Arlin Kiremitci

Effect of adhesive system type and root region on the push-out bond strength of glass–fibre posts to radicular dentine

AIM To compare interfacial strength in different thirds of the root canal amongst glass-fibre posts luted with four different adhesive luting agents. METHODOLOGY A total of 44 extracted human single-rooted teeth were randomly divided in four groups and restored using glass-fibre posts and the following luting agents: All Bond SE/Duo-Link (ABSE), All Bond 3/Duo-Link (AB3), BisCem (BC), Clearfil ED primer II/Clearfil Esthetic Cement (CLF). One week after luting, the samples were thermocycled in water, and then embedded in acrylic resin. Three sections (cervical, middle and apical) of 2 mm thickness were prepared from each specimen, and the post in each section was subjected to a push-out test. One additional specimen for each group was prepared for scanning electron microscopy analysis and the bonding effectiveness to dentine was assessed. The data were analysed using the Kolmogorov-Smirnov test, two-way anova, one-way anova, and the Scheffe test (P < 0.05). RESULTS The push-out bond strength values for BC and ABSE were not significantly different (P > 0.05), but both were significantly higher than the means for AB3 and CLF (P < 0.05) in the cervical and middle regions. The same trend was observed in the apical region, except for the AB3 and ABSE which were not significantly different (P > 0.05) from each other. There were significant differences in bond strength amongst root thirds, with a reduction in values from the cervical to apical third (P < 0.05). CONCLUSIONS The use of BisCem and All Bond SE/Duo-Link combination with their simplified application procedures may be considered an alternative to the currently used systems for luting glass-fibre posts in root canal.

Effect of different adhesive systems and laser treatment on the shear bond strength of bleached enamel

PURPOSE This study determined the shear bond strength of a nanohybrid composite resin to bleached enamel immediately or 15 days later using different adhesive systems and laser application. METHODS One hundred and forty enamel specimens were prepared from human molar teeth and bleached either with 16% carbamide peroxide (CP) or 30% CP according to the manufacturers (Vivastyle/Vivadent) recommendations. After bleaching treatments specimens were divided into two groups according to the treatment time of the adhesive procedures: immediately or 15 days after the bleaching treatments. The four groups were then divided into five subgroups due to the surface treatments: using a two-step self-etching adhesive (AdheSe, Ivoclar Vivadent G, Schaan, Liechtenstein) or a two-step etch and rinse adhesive (Excite, Ivoclar Vivadent G, Schaan, Liechtenstein) and application of laser prior to adhesive procedures or not. After adhesive procedures nanohybrid composite resin cylinders of 4 mm x 2 mm (Tetric Evo Ceram/Vivadent) were bonded to the enamel surfaces. All specimens were subjected to shear bond strength test after thermocycling and 24h of storage in water. Data were analyzed statistically. RESULTS Mann-Whitney U-test analysis showed no significant difference in the mean bond strength values of enamel bleached with either 16% CP or 30% CP (p>0.05). There was no difference between the groups bonded immediately or 15 days after bleaching (p>0.05). Application of the etch and rinse adhesive after 15 days showed the highest bond strength values, whereas self-etching adhesive and laser application showed the lowest values in both bleaching treatments. CONCLUSIONS The results suggested that following the bleaching treatments, the use of etch and rinse adhesive system may provide higher bond strengths than self-etching adhesive and laser application.

Shear bond strength of composite bonded to Er,Cr:YSGG laser-prepared dentin.

OBJECTIVE The purpose of this in vitro study was to evaluate dentin bond strength to resin composite following high-speed rotary or Er,Cr:YSGG laser preparation using two different adhesive systems. MATERIALS AND METHODS One hundred and forty dentin specimens were prepared from human molars. Seventy specimens were prepared with a high-speed diamond bur and 70 of the specimens were prepared with an Er,Cr:YSGG laser. Each group was subdivided into 7 groups of 10 teeth and etched with either 37% H3PO4, laser etched at two different power levels (1.25 W and 3 W), or not etched. Nano-hybrid composite resin cylinders 4 x 2 mm in size (Tetric EvoCeram, Vivadent) were bonded to the dentin surfaces with the application of an etch-and-rinse adhesive (Exite/Vivadent), or a self-etching adhesive (AdheSe/Vivadent). After storage in distilled water and thermocycling, a shear bond strength test was performed on all specimens and the data were statistically analyzed. RESULTS ANOVA detected significant differences between the tested groups (p < 0.001). Duncans multiple comparison test showed that Excite-applied specimens that were prepared with laser and laser etched (1.25 W or 3 W) had higher mean bond strengths. Both AdheSe- and Excite-applied specimens prepared with the diamond bur and laser etched (1.25 W) showed the lowest mean bond strength values (p < 0.05). CONCLUSION The results suggest that dentin surfaces prepared with the Er,Cr:YSGG laser and etched with the laser (at either 1.25 or 3 W) may provide comparable or increased composite resin bond strengths, depending on the adhesive used.

