The journal of adhesive dentistry最新文献

Purpose: The first objective was to determine if dual-curing of resin cement with reduced light could affect interfacial adaptations of zirconia restoration. The second objective was to examine whether cement type and pretreatment method of universal adhesive affected interfacial adaptation. The final objective was to compare the polymerization degree of cement under different reduced-light conditions.

Materials and methods: Inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray Noritake) in three groups with restoration thicknesses of 1, 2, and 3 mm, respectively. Each group had three subgroups using different cementation methods. For subgroup 1, restorations were cemented with self-adhesive cement. For subgroup 2, universal adhesive was applied and light cured. After the restoration was seated with conventional resin cement, light curing was performed. For subgroup 3, after adhesive was applied, the restoration was seated with conventional resin cement. Light curing was performed for the adhesive and cement simultaneously. After thermocycling, interfacial adaptation at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, polymerization shrinkage of the cement was measured using a linometer and compared under the conditions of different zirconia thicknesses and light-curing durations.

Results: Interfacial adaptation varied signficantly depending on the zirconia thickness, pretreatment, polymerization mode and cements used (p < 0.05). The effects of the adhesive and polymerization shrinkage differed signficantly, depending on the reduced light under the zirconia (p < 0.05).

Conclusion: Lower curing-light irradiance may lead to inferior adaptation and lower polymerization of the cement. Polymerization of resin cement can differ depending on the light irradiance and exposure duration.

Purpose: Newly developed non-invasive methods for replace a missing tooth and closing single-tooth gaps in the poster- ior region using resin composite are presented.

Materials and methods: Four different non-invasive methods and the technical procedures, materials and instruments used are presented in a case series. These include the direct intraoral insertion of composite (with and without individual shaping aids) and indirect restorations, which are fabricated conventionally or digitally and bonded.

Results: The case series showed that all four methods can be used to replace single missing teeth in the posterior region, meeting current clinical requirements. Particular attention was paid to the design of the pontics, the dimension of the connector area, firm proximal contacts to the adjacent teeth, hygiene, and appearance of the non-prep bridges (NPBs). The advantages and disadvantages for both the direct and indirect techniques illustrated in this case series were com- pared in detail.

Conclusions: Several direct and indirect non-invasive methods for single-tooth replacement are available today. Although the evidence is still limited, there is a potential for frugal dental interventions with NPBs. Further experimental and clinical studies are necessary to demonstrate that they reliably meet quality requirements (including sufficient survival rates), satisfy the criteria of cost-effectiveness (compared to treatment alternatives) and that there is a demand from the population.

Purpose: Resin composites are commonly used in pediatric dentistry, but there is limited evidence on adhesion to primary teeth, especially primary enamel. In this study, three bonding strategies were assessed - one-step self-etch (1-SE), two-step self-etch (2-SE), and three-step etch-and-rinse (3-ER) - by measuring the immediate and aged microshear bond strength (µSBS) to sound primary enamel.

Materials and methods: 120 extracted human primary molars with sound buccal surfaces were used for µSBS testing. Six adhesive protocols (two per bonding strategy) were selected and µSBS was measured either after 24 h or 10,000 thermal cycles (n = 10). Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were used to determine failure modes. Furthermore, 18 primary molars were etched using the different adhesive protocols (n = 3) for the measurement of surface roughness (Sa) using CLSM and morphological analysis using SEM.

Results: After 24 h, there was no significant difference in µSBS between 1-SE and 2-SE strategies (p = 0.96), but the 2-SE strategy yielded significantly higher µSBS after thermocycling (p < 0.001). The highest µSBS was obtained using the 3-ER strategy regardless of aging (p < 0.001). The 3-ER strategy clearly exposed enamel prisms and resulted in the highest Sa (p < 0.001). In contrast, if SE strategies were used, enamel prisms were barely recognizable, and Sa was not significantly different from baseline (p > 0.95).

Conclusion: The 3-ER strategy is optimal for bonding to primary enamel. The etching effect of SE strategies is weaker, resulting in lower µSBS. Thermocycling revealed that the bonding durability of the 1-SE strategy is inferior to that of to multi-step strategies.

Purpose: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient.

Materials and methods: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices.

Results: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent.

Conclusion: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.

Purpose: This follow-up of a randomized clinical split-mouth study aimed to investigate the influence of selective enamel etching on the long-term clinical performance of partial ceramic crowns (PCCs) luted with a self-adhesive resin cement.

Materials and methods: 43 patients received two PCCs (Vita Mark II; Cerec 3D) each for the restoration of extensive lesions with multiple cusp coverage, inserted with a self-adhesive resin cement (RelyX Unicem, RXU). Using a split-mouth design, one PCC received additional selective enamel etching (RXU+E) and one did not (RXU-E). Patients were clinically evaluated at baseline and after up to 15 years (median observation period 176 months) using modified USPHS and FDI criteria. The data were analyzed non-parametrically (chi-squared tests, α = 0.05). Clinical survival of all restorations after 15 years was evaluated using the Kaplan-Meier analysis.

Results: After 15 years, 19 patients were available for clinical assessment (recall rate: 56%). Kaplan-Meier analysis showed a cumulative survival of 78.1% for RXU+E and of 42.9% for RXU-E, indicating a significantly higher survival rate for RXU+E (p = 0.004). Regarding the clinical performance of PCCs available for the 15-year evaluation, no statistically significant differences were found between RXU+E and RXU-E using modified USPHS and FDI criteria. Both groups revealed significant deterioration over time regarding surface luster, marginal adaptation, and marginal discoloration. RXU+E resulted in significantly inferior anatomic form over time and a significant improvement in post-operative hypersensitivity compared to baseline.

Conclusion: For posterior PCCs, selective enamel etching can be recommended based on higher survival rates after 15 years. Clinically, deterioration due to aging is similar in both groups.

Purpose: To determine the polymerization kinetics and color stability of a self-adhesive and conventional resin composite after accelerated shelf-life simulation.

Materials and methods: Two composites were tested - universal Filtek Z250 (3M Oral Care) and self-adhesive Constic (DMG). They were stored for 2 months in an incubator to simulate an Arrhenius aging model (60°C) and tested at 5 different time points. Polymerization kinetics (n = 3) were studied using an attenuated total reflectance technique (ATR), through continuous FTIR spectral acquisition (20 min). Spectra were obtained before, during and after 20 s of light curing. With the spectral data, qualitative analysis was performed yielding chemical stability, and quantitative data including extrapolated degree of conversion (DCmax) and polymerization rate (Rpmax) were assessed. To evaluate color stability (n = 3), a spectrophotometer was used to record CIELAB color parameters. Inferential statistics, including repeated measures two-way ANOVA were carried out at a significance level of 5%.

Results: The composites did not appear to undergo significant chemical changes after 2 months of accelerated aging. There was a significant impact of aging on the mean DCmax (p < 0.001). Similarly, a reduction in Rpmax, measured for both composites, was also noted (ANOVA; Z = 203.7; p < 0.001). The two-way ANOVA confirmed that the composite had no influence on the color stability (F = 0.94; p = 0.34), while aging did (p = 0.013).

Conclusion: Minimal changes in absorbance levels were noted for both composites, without overly affecting their chemical composition. The presence of an acidic monomer did not seem to potentiate the degradation of the self-adhesive composite. This composite even showed greater color stability after aging.