Half Of Enamel Research Articles

Occlusal caries detection on 3D models obtained with an intraoral scanner. A validation study

ObjectivesTo evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection. MethodsFifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments. ResultsThe ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures. ConclusionsOn-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth. Clinical significance3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Proximal caries infiltration – Pragmatic RCT with 4 years of follow-up

ObjectivesEfficacy of proximal caries infiltration to arrest lesion progression has been shown in university settings, but only once in a practice-based pragmatic design with a follow-up of 18 months. The aim of this randomized split-mouth placebo-controlled study was to follow-up this cohort for 3 years and those with high caries risk for 4 years. MethodsOriginally, in 87 children and young adults pairs of 238 proximal caries lesions, radiographically extending into inner half of enamel (E2) or outer third of dentin (D1), were randomly allocated to two groups: infiltration (Icon; DMG) or mock (control) treatment by five dentists in four private practices. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated by two evaluators independently being blinded to treatment allocation. ResultsAfter 36 months [mean (SD): 1152 (166) days] 165 lesion pairs in 64 patients as well as after 48 months [mean (SD): 1496 (121) days] 71 lesion pairs in 20 high caries risk patients could be re-evaluated clinically as well as radiographically using individualized bitewing holders as at baseline. No adverse events could be observed. After 36 months, progression was recorded in 23/165 test (14%) and 64/165 control lesions (39%) [McNemar/Obuchowski test; p<0.001; relative risk reduction (CI95%): 64 (45–77%)]. After 48 months lesion progression was recorded in 13/71 test (18%) and 34/71 control lesions (48%) [p = 0.003; relative risk reduction (CI95%): 62 (34–78%)] of high caries risk patients. ConclusionsIt can be concluded that also in a practice-setting proximal caries infiltration is more efficacious in reducing lesion progression compared with individualized non-invasive measures alone over a period of four years.

Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study.

Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient's caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.

Seven-year-efficacy of proximal caries infiltration – Randomized clinical trial

ObjectivesWe report efficacy of resin infiltration to arrest progression of caries lesions as compared with non-invasive measures and oral hygiene education alone after a mean observation time of seven years. Materials and methodsThis randomized split-mouth placebo-controlled clinical trial included 22 young adults having 29 pairs of interproximal non-cavitated caries lesions with radiographic extensions into inner half of enamel (E2) or outer third of dentin (D1). Lesion pairs were randomly allocated to two treatment groups: infiltration (Icon, pre-product; DMG) or mock (control) treatment. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic (digital subtraction radiography) lesion progression after seven years. Secondly, Kaplan-Meier-analyses were applied to analyze time-to-failure additionally including patients followed up for less than 54 months as well. ResultsTwo lesion pairs were excluded due to invasive treatment decision by another dentist, five lesion pairs were lost to follow-up prior to 54 months but included in the survival analysis. No unwanted effects could be observed. For the primary outcome in 17 patients followed up in mean for 84 months 2/22 infiltrated lesions (9 %) compared with 10/22 control lesions (45 %) progressed (p = 0.018). The relative risk reduction for test in relation to control was 80 % (CI 95 % = 19–95 %). For the survival analysis within a mean (SD) observation time of 73 (25) months mean failure rates of 1.3 % and 7.8 % could be observed for test and controls, respectively. Hazard risk (95 % CI) for caries progression was 6.6 (2–22) for the control compared with the test lesions (p = 0.002). ConclusionsWe conclude that resin infiltration of proximal caries lesions extending radiographically around the enamel dentin junction is efficacious to reduce lesion progression after a mean observation time of seven years. Clinical significanceThis randomized clinical trial proves that caries infiltration is highly efficacious compared with non-invasive measures and oral hygiene education alone after a considerably longer observation time of 7 years than studied so far before.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study.

