The effect of a novel crystallised bioactive glass‐ceramic powder on dentine hypersensitivity: a long‐term clinical study

Summary The aim of this comparative clinical study was to evaluate a novel bioactive glass‐ceramic (Biosilicate^® 1–20 μm particles) to treat dentine hypersensitivity (DH). Volunteers (n = 120 patients/ 230 teeth) received the following treatments: G1‐Sensodyne^®, G2‐SensiKill^®, G3‐Biosilicate^® incorporated in a 1% water‐free‐gel and G4‐Biosilicate^® mixed with distilled water at 1:10 ratio. G1 and G3 were applied at home, daily for 30 days; G2 and G4 were applied once a week by a dentist (four applications). A visual analogue scale (VAS) was employed to evaluate pain for each quadrant in one sensitive tooth at baseline, weekly during treatment and during a 6‐month follow‐up period. Dentine hypersensitivity values (G1/n = 52), (G2/n = 62), (G3/n = 59) and (G4/n = 59) were analysed with Kruskal–Wallis/Dunn tests. All the products were efficient in reducing DH after 4 weeks. Among the four materials tested, G4 demonstrated the best clinical performance and provided the fastest treatment to reduce DH pain. Distilled water proved to be an adequate vehicle to disperse Biosilicate^®. Low DH scores were maintained during the 6‐month follow‐up period. The hypothesis that the novel bioactive glass‐ceramic may be an efficient treatment for DH was confirmed.     

Role of preliminary etching for one‐step self‐etch adhesives

Taschner M, Nato F, Mazzoni A, Frankenberger R, Krämer N, Di Lenarda R, Petschelt A, Breschi L. Role of preliminary etching for one‐step self‐etch adhesives.
Eur J Oral Sci 2010; 118: 517–524. © 2010 Eur J Oral Sci The aim of this study was to analyse the effect of preliminary phosphoric acid etching of enamel and dentine before the application of two, one‐step self‐etch adhesive systems. The systems were applied onto acid‐etched or smear‐layer‐covered enamel and dentine. The treatment groups were as follows: group 1, Adper Easy Bond (3M ESPE) on etched substrate; group 2, Adper Easy Bond (control); group 3, iBond Self‐Etch (Heraeus Kulzer) on etched substrate; and group 4, iBond Self‐Etch (control). Enamel and dentine bond strengths were calculated using microshear and microtensile bond‐strength tests. Additional specimens were prepared to evaluate nanoleakage at the dentine–adhesive interface and were investigated using light microscopy or transmission electron microscopy. Both adhesives demonstrated higher microshear bond strengths when enamel was pre‐acid‐etched with phosphoric acid (Adper Easy Bond 28.7 ± 4.8 MPa; iBond Self‐Etch 19.7 ± 3.6 MPa) compared with controls (Adper Easy Bond 19.2 ± 3.3 MPa; iBond Self‐Etch 17.5 ± 2.7 MPa) and increased microtensile bond strength when applied on acid‐etched (Adper Easy Bond 35.8 ± 5.7 MPa; iBond Self‐Etch 24.3 ± 7.9 MPa) vs. smear‐layer‐covered dentine (Adper Easy Bond 26.9 ± 6.2 MPa; iBond Self‐Etch 17.6 ± 4.3 MPa). Adper Easy Bond showed lower nanoleakage than iBond Self‐Etch, irrespective of preliminary etching. The results of this study support the use of phosphoric acid etching before the application of one‐step self‐etch adhesive systems.     

Arrest of non‐cavitated dentinal occlusal caries by sealing pits and fissures: a 36‐month,randomised controlled clinical trial

Objective: This study aimed to evaluate the progression of sealed non‐cavitated dentinal occlusal caries in a randomised controlled clinical trial. Materials and methods: Sixty teeth with non‐cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. Results: Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12‐month follow‐up. At the 24‐ and 36‐month recall appointments, neither sealant loss nor caries progression were observed. Conclusion: The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.     

