A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up

Abstract Objective To compare the effectiveness of ART restorations using High Viscosity Glass-ionomer cement (HVGIC) with conventional restorations using resin composite in Class II cavities of permanent teeth, in a 2-year follow-up. Methodology Seventy-seven restorations were made with each restorative material, Equia Fil-GC Corporation (ART restorations) and Z350-3M (conventional restoration), in 54 participants in this parallel and randomized clinical trial. Restorations were evaluated at 6 months, 1 and 2 years using the ART and the modified United States Public Health Service (USPHS) criteria. Chi-square test and Survival Analysis (p<0.05) were used for statistical analysis. Results The success rates for ART restorations were 98.7% (6 months) and 95.8% (1 year) for both criteria. At 2 years, success rate was 92% and 90.3% when scored by the modified USPHS and ART criteria (p=0.466), respectively. The success rates for conventional restorations were 100% (6 months), 98.7% (1 year) and 91.5% (2 years) for both assessment criteria. ART restorations presented a lower survival rate by the criterion of ART (83.7%) when compared to the modified USPHS criterion of (87.8%), after 2 years (p=0.051). The survival of conventional restorations was 90.7% for both evaluation criteria. Conclusion At the 2-years follow-up evaluation, no statistically significant difference was observed between the success rate of ART restorations with HVGIC compared to conventional restorations with resin composite in Class II cavities of permanent teeth.

Dental caries spectrum profile in Brazilian public school children and adolescents

Abstract Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

Molecular response of pulp fibroblasts after stimulation with pulp capping materials

Abstract This in vitro study evaluated cell viability and metabolism, nitric oxide release and production of two chemokines and one cytokine by cultured human dental pulp fibroblasts (HDPF) in contact with two glass ionomer cements (Ketac Molar-KM and Vitrebond-VB), Single Bond (SB) and calcium hydroxide (Dycal-DY). Cultures of HDPF were established by means of an explant technique. The specimens were prepared under sterile conditions and in disks measuring 5 mm x 2 mm obtained from a prefabricated mold and placed on a permeable membrane to avoid direct contact with the cells. Cytotoxicity was assessed by Trypan Blue exclusion method and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Nitric oxide release in cell supernatant was detected by the Griess Method whereas stromal derived factor-1 alpha (SDF-1α or CXCL12), chemokine (C-X-C motif) ligand 8 [Interleukin 8 (IL-8 or CXCL8)] and interleukin-6 (IL-6) were detected by ELISA. RT-qPCR was employed for gene expression analysis. Statistical analyses were performed by One-way ANOVA followed by Tukey's post hoc test for materials independent of the time, and Two-way ANOVA followed by Bonferroni correction test for the comparisons between materials and experimental time (p<0.05). Cytotoxic tests showed significant differences only for DY. Protein levels and mRNA expression were significantly increased for IL-8 for both periods of time. IL-6 production increased when fibroblasts were stimulated by KM. SDF-1α protein production and mRNA expression were not affected by any of the materials. There was a decrease in nitrate/nitrite levels only for KM. Although DY caused intense cell death and did not stimulate the production of the inflammatory mediators evaluated in this work, it is known that this event seems to be fundamental for the process of repair of the pulp tissue and formation of mineralized barrier. KM and VB increased production of proteins related to the inflammatory process, thus favoring tissue repair. Therefore, although these glass ionomer cements did not lead to large cell death, they should be used with caution.

