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The LEC (Long-Evans Cinnamon) rat as an animal model for bilirubin-induced tooth pigmentation.

The LEC (Long-Evans Cinnamon) rat is well known as a useful animal model for hepatic disease. We noticed the green pigmentation in incisors 2-3 weeks after acute hepatitis accompanied by severe jaundice. This study was undertaken to elucidate the cause of this phenomenon. Half of the pigmented teeth were examined by histopathological analysis and microradiographic analysis. Pigmentation was observed as a green stripe that ran parallel to the incremental line in the dentine. The microradiographic analysis disclosed enhanced permeability of the pigmented area as compared with other areas. The rest of pigmented teeth were dried, powdered and bilirubin was extracted with chloroform /methanol/acetic acid, 30:10:0.5; v/v under sonication. After centrifugation, the supernatant was collected and evaporated. The residue was dissolved in chloroform and its absorption spectrum measured after diazo reaction to reveal the presence of bilirubin. The spectral characteristics indicated the presence of bilirubin in the pigmented teeth. Thus, the LEC rat may be useful animal model for bilirubin-induced tooth pigmentation.

Animals↗

Clinical dentin hypersensitivity: understanding the causes and prescribing a treatment.

Dentin hypersensitivity is a common condition of transient tooth pain associated with a variety of exogenous stimuli. There is substantial variation in the response to such stimuli from one person to another. Except for sensitivity associated with tooth bleaching or other tooth pathology, the clinical cause of dentin hypersensitivity is exposed dentinal tubules as a result of gingival recession and subsequent loss of cementum on root surfaces. The most widely accepted theory of how the pain occurs is Brännström's hydrodynamic theory of dentin hypersensitivity. Dentinal hypersensitivity must be differentiated from other conditions that may cause sensitive teeth prior to treatment. Three principal treatment strategies are used. Dentinal tubules can be covered by gingival grafts or dental restorations. The tubules can be plugged using compounds that can precipitate together into a large enough mass to occlude the tubules. The third strategy is to desensitize the nerve tissue within the tubules using potassium nitrate. Several over-the-counter products are available to patients to treat this condition.

Dental Cementum↗

Bond strength between root dentin and three glass-fiber post systems.

STATEMENT OF PROBLEM: Glass-fiber posts were introduced for use after endodontic therapy instead of metal alloy and ceramic posts. There are several new types of glass-fiber post systems available, but little is known about how well these posts bond to the root surface. PURPOSE: The purpose of this in vitro study was to compare the bond strengths of 3 different types of glass-fiber post systems-opaque, translucent, and electrical glass-in 3 different locations of prepared post spaces. MATERIAL AND METHODS: Sixty human intact single-rooted extracted teeth were used. The root canals were prepared using a step-back technique and obturated with gutta-percha using lateral condensation. The roots were divided into 3 experimental groups and further divided into 2 subgroups according to testing time (n=10). Roots were restored with 1 of the following post systems according to the manufacturer's instructions: opaque glass-fiber posts (Snowpost), translucent glass-fiber posts (FiberMaster), and electrical glass-fiber posts (Everstick). A self-etching primer (Clearfil Liner Bond) was applied to the walls of the post spaces, allowed to etch for 30 seconds, and gently air dried. A dual-polymerized bonding agent (Clearfil Liner Bond, Bond A and B) was then applied to the same walls. A dual-polymerizing resin luting agent (Panavia F) was mixed for 20 seconds and then placed in the post spaces using a lentulo spiral instrument. The roots were placed in light-protected cylinders; then the light source was placed directly on the flat cervical tooth surfaces and the cement was polymerized. Specimens were stored in light-proof boxes for 24 hours or 1 week after the polymerization procedure. Each root was cut horizontally, and six 1-mm-thick root segments (2 apical, 2 middle, and 2 cervical) were prepared. Using a push-out test, the bond strength between post and dentin was measured after 24 hours or 1 week using a universal testing machine. Statistical analysis was performed with 3-way ANOVA followed by independent t tests (alpha=.05) to detect differences between groups defined by the specific interacting variables. The different combinations of posts and luting material from the cervical segments were analyzed with SEM. RESULTS: The 3-way ANOVA indicated that push-out test values varied significantly according to the post system used (opaque, electrical, and translucent) (P<.01); the root segments (cervical, middle, and apical) (P<.01), however, did not vary statistically according to the time of testing (24 hours and 1 week). Opaque and electrical glass-fiber posts showed higher bond strength values than translucent posts (P<.01). Push-out bond strength values of cervical segments were significantly higher than the middle and apical segments in translucent and electrical glass-fiber post groups (P<.01). In the opaque glass-fiber post group, there were no significant differences between cervical and middle segments. In SEM analysis, a distinct hybrid zone with long, numerous resin tags located between luting material and dentin was exhibited in all post systems. CONCLUSION: The opaque and electrical glass-fiber posts exhibited similar bond strengths, and translucent posts exhibited the lowest bond strength. The highest bond strength was observed in the cervical third of the post spaces for translucent and electrical glass-fiber post groups.

