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Objective To evaluate clinical performance of the new CAD/CAM resin-matrix ceramics and compare it with ceramic partial coverage restorations. Materials and methods An electronic search of 3 databases (The National Library of Medicine (MEDLINE/PubMed), Scopus, and the Cochrane Central Register of Controlled Trials) was conducted. English clinical studies published between 2005 and September 2020 that evaluated the clinical performance of CAD/CAM resin-matrix ceramics inlays, onlays, or overlays were selected. The primary clinical question was applied according to PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). The included studies were individually evaluated for risk of bias according to the modified Cochrane Collaboration tool criteria. Results A total of 7 studies were included according to the established inclusion and exclusion criteria. From the included studies, 6 were randomized clinical trials while one study was longitudinal observational study without control group. According to the results of the included studies, the success rate of CAD/CAM resin-based composite ranged from 85.7 to 100% whereas the success rate reported for ceramic partial coverage restorations ranged from 93.3 to 100%. Fractures and debondings are found to be the most common cause of restorations failure. Conclusion CAD/CAM resin-based composite can be considered a reliable material for partial coverage restorations with clinical performance similar to glass ceramic restorations. However, this result needs to be confirmed in long-term evaluations. Clinical relevance CAD/CAM resin-based composites provide a potential alternative to ceramic indirect restorations. However, clinicians must be aware of the lake of knowledge regarding long-term outcome.

Objectives The aim of this study was to comparatively evaluate microshear bond strength (μSBS) of bioactive ionic resin composite and resin-modified glass ionomer liner (RMGI) to dentin and resin composite. Materials and Methods The enamel of 11 posterior molar teeth was removed to expose dentin and then placed in acrylic blocks. Each specimen received three microcylindrical Tygon tubes filled with bioactive ionic resin composite (Activa Bioactive base/liner (Pulpdent, MA, USA)), RMGI (Riva light cure SDI LTD, Bayswater, Australia), and resin composite (Filtek Z350xt, MN, USA). Composite discs (n = 11) were fabricated from nanofilled resin composite (Filtek Z350xt) and then fixed in acrylic blocks. Each specimen received two microcylindrical Tygon tubes filled with Activa Bioactive base/liner and Riva RMGI. All specimens were mounted individually to universal testing machine for μSBS test. Failure modes were analyzed using stereomicroscope and scanning electron microscope. Results Filtek Z350xt nanofilled resin composite showed the highest μSBS values. No statistical significant difference was found between Activa Bioactive and Riva RMGI (p > 0.05). Conclusion Bioactive ionic resin composite liner exhibited similar bond strength as RMGI to dentin and resin composite.

Background Endodontic surgical procedures, when performed, require retrograde filling materials that are biocompatible, non-toxic, non-irritant, dimensionally stable, and ideally promote bone formation. Precise evaluation of retrograde filling materials in clinical trials is necessary to give holistic view for properties of material and potential outcome from its use. The purpose of this review is to evaluate the effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment. Methods An electronic search was performed in the time frame between 1st of January 2000 to 1st of September 2020 using database. Sources Web of Science, PubMed and redundant hand searches through their references. Seven inclusion–exclusion criteria were set for the selection and identification of relevant articles. Risk of bias was conducted for the included studies. Results Nine randomized clinical trials (RCTs) fulfilled the inclusion criteria for this systematic review. The outcome of this review revealed that none of the reviewed trials totally-fulfilled CONSORT 2010 criteria. Conclusions In light of the outcome of this review, there is no enough evidence to support the superiority of certain retrograde filling material or surgical technique over another in the success rate of surgical endodontics retreatment. The variety of methodologies and strategies, such as patient selection, the method of treatment and study analysis, led to doubtful credibility of the obtained clinical evidence. Further prospective randomized controlled clinical trials evaluating the specific effect of the various used materials are needed.

The aim of the current study is to evaluate the remineralization potential of experimental tricalcium silicate (TCS) paste in comparison with more popular remineralizing agents like silver diamine fluoride potassium iodide (SDF-KI) and casein phosphopeptide amorphous calcium phosphate (CPP-ACP) on early enamel lesions.Forty-five patients in the age range of 15-50 years had early enamel lesions on the buccal surface of molar teeth. The patients were randomly divided into three treatment groups (SDF-KI, CPP-ACP, and TCS group) with 15 patients per group. Lesions were evaluated clinically by DIAGNOdent pen immediately and after 3,6,12, and 24 months of treatment.The study was completed with 45 patients and 92 teeth. Twice-daily application of CPP-ACP and TCS paste showed a significant remineralization effect on early enamel lesions after 24 months (p 0.001). Also, annual application of SDF-KI showed a significant remineralization effect after 24 months (p 0.001). There was a significant difference between (SDF-KI and CPP-ACP) and (SDF-KI and TCS) at the different follow-up periods 3,6,12, and 24 months (p 0.001). Meanwhile, there was no significant difference between CPP-ACP and TCS at the mentioned follow-up periods (p 0.05).TCS showed potential remineralization for early enamel lesions.Experimental TCS is a promising remineralizing agent for management of early enamel lesions.

