Occlusal Cavities Research Articles

Five-year clinical performance of two fluoride-releasing giomer resin materials in occlusal restorations.

To evaluate and compare the clinical performance of two nano-hybrid giomer restorative composite materials after 5 years. Forty-four pairs of restorations (total n=88) of a flowable giomer (Beautifil Flow Plus F00; Shofu Inc., Kyoto, Japan) and a conventional nano-hybrid giomer restorative material (Beautifil II; Shofu Inc.) were placed in Class I cavities after the application of a dentin adhesive (FL-Bond II; Shofu Inc.) and a flowable liner (Beautifil Flow Plus F03; Shofu Inc). After 5 years, 32 pairs of restorations were assessed using the modified United States Public Health Service criteria. Both tested materials were compared using Fisher's exact test and each tested clinical criterion for each material was analyzed separately with respect to different follow-up periods using Friedman's test (a=0.05). None of the restorations showed complete retention loss, post-operative sensitivity, secondary caries or color change. There were no significant changes to any of the clinical criteria for each material during the 5-year evaluation period (p > 0.05) and no significant differences between the two materials in all clinical parameters after 5 years (p > 0.05). Five-year clinical performance of both two nano-hybrid giomer restorative materials was comparably acceptable and not significantly different for any of the parameters evaluated. Nano-hybrid giomer-based materials are clinically acceptable for the restoration of occlusal cavities as they demonstrate excellent performance after 5 years.

Comparative Evaluation of Clinical Performance of Three Different Glass Hybrid Restorations in High Caries Risk Patients: A Randomized Control Trial

BACKGROUND: Finding a restorative material that can survive and be quite resistant in high caries risk patients is very challenging, that’s why three different glass hybrid restorations were tested for their clinical performance for one year in high caries risk patients. AIM: This study was conducted to evaluate the clinical performance of three glass hybrid restorations; nano-ionomer restoration (Ketac Nano), bioactive ionomer glass fillers (Activa bioactive), and alkasite restorative material (Cention N) in Class I cavity in high caries risk patients after 1 year according to the FDI criteria for the assessment of dental restorations. METHODS AND MATERIALS: Fifteen cooperative patients, males or females with high caries risk who were approving to participate in the trial of age range 18–50 years, were selected in the present study. Every patient should have three or more posterior teeth having occlusal pits and fissure carious lesions. Three Class I cavities were performed for every patient and restored randomly with Ketac Nano™, Activa Bioactive™, and Cention N™. All three restorations were applied, according to the manufacturers’ instructions. Restorations were evaluated at baseline (immediately), after 3 months, 6 months, and 1 year by two blinded assessors using FDI criteria for the assessment of dental restorations measuring functional properties. STATISTICAL ANALYSIS USED: Evaluation of functional properties was checked by Kruskal–Wallis non-parametric test statistics at 0.05 level. Collected data were analyzed for descriptive statistics both graphically and mathematically in terms of frequency, percent, median, interquartile range, and mean and standard deviations. Differences in evaluations between materials (M1, M2, and M3) were carried out by Chi-squared test at 0.05 level. However, differences between follow-up times (T0, T1, T2, and T3) were carried out by Friedman’s test for related samples for non-parametric data. Variations caused by the three materials and follow-up times in addition to interaction between them were assessed by repeated measures ANOVA for ranked data at significance levels of 0.05. Data analysis was carried out using computer software Statistical Package for the Social Sciences SPSS (IBM-SPSSver.23.0 for MacOS). RESULTS: Results of functional properties of the three restorative materials revealed that at baseline (T0) and 3 months (T1), all cases (100%) of the three materials were clinically successful, with no significant difference between them. However, after 6 months, 58 cases (97%) of M1, 56 cases (93%) of M2, and 54 cases (90%) of M3 were clinically successful, with non-significant difference between them. Moreover, after 12 months, 55 cases (91.6%) of M1, 56 cases (93%) of M2, and 53 cases (88%) of M3 were clinically successful, with non-significant difference between them. CONCLUSION: In the purpose of restoring posterior permanent teeth in high caries risk patients, all three restorative materials demonstrated acceptable clinical performance in Class I cavities with the same success rate.

Comparison of Retention between Conventional and Nanofilled Resin Sealants in a Paediatric Population: A Randomized Clinical Trial.

