Age and Type of Delivery as Risk Indicators for Maternal Mortality / Idade e tipo de parto como indicadores de risco para mortalidade materna

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

Application of polyetheretherketone (PEEK) posts: evaluation of fracture resistance and stress distribution in the root: in vitro and finite element analyses

Abstract To evaluate the feasibility of using a milled polyetheretherketone (PEEK) post and core in endodontically treated teeth with or without a ferrule. Sixty bovine tooth roots were endodontically treated followed by cementation of intraradicular retainers (IR), according to each experimental group: a) non-ferrule glass fiber post (f0FP); b) 2-mm-ferrule glass fiber post (f2FP); c) non-ferrule resized glass fiber post (f0PR); d) 2-mm-ferrule resized glass fiber post (f2PR); e) non-ferrule PEEK post and core (f0PPC); and f) 2-mm-ferrule PEEK post and core (f2PPC). Metal crowns were made and cemented. A periodontal ligament was simulated using polyether. A force was applied to the palatine portion of each sample at 45°, until fracture. Fracture resistance data were submitted to two-way ANOVA and Tukey's test (α = 0.05). Three-dimensional digital models were developed to calculate the tensions formed in the root using finite element analysis. Models of glass fiber posts and PEEK posts and cores were evaluated with or without a ferrule. The results were analyzed by the Mohr-Coulomb criterion. The type of IR was not influenced by fracture strength (p = 0.243). There were significant statistical differences among the remaining factors. Ferrule groups had greater fracture resistance, and the failure mode of teeth with a ferrule was more catastrophic than the non-ferrule group. A ferrule increases fracture resistance and influences failure mode; the PEEK post and core did not modify the biomechanics of endodontically treated teeth, and resembled the glass fiber post results. The crack initiation point differed between the ferrule and non-ferrule groups.

Effect of endodontic sealers on push-out bond strength of CAD-CAM or prefabricated fiber glass posts

Abstract This study aimed to evaluate the effect of endodontic sealer (ES) on bond strength (BS) of prefabricated or milled-CAD-CAM (computer-aided design and computer-aided manufacturing) glass-fiber-posts (GFP). Canals of 90 single-rooted teeth were prepared for filling by the single-cone technique with gutta-percha and one of the following ES: AH Plus (epoxy resin), Endofill (zinc-oxide and eugenol), and Bio-C Sealer (calcium-silicate). After post-space preparation, tooth-specimens were equally divided in half according to type of GFP to be used. In the half to receive milled-CAD-CAM posts, tooth specimens were molded with acrylic resin to obtain replicas. These were scanned to enable the laboratory to produce the milled-CAD-CAM GFPs (Fiber CAD Lab, Angelus) by the subtractive technique. The other half of samples received prefabricated GFPs (Exacto, Angelus) (n=15). The GFPs were cemented with dual-cure resin cement (Panavia F2.0, Kuraray). Each root was sectioned into two slices per root region (cervical, middle, apical) that were subjected to the push-out BS test, in a universal testing machine. Failure mode (FM) was classified by scores. The BS data were submitted to generalized linear model analyses, while FM was analyzed using the chi-square test (a=0.05). BS showed no significant difference among the three ES (p > 0.05). BS was significantly higher for prefabricated (mean 10.84 MPa) versus milled-CAD-CAM GFPs (mean 6.94 MPa) (p <0.0001), irrespective of ES. The majority showed mixed failures. It could be concluded that type of ES did not affect BS of GFPs to dentin, and prefabricated-GFPs had higher bond-strength than customized-milled-CAD-CAM GFPs.

Dentin permeability after pretreatment with titanium tetrafluoride and self-etching or universal adhesive systems

Aim: To evaluate dentin permeability after pretreatment with 2.5% aqueous solution of titanium tetrafluoride (TiF4), followed by a self-etching universal adhesive system. Methods: Forty dentin discs (1.5 mm thick) were randomly divided into groups according to the application or non-application of a pretreatment, and the type of adhesive system to be tested (two-step self-etching/ Clearfil SE Bond/ Kuraray Medical, or universal adhesive system/ Single Bond Universal/ 3M ESPE). Both sides of the discs were conditioned with 37% phosphoric acid to remove the smear layer. The first hydraulic conductivity measurement (L1) was performed in a permeability machine, under 5 PSI pressure. The samples were sanded again to form a standardized smear layer. The teeth designated for pre-treatment with TiF4 received the TiF4 solutions applied actively for 60 seconds, and the adhesive systems were applied according to the manufacturer's instructions. Then, a new hydraulic conductivity measurement (L2) was performed for the purpose of calculating the hydraulic conductance at a later time, considering the water viscosity and the thickness of the specimen. The percentage (L) of dentin permeability after application of the adhesive system was obtained (L (%) = [(L1-L2) x100] / L1). The Mann-Whitney non-parametric test was applied. Results: There was no difference between the two adhesive systems, or between the groups with or without pretreatment, as regards dentin permeability (p>0.05). Conclusion: Pretreatment with 2.5% TiF4 did not influence dentin permeability, irrespective of the adhesive system used

Influence of restorative materials on occlusal and internal adaptation of CAD-CAM inlays

