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Objective: To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials., Design: A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05)., Results: The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05)., Conclusion: Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials., (© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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.

Introduction: The purpose of this study was to compare the clinical failure rates and the in-vitro bond strengths of metal brackets bonded with different light-emitting diode (LED) devices and curing times., Methods: Forty patients were included in the clinical part of this study. A split-mouth design was used, with the adhesive in group 1 cured for 10 seconds with an LED unit (Elipar S10; 3M Unitek, Monrovia, Calif), and the adhesive in group 2 cured for 3 seconds with another LED unit (VALO Ortho; Ultradent Products, South Jordan, Utah). Bond failures during 12 months of orthodontic treatment were recorded. In-vitro performance of the brackets was also compared by bonding brackets to extracted premolars and using the same light units and curing times (n = 20 for each group). The adhesive remnant index was used to determine the bond failure interface., Results: Clinical bond failure rates were 2.90% for the Elipar and 3.16% for the VALO curing units. The difference in bracket failure rates between the 2 LED devices was not statistically significant. No statistically significant difference was found between the in-vitro bond strengths of the groups., Conclusions: Our findings regarding long-term clinical survival rates and in-vitro bond strengths indicate that bracket bonding can be safely accomplished in 10 seconds of light-curing with an Elipar LED and 3 seconds of light-curing with a VALO LED., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the light irradiance (LI) delivered by two light-curing units and to measure the degree of conversion (DC) of three composite cements and one flowable composite when cured through zirconia or ceramic-veneered zirconia plates with different thicknesses., Materials and Methods: Three dual-curing composite cements (Clearfil Esthetic Cement, Panavia F2.0, G-CEM LinkAce) and one light-curing flowable composite (G-aenial Universal Flo) were investigated. Nine different kinds of zirconia plates were prepared from three zirconia grades (YSZ: Aadva and KATANA; Ce-TZP/Al2O3: NANOZR) in three different thicknesses (0.5- and 1.5-mm-thick zirconia, and 0.5-mm-thick zirconia veneered with a 1.0-mm-thick veneering ceramic). Portions of the mixed composite cements and the flowable composite were placed on a light spectrometer to measure LI while being light cured through the zirconia plates for 40 s using two light-curing units (n = 5). After light curing, micro-Raman spectra of the composite films were acquired to determine DC at 5 and 10 min, 1 and 24 h, and at 1 week., Results: The zirconia grade and the thickness of the zirconia/veneered zirconia plates significantly decreased LI. Increased LI did not increase DC. Only the Ce-TZP/Al2O3 (NANOZR) zirconia was too opaque to allow sufficient light transmission and resulted in significantly lower DC., Conclusion: Although zirconia-based restorations attenuate the LI of light-curing units, the composite cements and the flowable composite could be light cured through the YSZ zirconia. LI is too low through Ce-TZP/Al2O3 zirconia, necessitating the use of self-/dual-curing composite cements.

Purpose: To evaluate the effects of three different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin., Materials and Methods: Eighty human third molars were randomly divided into four groups (n = 20) according to the radiation dose (control/no radiation, 20 Gy, 40 Gy, and 70 Gy). The teeth were sagittally sectioned into three slices: one mesial and one distal section containing enamel and one middle section containing dentin. The sections were then placed in the enamel and dentin groups, which were further divided into two subgroups (n = 10) according to the adhesive used. Three restorations were performed in each tooth (one per section) using Adper Single Bond 2 (3M ESPE) or Universal Single Bond (3M ESPE) adhesive system and Filtek Z350 XT (3M ESPE) resin composite and subjected to the microshear bond test. Data were analyzed using a two-way ANOVA followed by Tukey's test. Failure modes were examined under a stereoscopic loupe., Results: Radiotherapy did not affect the bond strengths of the adhesives to either enamel or dentin. In dentin, the Universal Single Bond adhesive system showed higher bond strength values when compared with the Adper Single Bond adhesive system. More adhesive failures were observed in the enamel for all radiation doses and adhesives., Conclusion: Radiotherapy did not influence the bond strength to enamel or dentin, irrespective of the adhesive or radiation dose used.

Objectives: To evaluate the effect of photoinitiators and reducing agents on cure efficiency and color stability of resin-based composites using different LED wavelengths., Methods: Model resin-based composites were associated with diphenyl(2,4,6-trimethylbenzoyl) phosphine oxide (TPO), phenylbis(2,4,6-trimethylbenzoyl) phosphine oxide (BAPO) or camphorquinone (CQ) associated with 2-(dimethylamino) ethyl methacrylate (DMAEMA), ethyl 4-(dimethyamino) benzoate (EDMAB) or 4-(N,N-dimethylamino) phenethyl alcohol (DMPOH). A narrow (Smartlite, Dentisply) and a broad spectrum (Bluephase G2, Ivoclar Vivadent) LEDs were used for photo-activation (20 J/cm(2)). Fourier transform infrared spectroscopy (FT-IR) was used to evaluate the cure efficiency for each composite, and CIELab parameters to evaluated color stability (ΔE00) after aging. The UV-vis absorption spectrophotometric analysis of each photoinitiator and reducing agent was determined. Data were analyzed using two-way ANOVA and Tukey's test for multiple comparisons (α=0.05)., Results: Higher cure efficiency was found for type-I photoinitiators photo-activated with a broad spectrum light, and for CQ-systems with a narrow band spectrum light, except when combined with an aliphatic amine (DMAEMA). Also, when combined with aromatic amines (EDMAB and DMPOH), similar cure efficiency with both wavelength LEDs was found. TPO had no cure efficiency when light-cured exclusively with a blue narrowband spectrum. CQ-systems presented higher color stability than type-I photoinitiators, especially when combined with DMPOH., Conclusions: After aging, CQ-based composites became more yellow and BAPO and TPO lighter and less yellow. However, CQ-systems presented higher color stability than type-I photoinitiators, as BAPO- and TPO-, despite their higher cure efficiency when photo-activated with corresponding wavelength range., Clinical Significance: Color matching is initially important, but color change over time will be one of the major reasons for replacing esthetic restorations; despite the less yellowing of these alternative photoinitiators, camphorquinone presented higher color stability., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: To measure and compare the depth of cure (DOC) of two bulk fill resin composites using a monowave and polywave light curing unit (LCU) according to ISO 4049 and using custom tooth molds., Methods: The DOC of Tetric Evoceram Bulk Fill and Filtek Bulk Fill Posterior were measured using a monowave LED LCU (Elipar S10) and a polywave LED LCU (Bluephase G2). Metal molds were used to fabricate 10 mm long DOC specimens (n = 10) according to ISO 4049. Uncured composite material was scraped away with a plastic instrument and half the length of remaining composite was measured as the DOC. Custom tooth molds were fabricated by preparing > 10 mm long square- shaped (4 x 4 mm) holes into the mesial/distal surfaces of extracted human molars. Resin composite was placed into one end of the prepared tooth and light polymerized. Uncured resin composite was removed from the opposite side from which the tooth was irradiated and the tooth was sectioned mesio-distally. Half the length of remaining cured composite was measured as the DOC. Data were analyzed by three-way ANOVA (α = 0.05) for factors material, LCU, and mold., Results: The main effect LCU was not significant (P = 0.58). The interaction effect between material x mold was significant (P = 0.0001). The DOC of the composites differed significantly only with the stainless steel mold in which Tetric Evoceram Bulk Fill showed a deeper DOC than Filtek Bulk Fill Posterior (4.03 ± 0.14 vs 3.56 ± 0.38 mm, P < 0.0001).

Purpose: To assess the resin microtensile bond strength (MTBS) and the degree of conversion (DC) of indirect composite resin restorations polymerized with light and heat., Materials and Methods: Two direct (Filtek Z100 and Premise) and one indirect (Premise Indirect) composite resins were polymerized with a combination of light and heat (138°C for 20 min). For MTBS, 42 cylinders were fabricated (n = 7). After the surface treatment, cylinders were bonded to each other using adhesive resin (Optibond FL). Specimens were stored in water for 24 h. Another 15 cylinders (n = 5) were fabricated for determining degree of conversion using Fourier Transform Infrared Spectrometry immediately and at 24 h. The MTBS and the DC was submitted to two-way ANOVA. The interaction with existing data was explored with univariate ANOVA and two-way ANOVA. Tukey's HSD post-hoc test was used to detect pairwise differences (α = 0.05)., Results: The MTBS to light and heat polymerized Z100 was 75.7 MPa, significantly higher than that to Premise (58.6 MPa) and Premise Indirect (63.9 MPa). The immediate DC for Z100, Premise, and Premise Indirect were 51.0%, 68.7%, and 61.8%, respectively. The DC at 24 h ranged from 53.4% (Z100) to 72.8% (Premise Indirect) and significantly increased for Premise Indirect only. Comparison with previously published data revealed that the heat treatment increased both MTBS and DC of Premise and Premise Indirect., Conclusion: Z100 showed better bond strength but lower DC. Heat treatment and a 24-h delay before delivery can benefit DC of Premise Indirect. The increase in DC of Premise and Premise Indirect did not affect their bond strength.

