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Effect of Carisolv on the human dental pulp: a histological study.

OBJECTIVES: The aim of this study was to investigate histopathologically after 1 week and 1 month the effect of Carisolv on exposed human pulp after a contact period of 10 min in comparison to sterile saline solution. METHODS: Class V cavities were prepared in 40 human first premolars, and the pulp chambers were perforated. The pulp tissue was either exposed to Carisolv or sterile saline solution for 10 min, covered with Teflon and restored with compomer filling material. After observation periods of 1 week and 1 month, the teeth were extracted and examined by light microscopy. RESULTS: Histological evaluation revealed similar pulpal response which consisted of a slight inflammation in both groups after 1 week. The only difference was localized haemorrhage in controls while no haemorrhage was observed in the test group which may show the haemostatic effect of Carisolv. After 1 month the test teeth displayed a very mild inflammation adjacent to the perforation area while haemorrhage disappeared in the controls. In general, pulps showed structural integrity in both groups. Statistical analysis showed no difference between the test and the control groups in both test periods. CONCLUSIONS: The results suggest that Carisolv is biocompatible with human pulp tissue and may have a haemostatic effect.

Adolescent↗

Restoration materials for primary molars-results from a European survey.

OBJECTIVE: The aim of this study was to obtain an overview of the materials and restorative techniques taught for Class I and Class II restorations in primary molars of different European departments for paediatric dentistry and to compare the results to those for North America. METHODS: The forms were sent to the chairmen of the departments of paediatric dentistry or-when included into the department for operative dentistry-to the director of 200 universities in 32 European Countries. The questions concerned the preferred materials and techniques, as well as the indications or contraindications for the use of the different tooth coloured materials. RESULTS: Forty-three percent of the universities from western European countries (excluding Germany) responded to the survey. A 97% answer rate was obtained from German Schools. Of the other European regions, the response rate varied remarkably (24-54%). Also, opinions on materials used and methods applied were different from country to country. Only in a few regions (Eastern Europe), amalgam remains the filling material of first choice for Class I and II cavities in primary molars, whereas in others, the use has been restricted and tooth coloured materials, especially compomers or resin-modified glass ionomer cements, are being preferred. CONCLUSIONS: Great diversity in teaching was observed not only among the European countries, but also within the countries themselves which makes it difficult to compare the results of our study to the ones obtained from the US.

Compomers↗

The accuracy of electrical method for microleakage evaluation by a three-dimensional analysis.

OBJECTIVES: This in vitro study aimed to investigate the accuracy of an electrical method for the evaluation of microleakage by a three-dimensional analysis of dye penetration. METHODS: Coronal cavities were prepared on buccal, palatal or lingual surfaces in extracted human molars. The cavities were then filled with resin composites and were subjected to 10,000 load cycles (425g). Before cavity preparation and after load cycling, physiological saline was applied and wiped off, and the change in conductance was measured across the margin of the restoration in each specimen. After dye penetration, the specimens were reduced by 100 microm in a direction parallel to the cavity floor, from the surface of the restoration to the cavity floor. The sequence of reducing the sections by 100 microm and image taking was repeated. Three-dimensional images of dye penetration were made and the proportions of the interface showing penetration were calculated. RESULTS: Pearson's correlation coefficients between changes in conductance and the surface area of dye penetration, between these and the rate of dye penetration, and between these and the depth of dye penetration were 0.932, 0.920 and 0.732, respectively. The correlations were significant (p<0.05). CONCLUSIONS: The results of this electrical method for microleakage evaluation showed stronger correlations with the three-dimensional amount of marginal leakage (surface area of dye penetration and rate of dye penetration) than the two-dimensional amount (depth of dye penetration).

Coloring Agents↗

Amalgam restoration and in vitro caries formation.

Black's class I classic cavity preparations were completed in 124 extracted intact human premolars, of which 120 were restored with one of two silver amalgams, five different base combinations, and with or without cavity varnish. This resulted in 20 different restoration combinations. The other four teeth remained unrestored. Aging for 3 months and 1 year in 1% NaC1 at 20 degrees C followed. After aging, 80 of the restored teeth and the four unrestored teeth were subjected to an in vitro bacterial challenge for 36 days. The other 40 specimens were placed in an acidified (pH 4.0) broth for the same length of time. Sections were prepared for polarized light microscopy, and outer wall and dentin carious lesions were measured. The results were evaluated with one-way ANOVA and Tukey's Student range test with a critical level of statistical significance of p < 0.05 and p < 0.005. Lesions produced by bacterial challenge were significantly smaller than those formed by acidified broth. Aging time and varnish did not significantly influence lesion size. Low copper amalgam, a calcium hydroxide paste base, and restoration per se significantly reduced lesion size. Reproducible measurement of wall lesion length was not possible. Secondary caries lesion size can be minimized by judicious selection of restoration material combinations.

