Fracture resistance and bonding performance after antioxidants pre-treatment in non-vital and bleached teeth

Abstract This study aimed to evaluate the effect of antioxidant solutions on fracture strength and bonding performance in non-vital and bleached (38% hydrogen peroxide) teeth. One hundred and eighty dentin specimens were obtained, 60 for each test: fracture strength, hybrid layer thickness, and bond strength. The groups (n=10) were randomly composed according to post-bleaching protocol: REST - restoration, without bleaching; BL - bleaching + restoration; SA - bleaching, 10% sodium ascorbate solution, and restoration; AT - bleaching, 10% α-tocopherol solution, and restoration; CRAN - bleaching, 5% cranberry solution, and restoration; CAP - bleaching, 0.0025% capsaicin solution, and restoration. Data were analyzed with ANOVA, Kruskal-Wallis, Dunn, and Qui-Square tests (α=0.05). The highest fracture strength values were observed in REST (1508.96 ±148.15 N), without significant difference for the bleached groups (p>0.05), regardless of the antioxidant use. The hybrid layer thickness in the group that was not subjected to bleaching (REST) was significantly higher than in any other group. The bond strength in the bleached and antioxidants-treated groups (SA, AT, CRAN, CAP) has no differences with the bleached group without antioxidants (BL). Adhesive failures were predominant in the groups that did not receive the antioxidant application. In conclusion, the evaluated antioxidants did not show an effect on the fracture strength, hybrid layer thickness, or bond strength of dentin bleached after endodontic treatment. The application of 10% sodium ascorbate, 10% alpha-tocopherol, 5% cranberry, or 0.0025% capsaicin solutions is not an effective step and should not be considered for the restorative protocols after non-vital bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito de soluções antioxidantes na resistência à fratura e resistência de união em dentes tratados endodonticamente e clareados (38% de peróxido de hidrogênio). Cento e oitenta espécimes de dentina foram obtidos, 60 para cada teste: resistência à fratura, espessura da camada híbrida e resistência de união. Os grupos (n=10) foram compostos aleatoriamente de acordo com o protocolo pós-clareamento: REST - restauração, sem clareamento; BL - clareamento + restauração; SA - clareamento, solução de ascorbato de sódio a 10% e restauração; AT - clareamento, solução de α-tocoferol a 10% e restauração; CRAN - clareamento, solução de cranberry a 5% e restauração; CAP - clareamento, solução de capsaicina 0,0025% e restauração. Os dados foram analisados ​​com os testes ANOVA, Kruskal-Wallis, Dunn e Qui-Quadrado (α=0,05). Os maiores valores de resistência à fratura foram observados em REST (1508,96 ±148,15 N), sem diferença significativa para os grupos clareados (p>0,05), independente do uso de antioxidantes. A espessura da camada híbrida no grupo que não foi submetido ao clareamento (REST) foi significativamente maior do que em qualquer outro grupo. A resistência de união nos grupos clareado e tratado com antioxidantes (SA, AT, CRAN, CAP) não apresentou diferenças com o grupo branqueado sem antioxidantes (BL). As falhas adesivas foram predominantes nos grupos que não receberam a aplicação do antioxidante. Em conclusão, os antioxidantes avaliados não mostraram efeito sobre a resistência à fratura, espessura da camada híbrida ou resistência de união à dentina clareada após tratamento endodôntico. A aplicação de soluções de ascorbato de sódio 10%, alfa-tocoferol 10%, cranberry 5% ou capsaicina 0,0025% não é uma etapa eficaz e não deve ser considerada para os protocolos restauradores após clareamento não vital.

Solução estética conservadora em paciente jovem com fluorose: clareamento e microabrasão: relato de caso / Conservative aesthetic solution in a young patient with fluorosis: whitening and microabrasion: case report

Introdução: a fluorose constitui uma patologia que afeta os dentes desencadeada pelo excesso de ingestão de flúor. Sua manifestação ocorre a nível de esmalte na presença de manchas ou defeitos anatômicos. Objetivo: relatar o manejo clínico de um paciente com fluorose tratado com procedimento minimamente invasivo. Relato do caso: paciente do sexo feminino, 18 anos, apresentando queixas estéticas clinicamente observadas na vestibular dos dentes, com diagnóstico de lesões fluoróticas. Foi executado protocolo de dessensibilização com Ultra EZ por 5 min e aplicação do Verniz (Enamelast Fluoride) previamente ao tratamento clareador. Foram realizados duas sessões de clareamento com peróxido de hidrogenio 35% (DMC) por 45 min com intervalo de sete dias entre elas. Imediatamente após a segunda sessão de clareamento, foi realizado microabrasão com pasta abrasiva Whitness RM (FGM) e taça de borracha com fricção por 20 segundos. Resultados: o tratamento clareador associado a técnica da microabrasão do esmalte demonstrou resultado estético favorável, microinvasivo e eficaz no tratamento da fluorose. Conclusão: a associação dos tratamentos resolveu o problema estético da paciente de forma rápida e segura, conservando a estrutura dentária.

