Concept of functional dentition and impact on the quality of life of partially edentulous patients / Concepto dentición funcional e impacto en la calidad de vida de los pacientes desdentados parciales

Main Objective: To compare, through the OHIP-7Sp, the impact on the quality of life of partially edentulous patients, according to WHO criteria "with functional dentition", 21 or more teeth and "without functional dentition", less than 21 teeth. Material and Methods: 97 partially edentulous patients were selected between 35 and 75 years old, ASA I or II with ≤ 28 teeth remaining. Were divided in two groups, non-functional dentition (NFD) n=47 and functional dentition (FD) n=50. OHIP-7Sp survey was applied to each patient to measure the impact on quality of life in the seven dimensions considered in this survey. The scale of measurement ranges from 0 to 4, in which 0 is "never" and 4 "always", with a maximum value of 28, considering the instrument in its entirety. Highest score indicates a greater impact on quality of life. For comparison of both groups, the non-parametric Mann-Whitney test was used with a level of 95% significance. Results: Concerning all patients evaluated through the OHIP-7Sp, the mean age was 53 years. There were significant differences in the total OHIP-7Sp score, with a mean and median for the NFD group of 9.53 and 9 and for the FD group 5.02 and 5, respectively. Disaggregating the analysis, significant differences emerged in dimensions 2, 3, 4, 5, and 6 (p<0.05). Conclusion: There was a significantly greater impact on the quality of life, measured with the OHIP-7Sp, in the NFD group compared to the FD group.

Objetivo Principal: Comparar mediante el OHIP-7Sp, el impacto en la calidad de vida de pacientes desdentados parciales, según criterio OMS "con dentición funcional", 21 o más dientes y "sin dentición funcional", menos de 21 dientes. 0 Material y Métodos: Fueron seleccionados 97 pacientes desdentados parciales entre 35 y 75 años, ASA I o II con remanencia de ≤ 28 dientes. Fueron divididos en 2 grupos, dentición no funcional (DNF) n=47 y dentición funcional (DF) n=50. Se aplicó encuesta OHIP-7Sp a cada paciente para medir el impacto en la calidad de vida en las 7 dimensiones que contempla esta encuesta. La escala de medición, abarca de 0 a 4, en la cual 0 es "nunca" y 4 "siempre", con un valor máximo de 28, considerado el instrumento en su totalidad. El puntaje más alto indica un mayor impacto en la calidad de vida. Para la comparación de ambos grupos se utilizó el test no paramétrico de Mann-Whitney con un nivel de significancia del 95%. Resultados: Del total de pacientes evaluados mediante el OHIP-7Sp, el promedio de edad fue de 53 años. Hubo diferencias significativas en el puntaje del OHIP-7Sp total, con una media y mediana para el grupo DNF de 9,53 y 9 y para el grupo DF de 5,02 y 5, respectivamente. Desagregando el análisis, emergieron diferencias significativas en las dimensiones 2, 3, 4, 5, y 6 (p<0,05). Conclusión: Hubo significativamente mayor impacto en la calidad de vida, medido con el OHIP-7Sp, en el grupo DNF comparado con el grupo DF.

Six month follow-up of two bulk-fill composites in non-carious cervical lesions: double blind randomized clinical trial / Evaluación clínica a 6 meses de restauraciones cervicales en lesiones no cariosas con resinas compuestas bulk-fill: estudio aleatorio doble ciego

