Aline de Almeida Neves

Relationship between bond-strength tests and clinical outcomes.

One often alleges that laboratory bond-strength testing cannot predict clinical effectiveness of adhesives. Major argument to sustain this claim is the wide variation in bond-strength values recorded for one specific adhesive among different research institutes worldwide. The main reason for these inconsistent bond-strength measurements is supposedly the current lack of a standard bond-strength testing protocol. This paper (and presentation) aimed to report on an extensive literature review with regard to the different laboratory bond-strength test methods and their data provided, along with a second extensive literature review on clinical effectiveness data of adhesives in terms of retention rates of adhesive Class-V restorations. Combining both systematic reviews, we have subsequently searched for a potential relationship between bond-strength data and clinical outcomes.

Lack of Causal Relationship between Dentinal Microcracks and Root Canal Preparation with Reciprocation Systems

INTRODUCTION This study aimed to evaluate the frequency of dentinal microcracks observed after root canal preparation with 2 reciprocating and a conventional full-sequence rotary system using micro-computed tomographic analysis. METHODS Thirty mesial roots of mandibular molars presenting a type II Vertucci canal configuration were scanned at an isotropic resolution of 14.16 μm. The sample was randomly assigned to 3 experimental groups (n = 10) according to the system used for the root canal preparation: group A-Reciproc (VDW, Munich, Germany), group B-WaveOne (Dentsply Maillefer, Baillagues, Switzerland), and group C-BioRaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland). Second and third scans were taken after the root canals were prepared with instruments sizes 25 and 40, respectively. Then, pre- and postoperative cross-section images of the roots (N = 65,340) were screened to identify the presence of dentinal defects. RESULTS Dentinal microcracks were observed in 8.72% (n = 5697), 11.01% (n = 7197), and 7.91% (n = 5169) of the cross-sections from groups A (Reciproc), B (WaveOne), and C (BioRaCe), respectively. All dentinal defects identified in the postoperative cross-sections were also observed in the corresponding preoperative images. CONCLUSIONS No causal relationship between dentinal microcrack formation and canal preparation procedures with Reciproc, WaveOne, and BioRaCe systems was observed.

Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer

UNLABELLED Glass-ionomers (GIs) exhibit excellent clinical bonding effectiveness, but still have shortcomings such as polishability and general aesthetics. The aims of this study were (1) to determine the micro-tensile bond strength (microTBS) to enamel and dentin of a nano-filled resin-modified GI (nano-RMGI; Ketac N100, 3M-ESPE), and (2) to characterize its interfacial interaction with enamel and dentin using transmission electron microscopy (TEM). METHODS The nano-RMGI was used both with and without its primer, while a conventional RMGI restorative material (conv-RMGI; Fuji II LC, GC) and a packable conventional GI cement (conv-GI; Fuji IX GP, GC) were used as controls. After bonding to freshly extracted human third molars, microspecimens of the interfaces were machined into a cylindrical hourglass shape and tested to failure in tension. Non-demineralized TEM sections were prepared and examined from additional teeth. RESULTS The microTBS to both enamel and dentin of nano-RMGI and conv-GI were not statistically different; the microTBS of non-primed nano-RMGI was significantly lower, while that of conv-RMGI was significantly higher than that of all other groups. TEM of nano-RMGI disclosed a tight interface at enamel and dentin without surface demineralization and hybrid-layer formation. A thin filler-free zone (<1 microm) was formed at dentin. A high filler loading and effective filler distribution were also evident, with localized areas exhibiting nano-filler clustering. CONCLUSIONS The nano-RMGI bonded as effectively to enamel and dentin as conv-GI, but bonded less effectively than conv-RMGI. Its bonding mechanism should be attributed to micro-mechanical interlocking provided by the surface roughness, most likely combined with chemical interaction through its acrylic/itaconic acid copolymers.

Micro-CT based quantitative evaluation of caries excavation

OBJECTIVES To optimize a microtomographic (micro-CT) technique to quantitatively evaluate the effectiveness of contemporary caries-excavation techniques. METHODS A beam-hardening curve was obtained from an initial reconstruction of a wedge-shaped hydroxyapatite (HAp) block and fitted with a 5th order polynomial function, after which each micro-CT tooth slice was corrected accordingly. Calibration of the 8-bit gray values into mineral-density values was obtained by scanning, reconstructing and processing volume of interests (VOIs) of HAp phantoms with different mineral densities (0.25, 0.75, 3.14g/cm(3)). One carious tooth was scanned before and after caries removal with an experimental enzyme-based gel. After reconstruction, a 3D-median filter was applied to each micro-CT slice, and a connected threshold grower algorithm was used to blank-out undesired structures in each slice. Volume rendering with a look-up-table (LUT), based on mineral densities, was accomplished for the tooth before and after caries removal. Finally, the actual volume of excavated tissue was quantified. RESULTS Correction for beam hardening produced tooth slices with relatively homogeneous gray values along the whole area of enamel and dentin. Accurate mineral-density values were obtained for enamel, dentin and carious regions (2.89, 1.74 and 0.27g/cm(3), respectively). After pre-processing (3D-median filtering and connected threshold grower algorithm), acceptable segmentation of carious dentin based on gray values was accomplished (Otsu method, gray value=75 or mineral density=1.12g/cm(3)), from which quantitative volumetric parameters were calculated. SIGNIFICANCE Accurate calibration, standardization of scanning and reconstruction steps and adequate pre-processing of micro-CT slices allowed detailed volumetric calculation of caries-excavation techniques.

