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    Clinical evaluation of a low-shrinkage resin composite in endodontically treated premolars: 3-year follow-up
    (Springer Heidelberg, 2019) Gonulol, Nihan; Kalyoncuoglu, Elif; Ertas, Ertan; Misilli, Tugba
    ObjectivesThis study compared the 3-year clinical performance of a low-shrinkage silorane-based composite material with that of a methacrylate-based composite material in the restoration of endodontically treated premolar teeth.Materials and methodsA total of 70 patients requiring a Class II composite-resin restoration of a premolar tooth following root-canal treatment participated in the study. Cavities were restored with either a silorane-based restorative (Filtek Silorane+Silorane System Adhesive) or a methacrylate-based restorative (Filtek Z250+Clearfil SE Bond) system applied according to the manufacturer's instructions. Restorations were evaluated by two blinded observers at five different time intervals (baseline; 6months; 1, 2, and 3years) according to modified USPHS criteria. Pearson's chi-square tests were used to examine differences in the clinical performance of the materials (retention, color match, marginal discoloration, secondary caries, anatomical form, marginal adaptation, and surface roughness), and Friedman and Wilcoxon tests were used to compare changes between baseline and each recall time, with a level of 0.05 considered statistically significant.ResultsAfter 3years, no statistically significant differences in clinical performance were observed between the two materials (p>0.05). Intra-system comparisons revealed a statistically significant deterioration in color match, marginal discoloration, anatomical form, marginal adaptation, and surface roughness scores after 3years for both systems. Although the difference was not significant at 3years of follow-up, the level of deterioration in marginal adaptation and surface roughness was greater for the Filtek Silorane restoration than for the Filtek Z250 restoration at the 1year follow-up (p>0.05).ConclusionRestorations of both materials were clinically acceptable after 3years. The Filtek Silorane system did not appear to offer any clinical advantages over the methacrylate-based system when used in the restoration of Class II cavities in endodontically treated premolars.Clinical relevanceThe restoration of endodontically treated premolars with minor or moderate loss of tooth structure can be directly performed either with silorane or methacrylate-based composite resins.
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    Cross-cultural adaptation of the Turkish version of the dentin hypersensitivity experience questionnaire short form (DHEQ-15)
    (BMC, 2024) Ayan, Gizem; Misilli, Tugba; Buldur, Mehmet
    Background The short form of the Dentin Hypersensitivity Experience Questionnaire (DHEQ-15) is a valid and reliable tool for Oral Health-Related Quality of Life (OHRQoL) studies. The aim of this study was cross-culturally adapt and validate the English version of DHEQ-15 for the Turkish language. Methods The Turkish version of the DHEQ-15 was developed using the forward-backward translation method. Two independent translators translated it from English to Turkish, followed by back-translation into English. A pilot study was conducted with 30 patients with dentin hypersensitivity (DH). The sample consisted of 150 individuals with DH and 150 without. DH was assessed using the Schiff Sensitivity Scale by applying air to the cervical area of the tooth for 1 s from a distance of 1 cm. A total of 300 individuals completed the Turkish DHEQ-15 in the waiting room. Subsequently, 30 randomly selected individuals with DH completed the questionnaire again after 7-10 days to assess test-retest reliability. Participants provided an overall oral health rating assessment on a 6-point scale. The reliability of the DHEQ-15 was assessed using internal consistency and test-retest methods. Exploratory Factor Analysis (EFA) identified its domains, while construct validity was evaluated through cross-cultural (Confirmatory Factor Analysis- CFA), discriminative (Mann-Whitney test) and convergent (Spearman correlation) validity. Results The demographic characteristics of the sample included 137 men and 163 women, with an average age of 36. The Turkish DHEQ-15 demonstrated excellent internal consistency (alpha = 0.970) and outstanding test-retest reliability (r = 0.920, p < 0.001), indicating an excellent correlation. Confirmatory factor analysis confirmed the unidimensional scale structure of the Turkish DHEQ-15 (p = 0.000). A statistically significant negative correlation was found between the DHEQ-15 score and the overall oral health rating assessment (p < 0.05). Participants with DH had a significantly higher DHEQ-15 score compared to those without DH (p < 0.001). Conclusions This study provides evidence supporting the cross-cultural validity and reliability of the Turkish DHEQ-15.
