Prognosis test by visualization of demineralized dentin under restorations to prevent initial
wall-lesions initiated by lactic acid
Morakot Piemjai, dds, mdsc, phd, Pareewan Chantarawej, dds, Nobuo
Nakabayashi, ms, phd
& Franklin Garcia-Godoy, dds, ms, phd, phd
Abstract: Purpose: To visualize the complete protection of restored dentin
in the acidic environment by the complete impregnation of resin into demineralized dentin. Methods: Class V cavities prepared in extracted human molars composed of enamel, cementum and dentin surfaces were sealed using either
4-META/MMA-TBB resin with conditioning periods of 10, 30, 60 seconds with 10%
citric acid and 3% ferric chloride mixed aqueous solution (10-3) or Single-Bond
2 adhesives prior to restoration with light-cured resin-composite. Specimens
were either immersed in artificial saliva or 0.1 mol/L buffered lactic acid
solutions at 37°C for 14 days. After immersion in 0.5% basic fuchsin dye for 24 hours, the extent of dye penetration at
the margin was measured. SEM micrography was used to
investigate the quality of hybridized dentin when immersed in HCl followed by NaOCl solutions. Results: After lactic acid exposure, dye penetration into the
adjacent demineralized cementum/dentin
was found to be significantly lower than the leakage distance under 30 and 60
seconds and Single-Bond 2 specimens. Leakage-free margins were found in
10-second conditioning period specimens for both control and after soaking in
buffered lactic solution with the stable hybridized dentin after chemical
challenge. (Am J Dent 2017:30:119-124).
Clinical significance: A leakage-free interfacial
layer, provided by complete hybrid layer formation, can block lactic acid
penetration. Using this novel prognosis test for visualization of demineralized dentin, clinical restorations are likely to
be more reliably predictable in the prevention of initial wall-lesions,
post-operative hypersensitivity and/or pulpal infection.
Mail: Dr. Morakot Piemjai,
Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Patumwon, Bangkok 10330, Thailand. E-mail: tmorakot@chula.ac.th
Porosity of flowable resin composites is not influenced by applicator
tip diameter
Rémy Balthazard, dds, phd, Stéphanie Jager, dds, phd, Olivier Ferry, eng, Abdessellam Dahoun, phd
& Eric Mortier, dds, phd
Abstract: Purpose: To assess the influence of
applicator tip diameter on the inclusion of porosities in three different flowable resin composites. Methods: The initial porosity of three syringes [Filtek Supreme XTE Flowable (XTE), Grandio Flow (GRF), Gradia Direct Flo (GDF)] was determined by 3D
tomography. 25 samples per syringe, i.e. 75 samples in total, were prepared
using five applicator tips of different diameters (n= 5). The porosity of the
75 samples was assessed by 3D tomography. Results: For each of the materials, the applicator tips, irrespective of type, all
generated an increase in the average porosity percentage compared to the
initial porosity of the syringes. For XTE and GRF, the applicator tips,
irrespective of type, all generated a decrease in the average porosity volume
compared to the initial average porosity volume in their respective syringes.
Conversely, for GDF the average porosity volume of the samples was increased.
Furthermore, for each of the materials, varying the diameter of the applicator
tips had no significant influence on the porosity percentage and volume. Using
the present study conditions, the applicator tip generated a variation in the
initial porosity of the materials; however, the diameter of the tip had no
influence on said variation. (Am J Dent 2017:30:125-130).
Clinical significance: It appears
that practitioners can choose an applicator tip with a diameter that best suits
the size and shape of the cavity to be filled using a syringe of flowable resin composite without this having any impact on
the percentage and volume of porosities in the final filling of the cavity.
Mail: Dr.
