Current Issue
March/April, Volume 33, Number 4

Introduction:
The treatment for this patient involved the lower left cuspid and first premolar. The premolar was restored with a conventional MOD inlay, while the cuspid was planned as a distal hollow grind preparation with a pin to keep tissue removal and final restoration as conservative as possible. Although the initial caries was extensive, the final restorations were invisible, except when viewed from a distal buccal aspect. While the patient was not so advised, these restorations will likely serve a lifetime with proper maintenance.

SUMMARY:
This randomized clinical trial compared the performance of an all-in-one adhesive (iBond) applied in sclerotic and non-sclerotic non-carious cervical lesions with that of a three-step etch-prime-bond adhesive (Gluma Solid Bond, SB). One-hundred and five lesions were randomly assigned to four groups according to adhesive, sclerosis scale and technique: 1) SB applied to lesions with sclerosis scale 1 and 2 (n=26); 2) iBond applied to lesions with sclerosis scale 1 and 2 (n=28); 3) iBond applied to lesions with sclerosis scale 3 and 4 (n=25) and 4) iBond applied with prior acid-etching to lesions with sclerosis scale 3 and 4 (n=26). A microfilled composite (Durafill VS) was used as the restorative material. The restorations were evaluated for retention, color match, marginal adaptation, anatomic form, cavosurface margin discoloration, secondary caries, pre- and post-operative sensitivity, surface texture and fracture at insertion (baseline), 6, 18 months and at 3 years using modified USPHS evaluation criteria (Alfa=excellent; Bravo=clinically acceptable; Charlie=clinically unacceptable). There was a high percentage of Bravo scores for marginal adaptation (4%-32%) and marginal discoloration (18%-60%) in Groups 2, 3 and 4, but all groups had <5% Charlie scores at 6 months and <10% Charlie scores at 18 months for retention and marginal discoloration, respectively. However, it should be noted that 13% of the restorations in Group 4 were not retained at three years.

SUMMARY:
This placebo-controlled, double-blind randomized clinical trial compared five 10% carbamide peroxide tooth whitening formulations. Three products contained varying concentrations of potassium nitrate as desensitizers. One contained no desensitizers and one was a placebo. During the two weeks of active bleaching, participants used a daily diary to record the number of days of sensitivity from hot, cold, gums, tongue and/or throat. The total number of days of sensitivity experienced by the participants in each group was compared. Participants using the agent with no desensitizers did not experience any more sensitivity than those using the agent containing 3% potassium nitrate. The products that included 0.5% potassium nitrate and 0.5% potassium nitrate and 0.25% sodium fluoride were not associated with any more sensitivity than the placebo group.

In addition, the shade tab change from baseline to 11 weeks following cessation of bleaching was compared. Using an active bleaching agent, no difference in color change was noted among the four groups. All four groups were associated with significantly higher color change than the placebo.

The addition of a small percentage of potassium nitrate to a 10% carbamide peroxide tooth whitener was shown to significantly reduce postoperative sensitivity without reducing efficacy.

