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[Tubular sclerosis].

Tubular sclerosis is a pulp-dentin complex defensive response to several physiologic and pathologic stimuli; it leads to an increasing tubular obliteration which enormously reduces dentinal permeability. Its typical structural features are either increased peritubular dentin thickness or "caries crystals". Pathogenesis is a much debated question: some authors assert that peritubular dentin thickening is the main liable for sclerosis while others support a centrifugal theory. Another point of view considers its pathogenesis the result of many integrated mechanism.

Apatites↗

Protective effects of cavity liners on dentin.

Smear layers are very soluble in acidic solutions. Removal of smear layers increases dentin permeability and the potential for pulpal irritation. In this study, smear layers were treated with either saline, Barrier, Copalite, LC-Scotchbond, Hydroxyline, or DDS 1 & 2 to determine how well they protected the dentin from subsequent acid attack with 37% phosphoric acid for two minutes. Using both SEM and permeability measurements, the materials were ranked from least to most effective as: Saline less than Barrier = Copalite less than Hydroxyline = Scotchbond = DDS 1 & 2.

Acid Etching, Dental↗

A morphometric analysis of the cross-sectional area of dentine occupied by dentinal tubules in human third molar teeth.

The number and the mean percentage tubular cross-sectional area of dentinal tubules per square millimetre were calculated in specimens of coronal dentine of 13 intact human third molar teeth from patients 18 to 28 years of age. The dentine was fractured at various known distances from the dentino-enamel junction. Near the dentino-enamel junction the number of tubules per square millimetre was 22,000 and the mean tubular cross-sectional area was 3.6%. Midway between the pulpal wall and the dentino-enamel junction the number of tubules was 37,000 mm-2 and the mean tubular cross-sectional area was 6.2%. Close to the pulp the number of dentinal tubules was 48,000 mm-2 and the mean cross sectional area of tubules was 10.2 percent. The number of tubules per square millimetre more than doubled and the area occupied by tubules increased threefold from the dentine close to the dentine-enamel junction, to that close to the pulp. These differences in tubular patterns at different depths in dentine are clinically significant in dentine permeability, the treatment of traumatized teeth, and pain transmission in dentine.

Dentin↗

A review of current approaches to in-office management of tooth hypersensitivity.

In-office treatment of dentinal hypersensitivity should be capable of providing the patient with immediate and lasting relief of pain. Regardless of the type of treatment employed, 20 to 40 per cent of hypersensitive teeth usually improve over a period of 4 to 8 weeks. Partial obturation of open tubules is the most widely practiced treatment, with other forms of therapy being recommended as a backup for patients in whom this approach fails. Obturation can be achieved with topical application of agents that form insoluble precipitates within the orifices of the tubules. Burnishing the exposed root surface produces a smear layer, which in itself can significantly reduce dentin permeability. At times, the use of a restorative resin or dentin bonding agent can be successful in reducing sensitivity when other forms of therapy have failed. Proper patient management should stress dietary counseling when dietary acids are an important etiologic factor. The importance of proper tooth brushing and plaque control must be stressed. At the present time, the use of oxalates for the obturation of tubules shows promise as a future in-office clinical agent; however, further clinical studies are required to evaluate and compare their efficacy with other currently effective methods and agents.

Calcium↗

[Dentin hypersensitivities and their treatment. A review of the literature].

Dentin hypersensitivity is a painful manifestation resulting from a response of the openings of dentin tubules to oral environment. It is probably caused by movements of intratubular fluids, under the influence of different types of stimuli at the dentin surface. Hypersensitivity has been known for a long time and its treatment has always been difficult. Sometimes, by a kind of natural reaction to aggression, dentin is able to increase its degree of mineralisation but, most of the time, an active treatment has to be performed. Unfortunately the mechanism of dentinal pain is not well known and the symptoms of sensitivity are unspecific and subjective, so that the ideal compound for treatment does not exist. Many products have been tested, but the results are most of the time contradictory and the placebo effect is often very significant. In all cases the aim of the treatment remains the obliteration of dentin tubules, in order to obtain a decrease of dentin permeability.

Dental Plaque↗

Permeability of normal versus carious dentin.

