Air-abrasive technology: its new role in restorative dentistry

Evaluation of the Efficacy of Recent Caries Removal Techniques: An In Vitro Study

INTRODUCTION

Dentistry is undergoing a gentle revolution that will consign drill and fill to history. In order to increase the acceptance of dental treatment, efforts are directed toward changing traditional painful dentistry into a new concept of painless dentistry. It is common practice to utilize burs for caries removal and cavity preparation. Chemomechanical caries removal is a painless procedure that uses a chemical substance to eradicate diseased dentine. With the Food and Drug Administration (FDA) approval of Erbium-doped yttrium-aluminum-garnet (Er: YAG) laser systems for caries removal and cavity preparation, the discipline of laser operational dentistry was born out of a desire to find a way to remove the decay without causing any pain or stress to the surrounding healthy tissue.

AIM AND OBJECTIVES

This in vitro research aimed to assess the relative advantages of chemomechanical and laser caries extraction techniques in comparison to the more traditional bur technique. The efficacy of each method was evaluated by microscopic examination of samples treated with each experimental method. We also evaluated the efficiency of each method by recording the time required for caries excavation.

MATERIAL AND METHODS

The methods used for caries excavation were bur excavation, chemo-mechanical method, and laser method. Histological slices were produced after all the samples had been treated with the experimental techniques, and they were studied using a binocular light transmission microscope. The samples were then scored as '0' for absence and '1' for the presence of demineralized dentine. These scores and the time recorded for each method were subjected to statistical analysis.

RESULTS

This study found no statistically significant difference in the effectiveness of the different approaches to removing caries; however, bur excavation was the quickest and chemo-mechanical was the slowest, with the latter not being useful in cases with low caries activity. The laser method of caries removal doesn't remove caries existing in the undercut areas of the cavity thus making the use of bur mandatory.

CONCLUSION

With more practice and experience, the chemo-mechanical and laser methods can be used in a more efficient way to render painless operative procedures to patients.

Role of the smear layer in adhesive dentistry and the clinical applications to improve bonding performance

Currently, dental adhesives can be divided into two systems; a smear layer-removal approach with etch-and-rinse adhesives or a smear layer-modified approach with self-etching adhesives. After phosphoric acid etching, the smear layer is completely removed. More attention is, however, required when using self-etching adhesives. The smear layer is partially demineralized by the weak acidic monomer and subsequently incorporated into the hybrid layer. Therefore, the characteristics of the smear layer play an important role on the bonding performance of self-etching adhesives. Such characteristics, for instance, smear layer thickness and smear layer density, are influenced by many factors, e.g., instruments used for dentin surface preparation, cutting speed, and the abrasive particle size of the cutting instruments. This review discusses the contributing factors that affect the smear layer characteristics, and the influence of the smear layer on the bonding performance of dental adhesives. Also, the application techniques regarding how to improve the bonding performance of self-etching adhesives – the smear layer removal by using chemical agents, or the modification of the adhesive application procedures – are provided.

Orthodontic Attachment Adhesion to Ceramic Surfaces

Ceramic materials are constantly evolving, achieving good functionality and aesthetics. Bonding to ceramics may be difficult because of high toxicity procedures and risk of surface damage. The review aims to answer several research questions: Is there a golden standard for bonding to ceramic? Are there adhesives or types of photopolymerization lamps that produce a higher bond strength on certain types of ceramics rather than others? Articles focusing on the bonding process of orthodontic attachments to ceramic surfaces searched in Pubmed, Medline and Embase, published between 1990 and 2018 were revised. Exclusions concerned bonding to non-ceramic surfaces, bonding to ceramic surfaces that are not destined for orthodontics or laser usage. Forty-nine articles that matched the inclusion criteria were researched. The following categories of original research articles were compared and discussed: metallic brackets bonding to ceramic surfaces, ceramic brackets to ceramic surfaces, bonding to new types of ceramics, such as zirconia, lithium disilicate, different photopolymerisation devices used on bonding to ceramics. Some types of adhesive may achieve minimal bond strength (6-8 MPa) even on glazed ceramic. Ceramic surface preparation may be done by sandblasting or hydrofluoric acid (60s application and 9.6%) with generally similar results. Studies rarely show any statistical difference and there are reduced number of samples in most studies. Ceramic brackets show better adhesion to ceramic surfaces and the same bonding protocol is advised. A higher bond strength may lead to ceramic surface. Few studies focus on newer types of ceramics; additional research is necessary. There is no clear evidence that a certain type of photopolymerization device produces higher shear bond strength values.

Substantial regional differences in the biomechanical behavior of molar treated with selective caries tissue removal technique: a finite element study

OBJECTIVES

Selective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM).

METHODS

Based on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface.

RESULTS

Regardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø₁ = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR.

SIGNIFICANCE

Retaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth's biomechanical condition.

Systematic review on alternative methods for caries removal in permanent teeth

Introduction:

Dental caries is the most common chronic dental disease in the world. It is defined as a multifactorial microbial infectious disease characterized by demineralization of the inorganic and destruction of the organic substance of the tooth. The host, flora, and the substrate should be there for the formation of dental caries. There are various microorganisms responsible for caries. The treatment for caries is essential to prevent teeth from involving pulp, leading to further damage. There are various methods in removing caries such as minimally invasive technique, rotary method with different types of burs, chemomechanical caries removal, and lasers. There are no data in literature for various methods of removing caries in permanent teeth.

Materials and Methods:

Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted, independently by two reviewers. Based on the specified inclusion and exclusion criteria's, the selected articles were subjected to quality assessment and the risk of bias was evaluated.

Objective:

The objective of this study was to evaluate the efficiency of caries removal by various methods in permanent teeth.

