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Objective: The aim of this study was to evaluate the influence of cavity preparation with different Er,Cr:YSGG laser handpieces on microleakage of different posterior composite restorations., Methods: Fifty-four extracted intact human premolars were randomly assigned to three groups according to cavity preparation method: Bur Group: high-speed diamond bur (Diatech), MD Group: Er,Cr:YSGG laser Waterlase MD handpiece (Biolase Millennium II), and Turbo Group: Er,Cr:YSGG laser Waterlase MD TURBO handpiece (Biolase Millennium II). One hundred eight Class II slot cavities were prepared on the mesial and distal proximal surfaces of each tooth, and the cavity preparation times required were determined. The groups were then subdivided according to the restorative systems used (n = 12): a conventional methacrylate-based microhybrid composite (Filtek P60+Adper Single Bond 2/3M); a silorane-based resin composite (Filtek Silorane+Silorane System Adhesive/3M); and a nanohybrid methacrylate-based composite (Kalore+G-Bond/GC). The restorative systems were applied according to the manufacturers' recommendations. Following thermocycling (X5000; 5°C-55°C), the teeth were coated with nail varnish except the restoration margins, immersed in 0.5% basic fuchsin dye solution, and sectioned in a mesiodistal direction. Dye penetration was evaluated under a light microscope for occlusal and cervical margins. Data were analyzed with one-way ANOVA and chi-square tests (p < 0.05)., Results: The cavity preparation time (mean ± SD) required for Bur, MD, and Turbo group was 31.25 ± 3.82, 222.94 ± 15.85, and 92.5 ± 7.42 sec, respectively, and the differences among the groups were statistically significant (p < 0.05). Comparing the occlusal and cervical microleakage scores, no statistically significant differences were found among the groups and subgroups (p > 0.05)., Conclusions: Er;Cr:YSGG laser cavity preparation with the Turbo handpiece needed shorter time than the MD handpiece, although it needed longer time than the conventional diamond bur. The use of different handpieces of Er,Cr:YSGG laser did not differ from conventional preparation with diamond bur in terms of microleakage with the tested methacrylate- and silorane-based posterior composite restorative systems.

Purpose: To assess the effect of the erbium:yttrium aluminum garnet (Er:YAG) laser on bond strength of a total-etch adhesive system to the caries-affected dentin on the gingival wall., Materials and Methods: Ten human molars with proximal carious lesions were randomly divided into two groups. In the first group, the carious dentin was removed with a bur, whereas in the second group it was removed with the Er:YAG laser. Carious lesions were excavated with one of these two techniques until laser fluorescence values decreased to 15 in the center of the lesions. The teeth were then restored with a total-etch adhesive system (Adper Single Bond 2) and composite resin (Filtek Z250). Five teeth from each group were sectioned to obtain 1 mm2 stick-shaped microtensile specimens from each tooth. Twenty-five specimens were obtained for each group with using this technique. The data were analyzed in independent-samples t-test (α = 0.05). For each removal technique, one sample was analyzed using scanning electron microscopy., Results: No statistically significant differences were found between the bond strength of the Er:YAG laser and the bur-treated groups (P > 0.05)., Conclusion: The Er:YAG laser treatment did not negatively affect the bonding performance of the total-etch adhesive system to caries-affected dentin on the gingival wall.

Purpose: To examine the effect that a stainless steel (SS) matrix band has on the depth and distribution of cure of a resin-based composite (RBC) in a simulated Class II cavity., Methods: RBC was cured for 20 seconds in a simulated Class II cavity with and without a SS matrix band, and after 24 hours the specimens were scraped back and ground to expose a vertical central plane where Knoop micro-hardness (KHN) mapping was conducted from 0.05-1.5 mm from the band and in 0.5 mm intervals from the top of the specimens. The effect of different angles of the light guide on the distribution of hardness was also examined., Results: KHN values near the SS matrix band were significantly lower (P < 0.05) than within the bulk of the specimen and were lower than those found without the matrix band. Angles of incidence for the curing light-guide produced changes in the distribution of KHN within the specimens, but particularly near the matrix band, and with a 35° angle of incidence, the depth of cure was significantly different from that of normal incidence of the light.

Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

Purpose: The purpose of this study was to evaluate the influence of prior etching on the sealing of silorane composite restorations in Class V cavity preparations prepared with an Er,Cr:YSGG laser compared to bur preparation in primary teeth., Methods: Standard Class V cavity preparations were prepared on the buccal surfaces of 56 extracted primary canines and randomly divided into four groups of 14 teeth each, according to laser or bur preparation and the use of prior acid etching in the preparation. All cavity preparations were restored with silorane adhesive and silorane composite. After water storage and thermocycling, the specimens were placed in 0.5 percent basic fuchsin dye solution. Dye penetration was evaluated with a stereomicroscope. The data were analyzed with nonparametric tests (P=.05)., Results: Laser preparation and prior etching in bur-prepared cavity preparation had no significant effect on enamel sealing (P>.05), but significantly increased microleakage at the dentin margin (P<.001 and P=.001, respectively). Prior etching in laser-prepared cavity preparations significantly improved sealing at the enamel and dentin margins (P=.009 and P=.003, respectively)., Conclusions: Prior acid etching may be necessary to ensure good marginal sealing when laser preparation is used. However, this step is not required when bur cutting is used in primary teeth.

Unlabelled: The aim of this study is to investigate different instruments for finishing composite restorations, as well as examining different surfaces and interfaces of the same restoration. The null hypothesis is represented by the fact that there are no significant differences on roughness of composite restorations finishing between tungsten carbide and diamond burs, furthermore the null hypothesis is that there are no significant differences on roughness between finishing on composite surfaces (C), compositeenamel (CE) and composite-dentin (CD) interfaces. The study was performed on 28 teeth, and class V cavities were prepared on the extracted teeth. Restorations were done in Filtek XTE nanofilled composite (3M Espe) in a standardized method, to then be finished. A comparison was made in the phase 1 between tungsten carbide burs (16 blades), diamond burs (46 μm), with a similar shape by the same manufacturer (Komet). Each surface received 5 bur applications. Consequently, an analysis with a profilometer was performed. Phase 2 involved further confrontation of ulterior finishing with ultrafine tungsten carbide burs (30 blades) and with extra and ultrafine diamond burs (25 and 8 μm) (the same shape as previously mentioned). A second analysis was then performed with a profilometer. All measurements were taken on C surfaces, CE and CD interfaces. Statistical analyses were carried out with c2 test (a = 0.05)., Conclusions: The finishing procedures with fine grit or toothing burs gave a better smoothness with tungsten carbide burs compared to diamond burs. While with the ultrafine grit no significant differences were noted between tungsten carbide and diamond burs on the CE and CD interfaces, the diamond bur left less superficial roughness on the C surfaces. With regards to the superficial roughness of the different areas of restoration, it can be concluded that: minor roughness was detected on C surfaces, while the CD interface had the most superficial roughness, regardless of whether the diamond burs or tungsten carbide burs were used. This study shows some statistical differences that could not be clinically perceivable. The clinical relevance could be resumed as follows: the fine tungsten carbide burs provided less roughness compared to a fine diamond bur. There were no differences between the ultrafine tungsten carbide and diamond burs. The less favourable interface to be finished is CD, compared to the CE interface and C surfaces.

