Dental Light-curing Units: An American Dental Association Clinical Evaluators Panel Survey

Background The ability to polymerize light-activated dental materials with dental light-curing units (DLCUs) has revolutionized dentistry. However, proper DLCU use is essential for ensuring the effectiveness and performance of these materials. Methods The authors developed an electronic cross-sectional survey in the American Dental Association Qualtrics Research Core platform. The survey included questions about DLCU use, unit type and selection, training, maintenance, technique, and safety measures. The authors deployed the survey to 809 American Dental Association Clinical Evaluators (ACE) panelists on October 9, 2019, and sent reminder links to nonrespondents 1 week later. They conducted exploratory and descriptive analyses using SAS software Version 9.4. Results Of the 353 ACE panelists who completed the survey, most used a DLCU in their practices (99%), and light-emitting diode multiwave units were the most common type of DLCU units (55%). Dentists use DLCUs for over one-half of their appointments each day (mean [standard deviation], 59% [22%]). Regarding technique, respondents reported that they modify their curing technique on the basis of material thickness (79%) and material type or light tip-to-target distances (59%). Maintenance practices varied, with two-thirds of respondents reporting that they periodically check their DLCUs\u27 light output. Conclusions DLCUs are an integral part of a general dentist’s daily practice, but maintenance, ocular safety, and technique varied widely among this sample. Practical Implications Because clinical effectiveness requires delivery of an adequate amount of light energy at the appropriate wavelength, variation in DLCU maintenance, safety, and techniques suggest that dentists could benefit from additional guidance and training on DLCU operation

Bonding Crowns and Bridges with Resin Cement

Background Bonding crowns and bridges with resin cement can improve retention and reinforcement of the restoration. However, there is variation in the steps taken by different practitioners to achieve this goal. Methods The authors developed a survey on bonding dental crowns and bridges with resin cement and distributed it electronically to the American Dental Association Clinical Evaluators (ACE) Panel on May 22, 2020. The survey remained open for 2 weeks. Descriptive data analysis was conducted using SAS Version 9.4. Results A total of 326 panelists responded to the survey, and 86% of respondents who place crowns or bridges use resin cements for bonding. When placing a lithium disilicate restoration, an almost equal proportion of respondents etch it with hydrofluoric acid in their office or asked the laboratory to do it for them, and more than two-thirds use a silane primer before bonding. For zirconia restorations, 70% reported their restorations are sandblasted in the laboratory, and 39% use a primer containing 10-methacryloyloxydecyl dihydrogen phosphate. One-half of respondents clean their lithium disilicate or zirconia restorations with a cleaning solution. Resin cements used with a primer in the etch-and-rinse mode are the most widely used. The technique used to cure and clean excess resin cement varies among respondents. Conclusions The types of resin cements used, tooth preparation, crown or bridge preparation, and bonding technique vary among this sample. Practical Implications Although many dentists bond crowns and bridges on the basis of best practices, improvement in the process may be achieved by dentists communicating with their laboratory to confirm the steps performed there, ensuring an effective cleaning technique is used after try-in and verifying that the correct primer is used with their chosen restorative material

Zirconia Restorations: An American Dental Association Clinical Evaluators Panel Survey

Background Zirconia is a relatively new dental material used for indirect dental restorations. Little is known about how dental practitioners are using this material in their practice. Methods A survey on zirconia restorations was developed and administered electronically through e-mail communications to the American Dental Association Clinical Evaluators (ACE) Panel on August 31, 2020. Reminders were sent to nonrespondents, and the survey closed 2 weeks after the launch date. Results When using zirconia for a restoration, respondents choose it to restore natural teeth (99%) more often than implants (76%). Almost all respondents (98%) use it for posterior crowns, whereas approximately two-thirds (61%) use it for anterior crowns. Restoration removal or replacement and shade matching and translucency were the top 2 cited disadvantages of zirconia, whereas most of the respondents (57%) cited flexural strength or fracture resistance as the biggest advantage. Fine diamonds and ceramic polishers are used most often to polish and adjust zirconia restorations, whereas coarse diamond rotary instruments and those made specifically for zirconia are most frequently used for removing these restorations. Compared with metal ceramic restorations, more than 50% of respondents experience debonding more often with zirconia restorations. Conclusions Dentists recognize the favorable fracture resistance and flexural strength properties of zirconia, and most use similar techniques when adjusting and removing this material. Removing these restorations and shade matching are a struggle for many. Practical Implications Dentists may benefit from tips on the best methods to remove, shade match, and adhesively bond zirconia restorations. Survey Results Data reflect the responses of 277 American Dental Association Clinical Evaluators (ACE) Panel member dentists in the United States

