American journal of dentistry (AM J DENT )


The American Journal of Dentistry, published by Mosher & Linder, Inc., provides peer-reviewed scientific articles with clinical significance for the general dental practitioner.

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the trans-enamel and trans-dentin toxicity of a 10% hydrogen peroxide (HP) whitening strip to odontoblast-like cells (MDPC-23). Enamel surfaces of enamel/dentin discs adapted to artificial pulp chambers were subjected to two 30-minute whitening strip applications to obtain indirect extracts (DMEM + bleaching components that diffused across enamel and dentin). The extracts were applied for 1 hour to the cells for 1 or 5 days. A bleaching gel with 35% HP was used as the positive control. Cell viability (MTT assay) and morphology (SEM) as well as the quantity of HP in the extracts were assessed. Discrete cell viability reduction (21.9%) associated with slight alterations in cell morphology occurred after application of the extracts for 5 days to the MDPC-23 cells (Tukey's test; P < 0.05). Lower enamel/dentin diffusion of HP was observed after the use of the whitening strip compared with the bleaching gel (Mann-Whitney; P < 0.05).
    American journal of dentistry 10/2013; 26(5):283-5.
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    ABSTRACT: To evaluate the microleakage of Class II cavities restored with experimental low-shrinking resin composites proposed for bulk filling and to measure their microtensile bond strength (microTBS) to dentin and compare to those of previously marketed low-shrinkage composites. Class II cavities (7 mm occluso-gingival height, 2 mm mesio-distal depth of the box, 4 mm occlusal depth, 4 mm bucco-lingual width) were prepared in 50 molars and randomly divided into five groups (n = 10), according to the material: SureFil SDR flow (SDR), Filtek Silorane (FS) and experimental materials (G-aenial Flo bulk fill, GF; G-aenial Universal Flo bulk fill, GUF; GC Kalore bulk fill, GK). Microleakage was separately assessed at enamel and dentin margins by scoring the depth of silver-nitrate penetration. Twenty teeth divided into five groups (n = 4) were selected for microTBS testing. The same materials as for microleakage assessment were placed in bulk to mid-coronal dentin. Microtensile beams were loaded in tension, and microTBS at failure was calculated in MPa. Microleakage and microTBS data were analyzed by ANOVA on ranks, followed Dunn's post hoc test (P< 0.05). Microleakage was not observed at the enamel interface in any of the groups. At the dentin interface, SDR recorded significantly higher microleakage than the other materials. microTBS of GF, GUF and GK did not differ among each other (33 +/- 12 MPa, 31 +/- 11 MPa, 30 +/- 9 MPa, respectively), while SDR (63 +/- 17 MPa) and FS (55 +/- 17MPa) achieved significantly higher microTBS values. No direct association between the sealing properties and the bond strength values was observed.
    American journal of dentistry 10/2013; 26(5):271-7.
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    ABSTRACT: To evaluate the effects of a surface pre-reacted glass-ionomer (S-PRG) filled coating material to arrest artificial enamel lesions in primary teeth. Buccal and lingual enamel was demineralized in 0.1 M lactic acid buffer solution (pH 4.75) for 5 days and then divided in the PRG-applied and non-PRG areas. Proximal surfaces were used as a control area without demineralization and coating application. Teeth were divided into three groups (n = 4) according to the 1-week immersion in different solutions: Group 1 (distilled water), Group 2 (demineralizing solution) and Group 3 (artificial saliva). Hardness and Young's modulus by nano-indentation test, and elemental contents and ultrastructure by SEM/EDX analysis were obtained. Data were statistically analyzed using ANOVA and Fisher's PLSD at alpha = 0.05. Only for the non-PRG area in Group 1, the hardness and Young's modulus of the demineralized surface enamel were significantly lower than those of the enamel 30-60 microm beneath the surface. Demineralized enamel of non-PRG and PRG-applied areas showed similar SEM views. Only for the non-PRG area in Group 2 and control area in Group 3, the Ca/P of the surface enamel was significantly higher than that of the enamel 5-10 microm beneath the surface. There was no significant difference of the Ca/P among the measuring points from the surface to 10 microm depth of enamel for the PRG applied area in Group 2.
    American journal of dentistry 10/2013; 26(5):286-90.
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    ABSTRACT: To evaluate the density effects of light power and energy on the volumetric polymerization shrinkage and acoustic emission (AE) characteristics of a dental resin composite in the cavities of human teeth. Two experiments were performed at different power levels (1,000 and 4,000 mW/cm2) using a light curing unit: (1) cylindrical cavities with diameters of 4 mm and depths of 2 mm were constructed using two symmetric steel molds. The cavities were filled with resin, and the shrinkage force during polymerization was measured using a load cell attached to the mold. Polymerization shrinkage forces were measured under four conditions (1,000 mW/cm2 x 10 seconds, 1,000 mW/cm2 x 20 seconds, 4,000 mW/cm2 x 3 seconds, and 4,000 mW/cm2 x 5 seconds); (2) tooth specimens with cavity diameters of 6 mm and depths of 2 mm were made from human molars. AE signals during polymerization shrinkage were monitored in real time for 10 minutes after irradiation and two AE factors (amplitude for defect size and hit number for defect number) were assessed in the examination of defects. Two levels of light energy (20 J/cm2 = 1,000 mW/cm2 x 20 seconds and 12 J/cm2 = 4,000 mW/cm2 x 3 seconds) were used. Shrinkage occurred more quickly at 4,000 mW/cm2 than at 1,000 mW/cm2 during the initial phase. The shrinkage force became almost the same for equivalent light energy as time increased. Higher light energy (20 J/cm2) under low-power conditions (1,000 mW/cm2) caused larger cumulative numbers of AE hits than did lower light energy (12 J/cm2) under high-power conditions (4,000 mW/cm2). At 4,000 mW/cm2 and 12 J/cm2 (i.e., high power, low energy), the average amplitude of the AE signals was larger than at 1,000 mW/cm2 and 20 J/cm2 (low power, high energy).
    American journal of dentistry 10/2013; 26(5):260-4.
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    ABSTRACT: To evaluate the mechanical strength and color stability of provisional restoration materials. For mechanical testing, four groups [Trim (PEMA), Alike (PMMA), Versatemp (bis-acrylic resin composite, BARC) and Perfectemp II (bis-acrylic fluoride enriched resin, BAFC)] of resin disks were prepared for fracture toughness and shear punch strength testing, respectively. Five samples were fabricated for each group; therefore, a total of 20 resin disks for each testing method was prepared. The load at fracture and shear punch values of each specimen were recorded after 24-hour storage in distilled water. The stress intensity factors (K(Ic)) were calculated by the formula reported by Atkinson et al. For shear strength, the following formula was used: Shear strength = Force (N)/section thickness (mm) x punch circumference (mm). Values of each group in both tests were analyzed using one-way-ANOVA and Tukey multiple comparison test. For color stability testing, provisional resin disk specimens of the above mentioned materials were fabricated. Five samples were prepared for each subgroup (with and without a surface coating agent - Permaseal) and three different solutions (distilled water, red wine and curry); a total of 120 disk specimens were fabricated. Color values of each group were measured using a spectrophotometer after 24 hours and 2 weeks of aging in the aforementioned solutions. The color differences (deltaE*ab) between before and after aging were calculated by CIE Lab color-difference formula. The interaction of deltaE*ab values were analyzed by two-way analysis of variance followed by Newman-Keuls Multiple comparison test. The highest fracture toughness value [(MPa (m)1/2)] was obtained by PMMA (0.89) followed by BARC (0.67), PEMA (0.54) and BAFC (0.42). Significant differences were observed among all test groups (P < 0.05). The highest shear punch strength (MPa) was obtained by BARC (160), followed by PMMA (141) and PEMA (132). The lowest value was obtained by BAFC (106). BARC showed a significantly higher mean value than the other groups (P < 0.05). PEMA and PMMA demonstrated better color stability than the two bis-acrylic resin composites. Wine and curry showed higher stainability than water, recording higher deltaE*ab values than the clinically perceptible difference level of deltaE*ab 3.3. The surface coating agent groups demonstrated more staining than the non-coated groups. All groups, except for BARC, demonstrated significant differences dependent upon surface coating and solutions (P < 0.05).
    American journal of dentistry 10/2013; 26(5):265-70.
