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Abstract: Researchers have reported false positive/negative results of the cold test in the diagnosis of pulpitis. Knowledge of the correlation between results of the cold test and proteins could aid in decreasing the frequency of incorrect diagnosis. To associate the levels of matrix metalloproteinase-8 (MMP-8) with the responses (in seconds) to the cold test in teeth diagnosed with reversible and irreversible pulpitis.A cross-sectional study was performed. A total of 150 subjects were evaluated, of which 60 subjects met the selection criteria. The participants were divided into 3 groups: Group 1, healthy pulps, 20 subjects with 20 posterior teeth (premolars) with clinically normal pulp tissue; Group 2, reversible pulpitis, 20 patients with 20 teeth diagnosed with reversible pulpitis; and Group 3, irreversible pulpitis, 20 subjects with 20 teeth diagnosed with irreversible pulpitis. All participants were evaluated based on the following variables: medical and dental history, cold test, and expression of MMP-8 by enzyme-linked immunosorbent assay in dentin samples.Responses to the cold test between 4 to 5 seconds (second evaluation; P < .0001) were associated with high levels of MMP-8 (mean, 0.36 ng/mL) in the reversible pulpitis group. In the irreversible pulpitis group, the responses from 6 to ≥10 seconds (second evaluation; P < .0001) were associated with a higher average of MMP-8 levels (mean, 1.97 ng/mL).We determined that an increase in the duration of response to the cold test was associated with an increase in MMP-8 levels (Rho = 0.81, P < .0001) in teeth with pulpitis. The above correlations can be considered an adjunct to the clinical diagnosis of pulpitis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Human dentin is a highly calcified tissue of mesenchymal origin with a heterogeneous structure. Its morphology is constantly remodelled throughout the life span of the tooth, as well as under the influence of external stimuli., Objective: The aim of the present study was to obtain information about the thermal changes in the crown and root dentin specimens of vital and devitalized teeth., Methods: The investigated samples were divided into 6 groups, depending on the patients' age and dentin location (crown, root). An additional group of endodontically treated teeth was created. The methods of choice were were combined thermal analysis (DTA-TG(DTG)-MS and gas chromatography-mass spectrometry., Results: After heating up to 1200 °C, endo- and exothermal effects were observed. The effects' dynamic was the same for all samples. The differences were in the samples' weight after the experiment, with root dentin showing the greatest mass loss percentage., Conclusions: The observed mass loss differences could be attributed to the presence of impurities in the dentin, as well as alterations in the collagen matrix. Ageing and endodontic treatment could catalyse the accumulation of such changes and affect the microstructure of the mineralized tissue.

Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To quantify the extent of crack-tip plasticity, crack opening displacement (COD) and crack bridging for crack growth perpendicular (HAH) and parallel (RAR) to the tubules in elephant dentin under both hydrated and dry conditions to better understand their influence on intrinsic and extrinsic toughening during crack growth., Methods: Compact tension test-pieces were prepared from a tusk of African elephant ivory. Crack-tip strain mapping and COD measurements by digital image correlation (DIC) technique were made under incremental loading and unloading of cracks for hydrated and dry dentin of different orientations., Results: For the RAR test-piece the plastic zones were significantly larger in the hydrated condition compared to when dry. By contrast, the plastic strains in the HAH test-piece were negligible in both wet and dry conditions. In the RAR condition the crack front was broken up into overlapping longitudinal 'fingers' with crack bridging regions in between, the ligaments extending 400μm behind the crack front in the dry case. This could only be seen in 3D by X-ray CT. Extrinsic shielding reduces the crack-tip stresses by 52% and 40% for hydrated and dry RAR test-pieces respectively. No significant bridging was found in the HAH case., Significance: For crack growth parallel to the tubules, collagen plasticity determines the intrinsic toughening, whereas microcracking from the tubules governs extrinsic shielding via ligament bridging, which is maintained further behind the crack in the hydrated case. For cracks grown perpendicular to the tubules, neither toughening mechanisms are significant., (Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

Since there is no consensus about whether starch increases the cariogenic potential of sucrose, we used a validated 3-species biofilm model to evaluate if starch combined with sucrose provokes higher root dentine demineralization than sucrose alone. Biofilms (n = 18) composed by Streptococcus mutans (the most cariogenic bacteria), Actinomces naeslundii (which has amylolytic activity), and Streptococcus gordonii (which binds salivary amylase) were formed on root dentine slabs under exposure 8 ×/day to one of the following treatments: 0.9% NaCl, 1% starch, 10% sucrose, or a combination of 1% starch and 10% sucrose. Before each treatment, biofilms were pretreated with human whole saliva for 1 min. The pH of the culture medium was measured daily as an indicator of biofilm acidogenicity. After 96 h of growth, the biofilms were collected, and the biomass, bacteria viability, and polysaccharides were analyzed. Dentine demineralization was assessed by surface hardness loss (% SHL). Biofilm bioarchitecture was analyzed using confocal laser scanning microscopy. Treatment with a starch and sucrose combination provoked higher (p = 0.01) dentine demineralization than sucrose alone (% SHL = 53.2 ± 7.0 vs. 43.2 ± 8.7). This was supported by lower pH values (p = 0.007) of the culture medium after daily exposure to the starch and sucrose combination compared with sucrose (4.89 ± 0.29 vs. 5.19 ± 0.32). Microbiological and biochemical findings did not differ between biofilms treated with the combination of starch and sucrose and sucrose alone (p > 0.05). Our findings give support to the hypothesis that a starch and sucrose combination is more cariogenic for root dentine than sucrose alone., (© 2018 S. Karger AG, Basel.)

