Gabriela Queiroz de Melo Monteiro

Marginal analysis of resin composite restorative systems using optical coherence tomography

OBJECTIVES To analyze marginal integrity of resin composites dental restorations using optical coherence tomography (OCT). METHODS Thirty extracted human premolars had occlusal cavities prepared and were randomly divided according to the restorative systems evaluated: Filtek P90™/P90 Adhesive System™, Filtek Z350™, and Filtek Z250™/Single Bond™ (3M/ESPE). The teeth were then stored in the dark for 24h in 0.9% saline solution. Restorations were finished and polished and stored again for 24h before thermocycling (500 cycles, 5-55°C). A commercially available OCT system was used (SR-OCT: OCP930SR/Thorlabs) with 930nm central wavelength. Cross-sectional images were obtained every 250μm and evaluated using Image J. A-scans were analyzed using the Origin 8.0 program, after a filter treatment using Matlab. RESULTS The qualitative analysis of the internal margins did not observe gaps even after A-scan examination, although distinctive patterns were found for each restorative system. Penetration of Single Bond and Filtek P90 self-etch primer into dentin was also observed. A thick adhesive layer was found for Filtek P90 bonding agent. SIGNIFICANCE Considering the characteristics of the OCT system, the setup used in this study was capable of evaluating the marginal integrity of resin composite restorations and detecting some interaction between dental bonding agents and dental substrates. OCT can be considered a promising method for the evaluation of the internal margins of restorations in vivo.

Alternative methods for determining shrinkage in restorative resin composites

OBJECTIVES The purpose of this study was to evaluate polymerization shrinkage of resin composites using a coordinate measuring machine, optical coherence tomography and a more widely known method, such as Archimedes Principle. Two null hypothesis were tested: (1) there are no differences between the materials tested; (2) there are no differences between the methods used for polymerization shrinkage measurements. METHODS Polymerization shrinkage of seven resin-based dental composites (Filtek Z250™, Filtek Z350™, Filtek P90™/3M ESPE, Esthet-X™, TPH Spectrum™/Dentsply 4 Seasons™, Tetric Ceram™/Ivoclar-Vivadent) was measured. For coordinate measuring machine measurements, composites were applied to a cylindrical Teflon mold (7 mm × 2 mm), polymerized and removed from the mold. The difference between the volume of the mold and the volume of the specimen was calculated as a percentage. Optical coherence tomography was also used for linear shrinkage evaluations. The thickness of the specimens was measured before and after photoactivation. Polymerization shrinkage was also measured using Archimedes Principle of buoyancy (n=5). Statistical analysis of the data was performed with ANOVA and the Games-Howell test. RESULTS The results show that polymerization shrinkage values vary with the method used. Despite numerical differences the ranking of the resins was very similar with Filtek P90 presenting the lowest shrinkage values. SIGNIFICANCE Because of the variations in the results, reported values could only be used to compare materials within the same method. However, it is possible rank composites for polymerization shrinkage and to relate these data from different test methods. Independently of the method used, reduced polymerization shrinkage was found for silorane resin-based composite.

Evaluation of linear polymerization shrinkage, flexural strength and modulus of elasticity of dental composites

Linear polymerization shrinkage (LPS), flexural strength (FS) and modulus of elasticity (ME) of 7 dental composites (Filtek Z350™, Filtek Z250™/3M ESPE; Grandio™, Polofil Supra™/VOCO; TPH Spectrum™, TPH3™, Esthet-X™/Denstply) were measured. For the measurement of LPS, composites were applied to a cylindrical metallic mold and polymerized (n = 8). The gap formed at the resin/mold interface was observed using scanning electron microscopy (1500×). For FS and ME, specimens were prepared according to the ISO 4049 specifications (n = 10). Statistical analysis of the data was performed with one-way ANOVA and the Tukey test. TPH Spectrum presented significantly higher LPS values (29.45 µm). Grandio had significantly higher mean values for FS (141.07 MPa) and ME (13.91 GPa). The relationship between modulus of elasticity and polymerization shrinkage is the main challenge for maintenance of the adhesive interface, thus composites presenting high shrinkage values, associated with a high modulus of elasticity tend to disrupt the adhesive interface under polymerization.

