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A comparison was made between the rate of iodide permeation of dentin by diffusion and by filtration. Before acid etching, filtration only doubled the rate of iodide permeation relative to that obtained by diffusion. After acid etching, filtration produced a 32-fold increase in permeation. Acid etching, by removing occluding debris, facilitates filtration more than diffusion.
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Lipopolysaccharides (LPS) from Bacteroides oralis and Veillonella parvula and cell wall material from Lactobacillus casei were studied for their capacity to induce leukocyte migration in the dental pulp and in an implanted wound chamber. Three adult monkeys were challenged using lyophilized material sealed into buccal Class V cavities prepared in dentin. Pulp tissue responses were observed histologically eight and 72 hours after initiation of the experiment. Subjacent to cut dentinal tubules, bacterial materials induced polymorphonuclear leukocyte (PMN's) infiltration in the pulp tissue of the majority of test teeth examined. Responses were similar for the three bacterial test materials at both time periods. Topical applications of bovine serum albumin (BSA), used as a control, induced significantly less accumulation of PMN's. Assessments of induced exudate volumes and leukocyte densities in chambers implanted in rats showed comparable rankings with pulpal experiment between test (i.e., bacterial) and control (BSA) materials. Analysis of the data indicates that high-molecular-weight complexes of bacterial cell walls may adversely affect pulpal tissue across freshly exposed dentin.
The purposes of this study were: (1) to measure the effect of distance from the pulp on the hydraulic conductance of human radicular dentin; (2) to determine the influence of dentin thickness on the rates of fluid flow; and (3) to attempt to correlate dentinal tubule densities and diameters with root dentin hydraulic conductance. Dentin slabs prepared from extracted, unerupted, human third molar teeth were placed in a split-chamber device to permit quantitation of fluid filtration rate (hydraulic conductance). In the SEM portion of the study, dentinal tubule numbers and diameters were recorded. The results indicated that radicular dentin hydraulic conductance decreased with distance from the pulp and with increasing dentin thickness. Tubule density and diameter correlated well with the measured hydraulic conductances. The relatively low hydraulic conductance of outer root dentin makes it a significant barrier to fluid movement across root structure.
This investigation presents an experimental model for studying interactions of glass-ionomer cements (GICs) with bovine dentin slabs. Fluoride incorporation was studied with five serial abrasion biopsies, each being approximately 10 microns thick. The time of interaction was a very important parameter, indicating continuous fluoride release from the GIC and diffusion into dentin over a 30-day period. Expressed in mass per volume (mg F/cm3), the fluoride incorporation reached 12.0 mg at the first and 2.5 mg at the fifth layer, several times greater than the baseline of 0.27 mg/cm3 in bovine dentin. A subsequent test of acid resistance in a lactic acid buffer (pH 4.0), followed by microradiography of lesions, showed a characteristic 40-microns-wide acid-resistant zone on surfaces exposed to the GICs. In contrast, the untreated control surfaces had lesions demineralized evenly from the surface to the intact tissue, without the higher-density zone at the surface of the lesion. The model seems promising for screening fluoride incorporation into dentin from fluoride-releasing dental materials.
The alternating current impedance characteristics of a uni-directional porous glass membrane and serial sections of dentin from unerupted human third permanent molars (with and without smear layers) were measured. The membrane was equilibrated at 20 +/- 1 degrees C in a range of concentrations of unbuffered KCl, and the tooth sections were equilibrated in 0.1 mmol/L unbuffered KCl. Each section's impedance was measured for a 50-mV (rms) alternating potential difference applied over 1 Hz to 65 kHz. By means of complex non-linear least-squares regression analysis, the dc resistance of each specimen was determined. Scanning electron microscopy and subsequent image analysis enabled the cross-sectional area of the pores in the membrane and dentin tubule surface-openings to be measured. The results showed that the measured cross-sectional area of pores in the membrane was in good agreement with that calculated from the measured dc resistance and solution resistivity over the range of electrolyte concentrations. In dentin, the presence of smear layers on the cut surfaces increased the measured resistance. The resistance of the smear layer varied, suggesting that its thickness changed across the surface of the dentin. This was superimposed on regional variations in resistance of smear-free dentin which were found to be related to alterations in the number of tubules present and their cross-sectional area. The resistivities of the dentin tubule contents and smear layer material were generally lower than that of the hydrating electrolyte. It is postulated that this could be due to ions from partial dissolution of the mineral in the dentin.
