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Biomedical subjects

B Van Meerbeek

Publications and source records attributed to B Van Meerbeek.

At least 73 records · Page 4Linked to original sources

[Dental pulp reactions and pulp protection: traditional underlayers versus dentin adhesive lacquer].

The dental pulp possesses an intrinsic healing capacity, by which pulpal reactions remain initially localised; they are often completely reversible. The younger and healthier the pulp is, the greater its healing capacity will be. Only in case of bacterial infection will the sterile pulpal inflammation convert into a local necrosis of the pulpal tissue that gradually will expand apically until the whole pulp is contaminated. The profit-effect of pulpal protection by means of traditional calcium hydroxide medicaments is compared with a more modern adhesive dentin sealing. Potential pulpal response to restorative materials and procedures are reviewed. Finally, clinical guidelines for optimal pulpal protection and dentinal sealing are formulated.

Calcium Hydroxide↗

[Resin-modified glass-ionomers in dentistry].

The resin-modified glass-ionomers contain the essential components of both a conventional glass-ionomer and a visible light-cured resin. They have several advantages like longer working time, shorter setting time, bonding to tooth structure, fluoride-release, better aesthetics than conventional glass-ionomers and ease in use. As disadvantages can be mentioned the polymerisation shrinkage, trapping of air-bubbles, difficulties in colour choice and contouring. A physical and mechanical characterisation was necessary to define the possibilities and limits of these materials. It can be stated that the strength and aesthetic appearance of resin-modified glass-ionomers are less than that of composites, but better than that of conventional glass-ionomers. Clinically, this is expressed in a rough and dull surface compared to a composite restoration. They are not indicated in stress bearing areas. Consequently, they are mainly indicated in cervical class V-restorations in the postcanine region, and probably restorations in pedodontics, geriatric dentistry and for patients with a high caries activity.

Compomers↗

[Characterization of resin-containing glass ionomers].

Recently, several new resin-modified glassionomers have been introduced on the dental market. At the moment a real confusion exists over the right terminology of the products and its limits in use. Therefore, an in vitro and in vivo study with simultaneously a comparison with conventional glassionomers and composite resins was really necessary. This study revealed that resin-modified glassionomers have physico-mechanical properties that are situated between those of conventional glassionomers and composite resins. The manufacturers have a different approach concerning the particle size distribution. The new materials give a rough surface. They are not indicated for posterior restorations, because their surface hardness is too low compared to that of enamel, and their fatigue resistance is insufficient. The elasticity decreases during setting and maturation. Consequently, they are mainly indicated in situations that require a moderate strength and esthetics, for patients with a high caries activity and when ease in use is requested.

Composite Resins↗

[Micro-abrasions of enamel: an alternative to the elimination of superficial demineralization and decalcification].

Tooth discoloration's may cause serious damage to the aesthetic appearance of the patients. These discoloration's can be treated in several ways but up to lately tooth structure had to be removed in an irreversible manner in order to provide sufficient bulk for the new restorative material. Nowadays thanks to the work of T. Croll and others a method has been established in a scientific way whereby tooth discoloration's confined to the outermost layer of enamel can be removed, through the application of an compound called PREMA which will simultaneous erode and abrade the enamel surface. If carefully selected the discoloration can be removed with only a limited loss of tooth structure. The authors describe the historical background of the method. Furthermore patient's selection, specific instruments and materials are described in detail. The clinical procedure is explained step by step, followed by a complete report of the effects of the procedure on the different tooth structures. Finally the long term results are discussed and the possibility to enhance the result by combining this method with home bleaching.

Complex Mixtures↗

The interaction of adhesive systems with human dentin.