Resumo Este estudo avalia in vitro a viabilidade e metabolismo celular, a liberação de óxido nítrico e a produção de duas quimiocinas e uma citocina por fibroblastos de polpa dentária humana em cultura (FPDH) em contato com dois cimentos de ionômero de vidro (Ketac Molar-KM e Vitrebond-VB), Single Bond (SB) e hidróxido de cálcio (Dycal-DY). As culturas de FPDH foram estabelecidas por meio de uma técnica de explante. As amostras foram preparadas em condições estéreis e em discos de 5 mm x 2 mm, obtidas de um molde pré-fabricado e colocadas em uma membrana permeável (Maxicell 24 W 0,4 µm) para evitar o contato direto com as células. A citotoxicidade foi avaliada pelo método de exclusão de Trypan Blue e pelo ensaio de MTT. A liberação de óxido nítrico no sobrenadante celular foi detectada pelo método Griess, enquanto fator 1 derivado do estroma (SDF-1α ou CXCL12), interleucina-8 (IL-8 ou CXCL8) and interleucina-6 (IL-6) foram detectados por ELISA. RT-qPCR foi empregada para análise de expressão gênica. As análises estatísticas foram realizadas por ANOVA a 1 critério, seguida pelo pós-teste de Tukey para os materiais independentes do tempo, e ANOVA a 2 critérios, seguida pelo teste de correção de Bonferroni para comparações entre materiais e tempo experimental (p<0,05). Os testes citotóxicos mostraram diferenças significativas apenas para DY. Os níveis da proteína e a expressão de RNAm para IL-8 aumentaram significativamente para ambos os tempos estudados. A produção de IL-6 aumentou quando os fibroblastos foram estimulados por KM. A produção da proteína e a expressão de RNAm para SDF-1α não foram afetadas por nenhum dos materiais. Houve uma diminuição nos níveis de nitrato/nitrito apenas para KM. Embora o DY tenha causado intensa morte celular e não tenha estimulado a produção dos mediadores inflamatórios avaliados neste trabalho, sabe-se que esse evento parece ser fundamental para o processo de reparo do tecido pulpar e formação de barreira mineralizada. Os cimentos de ionômero de vidro utilizados aumentaram a produção de proteínas relacionadas ao processo inflamatório, favorecendo a reparação tecidual e, portanto, esses materiais, embora não causem grande morte celular, devem ser utilizados com cautela.

Correlation between mechanical properties and stabilization time of chemical bonds in glass-ionomer cements

Abstract The objective was to evaluate the compressive strength (CS), diametral tensile strength (DTS), flexural strength (FS), and Knoop microhardness (KH) of different conventional restorative glass-ionomer cements (GICs) and to correlate these mechanical properties (MP) with the stabilization time (ST) of their chemical bonds. Eighteen GICs were tested: Bioglass [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z[ IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [Ma], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. The mechanical strength tests were performed in a universal testing machine. KH readings were done with a diamond indenter. STs were examined by Fourier Transform Infrared spectroscopy (FTIR). Data were analyzed with ANOVA and Tukey test (p<0.05). The Spearman rank test was used to evaluate the dependence between the MPs and ST results. The highest MP values were EF, GL2, GL9, GI and KM and the lowest for MG, MA, B, VF and IM. The longest ST was for GL2 and the shortest was for B. ST correlated positively with MP. GICs with longer chemical bonds ST are generally stronger and the ST value obtained from FTIR was useful in predicting the strength of GICs tested.

Proximal retention grooves may increase early fracture strength of ART restorations / Sulcos de retenção proximal podem aumentar a resistência a fratura precoce de restaurações de ART

Objective: To evaluate the fracture resistance (RF) of Class II Glass-ionomer Cement (GIC) ART restorations with and without proximal retentions. Material and Methods: 20 freshly extracted human molars were used. Forty (40) standard Mesial-Occlusal (MO) and DistalOcclusal (DO) preparations (20 for each material) were performed with a 245 bur. The unprepared surfaces of the teeth were protected with nail polish and the specimens submerged in 0.5Mol EDTA solution, pH 7.4 for 8h under stirring. The preparations were finished with dentine spoons and 50% received proximal retention with # 3 excavators. 20 cavities were restored with Chemfil Rock (10 with retention and 10 without retention) and 20 cavities were restored with Equia Fil (10 with retention and 10 with no retention) and were stored in an oven at 37ºC and 100% relative humidity for 24h and submitted to axial compression loading in Test Machine - EMIC at a rate of 0.5 mm / minute, until restoration fracture occurred. The values were analyzed by two-way ANOVA (p<0.05). Results: ChemFil Rock presented 300.84 (69.20) (without retention) and 361.70 (81.08) (with retention) and Equia Fil showed 314.60 (69.97) (without retention) and 366.67 (103.38) (with retention). Data obtained with retention were statistically superior to those obtained with non-retained ART restorations (p=0.014). No statistical differences were detected between materials (p=0.761). Conclusion: Retentive grooves improved fracture resistance of Class II GIC ART restorations. (AU)

