Influence of different application protocols of universal adhesive system on the clinical behavior of Class I and II restorations of composite resin - a randomized and double-blind controlled clinical trial

Efficacy of different adhesive systems in bonding direct resin composite restorations: a systematic review and meta-analysis

OBJECTIVE

This study aimed to identify and evaluate scholarly research on the efficacy, durability, and long-term stability of various adhesive systems used for bonding direct resin composite restorations and to identify factors influencing bonding performance, such as adhesive composition, application protocol, substrate type, and etching technique.

MATERIALS AND METHODS

An all-inclusive electronic database search for peer-reviewed scholarly journal articles was conducted using PubMed, ScienceDirect, Google Scholar, Dimensions, and the Cochrane Library for research articles investigating the effectiveness of different adhesive systems in direct resin composite restorations, excluding reviews, meta-analyses, opinion pieces, and case reports. The risk of bias was assessed using the Cochrane tool (Robvis 2.0). Data were extracted and thematically analyzed, and quantitative data were statistically analyzed using Review Manager software. Dichotomous data were evaluated using the Mantel-Haenszel method, applying a random effects model and 95% confidence interval.

RESULTS

The database search yielded 1632 potential articles, of which 14 were included in this study. Several adhesive systems exhibit excellent tensile bond strength. In addition, the type of resin composite, adhesive system, and artificial aging significantly influenced the bonding performance of resin composite restorations. However, the failure rates were low in the different adhesive systems, showing comparable results between the two-step etch-and-rinse and one-step self-etch adhesive systems (p = 0.71). The results showed an overall trend of high bonding effectiveness with a low incidence of adverse events, such as postoperative sensitivity, adhesive failure, and fractures.

CONCLUSION

The study results emphasize the importance of selecting appropriate adhesive systems based on clinical case requirements, restoration characteristics, and patient factors to enhance bonding efficacy, durability, and long-term stability.

Prospective, randomized clinical trial evaluating the clinical performance of a new universal adhesive in Class I and Class II restorations at 1 year

OBJECTIVE

This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients.

MATERIALS AND METHODS

Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes.

RESULTS

No restorations were graded as "Insufficient/Unsatisfactory" or "Poor" for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded "Excellent/Very Good" (p > 0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit.

CONCLUSIONS

The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy.

CLINICAL RELEVANCE

The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.

Clinical Evaluation of Bioactive Injectable Resin Composite vs Conventional Nanohybrid Composite in Posterior Restorations: An 18-Month Randomized Controlled Clinical Trial

AIM

To evaluate the clinical performance of bioactive injectable resin composite vs nanohybrid resin composite in restoring carious posterior teeth.

MATERIALS AND METHODS

A total of 18 patients with 26 class I and II carious cavities were recruited. Teeth were divided into two groups (n = 13): group I: Bioactive injectable resin composite (Beautifil Flow Plus X F00) while group II: Nanohybrid resin composite (Tetric N-Ceram) and were restored according to the manufacturer's instructions. The restorations were evaluated using the modified USPHS criteria at baseline, 6, 12, and 18 months. Data were tabulated and statistically analyzed with a significant level set at (p ≤ 0.05). Using the Chi-squared test and Cochran's Q test. The survival rate was analyzed using the Kaplan-Meier and Log-rank tests.

RESULTS

Inter- and intra-group comparisons showed no statistically significant difference between bioactive injectable resin composite and nanohybrid resin composite at different time intervals in terms of anatomical form, marginal adaptation, secondary caries, marginal staining, postoperative sensitivity. Moreover, there was no statistically significant difference between both materials regarding the overall survival rate after 18 months.

CONCLUSIONS

The clinical performance of bioactive injectable resin composite and nanohybrid resin composite was similar and found to be clinically acceptable after 18 months of clinical use.

