Non-thermal atmospheric plasmas in dental restoration: improved resin adhesive penetration

Effect of nonthermal atmospheric plasma application at different time intervals on the dentinal shear bond strength pretreated with 2% chlorhexidine as cavity disinfectant: An in vitro study

Context

Effective use of nonthermal atmospheric plasma (NTAP) to strengthen adhesive-dentin interfacial bonding while disinfecting with chlorhexidine (CHX).

Aim

NTAP application at different time intervals on the dentinal shear bond strength (SBS) after pretreatment with 2% CHX as a cavity disinfectant.

Settings and Design

The design of the study was an in vitro study.

Materials and Methods

Forty permanent mandibular teeth were collected (n = 40) and the occlusal surfaces were flattened. For, all the specimens 37% phosphoric acid etching was done followed by pretreatment with 2% CHX as cavity disinfectant for 5 s. According to the surface treatment, divided into four groups of n = 10. Group I (Control): No NTAP pretreatment was done. Group II: NTAP pretreatment done for 15 s. Group III: NTAP pretreatment done for 30 s. Group IV: NTAP pretreatment done for 45 s. Later, all the specimens were treated with a bonding agent, incremental build-up of composite resin on the dentin surface was done and evaluation of SBS was done. Analyzed using One-way analysis of variance with a post hoc Tukey's test (P < 0.05).

Results

Two percent CHX pretreatment as cavity disinfectant followed by NTAP application for 30 s (Group III) exhibited greater values compared to the control group (Group I).

Conclusion

Two percent CHX pretreatment as cavity disinfectant followed by NTAP pretreatment for 30 s was found to exhibit better bond strength values compared to 15 s as well as 45 s.

Effect of non-thermal plasma treatment and resin cements on the bond strength of zirconia ceramics with different yttria concentrations

OBJECTIVES

To investigate the effect of different surface treatments and resin cements on the shear bond strength of zirconia ceramics with different yttria concentrations.

METHODS

Zirconia blocks characterized by different yttria concentrations [Vita YZ HT (HT), Vita YZ ST (ST) and Vita YZ XT (XT)] were used to prepare disc-shaped specimens (n=252). Specimens prepared to investigate shear bond strength (SBS), water contact angle and surface roughness (Ra) were divided into four subgroups; control (C), sandblasting (S), sandblasting + nonthermal plasma treatment (SNTP) and nonthermal plasma treatment (NTP). For SBS testing, specimens were further divided into two groups (n=108) according to the luting cement used [Panavia F2.0 (P) and Rely X U200 (R)]. The water contact angles were determined by sessile drop technique and Ra was analyzed with optical profilometer. SBS tests were performed in a universal testing machine at a crosshead speed of 0.5 mm/min. The data sets were statistically analyzed with two and three-way ANOVAs followed by post-hoc comparisons (α=0.05).

RESULTS

The water contact angle and Ra data were significantly affected by surface treatments. The mean Ra values of ST and XT were significantly lower than HT for the surface treatment groups of C and NTP. The SBS values were significantly different among the groups subjected to different surface treatments. The mean SBS values of surface treatment groups (S, SNTP and NTP) when cemented with R were significantly higher than the groups of C (p<0.05).

CONCLUSIONS

For the tested zirconia ceramics with different yttria concentrations, non-thermal plasma activation helps to improve SBS and is a promising tool in practical use.

Structural characterization and preventive effect on alcoholic gastric mucosa and liver injury of a novel polysaccharide from Dendrobium officinale

In this study, a polysaccharide (DOP) with molecular weight of 8.25 × 105 Da and monosaccharide composition of mannose (Man) and glucose (Glc) at a molar ratio of 4.2: 1 was isolated from Dendrobium officinale. The preventive effect on alcoholic gastric mucosa and liver injury of DOP was also investigated. In vitro data exhibited that the IC50 values of 1, 1-diphenyl-2-picrylhydrazy (DPPH) radical scavenging ability and Fe2+ chelating capacity were 2.762 mg/mL and 6.667 mg/mL, respectively. Both the alcoholic gastric mucosal injury (AGMI) and alcoholic liver injury (ALI) animal models were used to investigate the gastrotrophic and hepatoprotective abilities of DOP. After administration of DOP, both gastric mucosal index (TNF-α, IL-6, PGE2, SOD, and MDA) and hepatic indicators (ALT, AST, SOD and MDA) improved compared to non-DOP groups. Histopathological results displayed that the DOP groups improved gastric epithelial defect and inflammatory cell redness caused by AGMI, and decreased vacuolization, hepatocyte necrosis and fibrosis caused by ALI. The results might be related to adjusting inflammatory factors, eliminating free radicals, and inhibiting lipid peroxidation capacities. These results manifested that DOP may be a therapeutic reagent to attenuate alcohol gastric mucosal and liver injury.

Dental silicate ceramics surface modification by nonthermal plasma: A systematic review

OBJECTIVES

Nonthermal atmospheric or low-pressure plasma (NTP) can improve the surface characteristics of dental materials without affecting their bulk properties. This study aimed to systematically review the available scientific evidence on the effectiveness of using NTP for the surface treatment of etchable, silica-based dental ceramics before cementation, and elucidate its potential to replace the hazardous and technically demanding protocol of hydrofluoric acid (HF) etching.

