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To answer the PICOS question: “Is the risk of retention loss equal for SEE and SE approach when universal adhesives and composite restorations are indicated for restoring NCCLs?”
Web ...of Science, PubMed, Cochrane Central Register of Controlled Trials, Scopus, Scientific Electronic Library Online, LILACS, Google Scholar™ and OpenGrey were searched. Only randomized controlled clinical trials in which NCCLs were restored with composites and universal adhesives applied in SEE or SE mode were included. The articles were assessed for the risk of bias, after which meta-analyses were run (fixed-effects model was applied; heterogeneity was explored using Cochran Q test and I2 statistics; α = 0.05) and the certainty of evidence was assessed by the GRADE tool.
Fifteen articles were included in qualitative, while 7 articles were included in quantitative analysis. Seven studies were judged as “low” risk of bias, while 8 were considered as “unclear” risk of bias. Statistically significant difference for retention were observed at 6- and 18/24 months (p = 0.05; OR=0.42, 95% CI 0.18, 0.99; very low certainty of evidence and p = 0.007; OR=0.31, 95% CI 0.13, 0.72; low certainty of evidence, respectively), favoring SEE approach. No other significant differences in clinical outcomes were observed between SEE and SE approach (very low certainty of evidence).
When restoring NCCLs, clinicians might consider applying universal adhesives in SEE mode since it could lead to more predictable retention compared to SE approach up to 2 years of follow-up.
The oral cavity and oropharynx are complex environments that are susceptible to physical, chemical, and microbiological insults. They are also common sites for pathological and cancerous changes. The ...effectiveness of conventional locally‐administered medications against diseases affecting these oral milieus may be compromised by constant salivary flow. For systemically‐administered medications, drug resistance and adverse side‐effects are issues that need to be resolved. New strategies for drug delivery have been investigated over the last decade to overcome these obstacles. Synthesis of nanoparticle‐containing agents that promote healing represents a quantum leap in ensuring safe, efficient drug delivery to the affected tissues. Micro/nanoencapsulants with unique structures and properties function as more favorable drug‐release platforms than conventional treatment approaches. The present review provides an overview of newly‐developed nanocarriers and discusses their potential applications and limitations in various fields of dentistry and oral medicine.
A wide variety of micro/nanoscale platforms are employed for oral and dental applications including tissue regeneration, infection control, and cancer management. Such micro and nanocarriers deliver ions (e.g., fluoride, calcium, strontium), antibiotic, antiviral, antifungal compounds, as well as genes and proteins.
Incomplete and inadequate removal of endodontic biofilm during root canal treatment often leads to the clinical failure. Over the past decade, biofilm eradication techniques, such as sonication of ...irrigant solutions, ultrasonic and laser devices have been investigated in laboratory settings. This review aimed to give an overview of endodontic biofilm cultivation methods described in papers which investigated sonic-, ultrasonic- and Er:Yag laser-assisted biofilm removal techniques. Furthermore, the effectiveness of these removal techniques was discussed, as well as methods used for the evaluation of the cleaning efficacy. In general, laser assisted agitation, as well as ultrasonic and sonic activation of the irrigants provide a more efficient biofilm removal compared to conventional irrigation conducted by syringe/needle. The choice of irrigant is an important factor for reducing the bacterial contamination inside the root canal, with water and saline being the least effective. Due to heterogeneity in methods among the reviewed studies, it is difficult to compare sonic-, ultrasonic- and Er:Yag laser-assisted techniques among each other and give recommendations for the most efficient method in biofilm removal. Future studies should standardize the methodology regarding biofilm cultivation and cleaning methods, root canals with complex morphology should be introduced in research, with the aim of simulating the clinical scenario more closely.
Objective
To investigate the long-term microtensile bond strength (µTBS), interfacial nanoleakage expression (NL), and adhesive stability of dual-cure resin cements with/out light activation to ...dentin.
Materials and methods
Composite overlays (
N
= 20) were luted to deep dentin surfaces with RelyX Ultimate (RXU, 3M) or Variolink EstheticDC (VAR, Ivoclar-Vivadent). A universal adhesive was used for bonding procedures (iBond universal, Heraeus Kulzer). The resin cements were either self-cured (SC; 1 h at 37 °C) or dual-cured (DC; 20s light-cure followed by 15 min self-cure at 37 °C). Specimens were submitted to µTBS immediately (
T
0
) or after 1 year of laboratory storage (
T
12
). The fracture pattern was evaluated using scanning electron microscopy (SEM). Data were statistically analyzed with two-way ANOVA/Tukey test. Further, the NL was quantified and analyzed (chi-square test) and in situ zymography was performed to evaluate the endogenous enzymatic activity within the hybrid layer (HL) at
T
0
and
T
12
(Mann–Whitney test)
.