CLINICAL SIGNIFICANCE

Bioactive injectable resin composite can be used to restore occlusal anatomy as a nanohybrid resin composite in restoring posterior cavities with acceptable clinical performance.

TRIAL REGISTRATION

It was registered in (www.

CLINICALTRIALS

gov) database in June 2022, with identification number NCT05499494. How to cite this article: Elderiny HM, Khallaf YS, Akah MM, et al. Clinical Evaluation of Bioactive Injectable Resin Composite vs Conventional Nanohybrid Composite in Posterior Restorations: An 18-Month Randomized Controlled Clinical Trial. J Contemp Dent Pract 2024;25(8):794-802.

Patients´ satisfaction concerning direct anterior dental restoration

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

A Three-step Etch-and-Rinse vs a Universal Adhesive in Nanohybrid Composite Anterior Restorations: A Retrospective Clinical Evaluation

PURPOSE

To retrospectively evaluate the clinical behavior of direct anterior composite restorations performed with a universal adhesive or with a three-step etch-and-rinse (E&R) adhesive.

MATERIAL AND METHODS

Patients were randomly treated with a three-step E&R adhesive (Optibond FL, Kerr) or a universal adhesive (Clearfil Universal Bond Quick, Kuraray Noritake) applied in E&R mode. All restorations were performed with a nanohybrid composite (ClearFil Majesty ES-2, Kuraray Noritake) by the same experienced operator. Two calibrated examiners evaluated the restorations using a dental mirror and explorer, in accordance with modified United States Public Health Service (USPHS) procedures. Clinical events were registered and classified as either failure (F), survival (SR), or success (S).

RESULTS

168 restorations were evaluated in 90 patients with an average follow-up period of 37.9 (± 22.9) months. A total of 132 restorations were performed on vital teeth, and 36 were performed on endodontically treated teeth (ETT). A total of 128 Class-IV and 40 Class-III restorations were performed. In 89 restorations, a three-step E&R adhesive was applied (14 Class-III and 75 Class-IV), while in 79, a universal adhesive was used (26 Class-III and 53 Class-IV, p = 0.0091). A Cox regression analysis was performed (p < 0.05) to analyze which factors were involved in the failure of the restorations, considering failure (F) as restorations that needed re-intervention at the follow-up period of 37.9 (± 22.9) months. No statistically significant differences were observed when considering parameters directly involved with the adhesives tested. Endodontically treated teeth were more prone to fractures (p = 0.0006) compared to vital teeth. Restorations made with universal adhesives failed by fracturing significantly more frequently (p = 0.0234), while restorations made on endodontically treated teeth had a significantly worse outcome (p = 0.0001). Restorations made on canines also failed significantly more frequently (HR = 3.8, 95% CI = 1.4-10.1, p = 0.0062).

CONCLUSIONS

Based on the obtained results, both the universal adhesive and the three-step E&R adhesive proved to be good treatment choices for direct anterior restorations after 37.9 (± 22.9) months of follow-up. Tooth vitality seems fundamental for the prognosis of a direct anterior composite restoration over time.

Long-term water sorption/solubility of two dental bonding agents containing a colloidal dispersion of titanium dioxide

The aim was to analyze the influence of the incorporation of 4% by mass of colloidal dispersion of titanium dioxide (TiO2) nanoparticles on the long-term water sorption and solubility of two commercial universal bonding agents. In vitro studies. A colloidal dispersion of TiO2 nanoparticles was formulated and blended into two commercial dental bonding agents, i.e., Ambar Universal (FGM, Brasil) and G-Premio Bond Universal (GC, America) at 4% by mass. Forty bonding agent discs were fabricated and segregated into four bonding agent groups of 10 discs each, i.e., GA: Ambar Universal (control), GB: Ambar Universal (4% TiO2 incorporated), GC: G-Premio Bond universal (control), and GD: G-Premio Bond (4% TiO2 incorporated). The bonding agent discs were developed by dispensing the bonding agents into a silicone cast of 5 mm diameter and 1 mm depth. After bonding agent discs were desiccated, the cured discs were weighed and kept in distilled water to be evaluated for water sorption and solubility over 1 year storage period. Statistical analysis was performed by independent variable t-test performed using the IBM SPSS software (Chicago, IL: SPSS Inc). The incorporated bonding agent groups (GA and GB) showed significantly lower (P < 0.05) water sorption and solubility following 1 year of water storage in comparison to the control bonding agents. Both GC and GD demonstrated remarkably lower water sorption and solubility than GA and GB. Incorporation of the colloidal dispersion of TiO2 nanoparticles at 4% by mass into the universal bonding agents has significantly reduced their water sorption and solubility contrast to their control groups.

