Secondary caries in situ around fluoride-releasing light-curing composites: a quantitative model investigation on four materials with a fluoride content between 0 and 26 vol%

Fluoride releasing in polymer blends of poly(ethylene oxide) and poly(methyl methacrylate)

Introduction: Polymethyl methacrylate is a polymer commonly used in clinical dentistry, including denture bases, occlusal splints and orthodontic retainers. Methods: To augment the polymethyl methacrylate-based dental appliances in counteracting dental caries, we designed a polymer blend film composed of polymethyl methacrylate and polyethylene oxide by solution casting and added sodium fluoride. Results: Polyethylene oxide facilitated the dispersion of sodium fluoride, decreased the surface average roughness, and positively influenced the hydrophilicity of the films. The blend film made of polymethyl methacrylate, polyethylene oxide and NaF with a mass ratio of 10: 1: 0.3 showed sustained release of fluoride ions and acceptable cytotoxicity. Antibacterial activity of all the films to Streptococcus mutans was negligible. Discussion: This study demonstrated that the polymer blends of polyethylene oxide and polymethyl methacrylate could realize the relatively steady release of fluoride ions with high biocompatibility. This strategy has promising potential to endow dental appliances with anti-cariogenicity.

Comparative Evaluation of Fluoride Release and Compressive Strength of Biodentine Modified Using Sodium Fluorosilicate and Hydrofluoric Acid: An In-Vitro Study

Introduction Calcium trisilicate derivatives have widely been used as dentin and enamel substitutes recently. These cements have excellent biological properties, but they do not show fluoride release. The release of fluoride from dental materials is a very important property of a material in restorative applications as fluoride confers antibacterial and anti-cariogenic properties. This study thus attempts to incorporate fluoride in the form of sodium fluorosilicate and hydrofluoric acid into Biodentine to assess its fluoride-releasing properties. Methods Biodentine was modified by adding 7% sodium fluorosilicate in the powder and 10% hydrofluoric acid to the liquid. Fluoride release was measured using a sodium 2-(parasulfophenylazo)-1,8-dihydroxy-3,6-naphthalenedisulfonate (SPADNS) spectrophotometer after 1, 3, 7, 14, 21, and 28 days. The compressive strength of the modified material was measured using a universal testing machine. Results Fluoride release was found to be higher in the group that had both powder and liquid modified than in groups in which either of the components were modified. The difference was found to be statistically significant (p<0.001). Conclusion Incorporation of fluoride in Biodentine is feasible with acceptable release of fluoride without adversely affecting the compressive strength of the Biodentine.

Demineralization prevention with a new antibacterial restorative composite containing QASi nanoparticles: an in situ study

OBJECTIVES

To investigate whether a newly developed dental composite with quaternary ammonium silica dioxide (QASi) nanoparticles incorporated with other fillers into the restorative material demonstrates antibacterial activity by reducing enamel demineralization in an in situ gap model.

MATERIALS AND METHODS

Twenty subjects wearing a lower removable partial denture (RPD) with acrylic flanges on both sides of the mouth were recruited into the 4-week in situ study. The gap model consisted of an enamel slab placed next to a composite, separated by a 38-μm space. In the split-mouth design on one side of the RPD, the composite was the Nobio Infinix composite (Nobio Ltd., Kadima, Israel), and the contralateral side used a control composite. Each participant received enamel slabs from one tooth. The gap model was recessed into the RPD buccal flange, allowing microbial plaque to accumulate within the gap. After 4 weeks of continuous wearing, decalcification (∆Z mineral loss) of the enamel slabs adjacent to the gap was determined by cross-sectional microhardness testing in the laboratory.

RESULTS

The ∆Z for the antibacterial composite test side was 235±354 (mean±standard deviation [SD]; data reported from 17 participants) and statistically significantly lower compared to ∆Z of the control side (774±556; mean±SD) (paired t-test, P<0.0001; mean of test minus control -539 (SD=392), 95% confidence interval of difference: -741, -338).

CONCLUSIONS

This in situ clinical study showed that composites with QASi antibacterial particles significantly reduced demineralization in enamel adjacent to a 38-μm gap over a 4-week period in comparison to a conventional composite.

CLINICAL RELEVANCE

Composites with QASi nanoparticle technology have the potential to reduce the occurrence of secondary caries.

TRIAL REGISTRATION

ClinicalTrials.gov #NCT04059250.

Assessment of Microstructure and Release of Fluoride Ions from Selected Fissure Sealants: An In Vitro Study

The aim of this study was to compare fluoride release from four selected fissure sealants: fissure sealant manufactured by Arkona, Helioseal F, Helioseal F Plus, and Conseal. Tested parameters included emission of fluoride ions into saline (0.9% NaCl) and deionized water over a period of 2 weeks. Values were recorded after 1, 3, 24, 48, 72, and 96 h, and then after 1 and 2 weeks. All sealants were characterized by a constant fluoride release level. The highest fluoride release level was noted for Conseal (0.0169 ppm/mg), while the lowest was noted for fissure sealant manufactured by Arkona (0.063 ppm/mg). Fissure sealants, which contain fluoride, release it not only during polymerization, but also for several days after application. The use of fissure sealants whose composition includes fluoride is an effective method of preventing tooth decay.

Novel fluoride rechargeable dental composites containing MgAl and CaAl layered double hydroxide (LDH)

OBJECTIVE

This study aims to incorporate 2:1 MgAl and 2:1 CaAl layered double hydroxides (LDHs) in experimental dental-composites to render them fluoride rechargeable. The effect of LDH on fluoride absorption and release, and their physico-mechanical properties are investigated.

