Marcelo Giannini

Ultimate tensile strength of tooth structures

OBJECTIVE This study determined the ultimate tensile strength (UTS) of enamel (E), dentin (D) and dentin-enamel junction (DEJ) using the microtensile technique. It was hypothesized that the UTS of dental structures varies according to location and nature. METHODS Intact occlusal enamel surfaces from extracted human third molars were etched with 37% phosphoric acid and bonded with a one-bottle adhesive system. The bonded occlusal surfaces received a resin composite build-up and teeth were serially, vertically sectioned into several 0.7 mm thick slabs. Each slab was then trimmed to a dumbbell-shaped specimen with irrigated diamond burs to reduce the cross-sectional area to approximately 0.5 mm2 at E, D or DEJ. E was tested according to its prismatic orientation (parallel, EP; and transversally, ET) and D as function of depth (superficial, DS; middle, DM and deep, DD). Specimens were tested in tension in an Instron testing machine at 0.5 mm/min. Results were analyzed by one-way ANOVA and Duncans Multiple Range test. RESULTS UTS mean values (N = 20) were, MPa (SD): DEJ, 46.9 (13.7)b; EP, 42.1 (11.9)b; ET, 11.5 (4.7)d; DS, 61.6 (16.2)a; DM, 48.7 (16.6)b and DD, 33.9 (7.9)c. Enamel stressed transversally to its prismatic orientation was significantly weaker (p < 0.05) Dentin depth significantly affected its UTS (p < 0.05) DEJ presented UTS that was similar to EP and DM (p > 0.05) SIGNIFICANCE The UTS of dental structures varies according to its nature and location.

Bond Strength of Resin Cements to a Zirconia Ceramic with Different Surface Treatments

This study evaluated the influence of surface treatments and metal primers on the bond strength of resin cements to a yttrium-stabilized tetragonal zirconia (Y-TZP) ceramic. Two-hundred and forty plates of Y-TZP ceramic were randomly assigned to 24 groups (n = 10) according to the combination of surface treatment (none, air abrasion with Al2O3 particles, Er:YAG laser irradiation), metal primer (none, Alloy Primer, Metal Primer II or Metaltite) and resin cement (Calibra [Bis-GMA-based] or Panavia F2.0 [MDP-based]). Fragments of dentin with a cylindrical edge (0.8 mm in diameter) were fixed to ceramic surfaces with the resin cements. The micro-shear bond test was carried out at a 1 mm/minute speed until failure, and the ceramic surfaces were examined after debonding. Bond strengths were analyzed through three-way ANOVA/Tukey test with a 5% significance level. Changes in topography after surface treatments were evaluated with scanning electron microscopy. Surface treatments significantly modified the topography of the Y-TZP ceramic. Air abrasion resulted in increased bond strength for both resin cements. However, air abraded and laser irradiated specimens presented higher bond strength with the Bis-GMA-based resin cement than with the MDP-based cement. Both cements presented similar behavior on untreated surfaces. The three metal primers yielded a significant increase in bond strength, regardless of the surface treatment and resin cement. Adhesive failures were the most prevalent. Air abrasion with Al2O3 particles and the application of metal primers increased bond strength to Y-TZP surfaces for both resin cements.

Effect of curing mode on the polymerization characteristics of dual-cured resin cement systems