SUMMARY:
Leucite-reinforced ceramics have a translucent structure, which may have an advantage when fabricating esthetic restorations. However, the different shades of cement and water storage may adversely affect the final color of translucent restorations. Over time, the final color of a restoration may be significantly affected by the shade of the cement. This in vitro study evaluated the effect of two different cement shades (Vita A1 and A3) and water storage on the final color of leucite-reinforced ceramics over time. Twenty disks of standardized thickness (0.8 mm), diameter (5 mm) and color (shade 110, Chromascope) were prepared from leucite-reinforced glass-ceramic (IPS Empress). Ten freshly extracted human molars were used as the underlying structure, and both the buccal and lingual surfaces of each tooth were prepared with a diamond rotary cutting instrument and flat surfaces were created. Initially, all of the disks were bonded to the flat surfaces of the teeth with a thin layer of bonding agent (Single Bond, 3M Dental Products) to ensure immobilization of the specimens (baseline). The teeth and ceramic specimens were not etched and silanated for easy removal of the specimens. The color of the ceramic specimens was measured with a colorimeter. All disks were gently removed from the tooth surfaces, and 10 specimens (Group A1) were luted to the buccal surfaces of teeth using a dual-polymerizing resin composite cement (Vita A1, Rely X ARC), while the remaining 10 specimens (Group A3) were luted to the lingual surfaces of the teeth with a different shade (Vita A3, Rely X ARC) of the same cement. The final color of the specimens was measured immediately after cementation and at 3-, 30- and 90-day intervals after cementation. Color coordinates L*, a*, b* were recorded. The teeth were stored in 37?C saline solution during measurement intervals. The Mann-Whitney U-test (post-hoc test) was performed to compare the results (a=0.05). The color difference of specimens luted with the two cements with different shades was not perceivable (DE<3.7) for AC (after cementation), AC/3, AC/30 and AC/90 measurements. The color alteration between baseline and immediately after cementation (AC) was not perceivable for each cement group. However, after water storage, color differences between the baseline and AC/3, AC/30 and AC/90 were above this limit in bo th cement groups. The shade of the luted 0.8 mm IPS Empress porcelain specimens became darker after cementation, particularly on the third day, regardless of the cement shade tested. When the final color of ceramics luted with cements in two different shades was compared, it was observed that the final color differences were not perceivable for each measurement session.

SUMMARY:
Self-etching adhesive systems are a new generation of materials that possess acidic methacrylates that can generate self-adhesion. There is limited data reported on the marginal leakage of ceramic restorations bonded with self-etching adhesive materials.

This study assessed and compared the amount of microleakage of bonded ceramic crowns using three different types of self-etching adhesive systems with and without a die spacer.

Eighteen human molars were prepared for all-ceramic IPS Empress crowns and the teeth were randomly assigned to each experimental group. The buccal side had the preparation finish line 1.5 mm below the CEJ, and the lingual finish line was 1.5 mm above the CEJ, creating margins in enamel and dentin. Two die-spacing techniques were used (three layers or no layer of die spacer). Each crown restoration was cemented with one of three self-etching resin luting agents (Panavia F 2.0, Multilink and RelyX Unicem). The specimens were thermally cycled for 1000 cycles, then immersed in a 5% methylene blue dye solution for 24 hours. The teeth were then rinsed, embedded in clear epoxy resin and sectioned. A total of 60 sections were evaluated for each type of resin luting agent using digital image analysis at 70x magnification. A novel formula, using mean percentage of microleakage, was developed by dividing the extent of dye penetration along the tooth/resin luting cement interphase and the total perimeter of the tooth crown surface. The data were analyzed using three-way analysis of variance at the 0.05 level of significance. Fisher's PLSD intervals were calculated for comparing significant means.

Panavia F 2.0 showed a lower degree of microleakage than RelyX Unicem and Multilink at both the enamel and dentin margins. Interactions of the main effects (cement, margin and die spacer technique) were all highly significant (p?0.004). The degree of microleakage was higher on the dentin margins than on the enamel margins (p<0.0001). The degree of microleakage for the die spacer group was not significantly different from the group with no die spacer technique (p>0.1).

Overall, Panavia F 2.0 showed the least microleakage, followed by RelyX Unicem and Multilink, respectively.

SUMMARY:
The new generation LED curing light units have significantly improved curing performance compared to first generation lights, and even some second generation LED curing light units. This study compared the curing performance of 10 new generation LED light curing units (FLASH-lite 1401, LE Demetron 1, Coltolux, Ultra-Lume 5, Mini LED, bluephase, Elipar FreeLight 2, Radii, Smartlite IQ and Allegro) for depth of cure against a high-powered halogen curing light unit (Optilux 501). Depth of cure measurements were utilized per the ANSI/ADA No 27 standard to detect differences between the lights at three time intervals (10, 20 and 40 seconds). A total of 660 samples were prepared (n=10/group). A full factorial ANOVA and Tukey's HSD test showed FLASH-lite 1401 performed significantly better than the other lights at 10- and 20-second time intervals (p<0.01). This study also demonstrated that an exposure time of 20 seconds or longer assures a better depth of cure, 40 seconds being the optimal polymerization time for all of the curing light units.

