Dimensional changes of demineralized human dentine during preparation for scanning electron microscopy

Influence of 2% Chlorhexidine on the Bond Strength of Three Adhesive Systems on Primary Molars: An In Vitro Study

The hydrolysis of the collagen matrix by metalloproteinases (MMPs) is one of the paradigms that currently arouses most interest due to its close relationship with a decrease in bond strength (BS) and consequent restoration failure. Chlorhexidine 2% has demonstrated its ability to inhibit MMPs’ activity in the permanent dentition, improving the duration of resin–dentine, but there are few studies on deciduous dentition and its possible repercussions. Aim: To determine the influence of 2% chlorhexidine digluconate (CHX) as a dentine pretreatment on the BS of three adhesive systems on primary molars. Methods: 128 primary extracted molars were assigned to eight groups at random. BS in vitro was recorded by micropush-out test, and analyzed by two-way ANOVA. Results: BS values oscillated from 15.01 MPa to 20.41 MPa. There was no statistically relevant variation between the BS total mean of those adhesive groups that had received CHX pretreatment versus those that did not. Adper Prompt L-Pop was the self-etching adhesive with the best BS. Adper Scotchbond 1XT was the total-etch adhesive with the best BS values. Conclusions: Application of 2% chlorhexidine for 60 s as dentine pretreatment did not affect the immediate BS of several adhesive systems used in primary dentition.

Effect of 2% Chlorhexidine Following Acid Etching on Microtensile Bond Strength of Resin Restorations: A Meta-Analysis

Background and Objectives: The aim of this systematic review was to examine the effect of 2% chlorhexidine following acid etching on the microtensile bond strength of resin restorations for different follow-up times. Materials and Methods: A thorough search of PubMed, Scopus, and Embase databases were conducted. In vitro experimental studies or in vivo studies published up to December 2018 with an experimental group treated with a 2% chlorhexidine solution following acid etching and a control group were included, wherein the final restoration used a resin composite in both the groups. Results: Twenty-one articles were identified for qualitative analysis and 18 for meta-analysis. The difference in the means of microtensile bond strength between the two groups was calculated for the different follow-up times. The differences were significant for 6 months (4.30 MPa; 95% CI 2.72–5.89), 12 months (8.41 MPa; 95% CI 4.93–11.88), and 2–5 years including aged and thermocycling samples (9.08 MPa; 95% CI 5.36–12.81). There were no significant differences for the type of adhesive used. A meta-regression model showed a significant effect of time on the microtensile bond strength. Conclusions: The application of a 2% chlorhexidine solution after acid etching increased the microtensile bond strength significantly for follow-up times of 6 months or more. The adhesive type had no influence.

Clinical Performance of Different Solvent-based Dentin Adhesives With Nanofill or Nanohybrid Composites in Class III Restorations: Five Year Results

Purpose:

To evaluate the clinical performance of water, acetone, ethanol, and ethanol-water solvent-based dentin adhesives with nanofill or nanohybrid composites in Class III restorations.

Methods and Materials:

A total of 22 patients aged between 14 and 48 years (mean age: 25.2 years) participated in the study. Each patient received four Class III restorations, which were performed using water (Scotchbond Multipurpose), acetone (Prime&Bond NT), ethanol (XP Bond) and ethanol-water (Xeno V) solvent-based dentin adhesive systems with a nanofill (Filtek Supreme XT) or nanohybrid composite (CeramX Duo). Two experienced examiners evaluated the restorations with regard to retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture at baseline and at one-, two-, three-, four-, and five-year recalls.

Results:

The five-year survival rates were 100% for Scotchbond Multipurpose, Prime&Bond NT, and XP Bond and 81.2% for Xeno V–bonded restorations. Only three Xeno V–bonded restorations failed. With the exception of marginal discoloration, there were no statistically significant differences among the four adhesive-bonded restorations in any of the evaluation periods in terms of the evaluation criteria.

Conclusions:

With the exception of marginal discoloration and marginal integrity deterioration of Xeno V–bonded restorations, all four adhesive-bonded restorations exhibited good long-term results. However, adhesion strategy (such as self-etch or etch-and-rinse) is more important than the solvent content of dentin adhesive systems in the success of Class III restorations.

Scanning Electron Microscopic Study on the Fibrillar Structures within Dentinal Tubules of Human Dentin

INTRODUCTION

Pulp biology is central to the whole tooth, and knowledge on its microstructure is changing with new studies. This study presents certain microfibrillar structures found within the dentin tubules of human teeth connecting dentin tubules and odontoblastic processes.

METHODS

We analyzed the crowns of 30 noncarious, human teeth. They were fixed; demineralized; and, later, processed and reviewed by means of scanning electron microscopy.

RESULTS

In the predentin layer, we found numerous fine fibrillar structures connecting the odontoblastic process and the wall of the dentinal tubule. In the inner dentinal third, we observed structures forming a dense microfibrillar network of variable thickness and diameters. These microstructures were very thin and numerous in this area, and their number decreased as more external dentin levels were examined.

CONCLUSIONS

According to the review of the literature and our findings, these microfibrillar structures may be an unrecognized support system that holds and secures the odontoblastic process within the dentinal tubule.

