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Unprotected protein at the dentin-adhesive interface.

OBJECTIVE: With dental bonding systems that require acid etching of dentin, inadequate adhesive penetration can leave exposed collagen at the dentin-adhesive interface. The exposed collagen could be degraded by bacterial proteases, compromising the integrity of the dentin-adhesive bond and, ultimately, the restoration. The purpose of this study was to develop a nondestructive staining technique to identify exposed collagenous protein at the dentin-adhesive interface. METHOD AND MATERIALS: The following adhesives were placed, according to manufacturer's instructions, on dentin cut from 15 human third molars: Scotchbond Multi-Purpose, Scotchbond Multi-Purpose Plus, and 3M Single Bond. Light microscopic sections of native dentin-adhesive interfaces of each tooth were cut and stained with Goldner's trichrome. This reagent stained exposed protein in the sections a distinct red-orange. RESULTS: Exposed protein was identified at the dentin-adhesive interface with each of the adhesives. Corollary scanning electron microscopic examination confirmed the presence of exposed protein, i.e., protein that was removed by sodium hypochlorite, at the interface. Sites of exposed protein that were clearly identified in the light microscopic sections were obscured in the transmission electron microscopic sections. CONCLUSION: In vitro identification of inadequacies in the dentin-adhesive bond is the first step in determining sites that may be vulnerable to premature breakdown under clinical conditions.

Azo Compounds↗

Esthetic and functional reproduction of occlusal morphology with composite resins.

The increasing use of composite resin restorations in posterior sectors produces some difficulties in the exact reproduction of occlusal morphology. In this article we present a new operative method that allows a quick and precise reproduction of occlusal morphology with minimal carious destruction of the occlusal enamel of posterior dental elements in the case of initial carious lesions. This method is indicated for class I and II carious lesions and is based on a preoperative record of the occlusal morphology made with a transparent silicone mold. This mold is placed on the tooth after the application of the last layer of composite resin, which is then polymerized through the silicone. Illustrated as a clinical case, the method is particularly rapid, easy to perform, and contributes to the improved quality and subsequent success of composite restorations in posterior sectors.

Adult↗

1-year clinical evaluation of one-step in non-carious cervical lesions.

PURPOSE: To evaluate the 1-year clinical retention rate of restorations of non-carious cervical lesions placed using a "one-bottle" adhesive (One-Step) and one of two low modulus resin-based composite (RBC) restorative materials (AEliteflo or Bisco Glaze) or a microfilled RBC (Silux Plus). MATERIALS AND METHODS: 105 non-carious cervical lesions in 14 patients, mean age 60 years, were restored using either AEliteflo, Bisco Glaze or Silux Plus with One-Step dentin bonding agent. The dentin surface was lightly roughened with a fine diamond stone, cleaned with pumice and water and restored according to the manufacturers' instructions. Patients were recalled at 6 months and 1 year, and the restoration sites examined. RESULTS: At 6 months all restorations were present. At 1 year, five restorations were missing (two Silux, three AEliteflo), three of which were in one patient. A cumulative retention rate of 95% was recorded. A small number of restorations exhibited marginal discoloration, but this was believed to be due to excess RBC on unetched enamel.

Adult↗

Class V lesions restored with flowable composite and added surface sealing resin.

This in vitro study evaluates the marginal sealing ability of three different flowable composite systems at enamel and dentin margins, using sealants. Class V preparations were made on the facial surfaces in enamel and dentin/cement of 60 freshly extracted teeth, which were allotted randomly into six groups of ten. The control groups (I, II, and III) showed leakage in the majority of cases. However, Groups IV and V had very limited microleakage scores (2 of 30) in comparison to Group VI (p < 0.001, Mann-Whitney Test).

Barium Compounds↗

Microleakage at the cervical margin of composite Class II cavities with different restorative techniques.

This study evaluated the microleakage at the cervical margins of Class II composite resin restorations restored with different techniques. Slot cavities were prepared on both proximals of 40 unerupted third molars with one cervical margin located above and the other below the cementoenamel junction. The prepared teeth were randomly assigned to four groups and restored using the following techniques: (I) 3-Sited, (II) Directed-Shrinkage, (III) Resin-Modified Glass-Ionomer Cement or a (IV) Flowable Composite as the gingival increment. All restorations were placed with the same bonding agent and composite resin. The difference among the groups was on the first increment and on its insertion and polymerization techniques. After restoration, the teeth were thermocycled and exposed to a dye. Results showed that all the techniques worked well for enamel, with almost no leakage. However, on cementum, all techniques demonstrated moderate to severe leakage.

