Chronological List of Articles

SUMMARY:
Just as vital dentin is moist after removing the smear layer, avoiding collapse of the collagen matrix after acid-etching requires in vivo validation. This study hypothesizes that there is no difference between moist bonding performed in vitro or in vivo, and that excessive drying or wetting of vital acid-etched dentin produces inferior results. Resin-dentin interfaces bonded with a moist bonding technique (control), either in vitro or in vivo with Excite DSC (Vivadent), were examined with and without tracer penetration using transmission electron microscopy. Specimens bonded in vivo under excessively dry and wet conditions were also examined. The patterns of silver deposition were similar within the adhesive and hybrid layers created in vitro or in vivo. No hybrid layer was observed in vivo after excessive drying. Excessive wetting in vivo resulted in more extensive nanoleakage and water tree formation along resin-dentin interfaces.

SUMMARY:
In this in vitro study, voids inside a minimal occlusal restoration using different consistencies of resin composite and various application techniques were investigated.

One hundred and fifty-two simulated, minimally invasive preparations, including a prepared fissure and an excavated carious dentin lesion, were ground in perspex blocks. After applying an acrylic primer (Artglass Connector, Kulzer), the preparations were restored with the adhesive PhotoBond (Kuraray) and one of three resin composites: a packable composite (Prodigy Condensable-Kerr), a syringable composite (Clearfil Photo Posterior, Kuraray) and a flowable composite (Revolution, Kerr). The restorations were inserted according to eight protocols (n=19). In three groups, the composite was placed in bulk. In another three groups, a layer of flowable composite was placed first, then cured, followed by a second layer of one of the three composites. In two groups, the first layer of flowable composite was left uncured before a second layer of a packable or syringable composite was inserted. The perspex blocks were sectioned and inspected for the presence of voids. Statistical analysis was conducted using Fischer’s exact tests at p<0.05.

The results showed that restoring minimal preparations in the absence of porosities and voids was very difficult to achieve. Placing a layer of flowable composite that was left uncured, directly followed by injecting a medium-viscous composite, was the technique that resulted in the most homogeneous restoration.

SUMMARY:
A number of “high power” in-office bleaching products have recently been re-introduced into the market. The use of such strong oxidizing agents has raised questions as to possible adverse effects on tooth structure and restorative materials. This study evaluated the effects of 35% carbamide peroxide (Opalescence Quick) and 35% hydrogen peroxide (Opalescence Xtra) on the surface finish of four tooth-colored restorative materials (Spectrum TPH, Dyract AP, Reactmer and Fuji II LC). Twenty-seven matrix-finished specimens of each material were fabricated, stored in distilled water at 37°C for seven days and randomly divided into three groups. Specimens in Group 1 were stored in distilled water at 37°C (control). Specimens in Groups 2 and 3 were treated with 35% carbamide peroxide and 35% hydrogen peroxide, respectively. A total of three 30-minute bleaching sessions were conducted at one-week intervals. Storage medium during the hiatus period was distilled water at 37°C. Surface roughness measurements were carried out using profilometry after each bleaching session. Data was analyzed using ANOVA/ Scheffe’s test at a 0.05 significance level. No significant difference in surface roughness was observed between the bleached and the control groups for all materials. In-office bleaching products are not detrimental to the surface finish of composites, compomers, giomers and resin-modified glass ionomer cements.

SUMMARY:
Human enamel, with its prismatic, rod-like apatitic morphology, is an anisotropic material. Because of this structural anisotropy, variation in enamel bonding sites might influence the bonding ability of current adhesive systems. This study investigated the effects of regional enamel and the direction of enamel sectioning on the bonding ability of two commercially available resin adhesives: a self-etching primer system (Clearfil SE Bond) and a one-bottle adhesive system intended for use with a total-etch wet bonding technique (Single Bond). Two regions of enamel, cuspal and mid-coronal enamel, were chosen, then sectioned in three different directions, horizontally, axially and tangentially. Slices of the sectioned enamel were then bonded with each adhesive system and submitted to a micro-shear bond test. The results of a micro-shear bond testing showed that the bonding of a one-bottle adhesive system (Single Bond) to enamel was high at the surface perpendicular to the enamel prisms (40 MPa to 51 MPa) and low at the surface parallel to the enamel prisms (24 MPa to 27 MPa). In the case of a self-etching primer system (Clearfil SE Bond), 35 MPa to 45 MPa bond strengths were obtained from all surfaces. The bond strengths of the two adhesive systems were significantly influenced by the anisotropic structure of enamel (p<0.05). However, the effect of a self-etching primer system was less influenced by the orientation of the prismatic structure of enamel than that of a one-bottle adhesive system (p<0.05).

SEM and CLSM microphotographs showed that the self-etching primer effectively modified the smear layer without being excessively destructive to the enamel.

SUMMARY:
The relatively low bond strengths of resin cements to dentin may result in poor interfacial adaptation of composite inlays. This study determined whether the interfacial adaptation of composite inlays could be improved by applying an adhesive system and a low viscosity microfilled resin to the prepared cavity walls before making an impression. Ten MOD cavities were prepared on extracted human premolars with gingival margins located above and below the cemento–enamel junction. A “resin coat” consisting of a self-etching primer system (Clearfil SE Bond) and a low viscosity microfilled resin (Protect Liner F) was applied to the cavities of half of the prepared teeth, while the remaining teeth served as non-coated control specimens. All the teeth were restored with composite inlays (Estenia) fabricated by the indirect method and cemented with a dual-cured resin cement (Panavia F). After finishing the margins with superfine burs, the bonded inlays were thermocycled between 4°C and 55°C for 400 cycles. Specimens were sectioned with a diamond saw and the tooth-restoration interfaces were observed with a confocal laser scanning microscope. The data were analyzed with two-way ANOVA and Fisher’s PLSD test (p<0.05). The percentage length of gap formation at the dentin-restoration interface of the “resin coated” teeth (7.1 ± 3.5) was significantly less than that of the non-coated teeth (85.7 ± 6.7) (p<0.05). The concept of coating the prepared cavity with an adhesive system and a low viscosity microfilled resin resulted in observing fewer gaps at the internal dentin-restoration interface compared with the non-coated specimens.

SUMMARY:
This study investigated the effect of finishing/polishing techniques on the microleakage of resin-modified glass ionomer restorations. Class V preparations were made on the buccal and lingual/palatal surfaces of freshly extracted teeth. The cavities on each tooth were restored with Fuji II LC (FT [GC]) and Photac-Fil Quick (PF [3M-ESPE]) according to manufacturers’ instructions. Immediately after light-polymerization, gross finishing was done with eight-fluted tungsten carbide burs. The teeth were then randomly divided into four groups and finishing/polishing was done with one of the following systems: (a) Robot Carbides (RC); (b) Super-Snap system (SS); (c) OneGloss (OG) and (d) CompoSite Polishers (CS). The sample size for each material-finishing/polishing system combination was eight. After finishing/polishing, the teeth were stored in distilled water at 37°C for one week. The root apices were then sealed with acrylic and two coats of varnish was applied 1 mm beyond the restoration margins. The teeth were subsequently subjected to dye penetration testing (0.5% basic fuchsin), sectioned and scored. Data was analyzed using Kruskal-Wallis and Mann-Whitney U tests at a significance level of 0.05. Results of statistical analysis were as follows: Enamel margins: PF–OG<SS; FT-OG<RC; Dentin margins: PF–no significant difference; FT–OG & CS<RC. Regardless of the finishing/polishing technique, leakage at dentin margins was significantly greater than at enamel margins for FT. For PF, no significant difference in leakage scores was observed between dentin and enamel with the exception of finishing/polishing with OG. FT restorations had significantly less enamel and dentin leakage than PF restorations when treated with OG. The effect of finishing/polishing techniques on microleakage was both tissue and material dependent.

SUMMARY:
This in vitro study investigated the microleakage of flowable resin composite as a restorative material and as a liner (either light cured separately or co-cured with hybrid resin composite) in Class V cavities. A light-cured hybrid resin composite was used as a control. Twenty extracted human premolars were prepared with standardized Class V cavity outlines on the buccal and lingual surfaces. The occlusal margin of the cavities was on enamel and the gingival margin was on dentin. One bottle adhesive system (Single Bond) was used after etching enamel and dentin with 34.5% phosphoric acid for 15 seconds. The cavities were randomly divided into four groups of 10 each and restored according to the manufacturers’ instructions: Group I–Hybrid resin composite (Z100); Group II–Flowable resin composite (Filtek Flow); Group III–Flowable resin composite (Filtek Flow)+Hybrid resin composite (Z100); light cured separately; Group IV–Flowable resin composite (Filtek Flow)+ Hybrid resin composite (Z100); co-cured. The samples were thermocycled 200 times with a 30-second dwell time. They were then immersed in a 0.5% basic fuchsin solution for 24 hours, sectioned and analyzed by stereomicroscopy. The degree of dye penetration was recorded and analyzed with the Kruskal-Wallis and Mann-Whitney U tests.

The results of this study indicate that there was no leakage at the occlusal margin for either restoration. Statistically significant differences were found among the groups at the gingival margin. No statistically significant difference was observed between the occlusal and gingival margins except in Group IV.

The combination of flowable resin composite and hybrid composite light cured separately yielded the best result in this study. The most leakage was observed when this combination was co-cured. The resistance to microleakage of flowable resin composite as a restorative material is similar to that of hybrid resin composite.

