Journal of Dental Medicine

Background and Aims: Despite the reduction of incidence of dental caries in recent years, this disease is common and many efforts were conducted to decrease the prevalence of dental caries. On the other hand secondary caries lesions are the main reason for replacement of direct restorations. Therefore, the aim of the current study was to evaluate suitable methods of preparation and restorative materials to reduce caries recurrence.

Materials and Methods: In this experimental study, eighty human teeth were collected and stored in normal saline. The teeth were soft-tissue debrided and cleaned with water/pumice slurry and rubber cups in a low-speed handpiece. Speciments were randomly divided in two main groups. Cavities were prepared with diamond burs or Er:YAG laser (10 Hz, 300 mJ, 3W). Each group was divided into 4 sub-groups, and restored with a glass-ionomer cement (Fuji IX), resin modified glass-ionomer (Fuji II LC), total etch bonding + composite resin or self-etch bonding + composite resin. The specimens were submitted to pH cycling. Speciments were then sectioned, polished and Vickers microhardness measurements were performed on each specimen. Differences among the medians were analyzed using two way ANOVA test at a 95% confidence level and Tukey test.

Results: Statistical analysis showed significant difference in the type of substrate (enamel, dentin) in both main groups (P<0.0001) but no differences in the caries lesion development between the cavities restored with the same material and prepared with diamond burs or Er:YAG laser.

Conclusion: The Er:YAG laser used for cavity preparation and different types of restorative materials used did not show the ability to guarantee significantly more acid-resistance tooth structure against demineralization.

Background and Aims: Delay in light irradiance can improve the polymeric structure and mechanical properties of resin cement and uniform stress distribution. The aim of this study was to evaluate the effect of light activation modes (immediate, 5 and 10-minute delay) on the push-out bond strength of cemented fiber posts with two types of resin cements in different of root canal regions.
Materials and Methods: In sixty extractedsingle canal and endodontic therapied roots, FRC Postec Plus were cemented with two resin cements, Nexus3 and Panavia F2.0, in three curing methods, immediate, 5, and 10 minute delay. After 24 hours storing in a dark place, they were cut into three sections: coronal, middle and apical. The push-out bond strength test was performed using the universal testing machine. Failure modes were evaluated using stereomicroscope. Data were analyzed by ANOVA and Tukey post hoc test with P<0.05 as the level of significance.
Results: In Nexus3, the immediate light curing had significantly higher bond strength (11.18±4.32) than delay methods (P=0.001). In Panavia F2.0, the 5-minute delay had significantly the highest bond strength (13.34±4.62) (P<0.05). There was no correlation between the different light curing methods and root canal regions. In Nexus3, the coronal region had higher bond strength (11.83±3.7) than that of middle (9.12±3.1) (P=0.015), and middle than of apical (5.65±2.77) (P=0.00), and coronal than that of apical (P=0.002). In Panavia F2.0, there were not significant differences among regions (P>0.05).
Conclusion: Delay in light curing of dual-cure resin cement's had different effects on the push-out bond strength.
 

Background and Aims: The aim of this study was to evaluate the effects of two fluoride containing mouth rinses on the color stability of two different resin composites.
Materials and Methods: 27 specimens (2×4×5 mm) were prepared from each of the following materials: a micro filled composite (Gradia, GC) and nanohybrid (Grandio). The specimens were polished by Soflex fine and superfine disks and then incubated in artificial saliva at 37°C for 24 h. The baseline color values (L, a, b) of each specimen were measured using an Easyshade spectrophotometer according to the CIELab color scale. The specimens were immersed in 20 mL of each mouth rinse and stored in an incubator at 37°C for 12 h. After incubation, the color values of all specimens were measured again, and the color change value (ΔE) was calculated. Data were analyzed by a 2-way analysis of variance at a significance level of 0.05.
Results: None of the mouth rinses created clinical significant color changes in the samples. There was no statistically significant difference among color susceptibility between resin composites (P=0.330). The interaction between the effect of mouth rinses and type of restorative materials was not statistically significant (P>0.05).
Conclusion: Accordance to the results of this study, the fluoride containing mouth rinses does not create color change in resin composites.

