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Efficacy of three toothbrushes on established gingivitis and plaque

Joseph Sowinski,  dds, ms,  Dolores M. Petrone, ba, Gerald N. Wachs, md, rph, facp,  Patricia Chaknis, bs,  James Kemp, ba, Al  A.  Sprosta, bs, me  &  William  DeVizio, dmd

Abstract: Purpose: To evaluate the efficacy of three toothbrushes [Colgate 360° Deep Clean (AFT version), the Colgate 360° Deep Clean (stapled version) and the Oral B Indicator] on the removal of established gingivitis and plaque. Methods: This examiner-blind, three-treatment, parallel clinical research study assessed plaque removal via the comparison of pre- to- post-brushing and 4-week plaque removal measured by the Rustogi Modification of the Modified Navy Plaque Index. This study also assessed gingivitis using the Löe & Silness Gingival Index. Qualifying adult male and female subjects from the Northern New Jersey area reported to the study site after refraining from any oral hygiene procedures for 12 hours; and from eating, drinking, or smoking for 4 hours. Following an examination for gingivitis and plaque (pre-brushing), they were randomized into three balanced groups, each group using one of the three study toothbrushes in the order specified by a pre-determined randomization plan. Subjects were instructed to brush their teeth for 1 minute under supervision with their assigned toothbrush and a commercially-available toothpaste (Colgate Cavity Protection), after which they were once again evaluated for plaque (post-brushing). Subjects were then dismissed from the study site with the toothpaste and their assigned toothbrush to use at home twice daily for the next 4 weeks. They again reported to the study site at which time they were evaluated for plaque and gingivitis. Results: 109 subjects complied with the protocol and completed the clinical study. For plaque removal, comparisons were made for whole mouth, at the gingival margin and at interproximal sites. The results of the study indicated that all three test toothbrushes provided  statistically significantly reductions in pre- to post-brushing plaque index scores of up to 44.0%, 38.6% and 23.6% respectively, after a single toothbrushing. Relative to the Oral B Indicator toothbrush, the Colgate 360° Deep Clean toothbrush (AFT version) and Colgate 360° Deep Clean toothbrush (stapled version) provided a statistically significantly greater removal of plaque of up to 107% and 93.0%, respectively, after a single toothbrushing. Also, the group using the Colgate 360° Deep Clean toothbrush (AFT version) and the Colgate 360° Deep Clean toothbrush (stapled version) exhibited a statistically significantly greater removal of plaque of up to 575% and 400%, respectively, when compared to the Oral B Indicator toothbrush after 4 weeks. The group using the Colgate 360° Deep Clean toothbrush (AFT version) and the Colgate 360° Deep Clean toothbrush (stapled version) exhibited statistically significantly greater reductions in gingivitis of up to 23% and 17%, respectively, and greater reductions in gingivitis severity (bleeding sites) of up to 73% and 52% respectively, as compared to the Oral B Indicator toothbrush after 4 weeks. There was no statistically significant difference between the two Colgate 360º toothbrushes for any parameter and at any comparison time. (Am J Dent 2008;21:339-345).

Address: Patricia Chaknis, Colgate-PalmoliveTechnology Center, 909 River Road, Piscataway, NJ 08854, USA. E-mail: Pat_Chaknis@colpal.com

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Research Article

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Effect of an oscillating rotating power toothbrush on plaque removal

and regrowth

Malgorzata Klukowska, dds, phd, Donald J. White, phd, Matthew L. Barker, phd & Robert D. Bartizek, phd

Abstract: Purpose: To measure the effectiveness of an oscillating rotating power toothbrush as compared to a manual toothbrush. Methods: 17 subjects were preliminarily assigned commercial tubes of Crest Cavity Protection (CCP) dentifrice and an Oral-B manual toothbrush (P35) with instructions for bid brushing morning and evening. Subjects remained on CCP dentifrice for 2 weeks during which they were imaged on 6 days (three each week) including daily assessments of morning plaque levels before brushing (AM), morning plaque levels after brushing (PB) and afternoon plaque levels allowing for regrowth (PM). Plaque was evaluated using standardized UV imaging techniques [Digital Plaque Image Analysis (DPIA) methodology]. At Week 3, subjects replaced their manual brush with an oscillating rotating power toothbrush (Oral-B Triumph) and were supplied with a detailed instruction/training video to assist in education and compliance with the power brush regimen. Plaque was evaluated during Week 3 on three  additional days with measures again including AM, PB and PM. Throughout, plaque results are reported as average plaque area coverage on dentition. Results: AM: Manual (2 week avg. ± SD): 18.7 ± 8.8; Power = 10.3 ± 3.3 (44.9% relative reduction P< 0.05); PB: Manual (2 week avg.): 8.5 ± 4.2; Power 4.6 ± 1.9 (45.9% relative reduction P< 0.05); PM: Manual (2 week avg.): 14.9 ± 6.4; Power = 8.2 ± 3.1 (45.0% relative reduction P< 0.05). (Am J Dent 2008;21:346-350).

