It has been eight years since CAD/CAM indirect resin crowns were included in the national health ... more It has been eight years since CAD/CAM indirect resin crowns were included in the national health insurance in Japan. During this period, members of the Japanese Society of Prosthodontics have been accumulating basic research data and clinical evidence to improve this treatment. This paper summarizes the results of the research, including "currently recommended bonding procedures" and "overall clinical outcomes", and proposes "appropriate clinical techniques" and "principal patient explanations" based on the latest data and evidence. A wide range of factors contribute to the success of CAD/CAM indirect resin crown treatment, and dentists need to manage them comprehensively. In addition, we would like to examine the existing dogma that needs to be changed, and to attain close collaboration among the medical practice, industry, government, academia and private sector in order to disseminate this new metal-free treatment from Japan.
Pioneers of the Japan Prosthodontic Society have previously stated the following opinion: Adhesiv... more Pioneers of the Japan Prosthodontic Society have previously stated the following opinion: Adhesive dentistry and dental implants have caused a major impact on modern prosthodontics. It is noteworthy that these two are not only new materials and technologies but have also brought about a paradigm shift in dental treatment [1]. I agree with this statement and would like to take this opportunity to promote "Adhesive Dentistry" in the field of Prosthodontics. Minimal Intervention and Prosthodontics The Prosthodontics Utilizing Adhesive Dentistry is constantly changing, and significant research for establishing new treatments should be conducted. JPR is the place where these research outcomes are distributed; therefore, one of the most-targeted topics of JPR is definitely "Adhesive Dentistry". Sincerely,
This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and... more This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and silane agent on the bonding effectiveness of indirect resin composite blocks with three different filler contents. Methods: A commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite block and two experimental resin composite blocks with different filler contents were alumina-blasted and two surface treatments (primer and silane agent) were applied. The resin cement was built up, and the micro-tensile bond strength (μTBS) was measured after 24 hours, 1 month or 3 months of water storage (n = 24 per group). The fracture surfaces after μTBS measurements and resin block/cement interface were observed by scanning electron microscopy (SEM). Results: The primer treatment group showed a significantly higher bond strength than the silane group only in F0 (filler content 0 wt%) group (P < 0.001). In the primer group, F0 and F41 (filler content 41 wt%) groups showed significantly higher bond strengths than F82 (filler content 82 wt%) group (P < 0.001). In contrast, in the silane group, F41 group showed significantly higher bond strength than F0 and F82 groups (P < 0.001), and F82 group showed significantly higher bond strength than F0 group (P < 0.001). SEM revealed that the matrix resin was partially destroyed on the fracture surface of the primer group, and an uneven interface surface was observed compared with that of the silane group. Conclusions: MMA-containing primers showed higher bonding effectiveness to CAD/CAM resin composite blocks than the silane treatment.
Purpose: This study evaluated the effects of different materials (composite resin system includin... more Purpose: This study evaluated the effects of different materials (composite resin system including a photo-cure adhesive (DC) vs. resin cement system including a self-etching primer (PV)) and techniques (direct vs. indirect) for resin core build-up on the bonding performance to root canal dentin. Methods: The human teeth were decoronated and root canal preparation was performed. All specimens were randomly divided into four groups according to the combinations of the methods (Direct or Indirect) and the materials (DC: Clearfil DC Core, Kuraray Noritake Dental or PV: Panavia V5, Kuraray Noritake Dental). Micro-tensile bond strength (μTBS) and push-out tests were performed. Scanning electron microscope observations of the interface were also performed, and microcomputed tomography and optical coherence tomography were applied to evaluate the sealing ability. Results: The Indirect group had significantly higher μTBSs than the Direct group in the DC group (P = 0.0076). The PV group had significantly higher bond strengths than the DC group in both the Direct and Indirect groups (P < 0.001). The Direct/PV group demonstrated significantly higher push-out bond strength than the Direct/DC group (P < 0.001). In the Direct/PV group, the formation of resin tags was observed even on the apical side of the canal. Microleakage was more clearly observed in the DC group than in the PV group. Conclusions: PV has a higher bonding ability to root canal dentin than DC. When using DC, the indirect technique exhibited a higher bonding ability than the direct technique.
