Restauraciones de lesiones cervicales no cariosas: un protocolo de revisión sistemática para la práctica clínica / Restorations of non-carious cervical lesions: a review protocol systematic for clinical practice

Las lesiones cervicales no cariosas son condiciones patológicas no bacterianas localizadas en el límite amelocementario de los dientes. Los principales biomateriales descritos para el tratamiento restaurador de estas lesiones son: vidrios ionómeros, vidrios ionómeros modificados con resinas, compómeros y resinas compuestas. El objetivo de este protocolo, consiste en establecer los elementos metodológicos de una revisión sistemática que evaluará el comportamiento clínico de restauraciones cervicales realizadas con estos biomateriales. Métodos: El protocolo fue diseñado, y será reportado, en línea con Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P 2015). Se realizará una búsqueda sensible en MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials y ClinicalTrials.gov, sin restricción por lenguaje o publicación, para identificar ensayos controlados aleatorizados que comparen dos o más tratamientos restauradores en lesiones cervicales no cariosas. Los desenlaces a evaluar serán la retención de las restauraciones y caries secundaria, según criterios RYGE/USPHS. Al menos dos investigadores realizarán de manera independiente la selección de los ensayos y la extracción de los datos. El riesgo de sesgo será evaluado utilizando la herramienta recomendada por la colaboración Cochrane. Si es posible, se realizará un metanálisis y los datos serán presentados en tablas de resúmenes de resultados mediante el método Grading of Recommendations Assesment, Development and Evaluation (GRADE). Fortalezas y debilidades: Esta revisión sistemática entregará evidencia actualizada sobre el comportamiento de cuatro biomateriales en el tratamiento de lesiones cervicales no cariosas. La principal limitación proviene de la baja cantidad o deficiencias metodológicas de los estudios primarios. Número de registro (PROSPERO): CRD42017071114.(AU)

Non-carious cervical lesions constitute a group of non-bacterial pathological conditions of the dental structure located at amelocementary junction. The main dental materials that have been described for the restorative treatment of these lesions are: ionomer glass, resin modified ionomer glass, compomers and composite resins. The objective of this protocol, is to establish the methodological elements of a systematic review, that will evaluate the clinical behavior of cervical restorations performed with four dental biomaterials. Methods: The protocol was designed, and will be reported, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Protocols (PRISMA-P 2015). We will conduct a sensitive search in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov, without language or publication restrictions, in order to identify randomized controlled trials comparing two or more restorative treatments in non-carious cervical lesions. The evaluated outcomes will be retention of restorations and secondary caries, according to RYGE/USPHS criteria. At least two reviewers will independently select studies and extract data. The risk of bias will be assessed using the tool recommended by the Cochrane Collaboration. If possible, a meta-analysis will be performed and the data will be presented in summary tables of results using the Grading of Recommendations Assesment, Development and Evaluation (GRADE) approach. Strength and Limitations: This systematic review will provide updated evidence on the behavior of four different dental biomaterials in the treatment of non-carious cervical lesions. The main limitation might arise from the low number or methodological limitations of primary studies. Register number (PROSPERO): CRD42017071114.(AU)

Hibridación a esmalte y dentina de los ionómeros de vidrio de alta densidad, estudio con MEB / Enamel and dentin hybridization of high density glass ionomers: a SEM study

