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Introduction: The aim of this study was to perform a descriptive analysis of the occurrence of external cervical resorption (ECR) in relation to the patients' characteristics (sex, age, and tooth type) and the potentially involved predisposing factors., Methods: This study includes data on 284 patients (337 teeth with evidence of ECR) referred to the University Hospital Leuven (Leuven, Belgium) and Endo Rotterdam (Rotterdam, the Netherlands) for diagnosis and treatment from 2010 to 2015. The medical history, existing radiographs, and dental records were available for evaluation. Each patient was then interviewed followed by a thorough clinical and radiographic examination. Intraoral pictures using a dental operating microscope and digital camera were taken during clinical examination. The radiographic examination consisted of digital periapical radiography and/or cone-beam computed tomographic imaging. A review of existing literature provided a potential predisposing factor checklist for ECR. The clinical data were correlated with the dental and medical history of each patient in an attempt to identify some potential predisposing factor(s) that could contribute to ECR. The frequency of the occurrence of ECR was correlated with tooth type, sex and age of the patient, and each 1 of the recorded potential predisposing factor(s)., Results: From the examined teeth (337) with ECR, 175 (54%) were found in male patients and 162 (46%) were found in female patients. In 59% of the cases, more than 1 potential predisposing factor was identified. Most ECR cases were observed on maxillary central incisors (29%) followed by maxillary canines (14%), mandibular molars (14%), and maxillary premolars (11%). In addition, most ECR cases were observed on maxillary teeth (72%). The most frequently appearing factor was orthodontics (45.7%). Other frequently observed factors were trauma (28.5%), parafunctional habits (23.2%), poor oral health (22.9%), malocclusion (17.5%), and extraction of a neighboring tooth (14%)., Conclusions: The data indicate that ECR is not related to patient sex. ECR occurs most often in the maxillary central incisor. In the majority of the cases, more than 1 potential predisposing factor was identified, indicating that ECR may be mainly multifactorial. The most frequently appearing factors were orthodontics, iatrogenic or accidental trauma, and poor oral health. This information may be helpful in diagnosing ECR at an early stage when screening patients presenting with these predisposing factors., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To analyse the effect of leucocyte- and platelet-rich fibrin (L-PRF) on bone regeneration procedures and osseointegration., Materials and Methods: An electronic and hand search was conducted in three databases (MEDLINE, EMBASE and Cochrane). Only randomized clinical trials, written in English where L-PRF was applied in bone regeneration and implant procedures, were selected. No follow-up restrictions were applied., Results: A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation and implant therapy. In SFE, for a lateral window as well as for the trans-alveolar technique, histologically faster bone healing was reported when L-PRF was added to most common xenografts. L-PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L-PRF was applied. Meta-analyses could not be performed due to the heterogeneity of the data., Conclusions: Despite the lack of strong evidence found in this systematic review, L-PRF might have a positive effect on bone regeneration and osseointegration., (© 2016 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

Aim: To analyse the regenerative potential of leucocyte- and platelet-rich fibrin (L-PRF) during periodontal surgery., Materials and Methods: An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow-up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta-analysis was performed., Results: Twenty-four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra-bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta-analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L-PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L-PRF to OFD. When L-PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05)., Conclusions: L-PRF enhances periodontal wound healing., (© 2016 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

Introduction: The aim of this study was to investigate the 3-dimensional (3D) structure and the cellular and tissue characteristics of external cervical resorption (ECR) in vital teeth and to understand the phenomenon of ECR by combining histomorphological and radiographic findings., Methods: Twenty-seven cases of vital permanent teeth displaying ECR were investigated. ECR diagnosis was based on clinical and radiographic examination with cone-beam computed tomographic imaging. The extracted teeth were further analyzed by using nanofocus computed tomographic imaging, hard tissue histology, and scanning electron microscopy., Results: All examined teeth showed some common characteristics. Based on the clinical and experimental findings, a 3-stage mechanism of ECR was proposed. At the first stage (ie, the initiation stage), ECR was initiated at the cementum below the gingival epithelial attachment. At the second stage (ie, the resorption stage), the resorption invaded the tooth structure 3-dimensionally toward the pulp space. However, it did not penetrate the pulp space because of the presence of a pericanalar resorption-resistant sheet. This layer was observed to consist of predentin, dentin, and occasionally reparative mineralized (bonelike) tissue, having a fluctuating thickness averaging 210 μm. At the last advanced stage (ie, the repair stage), repair took place by an ingrowth and apposition of bonelike tissue into the resorption cavity. During the reparative stage, repair and remodeling phenomena evolve simultaneously, whereas both resorption and reparative stages progress in parallel at different areas of the tooth., Conclusions: ECR is a dynamic and complex condition that involves periodontal and endodontic tissues. Using clinical, histologic, radiographic, and scanning microscopic analysis, a better understanding of the evolution of ECR is possible. Based on the experimental findings, a 3-stage mechanism for the initiation and growth of ECR is proposed., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: An immunohistological study of an infected immature permanent human tooth after a regenerative endodontic procedure (REP) was conducted in order to determine the histologic outcome of this procedure. Besides observed signs of angiogenesis and neurogenesis, repair and/or regeneration of the pulp-dentin complex was also investigated., Materials and Methods: A REP was performed on tooth 45 of a 10-year-old girl. Eleven months post-treatment, the tooth had to be removed for orthodontic reasons. The following investigations were performed: immunohistology and radiographic quantification of root development. After hematoxylin-eosin (HE) staining, the following immunomarkers were selected: neurofilament (NF), pan cytokeratin (PK), osteocalcin (OC), and CD34., Results: The REP resulted in clinical and radiographic healing of the periradicular lesion and quantifiable root development. The HE staining matches with the medical imaging post-REP: underneath the mineral trioxide aggregate a calcified bridge with cell inclusions, connective pulp-like tissue (PLT) with blood vessels, osteodentin against the root canal walls, on the root surface cementum (Ce), and periodontal ligament (PDL). The PDL was PK(+). The blood vessels in the PLT and PDL were CD34(+). The Ce, osteodentin, and stromal cells in the PLT were OC(+). The neurovascular bundles in the PLT were NF(+)., Conclusions: Immunohistologically, REP of this infected immature permanent tooth resulted in an intracanalar connective tissue with a regulated physiology, but not pulp tissue., Clinical Relevance: REP of an immature permanent infected tooth may heal the periapical infection and may result in a combination of regeneration and repair of the pulp-dentin complex.

