Exploration and preliminary clinical investigation of an adhesive approach for primary tooth restoration

The current study aims to investigate a suitable adhesive for primary tooth enamel. Shear bond strength (SBS) of primary teeth and the length of resin protrusion were analyzed using one-way ANOVA with Bonferroni multiple comparison tests after etching with 35% H₃PO₄. SBS and marginal microleakage tests were conducted with Single Bond Universal (SBU)/Single Bond 2 (SB2) adhesives with or without pre-etching using a nonparametric Kruskal-Wallis test. Clinical investigations were performed to validate the adhesive for primary teeth restoration using Chi-square tests. Results showed that the SBS and length of resin protrusion increased significantly with the etching time. Teeth in the SBU with 35% H₃PO₄ pre-etching groups had higher bond strength and lower marginal microleakage than those in the SB2 groups. Mixed fractures were more common in the 35% H₃PO₄ etched 30 s + SB2/SBU groups. Clinical investigations showed significant differences between the two groups in cumulative retention rates at the 6-, 12- and 18-month follow-up evaluations, as well as in marginal adaptation, discoloration, and secondary caries at the 12- and 18-month follow-up assessments. Together, pre-etching primary teeth enamel for 30 s before SBU treatment improved clinical composite resin restoration, which can provide a suitable approach for restoration of primary teeth.     

Patterns of morphological variation in enamel–dentin junction and outer enamel surface of human molars

Tooth crown patterning is governed by the growth and folding of the inner enamel epithelium (IEE) and the following enamel deposition forms outer enamel surface (OES). We hypothesized that overall dental crown shape and covariation structure are determined by processes that configurate shape at the enamel–dentine junction (EDJ), the developmental vestige of IEE. This this hypothesis was tested by comparing patterns of morphological variation between EDJ and OES in human permanent maxillary first molar (UM1) and deciduous second molar (um2). Using geometric morphometric methods, we described morphological variation and covariation between EDJ and OES, and evaluated the strength of two components of phenotypic variability, canalization and morphological integration, in addition to the relevant evolutionary flexibility, i.e. the ability to respond to selective pressure. The strength of covariation between EDJ and OES was greater in um2 than in UM1, and the way that multiple traits covary between EDJ and OES was different between these teeth. The variability analyses showed that EDJ had less shape variation and a higher level of morphological integration than OES, which indicated that canalization and morphological integration acted as developmental constraints. These tendencies were greater in UM1 than in um2. On the other hand, EDJ and OES had a comparable level of evolvability in these teeth. Amelogenesis could play a significant role in tooth shape and covariation structure, and its influence was not constant among teeth, which may be responsible for the differences in the rate and/or period of enamel formation.     

无创渗透树脂材料修复早期乳牙邻面龋

背景：乳牙早期邻面龋因解剖位置的原因菌斑不易去除,常规再矿化治疗疗效不佳。 目的：观察无创渗透树脂技术治疗乳牙早期邻面龋的临床疗效。 方法：选择乳牙邻面早期龋的患牙120颗,随机分为渗透树脂组和流动树脂组,每组60颗,分别应用渗透树脂和流动树脂进行治疗,治疗后1年随访,对患者邻面龋的牙体形态、去除釉质脱矿造成的白垩色斑和色泽稳定性、继发龋和治疗成功率方面进行临床评价。 结果与结论：两组患者在充填治疗后1年的疗效检查结果中发现,渗透树脂组邻面龋的牙体形态、去除釉质脱矿造成的白垩色斑以及色泽稳定性、继发龋方面均好于流动树脂组。渗透树脂组的治疗成功率96.7%远高于流动树脂组的76.7%,差异有显著性意义(P < 0.05)。无创渗透树脂材料是目前阻断龋病发展简便高效的方法。     

Development of self-etching primer comprised of methacrylamide, N-methacryloyl glycine

In order to develop a more effective self-etching primer, it is helpful to understand how a functional monomer conditions the surface of the teeth.

