The possibility of clinical bonding between metal/ceramic brackets to zirconia: in vitro study

Objective: The present study aimed to assess the bond strength and durability of six bonding agents concerning their application to metal or ceramic brackets and zirconia. Materials and Methods: Six resin cement bonding agents (XT, XTS, RSBU, RGBU, SBPM, and GMP) were chosen for this investigation. Specimens were either stored in distilled water at 37°C for 24 h or subjected to 5,000 thermocycles before conducting a Shear Bond Strength (SBS) test. Statistical analysis of the SBS data was performed using three-way ANOVA and Games-Howell tests (α = 0.05). The Adhesive Remnant Index was examined, and the debonding surface details on brackets and zirconia were observed. Results: For metal brackets, all groups demonstrated clinically acceptable bond strength, irrespective of storage conditions, except for the XT group. Regarding ceramic brackets, all groups displayed acceptable bond strength after 24 h of water storage. However, following thermocycling, a significant decrease in SBS was noted across all groups (p < 0.05), with SBPM exhibiting a higher bond strength. Three-way ANOVA analysis indicated that SBS values were notably influenced by each factor, and an interaction among the three independent variables was observed (p = 0.000). Conclusion: The reliable bond strength between ceramic brackets and zirconia was significantly lower after thermocycling compared to that of metal brackets and zirconia. SBPM exhibited consistent and robust bond strength between ceramic/metal brackets and zirconia across various storage conditions. Furthermore, the HEMA-free adhesive demonstrated a potentially more consistent bonding performance compared to the HEMA-containing adhesive employed in this study.

Chlorhexidine-Containing Electrospun Polymeric Nanofibers for Dental Applications: An In Vitro Study

Chlorhexidine is the most commonly used anti-infective drug in dentistry. To treat infected void areas, a drug-loaded material that swells to fill the void and releases the drug slowly is needed. This study investigated the encapsulation and release of chlorhexidine from cellulose acetate nanofibers for use as an antibacterial treatment for dental bacterial infections by oral bacteria Streptococcus mutans and Enterococcus faecalis. This study used a commercial electrospinning machine to finely control the manufacture of thin, flexible, chlorhexidine-loaded cellulose acetate nanofiber mats with very-small-diameter fibers (measured using SEM). Water absorption was measured gravimetrically, drug release was analyzed by absorbance at 254 nm, and antibiotic effects were measured by halo analysis in agar. Slow electrospinning at lower voltage (14 kV), short target distance (14 cm), slow traverse and rotation, and syringe injection speeds with controlled humidity and temperature allowed for the manufacture of strong, thin films with evenly cross-meshed, uniform low-diameter nanofibers (640 nm) that were flexible and absorbed over 600% in water. Chlorhexidine was encapsulated efficiently and released in a controlled manner. All formulations killed both bacteria and may be used to fill infected voids by swelling for intimate contact with surfaces and hold the drug in the swollen matrix for effective bacterial killing in dental settings.

Characterization of polymethylmethacrylate microspheres loaded with silver and doxycycline for dental materials applications

OBJECTIVES

The manufacturing of polymethylmethacrylate(PMMA) microspheres loaded with doxycycline(DOX) and/or silver sulfate(Ag₂SO₄) to be incorporated into glass ionomer cement(GIC).

METHODS

PMMA microspheres were manufactured with Ag₂SO₄(1-5%) and/or DOX(5-15%). Particle size, encapsulation efficiency and drug release were measured by light microscope, ICP, and HPLC. Microspheres were added to a dental GIC(20%w/w). Drug release and DTS were investigated. Minimum inhibitory concentration and antibacterial effects of PMMA microspheres into GIC materials were tested.

RESULTS

The median diameter of 50 µm was obtained for microspheres. DOX was encapsulated at an efficiency of 8.3% using a theoretical loading of 15%DOX + 5%Ag₂SO₄. The Ag₂SO₄ encapsulation efficiency was 0.63% using a theoretical loading of 5%AgSO₄. All groups showed burst release within the first day and continued released up to 15 days, with 60-83% of DOX and approximately 30% of silver. For GIC, approximately 15% of DOX and 0.18% of silver were released in a 7-day period. Microbiological results showed an antimicrobial effect against S. mutans when the lead formulation of microspheres was added. The DTS was reduced by the inclusion of microspheres.

SIGNIFICANCE

PMMA microspheres containing DOX and Ag₂SO₄ offer a sustained antimicrobial activity for dental applications and promising potential for the biomedical field.

Periodontal disease prevalence, extent, and risk associations in untreated individuals

Objectives

to examine the prevalence, extent, and risk associations of untreated periodontitis.

Materials and Methods

A purposive sample of subjects who were never treated for periodontal conditions was clinically examined after collecting information about their sociodemographic characteristics, medical conditions, oral health behaviors, perceived stress, and perceived social support.

Results

A total of 431 subjects were recruited (response rate, 97.0%), and their mean age (SD) was 35.4 (13.3) years. Overall, high plaque levels were observed in all untreated individuals. The prevalence of periodontitis and severe (stage III/IV) periodontitis using the American Academy of Periodontology and European Federation of Periodontology (AAP/EFP) classification were 85.4% and 48.5%, respectively. The prevalence of moderate‐severe and severe periodontitis using the definitions of the Centers for Disease Control and Prevention (CDC) and AAP were 78.4% and 31.1%, respectively. The extent of periodontitis expressed as mean% of clinical attachment loss (CAL) ≥ 3 mm and CAL ≥ 5 mm were 34.9% and 14.4%, respectively, while the mean% of a periodontal probing depth (PPD) ≥4 mm and PPD ≥6 mm were 22.0% and 9.2%, respectively. Risk determinants associated with AAP/EFP periodontitis after the adjustment for other variables were age ≥35 years (odds ratio [OR] = 11.5) and lower income (OR = 2.5). Adjusted risk associations with stage II/IV periodontitis included age ≥35 years (OR = 8.2), males (OR = 2.5), lower income (OR = 2.3), and lower perceived stress (OR = 2.0). Adjusted risk associations with CDC/AAP moderate‐severe periodontitis included age ≥35 years (OR = 12.0), lower income (OR = 2.1), and current cigarette smoking (OR = 4.2). Adjusted risk associations with CDC/AAP severe periodontitis included age ≥35 years (OR = 4.5), males (OR = 1.9), lower education (OR = 2.0), lower income (OR = 1.7), uncontrolled diabetes mellitus (OR = 2.0), and current cigarette smoking (OR = 2.3).

Conclusions

The prevalence and extent of periodontitis were high in untreated subjects. Risk associations with untreated periodontitis included age ≥35 years, males, lower income, lower education, current cigarette smoking, uncontrolled diabetes mellitus, and lower perceived stress.

Pulpal response to mineral trioxide aggregate containing phosphorylated pullulan-based capping material

This study aimed to evaluate the pulpal responses of monkey's pulp after direct pulp capping (DPC) with the novel mineral trioxide aggregate containing phosphorylated pullulan-based material (MTAPPL). Seventy-two teeth were randomly divided into four groups: MTAPPL; Nex-Cem MTA (NX); TheraCal LC (TH); and Dycal (DY). Histopathological changes in the pulps were observed at days 3, 7 and 70. On day 3, mild inflammatory responses were observed in the MTAPPL, no to moderate inflammatory responses in the TH, whereas moderate inflammatory responses in the NX and DY. No mineralized tissue formation (MTF) was observed in all groups. On day 7, no or mild inflammatory responses were observed in all groups. Initial MTF was observed except for DY. No inflammation with complete MTF including presence of odontoblast-like cells was observed in the MTAPPL, NX and TH groups at day 70. These findings indicate that MTAPPL could be an efficient DPC material.