Evaluation of the microleakage of different class V cavities prepared by using Er:YAG laser, ultrasonic device, and conventional rotary instruments with two dentin bonding systems (an in vitro study)

This study aimed to evaluate the extent of microleakage in class V cavities prepared with bur, Er:YAG laser, and ultrasonic, hybridized with two different bonding agents ("Single bonding" solvent-free bonding agent and "Swiss TEC SL bond" alcohol-based solvent). Thirty freshly extracted human premolars were divided into three groups (n = 10), on each tooth, two cavities were prepared on the buccal and the lingual surfaces, and each group was subdivided into two subgroups (n = 5). Group 1: 20 cavities were prepared by using Er:YAG laser (500 mJ, 10 Hz, 63.69 J/cm(2)) (subgroup1a: Single bonding was used with 10 cavities; subgroup 1b: Swiss TEC SL bond was used with 10 cavities). Group 2: 20 cavities were prepared by using ultrasonic (subgroup 2a: Single bonding was used with 10 cavities; subgroup 2b: Swiss TEC SL bond was used with 10 cavities). Group 3: 20 cavities were prepared by using burs (subgroup 3a: Single bonding was used with 10 cavities; subgroup 3b: Swiss TEC SL bond was used with 10 cavities). Cavities were restored with a micro-hybrid composite resin. After thermocycling, the specimens were immersed in 2 % methylene blue solution for 4 h and then sectioned in the bucco-lingual direction. Dye penetration was scored based upon the extent of the dye using a stereomicroscope. The two-way ANOVA test and paired t-test revealed no statistically significant differences among the methods of preparation (conventional, laser, and ultrasonic). However, statistical differences were found between the adhesives tested: the "Single bonding", which represented the solvent-free bonding agent, had lower microleakage values than "Swiss TEC SL bond", which represented the alcohol-based bonding agent. Based on the results of this study, it can be concluded that the Erbium:Yttrium-Aluminum Garnet (Er:YAG) laser and ultrasonic are as effective as the conventional method for preparing cavities and the extent of microleakage depends on the type of the bonding agents.

Antimicrobial substantivity over time of chlorhexidine and cetrimide

INTRODUCTION

To reach an adequate control of dentin infection and to promote success in endodontic therapy, antimicrobial irrigating solutions with confirmed substantivity are recommended. The aim of the present study was to evaluate the antimicrobial substantivity against Enterococcus faecalis of a dentin-volumetric unit exposed for 1 minute to chlorhexidine (CHX) and cetrimide (CTR).

METHODS

Standardized coronal dentin blocks of human molars, with and without collagen, were treated for 1 minute with 0.2% and 2% CHX and 0.2% CTR. Afterwards, they were exposed to E. faecalis suspension to determine the antimicrobial substantivity over a period of 60 days. Results were analyzed by means of Kaplan-Meier survival analysis (P < .05).

RESULTS

A direct relationship was seen between CHX concentration and survival time, and the most statistically significant results were obtained in specimens with collagen. CTR showed intermediate survival values close to those of 2% CHX.

CONCLUSIONS

The present study shows that 2% CHX used for 1 minute provides the longest substantivity followed by 0.2% CTR when applied to a dentin-volumetric model.

Apatite crystal protection against acid-attack beneath resin-dentin interface with four adhesives: TEM and crystallography evidence

OBJECTIVES

Interaction between specific functional groups and apatite crystals may contribute to adhesion. The present study investigated effects of four adhesives with different compositions on protection of crystals beneath the hybrid layer against acid-attack using transmission electron microscopy (TEM) and selected area electron diffraction (SAED).

METHODS

Human dentin was bonded with four adhesives; two with a carboxylic-based functional co-polymer (PAA): three-step etch-and-rinse Scotchbond Multi-Purpose (SMP, 3M ESPE) and one-step self-etch Adper Easy Bond (AEB, 3M ESPE), and two with a phosphate-based functional monomer (MDP): two-step etch-and-rinse Clearfil Photo Bond (CPB, Kuraray Medical) and two-step self-etch Clearfil SE Bond (CSE, Kuraray Medical). The specimens were the either left untreated (control) or subjected to acid-base challenge with demineralizing solution (pH 4.5) and 5% NaClO. All specimens were processed and observed by TEM. SAED was used to identify the presence or absence of apatite crystallites at the base or beneath hybrid layer before and after acid-base challenge.

RESULTS

An apatite-rich zone was observed beneath the partially demineralized hybrid layer of CSE. The zone was thinner in AEB, but a demineralization-susceptible area was found beneath it. The etch-and-rinse adhesives (SMP and CPB) demonstrated completely or predominantly demineralized hybrid layers, which were devoid of the acid-resistant apatite-rich zone.

SIGNIFICANCE

TEM/SAED evidence disclosed that the preserved dentin apatite crystals beneath the thin hybrid layer of the mild self-etch adhesives were protected against acid. Diffusion of reactive components beyond the hybrid layer, and their chemical bonding potential with the remaining crystals created the acid-base resistant zone.

Tensile resistance of mineralized and demineralized rat bones in different regions (calvarial and femur)

The aim of this study was to evaluate the tensile resistance of mineralized and demineralized bones. Twelve mice were used. Specimens were collected and divided into groups 1 and 2, mineralized and demineralized calvarial bone, and groups 3 and 4, mineralized and demineralized femoral bone. There was not a statistically significant difference (analysis of variance) between the regions; however, when comparing the demineralized and mineralized groups, a statistically significant difference (Student test) for the mineralized group was noticed.

Chlorhexidine binding to mineralized versus demineralized dentin powder

OBJECTIVES

The purposes of this work were to quantitate the affinity and binding capacity of chlorhexidine (CHX) digluconate to mineralized versus demineralized dentin powder and to determine how much debinding would result from rinsing with water, ethanol, hydroxyethylmethacrylate (HEMA) or 0.5M NaCl in water.

METHODS

Dentin powder was made from coronal dentin of extracted human third molars. Standard amounts of dentin powder were tumbled with increasing concentrations of CHX (0-30 mM) for 30 min at 37 degrees C. After centrifuging the tubes, the supernatant was removed and the decrease in CHX concentration quantitated by UV-spectroscopy. CHX-treated dentin powder was resuspended in one of the four debinding solutions for 3 min. The amount of debound CHX in the solvents was also quantitated by UV-spectroscopy.