Address: Dr. Malgorzata Klukowska, The Procter and Gamble Company, 8700 Mason Montgomery Road, Mason , OH 45040, USA .  E-mail: klukowska.m@pg.com

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Influence of chlorhexidine on fluoride uptake by bovine dentin in vitro

Alexandra S. Rieben, dr med dent,  Burghardt Zimny, dr med dent, Jörn Noetzel, dr med dent,

Konrad Neumann, dr rer nat  &  Andrej M. Kielbassa, dr med dent

Abstract: Purpose: To evaluate five different mouthrinses with respect to fluoride uptake by sound and demineralized dentin. Methods: The pharmacy-made mouthrinses contained either (1) 0.06% chlorhexidine, (2) 0.025% sodium fluoride, (3) 0.06% chlorhexidine and 0.025% fluoride (NaF) or (4) water (control). Additionally, the commercially available solution (5) Chlorhexamed Lösung 0.06% + F (GlaxoSmithKline) was used. 240 cylindrical dentin blocks were obtained from 120 bovine incisors. Half of the specimens were divided into five groups of 24 samples each and immersed in one of the mouthrinses (2.5 ml/specimen, 30 seconds). Accordingly, the remaining specimens were again divided into five groups of 24 specimens each; prior to treatment with one of the mouthrinses, these specimens were subjected to a demineralization procedure (lesion depth: 90-100 µm) using Buskes’ solution for 6 days. All specimens were assessed for KOH-soluble fluoride and structurally bound fluoride immediately after treatment. Structurally bound fluoride was determined in three successive layers of 30 µm each. Results: Compared with all other mouthrinses, only the application of NaF resulted in higher amounts of KOH-soluble fluoride, and, in the outer layer, of structurally bound fluoride in both sound and demineralized dentin. Similarly, in the deeper layers, only the NaF groups showed elevated fluoride levels. (Am J Dent 2008;21:351-355).

Address: Dr. Alexandra S. Rieben, CharitéCentrum für Zahn-, Mund- und Kieferheilkunde, Abteilung für Zahnerhaltungskunde und Parodontologie, Charité - Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, D - 14197 Berlin, Germany.  E-mail: alexandra.rieben@charite.de

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Research Article

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Marginal and internal adaptation of composite restorations to dentin

in vivo and in vitro

Petra  Hahn, priv doz, dr med dent,   Gerko  Weyen, dr med dent,   Priska  Fischer, dr med dent,

Sebastian  Plogmann, dr med dent   &   Matthias  Hannig, Prof dr med dent

Abstract: Purpose: To compare the influence of in vivo and in vitro conditions on marginal and internal adaptation of composite restorations using three adhesive systems. Methods: 60 human teeth were distributed among three material groups. In each root, three Class V cavities were prepared and filled with the same material, one in vivo and, after extraction, one in perfused and one in not-perfused dentin specimens. Results: Evaluation of gap formation at the composite/dentin interface with SEM revealed no significant differences between marginal and internal adaptation. Adaptation data were different according to the materials used (P= 0.002), and to experimental conditions (P= 0.04). According to the gap frequency concerning experimental conditions, it was concluded that in vivo adaptation of composite restorations to dentin seemed to be better compared to in vitro results achieved with perfused dentin, and worse compared to in vitro results achieved without perfused dentin. Additionally, it was noted that the impact of the experimental conditions on the performance of different adhesive materials was dependent on the composition of the materials. Least adaptation was found for the perfused specimens in most groups, and least gap formation for the non- perfused in vitro specimens. A material dependent influence of experimental conditions on the study influenced the results. In vitro adaptation to perfused dentin seems to be undervalued compared to the clinical situation in certain circumstances. (Am J Dent 2008;21:356-360).