Aim: To evaluate the occlusal and internal marginal adaptation of inlay restorations made of different materials, using CAD-CAM. Methods: Preparations were made for MOD inlays of one-third intercuspal width and 4 mm depth in 30 third human molars. The teeth were restored using CAD-CAM materials (n=10) of nanoceramic resin (Lava Ultimate), polymer-infiltrated ceramic network (VITA ENAMIC), or lithium disilicate glass-ceramic (IPS e.max CAD). The specimens were cemented with dual resin cement and sectioned at the center of the restoration, after which the two halves were evaluated, and photographed The occlusal and internal discrepancy (µm) was determined at five points: cavosurface angle of the occlusal-facial wall (CA-O); center of the facial wall (FW); faciopulpal angle (FPA); center of the pulpal wall (PW); and center of the lingual wall (LW). The data were submitted to the Kruskal-Wallis and the Dunn tests (α=0.05). Results: No difference was observed among the materials regarding the occlusal discrepancy at the CA-O, FPA, or PW internal points. The e.max CAD measurement at FW showed larger internal discrepancy than that of Lava (p=0.02). The internal discrepancy at LW was greater for e.max CAD than VITA ENAMIC (p=0.02). Conclusion: Lithium disilicate glass-ceramic presented greater internal discrepancy in relation to the surrounding walls of the inlay preparations

Diagnostic methods for stained pits and fissures caries lesions on the occlusal surface / Métodos diagnósticos para lesões de cárie com sulcos pigmentados em superfície oclusal

ABSTRACT Objective: The aim of this study was to compare methods for in vitro diagnosis of pigmented pits and fissures on the occlusal surface. Methods: Forty-one human molars and premolars extracted with pigmentation in pits and fissures were used. The teeth were evaluated with artificial illumination for classification according to ICDAS, followed by fluorescent laser evaluation. For the radiographic evaluation, the teeth were positioned to obtain interproximal images, adopting the criterion of Rodrigues et al. 2008 for diagnosis of lesions. For histological evaluation, the teeth were sectioned in the mesiodistal direction in the occlusal sulcus region and evaluated in a 20-fold stereoscopic magnifying glass, using the criterion of Ekstrand et al. (1997) for evaluation. The methods were compared with the histological evaluation, obtaining values of accuracy, sensitivity and specificity regarding the response variables "presence / absence" of enamel caries. Results: When comparing visual inspection with histological analysis, 65.85% accuracy, 40% sensitivity and 90.48% specificity were observed with false positive and negative probability of 20% and 38.71%. When comparing the fluorescent laser with the histological analysis, the accuracy was 58.54%, sensitivity 70% and specificity 47.62%. Comparing the radiographic analysis with the histological analysis, it was obtained 53.66% accuracy, sensitivity of 42.11% and specificity of 73.68%. Conclusion: The ROC curve and the Yuden index showed that visual inspection presented the best combination of sensitivity and specificity than fluorescent laser and radiographic analysis for diagnosis, which represented the best method for detecting inactive carious lesions in enamel.

RESUMO Objetivo: O objetivo deste estudo foi comparar métodos para diagnóstico in vitro de sulcos pigmentados em superfície oclusal. Métodos: Foram utilizados 41 molares e pré-molares humanos extraídos com pigmentação em sulcos e fissuras. Os dentes foram avaliados com iluminação artificial para classificação quanto ao critério ICDAS, seguida por avaliação com laser fluorescente. Para a avaliação radiográfica, os dentes foram posicionados para obtenção de imagens interproximais, adotando-se o critério de Rodrigues et al. (2008) para diagnóstico. Para avaliação histológica, os dentes foram seccionados no sentido mésio-distal na região de sulco oclusal e avaliados em lupa estereoscópica com aumento de 20 vezes, adotando-se o critério de Ekstrand et al. (1997). Os métodos foram comparados com a avaliação histológica, obtendo-se valores de acurácia, sensibilidade e especificidade quanto às variáveis de resposta "presença/ausência" de lesão de cárie em esmalte. Resultados: Ao comparar a inspeção visual com a análise histológica, observou-se acurácia de 65,85%, sensibilidade de 40% e especificidade de 90,48%. Ao comparar o laser fluorescente com a análise histológica, a acurácia foi de 58,54%, sensibilidade de 70% e especificidade de 47,62%. Na comparação da análise radiográfica com a histológica, obteve-se acurácia de 53,66%, sensibilidade de 42,11% e especificidade de 73,68%. Conclusão: A curva ROC mostrou que a inspeção visual apresentou a melhor combinação de sensibilidade e especificidade que o laser fluorescente e que a análise radiográfica para o diagnóstico, representando o melhor método para detecção de cárie em lesões com sulcos pigmentados em esmalte

Influence of calcium lactate and sodium fluoride solution mouthwashes on enamel microhardness and dentin permeability during in-office bleaching / Influência das soluções enxaguatórias de lactato de cálcio e fluoreto de sódio na microdureza do esmalte e permeabilidade dentinária durante o clareamento em consultório

Objective: This study evaluated the influence of calcium lactate and sodium fluoride mouthwashes on enamel microhardness and dentin permeability during in-office bleaching. Material and Methods: For the microhardness evaluation, enamel blocks were randomly submitted to different treatments associated with in-office bleaching agent using 40% hydrogen peroxide (Opalescence Boost PF 40%/ Ultradent; 3 sessions x 40-minute each) (n = 10): 1) Control: application of bleaching agent; 2) Calcium lactate: 1-minute immersion before bleaching treatment; 3) Sodium fluoride: immersion for 1 minute before bleaching treatment; 4) Calcium lactate + sodium fluoride: 1 minute immersion in calcium lactate solution, followed by 1 minute immersion in sodium fluoride before bleaching treatment. Dentin discs received the same treatment protocols (n = 10) to evaluate permeability. Knoop microhardness and dentin permeability assessments were performed twice (at baseline and 48 hours after the end of bleaching treatment). Results: The generalized linear model considering the design of repeated measures over time showed that there was no significant difference between treatments (p = 0.9577) and between assessments (p = 0.3267) regarding Knoop microhardness. Kruskal Wallis and Dunn tests showed that calcium lactate immersion before bleaching treatment provided higher dentin permeability than other groups (p = 0.0009). Conclusion: The use of sodium fluoride solution and calcium lactate in association with in-office bleaching treatment did not influence the microhardness of tooth enamel, although calcium lactate may increase dentin permeability. (AU)

