Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial

Abstract The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays. Objective This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity. Methodology Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4. Results G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis. Conclusion Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Efeito de dentifrícios com alta concentração de flúor na remineralização de substrato dentário com cárie artificial / Effect of toothpaste with high fluoride concentration on remineralization of dental substrate with artificial caries

Introduction: fluoride toothpaste is widely used by the population. Objective: dentifrices with a high concentration of sodium fluoride and the presence of tricalcium phosphate were developed, providing additional protection to patients vulnerable to the development of caries. This study aimed to evaluate the influence of different dentifrices on the surface and internal hardness and enamel wear after artificial caries, pH cycling, and toothbrushing. Material and method: enamel blocks (4x4 mm) were obtained from 20 bovine teeth. The specimens were submitted to artificial caries lesion and then to pH cycling and brushing according to the dentifrice: Colgate Total 12 and Clinpro + Tricalcium Phosphate. Result: after this period, they were submitted to analysis of superficial and internal hardness and profilometry. Scanning Electron Microscopy (SEM) was performed. The data obtained were evaluated by one-way Analysis of Variance (ANOVA) to evaluate the mineral recovery and profilometry, and two-way repeated measures ANOVA to evaluate the superficial and internal hardness. Conclusion: analyzing the surface hardness, after caries induction, there was a significant reduction in hardness that was partially recovered regardless of the dentifrice used. For internal hardness, Clinpro obtained lower values on the control side and up to 90 micrometers on the test side. As for profilometry, Colgate Total 12 showed greater wear when compared to Clinpro. It was concluded that Clinpro promoted lower internal hardness, however, Colgate Total 12 resulted in greater surface wear of tooth enamel.

Introdução: dentifrícios fluoretados são amplamente utilizados pela população. Foram desenvolvidos dentifrícios com alta concentração de fluoreto de sódio e presença de tricálcio fosfato, fornecendo proteção adicional a pacientes vulneráveis ao desenvolvimento da cárie. Objetivo: o objetivo deste estudo foi avaliar a influência de diferentes dentifrícios na dureza superficial, interna e desgaste do esmalte após cárie artificial, ciclagem de pH e escovação. Material e método: blocos de esmalte (4x4 mm) foram obtidos a partir de 20 dentes bovinos. Os espécimes foram submetidos à lesão de cárie artificial e, em seguida, à ciclagem de pH e escovação de acordo com o dentifrício: Colgate Total 12 e Clinpro + Tricálcio Fosfato. Após este período, foram submetidos à análise de dureza superficial e interna e perfilometria. Foi realizada microscopia eletrônica de varredura. Resultado: os dados obtidos foram avaliados por ANOVA um critério para avaliar a recuperação mineral e perfilometria, ANOVA dois critérios medidas repetidas para avaliar a dureza superficial e interna. Conclusão: analisando a dureza superficial, após a indução da cárie houve uma redução significativa na dureza que foi parcialmente recuperada independente do dentifrício utilizado. Para dureza interna, Clinpro obteve valores menores no lado controle e até 90 micrômetros no lado teste. Quanto à perfilometria, o Colgate Total 12 apresentou maior desgaste quando comparado ao Clinpro. Concluiu-se que Clinpro promoveu menor dureza interna, porém, o Colgate Total 12 resultou em maior desgaste superficial do esmalte dentário.

Three-year evaluation of different adhesion strategies in non-carious cervical lesion restorations: a randomized clinical trial

Abstract: Objective: To evaluate non-carious cervical lesions (NCCLs) restored with different adhesion strategies. Methodology: This is a prospective, randomized, double-blind, split-mouth study. An adhesive restorative system (Single Bond Universal/Filtek Z350XT - SBU) was evaluated both without and with selective enamel conditioning (E-SBU), resin-modified glass-ionomer cements (Vitremer; RMGIC), and ethylenediaminetetraacetic acid pretreatment (EDTA; E-RMGIC). In total, 200 restorations, placed in 50 patients, were evaluated at baseline and at a 3-year follow-up using the modified United States Public Health Service (USPHS) criteria. Data were analyzed using the two-proportion equality test, multinomial logistic regression, Wilcoxon test, and Kaplan-Meier survival curves. Results: In total, 42 (84%) patients returned for the 3-year follow-up. SBU showed restoration losses statistically different from RMGIC. Retention was also statistically different in SBU between baseline and the 3-year follow-up. Marginal defects and surface texture were statistically significant for all groups in the period studied, except for the surface texture of SBU and the marginal integrity in E-RMGIC. We observed no statistically significant difference in wear, secondary caries, anatomical form, surface staining, and color over time. Recession degree was the only factor to influence retention rates. Cumulative survival (%) was 89, 98, 98, and 95.3, for SBU, SE-SBU, RMGIC, and E-RMGIC, respectively, without significant differences among them. There was a statistically significant difference between survival curves; however, multiple comparison procedures found no statistical differences. Conclusion: Selective enamel etching affected the retention of non-carious cervical restorations. Adhesion using EDTA and resin-modified glass-ionomer cements delayed marginal defects over time. The degree of gingival recession influenced retention rates. Resin composite restorations showed initial marginal defects, and ionomer restorations, reduced surface luster. EDTA pre-treatment followed by resin-modified glass-ionomer cements may be a promising adhesion strategy for NCCL restorations.

