Dentistry School Theses and Dissertations

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Evaluation of Second Generation Indirect Composite Resins
(2008) Jain, Vishal V.; Platt, Jeffrey A., 1958-; Moore, B. Keith; Xie, Dong; Taskonak, Burak
Indirect composites were introduced so that the composites can be cured extraorally to improve the degree of conversion and other material properties. These materials are indicated as long term full coverage dental restorative materials. However the mechanical and physical properties of new Second Generation Indirect Composites for this particular application have not been fully evaluated. The purpose of the study was to compare the appropriateness of the four commercially available laboratory composite resins for application as long term full coverage restorative materials. Water solubility and sorption levels, staining resistance, gloss, surface roughness, wear due to tooth brush abrasion, two-body and three-body wear, fracture toughness and radiopacity of four indirect composite restorative materials; Radica (Dentsply), Sculpture Plus (Pentron), Belleglass-NG (Kerr) and Gradia Indirect (GC America) were determined. The results showed that the four composites differed significantly from each other. Bell eglass-NG and Gradia Indirect showed negative water solubility. All the four groups demonstrated less color stability when exposed to coffee slurry for 3 weeks. Significant decrease in gloss and volume occurred when the omposites were exposed to simulated tooth-brush abrasion. Sculpture Plus v demonstrated lowest abrasion and attrition wear resistance among the four indirect composites. Radica had the highest fracture toughness and radiopacity of all the composites with values close to or less then dentin. In conclusion, different indirect composite systems possessed different mechanical and physical advantages when compared to each other. In general, Belleglass-NG demonstrated superior advantages due to its higher abrasion and attrition wear resistance and stain resistance. This was followed by Radica,Gradia Indirect and Sculpture Plus.
Effect of Gap Geometry on Secondary Caries in Vitro
(2009) Nassar, Hani M.; Cabezas, Carlos Gonzales, 1966-; Chu, Tien-Min Gabriel; Fontana, Margherita Ruth, 1966-; Gregory, Richard; Matis, Bruce; Cochran, Michael
Objective: To investigate the effect of the size of the space between the restoration and the dentinal wall of the tooth (i.e. the dentinal portion of the gap) on the development of secondary caries. Methods: Tooth-resin-matrix composite specimens were mounted on custom-made gap-model stages. Specimens were divided into four groups (n=10). Group 1 had a uniform gap size of 30μm throughout both enamel and dentin. Group 2 had a 30μm enamel gap size with a 530μm dentinal gap. Group 3 had 525μm gaps in both enamel and dentin. Group 4 had 525μm and 1025μm gaps in enamel and dentin, respectively. Specimens were attached to plastic Petri plates, gas-sterilized and then incubated in a microbial caries model with S. mutans TH16 in (1% sucrose tryptic soy broth for 1 h, 4 times/day, and with a buffer solution for the rest of the day). After 8 days of incubation, tooth specimens were sectioned and stained with a rhodamine B solution. Digital images were taken under a confocal microscope and analyzed for lesion size at the enamel outer lesion (EOL), enamel wall lesion (EWL), dentin wall lesion next to the DEJ (DWL-A) and dentin wall lesion at 750µm from the DEJ (DWL-B). Results: No difference in EOL size was found between the groups. DWL-A and -B were larger in group 3 than groups 1and 2. Larger DWL-B was found in group 3 than group 4. Group 4 had marginally significant larger EWL than groups 1 and 2 (p=0.0652 and p=0.0648, respectively). Also, group 4 had marginally significant (p=0.0607) larger DWL-B than group 1. Conclusions: Based on the results of this study, it can be concluded that the presence of additional space at the dentinal wall area did not affect secondary caries development as long as the enamel gap was small. However, with enamel gaps of ≈500 µm, the presence of the additional gap space at the dentinal wall led to the development of smaller dentinal wall lesions at the deeper parts of the simulated cavity. Also, in uniform gaps, the size of the interface was positively correlated with size of the dentinal wall lesions.