Background and Aims: One of the main disadvantages of light cured composite resin materials is polymerization shrinkage upon curing. This leads to the microleakage of restoration and finally failure of the restoration. The purpose of this study was to investigate the effect of two types of light curing devices with different modes on the microleakage of posterior composite filling in Cl II restorations.
Materials and Methods: In this experimental study, 30 extracted sound molar human teeth were collected. All specimens were randomly divided into 3 groups of ten: Standard LED irradiation, pulse curing LED irradiation and QTH irradiation. All samples were prepared with mesial and distal boxes and composite fillings were done with three different light curing patterns for 20 s. After thermocycling, the specimens were kept in 2% methylene Blue solution for 24 h for microleakage test. After sectioning, the samples were evaluated by a stereomicroscope. For data analysis one-way ANOVA and Kolmogorov-Smirnov were used. P<0.05 was considered statistically significant.
Results: The quantitative tests showed that there were no statistical difference between study groups (P>0.05).
Conclusion: The results showed that both light curing devices were effective and no significant difference between different modes of LED light curing device on microleakage of class II composite restorations was found.

Background and Aims: Microhardness, sorption, and solubility are useful predictors of a resin composite’s clinical success. This study aimed to evaluate the effect of 60 days of water storage on the microhardness, sorption, and solubility of 3 commercial nanohybrid resin composites.
Materials and Methods: Three nanohybrid composites were evaluated: GC Kalore (GC), Aura (SDI), and G-ænial Universal Flo Universal Flo (GC). Ten disc-shaped samples were prepared for each material. After baseline weight measurement, the specimens were stored in distilled water for a period of 60 days, and then in desiccators for another 60 days. Specimens were weighed at 24 hours, 7 and 60 days of water storage and desiccation. For the microhardness test, 24 were prepared for each material and divided into 6 groups based on storage media (dry and wet) and storage time (24 hours, 7 days, and 60 days). Specimens were tested by a digital Vickers microhardness tester after storage and data were analyzed using SPSS software.
Results: G-ænial Universal Flo Universal Flo showed the highest sorption and solubility and the lowest microhardness after 60 days of water storage. GC Kalore showed lower sorption and solubility compared to Aura. Also GC Kalore had higher microhardness than Aura after 60 days of storage in water, while Aura had higher microhardness in dry storage.
Conclusion: Composites with lower sorption and solubility showed higher microhardnss in wet conditions. Flowable composite resin showed the lowest microhardness and the highest sorption and solubility values. Therefore, the negative effect of water sorption and solubility on Surface microhardness should be considered in clinical decisions.

Background and Aims: A suitable restorative material must have acceptable mechanical properties. The aim of this study was to evaluate the effect of conventional acidic drinks on the micro-hardness of two dental resins.
Materials and Methods: 48 samples of each of P60 and G-aenial composites were prepared and randomly divided into six groups: Coca-Cola, Fanta, yoghurt drinks, soft beer, Sprites and control groups. The study was in 3 steps: after one day in distilled water and after one day and one week of immersion in beverages per day
(6 hours). The Vickers micro-hardness was then evaluated. Finally, data were analyzed by, t-tests, ANOVA and Tukey tests.
Resultes: Comparing the results between the two groups, a significant difference between the two composite was found. After one day in the water, the average micro-hardness for P60 was of 27.12 (kgf/mm²) and 16.51 (kgf/mm²) for G-aenial amount and these differences were found statistically significant (P=0.0001). For the
6-hour maintenance interval, the average micro-hardness between P60 and G-aenial was statistically significant (P=0.0001). For 42 hours, the average micro-hardness ranged between P60 and G-aenial that were statistically significant (P=0.0004). The stiffness of the P60 composite after 42 hours’ storage in soft beer significantly decreased compared with the control group (P=0.03). G-aenial composite hardness after 42 hours of soaking in the Coca-Cola was reduced significantly compared to yogurt drinks (P=0.02).
Conclusion: As a result, the hardness of P60 composite was higher than that of G-aenial. The hardness of both composites reduced in acidic drinks after one week.