Porcelain Veneers in Vital vs. Non-Vital Teeth: A Retrospective Clinical Evaluation

Nowadays, the ceramic veneer approach can be considered more predictable than direct composite veneer. To date, there is a lack of studies comparing the clinical performance of anterior veneers cemented on vital teeth (VT) and non-vital teeth (NVT). This longitudinal clinical study investigated the performance of ceramic veneers in VT or anterior NVT. A total of 55 patients were evaluated in the study. Two groups were defined based on the vitality status of the teeth (93 teeth-vital and 61 teeth-non-vital). The United States Public Health Service (USPHS) criteria were used to assess the clinical status. The data were evaluated statistically with the Mann-Whitney U test. All restorations were considered acceptable, and only one veneer in VT failed for the criteria of secondary caries. There were no statistically significant differences in any of the criteria evaluated (p ≤ 0.671). The ceramic veneers evaluated showed a satisfactory clinical performance both in VT and NVT.

Efficacy of adhesive strategies for restorative dentistry: A systematic review and network meta-analysis of double-blind randomized controlled trials over 12 months of follow-up

PURPOSE

The efficacy of etch-and-rinse, selective enamel-etching, and self-etching protocols for universal adhesives in follow-ups of over 12 months was compared in a network meta-analysis.

STUDY SELECTION

Randomized controlled trials (RCTs) published from 1998 to 2022 that compared marginal staining, marginal adaptation, retention and fractures, post-operative sensitivity, or recurrence of caries that took place over 12-months post-restoration were selected. A network meta-analysis determined the performance of each adhesive protocol.

RESULTS

After screening 981 articles, 16 RCTs were subjected to data extraction. Of which, 674 patients with 2816 restorations, were included in the network meta-analysis. The pooled risk of marginal discoloration following self-etching was significantly higher than that following etch-and-rinse at over 12, 24, and 36 months, which was time-dependent. The pooled risks of unfavorable marginal adaptation and unfavorable retention and fractures following self-etching were also significantly higher than that following etch-and-rinse, with the rates of unfavorable retention and fractures in non-carious cervical lesions increasing in a time-dependent manner. The pooled risks of marginal discoloration, unfavorable marginal adaptation, retention and fractures were similar between etch-and-rinse and selective enamel-etching protocols. Post-operative hypersensitivity and recurrence of caries were not significantly different among etch-and-rinse, selective enamel-etching, and self-etching protocols.

CONCLUSIONS

In follow-ups over 12 months, esthetic and functional outcomes of restorations completed with an etch-and-rinse adhesive protocol were superior to the ones achieved with a self-etching strategy without selective enamel-etching. Selective enamel etching is recommended for self-etching systems. Biological responses were similar for all three adhesive strategies.

