American Journal of Dentistry
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Abstracts of the June 2006 Issue

An occlusal plaque index. Measurements of repeatability, reproducibility, and sensitivity


Christian H. Splieth, prof, dr med dent, dds & Abduhl W. Nourallah, prof, dr med dent, dds


Abstract: Purpose: To evaluate a new, computerized method of measuring dental plaque on occlusal surfaces which exhibit the highest caries prevalence. Methods: In 16 patients (6-9 years of age), plaque on the occlusal surfaces of permanent molars was stained (Mira-2-Tone) and photographed with an intra-oral camera. In a conventional picture editing program (PC/Adobe PhotoShop 6.0), the occlusal surface and plaque were measured in pixels and the relative proportion of occlusal plaque was calculated (ANALYSIS 3.0). The repeatability and reproducibility of the method were analyzed by re-taking and analyzing four images by two examiners four times via intra- and inter-examiner correlation coefficients and by re-analyzing 10 images. Sensitivity was tested by re-taking and analyzing the images of the same occlusal surfaces in all patients after instructed brushing with an electric toothbrush. Results: Intra- and inter-examiner correlation coefficients for repeatability and reproducibility of the analysis were excellent (ICC> 0.997 and ICC=0.98, resp.; 95% confidence interval: 0.955-0.995). The inter- and intra-examiner coefficients for the whole procedure including the re-taking of images were also high (ICC > 0.90). The method was also highly sensitive, proving a statistically significant plaque reduction after brushing (before: mean 29.2% plaque, after: 14.7% plaque; t-test, P= 0.025). (Am J Dent 2006;19: 135-137).


Clinical significance: The computer-assisted analysis of images taken with an intra-oral camera offers a sensitive, easy, extremely accurate and reproducible method for occlusal plaque index which could be used for clinical oral hygiene assessments and research on occlusal plaque growth and removal.


Address: Prof. Dr. Christian H. Splieth, Department of Preventive and Pediatric Dentistry, Ernst Moritz Arndt University, Rotgerberstr. 8, D-17487 Greifswald, Germany. E-mail:



Bond strengths of resin cements to fiber-reinforced composite posts


Kerstin Bitter, dds, Hendrik Meyer-Lückel, dds, Karsten Priehn, dds, Peter Martus, phd

& Andrej M. Kielbassa, dds, phd


Abstract: Purpose: To evaluate the bond strengths of six different luting cements to fiber-reinforced composite (FRC) posts after various pre-treatment procedures. Methods: 180 FRC posts were divided into three groups (n=60) and received the following surface treatments. Group 1: untreated control; Group 2: silane treatment; Group 3: CoJet treatment. The posts of each group were fixed with six different luting cements. Push-out tests were performed to deter-mine the bond strengths between the cements and the fiber posts. Results: The observed bond strengths (MPa) of the different resin cements to the posts were significantly affected by the type of cement (P< 0.001), but not by the pre-treatment chosen (P> 0.05; 2-way-ANOVA). Without consideration of the pre-treatment procedures, Clearfil showed the highest bond strengths, followed by Panavia F and RelyX, whereas Multilink, Variolink and PermaFlo showed significantly lower bond strength values (P< 0.05; Tukey's B). (Am J Dent 2006;19: 138-142).


Clinical significance: Luting cements containing functional phosphate monomers showed higher bond strengths to FRC posts than conventional bis-GMA-based resin cements. Pre-treatment of the investigated fiber-reinforced composite posts had little influence on bond strength depending on the resin cement used.