RESULTS

As the CHX concentration in the medium increased, the CHX binding to mineralized dentin powder also increased up to 6.8 micromol/g of dry dentin powder. Demineralized dentin powder took up significantly (p<0.01) more CHX, reaching 30.1 micromol CHX/g of dry dentin powder. Debinding of CHX was in the order: HEMA

SIGNIFICANCE

As CHX is not debound by HEMA, it may remain bound to demineralized dentin during resin-dentin bonding. This may be responsible for the long-term efficacy of CHX as an MMP inhibitor in resin-dentin bonds.

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Key Words

• chlorhexidine
• binding
• debinding
• dentin bonding

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MESH Headings

• Anti-Infective Agents, Local/pharmacokinetics
• Anti-Infective Agents, Local/pharmacology
• Chlorhexidine/analogs & derivatives
• Chlorhexidine/pharmacokinetics
• Chlorhexidine/pharmacology
• Collagen/metabolism
• Dental Bonding
• Dentin/metabolism
• Durapatite
• Ethanol
• Humans
• Hydrogen Bonding
• Linear Models
• Matrix Metalloproteinase Inhibitors
• Methacrylates
• Protease Inhibitors/pharmacology
• Protein Binding
• Resin Cements/chemistry
• Sodium Chloride
• Solubility
• Spectroscopy, Fourier Transform Infrared
• Tooth Demineralization/metabolism
• Water

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Grants

• R01 DE015306 NIDCR NIH HHS
• R01 DE015306-06A1 NIDCR NIH HHS
• R01 DE015306-06 NIDCR NIH HHS

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Affiliation(s)

Jongryul Kim Department of Conservative Dentistry, School of Dentistry, Kyung Hee National University, Seoul, Republic of Korea
Toshikazu Uchiyama Department of Regenerative Dentistry, Nihon University School of Dentistry at Matsuso, Chiba, Japan
Marcela Carrilho GEO/UNIBAN, Health Institute, Bandeirante University of São Paulo, Brazil and Department of Dental Materials and Oral Biochemistry, University of São Paulo, School of Dentistry, São Paulo/SP, Brazil
Kelli A. Agee Medical College of Georgia, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA
Annalisa Mazzoni Department of SAU & FAL, University of Bologna, Bologna, Italy
Lorenzo Breschi Department of Biomedicine, University of Trieste + IGM-CNR, Unit of Bologna, c/o IOR, Bologna, Italy
Ricardo M. Carvalho Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
Leo Tjäderhane Institute of Dentistry, University of Oulu and Oulu University Hospital, Oulu, Finland
Stephen Looney Department of Biostatistics, Medical College of Georgia, Augusta, Georgia, USA
Courtney Wimmer Department of Biostatistics, Medical College of Georgia, Augusta, Georgia, USA
Arzu Tezvergil-Mutluay Department of Prosthodontics, School of Dentistry, University of Turku, Turku, Finland
Franklin R. Tay Department of Endodontics, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA
David H. Pashley Medical College of Georgia, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA

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Scanning electron microscopy of pulp cavity dentin in dogs

Dentin morphology and tubule diameter and density of peripulpal dentin were evaluated in 36 teeth from 12 adult dogs, aged between 2.5 and 13-years. The right maxillary canine and third premolar and right mandibular first molar teeth were extracted from euthanized dogs. The teeth were prepared and photomicrographs (n=108) were taken of the radicular and coronal dentin. Dentinal tubule density (tubules/mm2) was determined and tubular diameter and luminal area were measured in 3240 randomly chosen tubules using measurement software. Results from group 1 dogs (< 7-years-old) were compared with group 2 dogs (> 7-years-old). The majority of dentinal tubules were round or oval in shape and had uniform distribution at the radicular coronal third, and coronal levels. Dentin surfaces showed morphological differences at different levels of the tooth. Group 1 dentinal tubule diameter (1.87 +/- 0.44 microm) and area (1.91 +/- 0.83 microm2) were significantly different compared with Group 2 dentinal tubule diameter (1.53 +/- 0.39 microm) and area (1.22 +/- 0.50 microm2). There was no significant difference in tubular density between groups 1 (74,692 +/- 25,991 tubules/mm2) and 2 (72,938 +/- 24,646 tubules/mm2). Site-specific differences were observed in the pulp cavity dentin in the same tooth. These results provide a reference for future research in dogs or where dogs are used as a model for investigations in human dentistry.

Morphological/chemical imaging of demineralized dentin layer in its natural, wet state

OBJECTIVE

Measuring the structure, composition or suitability for bonding of the acid-etched dentin substrate, especially in its hydrated state, has been a formidable problem. The purpose of this study was to determine the morphological and structural profiles of the dentin demineralized layer measured in its natural wet state using environmental scanning electron microscopy (ESEM) and micro-Raman imaging.

MATERIALS AND METHODS

The occlusal 1/3 of the crown was removed from nine extracted, unerupted human third molars. Dentin surfaces were abraded with 600-grit SiC sandpaper under water to create smear layers. The prepared dentin surfaces were randomly selected for treatment with the self-etching agent (Adper Prompt L-Pop) or the total-etching agent 35% H(3)PO(4) gel (with/without agitation). Micro-Raman spectra and imaging were acquired at 1-1.5microm spatial resolution at positions perpendicular to the treated surfaces; since this technique is non-destructive, the same specimens were also imaged with ESEM. Specimens were kept wet throughout spectral acquisition and ESEM observations.

