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

Long-term clinical comparison of a resin-based composite and resin modified glass ionomer in the treatment of cervical caries lesions

This 72-month study compared the clinical effectiveness of a resin-based composite (RBC) (Spectrum TPH3, Dentsply Sirona) with a resin-modified glass ionomer cement (RMGIC) (Riva Light Cure, SDI) in restoring cervical caries lesions (CCLs). Thirty-three patients, each with at least two CCLs, were enrolled. After caries removal, the dimensions of the cavities were recorded. In a split-mouth study design, a total of 110 restorations were randomly placed. Fifty-five restorations were placed with RBC using an etch-and-rinse adhesive system (Prime&Bond NT, Dentsply Sirona), while the remaining 55 were restored with RMGIC. The restorations were assessed at baseline, 6, 12, 18, 24, 36, 60, and 72 months according to modified USPHS criteria. Statistical analysis included Pearson Chi-square, Friedman tests, Kaplan Meier, and Logistic Regression analysis (p < 0.05). After 72 months, 47 restorations in 19 patients were evaluated (55% follow-up rate). Seventy-five percent of the RBC (n = 26) and 74% (n = 21) of the RMGIC restorations were fully retained. There were no significant differences between materials regarding retention and marginal adaptation (p > 0.05). Cavity dimensions, caries activity, and retention exhibited no correlation (p > 0.05). The increase in marginal staining in both groups over time was significant (p < 0.001). RMGIC restorations exhibited higher discoloration than RBC restorations (p = 0.014). At 72 months, three secondary caries lesions were detected in both restoration groups: two RMGIC and one RBC. There were no reports of sensitivity. After 72 months, both RBC and RMGIC restorations were clinically successful, with similar retention and marginal adaptation scores. However, it is noteworthy that RMGIC restorations tend to discoloration over time compared to RBC. The trial is registered in the database of "Clinical Trials". The registration number is NCT0372-2758, October 29, 2018.

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials.

Antibacterial quaternary ammonium compounds in dental materials: A systematic review

OBJECTIVE

Quaternary ammonium compounds (QACs) represent one of the most effective classes of disinfectant agents in dental materials and resin nanocomposites. This reviews aims to give a wide overview on the research in the field of antibacterial QACs in dental materials and nanocomposites.

METHOD

An introduction to dental materials components as well as the microorganisms and methods of evaluation for the antimicrobial assays are presented. Then, the properties and synthesis route of QACs, as monomer and filler, are shown. Finally, antimicrobial monomers and fillers, specifically those contain quaternary ammonium salts (QASs), in dental materials are reviewed.

RESULTS

QACs have been used as monomer and micro/nanofiller in restorative dentistry. They possess one or more methacrylate functional groups to participate in polymerization reactions. QACs with multiple methacrylate groups can also be used as crosslinking agents. Furthermore, QACs with chain length from ∼12 to 16 have higher antimicrobial activity in cured dental resins. In general, increasing the chain length leads to a threshold value (critical point) and then it causes decrease in the antimicrobial activity.

SIGNIFICANCE

The current state of the art of dental materials and resin nanocomposites includes a wide variety of antimicrobial materials. Among them, QACs presents low cytotoxicity and excellent long-term antimicrobial activity without leaching out over time.

Effect of surface treatments on the mechanical properties and antimicrobial activity of desiccated glass ionomers

OBJECTIVES

The purpose of this study was to evaluate the effect of various surface treatments on the mechanical properties and antibacterial activity of desiccated glass-ionomer (GI) and resin-modified glass-ionomer (RMGI) materials.

METHODS

One hundred GI and RMGI specimens were fabricated in a mold, stored in 100% humidity for 24h, placed in air to desiccate for 24h, and then stored for one week in one of the five media [casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), chlorhexidine (CHX), sodium fluoride (NaF), cetylpyridinium chloride (CPC), or 100% humidity (control)]. Fifty GI and RMGI specimens were tested in flexure to determine flexural strength and modulus, with the fragments used for Knoop hardness testing. The remaining 50 GI and RMGI specimens were covered with a suspension of Streptococcus mutans and incubated for 24h. The bacterial suspension was removed and the specimens were washed. Sterile saline was added, vortex mixed, serially diluted, and plated. CFU/mLs were calculated after 3days of incubation.

