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The aim of this study was to investigate the mechanical, chemical, optical, and adhesive properties of BisGMA-free experimental resin composites containing Exothane-24—an elastomeric urethane monomer—and different co-initiators. A blend of urethane dimethacrylate (UDMA), extended dimethacrylate urethane (PEG 400), triethylene glycol dimethacrylate (TEGDMA), and camphorquinone was prepared. Two different co-initiators—dimethyl aminoethyl methacrylate (DMAEMA) or 4-N alcohol, N-dimethylamine phenylethyl (DMPOH)—were added to the blend. Exothane-24 monomer was added to the blend for each co-initiator and four groups were established as follows: DMAEMA; DMAEMA + Exothane; DMPOH; and DMPOH + Exothane. Specimens were photo-activated using a multi-wave LED light-curing unit (VALO; 954 mW/cm2 of irradiance). Mechanical (ultimate tensile strength, flexural strength, flexural modulus and hardness), chemical (degree of conversion, hardness reduction, water sorption and solubility), optical (color change), and adhesive (microtensile bond strength) properties were analyzed. Data were submitted to two-way ANOVA and Tukey’s test (α = 0.05). The resin composite containing DMPOH and Exothane-24 showed similar or superior performance to those of the other experimental composites for mechanical and chemical properties, except for flexural strength. It also showed less color change and greater micro-tensile bond strength. Among the combinations tested, the BisGMA-free resin composite containing Exothane-24 combined with the DMPOH co-initiator showed the best mechanical, chemical, optical, and adhesive properties. Clinical relevance Exothane-24 monomer and DMPOH co-initiator could be useful in the formulation of BisGMA-free resin composites in order to minimize exposure to BPA.

This study investigated the effect of butylated hydroxytoluene (BHT) inhibitor on degree of conversion (DC), flexural strength (FS), flexural modulus (FM), Knoop microhardness (KH), microhardness reduction (HR), and consistency of experimental resin composites at different BHT concentrations: C0 (control-0%); C0.01 (0.01%); C0.025 (0.025%); C0.05 (0.05%); C0.1 (0.1%); and C0.5 (0.5%). For the consistency, the composites were tested immediately after being exposed to a dental chair headlight (0, 20, 40 and 60 s). Data concerning DC, FS, FM, KH, and HR were submitted to one-way ANOVA, while the consistency data was submitted to 2-way ANOVA; mean values were then compared (Tukey’s test; α=0.05). The KH, FS and FM analyses showed no significant difference among the composites tested. For DC, C0 showed the highest mean value (74.2%) and differed only from C0.5 (67.2%). For HR, C0.5 showed the lowest mean (13.09%) value and differed from C0 (26.4%) and C0.01 (24.87). The consistency analysis showed no difference among C0.05, C0.1 and C0.5, considering 0 and 20 s of light exposure, while C0 (14.07 mm), C0.01 (13.97 mm), and C0.025 (14.18 mm) showed higher mean values at 0 s when compared to 20 s (12.67, 12.77 and 13.05 mm, respectivelly). Polymerization occurred within 40 s of light exposure for C0, C0.01, C0.025, and C0.05 and within 60 s for C0.1. In conclusion, the BHT concentrations had no significant influence on FS, FM and KH. The higher the BHT concentration, the longer was its handling time under light, with a significant improvement in the HR, but a decrease in DC. Therefore, BHT at 0.1% showed the best outcomes concerning all the BHT concentrations tested.

Dental caries and periodontal disease are responsible for the most frequent set of chronic diseases in humans, for which no perfectly regenerative solutions are available yet. As a result, materials combining an intrinsic antibacterial activity with tissue regeneration properties for minimally invasive dental therapies are in high demand. Here we report on the fabrication and characterization of a novel nanocomposite material for such dental applications. The material is composed of narrowly disperse Na2O–CaO–P2O5–SiO2 bioglass-ceramic nanoparticles, 30–70 nm in diameter, doped with antibacterial and osteogenic zinc and niobium ions, and hybridized with chitosan. These systems were characterized for their particle size, morphology, atomic and phase composition, and glass-ceramic/polymer interface with the use of transmission electron microscopy, energy-dispersive X-ray analysis, X-ray diffraction and Fourier transform infrared spectroscopy. After annealing at 680 °C, amorphous silica in the bioglass-ceramic coexisted with silicalite-1 and combeite, the average crystallite size of which was 20–40 nm. In spite of the significantly better incorporation of zinc than of niobium inside the glass-ceramic network, zinc did not affect the particle size and shape distribution, while niobium lowered the average particle size. Chitosan increased the hydration capacity of the bioglass-ceramic and it formed a continuous interface around the bioglass-ceramic nanoparticles, devoid of micropores. This intimacy of the interface was confirmed by the downshift of the critical Si–O(–Si) vibration modes in the bioglass-ceramic upon hybridization with chitosan. The addition of zinc ions hampered the partial recrystallization during annealing by interfering with the Si–O network restructuring, in direct proportion with its concentration. Niobium ions produced a similar structure-breaking effect, which was evidenced, as in the case of zinc, by upshifting the antisymmetric Si–O–Si stretch of the bridging oxygen and increasing the full-width at half maxima for all the major Si–O(–Si) vibration modes. The effective electrostatic attraction between the aminated hydrocarbon chains of chitosan and the negatively charged silanol groups of silica may extend to the interaction with dentin collagen fibrils decalcified due to caries, making the material of potential interest for adhesive fillers of cariogenic lesions in teeth. Both the undoped and the doped bioactive glass-ceramics interacted favorably with odontoblast-like cells, accentuating their potential for further research for applications in minimally invasive reparative dentistry.

This study evaluated the effect of incorporating different concentrations of biosilicate in an experimental self-etch adhesive (SE).Biosilicate microparticles (0, 2, 5, and 10 wt%) were incorporated into the primer, and degree of conversion (DC) and wettability were tested (one-way ANOVA, Tukey's test, p0.05). The two best concentrations were selected (2% and 5%) for µTBS evaluation. Sound human molars (n=20) were sectioned into quarters and randomly assigned to 4 experimental groups: 1. experimental SE + 0% biosilicate (Exp0%; negative control); 2. experimental SE + 2% biosilicate (Exp2%); 3. experimental SE + 5% biosilicate (Exp5%); 4. AdheSE (Ivoclar Vivadent, positive control). After adhesive application, Filtek Z350 (3M Oral Care) composite was built up incrementally to 5 mm. Each quarter tooth was sectioned into sticks (0.9 mm2) and stored in distilled water (37°C) for 24 h, 6 months, or 1 year. After storage, sticks were submitted to µTBS (0.75 mm/min). The Ca:P ratio was analyzed using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Data were analyzed using two-way ANOVA with Bonferroni's correction, with statistical siginificance set at p0.05. Fracture patterns were observed under a digital microscope and adhesive interfaces with transmission electron microscopy (TEM).Exp2% presented the highest DC (p0.05), Exp5% exhibited the lowest µTBS (p0.05), and adhesive failures were predominant in all groups. TEM suggested remineralized areas in Exp2% and to a lesser degree in Exp5%. Exp2% and Exp5% showed a higher Ca:P ratio after aging (p0.05).The incorporation of biosilicate microparticles can improve the properties of self-etch adhesives. It increased the DC of the experimental adhesive as well as mineral deposition. However, the adhesive properties are concentration dependent, as a higher concentration of microparticles can adversely affect the mechanical properties of an adhesive.

Objectives: The aim of this study is to evaluate bond strength (BS), shrinkage stress (SS), flexural strength (FS), and elastic modulus (E) of three flowable bulk fill in comparison with conventional composites. Materials and Methods: Three bulk fill (Filtek Bulk Fill Flow, Surefil SDR, X-tra Base) and three conventional composites (Filtek Z250 XT, Grandioso, Dentsply TPH3) were used. For BS, conical cavities (n = 10) were prepared in bovine dentine and restored with materials and were analyzed through push-out test in a universal testing machine (UTM). For FS/EM, 60 (n = 10) bar specimens (7 mm × 2 mm × 1 mm) were prepared and evaluated with a UTM. SS was measured in UTM coupled to an extensometer (n = 5). The data were statistically evaluated using one-way ANOVA/Tukey tests (P < 0.05). Results: Conventional composites showed higher E when compared to bulk-fill composites. Regarding FS, they showed similar results, except for (XBF) Xtra Bulk Fill that was inferior. SS and BS of bulk-fill composites were significantly lower and higher than conventional composites, respectively, except for XBF, which showed similar BS to conventional ones. Conclusions: Flowable bulk-fill composites, except XBF, showed higher BS, lower SS, similar FS, and lower E when compared to conventional ones.