RESULTS

ESEM could be used to reveal demineralized layers in acid-etched dentin, but the resolution was low and no collagen fibrils were disclosed. The detailed chemical maps/profiles of demineralized dentin layers under wet conditions could be obtained using Raman imaging. It was shown that the mineral existed in the superficial layer of all etched dentin covered with smear layers. The mineral was much easier to be removed underneath the superficial layer. The depth, degree, and profile of dentin demineralization were dependent on the types of acids (self-etching vs. total etching) and application procedures (with vs. without agitation).

SIGNIFICANCE

Most current adhesives are applied using wet bonding techniques in which the dentin is kept fully hydrated throughout the bonding. Our ability to fully characterize the hydrated, etched dentin substrates is very important for understanding bonding under in vivo conditions.

Host-derived loss of dentin matrix stiffness associated with solubilization of collagen

Matrix metalloproteinases (MMPs) bound to dentin matrices are activated during adhesive bonding procedures and are thought to contribute to the progressive degradation of resin-dentin bonds over time. The purpose of this study was to evaluate the changes in mechanical, biochemical, and structural properties of demineralized dentin treated with or without chlorhexidine (CHX), a known MMP-inhibitor. After demineralizing dentin beams in EDTA or phosphoric acid (PA), the baseline modulus of elasticity (E) of each beam was measured by three-point flexure. Specimens were pretreated with water (control) or with 2% CHX (experimental) and then incubated in artificial saliva (AS) at 37 degrees C for 4 weeks. The E of each specimen was remeasured weekly and, the media was analyzed for solubilized dentin collagen at first and fourth week of incubation. Some specimens were processed for electron microscopy (TEM) immediately after demineralization and after 4 weeks of incubation. In EDTA and PA-demineralized specimens, the E of the control specimens fell (p < 0.05) after incubation in AS, whereas there were no changes in E of the CHX-pretreated specimens over time. More collagen was solubilized from PA-demineralized controls (p < 0.05) than from EDTA-demineralized matrices after 1 or 4 weeks. Less collagen (p < 0.05) was solubilized from CHX-pretreated specimens demineralized in EDTA compared with PA. TEM examination of control beams revealed that prolonged demineralization of dentin in 10% PA (12 h) did not denature the collagen fibrils.

Dehydration and the dynamic dimensional changes within dentin and enamel

OBJECTIVES

The objectives of this study were to quantify the dimensional changes in dentin and enamel during dehydration, and to determine if there are differences between the responses of these tissues from young and old patients.

METHODS

Microscopic digital image correlation (DIC) was used to evaluate deformation of dentin and enamel as a function of water loss resulting from free convection in air. Dimensional changes within both tissues were quantified for two patient age groups (i.e. young 18< or =age< or =30 and old 50< or =age) and in two orthogonal directions (i.e. parallel and perpendicular to the prevailing structural feature (dentin tubules or enamel prisms)). The deformation histories were used to estimate effective dehydration coefficients that can be used in quantifying the strains induced by dehydration.

RESULTS

Both dentin and enamel underwent contraction with water loss, regardless of the patient age. There was no significant difference between responses of the two age groups or the two orthogonal directions. Over 1h of free convection, the average water loss in dentin was 6% and resulted in approximately 0.5% shrinkage. In the same time period the average water loss in the enamel was approximately 1% and resulted in 0.03% shrinkage. The estimated effective dehydration coefficients were -810microm/m/(% weight loss) and -50microm/m/(% weight loss) for dentin and enamel, respectively.

SIGNIFICANCE

The degree of deformation shrinkage resulting from dehydration is over a factor of magnitude larger in dentin than enamel.

Demineralized dentin 3D porosity and pore size distribution using mercury porosimetry

OBJECTIVES

The objectives of this study were to assess demineralized dentin porosity and quantify the different porous features distribution within the material using mercury intrusion porosimetry (MIP) technique. We compared hexamethyldisilazane (HMDS) drying and lyophilization (LYO) (freeze-drying) in sample preparation.

METHODS

Fifty-six dentin discs were assigned into three groups. The control (CTR) group discs were superficially acid-etched (15s 37% H(3)PO(4)) to remove the smear layer and then freeze-dried whereas LYO and HMDS groups samples were first totally demineralized using EDTA 0.5M and then freeze-dried and HMDS-dried respectively. MIP was used to determine open porosity and pore size distribution of each pair of samples. Field emission scanning electron microscopy (FESEM) was used to illustrate the results.

RESULTS

The results showed two types of pores corresponding either to tubules and micro-branches or to inter-fibrillar spaces created by demineralization. Global porosity varied from 59% (HMDS-dried samples) to 70% (freeze-dried samples). Lyophilization drying technique seems to lead to less shrinkage than HMDS drying. FESEM revealed that collagen fibers of demineralized lyophilized samples are less melted together than in the HMDS-dried samples.

SIGNIFICANCE

Demineralized dentin porosity is a key parameter in dentin bonding that will influence the hybrid layer quality. Its characterization could be helpful to improve the monomers infiltration.

Morphology of the smear layer after the application of simplified self-etch adhesives on enamel and dentin surfaces created with different preparation methods

Mild self-etching adhesive systems modify and/or incorporate the smear layer into the resin-infiltrated demineralised dentin. Some factors such as type of bur and use of water spray might affect the thickness of the smear layer on substrates, enamel and dentin. Because of this, the present study evaluated the thickness of smear layers created by different finishing procedures, after the application of three simplified self-etching primers (Adper Prompt L-Pop and two experimental formulations) on enamel and dentin. After the application and removal of the primers' resinous component, the specimens were prepared for examination under a scanning electron microscope. Smear layers were thicker on enamel than on dentin, irrespective of the finishing methods used. Therefore, different thicknesses of smear layer on enamel/dentin might be an important factor to consider when evaluating the bonding efficacy of self-etching adhesives to both tooth substrates.