Purpose: To evaluate shear bond strength and microleakage of a new self-etching/self-adhesive fissure sealant on prismless enamel compared with conventional fissure sealing., Materials and Methods: A total of 90 extracted third molars were assigned to 3 main groups: group 1: self-etching/self-adhesive sealant, without acid etching; group 2: self-etching/self-adhesive sealant, with prior acid etching; group 3: conventional fissure sealing (control group). After specimen preparation, each group was divided into 3 subgroups according to storage time (1-day water storage, 3-month water storage, and 1-day water storage followed by 5000x thermocycling). The shear bond strength was determined with a universal testing machine, according to ISO standard 29022. Afterwards, the failure mode was analyzed. An additional 24 third molars were used for microleakage assessment. The fissure pattern was sealed in strict accordance with the manufacturers' instructions. After thermocycling, the dye penetration was examined. Data were analyzed using the Mann-Whitney U-Test at a significance level of 0.05., Results: The shear bond strength of the self-etching/self-adhesive fissure sealant without prior acid etching was significantly lower (4.3 MPa) than that of the self-etching/self-adhesive fissure sealant with prior acid etching (17.1 MPa) and the conventional fissure sealing (19.1 MPa). Microleakage was significantly lower in the control group (1.1%) and in the group with the self-etching/self-adhesive sealant with prior acid etching (0.8%) compared to the group that used the self-etching/self-adhesive material alone (49.4%)., Conclusion: The self-etching/self-adhesive fissure sealant can be recommended for clinical use when enamel is etched with phosphoric acid. The self-etching/self-adhesive sealant without prior acid etching showed significantly inferior results.

Introduction: In this study, we compared the shear bond strengths of five different adhesive techniques for attaching metal orthodontic brackets onto acrylic pontics., Materials and Methods: Two hundred upper left lateral incisor acrylic teeth with bonded brackets were divided into five groups - composite alone (control), composite following sandblasting, composite held with a mechanical undercut, cyanoacrylate adhesive and Panavia(®). The initial bond strength was tested using the Instron Universal Testing Machine. The fatigue bond strength was tested by subjecting each bracket to 5000 repetitive low-load cycles at 50% of the mean shear bond strength using the Dartec machine at 2 Hz., Results: Cyanoacrylate adhesive statistically exhibited the highest mean bond strength (19·82 MPa). This was followed by the mechanical undercut group (17·69 MPa) and the sandblasted group (17·18 MPa). There was no statistically significant difference when considering the effect of fatiguing (p = 0·238) as well as the interaction between the adhesive technique and the effect of fatiguing on the bond strength (p = 0·440)., Conclusion: The initial and fatigue bond strengths of the cyanoacrylate adhesive, sandblasted and undercut groups were significantly higher than the control and Panavia(®) groups when tested under laboratory conditions.

Purpose: To investigate the effects of placement technique and adhesive material on adaptation of composites before and after light curing., Materials and Methods: Cylindrical cavities (3 mm diameter, 1.7 mm depth) in extracted human molars were restored in 6 groups (n=5) using 2 adhesives--two-step self-etching Clearfil SE Bond 2 (SE2) and all-in-one Clearfil Tri-S Bond Plus (TSP) (Kuraray Noritake Dental)--and 2 composites--Estelite Sigma Quick (ESQ) and Estelite Flow Quick (FLQ) (Tokuyama Dental)--placed with three different techniques: ESQ bulk placed, FLQ lining followed by ESQ and FLQ bulk placed. Specimens were scanned twice using swept-source optical coherence tomography (SS-OCT) before and after photopolymerization of the composite. Gap formation during polymerization or the difference in floor interface (DFI%) and final unsealed interface (USI%) were measured by image coregistration and subtraction on 6 diametrical planes across each scan., Results: Two-way ANOVA suggested that both factors (adhesive and filling technique) and their interaction were significant (p<0.001). SE2 showed significantly lower DFI% than did TSP when the composites were placed in bulk, but no difference was found when flowable lining was applied (p<0.05). Within TSP, all filling techniques were significantly different and the lining group showed the lowest values, followed by ESQ-bulk. Overall, SE2 always showed lower UFI% than did TSP, while there was no difference among different techniques within SE2., Conclusion: SS-OCT is a unique method to observe the pre-existing interfacial defects and gaps developed during polymerization, which were found to depend on both placement technique and applied adhesive.

Objective: To measure enamel surface changes after ceramic bracket debonding and after cleanup., Materials and Methods: Forty extracted teeth were scanned in three dimensions using an optical scanner (baseline). Two ceramic bracket systems were placed (19 metal-reinforced polycrystalline ceramic brackets; 21 monocrystalline ceramic brackets). Seven days later, brackets were debonded and teeth scanned (post-debond). Adhesive remnants and bracket fragments were recorded. Tooth surfaces were cleaned using a finishing carbide bur and scanned again (post-cleanup). Post-debond and post-cleanup scans were aligned with the baseline, and surface changes were quantified. Results were statistically compared using t-tests and Mann-Whitney tests (α  =  .05)., Results: The depth of enamel loss (mean ± standard deviation) post-debond was 21 ± 8 µm and 33 µm and post-cleanup was 28 ± 14 µm and 18 ± 8 µm (P  =  .0191); the post-debond remnant thickness was 188 ± 113 µm and 120 ± 37 µm (P  =  .2381) and post-cleanup was 16 ± 5 µm and 15 µm for polycrystalline and monocrystalline ceramic brackets, respectively. The monocrystalline ceramic brackets predominantly left all adhesive on the tooth; the polycrystalline ceramic brackets were more likely to leave bracket fragments attached., Conclusion: Both systems allowed successful removal of the brackets with minimal enamel loss. However, the polycrystalline ceramic brackets left more fragments on the tooth, which complicated cleanup efforts.

Purpose: To investigate sealant depth of cure after increasing the curing times of high-intensity light-emitting diode units (LEDs)., Methods: Three sealants (opaque-unfilled, opaque-filled, and clear-filled) were light cured in a covered-slot mold with: (a) three LEDs (VALO, SmartLite, Fusion) for six to 15 seconds; and (b) a quartz-tungsten halogen (QTH) light for 40 seconds as a control (N=10). Twenty-four hours after light curing, microhardness was measured at the sealant surface and through the depth at 0.5 mm increments. Results were analyzed via analysis of variance followed by the Student-Newman-Keuls test (significance level 0.05)., Results: The opaque-filled and clear-filled sealants cured with VALO for six or nine seconds had hardness values that were statistically equivalent to or better than the QTH to a depth of 1.5 mm. Using Fusion for 10 seconds (exposure limit) did not adequately cure the three sealants beyond one mm. SmartLite at 15 seconds (maximum exposure period without overheating) did not adequately cure the sealants beyond 0.5 mm., Conclusions: Among the tested high-intensity LEDs, only VALO at double or triple the manufacturers' shortest curing time (six or nine seconds) provided adequate curing of opaque-filled and clear-filled sealants at 1.5 mm depth compared to the 40-second QTH light.

Fiber-reinforced composites (FRC) can potentially help in a physiologic stress transmission due to its excellent biomechanical matching with living tissues. Novel one-piece FRC implants and abutments with two different fiber orientations were loaded until failure to assess the load-bearing capacity, fracture patterns, and precision of fit. The one-piece FRC implants showed significantly higher load-bearing capacity compared to FRC abutments regardless of the fiber orientation (p < 0.001). For FRC abutments, bidirectional abutments showed significantly higher loads compared to unidirectional abutments (p < 0.001). The type of structure and fiber orientation are strong determinant factors of the load-bearing capacity of FRC implants and abutments.

Purpose: To evaluate the hardness of a dual-curing self-adhesive resin cement (RelyX U200) and a conventional dual-curing resin cement (RelyX ARC) cured with different light curing units of different wavelengths (Elipar Freelight 2 LED [430 to 480 nm, conventional], Bluephase LED [380 to 515 nm, polywave], AccuCure 3000 Laser [488 nm]) by means of the nanoindentation test., Materials and Methods: Bovine incisors were cleaned and then sectioned at the cementoenamel junction to remove the crown. After embedding in acrylic, dentin surfaces of the specimens were exposed and ground flat to standardize the surfaces. To simulate clinically placing indirect restorations, ceramic (IPS e.maxPress/Ivoclar Vivadent) or indirect composite resin (SR Adoro/Ivoclar Vivadent) slabs were cemented on dentin surfaces. The specimens were sectioned longitudinally at low speed under constant irrigation and then polished. In the positive control group, the cement was light cured without the interposition of indirect restorative material; in the negative control group, after the indirect restorative material was cemented, no light curing was performed, allowing only chemical polymerization of the cement. All specimens were stored in distilled water at 37°C for 7 days. Nanoindentadion hardness of the cement layer was measured under a 100-mN load. Data were statistically analyzed using ANOVA and Tukey's test (p < 0.05)., Results: Although the self-adhesive cement is technically simple, conventional cement showed the best polymerization performance. The polywave LED technology did not differ significantly from other light-curing units. The hardness of the resin cements evaluated was negatively influenced by the interposition of an indirect restorative material; only the LEDs were able to maintain the same degree of cement polymerization when an indirect restorative material was used., Conclusion: The photoactivation step is required during the cementation of indirect restorations to ensure adequate polymerization of dual-curing resin cements.

