The aim of this literature review was to assess the clinical performance of MTA to establish the evidence level for its effectiveness in vital pulp therapy, perforation repair, and retrograde root canal filling. A comprehensive literature survey was performed via electronic databases of PubMed/MEDLINE. A total of 58 papers were reviewed in this study, of which 2 were systematic reviews/meta-analysis, 9 were randomized controlled trials (RCTs), and the rest were fallen into other categories. Mineral trioxide aggregate (MTA) provided better pulp protection as a direct capping material when compared with calcium hydroxide. As perforation repair materials, MTA demonstrated an excellent sealing ability in vitro. For periodontal tissues around a perforation, MTA provided normal healing processes in clinical trials. It is therefore concluded that MTA has a high potential in repairing perforations. MTA is the most promising material when used for retrograde root canal filling demonstrating normal healing in short/long term clinical outcomes.

The sealers’ antibacterial and antibiofilm activities against Enterococcus faecalis were evaluated by direct contact test (DCT) and confocal laser scanning microscopy (CLSM), respectively, after 1 day, and 1 and 4 weeks of aging. Cell viability was determined by adenosin triphosphate (ATP) assay after DCT. The parameters evaluated for the antibiofilm property were total biovolume and percentage of green cells in E.faecalis biofilms. The data from the bioluminescence ATP assay as well as the total biovolume and green percentage were analyzed by non-parametric tests, Kruskal-Wallis for global comparison and Kolmogorov-Smirnov for each two variables. Results of the DCT and CLSM for all parameters evaluated show that the antimicrobial activity of AH Plus decreased over time, whereas GuttaFlow Bioseal had an opposite property, increasing its antibacterial activity as the material aged.

Ion incorporation into the tooth is expected to be effective for caries prevention. Time-dependent ion incorporation released from surface pre-reacted glass-ionomer (S-PRG) filler eluate into tooth enamel was estimated by using inductively coupled plasma atomic emission spectroscopy (ICP-AES). Al, B, and Sr contents in enamel were increased in a time-dependent manner with immersion in S-PRG eluate. Clear ion incorporation was observed after 1 h of immersion in S-PRG filler eluate. Sr showed remarkable incorporation in enamel —up to 7,900 ppm— after 28 days of immersion. Sr and B incorporation rapidly occurred in S-PRG filler eluate, compared with their single component solutions. Simultaneous incorporation of cations and anions from S-PRG eluate occurred under balanced charge and may assist in rapid ion incorporation. Thus, various useful ions could be effectively incorporated into tooth enamel by applying S-PRG filler or its eluate; a bioactive effect can be expected.

We have previously fabricated hydroxyapatite (HAP) nanoparticle-assembled powder (nano-HAP) plates and granules by assembling low-crystallinity HAP nanoparticles without template/binder molecules or high-temperature/pressure treatments. In this study, we combined the nano-HAP with fibroblast growth factor (FGF) 2, which promotes odontoblast differentiation, and used this as a pulpcapping agent for dentin defects created in rat molars. The tissue response was then radiologically and histologically assessed at 1 and 2 weeks after capping, to assess the biocompatibility and ability of this material to promote hard tissue formation. The application of nano-HAP/FGF2 induced the invasion of dental pulp cells and vessels, and was consistently found to stimulate formation of a dentinal bridge containing numerous dentinal tubules. We thus succeeded in treating the pulp exposure by using a physiological approach to promote tissue regeneration. Further investigations should be performed to explain exactly how the nano-HAP/FGF2 combination contributes to calcified tissue formation.