Systematic review of the chemical composition of contemporary dental adhesives

Dental adhesives are designed to bond composite resins to enamel and dentin. Their chemical formulation determines to a large extent their adhesive performance in clinic. Irrespective of the number of bottles, an adhesive system typically contains resin monomers, curing initiators, inhibitors or stabilizers, solvents and sometimes inorganic filler. Each one of these components has a specific function. The aim of this article is to systematically review the ingredients commonly used in current dental adhesives as well as the properties of these ingredients. This paper includes an extensive table with the chemical formulation of contemporary dental adhesives.

Morphological Evaluation of 2- and 1-step Self-etching System Interfaces with Dentin

This study investigated the interface of different self-etching systems with dentin and showed that the intensity of interaction was mostly dependent on the acidity of the primers/adhesives used.

Extension of a one-step self-etch adhesive into a multi-step adhesive

One-step self-etch adhesives are undoubtedly the most user-friendly adhesives, but have been associated with lower bonding effectiveness as compared to two-step and three-step adhesives. Conversion of a one-step self-etch system into a two-step self-etch adhesive by adding a bonding step, or into a three-step etch&rinse adhesive by adding a beforehand etching step and a bonding step might be tempting in order to improve bond strength.

OBJECTIVES

The objective of this study was to investigate whether adding application steps influences the bond strength of a one-step self-etch adhesive.

METHODS

In this study, the bonding effectiveness of two experimental one-step self-etch adhesives and three different commercial adhesives to enamel and dentin was determined using a micro-tensile bond-strength protocol. This procedure was repeated for the experimental adhesives transformed into two-step self-etch and three-step etch&rinse adhesives. In addition, their interaction with tooth tissue was investigated using TEM and Feg-SEM.

RESULTS

Transforming a one-step into a two-step self-etch adhesive did improve the bond strength to enamel and dentin, though not significantly. By adding a preceding etching step, the bond strength to enamel was significantly improved, but that to dentin was decreased considerably. The latter must be attributed to hampered resin infiltration of the one-step self-etch adhesive within the relatively deeply exposed collagen fibril network.

SIGNIFICANCE

Additional application of a hydrophobic bonding agent slightly improved bonding effectiveness. Adding a preceding etching step is beneficial for enamel but should be avoided for dentin as this will decrease bond strengths, and may even jeopardize the bonding durability.

Interfacial chemistry of class II composite restoration: structure analysis

The gingival margins of class II composite restorations are particularly vulnerable to marginal leakage and secondary caries. In identifying the factors contributing to caries development, the molecular structure and differences in the structure at the proximal and gingival margins have been largely overlooked. The purpose of this study was to compare the molecular structure at the adhesive/dentin interface of the proximal and gingival walls of class II composite restorations. Class II preparations were cut in 12 unerupted third molars with a water-cooled high-speed dental handpiece. The prepared teeth were randomly selected for treatment with Single Bond (SB) + Z100 (3M). Teeth were restored, per manufacturer's directions, under humidity and temperature characteristic of the oral cavity. Restored teeth were kept in sterile Delbecco's phosphate saline for 48 h. The samples were sectioned occluso-gingivally and micro-Raman spectra were acquired at approximately 1.5-microm spatial resolution across the composite/adhesive/dentin interfaces. Samples were wet throughout spectral acquisition. Raman spectral characteristics at the proximal and gingival margins were distinctly different; the depth of demineralized dentin was 6-7 microm at proximal margin, 12-13 microm at gingival margin. SB adhesive penetrated the depth of demineralized dentin in a gradient at the proximal margin. The "single bottle" adhesive used in this study, gradually penetrated the depth of the demineralized dentin at the proximal margin but failed to infiltrate the depth at the gingival margin, leaving a thick exposed collagen layer.

Effects of moisture degree and rubbing action on the immediate resin-dentin bond strength

OBJECTIVES

To compare the effects of moisture and rubbing action on the microtensile bond strength (BS) of an ethanol/water-based (Single Bond [SB]) and an acetone-based system (One-Step [OS]) to dentin.

METHODS

On 60 human molars, a flat superficial dentin surface was exposed by wet abrasion. Two coats of the adhesives were applied on either a dry (D) or rewetted surface (W), under no rubbing action (NRA), slight (SRA) or vigorous rubbing action (VRA). After light curing (600 mW/cm2/10 s), composite build-ups were constructed incrementally and specimens were stored in water (37 degrees C/24 h). They were longitudinally sectioned in the "x" and "y" directions to obtain bonded sticks (0.8 mm2) to be tested in tension at 0.5 mm/min. Resultant BS was expressed as an index that includes bond strength values of the different fracture patterns and the specimens that failed during preparation for testing. The data were analyzed by a three-way ANOVA and Tukey's multiple comparison tests (95%).

RESULTS

The interactions moisture/agitation and adhesive/agitation were statistically significant (p < 0.05). In D groups, the highest BS was obtained under VRA (37.11 +/- 7.3). In W groups, the BS at SRA (41.82 +/- 8.4) and VRA (38.89 +/- 8.2) were similar. For SB system, the SRA (33.6 +/- 8.3) and VRA groups (41.26 +/- 5.9) yielded similar BS while for OS the VRA was essential to reach high BS (34.2 +/- 8.4).

SIGNIFICANCE

High BS to dentin can be obtained, under dry conditions, when ethanol/water and acetone-based systems, are vigorously agitated in the surface. On wet dentin, slight agitation seems to be enough to provide high BS to dentin.

