Rhk Wong

Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995–2005 and 2006–2016 periods

Composites are increasing in popularity as restorative materials. This growing role indicates the necessity of studies on their clinical outcome. In this study, clinical studies published on the performance of posterior composite restorations were included except those of less than a 24-month assessment period. Results of non-vital, anterior or primary teeth and cervical single-surface restorations were also excluded. Records about composite type, number of final recall restorations, failure/survival rate, assessment period and failure reasons were analysed for each decade. Overall survival/failure rates for studies in 1995-2005 were 89.41%/10.59% and for 2006-2016 were 86.87%/13.13%, respectively. In 1995-2005, the reasons for failure were secondary caries (29.47%) and composite fracture (28.84%) with low tooth fracture (3.45%) compared with reasons of failure in 2006-2016, which were secondary caries (25.68%), composite fracture (39.07%), and tooth fracture (23.76%). An increase in incidence of composite fracture, tooth fracture and need for endodontic treatment as failure reasons was noted in the latter decade in addition to a decrease in secondary caries, postoperative sensitivity, unsatisfactory marginal adaptation and wear. The overall rates of failure showed little difference, but the causes showed a notable change. This is believed to be a reflection of increased use of composites for larger restorations and possibly changes of material characteristics.

Ion release and physical properties of CPP–ACP modified GIC in acid solutions

UNLABELLED A new glass-ionomer cement (GIC) (Fuji VII™ EP) includes 3% (w/w) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) to enhance ion release. OBJECTIVES To assess this new GIC compared with a GIC without CPP-ACP (Fuji VII™) with respect to ion release, changes in surface hardness and in mass under a variety of acidic and neutral conditions. METHODS Eighty blocks of Fuji VII™ (F7) and Fuji VII™ EP (F7EP) were subjected to three acidic solutions (lactic and citric acids pH 5.0, hydrochloric acid pH 2.0) and water (pH 6.9) over a three-day period. Ion release, surface hardness and weight measurements were carried out every 24h. RESULTS Higher calcium ion release from F7EP was observed under all acidic conditions. Increased inorganic phosphate ion release was observed for F7EP in hydrochloric and citric acids. Fluoride ion release was similar between F7 and F7EP under all conditions but was significantly higher in acids compared with water. After three days there was no significant difference in surface hardness (p>0.05) between the two materials under all conditions except hydrochloric acid. Minimal change in mass was observed for F7 and F7EP in water, lactic and hydrochloric acids, however citric acid caused significantly more mass loss compared with water (p<0.001). CONCLUSION Incorporation of 3% (w/w) CPP-ACP into F7 enhanced calcium and phosphate ion release, with no significant change in fluoride ion release and no adverse effects on surface hardness or change in mass. CLINICAL SIGNIFICANCE STATEMENT GICs have the potential to release fluoride ions particularly under acidic conditions associated with dental caries and erosion. A new GIC containing CPP-ACP and fluoride releases not only fluoride ions but also calcium and phosphate ions under acidic conditions which should help to inhibit demineralisation associated with caries and erosion.

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 3: Dentists' attitudes

BACKGROUND The Minamata Convention has agreed to a worldwide reduction in the production and use of mercury-containing products and processes. This will change the approach to use of direct restorative materials in the future. There is little research exploring the attitudes of dentists to any change. METHODS A survey relating to the use of direct restorative materials was distributed to dentists who were members of the Australian Dental Association or Members and Fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. RESULTS There were 408 respondents. Responses to statements concerning attitudes toward a phase-down of amalgam depended on whether the respondent used amalgam, year of primary dental qualification and association with academia. Thirty per cent of respondents indicated they do not use amalgam. The mean use of amalgam for all direct restorative procedures was 18%. CONCLUSIONS Dentists are concerned over potential implications of a phase-down of amalgam and much should be done to address these concerns. Many dentists are undecided as to what are the implications, which may reflect a lack of understanding of the issues. It is incumbent on policy-makers to produce and disseminate information relating to the issues identified by this research.