SUMMARY:
The optimal degree of curing throughout the bulk of a visible light-activated dental resin composite is acknowledged to be important to the clinical success of a resin composite restoration. Unfortunately, the dentist has no means of monitoring the cure of the resin surfaces not directly exposed to the curing light. Techniques, such as the layered buildup of restorations in 2 mm increments with longer activation times than 20 seconds, have been suggested. This study investigated the depth of cure (DOC) of a commercial resin composite in three types: flowable, hybrid and packable and in three shades: B1, A3 and D3 after 20 second activation with a quartz halogen light (620 mW/cm2). Depth of cure was measured by scraping the uncured material and by using a Knoop Hardness profile, starting from the surface exposed to the light. Using a minimum Knoop Hardness ratio of 0.8 bottom/top only, the flowable in shade B1 achieved a 2 mm DOC. Using the less restrictive scraping test, only the B1 shade of flowable and hybrid significantly exceeded a 2 mm DOC. Knoop Hardness at the DOC obtained by scraping ranged from 55%-70% of the top surface hardness.

These data suggest that a 2 mm buildup layering technique may not result in adequate curing of the bottom layer for such a wide range of materials and that manufacturers need to provide quantitative information about DOC at specific activation times and light intensities for their entire range of resin materials and shades so that the dentist can devise a placement technique that will ensure adequate cure of the bulk of a restoration.

SUMMARY:
Objective: This study compared the color changes of five novel resin composites polished with two one-step polishing systems when exposed to coffee solution.

Methods: The resin composites tested were Filtek Supreme XT, Grandio, CeramX, Premise and Tetric EvoCeram. A total of 150 discs (30/resin composites, 10 x 2 mm) were fabricated. Ten specimens/resin composites cured under Mylar strips served as the control. The other samples were polished with PoGo and OptraPol discs for 30 seconds using a slow speed handpiece and immersed in coffee (Nescafe) for seven days. Color measurements were made with Vita Easyshade at baseline and after one and seven days. Repeated Measures ANOVA and Bonferroni tests were used for statistical analyses (p?0.05).

Results: The differences between the mean DE* values for the resin composites polished with two different one-step systems were statistically significant (p<0.05). After one week, all materials exhibited significant color changes compared to baseline. All Mylar finished specimens showed the most intense staining (p<0.05).

There were no significant differences between the OptraPol and PoGo polished groups. Mylar-finished specimens of CeramX, Tetric EvoCeram, Premise and Filtek Supreme XT presented the greatest staining (p<0.05). For Grandio, there were no significant differences between the Mylar and PoGo groups, while the most stain resistant surfaces were attained with OptraPol.

Conclusion: Removing the outermost resin layer by polishing procedures is essential to achieving a stain resistant, more esthetically stable surface. One-step polishing systems can be used successfully for polishing nanocomposites.

SUMMARY:
This study investigated the influence of different light sources associated with a transdental photo-activation technique on the marginal adaptation and hardness of composite restorations. Cavities (3 mm wide x 3 mm long x 1.5 mm in deep) were prepared on flattened bovine dentin and filled with Z250 composite (3M ESPE). Nine groups (n=10) were defined according to the curing technique (direct; transdental-photo-activation through 1 mm of enamel and 2 mm of dentin; mixed-transdental + direct) and light source (QTH XL2500, 3M ESPE; PAC Apollo 95E, DMD; LED Ultrablue Is, DMC) combination. Marginal adaptation was evaluated using a dye staining method, and the percentage of stained margins was recorded. Knoop Hardness readings were made across the transversal section of the fillings. Data were submitted to two-way ANOVA and Tukey's test (p?0.05). For margin analysis, although none of the curing conditions provided perfect adaptation, the mixed technique showed lower gap formation. No significant differences were detected between the transdental and other techniques, and no significant differences were detected among the light sources. For hardness, the direct technique showed slightly greater hardness than the mixed technique. Also, the mixed technique yielded greater hardness than the transdental technique. Among the light sources, the LED showed greater hardness than the PAC; whereas, no significant differences between the QTH and other sources were detected. The mixed technique might improve the marginal adaptation of restorations, while not being detrimental to composite hardness.