This study compared marginal microleakage of Class II cavities restored with bulk-fill resin (Filtek™ Bulk Fill) and conventional composite resin (Filtek™ Supreme XTE). Two standardized Class II cavities were prepared in forty extracted human molars. The gingival margin was located above the cemento-enamel junction for twenty molars (groups 1 and 2) and apically for the other twenty (groups 3 and 4) (n=20). The occlusomesial cavity was filled with bulk-fill resin by insertion in bulk (groups 1 and 3) and the occlusodistal cavity was restored with conventional composite using incremental technique (groups 2 and 4). The teeth were thermocycled (500 cycles 5–55°C), stained and observed under light microscope. The microleakage was significantly lower in gingival margins located in enamel compared with dentin margins (p<0.01). There was no statistically significant difference between groups 1 and 2 (p=0.86) and groups 3 and 4 (p=0.26). Bulk-Fill resins presents gingival microleakage similar to conventional composites.

We investigated the influence of different curing modes on the mechanical properties and wear behavior of dual-cure provisional resin-based composites (DCPRs). Three DCPRs and a self-curing bis-acryl provisional resin-based composite were used. Flexural strength (σ_F), elastic modulus (E), resilience (R), and fracture toughness (K_IC) were measured. The specimens were fabricated with and without light irradiation, stored in distilled water at 37°C for 24 h, and subjected to 5,000 or 10,000 thermal cycles. For sliding impact wear testing, 12 specimens were prepared with and without light irradiation. The maximum facet depth and volume loss were determined using a noncontact profilometer. Some of the mechanical properties and wear behavior of DCPRs are affected by light irradiation. This study indicated that proper light irradiation is important in polymerization process of the DCPRs to enhance the wear resistance and some mechanical properties.

A fiberglass-reinforced composite resin (FRP) block using a plain woven fiberglass sheet for CAD/CAM has been introduced in dental practice. The aim of the present study was to evaluate the effects of the fiberglass sheet orientation on the flexural properties of an FRP block. The flexural properties of five types of fiberglass sheet-assigned specimens were examined using a three-point bending test. A one-way analysis of variance revealed that the orientation of fiberglass sheet significantly influenced the flexural strength, 0.2% yield strength, and flexural modulus. The values of the flexural properties of the FRP were the largest when the fiberglass sheets were perpendicular to the applied force, and the smallest when the fiberglass was parallel to the same. The flexural properties of the FRP block were anisotropic and they were significantly influenced by the orientation of fiberglass sheet.

Dual-cured resin-based composites are gaining popularity as core build-up materials. Physical and elastoplastic characteristics of new experimental core build-up materials with variable filler contents (+2.5 and +5 wt%) were investigated using classic macroexperiments and nanoindentation. Flexural fracture strength increased from 91.7±11.8 to 114.1±9.1 and 116.6±14.7 MPa in the +2.5 and +5 wt% groups, respectively; similarly, elastic moduli increased from 12.6±0.9 to 15.4±1.2 and 15.3±2.0 MPa, respectively. Fracture toughness increased from 1.82±0.60 to 2.28±0.53 and 2.67±0.88 MPa•m^1/2 for the +2.5 and +5 wt% groups, respectively; indentation hardness increased significantly from 0.45±0.03 to 0.55±0.04 and 0.60±0.10 GPa, respectively. The addition of +5 wt% filler content led to a mechanically superior material; the addition of +2.5 wt% filler led to better reliability.

Two types of synthetic carbonate apatite [potassium-containing carbonate apatite (CAK) and sodium-containing carbonate apatite (CANa)] were prepared and characterized by thermogravimetric analysis, X-ray diffraction analysis (XRD) and Fourier transform infrared spectroscopy. The chemical formulas of carbonate apatite were determined to be Ca_9.36K_0.12(PO₄)_5.12(CO₃)_0.88(OH)_1.73 and Ca_8.72Na_1.33(PO₄)_4.96(CO₃)_1.04(OH)_1.80, respectively. Thermogravimetric analysis showed that the final weight loss at 1,200°C reached about 11.2% for CAK and 13.9% for CANa. Carbonate loss gradually occurred above 150°C and continued to 1,200°C. The crystallinity of the apatite phase was found to be much improved between 800 and 850°C for CAK and 750 and 800°C for CANa, where rapid carbonate loss occurred. A small amount of CaO formed above 900°C. For CANa, NaCaPO₄ also formed above 700°C in both apatites. Although the lattice parameters of the carbonate apatites varied with temperature, the final a and c lattice parameters attained constant values of 0.9421 and 0.6881 nm.