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Pressure changes in the pulp chamber resulting from crown cementation have not been previously quantified. An experiment was designed to investigate the effect of smear layer removal on the peak pressure transmitted to the pulp chamber with crown cementation. Ten matched pairs of single-rooted premolar teeth were collected from adolescents and prepared for full-coverage crowns. The pulp tissue from each tooth was removed. One tooth from each pair had the smear layer removed with the application of 37% phosphoric acid for 30 s. The null hypothesis states that the removal of the dentinal smear layer will not change pressure in the pulp chamber resulting from the cementation. Before cementation, a hydrostatic head of pressure was used to perfuse the tooth, and the perfusion rate was recorded. Crowns were cemented with zinc phosphate cement with a seating force of 100 N. The mean peak pressures recorded were 85 Pa (SE 12 Pa) with the smear layer intact, and 194 Pa (SE 49 Pa) when the dentin was etched. The difference in the peak pressures transmitted to the pulp chamber with the two groups was significant (p < or = 0.05). A significant negative correlation was found between dentin thickness and the peak pressure transmitted to the pulp chamber (r = -0.5531, p < or = 0.01). We have shown that the pressure transmission to the pulp chamber during crown cementation can be measured. Since smear layer removal significantly influences the peak pressure, it is concluded that the pressure detected is at least partially dependent on the fluid flow through the dentin.
The diagnosis of root caries, in particular the judgment of the activity of a visually observed lesion, is difficult. Quantitative determination of lesion severity would allow the lesion to be monitored with time, so that an indication of lesion activity could be obtained. This paper describes a step in the development of a method that provides such a quantitative determination. Specifically, fluorescein sodium salt is used as a penetrating dye, the subject of study being the relationship between dye concentration and porosity in demineralized root dentin. Fourteen human third molars were demineralized in vitro (lactic acid CMC-gel, pH 5; in each of 6 groups for 4, 7, 11, 14, 18, and 21 days). Fluorescein sodium salt (0.2 g/L) was applied for 2 min. Thin slices (+/- 130 microns) were cut from the root surfaces without water cooling. The dye fluorescence radiance in the demineralized dentin was determined by means of a micro-Raman spectroscope and compared with the mineral loss profiles measured with transverse microradiography (TMR). The TMR data were corrected for the difference in measurement area between the two measurement systems. Corrected TMR profiles were compared with the corresponding fluorescence scans, showing linear correspondence. The correlation coefficient was r = 0.96. We conclude that, after uptake of fluorescein sodium salt for 2 min, the dye concentration in an artificially produced root-surface caries lesion is proportional to the amount of mineral lost from that lesion.
Laser irradiation alters the structure of dentin and produces surface layers that give the appearance of being more enamel-like. The laser-modified surface may be more resistant to demineralization; hence, many investigators are proposing continued development of the laser as a possible preventive treatment for caries. The purpose of this study was to explore the morphological changes that occur in dentin when treated at threshold illuminance with two clinically interesting laser wavelengths, and to evaluate the effectiveness of the laser-treated surface at resisting demineralization in an acid-gel solution. The Nd: YAG laser (wavelength 1060 nm) produced significant recrystallization and grain growth of the apatite, without the formation of second phases such as beta-tricalcium phosphate. This recrystallized surface layer showed resistance to demineralization; however, the layer did not provide protection of the underlying dentin from demineralization because of cracks and macroscopic voids that allowed for penetration of the demineralizing gel. The Ho: YAG laser-treated surface (wavelength 2100 nm) did not show significant evidence of recrystallization and grain growth, and only a trace amount of an acid-resistant layer was observed with demineralization. It is speculated that the Ho:YAG laser is coupling with absorbed water, and that the heat transfer from the water to the mineral phase is inefficient. For the purposes of creating a demineralization-resistant layer, threshold illuminance with both Nd: YAG and Ho: YAG was ineffective.