Bonding Performance of Self-etching Adhesives to Bur-cut Dentin with Active Application Mode

PURPOSE

This study evaluated whether active application of self-etching adhesives would influence their microtensile bond strength (µTBS) to dentin cut with burs of different grit sizes.

MATERIALS AND METHODS

Eighty-four human premolars were divided into 12 groups according to 1) two dentin surface preparations with either superfine- or regular-grit diamond burs; 2) three adhesives - Clearfil SE Bond 2 (SE2), Scotchbond Universal (SBU, 3M Oral Care) and G-Premio Bond (GPB, GC); and 3) two application modes of each adhesive (active or passive). Six bonded teeth per group were sectioned into sticks for µTBS testing. Statistical analyses were performed using 3-way ANOVA followed by Duncan's test (p < 0.05). Additional teeth were prepared to observe the interaction between the dentin smear layer obtained from each bur with adhesives under different application modes using transmission electron microscopy (TEM).

RESULTS

Active application significantly increased the dentin bond strength of SE2, irrespective of the kind of bur used (p < 0.05). The highest bond strength of SBU was observed when bonded to superfine-grit diamond bur-cut dentin with the active application. There was, however, no influence of the tested factors on GPB group (p > 0.05). TEM observation showed that active application promoted dentin smear layer dissolution in all adhesive groups.

CONCLUSIONS

Bond strengths of self-etching adhesives to dentin are influenced by bur-cut smear layers and mainly by application mode of adhesive materials. Active application improves µTBS of self-etching adhesives by enhancing smear layer modification and resin penetration into bur-cut dentin.

Effects of remaining dentin thickness, smear layer and aging on the bond strengths of self-etch adhesives to dentin

This study evaluated the effects of remaining dentin thickness (RDT), different smear layers, and aging on the microtensile bond strength (µTBS) of universal adhesives to dentin when applied in self-etch mode. Ninety-six human third molars were randomly allocated to 12 groups (n=8) based on adhesives: Clearfil^TM SE Bond 2 (SE, control), Clearfil^TM Universal Bond (CU) and ScotchBond^TM Universal Adhesive (SB); smear layers: prepared either with 600-grit SiC paper (P) or regular diamond bur (B); and aging: stored in distilled water at 37ºC for 24 hours (24h) or 1 year (1y). µTBS was significantly affected by the type of adhesives, smear layers, and aging (p<0.001). A statistically significant and positive linear relationship was also observed between µTBS and RDT (p<0.05) in all the tested groups, except for SEB1y and CUB24h (p>0.05). RDT, smear layer types, and aging can influence the bonding performances of universal adhesives when applied in self-etch mode.

Fit of tooth-supported zirconia single crowns-A systematic review of the literature

PURPOSE

The purpose of this study is to systematically map all the factors that influence the fit and adaptation of zirconia crowns and/or copings.

MATERIALS AND METHODS

The investigational strategy involved carrying out an electronic search between December 1, 2009 and September 1, 2019 through the Embase and Medline databases using Boolean operators to locate appropriate articles.

RESULTS

A total of 637 articles were discovered after the removal of duplicates, and 46 of these were selected for evaluation. Further, a quality assessment was performed using GRADE evaluation criteria.

CONCLUSIONS

Shoulder finish line preparations had slightly better marginal fit compared to chamfer finish lines. Crowns obtained from digital impressions had comparable to superior marginal adaptation compared to conventional impressions. Increasing cement space showed to improve zirconia crown adaptation. Cementation and veneering zirconia frameworks found to increase the marginal and internal gaps. Limited information is available on the effect of the alteration of sintering time/Temperature and/or sintering techniques on the adaptation of zirconia crowns. Most of the selected studies had a moderate quality assessment evaluation. Future studies could investigate the chair-side, ultra-fast sintering effect on the marginal gap of zirconia crowns.

Effects of Double Application of a Resin Cement Primer and Different Diamond Burs on Cement-Dentin Bond Strength

PURPOSE

To evaluate the effects of double application of resin cement primers to dentin prepared with different diamond burs on the cement-dentin bond strengths.

MATERIALS AND METHODS

Sixty flat dentin surfaces were prepared and divided into 12 groups (n = 5) according to three experimental factors: 1. resin cements: RelyX Ultimate (RU), Multilink Automix (ML), and Panavia V5 (PV); 2. resin cement primer application: single or double; 3. dentin surface preparation with regular or superfine diamond burs. Cement-dentin sticks (1 mm2) were prepared for and underwent microtensile bond strength testing (µTBS). Statistical analysis was performed using three-way ANOVA and Duncan's test (α = 0.05). Fractured surfaces and cement-dentin interfaces were observed using SEM. Additional teeth were used to observe the demineralization effect of resin cement primers with SEM and transmission electron microscopy (TEM).

RESULTS

All tested factors demonstrated significant effects on µTBS (p < 0.001). The combination of PV with superfine-grit bur and double application yielded the highest bond strengths. Surfaces prepared with superfine-grit burs demonstrated higher µTBS than did the regular-grit group, but a significant effect was not observed for all groups. The double application of primer significantly increased the bond strength for most combinations, except for PV with superfine-grit bur-prepared dentin.

CONCLUSIONS

PV showed higher bond strengths than other resin cements. Double application of primer improved the bond strength of all cements to dentin. Bond strengths were higher when dentin was prepared with a superfine-grit bur.

Doxycycline release and antibacterial activity from PMMA/PEO electrospun fiber mats

Objective:

To investigate the use of polymethyl methacrylate (PMMA) electrospun fiber mats containing different amounts of polyethylene oxide (PEO) as a doxycycline delivery system and to test antibacterial activity against an oral pathogen.

Methodology:

PMMA powders or PEO (mol wt 200 Kd) (10,20,30% w/w/) were dissolved in N, N-dimethylformamide (DMF) to obtain a final polymer concentration of 15% in DMF (w/v). 2% Doxycycline monohydrate was added to the solutions and submitted to vortex mixing. The solution was transferred to a plastic syringe and fit into a nanofiber electrospinning unit. The parameters applied were: voltage at 17.2 kV; distance of 20 cm between the needle tip and the collector plate; target speed at 2 m/min; and transverse speed at 1cm/min. Syringe pump speed was 0.15 mm/min. The drug release analysis was performed by removing aliquots of the drug-containing solution (in PBS) at specific periods. Doxycycline release was quantified using RP-HPLC. Fiber mats from all groups had their antibacterial action tested against S. mutans based on inhibition halos formed around the specimens. The experiments were performed in triplicate. Gravimetric analysis at specific periods was performed to determine any polymer loss. Morphological characterization of the electrospun fibers was completed under an optical microscope followed by SEM analysis.

Results:

The addition of PEO to the PMMA fibers did not affect the appearance and diameter of fibers. However, increasing the %PEO caused higher doxycycline release in the first 24 h. Fibers containing 30% PEO showed statistically significant higher release when compared with the other groups. Doxycycline released from the fibers containing 20% or 30% of PEO showed effective against S. mutans.

Conclusion:

The incorporation of PEO at 20% and 30% into PMMA fiber mat resulted in effective drug release systems, with detected antibacterial activity against S. mutans.

