Znanstvene novosti u stomatologiji News in Dental Sciences

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Restaurativna stomatologija
Restorative dentistry
Mjerenjem učinkovitosti polimerizacije bulk kompozitnih materijala u debljini od 4 mm određivanjem tvrdoće materijala po Vickersu
u slojevima od 0,3 mm pokazalo se kako su od 5 testiranih materijala
(Tetric EvoCeram Bulk Fill, X-tra base, Venus Bulk Fill, Filtek Bulk Fill, SonicFill) najbolje vrijednosti imali SonicFill i Tetric EvoCeram Bulk
fill. Bitno je napomenuti kako su svi navedeni materijali imali prihvatljivu polimerizaciju na dubini koju propagiraju proizvođači (1). Trogodišnja studija o utjecaju selektivnog jetkanja cakline (u tretmanu nekarijesnih cervikalnih lezija) kod dvokomponentnog samojetkajućeg adheziva
(AdheSE) pokazala je kako nije bilo razlika u marginalnom prilijeganju uz
dentin, pojavnosti sekundarnog karijesa, pojavnosti preosjetljivosti i gubicima ispuna između ispitivanih skupina. Međutim, postojala je razlika u rubnom integritetu u području cakline, kao i u pojavnosti diskoloracija između dvije skupine. Selektivno jetkanje imalo je za posljedicu
manje caklinskih defekata i manju diskoloraciju ruba ispuna (2). Istraživanje učinkovitosti novog samojetkajućeg tekućeg kompozita Vertise Flow kod kaviteta I razreda pokazalo je niže vrijednosti snage veze i
na dentin i na caklinu u usporedbi s jednokomponentim samojetkajućim sustavima. Međutim, marginalno nanocurenje bilo je znatno manje kod Vertise-a (3). Vertise flow se također pokazao uspješnim kod
pečaćenja fisura, pri čemu je pokazao rezultate usporedive s materijalima za pečačenje (Clinpro Sealant, 3M ESPE i Guardian Seal, Kerr) (4).
U istraživanju higroskopne ekspanzije kompozitnih materijala pokazalo se
kako ekspanzija među materijalima varira i do 400%. Pri tome su materijali svrstani u tri kategorije unutar kojih nije bilo značajne razlike u volumetrijskoj ekspanziji. Najveću ekspanziju pokazao je Vertise flow, u drugoj kategoriji s manjom ekspanzijom bili su Venus Diamond Flow, Tetric
EvoCeram i Ceram X duo, dok su u skupini s najmanjom ekspanzijom
bili Bright light, GrandioSo, Nanoceram-Bright i X-tra base (5). U sličnom istraživanju, siloranski kompozitni materijali pokazali su najmanje
dimenzionalne promjene i higroskopnu promjenu volumena (6). Karijesogene bakerije mogu nepovoljno djelovati na kompozitne materijale. Naime, Streptococcus mutans je pomoću esteraze uzrokovao oštećenje kako
kompozita tako i adheziva, što je dokazano SEM snimkama i porastom
koncentracije bishidroksi-propoksi-fenil-propana (BisHPPP) kod ispitivane skupine. BisHPPP je pokazatelj razgradnje BisGMA. Na taj način bi
karijesogene bakterije kod sekundarnog karijesa mogle doprinijeti razaranju veze dentin – adhezijski sustav (7). U istraživanja dinamike otpuštanja
fluorida uočeno je drastično smanjenje otpuštanja fluorida kod korištenja
premaza za staklene ionomere, dok je kod premazivanja vazelinom to smanjenje bilo nešto manje, te se u pojedinim situacijama predlaže izbjegavanje korištenja bilo kakvih premaza (8). Caklinsko dentinski adhezijski sustav modificiran nanočesticama srebra, kvaternim amonij metakrilatom i
nanočesticama amorfnog kalcij fosfata pokazao je dobra antibakterijska
svojstva uz remineralizirajuće djelovanje. Na ovaj način se mogu učinkovito neutralizirati i rezidualne bakterije u kavitetu, dok sustav istovremeno može djelovati remineralizirajuće na tvrda zubna tkiva (9). Snaga svezivanja srednje kiselih samojetkajućih adheziva (G bond i Clearfil S3 bond)
nije bila smanjena pri prethodnom tretmanu dentina desenzibilizirajućim
preparatima temeljenim na kalciju (10).
