Journal of Dental Medicine

Statement of Problem: Porcelain restorations are susceptible to fracture and a common method for repairing is the use of silane and composite on etched porcelain. Although HF is very effective in porcelain etching but has detrimental effects on tissues.

Purpose: In this study, the effect of APF and PHA was compared with HF in porcelain etching. Also the role of silane, unfilled resin and dentin bonding in bond strength of composite- porcelain was evaluated.

Methods and Materials: In this experimental in-vitro study, one-hundred twenty porcelain square blocks (552 mm) were prepared and bonding surfaces of each sandblasted. Samples were divided into three groups. The first group (n=40) were etched with buffered HF 9.5% (Ultradent) for 1 min., the second group (n=40) were etched with Iranian APF 1.23% (Kimia) for 10 minutes and the third group (n=40) were etched with Iranian PHA 37% (Kimia) for 1 min. Ultradent silane was applied on the surfaces of half of cases in each group. On the surfaces of half of silane-treated samples unfilled resin was applied and dentin bonding was used on the surfaces of the remaining. Samples without silane were treated in a similar manner. Composite cylinder with 4mm diameter and 2 mm height was bonded to porcelain. Specimens were stored in 37°C distilled water for 24 hours and subjected to 500 cycles. Shear bond strength was measured with an Instron machine and type of fracture was evaluated using a stereomicroscope. Results were analyzed using 3 way ANOVA, Kaplan- Maier and Tukey HSD tests.

Results: Findings showed that PHA and APF roughened the porcelain surface without creating retentive micro undercuts but HF etches porcelain and creates retentive microundercuts. Ultradent silane had no significant effect on bond strength of porcelain- composite. Unfilled resin with Ultradent silane compared with dentin bonding with the same silane is more effective in bond strength of composite- porcelain.

Conclusion: Based on present study, application of Ultradent silane on sandblasted and etched porcelain with PHA or APF cannot be used as an alternative to this silane on sandblasted and etched porcelain with HF.

Background and Aim: Insufficient polymerization of resin cements is of considerable clinical importance, because of mechanical deficiencies and biological side effects of uncured resin. Dual cure resin cements are getting popular in luting tooth colored posts and although their curing is claimed to proceed chemically, polymerization efficiency in deep areas of canal is uncertain. The aim of this study was to evaluate degree of polymerization of dual-cure resin cements used for luting translucent and opaque fiber posts in different distances from the light tip.

Materials and Methods: In this experimental in vitro study, degree of conversion of two dual cured resin cements, Rely X ARC (3M, ESPE) and Nexus 2 (Kerr, USA) were measured when used with DT-Light and DT-White posts (RTD, France). The light curing unit used was Optilux 501, with output of 650-700 mw/cm2 with emitting time of 60 seconds. Degree of conversion was measured in three different depths (4, 6, 8 mm) by FTIR. The data were analyzed using ANOVA and Post hoc tests. P<0.05 was considered as the level of significance.

Results: DC% of Rely X with either of the posts was not significantly different in the studied depths (P>0.05). Nexus used with DT-Light had lower DC% in 8 mm depth (P<0.05). Nexus used with DT-White showed lower DC% in 8 mm depth compared to 4 mm depth. The control groups of both cements showed significant increased DC% in 4 mm depth compared to 6 and 8 mm depths (P<0.05). DT-White caused decreased DC% in both cements in 4 mm. DT-Light caused increased DC% of Rely X in 6 mm depth compared to DT-White and control. DT-Light increased DC% of Nexus in 6 and 8 mm depths, compared to DT-White and control groups.

Conclusion: Based on the results of this study, application of translucent fiber posts has a significant effect on degree of polymerization in dual-cure resin cements, compared to opaque types. Their better light transmission to deep areas due to the effect of optical fibers, can lead to better results.

Background and Aim: All ceramic, inlay-retained resin bonded fixed partial denture is a conservative method for replacement of missing teeth, because of minimal tooth reduction. The connector between the retainer and the pontic is the weak point of these bridges. Reinforcement of ceramic core will increase the clinical longevity. The aim of this study was to determine the effect of zirconia on flexural strength of IPS Empress 2 core ceramic.

