Resistance of an enamel-bonding agent to saliva and acid exposure in vitro assessed by liquid scintillation

Stability against brushing abrasion and the erosion-protective effect of different fluoride compounds

This study aimed to analyse the impact of brushing on the protective effect of different fluoride solutions on enamel and dentin erosion. Bovine enamel and dentin specimens were rinsed once with TiF4, AmF, SnF2 (0.5 M F, 2 min) or water (control). Specimens were either left unbrushed or brushed with 10, 20, 50, 100 or 500 brushing strokes in an automatic brushing machine (2 N, non-fluoridated toothpaste slurry). Ten specimens per group were eroded with hydrochloric acid (HCl) (pH 2.3) for 60 s, and calcium release into the acid was determined by atomic absorption spectroscopy. Additionally, enamel and dentin surfaces were analysed by X-ray energy-dispersive spectroscopy (EDS) (n = 6/group) and scanning electron microscopy (SEM) (n = 2/group) before brushing and after 500 brushing strokes. Statistical analysis (p < 0.05) was performed by three- and one-way ANOVA (calcium release) or repeated measures ANOVA (EDS). TiF4, AmF and SnF2 reduced the erosive calcium loss in unbrushed specimens to 58-67% (enamel) and 23-31% (dentin) of control. Calcium release increased with increasing brushing strokes prior to erosion and amounted to 70-88% (enamel) and 45-78% (dentin) of control after 500 brushing strokes. Brushing reduced the surface concentration of fluoride (AmF), tin (SnF2) and titanium (TiF4). SEM revealed that surface precipitates were affected by long-term brushing. Brushing reduced the protective potential of TiF4, AmF and SnF2 solutions. However, considering a small number of brushing strokes, the protective effect of fluoride solutions is only slightly affected by brushing abrasion.

Protection of sound enamel and artificial enamel lesions against demineralisation: caries infiltrant versus adhesive

OBJECTIVE

To compare the protective potential of a conventional adhesive, a caries infiltrant and a combination of both against acidic challenge in vitro.

METHODS

One-hundred-and-fifty discs from bovine lower central incisors were fabricated. Seventy-five samples remained untreated, whereas the other half was subjected to a demineralisation process (14 days, acidic buffer, and pH 5) to create artificial enamel lesions. Specimens were then radioactively irradiated, and each 15 sound and demineralised specimens were treated with a caries infiltrant (Icon, DMG), an unfilled adhesive (Heliobond, IvoclarVivadent) or a combination of infiltrant and adhesive. Specimens treated with the adhesive followed by a flowable composite (TetricEvoFlow, IvoclarVivadent) served as positive control, while untreated specimens served as negative control. All samples were then subjected to lactic acid for 3 weeks at pH 4. Loss of apatite was determined using the radiochemical method of liquid scintillation. Data were statistically analysed by Kruskal-Wallis-test, one-way ANOVA and Scheffe's post hoc tests (p ≤.05).

RESULTS

In both sound enamel and artificial caries lesions, untreated specimens showed the highest rate of apatite loss, whereas enamel treated with the adhesive and the flowable composite showed almost complete protection surface against dissolution. The caries infiltrant, the adhesive and the combination of both were able to decrease enamel dissolution, but the adhesive and the combination of adhesive and infiltrant were more effective than the infiltrant alone.

CONCLUSION

Within the limitations of this in vitro study, the application of an adhesive (alone or in combination with the caries infiltrant) is more effective to protect enamel dissolution than the infiltrant alone.

Laboratory evaluation of toothbrush/toothpaste abrasion resistance after smooth enamel surface sealing

OBJECTIVES

The use of dental sealants has been extended to smooth enamel surfaces. The present study was conducted to test the in vitro performance of four sealants with different characteristics (highly and lowly filled, self-etching features).

