Sevil Gurgan

Chemical Analysis of Enamel and Dentin Following the Application of Three Different At-home Bleaching Systems

PURPOSE To determine the change in the chemical composition of enamel and dentin as well as to evaluate the differences in surface texture of the same dental hard tissues following three at-home bleaching systems in vitro. METHODS Sixty extracted intact human anterior teeth were used in this study. Thirty teeth were used as samples for enamel, and the buccal surfaces of the remaining 30 teeth were abraded and used as dentin samples. Prior to bleaching treatments, calcium (Ca), phosphorus (P), potassium (K), sodium (Na), magnesium (Mg), fluoride (F), and oxygen (O) levels of each sample were measured using an energy dispersive spectrometer. The teeth were then randomly allocated into three groups according to the bleaching system used, as follows: GI, 10% carbamide peroxide (CP); GII, 20% CP; GIII, and 35% CP. Following the bleaching treatments, Ca, P, K, Na, Mg, F, and O measurements were repeated. The surface configurations were examined using scanning electron microscopy (SEM). The data were analyzed using Wilcoxon signed rank and Kruskal-Wallis tests followed by the Dunn test. RESULTS All three bleaching systems tested caused similar changes in the chemical composition of enamel and dentin. Bleaching systems decreased Ca and K, while F and O levels increased in enamel. In dentin, Ca, P, and K levels decreased; however, Na, F, and O levels increased. SEM observations revealed no deleterious effect on enamel and dentin. CONCLUSION The use of home bleaching agents could affect the chemical composition of dental hard tissues, whereas the change in the chemical composition of enamel and dentin was not affected by the CP concentration of the bleaching systems used.

Effect of different adhesive systems and laser treatment on the shear bond strength of bleached enamel

PURPOSE This study determined the shear bond strength of a nanohybrid composite resin to bleached enamel immediately or 15 days later using different adhesive systems and laser application. METHODS One hundred and forty enamel specimens were prepared from human molar teeth and bleached either with 16% carbamide peroxide (CP) or 30% CP according to the manufacturers (Vivastyle/Vivadent) recommendations. After bleaching treatments specimens were divided into two groups according to the treatment time of the adhesive procedures: immediately or 15 days after the bleaching treatments. The four groups were then divided into five subgroups due to the surface treatments: using a two-step self-etching adhesive (AdheSe, Ivoclar Vivadent G, Schaan, Liechtenstein) or a two-step etch and rinse adhesive (Excite, Ivoclar Vivadent G, Schaan, Liechtenstein) and application of laser prior to adhesive procedures or not. After adhesive procedures nanohybrid composite resin cylinders of 4 mm x 2 mm (Tetric Evo Ceram/Vivadent) were bonded to the enamel surfaces. All specimens were subjected to shear bond strength test after thermocycling and 24h of storage in water. Data were analyzed statistically. RESULTS Mann-Whitney U-test analysis showed no significant difference in the mean bond strength values of enamel bleached with either 16% CP or 30% CP (p>0.05). There was no difference between the groups bonded immediately or 15 days after bleaching (p>0.05). Application of the etch and rinse adhesive after 15 days showed the highest bond strength values, whereas self-etching adhesive and laser application showed the lowest values in both bleaching treatments. CONCLUSIONS The results suggested that following the bleaching treatments, the use of etch and rinse adhesive system may provide higher bond strengths than self-etching adhesive and laser application.

Six-year clinical evaluation of packable composite restorations.

