MAY-JUN 2024

DENTAL Vol. 41, No. 03

ADVISOR
™

Product insights you can trust.

CLINICAL TIE
TO THE LAB
MAIN TOPIC: RESEARCH
METHODS & EQUIPMENT
AT DENTAL ADVISOR

HYDROGEN PEROXIDE
TOOTHPASTE LABORATORY
EVALUATION

OVERNIGHT TEETH
WHITENING PEN
LABORATORY EVALUATION

RECENTLY-DEVELOPED
SINGLE-SHADE COMPOSITE
Product insights you can trust.
FROM THE DESK OF
Dr. Sabiha S. Bunek
MAY-JUN, 2024 CEO & Editor-in-Chief
VOL. 41 NO. 3

PUBLISHER: DENTAL CONSULTANTS, INC. At DENTAL ADVISOR, we have the unique ability to translate our materials
John M. Powers, Ph.D.
Sabiha S. Bunek, D.D.S.
research into clinically relevant data. Our state-of-the art laboratory provides
independent analysis that is tailored for everyday dentistry, including explanations
CHIEF EXECUTIVE OFFICER
of benchmarks that can impact clinical outcomes. Our testing adheres to ISO,
Sabiha S. Bunek, D.D.S.
ADA, and ASTM standards, ensuring the reliability of our results. We are a trusted,
EDITORIAL BOARD independent third-party resource for manufacturers and distributors seeking
Julius Bunek, D.D.S., M.S.
Preeya Genz, D.D.S. to develop and enhance their products. Our scientific team often designs
Adam Hodges, D.D.S. custom tests to verify the accuracy and significance of product claims for dental
Marc Harrison Lai, D.D.S.
Christopher Mazzola, D.D.S.
professionals, the end users. When combined with clinical evaluations, our
Jack W. Nash, D.D.S. recommendations to the dental community are aimed at truly improving patient
Kathy O’Keefe, D.D.S. care. As always, we welcome your feedback. Please feel free to reach out to me at
Joy Poskozim, D.D.S.
Paresh Shah, D.M.D. [email protected] or to our team at [email protected] with
David Yang, D.M.D. any questions or concerns. Thank you for reading!
CHIEF OPERATING OFFICER
Mary E. Yakas, B.A., C.M.C. - Sabiha S. Bunek
VICE-PRESIDENT
CUSTOMER ENGAGEMENT
Linda Bellisario, M.B.A., R.D.H.

CONTENT MARKETING MANAGER

C L I N I C A L E VA L U AT O R P R O F I L E
Abigail Noreen, B.A.

CUSTOMER SUCCESS MANAGER Dr. Frank A. Berman graduated

Spencer Redmond, B.S. from Wilkes University in 1971
SCIENTIFIC RESEARCH with degrees in Psychology
John A. Molinari, Ph.D. and Elementary/Secondary
Matt G. Cowen, B.S. Education. He joined the Navy
Margaret Gilmartin, B.S.
in 1970 and upon graduating
CLINICAL EVALUATOR COORDINATOR in 1971 was commissioned as
Lesley Correll, B.A., B.S., R.D.H. an Ensign. He completed flight
training and received his gold
CLINICAL AMBASSADORS
Matthew R. Miller, D.D.S. Naval Aviator wings in 1972.
Ashton A. Prince, D.M.D. After graduation from flight
school, he was assigned to
Please send inquiries and address changes to: Patrol Squadron 46 at Moffett
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Call: 734.665.2020
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Email: [email protected] deployments to the western Pacific and East Asia, taking part in the
Website: dentaladvisor.com end of the Vietnam War, in 1976 he became the chief pilot of Naval
No unauthorized duplication or reprints may be Air Station Key West, Florida.
made. Inquiries concerning duplication may be
directed to the publisher. Copyright ©2024, Dental Though he left active duty in 1977, Frank stayed in the Naval
Consultants, Inc. All rights reserved. Printed in the Reserve as a P-3 patrol plane commander at Willow Grove Naval Air
U.S.A. (ISSN 0748-4666) by Print-Tech, Inc. Station, Pennsylvania for the next 14 years, until his retirement as a
Lieutenant Commander from the Navy in 1991. After leaving active
duty, he subsequently flew commercial airliners for Allegheny Airlines
in 1978, but found commercial aviation unfulfilling and entered
VISIT US ON SOCIAL MEDIA Temple University Kornberg School of Dentistry, graduating in 1982.
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LINKEDIN
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2 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 Clinical Tie to the Lab

SPECTROPHOTOMETER
X-Rite VS3200 MetaVue Imaging
Spectrophotometer
TESTING
What it Does: How This Applies Clinically:
Tests color change and The color matching and long-term
translucency of materials as well performance of restoratives is a critical
as shade match of composites, feature of patient acceptance. New single-
and ceramics. Non-contact shade and limited shade composites
imaging spectrophotometry benefit from in-vitro testing to determine
allows sampling of 2 mm limitations and strengths for shade
diameter of surfaces for precise matching ability to inform clinical choices
measurements. in composites for different procedures.
Whitening Performance

Example of Lab Testing Performed by DENTAL ADVISOR:

Whitening studies performed on Colgate® Optic White® Renewal Toothpaste
and Colgate® Optic White® Overnight Teeth Whitening Pen (Colgate-Palmolive)
showed significant improvement in whiteness levels on stained teeth in under a
week of use.