Research on bulk materials polymerization efficacy of 4 mm thick
samples using Vickers hardness testing (layers of 0.3 mm) revealed that
of 5 tested materials (Tetric EvoCeram Bulk Fill, X-tra base, Venus Bulk
Fill, Filtek Bulk Fill, SonicFill), SonicFill and Tetric EvoCeram Bulk fill
had the best results. However, all the tested materials had acceptable polymerization at depths claimed by producers (1). Three year prospective
study on selective enamel etching (non carious cervical lesions) before application of two component self-etch system (AdheSE) showed no differences in dentin marginal integrity, secondary caries, hypersensitivity and
filling loss between tested groups. There was substantial difference in marginal integrity of the enamel well as incidence of marginal discoloration.
Namely, selective etching caused less enamel cracks and pitting as well as
less marginal filling discoloration (2). Vertise Flow, a self-etch flowable
composite, was shown to have a lower strength of adhesion on enamel and
dentine in class I cavities when compared to single bottle self-etch adhesive systems. However, marginal micro leakage was lower in case of Vertise
Flow (3). It was also tested as a fissure and pit sealant, where it performed
equally or better than dedicated materials (Clinpro Sealant, 3M ESPE and
Guardian Seal, Kerr) (4). Research of a hygroscopic volumetric expansion
of composites showed it can differ up to 400% between different materials. Namely, materials were divided into three groups, depending on the
quantity of expansion. Highest volumetric expansion group included Vertise Flow. Moderate expansion group included Venus Diamond Flow, Tetric EvoCeram and Ceram X duo, while the lowest expansion group included Bright light, Grandio So, Nanoceram-Bright and X-tra base (5).
In a similar study, silorane composite materials demonstrated lowest hygroscopic volumetric change (6). Cariogenic bacteria can damage composite materials by means of esterase enzymes. Namely, Streptococcus mutans
caused damage to composite materials as well as adhesive layers. Findings
were confirmed using SEM and detecting a bishydroxy-propoxy-phenylpropane (BisHPPP) in the tested groups. BisHPPP is a degradation product of Bis GMA. Thus, bacterial activity during secondary caries could
help disintegrating hybrid layer (7). Fluoride release dynamics research revealed substantially less fluoride release from glass ionomere fillings when
a coating was used. When petroleum jelly instead of coating was used, fluoride release was less inhibited. In certain situations where fluoride release
action is expected and desirable, it is suggested that no coating is used (8).
Modification of dental adhesive system that included silver nanoparticles,
quaternary ammonium methacrylate and amorphous calcium phosphate
nanoparticles showed good antibacterial action as well as remineralization
activity. This way it would be possible to destroy residual bacteria as well
as to promote remineralization (9). It was shown that bonding strength of
medium acidic self-etch adhesives (G bond and Clearfil S3 bond) wasn’t
affected by desensitizing solutions based on calcium (10).
Literatura
1. Alrahlah A, Silikas N, Watts DC. Post-cure depth of
cure of bulk fill dental resin-composites. Dent Mater. 2013 Nov 19. doi:pii: S0109-5641(13)00482X. 10.1016/j.dental.2013.10.011. [Epub ahead of
print] PubMed PMID: 24268044.
2. Can Say E, Ozel E, Yurdagüven H, Soyman M.
Three-year clinical evaluation of a two-step selfetch adhesive with or without selective enamel etching in non-carious cervical sclerotic lesions. Clin
Oral Investig. 2013 Nov 22. [Epub ahead of print]
PubMed PMID: 24264636.
3. Vichi A, Margvelashvili M, Goracci C, Papacchini F,
Ferrari M. Bonding and sealing ability of a new selfadhering flowable composite resin in class I restorations. Clin Oral Investig. 2013 Jul;17(6):1497-506.
doi: 10.1007/s00784-012-0846-6. Epub 2012 Oct
20. PubMed PMID: 23086332.
4. Margvelashvili M, Vichi A, Carrabba M, Goracci
C, Ferrari M. Bond strength to unground enamel and sealing ability in pits and fissures of a new
self-adhering flowable resin composite. J Clin Pediatr Dent. 2013 Summer;37(4):397-402. PubMed
PMID: 24046989.
