El-Deeb, H. A., L. E. Daifalla, O. I. Badran, and E. H. Mobarak, "Bond Strength Durability of Different Adhesives to Dentin After Aging in Two Different Solutions.", The journal of adhesive dentistry, vol. 18, issue 4, pp. 303-9, 2016. Abstract

PURPOSE: To determine the influence of aging in artificial saliva compared to distilled water on the dentin microtensile bond strength (μTBS) of different adhesive systems.

MATERIALS AND METHODS: Occlusal enamel and superficial dentin of 42 teeth were removed and roots were sectioned to expose the pulp chamber for connecting the tooth segments to an intrapulpal pressure assembly. According to the tested adhesives, tooth segments were allocated to three groups (n = 14): an etch-and-rinse adhesive (Adper Scotchbond Multi-Purpose, SBMP), a two-step self-etching adhesive (Clearfil SE Bond, CSE), and a singlestep self-etching adhesive (Clearfil S3 Bond, S3). Each adhesive system was applied to the dentin surface according to its manufacturer's instructions, while intrapulpal pressure was simulated. Resin composite (3M ESPE) was built up in two increments of 2 mm each. Each bonded specimen was sectioned to obtain eight sticks (0.8 ± 0.01 mm2). Sticks of each group were divided equally (n = 56) according to the storage solution, either distilled water or artificial saliva. For each storage solution, half of the sticks of each subgroup (n = 28) was stored for 24 h at 37°C and the other half was thermocycled for 10,000 cycles between 5°C and 55°C. Sticks were then subjected to μTBS testing. Data were statistically analyzed using multifactor ANOVA with repeated measures and Bonferroni's post-hoc test (p < 0.05). Student's t-test was used for pairwise comparison. Failure modes were determined for all tested sticks using scanning electron microscopy.

RESULTS: The decrease in bond strength of the three adhesives was significantly higher in distilled water than in artificial saliva. The predominant failure modes were adhesive and mixed.

CONCLUSION: The decrease in bond strength was more pronounced for specimens stored in distilled water than in artificial saliva.

El-Deeb, H. A., R. M. Ghalab, M. M. Elsayed Akah, and E. H. Mobarak, "Repair bond strength of dual-cured resin composite core buildup materials.", Journal of advanced research, vol. 7, issue 2, pp. 263-9, 2016. Abstract

The reparability of dual-cured resin composite core buildup materials using a light-cured one following one week or three months storage, prior to repair was evaluated. Two different dual-cured resin composites; Cosmecore™ DC automix and Clearfil™ DC automix core buildup materials and a light-cured nanofilled resin composite; Filtek™ Z350 XT were used. Substrate specimens were prepared (n = 12/each substrate material) and stored in artificial saliva at 37 °C either for one week or three months. Afterward, all specimens were ground flat, etched using Scotchbond™ phosphoric acid etchant and received Single Bond Universal adhesive system according to the manufacturers' instructions. The light-cured nanofilled resin composite (Filtek™ Z350 XT) was used as a repair material buildup. To determine the cohesive strength of each solid substrate material, additional specimens from each core material (n = 12) were prepared and stored for the same periods. Five sticks (0.8 ± 0.01 mm(2)) were obtained from each specimen (30 sticks/group) for microtensile bond strength (μTBS) testing. Modes of failure were also determined. Two-way ANOVA revealed a significant effect for the core materials but not for the storage periods or their interaction. After one week, dual-cured resin composite core buildup materials (Cosmecore™ DC and Clearfil™ DC) achieved significantly higher repair μTBS than the light-cured nanofilled resin composite (Filtek™ Z350 XT). However, Clearfil™ DC revealed the highest value, then Cosmecore™ DC and Filtek™ Z350 XT, following storage for 3-month. Repair strength values recovered 64-86% of the cohesive strengths of solid substrate materials. The predominant mode of failure was the mixed type. Dual-cured resin composite core buildup materials revealed acceptable repair bond strength values even after 3-month storage.

Mobarak, E., H. El-Deeb, L. E. Daifalla, M. Ghaly, M. Mustafa, D. Sabry, H. Fatah, J. Mulder, N. H. J. Creugers, and J. E. Frencken, "Survival of multiple-surface ART restorations using a zinc-reinforced glass-ionomer restorative after 2 years: A randomized triple-blind clinical trial.", Dental materials : official publication of the Academy of Dental Materials, vol. 35, issue 9, pp. e185-e192, 2019. Abstract

OBJECTIVE: To investigate the effectiveness of a new zinc-reinforced glass-ionomer in comparison to a common high-viscous glass-ionomer cement (HVGIC) used in multiple-surface ART-prepared cavities. The hypothesis tested was that the cumulative survival percentage of the new HVGIC is higher than that of the common HVGIC over 2 years.

