A multilevel analysis model for dental caries determinants in independently-living elderly

To evaluate the prevalence of untreated caries and its association with biological, individual, and environmental variables in independently-living elderly people. Methods: This cross-sectional study included 72 elderly (≥60 years) patients of a university dental clinic in Belo Horizonte, Brazil. Sociodemographic data, systemic diseases, medications, and free sugar intake were collected. Visible plaque, Decayed, Missing, and Filled Teeth (DMFT), and Decayed and Filled Root (DFR) indexes were assessed through clinical examination. Unstimulated saliva was collected to determine salivary flow, pH, and buffering capacity. Descriptive analysis and multilevel logistic regression analysis were performed following a dental caries theoretical model (p <0.05, 95% CI). Results: The mean DMFT and DFR were 24.44 (SD=4.59) and 3.21 (SD=2.93), respectively. The prevalence of untreated caries was 61.11%. In the adjusted multilevel regression model involving 1639 teeth, untreated dental caries was significantly associated with the presence of biofilm (OR = 1.84; 95% CI: 1.24­2.74), salivary buffering capacity (OR = 0.87; 95% CI: 0.77­0.99) and per capita income (OR = 0.06; 95% CI: 0.004­0.74). Conclusion: The experience of dental caries was widespread among independently-living elderly patients, and its variability was best explained by the presence of biofilm, reduced salivary buffering capacity, and low per capita income. A comprehensive assessment is needed of the biological, individual, and environmental factors related to the presence of dental caries in independently-living elderly people

Association between Dentin Hypersensitivity and Health/Oral Health-related Quality of Life: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To investigate the association between DH and Health (HRQoL) or Oral Health-Related Quality of Life (OHRQoL). Material and Methods: PubMed, Web of Science, Scopus, EMBASE, Cochrane, Scielo, LILACS/BBO, Biblioteca Digital de Teses e Dissertações (BDTD), Open Grey, and Google Scholar databases were screened in September 2019 (updated in October 2022). Observational studies were selected to compare HRQoL/OHRQoL(outcome) according to DH(exposure) or evaluate the association among these variables. Standardized Joanna Briggs Institute critical appraisal tool for analytical cross-sectional studies was used to analyze the risk of bias. A random-effects meta-analysis was conducted to synthesize evidence for the association between DH and OHRQoL. Results: 10 papers met inclusion criteria and were evaluated. In most studies, presenting or having a greater intensity of DH was associated with a negative impact on one's quality of life. However, most of these studies showed a moderate to high risk of methodological bias. The consistent finding from studies with a low risk of bias suggests a significant association between DH and OHRQoL. Meta-analysis was feasible for three studies with substantial heterogeneity. The pooled Odds Ratio was 2.14 (95%CI 1.15-3.99; I2= 57,44%). Conclusion: Many studies presented a high risk of bias; therefore, the actual effect of DH on one's quality of life remains uncertain.

Anatomical post: a simple and safe alternative

Objective: To describe a clinical case that called for an anatomical post to be made to support and retain an indirect restoration in the anterior tooth. Case report: A 72-year-old female patient came to the office complaining that the crown of tooth 22 had come loose. A clinical and radiographic examination of element 22 was performed, and showed a very broad root canal, total displacement of the cast metal crown-core set, and satisfactory endodontic treatment. The restorative planning for this patient included the making of an anatomical post from Exacto # 2 fiberglass post (Angelus, Brazil), and refilling it with Bulk One composite resin (3M, USA), using self-adhesive resin cement U200 (3M, USA). The reconstruction of the coronary portion of the post was also performed with the same composite resin (Bulk One 3M, USA). The preparation for full crown and temporary restoration was performed in the same session, using self-curing acrylic resin. The all-ceramic crown was molded and cemented in subsequent sessions. Conclusion: The use of anatomical posts with composite resin represents a technically viable alternative for rehabilitating endodontically treated teeth with wide root canals, in cases where conventional prefabricated fiber posts cannot be adapted easily. The advantages that stand out are that these posts can be applied easily, at low cost, and in a single session.

Objetivo: Descrever um caso clínico de confecção do pino anatômico para suporte e retenção de restauração indireta em dente anterior. Relato do Caso: Paciente feminina, 72 anos, compareceu ao consultório queixando-se que a coroa do dente 22 havia "soltado". Realizou-se exame clínico e radiográfico do elemento 22, que apresentou conduto radicular bastante amplo, deslocamento total do conjunto núcleo/coroa e tratamento endodôntico satisfatório. O planejamento restaurador para essa paciente incluiu a confecção de pino anatômico, com pino de fibra de vidro Exato #2(Angelus, Brasil) reembasado com resina composta Bulk One (3M, EUA), utilizando o cimento resinoso autoadesivo U200 (3M, EUA). Foi realizada a reconstrução da porção coronária do pino também com resina composta do tipo Bulk. Realizou-se, na mesma sessão de atendimento, o preparo para coroa total e restauração provisória utilizando dente de estoque e resinaacrílica autopolimerizável. Em sessões seguintes foi realizada a moldagem e cimentação da coroa total em cerâmica pura. Conclusão: A utilização de pinos anatômicos com resina composta representa uma alternativa tecnicamente viável, de fácil aplicabilidade, com baixo custo e em única sessão, para reabilitação de dentes tratados endodonticamente com conduto radicular onde os pinos em fibra pré-fabricados convencionais não apresentam boa adaptação.