This study was to evaluate whether UV light irradiation and He plasma treatment of zirconia disks enhances its biocompatibility with human gingival fibroblasts (HGFs), and to compare the difference of two methods. Zirconia disks were prepared and divided into three groups: UVC light treatment (Group UV), He plasma (Group P), and control group. The surface morphology, wettability were analyzed. The cultured HGFs’ adhesive density, morphology, proliferation and collagen synthesis were measured. After UV light and plasma treatment, contact angles decreased. HGFs’ adhesion and proliferation in Group P was the highest (p<0.05) at each time point. HGFs on Group P also released the highest level of Col-1 after 3 and 7 days. Our study demonstrated that plasma and UV light treatment on smooth zirconia improved the hydrophilic property of surface in different mechanism and He plasma had the better effect on cells adhesion, proliferation, and especially on collagen synthesis.

Bone marrow mesenchymal stem cells (BMSCs) of rats were isolated and Bio-Oss^® and R.T.R^® materials were used in this study.Alkaline phosphatase (ALP) activity in each group was calculated. The ability of adhesion and proliferation of BMSCs on Bio-Oss^® and R.T.R^® increased with time, but they were significantly higher on R.T.R^® than that of Bio-Oss^® at all time points (p<0.05). Compared with Bio-Oss^®, R.T.R^® could promote the expression and activity of ALP in BMSCs, and the expression of bone formation related transcription factors bone morphogenetic protein-1 (BMP-1), Cbfa1 and osteoblast marker genes ALP, collagen I, osteopontin, osseomucin and osteocalcin. The expression levels of cbfa1, ALP, collagen I, osteopontin, osseomucin and osteocalcin were inhibited after downregulated expression of BMP-1 in BMSCs and inoculation with R.T.R^®. R.T.R^® could up-regulate BMP-1 expression and cbfa1 expression through BMPs/SMAD signaling pathway, thereby promoting the expression of ALP, collagen I, osteopontin, osseomucin and osteocalcin and promoting osteoblast differentiation.

Despite the benefits of hydroxyapatite fiber (HAf) as a synthetic bone substitute, materials capable of faster bone regeneration would be more preferable. In this study, effects of HAf with magnesium (Mg-HAf) on bone regeneration were evaluated. In vitro, levels of osteogenic genes were significantly higher in bone marrow cells cultured with Mg-HAf than in those cultured with HAf alone. Moreover, effects of HAf only (control) and 5.7 mol% Mg-HAf on the cranial bones of Japanese white rabbits were evaluated. MicroCT imaging and histology indicated significant differences between the control and Mg-HAf groups. Significantly higher new bone volumes and percentages were observed in the Mg-HAf group than in controls at 4 and 8 weeks (p<0.05); the newly formed bone was more mature in the Mg-HAf group than in controls. These results indicated that Mg-HAf can enhance osteogenic differentiationrelated gene expression and promote rapid bone formation and maturation.

Evaluation of gap formation at the interfaces of a two-step self-etching adhesive with/without pre-etching was performed using sweptsource optical coherence tomography (SS-OCT). Round cavities were prepared in bovine incisors at the middle (MC) and cervical (CC) thirds of the crown and the cervical third of the root (CR). Clearfil SE bond was directly applied to one group (SE) and another (PA) was pretreated with K-etchant gel. Following restoration by flowable composite resin, the teeth were thermally challenged and stored for 2 months. Interfacial gaps observed in the cross-sectional OCT images were analyzed and the bottom cavities exhibited increased gaps compared to the margin and dentin-enamel junction (DEJ). The CR site had a larger gap than at MC and CC in the SE group. DEJ separation at the MC was significantly smaller than that at CC in both groups. Therefore, gap formation depends on the cavity region, location, and bonding protocol.