Eric Mortier, Department of Conservative Dentistry,
Faculty of Dentistry, University of Lorraine, 96 Avenue de Lattre de Tassigny, 54000 Nancy, France. E-mail:
eric.mortier@gmx.fr
Clinical and radiographic evaluation of white MTA
versus formocresol
pulpotomy: A 48-month follow-up study
María Biedma Perea, dds, phd, Beatriz Solano Mendoza, dds, mds, Franklin Garcia-Godoy, dds, ms, phd, phd,
Asunción Mendoza Mendoza, mds, phd & Alejandro Iglesias-Linares, dds, ms, phd
Abstract: Purpose: To determine whether there were differences between formocresol (FC) and white mineral trioxide aggregate (MTA) pulpotomy in terms of clinical and radiographic signs
or effects upon the permanent successor over a long term. Methods: A total of 212 molars (74 treated with FC and 138 with
white MTA) corresponding to 129 subjects [66 females (51.1%) and 63 males
(48.8%)] were evaluated. The coronal pulp was carefully amputated up to the
entrance of the root canals using a sharp spoon excavator. Post-amputation
bleeding was confirmed to be bright red and was seen to subside after applying
2-3 minutes of gentle pressure with a sterile cotton pellet. One group was
treated with a 1:5 dilution of formocresol (20%
Buckley’s formocresol solution), while a second group
was treated using white MTA powder (ProRoot). Results: There were no significant
differences in clinical success rate between the two groups (89.9% in the white
MTA group versus 82.5% if the FC group). However, the radiographic success rate
was significantly greater for white MTA versus FC. The radiographic failure
rate in the molars treated with MTA was 7.9% versus 18.9% with FC. Regarding
alterations in the timing of eruption, early and delayed eruption were
respectively recorded in 7.24% and 8.69% of the cases in the MTA group, versus
9.45% and 4.05% of the cases in the FC group. Thus, neither group showed
relevant alterations in the timing of eruption. (Am J Dent 2017;30:131-136).
Clinical significance: Mineral trioxide aggregate
showed a significantly greater radiographic success rate than formocresol in pulpotomy in
primary teeth over 6 to 48 months of follow-up. MTA may be indicated as a
substitute of formocresol in pulpotomy treatments of temporary molars, with no pathological consequences of any kind to
the permanent successor premolar.
Mail: Dr. María Biedma Perea, Manuel Siurot, 52 – 2ª
Planta - 41013 Sevilla, Spain. *-mail: Coinsol@clinicadentalcoinsol.com
Magnesium hydroxide-based dentifrice as an
anti-erosive agent
in an in situ intrinsic erosion model
Vanara Florêncio Passos, dds, msc, phd, Lidiany Karla Azevedo Rodrigues Gerage, dds, msc, phd
& Sérgio Lima Santiago, dds, msc, phd
Abstract: Purpose: To evaluate in situ a magnesium
hydroxide-[Mg(OH)2] based dentifrice on
enamel erosion. Methods: Human
dental enamel slabs were selected by surface microhardness and randomly assigned to one out of the following three groups (n=18):
non-fluoride (control); NaF (1,450 ppm F); and Mg(OH)2 dentifrices.
18 volunteers were enrolled in a randomized, crossover and double-blind study,
with three phases in 5 days. They wore acrylic palatal appliances containing
two human enamel slabs, which were treated with one of the three dentifrices.
During each experimental phase, the specimens were subjected to erosion by
immersion in 0.01 M HCl for 60 seconds, 4x/day, followed by a 1-minute treatment with the
correspondent slurry (saliva/dentifrice). Enamel changes were determined by the
percentage of surface hardness loss (%SHL) and mechanical profilometry analysis. Data were analyzed by ANOVA, followed by Tukey's test (P< 0.05). Results: The
means (SD) for %SHL and surface wear (µm) were, respectively, as follows:
control [50.67(17.48); 2.70(1.24)]; NaF [45.45(15.44); 1.95(0.70)]; and Mg(OH)2 [(53.94(19.48); 1.95(0.67)]. There was no statistically significant difference
among the treated and control groups for %SHL (P= 0.349); however, for wear
rates, a statistically significant difference was found between the groups
treated with NaF and Mg(OH)2 and the control group (P= 0.04). (Am J Dent 2017;30:137-141).
Clinical significance: Dentifrices containing magnesium
hydroxide or sodium fluoride might be an important strategy to minimize the
effects of erosive challenges.
mail: Dr.