Previous studies using scanning electron microscopy and infrared absorption spectroscopy reported that laser irradiation causes compositional changes in enamel. The purpose of this study was to evaluate the ultrastructural and compositional changes in dentin caused by irradiation with a short-pulse laser (Q-switched Nd:YAG). The irradiated and non-irradiated areas of the lased dentin samples were investigated by scanning (SEM) and transmission electron microscopy (TEM), micro-micro electron diffraction, and electron microprobe analysis of dispersive energy (EDX). Heat-treated dentin was similarly investigated. This study demonstrated that laser irradiation resulted in the recrystallization of dentin apatite and in the formation of additional calcium phosphate phases consisting of magnesium-substituted beta-tricalcium phosphate, beta-TCMP, beta-(Ca,Mg)3(PO4)2, and tetracalcium phosphate, TetCP, Ca4(PO4)O. TEM analyses of the modified and unmodified zones of the irradiated areas showed two types of crystal populations: much larger crystals from the modified zone and crystals with size and morphology similar to those of dentin apatite in the unmodified zone. The morphology of crystals in the modified zones in the irradiated dentin resembled those of dentin sintered at 800 or 950 degrees C. In the irradiated areas (modified and unmodified zones), the Ca/P ratio was lower compared with that in the non-irradiated dentin. The Mg/Ca ratio in the modified zones was higher than that in the unmodified zones and in the non-irradiated dentin. In sintered dentin, the Mg/Ca ratio increased as a function of sintering temperature. The ultrastructural and compositional changes observed in laser-irradiated dentin may be attributed to high temperature and high pressure induced by microplasma during laser irradiation. These changes may alter the solubility of the irradiated dentin, making it less susceptible to acid dissolution or to the caries process.
The widespread use of resin and resin-monomers for bonding of dental restorations to dentin has occurred because of a fundamental shift in the view that injury to the pulp is induced by restorative procedures. While, for many years, the toxic effects of restorative materials were thought to be of crucial importance in the development of adverse pulpal responses, the key role of bacterial leakage at the restoration-tooth interface is now well-recognized. Consequently, if optimal conditions for the preservation of pulpal health are to be ensured, dental restorations should provide an impervious seal against the surrounding tooth structure. However, polymerization shrinkage and contraction stresses induced during setting, as well as a variety of technical difficulties encountered during the clinical operation, often produce less than perfect results. Therefore, modern restorative procedures involving resin and resin-bonded restoratives must still rely on the ability of the pulp to cope with the injurious elements to which it may be exposed during and after the procedure. This review examines factors that may govern the pulp's response to restorative procedures that involve adhesive technologies. An assessment is made of the risks involved as far as the continued vital function of the pulp is concerned. It is concluded that an intact, although thin, wall of primary dentin often enables the pulp to overcome both toxic material effects and the influences of bacterial leakage. In contrast, the pulp may not do equally well following capping of open exposures with resin composites. A dearth of controlled clinical studies in this area of dentistry calls for confirmation that pulpal health prevails over the long term following the use of total-etch and resin-bonding techniques.