Materials and Methods: In this experimental in vitro study, twenty eight bar shape specimens (17´3.1´3.1 mm) were made of four different materials: (1) Slip casting in-ceram alumina core (control group) (2) Hot-pressed lithium disilicate core ceramic (IPS Empress 2) (3) IPS Empress 2 with cosmopost (zirconia post) inserted longitudinally in the center of the bar (4) IPS Empress 2 with cosmopost (zirconia post) inserted longitudinally in bottom of the bar. Specimens were subjected to three-point flexure loading with the span of 15mm, at a cross-head speed of 0.5 mm/min. Failure loads were recorded and analyzed using one-way ANOVA and Tomhane Post-hoc tests and p<0.05 was set as the level of significance. Fractured surfaces were then observed by scanning electron microscope (SEM). Four additional samples were made as the third group, and zirconia-IPS interface was observed by SEM before fracture.

Results: Mean values and standard deviations of three point flexural strengths of groups 1 to 4, were: 378.4±44.6, 258.6±27.5, 144.3±51.7, 230±22.3 MPa respectively. All the groups were statistically different from each other (P<0.05), except groups 2 and 4. The flexural strengths of groups 2, 3, 4 were significantly lower than group 1. Group 3 had the lowest flexural strength. SEM analysis showed that the initiated cracks propagated in the interface of zirconia post and IPS Empress 2 ceramic.

Background and Aim: The efficiency of disinfecting materials and procedures in removal of contamination from dental surfaces and equipments is essential. In authors' previous study, daily use of 2:100 dilution of 5% sodium hypochlorite in water and disposable covers were recommended since HBV contamination was found on semi-critical parts of the operative dentistry department. The aim of this study was to evaluate the HBV contamination following application of the recommended procedures.

Materials and Methods: The study was conducted in two parts. In the first cross-sectional part, samples were collected from 17 sites of dental surfaces. In the second interventional part samples were collected from 10 sites of 9 dental and 3 sites of 2 light cure units, before and after disinfection with 5% sodium hypochlorite solution diluted to 2:100. Sterile cotton swabs moistened with sterile BSAS (Bovine Serum Albumin in Sodium Chloride) solution were used for sampling. Samples were tested by PCR technique in Pasteur Institute, Iran.

Results: None of the samples collected in the first part of the study showed contamination. In the second part of the study, from 96 samples taken from various parts of dental and light cure units, before and after disinfection, there was only one HBV contaminated site before disinfection which showed no contamination after disinfection.

Conclusion: Based on the results of this study, disinfecting procedure with 5% sodium hypochlorite solution diluted to 2:100 along with using disposable covers is effective in preventing HBV contamination.

Background and Aim: Because of polymerization shrinkage and high viscosity of posterior composites, there are some difficulties in using them in posterior restorations. Several methods have been represented to reduce the effect of shrinkage. The aim of this study was to investigate the effect of curing flowable composites under condensable ones in adaptation and microleakage reduction of posterior composite restorations.

Materials and Methods: In this experimental in vitro study, forty class II MO cavities were prepared on extracted intact molar and premolar human teeth. Gingival margins were placed 1 mm apical to CEJ. The teeth were divided into two groups. In group 1, flowable composite (Filek Flow, 3M, ESPE, USA) with 0.5-1 mm thickness was applied and cured following application of bonding agent (Single Bond, 3M, ESPE, USA). The rest of the cavity was filled by condensable composite (p60, 3M, ESPE, USA). In group 2 the flowable composite was not cured, and the condensable composite was applied in two increments. After light curing of composites, all the specimens were thermocycled and then immersed in 0.3% basic fuschin. Specimens were sectioned and evaluated for degree of dye penetration under a stereomicroscope. Data were analyzed by Mann-Whitney test with p<0.05 as the level of significance.

Results:. There was no significant difference between the two studied groups regarding microleakage.

Conclusion: Based on the results of this study, neither cured nor uncured flowable composite under condensable composite can omit microleakage in posterior composite restorations.

Background and Aim: Amalgam is one of the mostly used restorative materials, but has some disadvantages. Microleakage is one of the short comings of amalgam which may lead to sensitivity and recurrent caries. The aim of this study was to evaluate the effect of three dentin bonding systems on reduction of microleakage in amalgam restorations.