Acids↗

Effect of restorative materials and in vitro carious challenge on amalgam margin quality.

The surface margin of a restoration is where the restored tooth is subjected to aggressive oral attack. Any resistance to this attack will have favorable consequences on the clinical performance and longevity of the restoration. In this study, Black's class I classic cavity preparations were completed in 120 extracted intact human premolars that were restored with one of two silver amalgams, six different base conditions, and with or without cavity varnish, resulting in 20 different restoration combinations. The cavities were aged for 3 months and 1 year in 1% NaCl at 20 degrees C. A resin cast impression was made of the restoration margin for each specimen. Thereafter 80 restored teeth were subjected to an in vitro bacterial challenge for 36 days. The other 40 specimens were placed in an acidified (pH = 4.0) broth for the same length of time. A second cast impression was then made of the margin of each specimen. The casts were examined with a scanning electron microscope and the widest gap of the margin opening and the length of margin showing a discrepancy were measured. Specimens were ranked first on the basis of the gap size and then on percent of margin discrepancy length. Results were evaluated with one-way ANOVA and Turkey's Student range test with a critical level of statistical significance (p < 0.05). Base type significantly affected aged margin quality. Cariogenic challenge caused a significant breakdown of the amalgam margin although the type of challenge was not significant. A shorter aging time, varnish, and high copper amalgam exacerbated the breakdown. Margin breakdown can be reduced by judicious selection of restoration material combinations.

Analysis of Variance↗

Clinical evaluation of two desensitizing agents for use under Class 5 silver amalgam restorations.

STATEMENT OF PROBLEM: Postoperative sensitivity is sometimes reported to be a clinical problem after placement of silver amalgam restorations. PURPOSE: This study compared postoperative sensitivity of Class 5 caries restored with amalgam restorations and Copalite or DentinBloc cavity liners. MATERIAL AND METHODS: At least 1 pair of amalgam restorations were placed in each of 16 patients and tested for sensitivity at 5 time periods. RESULTS: Sensitivity was significantly less with DentinBloc cavity liner (P < .05) at 24 hours, and 2 and 4 weeks. There was a directional but nonsignificant effect (P > .05) in favor of DentinBloc cavity liner at 1 and 16 weeks. CONCLUSION: DentinBloc cavity liner was more effective than Copalite cavity liner in reducing sort term postoperative sensitivity for amalgam restorations.

Adolescent↗

Resistance to fracture of endodontically treated premolars restored with glass ionomer cement or acid etch composite resin.

MOD cavity preparations in 64 endodontically treated premolars were restored using four different methods. Copper rings were filled with commercial hard-setting cement and the teeth were placed into the cement up to the level of the cementoenamel junction. The teeth were grouped according to restorative method, mounted in an Instrom T.T. machine, and the buccal walls subjected to a slowly increasing compressive force until fracture occurred. The force of fracture of the walls of each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner irrespective of the restorative method used. The resistance to fracture of the teeth was the same when they were restored with glass ionomer cement as a base over which an amalgam or composite resin was placed or with acid-etched resin. When the entire cavities were filled with glass ionomer cement the resistance to fracture of the teeth decreased significantly compared with the acid etch resin technique.

Acid Etching, Dental↗

A light curing method for improving marginal sealing and cavity wall adaptation of resin composite restorations.

OBJECTIVE: The aim of this study was to evaluate whether the method of light curing could influence: (a) marginal sealing and resin composite adaptation to the cavity wall; (b) polymerization contraction rate; and (c) the hardness at the top and bottom surfaces of a body of resin composite. METHODS: Standard cylindrical cavities, 1mm deep and 3mm in diameter were prepared on flat superficial dentin surfaces in bovine teeth. The teeth were bonded with one of two adhesive systems (Clearfil Photo Bond, and Super-Bond D Liner) and filled with a hybrid resin composite. The resins were cured using three light intensities of 600, 270 and 20mW/cm(2), and various curing times. After thermal cycling, the specimens were subjected to a dye penetration test to evaluate marginal sealing and adaptation of the resin composite to the cavity walls. In addition, using the same curing conditions, the rate of polymerization contraction was measured. The difference of hardness over time of composite specimens was measured using Knoop hardness measurements taken at the top and bottom surfaces of resin specimens made in a Teflon mold the same dimensions as the cavity prepared in dentin. RESULTS: When the composite was light cured with an initial light intensity of 270mW/cm(2) for 10s, a 5s interval then a light intensity of 600mW/cm(2) for 50s, the best marginal sealing and cavity wall adaptation was observed compared with the other curing modes. Earlier hardening occurred at the resin composite base compared with the top surface of the composite, and most of the polymerization contraction was completed during the initial flowable stage of the resin composite. All other methods demonstrated results with some degree of marginal opening and cavity wall gap formation, the worst being 600mW/s for 60s. SIGNIFICANCE: The use of a low initial light intensity (270mW/cm(2)) for 10s followed by high intensity light (600mW/cm(2)) for 50s provides the best adaptation of resin composite to cavity walls and possibly the least polymerization contraction stress.

