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Dentin permeability. The clinical ramifications.

Dentin is a unique material with the ability to provide not only sensation to the pulp but protection of this soft tissue. The jury is still out concerning the practice of etching dentin with caustic substances in order to remove the smear layer and to open dentinal tubules prior to restorative procedures. Additional research is required to evaluate the long-term vitality of teeth that have been treated in this fashion. The dentinal tubule is truly a window through which the clinician and the researcher may find answers to a variety of clinical problems. Furthermore, dentinal tubules may provide a noninvasive path by which the difficulty of accurately assessing pulpal health may be overcome.

Biology↗

Effect of periodontal root planing on dentin permeability.

The purpose of this study was to quantitate the effects of root planing on the permeability of human root dentin in vitro. Unerupted 3rd molars were used. The crowns were removed and longitudinal slices made of the root. The hydraulic conductance of the root dentin was measured before and after root planing, acid etching and potassium oxalate application using a fluid filtration method. The results showed that root planing creates a smear layer that reduces the permeability of the underlying dentin. However, this smear layer is acid labile. Thus, root planing may ultimately cause increased dentin permeability and the associated sequelae of sensitive dentin, bacterial invasion of tubules, reduced periodontal reattachment and pulpal irritation.

Acid Etching, Dental↗

Effect of self-etching adhesives on dentin permeability in a fluid flow model.

STATEMENT OF PROBLEM: Numerous self-etching bonding systems exist, with composition differing from one product to another. It is important for the clinician to know if they are all equally effective, and whether they provide an effective seal between dentin and restorative materials. PURPOSE: This study was designed to measure the hydraulic conductance of physiologic saline across dentin after application of various self-etching bonding systems or of a 1-bottle adhesive system preceded by a phosphoric acid etch. MATERIAL AND METHODS: One hundred extracted noncarious human third molars from patients 18-25 years old were used for this study. Dentin disks were cut from crown segments parallel to the occlusal surface at the top of the pulp cavity. The 100 disks, each 1 mm thick, were divided into 10 groups (n=10 per group), each of which was treated with 1 of 9 self-etching systems-AdheSE, Adper Prompt L-Pop, Clearfil SE Bond, Etch & Prime 3.0, Prime & Bond NRC Nt, One-Up Bond F, optiBond solo Plus Self Etch, Prompt L-Pop, or Xeno III-or a control bonding system (Prime & Bond NT) preceded by a phosphoric acid etch. Hydraulic conductance, the volume of fluid transported across a known area of surface (0.28 cm2) per unit time under a unit pressure gradient (200 cm H2O), was analyzed for the adhesive systems using a fluid flow apparatus (Flodec). First, both sides of each specimen were etched with 36% phosphoric acid for 30 seconds, and the hydraulic conductance was measured every 30 seconds for 15 minutes. The initial set of measurements served as the reference value for each specimen. The measurements were repeated when a smear layer had been formed and, finally, after 1 of the 10 bonding systems had been applied. The data were analyzed using a 1-way ANOVA and Duncan's multiple range test (alpha=.05). RESULTS: The control 1-bottle adhesive used with a phosphoric acid pre-etch did not provide the largest reduction in penetration (42.3%). The greatest mean reduction (68.9%, P<.05) was observed with the self-etching product Xeno III. The mean reduction for the other materials tested were: One-Up Bond F, 60.5%; AdheSE, 58.2%; Etch & Prime 3.0, 56.8%; Adper Prompt L-Pop, 51%; optiBond solo Plus Self Etch, 45%; Clearfil SE Bond, 35.5%, Prime & Bond NRC Nt, 16.4%; and Prompt L-Pop, 16.3%. CONCLUSION: Within the limitations of this study, the self-etching systems tested produced different reductions in dentin permeability. For some, the reduction was much greater than the decrease in dentin permeability provided by the bonding system with a phosphoric acid pre-etch; for others, the reduction was small.

Adolescent↗

Effects of aluminum oxalate/glycine pretreatment solutions on dentin permeability.