Background and Aims: Fracture and color change are among the most common causes of clinical failure of resin composite restorations. Therefore, this study aimed to examine the fracture toughness and color changes of 3 Nano-hybrid resin composites in dry and wet conditions.
Materials and Methods: Three resin composites were studied. A total of 36 rectangular specimens were prepared for each material, randomly divided into 2 groups, and stored at 37°C dry or soaked in distilled water. In each group, the specimens were subdivided into three groups (n=6) and stored for 1, 7, and 60 days. After each time interval, the specimens were tested for the fracture toughness and loaded at a cross-head speed of 0.5mm/min using a universal testing machine. The baseline and final color measurement was recorded for each specimen using a spectrophotometer. The collected data was analyzed using ANOVA and Kruskal-Wallis tests.
Results: After 60 days, the mean value of fracture toughness was lower in the wet condition compared to that of dry condition. However, it was not significantly different except for aura Bulkfil (P=0.001). Color change was significantly different for Tetric Evoceram and aura with a greater value in the wet condition compared to that of dry (P=0.004). The greatest color stability was found for aura and the least for Tetric Evoceram.
Conclusion: In this study, most of the materials stored in a dry condition showed a greater fracture toughness and color change.

Background and Aims: Wear resistance of artificial teeth has an important role in denture longevity. The purpose of this in vitro study was to evaluate the wear resistance of three types of composite resin denture teeth with that of acrylic resin.
Materials and Methods: In this study, four types of artificial teeth, including 3 types of composite artificial teeth (Ivoclar, Apple and Yamahachita) and 1 type of acrylic resin artificial teeth (Ivoclar) were used. Ten maxillary first premolars were selected from each set and were fixed in autopolymerising acrylic resin. The wear test was performed for 1000 and 2000 cycles. The heights and weights were measured under a light stereo microscope and scales (0.001 gram accuracy) before and after wear cycles. Data were analysed by ANOVA and Duncan tests (P=0.05).
Results: There was no significant difference between the mean wear of the composite and acrylic resin ivoclar artificial teeth in 1000 and 2000 cycles (P>0.05), but this difference was significant between the other artificial teeth (P<0.05). In 1000 and 2000 cycles, there was a significant difference between the mean weight loss of samples of all four artificial teeth groups (P<0.05). Also, in this study, the composite and acrylic ivoclar artificial teeth showed significantly less wear-resistant than that of other teeth, and the highest wear rate was found for Yamahachita's composite artificial teeth.
Conclusion: The findings of this study suggested that Ivoclar composite or acrylic resin denture teeth can be more suitable options than other artificial teeth used in this study in cases susceptible to abrasion.

Background and Aims: In endodontically treated teeth, the fiber posts are used to retain a core restoration. The purpose of this study was to evaluate the effect of different resin cements on the bond strength of fiber reinforced composite posts to root canal dentin, and comparing the bond strength in different sections of root.
Materials and Methods: In this in-vitro experimental study, 48 extracted single-canal central incisors were endodontically treated. For the push out test, the posts were divided into 3 groups according to one of the following three different cement materials (n=16) (Bifix SE, Bifix QM, Rebilda). Three slices with a thickness of 2-mm were prepared of each root. The push-out tests were performed at a cross-head speed of 1 mm/minute using a universal testing machine. Data were analyzed by two-way and one-way ANOVA test followed by Tukey post hoc test (α=0.05).
Results: There was no significant differences between the mean push out bond strength of three experimental groups (P=0.650), but there were significant differences between the mean push out bond strength of root dentin regions (P<0.001).
Conclusion: Under the conditions of this study, there was no significant difference between the mean push out bond strength of 3 different resin cement systems. The coronal region of root dentin showed significantly higher mean bond strength values than that of the middle and apical thirds.