Obliteration of Dentinal Tubules by Desensitizing Agents Based on Silver Fluoride/Potassium Iodide or Pre-Reacted Glass Particles: An in Vitro Study

Abstract Objective: To evaluate the efficacy of desensitizing agents for the obliteration of dentinal tubules subjected or not to a simulated oral environment. Material and Methods: Dentinal discs (n=8) treated with Riva-Star (RS) or PRG-Barrier-Coat (PRG) were submitted (cycled) or not submitted (control) to erosive-abrasive-thermal cycles and evaluated using scanning electron microscopy/energy dispersive spectroscopic analysis. The variables analyzed were tubule obliteration and dentin surface chemical composition. Data were analyzed by non-parametric tests (p<0.05). Results: The cycled and control groups did not differ significantly for the responses in each material. The PRG control and cycled groups had fewer visible tubules and a higher proportion of totally obliterated tubules than the RS groups. The percentages of silver coverage were higher in the RS-control than in the RS-cycled. There was a significant inverse correlation between the presence of silver and non-obliterated tubules (R=-0.791; p<0.001). The percentages of carbon, aluminum, strontium, and potassium were significantly higher in the PRG-control and PRG-cycled compared to the RS control. The percentages of calcium, phosphorus, and silver were significantly higher in the RS compared to the PRG groups. PRG-control showed a higher percentage of boron than RS-control. Conclusion: PRG promoted greater tubule obliteration than SR. Simulated stress did not affect the obliterating effect of each agent. Greater silver coverage corresponded to a lower proportion of non-obliterated tubules in RS. Carbon, aluminum, strontium, boron, and potassium predominated in the dentin surface treated with PRG, while calcium, phosphorus, and silver prevailed in RS groups (AU).

Grafting biomaterials associated to topical glucocorticoid: effects on pre-osteoblastic cells (MC3T3-E1)

Abstract The topical glucocorticoid budesonide has been prescribed before and after sinus lift surgery as adjuvant drug treatment for maxillary sinus membrane inflammation. However, there is no study on the effects of budesonide on the regenerative process of bone grafting biomaterials. We investigated the effect of the association of budesonide with some biomaterials on the growth and differentiation capacity of pre-osteoblastic cells (MC3T3-E1 subclone 4). Xenogeneic (Bio-Oss and Bio-Gen) and synthetic hydroxyapatites (Osteogen, Bonesynth, and HAP-91) were tested in conditioned medium (1% w/v). The conditioned medium was then supplemented with budesonide (0.5% v/v). Cell viability was assessed using the MTT assay (48, 96, and 144 h), and mineralized nodules were quantified after 14 days of culture using the Alizarin Red Staining. Alkaline phosphatase activity was assessed through the release of thymolphthalein at day seven. All biomaterials showed little or no cytotoxicity. The Bio-Gen allowed significantly less growth than the control group regardless of the experimental time. Regarding differentiation potential of MC3T3-E1, the HAP-91-conditioned medium showed remarkable osteoinductive properties. In osteodifferentiation, the addition of budesonide favored the formation of mineral nodules when cells were cultured in medium conditioned with synthetic materials, whereas it weakened the mineralization potential of cells cultured in xenogeneic medium. Regardless of whether budesonide was added or not, Osteogen and Bio-Oss showed higher alkaline phosphatase activity than the other groups. Budesonide may improve bone formation when associated with synthetic biomaterials. Conversely, the presence of this glucocorticoid weakens the mineralization potential of pre-osteoblastic cells cultured with xenogeneic hydroxyapatites.

Effect of surface treatments on staining and roughness of bleached enamel

Background: The objectives were to evaluate the effect of surface treatments and waiting time before contact with dye on bleached enamel staining and surface treatments on roughness. Methods: One hundred bleached teeth were randomly assigned to G1 artificial saliva, G2 2% sodium fluoride (Flugel, Nova DFL), G3 casein phosphopeptide-amorphous calcium phosphate fluoride paste (MI Paste Plus, GC America), G4 rinse for bleached color maintenance (Keep White Rinse, DMC), and G5 polishing with impregnated disks (SuperBuff Disk, Shofu). Fifty specimens were immersed in coffee immediately after treatment; the others 1 h after. Color difference (ΔE) was evaluated with a spectrophotometer (Vita EasyShade) and roughness (Ra, Rq) with an optical profilometer (NewView 7300). Effects were analyzed with two-way ANOVA, Friedman, and Kruskal–Wallis test (P < 0.05). Results: Surface treatments (P = 0.878), waiting time (P = 0.105), and interaction (P = 0.145) were not significant to bleached color maintenance. Roughness was different among the evaluation time points (2nd evaluation >1st evaluation >3rd evaluation) (P < 0.001); not among surface treatments (G1, G2, G3, G4, G5) (P > 0.05). Conclusions: Surface treatments were similar to saliva for bleached enamel color maintenance. Immediate or 1-h postponed contact with coffee did not affect bleached enamel color. Bleaching increased enamel roughness; surface treatments and artificial saliva decreased it.