Universal Adhesives and Adhesion Modes in Non-Carious Cervical Restorations: 2-Year Randomised Clinical Trial

This prospective, double-blind, six-arm parallel randomised controlled trial aimed to compare the performance of two universal adhesives (UAs) in non-carious cervical lesions (NCCLs), using the FDI criteria, and analysed if participants/NCCLs’ characteristics influenced the outcome. Thirty-eight 18- to 65-year-old participants were seeking routine dental care at a university clinic. At baseline, 210 NCCLs were randomly allocated to six groups (35 restorations’ each). The UAs tested were FuturabondU (FBU) and AdheseUniversal (ADU) applied in either etch-and-rinse (ER) and self-etch (SE) modes. FuturabondDC (FBDC) in SE and in SE with selective enamel etching (SE-EE) modes were controls. NCCLs were restored with AdmiraFusion. The analysis included nonparametric tests, Kaplan-Meier and log-rank tests (α = 0.05). At 2-years, of 191 restorations, ten were missed due to retention loss (all groups, p > 0.05). FBDC (p = 0.037) and FBU (p = 0.041) performed worse than ADU in SE mode. FBDC and FBU also showed worse functional success rate (p = 0.012, p = 0.007, respectively) and cumulative retention rates (p = 0.022, p = 0.012, respectively) than ADU. Some participants/NCCLs’ characteristics influenced (p < 0.05) the outcomes. FBU did not perform as well as ADU, especially in SE mode and due to functional properties. Participants’ age and NCCLs’ degree of dentin sclerosis and internal shape angle influenced FBU performance.

Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial

OBJECTIVES

To compare the clinical performance of the universal adhesive used in etch-and-rinse (ER) and self-etch (SE) adhesive strategies for 48-month in class II bulk-fill restorations.

METHODS

A total of 84 class II bulk-fill resin composite (Tetric EvoCeram Bulk Fill) restorations were placed in 35 participants by one operator using the universal adhesive's (Adhese Universal VivaPen) etch-and-rinse or self-etch mode randomly. The restorations were evaluated by two calibrated examiners at baseline and after 6-, 12-, 24-, 36- and 48-month using modified USPHS criteria. The comparison of the two adhesive strategies for each evaluation criteria was performed with the chi-square test. The baseline scores were compared with those at the recalls using the Friedman and Cochran's Q-test (p < .05).

RESULTS

At 48-month, 74 restorations were evaluated in 30 participants (recall rate: 85.7%). Marginal discoloration was statistically more frequent in SE approach (p < .05), whereas no significant difference was observed between the two strategies in terms of marginal adaptation (p > .05). There were statistically significant differences between the baseline and 48-month recall in the SE group in terms of marginal adaptation and discoloration (p < .05). In ER group, significant differences were found between baseline and 48-month only for marginal adaptation (p < .05). None of the restorations showed post-operative sensitivity. Secondary caries was observed in one restoration from SE group.

CONCLUSIONS

The tested bulk-fill restorative exhibited better clinical performance only in terms of marginal discoloration when the universal adhesive was used with ER strategy.

CLINICAL RELEVANCE

Though ER approach of the tested universal adhesive appears to be advantageous in terms of marginal discoloration, both adhesive strategies had similar impact on the clinical success of bulk-fill resin restorations.

Effect of Curcumin Suspension and Vitamin C on Dentin Shear Bond Strength and Durability. A Pilot Study

Background:

Preserving the strength and durability of dentin bonds is a concern of dental researchers and practitioners.

Objective:

The aim of this study was to investigate the effect of treating etched dentin with vitamin C and curcumin suspension as cross-linking agents on the shear bond strength and durability of a universal dental adhesive.

Methods:

Extracted human third molar teeth were collected. Fifty-six flat coronal dentin surfaces were divided equally into four groups: (1) treated with adhesives; (2) etched with 37% H3PO4 for 10s before application of adhesives; (3) same as group (2), but with dentin treated with 2.5% curcumin suspension for 60s before the application of adhesive; and (4) same as group (3), but with the use of a 20% vitamin C suspension instead of a curcumin suspension. Filtek Z350XT composite was built for all samples. Half of the samples in each group were subjected to thermocycling. Shear bond strength was measured using a universal testing machine. Scanning electron microscopy was used to investigate the dentinal surfaces after treatment.

