Beatrice Sener

Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer

AIM To evaluate the effects of ethylenediaminetetraacetic (EDTA), etidronic (EA) and peracetic acid (PA) when used in conjunction with sodium hypochlorite (NaOCl) as root canal irrigants on calcium eluted from canals, smear layer, and root dentine demineralization after instrumentation/irrigation. METHODOLOGY Single-rooted human premolars were irrigated as follows (n = 12 per group): (1) 1% NaOCl during instrumentation, deionized water after instrumentation, (2) 1% NaOCl during, 17% EDTA after instrumentation, (3) a 1 : 1-mixture of 2% NaOCl and 18% EA during and after instrumentation, and (4) 1% NaOCl during, 2.25% PA after instrumentation. Irrigant volumes and contact times were 10 mL/15 min during and 5 mL/3 min after instrumentation. The evaluated outcomes were eluted calcium by atomic absorption spectroscopy, smear-covered areas by scanning electron microscopy in secondary electron mode and apparent canal wall decalcifications on root transsections in backscatter mode. For the smear layer analysis, sclerotic dentine was taken into consideration. Results were compared using appropriate parametric and nonparametric tests, alpha = 0.05. RESULTS The statistical comparison of the protocols regarding calcium elution revealed that protocol (1) yielded less calcium than (3), which yielded less than protocols (2) and (4). Most of the instrumented canal walls treated with one of the decalcifying agents were free of smear layer. Protocols (1) and (3) caused no decalcification of root dentine, whilst (2) and (4) showed substance typical demineralization patterns. CONCLUSIONS The decalcifying agents under investigation were all able to remove or prevent a smear layer. However, they eroded the dentine wall differently.

Wear characteristics of current aesthetic dental restorative CAD/CAM materials: two-body wear, gloss retention, roughness and Martens hardness.

OBJECTIVES This study determined the two-body wear and toothbrushing wear parameters, including gloss and roughness measurements and additionally Martens hardness, of nine aesthetic CAD/CAM materials, one direct resin-based nanocomposite plus that of human enamel as a control group. MATERIALS AND METHODS Two-body wear was investigated in a computer-controlled chewing simulator (1.2 million loadings, 49N at 1.7Hz; 3000 thermocycles 5/50°C). Each of the 11 groups consisted of 12 specimens and 12 enamel antagonists. Quantitative analysis of wear was carried out with a 3D-surface analyser. Gloss and roughness measurements were evaluated using a glossmeter and an inductive surface profilometer before and after abrasive toothbrushing of machine-polished specimens. Additionally Martens hardness was measured. Statistically significant differences were calculated with one-way ANOVA (analysis of variance). RESULTS Statistically significant differences were found for two-body wear, gloss, surface roughness and hardness. Zirconium dioxide ceramics showed no material wear and low wear of the enamel antagonist. Two-body wear of CAD/CAM-silicate and -lithium disilicate ceramics, -hybrid ceramics and -nanocomposite as well as direct nanocomposite did not differ significantly from that of human enamel. Temporary polymers showed significantly higher material wear than permanent materials. Abrasive toothbrushing significantly reduced gloss and increased roughness of all materials except zirconium dioxide ceramics. Gloss retention was highest with zirconium dioxide ceramics, silicate ceramics, hybrid ceramics and nanocomposites. Temporary polymers showed least gloss retention. Martens hardness differed significantly among ceramics, between ceramics and composites, and between resin composites and acrylic block materials as well. CONCLUSIONS All permanent aesthetic CAD/CAM block materials tested behave similarly or better with respect to two-body wear and toothbrushing wear than human enamel, which is not true for temporary polymer CAD/CAM block materials. Ceramics show the best gloss retention compared to hybrid ceramics, composites and acrylic polymers.