Background: This study compared conventional-resin-sealant versus nanofilled-sealant retention at different intervals. Methods: A double-blinded split-mouth randomized control trial was performed on sixty-two children aged from six to nine years. Participants with one pair of contralateral permanent first molars with deep fissures or noncavitated carious lesions were randomly selected for sealant application. Conventional resin sealant was applied on one molar and nanofilled sealant on the contralateral molar. Evaluations were performed at one, three, six, twelve and eighteen months to check for retention. The chi-squared test, McNemar test, Wilcoxon signed-rank test and Friedman test were used for statistical analysis. Results: Conventional resin sealant showed complete retention in 91.4%, 86.2%, 74.1%, 62.1% and 55.2% of the teeth, and nanofilled sealant showed complete retention in 89.7%, 81%, 77.6%, 69% and 67.2% of the teeth, at the end of 1 month, 3 months, 6 months, 12 months and 18 months evaluation, respectively. Each sealant exhibited a statistically significant change (p < 0.05) in the retention rate during the evaluation period. However, when both the sealants were compared with each other, there was no statistically significant difference in any phase. At the end of 18 months, caries development was observed in 13.8% of the teeth sealed with conventional sealant, and in 10.3% of the teeth sealed with nanofilled sealant. Conclusion: At eighteen months, the nanofilled resin sealant exhibited complete retention in 12% more teeth than the conventional sealant. However, the difference was not statistically significant. The nanofilled resin sealant yielded an acceptable performance in sealing the occlusal pits and fissures of mandibular permanent first molars, compared to conventional pit-and-fissure sealants.

The influence of dental restoration depth, internal cavity angle, and material properties on biomechanical resistance of a treated molar tooth

ObjectivesTo assess the hypotheses that a restored tooth structure for a class II occlusal-distal (OD) cavity can be reinforced by optimizing the cavity geometry and choosing composites with adequate mechanical properties. MethodsA human maxillary molar tooth was scanned, and segmented. The 2D profiles of dentin and enamel were drawn and imported to ABAQUS software. Eighteen restored tooth models with different cavity occlusal depths (OcDs) and internal cavity angles were developed. A semi-circular stone part was used to apply contact loads to the restored tooth model. After setting up the required interactions and boundary conditions, a written Python code was used to automatically assign a wide range of elastic moduli, from 2 GPa to 26 GPa, to the composite restorations, and assign constant material properties to the enamel and dentine.For simplicity, the behaviour of the mechanical material was postulated homogeneous and elastic, while the FE analyses were linearly carried out in this study. Also, the code enabled the FEA software to conduct the stress analyses, determine maximum principal stresses, and record the obtained results. ResultsThe internal cavity angle formed between the mesial wall and the pulpal floor of the cavity significantly changed the peak maximum principal stress both in the enamel and restoration. The peak stress concentrations were observed mostly at the enamel-restoration interface, with an almost perpendicular orientation to this interface. Regarding the effect of occlusal cavity depth (OcD), the model with the shallowest cavity (OcD = 1.5 mm) represented greater resistance to applied loads than the model with deeper cavities (OcD = 2.0 mm and OcD 2.5 mm). The composite modulus (CM) in the range of 10–18 GPa reduced the maximum principal stress concentrations in the enamel. The lowest result for maximum principal stress was observed in the model with OcD = 1.5 mm, CM = 10 GPa and internal cavity angles = 100°, which was the strongest model against contact loads. SignificanceClass II OD cavities with optimal geometry have reduced induced stress levels, thus being able to be more mechanically robust against contact load transmitted by a stone. Cavity geometry designs with obtuse (more than 90°) internal cavity angles were significantly efficient in minimizing peak stress concentrations. The results indicated that for the model with obtuse internal cavity angles, choosing a composite with optimised properties can diminish stress, particularly at the tooth-restoration interface. Furthermore, the shallowest the cavity, the sturdier the restoration was, especially when the interface tooth-restoration laid on enamel and not on dentine.

New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial.

BackgroundThe clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth.AimThis randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up.Materials and methodsA total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%).ResultsThe overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008).ConclusionAll evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities.Clinical significanceCention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements.Trial registration number RBR-9nqszrHow to cite this articleda Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.

Microtensile Bond Strength of Bioactive Pit and Fissure Sealants Bonded to Primary and Permanent Teeth.

Background: Sealing occlusal pits and fissures is an effective preventive measure against dental caries. Pit and fissure sealants (PFS) should be strongly bonded to the teeth to prevent partial or complete loss of the sealant, which may limit its preventive effect. Objective: The objective of the study was to compare the microtensile bond strength (μTBS) of bioactive resin-based sealants (Bio-RBS) and resin-based sealants (RBS), with and without the use of a bonding agent, to the enamel of primary and permanent teeth. Methods: One hundred and twenty caries-free primary molar specimens and 120 permanent molar specimens were divided to eight groups (30 specimens per group), both primary and permanent teeth were sealed with a Bio-RBS BioCoatTM (Premier®, Plymouth Meeting, PA, USA) or with a RBS ClinproTM (3M ESPE, Saint Paul, MN, USA), with or without the use of a bonding agent (Prime & Bond NT; Dentsply, Inc., Charlotte, NC, USA). Half the specimens were aged with 5000 thermal cycles, and all specimens were tested for the μTBS and failure mode. Results: The mean μTBS of aged Bio-RBS was higher in permanent teeth than primary teeth, and the aging process reduced the μTBS of RBS more than that of Bio-RBS. Moreover, the addition of a bonding agent improved the μTBS of aged RBS in permanent teeth. Conclusion: We concluded that Bio-RBS exhibit superior μTBS than RBS when applied to permanent teeth.

