José Vreven

Meta-analytical review of factors involved in dentin adherence.

Literature data on adherence tests of dentin-bonding systems (DBS) may differ widely, even for the same DBS. The problem of bond testing is that materials are seldom compared with a standard, and experimental conditions often vary. We sought to identify the parameters that influence this variability. Using inclusion and exclusion criteria, we conducted a meta-analytical review of 75 articles, published between 1992 and 1996 in SCI reviews, that give bond strength data for 15 dentin-bonding agents of the so-called third and fourth generations. Seventeen selected parameters were classified into four groups: Group A includes factors related to the dentin substrate (i.e., nature of teeth); group B, composite and bonding area (i.e., composite stiffness); group C, storage conditions of the bonded samples (i.e., thermocycling); and group D, test design (i.e., crosshead speed). For each report, the experimental features, the bond strength means and standard deviations, and the failure mode were extracted and tabulated. Statistical Analysis System software was used to perform Pearson correlation analysis and analysis of variance, with bond strength as the dependent variable and experimental conditions as the independent variables. The meta-analytical review highlighted the significant influence of various parameters in the different groups: origin of dentin, types of teeth, pulpal pressure, tooth storage temperature, maximum storage time of teeth, and dentin depth in group A; type and stiffness of composite and bonding area in group B; storage of bonded samples (medium, temperature, and time) in group C, and testing mode and crosshead speed in group D. A significant positive correlation was observed between the mean bond strength and the rate of cohesive failure. It can be concluded from this study that some of these parameters should be controlled by the use of a standardized protocol. Unfortunately, the substrate-related variables are more difficult to control, even though their influence is consistent.

Clinical evaluation of a posterior composite 10-year report

OBJECTIVE The 10-year findings of one of the studies which comprised the multicentre clinical evaluation of a light-cured posterior composite restorative are reported, with special emphasis on the reasons and timing of failure of restorations included in the study. Effects of the use of rubber dam or cotton rolls and aspiration for isolation at the time of placement are considered. METHOD One hundred Class I and II restorations of the resin composite investigated were placed by a single operator in a group of selected, predominantly young-adult patients under highly controlled conditions, with the use of rubber dam or cotton rolls and aspiration for isolation being determined according to a scheme of randomisation. The restorations were reviewed clinically after 1 week and within 1 month of placement (baseline) and, thereafter, at 6 months, 1, 2, 3, 4, 5, 6 and 10 years using modified USPHS codes and criteria. Epoxy models and photographs were obtained for retrospective analysis. RESULTS After 10 years, 37 restorations were reviewed and 32 restorations were known to have failed. Regarding the reasons for failure, loss of occlusal anatomic form during the first 5 years and loss of approximal contacts near the end of the study accounted for most of the failures. Only two failures were attributed to recurrent caries. Few of the restorations found to be clinically satisfactory at 10 years had retained ideal functional characteristics. Location, Class and size of restoration and the method of isolation were not found to significantly influence 10-year performance and survival. CONCLUSION The actual 10-year failure rate, estimated to have been between 40 and 50% is considered to have been high, notably given the limited incidence of recurrent caries and bulk fracture. However, the findings indicate that certain restorations of the material investigated, despite the use of outdated operative techniques, may be found to perform satisfactorily over periods in excess of 10 years.

