The purpose of this study was to evaluate the effectiveness of five different polishing systems on a CAD/CAM polymer-infiltrated ceramic network restoration with nanoscale assessment using atomic force microscopy (AFM) and visual assessment performed by dental school senior students and faculty members. Ceramic and composite polishing systems produced similar polishing results as that observed using a company proprietary polishing system. However, effectiveness for polishing using a company proprietary and ceramic polishing system tend to be higher than composite polishing systems.

Operative Dentistry, 2020. Link coming soon!
Dental materials are susceptible to dental plaque formation, which increases the risk of biofilm associated oral diseases. Physical-chemical properties of dental material surfaces can affect salivary pellicle formation and bacteria attachment, but relationships between these properties have been understudied. We aimed to assess the effects of surface properties and adsorbed salivary pellicle on Streptococcus gordonii adhesion to traditional dental materials. Adsorption of salivary pellicle  on gold, stainless steel, alumina and zirconia was monitored with a quartz crystal microbalance with dissipation monitoring (QCM-D). Our findings suggested that the critical factor increasing S. gordonii attachment was the salivary pellicle formed on dental materials. This is attributed to increased work of adhesion between bacteria and substrates with pellicle. New dental materials should be designed for controlling bacteria attachment by tuning thickness, composition and structure of the adsorbed salivary pellicle.

Colloids and Surfaces B: Biointerfaces, 2020. Link here
The successful process of transcutaneous metal integration into host bone requires three synergistic systems: the host bone, the metal implant, and the skin-implant interface. All three systems must be optimized for successful incorporation and longevity of the implant. Osseointegration begins during surgical implantation of the metal components through a complex interplay of cellular mechanisms. While implants can vary in design – including the original screw, press fit implants, and compressive osseointegration - they face common challenges to successful integration and maintenance of fixation within the host bone. Overcoming these challenges requires the understanding of the complex interactions between each element of OI. This review outlines 1) the basic components of OI, 2) the science behind both the bone-implant and the skin-implant interfaces, 3) the current challenges of OI, and 4) future opportunities within the field.

​Journal of Orthopedic Research, 2019. Link here
Purpose: The purpose of this study was to evaluate the influence of 38% silver diamine fluoride (SDF) on enamel and dentin bonding (static and fatigue) using three universal adhesives in self-etch mode.

Conclusion: Despite the conflicting results in the literature, our results suggest that SDF applications on enamel and dentin surfaces reduces the bond fatigue durability of bonded resin composite using universal adhesives in self-etch mode

European Journal of Oral Sciences, ​2020. Link here
It has been well documented that uncontaminated ground enamel provides the most predictable substrate for the bonding of ceramic veneers, and thus conservative tooth preparation with complete isolation using a rubber dam are key to the success of the restorations. Rubber dam isolation provides several advantages to the clinician, such as preventing contamination of the working field by saliva, blood and sulcular fluids, and improving direct visibility. However, it may be a challenge to the younger clinician to properly isolate teeth prior to bonding ceramic veneers. The present article demonstrates the sequence and some clinical tips for a case in which the rubber dam is placed from one second premolar to the opposite second premolar and held with clamps, the rubber dam is gently invaginated into the sulcus, and clamps are selected and placed on each tooth to create an ideal situation for the adhesion of the ceramic veneer.

Case Reports in Dentistry, 2020. ​Link coming soon!
Hypodontia is a common developmental problem of human dentition. The treatment of missing maxillary central incisors is always a challenging task, often requiring a multidisciplinary approach. Critical analysis of the treatment plan through cooperation among specialists is required to obtain the ideal result. Orthodontic treatment may be necessary to close or gain more space, followed by implant placement and restorative treatment. It is important to create the treatment plan through a multidisciplinary approach involving orthodontists, surgeons, and restorative specialists before initiating treatment, This case report describes such a multidisciplinary approach for a female patient with congenitally missing maxillary central incisors and class II division 1 occlusion.