Marginal and internal analysis of preheated dental fissure-sealing materials using optical coherence tomography

OBJECTIVES This study aimed to evaluate the influence of pre-photoactivation temperature on the marginal and internal integrity (occurrence of voids) of fissure-sealing materials on occlusal fissures using optical coherence tomography (OCT). METHODS Occlusal fissures of 40 human third molars were sealed using a resin-based fissure sealant (Fluroshield) and a flowable composite (Permaflo) photoactivated at 68 °C (preheated) or at room temperature (25 °C) (n=10). After sealing, the teeth were subjected to thermocycling (500 cycles, 5-55 °C) and 14 days of pH cycling (demineralisation for 6 hours/day and remineralisation for 18 hours/day). The occlusal surfaces were scanned in a buccolingual direction, and 20 tomographic images parallel to the long axis of each tooth were obtained. Images presenting marginal gaps and internal voids were counted and statistically analysed using analysis of variance and Tukeys test (P<0.05). RESULTS There were statistically significant differences between materials and temperatures (P<0.01). The flowable composite had a lower percentage of gaps and internal voids than the resin-based sealant. Preheated materials had a lower percentage of gaps and internal voids than the materials at room temperature. CONCLUSION Therefore, preheated flowable composite provided the best marginal sealing of fissures, and internal homogeneity of the material.

Polymerization Shrinkage and Flexural Modulus of Flowable Dental Composites

Linear polymerization shrinkage (LPS), flexural strength (FS) and modulus of elasticity (ME) of low-viscosity resin composites (Admira Flow™, Grandio Flow™/VOCO; Filtek Z350 Flow™/3M ESPE; Tetric Flow™/Ivoclar-Vivadent) was evaluated using a well-established conventional micro-hybrid composite as a standard (Filtek Z250™/3M ESPE). For the measurement of LPS, composites were applied to a cylindrical metallic mould and polymerized (n = 8). The gap formed at the resin/mould interface was observed using SEM (1500×). For FS and ME, specimens were prepared according to the ISO 4049 specifications (n = 10). Statistical analysis of the data was performed with one-way ANOVA and the Tukey test. The conventional resin presented significantly lower LPS associated with high FS and ME, but only the ME values of the conventional resin differed significantly from the low-viscosity composites. The relationship between ME and LPS of low-viscosity resin composites when used as restorative material is a critical factor in contraction stress relief and marginal leakage.

Effect of dentin pretreatment with potassium oxalate: A 6-year follow-up: PORTO et al.

Oxalate‐based products are effective against dentine sensitivity and have been studied as an option to improve long‐term adhesive bonding strength. Our aim was to evaluate the effect of potassium oxalate on the microtensile bond strength (µTBS) of the dentin/resin interface after 24 h, 1, and 6 years. Dentin on the occlusal surface of 16 human premolars was exposed and etched with 35% phosphoric acid. The teeth were divided into four groups. Two groups received 3% monohydrated potassium oxalate and the following adhesive systems and composites: Adper Scotchbond Multipurpose + FiltekZ350 (3M/ESPE) and Prime & Bond NT + Esthet‐X (Dentsply). Two control groups did not receive potassium oxalate. Teeth were cut into sticks and kept in distilled water at 37°C for 24 h, 1, and 6 years. The sticks underwent µTBS testing after storage. ANOVA, Tukeys post hoc test, and paired t test were used to compare storage times (α = 0.05). The fracture mode of the specimens was classified under a stereomicroscope (40×). Morphology of the hybrid layer and the fracture pattern were observed with scanning electronic microscopy (SEM). Mean µTBS was high at 24 h and decreased after 1 and 6 years. After 6 years, the mean µTBS values were similar with no statistically significant difference between the groups (p = .121). SEM images showed proper dentin hybridization. Dentin pretreatment with potassium oxalate did not affect hybrid layer formation, but bond strength decreased over time after 24 h. Therefore, the clinical use of potassium oxalate to increase dentin bond durability is not indicated.