Clinical Relevance Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. SUMMARY In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient’s caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.

Objectives The purpose of this study was to synthesize chlorhexidine (CHX)-encapsulated aluminosilicate clay nanotubes (Halloysite®, HNTs) and to incorporate them into the primer/adhesive components of an etch-and-rinse adhesive system (SBMP; Scotchbond Multipurpose, 3M ESPE) and to test their effects on degree of conversion, viscosity, immediate and long-term bonding to dentin. Methods CHX-modified HNTs were synthesized using 10% or 20% CHX solutions. The primer and the adhesive components of SBMP were incorporated with 15 wt.% of the CHX-encapsulated HNTs. Degree of conversion (DC) and viscosity analyses were performed to characterize the modified primers/adhesives. For bond strength testing, acid-etched dentin was treated with one of the following: SBMP (control); 0.2%CHX solution before SBMP; CHX-modified primers + SBMP adhesive; SBMP primer + CHX-modified adhesives; and SBMP primer + CHX-free HNT-modified adhesive. The microtensile bond strength test was performed after immediate (24 h) and long-term (6 months) of water storage. Data were analyzed using ANOVA and Tukey (α = 5%) and the Weibull analysis. Results DC was greater for the CHX-free HNT-modified adhesive, whereas the other experimental adhesives showed similar DC as compared with the control. Primers were less viscous than the adhesives, without significant differences within the respective materials. At 24 h, all groups showed similar bonding performance and structural reliability; whereas at the 6-month period, groups treated with the 0.2%CHX solution prior bonding or with the CHX-modified primers resulted in greater bond strength than the control and superior reliability. Significance The modification of a primer or adhesive with CHX-encapsulated HNTs was an advantageous approach that did not impair the polymerization, viscosity and bonding performance of the materials, showing a promising long-term effect on resin-dentin bonds.

(1) Background: The amino acid arginine is now receiving great attention due to its potential anti-caries benefits. The purpose of this in vitro study was to evaluate the shear bond strength (SBS), ultimate tensile strength (UTS), and antimicrobial potential (CFU) of two arginine-containing orthodontic resin cements. (2) Methods: Forty bovine incisors were separated into four groups (n = 10): Orthocem, Orthocem + arginine (2.5 wt%), Transbond XT, and Transbond XT + arginine (2.5 wt%). The brackets were fixed to the flat surface of the enamel, and after 24 h the SBS was evaluated using the universal testing machine (Instron). For the UTS test, hourglass samples (n = 10) were made and tested in a mini-testing machine (OM-100, Odeme). For the antibacterial test (colony forming unit-CFU), six cement discs from each group were made and exposed to Streptococcus mutans UA159 biofilm for 7 days. The microbiological experiment was performed by serial and triplicate dilutions. The data from each test were statistically analyzed using a two-way ANOVA, followed by Tukey’s test (α = 0.05). (3) Results: The enamel SBS mean values of Transbond XT were statistically higher than those of Orthocem, both with and without arginine (p = 0.02033). There was no significant difference in the SBS mean values between the orthodontic resin cements, either with or without arginine (p = 0.29869). The UTS of the Transbond XT was statistically higher than the Orthocem, but the addition of arginine at 2.5 wt% did not influence the UTS for either resin cement. The Orthocem + arginine orthodontic resin cement was able to significantly reduce S. mutans growth, but no difference was observed for the Transbond XT (p = 0.03439). (4) Conclusion: The incorporation of arginine to commercial orthodontic resin cements may be an efficient preventive strategy to reduce bacterial growth without compromising their adhesive and mechanical properties.

The aim of this study was to evaluate of pre-heating, filler contents and ceramic thickness on film thickness, microshear bond strength, degree of conversion and color change on ceramic veneers. Two experimental composites were prepared (Bis-GMA/UDMA/BisEMA/ TEGDMA), with different amounts of filler (65% or 50%wt) simulating a conventional and a flowable composite. The flowable (F) was used at room temperature and, the conventional either at room temperature (C) or pre-heated (CPH). Disk-shaped ceramics with different thickness (0.4 mm, 0.8 mm, 1.5 mm) were prepared. The film thickness was evaluated according to the ISO 4049 (n=10). The microshear bond strength (n=10) was evaluated in enamel using tubing specimens light-cured through the ceramic veneer. The degree of conversion was evaluated using Raman spectroscopy. The color change of the ceramic restorations (n=10) was evaluated by spectrophotometry. The results were submitted to 2-way ANOVA and Tukey’s post hoc test (a=5%). For the film thickness 1-way ANOVA was used (a=5%). The C presented the thicker film thickness; the CPH produced a similar film thickness in comparison to the F. All composites showed similar microshear bond strength. The degree of conversion of the F was higher than the C and CPH. The degree of conversion of the composites photo-activated through a 0.4 mm was higher than the composites photo-activated through thicker ceramics. The C showed the highest color change, while the CPH showed similar color change to the F. In conclusion, pre-heated conventional composites seem to be a potential alternative to lute ceramic veneers such as the flowable composites. Resumo O objetivo neste estudo foi avaliar a influência do pré-aquecimento, conteúdo de carga e espessura da cerâmica na espessura da película, resistência de união ao microcisalhamento, grau de conversão e alteração de cor na cimentação de cerâmicas. Dois compósitos experimentais foram preparados (Bis-GMA / UDMA / BisEMA / TEGDMA), com diferentes quantidades de carga (65% ou 50% em peso), simulando um compósito convencional e um fluido. O fluido (F) foi usado à temperatura ambiente e o convencional, à temperatura ambiente (C) ou pré-aquecido (CPH). Foram preparados discos de cerâmica com diferentes espessuras (0,4mm, 0,8mm, 1,5mm). A espessura da película foi avaliada de acordo com a ISO 4049 (n=10). A resistência de união ao microcisalhamento (n=10) foi avaliada em esmalte utilizando espécimes fotopolimerizados através da cerâmica. O grau de conversão foi avaliado usando espectroscopia Raman. A alteração de cor das restaurações cerâmicas (n=10) foi avaliada por espectrofotometria. Os resultados foram submetidos à ANOVA 2- fatores e ao teste post hoc de Tukey (a=5%). Para espessura de película foi utilizada a ANOVA 1-fator (a=5%). O grupo C apresentou maior espessura de película; o CPH produziu uma espessura semelhante ao F. Todos os compósitos mostraram resistência de união ao microcisalhamento similares. O grau de conversão do F foi maior que C e CPH. O grau de conversão dos compósitos fotoativados através 0,4 mm foi maior que dos compósitos fotoativados através de cerâmicas mais espessas. O grupo C apresentou a maior mudança de cor, enquanto o CPH apresentou mudança de cor semelhante ao F. Em conclusão, compósitos convencionais pré-aquecidos assim como compósitos fluídos, parecem ser uma alternativa em potencial para cimentar laminados cerâmicos.