Although a number of reports have been published demonstrating that carious dentin is less permeable than normal dentin, these reports have been qualitative rather than quantitative. The purpose of this in vitro study was to apply a quantitative technique to the study of the permeability of carious human teeth before and after excavation, before and after removal of the smear layer and before and after preparation of a control cavity of similar size and depth in normal dentin subjected to the same measurements, for comparative purposes. Dentin permeability was measured as a hydraulic conductance. The permeability values measured at each step in the protocol were expressed as a percent of the maximum permeability of both cavities, permitting each tooth the serve as its own control. Carious lesions exhibited a slight degree of permeability (2.3 +/- 0.6% of controls) which remained unchanged after excavation of the lesions. Removal of the smear layer in the excavated carious lesions increased the permeability significantly to 6.9 +/- 3.2%. Preparation of a control cavity of the same area and depth increased the permeability slightly. Removal of its smear layer increased the permeability of the dentin 91%. These results confirm previous qualitative studies that carious dentin, even after excavation and removal of the smear layer has a very low permeability.

Acid Etching, Dental↗

Single-bottle adhesives behave as permeable membranes after polymerization. I. In vivo evidence.

OBJECTIVES: This study tested the hypothesis that single-bottle total-etch adhesives are effective in reducing dentine permeability under in vivo conditions. METHODS: Crown preparations on vital human teeth were performed under local analgesia as part of the treatment plan for prosthetic rehabilitation. Four single-bottle adhesives (Single Bond, 3M ESPE; Excite DSC, Ivoclar Vivadent; Prime and Bond NT Dual-Cure, Dentsply DeTrey and One-Step, Bisco Inc.) were applied to the cut dentine after acid-etching. Polyvinyl siloxane impressions were taken, using an ultra-low viscosity impression material, of the smear layer-covered dentine before applying the adhesives to deep vital dentine, and after adhesive placement. Additional impressions were taken of the adhesive-sealed dentine following the removal of the provisional prostheses after a 7-10 day period. Epoxy resin replicas of the crown preparations were examined with scanning electron microscopy to evaluate the extent of dentinal fluid transudation during pre-bonded, immediately bonded and post-bonded periods. RESULTS: Dentinal fluid transudation from localised areas that were close to the dental pulp was universally observed from all epoxy resin replicas, irrespective of the adhesive employed. The transudation of dentinal fluid from the control smear layer-covered dentine of each crown preparation was comparatively mild when compared to the extent that was observed after total-etching and application of the single-bottle adhesive. Dentinal fluid droplets were specifically located over the surface of the adhesive layer. Continuous transudation of dentinal fluid occurred even after the removal of the provisional prostheses, and was considerably more profuse in subjects who opted for the fitting of the permanent prostheses without the use of a local anaesthetic solution. CONCLUSION: Single-bottle adhesives, because of their lack of a comparatively more hydrophobic bonding resin layer, behave as permeable membranes after polymerisation. They permit the continuous transudation of dentinal fluid and do not provide a hermetic seal in vital deep dentine. Although the relatively slow rate of diffusion of dentinal fluid is unlikely to result in post-operative cold sensitivity, it may interfere with the optimal polymerisation of dual-cured or auto-cured composites or resin cements in both direct and indirect restorations.

Adhesives↗

Technique-sensitivity of contemporary adhesives.

Besides micro-mechanical interlocking through hybrid-layer formation, self-etch adhesives may benefit from additional chemical interaction between the functional monomer and residual hydroxyapatite. One-step adhesives are commonly associated with lower bonding effectiveness, which must be attributed in part to the dissolution of hydrophilic and hydrophobic monomers in a relatively highly concentrated solvent. In this 'difficult' mixture, also water is essential as ionization medium to enable self-etching activity. Due to the high hydrophilicity, one-step self-etch adhesives have been reported to behave as semi-permeable membranes, allowing fluids to pass through and seriously jeopardizing bond durability. Recent research has also revealed that HEMA-free one-step adhesives are prone to phase-separation, which may also account for their lower bonding effectiveness. Employing an appropriate air-drying technique may, however, improve the bonding effectiveness of such phase-separating adhesives by getting rid of substantially more interfacial water than HEMA-containing adhesives, of which water might be more difficult to remove from.

Acid Etching, Dental↗

An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans.

