Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial

Abstract Objectives This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. Results After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). Conclusion Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Effect of silver and resin reinforced glass ionomers on the enamel microhardness after exposure to cariogenic biofilm

Objective: To assess the superficial microhardness of enamel-restorations margins of glass ionomer cement reinforced with silver (RS), modified with resin (RI) and composite resin (CO) after cariogenic biofilm. Materials and Methods: Thirty bovine enamel blocks with standard cavities were divided into three groups according to the materials used: RI (Riva Light Cure™, SDI), RS (Riva Silver™, SDI) and CO (Filtek™ Z350 XT, 3M). Half of each enamel block surface was covered by acid resistant varnish. After that, the blocks were exposed to Streptococcus mutans biofilm. The varnish was removed from the blocks and superficial microhardness (MDS) was measured (Knoop, 50 g, 15 s), with five indentations, 100 µm from each other in three different directions. The data were analyzed by the Shapiro Wilk, Kruskal Wallis and Mann Whitney tests (p<0.05). Results: MDS analysis indicated that in 50 µm distance from the restoration, RS group obtained hardness gain (6.31±0.01), unlike RI (-0.36±0.05) and CO (-11.43±0.02) groups that demonstrated significant loss (p<0.05). In other distances did not observe statistical difference between the groups. Regardless of the distance up to 450 µm, significant high total mineral gain was observed for RS group compared to the CO group; however, RS and RI presented similar enamel microhardness. Conclusion: All glass ionomers increased microhardness of enamel blocks even in contact with cariogenic biofilm. Although only the silver reinforced glass ionomer prevented demineralization at the margin restorations in 50 µm from the margin.

Objetivo: Comparar a desmineralização nas margens da interface dente/restauração utilizando cimento de ionômero de vidro modificado com resina (RI) e reforçado com prata (RS) e com resina composta (CO) após desafio cariogênico. Materiais e Métodos: 30 blocos de esmalte bovino com cavidades padronizadas foram divididos em 3 grupos de acordo com os materiais utilizados: RI (Riva Light CureTM, SDI), RS (Riva SilverTM, SDI) e CO (FiltekTM Z350 XT, 3M). Metade de cada superfície de esmalte restaurada foi protegida com verniz ácido-resistente. Os blocos foram expostos ao biofilme de Streptococcus mutans. O verniz foi removido dos espécimes com algodão e álcool para mensuração da microdureza superficial (MDS - Knoop, 50 g, 15 s), através de 3 linhas com 5 indentações em cada e 100 µm de distância entre elas. Os dados foram submetidos ao programa SPSS 20.0, teste de normalidade de Shapiro Wilk, Kruskal Wallis e Mann Whitney (p<0,05). Resultados: A análise da MDS demonstrou que na distância de 50 µm da restauração, o grupo RS apresentou ganho percentual de dureza (6,31 ± 0,01), diferentemente dos grupo RI (-0,036 ± 0,05) e CO (-11,43 ± 0,02) que apresentaram perda significativa (p<0,05). Nas demais distâncias, não foi observada diferença estatística entre os grupos. Conclusão: Todos os cimentos de ionômero de vidro aumentaram a microdureza superficial total dos blocos de esmalte mesmo após exposição ao biofilme cariogênico. No entanto, apenas o grupo RS impediu a desmineralização a 50 µm das margens de restaurações submetidas a biofilme cariogênico.

Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial

Abstract The objectives of this double-blind randomized clinical trial were to compare (a) the clinical times and (b) the occurrence and severity of postoperative sensitivity, of posterior restoration that used a universal adhesive, in a self-etch or selective enamel-etching technique, along with incremental or bulk-fill composites (presented in syringes or capsules). A total of 295 posterior restorations were placed according to the following groups: SETB - self-etch/bulk-fill in syringe; SETC - self-etch/bulk-fill in capsules; SETI - self-etch/incremental; SEEB - selective enamel-etching/bulk-fill in syringe; SEEC - selective enamel-etching/bulk-fill in capsules; and SEEI - selective enamel-etching/incremental. Clinical time was assessed by a reason (s/mm3) between the total volume of resin inserted and the total time required to perform the restorations. Postoperative sensitivity was evaluated using two scales (Numeric Rating Scale and Visual Analogue Scale). Mean clinical time results, analyzed by Wald's Chi-square, showed significant statistical differences among all groups (p<0.001), indicating that the restorative strategy affected the time required for the restoration. A generalized estimating equation model statistical analysis, performed to compare postoperative sensitivity, showed that neither the restorative technique, the adhesive strategy nor the presentation mode of the bulk-fill composite affected the overall risk of postoperative sensitivity (4.06 [2.22-6.81]). The use of bulk-fill composite, presented in capsules or syringes, is less time consuming and does not increase the risk or intensity of postoperative sensitivity relative to the traditional incremental technique.

Protocolo das possibilidades técnicas de aplicação dos sistemas adesivos universais: revisão de literatura com relato de caso / Clinical strategies using universal adhesive systems: literature review with case report

Este relato de caso demonstra a utilização clínica de um novo sistema adesivo universal, Xeno Universal (Dentsply DeTrey, Alemanha) descrevendo quatro formas possíveis de aplicação: autocondicionante, com ou sem condicionamento seletivo do esmalte, ou com condicionamento ácido total, seguido da aplicação do adesivo sobre dentina seca ou úmida. Os adesivos universais de uma maneira geral são de fácil aplicação e versáteis, uma vez que o mesmo produto pode ter várias formas de aplicação, reduzindo o tempo clínico e em muitas situações a sensibilidade técnica. No entanto, mais estudos laboratoriais e clínicos que comprovem a eficácia deste novo adesivo universal em particular são necessários, antes que seu uso seja bem indicado aos cirurgiões-dentistas.

This case report describes the clinical application of a new universal adhesive system, Xeno Universal (Dentsply DeTrey, Germany) describing four application modes: self-etching, with or without selective enamel etching, or total etching followed by adhesive application on dry or moist dentin. Universal adhesive systems usually are versatile and easy to use, facilitating the operator, since the same product has several technical possibilities, thus reducing the operating time and the technique sensitivity. However, long-term laboratory studies and more clinical reports and/or clinical trials are needed to prove the quality of this new universal adhesive system, before dentists can start using them in their dental offices.

Avaliação do potencial remineralizante de pastas e soluções com compostos bioativos no esmalte dental bovino submetido a ciclos de desafio erosivo / Remineralizing effectiveness of different bioactive principles in bovine enamel subjected to acidic challenges

O objetivo deste estudo foi avaliar in vitro por meio da Fluorescência de Raios X por Dispersão de Energia (XRF), Microdureza Vickers (MV) e Microscopia Eletrônica de Varredura (MEV) o efeito remineralizante de diferentes princípios bioativos, tais quais, nanopartículas de hidroxiapatita de cálcio (nanoHAp) associadas ou não a fluoreto, fosfopeptídeos de caseína do leite e fosfato de cálcio amorfo (CPP-ACP) associados ou não a fluoreto, fluoreto de sódio e saliva no esmalte dental bovino submetido a ciclagem des-remineralizante simulando lesão erosiva por alto desafio ácido. Foram obtidos 58 corpos de prova (CP) a partir de 58 incisivos bovinos que foram divididos aleatoriamente em 8 grupos, com 7 CP cada um e 2 CP para obtenção de imagem em MEV do esmalte hígido. Cada grupo foi denominado conforme os respectivos tratamentos a serem utilizados. Grupo 1 (G1) Controle; Grupo 2 (G2) Desensibilize Nano P experimental (nanopartículas de hidroxiapatita de cálcio); Grupo 3 (G3) Desensibilize Nano P (nanopartículas de hidroxiapatita de cálcio e flúor); Grupo4 (G4) GC Tooth Mousse (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™); Grupo 5 (G5) GC Tooth Mousse Plus (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™ + 900 ppm de flúor); Grupo 6 (G6) solução aquosa de fluoreto de sódio (0,05%); Grupo 7 (G7) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) e Grupo 8 (G8) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) + flúor (0,05%). Foram obtidos os valores de XRF e MV antes e depois do tratamento. Durante um período experimental de 10 dias, os CPs foram submetidos a um processo cíclico de des-remineralização incluindo vários ataques diários com ácido cítrico 0,05M (pH 2,3), 6 vezes de 2 minutos ao dia, bem como as aplicações das soluções teste e períodos de remineralização em saliva artificial. O tempo entre os ciclos ...