SUMMARY:
This study investigated the effect of instrumentation time on the microleakage of resin-modified glass ionomer cements (RMGICs). Class V cavities were prepared on buccal and lingual/ palatal surfaces of 64 freshly extracted non-carious premolars. The cavities on each tooth were restored with Fuji II LC (FT [GC]) and Photac-Fil Quick (PF [3M-ESPE]). The restored teeth were randomly divided into two groups of 32 teeth. Finishing/polishing was done immediately after light-polymerization in one group and was delayed for one week in the other group. The following finishing/polishing systems were evaluated: (a) Robot Carbides (RC); (b) SuperSnap (SS); (c) OneGloss (OG) and (d) CompoSite Polishers (CS). The sample size for each instrumentation time, material and finishing/polishing system combination was 8. Storage medium for both immediate and delayed instrumentation groups was distilled water at 37°C during the hiatus period. The teeth were subsequently subjected to dye penetration testing (0.5% basic fushcin), sectioned and scored. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests at significance level 0.05. For PF, significant difference in enamel leakage was observed between immediate and delayed instrumentation with SS and CS. Significant differences in dentin leakage were also observed between the two instrumentation times for SS. For FT, significant differences in leakage between instrumentation times were observed only in dentin and with RC. Where significant differences in dye penetration scores existed, delayed finishing/polishing resulted in less microleakage.

SUMMARY:
This study compared the effects of different finishing techniques on the surface of a traditional hybrid composite and three packable composites.

Four composites were used in the study (Herculite XRV/Kerr, Definite/Degussa, SureFil/ Dentsply and Solitaire/Heraeus-Kulzer). Fifty specimens were made of each material, sized 7 x 7 x 4 mm. Fifteen specimens of each material were subjected to the following finishing procedures: (1) a 30 µm diamond, (2) a 30 µm and a 20 µm diamond and (3) a 30 µm diamond followed by a tungsten carbide finishing bur. As a reference, five specimens of each material were treated by Sof-Lex discs (3M). For quantitative surface evaluation, laser-stylus profilometry was used. Roughness parameters included average roughness (Ra) and profile-length-ratio (LR). Statistical analysis was performed with one- and two-way Anova and Scheffé post-hoc tests. Qualitative surface evaluation in SEM was performed at a tension of 25kV.

Significant effects were found with both the composites and the finishing methods with respect to surface roughness (p<0.001 for Ra and LR). A 30 µm diamond caused the greatest roughness on all composites, with Ra ranging from 2.015 - 2.079 µm (p<0.001). After finishing using methods 2 and 3, the Solitaire surfaces were significantly smoother (p<0.001 for LR). The lowest roughness values were achieved after using disks; again, the Solitaire specimens yielded the lowest Ra and LR values (p<0.001 except for Sure-Fil). With scanning electron microscopy, surface areas with signs of destruction were found after using a 30 µm diamond on Definite specimens.

SUMMARY:
To evaluate the correlation between microtensile dentin bond strength (µTBS) and silver ion penetration, two total-etch 3-step and one self-etch 2-step system were investigated. OptiBond FL adhesive was applied to flat occlusal dentin on six non-carious human molars, and a resin composite “crown” was formed in 2 mm increments. After 24-hour water storage, the teeth were sectioned with a low-speed diamond saw to obtain four-square sticks (~2 mm X 2 mm) per tooth. Cylindrical tensile test specimens were formed with an 0.5 mm2 cross-sectional area. Nail varnish was applied to the dentin within 0.5–1.0 mm of the interface before immersing in 50% silver nitrate for 15 minutes. Following silver fixation, tensile testing was performed in a Zwick UTM at 1 mm/minute using a passive gripping fixture to obtain 72-hour µTBS [23.9 MPa]. The percentage area of silver penetration was measured on debonded specimens using light microscopy and Image-Pro Plus Software [89%]. The procedures were repeated using Scotchbond Multi-Purpose Plus [µTBS =27.8 MPa; nanoleakage = 67%] and Clearfil SE bond [µTBS = 36 MPa; nanoleakage = 55%]. No significant correlation between microtensile bond strength and nanoleakage was found for all systems. A weak-to-moderate negative relationship was found between µTBS and nanoleakage for OptiBond FL (Spearman r = -0.3844). No correlation was found for the remaining adhesive systems. The correlation between these two common laboratory measurements appears to be adhesive-system dependent.

SUMMARY:
Sixty-seven extracted molars were selected (134 samples). Dentin and enamel samples were prepared by buccal and lingual surface sectioning to expose a planar enamel or dentin surface.

For the roughness study, 80 samples were randomly assigned to eight groups. Enamel and dentin surfaces were etched with a 37% phosphoric acid solution, irradiated with an Er:YAG laser or irradiated with a Nd:YAP laser. Samples were then observed in SEM using BSE.

For the free-surface energy study, 54 samples received the same treatment as above. Two contact angle measurements were made on each surface using a goniometer. Data were analyzed by a non-parametric statistical test.

Morphological changes on enamel and dentin were greater with acid-etch and Er:YAG laser than with Nd:YAP laser. Free surface energy was significantly greater with acid-etch or Er:YAG laser than with Nd:YAP laser (p<0.001).

SUMMARY:
The effects of mechanical stress on apoptosis induction during pulp wound healing were examined. Mechanical stress cavities of two different sizes were prepared on individual rat molars, one twice the size of the other in the occlusocervical direction. The authors compared the distribution pattern and number of apoptotic cells of the two groups by terminal deoxynucleotidyl transferase-mediated labeling assay. At one hour and one day, significant differences were observed in the distribution patterns and number of apoptotic cells between the single-size and double-size group. Four days after injury, apoptosis still existed on pulp cells in the double-size group but not in the single-size group. At 14 days, no difference in the number of apoptotic cells between the two groups was observed. These results suggest that the magnitude of mechanical stress, such as cavity preparation, may modulate the induction of apoptosis during pulp wound healing.

SUMMARY:
The fracture resistance of provisional restorations is an important concern for the restorative dentist. The fracture resistance of a material is directly related to its transverse strength. Six specimens of similar dimensions were prepared from three resins (PMMA, PEMA and BIS acryl-composite). The resins were reinforced with glass and aramid fibers. The samples were tested immediately after the material set, following seven days of wet storage using three-point compression loading. The results were analyzed with an analysis of variance (ANOVA). Fracture resistance of the specimens was statistically different (p<0.001) among the materials. Specimens reinforced with glass fibers showed higher transverse strength (149.82 MPa). The fiber reinforcement of resin materials increased the strength values (20-50%). Within the limitations of this study, the transverse strengths of PMMA, PEMA and BIS acryl-resin composites were improved after reinforcement with glass and aramid fibers.

INTRODUCTION:
The Academy of Operative Dentistry has developed the following recommendations for diagnosis, treatment and prevention of non-carious cervical lesions. Patients should be informed of the possible etiologies, implications of the presence of these lesions, methods of minimizing their occurrence, treatment alternatives and expected outcomes. Failure to appropriately prevent and treat non-carious cervical lesions can result in continued loss of tooth structure, tooth sensitivity, weakening of the tooth, the need for endodontic therapy, or tooth loss and the occurrence of additional lesions in other teeth.

SUMMARY:
This three-month, single-blind clinical study compared two whitening treatments, at-home with 10% carbamide peroxide and in-office with 35% hydrogen peroxide, for the degree of color change of teeth, color relapse and tooth and gum sensitivity. The degree of color change and color relapse was evaluated by using a colorimeter, shade guide and color slide photography. Teeth and gum sensitivity were self-evaluated by the subjects, who recorded daily the tooth and gum sensitivity they experienced during the two weeks of treatment and one week post-treatment.

A 14-day at-home treatment was compared with 60 minutes of in-office treatment (two appointments, each with three 10-minute applications). The at-home treatment produced significantly lighter teeth than the in-office treatment during all active-treatment periods and follow-up visits according to all three-color evaluation methods. Color relapse for both treatments stabilized by six weeks. At-home treatment resulted in statistically significant higher gum sensitivity than in-office treatment during the latter part of the first week. For tooth sensitivity there were no significant differences between the treatments. Eighty four percent of the subjects reported at-home treatment to be more effective and 16% found no difference between the treatments. There were no subjects who reported the in-office treatment to be superior in tooth whitening to the at-home treatment.

SUMMARY:
This study compared excess formation of direct bonded Class II restorations using different matrix systems—metal or transparent. Sixty freshly extracted, non-carious, posterior human teeth were used. In all of the teeth, standardized MOD-cavities were prepared with the gingivoproximal margins located 1.0-1.5 mm cervical to the cemento-enamel junction. The prepared teeth were randomly assigned to six groups. Half were restored using metal matrices and wooden wedges; the other half were restored using transparent matrices and reflective wedges. Three different material systems were used to fill the cavities: 1) a hybrid composite (Tetric) plus an adhesive bonding agent (Syntac Classic), 2) a flowable composite (Tetric Flow) plus Syntac Classic and 3) a compomer (Dyract AP) together with an adhesive bonding agent designed for compomers (Prime & Bond NT). After the specimens were preserved in saline solution, scanning electron microscopy (SEM) assessed the amount of overhang formation at the restoration margins. The data collected indicated the use of transparent matrices resulted in significantly higher amounts of excess material at the restoration margins compared with metal matrices. Moreover, there was no significant difference between the materials when the same matrix was used. All of the dental restorations examined displayed material overhang. Based on these findings, the authors concluded that the type of matrix exerts a major impact on overhang formation, with metal matrices resulting in significantly less excess material buildup.

SUMMARY:
This in vitro study generated data on the quality of marginal adaptation, fracture resistance and retention of several indirect adhesive composite configurations on root-treated premolars before and after a long-term fatigue test and compared these results to a control group of adhesive onlays on “vital” teeth.

Six root-treated extracted human premolars per group, with four different restorative configurations with and without adhesive fiber posts, were evaluated. Another group of six premolars, “revitalized” by using diluted horse serum to simulate pulpal fluid and restored with adhesive composite onlays, served as the control. Marginal adaptation before and after long-term occlusal loading (1,200,000 occlusal loading cycles at max 49 N) was assessed by using the replica technique and quantitative evaluation in SEM at 200x magnification. The number of lost restorations was recorded after loading. Fracture resistance and fracture patterns were evaluated by using a universal-testing machine on the fatigued samples.

