Whitening efficacy and tooth sensitivity in a combined in-office and at-home whitening protocol: A randomized controlled clinical trial

OBJECTIVE

This controlled randomized clinical trial determined the whitening efficacy and the intensity and absolute risk of tooth sensitivity in dual whitening when prefilled at-home whitening trays were used between in-office whitening intervals.

MATERIALS AND METHODS

An in-office whitening agent containing 35% hydrogen peroxide was used. A prefilled tray with a whitening agent containing 6% hydrogen peroxide was used for at-home whitening. Sixty-six subjects were randomly assigned to three groups. Group I: at-home whitening was performed 10 times between the in-office whitening treatments. Group II: at-home whitening was performed five times between the in-office whitening treatments. Group III: only in-office whitening was performed. The tooth color changes were evaluated using a spectrophotometer. A visual analog scale was used to express the pain intensity.

RESULTS

All the groups showed increased ΔE*ab, ΔE00 , and ΔWID with increased whitening sessions. Group I at the 3rd whitening session showed significantly higher ΔE*ab, ΔE00 , and ΔWID than group III. Tooth sensitivity showed higher values up to 24 h after whitening.

CONCLUSIONS

Although dual whitening with the prefilled tray and in-office whitening had higher whitening ability than in-office whitening alone, the intensity and absolute risk of tooth sensitivity was similar.

CLINICAL RELEVANCE

The dual whitening might produce faster and stronger whitening effects than in-office whitening alone.

Bond durability of a two-step adhesive with a universal-adhesive-derived primer in different etching modes under different degradation conditions

This study investigated the enamel and dentin bond durability of a two-step adhesive system, using a universal adhesive-derived primer (G2-Bond Universal [GU]), and compared it with the two conventional, two-step, self-etch adhesive systems (Clearfil SE Bond 2 [CS] and OptiBond XTR [OX]) under thermal cycling (TC) and long-term water storage (WS). The shear bond strengths to bovine enamel and dentin were determined using the etch-and-rinse and self-etch modes. Twelve specimens per test group were prepared and further divided into the following subgroups: 1) subjected to TC, 2) long-term WS, and 3) WS for 24 h (baseline). The enamel and dentin bond durability of GU was superior to those of CS and OX in different etching modes and under different degradation conditions. The latest two-step adhesive system, which utilizes universal adhesives' benefits in its primer, might offer durable clinical bonding performances and can be widely used in a clinical setting.

Bonding ability of resin cements to different types of CAD/CAM composite blocks

This study investigated the bonding performance of two different types of resin cements to computer-aided design/computer-aided manufacturing (CAD/CAM) composite blocks based on the shear bond strength (SBS) test. A silane-containing self-adhesive resin cement (Panavia SA Cement Universal) and resin luting cement (Block HC Cem) with a primer, were used. Specimens were fabricated from three different types of CAD/CAM composite blocks, and their surfaces were blasted with alumina. Resin cements were bonded to the specimens, and their SBSs were measured after 15 min, 24 h, and after being subjected to thermal cycling for 10,000 and 30,000 cycles. Three-way ANOVA for bond strength revealed that CAD/CAM composite block, resin cement and storage time significantly influenced the SBS values, and the three-way interactions between the evaluated factors, and all the interactions were significant. It was concluded that the bonding performance of resin cements to CAD/CAM composite blocks were material and storage period dependent.

Handling and Mechanical Properties of Low-viscosity Bulk-fill Resin Composites

This study aimed to evaluate the filler contents (FCs), flexural properties, depth of cure (DOC), wear resistance, and handling properties of different low-viscosity bulk-fill resin composites (LVBRCs) and to determine the correlations between the tested parameters. Six LVBRCs, Beautifil-Bulk (BBF), Bulk Base Hard (BBH), Bulk Base Medium (BBM), Filtek Bulk-Fill Flowable Restorative (FBF), G-ænial Bulk Injectable (GBI), and SDR flow+ Bulk-Fill Flowable (SDR) were used. The DOC and flexural property tests were conducted according to the ISO 4049 specifications. The flexural strength, elastic modulus, and resilience were determined in 12 specimens that were obtained from each of the 6 materials. Sliding-impact-wear testing was conducted by evaluating the wear facets of the specimens using a noncontact profilometer and by confocal laser scanning microscopy. The handling properties of the LVBRC was assessed via extrusion force and thread formation measurements. The DOC for the majority of the LVBRCs was approximately 4 mm. Although the FCs and mechanical properties were material dependent, some LVBRCs exhibited excellent flexural properties and wear resistance. The LVBRCs demonstrated a wide range of extrusion force and thread formation. Regarding the correlations between the tested parameters, extremely strong negative and positive correlations were observed for the DOC versus extrusion force, flexural strength versus elastic modulus, maximum depth versus volume loss, and maximum depth versus thread formation. In addition, strong correlations between FCs and DOC, resilience, wear resistance, and extrusion force were observed.

