Cesare Nucci

Effect of Two In-office Whitening Agents on the Enamel Surface In Vivo: A Morphological and Non-contact Profilometric Study

This study evaluated the morphological effects produced in vivo by two in-office bleaching agents on enamel surface roughness using a noncontact profilometric analysis of epoxy replicas. The null hypothesis tested was that there would be no difference in the micromorphology of the enamel surface during or after bleaching with two different bleaching agents. Eighteen subjects were selected and randomly assigned to two treatment groups (n=9). The tooth whitening materials tested were 38% hydrogen peroxide (HP) (Opalescence Xtra Boost) and 35% carbamide peroxide (CP) (Rembrandt Quik Start). The bleaching agents were applied in accordance with manufacturer protocols. The treatments were repeated four times at one-week intervals. High precision impressions of the upper right incisor were taken at baseline as the control (CTRL) and after each bleaching treatment (T0: first application, T1: second application at one week, T2: third application at two weeks and T3: fourth application at three weeks). Epoxy resin replicas were poured from impressions, and the surface roughness was analyzed by means of a non-contact profilometer (Talysurf CLI 1000). Epoxy replicas were then observed using SEM. All data were statistically analyzed using ANOVA and differences were determined with a t-test. No significant differences in surface roughness were found on enamel replicas using either 38% hydrogen peroxide or 35% carbamide peroxide in vivo. This in vivo study supports the null hypothesis that two in-office bleaching agents, with either a high concentration of hydrogen or carbamide peroxide, do not alter enamel surface roughness, even after multiple applications.

Early marginal leakage and shear bond strength of adhesive restorative systems

The aims of this study were to assess in vitro the early marginal seal effectiveness in Class V restorations at the cemento-enamel junction, and the early shear bond strength of several composite and dentin bonding system combinations. The seal effectiveness was studied by evaluating the dye penetrations: (a) along the superficial margin of restorations (width of surface microleakage); (b) along the dentin cavity walls (length of microleakage); and (c) toward the pulp (depth of microleakage). Good correlations were demonstrated among the seal evaluations, but no relationships were apparent between these and shear bond strength. Our study suggests that the marginal seal is influenced by composite properties more than by bonding agents. The shear bond analysis indicates only the adhesive potential of the materials without considering the composite shrinkage effects on marginal gap after the photocuring setting reactions.

MMP-2 assay within the hybrid layer created by a two-step etch-and-rinse adhesive: Biochemical and immunohistochemical analysis

OBJECTIVE Degradation of hybrid layers (HLs) within resin-infiltrated dentine results from multiple degradation factors, including collagenolytic activity of specific matrix metalloproteinases (MMPs). Inhibition of host-derived MMPs may, therefore, slow the degradation of HL. The null hypothesis tested is that the presence of MMP-2 is similar regardless of chlorhexidine (CHX) pre-treatment or the use of an adhesive. METHODS Powdered dentine prepared from extracted human teeth was divided into 4 groups: (G1) mineralised powder (control group); (G2) dentine powder treated with 1% phosphoric acid for 1 min; (G3) 1% phosphoric acid-etched dentine treated with Adper Scotchbond 1 XT (SB1XT; 3M ESPE); (G4) 1% phosphoric acid-etched dentine treated with 0.2% CHX followed by SB1XT. The concentration of detectable pro-MMP-2 and MMP-2 was assayed using a colorimetric assay system (QuantiSir). In addition, the presence of MMP-2 in the HL was assessed in 1 year-aged adhesive-dentine interfaces using an immunohistochemical approach under FEI-SEM/TEM. RESULTS In dentine powder treated with 1% phosphoric acid (G2), MMP-2 level decreased compared to controls (G1); the application of SB1XT (G3) resulted in an increase of MMP-2, whilst 0.2% CHX before SB1XT application (G4), reduced MMP-2. The FEI-SEM/TEM analysis revealed MMP-2 distribution within the HL of aged interfaces showing increase MMP-2 patterns in the control group and minor labelling in the CHX-pretreated specimens. CONCLUSION The results of this study support the use of non-toxic MMPs inhibitors, such as CHX, as an appropriate additional step in bonding procedures in order to increase the longevity of the adhesive restorations.