Dental Bonding↗

Resin-tooth adhesive interfaces after long-term function.

PURPOSE: To characterize with scanning electron microscopy (SEM), the morphology of adhesive interfaces that had been functioning in an oral cavity for several years. MATERIALS AND METHODS: Cavities were prepared in vivo in caries-affected primary molars under local anesthesia. After removal of the entire carious lesion, the cavity was restored with a dentin adhesive system (Scotchbond Multi-Purpose). After several yrs, as the successor permanent teeth erupted, the resin-filled teeth were extracted. Then, the extracted resin-restored primary molars were cross-sectioned perpendicular to the adhesive interface using a low speed diamond saw and then polished for SEM examination. RESULTS: Morphological changes, such as digestion of the collagen fibrils and deterioration of the bonding resin and hybrid layer, were observed at the interface of the oral environment specimens. The results of this study demonstrated that degradation of resin-dentin bond structures appeared to occur in the human oral environment over time.

Child↗

Clinical effectiveness of two agents on the treatment of tooth cervical hypersensitivity.

PURPOSE: To investigate the desensitizing ability of a one-bottle bonding agent and a glutaraldehyde-based HEMA formulation on sensitive tooth cervical areas for a period up to 9 months. METHODS: The sample consisted of 40 patients with cervical hypersensitivity. Three sensitive teeth per patient were treated; one received One-Step (one-bottle bonding agent), the other Gluma Desensitizer (glutaraldehyde-based agent) and the third distilled water (control group). The hypersensitivity level was determined before, immediately after the desensitizing session, at 8 weeks, and 9 months post-treatment. Measurements of sensitivity were determined by the patient's response to tactile and air-blast stimuli. A verbal rating scale was used and scored as follows: 0, no discomfort; 1, discomfort but no severe pain; 2, severe pain during simulation; 3, severe pain after simulation. The results were subjected to statistical analysis by Kruskal-Wallis test (a=0.05). RESULTS: Both treatment procedures resulted in reduction of hypersensitivity to both stimuli, for up to 9 months. No significant differences were recorded between One-Step and Gluma Desensitizer at immediate and 8-week examinations, whereas Gluma Desensitizer produced lower hypersensitivity than One-Step at the 9-month assessment. In general, a lower level of reduction was found for the 9-month interval compared to the 8-week hypersensitivity score for both agents tested. A placebo effect was observed with water treatment, ranging from 4.7 to 27.5% reduction of hypersensitivity.

Adult↗

pH changes at the surface of root dentin when using root canal sealers containing calcium hydroxide.