Effect of bur type and conditioning on the surface and interface of dentine

The purpose of this in vitro study was to evaluate the surface and resin-dentine interface characteristics of permanent tooth dentine cut with diamond or carbide burs and treated with phosphoric acid (PA) or an acidic conditioner. Labial surfaces of permanent incisors were prepared into dentine with high-speed carbide or diamond burs and divided into two halves. Phosphoric acid 36% was applied on one half and non-rinse conditioner (NRC) was applied on the other half. Ten randomly selected scanning electron microscopy (SEM) fields from each specimen (n = 15) were evaluated. Occlusal surfaces of third molars were divided in two halves for evaluation of the resin-dentine interface. The halves were randomly assigned to one of each conditioner and restored with Prime & Bond NT/Spectrum. Ten specimens were analysed by SEM to evaluate hybrid layer formation and interfacial seal. We observed that surfaces prepared with carbide bur presented less residual smear plugs (P < 0.05) than surfaces prepared with diamond burs. Surfaces conditioned with NRC, which is a smear layer modifier, presented more residual smear plugs than surfaces conditioned with PA (P < 0.05). Treatment with PA resulted in more sealed interfaces than specimens treated with NRC. Within the limitations of this study the results showed that carbide burs leave a surface that is more conducive to bonding than diamond burs.

Comparison of depth of dentin etching and resin infiltration with single-step adhesive systems

OBJECTIVES

Adhesion of resin composites to dentin is currently believed to result from impregnation of adhesive resin into superficially demineralized dentin. The purpose of this study was to use micro-Raman spectroscopy and scanning electron microscopy (SEM) to investigate the extent of resin penetration into etched dentin with single-step adhesive systems.

METHODS

Adhesive systems used were One-Up Bond F (Tokuyama Dental) and Reactmer Bond (Shofu, Inc.). A self-etching primer system Mac Bond II (Tokuyama Dental) was employed as a control. Resin composites were bonded to bovine dentin with the adhesive systems, and specimens were sectioned parallel to dentinal tubules. Raman spectra were successively recorded along a line perpendicular to the dentin-adhesive interface in steps of 0.2 microm and the spectra were obtained. SEM observations of the resin-dentin interface were also conducted.

RESULTS

The dentin-resin interface of single-step adhesive systems showed a gradual transition in the relative amount of adhesive from the resin side to dentin side. The widths of resin penetration into demineralized dentin detected by Raman microscopy were greater than those obtained by the morphological analysis using SEM.

CONCLUSIONS

From the results of this study, a gradual variation in the composition of the dentin-resin interface was detected, and the degree of resin impregnation observed with SEM observation was less than that detected with the Raman microscopy.

Characterising the micro-mechanical behaviour of the carious dentine of primary teeth using nano-indentation

A better appreciation of the properties of carious dentine would be of clinical advantage in carious assessment and management. The aim of this study is to understand the deterioration of the mechanical properties of carious dentine as a result of bacterial demineralising process as well as change in dentine structures observed under scanning electronic microscope. Eight primary molar teeth with untreated carious dentine were axially sectioned and fine polished for nano-indentation. On each specimen, six lines of indentation, evenly distributed through the lesion, were made from the pulp to lesion cavity floor parallel to tubule direction using nano-indentation (Ultra Micro Indentation System, UMIS-2000), while another two indentation lines were made on an adjacent region of sound dentine in the same manner. All tests were conducted on hydrated specimens. Hardness and elastic modulus decreased significantly and progressively toward the cavity floor varying from 0.56 to 0.001 GPa and 14.55 to 0.015 GPa, respectively. The change in mechanical properties was in a specific pattern as a function of lesion depth, in which the hardness could be fitted to an exponential function, while the variation of the elastic modulus across the entire lesion was fitted to a power law relationship. More critical evaluation of the elastic modulus data indicated that two distinct exponential functions provided an excellent fit to the results. These changes in elastic modulus also matched the structural changes seen across a lesion, which were associated with a change from primarily peritubular to intertubular dissolution.

Scanning Electron Microscope Analysis of Internal Adaptation of Materials Used for Pulp Protection under Composite Resin Restorations

PURPOSE

The aim of this study was to evaluate the interfacial microgap with different materials used for pulp protection. The null hypothesis tested was that the combination of calcium hydroxide, resin-modified glass ionomer, and dentin adhesive used as pulp protection in composite restorations would not result in a greater axial gap than that obtained with hybridization only.

MATERIALS AND METHODS

Standardized Class V preparations were performed in buccal and lingual surfaces of 60 caries-free, extracted human third molars. The prepared teeth were randomly assessed in six groups: (1) Single Bond (SB) (3M ESPE, St. Paul, MN, USA); (2) Life (LF) (Kerr Co., Romulus, MI, USA) + SB; (3) LF + Vitrebond (VT) (3M ESPE) + SB; (4) VT + SB; (5) SB + VT; (6) SB + VT + SB. They were restored with microhybrid composite resin Filtek Z250 (3M ESPE), according to the manufacturer's instructions. However, to groups 5 and 6, the dentin bonding adhesive was applied prior to the resin-modified glass ionomer. The specimens were then thermocycled, cross-sectioned through the center of the restoration, fixed, and processed for scanning electron microscopy. The specimens were mounted on stubs and sputter coated. The internal adaptation of the materials to the axial wall was analyzed under SEM with x1,000 magnification.

RESULTS

The data obtained were analyzed with nonparametric tests (Kruskal-Wallis, p < or = .05). The null hypothesis was rejected. Calcium hydroxide and resin-modified glass ionomer applied alone or in conjunction with each other (p < .001) resulted in statistically wider microgaps than occurred when the dentin was only hybridized prior to the restoration.

