Abstract

ER:YAG laser and experimental resin-based dental adhesive loaded with functionalized carbonated apatite filler were used in this study to evaluate the dentin interaction in terms of penetration and occlusion of the dentinal tubules aiding in the control of dentin hypersensitivity (DH). Spheroidal Carbonated apatite nanoparticles (N-CAP), with an average size of 20±5 nm diameter, were synthesized, characterized, and incorporated in a universal adhesive “All Bond Universal, Bisco, USA”, in (2% weight) concentration. Er:YAG laser “Lightwalker, FOTONA, EU” was adjusted to an energy output of 40mJ/ pulse and pulse repetition of 10 Hz for 10 seconds. Dentin specimens were prepared from the buccal surface of 75 extracted sound human molars. The specimens were randomly divided into five groups (n=15) according to the surface treatment: Group (L): Laser only; Group (LB): Laser in combination with adhesive; Group (LBN): Laser in combination with adhesive loaded with N-CAP; Group (B): adhesive only; and Group (BN): adhesive loaded with N-CAP. Depth of penetration and occlusion of the dentinal tubules were assessed using Environmental Scanning Electron Microscope Examination (ESEM). One-way ANOVA was used to compare groups, followed by a pairwise test for multiple comparisons (α=0.05). Groups (LB), and (LBN) showed the highest mean of dentinal tubules’ penetration, with a non-significant difference between them. In contrast, the specimens treated with laser only (L) showed the most minor penetration. The employment of ER-YAG laser irradiation with the adhesive loaded with N-CAP was evaluated to be effective in penetrating and occluding the opened dentinal tubules.

Background

This clinical study was conducted aiming to evaluate the impact of repeated preheating of bulk-fill resin composite on postoperative hypersensitivity.

Methods

A total of 105 eligible, consenting adults were recruited. Patients had posterior teeth suffering from proximal decay with no signs of irreversible pulpitis. Patients were prepared for Class II restorations and restored with bulk-fill resin composite. Patients were randomized into three groups of 35 patients according to the number of preheating cycles for the resin composite syringe used; group I: no preheating; control group at room temperature, group II: Resin composite preheated once, and group III: Resin composite preheated ten cycles. Patients were assessed for postoperative dentin hypersensitivity using the visual analogue scale (VAS) at three-time intervals: day one, one week and by the end of one month after restorative treatment. Statistical analysis was performed; ANOVA with a single factor was used to test for significance at a p value ≤ 0.05. For nonparametric data, the Kruskal‒Wallis test was used to compare the three testing groups. Friedman’s test was used to study the changes within each group. Dunn’s test was used for pairwise comparisons when the Kruskal‒Wallis test or Friedman’s test was significant.

Results

The scores of the three groups through the three time intervals were almost zero except for the first day where VAS scores were recorded with maximum score of 3 for groups I and II. Groups II and III; there was no statistically significant change in hypersensitivity scores by time with P-values 0.135 and 0.368, respectively. However, for group I there was a significant difference from VAS score recorded on first day and the two following time intervals.

Conclusion

The repeated preheating cycles of bulk-fill resin composite prior to curing had no adverse effect on the patients regarding postoperative dentin hypersensitivity. This information could be of utmost significance, as the same resin composite syringe can undergo numerous preheating cycles clinically before it is completely consumed with the advantage of improvement on the handling properties.

Trial registration

The protocol of the current study was registered at www.clinicaltrials.gov, with the identification number NCT05289479 on 21/03/2022. All procedures involving human participants were performed in accordance with the ethical standards of the Research Ethics Committee of the Faculty of Dentistry, Minia University, Egypt, under the approval number 73/440 on 11/09/2020.