RESULTS

Compared to the 100% humidity control group, surface treatment of the desiccated GI and RMGI materials had a variable effect on the mechanical properties. In general, NaF provided the greatest improvement in flexural strength and modulus. Surface treatment of the desiccated GI or RMGI specimens with CHX or CPC resulted in no growth of the S. mutans. NaF resulted in significantly lower CFU/mL than CPP-ACP, which was significantly lower than the control group.

SIGNIFICANCE

Surface treatment with 5% NaF provides improved antimicrobial and strength properties of desiccated GI or RMGI materials.

Antimicrobial effect of chlorhexidine digluconate in dentin: In vitro and in situ study

Aim:

The aim of this study was to evaluate a very short-term in vitro and in situ effect of 2% chlorhexidine-digluconate-based (CHX) cavity cleanser on the disinfection of dentin demineralized by cariogenic bacteria.

Materials and Methods:

Human dentin slabs were randomly allocated and used in 2 distinct phases, in vitro and in situ, for obtaining demineralized dentin. In vitro, the slabs (n=15) were immersed for 5 days in BHI broth inoculated with Streptococcus mutans CTT 3440. In situ, a double-blind design was conducted in one phase of 14 days, during which 20 volunteers wore palatal devices containing two human dental dentin slabs. On 5^th day in vitro and 14^th day in situ, the slabs were allocated to the two groups: Control group (5 μl of 0.9% NaCl solution) and CHX group (5 μl of 2% chlorhexidine digluconate solution, Cavity Cleanser™ BISCO, Schaumburg, IL, EUA), for 5 minutes. The microbiological analyses were performed immediately before and after the treatments.

Results:

The log reductions means found for CHX treatment on tested micro organisms were higher when compared to Control group either in vitro or in situ conditions.

Conclusions:

Our results showed that CHX was effective in reducing the cultivable microbiota in contaminated dentin. Furthermore, although the use of chlorhexidine-digluconate-based cavity disinfectant did not completely eliminate the viable microorganisms, it served as a suitable agent to disinfect tooth preparations.

Synthesis and characterization of antibacterial dental monomers and composites

The objective of this study is to synthesize antibacterial methacrylate and methacrylamide monomers and formulate antibacterial fluoride-releasing dental composites. Three antibacterial methacrylate or methacrylamide monomers containing long-chain quaternary ammonium fluoride, 1,2-methacrylamido-N,N,N-trimethyldodecan-1-aminium fluoride (monomer I), N-benzyl-11-(methacryloyloxy)-N,N-dimethylundecan-1-aminium fluoride (monomer II), and methacryloxyldecylpyridinium fluoride (monomer III) have been synthesized and analyzed by nuclear magnetic resonance (NMR) and mass spectrometry (MS). The cytotoxicity test and bactericidal test against Streptococcus mutans indicate that antibacterial monomer II is superior to monomers I and III. A series of dental composites containing 0-6% of antibacterial monomer II have been formulated and tested for degree of conversion (DC), flexure strength, water sorption, solubility, and inhibition of S. mutans biofilms. An antibacterial fluoride-releasing dental composite has also been formulated and tested for flexure strength and fluoride release. The dental composite containing 3% of monomer II has a significant effect against S. mutans biofilm formation without major adverse effects on its physical and mechanical properties. The new antibacterial monomers can be used together with the fluoride-releasing monomers containing a ternary zirconiun-fluoride chelate to formulate a new antibacterial fluoride-releasing dental composite. Such a new dental composite is expected to have higher anticaries efficacy and longer service life.

