Stefano Chersoni

In vivo and in vitro Permeability of One-step Self-etch Adhesives

Adhesive dentistry should effectively restore the peripheral seal of dentin after enamel removal. We hypothesize that non-rinsing, simplified, one-step self-etch adhesives are effective for minimizing dentin permeability after tooth preparation procedures. Crown preparations in vital human teeth were sealed with Adper Prompt, Xeno III, iBond, or One-Up Bond F. Epoxy resin replicas were produced from polyvinyl siloxane impressions for SEM examination. Dentin surfaces from extracted human teeth were bonded with these adhesives and connected to a fluid-transport model for permeability measurements and TEM examination. Dentinal fluid droplets were observed from adhesive surfaces in resin replicas of in vivo specimens. In vitro fluid conductance of dentin bonded with one-step self-etch adhesives was either similar to or greater than that of smear-layer-covered dentin. TEM revealed water trees within the adhesives that facilitate water movement across the polymerized, highly permeable adhesives. Both in vitro and in vivo results did not support the proposed hypothesis.

Osmotic Blistering in Enamel Bonded with One-step Self-etch Adhesives:

One-step self-etch adhesives behave as permeable membranes after polymerization, permitting water to move through the cured adhesives. We hypothesize that osmotic blistering occurs in bonded enamel when these adhesives are used without composite coupling. Tooth surfaces from extracted human premolars were bonded with 5 one-step self-etch adhesives. They were immersed in distilled water or 4.8 M CaCl2, and examined by stereomicroscopy, field-emission/environmental SEM, and TEM. Water blisters were observed in bonded enamel but not in bonded dentin when specimens were immersed in water. They collapsed when water was subsequently replaced with CaCl2. Blisters were absent from enamel in specimens that were immersed in CaCl2 only. Water trees were identified from adhesive-enamel interfaces. Osmotic blistering in enamel is probably caused by the low water permeability of enamel. This creates an osmotic gradient between the bonded enamel and the external environment, causing water sorption into the interface.

Cyclic Fatigue Testing and Metallographic Analysis of Nickel-Titanium Rotary Instruments

INTRODUCTION The aim of this study was to compare cyclic fatigue resistance of four nickel-titanium rotary systems and to evaluate their surface, fractographic, and matrix morphology. METHODS Four models of endodontic rotary files (EasyShape [Komet/Gebr. Brasseler, Lemgo, Germany], ProTaper [Dentsply Maillefer, Ballaigues, Switzerland], NRT [MANI Inc, Toshigi-Ken, Japan], and AlphaKite [Komet/Gebr. Brasseler]) were subjected to fatigue testing in artificial canals with angle of curvature of 45° and 60° and a radius of curvature of 5 mm until fracture occurred. Nickel-titanium (NiTi) alloy properties were investigated by light microscopy, environmental scanning electron microscopy (ESEM), and energy dispersive x-ray spectrophotometry (EDS). ESEM analysis was conducted on new files to examine surface characteristics and on fractured samples to identify the crack origin and the fractographic features. RESULTS Analysis of variance testing revealed significant differences (P < .001) among the groups. NRT files had the highest fatigue resistance followed by AlphaKite, EasyShape, and ProTaper. All the new files presented surface imperfections. Fractographic analysis found the crack initiation to originate at the level of surface irregularities. Optical microscope inspection of the NiTi alloy matrix disclosed different-sized nonmetallic inclusions among models. EDS analysis of these inclusions showed that they were composed of carbon and oxygen in addition to nickel and titanium. Under light microscopy, austenitic grains appeared larger near the handle and smaller near the tip in all instruments. CONCLUSIONS NRT files presented the longest fatigue life. All samples showed surface irregularities and nonmetallic inclusions. Austenitic grains were smaller near the tip than near the handle. The angle of curvature was confirmed to influence the fatigue life of NiTi instruments.

Development of experimental HEMA-free three-step adhesive system.