Handling properties and surface characteristics of universal resin composites

OBJECTIVE

This study investigated the handling and surface characteristics of universal resin composites and determined the interrelations among the composites' handling, mechanical, and physical properties.

METHODS

Five recently introduced universal resin composites were tested. Twelve specimens per material were used to measure the stiffness and stickiness (handling properties) of the resin composite pastes. Additionally, surface properties (Knoop hardness number [KHN], surface roughness [Sa], surface gloss [SG], water contact angle [CA], and surface free energy [SFE]) of cured resin composites were determined in 12 specimens per material immediately after preparation (baseline) and after subjection to thermal cycles (TCs).

RESULTS

Handling and surface properties of the resin composites were material dependent. All the resin composites showed significantly lower KHN in the post-TC subgroups than that in the baseline subgroups. However, the influence of TC on the other surface properties was dependent on the material used. Some resin composites did not indicate any significant differences in Sa, SG, or CA between the baseline and post-TC groups.

SIGNIFICANCE

Although the resin composites in the baseline groups presented with different handling and surface properties, the surface properties of most of the composites were significantly affected by TC. Extremely strong positive or negative correlations were observed between stiffness and stickiness, KHN and Sa, KHN and SG, Sa and SG, and CA and SFE. Most correlations between the handling and surface properties were weak. Therefore, the selection of resin composites in clinical situations should be based on comprehensive consideration of their properties.

Prevention of acidic attack on tooth enamel surfaces using polishing paste containing ion-releasing filler

The purpose of this study was to investigate the ability of polishing paste containing surface pre-reacted glass-ionomer (S-PRG) filler to prevent acidic attack on tooth enamel surfaces. Resin composites were filled in the standardized cavities and finished with silicon carbide paper. These specimens were divided into three groups: the unpolished "control" group, the "PRG" group polished with S-PRG paste, and the "DDP" group polished with diamond-containing polishing paste. Following polishing, the specimens were immersed in a lactic acid buffer solution for 28 days. Optical coherence tomography (OCT) signals were measured to obtain the signal intensity and width at 1/e² at selected locations on the enamel surface adjacent to the restoration. Although signal intensity significantly increased in all groups, widths at 1/e² did not change significantly in the PRG group. For both the control and DDP groups, signal intensity and width at 1/e² increased and decreased over time, respectively.

Bond durability of universal adhesives to intact enamel surface in different etching modes

This study aimed at determining the enamel bond durability of universal adhesives to intact enamel (IE) and ground enamel (GE) in different etching modes under thermal cycling (TC) and fatigue stresses. Two universal adhesives and a two-step self-etch adhesive were used. Enamel specimens were divided into four groups by treatment: (i) GE in etch-and-rinse, (ii) IE in etch-and-rinse, (iii) GE in self-etch, and (iv) IE in self-etch. Bonded specimens were subjected to TC, and then shear bond strengths (SBS) were conducted. SBS tests were also conducted after storage in 37°C water for 24 h (baseline). For shear fatigue strength (SFS) testing, bonded specimens were subjected to fatigue stress at a frequency of 10 Hz for 50,000 cycles. At baseline, all adhesives showed significantly higher SBS values with GE than IE in self-etch mode in contrast to in etch-and-rinse mode. After TC, the universal adhesives with IE showed lower SBS values than the baseline, regardless of the etching mode. Universal adhesives showed significantly lower SFS values with IE in etch-and-rinse, but not in self-etch mode. Phosphoric acid pre-etching or grinding of the aprismatic enamel may be helpful in establishing reliable initial and long-term bonds to enamel when using universal adhesives in self-etch mode.

Influence of a Primer Resembling Universal Adhesive on the Bonding Effectiveness of an Experimental Two-step Self-etch Adhesive