Aim This laboratory study aimed to investigate the effects of three endodontic biomaterials; MTA-HP, iRoot-BP-Plus and ACTIVA on the proliferation, adhesion and osteogenic differentiation of human Dental Pulp Stem Cells (hDPSCs). Methodology The hDPSCs were isolated from the dental pulps of 21 patients scheduled for surgical extraction of their impacted third molars. The MTT assay was used for assessing cellular proliferation. Ninety-six-well plates were used and the experiment was repeated four times under the same condition and the assay was done in triplicate. Four groups were assigned in which the hDPSCs were cultured in complete media only and considered as negative control. Whilst in the 2nd , 3rd and 4th groups, the cells were treated with CM supplemented with 1.5 μl MTA-HP (CM-MTA, iRoot-BP-Plus (CM-BP), and ACTIVA(CM-AC) extracts, respectively. Attachment adhesion and growth morphology of hDPSCs were observed using SEM and the osteogenic differentiation assay was evaluated by Alizarin red stain test (ARS). The data of proliferation and osteogenic differentiation were analysed using two-way ANOVA followed by Tukey's post hoc multiple comparison test. A p-value Results Both CM-MTA and CM-BP groups were associated with a significant increase in hDPSC proliferation in comparison with CM-AC and CM groups (p = 0.001). hDPSCs exhibited a greater cellular attachment to iRoot-BP-Plus surfaces followed by MTA-HP, whilst less attachment was observed in the ACTIVA group. Moreover, at day 7 there was a significant difference in formation of mineralizing nodules; CM-BP, CM-MTA and CM-AC groups respectively (p = 0.001). Whilst there was no significance of difference between CM-AC and CM groups (p > 0.05). Conclusions In a laboratory setting, ACTIVA, MTA-HP and iRoot-BP-Plus promoted hDPSCs proliferation, mineralization and attachment, which may explain their in-situ success as endodontic biomaterials.

The aim of this study was to investigate the outcomes of direct pulp capping performed with two types of tricalcium silicate-based materials (mineral trioxide aggregate/MTA and Biodentine/BD); nano-hydroxyapatite (nHAP) crystals or calcium hydroxide (CH) in dogs. Following mechanical exposure, the pulps were randomly capped with one of the four materials. Histological analyses were performed to examine the outcomes after 7 days or 3 months. At 7 days, BD and nHAP showed significantly less inflammatory cell response than MTA and CH. At 3 months, the inflammatory cell response and tissue necrosis were significantly higher in the CH group. There was no significant difference between the tested materials in the calcific bridge formation after 7 days; however, a significant difference was noticed at the 3-month period. Tricalcium silicate-based cements and nHAP are potential alternatives to CH in vital pulp therapy following accidental pulp exposure.

To evaluate clinical performance of the new CAD/CAM resin-matrix ceramics and compare it with ceramic partial coverage restorations.An electronic search of 3 databases (The National Library of Medicine (MEDLINE/PubMed), Scopus, and the Cochrane Central Register of Controlled Trials) was conducted. English clinical studies published between 2005 and September 2020 that evaluated the clinical performance of CAD/CAM resin-matrix ceramics inlays, onlays, or overlays were selected. The primary clinical question was applied according to PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). The included studies were individually evaluated for risk of bias according to the modified Cochrane Collaboration tool criteria.A total of 7 studies were included according to the established inclusion and exclusion criteria. From the included studies, 6 were randomized clinical trials while one study was longitudinal observational study without control group. According to the results of the included studies, the success rate of CAD/CAM resin-based composite ranged from 85.7 to 100% whereas the success rate reported for ceramic partial coverage restorations ranged from 93.3 to 100%. Fractures and debondings are found to be the most common cause of restorations failure.CAD/CAM resin-based composite can be considered a reliable material for partial coverage restorations with clinical performance similar to glass ceramic restorations. However, this result needs to be confirmed in long-term evaluations.CAD/CAM resin-based composites provide a potential alternative to ceramic indirect restorations. However, clinicians must be aware of the lake of knowledge regarding long-term outcome.