METHODS

A valid search query was developed with the help of PubMed's Medical Subject Headings (MeSH) vocabulary thesaurus and translated to three electronic databases: PubMed, Web of Science, and Scopus. The methodological quality of the studies was assessed according to an adapted version of the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Thirteen in vitro study reports published between 2008 and 2023 were selected for the qualitative and quantitative data synthesis. The implemented methodologies were diverse, comprising 19 different plasma treatment protocols with various device settings. Argon, helium, oxygen, or atmospheric air plasma may significantly increase the wettability and roughness of silicate ceramics by plasma cleaning, etching, and activation, but the treatment generally results in inferior bond strength values after cementation compared to those achieved with HF etching. The technically demanding protocol of plasma-enhanced chemical vapor deposition was employed more commonly, in which the surface deposition of hexamethyl disiloxane with subsequent oxygen plasma activation proved the most promising, yielding bond strengths comparable to those of the positive control. Lack of power analysis, missing adequate control, absence of examiner blinding, and non-performance of specimen aging were common methodological frailties that contributed most to the increase in bias risk (mean MINORS score 15.3 ± 1.1).

SIGNIFICANCE

NTP can potentially improve the adhesive surface characteristics of dental silicate ceramics in laboratory conditions, but the conventional protocol of HF etching still performs better in terms of the resin-ceramic bond strength and longevity. More preclinical research is needed to determine the optimal NTP treatment settings and assess the aging of plasma-treated ceramic surfaces in atmospheric conditions.

Effect of pretreatment of root dentin surface with cold atmospheric plasma on improving the bond strength of fiber post and resin cement: In vitro study

INTRODUCTION

Achieving stable adhesion between fiber post and interradicular dentin is a challenging process in the restoration of endodontically treated teeth. This study was conducted to investigate the effect of surface pretreatment with cold atmospheric plasma (CAP) on improving the bond strength between them.

MATERIALS AND METHODS

Forty-eight single-canal mandibular premolars were cut 1 mm above the cementoenamel junction to keep the root length of 14 mm or more. After endodontic treatment and preparation of the post space, the teeth were divided into four groups regarding the pretreatment of dentin surfaces, including normal saline, ethylenediaminetetraacetic acid (EDTA), CAP, and CAP + EDTA groups. The data were analyzed using paired and independent t-test and one-way analysis of variance and the significance level was set at p < .05.

RESULTS

The bond strength was significantly higher in the coronal third than in the apical third in all the groups. Moreover, the bond strength was significantly higher in the CAP + EDTA-treated group. The bond strength increased significantly in the CAP group compared to the normal saline group. In addition, the bond strength increased significantly in the CAP or EDTA groups compared to the control group. The lowest bond strength belonged to the control group (normal saline).

CONCLUSION

The surface pretreatment with CAP (alone or in combination with EDTA) played a significant role in improving the bond strength of fiber post and root canal dentin.

Effect of nonthermal atmospheric plasma on bond strength of composite resin using total-etch and self-etch adhesive systems

Aim

The aim of this study was to assess the impact of nonthermal atmospheric plasma (NTAP) on the bond strength of composite resin following plasma application at different steps of dentin bonding in total-etch and self-etch adhesive systems.

Materials and Methods

Ninety extracted third molars were taken, and the occlusal surfaces were removed until the exposure of the dentin. Samples were distributed into two main groups: Group T: total-etch adhesive system and Group S: self-etch adhesive system. Groups are further subdivided (n = 10) based on plasma application at different steps of dentin bonding. T1: surface etching with 37% phosphoric acid and bonding agent application. T2: plasma application and bonding agent application. T3: plasma application, etching, and bonding agent application. T4: etching, plasma application, and bonding agent application. T5: etching, plasma application, bonding agent application, and again plasma application. S1: self-etch bonding agent application. S2: plasma application and bonding agent application. S3: Bonding agent application and plasma application. S4: plasma application, bonding agent application, and again plasma application. For all the samples, composite resin buildup was done, and shear bond strength (SBS) was measured. The contact angle was measured at different steps of dental adhesive systems.

Statistical Analysis

Two-way analysis of variance and the post hoc Tukey's test were used for analysis, regarding P < 0.05 as statistically significant.

Results

Among all groups of total-etch and self-etch adhesives, Group T4 (48.81 Mpa) and Group S2 (36.59 Mpa), respectively, have demonstrated significantly greater bond strength values than the corresponding control groups.

Conclusion

NTAP enhanced the composite resin's SBS when plasma treatment was done before bonding agent application and significantly reduced the contact angles of the distilled water.

Evaluation of the bonding effectiveness of a universal adhesive to the plasma-activated dentin surface

This study aimed to evaluate the effect of non-thermal atmospheric pressure plasma on the bond strength of a universal adhesive used in etch-and-rinse mode. Dentin surfaces were etched with phosphoric acid and samples were divided into groups exposed to either dry bonding, plasma-dried bonding, plasma-dried and rewetted bonding, or wet bonding (n  =  10). Dentin surfaces of the plasma-dried specimens were treated with a plasma jet before the adhesive procedure. After application, composite blocks were built, and specimens were subjected to micro-tensile bond strength testing after 24 h and after 10,000 thermal cycles. The hybrid layer formation was evaluated by micro-Raman spectral analysis; the resin-dentin interface was analyzed by scanning electron microscopy. One-way ANOVA and Tukey's post hoc multiple comparison tests were used to statistically analyze the data. The bond strength values of the plasma-dried bonding groups were statistically higher than the non-plasma-treated groups both before and after aging. After the thermal cycles, bond strength values decreased significantly only in the wet bonding group. Micro-Raman spectral analysis revealed that plasma-drying increased adhesive penetration, especially hydrophobic monomer infiltration. This may increase the mechanical properties and durability of the resin-dentin interface, provide long-term stability, and improve the polymerization rate of the adhesive layer.

