C. C. Youngson

An in vitro Study of the Bond Strength of a Glass Ionomer Cement in the Direct Bonding of Orthodontic Brackets

The shear/peel bond strength of a ‘no-mix’ composite orthodontic bonding resin was compared in vitro with that of a glass ionomer cement. The effect of pre-treatment of the enamel, with either phosphoric acid or polyacrylic acid, prior to using the glass ionomer cement was also assessed. The composite resin had a significantly higher bond strength than the glass ionomer cement. Simple prophylaxis and drying of the enamel achieved the best results when using the glass ionomer cement, whilst etching the tooth surface with phosphoric acid produced a significantly poorer bond to the enamel. Investigation of the site of failure showed the composite resin bonded very well to the tooth and less well to the bracket, whilst the glass ionomer adhered significantly better to the bracket base than to the tooth surface.

Eruptive tooth movement — the current state of knowledge

How the dentition erupts, and what controls it, is fundamental to almost all aspects of clinical dentistry, yet the mechanisms behind this have not yet been fully elucidated. When the process continues into space that has been created through toothwear or tooth loss, problems in placing restorations can be encountered. This review examines the possible mechanisms of tooth eruption. Differences between processes in animals and humans are highlighted. The limitations of conclusions drawn from animal studies are then discussed with reference to human dental conditions. The differing forms of overeruption in humans are described and the treatment options for overerupted teeth, including prevention of the situation arising, are provided with a discussion of the quality of the evidence base behind these.

A fluid filtration and clearing technique to assess microleakage associated with three dentine bonding systems

OBJECTIVES The aims of this in vitro study were to (a) measure fluid flow through teeth restored with one of three dentine bonding systems and a resin composite restoration; (b) measure the distribution of a silver tracer through the same teeth, and make a comparison with fluid flow; and (c) investigate the effect of thermocycling on both measurement types. METHODS Coronal segments of 30 premolars, randomly allocated to three equal groups, were assessed by fluid filtration. Each group was restored with a resin composite restoration in conjunction with Fuji Bond LC (FBLC), Scotchbond Multi-Purpose Plus (SMP+) or Prime&Bond 2.1 (P&B2.1). Fluid filtration rates were measured in the intact crown and then after cavity preparation, conditioning, dentine bonding, restoration and at 2 and 24 h, 1 week and 1 month following restoration. Six specimens from each group were thermocycled at 1 week. After final filtration measurements the specimens were perfused with silver nitrate and cleared before scoring tracer penetration. RESULTS No significant differences (P > 0.05) in fluid filtration rates were found amongst the different bonding systems or at any restoration stage. Thermocycling was not associated with any significant (P > 0.05) increase in fluid filtration. Final fluid filtration and tracer distribution showed a weak and not statistically significant correlation (P > 0.05). The penetration of silver stain indicated a failure of the restorations to seal the cavity and demonstrated a possible pathway by which in vivo post-operative sensitivity could occur. CONCLUSIONS Although not statistically significant, conditioning of the cavity increased the dentinal permeability but this effect was variable. Thermocycling had no statistically significant effect on microleakage.

The effect of luting media on the fracture resistance of a flame sprayed all-ceramic crown

OBJECTIVES This in vitro study investigated the effect of selected luting media on the fracture resistance of a flame-sprayed all-ceramic crown. METHODS Three groups of 10 human upper premolar teeth were prepared for crowning using a standardised technique. Flame sprayed crowns were fabricated and cemented onto the preparations using zinc phosphate (ZPC), glass polyalkenoate (GPC) or composite luting cement (CLC). During crown seating, a pressure perfusion system simulated pulpal fluid outflow equivalent to 300mm of H2O. Compressive fracture resistance was determined for each group using a Universal Testing Machine with a crosshead speed of 1mm min(-1). A group of unrestored teeth acted as a control. RESULTS The fracture resistance of the groups ranked as follows: ZPC>CLC>>GPC=unrestored teeth. The difference between the fracture resistance of ZPC and CLC groups and the control group was statistically significant. The mode of fracture between the luted crowns and natural crowns was markedly different. CONCLUSIONS When tested in compression, a new, flame-sprayed all-ceramic crown, when luted in place using ZPC, GPC or CLC, could produce strengths comparable to or greater than natural unrestored teeth. The luting agent used significantly affected the recorded fracture loads.

A fluoride-containing composite resin--an in vitro study of a new material for orthodontic bonding.

The shear/peel bond strength of a new material, a ‘hybrid’ of a composite resin and a glass ionomer cement, was compared in vitro with the bond strengths of a composite resin and of a glass ionomer cement. The new material had a significantly greater bond strength than the other materials tested and its properties were very similar to the composite resin. Unlike the glass ionomer cement, etching of the enamel before applying the adhesive is required. The clinical indications for using this new cement are discussed.