Materials and Methods: Class II amalgam restorations were made in 40 noncarious molar and premolar teeth. Then the specimens were divided into four equal groups. Scotch Bond Multi Purpose, Single bond,
iBond, were used as liner in groups one to three respectively and in group four no liner was used. The teeth were restored with high copper spherical amalgam. After thermocycling for 500 cycles at 5⁰C and 55⁰C, the specimens were immersed in basic fuchsin for 24 hours, bisectioned mesiodistally and evaluated under stereomicroscope at X25 for dye penetration. The data were analyzed by Kruskal-wallis and Scheffe. P<0.05 was considered as the level of significance.

Results: The groups showed significant difference (p=0.003). The group four had significantly less microleakage than the first and second groups (p<0.05). The second and third groups showed significantly different microleakage (p=0.038).

Conclusion: Based on the results of this investigation applying dentin bonding agents has no effect on reducing microleakage in amalgam restorations, however more studies are recommended.

Background and Aim: Various studies have shown that reliable bond at the root - post - core interfaces are critical for the clinical success of post - retained restorations. Severe stress concentration at post - cement interface increases post debonding from the root. To form a bonded unit that reduces the risk of fracture, it is important to optimize the adhesion. Therefore, some post surface treatments have been proposed. The purpose of this study was to investigate the influence of various surface treatments of tooth - colored posts on the bonding of resin cement.

Materials and Methods: In this interventional study, 144 tooth colored posts were used in 18 groups (8 samples in each group). The posts included quartz fiber (Matchpost), glass fiber (Glassix), and zirconia ceramic (Cosmopost) and the resin cement was Panavia F 2.0. The posts received the following surface treatments: 1- No surface treatment (control group), 2- Etching with HF and silane, 3- Sandblasting with Cojet sand, 4- Sandblasting with Cojet sand and application of silane, 5- Sandblasting with alumina particles, 6- Sandblasting with alumina particles and application of silane. Then, posts were cemented into acrylic molds with Panavia F 2.0 resin cement. The specimens were placed in water for 2 days and debonded in pull - out test. Statistical analysis was performed using ANOVA followed by Tamhane and Tukey HSD. Failure modes were observed under a stereomicroscope (10 ). P<0.05 was considered as the significant level.

Results: Surface treatments (sandblasting with Cojet and alumina particles ,with or without silane) resulted in improved bond strength of resin cement to glass fiber post (Glassix) and zirconia ceramic (Cosmopost) [p<0/05], but not to the quartz fiber post (Matchpost). In general, higher bond strengths resulted in a to higher percentage of cohesive failures within the cement.

Conclusion: Based on the results of this study, sandblasting with cojet and alumina particles increases bond strength of resin cement to glass fiber post (Glassix) and zirconia ceramic (Cosmopost).Generally, the bond strength of resin cement to the posts is affected by the post's composition and surface treatment.

Background and Aim: Nonmetallic tooth- colored posts adhere to canal walls by dentin bonding agents and resin cements. Better retention and proper distribution of stress result from enough and proper bonding. The purpose of this study was to evaluate bond strength of D.T. Light - post with two different resin cements (self-cure & dual-cure) and to investigate the effect of irrigating solutions applied in root canal on bond strength of the resin cements and D.T.Light- post to root canal wall.

Materials and Methods: In this experimental study 40 single root teeth (maxillary canine & central) were selected and stored in 0.1% thymol solution for one week and transferred to distilled water. The teeth were decoronated 2mm above CEJ. The canal space was mechanically enlarged using k-files (up to # 70). The teeth were randomly divided into two groups. The first group was irrigated with 2.6% NaOCl, and the second was irrigated with normal saline. After drying, the teeth were filled with gutta percha cones using lateral condensing method. After two weeks the post space was prepared and D.T.Light- post was inserted in each subgroup using self or dual-cure cements according to manufacturer's instructions. After thermocycling, the apical part was cut 1cm below CEJ. The remained length was divided into 9 equal sequential sections. Each section was submitted to shear push-out test in universal testing machine. Statistical analysis of the bond strength data was performed using ANOVA and post hoc tests with p<0.05 as the level of significance. All failed specimens were examined under stereomicroscope. Degrees of conversion of the cements were determined by FTIR.