Introduction: fluorosis is a pathology that affects teeth triggered by excess fluoride intake. Its manifestation occurs at the enamel level in the presence of stains or anatomical defects. Objective: to report the clinical management of a patient with fluorosis treated with a minimally invasive procedure. Case report: female patient, 18 years old, presenting aesthetic complaints clinically observed in the buccal of the teeth, with a diagnosis of fluorotic lesions. A desensitization protocol was performed with Ultra EZ for 5 min and Varnish (Enamelast Fluoride) was applied prior to the bleaching treatment. Two bleaching sessions were performed with 35% hydrogen peroxide (DMC) for 45 min, with an interval of seven days between them. Immediately after the second bleaching session, microabrasion was performed with Whitness RM abrasive paste (FGM) and a rubber cup with friction for 20 seconds. Results: The bleaching treatment associated with the enamel microabrasion technique demonstrated a favorable, microinvasive and effective esthetic result in the treatment of fluorosis. Conclusion: the combination of treatments solved the patient's aesthetic problem quickly and safely, preserving the dental structure.

Effects of the Finishing Protocols and Oral Hygiene Procedures in the Microhardness and Surface Roughness of CAD/CAM Ceramics

ABSTRACT: The objective of this in vitro study was to evaluate the effects of finishing protocols and oral hygiene procedures on the surface and mechanical properties of CAD/CAM ceramics. Specimens (n = 96, (15x10x2mm) of the leucite glass-ceramic (LGC) and feldspathic ceramic (FP) received mechanical polishing or glazing. Surface roughness (Ra) and microhardness (VHN) were obtained with a profilometer and a hardness tester, respectively, before and after each oral hygiene procedure (TB: toothbrushing; PB: prophylaxis with paste and rubber cup; and BJ: prophylaxis with bicarbonate jet). ANOVA, paired t and Tukey's tests were applied (a=0.05). For both materials, only BJ affected Ra's values when mechanical polishing was performed. Moreover, no significant variations in VHN were observed only for LGC glazed with TB. Significant Ra and VHN changes in both materials were observed with BJ. Besides, BJ exhibited similar effects to TB on VHN, regardless of the material and finishing protocol used. Changes in mechanical and surface properties varied with the finishing protocol and the oral hygiene method. In general, prophylaxis with bicarbonate jet was the most harmful method for both materials and the type of finishing protocol did not have a protective effect against changes produced by oral hygiene methods.

RESUMEN: El objetivo de este estudio in vitro fue evaluar los efectos de los protocolos de acabado y los procedimientos de higiene oral sobre la superficie y las propiedades mecánicas de las cerámicas CAD/CAM. Los especímenes (n = 96, (15x10x2mm) de vitrocerámica de leucita (LGC) y cerámica feldespática (FP) recibieron pulido mecánico o glaseado. La rugosidad de la superficie (Ra) y la microdureza (VHN) se obtuvieron con un perfilómetro y un probador de dureza, respectivamente, antes y después de cada procedimiento de higiene oral (TB: cepillado dental; PB: profilaxis con pasta y vaso de hule; y BJ: profilaxis con chorro de bicarbonato). Se aplicaron ANOVA, t pareada y prueba de Tukey (a=0.05). Para ambos materiales, solo BJ afectó los valores de Ra cuando se realizó el pulido mecánico. Además, no se observaron variaciones significativas en VHN solo para LGC vidriado con TB. Se observaron cambios significativos de Ra y VHN en ambos materiales con BJ. Además, BJ exhibió efectos similares a TB en VHN, independientemente del material y protocolo de acabado utilizado Los cambios en las propiedades mecánicas y superficiales variaron con el protocolo de acabado y el método de higiene oral. En general, la profilaxis con chorro de bicarbonato fue el método más perjudicial, tanto los materiales como el tipo de protocolo de acabado no tuvieron un efecto protector frente a los cambios producidos por los métodos de higiene oral.

Anti-erosive profile of an experimental 5% SnCl₂ varnish containing different concentrations of NaF

Abstract This in vitro study evaluated the anti-erosive effect of an experimental varnish containing 5% stannous chloride (SnCl₂) associated with different concentrations of NaF (NaF-free, 2.5% NaF, or 5.2% NaF) on bovine enamel and root dentin. One hundred samples were pre-eroded (0.3% citric acid, pH 2.6, 10 min) and randomized into five groups (n=10 for each substrate): Negative control - milli-Q water; NaF-free - Experimental varnish SnCl₂-free and NaF-free; 2.5 NaF - Experimental varnish 5% SnCl₂ associated with 2.5% NaF; 5.2 NaF: Experimental varnish 5% SnCl₂ associated with 5.2% NaF and positive control - Commercial varnish containing 5% NaF (Duraphat). After the varnishes were applied, the erosive and abrasive challenges were carried out for five days. Loss of tooth structure (TSL) was determined by optical profilometry, and the loss of calcium (ΔCa2+) using atomic absorption spectroscopy. Dentin analysis was also performed by SEM. A one-way ANOVA/Bonferroni test was performed to analyze the data (α=0.05). The experimental 2.5 NaF and 5.2 NaF groups showed greater effectiveness in preventing TSL when compared to the other groups (p <0.05), regardless of the substrate. In addition, these groups showed lower loss in Ca2+ content when compared to the other groups (p <0.05), for enamel and dentin. Dentin showed greater TSL and ΔCa2+ loss when compared to enamel in all treatments (p <0.05). The 5.2% and 2.5% NaF-containing experimental varnishes showed promising results in both, the prevention of TSL and the loss of Ca2+, regardless of the substrate studied.