OBJECTIVE For decades, resin composites have been used with increasing frequency as posterior restorative materials, because of the demand for aesthetic restoration. This study evaluated the six-year clinical performance of Filtek P60 (3M ESPE) packable composite restorations in combination with a one-bottle etch and rinse adhesive, Single Bond (3M ESPE), in Class II restorations. METHODS A total of 47 restorations were placed in the Class II cavity preparations (27 premolars and 20 molars) of 33 patients (22 female/11 male; mean age 34) by the same operator. The restorations were evaluated by two examiners at baseline and 1, 2, 3 and 6 years according to the method developed by Ryge, which also is known as the United States Public Health Service (USPHS) criteria. The following characteristics were observed: marginal adaptation, anatomical form, surface texture, marginal discoloration, surface staining, post-operative sensitivity and secondary caries. The Chi-square and Wilcoxon signed rank test with Bonferroni adjustment were used for statistical analysis (p = 0.05). RESULTS All the restorations received Alpha scores at baseline assessment, except for one restoration, which showed post-operative sensitivity. At the three-year recall examination, two patients, with a total of three restorations, were not included. From baseline to three years, only two of the 44 restorations changed from Alpha to Bravo, for numerous reasons. At the six-year recall, 44 restorations were available for examination. The majority of restorations exhibited Alpha or Bravo scores for the evaluated criteria. No significant differences were found for any of the clinical criteria (p > 0.05). Only two restorations needed to be repaired due to caries that began independently from the restorations. Three or four restorations showed slight surface staining and marginal discoloration. CONCLUSIONS The clinical performance of the posterior composite restorations that were evaluated was acceptable after six years of service.

Shear bond strength of composite bonded to Er,Cr:YSGG laser-prepared dentin.

OBJECTIVE The purpose of this in vitro study was to evaluate dentin bond strength to resin composite following high-speed rotary or Er,Cr:YSGG laser preparation using two different adhesive systems. MATERIALS AND METHODS One hundred and forty dentin specimens were prepared from human molars. Seventy specimens were prepared with a high-speed diamond bur and 70 of the specimens were prepared with an Er,Cr:YSGG laser. Each group was subdivided into 7 groups of 10 teeth and etched with either 37% H3PO4, laser etched at two different power levels (1.25 W and 3 W), or not etched. Nano-hybrid composite resin cylinders 4 x 2 mm in size (Tetric EvoCeram, Vivadent) were bonded to the dentin surfaces with the application of an etch-and-rinse adhesive (Exite/Vivadent), or a self-etching adhesive (AdheSe/Vivadent). After storage in distilled water and thermocycling, a shear bond strength test was performed on all specimens and the data were statistically analyzed. RESULTS ANOVA detected significant differences between the tested groups (p < 0.001). Duncans multiple comparison test showed that Excite-applied specimens that were prepared with laser and laser etched (1.25 W or 3 W) had higher mean bond strengths. Both AdheSe- and Excite-applied specimens prepared with the diamond bur and laser etched (1.25 W) showed the lowest mean bond strength values (p < 0.05). CONCLUSION The results suggest that dentin surfaces prepared with the Er,Cr:YSGG laser and etched with the laser (at either 1.25 or 3 W) may provide comparable or increased composite resin bond strengths, depending on the adhesive used.

Bleaching-induced colour change in plastic filling materials.

The purpose of this in vitro study is to compare the colour changes of five different tooth-coloured restoratives: Ormocer (Definite/Degussa), compomer (Dyract AP/Dentsply De Tray), packable composite (Filtek P60/3M), flowable composite (Filtek Flow/3M) and hybrid composite (Filtek Z250/3M) after two different bleaching regimens [Vivastyle (10% carbamide peroxide)/Vivadent and Crest Professional Whitestrips (6.5% hydrogen peroxide strip bands)/Procter & Gamble]. Fifteen specimens of 30 × 30 × 2mm3 size were fabricated from each material and randomly divided into three groups of five. Specimens in group one were stored in distilled water at 37°C for two weeks and served as control. Group two specimens were treated with Vivastyle for two hours per day for two weeks and group three specimens were treated with Whitestrips for 30 min twice daily for two weeks. During the test period the specimens were kept at 37 C and in 100% relative humidity. At the end of the bleaching regimens colour measurements of the control and test groups were made with UV visible recording spectrophotometer. Colour changes were calculated with the use of the CIE-LAB uniform colour scale and compared by the use of Kruskall–Wallis test, followed by the Mann–Whitney U test. Control, Vivastyle and Whitestrips L*, a* and b* values differed significantly for all materials except Filtek Z250 (p < 0.05). All restorative materials demonstrated significantly higher colour change (ΔE) with Whitestrips (p < 0.05). Dyract AP demonstrated the highest colour change both for the bleaching regimens followed by Filtek Flow, Definite, Filtek P60, and Filtek Z250 showed the smallest colour change. Colour change of plastic restorative materials during bleaching is both filling material and bleach specific.