The aim of this in vitro study was to evaluate the effects of desensitizer pre-treatment on in-office bleaching using an artificial discoloration tooth model. The stained specimens were divided into four groups (n=10); without application (Control group), Shield Force plus (SF group), UltraEz (UE group) and Teeth Mate AP paste (TM group) applied before bleaching. Each group was bleached by an in-office bleaching agent. The CIE L*a*b* values were measured by a colorimeter before and after ten consecutive bleaching treatments and the color difference (∆E) was calculated. There was no statistical difference among ∆E values of Control, UE, and TM groups (p>0.05). There was a significant difference between SF and Control groups (p<0.001). It was concluded that application of TM and UE did not affect the change of tooth shade while SF application impeded the bleaching effect.

The objective of this study was to determine the effect of flowable composite lining and dentin location on internal dentin fracture formation in the microtensile bond strength (MTBS) test using swept-source optical coherence tomography (SS-OCT). MTBS test beams (1.0×1.0 mm) were prepared from human superficial and deep dentin, which was bonded with a self-etch adhesive (Clearfil SE Bond) and hybrid composite resin (Clearfil AP-X), with or without flowable lining (Clearfil Majesty ES-Flow). We tested 4 groups according to placement technique (with vs. without flowable liner) and dentin (superficial vs. deep) locations. Cross-sectional 2D images of the bonded interface were obtained before and after the MTBS test. Internal dentin fracture after MTBT was observed as a bright zone in SS-OCT. Flowable lining significantly reduced internal fracture formation in dentin (p<0.05). Dentin location significantly influenced MTBS (p<0.05), and this was reduced by flowable lining usage.

To determine the influence of the fracture toughness (K_IC) methods [single-edge-V-notch-beam (SEVNB) and chevron-notch-beam (CNB)] as well as an optional heat treatment on the K_IC of three different zirconia generations (1st: ZI, 3rd: FX, 4th: HT). One hundred and twenty specimens each (3×4×45 mm) were fabricated, sintered, notched (n=360) and half of them heat treated before K_IC measurements with 4-point-flexural-strength test. SEM images of the notches were recorded. Highest K_IC was found for ZI followed by HT and FX. SEVNB resulted in significantly higher K_IC than CNB. Heat treatment resulted in decrease for SEVNB and increase for CNB of K_IC (except for FX). Groups tested using CNB showed higher reliability of values (Weibull modulus) than tested using SEVNB. SEM images present crack path and fracture surface. Different zirconia materials lead to different K_IC values. The test method and a prior heat treatment showed an influence on the K_IC values and their reliability.

Zirconia is commonly used in dental applications. It has been reported that surface-modified zirconia implants showed better performance in vivo than machined zirconia implants. Silk fibroin electrogel is a good candidate for controlled drug delivery; however, the use of silk fibroin electrogel on zirconia implants has not previously been reported. The aim of this study was to investigate a method to coat zirconia implants with silk fibroin electrogel and evaluate the mechanical and biological properties of the coating. The results show that the wettability of the coating was close to that of sand-blasted and acid-etched (SLA)-treated zirconia, and the bond strength was larger than that of the coating prepared from silk fibroin aqueous solution. ATR-FTIR spectra provided evidence that the secondary structure changed during the electrogelation process. Culturing cells on the coating revealed its nontoxicity to osteoblast-like cells. Thus, it can be suggested that a silk fibroin electrogel coating is a promising biocompatible and degradable drugdelivery material for zirconia implants.

Use of non-thermal atmospheric plasma (NTAP) brush on immobilization of dimethylaminohexadecyl methacrylate (DMAHDM) onto dentin bonding substrate, and resulting antibacterial activity against Streptococcus mutans were investigated. A bonding substrate with several-micron-demineralized layer was created from human dentin. DMAHDM was applied onto the demineralized layer with or without plasma exposure. Scanning electron microscopy (SEM) and Fourier transformed infrared (FTIR) spectroscopy were employed to verify immobilization/grafting of DMAHDM onto the substrate. Antibacterial activity of the resulting substrate was assessed by using colony-forming unit (CFU) and confocal scanning laser microscopy. Effects of saliva pellicle treatment and aging process on the above substrate were also evaluated. The SEM/FTIR results demonstrated that NTAP could induce DMAHDM immobilization onto dentin substrate, which was further verified via quantitative FTIR analysis. Comparing with non-plasma-treated, the plasmatreated substrate, with CFU 4 log lower, exhibited much stronger inhibitory effects, which were minimally affected by saliva or aging. The DMAHDM-immobilized dentin substrate showed effective and sustained antibacterial characteristics.