International Journal of Esthetic Dentistry,  2020. Link coming soon!
The evolution of bonded restorations has undergone a great progress over several decades. Over time, water and waterborne agents (acids, enzymes) degrade the components of the dentin/restoration interface allowing bacterial colonization and dentin re-infection at the margins of the restoration. We developed a 2- tier protective technology consisting of priming/coating dentin with amphipathic and antimicrobial peptides (AAMPs) to obtain hydrophobic/water-repellent and antibiofilm dentin resisting recurrent caries around bonded restorations. We tested a series of AAMPs to assess their structure-function relationships as well as the effects of different dentin-conditioning methods on the structural features of AAMPs-coated dentin. We also determined that AAMPs had preferential adsorption on the mineral phase of dentin, which suggested that peptides arrange their cationic and hydrophilic motifs in direct contact with the negatively-charged minerals in the hydrophilic dentin. We innovatively imaged the spatial distribution of the AAMPs in relation to the dentinal tubules and collagen network using a minimally invasive multimodal imaging technique, multi photon-second harmonic generation (MP- SHG). Using MP-SHG, we determined that partial deproteinization of dentin increased the amount of immobilized AAMPs compared to the total-etched dentin at the dentin surface and extended deeply around dentinal tubules.  In conclusion, priming dentin with AAMPs is a versatile new approach with potential to fortify the otherwise vulnerable adhesive-based interfaces.

Journal of Dental Research, 2019. ​​Link here
Purpose: 1) evaluate the role of enamel surface roughness on bond fatigue durability and 2) evaluate statistical differences in roughness values based on measurement technique, including the use of spatial filtering for optical profilometry.

Conclusion: Roughness values showed differences based on measurement technique and strong correlations with bond and fatigue strength. The filtered op group demonstrated the importance of careful usage and reporting of atomic force microscopy and optical profilometry metrics in adhesive dentistry. Best practices for surface roughness analysis were also discussed.

Microscopy Research and Technique, 2019.  Link here
Post and core fabrication are key factors in the restoration of endodontically treated teeth. Teeth with endodontic treatment have commonly experienced significant coronal  and radicular dentin destruction, thus preserving all the remaining tooth structure is  imperative to improve the prognosis of the restorative treatment. Core height and width need to be carefully designed and built in order to receive the final restoration. Direct free-hand resin composite core build-up in increments may be a challenging and time consuming procedure. This case report describes a clinical technique using a clear matrix to receive injections of a low viscosity bulk-fill resin composite in order to achieve an ideal shape and core size.

International Journal of Esthetic Dentistry, ​2020.  Link here
Purpose: The purpose of this study was to evaluate whether different enamel etching methods with reduced etching times would improve the bonding effectiveness of universal adhesives.

Conclusion: Phosphoric acid etching for <1 s to 15 seconds, and polyalkenoic acid etching for 15 seconds improve universal adhesive bonding, surface Ra roughness and surface area of enamel. However, phosphoric acid ester monomer etching is not effective, regardless of etching time, in improving bonds strengths, increasing surface roughness or increasing surface area.

Operative Dentistry, ​2019.  Link here
The clinical report describes a three-dimensional (3D) printed coping for intraoral evaluation before milling final anterior restorations. The use of printed copings allows restorations for complex and esthetically important restorations to be thoroughly tested at relatively low cost without introducing large delays into the fabrication process

Quintessence International, 2019.  Link here
Purpose: The aim of this laboratory study was to investigate simulated localized and generalized wear of indirect resin composites used for implant supported provisional restorations.

Conclusion: Although only some indirect resin composites showed similar wear resistance to CAD/CAM resin composites, the wear of all the indirect resin composites was lower than that of bis-acryl base provisional resin and polymethyl methacrylate resins.

Journal of Advanced Prosthodontics, 2019.  Link here
Purpose: This study investigates simulated cuspal deflection and flexural properties of low viscosity bulk fill and conventional flowable resin composites.

Conclusion: These results indicate that some low viscosity bulk-fill resin composites exhibit lower cuspal deflection with the bulk-filling technique than is shown by conventional flowable resin composites using the incremental filling technique. Simulated cuspal deflection can be measured using either a micrometre or clsm, but this experiment failed to show a relationship between cuspal deflection and flexural properties of resin composites.

Operative Dentistry​, 2019.  Link here
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Purpose: The purpose of this study was to evaluate whether surface moisture would influence the bonding effectiveness of universal adhesives in etch-and-rinse mode. 
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Conclusion: Some universal adhesives with the addition of specific components and optimization of water content can achieve stable bonds regardless of surface moisture, but the surface moisture of dentin, but not enamel, is still a significant factor for universal adhesive bonding in etch-and rinse mode.