Results:

Treatment with curcumin suspension preserved immediate and long-term bond strength. Conversely, treatment of etched dentin with vitamin C solution significantly reduced the immediate bond strength, but a significant improvement was observed after aging. SEM showed that both cross-linking agents resulted in narrowing or closing of the dentinal tubules, with an adhesive mode of failure.

Conclusion:

The application of curcumin or vitamin C suspension to acid-etched dentin resulted in different effects on immediate and long-term shear bond strength when using universal adhesives.

Compliance of randomized controlled trials in posterior restorations with the CONSORT statement: a systematic review of methodology

OBJECTIVES

This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and Cochrane Library. Only RCTs published in peer-reviewed journals were included. The compliance with the CONSORT was evaluated in a 0-2 scale where 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the CONSORT mean score by journal, country, and RoB were performed. The RoB in RCTs was evaluated by using the Cochrane Collaboration's tool version 1.0.

RESULTS

A total of 15,476 studies were identified after duplicates removal. O only 202 meet the eligibility criteria, among which 31 were follow-up studies. Concerning the overall RoB, only 29 out of 171 were classified as low risk of bias. The overall mean CONSORT score was 19 ± 5.4 points, which means compliance of approximately 59%. Significant differences among countries, publication period, and RoB were observed (p < 0.001). The journal's impact factor was not correlated with the overall CONSORT score (p = 0.36).

CONCLUSIONS

The adherence of RCTs conducted in posterior restorations to the CONSORT Statement is still low. In addition, most studies were classified as at unclear risk of bias. These results call up an urgent need for improvement.

CLINICAL RELEVANCE

Most RCTs conducted in posterior teeth have poor reporting and are mainly classified as having an unclear risk of bias.

A Two-Year Comparative Evaluation of Clinical Performance of a Nanohybrid Composite Resin to a Flowable Composite Resin

Objective: This prospective in vivo study aimed to compare the clinical behavior of a flowable composite resin (Genial Universal Flo, GC) and a nanohybrid universal composite resin (Tetric Evo Ceram, Ivoclar Vivadent) used in Class I and II direct esthetic restorations in posterior teeth. Methods: A total of 108 Class I and II direct restorations were performed in patients aged between 20 and 60 years. The originality of this study lies in the fact that both materials were placed in pairs, in the same clinical environment (i.e., the same patient and the same type of tooth). The evaluations were performed now of restoration and after 2-weeks, 6-, 12-, and 24-months intervals using clinical examination, clinical photographs, and radiological examination, according to modified USPHS criteria. Statistical analysis was performed using the Fisher exact test and chi-square analysis. Results: At baseline, the universal composite resin showed better esthetic properties such as surface luster, surface staining marginal staining. Both materials regressed significantly over time with no significant difference between groups. Conclusions: Both flowable and nanohybrid composite resins exhibit acceptable clinical performance. The present 24 months of evaluation of different composites showed that the G-ænial Universal Flo could be an effective esthetic material for posterior restoration. No significant difference between both materials over time concerning surface luster, surface staining, and marginal staining.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation

OBJECTIVE

This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators.

METHODS

Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers.

RESULTS

The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers.

CONCLUSIONS

In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly.

CLINICAL SIGNIFICANCE

Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

A three-year randomized clinical trial evaluating direct posterior composite restorations placed with three self-etch adhesives

Aim

To compare the clinical performance of composite restorations placed with a universal adhesive, one-step and two-step self-etch adhesives in class I and II posterior cavities.

Materials and methods

In this in vivo study, 46 volunteers presenting with at least three carious lesions were included. Each participant received the three restorative systems: universal adhesive/nanofilled composite (Scotchbond Universal/Filtek Z350 XT: SBU/FZXT), one-step self-etch adhesive/microhybrid composite (G-aenial bond/G-aenial Posterior: GB/GP) and the two-step self-etch adhesive/nanohybrid composite (OptiBond XTR/Herculite Ultra: OBX/HU). The adhesives were all placed in self-etch mode. In total, 138 restorations were evaluated at baseline and at 6,12 and 36 months using the modified United States Public Health Service criteria. Data were analysed using Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon non-parametric tests (p < .05). Ninety-one restorations were evaluated at 36 months.

