CHX stabilizes the resin/demineralized dentin interface

Abstract The aim of this study was to evaluate the effect of 2% chlorhexidine digluconate (CHX) on microtensile bond strength (µTBS) between an adhesive system and under 3 dentin conditions. For that, this study evaluated the adhesive interface at initial, after 6 months and 1 year of storage. Forty-eight human third molars were prepared and randomly divided into 3 groups, according to dentin substrates: sound dentin (Sd), caries-infected dentin (Ci) and caries-affected dentin (Ca). The groups were subdivided into two according to the dentin pre-treatment: application of 2% CHX or without pre-treatment (control). The dentin surfaces were etched with 35% phosphoric acid gel and bonded with Adper Single Bond 2 (3M ESPE) adhesive system according to manufacturer's instructions. Subsequently, the specimens were stored in deionized water at 37°C for 24h, 6 months and 1 year. Two additional teeth were used to analyze the bonding interfaces by SEM. Data was submitted to three-way ANOVA in a split plot design and Tukey's test (α = 0.05). The results showed that Ci decreased µTBS values when compared to Ca and Sd, regardless storages time or treatment. Stored samples for 6 months and 1 year decreased the µTBS for the control group, but no difference was found between storages time for the CHX group. As a conclusion, the 2% CHX application after etching showed improved dentin bond strength in the storage time, regardless of the substrates evaluated.

Resumo O objetivo deste estudo foi avaliar o efeito do digluconato de clorexidina 2% (CHX) na resistência de união à microtração (µTBS) entre um sistema adesivo e sob 3 condições de dentina. Para tanto, este estudo avaliou a interface adesiva no início, após 6 meses e 1 ano de armazenamento. Quarenta e oito terceiros molares humanos foram preparados e divididos aleatoriamente em 3 grupos, de acordo com os substratos dentinários: dentina hígida (Dh), dentina infectada por cárie (Di) e dentina afetada por cárie (Da). Os grupos foram subdivididos em dois de acordo com o pré-tratamento: aplicação de CHX 2% ou sem pré-tratamento (controle). As superfícies da dentina foram condicionadas com gel de ácido fosfórico a 35%, em seguida, utilizou-se o sistema adesivo Adper Single Bond 2 (3M ESPE) de acordo com as instruções do fabricante. Posteriormente, os corpos-de-prova foram armazenados em água deionizada a 37°C por 24h, 6 meses e 1 ano. Dois dentes adicionais foram usados ​​para analisar as interfaces de união no MEV. Os dados foram submetidos a ANOVA três fatores em esquema de parcela subdividida e ao teste de Tukey (α = 0,05). Os resultados mostram que a Di diminuiu os valores de µTBS quando comparado as Da e Dh, independente do tempo de armazenamento ou tratamento. Amostras armazenadas por 6 meses e 1 ano diminuíram a µTBS para o grupo de controle, mas nenhuma diferença foi encontrada entre o tempo de armazenamento para o grupo CHX. A aplicação de CHX 2% após o condicionamento apresentou melhora na resistência de união à dentina no tempo de armazenamento, independente dos substratos avaliados.

Influence of Different Dentin Substrate (Caries-Affected, Caries-Infected, Sound) on Long-Term muTBS

Abstract The aim of this study was to evaluate the μTBS in different dentin substrates and water-storage periods. Twenty-four dentin blocks obtained from sound third molars were randomly divided into 3 groups: Sound dentin (Sd), Caries-affected dentin (Ca) and Caries-infected dentin (Ci). Dentin blocks from Ca and Ci groups were subjected to artificial caries development (S. mutans biofilm). The softest carious tissue was removed using spherical drills under visual inspection with Caries Detector solution (Ca group). It was considered as Ci (softer and deeply red stained dentin) and Ca (harder and slightly red stained dentin). The Adper Single Bond 2 adhesive system was applied and Z350 composite blocks were built in all groups. Teeth were stored in deionized water for 24 h at 37 ºC and sectioned into beams (1.0 mm2 section area). The beams from each tooth were randomly divided into three storages periods: 24 h, 6 months or 1 year. Specimens were submitted to µTBS using EZ test machine at a crosshead speed of 1.0 mm/min. Failure mode was examined by SEM. Data from µTBS were submitted to split plot two-way ANOVA and Tukey’s HSD tests (a=0.05). The µTBS (MPa) of Sd (41.2) was significantly higher than Ca (32.4) and Ci (27.2), regardless of storage. Ca and Ci after 6 months and 1 year, presented similar µTBS. Mixed and adhesive failures predominated in all groups. The highest µTBS values (48.1±9.1) were found for Sd at 24 h storage. Storage of specimens decreased the µTBS values for all conditions.