Effect of hydration variability on hybrid layer properties of a self-etching versus an acid-etching system

The hypothesis tested in this study was that the self-etching system (Clearfil SE Bond, CSE) is less sensitive to surface moisture variability than the system that uses a separate acid-etching step (Single Bond, SB). Eighteen dentin specimens were bonded to composite using CSE or SB. Three different surface moisture conditions per bonding type (overwet, w; dry, d; and visibly moist, n [normal]) were applied prior to bonding dentin to composite. One cross section of each sample was analyzed with lines of nanoindentations crossing perpendicular to the bonding interface. An additional set of bonded samples was fixed and cross sectioned before the hybrid layer thickness was measured in scanning electron microscopy. The nanoindentations revealed significant differences in indentation modulus (E(i)) and hardness (H) for the hybrid layer comparing SBn, E(i) = 2.7(+/-1.6); H = 0.24(+/-0.1) GPa with SBd, E(i) = 0.9(+/-0.7); H = 0.9(+/-0.05) GPa, respectively, while CSE showed no differences among the groups. A significantly greater demineralized zone below the hybrid layer was found for SBd. The hybrid layer was wider for both CSEd and SBd. In conclusion the hypothesis was verified; CSE exhibited no significant changes of hybrid layer properties (E(i), H) at different hydration conditions, while SB had significant differences, especially after air-drying.

Lactic acid root canal irrigation for dowel and core treatment: A pilot study

STATEMENT OF PROBLEM

Various solutions used to irrigate root canals and remove the smear layer prior to obturation of a root canal affect surface topography and may influence the sealing ability of endodontic therapy, retention of endodontic dowels, and restoration survival.

PURPOSE

This study microscopically evaluated the effects of varying dilutions of lactic acid on the removal of the smear layer created by hand instrumentation in the coronal, middle, and apical thirds of root canals. Lactic acid solution was compared with other solutions deemed to be suitable root canal irrigants.

MATERIAL AND METHODS

Thirty-five extracted human single-rooted teeth were manually shaped with files (K-flex) using the step-back technique. ISO size 50 files were used as master apical files. The teeth were equally divided into 7 test groups according to the canal irrigant used. While the teeth were cleaned and shaped, the root canals were irrigated with 3 mL of 1 of the following irrigants between each file size and as a final flush: no irrigant (control), 5% hydrogen peroxide, 5% sodium hypochlorite, a combination of 5% hydrogen peroxide and 5% sodium hypochlorite, 15% ethylenediaminotetraacetic acid (EDTA), 10% lactic acid, or 20% lactic acid. Specimens were critical-point dried and freeze-fractured for scanning electron microscope analysis at 3 sites (cervical, middle, and apical).

RESULTS

Scanning electron micrographs showed no differences between the cervical, middle, and apical levels of the specimens tested with any of the irrigants used. Also, no difference was found within individual groups. The surface of the control specimens had a smear layer that contained smear plug material. Hydrogen peroxide and sodium hypochlorite used separately and in combination consistently produced surfaces with a smear layer. Lactic acid solutions and EDTA, however, removed the dentinal smear layer but left remnants of smear plugs in the dentinal tubules.

CONCLUSIONS

Within the limitations of this study, differences related to the type of irrigant used were found in the characteristics of the pulpal dentin surface. Although lactic acid effectively cleaned and smoothed the dentin walls of root canals of endodontically prepared teeth, further study is needed before this procedure can be recommended for routine clinical use.

Effect of sodium hypochlorite on the bond strength of an adhesive system to superficial and deep dentin

The objective of this study was to evaluate the bond strength to superficial (SU) and deep (D) dentin, accessed via apical (DA) or occlusal (DO), using One-Step adhesive system applied according to the manufacturer's instructions (C) or following deproteinization with 10% sodium hypochlorite (H) for 60s, after acid etching. Three sound extracted human molars were prepared for each experimental condition. Restorations were performed using Z100 in 2mm increments, each one being light-cured for 40s. Teeth were longitudinally sectioned to obtain stick-shaped specimens with a cross-sectional area of 0.8mm², which were submitted to bond strength test (0.6mm/min). Results obtained after statistical analysis using a two-way ANOVA (substrate vs. surface treatment) and Tukey's test were: SU (35.4 ± 12.3), DO (26.5 ± 8.5), DA (26.1 ± 10.2) following conventional surface treatment, and SU (28.82 ± 12.7), DO (24.3 ± 8.3) and DA (23.5 ± 8.5), after surface treatment using sodium hypochlorite. The interaction of the factors was not significant (p>0.05). However, the main factors were significant (p<0.05). Mean bond strength values in superficial dentin were statistically superior to deep dentin (p<0.05), although no statistically significant difference was observed between the two via of access to deep dentin (SU>DO=DA). The conventional surface treatment resulted in higher bond strength values than the sodium hypochlorite treatment (p<0.05). It was concluded: 1) bond strength values were higher in superficial dentin, 2) no difference was found between the two deep substrate preparations, and 3) the application of sodium hypochlorite following dentin acid etching may reduce bond strengths.

Micro-mechanical characterisation of the properties of primary tooth dentine

OBJECTIVES

Understanding the mechanical properties of dentine is of importance as adhesive restorative materials mainly achieve their bonding to the tooth structure through dentine. The current study measures the hardness and modulus of elasticity of primary molar dentine using an Ultra-Micro-Indentation System (UMIS), which allows the dentine to remain hydrated and thus is assumed to be closer to the in vivo conditions.

METHODS

Eight sound primary molar teeth were axially sectioned, embedded in resin and fine polished. Two linear arrays of indentations were done on coronal dentine, from the pulp wall to dentino-enamel junction (DEJ) parallel to the tubule direction under a force load of 25mN.