METHODS

2:1 CaAl and 2:1 MgAl LDH-composite discs prepared with 0, 10 and 30wt% LDH were charged with fluoride (48h) and transferred to deionized water (DW)/artificial saliva (AS). Fluoride release/re-release was measured every 24h (ion-selective electrodes) with DW/AS replaced daily, and samples re-charged (5min) with fluoride every 2 days. Five absorption-release cycles were conducted over 10 days. CaAl and MgAl LDH rod-shaped specimens (dry and hydrated; 0, 10 and 30wt%) were studied for flexural strength and modulus. CaAl and MgAl LDH-composite discs (0, 10, 30 and 45wt% LDH) were prepared to study water uptake (over 7 weeks), water desorption (3 weeks), diffusion coefficients, solubility and cation release (ICP-OES).

RESULTS

CaAl LDH and MgAl LDH-composites significantly increased the amount of fluoride released in both media (P<0.05). In AS, the mean release after every recharge was greater for MgAl LDH-composites compared to CaAl LDH-composites (P<0.05). After every recharge, the fluoride release was greater than the previous release cycle (P<0.05) for all LDH-composites. Physico-mechanical properties of the LDH-composites demonstrated similar values to those reported in literature. The solubility and cation release showed a linear increase with LDH loading.

SIGNIFICANCE

LDH-composites repeatedly absorbed/released fluoride and maintained desired physico-mechanical properties. A sustained low-level fluoride release with LDH-composites could lead to a potential breakthrough in preventing early stage carious-lesions.

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.

Effect of CaF2 Content on Rate of Fluoride Release from Filled Resins

Information on the time-dependent release of fluoride from filled resins containing fluoride particles as a function of particle content and solution pH is limited. This study characterized the fluoride ion release from filled resins containing CaF2 particles as a function of filler content and pH. Urethane dimethacrylate and triethylene glycol dimethacrylate resins were used to make filled-resin disks containing 9.09, 23.08, or 33.33 mass% CaF2 filler. Fluoride ion release for the 9.09 mass% concentration was independent of pH. Increasing the filler content from 9.09 to 33.33 mass% increased the fluoride release rate in pH 4.0 buffer solution, because of greater surface degradation. Fluoride ion release from disks stored in pH 6.0 buffer solutions occurred mainly by diffusion from disk surfaces, while fluoride release from disks in pH 4.0 buffers was controlled by diffusion from disk surfaces and degeneration of the resin matrix, which exposed more CaF2 particle surface area.

Evaluation of Fluoride-Releasing Dental Materials by Means of in Vitro and in Vivo Demineralization Models: Reaction Paper

It is essential that we understand the dose-response mechanisms of fluoride delivered intra-orally at sites in intimate contact with dental tissues. Many studies show that extremely low levels of fluoride can inhibit caries. However, few of these studies provide a direct comparison between fluoride release and the inhibition of secondary caries. For this, laboratory, animal, and in situ caries models are required which can predict clinical efficacy. This paper supplements Dr. Erickson's presentation (Erickson and Glasspoole, 1995) by illustrating the adaptation of currently used demineralization and caries models to the development and evaluation of fluoride-containing resin materials. As representative of this class of material, those which release by ion-exchange are reviewed. It is concluded that model systems designed for topical fluorides and non-fluoride dental materials can be adapted for use with fluoride-releasing materials. Further, the use of materials with a long history of clinical efficacy as inhibitors of marginal caries, such as the silicates, is a useful means of determining target values for developing new fluoride-releasing materials. The minimum concentration of F- that must be maintained in the immediate vicinity of a material to provide caries protection at localized sites is not yet known. Nor is it known what combination of release rate, pattern of release, and duration of release is needed to optimize either localized or full-mouth protection. These issues deserve closer examination to aid our understanding of F- action when delivered from dental materials, so that improved caries model systems can be designed for use with dental materials.

Review of Fluoride Release and Secondary Caries Reduction by Fluoridating Composites

Secondary caries is one of the main reasons to replace restorations. Due to the pressure to eliminate or reduce the number of amalgam restorations in many countries, fluoride-releasing composites have gained in importance. This review limits itself to information relevant to secondary caries near fluoride-releasing anterior or posterior composites. Although many parameters are very important in composite functioning, a weak spot near a filling is always the interface and the locally present interfacial gap between the composite and the hard tissues, where secondary caries takes place due to plaque action. Relevant parameters such as the amount of fluoride released in vitro in μg.cm-2, the rate of fluoride release, and the period of fluoride release are compared for several composites. In vitro F release has been measured for some fluoridating composites for more than five years. Unfortunately, F release in vivo or in situ cannot be measured adequately.

The fluoride released by the composites considered is partly taken up by the surrounding tissues, partly released to the saliva, and partly efficacious in possible marginal gaps and defects. A major part of this paper pertains to in vitro, in situ, and in vivo secondary caries reduction experiments. In vitro caries reductions in the order of 40% from F-releasing composites vs. controls have been found. In in situ model investigations under plaque and saliva conditions, secondary caries reduction percentages of between 40 and 50% have been experimentally measured in gaps in enamel near F composites.

Surface Changes of Fluoride-Releasing Composites: a Comparison of in Vivo and in Vitro Results

Fluoride-releasing composites lose fluoride very slowly over time. An interesting question is the possible change in mechanical properties related to the F release. If this happens, it might be expected that the mechanical properties of the outer surface of a fluoridating composite are affected first. The purpose of this study was to investigate in vivo and in vitro the changes in surface microhardness and surface structure of three fluoride-releasing composites and a non-F-containing control after 28 days. In the in vitro experiment, the composites were stored in tap water at 37°C. The results show that all composites stored in water were significantly softened after 28 days.