Repair bond strength and degradation of glass ionomer cements after mechanical and chemical challenges

Aim: Little is known about the reparability of glass ionomer cements (GICs) after storage in acid environments. The aim of this study was to evaluate the solubility and repairability of GICs immersed in acid solutions and subjected to brushing. Methods: Thirty discs of each GIC (Vitremer, VitroFil LC, VitroFil, and Maxxion R) were divided into three immersion groups: distilled water, Coca-Cola, or hydrochloric acid (HCl), then subjected to brushing. The weight of discs was measured before and after the immersions to determine mass alteration. Each disc was repaired, by adding the same brand of GIC over its surface. After immersing the repaired specimens in same solutions, shear bond strengths using universal testing machine were measured. Two-way ANOVA and Tukey's test was used (α=0.05). Results: Resin-modified GICs degrade after HCl immersion followed by brushing (p<0.05), while self-cured GICs were negatively affected by all challenges (p<0.05). The challenges decreased the repair strength for VitroFil LC (p<0.05), which had higher repair shear bond strength than the other GICs (p<0.05), exhibiting most cohesive failures. Conclusion: Self-cured GICs degraded when immersed in all acid solutions with brushing while resin-modified GICs only degraded following HCl immersion with brushing. Despite exhibiting the best repair results, VitroFil LC was the only GIC that was influenced by all the acid challenges

Effects of different toothpastes on the prevention of erosion in composite resin and glass ionomer cement enamel and dentin restorations

Abstract Objective This study aimed to evaluate the effects of different toothpastes on the surface wear of enamel, dentin, composite resin (CR), and resin-modified glass ionomer cement (RMGIC), and to perform a topographic analysis of the surfaces, based on representative images generated by atomic force microscopy (AFM) after erosion-abrasion cycles. Methodology One hundred and forty bovine incisors were collected and divided into two groups: 72 enamel and 72 dentin blocks (4×4 mm). Half of the specimens were restored with CR (Filtek Z350 XT) and the other half with RMGIC (Fuji II LC). Then, samples were submitted to a demineralization cycle (5 days, 4×2 min/day, 1% citric acid, pH 3.2) and exposed to three different toothpastes (2×15 s/day): without fluoride (WF, n=12), sodium fluoride-based (NaF, n=12), and stannous fluoride-based (SnF2, n=12). Surface wear, as well as restoration interfaces wear, were investigated by profilometry of the dental substrates and restorative materials. All representative surfaces underwent AFM analysis. Data were analyzed by two-way analysis of variance and Tukey's tests (α=0.05). Results NaF-based toothpaste caused the greater dentin surface wear (p<0.05). Toothpastes affected only enamel-restoration interfaces. AFM analysis showed precipitate formation in dentinal tubules caused by the use of fluoride toothpastes. Conclusions NaF-based toothpastes had no protective effect on enamel adjacent to CR and RMGIC against erosion-abrasion challenges, nor on dentin adjacent to RMGIC material. SnF2-based toothpastes caused more damage to interfaces between enamel and RMGIC.

Influence of different types of light curing units and photoinitiators in microhardness and color of composite resins after immersion in wine / Influencia dos diferentes tipos de unidade fotoativadoras e fotoiniciadores na microdureza e cor de resinas compostas após imersão em vinho

Objective: the aim of this study is to evaluate the microhardness and color change (∆E) of composite resins, that were light-cured with different LEDs, after being immersed in a staining drink. Material and Methods: Two composite resins with Lucerin-TPO (Tetric N-Ceram/ Vit-l-escence) and camphorquinone (Filtek Z350) were selected. The specimens (n=120) were prepared and lightcured with LED of monowave or polywave lightemitting diode (LED) devices. Microhardness and color evaluations were measured before and after immersion in staining drink. Microhardness data were evaluated by Kruskal-Wallis test, MannWhitney and Wilcoxon tests. Color changes were evaluated by two-way analysis of variance (ANOVA) and Tukey test (p ≤ 0.05). Results: No statistically significant difference between the two generations of LEDs was found for microhardness data. Regarding the ∆E, a statistical difference between the two LEDs was observed for Tetric NCeram and Filtek Z350. Conclusion: The compostion of composites appears to have more influence on analyses than the type of LEDs used. A decreased microhardness occurred to Vit-lescence for monowave and to Filtek Z350 for both LED devices. A clinically perceptible color change was observed for Tetric-N Ceram and Filtek Z350 when polywave LED were used. (AU)