Resumo O objetivo neste estudo foi avaliar a resistência de união à microtração (RUµT) de um sistema adesivo convencional (Adper Single Bond 2 - SB) em diferentes substratos dentinários e períodos de armazenagem. Vinte e quatro blocos de dentina foram obtidos de terceiros molares hígidos e separados aleatoriamente em 3 grupos (n=8): dentina sadia (Ds), dentina afetada (Da) e dentina infectada (Di). A Da e a Di foram submetidas ao desenvolvimento biológico artificial de cárie (S. mutans). O tecido cariado amolecido foi removido usando broca esférica sob inspeção visual com a solução Caries Detector (grupo Da). Considerou-se como Di a dentina amolecida e fortemente pigmentada de vermelho e como Da, a dentina hígida e levemente pigmentada de vermelho. O sistema adesivo SB foi aplicado de acordo com as recomendações do fabricante e blocos da resina composta Z350 foram construídos (6 mm de altura). O conjunto (dente/bloco de resina) foi armazenado em água deionizada por 24 horas a 37 °C. Estes foram seccionados em palitos (1,0 mm2 de área), que foram separados aleatoriamente em 3 períodos de armazenagem: 24 horas, 6 meses e 1 ano. Os palitos foram submetidos ao ensaio de resistência de união à microtração na máquina EZ teste a uma velocidade de 1,0 mm/min. Dados de RUµT foram submetidos à Análise de Variância 2 fatores em esquema de parcela subdividida e ao teste de Tukey (a=0,05). Os valores de resistência (MPa) da Ds (41,2) foram significativamente maiores do que os da Da (32,4) e Di (27,2), independente do tempo de armazenagem. Di e Da, 6 meses e 1ano, apresentaram valores similares de resistência de união. As falhas adesivas e mistas foram predominantes para todos os grupos. Em conclusão, os maiores valores de RUµT (48,1±9,1) foram verificados para a Ds e 24 h de armazenagem. A armazenagem diminuiu os valores de RUµT para todas as condições.

Influence of crosshead speed on failure load and failure mode of restored maxillary premolars

We analyzed the effect of the crosshead speed of an applied load on failure load and failure mode of restored human premolars. Fifty intact, noncarious human premolars were selected. Class II mesio-occlusodistal preparations were made with a water-cooled high-speed preparation machine, and the teeth were restored with composite resin. The specimens were divided into five groups (n = 10 each) and tested individually in a mechanical testing machine, in which a 6.0-mm-diameter steel cylinder was mounted to vary the crosshead speed: v0.5: 0.5 mm/min; v1: 1.0 mm/min; v2.5: 2.5 mm/min; v5: 5.0 mm/min; and v10: 10.0 mm/min. The cylinder contacted the facial and lingual ridges beyond the margins of the restorations. Peak load to fracture was measured for each specimen (N). The means were calculated and analyzed with one-way analysis of variance followed by Tukey's test (a = 0.05). The mean load at failure values were (N) as follows: v0.5, 769.4 ± 174.8; v1, 645.2 ± 115.7; v5, 614.3 ± 126.0; v2.5, 609.2 ± 208.1; and v10, 432.5 ± 136.9. The fracture modes were recorded on the basis of the degree of the tooth structural and restorative damage: (I) fracture of the restoration involving a small portion of the tooth; (II) fractures involving the coronal portion of the tooth with cohesive failure of the composite resin; (III) oblique tooth and restoration fracture with periodontal involvement; and (IV) vertical root and coronal fracture. Varying crosshead speeds of 0.5–5.0 mm/min did not influence the failure load of restored maxillary premolars; however, increasing the crosshead speed to 10 mm/min decreased the failure load values and the degree of tooth structural damage.

