G.J. Pearson

Microbiological evaluation of photo-activated disinfection in endodontics (An in vivo study)

Objective To determine the microbiological effect of photoactivated disinfection (PAD) as an adjunct to normal root canal disinfection in vivo.Design A randomised trial carried out in general dental practice.Subjects and methods Patients presenting with symptoms of irreversible pulpitis or periradicular periodontitis requiring endodontic therapy were selected at random. A microbiological sample of the canal was taken on accessing the canal, after conventional endodontic therapy, and finally after the PAD process (photosensitiser and light) had been carried out on the prepared canal. All three samples from each canal were plated within 30 minutes of sampling and cultured anaerobically for five days. Growth of viable bacteria was recorded for each sample to determine bacterial load.Results Thirty of the 32 canals were included in the results. Cultures from the remaining two did not reach the laboratory within the target time during which viability was sustained. Of the remaining 30, 10 canals were negative to culture. These were either one of the canals in multi rooted teeth where the others were infected or where a pre-treatment with a poly-antibiotic paste had been applied to hyperaemic vital tissue. Sixteen of the remainder were negative to culture after conventional endodontic therapy. Three of the four which had remained infected cultured negative after the PAD process. In the one canal where culturable bacteria were still present, a review of the light delivery system showed a fracture in the fibre reducing the effective light output by 90%.Conclusions The PAD system offers a means of destroying bacteria remaining after using conventional irrigants in endodontic therapy.

The in vivo perception of roughness of restorations.

Objective To determine a threshold of detection value for surface roughness of restorations by patients using their tongue.Method Samples of composite resin were finished with differing grades of abrasive. The surface roughness (Ra) was measured and representative scanning electro-micrographs taken. These were compared with labial enamel. Twenty-five volunteers were asked to rank them in order of perceived roughness using the tip of their tongue.Results These showed that the 60% of volunteers were able to rank the specimens correctly, and were able to distinguish differences in roughness values from between 0.25 and 0.50 μm. This range encompasses that of natural enamel.Conclusions The subjects were able to distinguish lower roughness values than have previously been reported. It is concluded that when finishing restorations the surface should have a maximum roughness 0.50 μm if it is not to be detected by the patient.

The photo-activated antibacterial action of toluidine blue O in a collagen matrix and in carious dentine.

The main aim of this study was to determine the susceptibility to photo-activated disinfection (PAD) of Streptococcus mutans when the organism was present in a collagen matrix – an environment similar to that which would exist within a carious tooth. In addition, the susceptibility to PAD of bacteria present in carious human teeth was also determined. Light was delivered to the collagen and teeth using a system comprising a 0.8-mm diameter isotropic tip emitting light at 633 ± 2 nm. A single concentration of TBO (10 µg/ml) was used with both collagen and dentine. Two contact times, 30 and 180 s, were evaluated in intact collagen and additionally, for 180 s only, in collagen partially disrupted by shredding. The effect of energy doses from 1.8 to 14.4 J on the kills attained was assessed by determining the number of surviving viable bacteria. In carious dentine, two contact times, 30 and 60 s and one energy dose, 4.8 J, were used. Antibacterial effects were less than those obtained using planktonic suspensions with a maximum mean log reduction of 1.4 in shredded collagen and dentine. Increasing contact time increased the antibacterial effectiveness in both substrates although this was not always of statistical significance. Shredding the collagen resulted in significantly increased bacterial kills compared to those obtained in intact collagen for the 30-second contact time. The collagen matrix appeared to be a suitable model for carious dentine with advantages of availability and reproducibility. The results of this study have shown that PAD can achieve appreciable kills of oral bacteria, including S. mutans, when the organisms are embedded in a collagen gel or are present in carious teeth.

The Effect of Variable Energy Input from a Novel Light Source on the Photoactivated Bactericidal Action of Toluidine Blue O on Streptococcus mutans

Although the combination of toluidine blue O (TBO) dye and laser light at a wavelength of 633 nm has a bactericidal effect, light from laboratory lasers can only be directed externally at a bacterial colony or suspension. In this study a novel delivery system guided the laser light to an 800-µm diameter spherical tip (an isotropic tip) from which light radiated producing a uniform sphere of light within the colony or suspension. The system was highly effective in killing TBO-treated Streptococcus mutans NCTC 10449 in stirred planktonic suspension, killing at least 109 cfu/ml. Antibacterial action increased as the delivered energy dose increased. Energy doses of 1.8 J or more produced 100% kills and log reductions of 8–10 cfu/ml. Neither TBO dye nor light alone had a significant antibacterial effect under the experimental conditions used. The existence of a threshold energy, i.e. a minimum energy required before bactericidal action occurred, could not be demonstrated.

An alternative regimen for root canal disinfection

Objective To compare the effect of a combination of 20% citric acid solution and photo-activated disinfection with the use of 20% citric acid and 2.25% sodium hypochlorite solutions on bacterial load on the dentine walls in prepared canals in vivo.Subjects and methods Sixty-four randomly selected cases were evaluated and allocated to one of two groups. In Group 1, after gaining access to the root canal, bacterial load on the canal walls was sampled using endodontic files. A further sample was taken after apex location and initial widening of the canal had been completed and the photo-activated disinfection process carried out. A final sample was taken after completion of the canal preparation using citric acid and sodium hypochlorite solutions. In Group 2, the initial sample was taken as described previously. A second sample was taken after conventional preparation using 20% citric acid and sodium hypochlorite solutions as co-irrigants. A final sample was then taken after a subsequent PAD treatment. All samples were cultured for facultative anaerobic bacteria.Results Of the canals treated in Group 1 only two of the 23 canals infected showed culturable bacteria after the use of citric acid and photo-activated disinfection. Of these two canals, one was free of culturable bacteria on completion of conventional treatment but the other still contained culturable bacteria. In Group 2, four canals of the 23 infected initially, remained contaminated after conventional treatment. After subsequent photo-activated disinfection three of these four canals were free of culturable bacteria.Conclusion Results indicate that the use of a chelating agent acting as a cleaner and disrupter of the biofilm and photo-activated disinfection to kill bacteria is an effective alternative to the use of hypochlorite as a root canal cleaning system.