Objective: To evaluate and compare intrapulpal temperature rise with three different light-curing units by using a study model simulating pulpal blood microcirculation., Materials and Methods: The roots of 10 extracted intact maxillary central incisors were separated approximately 2 mm below the cement-enamel junction. The crowns of these teeth were fixed on an apparatus for the simulation of blood microcirculation in pulp. A J-type thermocouple wire was inserted into the pulp chamber through a drilled access on the palatal surfaces of the teeth. Four measurements were made using each tooth for four different modes: group 1, 1000 mW/cm(2) for 15 seconds; group 2, 1200 mW/cm(2) for 10 seconds; group 3, 1400 mW/cm(2) for 8 seconds; and group 4, 3200 mW/cm(2) for 3 seconds. The tip of the light source was positioned at 2 mm to the incisor's labial surface., Results: The highest temperature rise was recorded in group 1 (2.6°C ± 0.54°C), followed by group 2 (2.57°C ± 0.62°C) and group 3 (2.35°C ± 0.61°C). The lowest temperature rise value was found in group 4 (1.74°C ± 0.52°C); this value represented significantly lower ΔT values when compared to group 1 and group 2 (P  =  .01 and P  =  .013, respectively)., Conclusions: The lowest intrapulpal temperature rise was induced by 3200 mW/cm(2) for 3 seconds of irradiation. Despite the significant differences among the groups, the temperature increases recorded for all groups were below the critical value of 5.6°C.

Objective: This study evaluated the impact of the distance between the light guide tip of the curing unit and material surface on the degree of conversion and Knoop microhardness of a composite resin., Materials and Methods: Circular samples were carried out of a methacrylate micro-hybrid resin-based composite and light cured at 0, 2 and 4 mm distance. Monomer conversion rate was measured using a Fourier-transform Raman spectrometer and Knoop hardness number was obtained using a microhardness tester on the top and bottom surfaces. Data were statistically analyzed by analysis of variance and Tukey's test (α=0.05)., Results: Overall, the increase of curing distance reduced the microhardness (p≤0.05), but did not influence the carbon double bond conversion rate (p>0.05) of the composite resin tested; and the top surface showed better properties compared to the bottom (p≤0.05)., Conclusions: The light curing at distance can reduce mechanical properties and could affect long-term durability of the composite restorations. Thus, the use of a curing device with high irradiance is recommended.

Aim: This study evaluated the effects of ceramic veneer thicknesses on the polymerization of two different resin cements., Materials and Methods: A total of 80 ceramic veneer disks were fabricated by using a pressable ceramic material (e.max Press; Ivoclar Vivadent) from a Low Translucency (LT) ingot (A1 shade). These disks were divided into light-cured (LC; NX3 Nexus LC; Kerr) and dual-cured (DC; NX3 Nexus DC; Kerr) and each group was further divided into four subgroups, based on ceramic disk thickness (0.3, 0.6, 0.9, and 1.2 mm). The values of Vickers microhardness (MH) and degree of conversion (DOC) were obtained for each specimen after a 24-hour storage period. Association between ceramic thickness, resin cement type, and light intensity readings (mW/cm(2)) with respect to microhardness and degree of conversion was statistically evaluated by using analysis of variance (ANOVA)., Results: For the DOC values, there was no significant difference observed among the LC resin cement subgroups, except in the 1.2 mm subgroup; only the DOC value (14.0 ± 7.4%) of 1.2 mm DC resin cement had significantly difference from that value (28.9 ± 7.5%) of 1.2 mm LC resin cement (p < 0.05). For the MH values between LC and DC resin cement groups, there was statistically significant difference (p < 0.05); overall, the MH values of LC resin cement groups demonstrated higher values than DC resin cement groups. On the other hands, among the DC resin cement subgroups, the MH values of 1.2 mm DC subgroup was significantly lower than the 0.3 mm and 0.6 mm subgroups (p < 0.05). However, among the LC subgroups, there was no statistically significant difference among them (p > 0.05)., Conclusion: The degree of conversion and hardness of the resin cement was unaffected with veneering thicknesses between 0.3 and 0.9 mm. However, the DC resin cement group resulted in a significantly lower DOC and MH values for the 1.2 mm subgroup., Clinical Significance: While clinically adequate polymerization of LC resin cement can be achieved with a maximum 1.2 mm of porcelain veneer restoration, the increase of curing time or light intensity is clinically needed for DC resin cements at the thickness of more than 0.9 mm.

Objectives: To evaluate the effects of intracoronary bleaching on the bond strength of orthodontic brackets using self-etching and total-etch adhesive systems., Material and Methods: In 60 bovine incisors, a coronal lingual access was made to clean the pulp chamber and standardise the thickness of the dentine. The sample was randomly divided into four groups (each n = 15): (CT), control group, without bleaching and bonded with the total-etch system (Transbond(™) XT-3M); (CTSE), without bleaching treatment and bonded with the self-etching system (Transbond(™) Plus Self-Etching Primer-3M); (BT), treated with 35% hydrogen peroxide for internal bleaching and bonded with the total-etch adhesive system; and (BTSE), treated with 35% hydrogen peroxide and bonded with the self-etching adhesive system. Shear bond strength was measured using a universal testing machine (EMIC). The adhesive remnant index (ARI) score was verified. The data were analysed using a two-way anova and Tukey test (p < 0.05)., Results: Significant differences were found, and the self-etching adhesive groups presented the highest bond strength values (CTSE=11.55 ± 2.85 MPa; BTSE=14.14 ± 2.23 MPa). The ARI scores revealed significant differences among the groups; the greater amount of remaining adhesive was observed in the CTSE group, and the lowest scores were observed in the BT group., Conclusions: The use of the self-etching adhesive system, even after intracoronal bleaching, presented satisfactory adhesive strength for the bonding of brackets., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: This study aimed to investigate the surface roughness of composite resins subjected to thermal cycles procedure., Materials and Methods: Two microfill, four microhybrid and four nanofill composites were used. The surface roughness (Ra) was initially measured in a profilometer using a cut-off 0f 0.25 mm, after 3000 and 10,000 thermal cycles. Data were subjected to ANOVA and Fischer's test (α = 0.05)., Results: Overall, 3000 thermal cycles increased the surface roughness values for all materials and there was a trend in all groups to decrease the roughness after 10,000 thermal cycles., Conclusions: The composition of material, including the type of organic matrix, could be more relevant to roughness maintenance over time than the general behavior of composites based on particles fillers. The maintenance of smooth surface in resin-based composite restorations is totally dependent of organic composition of the material.

Purpose: To evaluate the marginal quality of composite resin restorations placed in extracted molars either in bulk (4 mm) or three increments., Materials and Methods: Sixteen extracted mandibular molars were selected and two two-surface cavities were prepared in each tooth (proximal depth 4 mm, occlusal width 5 mm). On one side of the tooth, Tetric EvoCeram Bulk Fill (Ivoclar Vivadent) was applied in a single increment; on the other side, Tetric EvoCeram (Ivoclar Vivadent) was applied in three increments: a horizontal gingival, an oblique buccal, and an oblique lingual increment. Each layer was light cured for 10 s with a Bluephase G2 curing light (1200 mW/cm2). Two adhesive systems were employed according to the instructions for use: the single-component etch-and-rinse system ExciTE F (Ivoclar Vivadent) and the self-etching two-component system AdheSE (Ivoclar Vivadent). The adhesive was light cured for 10 s with a Bluephase G2 curing light (1200 mW/cm2). Eight fillings were placed for each test group and all restoration margins were confined to the enamel. After 10,000 cycles of thermocycling (5°C/55°C), the quality of the proximal margins was semiquantitatively directly evaluated with a stereomicroscope at low magnification and a dental explorer using the SQUACE (semi-quantitative evaluation of restorations) method. In addition, replicas were made for SEM analysis, which was carried out four weeks later at high magnification (200X) by measuring the percentage of regular proximal margins in relation to the entire margin., Results: After thermocycling, statistically significantly higher percentages of regular margins were detected for those fillings placed with the etch-and-rinse system ExciTE F than for those placed with the self-etching system AdheSE - irrespective of the evaluation method (Mann-Whitney non-parametric test, p < 0.05). There was no statistically significant difference between the resin restorations placed in bulk and those placed in three increments (Mann-Whitney, p > 0.05). The semi-quantitative evaluation by means of a light microscope yielded statistically significantly higher values for regular margin than did the SEM evaluation for all 4 test groups (p < 0.05). Pearson's correlation coefficient for both evaluation groups was 0.87 (p < 0.0001)., Conclusions: The marginal quality of medium-sized Class II restorations of composite resins placed in one increment was similar to that of restorations placed in several increments. The semiquantitative evaluation of the marginal quality with an explorer at low magnification is an effective and rapid method to predict the clinical performance of direct restorations.