SUMMARY:
This study investigated the effect of prior phosphoric acid etching on the enamel bond strength of five single-step self-etch adhesive systems: Absolute, Clearfil tri-S Bond, Fluoro Bond Shake One, G-Bond and One-Up Bond F Plus. Bovine mandibular incisors were mounted in self-curing resin, and the facial surfaces were wet ground with #600 silicon carbide paper. Adhesives were applied to the enamel surfaces with or without prior phosphoric-acid etching and light irradiated. The resin composites were condensed into a mold and light irradiated. In total, 40 specimens were tested per adhesive system with and without prior acid etching and were further divided into two groups: those stored in water at 37?C for 24 hours without cycling and those stored in water at 37?C for 24 hours followed by thermal cycling between 5?C and 55?C with 10,000 repeats. After storage under each set of conditions, the specimens were tested in shear mode at a crosshead speed of 1.0 mm/minute. Two-way analysis of variance, the Student's t-test and the Tukey HSD test were used to analyze the data at a significance level of 0.05. For the specimens without prior acid etching, the mean bond strengths to enamel ranged from 11.0 to 14.6 MPa after 24-hour storage in water, while the corresponding values for specimens with prior acid etching ranged from 15.2 to 19.3 MPa. When these specimens were subjected to thermal cycling, the mean bond strengths ranged from 11.3 to 17.0 MPa without prior acid etching and from 12.3 to 23.2 MPa with prior acid etching. The changes in enamel bond strengths differed among the adhesive systems tested. After 24-hour storage in water, the most common failure modes were adhesive failure and mixed failure for specimens with and without prior acid etching, respectively. Thus, through a careful choice of adhesive system, prior acid etching can increase the bond strengths of single-step self-etch adhesive systems.

SUMMARY:
This study evaluated the compressive strength and marginal adaptation of composite onlays using indirect and direct techniques after thermal and mechanical cycling. Onlay standardized cavities were prepared in 50 permanent molars and restored with Z-250 resin composite using indirect (IRT) or direct (DRT) restorative techniques. The restorations were either submitted or not submitted to thermal (500 cycles, 5? to 55?C) and mechanical cycling (50,000 cycles, 50N). The teeth were distributed to five groups (n=10): G1-IRT/cycling; G2-IRT/no cycling; G3-DRT/ cycling; G4-DRT/no cycling and G5 (control group)-sound teeth. All prepared teeth were stored in 100% relative humidity at 37?C for 24 hours, followed by finishing with Sof-Lex discs. A caries detector solution was applied on the tooth-restoration interface of all teeth for five seconds, followed by washing and drying. Four digital photographs were taken of each tooth surface. The extent of gaps was measured using standard software (Image Tool 3.0). All groups were submitted to compression testing in a universal testing machine (INSTRON) at a crosshead speed of 1 mm/minute until failure. The compressive strength (CS) and marginal adaptation data were submitted to ANOVA and Tukey test (p<0.05). For both evaluation criteria (compressive strength and marginal adaptation), there were no statistically significant differences among the restorative techniques. Deterioration over time was observed for both types of restorations. However, the prevalence of catastrophic fractures increased among direct restorations. The application of thermal/mechanical cycling only influenced marginal adaptation.

SUMMARY:
Many studies have shown a considerable reduction in the enamel bond strength of resin composite restorations when the bonding procedure is carried out immediately after bleaching. These studies claim that a certain waiting period is needed prior to performing the restoration in order to attain the original bond strength values. This study determined the most effective time duration for the application of sodium ascorbate prepared in gel form. The labial surfaces of 70 bovine incisors were polished with 600-grit silicon carbide paper on a water-irrigated metallurgical polishing wheel. The specimens were randomly divided into seven groups: 1) bleaching (10% Rembrandt Xtra-Comfort +) immersed in artificial saliva for seven days, 2) bonded immediately after bleaching, 3) bleaching + 10% sodium ascorbate (SA) gel for 10 minutes, 4) bleaching + 10% SA gel for 60 minutes, 5) bleaching + 10% SA gel for 120 minutes, 6) bleaching + 10% SA gel for 240 minutes and 7) bleaching + 10% SA gel for 480 minutes. After preparation, a standard-shaped resin composite was applied to all specimens. The teeth were stored in distilled water at 37?C for 24 hours and a universal testing machine determined their shear bond strength. The data were evaluated using ANOVA and Tukey tests. Antioxidant gel proved to be effective for increasing the shear bond strength of the resin composite to enamel. For maximum effectiveness, antioxidant gel should be applied to enamel for at least 60 minutes. As the application period of the antioxidant increased, the bond strength of the composite on enamel tissue also increased. The increase noticed in Groups 5, 6 and 7 was statistically significant (p<0.05). Application of the antioxidant gel by the patient shortens the time spent in the clinic.