No significant differences (p>0.05) between groups were detected before and after loading for the percentage of “continuous margin” at the total marginal length. Loading had a significant (p<0.05) effect on the percentage of “continuous margin” for the total marginal length of two groups only. No significant difference (p>0.05) for fracture resistance was detected and no lost restorations were observed.

The results suggest that for both the less decayed and the more significantly decayed devital teeth, the minimally invasive adhesive restorative approach is promising.

SUMMARY:
Adhesion of resin composites into enamel is currently believed to rely on infiltration of bonding resin into the porous zone, establishing micro-mechanical retention to etched enamel. This study investigated the change in chemical composition of the enamel/resin interface using a laser Raman microscopic system (System-2000, Renishaw). Two-step bonding systems, Mac Bond II (Tokuyama Corp), Clearfil Mega Bond and Single Bond (3M/ESPE) were employed. Resin composites were bonded to bovine enamel wi ring) and alkyl group (1450cm-1, C-H) in the enamel/resin bonding area were calculated. From Raman spectroscopy, a gradual decrease in hydroxyapatite was observed, and it was estimated to extend 2.2~2.6 µm for Mac Bond II, 1.2~1.6 µm for Clearfil Mega Bond and 5.2~5.6 µm for Single Bond. Furthermore, the enamel/resin interface represents a gradual transition of bonding agent from the resin to tooth side. Evidence of poor saturation of adhesive resin in etched enamel with Single Bond was detected. From the results of this study, non-uniform resin infiltration into etched enamel was detected and the degree of resin infiltration was found to be different among the bonding systems used

SUMMARY:
Self-etching primers are now considered the new generation of dentin bonding systems that modify and incorporate the bacteria-containing smear layer into their bonding mechanism. The antibacterial effects of the self-etching primers Clearfil SE Bond, Mac Bond, Imperva FL Bond, One-Up BondF and Prompt L-Pop were evaluated using the bacteria Streptococcus mutans ATCC25175, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, Peptostreptococcus asaccharolyticus, Lactobacillus acidophilus, Lactobacillus catenaforme, Lactobacillus jensenii, Actinomyces odontolyticus, Porphyromonas endodontalis, Clostridium ramosum, Prevotella oris, Prevotella denticola and Fusobacterium nucleatum, with a disk diffusion method. A single-bottle total-etch dentin adhesive (Excite) was used for comparisons and chlorhexidine (0.2%) was used as the positive control. After incubation, zones of inhibited bacterial growth were observed. One-Up BondF, Prompt L-Pop and Excite showed growth inhibition for all bacterial strains. The bonding agents of Clearfil SE Bond, Mac Bond and Imperva FL Bond were unable to inhibit the growth of Lactobacillus jensenii and Actinomyces odontolyticus, while the primers of these systems produced inhibition halos to all tested microorganisms greater than that of chlorhexidine.

SUMMARY:
This study evaluated the shear bond strength of repairs made with a composite (Herculite/Kerr) when two different surface treatment methods and two new generation bond materials were used. The bonding surfaces were prepared by sanding with 500-grit aluminum oxide sandpaper or air abrading with 25-micron aluminum oxide. Treated resin surfaces were acid etched, washed for one minute and air dried. Before adding the composite Herculite, either Optibond Solo (Kerr), Solobond M (Voco) bonding agent or no bonding agent (control group) was applied. The specimens were evaluated for shear bond strength after thermocycling. Fracture surfaces of some samples were also evaluated with SEM. Light microscope and SEM examination of fractured repair surfaces indicated mostly cohesive failure within the air-abraded group. The results showed that surface treatment with air abrasion plus Optibond Solo application had the highest shear bond strength.

SUMMARY:
This study verified the polymerization depth of the composite Z100 (3M Dental Products) by Knoop Hardness test using four photoactivation methods. Twenty cylindrical specimens (5 mm in diameter by 5 mm in height) were prepared in a metallic mold and photoactivated by one of the four methods: continuous light (520 mW/cm2 for 40 seconds); stepped light (150 mW/cm2 for 10 seconds followed by 520 mW/cm2 for 30 seconds); intermittent light (cycle of 1 second, 1/2 second with the light on and 1/2 second with the light off for 60 seconds at 520 mW/cm2) and Xenon plasma arc (1370 mW/cm2 for 3 seconds). Knoop hardness measurements were obtained on the surface, at the depths of 1.5 mm, 2.5 mm, 4.0 mm and at the bottom area by the HMV-2000 microhardness, with a load of 50 grams for 30 seconds. Twenty-five indentations were performed in each sample, and a total of five samples were prepared for each photoactivation method. The obtained values were submitted to ANOVA and Tukey’s test at the 5% significance level. The results indicated that (1) for the continuous light method, the values of hardness were statistically superior in the surface area when compared to other areas. For the other methods, there were no statistical differences between the surface area and 1.5 mm; (2) the continuous and stepped light methods showed the highest mean Knoop Hardness Number in all areas; (3) the Xenon plasma arc method was not statistically different from continuous and stepped light ones on the surface at 1.5 mm and 2.5 mm of depth. However, a great decrease in hardness was observed in the deeper areas; (4) the intermittent light method showed intermediate results.

SUMMARY:
The study tests the hypothesis that soft-start irradiation improves, whereas, high intensity irradiation compromises the margin quality and marginal seal of Class V resin based composite [RBC] restorations. Box-shaped Class V cavities were prepared in extracted, human third molars with cervical margins located apical to the CEJ. Cavities were restored using a multi-step bonding agent (Optibond FL, Kerr), a thin layer of flowable resin composite and two increments of fine hybrid resin composite (Filtek Flow/Filtek Z250, 3M ESPE; Revolution f2/Herculite XRV, Kerr). Light irradiation was performed using either the standard (40 seconds) or the soft-start mode (40 seconds with exponential increase) of a quartz tungsten halogen or an LED curing light (Elipar Trilight, Elipar Freelight, 3M ESPE); for high intensity irradiation, a Plasma Arc curing unit was used with three irradiations of three seconds (Apollo 95E, DMDS). After 30 days of water storage and thermal cycling (n=2500, 5-55°C), margin quality was assessed in the SEM using the replica technique and marginal seal was evaluated using dye penetration (AgNO3 50%). Few differences were observed between the light curing protocols. However, less leakage was observed in the case of the lower shrinking RBC Filtek Z250.

SUMMARY:
Capsulation should enable uniform propor- tioning and mixing of dental restoratives so that functional properties of the cementitious mass will not be susceptible to clinically induced variability. Mechanical mixing induces a definite pore distribution determined by the viscosity of the system. This study evaluated the mixing process on the performance of a range of glass ionomer dental restoratives.

Mean compressive fracture strengths and standard deviations and the associated Weibull Moduli (m) were determined for six glass ionomer restoratives that were either encapsulated or mixed by hand. Working characteristics were assessed using an oscillating rheometer. Scanning electron microscopy and image analysis was used to investigate the influence of the mixing method on pore distribution.

The fracture strength data for some encapsulated restoratives resulted in significant differences compared with hand-mixing. Rotomix (compared with the Capmix mechanical agitator) resulted in increased Weibull moduli and 10% failure stress for the two restoratives that were investigated. Encapsulated restoratives that were prepared utilizing Rotomix or Capmix resulted in no significant differences for working characteristics; however, the setting time for the ChemFlex in Caps was extended compared with the hand-mixed ChemFlex.

Not all restoratives had reduced porosity and improved performance following mixing with a Rotomix. This suggested that optimization of the initial viscosity of the system by manipulating the individual proportions of the constituents may not have been appropriate for all the restoratives investigated. The increased viscosity for hand-mixed ChemFlex prepared to a consistency of 3.8 g/ml compared with encapsulated ChemFlex in Caps prepared to a consistency of 3.5 g/ml was responsible for the reduced setting time.

SUMMARY:
It is well documented that glass ionomer cements absorb and release fluoride following single fluoride exposures. This study examined fluoride release among three glass ionomer-based restorative materials following multiple daily exposures to three topical fluoride regimens. Using a Delrin mold, 32 cylindrical specimens, each of a glass ionomer (Ketac-Fil), resin-modified glass ionomer (Photac-Fil) and polyacid-modified resin (Dyract AP) were created. Each specimen was subjected to one of four daily treatments (n=8): (1) no fluoride treatment (control); (2) application of a fluoride dentifrice (1000 ppm) for one minute once daily; (3) application of the same dentifrice for one minute twice daily; (4) the same regimen as (3), plus immersion in a 0.05% sodium fluoride (NaF) mouth rinse (225 ppm) for one minute immediately following the second dentifrice application. Each specimen was suspended in a polyethylene test tube containing 1.0 ml demineralizing solution (pH 4.3) at 37°C for six hours, then transferred to a new test tube containing 1.0 ml remineralizing solution (pH 7.0) at 37°C for 18 hours. Fluoride treatments were completed at the time of transfer daily for seven days. Media solutions were buffered with equal volumes of TISAB II; fluoride levels were measured using a digital ion analyzer and fluoride electrode. Fluoride release decreased significantly from Day 1 to Day 3 for all materials regardless of fluoride treatment (Repeated Measures ANOVA, Tukey HSD, p<0.05). All specimens released significantly more fluoride in demineralizing solution than in remineralizing solution. For Days 2-7, Treatment 4 produced greater fluoride release than both the control and Treatment 2 for all three materials (p<0.05); For each material, the fluoride release produced by Treatments 3 and 4 was statistically similar on most days throughout the study. By Day 7, Photac-Fil demonstrated both the greatest total fluoride release and the greatest rechargability, followed by Ketac-Fil and Dyract AP. Although subsequent daily fluoride release never approached that of Day 1, increasing daily fluoride exposures enhanced fluoride release for all three restorative materials.