Statement of Problem: Clinicians continue to search for ways to simplify bonding procedures without compromising clinical efficacy., Purpose: The purpose of this study was to evaluate the shear strength of self-adhesive cements RelyX U100 and RelyX U200, and conventional resin cement RelyX ARC to enamel and dentin after different surface treatments., Material and Methods: The crowns of 120 bovine incisor teeth were separated from the roots and embedded in epoxy resin in polyvinyl chloride tubes. In each tooth, the area to be cemented was delimited with central holed adhesive tape. The teeth were distributed into 12 groups (n=10) according to the substrate; etched or not with 37% phosphoric acid; and cement type of enamel-U100, enamel-phosphoric acid-U100, enamel-U200, enamel-phosphoric acid-U200, enamel-ARC, enamel-phosphoric acid-ARC, dentin-U100, dentin-phosphoric acid-U100, dentin-U200, dentin-phosphoric acid-U200, dentin-ARC, and dentin-phosphoric acid-ARC. After 7 days of storage in artificial saliva, shear strength tests were performed by using a universal testing machine (0.5 mm/min). The data were analyzed with 3-way ANOVA and the Tukey test (α=.05). Fracture analysis was performed with a light microscope. Two specimens from each group were analyzed with a scanning electron microscope., Results: In enamel, ARC (9.96 MPa) had higher shear strength (P=.038) than U100 (5.14 MPa); however, after surface etching, U100 (17.81 MPa) and U200 (17.52 MPa) had higher shear strength (P<.001). With dentin, no significant differences were observed (P=.999), except for dentin-ARC (0.34 MPa) (P=.001). Most fractures were of the adhesive type., Conclusions: U200 self-adhesive cement had similar bond strength to the ARC in enamel, but the combination with phosphoric acid had the best bond strength. For dentin, self-adhesive resin cements are equally effective alternatives to conventional resin cement., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to evaluate the flexural and μTBS of bulk-fill materials., Study Design: Bulk-fill materials SDR, X-trabase (XTR) and TetricEvoCeramBulkFill (EVO) were used in this study. To test flexural strength, 25x2x2mm samples were prepared and tested with three point bending test. To test the microtensile bond strength (μTBS), two blocks (4x4x4mm) were prepared for each material. In Group A+B, acid-etching was applied to the surface of one of these blocks and no acid-etching was applied in Group B. After applying bonding agent, two blocks were placed into the mold and composite resin (COMP; Tetric N-Ceram) was applied with incremental layering. To evaluate the μTBS of primary dentin, the bulk-fill materials were applied to flat dentin up to 4mm. The new blocks and the teeth were sectioned to obtain sticks and the sticks were loaded in tension until failure. Flexural and microtensile bond strength was calculated based on failure load., Results: The ranking of materials with regards to flexural strength values were SDR>XTR>EVO>COMP,respectively. In GroupA+B, the μTBS values were XTR>SDR>EVO and were XTR>EVO>SDR in GroupB (p>0.05). The μTBS values of these materials to dentin were XTR>EVO>SDR (p>0.05)., Conclusion: Within the limitations of this study, the use of a bonding agent without acid-etching showed positive interactions between base materials and composite resin and there were no significant differences in μTBS of these materials to dentin.

Statement of Problem: Understanding the effect of the degree of conversion on the mechanical properties of auto- and dual-polymerizing self-adhesive resin cements leads to a better estimation of their performance in different clinical scenarios., Purpose: The purpose of this study was to evaluate the effect of photopolymerization on the degree of conversion (DC) and polymerization kinetic of 4 dual-polymerized resin cements, 20 minutes after mixing, and its effects on the mechanical properties (biaxial flexural strength [FS] and modulus [FM]) after short-term aging., Material and Methods: Conventional (RelyX ARC and Clearfil Esthetic Cement) and self-adhesive resin cements (RelyX Unicem and Clearfil SA Cement) were applied to a Fourier infrared spectrometer to assess the DC (n=5) under the following 3 polymerization conditions: direct light exposure (dual-polymerizing mode), exposure through the prepolymerized disk, or autopolymerizing. The polymerization kinetic was recorded for 20 minutes. Then, disk-shaped specimens (n=11) were prepared to evaluate the effect of polymerization on the FS and FM in both extreme polymerization conditions (dual-polymerizing or autopolymerizing). Data were statistically analyzed by 2-way repeated measure ANOVA (DC) and by 2-way ANOVA (FS and FM), followed by the Tukey-Kramer post hoc test (α=.05)., Results: Autopolymerizing groups exhibited reduced DC means, whereas intermediate values were observed when resin cements were polymerized through the disk. All groups exhibited higher DC at the end of 20 minutes. The polymerization kinetic revealed a rising curve, and materials, when directly photopolymerized, reached a plateau immediately after light exposure. Regarding the flexural biaxial testing, most of the resin cements were affected by polymerization mode and differences among groups were product dependent., Conclusions: The resin cements achieved immediate higher DC and mechanical properties when photopolymerized. The total absence of photoactivation may still impair their mechanical properties even after short-term aging., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Although the use of anatomic-contour zirconia restorations has expanded in the recent past, disagreement still exists as to reliable cementation techniques and materials., Purpose: The purpose of this in vitro study was to compare the immediate and artificially aged shear bond strength of 2 commercially available self-adhesive resin cements to zirconia: one with silica coating and silanation as a zirconia surface treatment and the other contained a phosphate monomer, which eliminated the need for a separate primer., Material and Methods: Sixty composite resin rods (2.5 mm in diameter and 3 mm in length) were fabricated from a nano-optimized composite resin by using a polypropylene mold, then light polymerized with a light-emitting diode. zirconia plates (10×10×4mm) were sectioned from an yttrium-stabilized zirconia puck, sintered, and then mounted in autopolymerizing acrylic resin custom tray material. Composite resin rods were cemented to the zirconia plates with 2 different cements. The surface treatment of zirconia followed the manufacturers' instructions for each cement. The specimens were tested for shear bond strength at 3 aging conditions: immediate, after 24 hours of moist storage, and after 30 days of moist storage with 10000 thermocycles. Specimens were loaded to failure in a universal testing machine, and the data were analyzed with 2-way ANOVA (α=.05). Weibull parameters (modulus and characteristic strength) also were calculated for each group., Results: Two-way ANOVA revealed that only the aging condition significantly affected the bond strength to zirconia. The cement and the interaction of the cement and aging did not significantly affect the shear bond strength to zirconia. The highest bond strength for both cements was achieved at 24 hours, whereas the lowest bond strength values were recorded in the immediate groups., Conclusions: No significant differences in bond strength to zirconia were observed between a cement with a silane priming step and an methacryloxydecyl dihydrogen phosphate-containing cement without a separate primer. Aging had a significant effect on the shear bond strength of the 2 self-adhesive resin cements to zirconia., (Published by Elsevier Inc.)