The influence of altering sintering protocols on the optical and mechanical properties of zirconia: A review

OBJECTIVE

As a result of advancements in chairside technology and speed sintering techniques and increased esthetic demands of patients, efforts have been made to produce monolithic zirconia restorations that are highly translucent, strong, and dense. While methods for processing zirconia are well known, there is a tendency to modify the process parameters with the aim of decreasing the overall processing time and, in particular, the sintering time. This review provides clinicians with scientific evidence of the effects of altering sintering parameters used for dental zirconia on its microstructure, phase transformation, and mechanical and optical properties.

MATERIALS AND METHODS

A systematic search of Embase and Medline using Boolean operators was performed to locate relevant articles.

RESULTS

Eleven articles were selected for this review. The following characteristics of monolithic zirconia have been confirmed to be affected by alterations in sintering: the microstructure, mechanical properties, optical properties, wear behavior, and low thermal degradation.

CONCLUSIONS

The alteration of sintering parameters has been found to alter the grain size, wear behavior, and translucency of zirconia. There is a lack of clinical studies that investigate the influence of altering sintering parameters or methods on the clinical performance of monolithic zirconia restorations.

CLINICAL SIGNIFICANCE

Alteration of sintering parameters alters the microstructural, mechanical, and optical properties of zirconia. This will consequently impact the clinical performance of zirconia prostheses. Future clinical investigations are encouraged to support these in vitro findings.

Gradual dehydration affects the mechanical properties and bonding outcome of adhesives to dentin

This study evaluated the effects of dehydration on the mechanical properties of adhesive resins and dentin, and on the microtensile bond strength (µTBS) of adhesives. Third molars were randomly bonded with Clearfil Mega Bond (MB) or Clearfil SE Bond 2 (SE). After water-storage (37°C; 24 h), µTBS was obtained in 'wet' (tested after 5 min of removal from storage) and 'dehydrated' (tested after 10, 15 min and 24 h) conditions by a universal tester (crosshead speed: 1 mm/min). Data were analyzed by two-way ANOVA and Duncan's test. Hardness (H), Elastic modulus (E) and weight-loss of dentin beams and adhesive-resin discs were also monitored over time and analyzed by one-way repeated measures ANOVA and Bonferroni's test (α=0.05). Significant differences in bond strength were observed for adhesives and for conditions. Except for dentin's E, dehydration caused significant gradual changes in the H, E and weight of adhesive resins and dentin (p<0.05).

Effects of Double Application of Contemporary Self-Etch Adhesives on Their Bonding Performance to Dentin with Clinically Relevant Smear Layers

PURPOSE

To evaluate the effects of double application of self-etch adhesives on their microtensile bond strength (μTBS) to dentin, as well as the hardness (H) of resin-dentin interfacial structures.

MATERIALS AND METHODS

Midcoronal dentin surfaces (n = 45) were polished with 180-grit SiC paper and randomly allocated to 9 groups based on three adhesives - Scotchbond Universal Adhesive (SB), G Premio Bond (GP), and Clearfil Megabond 2 (MB) - and three application modes: single application (S), double application with light curing after each application (DL), and double application with light curing only at the end (D). Following composite-resin build up and water storage (37°C; 24 h), μTBS were obtained. The hardness of adhesive, resin-dentin interface and dentin were evaluated by nanoindentation. The μTBS and H data were analyzed by two-way ANOVA to demonstrate the effects of adhesive and application mode as well as their interaction, followed by Tukey's test (α = 0.05). Fracture modes were determined using a stereomicroscope.

RESULTS

μTBS and H were significantly affected by the adhesives and their application modes (p ˂ 0.001). Double application significantly increased the µTBS and H of adhesive and resin-dentin interface (p ˂ 0.05). SB and MB showed significantly higher µTBS than GP (p ˂ 0.05).

CONCLUSION

Double applications during bonding of dentin having clinically relevant smear layers were beneficial for three contemporary self-etch adhesives. The improvement in bonding performance is believed to be the result of increased chemical interaction, better solvent removal, and improved resin infiltration, leading to improved mechanical properties of the resin-dentin interface or thicker adhesive layers providing improved stress distribution.

Marginal Discrepancies of Monolithic Zirconia Crowns: The Influence of Preparation Designs and Sintering Techniques

PURPOSE

The marginal fit is an essential component for the clinical success of prosthodontic restorations. The aim of this study was to investigate the influence of different abutment finish line widths and crown thicknesses on the marginal fit of zirconia crowns fabricated using either standard or fast sintering protocols.

MATERIALS AND METHODS

Six titanium abutments were fabricated for receiving zirconia molar crowns. Crowns were designed virtually and milled from partially sintered zirconia blanks and divided into 12 groups (n = 10/group). Crowns in groups 1 to 6 were sintered by standard sintering, while those in groups 7 to 12 were sintered by fast sintering. Groups were further categorized according to abutment finish line and crown thickness: G1/G7 (0.5 mm chamfer, 0.8 mm thick); G2/G8 (0.5 mm chamfer, 1.5 mm thick); G3/G9 (1.0 mm chamfer, 0.8 mm thick); G4/10 (1.0 mm chamfer, 1.5 mm thick); G5/G11 (1.2 mm chamfer, 0.8 mm thick); G6/G12 (1.2 mm chamfer, 1.5 mm thick). The marginal gaps were assessed at 8 locations using digital microscopy. The linear mixed effect model analysis was performed at a significance level of 0.05.

RESULTS

All vertical marginal gaps were within the clinically acceptable range (∼11-52 μm). G8 (FS, 0.5 mm chamfer, 1.5 mm thick) demonstrated the largest gaps (47.95 μm, 95% CI: 44.57-51.23), whereas G3 (SS, 1.0 mm chamfer, 0.8 thick) had the smallest marginal gap (14.43 μm, 95% CI: 11.15-17.71). A linear mixed effect models showed significant differences for the interaction between finish line × crown thickness × sintering (F = 18.96, p < 0.001). The lingual surfaces showed the largest gaps in both sintering protocols, while the mesial and mesiobuccal surfaces demonstrated the smallest gaps.

CONCLUSIONS

There was a significant interaction between finish line widths, crown thickness, and sintering protocol on the marginal gaps in both sintering protocols; 1.0 mm finish line preparations with either 0.8 mm or 1.5 mm occlusal reduction had better marginal fit in both sintering protocols compared to 0.5 mm or 1.2 mm finish lines. Smaller marginal discrepancies were observed for standard sintering crowns with a 0.5 mm finish line and 1.5 mm occlusal reduction. Conservative occlusal reduction should be accompanied with a 1.2 mm finish line to obtain better marginal fit for full-contoured zirconia crowns.

Dental Cements for Luting and Bonding Restorations: Self-Adhesive Resin Cements

Self-adhesive resin cements combine easy application of conventional luting materials with improved mechanical properties and bonding capability of resin cements. The presence of functional acidic monomers, dual cure setting mechanism, and fillers capable of neutralizing the initial low pH of the cement are essential elements of the material and should be understood when selecting the ideal luting material for each clinical situation. This article addresses the most relevant aspects of self-adhesive resin cements and their potential impact on clinical performance. Although few clinical studies are available to establish solid clinical evidence, the information presented provides clinical guidance in the dynamic environment of material development.

Does Shortened Application Time Affect Long-Term Bond Strength of Universal Adhesives to Dentin?

OBJECTIVE

This study evaluated the effect of shortened application time on long-term bond strength with universal adhesives.