Search Strategy:

A search was performed in electronic database (i.e. PubMed and Medline) using search terms alone and in combination by means of PubMed search builder from January 1985 to January 2018.

Selection Criteria:

Studies were selected if they met the following criteria: in vivo studies comparing various methods of caries removal in permanent teeth.

Results:

The search identified 338 publications, out of which 328 were excluded after examination of the title and 2 were excluded after examination of the abstract. Through the hand search, three articles were included. Eight articles were retrieved for more detailed evaluation from the search. A total of 11 publications fulfilled all the criteria for inclusion.

Conclusion:

With the available evidence, this review concludes that the studies included in this review have a high risk of quality evidence.

In Vitro Shear Bond Strength of Orthodontic Brackets after Enamel Conditioning with Acid Etching and Hydroabrasion

The purpose of this study was to evaluate the shear bond strength and adhesive remnant index ARI) of orthodontic brackets following enamel conditioning with acid etching, hydroabrasion, and with both procedures. Thirty extracted human premolars were divided into three groups and received either acid etching, hydroabrasion or both procedures. Orthodontic brackets were bonded with composite resin. Shear bond strength was tested with a tensile machine, then the teeth were observed under a stereomicroscope to evaluate ARI scores. The enamel morphology after each conditioning method was evaluated with scanning electron microscope imaging. A one-way ANOVA and a Kruskal−Wallis H test were used to compare the bond strength and the ARI scores among the three groups. Hydroabrasion alone produced shear bond strength values below clinical acceptability, while the combination of acid etching and hydroabrasion produced the highest values. The ARI scores in the hydroabrasion group were significantly different from the other groups. Hydroabrasion followed by acid etching was effective in increasing the shear bond strength of orthodontic brackets. Further in vivo studies are needed to confirm the cost and benefits of this technique.

Factors Affecting the Shear Bond Strength of Orthodontic Brackets - a Review of In Vitro Studies

The adhesive material used to bond orthodontic brackets to teeth should neither fail during the treatment period, resulting in treatment delays, untoward expenses or patient inconvenience nor should it damage the enamel on debonding at the end of the treatment. Although the effectiveness of a bonding system and any unfavorable effects on the enamel may be studied by conducting in-vivo studies, it is nearly impossible to independently analyze different variables that influence a specific bonding system in the oral environment. In-vitro studies, on the other hand, may utilize more standardized protocols for testing different bonding systems and materials available. Thus, the present review focused attention on in-vitro studies and made an attempt to discuss material-related, teeth-related (fluorotic vs non-fluorotic teeth) and other miscellaneous factors that influences the shear bond strength of orthodontic brackets. Within the limitations of this review, using conventional acid-etch technique, ceramic brackets and bonding to non-fluorotic teeth was reported to have a positive influence on the shear bond strength of orthodontic brackets, but higher shear bond strength found on using ceramic brackets can be dangerous for the enamel.

Alternative treatment strategies for carious primary teeth: An overview of the evidence

BACKGROUND

Dental decay in children's primary teeth is a major health problem in the Great Britain with, in some areas, nearly 60% of five-year-olds having some experience of caries and 16% already having had at least one tooth extracted. Whilst currently accepted best practice for the management of carious primary teeth involves complete caries removal and placement of a plastic restoration, such conventional treatment is unpopular with general dental practitioners. Indeed, less than 15% of carious cavities in five-year-olds are currently restored and as such, there has been recent interest in alternative 'minimal intervention' treatment techniques for managing dental caries.

REVIEW

This review summarises the literature and also recent research efforts directed towards understanding the role of alternative treatment regimens including: (1) alternative techniques for cavity preparation and excavation and (2) the isolation of the carious process (in some cases, using cariostatic materials) from the oral environment or sealing in dental caries.

Effect of air abrasion and thermocycling on resin adaptation and shear bond strength to dentin for an etch-and-rinse and self-etch resin adhesive

This study examined the effect of air abrasion and thermocycling on the adaptation and shear bond strength, of composite resin bonded to dentin using etch-and-rinse and self-etch resin adhesives. Confocal microscopy showed both adhesives closely adapted to dentin and a significantly (p<0.001) greater number of resin tags were observed for the etch-and-rinse adhesive. Air abrasion significantly increased resin tag length (p<0.05) for the etch-and-rinse adhesive and significantly increased the number (p<0.001), length (p<0.001) and thickness (p<0.01) of tags for the self-etch adhesive. However, air abrasion resulted in defect formation within the hybrid layer and thermocycling caused separation of the hybrid layer from adjacent dentin containing resin tags. A significant (p<0.05) reduction in shear bond strength was observed for the etch-and-rinse adhesive following thermocycling. Both adhesive systems adapted well to dentin in vitro and shear bond strengths were similar. The area of tag penetration into dentin was significantly (p<0.0001) enhanced following air abrasion.