TOOTHBRUSH ABRASION
SIMULATOR
What it Does: Example of Lab
This simulates toothbrush use for long-term wear Testing Performed by
studies and short-term simulations. This can be used DENTAL ADVISOR:
to measure the abrasivity of toothpaste & toothbrush The Toothbrush Simulator was used to
combinations as well as gloss retention and wear of evaluate Panavia Veneer LC (Kuraray
restoratives in combination with measuring surface Noritake) and assess the long-term
roughness (profilometry). stability of its durability and esthetics
under simulated brushing conditions.
How This Applies Clinically: The spherical filler particles in the
High gloss retention of composites allows resin cement not only contribute
restorations to maintain esthetics over time while to sustained gloss and esthetics
also minimizing staining and bacterial adhesion. along the margin over time but also
Characterizing toothpaste and toothbrush abrasivity improve flowability and film thickness,
is a common concern for the general population. facilitating easy application.

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 3

Clinical Tie to the Lab

MARGINAL GAP TESTING

X-Rite VS3200 MetaVue What it Does: How This Applies Clinically:
Imaging Spectrophotometer
Marginal gap assessment Marginal gap assessment under SEM and dye penetration
with SEM, MicroCT and dye tests indicate the risk potential associated for microleakage
penetration tests evaluate and secondary caries. These tests can evaluate the effects of
the integrity of the marginal technique or materials on the resultant leakage potential of
seal. clinical procedures.

Example of Lab Testing Performed by DENTAL ADVISOR:

Results of research of STELA (SDI Limited), a self-curing composite resin showed remarkably low
incident of open margins and perfect dentin interfaces due to the lack of light polymerization
required. This allows the polymerization stresses to be spread equally across the entire bonding
interface of placed restorations. Extensive testing also showed great mechanical properties and this
product features two different consistencies to cover all indications for direct composite placement,
including core build-up.

MILLING & PRINTING ACCURACY OF

CAD/CAM AND PRINTED MATERIALS
What it Does: Machining Accuracy Discrepancy
Intaglio External Intaglio External
Tests the accuracy of machined and additively manufactured Material Prep-line, µm
Lateral, µm Lateral, µm Z-Direction, µm Z-Direction, µm
products compared to the original design file. Amber Mill 31 (25) 42 (20) 89 (22) 89 (26) 20 (50)

How This Applies Clinically:

Accurate restoratives, models and other products provide
better fit which can reduce occurrence of marginal gaps,
adjustments of occlusion, and the need to remake products.

Example of Lab Testing Performed by Specimen intaglio

surface plane in the
Specimen external
surface plane in the
Specimen intaglio
surface plane in the
Specimen external
surface plane in the
Specimen prep-line
surface in the
DENTAL ADVISOR: lateral direction. lateral direction. Z-direction. Z-direction. Z-direction.

Amber Mill (Hass Bio) is a lithium disilicate block that may be used with or without heat treatment allowing the translucency to be customized from a
single block. Machining accuracy testing showed high machining accuracy in the critical areas of the margin, intaglio and external lateral areas.

4 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 MICRO-CT ANALYSIS
Composite MicroCT Orthoslice

What it Does: How This Applies Clinically:

Non-destructive 3D imaging using x-rays Voids can be quantified to provide insight into
of restorative procedures and materials clinical technique and material properties.
including composites, ceramics, and Marginal gap analysis provides insight into
endodontic procedures. This can provide accuracy of fit of indirect restoratives or the
quantifiable data on voids, marginal gaps, fit, effect of shrinkage stress on direct restoratives.
canal transportation, remineralization, filler Remineralization of tooth structure of varnishes or
distribution, polymerization shrinkage and bioactive restoratives can be measured showing
grain analysis of metal products. differences between products.

Example of Lab Testing Performed by DENTAL ADVISOR:

BRILLIANT EverGlow (Coltene) in combination with BRILLIANT EverGlow Flow showed great
synergy in a battery of tests including a MicroCT analysis of the adaptation to the bonding interface.
The combination of using BRILLIANT EverGlow Flow as a base-liner allowed perfect adaptation to
the tooth structure while providing a flexible base which can be capped with BRILLIANT EverGlow
packable for resisting occlusal forces and wear.

REMINERALIZATION
What it Does: Example of Lab Testing Performed by DENTAL ADVISOR:
Artificial caries are produced in extracted teeth and Testing of Ketac Universal (3M Oral Care), a Glass Ionomer Restorative, showed the benefit of
then a remineralizing agent or restorative is applied. remineralizing carious enamel by examining the hardness and radiodensity changes after 3
Differences in hardness, composition of calcium weeks of placement. Ketac Universal restored over half of the hardness and radiodensity lost
or phosphate, and radiodensity measured using a due to demineralization of a 60 micron lesion.
MicroCT technique can be compared to a control
group to determine how well the product performs.
Similar testing can also determine how well a Lower gray values =
varnish or other product protects teeth from acid or Remin Demin less mineral density
bacterial attack. [ ]

sound enamel
How This Applies Clinically: 100 micron depth measurement area
Comparing the performance of different products 1 mm
in protecting and remineralizing teeth can aid in
Transverse cross-section of a demineralized enamel specimen, the left had glass ionomer applied,
determining treatment approaches and material the right was covered by a varnish as a control
selection.

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 5

 Clinical Tie to the Lab

BOND STRENGTH &

THERMOCYCLING
What it Does: How This Applies Clinically:
Shear Bond Strength is the ability Bond strength data, both initial and after thermocycling, should be
of the bonding agent to adhere considered in the performance of materials intraorally. In general,
to both dentin and enamel, both the higher the numbers are, the more adhesive the product is.
immediately and over time. Bond Performance of materials over time can be applied to reduced
strength measures the force sensitivity and microleakage in practice.
needed to separate a material
from a substrate, which assesses Example of Lab Testing Performed by
the strength of adhesion.
DENTAL ADVISOR:
Thermocycling materials expose
In our lab study, G2-BOND Universal (GC America) performed
them to hot and cold baths
better than CLEARFIL SE Bond 2 and Optibond FL when tested in
and can mimic oral conditions
their respective etching modes to dentin and enamel in immediate
and simulate advanced aging
24-hour shear bond strength and after accelerated aging and
over different periods of time by
12-month storage.
stressing the bonding interface.