De acuerdo con la filosofía de la odontología de mínima intervención, los ionómeros de vidrio están resurgiendo en la odontología restauradora por sus ventajas actuales: dureza, estética y liberación activa defl úor. En la actualidad se ha comprobado mediante estudios y trabajo clínico que estos nuevos ionómeros de vidrio llamados ionómeros de alta densidad tienen un periodo de duración signifi cativo similar a las resinas, pero con más ventajas y con una muy simplifi cada técnica de colocación. El objetivo de este estudio es analizar la adhesión yadaptación marginal de cuatro ionómeros de vidrio de alta densidad, alesmalte y dentina. Material y métodos: Se seleccionaron 16 primeros premolares. A cada uno se le aplicó la preparación convencional de cavidad clase uno de Black de 2 mm de altura por 2 mm de ancho. Se acondicionó la cavidad (esmalte y dentina) con ácido poliacrílico al 10 por ciento por 10 segundos, posteriormente se lavó y secó generosamente y se colocaron los ionómeros de vidrio. Se dividieron en cuatro grupos: 1. Ionofi l Molar® (VOCO), 2. Ketac Molar® (3M ESPE), 3. EQUIA FiL® (GC) y 4. EQUIA Forte® (GC). En la parte final de la obturación,una vez seleccionadas y preparadas las muestras, se analizaron bajo el microscopio electrónico de barrido (MEB). Resultados: Las características encontradas en los cuatro grupos fueron: la integración del ionómero de vidrio a la dentina resultó mejor que al esmalte. Los rellenos inorgánicos de estos materiales se apreciaron mejor definidos en los últimos dos grupos. La adaptación al material de restauraciónse observó bien ajustada en el interior de la cavidad. La formación dehibridación en el esmalte y la dentina fue mejor en los grupos 2, 3 y 4. Conclusión: De los cuatro grupos estudiados el EQUIA FiL y el EQUIA Forte fueron los que presentaron excelente adaptación marginal e hibridación al esmalte y dentina.

According to minimal invasive dentistry philosophy glass ionomers,are making a comeback in restorative dentistry, due to their actualadvantages like: hardness, aesthetics and active fl uor liberation. Nowit has been demonstrated, thanks to studies and clinical trials, thatthe new glass ionomers called high-density glass ionomers have animportant clinical time span, similar to resins, with more advantages;and with a very simplifi ed placement technique. The aim of this studyis to analyze the adhesion and marginal adaptation of four high-densityglass ionomers to the enamel and dentin. Material and methods: 16fi rst premolars were selected. To each one was made the conventionalpreparation class, one cavity of Black of 2 mm of height by 2 mm ofwidth. The cavity (enamel and dentin) was conditioned with 10%polycyclic acid for 10 seconds, then washed and dried generously; andthe glass ionomers were placed. They were divided into four groups; 1.Ionofi l Molar® (VOCO), 2. Ketac Molar® (3M ESPE), 3. EQUIA FiL®(GC), 4. EQUIA Forte® (GC). At the end of the obturation. When thesamples were already selected and prepared, were analyzed by scanningelectron microscopy (SEM). Results: The characteristics found in thefour groups, were as follows: the integration of glass ionomer withthe dentin, was better than the enamel. The inorganic fi llings of thesematerials are better defi ned in the last two groups. The adaptation ofthe restorative material is well observed inside the cavity. The formationof hybridization in the enamel and the dentin, were better in groups2, 3 and 4. Conclusion: Of four studied groups: those that presentedexcellent marginal adaptation, hybridization to the enamel and dentin,were EQUIA FiL and EQUIA Forte, noting that those of group 4(EQUIA Forte) resulted in having the best marginal adaptation, thanany other glass ionomer included in this study.

Grado de degradación de ionómeros de vidrio modificados con resina al contacto con diferentes enjuagues bucales: estudio in vitro

Objetivos: Evaluar los cambios de masa y rugosidad del ionómero de vidrio al contacto con los enjuagues, considerando el tiempo de exposición y su composición. Materiales y métodos: Se realizaron 88 cuerpos de prueba de ionómeros de vidrio Ionolux y Vitremer que se mantuvieron en contacto con Listerine Zero sin alcohol, Cool Mint con alcohol, y Whitening con alcohol y agentes blanqueadores; durante 21, 546 y 1092 minutos con ciclos de permanencia de los especímenes en saliva artificial, y se realizó pesaje de pruebas de perfilómetro de forma continua. Resultados: los datos tabulados y analizados mediante prueba de ANOVA mostraron degradación en las muestras, sin diferencia estadísticamente significante evidenciada también en la rugosidad, de manera proporcional al tiempo de exposición. Conclusiones: existen cambios tanto en peso como en rugosidad sobre los ionómeros evaluados tras contacto con los diferentes enjuagues utilizados, proporcionales al tiempo de exposición. La presencia de alcohol en el enjuague bucal no determina mayor cambio de la masa de los materiales evaluados; pero sí en rugosidad, en comparación con otras composiciones de enjuagues y el tiempo de exposición.