SUMMARY:
The durability of a fluoride-free (SE Bond) and a fluoride-containing (KBF) self-etching primer/ adhesive system were compared by measuring the microtensile bond strengths (µTBS) of these adhesive systems to human dentin in vitro. After bonding, the restored teeth were serially sectioned into multiple slabs that were trimmed to a 1 mm2 cross-sectional area at the bonded interface. For the three and six month specimens, half were fully covered with nail varnish (SE+, KBF+), while the other half were incubated at 37°C in water without any protective varnish (SE-, KBF-). The µTBS of the one-day specimens were 44.6 ± 11.2 MPa for SE Bond and 39.8 ± 8.0 MPa for KBF (p>0.05). When unprotected specimens were incubated in water for three and six months, the µTBS fell to 26.3 ± 8.8 MPa and 23.6 ± 10.7 MPa for SE-, respectively, but did not change in the specimens protected with nail varnish (SE+, 41.9 ± 12.8 MPa and 41.8 ± 9.8 MPa, respectively). In contrast, in specimens bonded with a fluoride-containing resin, KBF, the bond strengths of the unprotected specimens did not change over three and six months KBF-. Values were 32.4 ± 6.1 MPa and 36.8 ± 2.3 MPa, respectively. Similarly, varnish-protected KBF+ specimens did not change over three and six months (39.3 ± 13.6 MPa and 40.9 ± 14.7 MPa, respectively). The results indicate that decreases in bond strength over six months’ storage are water-dependent but can be prevented by using fluoride-containing resins.

SUMMARY:
High-strength dental stone is widely used to produce dies for the fabrication of restorations with the lost-wax technique. It is normal to wait at least 24 hours for casts to dry and gain sufficient strength prior to initiating laboratory procedures. This waiting time may be greatly reduced by using microwave drying. This study determined the optimum microwave energy density for preserving working die accuracy of a Type IV high-strength dental stone (Silky Rock; Whipmix). Cylindrical die specimens were fabricated according to manufacturer’s instructions and allowed to set for one hour. The specimens were subsequently treated as follows: Group I (Control group)—air dried; Group II—microwaved at 700W for 40 seconds; Group III—microwaved at 490W for 60 seconds. The percentage weight loss of cylindrical specimens (n=6) and the percentage dimensional change (n=7) of die specimens in three axes (x, y and z) were determined at 30 minutes, 1 hour and 24 hours after air drying/microwaving. Weight loss was measured using an electronic digital balance, while dimensional changes were assessed using image analysis software. Data was subject to ANOVA/Scheffe’s tests at significance level 0.05. No significant difference in percentage weight loss was observed between air drying for 24 hours and microwaved specimens at all time intervals. Although no significant difference in percentage dimensional changes was observed between specimens microwaved at 490W for 60 seconds and specimens air dried for 24 hours, significant changes in x, y and z dimensions were observed after microwaving at 700W for 40 seconds at various time intervals. Microwave radiation at 490W for 60 seconds is recommended for drying Type IV high-strength dental stone. Further investigations are required to determine changes in physical properties associated with the aforementioned microwave power density.

SUMMARY:
This study evaluated the influence of three polymer468mW/cm2 for three or six seconds. One hundred and fifty-two “Vertical Slot type Class II cavities” at the mesial and distal surfaces were prepared and divided into eight groups (n=19). After the restorative procedures, the samples were thermocycled (1,000 cycles at 5°C and 55°C), then immersed in 2% methylene blue dye solution for four hours. The microleakage was evaluated and the results analyzed by the Kruskal–Wallis and Multiple Comparisons tests. Ten samples from each group were randomly selected, embedded in polyester resin, polished and submitted to the Knoop microhardness test. ANOVA (split-plot) and Tukey’s test (p<0.01) revealed significant differences among depths: the hardness at the top surface was significantly higher followed by the middle and bottom surfaces. There was no significant difference in microleakage among the techniques when microhybrid resin composite was employed. However, when using a “packable” resin composite, the conventional technique for polymerization was comparable to Soft-Start and better than PAC.

SUMMARY:
Bonding to tooth tissue can be achieved through an “etch&rinse,” “self-etch” or “glass-ionomer” approach. In this paper, the basic bonding mechanism to enamel and dentin of these three approaches is demonstrated by means of ultra-morphological and chemical characterization of tooth-biomaterial interfacial interactions. Further-more, bond-strength testing and measurement of marginal-sealing effectiveness (the two most commonly employed methodologies to determine “bonding effectiveness” in the laboratory) are evaluated upon their value and relevance in predicting clinical performance. A new dynamic methodology to test biomaterial-tooth bonds in a fatigue mode is introduced with a recently developed micro-rotary fatigue-testing device. Eventually, today’s adhesives will be critically weighted upon their performance in diverse laboratory studies and clinical trials. Special attention has been given to the benefits/drawbacks of an etch&rinse versus a self-etch approach and the long-term performance of these adhesives. Correlating data gathered in the laboratory with clinical results clearly showed that laboratory research CAN predict clinical effectiveness. Although there is a tendency to simplify bonding procedures, the data presented confirm that conventional three-step etch&rinse adhesives still perform most favorably and are most reliable in the long-term. Nevertheless, a self-etch approach may have the best future perspective. Clinically, when adhesives no longer require an “etch&rinse” step, the application time, and probably more importantly, the technique-sensitivity are substantially reduced. Especially “mild,” two-step self-etch adhesives that bond through a combined micromechanical and chemical interaction with tooth tissue closely approach conventional three-step systems in bonding performance.

SUMMARY:
This in vivo study determined the kinetics of 3% hydrogen peroxide in a bleaching gel within the first hour. The material used in this study was 3% hydrogen peroxide gel (Perfecta 3/15, Premier Dental Products Co) and the study involved 10 subjects who met the inclusion and exclusion criteria. Each subject wore the tray with gel six different times on separate days. Evaluation of remaining amount of hydrogen peroxide was calculated by the method stated in US Pharmacopoeia. The study results indicate that the mean percentage of hydrogen peroxide recovered for 5, 10, 20, 30, 45 and 60 minutes was 61, 56, 49, 44, 38 and 32, respectively. The amount of hydrogen peroxide in the saliva sample after one hour was 0.42 mg. Excluding the first 10 minutes, the kinetics of hydrogen peroxide in the tray and teeth sample was exponential.

SUMMARY:
Diverse reports have described how various types of adhesive systems cause disastrous pulp necrosis, chronic severe inflammation or failure to stimulate any pulp reactions. This article reports on the effects of five common adhesive systems and how they compare in terms of pulp injury as measured by odontoblast survival or dentin regeneration and reactionary dentin formation. One hundred and thirty Class V pulp, non-exposed cavities were prepared in non-human primate teeth and were restored with five different adhesive systems. After a period of time between 3 and 172 days, the teeth were extracted, fixed, processed and examined histomorphometrically. Bacterial microleakage was detected with McKays stain and inflammation was categorized according to the International Organization for Standardization (ISO) criteria. The number of odontoblasts and the area of reactionary dentin were measured. Pulp reactions of all adhesive systems were generally minimal, although some systems permitted bacterial microleakage in 33% of restorations, and some other systems were associated with pulp inflammation in 22% of restorations. These observations suggest that adhesive systems provide acceptable biocompatibility, however, there is strong potential for improvement.

SUMMARY:
Various glass ionomer cements (GICs) and resin-modified GICs are widely used as tooth-colored restorative materials. However, their potential effects on pulp tissues are not fully understood. In this study, the authors compared the toxicity of nine types of GICs on cultured human dental pulp cells. Exposure of pulp cells to GICs for five days led to differential growth inhibition as analyzed by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay. Exposure of pulp cells to ProTec CEM, Fuji II LC, Compoglass and GC Lining cement for five days decreased the cell numbers to 11%, 12%, 19% and 25%, respectively, of the control. Exposure of pulp cells to Fuji IX, GIC FX and Fuji II SC also decreased cell numbers by 62%, 33% and 24%, respectively. By contrast, Hy-Bond and Fuji I showed only mild suppression on the growth of pulp cells, with 12% and 16% decreased cell numbers. Morphologically, marked retraction and rounding of pulp cells were noted following exposure to GC Lining cement; in addition, cell surface blebbing was noted following exposure to Compoglass, Fuji II LC and ProTec CEM. Exposure of the pulp cells to Fuji II SC and Fuji IX, however, led to decreases in the cell density, with no obvious morphological changes. These results indicate that resin-modified GICs, such as Compoglass, Fuji II LC, ProTec CEM and GC Lining cements, are more toxic to pulp cells than conventional GICs. It is not recommended that resin-modified GICs be directly applied onto dental pulp cells. However, additional in vivo studies are needed to evaluate the potential toxicities of these resin-modified GICs during clinical operative procedures.

SUMMARY:
This study quantified and compared the thermal emission of different light curing units (LCU). Three LED (Elipar Freelight [3M]; GC e-light [GC]; Coolblu [Dentalsystems.com]) and three halogen (Max [Dentsply-Caulk]; Elipar Trilight [3M]; Astralis 10 [Ivoclar-Vivadent]) lights were selected for the study. Thermal emission of the LCUs, when used in various curing modes, was assessed using a K-type thermocouple and a digital thermometer at distances of 3 mm and 6 mm compared to the conventional halogen LCU (Max). The temperature profiles and mean maximum temperature change (n=7) generated by each LCU were obtained. Data was subjected to ANOVA/Scheffe’s post-hoc test and Independent Samples t-test at significance level 0.05. At 3 mm, temperature rise observed with LED lights ranged from 4.1°C to 12.9°C, while halogen lights ranged from 17.4°C to 46.4°C. At 6 mm, temperature rise ranged from 2.4°C to 7.5°C and 12.7°C to 25.5°C for LED and halogen lights, respectively. Thermal emission of LED lights was significantly lower than halogen lights. Significant differences in temperature rise were observed between different curing modes for the same light and between different LED/halogen lights.