Objetivo: avaliar a resistência à fratura (FR) de restaurações de ART de Classe II de Cimento de ionômero de vidro (CIV) com e sem retenções proximais. Material e Métodos: Foram utilizados 20 molares humanos recém-extraídos. 40 cavidades padronizadas no sentido Mesial-Oclusal (MO) e Oclusal-Distal (OD) (20 para cada material) foram realizadas com uma broca 245. Os preparos cavitários foram submersos em solução 0,5 mol Mol EDTA, pH 7,4 por 8h sob agitação e foram finalizados com colheres de dentina, nos quais 50% receberam retenções proximais com escavadores #3. 20 cavidades foram restauradas com Chemfil Rock (10 com e 10 sem retenção) e 20 cavidades foram restauradas com Equia Fil (10 com e 10 sem retenção) e armazenadas em estufa a 37ºC e 100% de umidade relativa por 24h e submetidos a carga axial de compressão na máquina de ensaios EMIC a uma taxa de 0,5mm/min, até que a fratura de restauração ocorresse. Os valores foram analisados por ANOVA twoway (p<0,05). Resultados: ChemFil Rock apresentou 300.84 (69.20) (sem retenção) e 361.70 (81.08) (com retenção) e o Equia Fil apresentou 314.60 (69.97) (sem retenção) e 366.67 (103.38) (com retenção). Os dados obtidos com retenção foram estatisticamente superiores àqueles sem retenção (p=0.014). Não houve diferença estatística entre os materiais (p=0.761). Conclusão: Os sulcos retentivos melhoraram a resistência à fratura de restaurações de ART de Classe II de Cimento de ionômero de vidro (CIV).(AU)

Mechanical and optical properties of conventional restorative glass-ionomer cements - a systematic review

Abstract Objectives To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs. Material and Methods Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity. Sources The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided. Conclusions It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Dental pulp fibroblasts response after stimulation with hema and adhesive system

Abstract This study evaluated in vitro cell viability and metabolism, nitric oxide release and production of chemokines by cultured human dental pulp fibroblasts (DPF) under contact with HEMA and Single Bond. Cultures of DPF were established by means of an explant technique. Once plated, cells were kept under contact with increasing concentrations of HEMA (10, 100 and 1000 nM) or Single Bond (SB) [10-fold serially diluted in culture medium (10-4, 10-3 and 10-2 v/v)] and also with polymerized SB components. Cytotoxicity was assessed by Trypan Blue exclusion method and MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. Nitric oxide release on cell supernatant was detected by Griess Method whereas chemokines (CXCL12 and CXCL8) were detected by ELISA. RT-qPCR was employed for chemokines gene expression analysis. Cytotoxic tests showed significant differences for SB 10-2. None of the tested materials significantly altered NO levels. Protein levels of CXCL12 were significantly decreased only by HEMA. On the other hand, while CXCL12 mRNA remained unaltered, gene expression of CXCL8 had significant decrease with all materials, except for polymerized SB. In conclusion, Single Bond and HEMA at various concentrations, decreased expression and production of molecules involved in inflammatory processes and, therefore, the use of adhesive systems such as pulp capping materials must be viewed with caution due to its large cytotoxic effect when in close contact with the pulp.

