Erosion of CAD/CAM restorative materials and human enamel: An in situ/in vivo study

Er:YAG laser settings for debonding zirconia restorations: An in vitro study

This in vitro study aimed to determine the optimal frequency and energy settings for debonding zirconia restorations using an erbium-doped yttrium aluminum garnet (Er:YAG) laser. A total of 200 zirconia specimens (5 mm × 5 mm × 1.5 mm) were fabricated from two types of materials: (1) 3 mol% yttria oxide stabilized tetragonal zirconia polycrystalline (3Y-TZP) and (2) 5 mol% yttria oxide stabilized tetragonal zirconia polycrystalline (5Y-TZP). The zirconia specimens were bonded to dentin using resin cement (RelyX Ultimate, 3 M) and divided into 20 groups based on their laser treatments (n = 5). Er:YAG laser treatment was applied at various frequencies (10 Hz and 20 Hz) and energies (80 mJ, 100 mJ, 120 mJ, 140 mJ, 160 mJ, 180 mJ, 200 mJ, 220 mJ, 240 mJ, and 260 mJ). The time required to debond the specimens and the temperature changes that dentin underwent during the laser treatment were recorded. The surface morphologies of the debonded dentin and zirconia specimens were observed using scanning electron microscopy (SEM). Additional zirconia specimens were fabricated for 4-point flexural strength testing and surface roughness measurements. Statistical analyses were conducted using three-way analysis of variance (ANOVA) and Student-Newman-Keuls (SNK)-q tests (α = 0.05). The debonding time of each specimen varied between 4.8 and 160.4 s, with an average value of 59.2 s. The dentin temperature change for each specimen ranged from 2.3 to 3.6 °C, with an average value of 2.7 °C. The debonding time was significantly influenced by the zirconia material type and laser energy, but it was not affected by the laser frequency. Among the specimens, those made of 3Y-TZP needed significantly more time for debonding than 5Y-TZP. The optimal energies were 220 mJ for 3Y-TZP and 200 mJ for 5Y-TZP. The laser frequency, laser energy, and type of zirconia material had no effect on the dentin temperature change. Additionally, no surface alternations were observed on the dentin or zirconia materials after laser treatment. The surface roughness and flexural strength of the zirconia materials remained unchanged after laser treatment. In summary, Er:YAG laser treatment effectively and safely removes zirconia restorations without impacting their mechanical properties, with a safe temperature change of less than 5.6 °C. The optimum frequency and energy settings for debonding 3Y-TZP and 5Y-TZP restorations were found to be 10/20 Hz and 220 mJ and 10/20 Hz and 200 mJ, respectively.

Effects of protease inhibitors on dentin erosion: an in situ study

OBJECTIVE

This in situ study aimed to evaluate the effects of the inhibitors of matrix metalloproteinases (MMPs) and cysteine cathepsins on dentin erosion.

MATERIALS AND METHODS

Ten volunteers participated in this study. Each volunteer wore an intraoral appliance containing 4 dentin specimens subjected to different treatments: deionized water as a control, 1 mM 1,10-phenanthroline (an MMP inhibitor), 50 µM E-64 (a cysteine cathepsin inhibitor), and 1 mM 1,10-phenanthroline + 50 µM E-64. The specimens were dipped in 5 ml of the respective solutions for 30 min at room temperature and then exposed to in vivo erosive challenges by rinsing with 150 ml of a cola drink (4 × 5 min/day) for 7 days. The substance loss of the specimens was measured by profilometry. The transverse sections of the specimens were examined using scanning electron microscopy. Thereafter, the demineralized organic matrix (DOM) of the specimens was removed using type I collagen enzyme and assessed by performing profilometry. The differences in substance loss and DOM thickness among the groups were analyzed by one-way repeated-measures analysis of variance (ANOVA) and Bonferroni's test at a level of P < 0.05.

RESULTS

Protease inhibitors significantly reduced substance loss in comparison to that of the control group (all P < 0.05). A significantly thicker DOM was observed for the specimens treated with protease inhibitors than for the control specimens (all P < 0.05). No significant differences in substance loss or DOM thickness were found among the MMP inhibitor, cysteine cathepsin inhibitor, and MMP + cysteine cathepsin inhibitor groups.

CONCLUSIONS

The use of MMP and cysteine cathepsin inhibitors was shown to increase the acid resistance of human dentin, which may be due to the preservation of the DOM.

CLINICAL RELEVANCE

The application of protease inhibitors could be considered an appropriate preventive strategy for dentin erosion.

Do matrix metalloproteinase and cathepsin K inhibitors work synergistically to reduce dentin erosion?

OBJECTIVES

To evaluate the effects of matrix metalloproteinase (MMP) and cathepsin K (catK) inhibitors on resistance to dentin erosion.