Effect of Sodium Ascorbate on Resin Bonding to Sodium Perborate–bleached Dentin

SUMMARY This was an in vitro study to evaluate the effect of sodium ascorbate on the microshear bond strength (MSBS) of resin composite to sodium perborate-bleached dentin. Molar dentin sections were divided into six groups: 1) control, 2) sodium perborate (SP) bleach and immediate bonding, 3) SP and 30 second sodium ascorbate (SA); 4) SP and 1 minute SA; 5) SP and 2 minute SA; and 6) SP and 7 day delay before bonding. They were further divided into two-step self-etching (Clearfil SE Bond) or all-in-one self-etching (Xeno IV) adhesive systems. Resin composite microtubes were bonded according to dentin location-center, pulp horn, and peripheral positions-and an MSBS test was carried out. Failure mode was determined using light microscopy and scanning electron microscopy. There were no significant differences between the treatment types/groups. MSBSs were significantly higher for two-step self-etching adhesive compared with all-in-one self-etching adhesive (p=0.028). For the all-in-one adhesive, MSBSs at the center and pulp horn positions were significantly lower than the peripheral positions (p<0.001). All-in-one groups had significantly more adhesive failures than two-step adhesive groups (p=0.015). The odds of adhesive failure were higher at the pulp horn position than the peripheral position (p=0.004). Sodium perborate bleaching of dentin had no effect on MSBS or mode of failure for either two-step or all-in-one self-etching adhesives; therefore, the effect of sodium ascorbate was negligible. The two-step adhesive groups demonstrated the highest MSBS, and the all-in-one groups, when bonded to center and pulp horn dentin, exhibited the lowest MSBS.

The Effect of Resin-modified Glass-ionomer Cement Base and Bulk-fill Resin Composite on Cuspal Deformation

OBJECTIVES This study investigated cuspal deformation in teeth restored with different types of adhesive materials with and without a base. METHODS Mesio-occluso-distal slot cavities of moderately large dimension were prepared on extracted maxillary premolars (n=24). Teeth were assigned to one of four groups and restored with either a sonic-activated bulk-fill resin composite (RC) (SonicFill), or a conventional nanohybrid RC (Herculite Ultra). The base materials used were a flowable nanofilled RC (Premise Flowable) and a high-viscosity resin-modified glass-ionomer cement (RMGIC) (Riva Light-Cure HV). Cuspal deflection was measured with two direct current differential transformers, each contacting a buccal and palatal cusp. Cuspal movements were recorded during and after restoration placement. Data for the buccal and palatal cusp deflections were combined to give the net cuspal deflection. RESULTS Data varied widely. All teeth experienced net inward cuspal movement. No statistically significant differences in cuspal deflection were found among the four test groups. CONCLUSIONS The use of a flowable RC or an RMGIC in closed-laminate restorations produced the same degree of cuspal movement as restorations filled with only a conventional nanohybrid or bulk-fill RC.

Incorporation of the microencapsulated antimicrobial agent phytoncide into denture base resin

BACKGROUND This study aimed to fabricate a denture base resin (DBR) containing phytoncide microcapsules (PTMCs) and determine the mechanical properties of the resin and antifungal activity. METHODS Fifty-four heat-cured rectangular DBR specimens (64 × 10 × 3.3 ± 0.2 mm) containing nine concentrations of PTMC between 0 and 5% (wt/wt) were fabricated and subjected to a three-point bending test. A phytoncide release bioassay was developed using DBR containing 0% and 2.5% PTMCs (wt/wt) in a 24 well-plate assay with incubation of Porphyromonas gingivalis at 37 °C for 74 h. The antifungal activity of PTMCs against Candida albicans, in a pH 5.5 acidic environment was determined in a plate assay. RESULTS Flexural strength decreased with increasing PTMC concentration from 97.58 ± 4.79 MPa for the DBR alone to 53.66 ± 2.46 MPa for DBR containing 5.0% PTMC. No release of phytoncide from the PTMCs in the DBR was detected at pH 7.4. The PTMCs had a minimal inhibitory concentration of 2.6% (wt/vol) against C. albicans at pH 5.5. CONCLUSIONS PTMCs can be added to DBR 2.5% (wt/wt) without adversely affecting flexural strength. PTMCs released the antimicrobial agent at pH 5.5 at concentrations sufficient to inhibit the growth of the C. albicans.