SUMMARY:
This study evaluated the microleakage of a flowable polyacid-modified resin composite used as a fissure sealant on air-abraded teeth in comparison to a resin-based fluoride sealant. Sixty extracted human third molars were divided into six subgroups (n=10) under two main groups (fissure sealant materials). The occlusal surfaces of the teeth were air-abraded at 80 psi using 50 µm particles of aluminum oxide for 30 seconds, followed by rinsing and drying. Delton FS+ (Dentsply International) and Dyract Flow (Dentsply DeTrey) were applied to the teeth in subgroups following application of: a) an acid etching and bonding agent, b) bonding agent alone or c) air-abrasion alone, respectively. Acid etching (Delton EZ Etch, Dentsply International) and bonding agent application (Prime & Bond NT, Dentsply DeTrey) were done according to the manufacturers’ instructions. The teeth were thermocycled for 500 cycles between 5°C and 55°C with dwell time of 15 seconds. Basic fuchsin (0.5%) staining followed by buccolingual sectioning was performed. Microleakage was evaluated at 20x optical magnification. Kruskal–Wallis test was used to make comparisons among six subgroups. Pairwise comparisons were done with the Mann–Whitney U test with the level of significance set as a=0.05.

Dyract Flow application as a fissure sealant on air-abraded permanent teeth in combination with acid etching and/or bonding agent provided microleakage results comparable to Delton FS+. Results also showed that the use of air abrasion, alone, resulted in significantly higher microleakage scores.

SUMMARY:
This study evaluated the physiological remineralization of artificially demineralized dentin beneath glass ionomer cements with and without bacterial contamination. The artificially demineralized dentin was produced on 84mineralized dentin was also analyzed using Electron Probe Microanalysis. For the samples, the mean nanohardness of the three-day samples was significantly lower than the 360-day samples (p<0.05). Although there was no significant difference in the mean nanohardness within all the bacterially-contaminated groups through the experimental periods (p>0.05), the mean nanohardness of the bacterial-contaminated samples were significantly lower than the non-bacteria-contaminated samples (p<0.05). From the EPMA results, fluoride release from both cements to the bottom of the artificially demineralized dentin was detected within three days. Although Ca density was sparse within this demineralized dentin lesion, for the Fuji IX sample, a high Mg density within this lesion was detected at 360 days.

SUMMARY:
This study assessed the in vitro influence of surface sealing on the surface roughness of a posterior resin composite before and after toothbrushing. Thirty specimens (13 mm diameter x 1 mm high) were fabricated from Filtek-P60 resin composite and randomly assigned to three groups (n=10): a non-sealed control and two groups sealed with one of the tested materials—a surface-penetrating sealant (Protect-it!-PI) and a one bottle adhesive system (Single Bond-SB). The samples were subjected to a surface roughness reading to determine the initial roughness, then submitted to simulated toothbrushing with 35,600 cycles for 100 minutes. Specimens were then cleaned and a post-abrasion surface roughness reading accomplished. Means (µm), recorded before (B) and after (A) toothbrushing, and standard deviations were: Control—(B): 0.032 (±0.005), (A): 0.054 (±0.005); PI—(B): 0.034 (±0.005), (A): 0.060 (±0.034); SB (B): 0.031 (±0.004), (A): 0.047 (±0.007). Data were tabulated and submitted to two-way ANOVA. No statistically significant difference was observed when the control and experimental groups were compared. However, a significant difference (p<0.05) was found between the measurements performed before and after toothbrushing. Based on these results, it may be concluded that using either a surface penetrating sealant or a one bottle adhesive system did not provide the optimization of superficial integrity. The use of a dentifrice and toothbrush resulted in significant alterations to the surface smoothness of the resin composite.

SUMMARY:
The difficulty related to achieving a balance between wet and dry dentin makes the dentin bonding technique extremely sensitive. This study evaluated the effect of rewetting dried dentin with two commercial desensitizing agents (Protect and HurriSeal) on the dentin shear bond strength of three total-etch dentin bonding agents (Syntac Single-Component, OptiBond Solo Plus and Prime & Bond NT) and compared both to applying these same bonding agents to moist dentin and dry dentin. Each bonding agent was paired with an appropriate resin composite from the same manufacturer (Table 1). Recently extracted, formalin-treated caries-free human molars were used. The occlusal surface of each tooth was ground to create a flat dentin surface. Then, each tooth was mounted in acrylic. Twelve groups (n=15) were prepared: 1) Syntac Single-Component with Heliomolar resin composite (SSC/H) to moist dentin; 2) SSC/H to dry dentin; 3) SSC/H to dried dentin rewet with Protect; 4) SSC/H to dried dentin rewet with HurriSeal; 5) OptiBond Solo Plus with Point 4 resin composite (OBS+/P4) to moist dentin; 6) OBS+/P4 to dry dentin; 7) OBS+/P4 to dried dentin rewet with Protect; 8) OBS+/P4 to dried dentin rewet with HurriSeal; 9) Prime & Bond NT with TPH Spectrum resin composite (PBNT/TPH) to moist dentin; 10) PBNT/TPH to dry dentin; 11) PBNT/THP to dried dentin rewet with Protect and 12) PBNT/TPH to dried dentin rewet with HurriSeal. Groups 1, 5 and 9 were placed according to manufacturers’ instructions (moist dentin) as control groups. All the other groups received a 15-second air blast after etching and prior to applying the one bottle adhesive or desensitizer and one bottle adhesive. Resin composite cylinders [4 mm in diameter and 2 mm in height] were then placed. The specimens were stored in distilled water at 37°C for 24 hours prior to thermocycling 2,500 times (at 8°C and 48°C). Shear bond strengths (SBSs) were measured one week after fabrication by using a circular knife-edge and crosshead speeds of 0.5 mm/minute. Failure modes of debonded specimens were determined under a stereomicroscope (30x). Failed specimens with the low and high shear bond strengths in each group were evaluated under a low vacuum Scanning Electron Microscope (SEM-LV). One-way ANOVA and Tukey’s tests were used to compare the different conditions for each bonding system. In the Syntac Single-Component bonding agent groups, there was no significant difference in shear bond strength between the control (15.73 MPa), dry (18.11 MPa) and HurriSeal (16.18 MPa) specimens. Protect specimens showed significantly lower shear bond strength (6.39 MPa). In the OptiBond Solo Plus bonding agent groups, there was no significant difference between the control (20.79 MPa) and the HurriSeal (21.29 MPa) groups, and both groups had significantly greater bonds than the dry (14.13MPa) and Protect (9.57 MPa) groups. In the Prime & Bond NT bonding agent groups, the shear bond strength of the HurriSeal group (20.73 MPa) was significantly higher than the other groups: control (8.05 MPa), dry (5.73 MPa) and Protect (5.45 MPa).

SUMMARY:
Polymerization shrinkage causes microleakage of resin composite restorations. New materials and operative techniques should be developed in order to reduce polymerization shrinkage. This research studied the effects of cooled composite inserts and room-temperature composite inserts in the sealing ability of resin composite restorations placed at intraoral temperatures. Forty-eight extracted human molars (providing a total of 155 sections) were kept at intraoral temperatures, and Class V cavities were restored with an ormocer-based resin composite (Admira, Voco). Three restorative techniques were used: conventional bulk insertion (Group I or control group) (n=53 sections), room-temperature resin composite inserts (Group II) (n=52) and cooled resin composite inserts (Group III) (n=50). Microleakage and penetrating microleakage were studied under the microscope. Cooled composite inserts reduce microleakage at the gingival margins with respect to Groups I (p=0.002) and II (p=0.014). When small-size cooled composite inserts were used, the sealing ability at the gingival margins of Class V composite restorations was improved with respect to the bulk insertion technique and the room-temperature composite inserts technique.

SUMMARY:
Although resin composite restorations may undergo relatively extreme temperature changes in the oral cavity, little is known about the effects of temperature on their adhesion to tooth structure. This study evaluated the effect of temperature on shear bond strength to dentin of three commercial resin dentin adhesives through testing of matured specimens over the 20° to 55°C temperature range. A significant difference (p<0.05) was observed between 20°C and 55°C for all the materials, and for one of the materials, a significant difference was also observed between 20°C and 37°C.

SUMMARY:
Predicting the polymerization throughout resin-based composite (RBC) has been reduced to a set of variables involving irradiance of the light source, exposure duration and RBC transmission properties, together with an energy-conversion relationship (ECR) derived from Fourier Transform Infrared Spectroscopic analysis (FTIR) of a single shade of photo-polymerized RBC. The ECR describes the localized energy density required to achieve a desired conversion independent of shade. Using this ECR, conversion was predicted and experimentally verified throughout different opacities of RBC based on knowledge of their transmission properties and the incident radiant energy density (irradiance times exposure time). Also, using RBC transmission properties, a critical scrape-back energy of approximately 32 mJcm-2 was determined from cylindrical samples of photo-polymerized RBC in which the poorly polymerized material was removed. This value correlates to approximately 22% conversion. The critical scrape-back energy was then used to predict scrape-back lengths obtained from samples polymerized at various energy densities. These results confirm the logarithmic relationship between depth of cure and energy of exposure and the reciprocal relationship between irradiance and time of exposure.