Objetivo: Este estudo avaliou a influência dos enxaguatórios bucais com lactato de cálcio e fluoreto de sódio na microdureza do esmalte e na permeabilidade da dentina durante o clareamento em consultório. Material e Métodos: Para avaliação da microdureza, blocos de esmalte foram submetidos aleatoriamente a diferentes tratamentos associados a agente clareador em consultório com peróxido de hidrogênio 40% (Opalescence Boost PF 40% / Ultradent; 3 sessões x 40 minutos cada) (n = 10): 1) Controle: aplicação de agente clareador; 2) Lactato de cálcio: imersão de 1 minuto antes do tratamento clareador; 3) Fluoreto de sódio: imersão por 1 minuto antes do tratamento clareador; 4) Lactato de cálcio + fluoreto de sódio: 1 minuto de imersão em solução de lactato de cálcio, seguido de 1 minuto de imersão em fluoreto de sódio antes do tratamento clareador. Os discos de dentina receberam os mesmos protocolos de tratamento (n = 10) para avaliar a permeabilidade. As avaliações da microdureza Knoop e da permeabilidade dentinária foram realizadas duas vezes (no início do estudo e 48 horas após o término do tratamento clareador). Resultados: O modelo linear generalizado considerando o delineamento de medidas repetidas ao longo do tempo mostrou que não houve diferença significativa entre os tratamentos (p = 0,9577) e entre as avaliações (p = 0,3267) em relação à microdureza Knoop. Os testes de Kruskal Wallis e Dunn mostraram que a imersão de lactato de cálcio antes do tratamento clareador proporcionou maior permeabilidade dentinária do que os outros grupos (p = 0,0009). Conclusão: O uso de fluoreto de sódio e lactato de cálcio associado ao clareamento em consultório não influenciou a microdureza do esmalte dentário, embora o lactato de cálcio possa aumentar a permeabilidade dentinária (AU)

Effect of acid challenge and photoactivation distance on microhardness and roughness of flow bulk-fill composite resins / Efeito do desafio ácido e distância de fotoativação na microdureza e rugosidade de resinas compostas bulk-fill flow

Abstract Introduction composite resins are indicated to the reconstruction of proximal walls and the evaluation of properties of flow bulk-fill composite resins exposed to acid challenge is necessary. Objective to evaluate the microhardness and roughness at different depths of photoactivation of bulk-fill flow composites (Filtek Bulk Fill Flow; SureFil SDR Flow; Tetric N Ceram Bulk fill) and conventional composite resin (control, Filtek Z350 XT) subjected to acid challenge. Material and method forty composites brick shaped specimens (3x3x4 mm) were made using a polyacetal matrix. To simulate pH challenges, the samples were immersed in a demineralizing solution. Each sample had Knoop microhardness (KHN) and roughness (Ra) evaluated at three depths (superficial, medium, and cervical), considering the lateral surface of the sample. Data were submitted to Kruskal-Wallis, Friedman's and Dunn's tests with a significance level of 5%. Result comparing the composites among themselves, in superficial (p=0.693), medium (p=0.053) and cervical (p=0.176) regions, there was no difference in the KHN values. There were also no differences in roughness between the composites in superficial (p=0.356), medium (p=0.734) and cervical (p=0.207) regions. Only the Filtek Z350 XT (p=0.027) showed less difference in KHN in the middle region caused by acid challenge. Changes in roughness showed that the greatest difference was at the cervical region for Bulk Fill Flow SDR (p=0.014) and Tetric N-Ceram Bulk Fill (p = 0.003) with an increase after acid challenge. Conclusion after acid challenge, bulk-fill flow composites showed alterations similar to those presented by the conventional nanoparticulate resin composite.

Resumo Introdução as resinas compostas são indicadas para reconstrução de paredes proximais e a avaliação das propriedades das resinas compostas bulk-fill flow expostas ao desafio ácido mostra-se necessária. Objetivo avaliar a microdureza e rugosidade em diferentes profundidades de fotoativação de resinas compostas bulk-fill flow (Filtek Bulk Fill Flow; SureFil SDR Flow; Tetric N Ceram Bulk fill) e convencional (controle, Filtek Z350 XT) submetidas ao desafio ácido. Material e método quarenta amostras retangulares (3x3x4 mm) foram confeccionadas utilizando uma matriz de poliacetal. Para simular o desafio ácido, as amostras foram imersas em uma solução desmineralizante. Cada amostra teve a microdureza Knoop (KHN) e rugosidade (Ra) avaliadas em três profundidades (superficial, média e cervical), considerando a superfície lateral da amostra. Os dados foram submetidos aos testes de Kruskal-Wallis, Friedman e Dunn com nível de significância de 5%. Resultado comparando as resinas compostas entre si, nas regiões superficial (p=0,693), média (p=0,053) e cervical (p=0,176), não houve diferença nos valores de KHN. Também não houve diferenças na rugosidade entre os materiais nas regiões superficial (p=0,356), média (p=0,734) e cervical (p=0,207). Apenas o Filtek Z350 XT (p=0,027) apresentou menor diferença de KHN na região intermediária causada pelo desafio ácido. As mudanças na rugosidade mostraram que a maior diferença foi na região cervical para Bulk Fill Flow SDR (p=0,014) e Tetric N-Ceram Bulk Fill (p=0,003), com aumento após o desafio ácido. Conclusão após desafio ácido, as resinas compostas bulk-fill flow apresentaram alterações semelhantes às apresentadas pela resina composta convencional nanoparticulada.