Avaliação topográfica e in vitro de superfícies de titânio revestidas com vidro bioativo / Topographic and in vitro evaluation of titanium surfaces coated with bioative glass

Objetivo: Avaliar e comparar a rugosidade superficial e a atividade dos osteoblastos em contato com uma nova superfície bioativa e nanoestruturada de titânio grau 4 revestida com vidro bioativo contendo fosfato de cálcio, sintetizada pelo método sol-gel. Material e método: Sessenta e três discos de titânio, medindo 4 mm de diâmetro por 2 mm de altura, foram preparados e divididos em três grupos: microtexturizado (Ticp - controle); revestido com vidro bioativo e seco a vácuo a 37 °C por 10 dias (BGTi37), e revestido com vidro bioativo e aquecido a 600 °C por cinco horas (BGTi600). Três espécimes de cada grupo foram utilizados para avaliação da topografia superficial e 18 espécimes, para cultura celular. Resultado: O revestimento de vidro bioativo diminuiu a rugosidade média quando comparado ao titânio microtexturizado. A proporção de células viáveis, a produção de fosfatase alcalina e o grau de mineralização da matriz óssea em contato com os espécimes de titânio do grupo BGTi600 foram significativamente menores em relação aos grupos controle e do titânio microtexturizado. Conclusão: Apesar de sua marcante menor rugosidade, a superfície BGTi37 apresentou comportamento biológico semelhante a uma superfície de titânio microtexturizada e moderadamente rugosa. A outra superfície experimental (BGTi600), a de menor rugosidade entre todas as testadas, apresentou os piores resultados de ativação dos osteoblastos.

Objective: To evaluate and compare the surface roughness and the activity of the osteoblasts in contact with a new bioactive and nanostructured surface of grade 4 titanium coated with bioactive glass containing calcium phosphate synthesized by the sol-gel method. Material and method: Sixty-three titanium disks, measuring 4 × 2 mm, were prepared and divided into three groups: rough surface, obtained by sandblasted, large-grit, acid-etched (SLA) treatment (Ticp); SLA surface coated with bioglass and dried in a vacuum at 37 °C for 10 days (BGTi37) and SLA surface coated with bioglass and dried in air at 600 °C for 5 hours (BGTi600). Three specimens of each group were used for evaluation of surface topography and 18 for cell cultures. Result: The bioactive glass coating decreased the average roughness when compared to rough titanium surface. The proportion of viable cells, the production of alkaline phosphatase and the degree of mineralization of the bone matrix in contact with the titanium specimens of the BGTi600 group was significantly lower in relation to the control and rough titanium surface groups. Conclusion: Despite its marked lower roughness, BGTi37 surface presented a similar biological behavior to a titanium rough surface obtained by SLA treatment. The other experimental surface (BGTi600), the one with the least roughness among all tested, presented the worst results of osteoblast activation.

Lipid accumulation product index in HIV-infected patients: a marker of cardiovascular risk

ABSTRACT The lipid accumulation product (LAP) index is an emerging cardiovascular risk marker. We aimed to assess the accuracy of this index as a marker of cardiovascular risk in HIV-infected patients. A cross-sectional study of 133 HIV-infected patients on antiretroviral drugs and 20 non-infected controls was conducted at the outpatient clinic of a referral center of infectious and parasitic diseases. Evaluations included LAP index, homeostasis model assessment (HOMA) index, anthropometric measurements, blood pressure, glucose tolerance test, and cholesterol and triglyceride levels. Body mass index (BMI) was similar in both groups; however, waist circumference was greater in the HIV-infected patients. Triglyceride levels were significantly higher (p < 0.001) and HDL cholesterol levels were lower in HIV-infected patients (p < 0.001). Plasma glucose (p = 0.01) and insulin (p = 0.005) levels two hours after a glucose load, HOMA-IR index (p < 0.001) and LAP index (p < 0.001) were higher in the HIV-infected patients. A positive and significant correlation was found between HOMA-IR index and LAP (r = 0.615; p < 0.01), BMI (r = 0.334; p < 0.01) and waist circumference (r = 0.452; p < 0.01) in the HIV-infected patients. In male HIV-infected patients and controls, ROC curve analyses revealed that the best cut-off value of LAP to define the presence of insulin resistance was 64.8 (sensitivity 86%, specificity 77% and area under the curve 0.824). These results confirm that insulin resistance is more common in HIV-patients on antiretroviral drugs than in HIV-negative controls. A positive and significant correlation was found between the LAP index and the HOMA index, with LAP ≥ 64.8 constituting an additional risk factor for cardiovascular disease in male HIV patients.

