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Objective: This study compares the quality of class I restorations made with the atraumatic restorative treatment (ART) technique and conventional class I amalgam restorations. Methods: The study was carried out among secondary school students in Mzuzu, Malawi. First-year students in 1987 who needed at least two class I restorations were selected. Based on a split-mouth design, each participant received both ART and conventional restorations. The 89 pairs of class I cavities were divided randomly into two groups, since two different cermet ionomer cement (CIC) filling materials were used. Impressions of the restorations and subsequent models were made shortly after restoration, after six months, one year, two years, and three years. The quality of the restorations was determined on the models following the US Public Health Service criteria. Bulk fracture, contour, marginal integrity, and surface texture of the restorations were recorded and evaluated separately. Survival rates were determined by the resultant score of all criteria. Results: Though conventional amalgam restorations performed better on all criteria, this difference was significant only for the contour criterion. The survival rates of ART restorations after three years (81.0%) were lower than those of amalgam restorations (90.4%) (P=.067). Conclusions: The quality of ART class I restorations is competitive with that of conventional amalgam restorations.

Purpose: This in vitro study determined the fracture strength of five core materials supported by two different endodontic dowels. Diametral tensile strength and microhardness of the three resin composite core materials used in this study were also tested. Material and Methods: The fracture strength study used one lanthanide-reinforced flowable resin composite (Ti-Core Auto E), one titanium- and lanthanide-reinforced composite (Ti-Core), one lanthanide-reinforced composite (Ti-Core Natural), and two metal-reinforced glass ionomer core materials (Ketac Silver and GC Miracle Mix). Two types of dowels were used: a multitiered, split-shank threaded dowel with a flange (#1 Flexi-Flange) and one without a flange design (#1 Flexi-Post). The specimens were divided into ten groups. Each tooth/dowel and core specimen was placed in a special jig at 45° and subjected to a load by a universal testing machine. The diametral tensile strength and the microhardness of the three resin composite core materials were measured by a universal testing machine and Barcol hardness tester, respectively. All test groups contained ten specimens. Results: The fracture strength value of the resin composite core materials was significantly larger ( p < 0.0001) than those for the metal-reinforced glass-ionomer core materials. Analysis of variance (ANOVA) also showed that the Flexi-Flange dowel interacted with Ti-Core and Ti-Core Auto E to significantly ( p < 0.0013) increase the fracture strength relative to the Flexi-Post. One-way ANOVA revealed that there were no significant differences between them in terms of diametral tensile strength. The Barcol hardness values of the composite core materials were statistically different ( p < 0.0001), with the Ti-Core the highest, followed by Ti-Core Natural, then Ti-Core Auto E. Conclusions: Resin composite core material performed better than glass ionomer material in this in vitro study. The flowable composite core material performed about the same in terms of fracture strength and diametral tensile strength compared with nonflowable composites. Combined with certain core materials, the flange design increased the fracture strength of the tooth/dowel and core combination.

Venturi M. Evaluation of canal filling after using two warm vertical gutta-percha compaction techniques in vivo: a preliminary study. International Endodontic Journal, 39, 538‐546, 2006. Aim To evaluate the quality of root canal filling when comparing two warm gutta-percha filling techniques in vivo. Methodology Human teeth were randomly divided into two equal groups, with 30 canals each. The root canals were shaped by hand and ProFile 0.04 rotary instrumentstosize20‐40attheend-pointandthenfilled with gutta-percha cones and AH-Plus. In group A, a traditional warm vertical compaction technique was performed using the Touch’n Heat, and back-filling with the Obtura II. In group B, a modified warm vertical compactiontechniquewasused:smallamountsofguttapercha were removed, and the remaining most apical 3 mm were compacted with a 1 mm movement; then thermomechanicalback-fillingwasperformed.Theteeth were extracted, stored in dye, cleared, and the distance betweentheapexandapicallimitofthefilling,lineardye penetration, and voids were measured from the buccal, lingual, mesial and distal perspective.The homogeneity of variance and means was verified using Levene’s test and t-test. anova and Dunnett post hoc test were used to establish the significance and to analyse the effects through multiple comparisons. Results Compared with the specimens of group A, the specimens of group B exhibited less mean linear dye penetration (P < 0.05), smaller void length (P £ 0.05) and maximal width (P £ 0.05) when examined in all four views, and a more precise filling when viewed from the buccal aspect (P < 0.05). Conclusions The modified warm vertical compaction technique with apical back-filling produced a more effective and precise three-dimensional filling.