Effect of different concentrations of green tea extract solutions on bonding durability of etchand- rinse adhesive system to caries affected dentin

Aim: The in vitro study evaluated the effect of different concentrations of green tea extract solution (GT) on the bonding durability of etch-and-rinse adhesive system to caries dentin affected (CAD). Methods: Dentinal surfaces of human third molars were polished and submitted to a microbiological caries induction protocol for 14 days. After removal of the infected dentin layer, the samples were randomly divided into 4 groups (n= 10), according to the concentration of GT solution applied in CAD, after acid etching: 0.05%; 0.2%; 2% and NT (no treatment ­ control). After application of a etch-and-rinse adhesive system (Adper Single Bond 2, 3M ESPE), composite resin restorations were performed on the dentin. After 24 hours, the resin-dentin blocks were sectioned 1mm2 specimens, which were subjected to the microtensile test immediately or after 6 months of storage in water. Data were submitted to two-way ANOVA for randomized blocks and Tukey test (α= 5%). Results: There was no effect of double interaction (p= 0.934). The application of 0.2% GT promoted a statistically significant increase in dentin bond strength values in comparison to the condition where GT was not used (p=0.012). There was a significant decrease of bond strength after 6 months of storage, regardless of dentin pretreatment (p = 0.007). The G test identified that there was no statistical difference regarding failure mode (p= 0.326). Conclusion: The concentration of 0.2% improved the bond strength of an etch-and-rinse adhesive system to caries affected dentin, however, none of dentin pretreatments could prevent the decrease in bond strength over time

Effect antioxidants application on microshear bond strength of universal adhesive to bleached enamel / Efeito da aplicação de antioxidantes na resistência de união do adesivo universal ao esmalte clareado

Purpose: To evaluate, in vitro, the influence of antioxidants (green tea extract - GT and sodium ascorbate - SA) on microshear bond strength (µSBS) of a universal adhesive system ­ self-etching mode (UAS) to bleached enamel. Material and Methods: After obtaining 50 fragments of human dental enamel (4 mm x 4 mm), forty fragments were submitted to at-home bleaching technique using 10% carbamide peroxide (Opalescence PF, Ultradent) for two h/day, for four weeks. They were randomly divided in four groups (n = 10): GT - 10% aqueous GT solution (60 min); SA - 10% SA solution (10 min); Negative control - no antioxidant agent, immediately restored; PC1 (positive control 1) - no antioxidant agent, restored 14 days the bleaching procedure. Ten enamel fragments were assigned to PC2 group (positive control 2), in which the adhesive procedures were realized in non-bleached enamel. The UAS (Adper Single Bond Universal, 3M ESPE) was applied on enamel surface according to manufacturer's instructions and two cylinders (0.8 mm diameter) of nanoparticulate composite resin (Z350, 3M ESPE) were made on each sample. After 24 h, the cylinders were submitted to µSBS in a universal test machine (0.5 mm/min). Fracture mode was evaluated in stereomicroscope (30x magnification). SBS data, in MPa, was submitted to one-way ANOVA and fracture mode to Chi-square test (α = 0.05). Results: There was no statistical difference between the experimental groups (p = 0.545) and fracture mode (p = 0.16424). There was predominance of adhesive fracture in all groups. Conclusion: Neither the bleaching procedure nor the application of antioxidants to bleached enamel interfered in the bond strength of the tested universal adhesive system (AU)

Objetivo: Avaliar, in vitro, a influência de antioxidantes (extrato de chá verde - GT e ascorbato de sódio - SA) na resistência de união ao microcisalhamento (µSBS) de um sistema adesivo universal - modo de autocondicionamento (UAS) ao esmalte clareado. Material e Métodos: Realizou-se a obtenção de 50 fragmentos de esmalte dental humano (4 mm x 4 mm), sendo que desses, quarenta fragmentos foram submetidos à técnica de clareamento caseiro utilizando peróxido de carbamida a 10% (Opalescence PF, Ultradent) por duas horas/dia, durante quatro semanas. Eles foram divididos aleatoriamente em quatro grupos (n= 10): Expostos a GT - solução aquosa de GT a 10% (60 min); expostos a SA - solução 10% SA (10 minutos); Sem exposição ao agente antioxidante e imediatamente restaurado - (controle negativo); Sem exposição ao agente antioxidante e restaurado 14 dias após o clareamento - PC1 (controle positivo 1). Os dez fragmentos de esmalte restantes foram atribuídos ao grupo PC2 (controle positivo 2), no qual os procedimentos adesivos foram realizados em esmalte não clareado. O UAS (Adper Single Bond Universal, 3M ESPE) foi aplicado na superfície do esmalte de acordo com as instruções do fabricante e dois cilindros (0,8 mm de diâmetro) de resina composta nanoparticulada (Z350, 3M ESPE) foram feitos em cada amostra. Após 24 h, os cilindros foram submetidos ao µSBS em uma máquina de teste universal (0,5 mm/min). O modulo de fratura foi avaliado em estereomicroscópio (aumento de 30x). Os dados do SBS, em MPa, foram submetidos à ANOVA unidirecional e ao modo fratura ao teste do qui-quadrado (α = 0,05). Resultados: Não houve diferença estatística entre os grupos experimentais (p = 0,545) e modulo de fratura (p = 0,16424). Houve predomínio de fratura adesiva em todos os grupos. Conclusão: Nem o procedimento de clareamento nem a aplicação de antioxidantes no esmalte clareado interferiram na resistência de união do sistema adesivo universal testado. (AU)