The purpose of this study was to investigate long-term pH changes in cavities prepared in root surface dentin of extracted teeth after obturation of the root canal with gutta-percha and a variety of sealers containing calcium hydroxide. After cleaning and shaping, root canals in 50 recently extracted, human single-rooted teeth were divided into five groups. Each of four groups was obturated with gutta-percha and either Sealapex, Sealer 26, Apexit, or CRCS, all of which contain calcium hydroxide. The remaining group served as the control and was not obturated with gutta-percha or sealer. Cavities were prepared in the facial surface of the roots in the cervical and middle regions. The pH was measured in these dentinal cavities at the initiation of the experiment, and 3, 7, 14, 21, 28, 45, 60, 90, and 120 days after obturation. Results indicate that the pH at the surface of the root does not become alkaline when calcium hydroxide cements are used as root canal sealers. Regardless of the sealer used, the observed pattern of pH change was not different from that seen in the control group of roots that were not treated with sealer. It is concluded that calcium hydroxide-containing cements, although suitable for use as root canal sealants, do not produce an alkaline pH at the root surface. If such a pH change is related to treatment of root resorption, these sealants do not contribute to this treatment.

Bismuth↗

Bonding of all-porcelain crowns: structural characteristics of the substrate.

OBJECTIVES: The aim of this in vitro study was to evaluate the morphology of dentin in teeth prepared for single-unit all-porcelain crowns (SUAPC) in terms of tubule orientation, density and increase in surface area after etching. METHODS: Twenty anterior and 20 posterior teeth from adults were prepared 1mm below the cemento-enamel junction (CEJ) for SUAPC. The samples were divided into groups based on type of tooth (anterior or posterior) and bonding system employed. The teeth were processed for evaluation of morphology of the substrate, hybrid layer thickness and resin tag formation. The observations were subdivided according to location in the preparation and tubule density was calculated. RESULTS: The observations revealed the variability in tubule density and orientation in different areas within any one preparation. The morphology of the cervical margin was less predictable with the presence of cementum and an ill-defined cemento-dentinal junction. Statistically significant differences in the density of tubules were found depending on location. Groups 2, 3, 5 and 6 samples showed that the hybrid layer thickness and resin tag morphology depended on the density and direction of tubules. In those sectors with parallel and oblique tubule orientation and with a low density of tubules, the hybrid layer was significantly thinner than in areas with cross-sectioned tubules. SIGNIFICANCE: The cementum and the peripheral intertubular dentin surface area are likely to be responsible for the bond strength after acid etching of crown preparations, but not all areas exhibited equal responses to etching. In particular, the bonding substrate at the gingival margins may contribute little in terms of micromechanical retention.

Acid Etching, Dental↗

Effects of one versus two applications of an unfilled, all-in-one adhesive on dentine bonding.

OBJECTIVES: This study examined the null hypothesis that there is no difference between the effect of a one versus two-layer applications of Prompt L-Pop (3M ESPE, Seefeld, Germany) to sound, abraded human coronal dentine. METHODS: In group I, the mixed adhesive was applied for 15s, and light-cured for 10s. In group II, after light-curing the first layer, the adhesive was re-applied and light-cured. Specimens bonded with a hybrid composite were sectioned into beams for microtensile bond strength evaluation. Additional teeth from each group were bonded similarly using a lining composite for transmission electron microscopy examination of the resin-dentine interfaces, and nanoleakage evaluation using ammoniacal silver nitrate. RESULTS: A significant difference (p<0.001) was detected between microtensile bond strengths in the two groups. Stained, demineralized sections revealed 3-5 microm thick hybrid layers in both groups. An electron-lucent layer between 7 and 20 microm thick was present between the adhesive and the overlying composite. This layer was absent from the interfaces after removal with ethanol before composite placement. The use of a single application in group I resulted in the direct contact of the electron-lucent layer with the dentine surface and tubular orifices. In unstained, undemineralized sections used to evaluate nanoleakage, silver deposits were found mostly in the hybrid layer in group II, but throughout the entire adhesive layer in group I. CONCLUSION: Bonding of this unfilled all-in-one adhesive to dentine may be improved by application of a second adhesive layer after light-curing the first layer. This ensures that the exposed dentine surface and dentinal tubules are coated with adhesive that is adequately polymerized.