OBJECTIVE To evaluate the influence of Bis-EMA 30 on the resin-to-dentin microtensile bond strength (microTBS) and structural reliability of the experimental three-step etch-and-rinse adhesive systems. METHODS Five experimental primers containing different dimethacrylate monomer concentrations (0, 10, 20, 40, 60 wt% of the Bis-EMA 30, P0.P60) added to acid monomer and solvents (ethanol/water), and a resin bond (Bis-GMA/TEGDMA, 50/50 wt%) were formulated. The adhesive system Scotchbond MultiPurpose (SBMP, 3M ESPE) was tested as commercial reference. Sixty bovine incisors were randomly separated into six groups, and their superficial coronal dentin was exposed. After acid etching and rinsing, the excess water was removed from the surface with absorbent paper. Each experimental primer was actively applied (30 s), followed by a mild air stream (10 s). The experimental adhesive resin was applied and light activated for 20 s. Resin composite restorations were incrementally built up. The restored teeth were stored in distilled water at 37 degrees C for 24 h, and then sectioned to obtain sticks with a cross-sectional area of approximately 0.5 mm(2), after which 24 specimens per group were subjected to the microTBS test. Data (MPa) were analyzed by One-way ANOVA, Tukey test (alpha=0.05) and Weibull analysis. RESULTS The P40 group showed microTBS means similar to those of the control (SBMP), whereas both had statistically higher values when compared with the other groups (p<0.001). Moreover, P40 showed higher structural reliability, represented by the high Weibull modulus and characteristic strength values. The lowest microTBS was observed in the P0, P10 and P20 groups, which also had low structural reliability. SIGNIFICANCE Bis-EMA 30 is a promising monomer to be considered as a substitute for HEMA in adhesive system compositions.

A new approach in self‐etching adhesive formulations: Replacing HEMA for surfactant dimethacrylate monomers

This study evaluated the influence of surfactant dimethacrylates (SD) on the resin-to-dentin microtensile bond strength (μTBS) and characterized the interfacial micromorphology of the hybrid layer of the experimental HEMA-free self-etching systems. Five experimental HEMA-free two-step self-etching systems containing different SD (Bis-EMA 10, Bis-EMA 30, PEG 400, PEG 1000, and PEG 400 UDMA) and a HEMA-containing system (control) were compared. Each experimental adhesive system was applied and resin composite restorations were incrementally built up in bovine incisors. After 24 h, restored teeth were sectioned to obtain 24 sticks per group. Thereafter, the specimens were subjected to the μTBS test. Data (MPa) were analyzed by One-way ANOVA and Tukeys test. Adhesive-dentin interfaces were analyzed through Scanning Electron Microscopy (SEM). The adhesive system formulated with PEG 400 UDMA produced μTBS similar to the HEMA-containing group and statistically higher than the HEMA-free groups. Similar failure percentages were observed in the PEG 400 UDMA and the control group. In the SEM analysis, all the adhesive systems presented similar partially demineralized hybrid layer (1.5-3.0 μm thickness) with well-formed resin tags. All SD presented reasonable initial μTBS, with the PEG 400 UDMA being a promising monomer to be considered as a HEMA substitute in adhesive systems compositions.

Retention and marginal adaptation of a compomer placed in non-stress-bearing areas used with the total-etch technique: a 3-year retrospective study

Abstract The aim of this clinical study was to evaluate class V and class III cavities restored with a polyacid-modified resin composite (compomer) restorative material in association with two different dentin-enamel bonding systems: Dyract-PSA (Primer Sealer Adhesive-DentSply, Germany) and Prime&Bond 2.0 (DentSply, Germany). The control group was a hybrid composite used with ProBond bonding system (DentSply, Germany). A total of 116 restorations (79 class V, 37 class III) were made and reevaluated after 1, 2 and 3 years in 55 patients in two private practices and in a university department. Class V nonretentive cavities were located at the CEJ level and class III at interproximal level close to CEJ. Each cavity was prepared using a water-cooled, high-speed handpiece with a fine diamond burr. A small bevel was prepared along enamel margin. Cavity dimensions were no more than 3.5×3.5 mm (using burr as reference point). Each restoration was finished immediately with fine diamond burrs and Sof-Lex disks (3 M, USA). The criteria that were evaluated by the USPHS method included: retention, color match, marginal integrity, marginal discoloration, and secondary caries. Results indicated that all compomer restorations were fully retained at 3 years, and that no secondary caries detected. Seven composite restorations were lost during the 3-year study. No statistical differences were observed between class III and class V or among other conditions (e.g., upper-lower arc, sex, age). This study demonstrates that compomers are suitable restorative materials for class III–V restorations. They may represent a clinical alternative to composites in class V and III restorations.

