American Journal of Dentistry
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Abstracts of the October 2007 Issue


Mineral trioxide aggregate as pulp dressing agent in pulpotomy treatment of primary molars: 42-month clinical study


Myriam Maroto, dmd, phd, Elena Barbería, md, dmd, phd, dds, Vicente Vera, md, phd, lds & Franklin García-Godoy, dds, ms


Abstract: Purpose: To evaluate the long-term clinical and radiographical results of using gray mineral trioxide aggregate (MTA) in pulpotomy treatments in primary molars. Methods: A total of 69 primary molars were treated with pulpotomy procedures using MTA and follow-up every 6 months up to 42 months. Results: Clinical success was 100% as none of the molars showed clinical pathologic signs; radiographical success was 98.5% as one case of internal resorption was recorded. Reparative dentin deposition was found as stenosis of the pulp canals in 84% of the cases 42 months after treatment and as dentin bridge formation in 83% of the cases 42 months after treatment. Moreover, 11 permanent successors erupted at their normal exfoliation time without pathology after pulpotomy treatment with gray MTA of the primary molars. (Am J Dent 2006;19:283-286).


Clinical significance: Gray MTA could be considered a reasonable alternative to the use of formocresol in pulpotomy treatments of primary molars.


Address: Dr. Myriam Maroto, Department of Prevention, Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Complutense University of Madrid, Avda. Complutense sn, Ciudad Universitaria, 28040 Madrid, Spain. E-:



Long-term retrospective study of the clinical performance of fiber posts


Marco Ferrari, md, dds, phd, Maria Crysanti Cagidiaco md, dds, phd, Cecilia Goracci, md, msc, phd, Alessandro Vichi, dds, msc, phd, Pier Nicola Mason, md, dds, Ivana Radovic, dds, msc & Franklin Tay, bdsc (hons), phd


Abstract: Purpose: To retrospectively evaluate the long-term clinical performance of three types of fiber posts after a service period of 7-11 years. Methods: 985 posts were included in the study: 615 Composiposts, 160 Æstethic Posts and 210 Æsthetic Plus Posts were placed into endodontically treated teeth. Four combinations of dentin adhesives/luting materials were used. Endodontic and prosthodontic results were recorded. Results: A 7-11% failure rate was recorded for the three types of posts. A total of 79 failures were recorded: 39 due to endodontic reasons, one root fracture, one fiber post fracture, 17 crown dislodgements and 21 due to post debonding. The mechanical failures were always related to the lack of coronal tooth structure. The results indicated that fiber posts in combination with bonding/luting materials may be used routinely for restoring endodontically treated teeth. Mechanical failure of restored teeth with fiber posts can be related to the amount of residual coronal structure. (Am J Dent 2007;20:287-291).


Clinical significance: The use of fiber posts in combination with adhesive restorative materials can provide a long term clinical success in endodontically treated teeth.


Address: Prof. Marco Ferrari, Department of Restorative Dentistry and Dental Materials, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. E-:


The use of a flowable ormocer for bonding brackets


Ascensión Vicente, dds, phd & Luis A. Bravo, md, dds, ms, phd


Abstract: Purpose: To evaluate the effectiveness of the ormocer Admira Flow for bonding brackets. Methods: 45 extracted human premolars were used. They were divided into two groups: (1) Brackets cemented with the traditional resin orthodontic bonding system Transbond XT, and (2) Brackets bonded with Admira Flow. Shear bond strength was measured with a universal testing machine with a cross-head speed of 1 mm/minute. The adhesive remnant on the tooth after debonding was quantified using image analysis equipment. Results: No significant differences were observed in bond strength for Transbond XT and that of Admira Flow, nor were there significant differences in the quantity of adhesive remnant left on the teeth after debonding (P< 0.05). (Am J Dent 2007;20:292-294).


Clinical significance: Although in vivo studies are necessary, the results of this study show that Admira Flow could be an alternative to traditional bracket bonding.


Address: Dr. Ascensión Vicente, Orthodontic Teaching Unit, Dental Clinic, The University of Murcia, Hospital Morales Meseguer, 2ª planta, C/Marqués de los Vélez, s/n. 30008 Murcia, Spain. E-:



The apical sealing ability of a new root canal filling material


Emre Bodrumlu, dds, phd & Umut Tunga, dds, phd


Abstract: Purpose: To assess the apical sealing property of a new root canal filling material, Epiphany. Methods: Seventy extracted maxillary and mandibular single-rooted teeth were used. They were randomly divided into three groups and obturated by lateral condensation with gutta-percha and AH 26/AH Plus sealers and Resilon core material and Epiphany sealer. Apical leakage was measured by the fluid-transport method. Results: The differences in leakage among gutta-percha with AH 26, gutta-percha with AH Plus, and Resilon with Epiphany were statistically significant (P< 0.05). The teeth filled with gutta-percha/AH 26 displayed the most apical leakage. There were no differences between the Resilon/Epiphany and gutta-percha/AH Plus groups (P> 0.05). (Am J Dent 2007;20:295-298).