Direct and indirect eluates from bulk fill resin-based-composites

ObjectivesTo compare elutable substances directly released from bulk-fill (BF) resin-based composites (RBCs) with indirect elution from teeth restored with a BF composite. In addition to (co)monomers, the analytical focus was on other potentially toxic ingredients or impurities. Furthermore, the barrier function of the residual dentin/adhesive layer was studied. MethodsSix BF-RBC materials were studied. For each material subgroup, ten human third molar teeth with standard Class-I occlusal cavities were prepared and provided with a three-step adhesive system and the respective composite restoration (tooth groups). Same sized control specimens of the restorative material were prepared (‘direct BF-RBC’ groups). Each specimen was placed in an elution chamber such that the elution media (ethanol/water, 3:1) only contacted the tooth root or ¾ height of each specimen. They were incubated at 37 °C for up to 7 d. Samples of eluate were taken after 1, 2, 4 and 7 d and were analysed by high-temperature gas chromatography/mass spectrometry. Results(Co)monomers such as Bisphenol A ethoxylate dimethacrylate (bisEMA) or tetraethylene glycol dimethacrylate (TEEGDMA) were mostly found in the eluates of the ‘direct BF-RBC’ groups in statistically significantly greater amounts than in the eluates of the ‘tooth groups’. The residual dentin and/or adhesive layers acted as a diffusion barrier for most of the substances except for triethylene glycol dimethacrylate (TEGDMA) or diethylene glycol dimethacrylate (DEGDMA). For TEGDMA up to 3 orders of magnitude more were found in the ‘tooth groups’ compared to the ‘direct BF-RBC’ groups, evidently released by the adhesive system.Substances of Very High Concern (SVHC) including TINUVIN® 328 and BPA were found mainly in the eluates of ‘direct BF-RBC’ groups. SignificanceFor estimation of biocompatibility, a total system, specifically BF-RBC + adhesive, should always be investigated since individual considerations, such as only elution from a BF-RBC, do not correctly reflect the total clinical situation. The focus of elution tests should not only be on the co(monomers), but also on other ingredients or impurities that may be released.

Effects of aging and light-curing unit type on the volume and internal porosity of bulk-fill resin composite restoration

This study explores the effects of aging (thermal cycling and cyclic loading–TC/CL) and different light-curing unit (LCU) types on the volume characteristics and internal porosity of a bulk-fill resin-based composite restoration. Occlusal cavities (4 × 4 × 3 mm) were prepared on extracted human molars (n = 5). Tetric N-Bond Universal was applied, and the cavities were restored using Tetric-N-Ceram Bulk Fill. Photoactivation was performed using a quartz-tungsten halogen (QTH) or a multiple-emission peak light-emitting diode (MLED). Digital images for all restorations were obtained using microcomputed tomography (micro-CT) before (baseline) and after (post-aging) TC/CL (5,000 TC cycles in 5–55 °C baths and a dwell time of 30 s followed by 10,000 sinusoidal CL load cycles in an Instron B3000 at 2 Hz and 10–110 N) and storage (37 °C) for three months. For the micro-CT analysis, three-dimensional images were used to determine the restoration volume and internal porosity. Data were analyzed using a two-way ANOVA and Tukey’s test (p < 0.05). Restorations photoactivated with QTH exhibited a higher object volume than the LED group at baseline and in post-aging conditions without any significant differences in the other evaluated characteristics. All volume/porosity characteristics increased considerably after TC/CL aging, except for the object volume of the QTH group and the closed porosity of the MLED group. The change in all the volume/porosity characteristics between both LCU groups after TC/CL were not significantly different. Thus, the aging process simulated herein increased the volume and porosity characteristics of the bulk-fill restoration, and no significant differences were obtained between the QTH and MLED equipment.