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been used to reduce the incidence of caries in primary dentitions but has been limited by the associated staining of both teeth and restorative materials. The application of potassium iodide (KI), following AgF prevents staining but its effects on the ability of AgF to reduce caries are not known. The aim of this study was to develop an in vitro model that would provide an indication of the permeability of demineralized dentine to Streptococcus mutans after treatment of the dentine with AgF followed by KI. METHODS: Forty dentine discs were bonded to the base of forty 5mL polycarbonate screw top vials (that had had their bases removed), filled with nutrient medium, sterilized and placed into a continuous culture of S. mutans. Samples were divided into four groups as follows: 10 samples of demineralized dentine as a control, 10 samples of demineralized dentine treated with AgF/KI, 10 samples of demineralized dentine treated with KI and 10 samples of demineralized dentine treated with AgF. After two weeks the optical density of the growth medium chambers was measured to determine bacterial penetration and growth. Cultures were plated out to determine migration through the discs by S. mutans. RESULTS: S. mutans migrated through all dentine discs. However, the samples treated with AgF and AgF/KI had significantly lower optical densities than the corresponding controls. The range of optical densities was least amongst demineralized samples treated with AgF/KI. CONCLUSIONS: Under the conditions of this study, treatment of demineralized dentine discs with AgF followed by KI allowed the penetration of S. mutans. Based on optical density measurements, the treatment resulted in significantly fewer microorganisms being present subjacent to the discs treated with AgF and KI than the control discs at the end of the experimental period.

Bacteriological Techniques↗

Pulp therapy in the primary dentition.

Several treatment options for pulp therapy in primary teeth are reviewed. Conservative treatments are recommended for primary teeth whose pulps have the potential to recover once the irritation has been removed. The role of dentin permeability and microleakage is emphasized when protective basis and indirect pulp treatment are discussed. Alternative dressings for formocresol pulpotomies such as 6.25% glutaraldehyde solution, antigen-extracted allogeneic dentin matrix, and crude bone morphogenetic protein are reported with promising results. Pulpectomy is recommended for teeth with evidence of chronic inflammation involving radicular pulp or pulp necrosis with and without periapical involvement. The main disadvantage of zinc oxide-eugenol paste, widely used for primary root fillings in the United States, is its slow resorption rate, frequently much slower than that of the root. Other root canal pastes containing iodoform, or a modification of this with the addition of calcium hydroxide, are being utilized in South America, Japan, and Europe.

Child, Preschool↗

The detection and prevalence of reactive and physiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age.

The pulpo-dentinal complex responds to external injuries with dentin sclerosis (DS), dead tracts (DT), or reparative dentin (RD). This investigation correlates the prevalence of these responses with age, sex, type and surface location of tooth lesions (caries, restorations, attrition, abrasion and erosion) utilizing ground sections, microradiographs and decalcified paraffin-embedded tooth sections treated with the Pollak trichrome stains (270 teeth from 113 patients). The main response to caries, restorations and erosion was DS, followed by RD and DT. DS, RD and DT occurred equally in any tooth, on any tooth surface and even beneath the same lesion. DS did not necessarily prevent RD. Root and furcation DS and RD in the floor of the pulp chamber and root canals were unrelated to particular lesions but did relate to increasing age. Root DS extended from apical to cervical area with increasing age. Beneath caries and restorations DS and RD were more prevalent in males, but DT was more prevalent in females. Pollak staining of decalcified paraffin sections for DS was approximately 80% as accurate as ground sections and microradiography. In pulp studies, where the result is contrary to previous experience, the Pollak stains reveal whether DS has decreased dentin permeability.

Adolescent↗

The effects of post-extraction time on the hydraulic conductance of human dentine in vitro.

The permeability characteristics of dentine have been used in many in vitro studies to evaluate longitudinally the efficacy of various restorative and preventative procedures. However, the permeability of human dentine increases over time after tooth extraction. The aim here was to determine if there is a steady phase in dentine permeability in vitro over time. The convective permeability of dentine discs cut from extracted human third molars to 0.8% albumin solution was measured initially on day 7 after extraction using a fluid-transport model and the hydraulic conductance was calculated. The permeability of each disc was then re-measured de- and re-mounting the split-chamber 1h after the initial measurement as well as on days 8, 9, and 37 after extraction. No significant difference was found between the initial and 1h hydraulic conductances. A significant increase in hydraulic conductance was seen from day 7 to 9, but there was no significant difference between the hydraulic conductances on days 9 and 37. These results suggest that the measurements were reproducible and that a steady phase of dentine permeability is established 9 days after extraction under these study conditions in vitro.

Albumins↗

Delineation of cytotoxic concentrations of two dentin bonding agents in vitro.

Until adhesiveness of dentin bonding agents and other restorative materials to dental structures can be assured, microleakage into resulting "gaps" and dentin permeability will remain major concerns in cases of pulpal irritation. The objectives of the present study were to (a) delineate the kinds and levels of metabolic cytotoxicity of the GLUMA and Scotchbond 2 systems as well as glutaraldehyde and 2-hydroxyethylmethacrylate, and (b) compare the effects of these same materials after diffusion through dentin discs approximately 0.5-mm thick. In monolayer cultures, glutaraldehyde was much more cytotoxic than 2-hydroxyethylmethacrylate. However, GLUMA sealer and Scotchbond 2 adhesive exhibited similar cytotoxicity in monolayer cultures. After diffusion through dentin, glutaraldehyde and 2-hydroxyethylmethacrylate effects were diluted 14.7 and 26.7 times, respectively. The postdiffusional effects of the GLUMA and Scotchbond 2 systems were not significantly different and less than those effects in monolayer cultures. This study should help in the evaluation of possible causes of pulpal irritation following restorative procedures.