Clinical significance: Resilon core material and Epiphany sealer and AH Plus groups were found to be superior to the gutta-percha and AH 26 in terms of apical leakage. However, Resilon core material and Epiphany sealer group was the most likely to give successful results similar to gutta-percha/AH Plus.


Address: Dr. Emre Bodrumlu, Department of Operative Dentistry and Endodontics, Ondokuz Mayis University, Faculty of Dentistry, Kurupelit-Samsun, 55139 Turkey. E-:



Influence of coffee on reflectance and chemistry of resin composite protected by surface sealant


Luís Eduardo Silva Soares, dds, ms, phd, Ilene Cristine Rosia Cesar, dds, msc, Carla Gabriela Couto Santos, dds, Ana Luiza Merigo de Oliveira Cardoso, dds, Priscila Christiane Suzy Liporoni, dds, ms, phd, Egberto Munin, phys, phd & Airton Abrahão Martin, phys, phd


Abstract: Purpose: To assess the influence of the light-curing unit type and whether or not it was worth using surface sealant protection on resin composite restorative materials stained by coffee. Another objective was to propose the monitoring of coffee staining by FT-Raman spectroscopy using carbon-hydrogen (C-H) bonds as reference to the composite matrix degradation. Methods: Sixty cylindrical specimens of resin composite were prepared and divided into six groups: HC (control) - cured with a halogen light; LC (control) cured with a LED; HF - cured with a halogen light + Fortify Plus; LF - cured with a LED + Fortify Plus; HP - cured with a halogen light + PermaSeal; LP - cured with a LED + PermaSeal. After storage for 24 hours at 37% and 100% of relative humidity, the top surface was protected, and the other surfaces isolated. Polishing with paper discs was performed after 24 hours of curing and prior to FT-Raman spectroscopy and reflectance measurements. All specimens were submitted to coffee staining for 14 days and evaluated by both systems. Results were statistically analyzed by ANOVA and Tukey tests. Results: FT-Raman spectrum only showed significant changes in groups LC and LP (P< 0.05). Reflectance demonstrated that staining was present in all specimens protected by sealants. Sealant staining was larger in the HF (P< 0.001) group. (Am J Dent 2007;20:299-304)


Clinical significance: Significant chemical changes were observed in the resin matrix cured with the LED light-curing unit, which produced a larger composite staining than the halogen light. The Fortify Plus sealant stained more than the PermaSeal sealant. There are no advantages to using surface sealants to prevent composite staining, as the sealants also stained.


Address: Dr. Luís Eduardo Silva Soares, Biomedical Vibrational Spectroscopy Laboratory, Research and Development Institute, University of Vale do Paraíba – UNIVAP, Av. Shishima Hifumi, 2911, Urbanova, 12,244-000, São José dos Campos, SP, Brazil. E-:



Morphological characterization of the interface between self-etching

adhesives and vital dentin


Ali I. Abdalla, dds, phd & Albert J. Feilzer, dds, phd


Abstract: Purpose: To evaluate the in vivo interface between one total-etch and two self-etching adhesives to dentin. Methods: Two self-etching primers, SE Bond and Hybrid Bond and one total-etch adhesive, Admira Bond, were applied in vivo to flat dentin surfaces on human teeth scheduled for extraction. After adhesive application and curing, a thin layer of resin composite was applied and cured. The teeth were extracted immediately after adhesive application. All samples were split fractured along their long axes. Half of the samples were decalcified and deproteinized to permit visualization of the hybrid layer. The other halves were completely dissolved to observe the morphology of resin tags. Results: The total-etch system Admira Bond showed a thick hybrid layer and long resin tags, while SE Bond showed very thin hybrid layer with short resin tags. The findings of Hybrid Bond were similar to that of Admira Bond. (Am J Dent 2007;20:305-308).


Clinical significance: The interaction between total-etch adhesives and vital dentin is characterized by the formation of hybrid layer and long resin tags. For the self-etching primer, the interaction was mainly superficial. For the single-bottle, self-etching adhesive, the thick hybrid layer dissolved when challenged by acid/base treatment.


