Two-year clinical evaluation of a proanthocyanidins-based primer in non-carious cervical lesions: A double-blind randomized clinical trial

Gelatinolytic activity in dentin upon adhesive treatment

In this multi-parameter study, the effect of diverse factors related to adhesive application on the activation of host-derived gelatinases was investigated by gelatin zymography, in-situ zymography, fluorogenic DQ-gelatin assay and micro-tensile bond-strength (μTBS) testing. Gelatin zymography disclosed the presence of gelatinases in phosphoric acid-etched dentin powder, while two gold-standard adhesives generated no measurable MMP activation. In-situ zymography revealed that the interfacial gelatinolytic activity from specimens treated with the two adhesives appeared similar as that of the EDTA negative control, indicating no detectable gelatinases were activated upon adhesive treatment. In solution, MMP-2/9 activity significantly decreased upon interaction with both adhesives (two-way linear mixed effects model [LMEM]: p < 0.05); gelatinases were almost completely deactivated upon 1-week incubation at 37 °C (general linear model: p < 0.05); light-curing adhesives increased temperature up to 55 °C, which appeared sufficient to dramatically decrease MMP-2/9 activity (two-way ANOVA: p < 0.05). Finally, challenging adhesive-dentin interfaces with highly concentrated MMP-9 (at a much higher concentration than present in saliva) for 1 m did not significantly affect μTBS (two-way LMEM: p > 0.05). Taken together, the two adhesives did not activate but rather inhibited the release and activation of dentinal gelatinases.

Influence of Natural Dentin Biomodification Agent on Push-Out Bond Strength and Nanoleakage of Self-Adhesive Resin Cement Luting of Glass-Fiber Posts

OBJECTIVE

To evaluate the plant-derived compound lignin (LIG) as a pretreatment of intraradicular dentin in combination with EDTA on push-out bond strength (PBS) and nanoleakage of the glass fiber posts (GFPs) cemented using adhesive resin cement.

MATERIAL AND METHODS

Twenty-eight human incisor roots were prepared for GFP cementation and divided based on dentin pretreatment: (1) CONTROL: no pretreatment, (2) EDTA: 17% EDTA for 3 min, (3) EDTA-LIG: 17% EDTA and 2% lignin for 3 min, (4) EDTA-PAC: 17% EDTA and 2% lignin for 3 min. The GFPs were cemented using the self-adhesive resin cement Multilink Speed. The roots (n = 7) were sectioned into 1 mm-thick discs and subjected to PBS testing after 1 week or 6 months. Nanoleakage was analyzed by SEM. Statistical analysis was performed using two-factor ANOVA and Tukey's test (p < 0.05).

RESULTS

Higher PBS was identified for the CONTROL group (p < 0.001). After 6 months, the EDTA-LIG maintained the bond strength with a predominance of mixed failures, while the EDTA-PAC, EDTA, and CONTROL groups showed reduction of bond strength, with a predominance of adhesive failures along with severe silver infiltration in the interface.

CONCLUSION

LIG associated with EDTA as a pretreatment for intraradicular dentin shows significant potential for attaining stable bond strength and interfacial integrity of self-adhesive resin cement to intraradicular dentin.

Effects on dentin nanomechanical properties, cell viability and dentin wettability of a novel plant-derived biomodification monomer

OBJECTIVES

To evaluate the effects of dentin biomodification agents (Proanthocyanidin (PAC), Cardol (CD) and Cardol-methacrylate (CDMA) on dentin hydrophilicity by contact angle measurement, viability of dental pulp stem cells (DPSCs) and nanomechanical properties of the hybrid layer (HL).

METHODS

CDMA monomer was synthesized from cardol through methacrylic acid esterification. Human extracted third molars were used for all experiments. For nanomechanical tests, specimens were divided in four groups according to the primer solutions (CD, CDMA, PAC and control) were applied before adhesive and composite coating. Nanomechanical properties of the HL were analyzed by nanoindentation test using a Berkovich probe in a nanoindenter. Wettability test was performed on dentin surfaces after 1 min biomodification and measured by contact angle analysis. Cytotoxicity was assessed by a MTT assay with DPSCs after 48 and 72 h. Data were analyzed with Student's t test or Two-way ANOVA and Tukey HSD test (p < 0.05).

RESULTS

CD and CDMA solutions achieved greater hydrophobicity and increased the water-surface contact angles when compared to PAC and control groups (p < 0.05). PAC group showed a greater reduction of elastic modulus in nanoindentation experiments when compared to CD and CDMA groups (p < 0.05) after 4 months of aging. CD inhibited cell proliferation compared to all further materials (p < 0.05), whilst CDMA and PAC indicated no cell cytotoxicity to human DPSCs.