Evaluation of the antimicrobial effect of photodynamic antimicrobial therapy in an in situ model of dentine caries

Photodynamic antimicrobial therapy (PACT) promotes bacterial death as a result of the photosensitization of microbial components. This study evaluated the effect of PACT on dentine caries produced in situ. Over the course of 14 d, 20 volunteers wore intra-oral devices containing human dentine slabs that were treated 10 times daily with a 40% sucrose solution. Afterwards, the antimicrobial effect of toluidine blue O, associated with 47 or 94 J cm(-2) of a light-emitting diode, was evaluated. Before and after the treatments, dentine samples were analysed with regard to the total number of microorganisms, total streptococci, mutans streptococci, and lactobacilli. Significant reductions in the bacterial count were observed for PACT with both energy densities tested, with the following values observed for 47 and 94 J cm(-2) of irradiation: for total streptococci, 3.45 and 5.18; for mutans streptococci, 3.08 and 4.16; for lactobacilli, 3.24 and 4.66; and for total microorganisms, 4.29 and 5.43, respectively. The control, treated with 94 J cm(-2) of irradiation alone, was also effective against all bacteria. To conclude, PACT was effective in killing oral microorganisms present in dentine caries produced in situ and may be a useful technique for eliminating bacteria from dentine carious lesions before restoration.

The efficacy of techniques for the disinfection of artificial sub-surface dentinal caries lesions and their effect on demineralization and remineralization in vitro

OBJECTIVES

The efficacy of three techniques for the disinfection of artificial sub-surface root caries lesions and their response to subsequent episodes of de- and remineralization was investigated quantitatively in vitro.

METHODS

Sub-surface dentinal lesions (n=20), cut into four experimental blocks and deliberately contaminated with Streptococcus mutans, were subject to either steam autoclaving (121 degrees C, 5min), gamma irradiation (4100Gy), immersion in 0.1% (w/v) thymol-distilled water solution (24h) or reserved as a control. Next, the lesions were incubated aerobically in sterile nutrient broth for 24h at 37 degrees C and resultant cultures plated onto blood agar and neutralisation agar. Ten blocks from each experimental group were then immersed in an acidic buffer solution or exposed to artificial saliva for 5 days. Baseline changes in the mineral content and distribution of the lesions were assessed by transverse microradiography (TMR).

RESULTS

Micro-organisms were recovered from each control block and one block treated by gamma irradiation. Steam autoclaving and immersion in a thymol solution significantly decreased (p<0.05) the amount of mineral lost from the body of lesions subject to a further acid challenge. Mineral ion uptake by lesions exposed to artificial saliva was significantly increased (p<0.05) through disinfection by steam autoclaving.

CONCLUSIONS

Gamma irradiation proved the most acceptable method for the disinfection of sub-surface root dentine lesions having the least adverse effect on demineralization and remineralization.

Effects of Er:YAG Laser on the Sealing of Glass Ionomer Cement Restorations of Bacterial Artificial Root Caries

OBJECTIVE

The aim of this study was to test the effect of Er:YAG laser irradiation on the marginal sealing of root cavities restored with two glass ionomer cements.

BACKGROUND DATA

For preventing secondary root caries, new technologies for dental caries removal, such as the Er:YAG laser irradiation, have been proposed.

METHODS

Forty-five human teeth were used. Artificial root caries were induced using a microbiological model (Streptococcus mutans). The lesions were removed by three different methods: conventional technique using burs (controls; groups 1 and 2); Er:YAG laser irradiation using dentine preparation parameters (250 mJ, 4 Hz, 80.6 J/cm2; groups 3 and 4); irradiation with the dentine preparation parameters followed by surface conditioning parameters (60 mJ, 2 Hz, 19.2 J/cm2; groups 6 and 7). After each preparation method, three teeth were prepared for scanning electron microscopy morphological observation. The remaining teeth were restored by conventional glass ionomer cement (G1, G3, and G5) or resin modified glass ionomer cement (G2, G4, and G6). After restoration, the samples were thermocycled (1,000 cycles) and prepared for microleakage test.

RESULTS

Scores of less infiltrated samples were observed in groups treated by Er:YAG laser, and the smallest infiltration occurred in the group treated by the dentine preparation parameter, followed by cavity restoration with resin-modified glass ionomer (p < 0.05).

CONCLUSION

Our results suggest that root caries removal by Er:YAG laser irradiation, followed by restoration with resin-modified glass ionomer cement, is a suitable choice for dental root caries restoration.

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.