PURPOSE: To investigate the interaction of six experimental and commercial bonding systems with dentin in vivo. MATERIALS AND METHODS: One-Step, Clearfil Liner Bond 2, OptiBond, Permagen with 10% phosphoric acid, Permagen with 35% phosphoric acid, and Prime & Bond were applied in standard Class I occlusal cavities in premolars scheduled for extraction for orthodontic reasons, combined either with a self-cured or with a light-cured resin composite. The teeth were carefully extracted 5 minutes after resin polymerization and fixed in 2.5% glutaraldehyde. After fixation, the specimens were dehydrated, sectioned, and processed for field-emission SEM. RESULTS: Although some systems produced gap-free intact interfaces in specific specimens, all of them showed detachment at the transition between the resin-dentin interdiffusion zone and the fluid resin placed over it. It was apparent that the presence of air-bubbles and/or thick layers of polymerized-filled fluid resin resulted in less frequent separation areas at the resin-dentin interface, providing support for the concept of the elastic cavity wall. It was also confirmed that some dentin adhesive systems do not form a thick layer over the dentin, otherwise the resin composite would not have penetrated the dentin tubules.

Adolescent↗

Three-year clinical effectiveness of four total-etch dentinal adhesive systems in cervical lesions.

A 3-year follow-up clinical trial of two experimental Bayer total-etch adhesive systems and two commercial total-etch systems. Clearfil Liner Bond System and Scotchbond Multi-Purpose, was conducted to evaluate their clinical effectiveness in Class V cervical lesions. Four hundred twenty abrasion-erosion lesions were restored randomly using the four adhesive systems. There were two experimental cavity designs, in which the adjacent enamel margins either were or were not beveled and acid etched. Clearfil Liner Bond System and Scotchbond Multi-Purpose demonstrated high retention rates in both types of cavity design at 3 years. The two experimental Bayer systems scored much lower retention rates in both cavity designs at 3 years. None of the systems guaranteed margins free of microleakage for a long time. At 3 years, superficial, localized marginal discolorations were observed, the least for Clearfil Liner Bond System, followed by Scotchbond Multi-Purpose and the two experimental systems. Small marginal defects were recorded at the cervical dentin and the incisal enamel margin. Retention of Clearfil Liner Bond and Scotchbond Multi-Purpose appears to be clearly improved over earlier systems, but marginal sealing remains problematic. The two Bayer systems were found to be clinically unreliable.

Acid Etching, Dental↗

[Characterization of glass ionomer cements containing resin].

Recently, several new resin-modified glassionomers have been introduced on the dental market. At the moment a real confusion exists over the right terminology of the products and its limits in use. Therefore, an in vitro and in vivo study with simultaneously a comparison with conventional glassionomers and composite resins was really necessary. This study revealed that resin-modified glassionomers have physico-mechanical properties that are situated between those of conventional glassionomers and composite resins. The manufacturers have a different approach concerning the particle size distribution. The new materials give a rough surface. They are not indicated for posterior restorations, because their surface hardness is too low compared to that of enamel, and their fatigue resistance is insufficient. The elasticity decreases during setting and maturation. Consequently, they are mainly indicated in situations that require a moderate strength and esthetics, for patients with a high caries activity and when ease in use is requested.

Chemical Phenomena↗

[Micro-abrasion of the enamel: an alternative to the removal of demineralization and superficial decalcification].

Tooth discoloration's may cause serious damage to the aesthetic appearance of the patients. These discoloration's can be treated in several ways but up to lately tooth structure had to be removed in an irreversible manner in order to provide sufficient bulk for the new restorative material. Nowadays thanks to the work of T. Croll and others a method has been established in a scientific way whereby tooth discoloration's confined to the outermost layer of enamel can be removed, through the application of an compound called PREMA which will simultaneous erode and abrade the enamel surface. If carefully selected the discoloration can be removed with only a limited loss of tooth structure. The authors describe the historical background of the method. Furthermore patient's selection, specific instruments and materials are described in detail. The clinical procedure is explained step by step, followed by a complete report of the effects of the procedure on the different tooth structures. Finally the long term results are discussed and the possibility to enhance the result by combining this method with home bleaching.

Complex Mixtures↗

Field emission SEM comparison of four postfixation drying techniques for human dentin.

