Influence of the combined effect of desensitizing dentifrices and universal adhesives on dentin bond strength under erosive conditions

Abstract Objective This study aimed to evaluate whether the use of desensitizing dentifrices containing obliterating agents can affect bond strength of eroded/abraded dentin. Methodology A total of 100 dentin samples were obtained from human molars. The teeth were cut into 3 mm-thickness discs and allocated in five groups (n=20), according to the toothpaste used: WoF - abrasion with fluoride-free toothpaste (Cocoricó); Arg - toothpaste containing arginine (Colgate Sensitive Pro-Relief); Nov - calcium sodium phosphosilicate toothpaste (Sensodyne Repair and Protect); SnF - fluoride-containing toothpaste (AmF/SnCl2/SnF2 - Elmex Erosion); and Control (no erosive/abrasive process). The erosive/abrasive cycle consisted of immersion in citric acid (1%, pH 2.6, 5 min, 4×/day) and abrasion (2×/day, 120-20 sec abrasion, 100 sec immersion) with each toothpaste. During intervals, samples were immersed in artificial saliva. This cycle was performed for five days. Two resin cylinders (2 mm in diameter) were constructed on each sample for the shear bond strength test using a universal adhesive system. The self-etch and etch-and-rinse (Scotchbond Universal) strategies were employed, each in half of the total sample (n=10). Bond strength (MPa) was measured in a shear test and failure modes were assessed with a stereomicroscope. Statistical analysis was performed using the two-way analysis of variance (ANOVA) and Tukey tests (p<0.05). Results A statistically significant difference was found between the adhesive strategies tested (p<0.001), with the self-etching form showing higher values than the etch-and-rinse. Moreover, no significant differences were observed between the tested toothpastes (p=0.750) and interactions (p=0.438). Conclusion The use of toothpaste containing obliterating agents does not affect bond strength to dentin subjected to erosive/abrasive conditions when a universal adhesive is used. However, the self-etch strategy might be preferred for eroded/abraded dentin.

Manejo de cárie radicular: um guia para o dentista brasileiro baseado na tradução e adaptação cultural do consenso internacional/ORCA E EFCD / Management of root caries: a guide for the Brazilian dentist based on the translation and cultural adaptation of the international consensus/ORCA and EFCD

Objetivo: A cárie radicular é um problema da Odontologia moderna, porém é notável a falta de diretrizes sobre o seu manejo. Objetivamos elaborar e adaptar um guia a partir da tradução das recomendações do consenso in-ternacional European Organization for Caries Research (ORCA) e European Federation of Conservative Dentistry (EFCD) para as tomadas de decisão clínica na intervenção do processo de cárie na pessoa idosa, com foco na cárie radicular. Materiais e métodos: O protocolo de tradução das recomendações do consenso internacional consistiu nas etapas: (1) tradução inicial, (2) síntese da tradução, (3) retradução, (4) revisão por comitê de especialistas, com adaptação cultural. A partir da tradução, foi desenvolvido um guia com diretrizes para tratamento de cárie radicular no Brasil. Resultados: Para prevenção de novas lesões é recomendada a escovação diária com dentifrício >1.500ppm/F. Dentifrícios com 5.000ppm/F ou vernizes (>20.000ppm/F) podem ser indicados para paralisar lesões radiculares ativas e para prevenção em pessoas idosas com alta suscetibilidade à cárie radicular, e o Diamino Fluoreto de Prata (>30%) para paralisar lesões ativas. Intervenções invasi-vas diretas são indicadas dependendo da situação clínica. Discussão: Nota-se uma falta de interesse em estudos primários sobre tratamentos para cárie radicular, criando assim uma lacuna em relação ao seu manejo, que reflete no nível de evidência detectado pelo consenso. Conclusão: Guias clíni-cos são importantes para reduzir a lacuna entre a pesquisa e a prática clínica. Essa tradução para o português facilitará o acesso dos dentistas bra-sileiros em relação a evidência consolidada até o momento para o manejo de cárie radicular.

Aim: Root caries are a problem in modern dentistry, but the lack of guidelines regarding their management is notable. We aim to develop and adapt a guide based on the translation of the recommendations of the international consensus as outlined by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) for clinical decision-making in the intervention of the caries process in the elderly, with a focus on root caries. Materials and methods: The protocol for translating the recommendations of the international consensus consisted of the following steps: (1) initial translation, (2) synthesis of the translation, (3) back-translation, (4) review by an expert committee with cultural adaptation. Based on the translation, a guide was developed with guidelines for the treatment of root caries in Brazil. Results: To prevent new lesions, daily brushing with toothpaste >1,500ppm/F is recommended. Toothpaste with 5,000ppm/F or varnishes (>20,000ppm/F) may be recommended to paralyze active root lesions and for prevention in elderly people with high susceptibility to root caries, and Silver Diamine Fluoride (>30%) to paralyze active lesions. Direct invasive interventions are indicated depending on the clinical situation. Discussion: There is a lack of interest in primary studies on treatments for root caries, thus creating a gap in relation to its management, which is reflected by the level of evidence detected in the consensus. Conclusion: Clinical guidelines are important to reduce the gap between research and clinical practice. This translation into Portuguese will facilitate access by Brazilian dentists to the consolidated evidence gathered to date for the management of root caries.

