|Year : 2017 | Volume
| Issue : 8 | Page : 964-970
The effect of calcium phosphate-containing desensitizing agent on the microtensile bond strength of multimode adhesive agent
SH Siso, N Dönmez, DS Kahya, YS Uslu
Department of Restorative Dentistry, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
|Date of Acceptance||31-Jan-2016|
|Date of Web Publication||11-Sep-2017|
Department of Restorative Dentistry, Faculty of Dentistry, Bezmialem Vakif University, Istanbul
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: The aim of this study was to investigate the effect of calcium phosphate containing desensitizing pretreatments on the microtensile bond strength (MTBS) and microleakage of the multimode adhesive agent to dentin. Materials and Methods: In this study, twelve noncarious, freshly extracted human third molar teeth for MTBS and 20 premolar teeth for the microleakage test were used. The teeth were restored using Clearfil Universal Bond + Clearfil APX and Teeth mate Desensitizer (TMD). For MTBS test, Group 1: Self-etch, Group 2: Etch and rinse (G1 and 2, nondesensitizer treatment served as a control), Group 3: TMD/self-etch, Group 4: Acid-etch/TMD/etch and rinse. For microleakage test, Class V adhesive cavities (3 mm × 2 mm × 2 mm) were prepared and restored as mentioned before. The restored teeth were subjected to thermal cycling. The MTBS test was performed in all procedures. The MTBS data were submitted to a one-way ANOVA and post hoc Tukey test (P < 0.05). One tooth in each group was prepared for scanning electron micrograph examination. Marginal microleakage was measured based on the penetration of a 0.5% basic fuchsin dye. Dye penetration was then scored. The data were submitted to the Kruskal–Wallis and Wilcoxon signed ranks tests (P < 0.05). Results: Control groups exhibited a higher mean MTBS value than TMD groups, and there were statistical differences between the groups. TMD groups also demonstrated significantly less microleakage than control groups (P < 0.05). Conclusions: This study proves that the application of TMD with a multimode adhesive bonding system produced significantly lower MTBS and microleakage.
Keywords: Calcium phosphate, desensitizer, microtensile bond strength, multimode dentin bonding agent
|How to cite this article:|
Siso S H, Dönmez N, Kahya D S, Uslu Y S. The effect of calcium phosphate-containing desensitizing agent on the microtensile bond strength of multimode adhesive agent. Niger J Clin Pract 2017;20:964-70
|How to cite this URL:|
Siso S H, Dönmez N, Kahya D S, Uslu Y S. The effect of calcium phosphate-containing desensitizing agent on the microtensile bond strength of multimode adhesive agent. Niger J Clin Pract [serial online] 2017 [cited 2019 Dec 15];20:964-70. Available from: http://www.njcponline.com/text.asp?2017/20/8/964/187322
| Introduction|| |
Dentin hypersensitivity is characterized by short and sharp, pain arising from exposed dentin in response to stimuli (thermal, tactile, osmotic, evaporative, and chemical) which may occur as a result of wear, caries, noncarious cervical lesions, or after dental procedures such as cavity preparation or reduction of vital abutment teeth.,,
Dentin hypersensitivity can be treated with invasive (gingival surgery, pulpectomy, application of resins, and laser) and noninvasive (topical agents and dentifrices that contain a desensitizing ingredient) procedures. Noninvasive treatment options are considered to be the simplest, most cost-effective, and most efficacious first line of treatment for most patients. Topical agents containing fluoride, oxalate, potassium nitrate and calcium phosphate occlude dentinal tubules and decrease the permeability of dentin.,,,,,
Calcium-containing desensitizing pastes should be used before bonding to occlude dentinal tubules, thereby managing immediate sensitivity and preventing post-operative sensitivity during and after adhesive restoration., Currently, calcium phosphate containing desensitizers have evoked considerable interest due to their biocompatible property, their outstanding characteristic in dentinal tubule occlusion and favorable reduction in dentin permeability in the oral environment., Teethmate Desensitizer (TMD; Kuraray Noritake Dental Inc., Tokyo, Japan) is a recently developed calcium-phosphate containing material; tetracalcium phosphate (TTCP; Ca4[PO4]2O) and dicalcium phosphate anhydrous (DCPA; CaHPO4), whose combination could spontaneously transform to hydroxyapatite (HA; Ca10[PO4]6[OH] 2).