Background The purpose of this study was to compare the biocompatibility of three bioactive materials, namely ACTIVA bioactive restorative resin composite, iRoot BP plus and Mineral Trioxide Aggregate (MTA) Angelus-HP. Methods Seventy-five Wistar male rats were subjected to subcutaneous implantation of four polyethylene tubes; one empty tube was used as control (Group 1), and the other tubes were filled with ACTIVA (Group 2), iRoot BP (Group 3) and MTA-HP (Group 4). Then, the rats were subdivided into 3 groups according to the sacrification time into one, two and 4 weeks (n = 25 rats). Tissue specimens were submitted to histopathological and immunohistochemical analysis of α-SMA and caspase 3. Results The one-way Anova test revealed that ACTIVA group exhibited minimal inflammation in comparison to calcium silicate cements (iRoot BP and MTA-HP groups). iRoot BP group significantly revealed a more severe degree of chronic inflammation in comparison to other groups (P

Objectives: To evaluate the effect of different dentine surface treatment methods on bonding of bioactive RMGI-based restorative material to dentineMethods: A total number of 25 caries-free human permanent molars were used as the bonding substrate. The occlusal enamel was removed using a low-speed diamond saw (Isomet, Buehler, USA). The selected molars were divided into 5 groups (n=5) according to the dentine surface treatment method used; saline (control), 10% citric acid (10s),17% EDTA (10s), 37% Phosphoric acid (10s) or polyacrylic acid (10s). Then, restorative material was placed to cover the exposed dentine surface following the manufacturer instructions. The hybrid/hybrid-like layer was observed using environmental field emission scanning electron microscopy E-FESEM operated in secondary electron/ back -scattered detection modes. Furthermore, the tooth/restoration interface was subjected to an elemental analysis using Energy Dispersive X-ray (EDX) and EDX mapping.Results: The micromorphological analysis of tooth/restoration interface showed that bioactive RMGI-based restorative material (Activa) exhibited good hybridization with dentine following surface treatment with 10% citric acid, as well as, saline. The outcome of elemental analysis showed that 10% citric acid did not adversely affect the calcium content of dentine in comparison with surface treatment using phosphoric acid. Conclusions: Water plays a great role in bonding of bioactive restorative materials to dentine. These materials can directly bond to dentine after rinsing of the surface with saline. Although, bioactive RMGI restorative material manufacturer recommends conditioning the dentine with phosphoric acid prior to insertion of materials, it is highly advisable and more conservative to use 10% citric acid.

Objectives: To characterize the bonding interfaces of a calcium silicate-based restorative material (Biodentine) and CPP/ACP-modified glass ionomer with dentine. Also, this study was designed to evaluate the influence of dentine-surface treatment with poly acrylic acid on the bonding of both materials to dentine.Methods: Sixty caries-free human molars were used in this study. Specimens were randomly divided into three groups according to type of restorative material used (n=20); calcium silicate-based (Biodentine, Septodont, France), conventional GIC Fuji VII-EP, GC Corporation, Tokyo, Japan) or CPP/ACP-modified glass ionomer (Fuji VII-EP, GC Corporation, Tokyo, Japan). Each group was divided into 2 sub-groups relative to the dentine surface treatment method (n=10); the dentine in control group was left without treatment, while the dentine surface in test groups was conditioned with poly acrylic acid (PAA) for 10s prior to the application of restorative. In each subgroup,5 specimens were double-labeled with fluorescein and rhodamine-B dyes then observed under a confocal laser scanning microscopy (CLSM). While the remaining 5 specimens were observed under scanning electron microscopy (SEM) then subjected to EDX elemental analysis.Results: CLSM micrographs showed that the mineral rich zone (MRZ) was obvious in non-conditioned Biodentine groups compared to conditioned groups. Both GICs groups exhibited obvious ion-exchange zones. In the non-conditioned Biodentine groups, polygonal crystal deposition was noticed beneath the hybrid layer. These findings were confirmed by the outcome of micromorphological analysis of restoration/tooth interface using SEM.Conclusions: Calcium silicate-based restorative material has a great affinity to exchange ions with tooth substrate and to bond chemically with dentine. The results of this study showed that calcium silicate-based restorative material (Biodentine) can be applied directly on dentine surface without any pre-surface treatment.