Variation in powder/liquid ratio of a restorative glass-ionomer cement used in dental practice

This study investigates the powder/liquid ratios of a glass-ionomer restorative (ChemFil II, Dentsply) mixed in clinical practice. Twenty-two dental surgery assistants (11 from general practice; 11 from a dental hospital) mixed this cement as they would for clinical use. Samples were taken of three mixes from each assistant and the powder/liquid ratios were derived from weight loss on dehydration. A wide range of ratios were obtained, but in no case was the manufacturers recommended ratio of 6.8:1 achieved. The consistency measured in accordance with BS 6039 showed the cement at 6.8:1 to be less fluid than the requirements of the standard and other glass-ionomer restoratives. When tested at the mean ratio used in practice, 5.0:1, the consistency complied with BS 6039, but the compressive and diametral strengths did not, being about half the values found at 6.8:1. It was concluded that this restorative was often mixed in practice at much lower powder/liquid ratios than that recommended by the manufacturer and that this would impair the cements mechanical properties

The comparative strengths of commercial glass-ionomer cements with and without metal additions

Metal reinforced glass-ionomer cements are said to possess superior mechanical properties when compared to non-metal reinforced glass-ionomer cements. However, the literature to date does not always support this view, owing to the variety of materials and test methods employed. In this study the mechanical properties of three reinforced and three standard materials were tested using the standard specification tests of compressive and diametral strength in addition to tensile strength using the four point bend test. The tensile strength was also measured using the shell test in order that this test, which on theoretical grounds is more suited to these materials, may be evaluated. Six specimens of each material were prepared for each of the test modalities resulting in the conclusion that the addition of metal to glass-ionomer cements can markedly increase the strength of the materials. However, the method of fusing the metal to the glass rather than by simple addition does not produce any advantages in strength. In this evaluation one reinforced material was significantly stronger than all other materials in all four test modalities. The compressive strength test which appears in most standards does not appear to be very discriminatory. Of the tensile tests, which have more clinical significance, the results of the diametral strength tests, which are included in some standards, appear to be at variance with the other two tensile tests, suggesting that the flexural or shell test would be more appropriate

The effect of the disc support system on biaxial tensile strength of a glass ionomer cement

OBJECTIVE This was to examine how varying the type of support, from a complete ring to a series of point supports, affected the biaxial tensile strength of one glass ionomer cement. METHOD Three support diameters from 11.5 to 28.6 mm were achieved using 3 mm ball bearings as point supports equidistantly spaced around the diameter. From 3-30 point supports were used depending on diameter. At the maximum number of point supports for each diameter the support points were 3 mm apart. After 24h storage in water at 37 degrees C the biaxial tensile strength of 1 mm thick glass ionomer restorative cement discs was measured using a loading rate of 1 mm min(-1). The load at break was converted to biaxial tensile strength using the Timoschenko and Woinowsky-Kreiger equation using a Poissons ratio value of 0.30. The mean strength of six specimens tested per support regime was calculated. RESULTS Comparison with the mean result obtained from using a continuous knife-edge support showed there to be no significant difference (unpaired t-test) between the different support systems except in two cases, both being when a four-point support was used. Neither the support diameter nor the number of point supports was crucial. SIGNIFICANCE Results from studies where different systems have been used to support brittle cement discs may be compared.

The effects of adding fluoride compounds to a fluoride-free glass ionomer cement on subsequent fluoride and sodium release.

Studies have shown that ions in a glass ionomer matrix are 1-10% of the amounts present in the original glass. To measure more precisely the release from a cement matrix, known amounts of ions were added to LG30 glass which was fluoride and sodium-free. Cement without additions acted as the control. 1.4-1.6% of each of sodium, calcium and aluminum fluorides were added to three portions of control blend. The sodium and fluoride release into deionised water from five discs of each cements blend was measured for 8 months. This represented complete release for sodium but not for fluoride. Traces of fluoride and sodium in the glass produced low but measurable amounts indicating about a third of the fluoride and substantially all sodium present in LG30 was released. The addition of calcium fluoride had no significant effect on sodium or fluoride release and aluminium fluoride minimal effects. Adding sodium fluoride significantly enhanced release of both ions although fluoride release was less than from a glass containing 5% fluoride. Only small proportions of the additions, 2-5% of the fluoride and 13% of sodium, were released. Sodium and fluoride appeared to be released independently. For LG30 cements additives were poor at supplying extra ions.

Fluoride ion release from two methacrylate polymer systems

The release of fluoride ions from two room-temperature polymerising systems containing sodium and potassium fluoride, respectively, has been studied. The polymer systems comprised poly(ethyl methacrylate) powder (PEM), with tetrahydrofurfuryl methacrylate (THFM), and n-butyl methacrylate (nBM), respectively. The water uptake of these systems was drastically increased by the presence of fluorides, the increase being much higher with the PEM/THFM system. In both cases, uptake was a monotonic function of the molarity of the fluoride added. The uptake process was in general non-Fickian. However, for all systems, the fluoride release process was Fickian, and diffusion coefficients could be calculated. The amount of fluoride released, and the diffusion coefficients obtained, appeared unrelated to the extent of water uptake of the parent polymers.