Pulpal-temperature Rise and Polymerization Efficiency of LED Curing Lights

This paper assesses the effects of light characteristics and irradiation time on the Vickers microhardness (VH) of a dual-photoinitiator commercial composite and on temperature increase in the pulp chamber (deltaT). Four recent light-emitting diodes (LEDs)--bluephaseG2 (BG2), bluephase16i (B16i), G-Light (G) and Freelight2 (F2)--and one control halogen light (XL3000-X) were tested on two shades of Tetric EvoCeram (A2 and Bleach XL), whose respective commercial formulations differed based on their concentration of camphorquinone and lucirin TPO. Three different irradiation times were applied--10, 20 and 40 seconds-and VH was measured on the upper and lower surfaces of 2-mm thick samples. The deltaT was measured by using a K-type thermocouple inserted into the pulp chamber of a molar that had been prepared to obtain a 2-mm thickness of dentin. The measurements were made either during polymerization of a 2 mm composite (Shade A2 or Bleach) or with an empty mold. The data were analyzed with the two-way ANOVA (p < 0.05) test. For shade A2, all but one irradiation condition (F2-10 seconds, lower surface) generated VH values that were statistically equal to or better than the standard chosen for this study (X-40 seconds). For Bleach shade, the VH values obtained with G and BG2-20 and 40 seconds were statistically comparable to X-40 seconds for both the upper and lower surfaces. This was not the case with either G and BG2-10 seconds or for all the procedures with other LCUs for which a VH of at least one of the surfaces was significantly lower than the reference. The results also highlight differences between the two material shades, whether the upper or lower surface is considered. Regarding temperature measurements for shade A2, B16i-20-40 seconds, BG2-40 seconds and G-40 seconds induced significantly higher deltaTs (3.98, 5.98, 5.21 and 4.95, respectively) than X-40 seconds (3.09). For Bleach shade, B16i-20 and 40 seconds, F2-20 and 40 seconds, BG2-40 seconds and G-40 seconds generated deltaTs significantly higher than the control values (2.70, 4.05, 3.03, 4.58, 2.74 and 2.44, respectively). The deltaT values obtained with uncovered tooth were generally higher than those obtained with a 2-mm layer of composite. In conclusion, this research emphasizes that a perfect correspondence between light and material spectra is of prime concern, both to insure optimal polymerization and to limit heating in the pulp chamber. Some reduction in curing time is possible, but only within certain limits.

In vivo comparison of a microfilled and a hybrid minifilled composite resin in class III restorations: 2-year follow-up

Abstract An in vivo comparison was made of two different types of restorative resins over a 2-year period: a microfilled resin ( -1158262462Silux Plus, 3M-1158262462, USA) and a hybrid minifilled composite resin (-1158262461Herculite XRV, Kerr-1158262461, USA); 56 restorations were placed in 28 patients by one experienced dentist and examined by two independent evaluators using the United States Public Health Service (UPSHS) rating system for marginal adaptation, marginal discoloration, surface roughness, anatomic form and modified criteria for color match (direct and indirect evaluation). Modified criteria divided the classic A score into A1 for ”not detectable” filling and A2 for ”slightly discernible filling”. Restorations were evaluated at baseline, 1 week, 6 months, 1 year and 2 years later. After 2 years, all materials were considered satisfactory for marginal adaptation, anatomic form and surface roughness (no ”Charlie”, or ”Delta” ratings). No recurrent caries was observed. Clinical evaluation showed a significantly higher rate of marginal discoloration for the microfilled composite resin than the other resin. Hybrid composite resin materials may be expected to perform well as an anterior restorative material. Photographic ratings confirmed the clinical evaluation. The modified evaluation for color match demonstrated differences, which are not discernible with the USPHS system and showed, more rapidly, differences that appear later with the USPHS system.

Structural Integrity of Resin-modified Glass Ionomers as Affected by the Delay or Omission of Light Activation

Since light activation of resin-modified glass ionomers as a means of polymerizing the HEMA is usually done shortly after mixing occurs, the acid-base reaction will proceed mainly within a formed HEMA-polymer matrix. Delaying or omitting light activation may alter the structure and consequently its integrity. The aim of this study was to investigate the effect on the structural integrity of Fuji II LC, Photac-Fil, and Vitremer by delaying or omitting light initiation as compared with the integrity when light activation is performed 2 min after mixing occurs. We evaluated integrity by three-body wear experiments, conducted 8 hrs after sample preparation, to establish the integrity in the early phase of hardening, as well as after 1 wk and after 4 mos, to follow the materials throughout the process of maturation. When light activation was delayed for 1 hr, the structural integrity of Fuji II LC and Photac-Fil improved significantly in the early stages of hardening. In the case of Vitremer, an hours delay of light activation significantly decreased integrity, which declined further when light activation was omitted. Fuji II LC was not affected by the omission of light activation, while Photac-Fil was markedly weakened. After 4 mos of aging, most of the samples of each product which had been cured by the different methods attained equal integrity, with the exception of the non-light-activated Vitremer samples, which remained weaker. We concluded that the structural integrity of resin-modified glass-ionomer cements benefits from a chemical integration of the polyalkenoate and poly-HEMA networks, as in Vitremer. Improvement in the structural integrity in the early phase for cements with a mechanical entanglement of the matrices, as in Fuji II LC and Photac-Fil, requires an acid-base reaction, a considerable portion of which may take place before activation of the HEMA polymerization.

A drilling technique to improve the retention of self-threading pins

This study determined the effect of a modification of the drilling technique on the retention of self-threading pins. The drilling technique in two stages significantly increased the retention of self-threading pins.