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Item A Comparison of Three Debonding Techniques Employing Two Different Cements(2004) McCabe, Russell; Katona, Thomas R.; Baldwin, James J.; Hohlt, William F.; Moore, B. Keith; Shanks, James C.The theory and practice of bonding orthodontic brackets to enamel has become the accepted standard. However, regardless of the adhesive of choice, much controversy exists regarding bond strength values and testing protocols. Most bond strength testing has been done in either shear/shear-peel or tension. Some studies have used shear and tension and very few have used shear, tension and torsion. Some authors contend there is no difference in the stress required to produce bond failure by either tensile or shear test models. However, it has been shown that stress is not distributed uniformly during loading and each mode of strength testing produces unique stress patterns. Additionally, since in the oral cavity brackets are subject to shear, tensile and torsion forces, it seems logical that a complete picture of bond strength could not be formulated without all three test methods. Confounding the issue is the fact that adhesive research is being performed in non-standardized manners making it impossible to compare results among different researchers. Despite the vast amount of information presented in articles, this has resulted in a lack of consensus regarding clinical bond strength values. The purpose of this investigation was to evaluate the three debonding techniques (shear-peal, tension, torsion) using stainless steel brackets and two different bonding agents (traditional resin cement vs. resin reinforced glass ionomer). The hypotheses of this investigation were (1) the relative shear-peal, tensile and torsional bond strengths will show consistent results and (2) cement type will have a significant effect on the bond strengths. One hundred sixty-two bovine incisors were randomly assigned to 6 groups of 27 specimens per group. Teeth were bonded with either a resin composite adhesive or a resin reinforced glass ionomer cement following manufacturers' instructions. Bonding was performed under controlled temperature and humidity (71 °F± 2° and 56% RH± 5%). In addition, specimens were bonded utilizing a bonding jig that held the thickness of the adhesive constant at 0.006 inches. All groups were tested to failure using the MTS Bionix machine in shear, tension and torsion. The results showed that the resin composite had a significantly higher load at failure in shear and torque than the resin-modified glass ionomer. However, in tension, no significant difference was found between the two cements. Additionally, analysis of relative strength indicated a difference between shear strength and tension suggesting that testing mode influences bond strength values. It is the conclusion of this study that the load at failure for resin composite and resin-modified glass ionomer are not consistent and depend on the loading mode.Item The Effect of Thermocycling on the Failure Load of a Standard Orthodontic Resin in Shear-Peel, Tension, and Torsion(2006) Bunch, Jason Keith; Katona, Thomas R.; Baldwin, James J.; Hohlt, William F.; Moore, B. Keith; Shanks, James C.New products are frequently developed for bonding brackets. This continuum brings about incessant studies attempting to prove or disprove their value. The need to compare the results of bond failure studies is made difficult if not impossible by the variation of published testing methods. The purpose of this study is to compare the differential effects of thermocycling, as a lab protocol, on three debonding techniques, shear-peel, tension, and torsion when using a traditional orthodontic resin adhesive. A standard orthodontic resin, Transbond™ XT (3M Unitek, Monrovia, CA) was used to bond 102 flattened 0.018-inch stainless steel brackets (3M Unitek) to flattened bovine incisors. Two step acid etching and priming (37 % phosphoric acid gel and Transbond MIP Primer, 3M Unitek) was used to prepare the enamel for bonding. During bonding, the resin thickness was held consistent. The bonding was accomplished under controlled temperature and humidity. Half of the samples were thermocycled prior to debonding. The samples were debonded in shear-peel, tension, and torsion. The data showed no significant differences between thermocycling and nonthermocycling in shear-peel or torsion, but in tension the thermocycling group had a statistically significant higher failure load. Overall, was a trend toward increased bond strength in the thermocycled