Serge Bouillaguet

Microtensile bond strength between adhesive cements and root canal dentin.

OBJECTIVES The hypotheses tested were that the bond strength of adhesive cements to root canal dentin (1) would be reduced as a function of configuration factor, polymerization process and type of luting material and (2) would be lowered near the apex of the tooth. METHODS Human canines and premolars were prepared for post cementation using Single Bond/Rely X ARC, ED Primer/Panavia F, C and B Metabond, and Fuji Plus. The specimens were divided into two groups. For intact roots, the posts were luted using standard clinical procedures. For flat roots, the posts were applied directly into flat ground canals. All roots were sectioned into 0.6 mm thick slices, trimmed mesio-distally and stressed to failure at 1 mm/min. The muTBS of each slab was calculated as the force at failure divided by the bonded cross-sectional surface area. The results were compared using a one-way ANOVA and Tukey multiple comparison intervals (alpha=0.05). Least squares linear regression analysis was used to assess the effect of dentin location on bond strength. RESULTS All cements showed significantly (p</=0.05) lower bond strengths in intact vs. flat roots. The muTBS of posts to intact roots were not significantly different for Single Bond/Rely X ARC and Panavia F, but both were significantly lower (p</=0.05) than the bonds produced by C and B Metabond and Fuji Plus cements. For Single Bond/Rely X ARC and Fuji Plus a significant decrease in bond strength was observed in dentin closer to the apex of the root. SIGNIFICANCE Stresses from polymerization shrinkage and problems with adequate access to the root canal complicate the formation of high-strength bonds when cementing endodontic posts with resin cements.

Dentinal Fluid Dynamics in Human Teeth, In Vivo

Cavities were prepared in human premolars scheduled for extraction for orthodontic reasons. The smear layer was removed from the dentin surface by acid etching, and the cavity was sealed using a hollow chamber. The chamber was filled with sterile saline solution and connected via tubing to a hydraulic circuit featuring an adjustable pressure reservoir and a device that measures fluid movement across dentin. In the absence of any exogenous pressure, all cavities exhibited an outward fluid flow rate of 0.36 microliters min-1 cm-2. As exogenous pressure was applied to the cavity, the outward flow slowed. The exogenous pressure that stopped outward fluid flow was taken to be equal to normal pulpal tissue pressure. The mean value was 14.1 cm H2O in five teeth. This simple method permits measurement of dentinal fluid flux, the hydraulic conductance of dentin, and estimates pulpal tissue pressure.

Bond strength of composite to dentin using conventional, one-step, and self-etching adhesive systems.

OBJECTIVES This in vitro study compared the dentin bonding performance of eight adhesive systems using a microtensile bond strength test. METHODS Thirty bovine teeth were ground to 600-grit to obtain flat root-dentin surfaces. Two conventional adhesive systems (Scotchbond Multipurpose Plus, OptiBond FL), four one-step adhesive systems (Scotchbond 1, Asba S.A.C., Prime and Bond NT, Excite) and two self-etching adhesive materials (Clearfil Liner Bond 2 V and Prompt L-Pop) were evaluated. Each bonding system was applied according to manufacturers instructions and followed by composite (Z100) application. Immediately after bonding, the teeth were prepared for microtensile testing. Bond strength to dentin was measured using a Vitrodyne V-1000 universal tester. There were 14 replicates for each material. Fractured specimens were further observed by SEM. RESULTS Scotchbond Multipurpose Plus exhibited significantly (p<0.05) higher bond strength values (30.3+/-9.4 MPa) than all other materials. The bond strengths of the other materials were (from highest to lowest): Opitbond FL (22.4+/-4.3 MPa); Scotchbond 1(18.9+/-3.2); Clearfil Liner Bond 2 V (18.9+/-3.0); Prime and Bond NT (18.3+/-6.9); Asba S.A.C. (14.4+/-2.9); Excite (13.8+/-3.7); and Prompt L-Pop (9.1+/-3.3). Statistical comparisons frequently overlapped, but Optibond was significantly (p<0.05) greater than Asba, Excite, and Prompt L-Pop; whereas, Scotchbond 1 was only significantly (p<0.05) greater than Prompt L-Pop. Asba, Excite and Prompt L-Pop were not significantly different. The fracture modes were mostly adhesive. CONCLUSIONS The conventional adhesive systems produced higher bond strengths to root dentin than most one-step adhesives and one self-etching adhesive; with the exception of one material in each respective system.

