2. Universidad Cardenal Herrera-CEU

Purpose: The aim of this study was to evaluate the chemomechanical properties, antibacterial activity, and cytotoxicity of an experimental adhesive resin containing halloysite nanotubes (HNT), doped with alkyl trimethyl ammonium bromide (ATAB). Materials and Methods: A filler of HNT doped with ATAB was obtained (ATAB:HNT) and incorporated (5 wt%) into a resin blend made of bisphenol A glycerolate dimethacrylate, 2-hydroxyethyl methacrylate and a photoinitiator/co-initiator system (GATAB:HNT). The same resin blend without ATAB:HNT was used as control (Ctrl). The ATAB:HNT filler was assessed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The two tested adhesives were evaluated for degree of conversion (DC) in vitro and in situ, softening in alcohol, dentin microtensile bond strength (μTBS), antibacterial activity, and cytotoxicity (n = 5). Results: SEM showed that the nanotubes had a characteristic tubular-needle morphology, while the TEM analysis confirmed the presence of ATAB inside the lumens of HNT. The incorporation of ATAB:HNT induced no reduction (p > 0.05) of the DC either in situ or in vitro. No difference was encountered after the softening challenge test (p > 0.05) and no difference was found in μTBS between the two adhesives, both at 24 h (p > 0.05) and after 6 months of storage in distilled water (p > 0.05). However, ATAB:HNT reduced Streptococcus mutans viability (p < 0.05) without a cytotoxic effect on pulp cells (p > 0.05). Conclusions: GATAB:HNT adhesive demonstrated appropriate polymerization without significant differences in softening after solvent immersion, while concomitantly maintaining reliable bond strength after 6 months of water aging. Moreover, the ATAB:HNT filler can provide antibacterial activity to the adhesive resin without affecting pulp cell viability.

Minimally invasive (MI) concepts in restorative dentistry in the year 2020 request from the practitioner, not only a scientifically supported rational for carious tissue removal/excavation and defect-oriented, biological cavity preparation, but also a deep understanding of how to ensure a biomechanically stable and durable restoration in different clinical situations by applying different restorative options. Bio-reactive materials play an increasingly relevant role, as they not only replace diseased or lost tissue but also optimise tissue mineral recovery (among other properties) when used in restorative and preventive dentistry. Indeed, this is of certain interest in MI restorative dentistry, especially in those cases where gap formation jeopardises the integrity of the margins along resin composite restorations, causing penetration of bacteria and eventually promoting the formation of secondary caries. Recently, the interest on whether ion-releasing materials may reduce such biofilm penetration into margin gaps and reduce such a risk for development and propagation of secondary caries is growing significantly among clinicians and scientists. The aim of this article was to explore mechanisms involved in the process that allow mineral deposition at the interface between such materials and dentine and describe how conventional “bioactive” restorative materials currently available on the market may beneficial treatments in MI Dentistry.

Introduction: This study compared bacterial percolation and sealer penetration of a novel obturation technique with the ones of warm vertical condensation technique. Methods and Materials: A bacterial percolation test was carried out with 80 single rooted human teeth divided into 5 groups; A (n=20): warm vertical condensation and AH-Plus, B (n=20): CPoint with AH-Plus, C (n= 20): CPoint with EndoSequence BC, +ve Control (n=10): teeth with no canal obturation, -ve Control (n=10): teeth with no access cavity. The samples were inoculated with a multispecies bacterial incoulum. Bacterial percolation was evaluated by turbidity. Confocal laser scanning microscopy (CLSM) was used to observe the presence of gaps and voids. Further 48 extracted human mandibular single-canal premolars were used to determine the sealer penetration. Slices of the samples were observed by CLSM to evaluate tubules penetration of the sealer. Kaplan Meyer survival, ANOVA one way and Tuckey HSD test and a Wilcoxon signed-rank test were utilised. Results: A Kaplan-Meier test showed no significant difference overall (P>0.05) between groups A, B and C. At 43 days, the group B showed a significantly inferior ability to prevent bacterial passage (P<0.05). The group C showed a deeper sealer penetration than group A and B with statistically significant differences (P<0.05) for the total penetration (ANOVA one way and Tukey HSD). A Wilcoxon signed-rank test showed statistically significant differences for the penetration in the middle-and apical third of the 3 groups. Conclusion: Based on this in vitro study, the single polymer-cone obturation technique with a resin based- and bioceramic based-sealer behaved similarly to the warm vertical obturation technique in preventing bacterial passage. The bioceramic sealer showed the deepest penetration but did not fully prevent bacterial leakage.

The objective of this systematic review was to determine the influence of surface treatment of glass fiber posts on bond strength to dentine. Laboratory studies were searched in MEDLINE, PubMed, Embase, PubMed Central, Scopus, and Web of Science search engine. All authors interdependently screened all identified articles for eligibility. The included studies were assessed for bias. Because of the considerable heterogeneity of the studies, a meta-analysis was not possible. Twelve articles were found eligible and included in the review. An assessment of the risk of bias in the included studies provided a result that classified the studies as low, medium, and high risk of bias. The available evidence indicated that the coronal region of the root canal bonded better to the glass fiber post than apical regions. Phosphoric acid, hydrogen peroxide, and silane application enhance post’s retentiveness. In light of the current evidence, surface treatment strategies increase the bond strength of glass fiber post to dentine. However, recommendations for standardized testing methods and reporting of future clinical studies are required to maintain clinically relevant information and to understand the effects of various surface treatment of glass fiber post and their bond strength with dentine walls of the root canal.