Background and Aims: Glass ionomer cements are among direct restorative materials which are used in an environment saturated with moisture. Therefore, having the ability to prevent water contamination is crucial. The aim of this study was to determine the water sorption and solubility of five glass ionomer restoratives with and without two nanofilled resin coating agents.
Materials and Methods: Five glass ionomer cements (Fuji BULK/GC, EQUIA Forte Fil/GC, Fuji II LC/GC, riva self cure/SDI, riva light cure/SDI) and two resin-based coating (G-COAT PLUS/GC and EQUIA Forte Coat/GC) were used in this study. Water sorption and solubility were measured in accordance with the ISO 4049's. For each material, 15 disc-shaped specimens were prepared using a polyethelyn mould. The specimens of each material were randomly divided into two groups: 10 coated and 5 uncoated. For the coated groups of each material, 5 specimens were coated with G-COAT PLUS, and 5 with EQUIA Forte Coat. Data were analyzed using SPSS software version 18 (SPSS Inc., Chicago, IL, USA). Two-way ANOVA was applied to investigate if there were any interactions between materials and coatings. One-way ANOVA was used to compare different variables between the materials, and post-hoc Tukey’s test was performed to show significant differences in subgroup comparisons.
Results: A significant interaction effect was obsevred between materials and coatings (P<0.05) using two-way ANOVA. The uncoated groups showed higher mean sorption and solubility values compared to the coated groups, and the groups coated by G-COAT PLUS showed less mean sorption and solubility values than that of EQUIA Forte Coat. In general, the lowest mean sorption and solubility values among glass ionomer cements belonged to Fuji BULK.
Conclusion: The water sorption and solubility values of glass ionomer cements could be reduced by the use of a protective coating.

Background and Aims: The aim of the present study was to evaluate the effect of applying hydrophobic resin after use of different generation of the bonding systems on nanoleakage.
Materials and Methods: 20 third molar teeth were selected. The teeth were randomly divided into 4 groups of 5, each was treated using the fourth, fifth, sixth, and seven generation of dentin bonding. Then, the crown of teeth was sectioned from the CEJ region and each specimen was divided into two halves with mesiodistal cut, one half for the application of dentin bonding without the addition of a hydrophobic resin, and the other for the same dentin bonding by the addition of a hydrophobic resin. Afterwards, the specimens were restotred by composites. After placement of specimens in silver nitrate, the amount of nanoleakage was evaluated by SEM. Data were analyzed using a repeated measurement statistical analysis (α=0.05).
Results: The use of hydrophobic resins decreased nanoleakage and range of variations in all groups (P<0.05). This reduction was greater for total-etch dentin bonding. Higher degree of nanoleakage occurred in total-etch dentin bonding in most evaluated areas. In general, Clearfil S³ bond showed the least percent of the nanoleakage.
Conclusion: All dentin bonding systems showed some degree of reduction in nanoleakage after hydrophobic layer application and the reduction was greater in Total-etch adhesives systems.

Background and Aims: Today, resin composites are one of the most commonly used materials in restorative dentistry. However, failure in resin treatments is also common due to its chemical nature and its high talent for decay recurrence. According to conservative approaches, "conservative" treatments are more likely to be considered than "Replacement" of damaged remedies. The purpose of this study was to compare different surface preparation methods on composite surfaces to achieve the highest bond strength between the old and new composites after accelerated aging.
Materials and Methods: First, composite cylinders with a diameter of 6 and a height of 5 mm were prepared using an incremental technique and a microhybrid resin composite. The specimens were stored in distilled water for 6 months at 37°C and then the surfaces of all aged compsites were roughened using diamond milling followed by phosphoric acid etching. The specimens were randomly subjected into five groups. Group 1: GC Composite Primer. Group 2: Universal bonding containing silane (Kuraray). Group 3: Self etching adhesive (SE bond; Kuraray) Group 4: silane (Ivoclar Vivadent) + Second bottle of SE bond bonding system (Kuraray). Group 5: control group with no treatment. Then, 5 mm incremental of new composite (similar to the aged composite with different color) were placed on the surfaces of specimens, sectioned, and thermocycled for 3000 cycles for the microtensile bond strength evaluation. The specimens were evaluated using a stereomicroscope after failure. Data were analyzed by one-way ANOVA and Post Hoc Tukey test.
Results: The specimens in which silane and SE bond were used showed the highest mean microtensile bond strength and those treated by universal bond showed the least bond strength which were significantly different (P=0.02). All samples had cohesive failure patterns in all groups and the percentage of failures in old and new composites did not differ significantly (P=0.69).
Conclusion: : Based on the results, all surface preparations used in this study could provide an appropriate bond strength for repair of old composite restorations. Also, the microtensile bond strength between the old and new composites was higher than the cohesive strength of resin composite itself. However, the mean microtensile bond strength value for the group treated by universal bond was significantly lower than those treated by silane and hydrophobic containing bonding system.