Influence of light transmission through fiber posts: Quantitative analysis, microhardness, and on bond strength of a resin cement

Light transmission (LT) into deeper areas of the dentin root is limited. Aim: The aim of this study is to perform a quantitative investigation of the radial transmission of light (LT) through different fiber posts and its influence on the Knoop hardness number (KHN) and bond strength (BS) of a dual-cure self-adhesive resin cement at 3 different depths. Materials and Methods: Four types of fiber posts (2 translucent and 2 conventional) were used. LT and KHN analyses were performed in a specially designed matrix, which allowed measurements at 3 different depths. LT was measured using a volt-ampere meter while KHN tests were performed in a microhardness tester. For BS analysis, endodontically treated bovine roots were divided into 4 groups, each group receiving one type of post. After cementation, cross sections of the root were tested for resistance to displacement using a universal testing machine. Statistical Analysis Used: Statistical analysis was performed by using this ANOVA and Tukey's test. Results: For LT, translucent posts showed significantly higher values at all depths compared to the conventional ones. For all posts, LT decreased at the deeper depths. The KHN results showed no statistical differences among the different posts, regardless of depth. For BS, a translucent post showed the highest values, and comparative analyses between the different depths of posts also showed statistically significant differences while comparisons among the different depths of the same post showed no differences. Conclusions: LT depended on the type of post and on depth. The type of post did not significantly influence the cement KHN. A translucent post showed higher BS in pooled data.

Ultramorphology of pre-treated adhesive interfaces between self-adhesive resin cement and tooth structures / Ultramorfologia de interfaces adesivas entre cimento resinoso auto-adesivo e estruturas dentárias pré-tratadas

Introduction: Convencional resin cements can be used in combination with a total-etch system in a conventional mode or as self-adhesive resin cements. The latter are less technique sensitive and able to bond to dental tissues without previous treatment or adhesive layer and requires only a single step to be applied to dental structures. Objective: To compare qualitatively the adhesive interfaces of two self-adhesive resin cements and one conventional resin cement after different tooth surface treatments under scanning electron microscopy. Material and method: 42 crowns of bovine incisors were sectioned and flattened exposing enamel (E) or dentine (D) substrate. Subgroups were defined according to conditioning type and time: E1—no treatment, E2—37% phosphoric acid for 15 seconds, E3—37% phosphoric acid for 30 seconds; D1—no treatment, D2—37% phosphoric acid for 5 seconds; D3—11.5% polyacrylic acid for 15 seconds. A resin block was bonded to each substrate using the self-adhesive resin cements RelyX U100 (3M ESPE) and RelyX U200 (3M ESPE). As a reference hybrid layer, six resin blocks were luted with RelyX ARC and Scotchbond Multi-Purpose adhesive system (3M ESPE) (enamel—EA; dentine—DA). After aging for 7 days in a moist environment at 37±1°C, samples were prepared for microscopy analysis. Result and Discussion: In the ARC specimens, there was hybrid layer formation in both EA and DA. U100 E1 showed gaps at the adhesive interface, while E2 and E3 showed interaction for both self-adhesive cements. There was superficial interaction with bothU100 and U200 in D1, while in D2 and D3, resin tags were only observed in the case of U100. Conclusion: It was concluded that substrate conditioning may enhance the interaction between self-adhesive resin cements and dental tissues, although this is not the case for RelyX U200 and dentine.

Introdução: Restaurações estéticas indiretas são preferencialmente cimentadas utilizando-se cimentos resinosos convencionais e sistema adesivo de condicionamento total ou cimentos resinosos autoadesivos. Estes últimos são tecnicamente menos sensíveis e aderem aos tecidos dentários sem tratamento prévio ou aplicação de adesivo, com um único passo para sua aplicação aos tecidos dentários. Objetivo: Comparar qualitativamente as interfaces adesivas de dois cimentos resinosos autoadesivos e um cimento resinoso convencional, sob microscopia eletrônica de varredura. Material e método: 42 coroas de incisivos bovinos foram seccionadas e as faces vestibulares planificadas expondo esmalte (E) ou dentina (D). Os subgrupos foram definidos de acordo com o tipo e tempo de condicionamento: E1-sem tratamento, E2-37% de ácido fosfórico por 15 segundos, E3-37% de ácido fosfórico por 30 segundos; D1-sem tratamento, D2-37% de ácido fosfórico durante 5 segundos; D3-11,5% de ácido poliacrílico durante 15 segundos. Um bloco de resina foi unido a cada substrato usando os cimentos resinosos autoadesivos RelyX U100 e RelyX U200 (3M ESPE) (n=3). Como referência de camada híbrida, foram cimentados seis blocos de resina com RelyX ARC e o sistema adesivo Scotchbond Multi-Purpose(esmalte-EA, dentina-DA). Após armazenamento (7 dias, umidade, 37±1°C), as amostras foram preparadas para análise microscópica. Resultado: Nos espécimes ARC, houve formação de camada híbrida em EA e DA. U100 E1 mostrou lacunas na interface adesiva, enquanto E2 e E3 apresentaram boa interação para ambos os cimentos autoadesivos. Houve interação superficial com U100 e U200 em D1, enquanto em D2 e ​​D3, foram observadas tags de resina apenas para U100. Conclusão: Concluiu-se que o condicionamento do substrato pode aumentar a interação entre cimentos resinosos autoadesivos e os tecidos dentários, embora este não seja o caso do RelyX U200 e da dentina.