5. Alrahlah A, Silikas N, Watts DC. Hygroscopic expansion kinetics of dental resin-composites. Dent Mater. 2013 Nov 20. doi:pii: S0109-5641(13)004818. 10.1016/j.dental.2013.10.010. [Epub ahead of
print] PubMed PMID: 24268572.
6. Wei YJ, Silikas N, Zhang ZT, Watts DC. The relationship between cyclic hygroscopic dimensional changes and water sorption/desorption of selfadhering and new resin-matrix composites. Dent
Mater. 2013 Sep;29(9):e218-26. doi: 10.1016/j.
dental.2013.05.010. Epub 2013 Jul 3. PubMed
PMID: 23830294.
www.ascro.hr
Znanstvene novosti u stomatologiji
News in Dental Sciences
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7. Bourbia M, Ma D, Cvitkovitch DG, Santerre JP, Finer Y. Cariogenic bacteria degrade dental resin composites and adhesives.
J Dent Res. 2013 Nov;92(11):989-94. doi:
10.1177/0022034513504436. Epub 2013 Sep 11.
PubMed PMID: 24026951; PubMed Central PMCID: PMC3797536.
8. Kamatham R, Reddy SJ. Surface coatings on glass
ionomer restorations in Pediatric dentistry-Wor-
PubMed Central PMCID: PMC3622776.
10.Pei D, Liu S, Huang C, Du X, Yang H, Wang Y,
Deng D. Effect of pretreatment with calcium-containing desensitizer on the dentine bonding of mild
self-etch adhesives. Eur J Oral Sci. 2013 Jun;121(3
Pt 1):204-10. doi: 10.1111/eos.12047.Epub 2013
Mar 28. PubMed PMID: 23659244.
Endodoncija
Endodontics
Biokeramički endodontski cement pokazao se jednako učinkovit kao
AH plus cement u istraživanju snage vezivanja gutaperke i dentinskih
stjenki (“push-out test”). Također, snaga svezivanja bila je neovisna o prisutnosti zaostatnog sloja (1). Istraživanje otpornosti endodontski liječenih zubi na frakturu pokazalo je kako cementi temeljeni na epoksi smolama (AH plus) i biokeramici (Endosequence BS) povećavaju silu potrebnu
za frakturu endodontski liječenih jednokorijenskih premolara in vitro (2).
Eksperimentalni epoksidni endodontski cement s dodatkom polietilenimina pokazao je iznimno jaku površinsku antibakterijsku aktivnost kroz
široki raspon pH i uništio kolonije Enteroccocus faecalisa kroz nekoliko
minuta. Istovremeno, formulacija epoksidnog cementa i nanočestica kvaternog amina ne dopušta curenje kvaternog amina u okolno područje, lokalizirajući time antibakterijsko djelovanje (3). Kod uklanjanja kalcij hidroksida iz kanala pokazalo se kako je obično ispiranje nedostatno kako bi
se uklonio sav kalcij hidroksid iz kanala, dok su se EndoVac i PiezoFlow
ultrazvučni irigacijski sustavi pokazali učinkovitima (4). U usporedbi s gutaperkom (Thermafil i System B), Resilon se nije pokazao boljim u brtvljenju korijenskog kanala (5). Modifikacije AH Plus cementa klorheksidinom, cetrimidom ili njihovom kombinacijom u svrhu antibakterijskog
djelovanja nisu negativno utjecale na njihova fizička svojstva, pri čemo su
fizikalni parametri ostali unutar zadanih ANSI/ADA zahtjeva (6). Usporedba eteričnog ulja naranče i kloroforma u otapanju gutaperke pokazala
je da nema značajne razlike između ova dva sredstva (7). Također, istraživanje utjecaja sredstva za otapanje gutaperke na svezivanje endodontskog cementa na dentin pokazalo je negativan utjecaj na snagu sveze cementa koji
ovisi o tipu otapala i tipu cementa koji se koriste (8). Istraživanje stresa generiranog pri instrumentaciji pokazalo je kako SAF tehnika instrumentacije uzrokuje puno manje naprezanje nego rotirajuće tehnike. Na ovaj način
se čuva integritet preostalog zubnog tkiva, smanjuje mogućnost nastajanja
pukotina i napuknuća, koji mogu dovesti do fraktura a s tim i gubitka zuba (9). Korištenje reciprocirajućih pokreta (140 stupnjeva u smjeru kazaljke na satu, 45 stupnjeva obrnuto) pri instrumentaciji ProTaper F2 i ProFile #25/.06 instrumentima nije pridonijelo njihovoj većoj otpornosti na
cikličko opterećenje (10). Istraživanje učinkovitosti revizije punjenja korijenskog kanala pokazalo je veću učinkovitost ProTaper instrumenata (D1D2-D3) u usporedbi s H-strugačima a korištenje kloroforma kao otapala nije dovelo do smanjenja zaostatne gutaperke na stjenkama korijenskog
kanala, već je samo skratilo vrijeme potrebno za reviziju (11). U istraživanju alginata kao zamjene za periradikularna tkiva u in vitro istraživanjima
apeks lokatora pokazalo se kako nije bilo razlike u određivanju radne duljine in vivo i in vitro sa zubima uloženim u alginat (12).