Address: Dr. Kerstin Bitter, Poliklinik für Zahnerhaltungskunde und Parodontologie, Universitätsklinik für Zahn-, Mund- und Kieferheilkunde, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, D - 14197 Berlin, Germany. E-mail:



Evaluation of the light intensity of high intensity light units


Kazuyoshi Hashimoto, dds, Norimichi Inai, dds, phd & Junji Tagami, dds, phd


Abstract: Purpose: To determine the intensity of PAC (plasma arc curing) light compared with conventional QTH (Quartz tungsten halogen) light using a hardness test. Methods: The spectral distribution of two light sources was analyzed with a spectroradiometer, after the light intensity was determined. AP-X composite was packed into a black mold (4 mm in diameter and 4 mm in depth) to prepare a cylindrical specimen. The irradiating conditions for the PAC unit in the current study were fixed at 6-second irradiation with 600 mW/cm2 (P600-6), 900 mW/cm2 (P900-6), 1200 mW/cm2 (P1200-6), 1500 mW/cm2 (P1500-6), 1800 mW/cm2 (P1800-6) and 40-second irradiation with 600 mW/cm2 (P600-40). The conventional irradiating condition for QTH was 600 mW/cm2 for 40 seconds (Q600-40). After storage in 37ºC water for 24 hours, the hardness of the resin composite was measured with a nanoindentation testing machine. Triplicate readings were made at a distance of every 0.5 mm down to 3.0 mm from the top irradiated surface. The comparison of means was statistically analyzed applying one-way ANOVA and Fisher's PLSD test at a significant level of P< 0.05. Results: Although the peak height of the PAC lamp was different due to the light intensity, the waveforms were parallel with one another and the wavelength of peaks was located at the same number. The hardness value at a depth of 2.0 mm and at values of P1800-6 was not significantly different from the control. (Am J Dent 2006;19: 143-146).


Clinical significance: The optimal intensity for 6 seconds of irradiation time by the PAC light unit was 1800 mW/cm2 compared with the QTH light unit. It was concluded that the high intensity light source could shorten the irradiation time for adequate polymerization of the resin composite tested.


Address: Dr. Kazuyoshi Hashimoto, Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo 113-8549, Japan. E-mail:




Bonding durability of a self-etching primer system to normal and caries-affected dentin under hydrostatic pulpal pressure in vitro


Masatoshi Nakajima, dds, phd, Keiichi Hosaka, dds, Monica Yamauti, dds, phd,

Richard M. Foxton, bds, mfds rcs ed, phd & Junji Tagami, dds, phd


Abstract: Purpose: To evaluate the bonding durability of a self-etching primer system to normal and caries-affected dentin under hydrostatic pulpal pressure. Methods: 18 extracted human molars with occlusal caries were used. Their occlusal dentin surfaces were ground flat to expose normal and caries-affected dentin using #600 SiC paper under running water. Clearfil SE Bond was placed on the dentin surface including the caries-affected dentin according to the manufacturer’s instructions and then the crowns were built up with resin composite (Clearfil AP-X) under either a pulpal pressure of 15 cm H2O or none (control). The bonded specimens were stored in 100% humidity for 1 day (control) or for 1 week and 1 month with hydrostatic pulpal pressure. After storage, the specimens were serially sectioned into 0.7 mm-thick slabs and trimmed to an hour-glass shape with a 1 mm2 cross-section, isolated by normal or caries-affected dentin, and then subjected to the micro-tensile bond test. Data were analyzed by two-way ANOVA and Tukey’s test (P< 0.05). Results: Hydrostatic pulpal pressure significantly reduced the bond strength to normal dentin after 1-month storage (P< 0.05), but did not affect the bond strength to caries-affected dentin. (Am J Dent 2006;19: 147-150).


Clinical significance: Under hydrostatic pulpal pressure, the bonding durability of the self-etching primer/adhesive system was dependent upon the type of dentin (sound or carious).