Do bioactive glasses convey a disinfecting mechanism beyond a mere increase in pH

AIM To test whether bioactive glasses kill microbiota via mineralization or the release of ions other than sodium. METHODOLOGY Flame-spray synthesis was applied to produce nanometric glasses of different sodium content and constant Ca/P ratio: 28S5, 45S5 and 77S. Calcium hydroxide and nanometric tricalcium phosphate (TCP) were used as controls. Apatite induction was monitored by Raman spectroscopy. Bovine dentine disks with adherent Enterococcus faecalis cells were exposed to test and control suspensions or buffered solutions for 1 h, 1 day and 1 week. Colony-forming units were counted and disks were inspected using scanning electron microscopy. Suspension supernatants and solutions were analysed for their pH, osmolarity, calcium and silicon content. RESULTS Sodium containing glasses induced pH levels above 12, compared with less than pH 9 with sodium-free 77S. Calcium hydroxide, 45S5 and 28S5 killed all bacteria after 1 day and lysed them after 1 week. TCP caused the highest apatite induction and substantial calcification on bacteria adhering to dentine, but did not reduce viable counts. 77S achieved disinfection after 1 week without visible apatite formation, whilst the buffer solution at pH 9 caused only minimal reduction in counts. CONCLUSION Bioactive glasses have a directly and an indirectly pH-related antibacterial effect. The effect not directly linked to pH is because of ion release rather than mineralization.

Polyetheretherketone—A suitable material for fixed dental prostheses?

OBJECTIVES To study the surface properties of polyetheretherketone (PEEK) and its bond strength with two veneering resins after different conditioning methods as well as fracture load of PEEK three-unit fixed dental prostheses (FDPs). METHODS Two hundred and twenty five PEEK specimens were fabricated and divided into five groups: no treatment (A), etching with 98% sulfuric acid for 1 min (B), air-abrasion for 10 s with either 50 or 110 μm alumina (C and D, respectively), and silica coating using the Rocatec System (E). On 15 specimens of each conditioning method, contact angle and surface roughness were determined. The remaining 150 specimens of each conditioning method were divided into two groups for the veneering procedure with the composites Gradia (GC Europe) and Sinfony (3M ESPE). Shear bond strength (SBS) was measured and failure types were assessed. In addition, 15 FDPs were milled and the fracture load was tested. Data were analyzed using descriptive statistics, one-way ANOVA (Scheffé test), two sample Students t-test, and Weibull statistics (p < 0.05). RESULTS Silica-coated PEEK surfaces showed the highest wettability. The highest roughness and lowest contact angles were observed for 110 μm air-abraded and silica-coated PEEK surfaces. The highest SBS values were, however, achieved in the acid-etched group. PEEK three-unit FDPs showed a mean fracture load of 1383 N with a plastic deformation starting approximately at 1200 N. CONCLUSIONS Acid etching should be applied when PEEK is used as substructure material and composite veneering material is applied. In this combination, PEEK might be a suitable material for FDPs, especially in load-bearing areas.

Comparison of the Effects of TiF4 and NaF Solutions at pH 1.2 and 3.5 on Enamel Erosion in vitro

This study aimed to analyse and compare the protective effect of buffered (pH 3.5) and native (pH 1.2) TiF4 in comparison with NaF solutions on enamel erosion. Bovine samples were pretreated with 1.50% TiF4 or 2.02% NaF (both 0.48 M F) solutions, each at a pH of 1.2 and 3.5. The control group received no fluoride pretreatment. Twenty samples per group were eroded with HCl (pH 2.6) for 10 × 60 s. Erosion was either investigated by profilometry (n = 10) or by determination of calcium release into the acid (n = 10). Additionally, the elemental surface composition was quantified by X-ray energy-dispersive spectroscopy in fluoridated but not eroded samples (6 samples per group). Scanning electron microscopy was performed prior and after erosion (2 samples per group). Cumulative enamel loss (μm) and calcium release (nmol/mm2) were analysed by repeated-measures ANOVA. The Ti and F surface composition was analysed by one-way ANOVA separately for each element. Only TiF4 at pH 1.2 reduced enamel surface loss significantly. Calcium release was significantly reduced by TiF4 and NaF at pH 1.2, but not by the solutions at pH 3.5. Samples pretreated with TiF4 at pH 1.2 showed a significant increase in Ti, while NaF increased F concentration significantly. Only TiF4 at pH 1.2 induced the formation of a glaze-like layer, which was still present after erosion. Enamel erosion can be significantly reduced by TiF4 at pH 1.2 but not at pH 3.5. TiF4 at pH 1.2 was more effective in protecting against enamel erosion than NaF.