Morphea is an inflammatory disorder of the skin and underlying tissues characterized by an overabundance of collagen leading to fibrosis. The prevalence of this disease is estimated at around 0.4-2.7/100,000 people. When the process occurs in the gingival tissues, it induces traction, which can cause gingival recession. A 19-year-old woman was referred to the clinic for a progressive recession on teeth 11 and 12. A pale, atrophic, linear region extending from her nose to her upper lip on the right-hand side of her face was diagnosed as morphea en coup de sabre. Cone beam computed tomography, quantitative polymerase chain reaction and histologic evaluation were used to assess the pathology. Treatment with methotrexate was conducted. After 12 months, no progression of the recession could be observed., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: The routine use of high-resolution images derived from 3-dimensional cone-beam computed tomography (CBCT) datasets enables the linear measurement of lesions in the maxillary and mandibular bones on 3 planes of space. Measurements on different planes would make it possible to obtain real volumetric assessments. In this study, we tested, in vitro, the accuracy and reliability of new dedicated software developed for volumetric lesion assessment in clinical endodontics., Methods: Twenty-seven bone defects were created around the apices of 8 teeth in 1 young bovine mandible to simulate periapical lesions of different sizes and shapes. The volume of each defect was determined by taking an impression of the defect using a silicone material. The samples were scanned using an Accuitomo 170 CBCT (J. Morita Mfg Co, Kyoto, Japan), and the data were uploaded into a newly developed dedicated software tool. Two endodontists acted as independent and calibrated observers. They analyzed each bone defect for volume. The difference between the direct volumetric measurements and the measurements obtained with the CBCT images was statistically assessed using a lack-of-fit test. A correlation study was undertaken using the Pearson product-moment correlation coefficient. Intra- and interobserver agreement was also evaluated., Results: The results showed a good fit and strong correlation between both volume measurements (ρ > 0.9) with excellent inter- and intraobserver agreement., Conclusions: Using this software, CBCT proved to be a reliable method in vitro for the estimation of endodontic lesion volumes in bovine jaws. Therefore, it may constitute a new, validated technique for the accurate evaluation and follow-up of apical periodontitis., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aims of this study are to determine the extent to which the ranking order for clinical Contact-Free-Occlusal-Area (CFOA) wear performance of composites correlates with the ranking based on in vitro scratch hardness, and to analyze the extent to which the microstructure influences the overall trend., Materials and Methods: The patient data and CFOA wear measurements of 16 Tetric-C, 17 Tetric-EC, 16 Gradia-DP, 18 Filtek Supreme, 19 Z100 restorations in 31 subjects (8 males, 23 females) of two randomized clinical trials were fitted in a mixed-effect model. The in vivo performance of the restoratives was summarized by ranking the estimated material-related coefficients in the model. Scratch tests on two specimens per composite were run at a constant speed of 0.05 mm/s under indenter with normal loads of 15, 25, and 35 mN. Scratch width, depth and hardness calculated by imaging the scratch tracks were summarized in a model, the material-related coefficients were ranked and correlated with that of in vivo ranking order., Results: The best in vivo model included as significant factors (p<0.0001) the variables material, time/month, cavity type, and jaw type. The CFOA wear ranking order - Filtek Supreme, Z100>Tetric-C, Tetric-EC>Gradia-DP-correlated closely (R(2)=0.991) with the order of scratch hardness - Z100>Filtek Supreme>Tetric-C, Tetric-EC>Gradia-DP., Significance: Scratch tests could roughly categorize a new material as to whether it will probably exhibit a high or low in vitro scratch resistance and/or clinical CFOA wear rate., (Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study aims to evaluate the influence of different surface preparation techniques on long-term bonding effectiveness to eroded dentin., Materials and Methods: Dentin specimens were eroded by pH cycling or were left untreated as control, respectively. Five different "preparation" techniques were applied: (1) cleaning with pumice, (2) air abrasion, (3) silicon polisher, (4) proxo-shape, and (5) diamond bur. The three-step etch-and-rinse adhesive OptiBond FL (O-FL; Kerr) and the mild two-step self-etch adhesive Clearfil SE Bond (C-SE; Kuraray) were evaluated. Micro-tensile bond strength was measured after water storage for 24 h and 1 year. Fracture analysis was performed by stereomicroscopy and SEM. Interfaces were characterized by TEM. Differences were statistically analyzed with a linear mixed effects model (α = 0.05)., Results: Erosion reduced bond strength in all groups, but this effect was less prominent when eroded dentin was prepared by diamond bur. Storage lowered bond strength in almost all groups significantly, but this ageing effect was more prominent for the eroded surfaces than for non-eroded controls. Whereas after 1-year control specimens revealed superior bond strength with the three-step etch-and-rinse adhesive (O-FL), the mild two-step self-etch adhesive (C-SE) revealed a better 1-year bond strength to eroded dentin. The interface at eroded dentin appeared very prone to degradation as was shown by the increased amount of adhesive failures and by the silver infiltration detected by TEM., Conclusions and Clinical Relevance: Although a minimally invasive approach should clinically always be strived for, superficial preparation (or minimal roughening) with a diamond bur is recommendable for long-term bonding to eroded dentin.

