Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

ABSTRACT Introduction: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. Objective: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. Methods: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. Results: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. Conclusion: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

RESUMO Introdução: a expansão rápida da maxila assistida cirurgicamente (ERMAC) é um procedimento que reduz a resistência das suturas, corrigindo a mordida cruzada posterior em adultos. Objetivo: o objetivo deste estudo foi avaliar o status periodontal de 17 adultos submetidos a esse procedimento. Métodos: o nível clínico de inserção (NCI), a recessão gengival, gengiva inserida e sangramento foram avaliados nos primeiros pré-molares, molares, incisivos centrais e laterais superiores dos lados direito e esquerdo antes da cirurgia, e depois de 5 dias e 6 meses. Médias, desvios-padrão, medianas, valores mínimos e máximos foram comparados entre as avaliações, usando os testes de Friedman e McNemar. Resultados: houve aumento estatisticamente significativo no NCI no incisivo central direito, pré-molares direito e esquerdo e molares direito e esquerdo. Houve aumento estatisticamente significativo na recessão gengival nos pré-molares e nos molares direito e esquerdo. A quantidade de gengiva inserida diminuiu significativamente nos pré-molares direitos e molares direitos e esquerdos. Houve aumento no sangramento na maioria dos dentes. Conclusão: os resultados indicaram que a ERMAC pode causar alterações no tecido periodontal.

A comparative study of bulk-fill composites: degree of conversion, post-gel shrinkage and cytotoxicity

Abstract: Bulk-fill composites are claimed to be restorative materials used in deep preparations and effectively photoactivated in layers up to 4 mm. The aim of the present study was to evaluate the degree of conversion, post-gel volumetric shrinkage, and cytotoxicity of six bulk-fill and two conventional composites. Degree of conversion was determined by FTIR spectroscopy; post-gel volumetric shrinkage was determined using the strain gauge method; and cytotoxicity in human fibroblasts was evaluated indirectly by the MTT assay. Data were subjected to one-way ANOVA/Tukey's test (α = 0.05). All materials, including bulk-fill and conventional composites, were classified as non-toxic, with cell viability higher than 70%. Bulk-fill composites exhibited volumetric shrinkage similar to or lower (1.4 to 0.4%) than that of conventional composites (1.7-2.1%). However, only four of the bulk-fill composites were able to sustain a homogeneous conversion at the 4-mm depth. Despite their non-toxicity and shrinkage similar to that of conventional materials, not all commercial bulk-fill materials were able to maintain a conversion as high as 80% of the superficial layer, at the 4-mm depth, indicating some failure in the bulk-fill design of some commercial brands. Therefore, the use of bulk-fill materials in dental practice is advantageous, but special attention should be given to the selection and correct use of the materials.

Influence of polymeric matrix on the physical and chemical properties of experimental composites

Nowadays, the main reasons for replacement of resin-based composite restorations are fracture or problems with the integrity of their interface, such as marginal staining, microleakage, or secondary caries. The aim of the present study was to evaluate the influence of the organic matrix on polymerization stress (PS), degree of conversion (DC), elastic modulus (E), flexural strength (FS), Knoop hardness (KHN), sorption (SP), and solubility (SL). In order to obtain a material which combines better mechanical properties with lower PS, seven experimental composites were prepared using BisGMA to TEGDMA molar ratios of 2:8, 3:7, 4:6, 5:5, 6:4, 7:3 and 8:2 and 40% of silica. PS was obtained in a universal testing machine, using acrylic as bonding substrate. DC was determined using Fourier Transform Raman spectroscopy. E and FS were obtained by the three-point bending test. KHN was measured by a microindentation test using a load of 25 g for 30 s. SP and SL were assessed according to ISO 4049. The data were submitted to one-way ANOVA. The increase in BisGMA concentration resulted in the decrease of PS, DC, E, FS and KHN. However, it did not change the SP and SL values. FS, E and KHN showed a strong and direct relationship with the DC of the materials. The composite material with a BisGMA to TEGDMA molar ratio of 1:1 was the one with better mechanical properties and lower PS.

Validação do ensaio de tensão de polimerização através das correlações com testes de qualidade de interface de restaurações em compósitos / Validation of polymerization stress test through correlations with interfacial quality tests