Objetivo: o objetivo deste estudo foi aviliar a microdureza e alteração de cor (∆E) de resinas compostas, fotoativadas com diferentes LEDs, imergidas em bebidas pigmetadas. Material e métodos: Duas resinas compostas com Lucerina-TPO (Tetric N-Ceram/ VIt-l-essence) e canforoquinona (Filtek Z350) foram selecionadas. Os espécimes (n=120) foram preparados. Os mesmos foram fotopolimerizados com LED monowave ou polywave. Microdureza e cor foram avaliadas antes e após a imersão em bebidas pigmentadas. Os dados de microdureza foram avaliados pelos testes de Kruskal-Wallis, Mann-Whitney e Wilcoxon. As alterações de cor foram avaliadas por análise de variância a dois critérios (ANOVA) e Tukey (p ≤ 0,05). Resultados: Não foi encontrada diferença estatística entre as duas gerações de LEDs, para os dados da microdureza. Quanto ao ∆E, foi encontrada diferença estatisticamente significante entre os dois LEDs, sendo observadas na Tetric N-Ceram na FIltek Z350. Conclusão: A composição das resinas compostas parece ter mais influencia nas análises do que o tipo de LEDs. Uma redução na microdureza ocorreu para Vit-lescence para monowave e para Filtek Z350 para ambos os dispositivos LED. Uma mudança de cor clinicamente perceptível foi observada em Tetric-N Ceram para polywave e Filtek Z350 para ambos os dispositivos LED. (AU)

Randomized clinical trial of encapsulated and hand-mixed glass-ionomer ART restorations: one-year follow-up

Abstract Objective This prospective, randomized, split-mouth clinical trial evaluated the clinical performance of conventional glass ionomer cement (GIC; Riva Self-Cure, SDI), supplied in capsules or in powder/liquid kits and placed in Class I cavities in permanent molars by the Atraumatic Restorative Treatment (ART) approach. Material and Methods A total of 80 restorations were randomly placed in 40 patients aged 11-15 years. Each patient received one restoration with each type of GIC. The restorations were evaluated after periods of 15 days (baseline), 6 months, and 1 year, according to ART criteria. Wilcoxon matched pairs, multivariate logistic regression, and Gehan-Wilcoxon tests were used for statistical analysis. Results Patients were evaluated after 15 days (n=40), 6 months (n=34), and 1 year (n=29). Encapsulated GICs showed significantly superior clinical performance compared with hand-mixed GICs at baseline (p=0.017), 6 months (p=0.001), and 1 year (p=0.026). For hand-mixed GIC, a statistically significant difference was only observed over the period of baseline to 1 year (p=0.001). Encapsulated GIC presented statistically significant differences for the following periods: 6 months to 1 year (p=0.028) and baseline to 1 year (p=0.002). Encapsulated GIC presented superior cumulative survival rate than hand-mixed GIC over one year. Importantly, both GICs exhibited decreased survival over time. Conclusions Encapsulated GIC promoted better ART performance, with an annual failure rate of 24%; in contrast, hand-mixed GIC demonstrated a failure rate of 42%.

Surface roughness, gloss and color change of different composites after exposure to ultimate challenges

Aim: The study aimed to investigate the effect of the association of chemical and mechanical degradation on the surface roughness, gloss and color of nano and microfilled composites. Method: Disc-shaped specimens (n=10) were prepared for three nanocomposites (Filtek Z350XT, IPS Empress Direct, Charisma Diamond) and three microfilled composites (Estelite Σ Quick, Durafill VS, Renamel). After polishing, baseline surface roughness, gloss and color measurements were obtained. Specimens were submitted subsequently to the following challenges: chemical for 1 week (Hydrochloric acid, Coca-Cola and Red Wine) and mechanical (Toothbrushing). Surface roughness and gloss data were analyzed by Kruskal-Wallis followed by Dunn's test. Color difference (ΔE) was analyzed by one-way ANOVA and Tukey test. Results: The initial data were compared with those after challenges using the Wilcoxon test (p<0.05). All composites showed a significant increase (p<0.05) of surface roughness, after overstress. Filtek Z350 XT and Renamel had the lowest final surface roughness values and roughness increase (p<0.05). The comparative analysis revealed that Estelite Σ Quick and Renamel did not significantly change the gloss after challenges (p=0.185). Filtek Z350 XT and IPS Empress Direct had higher color variations, after the challenges than the other resins (p<0.05). Conclusion: Chemical and mechanical challenges influence on characteristics of all composites, except for gloss on Estelite Σ Quick and Renamel composites (AU)