Address: Dr. Petra Hahn, Department of Operative Dentistry and Periodontology, Dental School and Hospital, University Medical Center Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany. E-mail: petra.hahn@uniklinik-freiburg.de

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Effect of thermocycling on optical parameters of resin composites

by the brand and shade

Seung-Hun  Lee, dds  &  Yong-Keun  Lee, dds, phd

Abstract: Purpose: To evaluate the difference in changes of optical properties of varied shades from varied brands of resin composites after thermocycling, and to determine the influence of the optical parameters, such as color coordinates, chroma and translucency, and the changes in these parameters on the color change. Methods: Eight light-curing resin composites (41 shades) were investigated. Color of 1-mm thick specimens was measured according to the CIELAB color scale over a white and over a black background on a reflection spectrophotometer before and after 5,000 cycles of thermocycling. Translucency parameter (TP) was calculated. The influence of the brand and shade on the changes in color, color coordinates, chroma, and TP was determined. Multiple regression analysis was performed to determine the influence of the optical parameters and the changes in these parameters on the color change. Results: Color change was in the range of 1.1 to 4.6 ∆E*_ab units, and TP change was in the range of -3.8 to 0.1. Changes in optical parameters investigated were influenced by the brand of resin composite (P< 0.05). Several brands showed no significant difference by the shade depending on the optical parameter (P> 0.05). Based on multiple regression analysis, ∆b*, ∆L*, ∆TP and L*-baseline significantly influenced the color change (P< 0.05). (Am J Dent 2008;21:361-367).

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-mail: ykleedm@snu.ac.kr

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Research Article

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Ultrastructural examination of one-step self-etch adhesive

bonded primary sound and caries-affected dentin

Yumiko  Hosoya, dds, phd,  Franklin  R.  Tay, bdsc (hons), phd, fadm,  Franklin  García-Godoy, dds, ms &  David  H.  Pashley, dds, phd, fadm

Abstract: Purpose: To examine the ultrastructure and silver nanoleakage of the resin-dentin interfaces in sound and caries-affected primary tooth dentin bonded with a 4-META one-step self-etch adhesive. Methods: Each of five sound and carious primary molars was bonded with Hybrid Bond. Resin-dentin interfaces were observed with TEM micrographs obtained from silver-impregnated, unstained and undemineralized sections of bonded sound and caries-affected primary dentin, and stained and demineralized sections of bonded sound and caries affected primary dentin without silver impregnation. Results: For sound dentin, silver nanoleakage was observed extensively in the patent dentin tubules, within the dentin beneath the hybrid layer, within the hybrid layer in some specimens, and as water trees that partially protruded into the overlying adhesive layer. The hybrid layer was about 1 µm thick. Smear plugs in the dentin tubules and smear on the ground dentin protruded in the hybrid layer. Remnants of demineralized smear were observed overlying the adhesive layer. For caries-affected dentin, the hybrid layer was obscure. Dentin tubules were occluded with mineral deposits. There were no water trees or nanoleakage in the adhesive layer or hybrid layer. However, smear remnants were observed in the adhesive layer and large silver deposits were observed in the highly porous underlying caries-affected dentin. (Am J Dent 2008;21:368-372).

Address: Dr. Yumiko Hosoya, Nagasaki University Graduate School of Biomedical Sciences, Medical and Dental Sciences, Unit of Translational Medicine, Department of Pediatric Dentistry, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan. E-mail: hosoya@nagasaki-u.ac.jp

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Research Article

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Fracture resistance of fiber posts: Combinations of several small posts vs. standardized single post

Pier F. Porciani, md, dds, msc,  Michele Vano, dds, msc,  Ivana Radovic, dds, msc, Cecilia Goracci, dds, msc, phd, Simone Grandini, dds, msc, phd,  Franklin García-Godoy, dds, ms  &   Marco Ferrari, md, dds, phd

Abstract: Purpose: To determine the fracture resistance of different sizes of standardized single fiber posts and the combinations of multiple small experimental posts. Methods: Single posts in three different sizes (1, 2 and 3; DT Light Posts, RTD; DT), as control, and seven different combinations of experimental small posts (Abrasive Technology), reproducing the sizes of several endodontic files were cemented in endodontic resin blocks. The combinations of small posts were made combining 2-4 small posts so as to reach the sizes of standardized DT posts. The posts were loaded at an angle of 45° to the long axis of the block using a crosshead speed of 1 mm/minute until specimen failure. Ten posts/combinations were tested. Statistical analysis was performed using one-way ANOVA followed by Tamhane test for the post hoc comparisons (P< 0.05). Results: For the single posts, fracture resistance increased when increasing the diameter of the post. The use of multiple posts resulted in fracture resistances comparable to that of the single post for two of the three diameters studied (DT1 and DT2). For the largest diameter (DT3), the use of multiple posts resulted in lower fracture resistances than did the single post. (Am J Dent 2008;21:000-000).