Statement of Problem: Dual-polymerized luting composite resin cements would benefit from enhanced irradiance transmitted through a ceramic restoration. A quantification of the amount of transmitted light through translucent zirconia is lacking., Purpose: The purpose of this study was to evaluate the amount of light (360 to 540 nm) passing through translucent and conventional zirconia and a glass ceramic with respect to material thickness and different polymerizing modes., Material and Methods: Six translucent and a conventional zirconia (negative control) and a glass ceramic (positive control) were considered. Ten specimens of each material and thickness (.5, 1, 1.5, 2, 2.5, 3 mm) were fabricated (n=480). Zirconia materials were sintered according to manufacturers' instructions. The irradiance passing the different ceramics and thicknesses was measured with a violet-blue LED polymerizing unit in 3 polymerizing modes (plasma, high, and standard power mode) with a USB4000 Spectrometer. The polymerizing unit was placed directly on the specimen's surface. Data were analyzed with one and multivariate analysis and the Pearson correlation analysis (α=.05)., Results: In all materials, the translucency and its rate decreased exponentially according to the specimen thickness. The highest influence on the measured irradiance passing through translucent zirconia was exerted by ceramic thickness (P<.05, partial eta squared [ηP²]=.998), closely followed by polymerizing mode (ηP²=.973), while the effect of the material (P=.03, ηP²=.06) and mean grain size (P=.029, ηP²=.027) was significant but low., Conclusions: Zirconia was less translucent than the glass ceramic, but the translucency decreased more slowly with material thickness, thus approaching the translucency of glass ceramics at a specimen thicknesses of 2.5 to 3 mm., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the influence of light-activation of second, third and fourth increments on degree of conversion (DC) and microhardness (KHN) of the top (T) and bottom (B) surface of the first increment., Materials and Methods: Forty samples (n = 5) were prepared. In groups 1-4, after each increment light-activation (multiple irradiation), T and B of the first increment were measured in DC and KHN. In groups 5-8, only the first increment was made (single irradiation) and measurements of DC and KHN were taken at 15 min intervals. The light-activation modes were (XL) 500 mW/cm(2) × 38 s (G1/G5); (S) 1000 mW/cm(2) × 19 s (G2/G6), (HP) 1400 mW/cm(2) × 14 s (G3/G7); (PE) 3200 mW/cm(2) × 6 s (G4/G8). Data for DC and KHN were analyzed separately by using PROC MIXED for repeated measures and Tukey-Kramer test (α = 0.05)., Results: For KHN, B showed lower values than T. PE resulted in lower values of KHN in B surface. For single and multiple irradiations, T and B of first measurement showed the lowest KHN and the fourth measurement showed the highest, with significant difference between them. For single irradiation, first and second increments presented similar KHN, different from the third and fourth increment, which did not differ between them. For multiple irradiations, the second light-activation resulted in KHN similar to first, third and fourth increments. For DC, except QTH, T presented higher DC than B., Conclusion: The light-activation of successive increments was not able to influence the KHN and DC of the first increment.

Aim: To evaluate the Influence of pH change and water storage up to 90 days on the sealing ability of two resin-based root-filling materials., Materials and Methods: Forty-four human mandibular single-rooted teeth were instrumented and filled with gutta-percha/ AH Plus or Resilon/Epiphany SE (n=20 per group). Two teeth each were used as positive and negative controls. Specimens were set for 7 days under 100% humidity at 37°C. They were allocated into two subgroups (n=10) according to whether they were tested immediately or stored for up to 90 days in water before testing. Sealing ability was evaluated by passive dye penetration. Absorbance at 630 nm (in μg/ml) was measured by spectrophotometry. The pH values were obtained in triplicate. Data were submitted to ANOVA by post-hoc Tukey's test (α=0.05)., Results: Specimens filled with Resilon/Epiphany SE exhibited more leakage than specimens filled with gutta-percha/AH Plus at the immediate time point (p<0.001). No differences were detected between the groups after storage, or between the materials with pH changes after 30, 60 and 90 days (p>0.05)., Conclusion: Gutta-percha/AH Plus provided superior sealing at the immediate time point. Water storage and pH changes did not Influence the sealing ability of tested materials., Clinical Significance: These results suggest that Resilon/ Epiphany SE sealer offered no apparent advantage over the more conventional gutta-percha/AH Plus sealer technique in terms of sealing ability.

Introduction: Our objective was to quantitatively assess and compare the bisphenol A (BPA) released from an orthodontic adhesive using a light-emitting diode device (LED) or a halogen light-curing unit (HLC) at 3 tip-to-bracket distances (0, 5, and 10 mm) and varying curing times using high-performance liquid chromatography. BPA release with self-etching and moisture-insensitive primers with light-cured and chemically cured composites was also evaluated. BPA release was correlated to the corresponding degree of conversion., Methods: Our sample consisted of 598 stainless steel first premolar brackets. Of these, 520 were used for assessing BPA release and divided into 13 groups of 40 each. In groups I, II, and III, the composite was cured with the LED for 20 seconds at distances of 0, 5, and 10 mm, respectively. Groups IV, V, and VI were cured with the HLC for 40 seconds at the same 3 distances. Groups VII and VIII were cured for 5 and 10 seconds with the LED, and groups IX and X were cured for 10 and 20 seconds with the HLC at 0-mm distance. Groups XI, XII, and XIII consisted of brackets bonded with a self-etching primer and Transbond (3M Unitek, Monrovia, Calif), with a moisture-insensitive primer and Transbond, and with a chemically cured composite. The remaining 78 brackets were also divided into 13 groups and used for assessing the degree of conversion., Results: The LED devices demonstrated significantly less BPA release and greater degrees of conversion (P <0.05). For both units, BPA release increased and the degree of conversion decreased as the tip distance increased and curing time decreased. The chemically cured group showed significantly less BPA release (P <0.05). Among the light-cured composites, those cured according to the manufacturers' recommendations (40 seconds and 0-mm distance for the HLC unit) released less BPA than did the self-etching primer and the moisture-insensitive primer. The degree of conversion was greatest for the chemically cured composite, whereas it was similar for the conventional, self-etching primer, and moisture-insensitive primer groups. However, correlations ranged from strongly negative to weakly positive between BPA release and degree of conversion., Conclusions: Clinicians should consider using LEDs in clinical practice and should keep the light-cure tip as close to the bracket as clinically possible. Curing time should be according to the manufacturer's recommendations. These steps will ensure less BPA release and a greater degree of conversion. Since chemically cured composites had less BPA release and a greater degree of conversion, they can be considered superior to light-cured composites in this aspect., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to evaluate the micro-mechanical properties of a light-cured resin cement in four different shades when polymerized through a leucite-reinforced glass-ceramic in different shades and thicknesses., Materials and Methods: A light-cured resin cement in four different shades (HV+1, HV+3, LV-1 and LV-3) was selected for this study. The specimens were cured by using a LED-unit (Bluephase®, IvoclarVivadent) for 20 s under a leucite-reinforced glass-ceramic (IPS Empress® CAD, IvoclarVivadent) in two different shades (A1 and A3) of different thicknesses (1 and 2 mm). Specimens cured directly, without an intermediate ceramic, served as control. The specimens were stored after curing for 24 h at 37°C by maintaining moisture conditions with distilled water. Micro-mechanical properties (indentation modulus, E; Hardness, HV; creep, Cr) of the resin cements were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). Twenty groups were included (n = 3), while 10 measurements were performed on each specimen. Data were statistically analyzed by using one-way ANOVA and Tukey's post-hoc test, as well as a multivariate analysis to test the influence of the study parameters., Results: Significant differences were observed between the micromechanical properties of the tested resin cements (p < 0.05). The resin cement shade showed the highest effect on the micromechanical properties (Partial-eta squared (ηP(2))-E = 0.45, ηP(2)-HV = 0.59, ηP(2)-Cr = 0.29) of the resin cement, followed by ceramic thickness (ηP(2)-E = 0.38, ηP(2)-HV = 0.3, ηP(2)-Cr = 0.04) and ceramic shade (ηP(2)-E = 0.2, ηP(2)-HV = 0.26)., Conclusions: Resin cement shade is an important factor influencing the mechanical properties of the material. Light shades of a resin cement express higher E and HV as well as lower Cr values compared with the darker ones.

Background: The purpose of this clinical longitudinal study was to investigate the effectiveness of indirect bonding technique evaluating the number of bond failures which occurred during treatment., Methods: Fifty-two patients were selected and divided into two groups: group A (33 patients) bonded with the direct technique and group B (19 patients) bonded with the indirect technique. The number and date of bracket failure were recorded for over 15 months. Moreover, also the effect of crowding level on bracket failures was calculated. Statistical analysis was performed by means of t-test, Kaplan-Meier survival estimates and chi-squared test., Results: No statistically significant differences were found in the total bond failure rate between direct and indirect techniques, also when comparing the upper and lower arches. The only significant difference was found comparing the posterior segment of the lower arches, in which a higher percentage of detachments were recorded in group B, bonded with the indirect technique. Moreover, no significant differences between direct and indirect bonding were found when evaluating crowding level., Conclusions: Orthodontic practitioners can safely use the indirect bonding technique, even in patients with severe crowding, because it does not influence the adhesive quality and the bracket survival rate.