Background and aims: Solubility is an important property of luting cements in determining clinical durability. The aim of this study was to compare the solubility of Panavia, Calibra and Maxcem resin cements with that of GC Fuji PLUS resin modified glass ionomer cement in three different pH values.
Materials and Methods: A total of 96 specimens were prepared (8mm diameter, 4mm thickness) according to manufacturer instructions. After setting, they were desiccated and weighed. The specimens were kept immersed in distilled water and lactic acid solution (pH values of 3 and 5) for 30 days and then removed and weighed again. Data were statistically analyzed by SPSS18 using two-way ANOVA with P≤0.05 set as the level of significance.
Results: The results of this study showed no significant difference between three pH values (P=0.08). The Calibra resin cement had the lowest value of solubility in distilled water and both pH of lactic acid. GC Fuji PLUS resin modified glass ionomer cement had the highest value of solubility in lactic acid and the Maxcem resin cement had the highest value of solubility in water.
Conclusion: The solubility characteristics of resin modified glass ionomer and three different resin cements were significantly affected by their composition and the storage condition.

Background and Aims: Erosion is the chemical dissolution of a tooth by acid without bacterial involvement. The purpose of the current study was to investigate the effect of resin infiltration (Icon), MI paste plus, and Nd:YAG laser on the enamel microhardness.
Materials and Methods: 40 enamel samples were obtained from the third molar tooth. Primary microhardness was measured in all specimens. Then, erosion was created using hydrochloride acid on the surfaces of enamel and the microhardness values were measured. The samples were randomly divided into four groups. G1: MI paste plus, G2: MI paste plus+ Nd:YA laser, G3: ICON without etching, G4: ICON with etching. Erosion was induced again by hydrochloric acid and then subjected to thermocycling. Finally, the microhardness of the samples was measured. Statistical analysis was performed using SPSS23 software, one-way ANOVA, multiple Tukey and T-test comparisons. P<0.05 was considered as a significant level.
Results: The microhardness increased in the third stage compared to the second stage in all groups, which was statistically significant (P<0.000). Also, the comparison of the increase of microhardness among groups, except second group with the fourth group, was statistically significant.
Conclusion: All the materials used in this study significantly increased the microhardness of the eroded enamel.

Background and Aims: Adding nanoparticles to dental composite resins, could reduce bacterial adhesion and secondary caries. Thermocycling can resemble in-vitro conditions to the oral environment. The aim of this study was to determine the effect of thermocycling on the microleakage of a mixture of copper oxide nanoparticles and flowable composite.
Materials and Methods: In this in-vitro study, 88 premolar teeth were divided into eight groups based on the application of copper oxide nanoparticles with concentrations of 0.1% and 0.3% w/w and thermocycling by 0, 1000, 5000 and 15,000 cycles. The occlusal grooves of the teeth were sealed with the mixture of flowable composite and copper oxide nanoparticles, and the teeth were thermocycled. Next, the teeth were immersed in methylene blue 2% solution for 24 hrs and were cut and the microleakage was evaluated by a stereomicroscope (hp/USA). Data were analyzed using Kruskal-Wallis and Mann-Whitney tests at the significance level of 0.05.
Results: In the groups with 0.1 % copper oxide nanoparticles, the mean microleakage increased significantly with increasing the number of thermocycling rounds (P=0.032). The difference in the microleakage between the groups exposed to 0 and 15,000 termocycling was significant (P=0.019). However, thermocycling had no significant effect on the microleakage of groups with concentration of 0.3% (P=0.780). The specimens subjected to the 0, 1000, 5000 and 15000 thermocycling in two concentrations of copper oxide nanoparticles showed no significant difference in the microleakage.
Conclusion: In groups containing copper oxide nanoparticles with a concentration of 0.1%, the microleakage increased by increasing the number of thermocycling up to 15,000 cycles compared to the control group. However, this did not have significant effect for the concentration of 0.3% copper oxide nanoparticles.