Composite Resins↗

Limitations in the intraoral demineralization of bovine enamel.

A model system was used to examine the relation between the duration of plaque pH fall and enamel demineralization following the intake of dietary carbohydrate in humans. Subjects wore palatal appliances containing blocks of bovine enamel covered with Streptococcus mutans IB 1600, and rinsed with 5 or 10% sucrose. Changes in iodide penetrability (delta Ip) of the enamel, and the pH and extracellular calcium and inorganic phosphate (Pi) concentrations of the streptococcal plaque were determined. Following rinses with 5% sucrose, delta Ip increased with time and reached a maximum (11.2 +/- 2.2 units) at 45-60 min although the S. mutans plaque remained acidic (pH = 4.8 +/- 0.6). After 10% sucrose, the maximum (14.7 +/- 3.1 units) was reached while the plaque pH was 4.0 +/- 0.3. Second rinses with sucrose increased delta Ip at most by 30%. Thus, demineralization did not persist throughout the period of low plaque pH, but occurred primarily during the early phase of plaque acidogenesis. Enamel demineralization appeared to be limited by factors other than the pH of the streptococcal plaque. Calcium concentrations in the S. mutans plaque rose to a maximum of 10.9 +/- 2.8 mEq/l at 30 min after the 5% sucrose rinses, then fell; Pi reached a stable level of 12.2 +/- 2.3 mEq/l by 60 min. Calculations showed that conditions approached saturation with respect to enamel and dicalcium phosphate dihydrate as demineralization reached a maximum. Demineralization appeared to be limited at low plaque pH, therefore, by the accumulation of high levels of mineral ions in the streptococcal plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Clinical performance and SEM evaluation of direct composite restorations in primary molars.

PURPOSE: To evaluate the clinical outcome of composite restorations performed in primary molars after 18 months and the morphology of the dentin/resin interface. METHODS: 41 primary molars from children aged 4-9 years were restored with Scotchbond Multi-Purpose Plus adhesive system and Z100 resin-based composite. The restorations were evaluated at baseline, 6, 12 and 18 months using the USPHS method for direct clinical analysis. Plaster models were made at each evaluation period for indirect evaluation. For the morphologic analysis of the dentin/resin interface, seven exfoliated teeth were sectioned longitudinally in a mesio/distal direction and observed in the electro scanning electron microscope. RESULTS: 100% (n = 40) of the restorations evaluated at 6 months were scored as Alpha for anatomical form, color matching, secondary caries, color alteration, and marginal degradation. At 12 months, 96.4% (n = 28) of the restorations received Alpha score and 3.4% Charlie score. At 18 months, all restorations evaluated (27/27) received Alpha score. 23 restorations were indirectly evaluated at 6, 12 and 18 months postoperatively. No significant wear or fractures were observed in any of the restorations. In the evaluation of the dentin/resin interface, the formation of a consistent hybrid layer was observed and the restorations were well adapted to the dentin at 18 months postoperatively.

Acid Etching, Dental↗

Glomerular permeability is altered by loss of P0, a myelin protein expressed in glomerular epithelial cells.