Analysis of Variance↗

Posterior composite Class II restorations: in vitro comparison of preparation designs and restoration techniques.

The aim of this study was to evaluate conservative preparation designs for the restoration of Class II lesions with posterior resin composite. Fourteen primary and 14 permanent molars were obtained. Conservative modified MO and DO preparations were placed in half the teeth; conventional MO and DO preparations were placed in the remaining teeth. Randomly, a glass-ionomer liner was placed over the exposed dentin in one preparation of each tooth, a calcium hydroxide liner was placed in the remaining preparations. Posterior resin composite was placed in all teeth, and the teeth were loaded with a 17-kg force. Teeth were thermocycled, stored in 37 degrees C water, then immersed in 50% silver nitrate solution and placed in developer. The teeth were sectioned and photographed. Microleakage was calculated according to the depth of dye penetration, on a 6-degree scale. Results demonstrated the conservative modified restorations and conventional restorations, when glass-ionomer liner was used, to have less marginal microleakage, in both primary and permanent teeth, than their calcium hydroxide counterparts.

Calcium Hydroxide↗

Composite resin restoration and postoperative sensitivity: clinical follow-up in an undergraduate program.

OBJECTIVES: To analyze the relationship between the cavity depth and liners with postoperative sensitivity of resin composite restorations. METHODS: A clinical follow-up was conducted on 319 resin composite restorations made in the final year of an undergraduate program over a 3-year period. Along with the analyses of cavity type, cavity depth, type of pulpal protection and the materials used, the postoperative sensitivity was also examined on each restoration. RESULTS: Thirty-nine percent of the restorations had no protective layer (Group 1). As the depth of the prepared cavities increased, the restorations received one of the three pulpal protection methods; a calcium hydroxide base (Group 2), glass ionomer cement (Group 3), or protection with a calcium hydroxide base in combination with glass ionomer cement (Group 4). The incidence of postoperative sensitivity showed no significant difference among Groups 1, 2 and 3, but was significantly lower in Group 1 than in Group 4. The restorations made in shallow and medium depth cavities demonstrated significantly less-postoperative sensitivity than those made in deep cavities. The newer generation dentine-bonding agents showed a significantly lower incidence of postoperative sensitivity than the early generation group. CONCLUSIONS: Postoperative sensitivity in resin composite restorations was not related to the absence of protective layers but increased with the depth of cavities restored with the resin composite. The type of dentine-bonding agents could also be responsible for postoperative sensitivity.

Adolescent↗

Comparison of pulp responses following restoration of exposed and non-exposed cavities.

OBJECTIVES: The purpose of this study is to compare and contrast differences of pulp responses between non-exposed and exposed cavity preparations in terms of inflammation, frequency of bacterial microleakage, odontoblast and odontoblastoid cell numbers, and tertiary dentine formation. METHODS: Class V non-exposed cavities (n=161) and exposed cavities (n=161 teeth) were prepared in non-human primate teeth. Cavities were restored with calcium hydroxide [Ca(OH)(2)], resin modified glass ionomer, or resin composite. Following extraction (7-730 days), bacteria were detected with McKays stain and pulp reactions were categorized according to ISO guidelines. Teeth were analyzed histomorphometrically and statistically using analysis of variance tests. RESULTS: Exposed cavities in comparison with non-exposed cavities were found to have more severe inflammation (p=0.0001), greater quantities of tertiary dentine (p=0.0001), and an increased frequency of bacterial microleakage (p=0.0034). The density of odontoblastoid cells beneath pulp exposed tertiary dentine was found to be 47.8% of odontoblast cell density beneath non-exposed dentine (p=0.0001). CONCLUSIONS: The restoration of exposed cavity preparations is associated with more traumatic pulp injury and repair responses. Consequently, efforts should be made to minimize iatrogenic dentine removal during cavity preparation and the creation of pulp exposures whenever possible.

Analysis of Variance↗

Odontoblast morphology and dental repair.