Purpose: To evaluate the influence of resin cements and aging on cuspal deflection, fracture resistance, and mode of failure of endodontically treated teeth restored with composite resin inlays., Materials and Methods: Seventy-two maxillary premolars were divided into 6 groups: 1: sound teeth as control (C); 2: preparations without restoration (WR); 3: inlays luted with RelyX ARC (ARC); 4: inlays luted with RelyX Unicem (RLXU); 5: inlays luted with Maxcem Elite (MCE); 6: inlays luted with SeT (ST). Groups 2 to 6 received mesio-occlusal-distal preparations and endodontic treatment. Stone casts were made for groups 3 to 6. Composite resin inlays were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal aspect and the cuspal deflection was measured using a micrometer before and after 500,000 cycles of fatigue loading (200 N; 500,000 cycles). The specimens were then submitted to an axial load until failure., Results: The median cuspal deflection (µm) and median fracture resistance (N) were calculated and statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.01). Values followed by the same letter represent no statistically significant difference. Cuspal deflection before cyclic loading: C = 3 µma; ARC = 4 µmab; RLXU= 5 µmab; MCE = 21 µmb; ST = 51 µmbc; WR = 69 µmc. Cuspal deflection after cyclic loading: ARC = 6 µma; RLXU = 19 µmab; MCE = 33 µmb; ST = 62 µmb. Fracture resistance in N: C = 1902a; ARC = 980b; RLXU = 670c; MCE = 533c; ST = 601c; WR = 526c. According to the Wilcoxon test, there was no statistical difference between the cuspal deflection before and after cyclic loading only for ARC (p = 0.015). There was a predominance of recovery fractures for the restored groups., Conclusion: Composite resin inlays luted with RelyX ARC maintained cuspal deflection stability and showed higher fracture resistance of the teeth than did inlays luted with the other cements tested.

Aim: This in vitro study compared the effect of a concave with a straight-bevelled cavity margin on the microleakage of Class V composite resin restorations in primary teeth., Materials and Methods: Standardised Class V cavity preparations were made in vitro on the buccal (all margins placed in enamel) and on the lingual (margins placed in enamel and cementum) surfaces of 20 sound primary molars. The teeth were randomly assigned to two groups of 10 each: in Group 1, a concave bevel was made with a high-speed No. 04 tungsten carbide bur and in Group 2, a straight bevel was made with a high-speed No. 556 tungsten carbide bur. The teeth were restored incrementally with Adper Single Bond 2 (3M) adhesive and Filtek Z 350 (3M) composite resin. All specimens were subsequently thermocycled and immersed in 50% silver nitrate solution. Microleakage of the restorations was then assessed by silver penetration. A grading scale of 0 to 4 was used as the scoring criterion., Results: At the enamel margins no statistically significant differences were observed between the two groups (p>>0.05). Occlusal walls in enamel, in both groups, exhibited less leakage than the cervical walls in cementum (p<0.01) and Group 1 showed better results than Group 2 in decreasing microleakage at the cementum margins (p <0.05)., Conclusion: Based on the results, it was concluded that concave-beveled cavity preparations may reduce but did not totally eliminate microleakage at the cementum margins of Class V composite resin restorations in primary teeth.

Purpose: This study investigated whether the tubular occluding effect of oxalate desensitizer (OX) during adhesive cementation (three resin cements) influenced fracture resistance of teeth restored with adhesive inlays., Materials and Methods: Ninety intact maxillary premolars were randomly divided into 9 groups of 10 each. The two control groups were Gr 1, intact teeth and Gr 2, mesio-occlusodistal preparation only. In six experimental groups, the composite inlays were cemented with ED Primer II/Panavia F 2.0, Excite DSC/Variolink II, and One-Step Plus/Duolink according to manufacturers' instructions (Groups 3, 5, and 7, respectively) or with OX during cementation (Groups 4, 6, and 8, respectively). In Group 9, inlays were cemented with a resin cement without adhesive system. After thermocycling, fracture strength was tested. The data were analyzed using two-way and one-way ANOVA and LSD post hoc tests (α = 0.05)., Results: Fracture resistance of the six groups were significantly affected by OX (p = 0.002) but not by the resin cement type (p > 0.05). The interaction of the two factors was statistically significant (p = 0.052). A statistically significant difference between all groups was found (p < 0.001). The mean fracture resistances (N) were: Gr1 = 1168 ± 157,(a) Gr2 = 360 ± 110,(d) Gr3 = 1026 ± 188,(b) Gr4 = 887 ± 143,(c) Gr5 = 1007 ± 132,(b) Gr6 = 810 ± 164,(c) Gr7 = 1033 ± 218,(a) Gr8 = 955 ± 147,(ab) Gr9 = 780 ± 86(c) (groups with the same superscript letter indicate statistical similarity)., Conclusions: Combining an OX with three resin cements had a significant negative effect on the fracture resistance of premolars restored with composite inlay cemented with Panavia F2.0 and Variolink II, but it had no significant effect when cemented with Duolink., (© 2012 by the American College of Prosthodontists.)

Clinical experience supports the notion that the restoration of MOD cavities may pose a challenge to the practitioner. Proper placement of precontoured matrices and commercial wedges help the clinician to establish an optimal emergence profile and sufficient contours. However, the presence of proximal concavities in premolars or molars can turn the reproduction of previous cervical architecture into an even more demanding task. Wedges with customized form or adequate design can precisely conform the matrix to the cavosurface area and prevent any gap formation. This article presents two different options that allow for successful and predictable reestablishing of anatomically correct contours and optimal proximal contacts in posterior teeth with proximal concavities.