Introduction: The aim of this study was to evaluate the efficacy of carboxymethyl chitosan (CMCS) and chitosan nanoparticles (CNps) to inactivate bacteria and prevent biofilm formation at sealer-dentin interfaces., Methods: The study was divided into 3 stages: first stage, the experiment was conducted to analyze the antibacterial properties of CMCS in different formulations against biofilms; second stage, direct-contact and membrane-restricted methods were used to evaluate the antibacterial properties of an epoxy resin (ThermaSeal Plus; Dentsply Tulsa Dental, Tulsa, OK) and calcium silicate (MTA Fillapex; Angelus SA, Londrina, PR, Brazil) based-sealers with or without CNps; and third stage, biofilm formation at the sealer dentin interfaces of root dentin treated with CMCS and filled with gutta-percha and CNp incorporated sealer were analyzed after 1- and 4-week aging periods. The samples were treated and filled as follows: (1) distilled water: unaltered sealer (control group), (2) CMCS: sealer+CNps (CMCS group), and (3) CMCS/rose bengal: sealer+CNps (CMCS/RB group). Enterococcus faecalis was used to infect all the samples. Microbiological and microscopic analyses were used to assess the antibacterial characteristics., Results: CMCS-based treatments effectively killed bacteria adherent on root dentin (P < .05). The addition of CNps to ThermaSeal enhanced its antibacterial ability by direct-contact and membrane-restricted tests (P < .05). The CNp incorporation significantly increased the antibacterial efficacy of root canal sealers even after a 4-week aging time (P < .05)., Conclusions: This study highlighted the ability of CMCS to disinfect root canal dentin and inhibit bacterial adhesion. CNps in root canal sealers are capable of maintaining their antibacterial activity even after prolonged aging., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Actinomyces naeslundii has been recovered from traumatized permanent teeth diagnosed with necrotic pulps. In this work, a triple antibiotic paste (TAP)-mimic scaffold is proposed as a drug-delivery strategy to eliminate A. naeslundii dentin biofilm., Methods: Metronidazole, ciprofloxacin, and minocycline were added to a polydioxanone (PDS) polymer solution and spun into fibrous scaffolds. Fiber morphology, mechanical properties, and drug release were investigated by using scanning electron microscopy, microtensile testing, and high-performance liquid chromatography, respectively. Human dentin specimens (4 × 4 × 1 mm(3), n = 4/group) were inoculated with A. naeslundii (ATCC 43146) for 7 days for biofilm formation. The infected dentin specimens were exposed to TAP-mimic scaffolds, TAP solution (positive control), and pure PDS (drug-free scaffold). Dentin infected (7-day biofilm) specimens were used for comparison (negative control). Confocal laser scanning microscopy was done to determine bacterial viability., Results: Scaffolds displayed a submicron mean fiber diameter (PDS = 689 ± 312 nm and TAP-mimic = 718 ± 125 nm). Overall, TAP-mimic scaffolds showed significantly (P ≤ .040) lower mechanical properties than PDS. Within the first 24 hours, a burst release for all drugs was seen. A sustained maintenance of metronidazole and ciprofloxacin was observed over 4 weeks, but not for minocycline. Confocal laser scanning microscopy demonstrated complete elimination of all viable bacteria exposed to the TAP solution. Meanwhile, TAP-mimic scaffolds led to a significant (P < .05) reduction in the percentage of viable bacteria compared with the negative control and PDS., Conclusions: Our findings suggest that TAP-mimic scaffolds hold significant potential in the eradication/elimination of bacterial biofilm, a critical step in regenerative endodontics., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the incidence of apical crack initiation and propagation in root dentin after several endodontic procedures., Methods: Sixty intact mandibular premolars were sectioned perpendicular to the long axis at 1 mm from the apex, and the apical surface was polished. Thirty teeth were left unprepared and served as a control, and the remaining 30 teeth were instrumented with ProTaper Universal instruments (Dentsply Maillefer, Ballaigues, Switzerland) up to size F5. The root canals were filled with the single-cone technique. Gutta-percha was removed with drills of the Rebilda post system (VOCO, Cuxhaven, Germany). Glass fiber-reinforced composite fiber posts were cemented using a dual-cure resin cement. The fiber posts were removed with a drill of the post system. Retreatment was completed after the removal of the gutta-percha. Crack initiation and propagation in the apical surfaces of the samples were examined with a stereomicroscope after each procedure. The absence/presence of cracks was recorded. Logistic regression was performed to analyze statistically the incidence of crack initiation and propagation with each procedure., Results: The initiation of the first crack and crack propagation was associated with F2 and F4 instruments, respectively. The logistic regression analysis revealed that instrumentation and F2 instrument significantly affected apical crack initiation (P < .001). Post space preparation had a significant effect on crack propagation (P = .0004). The other procedures had no significant effects on crack initiation and propagation (P > .05)., Conclusions: Rotary nickel-titanium instrumentation had a significant effect on apical crack initiation, and post space preparation with drills had a significant impact on crack propagation., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the incidence of root cracks after root canal instrumentation with the TF Adaptive, WaveOne, ProTaper Next, and ProTaper Universal systems., Methods: Seventy-five extracted mandibular central incisors with mature apices and straight root canals (<5°) were selected and kept in distilled water. The root canals were instrumented by using the ProTaper Universal, ProTaper Next, WaveOne, and TF Adaptive systems. All the roots were horizontally sectioned 3, 6, and 9 mm from the apex with a low-speed saw under water cooling. The slices were then viewed through a stereomicroscope at ×25 magnification. The samples were photographed with a camera to determine the presence of dentinal cracks., Results: The control group had no cracks, and the difference between the control group and the experimental groups was statistically significant (P < .001). The ProTaper Next and TF Adaptive systems produced significantly less cracks than the ProTaper Universal and WaveOne systems in the apical section (3 mm) (P < .05)., Conclusions: Under the study conditions and within the limitations of this study, it can be concluded that the ProTaper Universal, ProTaper Next, WaveOne, and TF Adaptive instruments can result in dentinal cracks., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this prospective clinical study was to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at 1-year and 3-year follow-up period., Methods: One hundred fifty-five teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm head diameter light-emitting diode microscope diagnostic probe light. After inspection, root-end preparations were performed using ultrasonic tips, and root-end fillings were placed. Follow-up visits occurred at 1 year and 3 years postoperatively. The primary outcome measure used was the change in the radiographic apical bone density, and the secondary outcome measure used was the absence of clinical symptoms., Results: Of the 155 treated teeth, a total of 134 teeth were assessed at the 1-year follow-up and 127 teeth at the 3-year evaluation. In the "intact" group, 94.8% healed at 1 year, and 97.3% healed at 3 years. In the "dentinal defect" group, 29.8% healed at 1 year, and 31.5% healed at 3 years. The baseline root condition of either "dentinal defect" or "intact" showed a statistical difference in the healing outcome at both 1 and 3 years., Conclusions: This prospective periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared with roots with dentinal defects at both 1 year and at 3 years postoperatively., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Unlabelled: The purpose of this study was to investigate the mechanical properties of intertubular dentin in sound, natural caries-affected (NCAD) and artificial caries-affected dentin (ACAD) using nanoindentation., Materials and Methods: Non-caries molars and caries molars with International Caries Detection and Assessment System (ICDAS II) score 5 at the occlusal site were used and caries was excavated using a spoon excavator, a round bur at low speed without water and a dye solution as guidance to detect the infected tissue. Specimens with remaining dentin thickness (RDT) >2mm were selected. ACAD teeth were created from sound teeth over 7 days in a demineralizing solution. Specimens were embedded into plastic rings with acrylic resin and then sagittal mesial-distal sectioned from crown to the long axis of the root under cooling water using a low-speed diamond blade. The surface of interest was fine polished sequentially. Hardness measurement was performed within an axial depth of 1000μm with at least of 320 indentations on each sample. Mann-Whitney U Test was used to compare the hardness as the variable among different dentin types (SOUND, NCAD and ACAD) at each dentin depth level., Results: There was no significant difference in nanohardness between NCAD and ACAD up to a depth of 130μm (p>0.05). NCAD consistently showed lower hardness. ACAD showed no significant difference in hardness with SOUND dentin beyond 190μm (p<0.05). The lesion front in ACAD was considered to be located around the depth of 180μm., Conclusion: Natural and artificial caries-affected dentin tissues were superficially comparable in intertubular nanohardness. There is a certain layer within the natural caries-affected dentin with higher hardness; however the long-term effects of caries beneath the lesion extend deeply through intertubular dentin. Sound dentin at deep areas (close to the pulp chamber) is considered to be soft., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to evaluate some physical-mechanical and morphological changes of demineralised dentine at early stages of dentine remineralisation., Methods: Extracted human third molars were sectioned to obtain dentine discs. After polishing the dentine surfaces, three groups were established: (1) untreated dentine - UD, (2) 37% phosphoric acid application for 15s (partially demineralised dentine - PDD) and (3) 10% phosphoric acid for 12h, at 25°C (totally demineralised dentine - TDD). Five different remineralizing fluids were used for 30min: chlorhexidine (CHX), artificial saliva (AS), phosphated solution (PS), ZnCl2 and ZnO solutions. Atomic force microscopy (AFM) imaging/nano-indentation, surface nano-roughness and fibrils diameter were determined. X-ray diffraction (XRD), energy dispersive elemental analyses (EDX) and high resolution scanning electron microscopy analysis (HRSEM) were applied., Results: PDD and TDD preserved some mineral contents. After demineralisation and immersion in all solutions, width of nanomechanical properties and fibrils was increased, and total nanoroughness was decreased. Peritubular and intertubular dentine were remineralised., Conclusion: Mineral exists in PA-demineralised dentine matrix and it is important since it may work as a constant site for further nucleation. The dentine surface remineralisation process may be stimulated as early as 30min in abiotic conditions, with a pH ranging from 7.0 to 7.5., Clinical Significance: The existence of enzymes and remineralising factors within the dentine matrix may facilitate early dentine remineralisation under favourable conditions. This process should be stimulated by new reparative materials., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: This study investigates the potential of a novel guided tissue regeneration strategy, using fully demineralized dentin infiltrated with silica and hydroxyapatite (HA) nanoparticles (NPs), to remineralize dentin collagen that is completely devoid of native hydroxyapatite., Methods: Dentin blocks were fully demineralized with 4N formic acid and subsequently infiltrated with silica and HA NPs. The remineralizing potential of infiltrated dentin was assessed following a twelve week exposure to an artificial saliva solution by means of TEM, EDS and micro-CT. Measurements were taken at baseline and repeated at regular intervals for the duration of the study to quantify the P and Ca levels, the mineral volume percentage and mineral separation of the infiltrated dentin specimens compared to sound dentin and non-infiltrated controls., Results: Infiltration of demineralized dentin with nano-HA restored up to 55% of the P and Ca levels at baseline. A local increase in the concentration of calcium phosphate compounds over a period of twelve weeks resulted in a higher concentration in P and Ca levels within the infiltrated specimens when compared to the non-infiltrated controls. Remineralization of demineralized dentin with silica NPs by immersion in artificial saliva was the most effective strategy, restoring 20% of the P levels of sound dentin. Micro-CT data showed a 16% recovery of the mineral volume in dentin infiltrated with silica NPs and a significant decrease in the mineral separation to levels comparable to sound dentin., Significance: Demineralized dentin infiltrated with silica NPs appears to encourage heterogeneous mineralization of the dentin collagen matrix following exposure to an artificial saliva solution., (Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Several studies have reported the mechanism of crack propagation with aging. Although structural modifications of dentinal microcracks with aging have been evaluated by observing the cracked surface using scanning electron microscope (SEM), very few attempts have been made at sectional observation of the microcracks inside dentine using transmission electron microscopy (TEM). The objectives of this study were to: (1) examine the process of dentinal microcrack formation using TEM and (2) to morphologically evaluate the relation between dentinal microcrack propagation and human aging. Molars from 'young' (16-28 years) and 'aged' (62-76 years) subjects were evaluated. Dentine blocks were cracked with an indenter and sectioned using a diamond knife and ultramicrotome after embedding in epoxy resin. Microcracks were observed by TEM and ultra-high-voltage electron microscope tomography to determine the characteristics of crack propagation in the young and aged teeth. The results show that, in young teeth, crack propagation tended to pass through the dentinal tubules, while in aged teeth, it tended to deflect to the outer side of peritubular dentine (PTD), especially in coronal dentine. The advantage of this method is that it allows visualization and evaluation of the ultrastructural propagation of microcracks in dentine. The differences in crack propagation between young and aged dentine could be explained by differences in PTD thickness.