Resumo Este estudo avaliou in vitro a viabilidade e metabolismo celular, liberação de óxido nítrico e produção de quimiocinas em cultura de fibroblastos de polpa dental humana (DPF) em contato com HEMA e Single Bond. Culturas de DPF foram estabelecidas por meio de uma técnica de explante. Uma vez plaqueadas, as células foram mantidas em contato com concentrações crescentes de HEMA (10, 100 e 1000 nM) ou Single Bond (SB) [10 vezes diluídas em série em meio de cultura (10-4, 10-3 e 10-2 v/v)] e também com SB polimerizado. A citotoxicidade foi avaliada pelo método de exclusão de Trypan Blue e pelo ensaio de 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazólio brometo (MTT). A liberação de óxido nítrico no sobrenadante celular foi detectada pelo método de Griess, enquanto as quimiocinas (CXCL12 e CXCL8) foram detectadas por ELISA. RT-qPCR foi empregada para análise de expressão gênica de quimiocinas. Testes citotóxicos mostraram diferenças significativas para SB 10-2. Nenhum dos materiais testados alterou significativamente os níveis de NO. Os níveis de proteína de CXCL12 foram significativamente diminuídos apenas pelo HEMA. Por outro lado, enquanto o RNAm de CXCL12 permaneceu inalterado, a expressão gênica de CXCL8 teve redução significativa com todos os materiais, com exceção do SB polimerizado. Em conclusão, Single Bond e HEMA, em várias concentrações, diminuíram a expressão e produção de moléculas envolvidas em processos inflamatórios e, portanto, o uso de sistemas adesivos, como o material protetor da polpa, deve ser visto com cautela devido ao seu grande efeito citotóxico quando em contato com a polpa.

Association Between Presence of Enamel Defects, Dental Caries and Socioeconomic Conditions on Brazilian Children

Objective: To verify the relationship between developmental enamel defects (DED) in permanent incisors and socioeconomic conditions and dental caries in children within the life course context. Material and Methods: A total of 350 children aged 9-11 years from 13 public schools in the city of Bauru, Brazil were examined. Clinical exams were performed to observe the presence of caries and developmental enamel defects using the DMFT and DED indexes, respectively. In addition, information about family income and parental schooling was collected. Statistical analysis used the Spearman Correlation Coefficient and the Chi-square test to verify the association between DED, socioeconomic conditions and dental caries. The significance level adopted was 5%. Results: Association between presence of dental caries and DED (p=0.04), delimited opacity (p=0.02) and opacity (p=0.01) was observed. Inverse correlation for the decayed component with maternal schooling and family income was also verified. Regarding the types of development enamel defect (DED), correlation between delimited opacity, opacity and DED with the DMFT index was observed. Conclusion: The results of this study indicated association between enamel defects and caries, as well as correlation between income and parental schooling and dental caries.

Using UV light for adhesive remnant removal after debonding of orthodontic accessories

Abstract The objective of this study was to assess the effect of a UV light-based auxiliary illumination on adhesive remnant (AR) removal after orthodontic debonding. Sixty human molars were divided according to the adhesive used for bonding: O-opaque; LF-low fluorescence; and HF-high fluorescence. After debonding, the teeth were subdivided according to the AR removal method: No UV light or With UV light. After AR removal, the teeth were polished. Direct visual analysis, scanning electron microscopy (SEM) and time quantification for AR removal analyses were performed (Fisher-Freeman-Halton, Fisher's exact, chi-square trend, ANOVA, and independent t-tests; α = 5%). Concerning the adhesives, there was no significant difference among direct visual, SEM and time analyses for AR removal (p ≥ 0.05). Regarding AR removal methods, a similarity among the subgroups was verified for direct visual and SEM analyses (p≥0.05). However, a significant trend was verified for the with UV light method to produce greater marks, and the no UV light method, to produce a greater rate of samples with AR before polishing (p = 0.015). AR removal with light was significantly quicker in comparison with the no UV light method (p < 0.0001). The use of UV light may aid orthodontists in removing AR more thoroughly and in less time. However, they should receive special training to apply this technology, and should never dismiss the final polishing procedure.