METHODS: A randomized triple-blind parallel group clinical trial was used. A total of 218 participants, average age 15.4 years (SD=0.2), with an occluso-proximal carious lesion in a permanent (pre-) molar were included. Restorations using test (ChemFil Rock) and control (Fuji IX GP) restoratives were placed according to the ART method by four calibrated operators. Restorations were evaluated after one week (baseline), and at 6-, 12-, 18- and 24 months from replicas and coloured photographs according to the ART restoration assessment criteria by two independent evaluators. Restoration survival curves were estimated using the Kaplan-Meier method and difference between dependent and independent variables tested with a Wald (chi-square) test.

RESULTS: There was a statistically significant difference in cumulative survival percentages between the two types of restorations at 2 years (P=0.02). A higher percentage of multiple-surface restorations of Fuji IX GP (95.4%) than ChemFil Rock (85.3%) survived. Gender (P=0.64), operator (P=0.56) and cavity size (P=0.81) had no effect on the survival of the type of restoration observed. Type of tooth (P=0.004) and type of jaw (P=0.05) showed an effect. Severe wear was the major reason for restoration failure (ChemFil Rock=7; Fuji IX GP=1).

SIGNIFICANCE: ChemFil Rock appears not to be a viable alternative to Fuji IX GP in restoring ART multiple-surface cavities in permanent posterior teeth.

Mobarak, E. H., M. M. Shabayek, H. A. El-Deeb, J. Mulder, F. M. Hassan, W. J. M. Van der Sanden, and J. E. Frencken, "Survival of occlusal ART restorations using high-viscosity glass-ionomer with and without chlorhexidine: A 2-year split-mouth quadruple-blind randomized controlled clinical trial.", Journal of advanced research, vol. 17, pp. 117-123, 2019. Abstract

The study question was whether the use of high-viscosity glass-ionomer with chlorhexidine (HVGIC/CHX) for the Atraumatic Restorative Treatment (ART) prepared cavities could achieve a higher restoration survival percentage and be more effective for preventing dentine carious lesions adjacent to the restoration than the use of HVGIC without CHX. The study followed a split-mouth, quadruple-blind, randomized controlled clinical design and lasted 2 years. Patients with at least two small- to medium-sized occlusal cavities were included. The occlusal cavities were prepared according to the ART method and restored with HVGIC/CHX (test) and HVGIC (control). A replica of all restorations available and digital photographs were fabricated at baseline and after 0.5, 1, 1.5 and 2 years and evaluated by two examiners using the ART and Federation Dentaire International (FDI) restoration assessment criteria. Survival curves were constructed using the Kaplan-Meier method, and the log-rank test was used to test for significance between the survival percentages. A total of 100 subjects with an average age of 14.4 years participated. According to the ART restoration assessment criteria, the 2-year survival percentages of ART/HVGIC/CHX (96.8%) and ART/HVGIC (94.8%) did not differ significantly and no significant difference was found between the test (97.9%) and control (96.9%) groups according to the FDI restoration assessment criteria. Eight and five occlusal restorations failed according to the ART and FDI restoration criteria, respectively. No dentine carious lesions along the restoration margin were observed. The 2-year survival of ART restorations in both groups was high. The development of carious dentine lesions adjacent to the restoration was not observed in either treatment group. There is no evidence for modifying HVGIC by incorporating chlorhexidine in order to prevent dentine carious lesion development or to improve the survival of ART restorations in occlusal surfaces in permanent teeth. HVGIC without chlorhexidine can be used successfully to restore occlusal 'ART-prepared' cavities in permanent teeth.

Mobarak, E. H., N. Ali, and L. E. Daifalla, "Microshear Bond Strength of Adhesives to Enamel Remineralized Using Casein Phosphopeptide Agents.", Operative dentistry, vol. 40, issue 5, pp. E180-8, 2015 Sep-Oct. Abstract

OBJECTIVE: This study was carried out to evaluate the difference between bonding to demineralized enamel and remineralized enamel using casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACFP) or without fluoride (CPP-ACP) compared to normal enamel. Another aim was to test if the newly introduced Single Bond Universal adhesive system would show better bonding to any enamel condition in comparison to the other tested adhesive systems.

METHODS: The lingual enamel surfaces of 40 non carious human third molars were divided into four main groups according to the enamel condition (ground normal enamel [negative control]; demineralized enamel [positive control]; and remineralized enamel with CPP-ACP or with CPP-ACFP, respectively). Within each main group, the lingual enamel surface of each tooth was sectioned into three slabs, resulting in 30 slabs that were distributed into three subgroups according to the adhesive system utilized (Clearfil S(3) Bond Plus, Single Bond Universal, or G-aenial Bond). Two resin composite microcylinder buildups were made on each enamel slab using Filtek Z350 XT. The μSBS was evaluated at a crosshead speed of 0.5 mm/min. Modes of failure were detected using an environmental scanning electron microscope at 300× magnification.