In vivo, however, a very different picture emerged: The surface microhardness of the fluoride-releasing composites did not change significantly. In vitro, the data indicate that the amount of softening of the fluoridating composites is related to the amount of fluoride released. No relation was found between the amount of F released in one month in vitro and the microhardness changes in vivo. SEM micrographs of fluoridating composites do not reflect the microhardness changes mentioned.

Effect of radiant heat and ultrasound on fluoride release and surface hardness of glass ionomer cements

PURPOSE

The purpose of this investigation was to evaluate the influence of radiant heat and ultrasound on fluoride release and surface hardness of 3 glass ionomer cements (GICs).

METHODS

There were 3 experimental groups for each GIC; in group 1, the specimens were left to set without any treatment; in group 2, the specimens were irradiated for 2 minutes using a LED unit; and in group 3, ultrasound was applied using a scaler for 55 seconds on the specimen surface. Fluoride release measurements were performed daily for 7 days and at days 14 and 28. Surface hardness of the tested GICs was determined using Vickers method. The measurements were performed 24 hours and 7 days after mixing. Statistical analysis of the data was made using 1-way ANOVA and Tukey's and Bonferroni post hoc tests (α = 0.05).

RESULTS

Radiant heat during setting reduced the fluoride release and increased the surface hardness of GICs (p&lt;0.05). Ultrasonic treatment also reduced the fluoride release and increased the surface hardness (p&lt;0.05) of GICs but in lower extent. Among the GICs there were differences in fluoride release and surface hardness properties depending on their composition (p&lt;0.05).

CONCLUSIONS

Radiant heat and ultrasonic treatments may be useful methods for GIC restorations in order to achieve faster adequate initial mechanical properties.

Fluoride ion release and solubility of fluoride enriched interim cements

STATEMENT OF PROBLEM

Interim and definitive restorations cemented with interim cements for a prolonged interval are susceptible to bacterial infiltration and caries formation.

PURPOSE

The purpose of this in vitro study was to evaluate the long-term fluoride release and solubility of aged ZnO-based interim cements enriched separately with 0.4% NaF and SnF2.

MATERIAL AND METHODS

Four different brands of cements (Tempbond, Tempbond NE, Procem, and Freegenol) were tested for fluoride release and solubility. For every test, 6 disk specimens of each cement with NaF and SnF2, and 6 with no fluoride enrichment (control) were fabricated, for a total of 72 specimens. The disks were incubated in deionized water. Fluoride ion release was recorded at 1, 7, 14, 21, 63, 91, and 182 days. Solubility was calculated as weight percent after 90 days of incubation. The data were analyzed by analysis of variance with repeated measures and the Tukey honestly significant difference post hoc test (P<.05).

RESULTS

Cements mixed with fluorides released fluoride ions for at least 182 days. Cements mixed with NaF released more fluoride ions than those mixed with SnF2 (P<.001). The cumulative release rates from all the tested cements mixed with either NaF or SnF2 were linear with respect to t(½) (r>.97), indicating a diffusion-controlled fluoride release. Cement and fluoride types were the main affecting factors in fluoride ion release. The addition of fluorides slightly increased the solubility of the cements.

CONCLUSIONS

Given their long-term sustained and diffusive controlled release, these fluorides, particularly NaF when mixed with ZnO-based interim cements, may be useful for caries prevention under provisionally cemented restorations.

Fluoride release and recharge abilities of contemporary fluoride-containing restorative materials and dental adhesives

The aim of this study was to evaluate the fluoride release of five fluoride-releasing restorative materials and three dental adhesives, before and after NaF solution treatment. Five restorative materials (Fuji IX GP, GC Corp.; Ketac N100, 3M ESPE; Dyract Extra, Dentsply; Beautifil II, Shofu Inc.; Wave, SDI) and three dental adhesives (Stae, SDI; Fluorobond II - Shofu Inc.; Prime & Bond NT, Dentsply) were investigated before and after NaF solution treatment. A fluoride ion-selective electrode was to measure fluoride concentrations. During the 86-day period before NaF solution treatment, Fuji IX GP released the highest amount of fluoride among the restorative materials while Prime & Bond NT was the highest among the dental adhesives. After NaF solution treatment, Fuji IX GP again ranked the highest in fluoride release among the restorative materials while Fluorobond II ranked the highest among dental adhesives. It was concluded that the compositions and setting mechanisms of fluoride-containing dental materials influenced their fluoride release and recharge abilities.

Step-by-step full mouth rehabilitation of a nasopharyngeal carcinoma patient with tooth and implant-supported prostheses: A clinical report

This clinical report presents a 46-year-old man diagnosed with nasopharyngeal carcinoma with the chief complaint of masticatory and speech deficiency because of radiation therapy. After a period of controlling post radiation caries, the patient was rehabilitated with tooth and implant supported metal ceramic restorations following surgical and endodontic intervention.

Fluoride release, recharge and mechanical property stability of various fluoride-containing resin composites

AIM

To determine the fluoride release and recharge of three fluoride-containing resin composites when aged in deionized water (pH 6.5) and lactic acid (pH 4.0) and to assess mechanical properties of these composites following aging.

METHODS

Three fluoride-containing resin composites were analyzed in this study; a new giomer material named Beautifil II, Gradia Direct X, and Tetric EvoCeram. A glass ionomer cement, Fuji IX Extra, was also analyzed for comparison. Specimens were fabricated for two test groups: group 1 included 10 disc specimens initially aged 43 days in deionized water (five specimens) and lactic acid (five specimens). The fluoride release from these specimens was measured using a fluoride-specific electrode on nine specific test days during the aging period. Following 49 days of aging, each specimen was recharged in 5000 ppm neutral sodium fluoride solution for 5 minutes. Specimen recharge was then repeated on a weekly basis for 3 weeks. The subsequent fluoride rerelease was measured at 1, 3, and 7 days after each recharge episode. Group 2 included six disc specimens aged for 3 months in deionized water (three specimens) and lactic acid (three specimens). The hardness and elastic modulus of each specimen was measured using nano-indentation at intervals of 24 hours, 1 month, and 3 months after fabrication. Two-way factorial analysis of variance (ANOVA) and post-hoc (Tukey) testing was used to assess the influence of storage media (two levels) and composite type (three levels) on the fluoride release, fluoride rerelease, hardness, and elastic modulus of the assessed materials. The level of significance was set at p=0.05.