The significance level for all statistical tests was set at
p
= 0.05.
Results
DC resulted in higher bond strength and decreased fluorescence at the adhesive interface, irrespective of the material and the storage period (
p
< 0.05). Significantly lower bonding performances (
p
< 0.05) and higher endogenous enzymatic activity (
p
< 0.05) were observed within the HL at
T
12
compared to
T
0
in all tested groups.
Conclusions
Light-curing the dual-cure resin cements, more than the cement materials, accounted for good bonding performances and higher HL stability over time when used with a universal adhesive.
Clinical significance
The curing condition influences the bonding performances of dual-cure resin cements to dentin when used with a universal adhesive.
Several lubricant materials can be used to model resin-based composites (RBCs) during restorative procedures. Clinically, instruments or brushes are wet with bonding agents (BAs) or modeling liquids ...(MLs) for sculpturing purposes. However, a knowledge gap exists on their effects on the mechanical properties of RBCs, requiring greater insight. Five databases were searched, including 295 in vitro studies on the use of lubricant materials for modeling RBCs during restorative procedures. Only articles in the English language were included, with no limits on the publication date. The last piece of research was dated 24 March 2022. In total, 16 studies were included in the review process, together with a paper retrieved after screening references. A total of 17 BAs and 7 MLs were investigated. Tensile (
= 5), flexural strength (
= 2), water sorption (
= 2), color stability (
= 8) and translucency (
= 3), micro-hardness (
= 4), roughness (
= 3), degree of conversion (
= 3), and monomer elution (
= 2) tests were carried out. In general, a maximum of 24 h of artificial storage was performed (
= 13), while four papers tested the specimens immediately. The present review identifies the possibilities and limitations of modeling lubricants used during restorative procedures on the mechanical, surface, and optical properties of RBCs. Clinicians should be aware that sculpturing RBCs with modeling resins might influence the composite surface properties in a way that is material-dependent.
Resin infiltration is a conservative treatment of initial enamel carious lesions. Only one infiltrant material is available on the market (Icon, DMG), and research is now investigating new chemical ...compositions so as to further exploit the benefits of the resin infiltration technique. A literature search of the articles testing the effects of different formulations on mechanical properties, resin penetration ability, remineralizing, and antibacterial activities was conducted. Of 238 articles, 29 resulted in being eligible for the literature review. The formulations investigated were all different and consisted in the inclusion of hydrophobic monomers (i.e., BisEMA, UDMA), solvents (ethanol, HEMA), alternative etchants (PAM) or molecules with antibacterial or bioactivity features (i.e., AgNP, YbF
MTZ, chitosan, DMAMM, HAp, MC-IL, NACP, PUA, CHX) and microfilled resins. Information on the long-term performances of the tested experimental materials were scarce. The combination of TEGDMA with hydrophobic monomers and the inclusion of a solvent alternative to ethanol reinforced mechanical properties of the materials. Hybrid-glass materials demonstrated an enhanced remineralization capacity. Techniques such as tunnelization increased the penetration depth and preserved the recourse to less-conservative treatments. Combining the min-invasive infiltrant approach with remineralizing and bacteriostatic properties would be beneficial for therapeutic and economical aspects, according to the principles of minimally invasive dentistry.
To investigate the effect of 0.3 M 1-ethyl-3(3-dimethylaminopropyl) carbodiimide (EDC) aqueous solution pretreatment on push-out bond strength (PBS) and matrix-metalloproteinases (MMPs) activity ...within radicular dentin when different post cementation strategies were employed.
One hundred and twenty monoradicular human teeth were endodontically treated and randomly divided into six groups, depending on the cementation strategy and root dentin pretreatment (n = 20): EAR: cementation with an etch-and-rinse adhesive (LuxaBond Total Etch, DMG) and resin cement (LuxaCore Z Dual, DMG); EAR/EDC: 1 min EDC pretreatment after etching + EAR; SE: cementation with a self-etch primer (Multilink Primer, Ivoclar Vivadent) and corresponding cement (Multilink Automix, Ivoclar Vivadent); SE/EDC: self-etch primer + EDC pretreatment + SE; SA: cementation with a universal self-adhesive cement (RelyX Universal, 3 M); SA/EDC: EDC pretreatment + SA. Slices were submitted to PBS test and interfacial nanoleakage evaluation 24 h after cementation or after thermocycling (40.000 cycles, 5-55 °C). To investigate the effect of EDC on MMPs activity, 4 additional first maxillary premolars per group were processed for in situ zymography analysis. Multivariate ANOVA and post hoc Tukey tests were used to analyze PBS values. The data from in situ zymography were analyzed with Kruskal-Wallis test and Dunn's pairwise multiple comparison procedures (α = 0.05).