Objetivo: validar o teste de tensão de polimerização através da correlação com resultados de diferentes testes de avaliação da qualidade de interface. Métodos: Foram testados sete compósitos comerciais: cinco compósitos à base de BisGMA (Filtek Z250/3M ESPE - FZ, Heliomolar/Ivoclar Vivadent - HM, Aelite LS Posterior/Bisco - AE, Filtek Supreme/3M ESPE - SU, ELS/Saremco - EL), um à base de uretano (Venus Diamond/Heraeus Kulzer - VD) e um à base de silorano (Filtek LS/3M ESPE - LS). A resistência de união foi analisada através do ensaio de push-out. Superfícies vestibulares de incisivos bovinos receberam preparos cavitários cônicos com =3,5mm na face vestibular e =2,9mm na face lingual (ambas superfícies livres) e h=2,0 mm. A razão entre a força máxima e a área aderida foi utilizada para o cálculo da resistência de união. Para o teste de microinfiltração e análise de fendas, incisivos bovinos receberam preparos cavitários cilíndricos na face vestibular, com margens em esmalte, com =4 mm e h=1,5 mm, os quais foram restaurados em bloco único. Foram obtidas réplicas em resina epóxica das restaurações, para análise de fendas em microscopia eletrônica de varredura (MEV, 200x). Após 24 horas de armazenamento em água a 37oC, os espécimes foram submetidos ao procedimento de microinfiltração pelo AgNO3. Após seccionados duas vezes, perpendicularmente, a microinfiltração foi determinada (em mm) em estereomicroscópio (60x). A deformação de cúspides (n=10) foi analisada em preparos MOD padronizados em pré-molares superiores humanos restaurados em bloco único utilizando-se extensometria. A tensão de polimerização (n=5) foi determinada pela inserção do compósito (h=1,5mm) entre dois bastões de poli(metacrilato de metila), PMMA, ou vidro (=4 mm). A razão entre a força de contração máxima registrada e a secção transversal do bastão foi utilizada para o cálculo da tensão nominal. Os dados foram analisados utilizando-se Kruskal-Wallis para microinfiltração e fendas e ANOVA/Tukey para resistência de união, deformação e tensão (=5%). O teste de Pearson foi utilizado para verificar correlações entre as variáveis. Resultados: Os dados de resistência de união variaram entre 4,7 e 7,9 MPa. Os dados de microinfiltração média variaram entre 0,34 e 0,89 mm. A microinfiltração máxima variou entre 0,61 e 1,34 mm. A incidência de fendas variou entre 13 e 47%. A deformação de cúspides variou entre 75,2 e 96,9 s para a cúspide palatina, e 58,5 e 66,8 s para a cúspide vestibular, sem diferença estatística entre os compósitos. A tensão de polimerização variou entre 2,5 e 4,4 MPa para o PMMA, e 2,1 e 8,2 para o vidro. Foram observadas correlações entre tensão e os testes de qualidade de interface apenas quando o compósito à base de silorano foi removido das análises. Essas correlações foram mais fortes quando o PMMA foi utilizado como substrato de colagem. Conclusões: Dentro das limitações deste estudo, pode-se concluir que a tensão desenvolvida em um sistema de teste utilizando PMMA como substrato de colagem é um preditor da qualidade de interface de restaurações realizadas in vitro utilizando de compósitos à base de dimatcrilatos.

Aim: to validate the polymerization stress test through correlations with the results from different interfacial quality tests. Methods: Seven comercial composites were tested. Five composites based on BisGMA (Filtek Z250/3M ESPE - FZ, Heliomolar/Ivoclar Vivadent - HM, Aelite LS Posterior/Bisco - AE, Filtek Supreme/3M ESPE - SU, ELS/Saremco - EL), one based on urethane (Venus Diamond/Heraeus Kulzer - VD) and one silorane based (Filtek LS/3M ESPE - LS). Bond strenght was evaluated by push-out test. Bovine incisors received conical cavities with =3,5mm on buccal surface and =2,9mm on lingual surface (both free surfaces) and h=2,0 mm. The ratio of maximum force and the adhered area was used for bond strength calculation. For the microleakage test and gap formation analysis, bovine incisors received cylindrical cavities with =4 mm and h=1,5 mm. Epoxy resin replicas were obtained of the buccal surface of restorations, to analysis gap formation using scanning electron microscopy (SEM, 200x). After 24 hours storage in water at 37oC, specimens were submitted to the microaleakage protocol by AgNO3. After sectioned twice perpendicularly, microleakage was determined using stereomicroscope (60x). The cusp deformation (n=10) was analysed in standardized MOD cavities in human upper premolars using strain gagea. Polymerization stress (n=5) was determined by the insertion of the composite (h=1,5mm) between rods of poly(methyl methacrylate), PMMA, or glass (=4 mm). The ratio of the maximum force of contraction recorded and the cross-sectional area of the rod were used the calculate the nominal stress. Data were analysed using Kruskal-Wallis for microleakage and gaps, and ANOVA/Tukey for bond strength, deformation and stress (=5%). Pearson test was used to verify correlations between variables. Results: Bond strenght data varied from 4,7 to 7,9 MPa. Average microleakage data varied from 0,34 to 0,89 mm. Maximum microleakage data varied from 0,61 to 1,34 mm. Gap data varied from 13 to 47%. Cusp deformation data varied from 75,2 to 96,9 s for lingual cusp, and 58,5 to 66,8 s for buccal cusp, without significant statical difference among composites. Polymerization stress data varied from 2,5 to 4,4 MPa for PMMA, and 2,1 to 8,2 for glass. Correlation were observes between stress and interfacial quality tests only when the LS composite was removed from the analysis. These correlations were stronger when PMMA was used as bonding substrate. Conclusions: Within the limitations of this study, the stress developed when the PMMA is used as bonding substrate is a predictor of interfacial quality tests analyzed, in restorations using dimethacrylates based composites.