Four-year Randomized Clinical Trial to Evaluate the Clinical Performance of a Glass Ionomer Restorative System

OBJECTIVE The aim of this study was to evaluate the clinical performance of a glass ionomer restorative system compared with a microfilled hybrid posterior composite in a four-year randomized clinical trial. METHODS A total of 140 (80 Class 1 and 60 Class 2) lesions in 59 patients were either restored with a glass ionomer restorative system (Equia, GC, Tokyo, Japan), which was a combination of a packable glass ionomer (Equia Fil, GC) and a self-adhesive nanofilled coating (Equia Coat, GC), or with a microfilled hybrid composite (Gradia Direct Posterior, GC) in combination with a self-etch adhesive (G-Bond, GC) by two experienced operators according to the manufacturers instructions. Two independent examiners evaluated the restorations at baseline and at one, two, three, and four years postrestoration according to the modified US Public Health Service criteria. Polyvinyl siloxane impression negative replicas at each recall were observed under scanning electron microscopy (SEM) to evaluate surface characteristics. The statistical analyses were carried out with McNemar, Pearson Chi-square, and Cochran Q-tests (p<0.05). RESULTS After four years, 126 (76 Class 1 and 50 Class 2) restorations were evaluated in 52 patients, with a recall rate of 88.1%. None of the restorations showed trends to downgrade in anatomical form, secondary caries, surface texture, postoperative sensitivity, and color match (p>0.05). Significant differences in marginal adaptation and discoloration were found at four years compared to baseline for both restorative materials for Class 1 and Class 2 restorations (p<0.05). Only one Class 2 Equia restoration was missing at three years (3.9%), and another one was missing at four years (7.7%) (p>0.05). SEM evaluations were in accordance with the clinical findings. CONCLUSIONS The use of both materials for the restoration of posterior teeth exhibited a similar and clinically successful performance after four years.

Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section

The replacement of a restoration is one of the most common procedures in dentistry. However, the criteria for such intervention, excluding catastrophic failure and persistent discomfort and pain, continue to be the subject of considerable debate. The decision-making process remains subjective on the part of the treating clinician, while the evidence base for refurbishment and repair rather than replacement for the management of defective and failing restorations continues to grow and strengthen. This article, prepared as an Academy of Operative Dentistry European Section consensus publication, reviews existing criteria for the replacement of restorations and encourages practitioners to shift, if not already doing so, to considering the replacement of a restoration as a last resort rather than as a prudent action to be taken if in any doubt about clinical acceptability. Further research in the area, spanning the risk assessment of defective and failing restorations and new diagnostic tools and processes, together with work to enhance the evidence base of restoration repair vs replacement, would be of immense value.

Effects of Ozone and ND:YAG Laser Pretreatment on Bond Strength of Self-Etch Adhesives to Coronal and Root Dentin

OBJECTIVES The aim of this study was to evaluate the effects of two different disinfection treatments--ozone and Nd:YAG laser application--on shear-bond strength (SBS) of self-etch adhesives to coronal and root dentin. MATERIALS AND METHODS Sixty extracted human canines were ground flat, exposing the coronal and root dentin surfaces, and randomly divided into three groups. The surfaces were untreated (Control) or treated with ozone (HealOzone, KaVo) or Nd:YAG laser (Fidelis III, Fotona). Coronal and root dentins of 10 teeth of each group were treated with a two-step self-etch adhesive (Clearfil SE Bond, Kuraray Medical; SE), whereas the remaining 10 teeth were treated with a one-step self-etch adhesive (Clearfil Tri-S Bond, Kuraray Medical; S3). A resin composite (Clearfil Majesty Esthetics, Kuraray Medical) was then placed, and SBS was tested with a universal testing machine. Failure modes were determined under a stereomicroscope. The mean SBS values of each group were calculated, and data were subjected to statistical analysis (p = 0.05). RESULTS For the coronal dentin, Control/SE showed significantly higher values than Control/S3, Ozone/S3, and Nd:YAG/S3. Although Ozone/SE showed significantly higher values than Nd:YAG/S3 (p < 0.05), the differences within the other groups were not significant for the root dentin (p > 0.05). Comparison of two dentin substrates in each group did not show any significant difference except for Control/SE, in which coronal dentin showed higher SBS. The failure modes of all groups were mainly adhesive. CONCLUSION Pretreatments with Ozone or Nd:YAG laser did not impair the SBS of both of the self-etch adhesives used to coronal and root dentin.