Impact of excess cement removal on vertical misfit and cement line quality in onlays / Impacto da remoção do excesso de cimento sobre desadaptação e qualidade da linha de cimento em onlays

Aim: To evaluate vertical misfit and cement line quality of onlays cemented with resin luting cements using two different methods for removal of excess cement. Materials & Methods: Lithium di-silicate restorations were fabricated and cemented at 24 human molars that received onlay type preparations. The specimens were randomly divided in two groups (n = 12): Group 1 (G1) where cement excess was removed at pre-gel stage and Group 2 (G2) with cement excess was removed after polymerization. Vertical misfits measurements at cement line were performed twice, before and after cementation. Epoxy resin replicas were obtained from the specimens and cement line quality was analyzed with a scanning electron microscope before and after the finishing and polishing procedures. The replicas were also classified according to their condition in unsatisfactory, acceptable or good. Vertical misfits values were submitted to Student test (p < 0.05) and the quality line data were analyzed with Mann-Whitney for independent samples (p < 0.05) and Wilcoxon test for paired specimens (p < 0.05). Results: Vertical misfit and cement line quality presented no difference values to G1 (26.60 ± 8.0) and G2 (24.10 ± 8.0). However, finishing and polishing procedures affect positively the cement line quality in both groups (p = 0.59). Conclusion: The cement excess removal methods had no influence on vertical misfit and cement line quality for restorations. Finishing and polishing procedures improved the cement line quality in both groups.

Objetivo: Avaliar adaptação marginal e a influência do polimento sobre a linha de cimentação de restaurações cerâmicas cimentadas com cimento resinoso utilizando duas formas dois métodos de remoção do excesso do cimento. Métodos: Foram fabricadas restaurações em cerâmica reforçada por dissilicato de Lítio e cimentadas à vinte e quatro molares humanos que receberam preparos protéticos tipo onlay. Os corpos de prova foram divididos aleatoriamente em dois grupos (n = 12): Grupo 1 (G1) em que o excesso de cimento foi removido no estágio pré-gel e Grupo 2 (G2) em que o excesso de cimento foi removido após a polimerização. A mensuração da desadaptação marginal foi realizadas em dois momentos, antes e depois da cimentação. Réplicas em resina epóxi de todos os corpos de prova foram confeccionadas para avaliação da qualidade da linha de cimentação utilizando um microscópio eletrônico de varredura antes de depois dos procedimentos de acabamento e polimento e classificado como insatisfatório, aceitável e boas condições. Os valores de desadaptação foram submetidos ao teste t de Student (p < 0,05) e os dados de qualidade da linha de cimentação foram analisados pelo teste de Mann-Whitney para amostras independentes (p < 0,05) e pelo teste de Wilcoxon para amostras pareadas (p < 0,05). Resultados: A desadaptação marginal e a qualidade da linha de cimentação não apresentaram diferença significativa G1 (26,60 ± 8,0) e G2 (24,10 ± 8,0). Entretanto, os procedimentos de acabamento e polimento influenciaram positivamente a qualidade da linha de cimentação em ambos grupos (p = 0,59). Conclusão: O método de remoção do excesso de cimento não influenciou a adaptação ou a qualidade da linha de cimentação das restaurações cerâmicas. Os procedimentos de acabamento e polimento melhoraram a qualidade da linha de cimento nos dois grupo

Terapia periodontal de suporte: objetivos, procedimentos e intervalos / Supportive periodontal therapy: objectives, procedures and intervals