Evaluation of the Effect of Cold Plasma Treatment on the Microshear Bond Strength of Composite Resin Restorations to Dentin using Different Adhesive Systems and the Effect of Thermocycling

Introduction:

Currently, non-thermal plasma is used to modify the enamel and dentin surfaces to improve the bonding surface to dental composite resins. Non-thermal plasma creates a hydrophilic surface, decreases the contact angle, and improves the bonding quality. The present study aimed to evaluate the microshear bond strength (µSBS) of composite resins to dentin using different adhesive systems.

Materials and Methods:

Bovine incisor teeth were randomly assigned to three groups of G-Premio, Clearfil SE Bond, and Adper Single Bond adhesive groups after preparation. Each group was divided into two subgroups in terms of argon plasma surface preparation, and each subgroup was divided into two groups in terms of thermocycling (n=12). The microshear bond strength of the samples was determined using a universal testing machine. Three-way ANOVA was used to analyze the effect of the adhesive, plasma preparation, and thermocycling. Post hoc Tukey tests were used for two-by-two comparisons of µSBS. Statistical significance was set at P <0.05.

Results:

The results of the µSBS test showed that the application of plasma resulted in a significant increase in the mean µSBS in the G-Premio group, with no significant increase in the Clearfil SE bond and Adper Single groups. The effect of thermocycling after plasma application was significant only in the Adper Single group.

Conclusion:

The application of plasma might increase the bond strength of composite resins to dentin. However, further studies are necessary.

Effects of a helium cold atmospheric plasma on bonding to artificial caries-affected dentin

This study investigated the effects of a helium cold atmospheric plasma (CAP) on the bonding performance and surface modification of the caries-affected dentin (CAD). Artificial CAD was created by pH-cycling. The microtensile bond of CAD were examined before and after CAP treatments at 24 h and after 2-year aging. The effects of surface modification were studied with contact-angle measurement, scanning electron microscopy and X-ray photoemission spectroscopy. Thirty-second CAP treatment increased the immediate bond strength of CAD to a level that was statistically the same as sound dentin, and slowed the aging process of the bonding as well. The CAP treatment induced modified CAD surface with increased wettability, cleaner appearance, and increased percentage of the mineral-associated elements and oxygen. This research demonstrated that the helium CAP jet treatments of 30 s and 45 s improved the bond strength of the artificial CAD, and was considerably effective in its surface modification.

The effect of atmospheric cold plasma on the dentinal tubule penetration of calcium silicate-based sealer used with different obturation techniques: A confocal laser scanning microscopy study

The aim of this study was to evaluate the effect of atmospheric cold plasma (ACP) on dentinal tubule penetration of EndoSequence BC. Sixty premolars were divided into four groups according to the obturation technique and plasma treatment. Root canals were filled with single cone in Group 1 (SC), single cone after ACP application in Group 2 (SC-P), warm vertical compaction in Group 3 (WVC), warm vertical compaction after ACP application in Group 4 (WVC-P). Horizontal sections were imaged using confocal laser scanning microscopy. The maximum penetration and percentage of penetration values were measured. These data were statistically analysed (P < 0.01). In the coronal region, the percentage of penetration values were higher in SC-P and WVC-P than in SC and WVC. In the middle region, SC-P and SC showed a higher penetration percentage than WVC and WVC-P. In the apical region, WVC showed a higher percentage of penetration value than SC-P, WVC-P and SC did. Maximum penetration of WVC was higher than of SC and SC-P. Within the limitations of this study, ACP improved the percentage of penetration values of EndoSequence BC when used with single-cone technique.

In vitro study on how cold plasma affects dentin surface characteristics

PURPOSE

Studies evaluating different features of cold plasma action on dentin surface characteristics are lacking. Thus, this in vitro study aimed to determine the effect of cold plasma under different protocols of exposure time, distance to plasma source, and the association of argon gas with distinct concentrations of oxygen on the wettability, surface energy, total free interaction energy, surface roughness, morphology and chemical composition of dentin.

MATERIAL AND METHODS

One hundred and twenty-five bovine dentin samples were used and divided into twenty-five groups according to the exposure time to plasma (15, 30, or 60 s); distance between plasma source and dentin surface (3 or 6 mm); argon gas without plasma generation; and plasma generated by argon gas and association of argon gas with distinct concentrations of oxygen (2 % or 3 %) (n = 5). Contact angle (θ), surface energy (γs) and total free interaction energy (ΔG) were measured using a goniometer (Krüss), while surface roughness (Ra) was evaluated by a profilometer (Mitutoyo). Representative samples were submitted to scanning electron microscopy (JEOL) to ilustrate the morphology and chemical composition of dentin. Data comparing control group with all experimental groups were submitted to ANOVA followed by Tukey's test (α = .05). Data comparing oxygen gas action at different concentrations and argon gas on dentin characteristics were submitted to non-parametric Kruskal-Wallis test, followed by Dunn test for comparison between the groups and methods (α = 0.05).