In this study, the reactivity by the carboxylic acid in the N-methacryloyl glycine (NMGly) on the calcium phosphate in hydroxyapatite or dentin was studied. The efficacy of the NMGly as a functional monomer for a self-etching primer was then examined.

Applying NMGly to both the enamel and dentin resulted in an increase in the bond strength of resin, since the carboxylic acid in the NMGly decalcified the calcium phosphate in the hydroxyapatite and dentin. The bond strength to dentin achieved was higher than with the enamel. This difference was most likely due to different enamel and dentin adhesion mechanisms.     

Analysis of fracture and deformation modes in teeth subjected to occlusal loading

An analysis of fracture and deformation modes in tooth enamel subjected to occlusal loading is presented. Several competing modes are identified: deformation by yield beneath the indenter; median cracking from the ensuing plastic zone and analogous radial cracking from the dentin–enamel junction along the load axis; and margin cracking from the cervical enamel–cement junction. The analysis, based on a simple model of tooth geometry, presents relations for the critical loads to initiate these damage modes within the enamel, and to drive ensuing cracks longitudinally around the tooth walls to failure. The relations are explicit in their dependence on characteristic tooth dimensions – enamel thickness and cuspal radius – and on material properties – modulus, hardness, toughness and strength. Provision is made to incorporate properties of the occlusal contact, whether from opposing dentition or intervening food particles. All these features are demonstrated on critical-load master diagrams. A characteristic feature of the damage evolution is the gradual evolution of each mode with increasing load, so that failure is generally a prolonged rather than abrupt event. This accounts for the remarkable damage tolerance of natural teeth. The equations may enable basic predictions of tooth responses for humans and animals under a variety of specified dietary and functional conditions.     

Quantitative analysis of the calcium and phosphorus content of developing and permanent human teeth.

It was the aim of this study to investigate the distribution of Ca, P and C in predentin, dentin and enamel in human tooth buds and permanent teeth by EDX element analysis. The mandible of a 16-week-old human fetus containing eight mineralizing tooth buds and three human permanent molars were fixed in formaldehyde and embedded in Technovit 9100. Serial sections of 80 microm thickness of the mandible were cut in the frontal-dorsal direction, and polarized light micrographs were taken of these sections. The permanent teeth were cut in mesio-distal direction. The sections were investigated with scanning electron microscopy and EDX element analysis with a Philips XL 30 FEG scanning microscope and an EDAX energy-dispersive X-ray system using spot measurements, EDX line-scans and element mapping. Quantitative measurements were made in predentin, mineralizing dentin adjacent to predentin, mature dentin, mineralizing enamel and young enamel of developing teeth and mature enamel of permanent teeth. In developing teeth the Ca and P content increased rapidly from outer predentin towards mineralizing dentin. In enamel prisms of developing teeth the Ca and P content increased linearly from the surface towards the enamel-dentin junction. In permanent teeth only a small layer of predentin was found. The Ca and P content in enamel and circumpulpal dentin of permanent teeth was higher than in developing teeth. The Ca/P ratio differed between predentin and dentin areas reflecting different calcium phosphate compositions, but it was the same in mineralizing and young enamel. The differences in the distribution of Ca and P reflect different mineralizing patterns of the enamel and dentin matrices.     

Use of focused ion beam milling for investigating the mechanical properties of biological tissues: A study of human primary molars