RESULTS

All three composites demonstrated fluoride release and recharge when aged in both deionized water and lactic acid. The cumulative fluoride released from Beautifil II into both media was substantially greater than the fluoride released from Gradia Direct X and Tetric EvoCeram after 43 days aging and was significantly (p<0.05, ANOVA, Tukey test) greater during several analysis periods. Beautifil II demonstrated the greatest recharge ability of the three composites over the 3-week recharge period in both media. Fuji IX Extra demonstrated a significantly (p<0.05) greater fluoride release and recharge compared with the three resin composites. The elastic modulus and hardness of the three composites did not decrease significantly (p<0.05) with fluoride release or fluid uptake over the 3-month aging period, in either media.

CONCLUSION

The three composites in the present study demonstrated fluoride release (Beautiful II > Gradia Direct X > Tetric EvoCeram) and fluoride recharge (Beautiful II > Gradia Direct X > Tetric EvoCeram). This capability raises the possibility of fluoride-containing composites exhibiting a lower incidence of recurrent caries than non fluoride–containing composites. The mechanical properties of each composite did not diminish with aging and fluoride release over the testing period.

Review on fluoride-releasing restorative materials--fluoride release and uptake characteristics, antibacterial activity and influence on caries formation

OBJECTIVES

The purpose of this article was to review the fluoride release and recharge capabilities, and antibacterial properties, of fluoride-releasing dental restoratives, and discuss the current status concerning the prevention or inhibition of caries development and progression.

METHODS

Information from original scientific full papers or reviews listed in PubMed (search term: fluoride release AND (restorative OR glass-ionomer OR compomer OR polyacid-modified composite resin OR composite OR amalgam)), published from 1980 to 2004, was included in the review. Papers dealing with endodontic or orthodontic topics were not taken into consideration. Clinical studies concerning secondary caries development were only included when performed in split-mouth design with an observation period of at least three years.

RESULTS

Fluoride-containing dental materials show clear differences in the fluoride release and uptake characteristics. Short- and long-term fluoride releases from restoratives are related to their matrices, setting mechanisms and fluoride content and depend on several environmental conditions. Fluoride-releasing materials may act as a fluoride reservoir and may increase the fluoride level in saliva, plaque and dental hard tissues. However, clinical studies exhibited conflicting data as to whether or not these materials significantly prevent or inhibit secondary caries and affect the growth of caries-associated bacteria compared to non-fluoridated restoratives.

SIGNIFICANCE

Fluoride release and uptake characteristics depend on the matrices, fillers and fluoride content as well as on the setting mechanisms and environmental conditions of the restoratives. Fluoride-releasing materials, predominantly glass-ionomers and compomers, did show cariostatic properties and may affect bacterial metabolism under simulated cariogenic conditions in vitro. However, it is not proven by prospective clinical studies whether the incidence of secondary caries can be significantly reduced by the fluoride release of restorative materials.

Microhardness evaluation around composite restorations using fluoride-containing adhesive systems

The purpose of this study was to evaluate the microhardness of dental enamel around composite restorations bonded with fluoride-containing adhesive systems (FCAS), after thermo- and pH-cycling protocols. Standardized cylindrical cavities were prepared on enamel surfaces of 175 dental fragments, which were randomly assigned into seven experimental groups (n=25). Four groups used FCAS: Optibond Solo (OS); Prime&Bond 2.1 (PB); Syntac Sprint (SS) and Tenure Quick (TC). Other groups consisted of "Sandwich" technique restoration (STR) (glass ionomer liner + hydrophobic adhesive resin /restorative composite) or used Single Bond with (SB) or without (SBWC) cycling protocols. Adhesive systems were applied according to manufacturers' instructions and cavities were restored with a microfilled composite (Durafill VS). After finishing and polishing, all groups were submitted to 1,000 thermal cycles (5 ºC and 55 ºC) and to demineralization (pH 4.3) and remineralization (pH 7.0) cycling protocols, except for SBWC group. The Knoop microhardness of enamel surfaces were measured around restorations. Indentations were recorded at 150, 300 and 450-mm from the cavity wall. Data were analyzed by two-way ANOVA and Duncan's Test (a=0.05%). Means ± SD of enamel microhardness for the groups were (Kg/mm²): SBWC: 314.50 ± 55.93ª ; SB: 256.78 ± 62.66b; STR: 253.90 ± 83.6b; TQ: 243.93 ± 68.3b; OS: 227.97 ± 67.1c; PB: 213.30 ± 91.3d; SS: 208.73 ± 86.6d. Means ± SD of microhardness for the distances 150, 300, 450mm from the cavity wall were, respectively: 234.46 ± 77.81ª; 240.24 ± 85.12ª; 262.06 ± 79.46b. SBWC group, which was not submitted to thermo- and pH-cycling protocols, showed the highest enamel microhardness mean value and the FCAS resulted in lower microhardness values. At 450 mm from the cavity wall, the enamel microhardness increased significantly.

