Analysis of color stability and degree of conversion of different types of resin composites

Abstract Resin composites containing surface pre-reacted glass (S-PRG) have been introduced to reduce demineralization and improve remineralization of the tooth structure. However, water diffusion within the material is necessary for its action, which can impair its overall physicomechanical properties over time, including color stability. This study aimed to evaluate the color stability and related degree of conversion (DC) of four resin composites. Discs (6 x 4 mm, n = 5/group) of microhybrid (MH), nanofilled (NF), nanohybrid (NH), and S-PRG-based nanohybrid (S-PRG-NH) composites with two opacities (A2/A2E and A2O/A2D) were prepared. Color (CIELab and CIEDE2000) was evaluated with a spectrophotometer after aging in grape juice (2 x 10 min/10mL/7days). The DC was analyzed by using Fourier transform infrared spectroscopy before and after light-curing. Data were statistically analyzed by using two-way analysis of variance and post-hoc least significant difference tests (p<0.05). In the color stability analysis, the interaction between filler type and opacity was significant (CIELab, p = 0.0015; CIEDE2000, p = 0.0026). NH presented the highest color stability, which did not differ from that of MH. The greatest color alteration was observed for S-PRG-NH. S-PRG fillers also influenced DC (p < 0.05). The nanohybrid resin composite presented favorable overall performance, which is likely related to its more stable organic content. Notwithstanding the benefits of using S-PRG-based nanohybrid resins, mostly in aesthetic procedures, professionals should consider the susceptibility of such resins to color alteration, probably due to the water-based bioactive mechanism of action.

Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools

Abstract The aim of this paper was to present a summary of the process of developing and preparing the final documents of the national consensus for teaching undergraduate Brazilian dental students the dental caries curriculum in the Portuguese language. The final document was developed in three steps: a) The ABENO and LAOHA cariology group invited experts from all five regions of Brazil to participate in the discussion. The theoretical support for crafting the first draft of the consensus was based on two publications: National Curriculum Guidelines of the Dentistry graduation in Brazil, Ministry of Education (2021) and the competences described in the European Core Curriculum for Cariology (ORCA-ADEE, 2011); b) The group of experts was divided into 5 working groups: G1-Domain, Main and Specific Competences, G2-Essential knowledge, G3-Life course perspective, G4-Social determinants and dental caries, G5- Glossary. The document was finalized by thoroughly reviewing the process using Delphi methodology; c) The 5-chapter document (one from each working group) was submitted to three open public consultations in 2022 (May-June, August, and October) using Google-forms. The suggestions (content/wording) were discussed within the group as: totally accepted, partially accepted, and rejected. A total of 192 suggestions were registered from 31 dental schools in all regions of Brazil. The number of suggestions received per Group were: 84, 28, 26, 24, 30 suggestions for G1, G2, G3, G4 and G5, respectively. The majority of suggestions were totally accepted by the group of experts (n = 172, 89.6%), 15 were partially accepted (7.8%), and 5 were rejected. Conclusion The final document could be considered to be the first national consensus for teaching the dental caries curriculum in Brazil.

Impact of COVID-19 on gender gap in dental publications: a retrospective cohort with three Brazilian journals

Abstract This was a retrospective cohort study to investigate the impact of COVID-19 pandemic on the gender gap in articles submitted to three international dental journals based in Brazil. All submissions performed to Brazilian Dental Journal, Brazilian Oral Research, and Journal of Applied Oral Science before (2019) and during the pandemic (2020) were assessed. Gender of the first, last, and corresponding authors were collected. Other variables collected were journal, continent studied by authors and stage of their careers (classified according to authors' highest degree), and final decision reached in the article. Absolute and relative frequencies with 95% confidence intervals, Pearson's Chi-square tests, and Fisher's Exact test were used (α = 0.05). In total, 4,726 unique submissions were analyzed. A higher proportion of early-career authors was observed during the pandemic (44.8% to 49.3%, p = 0.021). Most articles were rejected but without association with gender. Increased proportion of male first authors from before to during the pandemic was observed (39% to 42.1%, p = 0.034). Drop in the proportion of articles with women as first authors was observed for researchers in their early- (65.9% to 58.8%, p = 0.02) and mid-career stages (63% to 55.8%, p = 0.014). Reduction in women as first authors was observed during the pandemic in South and Central Americas (66.7% to 61.5%, p = 0.010), and when the last author was a female, or the corresponding author was a male. In conclusion, a disproportionate impact on female dental researchers in submitting articles in the period from before to during the pandemic was observed when considering first authorship, suggesting that the COVID-19 may have increased the gender inequality in dental science.