A comparative study of shear bond strength between metal and ceramic brackets and artificially aged composite restorations using different surface treatments

This in vitro study evaluated the shear bond strength (SBS) between ceramic brackets (CBs) and resin composite restorations (RCRs) prepared using different surface treatments. The findings were also compared with a similar study that used stainless steel brackets (SSBs). Forty-five premolars were restored with a nano-hybrid composite resin (Tetric EvoCeram) and randomly assigned to three surface treatment groups: group 1, 5 per cent hydrofluoric acid (HF); group 2, air abrasion (50 μm alumina particles); and group 3, diamond bur. Specimens were bonded with CBs (Fascination) and exposed to thermo-cycling (500 cycles). The shear force at a crosshead speed of 1 mm/minute was transmitted to brackets. The adhesive remnant index (ARIs) scores were recorded after bracket failure. The analysis of SBS variance (P < 0.01) and chi-square test of ARIs scores (P < 0.01) revealed significant differences among three groups tested. The SBS in group 3 (mean: 26.34 ± 4.76 MPa) and group 2 (mean: 26.68 ± 5.93 MPa) was significantly higher than group 1 (mean: 16.25 ± 5.42 MPa). The SBS was significantly higher in CBs (mean: 23.09 ± 7.19 MPa) compared to SSBs (mean: 15.56 ± 5.13 MPa). High ARIs (100 per cent) occurred in SSBs treated with a diamond bur, whereas CBs primarily failed at the resin-adhesive interface (P < 0.01). In two-thirds of the specimens (SSBs or CBs), no adhesive was left on the restoration after HF conditioning. The ARIs profile of CBs and SSBs that received surface treatments with air abrasion were similar (P > 0.05) and bond failure occurred mainly in adhesive-bracket base and resin-adhesive interfaces. The diamond bur surface treatment is recommended as a safe and cost-effective method of bonding CBs to RCRs.

Effects of Er:YAG laser and air abrasion on the microleakage of a resin-based fissure sealant material

OBJECTIVES

The aim of the present study was to evaluate the effects of different surface pre-treatment techniques on the microleakage of a resin-based fissure sealant material.

METHODS

Thirty-five molars were divided into the following seven groups based on the surface pre-treatment technique used: (a) Erbium: Yttrium Aluminium Garnet (Er:YAG) laser (7 W); (b) Er:YAG laser (7 W)+acid etching (with 37% phosphoric acid); (c) Er:YAG laser (5.5 W); (d) Er:YAG laser (5.5 W)+acid etching; (e) air abrasion+acid etching; (f) air abrasion; and (g) conventional acid etching. The sealant was placed according to the manufacturers' instructions and light-cured for 20 sec. The sealed teeth were thermocycled for 10,000 cycles (5°-55°C), then immersed in 5% methylene blue for 24 h and sectioned mesiodistally. Each section was analyzed and photographed using a light microscope. Microleakage was assessed quantitatively by the degree of dye penetration and also qualitatively, scored on a three-point rating scale. Data were analyzed by one-way analysis of variance (ANOVA) and the Kruskal-Wallis test. The level of significance was set at p < 0.05.

RESULTS

Regardless of the fissure morphology and penetration depth, enamel surfaces conditioned with Er:YAG laser irradiation exhibited significantly higher microleakage than those conditioned with air abrasion followed by acid etching, and those conditioned with conventional acid etching (p < 0.05). Air abrasion followed by acid etching, as well as conventional acid etching, provided a sufficient seal, whereas laser irradiation alone or in combination with acid etching exhibited higher microleakage than did the other groups.

CONCLUSIONS

Conventional acid etching remains the most effective and the simplest technique.

Removal of enamel caries with an air abrasion powder

This study compared the efficiency of air abrasion on enamel caries with selective enamel powder (SEP) or with alumina powder and a negative and positive control group. Ninety-three extracted molars with non-cavitated incipient enamel lesions were selected. After embedding the roots in resin, each lesion was sectioned perpendicular to the surface and photographed. Each lesion was classified microscopically as having or not having dentin involvement. The lesions were distributed into four groups with an equal number of enamel caries with or without dentin involvement. Each group was treated differently: Group 1 had SEP abrasion, Group 2 had alumina abrasion, Group 3 had sodium bicarbonate abrasion (negative control) and Group 4 had bur treatment (positive control). The surface was rephotographed after treatment. Superimposition of the photographs identified areas of "correct-excavation," "under-excavation" and "over-excavation." There were no statistical differences between lesions treated with or without dentin involvement for Groups 2 through 4. However, in the SEP group, all measured areas were significantly influenced by dentin involvement. In pairwise comparisons, no statistical differences were found between the alumina and bur groups. The SEP group, however, showed statistically significant differences for each area compared to the alumina group in enamel caries without dentin involvement. SEP performed as well as alumina and bur in lesions with dentin involvement. SEP is different in its ablative properties toward caries with dentin involvement or no dentin involvement. In terms of dental treatment, SEP seems to have a diagnostic potential for enamel lesions before operative intervention in patients with high caries risk.

[Enamel micro-abrasion]

Enamel conditioning (elimination of dental plaque and creation of an irregular surface) is an essential step before bonding of orthodontic brackets. The most popular procedure in our practice is bonding with resin which requires enamel etching in order to get enough shear bond strength. Many studies have tried to evaluate the effects of enamel bonding using the acid-etching procedure as well as the changes caused by detachment of brackets. Thanks to the development of other adhesives such as glass ionomer cements which chemically bind to the enamel, new enamel conditioning methods appeared, in particular sandblasting with aluminium oxide particles. This technique is a mechanical preparation of the tooth that avoids the harmful effects of acid products. By suitably choosing the parameters of sandblasting (pressure, time and quantity of powder), enamel loss is lower than with the acid-etch procedure and the surface of the enamel seems less affected. However the bond strength remains superior to the values required for treatment. The presented results indicate that enamel sandblasting can be considered as an alternative for the acid-etching technique currently used in orthodontic practice because it creates sufficient strength and respects enamel thickness better.