Sérgio Lima Santiago, Cap. Francisco Pedro St., CEP: 60430-170 - Fortaleza, CE
Brazil. E-mail:
sergiosantiago@ufc.br; sergiosantiago@yahoo.com
The abrasive
effect of commercial whitening toothpastes on eroded enamel
Victor Mosquim, dds, Beatriz Martines Souza, dds, ms, Gerson Aparecido Foratori Junior, dds,
Linda
Wang, dds, ms, phd & Ana Carolina Magalhães, dds, ms, phd
Abstract: Purpose: To evaluate the in vitro abrasive
effect of commercial whitening toothpastes on eroded bovine enamel samples in
respect to erosive tooth wear. Methods: 72 bovine crowns were embedded, polished and subjected to the baseline profile
analysis. The samples were then protected in 2/3 of the enamel surface and were
randomly assigned to six groups (n= 12/group): G1: Oral-B 3D White; G2: Close-up
Diamond Attraction Power White; G3: Sorriso Xtreme White 4D; G4: Colgate Luminous White; G5: Crest
(conventional toothpaste); G6: erosion only (control). All samples were
submitted to an erosive pH cycling (4 × 90 seconds in 0.1% citric acid, pH 2.5,
per day) and abrasive challenges (2 × 15 seconds, per day) for 7 days. After
the first and the last daily cycles, the samples were subjected to abrasive
challenges, using a toothbrushing machine, soft
toothbrushes and slurry of the tested toothpastes (1.5 N). Between the
challenges, the samples were immersed in artificial saliva. The final profile
was obtained and overlaid to the baseline profile for the calculation of the
erosive tooth wear (µm). The data were subjected to Kruskal-Wallis/Dunn
tests (P< 0.05). Results: G1
promoted the highest enamel wear (3.68±1.06 µm), similarly to G3 (3.17± 0.80
µm) and G4 (3.44± 1.29 µm). G3 and G4 performed similarly between them and
compared with G5 (2.35± 1.44 µm). G2 (1.51± 0.95 µm) and G6 (0.85± 0.36 µm)
showed the lowest enamel wear, which did not differ between them and from G5.
Oral-B 3D White showed the highest abrasive potential while Close-up Diamond
Attraction Power White showed the lowest abrasive potential on eroded enamel in
vitro. (Am J Dent 2017;30:142-146).
Clinical significance: This study showed that some
commercial whitening toothpastes, especially those
containing pyrophosphate associated with hydrated silica, enhanced enamel
erosive wear.
Mail: Dr. Ana Carolina Magalhães, Department of Biological Sciences, Bauru School
of Dentistry - University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75. Bauru-SP, Brazil. E-mail:
acm@usp.br
Clinical
evaluation of a toothpaste containing lysozyme for
removal
of extrinsic stains on the tooth surface: An 8-week, double-blind, randomized
study
Yanxiong Shao, mmed, Jiaojiao Xue, mmed, Canbang Peng, mmed, Chenxi Li, mmed, Shiyun Zhang, mmed
& Haiwen Zhou, dds
Abstract: Purpose: To assess the efficacy and
safety of application of a toothpaste containing lysozyme to remove extrinsic stains on the tooth surface in
an 8-week trial. Methods: 70 adult
participants with extrinsic staining of the tooth surface were recruited to this
randomized, parallel-controlled, double-blind clinical trial. Participants were
allocated randomly to the test group or the control group and the study
procedure and correct usage of the toothpaste were explained to them. Staining,
measured by the Lobene stain index, and any side
effects, were recorded over the course of the 8 weeks. All data were analyzed
using SAS software version 8.0. Results: 69 participants completed the study. The value of the Lobene stain index was significantly reduced (P< 0.05) in the treatment group
compared with the control group after both 4 and 8 weeks. No obvious side
effects were observed. (Am J Dent 2017;30:147-150).
Clinical significance: The results of this clinical
study showed that the toothpaste containing lysozyme was
effective in removing extrinsic staining on the tooth surface.