METHODS AND MATERIALS

Three universal adhesives were used: Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc, Tokyo, Japan), Scotchbond Universal Adhesive (SB, 3M ESPE, St Paul, MN, USA) or G-Premio Bond (GP, GC Corp, Tokyo, Japan). Sixty molars were cut to expose midcoronal dentin and prepared with a regular diamond bur. Each adhesive was applied either according to the manufacturer's instruction or with shortened time. Specimens were stored in distilled water at 37°C for 24 hours and then cut into resin-dentin sticks. Microtensile bond strength (μTBS) was tested after either 24 hours or 1 year of water storage. Data were analyzed by the three-way ANOVA and Duncan tests ( α=0.05). Fracture modes were analyzed under a scanning electron microscope (SEM). One dentin stick per group was selected after fracture mode analysis and further observed using transmission electron microscopy (TEM). Six additional dentin discs were prepared and conditioned with each adhesive under the different application time to observe the adhesive-smear layer interaction by SEM.

RESULTS

Shortened application time affected the μTBS ( p<0.001) while storage time did not affect bond strength ( p=0.187). A significant effect of shortened application time on μTBS was observed in the CU at 1 year and in the GP at both storage times.

CONCLUSIONS

One-year storage time had no effect on the μTBS of universal adhesives to bur-cut dentin. The performance of universal adhesives can be compromised when applied using a shortened application time.

Effect of topical fluoride application on enamel after in-office bleaching, as evaluated using a novel hardness tester and a transverse microradiography method

This study evaluated the effect of topical fluoride application on enamel hardness after in-office bleaching. Twelve human incisors were cut along the long axis, resulting in 24 halves used in four treatment groups (n = 6 in each group): (i) untreated group (C); (ii) in-office bleaching material (B); (iii) treatment with surface reaction-type prereacted glass-ionomer varnish after in-office bleaching (B+PRG); and (iv) treatment with acidulated phosphate fluoride solution after bleaching (B+F). All specimens were subjected to pH-cycling for 4 wk. Knoop hardness was measured using a Cariotester. The decalcification of enamel was assessed quantitatively by measuring the integrated mineral loss (ΔIML). Games-Howell analysis was used to assess statistical significance of between-group differences. The Knoop hardness decreased significantly after bleaching for all groups. In treatment groups B+PRG and B+F, the Knoop hardness returned to the original unbleached values after the first pH cycle and did not change afterwards. In treatment groups C and B there was a gradual decrease in the Knoop hardness until the fourth pH cycle. The integrated mineral loss, ΔIML, was significantly higher in treatment group B+F after 2 wk than in the other treatment groups. After 4 wk, the ΔIML in treatment group B was significantly higher than in treatment group B+PRG. The application of fluoride-containing materials after bleaching results in recuperation of hardness to levels similar to those of unbleached enamel.

The potential effect of ultra-long insulin degludec on glycemic variability

Despite the therapeutic advances in the treatment of diabetes, metabolic control instability due to glycemic variability (GV) is frequently observed in patients with diabetes on intensive insulin therapy and is associated with hyperglycemic peaks and hypoglycemic episodes. Hyperglycemia associated with GV has been implicated in the development of chronic complications due to its pro-oxidative consequences. On the other hand, hypoglycemia can be associated with increased cardiovascular risk secondarily to adrenergic activation. The ultra-long-acting insulin analogue, insulin degludec (IDeg), presents a flat and stable glucose-lowering effect both in Type 1 and Type 2 diabetes patients. In pharmacodynamic studies, IDeg has been associated with a lower variability in its insulin action than other alternatives for basal insulin, which might have clinical advantages for the stability of the glycemic control. The main objective of this review is to present pharmacological and clinical data regarding the efficacy and safety of IDeg for the treatment of diabetes focusing on its effects on GV and on hypoglycemia frequency.

Marginal Fit of Lithium Disilicate Crowns Fabricated Using Conventional and Digital Methodology: A Three-Dimensional Analysis

PURPOSE

To compare the marginal fit of lithium disilicate (LD) crowns fabricated with digital impression and manufacturing (DD), digital impression and traditional pressed manufacturing (DP), and traditional impression and manufacturing (TP).

MATERIALS AND METHODS

Tooth #15 was prepared for all-ceramic crowns on an ivorine typodont. There were 45 LD crowns fabricated using three techniques: DD, DP, and TP. Microcomputed tomography (micro-CT) was used to assess the 2D and 3D marginal fit of crowns in all three groups. The 2D vertical marginal gap (MG) measurements were done at 20 systematically selected points/crown, while the 3D measurements represented the 3D volume of the gap measured circumferentially at the crown margin. Frequencies of different marginal discrepancies were also recorded, including overextension (OE), underextension (UE), and marginal chipping. Crowns with vertical MG > 120 μm at more than five points were considered unacceptable and were rejected. The results were analyzed by one-way ANOVA with Scheffe post hoc test (α = 0.05).

RESULTS

DD crowns demonstrated significantly smaller mean vertical MG (33.3 ± 19.99 μm) compared to DP (54.08 ± 32.34 μm) and TP (51.88 ± 35.34 μm) crowns. Similarly, MG volume was significantly lower in the DD group (3.32 ± 0.58 mm³ ) compared to TP group (4.16 ± 0.59 mm³ ). The mean MG volume for the DP group (3.55 ± 0.78 mm³ ) was not significantly different from the other groups. The occurrence of underextension error was higher in DP (6.25%) and TP (5.4%) than in DD (0.33%) group, while overextension was more frequent in DD (37.67%) than in TP (28.85%) and DP (18.75%) groups. Overall, 4 out of 45 crowns fabricated were deemed unacceptable based on the vertical MG measurements (three in TP group and one in DP group; all crowns in DD group were deemed acceptable).

CONCLUSION

The results suggested that digital impression and CAD/CAM technology is a suitable, better alternative to traditional impression and manufacturing.

Effect of Mechanical Fatigue on the Bond Between Zirconia and Composite Cement

PURPOSE

To examine the effect of mechanical fatigue on the bond strength of resin composite cemented to silica-coated yttria-tetragonal zirconia polycrystal ceramic (Y-TZP).

MATERIALS AND METHODS

Ten Y-TZP blocks were polished down to 600-grit silicon carbide paper. Specimens were silica coated by airborne-particle abrasion with 30-μm silica-modified Al2O3 particles. Blocks were cleaned in an ultrasonic bath, and a dental adhesive was applied and light cured for 20 s. Pre-cured composite blocks were luted to treated Y-TZP surfaces with a dual-curing resin cement. Half of the samples (n = 5) were subjected to mechanical fatigue before trimming (fatigue group) and the other half tested 24 h after bonding procedures (control group). Forty-five beam-shaped samples with an approximately 1 mm2 cross-sectional area were prepared for each group and tested in microtensile mode at 0.5 mm/min. Fractographic analysis was performed by optical and scanning electron microscopy. Only specimens that failed at the interface area were considered for statistical analysis. Weibull distribution (95% confidence bounds) was used to determine the characteristic strength (σ0 in MPa) and Weibull modulus (m) for each group. Probability of survival was calculated over the range of loads until specimens failed.

RESULTS

The control group showed σ0 = 45.91 MPa and m = 7.98, and the fatigue group σ0 = 43.94 MPa and m = 6.44 (p > 0.05). The probability of survival did not differ significantly between groups.

CONCLUSIONS

Fatigue did not affect the bond strength between silica-treated Y-TZP intaglio surfaces and composite cement under these experimental conditions.

