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Diffusion behavior of eugenol from zinc oxide-eugenol mixtures through human and bovine dentin in vitro.

The objective of this in vitro study was to evaluate the long-term diffusion behavior of eugenol from different zinc oxide-eugenol mixtures through thin dentin layers. In 24 freshly extracted, caries-free human teeth standardized cavities were prepared exhibiting a dentin surface area of 7 mm2. The remaining thickness of the dentin close to the pulp chamber amounted to at least 0.2 mm. In a second experiment standardized dentin disks (0.2 mm thick) were prepared from 24 bovine incisors. The disks were embedded in epoxy resin, thus exposing a resin-free, standardized area of 7 mm2. Specimens from both experiments were inserted into a screw cap of a vial. Cp-Cap, Temp Bond, and two zinc oxide-eugenol mixtures (P/L ratios of 10:1 and 2:1) were applied to each of six specimens from both experiments. The opposing surface was in contact with 1 ml of Ringer solution. After 1 day, 7 days, and 21 days respectively, the amount of penetrated eugenol was determined with High-Performance Liquid Chromatography (HPLC). In both experiments we found a persistent release and diffusion of eugenol, irrespective of the applied material. However, for the second experiment, we saw more pronounced diffusion rates. Furthermore, the materials showed significant differences, particularly for low versus high P/L ratios.

Adolescent↗

Bond strength and interface micromorphology of an improved resin-modified glass ionomer cement.

PURPOSE: To evaluate the influence of surface treatment with 20% polyacrylic acid containing 3% aluminum chloride (AlCl3) on the shear bond strength of an improved resin-modified glass ionomer cement to enamel and dentin, and to analyze the micromorphology of the cement-tooth interface. MATERIALS AND METHODS: Flat enamel and dentin surfaces of bovine incisors were ground up with sequentially finer abrasives to 1000-grit silicon carbide paper. Each surface was treated with 10% polyacrylic acid (Dentin Conditioner: DC) for 20 seconds or with 20% polyacrylic acid containing 3% aluminum chloride (Cavity Conditioner: CC) for 10 seconds, rinsed, and gently air-dried. A resin-modified glass ionomer cement (Fuji II LC) and its improved version (Fuji II LC-I) were applied to the tooth substrate, and bond strengths measured at periods of 5 minutes, 1 day, and 1 week after light curing. As a control, the resin-modified glass ionomer cements were applied to untreated surfaces and were tested at 1 day. To evaluate the interface micromorphology, specimens were prepared following the adhesive-sandwich technique, cut in equal halves, and observed under a scanning electron microscope (SEM). Additionally, in order to observe the effect of surface pre-treatment of each conditioner on dentin, pre-treated dentin disks were freeze-dried, fractured, and the morphology of the treated and fractured surfaces were observed. RESULTS: Shear bond strength of CC+ Fuji II LC-I to enamel was significantly higher than that of DC+ Fuji II LC at 1 day and 1 week (P < 0.0001). As for dentin, the improved system showed significantly higher bond strength at 5 minutes after light curing (P < 0.001), but bond strengths were not statistically different at 1 day and 1 week. Fracture patterns, examined with a stereomicroscope, were mixed adhesive/cohesive within the cement for all groups. Interface micromorphology, observed with an SEM, suggested the formation of a resin-rich layer and an indistinct zone between the resin-modified glass ionomer cements and the underlying dentin.

Acid Etching, Dental↗

An SEM examination of etched dentin and the structure of the hybrid layer.

The clinical requirements of dentin bonds are that they should be non-permeable to oral fluids, seal dentinal tubules, protect the pulp, and be long lasting and durable. Dentin bonding systems that use acidic agents to remove the smear layer are currently being used. Acid conditioning not only removes the smear layer, but also demineralizes the surface of the intertubular dentin and produces intratubular demineralization and funnelling. A dentin bond is produced when hydrophillic resin monomers infiltrate the dentinal tubules and collagen of the demineralized intertubular zone, producing a hybrid layer. The use of a critical point drying technique and SEM allows a clear visualization of the structure of the hybrid layer. This study showed that currently used hydrophillic resin monomers are unable to completely infiltrate the demineralized zone, and it is speculated that this failure could contribute to microleakage and influence the long-term durability of the bond. It is also apparent that these bonds depend on the mechanical investment of collagen by the infiltrating monomer. Since none of the unfilled resins tested seem capable of completely infiltrating the demineralized collagenous zone, the degree of demineralization produced by the commercial acid concentrations in current use is questioned. More dilute acids than those available commercially are shown to reduce both the degree and depth of demineralization, and we suggest that the resultant thinner layer may lend itself to more complete resin infiltration of the collagen.