Mail: Dr. Haiwen Zhou, Department of Oral Mucosal Diseases, Shanghai Ninth People’s Hospital,
Shanghai Jiao Tong University School of Medicine, 500 Qu-xi
Road, Shanghai, 200011, PR China. E-mail: haiwen39@126.com
Long-term outcomes of pulpotomy in permanent teeth with irreversible
pulpitis: A multi-center randomized controlled trial
Saeed Asgary, dds, msc, Mohammad Jafar Eghbal, dds, msc & Alireza Akbarzadeh Bagheban, phd
Abstract: Purpose: To compare success rates of full pulpotomy (FP) with two endodontic biomaterials on
symptomatic vital teeth with closed apices in the presence of apical
periodontitis. Methods: In this
multicenter controlled clinical trial, 412 volunteers met the inclusion
criteria; they were all randomly allocated to either FP/ProRoot mineral trioxide aggregate (MTA) or FP/calcium enriched mixture (CEM) group.
The subjects were followed up for 2- and 5-years to evaluate and compare the
treatment outcomes. Data were analyzed using Chi square test and the multiple
binary logistic regression model. Results: Data for a total number of 344 and 304 subjects were
available for 2- and 5-year follow-ups. In terms of clinical outcomes, 2- and 5-year
success rates of both groups were ≥ 98%, without significant differences.
In terms of radiographic outcomes, the 2-year result of FP/MTA was
significantly superior to FP/CEM (P= 0.005); however, the 5-year success rates
were similar (P= 0.413). Age and preoperative periapical status did not affect the treatment outcomes. (Am J Dent 2017;30:151-155).
Clinical significance: Both MTA and CEM biomaterials
were found to be equally effective pulpotomy agents
for mature permanent molars with irreversible pulpitis and associated apical periodontitis in different age groups. The performance of
this novel minimally invasive biotechnology may support a paradigm shift
towards more biologic/conservative treatments in dentistry worldwide.
Mail: Prof. Saeed Asgary, Iranian
Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of
Medical Sciences, Evin, Postal Code:1983963113,
Tehran, Iran. E-mail: saasgary@yahoo.com
Influence of different cavity preparation designs on
fracture resistance
of onlay and overlay restorations using different CAD/CAM
materials
Gizem Ön Salman, DClinDent, İbrahim Halil Tacír, PhD, Zelal Seyfioğlu Polat, PhD & Afşin Salman, DClinDent
Abstract: Purpose: To evaluate fracture strength of
different preparation designed onlay and overlay
restorations produced by Computer Aided Design/Computer Aided Manufacturing (CAD/CAM)
and three different new ceramic-polymer blocks. Methods: Ninety-one extracted human mandibular molars were used in
this study. Preparations were made as (1) Only functional cusps reduction, (2)
Only functional cusps reduction+rounded shoulder
finish line, (3) All cusps reduction, or (4) All cusps reduction+rounded shoulder finish line. Then these four cavity types were restored with three
different materials: VITA Enamic, GC Cerasmart, Lava Ultimate. Thirteen
groups were created by added control group (n= 7). Adhesive cementation was
achieved by using a dual cured composite resin
adhesive cement RelyX Ultimate. All samples were
subjected to thermocycling for 5,000 cycles in water
baths between 50°C and 55°C. The fracture resistance of specimens was
determined under compressive loads along the long axis of the restored teeth at
0.5 mm/minute crosshead speed until fracture with a universal test machine.
Fracture types of restored groups were evaluated. For fracture resistance data,
one-way ANOVA; for correlation between material type and preparation design,
two-way ANOVA were used. Percentage table and Kruskal-Wallis
test were performed for analysis of fracture types. Results: There was no significant difference between all the groups
(one-way ANOVA, P> 0.05). Group 4 showed statistically higher fracture
strength values than Group 1 and no significant difference was found among
other preparation designs by two-way ANOVA that compared all types of
preparation designs regardless of material difference (P< 0.05). (Am J Dent 2017;30:165-170).
Clinical significance: The results of the present study
could help clinicians regarding which materials and type of preparations should
be selected for onlay and overlay restorations
produced with newly introduced ceramic-polymer CAD/CAM materials.