Photosensitization of in vitro biofilms by toluidine blue O combined with a light-emitting diode

In natural ecosystems, micro-organisms grow preferentially attached to surfaces, forming matrix-enclosed biofilms. The aim of this study was to determine photodestruction levels in biofilms after subjecting them to photodynamic therapy. Biofilms of Streptococcus mutans, S. sobrinus, and S. sanguinis were grown on enamel slabs for 3, 5 or 7 d. Both the number of viable micro-organisms and the concentration of water-insoluble polysaccharides were analysed, and mineral loss (DeltaZ) analyses were performed on the enamel slabs. The antimicrobial potential of toluidine blue O (0.1 mg ml(-1)), associated with 85.7 J cm(-2) of a light-emission diode, was evaluated on the viability of 5-d biofilms. Both the number of micro-organisms and the concentration of water-insoluble polysaccharide increased with the age of the biofilms. A significant reduction ( approximately 95%) in viability was observed for S. mutans and S. sobrinus biofilms following photosensitization, with a > 99.9% reduction in the viability of S. sanguinis biofilms. In conclusion, a biofilm model was shown to be suitable for studying changes in bacterial numbers and enamel mineralization and for demonstrating the potential value of photosensitization in the control of in vitro biofilms.

Fluoride-containing restorative materials

Dental practitioners are exposed to an increasing number of dental materials, which claim the benefits of fluoride release. The purpose of this paper is to critically review the literature of these materials. Glass ionomers, resin modified glass ionomers, compomers, resin composites, fissure sealants and amalgam are discussed. It is clear that a long-term measurable release of fluoride can be observed from certain restorative materials, in vitro, particularly glass ionomer cement, resin modified glass ionomer cement, fluoridated cements, fluoridated dental amalgam and certain fissure sealants. In general, the rate of fluoride release is not constant but exhibits a relatively rapid initial rate, which decreases with time. However, the fluoride release profiles may be dependent on specific formulation and on experimental design and sampling methods. These materials may feature greater longevity, a reduced incidence of marginal failure, an elevated concentration of fluoride in contingent plaque, together with an antibacterial action when compared with non-fluoride releasing materials. In addition, fluoride-releasing materials may perform better in caries inhibition in artificial caries model studies than non-fluoridated materials. While any, or all, of these anti-cariogenic effects may be associated with fluoride release, a direct relationship between fluoride release profiles and such effects has not been determined in vivo.

In vitro evaluation of caries inhibition promoted by self-etching adhesive systems containing antibacterial agents

This study evaluated the cariostatic effect of antibacterial self-etching adhesive systems, by means of an in vitro bacterial caries model. Seventy-five prepared bovine slabs were randomly divided into groups (n=15): (1) unbonded composite, no carious challenge (UNB-NC); (2) unbonded composite, carious challenge (UNB-C); (3) Clearfil SE Bond, no antibacterial agent (CSE); (4) Protect Bond, containing MDPB and fluoride (PB); and (5) Reactmer Bond, fluoride-releasing (RB). All preparations were restored with Filtek Z-250. Groups (2)-(5) were submitted to a medium containing Streptococcus mutans (ATCC-- 25175) for 5 days, and Group (1) was kept in a noninoculated medium. Insoluble polysaccharides present in tooth biofilms were quantified, Knoop hardness (KHN) was measured on the enamel adjacent to restorations, and standard 35-mm polarized light photomicrographs were taken as illustrations. Polysaccharide and Knoop hardness results were analyzed with the use of ANOVA, with a split-split-plot statistical design for KHN. Except for Group (1), all groups showed similar caries formation. Biofilm over PB restorations showed the smallest amounts of polysaccharides (14.37 microg/mg), and CSE showed the highest amounts (20.87 microg/mg). All self-etching systems tested were unable to inhibit secondary caries in a bacterial model simulating a high caries challenge, even though there was reduced glucan synthesis provided by the adhesive system containing MDPB and fluoride.