Aim: To evaluate the degree of conversion (DC) of orthodontic adhesives (RBOAs) cured with dual peak or single peak light-emitting diode (LED) light-curing units (LCUs)., Materials and Methods: Standardized samples of RBOAs, APCPlus, Opal® Bond® and LightBond(TM) were prepared (n = 3) and cured with one of two dual peak LCUs (bluephase® G2-Ivoclar-Vivadent or Valo-Ultradent) or a single peak control (bluephase® Ivoclar-Vivadent). The DC was determined using micro-Raman spectroscopy. The presence or absence of initiators other than camphorquinone was confirmed by high-performance liquid chromatography and nuclear magnetic resonance spectroscopy. Data were analysed using general linear model in Minitab 15 (Minitab Inc., State College, PA, USA)., Results: There was no significant difference in DC between APCPlus, and Opal® Bond (confidence interval: -3.89- to 2.48); significant difference between APCPlus and LightBond(TM) (-18.55 to -12.18) and Opal® Bond and Lightbond(TM) (-17.85 to -11.48); no significant difference between bluephase (single peak) and dual peak LCUs, bluephase G2 (-4.896 to 1.476) and Valo (-3.935 to 2.437) and between bluephase G2 and Valo (-2.225 to 4.147). APCPlus and Opal® Bond showed higher DC values than LightBond(TM) (P<0.05). Lucirin® TPO was found only in Vit-l-escence., Conclusion: Lucirin® TPO was not identified in the three orthodontic adhesives. All three LCUs performed similarly with the orthodontic adhesives: orthodontic adhesive make had a greater effect on DC than the LCUs. It is strongly suggested that manufacturers of resin-based orthodontic materials test report whether or not dual peak LCUs should be used with their materials. Dual peak LED LCUs, though suitable in the majority of cases, may not be recommended for certain non Lucirin® TPO-containing materials., (© 2014 British Orthodontic Society.)

Objective: To demonstrate the effect of localized irradiance and spectral distribution inhomogeneities of one LED-based dental light-curing unit (LCU) on the corresponding microhardness values at the top, and bottom surfaces of four dental resin-based composites (RBCs), which contained either camphorquinone (CQ) alone or a combination of CQ and monoacylphosphine oxide (TPO) as photoinitiators., Methods: Localized irradiance beam profiles from a polywave LED-based LCU were recorded five times using a laser beam analyzer, without and with either a 400 nm or 460 nm narrow bandpass filter placed in front of the camera lens. Five specimens of each of the four RBCs (two containing CQ/TPO and two containing CQ-only) were exposed for 5-, 10-, or 30-s with the light guide directly on the top surface of the RBC. After 24 h, Knoop microhardness values were measured at 45 locations across the top and bottom surfaces of each specimen. Microhardness readings for each RBC surface and exposure time were correlated with localized patterns of the LCU beam profile, measured using the 400 nm and 460 nm bandpass filters. Spearman rank correlation was used to avoid relying on an assumption of a bivariate normal distribution for the KHN and irradiance., Results: The local irradiance and spectral emission values were not uniformly distributed across the light tip. There was a strong significant positive correlation with the irradiance beam profile values from the LCU taken through bandpass filters and the microhardness maps of the RBC surfaces exposed for 5 and 10 s. The strength of this correlation decreased with increasing exposure time for the RBCs containing CQ only, and increased for the RBCs containing both CQ and TPO., Conclusions: Localized beam and spectral distributions across the tip end of the light guide strongly correlated with corresponding areas of microhardness in both the top and bottom surfaces among four RBCs with different photoinitiator contents. Significance: A light-curing unit with a highly inhomogeneous light output can adversely affect localized microhardness of resin-based composites and this may be a contributing factor for premature failure of a restoration.

Objective: To evaluate the degree of conversion (DC) of two light-cured composites with different protocols of light curing., Materials and Methods: One hundred and ninety two specimens (n = 8) were prepared (5 mm × 2 mm) according to experimental groups: two composite resins (Filtek Supreme and four seasons); three light curing protocols [20 s with the tip of the light curing unit (LCU) device touching composite surface (C); 20 s with the tip of the LCU at 8 mm distant from composite surface (D); and tip of the LCU at 8 mm distant from composite surface and polymerization time required to obtain a radiant exposure of 16 J/cm(2) (DS)]. Four LCUs (Bluephase 16i, Ultralume LED 5, XL 3000 and Optilux 501C) were used. DC of the bottom and top surface of specimens were measured using a FTIR spectrometer. Data were statistically analyzed by 3-way split splot ANOVA and Tukey's test (alpha = 0.05)., Results: The results showed that DC of the top surface was higher than the bottom at all experimental conditions (p < 0.0001). Overall, the curing at 8 mm of distance did not affect conversion rate on the top surface (p > 0.05), but bottom surfaces showed DC reduction (p < 0.05). The highest monomer conversion values were observed for C and DS situations., Conclusion: The distance between the LCU and material surface and radiant exposure can affect the DC. Polymerization at distance should be performed with curing units with higher light power and/or extended exposure time.

Objective: The purpose of the current in-vivo study was to assess the effect of using 0.12% chlorhexidine (CHX) mouth rinse, before bonding, on shear bond strength of polycarbonate brackets bonded with composite adhesive., Subjects and Methods: Eighteen orthodontic patients with a mean age 21.41 ± 1.2 years, who were scheduled to have 2 or more first premolars extracted, were included in this study. Patients were referred for an oral prophylaxis program which included, in part, the use of a mouth rinse. Patients were divided into 2 groups, a test group of 9 patients who used 0.12% CHX gluconate mouth rinse twice daily and a control group of 9 patients who used a mouth rinse without CHX, but with same color. After 1 week, polycarbonate brackets were bonded to first premolars with Transbond XT composite adhesive. Premolars were extracted after 28 days and tested for shear bond strength on a universal testing machine. Student's t-test was used to compare shear bond strengths of both groups., Results: No statistically significant difference was found in bond strengths' values between both groups. The test group (with CHX) has mean shear bond strength of 14.21 ± 2.42 MPa whereas the control group (without CHX) revealed a mean strength of 14.52 ± 2.31 MPa., Conclusion: The use of 0.12% CHX mouth rinse, for one week before bonding, did not affect the shear bond strength of polycarbonate brackets bonded with Transbond composite. Furthermore, these brackets showed clinically acceptable bond strength.

Objective: To compare the clinical performance of brackets bonded to anterior and posterior teeth, including second molars., Materials and Methods: One operator, using the straight-wire technique, bonded metallic brackets to the teeth of 127 consecutive patients. All patients were observed for 12 months during their regular orthodontic appointments. Bracket failures were recorded and summarized for statistical analysis. The Cox proportional hazards regression analysis was performed to evaluate bracket failure rates., Results: Statistically significant differences in survival rates were observed between molar tubes and anterior brackets (P < .05). Twelve-month failure rates of incisor, canine, premolar, and molar brackets were 3.6, 1.6, 4.8, and 11.6%, respectively. The first and second molar did not show significant difference in bond failure. Young patients (age <18 years) showed a higher failure rate than old patients (≥18 years)., Conclusions: Brackets directly bonded to the buccal surfaces of molars failed significantly more often than those directly bonded to anterior teeth or premolars, but showed acceptable failure rate especially in adult patients. Bonding on second molars seems to be as reliable as bonding on the first molars.

Aim: The aim of this in vitro study was to evaluate the effectiveness of a resin infiltrant (ICON) on marginal sealing ability of class II resin restorations with/without-caries., Materials and Methods: Forty-eight noncarious human pre-molar teeth were embedded and MO and DO preparations of standard dimensions were prepared. The left side of dentin margins of the cavities were left nonbonded (UB) while the right side were bonded using total etch-bonding agent and all restored with a Nanohybrid composite. The teeth were thermocycled and half of the specimens in the UB and B groups were subjected to an artificial caries process. ICON was applied to caries and noncaries subgroups following the manufacturer's directions. Impressions were made at each step: after the restorations were completed, thermocycling, artificial caries procedures, and infiltrant application and the silicone tag lengths were measured with a stereomicroscope. The specimens were immersed in 0.5% basic fuchsine at 37° C for 24 hours, sectioned and microleakage was evaluated with a stereomicroscope. Selected samples and their replicas were assessed for marginal quality under a stereomicroscope and SEM. Statistical evaluation of the data were made using Kruskal-Wallis, Mann-Whitney U and Wilcoxon Sign Rank tests., Results: While bonding application did not create a meaningful difference, the thermocycling and artificial caries significantly increased the gap length and microleakage (p < 0.05). ICON application was decreased the microleakage, created gap-free margins and closed the gaps which were previously occurred at the same cavities (p < 0.05)., Conclusion: A resin infiltrant (ICON) application decreased the microleakage, created gap-free margins and closed the gaps, which previously occurred at the same cavities., Clinical Significance: Approximal application of resin infiltrant may increase the success of the class II composite restorations also reduced the risk of needing more complex restoration therapy.