Mail: Dr. Gizem Ön Salman, Department of Prosthodontics,
Faculty of Dentistry, Dicle University, Diyarbakır, 21280, Kıtılbil, Bağlar, Turkey. E-mail: gizem_on@hotmail.com
Initial microbial colonization of enamel
in children with different levels of
caries activity: An in situ study
Susann Hertel, dr med dent, Alexandra Wolf, dr med dent, Sabine Basche, Gabriele Viergutz, dr med,
Stefan Rupf, dr med dent, Matthias Hannig, dr med dent & Christian Hannig, dr med dent
Abstract: Purpose: To investigate patterns of overnight in situ
microbial colonization of enamel in children. Methods: Overall, 29 children (aged 5–9 years) participated in the
study. Nine were caries-free with no decayed, missing, or filled teeth (DMFT),
11 were caries-rehabilitated (DMFT ≥ 2, no active carious lesions), and
nine were caries-active (DMFT ≥ 2, at least two carious lesions). Bovine
enamel samples were fixed on individual upper jaw splints stored overnight in
situ. 4´,6-diamidino-2-phenylindole (DAPI) combined
with Concanavalin A staining was applied for
fluorescence microscopic visualization of total adherent bacteria and glucans. Fluorescence in situ hybridization (FISH) was used
for distinction of eubacteria, streptococci, and Candida albicans.
Salivary samples were investigated for Streptococcus mutans (S. mutans) by using CRT bacteria test and yeasts with Calcofluor white (CFW) staining. Results: With all fluorescence methods, bacteria but not Candida albicans were detected on enamel samples. No statistically significant differences were
observed in distribution patterns of the adherent bacteria between the groups.
CFW staining indicated fungal structures in saliva samples of all participants.
Based on CRT test results, the lowest amount of S. mutans were observed in caries-free
children. Thus, initial microbial colonization patterns of enamel in children
are not influenced by caries activity. (Am
J Dent 2017;30:171-176).
Clinical
significance: Caries
activity in children may influence the process of initial bioadhesion and thus distribution patterns of bacterial attachment to the enamel surface.
Investigation of in situ biofilm formation might provide valuable insights
regarding the varying caries susceptibility in children.
Mail:
Dr. Susann Hertel, Clinic of Operative and Pediatric Dentistry, Medical Faculty
Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany. E-mail: susann.hertel@uniklinikum-dresden.de
Adverse effects of salivary
contamination for adhesives in restorative
dentistry. A literature review
Pooja Nair, bds, Reinhard Hickel, dds, phd & Nicoleta Ilie, dipl-eng, phd
Abstract: Purpose: To
review and critically analyze the literature concerning the influence of
salivary contamination on the bond quality of adhesives used in restorative
materials by comparing and contrasting the different adhesive materials. Methods: A detailed search on PUBMED,
Cochrane Library, Google Scholar and Web of Science was carried out to identify
publications on salivary contamination and dental adhesive materials, from
1990-2017 (March) which resulted in a total of 6,202 web-identified
publications. After screening titles/abstracts and de-duplicating, 54
publications were selected that matched the requirements for this review. The
condition for selection was English literature concerning the effect of
salivary contamination on the adhesives used in restorative dentistry. The
obtained articles were systematically evaluated. Results: Salivary contamination of adhesives during restorative
procedures statistically (64.6%) showed an adverse effect on adhesives,
occurring either at one or many stages of restoration. Methodological
dissimilarities impeded the direct comparison of the selected studies.
Nevertheless, the 2-step etch and rinse adhesives were
relatively less vulnerable to salivary contamination than the others. 65% of
the evaluated studies for decontamination achieved improved bonding when the
contaminated surface was subjected to some kind of decontamination procedure.
However, the duration and other specificities were not standard in all the
evaluations and need further research to assess the course of action. It is
necessary to do long term studies to evaluate the effectiveness of contaminated
adhesive over time. (Am J Dent 2017;30:156-164).
Clinical
significance: Salivary
contamination is a potential cause for poor bond quality of adhesive systems
during restorative procedures and to provide a successful treatment, proper
care must be taken to ensure the operating area is free from contamination.
Understanding the properties of the materials and its constituents as well as
considering measures to manage the potential vulnerabilities due to salivary
contamination in the area of bonding might help a clinician to produce better
results.
Mail: Pooja
Nair, Department of Operative Dentistry and Periodontology,
Ludwig Maximilians University Munich, Goethestraße 70, 80336 Munich, Germany. E-mail:
poojanair8888@gmail.com