OBJECTIVE : To evaluate the clinical performance of class II large-size direct composite restorations. MATERIALS AND METHODS : Fifty (50) patients 18 years or older were included in this clinical trial restoring 75 vital molar teeth with large-size cavities. Inclusion Criteria : Occlusal extension greater than two-thirds the intercuspal distance and proximal extension greater than half the distance between line angles. Teeth with residual cavity walls less than 1 mm and with one or more cusps involved were excluded. Teeth were randomly divided in three groups. Group 1: Opti-Bond FL; group 2: Scotchbond 1 XT; group 3: PQ1. Total-etching was performed using 35% phosphoric acid followed by the application of 2% chlorhexidine gluconate in the three groups. All teeth were restored using Vit-l-escence microhybrid composite resin. The proximal surface was built up first, followed by dentin and enamel occlusal surface stratification; wedge-shaped increments of composite resin were placed and cured using the UltraLume V curing light through a combination of pulse and progressive curing techniques. RESULTS : Restorations were evaluated at six-month intervals during the two-year period using a modified US Public Health Service criteria by two independent evaluators precalibrated at 85% reliability. No failures were reported and α scores were recorded for all parameters. Statistical analysis was performed using a χ(2) test and the Fisher exact test (χ(2)=10.6; p=0.001). No teeth exhibited sensitivity in the three groups both at the two-week recall and two-year follow-up.

After 20 years of use by the dental profession, chlorhexidine is recognized as the gold standard against which other antiplaque and gingivitis agents are measured. Chlorhexidine's antiplaque effect is a result of the dicationic nature of the chlorhexidine molecule, which affords the agent the property of persistence of antimicrobial effect at the tooth surface, through both bactericidal and bacteriostatic effects. Although other antiplaque agents may show either purely immediate effect, or limited persistence, the degree of chlorhexidine's persistence of effect at the tooth surface is the basis of its clinical efficacy. Similarly, the cationic nature of the chlorhexidine molecule is the basis of the most common side effect associated with the use of the agent--extrinsic tooth staining. Such tooth staining seems to be the result of a local precipitation reaction between tooth-bound chlorhexidine and chromogens found within foodstuffs and beverages. The cationic nature of the chlorhexidine molecule also means that the activity of the agent is rapidly reduced in the presence of anionic agents, specifically those found within certain types of toothpaste; thus care is required when using normal toothbrushing alongside chlorhexidine. By understanding how the chemical properties of the chlorhexidine molecule can explain the plethora of clinical efficacy and safety data, the use of chlorhexidine can be optimally aimed towards the patient groups who would most benefit from the superior therapeutic effect of the agent. Specifically, chlorhexidine would seem to be of most value to patients in whom the ability to perform adequate oral hygiene procedures has been compromised. In these individuals the delivery of the correct dose of chlorhexidine to the tooth surface can be optimized through the judicial use of the several different chlorhexidine formulations now available. Thus, by understanding the properties and limitations of the chlorhexidine molecule, the dental profession can ensure that the efficacy of the agent is maximized, and the side effects associated with the agent are minimized, allowing chlorhexidine to rightly remain the gold standard against which other antiplaque agents are measured.

Triclosan is a widely accepted antimicrobial ingredient because of its safety and antimicrobial efficacy. Triclosan is a unique antimicrobial well suited for use in the health care industry in which mildness is a necessity to protect the health care worker during repeated use and antimicrobial activity is a necessity to protect public health. Triclosan has demonstrated immediate, persistent, broad-spectrum antimicrobial effectiveness and utility in clinical health care settings. This review highlights the utility and effectiveness of a 1% triclosan formulation for use in high-risk, high-frequency handwashing.

This investigation deals with the development of buccal formulations (tablets) based on chitosan microspheres containing chlorhexidine diacetate. The microparticles were prepared by a spray-drying technique, their morphological characteristics were studied by scanning electron microscopy and the in vitro release behaviour was investigated in pH 7.0 USP buffer. Chlorhexidine in the chitosan microspheres dissolves more quickly in vitro than does chlorhexidine powder. The anti-microbial activity of the microparticles was investigated as minimum inhibitory concentration, minimum bacterial concentration and killing time. The loading of chlorhexidine into chitosan is able to maintain or improve the anti-microbial activity of the drug. The improvement is particularly high against Candida albicans. This is important for a formulation whose potential use is against buccal infections. Drug-empty microparticles have an anti-microbial activity due to the polymer itself. Buccal tablets were prepared by direct compression of the microparticles with mannitol alone or with sodium alginate. After their in vivo administration the determination of chlorhexidine in saliva showed the capacity of these formulations to give a prolonged release of the drug in the buccal cavity.