Address: Dr. Pier Francesco Porciani, Piazza Pietro Leopoldo 8, Firenze 50134, Italy. E-mail: piercateadsl@libero.it

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Research Article

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Marginal adaptation of pit and fissure sealants after thermal

and chemical stress. A SEM study

Kamila Rosamilia Kantovitz, dds, ms,   Fernanda Miori Pascon, dds, ms,  

Roberta Caroline Bruschi Alonso, dds, ms, phd,  Marines Nobre-dos-Santos, dds, ms, phd 

&  Regina Maria Puppin Rontani, dds, ms, phd

Abstract: Purpose: To evaluate the in vitro marginal adaptation (gap formation) in the fissure of different sealer materials (resin sealant, glass-ionomer cement, resin-modified glass-ionomer cement, and adhesive system) submitted to thermal and chemical stress, using scanning electron microscopy evaluation (SEM). Methods: 80 impacted human third molars were randomly assigned to the following experimental groups (n=10): FluroShield (F), Helioseal Clear Chroma (H), Vitremer (V), Fuji II-LC (FII), Ketac-Molar (KM), Fuji IX (FIX), Single Bond (SB), and Clearfil Protect Bond (CF). All groups were subjected to thermocycling and 14 days of pH cycling. A blinded and calibrated examiner performed SEM analysis. Gap formation was scored according to: 0= no sealant marginal gaps; 1= sealant marginal gaps present or total sealant loss. The score 0 was considered a success, while score 1 represented failure. Data were analyzed by Kruskal-Wallis and Bonferroni tests (P< 0.05). Results: The success rates of SB (100%) and V (90%) were similar, but statistically superior to F (30%), H (20%), FIX (20%), and CF (0%) (P< 0.05). A tendency for similar behaviors of FII and KM to SB and V was observed and for similar behaviors of F, FIX and H to CF. The worst results were obtained for CF. (Am J Dent 2008;21:377-382).

Address: Prof. Dr. Regina Maria Puppin-Rontani, Av. Limeira, 901 - Caixa Postal 52, CEP 13414-900 Piracicaba, SP, Brazil. E-mail: rmpuppin@fop.unicamp.br

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Research Article

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Preparation for invasive pit and fissure sealing: Air-abrasion or bur?

Norbert Krämer, dmd, phd, Franklin García-Godoy, dds, ms, Ulrich Lohbauer, phd, Katja Schneider, dmd, Irene Assmann, dmd  &  Roland Frankenberger, dmd, phd

Abstract: Purpose: To evaluate the effect of different air-abrasion devices on substance loss on flattened enamel, preparation extent, and microleakage of invasive pit and fissure sealings. Methods: 150 freshly extracted caries-free human third molars were used. 60 teeth (n=10) were embedded, enamel surfaces were polished to #1200, and six air abrasion devices abraded specimens for 5 seconds. Substance loss was profilometrically recorded as maximum and mean width, and maximum and mean depth. From 90 intact teeth (n=10), fissures were enlarged by air abrasion (Rondoflex 27 µm/50 µm, Airsonic Mini Sandblaster, CoJet Prep, PrepStart, Primus CPE), or treated with a diamond bur (De Craene), or using a metal bur (Fissurotomy Micro NTF), or with oscillating diamond tips (SONICSeal). Prepared fissures were etched and rinsed and sealed with a light-curing sealant (Helioseal). After four weeks water storage and subsequent 2,000 thermocycles (5°C/55°C), microleakage was assessed with 5% methylene blue for 3 minutes at 30G on cross cuts at x40 magnification. Furthermore the parameters upper fissure width, prepared and unprepared area, penetration depth of the sealer, and area of voids were recorded. Results: For substance loss on flattened enamel, CoJet Prep and Mini Sandblaster revealed the widest abrasion areas, PrepStart produced the deepest craters (P< 0.05). Regarding preparation characteristics, rotary burs and PrepStart caused significantly less substance loss than the other devices (P< 0.05). Due to the etch&rinse approach, microleakage was generally minimal. Only after air abrasion with Rondoflex (50 µm) significantly less complete sealings were recorded (P< 0.05). (Am J Dent 2008;21:383-387).