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    Effects of staining and bleaching procedures on the optical and surface properties of CAD-CAM materials
    (Mosher & Linder, Inc, 2023) Yenidunya, Ozge Gizem; Gonulol, Niran; Misilli, Tugba; Bal, Lena; Inanc, Ibrahim
    Purpose: To examine the effects of coffee staining and bleaching applications on the optical properties of CAD-CAM blocks, and to provide a three-dimensional visualization of surface changes with atomic force microscope (AFM). Methods: 80 samples were prepared from four different CAD-CAM blocks: [Cerec (CR), Shofu (SH), Cerasmart (CRS), Lava Ultimate (LU)], and a microhybrid composite resin [Filtek Z250 (Z250)]. After staining, the samples were divided into two subgroups according to bleaching methods: 16% carbamide peroxide (HB), and 40% hydrogen peroxide (OB). Color measurements were performed at baseline (t(0)), after staining (t(1)), and after bleaching (t(2)) to obtain translucency parameters (TP00), color change (AE(00)), and whiteness index (WID) values. Surface roughness analysis (Ra) was performed with AFM after coffee staining and bleaching procedures (at t(1), and t(2)). Data were analyzed with Generalized Linear Model, and Bonferroni correction (P< 0.05). Results: TP00 values increased only in the CRS group after the bleaching application, and the effect of method was again observed only in CRS. While bleaching increased WID values of all groups except CRS, no difference was found between bleaching methods. Regardless of evaluation time, the roughest group is Z250, and the only difference between bleaching methods was observed in the CR group. In conclusion, the effects of staining and bleaching applications on the optical and surface properties of CAD-CAM blocks are material-dependent.
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    Home-use agents in the treatment of dentin hypersensitivity: clinical effectiveness evaluation with different measurement methods
    (Springer Heidelberg, 2025) Ayan, Gizem; Misilli, Tugba; Buldur, Mehmet
    Objectives This study aimed to evaluate the effectiveness of home-use desensitizing agents over an 8-week period by comparing them using different measurement methods. Methods A randomized, controlled clinical trial was conducted with 180 individuals aged between 18 and 70 who clinically diagnosed dentin hypersensitivity (DH) in two or more non-adjacent teeth. Subjects who met the inclusion criteria (n = 164) were randomly allocated into five test groups-using Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), Arginine, Novamin, Propolis, and Potassium nitrate-and a control group using standard fluoride toothpaste. The status of DH was assessed at week 4 and week 8 by the same independent examiner. Changes from baseline in Dentine Hypersensitivity Experience Questionnaire-15 (DHEQ-15), Schiff Sensitivity Scale (SSS) and Visual Analog Scale (VAS) were analysed using ANOVA and Kruskall-Wallis tests. Results All test groups showed statistically significant improvements in DH at weeks 4 and 8 compared to baseline in the DHEQ-15, VAS, and SSS assessments (p < 0.005). In the control group, significant improvements were observed only in the VAS and SSS measurements from baseline to weeks 8 (p < 0.005). The CPP-ACP group demonstrated the greatest reduction in scores by the end of week 8 compared to baseline, with DHEQ-15 (56.68 +/- 17.87), VAS (6.52 +/- 1.48), and SSS (2.32 +/- 0.56). Conclusions Among the tested agents, the CPP-ACP group demonstrated the most notable reduction in DH symptoms by week 8, highlighting its potential as an effective method for alleviating DH symptoms in a home-use agents. Clinical relevance Home-use desensitizing agents are effective in the treatment of DH, improving the daily activities of patients who cannot access clinical care and ensuring the relief of DH before clinical invasive procedures. Trial registrationClinicalTrials.gov Identifier: NCT06216262.
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    In-vivo evaluation of the effects of short-term dehydration and rehydration on the color differences of immature permanent incisor teeth
    (Wiley, 2024) Buldur, Mehmet; Misilli, Tugba; Sezer, Berkant
    Objective: It is aimed to evaluate the color changes of upper central incisor teeth with different root maturation levels after 15 min of dehydration and rehydration. Materials and Methods: Using the Cvek classification, 60 participants were divided into five groups. A spectrophotometer, equipped with a specially designed jig, was utilized for color measurements. Following isolation, color measurements were conducted at the dehydration process intervals of baseline, 1st, 2nd, 3rd, 5th, 7th, 10th, and 15th minutes. After mouth rinsing, measurements were repeated at the same time intervals during the rehydration process. CIEDE2000 (Delta E-00) values and the Whiteness Index (WID) were obtained to compare the color changes between the initial readings and each interval. Friedman and Repeated Measures ANOVA were applied to compare classes by time during the dehydration and rehydration periods, as well as ANOVA and Kruskal-Wallis tests to compare by classes for each time (p < 0.05). Results: Significant differences emerged in the mean Delta E-00 values during dehydration and rehydration periods across all Cvek Classes (p < 0.05). While no statistically significant differences were observed among Classes at different minutes during the rehydration period (p > 0.05), it was particularly noted that the mean Delta E-00 values of Classes 2, 3, and 5 at the 2nd minute of dehydration were statistically significantly higher than the mean of Class 1 (p < 0.05). However, when evaluating the starting and ending measurements of both dehydration and rehydration processes, and the overall change in Delta E-00 and Delta WID, no significant variations were detected across the Classes (p > 0.05). Conclusions: In teeth that have just erupted and are still undergoing root development, dehydration in the initial minutes results in noticeable color changes. However, the change in Delta E-00 and Delta WID of the teeth was found to be similar after the dehydration and rehydration processes.