This 13-year randomized clinical trial compared the clinical effectiveness of two three-step etch-and-rinse adhesives in combination with a hybrid, stiffer composite versus a micro-filled, more flexible composite. The influence of composite stiffness on the clinical performance of one of the adhesives was assessed as well. One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness. Seventy-one patients randomly received two cervical restorations placed following two out of three adhesive procedures: (1) the three-step etch-and-rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid (PMQ-H, Ultradent), (2) Permaquick applied with the more flexible micro-filled Amelogen Microfill (PMQ-M, Ultradent), or (3) the "gold-standard" three-step etch-and-rinse adhesive Optibond FL applied with the micro-hybrid composite Prodigy (OFL-P, Kerr). The restorations were evaluated after 6 months, 1, 2, 3, 5, 7, and 13 years of clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality, and post-operative sensitivity. Retention loss, severe marginal defects, and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. The recall rate at 13 years was 77%. Bond degradation after 13 years was mainly characterized by a further increase in the presence of small but clinically acceptable marginal defects and superficial marginal discoloration. Twelve percent of the OFL-P restorations were clinically unacceptable. In the PMQ group, 22% of the PMQ-M restorations and 26% of the PMQ-H restorations needed repair or replacement. Regarding the clinical failure rate, Optibond FL scored significantly better than Permaquick (McNemar; p = 0.015). No statistically significant differences were found between the micro-filled and the hybrid composite for each of the parameters evaluated (McNemar, p > 0.05). After 13 years of clinical functioning, the clinical effectiveness of the three adhesive/composite combinations remained highly acceptable.

Unlabelled: The 5-year findings of a randomized clinical trial testing the null hypothesis that there are no differences between the clinical-wear performances of nano-, microfilled-, and conventional hybrids placed in class I and class II cavities are reported. Effects of subject-, operator-, and restoration-related variables on wear were assessed. Sixteen Tetric-C, 17 Tetric-EC, and 16 Gradia-DP restorations were placed in human molars and recalled at baseline, 6 months and at yearly intervals. The gypsum replicas at each recall were scanned (3D laser scanning), epoxy resin replicas were observed under scanning electron microscope and linear mixed models were used to study the influence of different variables on wear. The generalized vertical wear rate/month were (1.4 μm Tetric-C and Tetric-EC; 1.8 μm Gradia-DP) and volume wear rate/month were (0.017 mm(3) Tetric-EC; 0.018 mm(3) Gradia-DP, and 0.011 mm(3) Tetric-EC). Operator-cavity type interaction and surface area of restorations did significantly influence the volume wear rates (p < 0.05). The three wear patterns: fatigue cracks at heavy occlusal contact area/OCA, pitting at light OCA, and scratches/striations along the food escape pathways were evident. The three hybrids differed significantly in volume wear due to material and operator variables., Clinical Relevance: Clinically, operators and cavity type can affect restorations' wear magnitude but do not contribute to increased functional risk of fracture or harmful effect on pulp and periodontal biocompatibility.