Address: Dr. A.I. Abdalla, Faculty of Dentistry, University of Tanta, Tanta, Egypt. E-:



Tooth whitening through the removal of extrinsic stain with two sodium

hexametaphosphate-containing whitening dentifrices


Geza T. Terézhalmy, dds, ma, Aaron R. Biesbrock, dmd, phd, ms, Svetlana Farrell, dds, phd,

Matthew L. Barker, phd & Robert D. Bartizek, ms


Abstract: Purpose: To evaluate the tooth whitening benefit through stain removal delivered by a marketed whitening dentifrice (Crest Vivid White) used twice a day or a combination regimen of two marketed dentifrices (Crest Vivid White Night used at night and Crest Cavity Protection used in the morning) relative to a positive control over a 2-week period. Methods: Both studies were randomized, two treatment, parallel group, examiner-blind, 2-week clinical trials involving 22 and 30 healthy adults with longstanding visible extrinsic stain on the facial surfaces of at least six anterior teeth. In each study, subjects were randomized to one of two treatments: a sodium fluoride/sodium hexametaphosphate whitening dentifrice used alone (Study 1) or in combination with a cavity protection dentifrice (Study 2) with an ADA reference manual toothbrush versus a control power toothbrush with a cavity protection dentifrice (both studies). Results: In both studies, all treatment groups statistically significantly (P< 0.001) reduced baseline stain scores following 1 and 2 weeks of brushing. After 2 weeks, the whitening dentifrice used twice daily had a median percent stain removal of 90% and the night-time whitening dentifrice (used once a day) in combination with the cavity protection dentifrice had a median percent stain removal of 85% while powered toothbrush groups showed median percent stain removal of 88-89% in both studies. Stain removal scores after 1 and 2 weeks of brushing did not differ significantly between the two treatment groups in either study. (Am J Dent 2007;20:309-314).


Clinical significance: These clinical studies showed that a sodium hexametaphosphate whitening dentifrice used twice daily and a regimen of sodium hexametaphosphate whitening dentifrice used at night with a cavity protection dentifrice used in the morning whiten teeth through extrinsic stain removal.


Address: Robert D. Bartizek, The Procter & Gamble Company, 8700 Mason-Montgomery Rd., Mason, OH 45040-9462, USA. E-:



A randomized controlled trial of home tooth-whitening products


Edward C.M. Lo, bds, phd, Anthony H.H. Wong, bds, mds & Colman McGrath, b dent sc, phd


Abstract: Purpose: To evaluate the effectiveness of two marketed home tooth-whitening products. Methods: A randomized controlled clinical trial involving 87 adults who were randomly allocated into one of three groups: (1) 6% hydrogen peroxide whitening strips, (2) 18% carbamide peroxide whitening gel, and (3) a placebo (fluoride toothpaste) control group. Subjects were instructed individually and then used the given product daily for 2 consecutive weeks. Color was determined in brightness (L*), yellowness (b*) and redness (a*) [color space] at baseline and 8 weeks after dispensing the product by employing a high resolution digital camera (Fuji HC1000 CCD) to image the subject’s anterior maxillary teeth under standard polarized lighting conditions. The subjects also completed a questionnaire on self-satisfaction with the treatment outcome. Results: One-way ANOVA (Bonferroni test) demonstrated significant differences in color between the three groups with changes in brightness (L*, P< 0.001), yellowness (b*, P< 0.001) and redness (a*, P< 0.001). Changes in L* a* b* was greatest among those who used the 6% hydrogen peroxide whitening strips. Subjects in the whitening strip group also rated that product significantly (P< 0.01) more favorably than other groups with respect to the amount of whiteness improvement, as well as whitening satisfaction and overall impression while there is no significant difference between the whitening gel and the placebo groups. (Am J Dent 2007;20:315-318).


Clinical significance: This study found that Crest Whitestrips (6.5% hydrogen peroxide) and Colgate Simply White (18% carbamide peroxide) are both effective in tooth whitening with the former being more effective.


