Pierre Colon

Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear—diagnosis and management

ObjectiveDue to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report.Materials and methodsThis report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD.ResultsETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies.ConclusionsEffective management of ETW includes screening for early signs of ETW and evaluating all etiological factors.Clinical RelevanceETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

Comparison of mechanical properties of a new fiber reinforced composite and bulk filling composites

Objectives The aim of this study was to evaluate the mechanical and physical properties of a newly developed fiber reinforced dental composite. Materials and Methods Fiber reinforced composite EverX Posterior (EXP, GC EUROPE), and other commercially available bulk fill composites, including Filtek Bulk Fill (FB, 3M ESPE), SonicFill (SF, Kerr Corp.), SureFil (SDR, Dentsply), Venus Bulk Fill (VB, HerausKultzer), Tetric evoceram bulk fill (TECB, Ivoclar Vivadent), and Xtra Base (XB, Voco) were characterized. Composite samples light-cured with a LED device were evaluated in terms of flexural strength, flexural modulus (ISO 4049, n = 6), fracture toughness (n = 6), and Vickers hardness (0, 2, and 4 mm in depth at 24 hr, n = 5). The EXP samples and the fracture surface were observed under a scanning electron microscopy. Data were statistically analyzed using one-way ANOVA and unpaired t-test. Results EXP, FB, and VB had significantly higher fracture toughness value compared to all the other bulk composite types. SF, EXP, and XB were not statistically different, and had significantly higher flexural strength values compared to other tested composite materials. EXP had the highest flexural modulus, VB had the lowest values. Vickers hardness values revealed SF, EXP, TECB, and XB were not statistically different, and had significantly higher values compared to other tested composite materials. SEM observations show well dispersed fibers working as a reinforcing phase. Conclusions The addition of fibers to methacrylate-based matrix results in composites with either comparable or superior mechanical properties compared to the other bulk fill materials tested.

Minimal intervention dentistry: part 5. Ultra-conservative approach to the treatment of erosive and abrasive lesions

The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse etiological factors may be associated with the condition and they could be difficult to eliminate; this has to be considered when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE). Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even extensive restorations. The possibility of managing subsequent interventions should be considered when planning the initial therapeutic approach.

Toxicity evaluation of two dental composites: three-dimensional confocal laser scanning microscopy time-lapse imaging of cell behavior.

The purpose of this study was to investigate the in vitro biocompatibility of two dental composites (namely A and B) with similar chemical composition used for direct restoration using three-dimensional confocal laser scanning microscopy (CLSM) time-lapse imaging. Time-lapse imaging was performed on cultured human HGF-1 fibroblast-like cells after staining using Live/Dead®. Image analysis showed a higher mortality rate in the presence of composite A than composite B. The viability rate decreased in a time-dependent manner during the 5 h of exposure. Morphological alterations were associated with toxic effects; cells were enlarged and more rounded in the presence of composite A as shown by F-actin and cell nuclei staining. Resazurin assay was used to confirm the active potential of composites in cell metabolism; results showed severe cytotoxic effects in the presence of both no light-curing composites after 24 h of direct contact. However, extracts of polymerized composites induced a moderate decrease in cell metabolism after the same incubation period. Composite B was significantly better tolerated than composite A at all investigated end points and all time points. The finding confirmed that the used CLSM method was sufficiently sensitive to differentiate the biocompatibility behavior of two composites based on similar methacrylate monomers.

Mesoporous silica fillers and resin composition effect on dental composites cytocompatibility

OBJECTIVE Many new dental composites containing mesoporous silica fillers have been developed to improve rheological properties and enhance the resin-filler interface. To investigate the correlation between the cytocompatibility of several dental composites and their composition; two aspects have been considered: presence of bisphenol A (BPA)-glycidyl methacrylate (Bis-GMA) or triethyleneglycol-dimethacrylate (TEGDMA) among the resin monomers and presence of porous particles among the filler blends. METHODS Five commercial composites with different resin matrices and mineral fillers were compared to four experimental composites designed without any BPA-based monomers or TEGDMA. Porous fillers, with or without silanation, were added in some of the experimental composites. Two reference resin matrices were also selected. Cytocompatibility with cultured primary human gingival fibroblasts was assessed by confocal laser scanning microscopy with time-lapse imaging. Fourier transform infrared spectroscopy was used to control monomer conversion rate. RESULTS Conversion rates of the experimental composites ranged from 57% to 71%, a comparable ratio for dental composites. Experimental samples were better tolerated than tested commercial samples not containing TEGDMA and significantly better than those containing TEGDMA. Experimental composites with porous fillers exhibited good cytocompatibility, especially when surfaces were silanated. SIGNIFICANCE Cytotoxicity was associated with resin amount and especially resin nature. Composites containing porous fillers might behave as if the resin trapped into pores has no effect on toxicity. The cytotoxicity of composites with and without BPA derivatives was mainly attributed to the release of residual TEGDMA rather than the BPA derivatives.