Abrasion of eroded dentin caused by toothpaste slurries of different abrasivity and toothbrushes of different filament diameter

OBJECTIVE This study aimed to evaluate the impact of toothpaste slurry abrasivity and toothbrush filament diameter on abrasion of eroded dentin in vitro. METHODS Eroded dentin samples (hydrochloric acid, pH 2.6, 15s) were brushed with 40 strokes in an automatic brushing machine using manual toothbrushes with different filament diameter (0.15, 0.20 or 0.25 mm). The toothbrushes were applied with a control slurry free of abrasive particles (RDA-value 10) or toothpastes slurries with different abrasivity (RDA-values 20, 50 or 100). Each erosive-abrasive cycle was followed by storage of the dentin samples in artificial saliva for 3h. After each 4 cycles, the samples were stored in artificial saliva for 15 h. After 60 cycles, dentin loss was measured by profilometry and statistically analysed by ANOVA and linear regression analysis. RESULTS Dentin loss increased along with the RDA-value of the toothpaste slurries. The impact of the filament diameter on dentin loss was less evident compared to the RDA-value. However, toothbrushes with smaller filament stiffness caused higher dentin wear in all toothpaste slurry groups (RDA 20, 50 and 100) except for the paste-free control group (RDA 10). CONCLUSION Abrasion of eroded dentin increased along with the RDA-value of the toothpaste slurry and with decreasing filament diameter of the toothbrush.

Impact of toothpaste slurry abrasivity and toothbrush filament stiffness on abrasion of eroded enamel – an in vitro study

Objective. Toothbrush abrasion is significant in the development of tooth wear, particularly when combined with erosion. This in vitro study aimed to evaluate the impact of toothpaste slurry abrasivity and toothbrush filament stiffness on abrasion of eroded enamel. Material and methods. Eroded enamel samples (hydrochloric acid, pH: 2.6, 15 s) were brushed with 40 strokes in an automatic brushing machine using manual toothbrushes with different filament stiffness (filament diameter: 0.15, 0.20, or 0.25 mm). A paste-free control slurry (relative enamel abrasion (REA) value 2) and toothpaste slurries with different abrasivity (REA values 6 or 9) were used for brushing. Erosion and abrasion were followed by storing the enamel samples in artificial saliva for 3 h. After each 4th cycle, the samples were stored in artificial saliva for 15 h. After 60 cycles, enamel loss was measured by profilometry and statistically analyzed by two-way and one-way ANOVA and Bonferroni/Dunn post-hoc tests. Results. Loss of enamel (mean, µm) was influenced mainly by the abrasivity of the slurry and increased along with REA value (REA 2: 0.0–0.2, REA 6: 2.1–3.3, REA 9: 2.9–3.7). Abrasion of eroded enamel was also affected by filament stiffness of the toothbrush, but only groups brushed with toothpaste slurry of REA 6 showed any significant difference between the different toothbrushes. Thereby, toothbrushes with 0.2 mm filament diameter caused higher enamel loss than 0.15 and 0.25 mm filaments. Conclusions. Toothbrush abrasion of eroded enamel is influenced mainly by the abrasivity of the toothpaste slurry, but is also modified by toothbrush filament stiffness.