Characterization of Experimental Nanoparticulated Dental Adhesive Resins with Long-Term Antibacterial Properties

Experimental adhesives with functional nitrogen-doped titanium dioxide nanoparticles (N_TiO2) have been shown to display improved properties. However, these materials have not been characterized regarding their degree of conversion (DC), biaxial flexure strength (BFS), surface roughness (SR), elastic modulus (EM), and long-term antibacterial functionalities. Experimental adhesives were synthesized by dispersing N_TiO2 (10%, 20%, or 30%, v/v%) into OptiBond Solo Plus (OPTB, Kerr Corp., USA). Unpolymerized adhesives (volume = 50 μL/drop, n = 3/group) were individually placed onto a heated (37 °C) attenuated total reflectance (ATR) monolithic diamond crystal (Golden Gate, Specac). The spectra of composites were obtained with a Fourier-transform infrared (FTIR) spectrometer (Nicolet IS50; 500–4500 cm−1; resolution = 4 cm−1, 10 internal scans/spectrum) before and after polymerization. Disk-shaped specimens (diameter = 6.0 mm, thickness = 0.5 mm) for BFS (n = 12/group), SR and EM (n = 3/group), and for antibacterial testing (n = 18/group/time-point) were fabricated and photopolymerized (1 min each; 385–515 nm, 1000 mW/cm2; VALO). DC values (%) were calculated from pre- and post-polymerization spectra using the two-frequency method and tangent-baseline technique. BFS was assessed using a universal testing machine (Instron 68TM-5, crosshead speed = 1.27 mm/min, 25 °C). SR and EM were investigated using an atomic force microscope (Multimode 8) with aluminum-coated silicon probes (8 nm pyramidal tip, spring constant 40 N/m, Bruker). Antibacterial testing was performed by growing Streptococcus mutans biofilms (UA159-ldh, 37 °C, microaerophilic) on the surfaces of specimens for 24 h and then measuring the relative luminescence units (RLU) with a Biotek Synergy HT multi-well plate reader. Results demonstrate that experimental materials containing 10%, 20%, and 30% of N_TiO2 displayed higher levels of DC, had better mechanical properties, and were able to exert strong and durable antibacterial properties without visible light irradiation and after extended periods of simulated shelf-life and aging in PBS. The reported experimental materials are expected to increase the service lives of polymer-based bonded restorations by decreasing the incidence of secondary caries

The Applicability of a Drop Penetration Method to Measure Contact Angles on TiO2 and ZnO Nanoparticles

In this study, six solvents (water, diiodomethane, bromonaphthalene, formamide, ethanol and ethylene glycol) were examined for three nanoparticle substrates, zinc oxide and titanium dioxide (21 nm and 100 nm), with the goal of assessing the suitability of a modified drop penetration method (DPM) for orders of magnitude smaller particles. Nanoparticles were compressed into flat discs and the solvent dropped on the surface while the image with time was recorded. Contact angles were in reasonable agreement with literature over the range of 20–80°, but failed to provide acceptable results for surface energy components. It was necessary to eliminate certain solvents and substrates not meeting the selection criteria

Dentist-administered vaccines An American Dental Association Clinical Evaluators Panel survey