Efficacy of a new jet nozzle for removal of carious dentin with an air abrasion system

A new version of an air abrasion device, which expelled abrasive sodium bicarbonate powder, was fabricated to remove carious tissue. This device had a motor-driven mechanism to control the amount of powder expelled. The purpose of this study was to estimate the abrading efficacy of this device, in particular the new jet nozzle, for removal of carious dentin. Powder was supplied to the handpiece by a rotary gear attached to the powder control motor. Two types of jet nozzles, a cylinder-type and a bugle-type, were fabricated and evaluated. The duct of bugle-type nozzle had an isthmus to increase the air pressure on the powder and to spread it out in a cone-shaped flow. Results obtained showed that the bugle-type jet nozzle exhibited a more prominent abrasive capability. Compared to the cylinder-type nozzle, it was thus more effective in removing the carious dentin which remained in the undercut region of the cavities.

Shear Bond Strength of the Amalgam-Resin Composite Interface

On the basis of the results of this in vitro study, resin composite may be an effective way to repair or mask the appearance of amalgams placed in visible areas of the mouth.

Effect of air abrasion on tensile bond strength of a single-bottle adhesive/indirect composite system to enamel

This study evaluated the efficiency of air abrasion alone and associated with phosphoric acid etching on tensile bond strength of a single-bottle adhesive/indirect composite restorative system (Bond 1/Alert) to human enamel. Forty enamel surfaces from extracted human third molars were assigned to 4 groups (n= 10). Mach 4.1 (Kreativ Inc.) air abrasion equipment was used for 20 s. A special system of rod pairs aligned in a specific apparatus was used for tensile strength tests, according to ISO/TR 11405 standard (1994) with some modifications. Bond strength means were: G1 (air abrasion + rinsing + condensable composite resin Alert) = 3.46 ± 0.83 MPa; G2 (air abrasion + rinsing + Bond 1 adhesive system + Alert) = 4.00 ± 1.60 MPa; G3 (air abrasion + rinsing + 37% phosphoric acid + rinsing + Bond 1 + Alert) = 20.80 ± 3.95 MPa; and G4 (37% phosphoric acid + rinsing + Bond 1 + Alert) = 17.00 ± 2.74 MPa. The statistical analysis by Kruskal-Wallis test revealed that G1 and G2 presented statistically significant difference (p< 0.05) from G3 and G4 (p<0.01) and G1 and G3 did not differ significantly (p> 0.05) from G2 and G4, respectively.

Sucção de alta potência no controle das partículas emitidas pelo sistema de abrasão a ar em consultório odontológico

O objetivo do estudo foi avaliar a deposição de óxido de alumínio no campo operatório do cirurgião-dentista durante a utilização do sistema de abrasão a ar em consultório odontológico, bem como a efetividade da sucção de alta potência na captação desse pó. Por meio de um dispositivo para a coleta das partículas nos locais correspondentes às posições e distâncias de trabalho do profissional, dentes artificiais foram abrasionados. O sistema de sucção empregado para aspiração das partículas foi o de alta potência com sugador de saliva convencional e sugador com abertura ampliada por funil. A mensuração das partículas foi determinada pela quantidade em massa de óxido de alumínio depositada em placas de Petri. Os resultados obtidos por meio de estatística descritiva gráfica revelaram que a maior quantidade de pó se encontrava a 20 cm do operador e na posição de trabalho 9h, quando foi utilizado o sugador de saliva convencional. Uma vez comprovado que a sucção não é totalmente eficiente na aspiração do pó de óxido de alumínio, reforça-se a importância da proteção individual apropriada para o emprego seguro do sistema de abrasão a ar para pacientes e, principalmente, para os profissionais que trabalham com este tipo de tecnologia.

Effects of sandblasting metal bracket base on the bond strength of a resin-modified glass ionomer cement: an in vitro study

The introduction of air abrasion (sandblasting) technology to orthodontics may allow reaching optimum bond strength between the metal bracket and resin-modified glass ionomer cement. This study examined the effects of sandblasting metal bracket bases on the in vitro tensile bond strength of a resin-modified glass ionomer cement. Two-hundred foil-mesh based brackets were divided into ten groups and combinations of three sizes of aluminum oxide powder (25, 50 and 110 microm) and three sandblasting times (3, 6 and 9 seconds) were tested. One group was not sandblasted and used as control. Analysis of variance showed that bond strength was significantly affected by the sandblasting time (p < 0.001) and size of the aluminum oxide powder (p < 0.001). Only the group (SO(25)) sandblasted with 25 microm aluminum oxide powder for 3 seconds yielded higher mean bond strength than that of the control group. The bond strength values were also analyzed using a Weibull analysis, which showed the most favorable size (25 microm) and time combination (3 seconds), and the 5% and 90% probabilities of failures. This study suggests that sandblasting time and particle size have and important effect on the bond between the metal bracket and resin-modified glass ionomer cement.

Application of the total etching technique or self-etching primers on primary teeth after air abrasion

Since the use of air abrasion has grown in pediatric dentistry, the aim of this study was to evaluate, by means of shear bond strength testing, the need to use the total etching technique or self-etching primers on dentin of primary teeth after air abrasion. Twenty-five exfoliated primary molars had their occlusal dentin exposed by trimming and polishing. Specimens were treated by: Air abrasion + Scotchbond MultiPurpose adhesive (G1); 37% phosphoric acid + Scotchbond MP adhesive (G2); Clearfil SE (G3); Air abrasion + 37% phosphoric acid + Scotchbond MP adhesive (G4); Air abrasion + Clearfil SE (G5). On the treated surface, a cylinder of 2 mm by 6 mm was made using a composite resin (Z100). Duncan's test showed that: (G2 = G3 = G5) > (G1 = G4). The use of a self-etching primer on air abraded dentin is recommended to obtain higher bond strengths.

Effects of buccal versus lingual surfaces, enamel conditioning procedures and storage duration on brackets debonding characteristics

OBJECTIVES

To determine the influence of two enamel conditioning techniques on buccal and lingual tooth surfaces at two different times on debonding strength and tooth damage.

