Detlef Heidemann

In vitro dentinal surface reaction of 9.5% buffered hydrofluoric acid in repair of ceramic restorations: A scanning electron microscopic investigation

STATEMENT OF PROBLEM Fracture of porcelain is a relatively common clinical misfortune. Recent research has indicated that strong bonds can be formed between composite and dental porcelain. Porcelain surfaces are etched with hydrofluoric acid and treated with silane coupling agents before composite application. The question is how exposed dentin may react to etching with hydrofluoric acid. PURPOSE This investigation examined the effect of 9.5% buffered hydrofluoric acid, of 36% o-phosphoric acid alone and in combination on the surface structure of cut human dentin. MATERIAL AND METHODS Human molar teeth were sectioned in approximately 0.8-mm thick slices and treated with different acids or their combinations. Application periods were 10, 60, and 180 seconds. Specimens were processed for SEM and for energy-dispersive x-ray (EDX) microanalysis. RESULTS The smear layer on the surface of sectioned dentin was not completely removed by hydrofluoric acid alone and that a dense amorphous precipitate was formed on the peritubular zone. Starlike structures in dentinal tubules were visible. EDX analysis revealed different fluoride content on the treated surface, dependent on the etchant used. CONCLUSION Topical application of hydrofluoric acid appeared to provide a dentinal surface with an amorphous precipitate of fluoride. This layer may be important both for resistance of dental caries in dentin and for bonding reactions.

Direct composite restorations: extended use in anterior and posterior situations

1. Minimally invasive restorations in the restoration of intracoronal defects, replacing diseased and otherwise damaged tooth structure. Such restorations are an alternative to conventional restorations and may be considered to include restorations restoring moderatesized defects involving one or more tooth surfaces. 2. Tooth structure saving restorations in teeth including larger defects. These restorations may be considered an alternative to indirect restorations, including onlays and partial crowns. 3. Repairs to existing restorations with limited defects as an alternative to much more invasive restoration replacement techniques. B) Changes to tooth form and enhancement of esthetics

In Vitro Cytotoxicity of Medicated and Nonmedicated Gutta-percha Points in Cultures of Gingival Fibroblasts

This investigation was designed to test the cellular toxicity of two medicated (Roeko activ point and Roeko Calcium Hydroxide) and four nonmedicated brands of gutta-percha (GP) points (Antaeos, DeTrey White, Roeko color, and Roeko Top color). The test points were transferred into a culture medium including the GP-point material with a concentration of 6 mg/ml, and eluates were obtained after 72 h. Five milliliters of each eluate were pipetted onto fibroblast cultures, incubated, and subsequently stained. Mitotic rates, cell densities, and the distribution of normal cells, pathologically altered and dead cells were determined and correlated with control cell cultures. Roeko activ point (containing chlorhexidine) resulted in the highest number of dead cells. The difference was statistically significant in comparison with all other materials. Concerning all parameters mentioned, the cytotoxicity of the points containing calcium hydroxide (Roeko Calcium Hydroxide) was not significantly different from all other points tested, with the exception of those containing chlorhexidine. All tested gutta-percha materials caused cytotoxic reactions in varying extents. Taking into consideration the limitations of an in vitro experiment, points containing calcium hydroxide and nonmedicated points seem to be the most recommendable products for clinical use.

Tooth-colored restorations of posterior teeth in German dental education

Abstract Optimizing the quality of tooth-colored restorations is one of the main topics of current research. But there is only little information available about university education in this field. The aim of this study was to collect and evaluate data about the different aspects of dental education in Germany concerning tooth-colored restorations. Based on the response to a questionnaire from 90% of all German dental schools in the fall of 1997 a detailed survey is given of the utilization, indications, practical procedure, problems and limitations of both direct and indirect tooth-colored restorations done by students. The results indicate a wide-spread use of directly inserted composite for posterior teeth in the different education programs. Indeed, the preferred preparation of the cavity margin differs from school to school. Rebuilding an adequate proximal contact and a precise fit at the gingival margin are looked upon as the main problems of class II composite fillings. Ceramic inlays are mainly inserted by students in advanced clinical courses with the insertion procedure being claimed as the main problem of this technique. The findings of this study mostly show the same limitations and difficulties of toothcolored restorations in education as found by research. Partly different teaching concepts are reflected in the differing scientific results.

Influence of femtosecond laser treatment on shear bond strength of composite resin bonding to human dentin under simulated pulpal pressure.

This in vitro study evaluated the influence of femtosecond laser (fs-laser)-generated patterns on shear bond strength (SBS) of composite resin bonded to human dentin under simulated pulpal pressure. Laser treatment was used to produce two different patterns on dentin surfaces. Three test groups and a control group without laser treatment under pulpal pressure were investigated. Dentin discs of 800 nm thickness were cut from 60 extracted caries-free human molars. Using a perfusion machine, the discs were exposed to Ringer solution on their basal surfaces. Clearfil SE Bond/Herculite XRV system was used. The samples were stored in distilled water and thermocycled. Bonding failures caused by a test set-up to challenge SBS were analyzed by scanning electron microscope (SEM). An 80 μm-sized cube-shaped pattern caused more cohesive failures in dentin or resin compared with the 160 μm-sized cube-shaped pattern. Weibull statistics demonstrated a significant difference between the two laser patterns, but only the test group with small-sized laser pattern was significantly different from the control group. The Weibull moduli ranged from 4.3 to 9.6 (control group). The 160 μm-sized pattern enhanced the bonding quality and avoided dentin weakening. It was concluded that fs-laser treatment in a 160 μm-sized cube-shaped pattern enabled a simplified bonding procedure by dispensing the primer without affecting SBS, compared with the control group.

Fracture resistance and failure mode of endodontically treated teeth restored using ceramic onlays with or without fiber posts—an ex vivo study

AIM This study aimed to compare the fracture resistance and fracture modes of ceramic onlay restorations with or without fiber posts in endodontically treated premolars. MATERIAL AND METHODS Fifty extracted human premolars with similar anatomic features were used in this study. Four groups (n = 10) were treated endodontically. Onlay cavities extended to the buccal and palatal cusps and reached out the endodontic accesses were prepared. Ceramic onlay restorations with or without fiber posts were categorized as Group CO (ceramic onlays without posts), Group COQF (ceramic onlays and quartz fiber posts), and Group COGF (ceramic onlays and glass fiber posts). Positive control group was left as non-restored (Group NR). Ten intact teeth were stored as negative control group (Group IT). Fracture resistance was measured using a universal load-testing machine applying compressive load at a crosshead speed of 1 mm min(-1) until fracture. Fracture resistance and modes were evaluated statistically. RESULTS Ceramic onlay restorations (Groups CO, COQF, COGF) increased the fracture resistance significantly, when compared with non-restored teeth (P < 0.05). However, no significant differences were found in the groups with fiber posts in terms of fracture resistance (P > 0.05). Negative control group (IT) had significantly higher fracture resistance than all others (P < 0.05). Fracture types had significant differences among the groups (P < 0.01). CONCLUSIONS Within the limitations of this ex-vivo study, partial coverage with ceramic onlays resulted in a significant improvement of the fracture resistance of endodontically treated premolars. However, insertion of glass or quartz fibers did not increase the fracture resistance significantly.