To investigate the effect of EDTA-treated dentin on the differentiation of mouse induced pluripotent stem (iPS) cells. Dentin discs were prepared from bovine incisors and treated with 17% EDTA. Embryoid bodies (EBs) formed from mouse iPS cells were seeded on the dentin discs for the experiment. The roughness of the EDTA-treated dentin surface, Sa and Sdr, was higher and collagen fibrillike structures were observed by the scanning electron microscopy (SEM) in vitro. In RT-PCR, the mRNA levels of the osteoblast markers Bsp and Ocn were significantly higher in the experimental group. Expression of the DMP1, DSP, and BSP proteins were more notable in the experimental group by immunofluorescence (ICF) study. In vivo study, cartilage and bone-like tissue were observed adjacent to the EDTA-treated dentin. The study demonstrates that the dentin treated with 17% EDTA induces mouse iPS cells to differentiate into the osteo/odontogenesis.

Using a trans-illumination device that applies digital imaging fiber-optic transillumination (DIFOTI) technology, which involves the use of transmitted near-infrared laser light for inspection, the effect of composite resin (CR) restoration of a tooth on caries detection was evaluated. A cavity was formed in a tooth of the lower jaw cut from the specimen, experimental CRs with various filler rates were filled, and the influence of the filler on the obtained image was investigated. On the near-infrared images, the lightness differences between the CR-restored portion and the tooth portion were measured. The translucency parameter (TP) value and the correlation between the lightness differences and TP value of the CRs were investigated. The experimental results showed that the greater rate of macro-filler is, the lighter image and larger TP value. In other words, CR with hybrid filler to increase the TP value is less likely to affect caries detection by DIFOTI.

Multi-directional forging (MDFing) can improve the various properties of metals and alloys due to the evolution of an ultrafine-grained structure. In the present study, electrochemical properties and corrosion behaviors in a fluoride solution of MDFed pure titanium (MDF-Ti) were evaluated by comparing with conventional coarse-grained pure titanium (Ti). The E_open value of MDF-Ti was significantly higher than that of Ti. However, similar potentiodynamic polarization profiles were obtained for Ti and MDF-Ti. Immersion in NaF solution caused no severe corrosion to Ti or MDF-Ti. However, immersion in acidulate phosphate fluoride solution (APF) revealed that MDF-Ti had better corrosion resistance than Ti at shorter time immersion periods and was more susceptible to corrosion for longer immersion. Significantly less release of titanium was observed for MDF-Ti in shorter immersion periods in APF. In conclusion, MDF-Ti showed similar electrochemical behaviors to Ti and less susceptible to corrosion in shorter time APF immersion.

The aim of this study is to investigate the efficiency of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) gel and resin infiltrant on decalcified enamel, and to explain the correlation, if any, between ion release capacities and shear bond strength (SBS). A total of 80 premolar teeth were used (n=20). Group I was the control, while a demineralization protocol was performed for other groups. CPP-ACP gel and resin infiltrant, respectively, was applied to Groups III and IV. Pre and post-demineralization energy dispersive X-Ray analysis of all groups and post-application of Groups III and IV were undertaken. SBS tests were performed. Ca/P ratio significantly increased after the applications. Both agent groups showed a significant decrease in SBS values compared to others. There was no correlation between SBS and Ca/P ratio changes. It can be said that CPP-ACP and resin infiltrant therapies enhance the tooth mineral content, but show lesser SBS values than the control and demineralization only groups.