OBJECTIVES To evaluate the effects of different curing conditions on the degree of conversion (DC) of dual-cured cementing systems [combination of bonding agent (BA) and resin cement (RC)] using infrared spectroscopy. METHODS Four fourth generation products [Scotchbond Multipurpose Plus/RelyX (3M ESPE), Optibond/Nexus 2 (Kerr), All Bond2/Duolink (Bisco), and Bond-It!/Lute-It! (Pentron)], and three fifth generation materials [Bond1/Lute-It! (Pentron), Prime&Bond NT Dual-Cure/Calibra (Dentsply), and Optibond Solo Dual Cure/Nexus 2 (Kerr)] were applied to the surface of a horizontal attenuated-total-reflectance unit, and were polymerized using one of four conditions: self-cure (SC), direct light exposure through glass slide (DLE, XL3000/3M ESPE) or through pre-cured resin discs (shades A2;A4/2mm thick/Z250/3M ESPE). Infrared spectra of the uncured cementing systems were recorded immediately after application to the ATR, after the system was light-cured or left to self-cure, and spectra were obtained 5 and 10 min later. DC was calculated using standard techniques of observing changes in aliphatic-to-aromatic peak ratios pre- and post-curing. Data (n=5) were analyzed by two-way repeated measures ANOVA and Tukeys test (p=0.05). RESULTS Changes in aliphatic-to-aromatic peak ratios before and after placing RC onto the BA demonstrated that a combined layer was created. All groups exhibited higher DC after 10 min than after 5 min, except the DLE group of Bond-it!/Lute-it!. No significant differences in DC were observed among light-activated groups regardless of the resin disc shade in three of the four fourth generation cementing systems. The SC groups exhibited lower DC than the DLE groups for both fourth and fifth generation products either after 5 or 10 min. CONCLUSION The chemistry of the bonding interface changed when RCs were applied to uncured BAs. The presence of an indirect restoration can decrease the DC of some cementing systems and the self-curing mode leads to lower DC than the light-activating one.

Y-TZP Ceramics: Key Concepts for Clinical Application

Compared to conventional ceramic systems, Yttrium-stabilized tetragonal zirconia (Y-TZP) ceramics have some superior mechanical properties, ensuring a broad application in dentistry. The current study aimed to present relevant information about Y-TZP ceramics gathered from peer-reviewed papers. A search of the English language peer-reviewed literature was conducted using the PubMed database between 1998 and 2008. Articles that did not focus exclusively on the clinical application of Y-TZP ceramic restorations were excluded from further evaluation. Selected papers describe the chief characteristics of zirconia ceramics and important clinical features, especially those related to cementation procedures. The literature shows that, although new substances and equipment for the surface preparation of zirconia ceramics are in development, the most promising luting protocol seems to be the use of air abrasion with aluminum oxide particles (silanated or not), followed by the application of resin cements or surface primers containing special reactive monomers. However, because zirconia ceramics have only recently been developed for dental applications, there is not enough clinical evidence to support any definitive cementation protocol.

Effect of sodium sulfinate salts on the polymerization characteristics of dual-cured resin cement systems exposed to attenuated light-activation

OBJECTIVES To evaluate the effectiveness of sodium sulfinate salt co-initiators on the degree of conversion (DC) of dual-cured cementing systems [combination of bonding agent (BA) and resin cement (RC)] when the activating light is attenuated or not available. METHODS Two 5th generation products [Prime&Bond NT Dual-Cure/Calibra (Dentsply), and Excite DSC/Variolink II (Ivoclar/Vivadent)] were applied, either with or without co-initiators (sodium sulfinate salts) added to the bonding agents, to the surface of a horizontal attenuated-total-reflectance unit, and were polymerized using one of four conditions: self-cure (SC), or direct light exposure (DLE/XL3000/3M) through a glass slide or through pre-cured resin discs (shades A2 or A4/2mm-thick) (Z250/3M-ESPE). Real-time infrared spectra were obtained after placing components (uncured) and during 10 min (cured) (16 scans at 2 cm(-1), FTS-40/Digilab/Bio-Rad) to obtain polymerization kinetics. DC and maximum rate of polymerization (Rpmax) were calculated using standard techniques of observing changes in aliphatic-to-aromatic peak ratios pre- and post-curing. Data (n=5) were analyzed by two-way ANOVA and Tukeys test (p=0.05). RESULTS The addition of co-initiators increased the DC in most of the groups. No significant difference in DC was observed between Prime Bond NT Dual-Cure/Calibra and its version without co-initiator using the DLE curing mode. All DLE groups exhibited the highest DC after 10 min. No significant difference in DC was observed between A2 and A4 pre-cured overlay groups. The SC groups exhibited lower DC than the light-activated groups regardless of the presence of co-initiator. Use of co-initiators increased the Rpmax only in the SC groups. The A2 and A4 groups exhibited lower Rpmax than DLE groups, regardless of the presence of co-initiator. CONCLUSION The detrimental effects of light attenuation on the DC were not avoided by inclusion of sodium sulfinate salts, despite their ability to eliminate the chemical incompatibility between acidic monomers and self-curing components.