Antibacterial activity of silver inorganic agent YDA filler

YDA filler is an antibacterial agent that is currently in commercial dental use. In this study, we attempted to determine whether it exerts an antibacterial effect on human saliva bacteria, and to determine whether it can be used in dental materials. CFUs in 1 mL stimulated human saliva were examined using blood agar and mitis salivarius agar after immersion, with or without YDA filler. The antibacterial effect was compared with that of Ketac-Silver. Dental materials containing 5% wt YDA filler were prepared for in vitro testing on S. mutans and A. viscosus. Furthermore, we examined the in vitro cytotoxicity of experimental MMA resin containing YDA filler on HeLa cells. Human saliva bacteria and mutans streptococci showed reduced viability following exposure to YDA filler after 12 h. The concentration of silver ions released by YDA filler was below 1 ppm after 12 h. Two tested strains showed reduced viability following exposure to dental materials containing YDA filler. In another experiment, MMA resin containing YDA filler did not show cytotoxicity on HeLa cells after 24- and 48-h exposure. Thus, YDA filler may help in the development of antibacterial dental materials, such as composite resin, glass-ionomer or temporary cement.

COMPARISON OF SHORT-TERM IN VITRO FLUORIDE RELEASE AND RECHARGE FROM FOUR DIFFERENT TYPES OF PIT-AND-FISSURE SEALANTS

OBJECTIVE

The purpose of this in vitro study was to assess the effects of four commercial fluoride-containing pit-and-fissure sealants on caries prevention.

MATERIALS AND METHODS

Four sealants containing fluoride, Fuji III, Fuji III LC (GC Co., Tokyo), Teethmate F-1 (Kuraray Medical Co., Osaka) and Helioseal F (Vivadent Co., Liechtenstein) were used to investigate fluoride release and recharge. Disk-shaped specimens prepared from each material were immersed in distilled water at a temperature of 37 degrees C. After seven days, acidulated phosphate fluoride solution (APF) was applied to each specimen, and it was then again immersed in distilled water for 14 days. We then determined how much fluoride had been released into the immersing water. Fuji III LC was used with APF solution to investigate the fluoride uptake.

RESULTS

Fuji III had the highest fluoride release, and Fuji III LC had the highest fluoride recharge. Helioseal F and Teethmate F-1 had almost no fluoride recharge. Fuji III LC/APF had a higher fluoride uptake to enamel than Fuji III LC.

CONCLUSIONS

These results suggest that GIC-sealants in the oral cavity can serve as a fluoride reservoir and contribute to retaining a low fluoride level in oral fluids, thereby preventing caries.

Detection of in vitro demineralization adjacent to restorations using quantitative light induced fluorescence (QLF)

AIM

Quantitative light-induced fluorescence (QLF) is a technique for the detection, quantification, and longitudinal monitoring of early carious lesions. The technique is non-destructive and can be used in vivo. Using the natural fluorescence of teeth, and the loss of such fluorescence in demineralized enamel, QLF is a repeatable and valid optical caries monitor. Previously used in smooth and occlusal surfaces, the purpose of this pilot study was to determine if QLF could detect, and longitudinally monitor, demineralization adjacent to a range of restorative materials.

METHODS

Fifteen previously extracted lower third molars were selected based upon the lack of any visible demineralization. A single burr hole was placed on the buccal surface and the cavity restored with amalgam, composite, compomer, glass ionomer or a temporary filling material. The buccal surface was then coated in an acid resistant nail varnish leaving an exposed area around the restoration and also a similar sized control region. The teeth had QLF images taken at baseline and were then subjected to a demineralizing buffer, further QLF images were subsequently taken at 72 and 144 h. Transverse microradiography was used to confirm the presence of early, subsurface lesions at the completion of the cycle (144 h). QLF images were analyzed by a single blinded examiner and values for change in radiance fluorescence were computed. These values were recorded as loss of radiance fluorescence loss integrated over area of lesion and expressed as DeltaQ.

RESULTS

The appearance of each material under QLF and the change in fluorescence is described. Amalgam, glass ionomer and the temporary material all exhibited reduced fluorescence, while composite and compomer showed increased fluorescence, when compared with surrounding enamel. There was no change in fluorescence of the materials when subjected to experimental demineralizing conditions. Readings at 72 and 144 h demonstrated demineralization adjacent to the restorations and at the exposed control. Significant differences were detected between baseline, 72 and 144 h using ANOVA on all restorations with the exception of compomer where significance was noted between baseline and 144 h, p>0.05.

CONCLUSIONS

This pilot study has demonstrated the ability for QLF to detect and monitor secondary caries. Analysis techniques should be based upon the subtraction of baseline DeltaQ scores from subsequent images. Further research is required to assess the ability of QLF to detect secondary lesions in vivo.

In vivo vs in vitro anticariogenic behavior of glass-ionomer and resin composite restorative materials

OBJECTIVE

To evaluate the in vivo vs the in vitro anticariogenic potential of glass-ionomer and resin composite restoratives, utilizing a standardized interfacial gap model.

METHODS

(a) In vitro study. Box shaped cavities were prepared at the buccal surfaces of extracted premolars limited to enamel. The incisal cavity walls received no treatment and were covered with 40 microm-thick metal spacers. The cavities were restored with a glass-ionomer (Ketac-Fil, n=8) and a fluoride-free resin composite (Scotchbond MP Plus/Z100, n=8). After 4 weeks immersion in an acidic gel (pH 4), thin sections were produced and examined under polarized-light microscopy.(b) In vivo study. Four low caries activity volunteers, with first four premolars, each planned to be extracted for orthodontic reasons, participated in the study. Cavities were prepared as before and filled contralaterally per patient with glass-ionomer (n=8) and resin composite (n=8). After 6 months in vivo, the teeth were extracted, sectioned and investigated by polarized-light microscopy, Raman microspectroscopy and SEM-EDS X-ray microanalysis. Unpaired t-test (lesion dimensions) and one-way ANOVA and Newman-Keuls tests (Ca, P wt%, Ca/P ratios) were used to identify statistically significant differences in lesion analysis (alpha=0.05).