Address: Dr. Roland Frankenberger, Glückstrasse 11, D-91054 Erlangen, Germany. E-mail: frankbg@dent.uni-erlangen.de

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Research Article

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Effects of the desensitizing agents Gluma and Hyposen

on the tensile bond strength of dentin adhesives

Annett  Kobler, dr med dent, dds,  Hans  Günter  Schaller, dr med dent, dds, phd

&   Christian  R.  Gernhardt, dr med dent, dds

Abstract: Purpose: To evaluate the influence of two desensitizers (Gluma Desensitizer and Hyposen) on the tensile bond strength of three different dentin adhesives. Methods: 90 freshly extracted third molars were specially prepared to allow simulation of dentin perfusion. The specimens were divided at random into nine groups: Group AC: Clearfil New Bond/Clearfil Core; Group AX: Xeno III/Tetric Flow; Group AA: AdheSE/Tetric Flow; Group BC: Gluma/Clearfil New Bond/Clearfil Core; Group BX: Gluma/Xeno III/Tetric Flow; Group BA: Gluma/AdheSE/Tetric Flow; Group CC: Hyposen/Clearfil New Bond/Clearfil Core; Group CX: Hyposen/Xeno III/Tetric Flow; Group CA: Hyposen/AdheSE/Tetric Flow. Tensile bond strength of the above mentioned bonding agents was measured using a universal testing machine. Results: The following tensile bond strengths were obtained (mean values and standard deviations in MPa): Group AC: 11.05 ± 1.92, Group AX: 6.01 ± 1.35, Group AA: 8.91 ± 1.20, Group BC: 10.25 ± 1.44, Group BX: 7.17 ± 1.24, Group BA: 10.35 ± 1.26, group CC: 8.11 ± 0.70, Group CX: 8.03 ± 1.20, Group CA: 9.22 ± 1.75. Statistical analysis showed a significant influence of the variable, dentin bonding agent on tensile bond strength (ANOVA, Tukey’s, P< 0.05). Treatment with Hyposen in combination with Clearfil New Bond resulted in significantly lower bond strength values. Gluma had no significant influence on bond strength of the three adhesive systems. Within the limitations of an in vitro investigation it can be concluded that Gluma did not significantly affect the bond strength of any of the adhesive systems tested. Hyposen significantly decreased the bond strength values of Clearfil New Bond. (Am J Dent 2008;21:388-392).

Address: Dr. Christian R. Gernhardt, Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Große Steinstraße 19, 06108 Halle/Saale, Germany. E-mail: christian.gernhardt@medizin.uni-halle.de

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Research Article

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Micro-CT for measuring marginal leakage of Class II resin composite restorations in primary molars prepared in vivo

Ece  Eden, dds, phd,  VAsli Topaloglu-Ak, dds, phd,  Vincent  Cuijpers, bsc  &  Jo  E.  Frencken, dds, msc, phd

Abstract: Purpose: To evaluate the reliability of marginal leakage assessment of self-etch adhesive Class II resin composite restorations in primary molars prepared in vivo using the micro-CT. Methods: Fourteen primary molars, divided over seven ART and seven traditional resin composite Class II restorations, were subjected to marginal leakage test using a 50% (w/v) silver nitrate solution for 4 hours by a micro-CT. Two evaluators selected the image with the deepest marginal dye penetration for each restoration from the occlusal and approximal surfaces on consensus. The deepest dye penetration depth and total length of the axial cavity wall from both the occlusal and from the approximal surface were measured manually using morphometric quantification software by three evaluators independently. ANOVA was applied to test for differences in marginal leakage scores between the three evaluators. Results: There was no marginal leakage found in five traditional and one ART restoration. The percentage of silver nitrate penetration depth from the cervical-approximal site ranged from 10.2-92.6%. There was only a statistically significant difference observed in measuring total axial wall length from the cervical-approximal site between the three evaluators (P= 0.02). This explanatory investigation showed that the micro-CT was a very useful device for developing a standardized method for measuring marginal leakage from samples obtained in vivo. In combination with 50% (w/v) silver nitrate and 4-hour immersion, marginal leakage along the restoration–tooth tissue interface was accurately and reliably measured. (Am J Dent 2008;21:393-397).

Address: Dr. J.E. Frencken, WHO Collaborating Centre for Oral Health Care Planning and Future Scenarios, Radboud University Medical Center, College of Dental Sciences, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: j.frencken@dent.umcn.nl

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