This study aimed at evaluating the e cacy of a novel silver-citrate root canal irrigation solution (BioAKT) on smear layer removal, sealer penetration after root canal instrumentation and antibacterial activity. Single-root teeth were endodontically treated, sealed with an epoxi-amine resin sealer and irrigated using: Group I: 5.25% sodium hypochlorite (NaOCl); Group II: silver-citrate solution (BioAKT); Group III: phosphate bu er solution (PBS); Group IV: 17% ethylenediaminetetraacetic acid (EDTA). Smear layer removal and silver deposition at the coronal, middle and apical portion of each canal were analyzed using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Sealer penetration into dentinal tubules at coronal, middle and apical portion was assessed through dye-assisted confocal microscopy (CSM). Both SEM and CSM micrographs were evaluated by two examiners ( = 0.86), who were blind to the irrigation regimens; scores were given according to the degree of penetration of the sealer. Data analysis included Pearson’s x2 and Sidak’s multiple comparisons. Dentin discs were polished and sterilized. Enterococcus faecalis biofilms were grown using a continuous-flow bioreactor under anaerobic conditions for 72 h. Specimens were irrigated with the tested solutions, and bacterial viability was assessed using a tetrazolium salt assay (MTT). Statistical analysis included one-way ANOVA and Student’s post-hoc t-test (p < 0.05). BioAKT and EDTA were the most e cient solutions both in removing the smear layer and allowing sealer penetration. However, at the apical portion BioAKT performed significantly better compared to EDTA both in smear layer removal and sealer penetration (p < 0.05). BioAKT and NaOCl showed comparable antibacterial e ect (p = 0.53). In conclusion, BioAKT represents a suitable smear layer removal agent, which allows for reliable sealer penetration at the apical portion of the root canal system and o ers significant antibacterial properties.

The aim of this study was to compare the physicochemical properties, filling ability, and antibacterial activity of a premixed calcium silicate-based sealer to those of a powder–liquid bioceramic sealer. Ceraseal (CS) and BioRoot (BR) materials were analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy at 7 and 14 d of immersion in distilled water. The filling ability of the two sealers as well as the water contact angle, solubility, flow, roughness, crystalline microstructure, pH, and compressive strength were also evaluated. The antibacterial activity was assessed through an agar di usion as well as through direct tests. All the results were statistically analyzed using one-way or two-way analysis of variance tests. Statistically significant lower void percentages were observed for CS at 2 and 8 mm from the working length (WL) compared to those for the BR group, whilst no significant di erence was observed at 5mmfrom the WL. BR sealer showed higher alkaline pH, rougher surface, lower water contact angle values, lower flowability, and higher solubility compared to CS. BR showed globular and needle-like crystalline microstructure, whilst CS had globular and flower-like crystalline microstructure up to 72 h. No statistical di erence was found for the compressive strength between the two sealers. BR and CS showed no antibacterial e ect against Enterococcus faecalis after 3 h, whilst both sealers showed antibacterial capacity after 24 and 72 h. BR demonstrated higher antibacterial activity after 24 h. In conclusion, the use of bioceramic sealers may play an important role in controlling bacterial growth. Moreover, CS may have superior filling ability and lower solubility than the BioRoot sealer due to its specific chemical composition and mixing method.

This study aimed at evaluating the shear bond strength (SBS) of modern self-adhesive resin cements and resin-modified glass ionomer cements applied to di erent prosthetic substrates. Zirconia, lithium-disilicate glass-ceramic and a noble metal alloy were used as bonding substrates. They were all sand-blasted with alumina, while LD was further etched with 9.6% hydrofluoric acid (10 s). A light-curing resin-modified glass ionomer cement (3M-GIC: Ketac Cem Plus) and a self-curing resin-modified glass ionomer cement (GC-GIC: FujiCEM 2) were compared to self-adhesive resin cements (PAN: Panavia SA Universal) and (3M-RES: Rely X Unicem 2). Ten specimens for each substrate were produced and up to five cylinders of each cement were bonded to each substrate. The shear bond strength (SBS) was evaluated after 24 h or after thermocycling (TC) aging (5000 cycles). The data was statistically analysed by two-way ANOVA and Student–Newman–Keuls test ( = 0.05). Failure modes were analysed through stereoscopic microscopy. The greatest SBS was attained with PAN, whilst 3M-GIC showed the lowest SBS and failed prevalently in adhesive mode. No di erence in SBS was observed between GC-GIC and 3M-RES. After TC aging, all cements showed significant drop (p < 0.05) in SBS, but PAN showed the greatest SBS. Reliable bond strength to prosthetic substrates can be achieved with specific universal resin-luting cements and may be an alternative to glass ionomer cements when luting alloy substrates.