Chemical or microbiological models of secondary caries development around different dental restorative materials

This study evaluated artificial secondary caries around restorative materials, induced by means of chemical or microbiological models. The following materials were used randomly to restore 130 dental blocks: (1) zinc-oxide eugenol-free temporary filling: Coltosol (Coltène/Whaledent Inc.; n = 30), (2) silver amalgam: Permite C (SDI Limited, n = 20), (3) composite resin: Filtek Z250 (3M ESPE; n = 20), (4) glass-ionomer cement: Fuji II (GC America Inc.; n = 20), (5) resin-modified glass ionomer: Vitremer (3M ESPE; n = 20), and (6) polyacid modified resin: Dyract AP (Dentsply; n = 20). Ten specimens of Group 1 were kept in humidity, and had no carious formation (NC). Ten specimens of each group were submitted to pH cycling (CG, n = 60), and the others were immersed in a medium containing Streptococcus mutans and sucrose (BG, n = 60). Mineral content was determined by microhardness assessment, and lesion depth was measured in polarized light photomicrographs. In the chemical model (CG), mineral content values in the vicinities of restoration were high for Groups 5 (75.7 +/- 11.9), 4 (70.8 +/- 14.2), and NC (95.4 +/- 3.8); intermediate for Groups 1 (55.8 +/- 18.5), 6 (45.6 +/- 11.0), and 2 (44.3 +/- 11.2); and reduced for Group 3 (34.7 +/- 9.7). In the microbiological model (BG), results were similar to CG, although there was less demineralization. The highest lesion depths were found for Groups 3 (182.3 +/- 33.2) in CG and 6 (126.5 +/- 42.8) in BG, when compared to Group 5 (114.6 +/- 26.0 and 56.2 +/- 33.2, respectively). In both models of caries induction, ionomeric materials showed a superior cariostatic effect when compared to the other restorative materials.

In vitro growth, acidogenicity and cariogenicity of predominant human root caries flora

Streptococcus mutans (Sm), Lactobacillus acidophilus (La) and Actinomyces israelii (Ai) have been associated with root surface caries, which is an increasing problem in elderly Chinese. The aim of this study therefore, was to evaluate in vitro, the growth, acidogenicity and cariogenicity of these organisms, both in mono- and co-cultures using an in vitro model. Forty-eight root specimens were prepared using intact extracted human molars. Fresh, wild-type bacteria obtained from root caries lesions were assembled into seven experimental groups as either mono- or co-cultures and incubated with the root specimens. Appropriate controls were included. Growth curve of each experimental group was monitored for 24h, aerobically, at 37 degrees C using a microplate reader. The pH of the medium was recorded after 24-h incubation using a pH meter. Mean depths of artificial root lesions produced in each cultural group were measured using polarized light microscopy in specimens cut into thin sections (100+/-20 microm). Compared with mono-cultures, synergistic growth was observed in co-cultures of 'La+Sm', 'Ai+La' and 'Ai+La+Sm'. Mean lesion depth produced in La group was significantly shallower than other mono- or co-culture groups (p<0.01). The pH values of all culture media were similar after 24-h incubation. The current data elucidate the complex interactions of three predominant bacterial species considered prime agents of human root surface caries.

Adhesive restorative materials: A review

'Adhesive' restorative dentistry originated with the work of Buonocore in 1955 in bonding resin to etched enamel. Since then, adhesive materials and techniques have developed at a rapid rate. The first chemically adhesive material (zinc polycarboxylate cement) was marketed in the late 1960s, and glass-ionomer cements and dentine bonding agents have since become available. This review focuses on the latter two products. Glass-ionomer cements have a particular role in adhesive dentistry because of their reliable chemical adhesion to enamel and dentine, and because of their apparent ability to promote the remineralization of 'affected' dentine. Dentine bonding agents have undergone marked changes in presentation over the last 15 years, but all have an essentially similar bonding system, that of hybrid layer formation. However, the most recent systems have limited clinical data supporting their use.

Inhibition of demineralization in vitro around fluoride releasing materials

Replacement of restorations because of secondary caries is a continuing problem in restorative dentistry. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in buccal and lingual surfaces of 30 extracted premolars and restored with one of three polyacid modified resin composites (F-2000, Hytac and Compoglass F), a resin modified glass-ionomer cement (Fuji II LC) a conventional glass ionomer (Ketac-Fil), and a resin composite (Z-100). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that restoration of caries with polyacid modified resin composites and resin modified glass ionomer cements may be of great importance in the prevention of secondary caries around the restorations in roots. Clinical Relevance Light cured fluoride-releasing restorations may inhibit caries-like lesions. Inhibition of demineralization in vitro around fluoride releasing materials.