Sodium trimetaphosphate combined to calcium as a strategy to improve dentin-bonding interface / Trimetafosfato de sódio associado ao cálcio como uma estratégia para melhorar a interface adesiva da dentina

Objective: The aim of this study was to evaluate the effect of STMP as biomimetic analog of dentin matrix on the dentin bond strength submitted to artificial cariogenic challenge over time. Material and Methods: The total number of teeth used in the experiment was 60 teeth, which were divided into 6 groups (n = 10). Of these total amount, 10 teeth were not submitted to the artificial cariogenic challenge (ACC), serving as control group (Sound Dentin - SD) while the other 50 were submitted to an ACC (7d/37ºC), being treated with treatment solutions according to each group: SD- deionized water/sound dentin, CD- deionized water/ artificial caries dentin, GIII- STMP, GIV- STMP + Ca(OH)2, GV- STMP + NaF, and GVI- NaF. After treatments (24h), the specimens were restored (Adper Single Bond Universal + Filtek Z250), to obtain resin­dentin sticks with a cross sectional area of 0.8mm2, approximately. Two-third of these sticks were stored in artificial saliva (37°C) for analyzes after 6 and 12 months. The 1/3 remains were subjected to µTBS test (baseline). Data were analyzed by two-way ANOVA and Tukey tests (p<0.05). Results: In general, the highest µTBS values were obtained in sound condition (SD), while the artificial caries condition (CD) determined minimum values. Groups treated with NaF (with or without STMP- GV and GVI) were not able to improve adhesion over time. Only the use of STMP + Ca(OH)2(GIV) improved the µTBS compared to the others caries-challenged dentin after 1 year. The adhesive failure pattern was predominant in all time. Conclusion: The use of the STMP associated with Ca(OH)2 seems to be a viable therapeutic strategy conciliating the biomimetizing capacity to the adhesive process satisfactorily even its performance is not superior to initial condition (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito do STMP como análogo biomimético da matriz dentinária na resistência de união à dentina submetida a desafio cariogênico artificial ao longo do tempo. Material e Métodos:foram utilizados um total de 60 dentes neste experimento, os quais foram divididos em 6 grupos (n = 10). Desse total, 10 dentes não foram submetidos ao desafio cariogênico artificial (DCA), servindo como grupo controle (Dentina Hígida - DH) enquanto os outros 50 foram submetidos ao DCA (7d / 37ºC), sendo tratados com soluções de tratamento específicas para cada grupo: DH- água deionizada / dentina hígida, DC- água deionizada / dentina submetida ao DCA, GIII- STMP, GIV- STMP + Ca(OH)2, GV- STMP + NaF e GVI- NaF. Após os tratamentos (24h), os corpos-de-prova foram restaurados (Adper Single Bond Universal + Filtek Z250), para obtenção de palitos de resina-dentina com área transversal de aproximadamente 0,8mm2. Dois terços desses palitos foram armazenados em saliva artificial (37°C) para análises após 6 e 12 meses. Os outros 1/3 foram submetidos ao teste µTBS (baseline). Os dados foram analisados por ANOVA a dois fatores e testes de Tukey (p <0,05). Resultados:Em geral, os maiores valores de µTBS foram obtidos em condição hígidas (DH), enquanto a condição subtmetidas ao DCA determinou os menores valores. Os grupos tratados com NaF (com ou sem STMP associado -GV e GVI) não foram capazes de melhorar a resistência de união, ao longo do tempo. Somente o uso de STMP + Ca (OH)2(GIV) melhorou o µTBS em comparação com as outras condições desafiadas por cárie após 1 ano. O padrão de falha adesiva foi predominante em todos os tempos. Conclusão: O uso do STMP associado ao Ca (OH)2 parece ser uma estratégia terapêutica viável conciliando a capacidade biomimetizante ao processo adesivo de forma satisfatória mesmo que seu desempenho não seja superior à condição inicial.(AU)

Giomer technology for preventive and restorative clinical management of erosive tooth wear: a case report / Tecnologia Giomer para manejo clínico preventivo e restaurador de desgaste dentário erosive: relato de caso

Increasing prevalence of erosive tooth wear (ETW) is notable mainly due to current knowledge and its early diagnosis. Once teeth are functionally and/or esthetically affected, dental restorations may become necessary. Materials capable of interacting with the eroded dental tissue allied to their resistance to subsequent continuous erosive challenges are desirable. Giomer technology based on S-PRG (surface pre-reactive glass) filler has been launching to provide benefits for the dental treatment due to its innovative multi-ionic release system, which involves fluoride. This case report describes the employment of preventive and restorative materials based on this technology for a patient under frequent erosive challenges and complaining about dental sensitivity. Patient reported immediate reduction on this sensitivity and the restorations has been followed up for 2 years, presenting satisfactory performance. S-PRG-based systems seem to be promissory for preventive and therapeutic management of ETW used simultaneously with the patient compliance. (AU)

O aumento da prevalência do desgaste dentário erosivo (DDE) é notável especialmente devido ao conhecimento atual e seu diagnóstico precoce. Uma vez que os dentes são afetados funcional e/ou esteticamente, restaurações dentárias se tornam necessárias. Materiais focados na habilidade de interagir com o tecido dentário erodido associados com sua resistência aos desafios erosivos contínuos subsequentes são desejáveis. A tecnologia Giomer baseada em partículas S-PRG (superfície de vidro pré-reativo) foi lançada no mercado para oferecer benefícios para o tratamento odontológico devido ao seu sistema inovador de liberação multi-iônica, que envolve o flúor. Esse caso clínico descreve o uso de materiais preventivo e restaurador baseados nessa tecnologia em um paciente em desafio erosivo e com queixa de sensibilidade. O paciente relatou redução imediata da sensibilidade e as restaurações foram acompanhadas por 2 anos apresentando desempenho satisfatório. Sistemas baseados em S-PRG se mostram promissores para manejo preventivo e terapêutico do DDE empregados simultaneamente à colaboração do paciente.(AU)