Resumo Este estudo in vitro avaliou o efeito anti-erosivo de um verniz experimental contendo 5% de cloreto estanoso (SnCl₂) associado a diferentes concentrações de NaF (sem NaF, 2,5% NaF ou 5,2% NaF) sobre esmalte e dentina radicular bovinos. Cem amostras foram pré-erodidas (ácido cítrico 0,3%, pH 2,6, 10 min) e randomizadas em cinco grupos (n=10 para cada substrato): Controle negativo - água milli-Q; Sem NaF - Verniz experimental sem SnCl2 e sem NaF; 2,5 NaF - Verniz experimental 5% SnCl2 associado a 2,5% NaF; 5,2 NaF: Verniz experimental 5% SnCl2 associado a 5,2% NaF e controle positivo - Verniz comercial contendo 5% NaF (Duraphat). Após a aplicação dos vernizes, os desafios erosivos e abrasivos foram realizados por cinco dias. A perda de estrutura dentária (PED) foi determinada por perfilometria óptica e a perda de cálcio (ΔCa2+) por espectroscopia de absorção atômica. A análise da dentina também foi realizada por MEV. Um teste ANOVA/Bonferroni de uma via foi realizado para analisar os dados (α=0,05). Os grupos experimentais 2,5 NaF e 5,2 NaF apresentaram maior eficácia na prevenção de PED quando comparados aos demais grupos (p<0,05), independentemente do substrato. Além disso, esses grupos apresentaram menor perda no teor de Ca2+ quando comparados aos demais grupos (p<0,05), para esmalte e dentina. A dentina apresentou maior PED e de ΔCa2+ quando comparada ao esmalte em todos os tratamentos (p<0,05). Os vernizes experimentais contendo NaF 5,2% e 2,5% apresentaram resultados promissores tanto na prevenção de PED quanto na perda de Ca2+, independente do substrato estudado.

Blue Covarine Toothpaste versus Office Whitening: Which is the Most Effective on Stained Teeth? / Creme Dental de Blue Covarine Versus Clareamento de Consultório: Qual é o Mais Efetivo em Dentes Pigmentados?

Alternative whitening strategies to hydrogen peroxide have been proposed, such as the inclusion of abrasive and/or pigmented particles in the toothpaste. This study compared the whitening effectiveness of a toothpaste containing Blue Covarine (BC) vs. an in-office whitening treatment using 35% hydrogen peroxide (HP) in teeth stained. Bovine incisors blocks (6.0x6.0x2.0 mm) were stained with green tea (GT), orange soda (OS), or red wine (RW). The samples were randomly assigned into 8 groups (n=15), according to the type of staining and whitening treatment: G1 ­ no staining, BC (Control); G2 ­ no staining, HP (Control); G3 ­ GT, BC; G4 ­ GT, HP; G5 ­ OS, BC; G6 ­ OS, HP; G7 ­ RW, BC; G8 ­ RW, HP. Color change (ΔE), luminosity (L*), green-red axis (a*), and blue-yellow axis (b*) were recorded with spectroscopy at T0 ­ baseline, T1 ­ immediately after toothbrushing or in office tooth whitening, and T2 ­ after the conclusion of the treatments. The whiteness index for dentistry (WID) was calculated. Data were analyzed by two-way repeated measured mixed ANOVA and Bonferroni test (α=0.05). HP showed a better whitening performance (ΔE) (p ≤ 0.042). Otherwise, no effects of the whitening agent were observed (p = 1.000). Data from ΔL, Δa, and Δb showed statistically significant differences for experimental groups (p < 0.001). In the WID analysis, BC and HP had similar effects within control and RW groups. In conclusion, blue covarine toothpaste may be a viable option for extrinsically stained teeth. However, for severe staining, HP-based whitening agents proved to be the most effective treatment strategy. (AU)

Estratégias de clareamento alternativas ao peróxido de hidrogênio têm sido propostas, como a inclusão de partículas abrasivas e/ou pigmentadas nos cremes dentais. Este estudo comparou a eficácia clareadora de um creme dental contendo Blue Covarine (BC) com um tratamento de clareamento em consultório com peróxido de hidrogênio a 35% (HP) em dentes pigmentados. Blocos de incisivos bovinos (6,0x6,0x2,0 mm) foram pigmentados com chá verde (GT), refrigerante de laranja (OS) ou vinho tinto (RW). As amostras foram distribuídas aleatoriamente em 8 grupos (n = 15), de acordo com o tipo de pigmento e tratamento clareador: G1 - sem coloração, CB (Controle); G2 - sem coloração, HP (Controle); G3 - GT, BC; G4 - GT, HP; G5 - OS, BC; G6 - SO, HP; G7 - RW, BC; G8 - RW, HP. Mudança de cor (ΔE), luminosidade (L *), eixo verde-vermelho (a*) e eixo azul-amarelo (b*) foram registrados com espectroscopia em T0 - baseline, T1 - imediatamente após a escovação ou clareamento dental em consultório, e T2 - após a conclusão dos tratamentos. O índice de brancura para odontologia (WID) foi calculado. Os dados foram analisados por ANOVA mista de duas vidas para medidas repetidas e teste de Bonferroni (α = 0,05). HP apresentou melhor desempenho de clareamento (ΔE) (p ≤ 0,042). Os dados de ΔL, Δa e Δb mostraram diferenças estatisticamente significativas para os grupos experimentais (p <0,001). Na análise WID, BC e HP tiveram efeitos semelhantes nos grupos controle e RW. Em conclusão, o creme dental covarine azul pode ser uma opção viável para dentes com coloração extrínseca. No entanto, para manchas graves, os agentes de clareamento à base de HP provaram ser a estratégia de tratamento mais eficaz. (AU)

Effect of Sodium Ascorbate or Alpha-Tocopherol on the Resin-Dentin Interface and Bond Strength after Endodontic Treatment and Bleaching

ABSTRACT: The objective of this in vitro study was to assess the effects of two antioxidants (sodium ascorbate [SA] and alpha-tocopherol [AT]) on the adhesive interface and dentin bond strength immediately after bleaching with 38 % hydrogen peroxide (38HP) in endodontically-treated teeth. Two stages of experimentation were carried out. Bovine incisors were allocated into four groups (n = 10/group for each experiment): NB, non-bleached restored crowns; 38HP, bleached and immediately restored crowns; 38HP-SA, bleached crowns and SA use; and 38HP-AT, bleached crowns and AT use. Hybrid layer length in dentin (μm) and bond strength (MPa) were assessed with confocal microscopy laser and micro-shear bond strength (μSBS) test, respectively. Failure mode was determined by stereomicroscope. Data analysis was performed with analysis of variance (ANOVA) and Kruskal-Wallis, Dunn, Tukey, and Fisher-exact tests (a = 0.05). Higher values of hybrid layer length were observed similarly in the NB and 38HP-SA groups. The highest μSBS mean values were observed in the NB group (18 .51 ? 1.33), whereas the SBS values for 38HP-AT (1.68 ? 0.32) were similar to the 38HP group (1.61 ? 0.51) (p > 0.05) and significantly lower than the 38HP-SA group (5.78 ? 0.71). Adhesive failures were predominant in the 38HP and 38HP-AT groups. Cohesive and mixed failures were mostly observed in the NB and 38HP-SA groups, respectively. In conclusion, AT has no immediate effect on the hybrid layer formation and μSBS of dentin. Although SA promotes an increase in hybrid layer formation, it was not reflected in the μSBS values.

RESUMEN: El objetivo de este estudio in vitro fue evaluar los efectos de dos antioxidantes (ascorbato de sodio [AS] y alfa-tocoferol [AT]) sobre la interfaz adhesiva y la fuerza de unión de la dentina inmediatamente después del blanqueamiento con peróxido de hidrógeno al 38 % (38HP) en endodoncia. -Dientes tratados. Se llevaron a cabo dos etapas de experimentación. Los incisivos bovinos se dividieron en cuatro grupos (n = 10 / grupo para cada experimento): NB, coronas restauradas no blanqueadas; 38HP, coronas blanqueadas y restauradas inmediatamente; 38HP- AS, coronas blanqueadas y uso SA; y 38HP-AT, coronas blanqueadas y uso de AT. La longitud de la capa híbrida en dentina (μm) y la fuerza de unión (MPa) se evaluaron con láser de microscopía confocal y la prueba de fuerza de unión por micro-cizallamiento (μSBS), respectivamente. El modo de falla se determinó mediante estereomicroscopio. El análisis de los datos se realizó con análisis de varianza (ANOVA) y pruebas de Kruskal-Wallis, Dunn, Tukey y Fisher (α = 0,05). De manera similar, se observaron valores más altos de longitud de capa híbrida en los grupos NB y 38HP-AS. Los valores medios más altos de μSBS se observaron en el grupo NB (18,51 ? 1,33), mientras que los valores de SBS para 38HP-AT (1,68 ? 0,32) fueron similares a los del grupo 38HP (1,61 ? 0,51) (p> 0,05) y significativamente más bajos que el grupo 38HP-AS (5,78 ? 0,71). Las fallas adhesivas fueron predominantes en los grupos de 38HP y 38HP-AT. Las fallas cohesivas y mixtas se observaron principalmente en los grupos NB y 38HP-AS, respectivamente. En conclusión, la AT no tiene un efecto inmediato sobre la formación de la capa híbrida y el μSBS de dentina. Aunque AS promueve un aumento en la formación de capas híbridas, no se refleja en los valores de μSBS.