BAŞLANGIÇ OKLUZAL ÇÜRÜKLERE UYGULANAN İKİ FARKLI NANO KOMPOZİTİN İKİ YILLIK KLİNİK PERFORMANSI

Amaç: Bu çalışmada; başlangıç okluzal çürüklerin tedavisinde kullanılan nanokompozitlerin 2 yıllık klinik performanslarının değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Araştırmaya katılan bireyler, Hacettepe Üniversitesi Diş Hekimliği Fakültesi Restoratif Diş Tedavisi Kliniğine başvuran, en az 2 adet başlangıç okluzal çürüğü bulunan hastalar arasından seçildi (yaş aralığı 18-30). Restore edilecek dişler görsel muayene yöntemi ile değerlendirildi. Radyografilerin incelenmesinden sonra DIAGNodent pen ile ölçümler yapıldı. Dişlere; minimal invaziv okluzal kavite preparasyonu yapıldıktan sonra kondanse edilebilen bir nanokompozit (Quixfil, Dentsply) ve akışkan nanokompozit (SureFil SDR Flow, Dentsply) üretici firmanın önerileri doğrultusunda uygulandı. Çalışmaya katılan 23’ü kadın 20’si erkek olmak üzere 43 gönüllü bireye 356 adet restorasyon yapıldı. Kompozit restorasyonlar, başlangıç, 6., 12., 18., 24. aylarda modifiye USPHS kriterlerine göre değerlendirildi. İstatistiksel değerlendirme için “Pearson Chi-square”, “Fisher Exact” ve “Cochran Q” testleri kullanıldı (p<0.05). Bulgular: 24 ay sonunda 38 hastada 316 adet restorasyon değerlendirildi. Tüm modifiye USPHS kriterleri için restorasyon grupları arasında istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Her grubun kendi içinde, kenar uyumu, kenar renklenmesi, anatomik form ve hassasiyet kriterlerinin zaman içindeki değişimi anlamlıyken (p<0.001); retansiyon, renk uyumu, sekonder çürük, yüzey yapısı, kriterlerinin değişimi anlamlı bulunmadı (p>0.05) Sonuç: Bu çalışmada her iki rezin kompozitin başlangıç okluzal çürüklerin tedavisinde klinik olarak kabul edilebilir bir performans gösterdiği sonucuna varılmıştır. Anahtar kelime: Nanokompozit, Başlangıç Okluzal Çürük, Klinik Performans, Dıagnodent Pen. CLINICAL PERFORMANCE OF TWO DIFFERENT NANO COMPOSITES IN INITIAL OCCLUSAL CARIES : TWO YEARS RESULTS ABSTRACT Aim: The purpose of this study was to evaluate the two-year clinical performance of one condansable nano composite and one flowable nanocomposite in minimal occlusal cavities. Material and methods: Patients were selected from who visiting the Hacettepe University School of Dentistry Department of Restorative Dentistry for the teratment of occlusal caries (age range 18-30 years). At the beginning of treatment, teeth were diagnosed by visual inspection with a mirror and lesions were evaluated with periapical and bitewing radiographs. After that to achieve standardization measurements were made with the DIAGNOdent Pen. 20 male and 23 female subjects participated to study. A total of 356 occlusal cavities were restored with condansable nano composite (Quixfil, Dentsply) and flowable nano composite (SureFil SDR Flow, Dentsply) according to manufacturers’ instructions. All restorations were placed by one operator. The restorations were evaluated clinically within 1 week after placement and after 6., 12., 18., 24. months using modified USPHS criteria by one examiner. Statistical analysis was completed using Pearson Chi-square, Fisher- Exact and Cochran Q tests (p<0,05). Results: At the end of 24 months; in 38 patients 316 restorations were evaluated. No statistically significant differences were found between two resin composites (p>0.05). There were significant differences between time zones with each restoration group for marginal adaptaion, marginal discoloration, anatomic form, post operative sensitivity (p<0.001). Interms of Retantion, color match, seconder caries, surface texture no significant differences have been found in each restorative materials groups (p>0,05). Conclusion: It was concluded that; different types of resin composites demonstrated acceptable clinical performance in initial occlusal caries. Keywords: nanocomposite, initial occlusa caries, clinical performance, DIAGNOdent Pen

Eighteen-month clinical performance of preheated nanoceramic resin-based composites in Class I occlusal cavities: A randomized clinical trial.

Aims:This study aimed to evaluate the effect of preheated nanoceramic resin-based composite (RBC) (Ceram-X-Mono) placed in Class I occlusal cavities over a period of 18 months.Settings and Design:This study involves split-mouth design, randomized controlled clinical trial (RCT)Materials and Methods:One operator restored 60 Class I occlusal cavities in 24 patients. Preheating of nanoceramic RBC to 60°C for 10 min was performed before insertion of the material into 30 prepared cavities, whereas 30 restorations in the nonpreheated group were placed according to the manufacturer's instructions. Two observers evaluated the restorations using Federation Dentaire Internationale (FDI) criteria at baseline, 6, 12, and 18 months.Statistical Analysis:Kappa index, Friedman and Wilcoxon matched pair test, and Krushal-Wallis and Mann-Whitney tests were used for statistical analysis.Results:100% retention rates were seen in both the groups. In nonpreheated group, significant difference was observed for surface staining (P = 0.0001), color stability (P = 0.0277), anatomic form (P = 0.0431), and marginal adaptation (P = 0.0051), whereas in preheated group, significant increase in surface staining (P = 0.0051) was recorded. There was a statistically significant difference observed between the preheated and nonpreheated groups at different time periods for the tested clinical parameters.Conclusion:Within the limitations of this RCT of 18 months, preheated nanoceramic RBC restorations showed better clinical performance compared to nonpreheated group.