Kinetic analysis of monomer conversion in auto- and dual-polymerizing modes of commercial resin luting cements

STATEMENT OF PROBLEM Lack of knowledge regarding the kinetics of the setting reaction of dual- and autopolymerizing resin luting agents (RLA) leads the clinician to underestimate the care required during occlusal adjustments of indirect restorations. PURPOSE The purpose of this study was to evaluate the degree of conversion (DC), maximum rate of polymerization (R(p)(max)), and potential of cure (ratio of conversions in autopolymerized relative to dual-polymerized modes; PC(A/D)) of 5 dual-polymerizable RLAs at 5 and 10 minutes, after mixing RLA components using infrared (IR) spectroscopy. MATERIAL AND METHODS The RLAs evaluated included Calibra, Duo-Link, Lute-It, Nexus 2, and RelyX ARC. The RLAs were manipulated and applied to the horizontal diamond element in the optical bench of an IR spectrometer. The materials were either light activated for 40 seconds (dual-polymerizing mode) or were allowed to autopolymerize (autopolymerizing mode). The DC, R(p)(max), and PC(A/D) were calculated using standard techniques of observing changes in aliphatic-to-aromatic peak ratios before and after polymerization. Data (n=5) were analyzed by 2-way repeated measures ANOVA and Tukeys post hoc test (alpha=.05). RESULTS All autopolymerizing groups exhibited lower DC and R(p)(max) values than the dual-polymerizing groups (P<.001), and higher DC values at 10 minutes than at 5 minutes, only in the autopolymerizing mode. Duo-Link exhibited the highest R(p)(max) values among dual-polymerizing groups, while Lute-It and Calibra showed the lowest R(p)(max) values and the highest PC(A/D) values. Within autopolymerizing groups, Nexus 2 and Lute-It exhibited the highest R(p)(max) values, while RelyX ARC demonstrated the lowest R(p)(max) as well as the lowest PC(A/D) values. CONCLUSIONS The DC values of all autopolymerized groups of RLAs were lower than those of the dual-polymerized RLAs, but the differences in R(p)(max) and PC(A/D) were product dependent. The DC of all products was higher at the 10-minute interval than at the 5-minute interval, only in the autopolymerizing mode.

The effects of filling techniques and a low-viscosity composite liner on bond strength to class II cavities

OBJECTIVE The aim of this study was to test the hypothesis that the effects of filling technique, cavity configuration and use of a low-viscosity composite liner influence resin bond strength to the dentin of class II cavities gingival floor; and analyze the failure modes of fractured specimens. METHODS Standardized class II cavities were prepared in the proximal surfaces of freshly extracted third molars, which were randomly assigned to 10 experimental groups. All prepared surfaces were acid-etched, bonded with Single Bond adhesive system and restored with TPH composite, according to each technique: G1 and G2-horizontal layering, G3 and G4-faciolingual layering, G5 and G6-oblique layering, G7 and G8-bulk filling, G9 and G10-control (flat dentin surfaces). Groups were tested, with or without a low-viscosity composite liner (Tetric Flow Chroma). After storage in water for 24h, teeth were vertically serially sectioned to yield a series of 0.8mm thick slabs. Each slab was trimmed into an hourglass shape of approximately 0.8mm(2) area at the gingival resin-dentin interface. Specimens were tested in tension at 0.5mm/min until failure. Fractured specimens were analyzed in an SEM to determine the failure modes. RESULTS No significant difference was found between groups restored with and without a low-viscosity composite liner (p>0.05). Among filling techniques, the bulk filling groups presented the lowest bond strength values (p<0.05), while incremental filling groups did not differ from control (flat dentin surfaces). Failure modes varied significantly among groups restored with and without the low-viscosity composite liner. SIGNIFICANCE Bond strengths were not improved when a low-viscosity composite liner was applied, but it remarkably influenced the failure modes. Incremental techniques improved bond strength.