An in vitro comparison of working length accuracy between a digital system and conventional film when vertical angulation of the object is variable
(2009) Christensen, Shane R. (Robert), 1977-; Vail, Mychel Macapagal, 1969-; Legan, Joseph J.; Parks, Edwin T. (Edwin Thomas), 1955-; Zunt, Susan L., 1951-; Spolnik, Kenneth Jacob, 1950-
Accurate determination of working length during endodontic therapy is critical in achieving a predictable and successful outcome. Working length is determined by the use of electronic apex locators, tactile perception, knowledge of average tooth lengths and dental radiography. Due to the increasing use of digital radiography in clinical practice, a comparison with conventional film in working length determination is justified. The purpose of this study is to determine if there is a difference between Schick digital radiography and Kodak Ultra-speed film in the accurate determination of working lengths when vertical angulation of the object is variable. Twelve teeth with #15 K-flex files at varying known lengths from the anatomical apex were mounted in a resin-plaster mix to simulate bone density. A mounting jig for the standardization of projection geometries allowed for exact changes in vertical angulation as it related to the object (tooth) and the film/sensor. Each tooth was imaged using Schick CDR and Kodak Ultra-speed film at varying angles with a consistent source-film distance and exposure time. Four dental professionals examined the images and films independently and measured the distance from the tip of the file to radiographic apex and recorded their results. The error in working length was calculated as the observed value minus the known working length for each tooth type. A mixed-effects, full-factorial analysis of variance (ANOVA) model was used to model the error in working length. Included in the ANOVA model were fixed effects for type of image, vertical angulation, and the interaction of angle and film type. Tooth type and examiner were included in the model as random effects assuming a compound symmetry covariance structure. The repeatability of each examiner, for each film type, was assessed by estimating the intra-class correlation coefficient (ICC). The ICC was determined when 12 randomly selected images and radiographs were reevaluated 10 days after initial measurements. The repeatability of each examiner for Schick CDR was good with ICCs ranging from 0.67 to 1.0. Repeatability for the conventional film was poor with ICCs varying from -0.29 to 0.55. We found the error in the working length was not significantly different between film types (p = 0.402). After adjusting for angle, we found that error in the working length from the digital image was only 0.02 mm greater (95-percent CI: -0.03, 0.06) than the conventional film. Furthermore, there was not a significant difference among the angles (p = 0.246) nor in the interaction of image type with angle (p = 0.149). Based on the results of our study, we conclude that there is not a statistically significant difference in determining working length between Schick CDR and Kodak Ektaspeed film when vertical angulation is modified.
Association Analysis of Class II Division 2 Malocclusion and Two Genes Linked to Hypodontia (MSX1 and PAX9)
(2009) Wall, Matthew D.; Kula, Katherine S.; Hartsfield, James K., Jr.; Shanks, James C.; Baldwin, James J. (James Joseph), 1925-; Stewart, Kelton T.
Purpose of the Study: Determine if there is an association of the CII/D2 malocclusion and genes linked to hypodontia, namely PAX9 and MSX1. Methods and Materials: One hundred probands with CII/D2 and one hundred non-CII/D2 with no hypodontia were enrolled in this study. Clinical exam, photographs, models, radiographs, and saliva were gathered. DNA was isolated from the saliva and sent for genetic analysis. Single Nucleotide Polymorphisms (SNPs) from the PAX9 and MSX1 genes were analyzed using the LightCycler® 480 to verify the presence of each with the CII/D2 malocclusion. A Hardy-Weinberg test was used to screen for genotyping errors, then a chi-square test was used to evaluate the association of the SNP genotypes. A p-value of 0.05 was considered significant. Results: The Hardy-Weinberg test showed no significant differences between observed and expected counts thus we used them for association analysis. Chi-square analysis indicated no significant association between CII/D2 and the MSX1 rs3821949 and the PAX9 1955734 genotypes. Although a p-value of 0.06 for the PAX9 rs8004560 suggested association, it was considered a grey area and insufficient to conclude that there was significant association. Since the SNP PAX9 rs8004560 was insufficient, additional statistical analysis was also performed on the PAX9 rs8004560 genotype of the CII/D2 affected subjects reported to have hypodontia of any tooth including third molars and excluding third molars. A chi-square test yielded a p-value of 0.08 on the analysis of CII/D2 with hypodontia for any permanent tooth except third molars, which suggested association, but insufficient to conclude a significant association. All other analyses indicated a lack of association of the PAX9 rs8004560 SNP. Conclusions: There is no significant association of CII/D2 and the SNPs MSX1 rs3821949 and PAX9 rs1955734. There is a suggestion that there is an association of the SNP PAX9 rs8004560 and CII/D2. There is a suggestion that there is an association of SNP PAX9 rs8004560 and CII/D2 subjects with hypodontia of any tooth except third molars.