Objective The objective of this review was to evaluate the effect of air-drying time on the adhesion (bond) strength of adhesives to dentin in previously published studies and to conduct a meta-analysis to quantify the differences in the bond strength obtained after the different air-drying times. Methods An electronic search was performed using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of adhesive air-drying time on adhesion (bond) strength of resin-based adhesives to coronal dentin. Studies which evaluated the effect of adhesives air-drying time on physical and mechanical properties of adhesives, interfacial properties, bond strength to root dentin, enamel, or bond strength of indirect composite restoration or orthodontic bracket, were excluded. The methodological quality of included studies was assessed. Meta-analysis was performed using Comprehensive Meta-Analysis software, version 2.0 (Biostat, Englewood, NJ, USA). The results of the meta-analysis were subjected to a further one-way analysis of variance, followed by the Tukey post hoc multiple comparison using R-software, version 3.4.3 (R Foundation for Statistical Computing, Vienna, Austria). Results Thirteen studies fulfilled the inclusion criteria of this review, while only five studies were included in meta-analysis. The effect of adhesive air-drying time on the bond strength was significant in eight studies (61.5%), material-dependent in four studies (30.8%), and not significant in one study (7.7%). Eight studies (61.54%) presented a medium-risk of bias, three studies (23.08%) presented a low-risk of bias, and two studies (15.38%) presented a high-risk of bias. The analysis of micro-tensile bond strength (μTBS) of adhesives showed statistically significant difference between different air-drying times (p Conclusion The air-drying time of adhesives is crucial to the adhesion strength to coronal dentin. Adhesive air-drying for shorter durations (5–10 s) may be insufficient to obtain adequately durable bonding to dentin, instead, Air-drying should be performed for longer durations (15–30 s), considering the pressure and distance of air-drying source.

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

Objective: The objective of this review was to evaluate the effect of non-thermal atmospheric plasma (NTAP) on adhesives resin–dentin micro-tensile bond strength (μTBS) in previously published studies. Methods: Electronic search was conducted using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of NTAP on adhesives μTBS to coronal dentin. Studies that evaluated the effect of NTAP on bond strength to indirect substrates, enamel or root dentin, were excluded. The methodological quality of included studies was assessed. Results: Thirteen studies were included in this systematic review. All the included studies were considered to have a medium risk of bias. NTAP significantly improved μTBS at 24 h or after short-term aging in five studies (38.5%) and both immediate and after long-term aging in 5 studies (38.5%). In two studies (15.4%), NTAP resulted in a short-term material-dependent effect that was not stable after long-term aging. Interestingly, in one study (7.7%), NTAP had a positive effect only in the etch-and-rinse (ER) mode after long-term aging. Conclusion: Within the limitations of this systematic review, NTAP application could enhance resin–dentin μTBS of ER adhesives or universal adhesives (UAs) applied in the ER mode. In the ER mode, the rewetting step after NTAP seems to be unnecessary. Because of the limited information currently available in the literature, further studies are required to evaluate the effect of the NTAP application on self-etch (SE) adhesives or UAs applied in the SE mode.

Objectives To evaluate the surface roughness and gloss of three nanohybrid resin composites after polishing with three different polishing systems. Materials and Methods A total number of 112 disc specimens (10 × 3 mm) were prepared from nanohybrid—Empress Direct (ID), Grandio (GR), Filtek Z350 (Z350) and a microhybrid resin composite restorative materials—Filtek Z250 (Z250). Following 24-hour storage in 37°C distilled water, each composite group (n = 28) was assigned into four groups (n = 7) according to finishing/polishing (F/P) system: Mylar strip, Optrapol, Politip, and Sof-Lex (SL). The surface roughness (Ra, mm) was measured by a novel three-dimensional method using an image analysis software attached to an environmental scanning electron microscope. A glossometer was used to measure the surface gloss. Results Statistical analysis used was ANOVA test. Two-way Anova test revealed that the “type of composite” and “F/P techniques” had a significant effect on both surface roughness and gloss of the tested resin composite materials (p < 0.05). Tukey’s post hoc test showed that ID, GR, and Z350 revealed lower surface roughness and higher surface gloss than Z250 within the same polishing system (p < 0.05). Sof-Lex polishing discs produced the lowest surface roughness and highest surface gloss values compared with Optrapol and Politip (p < 0.05). Conclusion The tested F/P systems provided comparable surface roughness and gloss for nanohybrid composites. The Sof-Lex system provided the best surface roughness and gloss for nanohybrid composites.