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up

ObjectiveThe aim of this split-mouth, randomized, controlled clinical trial was to evaluate the efficacy of resin infiltration in controlling the progression of non-cavitated proximal lesions in primary molars after two-years follow-up. MethodsFifty healthy children presenting at least two primary molars with proximal lesion detected radiographically (in the inner half of enamel or the outer third of dentin) were included in the study. The proximal lesions were randomly allocated into resin infltration + flossing (test group) or flossing (control group). All patients received oral hygiene instructions for daily brushing with fluoride toothpaste (1100 ppmF) and flossing. The proportion of caries progression was compared using the McNemar test. The main outcome after 2-years, caries progression in the radiography was assessed by pair-wise reading by an independent examiner who was blind regarding the treatment. ResultsThe sample comprised 28 (56%) girls and 22 (44%) boys with a defs of 7,3 (SD = 6,5), mainly of moderate (46%) to high (48%) caries risk. Results after one year were published previously. After 2-years, 29 (58%) patients were assessed. Caries progression was observed in 24.1% (7/29) of the test lesions, compared with 55.2% (16/29) of the control lesions (p = 0.012). The therapeutic effect was 31.1% and the relative risk reduction (RRR) was 56.3%. Eigth lesions from the control group and two lesions from the test group progressed to the inner third of dentin and were restored. ConclusionsIn conclusion, resin infiltration was more efficacious in controlling proximal caries lesions in primary molars than non-invasive approach alone. Clinical Significance: The results indicate that resin infiltration was an efficacious method in controlling proximal caries lesions in primary molars after 2 years, even in patients with high caries risk, reaffirming the results of 1-year follow-up.

Dentists' perspectives on caries-related treatment decisions.

To assess the impact of patient risk status on Colombian dentists' caries related treatment decisions for early to intermediate caries lesions (ICDAS code 2 to 4). A web-based questionnaire assessed dentists' views on the management of early/intermediate lesions. The questionnaire included questions on demographic characteristics, five clinical scenarios with randomised levels of caries risk, and two questions on different clinical and radiographic sets of images with different thresholds of caries. Questionnaires were completed by 439 dentists. For the two scenarios describing occlusal lesions ICDAS code 2, dentists chose to provide a preventive option in 63% and 60% of the cases. For the approximal lesion ICDAS code 2, 81% of the dentists chose to restore. The main findings of the binary logistic regression analysis for the clinical scenarios suggest that for the ICDAS code 2 occlusal lesions, the odds of a high caries risk patient having restorations is higher than for a low caries risk patient. For the questions describing different clinical thresholds of caries, most dentists would restore at ICDAS code 2 (55%) and for the question showing different radiographic thresholds images, 65% of dentists would intervene operatively at the inner half of enamel. No significant differences with respect to risk were found for these questions with the logistic regression. The results of this study indicate that Colombian dentists have not yet fully adopted non-invasive treatment for early caries lesions.

Effect of Thermocycling on Microleakage of New Adhesive Systems on Primary Teeth: An In-Vitro Study

Introduction: This study investigated the sealing ability of three different adhesives in primary bovine teeth. Methods: Facial and lingual class V cavities were prepared half in enamel and half in cementum, in 48 bovine primary mandibular incisors and randomly divided into three groups and each group divided to two subgroups. The tested adhesives were XPBond (XP), ClearfilS3 Bond (S3), and Xeno III (XE). All cavities were restored with composite and light cured. After 24 hours storage in 37 ° C distilled water and polishing, teeth were thermocycled and sealed with nail varnish. Then, they were stored in 2% methylene blue and dye penetration was evaluated under a stereomicroscope. Results: No significant differences were recorded in the microleakage value between three adhesives in enamel and dentin margins (p>0.0.5) before and after thermocycling. The lowest microleakage value was obtained in XE followed by XP and S3. Conclusion: There were not any differences between adhesives in enamel and dentin margins of class V cavities on primary bovine teeth.