In vitro cytotoxicity and dentin permeability of HEMA

An in vitro diffusion chamber was used to measure the diffusion of 2-hydroxyethyl methacrylate (HEMA) through etched human dentin disks. Concentrations of HEMA, which diffused through dentin, were measured by ultraviolet spectroscopy, and the effect of initial HEMA concentration, dentin thickness, and back pressure on diffusion were assessed. The cytotoxicity of HEMA was determined using BALB/c 3T3 mouse fibroblasts in direct contact with HEMA for 12 or 24 h. HEMA diffused rapidly through dentin under all conditions, but increased thickness, back pressure, or decreased initial concentration all reduced diffusion. The permeability coefficient of HEMA was approximately 0.0003 cm/min, and diffusion through 0.5 mm of dentin reduced the HEMA concentration by a factor of approximately 6,000 (with 10 cm of H2O back pressure). It was concluded that the risk of acute cytotoxicity to HEMA through dentin was probably low, but that decreased dentin thickness, lack of polymerization, or extended exposure times might increase the risk significantly.

Volume of the internal gap formed under composite restorations in vitro

OBJECTIVES The gap that develops at the interface of dentin composite restoration during the polymerization of the resin can be subsequently filled by fluid filtrating from the pulp via the dentinal tubules. This in vitro study was designed to determine the volume of such a gap, at the occlusal floor of class I restoration and as a result of different dentin treatments and restoration procedures. METHODS Fifty-six human third molars had their pulp chambers first sealed and connected to a hydraulic apparatus permitting microlitre fluid shift recordings. The teeth then received class I cavities of uniform dimensions and were sampled into nine groups for three dentin treatments (bonding with a dentin bonding agent, lining with a resin modified light-cured glass ionomer, lining with a zinc phosphate cement) and three restoration procedures (Bulk placement of the composite material, Multilayer, Indirect inlay). Fluid displacements were recorded during the filling procedures and stopped 30 min after the completion of the restorations. RESULTS Dentin bonding agent treated cavities consistently presented the smallest gap volumes, followed by the GI and the ZnPO4 lined specimen. Multilayer and Indirect restoration techniques reduced the formation of gaps. CONCLUSIONS None of the materials or techniques tested assured a gap-free interface and more effort should be directed at increasing the adhesive and sealing properties of restorative materials to be placed on the dentin.

Bonding characteristics to dentin walls of class II cavities, in vitro

OBJECTIVES The objective of this study was to test the hypothesis that bond strengths to intact class II cavity wall surfaces are lower than those measured on corresponding flat surfaces isolated by cutting away the rest of the cavity walls. METHODS Class II (MOD) cavities were prepared in extracted human third molars and then divided into two groups: Intact cavity bonding group or flat surface group. All prepared surfaces were acid-etched and bonded with Scotchbond Multi-Purpose Plus adhesive system and restored with Z100 resin composite. After storage in water for 2 days, the teeth were divided mesio-distally into two equal halves. One half was vertically serially sectioned, while the other half was horizontally serially sectioned to yield a series of 0.5mm thick slabs. Each slab was trimmed into an hour-glass outline with the narrowest cross-sectional area at the region of interest (i.e., axial resin-dentin interface). RESULTS The mean bond strengths obtained in the cavity bonding group were significantly lower (p<0.05) than those of the flat bonding group. However, within either group, there were no significant consistent differences among the various regions. SIGNIFICANCE The large flat surfaces used in most laboratory bonding studies may overestimate the bond strengths that can be achieved in complex cavities prepared and restored under clinically relevant conditions.

Biological Risks of Resin-based Materials to the Dentin-Pulp Complex

Over the past 30 years, restorative dentistry has seen a revolution in materials, restorative techniques, and patient priorities. This revolution has been made possible with the development of new resin-based materials which can be bonded to the tooth structure. Not all of these changes have been without controversy or concern, and some have raised questions about the biological safety of these new materials and techniques. It is the purpose of this review to present recent and relevant information about the biological risks and consequences of resin-tooth bonding and how these risks are affected by the material, its clinical properties, and its manipulation by the practitioner. These biological risks are complex and interactive, and are still incompletely defined. In broad terms, these risks can be divided into those stemming from the toxicological properties of the materials themselves (direct biological risks) and those stemming from microbiological leakage (indirect biological risks).

