Chronological List of Articles

SUMMARY:
This study evaluated the effectiveness of a plasma arc curing (PAC) unit for packable resin composite curing. The amount and speed of polymerization shrinkage and the microhardness of packable composites were evaluated in order to compare the PAC unit’s effectiveness with a quartz tungsten halogen (QTH) unit. Sure Fil (Dentsply Caulk), Pyramid (BISCO Inc) and Synergy Compact (Colténe/Whaledent) were used as the packable composites. In the case of curing with the PAC unit, the composites were light cured with Apollo 95E (DMD System Inc) for 1 second (Group 1), 2 seconds (Group 2), 3 seconds (Group 3), 6 seconds (Group 4) and 12 seconds (Group 5). For light curing with the QTH unit, the composites were light cured for 60 seconds using XL3000 (Group 6). The linear polymerization shrinkage of each composite was measured using a custom made linometer, and the data was stored in a computer every 0.5 to 0.55 seconds for a total of 60 seconds. For each composite, the amount of polymerization was compared using one-way ANOVA with Tukey at the 95% confidence level. In order to compare the speed of polymerization, the peak time (PT), showing the highest speed of polymerization and maximum speed of polymerization (Smax), were determined from the data and compared using one-way ANOVA with Tukey at the 95% confidence level for each material.

Based on the statistical analysis among the PAC-cure groups (Groups 1 through 5), the group that was not statistically different from the QTH-cure group (Group 6) in the amount of linear polymerization shrinkage was determined for each material, and the corresponding curing time of the group was defined as the tentative minimum PAC-curing time (TMPT).

For microhardness measurements, the samples were placed in a 2-mm thick Teflon plate. Twenty specimens, randomly divided into the PAC-cure group (Group 1) or the QTH-cure group (Group 2), were prepared for each material. In Group 1, each composite was light cured for TMPT with the PAC unit. In Group 2, each composite was light cured for 60 seconds with the QTH unit. Microhardness was measured on the upper and lower surface. For each material, the microhardness of the upper and lower surface of Groups 1 and 2 was analyzed using two-way ANOVA with Tukey at the 95% confidence level.

The amount of polymerization was Group 1<Group 2<Group 3<Group 4<Groups 5, 6 in the Sure Fil composite (p<0.05); Groups 1, 2<Group 3<Groups 4, 6<Group 5 in the Synergy Compact composite (p<0.05) and Group 1 <Group 2 <Group 3 <Groups 4, 6 <Group 5 in the Pyramid composite (p<0.05)

Regarding the speed of polymerization, the order of PT was G1, G2, G3<G4, G5<G6 (p<0.05). The order of Rmax was G6<G1, G2, G3, G4, G5 in Sure Fil; G6<G1<G2, G3, G4<G5 in Synergy Compact (p<0.05) and G6<G1<G2, G3<G4, G5 in Pyramid (p<0.05)

On the upper surface, there was no statistical difference in microhardness between Groups 1 and 2 in all materials. On the lower surface, the microhardness of Group 2 was significantly higher than Group 1 in all materials. In all materials in Group 1 and the Synergy Compact of Group 2, microhardness of the upper surface was significantly higher than the lower surface (p<0.05). In Sure Fil and Pyramid of Group 2, there was no difference in microhardness between the upper and lower surfaces.

SUMMARY:
This study evaluated the effects of immediate and delayed polishing on the surface roughness, microhardness and microleakage of a microfilled (Filtek A110) and a hybrid (Filtek Z250) resin composite. Standardized preparations were made on the buccal surfaces of 256 bovine teeth; half were restored with each composite (128 teeth per composite). Immediately after curing, gross finishing was carried out with #280 sandpaper. The specimens restored with each composite were divided into two subgroups. The first group (IM) was polished immediately after gross finishing, using three different systems (n=16): Sequence A, Sof-Lex; Sequence B, Flexicups and Sequence C, Flexicups + Jiffy Polishing Brush + Flexibuffs. The specimens were then stored for three weeks in saline 37°C. The second group (DE) was stored for two weeks, then polished with the same systems and stored for one additional week. The controls (n=16) were analyzed without polishing. Five readings per specimen were taken for surface roughness and hardness. After immersion in basic fuchsin, microleakage was evaluated (40x) using standardized scores. The data were analyzed at a significance level of 0.05, with analysis of variance and an SNK test (surface roughness and microhardness) or with Kruskal-Wallis (microleakage). In both composites, only for the sequential technique was there an influence of delay in polishing on roughness (Ra). Flexicups exhibited the highest Ra of the three systems. The IM and Filtek Z-250 groups showed higher hardness than the DE and Filtek A-110 groups, respectively. Dentin margins showed more leakage than enamel margins; the sequential technique produced more leakage than the other techniques in dentin (p<0.05) and delay of polishing was not significant in the majority of situations. In conclusion, several conditions—composite, time and polishing technique—had a significant influence on surface roughness, hardness and microleakage. Generally, immediate polishing produced no detrimental effect compared to delayed polishing.

SUMMARY:
This study examined the relationship between delay in composite placement over cured adhesives and the dentin bond strength of several single-application self-etch adhesive systems. The adhesive system/resin composite combinations used were: Adper Prompt L-Pop/Filtek Z250 (AP), AQ Bond Plus/Metafil C (AQ), Fluoro Bond Shake One/Beautifil (FB), G-Bond/Solare (GB), One-Up Bond F Plus/Palfique Estelite (OF), Xeno IICF Bond/Xeno CF (XE). Bovine mandibular incisors were mounted in self-curing resin and wet ground with #600 SiC to expose labial dentin. The adhesives were applied according to each manufacturer’s instructions, and resin pastes were condensed into a mold (ø4x2 mm) immediately, and 1, 2, 5 and 10 minutes after light irradiation of the adhesives. Ten samples per test group were stored in 37°C water for 24 hours, then shear tested at a crosshead speed of 1.0 mm/minute. One-way ANOVA followed by Tukey’s HSD test (a=0.05) was done. SEM observations of the dentin surface after the tests were also conducted. Dentin bond strength ranged from 9.5 ± 2.2 to 14.0 ± 2.4 MPa for AP, 7.3 ± 2.2 to 12.2 ± 3.1 MPa for AQ, 10.0 ± 3.5 to 16.3 ± 2.4 MPa for FB, 11.4 ± 1.5 to 16.3 ± 1.2 MPa for GB, 14.2 ± 3.4 to 15.1 ± 3.0 MPa for OF and 11.5 ± 2.4 to 15.9 ± 2.2 MPa for XE. Except for OF, no significant differences were found among the 2 to 10 minute delayed placement groups for the systems used. Significant lower bond strengths were obtained for the immediate placement groups except for OF. From SEM observations, cohesive failure of the dentin surface was more pronounced with the longer delay in placement. The data suggest that delayed composite placement over the cured adhesives are suggested for optimum dentin bond strength of single-application self-etch adhesive systems.

SUMMARY:
Objective: To evaluate the effect of mechanical loading on the microtensile bond strength (MTBS) of five adhesive systems to dentin. Methods: Flat dentin surfaces from human molars were divided into five groups and bonded with total-etch self-priming adhesives (Single Bond, Prime&Bond NT and Prime&Bond XP), two-step self-etching primer (Clearfil SE Bond) and an all-in-one adhesive (Etch&Prime 3.0), according to the manufacturers’ instructions. Composite build-ups were constructed incrementally with Tetric Ceram. After 24 hours of water storage, half the specimens were load cycled (5000 cycles, 90 N). The teeth were then sectioned into beams of 1.0 mm2 cross-sectional area. Each beam was tested in tension in an Instron machine at 0.5 mm/minute. Data were analyzed by two-way ANOVA and Student Newman Keuls multiple comparisons tests (p<0.05). Results: Clearfil SE Bond and Single Bond attained higher MTBS than the other three adhesives. Prime&Bond NT and Prime&Bond XP performed equally, and Etch&Prime 3.0 resulted in the lowest MTBS. After mechanical loading, MTBS decreased in all groups except Prime&Bond XP. Clearfil SE Bond, Single Bond and Prime&Bond XP obtained higher MTBS than Prime&Bond NT. Specimens bonded with Etch&Prime 3.0 resulted in premature failures and MTBS could not be measured. Clinical Relevance: When using Etch&Prime 3.0, bond structures did not withstand mechanical loading, which may have an influence on the long-term success of restorations. If dentin is acid-etched, alcohol-based adhesive systems showed higher bond strength after mechanical loading.

SUMMARY:
This study examined the extent of cuspal flexure caused by progressively larger cavity preparations, including endodontic access, and progressive simulated occlusal loading with 50N, 100N and 150N.