OBJECTIVES: To investigate the changes in morphology and activity of pulp odontoblasts in response to cavity restoration variables and patient factors. METHODS: Class V non exposed cavities were prepared in the intact 1st or 2nd premolar teeth of 27 patients, aged between 9 and 17 years-old. Following tooth extraction, the area of reactionary dentine and the area of the odontoblasts were measured using computerised histomorphometry. RESULTS: The cytoplasm to nucleus ratio of the odontoblasts was found to increase beneath cut dentinal tubules, following the secretion of reactionary dentine. However, none of the patient or preparation variables were found to be correlated with changes in the odontoblast cytoplasm to nucleus ratio. CONCLUSIONS: Morphological changes in human odontoblasts is directly related to their capacity to repair dentine injuries and provide pulp protection. Changes in odontoblast morphology reflect secretory activity.

Adolescent↗

The effects of filling techniques and a low-viscosity composite liner on bond strength to class II cavities.

OBJECTIVE: The aim of this study was to test the hypothesis that the effects of filling technique, cavity configuration and use of a low-viscosity composite liner influence resin bond strength to the dentin of class II cavities gingival floor; and analyze the failure modes of fractured specimens. METHODS: Standardized class II cavities were prepared in the proximal surfaces of freshly extracted third molars, which were randomly assigned to 10 experimental groups. All prepared surfaces were acid-etched, bonded with Single Bond adhesive system and restored with TPH composite, according to each technique: G1 and G2-horizontal layering, G3 and G4-faciolingual layering, G5 and G6-oblique layering, G7 and G8-bulk filling, G9 and G10-control (flat dentin surfaces). Groups were tested, with or without a low-viscosity composite liner (Tetric Flow Chroma). After storage in water for 24h, teeth were vertically serially sectioned to yield a series of 0.8mm thick slabs. Each slab was trimmed into an hourglass shape of approximately 0.8mm(2) area at the gingival resin-dentin interface. Specimens were tested in tension at 0.5mm/min until failure. Fractured specimens were analyzed in an SEM to determine the failure modes. RESULTS: No significant difference was found between groups restored with and without a low-viscosity composite liner (p>0.05). Among filling techniques, the bulk filling groups presented the lowest bond strength values (p<0.05), while incremental filling groups did not differ from control (flat dentin surfaces). Failure modes varied significantly among groups restored with and without the low-viscosity composite liner. SIGNIFICANCE: Bond strengths were not improved when a low-viscosity composite liner was applied, but it remarkably influenced the failure modes. Incremental techniques improved bond strength.

Acid Etching, Dental↗

Replacement risk of amalgam treatment modalities: 15-year results.

OBJECTIVES: This paper reports on the replacement risk of different treatment modalities for Class II amalgam restorations in a clinical trial of 15 years duration. METHODS: The performance of 1117 conventional Class II amalgam restorations in a controlled, longitudinal study were analysed using logistic regression with a random component. Primary variables regarding replacement risk were the treatment modality (cavity wall treatments) and alloy (conventional versus high copper). Secondly, the operator, type of tooth and type of restoration (MO/DO vs MOD) were considered. RESULTS: Over 15 years, 17% of the restorations were replaced (true failures). The application of copalite varnish or silver suspension and the type of alloy did not reduce the replacement risk. Reduced risks were observed by providing a 90-degree cavosurface angle combined with a cavity wall finish. The operator and the type of restoration determine replacement risk to a significant extent. CONCLUSIONS: Additional treatment modalities do not necessarily reduce replacement risks of Class II amalgam restorations within 15 years, while clinical variables affect the risk of replacement to a certain degree.

Adult↗

Human pulp response after an adhesive system application in deep cavities.

OBJECTIVES: To evaluate the pulpo-dentin complex response to a dentin adhesive application in deep cavities performed in human teeth. METHODS: Deep class V cavities were prepared on the buccal surface of 46 premolars. The remaining dentin of the axial wall received 10% phosphoric acid and dentin adhesive (group DA), or was protected before the acid and dentin adhesive application with calcium hydroxide cement (group CH). Half of the teeth, which received the acid application directly over the axial wall, were contaminated prior to the procedures with dental plaque collected from the patient's own teeth (group DAC). The plaque was placed on the dentin for 5 min and then the cavity was washed. All teeth were restored with a light-cured composite resin. The teeth were extracted after 7, 30 or 60 days and prepared according to normal histologic techniques. Serial sections were stained with H/E, Masson's trichrome and Brown & Brenn technique for demonstration of bacteria. RESULTS: The histopathologic evaluation showed that in groups DA and DAC, the inflammatory response was more evident than in group CH. Also, the intensity of the pulp reaction increased as the remaining dentin thickness decreased. There was no statistical difference in the inflammatory response between the groups DA and DAC. CONCLUSION: Based on the experimental conditions, we concluded that the All Bond 2 adhesive system, when applied on dentin in deep cavities, showed an acceptable biocompatibility. However, the intensity of the pulpo-dentin complex response depends on the remaining dentin thickness.

Acid Etching, Dental↗