SUMMARY:
The current trend towards minimum-intervention dentistry has introduced laser technology as an alternative technique for cavity preparation. This study assessed the null hypothesis that enamel prepared either by Er,Cr:YSGG laser or conventional diamond bur is equally receptive to adhesive procedures. The buccal and lingual surfaces of 35 sound human molars were prepared with Er,Cr:YSGG laser or a medium-grit diamond bur. One etch&rinse (OptiBond FL) and three self-etch adhesives (Adper Prompt L-Pop, Clearfil SE Bond and Clearfil S3 Bond) were applied on laser-irradiated and bur-cut enamel, followed by the application of a 5-6 mm build-up of Z100. The micro-tensile bond strength (?TBS) was determined after 24 hours of storage in water at 37?C. Prepared enamel surfaces and failure patterns were evaluated using a stereo-microscope and a field-emission-gun scanning electron microscope (Feg-SEM). The ?TBS to laser-irradiated enamel was significantly lower than to bur-cut enamel (p<0.05), with the exception of Clearfil S3 Bond, which bonded equally effectively to both substrates. The latter presented the highest ?TBS on laser-irradiated enamel, though it was not statistically different from the ?TBS of OptiBond FL. SEM analysis revealed significant morphological alterations of the laser-irradiated enamel surface, such as areas of melted and recrystalized hydroxyapatite and deep extensive micro-cracks. In conclusion, the bonding effectiveness of adhesives to laser-irradiated enamel depends not only on the structural substrate alterations induced by the laser, but also on the characteristics of the adhesive employed.

SUMMARY:
Data on the adhesive strength of new all-in-one adhesives are still relatively limited. This study compared the microshear bond strengths of five recent all-in-one self-etching priming systems (G-Bond, One-Up Bond-F Plus, Clearfil S3 Bond, Adper Prompt L-Pop and Go!) with a widely used two-step self-etching priming system (Clearfil SE Bond).

Human molars were sectioned and finished with 600-grit SiC paper. Both enamel and dentin were bonded using adhesives with a 0.7 mm bonding diameter. Bond strengths were tested using a microshear bond test method at a crosshead speed of 1 mm/minute. The mean bond strengths and standard deviations were calcula-ted and analyzed using ANOVA and the Tukey's HSD test.

Results showed the two-step self-etching system had significantly higher bond strengths to dentin. However, for enamel bond strength, Clearfil SE Bond showed no statistical difference to G-Bond and Go!; however, all of the other materials were statistically lower. It is necessary to examine these new materials clinically to determine their efficacy.

SUMMARY:
Objective: To investigate Nigerian dentists' perception of amalgam safety and to highlight the dentists' attitude toward amalgam.

Methods: A cross-sectional survey of all dentists in Southeastern Nigeria was done using a self-administered, structured questionnaire.

Results: The report recorded a 90.9% response rate. More specialists (95.7%) than general dentists (74.5%) agreed to the safety of amalgam. Furthermore, more patients seen by the general dentists (85.1%) than by specialists (34.88%) agreed with amalgam safety. Undergraduates' education (82.9%) was the highest source of awareness of the amalgam controversy, followed by inquires (64.3%), colleagues (47.1%), TV/radio (41.4%), conferences (27.1%) and continuing dental education (15.7%). About 37% of respondents knew all the signs and symptoms of amalgam toxicity, while 47.1% of respondents knew that the lung is the fastest route for mercury absorption. About 81.0% of dentists do not support an amalgam ban and 84.3% would not even recommend an alternative to amalgam. Amalgam is well accepted by both dentists and patients in the studied population.