Objectives: To compare the clinical wear performance of nanofilled restorations (Filtek Supreme) against microhybrid restorations (Z100) in a 5-year randomized clinical trial to evaluate the wear rate and the influence of subject-, operator- and restoration-related variables on wear rate., Materials and Methods: 18 Filtek Supreme and 17 Z100 restorations were placed in human molars (split-mouth-model) and bonded with Single Bond/Scotch Bond Adhesive. Restorations were recalled at baseline, 6-, 12-months and at annual intervals until 5-years of clinical service. The gypsum replicas at each recall were used for 3D-Pro-laser scanning to quantify wear and the epoxy resin replicas were observed under SEM for microwear patterns. Linear-mixed-models were used to study the influence of the different variables on the vertical and volume loss., Results: Volume wear, but not the vertical wear rate of the two restorative materials were significantly influenced (p<0.05) by the factors such as operator, cavity type, as well as combination of operator-cavity type and quadrant type. The variations in the occlusal surface microwear patterns over time reflect the effect of biomechanics of mastication on the restorative composite., Conclusions: The rate of vertical and volume loss of both the restoratives appear, on average, not to be constant even after the early stage wear, under the influence of certain clinical variables., (Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objectives: To compare mineral density of residual dentine after excavation with different caries-removal techniques and to evaluate the diagnostic potential of laser-induced fluorescence (LIF), measured by DIAGNOdent, as a tool to determine the caries-removal endpoint., Methods: Carious teeth were excavated by tungsten-carbide round burs (Komet), ceramic burs (CeraBurs, Komet), sono-abrasion (Cariex TC tips, Kavo), and by chemo-mechanical excavation using two enzyme-based solutions (exp. SFC-V and SFC-VIII, 3M-ESPE) or a sodium hypochlorite-based solution (Carisolv, MediTeam). The caries-excavated teeth were scanned by micro-CT (1172, Skyscan), after which the mineral density at the bottom dentine was correlated to LIF measurements at the same region. A micro-CT threshold for dentine caries was defined by comparison with surface-hardness measurements. The intensity of dentine staining was evaluated by analysing the component 'L*' in CIE-L*a*b-converted images from the excavated teeth., Results: No statistically significant difference in mineral density was found at the bottom of the cavities prepared with the different caries-excavation techniques, except for exp. SFC-V that left residual dentine with a significantly higher mineral density than when CeraBurs were used (Tukey-Kramer, p<0.05). Absence of residual caries was associated with darker staining of dentine. No significant correlation was found between the distance from the deepest cavity point to the pulp-chamber roof and LIF measurements. A strong negative correlation (R=-0.86, p<0.01) was however found between L* values and LIF measurements, indicating that staining in residual dentine leads to higher LIF measurements., Conclusions: LIF measured by DIAGNOdent is influenced by staining in residual dentine. Therefore, its use to determine the caries-removal endpoint is doubtful., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Unlabelled: A static bond-strength test is often regarded as clinically less relevant, since such abrupt loading of the adhesive-tooth bond clinically never occurs. Therefore, dynamic fatigue testing is often claimed to better predict the clinical effectiveness of adhesives., Objectives: To measure the micro-tensile fatigue resistance (μTFR) of adhesives bonded to dentin, and to compare their μTFR to their micro-tensile bond strength (μTBS)., Methods: The bonding effectiveness (including fracture analysis) of three adhesives (OptiBond FL, Kerr: 3-step etch-and-rinse adhesive or 3-E&Ra; Clearfil SE, Kuraray: 2-step self-etch adhesive or 2-SEa; G-Bond, GC: 1-step self-etch adhesive or 1-SEa) was measured by means of both a dynamic μTFR and a static μTBS approach. Preparation and test set-up of the micro-specimens were identical for both tests. In fatigue, specimens were tested with a wide range of selected loads at 2Hz and at 10Hz until failure, or until 10(4) cycles were reached. At 2Hz, the μTFR was also measured after 3-month water storage. The μTFR was determined using a logistic regression model. Two-way ANOVA and Tukey HSD multiple comparisons test were used to determine statistical differences in μTBS., Results: The 1-SEa recorded significantly lower values in μTFR at 10Hz and in μTBS than the 2-SEa and 3-E&Ra. The 1-SEa and the 2-SEa performed significantly lower in μTFR than the 3-E&Ra, when tested at 2Hz after 3-month water storage. Fatigue testing at 2Hz after 1-week water storage did not reveal any differences in μTFR between the three adhesives., Significance: The 3-E&Ra performed best in terms of bonding effectiveness, irrespective of the experimental condition or test used. The μTBS test proved once more to be a reliable laboratory test in ranking contemporary adhesives on their bonding effectiveness., (Copyright © 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

Objectives: Polymerization shrinkage of a composite in a high configuration-factor (C-factor) cavity leads to polymerization shrinkage stress. In the prevention of high polymerization shrinkage stress, a low-shrinking silorane composite (Filtek Silorane, FS, 3M ESPE) was recently marketed. Therefore, we investigated the effect of C-factor (flat surface vs. class-I cavity) and different composite application protocols on the bonding effectiveness of a low-shrinking composite to human dentin., Methods: A low-shrinking silorane-based composite (FS) and a conventional methacrylate-based composite (Filtek Z100, 3M-ESPE) were bonded to standardized occlusal class-I cavities (4 mm x 4 mm x 2.5 mm) and to flat mid-coronal dentin surfaces using the two-step self-etch adhesive 'Silorane System Adhesive' (3M-ESPE). Eight experimental groups were formed, according to the following treatment protocols: Z100 'flat'(1), Z100 'cavity'(2), FS 'flat'(3), FS 'flat/bulk-filled'(4), FS 'cavity/bulk-filled'(5), FS 'cavity/layered-filled'(6), FS 'cavity/flowable cured'(7) and FS 'cavity/flowable uncured'(8). For each group, at least 5 teeth were used. After 1 week of water storage, the teeth were sectioned to 1 mm x 1 mm (non-trimmed) sticks to measure the micro-tensile bond strength (microTBS)., Results: No statistical difference in microTBS was recorded between Z100 'flat'(1) and FS 'flat'(3). Bonding to class-I cavity dentin lowered the microTBS in all groups, but this was only statistically significant for FS 'cavity/bulk-filled'(5) and FS 'cavity/flowable uncured'(8)., Significance: Using the two-step self-etch Silorane System Adhesive, the conventional composite Filtek Z100 and the low-shrinking composite Filtek Silorane bonded equally well to dentin. Bulk-filling with Filtek Silorane (FS 'flat/bulk-filled'(4)) significantly decreased the microTBS, suggesting that factors other than polymerization shrinkage influenced the microTBS., (Copyright 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objectives: Among contemporary adhesives, self-etch adhesives have been adopted by general practitioners for routine adhesive restorative purposes, mainly because of their ease of use. However, many versions that differ for their clinical application procedure, pH, number of components, etc., are currently available on the market. The purpose of this study was to determine the bonding effectiveness of two new self-etch adhesives (Adper Easy Bond and Adper ScotchBond SE, 3M ESPE) to enamel and dentin using a micro-tensile bond strength (microTBS) protocol and to characterise the interfacial ultra-structure at enamel and dentin using transmission electron microscopy (TEM)., Methods: The adhesives were applied onto coronal human enamel and dentin surfaces and built up with the micro-hybrid resin composite Z100 (3M ESPE). The 'gold-standard' two-step self-etch adhesive Clearfil SE Bond (Kuraray) served as control. Specimens were sectioned to sticks and trimmed at the interface to a cylindrical hour-glass shape ('trimmed' micro-specimens). Non-demineralized and demineralized TEM sections through the adhesive-dentin/enamel interface were prepared by ultra-microtomy., Results: The microTBS of the two self-etch adhesives to enamel was statistically significantly lower than that of the control. To dentin, the microTBS of Adper Easy Bond was significantly lower than that of Adper ScotchBond SE and the control. TEM showed a tight interface to enamel for all three self-etch adhesives. A relatively thick, completely demineralized and acid-resistant hybrid layer was formed at dentin by Adper ScotchBond SE, whereas the interaction of Adper Easy Bond was much shallower, and comparable to that of so-called 'ultra-mild' self-etch adhesives. Some degree of spot- and cluster-like nano-leakage was observed for both adhesives, but did not differ in extent and form from that observed for the control., Conclusions: Although the new two self-etch adhesives revealed a tight interaction at both enamel and dentin, their bond strength to both tooth tissues was generally lower than that of the control adhesive. Nevertheless, their bonding effectiveness appears in line with other simplified self-etch adhesives.