Purpose: To investigate the effect of application of a primer resembling a universal adhesive with or without light irradiation followed by a hydrophobic bonding agent on bonding effectiveness, based on shear bond strength (SBS) and shear fatigue strength (SFS) tests. Materials and Methods: An experimental two-step self-etch adhesive (BZF) that comprises a primer resembling a universal adhesive (BZP) and a hydrophobic bonding agent (BZB) were used. The two-step self-etch adhesive, Clearfil SE Bond 2 (SE), served as a comparison. Three experiments were conducted. Experiment 1: (1) BZP alone without light irradiation (BZP w/o); (2) BZP alone with light irradiation (BZP w/); (3) BZP without light irradiation followed by BZB (BZPB w/o); (4) BZP with light irradiation followed by BZB (BZPB w/). Experiment 2: (1) BZPB w/o, (2) SE primer + BZ bonding agent (SEP + BZB), and (3) SE primer + SE bonding agent (SEPB). The bonded specimens of experiment 1 and 2 were subjected to SBS tests. Experiment 3: Bonded specimens following the same experimental protocol as experiment 2 were subjected to SFS tests. Results: BZPB showed significantly higher mean enamel and dentin SBS than did BZP. BZPB showed significantly higher SBS without light irradiation than with light irradiation to both substrates. The group of BZPB without light irradiation showed significantly higher SBS than the group of BZPB with light irradiation to both substrates. For experiments 2 and 3, although no significant differences were found in SBS among groups for enamel, SEP + BZB showed a significantly lower SBS and SFS than other groups for dentin. Conclusions: BZF showed bonding performance equivalent to that of the gold standard Clearfil SE Bond 2.

Comparison of different etch-and-rinse adhesive systems based on shear fatigue dentin bond strength and morphological features the interface

OBJECTIVES

The aim of this study was to investigate dentin bonding durability of different etch-and-rinse (ER) adhesive systems under fatigue stress and to compare morphological features of resin/dentin interfaces using SEM.

METHODS

Two three-step ER adhesives, a two-step ER adhesive, and a universal adhesive in ER mode were evaluated. Before application of either primer or adhesive, phosphoric acid etching of human dentin was completed. Fifteen bonded specimens for each adhesive system were stored in distilled water at 37 °C for 24 h, then subjected to a shear bond strength (SBS) test. Bonding durability was assessed from the perspective of biomechanical stress. 25 bonded specimens for each adhesive system were subjected to shear fatigue strength (SFS) testing with a repeated subcritical load at a frequency of 20 Hz for 50,000 cycles or until failure.

RESULTS

Mean SBS and SFS values ranged from 33.3 to 41.2 MPa, and from 18.3 to 20.3 MPa, respectively. Three-step adhesives showed higher SBS and SFS values than the other adhesive systems. Under SEM, resin tags in different adhesive systems showed similar features, but morphology below the hybrid layer was material dependent. The universal adhesive in ER mode showed an obvious thin, high-density reaction layer below the hybrid layer.

SIGNIFICANCE

Three-step adhesives showed higher dentin bond durability than the other ER adhesives; no significant differences in SFS were found between the universal adhesive in ER mode and the three-step ER adhesives. The results of this in vitro study indicate that some ER adhesives might establish chemical bonding with intact dentin below the hybrid layer in addition to micromechanical retention.

Effect of double-layer application on the early enamel bond strength of universal adhesives

OBJECTIVES

The present study aimed to investigate the changes in the enamel bond strengths of universal adhesives in the early phase of specimen creation and evaluate the effect of double-layer application on enamel bond effectiveness using different etching modes.

METHOD

Four universal adhesives, namely Clearfil Universal Bond Quick, G-Premio Bond, Scotchbond Universal, and Tokuyama Universal Bond, were used. Clearfil SE Bond two-step self-etch adhesive system was used as a comparison. Fifteen specimens per group were used for determining the shear bond strength (SBS) to bovine enamel in the etch-and-rinse or self-etch mode. The adhesive was applied to specimens in accordance with the manufacturers' instructions (single-layer application), or the adhesive was applied twice (double-layer application). The bonded specimens were stored in distilled water at 37 °C for 5 min or 1, 6, 12, or 24 h before SBS testing. The flexural properties of the resin composite Clearfil AP-X were measured for the same storage periods.

RESULTS

All universal adhesives exhibited increased SBS values with prolonged storage periods regardless of the application technique or etching mode used. Double-layer application was associated with higher SBS values than single-layer application for most universal adhesives over the same storage period.

CONCLUSION

Phosphoric acid pre-etching and double-layer application of universal adhesives resulted in increased enamel bond strength in the early phase of specimen bonding.

CLINICAL RELEVANCE

Care should be taken when using universal adhesives in the self-etch mode for enamel bonding because the enamel adhesion is sensitive to the duration after filling.

Comparison of dentin bond durability of a universal adhesive and two etch-and-rinse adhesive systems

OBJECTIVE

This study aimed to compare dentin bond durability under different degradation conditions between two etch-and-rinse (ER) systems and a universal adhesive in ER mode.