The effect of ultrasonic removal of various root-end filling materials

AIM To compare residual root-end filling material in apical root-end cavities following their removal with ultrasonic retrotips. METHODOLOGY Thirty single-rooted teeth were filled with Thermafil and AH Plus sealer. Root-ends were resected at 90 degrees, 3 mm from the apex. Root-end cavities were prepared with diamond burs and ultrasonic retrotips and filled with one of three filling materials: group I: Retro-TC (calcium silicate-based cement), group II: IRM (Dentsply, Germany), group III: Vitrebond (3M ESPE, USA). After 30 days of storage, ultrasonic retrotips were used to remove materials from the root-end cavities. The ultrasonic application time was fixed at 60 s. Polyether impressions and replicas of the root-ends were made. Root apices and replicas were examined by one operator under a scanning electron microscope. Remnants of residual materials were evaluated using a four-level scoring system; fractures, smear layer and exposed dentinal tubules were also examined. RESULTS Forty per cent of the specimens filled with Retro-TC revealed complete removal of the material with exposure of dentinal tubules, whilst 60% contained residual cement. Twenty per cent of specimens filled with IRM were completely devoid of material, whereas 80% had retained material. Ten per cent of specimens filled with Vitrebond retained a moderate amount of material whilst 90% had substantial retention of the material. Statistically significant differences were found (P < 0.05) amongst the three groups of materials. CONCLUSIONS Retro-TC was successfully removed in 40% of cases using ultrasonics retrotips for 60 s, whereas IRM and Vitrebond specimens had evidence of retained material in 80% and 90% of all specimens respectively.

Enamel structural changes induced by hydrochloric and phosphoric acid treatment

Purpose The aim of this study was to evaluate enamel acid-induced structural changes after 2 different treatments, by means of Raman and infrared (IR) spectroscopy analyses, and to correlate these findings with permeability measured as fluid discharge from outer enamel. Methods Two different treatments were investigated: 10 enamel slices were etched with 15% hydrochloric acid (HCl) for 120 seconds and 10 slices with 37% phosphoric acid gel (H3PO4) for 30 seconds, rinsed for 30 seconds and then air-dried for 20 seconds. Powders of enamel treated as previously described were produced. Replicas of enamel subjected to the same treatments were obtained to evaluate the presence of fluid droplets on enamel surface. Results and Conclusions Raman and IR spectroscopy showed that the treatment with both hydrochloric and phosphoric acids induced a decrease in the carbonate content of the enamel apatite. At the same time, both acids induced the formation of HPO42- ions. After H3PO4 treatment, the bands due to the organic component of enamel decreased in intensity, while they increased after HCl treatment. Replicas of H3PO4 treated enamel showed a strongly reduced permeability. Replicas of HCl 15% treated samples showed a maintained permeability. A decrease of the enamel organic component, as resulted after H3PO4 treatment, involves a decrease in enamel permeability, while the increase of the organic matter (achieved by HCl treatment) still maintains enamel permeability. The results suggested a correlation between organic matter and enamel permeability. Permeability was affected by etching technique and could be involved in marginal seal, gap and discoloration at the enamel interface, still causes of restoration failure.

The effect of the NRT files instrumentation on the quality of the surface of the root canal wall

Purpose To analyze in vitro, trough scanning electron microscope (SEM), the shaping ability of NRT NiTi rotary system (Mani, Inc, Toshigi-Ken, Japan). Methods Ten extracted human teeth were cut at the level of the CEJ and prepared with Gates-Glidden burs 4-3-2 and NRT rotary files up to size #35. Irrigation was performed with 7.5 mL of 5% NaOCl and 7.5 mL of 10% EDTA during each canal instrumentation. Following the shaping sequence, a final irrigation was performed with EDTA followed by NaOCl, each left in situ for three minutes. Teeth were then fractured longitudinally, and the coronal, middle, and apical thirds of the canals were inspected with SEM. Three parameters, divided into four different levels (Alfa and Bravo, considered clinically acceptable; Charlie and Delta, considered clinically unacceptable), were used to score the canal morphology: presence and amount of smear layer; presence of organic and inorganic debris; surface profile. Results SEM assessment revealed that in the coronal and middle third the majority of canals shaped with NRT rotary system presented a clinically acceptable surface. The apical third presented a higher amount of smear layer and dentinal debris instead, compared to the coronal and middle third. Conclusions NRT files demonstrated that they provided good instrumentation of the coronal and middle third, while being unable to obtain a defects-free surface in the apical third.