Address: Dr. Masatoshi Nakajima, Cariology and Operative Dentistry, Department of Restorative Sciences, Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo 113-8549, Japan. E-mail:



Effect of bonding systems on post-operative sensitivity from posterior composites


Enosakhare S. Akpata, bchd, mdsc, fds & Jawad Behbehani, dmd, dmsc, ob, ficd


Abstract: Purpose: To compare post-operative sensitivity from posterior composites lined with bonding systems that utilize either a self-etching primer or phosphoric acid conditioner. Methods: Occlusal cavities on homologous contra-lateral posterior teeth in 28 selected subjects were lined with either One-Step Plus (a bonding system that utilizes phosphoric acid conditioner) or Clearfil SE Bond with a self-etching primer, and then restored with a hybrid resin composite. Post-operative sensitivity was assessed subjectively by asking the patient to classify pain from the restored tooth into none, mild or severe; and objectively by measuring the time it took for the patient to feel cold sensation when standardized ice stick was placed against the mid-buccal surface of the tooth. Results: Subjective assessment showed that post-operative sensitivity was mild with either of the bonding systems; and marginal homogeneity test showed no statistically significant difference in the prevalence of post-operative sensitivity (P> 0.05), although there was a trend towards decreasing sensitivity with Clearfil SE Bond as post-operative period increased (P= 0.027). In the objective assessment, repeated measures of ANOVA showed that cold response measurements increased significantly with post-operative period only in the teeth lined with Clearfil SE Bond (P< 0.05), indicating decreasing post-operative sensitivity. However, paired t-test showed no significant difference between the cold response measurements obtained for the two bonding systems (P> 0.05). (Am J Dent 2006;19: 151-154).


Clinical significance: Post-operative sensitivity was mild, and not significantly different in occlusal posterior composites, on homologous teeth, lined with the adhesive resin utilizing either phosphoric acid conditioner or self-etching primer. Unlike the resin composites lined with the adhesive resin involving the use of phosphoric acid conditioner, however, post-operative sensitivity decreased significantly with post-operative period in the composites that received adhesive resin liner with a self-etching primer.


Address: Professor E.S. Akpata, Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait. E-mail:



Optical properties of four esthetic restorative materials

after accelerated aging


Yong-Keun Lee, dds, phd, Huan Lu, dds, phd & John M. Powers, phd


Abstract: Purpose: To determine the differences in CIE L*, a*, and b* values, translucency parameter (TP), opalescence parameter (ΔO*ab), and color difference caused by the fluorescence (ΔE*ab-FL) of resin composite, glass-ionomer, resin-modified glass-ionomer, and compomer of A2 shade before and after accelerated aging. Methods: Color and spectral distribution of the materials were measured according to the CIELAB color scale relative to the standard illuminant D65 in the transmittance and reflectance modes. Aging was performed in an accelerated aging chamber with an energy exposure of 150 kJ/m2. The translucency parameter (TP) was calculated as the color difference (ΔE*ab) of the specimen over white and black backgrounds. Opalescence parameter (ΔO*ab) was calculated as the difference in blue-yellow coordinate (Δb*) and red-green coordinate (Δa*) between the transmitted and reflected colors of a 1 mm-thick specimen. Color difference by the fluorescence (ΔE*ab-FL) in reflectance mode was calculated as an index of fluorescence. Differences and changes in optical properties were analyzed by the repeated-measures ANOVA. Results: Type of material and the mode of measurement (transmittance and reflectance) influenced CIE L*, a* and b* values significantly (P< 0.05) before aging. Accelerated aging influenced CIE L*, a* and b* values. Aging and the type of material influenced TP, ΔO*ab and ΔE*ab-FL values significantly (P< 0.05). (Am J Dent 2006;19:155-158).


Clinical significance: Color parameters, translucency, opalescence and fluorescence of resin composite, glass-ionomer, resin-modified glass-ionomer, and compomer of A2 shade were affected differently by accelerated aging.


Address: Dr. Yong-Keun Lee, Department of Dental Biomaterials Science, Dental Research Institute, College of Dentistry, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul, Korea.