The myelin protein 0 (MPZ or P0) is a transmembrane glycoprotein that represents the most abundant myelin component. Mutations in the P0 gene are associated with one form of autosomal dominant demyelinating peripheral neuropathy, Charcot-Marie-Tooth disease type 1B (CMT1B). Because CMT1 may be associated with renal involvement, mostly focal segmental glomerulosclerosis, we hypothesized that P0 could be expressed in the kidney. P0 mRNA was detected by reverse transcriptase-PCR in the human and mouse renal cortex. P0 transcripts were identified by in situ hybridization at different stages of the mouse kidney development, especially in embryonic structures that give rise to the glomerulus. P0 protein was also detected by Western blot in human and rat glomerular extracts and in a human podocyte cell line using a monoclonal anti-P0 antibody. Immunofluorescence studies on human kidney sections showed that the podocytes were intensely labeled. Immunogold electron microscopy disclosed a predominant staining of the membranes of intracellular vesicles in podocytes. P0 was also detected in the podocyte cell membrane, including at the foot processes. P0(-/-) mice exhibited mild growth retardation and demyelinating neuropathy similar to the one observed in patients with CMT1B. They also presented mild albuminuria, without significant ultrastructural change of the glomerular basement membrane or the podocytes. These results demonstrate that P0, the major myelin protein, is also expressed during nephrogenesis and in mature kidney, mostly in podocytes. They suggest that P0 gene mutations might be involved in renal diseases.

Adult↗

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 influence of various conditioner agents on the interdiffusion zone and microleakage of a glass lonomer cement with a high viscosity in primary teeth.

The smear layer, which occurs during cavity preparation procedures, does not constitute a stable substructure in the bond of restorative material to dental hard tissues. Depending on the dissolution of this material in the course of time, microleakage occurs between the tooth and restorative material. This study evaluated the effects of different conditioner agents (Fuji Cavity Conditioner, 10% maleic acid, 35% phosphoric acid and 3% hydrogen peroxide) on Fuji IX microleakage, Fuji IX-enamel and Fuji IX-dentin combination in Class I cavities prepared to standards having the dimensions of 4x3x2 mm3 in extracted primary molars. The restorations were then subjected to thermocycling procedures and soaked in the 0.5% basic-fuchsin dye for 24 hours. Some sections were taken, parallel to the long axis of the tooth in a mesio-distal direction, and evaluated under a stereo-microscope for leakage. Also, two samples of Fuji IX-enamel and dentin combinations were chosen randomly from each group for evaluation in scanning electron microscopy (SEM). The distribution of microleakage occurred as follows: Control Group > Hydrogen Peroxide > 10% Maleic acid > Fuji Cavity Conditioner = Phosphoric acid. The difference between microleakage scores obtained from the groups was statistically significant (p<0.05). The SEM evaluation revealed a close interface connection in all groups except for the control and hydrogen peroxide groups in the Fuji IX-enamel combination. In the Fuji IX-dentin combination, however, a close interface connection was observed except in the control group. In conclusion, the application of conditioner agents to Class I cavities restored with glass ionomer cement with a high viscosity in vitro either diminishes or completely eliminates microleakage.

Acid Etching, Dental↗

Fluoride action on acid resistance of unaltered human surface enamel.

Unaltered surface enamel of extracted human teeth was subjected to tests of resistance to dissolution in 10 mM acetic acid at pH 4.0 and 10 mM EDTA at pH 7.4 in a miniature continuous flow system. Fluoride in EDTA had no effect on enamel dissolution. Inclusion of 0.25, 0.50 and 5.0 mM NaF in the acid at pH 4.0 greatly increased the resistance of the enamel to dissolution. The 0.5 mM NaF in the acid almost instantly reduced enamel dissolution and the effect persisted through the 1 h experiments. These results suggested that the acid labile fluoride in plaque and tooth minerals may provide the primary beneficial effect of all types of enamel fluoridation.

Acetates↗

Real-time atomic force microscopy of root dentine during demineralization when subjected to chelating agents.