Ten intact extracted maxillary premolars were embedded in acrylic resin, and a small ball was attached to each cuspal tip as a reference point for intercuspal distance measurements. The teeth were subjected sequentially to the following procedures: conservative MO cavity preparation, extensive MO cavity preparation, endodontic access step and MOD cavity preparation. After each cavity preparation procedure, the specimens were subjected to increasing loads of 50, 100 and 150 N, and the intercuspal distance was recorded by means of a digital caliper. The extension of cavity preparation and the magnitude of occlusal load significantly influenced cuspal deflection. After 50 and 100 N loading, a similar cuspal deflection was exhibited by conservative and extensive MO preparations with or without the endodontic access step. With 150 N loading, the endodontic access step was related to a statistically larger cuspal deflection versus the deflection recorded for conservative and extensive MO preparations. The removal of both marginal ridges in MOD cavity preparation with endodontic access produced a dramatic increase in cuspal deflection for the three loads tested.

SUMMARY:
This study had two aims: determine how well four esthetic restorative materials lent themselves to polishing and compare the results obtained using two different techniques for evaluating surface roughness.

The four materials used were two composites modified by the addition of resin, Dyract AP (Dentsply) and Dyract Flow (Dentsply); one composite designed for posterior restorations, SureFil (Dentsply) and one universal micromatrix composite, Esthet-X (Dentsply). Five test pieces were made with each product by inserting the material into cylindrical molds and polymerizing it layer by layer. A single operator polished the specimens on the same day using the Enhance system (Dentsply) and two aluminum oxide pastes. The surfaces were studied successively by means of two surface analyzers: a high-resolution optical profilometer (Nanosurf 488, SAS Technology) and a mechanical profilometer (Mitutoyo Surftest-SV 402). These measurements gave the mean roughness of the surface (Ra). Ten zones were examined for each specimen, and the specimens were observed under an optical microscope (PMG3 inverted metallographic microscope) at 50x magnification.

The qualitative and quantitative analyses of the results showed good surface states for all materials. However, the composites based on nano- and micro-filler technology gave the smoothest surfaces after polishing. A comparison of the values obtained with each method of observation showed that mechanical profilometry tended to show roughness caused by polishing, while optical profilometry brought out roughness due to the structure of the material itself.

SUMMARY:
Aims
This work studied how prefabricated intraradicular post material affects the mechanical performance of restored teeth. The effect of using two different materials (glass fiber and stainless steel) with significantly different elastic moduli was studied.

Methods
A combined theoretical and experimental method was used: first, an experimental fracture strength test was performed on 60 extracted human maxillary central incisors. The teeth were decoronated, treated endodontically and restored, 30 with glass fiber posts and 30 with stainless steel posts. The data were recorded and the results compared using an ANOVA test.

Then, the finite element technique was used to develop a model of the restored tooth. For both post systems, the model allowed for the study of stress distribution patterns on the restored tooth under external loads.

Results
For teeth restored with stainless steel posts, a significantly lower failure load was found, as compared with those teeth restored with glass fiber posts (520 N versus 803 N). The estimated distributions confirmed a worse mechanical performance on teeth restored using stainless steel posts, with a high stress concentration due to the significant difference between the elastic moduli of the steel and the surrounding materials.

Conclusion
Within the limitations of this study, post systems, where the elastic modulus of the post is similar to that of dentin and core, have a better biomechanical performance.

SUMMARY:
This study assessed the restorative treatment options of the occlusal surfaces of teeth examined with unaided visual assistance, an intraoral camera and an operating microscope. Sixty-eight extracted human molars were mounted to perform mouth models with a premolar in contact on both sides. Four observers examined the models in a phantom head, which simulated clinical conditions, using three techniques: unaided visual examination, intraoral camera and operating microscope. The observers were asked to assess the occlusal surface of each tooth and make a treatment decision based on the following scale: 1) the occlusal surface being sound and “not needing a restoration,” 2) the occlusal surface having a subsurface or enamel lesion. No operative treatment was needed at this visit, but special attention was given to this surface at recall visits: “preventive care-defer treatment” and 3) the surface had a carious lesion and “needed a restoration.” The teeth were then sectioned in the mesio-distal direction and examined under a stereomicroscope with 10x magnification to determine the true extent of caries. Statistical analysis was conducted by calculating percentages and kappa values of the restorative treatment scores based on examinations by four observers. According to all the observers’ treatment decisions, the kappa values were found to be 0.341 (p<0.001), 0.471 (p<0.001) and 0.345 (p<0.001) for unaided visual examination, intraoral camera and operating microscope, respectively. There was a statistically significant difference between the intraoral camera and the other two methods (p<0.05), while there was no significant difference between the unaided visual examination and operating microscope (p>0.05).

As a result of a comparison between the unaided visual examination and operating microscope, the use of an intraoral camera improved the restorative treatment decisions of the occlusal surfaces on posterior teeth.

SUMMARY:
This study evaluated microleakage in vitro of self-etch and multi-step, total-etch adhesive systems. Ninety-six extracted non-carious human molars were randomly assigned to eight groups (n=12) and restored with different adhesive systems: Optibond Solo Plus, iBond, Adper Prompt L-Pop, Xeno III, Simplicity, Nano-Bond, Adper Scotchbond Multi-Purpose and Touch & Bond. Each group was treated following the manufacturer’s instructions. Class V cavities were prepared on the facial or lingual surfaces of each tooth with coronal margins in enamel and apical margins in cementum (dentin). The teeth were restored with Z-100 resin composite. After polishing with Sof-Lex disks, the teeth were thermocycled for 1000 cycles and coated with nail varnish to within 1.0 mm of the restoration. The teeth were stained in 1% methylene blue dye for 24 hours and sectioned from the facial to lingual surface. Dye penetration (microleakage) was examined with a 20x binocular microscope. Enamel and dentin margin leakage was scored on a 0 to 3 ordinal scale. Data were analyzed using Kruskal-Wallis Analysis of Variance and Mann-Whitney U tests. Comparison of the adhesive groups at the enamel margin revealed: 1) Adper Scotchbond Multi-Purpose exhibited significantly less leakage than the other adhesive groups (except iBond); 2) among the self-etch adhesive groups, iBond exhibited significantly less leakage than Nano-Bond and 3) the other adhesive groups clustered intermediately. In contrast, there were no significant differences among the adhesive groups when the dentin margin was evaluated. A Wilcoxin signed rank test showed significantly less leakage at the enamel margins compared to the dentin margins of the eight adhesive systems tested. All data were submitted to statistical analysis at p<0.05 level of significance.

SUMMARY:
This study compared the ability of a variety of light sources and exposure modes to polymerize a dual-cured resin composite through ceramic discs of different thicknesses by depth of cure and Vickers microhardness (VHN). Ceramic specimens (360) (Empress 2 [Ivoclar Vivadent], color 300, diameter 4 mm, height 1 or 2 mm) were prepared and inserted into steel molds according to ISO 4049, after which a dual-cured composite resin luting material (Variolink II [Ivoclar Vivadent]) with and without self-curing catalyst was placed. The light curing units used were either a conventional halogen curing unit (Elipar TriLight [3M/ESPE] for 40 seconds), a high-power halogen curing unit (Astralis 10 [Ivoclar Vivadent] for 20 seconds), a plasma arc curing unit (Aurys [Degré K] for 10 seconds or 20 seconds) or different light emitting diode (LED) curing units (Elipar FreeLight I [3M/ESPE] for 40 seconds, Elipar FreeLight II [3M/ESPE] for 20 seconds, LuxOmax [Akeda] for 40 seconds, e-Light [GC] for 12 seconds or 40 seconds). Depth of cure under the ceramic discs was assessed according to ISO 4049, and VHN at 0.5 and 1.0 mm distance from the ceramic disc bottom was determined (ISO 6507-1). Medians and the 25th and 75th percentiles were determined for each group (n=10), and statistical analysis was performed using the Mann-Whitney-U-test (p≤0.05).

The results showed that increasing ceramic disc thickness had a negative effect on the curing depth and hardness of all light curing units, with hardness decreasing dramatically under the 2-mm thick discs using LuxOmax, e-Light (12 seconds) or Aurys (10 seconds or 20 seconds). The use of a self-curing catalyst is recommended over the light-curable portion only, because it produced an equivalent or greater hardness and depth of cure with all light polymerization modes.