In this paper, the usefulness of the specimen shaping ability of focused ion beam (FIB) milling in the micrometer scale and the high force resolution of the nanoindentation technique are demonstrated on human primary teeth. Micro-cantilevers, with a triangular cross-section <5 μm in width and 10 μm in length, were produced within 50 μm of the dentin–enamel junction (DEJ) using FIB milling, and were point-loaded at their free ends at 20 μN/s until failure using a nanoindenter. The elastic modulus and flexural strength of such micro-samples of human enamel, and their variation with respect to prism orientation, were studied and compared to data from bulk enamel measured using nanoindentation and three-point bend tests. The elastic modulus of the micro-cantilever samples was found to be comparable to that obtained by nanoindentation on bulk samples, but it demonstrated significant anisotropy commensurate with the microstructure of enamel which was not measurable using nanoindentation on bulk samples. The flexural strength of the enamel micro-cantilevers also exhibited strong anisotropy, and was about one order of magnitude higher than that of bulk specimens measured by three-point bending. Through a Weibull analysis, this size dependence of the strength was found to be similar to the normal behaviour in brittle materials. The flexural strength of the enamel samples was also found to be sensitive to changes in the degree of mineralization of the samples.     

Improved photochemical bonding of composites to dentin using 4-methacryloxyethyl trimellitate anhydride

The main objective was to evaluate the use of 4-methacryloxyethyl trimellitate anhydride (4-META) to improve bonding of composite materials to dentin. Bowen's resin, containing camphoroquinone, was polymerized by exposure to visible light. In composites, made with a silanated silicate, inclusion of 4-META (3%) had little effect in increasing mechanical strength or adhesion to bovine teeth. However, direct application of 4-META via acetone solution was found to be an effective way of increasing tensile adhesive strength; by 240% to dentin (to 7.2 MPa) and by 160% to enamel (to 10.8 MPa). Applying the experience mentioned above, 4-META was used to bond a proprietary photocuring microfilled composite material to Class V cavities in freshly extracted human teeth. After thermal cycling between water baths held at 5 degrees C and 60 degrees C, all dentin restorations without 4-META failed, as judged by marginal leakage of a dyestuff. In contrast, using 4-META there was no leakage in 9 out of 10 cases. In restorations involving enamel, 4-META failed to prevent marginal leakage at the enamel margins but did prevent penetration along the dentin/composite interface. It is concluded that 4-META shows great promise for preventing marginal leakage at dentin/composite interfaces.     

Dimensional behavior of enamel prisms in various depths and regions of the enamel of human permanent teeth

Different regions of broken enamel of human permanent teeth are observed by means of a scanning electron microscope. The diameter of the prisms must be considered as constant from the dentino-enamel junction up to the enamel surface.     

Digital Image Analysis in Dental Research Applied for Treatment of Fissures on Occlusal Surfaces of Premolars

The aim of this paper was to quantitatively assess caries changes of teeth by using digital image analysis. Digital images of stained sections of crowns of teeth were acquired with a computer-assisted light microscope. In each image, spots representing the main and total demineralization of enamel were segmented to determine their area. The area of total demineralization was significantly different between premolars with sealed fissures and unprotected premolars as indicated by the Mann–Whitney test. Fissures on occlusal surfaces of premolars were characterized by their width, height, and distance from the bottom of the fissure to the enamel–dentin junction. This distance was also significantly different between protected and unprotected teeth. The results of our in vitro studies of enamel lesions allow us to plan an effective diagnosis, prophylaxis, and treatment of early caries changes in in vivo conditions. © 2003 Biomedical Engineering Society. PAC2003: 8764Rr, 8757Ra, 8757Nk, 8780Pa     

Analysis of the surface characteristics and mineralization status of feline teeth using scanning electron microscopy

External resorption of teeth by odontoclasts is a common condition of unknown origin affecting domestic cats. Odontoclastic resorptive lesions involve the enamel cementum junction (ECJ, cervix) and root surface, leading to extensive loss of enamel, dentine and cementum. This study was undertaken in order to determine whether features of the surface anatomy and mineralization of feline teeth could explain why odontoclastic resorptive lesions are so prevalent in this species. Backscattered electron scanning electron microscopy was used to study enamel, cementum and dentine in non-resorbed, undemineralized teeth from adult cats. Analysis of the ECJ revealed thin enamel and cementum and exposed dentine at this site. Furthermore, enamel mineralization decreased from the crown tip to the ECJ, and dentine mineralization was lowest at the ECJ and cervical root. Analysis of cementum revealed variations in the organization and composition of fibres between the cervical, mid- and apical root although no significant differences in mineralization of cementum were detected between different regions of the root. Reparative patches associated with resorption of cementum by odontoclasts and repair by cementoblasts were present on the root surface. In conclusion, results suggest that the ECJ and cervical dentine could be at a greater risk of destruction by odontoclasts compared with other regions of the tooth. The relationship of these features to the development and progression of resorption now requires further examination.     