Three restorative materials and topical fluoride gel used in xerostomic patients: a clinical comparison

BACKGROUND

The authors compare the incidence of recurrent caries around two glass ionomer restorative materials and one amalgam material.

METHODS

The authors placed 111 restorations in nine xerostomic patients. Patients were given oral hygiene instructions and fluoride gel to use daily. The authors evaluated the restorations clinically and with photographs and impressions at six months, one year and two years according to criteria for marginal adaptation, anatomical form, caries in adjacent tooth structure and caries at the cavosurface margin. The authors divided patients into users and nonusers of fluoride.

RESULTS

At the two-year recall appointments, the authors evaluated 95 (86 percent) of the 111 restorations. They analyzed two-year data using an analysis of variance for repeated measures and Fisher's post hoc test. The study results showed no significant differences among materials in regard to caries at the cavosurface margin among fluoride users. However, among fluoride nonusers, patients with amalgam restorations had a significantly higher incidence of caries at the cavosurface margins than did patients with either of the two glass ionomer restorations. The authors found no statistically significant difference between restorations with regard to marginal integrity or anatomical form. However, one patient exhibited failure of glass ionomer restorations owing to material loss.

CONCLUSIONS

Less caries developed at the margins of glass ionomer restorations compared with amalgam restorations in xerostomic patients who did not routinely use a neutral topical sodium fluoride gel.

CLINICAL IMPLICATIONS

Fluoride-releasing materials may reduce caries surrounding restorations in high-risk patients who do not routinely use topical fluoride. Patients who routinely used topical fluoride gel did not develop recurrent caries, and clinicians should encourage the use of fluoride gel on a daily basis.

Practitioner's guide to fluoride

The current health care trend is to provide evidence-based recommendations and treatment. Many literature reviews have shown fluoride's effectiveness against caries. The current use of fluoride in the prevention of dental caries is based on community, professional, and individual strategies. Personalized fluoride regimens should include a risk analysis and a review of the patient's current fluoride exposure. The future of fluoride may be found in its slow release and retention in the oral cavity through various modalities. Because of the many uncertainties still associated with fluoride, further research is needed.

Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin

OBJECTIVE

The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development.

METHODS

One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0mm-deep and 1.5mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F(-) (Sensodyne Baking Soda) or without F(-) (Sensodyne Original) (n=18). After surface polishing, a 1mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHN(i)) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHN(f)) were measured.

RESULTS

The differences between KHN(i) and KHN(f), and the covariate KHN(i) were considered by the ANCOVA and Tukey's test (alpha=0.05). The interaction between restorative system and dentifrice was statistically significant (p=0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)(a), Fj: 41.9(1.02)(b), F2: 43.3(1.04)(c), Su: 43.5(1.00)(c), Z2: 44.0(1.02)(c); and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)(a), Fj: 44.7(1.01)(b), F2: 45.2(1.09)(bc), Su: 46.0(0.99)(c), Z2: 46.6(0.99)(c) (statistical differences were expressed by different letters).

CONCLUSION

The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000.

The effect of fluoridated and non-fluoridated rewetting agents on in vitro recurrent caries

OBJECTIVE

This study examined the in vitro caries inhibiting potential of fluoridated and non-fluoridated rewetting agents that are applied to acid-etched enamel and dentine before the use of a water-free, dentine adhesive.

MATERIALS AND METHODS

Twelve caries-free premolars were divided into three groups of four teeth each. 2 x 3 x 1.5 mm cavities were prepared on the mesial and distal surfaces of each tooth, with half of the cavosurface margin in enamel and half in root dentine. In Group I (control), One-Step (Bisco, Schaumburg, USA) was applied without etching or rewetting agents. In Group II, cavities were acid-etched, rinsed, dried, and rewetted with Aqua-Prep (Bisco), a non-fluoridated rewetting agent, and then bonded with One-Step. Treatment for Group III was similar to Group II, except that Aqua-Prep F (Bisco), a fluoridated rewetting agent was used. Bonded cavities were restored with a non-fluoride-containing flowable composite (AEliteFlo, Bisco). Artificial carious lesions were induced in these specimens, from which multiple 100+/-20 microm thick longitudinal sections were prepared, yielding 16 specimens per group for evaluation with polarised light microscopy (PLM) and microradiography (MRG). Representative sections were processed for transmission electron microscopy (TEM) examination and scanning transmission electron microscopy/energy dispersive X-ray (STEM/EDX) analyses.