METHODS

The study included 50 premolars. Buccal and lingual surfaces of 10 teeth were scanned using SEM before (N=4) and after enamel conditioning by either acid etching or sandblasting prior to acid etching (N=6) for their morphology. The remaining 40 teeth were divided into 2 equal groups, differing in enamel conditioning prior to metallic bracket bonding on the buccal and lingual surfaces. Each group was equally subdivided into short-term (48h) or long-term (12m) water storage. Debonding strength was measured followed by SEM and EDAX for adhesive remnant index (ARI) and calcium remnant index (CRI) left on bracket bases. ANOVA with repeated measures was applied to the results.

RESULTS

The buccal enamel was rougher than the lingual one. The surface morphology after the two types of conditioning showed a different pattern. A significantly higher debonding strength was needed to debond the buccal brackets compared to the lingual ones (p<0.05). A significantly higher ARI (p<0.002) and higher CRI (p<0.005) were found in the lingual surface compared with the buccal. No differences were found in debonding strength ARI or CRI regarding the different conditioning or storage duration.

CONCLUSIONS

Lingual bonding leads to higher ARI and CRI than buccal bonding. Sandblasting prior to etching does not improve bonding strength for lingual or buccal bonding.

The effect of airborne-particle abrasion on the shear bond strength of four restorative materials to enamel and dentin

STATEMENT OF PROBLEM

The role of airborne-particle abrasion on the bond strength of restorative materials to enamel and dentin is controversial.

PURPOSE

The purpose of this study was to evaluate the effect of airborne-particle abrasion on the shear bond strengths of 4 restorative materials to enamel and dentin.

MATERIAL AND METHODS

One hundred twelve extracted human maxillary anterior teeth were divided into 2 groups of 56 teeth each. In the first group flat enamel surfaces were prepared, and in the second flat dentin surfaces were prepared. Half the teeth in each group (n=28) were airborne-particle abraded. The remaining 28 teeth in each group were prepared with silicone carbide paper (control). Specimens in both groups were divided into 4 subgroups (n=7). A composite, a compomer, a resin-modified glass ionomer cement, and a conventional glass ionomer cement were applied to enamel and dentin surfaces (3 mm diameter and 4 mm height). After 24 hours of storage in water, specimens were subjected to shear forces in a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. Shear bond strength data (MPa) were analyzed with 3-way ANOVA and Tukey HSD tests (alpha=.05).

RESULTS

Airborne-particle-abraded specimens showed significantly higher shear bond strengths than control specimens. The 2-way interaction between tooth structure and restorative materials was significant.

CONCLUSION

The use of airborne-particle abrasion increased the shear bond strength of restorative materials tested to enamel and dentin.

Effect of Carisolv on the human dental pulp: a histological study

OBJECTIVES

The aim of this study was to investigate histopathologically after 1 week and 1 month the effect of Carisolv on exposed human pulp after a contact period of 10 min in comparison to sterile saline solution.

METHODS

Class V cavities were prepared in 40 human first premolars, and the pulp chambers were perforated. The pulp tissue was either exposed to Carisolv or sterile saline solution for 10 min, covered with Teflon and restored with compomer filling material. After observation periods of 1 week and 1 month, the teeth were extracted and examined by light microscopy.

RESULTS

Histological evaluation revealed similar pulpal response which consisted of a slight inflammation in both groups after 1 week. The only difference was localized haemorrhage in controls while no haemorrhage was observed in the test group which may show the haemostatic effect of Carisolv. After 1 month the test teeth displayed a very mild inflammation adjacent to the perforation area while haemorrhage disappeared in the controls. In general, pulps showed structural integrity in both groups. Statistical analysis showed no difference between the test and the control groups in both test periods.

CONCLUSIONS

The results suggest that Carisolv is biocompatible with human pulp tissue and may have a haemostatic effect.

A morphological and micro-tensile bond strength evaluation of a single-bottle adhesive to caries-affected human dentine after four different caries removal techniques

OBJECTIVES

This study evaluated the influence of different caries removal techniques (conventional bur; chemomechanical removal/Carisolv()-MediTeam; a sonic preparation system/SonicsysMicro-Kavo and air abrasion/PrepStar-Danville Engineering) on microtensile bond strength to caries-affected human dentine.

METHODS

Occlusal surfaces of extracted human permanent third molars with coronal dentine caries extending approximately halfway through the dentine was ground perpendicular to the long axis of the tooth to expose a flat surface of normal dentine surrounding the carious lesion with laser fluorescence values of approximately 30 (DIAGNODent), KaVo). Carious lesions were excavated with one of the four techniques until laser fluorescence values decreased to 15 in the center of the lesions. An ethanol-based dentine adhesive (Single Bond, 3M) was used to bond composite resin (P60, 3M) to the substrate. Vertical slices (n=11/group), approximately 0.8 mm thick were made through the caries-affected portions of each tooth, perpendicular to the bonding surface. Specimens were subjected to tensile stress at a crosshead speed of 1 mm/min. Data were analyzed by Kruskal-Wallis test. SEM investigation was performed for the qualitative evaluation of resin-dentine hybridization.

RESULTS

The microtensile bond strengths were as follows (mean+/-SD in MPa): 6.4+/-5.3 (bur), 8.4+/-3.3 (Carisolv), 8.5+/-5.9 (Sonicsys Micro), and 8.8+/-8.8 (air abrasion). Statistical analysis did not show significant differences between any of the treatment modalities (p=0.160). Tensile fracture was cohesive within caries-affected dentine in all specimens.

CONCLUSIONS

The four different caries removal techniques used within this study did not influence the bond strength of the tested dentine adhesive to caries-affected human dentine.