Current Cariology Education in Dental Schools in Spanish–Speaking Latin American Countries

This study sought to provide an overview of current cariology education in Spanish-speaking Latin American dental schools. Data collection was via an eighteen-item survey with questions about curriculum, methods of diagnosis and treatment, and instructors' perceptions about cariology teaching. The response rate was 62.1 percent (n=54), and distribution of participating schools by country was as follows: Bolivia (four), Chile (four), Colombia (twenty-four), Costa Rica (one), Cuba (one), Dominican Republic (two), El Salvador (two), Mexico (six), Panama (two), Peru (four), Puerto Rico (one), Uruguay (two), and Venezuela (one). Forty percent of the responding schools considered cariology the key axis of a course, with a cariology department in 16.7 percent. All schools reported teaching cariology, but with varying hours and at varying times in the curriculum, and 77.8 percent reported having preclinical practices. The majority reported teaching most main teaching topics, except for behavioral sciences, microbiology, saliva and systemic diseases, caries-risk factors, root caries, erosion, and early caries management strategies. The most frequently taught caries detection methods were visual-tactile (96.3 percent), radiographic (92.6 percent), and the International Caries Detection and Assessment System (ICDAS) (61.1 percent). Respondents said their schools' clinics make an operative treatment decision when radiolucency is in the inner half of enamel (42.3 percent) for radiographic criteria and when the lesion is visually non-cavitated (5.8 percent). All respondents reported that their schools teach preventive strategies, but only 43.4 percent said they tie it to risk assessment and 40.7 percent said they implement nonsurgical management regularly.

A Pilot Study of a Modified Radiographic Technique for Detecting Early Proximal Cavities

Diagnosing the necessity of cavity preparation in demineralized proximal areas has been considered as a challenge in restorative treatment planning. The purpose of this study was to investigate the clinical performance of a modified radiographic technique for the detection of proximal cavities. The sample consisted of 44 proximal surfaces in 38 dental students. The patients had radiolucent proximal lesions restricted to the inner half of enamel or the outer third of dentine in bitewing radiographs, and there was doubt regarding the presence or absence of cavities in the approximal areas. The suspected surfaces were then examined by secondary bitewing radiographs which were taken after pressing radiopaque material into the proximal areas. Finally, orthodontic elastic separators were placed in the contact areas to provide enough space for direct visual and tactile examination, thus detecting any proximal cavity (reference standard). The sensitivity, specificity and accuracy of the modified bitewing radiography were calculated against the reference standard. Overall, 7 surfaces presented caries cavities according to the reference standard. All proximal radiolucencies observed in the inner half of enamel and 46% of those extended to the outer third of dentine were not cavitated when evaluated by direct visual and tactile examination. The sensitivity, specificity and accuracy of bitewing radiography with opaque material for detecting proximal cavities (n = 7) were 86, 100 and 98%, respectively. The tested radiographic technique displayed good validity in this pilot study for detecting proximal cavities in posterior teeth and should be further investigated.

Effect of Postoperative Peroxide Bleaching on the Marginal Seal of Composite Restorations Bonded With Self-etch Adhesives

The aim of this study was to determine the effect of peroxide bleaching on the marginal seal of composite restorations bonded with several adhesive systems. Combined cylindrical Class V cavities located half in enamel and half in dentin were prepared on the buccal and lingual surfaces of human molars. The cavities were bonded with the self-etch adhesives Clearfil SE-Bond (CLF), Adper Prompt (ADP), and iBond (IBO) and an etch-and-rinse adhesive Gluma Comfort Bond (GLU) and restored with a microhybrid composite Charisma. Experimental groups were treated 25 times for eight hours per day with a peroxide bleaching gel Opalescence PF 20, while the control groups were stored in distilled water for two months and then subjected to a microleakage test using a dye penetration method. Scanning electron microscopy was used to investigate the etching and penetration abilities of the adhesives and morphology of debonded restoration-enamel interfaces after the microleakage tests. Statistical analyses were performed using nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests at p=0.05. The microleakage of all GLU groups was low and not significantly affected by peroxide bleaching. Low microleakage was recorded for CLF control groups, but after bleaching, a small but significant increase in microleakage at the enamel margin indicated its sensitivity to peroxide bleaching. For ADP and IBO control groups, the microleakage at the enamel margins was significantly higher than for GLU and CLF and exceeded that at the dentin margins. Bleaching did not induce any significant changes in the microleakage. Electron microscopy analysis indicated that in our experimental setup, decreased adhesion and mechanical resistance of the ADP- and IBO-enamel interfaces could be more important than the chemical degradation effects induced by the peroxide bleaching gel.