Objectives: Compare the 3-year clinical performance (wear as an additional parameter) of a nanocomposite and a microhybrid composite, versus ADA guidelines (2001) using direct (clinical/USPHS) and indirect (quantitative/3D laser scan and qualitative/SEM) methods, in parallel., Materials and Methods: 18 Filtek Supreme and 17 Z100 restorations were placed in molars (split mouth model) and bonded with Single bond Adhesive. Restorations were evaluated at baseline and 6-, 12-, 24-, 36-months of clinical service according to modified USPHS criteria. The gypsum replicas at each recall were used for 3D-Pro-laser scanning to quantify wear and the epoxy resin replicas were observed under SEM to study the qualitative wear patterns. Repaired restorations were considered functionally present and not failed. Restorations were judged as failed, whenever completely replaced or when scored Delta due to material related factors impairing clinical function., Results: Filtek Supreme appeared better polishable than Z100 (p=0.0078; McNemar test). However, there were no significant differences between groups for other criteria including wear (p>0.05; Mann-Whitney U test). Qualitatively, fatigue wear at heavy occlusal contact areas (OCA), pitting at light OCA and scratches/striations along the food escape pathways were evident in almost all worn surfaces under SEM., Conclusions: At 3 years, nanocomposite and microhybrid composite meet ADA Acceptance Guidelines (2001) for tooth-colored restorative materials for posterior teeth.

Objectives: The objective of this study was to determine the optimal concentration of photo-initiator (camphorquinone) in an experimental one-step self-etch adhesive and to investigate the role of the photo-initiator., Methods: Seven experimental one-step adhesives with a varying amount of camphorquinone ranging from 0 to 5.25wt% were prepared. Their micro-tensile bond strength to enamel and dentin was determined. In addition, the bond strength was also determined when the adhesive was not light-cured prior to the application of the composite. SEM and TEM were used for further evaluation of the resultant interfacial ultrastructure., Results: The bond strength to enamel was not influenced by the amount of photo-initiator, whereas the bond strength to dentin dropped significantly when concentrations below 0.35wt% camphorquinone were used. Besides phase-separation droplets, electron microscopy revealed the presence of many small droplets at the bottom of the adhesive layer when the adhesive contained no or only a low concentration of initiator, or when the adhesive was not light-cured., Significance: Since polymerization is severely hampered by oxygen inhibition in thin layers, one-step self-etch adhesives depend greatly on the polymerization of the first layer of lining composite to achieve their ultimate mechanical strength. Consequently, the bond strength to enamel is not influenced by the amount of photo-initiator, but on dentin, bond strength is compromised by droplets, probably due to water absorption, and additionally by the negative effect of water on polymerization and by continuing demineralization of unpolymerized acidic monomers. Overall, it was found that minimally 0.7wt% camphorquinone was needed.

Objectives: The objectives of this study were (1) to clarify the relationship between the duration of air-drying of one-step self-etch adhesives (1-SEAs) and the evaporation degree (ED) of solvents, and (2) to evaluate the effect of ED on the ultimate micro-tensile strength (microTS) of the adhesives., Methods: The ED of one HEMA-rich 1-SEA, Clearfil S3 Bond (Kuraray), and two HEMA-free 1-SEAs, iBond (Heraeus-Kulzer) and G-Bond (GC), was determined without air-drying and after, respectively, 5- and 10-s air-drying using a gravimetric method. Next, the microTS of the adhesives at ED equivalent to 0-, 5- and 10-s air-drying was measured., Results: The ED increased with extension of air-drying time. Among the adhesives tested, iBond showed the largest ED, followed by G-Bond and Clearfil S3 Bond in this order. A longer air-drying time for 10-s resulted in a statistically significantly higher microTS for the HEMA-rich Clearfil S3 Bond. The microTS of the latter was higher than that of the other two HEMA-free adhesives for each air-drying time., Significance: Air-drying of 1-SEAs had a significant effect on the degree of solvent evaporation (ED) and also on the mechanical properties (microTS) of the 1-SEAs upon setting. It is therefore beneficial to remove solvents of the 1-SEAs as much as possible by thorough, strong air-drying in order to achieve a strong adhesive layer at the interface.