Aluminum oxalate buffered with glycine to pH 0.5-2.5 has been proposed as a dentin pretreatment for the Gluma bonding system. In this experiment, the effects of 1-minute treatments of smear layers with these aluminum oxalates on the permeability of human dentin were determined in vitro. The aluminum oxalate solutions at pH 0.5-1.5 removed most of the original smear layer but occluded the tubules with crystalline deposits which decreased dentin permeability. Those solutions used at pH 2.0 and 2.5 increased dentin permeability. All dentin pretreatments increased dentin permeability when measured after a 24-hour storage period, especially the solutions at pH 2.0 and 2.5. The SEM correlates of these permeability changes indicated that these solutions remove the smear layer but reocclude the tubules with precipitates which are probably different forms of calcium oxalate, aluminum phosphate and calcium phosphates.

Adult↗

Influence of the pulpal components on human dentine permeability in vitro.

AIM: To examine the influence of the retained pulpal components on permeability of human dentine by monitoring drug diffusion. METHODOLOGY: Twelve intact dentine discs were prepared from freshly extracted human third molars. The dentine surface on the enamel side was etched with 10% polyacrylic acid for 30 s. The drug diffusion test was carried out before and after removal of the retained pulpal components. Each dentine disc was inserted between two plastic chambers; enamel- and pulpal-side chambers, which were filled with 0.05 mol L(-1) naproxen sodium (NA) and phosphate-buffered saline (PBS), respectively. After 10 min, the solution on the pulpal-side chamber was collected to determine the concentration of NA using a spectrophotometer. To remove the retained pulpal components and residual NA, the pulp chamber of each disc was washed out with PBS and placed in an ultrasonic cleaner. After removal of these components and the residual NA, the drug diffusion test was repeated. The inner surface of the pulp chamber was observed using scanning electron microscopy (SEM) before and after the removal of the retained pulpal components. RESULTS: The amount of NA that diffused through dentine into the pulp was significantly higher after the pulp chamber was washed out with PBS (paired t-test, P < 0.05). SEM observation demonstrated the presence of the retained pulpal components, odontoblastic layer and some parts of subodontoblastic zone, covering the surface of predentine. These components were removed after the pulp chamber was washed out with PBS followed by cleaning in an ultrasonic cleaner. CONCLUSIONS: The presence of retained pulpal components had a significant influence on drug diffusion through dentine discs.

Anti-Inflammatory Agents, Non-Steroidal↗

Dentin permeability. Effects of desensitizing dentifrices in vitro.

Patients using placebo dentifrices in clinical trials usually show a significant decrease in dentin sensitivity over a 2- to 4-week period. If their sensitivity were due to hydrodynamic fluid movement, then the results suggest that there was a decrease in their dentin permeability. This hypothesis was tested in vitro by measuring the ease with which fluid could flow (i.e., hydraulic conductance) across dentin discs before and after brushing the discs with a variety of dentifrices, including most of the marketed densensitizing dentifrices. All dentifrices decreased the hydraulic conductance of dentin. An experimental dentifrice containing oxalate as the active ingredient was far more effective than any of the marketed dentifrices. The results tend to support the hypothesis that, at least part of the reduction in clinical sensitivity in patients with hypersensitive dentin is due to the abrasive action of the dentifrice.

Dentifrices↗

In vitro dentine permeability evaluation of HEMA-based (desensitizing) products using split-chamber model following in vivo application in the dog.

The aim of this study was to evaluate in vitro dentine permeability evaluation of 2-Hydroxyethyl methacrylate (HEMA)-based desensitizing products using split-chamber model following in vivo application in the dogs for three experimental time periods of 1 week, 1 month and 3 months. Buccal enamel of upper and lower canines of nine young dogs was removed and flat dentinal surface was obtained using a water-cooled diamond bur. The dentinal surface divided into four quarters, three experimental and a control. Health-Dent and Gluma Desensitizing agent and Single bond were applied to respective quarters of one tooth, according to manufacturers' instructions. The last quarters were left as control without any applications. For the each experimental period, 10 dentine samples from each group including control were used to measure the hydraulic conductance values. The dentine discs were placed pulp-side down in a split-chamber device in which the plastic spacers containing the rubber 0 rings have a surface area of 1 mm(2) and permeability was measured by fluid filtration. The data were expressed as hydraulic conductance (Lp). Differences in dentine permeability obtained for the desensitizing agents against the control were tested for statistical significance using Kruskal-Wallis one-way ANOVA and Bonferroni-adjusted Mann-Whitney U-tests. Differences in permeability in three time periods for each desensitizing agent were analysed using Friedman's anova and Wilcoxon signed rank tests. All desensitizing applications caused decreased Lp values compared with the control Lp value at the end of 1 week. In the 1-month samples, between the Lp values of Single bond and control, no statistical difference was found (P > 0.05). At the end of the 3-month period, the Gluma Desensitizing agent had the lowest the Lp value (P < 0.05). The result of this study is that the topical application of desensitizing agents led to decrease in dentine permeability in the dog model. The Gluma Desensitizing agent provide the more lasting tubule-occluding effect than the other material tested in this model.