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    ABSTRACT: This study tested the materials available on the market for Cerec CAD/CAM, comparing the mean flexural strength in an ISO standardized set-up, since the ISO standard for testing such materials was issued later than the marketing of the materials tested. Following the recent Standard ISO 6872:2008, eight types of ceramic blocks were tested: Paradigm C, IPS Empress CAD LT, IPS Empress CAD Multi, Cerec Blocs, Cerec Blocs PC, Triluxe, Triluxe Forte, Mark II. Specimens were cut out from ceramic blocks, finished, polished, and tested in a three-point bending test apparatus until failure. Flexural strength, Weibull characteristic strength, and Weibull modulus, were calculated. The results obtained from the materials for flexural strength were IPS Empress CAD (125.10 +/- 13.05), Cerec Blocs (112.68 +/- 7.97), Paradigm C (109.14 +/- 10.10), Cerec Blocs PC (105.40 +/- 5.39), Triluxe Forte (105.06 +/- 4.93), Mark II (102.77 +/- 3.60), Triluxe (101.95 +/- 7.28) and IPS Empress CAD Multi (100.86 +/- 15.82). All the tested materials had a flexural strength greater than 100 MPa, thereby satisfying the requirements of the ISO standard for the clinical indications of the materials tested. In all tested materials the Weibull characteristic strength was greater than 100 MPa.
    American journal of dentistry 10/2013; 26(5):255-9.
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    ABSTRACT: To investigate the effects of exogenous dextranase and sodium fluoride on a S. mutans monospecies biofilm. S. mutans 25175 was grown in tryptone soya broth medium, and biofilm was formed on glass slides with 1.0% sucrose. Exogenous dextranase and sodium fluoride were added alone or together. The biofilm morphology was analyzed by confocal laser scanning microscopy. The effects of the drug on the adhesion and exopolysaccharide production by the biofilms were evaluated by scintillation counting and the anthrone method, respectively. In this study, we found that the structure of initial biofilm and mature biofilm were partly altered by dextranase and high concentrations of sodium fluoride separately. However, dextranase combined with a low concentration of sodium fluoride could clearly destroy the typical tree-like structure of the biofilm, and led to less bacterial adhesion than when the dextranase or fluoride were used alone (P < 0.05). The amounts of soluble and insoluble exopolysaccharide were significantly reduced by combining dextranase with a low concentration of sodium fluoride, much more than when they were used alone (P < 0.05). These data indicate that dextranase and a low concentration of sodium fluoride may have synergistic effects against S. mutans biofilm and suggest the application of a low concentration of sodium fluoride in anticaries treatment.
    American journal of dentistry 10/2013; 26(5):239-43.
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    ABSTRACT: To measure the pH, titratable acidity, fluoride concentration and erosive potential of brewed teas. Bag teas were purchased to represent black, green, citrus, fruity, and floral tea flavors from Tulsi, Bigelow, HyVee, Tazo, and Yogi brands and brewed (1 bag/240 ml) in boiling water for 3 minutes. The pH, titratable acidity, and fluoride concentrations were measured. Following these measurements, a representative tea from each flavor was selected for investigation of erosion potential. Six extracted human molars were randomly assigned to each tea. Teeth were painted with fingernail polish to expose a 1 x 4 mm window and then soaked in tea for a total of 25 hours with teas refreshed every 5 hours. Teeth were then sectioned using a microtome and photographed using a polarized light microscope. Lesion depths (i.e., eroded surfaces) were measured using Image Pro Plus software. Differences in physiochemical properties and lesion depths between beverages were investigated using one-way ANOVA with post-hoc Tukey's HSD test. Relationships among lesion depths and physiochemical properties were evaluated using the Pearson correlation test. pH, titratable acidity and fluoride concentrations differed between tea flavors (P < 0.05) and between brands (P < 0.05). Lesion depths produced by the citrus tea (83.1 +/- 10.3 microm) were greater than those produced by the fruity tea (56.5 +/- 6.1 microm); both teas produced greater depths than black (30.1 +/- 7.4 microm), floral (25.0 +/- 3.2 microm) or green (22.3 +/- 6.3 microm) teas (P < 0.05). pH (r = -0.96; P = 0.009) was inversely and titratable acidity (r = 0.97; P = 0.006) was positively associated with lesion depths.
    American journal of dentistry 10/2013; 26(5):278-82.