METHODOLOGY

A total of 96 dentin specimens (3×3×2 mm) were prepared and randomly assigned into four groups (n=24): deionized water (DW); 1 µM odanacatib (ODN, catK inhibitor); 1 mM 1,10-phenanthroline (PHEN, MMP inhibitor); and 1 µM odanacatib + 1 mM 1,10-phenanthroline (COM). Each group was further divided into two subgroups for the application of treatment solutions before (PRE) and after erosive challenges (POST). All specimens were subjected to four daily erosive challenges for 5 d. For each erosive challenge, the specimens in subgroup PRE were immersed in the respective solutions before cola drinks, while the specimens in subgroup POST were immersed in the respective solutions after cola drinks (the immersion duration was 5 min in both cases). All specimens were stored in artificial saliva at 37°C between erosive challenges. The erosive dentin loss (EDL) was measured by profilometry. The residual demineralized organic matrix (DOM) of specimens was removed using type VII collagenase and evaluated by profilometry. Both the EDL and thickness of the residual DOM were statistically analyzed by two-way analysis of variance (ANOVA) and Bonferroni's test (α=0.05). The surface topography and transverse sections of the specimens were observed using SEM. MMPs and catK were immunolabeled in the eroded dentin and in situ zymography was performed to evaluate the enzyme activity.

RESULTS

Significantly lower EDL was found in the groups ODN, PHEN, and COM than in the control group (all p<0.05), while no significant difference in EDL was found among the groups ODN, PHEN, and COM (all p>0.05). The application sequence showed no significant effect on the EDL of the tested groups (p=0.310). A significantly thicker DOM was observed in the group ODN than in the control group regardless of the application sequence (both p<0.05). The treatment with ODN, PHEN, and COM inhibited the gelatinolytic activity by approximately 46.32%, 58.6%, and 74.56%, respectively.

CONCLUSIONS

The inhibition of endogenous dentinal MMPs and catK increases the acid resistance of human dentin but without an apparent synergistic effect. The inhibition of MMPs and catK is equally effective either before or after the acid challenge.

Effects of Acidic Environments on Dental Structures after Bracket Debonding

Brackets are metallic dental devices that are very often associated with acidic soft drinks such as cola and energy drinks. Acid erosion may affect the bonding between brackets and the enamel surface. The purpose of this study was to investigate the characteristics of brackets' adhesion, in the presence of two different commercially available drinks. Sixty human teeth were divided into six groups and bonded with either resin-modified glass ionomer (RMGIC) or resin composite (CR). A shared bond test (SBS) was evaluated by comparing two control groups with four other categories, in which teeth were immersed in either Coca-Cola^TM or Red Bull^TM energy drink. The debonding between the bracket and enamel was evaluated by SEM. The morphological aspect correlated with SBS results showed the best results for the samples exposed to artificial saliva. The best adhesion resistance to the acid erosion environment was observed in the group of teeth immersed in Red Bull^TM and with brackets bonded with RMGIC. The debonded structures were also exposed to Coca-Cola^TM and Red Bull^TM to assess, by atomic force microscopy investigation (AFM), the erosive effect on the enamel surface after debonding and after polishing restoration. The results showed a significant increase in surface roughness due to acid erosion. Polishing restoration of the enamel surface significantly reduced the surface roughness that resulted after debonding, and inhibited acid erosion. The roughness values obtained from polished samples after exposure to Coca-Cola^TM and Red Bull^TM were significantly lower in that case than for the debonded structures. Statistical results evaluating roughness showed that Red Bull^TM has a more erosive effect than Coca-Cola™. This result is supported by the large contact surface that resulted after debonding. In conclusion, the prolonged exposure of the brackets to acidic drinks affected the bonding strength due to erosion propagation into both the enamel-adhesive interface and the bonding layer. The best resistance to acid erosion was obtained by RMGIC.

Dual function of quercetin as an MMP inhibitor and crosslinker in preventing dentin erosion and abrasion: An in situ/in vivo study

OBJECTIVE

The aim of the present study was to evaluate the in situ/in vivo effect of quercetin on dentin erosion and abrasion.

METHODS

Human dentin blocks (2 × 2 × 2 mm) were embedded and assigned to 6 groups: 75 μg/mL, 150 μg/mL and 300 μg/mL quercetin (Q75, Q150, Q300); 120 μg/mL chlorhexidine (CHX, positive control); and deionized water and ethanol (the negative controls). The specimens were treated with the respective solutions for 2 min and then subjected to in situ/in vivo erosive/abrasive challenge for 7 d as follows: in vivo erosion 4 times a day and then in vivo toothbrush abrasion after the first and last erosive challenges of each day. Dentin loss was assessed by profilometry. An additional dentin specimen was used to evaluate the penetration depth of quercetin into dentin by tracking the spatial distribution of its characteristic Raman peak. Moreover, dentin blocks (7 × 1.7 × 0.7 mm) were used to detect the impact of quercetin on dentin-derived matrix metalloproteinase (MMP) inhibition by in situ zymography, and the inhibition percentage (%) was calculated. Additionally, the potential collagen crosslinking interactions with quercetin were detected by Raman spectroscopy, and the crosslinking degree was determined with a ninhydrin assay. Fully demineralized dentin beams (0.5 × 0.5 × 10 mm) were used to evaluate the impact of quercetin on the mechanical properties of dentin collagen fibre by the ultimate micro-tensile strength test (μUTS). The data were analysed by one-way analysis of variance and Tukey's test (α = 0.05).