The influence of orthodontic bracket base design on shear bond strength

Many bracket base designs and adhesive materials are in clinical use today. Bases have evolved from perforated metal bases to the present foil mesh bases, and treatments range from none, to spraying metal alloy onto the base, to the most common treatment of microetching. The purpose of this study was to determine the effect of orthodontic bracket base design on mean shear bond strength 1 hour or 24 hours after bonding. For each time group, 12 specimens of 6 types of metal brackets were bonded to bovine incisors with Transbond XT (3M Unitek, Monrovia, Calif) light-cured composite resin. Brackets were debonded 1 hour or 24 hours later, and the shear bond strength was recorded. Six debonded brackets of each type from each time group were selected at random and sandblasted. All the teeth were cleaned, and half were rebonded with used brackets, and half were rebonded with new brackets. Bond strength was measured again, 1 hour or 24 hours later. Representative specimens were inspected under the scanning electron microscope. Bracket base design significantly affected mean shear bond strength. Speed (60-gauge, microetched foil-mesh base; Strite Industries, Cambridge, Ontario, Canada) had the highest bond strength at 1 hour; followed by Time (machined, integral, microetched base with mechanical undercuts; American Orthodontics, Sheboygan, Wis); American Master Series (80-gauge foil-mesh base; American Orthodontics); Ovation Roth (80-gauge layered onto 150-gauge, microetched foil-mesh base; GAC, Central Islip, NY); Orthos Optimesh XRT (100-gauge microetched foil-mesh base; Ormco, Orange, Calif); and, finally, the nickel-free brackets (injection molded, 100-gauge, microetched, foil-mesh base; World Class Technology, McMinnville, Ore). The 24-hour results were similar except that Time had the highest mean shear bond strength (ANOVA, P <.05). Chairside sandblasting significantly affected the 1-hour, but not the 24-hour, mean shear bond strengths (ANOVA, P <.05). Sandblasting appears to be an effective method of cleaning bracket bases before rebonding.

Influence of the frequency of Er:YAG laser on the bond strength of dental enamel

OBJECTIVE

The present study had the aim of evaluating the influence of different frequencies of the Er:YAG laser on adhesive resistance of enamel and one restorative system.

BACKGROUND DATA

There have been no reports of studies assessing the influence of the pulse frequency variation of the Er:YAG laser on adhesive resistance of the enamel/resin interface.

MATERIALS AND METHODS

Fifty surfaces of enamel from extracted human third molars were planed and divided into five groups at random. Enamel surface treatment was realized by the Er:YAG laser at 80-mJ power and 1-, 2-, 3-, and 4-Hz pulse frequencies, followed by etching. For the control group, only acid conditioning with 37% phosphoric acid for 15 sec was used. The Single Bond/Filtek Z250 system was chosen for the fabrication of the specimens, which were stored in 100% relative humidity for 24 h, at 37 degrees C. The specimens were submitted to tensile resistance tests using a Universal Testing Machine (50 Kgf and 0.5 mm/min).

RESULTS

The mean values in MPa were 1 Hz, 25.58 (+/-6.16); 2 Hz, 25.58 (+/-3.79); 3 Hz, 21.34 (+/-3.78); 4 Hz, 21.17 (+/-3.13); and phosphoric acid only, 22.44 (+/-7.0). Data were submitted to statistical analysis using ANOVA, and there was no significant difference in tensile resistance between the studied groups.

CONCLUSION

The results suggest that the Er:YAG laser, with 80-mJ power associated with acid conditioning at 1-, 2-, 3-, and 4-Hz frequencies, did not present significant improvement in tensile bonding of enamel, as compared to acid conditioning only.

Tensile bond strength of dentin-resinous system interfaces conditioned with Er:YAG laser irradiation

OBJECTIVE

The aim of this in vitro study was to assess tensile bond strength of dentin-resinous system interfaces conditioned with Er:YAG laser irradiation.

BACKGROUND DATA

There are different results reported in the literature which relate to laser Er:YAG effects on dentin surface as a pretreatment during adhesives procedures.

MATERIALS AND METHODS

Forty-two surfaces of human dentin from third upper molar were used after being extracted and kept in the refrigerator in 0.5% chloramines aqueous solution and then divided into three experimental groups and three control groups. The chosen restorative systems were Alert (Jeneric/Penton), Prodigy (Kerr Co.), and Z-100 (3M Co.), with correspondent dental adhesives Bond 1, Optibond Solo, and Single Bond, respectively. To conduct tensile tests, a special system of pairs of rods aligned in a specific apparatus was used, in accordance with ISO/TR 11405 standard (1994).

RESULTS

By means of statistical analysis, the Kruskal Wallis test, it was noticed that group IE (laser + acid + Alert), 18.89 MPa, differed considerably from group IC (acid + Alert), 8.03 MPa (p < 0.10), but did not differ from the other groups. Group IIC (acid + Prodigy), 19.88 MPa, differed from group IIE (laser + acid + Prodigy), 12.57 MPa (p < 0.05), but did not differ from groups IIIE (laser + acid + Z-100), 14.11 MPa, and IIIC (acid + Z-100), 19.58 MPa. Group IIIE did not differ statistically from group IIIC.

CONCLUSION

It was concluded that previous Er:YAG laser treatment on the dentinal structure only improved the tensile bond resistance of the Alert restorative system.

A laser-abrasive method for the cutting of enamel and dentin

BACKGROUND AND OBJECTIVE

This paper introduced a new method for the removal of hard dental tissue based upon the use of particles accelerated by laser irradiation, which the authors have called the laser-abrasive method.