SUMMARY:
This in vitro study evaluated the influence of curing tip distance on the Knoop Hardness Number (KHN) of a resin composite when using three different light curing units: (1) a halogen light (XL 1500 curing unit–3M), (2) a “softstart-polymerization” (Elipar Trilight curing in an exponential mode-ESPE) and (3) a PAC (Apolo 95E curing unit-DMD). The resin composite, Filtek Z250 (3M), was cured by these curing units at three light-tip distances from the resin composite: 0 mm, 6 mm and 12 mm. The resin composite specimens were flattened to their middle portion and submitted to 18 KHN measurements per specimen. The results showed that for the Elipar Trilight unit, the hardness of the resin composite decreased as the light tip distance increased. The XL 1500 unit presented a significant decrease in hardness as the depth of cure of the resin composite increased. Apolo 95E caused a decrease in the resin composite hardness values when the depth of cure and light tip distance increased.

SUMMARY:
Improvements in healthcare and health awareness have lengthened life spans and decreased edentulism, while at the same time presenting significant challenges to the dental community in the form of root caries. The incidence of root caries is dramatically high in spite of the vast amount of preventive tools available to patients and dentists (Cochran & Matis, 2000). Relative to coronal caries, root caries is not as easily diagnosed and treated. Diagnosis, access and isolation for restorative material placement can be extremely difficult, especially in the posterior regions of the mouth. When using the traditional Class II approach to restoring proximal root caries, a significant amount of sound tooth structure may have to be removed.

Glass ionomers (glass ionomer cements and resin-modified glass ionomers) are biocompatible restorative materials that chemically bond to tooth structure while serving as rechargeable fluoride delivery devices (Williams, Billington & Pearson, 2002; Creanor & others, 1995; Forsten, 1995). Recent advances in glass ionomer materials have improved not only the physical properties but also their ease of use. This paper presents an expedient clinical application for applying encapsulated glass ionomer cement when restoring proximal root decay in the presence of the contiguous tooth.

SUMMARY:
This study investigated the clinical efficacy of a bonded resin composite restoration with and without cuspal coverage for the treatment of painful, cracked teeth. Patients in a private dental practice who presented with complaints were selected. Inclusion criteria were sensitivity to cold, biting and a clinically-visible crack after removal of the existing restoration. All 40 teeth were restored with a three-step total etch system (Phosphoric acid/Clearfil SA primer/PhotoBond), 20 with cuspal coverage and 20 without. Patients were interviewed at one week, five weeks and six months regarding the presence of pain. In addition, the teeth were clinically examined after six months to reveal any sensitivity. At one week, patients reported that 12 teeth (30%) were free of pain and 28 teeth (70%) still had symptoms. At five weeks, patients reported that 25 teeth (62.5%) were free of pain and 13 teeth (32.5%) still had symptoms. Two teeth (5%) needed endodontic treatment after two and five weeks. At six months, patients reported that 30 teeth (75%) were functioning without any complaints. Upon clinical examination, only 20 teeth (50%) were free of symptoms.

No statistically significant difference between the results of the teeth treated with and without cuspal coverage could be shown (Fischer’s exact test at p<0.05).

SUMMARY:
This clinical study compared the effectiveness of bleaching non-vital teeth with an open pulp chamber during bleaching using 10% carbamide peroxide compared to the modified walking bleach technique and extracoronal bleaching. Sixty discolored, non-vital teeth were treated. They were divided into three groups. Each group was treated with one of the bleaching materials and methods: extracoronally using 10% carbamide peroxide for two weeks as negative control (Group A), intracoronally using sodium perborate mixed with 3% hydrogen peroxide (modified walking bleach technique) (Rotstein, Mor & Friedman, 1993) for four weeks (Group B) and intracoronally and extracoronally using 10% carbamide peroxide for two weeks (Group C) (Liebenberg, 1997). Tooth color was measured at baseline, (BL), immediately post-bleaching (IP) and six months post-bleaching (SP) with a colorimeter (Castor, Sigma, Germany) using a tooth-positioning jig. The color was determined according to the CIELAB system, which records lightness as L* and chromaticity coordinates as a* and b*. The difference in L* and b* among the three groups was significant between BL and IP examination. The post-bleaching, whitening effect in Group C was significantly better, but after six months, in Group C, it was as effective as in Group B.

SUMMARY:
A recent study showed that orange-red fluorescence in carious dentin could be used to detect residual caries (Lennon & others, 2002). This study compared the ability of a new fluorescence-aided caries excavation technique (FACE) with the conventional method. Forty extracted teeth with occlusal dentin caries were selected. The teeth were bisected longitudinally through the center of the lesion. Lesion depth and width were measured and the teeth were divided into two groups of 20, each with the same average lesion size. The tooth halves were reassembled and fixed by embedding the roots in acrylic resin. Access cavities were prepared using a high-speed handpiece and diamond fissure bur. In the FACE group, violet light (370–420 nm) was fed into the fiber optics of a slow-speed handpiece, so that it illuminated the operating field. The cavity was observed through a 530-nm highpass filter and orange-red fluorescing areas were removed. In the conventional group, a sharp probe was used to detect soft dentin, which was removed. One-half of each tooth was stained for bacteria using Ethidium Bromide and examined using Confocal Laser Scanning Microscopy (CLSM). Bacteria were present in significantly (p=0.037) fewer FACE samples (3) compared to conventional samples (9). It can be concluded that the new method is more effective than conventional caries excavation.

SUMMARY:
This study evaluated the dentinal composition and Knoop hardness measurements of the cavity floor following the removal of carious dentin by the Carisolv chemo-mechanical caries removal system, in vitro. The carious dentin of 25 extracted human teeth was removed by using Carisolv for one minute with instruments and excavation that was performed until the gel was clear. Caries removal with a sharp explorer was verified according to the color and hardness of the lesion, then, by means of DIAGNOdent. Atomic analysis of treated cavities was performed by energy dispersive x-ray spectroscopy (SEM-EDX) and the Knoop hardness number (KHN) of the cavity floor was determined. Surface characteristics were observed by the scanning electron microscope (SEM). Adjacent sound dentin was used as a control reference. No significant differences were found between the quantities of calcium content (Ca weight %), phosphorus content (P weight %) and the Ca/P weight ratio of Carisolv cavities with that of the adjacent, sound dentin (p<0.01). KHN of the Carisolv cavity floor was almost similar to that of the adjacent sound dentin. SEM analysis revealed an extremely rough or irregular surface, and there remained a minimal debris-like smear layer; most of the dentinal tubules were opened. The results indicated that Carisolv does not produce any adverse side effects on dentinal compositions of the treated cavities. The possibility of remaining residual softened dentin was also minimal in this study.

SUMMARY:
The application and polymerization of composite or polyacid-modified resin composites in thin layers (increment technique) for filling cavities might partially compensate for the stress associated with polymerization shrinkage. In this study, the effect of this technique on the marginal integrity of Class V polyacid-modified composite restorations was investigated.

In 30 extracted premolars, extended Class V cavities were prepared with the apical margin in root dentin and the coronal margin in enamel. They were then subjected to different treatments (10 teeth in each case): a) placement and polymerization of a thin resin composite layer (Dyract-Dyract PSA) in the coronal part of the cavity (plus one increment for the residual part) (Group 1), b) a thin layer at the apical part of the cavity (plus one increment for the residual part) (Group 2) and c) restoration of the entire cavity with one increment (bulk technique) (Group 3). Following three days’ storage in water, the teeth were subjected to cyclic thermal loading (4°C <-> 55°C, 2,000 cycles).

The percentages of defective bonding detected along the total length of the restoration margin were assessed before and after thermocycling by scanning electron microscopy. Following loading and thermocycling, no significant differences were found at the restoration-enamel interface. Fewer gaps were found at the restoration-dentin interface in Group 1 (18.7 ± 25.7%) and Group 2 (20.5 ± 22.8%) compared to the reference Group 3 (42.2 ± 30.6%) (Mann-Whitney U test: p<0.05).

Moreover, there were no significant differences between the two increment groups (1 and 2). In a significantly larger number of cases, a completely intact dentin restoration margin was detected when a coronal increment (Group 1) (44.4%) was used instead of the bulk technique (Group 3) (13.6%) (Chi square test: p<0.05).

These results indicate that gap formation can be significantly minimized by using an increment technique to restore extended Class V cavities with polyacid-modified composite materials.

SUMMARY:
This study investigated the effectiveness of cure and post-gel shrinkage of three visible light-cured composite resins (In Ten-S [IT], Ivoclar Vivadent; Z100 [ZO], 3M-ESPE; Tetric Ceram [TC], Ivoclar Vivadent) when polymerized with a very high intensity (1296 ± 2 mW/cm2) halogen light (Astralis 10, Ivoclar Vivadent) for 10 seconds. Irradiation with a conventional (494 ± 3 mW/cm2) halogen light (Spectrum, Dentsply) for 40 seconds was used for comparison. The effectiveness of cure was assessed by computing the hardness gradient between the top and bottom surfaces of 2-mm composite specimens after curing. A strain-monitoring device was used to measure the linear polymerization shrinkage associated with the various composites and curing lights. A sample size of five was used for both experiments. Data was analyzed using ANOVA/Scheffe’s post-hoc and Independent Samples t-tests at significance level 0.05. Results showed that the effect of the curing method on the effectiveness of cure and shrinkage was material-dependent. Polymerization of IT and TC with Spectrum for 40 seconds resulted in significantly more effective cure than polymerization with Astralis for 10 seconds. Polymerization of ZO with Spectrum for 40 seconds resulted in significantly more shrinkage than polymerization with Astralis for 10 seconds. In view of the substantial time saving, using high intensity lights may be a viable method to polymerize composites.