S-PRG-based toothpastes compared to NaF toothpaste and NaF varnish on dentin permeability in vitro

Abstract Objectives To analyze the effect of 5 toothpastes containing different percentages of S-PRG fillers compared to NaF toothpaste and NaF varnish on the dentin hydraulic conductance (Lp). Methodology Dentin disks (1.0±0.2 mm thickness) were cut from third molars, and their Lp values were evaluated using Flodec. The specimens were allocated into 7 groups (n=8). The minimum (smear layer) and the maximum (after acid etching) Lp values were recorded. Lp was also assessed after treatment with either a 0wt.%, 1wt.%, 5wt.%, 20wt.%, or 30wt.% S-PRG toothpaste, a NaF toothpaste, or a NaF varnish. Toothpastes were applied by brushing for 15 s, allowing it to settle for 1 min, and rinsing with deionized water. The NaF varnish was applied for 4 min and was removed with a probe. Specimens were exposed to citric acid (6%, pH 2.1, 1 min) and their final Lp was recorded. The pH of all products was recorded (n=3) and specimens from each group were analyzed by Laser Scanning Confocal Microscopy (LSCM). Data were subjected to 2-way repeated measures ANOVA and post-hoc Bonferroni (a=0.05). Results The highest Lp reduction was noticed for the 5wt.% S-PRG toothpaste, NaF toothpaste, and NaF varnish. However, the toothpastes containing 5wt.%, 20wt.%, and 30wt.% of S-PRG were similar to all toothpastes but differed from the NaF varnish. After erosion, all groups retrieved their maximum Lp values, except for the NaF varnish. The LSCM evidenced deposits on the surface of specimens treated with 5%, 20%, and 30% S-PRG-based toothpastes and NaF toothpaste. Even more deposits were observed for the NaF varnish. After the erosive challenge, the deposits were diminished in all groups. Conclusion Toothpastes containing 5wt.%, 20wt.%, and 30wt.% of S-PRG fillers behaved similarly to a conventional NaF toothpaste, even after an erosive challenge. The NaF varnish promoted better reduction of the Lp, but its effect was also diminished after erosion.

Non-inferiority clinical trials: importance and applications in health sciences

Abstract Non-inferiority randomized clinical trials are indicated when it is intended to prove that an experimental group is not inferior to a control group by more than a margin of non-inferiority. However, this type of study differs from traditional randomized clinical trials (superiority studies) because they have particularities that impact on the formulation of hypothesis to be tested, experimental design (non-inferiority margin determination, adapted sample size calculation, sensitivity of the study and data final analysis) and also on the presentation of data when writing the manuscript. Therefore, this article aims to present and discuss the particularities of non-inferiority clinical studies, since these requirements are fundamental to guarantee the validity of the conclusions of this type of study.

In situ effect of a proanthocyanidin mouthrinse on dentin subjected to erosion

Abstract Proanthocyanidin has been shown to be efficient in inhibiting matrix metalloproteinases. Objective The aim of this in situ study was to evaluate the protective effect of Proanthocyanidin-based mouthrinses either with naturally acidic or with a neutral pH applied on dentin subjected to erosion. Methodology Eight volunteers wore one palatal device in two phases (7 days washout) with 16 samples per group (n=8). The groups under study were: First Phase/ G1 - 10% proanthocyanidin mouthrinse (pH 7.0, Experimental group 1 - Purified Grape Seeds Oligomeric Proanthocyanidins), G2 - 10% proanthocyanidin mouthrinse (pH 3.0, Experimental group 2 - Purified Grape Seeds Oligomeric Proanthocyanidins). Second Phase/ G3 - 0.12% chlorhexidine mouthrinse (pH 7.0, Positive control group), G4 - no previous treatment (Negative control group). Each device was subjected to 3 erosive cycles (5 minutes) per day for 5 days. Treatments with different mouthrinses were applied once after the second erosive challenge (5 minutes). Profilometry was used to quantify dentin loss (µm). Results Data were analyzed by repeated measures of ANOVA followed by Fisher's test (p<0.05). G1 (1.17±0.69) and G3 (1.22±0.25) showed significantly lower wear values with no statistical difference between them. G2 (2.99±1.15) and G4 (2.29±1.13) presented higher wear values with no significant differences between them. Conclusion The 10% proanthocyanidin mouthrinse (pH 7.0) could be a good strategy to reduce dentin wear progression.