STUDY DESIGN/MATERIALS AND METHODS

The particles used were sapphire as powder or an aqueous suspension. The effect of the products of enamel ablation was also investigated. The particles were accelerated using submillisecond pulses of Er:YAG and Nd:YAG lasers. A strobing CCD camera was used to measure the speed of the ejected particles. The additional contribution of these particles to the efficiency of laser ablation of enamel and dentin was also investigated.

RESULTS

The results showed that the enamel particles produced by the beam-tissue interaction were also accelerated by this process of ablation and were effective in the removal of enamel and dentin. The use of an aqueous suspension of sapphire particles increased the efficiency of enamel removal threefold when compared with the use of an Er:YAG laser with water spray.

CONCLUSIONS

The laser-abrasive method allowed for the removal of enamel and dentin at speeds approaching those of the high-speed turbine.

Microleakage of a resin sealant after acid-etching, Er:YAG laser irradiation and air-abrasion of pits and fissures

OBJECTIVE

The aim of this in vitro study was to assess microleakage underneath a filled pit-and-fissure sealant bonded to occlusal surfaces treated by four enamel etching techniques.

SUMMARY BACKGROUND DATA

There has been no report of a study assessing microleakage of a pit-and-fissure sealant, comparing acid-etching, Er:YAG laser and air-abrasion for treating enamel surface.

METHODS

Forty extracted human third molars were selected and randomly assigned into four groups of ten teeth: group I, the occlusal surfaces were acid-etched; group II, a very short pulsed Er:YAG laser was used to treat the surfaces; group III, aluminum oxide air-abrasion was associated with acid-etching; group IV, Er:YAG laser was associated with acid-conditioning. The surfaces were sealed and the teeth were stored for 7 days in distilled water. Then, specimens were thermocycled, immersed in a 0.2% rhodamine solution, sectioned, and analyzed for leakage using an optical microscope connected to a video camera. The images were digitized and analyzed by software that allowed microleakage assessment in millimeters.

RESULTS

Statistical analysis showed that occlusal surfaces treated exclusively by the Er:YAG laser (group II) provided the poorest marginal sealing and that acid-etching (group I) was statistically similar to aluminum oxide air-abrasion + acid etching (group III) and to Er:YAG laser + acid-etching (group IV).

CONCLUSIONS

The results suggest that complementing either air-abrasion or Er:YAG laser irradiation with a subsequent acid-conditioning did not lessen microleakage at the enamel-sealant interface when compared with an acid-etched group. It was also observed that treating the enamel surface exclusively by Er:YAG laser resulted in the highest degree of leakage.

Effects of air abrasion and acid etching on the microleakage of preventive Class I resin restorations: an in vitro study

PURPOSE

To evaluate the effects of air abrasion, acid etching, and the combination of both procedures on the microleakage of preventive Class I resin restorations.

MATERIALS AND METHODS

Eighty-four extracted human molar teeth were randomly assigned to seven groups with 12 teeth each. Occlusal fissures were opened with a diamond bur and etched with phosphoric acid (groups I and VI); prepared with a diamond bur without etching (group VII); air abraded with the KCP 1000, using 50-micron aluminum oxide particles without etching (group II), and with phosphoric acid etching (group III); or air abraded with 27-micron aluminum oxide particles without etching (group IV), and with phosphoric acid etching (group V). Preparations were filled with a low-viscosity resin composite (Liquicoat, groups I to V) or with a low-viscosity polyacid-modified resin composite (PrimaFlow, groups VI and VII). Six teeth in each group were thermocycled (5 degrees-55 degrees C, 2500 cycles). Dye penetration (methylene blue) was evaluated in ordinal scale.

RESULTS

The number of non-thermocycled and thermocycled specimens revealing no microleakage was as follows: group I, 6 and 1; group II, 2 and 2; group III, 4 and 3; group IV, 0 and 0; group V, 1 and 0; group VI, 3 and 2; and group VII, 0 and 0, respectively. No significant differences existed between the thermocycled specimens and non-thermocycled specimens, except within group I.

CLINICAL SIGNIFICANCE

Results indicated that (1) air-abrasion treatment with 27-micron particles is less effective in preventing microleakage compared to 50-micron particles, (2) air abrasion should be combined with acid etching to reduce microleakage of preventive Class I resin restorations, and (3) acid etching significantly reduces microleakage of the low-viscosity polyacid-modified resin composite in preventive Class I restorations.

Dentine caries excavation: a review of current clinical techniques

Since the invention and application of rotary instruments, the operative treatment of carious lesions has often resulted in considerable removal of tooth structure. More recently, newer techniques for removal of carious dentine have been developed in an attempt to minimise this excessive tissue loss. The following article reviews and discusses some of the techniques available to excavate demineralised dentine clinically. These methods can be classified as mechanical and non-mechanical, rotary and non-rotary and include: dental handpieces/burs, manual excavators, air-abrasion, air-polishing, ultrasonication, sono-abrasion, chemo-mechanical methods, lasers and enzymes. The advantages and disadvantages of each technique are discussed.

Scanning electron microscopic observations of human dentine after mechanical caries excavation

OBJECTIVES

The structural integrity and surface characteristics of dentine remaining after caries excavation may be relevant to the subsequent bonding of adhesive restorative materials to the prepared cavity. This in vitro investigation aimed to analyse the different surface characteristics of the dentine cavity floor created after preparation using five different mechanical and chemo-mechanical methods of excavation: hand excavation, slow-speed bur, sono-abrasion, air-abrasion and Carisolv gel.

METHODS

Ten cavities were prepared using each excavation method in extracted teeth with occlusal carious lesions. Epoxy resin replicas of the 50 cavities were manufactured from silicone impressions and then analysed using secondary electron scanning electron microscopy (SEM) to ascertain the surface characteristics of the dentine at the cavity floor.