Acid Etching, Dental↗

[Should the dentin smear layer be preserved or eliminated? (Review of the literature)].

The smear layer is a direct consequence of instrumentation of the root canal wall. Hand instrumentation as well as ultrasonic instrumentation produce a smear layer on the canal wall. This smear layer is composed of dentine, remnants of pulp tissue and odontoblastic processes and bacteria in an infected canal. Removal of the smear layer is accomplished by the irrigation of root canals with EDTA (17%) followed by NaOCl (5.25%). Permeability of the dentine is increased by the removal of smear layer. In this way the bacteria within the infected tubuli can be more easily destroyed by an intracanal dressing. Whether the removal of smear layer decreases the apical leakage is uncertain. To establish the clinical consequences from removal or preservation of the smear layer, further research is needed.

Bacteria↗

The diameter of dentinal tubules in human coronal dentine after demineralization and air drying. A combined light microscopy and SEM study.

The diameter of dentinal tubules after demineralization and/or air drying has been quantified using light microscopy and scanning electron microscopy (SEM). The tubule diameter was assessed at a distance of about 1.5 mm (range 1.0-2.0 mm) from the pulp. Tubule diameter was measured in the wet state, after 10-min and 12-hour air drying as well as after critical point drying (CO2) by SEM. The results show that drying effects on tubule diameter are small in sound tissue, but are sizeable in demineralized dentine. Comparing light microscopic (wet) and SEM observations show that the differences in tubule diameter are small for sound but substantial for demineralized dentine. An important result is that in the wet state the diameters of the tubules (being 1.3 +/- 0.2 microns in sound dentine) are 2.5 +/- 0.3, 2.2 +/- 0.3 and 1.7 +/- 0.2 microns after 1, 2 and 3 weeks of demineralization, respectively. The decreased tubule diameter with increasing demineralization may be important for permeability and transport phenomena in dentine caries and presumably in hypersensitivity.

Adolescent↗

Pulp-dentin biology in restorative dentistry. Part 4: Dental caries--characteristics of lesions and pulpal reactions.

The infectious disease dental caries results in lesions that may affect enamel, dentin, pulp, and cementum. If a caries lesion has progressed to the stage at which it requires restorative intervention, it is important that the clinician understand the tissue changes in the dentin that are likely to have taken place during lesion development. Until the present, no major distinction between the restorative treatment of active (rapidly progressing) and arrested (slowly progressing) lesions has been made, despite the fact that the two conditions exhibit major differences in tissue changes in the pulp-dentin complex. Intratubular changes and tertiary dentin formation will affect the outcome of the restorative treatment. In unaffected dentin and in rapidly progressing lesions, permeable tubules persist, and when the preparation of carious teeth results in the opening of unaffected dentin, greater care must be taken in all phases of the restorative procedures than if the dentin is impermeable. An active, deep lesion can be changed to an arrested lesion by a two-step excavation approach. Optimal assessment of the prevailing clinical conditions can only be made on the basis of thorough knowledge of the biology of the pulp-dentin organ.

Dental Caries↗

Novel priming and crosslinking systems for use with isocyanatomethacrylate dental adhesives.