SUMMARY Objective: To evaluate the effect of different photoinitiator systems on photopolymerizing resin cements through ceramic veneers with different thickness on microshear bond strength (μSBS), flexural strength (FS), and ultimate tensile strength (UTS) and verify the light attenuation through these ceramic veneers. Methods and Materials: Four photopolymerizing experimental resin cements were produced with the same resin matrix and associated with four different photoinitiator systems: camphorquinone (CQ), diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO), Ivocerin, and TPO + Ivocerin. Eighty disc-shaped ceramic veneers (IPS Empress Esthetic, Ivoclar Vivadent) were fabricated (10-mm diameter) in two different thicknesses: 0.7 and 1.5 mm. A previously characterized multiwave LED (Bluephase G2, Ivoclar Vivadent) was standardized for 40 seconds of photoactivation. Light transmittance through each ceramic veneer thickness (n=5) was measured using a spectrometer (USB 2000, Ocean Optics). The μSBS of each resin cement (n=15) to the ceramic veneer was evaluated using 0.5-mm cylinders with 0.7-mm diameters photoactivated through the different ceramic veneer thicknesses. Samples for FS and UTS tests were made either with or without ceramics veneers (0.7 and 1.5 mm) fixed to the light-curing tip. Data were submitted to two-way analysis of variance and the Tukey test (α=0.05). Results: The multiwave LED emitted higher irradiance into the blue wavelength spectra than into the violet wavelength spectra (p=0.0001). Light transmittance through the ceramic veneers was reduced in a systematic manner based on thickness regardless of the wavelength spectra emitted from the multiwave LED (p=0.00037). The μSBS was reduced in a systematic manner based on thickness regardless of the photoinitiator system (p Conclusions: The thickness of the ceramic veneers reduced the irradiance of the multiwave LED in all wavelength spectra. Ivocerin alone or associated with TPO showed to be an effective alternative photoinitiator to substitute for CQ. The resin cement containing only TPO had lower bond strength values in comparison to resin cements with CQ, Ivocerin, and Ivocerin + TPO.

Objective This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators. Methods Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers. Results The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers. Conclusions In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly. Clinical Significance Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

To evaluate the effect of three adhesive systems applied under electric current on microtensile bond strength (μTBS) and degree of conversion (DC). Molar teeth were restored with the aid of three adhesive systems (Adper Single Bond 2—SB2; Clearfil SE Bond—CSE; and Single Bond Universal—SBU) under different electric current intensities (0 μA; 25 μA; and 50 μA). Composite resin blocks were built up in increments (2 mm) and sectioned into 1 × 1 mm beams. The μTBS was tested after 24 h and 1 y distilled water storages. Samples (n = 10) from 24 h to 1 y storages were immersed in a 50% ammoniacal silver nitrate solution and submitted to scanning electron microscopy. The silver nitrate in the hybrid layer was quantified (ImageJ software). The adhesive systems' dentinal infiltration was analyzed using confocal laser scanning microscopy. Fourier transform near infrared spectroscopy was used to measure the DC. The μTBS data were submitted to two-way ANOVA (time vs. electric current) and Bonferroni's test (α = 0.05). Quantitative nanoleakage data were submitted to two-way ANOVA (electric current vs. adhesive) and Bonferroni's test (α = 0.05). DC data were submitted to one-way ANOVA and Tukey's test (α = 0.05) for each adhesive system. The electric current statistically increased the μTBS for SB2 and CSE in 24 h storage, as well as for SB2, CSE and SBU in 1 y storage. No significant difference was observed between storage time for CSE and SBU. When compared to the control, electric currents (25 μA and 50 μA) showed significantly higher DC mean values for SB2 and SBU, and had no effect on CSE. The electric currents (25 μA and 50 μA) reduced the adhesive system's nanoleakage after 1-year storage, and improved the infiltration of SB2 and CSE. Both electric current intensities improved dentinal interface stability.

Objective To a self-etch adhesive doped with nano-bioglass and evaluate its ability to bond and re-mineralize artificially demineralized dentin. Methods Experimental Si, Ca, Na and PO4 based nanobioglass particles were synthesized, doped into experimental self-etch adhesives, and divided into 3 groups: Clearfi SE2 (CSE2), experimental (EXC), and experimental doped with 10% of nanobioglass (ExNB). The adhesives were applied onto the caries-affected dentin (chemically simulated), and evaluated after 24 h and 28 days of immersion in simulated body fluid. The remineralization process was assessed using optical coherence tomography, nanoindentation, in situ zymography, transmission electron microscopy, confocal laser scanning microscopy, μ-tensile bond strength, and pH buffer. Results The addition of nanobioglass particles into the experimental self-etch adhesives altered the μTBS in the short-term jeopardizing dentin bonding properties, when compared to the non-doped self-etch adhesive. The remineralization recovered the nanohardness, and volume lost by caries lesion (p = 0.02). Moreover, reduced the enzymatic activity (p = 1.24E−4) and formed new crystals within of the hybrid layer. Conclusion The use of nanobioglass was efficient to recover the properties of a caries affected dentin. Furthermore, the adhesive properties were not hampered and the probabilistic reliability increased.

A commercially available three-step (etch-and-rinse) adhesive was modified by adding chlorhexidine (CHX)-loaded nanotubes (Halloysite®, HNT) at two concentrations (CHX10% and CHX20%). The experimental groups were: SBMP (unmodified adhesive, control), HNT (SBMP modified with HNT), CHX10 (SBMP modified with HNT loaded with CHX10%), and CHX20 (SBMP modified with HNT loaded with CHX20%). Changes in the degree of conversion (DC%), Knoop hardness (KHN), water sorption (WS), solubility (SL), antimicrobial activity, cytotoxicity, and anti-matrix metalloproteinase [MMP-1] activity (collagenase-I) were evaluated. In regards to DC%, two-way ANOVA followed by Tukey's post-hoc test revealed that only the factor "adhesive" was statistically significant (p 0.05). For Knoop microhardness, one-way ANOVA followed by the Tukey's test showed statistically significant differences when comparing HNT (20.82 ± 1.65) and CHX20% (21.71 ± 2.83) with the SBMP and CHX10% groups. All adhesives presented similar WS and cytocompatibility. The CHX-loaded nanotube-modified adhesive released enough CHX to inhibit the growth of S. mutans and L. casei. Adhesive eluates were not able to effectively inhibit MMP-1 activity. The evaluation of higher CHX concentrations might be necessary to provide an effective and predictable MMP inhibition. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 868-875, 2019.

SUMMARY Objectives: To compare the degree of conversion (DC), depth of polymerization (DP), shrinkage stress (SS), flexural strength (FS), elastic modulus (EM), and bond strength (BS) of a low-viscosity bulk fill resin composite and a paste-like traditional composite. Methods: Tetric Evo-Flow Bulk Fill (TBF) and Empress Direct (ED; Ivoclar Vivadent) composites were used. DC (%) and FS/EM (MPa/GPa) were evaluated in bar specimens (7×2×1 mm; n=10) using Fourier-transform infrared spectroscopy and a three-point bending test in a universal testing machine (UTM), respectively. For DP and BS tests, conical cavities (n=10) were prepared in bovine dentin and restored with the composites. DP was analyzed by calculating the bottom-to-top surface microhardness ratio (BTHR), and BS (MPa) was determined by push-out testing in the UTM. SS (MPa) was measured for one increment of TBF and two increments of ED in a UTM attached to an extensometer (n=5). Data were analyzed using Student t-test and analysis of variance (α=0.05). Results: TBF presented higher values than ED for DC (85.7±6.6% vs 54.2±4.9%) and BS (0.95±0.70 MPa vs 0.35±0.15 MPa). TBF values were lower than ED values for FS (76.6±16.8 MPa vs 144.9±24.1 MPa) and maximum SS (0.77±0.07 MPa vs 1.07±0.15 MPa). TBF and ED values were similar for BTHR (0.83±0.16 vs 0.84±0.08) and EM (11.5±2.8 GPa vs 12.5±2.6 GPa). Conclusions: The physical and mechanical properties of TBF, a bulk fill resin composite, were similar or superior to those of ED, a conventional composite, with the exception of FS measurements.