Results

Seven restorations, three SBU/FZXT, three GB/GP and one OBX/HU failed during this study. The reasons for failure were marginal fracture and secondary caries. SBU/FZXT restorations showed significant marginal deterioration in all parameters. Overall success rates were: 93.5% (SBU/FZXT), 96.6% (GB/GP) and 96.8% (OBX/HU).

Conclusions

After three years, the three restorative systems have comparable clinical effectiveness and success rates, except for the marginal integrity, that was suboptimal for both the SBU/FZXT and GB/GP restorations in comparison to the OBX/HU restorations.

Effect of 940 nm laser diode irradiation prior to bonding procedure on postoperative sensitivity following class II composite restorations: a split-mouth randomized clinical trial

The aim of this study was to evaluate the effect of 940 nm laser diode on class II composite cavities prior to bonding and restoration process on the postoperative sensitivity (POS). Thirty patients with two bilateral premolars with mesio or disto-occlusal carious lesions were evaluated. In each patient, the teeth were randomly divided into the control and laser groups. After cavity preparation and isolation and before the bonding process, the laser group was subjected to 940 nm irradiation (Epic 10, Biolase, USA) by 400 μ tip continuously at 100 mW with 398 J/cm² energy density of tip, which was applied for 5 s at a distance of 2 mm on the axial wall of the cavity. In the control group, irradiation was performed by using the aiming beam. Access cavity was then restored with a composite resin. Cold sensitivity was measured using a cold spray application on the middle third of teeth buccal surface at baseline (before the intervention), 1, 14, and 30 days after the restoration by visual analog scale (VAS) criteria. The mean Friedman and Wilcoxon signed-rank tests were used for data analysis. It was shown that in both laser and control groups, the VAS was significantly decreased at all times compared to the baseline (p ≤ 0.05). There was no statistically significant difference between the mean VAS of two groups at baseline and first day (p ≤ 0.05), but at 14 and 30 days after the intervention, it was significantly lower in the laser group (p ≤ 0.05). The results of this study demonstrated that the cavity pretreatment with laser diode (940 nm) effectively reduces the postoperative sensitivity in class II composite restorations.

The Cytotoxicity and Genotoxicity of Three Dental Universal Adhesives-An In Vitro Study

Dental universal adhesives are considered an useful tool in modern dentistry as they can be used in different etching techniques, allow for simplified protocol and provide sufficient bond strength. However, there is still no consensus as to their toxicity towards pulp. Thus, the present study aimed to evaluate the cytotoxicity and genotoxicity of three universal adhesives: OptiBond Universal, Prime&Bond Universal and Adhese in an in vitro experimental model, monocyte/macrophage cell line SC (ATCC CRL-9855). The cytotoxicity was measured by means of XTT assay, whereas the genotoxicity (comet assay) was evaluated based on the percentage of DNA present in the comet tail. Furthermore, the ability of the adhesives to induce apoptosis was analyzed using flow cytometry (FC) with the FITC annexin V/propidium iodide (PI) double staining. The analysis of the cell cycle progression was performed with FC using PI staining. OptiBond Universal presented significant, while Prime&Bond Universal and Adhese Universal had minimal cytotoxicity and genotoxicity towards human SC cells. Moreover, only OptiBond Universal increased the level of apoptosis in SC cell line. None of the adhesives showed significant cell cycle arrest, as revealed by FC analysis. Due to substantial differences in toxicity in in vitro studies of dental adhesives, there is a great need for further research in order to establish more reliable test protocols allowing for standardized methodology.