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SUMMARYObjectives: To evaluate the impact of magnification aids on the precision of tooth preparation under simulated clinical conditions.Methods and Materials: Two plastic blocks marked with a geometric shape were fixed in a dental phantom head: a circle as the distal surface of tooth 16 (UNS 3) and a y-shaped figure as the occlusal surface of tooth 36 (UNS 19). Sixteen dentists (mean age: 39 years; range: 26-67 years) prepared the geometric shapes from the inside to the boundary line with a cylindrical bur and water-cooling. The boundary line had to be touched but not erased. Chair-side assistance was provided to simulate the clinical situation. Tooth 16 was prepared under indirect vision via a dental mirror. Tooth 36 was prepared under direct vision A) without magnification aids, B) with Galilean loupes, 2.5× and light-emitting diode light, and C) with a microscope, 6.4× and coaxial light. The preparation procedure was performed three times in different sequences of the magnification devices and with a break of at least 1 week between each procedure. The correctly prepared contour and the incorrectly prepared areas were evaluated in relation to the whole circumference of the geometric shapes.Results: For both values the precision was significantly higher when a microscope was used, followed by preparation using loupes; precision was lowest without magnification aids (pConclusions: Magnification devices improved the precision of tooth preparation under simulated clinical conditions.

SUMMARY Objective This study evaluated the differences in enamel color change, surface hardness, elastic modulus, and surface roughness between treatments with four bleaching gels containing carbamide peroxide (two at 10% and one each at 35%, and 45%) and two bleaching gels containing hydrogen peroxide (two at 40%). Methods Enamel specimens were bleached and color changes were measured. Color change was calculated using either ΔE or the Bleaching Index (BI). Then, surface hardness, elastic modulus, and surface roughness of the enamel specimens were evaluated. All measurements were performed at baseline and directly after the first bleaching treatment for all carbamide peroxide– and hydrogen peroxide–containing bleaching gels. In addition, final measurements were made 24 hours after each of a total of 10 bleaching treatments for carbamide peroxide bleaching gels, and 1 week after each of a total of three bleaching treatments for hydrogen peroxide bleaching gels. Results After the last bleaching treatment, respective ΔE scores were 17.6 and 8.2 for the two 10% carbamide peroxide gels, 12.9 and 5.6 for the 45% and 35% carbamide peroxide gels, and 9.6 and 13.9 for the two 40% hydrogen peroxide gels. The respective BI scores were −2.0 and −2.0 for the two 10% carbamide peroxide gels, −3.5 and −1.5 for the 45% and 35% carbamide peroxide gels, and −2.0 and −3.0 for the two 40% hydrogen peroxide gels. Each bleaching gel treatment resulted in significant whitening; however, no significant difference was found among the gels after the last bleaching. Whitening occurred within the first bleaching treatments and did not increase significantly during the remaining treatments. Surface hardness significantly decreased after the last bleaching treatment, when 10% carbamide peroxide was used. Furthermore, significant changes in the elastic modulus or surface roughness occurred only after treatment with 10% carbamide peroxide. Conclusion All six bleaching gels effectively bleached the enamel specimens independent of their concentration of peroxide. Gels with low peroxide concentration and longer contact time negatively affected the enamel surface.

SUMMARYAlthough there has been a significant decrease in caries prevalence in developed countries, the slower progression of dental caries requires methods capable of detecting and quantifying lesions at an early stage. The aim of this study was to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent 2095 laser fluorescence device [LF], DIAGNOdent 2190 pen [LFpen], and VistaProof fluorescence camera [FC]) in monitoring the progression of noncavitated caries-like lesions on smooth surfaces. Caries-like lesions were developed in 60 blocks of bovine enamel using a bacterial model of Streptococcus mutans and Lactobacillus acidophilus. Enamel blocks were evaluated by two independent examiners at baseline (phase I), after the first cariogenic challenge (eight days) (phase II), and after the second cariogenic challenge (a further eight days) (phase III) by two independent examiners using the LF, LFpen, and FC. Blocks were submitted to surface microhardness (SMH) and cross-sectional microhardness analyses. The intraclass correlation coefficient for intra- and interexaminer reproducibility ranged from 0.49 (FC) to 0.94 (LF/LFpen). SMH values decreased and fluorescence values increased significantly among the three phases. Higher values for sensitivity, specificity, and area under the receiver operating characteristic curve were observed for FC (phase II) and LFpen (phase III). A significant correlation was found between fluorescence values and SMH in all phases and integrated loss of surface hardness (ΔKHN) in phase III. In conclusion, fluorescence-based methods were effective in monitoring noncavitated caries-like lesions on smooth surfaces, with moderate correlation with SMH, allowing differentiation between sound and demineralized enamel.