Effect of a carbamide peroxide bleaching gel containing calcium or fluoride on human enamel surface microhardness

This in vitro study evaluated the surface microhardness of human enamel submitted to bleaching with 10% carbamide peroxide (CP) containing calcium or fluoride. Ninety-eight dental blocks (5 x 5 mm2) with polished enamel surfaces were randomly assigned to 7 treatment groups (n=14), as follows: without bleaching and storage in artificial saliva (control); 10% CP; 10% CP + 0.05% calcium; 10% CP + 0.1% calcium; 10% CP + 0.2% calcium; 10% CP + 0.2% fluoride; and 10% CP + 0.5% fluoride. During 14 days, enamel surfaces were daily exposed to a 6-h bleaching regimen followed by storage in artificial saliva. Surface microhardness was measured before (baseline), during (7th day), immediately after bleaching (14th day) and 1 week post bleaching. Data were analyzed by two-way ANOVA and Tukeys test (p<0.05). All treatments reduced SM significantly during the bleaching cycle (7th day), immediately after bleaching (14th day) and 1 week post bleaching, compared to baseline and to the unbleached control group. In conclusion, in spite of the addition of calcium and fluoride, all bleaching treatments affected the enamel surface microhardness.

Analysis of differential artificial ageing of the adhesive interface produced by a two‐step etch‐and‐rinse adhesive

This study was performed to evaluate the effects of different in vitro ageing techniques on the dentine-bonded interface produced by a two-step etch-and-rinse adhesive. Composite build-ups were bonded to sectioned human molars using XP BOND and cut into non-trimmed dentine-composite beams for microtensile testing. Beams were assigned to one of the following storage conditions: (i) artificial saliva, 24 h (control); (ii) 10% sodium hypochlorite (NaOCl), 1 h; (iii) 10% NaOCl, 3 h; (iv) 60,000 thermal cycles, 2 months; (v) artificial saliva, 2 months; (vi) 60,000 thermal cycles, 6 months; and (vii) artificial saliva, 6 months. Beams were then pulled until failure and bond strength was calculated. Additional specimens were examined to investigate interfacial nanoleakage expression. NaOCl solution significantly reduced bonding compared with the control (group 2 = group 3 < group 1); and thermocycling reduced the bond strength in comparison to specimens stored for the same time-period in artificial saliva (group 4 < group 5; group 6 < group 7). Artificial ageing affected bond strength only after 6 months of storage (group 7 < group 5 = group 1). Increased nanoleakage was found under all ageing conditions in comparison with controls. NaOCl solution is a rapid and reliable in vitro ageing method for examining the durability of the adhesive interface produced by two-step etch-and-rinse adhesive systems.

Occluding effect of dentifrices on dentinal tubules

OBJECTIVES The objective of this study was to evaluate the tubule occluding ability of three commercial available dentifrices (Sensodyne, Emoform and Sorriso) by Scanning Electron Microscopy. METHODS Fifty cervical areas from buccal and lingual surfaces of sound third human molars were used. Cervical enamel was wet abraded to expose flat dentin surfaces and further polished with diamond pastes. Specimens were randomly divided into five groups (n=10): G1-no brushing; G2-brushing without dentifrice; G3-brushing with Sensodyne; G4-brushing with Emoform; G5-brushing with Sorriso. Brushed specimens were treated for 4 min per day, for 7 days in a toothbrushing machine. Specimens were prepared and observed under SEM for calculation of the percentage of occluded tubules. In addition, slurries of toothpastes were analyzed by X-ray microanalysis. Data were statistically analyzed by ANOVA and Tukey test (p<0.05). RESULTS Means of occluded tubules in descending order were: G5-98.83+/-3.31% (a), G4-96.02+/-5.24% (a), G3-80.12+/-24.65% (a), G1-37.31+/-24.22% (b); G2-22.92+/-15.19% (b). The three tested dentifrices produced increased dentinal occlusion as compared to controls (p<0.05) but equivalent occlusion among each other. Calcium from calcium-carbonate abrasive was identified in all dentifrices. CONCLUSIONS Results indicated that the use of all dentifrices occluded tubules more than no brushing and brushing without dentifrices groups. Thus, the tested dentifrices seem effective for desensitization by tubule occlusion.