SIGNIFICANCE

Cardol-methacrylate provided significantly higher hydrophobicity to dentin and demonstrated remarkable potential as collagen crosslinking, attaining the lowest decrease of HL's mechanical properties. Furthermore, such monomer did not affect pulp cytotoxicity, thereby highlighting promising feasibility for clinical applications.

48-month clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A double-blind randomised clinical trial

OBJECTIVES

This study aimed to evaluate the effect of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as an etch-and-rinse or self-etch strategy.

METHODS

A total of 216 class V (non-carious lesions) restorations were randomly placed in 36 subjects according to the following groups: ERcu, adhesive in etch-and-rinse with 0.1% CuNp; ERct, adhesive in etch-and-rinse without CuNp; SEcu, adhesive in self-etch with 0.1% CuNp; and Sect, adhesive in self-etch without CuNp. Restorations were evaluated at baseline and at 6, 12, 18, 36, and 48 months, using the FDI and USPHS criteria. Appropriate statistical analyses were performed (α = 0.05).

RESULTS

After 48 months, 14 restorations were lost (two for ERcu, five for SEcu, and seven for SEct) and the retention rates (95% confidence interval [CI]) were 74.1% for ERcu (95% CI 61.1-83.8); 81.5% for ERct (95% CI 69.2-89.6); 64.8% (95% CI 51.5-76.2) for SEcu; and 64.8% (95% CI 51.5-76.2) for SEct, with statistical differences between SEct vs. ERct and SEcu vs. ERct (p < 0.05). No significant differences between the groups were observed when the secondary parameters were evaluated (p > 0.05). Nineteen restorations (two for ERcu, two for ERct, six for SEcu, and nine for SEct) showed minor marginal staining, and 44 restorations (7 for ERcu, 8 for ERct, 14 for SEcu, and 15 for SEct) presented minimal marginal adaptation defects.

SIGNIFICANCE

This is the first long-term clinical trial to show that the addition of CuNp to a universal adhesive system does not affect clinical performance.

Spectroscopic investigation, thermal behavior, catalytic reduction, biological and computational studies of novel four transition metal complexes based on 5-methylthiophene Schiff base type

Four new complexes prepared from 5-Methyl-2-carboxaldehyde-thiophene and 2,6-pyridinediamine with cobalt, nickel, copper and cadmium ions have been synthesized because of the significance of these complexes in pharmacological research and catalytic reduction. The prepared compounds were characterized using elemental analysis, mass, UV-visible, NMR and FTIR spectroscopy, as well as molar conductance, magnetic susceptibility measurements, fluorescence properties and TGA analysis. The stoichiometry mode was confirmed as 1:1 (metal: ligand) for Co, Ni and Cu complexes and 1:2 (metal: ligand) for Cd complex according to the results of the elemental and spectral studies. Furthermore, the thermal stability and luminescence properties of complexes have been studied. Thermal studies confirmed the presence of water molecules. The thermodynamic properties of the complexes were measured via the Coats-Redfern procedure. The geometric structures of the complexes were found to be octahedral around the metal ions. The optical energy gaps (Eopt) vary between 2.92 and 3.71 eV indicating that these compounds can be used as selective absorbing solar energy in photovoltaic applications. In the presence of NaBH₄, the greatest reduction efficiency for the conversion of 2-NP to 2-AP was discovered to be 73-91% within 15-25 min. In vitro, high antifungal and antibacterial activity was shown by complexes than the ligand alone. The Cd(II) complex was shown to have greater activity than all of the examined microorganisms when compared to the reference drug in addition it had 4.94 μg/ml minimal inhibitory concentration against "S. aureus", "B. subtilis", and "E. coli". The bond angles, bond lengths, and quantum chemical factors of the ligand and complexes were shown in the molecular modeling using the DFT approach. The studied compounds' binding modes were confirmed using the Gaussian 09 program.

Patients´ satisfaction concerning direct anterior dental restoration

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Numerical Study of the Mechanical Behaviour of Wedge-Shaped Defect Filling Materials

This paper deals with direct restorations of teeth with non-carious cervical lesions (NCCL). NCCL defects are capable of gradual growth and are accompanied by the degradation of the surrounding tissue. Direct restorative treatment, in which the cavity is filled with a cementing agent, is considered to be an accessible and common treatment option. The study included simulations of the teeth without lesions, the teeth with V and U lesions and the tooth-restorative system. Parameterised numerical tooth models were constructed. Two cases with defect depths of 0.8 mm and ~1.7 mm and three variants with fillet radii of the defect end of 0.1, 0.2 and 0.3 mm were considered. The effect of two biomaterials for restorations was studied, namely Herculite XRV (Kerr Corp, Orange, CA, USA) and Charisma (Heraeus Kulzer GmbH, Hanau, Germany). The models were deformed with a vertical load of 100 to 1000 N from the antagonist tooth. The tooth-restorative system was considered, taking into consideration the contact interaction in the interface areas with the tooth tissues. Within the limits of the research, the character of the distribution of the deformation characteristics and their dependence on the level of loading, the depth of the defect and the radius of the curvature of the "wedge" were established.