Tissue-nonspecific alkaline phosphatase (TNAP) is expressed in mineralizing tissues and functions to reduce pyrophosphate (PP(i) ), a potent inhibitor of mineralization. Loss of TNAP function causes hypophosphatasia (HPP), a heritable disorder marked by increased PP(i) , resulting in rickets and osteomalacia. Tooth root cementum defects are well described in both HPP patients and in Alpl(-/-) mice, a model for infantile HPP. In Alpl(-/-) mice, dentin mineralization is specifically delayed in the root; however, reports from human HPP patients are variable and inconsistent regarding dentin defects. In the current study, we aimed to define the molecular basis for changes in dentinogenesis observed in Alpl(-/-) mice. TNAP was found to be highly expressed by mature odontoblasts, and Alpl(-/-) molar and incisor roots featured defective dentin mineralization, ranging from a mild delay to severely disturbed root dentinogenesis. Lack of mantle dentin mineralization was associated with disordered and dysmorphic odontoblasts having disrupted expression of marker genes osteocalcin and dentin sialophosphoprotein. The formation of, initiation of mineralization within, and rupture of matrix vesicles in Alpl(-/-) dentin matrix was not affected. Osteopontin (OPN), an inhibitor of mineralization that contributes to the skeletal pathology in Alpl(-/-) mice, was present in the generally unmineralized Alpl(-/-) mantle dentin at ruptured mineralizing matrix vesicles, as detected by immunohistochemistry and by immunogold labeling. However, ablating the OPN-encoding Spp1 gene in Alpl(-/-) mice was insufficient to rescue the dentin mineralization defect. Administration of bioengineered mineral-targeting human TNAP (ENB-0040) to Alpl(-/-) mice corrected defective dentin mineralization in the molar roots. These studies reveal that TNAP participates in root dentin formation and confirm that reduction of PP(i) during dentinogenesis is necessary for odontoblast differentiation, dentin matrix secretion, and mineralization. Furthermore, these results elucidate developmental mechanisms underlying dentin pathology in HPP patients, and begin to explain the reported variability in the dentin/pulp complex pathology in these patients., (Copyright © 2013 American Society for Bone and Mineral Research.)