Incompatibility of Oxalate Desensitizers with Acidic, Fluoride-containing Total-etch Adhesives

The use of oxalate desensitizers on acid-etched dentin prior to adhesive application can result in subsurface tubular occlusion by calcium oxalate crystals. However, the solubility of calcium oxalate increases in acidic solution. We hypothesized that total-etch adhesives can, depending upon their pH, interact with oxalate-desensitizer-treated dentin in an adverse manner. Acid-etched human dentin treated with 2 oxalate desensitizers (BisBlock and Super Seal) was bonded with 4 simplified total-etch adhesives: One-Step (OS), Single Bond (SB), OptiBond Solo Plus (OB), and Prime&Bond NT (PB). Composite-dentin beams were examined by SEM and TEM, both of which revealed numerous spherical globules on OB- and PB-bonded, desensitizer-treated dentin, but not in OS or SB samples. Bond strengths produced by OB and PB were significantly lower in oxalate-treated specimens than those produced by OS or SB. These surface globules may have interfered with hybridization of demineralized dentin with OB and PB resins and caused compromised bond strengths.

Evaluation of a Self-limiting Concept in Dentinal Caries Removal

The mechanical removal of dentinal caries traditionally involves the use of tactile sensation and/or caries-indicating dyes. This study tested the hypothesis that self-limiting polymer burs are as effective as conventional carbide burs in creating substrates for dentin bonding. Carious dentin from extracted human molars was removed with carbide or polymer burs, with dental explorer hardness as the end-point for caries removal. Dentin substrates were bonded with etch-and-rinse or self-etch adhesives and prepared for microtensile bond testing and transmission electron microscopy. For each bur type, there was no difference in bond strength between adhesives. However, the polymer bur surface exhibited significantly lower bond strengths than the carbide bur, and both were lower than flat, non-carious dentin controls. TEM revealed areas of incompletely removed, denatured caries-infected dentin in the polymer bur specimens. These first-generation polymer burs might best be utilized for deep caries removal where pulpal exposure is a concern.

Collagen Degradation by Host-derived Enzymes during Aging

Incompletely infiltrated collagen fibrils in acid-etched dentin are susceptible to degradation. We hypothesize that degradation can occur in the absence of bacteria. Partially demineralized collagen matrices (DCMs) prepared from human dentin were stored in artificial saliva. Control specimens were stored in artificial saliva containing proteolytic enzyme inhibitors, or pure mineral oil. We retrieved them at 24 hrs, 90 and 250 days to examine the extent of degradation of DCM. In the 24-hour experimental and 90- and 250-day control specimens, we observed 5- to 6-μm-thick layers of DCM containing banded collagen fibrils. DCMs were almost completely destroyed in the 250-day experimental specimens, but not when incubated with enzyme inhibitors or mineral oil. Functional enzyme analysis of dentin powder revealed low levels of collagenolytic activity that was inhibited by protease inhibitors or 0.2% chlorhexidine. We hypothesize that collagen degradation occurred over time, via host-derived matrix metalloproteinases that are released slowly over time.

What constitutes an ideal dental restorative material?

Intense environmental concerns recently have prompted dentistry to evaluate the performance and environmental impact of existing restoration materials. Doing so entices us to explore the 'what if?' innovation in materials science to create more ideal restorative materials. Articulating a specification for our design and evaluation methods is proving to be more complicated than originally anticipated. Challenges exist not only in specifying how the material should be manipulated and perform clinically but also in understanding and incorporating implications of the skill of the operator placing the restoration, economic considerations, expectations patients have for their investment, cost-effectiveness, influences of the health care system on how and for whom restorations are to be placed, and global challenges that limit the types of materials available in different areas of the world. The quandary is to find ways to actively engage multiple stakeholders to agree on priorities and future actions to focus future directions on the creation of more ideal restorative materials that can be available throughout the world.

Flexural properties of experimental nanofiber reinforced composite are affected by resin composition and nanofiber/resin ratio

OBJECTIVES

To evaluate the influence of different resin blends concentrations and nanofibers mass ratio on flexural properties of experimental Poliacrylonitrile (PAN) nanofibers reinforced composites.

MATERIALS AND METHODS

Poliacrylonitrile (PAN) nanofibers mats were produced by electrospinning and characterized by tensile testing and scanning electron microscopy (SEM). Experimental resin-fiber composite beams were manufactured by infiltrating PAN nanofiber mats with varied concentrations of BisGMA-TEGDMA resin blends (BisGMA/TEGDMA: 30/70, 50/50 and 70/30weight%). The mass ratio of fiber to resin varied from 0% to 8%. Beams were cured and stored in water at 37°C. Flexural strength (FS), flexural modulus (FM) and work of fracture (WF) were evaluated by three-point bending test after 24h storage.

RESULTS

The tensile properties of the PAN nanofibers indicated an anisotropic behavior being always higher when tested in a direction perpendicular to the rotation of the collector drum. Except for WF, the other flexural properties (FS and FM) were always higher as the ratio of BisGMA to TEGDMA increased in the neat resin beams. The addition of different ratios of PAN fibers did not affect FS and FM of the composite beams as compared to neat resin beams (p>0.05). However, the addition of fibers significantly increased the WF of the composite beams, and this was more evident for the blends with higher TEGDMA ratios (p<0.05).

SIGNIFICANCE

The inclusion of PAN nanofibers into resin blends did not negatively affect the properties of the composite and resulted in an increase in toughness that is a desirable property for a candidate material for prosthodontics application.

Effects of Temperature and Aging on Working/Setting Time of Dual-cured Resin Cements

OBJECTIVES

To evaluate the effects of aging and temperature on working time (WT) and setting time (ST) of several dual-cured resin cements.

METHODS

WT and ST were determined with a thermo-controlled stage oscillating rheometer. New cement kits were used for the study. Cements were mixed according to instructions and dispensed on the oscillating stage that was preset at 22°C or 37°C. Rheologic charts were generated from the beginning of mixing until no further oscillation was detected. After initial measurements, cement kits were aged at 37°C for 12 weeks, and WT/ST was determined again at both temperatures. Five samples were read for each material and condition. Data were analyzed with repeated measures analysis of variance and a Tukey test at α=5% for each individual material.

RESULTS

The WT and ST of all cements were significantly affected by temperature and aging (p<0.05). In general, higher temperature accelerated WT/ST, but aging effects were material dependent. Some materials presented reduced WT/ST, whereas others showed increased WT/ST, regardless of the temperature.

CONCLUSIONS

The WT and ST were significantly affected by temperature variation and aging condition. Although temperature changes appeared to affect all materials similarly, aging effects were material dependent.

Can quaternary ammonium methacrylates inhibit matrix MMPs and cathepsins?

OBJECTIVE

Dentin matrices release ICTP and CTX fragments during collagen degradation. ICTP fragments are known to be produced by MMPs. CTX fragments are thought to come from cathepsin K activity. The purpose of this study was to determine if quaternary methacrylates (QAMs) can inhibit matrix MMPs and cathepsins.

METHODS

Dentin beams were demineralizated, and dried to constant weight. Beams were incubated with rh-cathepsin B, K, L or S for 24h at pH 7.4 to identify which cathepsins release CTX at neutral pH. Beams were dipped in ATA, an antimicrobial QAM to determine if it can inhibit dentin matrix proteases. Other beams were dipped in another QAM (MDPB) to determine if it produced similar inhibition of dentin proteases.

RESULTS

Only beams incubated with cathepsin K lost more dry mass than the controls and released CTX. Dentin beams dipped in ATA and incubated for 1 week at pH 7.4, showed a concentration-dependent reduction in weight-loss. There was no change in ICTP release from control values, meaning that ATA did not inhibit MMPs. Media concentrations of CTX fell significantly at 15wt% ATA indicating that ATA inhibits capthesins. Beams dipped in increasing concentrations of MDPB lost progressively less mass, showing that MDPB is a protease-inhibitor. ICTP released from controls or beams exposed to low concentrations were the same, while 5 or 10% MDPB significantly lowered ICTP production. CTX levels were strongly inhibited by 2.5-10% MDPB, indicating that MDPB is a potent inhibitor of both MMPs and cathepsin K.