29 - Influence of Bromelain and Biosilicate on Adhesive Bond Strength

This study evaluated the effect of bromelain associated with Biosilicate on the bond strength (BS) of composite restorations to sound and caries-affected dentin. 360 sound human molars were selected, and occlusal cavities (6 mm×6 mm x 3 mm) were prepared using carbide burs. Half of them were submitted to cariogenic challenge with Streptococcus mutans strain ATCC25175. All the teeth were separated into nine groups (n = 20), according to the treatment received before the adhesive system (Single Bond Universal, 3 M ESPE): Control group Adhesive System (two coats in self-etch mode); CHX group 0,12% chlorhexidine; NaOCl group 5% sodium hypochlorite; Bio group 10% Biosilicate; Br5 group - 5% bromelain; Br10 group - 10% bromelain; Br5Bio group 5% bromelain + 10% Biosilicate; Br10Bio group 10% bromelain + 10% Biosilicate; NaOClBio group 5% sodium hypochlorite + 10% Biosilicate. After restorative procedures (Filtek Z350XT, 3 M ESPE), the samples were sectioned into sticks, separated, and stored in distilled water at 37 C for 24 h. After that, the sticks were submitted to microtensile test (0.5 mm/min). Data were analyzed using 2-way ANOVA and Bonferronis test (p <.05). The fracture pattern was observed with digital microscope (VH-M100). The caries-affected dentin presented higher BS (p <.05) than the sound substrate under control conditions and when the surface was treated with Biosilicate. Among the sound samples, there was no difference (p >.05), regardless of the treatment employed. In the caries-affected samples, Control and Br10 groups resulted in higher (p <.05) BS than Br5Bio group, with no difference (p >.05) between them. Br10 group also demonstrated higher values (p <.05) than Br10Bio group. The other groups showed no difference (p >.05). Both substrates presented higher incidence of non-adhesive fractures irrespective of the treatment. The pre-treatments with bromelain and bioactive glass-ceramic can affect the bond strength of composite restorations to sound and caries-affected dentin.

Does a Self-adhesive Flowable Resin Composite Perform Similarly to Highly Filled and Conventional Flowable Resin Composites in Occlusal Cavities? A 2-year Follow-up Study.

The aim of this clinical trial was to compare a self-adhesive flowable resin composite, a highly filled flowable resin composite used in combination with a universal adhesive applied in self-etch mode, and a conventional flowable resin composite used in combination with a universal adhesive applied using two different application modes in occlusal cavities. Twenty-eight patients received 114 occlusal restorations. Cavities were divided into four groups: CS: a self-adhering flowable (Constic, DMG); GF: a highly filled flowable (G-ænial Universal Flo, GC) in combination with a universal adhesive applied in self-etch mode (G-Premio Bond, GC); TF-SE: a conventional flowable (Tetric N-Flow, Ivoclar Vivadent) in combination with a universal adhesive (Tetric N-Bond Universal, Ivoclar Vivadent) applied in self-etch mode; TF-ER: a conventional flowable (Tetric N-Flow, Ivoclar Vivadent) in combination with a universal adhesive (Tetric N-Bond Universal, Ivoclar Vivadent) applied in etch&rinse mode. Restorations were scored using modified USPHS criteria. Descriptive statistics were performed using chi-squared tests. At 24-month evaluations, none of the restorations were lost. The CS group showed significantly higher bravo scores for marginal adaptation than did the other experimental groups (p = 0.024). Significant changes were seen for CS and GF regarding marginal adaptation compared to baseline. Although the self-adhering flowable resin composite exhibited inferior marginal adaptation compared to the highly filled flowable and conventional flowable resin composites, the restored teeth demonstrated a clinically acceptable performance after 24 months.