生物活性玻璃抑制酸蚀后不同时间牙釉质的刷牙磨损

背景：生物活性玻璃具有良好的生物相容性,并具有优异的促进牙齿再矿化和抗酸蚀效果。 目的：比较生物活性玻璃牙膏和含氟牙膏对牙釉质酸蚀后不同时间点刷牙磨损的影响。 方法：制备56个牛牙釉质片,树脂包埋并暴露大小约6 mm×6 mm的釉质平面,表面制备沟槽并充填银汞合金,磨平抛光后随机均分为7组,模拟酸性饮食后刷牙的过程,其中6组分别用普通牙膏、含氟牙膏、生物活性玻璃牙膏在雪碧酸蚀后即刻和酸蚀后30 min两个时间点以牙刷磨刷,另1组不酸蚀,只用普通牙膏磨刷,为无酸蚀对照组,过程循环60次。以银汞合金为参照,用激光共聚焦显微镜观察各组样本磨刷后的表面磨损量。 结果与结论：酸蚀后刷牙各组磨损量明显高于无酸蚀对照组(P < 0.05)。在酸蚀后同一时间刷牙条件下,生物活性玻璃牙膏组磨损量均低于含氟牙膏组(P < 0.05);使用同种牙膏条件下,牙齿酸蚀后唾液浸泡30 min后刷牙组的磨损量均低于酸蚀后即刻组(P < 0.05)。说明应用生物活性玻璃牙膏在酸性饮食30 min后刷牙,可有效减少刷牙对酸蚀牙釉质的磨损。  中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Immediate and delayed micro-tensile bond strength of different luting resin cements to different regional dentin

We sought to evaluate immediate and delayed micro-tensile bond strength of Panavia F2.0 and Multilink Sprint resin cement to superficial, deep and cervical dentin. Thirty-six freshly extracted non-carious human molars were sectioned in the mesiodistal direction to expose three different dentin regions including superficial dentin (1 mm below the dentine-enamel junction), deep dentin (1 mm above the highest pulp horn) and cervical dentin (0.5 mm above the cemento-enamel junction and 0.5 mm below the dentine-enamel junction). Resin cements were applied on dentin surfaces and composite blocks were luted under constant seating pressure. Each group was divided into three subgroups according to time intervals. Specimens were sectioned to obtain sticks of 1 mm² in diameter and subjected to microtensile bond strength testing at a cross head speed of 1 mm/min. Both resin cements showed higher micro-tensile bond strength to superficial dentin than that to deep or cervical dentin (P < 0.001). Micro-tensile bond strengths of Panavia F2.0 were higher than those of Multilink Sprint at different dentin regions (P < 0.001). Immediate micro-tensile bond strengths were higher than those of delayed micro-tensile bond strengths for both resin cements (P < 0.001). It was concluded that resin cements with different chemical formulations and applications yield significantly different micro-tensile bond strengths to different dentin regions.     