HyFlex EDM: superficial features, metallurgical analysis and fatigue resistance of innovative electro discharge machined NiTi rotary instruments

AIM To evaluate the surface and microstructural alterations of new and used HyFlex EDM prototypes and to test their fatigue resistance. METHODOLOGY Fifteen HyFlex EDM prototypes were used for in vitro instrumentation of severely curved root canals. Surface and microstructural characteristics of new and used files were compared by ESEM analysis equipped with energy dispersive X-ray spectrophotometry (EDS) and optical metallographic imaging. Usage-induced degradation was assessed. Thirty additional HyFlex EDM prototypes and 20 standard manufactured HyFlex CM files were subjected to cyclic fatigue tests. Time to fracture was recorded, and results were validated using the Kruskal-Wallis test (α-level 0.05). Fatigued files were analysed by ESEM for fractographic evaluation. RESULTS Surface and microstructural characterization of EDM prototypes revealed the typical spark-machined surface of a NiTi EDM alloy. No fractures were registered during root canal instrumentation. No evident surface alterations and minor degradation were observed between new and used instruments. The metallographic analysis of new and used files disclosed a homogeneous structure, mostly composed of lenticular martensite grains, and some residual austenite. The cyclic fatigue test showed an increase of fatigue resistance up to 700% on the EDM compared to CM files. CONCLUSIONS Spark-machined peculiar surface is the main feature of HyFlex EDM. Low degradation was observed after multiple canal instrumentations. Prototypes exhibited surprising high values of cyclic fatigue resistance and a safe in vitro use in severely curved canals.

Influence of air-abrasion executed with polyacrylic acid-Bioglass 45S5 on the bonding performance of a resin-modified glass ionomer cement.

The aim of this study was to test the microtensile bond strength (μTBS), after 6 months of storage in PBS, of a resin-modified glass ionomer cement (RMGIC) bonded to dentine pretreated with Bioglass 45S5 (BAG) using various etching and air-abrasion techniques. The RMGIC (GC Fuji II LC) was applied onto differently treated dentine surfaces followed by light curing for 30 s. The specimens were cut into matchsticks with cross-sectional areas of 0.9 mm(2). The μTBS of the specimens was measured after 24 h or 6 months of storage in PBS and the results were statistically analysed using two-way anova and the Student-Newman-Keuls test (α = 0.05). Further RMCGIC-bonded dentine specimens were used for interfacial characterization, micropermeability, and nanoleakage analyses by confocal microscopy. The RMGIC-dentine interface layer showed no water absorption after 6 months of storage in PBS except for the interdiffusion layer of the silicon carbide (SiC)-abraded/polyacrylic acid (PAA)-etched bonded dentine. The RMGIC applied onto dentine air-abraded with BAG/H(2)O only or with BAG/PAA-fluid followed by etching procedures (10% PAA gel) showed no statistically significant reduction in μTBS after 6 months of storage in PBS. The abrasion procedures performed using BAG in combination with PAA might be a suitable strategy to enhance the bonding durability and the healing ability of RMGIC bonded to dentine.

Shear bond strength and microleakage of dentin bonding systems

This study evaluated the shear bond strength and microleakage of class V non-retentive restorations with 10 different dentin bonding systems. Some were tested with different composite resins. For the shear bond test, eight specimens were prepared for each product and tested in a universal testing machine. For the microleakage test, 158 V-shaped class V cavities extending to the cementoenamel junction were prepared, coated with a dentin bonding system, and restored with a composite resin. After 250 thermocycles, the teeth were immersed in a dye solution for 48 hours, longitudinally sectioned, and evaluated for microleakage. Both test procedures resulted in significant differences between the various materials. The bond strength failed to completely prevent microleakage at the dentinal wall. The new generation of dentin bonding systems offer a significant improvement over previous materials.

Effects of acid and cleansing agents on shear bond strength and marginal microleakage of glass-ionomer cements

The aims of the present study were to evaluate the effects of various dentin chemical pretreatments (a) on the shear bond strength of five glass-ionomer cements (GICs) and (b) on marginal microleakage of the five GICs used in association with resin composites in Class V restorations. The dentin treatments were: three acid agents (polyacrylic acid, tannic acid, orthophosphoric acid), three cleansing agents (Tubulicid blue solution, hydrogen peroxide, and sodium hypochlorite), and an aqueous solution as control. After dentin treatment, the test specimens were stored in water at 37 degrees C for 24 hr. Shear bond strength was determined with a universal testing machine at a cross-head speed of 0.5 cm/min. Sodium hypochlorite and polyacrylic acid significantly improved the adhesion of GICs to a different degree in the various materials. Regarding microleakage tests, 320 non-retentive cavities were prepared at the cementum-enamel junction in freshly extracted human teeth. The teeth were thermocycled, immersed in dye solution, and serial-sectioned longitudinally at three sites. Treatment with sodium hypochlorite was the most effective in reducing marginal leakage. The present results suggest that dentin treatment is an important step in all resin composite/GIC restorations.