Adhesive composite resin restorations may be performed after dentin hypersensitivity treatment procedures. However, the effect of desensitizers on the bond strength of adhesive restorations is controversial. Pashley et al. reported that dentin surfaces were less favorable bonding substrates after using desensitizing agents.
Yang et al. proposed that calcium-containing pastes, when applied after etching, could provide a new potential strategy to achieve effective tubule occlusion without affecting bonding effectiveness during etch and rinse adhesive restoration in clinical practice.
Recently, some manufacturers have released more versatile adhesive systems that give the dentist the opportunity to decide which adhesive strategy to use: Etch and rinse or self-etch.
This new family of dental adhesives is known as “universal” or “multi-mode” and represents the latest generation of adhesives on the market., They are designed under the “all-in-one” concept of the already existing one-step self-etch adhesives but also incorporate the versatility of being adaptable to the clinical situation.
The question still remains whether clinicians should consider using these new adhesives with prior calcium phosphate-containing desensitizing agent.
Therefore, this study has focused on the compatibility of calcium phosphate-containing desensitizing pastes when used with multimode adhesive systems. The purpose of this study was to evaluate the effect of calcium phosphate-containing desensitizing agent on the microtensile bond strength (MTBS) and microleakage of a multimode adhesive resin.
| Materials and Methods|| |
All teeth were collected after the donor's informed consents were obtained according to a protocol approved by the Ethics Committee of the Bezmialem Vakif University, Turkey (March 25, 2015, 4384).
Teeth and surface preparation
Microtensile bond strength test
Twelve noncarious, freshly extracted human third molar teeth, were used in this study. Soft and infected tissues were cleaned from the extracted teeth. After this, they were stored in 1% chloramine T at 4°C for 1 week to prevent bacterial growth. The teeth were sectioned parallel to the occlusal surface to expose the mid-coronal dentin by using a high-speed diamond bur (G & Z Instrumente Gmbh, Lustenau, Austria). The exposed dentin surfaces were ground using 600-grit silicon carbide paper under running water for 60 s to create a standard smear layer formation.
Twenty caries-free human premolar teeth were used in this study. Two Class V cavities were prepared in each tooth, one in the buccal surface and the other in the lingual surface, with occlusal margins at the enamel and cervical margins at the cementum/dentin level. Dimensions of the cavities were 3 mm wide, 2 mm high, and 2 mm deep, prepared with a 1.6 mm/1 pieces diamond bur (G & Z Instrumente Gmbh, Lustenau, Austria) in a water-cooled high-speed handpiece. No bevels were placed. The cavities were restored according to manufacturer recommendations (as detailed below in Group 1, 2, 3, 4) and polished with aluminum oxide polishing disks (Sof-Lex, 3M ESPE Dental Products, St. Paul, MN, USA). All specimens were then stored in distilled water at room temperature (24°C) for 24 h.
The prepared teeth were randomly divided into four groups (n = 3, for MTBS test, n = 10, each group for microleakage test) as follows.
To the self-etch procedure, Clearfil Universal Bond (CUB) (Kuraray, Japan) was applied to dentin surface and rubbed for 10 s, then dried by blowing mild air for 5 s, and light cured (Demi Ultra, LED Ultracapacitor, Kerr, USA) for 5 s according to manufacturer instructions.
To the etch and rinse procedure, specimens were etched with 37.5% phosphoric acid (Kerr Etchant, Kerr Corporotion, California, USA) for 15 s and rinsed thoroughly with water, gently air dried for 5 s, and then according to the self-etch procedure.
The flattened dentin surfaces were initially pretreated with calcium phosphate containing desensitizing paste (TMD; Kuraray Noritake Dental Inc., Tokyo, Japan), respectively, according to the manufacturers' instructions and subsequently rinsed and dried, then CUB was performed as Group 1.
Initially specimens were etched with 37.5% phosphoric acid for 15 s then treated with TMD paste as Group 3 then CUB was performed as Group 2.
The teeth were restored with composite resin (Clearfil AP-X, Kuraray, Japan). For MTBS test; 2-mm-high composite resin core buildups were created with the help of a matrix (Super Mat Adapt Supercap Matrix, Kerr, Switzerland). Incremental technique was used for this purpose, and each increment (2 mm) was cured for 20 s using an LED light curing unit (Demi Ultra, LED Ultracapacitor, Kerr, USA). The application protocols suggested by each manufacturer are listed in [Table 1].
|Table 1: Materials, compositions, and application procedures in this study|
Click here to view
The specimens were subjected to 1000 thermal cycles between 5°C and 55°C. The dwelling time in the water was 30 s, and the transfer time was 10 s (SD Mechatronic Thermocycler, Germany).
Microtensile bond strength test
After treatment, all teeth were sectioned with a slow-speed saw (Isomet, Buehler Ltd., Lake Bluff, IL, USA) under water cooling into multiple 0.9 mm × 0.9 mm beams, with the “nontrimming” version (13) of the MTBS test. The obtained composite-resin-dentin sticks (n = 23) were performed in tension using a universal testing machine (SD Mechatronic MTD 500, Germany) at a crosshead speed of 0.5 mm/min until failure. The cross-sectional area at the site of failure was measured to the nearest 0.01 mm with a digital caliper (Model CD-6BS; Mitutoyo, Tokyo, Japan), from which the MTBS was calculated and expressed in MPa. Data were submitted to one-way ANOVA and post hoc Tukey tests. The significance level was set at = 0.05. One tooth in each group was prepared for scanning electron micrograph (SEM) examination.
Failure mode analysis
After MTBS test, the debonded dentin specimens were evaluated using a stereomicroscope (Nikon SMZ 800) at ×30 and classified as follows: A: Adhesive failure between dentin and resin; CD: Cohesive failure in dentin; CC: Cohesive failure in composite; and M: Mixed failure involving a maximum of 50% each of the adhesive and cohesive resin composite failures. In addition, the representative failures of each subgroup were observed under SEM.
After thermocycling, coronary and radicular surfaces of the teeth, except the restorations and 1 mm around their margins, were isolated with two layers of nail varnish. The apexes of the teeth were sealed with composite resin to avoid penetration of the tracer toward the pulp. The specimens were then immersed in a solution of 0.5% basic fuchsin dye for 24 h to produce a visible stain while in the incubator (37°C). After this procedure, any surface adhered dye was carefully rinsed away with tap water. Dye penetration around the specimens was used to determine the presence of a gap around the restoration. Then, each tooth was sectioned longitudinally in a bucco-lingual plan through the center of the restoration with a water cooled, slow speed diamond blade (Mecatome T180, Presi, France) to obtain two sections of each tooth. The marginal sealing ability as indicated by the depth of dye penetration around the enamel or dentin margins was evaluated under a stereomicroscope (Nikon SMZ 800) at ×30. The following scoring scale was used to assess the extent of dye penetration at the tooth-restoration interface; Score 0: Without evidence of infiltration in the tooth/restoration interface; Score 1: Infiltration of the tracer up to one-third of the walls of the restoration; Score 2: Infiltration of the tracer in more than one-third of the walls of the restoration, without reaching the axio-cervical or axio-occlusal angles; Score 3: Infiltration of the tracer reaching the axio-cervical or axio-occlusal angles and going toward the pulp.
Statistical analysis of the results was obtained by the Kruskall–Wallis test (comparing the adhesives and the restorative materials) and the Wilcoxon signed ranks test (comparing the occlusal and cervical margins).
| Results|| |
Microtensile bond strength results
Mean MTBS values were calculated from all experimental groups and are shown in [Table 2]. The control groups (Groups 1 and 2) exhibited a higher mean MTBS value than TMD Groups (Groups 3 and 4), and there were statistically significant differences (P < 0.05). Moreover, there were significant differences among the control groups (P < 0.05). Highest MTBS value was seen in Group 2 (27.74 ± 7.84).
|Table 2: Means and standard deviations of microtensile bond strengths for each group|
Click here to view
The distribution of failure modes, as observed by stereo microscopy, is shown in [Table 3]. Most failures were recorded in all groups as an adhesive failure. Moreover, the minimal mixed failure was seen in Group 3.
|Table 3: Failure mode distribution of fracture specimens after microtensile bond strength test|
Click here to view
The microleakage scores are given in [Table 4]. According to the Kruskal–Wallis test, when the groups were compared in terms of microleakage scores, there were significant differences between control groups and TMD groups in occlusal and gingival leakage scores (P < 0.05). In TMD groups, less microleakage was seen than in the control groups.
|Table 4: Microleakage scores and Kruskal–Wallis test results of the groups|
Click here to view
Scanning electron micrograph examination of dentin surface
[Figure 1]a, [Figure 1]b, [Figure 1]b”, [Figure 1]c and [Figure 2]d, [Figure 2]e, [Figure 2]e” show the microstructure alterations of the dentin surfaces after treatment with or without TMD. In the control groups, both adhesive failure and mixed failure in the self-etch procedure were seen. The etch and rinse procedure shows an adhesive failure too. Dentinal tubules occluded by resin tags demonstrate that the failure was at the top of the hybrid layer. Following application of TMD, the dentinal tubules were occluded to different extents [Figure 2]d, [Figure 2]e, [Figure 2]e”.
|Figure 1: Control groups scanning electron micrograph figures. (a-c) scanning electron micrograph of different control group specimen's, but (b'') higher magnification of same specimen (b)|
Click here to view
|Figure 2: Teethmate groups scanning electron micrograph figure. (d and e) scanning electron micrograph of different specimen's , but (e''); higher magnification of same specimen (e)|
Click here to view
| Discussion|| |
In the present study, newly developed calcium phosphate-containing desensitizing paste (TMD) was applied to seal dentinal tubules before bonding with multimode adhesives (self-etch and etch and rinse). The results of the MTBS test showed that the application of TMD significantly affects MTBS during multimode adhesive bonding agent, especially when the multimode bonding agent is applied to the etch and rinse procedure, as the lowest MTBS value was found in this procedure. TMD was applied on the etched dentin surface, as dentinal tubules were mostly occluded with particles and a protective layer was formed [Figure 2]e”.
The effectiveness of TMD in forming a layer on dentin regardless of pretreatment and maintaining tubule occlusion should be attributed to its chemical composition. TMD consists of TTCP and DCPA as the major starting components. The mixing of these two components provides a thick paste which can penetrate into the dentinal tubules [Figure 2]e by scrubbing on dry dentin surface. This occluding effect resulted in the immediate dentinal permeability reduction and hence, clinical hypersensitivity reduction could be expected. Previous studies on the combination of TTCP and DCPA demonstrated that this compound in an aqueous environment could transform to HA as the final product., The mechanism of transformation was described as the dissolution of calcium and phosphate ions from TTCP and DCPA powder, which then precipitated as HA on the surface of the particles in the mixture  contributing to the setting and solidification process. This expected formation of HA gives a superior advantage over other desensitizers such as oxalate-containing mixtures, as the calcium-phosphate rich layer of TMD could act as a substrate for crystal growth by conducting calcium and phosphate ions from the surrounding supersaturated solution.
In previous studies, different types of desensitizers have been used  such as monopotassium oxalate, sodium fluoride, strontium chloride + calcium carbonate, and gluma desensitizer. These desensitizers when used with an adhesive system have given conflicting reports.
Arısu et al. reported that desensitizing treatment procedures (except Clearfil SE Bond Nd: YAG laser) reduced the bond strength of a Clearfil SE Bond (two-step self-etch adhesive) to dentin. They used three topical agents (Vivasens [potassium fluoride], BisBlock [Oxalate], fluoride gel) for desensitizing. In contrast with other oxalate desensitizers, BisBlock's patented technique for the total-etch procedure occurs before oxalate and adhesive placement.
This technique provides a durable effect because calcium is removed from the surface and oxalate crystals form deep within the dentinal tubules.
Yiu et al. reported that oxalate desensitizers did not negatively affect the bond strength of adhesives, such as Single Bond (3M ESPE) or One-Step (Bisco Inc.). However, Pashley et al. reported a reduced bond strength because of crystal precipitation on the dentin surface. Pashley et al. and Tay et al. reported that when oxalates were used on acid-etched cavities that contained enamel margins, the enamel surfaces became covered with calcium oxalate crystals. In this study, oxalates are not used which contain calcium phosphate as Teethmate's (TM) has, even though MTBS results of our study are consistent with the study of Pashley et al.
The manufacturer claims that it has no film thickness and can be used easily under restorations. When TMD is applied on a decalcified (by acid etching and rinsing) dentin surface, it might create HA crystals, providing a localized source for occluding open dentinal tubules. Thanatvarakorn et al. reported that the calcium-phosphate rich layer of TMD had interacted closely with the dentin surface. Dong et al. showed that the calcium phosphate-based bioactive materials can effectively form a chemical bond with dentin tissue. Endo et al. reported that the application of TMD within the tubules was effective on the inhibition of dentin demineralization. The obliteration of dentinal tubules by repeated application of TMD prevents demineralization, and the occluded dentinal tubules reduce dentinal fluid movement with consequent clinical improvement of dentin hypersensitivity. The current study supports the use of TMD to prevent postoperative sensitivity before applying the multimode adhesive to decrease microleakage of Class V composite restorations. Findings of the current study, however, contradict the manufacturer reports and show that the etch and rinse approach of a multimode (self-etch and etch and rinse) adhesive's (Clearfil Universal Bond) did not bond ideally to dentin surfaces. The MTBS value has shown the lowest bond degree of the etch and rinse group, therefore TMD is not recommended on dentin surfaces before the placement of direct restorations.
Microleakage has been a focus in detecting the performance of any restorative material used in tooth restoration. The amount of microleakage is administrated by marginal adaptation of the restorative material to the tooth and is affected by polymerization shrinkage and the coefficient of thermal expansion among the tooth structure and the restorative material.
Consequently, when temperature changes happen in the oral cavity, the tooth and the restoration extend and shrink at dissimilar rates, generating a gap at the restoration-tooth interface where microleakage can occur.
In vitro multimode adhesive resin bonding and microleakage performance of TMD are being described for the first time in this study. In the existing literature, there is only one study of TMD and it evaluated dentin permeability reduction and its integration with dentin surface before and after immersion in artificial saliva. Therefore, the results of the present study were compared with the results reported by the manufacturer.
Our study showed a reduction of dentin's permeability in the microleakage method so that TMD may be applied to the dentin self-etch procedure of a multimode adhesive. Further studies are required to determine the clinical success of the newly introduced material.
| Conclusion|| |
Within the limitation of this study, calcium phosphate-containing desensitizing agent used with an multimode adhesive system provided to etch and rinse procedure lowest bond strength and a better marginal seal than the control group. To prevent postoperative sensitivity, the clinicians can reliably use self-etch procedure of multimode adhesive resin with a TMD under cavities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gordan VV, Mjör IA. Short- and long-term clinical evaluation of post-operative sensitivity of a new resin-based restorative material and self-etching primer. Oper Dent 2002;27:543-8.
Perdigão J, Geraldeli S, Hodges JS. Total-etch versus self-etch adhesive: Effect on postoperative sensitivity. J Am Dent Assoc 2003;134:1621-9.
Auschill TM, Koch CA, Wolkewitz M, Hellwig E, Arweiler NB. Occurrence and causing stimuli of postoperative sensitivity in composite restorations. Oper Dent 2009;34:3-10.
Berkowitz GS, Horowitz AJ, Curro FA, Craig RG, Ship JA, Vena D, et al.
Postoperative hypersensitivity in class I resin-based composite restorations in general practice: Interim results. Compend Contin Educ Dent 2009;30:356-8, 360, 362-3.
Jacobsen PL, Bruce G. Clinical dentin hypersensitivity: Understanding the causes and prescribing a treatment. J Contemp Dent Pract 2001;2:1-12.
Orchardson R, Gillam DG. Managing dentin hypersensitivity. J Am Dent Assoc 2006;137:990-8.
Greenhill JD, Pashley DH. The effects of desensitizing agents on the hydraulic conductance of human dentin in vitro
. J Dent Res 1981;60:686-98.
Gillam DG, Mordan NJ, Sinodinou AD, Tang JY, Knowles JC, Gibson IR. The effects of oxalate-containing products on the exposed dentine surface: An SEM investigation. J Oral Rehabil 2001;28:1037-44.
Pereira JC, Segala AD, Gillam DG. Effect of desensitizing agents on the hydraulic conductance of human dentin subjected to different surface pre-treatments – An in vitro
study. Dent Mater 2005;21:129-38.
Suge T, Ishikawa K, Kawasaki A, Suzuki K, Matsuo T, Noiri Y, et al.
Calcium phosphate precipitation method for the treatment of dentin hypersensitivity. Am J Dent 2002;15:220-6.
Forsback AP, Areva S, Salonen JI. Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro
. Acta Odontol Scand 2004;62:14-20.
Pei D, Liu S, Huang C, Du X, Yang H, Wang Y, et al.
Effect of pretreatment with calcium-containing desensitizer on the dentine bonding of mild self-etch adhesives. Eur J Oral Sci 2013;121(3 Pt 1):204-10.
Wang Y, Liu S, Pei D, Du X, Ouyang X, Huang C. Effect of an 8.0% arginine and calcium carbonate in-office desensitizing paste on the microtensile bond strength of self-etching dental adhesives to human dentin. Am J Dent 2012;25:281-6.
Guentsch A, Seidler K, Nietzsche S, Hefti AF, Preshaw PM, Watts DC, et al.
Biomimetic mineralization: Long-term observations in patients with dentin sensitivity. Dent Mater 2012;28:457-64.
Shetty S, Kohad R, Yeltiwar R. Hydroxyapatite as an in-office agent for tooth hypersensitivity: A clinical and scanning electron microscopic study. J Periodontol 2010;81:1781-9.
Chow LC. Next generation calcium phosphate-based biomaterials. Dent Mater J 2009;28:1-10.
Pashley EL, Tao L, Pashley DH. Effects of oxalate on dentin bonding. Am J Dent 1993;6:116-8.
Yang H, Pei D, Chen Z, Lei J, Zhou L, Huang C. Effects of the application sequence of calcium-containing desensitising pastes during etch-and-rinse adhesive restoration. J Dent 2014;42:1115-23.
Hanabusa M, Mine A, Kuboki T, Momoi Y, Van Ende A, Van Meerbeek B, et al.
Bonding effectiveness of a new 'multi-mode' adhesive to enamel and dentine. J Dent 2012;40:475-84.
Muñoz MA, Sezinando A, Luque-Martinez I, Szesz AL, Reis A, Loguercio AD, et al.
Influence of a hydrophobic resin coating on the bonding efficacy of three universal adhesives. J Dent 2014;42:595-602.
Wagner A, Wendler M, Petschelt A, Belli R, Lohbauer U. Bonding performance of universal adhesives in different etching modes. J Dent 2014;42:800-7.
Ishikawa K, Takagi S, Chow LC, Suzuki K. Reaction of calcium phosphate cements with different amounts of tetracalcium phosphate and dicalcium phosphate anhydrous. J Biomed Mater Res 1999;46:504-10.
Suge T, Ishikawa K, Kawasaki A, Yoshiyama M, Asaoka K, Ebisu S. Duration of dentinal tubule occlusion formed by calcium phosphate precipitation method: In vitro
evaluation using synthetic saliva. J Dent Res 1995;74:1709-14.
Franco A, Carlos J, Gabriel R. Occlusion of dentin tubules by desensitizing agent's. Am J Dent 2004;17:368-72.
Hashimoto M, Ito S, Tay FR, Svizero NR, Sano H, Kaga M, et al.
Fluid movement across the resin-dentin interface during and after bonding. J Dent Res 2004;83:843-8.
Arisu HD, Dalkılıç E, Üçtasli MB. Effect of desensitizing agents on the microtensile bond strength of a two-step self-etch adhesive to dentin. Oper Dent 2011;36:153-61.
Tay FR, Pashley DH, Mak YF, Carvalho RM, Lai SC, Suh BI. Integrating oxalate desensitizers with total-etch two-step adhesive. J Dent Res 2003;82:703-7.
Yiu CK, King NM, Suh BI, Sharp LJ, Carvalho RM, Pashley DH, et al.
Incompatibility of oxalate desensitizers with acidic, fluoride-containing total-etch adhesives. J Dent Res 2005;84:730-5.
Thanatvarakorn O, Nakashima S, Sadr A, Prasansuttiporn T, Ikeda M, Tagami J.In vitro
evaluation of dentinal hydraulic conductance and tubule sealing by a novel calcium-phosphate desensitizer. J Biomed Mater Res B Appl Biomater 2013;101:303-9.
Dong Z, Chang J, Deng Y, Joiner A. Tricalcium silicate induced mineralization for occlusion of dentinal tubules. Aust Dent J 2011;56:175-80.
Endo H, Kawamoto R, Takahashi F, Takenaka H, Yoshida F, Nojiri K, et al.
Evaluation of a calcium phosphate desensitizer using an ultrasonic device. Dent Mater J 2013;32:456-61.
Sidhu SK, Henderson LJ.In vitro
marginal leakage of cervical composite restorations lined with a light-cured glass ionomer. Oper Dent 1992;17:7-12.
Quo BC, Drummond JL, Koerber A, Fadavi S, Punwani I. Glass ionomer microleakage from preparations by an Er/YAG laser or a high-speed handpiece. J Dent 2002;30:141-6.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]