Secondary caries at the margins of composite restorations has been attributed to adhesive failure and consequent accumulation of cariogenic biofilms. Objectives To develop and evaluate an etch-and-rinse adhesive system containing arginine for sustainable release and recharge without affecting its mechanical properties. Arginine metabolism by oral bacteria generates ammonia, which neutralizes glycolytic acids and creates a neutral environmental pH that is less favorable to the growth of caries pathogens, thus reducing the caries risk at the tooth-composite interface. Methods Experimental adhesives were formulated with methacrylate monomers and arginine at 5%, 7%, and 10% or no arginine (control). Adhesives were tested for: (i) mechanical properties of true stress (FS and UTS), modulus of elasticity (E), degree of conversion (DC), Knoop hardness number (KHN) and dentin microtensile bond strength (μ-TBS), (ii) arginine release and recharge, and (iii) antibacterial activities. Data was analyzed by t -test, one-way ANOVA and Tukey’s tests. Results FS and UTS results showed no statistically significant differences between the 7% arginine-adhesive and control, while the results for E, DC, KHN and μ-TBS showed no difference among all groups. The 7% arginine-adhesive showed a high release rate of arginine (75.0 μmol/cm 2 ) at 2 h, and a more sustainable, controlled release rate (up to 0.2 μmol/cm 2 ) at 30 days. Conclusions Incorporation of 7% arginine did not affect the physical and mechanical properties of the adhesive. Arginine was released from the adhesive at a rate and concentration that exhibited antibacterial effects, regardless of shifts in biofilm conditions such as sugar availability and pH. Clinical significance Secondary caries is recognized as the main reason for failure of dental restorations. The development of an arginine-based adhesive system has the potential to dramatically reduce the incidence and severity of secondary caries in adhesive restorations in a very economical fashion.

The main of the study was quantify the effect of two ceramics with two underlying resin cements on apparent fluorescence levels. Buccal surfaces of two bovine incisors were ground flat producing one enamel and one dentin substrate. The veneers were fabricated (0.5 and 1.0 mm thickness) using two ceramics (IPSe.max Press and IPSe.max Zirpress, Ivoclar Vivadent). Veneers were cemented using either light-cured (Variolink II, Ivoclar Vivadent) or self-adhesive dual (Rely X U200, 3M ESPE) cement. The layered Control group materials had no cement application. Semi-quantitative fluorescence image analysis (Matlabs software, Matworks) involved processing the images as captured under each daylight (DL, Gretagmacbeth) and ultraviolet illuminants (UVA, Sylvania) within a neutral-gray lightbox (Macbeth Spectral Light). Statistical analysis of the quantitative fluorescence values was performed using two-way ANOVA and Tukey’s test (p < 0.05). The e.max Zirpress on the dentin substrate produced greater fluorescence (p < 0.05) when subjected to UV illumination and more fluorescence (p < 0.05) than e.max Press in both cement groups. Light-cured cement produced higher (p < 0.05) fluorescence than the dual-cement with e.max Press on enamel under UV illumination. The fluorescence for e.max Press on the dentin substrate was greater (p < 0.05) than for e.max Zirpress using dual self-adhesive cement subjected to daylight illumination. Thus, it is possible to conclude that the combination of ceramic and cement produce definite, significant effects on the apparent fluorescence, vital quality for restorative dentistry.

To evaluate the light transmittance of ceramic veneers of different thicknesses and verify their influence on the degree of conversion, color stability, and dentin bond strength of light-curing resin cements containing different photoinitiator systems.Experimental resin cements were fabricated containing camphorquinone and amine (CQ-amine), TPO, Ivocerin (IVO), or TPO and Ivocerin (TPO-IVO). All photoinitiators were characterized by UV-Vis spectrophotometry. Disk-shaped lithium disilicate ceramic specimens that were 0.4, 0.7, and 1.5 mm in thickness were prepared using IPS e.max Press (Ivoclar Vivadent, shade LT/A2). Light transmittance through each specimen was measured using spectrophotometry. Specimens of each cement (n = 10) were made in a custom-designed mold and were light cured through each glass-ceramic disk using a multiwave LED (Bluephase G2, Ivoclar Vivadent). CS was evaluated using spectrophotometry before and after artificial aging with UV light. DC was evaluated using FTIR-spectroscopy. Dentin µSBS was evaluated using 0.75-mm-thick specimens that were light cured under the same protocol (n = 10). All data were submitted to two-way ANOVA and Tukey's test (α = 0.05; β = 0.2).CQ-amine cements showed the highest color changes (p0.05) due to increased yellowing when compared to the amine-free cements (p0.05). However, all cements showed a significant color change after aging when cured through ceramics up to 1.5 mm thick (p0.05). The TPO-IVO cement showed the highest DC and the IVO cement showed a similar DC when compared to the CQ-amine cement. The TPO cement presented the lowest DC (p = 0.0377). No differences in mean dentin µSBS were found among the cements, except for the TPO cement, which presented a lower mean dentin µSBS (p = 0.0277).Amine-free cements containing Ivocerin and TPO seem to be a better alternative to CQ-amine cements, while not reducing either DC or dentin µSBS of amine-free cements. However, CQ-amine and amine-free cements still seem to change color over time.

This study evaluated the bond durability produced by etch-and-rinse (E&R) adhesive systems in response to traditional and accelerated aging methods. Tridimensional dentin cavities were prepared on 80 bovine incisors, which were bonded with a 3-step E&R (Adper Scotchbond Multipurpose Plus – MP) and a 2-step E&R (Adper Single Bond 2 (SB) adhesive systems, and restored with composite. The samples were stored in water for 24 h, and then subjected to each of the aging methods (n = 10): control group – only 24-h storage (not exposed to additional aging), 6- and 12-month water storage, and 10% NaOCl storage. The push-out bond strength test was performed in a universal testing machine. Failure modes were evaluated by scanning electron microscopy. Data were analyzed by two-way ANOVA and Tukey tests (p 0.05). 10% NaOCl storage provides statistically similar bond strength values to 6- and 12-month water st...

The objective of this study was to evaluate the effect of a Biosilicate®, associated with dentin adhesive system, on microtensile bond strength (μTBS) to sound and demineralized dentin. Eighty sound-extracted molars had their middle occlusal dentin exposed. In forty teeth, dentin was artificially demineralized (pH cycling). Sound and demineralized dentin teeth were separated into four groups (n = 10), according to the substrate treatment before restoration: Group 1—total-etching adhesive Adper TM Single bond 2 (ASB) + Biosilicate®, Group 2—ASB (without Biosilicate®), Group 3—AdheSE self-etching adhesive system (AdSE) + Biosilicate®, and Group 4—AdSE (without Biosilicate®). Each tooth was restored with a hybrid composite and stored in water at 37 °C for 6 months. After water aging, teeth were cut in sticks (≈ 1 mm2 cross-sectional area) and all samples were submitted to μTBS test. The fracture modes of the samples were analyzed by stereomicroscopy. The representatively fractured samples were observed by scanning electron microscopy. Representative samples of each group were analyzed on energy dispersive X-ray spectrometry (EDX). The μTBS and Ca-P ratio values were analyzed by 2-way ANOVA, Bonferroni, and Tukey test, respectively, p

Introduction: Defects caused by root resorption are often associated with a variety of idiopathic, external resorptions or perforations located at the mid-third of the root surface. These defects can lead to gingival inflammation, breakdown of periodontal fibers, bone resorption, and damage to the periodontal apparatus. Treatment protocols that preclude tooth extraction are important adjuncts toward an ultimate goal of tooth/root preservation. Although a number of materials have been proposed to repair root resorption defects, only a few have been effective in the long-term management of subgingival defects.Case Presentation: This case report presents long-term follow-up of a subgingival, external root resorption lesion that was successfully treated with mineral trioxide aggregate (MTA) and a coronally advanced flap. At 30 months, the results revealed gain in clinical attachment, reduction in probing depth, additional bone formation, and, ultimately, preservation of the gingival margin and esthetic appear...

To compare the dentin microtensile bond strength (µTBS) and the Knoop hardness of bulk-fill and conventional restorative composites in box-shaped Class I cavities using different insertion techniques.Forty box-shaped Class I preparatons 4 mm deep were performed in the pulp chamber of sound human third molars. The restorations were made using either a conventional microhybrid (Z250, 3M ESPE) or bulk-fill (Tetric EvoCeram Bulk-fill, TCBF) composite using two incremental thicknesses: 2 mm or 4 mm (n = 10). After 24-h water storage, the restorations were sectioned. The first slice (0.7 mm thick) taken from a proximal surface was submitted to the Knoop hardness (KHN) test at five depths from the occlusal cavosurface to the pulpal line angle. Sticks were fabricated from the remaining sections and tested for dentin microtensile bond strength (µTBS). Means were analyzed using two-way ANOVA and Tukey's test (p0.05).Higher (p0.05) µTBS resulted when both composites were restored with 2-mm increments, with no significant difference between materials (p0.05). Higher (p0.05) KHN means were found when 2-mm increments were used, with no significant differences (p0.05) between the materials. When the teeth were restored with one bulk increment (4 mm), the deeper layers presented lower KHN means (p0.05) starting at 2 mm for Z250 and 3 mm for TCBF.The 2-mm increment restorations in box-shaped cavities yielded higher µTBS and microhardness for conventional and bulk-fill composites.