Background and Aims: Poly methyl methacrylate (PMMA) is still the most commonly used material in prosthetic dentistry. However, there are problems with the mechanical properties of this type of material including low flexural strength. Addition of nanoparticles into the polymer is one way to improve the mechanical properties of acrylic resin. In the present study, the effect of silicon dioxide (SiO₂) nanoparticles addition into the heat-cured acrylic resin in different concentrations was investigated. Because of the controversy had been observed in previous articles, the aim of this study was to investigate the mechanical properties of PMMA/SiO₂ nanoparticle obtained from different percentages of SiO₂.
Materials and Methods: In this in-vitro study, acrylic resin specimens containing 0, 1, 3 and 5% silicon dioxide (SiO₂) were prepared. The specimens were placed inside the gypsum molds and placed under pressure for three times. The mold cured in boiling water for 30 min. A trimmer was used to remove the additives. Sandpapers with 180, 320 and 600 grains of silicon-carbide were used for final finishing and polishing. Finally, the flexural strengths were measured using a universal testing machine. Data were finally analyzed by ANOVA and Tukey tests at a significant level of 5% using SPSS software.
Results: The mean flexural strengths and standard deviations of control group, 1% filler, 3% filler, and 5% filler, were 57.24±8.30, 69.98±7.26, 60.16±9.18, and 61.59±9.28 MPa, respectively. After comparing significant values between each group with the control group, a significant difference was observed between the control and 1% filler group (P=0.021). However, no significant difference was observed between 3 and 5% fillers with the control group or each other. The significant differences (P-value) between 3% filler and control group were 0.892 and between 5% filler and control group was 0.975.
Conclusion: The results of the present study showed that the use of low percentage of silicone dioxide (SiO₂) nanofiller could improve the flexural strength of poly methyl methacrylate acrylic resin.

Background and Aims: Nowadays, new techniques are used to control dental caries that have the ability to kill cariogenic bacteria. Recently, the addition of antibiotics to glass ionomers has been proposed to reduce the overall number of saliva bacteria. The aim of this study was to compare the antimicrobial effect and compressive strength of resin- modified glass ionomer (RMGI) containing different antibiotics on Streptococcus mutans.
Materials and Methods: A total of 120 specimens were prepared in 3 groups (n=40) including RMGI containing doxycycline with a concentration of 1.5%, RMGI containing a combination of ciprofloxacin, metronidazole and minocycline with a concentration of 1.5%, and RMGI without antibiotics as control group. To measure the antibacterial effect, the disk diffusion method and counting of Streptococcus mutans bacterial colonies were used and then the compressive strength test was performed. Data were collected into SPSS25 and analyzed by ANOVA and Kruskal-Wallis tests and the significance level was considered α=0.05.
Results: The mean number of bacterial colonies in the RMGI group containing doxycycline in all three time intervals 1, 24 hours and 7 days was significantly lower than the specimens in the RMGI group containing the triple antibiotic (P<0.001). The mean compressive strength of the two experimental groups was lower than the control group but was not statistically significant (P=0.326).
Conclusion: The addition of antibiotics at a concentration of 1.5% to RMGI resulted in a favorable antibacterial property with no significantly change in the compressive strength.

Background and Aims: Finishing and polishing of composites is a critical step influencing the clinical service of restorations. The aim of this article was to evaluate and compare the effect of two liquid polishes on the polish retention of two nanocomposites.
Materials and Methods: Eighty standardized disk-shaped specimens (4×2 mm) were prepared from two nanocomposites (n=40), including one nano-filled composite (Filtek Z350 XT-3M ESPE, USA) and one nano-hybrid composite (Aelite Aesthetic Enamel-Bisco, Inc. Schaumburg, USA). The specimens were randomly divided into 4 subgroups (n=10) based on the method of finishing (F) and polishing (P) procedures: M: as control, polymerized under Mylar strip; S: finish and polish with a sequence of Sof-Lex discs (3M ESPE, USA); SP: finish and polish with Sof-Lex discs and use of Permaseal liquid polish (Ultradent products, Inc. USA); SB: finish and polish with Sof-Lex discs and use of Biscover liquid polish (Bisco, Inc. Schaumburg, USA). The specimens were undergone pH cycling and brushing machine and then, the average surface roughness (Ra) and average profile changes along the desired area (Rz) of the specimens were determined with profilometer instrument. Two-way and one-way analysis of variance (ANOVA) was used to compare the mean of surface roughness. Then, Tukey test was used to identify the groups responsible for the difference and t-test was used to compare the mean of surface roughness.
Results: The type of composite and the method of polishing procedure had no effect on the mean Ra (P=0.733) but it had significant effect on Rz1 factor (P=0.025).
Conclusion: Using liquid polish after polishing discs had no effect on the polish retention of nanocomposites.