group. The increase is likely the result of continued polymerization during thermocycling. The statistical difference that is noted in tension is thought to be due to the location of the highest stress being in the center of the resin pad. This would be the location of the least initial polymerization. The use of thermocycling as a lab protocol during bracket failure studies in shear-peel and torsion is not necessary when using traditional orthodontic resin.Item Effects of etching duration on the surface roughness, surface loss, flexural strength, and shear bond strength to a resin cement of e.max cad glass ceramic(2017) Al-Johani, Hanan; Chu, Tien-Min Gabriel; Platt, Jeffrey A.; Cook, Norman B.; Bottino, Marco C.Background: Long-term retention of ceramic restorations is dependent on the bond strength of the luting resin to both the tooth and porcelain substrates. In order to achieve successful bonding, the surface of the porcelain substrate must be modified to increase the surface roughness, and this can be achieved chemically by hydrofluoric (HF) acid etching. However, prolonged HF acid etching has shown to have a weakening effect on the evaluated lithium disilicate glass-ceramics. Therefore, it is essential to quantify the required etching duration of HF acid to minimize the possible deleterious effects on ceramic strength while maximizing the bond strength to tooth structure. Objectives: To evaluate the effects of HF acid etching duration on the surface roughness, surface loss, flexural strength, and shear bond strength of IPS e.max CAD (Ivoclar Vivadent) lithium disilicate-based glass ceramic to a resin cement. Hypothesis: The differences in HF acid etching durations will not have a significant effect on the surface roughness, surface loss, flexural strength, or shear bond strength of IPS e.max CAD to a resin cement. Methods: 168 specimens were prepared from IPS e.max CAD blocks. All specimens were polished and sonically cleaned in distilled water. Specimens were fired in the vacuum pump furnace according to the manufacturer’s instructions. Specimens were then divided into 4 groups, according to etching durations, then further divided into 3 subgroups, according to the properties tested. Group A was not etched (control), Groups B, C and D were etched with 5-percent HF acid (IPS Ceramic Etching gel, Ivoclar Vivadent) for 20 s, 60 s and 90 s respectively. The morphologies of both etched and non-etched surfaces in specimens of subgroup 1 of each etching group (n = 16/group) were observed under scanning electron microscopy (SEM). In addition, non-contact surface profilometry (Proscan 2000) was used to calculate the surface loss and to examine the surface roughness of the etched ceramic surfaces and roughness values (Ra, Rq) were documented for each group. Furthermore, etched specimens of subgroup 2 (n = 16/group) were silanated (Monobond Plus, Ivoclar Vivadent) and cemented with a resin cement (Multilink Automix, Ivoclar Vivadent). The shear bond strength (SBS) was measured using a universal mechanical testing machine. For each etching group, subgroup 3 specimens (n = 10/group) were loaded to failure in a three-point bending test to measure their flexural strength values using a universal mechanical testing machine. Data for surface roughness, surface loss, and flexural strength were analyzed using one-way analysis of variance (ANOVA), to identify the significant effects of different HF acid etching durations. Data for shear bond strength test were analyzed using two-way ANOVA to test the effects of etching duration, storage for 24 hours/thermocycling, and their interaction. All pair-wise comparisons from ANOVA analysis were made using Fisher’s Protected Least Significant Differences to control the overall significance level at 5 percent. Results: Difference in HF etching durations did not have a significant effect on surface roughness values Ra or Rq (p = 0.3408; p = 0.3245) respectively, but had a significant effect on surface loss (p = 0.0006). SBS values were not significantly different between experimental groups (p = 0.4650); however, SBS values after 24-h storage were significantly higher than that found after thermocycling (p = 0.0166) among different etching durations. Finally, different HF etching durations did not have a significant effect on flexural strength values (p = 0.1260). Conclusion: Within the limitations of this study, different HF etching durations did not have a significant effect on surface roughness, flexural strength, or shear bond strength of IPS e.max CAD. However, the different etching durations