SUMMARY:
This study evaluated the effect of a non-rinse conditioner (NRC) associated with two adhesive systems, Prime & Bond NT and Prime & Bond 2.1. The study also evaluated a self-etching adhesive, comparing it with the 37% phosphoric acid effects related to the regularity and infiltration depth of adhesives in human tooth enamel via observation using Scanning Electronic Microscopy (SEM). Fifteen third molars were longitudinally sectioned into four parts by means of a mesio-distal cut and facio-lingual cut. All pieces were flattened with silicon carbide paper, randomly separated and divided into five groups where the enamel surfaces were treated with different materials according to the manufacturers’ instructions as follows: Group 1–Prime & Bond NT (Dentsply); Group 2–37% phosphoric acid + Prime & Bond NT; Group 3–Non-Rinse Conditioner (Dentsply) + Prime & Bond NT; Group 4–NRC + Prime & Bond 2.1 (Dentsply); Group 5—Prompt L–Pop (3M ESPE). All teeth were covered with Dyract AP (Dentsply). Specimens were decalcified, metalized and the inner portions of Dyract were observed in SEM and evaluated by calibrated examiners to evaluate resin penetration on enamel. Resin penetration was ranked from 0 = no penetration, to 3 = maximum penetration. The Kruskal-Wallis and Mann-Whitney U tests (p<0.05) showed only three statistically homogeneous groups: {1}, {2,3} and {4,5}. The authors concluded that Prime & Bond NT showed the lowest penetration, NRC showed similar effects compared to phosphoric acid when associated with Prime & Bond NT, and concluded that Prompt L-Pop showed similar effects to NRC, which was associated with Prime & Bond 2.1.

SUMMARY:
This Predictor Variables study is designed to determine which one of 11 factors evaluated may be correlated to Non-carious Loss of Cervical Tooth Tissues (NLCTT) using subjects with and without NLCTT. The ultimate objective is to successfully predict the path toward risky behaviors and reduce the incidence of NLCTT.

SUMMARY:
This study evaluated the stress distribution on an endodontically treated maxillary central incisor restored with different post-and-core systems by using a three-dimensional finite element analysis model. Seven three-dimensional finite element models were created. Each model contained cortical bone, cancelous bone, periodontal ligament, 3-mm apical root canal filling, post-and-core and all-ceramic crowns. Two different prefabricated zirconia ceramic post systems, a glass fiber-reinforced post system and a titanium post system were modeled. As a control, an all-ceramic crown on an endodontically treated maxillary central incisor without a post-and-core was modeled. Each model received a 45° oblique occlusal load at a constant intensity of 100 N. In each model, the ratio of Von Mises stress distribution was compared. The greatest stresses were observed in the coronal third of the roots on facial surfaces. The ratio of Von Mises stress distribution in dentin for the zirconia ceramic post (CosmoPost) and ceramic core (Cosmo Ingot), zirconia ceramic post (CosmoPost) and composite core (Tetric Ceram), glass fiber-reinforced post (FRC Postec) and composite core (Tetric Ceram), titanium post (Er post) and composite core (Tetric Ceram), zirconia ceramic post (Cerapost) and ceramic core (Cosmo Ingot), zirconia ceramic post (Cerapost) and composite core (Tetric Ceram) and the control group were 0.886, 0.889, 0.988, 0.924, 0.889, 0.893 and 1, respectively. The stress concentrations in dentin created by two different zirconia ceramic post systems were nearly the same. The zirconia ceramic post systems created slightly less stress concentration in dentin than the glass fiber-reinforced and titanium posts.

SUMMARY:
This study determined the influence of light curing protocols and matrix type on the margin quality and marginal seal of Class II resin-based composite restorations.

In extracted human molars, box-shaped MOD cavities with 1 mm wide interproximal bevels were prepared with cervical margins located at least 1 mm coronal to the cemento-enamel junction. The prepared teeth were mounted in a jig featuring artificial training teeth that served as adjacent teeth. A contoured sectional metal matrix band was placed in one interproximal area, and a section of a contoured transparent matrix band was placed in the opposite interproximal area. Both were kept in position using wooden wedges. After etching (35% H3PO4 gel) and the application of a three-step etch & rinse dentin adhesive (Optibond FL, Kerr), a thin layer of flowable resin-based composite (Revolution, Kerr) was applied to the interproximal margins. The cavities were restored by placing one horizontal and two oblique increments of a fine hybrid resin-based composite (Herculite XRV, Kerr). The curing protocols included one standard halogen protocol (Elipar Trilight, 3M ESPE, 40 seconds @ 800 mW/cm2), 3 halogen soft-start protocols (Step: Elipar HiLight, 3M ESPE; 10 seconds @ 150 mW/cm2, 30 seconds @ 850 mW/cm2; Ramp: Elipar TriLight, 3M ESPE, 5 seconds @ 100 mW/cm2, exponential increase for 10 seconds, 25 seconds @ 800 mW/cm2; Pulse delay: VIP Light, BISCO, cervical increment: 10 seconds @ 500 mW/cm2, occlusal increments: 3 seconds @ 200 mW/cm2, final irradiation after a 5 minute interval: 30 seconds @ mW/cm2) and 2 plasma arc high intensity protocols (PAC: Lightning Cure, ADT, 10 seconds @ 1400 mW/cm2; APO: Apollo 95E, DMDS, 2 x 3 seconds @ 1570 mW/cm2). The restored teeth were stored in 0.9% saline at 37°C for 4 weeks and submitted to thermal cycling [TC] with 2500 cycles between 5°C and 55°C after 2 weeks. The margin quality before and after TC was analyzed in SEM using the replica technique, and the marginal seal was determined using the dye penetration test (50% AgNO3, 2 hours) at the end of the study.

The matrix type did not significantly influence the quality and seal of the respective margins. For the complete restoration margin, one of the high intensity protocols (APO) produced a higher percentage of “continuous margin” compared to pulse delay irradiation after TC and lower percentages of “marginal opening” compared to halogen standard irradiation before and after TC. Halogen step irradiation produced a superior marginal seal compared to pulse delay curing at the occlusal margins; equivalent results were observed for all curing modes at the cervical margins. Neither a general advantage of soft-start irradiation nor a general disadvantage of high intensity curing was confirmed.

SUMMARY:
This research sought to determine the shear bond strength, degree of resin infiltration and failure mode when organic solvent-based adhesives (acetone or ethanol) were used in immediate bonding to enamel bleached with 10% carbamide peroxide or 38% hydrogen peroxide systems. Seventy-two non-carious bovine incisors were randomly assigned to three groups of 24 specimens each—control group (deionized water), 38% hydrogen peroxide bleach group and 10% carbamide peroxide bleach group. Each group was further subdivided into two subgroups of 12 specimens each according to the adhesive system used to bond the resin composite to enamel surfaces. The two adhesive systems used were Single Bond, an ethanol-based adhesive, and One Step, an acetone-based adhesive. The shear bond strengths of 38% hydrogen peroxide and 10% carbamide peroxide were significantly lower compared to the non-bleached controls. Fractography revealed an adhesive failure mode in all specimens. Qualitative comparisons of resin tags present in the bleached and unbleached specimens using scanning electron microscopy (SEM) revealed few, thin and fragmented resin tags when 38% hydrogen peroxide and 10% carbamide peroxide were used.

SUMMARY:
A laboratory study assessed the wear resistance and surface roughness after chemical and mechanical wear of a newly devised adhesive patch when used as a smooth surface sealant.

Forty-eight enamel discs were prepared from bovine lower central incisors. Sixteen specimens were treated with one of two sealing options: the prototype of an adhesive patch or a flowable resin. Unsealed enamel served as the positive control. Wear and surface roughness was measured at baseline and after all the samples were immersed in saliva or lactic acid (n=8 per treatment group) for up to 21 days, during which the experimental and control enamel surfaces were exposed to 10 double-stroke toothbrush cycles per day.

In saliva and lactic acid, the sealed specimens showed no significant wear during the observation period (p=0.1841). Only untreated specimens exposed to lactic acid showed a significant substance loss after 14 and 21 days (p=0.0186). The patch and flowable resin showed no differences in surface roughness values at respective times (p=0.385); whereas the surface roughness of the unsealed specimens in lactic acid was significantly higher (p<0.0001).

It was concluded that the adhesive patch under investigation merits further study to assess its potential as a sealant for smooth enamel surfaces.

SUMMARY:
This study tested the hypothesis that newly triturated amalgam condensed vertically on old amalgam was essential for establishing a bond between the new and old amalgams.

Twelve rectangular bars were prepared with Dispersalloy and Tytin to establish their baseline flexure strength values. An additional 12 specimens were made and separated into 24 equal halves. All fracture surfaces were abraded with a flat end fissure bur. Twelve surfaces were paired with the original amalgam, and the remaining 12 surfaces were repaired with a different amalgam. At first, freshly triturated amalgam was condensed vertically on the floor of the specimen mold (Group A). The majority of specimens repaired with Group A failed to establish bond at the repair interface. All repair surfaces were abraded again and prepared by a second method. A metal spacer was used to create a four-wall cavity to facilitate vertical condensation directly on the repair surface (Group B). The specimens were stored in ambient air for seven days prior to flexure testing.

The strength of specimens repaired with Group B ranged from 26% to 54% of the baseline specimens. ANOVA showed that amalgams repaired with a different amalgam yielded higher strength values than those repaired with the original amalgam, and the baseline specimens exhibited significantly higher strength values than all the repaired specimens.