SUMMARYObjectivesThe aims of the present study in Swiss dental practices were 1) to provide an update on the prevalence of different magnification devices, 2) to examine the relationship between self-assessed and objectively measured visual acuity, and 3) to evaluate the visual performance of dentists in the individually optimized clinical situation of their respective practices.Methods and MaterialsSixty-nine dentists from 40 randomly selected private practices (n=20, ResultsA total of 64% of the dentists owned a dental loupe: 45% Galilean loupes, 16% Keplerian loupes, and 3% single lens loupes. In total, 19% of the questioned dentists owned a microscope in addition to the loupes. The correlation between the self-assessed and the objective visual performance of the dentists was weak (Spearman rank correlation coefficient=0.25). In the habitual clinical situation, magnification devices (p=0.03) and the dentist's age (p=0.0012) had a significant influence on the visual performance.ConclusionsMany dentists were not aware of their visual handicaps. Optical aids such as loupes or microscopes should be used early enough to compensate for individual or age-related visual deficiencies.

SUMMARY The aim of this in vitro study was to investigate the marginal gap formation of a packable “regular” resin composite (Filtek Supreme XTE [3M ESPE]) and two flowable “bulk fill” resin composites (Filtek Bulk Fill [3M ESPE] and SDR [DENTSPLY DeTrey]) along the approximal margins of Class II restorations. In each of 39 extracted human molars (n=13 per resin composite), mesial and distal Class II cavities were prepared, placing the gingival margins below the cemento-enamel junction. The cavities were restored with the adhesive system OptiBond FL (Kerr) and one of the three resin composites. After restoration, each molar was cut in half in the oro-vestibular direction between the two restorations, resulting in two specimens per molar. Polyvinylsiloxane impressions were taken and “baseline” replicas were produced. The specimens were then divided into two groups: At the beginning of each month over the course of six months' tap water storage (37°C), one specimen per molar was subjected to mechanical toothbrushing, whereas the other was subjected to thermocycling. After artificial ageing, “final” replicas were produced. Baseline and final replicas were examined under the scanning electron microscope (SEM), and the SEM micrographs were used to determine the percentage of marginal gap formation in enamel or dentin. Paramarginal gaps were registered. The percentages of marginal gap formation were statistically analyzed with a nonparametric analysis of variance followed by Wilcoxon-Mann-Whitney tests and Wilcoxon signed rank tests, and all p-values were corrected with the Bonferroni-Holm adjustment for multiple testing (significance level: α=0.05). Paramarginal gaps were analyzed descriptively. In enamel, significantly lower marginal gap formation was found for Filtek Supreme XTE compared to Filtek Bulk Fill (p=0.0052) and SDR (p=0.0289), with no significant difference between Filtek Bulk Fill and SDR (p=0.4072). In dentin, significantly lower marginal gap formation was found for SDR compared to Filtek Supreme XTE (p

SUMMARYUnimpaired near vision is crucial in dentistry, but appropriate visual tests at dental working distance are not publicly available. The aim of this study was to validate a novel visual triage test for dentists that is easy to use and freely available. The near visual acuity at 300 mm of 106 dental professionals (aged 21–65 years) was assessed with 1) a validated near visual test for scientific purposes miniaturized on a microfilm; 2) an experimental test using a US $5 bill, in which the first five words of each line in the Lincoln Memorial frieze had to be read under a dental operating light. The Spearman rank correlation coefficient of 0.784 revealed a strong correlation between the two tests (p

This study compared the efficiency of air abrasion on enamel caries with selective enamel powder (SEP) or with alumina powder and a negative and positive control group. Ninety-three extracted molars with non-cavitated incipient enamel lesions were selected. After embedding the roots in resin, each lesion was sectioned perpendicular to the surface and photographed. Each lesion was classified microscopically as having or not having dentin involvement. The lesions were distributed into four groups with an equal number of enamel caries with or without dentin involvement. Each group was treated differently: Group 1 had SEP abrasion, Group 2 had alumina abrasion, Group 3 had sodium bicarbonate abrasion (negative control) and Group 4 had bur treatment (positive control). The surface was rephotographed after treatment. Superimposition of the photographs identified areas of "correct-excavation," "under-excavation" and "over-excavation." There were no statistical differences between lesions treated with or without dentin involvement for Groups 2 through 4. However, in the SEP group, all measured areas were significantly influenced by dentin involvement. In pairwise comparisons, no statistical differences were found between the alumina and bur groups. The SEP group, however, showed statistically significant differences for each area compared to the alumina group in enamel caries without dentin involvement. SEP performed as well as alumina and bur in lesions with dentin involvement. SEP is different in its ablative properties toward caries with dentin involvement or no dentin involvement. In terms of dental treatment, SEP seems to have a diagnostic potential for enamel lesions before operative intervention in patients with high caries risk.