Improved dental adhesive technology has extensively influenced modern concepts in restorative den... more Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal‐invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel‐dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch‐and‐rinse and a self‐etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two‐step etch‐and‐rinse and one‐step (self‐etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user‐friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one‐step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi‐step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.
Temporomanbular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacia... more Temporomanbular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacial pain. Painful temporomandibular disorders (TMD) condition such as myalgia and arthralgia can be managed by exercise therapy. However, as it is hard to access actual effect of each modality that is included in an exercise therapy program due to multiple choice of the management modality, their efficacy remains controversial. Therefore, this review focused on the effects of exercise therapy for the management of painful TMD. The aims of this review were to summarize the effects of exercise therapy for major symptoms of painful TMD and to establish a guideline for the management of painful TMD, resulting in higher quality and reliability of dental treatment. In this review, exercise modalities are clearly defined as follows: mobilization exercise, muscle-strengthening exercise (resistance training), coordination exercise, and postural exercise. Furthermore, pain intensity and range of movements were focused as outcome parameters in this review. Mobilization exercise including manual therapy, passive jaw mobilization with oral appliances, and voluntary jaw exercise appeared to be a promising option for painful TMD conditions such as myalgia and arthralgia. This review addressed not only the effects of exercise therapy on various clinical conditions of painful TMD shown in the past, but also an urgent need for consensus among dentists and clinicians in terms of the management of each condition, as well as terminology.
PURPOSE This study evaluated the effects of different materials (composite resin system including... more PURPOSE This study evaluated the effects of different materials (composite resin system including a photo-cure adhesive (DC) vs. resin cement system including a self-etching primer (PV)) and techniques (direct vs. indirect) for resin core build-up on the bonding performance to root canal dentin. METHODS The human teeth were decoronated and root canal preparation was performed. All specimens were randomly divided into four groups according to the combinations of the methods (Direct or Indirect) and the materials (DC: Clearfil DC Core, Kuraray Noritake Dental or PV: Panavia V5, Kuraray Noritake Dental). Micro-tensile bond strength (μTBS) and push-out tests were performed. Scanning electron microscope observations of the interface were also performed, and microcomputed tomography and optical coherence tomography were applied to evaluate the sealing ability. RESULTS The Indirect group had significantly higher μTBSs than the Direct group in the DC group (P = 0.0076). The PV group had sig...
Small and hydrophilic monomers as HEMA and TEGDMA can easily penetrate human tissues. For biocomp... more Small and hydrophilic monomers as HEMA and TEGDMA can easily penetrate human tissues. For biocompatibility issues it is therefore better to avoid such monomers in dental adhesive formulations. The purpose of this study was (1) to determine the micro-tensile bond strength (muTBS) to enamel/dentin of a HEMA/TEGDMA-free three-step etch&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;rinse adhesive (cmf Adhesive System, Saremco), and (2) to characterize it&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s interfacial interaction with enamel/dentin using transmission electron microscopy (TEM). Twelve intact freshly extracted human third molars were used for muTBS. The three-step etch&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;rinse adhesive OptiBond FL (Kerr) served as control adhesive. After bonding procedures and subsequent composite build-up (Z100, 3M ESPE), specimens were sectioned to sticks and trimmed at the interface to a cylindrical hour-glass shape. TEM section of non-demineralized and demineralized sections were prepared by ultra-microtomy and examined. The muTBS of the cmf Adhesive System to enamel was not statistically significantly different from that of the control (OptiBond FL) adhesive (p=0.3512); the muTBS to dentin was however significantly lower (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). TEM showed a tight interface at enamel for both adhesives. A relatively thick, completely demineralized and acid-resistant hybrid layer was formed at dentin. Some degree of spot- and cluster-like nano-leakage was observed with cmf Adhesive System, but did not differ in extent and form in comparison to that observed with the OptiBond FL control. The new three-step adhesive cmf Adhesive System showed indications of good bonding effectiveness, certainly to enamel and only significantly lower to dentin, when compared to the gold-standard adhesive. The latter may be related to the adapted HEMA/TEGDMA-free formulation and the somewhat lower mechanical properties.