Color evaluation of white spot lesions treated with resin infiltration after water or grape juice storage

Aim: To evaluate the color stability of bovine enamel with artificial white spot lesions treated with resin infiltration (ICON) or remineralization with fluoride using two storage methods. Methods: Sixty incisors were submitted to artificial white spot lesion induced by demineralization-remineralization (DE-RE) cycling. Initial color was evaluated with CIE-Lab to measure ΔEab. Demineralized teeth were divided according to the treatment of the white spot lesion (n = 20): 1) Remineralization with 2% neutral fluoride gel for 4min (control); 2) ICON application following manufacturer's recommendations; and 3) ICON with decreased drying time after the application of ethanol. After 24h, color was evaluated and samples were subdivided (n = 10) according to storage: 1) distilled water for 1 month; 2) grape juice for 10min daily. After storage, color was evaluated. L*, a* and b* data were analyzed by one-way ANOVA and ∆Eab data by two-way ANOVA followed by Tukey's HSD (α = 0.05). Results: L* was affected by juice storage, and decreased when ICON was applied with decreased drying time after the ethanol application. The same behavior occurred with a* (increase with reduced drying time), while b* was not affected. For ∆Eab significant differences were observed between groups (p = 0.0219) and storage methods (p = 0.0007). There was no interaction effect (p = 0.1118). Remineralization with fluoride presented the lowest color changes after storage in water. Conclusion: Treatment of artificial carious lesions with resin infiltration presented greater color changes than fluoride remineralization after storage in both solutions in vitro

Influence of modulated photo-activation on shrinkage stress and degree of conversion of bulk-fill composites

Abstract This study aimed to evaluate the polymerization properties of bulk-fill materials (low and high-viscosity) by using high-intensity continuous light and intermittent photo-activation in terms of polymerization shrinkage stress and degree of conversion (DC). The following Bulk-fill and Conventional nanofilled resin composites were evaluated: Filtek Z350XT Flow (3M/ESPE), SureFil SDR Flow (Dentsply), Filtek Bulk Fill Flow (3M/ESPE), Filtek Z350XT (3M/ESPE) and Filtek Bulk Fill Posterior (3M/ESPE). A LED device (DB 685, Dabi Atlante) was used for both protocols: continuous uniform and intermittent photo-activation (light-on and light-off cycles) with identical radiant exposure (14 J/cm2). The polymerization shrinkage stress (n=6) was evaluated by inserting a single increment of 12 mm3 between two stainless steel plates (6×2 mm) adapted to a Universal Testing Machine (UTM), at different times. Measurements were recorded after photo-activation. The degree of conversion was evaluated by Fourier transformed infrared spectroscope (FTIR) with an attenuated total reflectance (ATR) accessory (n=5). Data were analyzed by three-way ANOVA and Tukey's HSD (α=0.05) tests. Bulk Fill Posterior presented higher shrinkage stress values when photo-activated with the intermittent technique (p<0.05). The intermittent photo-activation increased the degree of conversion for the low-viscosity bulk-fills (p<0.05). Therefore, the use of modulated photo-activation (intermittent) must be indicated with caution since its use can influence the shrinkage stress and degree of conversion of composites, which varies according to the resin formulations.

Resumo O presente estudo teve como objetivo avaliar as propriedades de polimerização de materiais bulk-fill (baixa e alta viscosidade) utilizando luz contínua de alta intensidade e fotoativação intermitente em relação ao estresse de contração de polimerização e grau de conversão (DC). As seguintes resinas compostas Bulk-fill e nanohíbridas convencionais foram avaliadas: Filtek Z350XT Flow (3M/ESPE), SureFil SDR Flow (Dentsply), Filtek Bulk Fill Flow (3M/ESPE), Filtek Z350XT (3M/ESPE) e Filtek Bulk Fill Posterior (3M/ESPE). Um dispositivo de LED (DB 685, Dabi Atlante) foi utilizado nos dois protocolos: fotoativação contínua e intermitente contínua (ciclos de liga e desliga) com exposição idêntica (14 J/cm2). A tensão de contração de polimerização (n=6) foi avaliada através da inserção de um incremento único de 12 mm3 entre duas placas de aço inoxidável (6×2 mm) adaptadas a uma Máquina de Ensaio Universal (UTM), em tempos diferentes. As medições foram registradas após a fotoativação. O grau de conversão foi avaliado por FTIR-ATR (n=5). Os dados foram analisados ​​pelos testes ANOVA a três fatores e teste de Tukey (α=0,05). A resina Bulk Fill Posterior apresentou maiores valores de tensão de contração quando fotoativadas com a técnica intermitente (p<0,05). A fotoativação intermitente aumentou o grau de conversão nas resinas bulk-fill de baixa viscosidade (p<0,05). Portanto, o uso de fotoativação modulada (intermitente) deve ser indicado com cautela, uma vez que seu uso pode influenciar a tensão de contração e o grau de conversão dos compósitos, o que varia de acordo com as formulações da resina.

Obesidade, cirurgia bariátrica e o impacto na saúde bucal: revisão de literatura / Obesity, bariatric surgery and the impact on oral health: a literature review

Introdução: o consumo irregular de alimentos calóricos e pouco nutritivos elevou a prevalência da obesidade e a procura pela cirurgia bariátrica. Entretanto, tais condições podem causar consequências negativas na cavidade bucal. Objetivo: o objetivo deste estudo foi revisar a literatura acerca da relação entre obesidade, cirurgia bariátrica e alterações bucais. Métodos: foi realizada consulta ao PubMED e ao BVS utilizando os termos "cirurgia bariátrica", "periodontite", "síndrome x metabólica", "obesidade", "força de mordida", "cardiopatias", "qualidade de vida", "desgaste dos dentes" e "eliminação salivar" entre 2000-2017. Documentos do Ministério da Saúde brasileiro e da Organização Mundial da Saúde com dados epidemiológicos foram incluídos. Resultados: observou-se que cárie dentária é frequente e o estado crônico de inflamação do obeso contribui para o desenvolvimento da doença periodontal. Além disso, o obeso possui maior risco de desordens cardiovasculares, que pode ser potencializada por bactérias da doença periodontal. Contudo, a cirurgia bariátrica, ao contrário do esperado, pode agravar ainda mais a doença periodontal e, devido a frequentes episódios de vômito, também pode levar ao desgaste dentário. Conclusão: a literatura evidencia a importância do cirurgião-dentista no controle de riscos, na prevenção e no tratamento dos pacientes obesos e bariátricos.