Effect of Collagen Crosslinkers on Dentin Bond Strength of Adhesive Systems: A Systematic Review and Meta-Analysis

This study aimed to identify the role of crosslinking agents in the resin–dentin bond strength (BS) when used as modifiers in adhesives or pretreatments to the dentin surface through a systematic review and meta-analysis. This paper was conducted according to the directions of the PRISMA 2020 statement. The research question of this review was: “Would the use of crosslinkers agents improve the BS of resin-based materials to dentin?” The literature search was conducted in the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts that reported the effect on the BS after the use of crosslinking agents were included. The meta-analyses were performed using Review Manager v5.4.1. The comparisons were performed by comparing the standardized mean difference between the BS values obtained using the crosslinker agent or the control group. The subgroup comparisons were performed based on the adhesive strategy used (total-etch or self-etch). The immediate and long-term data were analyzed separately. A total of 50 articles were included in the qualitative analysis, while 45 articles were considered for the quantitative analysis. The meta-analysis suggested that pretreatment with epigallocatechin-3-gallate (EGCG), carbodiimide, ethylenediaminetetraacetic acid (EDTA), glutaraldehyde, and riboflavin crosslinking agents improved the long-term BS of resin composites to dentin (p ≤ 0.02). On the other hand, the use of proanthocyanidins as a pretreatment improved both the immediate and long-term BS values (p ≤ 0.02). When incorporated within the adhesive formulation, only glutaraldehyde, riboflavin, and EGCG improved the long-term BS to dentin. It could be concluded that the application of different crosslinking agents such as carbodiimide, EDTA, glutaraldehyde, riboflavin, and EGCG improved the long-term BS of adhesive systems to dentin. This effect was observed when these crosslinkers were used as a separate step and when incorporated within the formulation of the adhesive system.

Is dentin biomodification with collagen cross-linking agents effective for improving dentin adhesion? A systematic review and meta-analysis

Objectives

The aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures.

Materials and Methods

In this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected.

Results

The selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period.

Conclusions

This systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.

Evaluation of resveratrol-doped adhesive with advanced dentin bond durability

OBJECTIVES

This paper aimed to evaluate the influence of resveratrol-doped adhesive on the durability and antibiofilm capability of dentin bonding.

METHODS

Experimental adhesives were prepared by incorporating resveratrol into a universal adhesive at concentrations of 0 (control), 0.1, 1, and 10 mg/mL. The microtensile bond strength, fracture modes, and adhesive-dentin interface nanoleakage were assessed after 24 h of water storage, 10,000 times of thermocycling or 1-month of collagenase ageing. Relevant antibiofilm capability on Streptococcus mutans (S. mutans), in situ zymography, degree of conversion, and cytotoxicity of resveratrol-doped adhesives were also determined.

RESULTS

Irrespective of thermocycled or collagenase ageing, the resveratrol-doped adhesive (1 mg/mL) maintained the bond strength and reduced the nanoleakage expression. Meanwhile, the inhibitory ability on endogenous protease activity and S. mutans biofilm formation with acceptable biocompatibility were obtained.

CONCLUSIONS

This study suggested that the resveratrol-doped adhesive achieved effective improvement on dentin bond durability and secondary caries management.

CLINICAL SIGNIFICANCE

The application of the resveratrol-doped adhesive indicates promising benefits to increase the lifetime of composite restorations.

Using Proanthocyanidin as a Root Dentin Conditioner for GIC Restorations

Glass ionomer cements (GICs) are considered the material of choice for restoration of root carious lesions (RCLs). When bonding to demineralized dentin, the collapse of dentinal collagen during restorative treatment may pose challenges. Considering its acidic nature and collagen biomodification effects, proanthocyanidin (PAC) could be potentially used as a dentin conditioner to remove the smear layer while simultaneously acting to biomodify the dentinal collagen involved in the bonding interface. In this study, 6.5% w/v PAC was used as a conditioner for sound (SD) and laboratory demineralized (DD) root dentin before bonding to resin-modified GIC (FII), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-modified GIC (FVII), or a high-viscosity GIC (FIX). Root dentin conditioned with deionized distilled water (DDW) or polyacrylic acid (PAA) served as controls. Results indicated FII showed higher shear bond strength (SBS) on SD than the other 2 GICs, especially in PAA-conditioned samples; FIX showed significantly higher SBS than FII and FVII on PAA- or PAC-conditioned DD. In each category of GIC, PAA and PAC did not have a significant influence on SBS in most cases compared to DDW except for a significant decrease in PAC-conditioned SD bonded to FII and a significant increase in PAA-conditioned DD bonded to FIX. The bonding interface between GIC and SD was generally more resistant to the acid-base challenge than DD. Although the alterations in failure modes indicated a compromised interfacial interaction between GICs and PAC-treated root dentin, biomodification effects of PAC on dentin were observed from Raman microspectroscopy analysis in terms of the changes in mineral-to-matrix ratio and hydroxyproline-to-proline ratio of dentin adjacent to the bonding interface, especially of DD. Results from this study also indicated the possibility of using in situ characterization such as Raman microspectroscopy as a complementary approach to SBS test to investigate the integrity of the bonding interface.