Address: Prof. Edward C. M. Lo, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong. E-:



Shear bond strength of resin composite to enamel and dentin submitted to a carbamide peroxide dentifrice


Bruna Maria Covre Garcia da Silva, dds, Flávia Martão Flório, dds, ms, scd & Roberta Tarkany Basting, dds, ms, scd, phd


Abstract: Purpose: To assess the shear bond strength of resin composite to human enamel and dentin after using a whitening dentifrice containing carbamide peroxide for 21 days. Methods: Thirty enamel and 30 dentin slabs were embedded, flattened and randomly divided into three groups (n=10) that received different treatments: carbamide peroxide containing dentifrice (Rembrandt Plus), fluoride containing dentifrice (Close Up with fluoride), and immersion in artificial saliva as the control group. Applications were made for a 15-minute period daily, immersing the slabs in a suspension with distilled water and dentifrice in the ratio of 3:1 (weight) for 21 days. For the rest of the time, the slabs were kept in an artificial saliva solution. After the last application, an adhesive system (Single Bond) was used to bond resin-based composite cylinders (Z100) to the enamel and dentin surfaces for the shear bond strength tests. These tests were carried out in a universal testing machine at a speed of 0.5 mm/minute. Results: ANOVA and the Tukey test for enamel and Kruskal-Wallis and the Dunn Method for dentin, showed significant differences between slabs treated with Rembrandt Plus (REM) and the artificial saliva control group, with higher values for REM (P< 0.05). There were no differences in mean bond strengths of enamel and dentin treated with Close Up with fluoride (CLO) and REM, nor were any differences shown between CLO and the artificial saliva control group. A whitening dentifrice containing carbamide peroxide increased the bond strength of restorative systems. (Am J Dent 2007;20:319-323).


Clinical significance: Enamel and dentin slabs treated with a whitening dentifrice containing carbamide peroxide produced greater mean shear bond strength values. Dentifrices containing carbamide peroxide changed the shear bond strength of restorative systems to enamel and dentin, but may be insignificant in a clinical situation.


Address: Prof. Dr. Roberta Tarkany Basting, Faculty of Dentistry and Dental Research Center São Leopoldo Mandic, Department of Restorative Dentistry - Operative, Rua José Rocha Junqueira, 13 Bairro Swift, Campinas, SP, CEP: 13045-755, Brazil. E-:



Enamel microhardness and shear bond strength after treatment

with an 18% carbamide peroxide bleaching varnish


Robson Tetsuo Sasaki, Cinthia Maria Barbosa, dds, Flávia Martão Flório, dds, ms scd & Roberta Tarkany Basting, dds, ms scd, phd


Abstract: Purpose: To evaluate the microhardness and shear bond strength of human enamel treated with an 18% carbamide peroxide bleaching varnish. Methods: 40 dental enamel slabs were embedded and ground flat, dividing them into four groups (n=10) which received the varnish application for 14 consecutive days: (G1) one daily varnish application; (G2) two daily varnish applications with an interval of 15 minutes; (G3) two daily varnish applications with an interval of 5 hours. After varnish application, the slabs were immersed in artificial saliva changed daily. The control group (G4) consisted of slabs (n=10) that did not receive any varnish treatment and were maintained in artificial saliva for 14 days. Microhardness tests were performed with Knoop indentation with a load of 25 grams for 5 seconds at the beginning of the treatment (baseline values) and after 7 and 14 days. Cylinders were made with microhybrid resin composite and one-bottle adhesive system for shear bond strength tests. Using a universal testing machine with a speed of 0.5 mm/minute to obtain the values in MPa. Results: The Kruskal-Wallis test showed no changes in microhardness values among groups after 7-day varnish application, although there was a decrease in microhardness values when using an 18% carbamide peroxide varnish twice a day with a time-interval of 5 hours between applications (P< 0.05). For enamel shear bond strength, ANOVA test (P> 0.05) did not show significant differences among the groups (G1=15.8; G2=15.2; G3=19.0; G4=15.1). (Am J Dent 2007;20:324-328).


Clinical significance: A bleaching varnish containing 18% carbamide peroxide did not affect enamel mineral content if used for a 7-day treatment, independent of the protocol chosen. However, changes in enamel mineral content were observed if used twice a day with a 5-hour time interval after 14 days treatment, although restorative procedures are recommended after 7 days post bleaching treatment.