Penatalaksanaan Perawatan Saluran Akar pada Gigi dengan Lesi Abfraksi : Laporan Kasus

Background: Pulp and periapical disease may also result from the presence of a cervical cavity reaching the pulp chamber as an abfraction lesion. Abfraction causes the dentinal tubules to be exposed so that it becomes a pathway for microorganisms to enter the pulp. Root canal treatment in cases with abfraction lesions requires special management, so that contamination does not occur during treatment due to the exposed cervical part. Objective: Discusses the management of root canal treatment in teeth with abfractional lesions that penetrate the pulp chamber. Case Management: A 53-year-old male patient came RSGM Unand because he wanted to be treated for a cavity in his right lower posterior tooth and had a sudden throbbing pain. Based on the results of subjective, objective and preoperative radiographs, tooth 45 was diagnosed with pulp necrosis with chronic apical abscess. Pulp and periapical disease of tooth 45 was probably caused by the entry of microorganisms through the abfraction lesion that reached the pulp chamber. Temporary coronal seal of the abfraction cavity and access occlusal cavity is necessary to prevent the entry of microorganisms during root canal treatment procedures. The final restoration is a direct composite resin using a fiber-reinforced composite (FRC). Conclusion: The management of root canal treatment in this case of abfraction lesion showed success as indicated by the absence of subjective complaints, objective examination showed negative results, and periapical lesions showed healing seen on periapical radiographs.&#x0D;

Effects of application method on shrinkage vectors and volumetric shrinkage of bulk-fill composites in class-II restorations

ObjectivesUpon initial proximal wall construction, the favorable C-factor of class-II cavities may become unfavorable. This study investigated the application method on bulk-fill resin composite polymerization shrinkage. MethodsOccluso-proximal class-II cavities were prepared in 40 molars and bonded with a self-etch adhesive (Adhese Universal). The study groups varied according to the resin composite application: group-1: bulk application, Tetric EvoCeram Bulk Fill (TBF); group-2: proximal wall construction (TBF) and occlusal cavity filling (TBF); group-3: thin flowable liner layer, Tetric EvoFlow Bulk Fill (TEF) and bulk filling (TBF); group-4: flowable liner (TEF), proximal wall (TBF), occlusal cavity (TBF); and group-5: bulk application, SDR (3 mm) and capping layer (TBF, 1 mm). Each resin composite increment was scanned twice using micro-CT (uncured, cured 40 s) at a resolution of 16 µm. Shrinkage vectors and volumetric polymerization shrinkage were evaluated and statistically analyzed (one-way ANOVA). SEM images were used to investigate the tooth-restoration interface. ResultsShrinkage vectors differed significantly among the groups and were greatest in gp5-fl/SDR (47.6 µm), followed by gp1-TBF (23.8 µm) and least in gp5-fl/SDR+TBF (11.1 µm). Volumetric shrinkage varied significantly with the use of SDR (gp5-fl/SDR: 2.6%) and TEF (gp4-fl/TEF: 2.5%) to TBF (gp4-fl/TEF+wl/TBF: 0.6%) in the incremental application. SignificanceBuilding a proximal resin composite wall yielded smaller shrinkage vectors than the bulk application. Applying a thin flowable liner decreased the shrinkage vectors, even more when building a proximal wall. A thin flowable liner is recommended when building a proximal resin composite wall.

The Effect of Resin-Based Dental Sealant Containing Vanillin on Biofilm Formation of &lt;i&gt;Candida albicans&lt;/i&gt;

Early childhood caries (ECC), or baby bottle tooth decay is one of the most common chronic diseases that affect young children at 6 years of age or younger. The disease is resulted from complex interactions between tooth structures and cariogenic microorganisms in dental biofilm after exposure to fermentable carbohydrates through improper feeding practices. This leads to a rapid development of demineralization of teeth shortly after they erupt in the oral cavity. Candida albicans have been reported recently to be associated with the pathogenesis of ECC. One of the general approaches currently used for the prevention of ECC is the application of dental sealant to occlusal (chewing surface) pits and fissures of caries-susceptible teeth. Many types of dental sealants have been extensively used and various antimicrobial agents were introduced to dental sealants to increase their caries preventive effect. The aim of the present study was to evaluate the antimicrobial effect of vanillin incorporated resin-based dental sealant on C. albicans biofilm. Resin-based dental sealants (Clinpro; 3M ESPE, USA) containing different concentrations of vanillin (0%, 0.5%, 1% and 5% w/v) were prepared in 96-well plate. The suspension (107 colony forming unit/mL) of each strain of Candida albicans (ATCC 10231, ATCC 18804 and 2 clinical isolates) was added to saliva-coated sealant resin samples and incubated at 37°C in 5% CO2 atmosphere for 24 h to allow the Candida biofilm formation. The quantity of vital biofilm was determined by WST Microbial Cell Counting Kit (Dojindo Molecular Technologies, USA) at 460 nm. All tests were done in triplicate and repeated three times. Kruskal-Wallis test followed by Dunn’s method were used to account for multiple comparisons. Statistical significance was set at p-value less than 0.05. The results showed that 0.5-5% vanillin-incorporated dental sealant resins showed a significant suppressive effect against all strains of Candida. No significant differences of anti-biofilm effects were found among Candida strains. Approximately 30-50% Candida biofilm reduction was noticed in sealant resins containing vanillin compared with controls without vanillin. In conclusion, the adding of vanillin (0.5-5% w/v) to dental sealant resins is effective in inhibiting biofilm formation of fungus related to early childhood caries, C. albicans. Therefore, the use of dental sealants containing vanillin has the potential to prevent this type of dental caries in young children and biofilm formation by oral Candida. Further clinical studies are required to investigate physical properties of this sealant and clinical evaluation in the patients.

