Marcos Antonio Japiassú Resende Montes

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.

Cytotoxicity of current adhesive systems: In vitro testing on cell cultures of primary murine macrophages

OBJECTIVES The aim of this study was to evaluate, in vitro, the potential cytotoxicity of dentinal adhesives on alveolar macrophages of Wistar rats, after diffusion through dentin. METHODS The cytotoxicity of adhesives [single bond plus (SB), clearfil SE bond (CF) and Xeno V (XE)] applied to the occlusal surface of human dentin disks adapted to a dentin barrier test device were analyzed. The sets placed on a monolayer of cells were incubated for 24, 48 and 72h. Culture medium and Escherichia coli lipopolysaccharides (LPS) were used as negative and positive controls, respectively. Cellular cytotoxicity was evaluated by observing the cell survival rate (MTT assay) and nitric oxide production (NO). The data were analyzed by one-way factorial ANOVA and Tukeys and Tamhanes paired comparisons T2 (α=0.05). RESULTS All the adhesive systems reduced the percentage of live cells by over 50%, compared with the control group. Within the same period of time, there was a statistically significant difference between the adhesives and LPS compared with the negative control group. SB presented a statistically significant difference between 24h and 72h, and XE between 48h and 72h. The quantity of NO produced in 24h did not differ statistically between the NC and adhesive groups. After 48h there was a significant difference between SB/CF and XE/NC. At 72h only CF showed a significant difference from each of the other groups. LPS differed statistically from all the other groups at all the evaluation times. SIGNIFICANCE Components of the adhesives tested may permeate the dentin in sufficient concentrations to cause death and damage to cell metabolism in the alveolar macrophages of rats, which indicates potential cytotoxicity to pulpal cells.

Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial

OBJECTIVE This study aimed to evaluate the progression of sealed non-cavitated dentinal occlusal caries in a randomised controlled clinical trial. MATERIALS AND METHODS Sixty teeth with non-cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. RESULTS Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12-month follow-up. At the 24- and 36-month recall appointments, neither sealant loss nor caries progression were observed. CONCLUSION The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.

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.

30-Month randomised clinical trial to evaluate the clinical performance of a nanofill and a nanohybrid composite

OBJECTIVE To evaluate the clinical performance of a nanofill and a nanohybrid composite in restorations in occlusal cavities of posterior teeth in a randomised trial over 30 months. METHODS Forty-one adolescents participated in the study. The teeth were restored with a nanofill (Filtek Z350, 3M ESPE), a nanohybrid (Esthet-X, Dentsply); Filtek Z250 (3M ESPE) was used as a control. After 30 months, the restorations were evaluated in accordance with the US Public Health Service (USPHS) modified criteria. The McNemar and Friedman tests were used for statistical analysis, at a level of significance of 5%. RESULTS There were significant differences in the roughness of Filtek Z250 (p=0.008) and Filtek Z350 (p<0.001) when the four time periods (baseline, 6 months, 12 months and 30 months) were compared. There were significant differences in the marginal adaptation of Filtek Z250 (p=0.001), Filtek Z350 (p<0.001) and Esthet-X (p=0.011). Except for one of each composite restoration, all the modifications ranged from Alpha to Bravo. There were significant differences in the surface roughness (p=0.005) when the three composites were compared after 30 months. CONCLUSIONS The materials investigated showed acceptable clinical performance after 30 months. Long-term re-evaluations are necessary for a more detailed analysis of these composites (CEP: #1252).

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.

Evaluation of surface roughness of a nanofill resin composite after simulated brushing and immersion in mouthrinses, alcohol and water

This study investigated the alteration of surface roughness of the nanofill composite Filtek Z350 3M/ESPE®, caused by simulated brushing associated with the use of mouthrinses with or without alcohol. Sixty specimens were prepared and distributed into six groups: distilled water, ethylic alcohol, Listerine® Vanilla Mint, Plax® without alcohol, Oral B® without alcohol and a control group. Each group was submitted to two intercalary 5,000 simulated brushing cycles. At the end of each cycle, the specimens were washed in tap water and immersed for two cycles of six hours equivalent to one year of daily use of the solution for 2 minutes. It was possible to verify significant alteration in surface roughness of the composite influenced by ethylic alcohol. It was not significant for distilled water and the mouthrinses.