The variables "EDC pretreatment", "root region" and "thermocycling" significantly influenced PBS (p < 0.05), while the variable "cementation strategy" had no influence (p > 0.05). Thermocycling significantly reduced PBS in SE and SA groups (p < 0.05). EDC was effective in preserving PBS after artificial aging. EDC pretreatment significantly reduced enzymatic activity at baseline in EAR and SE groups, and in SA group after thermocycling (p < 0.05).
The use of EDC prevents the reduction of bond-strength values after artificial aging and silences endogenous enzymatic activity within radicular dentin when different cementation strategies were employed.
The purpose of this study was to clarify the structural and ultrastructural alterations of the enamel and dentin collagen network in the deciduous teeth of children affected by osteogenesis ...imperfecta (OI) using field-emission in-lens scanning electron microscopy (FEI-SEM) and transmission electron microscopy (TEM) analyses. Exfoliated primary teeth were collected from children with a diagnosis of OI and from healthy individuals (N = 24). Tooth slices containing both dentin and enamel were fixed, dehydrated and dried, gold sputtered, and observed using FEI-SEM. Additional dentin fragments were decalcified, dehydrated, embedded in resin, cut, and processed for TEM analysis. Under FEI-SEM, the enamel in OI-affected children showed an irregular prism distribution with the enamel hydroxyapatite crystals unpacked. Ultrastructural correlative analysis of the dentin in patients affected by OI showed an altered collagen pattern with a low density. In some areas, teeth in OI patients showed a reduction in the number of dentinal tubules, with odontoblastic process missing in most of the tubules. The presence of altered dentine and enamel organization in OI children was firmly established at an ultrastructural level, but additional biochemical studies are necessary in order to clarify quantitatively and qualitatively the collagenic and non-collagenic proteins in this disorder.
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To answer the following PICOS question: “Is the risk of retention loss, marginal discoloration, marginal adaptation and postoperative sensitivity (POS) equal for etch-and-rinse (EAR) ...compared to self-etch (SE) or selective-enamel etch (SEE) mode when restoring non carious cervical lesions (NCCLs) with universal adhesives?”.
PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google Scholar™ were searched. Randomized controlled clinical trials in which resin composites and universal adhesives were used for restoration of NCCLs were considered. Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analyses were performed using Revman; random-effects models were applied, and heterogeneity was tested using the I2 index. The significance level was set at p < 0.05. Certainty of evidence was assessed by GRADE tool.
After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis. Twelve studies ranked as “low”, while 8 studies scored as “unclear” for risk of bias. At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups (p = 0.005; RR = 0.22, 95% CI 0.08, 0.63,moderate certainty of evidence and p = 0.0002; RR = 0.32, 95% CI 0.17, 0.58, moderate certainty of evidence, respectively). No significant differences were observed for marginal discoloration and adaptation (p > 0.05). The probability of POS occurrence was less in SE than in EAR groups (RR = 2.12, 95% CI 1.23, 3.64, moderate certainty of evidence). The certainty of evidence for other outcomes was scored as “low” or “moderate”, depending on the follow-up period.
Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.
Objective
A comprehensive classification of structurally compromised teeth (SCT) was introduced.
Clinical Considerations
Dental injuries or operative mismanagement undermine the structural integrity ...of the tooth abutment, reducing its biomechanical strength and rendering restorative procedures challenging. To standardize the overall pre‐operative evaluations and determine the biological and mechanical features, a classification of the coronal and cervical tooth defects, as well as an attentive analysis of the most apical location of the residual cervical tooth structure along the whole perimeter and the most coronal location of the bucco/lingual residual structure was presented. Considering the residual cervical structure, five possible clinical scenarios were individuated with respect to the gingival margin, gingival sulcus, supracrestal tissue attachment and bone crest (BC). The latter prevents the isolation procedures rendering the adhesive restorations unfeasible. Instead, the location of the most apical portion of residual cervical structure within subgingival/intrasulcular depth (>1.5 mm above BC) can be considered restorable.
Conclusions
This classification is threefold: to enclose all the possible clinically encountered tooth defects, to identify the apical problems of SCT to appropriately manage the perio‐restorative interfaces, and to evaluate the tooth resistance capacity of SCT, as to plan and perform the most adequate biomechanical restorative approach.
Clinical Significance
The present classification is proposed to provide a complete perspective of structurally compromised teeth to standardize the biologic and biomechanical evaluations during planning of restorative procedures.
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