RESULTS

(a) In vitro study. All restorations developed lesions at incisal and cervical margins. At gap-free regions glass-ionomers showed reduced lesion dimensions compared to those of composites (p<0.05). At regions with gaps, no significant differences were found in lesion depth between the restorative groups tested. Lesion length was increased in composite, and decreased in glass-ionomer, whereas lesion depth in both restorative groups was increased in comparison to gap-free regions (p<0.05).(b) In vivo study. No lesions were observed at gap-free regions. At gap regions, 75.5% of glass-ionomer and 62.5% of composite restorations developed lesions. The lesion dimensions were significantly greater in glass-ionomer (p<0.05). A reduction in PO4(3-), CO3(2-), Ca and P was found in lesions compared to intact tissues. No F was detected and no CaF2 lattice vibrations were found at the enamel margins facing the gap adjacent to glass-ionomers.

SIGNIFICANCE

In the presence of a standardized interfacial gap, no preventive effect was exerted in vivo from the glass-ionomer to protect the adjacent enamel wall from secondary caries attack. The lack of any correlation between the in vivo and in vitro models tested implies that artificial caries experiments have a negligible clinical relevance in predicting the in vivo effect.

Effects of fluoride release from bis-GMA/TEGDMA resin regulated by gamma-methacryloxypropyltrimethoxysilane on demineralization of bovine enamel

We previously demonstrated that fluoride release from resins could be regulated by the polysiloxane coating of the fluoride additives. The present study investigated the effects of regulated fluoride release from resin on enamel demineralization in vitro. Bovine enamel cavities were restored with bis-GMA/TEGDMA resins containing 50 wt% NaF powders treated with or without gamma-methacryloxypropyltrimethoxysilane. Specimens were immersed in distilled water that was changed daily to measure the amount of fluoride released over 40 days, and thereafter subjected to pH-cycling. Microradiographic observations were performed to determine total mineral loss (AZ) and lesion depth (Ld) on the enamel. In addition, fluorine distribution was analyzed using EPMA. The resin containing untreated NaF exhibited high-rate and short-term fluoride release, whereas the resin containing treated NaF released low concentrations of fluoride over a longer period. The former showed high fluorine uptake in the adjacent enamel. In contrast, the latter showed high fluorine uptake not only in the adjacent enamel, but also in a wider area of enamel surface. The latter also showed lower AZ and Ld values in the surrounding enamel, indicating a high inhibitory effect on caries formation. Therefore, it is suggested that regulated fluoride release from the resin based on polysiloxane coating is effective in preventing caries formation.

Fluoride-releasing restorative materials and secondary caries

Secondary caries are responsible for 60% of all replacement restorations in the typical dental practice. Risk factors for secondary caries are similar to those for primary caries development. Unfortunately, it is not possible to predict accurately which patients are at risk for restoration failure. Fluoride-releasing dental materials provide for improved resistance against primary and secondary caries in coronal and root surfaces and have become a part of the dentist's armamentarium. This article discusses the improvement in the properties of dental materials with the ability to release fluoride. It is anticipated that in the near future, the vast majority of restorative procedures will employ fluoride-releasing dental materials as bonding agents, cavity liners, luting agents, adhesives for orthodontic brackets, and as definitive restoratives.

Comparison of fluoride release protocols for in-vitro testing of 3 orthodontic adhesives

The objective of this study was to compare the fluoride release of 3 orthodontic adhesives using disks and bracketed teeth with different storage protocols. The adhesives used were a resin-modified glass ionomer (RMGI) (Fuji Ortho LC; GC America, Aslip, Ill), a polyacid-modified composite resin (PMCR)(Assure; Reliance Orthodontic Products, Itasca, Ill), and a composite control, Transbond XT (3M Unitek, Monrovia, Calif). Metal brackets were bonded to the buccal and lingual surfaces of 120 extracted human premolars. Five plastic containers holding 4 teeth (8 brackets) were used for each adhesive protocol. The samples were stored in containers holding 4 mL of deionized water at 37 degrees C for 28 and 84 days for the brackets and disks, respectively. The bracketed samples released larger initial amounts of fluoride compared with the disk samples during the first 5 to 6 days for both fluoride-releasing adhesives. The PMCR (Assure) released more fluoride (mg/cm(2)/day) than did the RMGI (Fuji Ortho LC) in all protocols with the exception of daily protocols when values diminished below the RMGI values near the 24th day and between the 56th and the 70th days for the bracketed and disk samples, respectively. Inconsistent values for fluoride release were noted in the bracket and disk samples when compared with daily versus cumulative water changes. Daily water changes revealed higher fluoride release levels (brackets), but this trend was not evident in the disk samples. Daily water changes may yield more clinically relevant data on fluoride release.

Regulation of NaF release from bis-GMA/TEGDMA resin using gamma-methacryloxypropyltrimethoxysilane

OBJECTIVES

The aim of this study was to evaluate the feasibility of regulation of NaF release from bis-GMA/TEGDMA resin using gamma-methacryloxypropyltrimethoxysilane (gamma-MPTS).

METHODS

NaF powder was treated with gamma-MPTS to form a polysiloxane layer on its surface. The morphology and the composition of the NaF powder treated with gamma-MPTS were evaluated using scanning electron microscopy, infrared spectroscopy, contact angle measurement and X-ray photoelectron spectroscopy. Bis-GMA/TEGDMA resin containing 50 wt% NaF powder was prepared as a model resin and immersed in distilled water at 37 degrees C, and the amount of fluoride released from the resin was measured using a fluoride electrode. The mechanical strength in terms of diametral tensile strength before and after fluoride release was also measured, and statistically analyzed using one-way factorial ANOVA and Fisher's PLSD method.