Statement of Problem: Information is lacking of the polymerization depth of dual-polymerized flowable composite resin foundation materials in simulated root canals., Purpose: The purpose of this study was to investigate the hardness gradients and the polymerization depth of dual-polymerized flowable composite resin foundation materials in simulated root canals., Material and Methods: Slots in steel split cylinders with 1 open end were filled with the following 6 materials: Luxa Core, Para Core, Clearfil DC Core, Multi Core Flow, Gradia Core, and Core-Flo DC. After filling, they were subjected to a light intensity of 1250 mWcm(-2) with a light-emitting diode light through their open ends for 20 seconds. The resulting specimens were stored in a light-proof box at 37°C, and the Knoop hardness gradients of each polymerized material were measured after 0.5 hour, 24 hours, and 120 hours. The surface readings were obtained in 1-mm intervals at 1 mm to 10 mm away from the open ends. The collected data were analyzed by 2-way ANOVA and the Student-Newman-Keuls test (α=.05)., Results: Before the Knoop hardness numbers of the 6 materials became stable, they decreased gradually in depth at each time point (P<.001). However, the depths at which they became stable differed. The Knoop hardness numbers of Luxa Core and Core-Flo DC reached stability at a depth of 3 mm, Para Core at 4 mm, and Clearfil DC Core, Multi Core Flow, and Gradia Core at 5 mm. Additionally, at 120 hours after exposure, the ratios of the Knoop hardness numbers at a depth of 5 mm to those at 1 mm were 63.08% for Luxa Core, 70.48% for Clearfil DC Core, 81.38% for Para Core, 80.49% for Gradia Core, 86.30% for Multi Core Flow, and 96.28% for Core-Flo DC., Conclusions: In simulated root canals, the flowable composite resin foundation materials tested had better polymerization under dual polymerizing than under chemical polymerizing, and their chemical-polymerized capabilities could determine the definitive polymerization depth., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aim: To quantify the microleakage on restorations carried out with a two-step etch-and-rise adhesive system and nanofilled composite resin after thermal and mechanical loading cycling., Methods: Ninety cavities were prepared on proximal surfaces of incisive teeth, and were randomly divided according to the photoactivation time (10, 20, or 30 s) and light-curing mode (Quartz Tungsten Halogen (QTH) lamps, 450 mW/cm(2); Light Emitting Diode (LED) second generation, 1100 mW/cm(2); or LED third generation, 700 mW/cm(2)) of an adhesive system (n = 10). Following restorative procedures and thermal and mechanical loading cycling, the samples were immersed in Methylene Blue for 2 h. The samples were ground, and the powder was prepared for analysis in an absorbance spectrophotometer. All results were statistically analyzed by anova and Tukey's test at the 5% level of significance., Results: There were no significant statistical difference in microleakage between the light-curing mode (P = 0.1212) and light-curing time (P = 0.2043)., Conclusion: Different curing modes and increasing the curing time were not factors that influenced the process of microleakage., (© 2013 Wiley Publishing Asia Pty Ltd.)

Statement of the Problem: The complete polymerization of luting resins through thick indirect restorations is still questioned., Purpose: The purpose of this study was to evaluate the degree of polymerization of light- and dual-polymerizable luting resins under thick indirect composite resin and ceramic endocrowns by means of Vickers microhardness measurements., Material and Methods: The Vickers microhardness measurements of a light-polymerizable microhybrid composite resin and a dual-polymerizable luting cement directly polymerized in a natural tooth mold for 40 seconds with a high-power light-emitting diode lamp (control) were compared with measurements after indirect irradiation through 7.5-mm-thick composite resin and ceramic endocrowns for 3 × 90 seconds. A test-to-control microhardness values ratio of 0.80 at a depth of 0.5 mm below the surface was assumed as the criterion for adequate conversion., Results: For the Vickers microhardness measurements of a dual-polymerizable luting cement, no differences (P>.05) were found between Vickers microhardness control values and values reported after polymerization through composite resin and ceramic endocrowns. For The Vickers microhardness measurements (±SD) of a light-polymerizable microhybrid composite resin, control values were significantly (P<.05) higher (111 ±3.3) than those reported after polymerization through composite resin (100.5 ±3.8) and ceramic (99.7 ±2.3) endocrowns. However, the hardness values of The Vickers microhardness measurements of a light-polymerizable microhybrid composite resin polymerized through the endocrowns were approximately 10% to 12% lower than those of the control values. Two-way ANOVA showed the influence of the luting material on the Vickers microhardness values (P<.05). The effect of endocrown material was not significant (P>.05)., Conclusions: Under the conditions of this in vitro study, Vickers microhardness values of the dual-polymerizable resin cement and the light-polymerizable restorative composite resin irradiated for 3 × 90 seconds with a high irradiance light-emitting diode lamp through 7.5-mm-thick endocrowns reached at least 80% of the control Vickers microhardness values, which means that both materials can be adequately polymerized when they are used for luting thick indirect restorations., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aim: This study evaluated the in vitro effect of 35% hydrogen peroxide (HP) on surface enamel change when activated with different light curing units (LCUs)., Materials and Methods: Enamel blocks (4 × 4 × 2 mm) were obtained from bovine incisors. The initial microhardness of the enamel was determined for each specimen. After this enamel blocks were randomly divided into four groups (n = 10) and treated as follows: Control, no bleaching procedure performed; HP - LCU, application of 35% HP gel without light activation; HP + QTH, application of 35% HP gel and light activation with a Quartz Tungsten-Halogen (QTH); and HP + Light Emitting Diode, application of 35% HP gel and light-activation with a LED. New microhardness measurements were obtained, immediately, 7 and 14 days after treatment. The percentage of surface mineral change was calculated according to the baseline and post-treatment microhardness values. Additionally, six samples from each group were randomly selected and prepared for scanning electron microscopy (SEM) characterization. The data were analyzed using an analysis of variance (ANOVA) to detect differences between the three time periods, and an ANOVA and Tukey's test with a confidence level of 95%., Results: There was no significant difference between the initial hardness values and hardness values after treatment in any of the groups or time periods (p > 0.05). No major surface alterations were detected with SEM when comparing control groups to those undergoing bleaching treatments., Conclusion: The use of 35% HP in combination to QTH or LED light curing units LCU does not have detrimental effect on the enamel surface topography or in the mineral content, when compared with unbleached enamel or enamel submitted to 35% HP treatment alone.