Impact of dental treatment on the oral health-related quality of life of Brazilian schoolchildren

Abstract: This before-after experimental study evaluated the impact of dental treatment on the oral health-related quality of life (OHRQoL) in children aged 6-8 years from Paranoá, DF, considering the presence or absence of cavitated dentin carious lesions pre- and post-treatment. The responsiveness and sensitivity of the questionnaires were also investigated. Caries was detected by using the Caries Assessment Spectrum and Treatment (CAST) instrument, while the impact of oral health on the children's health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ8-10), which was completed by the children and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), which was completed by their parents. Sociodemographic characteristics were also assessed. After the examinations, the children were categorized into two groups according to the presence (treatment/n = 34) or absence (control/n = 34) of cavitated dentin carious lesions. Restorative/curative care was provided to the treatment group, while the control group received preventive measures. OHRQoL was assessed at baseline and at four weeks post-treatment. No significant sociodemographic differences were observed between the groups. In the treatment group, the children and their families reported a greater impact of oral health on their OHRQoL in both questionnaires (p < 0.05). However, there was a significant reduction in the impact of oral health, with differences between the pre-treatment and post-treatment phases (p = 0.001). Good sensitivity and responsiveness were observed for both questionnaires. Dental treatment was found to reduce the negative impact of dental caries on OHRQoL in 6-8-year-old children, which was detected by both questionnaires (B-ECOHIS and CPQ8-10).

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Abstract Objective: This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren. Methodology: Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis. Results: The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth. Conclusions: No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Are Brazilian dentists and dental students using the ICCC recommendations for caries management?

Abstract The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833-0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118-1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203-0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336-3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria

Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Caries risk assessment in schoolchildren - a form based on Cariogram® software

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. Conclusion: The use of the form based on the Cariogram® software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk. .

Effects of solvent evaporation on water sorption/solubility and nanoleakage of adhesive systems

Objective: To evaluate the influence of solvent evaporation in the kinetics of water diffusion (water sorption-WS, solubility-SL, and net water uptake) and nanoleakage of adhesive systems. Material and Methods: Disk-shaped specimens (5.0 mm in diameter x 0.8 mm in thickness) were produced (N=48) using the adhesives: Clearfil S3 Bond (CS3)/Kuraray, Clearfil SE Bond - control group (CSE)/Kuraray, Optibond Solo Plus (OS)/Kerr and Scotchbond Universal Adhesive (SBU)/3M ESPE. The solvents were either evaporated for 30 s or not evaporated (N=24/per group), and then photoactivated for 80 s (550 mW/cm2). After desiccation, the specimens were weighed and stored in distilled water (N=12) or mineral oil (N=12) to evaluate the water diffusion over a 7-day period. Net water uptake (%) was also calculated as the sum of WS and SL. Data were submitted to 3-way ANOVA/Tukey's test (α=5%). The nanoleakage expression in three additional specimens per group was also evaluated after ammoniacal silver impregnation after 7 days of water storage under SEM. Results: Statistical analysis revealed that only the factor "adhesive" was significant (p<0.05). Solvent evaporation had no influence in the WS and SL of the adhesives. CSE (control) presented significantly lower net uptake (5.4%). The nanoleakage was enhanced by the presence of solvent in the adhesives. Conclusions: Although the evaporation has no effect in the kinetics of water diffusion, the nanoleakage expression of the adhesives tested increases when the solvents are not evaporated. .

Bonding to dentin as a function of air-stream temperatures for solvent evaporation

This study evaluated the influence of solvent evaporation conditions of acid-etching adhesives. The medium dentin of thirty extracted human third molars was exposed and bonded to different types of etch-and-rinse adhesives: 1) Scotchbond Multi-Purpose (SBMP) ; water-based; 2) Adper Single Bond 2 (SB) ; ethanol/water-based, and 3) Prime & Bond 2.1 (PB) ; acetone-based. Solvents were evaporated at air-drying temperatures of 21ºC or 38ºC. Composite buildups were incrementally constructed. After storage in water for 24 h at 37ºC, the specimens were prepared for bond strength testing. Data were analyzed by two-way ANOVA and Tukey's test (5%). SBMP performed better when the solvents were evaporated at a higher temperature (p < 0.05). Higher temperatures did not affect the performance of SB or PB. Bond strength at room temperature was material-dependent, and air-drying temperatures affected bonding of the water-based, acid-etching adhesive.