This study evaluated the performance of the DIAGNOdent pen laser fluorescence device (LFpen) in comparison with visual examination (VE), bitewing radiographs (BW) and visual examination combined with bitewing radiographs (VEBW) in detecting secondary approximal caries associated with composite restorations. In total, 60 approximal surfaces from 43 permanent molars with composite restorations were assessed twice by two examiners using the LFpen, VE, BW and VEBW. After histological preparation and hardness measurements, the sample was assigned to either a crown or root caries group, depending on the location of the lesions as the gold standard. For crown caries at D1, the highest values of specificity and sensitivity were observed for the LFpen at a cutoff value of 18 (1.00) and for the VEBW (0.89). At D3 (cutoff of 30), the LFpen showed the highest values of sensitivity and specificity. For root caries, the LFpen and VEBW showed the highest values of specificity (0.54), sensitivity (0.81) and accuracy (0.69). The Spearman rank correlation coefficients for crown/root caries with histology were 0.54/0.37 (LFpen), 0.29/0.10 (BW), 0.29/0.18 (VE) and 0.23/0.37 (VEBW). For the LFpen, the ICC varied from 0.80 (interexaminer) to 0.97 (intraexaminer B); the kappa value was 0.19 for BW and 0.35 for VE (interexaminer). Intraexaminer kappa values for BW were 0.25 (A) and 0.29 (B), and those for VE were 0.31 (A) and 0.32 (B). The LFpen device exhibited a performance comparable to that of conventional methods but with higher interexaminer reproducibility. Therefore, the LFpen should be considered an auxiliary method for the detection of secondary approximal caries associated with composite restorations.

SUMMARY There is some evidence that dental erosion is steadily spreading. To diagnose erosion, dental professionals have to rely on clinical appearance, as there is no device available to detect it. Adequate preventive measures can only be initiated if the different risk factors and potential interactions between them are known. When substance loss, caused by erosive tooth wear, reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridgework or removable dentures. As a result of the improvements in composite restorative materials and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner.

SUMMARY The aim of this study was to evaluate the influence of surface roughness on surface hardness (Vickers; VHN), elastic modulus (EM), and flexural strength (FLS) of two computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials. One hundred sixty-two samples of VITABLOCS Mark II (VMII) and 162 samples of IPS Empress CAD (IPS) were ground according to six standardized protocols producing decreasing surface roughnesses (n=27/group): grinding with 1) silicon carbide (SiC) paper #80, 2) SiC paper #120, 3) SiC paper #220, 4) SiC paper #320, 5) SiC paper #500, and 6) SiC paper #1000. Surface roughness (Ra/Rz) was measured with a surface roughness meter, VHN and EM with a hardness indentation device, and FLS with a three-point bending test. To test for a correlation between surface roughness (Ra/Rz) and VHN, EM, or FLS, Spearman rank correlation coefficients were calculated. The decrease in surface roughness led to an increase in VHN from (VMII/IPS; medians) 263.7/256.5 VHN to 646.8/601.5 VHN, an increase in EM from 45.4/41.0 GPa to 66.8/58.4 GPa, and an increase in FLS from 49.5/44.3 MPa to 73.0/97.2 MPa. For both ceramic materials, Spearman rank correlation coefficients showed a strong negative correlation between surface roughness (Ra/Rz) and VHN or EM and a moderate negative correlation between Ra/Rz and FLS. In conclusion, a decrease in surface roughness generally improved the mechanical properties of the CAD/CAM ceramic materials tested. However, FLS was less influenced by surface roughness than expected.

A laboratory study was performed to assess the influence of beveling the margins of cavities and the effects on marginal adaptation of the application of ultrasound during setting and initial light curing. After minimal access cavities had been prepared with an 80 microm diamond bur, 80 box-only Class II cavities were prepared mesially and distally in 40 extracted human molars using four different oscillating diamond coated instruments: (A) a U-shaped PCS insert as the non-beveled control (EMS), (B) Bevelshape (Intensiv), (C) SonicSys (KaVo) and (D) SuperPrep (KaVo). In groups B-D, the time taken for additional bevel finishing was measured. The cavities were filled with a hybrid composite material in three increments. Ultrasound was also applied to one cavity per tooth before and during initial light curing (10 seconds). The specimens were subjected to thermomechanical stress in a computer-controlled masticator device. Marginal quality was assessed by scanning electron microscopy and the results were compared statistically. The additional time required for finishing was BDC (por = 0.05). In all groups, thermomechanical loading resulted in a decrease in marginal quality. Beveling resulted in higher values for "continuous" margins compared with that of the unbeveled controls. The latter showed better marginal quality at the axial walls when ultrasound was used. Beveling seems essential for good marginal adaptation but requires more preparation time. The use of ultrasonic vibrations may improve the marginal quality of unbeveled fillings and warrants further investigation.