Comparison between two glass-ionomer sealants placed using finger pressure (ART approach) and a ball burnisher


Nabil Beiruti, dds, ddph, Jo E. Frencken, bds, msc, phd & Jan Mulder, ti


Abstract: Purpose: To compare in vitro marginal leakage and fissure penetration depth of sealants placed under finger pressure (ART) and a ball burnisher. Methods: High-viscosity glass-ionomer hand-mixed Fuji IX GP and encapsulated Fuji IX GP Fast were used to seal 72 patent occlusal pits and fissures according to the ART approach or with the aid of a ball burnisher in surgically removed molars. All teeth were thermocycled for 500 cycles in water between 6 and 55ºC, then varnished until 1 mm from the sealant, submerged in 1% methylene blue for 4 hours, had roots dissected, crowns embedded in epoxy resin and sectioned before examination with a light reflection microscope. Marginal leakage at the enamel-sealant interface and fissure penetration depth was measured on a scale of 0 to 4. Results: There was no statistically significant difference in marginal leakage (P= 0.62) and fissure penetration depth (P= 0.46) between sealants placed using the application procedures. One of the operators scored statistically significant lower on the marginal leakage and higher on fissure penetration depth in sealants produced using finger pressure than with a ball burnisher (P= 0.01). All nine sealants placed by this operator using finger pressure and encapsulated glass-ionomer showed no marginal leakage. The mean fissure penetration depth of these sealants was 3.6 (SD=0.9). (Am J Dent 2006;19:159-162).


Clinical significance: If one has to choose between applying high-viscosity glass-ionomers in pits and fissures with a ball burnisher or under pressure with a petroleum jelly thinly coated gloved finger (ART approach), results of this study lean towards using the latter. The petroleum jelly impregnated top layer needs to be fully removed in the finishing process.


Address: Dr. J.E. Frencken, Radboud University Medical Centre, College of Dental Sciences, WHO Collaborating Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail:



Incidence of periodontal diagnosis in private dental practice


Patricia Ramos Cury, phd, Marília Trierveiler Martins, phd, Marcelo Bonecker, phd

& Ney Soares de Araújo, phd


Abstract: Purpose: To evaluate the rates of periodontal examination in private dental practices in Brazil. Methods: 235 dentists, 117 female and 118 males (mean age 33.1 years), presenting different levels of experience (mean: 11.2 years) were audited. In each dental practice, a team of two trained auditors evaluated dental examination kits for the presence of a periodontal probe, and checked whether there was any specific diagram to record the periodontal status of the patient in the model of clinical charts. The dentists were then asked whether or not they performed periodontal probing and radiographic examination of periodontal structures in all their patients. The degree of association between variables was evaluated using Chi-square or correlation tests. Results: The dentists, 117 female and 118 males, were from 22 to 62 years old (mean age, 33.1 years), and presented 0.5 to 40 years of experience (mean of 11.2 years). Of the 235 clinicians, 19.3% performed periodontal probing in all their patients, and 17.5% of them record the periodontal examination, 48.9% of the professionals occasionally performed periodontal probing while 31.8% did not perform periodontal probing at all. Specialists in prosthodontics, and dentists having more than two specialties, excluding periodontists, performed periodontal probing more frequently than other specialists. (Am J Dent 2006;19: 163-165).


Clinical significance: Periodontitis can be found in most dental patients, thus all dental patients should receive thorough periodontal examination. However, evidence suggests that most dentists fail to perform adequate periodontal diagnoses, which calls for changes in the profession’s attitudes toward the importance of periodontal disease diagnosis.


Address: Dr. Patricia R. Cury, Dept. of Microbiology and Immunology, São Leopoldo Mandic Dental Research Institute, R. José Rocha Junqueira, 13, CEP 13041-445, Campinas, SP, Brazil.




Is an antibacterial adhesive system more effective than cavity disinfectants?