Influence of Different Photoinitiators on Polymerization Kinetics and Marginal Microleakage in Restorations using Photopolymerizable Dental Composites

Objective: To evaluate the influence of four different photoinitiators on the polymerization kinetics and marginal microleakage in class V restorations using photopolymerizable dental composites. Material and Methods: Four photopolymerizable dental composites based on Bis-GMA (14.5 wt %), UDMA (6.5 wt %) and silanized filler particles (79 wt %) containing different photoinitiators were formulated. Camphorquinone (CQ)/amine, phenyl-propanedione (PPD), monoacylphosphine oxide (Lucirin® TPO) and bisacylphosphine oxide (Irgacure® 819) were used as photoinitiators. Sixteen intact human third molars were selected and divided into four groups. All teeth received class V cavity preparations in their buccal and lingual surfaces and were submitted to a dye leakage test. Data were independently analyzed for both enamel and dentin, and the results were assessed by a Kruskal-Walis test. The polymerization reactions of the four composites were evaluated by differential scanning calorimeter coupled with photocalorimeter accessory. Results: Lucirin® TPO presented the highest scores for microleakage in enamel, whereas the other photoinitiators have not demonstrated statistical differences. The lowest scores were obtained for PPD in dentin while the highest scores have been achieved by Irgacure® 819 and Lucirin® TPO. Photocalorimetric measurements demonstrated a correlation between polymerization reaction rate and marginal leakage, showing that faster reactions cause greater marginal leakage. Conclusion: Marginal microleakage scores in photopolymerizable dental composites can be greatly influenced by different types of photoinitiators through their distinct reaction rates.

Comparison of Resin Cement Insertion Techniques for Luting Fiberglass Posts

Objective: To evaluate the effect of two insertion techniques of self-adhesive dual resin cement on the bond strength of fiberglass posts in different portions of the root. The homogeneity of the cement layer along the root canal was also evaluated. Material and Methods: The root canals of 28 bovine teeth were instrumented, filled, and 14mm-space was prepared for luting fiberglass posts (Reforpost #3, Angelus), maintaining 4mm of apical sealing. The roots were randomly allocated into two groups according to the cement insertion technique (n=14): Lentulo Drill (Dentsply/Maillefer) or Centrix syringe (Dentsply). The posts were fixed with self-adhesive resin cement (RelyX U200, 3M ESPE). After 7 days, the roots were cross-sectioned to obtain three 1.0-mm-thick samples of each third of the space prepared for the post. Two samples of each third were subjected to push-out test (0.5 mm/min; 200N) and the third specimen was used for the analysis of cementation layer homogeneity. Images of specimens (40x magnification) were assessed and classified by two calibrated examiners (Kappa = 0.87) according to the presence or absence of voids and misfit. Data were analyzed by two-way ANOVA and Pearson Chi-Square test. Results: There was no statistically significant effect of insertion technique (p=0.278) or post-space thirds (p = 0.521) on bond strength of fiberglass posts. Chi-Square test showed that cement insertion with the Lentulo drill produced more cement voids than Centrix syringe (p = 0.023). Conclusion: The cement insertion technique did not influence bond strength of fiberglass posts in bovine root dentin. The use of Centrix syringe for cement insertion is preferred since it produced more homogenous cement layer.

LED and Halogen Light Transmission through a CAD/CAM Lithium Disilicate Glass-Ceramic

The effect of thickness, shade and translucency of CAD/CAM lithium disilicate glass-ceramic on light transmission of light-emitting diode (LED) and quartz-tungsten-halogen units (QTH) were evaluated. Ceramic IPS e.max CAD shades A1, A2, A3, A3.5, high (HT) and low (LT) translucency were cut (1, 2, 3, 4 and 5 mm). Light sources emission spectra were determined. Light intensity incident and transmitted through each ceramic sample was measured to determine light transmission percentage (TP). Statistical analysis used a linear regression model. There was significant interaction between light source and ceramic translucency (p=0.008) and strong negative correlation (R=-0.845, p<0.001) between ceramic thickness and TP. Increasing one unit in thickness led to 3.17 reduction in TP. There was no significant difference in TP (p=0.124) between shades A1 (ß1=0) and A2 (ß1=-0.45) but significant reduction occurred for A3 (ß1=-0.83) and A3.5 (ß1=-2.18). The interaction QTH/HT provided higher TP (ß1=0) than LED/HT (ß1=-2.92), QTH/LT (ß1=-3.75) and LED/LT (ß1=-5.58). Light transmission was more effective using halogen source and high-translucency ceramics, decreased as the ceramic thickness increased and was higher for the lighter shades, A1 and A2. From the regression model (R2=0.85), an equation was obtained to estimate TP value using each variable ß1 found. A maximum TP of 25% for QTH and 20% for LED was found, suggesting that ceramic light attenuation could compromise light cured and dual cure resin cements polymerization.

Resumo Avaliou-se o efeito da espessura, cor e translucidez de uma cerâmica vítrea a base de dissilicato de lítio para CAD / CAM sobre a transmissão da luz de unidades de diodos emissores de luz (LED) e de quartzo-tungstênio-halogênio (QTH). Cerâmica IPS e.max CAD nas cores A1, A2, A3, A3.5 de translucidez alta (HT) e baixa (LT) foram cortadas (1, 2, 3, 4, 5 mm). Os espectros de emissão das fontes de luz foram determinados. A intensidade da luz incidente e transmitida através de cada espécime de cerâmica foi medida para determinar a percentagem de transmissão de luz (TP). Um modelo de regressão linear foi utilizado para a análise estatística. Houve interação significativa entre a fonte de luz e translucidez cerâmica (p = 0.008) e forte correlação negativa (r = -0.845, p <0.001) entre a espessura da cerâmica e TP. O aumento da espessura em uma unidade levou a uma redução média de 3.17 em TP. Não houve diferença significativa em TP (p = 0.124) entre as cores A1 (ß1 = 0) e A2 (ß1 = -0.45), mas ocorreu redução significativa para as cores A3 (ß1 = -0.83) e A3.5 (ß1 = -2.18). A interação QTH/HT proporcionou maior TP (ß1 = 0) do que LED/HT (ß1 = -2.92), QTH/LT (ß1 = -3.75) e LED/LT (ß1 = -5.58). A transmissão de luz foi mais eficaz utilizando QTH e cerâmica de alta translucidez, diminuiu à medida que a espessura de cerâmica aumentou, e foi maior para as cores A1 e A2. A partir do modelo de regressão (R2 = 0.85), obteve-se uma equação para estimar o valor de TP utilizando os valores de ß1 encontrado. Foi observada TP máxima de 25% para QTH e 20% para LED, sugerindo que a atenuação promovida pela cerâmica pode comprometer a ativação de um cimento resinoso fotoativado e de ativação dupla.

Definitive Presurgical CAD/CAM-Guided Implant-Supported Crown in an Esthetic Area

This paper describes the digital workflow from cone beam computer tomography (CBCT) to the installation of a definitive presurgical zirconium individual crown in a 19-year-old woman requiring implant replacement of a maxillary right lateral incisor. The patient had agenesis of this tooth and had completed the orthodontic treatment. CBCT was conducted and diagnostic casts were digitized. Virtual planning was completed by defining a prosthetically driven implant and a stereolithographic surgical template was produced. Good adaptation of a stereolithographic surgical template was verified in the working cast. Implant and abutment were installed in this cast using a stereolithographic surgical template, and a CAD/CAM definitive zirconium crown was produced. Flapless computer-guided implant surgery was performed. The abutment was connected, and a definitive zirconium crown was cemented using resin cement. The digital workflow presented herein shows high accuracy for a virtually planned implant with flapless guided placement, allowing the successful delivery of a definitive presurgical zirconium single crown in an esthetic area in a single visit. The patient was revaluated after 1 year of function with an excellent outcome of the treatment.

Resumo Este relato descreve o fluxo de trabalho digital desde tomografia de feixes cônicos até a instalação de uma coroa unitária pré cirúrgica definitiva em zircônia em uma mulher de 19 anos que necessitava de reabilitação com implante do incisivo lateral superior direito. A paciente apresentava agenesia deste dente e tinha finalizado o tratamento ortodôntico. Foi realizada a tomografia e os modelos diagnósticos foram digitalizados. O planejamento virtual do implante foi definido pelo planejamento protético virtual e em seguida um guia cirúrgico foi produzido pelo método da esteriolitografia. Foi verificada a boa adaptação deste guia cirúrgico sobre o modelo de trabalho. O implante e o pilar foram instalados neste modelo de trabalho usando o guia cirúrgico e confeccionada coroa pré cirúrgica definitiva em zircônia pela técnica de CAD / CAM. A cirurgia guiada de instalação do implante foi realizada sem deslocamento de retalho. O pilar selecionado foi instalado e coroa pré cirúrgica definitiva em zircônia foi cimentada com cimento resinoso. O fluxo de trabalho digital apresentado mostrou grande precisão para instalação guiada do implante em uma área estética, permitindo a instalação de uma coroa pré cirúrgica definitiva em zircônia em uma única sessão clínica. A paciente foi reavaliada e apresentou excelentes resultados do tratamento após um ano em função.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.

Review of follow-up of clinical success of implant-supported complete dental prostheses / Revisão do sucesso clínico longitudinal dos implantes pilares de prótese total

OBJECTIVE: The aim of this study was to assess the clinical success rate of implant-supported complete dental prostheses, which are being used as a feasible alternative in planning of oral rehabilitation. Over the years, the two-stage surgical protocol has increasingly been replaced by immediate loading procedures, especially in the mandibular anterior region in cases of rehabilitation of completely edentulous patients. This procedure has become feasible due to the high success rate of the technique with very satisfactory results. METHODS: By means of a literature review focused on published articles with clinical follow-up between 8 and 15 years. RESULTS: Implants placed in the mandible had higher success rates than those inserted in the maxilla. Cases with longer follow-up periods, 15 years, showed higher success rates in comparison with follow-up periods of 8 and 10 years. CONCLUSION: Success rates of implant-supported complete dental prostheses are very high. .

OBJETIVO: Avaliar o índice de sucesso clínico dos implantes pilares de próteses totais implantossuportadas. As próteses implantossuportadas vêm sendo utilizadas como uma alternativa viável ao planejamento de reabilitação oral. O protocolo de dois estágios cirúrgicos, ao passar dos anos, vem sendo cada vez mais substituídos pelos procedimentos de carga imediata, principalmente na região anterior inferior, nos casos de reabilitação de pacientes totalmente desdentados. Tal procedimento torna-se viável devido ao alto índice de sucesso da técnica com resultados bastante satisfatórios. MÉTODOS: Por meio de uma revisão de literatura focada em trabalhos publicados com acompanhamento clínico entre 8 e 15 anos. RESULTADOS: Os implantes instalados em mandíbula apresentaram índices de sucesso maiores que os instalados em maxila. Os casos com acompanhamento mais longos, com 15 anos, apresentaram índices de sucesso maiores do que quando comparados aos acompanhamentos de 8 e 10 anos. CONCLUSÃO: O índice de sucesso dos implantes pilares de prótese total é bastante alto. .

Perfil e produção científica dos pesquisadores brasileiros do CNPq em Periodontia / Profile and scientific production of Brazilian researchers of CNPq in Periodontics

Introdução: indicadores bibliométricos apontam para mudanças na produção científica, evidenciando sua expansão internacional e nacional.Em comum às demais áreas da saúde, a investigação científica em Periodontia está aumentando exponencialmente. Objetivo: avaliar o perfil e a produção científica de pesquisadores brasileiros na área de Periodontia do Conselho Nacional de Desenvolvimento Científico e Tecnológico. Metodologia: estudo de caráter transversal, observacional e descritivo, utilizando-se de dados secundários. Informações relativas ao perfil e produção científica dos pesquisadores da área de Periodontia foram coletadas a partir de consultas ao currículo Lattes de todos os pesquisadores bolsistas de produtividade na área de Odontologia. A produção científica considerada correspondeu ao biênio 2011/2012. Resultados: a amostra de estudo foi composta por 32 pesquisadores, sendo a maioria do sexo masculino (65,6%), pertencente à categoria 2 de bolsa (75%), especialistas (56,3%) e atuantes, sobretudo, no estado de São Paulo (71,9%). A maioria (71,9%) concluiu o doutorado entre 11 e 20 anos atrás e em instituições brasileiras (84,4%). Universidades paulistas respondem pela graduação da maioria. Maiores médias (10,31) de publicação em periódicos Qualis A internacional, de capítulos de livro (2,31) e de orientações de mestrado (3,50) foram observadas. Conclusão: a maioria dos pesquisadores de Periodontia é do sexo masculino, encontra-se no estado de São Paulo e concluiu seu doutorado há mais de uma década. Periódicos Qualis A internacional respondem pela maioria de suas publicações e orientações de mestrado pela principal formação de recursos humanos. Tais achados indicam relevante contribuição desses pesquisadores para a produção odontológica nacional.

Silorane-based composite as repair material: a six-month randomizedclinical trial / Resina composta à base de silorano como material de reparo: estudo clínico randomizado de seis meses

Objective: This study investigated the clinical performance of a silorane-based composite resin when used for repairing conventional composite restorations. Methods: Defective dimethacrylate-based composite resin restorations were randomly assigned to one of two treatment groups: Control group - Adper SE Plus + Filtek P60 (3M/ESPE, St. Paul, EUA) and Test Group - P90 Adhesive System + Filtek P90 (3M/ESPE, St. Paul, EUA). All repaired restorations were evaluated at baseline, and at six-month recall. The parameters examined were marginal adaptation, anatomic form, surface roughness, marginal discoloration, post-operative sensitivity and secondary caries. The restorations were classified according to modified USPHS criteria. Mann-Whitney and Wilcoxon tests were used to compare the groups. Results: Of the 100 restorations repaired in this study, 93 were reexamined at baseline and 91 at 6-month recall. Drop-out was about 9%. No statistically significant differences were found between the materials for all clinical criteria, at baseline and at 6-month recall (p > 0.05). No statistically significant differences were registered (p > 0.05) for each material when compared for all clinical criteria, at baseline and at 6-month recall. The hypothesis tested in this randomized controlled clinical trial was accepted. Conclusion: After the six-month evaluations, silorane-based composite exhibit a similar performance compared to dimethacrylate-based composite when used as repair material.

Objetivo: Investigar o desempenho clínico de uma resina de baixa contração à base de silorano quando utilizada para reparar restaurações convencionais de resina composta. Métodos: Restaurações defeituosas de resina composta à base de dimetacrilato foram aleatoriamente reparadas por um de dois grupos de tratamento: Grupo Controle - Adper SE Plus + Filtek P60 (3M/ESPE, St. Paul, EUA) e Grupo Teste - Sistema adesivo P90 + Filtek P90 (3M/ESPE, St. Paul, EUA). Todas as restaurações reparadas foram avaliadas em baseline e ao longo de 6 meses. Os parâmetros analisados foram a adaptação marginal, forma anatômica, rugosidade superficial, descoloração marginal, sensibilidade pós-operatória e lesões de cárie. As restaurações foram classificadas de acordo com os critérios do Serviço de Saúde Público dos Estados Unidos modificados. Os testes de Mann-Whitney e Wilcoxon foram utilizados para comparar os grupos. Resultados: Das 100 restaurações reparadas neste estudo, 93 foram examinadas uma semana após terem sido reparadas - baseline e 91 após 6 meses. A perda foi de aproximadamente 9%. Nenhuma diferença estatisticamente significativa foi encontrada entre os materiais para todos os critérios clínicos, em baseline e ao longo de 6 meses (p> 0,05). Conclusão: A hipótese testada neste ensaio clínico controlado randomizado foi aceita. Após 6 meses de avaliações, resinas compostas à base de silorano apresentaram desempenho clínico semelhante às resinas compostas à base de dimetacrilato quando utilizadas para reparar restaurações de resina composta à base de dimetacrilato.