RESULTS: The two-way analysis of variance with repeated measures revealed a significant effect for the enamel condition. However, there was no significant effect for the type of adhesive system. The interaction between the enamel condition and the type of adhesive system was also not significant. Modes of failure were mainly adhesive except for the demineralized enamel. It showed a mixed type of failure, in which cohesive failure in enamel was recorded.

CONCLUSIONS: All single-step self-etch adhesives revealed comparable μSBS values to ground enamel and enamel remineralized with CPP-ACP or CPP-ACFP. Bonding to demineralized enamel was ineffective. With any enamel condition, no tested single-step self-etch adhesive was superior in its bonding.

Daifalla, L. E., and E. H. Mobarak, "Effect of ultrasound application during setting on the mechanical properties of high viscous glass-ionomers used for ART restorations.", Journal of advanced research, vol. 6, issue 6, pp. 805-10, 2015 Nov. Abstract

This study was conducted to evaluate the effect of ultrasound application on the surface microhardness (VHN) and diametral tensile strength (DTS) of three high viscous glass-ionomer restorative materials (HVGIRMs). For each test (VHN and DTS), a total of 180 specimens were prepared from three HVGIRMs (Ketac-Molar Aplicap, Fuji IX GP Fast, and ChemFil Rock). Specimens of each material (n = 60) were further subdivided into three subgroups (n = 20) according to the setting modality whether ultrasound (20 or 40 s) was applied during setting or not (control). Specimens within each subgroup were then equally divided (n = 10) and tested at 24 h or 28 days. For the VHN measurement, five indentations, with a 200 g load and a dwell time for 20 s, were made on the top surface of each specimen. The DTS test was done using Lloyd Testing machine at a cross-head speed of 0.5 mm/min. Ultrasound application had no significant effect on the VHN. Fuji IX GP Fast revealed the highest VHN value, followed by Ketac-Molar Aplicap, and the least was recorded for ChemFil Rock. Fuji IX GP Fast and Ketac-Molar Aplicap VHN values were significantly increased by time. ChemFil Rock recorded the highest DTS value at 24 h and was the only material that showed significant improvement with both US application times. However, this improvement did not sustain till 28 days. The ultrasound did not enhance the surface microhardness, but its positive effect on the diametral tensile strength values was material and time dependent.

Mobarak, E., and R. Seyam, "Interfacial nanoleakage and bonding of self-adhesive systems cured with a modified-layering technique to dentin of weakened roots.", Operative dentistry, vol. 38, issue 5, pp. E154-65, 2013 Sep-Oct. Abstract

OBJECTIVE: The purpose of the study was to evaluate the nanoleakage and bond strength of different self adhesive systems cured with a modified-layering technique (MLT) to dentin of weakened roots.

METHODS: Twenty-one maxillary incisors were decoronated and then root canals were instrumented and obturated with the cold lateral compaction technique. Weakened roots were simulated by flaring root canals until only 1 mm dentin thickness remained. Teeth were distributed into three groups. The canals were backfilled with Vertise Flow (VF group), a self-adhering system, following a modified-layering technique using two light-transmitting posts, sizes 6 and 3. DT Light Post size 2 was cemented using the same material. Remaining roots were prepared and cured in the same way as the VF group. However, in the TS/MF group, Clearfil Tri-S Bond (TS) adhesive and Clearfil Majesty Flow (MF) composite were used, while in the ED/PF group, ED primer II (ED)/Panavia F2.0 (PF) were used. After one week of storage, each root was sectioned to obtain six slices (two slices from each root third: coronal, middle and apical) of 0.9 ± 0.1 mm thickness. Interfacial nanoleakage expression was analyzed using a field emission scanning electron microscope (FEG-SEM), and the micro push-out bond strength (μPOBS) was measured at different root regions. Modes of failure were also determined using SEM. Data were statistically analyzed using two-way analysis of variance with repeated measures and Tukey post hoc test (p≤0.05).

RESULTS: With MLT, all adhesive systems showed nanoleakage. For μPOBS, there was a statistically significant effect for adhesive systems (p<0.001) but not for root region (p<0.64) or for their interaction (p=0.99). Tukey post hoc test revealed that the bond strength of the VF group was significantly higher than the TS/MF and ED/PF groups for all root regions.

CONCLUSION: All of the tested self-adhesive systems cured using MLT had slight nanoleakage and were not sensitive to root regional differences. Self-adhering systems had higher bond strength than self-etch adhesives.

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