Objectives: To assess the adhesive performance of three universal bonding systems (self-etch and total-etch protocols) with cuspal deflection and cervical microleakage score., Methods: Fifty-six standardised sound maxillary premolar teeth with uniform mesio-occlusal-distal (MOD) cavities were randomly allocated to six groups. Restoration with resin-based composite (RBC) was performed in conjunction with a universal bonding system facilitated by a quartz-tungsten-halogen light-curing-unit. The dependent variable was the universal bonding protocol (self-etch or total-etch). Buccal and palatal cuspal deflections were recorded at 0, 30, 60 and 180s post-irradiation using a twin channel deflection measuring gauge. Following restoration, the teeth subjected to 500 thermocycles, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage., Results: Comparing between bonding protocol (self-etch or total-etch), a decrease in total cuspal deflection and a concomitant increase in cervical microleakage were evident when employing the total-etch compared with the self-etch protocol for two of the three universal dental adhesives., Conclusions: The 'Adhesion-Decalcification concept' suggests a trend towards 'mild self-etch' adhesives. Differences in adhesive performance (cuspal deflection and cervical microleakage) between the teeth restored using the self-etch or total-etch protocols is suggested to be a result of the pH of the self-etch solutions. 'Mild self-etch' (pH∼2.0) adhesives out-performed ultra-mild (pH>2.5) or strong (pH<1.5) self-etch solutions., Clinical Significance: Poorly performing adhesives could be identified using the cuspal deflection and cervical microleakage protocol reported which could save the complications encountered clinically with Class II RBC restorations., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: Many studies have reported the clinical problems associated with resin composite restorations in NCCLs. None has compared these clinical problems in NCCLs with and without occlusal wear facets. The present study sets out to determine the proportion of NCCLs that presents occlusal wear facets, and to compare the failure pattern of resin composite restorations in NCCLs with and without occlusal wear facets., Methods: Teeth with NCCLs were classified into two groups, those with and without occlusal wear facets. Both groups were restored using micro hybrid resin composite. The restorations were evaluated at the end of 2 years concerning post-operative sensitivity, retention, marginal integrity, marginal discolouration, wear, and secondary caries, using the USPHS criteria. Statistical analysis compared the ratings of each criterion between the two groups using Pearson's χ(2) or Fisher's exact test., Results: About one-third (33.8%) of teeth with NCCLs presented with occlusal wear facets, more NCCLs with occlusal wear facets in mandibular teeth (44.7%) than maxillary teeth (24.5%). Retention rate of composite resin restorations in NCCLs with and without occlusal wear facets was 63.9% and 74.4% respectively at the end of 2 years. More marginal discolouration and defects were observed in restorations in NCCLs with occlusal wear facets, the differences were not statistically significant (p>0.05)., Conclusions: The decline in ratings of marginal discolouration and defects, and the lower retention rate of restorations in NCCLs with occlusal wear facets may support the role of occlusal stress and tooth flexure as a cause of failure of restorations in NCCLs., Clinical Significance: The ability to distinguish between stress induced lesions (with occlusal wear facets) and other cervical lesions will have important ramifications for the success of their restorations because they are not subjected to the same physical forces that are responsible for the deterioration of the restoration., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: The aim of this study was to assess the influence of curing time and power on the degree of conversion and surface microhardness of 3 orthodontic composites., Methods: One hundred eighty discs, 6 mm in diameter, were divided into 3 groups of 60 samples according to the composite used-Transbond XT (3M Unitek, Monrovia, Calif), Opal Bond MV (Ultradent, South Jordan, Utah), and Transbond Plus Color Change (3M Unitek)- and each group was further divided into 3 subgroups (n = 20). Five samples were used to measure conversion, and 15 were used to measure microhardness. A light-emitting diode curing unit with multiwavelength emission of broad light was used for curing at 3 power levels (530, 760, and 1520 mW) and 3 times (8.5, 6, and 3 seconds), always totaling 4.56 joules. Five specimens from each subgroup were ground and mixed with potassium bromide to produce 8-mm tablets to be compared with 5 others made similarly with the respective noncured composite. These were placed into a spectrometer, and software was used for analysis. A microhardness tester was used to take Knoop hardness (KHN) measurements in 15 discs of each subgroup. The data were analyzed with 2 analysis of variance tests at 2 levels., Results: Differences were found in the conversion degree of the composites cured at different times and powers (P <0.01). The composites showed similar degrees of conversion when light cured at 8.5 seconds (80.7%) and 6 seconds (79.0%), but not at 3 seconds (75.0%). The conversion degrees of the composites were different, with group 3 (87.2%) higher than group 2 (83.5%), which was higher than group 1 (64.0%). Differences in microhardness were also found (P <0.01), with lower microhardness at 8.5 seconds (35.2 KHN), but no difference was observed between 6 seconds (41.6 KHN) and 3 seconds (42.8 KHN). Group 3 had the highest surface microhardness (35.9 KHN) compared with group 2 (33.7 KHN) and group 1 (30.0 KHN)., Conclusions: Curing time can be reduced up to 6 seconds by increasing the power, with a slight decrease in the degree of conversion at 3 seconds; the decrease has a positive effect on the surface microhardness., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Glass Carbomer is a new generation of restorative material developed from glass-ionomer cements with possibility of gradual mineralization into fluorapatite. The aim of this clinical trial was to investigate the retention of Glass Carbomer fissure sealant after 12 months, in comparison to a commonly used conventional resin-based sealant. Forty-eight teeth in 24 patients [mean (SD) = 8 (2.3) years] with well-delineated fissure morphology were randomly divided into two equal groups and sealed with Bis-GMA resin-based Helioseal F (group A, Ivoclar Vivadent, Liechtenstein) and Glass Carbomer (group B, Glass Carbomer Sealant, Glass Carbomer Products, Leiden, Netherlands) using the split mouth design. Materials were placed and set according to the manufacturer's instructions using a polymerization unit Bluephase 16i (Vivadent, Liechtenstein). Complete sealant retentions in both groups were 100% and 75% after 6 and 12 months of clinical service, respectively. There were there were no secondary caries lesions in both groups after 6 months; two new carious lesions were detected in both groups after 12 months. The Mann-Whitney U test revealed no significant difference between the two groups at both evaluations points (P > 0.05). Glass Carbomer material showed a similar retention rate when compared with a resin-based sealant. Future studies are required to examine the long-term performance of Glass Carbomer sealants.

Objective: This study aimed to evaluate the amount of light (360-540 nm) passing through shaded zirconia with respect to material thickness, exposure distance, and different curing modes., Methods: The specimens were divided into groups according to thickness as follows: 0.5, 1, 1.5, 2, 2.5, and 3 mm. Thirty-five zirconia and seven glass-ceramic (control group) specimens were fabricated for each group (N=252). Zirconia was divided into five subgroups (n=7) and stained to the following shades: CL1, CL2, CL3, and CL4. One zirconia group remained unstained (CL0). Irradiance passing through the different specimens was measured using a violet-blue LED curing unit in three curing modes (Xtra-power, high-power, and standard-power mode) with a fibre-optic USB4000 spectrometer. Irradiance was measured at varying exposure distances, ranging from direct contact of the curing unit with the surface to a distance of 7 mm from the surface, increasing in 1 mm steps. Data were analyzed using a multivariate analysis and linear mixed models (p<0.05)., Results: The control group, the glass-ceramics, transmitted the highest irradiance values, followed by CL0 (unshaded zirconia), CL1 (~A1/B1), CL2 (~A3/A3.5/A4/B3/B4), and CL3 (~A3.5/B3/B4/C3/D3), respectively. The highest transmitted irradiance was measured at a specimen thickness of 0.5 mm for all materials, decreasing exponentially with increased ceramic thickness. Within one type of ceramic, one thickness, and one polymerization mode, a decrease in transmitted irradiance with increased exposure distance could be observed only at a distance of 3 mm and above., Conclusions: Unshaded zirconia was significantly less translucent compared with the glass-ceramic, but the translucency decreased slower with material thickness. The Beer-Lambert law describes well the decrease of transmitted irradiance with an increase of the specimens' thickness for all materials. Except for dark ceramics, this would allow for calculating the transmitted irradiance through any material thickness and any initial irradiance., Clinical Significance: The amount of light passing through ceramics is an important aspect for an adhesive cementation, since many dual-cured luting materials reveal a high sensitivity to additional occurrence of blue light. For restorations thicker than 1.5 mm in light-shaded zirconia and 0.5 mm in darker-shaded zirconia the use of less-light-sensitive dual-cured cements are recommended., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Surface sealants have been successfully used in the prevention of erosive tooth wear. However, when multiple tooth surfaces should be sealed, the light-curing procedure is very time-consuming. Therefore, the aim of this study was to investigate whether reduced light-curing time (while maintaining similar energy density) has an influence on resin-based surface sealant cytotoxicity., Methods: Bovine dentine discs were treated as follows: group 1: untreated, groups 2-5: Seal&Protect and groups 6-9: experimental sealer. Groups 2 and 6 were light-cured (VALO LED light-curing device) for 40 s (1000 mW/cm2), groups 3 and 7 for 10 s (1000 mW/cm2), groups 4 and 8 for 7 s (1400 mW/cm2) and groups 5 and 9 for 3 s (3200 mW/cm2). Later, materials were extracted in culture medium for 24 h, and released lactate dehydrogenase (LDH) activity as a measure of cytotoxicity was determined photometrically after cells (dental pulp cells and gingival fibroblasts) were exposed to the extracts for 24 h. Three independent experiments, for both sample preparation and cytotoxicity testing, were performed., Results: Overall, lowest cytotoxicity was observed for the unsealed control group. No significant influence of light-curing settings on the cytotoxicity was observed (p = 0.537 and 0.838 for pulp cells and gingival fibroblasts, respectively). No significant difference in the cytotoxicity of the two sealants was observed after light-curing with same light-curing settings (group 2 vs. 6, 3 vs. 7, 4 vs. 8 and 5 vs. 9: p > 0.05, respectively)., Conclusions: Shortening the light-curing time, while maintaining constant energy density, resulted in no higher cytotoxicity of the investigated sealants.

Objectives: The aim of this study was to investigate the adhesive stability over time of a multi-mode one-step adhesive applied using different bonding techniques on human coronal dentine. The hypotheses tested were that microtensile bond strength (μTBS), interfacial nanoleakage expression and matrix metalloproteinases (MMPs) activation are not affected by the adhesive application mode (following the use of self-etch technique or with the etch-and-rinse technique on dry or wet dentine) or by ageing for 24h, 6 months and 1year in artificial saliva., Methods: Human molars were cut to expose middle/deep dentine and assigned to one of the following bonding systems (N=15): (1) Scotchbond Universal (3M ESPE) self-etch mode, (2) Scotchbond Universal etch-and-rinse technique on wet dentine, (3) Scotchbond Universal etch-and-rinse technique on dry dentine, and (4) Prime&Bond NT (Dentsply De Trey) etch-and-rinse technique on wet dentine (control). Specimens were processed for μTBS test in accordance with the non-trimming technique and stressed to failure after 24h, 6 months or 1 year. Additional specimens were processed and examined to assay interfacial nanoleakage and MMP expression., Results: At baseline, no differences between groups were found. After 1 year of storage, Scotchbond Universal applied in the self-etch mode and Prime&Bond NT showed higher μTBS compared to the other groups. The lowest nanoleakage expression was found for Scotchbond Universal applied in the self-etch mode, both at baseline and after storage. MMPs activation was found after application of each tested adhesive., Conclusions: The results of this study support the use of the self-etch approach for bonding the tested multi-mode adhesive system to dentine due to improved stability over time., Clinical Significance: Improved bonding effectiveness of the tested universal adhesive system on dentine may be obtained if the adhesive is applied with the self-etch approach., (Copyright © 2014 Elsevier Ltd. All rights reserved.)