The aim of this study was to evaluate the physicochemical properties of experimental adhesives containing tailored fluoridated calcium phosphate fillers. Five experimental resins were formulated, one contained no calcium phosphate filler (Control) and the other four resins contained 40 wt% of calcium phosphate fillers doped with increasing concentrations of fluoride: adhesives CaP (no fluoride), CaP-2F (2 wt% F), CaP-4F (4 wt% F), and CaP-8F (8 wt% F). Resin specimens were prepared for a three-point bending test to evaluate the elastic modulus (E) and flexural strength (FS) at 24 h and after 2 months of water storage. Disk-shaped specimens were prepared to analyze the water sorption (Ws) according to ISO 4049. The degree of conversion (DC) of the tested resins was also assessed through FTIR. Statistical analysis was performed with ANOVA and Tukey’s test (p < 0.05). The addition of F-CaP particles at 0 and 2 wt% fluoride had no effect on the DC (p > 0.05) compared to the filler-free resin. However, these same experimental resins showed the highest E after water storage. All resins had a significant reduction of the FS after water storage (p < 0.001), but at a lower percentage rate for those experimental resins containing fluoride-free CaP or fluoride-doped CaP- 2F. These latter experimental resins achieved similar Ws to control the filler-free resin. Conversely, those resins containing 4 or 8 wt% fluoride-doped CaP had a significant Ws increase (p < 0.05). In conclusion, the incorporation of calcium phosphate particles without fluoride or with 2 wt% fluoride may represent a promising strategy to generate adhesive resins with specific physicochemical properties. Fluoride incorporation in CaP fillers for dental resin adhesive should be performed at low concentrations in order to avoid excessive water sorption and a decrease of polymerization.

The aim of this study was to evaluate the infuence of boron-nitride nanotubes (BNNTs) on the properties of resin-based light-curing dental sealants (RBSs) when incorporated at diferent concentration. RBSs were formulated using methacrylate monomers (90 wt.% TEGDMA, 10 wt.% BisGMA). BNNTs were added to the resin blend at 0.1 wt.% and 0.2 wt.%. A Control group without fller was also designed. Degree of conversion, ultimate tensile strength, contact angle, surface free energy, surface roughness and color of the RBSs were evaluated for the tested materials. Their cytotoxicity and mineral deposition ability (Bioactivity) were also assessed. A suitable degree of conversion, no efect in mechanical properties and no cytotoxic efect was observed for the experimental materials. Moreover, the surface free energy and the surface roughness decreased with the addition of BNNTs. While the color analysis showed no diference between specimens containing BNNTs and the control group. Mineral deposition occurred in all specimens containing BNNTs after 7d. In conclusion, the incorporation of BNNTs may provide bioactivity to resin-based dental sealants and reduce their surface free energy.

Objective:To evaluate the effect of a new application method of bulk-fill flowable compositeresin material on bond-strength, nanoleakage, and mechanical properties of dentine bonding agents.Materials and methods: Sound extracted human molars were randomly divided into: manufacturer ’sinstructions (MI), manual blend 2 mm (MB2), and manual blend 4 mm (MB4). Occlusal enamelwas removed and flattened, dentin surfaces were bonded by Prime & Bond universal (Dentsplyand Optibond FL, Kerr). For the MI group, adhesives were applied following the manufacturer’sinstructions then light-cured. For MB groups, SDR flow+bulk-fill flowable composite resin wasapplied in 2- or 4-mm increment then manually rubbed by a micro brush for 15 s with uncured dentinebonding agents and the mixture was light-cured. Composite buildup was fabricated incrementallyusing Ceram.X One, Dentsply nanohybrid composite resin restorative material. After 24-h waterstorage, the teeth were sectioned to obtain beams of about 0.8 mm2for 24-h and thermocycledmicro-tensile bond strength at 0.5 mm/min crosshead speed. Degree of conversion was evaluatedwith micro-Raman spectroscopy. Contraction gaps at 24 h after polymerization were evaluated andatomic force microscopy (AFM) nano-indentation processes were undertaken for measuring thehardness across the interface. Depth of resin penetration was studied using a scanning electronmicroscope (SEM). Bond strength data was expressed using two-way ANOVA followed by Tukey’stest. Nanoindentation hardness was separately analyzed using one-way ANOVA. Results: Factors“storage F=6.3” and “application F=30.11” significantly affected the bond strength to dentine.For Optibond FL, no significant difference in nanoleakage was found in MI/MB4 groups betweenbaseline and aged specimens; significant difference in nanoleakage score was observed in MB2 groups.Confocal microscopy analysis showed MB2 Optibond FL and Prime & Bond universal specimensdiffusing within the dentine. Contraction gap was significantly reduced in MB2 specimens in bothadhesive systems. Degree of conversion (DC) of the MB2 specimens were numerically more comparedto MS1 in both adhesive systems. Conclusion: Present study suggests that the new co-blend techniquemight have a positive effect on bond strengths of etch-and-rinse adhesives to dentine.