Effect of Dental Pigmentation Intensity on the Transenamel and Transdentinal Penetration of Hydrogen Peroxide

Abastract This study aimed to evaluate the transenamel and transdentinal penetration of hydrogen peroxide (H202) applied to bovine teeth pigmented with black tea at different intensities. The following groups were formed DW: immersion in distilled water; BT100: immersion in an infusion of 1.6 g of black tea per 100 mL distilled water; BT10: immersion in an infusion of 1.6 g black tea per 10 mL distilled water. All groups were immersed for 6 days. To quantify the penetration of H202, the specimens were placed in artificial pulp chambers (APCs) and subjected to bleaching treatment with 38% H2O2 once per week for 3 weeks. After bleaching treatment, the acetate buffer solution of APCs with peroxidase enzyme was evaluated in a reflection spectrophotometer. The transenamel and transdentinal penetration of H2O2 and the L* values obtained at T1, T2 and T3 were subjected to Kruskal-Wallis and Friedman statistical tests. At T1, the H2O2 diffusion in DW was higher than that in BT100 and BT10. At the other evaluation times, the penetration values in BT100 and BT10 increased and remained similar. The L* values increased significantly in all groups at T1. At T2, the L* values were higher in DW, while the values in BT100 and BT10 were similar to each other. At the end of the experiment, BT10 showed the lowest L* values. The pigmentation level did not affect the penetration of H2O2 through the enamel and dentin and the bleaching agent effectively changed the color of the teeth.

Resumo Este estudo teve como objetivo avaliar a penetração trans-amelodentinária do peróxido de hidrogênio (H2O2) aplicados em dentes bovinos pigmentados com chá preto em diferentes intensidades. Divisão dos grupos: AD em água destilada; CP100 em uma infusão de 1,6 g de chá preto para 100 mL de água destilada; CP10 em uma infusão de 1,6 g de chá preto para 10 mL de água destilada. Todos os grupos foram imersos por 6 dias. Para quantificar a penetração de H2O2, as amostras foram colocadas em câmaras pulpares artificiais (CPAs) e submetidas a um tratamento clareador com PH a 38%, uma vez por semana durante 3 semanas. Após o tratamento clareador, a solução tampão de acetato das CPAs com a enzima da peroxidase, foi avaliada num espectrofotômetro de reflexão. A penetração trans-amelodentinária de PH e os valores de L* obtidos em T1, T2 e T3 foram submetidos ao teste estatístico de Kruskal-Wallis e Friedman. Em T1, a difusão de H2O2 no AD foi mais elevada do que em CP100 e CP10. Nos outros tempos de avaliação, os valores de penetração no CP100 e CP10 aumentaram e permaneceram semelhantes. Os valores L* aumentaram significativamente em todos os grupos no T1. No T2, os valores L* foram maiores no AD e os valores em CP100 e CP10 foram semelhantes entre si. No último tempo, o CP10 apresentou os menores valores de L*. Diferentes níveis de pigmentação não afetaram a penetração de H2O2 através do esmalte e dentina e o agente de clareador foi eficaz na alteração cromática.

Repairabilitiy of aged resin composites mediated by different restorative systems / Reparo de resinas compostas envelhecidas e mediadas por diferentes materiais restauradores

The aim of this study was to evaluate the shear bond strengthof resin composite repairs with and without aging of thesurface to be repaired, using different adhesive systems andresin composites. Ninety specimens were prepared: 10 for theControl Group (GC - without repair); 40 for Group I (GI -repairs after 7 days) and 40 for Group II (GII - repairs after180 days). Groups I and II were divided into 4 subgroups of10 specimens each, according to the adhesive system andcomposite resin used: A) Adper Scotch Bond Multipurpose +Filtek Z350 XT; B) Adper Single Bond Plus + Filtek Z350 XT;C) Adper Scotch Bond Multipurpose + Esthet-X; D) AdperSingle Bond Plus + Esthet-X. The specimens were tested forshear strength in a universal testing machine. The resultswere analyzed by two-factor one-way ANOVA and Fisher’spost hoc tests (alpha=0.05). The control group had betterperformance than the other groups. There was no significantdifference when comparing different adhesive systems andcomposite resins. Repairs performed at 7 days were betterthan those performed at 180 days. The composite repairsdecreased the mechanical strength of the restoration. Agingof the resin substrate may decrease repair bond strength overtime, regardless of the type of adhesive systems and resin composites used.