Objectives: Small and hydrophilic monomers as HEMA and TEGDMA can easily penetrate human tissues. For biocompatibility issues it is therefore better to avoid such monomers in dental adhesive formulations. The purpose of this study was (1) to determine the micro-tensile bond strength (muTBS) to enamel/dentin of a HEMA/TEGDMA-free three-step etch&rinse adhesive (cmf Adhesive System, Saremco), and (2) to characterize it's interfacial interaction with enamel/dentin using transmission electron microscopy (TEM)., Methods: Twelve intact freshly extracted human third molars were used for muTBS. The three-step etch&rinse adhesive OptiBond FL (Kerr) served as control adhesive. After bonding procedures and subsequent composite build-up (Z100, 3M ESPE), specimens were sectioned to sticks and trimmed at the interface to a cylindrical hour-glass shape. TEM section of non-demineralized and demineralized sections were prepared by ultra-microtomy and examined., Results: The muTBS of the cmf Adhesive System to enamel was not statistically significantly different from that of the control (OptiBond FL) adhesive (p=0.3512); the muTBS to dentin was however significantly lower (p<0.0001). TEM showed a tight interface at enamel for both adhesives. A relatively thick, completely demineralized and acid-resistant hybrid layer was formed at dentin. Some degree of spot- and cluster-like nano-leakage was observed with cmf Adhesive System, but did not differ in extent and form in comparison to that observed with the OptiBond FL control., Conclusions: The new three-step adhesive cmf Adhesive System showed indications of good bonding effectiveness, certainly to enamel and only significantly lower to dentin, when compared to the gold-standard adhesive. The latter may be related to the adapted HEMA/TEGDMA-free formulation and the somewhat lower mechanical properties.

Objectives: Describe stress distribution and compare stress concentration factor (K(t)) for homogeneous micro-specimens with different notch geometries and stick-shaped homogeneous and bimaterial specimens by means of finite element (FE) analysis., Methods: Axisymmetric models were created for homogeneous specimens with different notches and for stick-shaped homogeneous and bimaterial specimens. FE mesh was refined at areas of expected stress concentration and boundary conditions included an applied tensile stress in the axial direction. Linear elastic analysis was used., Results: For hourglass homogeneous specimens, K(t) equaled 1.32 and 1.12 for a notch radius of 0.6mm and 3.3mm, respectively. A non-uniform axial (sigma(zz)) stress distribution was found in the notch cross-section, with values at the outer edge being 78% and 25% larger than at the center. In addition, a triaxial stress state was generated. Stick-shaped and dumbbell homogeneous specimens presented K(t)=1 and a uniform, uniaxial stress distribution along the entire cross-section. Shear stresses were zero for all homogeneous specimens. When an adhesive interface was added to the stick-shaped specimen, an area of localized axial stress concentration (K(t)=1.55) was detected at the bimaterial joint near the outer edge. Normal stresses sigma(rr) and sigma(thetatheta) and shear stress tau(zr) were also non-zero at the free-edge., Conclusions: Dumbbell or stick-shaped specimens are favored for muTBS testing, as they do not present stress concentrations due to geometry. However, dissimilar mechanical properties of joint components will lead to stress concentrations and non-uniform multi-axial stresses, although to a lesser extent.

Objectives: To evaluate the micro-tensile bond strength (mu TBS) of a control etch-and-rinse and three self-etch (strong, mild, ultra-mild) adhesive systems to dentin prepared with three different grit size of diamond burs., Methods: Dentin surfaces were created from mid-coronal sound dentin in extracted, human third molars. The teeth were ground with high-speed medium grit (100 microm), fine grit (30 microm), or extra-fine grit (15 microm) diamond bur. Resin composite (Z100) was bonded to the surfaces using Optibond FL, Adper Prompt L-Pop, Clearfil SE Bond, or Clearfil S3 Bond. Rectangular micro-specimens were prepared using the slow-speed diamond saw and tested in tensile to determine the mu TBS. Failure analysis was performed using a stereo-microscope and Fe-SEM. Data were analyzed by two-way analysis of variance and Tukey's HSD test (p<0.05)., Results: The etch-and-rinse adhesive yielded high micro-tensile values (58-69 MPa), irrespective of the diamond burs used. The bond strength values were comparable for Adper Prompt L-Pop and Clearfil SE Bond irrespective of the burs used. The mu TBS values were significantly higher as the particle size of diamond burs is smaller for Clearfil S3 Bond. Most failures were recorded as interfacial failure when the fine and extra-fine diamond burs were used., Significance: Overall, different grit-sized diamond burs did not affect the mechanical properties of the interface, except for the ultra-mild one step self-etch adhesive. This adhesive performed significantly better when a smaller grit size was used to prepare dentin surface.

Purpose: In light of the concept of minimally invasive dentistry, erbium lasers have been considered as an alternative technique to the use of diamond burs for cavity preparation. The purpose of this study was to assess the bonding effectiveness of adhesives to Er,Cr:YSGG laser-irradiated dentin using irradiation settings specific for cavity preparation., Materials and Methods: Fifty-four midcoronal dentin surfaces, obtained from sound human molars, were irradiated with an Er,Cr:YSGG laser or prepared with a diamond bur using a high-speed turbine. One etch-and-rinse (Optibond FL/Kerr) and three self-etching adhesives (Adper Prompt L-Pop/3M ESPE, Clearfil SE Bond/Kuraray, and Clearfil S3 Bond/Kuraray) were used to bond the composite to dentin. The microtensile bond strength (microTBS) was determined after 24 h of storage in water at 37 degrees C. The Kruskal-Wallis test was used to determine pairwise statistical differences (p < 0.05). Prepared dentin surfaces, adhesive interfaces, and failure patterns were analyzed using a stereomicroscope and Field-emission gun Scanning Electron Microscopy (Feg-SEM)., Results: Significantly lower microTBS was observed to laser-irradiated than to bur-cut dentin (p < 0.05), irrespective of the adhesive employed. Feg-SEM photomicrographs of lased dentin revealed an imbricate patterned substrate and the presence of microcracks at the dentin surface., Conclusion: Morphological alterations produced by Er,Cr:YSGG laser-irradiation adversely influence the bonding effectiveness of adhesives to dentin.