PURPOSE The present in vitro study examined 3 mechanical properties, namely compressive, flexural, and diametral tensile strength, of various commercially available cements and core materials as a function of time after mixing. MATERIALS AND METHODS The examined materials were 2 cermet cements (Ketac Silver [ESPE, Seefeld, Germany] and Chelon Silver [ESPE]), 1 metal-reinforced glass ionomer cement (Miracle Mix [GC Dental Industrial Corp, Tokyo, Japan]), 2 conventional glass ionomer cements (Ketac Bond [ESPE] and Ketac Cem [ESPE]), 1 standard cure zinc phosphate cement (Harvard Cement [Richter and Hoffmann, Berlin, Germany]), and 1 zinc phosphate cement with the addition of 30% silver amalgam alloy powder (Harvard Cement 70% with Dispersalloy 30% [Richter and Hoffmann/Johnson and Johnson, East Windsor, NJ]). Properties were measured using a universal testing machine at 15 minutes, 1 hour, and 24 hours after first mixing. RESULTS Compressive strengths varied widely between the 3 times of measurement from 5.8 +/- 6.6 MPa for Ketac Cem to 144.3 +/- 10.2 MPa for Ketac Silver. Twenty-four hours after mixing, the Bonferroni test showed significant (p

The strength of a modern, low metal:glass ratio, metal-reinforced glass-ionomer cement was measured evaluating a number of protective barriers: one light-cured resin, two solvent-based dental varnishes and petroleum jelly. The cement was exposed to water at 10 and 60 min from start of mix. The results obtained with these protecting agents were compared with those obtained where no protection was applied. A comparison of uniaxial flexural strength and biaxial flexural strength showed the latter to be more discriminating. Proprietary dental varnishes were superior to petroleum jelly, producing similar strengths of 50 MPa. Petroleum jelly was, however, preferable to no protection. Moisture protection during the first 30 min was found to be beneficial, thereafter no further strength increase was found. A second material, a cement which has a high metal:glass ratio, was found to be more moisture resistant but weaker in strength than the modern material, with a biaxial strength of 39 MPa.

This study was designed to investigate the effect of retaining coronal tooth substance on the performance of post-retained core materials, and to compare the fracture resistance of the system with an intact tooth prepared to similar dimensions. Ten teeth restored with post-retained silver amalgam, and 10 teeth restored with silver-glass cermet, all with a retained single wall of coronal tooth substance, were compared with 10 unrestored teeth prepared to similar dimensions when subjected to a shearing load. The results showed no statistically significant difference between the unrestored teeth and those restored with a silver-glass cermet. Whilst the teeth restored with silver amalgam had a significantly higher fracture resistance (P > 0.01) there was greater tendency to root fracture.

The aims of the present study were to measure the fluoride release of 1 glass ionomer cement, 1 cermet cement, 3 resin-modified glass ionomer cements and 1 compomer, and to determine the influence of each material on bacterial growth. Test specimens were eluted in saline for 180 days. Every 2 days, the specimens were transferred into fresh saline and the fluoride content of the solution was measured. Furthermore, 48-h, 14-d, 90-d, and 180-d eluates were inoculated with Streptococcus mutans and bacterial growth was recorded nephelometrically. Fluoride release dropped significantly over time for each material with values between 6.2 (Ketac-Silver) and 29.3 (Photac-Fil) ppm after 48 h to values between 0.6 (Ketac-Silver) and 1.7 (Ketac-Fil, Vitremer) ppm after 180 days. Each material reduced bacterial growth at each time of examination, but the effect decreased significantly over time with a maximum growth of 71.7% (Ketac-Fil) to 85.6% (Ketac-Silver) after 48 h and 94.7 (Vitremer) to 99.0% (Ketac-Silver) after 180 days (growth control = 100%). Both Ketac-Silver and Dyract showed a significantly lower inhibiting effect on bacterial growth than the other materials. The tested materials showed a good correlation between fluoride release and influence on bacterial growth. However, both effects dropped dramatically over the 180-days period.