Objectives: The aim of the present study was to evaluate hybrid layer thickness of primary molars sectioned with diamond, carbide and ultrasonic CVD burs., Study Design: The occlusal enamel surfaces often molars were removed and superficial dentin was exposed. Three standardized cavities were prepared at mesial, central and distal exposed dentin with diamond, carbide and ultrasonic CVD burs, respectively. A self-etching adhesive system (Adhese, Ivoclar/Vivadent) was applied to prepared cavities and composite resin Z100 (3M/ESPE) was inserted according to manufacturers'instructions to hybridized dentin. Samples were light-cured and the crown was sectioned mesio-distally dividing the restored cavities in two halves which were observed under scanning electron microscopy (SEM), in order to quantitatively evaluate hybrid layer thickness (microm). Three repeated measures were performed at mesial, central and distal sites and mean values obtained were submitted to one-way analysis of variance (ANOVA)., Results: Data (mean +/- sd) obtained were (microm): 2.69 (0.44), 3.38 (1.23) and 2.72 (1.18)for diamond, carbide and CVD burs, respectively. No differences were observed among groups (p > 0.05). The adhesive systems promoted mechanical retention, uniform and continuous hybrid layer and resin tags formation at all dentin sites for all instruments tested., Conclusion: The results suggest that the minimally invasive cavities prepared with diamond, carbide and CVD for ultrasound, promoted hybrid layer formation with a similar thickness regardless the bur used.

Objective: To compare surface treatments with CVDentUS ultrasound tips (UT) and KGSorensen diamond burs (DB) on etched (e) and non-etched (n/e) dentin. The microtensile bond strength (μTBS) was measured and fractography was assessed by scanning electron microscope (SEM)., Materials and Methods: Sixteen molars were divided into four groups of four teeth each according to treatment (DB-n/e; DB-e; UT-n/e; UT-e). The teeth were restored, sectioned into samples for μTBS (n=40) and tested on a EMIC DL-2000 universal machine (0.5 mm/min) and analyzed by SEM for fracture classification., Statistical Analysis: For analysis of the data on μTBS, the two-way ANOVA, using treatment and acid etching as fixed factor, and the Tukey test were used (α=0.05). To failures classification in cohesive in dentin (CD); cohesive in composite resin (CC); cohesive interfacial on base or top of hybrid layer (CBT); cohesive in adhesive (CA); mixed (M); interfacial on smear layer (S) the Fisher's exact test (α=0.05) was performed., Results: The mean values of μTBS (in MPa) in the different groups were as follows: UT-e: 45.31 ± 8.16; DB-e: 34.04 ± 9.29; UT-n/e: 15.17 ± 3.71; and DB-n/e: 9.86 ± 3.80. On analysis of the SEM micrographs, the DB-n/e group showed total obstruction of dentinal tubules; the UT-n/e group showed partial desobstruction of dentinal tubules and irregular surface; the DB-e group showed complete desobstruction of dentinal tubules; and the UT-e group showed complete desobstruction of dentinal tubules and irregular surface., Conclusion: The combination of ultrasound treatment and acid etching provides high values of μTBS. An association exists between CA/CC failures and the UT method, CBT failure and the DB method, CBT/CC failures and etching, S failure and non-etching.

One of the challenges in durability of posterior tooth-colored restorative materials is polymerization shrinkage, which results in gap formation between the restoration and tooth structure. The aim of the present study was to investigate marginal adaptation of Class II composite restorations using a self-etching and two etch-and-rinse adhesive systems in cavities prepared either with bur or Er,Cr:YSGG laser. A total of 45 extracted sound human premolars were selected. In each tooth, mesial and distal Class II cavities were prepared either by a diamond bur or by Er,Cr:YSGG laser with the margins 1 mm apical to the cemento-enamel junction. Then the teeth were randomly divided into three groups of 15 each, according to the type of the adhesive system used (Single Bond, Single Bond 2, and Adper Easy One adhesive systems). Subsequent to restoring the teeth, the specimens were subjected to thermal cycling between 5 ± 2°C and 55 ± 2°C for 500 cycles and were then cut longitudinally into two halves using a diamond disk. Marginal adaptation was evaluated using a stereomicroscope, and the values for gap widths were obtained in micrometers. Data were analyzed using two-factor analysis of variance and post hoc tests. There were statistically significant differences in mean marginal gap widths between the adhesive type and preparation groups (p<0.05). The interfacial gap width in bur-prepared cavities was significantly less than that in laser-prepared cavities, and the lowest gap width was observed in Adper Easy One regardless of the type of the preparation.

A new approach to fill tunnel preparations with composites of two different consistencies is presented. Removal of caries through a narrow access space and reliably filling this cavity are the two main problems with tunnel-prepared teeth. Caries removal can be supplemented by the use of hand instruments, especially curettes, but filling the lesion with composite of a single consistency is problematic. Flowable composite alone does not create enough pressure to place the filling material into shallow extensions of the lesion; packable composite does not flow well enough. A solution for this problem may be a dual-consistency technique: flowable composite is placed, followed by packable composite, with no light curing in between. The flowable composite is pressed into small details of the cavity by the pressure created by the packable composite.

Aim: The goal of the study was to evaluate the effect of caries removal by three various methods on the permeability of class II composite resin restorations in primary molar teeth., Materials and Methods: Forty-five recently extracted primary molars were randomly assigned to three groups for three different methods of caries removal; group 1-mechanical, group 2-caries detector dye, and group 3-Carisolv (n = 15). After that, class II cavities in all groups were restored with the adhesive (Opti Bond Solo Plus) that was applied according to the manufacturer's instruction and a posterior composite (Herculite XRV), which was used incrementally. After 24 hours the samples were thermocycled in water for 500 cycles between 5 and 55°C with a dwell time of 30 sec. Permeability was assessed by the fluid filtration method. The data were analyzed using the ANOVA test while study groups were compared with Tukey test for statistically significant differences at a 5% significance level., Results: The evaluation of tested groups indicated that the highest (0.80) and least (0.37) mean of permeability was observed in group 2 and 3 respectively. Significant difference was revealed among the tested groups (p = 0.045). The comparison of Carisolv and caries detector dye groups indicated a statistically significant difference (p = 0.037). There was not any significant difference between Carisolv or caries dye in the conventional group., Conclusion: Using the chemomechanical and staining methods for caries removal had no more detrimental effect on permeability than the conventional technique. However, caries detection dye for caries removal could be more harmful than chemomechanical method., Clinical Significance: None of the current caries-excavation techniques could eliminate permeability in class II composite resin restorations. Furthermore, staining methods do not have an adverse effect on sealing ability in comparison to the conventional technique.