Factors associated with depression, anxiety and stress among dentists during the COVID-19 pandemic

Abstract The objective of this work was to evaluate the relationship between factors associated with the COVID-19 pandemic and depression, anxiety, and stress (DAS) in dentists. Factors associated with the COVID-19 pandemic were evaluated using a questionnaire and scores of the Depression, Anxiety, and Stress Scales-21 were measured. The differences between the DAS scores based on the factors associated with the COVID-19 pandemic were tested through the successive application of multivariate analysis of variance (MANOVA, α = 0.05). After a sample size calculation, 998 participants with a mean age of 39.39 (± 11.69) years were included. The effect size indicated that changes in sleep quality (η2 = 0.161), eating habits (η2 = 0.057), and physical health (η2 = 0.051) were the ones that most negatively affected DAS scores. The highest DAS scores were observed in professionals who lived with someone at high-risk for COVID-19 (p < 0.001) and in those who did not engage in leisure activities during the pandemic (p < 0.001). Dentists who worked on the frontline against COVID-19 had higher scores of anxiety and stress (p = 0.029). The highest scores for anxiety, depression, and/or stress were seen in dentists living with someone at high-risk for COVID-19, who acts on the frontline, who does not practice in leisure activities during the pandemic, who completely changed eating habits, quality of sleep and physical health during the pandemic. In general, DAS levels of dentists were associated with factors related to the COVID-19 pandemic.

Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study

Abstract This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.

Dental Caries Experience and Associated Factors Among Brazilian Homeless Persons: A Cross-Sectional Study / Experiencia de Caries Dental y Factores Asociados entre Personas sin Hogar Brasileñas: Un Estudio Transversal

ABSTRACT: The objective of this study was to evaluate the dental caries experience and its associated factors in homeless persons. A non-probabilistic sample of 176 participants (mean age 37.8 years) was included in this cross-sectional study. Interviews and clinical examinations were performed. Dental caries experience was recorded based on the decayed, missing and filled teeth-index (DMFT). The dental caries experience was observed among 98.9 % of participants (mean DMFT 11.0 ± 6.95). Individuals in the "Over 44 years" age groups (PR = 1.4; 95 % CI = 1.1-1.6) and "30 to 36 years" (PR = 1.2; 95 % CI = 1.0 -1.4) had significantly higher caries experience. Individuals who do not brush or brush only 1x/day have 40 % and 20 % higher caries experience, respectively. Homeless persons had a high experience of dental caries, with significant tooth loss. Individuals in the advanced age groups, lack of income and non-achievement or low frequency of tooth brushing are factors associated with a greater experience of the disease in these individuals.

RESUMEN: El objetivo de este estudio fue evaluar la experiencia de caries dental y sus factores asociados en personas sin hogar. En este estudio transversal se incluyó una muestra no probabilística de 176 participantes (edad media 37,8 años). Se realizaron entrevistas y exámenes clínicos. La experiencia de caries dental se registró en fun- ción del índice de dientes cariados, perdidos y obturados (DMFT). Se observó una experiencia positiva de caries dental entre el 98,9 % de los participantes (DMFT promedio 11,0 ± 6,95). Las personas en los grupos de edad "Ma- yores de 44 años" (PR = 1,4; IC del 95 % = 1,1-1,6) y "30 a 36 años" (PR = 1,2; IC del 95 % = 1,0 -1,4) tuvieron una experiencia de caries significativamente mayor. Las perso- nas que no se cepillan, o se cepillan solamente 1x / día tienen una tasa mayor de caries, de 40 % y 20 % más, respectivamente. En las personas en situación de calle se observó una alta tasa de caries dental, con una pérdida dentaria significativa. Los factores asociados a una mayor tasa de la enfermedad, fueron personas de edad avanzada, la falta de ingreso, no lograr el cepillado, o tener una menor frecuencia de cepillado.

Assessment of Marginal Adaptation Before and After Thermo-Mechanical Loading and Volumetric Shrinkage: Bulk Fill versus Conventional Composite / Evaluación de la Adaptación Marginal Antes y Después de la Carga Termomecánica y la Contracción Volumétrica: Relleno Bulk-Fill- versus Compuesto Convencional

ABSTRACT: The objective of the study was to evaluate marginal adaptation of Class II mesial-occlusal-distal (MOD) restorations before and after thermo-mechanical loading and volumetric shrinkage of the bulk-fill vs conventional composite resin. For marginal adaptation assessment, 24 Class II MOD cavities with cervical margins extending 1.0 mm below (distal) and 1.0 mm beyond (mesial) the cement-enamel junction were prepared in extracted human molars. The teeth were filled as follows: Group A - bulk-fill with SureFil SDR flow (first increment, 4 mm; second increment, 2 mm); Group B - bulk-fill with SureFil SDR flow as a base (first increment, 4 mm) and covered with the conventional nanohybrid composite Esthet-X HD (second increment, 2 mm); and Group C - incrementally filled with Esthet-X HD. Marginal adaptation was evaluated by scanning electron microscopy before and after thermomechanical loading (240,000 loading cycles and simultaneous 600 thermal cycles). To evaluate volumetric polymerization shrinkage, a semi-spherical mold was filled with the tested composites and placed in an AccuVol device after light curing. Both before and after loading, marginal adaptation in cervical dentin was superior (p < 0.05) for Groups A and B compared with Group C. In cervical enamel, Group B showed better marginal adaptation than Group C, and Group A presented intermediary results, between Groups B and C. Furthermore, bulk-fill flow resulted in greater shrinkage than Esthet-X HD. A significant improvement of marginal adaptation was observed when bulkfill flow was used instead of conventional composite resin both before and after thermomechanical loading. However, the bulk-fill flow presented higher volumetric polymerization shrinkage than the conventional composite.