Bioceremic endodontic sealer was equally efficient as AH Plus sealer
in push out test when used with gutta-percha. Also, smear layer removed
didn’t influence bonding strength (1). Research on endodontically treated
teeth resistance to fracture showed that epoxy based (AH Plus) and bioceramic (Endosequence BS) sealers increased fracture resistance of endodontically treated single root premolars in vitro (2). Experimental epoxy
sealer modified with polyethileneimine showed high surface antibacterial activity in a wide pH range, destroying Enterococcus faecalis colonies
within minutes. At the same time, due to its formulation and nanoparticulated form of quaternary amine, leakage of amine into surrounding tissue
was prevented. Thus, antibacterial action is at the surface only (3). Common irrigation was shown inadequate to remove calcium hydroxide from
the root canal. EndoVac and PiezoFlow ultrasonic irrigation systems were,
however, effective (4). When compared to gutta-percha (Thermafil and
System B), Resilon was equally effective in quality of the root canal obturation (5). AH Plus modified with chlorhexidine, cetrimide or both was
shown to retain its physical properties within ANSI/ADA defined range
exhibiting additional antibacterial properties (6). Comparison of orange
essential oil with chloroform in efficacy of softening gutta-percha showed
no significant differences (7). Also, research on gutta-percha solvents influence on sealer to dentin adhesion showed it had a detrimental effect on
bonding strength, depending on combination of sealer and solvent (8). It
was demonstrated that SAF instrumentation system causes less strain then
rotating systems. Less stress leads to decreased incidence of micro-fractures
or fissures that can possibly lead to the vertical tooth fracture and tooth
loss (9). Usage of ProTaper F2 and ProFile #25/.06 instruments in reciprocating mode (140 degrees clockwise, 45 degrees counterclockwise) yielded no increase in their cyclic load resistance (10). Research on retreatment
efficacy using H files and ProTaper D files and solvents showed that ProTaper was more efficient. Chloroform solvent reduced only retreatment
time, but not the residual gutta-percha, when compared to control (11).
Alginate was shown to be adequate substitution for periradicular tissues in
in vitro research of electronic apex locator efficacy (12).
Literatura
www.ascro.hr
thy or not? J Indian Soc Pedod Prev Dent. 2013
Oct-Dec;31(4):229-33. doi: 10.4103/09704388.121818. PubMed PMID: 24262395.
9. Melo MA, Cheng L, Weir MD, Hsia RC, Rodrigues
LK, Xu HH. Novel dental adhesive containing antibacterial agents and calcium phosphate nanoparticles. J Biomed Mater Res B Appl Biomater. 2013
May;101(4):620-9. doi: 10.1002/jbm.b.32864.
Epub 2012 Dec 20. PubMed PMID: 23281264;
1. Shokouhinejad N, Gorjestani H, Nasseh AA, Hoseini A, Mohammadi M, Shamshiri AR. Push-out
bond strength of gutta-percha with a new bioceramic sealer in the presence or absence of smear layer.
Aust Endod J. 2013 Dec;39(3):102-6. doi:10.1111/
j.1747-4477.2011.00310.x. Epub 2011 May 29.
PubMed PMID: 24279654.