Objectives: To evaluate the proximal contact on class II composite restorations constructed using various restorative approaches by a morphological analysis., Methods: Sixty plastic premolar teeth were prepared for class II cavities. These teeth were divided into six groups and restored using different materials and matrix systems. Two composite materials used were a microhybrid composite Filtek Z100 (3M/ESPE) and a packable composite P60 (3M/ESPE). Three interproximal matrix systems were two circumferential metal matrices (0.05 mm and 0.03 mm thin, respectively) combined with a Tofflemire retainer, and a pre-contoured sectional matrix system (Palodent). The contact morphologies of the restorations were visually inspected with regard to their buccolinugal and mesiodistal aspects. The contact tightness was measured by inserting different amounts of metal strips. For quantitatively morphologic analysis, three-dimensional (3D) scans of proximal contacts were performed. The results were analysed with two-way ANOVA and the Tukey test., Results: Under visual observation, contact surfaces in sectional matrix groups showed anatomic profile but concave in the centre, whilst the circumferential matrix groups showed flat profiles. The sectional matrix improved the contact tightness. The 3D analysis revealed that the matrix system was correlated with the contact morphology, since the sectional matrix generated significantly deeper and wider surface concavity., Conclusions: All the interproximal matrix systems presented some deficiency in either the contact tightness or contours. Although the sectional matrix system enhanced contact tightness, it caused contact concavity by formation of interproximal marginal overhang. The quantitative morphologic analysis helps to examine improper proximal contact and the associated problems., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to investigate the effect of Carisolv(®) on resin composite adhesion on caries-affected dentin., Methods: Carious lesion specimens (N =46) were prepared from 45 extracted primary molars: Group 1 (N =23)-chemomechanical (Carisolv(®)) treatment; Group 2 (N =23)-rotary instrumentation; and Group 3 (N =23)-caries-free specimens from 20 noncarious primary molars. After caries removal (Groups 1 and 2) or washing and drying (Group 3), a resin composite rod (2-mm high, 0.975-mm diameter) was bonded vertically to dentin. Specimens were stressed at constant displacement (1.0 mm/minute) to failure; treated surfaces were examined under a scanning electron microscope., Results: The mean (±SD) microshear bond strengths of resin composite to dentin were: Group 1=6.69 (±4.08) MPa; Group 2=10.31 (±5.47) MPa; and Group 3=7.16 (±6.64) MPa. The mean bond strength of resin composite of Group 2 significantly exceeded that of Groups 1 (P=.02) and 3 (P=.01); Groups 1 and 3 did not differ significantly. There was no significant association between failure mode and treatment type (P=.22) or mean bond strength (P=.44). Carisolv(®) removed the smear layer or limited its formation, producing demineralization incompletely infiltrated by resin composite., Conclusion: Chemomechanical treatment of caries-affected dentin of primary teeth did not adversely affect resin composite bonding.

Objectives: To investigate the influence of cavity preparation (MO/DO/MOD) and type of matrix system on proximal contact tightness of direct posterior composite restorations., Materials and Methods: 85 patients in need of a two- or three surface Class II direct composite restoration were randomly divided into two treatment groups. Group 1 was treated with a sectional matrix system combined with a separation ring (Palodent); Group 2 was treated with a circumferential matrix system in combination with a retainer (Tofflemire). Proximal contact tightness was recorded before treatment and directly after finishing the restoration., Results: For the two-surface cavities use of the separation ring resulted in a statistically significantly tighter proximal contacts at both the mesial and distal site (MO: 2.51±0.81 N; DO: 2.82±1.14 N) compared to the use of the circumferential (MO: -1.08±1.04 N; DO: -0.22±0.87 N) (p=0.01). Regarding the three-surface (MOD) cavities no statistically significant differences were found between the mesial and distal site, nor was there an effect of the used matrix system. No statistically significant influence of cavity design (mesially/distally) was recorded for all cavities (MO, DO and MOD)., Conclusions: Use of the sectional matrix system in two-surface Class II cavities resulted in statistically significantly tighter proximal contacts than the use of the circumferential matrix system. For the three-surface no statistically significant differences in contact tightness were found between the different matrix systems. Location of the cavity (mesially or distally) did not show to have any statistically significant effect on the obtained proximal contact tightness., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The aims of this study were to clarify which steps in approximal restorative procedure were difficult for the final-year undergraduate students at Tokyo Medical and Dental University, and to examine the relationship between perception of difficulty and clinical experience. At mid-term of the clinical education experience, a self-questionnaire was performed by final-year undergraduate students to clarify the difficulty of restorative procedures at the time. There were statistically significant differences in the number of clinical cases experienced at the time between students who designated the matrix application, shade selection and finishing as the easy steps and those who considered them as the difficult ones (Fisher exact test with Bonferroni correction, p < 0.05). There was a significant difference in the total number of procedures designated as difficult between students who had treated above 15 cases and those who had fewer than 15 cases (Wilcoxon rank-sum test, p< 0.05). In the final-year clinical education for operative dentistry, students might need to treat over 15 cases to gain confidence in performing approximal composite restorations independently.