Effects of Dentine Pretreatment Solutions Containing Flavonoids on the Resin Polymer-Dentine Interface Created Using a Modern Universal Adhesive

The aim of the present study was to evaluate the influence of several experimental pretreatment crosslinker solutions on the resin polymer–dentine interface created using a representative universal adhesive system, by means of microtensile bond strength testing (μTBS), nanomechanical properties and ultramorphology confocal laser scanning microscopy (CLSM). Five experimental solutions containing different flavonoids were applied as dentine pretreatment after acid etching. A control pretreatment group containing no flavonoid was also employed. A representative modern universal adhesive was then applied, followed by a 3 mm thick composite built up. Specimens were sectioned into sticks and submitted to a μTBS test or nanoindentation analysis along the interface (24 h or 25,000 thermocycles). The ultramorphology of the polymer–resin interface was also evaluated using CLSM. The results were analyzed using two-way ANOVA and Bonferroni’s post hoc test (α = 0.05). All flavonoids improved short- and long-term μTBS values (p < 0.01), while only some specific such solutions improved the nanomechanical properties (p < 0.05) and preserved the structural morphology of the interface after aging. Pretreatment of acid-etched dentine using specific flavonoid-containing solutions may be a promising approach to improve both the nanomechanical properties and the durability of modern universal adhesive systems.

Effect of myricetin on odontoblast-like cells and its potential to preserve resin-dentin Bonds

Stabilization of the resin-dentin interface to increase the durability of adhesive dental restorations is a challenging task. The use of naturally occurring collagen crosslinking agents has been proposed to prevent degradation of the hybrid layer. Myricetin (MYR) is a flavonoid with a wide variety of beneficial effects and it has been used for the treatment of different systemic pathologies. The chemical structure of MYR makes it a powerful antioxidant, an inhibitor of matrix metalloproteinase (MMP) activity, and a collagen cross-linker. This study presents MYR as a novel treatment in operative dentistry to stabilize the resin-dentin interface by inhibiting MMPs and crosslinking the collagen. Viability tests carried out using a resazurin assay showed that MYR had no cytotoxic effects on human odontoblast-like cells and the phenotype was preserved. Fluorometric MMP activity assay and fluorescence microscopy revealed that the MMPs in the demineralized dentin were effectively inhibited by the application of MYR (600 μM for 120 s). A microtensile bond strength test was performed immediately and after six months of storage. The bond strength to dentin was not affected by MYR and was preserved over time. Demineralized dentin beams were evaluated to determine the dentin biomodification using microtensile strength and elastic modulus assays. MYR improved the biomechanical behavior of the demineralized dentin similarly to glutaraldehyde, a recognized crosslinking agent. These findings indicated that MYR acts as an MMP inhibitor, collagen cross-linker, and preserver of the bond strength. Furthermore, MYR is an ethanol-soluble molecule with a lower molecular weight than the other polyphenols; hence, it can be applied for a short time and diffuses deeply through the dentin without any associated cytotoxicity. This molecule has beneficial effects on the biological and mechanical behavior of the resin-dentin interface and may be used to effectively stabilize the hybrid layer in a clinical setting.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Harnessing biomolecules for bioinspired dental biomaterials

Dental clinicians have relied for centuries on traditional dental materials (polymers, ceramics, metals, and composites) to restore oral health and function to patients. Clinical outcomes for many crucial dental therapies remain poor despite many decades of intense research on these materials. Recent attention has been paid to biomolecules as a chassis for engineered preventive, restorative, and regenerative approaches in dentistry. Indeed, biomolecules represent a uniquely versatile and precise tool to enable the design and development of bioinspired multifunctional dental materials to spur advancements in dentistry. In this review, we survey the range of biomolecules that have been used across dental biomaterials. Our particular focus is on the key biological activity imparted by each biomolecule toward prevention of dental and oral diseases as well as restoration of oral health. Additional emphasis is placed on the structure-function relationships between biomolecules and their biological activity, the unique challenges of each clinical condition, limitations of conventional therapies, and the advantages of each class of biomolecule for said challenge. Biomaterials for bone regeneration are not reviewed as numerous existing reviews on the topic have been recently published. We conclude our narrative review with an outlook on the future of biomolecules in dental biomaterials and potential avenues of innovation for biomaterial-based patient oral care.