Objective The purpose of this systematic review was to summarize scientific evidence that evaluates in vitro fracture and fatigue strength of occlusal veneers in different thicknesses, CAD/CAM materials, and under different aging methodologies. Materials and methods An electronic search of 3 English databases (The National Library of Medicine (MEDLINE/PubMed), ScienceDirect, and EBSCOhost) was conducted. Laboratory studies published between September 2009 and October 2019 that evaluated fracture or fatigue strength of CAD/CAM occlusal veneers and used human teeth were selected. The included studies were individually evaluated for the risk of bias following a predetermined criterion. The outcomes assessed included the types of the restorative material, the thickness of the veneers, and aging methods. Results A total of 12 studies fulfilled the inclusion criteria. Most of the included studies (86%) evaluated the fracture strength of occlusal veneers. Two studies evaluated fatigue resistance. There was a significant relationship between the choice of materials and fracture strength. Polymeric materials performed better in fatigue testing in comparison to ceramics. Lithium silicate-based glass ceramics showed more favorable outcomes in a thickness of 0.7–1.0 mm. Fracture resistance values in all the included studies exceeded maximum bite forces in the posterior region. Conclusions The outcomes of this systematic review suggest that occlusal veneers can withstand bite forces in the posterior region, whereas the measurement of thickness should be standardized in order to have a fair comparison. Further research needs to be conducted to evaluate the longevity of this type of restorations clinically.

The present study aimed to evaluate the effect of restoration thickness, CAD/CAM material, and 6 months of artificial saliva storage on the fracture resistance of occlusal veneers.A total of 84 intact maxillary molars were sectioned 4.0 mm occlusal to the cementoenamel junction to expose the dentine. The teeth were assigned into 3 main groups according to the type of restorative material (e.max CAD, Vita Enamic, and Lava Ultimate). In each group, the teeth were allocated into 2 subgroups (n = 14) according to restoration thickness (1.0 and 1.5 mm). The veneers were adhesively bonded using dual-cure self-adhesive luting agent. A total of 42 specimens comprising half the tested subgroups were stored in distilled water for 24-h before the test. The remaining half was stored in artificial saliva at 37 ± 1 °C in an incubator for 6 months. All specimens (n = 84) were subjected to 5000 thermal cycles between 5 and 55 °C ± 2 before the fracture resistance test. The maximum force at fracture was recorded in Newton. Failure mode was analyzed using a stereomicroscope. The results were analyzed using a parametric Three-way ANOVA test.The results of the Three-way ANOVA test revealed that material type and restoration thickness significantly affected fracture resistance values (p 0.5), while 6 months of storage in artificial saliva had no significant effect on mean fracture resistance values (p˃0.5). The most common failure patterns in CAD/CAM resin composite and polymer-infiltrated ceramics were scores I and score II. For glass ceramic groups, score IV and III were more dominant.All the tested CAD/CAM restorations in both thicknesses exhibited fracture resistance values exceeding normal and parafunctional bite forces. Polymer-infiltrated ceramics and CAD/CAM resin composite veneers showed more favorable fracture patterns.

Background The purpose of this in vitro study is to compare the antimicrobial effect and pH of two calcium silicate cements Mineral trioxide aggregate high plasticity (Angelus PR, Brazil) and iRoot BP Plus (BioCeramix Inc., Vancouver, BC, Canada) and new bioactive restorative resin composite restorative material (ACTIVA, MA, Pulpdent, USA) against aerobic bacteria, strictly anaerobic bacteria and a yeast by using an agar diffusion test. Methods The materials were tested immediately after manipulation and were applied to the agar plates. Sodium hypochlorite (NaOCl) 5.25% was used as a positive control group. The dry filter paper acted as a negative control group for this study. The size of the inhibition zone for each material was measured after 12, 24 and 48 h. At the time of pH measurement; materials were prepared, crushed then dispersed in distilled water. Results The one-way Anova test revealed that iRoot BP Plus significantly showed superior antimicrobial efficacy compared to MTA-HP against the following species; Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, Enterococcus faecium, Peptostreptococcus anaerobius and Candida albicans (P All of the tested materials did not show any antimicrobial effect against Porphyromonas gingivalis and Actinomyces israelii. The new bioactive resin composite material (ACTIVA) showed the least antimicrobial activity against the previously mentioned microorganisms except E. faecalis. NaOCl significantly showed the highest antimicrobial activity among the test group (P Conclusions According to the findings of this study, it was concluded that calcium silicate- based cements showed a potential antimicrobial activity mainly due to its high alkalinity. The new bioactive resin composite restorative material exhibits less antimicrobial activity due to its resinous ingredients and slightly acidic nature. Antimicrobial effect of calcium silicate cements against strictly anaerobic bacterial species is still questionable.