OBJECTIVES: (a) to design, formulate and evaluate prototype primers and a crosslinking agent for use with isocyanatomethacrylate-based comonomer adhesives and (b) to establish correlations between bond strength and solubility parameter differences between the adhesives and etched dentin, and the permeability coefficients of the adhesives. METHODS: Equimolar mixtures of 2-isocyanatoethyl methacrylate (IEM) and a methacrylate comonomer were formulated with tri-n-butyl borane oxide (TBBO) as the free radical initiator to have cure times of 6-10 min. Shear bond strengths to dentin were determined for each adhesive mixture (n = 7) using standard testing protocols. Shear bond strengths for the three systems were also determined after application of "reactive primers" to the dentin surface. The "reactive primers" contained 10-20 parts by weight of the respective comonomer mixture and 3.5 parts by weight TBBO in acetone. Solubility parameters difference values (delta delta) and permeability coefficients (P) were approximated for each adhesive system and correlated with shear bond strength values. Additionally, a crosslinking agent was prepared by bulk reaction of an equimolar mixture containing IEM and a methacrylate comonomer. The effects of crosslinker addition on: (a) the setting time of IEM; and (b) the setting times and initiator requirements of selected IEM/comonomer mixtures were determined. RESULTS: Shear bond strength values (MPa): IEM/HEMA 13.6 +/- 2.0 (no primer), 20.1 +/- 2.0 (with primer); IEM/HETMA 9.3 +/- 3.3 (no primer), 20.8 +/- 8.1 (with primer); IEM/AAEMA 13.6 +/- 1.9 (no primer), 17.3 +/- 3.2 (with primer). Also, approximated permeability coefficients showed a significant correlation (r = +0.867, p < 0.001) with shear bond strength values. Crosslinker addition studies with IEM/4-META: (a) at 5-9 mol% reduced the setting time of IEM polymerization by 79%; and (b) at 6 mol% reduced initiator level requirements 60-70% to achieve a comparable setting time, and decreased setting times by ca. 75% for a given initiator level with selected IEM/methacrylate adhesive systems. SIGNIFICANCE: The shear bond strengths of isocyanatomethacrylate-based dental adhesives can be enhanced by using reactive primers; their setting times and initiator requirements can be improved using a dimethacrylate crosslinker. Approximated permeability coefficients may be useful as indicators of bonding performance for dentin adhesive systems.

Adhesives↗

Permeability of the root canal wall and occlusion of dentinal tubules by Ag(NH3)2F: a comparison of combined use with pulsed Nd:YAG laser or iontophoresis.

OBJECTIVE: We used SEM-EDX and the Vickers hardness test to compare the penetration and hardness of silver resulting from use of either (i) pulsed Nd:YAG laser or (ii) iontophoresis, after root canal wall shaping using the standard method of coating with 38% Ag(NH3)2F solution. SUMMARY BACKGROUND DATA: There have not been any reports of penetration and hardness following the application of Ag(NH3)2F solution together with laser or iontophoresis. METHODS: We used 21 extracted human single-rooted teeth randomly divided into three groups. Group 1 was coated with Ag(NH3)2F, Group 2 was irradiated with a Nd:YAG laser after coating with Ag(NH3)2F solution, and Group 3 was iontophoresised after coating. Then we observed the permeability of silver through the root canal wall using SEM-EDX. RESULTS: The results show that iontophoresis after coating with Ag(NH3)2F solution (Group 3) resulted in the greatest and deepest penetration of silver into the root canal wall. There was no significant difference between teeth in Groups 1 and 2. For the hardness test, the 21 teeth were tested using SEM-EDX test, 7 untreated teeth were used as a control. The results show that Group 2 (laser treatment) teeth were the hardest. CONCLUSION: We therefore propose that root canals should be treated using irradiation with an Nd:YAG laser that has been coated with Ag(NH3)2F solution and that this method provides better results than either iontophoresis after coating, or coating alone.

Combined Modality Therapy↗

Morphological features of dentine and pulp related to dentine sensitivity.

This review considers those structural features of the pulp and dentine relevant to an understanding of dentine sensitivity. It does not discuss innervation, or microvasculature, which are covered in other contributions. The sensitivity of dentine is directly related to the size and patency of the dentinal tubules. Tubular occlusion by peritubular dentine deposition or the formation of other intratubular material would reduce the flow of fluid and diffusion of molecules through dentine. Irregular (reparative) secondary dentine would, because its tubules are not continuous with those of primary dentine, be expected to reduce permeability and fluid flow and decrease sensitivity. Regular secondary dentine would have little or no effect other than by increasing diffusion distances. The odontoblast layer is of limited permeability and could restrict the access of materials diffusing through the dentinal tubules to pulpal axons. Odontoblasts are not involved in the sensory process as special sensory receptors but may, by modifying the local ionic environment, alter the threshold of intradentinal nerves.