An in-vitro comparison of working length determination between a digital system and conventional film when source-film/sensor distance and exposure time are modified
(2009) Ley, Paul J. (Joseph), 1980-; Vail, Mychel Macapagal, 1969-; Parks, Edwin T. (Edwin Thomas), 1955-; Spolnik, Kenneth Jacob, 1950-; Legan, Joseph J.; Zunt, Susan L., 1951-
Accurate determination of working length during endodontic therapy is a crucial step in achieving a predictable outcome. This is determined by the use of electronic apex locators, tactile perception, and knowledge of average tooth lengths and/or dental radiography whether digital or conventional is utilized. It is the aim of this study to determine if there is a difference between Schick digital radiography and Kodak Insight conventional film in accurately determining working lengths when modifying exposure time and source-film/sensor distance. Twelve teeth with size 15 K-flex files at varying known lengths from the anatomical apex were mounted in a resin-plaster mix to simulate bone density. Each tooth was radiographed while varying the source-film/sensor distance and exposure 122 time. Four dental professionals examined the images and films independently. Ten images and 10 films were selected at random and re-examined to determine each examiner?s repeatability. The error in working length was calculated as the observed value minus the known working length for each tooth type. A mixed-effects, full-factorial analysis of variance (ANOVA) model was used to model the error in working length. Included in the ANOVA model were fixed effects for type of image, distance, exposure time, and all two-way and three-way interactions. The repeatability of each examiner for each film type was assessed by estimating the intra-class correlation coefficient (ICC). The repeatability of each examiner on digital film was good with ICCs ranging from 0.67 to 1.0. Repeatability on the conventional film was poor with ICCs varying from -0.29 to 0.55.We found there was an overall difference between the conventional and digital films (p < 0.001). After adjusting for the effects of distance and exposure time, the error in the working length from the digital image was 0.1 mm shorter (95% CI: 0.06, 0.14) than the error in the working length from the film image. There was no difference among distances (p = 0.999) nor exposure time (p = 0.158) for film or images. Based on the results of our study we conclude that although there is a statistically significant difference, there is no clinically significant difference between digital radiography and conventional film when exposure time and source-film/sensor distance are adjusted.
Evaluation of fracture resistance of three post and core systems in endodontically treated teeth under loading to failure; and marginal gap measurement before and after cyclic loading
(2009) Saad, Amir N., 1979-; Platt, Jeffrey A., 1958-; Matis, Bruce A.; Andres, Carl J., 1942-; Katona, Thomas R.; Levon, John A.
The purpose of this study was to evaluate the fracture resistance of three post and core systems in endodontically treated teeth by loading to failure, and to measure marginal gaps before and after cyclic loading. Sixty extracted canines were assigned to three groups. The groups tested were: 1) Single cast post and core (Group CP). 2) Prefabricated metal post and composite resin core (Group MR). 3) Glass fiber post and composite resin core (Group FR). All teeth were obturated and prepared to receive a post and core with a coping. Thirty teeth (10 from each group) were loaded to failure, and the other 30 teeth were fatigue-loaded. The marginal gaps on the facial and lingual surface of the fatigue-loaded group were measured before and after cyclic loading. There were two hypotheses for this study. The first was that the FR group would have less marginal gap opening on the lingual surface than the other groups. The second was that the CP group would have a higher load at failure than the other groups. Group CP was found to have a significantly smaller pre-loading marginal gap than group FR (p = 0.0265) and group MR (p = 0.0273), while groups FR and MR did not have a significantly different pre-loading marginal gaps (p = 0.86). Group FR had significantly less change in marginal gap than group MR (p = 0.0013). Groups CP and MR did not have significantly different changes in marginal gap (p = 0.09). Groups CP and FR did not have significantly different changes in marginal gap (p = 0.11). The three post types did not have significantly different maximum loads to failure (p= 0.49), moments of inertia at cervical area (p = 0.75), or moments of inertia at fracture site (p=0.12). There was no significant difference between groups CP, FR, and MR in the load-to-failure test. Group CP demonstrated the highest load-to-failure values; however, the highest load-to-failure mean was for group MR. All fractures observed in this study were catastrophic. Group FR demonstrated better stress distribution and caused no early fractures in the fatigue-loading group. All groups demonstrated significant marginal gap changes on the lingual surface after fatigue loading; however, group FR demonstrated <45 μm marginal gap opening. In group FR, the reduced marginal gap opening was attributed to the use of Panavia 21 with the proper surface treatments to bond to the tooth structure, the resin composite, and the metal coping.