Hardened exogenous material after extrusion of calcium hydroxide with barium sulfate: Case study and histopathologic and laboratory analyses

BACKGROUND AND OVERVIEW Although calcium hydroxide (Ca[OH]2) paste associated with barium sulfate (BaSO4) is considered a safe agent, there is a lack of clinical research on its effects on periodontal and submucosal tissues. The aim of the authors was to report the effects of extrusion of Ultracal XS paste (Ultradent Products) in 2 cases. The authors also analyzed the paste constituents and compared them with the proportion reported by the manufacturer and the material extruded. CASE DESCRIPTION The authors present 2 cases in which root canals were restored with Ultracal XS paste after cleaning and shaping, and there was unintentional overextension of the paste into periradicular tissues, with a hardened exogenous material observed associated with inflammatory signs and symptoms. A biopsy was performed, and the material was subjected to histopathologic analysis and characterization through scanning electron microscopy, energy dispersive x-ray spectroscopy, Fourier transform infrared spectroscopy, and x-ray diffraction. CONCLUSIONS BaSO4 and calcium carbonate (CaCO3) were associated with a hardened material after Ultracal XS paste extrusion. The Ca(OH)2 percentage on the Ultracal XS paste was approximately 2 times greater than the proportion reported by the manufacturer. PRACTICAL IMPLICATIONS Ca(OH)2 with BaSO4 paste application should be performed carefully, and its extrusion to periradicular and submucosal tissues should not occur. Its extrusion may result in the formation of a persistent exogenous material of hardened consistency associated with inflammatory signs and symptoms.

Mitigation of enamel erosion using commercial toothpastes evaluated with optical coherence tomography

The aim of this study was to evaluate the efficacy of commercial toothpastes containing sodium fluoride (NaF), stannous fluoride (SnF2), or casein phosphopeptides (CPP)-amorphous calcium phosphate (ACP)/NaF regarding their potential to inhibit enamel erosion. Twenty-eight 4×4 mm enamel specimens were randomly allocated into 4 groups (n=7): negative control; Pronamel (NaF); Pro Health (SnF2/NaF); Mi Paste Plus (CPP-ACP/NaF). Erosive cycles with 0.5% citric acid, 5 times, 3 minutes/day for 7 days were performed. After the first and last cycle of each day, toothpaste slurries were applied for 2 min. The quantitative analysis was accomplished using Contact Profilometry and Optical Coherence Tomography (OCT), complemented by roughness and qualitative scanning electron microscopy (SEM) analysis. OCT and Profilometry analysis showed similar effectiveness in measuring the reduction of mineral loss. A significant increase in the mean roughness values was observed on eroded surface and also on treated surface as revealed by scanning electron microscopy. The use of SnF2/NaF toothpaste was the most effective method for reducing mineral loss. As quantitative methods, OCT and Contact Profilometry showed no statistical differences. OCT, which was used for this purpose for the first time, has the advantage of being noninvasive, and therefore have the potential for clinical application.

Evaluation of microshear bond strength of resin composites to enamel of dental adhesive systems associated with Er,Cr:YSGG laser

The aim of this in vitro study was to evaluate the microshear bond strength (μSBS) of resin composite to enamel etching by Er,Cr:YSGG laser with the use of two differents adhesives systems. Fifty freshly extracted human molars halves were embedded in acrylic resin before preparation for the study, making a total of up to 100 available samples. The specimens were randomly assigned into six groups (η=10) according to substrate pre-treatment and adhesive system on the enamel. A two-step self-etching primer system (Clearfil SE Bond) and a universal adhesive used as an etch-andrinse adhesive (Adper Single Bond Universal) were applied to the nonirradiated enamel surface according to manufacturer’s instructions, as control groups (Control CF and Control SB, respectively). For the other groups, enamel surfaces were previously irradiated with the Er,Cr:YSGG laser with 0.5 W, 75 mJ and 66 J/cm2 (CF 5 Hz and SB 5 Hz) and 1.25 W, 50 mJ and 44 J/cm2 (CF 15 Hz and SB 15 Hz). Irradiation was performed under air (50%) and water (50%) cooling. An independent t-test was performed to compare the adhesive systems. Mean μSBS ± sd (MPa) for each group was 16.857 ± 2.61, 17.87 ± 5.83, 12.23 ± 2.02, 9.88 ± 2.26, 15.94 ± 1.98, 17.62 ± 2.10, respectively. The control groups and the 50 mJ laser groups showed no statistically significant differences, regardless of the adhesive system used. The results obtained lead us to affirm that the bonding interaction of adhesives to enamel depends not only on the morphological aspects of the dental surface, but also on the characteristics of the adhesive employed and the parameters of the laser.