Animals↗

The effects of Pain-Free Desensitizer on dentine permeability and tubule occlusion over time, in vitro.

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.

Analysis of Variance↗

Effects of ferric and aluminum oxalates on dentin permeability.

The purpose of this study was to compare the efficacy of ferric oxalate, aluminum oxalate, or Tenure dentin conditioner, a marketed product containing aluminum oxalate, at reducing the permeability of human dentin in vitro. Topical treatment with these acidified agents or 2.5% nitric acid for 10, 30, or 60 seconds was compared. The results indicate that 10-second treatments of dentin with all agents increased dentin permeability. Extending the treatment to 30 seconds produced a decrease in dentin permeability for acidified aluminum and ferric oxalate with 60-second treatments being even more effective. Treatment with Tenure dentin conditioner for 60 seconds did not reduce dentin permeability as well as treatment with the other oxalate salts.

Dentin Permeability↗

In vitro evaluation of the effects of the interaction between irrigating solutions, intracanal medication and Er:YAG laser in dentin permeability of the endodontic system.

The purpose of this study was to evaluate in vitro the effects of different associations between irrigating solutions (EDTA-T and citric acid), intracanal medicament (NDP), and Er:YAG laser irradiation on dentin permeability. Fifty-one extracted single-rooted teeth were instrumented and divided into seven groups. Groups GI and GII had final irrigation with a demineralizing solution only (EDTA-T and citric acid, respectively). Groups GIII and GIV had final irrigation with EDTA-T and citric acid, respectively, plus an association of irrigating solution and Er:YAG laser. Groups GV and GVI had final irrigation with EDTA-T and citric acid, respectively, plus an association of intracanal medication and Er:YAG laser. Group GVII (control group) had final irrigation with distilled water. All root canals were filled with NDP associated with rhodamine B dye. After the experimental period, the samples were transversely cut into six 2.0 mm thick slices for subsequent reading using the ImageLab software. Analysis of the results allowed us to conclude that there were statistically significant differences (p < 0.05) between the groups as to the penetration of the dye-intracanal medication solution. Groups III and IV presented smaller values of dentinal permeability when compared to the other groups. The best results were obtained with the interaction between a demineralizing irrigating solution and the association of intracanal medicament and laser Er:YAG (groups V and VI). In these groups the observed penetration of the intracanal medicament plus dye solution in the apical third was, on average, 29% greater than in the other groups.

Chelating Agents↗

Effect of bleaching agents on dentin permeability to Streptococcus faecalis.

Bacterial contamination of dentin may be a contributing factor in the development of bleaching-associated root resorption. In this study, the effect of commonly used bleaching agents on the permeability of dentin tubules to Streptococcus faecalis was evaluated. Sixty extracted bovine incisors were horizontally sectioned apically to the cementoenamel junction. In each tooth, a standard cavity was prepared, the pulp tissue extirpated, and remnants of soft tissue and smear layer were removed. Following rinsing and repeated autoclave sterilization, the teeth were divided into four groups, each treated with one of the following materials: 30% hydrogen peroxide, sodium perborate mixed with 30% hydrogen peroxide, sodium perborate mixed with distilled water, and distilled water alone that served as control. The bleaching agents were sealed in the teeth and incubated at 37 degrees C for 7, 14, and 21 days. At each time interval the bleaching agents were removed and the teeth incubated at 37 degrees C in brain heart infusion infected with S. faecalis. Histological sections were prepared, and the maximal bacterial penetration for each group was measured using a computerized morphometric system. Statistical analysis of the results revealed that teeth treated with either 30% hydrogen peroxide alone or in combination with sodium perborate were significantly more permeable to S. faecalis than those treated with sodium perborate mixed with water (p < 0.0001). Sodium perborate mixed with water did not cause an increase in dentin permeability to S. faecalis and was similar to the water control. In conclusion, it seems that bleaching agents containing hydrogen peroxide in high concentrations may increase bacterial penetration through dentinal tubules.