Objective: To assess the six-month clinical outcome of restorations of non-carious cervical lesions (NCCL) with two composite resins: Bulk-Fill and nanohybrid resin. Materials and methods: Fifty-one patients, with three NCCLs each, were randomly allocated into three restoration groups: Tetric-N-Ceram Bulk-Fill (TB); Filtek Bulk-Fill (FB); y Filtek Z350XT (Z350). Adhesive techniques and restorative procedures were performed according to the manufacturers' instructions for the different materials. A 4mm increment was applied in TB and FB, and increments of ≤2mm depth were applied in Z350. Restorations were assessed by two calibrated examiners at baseline and at six months according to the FDI World Dental Federation guidelines (1: excellent, 2: acceptable, 3: sufficient, 4: unsatisfactory, 5: unacceptable) in Marginal Staining (MS), Fracture-Retention (FR), Marginal Adaptation (MA), Postoperative Sensitivity (S) and Caries (C). Wilcoxon test was used for the comparison between baseline and 6 months, and Kruskal-Wallis for the comparison of the three groups at six months (95% significance). Results: Forty-six patients with a total of 138 restorations attended a check-up at six months and were evaluated with excellent clinical outcome. In MS, 91.2% for Z350 and 97.8% for FB and TB; in FR, 97.8% for Z350 and 100% for FB and TB; in MA, 95.6% for Z350, 97.8% for FB and 100% for TN; in S, 95.6% for all three groups; and 100% for C. No statistically significant differences were found between the three groups nor in the comparison between the baseline and 6 months (p>0.05) Conclusion: No significant differences are observed between the three groups of resins in the parameters of MS, MA, S, FR and C regarding clinical outcome at six months.

Objetivo: Evaluar el comportamiento clínico a 6 meses en restauraciones de lesiones cervicales no cariosas (LCNC) con dos resinas compuestas Bulk-Fill y una resina nanohíbrida. Materiales y métodos: En 51 pacientes se restauraron 3 LCNC distribuidas aleatoriamente en 3 grupos, TB: Tetric-N-Ceram Bulk-Fill, FB: Filtek Bulk-Fill y Z350: Filtek Z350XT. Las técnicas adhesivas y procedimientos restauradores fueron realizados según las instrucciones de los fabricantes para los diferentes materiales. En TB y FB se aplicó un incremento de 4mm y en Z350 se aplicó incrementos ≤2mm de profundidad. Dos operadores calibrados evaluaron las restauraciones al baseline y 6 meses mediante los criterios clínicos FDI (1: excelente, 2: aceptable, 3: suficiente, 4: insatisfactorio, 5: inaceptable) en Tinción Marginal (TM), Fractura-Retención (FR), Adaptación Marginal (AM), Sensibilidad Postoperatoria (S) y Caries (C). Se utilizó Wilcoxon para la comparación entre baseline ­ 6 meses y Kruskal-Wallis para la comparación de los 3 grupos a 6 meses (significancia de 95%). Resultados: A los 6 meses asistieron 46 pacientes con un total de 138 restauraciones siendo evaluados con comportamiento clínico excelente; en TM 91,2% para Z350 y 97,8% para FB y TB; en FR, Z350 presentó 97,8% y en FB y TB el 100%; en AM, 95,6% para Z350, 97,8% para FB y 100% para TN; en S presentó 95,6% para los tres grupos; en C se presentó el 100%. No hubo diferencias estadísticamente significativas entre los 3 grupos y en la comparación de baseline - 6 meses (p>0.05). Conclusión: No existen diferencias significativas en el comportamiento clínico a 6 meses entre los 3 grupos de resinas en los parámetros TM, AM, S, FR Y C.

Effect of gender of the operator and application mode of adhesives on dentin hydraulic conductance in an in vitro model

ABSTRACT: Aim: To compare the hydraulic conductance of human dentin disks which have been treated with an adhesive by operators of different genders and by active or passive modes of application. 60 third molars of healthy adults were included in resin blocks. These were cut to obtain 60 dentin disks of 1mm +/- 0.1 mm thick. Group 1 and 2, the adhesive was applied by 15 male operators passively (group 1) and vigorously (group 2). Groups 3 and 4, the adhesive was applied by 15 female operators passively (group 3) and vigorously (group 4). The flow rate was measured with a diffusion chamber and the hydraulic conductance of the disks was determined. Results: Mean for hydraulic conductance of each group was: 1 (0.01752), 2 (0.00355), 3 (0.01215), 4 (0.00877) in μl/minxcm2. There was statistically significant difference in the hydraulic conductance between experimental and control groups. There was no difference in dentin hydraulic conductance between genders. There was statistically significant difference in hydraulic conductance between the different modes of application. There was a moderate association between the pressure exerted when applying the adhesive and the values of dentin hydraulic conductance in vitro.