2. Topçuoğlu HS, Tuncay O, Karataş E, Arslan H,
Yeter K. In Vitro Fracture Resistance of Roots Obturated with Epoxy Resin-based, Mineral Trioxide Aggregate-based, and Bioceramic Root Canal
Sealers. J Endod. 2013 Dec;39(12):1630-3. doi:
10.1016/j.joen.2013.07.034. Epub 2013 Sep 5.
PubMed PMID:24238462.
3. Beyth N, Kesler Shvero D, Zaltsman N, HouriHaddad Y, Abramovitz I, Davidi MP,Weiss EI. Rapid Kill-Novel Endodontic Sealer and Enterococcus faecalis. PLoS One.2013 Nov 6;8(11):e78586.
doi:10.1371/journal.pone.0078586.
PubMed
PMID:24223159; PubMed Central PMCID:
PMC3819367.
4. Yücel AÇ, Gürel M, Güler E, Karabucak B. Comparison of final irrigation techniques in removal of calcium hydroxide. Aust Endod J. 2013 Dec;39(3):11621.doi: 10.1111/j.1747-4477.2011.00326.x. Epub
2011 Dec 13. PubMed PMID: 24279657.
5. Castelo-Baz P, Martin-Biedma B, Lopes MM, PiresLopes L, Silveira J, López-Rosales E, Varela-Patiño P. Ultramicroscopic study of the interface and
sealing ability of four root canal obturation methods: Resilon versus gutta-percha. Aust Endod J.
2013 Dec;39(3):159-63. doi: 10.1111/j.17474477.2012.00370.x. Epub 2012 Sep 24. PubMed
PMID: 24279665.
6. Ruiz-Linares M, Bailón-Sánchez ME, Baca P,
Valderrama M, Ferrer-Luque CM. Physical Properties of AH Plus with Chlorhexidine and Cetrimide.
J Endod. 2013 Dec;39(12):1611-4. doi: 10.1016/j.
joen.2013.08.002. Epub 2013 Sep 11. PubMed
PMID: 24238458.
7. Rehman K, Khan FR, Aman N. Comparison of
orange oil and chloroform as gutta-percha solvents in endodontic retreatment. J Contemp Dent
Pract. 2013 May 1;14(3):478-82. PubMed PMID:
24171993.
8. Nasim I, Neelakantan P, Subbarao CV. Effect of
gutta-percha solvents on the bond strength of two
resin-based sealers to root canal dentin. Acta Odontol Scand. 2013 Nov 21. [Epub ahead of print]
PubMed PMID: 24255957.
9. Kim HC, Sung SY, Ha JH, Solomonov M, Lee JM,
Lee CJ, Kim BM. Stress Generation during Self-Adjusting File Movement: Minimally Invasive Instrumentation. J Endod. 2013 Dec;39(12):1572-5. doi:
10.1016/j.joen.2013.07.021. Epub 2013 Aug 31.
PubMed PMID: 24238449.
357
11.Khalilak Z, Vatanpour M, Dadresanfar B, Moshkelgosha P, Nourbakhsh H. In Vitro Comparison of Gutta-Percha Removal with H-File and
ProTaper with or without Chloroform. Iran Endod J. 2013 Winter;8(1):6-9. Epub 2013 Jan 20.
PubMed PMID: 23413203; PubMed Central PMCID: PMC3570960.
12.Lipski M, Trąbska-Świstelnicka M, Woźniak K,
Dembowska E, Droździk A. Evaluation of alginate as a substitute for root-surrounding tissues in
electronic root canal measurements. Aust Endod
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PMID: 24279664.