Results: Significant difference in bond strength values were found among sites (P=0.001) and cements (P=0.03). With increasing in depth, bond strength decreased. The mean bond strength value in dual-cure resin cement was higher than self-cure cement. The irrigating solutions caused no significant difference in bond strength (P=0.46). DC% had significant difference in various depths.

Conclusion: According to the results of this investigation, bond strength of dual-cure cement is higher than self-cure one in D.T Light- post because of post's translucency. 2.6% sodium hypochlorite does not affect the bond strength.

Background and Aim: The microbial cause of dental caries has been proved among its multifactorial etiologies. The prevention and control of dental caries is very critical because of high prevalence and cost especially in high risk patient such as xerostomia. Based on the world attraction to traditional treatment and importance of drug extraction of natural materials and plants, in this in vitro study effect of hydroalcoholic extract of Salvia officinalis and Pimpinella anisum which were very useful in traditional treatment of mouth and teeth disease has been determined against cariogenic bacteria.

Materials and Methods: In this experimental study, hydroalcoholic extracts have been prepared from Salvia officinalis and Pimpinella anisum with maceration method. Their antibacterial activity against Streptococcus mutans, Lactobacillus rhamnosus and Actinomyces viscosus have been evaluated with broth macrodilution method. Data were analyzed with Mann-Whitney test.

Results: Minimum Inhibitory Concentration for Salvia officinalis and Pimpinella anisum for streptococcus mutans were respectively 6.25 and 12.5 µg/ml, for Lactobacillus rhamnosus were 1.56 and 12.5 µg/ml and for Actinomyces viscosus were 12.5 and 50 µg/ml.

Conclusion:Both extracts had growth inhibitory effect on all three bacteria. Salvia officinalis had significantly greater effect on inhibition of growth of all three bacteria. Both extracts had bactericidal effect in the range of concentration.

Background and Aim: Decreasing the hardness of dental restorative composites after curing in oral environment can influence their clinical durability. The aim of this study was to evaluate the effect of food-simulating liquids such as 25%, 50%, 75 % ethanol and 50 % heptane on surface hardness of two composites - (Gradia and P60) after curing and immersing time of 24 hours and 7 days.
Materials and Methods: 45 specimens of each composite were prepared in a stainless steel mold with 6 mm diameter and 2 mm depth. 5 specimens of each composite were tested for microhardness immediately after curing as the control group. The other specimens of each composite were randomly divided into eight groups. Each specimen was immersed in one of the following solutions 25%, 50%, 75 % ethanol and 50 % heptane for either 24 hours or 7 days. Then the specimens were taken out of the solutions and washed and dried and transferred to the refrigerator until performing the test. In standard conditions, surface microhardness of specimens was evaluated by the microhardness device based on Vickers. The data were analyzed by one way ANOVA 3 way ANOVA and Tukey Post Hoc tests. The level of significance was set at p<0.05.
Results: Surface hardness of P60 composite was higher than that of Gradia. An analysis of variance in gradia and p60 showed significant difference between the control and all the other groups (P<0.05) except the 25% ethanol (P=0.514). After 24 hours all the solutions had significant effect on Gradia (P<0.05) except 50% and 75% ethanol (P=0.793). After 7 days all the solutions had significant effect on Gradia except 50% and 25% ethanol (P=0.385)and 50% and 75% ethanol (P=0.150) According to P60 after both 24 hours and 7 days all the solutions had significant effect on the hardness. 50 % heptane increased the hardness (P=0.00). 75% ethanol significantly decreased the hardness (P=0.000) followed by 50% (P=0.001) and 25% ethanol (P=0.007).
Conclusion: Based on the results of this study, the effect of time was not significant. P60 showed to be more resistant. 75% ethanol had much more effect followed by 50% and 25% ethanol. Heptane increased the mean surface hardness.