This study evaluated the two-year clinical performance of two minimally invasive cavity preparation techniques, bur and laser, in Class I occlusal resin composite restorations. Twenty-seven patients, each having at least one pair of occlusal caries, were enrolled in this study. For each patient, one of the cavities was prepared with a diamond bur, and the other was prepared with Er, Cr:YSGG laser. The cavities were restored with a nanofilled flowable resin composite, Grandio Flow, using an etch-and-rinse adhesive, Solobond M. A total of 108 restorations were placed in molars by a single operator. The restorations were evaluated according to modified Cvar/Ryge criteria. The evaluations were performed at baseline, 6, 12, 18 and 24 months after initial placement by two calibrated operators. The Chi-square and Fisher's exact test were used for statistical analysis. All the patients were available during all evaluated periods, resulting in a recall rate of 100%. The retention rates of the restorations at 24 months were 98.1% for bur and 100% for the laser-prepared group. After 24 months, 5.6% of the bur-prepared and 7.4% of the laser-prepared restorations were rated Bravo in marginal discoloration (p > 0.05). Bur-prepared (9.3%) and laser-prepared (13%) restorations were rated Bravo in marginal adaptation (p > 0.05). There were no significant differences between the two cavity preparation techniques regarding the evaluated parameters (p > 0.05). Both cavity preparation techniques performed equally, with excellent outcomes after a 24-month period.

Purpose: This in vitro study evaluated the efficiency of various types of matrices in reconstructing the proximal contact area in Class II resin composite restorations., Materials and Methods: Standardized MO cavities were prepared on artificial molars of a manikin model. Resin composite (Spectrum TPH-3) restorations were placed using the following matrices (n=10): a) circumferential straight metal matrix with Tofflemire retainer-A, b) circumferential pre-contoured metal matrix system-B (Adapt SuperCap), c) circumferential pre-contoured transparent matrix system-C (Adapt SuperCap) and d) sectional pre-contoured metal matrix system-D (Palodent). After completion of each restoration, the manikin model was fixed on a tension-meter apparatus and an orthodontic wire was used to assess the contact tightness (CT), length of contact arc (LCA) and position of contact point relative to LCA% (PCP). The same measurements were performed on a group of intact molars (REF). The results were statistically analyzed with one-way ANOVA and the Tukey test, as well as the unpaired t-test (alpha=0.05)., Results: Matrix D provided the highest CT with the highest LCA, which presented a statistical difference relative to the intact tooth. Restorations with matrix B provided higher LCA than those with matrices A and C, which were found to be comparable to that of an intact tooth. The contact points (PCP) of the filled teeth were located more cervically in matrix D relative to the intact tooth (lower PCP), whereas matrices A, B and C showed more occlusal location (higher PCP)., Conclusions: Differences were noted among all the matrices evaluated and none was proven sufficient to reconstruct the proximal contact characteristics of an intact tooth.

When placing posterior composite resin restorations, clinicians often struggle to achieve good contacts. Frequently contacts that are successful are only confined to the occlusal aspect of the proximal wall. A clinical technique is discussed which achieves the correct contour as well as tight contacts. The technique is also minimally invasive and highly aesthetic.

Class V restorations are a very common occurrence in clinics. Some reasons include an increase in non-carious cervical lesions (NCCL), root caries and the elderly population. Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, finishing and polishing procedures. This technique demonstrates an alternative isolation and insertion method using photocured gingival barrier in association with a flowable resin and hybrid resin composite to recreate the gingival wall with minimum or no excess.

Considering the increase in esthetic restorative materials and need for improvement in unsatisfactory restoration substitution with minimal inadvertent removal of healthy tissues, this study assessed the efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser for composite resin removal and the influence of pulse repetition rate on the morphological analyses of the cavity by scanning electron microscope. Composite resin fillings were placed in cavities (1.0 mm deep) prepared in bovine teeth, and the 75 specimens were randomly assigned to five groups according to the technique used for composite filling removal (high-speed diamond bur, group I, as a control, and Er:YAG laser, 250 mJ output energy and 80 J/cm(2) energy density, using different pulse repetition rates: group II, 2 Hz; group III, 4 Hz; group IV, 6 Hz; group V, 10 Hz). After the removal, the specimens were split in the middle, and we analyzed the surrounding and deep walls to check for the presence of restorative material. The estimation was qualitative. The surfaces were examined with a scanning electron microscope. The results revealed that the experimental groups presented bigger amounts of remaining restorative material. The scanning electron microscopy (SEM) analyses showed irregularities of the resultant cavities of the experimental groups that increased proportionally with increase in repetition rate.

Objective: The objective of the current study was to compare in-vitro the proximal contact tightness (PCT) of Class II resin composite restorations (RCR) placed with different established and new placement techniques., Methods: 105 ivorine lower left first molars with standardized MO cavities were randomly divided into seven groups (n = 15) as follows: SRing: sectional matrix and separation ring (Garrison Dental); CRing: circumferential matrix (1101-c, KerrHawe SA) with separation ring; CWedge: circumferential matrix with a wedge only; COptra: circumferential matrix and OptraContact (Vivadent); CCerana: circumferential matrix and a Cerana insert (Nordiska Dental); CElliot: circumferential matrix and Elliot separator (PFINGST & Co) and Walser: Walser matrix O-type (Dr Walser Dental GmbH). In all the groups, the matrix band was secured using a wooden wedge except for the Walser group, following manufacturer's recommendations. A Tofflemire retainer (Kerr Corporation) was used to apply the circumferential matrix band whenever it was used. All the prepared teeth were restored with resin composite (Premise, Kerr) mounted in a manikin head to simulate the clinical environment. PCT was measured using the Tooth Pressure Meter (University of Technology, Delft). The data were analyzed using one-way ANOVA and Tukey post-hoc tests (p < 0.05)., Results: Compared to the control group (SRing) (6.64 +/- 1.06N), all other systems resulted in significantly lower PCT values (p < 0.001). Within the circumferential matrix groups, CRing (4.01 +/- 0.53N) and CElliot (4.29 +/- 1.08N) showed significantly tighter contacts compared to the CWedge (0.37 +/- 0.22N), COptra (0.91 +/- 0.49N), CCerana (2.99 +/- 1.98N) and Walser (1.34 +/- 0.55N) (p < 0.05) group. Between CWedge and COptra, no significant difference was found (p = 0.57)., Conclusion: The use of separation rings with sectional matrices provides superior contacts when placing Class II RCRs.