Three different fissure preparation procedures were tested and compared to the non-invasive approach using a conventional unfilled sealant and a flowable composite. Eighty permanent molars were selected and divided into 4 groups of 20 teeth each. All the teeth were split into 2 halves, and the exposed fissures were photographed under a microscope (35x) before and after being prepared using the following methods: (I) Er:YAG laser (KEY Laser, KaVo) 600 mJ pulse energy, 6 Hz; (II) diamond bur; (III) Er: YAG laser (KEY Laser, KaVo) 200 mJ pulse energy, 4 Hz; (IV) Control group: Powder jet cleaner (Prophyflex, KaVo, Germany). The pre-and postimages were superimposed in order to evaluate the amount of hard tissue removed. Ten teeth in each group were then acid etched and sealed with an unfilled sealant (Delton opaque, Dentsply), while the remaining 10 teeth were acid etched, primed and bonded (PrimeBond NT, Dentsply) and sealed with a flowable composite (X-flow, DeTrey, Dentsply). Material penetration and microleakage were evaluated after thermocycling (5000 cycles) and staining with methylene blue 5%. ANOVA and Mann-Whitney tests were applied for statistical analysis. The laser 600 mJ and bur eliminated the greatest amount of hard tissue. The control teeth presented the least microleakage when sealed with Delton or X-flow. A correlation between material penetration and microleakage could not be statistically confirmed. Mechanical preparation prior to fissure sealing did not enhance the final performance of the sealant.

Class II cavities were prepared in extracted lower molars filled and cured in three 2-mm increments using a metal matrix. Three composites (Spectrum TPH A4, Ceram X mono M7 and Tetric Ceram A4) were cured with both the SmartLite PS LED LCU and the Spectrum 800 continuous cure halogen LCU using curing cycles of 10, 20 and 40 seconds. Each increment was cured before adding the next. After a seven-day incubation period, the composite specimens were removed from the teeth, embedded in self-curing resin and ground to half the orofacial width. Knoop microhardness was determined 100, 200, 500, 1000, 1500, 2500, 3500, 4500 and 5500 microm from the occlusal surface at a distance of 150 microm and 1000 microm from the metal matrix. The total degree of polymerization of a composite specimen for any given curing time and curing light was determined by calculating the area under the hardness curve. Hardness values 150 microm from the metal matrix never reached maximum values and were generally lower than those 1000 microm from the matrix. The hardest composite was usually encountered between 200 microm and 1000 microm from the occlusal surface. For every composite-curing time combination, there was an increase in microhardness at the top of each increment (measurements at 500, 2500 and 4500 microm) and a decrease towards the bottom of each increment (measurements at 1500, 3500 and 5500 microm). Longer curing times were usually combined with harder composite samples. Spectrum TPH composite was the only composite showing a satisfactory degree of polymerization for all three curing times and both LCUs. Multiple linear regression showed that only the curing time (p < 0.001) and composite material (p < 0.001) had a significant association with the degree of polymerization. The degree of polymerization achieved by the LED LCU was not significantly different from that achieved by the halogen LCU (p = 0.54).

This study investigated the factors that could influence microleakage, penetration ability and the formation of resin tags of different sealants used in routine oral health care. One hundred and two caries-free extracted molars were divided into 34 groups of three teeth each. A questionnaire and three teeth were submitted to 34 dentists participating in the study. They completed the questionnaire anonymously based on their own clinical procedures. The teeth were then treated, corresponding to the questionnaires. The types of sealants were categorized into three groups: classical sealant, flowable composite and flowable compomer. The molars were thermocycled in water (5,000 cycles between 5 degrees C and 55 degrees C), then stained with 5% methylene blue for 24 hours. Each tooth was then sectioned longitudinally at three sites. Fissure type, microleakage and penetration ability of the sealants was evaluated with a computer-linked light microscope (25x magnification). Formation of resin tags at the enamel-sealant interfaces was examined using SEM. Variables thought to influence performance of the sealants were analyzed by multiple regression analyses. Classical sealants showed significantly lower microleakage than flowable composites and flowable compomers. Conventional etching with phosphoric acid was critical for sealant success. Agitating the etchant could improve the quality of sealing by decreasing microleakage significantly. In addition, the fissure types had a significant effect on the penetration ability of sealants.

There is some evidence that dental erosion is steadily spreading. To diagnose erosion, dental professionals have to rely on clinical appearance, as there is no device available to detect it. Adequate preventive measures can only be initiated if the different risk factors and potential interactions between them are known. When substance loss, caused by erosive tooth wear, reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridgework or removable dentures. As a result of the improvements in composite restorative materials and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner.