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August 2011

Laboratory efficacy of three compact toothbrushes to reduce artificial plaque in hard to reach areas

Samuel L. Yankell, ms, phd, rdh,  Caren M. Barnes, rdh, ms,  Xiuren Shi, dds  &  James Cwik, bsba, mba


Abstract: Purpose: To evaluate the effect of three toothbrushes [GUM Summit+Compact Head, GUM Technique Deep Clean Compact Head, and Oral-B Indicator 35 (compact head)] on plaque reduction in difficult to reach areas: interproximal sites (Interproximal Access Efficacy, IAE), the gingival margin (Gingival Margin Cleaning, GMC) and under the gumline (Subgingival Access Efficacy, SAE). Methods: Six toothbrushes from each product group were randomly tested four times for a total of 24 tests on each toothbrush design. In the IAE studies, toothbrushing was conducted for 15 seconds using horizontal and vertical brushing motions, simulated anterior and posterior teeth and a brushing pressure of 250 g. IAE was recorded as the maximum width of artificial plaque removed. In the GMC and SAE assays, the toothbrush to be tested was aligned with the papillae of artificial gingiva placed over simulated posterior teeth and brushing was conducted for 15 seconds using horizontal brushing and a brushing pressure of 500 g. The GMC efficacy was recorded as the maximum length of artificial plaque removed at the gingival margin. The maximum depth of the plaque substrate removed under the gingiva was recorded as the SAE. Significant mean differences between the toothbrushes were determined using ANOVA and Tukey’s test for pairwise comparisons with a significance level of P< 0.05. Results: In all three assays conducted, the GUM Summit+Compact Head and GUM Technique Deep Clean Compact Head toothbrushes had significantly higher efficacy means compared to the Oral-B Indicator 35 (compact head) toothbrush. There was no significant difference in efficacy between the GUM Summit+Compact Head and GUM Technique Deep Clean Compact Head toothbrushes in the testing performed. (Am J Dent 2011;24:195-199).


Clinical significance: The presence of dental plaque at interproximal, subgingival and gingival margin sites will result in the development of gingivitis if not removed regularly and thoroughly. The demonstrated efficacy of the GUM Summit+Compact Head and GUM Technique Deep Clean Compact Head toothbrushes in removal of artificial dental plaque at these key sites indicated that when used properly they can be used for the treatment and prevention of gingivitis.



Address: Dr. S. L. Yankell, Yankell Research Consultants, Inc., 405 East Second Street, Moorestown, NJ, 08057 USA. E-mail:




Color stability of chemically activated reline resin after microwave disinfection: A 1-year clinical trial


Roberta  Chuqui  Ribeiro, dds, msc, phd,  Eunice  Teresinha  Giampaolo, dds, msc, phd, Fernanda Emiko Izumida, dds, msc, Ana ClÁudia Pavarina, dds, msc, phd, Eduardo Buozi Moffa, dds, msc &  Carlos Eduardo Vergani, dds, msc, phd


Abstract: Purpose: To evaluate the effect of microwave disinfection on the color stability of a hard chairside reline resin after a 1-year service period. Methods: 40 adult patients aged between 30-75 years, who required denture reline treatment, participated in this study. Tokuyama Rebase II was used to reline complete maxillary dentures. The edentulous subjects were randomly divided into two groups (n=20) and dentures were cleansed according to two methods: CG (control group) - brushing with coconut soap and soft toothbrush; DG (disinfection group) - brushing according to previous methods and microwave disinfection once a week for 3 minutes at 650W. Color parameters in L*a*b* were recorded by spectrophotometer immediately after the reline, at 7 and 15 days, 1, 3, 6 and 9 months and 1 year post-placement. Data were analyzed by two-way repeated-measures ANOVA and Tukey tests (α= 0.05). Results: Color alteration values of DG were significantly lower than those of CG (P< 0.05). Color changes observed after 15 days were greater than values obtained at 7 days recall (P< 0.05). All color changes observed for the CG were considered noticeable (between 1.5 and 3.0 NBS). In DG, color change was slight (between 0.5 and 1.5 NBS). There were statistically significant differences between L* values obtained initially and after 3 months, between 15 days and 3 months and between 15 days and 1 year (P< 0.05). No significant differences were observed between group and time for the parameters a* and b*. (Am J Dent 2011;24:200-204).


Clinical significance: Microwave disinfection caused improvement in color stability of the reline material.


Address: Dr. Roberta Chuqui Ribeiro, Araraquara Dental School – UNESP, R. Humaitá, nº1680, CEP 14801-903 Araraquara, São Paulo, Brazil.  E- mail:




Enamel protection: A comparison of marketed dentifrice performance against dental erosion

Robert  V.  Faller, bs,  Sandra  L.  Eversole, aas  &  Ghebre  E.  Tzeghai, phd


Abstract: Purpose: To determine the relative ability of various marketed toothpastes formulated with either stabilized stannous fluoride (SnF2), sodium fluoride (NaF), or sodium monofluorophosphate (SMFP) to protect human enamel against the initiation and progression of damage due to dietary acid attack, using a laboratory erosion cycling model. Methods: Cores of ground and polished enamel from extracted human teeth were soaked in pooled, human saliva (pellicle formation) and then subjected to erosion cycling conditions that included exposure of tooth specimens to: (1) treatments in a 1:3 slurry (w/w) of toothpastes and saliva; and (2) acid challenges using either citric acid (Study 1) or both citric and phosphoric acids (Study 2). These acids represent potentially damaging acids found in common food and drinks. Upon completion of treatments, specimens were analyzed with regard to the depth of tooth mineral removed from exposed areas of the treated specimens over the course of the study. Two studies were conducted: Study 1 included a marketed, stabilized SnF2 toothpaste vs. marketed NaF toothpastes; Study 2 tested the same stabilized SnF2 product compared to a marketed SMFP toothpaste and a NaF control. Results: The stabilized SnF2 toothpaste included in these studies demonstrated a highly significant reduction in enamel surface loss, relative to the control, in each study: Study 1 = 65% reduction; Study 2 = 58% reduction when using citric acid and 84% reduction when using phosphoric acid. Products formulated with NaF resulted in a net loss of between +1% and -21%, with none of the NaF toothpastes performing significantly different from the control (P< 0.05, ANOVA). For the SMFP product included in Study 2, results were also not significantly different from the NaF control. In both studies, the stabilized SnF2 paste demonstrated a highly significant level of protection compared to all other test groups included in the study, regardless of the type of dietary acid challenge considered. (Am J Dent 2011;24:205-210).


Clinical significance: Results of these studies suggested that the stabilized SnF2 paste could be used to provide significant acid protection over that provided by conventional fluoride products.


Address: Sandra L. Eversole The Procter and Gamble Company, Advanced Technology and Innovation Department, Enamel Care Research Group, 8700 Mason-Montgomery Road, Mason, OH 45040, USA. E- mail:



Incomplete caries removal in deep lesions: A 10-year prospective study

Marisa Maltz, dds, ms, dr odont, Luana Severo Alves, dds, ms, Juliana Jobim Jardim, dds, ms, phd, Maurício dos Santos Moura, dds  &  Elenara Ferreira de Oliveira, dds, ms, phd


Abstract: Purpose: To follow-up teeth with deep caries lesions submitted to incomplete caries removal over a 10-year period. Methods: 27 subjects (32 permanent posterior teeth) with deep caries lesions composed the sample. In this single-arm long-term prospective study, the inclusion criteria were risk of pulp exposure during caries excavation, positive response to the cold test, absence of spontaneous pain or sensitivity during percussion, and radiographic absence of a periapical lesion. Subjects were submitted to the following procedures: complete caries removal from the surrounding cavity walls, incomplete caries removal from the pulpal wall, capping with a calcium hydroxide cement, and sealing with a modified zinc oxide-eugenol cement. After 6-7 months, the temporary sealing was removed for methodological purposes (no further excavation was performed), and teeth were capped with a calcium hydroxide cement and filled with resin composite. Clinical and radiographic assessments were conducted after 6-7 months, 1.5, 3, 5 and 10 years. Success was defined as clinical and radiographic signs and symptoms of pulp sensitivity while failure was defined as endodontic treatment need. Results: Over 10 years, one tooth was excluded from the sample (pulp exposure during treatment), five were lost to recall, 10 had therapy failure (five fractures and four necroses leading to endodontic treatment need, and one extraction) and 16 had therapy success (pulp sensitivity). Overall survival rates were 97%, 90%, 82% and 63% at 1.5-, 3-, 5- and 10-year follow-ups, respectively. Teeth with two or more restored surfaces failed significantly more than teeth with one restored surface (P= 0.01). (Am J Dent 2011;24:211-214).



Clinical significance: Incomplete caries removal may be seen as an alternative to complete excavation in deep caries lesions, arresting caries progression, preventing pulp exposure; therefore the need for more invasive techniques, such as direct pulp capping or endodontics may be avoided.



Address: Dr. Marisa Maltz, Department of Social and Preventive Dentistry, Faculty of Dentistry, UFRGS, Ramiro Barcelos, 2492, Bom Fim 90035-003, Brazil.  E- mail:



Microtensile bond strengths and interfacial examination of a polyalkenoate-based 1-step adhesive

Jorge  PerdigÃo, dmd, ms, phd,  Ana  Sezinando, dmd, ms  &  George  Gomes, dmd


Abstract: Purpose: To study the effect of acid etching and the application of a hydrophobic bonding resin on the microtensile bond strengths (µTBS) and marginal sealing of the 1-step self-etch adhesive Adper Easy Bond (AEB). Methods: Middle dentin was exposed in 30 extracted molars and randomly divided into six groups: (1) AEB applied as per manufacturer's directions; (2) as in AEB, but one coat of hydrophobic resin (HR) was applied and cured over AEB (AEB+HR); (3) etching with 35% H3PO4 for 15 seconds followed by AEB (Etch+AEB); (4) as in group Etch+AEB, but one coat of HR was applied and cured over AEB (Etch+AEB+HR); (5) Adper Single Bond Plus, the 2-step etch-&-rinse adhesive control (ASB); (6) Adper Scotchbond Multi-Purpose, the 3-step etch-&-rinse adhesive control (SBMP). Buildups were constructed with Filtek Z250 and cured in three increments of 2 mm each. Specimens were sectioned with a slow-speed diamond saw under water in X and Y directions to obtain bonded sticks with a cross section of 0.8 ± 0.2 mm2 and tested to failure in tension mode at a crosshead speed of 1 mm/minute. Statistical analyses were computed using one-way ANOVA followed by Duncan’s post-hoc test at P< 0.05. For marginal sealing, 36 Class V preparations were restored with one of the six adhesive combinations and processed with 50% ammoniacal silver nitrate. After sectioning, specimens were observed under a backscattered FE-SEM to evaluate silver infiltration into the resin-dentin interface, which was measured in ranks (0-4) and compared with non-parametric statistical tests (P< 0.05). Results: AEB resulted in statistically lower mean µTBS than all other groups at P< 0.05. All the remaining groups resulted in statistically similar mean µTBS. For marginal sealing, data were grouped in three statistical subsets: Groups AEB and AEB+HR resulted in statistically less silver infiltration than groups Etch+AEB and Etch+AEB+HR. Groups ASB and SBMP resulted in similar silver infiltration compared to Groups AEB and AEB+HR. The nanoleakage pattern consisted of agglomerates of silver deposits located predominantly in the hybrid layer, while reticular or water-tree silver deposits were observed in both the AEB and ASB adhesive layers. (Am J Dent 2011;24:215-220).


Clinical significance: As with other 1-step self-etch adhesives, Adper Easy Bond is more reliable in the laboratory when used as a 2-step self-etch adhesive.




Address: Dr. Jorge Perdigão, University of Minnesota, Department of Restorative Sciences, 515 SE Delaware St, 8-450 Moos Tower, Minneapolis, MN 55455, USA. E- mail:


Clinical versus laboratory adhesive performance to wet and dry demineralized primary dentin


Ana  ClaÚdia  Chibinski, dds, ms,  Rodrigo  Stanislawczuk, dds, ms,  Douglas  Augusto Roderjan, dds, ms, Alessandro  Dourado  Loguercio, dds, ms, phd,  Denise  Stadler  Wambier, dds, ms, phd, Rosa  Helena  Miranda  Grande, dds, ms, phd  &  Alessandra  Reis, dds, phd


Abstract: Purpose: To evaluate the influence of dentin moisture on bond strengths of an etch-and-rinse bonding agent to primary dentin clinically and in the laboratory. Methods: The sample consisted of two groups of 20 caries-free primary second molars: molars in exfoliation period (clinical group) and extracted molars (laboratory group). Class I cavities were prepared in all specimens leaving a flat dentin surface on the pulpal floor. A two-step etch-and-rinse adhesive was vigorously rubbed on either dry (n= 5) or wet demineralized dentin (n= 5) under clinical or laboratory conditions. After restorative procedures, the teeth from the clinical group were extracted after 20 minutes. All samples were processed and underwent microtensile bond strength test and silver nitrate uptake evaluation under scanning electron microscopy. Results: Statistically higher bond strength values were observed when the bonding was performed under laboratory conditions and on a wet demineralized dentin. Most of the failures were adhesive and mixed irrespective of the experimental condition. Silver nitrate uptake occurred in all groups irrespective of the experimental condition. Resin-dentin bond strengths produced in the laboratory in primary teeth may overestimate those produced under clinical circumstances. (Am J Dent 2011;24:221-225).


Clinical significance: Wet bonding technique still seems to be required for primary teeth in order to achieve high immediate resin-dentin bond strength values for the etch-and-rinse adhesive system tested.


Address: Dr. Alessandra Reis, Rua General Osório, Apto 422, Centro, Ponta Grossa, Paraná, Brazil – 84010-080. E- mail:



The effect of polymerization procedure on Vickers hardness of dual-curing resin cements


Simon Flury, dds, Anne Peutzfeldt, dds, phd, dr odont  &  Adrian Lussi, dds, dipl chem ing


Abstract: Purpose: To investigate the surface hardness (Vickers hardness, HVN) of one light-curing flowable resin composite and five dual-curing resin cements after different polymerization procedures. Methods: The HVN was measured with a hardness-indentation device on one light-curing flowable resin composite (Tetric EvoFlow) and five dual-curing resin cements (Panavia F2.0, SpeedCEM, RelyX Unicem Clicker, SmartCem2 and iCEM) after the resin material had been cured at constant 30°C according to one of five polymerization procedures (n= 30/procedure and material): (1) 5-minute light-curing (positive control; prolonged light-curing), (2) 40-second light-curing (immediate light-curing), (3) 6-minute auto-curing (negative control; dual-curing resin cements only), (4) 6-minute auto-curing followed by 40-second light-curing (delayed light-curing), and (5) 5-second light-curing, 1-minute auto-curing and 40-second light-curing (instructions for removal of excess cement). A Kruskal Wallis test followed by pairwise Wilcoxon rank-sum tests with Bonferroni-Holm adjustment was applied for each material and procedure (level of significance: α= 0.05). Results: For each material, Procedure 1 showed the significantly highest HVN and Procedure 3 the significantly lowest HVN. Procedure 4 showed significantly increased HVN for each material compared to Procedure 3. With Procedure 1, Panavia F2.0 and RelyX Unicem yielded significantly higher HVN than the other resin materials. With Procedure 3, no significant differences in HVN were found between Panavia F2.0, SpeedCEM and SmartCem2 which all showed significantly higher HVN than RelyX Unicem and iCEM. (Am J Dent 2011;24:226-232).


Clinical significance: Prolonged light-curing increased the surface hardness. Auto-curing alone resulted in the lowest surface hardness. However, light-curing after auto-curing was able to restore the surface hardness. The light-curing flowable resin composite did not perform better than the dual-curing resin cements. Certain dual-curing resin cements performed poorly when only auto-cured and should be used only when effective light-curing can be guaranteed.


Address: Dr. Simon Flury, Freiburgstrasse 7, CH-3010 Bern, Switzerland.  E- mail:




Influence of the activation mode of a self-etch resin-based luting cementupon the metabolism of odontoblast-like cells


Adriano Melo de MendonÇa, dds, ms, phd,   Camila Favero de Oliveira, dds, ms, phd,   Josimeri Hebling, dds, ms, phd & Carlos Alberto de Souza Costa, dds, ms, phd


Abstract: Purpose: To evaluate the cytotoxicity of a self-etch resin-based luting cement, RelyXUnicem (RXU) upon chemical or dual cure and with or without interposition of IPS d.SIGN (IPSD) or IPS Empress II (IPSE) ceramic discs between cement and light source. Methods: 112 RXU specimens were subjected to different curing conditions and incubated in culture medium (DMEM) to obtain extracts. The following groups were formed: G1: DMEM (control); G2: dual RXU; G3: chemical RXU; G4: dual RXU+IPSD; G5: chemical RXU+IPSD; G6: dual RXU+IPSE; and G7: chemical RXU+IPSE. Cultured odontoblast-like cells were incubated for 24 hours in contact with the extracts. Data from cell metabolism (CM), total protein dosage (TPD) and alkaline phosphatase activity (APA) were obtained and analyzed statistically (α= 0.05; Kruskal Wallis and Mann-Whitney tests). Cell morphology was analyzed by SEM. Results: CM and APA were significantly lower in G3 and G7 than in G1 (P< 0.05). Significant TPD decrease occurred in G5 and G7 compared to G1 (P< 0.05). Only G4 and G6 presented CM changes. RXU caused no cytotoxicity when subjected to dual cure without ceramic interposition. However, mild cytopathic effects were observed after chemical setting without ceramic interposition, and after chemical and dual activation under ceramic discs. (Am J Dent 2011;24:233-238).


Clinical significance: The interposition of ceramic restoration between the light source and self-etching luting cements during their chemical and/or dual polymerization may decrease the degree of monomer-polymer conversion. Consequently, the release of unreacted monomers from these resin-based cements may cause toxic effects to pulp cells.


Address: Prof. Dr. Carlos Alberto de Souza Costa, Department of Physiology and Pathology, Faculty of Dentistry of Araraquara, Paulista State University (UNESP), Rua Humaitá, 1680, Centro, P.O. Box 331, CEP: 14801-903 Araraquara, SP, Brazil.  E- mail:



The effect of 6-month water storage on the bond strength of self-etch adhesives bonded to dentin

Christiana  Zander-Grande, dds, ms,  Alessandro  D.  Loguercio, dds, ms, phd, Rodrigo  Stanislawczuk, dds, ms,  Gislaine  Cristine  Martins, dds, ms, Osnara Maria Mongruel Gomes, dds, ms, phd  &  Alessandra Reis, dds, phd


Abstract: Purpose: To evaluate the microtensile bond strengths (µTBS) of 1-step vs. 2-step self-etch systems to dentin after 24 hours and after 6 months of water storage. Methods: Resin composite buildups were bonded to occlusal dentin of third molars using the following adhesives: Xeno IV (XE, Dentsply), G-Bond (GB, GC Inc), Clearfil S3 Bond (CS3, Kuraray); Adper Prompt L-Pop (AD, 3M ESPE); Go (GO, SDI), All Bond SE (ABSE 1-step or ABSE 2-step, Bisco) and Clearfil SE Bond (CSE, Kuraray). The bonded sticks (cross-sectioned area of 0.8-0.9 mm2) originated from the same teeth were randomly divided to be tested after 24 hours or after 6 months of water storage. The data was submitted to two-way repeated measures ANOVA and Tukey’s test with and without the inclusion of premature failures (PF) (α = 0.05). Results: The inclusion of PF resulted in different statistically significant means for CS3, CSE and AD (P< 0.05). Only the ABSE2 showed stable bonds after 6 months of water storage (P> 0.05). (Am J Dent 2011;24:239-244).