​American Journal of Dentistry, 2019.  Link here
Esthetic rehabilitation of a maxillary central incisor using a dental implant can be a challenging task. The hard and soft tissues must be managed in a way that minimizes the risk of tissue loss, while preserving and/or regenerating full interdental papillae. In addition, advances in restorative materials for implants have led to the introduction of translucent zirconia that can be synergistically combined with zirconia custom abutments. This case report describes implant therapy with monolithic translucent zirconia restorations in the esthetic zone. In this implant therapy, an adequate pink esthetics can be achieved by delayed titanium implant placement with guided bond regeneration. Monolithic translucent zirconia restorations with zirconia custom abutments provide predictable esthetic results.

General Dentistry, 2019. Link here
Objective: The purpose of this study was to evaluate the effect of reduced application times of universal adhesives on enamel bond fatigue and surface morphology of the treated enamel with constant force atomic force microscopy (AFM).

Conclusion: The results of this study suggest that universal adhesives, used with reduced application times, have adequate Ra surface roughness to provide sufficient resistance to enamel bond fatigue at application times from <1 second to 20 seconds, while the geometric surface area of adhesive-treated enamel did not show any significant changes at these different application times.

Operative Dentistry, ​2019.  Link here
The purpose of this study was to examine the shear fatigue strengths of a resin composite bonded to dentin. Three adhesive systems – a two-step self-etch adhesive (OptiBond XTR; Kerr) and two universal adhesives [Scotchbond Universal (3M ESPE) and G-Premio Bond (GC)] – were used in self-etch mode to bond a resin composite to dentin at a physiologic frequency of 2 Hz over 50,000, 100,000, and 1,000,000 cycles. A staircase method of fatigue testing was used. Twenty specimens were used for each test condition. There was no significant difference in shear fatigue strength across the cycling periods for the three individual adhesives. Differences in shear fatigue strength were found among the three adhesives within each cycling period. Regardless of the adhesive used in self-etch mode for bonding a resin composite to dentin, shear fatigue strength was not influenced by the number of cycles used for testing.

European Journal of Oral Sciences, ​2018.  Link here
Purpose: Limited information is available on how to polish and finish zirconia surfaces following computer-aided design/computer aided manufacturing (CAD/CAM), specifically, how differing application forces and reuse of zirconia polishing systems affect zirconia topography. Our purpose was to determine the effect of differing, clinically relevant, polishing application forces and multiple usages of polishing burs on the surface topography of CAD/CAM zirconia.

Conclusion: These in vitro results suggest changes in OP Ra due to bur reuse and polishing application force. Within the parameter of this study, the resultant topography of zirconia polishing is force-dependent and the reuse of coarse polishing burs is possible without statistically significant differences in Ra values after initial use. Nanoscale and microscale topography were shown to depend on specific polishing bur type.

Operative Dentistry​, 2018.  Link here
The application of resin composites in dentistry has become increasingly widespread due to the increased aesthetic demands of patients, improvements in the for-mulation of resin composites, and the ability of these materials to bond to tooth structures, together with concerns about dental amalgam fillings. As resistance to wear is an important factor in determining the clinical success of resin composite restoratives, this review article defines what constitutes wear and describes the major underlying phenomena involved in this process. Insights are further included on both in vivo and in vitro tests used to determine thewear resistance of resin composite and the relationships between these tests. The discussion focuses on factors that contribute to the wear of resin composite. Finally, future perspective sare included on both clinical and laboratory tests and on the development of resin composite restorations.

Japanese Dental Science Review, 2018. Link here
Mucosal seal formation around dental abutments is critical to the successful integration of dental implants into the human oral cavity. No information exists for how clinically relevant polishing procedures for computer-aided design and computer-aided manufactured (CAD/CAM) zirconia abutments affects cellular responses important to mucosal seal formation.

Materials, 2017.  Link here
Purpose: To examine the effect of reduced phosphoric acid pre-etching times on enamel fatigue bond strength of universal adhesives and surface characteristics by using atomic force microscopy (AFM).

Conclusions: The results of this in vitro study suggest that reduced phosphoric acid pre-etching times do not impair the fatigue bond strength of universal adhesives. Although fatigue bond strength and surface area were not influenced by phosphoric-  acid etching times, surface roughness increased with increasing etching time.

Journal of Adhesive Dentistry, 2017.  Link here