Aim: To analyze the influence of various placement techniques on Vickers microhardness of Class II cavities restored using resin composite in different depths and layers., Methods and Materials: Sixty-four standardized Class II cavities (5.0 x 3.0 x 1.5 mm3) were prepared in sound human, maxillary premolars. The cavities were divided into four experimental groups (n=16) according to the composite placement technique used: incremental technique using a Palodent matrix (IP), incremental technique using a transparent matrix (IT), centripetal technique using a Palodent matrix (CP), and the centripetal technique using a transparent matrix (CT). The cavities were restored with Single Bond, Z100 composite resin system. After 24 hours of storage in envelopes in an amber-colored box, the restorations were finished, polished, and kept for one week before conducting a hardness test. The microhardness test was carried out using a 0.5 kg load for 20 seconds at different depths and layers of proximal surfaces. Statistical analysis was done using a t-test, ANOVA, and a Tukey's test (alpha=0.05)., Results: In contrast, the matrix bands, the methods of composite insertion, had a significant effect on hardness. The greatest surface hardness of resin composite was related to the use of the centripetal technique and a transparent matrix (p<0.05). With regard to cavity depths, the hardness at the top surface was significantly greater, followed by the middle and bottom cavity depths. A greater hardness was obtained in the mesial-distal direction within the external layer compared with the middle and internal layers using the centripetal method (p<0.05)., Conclusion: The kind of matrix and filling technique could have a significant effect on surface microhardness. The top surface had the greatest hardness in comparison to different depths. In the centripetal technique, the external layer of the proximal wall had greater hardness than the other layers., Clinical Significance: While the microhardness of all of the experimental placement techniques in the different depths and layers was within a clinically acceptable range, the greatest hardness was obtained using the centripetal technique with a transparent matrix, making it the technique of choice.

Purpose: The objective of this in vitro study was to compare the degree of microleakage of composite restorations performed by lasers and conventional drills associated with two adhesive systems., Materials and Methods: Sixty bovine teeth were divided into 6 groups (n = 10). The preparations were performed in groups 1 and 2 with a high-speed drill (HD), in groups 3 and 5 with Er:YAG laser, and in groups 4 and 6 with Er,Cr:YSGG laser. The specimens were restored with resin composite associated with an etch-and-rinse two-step adhesive system (Single Bond 2 [SB]) (groups 1, 3, 4) and a self-etching adhesive (One-Up Bond F [OB]) (groups 2, 5, 6). After storage, the specimens were polished, thermocycled, immersed in 50% silver nitrate tracer solution, and then sectioned longitudinally. The specimens were placed under a stereomicroscope (25X) and digital images were obtained. These were evaluated by three blinded evaluators who assigned a microleakage score (0 to 3). The original data were submitted to Kruskal-Wallis and Mann-Whitney statistical tests., Results: The occlusal/enamel margins demonstrated no differences in microleakage for all treatments (p > 0.05). The gingival/dentin margins presented similar microleakage in cavities prepared with Er:YAG, Er,Cr:YSGG, and HD using the etch-and-rinse two-step adhesive system (SB) (p > 0.05); otherwise, both Er:YAG and Er,Cr:YSGG lasers demonstrated lower microleakage scores with OB than SB adhesive (p < 0.05)., Conclusion: The microleakage score at gingival margins is dependent on the interaction of the hard tissue removal tool and the adhesive system used. The self-etching adhesive system had a lower microleakage score at dentin margins for cavities prepared with Er:YAG and Er,Cr:YSGG than the etch-and-rinse two-step adhesive system.

Objective: The objective of this study was to investigate the effect of different Er,Cr:YSGG laser parameters on the morphology of irradiated dentine and the shear bond strength between resin composites and irradiated dentine., Materials and Methods: Dentine specimens prepared from extracted human third molars were randomly assigned to six groups, including one receiving phosphoric acid etching, and five others with different laser parameters: 5 W for 30 sec, 2.5 W for 30 sec, 2.5 W for 60 sec, 1.5 W for 30 sec, and 1.5 W for 100 sec. Surface morphology was examined using a scanning electron microscope (SEM). Average roughness (Ra) was determined with a profilometer. Bonding of resin composites to the dentine specimens was tested in shear mode., Results: The dentine surfaces irradiated by the Er,Cr:YSGG laser showed a scaly and rugged appearance and open dentinal tubules without smear layer production. The 5-W-irradiated group had the highest roughness value (p < 0.05). One-way ANOVA revealed that the shear bond strength of resin composites to the laser-irradiated dentine ranged from 12.35-15.61 MPa, and was not significantly (p > 0.05) different from the bond strength seen in the acid-etched dentine of 19.06 MPa. However, the surface roughness of the laser-irradiated dentine was significantly (p < 0.05) higher than that of the acid-etched dentine., Conclusions: The 5-W power setting may be suitable for dental restoration applications in terms of shear bond strength and activation area.

This aim of this study was to determine the effect of type of bur and resin-coating material on microtensile bond strength (microTBS) of indirect composite to dentin. Dentin surfaces were first ground with two types of diamond bur and resin-coated using UniFil Bond (UB) or Adper Single Bond (SB), and then bonded to a resin composite disc for indirect restoration with adhesive resin cement. After storage for 24 hr in distilled water at 37 degrees C, microTBS was measured (crosshead speed 1 mm/min). When UB was applied to dentin prepared using the regular-grit diamond bur, microTBS was significantly lower than that in dentin prepared using the superfine-grit bur. In contrast, no significant difference was found between regular-grit and superfine-grit bur with SB. However, more than half of the superfine-grit specimens failed before microTBS testing. These results indicate that selection of bur type is important in improving the bond strength of adhesive resin cement between indirect resin composite and resin-coated dentin.

Aim: The aim of this study was to evaluate how cavity preparation and primer application methods influence the adhesion of composite resin to dentin using a self-etching system., Methods and Materials: Forty-eight extracted, sound human molars were divided into six groups (n=8) according to the method used for the surface preparation of the teeth (#600-grit paper disc, diamond bur, and Er:YAG laser) and the primer application method utilized (active or passive). Following the adhesive procedure using a self-etching system, 5 mm high composite buildups were created with Z-250 composite resin. After storage in water at 37 degrees C for 24 hours, the specimens were vertically sectioned into serial 1 mm2 sticks and tested for microtensile strength (micro-TBS). Nine additional molars were prepared for morphological analysis using scanning electron microscopy (SEM)., Results: Statistical analysis showed surface preparation technique (p < 0.00) and primer application methods (p < 0.001) do influence bond strength of the self-etching system tested. The best adhesion was achieved with specimens having the dentin ground with sandpaper followed by those ground with diamond burs. The worst bonding was obtained with Er:YAG laser ablated dentin. The active primer application method increased bonding performance compared to the passive method., Conclusions: Within the limitations of the study, it can be stated surface treatment can influence the bond strength of the self-etching system tested and the active primer application method is more effective in achieving success in bonding to dentin compared with the passive application method., Clinical Significance: Clinicians should use the active application method to apply a mild acidic self-etching primer along with an appropriate tooth surface preparation to facilitate the bond strength between dentin and composite resin.