Topical delivery of antimicrobial agents is the most widely accepted approach aimed at prolonging active drug concentrations in the oral cavity. As most antifungals do not posses inherent ability to bind to the oral mucosa, this is best achieved through improved formulations. Chitosan, a partially deacetylated chitin, which is a biologically safe biopolymer, prolongs the adhesion time of oral gels and drug release from them. Chitosan also inhibits the adhesion of Candida albicans to human buccal cells and has antifungal activity. The antifungal agent, chlorhexidine gluconate (Chx), also reduces C. albicans adhesion to oral mucosal cells. The aim of this study was to design a formulation containing chitosan for local delivery of Chx to the oral cavity. Gels (at 1 or 2% concentration) or film forms of chitosan were prepared containing 0.1 or 0.2% Chx and their in vitro release properties were studied. The antifungal activity of chitosan itself as well as the various formulations containing Chx was also examined. Release of Chx from gels was maintained for 3 h. A prolonged release was observed with film formulations. No lag-time was observed in release of Chx from either gels or films. The highest antifungal activity was obtained with 2% chitosan gel containing 0.1% Chx.

The use of intravascular catheters is associated with infectious complications. Using plastic materials with antibacterial activity may reduce catheter-related bacterial colonization. A novel intravascular catheter impregnated with the antiseptics silver-sulphadiazine and chlorhexidine was tested in an in-vivo model using implantation of catheters into the internal jugular veins of rats. The rate and magnitude of bacterial colonization in groups with implantation of silver-sulphadiazine and chlorhexidine bonded (SSC) and control (C) catheters were assessed 3 and 7 days after intravenous implantation, and local challenge at the exit site by 10(7) cfu Staphylococcus epidermidis ATCC 35984. Significant reductions in the culture positivity of catheters were observed in the test compared with control groups. After 3 and 7 days, the magnitude of bacterial colonization of implanted catheter segments was significantly lower compared with control catheters (P < 0.01). These findings indicate that antiseptic-bonded catheters substantially reduce the incidence and magnitude of catheter-related bacterial colonization, and may subsequently reduce catheter-related infection.

A series of different methacrylate monomers (with either 1 or 2.5% dimethyl-p-toluidine, DMPT) was gelled with poly(ethyl methacrylate) powder (containing benzoyl peroxide) thus forming a room temperature curing system. When doped with 5.625% chlorhexidine diacetate the release from the tetrahydrofurfuryl methacrylate-based samples was considerably greater than that from other methacrylate monomers. This seems to be due to the formation of channels in the polymer. Nuclear magnetic resonance spectroscopy, of solutions that the samples were immersed in, showed chlorhexidine was indeed being released from the polymer. It also showed that doping the polymer with chlorhexidine hindered the polymerisation, resulting in a higher level of residual monomer and low molecular weight components being leached from the polymer. The DMPT also affected the polymerisation with greater leaching from the 2.5% DMPT sample.

The aims of the present study were to investigate the antibacterial properties of glass-ionomer cements containing different concentrations of chlorhexidine and the possible release of chlorhexidine from the compound. Chlorhexidine gluconate or diacetate was mixed with glass-ionomer cements and tested in vitro against strains of Lactobacillus casei and mutans streptococci. A spectrophotometric test was used to monitor the release of chlorhexidine from the mixture. In a broth culture test, the higher the concentrations of chlorhexidine in the mixture, the longer the time of antibacterial effect on Streptococcus mutans and the greater the tendency of the material to deteriorate. Agar diffusion tests revealed bacterial inhibition in a dose-response manner. The tested bacterial strains were similarly inhibited and the antibacterial properties decreased with time. A minor portion of added chlorhexidine was released from the cement. The deterioration of the cements indicates that the material could be useful as a varnish-like chlorhexidine carrier.

This in vitro study examined the effects of chlorhexidine on dentin surfaces and on the bond strengths of composite to dentin. Scanning electron microscopy revealed that the chlorhexidine solution deposited debris on the surface and within the tubules of etched dentin but chlorhexidine had no significant effect on the shear bond strengths of composite to dentin using the All-Bond 2 adhesive system.

This study evaluates the effects of long-term disinfection immersion on the flexural properties of denture base resins; it was conducted against a background of increasing awareness of the importance of cross-infection control in dental clinics and laboratories. The transverse bend testing procedure used followed that specified in the International Standard for denture base polymers. The results demonstrate that alcohol-based disinfectants are not suitable for use with denture base materials of non-cross-linked acrylic resin.

The purpose of this study was to evaluate the accuracy of the Root ZX in vitro in the presence of a variety of endodontic irrigants. The in vitro model, described by Donnelly, consisted of refrigerated gelatin made with 0.9% sodium chloride instead of water. The following irrigants were tested: 2% lidocaine with 1:100,000 epinephrine, 5.25% sodium hypochlorite, RC Prep, liquid EDTA, 3% hydrogen peroxide, and Peridex. A total of 30 extracted, single-rooted teeth were used. The experimental measurements in the presence of the various irrigants were compared with the actual canal lengths. The present data indicate that the Root ZX electronic apex locator reliably measured canal lengths to within 0.31 mm and that there was virtually no difference in the length determination as a function of the seven irrigants used. These results strongly support the concept that the Root ZX is a useful, versatile, and accurate device for the determination of canal lengths over a wide range of irrigants commonly used in the practice of endodontics.