Introduction: irregular intake of caloric and low-nutrient foods has raised the prevalence of obesity and the demand for bariatric surgery. However, such conditions may have negative consequences on the oral cavity. Objective: the aim of this study was to review the literature on the relationship between obesity, bariatric surgery and oral disorders. Methods: PubMED and BVS were consulted using the terms "bariatric surgery", "periodontitis", "metabolic syndrome", "obesity", "bite force", "heart disease", "quality of life", "tooth wear" and "salivary elimination"between 2000-2017. Documents from the Brazilian Ministry of Health and the World Health Organization with epidemiological data were included. Results: it was observed that dental caries is frequent, and the chronic inflammatory state of the obese patient contributes to the development of periodontal disease. In addition, the obese is at increased risk for cardiovascular disorders, which may be worsened by bacteria from periodontal disease. Yet, bariatric surgery, contrary to expectations, may further aggravate periodontal disease and, due to frequent vomiting episodes, can also lead to tooth wear. Conclusion: it can be concluded that literature highlights the importance of the dentist in the control of risks, in the prevention and treatment of obese and bariatric patients.

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)

Effect of enamel pretreatment on the fluoride remineralization of artificial white spot lesions / Efeito do pré-tratamento do esmalte na remineralização de lesões brancas de cárie artificiais com fluoreto

Objective: The topical fluoride application is the main strategy to remineralize white spots lesions (WSL). It is assumed that increasing its retention in the surface can favor remineralization. Therefore, previous treatments of the enamel surface are purposed to optimize its efficacy. This study aimed to evaluate the remineralization capacity of the fluoride without and with the pre-treatment of the enamel with phosphoric acid and aluminum nitrate and then, the enamel acid-resistance after new acid challenge. Material and Methods: Twenty-four enamel bovine blocks were obtained and selected by means of initial surface microhardness (SMH) measurements. In sequence, WSL were artificially inducted by DE-RE cycling and randomized in two groups according to the enamel pretreatment to be tested (n=12): F (1.23% fluoride gel - APF- 4min) and P-Al-F (37% phosphoric acid- 30s + 0.05M aluminum nitrate 1min + APF- 4min). After then, a new acid challenge was equally performed. Additional SMH assessments were performed in each step. The values were processed and the percentage of SH loss (%SHL) was obtained. Data were statically analyzed by two-way ANOVA and Tukey tests (p <0.05). Results: There was no difference between evaluated protocols. For both groups, a significant difference among the steps of study was detected: it was observed a decrease of %SHL after the treatment and increase of %SHL after the new acid challenge. Conclusion: Enamel pretreatment with phosphoric acid associated with aluminum nitrate promoted similar protective effect compared to fluoride itself on the remineralization of artificial WSL, partially recovering the surface hardness. After new challenge, they also offered partial resistance. (AU)

Objetivos: A aplicação tópica de flúor é a principal estratégia para remineralizar lesões de mancha branca (MB). Foi proposto que o aumento na retenção deste íon na superfície pode favorecer a remineralização. Portanto, o tratamento prévio da superfície do esmalte foi proposto para otimizar sua eficácia. Material e Métodos: Este estudo objetivou avaliar a capacidade de remineralização do fluoreto com e sem pré-tratamento do esmalte com ácido fosfórico e nitrato de alumínio e a resistência do esmalte após novo desafio ácido. Vinte e quatro blocos de esmalte bovino foram obtidos e selecionados pela média inicial de microdureza de superfície (MS). Em seguida, MB foram artificialmente induzidas através de ciclagem DES-RE e os espécimes aleatorizados em dois grupos de acordo com o pré-tratamento do esmalte a ser avaliado (n=12): F (flúor gel acidulado 1,23% - APF - 4 min) e P-Al-F (ácido fosfórico 37% - 30s + nitrato de alumínio 0,05M 1min + APF por 4 min). Após o tratamento, um novo desafio ácido semelhante ao inicial foi realizado. Novas avaliações de MS foram obtidas em cada etapa. Os valores foram processados e a porcentagem de perda mineral da superfície (%PDS) foi obtida. Os dados foram analisados estatisticamente por ANOVA dois critérios e teste de Tukey (p <0,05). Resultados: Não houveram diferenças entre os protocolos avaliados. Para ambos grupos, uma diferença significante entre as fases do estudo foi detectada: observouse uma queda no %PDS após o tratamento e aumento do %PDS após novo desafio ácido. Conclusão: O pré-tratamento do esmalte com ácido fosfórico associado com nitrato de alumínio promoveu efeito similar à aplicação isolada do APF na remineralização das MB artificiais, recuperando parcialmente a dureza de superfície. Após o novo desafio ácido, os dois grupos ofereceram resistência parcial. (AU)

