Relationship between bond-strength tests and clinical outcomes

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A textbook of oral pathology: William G. Shafer, D.D.S., Maynard K. Hine, D.D.S., Barnet M. Levy, D.D.S., and Charles E. Tomich, D.D.S., ed. 4, Philadelphia, 1983, W. B. Saunders Co. 917 pages. $36.50

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/iej.12841

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part I: vital pulp therapy

Heavy metal associated health hazards: An interplay of oxidative stress and signal transduction.

Background
In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament.

This is an update of a Cochrane review first published in 2003. The previous review found insufficient evidence regarding the relative efficacy of these interventions, combining one pulp treatment technique and one medicament.

Objectives
To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth.

Search methods
We searched the Cochrane Oral Health Group's Trials Register (to 25 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 25 October 2013), EMBASE via OVID (1980 to 25 October 2013) and the Web of Science (1945 to 25 October 2013). We searched OpenGrey for grey literature and the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.

Selection criteria
Eligible studies were randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in children with extensive decay involving dental pulp in primary teeth.

Data collection and analysis
Two review authors independently carried out data extraction and risk of bias assessment in duplicate. We contacted authors of randomised controlled trials for additional information if necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pairwise meta-analyses using fixed-effect models. We assessed statistical heterogeneity using by I2 coefficients.

Main results
We included 47 trials (3910 randomised teeth) compared to three trials in the previous version of the review published in 2003. All trials were single centre and small sized (median number of randomised teeth 68). Overall, the risk of bias was low in only one trial with all other trials being at unclear or high risk of bias. The overall quality of the evidence was low. The 47 trials examined 53 different comparisons: 25 comparisons between different medicaments/techniques for pulpotomy, 13 comparisons between different medicaments for pulpectomy, 13 comparisons between different medicaments for direct pulp capping and two comparisons between pulpotomy and pulpectomy. Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.

FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.

For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation.

Authors' conclusions
We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.

Pulp treatment for extensive decay in primary teeth.

Objective: The aim of this study is to evaluate four different pulpotomy medicaments in primary molars. Materials and Methods: A total of 147 primary molars with deep caries were treated with four different pulpotomy medicaments (FC: formocresol, FS: ferric sulfate, CH: calcium hydroxide, and MTA: mineral trioxide aggregate) in this study. The criteria for tooth selection for inclusion were no clinical and radiographic evidence of pulp pathology. During 30 months of follow-up at 6-month intervals, clinical and radiographic success and failures were recorded. The differences between the groups were statistically analyzed using the Chi-square test and Kaplan-Meier analysis. Results: At 30 months, clinical success rates were 100%, 95.2%, 96.4%, and 85% in the FC, FS, MTA, and CH groups, respectively. In radiographic analysis, the MTA group had the highest (96.4%), and the CH group had the lowest success rate (85%). There were no clinical and radiographic differences between materials ( P > 0.05). Conclusions: Although there were no differences between materials, only in the CH group did three teeth require extraction due to further clinical symptoms of radiographic failures during the 30-month follow-up period. None of the failed teeth in the other groups required extraction during the 30-month follow-up period.

/pdf/evaluation-of-formocresol-calcium-hydroxide-ferric-sulfate-4fjjwvq6kg.pdf

Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies.

Objectives The aim of this study was to determine the fluoride levels in breast milk and plasma of lactating mothers who regularly consumed drinking water with low levels of fluoride. Methods One hundred twenty five healthy mothers aged between 20-30 years old who had given birth within 5-7 days were included in the study. Besides being otherwise healthy, the primary selection criteria stipulated the absence of fluoride supplement consumption one month before delivery. Approximately 5 ml breast milk and 5 ml blood samples were obtained from each participating mother at a hospital setting, where the mothers were scheduled for a regular hospital diet. The blood samples were centrifuged in fluoride-free heparinized polyethylene tubes and stored at -18 degrees C until measurements were made. Breast milk samples were directly refrigerated as with blood samples until measurements. The fluoride concentrations of milk and blood samples were assessed using an ion-selective fluoride electrode combined with an ion analyzer. Results The fluoride levels of the plasma and breast milk samples were measured as 0.017+/-0.011 ppm and 0.006+/-0.002 ppm, respectively. The fluoride concentration of plasma was significantly higher than that of breast milk (P Conclusion A limited level of fluoride transmission from plasma to breast milk was detected. Nevertheless, a significant correlation between the fluoride concentrations of breast milk and plasma was evident.