Tunnel restorations (n = 161) performed by 4 dentists were evaluated after a mean of 35 months in situ. Demineralized enamel was to be spared during preparation. The preparations were filled with a cermet glass ionomer (polyalkenoate) cement. Evaluation was carried out using clinical and radiographical criteria. During the observation period, approximately 16% of the restorations were replaced due to caries in dentin and 14% due to marginal ridge fracture. Cavitation in the approximal surface and/or increased radiolucency of the approximal enamel were observed in 34% of the remaining tunnel-restored teeth. A significantly higher frequency of failures were registered when treating patients with a high caries activity, where the initial lesion was large, and where the restoration did not reach the approximal surface.

The two-body and three-body wear of glass-ionomers (GIC), visible light cured glass-ionomers (VLC-GIC), and composites were compared. The wear simulations were performed for the two-body wear in an artificial mouth and for the three-body wear with the so-called ACTA machine. The tested materials were different conventional glass-ionomers, light cured glass-ionomers, composites, and amalgam. The wear rates of 8 specimens of each material for the two-body and 16 for the three-body wear test were compared. After 10(5) cycles with each testing device, the wear shapes were measured. All measurements were related to the wear rate of amalgam. For the two-body wear method, the worn materials were qualitatively judged by scanning electron microscopy. The two different wear testing methods lead to similar results with slight differences in ranking. Amalgam showed the lowest wear rates with both methods. Photac Fil, a newly developed VLC-GIC, showed dramatically lower wear resistance than composites and conventional GIC with both methods. Further investigations are necessary to identify the material-specific parameters influencing the wear behaviour of a material in relation to different wear testing methods.

Summary The purpose of this study was to compare the sealing ability of high-copper amalgam, glass ionomer cement, and silver glass ionomer cement as retrofitting materials when used with and without varnish. Seventy extracted human single-rooted anterior teeth were instrumented and the root canals obturated with laterally condensed gutta-percha and sealer. The apical 3 mm of each root was resected and a 2 mm-deep apical Class I preparation cut. The roots were then randomly allocated to six groups of 10 teeth and retrofitled with one of die experiment materials. Group I comprised high-copper amalgam; group 2, high-copper amalgam with cavity varnish; group 3, glass ionomer cement without varnish: group 4, glass ionomer cement with varnish; group 5, silver glass ionomer cement without varnish; and group 6, silver glass ionomer cement with varnish. Two groups of five roots each were used as positive and negative controls. The root surfaces were coated with nail polish and specimens immersed in 2% methylene blue solution for 14 days. After vertical sectioning, dye penetration was examined under a stereomicroscope. The results of the study were analysed statistically. The sealing ability of the conventional glass ionomer cement with varnish was significantly better while dye penetration was higher in silver glass ionomer cement without varnish group than the other groups (P > 0.01).

The physical properties and bond strengths of two glass ionomer materials reinforced with silver and amalgam alloy powders were compared with those of a conventional material from the same manufacture as well as two commercially available products. The diametral tensile strength, hardness and bonding strength are improved with the addition of either commercial available silver particles or fabricated high-copper amalgam alloy powders to the glass. Simple mixture of the metal or alloy powders with the glass ionomer cement seems to be feasible to improve the properties of the regular cement. However, further studies in formulating an optimal composition of metal or alloy, setting characteristics and long-term clinical evaluation are necessary before proposing uses for this new material.

The clinical potential of the tunnel restoration is restrained by perceived difficulties of access to proximal caries and lack of long-term clinical data. This paper describes a technique that affords proximal access similar to that of a standard Class II cavity preparation and provides an evaluation of a technique, using capsulated glass ionomer cements. It is supported by more than nine years of clinical experience that confirms the viability of this procedure as an alternative to conventional Class II cavity restorations for initial proximal lesions.