RESULTS

In general, argon gas without plasma generation promoted no significant difference on dentin surface characteristics compared to control group (P > .05), differently for the cold plasma that significantly reduced contact angle values and increased total free interaction energy of dentin surface (P < .05). Overall, feeding of oxygen at distinct concentrations promoted significant difference on dentin surface characteristics compared to control group (P < .05). Exposure time and distance protocols interfered with contact angle, surface energy and total free interaction energy analyses for each gas. There was no significant difference on surface roughness (P > .05), morphology and chemical composition of dentin submitted to argon gas, cold plasma, and distinct concentrations of oxygen.

CONCLUSION

In conclusion, plasma generated by argon gas and its feeding with 2 % and 3 % oxygen gas improved the dentin surface characteristics about wettability, surface energy and total free interaction energy. Such treatments preserved the surface roughness, morphology and chemical composition of dentin. The protocols of groups Ar-6mm-15sec, ArO2-3mm-30sec and ArO3-3mm-15sec are recommended for improvement of dentin surface characteristics.

Effects of non-thermal atmospheric plasma on dentin wetting and adhesive bonding efficiency: Systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluated the effects of non-thermal atmospheric plasma (NTAP) treatment on dentin wetting and adhesive-dentin bond strength.

DATA/SOURCES

This report followed the PRISMA 2020 statement. Two reviewers conducted literature search of MEDLINE, Web of Science and Scopus databases up to the end of November 2020. Included in vitro studies compared the effect of NTAP on treated dentin of non-carious, intact, extracted human third molar teeth with different control groups. Studies with no adequate methods, missing data, lack of control group, or those using animal teeth were excluded. The random effects model was used to summarize the treatment effect with standardized mean difference (SMD) and 95% CI. Risk of bias was assessed using the custom Cochrane Collaboration's tool.

STUDY SELECTION/RESULTS

Seventeen studies met inclusion criteria. The effects on dentin wetting were reported in favor of NTAP (SMD -5.38; 95% CI [-6.97, -3.78]; p<0.00001; I2=81%). Regarding adhesive-dentin bond strength, statistically significant differences between the NTAP and control group were in favor of NTAP in the short-term (SMD 1.92; 95%CI [1.35, 2.50]; p<0.00001; I2=97%), and long-term (SMD 3.28; 95%CI [2.46, 4.09]; p<0.00001; I2=97%). A limitation of meta-analysis is moderate heterogeneity caused by methodological differences and lack of data, which was evaluated through risk of bias and sensitivity analysis.

CONCLUSIONS

NTAP substantially improves dentin wetting and adhesive-dentin bond strength with 30 seconds exposure time and up to 10 mm tip-to-surface distances being sufficient for positive NTAP effects on bonding efficiency.

FUNDING

ON172207 and III41008 from the Ministry of Education, Science and Technological Development, Republic of Serbia. NP is funded by MESTD grant number 451-03-68/2020-14/200024.

CLINICAL SIGNIFICANCE

This systematic review and meta-analysis substantiate potential applicability of NTAP treatment of dentin in improving adhesive bonding clinically. Further research should be based on the optimized parameters such as time and distance with additional refinement of NTAP power.

Evaluation of the bond strengths of restorative materials to primary tooth dentin treated with different pulpotomy techniques

The aim of this study was to investigate the changes of different pulpotomy techniques on the primary tooth dentin and to evaluate the effects of these pulpotomy methods on the shear bond strength of restorative materials to primary tooth dentin. Two hundred and forty dentin specimens were distributed randomly to the study groups as; control, ferric sulphate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma (APCP). After the application of pulpotomy methods, samples were again randomly divided to two restorative materials (glass hybrid and composite resin) (n = 20) and shear bond strength (SBS) test was performed. Then, 12 new dentin specimens were prepared for all groups for surface analysis. Surface examination (n = 12) and fracture analyses (n = 240) were carried out with scanning electron microscope (SEM). Statistical significance range was accepted as α <.05 for all data. A statistically significant difference was obtained among all study groups for glass hybrid material as well as composite material (p <.05). While the highest mean SBS value was obtained with Nd:YAG laser (7.58 ± 0.60 MPa), the lowest value was observed with Biodentine® (6.70 ± 0.91 MPa; p = .001) for glass hybrid material. For composite material, the highest mean SBS value was calculated for Nd:YAG laser (13.79 ± 1.24 MPa), while the lowest value was obtained with ferric sulphate (10.17 ± 1.45 MPa; p = .001). Fracture modes were mainly adhesive and mixed type according to SEM analysis. Moreover, morphological changes were observed with SEM on the dentin surfaces of ferric sulphate, Biodentine® and Nd:YAG laser. Within the limitations of this study, Nd:YAG laser increased the shear bond strength values in groups of composite resin. RESEARCH HIGHLIGHTS: In this article, we report the results of the shear bonding strength test of two restorative materials (glass-hybrid vs. composite resin) to primary tooth dentin following the application of five different pulpotomy techniques (ferric sulfate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma) were reported. This article will contribute to the literature that there are considerably limited researches concerning the bond strength of glass hybrid to primary dentin and also atmospheric pressure cold plasma in pulpotomies. The SEM examination was performed in two stages in this study; the morphological changes in both treated dentin surfaces and the surfaces of the samples subjected to the shear bond strength test.