Barium Compounds↗

Effect of stepped light exposure on the volumetric polymerization shrinkage and bulk modulus of dental composites and an unfilled resin.

PURPOSE: To compare the volumetric polymerization shrinkage and dynamic bulk modulus of five resins and an experimental unfilled resin polymerized with a stepped power light and with a conventional one step curing light. MATERIALS AND METHODS: Parallel sided glass rings 5 mm in diameter and 2 mm high were etched for 5 min with hydrofluoric acid and silanated. The density and volume of the rings were calculated before they were filled with either SureFil, AEliteflo, Pertac II, Z100, or an experimental unfilled resin. When cured, the resin was bonded to the glass ring which produced a mold with a configuration C-factor of approximately 0.8. The resin was cured for 40 s on each side using either a one step curing light or a stepped power curing light. After curing, the specimens were weighed in air and in water to calculate their final density and volumetric shrinkage. Ten samples were made using each light system and for each resin (total of 100 samples). The bulk modulus was determined for each resin using an ultrasonic method, and the percentage filler contents were determined by thermogravimetric analysis. RESULTS: The mean +/- SD volumetric polymerization shrinkage values ranged from 3.10 +/- 1.19% for SureFil using the one step light to 12.35 +/- 1.38% for the unfilled resin using the stepped power curing light. Student-Newman-Keuls post hoc test separated the 10 different materials into three significant groups at P= 0.05. The unfilled resin exhibited the highest volumetric shrinkage followed by the flowable composite (AEliteflo). For all materials tested, there was no significant difference in the volumetric shrinkage values when the resin was cured with the one step or the stepped power curing light. There was no significant difference in the volumetric shrinkage values for the hybrid composites (Pertac II, Z100, and SureFil). The volumetric shrinkage values were highly sensitive to filler weight (P < 0.001). Except for Z100, there was no difference in the specific gravity values and velocities of the longitudinal and shear waves and bulk modulus when the one step and stepped power curing lights were used. The bulk modulus values ranged from 6.30 +/- 0.19 GPa for unfilled resin, to 17.10 +/- 1.09 GPa for Z100. Curing with the one step or the stepped curing light had no significant effect on the modulus values for any resin with the exception of Z100, P = 0.05. The bulk modulus values were highly sensitive to filler weight, and higher modulus values were associated with increased filler weight (P < 0.001). There was no significant difference between the bulk modulus of Pertac II and SureFil (P = 0.05).

Acid Etching, Dental↗

Fracture strength of fragment-bonded teeth. Effect of calcium hydroxide lining before bonding.

PURPOSE: To measure, in vitro the strength of intact teeth, fracture-bonded teeth, and fracture-bonded teeth bonded after a preliminary calcium hydroxide lining of the dentin part of the remaining tooth. MATERIALS AND METHODS: The study used 30 young, similarly aged sheep incisors. Twenty incisors were fractured 2.5 mm from the incisal edge and another 10 incisors remained non-fractured and served as control (Group 1). Group 2 comprised 10 fractured incisors, which after 3 weeks water storage were bonded by use of acid etching and a dentin bonding agent. In Group 3, the root part of 10 fractured incisors were lined with calcium hydroxide and kept in water for 3 weeks. Then the lining was removed with a hand instrument before bonding as above. The strength of the teeth in Groups 1-3 was measured and the mean fracture strengths representing the three groups were compared by Newman-Keuls' multiple range tests at a 5% level of significance. RESULTS: The mean fracture strength of the lined teeth (9.6 MPa) was significantly different from that of intact teeth (17.8 MPa) as well as from that of the bonded but unlined teeth (15.8 MPa). The latter two means were not significantly different. It is concluded that the use of calcium hydroxide on the fracture surfaces of fractured teeth before bonding lowers the fracture strength of the restored teeth.

Acid Etching, Dental↗

Flow characteristics and film thickness of flowable resin composites.