SUMMARY:
This study evaluated the effect of saliva contamination and decontamination methods on the dentin bond strength of one-step self-etching adhesive systems. Three commercially available “all-in-one” adhesives (One Up Bond F, Xeno III and Adper Prompt) and one resin composite (Filtek Z-250) were used. Third molars stored in distilled water with 0.5% thymol at 4°C were ground with #600 SiC paper under running water to produce a standardized smear layer. The specimens were randomly divided into groups according to contamination methods: no contamination, which was the control (C); contamination of the adhesive surface with fresh saliva before light curing (A) and contamination of the adhesive surface with fresh saliva after light curing (B). Each contamination group was further subdivided into three subgroups according to the decontamination method: A1–Saliva was removed by a gentle air blast and the adhesive was light-cured; A2–Saliva was rinsed for 10 seconds, gently air-dried and the was adhesive light-cured; A3–Saliva was rinsed and dried as in A2, then the adhesive was re-applied to the dentin surface and light-cured; B1–Saliva was removed with a gentle air blast; B2–Saliva was rinsed and dried; B3–Saliva was rinsed, dried and the adhesive was re-applied and light cured. Tygon tubes filled with resin composite were placed on each surface and light cured. All specimens were stored in distilled water at 37°C for 24 hours. Microshear bond strength was measured using a universal testing machine (EZ test), and data were analyzed by one-way ANOVA followed by the Duncan test to make comparisons among the groups (p<0.05). After debonding, five specimens were selected and examined in a scanning electron microscope to evaluate the modes of fracture.

The A2 subgroup resulted in the lowest bond strength. For One Up Bond F and Adper Prompt, there was no significant difference between subgroup A1 and the control, and subgroup A3 and the control (p>0.05). Bond strengths of all B groups were significantly lower compared to the controls (p<0.05). For Xeno III, A1 subgroup showed the greatest decrease in bond strength as compared to the control (p<0.05). On the other hand, it showed more resistance to salivary contamination after adhesive curing. There was no statistically significant difference among the control groups (p>0.05).

SUMMARY:
This study investigated the effect of fluoride containing resin composites and bonding agents, as well as the topical fluoride (F) application on the inhibition of artificial caries progression by using a pH-cycling model with alternating demineralizing (pH:4.5) and remineralizing (pH:7.0) solutions.

Two bonding systems (F-containing bonding system [Reactmer Bond: RB] and non-F containing bonding system [Clearfil SE Bond: SE]), two resin composites, (F-containing [Reactmer Paste: RP] and non-F containing [Clearfil AP-X: AP]) were used. A combination of each bonding agent and a resin composite, RB+RP, RB+AP, SE+RP and SE+AP, was placed in 2 x 3 x 1.5-mm cavities on root dentin of extracted molars (n=96). Specimens were subjected to pH-cycling for 6 or 12 weeks. Half of all specimens were immersed in 0.05% NaF solution for 1 minute once a day as a topical F application. After the pH cycling period, a microradiograph of each specimen was taken, and the outer lesion depth of the artificial caries was measured by means of image analyzing software. The depths of the outer lesions at different periods were analyzed by one-way ANOVA and Sheffe’s test at p=0.05.

The combination that received F treatment showed reduced lesion depth compared to the same combination without F application. Except for the F application group of 12 weeks, there was no significant difference in lesion depth among each bonding and composite combination (p>0.05). At week 12 with the F application, RB+RP showed the shallowest lesion compared to the other combinations (p<0.05).

The results indicated that the F application reduced the progression of artificial caries. Moreover, the combination of fluoride containing bonding agent and restorative material was the most effective for the inhibition of artificial caries progression based on the 12-week experimental period with topical F application.

SUMMARY:
The clinical success of direct composite restorations is the result of the correct use and performance of adhesive systems, resin composites and light curing systems. Total-etch adhesive systems and microhybrid resin composites have seen continuous improvement; various clinical techniques have been introduced to address polymerization shrinkage. Manufacturers have introduced sophisticated light-curing devices with the hope of improving performance. Direct resin bonded composites (RBCs) are becoming the first choice in many clinical situations. This article presents an experimental clinical technique that outlines the reconstruction of severely damaged posterior teeth missing multiple cusps; particular attention to incremental and curing techniques is adopted to complete each restoration.

SUMMARY:
Cavity lining with flowable composites has been suggested for better marginal adaptation and a reduction in interfacial stress and post-operative sensitivity. The following in vitro study compares the spreading of flowable composite that lines the inner wall of a test cavity using an explorer and a specially designed smooth, oscillating, off-center rotating bur spun at 300 to 600 rpm. Two commercial flowable materials were used in this study. Results: With use of the rotating bur, a more consistent, uniform cavity lining was achieved. This was not possible using the dental explorer. Conclusion: The specially designed rotating bur provides an effective way for clinicians to form a uniform cavity lining.

SUMMARY:
In Class II restorations, the restoration of proximal contacts is a challenge with any direct restorative material. The Tofflemire and other circumferential matrices have long been the standard for amalgam restorations, because of ease and speed of application, and because they constrict around gingival margins when tightened, lessening the chance of an overhanging restoration. It has also been long recognized that circumferential matrices produce relatively flat proximal surfaces unless they are contoured prior to placement of the restoration (Yetto, 2003).

Increased usage of resin composites for Class II restorations has increased the difficulty of restoring proximal contacts, because the consistency of the material does not displace a band toward an adjacent tooth as effectively as does amalgam (Brackett & Covey, 2000). Spring-loaded rings with tines that engage the line angles of the teeth and provide proximal separation, in addition to that produced by wedging, have been very effective in compensating for this short-coming of resin composites (Hilton & others, 2001; Yetto, 2003). The only limitation of these separating rings is that, when too little tooth structure remains on the facial or lingual surface for them to engage, these surfaces must be restored before the rings are applied.

Separating rings are usually sold with metal segmental matrices that have the advantage of being pre-contoured. Because these rings are not circumferential, all adaptation along gingival margins must be provided by wedges, and it is difficult to reproduce facial and lingual contours in extensive restorations. While the pre-contoured shape of these matrices produces some rounding of marginal ridges relative to circumferential bands, this shape restricts access for the exact contouring of marginal ridges prior to light curing.

The following case illustrates that circumferential bands can be paired with separating rings in order to realize the advantages of both.

SUMMARY:
Dental amalgam seals itself over time. The reduction of microleakage in amalgam restorations has been explained by corrosion products filling in the interface gap between amalgam and tooth structure in order to seal the restoration interface. This concept has been widely accepted; yet, curiously, there is little research supporting this theory. The creep mechanism may be a plausible alternative to explaining why microleakage is reduced over time in amalgam restorations. Amalgam restorations are confined to the fixed space of the cavity preparation; expansion of the amalgam through internal phase changes in this confined area must be relieved. The resultant creep-expansion of the amalgam restoration fills in the tooth/amalgam interface gap. Once the interfacial gap is filled and amalgam has made intimate contact with the cavity wall, the dental amalgam slides along the tooth preparation plane as predicted by classic metallurgical studies.

The results of the creep of amalgam have been observed clinically as the extrusion of amalgam from the cavity preparation. This explanation for amalgam sealing the tooth/amalgam gap fits many clinical observations and certain research data.

SUMMARY:
This clinical study assessed the postoperative cold sensitivity reported by patients following the Class I and Class II amalgam restoration of primary carious lesions after different cavity treatments. One hundred and twenty patients, each with a previously untreated tooth requiring an amalgam restoration due to the presence of a carious lesion, were included. Sixty teeth had lesions that were radiographically judged to be located in the middle third of dentin, and another 60 were located in the inner third of dentin. Six different cavity treatment regimens were used: Group 1—no treatment; Group 2—calcium hydroxide liner (Life); Group 3—cavity varnish (Copalite); Group 4—resin modified glass ionomer liner (Vitrebond); Group 5—dentin adhesive resin liner (Single Bond); Group 6—chlorhexidine disinfectant (Consepsis). Patients were telephoned on days 2 and 7 postoperatively and asked whether they experienced sensitivity to cold, and if so, its duration and intensity. If sensitivity remained up to day 7, patients were also contacted on days 30 and 90. The Kruskal-Wallis test showed postoperative sensitivity to be significantly different among cavity treatments at days 2, 7 and 30 (p=0.026, 0.044, 0.015, respectively). Lesion depth also affected postoperative sensitivity at day 2, with 27% of teeth with middle-third lesions producing pain, and 58% of those with lesions extending to the inner third producing pain (p=0.000). This difference showed up at 7 and 30 days (p=0.001, 0.015, respectively). Of the 51 teeth with sensitivity at day 2, 17 had mild pain, 26 were moderately painful and 8 had severe pain; each category reduced in degree of sensitivity and number with time. It would seem that medium-term (beyond 30 days) postoperative sensitivity is affected neither by the method of cavity treatment nor the depth of lesion, although, in the shorter term, these factors do influence the postoperative sensitivity reported.