significantly affected the surface loss of the lithium disilicate glass ceramics.Item Efficacy of resin-based materials against erosive-abrasive wear in vitro(2015) Capin, Oriana Reis; Hara, Anderson T.; Cook, N. Blane; Platt, Jeffrey A.; Masatoshi, Ando; Lippert, FrankBackground: Increasing prevalence of dental erosion has been observed in many countries, in both children and adults. This condition is often associated with softening of the dental surface by acid exposure, which may lead to severe and irreversible damage. The use of fluoride, pit and fissure sealants, dental adhesives and more recently a resin infiltrant has been suggested to manage dental erosion. Objective: To compare the protective effect of a resin infiltrant and other resin-based materials against dental erosion/toothbrushing abrasion in vitro. Materials and methods: Bovine enamel and dentin slabs were prepared, embedded, flattened and polished. Dental erosion lesions were created using 0.01 M of hydrochloric acid (pH 2.3 for 30 sec) and treated with resin-based materials (HS: Helioseal pit and fissure sealant; SP: Seal and Protect dentin 78 sealant, and IC: Icon resin infiltrant) or fluoride varnish (FV: Duraphat). A no-treatment group represented the negative control (C). The specimens were subjected to an erosion-abrasion cycling model for a total of 10 days. Each cycling day consisted of 2 min immersion in 0.01M HCl, at room temperature, for 4 times; and toothbrushing with either of the abrasive suspensions (low and high, as previously determined by the radioactive dentin abrasivity method). Enamel and dentin surfaces were scanned at baseline, after treatment, at 5 days and at 10 days using an optical profilometer. Surface change (loss/gain) was determined by subtracting the treated area from the reference (protected) areas. Significance level of 5% was adopted for the statistical analysis. Results: No differences were found among groups at baseline, regardless of substrate. After treatment, surface deposition was found for all test groups except for IC, which did not differ from C. For enamel, at day 5, FV, HS and SP had less surface loss than C and IC (p<0.0008), which did not differ from each other (p=1.00). At day 10, similar trend was observed except for FV, which showed surface loss similar to C, when brushed with high abrasive suspension. High abrasive caused more surface loss than low abrasive only for C at day 5 (p=0.0117) and 10 (p=0.0162). For dentin, at day 5, FV, HS and SP had less surface loss than C and IC (p≤0.0001), which did not differ from each other (p=1.00). At day 10, HS and SP had less surface loss than C, IC, and FV (p<0.0001), and FV had less surface loss than C for low abrasive (p=0.0009). Overall, high abrasive had significantly more surface loss than low abrasive at 10 days (p=0.0280). Conclusion: HS was the most effective material protecting enamel and dentin from erosion-abrasion, followed by SP. FV offered limited protection, while no benefit was observed for resin infitrant IC.Item Evaluation of Tensile Bond Strength of a Fluoride-Releasing Resin Adhesive with Ceramic Brackets(1991) Lehman, David Alan; Roberts, W. Eugene; Moore, B. Keith; Shanks, James C.; Arbuckle, Gordon R.; Miller, James R.The increased attention to the esthetics of orthodontic appliances has led to the popularity of ceramic brackets in the last decade. Although the bonding of ceramic brackets has become predictably successful, the extreme brittleness of ceramics coupled with higher bond strengths has caused significant clinical problems in debonding and risk of enamel damage. This study evaluated an experimental bonding resin with different levels of fluoride concentration, linking the therapeutic property of long-term fluoride release to the benefit of decreased bond strength to ceramic brackets. Four groups of 40 Transcend™ ceramic brackets each were bonded to bovine teeth, using 0, 3, 6, and 12 percent fluoride concentrations. At two weeks, one-half of each group was tested for tensile bond strength in an lnstron machine. The remaining half were tested at six months. In the groups broken at two weeks, the bond strength peaked around 6 percent fluoride, but the three top groups were not significantly different. In the groups tested at six months, peak strength was observed at 3 percent fluoride and was significantly greater than the others. The overall mean at six months than at two weeks. The study found bond strength values in the range of 25-50 kg/cm2. Although minimum values have not been established, the low values reported in this