/pdf/fluoride-levels-of-human-plasma-and-breast-milk-57jvitp7x5.pdf

Fluoride levels of human plasma and breast milk.

Odontomas generally appear as small, solitary or multiple radio-opaque lesions found on routine radiographic examinations. Traditionally, odontomas have been classified as benign odontogenic tumors and are subdivided into complex or compound odontomas morphologically. Compound odontomas commonly occur in the incisor-canine region of the maxilla and complex odontomas are frequently located in the premolar and molar region of both jaws. Occasionally, odontoma may cause disturbances in the eruption of teeth such as impaction, delay eruption or retention of primary teeth. In general, odontomas occur more often in the permanent dentition and are very rarely associated with the primary teeth. In this report; two cases of compound odontoma associated with primary teeth is presented. (Eur J Dent 2007;1:45-49).

/pdf/an-unusual-association-of-odontomas-with-primary-teeth-5fihprfhza.pdf

An unusual association of odontomas with primary teeth.

Aim. As bond strength of currently available adhesive systems in caries-affected teeth dentin on primary tooth dentin was not well known, the bond strength of two bonding systems (PQI and OptiBond Solo Plus) was evaluated on caries-affected and sound primary molar tooth dentin and observed the micromorphology of the adhesive–dentin interfaces.



Methods.  By grinding both the sound (n = 30) and caries-affected (n = 30) approximal surfaces of teeth, flat dentin surfaces were obtained. The prepared surfaces were bonded with one of the each adhesive systems and a composite resin. After storing the bonded specimens in water at 37 °C for 24 h, the samples were sectioned and the bond strength of the adhesive systems was tested by the microshear test method. The data were statistically analysed.



Results.  Microshear bond strengths of PQI group for caries-affected and sound primary tooth dentin were 9.43 ± 2.44 (MPa) and 9.32 ± 2.95 (MPa) (P > 0.05), respectively, and the bond strengths of OptiBond Solo Plus group for caries-affected and sound primary tooth dentin were 15.33 ± 3.59 (MPa) and 11.96 ± 2.30 (MPa) (P < 0.05), respectively. Micromorphological features between sound and caries-affected dentin were similar in both PQI and OptiBond Solo Plus groups.



Conclusion.  Both the adhesives showed significantly different bond strengths in caries-affected dentin but showed similar bond strengths in sound dentin.

Bond strength of two total-etching bonding systems on caries-affected and sound primary teeth dentin.

Objectives: The aim of this study was to test the hypothesis that the bonding ability of antibacterial bonding system to primary dentin was not different from the parental material which did not contain any antibacterial component. Methods: Extracted human non-carious primary molars were ground to expose the coronal dentin, and then randomly divided into two experimental groups: treatment with Clearfil Protect Bond or with Clearfil SE Bond (Kuraray Medical Inc.). Composite-dentin sticks with a cross-sectional area of approximately 0.90 mm 2 were prepared and subsequently subjected to microtensile bond strength (μTBS) and microshear bond strength (μSBS) tests. For the μTBS tests, specimens were attached to an Instron testing machine with a cyanoacrylate adhesive. For μSBS testing, the sticks were mechanically fixed to the μSBS testing apparatus. The bonds were stressed in shear or tension at a crosshead speed of 1mm/min until failure occurred. Resin-dentin interfaces produced by each system were examined using SEM. The data were analyzed with Mann-Whitney’s U test. Results: The μTBS and μSBS of Clearfil Protect Bond were 30.69±9.71 and 9.94±3.78 MPa, respectively. Clearfil SE Bond showed significantly greater values of 37.31±9.57 and 12.83±3.15 MPa, respectively. SEM analysis demonstrated similar micro-morphological features including the thickness of the hybrid layer for both materials. Conclusions: It was showed that antibacterial self-etching system Clearfil Protect Bond showed lower bond strength values compared to primary dentin than that of to Clearfil SE Bond on primary dentin. (Eur J Dent 2008;2:11-17)

/pdf/microtensile-and-microshear-bond-strength-of-an-3lrs42amye.pdf

Gül Tosun

Papers

Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies.

Fluoride levels of human plasma and breast milk.

An unusual association of odontomas with primary teeth.

Bond strength of two total-etching bonding systems on caries-affected and sound primary teeth dentin.

Microtensile and Microshear Bond Strength of an Antibacterial Self-Etching System to Primary Tooth Dentin