Orthodontic Mechanotransduction and the Role of the P2X7 Receptor
(2009) Viecilli, Rodrigo F.; Katona, Thomas R.; Chen, Jie; Roberts, W. Eugene, Jr.; Hartsfield, James K., Jr.; Bidwell, Joseph
The first part of the study describes the development of a microCT based engineering model to study orthodontic responses. The second part investigated the relationship between orthodontic stimulus, root resorption and bone modeling. It was hypothesized that stress magnitudes are insufficient to portray the mechanical environment and explain the clinical response; directions also play a role. An idealized tooth model was constructed for finite element analysis. The principal stress magnitudes and directions were calculated in tipping and translation. It was concluded that within the same region of root, PDL and bone, there can be compression in one structure, tension in another. At a given point in a structure, compression and tension can coexist in different directions. Magnitudes of compression or tension are typically different in different directions. Previously published data presenting only stress magnitude plots can be confusing, perhaps impossible to understand and/or correlate with biological responses. To avoid ambiguities, a reference to a principal stress should include its predominant direction. Combined stress magnitude/direction results suggest that the PDL is the initiator of mechanotransduction. The third part of this project tested the role of the P2X7 receptor in the dentoalveolar morphology of C57B/6 mice. P2X7R KO (knockout) mice were compared to C57B/6 WT to identify differences in a maxillary molar and bone. Tooth dimensions were measured and 3D bone morphometry was conducted. No statistically significant differences were found between the two mouse types. P2X7R does not have a major effect on alveolar bone or tooth morphology. The final part examines the role of the P2X7 receptor in a controlled biomechanical model. Orthodontic mechanotransduction was compared in wild-type (WT) and P2X7R knock-out (KO) mice. Using Finite Element Analysis, mouse mechanics were scaled to produce typical human stress levels. Relationships between the biological responses and the calculated stresses were statistically tested and compared. There were direct relationships between certain stress magnitudes and root resorption and bone formation. Hyalinization and root and bone resorption were different in WT and KO. Orthodontic responses are related to the principal stress patterns in the PDL and the P2X7 receptor plays a significant role in their mechanotransduction.
Enamel conditioning effect on penetration and microleakage of glass ionemer-based sealants
(2009) Ahmed, Senan Raad; Cabezas, Carlos Gonzales; Chu, Tien-Min Gabriel; Fontana, Margherita Ruth, 1966-; Matis, Bruce; Cochran, Michael
While most sealants available are resin-based, glass ionomer-based cements can be used as sealants, with the advantage of being more tolerant to moisture during placement and of releasing fluoride. The objective of this study was to evaluate the influence of different fissure conditioning techniques on penetration and microleakage of glass ionomer (GI) and resin-modified glass ionomer cements (RMGI) used as sealants. Clinically sound extracted human molars were distributed into nine experimental groups (n = 15 each). Group 1 (control) was sealed with resin-based sealant (Delton) following clinically accepted techniques. Groups 2 through 6 were sealed with RMGI (Vitremer) after having the fissure conditioned with either polyacrylic acid (RMGI-control), 35-percent H3PO4, low viscosity 35-percent H3PO4 with a surfactant, self-etch conditioner, or 35-percent H3PO4 followed by self-etch conditioner. Groups 7 through 9 were sealed with GI sealant (Fuji Triage) after having the fissures conditioned with either polyacrylic acid (GI-control), 35- percent H3PO4 or low viscosity 35-percent H3PO4 with a surfactant. After aging through thermocycling (2500 cycles), specimens were incubated in methylene blue for four hours and sectioned at multiple locations. Digital images were obtained using a digital stereomicroscope, and microleakage was determined by scoring the dye penetration along the enamel-sealant interface. The penetration of the material was determined by calculating the percentage of the total length of the fissure penetrated by the material. Results: The use of self etch-conditioner significantly increased RMGI penetration, while surface conditioning with 35-percent phosphoric acid with surfactant significantly decreased microleakage of GI. The resin-based sealant placed after 35-percent phosphoric acid surface conditioning showed the best penetration and the least level of microleakage. In conclusion, results from this study suggest that the placement of glass ionomer-based sealants can be enhanced by modifying current conditioning methods.