Avaliar a resistência de união ao cisalhamento de reparos deresina composta com e sem envelhecimento da superfície a serreparada, utilizando diferentes sistemas adesivos. Noventacorpos de prova foram confeccionados sendo: 10 para o GrupoControle (GC - sem reparo); 40 para o Grupo I (GI - reparosapós 7 dias) e 40 para o Grupo II (GII – reparos após 180 dias).Para os reparos, os grupos GI e GII foram subdivididos em 4subgrupos com 10 corpos de prova, variando o sistema adesivoe a resina composta: A) Adper Scotch Bond Multipurpose+Filtek Z350XT; B)Adper Single Bond Plus+ Filtek Z350XT;C)Adper Scotch Bond Multipurpose+ Esthet-X; D) AdperSingle Bond Plus+ Esthet-X. Os corpos de prova foramsubmetidos a uma força de cisalhamento em uma máquina deensaio universal (EMIC). Os resultados foram analisados peloteste estatístico Anova dois fatores, seguido pelo teste deFisher ́s. Observou-se melhor comportamento do grupocontrole sobre os demais grupos, além disso, os reparosrealizados aos 7 dias foram superiores aos dos realizados em180 dias. Não houve diferença significativaquando secomparou diferentes sistemas adesivos e resinas compostas.Os reparos de resina composta diminuem a resistênciamecânica da restauração.O envelheci mento do substrato deresina pode diminuir a resistência ao reparo ao longo dotempo, independentemente do tipo de sistemas adesivos eresinas compostas utilizados.

Nine-year clinical evaluation of composite resins in Class III restorations / Avaliação de nove anos de restaurações de classe III em resina composta

The aim of this study was to evaluate thenine-year clinical performance of Class III composite restorations using two microhybrid anterior composite resins [Magic™-Vigodent/(F) and Z100™-3M ESPE/(Z)]. Material and Methods: The study was a randomized controlled trial, following the splitmouth design. Seventy restorations were placed, thirty-five for each resin composite into 35 patients. The restorations were placed by one operator according to the manufacturers’ specifications. Two independent evaluators conducted the clinical evaluation using modified USPHS criteria. After nine years, 56 restorations (28F-28Z) were evaluated. Data were analyzed using Chi-square, Exact Fisherand McNemar tests (p < 0.05). Results: Nopost operative sensitivity, secondary caries and loss of anatomic form was observed after nine-years for both composites. There were no significant differences between the two composites tested at baseline and after nine-years. Significant differen ces for Z and Frestorations between baseline and nine-year with respect to color matching and for F regarding themarginal integrity were detected. Conclusion: The clinical performance of both materials was consideredacceptable after the 9-year evaluation...

Objetivo: O objetivo deste estudo foi avaliar após nove anos a performance clínica de restaurações de classe III em resina composta, utilizando-se duas resinas microhíbridas para dentes anteriores [Magic-Vigodent/(F) e Z100-3M ESPE/(Z)]. Material e Métodos: Trata-se de um estudo clínico controlado aleatório, o qual utilizou o desenho de boca dividida.Setenta restaurações foram realizadas em trinta e cinco pacientes, sendo trinta e cinco para cada resina composta. As restaurações foram realizadas por um único operador seguindo as especificações dos fabricantes. Dois avaliadores independentes avaliaram as restaurações utilizando-se o critério USPHS modificado. Após nove anos, 56 restaurações(38F – 28Z) foram avaliadas. Os dados foram analisados por meio dos testes Qui-quadrado, Exato de Fisher e McNemar (p < 0,05). Resultados: Não foram detectados sensibilidade pós-operatória, cárie secundária e perda de forma anatômica no período analisado para ambas resinas. Não houve diferenças entre o período inicial e de nove anos para as resinas testadas, exceto para Z e F foram em relação à a cor e para a integridade do material para F. Conclusão: O comportamento clínico das duas resinas testadas foi considerado adequado após nove anos de avaliação...

Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups.