Murat Türkün, dds, phd, L. Şebnem Türkün, dds, phd, Zeynep Ergücü, dds, phd & Mustafa Ateş, phd


Abstract: Purpose: To compare the antibacterial activity of an adhesive system containing an antibacterial monomer MDPB, Clearfil Protect Bond with three different cavity disinfectants, chlorhexidine gluconate-based Consepsis, benzalkonium chloride-based Tubulicid Red and 3% hydrogen peroxide. Methods: Materials were tested using agar well technique and a tooth cavity model. The test materials were filled in the agar wells of plates inoculated with Streptococcus mutans. After 48 hours of incubation, the zones of inhibitions were measured in millimeters. For the tooth cavity model test, cylindrical cavities were prepared in the flat occlusal dentin of human extracted molars. The teeth were left in a broth culture of Streptococcus mutans at 37°C for 72 hours allowing bacteria to invade. Teeth were then randomly assigned into five groups of five teeth (10 cavity preparations) each. In the first four groups test materials were applied into the cavities following the manufacturer’s instructions and the cavities in the fifth group were left untreated for control. The teeth were kept in saline for 72 hours. Standard amounts of dentin chips were obtained from the cavity walls and the number of bacteria recovered was counted. Results: The results were analyzed by ANOVA, Dunnett C and Bonferroni tests. For the agar well technique, Clearfil Protect Bond primer exhibited greater inhibition zones than all three cavity disinfectants (P< 0.05). When tested by the cavity method, the application of Clearfil Protect Bond system resulted in significantly less bacterial recovery than all disinfectants (P< 0.05). For both microbiological methods, there were no significant differences between the antibacterial activities of Consepsis and Tubulicid Red (P> 0.05). They were superior to hydrogen peroxide in the cavity test method (P< 0.05). (Am J Dent 2006;19:166-170).


Clinical significance: Clearfil Protect Bond system was able to inactivate the bacteria in the cavity more effectively than the tested cavity disinfectants.


Address: Dr. L. Şebnem Türkün, Department of Restorative Dentistry and Endodontics, Ege University School of Dentistry, 35100 Izmir - Turkey. E-mail:



In vitro enamel caries formation and orthodontic bonding agents


Karin Cain, dds, ms, John Hicks, dds, ms, phd, md, Jeryl English, dds, Catherine Flaitz, dds, ms,

John M. Powers, phd & Terry Rives, phd


Abstract: Purpose: To examine, in vitro, the caries-like lesion formation in enamel adjacent to fluoride-releasing orthodontic bonding agents using polarized light microscopic techniques. Methods: 40 human extracted permanent third molars with sound enamel smooth surfaces were divided into two treatment groups: Light Bond group, a fluoride-releasing filled resin orthodontic bonding agent (n=20); and Pro Seal group, an orthodontic bonding agent with glass-ionomer (n=20). Prior to bonding agent placement on the buccal surfaces, acid-resistant varnish was applied to the molar teeth leaving a 2 mm (occlusal-cervical direction) by 5 mm (mesial-distal direction) exposed sound enamel window on the buccal surfaces of each molar tooth. The exposed window had the assigned orthodontic bonding agent applied, according to the manufacturer’s instructions. With each specimen, a 1 mm (occlusal-cervical direction) by 5 mm (mesiodistal direction) sound enamel window was exposed by selectively removing the acid-resistant varnish on the opposing lingual or palatal surface with each molar tooth, and serving as a matched internal control with each molar. The molar teeth were then sectioned into buccal and lingual/palatal tooth halves. Acid-resistant varnish was applied to the cut surfaces. Each group underwent synthetic saliva rinsing for 2 weeks prior to in vitro caries formation using a modified ten Cate solution over a 2-week lesion initiation period. Longitudinal sections (three per treatment and control groups) were taken for polarized light study. The remaining tooth portions were exposed to synthetic saliva rinsing for 1 week and then exposed to the in vitro caries solution for an additional 1-week period to allow for lesion progression within the exposed enamel windows (progression 1 period). Longitudinal sections (three per treatment and control groups) were taken at the end of lesion progression 1 for polarized light study. After lesion progression 1, the remaining tooth portions were exposed to synthetic saliva rinsing for 1 week and then exposed to the in vitro caries solution for 1 week to allow for additional lesion progression within the exposed enamel windows (progression 2 period). Longitudinal sections (three per treatment and control groups) were taken at the end of lesion progression 2 for polarized light study. All longitudinal sections from the treatment and control groups at all three time periods (lesion initiation, progression 1 and progression 2) were imbibed with water and examined with polarized light microscopy to determine lesion depths and evaluate the enamel-resin interface. Mean (SD) lesion depths were determined and compared (ANOVA, t-test). Results: Following lesion initiation, lesion progression 1 and lesion progression 2 periods, both treatment groups exhibited significant reductions in mean lesion depth when compared with the matched no treatment control group (P< 0.05). The Pro Seal group exhibited statistically significant reductions in mean lesion depths when compared with those for the Light Bond group at lesion initiation, lesion progression 1 and lesion progression 2 periods (P< 0.05, ANOVA, t-test). Both orthodontic bonding agents showed intact and intimate enamel-bonding agent interfaces with no lesion formation within the underlying bonded enamel. Caries-like lesions were only present in the exposed enamel windows adjacent to the orthodontic bonding agents. (Am J Dent 2006;19: 187-192).