Effect of Root Dentin Pretreatment on Micro-Push-Out Bond Strength of Fiber Posts to Root Canal Dentin: Cold Atmospheric Argon Plasma (CAAP) and Ethylenediaminetetraacetic Acid (EDTA)

Purpose

Debonding from the root canal dentin is the most common failure mode of fiber posts. This study aimed to assess the effects of cold atmospheric argon plasma (CAAP) and ethylenediaminetetraacetic acid (EDTA) on micro-push-out bond strength of fiber posts to root canal dentin.

Materials and Methods

Forty maxillary canine teeth were decoronated, underwent endodontic treatment, and were stored in an incubator for 7 days. After post space preparation, the teeth were randomly divided into four groups for different surface treatments: (I) saline, (II) 17% EDTA, (III) CAAP, and (IV) 17% EDTA + CAAP. Fiber posts (Whitepost no. 2, FGM) were cemented into the root canals using Panavia F2.0 resin cement, and 1 mm-thick sections were made at the coronal, middle, and apical thirds of the roots. The samples underwent micro-push-out bond strength test. The mode of failure was also determined under a stereomicroscope. Data were analyzed using three-way ANOVA and Tukey's post hoc test (α = 0.05). The mode of failure data were analyzed using the chi-square test.

Results

The mean micro-push-out bond strength of fiber posts was not significantly different in the four groups (P > 0.05). However, the bond strength values in the coronal third were significantly higher than the corresponding values in the apical third (P=0.01). There was no significant difference in the modes of failure between the groups (P > 0.05).

Conclusion

Application of CAAP alone or in combination with 17% EDTA could not successfully increase the bond strength of fiber posts to root canal dentin.

Plasma bioscience and its application to medicine

Nonthermal atmospheric pressure biocompatible plasma (NBP), alternatively called bio-cold plasma, is a partially ionized gas that consists of charged particles, neutral atoms and molecules, photons, an electric field, and heat. Recently, nonthermal plasma-based technology has been applied to bioscience, medicine, agriculture, food processing, and safety. Various plasma device configurations and electrode layouts has fast-tracked plasma applications in the treatment of biological and material surfaces. The NBP action mechanism may be related to the synergy of plasma constituents, such as ultraviolet radiation or a reactive species. Recently, plasma has been used in the inactivation of viruses and resistant microbes, such as fungal cells, bacteria, spores, and biofilms made by microbes. It has also been used to heal wounds, coagulate blood, degrade pollutants, functionalize material surfaces, kill cancers, and for dental applications. This review provides an outline of NBP devices and their applications in bioscience and medicine. We also discuss the role of plasma-activated liquids in biological applications, such as cancer treatments and agriculture. The individual adaptation of plasma to meet specific medical requirements necessitates real-time monitoring of both the plasma performance and the target that is treated and will provide a new paradigm of plasma-based therapeutic clinical systems.

Bond Strength of Universal Adhesives to Dentin: A Systematic Review and Meta-Analysis

Currently, the availability of a wide variety of universal adhesives makes it difficult for clinicians to choose the correct system for specific bonding situations to dentin substrate. This study aimed to determine whether there are any alternative techniques or additional strategies available to enhance the bond strength of universal adhesives to dentin through a systematic review and meta-analysis. Two reviewers executed a literature search up to September 2020 in four electronic databases: PubMed, ISI Web of Science, Scopus, and EMBASE. Only in vitro studies that reported the dentin bond strength of universal adhesives using additional strategies were included. An analysis was carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic. A total of 5671 potentially relevant studies were identified. After title and abstract examination, 74 studies remained in systematic review. From these, a total of 61 studies were included in the meta-analysis. The bond strength of universal adhesives to dentin was improved by the use of one of the following techniques: Previous application of matrix metalloproteinases (MMP) inhibitors (p < 0.001), prolonged application time (p = 0.007), scrubbing technique (p < 0.001), selective dentin etching (p < 0.001), non-atmospheric plasma (p = 0.01), ethanol-wet bonding (p < 0.01), prolonged blowing time (p = 0.02), multiple layer application (p = 0.005), prolonged curing time (p = 0.006), and hydrophobic layer coating (p < 0.001). On the other hand, the use of a shortened application time (p = 0.006), and dentin desensitizers (p = 0.01) impaired the bond strength of universal adhesives to dentin. Most of the analyses performed showed a high heterogenicity. The in vitro evidence suggests that the application of universal adhesives using some alternative techniques or additional strategies may be beneficial for improving their bonding performance to dentin. This research received no external funding. Considering that this systematic review was carried out only with in vitro studies, registration was not performed.