BackgroundWith many states in the United States permitting dentists to administer the COVID-19 vaccine, there is much discussion about their scope of practice in relation to delivering other vaccines.MethodsSurvey questions were developed to assess dentists' awareness about their vaccine administration scope of practice and attitudes and barriers if choosing to incorporate vaccine delivery into their practice scope. The survey was deployed electronically to members of the American Dental Association Clinical Evaluators (ACE) Panel (N = 989) on September 2, 2021, and remained open for 2 weeks. Data were summarized descriptively in Qualtrics and SAS Version 9.4.ResultsOf the 330 ACE Panel members who responded to the survey, 42% were not aware of which vaccines their state permits them to deliver. More than one-half (55%) would be willing to administer influenza or COVID-19 vaccines in their practice setting, but at present only 2% of respondents administer vaccines. To overcome vaccine administration barriers, the top 3 resources respondents want access to are the following: training or education, financial support, and access to protocols. Of all the respondents, 91% indicated the dental hygienist should be involved in certain capacities.ConclusionsFew dentists are administering vaccines, possibly owing to a number of challenges. Dental hygienists may play an integral role in the administration of vaccines in the dental clinic, but few dentists are educating their patients about vaccines.Practical implicationsAlthough dentists wishing to administer vaccines in their practice may encounter barriers, support at the state, federal, and organizational levels could help them overcome these challenges

Physicochemical, Mechanical, and Antimicrobial Properties of Novel Dental Polymers Containing Quaternary Ammonium and Trimethoxysilyl Functionalities

The aims of this study were to evaluate the physicochemical and mechanical properties, antimicrobial (AM) functionality, and cytotoxic potential of novel dental polymers containing quaternary ammonium and trimethoxysilyl functionalities (e.g., N-(2-(methacryloyloxy)ethyl)-N,N-dimethyl-3-(trimethoxysilyl)propan-1-aminium iodide (AMsil1) and N-(2-(methacryloyloxy)ethyl)-N,N-dimethyl-11-(trimethoxysilyl)undecan-1-aminium bromide (AMsil2)). AMsil1 or AMsil2 were incorporated into light-cured (camphorquinone + ethyl-4-N,N-dimethylamino benzoate) urethane dimethacrylate (UDMA)/polyethylene glycol-extended UDMA/ethyl 2-(hydroxymethyl)acrylate (EHMA) resins (hereafter, UPE resin) at 10 or 20 mass %. Cytotoxic potential was assessed by measuring viability and metabolic activity of immortalized mouse connective tissue and human gingival fibroblasts in direct contact with monomers. AMsil–UPE resins were evaluated for wettability by contact angle measurements and degree of vinyl conversion (DVC) by near infra-red spectroscopy analyses. Mechanical property evaluations entailed flexural strength (FS) and elastic modulus (E) testing of copolymer specimens. The AM properties were assessed using Streptococcus mutans (planktonic and biofilm forms) and Porphyromonas gingivalis biofilm. Neither AMsil exhibited significant toxicity in direct contact with cells at biologically relevant concentrations. Addition of AMsils made the UPE resin more hydrophilic. DVC values for the AMsil–UPE copolymers were 2–31% lower than that attained in the UPE resin control. The mechanical properties (FS and E) of AMsil–UPE specimens were reduced (11–57%) compared to the control. Compared to UPE resin, AMsil1–UPE and AMsil2–UPE (10% mass) copolymers reduced S. mutans biofilm 4.7- and 1.7-fold, respectively (p ≤ 0.005). Although not statistically different, P. gingivalis biofilm biomass on AMsil1–UPE and AM AMsil2–UPE copolymer disks were lower (71% and 85%, respectively) than that observed with a commercial AM dental material. In conclusion, the AM function of new monomers is not inundated by their toxicity towards cells. Despite the reduction in mechanical properties of the AMsil–UPE copolymers, AMsil2 is a good candidate for incorporation into multifunctional composites due to the favorable overall hydrophilicity of the resins and the satisfactory DVC values attained upon light polymerization of AMsil-containing UDMA/PEG-U/EHMA copolymers