AIM: To explore the potential of atomic force microscopy (AFM) for the examination of changes to dentine surfaces during demineralization and evaluate qualitatively the effect of EDTA, EDTAC and citric acid. METHODOLOGY: Nine canine teeth were sectioned transversely at the cemento-enamel junction, and the crowns discarded. Subsequently, each root was embedded in an epoxy cylinder and discs approximately 5 mm thick were cut. A standard metallographic procedure was then used to prepare the surfaces for observation. From the central portion of these samples, two specimens were symmetrically prepared per tooth so that a total number of 18 samples was produced. To allow the use of a liquid cell during AFM, the samples were embedded in silicone rubber and were then randomly divided into three groups, as follows: group 1: 17% EDTA (pH 7.7), group 2: 17% EDTAC (pH 7.7) and group 3: 10% citric acid (pH 1.4). Topographical images were acquired during the demineralization process, allowing real-time observation of the dentine surface. Two operators assigned scores to the AFM images using a double-blind method. anova analysis with random effects (P < 0.05) was used to compare the results. RESULTS: The average scores were 6.13 +/- 0.35 for EDTAC, 7.36 +/- 0.23 for EDTA and 14.55 +/- 1.21 for citric acid. Citric acid was statistically different from EDTA and EDTAC while EDTA and EDTAC were not statistically different. CONCLUSIONS: The most effective demineralizing substance was citric acid. The methodology developed for real-time observation of dentine surfaces is a valuable method to evaluate demineralization.

Chelating Agents↗

Alterations in human enamel surface morphology following vital bleaching.

Extracted intact human teeth (n = 4) were treated for 30 days by three protocols: Home 1 (Proxigel, n = 4) for 8 hours daily, Home 2 (White & Bright, n = 4) for 24 hours with 3 minutes of stannous fluoride gel, or an Office protocol (n = 4) using 30% hydrogen peroxide (Superoxol) warmed by a high-intensity light while the controls remained untreated. "Home" bleaching agents contain approximately 10% carbamide peroxide. After treatment, the coronal surfaces were examined with a scanning electron microscope (SEM) at 2000 power magnification, and the surface topography was measured by a profilometer. The SEM photomicrographs of the controls and office-treated groups were similar to previously reported descriptions, while the home bleached surfaces appeared similar to each other. Profilometric analysis was used to examine surface roughness and surface waviness. Mean surface roughness in microns was: control, 1.9; Home 1, 0.6; Home 2, 0.9; and Office, 0.6. Surface waviness was ranked control > office > Home 1 = Home 2. Enamel surface alterations were evident after the three bleaching methods. The differences between the office and home-treated surfaces were unrelated to the pH of the bleaching agents.

Carbamide Peroxide↗

Water uptake of bonding systems applied on root dentin surfaces: a SEM and confocal microscopic study.

OBJECTIVES: Dentin adhesives have been proposed as desensitizing agents to seal exposed root dentin surfaces. Simplified 'one-step' dentin adhesives are highly permeable to water. The authors hypothesized that a lactic acid challenge may increase permeability of simplified adhesives and may induce fast degradation of bonding. This phenomenon adversely affects their durability as long term desensitizing agents. The aim of this in vitro study was to evaluate the ability of four dentin adhesives to seal root dentin surfaces that were exposed to water and lactic acid challenges. METHODS: Four commercially-available dentin adhesives were applied with a small sponge to the root dentin of extracted human molars as de-sensitizing agents. Impression replicas of the adhesive-covered root dentin were fabricated after water immersion, as a control, and after lactic acid challenge. The replicas were examined with SEM for quantitative comparison of fluid droplet formation on the surfaces. The bonded specimens were also examined using reflected light confocal microscopy. RESULTS: Replicas of water droplets were observed on the adhesive surfaces, by SEM which corresponded with direct confocal observation of blisters and voids from the surface of the bonded specimens. There were significantly more water droplets from samples that were subjected to lactic acid challenge than water only immersion. SIGNIFICANCE: Although the dentin adhesives examined were able to cover exposed root dentin, they all exhibited fluid transudation through the polymerized adhesives. Dentin adhesives were also susceptible to surface degradation after lactic acid challenge. As simplified self-etch adhesives were highly water permeable and exhibited the most extensive surface damage, they may not be the best adhesives to be used for long-term dentin desensitization. These preliminary in vitro findings warrant validation in vivo.

Dentin Permeability↗