A commercially available three-step (etch-and-rinse) adhesive was modified by adding chlorhexidine (CHX)-loaded nanotubes (Halloysite®, HNT) at two concentrations (CHX10% and CHX20%). The experimental groups were: SBMP (unmodified adhesive, control), HNT (SBMP modified with HNT), CHX10 (SBMP modified with HNT loaded with CHX10%), and CHX20 (SBMP modified with HNT loaded with CHX20%). Changes in the degree of conversion (DC%), Knoop hardness (KHN), water sorption (WS), solubility (SL), antimicrobial activity, cytotoxicity, and anti-matrix metalloproteinase [MMP-1] activity (collagenase-I) were evaluated. In regards to DC%, two-way ANOVA followed by Tukey's post-hoc test revealed that only the factor "adhesive" was statistically significant (p0.05). No significant differences were detected in DC% when 20 s light-curing was used (p0.05). For Knoop microhardness, one-way ANOVA followed by the Tukey's test showed statistically significant differences when comparing HNT (20.82 ± 1.65) and CHX20% (21.71 ± 2.83) with the SBMP and CHX10% groups. All adhesives presented similar WS and cytocompatibility. The CHX-loaded nanotube-modified adhesive released enough CHX to inhibit the growth of S. mutans and L. casei. Adhesive eluates were not able to effectively inhibit MMP-1 activity. The evaluation of higher CHX concentrations might be necessary to provide an effective and predictable MMP inhibition. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 868-875, 2019.

The aim in this study was to evaluate the influence of different ratio of camphorquinone/tertiary amine concentration on the flexural strength (FS), elastic modulus (EM), degree of conversion (DC), yellowing (YL), water sorption (WS) and water solubility (WSL) of experimental composites. Thus, acrylate blends were prepared with different camphorquinone (CQ) and amine (DABE) concentrations and ratios by weight: (CQ/DABE%): 0.4/0.4% (C1), 0.4/0.8% (C2), 0.6/0.6% (C3), 0.6/1.2% (C4), 0.8/0.8% (C5), 0.8/1.6% (C6), 1.0/1.0% (C7), 1.0/2.0% (C8), 1.5/1.5% (C9), 1.5/3.0% (C10). For the FS and EM, rectangular specimens (7x2x1 mm, n=10) were photo-activated by single-peak LED for 20 s and tested at Instron (0.5 mm/min). Then, the same specimens were evaluated by FTIR for DC measurement. For YL, disks (5x2 mm, n=10) were prepared, light-cured for 20 s and evaluated in spectrophotometer using the b aspect of the CIEL*a*b* system. For WS and WSL, the volume of the samples was calculated (mm³). For WS and WSL, composites disks (5x0.5 mm, n=5) were prepared. After desiccation, the specimens were stored in distilled water for 7 days and again desiccated, in order to measure the WS and WSL. Data were submitted to one-way ANOVA and Tukey’s test (5%). The groups C8, C9 and C10 showed higher DC, EM and YL means, compared to other composites. Therefore, the FS and WS values were similar among all groups. Also, C1, C2 and C3 presented higher WSL in 7 days, compared to other composites. In general, higher concentrations of camphorquinone promoted higher physical-mechanical properties; however, inducing higher yellowing effect for the experimental composites Resumo O objetivo foi avaliar a influência da concentração e proporção de canforoquinona (CQ)/amina terciária (DABE) na resistência à flexão (RF), módulo flexural (MF), grau de conversão (GC), amarelamento (AM), sorpção (SA) e solubilidade em água (SL) de compósitos experimentais. Blendas acrilatas foram preparadas com diferentes concentrações e proporções de CQ/DABE em peso, como segue: (CQ/DABE%): 0,4/0,4% (C1); 0,4/0,8% (C2); 0,6/0,6% (C3); 0,6/1,2% (C4); 0,8/0,8% (C5); 0,8/1,6% (C6); 1,0/1,0% (C7); 1,0/2,0% (C8); 1,5/1,5% (C9); 1,5/3,0% (C10). Para RF e MF, espécimes retangulares (7x2x1 mm, n=10) foram fotoativados com LED de pico único (Radii Cal) por 20 s e testados em máquina Instron (0,5 mm/min). Após, o GC dos mesmos espécimes (fragmentos) foi mensurado por FTIR. Para AM, discos de compósito (5x2 mm, n=10) foram preparados, fotoativados por 20 s e imediatamente avaliados em espectrofotômetro, considerando o aspecto b do sistema CIEL*a*b*. Para SA e SL, discos de compósito (5x0,5 mm, n=5) foram preparados e seus volumes calculados (mm³). Após desidratação, as amostras foram pesadas e armazenadas em água destilada por 7 dias, pesadas e novamente desidratadas e pesadas, para se calcular o SA e SL. Os dados foram submetidos a one-way ANOVA e teste de Tukey (5%). Os grupos C8, C9 e C10 mostraram maior GC, MF e AM, comparado aos outros grupos. No entanto, RF e SA foram similares entre todos os grupos. Ainda, C1, C2 e C3 apresentaram maior SL em 7 dias comparado aos outros grupos. Em geral, maiores concentrações de CQ promoveram melhores propriedades físico-mecânicas; no entanto, levaram ao maior amarelamento dos compósitos.

The aim of this study was to evaluate microtensile bond strength (µTBS) of self-etch and etch-and-rinse adhesives systems compared in different dentin regions (central-CD or proximal-PD) in a class II cavity configuration. A class II (mesial-oclusal-distal) cavity configuration was simulated on 20 extracted human third-molars (4 mm wide/3 mm deep). Etch-and-rinse adhesive (Scotchbond Multi Purpose, n=5, SBMP and Optibond FL, n=5, OPFL) and self-etch adhesives (Clearfil SE Bond, n=5, CSE and Optibond XTR, n=5, OPXTR) were applied. Class II restorations were performed by incremental technique and photo-activated (Bluephase/G2). Samples were sectioned to beam shape (1 mm² cross-section), placed on Geraldeli’s device for µTBS test (0.5 mm/min cross-head speed). Fracture patterns were analyzed on stereomicroscope and classified as cohesive-resin, adhesive, mixed/resin or mixed/dentin. Samples (n=4) were prepared for scanning electron microscope observation. Data were submitted to one-way ANOVA with Split-Plot arrangement and Tukey’s test (α=0.05). There were no statistically significant differences among SBMP, OPFL, CSE and OPXTR on CD (p>0.05). However, on PD for SBMP and OPFL, µTBS values were significantly lower compared to CSE and OPXTR (p0,05). Entretanto, para SBMP e OPFL em DP, valores µTBS foram significativamente menores comparados com CSE e OPXTR (p

Objective Endogenous dentin collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins, are responsible for the time-dependent hydrolysis of collagen matrix of hybrid layers. As collagen matrix integrity is essential for the preservation of long-term dentin bond strength, inhibition of endogenous dentin proteases is necessary for durable resin-bonded restorations. Methods Several tentative approaches to prevent enzyme function have been proposed. Some of them have already demonstrated clinical efficacy, while others need to be researched further before clinical protocols can be proposed. This review will examine both the principles and outcomes of techniques to prevent collagen hydrolysis in dentin–resin interfaces. Results Chlorhexidine, a general inhibitor of MMPs and cysteine cathepsins, is the most tested method. In general, these experiments have shown that enzyme inhibition is a promising approach to improve hybrid layer preservation and bond strength durability. Other enzyme inhibitors, e.g. enzyme-inhibiting monomers, may be considered promising alternatives that would allow more simple clinical application than chlorhexidine. Cross-linking collagen and/or dentin matrix-bound enzymes could render hybrid layer organic matrices resistant to degradation. Alternatively, complete removal of water from the hybrid layer with ethanol wet bonding or biomimetic remineralization should eliminate hydrolysis of both collagen and resin components. Significance Understanding the function of the enzymes responsible for the hydrolysis of hybrid layer collagen has prompted several innovative approaches to retain hybrid layer integrity and strong dentin bonding. The ultimate goal, prevention of collagen matrix degradation with clinically applicable techniques and commercially available materials may be achievable in several ways.