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

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

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

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

Endocrown: a conservative approach / Endocrown: uma abordagem conservadora

The purpose of this clinical case description article was to present the planning sequence, indication, treatment and performance to obtain a crown of the Endocrown type. This clinical case description article illustrates a therapeutic option for functional and esthetic rehabilitation of a devitalized mandibular molar, presenting a small amount of remaining coronal tooth structure, by means of cementing a pure porcelain crown of the Endocrowntype (Adhesive Endodontic Crown). A 39-year-oldwoman presented to the Graduate clinic of the Bauru Dental School (FOB), University of São Paulo (USP),with the complaint that tooth #36 had an extensive and unsatisfactory composite resin restoration. The lithium disilicate-based system of monolithic porcelain was used with the lost wax technique. This therapy promoted the stability and retention of the indirect restoration, without the need for performing reconstruction of the above mentioned tooth, either by means of a cast metal core or reconstruction with intracanal post, there by reducing the treatment time. After the tooth preparation, the provisional restoration was done with acrylic resin to determine if the retention and stability of the remaining tooth was adequate to receive the indirect. The characteristics of the internal and external walls of the dental remnants, cervical termination, impression-taking, laboratory stages and adhesive cementation will be discussed. The major advantage of indicating an endocrown is the use of the dental remnants it self, particularly the pulp chamber, to promote retention and stability in cases without adequate height for performing complete dental and crown reconstruction...

O objetivo deste artigo de descrição de caso clínico foi apresentar a sequência de planejamento, indicação, tratamento e execução de uma coroa do tipo Endocrown (Coroa Endodôntica Adesiva).Este artigo ilustra uma opção terapêutica para reabilitação funcional e estética de um molar inferior desvitalizado, apresentando uma pequena quantidade de remanescente coronário, por meio da cimentação de uma coroa pura de porcelana do tipo Endocrown. Uma mulher de 39 anos de idade, apresentou-se à clínica de Pós-Graduação da Faculdade de Odontologia de Bauru (FOB) da Universidade de São Paulo(USP), com a queixa de uma extensa e insatisfatória restauração de resina composta no dente 36. O sistema monolítico de porcelana à base de dissilicato de lítio foi utilizado com a técnica da cera perdida.Esta técnica promoveu a estabilidade e a retenção da restauração indireta, sem a necessidade de realizara reconstrução do dente 36, quer por meio de um núcleo metálico fundido ou reconstrução com pino intra canal, reduzindo assim o tempo de tratamento.Após o preparo do dente, realizou-se a restauração provisória com resina acrílica e verificou-se se a retenção e estabilidade do remanescente dentário era adequada para receber a restauração do tipo Endocrown. As características das paredes internas e externas do preparo do remanescente dentário,término cervical, moldagem, etapas laboratoriais e de cimentação são discutidas. A principal vantagem da indicação de uma coroa do tipo Endocrown é a utilização do próprio remanescente dentário,particularmente a câmara pulpar, para promover a retenção e estabilidade em casos onde não haja altura adequada para a reconstrução coronária...

Tratamento Restaurador Atraumático: atualidades e perspectivas / Atraumatic Restorative Treatment: advances and perspectives