Objective: To analyze the effect of different combinations of post and core materials on stress distribution in dentin of an endodontically treated tooth., Materials and Methods: This was an experimental stress analysis study. Models were made in photoelastic material, i.e., epoxy resin. Different combinations of post and core materials used were: Glass fiber post with composite core, stainless steel post with composite core, and cast metal post and core. Stresses generated were frozen, models were sliced and viewed under circular polariscope, and photographs were taken. Stress was calculated by counting the number of fringes., Results: For the combination of glass fiber post with composite core, the shear stresses calculated were 1.196, 1.196, and 2.898 MPa in the apical, mid-root, and cervical region, respectively. For the combination of stainless steel post with composite core, the apical, mid-root and cervical stresses were 1.534, 0.511, and 2.557 MPa, respectively. For cast metal post and core, the apical, mid-root, and cervical stresses were 0.852, 0.511, and 1.534 MPa, respectively., Conclusion: The cervical region of the teeth is subjected to the highest stresses irrespective of the material used. The stainless steel post with the composite core generated the highest stress concentration in different regions. A glass fiber post generated a uniform stress distribution. A cast metal post and core combination generated lesser stress than the other combinations. The vast difference in the elastic modulus of the restorative materials can lead to nonuniform stress distribution and concentration of stresses in different areas which can have deleterious effect on the survival of already compromised teeth and restoration. Such combinations should be avoided and the material which has an elastic modulus close to that of dentin should be preferred.

This study aimed to investigate an artificial caries-affected dentin (ACAD) model for in vitro bonding studies in comparison to natural caries-affected dentin (NCAD) of human teeth. ACAD was created over 7 days in a demineralizing solution. Mineral density (MD) at different depth levels (0-150 µm) was compared between NCAD and ACAD by transverse microradiography. Micro-tensile bond strengths (µTBS) of two two-step self-etch adhesives to sound dentin, NCAD and ACAD were evaluated. Caries-affected dentin type was not a significant factor when comparing MD at different lesion levels (p>0.05). Under SEM, the dentinal tubules appeared occluded with crystal logs 1-2 µm in thickness in the NCAD; whereas they remained open in the ACAD. The µTBS to caries-affected dentin was lower than sound dentin, but was not affected by the type of caries (p>0.05). In spite of their different morphologies, the ACAD model showed similar MD and µTBS compared to NCAD.

Purpose: To examine morphologically the hybrid layer of one-step self-etching adhesive, Clearfil S3 Bond (S3bond), in caries-affected dentin (CAD) and deep sound dentin (DSD) cavities performed clinically. For a comparative group, the two-step self etching adhesive Clearfil Protect Bond (Pbond) was used in a similar clinical situation., Methods: This study was carried out on carious and sound teeth clinically selected for extraction. In carious teeth, CAD was obtained by way of subjective criteria by removing infected tissue to form a cavity bottom. DSD was obtained at a depth of 4 mm in the dentin cavity of sound teeth. S3bond and Pbond were applied in the CAD and DSD cavities as indicated by the manufacturer, followed by a composite restoration. Teeth were extracted about 20 minutes after the bonding procedure, and processed for TEM analysis., Results: Expression of S3bond in CAD was morphologically highly variable. When affected tubules were occluded by intratubular mineralized deposits, the interface displayed a dense poly-HEMA hydrogel as water sorption by the hydrophilic S3bond toward the porous affected collagen. Conversely, when tubules appeared empty, voids of various sizes were formed by tubular fluid shift. In DSD, S3bond clearly exhibited voids and water channels as signs of the high permeability of the sub-surface. Although porosities were somewhat retained, Pbond expression showed a hermetic character which was independent of the dentin substrate.

Context: In dental practice, dentin hypersensitivity is a commonly presenting condition, which consists of sharp pain arising from exposed dentin in response to a varied assortment of stimuli; for example, dietary factors, such as an ice-cold beverage, to even environmental considerations, such as the exposure to atmospheric air on a cold winter's day. The heterogeneity of this presentation, ranging from minor inconvenience to the patient, to a near incapacitating quality-of-life disturbance, as well as the wide range of treatment strategies, as is discussed in this article, certainly pose a challenge to the clinician., Evidence Acquisition: A search was performed on the MEDLINE database (2002 to present) by way of OVID. Search terms, such as dentin hypersensitivity and variants (eg, dentinal hypersensitivity, cervical dentin hypersensitivity) were used. Select references of review-type articles from the original search were sought., Evidence Synthesis: Efforts were made to identify multiple comparative clinical treatment studies that were of highest quality study design-specifically, randomized control trials. Efforts also were made to identify rigorous meta-analysis in the literature on the subject of dentin hypersensitivity treatment., Conclusion: Although multiple treatment approaches appear to provide clinical success in managing dentin hypersensitivity, the entire body of clinical research literature is far from being unequivocal in pronouncing one superior strategy. Equally as important is the clinician's consideration of the predisposing factors that initially localized the lesion on the tooth surface. Together, personalized preventive measures and therapies focusing on disrupting pathophysiology form the core of effective dentin hypersensitivity management., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The management of demineralized dentin resulting from dental caries or acid erosion remains an oral healthcare clinical challenge. This paper investigates, through a range of studies, the ability of colloidal silica and hydroxyapatite (HA) nanoparticles to infiltrate the collagen structure of demineralized dentin., Methods: Dentin samples were completely demineralized in 4 N formic acid. The remaining collagen matrix of the dentin samples was subsequently infiltrated with a range of nano-particulate colloidal silica and HA solutions. The effectiveness and extent of the infiltration was evaluated by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDS)., Results: Silica nanoparticles have the ability to penetrate dentin and remain embedded within the collagen matrix. It is suggested that particle size plays a major role in the degree of dentin infiltration, with smaller diameter particles demonstrating a greater infiltrative capacity. The infiltration of demineralized dentin with sol-gel HA nanoparticles was limited but was significantly increased when combined with the deflocculating agent sodium hexametaphosphate. The use of acetone as a transport vehicle is reported to enhance the infiltration capacity of sol-gel HA nanoparticles., Significance: Collagen infiltrated with HA and silica nanoparticles may provide a suitable scaffold for the remineralization of dentin, whereby the infiltrated particles act as seeds within the collage matrix and given the appropriate remineralizing environment, mineral growth may occur., (Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Dental erosion is the non-carious dental substance loss induced by direct impact of exogenous or endogenous acids. It results in a loss of dental hard tissue, which can be serious in some groups, such as those with eating disorders, in patients with gastroesophageal reflux disease, and also in persons consuming high amounts of acidic drinks and foodstuffs. For these persons, erosion can impair their well-being, due to changes in appearance and/or loss of function of the teeth, e.g., the occurrence of hypersensitivity of teeth if the dentin is exposed. If erosion reaches an advanced stage, time- and money-consuming therapies may be necessary. The therapy, in turn, poses a challenge for the dentist, particularly if the defects are diagnosed at an advanced stage. While initial and moderate defects can mostly be treated non- or minimally invasively, severe defects often require complex therapeutic strategies, which often entail extensive loss of dental hard tissue due to preparatory measures. A major goal should therefore be to diagnose dental erosion at an early stage, to avoid functional and esthetic impairments as well as pain sensations and to ensure longevity of the dentition.