Objectives: Contemporary adhesives lose their bond strength to dentin regardless of the bonding system used. This loss relates to the hydrolysis of collagen matrix of the hybrid layers. The preservation of the collagen matrix integrity is a key issue in the attempts to improve the dentin bonding durability. Methods: Dentin contains collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins, which are responsible for the hydrolytic degradation of collagen matrix in the bonded interface. Results: The identities, roles and function of collagenolytic enzymes in mineralized dentin has been gathered only within last 15 years, but they have already been demonstrated to have an important role in dental hard tissue pathologies, including the degradation of the hybrid layer. Identifying responsible enzymes facilitates the development of new, more efficient methods to improve the stability of dentin-adhesive bond and durability of bond strength. Significance: Understanding the nature and role of proteolytic degradation of dentin-adhesive interfaces has improved immensely and has practically grown to a scientific field of its own within only 10 years, holding excellent promise that stable resin-dentin bonds will be routinely available in a daily clinical setting already in a near future.

In the spirit of primum non nocere, latin for first do no harm, it is our responsibility as dentists to correctly evaluate our patients and counsel them regarding their disease prior to treating them surgically. We must also critically evaluate dental materials for treating or arresting dental caries as these become available and efficacious in the years to come.

Background The authors aimed to determine whether dentists in practices belonging to The Dental Practice-Based Research Network (DPBRN) were more likely to repair or to replace a restoration that they diagnosed as defective; to quantify dentists' specific reasons for repairing or replacing restorations; and to test the hypothesis that certain dentist-, patient- and restoration-related variables are associated with the decision between repairing and replacing restorations. Methods This cross-sectional study had a consecutive patient and restoration recruitment design. Practitioner-investigators (P-Is) recorded data for consecutively seen restorations in permanent teeth that needed repair or replacement. The DPBRN is a consortium of dental practitioners and dental organizations in the United States and Scandinavia. The collected data included the primary reason for repair or replacement, tooth surface or surfaces involved, restorative materials used and patients' demographic information. Results P-Is collected data regarding 9,484 restorations from 7,502 patients in 197 practices. Seventy-five percent (7,073) of restorations were replaced and 25 percent (2,411) repaired. Secondary caries was the main reason (43 percent, n = 4,124) for treatment. Factors associated with a greater likelihood of repairing versus replacing restorations ( P N/A .05) included having graduated from dental school more recently, practicing in a large group practice, being the dentist who placed the original restoration, patient's being of an older age, the original restorative material's being something other than amalgam, restoration of a molar and the original restoration's involving fewer tooth surfaces. Conclusions DPBRN dentists were more likely to replace than to repair restorations. Secondary caries was the most common reason for repairing or replacing restorations. Certain dentist-, patient- and restoration-related variables were associated with the repair-or-replace decision. Clinical Implications The selection of minimally invasive treatment for an existing restoration is critical, as it may affect the longevity of the tooth.

Background Chemokines and cytokines may occur in dentinal fluids in response to local infection and inflammation. To test this hypothesis, we assessed the presence and concentration of inflammatory mediators in fluid extracted from the coronal occlusal dentine of trimmed teeth. Design Freshly extracted sound, carious, and restored molars were trimmed through the enamel to expose the underlying dentine, etched with 35% phosphoric acid, and rinsed. Fluid was extracted from the coronal occlusal dentine of these trimmed teeth by centrifugation at 2750 × g for 30 min. Results When assessed by MALDI-TOF, fluid extracted from the coronal occlusal dentine from 16 molars contained at least 117 peaks with different masses suggesting that this fluid was rich with molecules within the appropriate mass range of potential mediators. Indeed, when assessed for chemokines and cytokines, fluid extracted from the coronal occlusal dentine from 25 extracted molars with caries lesions, 10 extracted restored molars with occlusal amalgam, and 77 extracted sound molars contained IL-1β, TNF-α, IL-6, IL-8, IL-12(p70), and IL-10. A significant elevation was found for TNF-α ( p = 0.041) in extracted fluid from teeth restored with amalgam fillings. Conclusions Overall, fluid extracted from the coronal occlusal dentine of trimmed teeth may be useful in identifying proteins and other molecules in dentine and pulpal fluids and determining their role as mediators in the pathogenesis of oral infection and inflammation.

Introduction Collagen-degrading matrix metalloproteinases (MMPs) are expressed by odontoblasts and present in dentin. We hypothesized that odontoblasts express other collagen-degrading enzymes such as cysteine cathepsins, and their activity would be present in dentin, because odontoblasts are known to express at least cathepsin D. Effect of transforming growth factor beta (TGF-β) on cathepsin expression was also analyzed. Methods Human odontoblasts and pulp tissue were cultured with and without TGF-β, and cathepsin gene expression was analyzed with DNA microarrays. Dentin cathepsin and MMP activities were analyzed by degradation of respective specific fluorogenic substrates. Results Both odontoblasts and pulp tissue demonstrated a wide range of cysteine cathepsin expression that gave minor responses to TGF-β. Cathepsin and MMP activities were observed in all dentin samples, with significant negative correlations in their activities with tooth age. Conclusions These results demonstrate for the first time the presence of cysteine cathepsins in dentin and suggest their role, along with MMPs, in dentin modification with aging.

O objetivo foi avaliar a resistência de união (µTBS) e nanoinfiltração (NI) de um sistema adesivo experimental multi-modo contendo análogos biomiméticos e fosfatos de cálcio bioativos. Foram utilizados 60 terceiros molares humanos. A composição base dos primers foi (% em peso): 15 % GDMA-P, 10 % HEMA, 15 % TEGDMA, 10 % UDMA, 10 % água e 40 % etanol. Nos primers, foram acrescentados ou não os análogos: 5 % ácido poliacrílico e 10 % ácido polivinilfosfônico. O adesivo foi composto por: 35% UDMA, 42% BisEMA, 10% TEGDMA, 10% GDMA-P e 3% fotoiniciadores. Nesse adesivo foram acrescentados os fosfatos bioativos: beta tricálcio fosfato e monocalciofosfato monohidrato (20% em peso da mistura). O teste de μTBS foi feito em máquina de ensaios OM100 (Odeme). Após, o tipo de fratura foi analisado em lupa estereoscópica. Um palito de cada dente de cada grupo foi usado para a análise de NI, em MEV. Metade dos dentes foram utilizados para a técnica úmida e a outra para a técnica auto- condicionante e testados em 24hs ou após 4 meses de armazenagem em SSFC. Os dados de μTBS foram submetidos a ANOVA 3-fatores e as médias ao teste de Tukey (5%). Não houve melhora da μTBS após a inclusão de fosfatos e/ou análogos, porém nesses grupos, houve a manutenção dos valores de μTBS após 4 meses de armazenagem, nas duas técnicas de aplicação. Após 4 meses, houve presença da prata em todos os grupos, porém nos grupos contendo análogos, a intensidade da NI foi menor. Os adesivos experimentais multi-modo contendo análogos no primer se mostraram promissores em preservar a união dentina-compósito da degradação em ambiente úmidoPalavras-chave: Adesivos Dentinários. Dentina. Fosfatos de Cálcio.

The objective of this paper is to critically review the literature regarding the mechanics, geometry, load application and other testing parameters of "micro" shear and tensile adhesion tests, and to outline their advantages and limitations. The testing of multiple specimens from a single tooth conserves teeth and allows research designs not possible using conventional 'macro' methods. Specimen fabrication, gripping and load application methods, in addition to material properties of the various components comprising the resin-tooth adhesive bond, will influence the stress distribution and consequently, the nominal bond strength and failure mode. These issues must be understood; as should the limitations inherent to strength-based testing of a complicated adhesive bond joining dissimilar substrates, for proper test selection, conduct and interpretation. Finite element analysis and comprehensive reporting of test conduct and results will further our efforts towards a standardization of test procedures. For the foreseeable future, both "micro" and "macro" bond strength tests will, as well as various morphological and spectroscopic investigative techniques, continue to be important tools for improving resin-tooth adhesion to increase the service life of dental resin-based composite restorations.