Characteristics of hydroxyapatite film formed on human enamel with the powder jet deposition technique

This study aimed to create hydroxyapatite (HAp) film by powder jet deposition with manipulating the blasting nozzle above human enamel and to examine the microstructural and mechanical properties of the HAp film and the bonding strength at the interface between the HAp film and the enamel substrate. HAp particles calcinated at 1200°C with an average size of 4.7 μm were used. The HAp particles were mixed with carrier gas (N?) to form an aerosol flow and was accelerated and blasted from the nozzle onto the enamel substrate at room temperature and atmospheric pressure. To evaluate the microstructure, scanning electron microscope (SEM) images of the surface and cross section of the HAp films and a three-dimensional profile of the HAp films were observed. To evaluate the mechanical properties, the micro-Vickers hardness and the bonding strength of the HAp films to the enamel substrate were measured. The deposition area of the HAp film was over 3 × 4 mm. The average and maximum thickness were about 30 and 40 μm, respectively. No significant difference was observed between the hardness of the HAp film and the enamel (p > 0.05). The bonding strength of the HAp film was the same as the bonding strength between composite resin and enamel. Compared with previous reports, wider and thicker HAp film was created on the enamel substrate successfully. The HAp film, which has same hardness with enamel and same bonding strength to the enamel with composite resin, would be a candidate as dental restorative materials.     

Effect of Down syndrome on the dimensions of dental crowns and tissues

Abnormal growth in Down syndrome (DS) is reflected by variable reduction in size and simplification in form of many physical traits. This study aimed to compare the thickness of enamel and dentine in deciduous and permanent mandibular incisor teeth between DS and non‐DS individuals and to clarify how these tissues contribute to altered tooth size in DS. Sample groups comprised 61 mandibular incisors (29 permanent and 32 deciduous) from DS individuals and 55 mandibular incisors (29 permanent and 26 deciduous) from non‐DS individuals. Maximum mesiodistal and labiolingual crown dimensions were measured initially, then the crowns were sectioned midsagittally and photographed using a stereomicroscope. Linear measurements of enamel and dentine thickness were obtained on the labial and lingual surfaces of the crowns, together with enamel and dentine–pulp areas and lengths of the dentino‐enamel junction. Reduced permanent crown size in DS was associated with a reduction in both enamel and dentine thickness. After adjustments were made for tooth size, DS permanent incisors had significantly thinner enamel than non‐DS permanent teeth. The DS permanent teeth also exhibited significant differences in shape and greater variability in dimensions than the non‐DS permanent teeth. Crown dimensions of deciduous incisors were similar in size or larger in DS compared with non‐DS deciduous teeth. Enamel and dentine thicknesses of the deciduous teeth were similar in DS and non‐DS individuals. The findings indicate that growth retardation in DS reduces both enamel and dentine deposition in the permanent incisors but not in the earlier‐forming deciduous predecessors. The results are also consistent with the concept of amplified developmental instability for dental traits in DS. Am. J. Hum. Biol. 13:690–698, 2001. © 2001 Wiley‐Liss, Inc.     

Properties of tooth enamel in great apes

A comparative study has been made of human and great ape molar tooth enamel. Nanoindentation techniques are used to map profiles of elastic modulus and hardness across sections from the enamel–dentin junction to the outer tooth surface. The measured data profiles overlap between species, suggesting a degree of commonality in material properties. Using established deformation and fracture relations, critical loads to produce function-threatening damage in the enamel of each species are calculated for characteristic tooth sizes and enamel thicknesses. The results suggest that differences in load-bearing capacity of molar teeth in primates are less a function of underlying material properties than of morphology.     

The Enamel Microstructures of Bovine Mandibular Incisors

Bovine teeth have been considered as an excellent substitute for human teeth for dental research, however, the enamel microstructures of bovine incisors that include arrangements of prisms and interprisms, and their spatial relationships have not been well described. The aim of this study was to investigate the detail enamel microstructures of bovine incisors. Eight bovine mandibular incisors were cut into 77 pieces at eight equal intervals either in the longitudinal direction or in the horizontal direction before each piece had been tangentially cut (parallel to enamel–dentin junction) through the middle of the enamel thickness. All the sectioned surfaces were treated 1 M HCl for 10 sec to expose the prisms and interprisms before observation by scanning electron microscopy. The parallel enamel prisms were located in all the outer enamel, the cervical region and the incisal ridge of the bovine incisors. Most labial inner enamel and the cingulum of lingual inner enamel were composed of the Hunter–Schreger bands with the characteristics of decussating groups of prisms and decussating planes between interprisms and prisms. The interprisms were thicker in the inner enamel than in the outer enamel. Anat Rec, 2012. © 2012 Wiley Periodicals, Inc.     