The aim of this study was to evaluate in vitro by X-ray fluorescence technique (XRF), surface microhardness (SMH) and SEM the remineralizing effect of different bioactive principles.We used 58bovine incisors that were sectioned into fragments (CP) and randomly divided into 8 groups. All teeth were initially evaluated to obtain the count of elements phosphorus (P) and calcium (Ca) interpreted from a range of X-Ray Fluorescence obtained by Artax ™ 200 and to obtain the initial SMH. Over a 10-day experimental period, the enamel samples weresubjected to erosive demineralization that was performed by immersion in 250 ml 0.05 M citric acid (pH 2.3) for 6 X 2 min per day. Subsequently, the samples were rinsed with distilled water for 1 min and afterwards received the corresponding treatments Group 1 (G1) Positive control; Group 2 (G2) Experimental Desensibilize Nano P (nanoparticles of calcium hydroxyapatite); Group 3 (G3) Desensibilize Nano P (nanoparticles of calcium hydroxyapatite and Fluor); Group 4 (G4) Recaldent: GC Tooth Mousse (CPP-ACP fosfopeptídios casein and amorphous calcium phosphate-Recaldent ™), Group 5 (G5) GC Tooth Mousse (CPP-ACP fosfopeptides casein and amorphous calcium phosphate-Recaldent ™ and 900 ppm Fluor); Group 6 (G6) NaF aqueous solution; (G7) nanoHAp aqueous solution and Group 8 (G8) nanoHAp + NaF aqueous solution. The samples were rinsed again with distilled water for 1 min and stored in artificial saliva. The time between cycles was 1.5 h. In the control group, the samples were eroded 6 X 2 min per day and stored in artificial saliva. All CP were evaluated again. SEM images for surface analysis were obtained after treatment. Through statistical analysis by Student t test ( p = 0.05 ) , the following results were found: control group had a severe demineralization, there was an increase in the count of P in all treated groups except G1 , that was an increase in Ca count in all treated ...

Avaliação do potencial remineralizante de pastas e soluções com compostos bioativos no esmalte dental bovino submetido a ciclos de desafio erosivo / Remineralizing effectiveness of different bioactive principles in bovine enamel subjected to acidic challenges