Critical-point drying (CPD) is generally considered essential for the preparation of biologic specimens for electron microscopy. Several attempts have been made to introduce alternative techniques. More recently, this problem has arisen in dentistry, because of the new developments in dentin bonding. The present study focuses on three alternative techniques to CPD: hexamethyldisilazane (HMDS) drying, Peldri II drying, and air drying. Twenty-four dentin disks were obtained from noncarious extracted human molars by microtome sectioning parallel to the occlusal surface. The dentin surfaces were etched with polymer-thickened, silica-free, 10% phosphoric acid semigel, fixed, dehydrated, and dried with one of the four techniques. The specimens were observed in two perpendicular planes, showing dentinal tubules in longitudinal view and cross-section, using a field emission scanning electron microscope. The intertubular demineralized dentin zone was composed of three different successive layers, which did not substantially differ between CPD and Peldri II drying, but were more evident in HMDS-dried specimens: first, an upper layer of denatured collagen and residual smear layer particles, with sectioned collagen fibrils and few open intertubular pores; second, an intermediate layer of closely packed cross-sectioned collagen fibers; and third, a deeper layer with unfilled spaces, scattered hydroxyapatite crystals, and few collagen fibers. HMDS drying seemed to preserve better the collagen network and the microporosity of the demineralized dentin surface. Moreover, HMDS drying is easy to perform. The air-drying method caused some artefacts, such as surface collapsing and thickening of the denatured collagen layer.

Air↗

Demonstration of a focused ion-beam cross-sectioning technique for ultrastructural examination of resin-dentin interfaces.

OBJECTIVES: focused ion-beam (FIB) etching, commonly used as a cross-sectioning technique for failure analysis of semiconductor devices, has recently been applied to biological tissues to expose their ultrastructure for examination. It was the aim of this investigation to determine the practical utility of FIB to cross-section resin-dentin interfaces in order to morphologically evaluate the completeness of resin penetration into the exposed collagen scaffold at the resin-dentin bond interface. METHODS: Two representative commercially available dentin adhesive systems were bonded to mid-coronal dentin. After appropriate fixation and dehydration of the resin-bonded dentin samples, a scanned focused ion-beam of a few tens of nano-meters in diameter was used to cross=section the resin-dentin interface. Examination of the interfacial ultrastructure was accomplished using a field-emission SEM. RESULTS: Results indicate possible artifact production at the cross-sectioned interface, hiding its actual ultrastructure, probably due to a heat-effect with possible recrystallization. Further studies of FIB are needed to optimize its usefulness for resin-dentin interface examinations and other biological tissue applications. SIGNIFICANCE: Complete resin saturation of the demineralized dentin surface-layer has been claimed to be the key factor for a long-lasting resin-dentin bond. A "clean" artifact-free micro-cross-sectioning technique may provide indisputable ultra-structural information about the depth of resin penetration into the demineralized zone. Such a test would be useful in the development of dentin adhesive systems.

Bisphenol A-Glycidyl Methacrylate↗

Clinical and semiquantitative marginal analysis of four tooth-coloured inlay systems at 3 years.

OBJECTIVES: The marginal quality of four tooth-coloured inlay systems was clinically investigated and subjected to computer-aided semiquantitative marginal analysis under scanning electron microscopy (SEM) after 3 years of clinical service. METHODS: Three of the restoration types were made using the Cerec CAD-CAM apparatus: one was milled from preformed glass ceramic blocks, and the two other inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect resin composite inlay system. Each inlay type was luted with a different luting resin composite. The clinical evaluation was performed with a mirror and explorer by two clinicians separately, and the marginal analysis was conducted microscopically on replicas (SEM x 200). RESULTS: After 3 years in situ, all the restorations were clinically acceptable. No recurrent caries was observed. Marginal analysis under SEM detected a high percentage of submargination for all four systems, which suggests that their respective resin composite luting agents were all subject to wear. The percentage of marginal fractures on the enamel side as well as on the inlay side did not increase dramatically compared to the 6-month results. CONCLUSION: The first recall after 6 months of clinical service indicated how tooth-coloured inlays behave at their margins. The 3-year results confirmed the early findings, indicating that wear of resin composite lutes is important and present in all systems. The two ceramic materials showed a similar behaviour at the margins. The resin composite inlay performed better at the inlay site than at the enamel site.

Adult↗

Morphological characterization of the interface between resin and sclerotic dentine.