SUMMARY:
Purpose: The study tested the hypothesis that the application of a rubber dam influences the reconstruction of proximal contact strengths, while the corresponding contra-lateral teeth are not affected.

Methods: Seventy-four systemically and periodontally healthy subjects in need of a direct posterior composite restoration were treated with the use of a rubber dam. The proximal contact strengths (PCS) were electronically evaluated by measuring frictional forces during removal of a 50.0 ± 5.0 µm-thick straight metal band.

Results: Proximal contact strengths significantly increased from 2.26 ± 1.45N before to 3.83 ± 2.34N after application of the rubber dam; whereas, the variation of PCS at the corresponding contacts in the contra-lateral quadrant remained within the intra-examiner variance of ± 0.2N. Upon removal of the rubber dam, there was a statistically significantly drop in PCS from 3.54 ± 1.87N to 2.31 ± 1.35N. Again, there was only minimal change in the contra-lateral quadrant. It was concluded that application of the rubber dam affects prox-imal contact strengths.

SUMMARY:
This study assessed the effect of rubber dam placement on arterial blood oxygen saturation in dental patients; it also determined whether the effects are technique sensitive. The study group consisted of 28 ASA Class I patients who were randomly allocated to one of two groups: Group A—rubber dam isolation of the maxilla (from tooth #14 to #6) and Group B—rubber dam isolation of the mandible (from tooth #19 to #27). A pulse oximeter was used to detect arterial blood oxygen saturation in both groups. Each patient’s oxygen saturation (Sp02) was recorded every 30 seconds for two minutes to establish a baseline. Group A subjects received local infiltration in the vestibule above tooth #14, while Group B subjects received an inferior alveolar nerve block using 1.8 ml of 2% Lidocaine with 1:100,000 epiphrine, respectively. During the subsequent five minutes, the patient’s Sp02 was recorded every 30 seconds. A rubber dam was then placed, which extended to the anterior septal angle (which completely covers the nose). This rubber dam remained in place for 20 minutes, with the patient’s Sp02 being recorded every 30 seconds. The rubber dam was then altered (cut) to expose the nasal passages, creating what is known as proper rubber dam isolation, and the Sp02 was recorded every 30 seconds for 20 minutes. In both groups, there was no significant change in arterial oxygen saturation before or after rubber dam isolation was performed. Also, there was no significant difference in Sp02 when comparing the rubber dam isolation technique. Although rubber dam placement has no effect on blood oxygen levels in healthy patients, its effects on unhealthy patients are unknown.

SUMMARY:
This study investigated the effect of two base materials with different elastic moduli (F2000 and Vitrebond) on the fracture load of machinable ceramic inlays. Standardized MOD cavities were prepared in 18 human maxillary first or second premolars. The teeth were randomly assigned to three groups of six premolars each; Group 1 (control: no base); Group 2 (base with a polyacid-modified resin composite: F2000); Group 3 (base with a resin-modified glass-ionomer cement: Vitrebond). The inlays were fabricated from Vitablocs Mark II using a Cerec II machine. After the inlays were cemented with Tetric Ceram and the Syntac adhesive system, using the Ultrasonic Insertion Technique (USI), they were stored in distilled water at 37°C for 24 hours prior to fracture testing in a universal testing machine using a crosshead speed of 0.5 mm/minute. The static transverse elastic moduli of base materials were measured using a three-point bending test. The mean fracture loads and standard deviations of the Cerec inlays in Groups 1, 2 and 3 were 1.15 ± 0.39 KN, 1.13 ± 0.36 KN and 0.58 ± 0.11 KN, respectively. Statistical analysis showed that the mean fracture load of Group 3 was significantly lower than that of Groups 1 and 2 (p<.05). There was no significant difference in fracture load between Groups 1 and 2. The means and standard deviations of the elastic moduli of F2000 and Vitrebond were 15.63 ± 0.32 and 2.16 ± 0.55 GPa, respectively. The results indicated that the fracture load increased significantly as the elastic modulus of a base material increased.

SUMMARY:
This study evaluated the effect of cutting teeth with different types of burs at various speeds on shear bond strength using Prime and Bond NT (Dentsply/DeTrey). A simulated pulpal pressure of 25-mmHg, equivalent to 34 cmH2O, was created in a false pulpal chamber filled with distilled water and maintained for seven days. The human teeth were divided into six groups of 10 teeth each: fine grit straight fissure diamond bur in air rotor (DA), fine grit straight fissure diamond bur in micromotor (DM), crosscut fissure carbide bur in air rotor (CCA), crosscut fissure carbide bur in micromotor (CCM), plain fissure carbide bur in micromotor (CM) and #600-grit silicon carbide paper (SiC). The tooth surfaces in these groups were cut under copious air-water spray and treated with Prime and Bond NT after etching with 38% phosphoric acid. Composite restorations were then prepared with TPH spectrum (Dentsply/ DeTrey). After soaking in water at 37°C for 24 hours, the specimens were loaded at a 45° angle to their longitudinal axes by using a Z 010 Universal Testing Machine (Zwick), and shear bond strengths were determined at a crosshead speed of 2 mm/minute. All of the specimens were then observed under Stereomicroscope at 10x. Statistical analysis was made using one-way and two-way ANOVA and t-test (p<0.05). The bond strengths achieved with a fine grit straight fissure diamond bur, a crosscut fissure carbide bur in air rotor and a crosscut fissure carbide bur in micromotor, were significantly higher than a fine grit straight fissure diamond bur, a plain fissure carbide bur and #600-grit silicon carbide abrasive paper in the micromotor. Therefore, selecting an appropriate bur and its speed may improve bonding for adhesive systems, although crosscut fissure carbide burs produced high bond strengths at either speed used.

SUMMARY:
This study measured the elution of TEGDMA and BisGMA monomers from hybrid, micro-filled resin composites over 72 hours at different time intervals after polymerization with standard quartz-tungsten-halogen (QTH), high-intensity fast-curing QTH and standard blue light emitting diode (LED) light units. Samples were polymerized from the top and bottom surfaces, then immersed in methanol. High performance liquid chromatography (HPLC) was used to measure the amount of monomers released from the samples at various time intervals, ranging from 0 to 72 hours (0, 3, 6, 9, 12, 24, 48 and 72 hours). Data was analyzed using two-way ANOVA and Duncan tests with a significance level of 0.05. No significant differences were observed among curing groups in the elution of TEGDMA monomers at 0, 9, 12, 24, 48 and 72 hours; whereas, significant differences were observed among curing groups at 3 and 6 hours. BisGMA elution in samples immersed for longer periods (9-72 hours) were significantly higher than samples immersed for shorter time periods (0-6 hours); however, 72 hours appeared to be too short a period for the total elution of BisGMA into methanol.Under the conditions of this study, when compared to standard QTH, both standard LED and high-intensity QTH light curing resulted in lower levels of the elution of TEGDMA, which is suspected to be the prime cause of cytotoxic reactions in resin composite restorations.

SUMMARY:
This in vitro study evaluated the fracture resistance of teeth restored with different designs of partial ceramic restorations using two diameters of steel ball to apply fracture stresses. One hundred and twenty sound maxillary premolars were randomly divided into three groups of 40 elements; each group was submitted to one of three indirect restoration designs: inlay, onlay with only lingual cuspal coverage and onlay with buccal and palatal cuspal coverage. Another 20 intact teeth were randomly assigned as control groups. The restorations were produced with Super Porcelain EX-3 and Vitadur Alpha ceramics and luted according to manufacturers’ instructions. The specimens were subjected to compressive axial loading in a universal testing machine at 0.5 mm/minute using two steel balls (3 and 10 mm in diameter), evaluating a total of 14 groups with 10 specimens each. Peak load to fracture was measured for each specimen. The results were submitted to analysis of variance and Tukey’s test. Statistical analysis revealed that the inlays showed a significantly higher fracture resistance than both onlay designs, but with fracture resistance lower than that of intact teeth. Onlay fracture strength was equivalent for both designs. The force required to cause fracture with the 10-mm diameter ball was greater than with the 3-mm diameter ball. There were no differences between the tested ceramics.