O objetivo deste estudo foi avaliar in vitro por meio da Fluorescência de Raios X por Dispersão de Energia (XRF), Microdureza Vickers (MV) e Microscopia Eletrônica de Varredura (MEV) o efeito remineralizante de diferentes princípios bioativos, tais quais, nanopartículas de hidroxiapatita de cálcio (nanoHAp) associadas ou não a fluoreto, fosfopeptídeos de caseína do leite e fosfato de cálcio amorfo (CPP-ACP) associados ou não a fluoreto, fluoreto de sódio e saliva no esmalte dental bovino submetido a ciclagem des-remineralizante simulando lesão erosiva por alto desafio ácido. Foram obtidos 58 corpos de prova (CP) a partir de 58 incisivos bovinos que foram divididos aleatoriamente em 8 grupos, com 7 CP cada um e 2 CP para obtenção de imagem em MEV do esmalte hígido. Cada grupo foi denominado conforme os respectivos tratamentos a serem utilizados. Grupo 1 (G1) Controle; Grupo 2 (G2) Desensibilize Nano P experimental (nanopartículas de hidroxiapatita de cálcio); Grupo 3 (G3) Desensibilize Nano P (nanopartículas de hidroxiapatita de cálcio e flúor); Grupo4 (G4) GC Tooth Mousse (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™); Grupo 5 (G5) GC Tooth Mousse Plus (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™ + 900 ppm de flúor); Grupo 6 (G6) solução aquosa de fluoreto de sódio (0,05%); Grupo 7 (G7) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) e Grupo 8 (G8) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) + flúor (0,05%). Foram obtidos os valores de XRF e MV antes e depois do tratamento. Durante um período experimental de 10 dias, os CPs foram submetidos a um processo cíclico de des-remineralização incluindo vários ataques diários com ácido cítrico 0,05M (pH 2,3), 6 vezes de 2 minutos ao dia, bem como as aplicações das soluções teste e períodos de remineralização em saliva artificial. O tempo entre os ciclos ...

The aim of this study was to evaluate in vitro by X-ray fluorescence technique (XRF), surface microhardness (SMH) and SEM the remineralizing effect of different bioactive principles.We used 58bovine incisors that were sectioned into fragments (CP) and randomly divided into 8 groups. All teeth were initially evaluated to obtain the count of elements phosphorus (P) and calcium (Ca) interpreted from a range of X-Ray Fluorescence obtained by Artax ™ 200 and to obtain the initial SMH. Over a 10-day experimental period, the enamel samples weresubjected to erosive demineralization that was performed by immersion in 250 ml 0.05 M citric acid (pH 2.3) for 6 X 2 min per day. Subsequently, the samples were rinsed with distilled water for 1 min and afterwards received the corresponding treatments Group 1 (G1) Positive control; Group 2 (G2) Experimental Desensibilize Nano P (nanoparticles of calcium hydroxyapatite); Group 3 (G3) Desensibilize Nano P (nanoparticles of calcium hydroxyapatite and Fluor); Group 4 (G4) Recaldent: GC Tooth Mousse (CPP-ACP fosfopeptídios casein and amorphous calcium phosphate-Recaldent ™), Group 5 (G5) GC Tooth Mousse (CPP-ACP fosfopeptides casein and amorphous calcium phosphate-Recaldent ™ and 900 ppm Fluor); Group 6 (G6) NaF aqueous solution; (G7) nanoHAp aqueous solution and Group 8 (G8) nanoHAp + NaF aqueous solution. The samples were rinsed again with distilled water for 1 min and stored in artificial saliva. The time between cycles was 1.5 h. In the control group, the samples were eroded 6 X 2 min per day and stored in artificial saliva. All CP were evaluated again. SEM images for surface analysis were obtained after treatment. Through statistical analysis by Student t test ( p = 0.05 ) , the following results were found: control group had a severe demineralization, there was an increase in the count of P in all treated groups except G1 , that was an increase in Ca count in all treated ...

Efeito da temperatura de armazenamento na resistência coesiva de um compósito / Effect of storage temperature on the composite cohesive strength

O objetivo deste estudo foi avaliar a resistência à tração diametral de um compósito fotopolimerizável em diferentes temperaturas de armazenamento. Foram confeccionados 12 espécimes cilíndricos (n = 6),que foram divididos em dois grupos: G1- resina à temperatura ambiente (25ºC) e G2- resina utilizada imediatamente após remoção do refrigerador (5ºC). Cada espécime foi confeccionado em três incrementos, cada incremento polimerizado por 40 segundos. Realizouse o teste a uma velocidade de 1.0 mm/min até a falha. Após cada teste, a resistência à tração diametral foi calculada (MPa) e os resultados submetidos à análise estatística, pelo teste t-student (p > 0,05). Não houve efeito da temperatura de armazenamento na resistência coesiva da resina utilizada neste estudo.