Clinical evaluation of multiple-surface ART restorations: three-year follow-up / Avaliação clínica de restaurações de ART de superfícies múltiplas: acompanhamento de três anos

Objective: To evaluate the performance of multiple-surface restorations made with two different glass-ionomer cements (GICs) in permanent teeth using the Atraumatic Restorative Treatment (ART). Material and methods: A total of 60 restorations were placed in schoolchildren (9-16 years of age) by two dentists using standard ART procedures. The restorations were randomly divided into two groups. Thirty cavities were filled with high-viscosity GIC (Ketac Molar-3M ESPE) and 30 cavities were filled with resin-modified GIC (Fuji VIII-GC Corp.). Two calibrated independent examiners carried out the evaluation according to ART criteria. Data were statistically analyzed using multiple logistic regression models to evaluate the variables associated with the success (GIC, operator, Class type). The 95% Confidence Intervals (CI) for success were based on the binomial distribution. A difference was statistically significant if p < 0.05. Results: In a 3-year follow-up, 57 restorations were evaluated. In the Ketac Molar group, 3 restorations were not evaluated, 21 were considered successful and 6 unsuccessful. In the Fuji VIII group, 28 restorations were considered successful and 2 unsuccessful. The logistic regression model showed that the combination of the variables was only statistically significant in relation to survival of ART restorations (p = 0.036). There were no statistically significant differences between the groups taking each variable into account. The best performance included the combination: Fuji VIII, operator B and Class I involving two or more tooth surfaces. Conclusion: The clinical performance of the multiplesurface ART restorations of both materials was considered satisfactory with a high success rate after 3 years.

Objetivo: Avaliar o comportamento clínico de restaurações de superfícies múltiplas, realizadas com dois cimentos de ionômero de vidro (CIVs) em dentes permanentes, utilizando-se o Tratamento Restaurador Atraumático (ART). Material e Métodos: 60 restaurações foram realizadas em escolares (idade entre 9 - 16 anos) por dois dentistas utilizando-se os procedimentos convencionais do AR. As restaurações foram distribuídas aleatoriamente em dois grupos. Trinta cavidades foram restauradas com CIV de alta viscosidade (Ketac Molar - 3M ESPE) e 30, com CIV modificado por resina (Fuji VIII-GC Corp.). Dois avaliadores calibrados e independentes realizaram a avaliação segundo os critérios do ART. Os resultados foram submetidos à análise estatística utilizando-se modelos de regressão logística múltipla, avaliando-se o sucesso em função das variáveis associadas (CIV, operador e tipo de cavidade). Intervalos de confiança de 95% para o sucesso foram baseados na distribuição binomial. Diferenças estatisticamente significantes ocorreram se p < 0,05. Resultados: Em 3 anos de acompanhamento 57 restaurações foram avaliadas. No grupo do Ketac Molar, 3 restaurações não foram avaliadas, 21 obtiveram sucesso e 6 falharam. No grupo do Fuji VIII, 28 restaurações obtiveram sucesso e 2 falharam. A combinação de variáveis foi somente significante em relação à sobrevida das restaurações (p = 0,036). Não houve diferenças entre os grupos considerando-se cada variável independentemente. A combinação apresentando melhor desempenho foi: Fuji VIII, operador B e Classe I envolvendo duas ou mais superfícies dentárias. Conclusão: O desempenho clínico de restaurações de ART de superfícies múltiplas foi considerado satisfatório para ambos os materiais testados, apresentando altos índices de sucesso após três anos.

Recubrimiento pulpar directo e idirecto: mantenimiento de vitalidad pulpar / Direct and indirect pulp capping: maintaining pulp vitality

El recubrimiento pulpar directo e indirecto, desde el punto de vista biológico y clínico, representa importantes mecanismos para el mantenimiento de la vitalidad pulpar; sin embargo aún es considerado un tema controversial en la clínica odontológica, debido a la complejidad del diagnóstico y a la delicada conducta terapéutica necesaria para obtener éxito en el tratamiento clínico. En tal sentido, este artículo realizará un abordaje biológico y clínico del Recubrimiento Pulpar Directo e Indirecto con la intención de resaltar la importancia fundamental del diagnóstico clínico y radiográfico de la condición pulpar, enfatizando las indicaciones y contra indicaciones de ambos tratamientos. Adicionalmente serán materia de discusión los materiales comúnmente utilizados para la protección del complejo dentinopulpar y las nuevas perspectivas en esta área

Direct and indirect pulp capping represents important mechanisms, from the point of clinical and biological aspects to maintain the pulp vitality. However, it still a controversy issue at dental field, once the complexity diagnosis and the accurately therapeutics are need to achieve the success of clinical treatment. Seeing that, this article outlines the broad of the biological and clinical approach of the direct and indirect pulp capping. Emphasizing fundamentally the importance of the corrected diagnose of clinical and radiographic pulp condition, further the indications and contra-indications of both treatments. Furthermore, it will be discussed regarding the classical dental materials used to dentin-pulp protection and contemporary perspectives in this area

Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up

This case report describes th Indirect Pulp Treatment (IPT) of deep caries lesion in a permanent molar. A 16-year-old male patient reported discomfort associated with thermal stimulation on the permanent mandibular left first molar. The radiographs revealed a deep distal caries lesion, very close to the pulp, absence of radiolucencies in the periapical region, and absence of periodontal space thickening. Pulp sensitivity was confirmed by thermal pulp vitality tests. Based on the main complaint and the clinical and radiographic examinations, the treatment plan was established to preserve pulp vitality. Clinical procedures consisted of removing the infected dentin and lining the caries-affected dentin with calcium hydroxide paste. The tooth was provisionally sealed for approximately 60 days. After this period, tooth vitality was confirmed, the remaining carious dentin was removed, and the tooth was restored. At 4-year follow-up, no clinical or radiographic pathological findings were found.

Transferring ART research into education in Brazil

The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. MATERIALS AND METHODS: A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the followig subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. RESULTS: A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3 percent), and in most of these schools it is taught both in theory and in clinical practice (62.9 percent). The majority (35.3 percent) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6 percent). It has been taught for the last 7 to 10 years in 34.3 percent of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. CONCLUSIONS: It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil.

Propriedades e adesão de cimentos de ionômero de vidro modificados por resina e vitrocerâmicas bioativas / Properties and adhesion of glass ionomer cements modified by resin and bioactive glass-ceramic

As vitrocerâmicas bioativas são materiais sintéticos capazes de aderirem quimicamente aos minerais presentes na estrutura dentária. A união dos cimentos de ionômero de vidro modificados por resina (CIVMRs) à dentina pode ser influenciada por diferentes tipos de tratamentos prévios à restauração. Os objetivos deste estudo foram: avaliar a resistência à compressão, a rugosidade e a adesão à dentina de CIVMRs (Fuji II LC e Vitremer) após a incorporação de partículas de vitrocerâmicas bioativas (Biosilicato®); foi ainda, avaliar a resistência à degradação da adesão à dentina dos CIVMRs, utilizando-se EDTA como pré-tratamento dentinário. Para o teste de resistência à compressão foram confeccionados cilindros sendo que 2, 5 e 10 % em peso de partículas de vitrocerâmica bioativa foram incorporadas aos pós dos CIVMRs, armazenados em água destilada por 24h a 37°C até a realização dos testes. A rugosidade dos cimentos experimentais (2% de vitrocerâmica bioativa) e controles foi avaliada por microscopia de força atômica (MFA) após armazenamento a seco e em 100 % de umidade por 1 mês. Para os testes de microtração, as superfícies das cavidades foram tratadas seguindo-se as instruções dos fabricantes ou utilizando-se EDTA. Os espécimes foram restaurados com os CIVMRs experimentais (2% de vitrocerâmica) e controles. Após as restaurações, os espécimes foram armazenados em água por 24h e 7d. Para o teste de degradação, os CIVMRs foram armazenados por 24h, 3m e imersos em 10% de hipoclorito de sódio por 5h. Os dentes foram seccionados em palitos e submetidos ao teste de microtração. ANOVA e teste de múltiplas comparações foram realizados (p < 0,05). O modo de fratura foi classificado em adesivo, misto e coesivo e alguns espécimes foram analisados em microscopia eletrônica de varredura (MEV). Apenas os cimentos com 2% de vitrocerâmica bioativa obtiveram resistência a compressão semelhante ao grupo controle. Para os grupos controles, Fuji II LC apresentou-se mais rugoso que o Vitremer e o seu armazenamento à seco aumentou sua rugosidade. A condição de armazenamento, seco ou úmido, não afetou a rugosidade dos CIVMRs experimentais. A vitrocerâmica bioativa aumentou significantemente a adesão à dentina dos CIVMRs após armazenamento por 24h, exceto para o Fuji II LC quando EDTA foi utilizado. A aplicação de EDTA aumentou significantemente os valores de resistência adesiva. No estudo de degradação da união, valores de resistência adesiva significantemente maiores foram obtidos nos grupos onde a dentina foi pré-tratada com EDTA. A resistência adesiva do Fuji II LC à dentina não foi afetada pelos métodos de degradação utilizados. Valores de resistência adesiva significantemente menores foram observados para os espécimes restaurados com Vitremer após os dois métodos de degradação, exceto quando a dentina foi prétratada com EDTA. As falhas do tipo mistas foram prevalentes. Em conclusão, 2% de partículas de vitrocerâmica bioativa podem ser incluídas nos CIVMRs sem afetar suas propriedades mecânicas. A rugosidade dos CIVMRs experimentais não foi afetada pelo meio de armazenamento. A inclusão de vitrocerâmicas bioativas aumentou a resistência adesiva somente após armazenamento de 24h. A utilização de EDTA como pré-tratamento dentinário aumentou a resistência adesiva para todas as condições e preveniu a degradação da interface adesiva do Vitremer.