COLOR STABILITY &

STAIN RESISTANCE
Baseline Aging Coffee Staining
What it Does: How This Applies Clinically:
Ecosite One

Color stability and stain resistance testing The ability of restorative products to maintain
examines the ability to maintain the original the same shade over time is of critical
shade over time. Color stability measures importance for esthetics. Measuring the
the color change due to different light, color differences between products can inform
OMNICHROMA

and temperature changes, while staining which products are more ideal in the anterior
resistance measures the color change due to zone. A highly polished and well polymerized
exposure to various liquids known to cause composite is also important to minimize color
color change such as wine, coffee or soda. change over time.

Example of Lab Testing Performed by DENTAL ADVISOR:

Ecosite One (DMG America) is a new single-shade composite indicated for posterior use. It was subjected to accelerated aging in a weathering chamber
and staining by coffee to simulate years of exposure and color properties were measured with a benchtop spectrophotometer. As a result, there was
minimal change in translucency critical for maintaining the chameleon effect over time and acceptable color change which indicates the ability for lasting
color matching.

6 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 POLISHABILITY &
GLOSS RETENTION
What it Does:
Polishability measures the speed and final result with which a restorative can be polished
and gloss retention measures the ability to maintain the gloss after toothbrush abrasion,
aging and staining.

How This Applies Clinically:

Maintaining a smooth outer surface of restoratives has many benefits including reducing
bacterial adhesion and minimizing staining. Testing validating the combination of a specific
polishing system and restorative can inform choices to optimize time spent polishing and
final results.

Example of Lab Testing Performed by DENTAL ADVISOR:

CEREC MTL Zirconia (Dentsply Sirona) is a multi-layered CAD/CAM zirconia block and was
evaluated for Polishability using Luster (Meisinger) polishers and was able to reach a mirror
like finish in less than 60 seconds of polishing. Example of a specimen after toothbrush abrasion, with
the polished surface (~86 gu) on the left, and abraded
surface (~63 gu) on the right.

DEPTH OF CURE
What it Does:
Depth of cure testing measures the extent that composites polymerize with a curing light exposure. This is often measured by using hardness indents at
different intervals of depth from the surface to determine how the composite polymerized with different curing conditions. This can also be used to compare
curing light performance.

How This Applies Clinically:

In-vitro testing is the only way to know how well a composite is going to cure with a given light
exposure. Curing lights vary in output of wavelength, intensity, and beam uniformity which can have
a massive effect on the polymerization of composites. Likewise, composites vary widely in how
much energy is required to polymerize and the maximum depth they can be cured. Having data on
specific combinations of composites and curing systems can inform the clinician of the duration of
curing and effective depth in clinical procedures.

Example of Lab Testing Performed by DENTAL ADVISOR:

Monet Laser Curing Light (AMD Lasers) was extensively tested with several different bulk-filled
composites. It was able to effectively cure them to a sufficient depth of cure in 3 seconds or less.
Hardness indents every 0.5 mm measures composite
depth of cure

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 7

Clinical Tie to the Lab

POLYMERIZATION SHRINKAGE
What it Does: How This Applies Clinically:
Polymerization shrinkage testing measures Polymerization shrinkage of composites can
dimensional changes during curing of induce enamel micro-fractures which often show
composite which can affect marginal leakage as white lines at the margin, and debonding of
and stress at the bonding interfaces. Volumetric dentin walls hidden from view which can lead to
shrinkage measures the overall shrinkage of increased sensitivity and overall lower strength of
a composite, while shrinkage stress testing the restoration. Composites with lower shrinkage
measures how much this shrinkage places in either volume or stress can lower the risk of
stress at the bonding interfaces. debonding and leakage.

Example of Lab Testing Performed by DENTAL ADVISOR:

Fit SA (SHOFU) was extensively tested including polymerization shrinkage using a MicroCT scanner Micro-CT scans before and after polymerization
which accurately measured the volumetric shrinkage while also showing the benefit of the self- with differences highlighted in red.
adhesive properties. All of the measured shrinkage occurred at the surface of the composite rather
than at the bonded interface.

FRACTURE TOUGHNESS
What it Does:
Fracture Toughness measures the ability of a material to resist flaws or cracks from expanding and is one of the most closely related tests to chipping
resistance. The most commonly tested materials are composites and ceramics.

How This Applies Clinically:

Fracture toughness is crucial for resistance to chipping and fracturing, thus prolonging
restoration longevity. The ability of restoratives with microscopic flaws to resist propagating
those flaws leading to fracture is one of the most important factors for determining if a
product can resist occlusal forces long-term.

Example of Lab Testing Performed by DENTAL ADVISOR:

A test program including fracture toughness showed that 3M Filtek Supreme Flowable
(3M Oral Care) possessed material properties that rivals other packable composites in a
project to assess the expansion of indications for this composite. Fracture toughness was
an important component to show that it could resist occlusal forces and resist fracture
propagation stresses.

8 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 FLEXURAL STRENGTH
& MODULUS
What it Does:
Flexural strength and modulus evaluates a material’s strength and resistance to
bending. All restoratives can be tested.

How This Applies Clinically:

Flexural strength testing is a way to compare all restorative materials by measuring
how much force can be absorbed as the material flexes from mastication or impact.
This is critically important for stress bearing areas such as posterior restorations. The
modulus or stiffness of the material is related to how much give the material has on
occlusal forces. A higher modulus is usually desirable for occlusal surfaces. Lower
modulus materials are ideal for cavity liners and class V restorations in particular,
but a low modulus won’t necessarily preclude a material from being used in other
indications based on the other properties.