Influence of adaptation of removable partial denture on masticatory performance / Influencia de la adaptación del aparato protésico parcial removible en el rendimiento masticatorio

Abstract: objective: To compare the masticatory performance (MP) of patients with old removable partial denture (RPD), recently inserted RPD and already adapted RPD by means of the simple sieve test. Material and Methods: Twenty-nine adult (>18 years old) volunteer patients were recruited, with lower and upper RPD, excluding total edentulous subjects in the upper and lower jaw, with temporomandibular disorders, severe periodontal disease, mental disability or systemic disease compromising the masticatory or nervous system. Dentures were designed and fabricated by an expert operator. MP was evaluated in old RPD (MP1), recently inserted RPD (MP2) and adapted RPD (MP3). The simple sieve test used was Edlund-Lamm in percentage of MP, using Optosil® Comfort condensation silicone tablets, with standard sizes (5.0x20mm). In each phase, the patient chewed the tablet with 20 masticatory strokes. The crushed fragments were dried at 80°C for 60 minutes and weighed on an analytical scale. A multiple vibration sieve analysis was performed, using sieves with opening sizes of 2.8mm and 1.4mm. Shapiro-Wilk test and Anova test with Bonferroni correction were performed. Results: It was observed that MP1 presented a mean of 8.40 percent (SD +/- 5.59), MP2 a mean of 8.56 percent (SD +/- 5.56), and MP3 a mean of 18.26 percent (SD +/- 8.12). There was a significant difference (p<0.05) between the MP1-MP3 groups, as well as between the MP2-MP3 (p<0.05). Conclusion: There is a significant increase in MP thirty days after the insertion of RPD, checkups, and adjustments performed by the dentist.

Resumen: comparar el rendimiento masticatorio (RM) de pacientes con prótesis parcial removible (PPR) antigua, PPR recién instaladas y adaptadas mediante test de trituración simple. Material y Método: Se reclutaron 29 pacientes voluntarios mayores 18 años, recambio PPR superior o inferior, excluyendo a desdentados totales superior y/o inferior, con trastornos temporomandibulares, enfermedad periodontal severa, enfermedad mental o enfermedad sistémica que comprometa el sistema masticatorio o nervioso. Las prótesis fueron planificadas y realizadas por un operador experto. El RM fue evaluado en PPR antigua (RM1), PPR recién instalada (RM2) y PPR adaptada (RM3). El test de trituración utilizado fue de Edlund-Lamm en porcentaje de RM, utilizando pastillas de silicona condensación Optosil® Comfort, con dimensiones estandares (5,0x20mm). Cada fase el paciente trituró la pastilla con 20 golpes masticatorios. Los restos triturados fueron secados a 80°C por 60 minutos y pesados en una balanza analítica. Se realizó un análisis de tamizado vibratorio múltiple, utilizando tamices de 2.8mm y 1.4mm de apertura. Se aplicaron el test Shapiro-Wilk, test Anova con corrección de Bonferroni. Resultados: Se observó que RM1 presentó una media de 8,40 por ciento (DS +/- 5,59), RM2 una media de 8,56 por ciento (DS +/- 5,56) y RM3 una media de 18,26 por ciento (DS +/- 8,12). Entre los grupos RM1-RM3 hubo diferencia significativa (p<0,05) al igual que RM2-RM3 (p<0,05). Conclusión: El RM aumenta significativamente tras 30 días de instalación de una PPR coincidiendo con los controles y ajustes por parte del odontólogo.