study are likely to be within acceptable clinical limits. Following debonding, the mode of bond failure was determined by viewing enamel specimens and bracket bases under a light microscope. In all but one group, 95 percent of the bond failure occurred at the bracket base/adhesive interface. No bracket failure occurred and no enamel damage could be observed under the light microscope. In a parallel study of physical properties, Knoop hardness was measured at one hour, 24 hours, and six months, and compressive strength was tested at one week and six months. While physical properties generally decreased over the period of study, bond strength was significantly greater in the six-month group. The results of this study regarding the correlation of these properties to bond strength is inconclusive. In addition, results of fluoride-release data by SISCO Inc. indicate that the 12 percent group was shown to release greater than 10 μg/g/day at six months. This was comparable to amounts known to have the clinical benefit of reducing demineralization, and equaled or exceeded other commercially available fluoride-releasing adhesives. The results of this study indicate that a fluoride-releasing resin can release clinically significant amounts of fluoride ions, and still have adequate bond strength.Item Evaluation of Tensile Bond Strength, Fluoride Release, Hardness, and Solubility of a Fluoride Containing Adhesive Resin(1994) Brandt, Marybeth; Moore, B. Keith; Zeldin, Martel; Katona, Thomas R.; Garetto, Lawrence P.; Roberts, W. EugeneDirect bonding of orthodontic brackets often results in decalcification of tooth structure surrounding bracket sites. Glass ionomer cements, while typically leaching fluoride over time, often exhibit a significantly lower bond strength. Fluoride-containing resins generally release high concentrations of fluoride for a short time, then cease to release any significant amount. The purpose of this study was to evaluate the tensile bond strength, fluoride release, hardness, solubility, and sorption of a newly formulated fluoride containing resin. The experimental resins were prepared with 5% and 7.5% fluoride (F-) monomer, and were compared to a fluoride-free control adhesive (Rely-a-Bond Phase II™, Reliance Orthodontics Inc ., Itasca, Ill .). To evaluate tensile bond strength, orthodontic brackets were bonded to bovine teeth and debonded using an lnstron machine. Fluoride release was tested using resin disks stored in deionized water. The fluoride content of the water was determined with an ion-specific electrode. Hardness, solubility, and sorption were tested using disks made of each material. Comparison of experimental and control resins by ANOVA followed by General Linear Models multiple comparisons revealed the control to show a statistically significant difference (p<.0001) for tensile bond strength. Experimental Control 5%F- 7.5%F- Peak Stress (MPa) 4.48±0.65 3.83±0.76 5.31±0.97. Fluoride continued to be released from the experimental resins (5% and 7.5% F-) at 18 days. The control was significantly harder than either of the experimental resins at 1 hour, 24 hours, 1 week, and 1 month (p<.0001). The 5% F- resin exhibited slight solubility (0.10 percent), while the 7.5%F- resin and the control exhibited very little solubility (0.01 percent). Phase II™ exhibited significantly lower sorption at 21 days (0.60 percent, p<.001) than either the 5%F- resin (1.69 percent) or the 7.5%F- resin (1.63 percent). These results indicate that while the experimental resin had lower bond strength, lower hardness, and higher sorption than the control, measurable fluoride was released from the experimental resins for up to 18 days. Further testing is indicated to determine the clinical acceptability of this adhesive.Item Evaluation of water sorption and solubility behavior of nine different polymeric luting materials(2009) Alsheikh, Rasha N.; Platt, Jeffrey A.; Lund, Melvin R., 1922-; Cochran, Michael A. (Michael Alan), 1944-; Moore, B. Keith; Matis, Bruce A.The cementation procedure is the key to long-term success of fixed restorations. The prognosis of prosthetic restoration is largely impacted by the maintenance of the luting cement and the adhesive bond. When exposed to water or saliva, most restorative materials undergo hydrolytic degradation. The purpose of this study is to evaluate the water solubility and water sorption characteristics of newly introduced acidic polymeric luting agents over a 180-day water-storage period. Nine different luting agents were tested. Fifty-two disc specimens of each material were