Analysis of Variance↗

Quantitative evaluation of self-etching primer action on dentin permeability: a correlation between impedance measurements and acidity.

PURPOSE: To evaluate quantitatively the effect of six contemporary self-etching systems on dentin permeability by means of the electrochemical impedance technique and to correlate these results with their acidity. METHODS: 36 1.1 mm thick dentin disks were embedded in a hollow polyurethane resin cylinder. The system used was a "like" permeation cell: two electrodes immersed in a 10(-1) KCl solution were attached to a potentiostat. It was connected to a microcomputer controlled frequency response analyzer, and a 10 mV sinusoidal voltage signal over a frequency range of 1 Hz to 65 kHz was applied between the electrodes. The current passing through the dentin was measured to enable a calculation of impedance expressed in a complex number. To establish an evaluation of permeability variation, the resistance was noted for all specimens before and after the application of self-etching adhesive. A pH meter used with a combined glass-electrode measured the pH of all the systems. RESULTS: The higher decrease of the resistance of dentin samples was obtained with Experimental (EXP), which presented no significant difference with Touch and Bond (TB), Etch and Prime 3.0 (EP), and Etch Free Tenure (EF). These acidic monomers improved the dentin permeability respectively to 6.7, 5.1, 5.0 and 5.0%. The lowest values were obtained with Clearfil SE Bond (SEB) (2.0%), which showed significant difference with all the other systems. Prompt L-Pop (PLP) with 4.3% showed significant difference with EXP and SEB and no significant difference with the three other systems. The pH and permeability variation were not systematically correlated. CLINICAL SIGNIFICANCE: Significant differences, in terms of quantitative evaluation of demineralization for self-etching systems on dentin, are of interest to clinical practitioners. Dentin bonding efficiency for this sort of adhesive system is not specifically related to this parameter, but low aggressiveness could be an area of concern on enamel.

Acid Etching, Dental↗

Dentin permeability and eugenol diffusion after full crown preparation.

PURPOSE: To compare teeth prepared to receive a metallic versus a metal-ceramic crown with respect to (1) in vitro dentin permeability before and after using a desensitizing agent and (2) pulpal eugenol concentration after sealing a temporary crown with a zinc oxide-eugenol based cement. MATERIALS AND METHODS: The roots of 20 human mandibular molars were separated and the crowns were prepared to receive a metallic crown. The hydraulic conductance was recorded before and after using Protect dentin desensitizer. The crowns were then further reduced to receive a metal-ceramic crown and the hydraulic conductance was recorded under the same conditions, on deeper dentin, before and after using the desensitizing agent. Twenty additional teeth were prepared: 10 to receive a metallic crown and 10 teeth to receive a metal-ceramic crown. A tube filled with 1 mL phosphate buffered saline (PBS) was sealed to the cementoenamel junction. A temporary crown was sealed onto the preparation with Temp Bond. The amount of eugenol that diffused across dentin into PBS was spectrofluorimetrically measured at Day 1 and Day 7. The crown preparations were vertically sectioned and the dentin remaining thickness was recorded. RESULTS: The hydraulic conductance of teeth prepared for a metal-ceramic crown was twice as high as teeth prepared for a metallic crown (P < 0.001). The desensitizing agent reduced the hydraulic conductance in both groups (P< 0.001). The two groups showed the same hydraulic conductance after using Protect (ns). No significant difference was found in the amount of eugenol diffusion between the two groups of teeth although eugenol diffusion decreased with time (P < 0.01). No correlation was found between eugenol diffusion and remaining dentin thickness.

Analysis of Variance↗

Effects of calcium phosphate solutions on dentin permeability.