RESULTS

Compared to the negative controls, all treatment solutions significantly reduced dentin loss. The dentin loss of Q150 and Q300 was significantly less than that of CHX (all P < 0.05). The amount of quercetin decreased with increasing dentin depth, and the maximum penetration depth was approximately 25-30 µm. In situ zymography showed that quercetin significantly inhibited the activities of dentin-derived MMPs. The inhibitory percentages of Q75 and Q150 were significantly lower than that of CHX (all P < 0.05), but no significant difference was found between Q300 and CHX (P = 0.58). The collagen crosslinking interactions with quercetin primarily involved hydrogen bonding and the degree of crosslinking increased in a concentration-dependent manner. Statistically significant increases in μUTS values were observed for demineralized dentin beams after quercetin treatment compared with those of the control treatments (all P < 0.05).

SIGNIFICANCE

This study provides the first direct evidence that quercetin could penetrate approximately 25-30 µm into dentin and further prevent dentin erosion and abrasion by inhibiting dentin-derived MMP activity as well as crosslinking collagen of the demineralized organic matrix.

Erosion of CAD/CAM restorative materials and human enamel: An in vitro study

This in vitro study used the same frequency and duration of acid contact as a previous in situ/in vivo study to evaluate the effect of erosion on CAD/CAM restorative materials and human enamel and to compare the effects of in vitro and in situ/in vivo acid challenges on CAD/CAM restorative materials and human enamel. The CAD/CAM restorative materials (IPS e.max CAD, Lava Ultimate, and PMMA block) and human enamel were eroded by immersion in 150 ml of cola drink for 14 days (4 × 5 min/day). The surface microhardness and surface roughness of the specimens were measured at baseline (T1), day 7 (T2), and day 14 (T3). The substance losses were measured at T2 and T3. The data were statistically analyzed using repeated measures ANOVA and Bonferroni's test (α = 0.05). Erosion significantly decreased the surface microhardness of the CAD/CAM restorative materials and human enamel (all P < 0.001). The overall percentage of surface microhardness loss (%SMH_l) of the PMMA block and enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P = 0.02 and P < 0.001, respectively). Consistent with in situ/in vivo erosion, the surface roughness and profile of the tested restorative materials remained unchanged after in vitro erosion. A significant increase in the surface roughness and substance loss was observed for enamel after in vitro erosion (all P < 0.001). The overall substance loss of enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P < 0.001). In conclusion, erosion decreased the surface microhardness of the CAD/CAM restorative materials and human enamel. Moreover, erosion negatively influenced the substance loss and surface roughness of human enamel. For the substance loss of enamel and %SMH_l of PMMA block and enamel, the in vitro erosive effects were approximately 1-2 times greater than the in situ/in vivo effects. However, for the surface roughness and profile of the CAD/CAM restorative materials, no significant difference was found between in vitro and in situ/in vivo erosion.

Repolishing in situ eroded CAD/CAM restorative materials and human enamel

This study aimed to evaluate the effects of repolishing on the surface microhardness (SMH), color change (ΔE), and translucency parameter (TP) of previously in situ eroded computer-aided design/computer-aided manufacturing (CAD/CAM) restorative materials and human enamel. Each of 8 volunteers wore an intraoral appliance containing 3 CAD/CAM restorative material specimens (IPS e.max CAD lithium disilicate ceramic, Lava Ultimate hybrid ceramic, and poly (methyl methacrylate) (PMMA) block) and 1 human enamel specimen. The specimens were subjected to in situ erosion cycles by rinsing with a cola drink (4 × 5 min/day) for 14 days. After erosion, the specimens were polished with a silicone polishing system (Ceramister, Shofu Inc, Kyoto, Japan). The SMH and color of the specimens were determined at baseline (T1), after erosion (T2), and after repolishing (T3). The ΔE and TP values of the specimens were further calculated. The data were statistically analyzed using repeated-measures analysis of variance (ANOVA) and Bonferroni's test (α = 0.05). After erosion, a decrease in the SMH of the restorative materials and enamel was observed (all P < 0.001), and a decrease in the TP of the enamel was observed (P = 0.016). The ΔE values of the enamel (ΔE = 7.32) and Lava Ultimate (ΔE = 3.19) exceeded the clinically unacceptable threshold after erosion. After repolishing, the SMH of the restorative materials and enamel at T3 was significantly higher than that at T2 (all P < 0.001). No significant difference was found in the TP and ΔE values of the restorative materials and enamel between T2 and T3. In conclusion, erosion negatively affected the surface properties and appearance of the CAD/CAM restorative materials and human enamel. Repolishing contributed to restoring the compromised SMH of the eroded restorative materials and enamel to a certain extent. However, repolishing did not restore the color of the eroded restorative materials and enamel.