Andrea Nóbrega Cavalcanti

Evaluation of the surface roughness and morphologic features of Y-TZP ceramics after different surface treatments.

OBJECTIVE This study aimed to investigate the effect of different energy intensities of the Er:YAG laser and of air abrasion with Al(2)O(3) particles on the surface roughness and morphologic characteristics of yttrium-stabilized tetragonal zirconia (Y-TZP) ceramics. BACKGROUND DATA Surface roughness enhances the micromechanical interlocking of luting agents to ceramic surfaces. However, the most appropriate surface treatment for Y-TZP ceramics has yet to be determined. MATERIALS AND METHODS Two Y-TZP materials were evaluated: Cercon Smart Ceramics and Procera Zirconia. Thirty plates from each ceramic material were randomly divided into five groups according to the surface treatment received (none [control], air abrasion, or irradiation with the Er:YAG laser at three different energy intensities [200, 400, or 600 mJ]). After the surface treatments, the ceramic plates were gold-coated and their surface roughness (Ra, microm) was measured using confocal microscopy. For each ceramic system, the surface roughness was analyzed through two-way ANOVA/Tukeys test, with a 5% significance level. Changes in the morphological characteristics of the ceramics were examined through light and scanning electron microscopy. RESULTS For both zirconia-based materials, irradiation with 400 mJ or 600 mJ increased surface roughness and provided significant morphological changes. Air-abraded Cercon surfaces were rougher compared to the ones irradiated with 200 mJ of laser energy, whereas Procera surfaces irradiated with 200 mJ were rougher than the air-abraded ones. CONCLUSIONS Higher laser power settings (400 and 600 mJ) cause excessive material deterioration, making them unsuitable as surface treatments for zirconia surfaces. Irradiation with 200 mJ provides mild surface alterations, with intermediary features between the effects of air abrasion and higher laser intensities.

Y-TZP Ceramics: Key Concepts for Clinical Application

Compared to conventional ceramic systems, Yttrium-stabilized tetragonal zirconia (Y-TZP) ceramics have some superior mechanical properties, ensuring a broad application in dentistry. The current study aimed to present relevant information about Y-TZP ceramics gathered from peer-reviewed papers. A search of the English language peer-reviewed literature was conducted using the PubMed database between 1998 and 2008. Articles that did not focus exclusively on the clinical application of Y-TZP ceramic restorations were excluded from further evaluation. Selected papers describe the chief characteristics of zirconia ceramics and important clinical features, especially those related to cementation procedures. The literature shows that, although new substances and equipment for the surface preparation of zirconia ceramics are in development, the most promising luting protocol seems to be the use of air abrasion with aluminum oxide particles (silanated or not), followed by the application of resin cements or surface primers containing special reactive monomers. However, because zirconia ceramics have only recently been developed for dental applications, there is not enough clinical evidence to support any definitive cementation protocol.

Durability of Resin Cement Bond to Aluminium Oxide and Zirconia Ceramics after Air Abrasion and Laser Treatment

PURPOSE The erbium laser has been introduced for cutting enamel and dentin and may have an application in the surface modification of high-strength aluminum oxide and zirconia ceramics. The aim of this study was to evaluate the durability of the bond of conventional dual-cured resin cements to Procera Al(2)O(3) and zirconium oxide ceramics after surface treatment with air abrasion and erbium laser. MATERIALS AND METHODS One hundred twenty Al(2)O(3) and 120 zirconia specimens measuring 3 × 3 × 0.7 mm(3) were divided equally into three groups, and their surfaces treated as follows: either untreated (controls), air abraded with Al(2)O(3) particles, or erbium-laser-treated at a power setting of 200 mJ. The surface of each specimen was then primed and bonded with one of two dual-cured resin cements (either SCP-100 Ceramic Primer and NAC-100 or Monobond S and Variolink II) using a 1-mm thick Tygon tube mold with a 0.75-mm internal bore diameter. After 24 hours and 6 months of water storage at 37°C, a microshear bond strength test was performed at a crosshead speed of 1 mm/min. Surface morphology was examined using a confocal microscope, and failure modes were observed using an optical microscope. The data were analyzed using the Kaplan-Meier nonparametric survival analysis. RESULTS In the case of zirconia, air abrasion and Erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment of the ceramic surface resulted in a significant reduction in the bond strengths of both resin cements after 6 months water storage; however, when the zirconia surface was left untreated, the SCP-100/NAC-100 group did not significantly reduce in bond strength. In the case of alumina, no treatment, air abrasion and Er:YAG laser treatment of the surface led to no significant reduction in the bond strengths of the three SCP-100/NAC-100 groups after 6 months water storage, whereas all three Monobond S/Variolink II groups showed a significant reduction. CONCLUSION Er:YAG laser treatment of the zirconia surface did not result in a durable resin cement/ceramic bond; however, a durable bond between a conventional dual-cured resin cement and Procera All Ceram and Procera All Zirkon was formed using a ceramic primer containing the phosphate monomer, MDP, without any additional surface treatment.

Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial

Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser - AsGaAl (Photon Lase III - PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm2, diameter tip 600 µm).The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05). Conclusion: Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.

Effect of chemical degradation followed by toothbrushing on the surface roughness of restorative composites.

Objectives The aim of the present study was to assess the effect of the exposure to food-simulating liquids prior to brushing simulation on the surface roughness of five composite materials (Quixfil, Filtek Supreme, Esthet-X, Filtek Z250, Tetric Ceram). Material and methods Twenty cylinders (5 mm diameter and 4 mm height) of each composite were randomly allocated to 4 groups (n=5), according to the food-simulating liquid in which they were immersed for 7 days at 37ºC: artificial saliva, heptane, citric acid, and ethanol. After this period, the top surface of composite cylinders was submitted to 7,500 brushing cycles (200 g load). Measurements of the surface roughness (Ra, µm) were carried out before and after the exposure to the chemicals/brushing simulation. Changes on the morphology of composite surfaces were observed through scanning electron microscopy (SEM). Results The statistical analysis (ANOVA with cofactor / Tukeys test, α=5%) detected a significant interaction between solutions and composite resins. Esthet-X, Filtek Z250 and Tetric Ceram were not affected by the food-simulating liquids/toothbrushing. Citric acid and ethanol increased the surface roughness of Quixfil and Filtek Supreme, respectively. SEM images corroborate the surface roughness findings, demonstrating the negative effect from chemical solutions and mechanical abrasion. Conclusions The surface roughness of composite resin materials are differently affected by the food-simulating solutions, depending on the immersion media.

Mechanical properties and degree of conversion of etch-and-rinse and self-etch adhesive systems cured by a quartz tungsten halogen lamp and a light-emitting diode.

The aim of the present study was to evaluate the degree of conversion (DC), elastic modulus (E), and flexural strength (FS) of five adhesive systems (only the bonding component of both Scotchbond MP-SBMP and Clearfil Protect Bond-CP; Single Bond 2-SB2; One-up Bond F Plus-OUP; and P90 System Adhesive: primer-P90P and bond-P90B) cured with a quartz tungsten halogen (QTH) lamp and a light-emitting diode (LED). Two groups per adhesive were formed (n=5), according to the light source (quartz tungsten halogen-QTH: Demetron LC; and light-emitting diode-LED: UltraLume 5). Bar-shaped specimens were evaluated using three-point bending. The DC was obtained by Fourier transform infrared spectroscopy (FTIR). SB2 and P90P exhibited better DC values for QTH curing. However, SB2 and P90P presented the worst results overall. The light source was statistically significant for all adhesives, except for P90B and OUP. Non-solvated adhesives presented the best E and FS values. It could be concluded that the DC and E values can be influenced by the light source; however, this interference is material dependent.