In vitro marginal microleakage: examination of measurements used in assessment

Premolar teeth with Class II amalgam restorations placed after the application of cavity varnish (Group A), a light cured glass ionomer base (Group B) and 40 per cent polyacrylic acid as a pretreatment agent, followed by unset cermet cement (Group C) were examined for marginal leakage using dye penetration and image analysis. Including amongst the parameters examined were linear leakage length and leakage area, which were found to have no consistent correlation. Group A and C did not generally show significant differences in the parameters examined, whereas Group B exhibited significantly less linear leakage (P less than 0.001), and significantly less leakage area when the stained area was expressed as a percentage of available dentine (P less than 0.001). While allowing some linear leakage, it was found that the light cured glass ionomer base appeared to prevent the dye from entering the dentine. It is concluded that an assessment based solely on the leakage length is inadequate and that some measurement of penetration into dentine should be included in order to fully assess the microleakage potential of a material or technique.

Marginal leakage associated with three posterior restorative materials

Seventy sound extracted premolar teeth were prepared with minimal Class II cavities and randomly divided into seven equal groups. One group was restored with posterior light-cured composite. In addition, this material was used to restore three other groups of teeth after (a) etching the magins, (b) applying two coats of a dentine bonding agent (c) etching and bonding. Cermet cement was used to restore two groups of teeth, one being pretreated with polyacrylic acid. The final group was restored with amalgam after the application of two coats of cavity varnish. The specimens were sealed to within 1 mm of the cavity margins and the crowns immersed in buffered eosin for 48 h. After mesio-distal sectioning the specimens were photographed. These were examined on an image analyser to calculate the percentage area of crown dentine exhibiting leakage. It is concluded that when composite is used to restore both etched and bonded cavities, marginal leakage is similar to that of amalgam. If either or both pretreatment stages are omitted leakage is significantly greater (P < 0·05) than for amalgam. Cermet with polyacrylic acid preconditioning of the cavity exhibits significantly less (P < 0·001) marginal leakage than with amalgam, composite or the other cermet group.

A technique for three-dimensional microleakage assessment using tooth sections

Microleakage is commonly assessed using restored teeth, sectioned through the midline of the restoration. It is impossible to determine if this is representative of the leakage throughout the whole tooth. This pilot study examined the feasibility of calculating areas and volumes of leakage using serial sections of restored teeth which had been subjected to dye immersion and image analysis. Using the sections, perspex models of the teeth were constructed to present the pattern of the dye leakage into dentine. This appears to be a viable technique for the three-dimensional assessment of microleakage.

The effect of bleaching, varying the shade or thickness of composite veneers on final colour: an in vitro study.

OBJECTIVE To investigate whether bleaching prior to placement of a composite veneer had an effect on the final shade of the restoration and whether this was affected by the thickness or shade of the veneer. METHODS Twenty bovine teeth were collected, sectioned and divided into two groups. One group was the non-bleached control, while the other was the bleached group. A colour reading was recorded using a spectrophotometer. The bleached group then underwent external bleaching with 38% hydrogen peroxide and a colour reading was recorded. Each of these two groups were further sub-divided into four subgroups, on which composite veneers were placed. These subgroups were: 0.5 m thick A1, 1 m thick A1, 0.5 mm thick A4 and 1 mm thick A4 composite veneers. Colour readings were recorded after veneer placement. Statistical significance was assessed using analysis of variance. RESULTS There was a difference between the colour produced for the same veneer properties, between the bleached and non-bleached groups. For a thin (0.5mm) A4 veneer bleaching produced a statistically significant difference in the amount of colour change (DeltaE) compared to veneering alone. For A1, non-bleached group there is a significant difference in the DeltaE produced by altering the thickness of the veneer. CONCLUSION Within the limitations of this study, we can conclude that bleaching prior to placement of a thin A4 dark veneer produces a significant difference in colour change. If no bleaching is performed, altering the thickness of an A1 veneer produces a significant colour difference DeltaE. However, if bleaching is carried out there is no significant difference.

In vitro microleakage associated with posterior composite restorations used with different base/bonding system combinations

The study aimed to determine the base/restoration combination which allowed the least microleakage in Class II cavities. One hundred premolar teeth were prepared with a standardized, minimal two-surface cavity and randomly ascribed to ten equal groups. The cavities were restored by use of one of ten different material/technique combinations. Restored teeth were sealed to within 1 mm of the restoration margins with nail varnish prior to the immersion of the crowns in 5% (buffered) eosin for 48 h. The teeth were then hemisected longitudinally, in a mesio-distal plane, through the midline of the restoration by means of a diamond disc with water coolant, and one half of each tooth was then photographed. The transparencies were examined by image analysis programmed to facilitate calculation of the percentage of the tooth/restoration interface and of the crown dentin exhibiting dye penetration. Light- and chemically-cured glass-ionomer-based restorations showed similar amounts of leakage when expressed as a percentage area of crown dentin. This was significantly (p less than 0.05) less than that shown by cavities both etched and bonded. Cavities restored without enamel etching or involving the use of a bonding system exhibited significantly (p less than 0.05) greatest leakage.