In the past two decades, dental posterior resin composites have been comprehensively developed to fulfill patients’ high aesthetic demands. Mechanical properties of resin composites have improved significantly in the past 5 years. Despite this, of the continuously developing procedures, polymerization shrinkage is still the major “inherited” drawback of resin composites. Several attempts were introduced to overcome or minimize the adverse effect of polymerization shrinkage on resin composite restorations. Some of these trials succeeded; however, many of them did not. It was found that, in current scientific literature, there are a lot of contradicting opinions about the benefits of using of low-shrink or bulk-fill resin composites. One of the critical steps in resin composite restoration is the isolation and application of dental adhesive systems. These technique-sensitive procedures play a significant role in the long-term clinical success of resin composite restorations. In this chapter, we tried to highlight the major challenges for bonding to tooth substrates (particularly dentine). Moreover, we tried to update the reader with the most recent classification of dental adhesives and adhesion technologies.

Objectives Recently a silver diamine fluoride and potassium iodide solution (Riva Star, SDI Australia) has been introduced for clinical use as a desensitizing agent or a cavity cleaner. Little is known whether the precipitate produced will affect adhesion to dentin. The aim of this study was to determine whether Riva Star influenced bond strengths to an etch-and-rinse (Optibond FL; Kerr, USA), 2-step self-etching (Clearfil Liner Bond F; Kuraray Noritake Dental, Japan) and all-in-one (Optibond Versa; Kerr) resin-based adhesives and a resin-modified GIC adhesive (Riva Bond LC; SDI Australia). Methods Human mid-coronal dentin was used; the adhesives were bonded according to the manufacturers׳ instructions or after the dentine surfaces had been treated with the Riva Star. Teeth were sectioned into 1 mm×1 mm samples and subjected to a microtensile bond strength test. Results were analysed using univariate analysis of variance and Tukey HSD test. Results Adhesive strengths were adversely affected for all adhesives: manufacturer instructions: Optibond FL 32 MPa, SE Bond 28.5 MPa, Optibond Versa 35, Riva Bond LC 18.4 MPa; Riva Star treated groups: Optibond FL 22 MPa, SE Bond 10.9 MPa, Optibond Versa 9.6 MPa, Riva Bond LC 14.5 MPa. Only the GIC and etch-and-rinse adhesive were less effected by the Riva Star application. SEM analysis showed that Riva Star left a precipitate on the dentine surface. Conclusions It was concluded that if Riva Star is used as a desensitizing and cavity cleaning agent then tooth surfaces should be lightly roughened. Riva Star should not be used as a ‘whole cavity’ ‘disinfecting’ agent but may be used for spot application where a cavity floor approximates the pulp where caries-affected dentine may still exist, otherwise adhesion may be compromised.

Objectives: This study evaluated the adhesion of a conventional (Fuji VII) and a recently introduced CPP–ACP containing glass-ionomer cement (Fuji VII EP) to human enamel, sound dentine, and caries-affected dentine (CAD). Material and Methods: Twenty caries-free human molars and 10 molars exhibiting frank dentine caries lesions were used. Caries removal was performed with conventional rotary method guided with a caries detector dye. The tooth surfaces were conditioned with Dentin Conditioner and then bonded with GIC restorative materials. The microtensile bond strengths were measured and analysed statistically using two-way ANOVA at the 95% confidence level. In addition, the micromorphological patterns of the GIC/tooth interfaces were observed using SEM.Results: Two-way ANOVA showed that the bond strength was not significantly affected by the type of GIC used and tooth substrate. The micromorphological analysis of the GIC/tooth interface revealed that the GICs adapted well to the tooth substrate surfaces and exhibited acid-base resistant zones on the ‘normal’ dentine but was variable on the enamel and caries-affected dentine, with the Fuji VII EP showing acid–base resistance on caries-affected dentine. Conclusions: The results demonstrate that incorporation of CPP–ACP into GIC has no adverse effect on the adhesion to enamel, sound dentine, and caries-affected dentine. It was concluded that the modified GIC can bond to commonly encountered tooth substrates.