SUMMARY:
This in vitro study evaluated the cytotoxic effects of a restorative resin composite applied to an immortalized odontoblast-cell line (MDPC-23). Seventy-two round resin discs (2-mm thick and 4 mm in diameter) were light-cured for 20 or 40 seconds and rinsed, or not, with PBS and culture medium. The resin discs were divided into four experimental groups: Group 1: Z-100/20 seconds; Group 2: Z-100/20 seconds/rinsed; Group 3: Z-100/40 seconds; Group 4: Z-100/40 seconds/rinsed. Circular filter paper was used as a control material (Group 5). The round resin discs and filter papers were placed in the bottom of wells of four 24-well dishes (18 wells for each experimental and control group). MDPC-23 cells (30,000 cells/cm2) were plated in the wells and allowed to incubate for 72 hours. The zone of inhibition around the resin discs was measured under inverted light microscopy; the MTT assay was carried out for mitochondrial respiration and cell morphology was measured under SEM. The scores obtained from inhibition zone and MTT assay were analyzed with the Kruskal-Wallis followed by Dunnett tests. In Groups 1, 2, 3 and 4, the thickness of the inhibition zone was 1,593 ± 12.82 µm, 403 ± 15.49 µm, 1,516 ± 9.81 µm and 313 ± 13.56 µm, respectively. There was statistically significant difference among the experimental and control groups at the 0.05 level of significance. The MTT assay demonstrated that the resin discs of the experimental groups 1, 2, 3 and 4 reduced the cell metabolism by 83%, 40.1%, 75.5% and 24.5%. Only between the Groups 2 and 4 was there no statistically significant difference for mitochondrial respiration. Close to the resin discs, the MDPC-23 cells exhibited rounded shapes, with only a few cellular processes keeping the cells attached to the substrate or, even disruption of plasma membrane. Adjacent to the inhibition zone, the cultured cells exhibited multiple fine cellular processes on the cytoplasmic membrane organized in epithelioid nodules, similar to the morphology observed to the control group. Based on the results, the authors may conclude that the Z-100 resin composite light cured for 20 seconds was more cytopathic to MDPC-23 cells than Z-100 light cured for 40 seconds. The cytotoxic effects of the resin discs decreased after rinsing them with PBS and culture medium. This was confirmed by MTT assay and upon evaluation of the inhibition zone, which was narrower following rinsing of the resin discs.

SUMMARY:
This study compared the effectiveness of cure of two LED (light-emitting diodes) lights (Elipar FreeLight [FL], 3M-ESPE; GC e-Light [EL], GC) to conventional (Max [MX], Dentsply-Caulk [control]), high intensity (Elipar TriLight [TL], 3M-ESPE) and very high intensity (Astralis 10 [AS], Ivoclar Vivadent) halogen lights. The 10 light-curing regimens investigated were: FL1 400 mW/cm2 [40 seconds], FL2 0-400 mW/cm2 [12 seconds] Æ 400 mW/cm2 [28 seconds], EL1 750 mW/cm2 [10 pulses x 2 seconds], EL2 350 mW/cm2 [40 seconds], EL3 600 mW/cm2 [20 seconds], EL4 0-600 mW/cm2 [20 seconds] Æ 600 mW/cm2 [20 seconds], TL1 800 mW/cm2 [40 seconds], TL2 100-800 mW/cm2 [15 seconds] Æ 800 mW/cm2 [25 seconds], AS1 1200 mW/cm2 [10 seconds], MX 400 mW/cm2 [40 seconds].

Effectiveness of cure with the different modes was determined by measuring the top and bottom surface hardness (KHN) of 2-mm thick composite (Z100, [3M-ESPE]) specimens using a digital microhardness tester (n=5, load=500 g; dwell time=15 seconds).

Results were analyzed using one-way ANOVA/Scheffe’s post-hoc test and Independent Samples t-test (p<0.05). At the top surface, the mean KHN observed with LED lights ranged from 55.42 ± 1.47 to 68.54 ± 1.46, while that of halogen lights was 62.64 ± 1.87 to 73.14 ± 0.97. At the bottom surface, the mean KHN observed with LED and halogen lights ranged from 46.90 ± 1.73 to 66.46 ± 1.18 and 62.26 ± 1.93 to 70.50 ± 0.87, respectively. Significant differences in top and bottom KHN values were observed between different curing regimens for the same light, and between LED and halogen lights. Although curing with most modes of EL resulted in significantly lower top and bottom KHN values than the control, no significant difference was observed for the different modes of FL. Hence, the effectiveness of composite cure with LED LCUs is product dependent.

SUMMARY:
This study evaluated the influence of collagen removal and the use of a low-viscosity liner on the marginal quality of composite restorations for the total-etch system, Prime & Bond 2.1 (PB) and the self-etching primer system, Clearfil SE Bond (CSEB), in high C-factor cavities with margins in dentin. High C-factor cavities were made on dentin exposed from ground labial surfaces of 100 bovine lower incisors, randomly assigned to 10 treatment groups and restored with composite Z 250, placed in bulk. In Group 1 (PB), control group, PB was applied according to the manufacturer’s directions; in Group 2 (PB/PLF), an intermediate layer of low-viscosity composite Protect Liner F (PLF) was applied on the bonding resin surface; in Group 3 (PB/SH) following acid-etching, the surfaces were treated with 10% sodium hypochlorite (SH) for one minute and in Group 4 (PB/SH/PLF), the same procedure was conducted as for Group 3, plus an intermediate layer of PLF was applied as for Group 2. In Group 5 (CSEB), the control group, CSEB was applied according to the manufacturer’s directions; in Group 6 (CSEB/PLF), an intermediate layer of PLF was applied; in Group 7 (SH/CSEB), the cavity surface was pre-treated with SH; in Group 8 (SH/CSEB/PLF), SH pre-treatment was conducted as for Group 7, then an intermediate layer of PLF was applied; in Group 9 (CSEB/SH), after CSEB-primer application, the surface was treated with SH, followed by CSEB-adhesive application and in Group 10 (CSEB/SH/PLF), the same was conducted as for Group 9, then an intermediate layer of PLF was applied. The specimens were stored at 37°C for 24 hours, polished, molded and replicas were obtained in epoxy resin. The replicas were gold-sputter coated and observed by SEM (300x) for marginal quality classification. The Kruskal-Wallis non-parametrical multi-comparison Test (p<0.05) was used to obtain statistical analysis of the data. Results demonstrated that both adhesive systems in the control groups presented low marginal quality and a high variability. The use of an intermediate layer of PLF significantly improved the marginal quality with the CSEB system but had no effect with the PB system. Collagen depletion with SH enhanced marginal quality for the PB system and did not influence the CSEB system results.

SUMMARY:
The difficulty with comparing data obtained from different research centers calls for the standardization of laboratory procedures. This in vitro study compared the shear bond strength (SBS) of two adhesive systems—a self-etching system, Etch&Prime 3.0 and a one-bottle total-etch system, Single Bond—using two methods of load application (orthodontic edge wire loop and knife-edge blade). The hypothesis of substrate influence on the results obtained for both tests was also investigated. Twenty-four recently extracted human teeth were embedded in PVC tubes using acrylic resin and divided into two groups (n=12). A proximal surface of each tooth was wet-ground flat to expose dentin. Etch&Prime 3.0 and Single Bond adhesive systems were applied according to the manufacturers’ instructions, and cone-shaped restorations were then built using Z100 resin composite. After storage in distilled water at 37°C for 24 hours, the specimens were submitted to SBS testing using an orthodontic edge wire loop. The same teeth were again embedded in PVC tubes using acrylic resin and the other proximal surface was wet-ground flat to expose dentin. The specimens were prepared as explained above, and after storage in distilled water under the same previous conditions, they were submitted to SBS testing using a knife-edge blade. Two-way ANOVA and Tukey’s tests were performed to determine any statistically significant differences among testing conditions. Results indicated that SBS values obtained for Etch&Prime 3.0 were significantly lower than Single Bond for both methods of load application (p<0.001). Regarding the load application method, statistically significant higher values (p<0.01) were obtained for Etch&Prime 3.0 when the knife-edge blade was used, whereas, no significant difference was observed between the two methods for Single Bond. There was a significant correlation between the bond strength values obtained on the same tooth (p<0.05). SEM examination found that Etch&Prime 3.0 demonstrated narrower tags than Single Bond. Moreover, the peritubular dentin was not adequately decalcified when Etch&Prime 3.0 was used.

SUMMARY:
Many fluoride-releasing dental materials are being sold on the basis of their cariostatic properties. However, the amount fluoride release of these materials is still uncertain. This study investigated the fluoride release and uptake characteristics of four flowable resin composites (Heliomolar Flow, Tetric Flow, Wave, Perma Flo), one flowable compomer (Dyract flow), one conventional glass ionomer cement mixed with two different powder/liquid ratios (ChemFlex Syringeable and ChemFlex Condensable), one packable resin composite (SureFil), one ion-releasing composite (Ariston pHc) and one resin-modified glass ionomer cement (Vitremer). Seven discs (6-mm diameter and 1.5-mm height) were prepared for each material. Each disc was immersed in 3.5 ml of deionized water within a plastic vial and stored at 37°C. The deionized water was changed every 24 hours and the release of fluoride was measured for 30 days. At the end of this period, the samples were recharged with 2 ml of 1.23% acidulated phosphate fluoride (APF) gel for four minutes. Then, all samples were reassessed for an additional 10 days. The fluoride release of all samples was measured with a specific fluoride electrode and an ionanalyzer. Statistical analyses were conducted using two-way repeated measure ANOVA and Duncan’s multiple range tests. For all tested materials, the greatest fluoride release was observed after the first day of the study (p<0.01) but gradually diminished with time. During the test period, Tetric Flow released the lowest amount of fluoride; however, no statistically significant difference was found from Wave and Heliomolar Flow (p>0.05). Ariston pHc released the highest amount of fluoride, followed by ChemFlex Syringeable, Vitremer and ChemFlex Condensable. There were statistically significant differences among these materials (p<0.05). Fluoride release of all materials were significantly increased after the first day following refluoridation and Ariston pHc released the greatest among all materials (p<0.01). At the end of two days of refluoridation, the fluoride release rate for each material dropped quickly and stabilized within three days.