Background and Aims: In spite of the advances achieved in the field of dentin adhesives, the longevity of bond to dentin is still a challenge. According to recent studies, Matrix Metaloproteinase (MMP) inhibitors can increase clinical longevity of bonding and decrease leakage. The aim of this study was to evaluate the amount and pattern of doxycycline release from an experimental dentin adhesive containing this MMP inhibitor.

Materials and Methods: In this experimental study, specimens containing 0.25 and 0.5 loading percent of doxycycline in an experimental monomer were prepared in cylindrical moulds of 12 mm diameter and 2 mm thickness. The adhesive monomer was composed of 12 wt% Bis-GMA, 10 wt% TMPTMA, 28 wt% HEMA and 50 wt% ethanol. Camphorquinone and amine were used as initiators.

Results: Addition of 0.25 and 0.5 w% doxycycline showed linear release in both groups. Increasing the loading percent of doxycycline caused more release. The release continued during the test period.

Conclusion: Doxycycline release was observed from the experimental adhesive. Further studies in this field will help in preparing adhesive systems with more clinical longevity.

Background and Aims: Marginal seal in class V cavities and determining the best restorative material to decrease microleakage is of great importance in operative dentistry. The aim of this study was to evaluate the effect of polishing time on the microleakage of three types of tooth-colored restorative materials in class V cavity preparations and to assess the marginal integrity of these materials using scanning electron microscope (SEM).
Materials and Methods: In this in vitro study, class V cavity preparations were made on the buccal and lingual surfaces of 30 bovine incisors (60 cavities). The specimens were divided into three groups each containing 10 teeth (20 cavities): group 1, Filtek Z350 (nanocomposite) group 2, Fuji IX/G Coat Plus (CGIC) and group 3, Fuji II LC (RMGI). In each group, half of the specimens (n = 20) were finished/polished immediately and the rest of them were finished/polished after 24 hours. All the specimens were thermocycled for 2000 cycles (5-50 °C). Epoxy resin replicas of 12 specimens (2 restorations in each subgroup) were evaluated using SEM and the interfacial gaps were measured. Finally, the teeth were immersed in 0.5% basic fuchsin dye for 24 hours at room temperature, sectioned and observed under stereomicroscope. The data were analyzed using Kruskal-Wallis and Mann-Whitney U tests and the comparison between incisal and cervical microleakage was made with Wilcoxon test.
Results: Incisal and cervical microleakage were not affected by polishing time in none of the three restorative materials (P>0.05). Cervical microleakage only in Fuji IX with immediate polishing was significantly higher than incisal microleakage (P<0.05). Incisal and cervical microleakage with immediate or delayed polishing were not significantly different in Fuji IX, Fuji II LC, and Z350 (P>0.05).
Conclusion: Immediate polishing is recommended in tooth-colored class V restorations.

Background and Aims: There is concern that leached components from dental composites may cause adverse changes in the reproductive health. This study aimed to assess the effects of leached components from a hybrid resin composite on the reproductive system of male mice.
Materials and Methods: In the present animal study, twenty adult Syrian male mice were divided into two groups of 10 mice each. In the test group, components which leached from samples made from Filtek Z250 resin composite into 75% ethanol were daily administered to the mice for 28 days. In the control group, the procedure was repeated in the same way as the test group but without placing composite samples in the solution. Then, the body weight, weights of paired testes, Gonado Somatic Index, sperm viability, sperm motility, epididymal sperm reserve and daily sperm production were recorded. Four male mice in each group were mated with untreated female mice for 10 days. After that, the number of pregnant females and number of infants were recorded. The data were analyzed using repeated measures ANOVA, Chi-square test and t-test.
Results: There was a significant reduction in the sperm viability and sperm motility of male mice in the test group compared to the control group (P=0.001). There was no any significant differences in other parameters between two groups (P>0.05).
Conclusion: This study showed that the leached components from resin composites cannot cause infertility but they could potentially cause some adverse effects on the reproductive system of male mice.

Background and Aims: To evaluate the effect of polishing on surface roughness of silorane-based composite using profilometery and Scanning Election Microscopy (SEM) and compare it with that of a methylmethacrylate-based composite and a glass ionomer.