RESULTS AND CONCLUSIONS

Results from the 50 cavities examined suggested that each alternative excavation technique produced a different and characteristic dentine surface. Carisolv gel was the only method examined that consistently removed the smear layer during excavation to leave exposed dentine tubules at the end of cavity preparation.

The effect of enamel air abrasion on the retention of bonded metallic orthodontic brackets

The purpose of this study was to compare the conventional acid-etch technique with an air abrasion surface preparation technique. Eighty freshly extracted noncarious human premolar teeth were randomly divided into the following 4 groups: (1) acid etched with 37% phosphoric acid for 15 seconds (Express Dental Products, Toronto, Canada), (2) sandblasted with 50 mu aluminum oxide by a microetcher (Danville Engineering Inc, Danville, Calif), (3) polished with pumice followed by acid etched with 37% phosphoric acid for 15 seconds, (4) sandblasted with 50 mu aluminum oxide by a microetcher followed by acid etched with 37% phosphoric acid for 15 seconds. All the groups had stainless steel brackets (Dentaurum, Standard Edgewise) bonded to the buccal surface of each tooth with no-mix adhesive (Express Dental Products, Toronto, Canada). A Lloyd testing machine (Lloyd Instrument LR 30K; Segensworth West, Foreham, UK) was used to determine tensile bond strengths at a crosshead speed of 0.5 mm/sec. The mean bond strength values of these are as follows: the only sandblasted group was 38.05 +/- 9.93 N; the only acid-etched group was 62.72 +/- 11.44 N; the group that was polished with pumice followed by acid etched was 69.78 +/- 14.87 N; and the group that was sandblasted followed by acid etched was 89.31 +/- 13. 34 N. The statistical analysis was done by an analysis of variance and Scheff¿e test. The sandblasting followed by acid etching group had significantly higher bond strength values when compared to the other 3 groups. This study showed that sandblasting should be followed by acid etching to produce enamel surfaces with comparable bond strength. The current findings indicate that enamel surface preparation using sandblasting with a microetcher alone results in a significantly lower bond strength and should not be advocated for clinical use as an enamel conditioner.

A confocal microscopic study relating the autofluorescence of carious dentine to its microhardness

OBJECTIVE

An in-vitro study to examine the correlation between the distribution of the autofluorescent signal emitted from carious dentine (detected using confocal laser scanning microscopy) and its microhardness, within the depths of human dentine lesions.

MATERIALS AND METHODS

Twelve carious teeth were sectioned longitudinally, the cut faces marked with a grid reference line system and colour photomicrographs taken. The same samples were imaged using confocal laser-scanning microscopy for autofluorescence and then subjected to microhardness testing using a Knoop microhardness indenter. Adjacent sound dentine was used as a control reference. Digital image superimposition allowed direct comparisons to be made between the colour, autofluorescence and microhardness of each lesion.

RESULTS

Sound enamel and dentine did not autofluorescence. Autofluorescence distribution from carious dentine correlated with the highly softened tissue (detected using the Knoop indenter) and terminated at a level superficial to the translucent zone. This zone was still pigmented. Normal, sound dentine hardness levels were found deep to the translucent zone.

CONCLUSIONS

A correlation existed between the zone of autofluorescence and carious dentine that was markedly softened by the carious process. These findings highlighted a possibility that the autofluorescence might be used as an in-vitro, objective histological marker for the softened, carious dentine requiring clinical excavation.

The safety and efficacy of treatment with air abrasion technology

AIMS

To evaluate patient and operator exposure to respirable particulates following the use of air abrasion in tooth preparation, and to compare the microleakage of pit and fissure sealants after conventional, bur and air abrasion preparation of the pits and fissures.

METHODS

To examine air abrasion safety, sampling data were collected using a physical model of the upper torso of a patient. Previously extracted bovine incisors were prepared using an air abrasion instrument. Patient and operator exposure samples were collected. The variables examined included the size of the alumina oxide particles, the speed of particle delivery and the method of dust collection. To assess the efficacy of air abrasion, 36 extracted human molars were divided into three groups. The groups were prepared by conventional acid etching, opening the pits and fissures with a round bur, or by air abrasion. To simulate oral conditions, sealed teeth were immersed in artificial saliva and thermocycled. Teeth were immersed in a 1% solution of methylene blue and sectioned to assess the microleakage associated with each sealant.

CONCLUSIONS

(1) Dust from the KCP 1000 is insufficient to be a health hazard to patients or operators, (2) chair-side suction can be used as an alternative to the KCP 1000 suction, (3) superior sealants were obtained when tooth surfaces were prepared by a bur, compared to air abrasion and conventionally prepared surfaces, and (4) air abrasion tooth surfaces demonstrated less microleakage than conventionally prepared tooth surfaces.

Air abrasion of failed bonded metal brackets: a study of shear bond strength and surface characteristics as determined by scanning electron microscopy

Failed bonded orthodontic brackets generally require their replacement with a new bracket. The introduction of air abrasion (microetching) technology to orthodontics may allow for immediate use of these failed brackets. This study compared the in vitro shear bond strengths of previously failed bonded metal brackets (experimental group) subjected to air abrasion with new untreated brackets (control group). All bonding used a light-cured orthodontic bonding system. In addition, representative samples from each group were examined by scanning electron microscopy. The results of this study found no significant differences in shear bond strengths between the two groups. Scanning electron microscopy examination of the air abraded brackets revealed a roughened mesh surface with residual bonded material in the bracket base. This simple technique should allow for the immediate reuse of previously failed bonded metal brackets.