Objectives: Dental tissue disease and trauma provides an excellent model for the interaction between tissue defence and regenerative processes and has application to many of the body's other tissues. Following dental tissue infection, characterised by caries, the molecular and cellular mediators of the immune/inflammatory processes clearly impact on the dental tissues' natural regenerative responses. This review of the literature was performed to better understand how these two processes interact and identify whether cross-talk may provide novel areas for future research and subsequent translation into clinical application., Data and Sources: A review of the literature was performed using the PubMed database resource and this was followed by extensive hand searching using reference lists from relevant articles., Conclusions: Frequently, the dental tissue inflammatory and regenerative processes are seen as both distinct and antagonistic and subsequently have often been studied in isolation; however, both direct and indirect data are now emerging which indicate significant inter-relationship. Whilst the ensuing inflammatory process will result in dental tissue breakdown and molecular signalling which may impede regeneration, low grade inflammation, potentially induced by mechanical trauma and tissue necrosis, may promote regenerative mechanisms, including angiogenic and stem cell processes. Notably, the locally derived growth factors, neuropeptides, cytokines and chemokines, released from the host dentine matrix and by resident pulpal cells, immune cells, neurons and/or dying cells, will modulate defence and repair processes within the tissue., (Copyright 2010 Elsevier Ltd. All rights reserved.)

High energy X-ray scattering (80.7keV photons) at station 1-ID of the Advanced Photon Source quantified internal strains as a function of applied stress in mature bovine tooth. These strains were mapped from dentin through the dentinoenamel junction (DEJ) into enamel as a function of applied compressive stress in two small parallelepiped specimens. One specimen was loaded perpendicular to the DEJ and the second parallel to the DEJ. Internal strains in enamel and dentin increased and, as expected from the relative values of the Young's modulus, the observed strains were much higher in dentin than in enamel. Large strain gradients were observed across the DEJ, and the data suggest that the mantle dentin-DEJ-aprismatic enamel structure may shield the near-surface volume of the enamel from large strains. In the enamel, drops in internal strain for applied stresses above 40MPa also suggest that this structure had cracked., (2010 Elsevier Ltd. All rights reserved.)

The purpose of this study was to investigate the strain and temperature change in dentin induced by laser irradiation of human root canals with or without water cooling. Twenty-eight palatal roots of extracted human maxillary first molars were used. The strain in dentin was measured using strain gauges fixed on the apical third of the buccal root surface. The temperature change of the root dentin was monitored using thermocouples embedded into dentin near the apex. The root canal was irradiated with Er:YAG or Nd:YAG laser at an output of 1 W (100 mJ, 10 pps) for 5 s. The tip of the irradiation fibre was located 2.0 mm from the root apex. With water cooling, the mean maximum strain induced by Er:YAG laser was significantly lower than that by Nd:YAG laser (P < 0.05). However, without water cooling, no significant difference between the two lasers (P > 0.05) was found. The results suggest that the strain induced by Er:YAG laser irradiation in dentin with water cooling may be minimal, but there still might be a risk of root micro-fracture if cooling is not sufficient.

Objective: To investigate the role of dentinal tubules in the fracture properties of human root dentin and whether resin-filled dentinal tubules can enhance fracture resistance., Materials and Methods: Crack propagation in human root dentin was investigated in 200 microm thick longitudinal samples and examined by light and scanning electron microscopy. 30 maxillary premolar teeth were prepared for work of fracture (Wf) test at different tubule orientations, one perpendicular and two parallel to dentinal tubules. Another 40 single canal premolars were randomly divided into four groups of 10 each: intact dentin, prepared but unobturated canal, canal obturated with epoxy rein (AH Plus/gutta percha), or with UDMA resin sealer (Resilon/RealSeal. The samples were prepared for Wf test parallel to dentinal tubules. Wf was compared under ANOVA with statistical significance set at p<0.05., Results: Dentinal tubules influenced the path of cracks through dentin, with micro-cracks initiated in peritubular dentin of individual tubules ahead of the main crack tip. A significant difference (p<0.001) was found between Wf perpendicular to tubule direction (254.9 J/m(2)) vs. parallel to tubule direction from inner to outer dentin (479.4 J/m(2)). Neither canal preparation nor obturation using epoxy- or UDMA-based resins as sealer cements substantially influenced fracture properties of root dentin, despite extensive infiltration of dentinal tubules by both sealer cements.

Dentin, the mineralized tissue forming the bulk of the tooth, serves as an energy-absorbing cushion for the hard, wear-resistant enamel and protects the inner soft tissues. Several studies used fracture mechanics methods to study the fracture toughness of dentin. However, all of them utilized precracks and cannot be used to estimate the intrinsic critical flaw size of dentin. We applied quantitative fractography to study the fracture pattern and fracture toughness of human dentin. Sixteen specimens were prepared from the coronal dentin and fractured in three-point flexure. Fracture surfaces were examined using a scanning electron microscope and the fracture toughness was calculated using a fracture mechanics equation. It was found that human dentin has a fracture surface similar to those of brittle materials. Twist hackle markings were observed and were used to identify the fracture origins. Average fracture toughness of all specimens was found to be 2.3 MPa m(1/2) and the average critical flaw size was estimated to 120 mum. It is suggested that fractography is a promising technique in analyzing the fracture of dentin under catastrophic failure.

An evaluation of the crack growth resistance of human coronal dentin was performed on tissue obtained from patients between ages 18 and 83. Stable crack extension was achieved over clinically relevant lengths (0< or = a < or =1mm) under Mode I quasi-static loading and perpendicular to the nominal tubule direction. Results distinguished that human dentin exhibits an increase in crack growth resistance with extension (i.e. rising R-curve) and that there is a significant reduction in both the initiation (K(o)) and plateau (K(p)) components of toughness with patient age. In the young dentin (18< or =age< or =35) there was a 25% increase in the crack growth resistance from the onset of extension (K(o)=1.34 MPa m(0.5)) to the maximum or "plateau" toughness (K(p)=1.65 MPa m(0.5)). In comparison, the crack growth resistance of the old dentin (55< or =age) increased with extension by less than 10% from K(o)=1.08 MPa m(0.5) to K(p)=1.17 MPa m(0.5). In young dentin toughening was achieved by a combination of inelastic deformation of the mineralized collagen matrix and microcracking of the peritubular cuffs. These mechanisms facilitated further toughening via the development of unbroken ligaments of tissue and posterior crack-bridging. Microstructural changes with aging decreased the capacity for near-tip inelastic deformation and microcracking of the tubules, which in turn suppressed the formation of unbroken ligaments and the degree of extrinsic toughening.