Purpose: To evaluate how six different test parameters (TP) of the microtensile bond strength (microTBS) methodology influence the test outcome., Materials and Methods: The microtensile bond strength of adhesives bonded to dentin was measured, and the resultant failure patterns and stress-time graphs were analyzed, varying the microTBS specimen-fixation mode (TP1), the microspecimen geometry (TP2), the microspecimen bond surface area (TP3), the remaining dentin thickness of the microspecimens (TP4), the procedure employed to glue the microspecimen to the microTBS jig (TP5), and the microTBS crosshead speed (TP6)., Results: The orientation of the microspecimens to the actual interface primarily influenced the resultant microTBS value and the eventual failure pattern. A notched jig consistently yielded significantly higher mciroTBS values than samples fixed onto a flat jig or following a "top-bottom" design (TP1). A higher bond strength, a lower standard deviation/coefficient of variation, a failure closer to the interface, and a more representative number of specimens per tooth were obtained for nontrimmed, square microspecimens (TP2). The most reproducible results were obtained using square specimens of 1 mm2 (TP3), which could also be most easily prepared. The remaining dentin thickness (TP4) was an influential factor as well, whereas the microspecimen gluing protocol (TP5) and the crosshead speed (TP6) appeared less influential., Conclusion: As several test parameters significantly influenced the microTBS outcome, sufficient attention should be paid to these methodology variables with regard to the microTBS-test reliability and reproducibility.

Adhesive-dentin interfaces degrade with time. This study determined the effect water storage may have on the bonding effectiveness of adhesives to occlusal Class I cavity-bottom dentin. Six adhesives, all representing contemporary classes of adhesives, were applied: a 3-step (OptiBond FL, Kerr) and 2-step (Scotchbond 1*, 3M ESPE) etch-and-rinse adhesive, a 2-step (Clearfil SE, Kuraray) and 1-step (Adper prompt, 3M ESPE) self-etch adhesive and a 2-step (FujiBond LC, GC) and 1-step (Reactmer, Shofu) resin-modified glass-ionomer adhesive. Bonding effectiveness was assessed by microtensile bond strength testing (MTBS) and electron microscopy (Feg-SEM and TEM). The MTBS was determined after 1 day and 1 year water storage of the entire restored cavity (indirect exposure of the adhesive-dentin interface to water) and prepared microTBS-beams (direct exposure of the adhesive-dentin interface to water). The hypotheses tested were: (1) resin-dentin bonds formed at the bottom of Class I cavities resist 1-year water storage and (2) an adjacent composite-enamel bond protects the composite-dentin bond against degradation. Non-parametric Kruskal-Wallis analysis statistically analyzed the microTBSs. The first hypothesis was rejected, as only the microTBS of OptiBond FL and Clearfil SE did not significantly decrease after 1-year direct and/or indirect water storage. The second hypothesis was corroborated, as the bonding effectiveness of most simplified adhesives (Scotchbond 1, Adper Prompt, FujiBond LC and Reactmer) approached 0 (because of the frequent pre-testing failures) after 1-year direct water exposure. The second hypothesis concluded that the 3-step etch-and-rinse adhesive must still be regarded the "gold standard." Though microTBS decreased significantly, Clearfil SE, as a 2-step self-etch adhesive, was the only simplified adhesive to perform reliably after 1-year direct water exposure.

Unlabelled: A widely used artificial aging methodology is thermo-cycling. The ISO TR 11450 standard (1994) recommends 500 cycles in water between 5 and 55 degrees C. Recent literature revealed that more cycles are needed to mimic long-term bonding effectiveness. Furthermore, the artificial aging effect induced by thermo-cycling is not clearly established. Two underlying mechanisms can be advanced: (1) hot water may accelerate hydrolysis and elution of interface components and (2) repetitive contraction/expansion stress can be generated., Objectives: The purpose of this study was to evaluate the relative contribution of both chemical (hydrolysis and elution of interface components) and mechanical (repetitive contraction/expansion stress) degradation pathways on the thermo-cycling-induced artificial aging of dentin-adhesive interfaces at the bottom of class-I cavities., Methods: The micro-tensile bond strength (muTBS) of contemporary adhesives (a three-step etch and rinse, a two-step and a one-step self-etch adhesive) bonded to class-I cavity-bottom dentin was determined after 20,000 cycles as well as after 20 days of water storage (control). Restored class-I cavities (repetitive contraction/expansion stress) as well as prepared micro-specimens (diffusion-dependent hydrolysis and elution) were subjected to the thermo-cycling regimen., Results: Thermo-cycling did not enhance chemical or mechanical degradation of the bonds produced by a two-step self-etch and a three-step etch and rinse adhesive to dentin. The one-step self-etch adhesive tested was, however, not able to withstand polymerization shrinkage stress, nor thermo-cycling, when applied in class-I cavities., Significance: Thermo-cycling results in combined contraction/expansion stress and accelerated chemical degradation. However, the relative contribution of each is strongly dependent on the specific test set-up and the adhesive used.