Applications of Cold Atmospheric Pressure Plasma in Dentistry

Plasma is an electrically conducting medium that responds to electric and magnetic fields. It consists of large quantities of highly reactive species, such as ions, energetic electrons, exited atoms and molecules, ultraviolet photons, and metastable and active radicals. Non-thermal or cold plasmas are partially ionized gases whose electron temperatures usually exceed several tens of thousand degrees K, while the ions and neutrals have much lower temperatures. Due to the presence of reactive species at low temperature, the biological effects of non-thermal plasmas have been studied for application in the medical area with promising results. This review outlines the application of cold atmospheric pressure plasma (CAPP) in dentistry for the control of several pathogenic microorganisms, induction of anti-inflammatory, tissue repair effects and apoptosis of cancer cells, with low toxicity to healthy cells. Therefore, CAPP has potential to be applied in many areas of dentistry such as cariology, periodontology, endodontics and oral oncology.

Effect of Non-Thermal Atmospheric Plasma on Micro-Tensile Bond Strength at Adhesive/Dentin Interface: A Systematic Review

Objective: The objective of this review was to evaluate the effect of non-thermal atmospheric plasma (NTAP) on adhesives resin–dentin micro-tensile bond strength (μTBS) in previously published studies. Methods: Electronic search was conducted using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of NTAP on adhesives μTBS to coronal dentin. Studies that evaluated the effect of NTAP on bond strength to indirect substrates, enamel or root dentin, were excluded. The methodological quality of included studies was assessed. Results: Thirteen studies were included in this systematic review. All the included studies were considered to have a medium risk of bias. NTAP significantly improved μTBS at 24 h or after short-term aging in five studies (38.5%) and both immediate and after long-term aging in 5 studies (38.5%). In two studies (15.4%), NTAP resulted in a short-term material-dependent effect that was not stable after long-term aging. Interestingly, in one study (7.7%), NTAP had a positive effect only in the etch-and-rinse (ER) mode after long-term aging. Conclusion: Within the limitations of this systematic review, NTAP application could enhance resin–dentin μTBS of ER adhesives or universal adhesives (UAs) applied in the ER mode. In the ER mode, the rewetting step after NTAP seems to be unnecessary. Because of the limited information currently available in the literature, further studies are required to evaluate the effect of the NTAP application on self-etch (SE) adhesives or UAs applied in the SE mode.

Effects of non-thermal plasma treatment on the polysaccharide from Dendrobium nobile Lindl. And its immune activities in vitro

In order to improve the hydrophilicity and immune activity of the polysaccharide from Dendrobium nobile Lindl., non-thermal plasma was used to treat the polysaccharide. It was found that the hydrophilicity of the polysaccharide plasma-treated was significantly enhanced. Infrared spectra showed that the content of OH in the molecule increased significantly, and the monosaccharide ring changed from β-pyran sugar to β-furan sugar. The detection of SEM, AFM and TEM showed that the degree of cross-linking of surface molecules increased, and the arrangement of the polysaccharide was more compact and orderly. In vitro cell tests showed that the polysaccharide plasma-treated significantly improve the phagocytosis ability of RAW264.7, and promote the secretion of cytokines TNF-α, IL-6, IL-1. However, the cell proliferation test indicated that the polysaccharide did not increase the concentration of cytokines by promoting cell proliferation. RT-PCR showed that the polysaccharide plasma-treated could promote the expression of IL-1β at the transcriptional level. These results showed that non-thermal plasma treatment can effectively enhance the hydrophilicity of the polysaccharide and enhance its immune activity in vitro. Therefore, it can be inferred that the non-thermal plasma technology can be applied to the modification of active polysaccharides and will promote active polysaccharides to work better.

Non-thermal plasma treatment to enhance the adhesion between enamel surface and orthodontic bracket

BACKGROUND

Adhesion strength of orthodontic attachments to enamel should be within optimal range to resist occlusal forces and to allow debonding without enamel damage.

OBJECTIVE

The present study compared the effect of non-thermal plasma (NTP) and conventional surface treatment on the adhesion strength of orthodontic bracket to enamel.

METHODS

A total of 100 premolar teeth were allocated into 5 groups according to the bonding procedure followed: Group 1 (Etch, prime and composite adhesive); Group 2 (Prime and composite adhesive); Group 3 (Glass ionomer cement); Group 4 (NTP, prime and composite adhesive) and Group 5 (NTP and glass ionomer cement). Ten specimens in each group were subjected to artificial aging and the remaining ten specimens served as baseline specimens. Adhesion strength values were recorded after debonding and bond failure types were scored. Water contact angles of the NTP treated and untreated enamel surface were measured.

RESULTS

Group 1 specimen demonstrated highest bond strength at baseline (21.5 ± 3.01) and thermocycling (15.8 ± 2.87) and the least values were in Group 2 specimens at baseline (3.9 ± 1.01) and thermocycling (1.6 ± 0.7). Among the experimental (NTP) groups, Group 4 specimens exhibited high adhesion strength at baseline (10.2 ± 1.76) and after thermocycling (9.8 ± 2.15) compared to Group 5 specimens at baseline (10.1 ± 1.05) and thermocycling (6.5 ± 2.19). The water contact angle on untreated enamel surface was 53.1° ± 2.1° as compared to 1.4° ± 0.7° in treated surface.

CONCLUSION

Non-thermal plasma (NTP) treatment in conjunction with composite adhesives demonstrated clinically acceptable adhesion strength and was well within the optimal range (7-14 MPa) for enamel bonding.