RESUMEN: El objetivo de este trabajo consistió en evaluar la adaptación marginal de las restauraciones mesiales-oclusales-distales (MOD) de Clase II antes y después de la carga termo-mecánica y la contracción volumétrica de la carga compuesta de resina "bulk-fill" en comparación con resina convencional. Para la evaluación de adaptación, se prepararon 24 cavidades MOD de Clase II en molares humanos extraídos, los que se restauraron de la siguiente manera: Grupo A: restaurado con resina fluida Bulk-Fill SureFilSDR (primer incremento, 4 mm; segundo incremento, 2 mm); Grupo B: restaurado con resina fluida Bulk-Fill SureFil SDR (primer incremento, 4 mm) y cubierto con resina compuesta nanohíbrida Esthet-X HD (segundo incremento, 2 mm); y Grupo C - rellenado incrementalmente con Esthet-X HD. La adaptación marginal se evaluó mediante microscopía electrónica de barrido antes y después de la carga termomecánica (240.000 ciclos de carga y 600 ciclos térmicos simultáneos). Para evaluar la contracción volumétrica de la polimerización, se llenó un molde semiesférico con los compuestos probados y se colocó en un dispositivo AccuVol después del fotopolimerización. Tanto antes como después de la carga, la adaptación marginal en la dentina cervical fue superior (p <0,05) para los grupos A y B en comparación con el grupo C. En el esmalte cervical, el grupo B mostró una mejor adaptación marginal que el grupo C, y el grupo A presentó resultados intermedios, entre Grupos B y C. Se observó una mejora significativa de la adaptación marginal al utilizar la resina fluida Bulk-Fill en lugar de resina compuesta convencional tanto antes como después de la carga termomecánica. Sin embargo, la resina fluida 'Bulk-Fill' presentó una mayor contracción volumétrica de polimerización que el compuesto convencional.

Physiological and Behavioral Manifestations of Children and Teenagers with Down Syndrome During the Dental Appointment: A Comparative Cross-Sectional Study

Abstract Objective: To measure the heart rate (HR) and the behavior of children and teenagers with Down Syndrome (DS) during the dental appointment. Material and Methods: Two groups (n = 52), of both genders, aged 2-14 years, matched by age group were formed: study group (SG) - individuals with DS and control group (CG) - normotypical school children. The participants were submitted to clinical examination and prophylaxis. An oximeter was used to measure the HR at five moments of the dental consultation: before entering the practice room (T0), when sitting in the dental chair (T1), during the clinical examination (T2), during prophylaxis (T3) and immediately after prophylaxis (T4). Behavior, classified according to the Frankl Scale, was observed at T3. Mann Whitney, Kruskal-Wallis, Dunn and Pearson's Chi-square tests were used to analyze and compare variables (significance level at 5%). Results: In SG, a significant difference in HR was observed according to the moment of dental appointment (p<0.001 SG; 0.3385 CG). The highest HR value in SG was observed at T3 (median 110.00; IIQ 96.00-124.00), the only moment significantly different (p<0.001) from HR values for CG. A difference in behavior between groups (p<0.001) was also observed. Conclusion: HR of individuals with DS varied throughout the dental appointment, and they also had a higher prevalence of uncooperative behavior.

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Revascularização pulpar em dentes permanentes imaturos sem vitalidade pulpar: uma revisão integrativa / Pulp revascularization in immature permanent teeth without pulp vitality: an integrative review

Introdução: Dentes permanentes imaturos que evoluem para necrose pulpar representam um desafio para tratamento endodôntico. A endodontia regenerativa e técnicas de revascularização pulpar surgem como um campo dinâmico e potencialmente ideal para terapia clínica em dentes com desenvolvimento radicular incompleto. Objetivo: Revisar a literatura sobre as técnicas de revascularização pulpar no tratamento de dentes com ausência de vitalidade pulpar com ápice radicular imaturo. Métodos: Os descritores "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp", "regeneration" foram utilizados para obtenção de artigos em língua inglesa, que apresentassem conteúdo disponibilizado na íntegra e publicados nos últimos 15 anos. Foram excluídos os trabalhos de relatos de caso e/ou séries de casos. Conclusão: Artigos revisados apresentaram uma heterogeneidade de resultados quanto à efetividade da técnica de revascularização pulpar, visto que os critérios estabelecidos para determinação do sucesso variavam entre os autores. O material mais comumente utilizado na técnica empregada consiste no Agregado Trióxido Mineral (MTA) em consistência pastosa aplicada sobre coágulo sanguíneo com formação induzida no interior do canal. Foi observada escassez de estudos laboratoriais e clínicos sobre as técnicas e materiais em revascularização pulpar, que suportem sua indicação, o que representa uma lacuna em potencial na literatura e requer cautela na indicação desta técnica.