RESULTS

The differences in demineralisation of dentine among the groups were not statistically significant for 'relative' lesion depth (p > 0.05, ANOVA, Student-Neuman-Keuls test), but highly significant for 'relative' lesion area (p < 0.001). Wall lesions were consistently present in Group I, while inhibition zones were invariably observed in Group III. 87.5% of Group II specimens exhibited neither wall lesion nor inhibition zone. TEM showed that remnant dentine apatite crystallites within the inhibition zones in Group III were larger and denser than those present within the corresponding wall lesions. STEM/EDX analyses confirmed the presence of calcium, phosphorus and fluorine in these plate-like crystallites.

CONCLUSION

When used with a water-free, single-bottle dentine adhesive, a non-fluoridated rewetting agent is able to reduce, but cannot completely prevent recurrent caries. The use of a fluoridated rewetting agent is useful under the situation when microleakage occurs, by providing the additional benefit of fluoride-induced demineralisation inhibition.

AL, SERRA MC. Efeito cariostático de restaurações adesivas em superfícies radiculares: estudo in vitro

Materiais restauradores que liberam íons flúor e/ou promovem adesão à estrutura dental têm sido relacionados com a inibição do desenvolvimento de lesões de cárie adjacentes às restaurações. A hipótese testada neste estudo foi a de que o uso de resina composta/sistema adesivo tem efeito cariostático semelhante a um material adesivo que libera íons flúor - cimento de ionômero de vidro - sobre a superfície radicular adjacente às restaurações. Foram utilizadas 20 raízes de terceiros molares humanos extraídos, embutidas em resina de poliestireno e planificadas. Cavidades padronizadas foram preparadas e restauradas aleatoriamente com (a) Chelon-Fil (Espe) ou (b) Z100/SingleBond (3M). Valores iniciais (KHNi) de microdureza superficial Knoop da dentina foram obtidos a 100, 200 e 300 mim da margem oclusal das restaurações. Uma área de 2,0 mm ao redor da restauração foi delimitada e submetida à indução de cárie artificial. Obtiveram-se, então, os valores finais (KHNf) de microdureza, nas mesmas condições e localizações da leitura inicial. As diferenças entre KHNi e KHNf foram consideradas para a análise estatística. As medianas de KHNi - KHNf nas distâncias de 100, 200 e 300 mim foram para (a): -3,8; -0,3; -1,0; e para (b): 3,3; 2,5; 1,7. O teste de Kruskal-Wallis não evidenciou diferença significativa entre as distâncias dentro de cada grupo. Às distâncias de 200 e 300 mim, não houve diferença significativa entre os materiais avaliados. À distância de 100 mim, (a) diferiu significativamente de (b) (p < 0,05). Sob as condições deste estudo, o cimento de ionômero de vidro apresentou maior potencial cariostático que a resina composta com sistema adesivo dentinário.

How effective is ART in the management of dental caries?

The ART approach involves excavating cavitated dentine caries with hand instruments, then restoring the cavity and sealing any associated fissures and pits with an adhesive restorative material, resulting in a sealant restoration. Until recently, ART has mainly been used under field conditions, and thus the adhesive restorative material used has been glass ionomer which does not require mixing machines and curing lights. Since the inception of ART, a growing number of studies world-wide have taken place. A total of four studies have reported 3-year survival percentages for one-surface ART restorations. The highest 3-year survival percentage in permanent teeth was 88%, which is comparable to the 85% survival of one-surface amalgam restorations placed under the same field conditions after 3 years. The outcomes depend to some extent on the material used, operator experience and presence of caries. The presence of caries as a reason for failure was higher in the early than in the most recent studies. Only one study has reported on the use of ART restorations in the deciduous dentition. It is concluded that: a very large proportion of dentine lesions in the permanent teeth can be treated using the ART approach; the 3-year survival rate of the more recently placed one-surface ART restorations in permanent teeth was higher than that of ART restorations placed in the beginning; the survival of one-surface ART restorations in the permanent dentition with newer glass ionomers is comparable to that of one-surface conventional restorations placed using amalgam in a comparable setting after 3 years; more studies of longer duration are needed to confirm these findings; ART should be considered a caries treatment modality that benefits people; and educational courses need to be organised before the approach is applied in the clinic.