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    Shear Bond Strength of Aged Composite Restorations Repaired with a Universal Injectable Composite
    (Pera Yayincilik Hizmetleri, 2019) Gonulol, Nihan; Almasifar, Lena; Cabadag, Ozge Gizem; Misilli, Tugba; Kalyoncuoglu, Elif
    Objective: The purpose of this study was to analyze the shear bond strength of a universal injectable composite used in the repair of aged composites. Methods: A total of 100 disk-shaped specimens (8 mmx2 mm) were produced using five different composites (n=20) (Gradia Direct Posterior, Tetric N Ceram BulkFill, Filtek Z250, SonicFill and Filtek BulkFill Posterior). Specimens were polymerized using an LED light curing unit for 20 s and stored at 37 degrees C in distilled water for 3 weeks. Specimens were subdivided into two groups per composite for repair using either the same composite used for the specimen or G-aenial Universal Flo. Following acid-etching and silane application, a universal adhesive (G-Premio BOND) was applied and light-cured. The repair materials were placed on the bonded surfaces of the specimens and polymerized in silicone molds (2 mmx2 mm). After thermocycling to simulate aging, shear bond strength (SBS) was tested using a universal testing machine at a crosshead speed of 1 mm/min. Failure modes were examined using a stereomicroscope at x40 magnification. Results: No statistically significant differences were found among the tested composites repaired with their own substrates. However, the SBS SonicFill and Filtek Bulk Fill Posterior groups had significantly lower bond strengths when repaired with G-aenial Universal Flo in comparison to repairs made with their own substrates (p<0.05). Conclusion: When repaired with their own substrates, reliable bond strengths were obtained for all the composites tested.
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    The effect of curing lights and modes on dentin bond strength of bulk-fill composites applied in different thickness
    (Taylor & Francis Ltd, 2019) Misilli, Tugba; Gonulol, Nihan; Cabadag, Ozge Gizem; Almasifar, Lena; Misilli, Umut
    To investigate shear bond strength (SBS) to dentin of a conventional and three bulk-fill composites applied in different increment thickness and cured by mono- and multi-wave LED LCUs. Two hundred and fifty-two extracted sound human molars were prepared for SBS test. The teeth were divided into four groups according to the resin composites used. Conventional composite: Tetric N-Ceram (control); high-viscosity bulk-fills: Tetric N-Ceram Bulk Fill, X-tra Fil, and SonicFill. Each group was subdivided (n = 7) according to increment thickness (2, 4, and 6 mm) and cured by standard mode of a mono-wave LED or two different modes (standard and xtra power) of a multi-wave LED. The failure mode was stereomicroscopically determined at 40x magnification. Data were analyzed using Three-way ANOVA and further comparisons were assessed by Bonferroni's multiple comparison test. There were no significant differences within X-tra fil and Tetric N-Ceram Bulk Fill groups for any of the variables (p > 0.05). A significant decrease in SBS values with increase of layer thickness was observed for SonicFill and control groups. Also, curing mode had a significant effect on both composites at 6 mm thickness and standard mode of multi-wave LED caused the highest SBS value (p < 0.05). Adhesive failure was the most common fracture pattern especially at 6 mm thickness applications. Based on the results of this study, the bulk-fill composites can be safely applied in one-step with 4 mm increments, although the examined composites performed better at 2 mm thickness. The performance of the composites at 6 mm increment may show differences related to the curing lights and modes.
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    The impact of remineralization agents on dental bleaching efficacy and mineral loss in bleached enamel
    (Wiley, 2022) Misilli, Tugba; Carikcioglu, Burak; Deniz, Yesim; Aktas, Cagatay
    This study evaluated the effect of remineralization agents on bleaching efficiency, enamel mineral changes, and post-bleaching color stability. A total of 112 enamel-dentin blocks were prepared from bovine teeth. Following initial color measurements, separate treatment regimens were carried out as follows: negative control (no treatment); positive control (bleaching only); bleaching, then NaF; bleaching + NaF (mix); bleaching, then CPP-ACPF; bleaching + CPP-ACPF (mix); bleaching, then nHAP+F; bleaching + nHAP+F (mix). Color measurements were repeated after immersion in distilled water for 7 days, and again after staining with coffee solution for 14 days. The CIELAB-based whiteness index was used to evaluate bleaching efficiency, and the CIEDE2000 color difference formula for color stability. Chemical investigation was performed using scanning electron microscopy with energy dispersive spectroscopy and X-ray diffraction analyses. The experimental groups showed significant increases in whiteness compared to the negative control, and the staining after bleaching did not result in statistically significant differences between the groups. Energy dispersive spectroscopic analysis revealed that bleaching protocols had no impact on elemental levels as well as the ratio of Ca/P. The combined use of bleaching agents with remineralization agents did not affect bleaching effectiveness but also did not provide an additional contribution.