Influence of Erosive and Abrasive Cycling on Bonding of Different Adhesive Systems to Enamel: An In situ Study

Abstract This study evaluated the impact of orange juice on the bond strength (BS) of dentin bonding systems (DBSs) to enamel surface after simulation with an in situ/ ex vivo erosive cycling. One hundred and ninety two bovine enamel fragments (4x4x2mm) were obtained and randomized regarding superficial microhardness and distributed to palatal devices for 8 volunteers, in three phases (one for each DBS), containing 8 blocks, which were, allocated in 4 pairs. Daily, these pairs were subjected extraorally to the following conditions: CONT- neither erosive nor abrasive challenge; ERO- erosive challenge only; ABR- abrasive challenge only and ERO + ABR- with erosive and abrasive challenges. Erosive cycles (immersion in orange juice, 3 times/day/5 min/5 days) or/and abrasive challenges (electric toothbrush, 3 times/day/1 min/5 days) were performed. After these cycles, all specimens were restored with the adhesive systems Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) or Clearfil SE Bond (SE), and the composite resin Filtek Z250. After 7 days, sticks (area ≅1 mm2) were obtained and subjected to the microtensile bond strength test (μTBS) at 0.5 mm/min. Data was statistically analyzed by ANOVA and Tukey tests (a=0.05). Failure modes were determined using a digital microscope (40´). DBS was the only statistical significant factor. SE was the unique DBS not affected in any challenge, whereas MP and SB performed according to the scenario. The adhesive and mixed failures were predominant in all groups. Overall performance suggested that BS to enamel after erosive /abrasive challenged by orange juice was not affected and it was material-dependent.

Resumo Este estudo avaliou o impacto de suco de laranja na resistência de união (RU) de sistemas adesivos dentinários (SAD) à superfície do esmalte após a simulação com uma ciclagem erosiva in situ/ex vivo. Cento e noventa e dois fragmentos de esmalte bovino (4x4x2mm) foram obtidos e randomizados considerando a microdureza superficial, e distribuídos em dispositivos palatinos para 8 voluntários, em três fases (uma para cada SAD), contendo 8 blocos, os quais foram alocados em 4 pares. Diariamente, esses pares eram submetidos às seguintes condições extraoralmente: CONT- sem desafio erosivo ou abrasivo; ERO- desafio erosivo somente; ABR- desafio abrasivo somente; e ERO+ABR- com desafio erosivo e abrasivo. A ciclagem erosiva (imersão em suco de laranja, 3 vezes/dia/5 min/5 dias) e/ou ciclagem abrasiva (escova dentária elétrica, 3 vezes/dia/1 min/5 dias) foram feitas. Após estas ciclagens, todos os espécimes foram restaurados com os sistemas adesivos Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) ou Clearfil SE Bond (SE), e com a resina composta Filtek Z250. Após 7 dias, palitos (área ≈1 mm) eram obtidos e submetidos ao teste de resistência de união por microtração (μTBS) a 0,5 mm/min. Os dados foram estatisticamente analisados por ANOVA e teste de Tukey (a=0,05). Os modos de fratura foram determinados utilizando um microscópio digital (40×). SAD foi o único fator estatisticamente significante. SE foi o único SAD não afetado por qualquer desafio, enquanto o MP e o SB apresentaram um desempenho de acordo com o cenário. As fraturas do tipo mista e adesiva foram predominantes em todos os grupos. O desempenho geral sugeriu que RU ao esmalte após desafio erosivo/abrasivo por suco de laranja não foi afetada e foi material-dependente.

Effect of Two Antioxidants Agents on Microtensile Bond Strength to Bleached Enamel

Abstract This in vitro study evaluated the effect of sodium bicarbonate and sodium ascorbate on the microtensile bond strength of an etch-and-rinse system to bleached bovine enamel. Sixty bovine enamel blocks (4x4 mm) were flattened and randomly allocated into 5 groups: G1 (negative control): without treatment; G2 (positive control): bleached with 35% hydrogen peroxide (HP); G3: bleached and stored for 7 days in artificial saliva before restorative procedures; G4: bleached and treated with 10% sodium bicarbonate solution for 5 min; G5: bleached and treated with 10% sodium ascorbate hydrogel for 15 min. HP gel was applied twice (20 min each, except in G1) and the adhesive restorations were performed. After 24 h, the specimens were sectioned into sticks and submitted to microtensile bond strength testing with a crosshead speed of 0.5 mm/min (n=12). As a complementary visual observation, the enamel surfaces of the G1 and G2 specimens were evaluated with scanning electron microscopy. Data were analyzed by one-way ANOVA (p<0.05). The means (standard deviation) were: G1: 24.22±7.74; G2: 18.29±5.88; G3: 40.88±7.95; G4: 19.95±5.67 and G5: 24.43±6.43. Adhesive failures were predominant in all groups. The comparison between the treatments indicates that waiting 7 days after bleaching is still the most effective approach. When this waiting period is not possible, application of sodium ascorbate or sodium bicarbonate seems to be a good alternative. Therefore, the practicality of obtaining sodium bicarbonate in the bleaching kits and its higher stability enables its clinical use.

