David G. Purton

A System of Calibrating Microtomography for Use in Caries Research

Desktop microcomputed tomography (micro-CT) offers a non-invasive 3-dimensional analysis of structures and their physical properties. To date, the use of micro-CT has mostly involved qualitative observations, with the extent of quantitative analysis relying on automated internal calibration by the micro-CT control software. However, the value of such calibration is limited by machine drift. For an accurate quantitative use of micro-CT, it is recognized that external means of calibration are needed. A novel system of calibration standards, also known as ‘phantoms’, is presented. A range of low mineral concentration phantoms involving triethylene glycol dimethacrylate/glycerolate dimethacrylate resin mixed with commercial pure hydroxyapatite (HAP), from 0.07 to 1.05 g/cm3, was fabricated. Sintered HAP was impregnated with the same resin, producing phantoms with medium-level mineral concentrations up to 1.90 g/cm3. These phantoms were easy to create, proved accurate and stable with repeated use, and were found to mimic the composite nature of dental enamel and dentine structures under investigation.

Rigidity and retention of ceramic root canal posts.

Ceramic root-canal posts offer potential advantages over other types with respect to aesthetics and biocompatibility. Any post must be sufficiently rigid and retentive to withstand functional forces. Ceraposts (1.2 mm coronal diameter, ceramic, tapering, smooth posts) and Paraposts (1.25 mm, stainless-steel, parallel, serrated posts) were tested for rigidity by means of a three-point bending test. To test retention in roots, ceramic posts were cemented using one of three protocols: (1) glass-ionomer cement, (2) silane coupling agent and resin cement, or (3) sandblasted post surface, silane coupling agent, and resin cement. Stainless-steel posts were cemented with resin. The tensile force required to dislodge the posts, following four weeks of storage in water, was recorded. Data were compared using Students t-test and Mann-Whitney U analysis. Ceraposts were significantly more rigid than Paraposts (p < 0.001). Paraposts cemented with resin were significantly more strongly retained than Ceraposts following any cementation protocol (p < 0.001). Retention of the ceramic posts was significantly greater with a silane coupling agent and resin cement than with glass-ionomer cement (p < 0.001). Sandblasting the ceramic posts produced variable results and needs further investigation before it could be recommended.

A novel polymer infiltrated ceramic for dental simulation.

Simulation of tooth preparation using rotary cutting instruments is viewed as beneficial and essential in dental training. Various types of materials have been used for simulation systems in dental preclinical training. However, the phantom tooth materials used for simulation have not changed significantly for decades and they are acknowledged to be different from natural teeth. This study investigated the mechanical properties and microstructure of a widely used phantom tooth material and compared them with a novel, polymer infiltrated, ceramic. It was concluded that the polymer infiltrated ceramic has mechanical properties more similar to natural teeth than current phantom tooth materials, suggesting that it might be a good candidate material for phantom teeth for trainees to acquire initial tactile sense for tooth preparation.

A suitable base material for composite resin restorations: zinc oxide eugenol.

OBJECTIVE This in vitro study evaluated the effects of a zinc oxide eugenol (ZOE) base on the mechanical properties of a composite resin restoration. METHODS Class I cavities were prepared on plastic teeth and filled with ZOE plus composite resin, following standard clinical procedures. The samples were sectioned sagittally and the ZOE-resin interface was exposed. After polishing, nanoindentation was performed on the region near the interface, and elastic modulus and hardness were plotted in the form of a color contour map. SEM was employed to observe the interface between composite resin and ZOE base. RESULTS In the region close to the ZOE base, the elastic modulus and hardness of composite resin reduced to the values of 9.71+/-0.54 and 0.51+/-0.05 GPa, respectively. Eugenol from ZOE had detrimental effects on the composite resin only to a distance of less than 100 microm from the ZOE base. CONCLUSION Although eugenol suppresses polymerization slightly, by considering the biological advantages of ZOE, together with the results of the current investigation, ZOE may still be considered a suitable base material for composite resin. Bonding is essential for composite resin restorations over ZOE bases to avoid shrinkage detachment.

Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control

INTRODUCTION Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation. OBJECTIVE To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT. DESIGN 27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present. RESULTS Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete. CONCLUSION Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.

The Effect of Ultrasonic Instruments on the Quality of Preparation Margins and Bonding to Dentin

STATEMENT OF THE PROBLEM Ultrasonic instruments have recently been developed for finishing crown preparations. They are successful in accessing difficult areas on the preparation margin, but their effects on the dentin surface and on bond strength are contradictory. PURPOSE The aim was to evaluate the condition of crown preparation margins finished using new ultrasonic instruments and to assess their effects on dentin bond strength. METHODS Characteristics of tooth surfaces prepared using two different ultrasonic protocols were compared; Perfect Margin Shoulder (PMS) (PMS 3, Satelec, Merignac, France) 1, 2, and 3 (complete finishing) versus PMS 1 and 2 (partial finishing). They were assessed using scanning electron microscopy (SEM) and surface roughness analysis. Bonding of composite resin to dentin surfaces prepared with the complete PMS kit was compared with dentin surfaces prepared with finishing diamond burs, using micro-tensile testing. RESULTS SEM images revealed a clear difference between the two preparation sequences (PMS 1, 2 versus PMS 1, 2, and 3). Surfaces finished using the PMS tips 1, 2, and 3 appeared continuous, even, and smooth compared with PMS tips 1 and 2 only. The additional use of the PMS 3 uncoated tip enhanced smear layer removal. There was no significant difference when comparing the surface roughness obtained with the PMS 1, 2, and 3 protocol with the PMS 1 and 2 only (p > 0.05). Micro-tensile bond strength was not significantly different between the surfaces prepared with the ultrasonic instruments and the surfaces prepared with the diamond burs (p > 0.05). CONCLUSION The use of the complete PMS finishing kit (PMS 1, 2, and 3) produced better quality finishing lines than PMS 1 and 2. The use of ultrasonic instruments to prepare dentin resulted in comparable bond strengths to the use of diamond burs. CLINICAL SIGNIFICANCE The extremely precise preparation margin possible with ultrasonic instruments improves the quality and accuracy of crown preparations, which may lead to better impressions and closer adaptation of restorations. The complete set of three Perfect Margin Shoulder instruments is recommended, which can produce comparable bond strengths to preparations with rotary instruments.