It has been eight years since CAD/CAM indirect resin crowns were included in the national health ... more It has been eight years since CAD/CAM indirect resin crowns were included in the national health insurance in Japan. During this period, members of the Japanese Society of Prosthodontics have been accumulating basic research data and clinical evidence to improve this treatment. This paper summarizes the results of the research, including "currently recommended bonding procedures" and "overall clinical outcomes", and proposes "appropriate clinical techniques" and "principal patient explanations" based on the latest data and evidence. A wide range of factors contribute to the success of CAD/CAM indirect resin crown treatment, and dentists need to manage them comprehensively. In addition, we would like to examine the existing dogma that needs to be changed, and to attain close collaboration among the medical practice, industry, government, academia and private sector in order to disseminate this new metal-free treatment from Japan.
Pioneers of the Japan Prosthodontic Society have previously stated the following opinion: Adhesiv... more Pioneers of the Japan Prosthodontic Society have previously stated the following opinion: Adhesive dentistry and dental implants have caused a major impact on modern prosthodontics. It is noteworthy that these two are not only new materials and technologies but have also brought about a paradigm shift in dental treatment [1]. I agree with this statement and would like to take this opportunity to promote "Adhesive Dentistry" in the field of Prosthodontics. Minimal Intervention and Prosthodontics The Prosthodontics Utilizing Adhesive Dentistry is constantly changing, and significant research for establishing new treatments should be conducted. JPR is the place where these research outcomes are distributed; therefore, one of the most-targeted topics of JPR is definitely "Adhesive Dentistry". Sincerely,
This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and... more This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and silane agent on the bonding effectiveness of indirect resin composite blocks with three different filler contents. Methods: A commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite block and two experimental resin composite blocks with different filler contents were alumina-blasted and two surface treatments (primer and silane agent) were applied. The resin cement was built up, and the micro-tensile bond strength (μTBS) was measured after 24 hours, 1 month or 3 months of water storage (n = 24 per group). The fracture surfaces after μTBS measurements and resin block/cement interface were observed by scanning electron microscopy (SEM). Results: The primer treatment group showed a significantly higher bond strength than the silane group only in F0 (filler content 0 wt%) group (P < 0.001). In the primer group, F0 and F41 (filler content 41 wt%) groups showed significantly higher bond strengths than F82 (filler content 82 wt%) group (P < 0.001). In contrast, in the silane group, F41 group showed significantly higher bond strength than F0 and F82 groups (P < 0.001), and F82 group showed significantly higher bond strength than F0 group (P < 0.001). SEM revealed that the matrix resin was partially destroyed on the fracture surface of the primer group, and an uneven interface surface was observed compared with that of the silane group. Conclusions: MMA-containing primers showed higher bonding effectiveness to CAD/CAM resin composite blocks than the silane treatment.
Purpose: This study evaluated the effects of different materials (composite resin system includin... more Purpose: This study evaluated the effects of different materials (composite resin system including a photo-cure adhesive (DC) vs. resin cement system including a self-etching primer (PV)) and techniques (direct vs. indirect) for resin core build-up on the bonding performance to root canal dentin. Methods: The human teeth were decoronated and root canal preparation was performed. All specimens were randomly divided into four groups according to the combinations of the methods (Direct or Indirect) and the materials (DC: Clearfil DC Core, Kuraray Noritake Dental or PV: Panavia V5, Kuraray Noritake Dental). Micro-tensile bond strength (μTBS) and push-out tests were performed. Scanning electron microscope observations of the interface were also performed, and microcomputed tomography and optical coherence tomography were applied to evaluate the sealing ability. Results: The Indirect group had significantly higher μTBSs than the Direct group in the DC group (P = 0.0076). The PV group had significantly higher bond strengths than the DC group in both the Direct and Indirect groups (P < 0.001). The Direct/PV group demonstrated significantly higher push-out bond strength than the Direct/DC group (P < 0.001). In the Direct/PV group, the formation of resin tags was observed even on the apical side of the canal. Microleakage was more clearly observed in the DC group than in the PV group. Conclusions: PV has a higher bonding ability to root canal dentin than DC. When using DC, the indirect technique exhibited a higher bonding ability than the direct technique.
