thermocycling tests (5-60 x 1500) and dye soaking, the teeth were sectioned in a mesiodistal direction along their longitudinal axis. Gingival-marginal microleakage and internal voids in three separate portions of the restoration (interface, cervical and occlusal voids) were observed with a microscope. Statistical analyses indicated that the use of flowable resin composites (Groups I and III) provided a reduction in marginal microleakage and a reduction in some parts of the internal voids or total voids (p<0.05). The condensable material (Filtek) in combination with the flowable liner showed fewer voids (interface, occlusal, total) than the hybrid resin (Tetric) (p<0.05). There was a correlation between the number of internal voids or total voids and the marginal microleakage (p<0.05). It was concluded that a composite lining in a Class II resin composite with margins below the cementoenamel junction may reduce marginal microleakage and voids in the interface and the total number of voids in the restoration.
PURPOSE: The objective of this study was to evaluate the tensile bond strength (BS) and microleakage (MI) of bonded amalgam restorations to dentin when an unfilled and a filled system are used under three application modes. MATERIAL AND METHODS: Seventy-two and 96 human molars, respectively, were employed for BS and MI tests. For BS, the occlusal surface of the molars was ground flat until dentin exposure. A 3-mm area was delimited for bonding. For MI, Class V cavities were prepared in the CEJ (4 mm x 4 mm x 2 mm). For each test, the molars were randomly divided into six treatment groups defined by a combination of the levels: Adhesive system (Scotchbond Multi-Purpose Plus [SBMP], Optibond dual cure [OPTB]) and Application mode (light-LC, chemical-C and combination of light and chemical curing-LCC). After adhesive application, the amalgam was condensed into a Teflon mold (BS) and into the cavities (MI). After storage in saline solution for seven days at 37 degrees C, the specimens were subjected to the BS test at 0.5 mm/minute. For microleakage evaluation, the restorations were sealed with nail varnish, except for an area 1 mm around the restoration, immersed in 5% methylene blue solution for 24 hours and sectioned into two halves. Each half was evaluated by two trained examiners at 25x magnification in a 0-3 score system and the highest score was recorded. The BS data was evaluated by two-way ANOVA and Tukey's test (alpha=0.05). The MI data were analyzed by Kruskal Wallis and Mann-Whitney tests (alpha=0.05). RESULTS: The main factors were significant for the BS test: the highest BS mean was obtained using the LCC technique and the OPTB system. Regarding the MI test, only the application mode was significant: lower dye infiltration was observed for LC and LCC.
This study evaluated the microleakage of resin-modified glass ionomer, flowable compomer and flowable resin composite restorations on a Class V cavity of simulated advanced root caries under a flexural load cycling condition. Thirty-six non-carious human maxillary premolars were mounted in cylindrical acrylic resin molds. The cavities were prepared in the proximal root surface, from the middle of the buccal surface to the middle of the lingual surface, approximately 1 mm below the cemento-enamel junction, 2 mm axial width and 1.2 mm in depth. The teeth were randomly assigned to one of three groups with 12 teeth in each group: Group 1: Cavity conditioner and Fuji II LC (GC America), Group 2: Prime & Bond NT and Dyract Flow (Caulk-Dentsply), Group 3: Excite and Tetric flow (Ivoclar/Vivadent). Specimens were settled laterally on a fatigue-testing machine that was adjusted to deliver a force of 60N. The specimens were load cycled at 1 Hz for 5000 cycles, placed in a staining solution and sectioned to evaluate microleakage penetration. Results indicate that the coronal and gingival margins showed significant microleakage differences among the three restorations (p<0.05). At the coronal margin, there was no significant difference between Groups 2 and 3. At the gingival margin, there was no significant difference between Groups 1 and 2. It was concluded that the marginal sealing ability of a flowable resin composite under a flexural cycling load was better than in other selected materials and that flowable resin composite with dentin adhesive was a desirable alternative for root caries restorations extended to the proximal surface.
OBJECTIVE: To compare enamel and dentin microleakage of three single-bottle dentin-bonding agents (DBA) (One-Step, Single Bond, and Dentamed P&B) on teeth that were then subjected to thermocycling and occlusal loading. METHOD AND MATERIALS: Class 5 cavities were prepared on the buccal and lingual surfaces of 30 extracted human molars and divided into three groups. The occlusal margins were in enamel, and the cervical margins were in cementum. DBA were applied strictly according to the manufacturers' recommendations, and the preparations were restored with resin composite. Specimens were subjected to 2,000 intermittent occlusal loads and 3,000 thermocycles and then immersed in 0.5% basic fuchsin dye for 72 hours. Four consecutive sections were cut for each specimen and examined under a stereomicroscope. The extent of dye penetration was measured and recorded using a nonparametric scale from 0 to 4. RESULTS: The Mann-Whitney U test showed a significant difference at cementum margins between One-Step and Dentamed P&B, as well as between Single Bond and Dentamed P&B, and an insignificant difference between Single Bond and One-Step. There was no significant difference in dye penetration at enamel margins between the three DBA. CONCLUSION: Under combined use of occlusal loads and thermocycling, the sealing ability of single-bottle DBA at dentin margins ranged from good for One-Step to moderate for Single Bond to poor for Dentamed P&B. At enamel margins, all materials performed equally well.
PURPOSE: To evaluate the retention of restorations placed in non-undercut, noncarious cervical lesions using One-Up Bond F and Palfique Estelite resin composite. MATERIALS AND METHODS: Fifty-one non-undercut, noncarious cervical lesions were restored with One-Up Bond F and Palfique Estelite in 15 patients (mean age 57.7 years). Teeth were cleaned with pumice and water and restored following the manufacturer's instructions. Restorations were evaluated at 6 months, 1 and 2 years for presence or absence, and for the degree of marginal staining using standardized colour photographs for comparison. RESULTS: At 1 year, 42 restorations were evaluated, and all were intact. Slight marginal staining was observed in three restorations. At 2 years, 37 restorations were evaluated from 11 patients, and all were intact. Marginal staining was observed around nine restorations. ANOVA for marginal staining showed a significant increase of staining at both the enamel and cervical margins over the 2 years of the study. No caries was detected in association with any restoration. CONCLUSION: Although a number of restorations could not be evaluated, the retention of 100% at 2 years showed very good promise for the treatment of noncarious cervical lesions. The marginal staining was limited to a small number of patients.
OBJECTIVE: To examine, in vitro study, the ultrastructure of resin-infiltrated sclerotic dentine following the application of a two-step self-etching dentin adhesive. METHODS: Non-carious, natural cervical sclerotic lesions were bonded using Contax (DMG Hamburg, Germany), a self-etching dentin adhesive. Artificially prepared wedge-shaped lesions were also made in sound bicuspids and bonded using the same adhesive as controls. By SEM examination, the morphological change of the dentin surface treated by Contax Primer, and the hybrid layer and resin tag in the dentin-resin interface were studied. RESULTS: Most dentinal tubules were occluded by rod-like sclerotic casts in the sclerotic dentin surface. Both hybrid layer and resin tag were observed in sclerotic dentin. The hybrid layer was almost similar to that in the sound dentin, but the resin tags were shorter than those in controls. CONCLUSIONS: Bonding to sclerotic dentin is different from sound dentin and may be compromised by occluded dentin tubules. Based on the present ultrastructural features of hybrid layer and resin tags, the Contax, a self-etching dentin adhesive with a low pH value primer, may have some bonding efficacy to sclerotic dentin.
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