A 24-Month Evaluation of Self-Adhering Flowable Composite Compared to Conventional Flowable Composite in Conservative Simple Occlusal Restorations: A Randomized Clinical Trial.

Background:Self-adhering flowable composite (SAFC) simplified restorative procedures, especially when compared to conventional techniques. Self-adhering composite revolutionized restorative dentistry by merging advances of adhesive and restorative materials to generate the so-called “eighth generation.”Aims:The objective of this clinical trial was to assess the clinical performance of SAFC compared to conventional flowable composite in minimally invasive occlusal cavities.Settings and Design:A total of 18 patients with conservative occlusal cavities received randomly two types of restorations in a split-mouth design.Materials and Methods:Vertise™ Flow or Filtek™ Z350XT Flowable was applied according to the manufacturer's instructions. All restorations were evaluated at baseline and after 24 months, respectively, by two blinded assessors using modified USPHS criteria.Statistical Analysis Used:Chi-square test was used for intragroup comparison between time points and intergroup comparison within each time point. A value of P ≤ 0.05 was considered statistically significant. Relative risk was used to determine the clinical significance.Results:The results of the current study have revealed no statistically significant difference between both materials for all tested outcomes at baseline and after 24 months.Conclusions:SAFC revealed satisfactory clinical performance in restoration of minimally invasive occlusal cavities after 24-month follow-up.

Low- and high-viscosity bulk-fill resin composites: a comparison of microhardness, microtensile bond strength, and fracture strength in restored molars.

The aim of this study was to compare low- and high-viscosity bulk-fill composites for Knoop microhardness (KHN), microtensile bond strength (MTBS) to dentin in occlusal cavities, and fracture strength (FS) in molars with mesialocclusal- distal restoration. Disk-shaped samples with different thicknesses (2 or 4 mm) of low-viscosity (SDR Flow, Dentsply) and high-viscosity bulk-fill composites (Filtek BulkFill, 3M ESPE; and Tetric-N Ceram Bulk Fill, Ivoclar Vivadent) were prepared for top and bottom KHN analysis (n=10). MTBS to dentin and fracture pattern was evaluated in human molars with occlusal cavities restored with (n=10): conventional nanocomposite (Z350XT, 3M ESPE), low-viscosity (Filtek Bulk-fill Flow, 3M ESPE) or high-viscosity bulk-fill composites (Filtek BulkFill). The FS and fracture pattern of human molar with mesial-occlusal-distal restorations submitted or not to thermomechanical cycling were investigated (n=10) using: intact tooth (control), and restoration based on conventional microhybrid composite (Z250, 3M ESPE), low-viscosity (SDR Flow) or high-viscosity bulk-fill composites (Filtek BulkFill). The data were submitted to split-plot ANOVA (KHN), one-way ANOVA (MTBS), two-way ANOVA (FS) followed by Tukey's test (α=0.05). For KHN, there was no significant difference for the resin composites between the top and bottom. For MTBS, no significant differences among the materials were detected; however, the low-viscosity composite presented lower frequency of adhesive failures. For FS, there was no significant difference between composites and intact tooth regardless of thermomechanical cycling. Low- and high-viscosity bulk-fill composites have comparable microhardness and microtensile bond strength when used in occlusal restorations. Likewise, the bulk-fill composites present similar fracture strength in molars with mesio-occlusal-distal restorations.

Evaluation of Efficiency of Polymerization, Surface Roughness, Porosity and Adaptation of Flowable and Sculptable Bulk Fill Composite Resins.