Odontologia restauradora com sistemas CAD/CAM: o estado atual da arte. Parte 3: materiais restauradores para sistemas CAD/CAM / CAD/CAM restorative dentistry: the present state-of-the-art. Part 3: restorative materials for CAD/CAM systems

A tecnologia de planejamento e produção computadorizada de restaurações dentárias pode ser utilizada para as mais diferentes situações clínicas. Isso, associado ao grande número de empresas fabricantes de equipamentos para o conceito CAD/CAM, resultou em uma miríade de materiais restauradores para a confecção de peças protéticas sob esse conceito. O presente artigo, último de uma série de três, discute os materiais metálicos, resinosos e, principalmente, cerâmicos indicados para produção por sistemas CAD/CAM. Ênfase é dada ao dióxido de zircônio, por ser um material que apresenta características relevantes para a odontologia restauradora e ter, na tecnologia automatizada, um grande facilitador de seu processamento

The computerized technology for the design and production of dental restorations can be employed in many clinical situations. This broad range of indications, associated to a great number of equipment’s manufactures for the CAD/CAM concept resulted in a myriad of restorative materials suitable for the manufacturing of prosthetic elements. This article, last of a series of three, discusses the metallic, resinous and, ceramic materials that are by dental CAD/CAM systems. An emphasis is given to the zirconium dioxide, a ceramic that presents very interesting properties for restorative dentistry and is highly benefited by the computerized manufacturing technology

Odontologia restauradora com sistemas CAD/CAM: o estado atual da arte. Parte 2: possibilidades restauradoras e sistemas CAD/CAM / CAD/CAM restorative dentistry: the present state-of-the-art. Part 2: restorative possibilities and CAD/CAM systems

Os sistemas CAD/CAM atuais podem ser utilizados para a confecção de inúmeros tipos de peças protéticas, desde inlays e onlays até amplas pontes fixas de 14 elementos. O desenvolvimento das tecnologias e consequente aumento da utilização dos métodos de planejamento e produção computadorizados resultaram em grande número de sistemas no mercado. O presente artigo, segundo de uma série de três, discute as possibilidades restauradoras com o uso de sistemas CAD/CAM e apresenta os principais equipamentos existentes no cenário odontológico mundial.

The present CAD/CAM systems are capable to produce a number of indirect restorations, from inlays and onlays to larg-span 14-units bridges. The development of technologies and consequent increasing use of computerized design and manufacturing methods resulted in a great number of CAD/CAM systems in the market. This article, the second of a series of three, discusses the restorative possibilities using CAD/CAM technology and presents the main equipment’s and systems available in the world dental scenario.

Odontologia restauradora com sistemas CAD/CAM: o estado atual da arte. Parte 1: princípios de utilização / Restorative dentistry using CAD/CAM systems: state-of-the-art. Part 1: fundamentals of use

A odontologia restauradora atual vem sendo transformada pela utilização de sistemas automatizados. As fases de impressão, planejamento e confecção de diversos tipos de restaurações podem ser realizadas com o auxílio de técnicas e equipamentos computadorizados, no conceito de produção chamado de CAD/CAM. O presente artigo, que é o primeiro de uma série de três, discute os princípios desse conceito, aponta vantagens, limitações e pondera sobre algumas mudanças que tais tecnologias provocam no cotidiano dos profissionais da odontologia.

One of the latest advances in restorative dentistry is the use of computer-based techniques and equipment’s in several procedures, from restoration planning (designing), impression-taking, and fabrication of a number of dental restorations. This concept is called CAD / CAM. This is the first article of a series of three, addresses the fundamentals of CAD/CAM concept, points out the advantages and limitations, and discusses some changes that these technologies brings to dentistry’s daily practice.

A escolha do agente cimentante para restaurações cerâmicas / The lutting agent choice for ceramic restorations

A escolha do sistema de cimentação ideal para restaurações indiretas totalmente cerâmicas depende de uma série de fatores ligados às propriedades e características dos agentes cimentantes, dos materiais restauradores e do preparo dentário, além da preferência profissional. O presente artigo revisa a literatura científica disponível e apresenta casos clínicos, com o objetivo de fornecer subsídios que colaborem para a tomada de decisão entre as abordagens adesiva e convencional, na cimentação dos mais variados tipos de restaurações cerâmicas sem metal.