Self-etch adhesives try to solve difficulties commonly associated with the clinical application of etch-and-rinse adhesives. Their application procedure is considered less time-consuming and, more importantly, less technique-sensitive. The main objective of this study was to determine the bonding effectiveness to and the interaction with enamel/dentin of three contemporary one- and two-step self-etch adhesives by microtensile bond strength testing (microTBS), Fe-SEM and TEM when compared to a control two-step self-etch and a three-step etch-and-rinse adhesive. The one-step self-etch adhesive, Adper Prompt (3M ESPE), scored the lowest microTBS of all experimental and control adhesives tested. Conversely, the two-step self-etch adhesives Clearfil SE (Kuraray) and OptiBond Solo Plus Self-Etch (Kerr) approached the values obtained by the three-step etch-and-rinse control (OptiBond FL, Kerr) when bonded to enamel and dentin. Ultramorphological characterization showed that interfacial morphology and the pH of the self-etch primer/adhesive are strongly associated. The interaction with dentin varied from the formation of a submicron, hydroxyapatite-containing hybrid layer for the "mild" self-etch adhesive Clearfil SE to a 3-5 microm thick, hydroxyapatite-depleted hybrid layer for the "strong" self-etch adhesive Adper Prompt. The two-step self-etch adhesives AdheSE and OptiBond Solo Plus Self-Etch presented with a hybrid layer with a hydroxyapatite-depleted top part and a hydroxyapatite-containing base part and were therefore classified into a new group of self-etch adhesives, namely "intermediary strong" self-etch adhesives.

The effect of a polyalkenoic acid conditioner pretreatment on the bond strength of a glass-ionomer adhesive to tooth substrates with or without smear layer was evaluated. Smear-layer covered and smear-layer free dentin and enamel surfaces were prepared from 24 extracted human molars. Resin composite was bonded to the surfaces using FujiBond LC with or without a polyalkenoic acid conditioner and subjected to microtensile bond strength (microTBS) testing. Failure modes were determined using scanning electron microscopy. For dentin, smear-layer coverage and conditioner treatment did not reveal significant differences in microTBS, which ranged from 20 to 29 MPa. For enamel, smear-layer coverage did not significantly affect microTBS, whereas, the use of conditioner significantly improved microTBS, reaching the same microTBS-values as when bonded to dentin. Regarding failure mode, most dentin specimens failed mixed adhesive cohesively. For enamel, adhesive failures mostly occurred when no conditioner was used, though mixed failures were predominant when the specimens were conditioned beforehand. Bonding of the glass ionomer adhesive to dentin can be achieved without the separate use of a polyalkenoic acid conditioner, even with the interposition of a smear layer. However, instrumented and non-instrumented enamel requires separate conditioning to provide sufficient micro-mechanical retention.

A three-year randomized, controlled prospective study evaluated the clinical performance of two three-step etch & rinse adhesives (OptiBond FL, Kerr: O-FL; PermaQuick, Ultradent: PMQ) in Class V cervical erosion-abrasion lesions. The latter adhesive was also tested with two restorative composites with contrasting stiffness in order to evaluate the effect composite stiffness might have on the clinical longevity of cervical restorations. A total of 150 lesions were randomly restored in pairs of the three adhesive/composite combinations (PMQ combined with Amelogen Hybrid: PMQ/A-Hy, Ultradent; PMQ combined with Amelogen Microfill: PMQ/A-Mi, Ultradent; O-FL combined with Prodigy: O-FLJPro, Kerr) per patient and evaluated at baseline, after six months, one year, two years and three years of clinical service. After three years, the retention rate was 100% for O-FL/Pro and 98% for both PMQ/A-Hy and PMQ/A-Mi, thereby, satisfying the "full acceptance" guidelines specified by the American Dental Association. A pairwise comparison showed no significant difference in adhesive performance between restorations made using the microfilled and hybrid composite for any evaluation criteria (p>0.05).

In light of the current trend towards "minimal invasive" dentistry, diverse cavity preparation techniques have been introduced as an alternative or addition to common bur instrumentation. This study investigated whether diamond sonoabrasion (SonicSys Micro, Kavo), air abrasion (Prep Start, Danville) and Er:YAG laser irradiation (Fidelis) produce surfaces at enamel/dentin that are equally receptive to bonding as traditional mid-grit diamond-bur (Komet) and 600-grit SiC-paper prepared surfaces, of which the latter two served as controls. An etch&rinse adhesive (OptiBond FL, Kerr) applied with and without prior acid-etching and a self-etch adhesive (Clearfil SE, Kuraray) were employed to bond the restorative composite (Z100, 3M ESPE) to the diversely prepared enamel and dentin surfaces. The microtensile bond strength (microTBS) was determined after 24 hours of storage in water at 37 degrees C. The results indicated that the manner of preparation of enamel and dentin prior to bonding procedures significantly influenced the bonding effectiveness of both the etch&rinse and the self-etch adhesive. Using an etch&rinse adhesive, separate acid-etching of air-abraded and Er:YAG-irradiated enamel and dentin surfaces remains mandatory. Bonding to diamond-sonoabraded and air-abraded enamel and dentin was, in general, not different from bonding to conventional diamond-bur prepared surfaces, whereas, bonding to Er:YAG-irradiated enamel and dentin surfaces in general resulted in a significantly lower bonding effectiveness compared to bonding to diamond-bur prepared surfaces.