In vitro cytotoxicity of traditional versus contemporary dental ceramics

STATEMENT OF PROBLEM The biocompatibility of new dental ceramics has not been assessed with the same scrutiny as has been applied to alloys and composites. Yet, the biocompatibility of ceramics is critical to the long-term success of dental prostheses because ceramics are in close contact with oral tissues for extended periods. MATERIAL AND METHODS Five dental ceramics (2 traditional feldspathic veneer porcelains [Vita Omega and Duceragold], 2 lithium disilicate pressable materials [Stylepress and Empress-2], and a pressable leucite-based material [Empress-1]) were tested for their ability to alter cellular mitochondrial dehydrogenase activity after fabrication using a tetrazolium assay, after aging for 2 weeks in a biologic solution and after post-aging polishing with either a fine diamond or diamond polishing paste. Cellular responses were compared with polytetrafluoroethylene controls (analysis of variance, Tukey pairwise post-hoc comparison, alpha=.05). RESULTS The feldspathic porcelains caused only mild (<25% of controls) mitochondrial suppression regardless of aging or polishing. The pressable leucite-based material initially caused a 5% stimulation (not significant) of mitochondrial activity, which decreased significantly (P<.05) by 30% with aging to levels comparable to the feldspathic porcelains, and did not change with polishing. Both lithium disilicate materials caused an initial suppression of mitochondrial activity that decreased significantly with aging, but Empress-2 was severely cytotoxic initially (<20% of controls, P<.01), and became more cytotoxic again after polishing. Stylepress was less cytotoxic initially (85% of controls, not significant) and did not become cytotoxic again after polishing. CONCLUSIONS Dental ceramics are not equivalent in their in vitro biologic effects, even within the same class of material, and biologic safety should not be assumed. Most ceramics caused only mild in vitro suppression of cell function to levels that would be acceptable on the basis of standards used to evaluate alloys and composites. However, 1 Li-disilicate material (Empress-2) exhibited cytotoxicity that would not be deemed biologically acceptable on the basis of prevailing empirical standards for dental alloys and composites.

In vitro biological response to core and flowable dental restorative materials.

OBJECTIVES In vitro cytotoxicities of commercially available core and flowable dental restorative materials were assessed and compared to traditional resin composites. Our hypothesis was that the increased resin diluents added to achieve higher flow in flowables would increase cytotoxicities, whereas the higher filler content of core materials would decrease cytotoxicities relative to traditional resin composites. METHODS Specimens were made under aseptic conditions, then extracted into an artificial saliva solution for 0-4 weeks, to assess the effect of aging on cytotoxicity. After extraction, specimens were tested for cytotoxicity in vitro using Balb/c fibroblasts in direct contact format. Cells were exposed to the materials for 48h, after which the mitochondrial activity of the cells was measured (MTT method). Cellular activity was normalized to Teflon negative controls. RESULTS Core materials were uniformly and severely (<50% of Teflon cellular activity) cytotoxic initially, but several materials (Corepaste, Definite core) improved somewhat with aging in artificial saliva. Flowable materials were uniformly and severely cytotoxic with no trend toward improvement with aging. The Definite-flow was the least cytotoxic of the flowable materials, but it too was severely cytotoxic. SIGNIFICANCE Commercially available core and flowable restorative materials showed severe in vitro cytotoxicities that are worse than some traditional composites and most dental casting alloys and amalgams used today. Of particular note was the persistent cytotoxicity of these materials after 4 weeks of extraction with artificial saliva. These cytotoxicities indicate a continuing release of mass from these materials at levels that have biological relevance in vitro. In vivo relevance of these cytotoxicities is less clear, but these results indicate a higher biological risk for these materials compared to traditional materials that exhibit less initial toxicity and improve with aging time.

Effect of sub-lethal concentrations of HEMA (2-hydroxyethyl methacrylate) on THP-1 human monocyte-macrophages, in vitro

OBJECTIVE Resin monomers such as HEMA (2-hydroxyethyl methacrylate) can be released from restorative materials and diffuse into the tooth pulp over long periods of time. Although the short-term toxicity of resin monomers has been well documented, little is known about the risk for chronic toxicity resulting from low concentrations of resins. Thus, the hypothesis tested in this study was that sub-lethal concentrations of HEMA alter the functions of macrophages after long-term exposure. METHODS Human THP-1 monocyte-macrophages were exposed to concentrations of HEMA between 0 and 1.5 mmol/l for up to 6 weeks. Cellular proliferation was measured by a hemocytometer with trypan-blue dye exclusion. Mitochondrial activity was measured by the MTT assay, and total cellular protein was measured using the bicinchoninic acid assay. RESULTS Macrophage proliferation was inhibited 40-50% (significant, p < 0.05) by as little as 0.75 mmol/l after 1 week of exposure. Inhibition of proliferation remained constant after 1 week. The total protein per cell increased by as much as 80% (significant, p < 0.05) after 2 weeks and remained elevated through 6 weeks. Mitochondrial activity per cell increased 60-80% (significant, p < 0.05) after 2 weeks, then decreased. However, mitochondrial activity remained significantly elevated above controls through 6 weeks. SIGNIFICANCE Findings from the current study indicate that 6-week exposures of monocytes to HEMA alter their proliferation and other activities at concentrations substantially lower than previously reported. This is particularly relevant in light of evidence that such concentrations have been previously shown to come through dentin by diffusion.