Introduction: Immature permanent teeth that evolve to pulp necrosis represent a challenge for endodontic treatment. Regenerative endodontics and pulp revascularization techniques appear as a dynamic and potentially ideal field for clinical therapy in teeth with incomplete root development. Objective: To review the literature on pulpal revascularization techniques in the treatment of teeth with absence of pulp vitality with immature root apex. Methods: The descriptors "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp" and "regeneration" were used to obtain articles in English that presented content available in full and published in the last 15 years. Works of case reports and/or series of cases were excluded. Conclusion: Reviewed articles presented a heterogeneity of results regarding the effectiveness of the pulp revascularization technique, since the established criteria for determining success varied among the authors. The material most commonly used in the technique used consists of the Mineral Trioxide Aggregate (MTA) in paste consistency applied on blood clot with induced formation inside the canal. A shortage of laboratory and clinical studies on pulp revascularization techniques and materials that support its indication has been observed, which represents a potential gap in the literature and requires caution in the indication of this technique.

Saúde Bucal de Indivíduos com Transtorno do Espectro Autista / Oral Health of Individuals with Autistic Spectrum Disorder

Transtorno do Espectro Autista (TEA) é um espectro de transtornos do desenvolvimento neurológico que afeta o desenvolvimento e funcionamento do cérebro, por mecanismos ainda desconhecidos. A prevalência estimada para TEA é de um a dois para cada mil nascidos vivos e estes indivíduos apresentam limitações físicas e psicológicas que incluem atrasos no desenvolvimento da linguagem, dificuldades de comunicação e interação social, comportamentos restritos e repetitivos e muitos podem ter deficiência intelectual. Supõe-se que a saúde bucal de indivíduos com TEA é precária, em parte por suas limitações e pouca destreza manual para realização de cuidados em saúde, bem como pelo maior consumo de alimentos com adição de açúcar e retenção prolongada do bolo alimentar na cavidade bucal, que são observados nesta população. O objetivo deste artigo é apresentar uma revisão da literatura sobre as condições de saúde bucal de indivíduos autistas. Para o desenvolvimento da presente revisão de literatura foram realizadas buscas nas bases de dados MedLine/PubMed, Scopus e SciELO. Os artigos foram selecionados segundo descritores relacionados com saúde bucal e transtorno do espectro autista. Menor prevalência de cárie em indivíduos com TEA é relatada na maioria dos estudos, porém, observa-se a necessidade de estudos longitudinais que possam avaliar incidência e fatores associados com cárie dentária nesta população. Estudos sugerem que indivíduos autistas tenham pior condição periodontal, havendo uma lacuna sobre as condições associadas a essa maior prevalência. Embora com um número limitado de estudos, indivíduos autistas parecem não serem mais propensos a traumatismos dentários. (AU).

Autism Spectrum Disorder (ASD) is a spectrum of neurodevelopmental disorders that affect the brain development and functioning, by still unknown mechanisms. The estimated prevalence for ASD is one to two per thousand live births and these individuals present physical and psychological limitations that include delays in language development, difficulties in social interaction, communication and restricted and repetitive behaviors, and many may have intellectual disabilities. It is assumed that the oral health of ASD individuals is precarious, in part because of their limitations and little manual dexterity to perform health care, as well as the high consumption of foods with added sugar and prolonged retention of the food bolus in the oral cavity, which are observed in this population. The aim of this article is to present a review of the literature about the oral health conditions of autistic individuals. For the development of the present literature review, the MedLine / PubMed, Scopus and SciELO databases were searched. The articles were selected according to descriptors related to oral health and autism spectrum disorder. Lower caries prevalence in ASD individuals is reported in most of the studies, however, it is observed the need for longitudinal studies that can assess incidence and factors associated with dental caries in this population. Studies suggest that autistic individuals have worse periodontal conditions, and there is a lack of conditions associated with this higher prevalence. Despite the limited number of studies, autistic individuals do not appear to be more prone to dental trauma. (AU).

Uso racional de antimicrobianos em Odontologia: percepção e conhecimento dos cirurgiões dentistas de Teresina / Rational use of antimicrobials in dentistry: perception and knowledge of Teresina dentists

Introdução: os cirurgiões-dentistas frequentemente empregam antimicrobianos em sua prática clínica a fim de controlar infecções bucais. O emprego indiscriminado de antimicrobianos tem desencadeado resistências bacterianas. Objetivo: determinar o perfil dos cirurgiões-dentistas de Teresina em relação à percepção e conhecimento sobre resistência bacteriana a antimicrobianos e o uso racional destes medicamentos em sua prática clínica. Material e métodos: questionários semiestruturados aplicados aos profissionais com atuação na cidade de Teresina. Os profissionais a participarem foram selecionados aleatoriamente através de uma lista disponibilizada pelo Conselho Regional de Odontologia do Piauí. Foram obtidos 90 questionários totalmente respondidos, que constituiu a amostra final. Resultados: a maioria dos participantes (78,9%) nunca procurou realizar curso de atualização em microbiologia e/ou farmacologia, e relatam que buscam atualizar seus conhecimentos através, principalmente, de artigos científicos (51,1%) e congressos (37,7%). Quanto à percepção dos processos que podem desencadear em resistência bacteriana a antimicrobianos, 74,2% dos participantes consideram que a sua prática clínica pode ocasionar processos adversos e 94,4% consideram que o emprego de posologia correta é o principal meio de prevenir tais processos. Quanto às situações que mais prescreviam antimicrobianos, os cirurgiões-dentistas citaram processos inflamatórios com envolvimento sistêmico (77,7%), procedimentos invasivos em pacientes portadores de válvula cardíaca (74,4%), abscessos dentoalveolares agudos (68,9%), tratamento de pericoronarite (50%), profilaxia antibiótica diante extração de terceiros molares (47,8%), dentre outras. Conclusões: os participantes demonstraram deficiência em conhecimentos sobre os mecanismos de resistência bacteriana e uso racional de antimicrobianos, prescrevendo-os em diversas situações desnecessárias, sugerindo o abuso no uso dos mesmos.