Clinical significance: All Bond SE systems showed stable bonds after 6-month water storage when used in the 2-step approach.


Address: Dr. Alessandra Reis, University Estadual de Ponta Grossa, Mestrado em Odontologia, Av. Carlos Cavalcanti, 4748, Bloco M, Sala 64A,   Ponta Grossa, Paraná 84010-900, Brazil.  E- mail:


Surface roughness evaluation and shade changes of a nanofilled resin composite after bleaching and immersion in staining solutions

Isabel Cristina G. Bandeira de Andrade, dds, ms, Roberta Tarkany Basting, dds, ms, scd,phd, Ynara Bosco de Oliveira Lima-Arsati, dds, ms, phd, FlÁvia Lucisano Botelho do Amaral, dds, ms, phd, JosÉ Augusto Rodrigues, dds, ms, phd  &  Fabiana Mantovani Gomes FranÇa, dds, ms, phd


Abstract: Purpose: To investigate the effect of bleaching and staining solutions on roughness and shade changes in a nanofilled resin composite [Filtek Supreme (FS)]. Methods: FS specimens (n= 135) were light cured and separated into groups (n=45) that were bleached with 10% carbamide peroxide (CP) agent or 16% or 35% hydrogen peroxide (HP). In the first two groups the bleaching gel was used for 4 hours a day, during 14 days, and for the third group in three sessions of 45 minutes. Each group was subdivided (n=15) and immersed in coffee, red wine or distilled water for 3 hours a day during 40 days. The roughness values (Ra) and shade (parameter CIELab) were evaluated at baseline, after bleaching and after staining. The data was analyzed by ANOVA and Tukey test or Kruskal Wallis. Results: The effects on specimens varied depending on the bleaching product and staining solution. FS after bleaching and after staining presented higher roughness. In the evaluation of shade changes after bleaching, it was observed that resin color changed and that 35% hydrogen peroxide bleached the resin more than the others. After staining in three solutions, all specimens changed color and wine showed the higher staining capacity. (Am J Dent 2011;24:245-249).




Clinical significance: Filtek Supreme nanofilled resin composite can undergo changes in the roughness and color after whitening or staining.




Address: Prof. Dr. Roberta Tarkany Basting, Faculty of Dentistry and São Leopoldo Mandic Dental Research Center, Department of Restorative-Operative Dentistry, University of Campinas, Rua José Rocha Junqueira 13, Bairro Swift, Campinas, SP CEP: 13045-755, Brazil.  E- mail:



Temperature rise during photo-polymerization for onlay luting

Ioana  Onisor, dr med dent,  Erik  Asmussen, prof  &  Ivo  Krejci, prof


Abstract: Purposes: (1) To measure the temperature rise during long-time irradiation needed to lute adhesive indirect restorations, with one halogen and five LED high-power lamps, in a simulated oral environment, and (2) to propose a technique to reduce heat. Methods: Temperature within the pulp chamber of an extracted human molar in a 35°C water bath, before and after restoration with a ceramic onlay, was continuously recorded during 3 x 120 seconds of irradiation for different curing regimens, with and without cooling by compressed air, water and water spray. Temperature rise in a thermo-insulated well was also measured during 120 seconds of irradiation with LEDemetron II and TuTu. Results: Maximal temperature rise of 6.2°C/7.7°C on intact/onlay restored tooth was found after 3 x 120 seconds of irradiation. Compressed air application reduced the temperature by 4°C for LEDemetron II, while water spray increased the temperature by 15.1°C for TuTu. Temperature decreased with irradiation distance, except for LEDemetron II. Air was heated up to 65°C after 120 seconds of irradiation in an insulated well with TuTu. (Am J Dent 2011;24:250-256).


Clinical significance: Recent high-power LED curing units developed high temperatures during extended irradiation. Active cooling may be effective to reduce heat during prolonged polymerization times used for luting of indirect adhesive restorations with light-cured materials.


Address: Dr. Ioana Onisor, School of Dentistry, University of Geneva, Rue Barthélemy-Menn 19, CH-1205 Geneva, Switzerland.  E- mail:



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