Flowable resin composites have been recommended for many clinical uses and have been formulated in a variety of compositions and viscosities to meet various uses. This study compared the variation in viscosity of flowable resin composites using the ADA Flow Test and measured film thickness with a test to simulate flow during cementation. The film thickness test for the flowable resin composites was performed at three different seating pressures to simulate pressure variation during seating of porcelain veneers, one of the potential uses of flowable resin composites that may favor a lower viscosity. The following flowable resin composites were evaluated: Revolution, StarFlow, Aeliteflo LV, Aelite, Flow-It, FloRestore, Versaflo, Durafill Flow and Tetric Flow, with Nexus2, a composite luting resin used as a control. Flow characteristic measurements suggest that resin composites may be divided into high flow (StarFlow, Revolution, Aeliteflo LV), medium flow (FloRestore, Durafill Flow, Flow-It) and low flow (Tetric Flow, Versaflo, Nexus2, Aelite) groupings. The film thickness measurements agreed with the ADA flow test, except for two exceptions. Durafill Flow resin composite had a higher film thickness than expected based on the ADA flow test. Also, Aeliteflo unexpectedly had a lower film thickness. At the lowest seating pressure (.016MPa) tested, eight out of the nine resin composites tested as well as the control luting resin had a film thickness greater than the 25 microns used as the clinical standard for cement film thickness. However, at the highest seating pressure (.038 MPa) tested, only two and the control, Versaflo, Durafill Flow and Nexus2, had film thicknesses significantly greater than 25 microns. The highly filled Nexus2 luting resin had the highest film thickness at all seating pressures.

Analysis of Variance↗

Effect of interfacial bond quality on the direction of polymerization shrinkage flow in resin composite restorations.

Shrinkage in light curing resin composites is assumed to be directed toward the light source. However, the strong bond at the dentin-resin interface achieved by newer generation dentin bonding systems may affect the direction of polymerization shrinkage. In this study, various curing modes of adhesive resin simulating different bond qualities were applied to determine the extent of interfacial gap formation with a scanning electron microscope. We also measured the free surface depression with a profilometer. The direction of polymerization shrinkage was inferred from the ratio of the interfacial gap measurement at the floor to the free surface depression. Various curing modes used in this study include Group 1: light curing of resin composite without the bonding agent as the negative control; Group 2: simultaneous light curing of the bonding agent and resin composite; Group 3: start of the chemical cure of the dual-cured bonding agent before light curing the resin composite; Group 4: curing the light-initiated bonding agent before insertion and light curing of the resin composite. When the bonding agent was light cured prior to inserting the resin composite (Group 4), the free surface depression was the greatest and the interfacial gap smallest among those in all groups. Therefore, if a good bond between dentin and resin composite can be established, the shrinkage flow will be directed toward a center located near the bonded interface rather than toward the incident light, thus reducing detrimental shrinkage stress.

Acid Etching, Dental↗

Composite restorations: influence of flowable and self-curing resin composite linings on microleakage in vitro.

This in vitro study evaluated the microleakage at enamel (occlusal) and dentin (gingival) margins of MOD resin composite restorations made with different incremental insertion techniques. MOD cavities were prepared on 60 extracted human molars with the proximal margins placed 1 mm below the cemento-enamel junction. All teeth were acid-etched and treated with One-Step adhesive, then restored with a hybrid resin composite (Renew) with and without a flowable composite (AEliteflo) or a self-curing composite (Bisfil 2B) as the first increment in the proximal boxes. The time of placement of the second increment in relation to curing of the first increment was also varied. After polishing, the teeth were soaked in 0.5% basic fuchsin for 24 hours, sectioned and evaluated for dye penetration. None of the restorative techniques prevented microleakage at the enamel and dentin margins. However, microleakage at dentin margins were significantly reduced by the use of a flowable composite as the first increment in the proximal boxes. Time of placement in relation to curing had no influence on microleakage. Microleakage was lower at enamel margins than at dentin margins; however, besides microleakage at the enamel-restoration interface, 37 of the 60 restored teeth (62%) displayed at least one white line in enamel adjacent to the composite restoration.

Barium Compounds↗

Three-year clinical evaluation of One-Step in non-carious cervical lesions.