SUMMARY:
This study evaluated the effect of Er:YAG laser irradiation of enamel and dentin on the shear bond strength of resin-modified glass ionomer cements (RMGIC). Twenty molars were selected and the roots removed. The crowns were bisected, embedded in polyester resin and ground to plane the enamel or expose the dentin. The bonding site was delimited, and samples were randomly assigned according to the cavity preparation device: I- Er:YAG laser (350mJ/2Hz); II—Carbide bur (control group). They were subdivided according to the restorative material employed: A) Fuji II LC (GC); B) Vitremer (3M). Samples were then fixed to a metallic device where ionomer cylinders were prepared. Sequentially, the molars were stored for 24 hours and subjected to a shear bond strength test (50Kgf at 0.5 mm/minute). Means in MPa were: Enamel—IA) 4.77(± 1.12); IB) 4.36(± 1.50); IIA) 7.70(± 1.53); IIB) 7.34(± 1.52) and Dentin—IA) 3.13(± 1.15); IB) 2.67(± 0.74); IIA) 6.38(± 1.44); IIB) 5.58(±2.09). Data were submitted to statistical analysis by ANOVA. Adhesion for enamel was more efficient than for dentin (p<0.01). The cavities prepared with a conventional bur (control group) presented higher bond strength values than those recorded for Er:YAG laser (p<0.01). No significant differences were observed between the restorative materials. Based on these results, it was concluded that Er:YAG laser adversely affected the shear bond strength of RMGIC for both enamel and dentin.

SUMMARY:
This study analyzed the degree of conversion, temperature increase and polymerization shrinkage of two hybrid composite materials polymerized with a halogen lamp using three illumination modes and a photopolymerization device based on blue light emitting diodes. The degree of conversion of Tetric Ceram (TC) (Ivoclar Vivadent) and Filtek Z 250 (F) (3M/ESPE) was measured by Fourier transformation infrared spectroscopy at the surface and 2-mm depth; temperature rise was measured by digital multimeter, and linear polymerization shrinkage was measured during cure by digital laser interferometry. Composite samples were illuminated by quartz-tungsten-halogen curing unit (QTH) (Astralis 7, Ivoclar Vivadent) under the following modes: “high power” (HH) 40 seconds at 750 mW/cm2, “low power” (HL) 40 seconds at 400 mW/cm2 and “pulse/soft-start” (HP) increasing from 150 to 400 mW/cm2 during 15 seconds followed by 25 seconds pulsating between 400 and 750 mW/cm2 in 2-second intervals and by light emitting diodes (LED) (Lux-o-Max, Akeda Dental) with emitted intensity 10 seconds at 50 mW/cm2 and 30 seconds at 150 mW/cm2. A significantly higher temperature increase was obtained for both materials using the HH curing mode of halogen light compared to the HP and HL modes and the LED curing unit after 40 seconds. Significantly lower temperature values after 10-second illumination were obtained when LED was used compared to all halogen modes. For all curing modes, there was no significant difference in temperature rise between 20 and 40 seconds of illumination. Results for the degree of conversion measurements show that there is a significant difference in the case of illumination of resin composite samples with LED at the surface and 2 mm depth. For polymerization shrinkage, lower values after 40 seconds were obtained using LED compared to QTH.

SUMMARY:
This study evaluated the microleakage of a giomer resin bonded with total-etch and self-etch adhesive systems after exposure to hydrogen peroxide. Thirty freshly extracted, caries-free human premolars and molars were used. The teeth were randomly divided into two groups: Group I was exposed to 33% hydrogen peroxide (Niveous-Shofu) for 30 minutes daily for five consecutive days; Group II received no treatment (control). A week later, Class V standardized preparations were performed on the facial and lingual surfaces, with the gingival margin placed 1 mm below the CEJ. Each group was then divided into two subgroups: in Groups IA and IIA, a self-etching adhesive system (FL Bond–Shofu) was applied, and in Groups IB and IIB, a total-etch adhesive system (Prime & Bond NT–Dentsply/Caulk) was applied according to manufacturers’ instructions. The teeth were restored using 2-mm increments of Beautifil A2 resin-based giomer material (Shofu). Each layer was cured using a Spectrum 800 curing light (Dentsply/Caulk) for 20 seconds at 600mW/cm2. The teeth were thermocycled 500x between 5°C and 55°C with a dwell of 30 seconds; they were then placed in a 0.5% methylene blue dye solution for 24 hours at 37°C. Samples were sectioned longitudinally and evaluated for microleakage at the occlusal and gingival margin under a stereomicroscope at 20x magnification. Dye penetration was scored using the following scoring system 0 = no penetration; 1 = partial dye penetration along the occlusal or gingival wall; 2 = partial dye penetration along the occlusal or gingival wall but did not include the axial wall; 3 = dye penetration to and along the axial wall. A Mann-Whitney test revealed a statistically significant difference between subgroups at the occlusal level (p<0.0001). Group IA yielded the most microleakage. No statistically significant difference was reported at the gingival level.

Microleakage was affected by hydrogen per-oxide exposure only at the enamel cavosurface margin when a self-etching primer adhesive system was used.

SUMMARY:
This study examined the effect of air-drying time of adhesives on the dentin bond strength of several single-application self-etch adhesive systems. The adhesive/resin composite combinations used were: Adper Prompt L-Pop/Filtek Z250 (AP), Clearfil Tri-S Bond/Clearfil AP-X (CT), Fluoro Bond Shake One/Beautifil (FB), G-Bond/Gradia Direct (GB) and One-Up Bond F Plus/Palfique Estelite (OF). Bovine mandibular incisors were mounted in self-curing resin and wet ground with #600 SiC to expose labial dentin. Adhesives were applied according to each manufacturer’s instructions followed by air-drying time for 0 (without air-drying), 5 and 10 seconds. After light irradiation of the adhesives, the resin composites were condensed into a mold (ø4x2 mm) and polymerized. Ten samples per test group were stored in 37°C distilled water for 24 hours; they were then shear tested at a crosshead speed of 1.0 mm/minute. One-way ANOVA followed by Tukey’s HSD tests (a=0.05) were done. FE-SEM observations of the resin/dentin interface were also conducted. Dentin bond strength varied with the different air drying times and ranged from 5.8 ± 2.4 to 13.9 ± 2.8 MPa for AP, 4.9 ± 1.5 to 17.1 ± 2.3 MPa for CT, 7.9 ± 2.8 to 13.8 ± 2.4 MPa for FB, 3.7 ± 1.4 to 13.4 ± 1.2 MPa for GB and 4.6 ± 2.1 to 13.7 ± 2.6 MPa for OF. With longer air drying of adhesives, no significant changes in bond strengths were found for the systems used except for OF. Significantly lower bond strengths were obtained for the 10-second air-drying group for OF. From FE-SEM observations, gaps between the cured adhesive and resin composites were observed for the specimens without the air drying of adhesives except for OF. The data suggests that, with four of the single-application self-etch adhesive systems, air drying is essential to obtain adequate dentin bond strengths, but increased drying time does not significantly influence bond strength. For the other system studied, the bond strength of the non-air dried group was not significantly different from the five second drying time, but prolonged drying was very detrimental to bond strength. For all five of the systems studied, a five-second air-drying time appeared to be appropriate.

SUMMARY:
This study evaluated the influence of different thermal (TC) and mechanical (MC) cycling protocols on microtensile bond strength (µTBS) to cervical dentin margins of Class II restorations using two total-etch (TE) adhesives and one self-etching (SE) primer. Class II slot cavities were prepared on the mesial surfaces of 168 bovine incisors and were divided into three groups according to the bonding system used: Single Bond, OptiBond Solo Plus and Clearfil SE Bond. All cavities were restored with Filtek Z250 composite. Following restorative procedures, the restored teeth were allocated to seven subgroups (n=8) according to the thermal/mechanical pro-tocol performed: G1-control (no cycling), G2-100,000 MC, G3-200,000 MC, G4-500,000 MC, G5-100,000 MC+1,000 TC, G6-200,000 MC+1,000 TC, G7-500,000 MC+1,000 TC. TC was performed using 5 ± 2°C and 55 ± 2°C baths, with a dwell time of 60 seconds in each bath. MC was achieved with an axial force of 80 N at 2 cycles/second. The restorations were sectioned perpendicular to the cervical bonded interface into two 0.8-1-mm thick slabs. The slabs were trimmed at the interface to obtain a cross-sectional surface area of 0.8-1 mm2. All specimens were then subjected to µTBS (v=0.5 mm/minute). Fracture mode analysis was performed using SEM. Bond strength mean values (MPa) were analyzed with ANOVA 3-way and Tukey’s test (a=5%). Dunnett’s test was used to compare tested groups against Control groups of each adhesive system (a=5%). SE primer presented lower mean bond strength values when compared to TE adhesives (p=0.05). In addition, specimens restored with the SE primer did not resist to the 200,000 and 500,000 MC associated with TC. The application of 100,000 MC did not present a significant decrease in bond strength when compared to the control. Mixed failures were predominant for all groups. The higher the amount of thermal/mechanical cycles, the greater the number of mixed failures and the lower the percentage of adhesive failures.