O Tratamento Restaurador Atraumático (Atraumatic Restorative Treatment) atualmente é entendido como uma abordagem minimamente invasiva que compreende medidas preventivas, terapêuticas e restauradoras em relação à cárie dental e no controle dessa doença, inclusive no atendimento à pacientes especiais. O tratamento é feito apenas com a utilização de instrumentos manuais e com o uso do cimento de ionômero de vidro (CIV), aplicado para o selamento de cicatrículas e fissuras em risco de cárie e na restauração de dentes com cavidades nas quais as fissuras adjacentes também são seladas. As razões mais frequentes para as falhas das restaurações ART estão associadas ao deslocamento do ionômero de vidro em função de insuficiente remoção de esmalte desmineralizado e dentina decomposta; manipulação inadequada do pó/líquido do ionômero de vidro; grau de umidade e temperatura da mistura do ionômero no momento da manipulação; não preenchimento completo da cavidade com o material restaurador; contaminação por saliva e/ou sangue; limpeza ou condicionamento insuficiente das cavidades; grau de cooperação do paciente; habilidade do operador. Materiais com propriedades estéticas melhoradas têm surgido no mercado odontológico e devem servir de estímulo para a realização de trabalhos de ART nos dentes anteriores. No preparo do dente para as restaurações de ART de Classe II, é recomendável confeccionar retenções adicionais nas paredes vestibular e lingual para evitar o deslocamento da restauração. O ART é capaz de diminuir o nível de ansiedade e medo dos pacientes quando o operador não é um especialista, além de ser um tratamento que proporciona menor dor e desconforto, podendo ser realizado num consultório odontológico ou fora dele. Sugestões para novas agendas de pesquisa sobre o ART são propostas.

The Atraumatic Restorative Treatment (A R T) is understood as a minimally invasive approach comprising preventive, therapeutic and restorative measures in relation to dental caries and in the control of this disease, including in attendance to patients of special needs. The treatment is done only with the use of hand instruments and with the use of glass ionomer cement (GIC), applied to the sealing of pits and fissures in caries risk and in the restoration of teeth with cavities in which the adjacent pits and fissures are also sealed. The most frequent reasons for the failures of ART restorations are the displacement of the glass ionomer due to inadequate removal of demineralized enamel and dentin decomposed; improper handling of the glass ionomer powder and liquid; degree of humidity and temperature of the mix GIC at the time of handling; not full fill of the cavity with the restorative material; contamination by saliva and/or blood; cleaning or conditioning of cavities; degree of cooperation of the patient; skill of the operator. Materials with improved aesthetic properties have emerged on the market and must serve as a stimulus for the works of ART in the anterior teeth. In the preparation of the tooth for class II ART restorations, we recommend that you make additional retentions in the vestibular and lingual walls to prevent the displacement of the restoration. The ART is able to reduce the level of anxiety and fear of patients when the operator is not an expert, and is a treatment that provides less pain and discomfort, and can be performed in a dental office or out of it. Suggestions for new research agendas on the ART are proposed.

Effect of resin-modified glass-ionomer cement lining and composite layering technique on the adhesive interface of lateral wall

Interface integrity can be maintained by setting the composite in a layering technique and using liners. Objective The aim of this in vitro study was to verify the effect of resin-modified glass-ionomer cement (RMGIC) lining and composite layering technique on the bond strength of the dentin/resin adhesive interface of lateral walls of occlusal restorations. Material and Methods Occlusal cavities were prepared in 52 extracted sound human molars, randomly assigned into 4 groups: Group 2H (control) – no lining + two horizontal layers; Group 4O: no lining + four oblique layers; Group V-2H: RMGIC lining (Vitrebond) + two horizontal layers; and Group V-4O: RMGIC lining (Vitrebond) + four oblique layers. Resin composite (Filtek Z250, 3M ESPE) was placed after application of an adhesive system (Adper™ Single Bond 2, 3M ESPE) dyed with a fluorescent reagent (Rhodamine B) to allow confocal microscopy analysis. The teeth were stored in deionized water at 37oC for 24 hours before being sectioned into 0.8 mm slices. One slice of each tooth was randomly selected for Confocal Laser Scanning Microscopy (CLSM) analysis. The other slices were sectioned into 0.8 mm x 0.8 mm sticks to microtensile bond strength test (MPa). Data were analyzed by two-way ANOVA and Fisher's test. Results There was no statistical difference on bond strength among groups (p>0.05). CLSM analysis showed no significant statistical difference regarding the presence of gap at the interface dentin/resin among groups. Conclusions RMGIC lining and composite layering techniques showed no effect on the microtensile bond strength and gap formation at the adhesive interface of lateral walls of high C-factor occlusal restorations. .