Example of Lab Testing Performed by DENTAL ADVISOR:

3M Filtek One Bulk Fill Restorative (3M Oral Care) is recognized as the strongest bulk-fill composite by DENTAL ADVISOR with flexural strength as high as
180 MPa, and also retained more of the flexural strength after water storage than other composites tested.

COMPRESSIVE STRENGTH
What it Does:
Compressive Strength measures the ability to withstand load-bearing forces without deformation. Higher compressive strength often correlates with greater
resistance to breakage under force. All restoratives can be tested.

How This Applies Clinically: Example of Lab Testing

This property is important for restoratives Performed by DENTAL ADVISOR:
in regards to occlusal forces, especially in Beautiful II LS (SHOFU) is a composite
posterior regions, as well as load bearing formulated to minimize shrinkage and
restoratives such as core materials. This is also one of the strongest composites
is also measured for other materials, such on the market at resisting compressive
as dental stone, as the material must be forces with a nearly 400 MPa compressive
strong enough to resist compressive forces strength.
when flasking and making models.

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 9

Clinical Tie to the Lab

HARDNESS
What it Does: How This Applies Clinically:
Hardness measures resistance to Hardness of materials is correlated to
indentation and is correlated with several properties, including wear, modulus
wear properties, polymerization as well as the polymerization of light-cured
percentage and modulus. materials. Hardness is a predictor as to which
Different hardness methods are materials can be used on occlusal surfaces.
used depending on the type of For composites, the threshold should mimic
material. dentin at minimum, which is 80 HV.

Example of Lab Testing Performed by DENTAL ADVISOR:

GrandioSO Heavy Flow (VOCO) is a notable composite for having one of the highest
filler contents for a flowable composite which also measured the highest hardness of
98 HV for a syringeable composite. This is a Vickers indent. The larger the indent, the lower the
hardness.

RADIOPACITY
What it Does:
Measures how radiopaque restorative materials appear on radiographs compared
to a standard Aluminum step wedge with thicknesses from 0.5 to 6 mm which is
radiographically equivalent to dentin, while enamel is approximately 2 times more
radiopaque compared to aluminum.

How This Applies Clinically:

Radiopacity is essential for detecting recurrent decay on radiographs, with ideally
a radiopacity that clearly distinguishes the composite from tooth material. An ideal
radiopacity for restorative materials is over 250% equivalent to aluminum to distinguish it
from dentin (100%) and enamel (200%).

Example of Lab Testing Performed by DENTAL ADVISOR:

3M Filtek One Bulk Fill Restorative (3M Oral Care) is recognized as the strongest bulk-fill composite by Dental Advisor, and has an exceptional
radiopacity equivalent to 310% of aluminum for clear radiographic visibility.

10 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 CUSTOM TEST:
APPLICATOR TESTING
What it Does:
An SEM was used to see shedding of microscopic hairs or pieces of the brush contaminating the
bonding layer. How well a microbrush takes up and delivers a bonding agent can be measured, as well
as determining whether or not a microbrush absorbs any of the material leading to waste.

How This Applies Clinically: Example of Lab Testing

Not all brushes are created equal. Some pick
Performed by DENTAL ADVISOR:
up adhesive and apply it to the tooth structure Testing of ZerofloX (Medmix Switzerland AG)
better than others. The ability to effectively deliver involved both flowable composites and Bond strength specimen with microfiber
adhesive to the tooth improves the application adhesives. Its design creates no risk of embedded in bonding interface.
of a bonding agent and thus also improves contaminating the bonding interface.
marginal adaptation by evenly coating the tooth Flock-Free elastomer bristles can be used
surface. A small, fine-tip applicator allows for with adhesives and achieve similar bond
precise placement of materials, reducing the risk strengths as conventional micro brushes
of over-application or waste. Furthermore, non- without worrying about contaminating the
linting, non-absorbent material minimizes the bonding interface. These brushes contributed
potential for contamination, ensuring the integrity to excellent marginal adaptation which in
of dental materials and maintaining aseptic turn reduced the potential for microleakage,
conditions during procedures. secondary caries, and failure of the restoration. New ZerofloX flock-free elastomer
applicator brush.

ZONE OF INHIBITION
What it Does: Example of Lab Testing
This test measures the ability of a material to Performed by DENTAL ADVISOR:
resist infiltration of bacteria associated with
Riva Star Aqua (SDI Limited) caused a
recurrent caries. It will quantify the area of
bacterial resistance, showing the efficacy of the larger zone of inhibition for all four of the
product. challenge microorganisms when compared
to FiteBac® Antimicrobial Cavity Cleanser.
How This Applies Clinically: Although more clinical studies are needed,
Utilizing a product with a good zone of inhibition this demonstrates that Riva Star Aqua
will successfully combat oral bacteria which can could have significant impact on inhibiting
lead to recurrent decay and or sensitive teeth. bacterial growth in addition to desensitizing.
Zone of inhibition (outlined) created by Riva
Star Aqua when challenged to S. mutans.

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 11

Clinical Tie to the Lab

AEROSOL REDUCTION
What it Does: How This Applies Clinically: Bioaerosol Sampler
Utilizing a bioaerosol capture device, If microbial counts are lower using
air samples are taken and plated devices such as HVE, external suction, or
for microbial growth. Typically use of air purification, it is likely these methods
external suction or air purification can are successful in delivering cleaner air
be tested against control conditions. and reducing bioaerosols.

Example of Lab Testing Performed by DENTAL ADVISOR:

The findings from this study showed trends of reduced airborne bacterial load when
the Vaniman PURE BREEZE HEPA Air Purifiers (Vaniman) were in use during a busy
practice workweek consisting of aerosol generating procedures.

WATERLINE TREATMENT EFFICACY

What it Does:
The technique tests the cleaning efficiency of waterline treatments that are used in dental practices.
Water samples are gathered using a sterile technique and plated for microbial growth both before
and after treatment with a waterline cleaner. Reduction in bacteria is measured to determine efficacy
of the product.