Immobilization of quaternary ammonium based antibacterial monomer onto dentin substrate by non-thermal atmospheric plasma

Use of non-thermal atmospheric plasma (NTAP) brush on immobilization of dimethylaminohexadecyl methacrylate (DMAHDM) onto dentin bonding substrate, and resulting antibacterial activity against Streptococcus mutans were investigated. A bonding substrate with several-micron-demineralized layer was created from human dentin. DMAHDM was applied onto the demineralized layer with or without plasma exposure. Scanning electron microscopy (SEM) and Fourier transformed infrared (FTIR) spectroscopy were employed to verify immobilization/grafting of DMAHDM onto the substrate. Antibacterial activity of the resulting substrate was assessed by using colony-forming unit (CFU) and confocal scanning laser microscopy. Effects of saliva pellicle treatment and aging process on the above substrate were also evaluated. The SEM/FTIR results demonstrated that NTAP could induce DMAHDM immobilization onto dentin substrate, which was further verified via quantitative FTIR analysis. Comparing with non-plasma-treated, the plasmatreated substrate, with CFU 4 log lower, exhibited much stronger inhibitory effects, which were minimally affected by saliva or aging. The DMAHDM-immobilized dentin substrate showed effective and sustained antibacterial characteristics.

Improved resin-to-dentin bond strength and durability via non-thermal atmospheric pressure plasma drying of etched dentin

This study aimed to evaluate the improvement in strength and durability of the bond between dentin and composite resins following plasma drying of the etched dentin surface using non-thermal atmospheric pressure plasma. Plasma drying was applied to the etched dentin before applying adhesive. Conventional wet-bonding and helium (He) gas-dried bonding schemes were used as control groups. The bond strength of the composite resin to dentin was measured as the microtensile bond strength at 24 h after bonding and after 10,000 cycles of thermocycling. Hybrid layer formation was observed using micro-Raman spectroscopy and scanning electron microscopy. Although the bond-strength values were not statistically different either at 24 h after bonding or after thermocycling, the bond strength of the plasma-dried bonding group was significantly higher than the conventional wet-bonding group and He gas-dried bonding group. Micro-Raman spectral analysis revealed effective penetration of the adhesive and an improved polymerization rate of the adhesive after plasma drying. Plasma drying increased the penetration of hydrophobic resin into the collagen mesh structure, which improved mechanical bonding and long-term durability between dentin and composite resin.

The Influence of Cold Atmospheric Plasma Irradiation on the Adhesive Bond Strength in Non-Demineralized and Demineralized Human Dentin: An In Vitro Study

Purpose:

While aiming at the use of Cold Atmospheric Plasmas (CAPs) in restorative dentistry, the present study intended to assess if plasma irradiation increases the Tensile Bond Strength (TBS) in non-demineralized and demineralized dentin.

Materials and Methods:

Forty-eight human dentin samples were assigned to three different treatment modalities: I: Plasma jet irradiation (CAP I); II: Dielectric barrier discharge plasma treatment (CAP II); and III: No plasma (control). In each group, half of the specimens had previously been demineralized. A fourth generation of adhesive and dental composite was applied to all of the samples. The testing of the TBS was performed after artificial aging.

Results:

In the non-demineralized dentin, the mean TBS values were significantly higher after using CAP II (16.95 MPa) than in the control samples (4.2 MPa; p = 0.001). Significantly higher TBS values were also obtained after irradiating the demineralized dentin with CAP I and CAP II (11.68 and 4.6 MPa) when compared to the control samples (0 MPa; p = 0.003 and 0.038). The differences between both of the plasma sources were only slightly significant (p = 0.05).

Conclusion:

CAPs can potentially enhance the adhesive/dentin interfacial bonding strength, whereby the underlying effects seem to depend on the type of plasma source and the degree of dentinal (de-) mineralization. In the non-demineralized dentin, after a complete caries excavation, dielectric barrier discharge devices might be favorable over the plasma jets, in order to improve the adhesive/dentin interfacial bonding. In contrast, the plasma jets could be more effective in the demineralized dentin after an incomplete caries excavation.

Benefits of Nonthermal Atmospheric Plasma Treatment on Dentin Adhesion

OBJECTIVES:

This study aimed to evaluate the influence of two nonthermal atmospheric plasma (NTAP) application times and two storage times on the microtensile bond strength (μTBS) to dentin. The influence of NTAP on the mechanical properties of the dentin-resin interface was studied by analyzing nanohardness (NH) and Young's modulus (YM). Water contact angles of pretreated dentin and hydroxyapatite blocks were also measured to assess possible alterations in the surface hydrophilicity upon NTAP.

METHODS AND MATERIALS:

Forty-eight human molars were used in a split-tooth design (n=8). Midcoronal exposed dentin was flattened by a 600-grit SiC paper. One-half of each dentin surface received phosphoric acid conditioning, while the other half was covered with a metallic barrier and remained unetched. Afterward, NTAP was applied on the entire dentin surface (etched or not) for 10 or 30 seconds. The control groups did not receive NTAP treatment. Scotchbond Universal (SBU; 3M ESPE) and a resin-based composite were applied to dentin following the manufacturer's instructions. After 24 hours of water storage at 37°C, the specimens were sectioned perpendicular to the interface to obtain approximately six specimens or bonded beams (approximately 0.9 mm² in cross-sectional area) representing the etch-and-rinse (ER) approach and another six specimens representing the self-etch (SE) approach. Half of the μTBS specimens were immediately loaded until failure, while the other half were first stored in deionized water for two years. Three other bonded teeth were selected from each group (n=3) for NH and YM evaluation. Water contact-angle analysis was conducted using a CAM200 (KSV Nima) goniometer. Droplet images of dentin and hydroxyapatite surfaces with or without 10 or 30 seconds of plasma treatment were captured at different water-deposition times (5 to 55 seconds).