SIGNIFICANCE

CTX seems to be released from dentin matrix only by cathepsin K. MMPs and cathepsin K and B may all contribute to matrix degradation.

Abstract P6-07-44: Overall survival and the prognostic factors among women with infiltrating lobular carcinoma of the breast in National Cancer Institute of Brazil

BACKGROUND: The infiltrating lobular carcinoma (ILC) comprises approximately 10% of breast cancers and appears to have a distinct biology. Because it is less common than infiltrating ductal carcinoma (IDC), there are less data published regarding about their clinical outcomes. This study estimates survival rates in women with infiltrating lobular carcinoma of the breast, diagnosed between 2000 to 2009 that had undergone treatment in the National Cancer Institute of Brazil.

OBJECTIVES: Analyze overall survival and the main prognostic factors among women with infiltrating lobular carcinoma of the breast, diagnosed from 2000 to 2009 that had undergone treatment in the National Cancer Institute of Brazil.

MATERIALS AND METHODS: The survival curves were obtained in a hospital cohort of 843 patients with infiltrating lobular carcinoma of the breast diagnosed and treated between 2000 to 2009. The study variables were: age, race, tobacco, alcohol consumption, tumor-related variables, and treatment-related variables. Survival functions were calculated by the Kaplan-Meier method.

RESULTS: The mean follow up time was 64,27 months (sd 33,76), with 30,2% of deaths occurred in the period where the mean patients age was 58,58 years (sd 13,22). The overall survival (OS) was 105,61 months (95% CI, 101,68 to 109,54). The OS for patients with 4 or more positives axillary lymph nodes was 91,66 months (95% CI, 83,19 to 100,13; p &lt; 0,0001) worse than patients with no positive axillary lymph node, where the overall survival was 124,26 months (95% CI, 119,41 to 129,12; p &lt; 0.0001). The OS in patients with estrogen receptor positive was 109,05 months (95% IC, 104,83 to 113,28; p &lt; 0.001) whereas in patients with hormone estrogen receptor negative, the OS was 81,75 months (95% CI, 69,93 to 93,58; p &lt; 0,0001). Among smokers patients, the OS was 97,46 months (95% CI, 90,80 to 104,12; p = 0,012) and for no smoking patients, the OS was109,01 months (95% CI, 104,24 to113,79; p = 0,012). Patients in stage 1 and 2 show an mean overall survival of 126,76 months (95% CI, 122,77 to130,75; p &lt; 0.0001) and patients in stage 3 and 4 show a worse overall survival with mean 74,61 months (95% CI, 68,59 to 80,62; p &lt; 0.0001). The patients younger than 40 years old had worse overall survival, with mean 88,88 months (95% C, 72,98 to 104,72; p = 0.032) than those with more than 40 years old, where the mean was 106,77 months (95% CI, 102,74 to 110,79; p = 0,032). The consumption of alcoholic beverages and pleomorphic histological variant showed no statistically significant difference in overall survival.

CONCLUSION: The mean follow up time was 64,27 months with 30,2% of deaths occurred in the period. The overall survival (OS) was 105,61 months. The OS was asssociated with axillary involvement, estrogen and progesterone receptor hormone, age and tobacco.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-44.

Effects of Potassium Oxalate on Knoop Hardness of Etch-and-Rinse Adhesives

The objective of this study was to determine whether the hardness of etch-and-rinse adhesives may be affected by the pretreatment of acid-etched dentin with potassium oxalate desensitizer. Unerupted human third molars were cut into crown segments by removing the occlusal enamel and roots. The pulp chamber of these crown segments was connected to a syringe barrel filled with phosphate-buffered saline so that the moisture of dentin was maintained during the bonding procedures. Three etch-and-rinse adhesives—two two-step systems (Adper Single Bond 2 [SB], One-Step [OS]) and one three-step system (Adper Scotchbond Multi-Purpose [MP])—were applied to acid-etched dentin that had been treated (experimental groups) or not (control groups) with potassium oxalate (BisBlock). The Knoop hardness (KHN) of adhesives was taken at different sites of the outer surface of the adhesive-bonded dentin. The KHN of the three tested adhesives applied to acid-etched dentin treated with potassium oxalate was significantly lower than that exhibited by the respective controls (not treated with oxalate; p&lt;0.05). Regardless of the adhesive, the treatment with potassium oxalate reduced the adhesives' KHN (p&lt;0.05), with the OS system exhibiting the lowest KHN compared with the MP and SB systems.

Durability of bonds and clinical success of adhesive restorations

Resin-dentin bond strength durability testing has been extensively used to evaluate the effectiveness of adhesive systems and the applicability of new strategies to improve that property. Clinical effectiveness is determined by the survival rates of restorations placed in non-carious cervical lesions (NCCL). While there is evidence that the bond strength data generated in laboratory studies somehow correlates with the clinical outcome of NCCL restorations, it is questionable whether the knowledge of bonding mechanisms obtained from laboratory testing can be used to justify clinical performance of resin-dentin bonds. There are significant morphological and structural differences between the bonding substrate used in in vitro testing versus the substrate encountered in NCCL. These differences qualify NCCL as a hostile substrate for bonding, yielding bond strengths that are usually lower than those obtained in normal dentin. However, clinical survival time of NCCL restorations often surpass the durability of normal dentin tested in the laboratory. Likewise, clinical reports on the long-term survival rates of posterior composite restorations defy the relatively rapid rate of degradation of adhesive interfaces reported in laboratory studies. This article critically analyzes how the effectiveness of adhesive systems is currently measured, to identify gaps in knowledge where new research could be encouraged. The morphological and chemical analysis of bonded interfaces of resin composite restorations in teeth that had been in clinical service for many years, but were extracted for periodontal reasons, could be a useful tool to observe the ultrastructural characteristics of restorations that are regarded as clinically acceptable. This could help determine how much degradation is acceptable for clinical success.

Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study

BACKGROUND

Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life-threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine.

METHODS

A questionnaire was sent to all associated doctors to the Brazilian Organ Transplantation Association through its website, calling for reports of organ transplanted patients who have been vaccinated against YF.

RESULTS

Twelve doctors reported 19 cases. None had important side effects. Only one had slight reaction at the site of YFV injection. Eleven patients were male. Organs received were 14 kidneys, 3 hearts, and 2 livers. Twelve patients received organs from deceased donors. Mean age at YFV was 45.6 ± 13.6 years old (range 11-69); creatinine: 1.46 ± 0.62 mg/dL (range 0.8-3.4); post-transplant time: 65 ± 83.9 months (range 3-340); and time from YFV at the time of survey: 45 ± 51 months (range 3-241). Immunosuppression varied widely with different drug combinations: azathioprine (7 patients), cyclosporine (8), deflazacort (1), mycophenolate (10), prednisone (11), sirolimus (3), and tacrolimus (4).

CONCLUSIONS

YFV showed no important side effects in this cohort of solid organ transplanted patients. However, owing to the small number of studied patients, it is not possible to extend these findings to the rest of the transplanted population, assuring safety. Therefore, these data are not strong enough to safely recommend YFV in organ transplanted recipients, as severe, even life-threatening side effects may occur.