Calcium phosphate solutions at various concentrations and pH levels were used to obstruct the dentinal tubules. The effects were evaluated by measurements of permeability through dentin discs and by scanning electron microscopy. Precipitation kinetics were followed by pH changes in the solutions and products were determined by X-ray powder diffraction. The solutions were applied in two ways: (a) calcium and phosphate solutions were mixed before application and (b) one solution (calcium or phosphate) was applied first followed by the other solution. Three kinds of human dentin discs were used; one with smear layer and the other two with tubules exposed by sonication or etched by acid. The high concentration calcium phosphate solutions at pH = 9.5 rapidly precipitated amorphous calcium phosphates that obstructed the dentinal tubules and decreased dentin permeability by 85% or more. At pH = 5.6, the calcium phosphate solutions precipitated large crystals of dicalcium phosphate dihydrate. In this case, the effectiveness in obstructing dentinal tubules was found to be procedure sensitive.

Acid Etching, Dental↗

Reduction in dentin permeability using mildly supersaturated calcium phosphate solutions.

Treatments that obturate dentin tubules have been used for reducing dentin hypersensitivity. The objective of this study was to determine the effects of multiple treatments with a mildly supersaturated calcium phosphate solution on the hydraulic conductance (Lp) of partially occluded dentin discs in vitro. The treatment solution contained 6.5 mmoll(-1) each of calcium and phosphate, 0.25 mmoll(-1) fluoride, 30 mmoll(-1) KCl, and 50 mmoll(-1) HEPES buffer (pH adjusted to 7.0). The mean baseline Lp (in microlcm(-2)min(-1) H(2)O cm(-1)) was 0.108+/-0.041 (mean +/- S.D.; n=9, microlcm(-2)min(-1) H(2)O cm(-1) = 10.20 microlcm(-2)min(-1)KPa(-1)) and after five consecutive treatments, the mean relative Lp, presented as percentage of baseline, were 71+/-11, 58+/-10, 46+/-18, 40+/-14, and 25+/-10, respectively. The Lp values of the baseline and treatment groups were significantly (P<0.05) different. Consecutive treatments appeared effective in further reducing Lp of dentin discs.

Calcium Phosphates↗

Dentin permeability: effects of smear layer removal.

The results of this study permit the following conclusions: 1. The use of dilute (6%) citric acid for very short time intervals permits sequential removal of the smear layer on human dentin. 2. Acid-etching for as little as 5 seconds removes much of the smear layer and exposes the orifices of dentinal tubules. 3. Dentin permeability increased rapidly during acid-etching with 6% citric acid, reaching a maximum value after only 15 seconds of etching. 4. The production of a smear layer on dentin during restorative procedures establishes a protective diffusion barrier. Removal of the smear layer by acid-etching increases the permeability of dentin which, under some conditions, must be regarded as a liability.

Acid Etching, Dental↗

["In vitro" analysis of root dentin permeability during endodontic instrument use, as a function of change of instruments and number of times used].

The increase of dentinal permeability is a very important issue related to root canal disinfection. Beside the auxiliary substance used for the chemical/mechanical preparation, time and type of instruments were also considered. Based on these facts, we have studied the percentage of dentinal penetration of a stain (Patent blue V), in recently extracted teeth. By this way, areas of tooth hemisection and dentinal stain penetration could be assessed. Two different brands of type Kerr files (kerr and Maillefer) and a type K-Flex file were used for root canal preparation. They were used with the Endo PTC as an auxiliary chemical substance. The number of time used by each file was also considered. Results have shown no significant statistical differences of percentage of dentin stained, when different instruments were used. Less stain penetration could be observed when an increase of instrument action was placed, mainly observed in the apical area and tooth hemisection.

Dentin Permeability↗

Apical dentin permeability and microleakage associated with root end resection and retrograde filling.

This study evaluated the apical leakage associated with various depths of retrograde fillings placed in root apices which had been resected at one of three different angles. Leakage was assessed with a hydraulic conductance apparatus. Teeth were divided into groups corresponding to the angle of apical resection (0, 30, and 45 degrees to the long axis of the root) and apical leakage was determined following incremental increases in the depth of the retrograde filling (Ketac Silver). Increasing the depth of the retrograde filling significantly decreased apical leakage; there was also a significant increase in leakage as the amount of bevel increased. Both the permeability of resected apical dentin and microleakage around the retrograde filling material had a significant influence on apical leakage.

Apicoectomy↗