Since dentine exposed to the oral environment undergoes important compositional and morphological transformations, bonding to it differs significantly from bonding to unaffected normal dentine. In this investigation, the interface between resin and sclerotic dentine, the dentine type clinically exhibited by cervical abrasive or erosive lesions, was morphologically characterized by scanning electron microscopy after an argon-ion-beam etching procedure. The microstructure of the resin-sclerotic dentine interface was compared with that produced to normal unaffected dentine in an attempt to find reasons for the reported less reliable bonding of adhesive resins to sclerotic dentine. A resin-dentine interdiffusion zone or hybrid layer with only a limited width was formed at the hypermineralized intertubular dentine. No or only short resin tags were developed in most dentinal tubules, since their orifices were obliterated due to increased peritubular dentine apposition, intratubular deposition of irregular minerals and formation of so-called sclerotic casts. Consequently, it is reasonable to predict that dentine adhesives with an adhesion strategy, which mainly involves micromechanical interlocking by the formations of a resin-dentine interdiffusion zone combined with resin-tag development into the dentinal tubules, will be less effective when applied to sclerotic dentine than to unaffected normal dentine. An adapted adhesive treatment may be necessary to make sclerotic dentine more receptive to bonding. Further research should be directed to develop adhesive systems that bond equally well to various kinds of dentine.

Acid Etching, Dental↗

Dual cure luting composites--Part II: Clinically related properties.

Thirteen dual cure luting composites were compared in function of film thickness, consistency, and working time by using the American National Standard/American Dental Association (ANS/ADA) specifications for zinc phosphate cement and direct filling resins. The effect of temperature and setting reaction on the film thickness was also evaluated for some representative products. All three clinically related properties varied widely among the products investigated. A strong linear correlation was found between film thickness and consistency. This relation is supported by the temperature dependence of film thickness of dual cure luting composites. Cooling of the material increased the consistency, resulting in a larger film thickness, while heating reduced the film thickness because of the lower consistency. However, one product with a rather short working time at room temperature occasionally exhibited a dramatically enlarged film thickness after heating, probably caused by accelerated chemical polymerization. No correlation emerged between film thickness and maximum filler size or between consistency and filler weight content. Maximum filler size and filler weight content had been measured previously in Part I of this study. Scanning electron microscope (SEM) analysis of the cured film thickness samples revealed that the largest filler particles had been crushed under the heavy load pressure during film thickness measurement. The lack of correlation between consistency and filler weight content can be explained by the multifactorial determination of the consistency. It is concluded that the great diversity in the currently available luting composites makes clear specifications with regard to the optimum composition of luting composites urgently needed. Furthermore, more adequate methods for testing the film thickness of luting composites are also required.

American Dental Association↗

Clinical status of ten dentin adhesive systems.

Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be validated. The objective of this clinical investigation was to evaluate, retrospectively, the clinical effectiveness of earlier-investigated dentin adhesive systems (Scotchbond, Gluma, Clearfil New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinical results with those obtained with four modern total-etch adhesive systems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond Multi-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidelines; in Group B, adjacent enamel was beveled and conditioned. Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard to adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinically better than systems that modified the disorderly layer of smear debris without complete removal. Hybridization by resin interdiffusion into the exposed dentinal collagen layer, combined with attachment of resin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The additional formation of an elastic bonding area as a polymerization shrinkage absorber and the use of a microfine restorative composite apparently guaranteed an efficient clinical result. The perfect one-year retention recorded for Clearfil Liner Bond System and Scotchbond Multi-Purpose must be confirmed at later recalls.

Clinical Trials as Topic↗

Evaluation of two dentin adhesives in cervical lesions.

The clinical effectiveness of two dentin adhesives, Clearfil New Bond and Scotchbond 2, was evaluated in two different cavity designs. Group A was without enamel bevel or acid etch and with a butt-joint cavity; and group B had enamel bevel, acid etch, and feather-edged cavities. The retentive rate and marginal adaptation were monitored for 2 years. In the Clearfil system, 21% of group A restorations failed after 2 years, whereas virtually all the group B restorations (99%) were retained. In addition, after 2 years, the total of debonded group A restorations in the Scotchbond 2 system expanded to 13%, whereas no restorations from group B were lost. There was clearly marginal deterioration in time irrespective of the bonding system. Nevertheless, the marginal adaptation of cervical lesions restored with Clearfil New Bond adhesive in combination with Clearfil Ray composite resin revealed fewer defects compared with the Scotchbond 2 adhesive with Silux Plus composite resin restorations. SEM evaluation disclosed composite resin remnants on the dentin surface in cavities with lost fillings, which indicates partial cohesive failure of the adhesive joint.