Micro-computed Tomographic Assessment on the Effect of ProTaper Next and Twisted File Adaptive Systems on Dentinal Cracks.

INTRODUCTION The aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal preparation with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA) systems through micro-computed tomographic analysis. METHODS Twenty moderately curved mesial roots of mandibular molars presenting a type II Vertucci canal configuration were randomly assigned to 2 experimental groups (n = 10) according to the system used for the root canal preparation: PTN or TFA systems. The specimens were scanned through high-resolution micro-computed tomographic imaging before and after root canal preparation. Afterward, pre- and postoperative cross-sectional images of the mesial roots (N = 25,820) were screened to identify the presence of dentinal defects. RESULTS Dentinal microcracks were observed in 38.72% (n = 5150) and 30.27% (n = 3790) of the cross-sectional images in the PTN and TFA groups, respectively. All dentinal defects identified in the postoperative scans were already present in the corresponding preoperative images. CONCLUSIONS Root canal preparation with PTN and TFA systems did not induce the formation of new dentinal microcracks.

Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation.

OBJECTIVES To determine the caries-removal effectiveness (CRE) and minimal-invasiveness potential (MIP) of contemporary caries-removal techniques. METHODS Carious molars were scanned using micro-CT, after which dentine caries was removed by 9 contemporary caries-removal techniques. The micro-CT was repeated and CRE was determined on basis of the relative volume of residual caries and the mineral density (MD) at the cavity floor. MIP was determined by measuring the cavity size relative to the initial size of the caries lesion. RESULTS CRE and MIP varied most for the Er:YAG laser (Kavo) despite its laser-induced fluorescence (LIF) feedback system. Whilst some specimens revealed much residual caries, others showed over-excavation into sound dentine. With the highest Relative Cavity Size, the Er:YAG laser presented the lowest MIP. Rotary/oscillating instruments revealed a more favourable CRE with some tendency towards over-excavation, except for CeraBur (Komet-Brasseler) and Cariex (Kavo) that typically left caries at the cavity floor and cavity walls, respectively. Chemo-mechanical excavation aided by conventional metal excavators (Carisolv, MediTeam; exp. SFC-V and SFC-VIII, 3M-ESPE) combined best CRE with MIP. When however a plastic excavator was used along with exp. SFC-VIII, caries was less completely removed. SIGNIFICANCE Er:YAG-laser aided by LIF resulted in non-selective caries removal. Rotary/oscillating caries removal may lead to over-excavation, especially when burs are combined with Caries Detector (Kuraray). This risk for over-excavation is reduced when a tungsten-carbide bur is solely used. On the contrary, Cariex (Kavo) and CeraBur showed a tendency for under-preparation. Chemo-mechanical methods were most selective in removing caries, whilst preserving sound tissue.

Apically extruded dentin debris by reciprocating single-file and multi-file rotary system

ObjectivesThis study aims to evaluate the apical extrusion of debris by the two reciprocating single-file systems: WaveOne and Reciproc. Conventional multi-file rotary system was used as a reference for comparison. The hypotheses tested were (i) the reciprocating single-file systems extrude more than conventional multi-file rotary system and (ii) the reciprocating single-file systems extrude similar amounts of dentin debris.Materials and methodsAfter solid selection criteria, 80 mesial roots of lower molars were included in the present study. The use of four different instrumentation techniques resulted in four groups (n = 20): G1 (hand-file technique), G2 (ProTaper), G3 (WaveOne), and G4 (Reciproc). The apparatus used to evaluate the collection of apically extruded debris was typical double-chamber collector. Statistical analysis was performed for multiple comparisons.ResultsNo significant difference was found in the amount of the debris extruded between the two reciprocating systems. In contrast, conventional multi-file rotary system group extruded significantly more debris than both reciprocating groups. Hand instrumentation group extruded significantly more debris than all other groups.ConclusionThe present results yielded favorable input for both reciprocation single-file systems, inasmuch as they showed an improved control of apically extruded debris.Clinical relevanceApical extrusion of debris has been studied extensively because of its clinical relevance, particularly since it may cause flare-ups, originated by the introduction of bacteria, pulpal tissue, and irrigating solutions into the periapical tissues.