RESULTS:

Two-way analysis of variance revealed significant differences in μTBS of SBU to dentin after two years of water storage in the SE approach, without differences among treatments. After two years of water aging, the ER control and ER NTAP 10-second groups showed lower μTBS means compared with the ER NTAP 30-second treated group. Nonthermal atmospheric plasma resulted in higher NH and YM for the hybrid layer. The influence of plasma treatment in hydrophilicity was more evident in the hydroxyapatite samples. Dentin hydrophilicity increased slightly after 10 seconds of NTAP, but the difference was higher when the plasma was used for 30 seconds.

CONCLUSIONS:

Dentin NTAP treatment for 30 seconds contributed to higher μTBS after two years of water storage in the ER approach, while no difference was observed among treatments in the SE evaluation. This result might be correlated to the increase in nanohardness and Young's modulus of the hybrid layer and to better adhesive infiltration, since dentin hydrophilicity was also improved. Although some effects were observed using NTAP for 10 seconds, the results suggest that 30 seconds is the most indicated treatment time.

Effect of different times of nonthermal argon plasma treatment on the microtensile bond strength of self-adhesive resin cement to yttria-stabilized tetragonal zirconia polycrystal ceramic

STATEMENT OF PROBLEM

Nonthermal argon plasma may increase the surface energy of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) dental ceramics. However, studies that evaluated the effect of increased plasma treatment times on the bond strength of resin cements to Y-TZP ceramics are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different nonthermal argon plasma (NTAP) treatment times on the surface energy and bond strength of a self-adhesive resin cement to Y-TZP ceramic.

MATERIAL AND METHODS

Forty-eighty Y-TZP plates were divided into 2 groups (n=24): as-sintered (AS) and airborne-particle abrasion (APA) with 50-μm Al₂O₃, which were subdivided into 4 groups (n=6) according to the time of NTAP treatment: 0, 20, 60, and 120 seconds. The surface energy was evaluated with a goniometer. Forty Y-TZP blocks submitted to the same surface treatments (8 groups; n=5) were cemented to composite resin blocks, using a self-adhesive resin cement. After storage in distilled water at 37°C for 24 hours, the Y-TZP-composite resin blocks were cut into beams and submitted to a microtensile bond strength (μTBS) test. Data were analyzed using 2-way ANOVA and the Tukey honestly significant differences test (α=.05).

RESULTS

Treatment with NTAP increased the surface energy for AS and APA groups (P<.05). For both groups, the μTBS was as follows: 0 seconds < 20 seconds < 60 seconds = 120 seconds (P<.05). Only after 120 seconds of NTAP treatment was the μTBS of APA higher than that of AS (P<.05).

CONCLUSIONS

Treatment with NTAP improved the surface energy and increased the μTBS of self-adhesive resin cement to Y-TZP ceramic, with higher times of plasma treatment resulting in higher bond strength.

Photoinitiators in Dentistry: Challenges and Advances

Photopolymerization is used in a wide range of clinical applications in dentistry and the demand for dental materials that can restore form, function and esthetics is increasing rapidly. Simultaneous with this demand is the growing need for photoinitiators that provide effective and efficient in situ polymerization of dental materials using visible light irradiation. This chapter reviews the fundamentals of Type I and II photoinitiators. The advantages and disadvantages of these photoinitiators will be considered with a particular focus on parameters that affect the polymerization process in the oral cavity. The chapter examines recent developments in photoinitiators and opportunities for future research in the design and development of photoinitiators for dental applications. Future research directions that employ computational models in conjunction with iterative synthesis and experimental methods will also be explored in this chapter.

Nonthermal Atmospheric Plasmas in Dental Restoration

It is well known that the service life of contemporary composite restoration is unsatisfactory, and longevity of dentin bonding is one of the major culprits. Bonding is essentially a hybridization process in which dental substrate and adhesive resin interact with each other through an exchange process. Thus, the longevity of dentin bonding can only be improved with enhanced qualities in substrate, adhesive resin, and their interaction within the hybridization zone. This review aims to collect and summarize recent advances in utilizing nonthermal atmospheric plasmas (NTAPs)-a novel technology that delivers highly reactive species in a gaseous medium at or below physiologic temperature-to improve the durability of dentin bonding by addressing these 3 issues simultaneously. Overall, NTAP has demonstrated efficacies in improving a number of critical properties for dentin bonding, including deactivation of oral pathogens, modification of surface chemistry/properties, resin polymerization, improvement in adhesive-dentin interactions, and establishment of auxiliary bonding mechanism. While a few preliminary studies have indicated the benefit of NTAP to bond strength and stability, additional researches are warranted to employ knowledge acquired so far and to evaluate these properties in a systematic way.