How This Applies Clinically:

Maintaining clean waterlines is necessary to ensure that the water being used in a patient’s mouth
is at or below 500 CFU/mL, the safe level of drinking water, and free of harmful contaminants. Results Culture of 1/10 dilution of water from unit #2
prior to treatment with Monarch Lines Cleaner.
should prove a bacterial reduction is present when a product is used correctly.

Example of Lab Testing Performed by DENTAL ADVISOR:

For this investigation, Monarch Lines Cleaner (Air Techniques), a chlorhexidine and ethanol-
containing solution, was used to reduce and maintain bacterial levels in dental units with
self-contained water bottles for a period of three months. While initial microbial levels varied
between dental units, in the end, bacterial concentrations met or were below the 500 cfu/mL level
recommended by the CDC. This level was observed as early as the first week of treatment. Dental
personnel in the offices also reported that they and their patients had positive comments regarding
the mint-flavored water during the investigation. Culture of undiluted water sample from unit #2
after treatment with Monarch Lines Cleaner.

12 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 ENVIRONMENTAL SURFACE
WETNESS
What it Does: Example of Lab Testing Performed
Environmental surface wetness by DENTAL ADVISOR:
tests determine if a disinfectant In this study, 9 disinfectant wipes were evaluated
wipe stays wet long enough to kill for their ability to maintain wetness when using a
substances on contaminated clinical designated contact time. Four surface quadrants
surfaces. It also can test the ability
treated with Optim Blue (SciCan), Optim 33TB
to clean and kill representative
(SciCan), and OXY-1 remained wet for the 1-minute
bacteria.
contact time. In contrast, the other commercial
disinfectants were unable to maintain surface
How This Applies
wetness past two quadrant applications. The 2 high
Clinically: alcohol preparations (FD 350, Mikrozid AF) and
It is important to know that the dual phenolic (Birex) wipes dried faster than the
disinfectant you are using stays contact time given on the label. In summary, the
effective for the amount of time that hydrogen peroxide disinfectant wipes performed
is required to kill based on claims. the best under the conditions tested.

LONG-TERM EXPOSURE OF
DISINFECTANT ON UPHOLSTERY
What it Does:
An electronic crockmeter repeatedly wipes upholstery samples with disinfectant
and can be replicated to a specific period of time. Tensile strength is then
measured on the material to determine if the material has degraded and
become weaker, susceptible to tearing.

How This Applies Clinically:

Some disinfectants have been found to be so harsh that they discolor material
and cause weakening of fibers, leading to tears and holes.

Example of Lab Testing Performed by DENTAL ADVISOR:

This study examined the effects caused by an accelerated 5-year interaction
between Monarch Surface Disinfectant Wipes (Air Techniques) and
Ultraleather and Dauphine dental chair upholstery. No visible changes in appearance were observed for either fabric treated with Monarch Surface
Disinfectant Wipes. In addition, there was no significant effect on the integrity of the Dauphine fabric after an extended exposure to test disinfectant
solution. However, Monarch Surface Disinfectant Wipes did weaken Ultraleather test fabric, which can be seen with the significant decrease (14%) in
tensile load. This suggests that the treated Ultraleather fabric may be more susceptible to tearing.

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 13

 Translating the Science
Matt Cowen, B.S.
DENTAL ADVISOR Biomaterials Research Center
Product insights Ann Arbor, MI 48104 Number 39
you can trust. [email protected] dentaladvisor.com

Colgate Optic White Hydrogen Peroxide

Toothpaste Laboratory Evaluation
M. Cowen, J.M. Powers

INTRODUCTION:
Staining or darkening the appearance of teeth can broadly be put into two categories which describes where the color
change is occurring: Intrinsic and Extrinsic staining. Extrinsic staining occurs on the tooth enamel surface where pigments
are trapped on the pellicle surface. This can be due to ingested substances, tobacco use and bacterial action and/or
other substances. Intrinsic staining occurs when the internal enamel /dentin of the tooth is discolored either during tooth
development, certain drug interactions, trauma and genetic factors. Internalization of discoloration can also occur when
extrinsic colored pigments become internalized in areas of enamel defect and exposed dentin.
There are many whitening toothpastes available on the market and they come in two primary categories. Most have
abrasives designed to primarily remove surface stains, while others have ingredients such as hydrogen peroxide (H2O2)
that can penetrate the small porosities of the enamel and break apart the pigments that cause staining on the surface
and inside enamel porosities. Hydrogen Peroxide is a popular bleaching agent as the relatively small molecule penetrates
anywhere stains may reach, oxidizes the stains, which reduces the intensity of their color.
In this study, we evaluated the in vitro whitening effectiveness of Colgate® Optic White® Platinum toothpaste, containing
3% hydrogen peroxide, by using a spectrophotometer on stained bovine teeth brushed with our Toothbrushing Simulator.
We compared its performance against Colgate® Cavity Protection toothpaste, which contains no hydrogen peroxide, to
assess the difference in in vitro stain removal efficacy between mechanical action and the combination of chemical and
mechanical action.