Color stability of a bulk-fill composite resin light-cured at different distances

Abstract The aim of this in vitro study was to evaluate the color stability of a bulk-fill (Filtek One Bulk Fill, 3M ESPE) and a conventional (Filtek Z350 XT, 3M ESPE) composite resin light-cured at different distances, before and after being submitted to staining with a coffee solution. Sixty specimens of each composite resin were prepared and light-cured at distances of 0, 2 and 4 mm, using a LED light-curing unit (Valo, Ultradent). The specimens were separated (n = 10) for immersion in either distilled water or coffee solution (10 minutes a day for 8 days) to stimulate staining. Color evaluations were performed before and after immersion in the solutions, according to CIELab (△Eab), CIEDE2000 (△E00) and the Whiteness Index for Dentistry (△WID). Kruskal Wallis and Dunn tests, Mann-Whitney tests and Wilcoxon test were applied (α = 5 %). The a* value for conventional composite resin showed a significant increase after immersion in coffee and distilled water (p < 0.05). Both composite resins showed greater b* values when immersed in coffee than in distilled water, with no significant difference among the light-activation distances (p > 0.05). There was no significant difference for L* among the light-activation distances; both resins showed significant decrease in L* after immersion in coffee (p < 0.05). Color change (△Eab, △E00) and difference in whiteness (△WID) were higher for conventional resin when immersed in the coffee solution at all the light-activation distances. Conventional composite resin presented a higher staining value than bulk-fill composite resin, regardless of the light-activation distance.

Remineralizing effect of commercial fluoride varnishes on artificial enamel lesions

Abstract: The aim of this study was to evaluate soluble and insoluble fluoride concentrations in commercial varnishes, and their remineralization effect on artificial caries enamel lesions using surface and cross-sectional microhardness evaluations. Forty bovine enamel blocks were separated into four groups (n=10): control (no treatment), Enamelast (Ultradent Products), Duraphat (Colgate-Palmolive) and Clinpro White Varnish (3M ESPE). Surface enamel microhardness evaluations were obtained, artificial enamel caries lesions were developed by dynamic pH-cycling, and the varnishes were then applied every 6 days, after which the enamel blocks were submitted to dynamic remineralization by pH cycles. After removal of the varnishes, the enamel surfaces were reassessed for microhardness. The blocks were sectioned longitudinally, and cross-sectional microhardness measurements were performed at different surface depths (up to 300 μm depth). Polarized light microscopy images (PLMI) were made to analyze subsurface caries lesions. The fluoride concentration in whole (soluble and insoluble fluoride) and centrifuged (soluble fluoride) varnishes was determined using an extraction method with acetone. The data were analyzed to evaluate the surface microhardness, making adjustments for generalized linear models. There was a significant decrease in enamel surface microhardness after performing all the treatments (p<0.0001). Enamelast and Duraphat showed significantly higher enamel microhardness values than the control and the Clinpro groups (p = 0.0002). Microhardness loss percentage was significantly lower for Enamelast (p = 0.071; One-way ANOVA). PLMI showed that subsurface caries lesions were not remineralized with the varnish treatments. No significant differences in the in-depth microhardness levels (p = 0.7536; ANOVA) were observed among the treatments. Enamelast presented higher soluble and insoluble fluoride concentrations than the other varnishes (p < 0.0001; Kruskal-Wallis and Dunn tests). Enamelast and Duraphat varnishes promoted enamel surface remineralization, but no varnish remineralized the subsurface lesion body. Although insoluble and soluble fluoride concentration values did not correspond to those declared by the manufacturer, Enamelast presented higher fluoride concentration than the others.

Sour Gummy Candies and their Effect on Salivary pH kinetics

Objective: This randomized controlled crossover clinical trial monitored the kinetics of salivary pH over time following the consumption of sour gummy candy. Material and Methods: Twenty participants underwent saliva assessment for flow, pH and buffer capacity. Following a two-arm crossover layout, the participants chewed a piece of a sour and a piece of an ordinary (control) gummy candy for 20 seconds. Participants expectorated saliva at 18 time points: immediately after ingesting the candies; then after every 15 second interval, for up to 1 minute; 30 seconds up to 4 minutes; 60 seconds up to 10 minutes; and at 15 minutes. The pH of the collected samples was measured with a pH microelectrode. The data concerning the pH measurements of the whole saliva samples collected over time following chewing of sour and ordinary gummy candies underwent repeated-measures three-way analysis of variance (ANOVA) using a significance level of 5%. Results: Repeated-measures three-way analysis of variance demonstrated a significant interaction between the type of candy and time (p<0.001). Tukey's test revealed that with the consumption of sour gummy candy, the salivary pH showed an initial marked exponential drop and remained lower than that observed with the consumption of the ordinary version for up to 120 seconds. Conclusion: The consumption of sour gummy candy induces a major, transient fall in salivary pH, which may represent a risk factor for dental erosion.

