Challenges and opportunities in preparing dentists for primary care

With the growing understanding of the relationship between oral and systemic diseases there is an increasing interest in integrating dental providers more completely into the health care delivery system. Technology advancements in traditional dental disease diagnosis and management as well as in salivary diagnostics for systemic disease provide great opportunities for the profession but numerous challenges for dental educators who are impacted by the intersection of numerous, sometimes competing interests. While economic factors play a significant role in curricular innovation and change, in the United States the accrediting process for dental education programs can be an equally vexing challenge. Movement away from primarily a competency-based assessment model to a model focusing on the establishment of Entrustable Professional Activities (EPAs) may provide a needed catalyst to enhance dental education to graduate dentists who embrace an expanded role as primary care providers.

Effect of mold enclosure and chisel design on fatigue bond strength of dental adhesive systems

To examine the effect of mold enclosure and chisel design on macro shear fatigue bond strengths of dental adhesive systems. The fatigue bond strength testing was conducted with two commercially available dental adhesive systems, (1) OptiBond eXTRa and (2) Scotchbond Universal, for bonding a resin composite (Filtek Supreme Ultra) to both enamel and dentin using a mold enclosure and a non‐mold enclosure with a knife‐edge and two sized notched‐edge chisel assemblies for loading. As a loading reference for the fatigue testing, macro shear bond strengths of the adhesive systems to enamel and dentin were conducted using a mold enclosure and a knife‐edge chisel assembly. The shear bond strengths with the mold enclosure using knife‐edge chisel assembly did not exhibit a significant difference between the adhesive systems for either enamel or dentin. The fatigue bond strengths of bonded specimens demonstrated significant differences when comparing the mold enclosure and non‐mold enclosure, but not between knife‐edge and notched‐edge chisel assemblies. The fatigue bond strengths of dental adhesive systems demonstrated significantly higher values when using mold‐enclosed bonded specimens than a non‐mold enclosure, regardless of type of chisel assembly.

Bond Strength of Self-Adhesive Restorative Materials Affected by Smear Layer Thickness but not Dentin Desiccation

PURPOSE

To use shear bond strength (SBS) testing to determine the effect of surface moisture and smear layer thickness on the adhesion of self-adhesive restorative materials and a universal adhesive.

MATERIALS AND METHODS

One single-step self-etch universal adhesive, Prime & Bond Active (PA), was used to bond Ceram.x Spectra ST HV composite resin to dentin and enamel using the self-etching technique. Three commercially available restorative materials and one newly developed material with self-adhesive properties, Activa (A), Fuji II LC(F), Equia Forte (E), and ASAR-MP4 (S), respectively, were also bonded to enamel and dentin prepared moist and dry and to dentin prepared with a thick smear layer. Shear bond testing was performed using an Ultradent bonding apparatus.

RESULTS

The universal adhesive generated the highest SBS to dentin and enamel, followed by the newly developed material. None of the materials tested were significantly affected by the moisture conditions on enamel or dentin. The thickness of smear layer significantly affected SBS to dentin for S, F, and E. However, S and F still exhibited higher shear bond strength to dentin with the thicker smear layer compared to the other self-adhesive materials. Only the universal adhesive in self-etch mode was not affected by the thicker smear layer and maintained significantly higher SBS.

CONCLUSION

None of the materials tested were affected by bonding to overdried dentin or enamel. All of the self-adhesive materials exhibited lower SBS to specimens with a thicker smear layer. The newly developed material ASAR-MP4 compared favorably to the other self-adhesive materials tested under all test conditions.