STUDY DESIGN: Change in Whitening

Bovine Teeth were stained and randomly divided between groups with 12 replications 6 cycles 14 cycles
-8.0
each. Teeth were measured at baseline, at 6 brushing cycles and 14 brushing cycles with -7.0 -7.6
a Spectroshade Micro II Spectrophotometer (MHT Optic Research, Switzerland).
Whitening Index, ∆W*

-6.0

Teeth were brushed with a 1:1 ratio of artificial saliva and toothpaste with Colgate Optic -5.0

White Platinum and Colgate Cavity Protection for 2 minutes at 120 rpm in a figure 8 -4.0
pattern for 14 total cycles before being rinsed. -3.0
-3.1
-2.0

-1.0 -0.6
-0.2
0

Whiteness Index Colgate Cavity Protection Colgate Optic White Platinum

½
W* = (a*² + b*² + (L* - 100)²)
The toothpaste without hydrogen peroxide showed
∆W* = W* treated - W* baseline
minimal change in color of the stained teeth, while
Colgate Optic White Platinum showed superior in
vitro whitening efficacy expressed as Delta W. This study
shows that for fourteen two-minute brushing treatments
RESULTS: which represents about a week of product usage, the
Tooth color was measured by a toothpaste with hydrogen peroxide performed better
spectrophotometer which gave L*a*b* color than a toothpaste without. The decolorizing property
coordinates. A common measurement of of hydrogen peroxide has been shown to chemically
whitening changes is calculated using a alter stain molecules on the surface and within teeth
formula ΔW*. In this “Whiteness Index” a leading to whiter results. This in vitro study validates the
negative value change indicates whiter. mode of action showing that incorporation of hydrogen
peroxide in a toothpaste leads to superior stain removal
and whitening results in comparison to a non-whitening
fluoride dentifrice.
Research supported by Colgate-Palmolive Company

14 DENTAL ADVISOR™
DENTAL ADVISOR l Ann Arbor, Michigan 48104 l [email protected] l © 2024 Dental Consultants, Inc.
Vol. 41, No. 03 May/Jun 2024
 Translating the Science
Matt Cowen, B.S.
DENTAL ADVISOR Biomaterials Research Center
Product insights Ann Arbor, MI 48104 Number 40
you can trust. [email protected] dentaladvisor.com

Colgate Optic White Overnight Teeth

Whitening Pen Laboratory Evaluation
M. Cowen, J.M. Powers

INTRODUCTION:
Among the many whitening products on the market, whitening gels which can be placed for longer periods can allow
the active ingredient time to work. Higher percentages of whitening agents like hydrogen peroxide may work faster, but
with the potentially greater risk of sensitivity if used improperly. Some whitening agents use greater than 30% hydrogen
peroxide or over 40% carbamide peroxide which are only considered safe for in-office use.
In this study, we measured the whitening effect of Colgate ® Optic White ® Overnight Teeth Whitening Pen which is
indicated for OTC use with 3% hydrogen peroxide overnight, or for several hours per use. We used stained bovine teeth
which were treated, stored in a humid environment and color change measured with a spectrophotometer. We compared
the whitening effect to a placebo pen without hydrogen peroxide to measure the total change in color by the whitening
pen.

STUDY DESIGN:
Commercially sourced stained and mounted bovine teeth were split into 2 groups with 12 replications each. One group
was treated with the Colgate Optic White Overnight Whitening Pen and one group was treated with a placebo product.
Tooth color was measured at baseline, after 3 treatments and after 7 treatments with a Spectroshade Micro II Spectrophotometer (MHT Optic Research,
Switzerland) which provides L*a*b* color coordinates.
The L*, a*, and b* values were used to calculate the change in the whiteness index for each tooth after the 3rd and 7th treatment cycle when compared to the
baseline reading. Whiteness is reported as ΔW*.
A more negative ΔW* indicates a closer resemblance of the tooth color to white.
The teeth were treated similar to product usage instructions. The teeth are dried with a tissue prior
Whiteness Index to application. A thin layer of formula is applied onto each tooth’s surface and then allowed to dry
½ for several seconds. The treated teeth are placed in a sealed jar covered in wet towels to produce a
W* = (a*² + b*² + (L* - 100)²) humid environment overnight. The next day, the clear coating is removed. This process is repeated
∆W* = W* treated - W* baseline for 7 treatment cycles for the Colgate Optic White Overnight Whitening Pen and the placebo
product.

Whitening Performance
RESULTS:
The results graph on the right shows the Whitening Index results, ΔW*,for the
Colgate Optic White Overnight Whitening Pen and the placebo product
after 3 and 7 overnight treatments. A more negative ΔW* indicates a closer
resemblance of the tooth color to white.
The Colgate Optic White Overnight Whitening Pen produced a statistically
significant whitening effect after only 3 treatments and continued through
7 treatments compared to the placebo product without hydrogen peroxide
which showed minimal change in color on the stained bovine teeth and was
not statistically significant.

CONCLUSION:
The results of this in vitro whitening study demonstrated that the Colgate
Optic White Overnight Whitening pen exhibited significantly better whitening
than the placebo formula after 3 and 7 overnight treatments.

Research supported by Colgate-Palmolive Company.

DENTAL ADVISOR l Ann Arbor, Michigan 48104 l [email protected] l © 2024 Dental Consultants, Inc.
Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 15
 Translating the Science
Matt Cowen, B.S.
DENTAL ADVISOR Biomaterials Research Center
Product insights Ann Arbor, MI 48104 Number 41
you can trust. [email protected] dentaladvisor.com

New Single-Shade Composite Ecosite One

M. Cowen, J.M. Powers

INTRODUCTION:
We recently tested a new single-shade composite Ecosite One from DMG America, which is primarily indicated
for posterior cases in class I, II, V restorations and core build-ups. Among the claims DMG America makes is that
the material can achieve over a 3 mm depth of cure in 10 seconds of curing time with a standard >1000 mW/
cm2 LED curing light for time savings, with excellent handling and polishing characteristics. In our testing, we
measured the depth of cure claim, the polishability and the color stability after accelerated aging and staining.

Since the release of universal single-shade composite systems, simplifying shade selection for most cases has
never been easier. Multiple studies have shown adequate color matching for the majority of shades. Single-
shade composites benefit from additional surrounding dentition, as the chameleon effect relies on light reflecting through the material from the dentition in order to
provide the chameleon effect. An added benefit of these single-shade composites is that a greater depth of cure can sometimes be achieved as the transluency of
the composites are higher due to the need to allow light to pass through the composite to reflect off the surrounding dentition. Overall, single-shade composites can
have a better color match in the long-term as their apparent shade can continue to change as the surrounding dentition changes color over time.