Whitening mouthwash containing hydrogen peroxide decreases enamel microhardness in vitro

Aim: To assess the effect of a mouthwash containing hydrogen peroxide (HP) on Knoop microhardness (KMH) of bovine enamel. Methods: Fifty-one enamel slabs were polished and divided into groups (n=17), according to the product used during 28 days: HP ­ mouthwash containing 1,5% of HP (4 min, once/day); CP - 10% carbamide peroxide gel (2 hours/day); AS - no treatment (kept in artificial saliva (AS). Each fragment was submitted to KMH test (three indentations/fragment, with a 50 g load for 5 sec) four times: before (baseline); during (14 and 28 days) and after (7 days immerged in AS) the bleaching treatment. The data were submitted to repeated-measures two-way ANOVA (α=0.05). Results: There was no effect of the interaction between the time and treatment factors (p=0.327). No significant effect was observed from the time factor (p = 0.054). The factor treatment showed significant effect (p =0.002). Regardless of time, the KMH of the enamel submitted to HP was lower than the value observed with the use of CP, which did not differ significantly from the control group (AS). Conclusion: Although there was a trend of decreasing enamel microhardness over time, only the mouthwash containing hydrogen peroxide had a significant effect (AU)

Long-term bond strength of a self-adhesive resin cement to intraradicular dentin pretreated with chlorhexidine and ethanol / Resistência de união ao longo do tempo de um cimento resinoso autoadesivo à dentina intrarradicular pré tratadas com clorexidina e etanol

Introduction: Self-adhesive resin cements do not require prior preparation of the tooth surface, therefore dentin pretreatments may influence long-term bond strength. Objective: To evaluate the influence of 100% ethanol (ET) and 2% chlorhexidine (CL) treatment of intraradicular dentin on the long-term bond strength (BS) of a self-adhesive resin cement (SRC). Material and method: 80 bovine roots were restored with fiber posts and SRC (U200 3M/ESPE) and distributed into 4 groups according to dentin treatment: Group 1 – without treatment; Group 2 – 2% CL for 1 minute; Group 3 – 100% ET for 1 minute; Group 4 – 2% CL, followed by 100% ET. The samples were cross-sectioned to obtain two sections (0.7 mm) thick for each root third: coronal, middle and apical. The immediate push-out test was carried out after 48 hours, and the long-term push-out test, after 180 days. Result: The three-way ANOVA test for randomized blocks showed no difference between the BS values at 48 hours and 80 days, irrespective of the treatment and the third (p>0.05). The interaction of the treatment/third pairing was significant (p = 0.041) since the treatment with CL promoted lower BS in the coronal third, while treatment with ET promoted better BS in the apical third. Conclusion: Treatment with CL and ET, separately or combined, promoted no differences between the BS values of the SRC to root dentin over time.

Introdução: Cimentos resinosos autoadesivos não necessitam de tratamento prévio da superfície dental, por esta razão o pré tratamento da dentina pode influenciar a longevidade da resistência adesiva. Objetivo: Avaliar a influência do tratamento dentinário com etanol (ET) 100% e clorexidina (CL) 2% na resistência de união (RU) de um cimento resinoso autoadesivo (CRA) à dentina intrarradicular. Material e método: 80 raízes bovinas restauradas com pino de fibra de vidro e CRA (U200 3M/ESPE) foram distribuídas em 4 grupos, de acordo com o tratamento prévio da dentina intrarradicular: Grupo 1 – nenhum tratamento; Grupo 2 – CL2% por 1 minuto; Grupo 3 – ET100% por 1 minuto; Grupo 4 – CL2% seguido pelo ET100%. As amostras foram seccionadas no sentido radial para obtenção de duas secções de aproximadamente 0,7 mm de espessura em cada terço – cervical, médio e apical. Após 48 horas e 180 dias foi realizado o teste push-out. Resultado: A ANOVA a três critérios para blocos casualizados demostrou que não houve diferença entre os valores de resistência de união nos tempos 48 h e 180 dias, independentemente do tratamento e do terço (p>0,05). A interação tratamento-terço foi significativa (p = 0,041) sendo que o tratamento com CL promoveu menor RU no terço cervical e o tratamento com ET promoveu melhor RU no terço apical. Conclusão: Os tratamentos com CL e ET individualmente ou associados não promoveram diferenças entre os valores de RU do CRA à dentina intrarradicular ao longo do tempo.

Chitosan in different concentrations added to a two-step etch-and-rinse adhesive system: influence on bond strength to dentin / Quitosana em diferentes concentrações adicionada a um sistema adesivo convencional de dois passos: influência na resistência de união à dentina

Objectives: the aim of the present study was to evaluate the influence of adding different concentrations of chitosan to an experimental two-step etch-and-rinse adhesive system on the bond strength and failure mode to dentin. Material and Methods: thirty-two flat dentin surfaces were obtained from extracted human third molars and divided into four groups (n=8) for application of the adhesive systems: AD - conventional two-step adhesive system (Adper Single Bond 2); EXP ­ experimental two-step etch-and-rinse adhesive system; Chi0.2% - EXP with addition of 0.2% Chitosan; Chi0.5% - EXP with addition of 0.5% Chitosan. Resin composite build-ups were made and the composite/ dentin specimens were sectioned to obtain rectangular beams with a bond area of approximately 1mm2 . After 24 hours, the sticks were submitted to microtensile bond strength tests in a universal test machine. The fracture pattern was evaluated under a stereoscopic loupe at 40X magnification. Results: one-way analysis of variance showed that the type of adhesive system had no significant effect on the bond strength values (p = 0.142), showing the mean bond strength values (standard deviation), in MPa, for the groups as follows: AD=20.1 (5.4); EXP=16.6 (2.3); Chi0.2%=16.1 (2.8); Chi0.5%=16.9 (2.3). In all the groups there was predominance of cohesive fractures in dentin, representing 68 to 82% of the failure modes. Conclusion: the addition of 0.2 or 0.5% of chitosan had no influence on the bond strength and failure mode of an experimental two-step etch-andrinse adhesive system to dentin. (AU)