Address: Prof. Dr. Roberta Tarkany Basting, Faculty of Dentistry and Dental Research Center São Leopoldo Mandic, Department of Restorative Dentistry - Operative, Rua José Rocha Junqueira, 13 Bairro Swift, Campinas, SP, CEP: 13045-755, Brazil. E-:



Comparison of the effect of storage media on hardness and shear punch strength of tooth-colored restorative materials


Rafat Bagheri, phd, Martin J. Tyas, bds, phd ddsc & Michael F. Burrow, mds, phd,med


Abstract: Purpose: To measure the surface hardness and shear punch strength of six tooth-colored restorative materials before and after immersion in acidic and alkaline solutions. Methods: Specimens were prepared from three resin composites; Ceram X, Filtek Supreme, Point 4, two polyacid-modified resin composites; Dyract, F2000, and one resin-modified glass-ionomer cement; Fuji II LC, immersed in distilled water for 24 hours at 60°C, polished with silicon carbide papers up to 2000-grit and subjected to baseline measurement for Vickers hardness or shear punch strength. Further specimens were transferred to one of four aqueous media at 60°C for a further 2 weeks; distilled water, 0.01 mol/L lactic acid, 0.1 N NaOH or coffee 15g /500mL, washed, dried and tested for final hardness or shear punch strength. Results: Data analysis using ANOVA and Tukey’s test showed that the hardness and shear punch strength values were material and solution dependent. Regardless of the solutions; the hardness of F2000 was the highest and Fuji II LC the lowest; Point 4 and Filtek Supreme had the highest shear punch strength; Fuji II LC and F2000 had lowest. NaOH significantly reduced the hardness of all materials and completely dissolved the structure of Fuji II LC. Lactic acid and coffee significantly increased shear punch strength compared to baseline. (Am J Dent 2007;20:329-334).


Clinical significance: Within the parameters of this study, the mechanical properties of the restorative materials were affected by immersion in various solutions. Regardless of the storage medium, for the shear punch strength, resin composites were significantly stronger than the PAMRCs, which in turn were significantly stronger than the RM-GIC.


Address: Dr. Martin J. Tyas, School of Dental Science, 720 Swanston Street, Melbourne 3010, Australia. E-:



Shade distribution of commercial resin composites and color difference with shade guide tabs


Seung-Kook Park, dds & Yong-Keun Lee, dds, phd


Abstract: Purpose: To determine the shade distribution of varied shades of contemporary resin composites, and to measure the color difference (∆E*ab) between individual shades of resin composites and the nearest shade tabs, which showed the smallest color difference with each shade of resin composite, in the VITA shade guide. Methods: Eight light-curing resin composites, with a total of 41 shades, were studied. Color of specimens was measured on a reflection spectrophotometer over a white background. Ranges and distributions of CIE L*, C*ab, a* and b* values of each brand of resin composites were determined. Color difference between each shade of resin composites and each shade of the shade guide tabs were calculated, and the nearest shade guide tab was selected. Results: The range of CIE L* value for eight brands of resin composites was 3.2-9.0, that of C*ab was 2.5-11.6, that of CIE a* value was 1.1-5.8, and that of CIE b* value was 5.9-11.5. Color differences (∆E*ab) between each shade of resin composites and the nearest shade tab of the shade guide was 0.9-12.8. (Am J Dent 2007;20:335-339).


Clinical significance: Color distribution ranges for each brand of resin composite varied depending on the brand of resin composite, and the color differences between each shade of the resin composite and the nearest shade tab of a shade guide was rated unacceptable in 34 of 41 shades of resin composites. This study supports the clinical practice of curing a small sample of resin composite on the tooth to select the desired shade before initiating restorative procedures.


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



Oral piercing: Complications and side effects


Liran Levin, dmd & Yehuda Zadik, dmd


Abstract: Purpose: To review current relative literature on oral piercing regarding its prevalence, complications and possible side effects An increasing number of patients present to their treating dental professionals wearing jewelry inserted into the peri-oral and intra-oral tissues. Since the literature is mainly confined to individual cases or a small series of patients, it is difficult to assess the magnitude of risks that face individuals with oral piercing. Methods: The current study was based on scientific literature published in English regarding oral piercing. A Medline search, using the PubMed Bibliographic Index to identify clinical articles published between January 1992 and August 2007, found 11 articles on the prevalence of oral piercing, and/or on the prevalence of complications and side effects. Results: Three studies reported the prevalence of oral piercing (ranging from 3.4% to 20.3%). Immediate post-operative complications reported were swelling and/or infections (24%-98%), pain or tenderness (14%-71%), and bleeding or hematoma. Jewelry-related complications mainly consisted of tooth fractures and wear (14%-41%) and gingival recessions (19%-68%). (Am J Dent 2007;20:340-344).


Clinical significance: Dental professionals should be aware of the increasing number of patients with pierced oral sites and should be able to provide appropriate guidance to patients contemplating body piercing of oral sites.


Address: Dr. Liran Levin, Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. E-:


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