A Terapia Periodontal de Suporte (TSP) denota a necessidade básica dos procedimentos terapêuticos para que os pacientes, por meio de esforços próprios, possam controlar a infecção periodontal, sendo considerada abordagem que está diretamente relacionada com o sucesso da terapia periodontal como um todo. Inúmeras experiências clínicas sobre os efeitos em longo prazo do tratamento de periodontite têm demonstrado que manutenção profissional cuidadosa pós-terapêutica é parte integrante do tratamento periodontal, constituindo o único meio de garantir a manutenção por longo período dos efeitos benéficos da terapia. Assim, o objetivo desse artigo é revisar alguns aspectos relacionados à TSP, incluindo filosofia e periodicidade do tratamento, índices para controle periodontal, abordagem profissional, recursos e técnicas disponíveis bem como o processo de reavaliação de pacientes. A avaliação desses tópicos permite afirmar que a TSP é pré-requisito indiscutível para garantir resultados benéficos dos tratamentos com manutenção dos níveis de inserção clínica por longos períodos de tempo, mesmo que abordagens em relação à avaliação contínua do risco nos níveis do paciente, dos dentes e dos sítios dos dentes representem desafio para o conceito da TSP.

Supportive Periodontal Therapy (SPT) denotes the basic need of therapeutic procedures in order patients can control periodontal infection through their own efforts, considering the approach that is directly related to the success of the periodontal therapy as a whole. Several clinical experiences on long-term effects of periodontitis treatments have shown that a careful professional post-therapeutic maintenance therapy is part of the periodontal treatment, consisting in the only means of assuring the maintenance of the therapy beneficial effects in long term. This paper aims to review a few aspects related to SPT, including philosophy and frequency of treatment, periodontal control indexes, professional approach, available resources and techniques, as well as the process of reassessing patients. The analysis of those topics allows us to state that SPT is an undeniable prerequisite to ensure beneficial outcomes of periodontal treatment with maintenance of clinical attachment levels for long periods, even though approaches to continuous assessment of the patient?s risk levels, teeth and tooth sites pose a challenge to SPT concept.

Permeability, roughness and topography of enamel after bleaching: tracking channels of penetration with silver nitrate

Aim: This study evaluated the surface roughness, topography and permeability of bovine enamel by profilometry and scanning electron microscopy (SEM) with and without silver nitrate solution, after exposure to different bleaching agents. Methods: Fifty-two enamel samples were randomly divided into four groups (n=13): CP16% –16% carbamide peroxide - Whiteness Perfect; HP6% - 6% hydrogen peroxide - White Class; HP35% - 35% hydrogen peroxide Whiteness HP Maxx; and Control - not bleached and kept in artificial saliva. For roughness analysis, average surface roughness (Ra) and flatness coefficient (Rku) parameters were used. The topography and permeability were examined by SEM. For permeability evaluation, the samples were immersed in a 50% silver nitrate solution and analyzed using a backscattered electron and secondary electron mode. Results: For the roughness (Ra) evaluation, Kruskal-Wallis and Wilcoxon Signed Ranks Test were used, showing an increase on the surface roughness in all bleached groups. The Rku parameter suggested changes on enamel integrity. The SEM micrographs indicated changes on enamel topography and different levels of silver nitrate penetration in the samples of the bleached groups. In the overall analysis, the bleaching agents promoted surface changes and higher silver nitrate penetration when compared to the control group. Conclusions: It may be concluded that different bleaching agents might alter the topography and roughness of enamel surface. Moreover, the higher infiltration of silver nitrate suggests an easier penetration path for the oxygen molecules into the dentin substrate.

Apical obturation quality of Epiphany/Resilon root canal filling system

Aim: This study analyzed by scanning electronic microscopy (SEM) the quality of the apical obturation of a methacrylate based (polycaprolactone) root-canal filling system (Epiphany/Resilon) compared to that of an epoxy-resin based endodontic sealer (Sealer 26/gutta-percha). Methods: Twenty roots of human maxillary canines were debrided using ProTaper nickel-titanium rotary instruments and 2.5% NaOCl solution. The roots were divided into two groups (n=10): group I was sealed with Epiphany/Resilon and group II with Sealer 26/gutta-percha points. After set, the apical region of the roots was abraded until filling exposure and was then sectioned to obtain 2-mm–thick specimens. The specimens were analyzed by SEM and the images obtained were recorded and evaluated using an integration grid that permitted the quantification of the obturated area. Results: Statistical analysis (2-way ANOVA - Bonferroni test - p<0.05) revealed no significant difference (p>0.05) between the root canal filling systems. Conclusion: In conclusion, the two tested root canal filling systems showed similar behavior regarding to the quality of the apical obturation.