Personality Style in Patients Looking for Tooth Bleaching and Its Correlation with Treatment Satisfaction

Abstract In the last years the focus in dentistry has shifted to an "esthetic dentistry" approach, where patients are concerned about reaching a better look of their teeth. Vital tooth bleaching is a technique with immediate results, which improves the appearance and patient's self-esteem. The aim of this study was to recognize personality characteristics determined by the Millon Index of Personality Styles of participants looking for tooth bleaching and to correlate them to satisfaction with the treatment. Forty participants were included and filled out the Millon Index of Personality Styles form before treatment. Expectation about tooth bleaching was quantified from 1 to 5. Patients were treated with bleaching agent according to manufacturer's directions. One week after treatment, the patient's satisfaction was quantified from 1 to 5. Prevailing personality characteristics were determined. Expectations and satisfaction values of all patients were correlated with each of the presented personality scales by Spearman Rho test. Ten scales prevailed over their counterpart. Median of patient's expectation was 2 and satisfaction 4. Only the score of a single characteristic (extraversing) showed statistically significant correlation with patient satisfaction. Patients looking for tooth bleaching treatment seem to have common personality characteristics. Almost all of them wanted to achieve a moderate change in teeth color and the result of the treatment was usually satisfactory.

Resumo Ultimamente, o foco da Odontologia deslocou-se para uma "odontologia estética", em que os pacientes se preocupam em conseguir uma aparência melhor para seus dentes. O branqueamento vital é uma técnica com resultados imediatos que melhora aparência e auto-estima do paciente. O objetivo deste estudo foi detectar características de personalidade definidas pelo Índice Millon de Estilos de Personalidade de pessoas que buscaram branqueamento dental e correlacioná-las com a satisfação com o tratamento. Foram incluídos 40 participantes que preencheram o formulário do Índice Millon de Estilos de Personalidade antes do tratamento. A expectative sobre o branqueamento dental foi quantificada com valores de 1 a 5. Os pacientes foram tratados com agente branqueador de acordo com as instruções do fabricante. Uma semana depois o tratamento, a satisfação do paciente foi quantificada com valores de 1 a 5. Foram determinados as características predominantes. Os valores da expectativa e da satisfação foram correlacionados com cada escala de personalidade apresentada através do teste de Spearman Rho. Dez escalas prevaleceram sobre a sua contrapartida. A mediana das expectativas foi 2 e das satisfações foi 4. O valor de uma característica apenas (extraversão) apresentou correlação estatisticamente significante com a satisfação do paciente. Os pacientes que buscam o branqueamento dental parecem ter características comuns de personalidade. Quase todos queriam conseguir uma mudança moderada na cor dos dentes e o resultado do tratamento foi geralmente satisfatório.

Increased longevity of resins based composite restorations and their adhesive bond: a literature review / Aumento de longevidad de restauraciones de resinas compuestas y de su unión adhesiva: revisión de tema

ABSTRACT. Introduction: the goal of this literature review is to analyze the findings included in the literature concerning different alternatives to increase longevity of resin-based composite restorations and their adhesive bond. Methods: bibliographies in the EBSCO database (Elton B Stephens Company) were reviewed using the following key words: "composite repair bond strength"; "restorations sealing"; composite restorations longevity"; "restorations refurbishment"; "composite bond strategy"; "dental adhesive collagen cross linking"; "proanthocyanidin dentin bond strength"; "multiple layer dentin bond strength", and "dentin adhesive evaporation bond strength". Clinical and laboratory results were analyzed in terms of repairing, sealing, and refurbishing defective restorations, in addition to improvements in impregnation of adhesive surfaces, resistance of adhesive polymers, and the progress recently made concerning resistance to hydrolytic collagen degradation. Results: repairing, sealing, or refurbishing defective restorations allow keeping tooth structure healthy, reducing potential damage to dental pulp, as well as operatory pain, often caused without anesthetics. New bonding management techniques provide adhesive procedures with increased longevity. Conclusions: repairing, refurbishing, or sealing defective composite resins increase the longevity of restorations and restored teeth by using minimally invasive dental techniques. Other methods, such as improving impregnation of adhesive surfaces, increasing adhesive polymers strength, and hydrolytic degradation of collagen are promising advances that modify the management of bonding techniques, providing patients with restorative treatments of increased longevity.