fabricated using a mold with an internal dimension of 15[plus-minus]0.1 mm in diameter and 1.0 [plus-minus]0.1 mm deep. A constant weight, W0 [subscript zero], was reached after desiccating the specimens. Then, 13 specimens were assigned randomly to one of the four testing periods in the water for seven, 30, 90 and 180 days. After each period, the specimens were removed from the water and weighed to get W1 [subscript one]. A second period of desiccating the samples provided a constant weight W2 [subscript two]. The water sorption and solubility were determined by the following equations: WSP [subscript SP](%) = (W1 [subscript one] W2 [subscript two] ) X 100/ W0 [subscript zero] ,WSL [subscript SL](%) = (W0 [subscript zero] W2 [subscript two) X 100/ W0 [subscript zero]. The resin-modified glass-ionomers showed the highest water sorption/solubility results. The resin luting agents had the lowest sorption/solubility results. The self-adhesives showed a wide range of solubility/sorption; in general, they showed lower results compared with the resin-modified glass-ionomers. All the materials reached some sort of equilibrium after 90-days. Based on the results of our study, we conclude that self-adhesive luting materials were not all alike. Rely X Unicem was the most comparable to the resin luting materials. The resin luting materials had the lowest solubility and sorption. Resin-modified glass-ionomers showed the highest sorption/solubility results.Item Flexural strength and shear bond strength of self-etching/self-adhesive resin luting agents(2009) Adcook, Richard S.; Cochran, Michael A.; Platt, Jeffrey A.; Gonzalez-Cabezas, Carlos, 1966-; Matis, Bruce A.; Lund, Melvin R.Traditional resin luting agents generally have mechanical properties that are superior to the newer so-called “universal” self-etching/self-adhesive resin luting agents. However, recent reports indicate that some properties of these new luting agents have been improved, approaching those of the traditional etch and rinse resin luting agents. The objective of this study was to test some mechanical properties of four of these self-etching/self-adhesive resin luting agents [Maxcem Elite (ME), Multilink Automix (MA), RelyX Unicem (RU), SmartCem 2 (SC)] and compare them to a traditional etch and rinse resin luting agent [RelyX ARC (RA)] and a resin-modified glass ionomer luting cement [Fuji Plus (FP)], both of which have much longer histories of clinical success. By comparing the properties of the newer cements to the standards, it may be possible to determine how clinically successful the newer cements may be. The mechanical properties tested were flexural strength (FS) and shear bond strength (SBS). The FS test included making beams of each material, storing them in water for periods of time (24 hours and 90 days) and then performing a three-point bending test on a universal testing machine. The 90 day groups were thermocycled. The SBS test involved preparing human molar specimens, making flat dentin surfaces. Composite cylinders were fabricated, luted to the dentin surfaces with each of the materials tested, stored in water for periods of time (24 hours or 90 days), and then a knife edge shear test was performed on a universal testing machine. The 90 day groups were thermocycled. A Weibull-distribution survival analysis was performed. The results revealed significant differences in the FS of all materials tested at 24 hours. After 90 days and thermocycling, only SC and RA were not significantly different. At both time periods, FP had the lowest and MA the highest FS. The SBS results showed MA, RA, and RU to have the highest bond strengths; SC and ME the lowest at 24 hours. After 90 days and thermocycling, RA had significantly higher bond strength than all other groups; ME, FP and SC had the lowest. The self-etching/self-adhesive resin luting agents all performed at least as well as FP, with the exception of SC (SBS 24 hour). They did not all perform as well as RA, with the exception of SC (FS 90 day), MA (SBS 24 hour, FS 24 hour and 90 day), and RU (SBS 24 hour). The newer luting agents should expect to have clinical success, regarding flexural strength and shear bond strength, at least as good as resin-modified glass ionomer luting cements and approach the level of traditional etch and rinse resin luting agents.Item An in-vitro comparison of the microleakage of RealSeal/Resilon and RealSeal Self-Etch/Resilon root canal obturation system(2011) Iqbal, Haris; Spolnik, Kenneth Jacob, 1950-; Vail, Mychel Macapagal, 1969-; Legan, Joseph L.; Gregory, Richard