Impact of monomer functional groups of resin-based materials on the interaction with water / Impacto de grupos funcionais de monômeros resinosos na interação com a água

Objetivo: O objetivo desse estudo in vitro foi comparar a sorção (SO) e a solubilidade (SB) em água de sistemas adesivos e resinas compostas baseados em seus grupos funcionais dos monômeros. Material e Métodos: Três sistemas adesivos (Adper Single Bond 2 – 3M ESPE, Clearfil SE Bond – Kuraray, sistema adesivo da P90 – 3M ESPE) e três resinas compostas (Filtek Z350 – 3M ESPE, Filtek Z250 – 3M ESPE, Filtek P90 – 3M ESPE) foram testados. Oito espécimes de cada material foram preparados para avaliar a SO e SB. Inicialmente, os discos foram individualmente armazenados em um dessecador até a obtenção de uma massa constante e, em seguida, armazenados individualmente em água destilada até a massa se estabilizar novamente. Finalmente, os espécimes foram secos novamente no dessecador até uma massa constante ser obtida. SO e SB foram calculadas a partir dessas mensurações. Resultados: Os dados foram analisados pelo teste de ANOVA a 1 critério e teste de Tukey (p < 0,05). O adesivo do sistema P-90 apresentou os menores valores de SO e o Clearfil SE Bond apresentou os menores valores de SB. A resina composta Filtek P-90 apresentou os menores valores de SO e SB. Conclusão: Baseado nos resultados, pode-se concluir que a sorção e a solubilidade foram influenciadas pela composição dos materiais. O principal grupo funcional dos materiais determina a suscetibilidade à água e influencia o seu desempenho.

Objective: The objective of this in vitro study was to compare dentin bonding systems and composite resins based on their functional groups in terms of water sorption (WS) and water solubility (WSB). Material and Methods: Three dentin bonding systems (Adper Single Bond 2 – 3M ESPE, Clearfil SE Bond – Kuraray, P90 Adhesive System – 3M ESPE) and three commercial composite resins (Filtek Z350 – 3M ESPE, Filtek Z250 – 3M ESPE, Filtek P90 – 3M ESPE) were tested. Eight specimens of each material were prepared to evaluate the WS and WSB. The discs were individually stored in a desiccator until constant mass was achieved. Specimens were then individually stored in distilled water until the mass was stabilized again. Finally, the specimens were dried again in the desiccator until constant mass was obtained. WS and WSB were calculated from these measurements. Results: Data were analyzed by oneway ANOVA and Tukey post hoc test (p < 0.05). Filtek Silorane-Bond presented the lowest values of WS, and Clearfil SE Bond presented the lowest WSB. Filtek Silorane resin showed the lowest WS and WSB results. Conclusion: Based on the results, it can be concluded that the WS and WSB were influenced by the composition of the materials. The main functional group of the materials determines their susceptibility to water and influences their performance.

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives: Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods: A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results: No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion: PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia. .

Efficacy of Papacarie¯ in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial

OBJECTIVES: The aim of the present study was to analyze the efficacy of Papacarie¯ gel compared with the traditional method (low-speed bur) in reducing the counts of total bacteria, Lactobacillus, total Streptococcus and Streptococcus mutans group. METHODS: A randomized, controlled clinical trial with a split-mouth design was performed. The sample comprised 40 deciduous teeth in 20 children (10 males and 10 females) aged four to seven years. The teeth were randomly allocated to two groups: G1, or chemomechanical caries removal with Papacarie Duo¯, and G2, or the removal of carious dentin tissue with a low-speed bur. Infected dentin was collected prior to the procedure, and the remaining dentin was collected immediately following the removal of the carious tissue. Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units (CFUs) of each microorganism studied. ClinicalTrials.gov: NCT01811420. RESULTS: Reductions were found in the numbers of total bacteria, total Streptococcus and Streptococcus mutans group following either of the caries removal methods (p<0.05). A reduction was also noted in the number of Lactobacillus CFUs; however, this difference did not achieve statistical significance (p>0.05). CONCLUSION: Papacarie¯ is an excellent option for the minimally invasive removal of carious tissue, achieving significant reductions in total bacteria, total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method. .