Effect of TiF4, ZrF4, HfF4 and AmF on erosion and erosion/abrasion of enamel and dentin in situ

OBJECTIVE This in situ study aimed to analyse the impact of different tetrafluorides (TiF(4), ZrF(4) and HfF(4)) and AmF on erosion and erosion plus abrasion of enamel and dentin. DESIGN Ten volunteers took part in this crossover and double-blind study performed in 8 phases of each 3 days. In each phase, 2 bovine enamel and 2 dentin specimens were fixed in intraoral appliances. One enamel and one dentin sample were pretreated once with TiF(4), ZrF(4), HfF(4) or AmF (all 0.5M F) for 60s, while the other samples remained unfluoridated and served as control. Then, all samples were subjected to either erosion only (4 times/day, 90 s) or to erosion and abrasion (2 times/day, 30 s/sample). Toothbrushing abrasion was performed 90 min after the first and last erosion with an electrical toothbrush and fluoridated toothpaste at 1.2N. After 3 days, enamel and dentin loss was assessed by profilometry (microm) and analysed by repeated measures ANOVA and paired t-test (p<0.05). RESULTS All fluoride solutions reduced enamel and dentin loss significantly compared to the controls. Generally, eroded samples showed less wear than eroded and abraded samples. The protective potential of the fluorides was not significantly different and was only slightly, but mostly not significantly, decreased by abrasion. The protective effect of the fluoride solutions was similar in enamel and dentin. CONCLUSION Tetrafluorides and AmF are able to reduce erosion and erosion plus abrasion in situ and are almost equally effective.

Impact of the in situ formed salivary pellicle on enamel and dentine erosion induced by different acids

Objective. To investigate and compare the protective impact of the in situ formed salivary pellicle on enamel and dentine erosion caused by different acids at pH 2.6. Methods. Bovine enamel and dentine samples were exposed for 120 min in the oral cavity of 10 healthy volunteers. Subsequently, enamel and dentine pellicle-covered specimens were extraorally immersed in 1 ml hydrochloric, citric or phosphoric acid (pH 2.6, 60 s, each acid n=30 samples). Pellicle-free samples (each acid n=10) served as controls. Calcium release into the acid was determined by atomic absorption spectroscopy. The data were analysed by two-way ANOVA and Tukeys test (α=0.05). Results. Pellicle-covered samples showed significantly less calcium loss compared to pellicle-free samples in all acid groups. The mean (SD) pellicle protection (% reduction of calcium loss) was significantly better for enamel samples [60.9 (5.3)] than for dentine samples [30.5 (5.0)], but revealed no differences among the acids. Conclusion. The efficacy of the in situ pellicle in reducing erosion was 2-fold better for enamel than for dentine. Protection of the pellicle was not influenced by the kind of acid when enamel and dentine erosion was performed at pH 2.6.

Influence of chemical activation of a 35% hydrogen peroxide bleaching gel on its penetration and efficacy—In vitro study

OBJECTIVES The aim of this study was to evaluate the effects of chemical activation of hydrogen peroxide (HP) gel on colour changes and penetration through the tooth structure. METHODS One hundred and four bovine incisors were used. One dentine (CD) disc and one enamel-dentine (ED) disc were prepared from each tooth. They were positioned over artificial pulpal chambers and the bleaching was performed with an experimental 35% HP gel. Two control and six experimental groups were prepared. In the positive control group (PC) no chemical activator was used. In the negative control group (NC) the specimens did not receive any bleaching. Each experimental group received a different chemical activator (manganese gluconate-MG; manganese chlorite-MC; ferrous sulphate-FS; ferrous chlorite-FC; and mulberries root extract-MRE). After the bleaching procedure a sample of solution was collected from the artificial pulpal chamber and the HP concentration was measured. The data were analysed using ANOVA, Tukeys, and Dunnetts tests. RESULTS The groups MG and FS showed a significantly lower penetration of HP than the PC group. For the parameter Delta E, all the groups, with the exception of the group MRE, showed a significantly higher means in relation to the PC group in ED colour. For dentine colour, just the groups MG and FS had significant differences in relation to PC. CONCLUSIONS The addition of MG and FS decreases the penetration of HP. The chemical activation using metal salts tested was effective in increasing the bleaching effect.