Background Nowadays, most of the dental manufacturers claimed that ‘Universal’ or ‘multi-mode’ adhesives in self-etch technique can obtain good bonding results comparing to etch-and-rinse or selective etching application techniques. The rationale behind this study was that a multi-mode adhesive, when proven to be effective, would enable general practitioners to apply the adhesive using either an ‘etch-and-rinse’ or an ‘self-etch’ adhesive mode strategy, basically depending on their interpretation of what appears to be most appropriate upon examination of the actual cavity and the overall restoration conditions. Objective This study examined the effect of acid etching on microtensile bond strength (μTBS), micromorphological patterns of resin-dentin interface using scanning electron microscope (SEM) and SEM of tracer-infused water-rich zones within the hybrid layers of ultra-mild self-etch adhesives bonded to coronal dentin. Methods Sixty extracted permanent molars were assigned into six groups based on μTBS (n = 10). The groups were bonded with Adper single bond (SB) plus adhesive in etch-and-rinse mode and Adper easy one (EO) bond in self-etch mode as controls; Single Bond Universal self-etch (SUSe) and etch-and-rinse (SUEr); Adhese Universal self-etch (AUSe) and etch-and-rinse (AUEr). The bonded specimens were stored in deionized water for 24 h. Composite/dentin beams were prepared (1 mm2). μTBS testing was performed. Micromorphological evaluation of extra teeth from each study group was conducted using SEM, and nanoleakage (NL) was evaluated. μTBS data were statistically analyzed using two-way ANOVA and multiple comparison post-hoc tests. Results AUEr had the highest μTBS (p 0.05). The μTBS for SUEr was similar to the SB control adhesive (p > 0.05), while the μTBS for SUSe was higher than the EO control adhesive (p Conclusion Application of an etching step prior to water-based adhesive improves its dentin penetration, but it does not affect its μTBS; while application of an etching step prior to ethanol-based adhesive improves its dentin penetration and its μTBS.

Objectives The aims of this study were to conduct a systematic review of the microtensile bond strength (µTBS) of multi-mode adhesives to dentin and to perform a meta-analysis to assess the significance of differences in the µTBS of one of the most commonly used universal adhesives (Scotchbond Universal, 3M ESPE) depending on whether the etch-and-rinse or self-etch mode was used. Materials and methods An electronic search was performed of MEDLINE/PubMed, ScienceDirect, and EBSCOhost. Laboratory studies that evaluated the µTBS of multi-mode adhesives to dentin using either the etch-and-rinse or self-etch mode were selected. A meta-analysis was conducted of the reviewed studies to quantify the differences in the µTBS of Scotchbond Universal adhesive. Results Only 10 studies fulfilled the inclusion criteria for the systematic review. Extensive variation was found in the restorative materials, testing methodologies, and failure mode in the reviewed articles. Furthermore, variation was also observed in the dimensions of the microtensile testing beams. The meta-analysis showed no statistically significant difference between the etch-and-rinse and self-etch modes for Scotchbond Universal adhesive (p > 0.05). Conclusions Multi-mode 'universal' adhesives can achieve substantial bonding to dentin, regardless of the used modes (either etch-and-rinse or self-etch).

Dental caries is a multifactorial microbial disease that affects tooth hard tissue leading to destruction of its mineral andorganic components. The current work reviewed the development of caries assessment methods and excavation conceptsin the past two centuries. In the late ninetieth century, G.V. Black introduced a classification of dental caries, as well asestablished the principals of tooth preparation, based on his understanding of the nature of the disease. However, dueto the great development of dental materials and caries detection methods, most of Black’s principals are no longer validnowadays. In light of the minimal invasive philosophy, several new caries excavation concepts were introduced. These conceptsconverts ‘old’ Black’s caries excavation concept of “extension for prevention” to “prevention of extension”. Since2000 the concepts of caries excavation have greatly changed due to the popularity of the ‘partial caries removal’ concept.As an example of this new ‘conservative’ vision, the “Fédération Dentaire Internationale” (FDI) (World Dental Federation) approved the atraumatic restorative technique (ART) as one of the caries excavation methods in 2002.