Oralna kirurgija
Oral surgery
Istraživanje sposobnosti brtvljenja materijala za retrogradno punjenje kod apikotomije pokazalo je kako nema razlike u propuštanju između
MTA i Resilon-a, pri čemu je bitno osigurati dobro izolirano radno polje (1). Predtretman površine implantata kolagenom i hondroitin sulfatom
potaknuo je povećanje volumena kosti u odnosu na kontrolu (2). Istraživanje oštećenja implantata pri postavljanju pokazala su kako prilikom
umetanja implantata uslijed smičnih sila može doći do oštećenja površine s posljedičnim otkidanjem čestica titana i aluminija. Pri tome je najveća količina čestica pronađena u području krestalnog kortikalisa (3). Metalurška ispitivanja pokazala su kako bi TiNbZr legure mogle zamijeniti
Ti6Al4V, pri čemu se uočilo stvaranje debljeg pasivnog sluja uz manju količinu TiO2 nego kod Ti6Al4V, što je bilo potvrđeno fotoelektronskom
spektroskopijom pomoću x zraka (4). DIVA (Dynamic Implant Valve
Approach) implantološki sustav pokazao se uspješnim u in vivo istraživanju na svinjama. Sustav omogućava unutrašnji sinus lifting korištenjem samog implantata uz mogućnost vizualizacije okolne kosti pomoću posebno
razvijenog dentalnog endoskopa, a moguća je aplikacija lijekova i otopina
postoperativno ili u slučaju komplikacija izravno kroz implantat, bez opsežnih kirurških zahvata (5). Pokazalo se kako titanske kapice za cijeljenje
potiču intenzivniji odgovor tkiva nego one izrađene od cirkon oksida. Pri
tome je bila začajno povećana ekspresija matriksne metaloproteinaze 8 i 9
(6). In vitro studija o utjecaju eteričnih ulja na biofilm na površini implantata pokazala je iznimno smanjenje broja bakterija i snažno djelovanje na
inhibiciju plaka, pri čemu postoji indikacija za provedbu in vivo istraživanja zbog njihove visoke učinkovitosti (7). Aditivna tehnologija proizvodnje izravnim laserskim sinteriranjem metala pokazala je dobre rezultate pri
proizvodnji dentalnih implantata uz mogućnost kontrole parametara sinteriranja čime bi se moglo postići funkcionalno graduirana struktura uz
povećanu otpornost na opterećenje i veću dugotrajnost implantata (8). Fotofunkcionalizacija Ti6Al4V implantata pomoću UV svjetla kroz 15 minuta pojačala je bioaktivnost i oseokonduktivnost. Pri tome se hidrofobna
površina implantata pretvara u super-hidrofilnu. Testovi na femuru štakora
testom izgurivanja pokazali su barem 100% jaču snagu veze nego kod netretiranih implantata. Izgledno je da bi fotofunkcionalizacija površine implantata mogla imati veću ulogu od površinske hrapavosti (9).
Research of retrograde cavity sealing properties showed no differences
between MTA and Resilon. However, it is vital to secure well isolated operational field (1). Implant surface pretreatment with collagen and chondroitin sulfate caused increased volume of bone tissue when compared to
control group (2). Smear forces during implant insertion can cause surface damage with dispersion of titanium and aluminum particles dislodgment and spread into the surrounding tissues. Greatest quantity of particles was found in the area of crestal cortical bone (3). TiNbZr alloys are a
possible replacement candidate for Ti6Al4V alloy. They presented a thicker passive layer with reduced quantity of TiO2, which was determined by
X-ray photo electronic spectroscopy (4). DIVA (Dynamic Implant Valve
Approach) implant system was successful in in vivo research performed on
pigs. The system enables internal sinus lifting during implant insertion. Also, a bone can be visualized using a propriety dental endoscope. It is also
possible to apply medications through the implant, thus avoiding complicated surgical procedures (5). It was demonstrated that titanium healing
caps induced increased tissue response then those made of zirconium with
increased activity of matrix metalloproteinases 8 and 9 (6). In vitro study
on influence of essential oils on implant surface biofilm showed decreased
number of bacteria and strong plaque inhibition with in vivo research indication due to their high efficacy (7). Additive direct laser metal sintering technology of production showed good results in dental implant field.
Namely, by changing sintering parameters it is possible to achieve functionally gradual structure which could lead to better physical properties
and thus increased longevity of dental implants (8). Photo functionalization of Ti6Al4V implants using UV source during 15 minutes increased
their bioactivity and oseoconductivity. During this process implant surface
turns from hydrophobic to super-hydrophilic. Rat femur push-out model
testing revealed at least 100% increased strength when compared to nontreated implant group. Present findings indicate that UV treatment of the
surface may be more important than surface roughness in promoting osseointegration (9).
Literatura
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2. de Barros RR, Novaes AB Jr, Korn P, Queiroz A, de
Almeida AL, Hintze V, Scharnweber D, Bierbaum
S, Stadlinger B. Bone Formation in a Local Defect
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