Clinical significance: Caries formation adjacent to orthodontic brackets in adolescence is a common occurrence. The use of fluoride-releasing orthodontic adhesives may help to reduce the prevalence of white spot lesion formation adjacent to orthodontic brackets and result in an esthetically pleasing and healthy smile and dentition.


Address: Dr. John Hicks, Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. MC1-2261, Houston, TX, 77030-2313 USA. E-mail:


The incidence of pulp healing defects with direct capping materials

Peter E. Murray, phd & Franklin García-Godoy, dds, ms


Abstract: Purpose: To (1) study the injury and healing activity of the pulp tissue to calcium hydroxide [Ca(OH)2], resin composite (RC) and resin-modified glass-ionomer (RMGI) materials when used as direct pulp capping agents, and (2) compare the incidence of healing defects between these materials. Methods: 135 Class V pulp exposed cavities were prepared in non-human primate teeth. Direct pulp capping was conducted over 6 to 730 days with hard set Ca(OH)2, RMGI and CR materials. Healing defects recorded were: (1) bacterial leakage with McKays stain; (2) operative debris including dentin fragments and particles of capping material; (3) pulpal inflammatory activity according to FDI standards; (4) area and absence of dentin bridge formation; and (5) presence of tunnel defects in bridge. Statistical analysis was evaluated using ANOVA. Results: The capping materials were associated with varying levels of pulp healing defects, including tunnel defects (P= 0.0001); operative debris (P= 0.0001); pulpal inflammatory cell activity (P= 0.0073) and bacterial leakage (P= 0.0260). Other healing defects, and the area of dentin bridge were not influenced by capping materials (P> 0.05). (Am J Dent 2006;19: 171-177).


Clinical significance: Pulp healing defects have some relationship with treatment failure, but the general lack of information on material-pulp interactions remains problematic. Resin composite and resin-modified glass-ionomer materials can optimize healing following pulp capping, because they appear to reduce the number of defects in comparison with Ca(OH)2.

Address: Dr. Peter. E. Murray, Department of Endodontics, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA. E-mail:



Indications and limitations of Er:YAG laser applications in dentistry


Carl Bader, med dent & Ivo Krejci, prof, dr med dent


Abstract: Purpose: To describe the development, indications, and limitations of Er:YAG lasers in the dental field. Methods: A review based on the literature search in PubMed and completed by other documents was performed. Results: Based on the synthesis of the reviewed literature different topics concerning the Er:YAG effects and applications in dentistry are discussed and recommendations for the use of this type of laser are given. (Am J Dent 2006;19: 178-186).


Clinical significance: This literature review allows the practitioner to better decide on the proper indications and limitations of Er:YAG lasers in dentistry.

Address: Prof. Dr. Ivo Krejci, Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Rue Barthélemy-Menn 19, CH-1205 Geneva, Switzerland. E-mail:



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July 2005 Special Issue -
Research on a novel alcohol-free CPC mouthrinse 

for the control of plaque and gingivitis

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