RESUMEN. Introducción: el objetivo de esta revisión es analizar los resultados de las diferentes alternativas que presenta la literatura para incrementar la longevidad de las restauraciones con base a resinas compuestas. Métodos: fueron revisadas las bibliografías en la base de datos EBSCO (Elton B Stephens Company), en idioma inglés bajo los siguientes acrónimos " composite repair bond strengh"; "restorations sealing"; composite restorations longevity; "restorations refurbishment"; "composite bond estrategy"; "dental adhesive collagen cross linking"; "proanthocyanidin dentin bond strength";" multiple layer dentin bond strength"; and "dentin adhesive evaporation bond strength". Se examinan los resultados clínicos y de laboratorio de reparación, sellado y remodelado de restauraciones defectuosas, además de las mejoras en la impregnación de las superficies adhesivas, la resistencia de los polímeros adhesivos y los avances en el aumento de la resistencia a la degradación hidrolítica del colágeno. Resultados: la reparación, sellado y remodelado de restauraciones defectuosas permite la preservación de estructura dentaria sana, reducción del potencial daño a la pulpa dental y reducción del dolor operatorio, la mayoría de las veces efectuado sin uso de anestésicos. Nuevas técnicas para el manejo de la adhesión proporcionan incremento en la longevidad de los procedimientos adhesivos. Conclusiones: la reparación, remodelado y sellado de resinas compuestas defectuosas, incrementa la longevidad de las restauraciones y de los dientes restaurados con la aplicación de técnicas de odontología mínimamente invasiva. Adicionalmente otras metodologías, tales como mejoras en la impregnación de las superficies adhesivas, aumento de la resistencia de los polímeros adhesivos e incremento de la resistencia a la degradación hidrolítica del colágeno constituyen promisorios avances que modifican el manejo de las técnicas adhesivas, que permitirá ofrecer tratamientos restauradores de mayor longevidad a la población.

Comparación de la conductancia hidráulica dentinaria, de acuerdo al tiempo de aplicación de desensibilizantes con base de oxalatos / Comparison of dentinal hydraulic conductance according to the application time of oxalate-based desensitizers

Introdución: se utilizó un modelo in vitro, para medir la conductancia hidráulica en discos de dentina humana, tratados con ácido oxálico por 15, 30 o 60 s y la mantención del efecto oclusivo, medido a los 7 y 14 días post aplicación. Métodos: 45 discos dentinarios de 1mm de grosor fueron obtenidos de terceros molares humanos libres de caries, en inoclusión, de pacientes entre 16 a 30 años de edad. Los discos fueron divididos en tres grupos de estudio (n = 15), dependiendo del tiempo de aplicación de una solución comercial de desensibilizante dentinario (DD) a base de oxalato (BisBlock®), que contiene ˂ 5% ácido oxálico pH 1,5-1,8: grupo A aplicación del agente por 15 s, grupo B aplicación por 30 s y grupo C por 60 s. La conductancia hidráulica de cada disco fue calculada posterior al grabado ácido, lo que corresponde a la máxima permeabilidad de dicho disco (100%), inmediatamente tras la aplicación del ácido oxálico y tras siete y 14 días de mantención en suero fisiológico.El análisis estadístico se hizo mediante test de ANOVA y post hoc de Games-Howell. Resultados: 35,46 ± 23,41% para el grupo A, 36,34 ± 15,88% para el grupo B y 24,99 ± 14,99% para el grupo C, por lo que la utilización de DD por 15, 30 ó 60 s generó una disminución en la permeabilidad que fue estadísticamente significativa (p ˂ 0,05). Conclusiones: el DD fue eficaz en reducir la conductancia hidráulica independiente del tiempo de aplicación, siendo esta reducción sólo temporal, ya que tras siete días la permeabilidad retorna a valores cercanos a los iniciales.