RESULTS

NaF powder was covered with hydrophobic gamma-MPTS delivered polysiloxane. A larger amount of fluoride was released at the initial stage from the resin containing NaF treated with no gamma-MPTS. However, fluoride release terminated in a relatively shorter period. In contrast, we observed a smaller amount of fluoride released for a longer period from the resin containing NaF treated with gamma-MPTS.

SIGNIFICANCE

We found that gamma-MPTS treatment is useful for the regulation of NaF release from bis-GMA/TEGDMA resin. The mechanism of slow NaF release may be the formation of a hydrophobic polysiloxane layer on the surface of NaF powder and resulting slow water diffusion to NaF powder.

The polarized light microscopic appearance of caries-like lesions adjacent to restored cavities in the crowns and roots of extracted human teeth

Longitudinal clinical studies indicate consistently that secondary caries is the major cause of failure of restorations. Recently there has been an increase in the number of fluoride-containing materials coming to the market place and this has renewed the debate about the cariostatic effectiveness of such materials. The present study examined the histologic appearance of caries-like lesions adjacent to a non-fluoride-containing material (amalgam), a low fluoride-containing material (composite) and a moderate fluoride-containing material (glass-ionomer). The artificial caries system used to produce lesions has been previously reported and is a microbial system using Streptococcus mutans NCTC 10832. The lesions produced were similar to naturally occurring lesions in many respects, indicating the usefulness of this in vitro technique. Variations in the appearance of lesions were found adjacent to the different materials and the effect of the fluoride contained within two of the materials is discussed.

Fluoride release and re-uptake in direct tooth colored restorative materials

OBJECTIVES

Glass ionomers may be "recharged" through topical fluoride (F-) treatments; however, this reported "recharging," may be attributed to surface changes after F- treatment. This study examined differences in F- release and re-uptake among dual-cured and chemically-cured glass ionomers, and a photo-cured F- releasing composite. A secondary goal was to determine if tensile strength or surface roughness changed due to F- release, or F- re-uptake and re-release.

METHODS

In Phase 1, initial surface roughness and diametral tensile strength were measured. F- release was measured for 30 days. Strength and roughness were then remeasured. In Phase 2, surface roughness was measured, then materials were treated with a 5000 ppm neutral F- gel, the same gel without F-, or phosphoric acid. F- release was measured for 30 days, then final surface roughness and strength were determined.

RESULTS

Significant differences were found in amount and rate of F- release, and F- re-uptake and re-release among study materials and enamel controls (p < 0.001). The amount and rate of F- re-release after NaF treatment differed significantly from F- release after acid treatment in glass ionomers, although both groups showed increased F- release after surface treatment (p < 0.001). There were no significant changes in tensile strength or surface roughness after F- release or F- re-uptake and re-release as determined by ANOVA.

SIGNIFICANCE

The results of this in vitro study indicate that applications of neutral 5000 ppm F- gel to aged glass ionomer restorations results in a significant fluoride uptake and subsequent release. The data suggest that the application of neutral fluoride gel to glass ionomer restorations in situ may result in increases in oral fluoride concentrations, without affecting the restoration's surface roughness or tensile strength.

New direct restorative materials. FDI Commission Project

People worldwide have become increasingly aware of the potential adverse effects on the environment, of pollution control and of toxic effects of food, drugs and biomaterials. Amalgam and its potential toxic side effects (still scientifically unproven) continue to be discussed with increasing controversy by the media in some countries. Consequently, new direct restorative materials are now being explored by dentists, materials scientists and patients who are searching for the so-called 'amalgam substitute' or 'amalgam alternative'. From a critical point of view some of the new direct restorative materials are good with respect to aesthetics, but all material characteristics must be considered, such as mechanical properties, biological effects, and longterm clinical behaviour.

Effects of aged fluoride-containing restorative materials on recurrent root caries

Accumulated evidence has illustrated that secondary caries is the major reason for the failure of amalgam and resin composite restorations. The purpose of this study was to assess the cariostatic effects of aged fluoride-containing restorative materials on the formation of secondary root caries. Fifty sound human molars were selected and randomly assigned to five material groups: non-fluoride-containing amalgam (NA), fluoride-containing amalgam (FA), non-fluoride-containing composite (NC), fluoride-containing composite (FC), and glass-ionomer cement (GIC). After standardized class V cavity preparations and placement of restorations, teeth within each group were randomly divided into two subgroups, "non-aged" and "aged". The aged subgroup was immersed in an inorganic buffer solution for 2 wks before being thermocycled. After being thermocycled and subjected to four cycles of caries formation in a bacterial model system, the teeth were sectioned. Depths of outer lesions and areas of lesions on the cavity walls were measured by polarized light microscopy. The results showed that the FA and GIC groups, whether aged or not, had significantly smaller outer lesion depth than the non-fluoride-containing NA and NC groups. After aging, the FA group demonstrated significantly greater lesion depth (p = 0.0002), while the GIC group exhibited no significant changes in lesion depths. The NA group had a greater wall lesion area than the NC group, while both demonstrated no significant changes following 2 weeks of aging. The FA and GIC groups had similar inhibition areas along the cavity walls, whereas both inhibition areas increased significantly after the aging process. It is concluded that the fluoride-containing amalgam and the glass-ionomer cement, even after a two-week aging process, can still elicit a significant preventive effect on recurrent root caries in an in vitro bacterial model system.