PURPOSE: To clinically evaluate the 3-year performance of a one-bottle dentin adhesive in the restoration of non-carious cervical lesions (NCCLs) with resin composite. MATERIALS AND METHODS: 105 NCCLs were restored with either AElite Flow, Bisco Glaze (both flowable resin-based composites) or Silux (a microfilled resin-based composite), using One-Step dentin adhesive. The cavities were cleaned with pumice and water slurry, the dentin lightly roughened with a fine diamond bur, and the restorations placed according to the manufacturer's instructions. Patients were recalled at 6 months, 1 year, 2 years and 3 years, and restoration integrity and marginal discoloration assessed. RESULTS: The overall retention rates were: 6 months, 100%; 1 year, 95%; 2 years, 87%; 3 years, 75%. Marginal discoloration was negligible, and there was no significant difference among the materials, although there was a trend for it to be greater around the Bisco Glaze restorations.

Adult↗

Flow, strength, stiffness and radiopacity of flowable resin composites.

OBJECTIVE: This study was undertaken to characterize 9 currently available proprietary flowable composites with respect to key properties of flow, flexural strength, stiffness (modulus of elasticity) and radiopacity. METHODS: Seven proprietary flowable composites (Aelite Flo, Filtek Flow, Heliomolar Flow, PermaFlo, Revolution Formula 2, Tetric Flow, Wave) and 2 flowable compomers (Compoglass Flow, Dyract Flow) were evaluated. A universal hybrid composite (Filtek Z250) and a restorative compomer (Dyract AP) were used as controls. Standard mechanical testing of 25 x 2 x 2 mm bar specimens was carried out at 24 hours and 1 month. Flow testing used a fixed volume of material under consistent loading, and radiopacity was measured simultaneously for all materials using disk specimens of 1 mm thickness. RESULTS: As expected, flowable composites showed higher flow and lower mechanical properties than the controls. Moduli of the composites were approximately 50% or less of the moduli of control materials, which indicates high flexibility. Flexural strengths approached that of the control composite. Flow properties varied widely. The material Tetric Flow had the highest radiopacity, above that of enamel and the control composite. Lowest radiopacity, below or equivalent to that of dentin, was shown by Wave and Revolution Formula 2. CONCLUSIONS: The flowable materials possessed a wide range of mechanical and physical properties. Their lower mechanical properties suggest that they should not be used in bulk in areas of high occlusal loading. Within intracoronal restorations, clinicians are advised to use materials with high radiopacity. A wide range of fluidity options is available. The clinical applications and performance of these materials require further study.

Analysis of Variance↗

Shear bond strength between composite resin and denture teeth: effect of tooth type and surface treatments.

PURPOSE: The purpose of this study was to investigate the strength of the composite resin-denture tooth bond as affected by different tooth surface treatments. MATERIALS AND METHODS: Spectrum TPH was condensed on 112 mandibular first molar acrylic resin and composite resin denture teeth, which received seven different treatments: Four groups were treated with Prime & Bond NT adhesive, and three groups were treated with One Step adhesive. Four groups (two of each adhesive category) were treated with Composite Activator and air abrasion. In one group, AeliteFlo was used just before the condensation of Spectrum TPH. Bond strength was evaluated with a shear test device on a Monsanto testing machine. The results were evaluated statistically with two-way ANOVA and the Scheffé method. RESULTS: There was a significant interaction between denture tooth type and surface treatments. Bond strength of composite resin was greater to composite than to acrylic resin teeth when the bond was mediated only with adhesives. One Step adhesive and AeliteFlo resulted in a higher bond of composite resin to both types of teeth. Wetting tooth surfaces with Composite Activator did not increase the bond. CONCLUSION: When repairing denture teeth with composite resin and adhesives, the bond strength was higher with composite than with acrylic resin teeth, and there were differences between the adhesives used.

Acid Etching, Dental↗

Effect of different polymerization methods on composite microleakage.

PURPOSE: To evaluate the microleakage of a condensable resin composite using a microhybrid flowable composite as a liner, cured with four different methods of polymerization. METHODS: 40 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 four groups. Group 1 (control group): conventional mode (Elipar Highlight), Group 2: step mode (Elipar Highlight), Group 3: ramp mode (Elipar Trilight) and Group 4: pulse mode (VIP). Preparations were etched with 32% phosphoric acid (Uni-Etch) and an adhesive system (One-Step) was used according to the manufacturer's instructions. Teeth were then restored using a 1 mm layer of flowable composite (A2 AEliteflo LV) on the gingival and pulpal floor and condensable composite (Pyramid A2 Dentin and A1 Enamel) in 2 mm increments. Teeth were thermocycled x500 between 5 degrees C and 55 degrees C with a dwell of 30 seconds and then placed in a 0.5% methylene blue dye solution for 24 hours at 37 degrees C. Samples were sectioned longitudinally and evaluated for microleakage at the gingival margin under a stereomicroscope at x30 magnification. Dye penetration was scored using an ordinal scoring system as 0: no penetration; 1: enamel penetration; 2: dentin penetration. RESULTS: A Mann-Whitney U Test revealed a statistically significant difference between Group 1 with Groups 2, 3 and 4 (P < 0.001). Group 1 yielded the most microleakage. No statistically significant difference was noted between Groups 2, 3 and 4.