Introduction: an in vitro model was used to measure the hydraulic conductance in human dentin discs treated with oxalic acid for 15, 30 or 60 s maintaining the occlusive effect and measuring 7 and 14 days after application. Methods: 45 dentin discs measuring 1 mm thick were obtained from human third molars which were free of caries and in no occlusion; the samples were obtained from patients aged 16 to 30 years. Discs were sorted out into three study groups (n = 15) depending on the time of application of a commercial solution of oxalate-based dentin desensitizer (DD) (BisBlock®) which contains ˂ 5% oxalic acid of 1.5-1.8 pH: in group A the agent was applied for 15 s, in group B it was applied for 30 s, and in group C for 60 s. The hydraulic conductance of each disc was calculated after acid etching, which corresponds to the maximum permeability of discs (100%) after immediate application of oxalic acid, as well as seven and fourteen days of storage in saline solution. The statistical analysis was done with ANOVA test and post-hoc Games-Howell test. Results: 35,46 ± 23.41% in Group A, 36.34 ± 15.88% in Group B and 24.99 ± 14.99% in Group C, showing that the use of DD for 15, 30 or 60 s decreased permeability in a statistically significant manner (p <0.05). Conclusions: DD was effective in reducing hydraulic conductance regardless of application time, but this reduction was temporary only, since after seven days permeability returns to values close to those of baseline.

Rol del 10-metacriloxidecilfosfato dihidrogenado en el cambio de paradigma de los sistemas adhesivos integrados en la dentina / The Role of 10-methacryloyloxydecyl dihydrogen phosphate in the paradigm of change to adhesive systems integrated to dentin

La aplicación de adhesivos dentarios autograbantes que contienen 10-metacriloxidecilfosfato dihidrogenado supera la resistencia a la biodegradación de la interfase adhesiva de los sistemas tradicionales de grabado total. El mecanismo de acción se basa en la formación de múltiples nanocapas de calcio unido a 2 moléculas 10-metacriloxidecilfosfato dihidrogenado sobre la dentina; estas múltiples capas de 3,5 nm son las que protegerían las fibras colágenas del fenómeno de hidrólisis. Las nanocapas explicarían su alta estabilidad en el tiempo y la fortaleza de la unión, probadas tanto en estudios clínicos como de laboratorio. La interacción con la hidroxiapatita sucede con ácidos de pH bajos, pero mayores que los tradicionales, por lo que surge la necesidad de recomendar el grabado selectivo previo del esmalte. El uso de metacriloxidecilfosfato dihidrogenado permite el cambio de filosofía adhesiva desde el grabado total a la integración adhesiva de la dentina.

Applying self-etching dental adhesives containing 10-MDP overcomes the resistance to biodegradation of the adhesive interface of traditional total etch. The mechanism of action is based on the formation of multiple nano-layers of calcium and two molecules of 10-MDP on the dentin surface. These multiple layers of 3.5 nm protect the collagen fibers from hydrolysis phenomenon. The nano-layer explains its high stability and bond strength over time, tested both by clinical and laboratory studies. Hydroxyapatite interaction occurs with acids of low pH, but are higher than traditional, thus increasing the need to recommend the previous selective etching of the enamel. The use of MDP allows a change of philosophy from the total-etch adhesive to adhesive integration of the dentin.

Influence of type of bur and acid etching on dentin hydraulic conductance

El objetivo de este estudio fue comparar la tasa de filtración ex vivo (conductancia hidráulica) en discos de dentina humana tratados mecánicamente con fresas de diamante de diferente granulometría y carbide con o sin grabado ácido. Método: 60terceros molares sanos recientemente extraídos de pacientes entre 18-30 años, fueron limpiados, desinfectados (0.1% timol) e incluidos en bloques de resina epóxica. Los discos de dentinase obtuvieron mediante la reducción de la superficie oclusal con instrumentos rotativos cilíndricos, formando los siguientes nueve grupos de 12 muestras c/u: 1: grano fino (FG); 2: granomedio (MG); 3: grano grueso (CG); 4: fresas de carburotungsteno (C); 5: FG con grabado ácido (AO); 6: GM con AO;7: GG con AO; 8: C con AO; 9: sólo grabado ácido. Se determinó la conductancia hidráulica en el modelo experimental bajo presión constante de 200 mm de altura de H2O. No seobservaron diferencias entre la conductancia hidráulica entre los diferentes tipos de fresas (p = 0,5).Se encontraron diferencias en la conductancia hidráulica de discos de dentina con y sin grabado ácido (p < 0,001). El tipo de fresa no afecta la conductacia hidráulica dentinaria.El grabado ácido aumenta significativamente la conductanciahidráulica dentinaria