In vitro demineralisation of the cervical region of human teeth

OBJECTIVE The aim of this study was to investigate a possible role for demineralisation of the cervical region of human teeth in the development of non-carious cervical lesions (NCCLs). MATERIALS AND METHODS Freshly extracted human premolars were demineralised and prepared for nanoindentation and scanning electron microscope (SEM) observation. After 1 day or 2 days demineralisation in a solution of pH 4.5, specimens were embedded, cut and polished to 1 μm diamond paste. Nanoindentation was done at the cementum-enamel junction (CEJ) region with an interval of 30 μm, to develop mechanical properties maps. After the indentation, SEM with back-scatter detector was employed to observe the degree of demineralisation at the CEJ. RESULTS After 1 day and 2 days demineralisation, the mechanical properties of enamel and dentine at the CEJ decreased by ∼50% and ∼90%, respectively. SEM images illustrate that artificial demineralisation generated typical demineralised zones in enamel near the CEJ. Moreover, 2 days demineralisation penetrated the sound enamel at the CEJ, and the dentine beneath was undermined. CONCLUSION AND SIGNIFICANCE One day and 2 days demineralisation reduced the mechanical properties of teeth at the CEJ significantly. Demineralised enamel and dentine with low mechanical properties are prone to wear and abrasion. The findings of the investigation indicate that acid typical of that produced by dental plaque may compromise the mechanical properties of enamel and dentine at the CEJ to the extent that they would be susceptible to tooth brush abrasion, producing NCCLs.

Ultrasonic margin preparation for fixed prosthodontics: a pilot study.

PURPOSE   Atraumatic, oscillating ultrasonic instruments have recently been developed for prosthodontic margin finishing. This in vitro observational pilot study aimed to compare the condition of crown preparation margins finished using new ultrasonic instruments with margins finished with conventional rotary instruments. METHODS   Two extracted human canine teeth were prepared for crowns. A split-tooth model was used to refine the margins: half of the margin was finished with conventional rotary instruments, the other with ultrasonic instruments. The profiles of the margins were observed using scanning electron microscopy, and a quantitative comparison of surface roughness was obtained using surface roughness analysis software. RESULTS   The margins finished with the ultrasonic instruments exhibited a better-defined axial wall/margin angle and a smoother marginal surface. Rotary instruments produced a sharper and more continuous external line angle. Two-dimensional surface roughness analysis showed that the margins produced with the ultrasonic instruments were approximately half as rough as the margins prepared with the conventional rotary instruments. CONCLUSION   The ultrasonic instruments produce margins in better condition than the current standard and appear to have some practical advantages. CLINICAL SIGNIFICANCE Preparations for fixed prosthodontics finished with these ultrasonic instruments created better-defined margins, which could result in more successful prostheses.

Rigidity and retention of root canal posts

Objective: To test the rigidity and the retention into roots of parallel root canal posts, one a spiral vented titanium post and the other a spiral serrated, hollow, stainless steel post. A serrated, stainless steel post was used as the control.Materials and methods: A three-point bending test was used to test rigidity. To test retention, ten posts of each type were cemented into the roots of extracted teeth with a resin cement and the tensile loads required to remove them were compared using Students t and Mann-Whitney U tests.Results: The serrated stainless steel posts were significantly more rigid than either of the other types. The titanium posts and the stainless steel hollow posts were not significantly different in rigidity. The serrated, stainless steel posts were significantly better retained than either of the other types. The titanium posts showed greater retention than the hollow posts.Conclusions: Within the limits of the study the stainless steel, serrated posts were superior to the two newer types in terms of rigidity and retention into roots

Antibacterial properties of root canal lubricants: A comparison with commonly used irrigants

The aim was to assess in vitro the antibacterial activity of 10 root canal lubricants. K-Y Jelly personal lubricant, RC-Prep, File-Eze, File-Rite, EndoPrep Gel, Endosure Prep Crème 15%, Prep-Rite, Glyde, SlickGel ES and Alpha Glide were selected and compared in their antimicrobial properties to seven irrigants. Serial dilutions of each agent in tryptic soy broth were inoculated with either Enterococcus faecalis or Pseudomonas aeruginosa and incubated at 37C for 24 h. During incubation bacterial growth was measured by optical density (A(600)), and samples removed for cultivation on tryptic soy broth agar. Against both test bacteria after 1 h incubation, six lubricants recorded minimum bactericidal concentrations ranging from 1/10 to 1/80, whereas the inhibitory activity of the irrigants ranged from 1/20 to 1/640. Under these conditions, several lubricants exhibited antimicrobial activity comparable with some irrigants. Three irrigants, Consepsis (containing chlorhexidine), Endosure EDTA/C (containing cetrimide) and EndoPrep Solution (containing cetrimide), showed superior antibacterial action to lubricants against both species. The irrigants containing ethylenediamine tetraacetic acid and cetrimide were the most effective against both bacterial species at all time intervals. Antimicrobial activity of the lubricants did not correlate to pH values, which ranged from 2.9 to 10.3. Root canal lubricants have antibacterial properties that may help to disinfect canals.