Composite Resins↗

Two-year clinical evaluation of two dentine-adhesive systems in cervical lesions.

Two commercially available dentine-adhesive systems, Tenure and Tripton, were tested in two different cavity designs by placing 132 Class V composite restorations in cervical lesions of 35 patients. In Group A, the cervical restorations were placed totally in dentine without any intentional enamel involvement. In Group B, they were placed in dentine with adjacent enamel margins bevelled and acid etched. The retention rate, the evidence of clinical microleakage, and the marginal integrity were monitored over a 2-year period. The results of this clinical investigation indicate a high failure rate when only dentinal bonding was involved. A loss rate of 30% for Tenure and 55% for Tripton was noted in Group A after 2 years of clinical service. However, both adhesive systems used in combination with micromechanical retention on the enamel border (Group B) performed extremely well with only one restoration each having debonded over the 2-year period. Identically, marginal integrity and evidence of clinical microleakage more severely deteriorated with time for the Group A restorations in comparison with their Group B counterparts. In summary, the overall results were more positive for Tenure than for Tripton. It is concluded that micromechanical retention by acid etching of the enamel margin is still indispensable for the clinical success of cervical Class V composite restorations, primarily for retention and clinical microleakage and also, but to a lesser degree, for marginal adaptation.

Acid Etching, Dental↗

Dual-cure luting composites: Part I: Filler particle distribution.

Fourteen dual-cure luting composites were analyzed for their filler particle shape, predominant and maximum filler size, and filler weight in function of their clinical use. Polished surfaces were etched with an argon ion beam and studied by means of scanning electron microscopy. The type of filler particles, either inorganic or prepolymerized, could clearly be recognized. Their shapes were angular, rounded or spherical, depending on the product. The maximum filler size varied extremely from less than 1 micron to 250 microns. A particle-size distribution analyser disclosed a bell-shaped filler-size distribution. The predominant filler size for all the products was much smaller than the maximum filler size. The filler weight varied from 36 to 77%. After ion etching, some products showed small areas with a low degree of filler loading. A classification of the luting composites based on the maximum filler size is proposed. Since the particle size varies widely within the group of products analyzed, a standard specification for luting composites is urgently needed.

Adhesives↗

Comparative SEM and TEM examination of the ultrastructure of the resin-dentin interdiffusion zone.

The resin-dentin interdiffusion zone produced by a dentin-adhesive system that removes the smear layer and concurrently decalcifies superficial dentin was morphologically examined by both scanning and transmission electron microscopy. Cross-sectioned resin-bonded dentin discs were etched with an argon-ion beam to make the resin-dentin interface observable by SEM. For the TEM examination, the sections were partly decalcified by an aqueous EDTA solution to facilitate ultramicrotomy and to disclose the ultrastructure of the interdiffusion zone. Both SEM and TEM confirmed the presence of the resin-dentin interdiffusion zone as the junction between the deep unaltered dentin structure and the restorative resin. Within the interdiffusion zone, three sublayers with characteristic ultrastructure and staining were identified by TEM. An upper diffuse black layer contained few structural features. Underneath, partially-altered collagen fibrils were closely packed, mostly running parallel with the interface and perpendicular to the dentinal tubules. Their outline was electron-dense, forming tunnel-like structures. At the base of the upper layer, several stained projections were found to bulge out into the underlying collagen network and appeared to be confined by obstructive, parallel-running collagen fibrils. Finally, the third dense layer, containing hydroxyapatite crystals, demarcated the superficially demineralized dentin layer from the deeper unaltered dentin. Resin diffusion into the decalcified dentin surface layer was evident, but diminished with depth, presumably reducing deeper resin impregnation into the interfibrillar spaces. The citric acid dentin-pretreatment probably caused denaturation of the superficial collagen fibrils. Its decalcifying effect gradually weakened with depth, leaving behind hydroxyapatite crystals at the base of the interdiffusion zone.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