Accumulated hard tissue debris produced during reciprocating and rotary nickel-titanium canal preparation.

INTRODUCTION This study compared the amount of hard tissue debris produced after different apical enlargement with single-file reciprocating systems (WaveOne [Dentsply Maillefer, Baillaigues, Switzerland] and Reciproc [VDW, Munich, Germany]) and a conventional multifile rotary system (BioRaCe [FKG Dentaire, La-Chaux-de-Fonds, Switzerland]) using micro-computed tomographic imaging. METHODS Thirty moderately curved mesial roots of mandibular molars presenting 2 independent root canals were selected and scanned at an isotropic resolution of 14.16 μm. The sample was assigned to 3 groups (n = 10) with respect to the root length and degree of curvature of the mesial root according to the system used for the root canal preparation: Reciproc, WaveOne, and BioRaCe. Second and third scans were taken after the root canals were prepared up to ISO sizes 25 and 40, respectively. The matched images of the mesial canals, before and after preparation, were examined from the furcation level to the apex to evaluate the amount of hard tissue debris (%). Data were statistically compared using a general linear model for repeated-measures with a significance level set at 5%. RESULTS Instrumentation systems per se did not influence the amount of hard tissue accumulation (P > .05), whereas a significant reduction in the percentage of hard tissue debris was observed after sequential enlargement in all groups (P < .05). CONCLUSIONS None of the systems yielded root canals completely free from packed hard tissue debris. The increased final apical size resulted in significantly less debris accumulation for both reciprocating and rotary systems.

Towards a better understanding of the adhesion mechanism of resin-modified glass-ionomers by bonding to differently prepared dentin

OBJECTIVES The purpose of this study was to evaluate the bonding effectiveness of a resin-modified glass-ionomer (RMGI) to differently prepared dentin and how this restorative material interacts with these distinct substrates. Also the potential adhesion-promoting role of a polyalkenoic-acid conditioner was assessed. METHODS Forty-eight dentin surfaces were prepared from sound human molars and randomly distributed among 6 experimental groups. Fuji II LC (GC) was applied on bur-cut (100 μm diamond), fractured and Er:YAG laser-irradiated (200mJ, 10Hz, 31.4J/cm(2)) dentin with or without the beforehand application of the aqueous polyalkenoic-acid conditioner, Cavity Conditioner (GC). After 7 days of storage in water at 37 °C, specimens were prepared for microtensile bond strength testing (μTBS), as well as for TEM characterization of the resultant RMGI-dentin interface. Statistical analysis of the μTBS results was performed using ANOVA and Tukeys test (p<0.05). RESULTS The use of conditioner resulted in a significantly higher bond strength only when dentin was prepared by diamond bur (p<0.05). Laser irradiation induced micro-cracks on the dentin surface and led to the lowest bond strength, irrespective of the use of conditioner (p<0.05). Fuji II LC was able to partially demineralise (up to 2.0μm) and infiltrate bur-cut and fractured dentin, but no evident interaction was observed at the interface between the RMGI and laser-irradiated dentin. CONCLUSIONS Laser-induced surface modifications impaired the interaction of the RMGI with dentin, thereby negatively influencing its bonding effectiveness. The use of a polyalkenoic-acid conditioner remains crucial for the RMGI to bond effectively to bur-cut dentin.

Reciprocating Versus Rotary Systems for Root Filling Removal: Assessment of the Apically Extruded Material

INTRODUCTION This study was designed to quantitatively evaluate the amount of apically extruded debris by comparing the ProTaper Universal Retreatment system (Dentsply Maillefer, Ballaigues, Switzerland) with 2 reciprocating single-file systems (Reciproc [VDW, Munich, Germany] and WaveOne [Dentsply Maillefer]) during endodontic retreatment. METHODS Forty-five mandibular premolars with a single canal were prepared with the ProTaper Universal system and then obturated. The specimens were divided into 3 groups (n = 15) according to the system used for filling removal: ProTaper Universal Retreatment system associated with the ProTaper Universal system (until file F4 40/0.06]), Reciproc system (Reciproc R40 [40/0.06]), and WaveOne system (WaveOne Large [40/0.08]). Sodium hypochlorite was used as an irrigant, and the apically extruded debris was collected in glass vials and then dried. The mean weight of debris was assessed with a microbalance and statistically analyzed using 1-way analysis of variance and post hoc Tukey multiple comparison tests (P < .05). RESULTS The ProTaper Universal Retreatment system produced significantly more debris compared with the Reciproc and WaveOne systems (P < .01). The reciprocating systems showed no significant difference between them (P > .05). CONCLUSIONS Under the conditions of the present study, all systems caused apical debris extrusion. Reciprocating systems were associated with less debris extrusion when compared with a conventional rotary retreatment system.