SUMMARY:
Objective: This study evaluated the shear bond strength of two resin composite luting cements to zirconium oxide ceramic substrate using two air-particle abrasion methods. Methods: Two resin composite cements, RelyX Unicem (3M ESPE) and Panavia F (Kuraray), each with an acidic composition, were used in combination with a zirconium oxide (DCS Dental AG) substrate containing Al2O3 and SiO2 (Rocatec system, 3M ESPE) and two air-particle abrasion methods. The shear bond strength of the resin composite cement to the substrate was tested after the samples were either water-stored for one week or thermocycled following 24 hours of water storage. Results: The RelyX Unicem resin composite cement specimens with the Rocatec treatment (20.9±4.6 Mpa and 20.1±4.2 MPa, respectively, n=12) demonstrated the highest shear bond strength. Alternatively, the lowest values were obtained for the Panavia F resin cement samples, with Al2O3 air-particle abrasion in both storage conditions, water storage for one week (17.7±8.9MPa) or thermocycling after 24 hours of water storage (16.3±4.9 MPa). Neither storage condition or particle abrasion system significantly affected shear bond strengths (ANOVA, p>0.05). Conclusion: It was concluded that two different surface conditioning methods and storage conditions did not significantly affect the bonding properties of Panavia F and RelyX Unicem resin composite luting cements to Zirconia.

SUMMARY:
SmartPrep is a rotating instrument for dentin caries excavation made from a special polymer. The manufacturer’s product information stated that SmartPrep removes carious dentin selectively. This in vitro study compared the efficiency of SmartPrep with conventional tungsten carbide bud burs. Fifty extracted teeth were split in the center of a carious lesion. The 100 specimens were randomly divided into five groups. Five dentists were asked to excavate 10 teeth each: one half with SmartPrep and the corresponding half with conventional bud burs. The time needed for the caries excavation was measured. Subsequently, histological specimens were produced from all cavities and analyzed by light-microscope after Mallory-Azan-staining. The thickness of the remaining caries was measured (<1 mm or >1 mm). The time expended was analyzed using the paired t-test. The results were analyzed for the remaining caries and thickness of the carious layer for every tooth, using the non-parametric Wilcoxon test for combined random samples. A binary logistical regression was performed to determine the influence of the three variables (tooth, sections or bur) on the criteria “caries” or “carious layer thickness (>1 mm).” The average time to excavate a cavity with SmartPrep was 208.1 seconds, and it was 228.32 seconds with conventional bud burs. The difference between the recorded times was not statistically significant (p>0.05). In 37 of 50 teeth, the number of carious sections was higher in the SmartPrep group than in the bud bur group. In nine teeth, the quantity of carious sections was higher in the bud bur group than in the SmartPrep group. Four teeth showed no difference in the number of carious sections. The results were statistically significantly different (p<0.001). In 30 teeth, the number of carious sections with a carious layer thicker than 1 mm was higher in the SmartPrep group compared with the bud bur group. In nine teeth, the number of carious sections was higher in the bud bur group than in the SmartPrep group. Eleven teeth showed no difference in thickness of the carious dentin layer. These results were statistically significantly different (p=0.003). Binary logistical regression showed that only the variable “bur” (bud bur or SmartPrep) influenced the results concerning the criterion “caries” (p<0.001).

SUMMARY:
This study compared the temperature increase in a pulp chamber as a result of using various light-curing units during resin composite polymerization, and it determined the effect of remaining dentin thickness on temperature rise. A Class II occlusodistal cavity with a remaining dentin thickness of 2 mm was prepared in an extracted human mandibular molar. A 2-mm layer of fine hybrid resin composite was placed on the floor of the proximal box. A K-type thermocouple was inserted into pulp chambers filled with heat sink compound, and pulp chamber temperature rise (starting temperature: 37.0 ± 0.1°C) during polymerization of the composite was measured. The light-curing units tested included two halogen lights, Spectrum 800 and Elipar Trilight (Standard and Exponential mode); a light-emitting diode (LED, Elipar Freelight) and a plasma arc (Virtuoso, Xenon Power Arc). Irradiation time was 40 seconds for the halogen and LED lights and 3 seconds for the plasma arc light. Five measurements were carried out for every light-curing unit. The same experimental design was conducted after the cavity preparation was modified, leaving a 1-mm thick dentin layer. The Kruskal-Wallis and multiple comparison tests were used to evaluate the differences among the tested curing units. Mann Whitney-U tests were used to compare the mean temperature rise in each curing unit for different remaining dentin thicknesses.

The increase in pulp chamber temperature ranged between 1.40-3.8°C. The highest temperature rise was observed when using Elipar Trilight Standard mode, and the lowest temperature rise was observed with light emitting diode for both remaining dentin thicknesses. The only significant differences in temperature rise were observed between Elipar Trilight Standard mode and LED. No significant difference (p>0.01) existed for the different modes of Elipar Trilight.

A statistically significant higher temperature rise was observed within each curing unit at a depth of 1 mm compared to 2 mm. Although the tested light-curing units caused a temperature rise in the pulp chamber, none exceed the critical value of 5.5°C.

SUMMARY:
Amelogenesis imperfecta is a hereditary condition that affects tooth enamel without systemic involvement. In the most severely affected patients, teeth can present alterations in enamel thickness, color and shape, all which compromise aesthetic appearance and mastigatory function. Several treatment options have been described to rehabilitate these patients, ranging from preventive intervention to a prosthodontic approach. Advances in the search for new techniques and bonding materials have provided less invasive treatment options. This study discusses the importance of preventive procedures and describes the clinical procedures of aesthetic and functional rehabilitation of a Brazilian adolescent with autosomal dominant amelogenesis imperfecta (ADAI) involving the use of direct and indirect resin composite restorations.

SUMMARY:
The fracture of core buildup material is common in dental practice. This article describes a core buildup repair technique utilizing a custom matrix. This technique enables the dentist to reestablish the original contour and alignment of the broken core buildup and assures excellent crown fit in a short amount of time with a predictably successful outcome.

SUMMARY:
This article describes an expedited, atraumatic technique of restoring cervical abrasion-erosion, abfraction or carious lesions using an alternative placement sequence of the dental rubber dam for adequate field isolation. As shown by this technique, the rubber dam retainer is modified and positioned on the tooth with subsequent placement of the dental dam material over the retainer and tooth. This technique saves time and provides good retraction of the gingival tissue and isolation of the cavity preparation from contamination (saliva, hemorrhage) that can potentially cause post-operative symptoms and possible restoration replacement.

SUMMARY:
In this clinical study, DIAGNOdent (KaVo) was used to assess previously diagnosed carious lesions in the pits and fissures of first and second molars. The measurements from this device were correlated with the depth and volume of the cavity preparations that resulted from minimal intervention to remove occlusal carious lesions. Twenty-five patients, 18 years of age and older, who were previously scheduled for an occlusal restoration due to caries, were recruited and enrolled in this clinical study. These patients had 48 qualifying teeth without previous restorations, sealants or other carious lesions. The occlusal surface of each study tooth was cleaned utilizing ProphyFlex2 (KaVo). Two dentists separately traced the pit and fissure system of each tooth using DIAGNOdent for two 15-second periods each. The peak reading of each of the four measurements was recorded. An impression of the occlusal surface of each tooth was recorded with a polyvinyl siloxane bite registration material. The carious lesions were removed with an air abrasion unit employing a 0.015-inch nozzle opening utilizing minimal operative intervention. A low viscosity polyvinyl siloxane was used to take an impression of the cavity preparation impression, using the bite registration impression to form the occlusal surface of the preparation impression. The preparation impression volume was calculated from its weight, using the known density of the impression material. The greatest depth of the preparation was measured. The Pearson correlation coefficient was used to investigate any relationship between depth or volume of the preparation impression and the DIAGNOdent measurements. The correlation for preparation volume and maximum DIAGNOdent measurement was 0.191 (p=0.189). Other logical subsets of cases also did not result in any statistically significant correlations between the DIAGNOdent readings and the depth or volume of the final cavity preparations.

SUMMARY:
This study evaluated the pulpal response in human dental pulp to direct pulp capping with the Single Bond Adhesive System (SBAS) after 10% or 37% phosphoric acid etching and after capping with Calcium Hydroxide (CH). The degree of bleeding and hemostasis conditions was considered during the adhesive technique. The pulps of 78 sound premolars were capped with SBAS after 37% phosphoric acid etching (Group I) or 10% phosphoric acid etching (Group II) and CH (Group III-control). The cavities were restored with a resin composite (Charisma). After 1, 3, 7 and 30 days, the teeth were extracted and processed for light microscopical examination (H/E, AgNOR silver stain and Brown-Brenn). The patients were followed for postoperative symptomatology evaluation. Clinical results showed the possibility of hemostasis with saline solution only. There was no statistical difference between bleeding generated by 10% and 37% acid solutions. In some cases, contact of the pulp tissue with SASB started the bleeding process, thus damaging the adhesive technique. The histological response was similar in Groups I and II, without signs of cellular differentiation and dentin neoformation up to 30 days. Bacteria were not observed in any specimens. In the control group (CH) at day 7, the pulps exhibited cells with high synthetic activity (Ag-NOR-positive) underneath the area of coagulation necrosis. Dentin bridging was observed at the thirtieth day. The postoperative period was asymptomatic for all groups. In conclusion, SBAS should be avoided for vital pulp therapy, while CH remains the capping agent of choice for mechanically exposed human dental pulp.