Purpose: The purpose of this study was to investigate dentin rehardening in the remaining carious dentin after indirect pulp treatment (IPT) using microhardness analysis after 37 to 71 months., Methods: Eighteen teeth submitted to IPT and capped with calcium hydroxide (CH) or gutta-percha (GP) were evaluated (treated group). Ten sound molars and 10 molars with deep acute carious lesions were selected to serve as positive and negative control groups, respectively. In the treated group, restorations and pulp-capping materials were removed. In the positive control group, 3- to 4-mm deep cavities were prepared. In the negative control group, the carious tissue was removed. Microhardness analysis was performed at 10-, 35-, 60-, 85-, and 110-microm depths. Data were analyzed using 1-way analysis of variance (P<.05)., Results: Microhardness values for sound, carious, and treated groups at 10-, 35-, 60-, 85-, and 110-microm depths showed a statistically significant difference (P

Erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers are currently being investigated for disinfecting the root canal system. Prior to using laser therapy, it is important to understand the temperature distribution and to assess thermal damage to the surrounding tissue. In this study, a theoretical simulation using the Pennes bioheat equation is conducted to evaluate how heat spreads from the canal surface using an Er,Cr:YSGG laser. Results of the investigation show that some of the proposed treatment protocols for killing bacteria in the deep dentin are ineffective, even for long heating durations. Based on the simulation, an alternative treatment protocol is identified that has improved effectiveness and is less likely to introduce collateral damage to the surrounding tissue. The alternative protocol uses 350 mW laser power with repeating laser tip movement to achieve bacterial disinfection in the deep dentin (800 microm lateral from the canal surface), while avoiding thermal damage to the surrounding tissue (T<47 degrees C). The alternative treatment protocol has the potential to not only achieve bacterial disinfection of deep dentin but also shorten the treatment time, thereby minimizing potential patient discomfort during laser procedures.

Aim: To determine whether resin-based sealer cements are able to strengthen root dentine, as measured by work of fracture (Wf), micro-punch shear strength (MPSS) and resistance to vertical root fracture (VRF)., Methodology: One hundred and twenty extracted premolar teeth were randomly assigned amongst four treatments before testing: intact, root canals prepared but unfilled, or root filled using epoxy- or urethane dimethacrylate (UDMA)-based sealer (plus core material). Samples were then prepared for measuring Wf, MPSS or VRF using standard test procedures. Data were analyzed using one-way anova with significance set at P < 0.05., Results: For all three tests, root canals filled using epoxy resin-based sealer were not statistically significantly different compared with UDMA resin (P = 1 for Wf, P = 0.7 for MPSS and P = 0.12 for VRF), or different from both sound and prepared dentine (P > 0.05). There was also no significant difference between sound dentine and prepared dentine for both Wf (P = 0.92) and resistance to VRF (P = 1)., Conclusions: Neither epoxy nor UDMA resins used as sealer cements enhanced fracture resistance of root dentine when placed within root canals of extracted teeth.

Objective: Previous in vitro studies have described the wear characteristics of specimens in which enamel has been opposed to enamel and dentine opposed to dentine. The aim of this study was to assess the characteristics of wear between specimens in which enamel was opposed to dentine at loads simulating attrition and at pH values simulating different erosive environments. It was hypothesized that enamel would wear more slowly than dentine under all conditions., Design: Opposing enamel and dentine specimens from 57 human third molar teeth were worn in electromechanical machines with various loads (32, 62 and 100 N) and lubricants (pH 1.2, 3.0 and 6.1). Tooth wear was quantified by measuring reduction in dentine volume over time using a 3D profilometer. Qualitative assessment was also carried out using scanning electron microscopy., Results: Dentine wear increased with increasing load, and dentine wear was faster at pH 1.2 than at pH 3.0 or 6.1 for all loads tested. Interestingly, enamel wore more rapidly than dentine at pH 1.2 under all loads. At pH values of 3.0 and 6.1, enamel wear rates were not measurably different from zero and they were less than wear rates for opposing dentine specimens at all loads. Micrographic assessment showed extensive surface destruction of dentine wear facets due to erosion at pH 1.2. Dentine wear facets were smoother at pH 3.0 that at pH 6.1., Conclusions: When enamel wears against dentine in an acidic environment enamel will wear more rapidly at very low pH, while under less acid conditions dentine will wear faster than enamel.

Objectives: To evaluate the longevity of sound (SD) and caries-affected dentin (CAD) bonds made with etch-and-rinse and self-etching adhesives after a 6-month water-storage period, using bond strength and morphological evaluations., Methods: Extracted human molars with coronal carious lesions were selected. Flat surfaces of CAD surrounded by SD were bonded with etch-and-rinse (Adper Scotchbond 1) or with self-etching (Clearfil Protect Bond and AdheSE) adhesives. Trimmed resin-dentin bonded interfaces (1mm2) were stored in distilled water for 24h or 6 months and subjected to microtensile bond strength (microTBS) evaluation. The quality of the dentin beneath fractured specimens was measured by Knoop microhardness (KHN). ANOVA and multiple comparisons tests were used (P<0.05). Fractographic analysis and interfacial nanoleakage evaluation were performed by scanning electron microscopy (SEM). Resin-dentin bonded sections (10microm thick) were stained with Masson's trichrome and examined using light microscopy. Collagen exposure and adhesive penetration were examined qualitatively., Results: microTBS to SD was significantly higher than that to CAD for all bonding agents. Bonds made with AdheSE were weaker than the other adhesives after 6-months storage regardless of the dentin substrate. CAD bonded specimens presented a significant muTBS decrease over time. Lower KHN was recorded in CAD compared to SD. An increase in the exposed collagen zone and a decrease in the quality of the adhesive infiltration were observed in CAD interfaces., Significance: CAD bonded interfaces are more prone to hydrolytic degradation than SD bonds. Additionally, as compared to SD, there were remarkable differences in depth of demineralization, adhesive infiltration and interfacial bond strength with CAD.

The purpose of this study was to compare the temperature rise under normal and caries-affected primary tooth dentin during photopolymerization of two adhesives and resin-containing restorative materials. Caries-affected and normal dentin disks were prepared from extracted primary molars with only mesial or distal approximal caries (4 mm in diameter, 1 mm in height). Temperature rise during photopolymerization of adhesive materials was measured with a J-type thermocouple wire that was connected to a data logger. Data were analyzed with two-way ANOVA and independent samples t-test. Temperature rise under caries-affected primary tooth dentin disks was higher than that of normal primary tooth dentin disks during polymerization of both adhesive systems and resin-containing dental materials (p < 0.05). It was found that adhesive systems induced a higher temperature rise during polymerization as compared to the resin-containing restorative materials (p < 0.05). In particular, temperature rise during polymerization of adhesive materials exceeded 5.5 degrees C under caries-affected primary tooth dentin.

Reconstitution of carious dentin has been recognized as difficult, because it progresses by loss of collagen polymerization and by demineralization under acidic conditions. Recently, colloidal alkaline nano-calcium phosphate, prepared by electrical discharge in a buffered physiological saline solution, has been shown to be effective in the formulation of a bone-like biocomposite by simply being mixed with acidic collagen solution. It was hypothesized that colloidal calcium phosphate was suitable for the reconstitution of carious dentin. Natural caries lesions in dentin from permanent teeth were exposed to colloidal hydroxyapatite and beta-tricalcium phosphate for 10 days. The micromechanical properties of these tissues were evaluated by nano-indentation. The elastic modulus of human carious dentin improved after samples were immersed in colloidal beta-tricalcium phosphate. The mineral density of carious dentin exposed to beta-tricalcium phosphate increased more than that immersed in hydroxyapatite. However, since it was not directly proportional to micromechanical recovery, mineral density alone was not a sufficient indicator of mechanical behavior.