Several studies have indicated differences in bond strength of dental materials to crown and root dentin. To investigate the potential differences in matrix properties between these locations, we analyzed upper root and crown dentin in human third molars for ultimate tensile strength and collagen biochemistry. In both locations, tensile strength tested perpendicular to the direction of dentinal tubules (undemineralized crown = 140.4 +/- 48.6/root = 95.9 +/- 26.1; demineralized crown = 16.6 +/- 6.3/root = 29.0 +/- 12.4) was greater than that tested parallel to the tubular direction (undemineralized crown = 73.1 +/- 21.2/root = 63.2 +/- 22.6; demineralized crown = 9.0 +/- 3.9/root = 16.2 +/- 8.0). The demineralized specimens showed significantly greater tensile strength in root than in crown. Although the collagen content was comparable in both locations, two major collagen cross-links, dehydrodihydroxylysinonorleucine/its ketoamine and pyridinoline, were significantly higher in the root (by ~ 30 and ~ 55%, respectively) when compared with those in the crown. These results indicate that the profile of collagen cross-linking varies as a function of anatomical location in dentin and that the difference may partly explain the site-specific tensile strength.
When glass ionomer cements were initially introduced, the pulpal responses were considered milder relative to other cements. However, the results mainly came from the application of glass ionomer cements as restorative materials. When ultimately tested with the basic laws of biocompatibility required of other cements, especially a luting agents, little difference has been shown. The judicious use of calcium hydroxide is highly recommended.
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BACKGROUND: The authors describe a new rotary polymer instrument that selectively removes infected dentin. This instrument has the potential to prepare selected cavities without the need for local anesthesia (LA). Patient acceptance has not been investigated in a clinical trial. METHODS: In this open-label clinical study, the authors enrolled 20 subjects with two Class I carious lesions and randomly assigned them to receive one restoration with the polymer instrument and no LA and the second restoration with a carbide bur and LA. Both procedures were completed in one appointment. Subjects completed dental history, dental anxiety and situational pain questionnaires. At specific points during the procedure, subjects rated their perception of the intensity of cold, heat, pain, pressure, vibration, fear and anxiety. On completion of the restorative procedures and at 48-hour and one-week telephone contacts, subjects indicated which procedure they preferred. RESULTS: During treatment with the polymer instrument, subjects indicated that they experienced slightly more pain, pressure, vibration and anxiety, but not more heat, cold or fear. Immediately after the procedure, 14 (70 percent) of 20 respondents (binomial test; P = .11) said that they would prefer having no LA and use of the polymer instrument for future dental work. The number of subjects indicating this preference increased to 15 (P < .05) at both the 48-hour and one-week contacts. One subject requested rescue LA during the polymer instrument treatment. CONCLUSIONS: A significant number of subjects preferred the rotary polymer instrumentation with no LA to the carbide bur instrumentation with LA. They held this preference despite experiencing slightly, but reliably, more pain and pressure when treated with the polymer instrument. CLINICAL IMPLICATIONS: A polymer (bur-like) rotary instrument with cutting ability limited to infected dentin can be used in Class I cavity preparations without the need for LA.
The purpose of this study was to evaluate the capacity of penetration of four endodontic sealers (Endo Fill, Sealapex, AH Plus and Pulp Canal Sealer) into dentinal tubules. Seventy-two extracted human maxillary anterior teeth were utilized in this study. The teeth were cleaned and shaped by means of the balanced-forces technique. The work length was established at 1 mm beyond the apex. Copious irrigation with 10 ml of 5.25% sodium hypochlorite was carried out. The teeth were divided in 8 groups - 4 had the smear layer maintained, and 4 had it removed. The smear layer was removed with a commercial solution of 17% EDTA, and the root canal system was flushed for 3 min. Finally, the roots were irrigated with 3 ml of 5.25% sodium hypochlorite. All teeth were sealed by means of the technique of the condensation wave with a medium nonstandardized cone. After filling, the roots were grooved, longitudinally split and examined under a scanning electron microscope (SEM). The focus of observation was the interface between the dentin and the sealing material. The Rickert sealer (Pulp Canal) presented the maximum penetration depths into the dentinal tubules, and Sealapex, the minimum. The Spearman test was used to determine whether there were significant differences between the groups. The removal of smear layer allowed significant penetration of the sealers (p <= 0.01).