Resumo Este estudo in vitro avaliou o efeito do bicarbonato de sódio e do ascorbato de sódio na resistência de união de um sistema adesivo convencional unido ao esmalte bovino clareado. Sessenta blocos de esmalte bovino (4x4 mm) foram planificados e distribuídos aleatoriamente em 5 grupos: G1: (controle negativo); G2 (controle positivo): clareamento com peróxido de hidrogênio 35% (HP); G3: clareamento com HP seguido de armazenamento por 7 dias em saliva artificial antes do procedimento restaurador; G4: clareamento com HP seguido de tratamento com a solução de bicarbonato de sódio 10% por 5 min; G5: clareamento com HP seguido de tratamento com hidrogel de ascorbato de sódio 10% por 15 min. O HP foi aplicado duas vezes (20 min cada, com exceção do grupo G1) e então as restaurações adesivas foram realizadas. Após 24 h, os espécimes foram seccionados em palitos e submetidos ao teste de resistência de união a uma velocidade de 0,5 mm/min (n=12). As superfícies de esmalte de G1 e G2 foram avaliadas com microscopia eletrônica de varredura para fins de análise visual complementar. Os dados foram analisados por ANOVA a um critério (p<0,05). As medias (desvio-padrão) foram: G1: 24,22±7,74; G2: 18,29±5,88; G3: 40,88±7,95; G4: 19,95±5,67 e G5: 24,43±6,43. Falhas adesivas foram predominantes em todos os grupos. A comparação entre os diferentes tratamentos indica que esperar 7 dias após o clareamento é ainda a abordagem mais eficaz. Nos casos em que este período de espera não é possível, a aplicação do ascorbato de sódio e do bicarbonate de sódio parecem ser boas alternativas. Entretanto, a praticidade na obtenção da solução de bicarbonato de sódio nos kits de clareamento e sua maior estabilidade favorecem o seu uso clínico.

Effects of the application techniques of self-adhesive resin cements on the interfacial integrity and bond strength of fiber posts to dentin

ABSTRACT Objective: To evaluate the influence of an application technique of a glass-fiber post using self-adhesive resin cements on the push-out bond strength and the presence of bubbles in the root thirds. The cements were either applied according to the manufacturer's instruction or using a commercial delivering system (Centrix), at which the cement pastes were collected and applied after manipulation. Material and Methods: Self-adhesive resin cements (RelyX U200/3M ESPE-U200; Maxcem Elite/Kerr-MAX; Clearfil SA Cement/Kuraray-CSA) and a conventional cement (RelyX ARC/3M ESPE-ARC) were used to cement a post and applied either based on the manufacturer's instructions or using a Centrix syringe to deliver the cements directly onto the post of choice, or directly into canal. The roots were scanned with a micro-computed tomography (μCT) and then sectioned into nine 1-mm thick slices for a push-out bond strength test. The μCT images showed the percentage of bubbles in the root thirds (cervical, medium, and apical). Data were analyzed with three-way ANOVA/Tukey (α=0.05). Results: Triple interaction was not significant (p>0.05). The interaction “material” vs “root third” was not significant. A significant interaction was observed between “material” vs “application technique” (p<0.05). For ARC, U200, and MAX, significantly lower percentages of bubbles were observed when the Centrix syringe delivered the cements. Equivalent percentages of voids were observed for CSA, irrespective of the application technique (p>0.05). Significantly higher bond strength was observed when the self-adhesive resin cements were applied using the Centrix delivery system, in comparison with the manufacturer's instructions (p<0.05). Bond strength varied with the root third: cervical>medium>apical (p<0.05). No correlations were found between the bond strength and voids. Conclusions: Bond strength and voids are negatively influenced by the conventional application technique for luting fiber posts. The delivery system (Centrix) seems to produce better results when cementing fiber posts.

Water interaction and bond strength to dentin of dye-labelled adhesive as a function of the addition of rhodamine B

ABSTRACT Objective This study investigated the effect of the fluorescent dye rhodamine B (RB) for interfacial micromorphology analysis of dental composite restorations on water sorption/solubility (WS/WSL) and microtensile bond strength to dentin (µTBS) of a 3-step total etch and a 2-step self-etch adhesive system. Material and Methods The adhesives Adper Scotchbond Multi-Purpose (MP) and Clearfil SE Bond (SE) were mixed with 0.1 mg/mL of RB. For the WS/WSL tests, cured resin disks (5.0 mm in diameter x 0.8 mm thick) were prepared and assigned into four groups (n=10): MP, MP-RB, SE, and SE-RB. For µTBS assessment, extracted human third molars (n=40) had the flat occlusal dentin prepared and assigned into the same experimental groups (n=10). After the bonding and restoration procedures, specimens were sectioned in rectangular beams, stored in water and tested after seven days or after 12 months. The failure mode of fractured specimens was qualitatively evaluated under optical microscope (x40). Data from WS/WSL and µTBS were assessed by one-way and three-way ANOVA, respectively, and Tukey’s test (α=5%). Results RB increased the WSL of MP and SE. On the other hand, WS of both MP and SE was not affected by the addition of RB. No significance in µTBS between MP and MP-RB for seven days or one year was observed, whereas for SE a decrease in the µTBS means occurred in both storage times. Conclusions RB should be incorporated into non-simplified DBSs with caution, as it can interfere with their physical-mechanical properties, leading to a possible misinterpretation of bonded interface.