A SEM and Non-Contact Surface White Light Profilometry In Vivo Study of the Effect of a Creme Containing CPP-ACP and Fluoride on Young Etched Enamel

The aim of this in vivo study was to evaluate the short and a longer term effect on enamel of the application of a crème containing 10% CPP-ACP and 900 ppm fluoride, in orthodontically planned, high caries-risk patients. Epoxy resin replicas of upper lateral incisors were obtained from polyvinyl siloxane (PVS) impressions, before and after etching. The right incisors were left untreated in order to control saliva remineralizing potential. The upper left surfaces were coated with a pea-size amount of the crème. Replicas were obtained at 3 weeks and 6 months and analyzed by SEM and non-contact surface white light profilometry. In the treated sample the profilometric roughness parameters at 3 weeks were statistically significantly lower than the control group values (p < 0.05). At 3 weeks SEM images of the enamel surface showed fewer irregularities. After 6 months, differences between test and control groups were not present on SEM images and profilometric values. CPP-ACP and fluoride crème had positive in vivo effects on enamel surfaces. Significant differences in surface roughness existed after a 3-week period of crème use.

X-linked hypophosphatemic rickets: Enamel abnormalities and oral clinical findings

X-linked hypophosphatemia (XLH) is a genetic disorder related to alterations in bones and teeth formation, due to low levels of phosphate in blood. Oral findings in XLH have been enamel and dentine abnormalities, high pulp horns, large pulp chambers, and some cases of periapical abscesses related to teeth without caries or traumatic injuries. The aim of our study was to assess the presence of enamel alterations, such as microclefts and/or structure defects in patients with XLH and give guidelines of prevention of XLH dental complications. History taking, oral clinical and radiological examination in 10 young patients affected by XLH (average age of 9) and in 6 patients without XLH (average age of 8). Impressions were performed on the vestibular surfaces of teeth in order to obtain replicas. The replicas were analyzed using scanning electron microscope (SEM) and compared to replicas of control group. The images of replicas of XLH patients showed deep microclefts and irregular enamel surface structure compared to replicas of control group. The replica of a patient with spontaneous periapical abscesses showed numerous enamel crater-shaped depressions and deep microcleavages penetrating into the enamel thickness. In absence of caries or fractures, the abscesses pathogenesis may be related to microcleavages of the enamel and dentin, which allow bacterial invasion of the pulp. There could be a relationship between XLH disease and enamel abnormalities.

Effects of pH, ionic strength, and applied voltage on migration of dental monomers in an organic matrix

OBJECTIVES The application of an electric field has been shown to positively influence the bonding of dentin bonding systems (DBS) by improving adhesive impregnation into dentin. However, the mechanism responsible for this phenomenon has not been completely elucidated. The aim of this study was to clarify the effects of pH, matrix ionic strength, and applied voltage on the migration of commonly used DBS monomers in a model matrix (agarose gel). METHODS Some common monomers examined were bis-GMA (2,2-bis[4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane); HEMA (2-hydroxyethyl methacrylate); 2-MP (bis[2-(methacryloyloxy) ethyl] phosphate); TCDM [di(hydroxyethyl methacrylate) ester of 5-(2,5,-dioxo tetrahydrofurfuryl)-3-methyl-3-cyclohexenyl-1,2-dicarboxylic acid]; and TEGDMA (triethylene glycol dimethacrylate). Agarose gels poured into a horizontal 10-well electrophoretic cell were used to mimic the collagen fibrils of the dentin organic matrix. The role of pH, matrix ionic strength, and voltage on monomer migration was assayed by modifying the experimental conditions. RESULTS Results of experiments performed at pH 3.1, 6.3, 8.5, and 12.3; at low, medium, and high ionic strength; and at 50 and 100 V clearly showed that DBA monomer migration toward both the anode and the cathode can be affected by each of these parameters. SIGNIFICANCE Migration of acrylic monomers toward the anode or cathode can be achieved as desired by selective choice of pH, ionic strength, and applied voltage. Additional studies are needed to evaluate the synergistic effects of DBS monomer blends on migration in an electric field.