The Effect of Bleachıng Systems on the Gingiva and the Levels of IL-1β and IL-10 in Gingival Crevicular Fluid

OBJECTIVE This study aimed to evaluate the color change and clinical periodontal parameters and to analyze the interleukin–1 beta (IL-1β) and interleukin-10 (IL-10) levels in gingival crevicular fluid (GCF) of patients treated with different bleaching systems. MATERIALS AND METHODS According to pre-established criteria, 30 healthy volunteers were selected and randomly divided into three groups (n=10): G1, home bleaching (Opalescence 35% Carbamide Peroxide, CP); G2, chemically activated office bleaching (Opalescence Xtra Boost 38% Hydrogen Peroxide, HP); G3, light-activated office bleaching (Opalescence Xtra 35% HP). Treatments were applied according to the manufacturers recommendations. After shade evaluation, clinical periodontal parameters were evaluated as follows: gingival index (GI), plaque index (PI), and bleeding on probing (BOP). GCF were collected from six maxillary sites per patient at baseline (T0), one day (T1) after bleaching treatments, and 15 days (T2) after bleaching treatments and analyzed for IL-1β and IL-10 by enzyme-linked immunosorbent assay. Data were subjected to statistical analysis (p<0.05). RESULTS Spectrophotometer readings exhibited significant differences among the groups (p<0.05). The ΔE values (color change) of G3 were statistically higher than the other groups (p<0.05). The PI of G3 after 15 days was significantly higher than the PI of G2 after 15 days (p<0.05). The GI of G2 was lower than that of G1 and G3 before bleaching (p<0.05). According to BOP, no significant differences were found among the groups at any time intervals (p>0.05). In G3, the total amount of IL-1β after 15 days was higher than the amount before bleaching (p<0.05). The IL-10 total amount and concentration levels did not exhibit any significant differences among the groups or by time (p>0.05). CONCLUSION Home and chemically activated bleaching systems could be considered as safer in tooth whitening and maintaining gingival health when compared with a light-activated bleaching system, which might lead to increased proinflammatory cytokine (IL-1β).

The Effect of Different Preparation and Etching Procedures on the Microleakage of Direct Composite Veneer Restorations

OBJECTIVES The aim of this in vitro study was to compare the microleakage of direct composite veneer restorations prepared by a conventional dental bur or Er,Cr:YSGG (erbium, chromium doped yttrium scandium gallium garnet) laser and etched with different procedures. METHODS Fifty maxillary incisor teeth prepared for direct veneers with gingival margins in dentin and incisal margins in enamel were randomly divided into five groups (n = 10): group 1 (control), prepared with diamond bur and etched with phosphoric acid; group 2, prepared with diamond bur and etched with Er,Cr:YSGG laser (Waterlase MD/Biolase); group 3, prepared with laser and not etched; group 4, prepared with laser and etched with phosphoric acid; and group 5, prepared and etched with laser. After the application of the etch and rinse adhesive system (Prime & Bond NT/Dentsply), teeth were restored with the nano ceramic restorative material (Ceram X Duo/Dentsply), subjected to thermocycling and immersed in 0.5% basic fuchsin dye for 24 h. The teeth were sectioned longitudinally and dye penetration was evaluated by a binocular stereomicroscope equipped with a measuring device. Data were analyzed by Kruskal-Wallis and Wilcoxon signed ranks tests. The level of significance was set at p = 0.05. RESULTS Significant differences were observed in enamel of the five groups (p < 0.05). Minimal microleakage was observed in groups 1 and 3. The highest microleakage was evaluated in group 5 (p < 0.05). No significant differences were found among the five groups in dentin (p > 0.05). No differences were recorded between the microleakage values in enamel and dentin within each group and this was valid for all groups (p > 0.05). CONCLUSIONS The results confirmed that enamel and dentin surfaces prepared with Er,Cr:YSGG laser for direct composite veneer restorations may provide comparable sealing.