A new category of commercial bulk fill composite resins (CRs) enables the placement of 4-mm-thick layers as an alternative to the traditional time-consuming incremental technique. The purpose of the present study was to compare the efficiency of the polymerization, adaptation and porosity of two high-viscosity ‘sculptable’ bulk fill CRs (Filtek™ Bulk Fill (3M™ ESPE, St. Paul, MN, USA) and Tetric EvoCeram® Bulk Fill (Ivoclar Vivadent AG, Schwan, Liechtenstein)) and two low-viscosity ‘flowable’ bulk fill CRs (SureFil® SDR™ flow (Dentsply Sirona, Charlotte, NC, USA) and Tetric EvoFlow® Bulk Fill (Ivoclar Vivadent AG, Schaan, Liechtenstein)). Cylindrical samples of the bulk fill CRs (4 mm height × 10 mm diameter) were analyzed by Fourier-transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). Additionally, occlusal cavities were prepared in twelve extracted human molars and restored with the bulk fill CRs (n = 3 for each CR). The adaptation and porosity of the bulk fill CRs were evaluated by X-ray microcomputed tomography (µCT) with a 3D morphometric analysis, and the adaptation was also analyzed by scanning electron microscopy (SEM) on longitudinal vestibulo-oral sections of the restored teeth. The AFM analysis demonstrated that the surface roughness of the SureFil® SDR™ flow was higher than that of the Tetric EvoFlow® Bulk Fill and that the surface roughness of Filtek™ Bulk Fill was higher than that of Tetric EvoCeram® Bulk Fill. µCT and SEM confirmed that the flowable bulk fill CRs had excellent adaptation to the cavity walls. The 3D morphometric analysis showed the highest and lowest degrees of porosity in Filtek™ Bulk Fill and Tetric EvoFlow® Bulk Fill, respectively. In general, the flowable bulk fill CRs exhibited better adaptation, a higher efficiency of polymerization and lower porosity than the sculptable materials.

Direct and indirect monomer elution from an RBC product family

ObjectiveTo develop a model for quantitative comparison of elutable substances by direct elution from resin-bonded composite (RBC) test specimens versus indirect elutability of substances from RBC-restored teeth. Furthermore, it was to be investigated whether the different composites of the Tetric® RBC product family release different types and amounts of substances. MethodsFour different composite materials from the Tetric® product family were studied. For each material subgroup ten human third molar teeth were prepared with standard Class-I occlusal cavities. These ‘tooth group’ specimens were provided with a three-step adhesive system (incorporating TEGDMA) and the respective composite restoration. Same sized control specimens, of each RBC restorative material, were prepared (‘direct RBC’ groups). All specimens were placed in individual elution chambers such that the elution media (ethanol/water, 3:1) only came into contact with either the tooth root or ¾ height of the ‘direct RBC’ materials. They were incubated at 37 °C for up to 7 d. Samples of the eluant were taken after 1, 2, 4 and 7 d and were analysed by high-temperature gas chromatography/mass spectrometry. ResultsBisphenol A ethoxylate dimethacrylate (bisEMA), bisphenol A glycidyldimethacrylate (bisGMA), tetraethylene glycol dimethacrylate (TEEGDMA), decan-1,10-diol dimethacrylate (DDDMA) were mostly found in the eluates of the ‘direct RBC’ groups in statistically significantly greater amounts than in the eluates of the ‘tooth groups’. Such quantitative differences were also the case with eluates containing bisphenol A (BPA), dicyclohexyl phthalate (DCHP) and drometrizole, which are common in the environment. In contrast to the behavior found with all the other monomers, up to 3 orders of magnitude more triethylene glycol dimethacrylate (TEGDMA) was found in the ‘tooth groups’ compared to the ‘direct RBC’ groups, evidently released by the adhesive system. SignificanceThe release of most of the substances was clearly delayed in the ‘tooth groups’ indicative of their chronic, rather than acute, elution to the oral environment. A barrier function of the residual dentin layer and the adhesion layer can be inferred. The different release patterns of substances from the various composites of the RBC product family is a manifestation of their different and indication-specific compositions. Consideration of an overall restorative care (RBC plus adhesive) system, when assessing the total amount of released substances, is emphasized.

Mesiodistal Width of Mandibular Central Incisors between Different Genders in Chennai Population Using Cone Beam Computed Tomography

Background: Using the CBCT, this technique has the ability to identify the proper dimensions of themesiodistal width of the tooth and other clearing techniques that in the past have been of higher value tothe other conventional techniques that can be implemented to give a three-dimensional perspective of thecomplete morphological details. With this, analysing the mesiodistal width of mandibular central incisorsbetween male and female based on CBCT can be accomplished.Methods: One hundred Cone Beam Computed Tomography (CBCT) images from different patients areselected randomly from Department of Oral Radiology of Saveetha Dental College and Hospital, India.All the CBCT images of patients are examined for the inclusion criterias in the mesiodistal width of themandibular incisors between different genders. All mesiodistal width of mandibular central incisors betweendifferent genders are investigated and compared.Conclusion:When both the genders were compared in terms of the number of canals, there was a significantdifference seen (p-value: 0.000002208). With the p-value calculated, it was found that there was a significantdifference between the genders in terms of the distance between the occlusal pit to the pulp chamber (p-value:&lt;0.0000001). Overall, there is no significant difference between the two genders at the level of the cervicalthird (p-value: 0.6554).