SUMMARY Objectives The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods. Methods An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques. Results Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphi's ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes). Conclusions It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

Objectives The aim of this systematic review was to critically analyze previously published studies of the effects of dentin surface pretreatment with deproteinizing agents on the bonding of self-etch (SE) adhesives to dentin. Additionally, a meta-analysis was conducted to quantify the effects of the above-mentioned surface pretreatment methods on the bonding of SE adhesives to dentin. Materials and methods An electronic search was performed using the following databases: Scopus, PubMed and ScienceDirect. The online search was performed using the following keywords: 'dentin' or 'hypochlorous acid' or 'sodium hypochlorite' and 'self-etch adhesive.' The following categories were excluded during the assessment process: non-English articles, randomized clinical trials, case reports, animal studies, and review articles. The reviewed studies were subjected to meta-analysis to quantify the effect of the application time and concentration of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) deproteinizing agents on bonding to dentin. Results Only 9 laboratory studies fit the inclusion criteria of this systematic review. The results of the meta-analysis revealed that the pooled average microtensile bond strength values to dentin pre-treated with deproteinizing agents (15.71 MPa) was significantly lower than those of the non-treated control group (20.94 MPa). Conclusions In light of the currently available scientific evidence, dentin surface pretreatment with deproteinizing agents does not enhance the bonding of SE adhesives to dentin. The HOCl deproteinizing agent exhibited minimal adverse effects on bonding to dentin in comparison with NaOCl solutions.

Background This study compared the chemical, morphological and microhardness changes in carious dentine following application of NaOCl-based (Carisolv), papain-based (Papacarie) chemomechanical caries removal agents with conventional rotary method. Methods Thirty-two carious and eight non-carious human permanent molars were used. The carious molars were randomly distributed into four groups: Group 1 (positive control) – molars were left without caries removal; Group 2 – caries excavated with rotary method; Group 3 – caries excavated with Carisolv; Group 4 – caries excavated with Papacarie. Group 5 (negative control) consisted of eight sound molars. After caries excavation, all specimens were prepared for chemical, morphological analysis and Vickers hardness testing. Results EDX analysis showed no significant difference in Ca wt%, P wt% and Ca/P ratio among Groups 2 to 5. Vickers hardness of dentine from Groups 3 and 4 was significantly lower (p

Nowadays, most of recent adhesive dentistry studies tried to show a great similarity between the ‘dynamic’ bone model and dentine. The main purpose of this short communication article is to advise the academic community to exert more efforts and direct more research money to conduct some controlled randomized clinical trials in this particular area. Also, to respect the clinical aspects, which is much more complicated in comparison with the standardized laboratory model performed under optimum conditions.

This work describes a new method using polarized light microscopy to determine the failure modes of fractured beams following microtensile bond strength testing. The outcomes were validated using SEM and EDX elemental analysis.Resin adhesives and resin composites bonded to caries-free dentin samples as well as disks of adhesive and composite were observed with reflected polarized light microscopy (PLM) to obtain standard images. A set of beams fractured in the microtensile bond test were observed with PLM and compared with the standard images to determine failure mode through PLM color matching with the standard dentin, adhesive, or composite images. Samples were analyzed by EDX under SEM and compared with the PLM outcomes.Reflected PLM images showed that the fractured surfaces covered with resin-based materials (adhesives or composite) appeared pink in color, in contrast to dentin surfaces, which appeared yellow. EDX mapping together with SEM observation confirmed the results obtained by PLM.The results of EDX mapping and SEM observation showed that the use of polarized light microscopy is a simple, viable method for differentiation between the resin-covered dentin surfaces for determining fracture pattern analysis after bond testing.

The aim of this study was to assess the effect on bacterial viability within dentinal tubules after the application of sodium hypochlorite (NaOCl)- or enzyme-based chemomechanical caries removal agents.Twenty-five caries-free dentin discs prepared from 25 sound maxillary premolars were used. The discs were then infected with Streptococcus mutans suspension and randomly divided into the following 6 groups according to the dentin treatments: the negative control group: noninfected sound dentin discs, the positive control group: infected discs were left untreated; the NaOCl group: treated with 5% NaOCl solution, the chlorhexidine (CHX) group: 2% CHX solution, the Carisolv group: Carisolv gel (Medi Team Dentalutveckling AB, Savedalen, Sweden), and the Papacarie group: Papacarie gel (FormulaAcao, São Paulo, Brazil). All the agents were applied for 5 minutes. The dentin discs were fractured into 2 halves and stained with fluorescent LIVE/DEAD Stain (Molecular Probes, Eugene, OR). Each specimen was observed using confocal laser scanning microscopy at 5 different randomly selected sites.The results of 1-way analysis of variance revealed that 5% NaOCl solution achieved the highest intratubular antibacterial effect, whereas Carisolv gel had the lowest antibacterial effect (P.05). No significant difference in antibacterial effect was observed between the Papacarie gel and 2% CHX solution (P.05).The enzyme-based chemomechanical caries removal (Papacarie) was effective in the reduction of residual cariogenic bacteria in the dentinal tubules of coronal dentin.