L.; Moore, B. Keith; Zunt, Susan L., 1951-The purpose of this investigation was to evaluate and compare microleakage of teeth obturated using either RealSeal/Resilon or RealSeal Self-Etch/Resilon systems. The goal was to determine whether a significant difference in microleakage exists between these two groups. To date, no study has been done comparing the microleakage of root canal systems obturated with using RealSeal/Resilon versus RealSeal SE/Resilon. Sixty-two human, single-rooted, anterior teeth were accessed and instrumented for non-surgical root canal therapy. Teeth were randomly assigned to two experimental groups of 27 teeth each. Group I consisted of teeth obturated with the RealSeal/Resilon system, whereas Group II consisted of teeth obturated with the RealSeal SE/Resilon system. In addition, two control groups containing four teeth each served as positive and negative controls, Group (+) and Group (-), respectively. The teeth were then evaluated for microleakage using a dual-chamber microleakage model. Visual turbidity in the lower chamber denoted microleakage within the experimental groups observed for 33 days. RealSeal SE Group II had a significantly higher proportion of samples than Real Seal Group I. Time to microleakage was also significantly lower in RealSeal SE Group II than in Real Seal Group I. No microleakage was observed in the negative control and microleakage was observed in all four samples in the positive control. To date, this is the first study comparing the microleakage of RealSeal/Resilon and RealSeal SE/Resilon systems. The higher microleakage associated with RealSeal SE is attributed to the higher pH of the self-etch (SE) sealer in comparison with the self-etch primer of RealSeal. The self-etching potential of the sealer system is particularly critical in areas inaccessible to calcium chelating agents such as EDTA in root canal systems. Further research needs to be done to corroborate the microleakage results from this study. The microbial leakage apparatus devised in this study, which used a selective growth medium with streptomycin, has also been validated by the results of the study. The bacterial leakage apparatus has been considered to be clinically relevant and acceptable by the Journal of Endodontics. Thus, the modified dual-chambered microleakage apparatus with a selective growth medium used in this research can be replicated easily in future microleakage studies.Item Longevity of Crown Margin Repairs Using Glass Ionomer: A Retrospective Study(2020) Watson, Justin I.; Cook, N. Blaine; Thyvalikakath, Thankam; Diefenderfer, Kim E.; Capin, OrianaObjectives: Repair of crown margins may extend the functional life of existing crowns. However, the longevity of such treatment is unknown. This study determined the survival time of crown margin repairs (CMR) with glass-ionomer (GI) and resin-modified glass-ionomer cements. Methods: We queried axiUm (Exan Group, Coquitlam, BC, Canada) database for permanent teeth that underwent CMR in the Graduate Operative Dentistry Clinic, Indiana University School of Dentistry (IUSD), Indianapolis, Ind., USA, from January 1, 2006 through January 1, 2018. Since there is no CDT code for the CMR procedure, CDT codes for resin-composite and GI restorations (D23XX) were queried; these patients also had treatment notes that indicated CMR. The final data set included patient ID, birth date, gender, dates of treatments, CDT codes, tooth type, tooth surface and existing findings. Two examiners developed guidelines for record review and manually reviewed the clinical notes of patient records to confirm CMR. Only records that were confirmed with the presence of CMR were retained in the final dataset for survival analysis. Survival time was calculated by Kaplan-Meier statistics and a Cox Proportional Hazards model was performed to assess the influence of selected variables (p < 0.05). Results: 214 teeth (115 patients) with CMR were evaluated. Patient average age was 69.4 11.7 years old. Posterior teeth accounted for 78.5 percent (n = 168) of teeth treated. CMRs using GI had a projected 5-year survival rate of 62.9 percent (K-M Analysis) and an 8.9 percent annual failure rate. Cox Proportional Hazards Regression analysis revealed that none of the factors examined (age, gender, tooth type) affected time to failure. Conclusion: CMRs may extend the longevity of crowns with defective margins. Larger EHR studies or case control studies are needed to investigate other variables, such as the caries risk status or the severity of defects that may affect the survival rate of CMRs.