RESULTS SUMMARY:
• Ecosite One can be cured with 10-second exposures to over a 3-mm depth of cure.
• Ecosite One has an ideal hardness of 86 HV, which is about 37% higher than OMNICHROMA, and may contribute to better strength and wear characteristics.
• The polishability of Ecosite One is excellent in terms of the speed of polishing and final result, with similar polishing characteristics to OMNICHROMA.
• After intense simulated aging and staining, both Ecosite One and OMNICHROMA showed good color stability while Ecosite One had less change in translucency.
Ecosite One in particular shows minimal change in color or translucency after aging in the 550-750
nm wavelength range responsible for yellow-red color, an important color range for apparent tooth Ecosite One
shade. This indicates a good ability to continue to match the color of the surrounding dentition
over time.

DEPTH OF CURE AND HARDNESS:

One 10-second exposure using a 1100 mW/cm2 curing light produced approximately 4 mm depth of
cure for Ecosite One and over a 5 mm depth of cure with a 20 second exposure. Keep in mind that this
curing test is in a laboratory environment with perfect stability of the curing light centrally focused on the
composite, so results achieved in a clinical environment might have a lower depth of cure. This should be
a good safety margin as the IFU gives a 3 mm depth of cure after 10 seconds of curing with a >1000 mW/
cm2 LED curing light.

Hardness is a measurement determined by applying a certain load and measuring how much area of the
material is deformed or how far the diamond indenter penetrates the surface. For composites, a hardness OMNICHROMA
above 80 HV (Vickers hardness number), which is the approximate value of dentin, is suggested for
composites to resist deformation and give better wear resistance.

Hardness measurements were made on composites cured for 40 seconds as well as the 10 and 20
seconds in the depth of cure test followed by 24 hours of curing at oral temperature. There were no
significant differences between these curing periods. This means that curing for 10 seconds with a 1,100
mW/cm2 LED curing light sufficiently cured the composites at the top.

Ecosite One has a higher overall hardness than OMNICHROMA (86 vs 64 HV), which may have
benefits in wear properties and higher modulus. A higher hardness is a particular benefit for posterior
composites to maintain shape under occlusal forces and reduce wear over time.

DENTAL
16 DENTAL ADVISOR™ ADVISOR l Ann Arbor, Michigan 48104 l [email protected] l © 2024 Dental Consultants,
Vol. 41,Inc.
No. 03 May/Jun 2024
Translating the Science New Single-Shade Composite Ecosite One

Hardness is also a useful measurement of the quality of cure for a composite, as it is closely correlated with the quality of the polymerization of a given composite.
The point in which the hardness drops to 80% of the maximum hardness is commonly suggested as the minimum clinically acceptable curing level. These graphs
depict the hardness ratio which is an indirect way of measuring the polymerization %; as the hardness drops, the polymerization % drops. Overall, Ecosite One and
OMNICHROMA have similar curing profiles over the critical depth of cure region. Keep in mind that these are hardness ratios, and the starting hardness of Ecosite One
at the 100% ratio is 86 vs 64 HV for OMNICHROMA.

Depth of Cure by Hardness Ratio Depth of Cure by Hardness Ratio

10-second cure @ 1100 mW/cm2 20-second cure @ 1100 mW/cm2

POLISHABILITY: Gloss
Polishing composites is an important step for not just esthetics, but also to reduce
the ability of microbes to adhere to the surface. Bacterial adhesion and staining
potential have been shown to attach to surfaces more when surface roughness is
higher, so achieving a smooth surface after the adjustment of composite surfaces
is paramount. A general threshold for an acceptable polish to minimize bacterial
adhesion and acceptable gloss is about 60 gloss units (gu) and 200 nm (0.2
microns) surface roughness. Average surface roughness is the measurement of
the variability of the surface texture, where a higher value indicates a rougher
surface, and a lower value indicates a smoother surface.
Our polishing test starts with a rough composite surface prepared with 320- Surface Roughness
grit paper to simulate adjustment with a medium bur. The polishing test was
conducted with the 3M™ Sof-Lex™ Diamond Polishing System, which is a
two-step polishing system. The surface is finished for 10 seconds with the pre-
polishers which create a starting average roughness of about 500 nm and gloss
of 10 gu for each composite. This was followed with 10, 20, 30, and 40 seconds
of polishing with water with the 2nd step polisher, with three gloss and surface
measurements taken on three independent samples for each step.
Ecosite One has a higher gloss value at a similar relative surface roughness
indicating that it is inherently glossier. In terms of polishing efficiency,
Ecosite One shows a good balance of hardness to resist wear while exhibiting high polishability. This is important as some composites with a high hardness
take longer to polish, especially those with larger filler particle sizes. Both materials can reach the goal of roughly 200 nm of surface roughness after 10 seconds of
polishing.
AFM scans show the surface topography on a small section of the polished specimens. The surface roughness of these small areas may better correlate with light
reflectance, or glossiness, but are subject to small area sampling bias.