MATERIALS AND METHODS

Eighty human teeth (lower incisors and premolars) were randomly divided into following sealant test groups: ProSeal(TM), LightBond(TM), OrthoSolo(TM), and Seal&Protect(®). Twenty untreated teeth served as a control group. Tooth brushing was conducted for a period of time simulating 12, 18, and 24 months. During the toothbrush abrasion protocol, the specimens were subjected to thermal and acidic challenge. Sealant thickness was determined with μCT imaging, and qualitative and quantitative surface effects were investigated using stereo microscopy and raster electron microscopy, respectively. Data were subjected to t test or Kruskal-Wallis/Mann-Whitney tests (alpha, 5%).

RESULTS

The wear behavior and film integrity of highly filled sealants were superior to lowly filled sealants. Even after 1 year of tooth brushing, significant surface deterioration with deleterious loss of enamel and discoloration was observed in all tested materials (χ(2) = 15.349; P = 0.004). The size of the observed defects increased over time.

CONCLUSION

These results suggest that the application of sealants on smooth enamel surfaces should be limited to special indications, and their usefulness has to be revisited.

CLINICAL RELEVANCE

Based on the results of this in vitro study, the general overall application of enamel sealants needs to be questioned.

Resin infiltration of natural caries lesions

Infiltration of non-cavitated caries lesions with light-curing resins could lead to an arrest of lesion progression. The aim of this study was to evaluate the penetration of a conventional adhesive into natural enamel caries after pre-treatment with two different etching gels in vitro. Extracted human molars and premolars showing proximal white-spot lesions were cut across the lesions perpendicular to the surface. Corresponding lesion halves were etched for 120 sec with either 37% phosphoric acid gel (H(3)PO(4)) or 15% hydrochloric acid gel (HCl), and subsequently infiltrated with an adhesive. Specimens were observed by confocal microscopy. Mean penetration depths (SD) in the HCl group [58 (37) microm] were significantly increased compared with those of the H(3)PO(4) group [18 (11) microm] (p < 0.001; Wilcoxon). It can be concluded that etching with 15% hydrochloric acid gel is more suitable than 37% phosphoric acid gel as a pre-treatment for caries lesions intended to be infiltrated.

Wear resistance and surface roughness of a newly devised adhesive patch for sealing smooth enamel surfaces

A laboratory study assessed the wear resistance and surface roughness after chemical and mechanical wear of a newly devised adhesive patch when used as a smooth surface sealant. Forty-eight enamel discs were prepared from bovine lower central incisors. Sixteen specimens were treated with one of two sealing options: the prototype of an adhesive patch or a flowable resin. Unsealed enamel served as the positive control. Wear and surface roughness was measured at baseline and after all the samples were immersed in saliva or lactic acid (n=8 per treatment group) for up to 21 days, during which the experimental and control enamel surfaces were exposed to 10 double-stroke toothbrush cycles per day. In saliva and lactic acid, the sealed specimens showed no significant wear during the observation period (p=0.1841). Only untreated specimens exposed to lactic acid showed a significant substance loss after 14 and 21 days (p=0.0186). The patch and flowable resin showed no differences in surface roughness values at respective times (p=0.385); whereas the surface roughness of the unsealed specimens in lactic acid was significantly higher (p<0.0001). It was concluded that the adhesive patch under investigation merits further study to assess its potential as a sealant for smooth enamel surfaces.

Water uptake of bonding systems applied on root dentin surfaces: a SEM and confocal microscopic study

OBJECTIVES

Dentin adhesives have been proposed as desensitizing agents to seal exposed root dentin surfaces. Simplified 'one-step' dentin adhesives are highly permeable to water. The authors hypothesized that a lactic acid challenge may increase permeability of simplified adhesives and may induce fast degradation of bonding. This phenomenon adversely affects their durability as long term desensitizing agents. The aim of this in vitro study was to evaluate the ability of four dentin adhesives to seal root dentin surfaces that were exposed to water and lactic acid challenges.

METHODS

Four commercially-available dentin adhesives were applied with a small sponge to the root dentin of extracted human molars as de-sensitizing agents. Impression replicas of the adhesive-covered root dentin were fabricated after water immersion, as a control, and after lactic acid challenge. The replicas were examined with SEM for quantitative comparison of fluid droplet formation on the surfaces. The bonded specimens were also examined using reflected light confocal microscopy.