SUMMARY:
Background: This study evaluated the clinical efficacy and duration of effectiveness of a new bleaching lacquer for self-application without the use of mouth guards. It compared two different application times. Methods: Forty-six adult subjects who requested bleaching treatment were selected to participate in this randomized, single-blind (examiner-blinded), single center, two-group trial. The subjects were randomly divided into two groups (n=23 each), each being instructed to bleach (8% carbamide peroxide) their six maxillary anterior teeth for two weeks. Daily contact time in Group 1 was 20 minutes once a day and, in Group 2, the time was 20 minutes twice a day. Efficacy was measured subjectively using the Chromascop Complete shade scores obtained at baseline and after one, two and three weeks, as well as after one, three, six and nine months. Results: After two weeks of treatment, the teeth in the Group 1 subjects exhibited a 2.4 ± 0.2 mean shade scores improvement compared to baseline (p<0.001; t-test for paired samples), and the subjects’ teeth in Group 2 exhibited a 3.5 ± 0.1 mean shade scores improvement (p<0.001). However, the difference between both groups was not statistically significant (p>0.05). The observed effects were stable for six months.

Conclusions: It can be concluded that the new bleaching lacquer is efficacious; however, a double application does not seem to be obligatory.

SUMMARY:
This study compared the microtensile bond strength (MTBS) of three all-in-one adhesive systems and a two-step system using two types of burs to prepare the dentin surfaces. Flat coronal s urfaces of 24 extracted human molars were produced using either regular-grit or superfine-grit diamond burs. Resin composite was then bonded to equal numbers of these surfaces using one of the four adhesives: Clearfil SE Bond (CSE), G-Bond (GB), SSB-200 (SSB) or Prompt L-Pop (PLP). After storage for 24 hours in 37°C distilled water, the bonded teeth were sectioned into slices (0.7-mm thick) perpendicular to the bonded surface. The specimens were then subjected to microtensile testing and the bond strengths were calculated at failure. Bond strength data were analyzed by two-way ANOVA and the Games-Howell test for interaction between adhesive and type of cut dentin. The fractured surfaces were observed by SEM to determine the failure mode. In addition, to observe the effect of conditioning, equal numbers of the two bur-cut dentin surfaces of eight additional teeth were conditioned with the adhesives and observed by SEM. Based on the results, when CSE and SSB were bonded to dentin cut with a regular-grit diamond bur, the MTBS values were significantly lower than that of superfine bur-cut dentin; whereas, GB and PLP showed no significant differences in MTBS between the two differently cut surfaces. SEM observation of the fractured surfaces revealed a mixed mode (adhesive in some areas and cohesive in others in the same sample) of failure in all specimens except PLP, which showed cohesive failure within the adhesive for both types of bur preparation. Generally, SEMs of the conditioned surfaces using both types of burs showed partial removal of the smear layer for CSE, minimal for GB and SSB and complete removal for PLP.

In conclusion, when cutting dentin, selecting the proper bur type is important for improving the bond strength of some self-etching adhesive systems.

SUMMARY:
This in vitro study assessed the effect of a step-cure light curing method on resin/dentin bond strength on the buccal wall of Class I cavities in human teeth. Occlusal enamel was removed to expose a flat dentin surface. Twenty four box-shaped cavities (C-factor = 4.5) were prepared in dentin. Prime&Bond 2.1 was applied and TPH Spectrum (Dentsply) was inserted using a bulk-filling increment. The composite was light-cured using either a step-cure photoactivation technique or a one-step continuous curing method. For step-cure polymerization, the initial cure intensity was varied by changing the distance between the light source and the resin surface. The light-cured resins were cured using four low light intensities: 150(G1), 200(G2), 250(G3) and 300(G4) mW/cm2. In the continuous exposure curing method, the samples were light-activated for 40 seconds at 740 mW/cm2 and irradiation was applied in a box-shaped cavity and a flat cavity (exposed buccal wall, C-factor = 0.22). Samples were prepared for TBS testing by creating bonded beams (of approximately 0.8 mm2) obtained from the buccal wall. The data were analyzed using one-way ANOVA, Tukey Test and Dunnett’s Test at a significance level of 0.05. The mean TBS values for the continuous exposure group in the flat and box-shaped cavities were 24.31 and 10.23 MPa, respectively. The corresponding TBS for step-cure polymerization was 23.13 (G3), 18.83 (G2), 14.87 (G1) and 13.26 MPa (G4). Bond strength values to the cavity wall were lower in the three-dimensional cavities and dependent on the light curing method (p<0.05). The use of a low initial light intensity (200-250 mW/cm2) for 10 seconds followed by high irradiation intensity provided the best bond strengths, similar to bonding in a flat cavity.

SUMMARY:
It is uncertain whether single-phase self-etching adhesives form bonds to enamel as reliable as those of etch-and-rinse adhesives. This study compared the microtensile bond strengths to ground enamel of three self-etching adhesive systems, a self-etching primer system and an etch-and-rinse adhesive system. Human enamel was ground flat with 320-grit silicone carbide paper. The self-etching adhesives iBond (Heraeus Kulzer), Prompt L-Pop (3M ESPE) and Xeno III (Caulk/Dentsply), the adhesive with a self-etching primer Clearfil SE Bond (Kuraray) and the etch-and-rinse adhesive Scotchbond Multipurpose (3M/ESPE) were applied as directed, followed by a core of the same manufacturers’ hybrid resin composite. A microtensile bond strength evaluation was performed after 48 hours of water storage, using untrimmed beams approximately 0.9 mm2 in cross-sectional area at a crosshead speed of 0.6 mm/minute. There were no pretest failures in any group, and failures were predominately adhesive or mixed. Adhesion to enamel of Clearfil SE was not significantly different from Scotchbond Multi-Purpose, while the three self-etching adhesive systems demonstrated significantly lower bond strengths (One-way ANOVA, Tukey-Kramer Multiple-Comparison Test, p<0.00001).

SUMMARY:
This study compared the progression of sealed initial enamel lesions penetrated with a fissure sealant (Helioseal, Vivadent) or various adhesives (Heliobond, Excite, Vivadent; Resulcin, Merz; Solobond M, Voco; Prompt L-Pop, 3M-ESPE) after exposure to a demineralizing solution, in vitro. From 27 bovine teeth, 54 enamel specimens were prepared and covered with nail varnish (control), thus obtaining three windows for treatment. After demineralization (pH 5.0; 14 days), two of the windows (A, B) were etched with phosphoric acid (20%; 5 seconds); whereas, the third area served as the control (C). The specimens were divided randomly into six groups (n=9), and the material was applied (90 seconds) either once (A) or twice (B). Light-curing followed each application. Half of the area of each specimen window was then covered with nail varnish, and the samples were again stored in the demineralizing solution (pH 5.0; 14 days). The specimens were cut perpendicular to the surface, and both enamel slabs were studied after infiltration using a fluorescent, low viscous resin (VIRIN) and confocal microscopy (CLSM). Lesion depths were calculated (ImageJ) from the surface to that point in the lesion where the grey values clearly changed to a darker grey. After demineralization, mean lesion depths (SD) (14 days) were measured at 105 (21) µm. The second demineralization led to a mean progression of the lesion depths of 52 (31)%. Adper Prompt L-Pop and Solobond M could not significantly prevent lesion progression after a single application (p>0.05; t-test); however, the second application of Solobond M significantly decreased lesion progression (p<0.05; t-test). Helioseal, Heliobond, Resulcin Monobond and Excite showed significantly better inhibition of the demineralization compared to the other materials (p<0.05; Bonferroni). It can be concluded that the penetration of adhesives into initial lesions inhibited a further demineralization in vitro.

SUMMARY:
This study compared silver penetration in the adhesive interface among four versions of adhesives from the same manufacturer: OptiBond FL, OptiBond Solo Plus, OptiBond Solo Plus Dual Cure, and OptiBond Solo Plus Self-Etch, when coupled with dual-cured composite, CoreRestore 2 (Kerr). Twenty flat dentin surfaces were prepared using one of the adhesives and bonded with the composite, following the manufacturer’s instructions. The surfaces were sectioned into 2-mm slabs and immersed in ammoniacal silver nitrate for 24 hours. Each specimen was exposed to a photodeveloping solution for eight hours and examined with a scann