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    ABSTRACT: To evaluate the anti-gingivitis benefits of a 0.454% highly bioavailable stannous fluoride dentifrice (SnF2) relative to a 0.3% triclosan/copolymer dentifrice (triclosan/copolymer) among triclosan/copolymer dentifrice users with residual gingivitis. This was a randomized, controlled, double-blind, parallel group, 2-month clinical study. Self-reported triclosan/copolymer dentifrice users were recruited and provided with triclosan/copolymer dentifrice to use for 1 month. After this 1-month acclimation period, subjects who had residual gingivitis at the baseline visit were randomized to either the SnF2 dentifrice or the triclosan/copolymer dentifrice (positive control). Subjects performed their treatment unsupervised using their assigned dentifrice following manufacturers' usage instructions for 2 months. The Gingival Bleeding Index (GBI) and Modified Gingival Index (MGI) were used to measure gingivitis benefits at baseline and Month 2. An analysis of covariance was performed to compare treatment groups for the post-baseline scores as well as change from baseline, with the baseline score as a covariate. All comparisons were two-sided at the 0.05 level of significance. A total of 150 subjects were randomized to treatment. Both treatment groups experienced significant reductions in number of bleeding sites, gingival bleeding index (GBI), and gingival inflammation (MGI) relative to baseline (P < 0.001). At Month 2, the SnF2 dentifrice group demonstrated significantly lower adjusted mean scores versus the triclosan/copolymer group for number of bleeding sites, GBI, and MGI (P < 0.001). Between-treatment group comparisons for change from baseline values showed that the improvement in number of bleeding sites from baseline for the SnF2 group was 49% greater versus that of the triclosan/copolymer group (P < 0.001), and the GBI and MGI improvements from baseline for the SnF2 group were 48% and 37%, greater, respectively, relative to the triclosan/copolymer group (P < 0.001).
    American journal of dentistry 08/2013; 26(4):175-9.
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    ABSTRACT: To investigate the effect of a fluoride-containing aluminocalciumsilicate nanoparticle glass dispersed aqueous solution (Nanoseal) on enamel and dentin, under the hypothesis that this material can form insoluble mineral deposits that confer acid resistance to the tooth structure and occlude open dentin tubules. Labial enamel and dentin of human extracted incisors were used. Morphology of the enamel and dentin artificially demineralized with a lactic acid solution that before and/or after coated with the test material were analyzed with a wavelength-dispersive X-ray spectroscopy electron probe microanalyzer with an image observation function (SEM-EPMA). Moreover, incorporation of the calcium and silicon by enamel and dentin were also detected with SEM-EPMA. Application of the fluoroaluminocalciumsilicate-based tooth coating material resulted in the deposition of substances (nanoparticles) onto the enamel surface porosities and open dentin tubules on the artificial lesions. Prior coating with the test material reduced the demineralization-induced loss of enamel and dentin. Moreover, Ca and Si incorporation into superficial enamel and dentin was detected.
    American journal of dentistry 08/2013; 26(4):191-5.
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    ABSTRACT: To evaluate the in vivo effect of chewing gum containing allyl isothiocyanate alone, and in combination with zinc salts on reduction of the level of volatile sulfur compounds responsible for oral malodor. 15 healthy volunteers between the ages of 20-50 chewed either an experimental gum or a placebo gum for 12 minutes. Their mouth air was analyzed for volatile sulfur compounds by a gas chromatograph at baseline, immediately after chewing, and at 60, 120 and 180 minutes after treatment. The study revealed that allyl isothiocyanate, a constituent of mustard seed extract, can effectively reduce the concentration of volatile sulfur compounds in mouth air. Chewing gum containing 0.1% zinc lactate and 0.01% of allyl isothiocyanate eliminated 89%, 55.5%, 48% and 24% of the total VSC concentration immediately after chewing and at 1, 2, and 3 hours after chewing, respectively.
    American journal of dentistry 08/2013; 26(4):180-4.
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    ABSTRACT: To evaluate the biochemical and microbiological characteristics of in situ biofilm formed on materials that release fluoride (F-) or calcium (Ca++) and phosphate (Pi). This study comprised an in situ and in vitro experiment, utilizing three materials [Auralay XF and Fuji IX GP, containing fluoride, and Aegis containing amorphous calcium phosphate (ACP)] and bovine dental enamel slabs. For the in situ: 10 volunteers wore palatal devices, each containing four material specimens or enamel slabs that were treated with 20% sucrose solution. The biofilm had pH measurements on Day 7 and the composition was analyzed on Day 8 by assessing the following: F-, Ca++, Pi and insoluble extracellular polysaccharides (EPS) concentrations, and then identification of the microbiota. For the in vitro: materials/enamel were subjected to a 7-day pH-cycling regimen to determine F, Ca++ and Pi release. The biofilm formed on F(-)-releasing materials was richer in F, Ca++ and Pi and had lower mutans streptococci counts than enamel biofilm. The biofilm on the ACP-containing material exhibited similar Ca++ and Pi concentrations to biofilm on F(-)-releasing materials. The materials showed buffering action compared with enamel. Biochemical and microbiological characteristics showed a less cariogenic biofilm on materials containing fluoride or amorphous calcium phosphate.
    American journal of dentistry 08/2013; 26(4):207-13.
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    ABSTRACT: To evaluate the desensitizing efficacy of 2% sodium fluoride solution (NaF), diode laser (DL), a DL and NaF association and a solution of hydroxyl-ethyl-methacrylate and glutaraldehyde (HEMA-G: Gluma desensitizer) in cervical dentin hypersensitivity (CDH). 262 teeth of 24 subjects (16 females and eight males; age 21 to 64 years, mean 38 years), each having at least two CHD teeth for each quadrant, were included in this prospective, split mouth, clinical study. Teeth of each oral quadrant were randomized in four groups (SG) to study the effectiveness of NaF (SG-1), of DL (SG-2) NaF-DL combination (SG-3) and HEMA-G (SG-4). The subjects were asked to rate the sensitivity experienced during air stimulation by placing a mark on a visual analogue scale (VAS) before treatment (baseline), immediately after treatment, and after 1, and 6 months. The outcomes showed a significant reduction of discomfort compared to baseline values for teeth of SG-3 immediately post treatment (82.6%) (P < 0.001), after 1 month (69.5%) (P < 0.001) and after 6 months (60.8%) (P < 0.001), respectively, compared with the reduction scores of 51.6% (P < 0.001), 29.7% (P < 0.05) and 4.7% (P > 0.05), recorded for SG-1; 72.2%, (P < 0.001), 62.5% (P < 0.001), and 47.2% (P < 0.05), recorded for SG-2; 77.4% (P < 0.001), 56.1% (P < 0.001), and 27.3% (P < 0.05), recorded for SG-4.
    American journal of dentistry 08/2013; 26(4):214-8.
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    ABSTRACT: To evaluate the effect of artificial demineralization upon color change of dentin in contact with dental amalgam. Sound human molars (n = 34) were embedded in resin and coronal enamel was removed. Dentin was exposed to artificial caries gel (pH 5.5) at 37 degrees C for 12 weeks (n = 24). Non-demineralized teeth served as controls (n = the 10). A dispersive high-Cu amalgam or conventional low-Cu amalgam was condensed onto dentin surfaces of all groups. After 10 weeks storage in saline, amalgam was removed and teeth were cut into three slices. Surfaces were inspected under optical microscopy and photographed. Penetration of black pigments was observed in dentin underneath both high-Cu and low-Cu amalgams in demineralized specimens. Black deposits were unevenly distributed and observed predominantly in dentin near to pulp horns. Discoloration was not limited to outer demineralized dentin but extended beyond this zone. Evenly distributed bluish-green discoloration was observed underneath all high-Cu amalgam specimens independent of demineralization.
    American journal of dentistry 08/2013; 26(4):185-90.
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    ABSTRACT: To evaluate the effect of the addition of sodium trimetaphosphate (TMP) with or without fluoride on enamel demineralization, and the hardness and release of fluoride and TMP of resin composites. Bovine enamel slabs (4 x 3 x 3 mm) were prepared and selected based on initial surface hardness (n = 96). Eight experimental resin composites were formulated, according to the combination of TMP and sodium fluoride (NaF): TMP/NaF-free (control), 1.6% sodium fluoride (NaF), and 1.5%, 14.1% and 36.8% TMP with and without 1.6% NaF. Resin composite specimens (n = 24) were attached to the enamel slabs with wax and the sets were subjected to pH cycling. Next, surface and cross-sectional hardness and fluoride content of enamel as well as fluoride and TMP release and hardness of the materials were evaluated. Data were statistically analyzed using ANOVA (P < 0.05). The presence of fluoride in enamel was similar in fluoridated resin composites (P > 0.05), but higher than in the other materials (P < 0.05). The combination of 14.1% TMP and fluoride resulted in less demineralization, especially on lesion surface (P < 0.05). The presence of TMP increased fluoride release from the materials and reduced their hardness.