Randomized Controlled Clinical Trial on Proximal Caries Infiltration: Three-Year Follow-Up

We report the 3-year efficacy of resin infiltration (Icon, pre-product; DMG, Hamburg) to arrest progression of proximal non-cavitated caries lesions as compared with placebo treatment. In 22 young adults, 29 lesion pairs with radiographic extensions into the inner half of enamel up to the outer third of dentin were included (split-mouth design). All subjects received risk-related instructions for diet, flossing and fluoridation. No unwanted effects could be observed. Radiographically 1/26 test lesions (4%) and 11/26 control lesions (42%) had progressed (p = 0.002, McNemar). After 3-year follow-up, infiltration of proximal caries lesions can be said to be efficacious to reduce lesion progression.

Retention loss of class v restorations after artificial aging.

to evaluate whether retention loss of Class V restorations can be simulated in the laboratory and to compare these results with those from clinical trials. nonretentive v-shaped Class V cavities were prepared on the lingual and buccal side of extracted premolars, half in dentin and half in enamel. Different adhesive systems (AS) were used with the same composite resin (Tetric EvoCeram) and 12 restorations per group: 1-step self-etching AS (AdheSE One, Adper Prompt L-Pop, Futurabond N, Hybrid Bond, iBond, Xeno III, Xeno IV), 2-step self-etching AS (AdheSE), 2-step etch-and-rinse AS (Excite, Prime & Bond NT), 3-step etch-and-rinse AS (Syntac) as well as a conventional glass ionomer (Ketac Fil) with and without conditioner. The comparison groups were the composite without adhesive and a 2-step etch-and-rinse AS (Prime & Bond NT) without etching of enamel and dentin. The restored teeth were submitted to an aging process involving 18 months of water storage, three intermittent phases of thermocycling (TC 10,000 times), and two phases of thermomechanical loading (1 x 640,000 chewing cycles after 12 months, 1 x 1,200,000 chewing cycles after 18 months; 100 N sine-wave force profile, pressing with steel ball without lifting). Retention loss of the restorations was evaluated after every 1000 thermocycles and every 120,000 cycles of thermomechanical loading. The databases MEDLINE and IADR abstracts were used to search for clinical studies on retention loss involving the adhesive systems that were included in the present study. retention loss was only observed in the following groups: composite without adhesive (100% after first 1000 TC), glass ionomer without conditioner (8% after 6 months; 33% after 12 months, 100% after 18 months), adhesive without etching (17% after 6 months, 42% after 12 months). The laboratory results, however, matched with the clinical results only for three adhesive systems (Futurabond NR, Hybrid Bond, Xeno IV, 0% retention loss, 5 studies, observation period between 1.5 and 2 years). if the materials were applied according to the manufacturer's instructions, no retention loss was observed in the laboratory model. The laboratory model did not reflect the clinical findings.

Resin Infiltration of Caries Lesions

Resin infiltration is an innovative approach to arrest progression of caries lesions. The aim of this randomized split-mouth placebo-controlled clinical trial was to assess whether resin infiltration of proximal lesions is more effective than non-operative measures alone with respect to the inhibition of caries progression. In 22 young adults, 29 pairs of interproximal lesions with radiological extension into the inner half of enamel or the outer third of dentin were randomly allocated to two treatment groups. In the test group, lesions were infiltrated (Icon, pre-product; DMG). A placebo treatment was performed in the control group. All participants received instructions for diet, flossing, and fluoridation. The primary outcome after 18 months was radiographic lesion progression (assessed by digital subtraction radiography). No unwanted effects could be observed. In the effect group, 2/27 lesions (7%) and in the control group 10/27 lesions (37%) showed progression (p = 0.021; McNemar). Infiltration of interproximal caries lesions is efficacious in reducing lesion progression.