Associações entre fatores de risco e complicações bucais em pacientes com câncer de cabeça e pescoço tratados com radioterapia associada ou não à quimioterapia / Association between risk factors and oral complications in patients with head and neck cancer treated with radiotherapy combined or not with chemotherapy

Objetivo: descrever as reações adversas que ocorreram em pacientes durante a radioterapia associada ou não à quimioterapia, bem como avaliar suas possíveis associações com fatores de risco. Métodos: neste estudo longitudinal prospectivo foram examinados 28 pacientes antes, durante e após completar seis meses do término do tratamento oncológico. Os dados coletados foram idade, gênero, cor da pele, tabagismo, etilismo. Sobre o tumor, foram registrados a localização, a classificação TNM (tamanho do tumor, presença de linfonodo acometido e metástase à distância), o tipo histológico, o grau de diferenciação, o número de frações da radioterapia e o tratamento oncológico proposto. Os pacientes foram encaminhados ao Projeto de Oncologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais e receberam adequação do meio bucal antes do tratamento oncológico. Durante a radioterapia foram coletados dados relativos à presença de mucosite, xerostomia, disfagia, ardência e candidose. Após análise descritiva dos dados, as associações entre efeitos adversos durante a radioterapia e fatores de risco foram verificadas usando os testes do Qui-quadrado e Exato de Fisher (p menor que 0,05). Resultados: foi encontrada maior frequência de pacientes do sexo masculino (78,6%), leucoderma (71,4%) com carcinoma de células escamosas (78,6%). A prevalência da mucosite grau I, II e III, xerostomia, disfagia, candidose e ardência foram de 10,7%; 82,2%; 7,1%; 96,4%; 53,6%; 28,6% e 57,1%, respectivamente. Associação estatisticamente significativa foi encontrada somente entre presença ou ausência de maxilares irradiados e mucosite (p=0,03). Conclusão: efeitos adversos ocorreram durante a radioterapia associada ou não à quimioterapia em pacientes com câncer em região de cabeça e pescoço. Associação significativa foi verificada entre o local de irradiação e a presença de mucosite.

Objective: This study described the adverse reactions that occurred in patients during radiotherapy combined or not with chemotherapy, and assessed their possible associations with risk factors. Method: Using a prospective cross-sectional design, 28 patients were evaluated before, during and six months after the end of cancer treatment. The following data were collected: age, gender, ethnicity, smoking and alcohol consumption. Information recorded about the tumor included primary site of tumor, TNM classification (tumor size, lymph node status and distant metastasis), histological type, differentiation grade, number of fractions of radiotherapy and oncologic treatment protocol. The patients were referred to the Oncology Project of the School of Dentistry of the Federal University of Minas Gerais, and had their oral cavity prepared for cancer treatment. During radiotherapy, data were collected with respect to mucositis, xerostomia, dysphagia, burning sensation, and candidosis. After descriptive analysis of data, the associations between adverse effects raised during radiotherapy and risk factors were verified using the Chi-square and Fisher's Exact Test (p less than 0.05). Results: There was a predominance of male (78.6%), Caucasian (71.4%) patients with squamous cell carcinoma (78.6%). The prevalence of mucositis grades I, II, III, xerostomia, dysphagia, candida infections and burning sensation was 10.7%, 82.2%, 7.1%, 96.4%, 53.6%, 28.6% and 57.1%, respectively. A statistically significant association was found only between the presence or absence of irradiation of jaws and mucositis (p=0.03). Conclusion: Oral complications occurred during radiotherapy in combination or not with chemotherapy in patients with cancer in the head and neck region. A significant association was found between the site of irradiation and the presence of mucositis.

Standard of disocclusion in complete dentures supported by implants without free distal ends: analysis by the finite elements method

OBJECTIVE: The occlusal patterns are key requirements for the clinical success of oral rehabilitation supported by implants. This study compared the stresses generated by the disocclusion in the canine guide occlusion (CGO) and bilateral balanced occlusion (BBO) on the implants and metallic infrastructure of a complete Brånemark protocol-type denture modified with the inclusion of one posterior short implant on each side. MATERIAL AND METHODS: A three-dimensional model simulated a mandible with seven titanium implants as pillars, five of them installed between the mental foramen and the two posterior implants, located at the midpoint of the occlusal surface of the first molar. A load of 15 N with an angle of 45° was applied to a tooth or distributed across three teeth to simulate the CGO or BBO, respectively. The commercial program ABAQUS® was used for the model development, before and after the processing of the data. The results were based on a linear static analysis and were used to compare the magnitude of the equivalent stress for each of the simulations. RESULTS: The results showed that the disocclusion in CGO generated higher stresses concentrated on the working side in the region of the short implant. In BBO, the stresses were less intense and more evenly distributed on the prosthesis. The maximum stress found in the simulation of the disocclusion in CGO was two times higher than that found in the simulation of the BBO. The point of maximum stress was located in the neck of the short implant on the working side. CONCLUSIONS: Under the conditions of this study, it was concluded that the BBO pattern was more suitable than CGO for the lower complete denture supported by implants without free distal ends.