Prevalence and depth of artificial caries-like lesions adjacent to cavities prepared in roots and restored with a glass ionomer or a dentin-bonded composite material

One potential advantage of glass-ionomer materials for the treatment of root caries is their ability to release fluoride and so resist cariogenic attack. A commercially available composite material has also been reported to release fluoride which reduced caries lesions in the tooth tissue adjacent to it. The aim of this study was to assess the effectiveness of a conventional glass-ionomer restoration compared with a dentin-bonded, fluoride-releasing, composite restoration when exposed to a microbial artificial caries system. Artificial caries-like lesions produced in relation to the restorations were examined and classified either as outer (surface) lesions or as wall lesions. A split-unit experimental design allowed for within-tooth comparisons of the 2 experimental restorations at different sites on the root surface. These were either totally within the root surface or positioned at the amelo-cemental junction. Outer lesion depths were significantly (p < 0.001) shallower at all sites adjacent to the glass ionomer when compared with the composite restorations. Wall lesions were significantly (p < 0.01) more prevalent adjacent to the composite material. In addition, the cavity margin position significantly (p < 0.05) affected the incidence of wall lesions, particularly in the composite group. In conclusion, glass ionomer was successful in reducing the caries-like lesion production in the adjacent root surface. This resulted from improved marginal integrity and fluoride release from this material when compared with the composite bonding system used.

Resin composites in dentistry: the monomer systems

The present review outlines the history of monomers used in resin composites, motivates further development, and highlights recent and ongoing research reported in the field of dental monomer systems. The monomer systems of most present-day resin composites are based on BisGMA, developed some 40 years ago, or derivatives of BisGMA. In the remaining resin composites, urethane monomers or oligomers are used as the basis of the monomer system. The main deficiencies of current resin composites are polymerization shrinkage and insufficient wear resistance under high masticatory forces. Both factors are highly influenced by the monomer system, and considerable efforts are being made around the world to reduce or eliminate these undesirable properties. The use of fluoride-releasing monomer systems, some of which are under investigation, has been suggested to mitigate the negative effects of marginal gaps formed in consequence of polymerization shrinkage. The very crux of the problem has also been approached with the synthesis of potentially low-shrinking/non-shrinking resin composites involving ring opening or cyclopolymerizable monomers. By the use of additives with a supposed chain transfer agent function, monomer systems have been formulated that improve the degree of conversion of methacrylate double bonds and mechanical properties. Many promising monomer systems have been devised, the implementation of which may be expected to improve the longevity of resin composite fillings and expand the indications for resin composites.

Fluoride release and uptake in vitro from a composite resin and two orthodontic adhesives

The aim of this study was to investigate the fluoride release and uptake characteristics of a composite resin (Tetric) and two orthodontic adhesives (VP 862 and Saga Bond), with a type-II glass ionomer cement (Ketac Fil) as a control. Test specimens in 2 ml deionized water released fluoride over a period of 33 days. Ketac Fil released 54 and 15 times more fluoride than Tetric after 24 h and 1 month, respectively, whereas the two adhesives released amounts between these values. Specimen exposure to 1000-ppm NaF solution increased the 24-h fluoride release from all materials, with near pre-exposure levels reached after 2-3 days. Ketac Fil had a tendency to recharge not seen with the other materials. The ytterbium trifluoride filler in Tetric has a very low water solubility, and it is therefore suggested that the increases in fluoride release from Tetric after exposure to fluoride were most probably due to release of surface-retained fluoride.

Modeling the caries-inhibitory effects of dental materials

The objectives of this review are to compare the models that are used to simulate the caries process in cardiology research and to suggest how these models might be used to assess caries-inhibitory properties of dental materials. Available caries-simulation models fall into the following classifications: 1) in vitro demineralization using acid buffers, 2) in vitro demineralization using bacterially generated acids, 3) in vitro demineralization/remineralization using a pH-cycling system, 4) an artificial mouth where a bacterially generated acid challenge is interspersed with a "saliva" treatment, 5) in vivo animal model (generally with rats), 6) in situ demineralization and/or remineralization using enamel or dentin blocks or slices in the human mouth, and 7) in vivo studies using teeth scheduled for extraction in the human mouth. Most dental materials studies have used simple in vitro demineralization models or component release experiments, each of which is inadequate to answer the questions that are being asked about the caries-inhibitory properties of the material being tested. Experimental methods must be chosen with care to ensure that the material to be tested is examined in an appropriate mode. The ultimate goal is to correctly predict clinical outcomes. The design or redesign of a model must eventually be tied to documented clinical outcomes to improve the model and allow for future successful development of new materials.

Model investigations of caries inhibition by fluoride-releasing dental materials

Fluoride-releasing dental materials are generally believed to reduce or prevent secondary caries. The evidence for this is largely anecdotal and centers on clinical experience with silicate cements and, more recently, with glass-ionomer cements. Unfortunately, corroborating evidence from controlled clinical trials is inadequate to establish precisely how effective these materials are or under what conditions they might be effective. Even less is known about the clinical effectiveness of newer materials that, often, release less fluoride. In vitro model systems have been used to study the effects of dental materials on de/remineralization of surrounding tooth structure. Fluoride-releasing materials have been shown in these models to reduce demineralization of both enamel and dentin compared with a material that does not release fluoride. This is useful from a mechanistic standpoint, but without clinical "standards" to guide model results, it is not possible to define an acceptable level of fluoride release or the length of time such release is required. A limited number of in situ model studies has been conducted, and some fluoride dose-response information has been obtained. These models are closer to the real situation and perhaps provide the best means to define required levels of fluoride release from materials in the absence of adequate clinical information.

Fluoride release from alternative restorative materials

Numerous laboratory studies have been performed to evaluate the fluoride releasing capacity of different restorative materials. The studies have comprised release of fluoride, uptake of fluoride in the dental hard tissues and the inhibitory effect on demineralization. The present paper discusses the results from and the clinical relevance of the laboratory studies especially as regards the glass ionomer materials and resin composites.