SUMMARY:
This research quantitatively evaluated the marginal adaptation of pit and fissure sealants. The occlusal surfaces of 48 intact, caries-free human molars were cleaned with an air-abrasion unit. The teeth were then randomly divided into eight groups of six teeth each according to the type of enamel conditioning, sealant material applied and curing unit used. After applying either 40% phosphoric acid gel (K-etch, Kuraray Co) or a self-etching primer adhesive system (Clearfil SE Bond, Kuraray Co), sealant materials of two viscosities were applied (Teethmate F-1 and Protect-Liner-F, Kuraray Co) and cured with halogen (Optilux 500, Demetron) or plasma arc (Apollo-95E, Dental & Medical Diagnostic Systems, Ltd) curing units. The marginal adaptation of the pit and fissure sealant restorations was evaluated by using a computer-assisted quantitative margin analysis in a scanning electron microscope (SEM) on epoxy replicas before and after thermal and mechanical stressing of the teeth. The results were statistically analyzed with one-way analysis of variance (ANOVA) at a confidence level of 95% (p=0.05). A post-hoc Tukey HSD-test was used for multiple pairwise comparisons between groups. The null hypothesis was that there was no statistically significant difference between the groups that were tested in this study.

The statistically significant differences between groups were more pronounced after loading. In most cases, the self-etching adhesive system (SE Bond) proved as effective as phosphoric acid etching (K-etch). The low viscosity sealant material (Teethmate F-1), in most cases, exhibited better marginal adaptation than the high viscosity material (Protect-Liner F). The high viscosity material performed equally well only when used in combination with the self-etching primer adhesive system as an intermediate layer. The halogen curing unit (Optilux 500) led to better marginal adaptation than the plasma arc curing unit (Apollo 95E), especially after thermal and mechanical stressing.

SUMMARY:
The authors hypothesize that the arrestment and remineralization of these lesions could be improved if secondary caries could be detected and monitored at earlier stages. Traditional diagnostic techniques detect secondary caries when it is relatively advanced and when significant tissue has been lost. This in vitro study evaluated the Quantitative Light-induced Fluorescence (QLF) system for detecting and monitoring demineralization surrounding tooth-colored restorations. This investigation was divided into three studies. The first study evaluated QLF for the detection and measurement of chemically induced lesions surrounding resin composite restorations. The second study evaluated QLF for the detection of demineralization around different tooth-colored restorations (glass ionomer, resin composite, compomer and smart material) created in a microbial caries model. Finally, the third study tested whether QLF was effective at detecting early wall lesions adjacent to resin composite restorations. Data from Study 1 demonstrated the potential for QLF to detect very early secondary caries and to distinguish between the different stages of early demineralization. Study 2 confirmed the potential for QLF to detect early secondary caries created by cariogenic bacteria and concluded that the four types of materials differed in their ability to prevent secondary caries in this model, with the glass ionomer being the most effective and the non-fluoride releasing composite performing the worst, which allowed for the development of larger lesions. The results of Study 3 suggest a potential application of the QLF system to detect early wall lesions. Data from this investigation strongly suggest that QLF is a potentially viable technology to detect and monitor early secondary caries.

SUMMARY:
This study evaluated the “in vitro” shear bond strength of two materials to bovine enamel when used as porcelain laminate veneer bonding systems. The authors used the dual-cured resin cement Variolink II (Vivadent) and the light-cured flowable composite Natural-Flow (DFL). Porcelain cylinders were bonded to bovine enamel following manufacturers’ directions. After 24 hours of storage in distilled water and thermocycling, the specimens were tested on a universal testing machine to determine the shear bond strengths. Mean strengths found in Groups 1 (resin cement) and 2 (flowable composite) were not statistically different (p≤ 0.05). The authors concluded that the shear bond strength of Natural-Flow is not different from Variolink II and that flowable composites can be a suitable alternative when used as porcelain laminate veneer bonding systems.

SUMMARY:
This in vitro study verifies whether there are differences between bonding to hypermineralized dentin and normal dentin and if longer acid etching can improve the bond strength to this modified substrate without damaging the bond to normal dentin. Forty-two extracted human molars with chronic occlusal caries were transversally cut with a diamond saw under refrigeration. The occlusal surfaces were ground until the carious lesion was removed, exposing the sclerotic dentin in the center and polished to 600/grid. A 35% phosphoric acid (3M) was applied for 15 seconds in 15 specimens. SingleBond (3M) adhesive system was applied and a hybrid resin composite (Filtek Z250, 3M) was inserted in four 1-mm increments and light-cured. The remaining 15 molars were prepared in the same manner, but with an acid etching time of 30 seconds. After 24 hours in water, the specimens were cut in two perpendicular directions to obtain a cross section of approximately 0.7 mm2 (n=25). A visual examination was conducted to select sticks between the two groups: sclerotic dentin (G15S or G30S) and normal dentin (G15N or G30N). Sticks without 100% sclerotic dentin (translucent area) or those with normal areas were not tested. Two-way ANOVA computed the µ-TBS data taking into consideration dentin type and acid etching time. The dentin Knoop hardness number (KHN) of the sticks was verified. A t-test compared the KHN data between sclerotic and normal dentin. Twelve additional molars (n=6) were prepared to observe the interface under a SEM. The mean (±SD) microtensile bond strengths (µ-TBS) were: G15S=56.4(±14.9), G15N=69.7(±17.2), G30S=63.2(±15.6) and G30N=67.7(±13.3). Two-way ANOVA showed higher µ-TBS to normal dentin than sclerotic dentin. Duncan’s Post Hoc showed G15N had higher mean µ-TBS than G15S. Other comparisons were not significantly different. The t-test showed statistically higher microhardness in sclerotic dentin than in normal dentin (p<0.0001). The hybrid layer (HL) formation was observed in all specimens without gap formation in any region. In sclerotic dentin (G15S), the HL was very thin, with minimal resin tags in the dentinal tubules and, when present, they were shorter. Doubling the etching time (G30S) resulted in more resin tags with an HL formation on peritubular dentin. The HL on normal dentin was thicker when it was acid etched for 30 seconds (G30N). Numerous resin tags were present with both etching times. The results suggest that the higher mineral amount in sclerotic dentin makes it difficult to bond to this substrate, resulting in a lower µ-TBS. However, doubling the etching time resulted in µ-TBS similar to normal dentin.

SUMMARY:
This study evaluated the cytotoxicity of four single component dentin bonding agents: Syntac Single Component, Prime & Bond 2.1, Single Bond and One Up Bond F. The test materials were applied on dentin discs of dentin barrier models in the same way as in the clinical procedures recommended by each manufacturer. Cell viability of L 929 after exposure with the bonding agents was determined by MTT assay. The results revealed that cell survival of the first three bonding agents was 60%, while the fourth was an impressive 93%. This study showed that a total-etching bonding system is more cytotoxic than a self-etching bonding system.

SUMMARY:
This study compared the interfacial integrity of Class II ceramic inlay restorations and direct resin composite restorations. The influence of a flowable resin composite liner was also evaluated. Class II DO cavities were prepared in 40 recently extracted mandibular molars and assigned to four treatment groups. Group A: direct composite restoration; Group B: Cerec inlays fabricated and cemented with a resin cement; Group C: adhesive lining with a flowable resin composite used prior to resin composite restoration; Group D: lining with a flowable resin composite prior to cementation of Cerec inlays. After finishing, polishing and thermocycling (4°C and 60°C x 500), the samples were cross-sectioned in a mesio-distal direction along the center of the fillings or inlays. The cross-sectioned surface was polished, and the adhesive interfaces between resin and enamel or dentin were observed under a scanning laser measurement microscope.

Ceramic inlay restorations showed no interfacial gaps in enamel, but direct resin composite restorations showed a significantly higher incidence of gaps at the interface or cracks in the interfacial enamel (p=0.0002). No differences were found in the resin–dentin interfaces for both the inlay and direct resin composite restorations. The use of a flowable resin com-posite as an adhesive liner produced a significantly greater gap-free resin-dentin interface in Cerec inlay and direct resin composite restorations (p=0.0233 & 0.0009), but it did not reduce gap formation at the resin-enamel interface.

SUMMARY:
This in vitro study compared three different methods to evaluate detectable levels of microleakage in Class II restorations placed with five commercially available packable resin composites: Alert, Glacier, Pyramid, Solitaire 2 and SureFil. A flowable resin composite, Flow-It, was used to line all packable composites. The hybrid resin composite Z100 was also included. The adhesive system used with all groups was Scotchbond MultiPurpose Plus. Standard Class II cavities were prepared on the mesial (enamel margins) and distal (dentin margins) sides of the teeth with no communication between them.

Based on a power analysis, 180 permanent human molars were randomly assign to each of six groups with 30 specimens per group. All restorative materials were placed following manufacturers’ recommendations. Following restoration and thermocycling, the specimens were stored at room temperature in solutions of 45Ca, methylene blue and rhodamine B, sequentially. Microleakage was ordinal scored as 1 (no penetration), 2 (penetration up to one-third of the cervical floor), 3 (penetration beyond one-third of the cervical floor to the axial wall) and 4 (penetration along the axial wall) by two independent evaluators. Analysis of the occlusal surfaces was also accomplished following the same scheme.

In this study, tracers/dyes were evaluated for differences in penetration using generalized estimating equation methodology applied to cumulative logistic regression models. The results showed that Rhodamine B detected more microleakage than 45Ca or methylene blue, and 45Ca generally detected more microleakage than methylene blue.

INTRODUCTION:
As a speaker at the February 2003 Academy of Operative Dentistry meeting, I was asked to wrap-up the meeting and try to “Put It All Together.” After considerable thought, I decided to attempt this huge task by telling my story of 30 years in dentistry, particularly regarding posterior direct and indirect restorations. Through personal experience and the refereed literature, I related what I had seen and experienced in the clinical and corporate setting. The following is a condensed, written version of that lecture.