Objective: To determine the relationship between pain intensity and the rate of fluid flow through dentine in human subjects., Design: The experiments were carried out on 16 premolars in 13 human subjects (aged 15-25 years). Dentine was exposed at the tip of the buccal cusp, etched with acid and covered with saline. A series of 5 s hydrostatic pressure stimuli between 400 mmHg above and 400 mmHg below atmospheric were applied to the dentine, in steps of 50 mmHg. The subject indicated the intensity of any pain produced on a visual analogue scale (VAS). The fluid flow through dentine during application of the same stimuli was measured in vitro within 3 h after tooth extraction., Results: The median pain threshold with negative (subatmospheric) stimuli was -125 mmHg and, with positive pressure stimuli, 200 mmHg, which corresponded to dentinal fluid flow rates of 3.29 nL/(s mm(2)) exposed dentine and 5.75 nL/(s mm(2)), respectively. Both the median pressure and the mean rate of flow at threshold with negative pressures were significantly lower than with positive pressures. The curves relating VAS score to stimulus intensity were similar with both negative and positive pressures., Conclusion: The sensory transduction mechanism for pain in human teeth is more sensitive to outward than inward flow through dentinal tubules. The difference in sensitivity was however much less than that of the hydrodynamic receptors in the cat, which respond very much more strongly to negative than positive pressure stimuli.

Aim: To investigate the fracture resistance and fracture patterns of teeth restored with composite cores supported by different pre-fabricated post systems and different heights of remaining coronal dentine., Methodology: Four groups of 30 single rooted teeth were used. Each group was divided into three subgroups of 10 teeth each and restored with carbon fibre, glass fibre, or Radix titanium posts luted with dual cure resin cement. The control group A had no retained coronal dentine. Groups B, C and D had 2, 3 and 4 mm of retained buccal and lingual coronal dentine, respectively. Teeth were tested to failure using an Instron Universal Testing Machine. Subsequently, the fracture mode of specimens was recorded., Results: Teeth with retained dentine were more resistant to fracture (P = 0.001). Tooth fracture resistance was not significantly different between groups B, C and D. Within group A, titanium posts were associated with higher fracture resistance than fibre posts. Within the other groups, tooth fracture resistance was not related to post material. Within groups C and D, fracture resistance of teeth restored with carbon fibre posts was significantly higher than those restored with glass fibre posts. The dominant fracture mode in group A was core and vertical oblique root fracture whilst a combination of core, coronal dentine and root fracture occurred in the other groups., Conclusions: Fracture resistance of teeth increased with the presence of retained coronal dentine. The use of glass and carbon fibre posts did not improve the fracture resistance or the fracture pattern of teeth when compared with metal titanium posts regardless of the presence of retained coronal dentine. The dominant fracture pattern of teeth was not related to the amount of retained dentine if it was >2 mm high.

Mice harboring the Col1a2(oim) mutation (oim) express dentinogenesis imperfecta. To determine the effect of Col1a2 genotype on tissue mechanical properties, we compared Young's modulus and hardness of dentin in the 3 Col1a2 genotypes. Upper incisors were tested by nanoindentation. Genotype had a significant effect on Young's modulus, but there was not a simple mutant allele dosage relationship. The effect of genotype on hardness did not reach significance. Hardness and Young's modulus were greater near the dento-enamel junction than near the pulp chamber. Greater hardness and Young's modulus values near the dento-enamel junction reflected continued mineralization of the dentin following its initial synthesis. Analysis showed the mechanical data to be consistent with Fourier transform infrared and backscattered electron microscopy studies that revealed increased mineralization in oim bone. Analysis of the data suggests that clinical fragility of teeth in oim mice is not due to deficiencies of hardness or Young's modulus, but may be due to defects in post-yield behavior or resistance to fatigue damage.

A preliminary study of the effects from age and dehydration on fatigue crack growth in human dentin was conducted. Compact tension (CT) fatigue specimens of coronal dentin were prepared from extracted molars and subjected to high cycle fatigue (10(5)

Dentinogenesis imperfecta (DGI) and dentin dysplasia (DD) are allelic disorders that primarily affect the formation of tooth dentin. Both conditions are autosomal-dominant and can be caused by mutations in the dentin sialophosphoprotein gene (DSPP, 4q21.3). We recruited 23 members of a four-generation kindred, including ten persons with dentin defects, and tested the hypothesis that these defects are linked to DSPP. The primary dentition showed amber discoloration, pulp obliteration, and severe attrition. The secondary dentition showed either pulp obliteration with bulbous crowns and gray discoloration or thistle-tube pulp configurations, normal crowns, and mild gray discoloration. Haplotype analyses showed no recombination between three 4q21-q24 markers and the disease locus. Mutational analyses identified no coding or intron junction sequence variations associated with affection status in DMP1, MEPE, or the DSP portion of DSPP. The defects in the permanent dentition were typically mild and consistent with a diagnosis of DD-II, but some dental features associated with DGI-II were also present. We conclude that DD-II and DGI-II are milder and more severe forms, respectively, of the same disease.

This study evaluated the stress distribution on an endodontically treated maxillary central incisor restored with different post-and-core systems by using a three-dimensional finite element analysis model. Seven three-dimensional finite element models were created. Each model contained cortical bone, cancelous bone, periodontal ligament, 3 mm apical root canal filling, post-and-core and all-ceramic crowns. Two different pre-fabricated zirconia ceramic post systems, a glass fiber-reinforced post system and a titanium post system were modeled. As a control, an all-ceramic crown on an endodontically treated maxillary central incisor without a post-and-core was modeled. Each model received a 45 degrees oblique occlusal load at a constant intensity of 100 N. In each model, the ratio of Von Mises stress distribution was compared. The greatest stresses were observed in the coronal third of the roots on facial surfaces. The ratio of Von Mises stress distribution in dentin for the zirconia ceramic post (CosmoPost) and ceramic core (Cosmo Ingot), zirconia ceramic post (CosmoPost) and composite core (Tetric Ceram), glass fiber-reinforced post (FRC Postec) and composite core (Tetric Ceram), titanium post (Er post) and composite core (Tetric Ceram), zirconia ceramic post (Cerapost) and ceramic core (Cosmo Ingot), zirconia ceramic post (Cerapost) and composite core (Tetric Ceram) and the control group were 0.886, 0.889, 0.988, 0.924, 0.889, 0.893 and 1, respectively. The stress concentrations in dentin created by two different zirconia ceramic post systems were nearly the same. The zirconia ceramic post systems created slightly less stress concentration in dentin than the glass fiber-reinforced and titanium posts.