Effect of Er,Cr:YSGG laser irradiation on the apical sealing ability of AH Plus/gutta-percha and Hybrid Root Seal/Resilon Combinations

OBJECTIVE The objective of this study was to evaluate the sealing ability of 2 different resin-based endodontic filling systems after smear layer removal with 2 different techniques. STUDY DESIGN Extracted human single-rooted teeth (n = 74) were instrumented using HERO Shaper rotary instruments and irrigated with 1 mL of 2.5% NaOCl between each instrument. Additionally, the canals received either an extra 3-minute rinse with 2 mL of 17% EDTA or a 40-second Er,Cr:YSGG laser treatment. The root canals were filled with either Hybrid Root Seal/Resilon combination or AH Plus/gutta-percha combination using lateral condensation technique (n = 11). Apical leakage quantity was measured with the computerized fluid filtration meter at 1 and 4 weeks. One root from each group, which was not submitted to the fluid filtration test, was selected for scanning electron microscopy (SEM) analysis. Statistical analysis was performed using 3-way ANOVA and the post hoc Tukey HSD test (α = 0.05). RESULTS A significant decrease was observed in the microleakage values of all the experimental groups tested with time (P < .0001). EDTA + AH Plus/gutta-percha combination exhibited the least microleakage, whereas laser irradiation + Hybrid Root Seal/Resilon combination showed the greatest microleakage at each of the 2 time periods. Each experimental combination exhibited architecture in SEM that seemed to correlate with its sealing performance. CONCLUSION Er,Cr:YSGG laser treatment does not enhance the sealing ability of the sealers compared with EDTA application. The root canal adaptation and sealing ability of the Hybrid Root Seal/Resilon combination is not superior to that of the AH Plus/gutta-percha combination.

Effect of bleaching on mercury release from amalgam fillings and antioxidant enzyme activities: a pilot study.

OBJECTIVE The aim of this pilot clinical study was to determine the mercury release from amalgam fillings and antioxidant enzyme activities (Superoxide Dismutase [SOD] and Catalase[CAT] ) in body fluids after exposure to two different vital tooth bleaching systems. MATERIAL AND METHODS Twenty eight subjects with an average age of 25.6 years (18-41) having at least two but not more than four Class II amalgam fillings on each quadrant arch in the mouth participated in the study. Baseline concentrations of mercury levels in whole blood, urine, and saliva were measured by a Vapor Generation Accessory connected to an Atomic Absorption Spectrometer. Erythrocyte enzymes, SOD, and CAT activities in blood were determined kinetically. Subjects were randomly assigned to two groups of 14 volunteers. Group 1 was treated with an at-home bleaching system (Opalescence PF 35% Carbamide Peroxide, Ultradent), and Group 2 was treated with a chemically activated office bleaching system (Opalescence Xtra Boost 38% Hydrogen Peroxide, Ultradent) according to the manufacturers recommendations. Twenty-four hours after bleaching treatments, concentrations of mercury and enzymes were remeasured. RESULTS There were no significant differences on mercury levels in blood, urine, and saliva before and after bleaching treatments (p > 0.05). No differences were also found in the level of antioxidant enzyme activities (SOD and CAT) before and after treatments (p > 0.05). Mercury release did not affect the enzyme activities (p > 0.05). CONCLUSION Bleaching treatments either office or home did not affect the amount of mercury released from amalgam fillings in blood, urine, and saliva and the antioxidant-enzyme activities in blood. CLINICAL SIGNIFICANCE Bleaching treatments with the systems tested in this pilot study have no deleterious effect on the mercury release from amalgam fillings and antioxidant enzymes in body fluids.

Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months

OBJECTIVE This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)2] in the treatment of deep carious lesions by the direct complete caries removal technique. METHODS AND MATERIALS A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)2 (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05. RESULTS The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)2 (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively). CONCLUSIONS Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

Nanofilled and conventional resin-modified glass ionomer fillings combined with connective tissue grafts for treatment of gingival recessions with non-carious cervical lesions

The aim of this study was to evaluate the clinical root coverage results of subepithelial connective tissue grafts (SCTG) performed on teeth with gingival recessions and non-carious cervical lesions (NCCLs) that were restored with cervical fillings and compare the results of two different filling materials: resin-modified glass ionomer (RMGIC) and nano-ionomer cements (NIC). A total of 54 teeth with Miller Class I gingival recessions with or without NCCLs in 36 patients (28 females, 8 males) were treated with SCTGs. Cervical lesions were randomly treated with RMGIC or NIC restorations. Periodontal clinical parameters, height of gingival recession (HGR), width of gingival recession (WGR), height of keratinized tissue, and dentin sensitivity were measured at baseline and 3, 6, and 12 months postoperatively. HGR and WGR values were statistically significantly reduced at all time points when compared to baseline values in all groups. There were no statistically significant differences between the groups in any clinical periodontal parameter (P > 0.05). The percentage of root coverage at 12 months was 89.5%, 90.1%, and 96.2% in the RMGIC, NIC, and control groups, respectively. Successful root coverage with connective tissue grafts may be achieved on teeth restored with RMGIC or NIC cervical fillings.

Clinical assessment of mineral trioxide aggregate in the treatment of deep carious lesions

Objective: This clinical study aimed to assess the effectiveness of mineral trioxide aggregate (MTA) and calcium hydroxide (Ca[OH]2) in the treatment of deep carious lesions using the direct complete caries excavation technique. Subjects and Methods: Hundred permanent molars/premolars were capped either with Ca (OH)2 (n = 49) or MTA (n = 51) and restored with composite resin in 73 patients. Periapical radiographs were taken prior to the treatment, at 6 months and 12 months. Two calibrated examiners clinically and radiographically assessed the periapical pathology and pulpal symptoms. Inter-group comparisons of the observed values were analyzed using Fishers exact test. Significance was predetermined at α = 0.05. Results: Recall rates were 100% at 6 and 12 months. Four teeth capped with Ca(OH)2 (two each at the end of 6 and 12 months) and one tooth capped with MTA (at the end of 12 months) received endodontic emergency treatment because of symptoms of irreversible pulpitis that were clinically and/or radiographically established. There was no significant difference between the protection of the tooth vitality and pulp capping agents at 6 and 12 months (P = 0.238, P = 0.606, respectively). Conclusion: Both materials were clinically applicable at the end of 12 months.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two‐Year Clinical Study

PURPOSE To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth. MATERIALS AND METHODS Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests. RESULTS A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029). CONCLUSION Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

A comparative study on monomer elution and cytotoxicity of different adhesive restoration materials

Abstract This study evaluated monomer release and cytotoxicity of different adhesive restoration materials used for dental restorations. The extracts (1, 2, and 7 days) of three types of adhesive dental restoration materials, [Quixfill (QF), Silorane Restorative (SR), and Ketac N 100 Restorative (KR)], and the adhesive resins, [XP Bond (XP), Silorane Primer (SP), Ketac N 100 Primer (KP), and Silorane Bond (SB)] were analyzed using high performance liquid chromatography/mass spectrometry (HPLC-MS). The cytotoxicity levels were determined at different time points (24, 48, and 72 h) of cell culture using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay. All adhesive resin materials showed monomer release at varying amounts with the highest release after 7 days. The lowest amount of release was observed in QF and the highest with KP. Bis-Phenol A (BPA) was not detected in SP and KR that contain bisphenol-A diglycidyl ether dimethacrylate (bis-GMA). Decamethylpenthasiloxane (D5) was not eluted from SR. Except for SR and QF, all other adhesive restoration materials showed different degrees of toxicity along with different monomer release kinetics. The correlation between the monomer release and cytotoxicity of the materials indicated that the cytotoxicity of the materials increased with the monomer release (Spearman’s rho correlation coefficient – r). The correlation after 48 h was statistically significant (r = −0.342, p = 0.017).