Influence of ageing on self‐etch adhesives: one‐step vs. two‐step systems

The aim of this study was to evaluate microtensile bond strength (μTBS) to dentine, interfacial nanoleakage expression, and stability after ageing, of two‐step vs. one‐step self‐etch adhesives. Human molars were cut to expose middle/deep dentine, assigned to groups (n = 15), and treated with the following bonding systems: (i) Optibond XTR (a two‐step self‐etch adhesive; Kerr), (ii) Clearfil SE Bond (a two‐step self‐etch adhesive; Kuraray), (iii) Adper Easy Bond (a one‐step self‐etch adhesive; 3M ESPE), and (iv) Bond Force (a one‐step self‐etch adhesive; Tokuyama). Specimens were processed for μTBS testing after 24 h, 6 months, or 1 yr of storage in artificial saliva at 37°C. Nanoleakage expression was examined in similarly processed additional specimens. At baseline the μTBS results ranked in the following order: Adper Easy Bond = Optibond XTR ≥Clearfil SE = Bond Force, and interfacial nanoleakage analysis showed Clearfil SE Bond = Adper Easy Bond = Optibond XTR> Bond Force. After 1 yr of storage, Optibond XTR, Clearfil SE Bond, and Adper Easy Bond showed higher μTBS and lower interfacial nanoleakage expression compared with Bond Force. In conclusion, immediate bond strength, nanoleakage expression, and stability over time were not related to the number of steps of the bonding systems, but to their chemical formulations.     

Molecular structural analysis of carious lesions using micro‐Raman spectroscopy

In clinical situations carious dentine tissues can be discriminated by most caries fluorescence detection tools, including a new fluorescence intra‐oral camera. The objectives of this study were: (i) to analyze the Raman spectra of sound, carious, and demineralized dentine, (ii) to compare this spectral analysis with the fluorescence variation observed when using a fluorescence camera, and (iii) to evaluate the involvement of the Maillard reaction in the fluorescence variations. The first positive hypothesis tested was that the fluorescence of carious dentine obtained using a fluorescence camera and the Raman spectra variation were closely related. The second was that the variation of fluorescence could be linked with the Maillard reaction. Sound dentine, sound dentine demineralized in aqueous nitric acid solution, carious soft dentine, sound dentine demineralized in lactic acid solution, sound dentine demineralized in aqueous nitric acid solution and immersed in methylglycoxal solution, and sound dentine demineralized in aqueous nitric acid solution and immersed in methylglycoxal and glucose solutions, were studied using micro‐Raman spectroscopy. Modifications in the band ratio of amide, phosphate, and carbonate were observed in the decayed and demineralized groups compared with the sound dentine group. The results indicate that a close relationship exists between the Maillard reaction and fluorescence variation.     

Comparison between micro‐computed tomography and transverse microradiography of sound dentine treated with fluorides and demineralized by microcosm biofilm

The study aimed to apply micro‐computed tomography (micro‐CT) and transverse microradiography (TMR) to measure dentine demineralization and to test the preventive effect of titanium tetrafluoride (TiF₄) under microcosm biofilm. Sound dentine specimens from bovine root were treated for 6 h with: (i) 4.0% titanium tetrafluoride (TiF₄) varnish [pH 1.0, 2.45% fluoride (F?); (ii) 5.42% sodium fluoride (NaF) varnish (pH 5.0, 2.45% F); (iii) 2% chlorhexidine (CHX) gel (pH 7.0); (iv) placebo varnish (pH 5.0); or (v) no agent (untreated). Dentine specimens were then exposed to human saliva mixed with McBain saliva for 8 h. Thereafter, McBain saliva containing 0.2% sucrose was applied daily, for 5 d, onto dentine specimens to stimulate formation of microcosm biofilm. Although a high correlation was found between the results of both methods regarding integrated mineral loss, the results of the methods did not show good agreement in Bland–Altman plots, with significant biases in calculations of lesion depth. Fluoride varnishes were able to reduce dentine demineralization (P < 0.05), while CHX failed to do so. Fluorides are still the best option to reduce dentine demineralization. Micro‐CT may be used to measure dentine mineral loss, but not the lesion depth, for which TMR is superior.     

Clinical investigation of G‐Bond resin‐based adhesive to non‐carious cervical lesions over five years

Background: The aim of this study was to evaluate the clinical performance of G‐Bond all‐in‐one adhesive with Gradia Direct resin composite placed in non‐carious cervical lesions (NCCLs) over a five‐year period. Methods: Forty‐seven restorations were placed in NCCLs in 10 subjects (age 45–75 years) after written informed consent was obtained. Institutional ethical approval for the trial was obtained before recruitment. Restorations were placed according to the manufacturer’s instructions and using 50% phosphoric acid to etch uncut enamel margins. Patients were recalled annually for five years and restorations reviewed for presence and marginal staining. Photographic records were obtained prior to restoration, immediately after placement and at each recall. Results: At five years, 6 of the original 10 subjects were available for recall, meaning 27 restoration sites could be evaluated. All restorations remained intact apart for one partial failure at four years. This resulted in a cumulative retention rate of 97.5% of restorations at five years. Marginal staining occurred around seven restorations during the study. Staining tended to be isolated to a few patients. Conclusions: It was concluded that G‐Bond with Gradia Direct resin composite showed excellent results over the five years of the study. This material combination seems very suitable for the restoration of NCCLs.     