10 seconds 20 seconds 30 seconds 40 seconds

Ecosite One
OMNICHROMA

10 seconds 20 seconds 30 seconds 40 seconds

Vol. 41, No. 03 May/Jun 2024 DENTAL ADVISOR™ 17

Translating the Science New Single-Shade Composite Ecosite One

COLOR STABILITY: Example of Ecosite One with slot prep

The long-term color stability and stain resistance of composites is an extremely important factor for in various shades of denture teeth
patient acceptance of composite restorations. The science of how the new category of one-shade
composites match color over time is a subject of active investigation. One of the primary attributes B1 A2 C3 D4
that allows the one-shade composites to blend with the surrounding dentition is the increased
translucency compared to conventional composites. This increased translucency or ability for light to
pass through the composite allows light to reflect off the surrounding dentition and appear to make
the composite match the shade of the teeth.
Ecosite One has a much more neutral starting shade with a similar translucency level as
OMNICHROMA. In shade matching tests with Ecosite One, the chameleon effect is apparent at
placement and appears to match most shades well, unlike OMNICHROMA in which the chameleon effect is not apparent until after light-curing.
OMNICHROMA has no pigments contained in the composite, but has spherical particles that generate a reddish yellow color from the structure of the filler particles.
Color is mixed with the light reflected off the surrounding dentition in an additive process to produce the final perceived appearance.
Color Stability and staining tests were conducted at the John M. Powers, PhD Houston Center for Biomaterials and Biomimetics at the UTHealth Houston School
of Dentistry using ISO 4892 standard procedures to simulate several years of aging and staining in coffee. The accelerated aging test is a cyclic test with changes
in humidity, water exposure, intense light and temperature. The coffee staining test involved 7 full days of immersion in coffee, which is the worst-case scenario
for staining compared to real use scenarios in which the coffee will be diluted by saliva and surface stains cleaned by toothbrushing. The specimens were then
compared to baseline readings to determine the change in color and translucency.

RESULTS:
Ecosite One had a slightly lower change in translucency than OMNICHROMA after aging and staining which might indicate less impact on the chameleon
effect over time. An image of the specimens side by side shows the color change for the different groups. The overall change in color after accelerated aging
was similarly low for both composites. Ecosite One, which starts from a
more neutral (lower b* meaning less yellow) value, ends with a lower b* than
Baseline Aging Coffee Staining OMNICHROMA after coffee staining.
Ecosite One shows less apparent color change on the reflectance curves after
aging, particularly in the 550-750 nm range.
Ecosite One

The curves below are useful for showing the relative differences between
materials. The curves on the left are the difference in the change in translucency
(white minus black backgrounds), and color appearance (white background)
after aging and staining. A value near 0 indicates no change, a value below zero
indicates an increase in color or transmission at that wavelength, a value above 0
indicates a decrease in color or translucency at that wavelength.
OMNICHROMA

The reflectance curves may not directly correlate with Translucency Parameter
(TP) or ΔE*00 values as the L* a* b* values are not weighted equally across
the color space as it is specialized to human color perception. The average TP
changes for Ecosite One were 0.4 after aging and 0.9 after staining compared
to 0.8 and 1.1 for OMNICHROMA, which are below the threshold for human
perceptibility of translucency change.

Reflectance Curve Translucency Change Reflectance Curve Color Change

Research supported by DMG America.

18 DENTAL ADVISOR™ Vol. 41, No. 03 May/Jun 2024

 C L I N I CA L E VA L U AT I O N

Grind Relief Pro

Grind Guard Technologies, LLC www.grindreliefpro.com

dentaladvisor.com RATING SYSTEM: Excellent +++++ Very Good ++++ Good +++

30 CLINICAL EVALUATORS
Clinical Tips
98 TOTAL USES • The thermoplastic
material gets very sticky
after heating,
86% CLINICAL RATING
don’t touch it.
• Once the device is
Key features: Small device l No lab required l Same day therapy fabricated and the patient
is wearing it regularly,
have the patient warm it
under warm water before
Description putting it in.
Grind Relief Pro is a thermoplastic medical device intended to treat
• Train the patients on how to adjust the device by including them
nighttime or stress-induced bruxism and reduce muscle activity by at
on the initial fitting. We found that many small adjustments can
least 60%. Built with a patented “Central Power Bar”, this additionally
be done at home without having to return
helps by preventing wear through the appliance.
to the office.
“QUICK AND
Indications • Leave it in for 10 minutes after fitting
EASY TO FIT.”
for improved retention.
• Bruxism patients
• Great for immediate assessment of TMD and Muscle Myalgia when
screening for muscle or joint pain Evaluators’ Comments
“I am able to provide the patient with an immediate device to
Unique Attributes take home to see if they get TMD and muscle myalgia relief.”
• Covers more of the dentition for a more secure fit
(back to the 1st or 2nd bicuspid) “Same day, no models!”

• Can be used on either the maxillary or the mandibular arch “Easy to use in a pinch and can use Peter Dawson’s NTI/
deprogrammer methods fast.”
• Adjustable with an ability to refit the appliance if the fit loosens
or changes “The rigid shell allows it to adapt better than the somewhat softer
shell in the OTC doctor’s nightguard.”
• Can be used with a Class 2 occlusion
“The fit is better and the end product is more durable than
Photos courtesy of Dr. Frank Berman QuickSplint”
“It is easy to fabricate chair side. It has great retention once
fully hardened, and it works very well in a dentition with severe
crowding. One patient said it was the most comfortable guard
she has ever worn.”
“Nice device for acute treatment. The innovation is the rigid
frame allowing for improved adaptation to undercuts and
improved retention.”

Evaluation Summary: Compared to Competitive Products:

Consultants who would: Excellent

20%
83% Recommend to a colleague
Very Good
Better

Good
Consultants who would
want to stock in office:
7% Yes, instead of current product Fair

40% 40%
63% Yes, in addition to current product Poor
Patient Ease of Fit of Ease of Comfort
Equivalent Not as good
Effectiveness Effectiveness
in reducing in reducing acceptance preparing Grind adjusting as reported
jaw pain headaches Grind Relief Pro Relief Pro by patient
for placement

DENTAL
Vol. 41, No. 03 ADVISOR
May/Jun 2024 Ann Arbor, Michigan 48104 l (734) 665-2020 l [email protected] l © 2024 Dental Consultants, Inc.
DENTAL ADVISOR™ 19
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