Changes in Water Sorption and Solubility of Dental Adhesive Systems after Cigarette Smoke

Aim. To evaluate the effect of cigarette smoke on water sorption and solubility of four adhesive systems. Materials and Methods. Sixteen disks of each adhesive system were prepared (Adper Scotchbond Multipurpose Adhesive (SA); Adper Scotchbond Multipurpose Adhesive System (Adhesive + Primer) (SAP); Adper Single Bond Plus (SB); Adper Easy One (EO)). Specimens were desiccated until a constant mass was obtained and divided into two groups (n = 8). One-half of the specimens were immersed in deionized water, while the other half were also immersed, but with daily exposure to tobacco smoke. After 21 days, disks were measured again and stored in desiccators until constant mass was achieved. Data were calculated according to ISO specifications and statistically analyzed. Results. The tobacco smoke only significantly affected the water sorption and solubility of EO. There were significant differences in both analyses among materials tested. The SB exhibited the highest water sorption, followed by EO, which demonstrated significantly higher solubility values than SB. The SA and SAP showed low water sorption and solubility, and there were no significant differences between the two. Conclusion. Regardless of smoke exposure, both simplified adhesive systems presented an inferior performance that could be related to the complex mixture of components in such versions.

Effect of a desensitizing dentifrice on the bond strength of different adhesive systems

AIM: This in vitro study evaluated the effect of using a dental hypersensitivity treatment on the bond strength to dentin of etch-and-rinse and self-etching simplified adhesive systems. METHODS: 40 healthy molars were used. The crowns of teeth were removed at the dentinoenamel junction, and remaining roots were sectioned in the mesiodistal direction along their long axis, separating the buccal and lingual/palatal halves. The segments obtained were ground, keeping the buccal or lingual/palatal face turned downwards in order to flatten the surface and produce a standardized smear layer. Prepared specimens were randomly distributed into 4 groups (n=10), according to the combination of surface treatment with the desensitizing dentifrice Colgate Sensitive Pro-Relief (Colgate Palmolive®) (test group - with dentifrice and control group - without dentifrice) and type of simplified bonding agent (etch-and-rinse and self-etching agents). Resin composite blocks were fabricated on the dentin surfaces, after application of bonding agents, and specimens were sectioned into rectangular stick-shaped specimens with cross-sectional area of approximately 0.8mm2. For microtensile bond strength tests, 4 sticks were randomly selected from the central region of specimens, and fixed to a universal test machine. Data were analyzed statistically by the Mann-Whitney U test (a=0.05). RESULTS: The bond strength obtained in the group without desensitizer (control) + etch-and-rinse agent was significantly higher compared with the other groups. Under both experimental conditions, the self-etching agent showed weak bond strength to dentin. CONCLUSIONS: Change in the dentin substrate by obliteration of tubules in the process of relieving dentinal sensitivity could reduce the bond strength of simplified etch-and-rinse and self-etching bonding agents.

Effect of agitation and storage temperature on water sorption and solubility of adhesive systems.

The purpose of this study was to evaluate the influence of storage temperature and flask agitation on the water sorption (WS) and solubility (SL) of simplified adhesive systems. Seventy-two disc-shaped specimens were prepared according to the adhesive system (water/ethanol-based: Adper Single Bond 2; and water-based: One Coat Bond SL) and experimental conditions tested (mechanical agitation and storage temperature). Statistical analysis (3-way ANOVA, alpha=5%) found significantly greater WS and SL means for the water/ethanol-based system when compared to the water-based. Irrespective of factors studied, significant differences in WS and SL were noted between cold and room temperatures, with greater values been obtained at 1°C, and lower ones at 20°C. Agitation provided increased WS for both materials at all temperatures, but did not affect their SL. The mechanical agitation of the flask may negatively affect the dynamics of diffusion of simplified adhesive systems, even at extremely cold or warm temperatures.

Statistical results on restorative dentistry experiments: effect of the interaction between main variables

Statistical analysis interpretation is a critical field in scientific research. When there is more than one main variable being studied in a research, the effect of the interaction between those variables is fundamental on experiments discussion. However, some doubts can occur when the p-value of the interaction is greater than the significance level. Objective To determine the most adequate interpretation for factorial experiments with p-values of the interaction nearly higher than the significance level. Materials and methods The p-values of the interactions found in two restorative dentistry experiments (0.053 and 0.068) were interpreted in two distinct ways: considering the interaction as not significant and as significant. Results Different findings were observed between the two analyses, and studies results became more coherent when the significant interaction was used. Conclusion The p-value of the interaction between main variables must be analyzed with caution because it can change the outcomes of research studies. Researchers are strongly advised to interpret carefully the results of their statistical analysis in order to discuss the findings of their experiments properly.