Background: Evaluation of microleakage is important for assessing the success of new methods for surface preparation and new adhesive restorative materials. The aim of this laboratory study was to assess microleakage at the margins of composite restorations in Er,Cr:YSGG laser prepared cavities on the cervical aspects of teeth by means of dye penetration, and compare this with conventionally prepared and conditioned cavities., Methods: Class V cavities were produced on sound extracted human teeth, which had been assigned randomly to one of three groups (N = 10 each), as follows: Group 1 - prepared using a diamond cylindrical bur and then treated with 37% phosphoric acid; Group 2 - irradiated with an Er,Cr:YSGG laser (Biolase Waterlase) and then treated with 37% phosphoric acid; Group 3 - irradiated only with the laser. After application of bonding agent (Excite, Ivoclar Vivadent), all cavities were restored with composite resin (Heliomolar). After polishing the restorations, the teeth were thermocycled from 5-50 degrees C for 500 cycles. Dye leakage was assessed after immersion in methylene blue, by examining longitudinal sections in a stereomicroscope at x 30 magnification., Results: The extent of dye penetration was lowest in the laser only group (Group 3). Penetration of dye to dentine and axial walls occurred in 80 per cent of conventionally prepared (bur + acid) specimens, but in the laser group, dye penetration to the axial wall occurred in only 30 per cent of cases. There was a strong statistical association between treatment group and the distribution of microleakage scores (Chi-square, P = 0.0023)., Conclusions: For Class V cavities, with the adhesive materials employed, higher microleakage occurs with phosphoric acid etching of bur- or laser-cut surfaces, than with the surface created by use of the laser alone without additional conditioning.

Purpose: To evaluate in vitro the influence of water flow rate on shear bond strength of a resin composite to enamel and dentin after Er:YAG cavity preparation., Methods: Ten bovine incisors were selected and roots removed. Crowns were sectioned in four pieces, resulting in 40 samples that were individually embedded in polyester resin (n = 10), and ground to plane the enamel and expose the dentin. The bonding site was delimited and samples were randomly assigned according to cavity preparation: (1) Er:YAG/1.0 mL/minute; (2) Er:YAG/1.5 mL/minute; (3) Er:YAG/2.0 mL/minute and (4) High speed handpiece/bur (control group). Samples were fixed to a metallic device, where composite resin cylinders were prepared. Subsequently, they were stored for 24 hours and subjected to a shear bond strength test (500N at 0.5 mm/minute)., Results: Means (MPa) were: enamel: 1: 12.8; 2: 16.8; 3: 17.5; 4: 36.0 and Dentin: 1: 13.6; 2: 18.7; 3: 12.1; 4: 21.3. Data were submitted to ANOVA and Tukey's test. Adhesion to enamel was more efficient than for dentin. The cavities prepared with conventional bur (control) presented higher statistically significant bond strength values (P < 0.05) than for Er:YAG laser for both enamel and dentin. No significant differences were observed between water flow rates employed during enamel ablation. For dentin, the shear bond strength of 2.0 mL/minute water flow rate was lower than for 1.5 mL/minute and 1.0 mL/minute rates. The Er:YAG laser adversely affected shear bond strength of resin composite to both enamel and dentin, regardless of the water flow rate used.

The purpose of this study was to investigate the tensile bond strength of composite inlays to human dentin with two different cavity preparation tools (bur versus Er, Cr: YSGG laser) and with two different bonding procedures (total-etch: Variolink II versus self-etch: Maxcem). The specimens were divided into four groups: bur-cut/Variolink II, bur-cut/Maxcem, laser-ablated/Variolink II, and laser-ablated/Maxcem. The following characteristics were then investigated: morphological change, dentin-resin cement interface, surface roughness, and tensile bond strength. Results demonstrated that the tensile bond strengths of the four groups were 19.11 +/- 5.88 MPa, 8.54 +/- 2.38 MPa, 13.72 +/- 3.43 MPa, and 12.11 +/- 3.71 MPa, respectively. We concluded that Variolink II provided higher tensile bond strength to composite inlays than Maxcem. On the other hand, the bond strength of Variolink II with dentin cavity prepared by Er, Cr: YSGG laser was statistically lower than that prepared by bur.

Aim: The aim of this study was to evaluate the influence of chlorhexidine on microleakage of composite restorations in class V cavities prepared with a carbide bur (CB) and a erbium:yttrium-aluminum-garnet (Er:YAG) laser., Methods and Materials: Cavity preparations were created on the buccal surfaces of 48 bovine incisors using different methods then equally dividing them into four groups. Groups I and II were prepared with a #56 CB in a high speed handpiece while Groups III and IV were prepared with a Er:YAG laser at 350m J/4Hz on enamel and at 80.24 J/cm2 on dentin. The cavity preparations were rinsed with 2% chlorhexidine solution before the application of Clearfill SE Bond system and placement of a Z100 composite resin restoration. After 24 hours, the teeth were polished, thermocycled, and sealed with cosmetic varnish. The samples were then immersed in 2% methylene blue for four hours and sectioned in the buccolingual direction to determine the degree of microleakage., Results: After statistical analysis (Kruskal-Wallis, p<0.05), no significant differences were verified among the tested groups and between the evaluated cervical or incisal margins of the restoration., Conclusion: The use of the chlorhexidine did not interfere with the adhesion process regardless of whether a CB or the Er:YAG laser were used to prepare class V cavities when restored with the tested self-etching adhesive system.

The increasing knowledge of microhybrid composite materials has offered clinicians multiple restorative options. The use of products that guarantee a high adhesive capacity, isolation via rubber dam, and anatomic shaping with thin layering and adequate cyclic polymerization are the bases for a predictable result. Further, a finishing and polishing system that takes into account the superficial roughness and esthetic characteristics of the restorative material is the final element of a restoration that has been fabricated following correct treatment guidelines. This article aims to provide a protocol for the management of direct resin composite restorations and to discuss the correct operative sequence, particularly for the restoration of Class II cavity preparations.

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 B > D > C (p < or = 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.