Introduction: dentists often employ antimicrobial agents in their clinical practice in order to control infections of the oral cavity. The indiscriminate use of antimicrobials has triggered resistance bacterial. Objective: to determine the profile of surgeon dentists of Teresina in relation to perception and knowledge about bacterial resistance to antimicrobials and the rational use of these medicines in their clinical practice. Material and methods: questionnaires (semistructured) applied to professionals working in the city of Teresina. Professionals to participate were selected randomly through a list provided by the Regional Council of Dentistry of Piauí. Data was obtained out of 90 questionnaires fully answered, which constituted the final sample. Results: the majority of the respondents (78.9%) never sought to carry out refresher course in microbiology and/or pharmacology, and report that wish to update their knowledge through mainly scientific articles (51.1%) and congress (37,7%). As to the perception of the processes that can trigger in bacterial resistance to antimicrobials, with 74.2% of the participants consider that their clinical practice may result in processes adverse and 94.4% consider that the job of dosage correct is the primary means of preventing such processes. As to the situations that the more it is prescribed antimicrobials, dentists cited the inflammatory processes with systemic involvement (77.7%), invasive procedures in patients with heart valve (74.4%), abscesses dentoalveolares acute (68.9%), the treatment of pericoronarite (50%), antibiotic prophylaxis before extraction of third molars (47,8%), among others. Conclusions: participants showed deficiency in knowledge about the mechanisms of bacterial resistance and rational use of antimicrobial agents, prescribing in some unnecessary situations, suggesting the abuse in the use of the same.

Efetividade de dentifrícios clareadores sobre esmalte de dentes bovinos / Effectiveness of whitening dentifrices on bovine teeth enamel

Introdução: devido à insatisfação relatada pelos pacientes com a coloração dos dentes e a busca por procedimentos que envolvam estética do sorriso associado com o desenvolvimento de técnicas e materiais amplamente propagados na mídia, as empresas responderam com a oferta no mercado de uma variedade de opções de dentifrícios que propõem efeito clareador prático e rápido. Objetivo: avaliar a efetividade de dentífricos clareadores em diferentes formas de apresentação sobre esmalte de dentes bovinos. Material e Métodos: quinze dentes bovinos foram imersos diariamente por um período de 1 hora em refrigerante a base de cola e em seguida foram divididos equitativamente em três grupos, onde cada grupo foi escovado com um dentifrício especifico por 2 minutos. O grupo A foi escovado com dentifrício Colgate Luminous White (Colgate ­ Palmolive), em forma de pasta, o grupo B com dentifrício Closeup Diamond Attraction Delicate White (Unilever) em forma de gel e o grupo C com dentifrício Oral-B Complete (Procter & Gamble) em forma de pasta. Resultados: as diferentes formas de apresentação estudadas foram efetivas na remoção das manchas extrínsecas em dentes bovinos; O dentifrício Colgate Luminous White na forma de apresentação pasta clareador apresentou-se mais efetivo na remoção das manchas extrínsecas; O dentifrício Oral ­ B Complete na forma de pasta foi efetivo, porém em menor intensidade em comparação aos dentifrícios clareadores estudados. Conclusão: as diferentes formas de apresentação dos dentifrícios utilizados foram efetivas na remoção de manchas extrínsecas.

Introduction: due to dissatisfaction reported by patients with tooth staining and the search for procedures involving smile aesthetics associated with the development of techniques and materials widespread on social medias, companies responded by offering to the market a variety of toothpaste choices in order to provide practical and fast bleaching effects. However, these dentifrices appear to have a limited efficiency since they only contain abrasives for the removing of extrinsic tooth stain. Objective: his research aimed to assess the effectiveness of different forms of presentation of bleaching agents on bovine teeth enamel. Methods: daily, fifteen bovine teeth were immersed in cola soft drink for a period of 1 hour and then they were divided into three groups (each group containing five bovine teeth). Each group was brushed with a specific dentifrice for 2 minutes: the group A was brushed with Colgate Luminous White in paste form (Colgate ­ Palmolive); the Group B with Diamond Closeup Attraction Delicate White in gel form (Unilever), and the group C with Oral-B complete in paste form (Procter & Gamble). Results: color change was observed through photographs and analysis of the interpreted samples based on the theoretical background. Conclusion: the dentifrices used were able to remove extrinsic stains and the bleaching dentifrice Colgate Luminous White was more effective as a result in this connection.