3T3 Cells↗

The ratio of the densities of dentinal tubules on the cervical and axial walls in cavities.

When dentin is exposed, the pulp and the oral environment communicate through the dentinal tubules. The density of the dentinal tubules is an important determinant in dentinal permeability. The purpose of this study was to investigate, with an indirect method, whether tubular density is higher on the axial or on the cervical wall in cavities in restorative dentistry. The results obtained indicated that density of tubules on the cervical wall was usually higher than that on the axial wall. Clinically, the cervical wall of restorations therefore warrants the same meticulous protection routinely provided to the pulpal wall.

Bicuspid↗

The effects of phosphoric acid, sodium hypochlorite, ferric oxalate and Scotchbond Multipurpose on the rate of pressure change across dentine: a laboratory study.

The aim of this study was to investigate the consequences of dentine treatment on dentine permeability of crown preparations treated with phosphoric acid, sodium hypochlorite (NaOCl), and then ferric oxalate (Sensodyne sealant) or bis-phenol-A-diglycidyldimethacrylate (BIS-GMA) and hydroxyethylmethacrylate (HEMA) resin combination (Scotchbond Multipurpose). Thirty human premolars received full crown preparations (stage A), were then acid etched (stage B) and subsequently the pulp chamber flushed with NaOCl (stage C). They were then randomly assigned to two groups: group 1 was treated with Scotchbond Multipurpose and group 2 with 6% ferric oxalate (Sensodyne sealant) (stage D). Both groups were acid etched a second time (stage E) as the final step in the sequence. The rise in pressure in the pulp chamber because of the transmission of saline from the pressure chamber through cut dentine was recorded by a pressure transducer after each of the stages described (A to E). The mean rate of pressure change across dentine (Pa s(-1)) for each measurement point (A to E) (n = 30) were A = 2.3; B = 9.8; C = 16; D = 2.1; E = 3.1. Acid etching and NaOCl were both effective in producing significant increases in the rate of pressure change across dentine (P < 0.05). Sensodyne sealant and Scotchbond Multipurpose are both effective dentine sealants and there is no significant difference (P > 0.05) in their abilities in sealing dentine. Acid etching-sealed dentine produced a significant increase in the rate of pressure change across dentine (P < 0.05). The sealing of dentine appears to be a sensible consideration following crown preparations on vital teeth.

Acid Etching, Dental↗

Net expansion of dried demineralized dentin matrix produced by monomer/alcohol saturation and solvent evaporation.

The purpose of this work was to determine if nonaqueous methacrylate monomer/alcohol mixtures could expand dried collapsed demineralized dentin matrix. Thin disks (ca. 200 microm) of human dentin were demineralized and placed in wells beneath contact probes of linear variable differential transformers. The probes were placed on water-saturated expanded matrices to record the shrinkage associated with drying. Monomer mixtures containing hydroxyethyl methacrylate, 2,2-bis[4-(2-hydroxy-3 methacryloyloxy)propoxyphenyl] propane, or triethyleneglycol dimethacrylate were mixed with methanol or ethanol at alcohol/monomer mass fraction % of 90/10, 70/30, 50/50, or 30/70. They were randomly applied to the dried matrices to determine the rate and magnitude of expansion; then shrinkage was recorded during evaporation of the alcohols. The results indicated that matrix expansion was positively correlated with the Hoy's solubility parameters for hydrogen bonding forces (delta(h)) of the monomer/solvent mixtures (p < 0.001). Expansions were more rapid with methanol-containing than with ethanol-containing monomer mixtures. For the test solutions, triethyleneglycol dimethacrylate-containing mixtures produced the slowest rate of matrix expansion and hydroxyethyl methacrylate-containing mixtures the most rapid expansion. When the solvents were evaporated, the matrix shrank in proportion to the solvent content and the delta(h) of the monomer-solvent mixtures. The results indicate that expansion of dried, collapsed dentin matrices requires that the delta(h) of the mixtures be larger than 17 (J/cm(3))(1/2). The greater the delta(h) of the monomer solutions, the greater the rate and extent of expansion.

Alcohols↗