A method for rapid measurement of laser ablation rate of hard dental tissue

The aim of the study reported here is the development of a new method which allows rapid and accurate in-vitro measurements of three-dimensional (3D) shape of laser ablated craters in hard dental tissues and the determination of crater volume, ablation rate and speed. The method is based on the optical triangulation principle. A laser sheet projector illuminates the surface of a tooth, mounted on a linear translation stage. As the tooth is moved by the translation stage a fast digital video camera captures series of images of the illuminated surface. The images are analyzed to determine a 3D model of the surface. Custom software is employed to analyze the 3D model and to determine the volume of the ablated craters. Key characteristics of the method are discussed as well as some practical aspects pertinent to its use. The method has been employed in an in-vitro study to examine the ablation rates and speeds of the two main laser types currently employed in dentistry, Er:YAG and Er,Cr:YSGG. Ten samples of extracted human molar teeth were irradiated with laser pulse energies from 80 mJ to the maximum available energy (970 mJ with the Er:YAG, and 260 mJ with the Er,Cr:YSGG). About 2000 images of each ablated tooth surface have been acquired along a translation range of 10 mm, taking about 10 s and providing close to 1 million surface measurement points. Volumes of 170 ablated craters (half of them in dentine and the other half in enamel) were determined from this data and used to examine the ablated volume per pulse energy and ablation speed. The results show that, under the same conditions, the ablated volume per pulse energy achieved by the Er:YAG laser exceeds that of the Er,Cr:YSGG laser in almost all regimes for dentine and enamel. The maximum Er:YAG laser ablation speeds (1.2 mm 3/s in dentine and 0.7 mm 3/s in enamel) exceed those obtained by the Er,Cr:YSGG laser (0.39 mm 3/s in dentine and 0.12 mm 3/s in enamel). Since the presented method proves to be easy to use and allows quite rapid measurements it may become a valuable tool to study the influence of various laser parameters on the outcome of laser ablation of dental tissues.

Clinical examination alone detects moresecondary caries on crowned teeth than radiograph alone

Summary Subjects The subjects were 100 patients with fixed prostheses 0689 who exhibited at least 1 secondary caries lesion. These subjects provided 820 teeth with crowns (365 single crowns, 455 fixed partial denture abutments) and 512 teeth with no restorations for the analyses. Exposure Both interproximal surfaces of each crowned and unrestored 0689 tooth were evaluated clinically and by radiographs for the presence of caries. The clinical examination included use of an explorer. Main outcome measure Presence of caries (clinical levels: initial caries, caries0689 suspicion, early caries, deep caries; radiographic levels: radiolucency limited to outer half of enamel, extending into inner half, reaching outer half of dentin, into inner half of dentin). Main results Clinical examination detected more caries lesions0689 (11.2%) on interproximal surfaces of crowned teeth than did radiographic examination (8.3%), a difference that was statistically significant at P . Conversely, radiographs detected slightly more lesions on interproximal surfaces of nonrestored teeth (4.1%) than did clinical examination (3.3%). This difference was also statistically significant ( P ).

The Effect of Different Drying Methods for Single Step Adhesive Systems on Microleakage of Tooth Colored Restorations