METHOD

This study used a universal adhesive [Scotchbond Universal (SU)], a three-step ER adhesive [Scotchbond Multi-Purpose Plus (SM)], and a two-step ER adhesive [Single Bond Plus (SB)]. A phosphoric acid-etching agent was applied to bovine dentin prior to the application of either a primer or the adhesive. After acid etching, bonding procedures were conducted. The specimens were divided into three group classes: (1) subjected to 10,000, 30,000, or 50,000 thermal cycles (TC); (2) stored in distilled water at 37 °C for 6 months or 1 year (WS); and (3) stored in distilled water for 24 h (baseline). Shear bond strength (SBS) tests were conducted.

RESULTS

SB showed a higher baseline SBS than the other adhesives. Defining the baseline SBS value for each adhesive system as 100%, TC groups ranged from 56.1 to 70.3% for SM, from 98.4 to 103.7% for SB, and from 120.3 to 126.7% for SU. WS groups ranged from 66.2 to 71.4% for SM, from 98.1 to 103.3% for SB, and from 102.5 to 118.1% for SU.

CONCLUSIONS

Although SB showed relatively stable dentin bond performance under all degradation conditions, SM showed decreased dentin SBS with prolonged degradation. SU did not show any significant decrease in SBS from the baseline under any degradation condition.

CLINICAL RELEVANCE

The universal adhesive showed comparable adhesive performance with the two-step ER adhesive.

SEM observation of novel characteristic of the dentin bond interfaces of universal adhesives

OBJECTIVE

The aim of this study was to observe the resin/dentin interfaces of universal adhesives by using scanning electron microscopy (SEM), and to compare their morphologies with conventional etch & rinse (ER) and self-etch (SE) adhesive systems.

METHODS

Two three-step and one two-step ER adhesives and two two-step and two single-step SE adhesives were used for comparison with seven universal adhesives in ER mode and SE mode, respectively. Bonded surfaces with bovine teeth were longitudinally sectioned and mirror-polished. Half of the samples were treated with HCl and NaOCl solutions. The interfaces were subjected to argon ion beam etching and then observed by scanning electron microscopy.

RESULTS

The thickness of the adhesive layer (AL) of most of the seven universal adhesives and single-step SE adhesives was similar. Universal adhesives in SE mode formed a hybrid smear layer as a high-density zone between the AL and dentin. The thickness of the hybrid layer (HL) of the universal adhesives in ER mode was ∼1-2μm, with a high-density zone (reaction layer [RL]) below the HL.

CONCLUSION

The morphological features of most universal adhesives in SE mode and single-step SE adhesives are similar. Although resin-dentin interfaces of universal adhesives in ER mode resemble those of ER adhesives, universal adhesives have a distinctive feature, an RL.

SIGNIFICANCE

The RL might be a sign of chemical bonding even when using universal adhesives in ER mode.

Influence of Application Time on Dentin Bond Performance in Different Etching Modes of Universal Adhesives

We attempted to determine the effect of universal adhesive application time on dentin bond performance in different etching modes based on shear bond strength (SBS) tests and surface free energy (SFE) measurements. The five universal adhesives used were Adhese Universal (AU), Clearfil Universal Bond Quick (CQ), G-Premio Bond (GP), Scotchbond Universal (SU), and Tokuyama Universal Bond (TU). Bovine dentin specimens were divided into four groups of 10 for each adhesive. SBS and SFE were determined after applying the following surface treatments: 1) self-etch (SE) mode with immediate air blowing after adhesive application (IA treatment), 2) SE mode with prolonged application time (PA treatment), 3) etch-and-rinse (ER) mode with IA treatment, and 4) ER mode with PA treatment. Bonded specimens were subjected to SBS testing. The SFE of adhesive-treated dentin surfaces was measured after rinsing with acetone and water. Three-way analysis of variance revealed that dentin SBS values (p<0.001) were significantly influenced by the factors of adhesive type and application duration, but the factor of pre-etching was not significant (p=0.985). The manufacturer's instructions require longer application times for AU and SU, which showed significantly lower SBS values in IA than in PA treatment in both etching modes. However, the difference in the other adhesives was not significant between the IA and PA treatments in either etching mode. The total SFE (γ_S) was dependent on the adhesive and etching mode. The γ_S value of the initial group (SiC paper ground group) at baseline was 69.5 (mN·m^-1) and that of the pre-etching group at baseline was 30.6 (mN·m^-1). For all the adhesives, γ_S in SE mode showed significantly higher values than in ER mode, regardless of the application time. In SE mode, almost all universal adhesives tested showed lower γ_S values in PA treatment than in IA treatment. For ER mode, all the adhesives showed significantly higher γ_S values than those of the pre-etching baseline, regardless of the application time. Most adhesives did not show any significant differences in γ_S values between IA and PA treatments, regardless of etching mode.