One‐year clinical evaluation of a two‐step self‐etch adhesive with and without additional enamel etching technique in cervical lesions

Background: The aim of this study was to determine the clinical performance of a two‐step self‐etch adhesive with and without additional enamel etching technique to advanced non‐carious cervical sclerotic lesions. Methods: Twenty‐two patients (mean age = 51.5) having at least two pairs of non‐carious cervical erosion/attrition/abfraction lesions with incisal or occlusal margins in enamel and gingival margins in dentine/cementum were included in the study. The two‐step self‐etch adhesive (AdheSE; Ivoclar‐Vivadent) was either applied following the self‐etch approach on both enamel and dentine (AdheSE non‐etch), or a similar application including additional acid‐etching of the enamel cavity margins with 37% phosphoric acid (AdheSE etch). Resin composite Point 4 was used for all 104 restorations. Restorations were evaluated at baseline and at one year according to the modified United States Public Health Service (USPHS) criteria. Data were analysed by using McNemar’s test (p <0.05). Results: There were no significant differences in the marginal adaptation both at the cervical and enamel margins between AdheSE non‐etch and AdheSE etch groups (p >0.05). At one year, marginal discolouration was evident in the AdheSE non‐etch group but it was not statistically significant from the AdheSE etch group (p = 0.12). Postoperative sensitivity was 5% at baseline and reduced to 2% at one year. Conclusions: At one year, the two‐step self‐etch adhesive with and without additional enamel etching technique showed excellent clinical results to advanced non‐carious cervical sclerotic lesions.     

The effects of Pain-Free® desensitizer on dentine permeability and tubule occlusion overtime, in vitro

Abstract. The purpose of this in vitro study was to evaluate the efficacy of a new resin emulsion (Pain-Free® Desensitizer) treatment for dentine hypersensitivity, for its ability to decrease dentine permeability. Crown segments were prepared from extracted, unerupted human 3rd molars by horizontal sectioning to remove occlusal enamel and the roots. The specimens were allocated in one of two groups: In group 1, the dentine surface was acid-etched to simulate the patent tubules of hypersensitive dentine. In group 2, the mineralized dentine surface was polished free of smear layer using a hydroxyapatite paste and ultrasonication. The hydraulic conductance of each specimen was then measured to obtain a pretreatment of control value. After a single treatment with resin desensitizer, the permeability was remeasured at 5 min, 1 day, 1 week and 1 month. Between measurements, the specimens were stored in buffer solution to simulate the solubilizing effects of saliva. Parallel specimens were followed by SEM examination. The results showed that a single treatment with resin desensitizer produced large, immediate, reductions in dentine permeability in both acid-etched and mineralized surfaces. In the acid-etched (group 1) specimens, the permeability returned to control values within 7 days, while the permeability of the group 2 specimens remained low even after 30 days of soaking. This simple treatment for occluding dentinal tubules may provide sufficient temporary reduction in dentine permeability to permit the development of natural desensitization.     

A cross‐sectional study: non‐carious cervical lesions,cervical dentine hypersensitivity and related risk factors

The present survey aims to study the prevalence and clinical characteristics of non‐carious cervical lesions (NCCLs) and cervical dentine hypersensitivity (CDH), as well as their possible risk factors in a general population in China. A total of 1023 subjects were included in the present study. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and CDH. Teeth with NCCLs and CDH were diagnosed according to the tooth wear index and by a blast of air from a triple syringe, respectively. Binary logistic regression was completed by analysing the association of risk factors with the occurrence of NCCLs and CDH. Loss of attachment (LOA) and gingival recession (GR) of teeth with NCCLs and/or CDH were measured using Williams periodontal probe. The diagnoses of NCCLs and CDH established following a clinical assessment yielded an overall prevalence of 61·7% and 27·1%, respectively. The 60–69 age group had the greatest proportion of subjects with NCCLs or CDH. The pre‐molars were the most commonly affected teeth type with NCCLs or CDH. The proportion of teeth with CDH associated with NCCLs increased significantly with age, but the proportion of teeth with CDH only associated with LOA or GR decreased slowly with age. The single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, occupation type, method of toothbrushing, frequency and method of toothbrushing, and method of toothbrushing and duration of a toothbrush used. Gender, age group, occupation type and frequency of toothbrushing were associated with the occurrence of CDH. The current study presented higher prevalence of NCCLs and CDH in a general Chinese population. Both diseases were closely associated with age and periodontal status. The portion of the population with NCCLs or CDH had different risk factors.