Improved dental adhesive technology has extensively influenced modern concepts in restorative den... more Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal‐invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel‐dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch‐and‐rinse and a self‐etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two‐step etch‐and‐rinse and one‐step (self‐etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user‐friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one‐step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi‐step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.
Temporomanbular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacia... more Temporomanbular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacial pain. Painful temporomandibular disorders (TMD) condition such as myalgia and arthralgia can be managed by exercise therapy. However, as it is hard to access actual effect of each modality that is included in an exercise therapy program due to multiple choice of the management modality, their efficacy remains controversial. Therefore, this review focused on the effects of exercise therapy for the management of painful TMD. The aims of this review were to summarize the effects of exercise therapy for major symptoms of painful TMD and to establish a guideline for the management of painful TMD, resulting in higher quality and reliability of dental treatment. In this review, exercise modalities are clearly defined as follows: mobilization exercise, muscle-strengthening exercise (resistance training), coordination exercise, and postural exercise. Furthermore, pain intensity and range of movements were focused as outcome parameters in this review. Mobilization exercise including manual therapy, passive jaw mobilization with oral appliances, and voluntary jaw exercise appeared to be a promising option for painful TMD conditions such as myalgia and arthralgia. This review addressed not only the effects of exercise therapy on various clinical conditions of painful TMD shown in the past, but also an urgent need for consensus among dentists and clinicians in terms of the management of each condition, as well as terminology.
PURPOSE This study evaluated the effects of different materials (composite resin system including... more PURPOSE This study evaluated the effects of different materials (composite resin system including a photo-cure adhesive (DC) vs. resin cement system including a self-etching primer (PV)) and techniques (direct vs. indirect) for resin core build-up on the bonding performance to root canal dentin. METHODS The human teeth were decoronated and root canal preparation was performed. All specimens were randomly divided into four groups according to the combinations of the methods (Direct or Indirect) and the materials (DC: Clearfil DC Core, Kuraray Noritake Dental or PV: Panavia V5, Kuraray Noritake Dental). Micro-tensile bond strength (μTBS) and push-out tests were performed. Scanning electron microscope observations of the interface were also performed, and microcomputed tomography and optical coherence tomography were applied to evaluate the sealing ability. RESULTS The Indirect group had significantly higher μTBSs than the Direct group in the DC group (P = 0.0076). The PV group had sig...
Small and hydrophilic monomers as HEMA and TEGDMA can easily penetrate human tissues. For biocomp... more Small and hydrophilic monomers as HEMA and TEGDMA can easily penetrate human tissues. For biocompatibility issues it is therefore better to avoid such monomers in dental adhesive formulations. The purpose of this study was (1) to determine the micro-tensile bond strength (muTBS) to enamel/dentin of a HEMA/TEGDMA-free three-step etch&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;rinse adhesive (cmf Adhesive System, Saremco), and (2) to characterize it&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s interfacial interaction with enamel/dentin using transmission electron microscopy (TEM). Twelve intact freshly extracted human third molars were used for muTBS. The three-step etch&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;rinse adhesive OptiBond FL (Kerr) served as control adhesive. After bonding procedures and subsequent composite build-up (Z100, 3M ESPE), specimens were sectioned to sticks and trimmed at the interface to a cylindrical hour-glass shape. TEM section of non-demineralized and demineralized sections were prepared by ultra-microtomy and examined. The muTBS of the cmf Adhesive System to enamel was not statistically significantly different from that of the control (OptiBond FL) adhesive (p=0.3512); the muTBS to dentin was however significantly lower (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). TEM showed a tight interface at enamel for both adhesives. A relatively thick, completely demineralized and acid-resistant hybrid layer was formed at dentin. Some degree of spot- and cluster-like nano-leakage was observed with cmf Adhesive System, but did not differ in extent and form in comparison to that observed with the OptiBond FL control. The new three-step adhesive cmf Adhesive System showed indications of good bonding effectiveness, certainly to enamel and only significantly lower to dentin, when compared to the gold-standard adhesive. The latter may be related to the adapted HEMA/TEGDMA-free formulation and the somewhat lower mechanical properties.
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