Objetivo: o objetivo deste estudo foi avaliar a influência da incorporação de diferentes concentrações de quitosana em um sistema adesivo experimental convencional de dois passos na resistência de união à dentina e modo de falha. Material e Métodos: trinta e duas superfícies de dentina planificadas foram obtidas de terceiros molares e separadas em quatro grupos (n=8) para aplicação dos sistemas adesivos: AD - sistema adesivo convencional de dois passos (Adper Single Bond 2); EXP ­ sistema adesivo convencional de dois passos experimental; Chi0,2% - EXP com incorporação de quitosana a 0,2%; Chi0,5% - EXP com incorporação de quitosana a 0,5%. Blocos de resina composta foram confeccionados e os espécimes de resina composte/ dentina foram seccionados para se obter palitos retangulares com interface adesiva foi seccionada para obtenção de palitos com área de união de aproximadamente 1mm2 . Após 24 horas, os palitos foram submetidos aos testes de resistência de união por microtração em máquina universal de ensaios. O modo de falha foi avaliada em lupa estereoscópica com aumento de 40 vezes. Resultados: análise de variância a um critério mostrou que o tipo de sistema adesivo não apresentou efeito significativo nos valores de resistência de união (p = 0,142), observando-se os respectivos valores de média (desvio-padrão), em MPa, para os grupos: AD=20,1 (5,4); EXP=16,6 (2,3); Chi0,2%=16,1 (2,8); Chi0,5%=16,9 (2,3). Para todos os grupos houve predominância de fraturas coesivas em dentina, representando 68 a 82% dos modos de falhas. Conclusão: a incorporação de quitosana a 0,2 ou 0,5% na influenciou a resistência de união à dentina e o modo de falha de um sistema adesivo convencional de dois passos experimental à dentina. (AU)

Longevity of restorations in direct composite resin: literature review / Longevidade de restaurações diretas em resina composta: revisão de literatura

ABSTRACT Composite resin restorations have increased considerably in popularity and predictability, enabling the realization of a minimally invasive dental treatment. However, to obtain the success of composite resin restorations, knowledge of adhesives and the use of the technique are required, otherwise failure may appear quickly. The objective of the present work was to conduct a literature review on the clinical performance of different types of composite resins and adhesive systems with regard to longevity. For this evaluation, some characteristics of the restorations were immediately verified after they were completed and after a determined time. Characteristics such as postoperative sensitivity, color, marginal integrity, secondary caries, texture, marginal adaptation, retention, displacement, marginal discoloration and anatomical shape had their performances compared. The influence of different adhesive systems on the longevity of the restorations was also observed as a function of its fundamental importance in the union between the tooth and the restorative material. It was concluded that most restorations performed clinically acceptable when hybrid, nanoparticle or microhybrid composite resins and conventional adhesive systems were used.

RESUMO As restaurações de resinas compostas têm aumentado consideravelmente em popularidade e previsibilidade, possibilitando a realização de um tratamento odontológico minimamente invasivo. No entanto, para se obter o sucesso das restaurações de resina composta é necessário ter conhecimento dos materiais adesivos e da técnica de utilização, caso contrário os insucessos podem aparecer rapidamente. Assim, o objetivo deste trabalho foi realizar uma revisão de literatura sobre o desempenho clínico de diferentes tipos de resinas compostas e de sistemas adesivos no que se refere à longevidade. Para essa avaliação foram verificadas algumas características das restaurações logo após elas serem finalizadas e depois de um determinado tempo. Características como sensibilidade pós-operatória, cor, integridade marginal, cárie secundária, textura, adaptação marginal, retenção, deslocamento, descoloração marginal, forma anatômica, tiveram seus desempenhos comparados. A influência dos vários sistemas adesivos na longevidade das restaurações foi também observada em função da sua fundamental importância na união entre o dente e o material restaurador. Concluiu-se que a maioria das restaurações se apresentou clinicamente aceitável, quando se usou resinas compostas híbridas, nanoparticuladas ou microhíbridas e sistema adesivo convencional.

Bond strength of glass-ceramic cemented to a zirconia structure: influence of adhesive cementation strategy / Resistência de união de uma cerâmica vítrea cimentada à estrutura de zirconia: influência da estratégia de união

ABSTRACT Objective This study evaluated the shear bond strength (SBS) of lithium disilicate glass (LDG) ceramic bonded to a zirconia (Y-TZP), using different cementation strategies. Methods LDG ceramic cylinders were cemented to Y-TZP structure according to the following adhesive system (AS)/resin cement (RC) (n = 15): U- self-adhesive dual-cure RC; AMBAR- AS containing phosphate monomers (PM) + dual-cure RC; group SBU: PM+Silane/AS + light-cure RC; group ALLB: PM/AS + dual-cure RC. Specimens were subjected to SBS in a universal testing machine (0.5 mm/min). Data (MPa) were subjected to one-way ANOVA and Tukey's test (α = 0,05). Results The groups SBU and ALLB had significantly higher SBS than those provided by the group U, in which the lowest values were observed. For the AMBAR group, intermediate SBS values were found, which did not differ significantly from the values observed in the other groups. Conclusion Regardless of resins cement, the use of adhesives containing phosphate monomers provided superior bond strength than self-adhesive cement.

RESUMO Objetivo Avaliar a resistência de união por cisalhamento (RU) de uma cerâmica de dissilicato de lítio (CDL) à zircônia (Y-TZP) utilizando diferentes estratégias de cimentação. Métodos Cilindros de CDL foram cimentados à estrutura de Y-TZP de acordo com os seguintes sistemas adesivos (SA)/ Cimentos resinosos (CR) (n=15): U: CR autoadesivo de cura dual; AMBAR: SA contendo monômeros fosfatados (MF) + CR convencional de cura dual; SBU: SA contendo MF/silano + RC de cura fotoativada; ALLB: SA contendo MF/silano + CR de cura dual. Os corpos de prova foram submetidos ao teste de cisalhamento em máquina universal de ensaios (0.5 mm/min). Os dados (MPa) foram submetidos a ANOVA a um critério e teste de Tukey (α = 0,05). Resultados Observou-se que os grupos SBU e ALLB promoveram valores de RU estatisticamente superiores ao grupo U, no qual observou-se a menor média de RU. Para o grupo AMBAR, valores de RU intermediários foram encontrados, os quais não diferiram dos demais grupos. Conclusão Independente do cimento resinoso, o uso de sistemas adesivos contendo monômeros fosfatados em sua composição promoveram resistência de união superior ao cimento resinoso autoadesivo.