Objectives: to evaluate changes in mass and roughness of glass ionomer in contact with mouthrinses considering time of exposure and their composition. Materials and Methods: 88 Ionolux and Vitremer glass ionomer test bodies were made and kept in contact with alcohol-free Listerine Zero, Cool Mint, with alcohol, and Whitening with alcohol and bleaching agents during 21, 546 and 1092 minutes with cycles of permanence of specimens in artificial saliva, weighing and profilometer tests were carrying out in a continuous way. Results: The data tabulated and analyzed by ANOVA test showed degradation in samples without any statistically significant difference evidenced even in roughness, it is proportional to time of exposure. Conclusions: There are changes in weight and roughness on ionomers evaluated aftercontact with different mouth rinses used proportional to time of exposure. The presence of alcohol in the mouthwash does not determine greater change in the mass of evaluated materials; but roughness does in comparison with other mouth rinse compositions and exposure time.

Surface micromorphological changes of glass ionomer following application of 1.23% acidulated phosphate fluoride: A scanning electron microscope study.

Objectives: The purpose of this study was to evaluate the surface micromorphological changes of conventional glass ionomer cement (GIC) (Fuji II, GC Corporation, Tokyo, Japan) and high strength, high viscosity GIC (Fuji IX GP, GC Corporation) subjected to 1.23% acidulated phosphate fluoride (APF) gel for 4 min. It also evaluated the surface micromorphological changes that occurred in these materials when they were coated with a layer of glass ionomer varnish prior to the application of 1.23% APF gel. Materials and Methods: A total of 60 uniform glass ionomer cylinders were prepared (30 of each Fuji II and Fuji IX) and stored in distilled water for 48 h, following which they were divided into six groups depending on the surface treatment. Group 1: Fuji II alone, Group 2: Fuji IX alone, Group 3: Fuji II + 1.23% APF gel for 4 min, Group 4: Fuji IX + 1.23% APF gel for 4 min, Group 5: Fuji II + varnish + 1.23% APF gel for 4 min, and Group 6: Fuji IX + varnish + 1.23% APF gel for 4 min. After the required surface treatment had been done, the specimens were mounted, coated, and evaluated under scanning electron microscope. Statistical Analysis: Kruskal–Wallis test applied to compare the level of degradation among the groups subjected to treatment was highly significant (P < 0.001). Mann–Whitney test was applied to test the association between glass ionomer varnish and level of surface degradation and was also statistically significant (P = 0.001). Results: The results indicated that APF gel etched the surface of both Fuji II and Fuji IX. However, Fuji IX showed to possess better resistance to the erosive effect of APF than Fuji II. It was also observed that application of glass ionomer varnish prior to APF gel application protected the glass ionomer from the erosive effect of APF gel. Conclusion: APF gel caused erosive wear of the GICs esp. Fuji II. Hence, it is advisable to avoid the use of APF containing preparations for regular home use especially in children having glass ionomer restoration. If APF gel is indicated or preferred for professional application, it is recommended to apply glass ionomer varnish on the restored teeth prior to the APF gel application.

Effect of powder/liquid ratio of glass ionomer cements on flexural and shear bond strengths to dentin

Aim: This study evaluated the effect of varying the powder/liquid (P/L) ratio on the shear bond to dentin (SBS) and flexural strength (FS) of glass ionomer cements (GIC)s. Methods: Three types of GICs (Fuji II, Fuji II LCi and Fuji IX GP) were mixed using the following P/L ratios: 20% lower than the manufacturer's ratio, manufacturer's ratio, 20% higher than the manufacturer's ratio (9 groups). SBS (MPa) was evaluated and the mode of failure checked under stereomicroscope. FS (MPa), of the specimens (25×2×2mm) assessed using a universal testing machine at a crosshead speed of 1 mm/min. The data were subjected to two-way ANOVA and Tukey's test for analysis (p< 0.05). Results: The highest SBS and FS (MPa) obtained for Fuji II, Fuji II LCi and Fuji IX were 6.12±2.11 and 16.96±2.73; 11.60±3.19 and 49.58±8.75; 7.39±2.77 and 20.32±2.09, respectively. The interaction between materials and P/L ratios had no significant effect on the properties tested in this study. Fuji II LCi exhibited significantly higher SBS and FS than the other two GICs in all P/L ratios. Conclusions: No significant differences were observed between Fuji II and Fuji IX. Twenty percent variation in P/L ratio had no significant effect on SBS and FS of GICs.