Evaluation of temperature increase during in-office bleaching

ABSTRACT The use of light sources in the bleaching process reduces the time required and promotes satisfactory results. However, these light sources can cause an increase in the pulp temperature. Objective The purpose of the present study was to measure the increase in intrapulpal temperature induced by different light-activated bleaching procedures with and without the use of a bleaching gel. Material and Methods A human maxillary central incisor was sectioned 2 mm below the cementoenamel junction. A K-type thermocouple probe was introduced into the pulp chamber. A 35% hydrogen peroxide bleaching gel was applied to the vestibular tooth surface. The light units used were a conventional halogen, a hybrid light (only LED and LED/Laser), a high intensity LED, and a green LED light. Temperature increase values were compared by two-way ANOVA and Tukey´s tests (p<0.05). Results There were statistically significant differences in temperature increases between the different light sources used and between the same light sources with and without the use of a bleaching gel. The presence of a bleaching gel generated an increase in intra-pulpal temperature in groups activated with halogen light, hybrid light, and high intensity LED. Compared to the other light sources, the conventional halogen lamp applied over the bleaching gel induced a significant increase in temperature (3.83±0.41°C). The green LED unit with and without gel application did not produce any significant intrapulpal temperature variations. Conclusion In the present study, the conventional halogen lamp caused the highest increase in intrapulpal temperature, and the green LED caused the least. There was an increase in temperature with all lights tested and the maximum temperature remained below the critical level (5.5°C). The addition of a bleaching gel led to a higher increase in intrapulpal temperatures.

Variação da temperatura intra-câmara pulpar em função da ativação com LED de géis clareadores de uso ambulatorial / Variation of temperature in pulp chamber due to LED bleaching gels activation

Este estudo avaliou o efeito da aplicação de diferentes géis clareadores na temperatura intra-câmara pulpar no clareamento fotoativado em consultório. Preencheu-se a câmara pulpar de um incisivo com pasta térmica e um sensor digital Termopar, e a raiz submersa em água a 37°C. Avaliaram-se 6 grupos: G1- SG: sem gel; PH: G2- peróxido de hidrogênio incolor a 35%; G3- OXB: Opalescence Xtra Boost; G4- WHP: Whiteness HP; G5- WM: Whiteness HP MAXX; G6- LP: Lase Peroxide. Para a ativação dos géis empregou-se o aparelho LED por 3 minutos. A aferição da variação de temperatura intra-câmara foi realizada com termômetro digital com termopar tipo K a cada 30 segundos. Os dados foram submetidos à ANOVA a dois critérios e teste de Tukey. Os resultados foram: 60 s - O grupo G2 (38° C) apresentou menor valor que os demais; 90 s - G2 (38,8°C) < G6 (39,6°C), G3 (39,8°C); 120 s - G2 (38,8°C) < G3 (40°C), G4 (39,6°C), G5 (39,8°C), G6 (40°C); 150 s - G2 (39°C) < G1 (39,8°C) G3, G4, G5, G6 (40°C); 180 s. A média final obtida foi: G2 (38,72°C) < G5 (39,16°C) < G1 (39,27°C) < G4 (39,30°C) < G6 (39,33°C) < G3 (39,47°C). O gel incolor não promoveu aumento significante na temperatura intrapulpar; géis clareadores com corante vermelho e verde aceleram este aumento quando ativados por luz LED azul de alta densidade de energia...

This study has evaluated the effect of different dental bleaching gels over the pulp chamber temperature during in-office photoactivated dental bleaching. The empty pulp chamber of an incisor was filled with a heat sink compound and a thin digital K-type thermocouple, immersed in distilled water at 37°C. Six groups were evaluated: G1 with no gel; G2 colorless gel; G3- OXB: Opalescence Xtra Boost; G4- WHP: Whiteness HP; G5- WM: Whiteness HP MAXX; G6- LP: Lase Peroxide. The gel light activation was made using LED, during 3 consecutive minutes. The intra-pulpal temperature was measured using a digital thin K-type thermocouple K at every 30 seconds. Data were submitted to ANOVA and TukeyÆs test. Results showed: 60 s -G2 (38°C) showed lower value than the others; 90s -G2 (38.8°C) < G6 (39.6°C), G3 (39.8°C); 120 s - G2 (38.8°C) < G3 (40°C), G4 (39.6°C), G5 (39.8°C), G6 (40°C); 150 s - G2 (39°C) < G1 (39.8°C) G3, G4, G5, G6 (40°C); 180 s. The final mean obtained was: G2 (38,72°C) < G5 (39,16°C) < G1 (39,27°C) < G4 (39,30°C) < G6 (39,33°C) < G3 (39,47°C). The colorless gel did not provided significant increase in the pulp chamber temperature; bleaching gels with red and green dyes accelerate this increase in temperature when activated by blue LED light with high energy density...