Cements and adhesives for all-ceramic restorations

Dental cements are designed to retain restorations, prefabricated or cast posts and cores, and appliances in a stable, and long-lasting position in the oral environment. Resin-based cements were developed to overcome drawbacks of nonresinous materials, including low strength, high solubility, and opacity. Successful cementation of esthetic restorations depends on appropriate treatment to the tooth substrate and intaglio surface of the restoration, which in turn, depends on the ceramic characteristics. A reliable resin cementation procedure can only be achieved if the operator is aware of the mechanisms involved to perform the cementation and material properties. This article addresses current knowledge of resin cementation concepts, exploring the bonding mechanisms that influence long-term clinical success of all-ceramic systems.

Methods used by Dental Practice-based Research Network (DPBRN) dentists to diagnose dental caries

OBJECTIVES

To (1) identify the methods that dentists in The Dental Practice-Based Research Network (DPBRN) use to diagnose dental caries; (2) quantify their frequency of use and (3) test the hypothesis that certain dentist and dental practice characteristics are significantly associated with their use.

METHODS

A questionnaire about methods used for caries diagnosis was sent to DPBRN dentists who reported doing some restorative dentistry; 522 dentists participated. Questions included the use of dental radiographs, the dental explorer, laser fluorescence, air-drying and fiber-optic devices and magnification as used when diagnosing primary, secondary/recurrent or non-specific caries lesions. Variations on the frequency of their use were tested using multivariate analysis and Bonferroni tests.

RESULTS

Overall, the dental explorer was the instrument most commonly used to detect primary occlusal caries and caries at the margins of existing restorations. In contrast, laser fluorescence was rarely used to help diagnose occlusal primary caries. For proximal caries, radiographs were used to help diagnose 75%–100% of lesions by 96% of the DPBRN dentists. Dentists who use radiographs most often to assess proximal surfaces of posterior teeth were significantly more likely to also report providing a higher percentage of patients with individualized caries prevention (p=.040) and seeing a higher percentage of pediatric patients (p=.001).

CONCLUSION

The use of specific diagnostic methods varied substantially. The dental explorer and radiographs are still the most commonly used diagnostic methods..

The anti-MMP activity of benzalkonium chloride

OBJECTIVE

This study evaluated the ability of benzalkonium chloride (BAC) to bind to dentine and to inhibit soluble recombinant MMPs and bound dentine matrix metalloproteinases (MMPs).

METHODS

Dentine powder was prepared from extracted human molars. Half was left mineralized; the other half was completely demineralized. The binding of BAC to dentine powder was followed by measuring changes in the supernatant concentration using UV spectrometry. The inhibitory effects of BAC on rhMMP-2, -8 and -9 were followed using a commercially available in vitro proteolytic assay. Matrix-bound endogenous MMP-activity was evaluated in completely demineralized beams. Each beam was either dipped into BAC and then dropped into 1 mL of a complete medium (CM) or they were placed in 1 mL of CM containing BAC for 30 days. After 30 days, changes in the dry mass of the beams or in the hydroxyproline (HYP) content of hydrolysates of the media were quantitated as indirect measures of matrix collagen hydrolysis by MMPs.

RESULTS

Demineralized dentine powder took up 10-times more BAC than did mineralized powder. Water rinsing removed about 50% of the bound BAC, whilst rinsing with 0.5M NaCl removed more than 90% of the bound BAC. BAC concentrations 0.5wt% produced 100% inhibition of soluble recombinant MMP-2, -8 or -9, and inhibited matrix-bound MMPs between 55 and 66% when measured as mass loss or 76-81% when measured as solubilization of collagen peptide fragments.

CONCLUSIONS

BAC is effective at inhibiting both soluble recombinant MMPs and matrix-bound dentine MMPs in the absence of resins.

State of the art etch-and-rinse adhesives

OBJECTIVES

The aim of this study was to explore the therapeutic opportunities of each step of 3-step etch-and-rinse adhesives.

METHODS

Etch-and-rinse adhesive systems are the oldest of the multi-generation evolution of resin bonding systems. In the 3-step version, they involve acid-etching, priming and application of a separate adhesive. Each step can accomplish multiple goals. Acid-etching, using 32-37% phosphoric acid (pH 0.1-0.4) not only simultaneously etches enamel and dentin, but the low pH kills many residual bacteria.

RESULTS

Some etchants include anti-microbial compounds such as benzalkonium chloride that also inhibits matrix metalloproteinases (MMPs) in dentin. Primers are usually water and HEMA-rich solutions that ensure complete expansion of the collagen fibril meshwork and wet the collagen with hydrophilic monomers. However, water alone can re-expand dried dentin and can also serve as a vehicle for protease inhibitors or protein cross-linking agents that may increase the durability of resin-dentin bonds. In the future, ethanol or other water-free solvents may serve as dehydrating primers that may also contain antibacterial quaternary ammonium methacrylates to inhibit dentin MMPs and increase the durability of resin-dentin bonds. The complete evaporation of solvents is nearly impossible.

SIGNIFICANCE

Manufacturers may need to optimize solvent concentrations. Solvent-free adhesives can seal resin-dentin interfaces with hydrophobic resins that may also contain fluoride and antimicrobial compounds. Etch-and-rinse adhesives produce higher resin-dentin bonds that are more durable than most 1 and 2-step adhesives. Incorporation of protease inhibitors in etchants and/or cross-linking agents in primers may increase the durability of resin-dentin bonds. The therapeutic potential of etch-and-rinse adhesives has yet to be fully exploited.

The requirement of zinc and calcium ions for functional MMP activity in demineralized dentin matrices

The progressive degradation of resin-dentin bonds is due, in part, to the slow degradation of collagen fibrils in the hybrid layer by endogenous matrix metalloproteinases (MMPs) of the dentin matrix. In in vitro durability studies, the storage medium composition might be important because the optimum activity of MMPs requires both zinc and calcium.

OBJECTIVE

This study evaluated the effect of different storage media on changes in matrix stiffness, loss of dry weight or solubilization of collagen from demineralized dentin beams incubated in vitro for up to 60 days.

METHODS

Dentin beams (1mm×2mm×6mm) were completely demineralized in 10% phosphoric acid. After baseline measurements of dry mass and elastic modulus (E) (3-point bending, 15% strain) the beams were divided into 5 groups (n=11/group) and incubated at 37°C in either media containing both zinc and calcium designated as complete medium (CM), calcium-free medium, zinc-free medium, a doubled-zinc medium or water. Beams were retested at 3, 7, 14, 30, and 60 days of incubation. The incubation media was hydrolyzed with HCl for the quantitation of hydroxyproline (HOP) as an index of solubilization of collagen by MMPs. Data were analyzed using repeated measures of ANOVA.

RESULTS

Both the storage medium and the storage time showed significant effects on E, mass loss and HOP release (p<0.05). The incubation in CM resulted in relatively rapid and significant (p<0.05) decreases in stiffness, and increasing amounts of mass loss. The HOP content of the experimental media also increased with incubation time but was significantly lower (p<0.05) than in the control CM medium, the recommended storage medium.

CONCLUSIONS

The storage solutions used to age resin-dentin bonds should be buffered solutions that contain both calcium and zinc. The common use of water as an aging medium may underestimate the hydrolytic activity of endogenous dentin MMPs.

Chlorhexidine binding to mineralized versus demineralized dentin powder

OBJECTIVES

The purposes of this work were to quantitate the affinity and binding capacity of chlorhexidine (CHX) digluconate to mineralized versus demineralized dentin powder and to determine how much debinding would result from rinsing with water, ethanol, hydroxyethylmethacrylate (HEMA) or 0.5M NaCl in water.