    American journal of dentistry 08/2013; 26(4):201-6.
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    ABSTRACT: To present an updated knowledge on the remineralizing dental restorative materials and their performance in vivo and/or in vitro. A search of English peer-reviewed dental literature over the last 30 years from PubMed and MEDLINE databases was conducted, and the key words included: remineralization, pulp capping, restoration, composite, cement, primer, bonding, adhesive, liner and sealant. Titles and abstracts of the articles listed from search results were reviewed and evaluated for appropriateness. A variety of dental restorative materials are able to promote tooth remineralization and/or inhibit tooth demineralization. These remineralizing materials include fluoride- and/or calcium-containing pulp capping materials, bonding agents, resin composites, resin cements, glass-ionomer cements, and sealants.
    American journal of dentistry 08/2013; 26(4):219-27.
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    ABSTRACT: To test different kinds of mechanical and chemical pre-treatments of previously sealed dentin before re-sealing. 75 bovine dentin samples were precycled for 3 days (per day: 6 x 1 minute erosion (HCl; pH 2.3), and kept in artificial saliva in dwell time and overnight. Group 1 samples (n = 15) remained untreated (control). Remaining samples were sealed with Seal&Protect (S&P). After thermo-mechanical loading (5,000 cycles, 50/5 degrees C, 11,000 brushing strokes) a first measurement was performed to evaluate permeability of the sealant. Permeability was tested by storing the samples in HCl (pH 2.3; 24 hours) and measuring the calcium release into the acid by atomic absorption spectroscopy. Based on these calcium release values, the previously sealed samples were allocated to four groups (2-5) according to a stratified randomization. Samples of Groups 2-5 were re-sealed with S&P after either being treated with ethanol (Group 3), silane-coupling-agent (Group 4) or sandblasting (Group 5). After re-sealing, all samples had a second measurement of permeability. After another thermo-mechanical loading, a third evaluation of permeability was conducted. At all measurements, calcium release was significantly higher in the untreated control group than in the sealed Groups 2-5 with no significant differences among the sealed groups. Within Groups 2-5, calcium release at the first and third measurement was higher compared with that at the second measurement (P < 0.05).
    American journal of dentistry 06/2013; 26(3):161-5.
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    ABSTRACT: To evaluate (1) the effect of a desensitizing paste containing 8% arginine and calcium carbonate on the microtensile bond strength between dentin and etch-and-rinse adhesive systems; and (2) to examine the dentin tubules occlusion quantitatively. 48 freshly extracted intact human mandibular third molars were divided randomly into three groups. The mid-coronal dentin of each tooth was exposed and treated. Group A: no treatment; Group B: specimens were polished with a desensitizing paste containing 8% arginine and calcium carbonate using a rotary cup operating at a low speed for 3 seconds, followed by an additional duration of 3 seconds (total operation time of 6 seconds), according to the manufacturer's instructions; Group C: specimens were handled in the same way with the exception of an increased operation time of 9 seconds, twice (total operation time of 18 seconds). Each group was randomly divided into two subgroups in order to evaluate the effectiveness of two different adhesive agents. A two-step etch-and-rinse adhesive agent (Adper SingleBond 2) and a three-step etch-and-rinse adhesive agent (Adper ScotchBond Multi-purpose) were applied to dentin surfaces. Then, microtensile bond strengths of the six subgroups were tested. Dentin surfaces were analyzed using field-emission scanning electron microscopy (FESEM) and laser scanning confocal microscopy (LSCM). There was no significant difference in microtensile bond strength between the control group and the experimental groups treated with the 8% arginine and calcium carbonate desensitizing paste during the application of etch-and-rinse adhesives. Both FESEM and LSCM showed that the desensitizing paste occluded dentin tubules effectively.
    American journal of dentistry 06/2013; 26(3):137-42.