Flexural strength comparison of monolayer resin composite to bilayer resin/ liner composite
(2009) Azzam, Mai; Platt, Jeffrey A.; Levon, John; Taskonak, Burak; Brown, David; Andres, Carl; Legan, Joseph
Clinical evidence suggests that the use of liners in posterior composite restorations may increase the frequency of restoration fractures. Materials that have been used as liner materials for resin composite (RC) restoration include conventional glass ionomers, resin-modified glass ionomers (RMGI), and flowable composites. The aim of this study was to compare the flexural strength of a monolayer of resin composite with that of a bilayer of resin composite and liner. Four types of RC beams were tested: a monolayer control that is an un-lined RC (Tetric EvoCeram, Ivoclar Vivadent) and three “bilayer” specimens that consisted of this same RC lined with one of three liners. The three liners used included two RMGI cements (Vitrebond LC liner; 3M ESPE and, GC Fuji Lining LC; GC America) and a flowable resin composite (Tetric EvoFlow, Ivoclar Vivadent). Each group was tested after water storage for 24 h and 30 d. Altogether, eight, 12-specimen groups were fabricated and tested. Methods: A 25 x 2 x 2 mm mold was completely filled with the RC to form the control beams. To form the bilayer beams, this mold was filled with 0.5 mm of the liner and then with 1.5 mm of the RC. Specimens were stored in 37oC distilled for either 24 h or 30 d. Immediately prior to testing, the 30-day groups were also thermocycled 2500 times, between water baths at 7 oC and 48oC with a 30-s dwell time and a 10-s transit time. Flexural strength was determined using a three-point–bending device. A twoway analysis of variance (ANOVA) with interactions was used to investigate how liner group (or no liner) and storage time affected strength. Results: The interaction between liner type and storage time was significant (p = 0.0128). The un-lined RC (the monolayer beam) was significantly stronger after 24 h than after 30 d in water (p = 0.0098). Water storage between 24 h and 30 d did not change the flexural strength of any of the bilayer (lined) beams (p > 0.05). After storage for 24 h and also for storage for 30 d, both un-lined RC and RC lined with the flowable RC exhibited significantly higher flexural strength (p = 0.0001) than the bilayer beams lined with either RMGI liners.
Evaluation of two methods of fissure treatment before sealant placement on different caries levels
(2009) Chitre, Swati; Cochran, Michael A.; Soto Rojas, Armando E.; Chu, Tien-Min Gabriel; Fontana, Margherita Ruth, 1966-; Carlson, Timothy
Occlusal pits and fissures are ideal places for caries development. Placement of dental sealants has been reported to be effective in preventing this process. However, the effectiveness of dental sealants has been reported to be influenced by clinical factors, such as preparation and placement techniques. A report recently published by the American Dental Association on the clinical recommendations for use of pit-and-fissure sealants included critical evaluation and a summary of relevant scientific evidence on the use of sealants aimed at assisting clinicians. The report addressed concerns such as: Does placing sealants over early (noncavitated) lesions prevent progression of the lesions? Are there any techniques that could improve sealants’ retention and ffectiveness in caries prevention? The investigators concluded that there is limited and conflicting evidence to support that mechanical preparation with a bur results in higher retention rates in children and recommend that pit-and-fissure sealants should be placed on early (noncavitated) carious lesions. The purpose of this in vitro study was to evaluate two methods of fissure treatment before sealant placement on different caries levels. In this study, 135 extracted human molars (ICDAS codes 0 to 2) were collected and ranked by a calibrated examiner into three groups. These were further divided into three subgroups (nine total). Occlusal surfaces were prepared with: 1) a ¼-mm round bur, 2) air abrasion, and 3) no treatment as a control. All groups were etched with 3.0- percent phosphoric acid for 15 seconds, rinsed thoroughly, and dried with an air water syringe. Opaque dental sealants were placed on the etched occlusal surfaces according to the accepted clinical standards and light-cured for 30 seconds. All groups were thermocycled for 5000 cycles. The roots of the teeth were painted with nail varnish, root apices were sealed with wax, and the occlusal surfaces were immersed in 1.0-percent methylene blue for a full 24 hours. The next day the teeth were cleaned, and the roots were sectioned to expose the crowns. Crowns were cut along the occlusal surfaces in the buccolingual direction. The sectioned surfaces were examined under the Nikon SMZ 1500 microscope for sealant penetration in the fissure and microleakage along the sealant enamel interface. The analyses were performed on a transformation of the sealant penetration percentage commonly used for calculated percentages: sin-1(p1/2). The effects of the type of group, the ICDAS code, and the fissure type on sealant penetration percentage were compared using ANOVA. The effects on microleakage and bubbles were compared using GEE methods applied to logistic regression. The effects on dye penetration were compared using GEE methods applied to cumulative logistic regression to account for the ordered categories of the dye penetration scale. In the findings of sealant penetration, the group type did not have a significant effect on sealant penetration (p = 0.195). ICDAS codes had a significant effect on sealant penetration (p = 0.0113) where ICDAS Code 0 had greater penetration than ICDAS codes 1 and 2. Fissure type had a significant effect on sealant penetration (p = 0.0001) where fissure types V and U had greater sealant penetration than Fissure types Y and W. In the findings of microleakage, the type of group had a significant effect on microleakage (p = 0.0004) where the abrasion group had increased microleakage as compared with the 1/4 round bur and control groups. ICDAS code had a significant effect on microleakage (p = 0.0022) where ICDAS code 0 had less microleakage as compared with ICDAS code 1 and 2. Fissure types V, U, Y, and W did not have a significant effect on microleakage (p = 0.721).

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