Materials and Methods: In this study, 3 groups (n=28) were tested: specimens of two composites (Filtek P90 and Filtek P60) and a glass ionomer (Fuji IX) which were prepared in polyethylene molds (4 mm diameter×10 mm height). Half of the specimens in each group were finished with 180-grit silicon carbide paper and the remaining were finished with 180-grit, and subsequently polished with 250, 400, 800, 1000, 2000, and 2500-grit silicon carbide papers. The surface roughness was evaluated using a contact profilometer and then mean (R_a) and maximum (R_max) of surface roughness were recorded. Then, the surface of 4 specimens of each subgroup was observed under SEM. Statistical analysis was performed with T-test, ANOVA and Dunnett T3 tests.

Results: In all materials, Ra was different between polishing with 180 and 2500-grit silicon carbide papers. In 180-grit group, only R_a of Filtek P60 and Fuji IX showed significant difference (P=0.01). In 2500-grit group, there was no significant difference between the Ra of Filtek P60 and Filtek P90 (P=0.56).

Conclusion: Polishing is recommended for the glass ionomer and posterior composite restorations.

Background and Aims: Marginal seal in class V cavity and determination of the best restorative material in reducing microleakage is of great concern in operative dentistry. The aim of this study was to evaluate the effect of load cycling on the microleakage of low shrinkage composites compared with methacrylate-based composites with low shirinkage rate in class V cavity preparation. Marginal integrity of these materials was assessed using scanning electron microscope (SEM).

Materials and Methods: In this in vitro study, class V cavity preparations were made on the buccal and lingual surfaces of 48 human premolars and molars (96 cavities). The specimens were divided into four groups each containing 12 teeth (24 cavities): group 1 (Kalore-GC+ G-Bond) , group 2 (Futurabond NR+Grandio), group 3 (All Bond SE+ Aelite LS Posterior), group 4 (LS System Adhesive Primer & Bond+Filtek P90). All the specimens were thermocycled for 2000 cycles (5-50^oC). In each group, half of the specimens (n=12) were subjected to 200,000 cycles of loading at 80 N. Epoxy resin replicas of 32 specimens (4 restorations in each subgroup) were evaluated using SEM and the interfacial gaps were measured. Finally, the teeth were immersed in 0.5% basic fuchsin dye for 24 hours at 37⁰C, then sectioned and observed under stereomicroscope. The data were analyzed using Kruskal-Wallis and Mann-Whitney U tests and the comparison between occlusal and gingival microleakage was made with Wilcoxon test.

Results: Within unloaded or loaded specimens, there were no significant differences in microleakage among four groups on the occlusal margins (P>0.05). But there were statistically significant differences in microleakage between silorane and Aelite on the gingival margins (P<0.05). No statistically significant differences were found between the microleakage of the loaded and unloaded groups on both occlusal and gingival margins for all materials (P>0.05).

Conclusion: Silorane did not perform better than the conventional low shrinkage methacrylate-based composite in terms of sealing ability (except Aelite). Cyclic loading did not increase the extent of leakage in any groups.

  Background and Aims: Porcelain restorations are often ground for clinical adjustment and this removes the surface glaze layer and introduces flaws that can grow in wet environments due to stress-corrosion, reduce the strength of porcelain and limit restoration lifetime. The aim of this study was to introduce some surface treatment methods to control the flaws of ceramic restorations external surface and improve their strength.

  Materials and Methods: 40 feldspathic discs were prepared and divided into 4 groups (n=10): not indented (group 1) and others indented by vickers with 29.4 N and received different treatments: no treatment (group 2), polished (group 3) and polished-silane-resin (group 4). Biaxial flexural strength of discs was tested after water storage. Data were analyzed using one-way ANOVA .

  Results: The mean flexural strength of specimens in group 1 (134.49±12.60), 2 (94.81±15.41), 3 (89.20±16.22) and 4 (80.67±12.01) were measured. Group 1 (not indented) revealed significantly higher strength (P<0.001) than that of indented groups (2, 3 and 4) . There was no significant difference between group 2 (no treatment) and 3 or 4 (treated) and between treatment methods (3 and 4) (P=0.136).

  Conclusion: The strength of porcelains is dependent on presence of cracks. With the limitations of this study, none of the treatment methods could strengthen the cracked ceramic.