METHODS

Dentin powder was made from coronal dentin of extracted human third molars. Standard amounts of dentin powder were tumbled with increasing concentrations of CHX (0-30 mM) for 30 min at 37 degrees C. After centrifuging the tubes, the supernatant was removed and the decrease in CHX concentration quantitated by UV-spectroscopy. CHX-treated dentin powder was resuspended in one of the four debinding solutions for 3 min. The amount of debound CHX in the solvents was also quantitated by UV-spectroscopy.

RESULTS

As the CHX concentration in the medium increased, the CHX binding to mineralized dentin powder also increased up to 6.8 micromol/g of dry dentin powder. Demineralized dentin powder took up significantly (p<0.01) more CHX, reaching 30.1 micromol CHX/g of dry dentin powder. Debinding of CHX was in the order: HEMA

SIGNIFICANCE

As CHX is not debound by HEMA, it may remain bound to demineralized dentin during resin-dentin bonding. This may be responsible for the long-term efficacy of CHX as an MMP inhibitor in resin-dentin bonds.

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Key Words

• chlorhexidine
• binding
• debinding
• dentin bonding

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MESH Headings

• Anti-Infective Agents, Local/pharmacokinetics
• Anti-Infective Agents, Local/pharmacology
• Chlorhexidine/analogs & derivatives
• Chlorhexidine/pharmacokinetics
• Chlorhexidine/pharmacology
• Collagen/metabolism
• Dental Bonding
• Dentin/metabolism
• Durapatite
• Ethanol
• Humans
• Hydrogen Bonding
• Linear Models
• Matrix Metalloproteinase Inhibitors
• Methacrylates
• Protease Inhibitors/pharmacology
• Protein Binding
• Resin Cements/chemistry
• Sodium Chloride
• Solubility
• Spectroscopy, Fourier Transform Infrared
• Tooth Demineralization/metabolism
• Water

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Grants

• R01 DE015306 NIDCR NIH HHS
• R01 DE015306-06A1 NIDCR NIH HHS
• R01 DE015306-06 NIDCR NIH HHS

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Effect of oxalate desensitizers and dentin moisture during total-etch bonding

PURPOSE

To evaluate the effect of oxalate during total-etch bonding, under different dentin moisture conditions, over time. The null hypothesis tested was that microtensile bond strength (microTBS) was not affected by oxalate treatment and dentin moisture during two evaluation periods.

METHODS

Extracted human third molars had their mid-coronal dentin exposed flat and polished with 600-grit SiC paper. The surfaces were etched with 35% phosphoric acid for 15 seconds, washed and blot dried. After etching, a 3% potassium oxalate gel was applied for 120 seconds, except for the control group (no desensitizer). The surface was then washed and left moist (Wet bonding) or air-dried for 30 seconds (Dry bonding). The surfaces were bonded with: (1) two 2-step etch-and-rinse adhesives: Single Bond (SB); Prime & Bond NT (PBNT) and (2) one 3-step etch-and-rinse adhesive: Scotchbond Multi Purpose (SBMP). Composite buildups were constructed incrementally with Tetric Ceram resin composite. Each increment was cured for 40 seconds. After storage in water for 24 hours or 1 year at 37 degrees C, the specimens were prepared for microTBS testing with a cross-sectional area of approximately 1 mm2. They were then tested in tension in an Instron machine at 0.5 mm/minute. Data were analyzed by ANOVA and Student-Newman-Keuls at alpha = 0.05.

RESULTS

Application of potassium oxalate had no significant effect on the bond strengths of SBMP and PBNT, regardless of the surface moisture condition (P > 0.05). Conversely, reduced bond strengths were observed after oxalate treatment for SB in both moisture conditions, that being significantly lower when using a dry-bonding procedure (P < 0.05). Lower bond strength was obtained for PBNT when a dry-bonding technique was used, regardless of the oxalate treatment (P < 0.05). After aging the specimens for 1 year, bond strengths decreased. Smaller reductions were observed for SBMP, regardless of moisture conditions. For the WB technique, smaller reductions after 1 year were observed without oxalate treatment for SB and after oxalate treatment for PBNT.

Substantivity of chlorhexidine to human dentin

OBJECTIVES

To better comprehend the role of CHX in the preservation of resin-dentin bonds, this study investigated the substantivity of CHX to human dentin.

MATERIAL AND METHODS

Dentin disks (n=45) were obtained from the mid-coronal portion of human third molars. One-third of dentin disks were kept mineralized (MD), while the other two-thirds had one of the surfaces partially demineralized with 37% phosphoric acid for 15 s (PDD) or they were totally demineralized with 10% phosphoric acid (TDD). Disks of hydroxyapatite (HA) were also prepared. Specimens were treated with: (1) 10 microL of distilled water (controls), (2) 10 microL of 0.2% chlorhexidine diacetate (0.2% CHX) or (3) 10 microL of 2% chlorhexidine diacetate (2% CHX). Then, they were incubated in 1 mL of PBS (pH 7.4, 37 degrees C). Substantivity was evaluated as a function of the CHX-applied dose after: 0.5 h, 1 h, 3 h, 6 h, 24 h, 168 h (1 week), 672 h (4 weeks) and 1344 h (8 weeks) of incubation. CHX concentration in eluates was spectrophotometrically analyzed at 260 nm.

RESULTS

Significant amounts of CHX remained retained in dentin substrates (MD, PPD or TDD), independent on the CHX-applied dose or time of incubation (p<0.05). High amounts of retained CHX onto HA were observed only for specimens treated with the highest concentration of CHX (2%) (p<0.05).

CONCLUSION

The outstanding substantivity of CHX to dentin and its reported effect on the inhibition of dentinal proteases may explain why CHX can prolong the durability of resin-dentin bonds.

Mechanical testing of indirect composite materials directly applied on implant abutments

PURPOSE

To test the strength to failure and fracture mode of three indirect composite materials directly applied onto Ti-6Al-4V implant abutments vs cemented standard porcelain-fused-to-metal (PFM) crowns.

MATERIALS AND METHODS

Sixty-four locking taper abutments were randomly allocated to four groups and were cleaned in ethanol in an ultrasonic bath for 5 min. After drying under ambient conditions, the abutments were grit blasted and a custom 4-cusp molar crown mold was utilized to produce identical crowns (n = 16 per group) of Tescera (Bisco), Ceramage (Shofu), and Diamond Crown (DRM) according to the manufacturer's instructions. The porcelain-fused-to-metal crowns were fabricated by conventional means involving the construction and a wax pattern and casting of a metallic coping followed by sintering of increasing layers of porcelain. All crowns were loaded to failure by an indenter placed at one of the cusp tips at a 1 mm/min rate. Subsequently, fracture analysis was performed by means of stereomicroscopy and scanning electron microscopy. One-way ANOVA at 95% level of significance was utilized for statistical analysis.

RESULTS

The single load to failure (± SD) results were: Tescera (1130 ± 239 N), Ceramage (1099 ± 257 N), Diamond Crown (1155 ± 284 N), and PFM (1081 ± 243 N). Stereomicroscopy analysis showed two distinct failure modes, where the loaded cusp failed either with or without abutment/metallic coping exposure. SEM analysis of the fractures showed multiple crack propagation towards the cervical region of the crown below a region of plastic deformation at the indenter contact region.

CONCLUSION

The three indirect composites and PFM systems fractured at loads higher than those typically associated with normal occlusal function. Although each material had a different composition and handling technique, no significant differences were found concerning their single load to fracture resistance among composite systems and PFM.