Bioactive glass-ceramics are synthetic materials capable of chemically bonding to dental structures. Adhesion of resin-modified glass-ionomer cements (RMGICs) to dentin may be influenced by different types of dentin pre-treatments. The objective of this study was to analyze the compressive strength, roughness and adhesion to dentin of RMGICs (Fuji II LC and Vitremer) after the incorporation of bioactive glassceramic particles (BiosilicateTM). Additionally, the durability of the RMGICs adhesion was analyzed after the application of EDTA as a pre-treatment of dentin. Cylinders of RMGICs with incorporation of 2, 5 and 10 % in weight of bioactive glass-ceramic particles were made for compressive strength, and stored in water for 24h at 37°C. Roughness of control and experimental (2% bioactive glass-ceramic) RMGICs was analyzed by atomic force microscopic (MFA) after storage in dry and humidity conditions for 1 month. For the microtensile test, the surfaces of the cavities were treated following the manufacturers’ instructions or by applying EDTA. The cavities were restored with control and experimental (2% bioactive glass-ceramic) RMGICs. After restorations, the specimens were stored in water for 24h and 7 days. For the degradation test, the RMGICs were stored for 24h, 3 months or immersed in 10% NaOCl for 5h. Teeth were sectioned in beams and submitted to microtensile test. ANOVA and multiple-comparisons tests were used (p < 0.05). Mode of failure was classified in adhesive, mixed and cohesive, some specimens were analyzed by scanning electronic microscopic. Only the RMGICs with 2% of bioactive glassceramic obtained compressive strength similar to the control RMGICs. The storage conditions, dry or humidity, did not affect the roughness of experimental RMGICs. Bioactive glass-ceramic significantly increased the adhesion to dentin of RMGICs after storage for 24h, except for Fuji II LC when EDTA was applied...

Compressive and diametral tensile strength of glass ionomer cements

Comparou-se a Resistência à Compressão (RC) e à Tração Diametral (TD) de um cimento de ionômero de vidro de alta viscosidade [Fuji IX (GC Corporation)] e de dois novos cimentos Brasileiros [Vitro Molar (DFL) e Bioglass R (Biodinamica)], recentemente lançados no mercado, ambos indicados para o Tratamento Restaurador Atraumático (ART), em diferentes períodos de tempo. Foram confeccionados quinze corpos-de-prova com 6,0 mm de diâmetro x 3,0 mm de altura para o teste de TD e quinze com 6,0 mm de diâmetro e 12,0 mm de altura para o teste de RC, para cada ionômero a ser testado. Os corpos-de-prova foram armazenados em recipientes plásticos, com água deionizada, e mantidos em estufa a 37°C e 100% de umidade, até a realização dos testes. Cinco corpos-de-prova de cada material foram submetidos aos testes de TD e RC em cada período de tempo: 1-hora, 24-horas e 7-dias, em uma máquina de testes universal (EMIC ù DL 500) a uma velocidade de 1,0 mm/min para RC e 0,5mm/min para TD. Os dados obtidos foram submetidos aos testes ANOVA a dois critérios e Tukey (á=0,05). Os valores médios de RC e TD variaram de 42,03 a 155.47 MPa e de 5,54 a 13,72 MPa, respectivamente para os períodos analisados. O Fuji IX e o Vitro Molar não apresentaram diferenças em relação aos testes de RC e TD, exceto para RC no período de 1-hora. O Bioglass R apresentou os menores valores de RC dos cimentos testados. Na TD o Bioglass R não apresentou diferença em relação aos outros cimentos testados no período de 1-hora e não foi diferente do Vitro-Molar nos períodos de 24-horas e 7-dias. Mais estudos são necessários para avaliar outras propriedades mecânicas desses novos cimentos de ionômero de vidro brasileiros, tais como: tenacidade e desgaste, bem como composição química e biocompatibilidade.

Enceramento e moldagem com silicona: uma nova técnica para fechamento de diastema / Waxing and molding with silicone: a new technique for diastema closure

Os autores apresentam uma nova técnica para fechamento de diastema, através de um caso clínico, utilizando enceramento de diagnóstico, feito em modelo de estudo e realizado em laboratório, com auxílio de uma moldeira de silicona