RESULTS

The mean hardness and elastic modulus of the dentine nearest the pulp wall was 0.52+/-0.24 and 11.59+/-3.95GPa, respectively, which was significantly lower than those of dentine in the middle area, which was 0.85+/-0.19 and 17.06+/-3.09GPa, respectively, and the dentine nearest DEJ, which was 0.91+/-0.15 and 16.33+/-3.83GPa, respectively. There is a statistically significant linear correlation between the hardness and modulus of elasticity.

CONCLUSIONS

The hardness and modulus of elasticity of dentine decreases with decreasing distance from the pulp. This is of importance to clinicians because an extension of cavity preparation towards the pulp may lead to less mechanical support for a restoration.

Evaluation of demineralized dentin contraction by stereo measurements using environmental and conventional scanning electron microscopy

Numerous investigations of etched human dentin are performed using scanning electron microscopy (SEM). Usually specimens are fractured and cross sections of etched layers with underlying unaffected dentin are observed. Results from this study showed that the edge of the etched layer contracted and became curved after fracture of wet specimens and that tensile stresses were developed in this layer by acid etching. The degree of contraction was determined utilizing profiles of the specimen edges obtained with the help of stereo measurements. Fixation in glutaraldehyde decreased the contraction in wet specimens prepared for environmental scanning electron microscopy (ESEM). Fixation also decreased shrinkage of the demineralized layer due to gradual desiccation in the ESEM during observation. For conventional SEM, the contraction was minimized if specimens of etched and fixed dentin were fractured in the dry condition after dehydration.

Effects of rotary instrumentation and different etchants on removal of smear layer on human dentin

STATEMENT OF PROBLEM

Various methods of rotary preparation and conditioning of teeth affect surface topography and may affect the retention of dental restorations.

PURPOSE

This study microscopically evaluated dentin surfaces prepared by different rotary instruments and etched using several types of acid etchants that have been deemed suitable dentin conditioners.

MATERIAL AND METHODS

Occlusal surfaces of 35 extracted human molars were ground wet with 320-grit silicon carbide paper to the depth of the central groove and then prepared with diamond (n = 5) and finishing burs (n = 30). Five specimens from each group were used for SEM evaluation of mechanical preparation effects. Dentin specimens (n = 5) prepared with finishing burs were then etched with 1 of 5 etchants (25% polyacrylic acid, 10% phosphoric acid, 10% citric acid, 20% lactic acid, or 32% phosphoric acid) for 10 seconds. Specimens were critical-point dried and freeze fractured for SEM analysis.

RESULTS

Diamond rotary instruments created more undulating surfaces than finishing burs. Fine grooves were observed running perpendicular to undulations and parallel to the direction of instrument rotation. Specimens prepared with finishing burs exhibited a smooth surface interrupted by only a slight granularity. The amorphous smear layer was partially removed after the application of 25% polyacrylic acid (pH 1.53), but all dentinal tubules contained plugs. The number of dentin tubules containing plug material and the amount of material in the tubules decreased noticeably with 10% phosphoric acid (pH 0.86), and the dentin surface had an appearance similar to the specimen etched with 10% citric acid (pH 1.70). The surfaces treated with 20% lactic acid (pH 1.40) produced a clearly etched surface with minimal demineralization. Etching of dentin with 32% phosphoric acid (pH 0.16) revealed significant changes in dentin with the evidence of increased tubule diameter.

CONCLUSION

Differences related to the method of instrumentation were found in the surface characteristics of dentin. The degree of smear layer removal was related to the pH of the acid etchant.

Dentine permeability and dentine adhesion

OBJECTIVES

The objectives of this paper are to review the structure of dentine as it pertains to adhesive bonding and to describe the importance of resin permeation into dentinal tubules and into spaces created between collagen fibrils by acid-etching during resin bonding. The advantages and disadvantages of separate acid-etching, priming and adhesive applications are discussed.

DATA SOURCES

Although not an exhaustive review, the concepts included in the review were obtained from the dentine bonding literature.

STUDY SELECTION

Attempts were made to critically evaluate what is known about dentine permeability and adhesion and what remains to be discovered. Speculations were made on a number of controversial issues that are not yet resolved.

CONCLUSIONS

Acid-etching of dentine produces profound changes in the chemical composition and physical properties of the matrix which can influence the quality of resin-dentine bonds, their strength and perhaps their durability.

The effects of acetone, ethanol, HEMA, and air on the stiffness of human decalcified dentin matrix

During resin-bonding procedures, dentin surfaces are treated with acidic conditioners to remove the smear layer and decalcify the surface to expose the collagen fibrils of the underlying matrix. These decalcified surfaces are then either air-dried or treated with dehydrating solvents, procedures which may modify the physical properties of the dentin matrix. The purpose of this study was to evaluate the effects of dehydration on the stiffness of the decalcified dentin matrix. Small (8 x 1.7 x 0.9 mm) beams of dentin were prepared from mid-coronal dentin of extracted human molars. The ends were covered with varnish for protection, and the specimens were placed in 0.5 M EDTA for 5 days to decalcify. The stiffness was measured by both the cantilever technique and by conventional stress-strain testing. Specimens tested by the cantilever technique were sequentially exposed to water, acetone, alcohol, HEMA, and glutaraldehyde. Specimens tested by conventional stress-strain testing were exposed either to water, acetone, or HEMA, or were allowed to air-dry. The results indicate that the stiffness of decalcified human dentin matrix is very low (ca. 7 MPa), if the specimens are wet with water. As they are dehydrated, either chemically in water-miscible organic solvents or physically in air, the stiffness increases 20- to 38-fold at low strains or three- to six-fold at high strains. These increases in modulus were rapidly reversed by rehydration in water. Exposure to glutaraldehyde also produced an increase in stiffness that was not reversible when the specimens were placed back in water.