Animals↗

Sterilization of teeth by gamma radiation.

Clinical simulations and restorative materials research and development conducted in vitro require the use of large numbers of extracted teeth. The simultaneous need for infection control procedures and minimal alterations of structure and properties of the tissue prompted this study of gamma irradiation as a method to eliminate microbes associated with extracted teeth and their storage solutions. Evaluations of potential change in structure of dentin were conducted in terms of permeability, Fourier transform infrared spectroscopy (FTIR), and optical properties. The dose required for sterilization by gamma irradiation was established by means of a tooth model inoculated with Bacillus subtilis (10(8) organisms/mL). Sterilization occurred at a dose above 173 krad with use of a Cesium (Cs137) radiation source. Gamma irradiation did not affect permeability of crown segments of dentin. A comparative evaluation of the effects of four sterilization methods on dentin disks was based on FTIR and ultraviolet-visible-near infrared (UV/VIS/NIR) spectra before and after sterilization by (1) gamma irradiation; (2) ethylene oxide; (3) dry heat; and (4) autoclaving. No detectable changes were found with gamma irradiation, but all other methods introduced some detectable change in the spectra. This suggests that common methods of sterilization alter the structure of the dentin, but gamma irradiation shows promise as a method which both is effective and introduces no detectable changes as measured by FTIR, UV/VIS/NIR, or permeability.

Bacteria↗

Effect of pH modified EDTA solution to the properties of dentin.

The purpose of this study was to evaluate the influence of smear layer removal with 3% EDTA solution (pH of 9.0) on the dentin in terms of the permeability of root canal disinfectants into the dentin, wetting by endodontic sealer, and adhesive strength of the sealer. Three types of disinfectant (formalin cresol, phenol, and calcium hydroxide) and 4 types of endodontic sealers (included eugenol, non-eugenol, polycarboxylic acid, and resin) were used. The contact angle between endodontic sealer solution and dentin decreased in the 3% EDTA group but increased in the 15% EDTA. The adhesive strength of endodontic sealer to dentin increased in the EDTA groups for all types of sealers. The permeability of root canal disinfectants increased to similar degrees in the 3% and the 15% EDTA groups. In comparing these properties, we propose that the 3% EDTA is more useful for clinical applications.

Adhesiveness↗

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↗

Polymerization kinetics of dental adhesives cured with LED: correlation between extent of conversion and permeability.

OBJECTIVES: The aim of this study was to analyze the polymerization kinetics of different adhesive films in relation to their permeability after exposure to different LED curing units. METHODS: One adhesive from each class was analyzed: a three-step etch-and-rinse (OptiBond FL; Sybron-Kerr), a two-step etch-and-rinse (One-Step, Bisco), a two-step self-etch (Clearfil Protect Bond, Kuraray) and a one-step self-etch adhesive (Xeno III; Dentsply DeTrey). Adhesive films were prepared and cured with SmartLite IQ (Dentsply) or L.E. Demetron I (Demetron Kerr) up to complete curing. Polymerization kinetic curves of the tested adhesives were obtained with differential scanning calorimetry (DSC). In particular, total reaction time and extent of polymerization (Ep) at 20, 40 or 60s were compared. Permeability of the adhesive films was evaluated on flat dentin surfaces of human extracted teeth connected to a permeability device and statistically analyzed. RESULTS: Total reaction time differed among the adhesives tested: OptiBond FL<Clearfil Protect Bond<One-Step<Xeno III with both curing units (p<0.05). At 20s OptiBond FL showed the highest Ep, while the lowest values were obtained with One-Step and Xeno III (p<0.05). E(p) increased when curing time was prolonged (40 and 60s) for all adhesives tested (p<0.05), however, on simplified adhesives, incomplete polymerization took place even after prolonged exposure intervals. An inverse correlation was found between Ep of the adhesives and their permeability using LED curing units. SIGNIFICANCE: This study supports the hypothesis that, longer curing times than those recommended by the respective manufacturer decrease permeability of the bonded interfaces.