Three-dimensional changes in direction and interrelationships among enamel prisms in the dog tooth.

This study describes the three-dimensional features of enamel prisms and their arrangement in dog teeth. Tangential semithin sections of demineralized tooth germ were serially cut from the enamel surface to the enamel-dentin junction. Straight rows of enamel prisms parallel or perpendicular to the meridian were selected at the enamel-dentin junction; these prisms were reconstructed from micrographs with a personal computer. Near the enamel-dentin junction, the arrangement of enamel prisms appeared regular. Viewed from the enamel surface, the cut-ends of the enamel prisms that were parallel to the meridian at the enamel-dentin junction appeared as a sine curve, with 16 enamel prisms forming one period. The enamel prisms in a row perpendicular to the meridian were parallel to each other and deflected to the left or right from the enamel-dentin junction. Away from the enamel-dentin junction, the periodicity of the prisms gradually disappeared. The sine curve formed by the cut-ends of prisms in a row parallel to the meridian became irregular, and prisms in rows perpendicular to the meridian crossed each other. The semithin sections showed belt-like zones arranged perpendicular to the meridian. Each belt-like zone consisted of enamel prisms oriented in the same direction, those in neighboring zones being oriented in opposite directions. The disappearance of the regular arrangement of prisms was related to changes in their location in the belt-like zones.     

Evaluation of dye penetrations around two resin-based materials used as fissure sealants

Two materials, based on Bis GMA resin, which may be used as fissure sealants were evaluated for dye penetration between sealant and enamel. The conventional fissure sealant (Durafil Flow) showed the greatest degree of dye penetration in the largest number of specimens. The penetration of the dye was less extensive when a filled resin (P30) was used. The use of a dentine adhesive together with the filled resin further reduced the penetration of the dye. The number of teeth exhibiting leakage with this treatment was the smallest noted.     

Effect of Enamel Prism Decussation and Chemical Composition on the Biomechanical Behavior of Dental Tissue: A Theoretical Approach to Determine the Loading Conditions to Which Modern Human Teeth are Adapted

This theoretical study explored whether the directions of loads to which modern human molars are commonly subjected to are reflected in the biomechanical behavior of the tissue itself. A detailed finite element model of a piece of decussating enamel (M³ paracone) was created, taking into account differences in crystal orientation between the prism head and the interprismatic matrix, and was tested under differently angled mediolateral loads (i.e., mimicking various stages of the chewing cycle). Second, although teeth are highly mineralized, they also contain organic material and water, while in modern humans, there are systematic differences in chemical composition from the outer enamel surface to the dentinoenamel junction. To test the biomechanical effects of this gradient in mineralization a second set of models with gradually changing properties was created and subjected to the same loads. Chemically heterogeneous enamel yielded overall lower stress levels than homogenous enamel, especially at extreme loading angles. However, the general trends regarding the increase in tensile stresses at more oblique angles, and the number of nodes exhibiting tension, were comparable between the different set‐ups. The findings support suggestions that (a) the biomechanical behavior of dental tissue is the combined result of micromorphology and chemical composition and (b) that the range of loading directions, to which teeth are normally subjected to, can be inferred from dental microanatomy. For (palaeo)biological applications, the findings suggest that the absolute strength of teeth (e.g., bite force) cannot be predicted with certainty, whereas kinematic parameters of the masticatory apparatus can. Anat Rec, 2007. © 2008 Wiley‐Liss, Inc.