Acid Etching, Dental↗

Single-visit, adjacent composite onlays--a dual-catalyst, inert gas-processed chairside technique.

Considerable research has been conducted on laboratory-processed composite resins in the last two decades. Substantial long-term studies support the theory that physical properties improve greatly if these composites are processed under high-pressure inert gas. In addition, the use of dual catalysts (light and heat) will generate higher conversion rates in the composite. This article describes a clinical technique for fabricating adjacent onlays or three-quarter crowns in a single visit that capitalizes on the inert gas and dual-catalyst research.

Acid Etching, Dental↗

In vitro effect of cavity disinfectants on the bond strength of dentin bonding systems.

OBJECTIVE: To evaluate the effect of two cavity disinfectants, a 2% chlorhexidine and a 1% benzalkonium chloride solution, on the shear and tensile bond strengths of dentin bonding systems to dentin. METHOD AND MATERIALS: Superficial dentin was exposed from 84 freshly extracted human third molars. The teeth were randomly assigned to two main groups according to the bonding agent used, either One Step or Optibond Solo. Each dentin bonding system had six test groups (three for shear, three for tensile testing), and each test group had a control and two cavity disinfectant groups. In the control groups, dentin bonding systems were applied after etching the dentin, whereas in the cavity disinfectant groups, dentin was conditioned and treated for 20 seconds with the disinfectants before applying the dentin bonding systems. A hybrid resin composite then was applied to all treated samples. After storage in distilled water at 37 degrees C for 24 hours, shear and tensile tests were performed. Data were analyzed using Kruskall-Wallis and Mann-Whitney U tests. RESULTS: The mean shear and tensile bond strengths of One Step and Optibond Solo were not significantly different from each other, and the cavity disinfectants also had no significant effects on shear and tensile bond strength values versus the controls. CONCLUSION: The results indicate that the use of 2% chlorhexidine and 1% benzalkonium chloride solutions as cavity disinfectants after etching the dentin did not affect the shear and tensile bond strengths of One Step and Optibond Solo.

Anti-Infective Agents, Local↗

Effects of incremental curing on contraction stresses associated with various resin composite buildups.

OBJECTIVE: The purpose of this study was to photoelastically evaluate contraction stresses associated with various resin composite build-up procedures, including incremental curing and the use of flowable composite for pulpless molars. METHOD AND MATERIALS: Life-sized photoelastic models of an endodontically treated molar were fabricated. The cavity represented a conservative access preparation and included four lateral walls. The following materials were used for buildup: dual-cured hybrid composite (Cleafil DC Core [DC], BIS-CORE [BC]); light-cured flowable composite (AELITEFLO LV [ALV]); and chemical-cured flowable composite (CORE-FLO [CF]). The photoelastic models were built up with the following techniques: bulk-cured (BDd [dual-cured DC], BDc [chemically-cured DC], BBd [dual-cured BC], and BC [CF]); and incremental-cured (1 mm gingivally + 3.5 mm occlusally; IAB [ALV + BC], ICB [CF + BC], and IBB [BC + BC]). Isochromatic fringes developed in the models were recorded photographically in the field of a circular polariscope, and maximum fringe order was determined. Five specimens were tested for each condition. RESULTS: Stress intensity of the build-up methods fell into two categories: high (BDd, BBd, BC, and IAB) and low (BDc, ICB, and IBB). The difference between high and low groups was statistically significant, except between BC and ICB. The maximum fringe order was developed around the point angles at the cavity floor for all the conditions tested. CONCLUSIONS: Type and setting mechanism of resin composite build-up technique had considerable influence on contraction stress. Incremental buildup using composites with low elastic modulus did not reduce contraction stress intensity compared with bulk-cured techniques.

Barium Compounds↗

Microleakage of cervical cavities restored with flowable composites.

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.

Animals↗