Adhesives↗

In vitro evaporative vs. convective water flux across human dentin before and after conditioning and placement of glass-ionomer cements.

PURPOSE: To assess the convective and evaporative fluid movement across glass-ionomer treated dentin. METHODS: Crown segments made from extracted human teeth, were divided into two groups of 14 teeth each. Each segment was cemented onto a plexiglass slab penetrated by a stainless steel tube, permitting filling of the pulp chamber with water. This set-up was attached to a device that measured fluid movement through the dentin in the crown segment. The experimental design involved repeated measurements of convective and evaporative fluid movements in each of the following conditions: smear layer-covered dentin, conditioned dentin, dentin after placement of one of two glass-ionomers (Fuji IX or Ketac-Molar), with and without a protective coating. The same water fluxes were remeasured after storage of the samples for 24 hours in distilled water. RESULTS: Statistical analysis of the results using ANOVA indicated a significant difference between the two measured water fluxes (P < 0.001). There was also a significant difference between the two materials (P < 0.001), with Ketac-Molar allowing higher permeability than Fuji IX. Conditioning the dentin surface with polyacrylic acid increased the convective water flux (P < 0.05) but did not change the evaporative water flux. Placement of the glass-ionomer material did not change the rate of spontaneous evaporation of water from the dentin, but the application of a coating agent reduced the evaporative water loss. These values were not significantly different when the specimens were stored for 24 hours.

Acrylic Resins↗

Relationship between water status in dentin and interfacial morphology in all-in-one adhesives.

OBJECTIVES: All-in-one adhesive systems have been recently developed to simplify bonding procedures. The adhesives containing acidic resin monomers generate a relatively thin bonding zone between dentin and composite. This zone may be left acidic and permeable when polymerization is poor. In this study, the effect of water contained in dentin on the quality of the bonding interface was morphologically investigated for all-in-one adhesives. METHODS: Intact coronal dentin (hydrated dentin), desiccated coronal dentin (dehydrated dentin), caries-affected dentin (CAD) and resin composites were used for adherends to assess the effects of water contained in dentin on the ultra-structures of bonding interfaces created with two all-in-one adhesives and a resin composite. RESULTS: The bonding interfaces were observed under TEM without demineralization. Voids of various sizes were found at the bottom of the adhesive resin layers along the bonding interface of hydrated dentin, while dehydrated dentin, CAD and resin composites did not generate voids. The results showed that the voids were possibly formed by water that had penetrated from the underlying dentin. CONCLUSION: When the adherend contains little water, the formation of voids will not occur. It was verified that a phenomenon of void formation would not occur in a clinical situation in which caries-affected dentin is mainly subjected to adhesive practices.

Acids↗

[Biophsical study of dental tissues under the effect of a local strontium application].

Microradiographic and electronmicroscopic observations show that topical application of concentrated strontium chloride solution on an abraded dentinal surface caused the formation in the dentine of very compact superficial layer composed of fine granules and with a high degree of radiodensity. This layer not only forms a continuous deposit on the superficial zone, but also penetrates and fills the canclicules to a certain distance. A barrier is thus created, diminishing the permeability of the dentine, which would explain the desensitization of the tooth. Electron probe microanalysis and X-ray diffraction studies show that the fundamental mechanism of the formation of strontium deposits is an exchange with the calcium fo the dentinal tissue, and recrystallization in the form of strontium apatite.

Dental Enamel↗

Effects of Nd: and Ho:yttrium-aluminium-garnet lasers on human dentine fluid flow and dental pulp-chamber temperature in vitro.

Dentine specimens were prepared from freshly extracted third molars and initial permeability measured. Each specimen was subjected to Nd:yttrium-aluminium-garnet (YAG) (1.06 or 1.32 microns wavelength) or Ho:YAG (2.10 microns wavelength) laser energy while temperatures in the pulp chambers were recorded. Permeability was again measured and the surfaces examined by scanning electron microscopy. Six crown segments were used for each laser variable and eight permeability measurements were taken before and eight after laser exposure, while temperature was recorded during treatment. All wavelengths reduced permeability but temperature rises were high enough to have caused pulpal damage, indicating that shorter treatment times and lower power settings may be necessary if used in vivo.

Aluminum Silicates↗