Effect of green tea extract on bonding durability of an etch-and-rinse adhesive system to caries-affected dentin

ABSTRACT Objective Green tea extract has been advocated as a matrix metalloproteinase (MMP) inhibitor; however, its effect on bond durability to caries-affected dentin has never been reported. Thus, the aim of this in vitro study was to evaluate the effect of two MMP inhibitors (2% chlorhexidine and 2% green tea extract), applied after acid etching, on bond durability of an etch-and-rinse adhesive system to caries-affected dentin. Material and Methods Occlusal enamel was removed from third molars to expose the dentin surface, and the molars were submitted to a caries induction protocol for 15 days. After removal of infected dentin, specimens were conditioned with 37% phosphoric acid (15 seconds) and randomly divided into three groups, according to the type of dentin pretreatment (n=10): NT: no treatment; GT: 2% green tea extract; CLX: 2% chlorhexidine. The etch-and-rinse adhesive system (Adper™ Single Bond 2, 3M ESPE, St. Paul, MN, USA) was applied according to the manufacturer's instructions, and composite resin restorations were built on the dentin. After 24 hours, at 37°C, the resin-tooth blocks were sectioned perpendicularly to the adhesive interface in the form of sticks (0.8 mm2 of adhesive area) and randomly subdivided into two groups according to when they were to be submitted to microtensile bond strength (μTBS) testing: immediately or 6 months after storage in distilled water. Data were reported in MPa and submitted to two-way ANOVA for completely randomized blocks, followed by Tukey’s test (α=0.05). Results After 24 hours, there was no significant difference in the μTBS of the groups. After 6 months, the GT group had significantly higher μTBS values. Conclusion It was concluded that the application of 2% green tea extract was able to increase bond durability of the etch-and-rinse system to dentin. Neither the application of chlorhexidine nor non-treatment (NT - control) had any effect on bond strength after water storage.

Effect of 10% sodium bicarbonate on bond strength of enamel and dentin after bleaching with 38% hydrogen peroxide / Efeito do bicarbonato de sódio a 10% na resistência de união do esmalte e dentina após clareamento com peróxido de hidrogênio a 38%

Introduction: By-products of hydrogen peroxide degradation released during dental bleaching influence the polymerization of adhesive systems and composite resins, causing a reduction in shear bond strength to the tooth. Objective: the aim of this article was to evaluate the effect of 10% sodium bicarbonate (SB), applied for different lengths of time, on the shear bond strength to enamel and dentin after bleaching. Material and method: Enamel and dentin blocks were divided into groups (n=10): (1) control: no bleaching; (2) immediate: bleaching immediately followed by restoration; (3) 14-day: bleaching, restoration 14 days later; (4) SB for 10 minutes: bleaching, SB gel for 10 minutes, immediately followed by restoration; (5) SB for 20 minutes: bleaching, SB gel for 20 minutes, immediately followed by restoration. A 38% hydrogen peroxide gel (Opalescence Boost/Ultradent) was used. After application of the adhesive system, composite resin cylinders were mounted on the surface of the substrates in order to test shear bond strength. Result: ANOVA and Tukey tests showed significantly higher mean enamel bond strength values for the 14-day follow-up group and without significant differences for control group. Mean bond strength values obtained for the other groups were intermediate. When testing dentin, the Tukey test revealed a significantly higher mean bond strength value for the 14-day follow-up group when compared with application of SB for 20 minutes. Conclusion: SB gel applied was unable to reverse the low bond strength to enamel and dentin after bleaching treatment.

Introdução: Subprodutos da degradação do peróxido de hidrogênio liberados durante o clareamento dental influenciam a polimerização de sistemas adesivos e resinas compostas, levando à redução da resistência de união à estrutura dental. Objetivo: O objetivo deste trabalho foi avaliar o efeito do bicarbonato de sódio a 10% (BS), aplicado por diferentes períodos de tempo na resistência de união ao esmalte e dentina após o clareamento. Material e método: Blocos de esmalte e dentina de terceiros molares humanos foram separados em grupos (n=10): (1) controle: ausência de clareamento; (2) imediato: clareamento seguido por restauração imediata; (3) 14 dias: clareamento, restauração 14 dias após; (4) BS por 10 minutos: clareamento, gel de BS por 10 minutos, restauração imediata; (5) BS por 20 minutos: clareamento, gel de BS por 20 minutos, restauração imediata. Um gel de peróxido de hidrogênio a 38% (Opalescence Boost/Ultradent) foi utilizado. Após aplicação do sistema adesivo, cilindros de resina composta foram confeccionados na superfície dos substratos para avaliar a resistência por cisalhamento. Resultado: ANOVA e teste de Tukey mostraram valores médios significativamente mais elevados para o grupo "14 dias" e sem diferença significativa do grupo "controle". Médias de valores para os outros grupos foram intermediárias. Para dentina, o teste de Tukey revelou maiores médias de valores significativos para a resistência de união para o grupo "14 dias" quando comparado à aplicação do BS por 20 minutos. Conclusão: O gel de BS não foi capaz de reverter os baixos valores de resistência de união ao esmalte e dentina após o tratamento clareador.