Clareamento de dente não-vital com a técnica inside-outside / Nonvital tooth bleaching with the inside-outside technique

O clareamento de dentes não-vitais escurecidos é um tratamento conservador que apresenta bons níveis de sucesso. Diversas são as técnicas e os materiais indicados para a execução do protocolo clareador em dentes despolpados. O presente artigo apresenta uma breve revisão da literatura pertinente ao tema e relata um caso clínico realizado com a técnica denominada inside-outside.

Hipersensibilidade dentinária: da etiologia ao tratamento / Dentin hypersensitivity from etiology to treatment

O tratamento da hipersensibilidade dentinária constitui um desafio para os profissionais, devido às várias alternativas terapêuticas existentes para essa sintomatologia dolorosa. Nesse sentido, este artigo apresenta uma seqüência lógica de métodos de controle e tratamento da hipersensibilidade dentinária, com base na identificação dos fatores etiológicos e no correto diagnóstico dessa condição clínica.

Restaurações CAD/CAM: o sistema CEREC 3 / CAD/CAM restorations: the CEREC 3 system

A utilização de métodos computadorizados para confecção de restaurações pode tornar o modo de trabalho do profissional da odontologia significativamente diferente. Para ilustrar tais diferenças, este artigo apresenta a técnica de utilização do sistema CEREC 3, bem como discute, mediante análise da literatura científica, aspectos relacionados à qualidade das restaurações produzidas por meio dessa tecnologia.

Influência da fonte de luz e do material restaurador sobre a dureza de um cimento resinoso dual cure / Ligth curing unit and restorative material influence on the hardness of a dual cure resin cement

Este estudo procurou investigar o grau de dureza de um cimento resinoso dual cure (RelyXARC - 3M ESPE) quando polimerizado sem o contato com a luz e quando fotoativado sob três diferentes materiais restauradores indiretos (Solidex - Shofu, Empress - Ivoclar, sistema In Ceram Alumina - Vita), com dois tipos de fotopolimerizadores: luz halógena (XL 1500 - 3M) e LED - ligth emitting diode - (UltraLed - Dabi Atlante). Foram criados sete grupos experimentais: grupo SH(Solidex Halógeno), grupo SL (Solidex LED), grupo EH(Empress Halógeno), grupo EL (Empress LED), grupo IH (InCeram Alumina Halógeno), grupo IL (InCeram Alumina LED) e grupo SCL (sem contato com a luz). Pra cada grupo foram confeccionados quatro discos de cimento resinoso dual fotopolimerizados por 40 segundos, sob o material restaurador indireto, exceto para o grupo CSL onde a polimerização se deu na ausência da luz. Após uma semana, imersos em água destilada a 37°C, os discos foram submetidos ao teste de microdureza, em microdurômetro Shimadzu, com a carga de 100g, por 15 segundos para a obtenção da dureza Vickers (VHN). Os resultados foram submetidos aos testes estatísticos de ANOVA e Tukey que demonstraram uma maior dureza superficial do grupo SH em relação a todos os outros. Os grupos SL, EH, e EL não tiveram diferença estatisticamente significativa entre si, porém obtiveram valores de dureza superiores aos dos grupos IH, IL e CSL que também não mostraram diferença estatisticamente significante entre si

Resistência de união à dentina de um sistema adesivo convencional após aplicação de dessensibilizantes dentinários / Bond strength of a conventional adhesive system after use of dentinal desensitizers

Para testar a influência da utilização de dessensibilizantes dentinários na resistência adesiva entre dentina e resina composta, usando o sistema adesivo convencional Scotchbond Multi-uso Plus - 3M, foram expostas as superfícies dentinárias de terceiros molares recém-extraídos e sobre estas foram aplicados os dessensibilizantes Gluma- Heraeus Kulzer (GL) ou Oxa-gel - Art-Dent (OX), seguidos do sistema adesivo e da restauração com resina composta Z250 - 3M. Foi também confeccionado um grupo de controle (CO), sem a aplicação de dessensibilizantes. Os dentes, devidamente preparados e restaurados, foram cortados longitudinalmente em palitos com área de união de aproximadamente 1,4 mm². Os palitos foram adaptados a um paquímetro modificado e este a uma máquina de ensaios universal EMIC DL2000, que realizou os testes de tração. As resistências adesivas expressas em MPa foram 29,63 ± 5,09 (CO), 29,08 ± 5,31 (GL) e 26,13 ± 6,56 (OX). Os dados foram submetidos a análise estatística pelo teste de análise de variância, que demonstrou não haver diferença estatisticamente significativa entre os grupos. Os resultados permitem concluir, dentro da metodologia deste estudo "in vitro", que a aplicação prévia de dessensibilizantes dentinários a um sistema adesivo convencional não altera a resistência adesiva entre dentina e resina composta