Many clinical reports suggest that deciduous teeth exhibit a greater susceptibility to resorption than permanent ones. To examine the difference between deciduous and permanent dentine in their susceptibility to osteoclastic resorption, osteoclast-like cells (OCLs) were cultured on deciduous and permanent dentine slices. The number, area, depth, and volume of resorption pits were then measured, using image-analyzing systems. We measured the level of degraded collagen (cross-linked N-telopeptide of type I collagen; NTx) in culture medium using an enzyme-linked immunosorbent assay (ELISA). The levels of cathepsin K, matrix metallo proteinase (MMP)-9, and MMP-13 mRNAs in the cells attached to dentine were also analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR). Deciduous dentine slices exhibited a significant (twofold) increase in resorbed area compared with the permanent slices. Three-dimensional analysis revealed that the volume of pits in deciduous dentine differed significantly (fourfold) compared to that in the permanent dentine. The depth of pits also followed the same trend. However, there was no significant difference in the number of pits or osteoclasts on the dentine slices. The NTx level in deciduous media was significantly more than that in permanent media. The mRNA levels also followed the same trend. These results suggest that deciduous dentine is more susceptible to resorption than permanent dentine and signals from the substrate play an important role in physiological resorption.

Background: This study aimed to evaluate microhardness and chemical analysis of carious and caries-affected dentine. The hypothesis tested was that calcium:phosphorous (Ca:P) ratios correlate with microhardness values., Methods: Four carious human third molars were sectioned through the caries lesion in the mesiodistal longitudinal plane. One half of each lesion underwent carious dentine removal using Carisolv gel. The cut surfaces were polished, microhardness tested using an Ultra-Micro-Indentation System (UMIS) and elemental analysis performed using energy dispersive analysis of x-rays (EDAX)., Results: The microhardness of carious dentine decreased gradually towards the cavity floor, but that for caries-affected dentine showed more variation with depth, having a mean hardness of (0.63 +/- 0.18) GPa. Ca:P ratios of carious dentine varied among the four specimens. The mean Ca:P ratio of caries-affected dentine was 1:2.03 +/- 0.08. The hypothesis was accepted for active lesions., Conclusions: The use of Carisolv to excavate carious tissue can be as effective as rotary instrumentation.

The bond strengths of resins to caries-affected dentin are low. This could be due to weakened organic matrix. The purpose of this work was to determine if the ultimate tensile strength (UTS) of excavated carious dentin is weaker than that of normal dentin. Soft caries was excavated from extracted human molars, and the tooth was vertically sectioned into slabs. Each slab was trimmed to an hourglass shape, parallel or perpendicular to the tubule direction. Half of the specimens were mineralized, while the other half were completely demineralized in EDTA. ANOVA on ranks showed that the three-factor interactions (mineralization, caries, tubule direction) were all significant (p < 0.0001), indicating that mineralization and tubule direction gave different UTS results in normal and caries-affected dentin. No significant differences were seen between the UTS of normal and and that of caries-affected demineralized dentin in the parallel or perpendicular group. The matrix of demineralized caries-affected dentin was as strong as that of normal demineralized dentin when tested in the same direction.

Statement of Problem: The dentino-enamel junction (DEJ) durably unites dissimilar hard brittle enamel and tough flexible dentin. In contrast to artificial bonds between restorations and dentin, the DEJ rarely fails except when it is affected by inherited disorders. Knowledge of DEJ toughening mechanisms is important in understanding inherited disorders, in biomimetic engineering of junctions between artificial restorations and teeth, and in tissue-engineering a DEJ., Purpose: The purpose of this study was to identify specific DEJ-zone failure mechanisms and to survey the fracture toughness of the human DEJ zone., Material and Methods: Fracture toughness indentations were made at 3 sites across the DEJ zone of 10 human incisor teeth. Failure modes identified using optical microscopy and fracture toughness (MPa.m(1/2)) were calculated following Vickers microindentation. Site mean values were then calculated and compared using 1-way analysis of variance (alpha=.05)., Results: The DEJ did not undergo catastrophic interfacial delamination; instead, damage was distributed over a broad zone. The primary damage mode involved cracking and damage dispersion in the specialized first-formed enamel close to the DEJ. Multiple, somewhat convoluted and sometimes branching, cracks spread and diffused damage over a wide area of adjacent enamel rather than producing catastrophic interfacial failure. Other secondary mechanisms included short microcracks in the DEJ adjacent dentin with possible cracked bridging, as well as plastic deformation of the DEJ without delamination. A DEJ-zone fracture toughness of approximately 0.8 to 0.9 MPa.m(1/2) was calculated., Conclusion: DEJ-zone damage occurred primarily within the adjacent layer of specialized first-formed enamel, and the optical DEJ interface resisted delamination.

The enamel is the toughest human tissue. The major component of the inorganic part is hydroxyl apatite (90-92%). The organic part of enamel is formed by proteins, proteoglycans and lipoids, and represents only 1-2% of the entire weight. The organic components are organized, forming histological structures like enamel lamellae, enamel rods sheaths, enamel spindles and tufts. The authors, with the aid of the scanning electron microscope and histochemical staining, have demonstrated that enamel lamellae presented a true histological structure, contrary to some opinions that consider this entities developmental failures or simple cracks. In the opinion of the authors, these lamellae confer elasticity to the enamel when exposed to lateral or tangential forces, or even torque. The lamellae are also considered pathways for the progression of dental caries. The dentine-enamel junction is another non-mineralized tooth-structure which functions like an elastic support for the tough enamel, opposing unfortunately a very low resistance in the face of dental caries progression. In such cases we talk about secondary enamel caries. The dentinal tubules with the organic structures inside are essential in maintaining the vitality of the dentine and enamel; but in pathological circumstances they represent pathways for pathological stimuli heading toward the pulp, and they are the weakest points in front of caries progression.

A better appreciation of the properties of carious dentine would be of clinical advantage in carious assessment and management. The aim of this study is to understand the deterioration of the mechanical properties of carious dentine as a result of bacterial demineralising process as well as change in dentine structures observed under scanning electronic microscope. Eight primary molar teeth with untreated carious dentine were axially sectioned and fine polished for nano-indentation. On each specimen, six lines of indentation, evenly distributed through the lesion, were made from the pulp to lesion cavity floor parallel to tubule direction using nano-indentation (Ultra Micro Indentation System, UMIS-2000), while another two indentation lines were made on an adjacent region of sound dentine in the same manner. All tests were conducted on hydrated specimens. Hardness and elastic modulus decreased significantly and progressively toward the cavity floor varying from 0.56 to 0.001 GPa and 14.55 to 0.015 GPa, respectively. The change in mechanical properties was in a specific pattern as a function of lesion depth, in which the hardness could be fitted to an exponential function, while the variation of the elastic modulus across the entire lesion was fitted to a power law relationship. More critical evaluation of the elastic modulus data indicated that two distinct exponential functions provided an excellent fit to the results. These changes in elastic modulus also matched the structural changes seen across a lesion, which were associated with a change from primarily peritubular to intertubular dissolution.