This study evaluated the influence of adhesive layer thickness (ADL) on the resin-dentin bond strength of two adhesive systems (AS) after thermal and mechanical loading (TML). A flat superficial dentin surface was exposed with 600-grit SiC paper on 40 molars. After primer application, the adhesive layer of Scotchbond Multipurpose (SBMP) or Clearfil SE Bond (CSEB) was applied in one or two layers to a delimited area (52 mm2) and resin blocks (Filtek Z250) were built incrementally. Half of the sample was stored in distilled water (37 degrees C, 24 hours) and submitted to thermal (1,000; 5 degrees -55 degrees C) and mechanical cycles (500,000; 10kgf) [TML]. The other half was stored in distilled water (72 hours). The teeth were then sectioned to obtain sticks (0.8 mm2) to be tested under tensile mode (1.0 mm/minute). The fracture mode was analyzed at 400x. The BS from all sticks from the same tooth was averaged for statistical purposes. The data was analyzed by three-way ANOVA. The chi2 test was used (p0.05) to compare the frequency of pre-testing failure specimens. Higher BS values were observed for SBMP regardless of the ADL. The TML reduced the BS values irrespective of the adhesive employed and the ADL. A higher frequency of pre-testing failure specimens was observed for the cycled groups. A thicker adhesive layer, acting as an intermediate flexible layer, did not minimize the damage caused by thermal/mechanical load cycling for a three-step etch-and-rinse and two-step self-etch system.

To evaluate how restoration characteristics are associated with the decision to repair or replace an existing restoration. The following hypotheses were studied: dentists who placed the original restoration are more likely to repair instead of replace restorations (H1) that are in molar teeth; (H2) that are in the upper arch; (H3) that have amalgam restorative material; (H4) if a fracture is not the primary reason for the defect; and (H5) when the restoration comprises more than one surface.This cross-sectional study used a consecutive patient/restoration recruitment design. 194 dentists members of a dental practice-based research network recorded data on restorations in permanent teeth that needed repair or replacement.For 6,623 of the 8,770 defective restorations in 6,643 patients, the treatment was provided by the dentist who had not placed the original restoration (75%). The 2-way interaction revealed that dentists who had placed the original restoration often chose to repair when the defective restoration was in a molar, relative to premolar or anterior teeth (OR = 2.2, p.001); and chose to replace when the restoration had amalgam (OR = 0.5, p.001), and when it was a fracture compared to another reason (OR = 0.8, p = 001).Most dentists are not conservative when they revisit a restoration that they originally placed regardless of type of failure, number of surfaces or material used. However, dentists who had placed the original restoration were significantly more likely to repair it when the defective restoration was in a molar tooth.Most dentists who placed the original restoration were prone to replace it, however if the defective restoration was located in a molar tooth they would consider repairing it.

Background Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations. The authors tested a twofold hypothesis: a self-etch, or SE, adhesive would result in less postoperative sensitivity than a total-etch, or TE, adhesive; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive. Methods Patients were selected on the basis of requiring Class I and II restorations in molars and premolars. The authors placed 30 restorations with the SE material (Clearfil SE Bond, Kuraray America, New York) and 36 restorations with Prime & Bond NT (Dentsply Caulk, Milford, Del.), which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously. Preparations were of standard design, with all margins in enamel without beveling. Upon rubber dam isolation, the authors conditioned the enamel and dentin walls with the self-etching primer (for Clearfil SE Bond) or etched with the proprietary 34 percent phosphoric acid (for Prime & Bond NT), followed by application of the corresponding dentin adhesive. Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations: Clearfil AP-X for Clearfil SE Bond or Esthet•X Micro Matrix Restorative for Prime & Bond NT. The restored teeth were evaluated preoperatively and at two weeks, eight weeks and six months postoperatively for sensitivity to cold (ice), air and masticatory forces, as well as for marginal discoloration. Results Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE materials at any recall time. Marginal discoloration was rated as “absent” for all restorations at six months. Only one tooth displayed sensitivity to occlusal forces at six months. Conclusion The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration. Clinical Implications Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used.

This study tested the null hypothesis that the preparation of the enamel surface would not affect the enamel microtensile bond strengths of self-etching adhesive materials.Ten bovine incisors were trimmed with a diamond saw to obtain a squared enamel surface with an area of 8 x 8 mm. The specimens were randomly assigned to five adhesives: (1) ABF (Kuraray), an experimental two-bottle self-etching adhesive; (2) Clearfil SE Bond (Kuraray), a two-bottle self-etching adhesive; (3) One-Up Bond F (Tokuyama), an all-in-one adhesive; (4) Prompt L-Pop (3M ESPE), an all-in-one adhesive; and (5) Single Bond (3M ESPE), a two-bottle total-etch adhesive used as positive control. For each specimen, one half was roughened with a diamond bur for 5 seconds under water spray, whereas the other half was left unprepared. The adhesives were applied as per manufacturers' directions. A universal hybrid composite resin (Filtek Z250, 3M ESPE) was inserted in three layers of 1.5 mm each and light-cured. Specimens were sectioned in X and Y directions to obtain bonded sticks with a cross-sectional area of 0.8 +/- 0.2 mm2. Sticks were tested in tension in an Instron at a cross-speed of 1 mm per minute. Statistical analysis was carried out with two-way analysis of variance and Duncan's test at p.05. Ten extra specimens were processed for observation under a field-emission scanning electron microscope.Single Bond, the total-etch adhesive, resulted in statistically higher microtensile bond strength than any of the other adhesives regardless of the enamel preparation (unprepared = 31.5 MPa; prepared = 34.9 MPa, not statistically different at p.05). All the self-etching adhesives resulted in higher microtensile bond strength when enamel was roughened than when enamel was left unprepared. However, for ABF and for Clearfil SE Bond this difference was not statistically significant at p.05. When applied to ground enamel, mean bond strengths of Prompt L-Pop were not statistically different from those of Clearfil SE Bond and ABF. One-Up Bond F did not bond to unprepared enamel. Commercial self-etching adhesives performed better on prepared enamel than on unprepared enamel. The field-emission scanning electron microscope revealed a deep interprismatic etching pattern for the total-etch adhesive, whereas the self-etching systems resulted in an etching pattern ranging from absent to moderate.

This article presents details of fabrication, biological activity ( i.e., anti–matrix metalloproteinase [anti-MMP] inhibition), cytocompatibility, and bonding characteristics to dentin of a unique doxycycline (DOX)–encapsulated halloysite nanotube (HNT)–modified adhesive. We tested the hypothesis that the release of DOX from the DOX-encapsulated nanotube-modified adhesive can effectively inhibit MMP activity. We incorporated nanotubes, encapsulated or not with DOX, into the adhesive resin of a commercially available bonding system (Scotchbond Multi-Purpose [SBMP]). The following groups were tested: unmodified SBMP (control), SBMP with nanotubes (HNT), and DOX-encapsulated nanotube-modified adhesive (HNT+DOX). Changes in degree of conversion (DC) and microtensile bond strength were evaluated. Cytotoxicity was examined on human dental pulp stem cells (hDPSCs). To prove the successful encapsulation of DOX within the adhesives—but, more important, to support the hypothesis that the HNT+DOX adhesive would release DOX at subantimicrobial levels—we tested the antimicrobial activity of synthesized adhesives and the DOX-containing eluates against Streptococcus mutans through agar diffusion assays. Anti-MMP properties were assessed via β-casein cleavage assays. Increasing curing times (10, 20, 40 sec) led to increased DC values. There were no statistically significant differences ( p > .05) in DC within each increasing curing time between the modified adhesives compared to SBMP. No statistically significant differences in microtensile bond strength were noted. None of the adhesives eluates were cytotoxic to the human dental pulp stem cells. A significant growth inhibition of S. mutans by direct contact illustrates successful encapsulation of DOX into the experimental adhesive. More important, DOX-containing eluates promoted inhibition of MMP-1 activity when compared to the control. Collectively, our findings provide a solid background for further testing of encapsulated MMP inhibitors into the synthesis of therapeutic adhesives that may enhance the longevity of hybrid layers and the overall clinical performance of adhesively bonded resin composite restorations.