RESULTS

Replicas of water droplets were observed on the adhesive surfaces, by SEM which corresponded with direct confocal observation of blisters and voids from the surface of the bonded specimens. There were significantly more water droplets from samples that were subjected to lactic acid challenge than water only immersion.

SIGNIFICANCE

Although the dentin adhesives examined were able to cover exposed root dentin, they all exhibited fluid transudation through the polymerized adhesives. Dentin adhesives were also susceptible to surface degradation after lactic acid challenge. As simplified self-etch adhesives were highly water permeable and exhibited the most extensive surface damage, they may not be the best adhesives to be used for long-term dentin desensitization. These preliminary in vitro findings warrant validation in vivo.

Adhesiveness of dental resin-based restorative materials investigated with atomic force microscopy

This study aimed to show that the polymerization contraction of dental methacrylate-based materials, when used as adhesives on hard substrate, produces voids at the material-substrate interface. This phenomenology is closely related with the nanoleakage and the sealing ability of these materials. One prime/bond system, three restorative composite resins, and one orthodontic bonding system were cured by using mirror-like glass slides as a compliance-free reference substrate. The adhesive surface was analyzed by atomic force microscopy, and the polymerization contraction of bulk material was tested by laser beam-scanning method. Nanoperiodic structure of three-dimensional (3D) images, section analysis, and roughness characteristics (R(a) and R(z)) indicated that polymerization contraction produced voids at the interface. When the adhesive surface was exposed to oral simulating fluids (water, ethanol, and lactic acid solutions), hydrolytic degradation involved some hundreds of nanometers in depth. In visible light-cured (VLC) materials, the interface porosity decreased when an irradiation pause ( approximately 2 min) was carried out during gelation.

In vitro microleakage of adhesive-sealed dentin with lactic acid and saliva exposure: a radio-isotope analysis

OBJECTIVES

The aim of this study was to evaluate the dentin-protective potential of two dentin-bonding systems (Syntac and Clearfil SE Bond) on artificial saliva and lactic acid exposure.

METHODS

Radiochemical analysis in combination with polarization-microscopy was used in the current study. Different applications in MOD preparations in irradiated human molars were compared. Untreated cavities and cavities covered with flowable resin served as controls. Forty-eight specimens were immersed in artificial saliva (pH 7.5), 48 in lactic acid (pH 4). Activity of (32)P was measured between days 1 and 21 and loss of mineralized tissue was estimated.

RESULTS

In lactic acid, cavities sealed with single bond, double bond or bond plus cavity sealer application resulted in significantly lower mineralized tissue loss compared to negative controls (p < 0.05). Upon both saliva and lactic acid exposure, bonding plus sealer application proved to be the most protective treatment (p < 0.05).

CONCLUSIONS

Based on these in vitro findings it may be advisable to use a filled cavity sealer or a flowable resin to protect dentin from demineralization. The radiochemical analysis appeared to be valuable in evaluating the protective potential of bonding agents against dentin demineralization.

The effect of magnification on the iatrogenic damage to adjacent tooth surfaces during class II preparation

OBJECTIVES

To determine the amount of damage to adjacent surfaces during cavity preparation of approximal box-cavities by using either no magnification or an individually adapted surgical telescope.

MATERIALS AND METHODS

Nine dentists prepared in a mannequin head 4 approximal (class II) box-cavities without magnification using a high speed handpiece with lighting from a dental unit. At least 2 months later the test was repeated with a surgical telescope system with integrated light. The degree of damage the 72 adjacent surfaces suffered was determined.

RESULTS

The average time needed to prepare one cavity was 14.9min without and 18.3min with magnification (p=0.01). Altogether, 29.7% of adjacent area were damaged when no surgical telescopes were used and 34.5% when surgical telescopes were applied (p>0.05). When the mesial-facing and distal-facing surfaces were analysed independently a statistically significant increase of damage was found on distal surfaces (p=0.03) when using surgical telescopes. Seventy surfaces (=97%) had a preparation trauma.

CONCLUSIONS

Surgical telescopes do not decrease damage of adjacent tooth surfaces.