Preliminary study of a novel in-office bleaching therapy modified with a casein phosphopeptide-amorphous calcium phosphate.

Although in‐office bleaching has been proven successful for bleaching teeth, controversy exists from morphological alterations in enamel morphology due to mineral loss and tooth sensitivity. This preliminary study aimed to evaluate the efficacy of a novel in‐office tooth bleaching technique modified with a casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) paste (MI paste—MI) and its effect on the enamel morphology and tooth sensitivity. Three patients received a 35% hydrogen peroxide (Whiteness HP—HP) dental bleaching system. HP was prepared and applied on the teeth on one of the hemiarches, whilst teeth on the other hemiarch were bleached with a mixture of HP and MI. Tooth color, epoxy resin replicas, and sensitivity levels were evaluated in the upper incisors. The results were analyzed descriptively. Right and left incisors showed similar color change after bleaching. Incisors bleached with the mixture of HP and MI presented unaltered enamel surfaces and lower sensitivity levels. The currently tested tooth bleaching technique did not reduce the gel effectiveness while decreasing hypersensitivity levels and protecting the enamel against surface alterations caused by the high‐concentration bleaching peroxide tested. The concomitant use of MI Paste and high‐concentration hydrogen peroxide might be a successful method for decreasing tooth sensitivity and limiting changes in the enamel morphology during in‐office bleaching. Microsc. Res. Tech. 2012.

Influence of etching time and bonding strategies on the microshear bond strength of self- and light-cured pit-and-fissure sealants

This study evaluated the impact of extended etching and bonding strategies on the microshear bond strength of three sealant materials. Two pit-and-fissure sealants [FluroShield, Dentsply (light-cured) and AlphaSeal, DFL (self-cured)] and one light-cured flowable composite resin (Permaflo, Ultradent) were evaluated according to different enamel etching times (15 s or 30 s) and bonding procedures (no adhesive application, application of primer/hydrophobic resin or hydrophobic resin only). Intact enamel blocks were obtained from bovine teeth and sealed via the tested protocols. After 24 h, the microshear bond strength test was performed in a universal testing machine at a crosshead speed of 0.5 mm/min. Failure modes were classified by stereomicroscopy. Data were submitted to a three-way ANOVA and to Tukeys test (α=0.05). There was no statistically significant difference (p>0.05) among the materials. Permaflo showed higher bond strength when etched for 30 s alone. Enamel overetching decreased the bond strength of the light-cured sealant. Primer/bond previous treatment improved bond performance for AlphaSeal. In conclusion, from the tested conditions, all sealant materials presented similar bond strength values in relation to bonding protocol and etching time. The flowable composite can be used as a pit-and-fissure sealant. The use of a three-step adhesive system was essential for the self-cured sealant application.

Filler morphology of resin-based low-viscosity materials and surface properties after several photoactivation times.

AIM This study aimed to characterize the morphology of filler particles and to analyze the effect of shortened and extended photoactivation times on hardness (VHN) and cross-link density (CLD) of resin-based low-viscosity materials. METHODS Sixteen commercially available materials were tested: four fissure sealants (Alpha Seal, Fluroshield Yellowed, Bioseal and Fluroshield White) and 12 flowable composites (Opallis T, Permaflo T, Opallis A2, Natural Flow A2, Master Flow A2, Permaflo A2, Filtek Z350 A2, Natural Flow O, Master Flow OA2, Opallis OA3.5, Filtek Z350 OA3, Opallis OP) at six curing times (10 s, 20 s, 30 s, 40 s, 50 s and 60 s). Specimens were fabricated (n = 5), analyzed by Scanning Electron Microscopy, by VHN and by CLD. RESULTS Unimodal and multimodal filler particles sizes with spherical and irregular shapes were observed. Unfilled materials were also detected. There were no differences among curing times for either VHN or CLD. Opallis A2 and Opallis OA3.5 showed the highest VHN at all curing times, whereas Master Flow A2 and Master Flow OA2 presented the lowest VHN. Opallis A2 presented the highest CLD at all curing times and Alpha Seal showed the lowest CLD. CONCLUSIONS Filler particle morphology differed among the resin-based low-viscosity materials tested. The shortest photoactivation time tested could yield similar VHN and CLD means to those provided by the most extended photoactivation time.