To directly test the effectiveness of ethanol-wet bonding (EW) in improving monomer infiltration into demineralized dentin through quantitative measurement of bis-GMA and TEG-DMA molar concentrations within hybrid layers, and to comprehensively evaluate the effect of EW and chlorhexidine on durability of resin-dentin bonds compared to conventional water-wet bonding (WW).A three-step etch-and-rinse adhesive (70% bis-GMA/28.75%TEG-DMA) was applied to coronal dentin using a clinically relevant ethanol-wet bonding protocol (EW) or the conventional water-wet bonding (WW) technique. Bis-GMA and TEG-DMA molar concentrations at various positions across the resin/dentin interfaces formed by EW and WW were measured using micro-Raman spectroscopy. The experiment was repeated at the same positions after 7-month storage in phosphate buffer solution containing 0.1% sodium azide. The μTBS and hybrid layer morphology (TEM) of bonding groups with and without chlorhexidine application were compared immediately and after 1-year storage in terms of nanoleakage, collagen fibril diameter, collagen interfibrillar width, and hybrid layer thickness.Specimens bonded with EW showed significantly higher monomer molar concentrations and μTBS throughout the hybrid layer immediately and after storage, providing direct evidence of superior infiltration of hydrophobic monomers in EW compared to WW. Microscopically, EW maintained interfibrillar width and hybrid layer thickness for resin infiltration and retention. The application of chlorhexidine further preserved collagen integrity and limited the degree of nanoleakage in EW after 1-year storage.EW enhances infiltration of hydrophobic monomers into demineralized dentin. The results suggest that a more durable resin-dentin bond may be achieved with combined usage of a clinically relevant EW and chlorhexidine.

Statement of problem Information regarding the differences in translucency among new ceramic systems is lacking. Purpose The purpose of this study was to compare the relative translucency of the different types of ceramic systems indicated for porcelain veneers and to evaluate the effect of shade and thickness on translucency. Material and methods Disk specimens 13 mm in diameter and 0.7-mm thick were fabricated for the following 9 materials (n=5): VITA VM9, IPS Empress Esthetic, VITA PM9, Vitablocks Mark II, Kavo Everest G-Blank, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as the positive control and Lava as the negative control. The disks were fabricated with the shade that corresponds to A1. For IPS e.maxPress, additional disks were made with different shades (BL2, BL4, A1, B1, O1, O2, V1, V2, V3), thickness (0.3 mm), and translucencies (high translucency, low translucency). Color coordinates (CIE L∗ a∗ b∗) were measured with a tristimulus colorimeter. The translucency parameter was calculated from the color difference of the material on a black versus a white background. One-way ANOVA, the post hoc Tukey honestly significant difference, and the Ryan-Einot-Gabriel-Welsch multiple range tests were used to analyze the data (α=.05). Results Statistically significant differences in the translucency parameter were found among porcelains (P PM9, Empress Esthetic>Empress CAD>Mark II, Everest, e.max CAD>e.max Press>Lava. Significant differences also were noted when different shades and thickness were compared ( P 001). Conclusions Different ceramic systems designed for porcelain veneers present varying degrees of translucency. The thickness and shade of lithium disilicate ceramic affect its translucency. Shade affects translucency parameter less than thickness.

SUMMARY Objective This study evaluated the degree of conversion (DC) and the water sorption/solubility of preheated single-bottle adhesive systems. Methods and Materials Five adhesive systems were tested: Adper Easy One and Adper Single Bond 2 (3M ESPE), Excite and Tetric N-Bond (Ivoclar/Vivadent), and XP Bond (Dentsply/Caulk). After storage for two hours at 25°C or 60°C, 50 samples (n=5) were prepared for all adhesive systems and stored dry in lightproof containers at 37°C for 24 hours. Fourier transform infrared/attenuated total reflectance spectroscopy was used to evaluate the DC, and water sorption/solubility was measured by means of mass loss and gain after water storage. The data were analyzed by two-way analysis of variance followed by Tukey's test (p Results Preheated adhesive systems showed statistically significantly higher DC than those kept at 25°C. Except for XP Bond, preheated adhesive systems presented statistically significantly lower water sorption/solubility means. Conclusions Preheating improved the DC for all tested adhesive systems. Also, it promoted a decrease of water sorption/solubility, except for the XP Bond adhesive system.

It has been suggested that the hybrid layer (HL) does not play any important role in the mechanism of adhesion to dentin. To substantiate this hypothetical insignificance of the HL, sodium hypochlorite (NaOCl) has been used to remove collagen from etched dentin prior to bonding. Objectives: The present study was conducted to determine the effect of a commercial 10% NaOCl gel on the dentin shear bond strengths and HL ultra-morphology of two simplified dentin adhesives. The null hypothesis tested was that treatment of etched dentin collagen with NaOCl would not compromise dentin bonding. Methods: The labial surface of eighty bovine incisors was polished to expose middle dentin. The specimens were randomly assigned to two total-etch adhesive systems (N=40): PrimeB and Single Bond (3M Dental Products Division). After rinsing off the etchant, one drop of 10% NaOCl (AD Gel, Kuraray Ltd.) was applied to the etched dentin surface and left for 0 (control), 15, 30, or 60 s. The gel was rinsed off with water and the dentin surface kept visibly moist prior to the application of the adhesive as per manufacturer's instructions. The respective composite resin was subsequently applied and light-cured. After 24 h in water at 37°C, the specimens were thermocycled for 500 cycles in baths kept at 5 and 55°C and the shear bond strengths measured. The data were analyzed with two-way ANOVA. For TEM, sixteen dentin disks were taken from middle dentin of extracted human third molars, assigned to the eight treatment sequences, and observed. Results: The increase in the NaOCl application time resulted in a progressive decrease in shear bond strengths for both dentin adhesives. For Single Bond, the application of AD Gel for 60 s resulted in a reduction of bond strengths to 38% of that obtained for the control. For Prime&Bond NT, the mean bond strength obtained when AD Gel was applied for 60 s was 31% of that obtained for the control. The application of AD Gel resulted in distinct morphology for each one of the two adhesives tested. For Single Bond, the general morphology of the collagen network was maintained, regardless of the deproteinization time. The interfibrillar space within the collagen network increased with increasing deproteinization times. For Prime&Bond NT, the general appearance of the HL was maintained for deproteinization times of 15 and 30 s. When the NaOCl gel was applied for 60 s, the morphological appearance of the HL lost its fibrillar arrangement. While remnants of the collagen fibers were observed in one of the dentin disks, the other specimen showed an amorphous structure without any discernible HL morphological features. Significance: The integrity of the collagen fibrils left exposed upon acid-etching plays a major role in the mechanism of adhesion of the specific adhesive systems tested in this study. The intermingling of the adhesive monomers with the filigree of collagen fibers or HL should still be considered the paramount dentin bonding mechanism.

Statement of problem Different parameters are used in the literature to describe translucency, making it difficult for clinicians to find clear information on ceramic translucency and compare studies. Purpose The purpose of this study was to assess the correlation between the contrast ratio (CR) and translucency parameter (TP) when the translucency of different types of ceramic systems is compared. Material and methods Disks 13 mm in diameter and 0.7 mm thick were fabricated for the following materials (n=5): VITA VM9, VITA PM9, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as positive control, while Lava Zirconia served as negative control. The luminous reflectance (Y) and color coordinates (CIE L* a* b*) of the specimens were measured with a tristimulus colorimeter. The CR (CR=Yb/Yw) was calculated from the reflectance of the light of the material on a black backing (Yb) to the reflectance on a white backing (Yw). The TP (TP=[(L b *L w *) 2+ (a b * - a w *) 2+ (b b * - b w *) 2 ] 1/2 ) was calculated from the color difference of the material on a black versus a white background. One-way ANOVA based on ranked data and the Pearson and Spearman rank correlation tests were used to analyze the data (α=.05). Results A significant correlation between CR and TP was found when all specimens were included ( P - 0.99 indicated a strong decreasing relationship between the 2 variables. Conclusions Either CR or TP can be used to evaluate the relative translucency of ceramic systems.