Amalgam restoration and in vitro caries formation

Secondary Caries in situ Models: A Systematic Review

In situ caries research serves as a bridge between clinical research and laboratory studies. In this kind of research, volunteers wear a removable intraoral splint or prosthesis containing research samples. Many different in situ models exist to investigate secondary caries. This systematic review compared currently existing secondary caries models and their lesion progression per day values.

MATERIALS AND METHODS

Three databases (Medline, Embase, and Cochrane) were searched for relevant literature. Bias risk was assessed and model parameters and caries-related outcomes were extracted by 2 independent researchers. Where possible, caries-related outcomes were normalized by estimating lesion progression per day by dividing lesion depth extracted from microradiographic or microhardness data by the number of days the study lasted.

RESULTS

The literature search identified 335 articles. After eliminating duplicates and selection, 31 articles were included. The models differed greatly on factors such as sample location, presence of fluoride in the model, and analysis methods. Three main groups could be identified by sample placement; 68% of models placed samples palatally in the upper jaw, and the lower jaw model could be divided into the buccal (26%) and approximal (6%) areas. Average lesion progression in enamel next to composite was 4.3 ± 2.8 µm (range1.1-8.8 µm/day).

DISCUSSION

Studies conducted with palatal models showed caries progression rates 2-5 times higher than the estimated clinical progression rates. Lesion progression per day could be a useful tool for future comparison of models and establishing a standardized model.

Structural, Surface, in vitro Bacterial Adhesion and Biofilm Formation Analysis of Three Dental Restorative Composites

This study was conducted to investigate the relationship between dental materials and bacterial adhesion on the grounds of their chemical composition and physical properties. Three commercially available dental restorative materials (Filtek™Z350, Filtek™P90 and Spectrum^®TPH^®) were structurally analyzed and their wettability and surface roughness were evaluated by using Fourier Transform Infrared Spectroscopy, Contact Angle Measurement and Atomic Force Microscopy, respectively. These materials were molded into discs and tested with three bacterial strains (Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia) for microbial attachment. The bacterial adhesion was observed at different time intervals, i.e., 0 h, 8 h, 24 h, 48 h and 72 h, along with Colony Forming Unit Count and Optical Density measurement of the media. It was found that all materials showed a degree of conversion with time intervals, i.e., 0 h, 8 h, 24 h, 48 h and 72 h, which led to the availability of functional groups (N–H and C–H) that might promote adhesion. The trend in difference in the extent of bacterial adhesion can be related to particle size, chemical composition and surface wettability of the dental materials.

The microfloral analysis of secondary caries biofilm around Class I and Class II composite and amalgam fillings

BACKGROUND

Secondary caries is responsible for 60 percent of all replacement restorations in the typical dental practice. The diversity of the bacterial sources and the different types of filling materials could play a role in secondary caries. The aim of this study was to determine and compare the microbial spectrum of secondary caries biofilms around amalgam and composite resin restorations.

METHODS

Clinical samples were collected from freshly extracted teeth diagnosed with clinical secondary caries. Samples were categorized into four groups according to the types of restoration materials and the classification of the cavity. Biofilms were harvested from the tooth-restoration interface using a dental explorer and after dilution were incubated on special agars. The bacteria were identified using the biochemical appraisal system. Statistical calculations were carried out using SPSS11.5 software to analyze the prevalence of the bacteria involved in secondary caries.

RESULTS

Samples from a total of four groups were collected: two groups were collected from amalgam restorations, each had 21 samples from both Class I and Class II caries; and the other two groups were from composite resin restorations, each had 13 samples from both class I and class II caries. Our results showed: (1) Anaerobic species were dominant in both restoration materials. (2) In terms of the types of individual bacteria, no significant differences were found among the four groups according to the geometric mean of the detected bacteria (P > 0.05). However, there were significant differences among the detected bacteria within each group (P < 0.05). The composition of each bacterium had no statistical difference among the four groups (P > 0.05), but showed significant differences among the detected bacteria in each group (P < 0.05). (3) Among the four groups, there were no significant differences for the detection rate of each bacterium (P > 0.05), however, the detection rate of each bacterium within each group was statistically different among the detected bacteria (P < 0.05).

CONCLUSIONS

The proportion of obligatory anaerobic species was much greater than the facultative anaerobic species in the biofilm of secondary caries. Statistically, the materials of restoration and the location of secondary caries did not show any significant effects on the composition of the microflora.

Effect of restorative materials and in vitro carious challenge on amalgam margin quality

The surface margin of a restoration is where the restored tooth is subjected to aggressive oral attack. Any resistance to this attack will have favorable consequences on the clinical performance and longevity of the restoration. In this study, Black's class I classic cavity preparations were completed in 120 extracted intact human premolars that were restored with one of two silver amalgams, six different base conditions, and with or without cavity varnish, resulting in 20 different restoration combinations. The cavities were aged for 3 months and 1 year in 1% NaCl at 20 degrees C. A resin cast impression was made of the restoration margin for each specimen. Thereafter 80 restored teeth were subjected to an in vitro bacterial challenge for 36 days. The other 40 specimens were placed in an acidified (pH = 4.0) broth for the same length of time. A second cast impression was then made of the margin of each specimen. The casts were examined with a scanning electron microscope and the widest gap of the margin opening and the length of margin showing a discrepancy were measured. Specimens were ranked first on the basis of the gap size and then on percent of margin discrepancy length. Results were evaluated with one-way ANOVA and Turkey's Student range test with a critical level of statistical significance (p < 0.05). Base type significantly affected aged margin quality. Cariogenic challenge caused a significant breakdown of the amalgam margin although the type of challenge was not significant. A shorter aging time, varnish, and high copper amalgam exacerbated the breakdown. Margin breakdown can be reduced by judicious selection of restoration material combinations.