Objectives: As the bond strength of composite resin to Er,Cr:YSGG laser-irradiated dentin has not yet been evaluated, the objectives of this study were to investigate the tensile bond strength and to analyze the resin-dentin interface among bur-cut/acid-etched, Er,Cr:YSGG laser-ablated/acid-etched and Er,Cr:YSGG laser-ablated human dentin., Methods: Crown dentin disks prepared from extracted human third permanent molars were used for the observation of surface morphological changes by scanning electron microscope (SEM). The laser energy parameters were 3.5 W and 20 Hz with water spray (air pressure level, 80%; water pressure level, maximum level). Another group of crown dentin disks were prepared for composite resin restoration and observation of resin-dentin bond interface after demineralization in 6N hydrochloric acid (HCl) for 1 min and deproteinization in 1% sodium hypochlorite solution (NaOCl) for 10 min. The tensile bond strengths of the three groups were measured by a universal testing machine at a crosshead speed of 0.5 mm/min. Fracture types at the dentin-resin interface were analyzed using the digital stereoscopic microscope and fractured surfaces of the debonded specimens were examined by SEM., Results: All three groups showed that the treated surfaces were free of dentin debris and smear layer. The peritubular dentin protruded from the surrounding intertubular dentin after laser irradiation. The dentin-resin interface treated with Er,Cr:YSGG laser irradiation and acid etching demonstrated numerous resin tags converging into a bulge and then diverging again. The length of resin tags was greater than 100 microm. The tensile bond strengths of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were 5.37+/-1.51, 5.17+/-1.41 and 3.29+/-0.86 MPa, respectively. No statistical significance was found between the bur-cut/acid-etched and laser-ablated/acid-etched groups. The predominant fracture modes of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were Type 1 (50%), Type 2 (70%) and Type 1 (70%), respectively., Significance: Er,Cr:YSGG laser irradiation affects adversely adhesion of resin to dentin but acid etching following laser irradiation could increase the tensile bond strength as high as that of bur-cut/acid-etched human dentin.

Purpose: To find the most appropriate Er:YAG laser parameters for an optimal marginal adaptation of Class V restorations in enamel and dentin., Methods: Six saucer-shaped mixed Class V cavities were prepared in each of the eight experimental groups with an Erbium:YAG hard laser (Opus Duo) on extracted human molars in near contact mode with a conical 800 microm sapphire tip under continuous water spray by using different pulse energy and pps (pulse per second) parameters. The cavities were restored under the simulation of dentin fluid with Clearfil SE Bond and Clearfil APX PLT composite applied in two layers and light-cured. Marginal adaptation in enamel and dentin was quantified before and after simultaneous thermal (5-50-5 degrees C, 2 minutes each) and mechanical (max. 49N; 1,200,000 cycles) stresses by using the replica technique in a SEM under x200 magnification., Results: With the exception of dentin margins before loading, significant differences for percentages of "continuous margin" and "enamel fractures" were detected before and after loading (P < 0.05, ANOVA, Student's t-test). A pulse energy of 100 mJ both on dentin and enamel was found optimal for finishing and smoothing the preparation margins after cavity preparation with 500 mJ or more.

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 (Prime & Bond 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.

Composite restorations should bring out the artist in the dentist. Today's composites are made to produce highly aesthetic, functioning restorations. There are several systems from which practitioners can choose, and the techniques for each system can be daunting. Composite restorations are conservative and a viable alternative, if proper protocol is followed. Each manufacturer has its own steps for applying its composites; however, by following the sound basic principles for bonded restorations, the practitioner can apply these procedures to every composite system. Thus, by utilizing proper techniques and understanding the material, one can both achieve a predictable outcome and desired aesthetics. The case study presented here illustrates the necessary steps required to achieve an anatomical, functional and aesthetic restoration.

Purpose: The purpose of this study was to assess in vitro the influence of 3 cavity preparation devices (carbide bur, Er:YAG laser, and air abrasion) on the microleakage of flowable composite restorations in primary teeth., Methods: Fifteen primary second molars were selected, and Class V cavities were prepared on the buccal/lingual surfaces, being assigned to 3 groups (n= 10). Group 1 (control) was prepared using a high-speed handpiece and was acid etched. Group 2 was prepared and treated with a Er:YAG laser (400mJ/4Hz and 80mJ/4Hz, respectively) and was acid etched. Group 3 was prepared and treated with an air abrasion system and was acid etched. Cavities were restored and stored for 7 days. Restorations were polished, thermocycled, immersed in 0.2% rhodamine B, sectioned, and analyzed for leakage., Results: Er:YAG laser-prepared cavities showed the highest degree of infiltration. The performance of the air abrasion device was comparable to that of the high-speed handpiece., Conclusion: It may be concluded that the method of cavity preparation affected the microleakage of Class V cavities restored with flowable composite in primary teeth.

Purpose: To investigate in vivo and in vitro Class II composite restorations performed with two matrix and wedge systems., Materials and Methods: One hundred nine Class II restorations were performed in 23 patients, 59 with metallic matrices and wooden wedges (group 1) and 50 with polyester matrices and reflective wedges (group 2). All cavities were restored using Single Bond and P-60 (3M ESPE). In the metal matrix group, polymerization was performed from the occlusal, and in the polyester group through the reflective wedge. To assess microleakage, 40 proximal standard slot cavities were prepared in 20 noncarious human third molars. In the mesial cavity, the gingival margin was located at the enamel level, and in the distal cavity at the cementum/dentin. Specimens were randomly divided into two groups (n = 20) and restored with Single Bond, Z-250 (3M ESPE), and the same techniques used in the in vivo study: metal matrix/wooden wedge (group 1) and polyester matrix/reflective wedge (group 2). Specimens were thermocycled (500 times, 5 degrees C to 55 degrees C), then isolated with nail varnish and immersed in fuchsin for 8 h. Specimens were sectioned longitudinally and microleakage was assessed under magnification (40X) using a standard scoring system., Results: Data were subjected to the chi-square test, Mann-Whitney U-test, and Kruskal-Wallis H-test. Matrix systems presented similar results in the clinical evaluation and the in vitro microleakage test of Class II composite restorations. Dye leakage was minimal at enamel margins, and statistically lower (p < 0.05) than at cementum/dentin margins., Conclusion: The different matrix systems had no influence on clinical performance or in vitro sealing ability of Class II composite restorations.