The purpose of this in vitro study was to evaluate microleakage of tooth colored restoratives and accompanying single step adhesive systems using two drying methods (syringe air versus "sponge" applicator blotting). Eighty teeth were randomly assigned to four material groups. Class V cavity preparations, located half in enamel and half in cementum at the cementoenamel junction (CEJ), with a 1.0 mm enamel bevel were completed. The adhesive/composite groups included: (1) Single-Bond/Z-100 Composite, (2) Prime & Bond 2.1/Dyract AP Compomer, (3) OptiBond Solo Plus/Prodigy Composite, and (4) Scotchbond MultiPurpose/Z-100 Composite. Each material group (n=20), consisted of preparation Subgroups dried with syringe air (A), (n=10) and sponge applicators (B), (n=10). The preparations were conditioned, rinsed, and gently dried followed by placement of the primer/adhesive and restorative materials. All teeth were thermocycled, stained with methylene blue dye, invested in clear acrylic resin, and sectioned longitudinally through the center of the restoration. Readings were taken at the occlusal and gingival surface positions of each restoration section. A ratio (%) of wall length to amount of leakage along each wall was established. One-way Analysis of Variance (ANOVA) testing revealed: (1) no significant (p<0.05) differences existed between materials at the occlusal surface position in Subgroups A and B (syringe vs. applicator drying), (2) significantly (P<0.05) greater leakage of OptiBond Solo Plus compared to Single-Bond, Prime & Bond 2.1, and Scotchbond MultiPurpose at the gingival surface position in Subgroups A and B, (3) significantly (p<0.05) greater leakage of OptiBond Solo Plus compared to Single-Bond and Scotchbond MultiPurpose, combining the occlusal/gingival surface position scores, (4) no significant difference existed between Single-Bond Subgroups A/B, OptiBond Solo Plus Subgroups A/B, Scotchbond MultiPurpose Subgroups A/B, (5) significantly (p<0.05) greater leakage of Prime & Bond 2.1 Subgroup B compared to Subgroup A, (6) no significant (p<0.05) difference existed between material groups, except OptiBond Solo Plus (occlusal vs. gingival surface position), (7) no significant (p<0.05) difference between Single-Bond, OptiBond Solo Plus, and Scotchbond MultiPurpose comparing both Subgroups, same materials, and surface positions, and (8) no significant (p<0.05) difference existed between Prime & Bond 2.1, comparing both Subgroups, occlusal surface position. In the present study, significantly greater leakage was revealed with OptiBond Solo Plus compared to the other material groups, especially at the gingival surface positions. Significantly greater leakage was also recorded with OptiBond Solo Plus and Prime & Bond 2.1 sponge applicator drying as compared to the same materials, syringe air drying.

Marginal adaptation of class V restorations using different restorative techniques

This in vitro study compares the marginal adaptation of Class V restorations with margins located half in enamel and half in dentine, which were placed using different restorative techniques. Five operative procedures were evaluated both in saucer-shaped erosion lesions and in box-shaped cavities with bevels in enamel. The five procedures included a composite inlay technique using both the chemically and the light curing versions of a resin based composite cement, a bulk placement technique using a chemically curing composite resin, an incremental technique and an incremental technique combined with a built-up base, using a light curing composite resin. A combination of Gluma/Clearfil served as the dentinal adhesive. The micromorphology of the tooth/restoration interface was analysed before and after thermal cycling; the marginal seal was analysed after thermal cycling only. In the conventional cavities, the restorations showed less leakage, and micromorphologically a better, but statistically insignificant superior marginal adaptation. The inlay technique rendered the best marginal quality in both enamel and dentine before and after thermal cycling. Due to the unique curing characteristics of the chemically cured composite resin and cement resulting in a significantly reduced rigid contraction, the inlays cemented with the chemically curing cement and the restorations placed with the chemically curing composite resin were superior to their light cured counterparts. The built-up base yielding a reduction of the composite mass did not enhance marginal adaptation because of the partial replacement of the strong adhesion to dentine mediated by the Gluma/Clearfil combination by the weaker bond promoted by the etched glass ionomer cement.

Diagnosis of non-cavernous posterior proximal caries: Radiographic observer performance

Accuracy in detecting non-cavernous posterior proximal caries from radiographs was determined. Ninety-seven surfaces including 45 surfaces without caries, 15 with caries limited to the outer half of the enamel, 17 with caries limited to the inner half of enamel, and 20 with caries penetrating into dentin, as determined by the histological appearance, were examined by ten dentists reading radiographs twice in the interval of two weeks. The detection rate of true positive findings and results derived from receiver operating characteristic (ROC) analysis in terms of the area under the curve (ROC area) demonstrated to be significant in caries penetration. However, detection rate and ROC analysis showed no significant differences between the two observations. These results indicate that the relatively low accuracy in detecting these lesions, especially those limited to the outer enamel might justify an additional mode of diagnosis to supplement radiography. The caries penetration determined by radiographs underestimated the actual state as previously reported.