Ninety-one extracted maxillary premolar teeth were restored with a prefabricated post and amalgam, composite resin or glass-cermet core. Each group was again divided into three groups of 9-13 teeth to be subjected to an increasing load in one of three standardized directions (10, 45 and 90 degrees to the long axis of the tooth). Failure load and characteristics of failure were recorded. The glass-cermet-restored teeth had a lower strength than the other groups for every load direction (Student's t-test: P less than 0.01). Amalgam and composite resin groups showed a significant difference only for the 10 degrees loading condition (Student's t-test: P less than 0.02). Teeth restored with amalgam cores displayed a higher mean failure load, in combination with a 46% occurrence of root fracture.

The effect of acid etching on the surface appearance and flexural strength of four glass polyalkenoate cements was investigated. Specimens were etched for intervals of 10-60 s, both at the recommended time after mixing and after a 24-h delay. The surface texture was examined microscopically. Further specimens were subjected to a 4-point bend test following etching 1 h and 24 h after mixing. Deterioration of the surface appearance occurred as the etching time was increased beyond 10 s following immediate etching. Etching after 24 h reduced surface damage, but a 10-s etch still gave the most favourable surface appearance without loss of particulate material. Etching beyond 10 s significantly reduces flexural strength.

Conservative dentistry in developing countries often poses a problem because of lack of expensive dental equipment. This survey was undertaken to test two more appropriate filling materials in vivo. In 94 secondary school students (in Mzuzu, Malawi) with two or more cavities, one cavity was prepared in the conventional way using drilling equipment and then filled with amalgam, and one cavity was prepared using hand instruments only and filled with either cermet ionomer or "miracle mix". Models of the filled teeth (99 amalgam, 53 "miracle mix", 54 cermet ionomer; all of them Class 1) were made and evaluated by three examiners after 6 months and after 1 yr. The fillings were given a score on a four-point scale. One year later all types of filling materials had significantly decreased in quality, but only five fillings (one amalgam, one "miracle mix", and three cermet ionomer) needed replacement. Compared to the amalgam filling in the same mouth, more cermet ionomer and "miracle mix" fillings performed poorly, but these differences were not statistically significant after 1 yr. Both cermet ionomer and "miracle mix" are very promising alternatives for Class I tooth cavities in areas without dental equipment.

– Fluoride was extracted by 1 or 50 ml deionized water from 0.3 ml samples of two conventional and three metal-reinforced glass-ionomer cements. The fluoride concentration was determined by electrode. It was found that the fluoride concentration around the glass-ionomer cements ranged 2–3 ppm after 15 min and 3–5 ppm after 45 min. The maximum fluoride concentration attained within 24 h varied from 15–21 ppm, while the total amount of fluoride released during 100 days varied from about 2 mg fluoride to 12 mg fluoride per ml glass-ionomer cement. An alloy reinforced cement and its conventional counterpart released the highest amount of fluoride whereas a glass-cermet type released the lowest amount. Within the premises of this study it was concluded that composition and handling of the cements are of importance for the release of fluoride, and that a caries inhibitory fluoride concentration can be established in the surroundings of all of the cements.

Summary. The usefulness of glass ionomer cements in endodontics is illustrated by selected case histories. The situations varied from root repair to root end filling. The use of regular glass ionomer cement and a reinforced version are presented. In addition, the preparation of a modified glass ionomer cement, that could be used alone, or with gutta-percha, for root canal obturation is described.

– Proximal cavities with or without a dovetail were prepared in primary molars of 5-7-yr-old children. The cavities were filled with either a traditional glass ionomer (Ketac-Fil) or a cermet (Ketac-Silver). A total number of 199 treated teeth were available for evaluation 5-14 months after placement of the fillings. The percentage of success was 84% for Ketac-Fil and 77% for Ketac-Silver. There was no clear difference in rate success between the two different types of cavities.

A method of treating an apical root fracture with accompanying resorption at the junction of the fracture fragments using glass-cermet cement is described. Endodontically, the material had previously been used for repair of lateral resorptive root defects and retrograde root fillings. Complete bone regeneration was observed three years post-operatively following treatment of the root fracture in the conventional manner. The various advantages of glass-cermet cement as a root filling material used in the technique described are discussed.