Fluoride release from restorative materials and its effects on dentin demineralization

As the use of adhesive restorative materials has increased during the last several years, interest in adhesive materials that release fluoride has also grown. The purpose of this study was to measure fluoride release from several adhesive restorative materials and to evaluate its effect on dentin resistance to demineralization and on bacterial metabolism in a modified in vitro system. Standardized cavities (1.8 mm in diameter) were prepared in bovine teeth that had been ground to dentin. One cavity in each tooth was restored with one of the following restorative systems: (a) Single Bond and Z100; (b) Single Bond and Tetric Ceram; (c) Fuji Bond LC and Z100; (d) Fuji Bond LC and Tetric Ceram; (e) Fuji II LC; or (f) Fuji IX GP. The other cavity in each tooth was "restored" with wax as a control. For each restorative system, 12 specimens were evaluated for fluoride release during the first 24 hrs after restoration placement. Dentin adjacent to the restored sites was subjected to lactic acid challenge (pH 4.3) for 3 hrs, after which calcium release was measured. Another 12 specimens in each group were stored for 24 hrs in de-ionized water, and were exposed to an S. mutans suspension (1:1 THB/de-ionized water and 50 mM glucose, A660 = 0.2) for 6 hrs, followed by calcium release and pH measurement. Bulk specimens of each material were also made and stored in water. Fluoride released from Fuji Bond LC, Fuji IX GP, and Fuji II LC in bulk was significantly greater than from the other materials. In the restored dentin specimens, increased resistance to demineralization from a lactic acid challenge was directly related to fluoride release. The same effects were seen as a result of the S. mutans challenge. While fluoride release from restorative materials increased the resistance of dentin to demineralization in this system, the clinical relevance of the findings is not known.

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.

ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years

Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the 'press-finger' technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%-84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Sealants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%-61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%-92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.

Microhardness of in vitro caries inhibition zone adjacent to conventional and resin-modified glass ionomer cements

OBJECTIVE

This study was conducted to correlate Knoop and triangular hardness numbers by measuring the microhardness of in vitro caries-inhibited and -demineralized dentin adjacent to a conventional and two resin-modified glass ionomer cements.

METHODS

Box-shaped cavities were prepared on bovine root dentin and restored with either Fuji II, Fuji II LC, or Vitremer. The teeth were then decalcified in an acid buffered solution of 50 mmol l-1 acetic acid adjusted to pH = 4.5 for 3 days. Knoop and triangular microhardness indentations were performed perpendicular to the surface and parallel to the cavity wall, in the demineralized lesion and inhibition zone. Calcium and phosphorous contents of the outer lesions and inhibition zones were compared using energy-dispersive X-ray spectrometry (EDS). The correlation between Knoop and triangular hardness was analyzed by correlation coefficient. The statistical significance of hardness data was analyzed by one-way ANOVA and Fisher's PLSD test (p < 0.05).

RESULTS

Triangular hardness (HT) correlated well with Knoop hardness number (KHN) (r2 = 0.81, p < 0.05). The microhardness of the inhibition zone created by Fuji II was of 59.2 +/- 3.8 HT and was statistically significantly higher than the zone produced by Fuji II LC and Vitremer. Fuji II LC and Vitremer produced inhibition zones with similar microhardness [48.3 +/- 3.5 HT and 44.0 +/- 7.6 HT, respectively (p > 0.05)]. Calcium and Phosphorous were present in the inhibition zone, but did not exist in the demineralized lesion.

SIGNIFICANCE

Knoop and triangular hardness numbers correlated significantly (p < 0.05), and the latter seems to be a promising alternative method for measuring very narrow surfaces. Despite the fact that all glass ionomer materials used in this study were effective in producing an acid-resistant layer, microhardness and intensity of these layers were material dependent.