Confocal laser scanning microscopy investigation of bond interfaces involved in fiber glass post cementation / Avaliação de dentes restaurados com pinos de fibra de vidro e agentes cimentantes, empregando-se microscopia confocal

Objective: This confocal microscopy study evaluated the cement/dentin and cement/post interfaces along the root canal walls when fiber glass posts were bonded to dentin using different types of cements. Material & Methods: Thirty endodontically treated premolars were divided into 3 groups according to the adhesive materials used in the bonding procedure: Prime & Bond 2.1/Self Cure + Enforce, RelyX Unicem and RelyX Luting. Rhodamine B dye was incorporated in the luting materials for the cementation of the fiber glass posts (Exacto, Angelus) to dentin. Three transversal slices (apical, middle and coronal) were examined under confocal laser scanning microscopy. Statistical analysis was performed using the Kappa, Kruskal-Wallis and Dunnet tests, in a significance level of 5%. Results: The Prime & Bond 2.1/Self Cure + Enforce presented a uniform formation of tags in the dentin but gaps in the cement/dentin interface. The RelyX Unicem and RelyX Luting presented an adhesive interface with a fewer amount of gaps, but showed shorter tag formation than the Enforce system. All cements presented the same pattern of bubbles inside the cements. The RelyX Luting presented a greater amount of cracks inside the cement in comparison with the other cements in the coronal third, while no difference was observed between RelyX Unicem and Enforce. The RelyX Luting showed the lowest quantity of cement penetration into the post. Conclusion: In general, the quality of bonding interfaces of fiber posts luted to root canals was affected by both location and type of cement.

Objetivo: O objetivo deste trabalho foi avaliar as interfaces cimento/dentina e cimento/pino quando diferentes agentes cimentantes foram utilizados na cimentação de pinos de fibra de vidro. Material e Métodos: Trinta pré-molares humanos foram tratados endodonticamente e divididos em 3 grupos de acordo com o procedimento adesivo: Prime & Bond 2.1/Self Cure + Enforce, RelyX Unicem e RelyX Luting. Corante fluorescente Rodamina B foi incorporado aos agentes cimentantes para a cimentação dos pinos de fibra (Exacto, Angelus). Os dentes foram seccionados em três terços (apical, médio e coronário) e examinados ao microscópio confocal. Os dados foram submetidos aos testes Kappa, Kruskal-Wallis e Dunnet, a um nível de significância de 5%. Resultados: O grupo Prime & Bond 2.1 / Self Cure + Enforce apresentou uma formação uniforme de tags na dentina, porém fendas na interface cimento/dentina. Os cimentos RelyX Unicem e RelyX Luting apresentaram uma interface adesiva com pequena quantidade de fendas, mas mostrou pequena formação de tags se comparados ao sistema Enforce. Todos os cimentos apresentaram o mesmo padrão de bolhas em seu interior. O cimento RelyX Luting apresentou grande quantidade de trincas em seu interior se comparado com os outros cimentos no terço coronário, enquanto nenhuma diferença foi observada entre os cimentos RelyX Unicem e Enforce. O cimento RelyX Luting a menor quantidade de penetração de cimento dentro do pino. Conclusão: Em geral, a qualidade das interfaces adesivas dos cimentos foi afetada pela localização e tipo de cimento.

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

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

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

56-month clinical performance of Class I and II resin composite restorations

OBJECTIVE: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. MATERIAL AND METHODS: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05). RESULTS: After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. CONCLUSIONS: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.