Three-year follow-up of flowable bulk-fill resin restorations in posterior teeth: a double-blind randomized controlled clinical trial / Acompanhamento de três anos de restaurações do tipo bulk-fill flow em dentes posteriores: ensaio clínico controlado randomizado duplo-cego

Objetivo: Este ensaio clínico randomizado avaliou o comportamento de restaurações com resina composta bulk-fill flow em dentes posteriores após três anos do tratamento restaurador. Métodos: Dezessete pacientes (12 mulheres, 5 homens, idade 23-59) foram selecionados para ter pelo menos duas restaurações de amálgama ou de resina composta substituídas, ou receber tratamento restaurador para lesão cariosa. As cavidades foram aleatoriamente alocadas para receberem o compósito bulk-fill flow Suferil SDR Flow, oclusamente coberto por uma resina composta convencional nano-híbrida Esthet-X HD (técnica bulk and body), ou serem preenchidas exclusivamente com Esthet-X HD, inseridas em incrementos de 2mm cada técnica incremental). Um adesivo convencional de dois passos foi aplicado em todas as cavidades. Trinta e quatro restaurações Classes I ou II foram realizados em dentes posteriores (n=17) no início do estudo (baseline). Após 03 anos, os critérios do USPHS modificado e FDI foram utilizados para avaliar as restaurações. Os dados foram submetidos à análise estatística Mann-Whitney (p<0,05). Resultados: No acompanhamento de 3 anos, vinte e quatro restaurações (17 Classes I e 7 Classes II) foram avaliadas. Não foram detectadas diferenças entre as técnicas restauradoras (p>0,05). Não houve falha em nenhuma restauração ao longo do tempo. Conclusão: Após 03 anos de serviço clínico, todas restaurações utilizando um compósito bulk-fill flow em dentes posteriores demonstraram uma performance satisfatória. Significância Clínica: A qualidade geral das restaurações em dentes posteriores realizadas com a técnica bulk and body foi similar ao das restaurações incrementais utilizando um compósito nano-híbrido. (AU)

Objective: This randomized clinical trial evaluated the behavior of restorations with flowable bulk-fill resin composite in posterior teeth three years after the restorative treatment. Methods: Seventeen patients (12 women, 5 men, age 23-59) were selected to have at least two failing amalgam or resin restorations replaced and/or to have a carious lesion restored. The cavities were randomly allocated to receive either the flowable bulk-fill composite Surefil SDR Flow occlusally covered with the conventional nano-hybrid composite Esthet-X HD (bulk and body technique) or filled exclusively with Esthet-X HD placed in 2 mm increments (incremental technique). A two-step etch-and-rinse adhesive was applied in all cavities. Thirty-four Class I or II restorations were performed in posterior teeth (n=17) during baseline. After 03 years, modified USPHS and FDI criteria were used to evaluate the restorations. Data were subjected to Mann-Whitney statistical analysis (p<0.05). Results: At the 3-year follow-up, twenty-four restorations (17 Class I and 7 Class II) were evaluated. No diff erences were detected between the bulk and body and the incremental restorations (p>0.05). No restoration failures were observed over time. Conclusion: After 03 years of clinical service, all restorations using a flowable bulk-fill composite in posterior teeth showed an acceptable performance. Clinical Significance: The overall quality of posterior restorations made with the bulk and body technique was similar to that of restorations made with a nano-hybrid composite incrementally placed. (AU)

Avaliação de custo-efetividade do cateterismo em veia jugular interna guiado por ultrassom no Sistema Único de Saúde brasileiro / Evaluation of cost-effectiveness of internal jugular vein catheterization by ultrasound in the Brazilian National Health System

Objetivo: Determinar a factibilidade econômica da técnica de cateterismo central em veia jugular interna guiada pelo ultrassom comparado à técnica-padrão, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Métodos: Análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária. Os custos diretos dos materiais e procedimentos foram estimados utilizando bancos de registros de compras nacionais. Os desfechos foram a ocorrência ou não da punção arterial acidental grave (principal complicação associada ao sítio de punção). Também foram conduzidas análises de sensibilidade determinística e probabilística, bem como curva de aceitabilidade. Resultados: A intervenção onerou o modelo em R$ 53,81. A razão de custo-efetividade incremental calculada foi de R$ 17.936,66 por complicação grave evitada e a curva de aceitabilidade evidenciou que a técnica é custo-efetiva sob uma intenção de pagar de R$ 18.125,00. Na análise de sensibilidade probabilística, 63,6% das simulações mostraram-se custo-efetivas. Conclusão: A intervenção é custo-efetiva, contribuindo para a redução das complicações graves, e o resultado pode proporcionar segurança para tomadas de decisões quanto à padronização do uso da ultrassonografia como orientador do procedimento.

Objective: To determine the economic feasibility of the central catheterization technique in the internal jugular vein guided by the ultrasound compared to the standard technique, under the perspective of the Brazilian Unified Health System. Methods: Cost-effectiveness analysis using decision tree model under a population of adult patients in a tertiary unit scenario. The direct costs of the materials and procedures were estimated using banks of national procurement records. The outcomes were the occurrence or not of severe accidental arterial puncture (the main complication associated with the puncture site). Analyzes of deterministic and probabilistic sensitivity were also conducted, as well as acceptability curve. Results: The intervention cost the model in R$ 53.81. The calculated incremental cost-effectiveness ratio was R$ 17,936.66 due to a serious complication avoided and the acceptability curve showed that the technique is cost-effective under an intention to pay R$ 18,125.00. In the probabilistic sensitivity analysis, 63.6% of the simulations were cost-effective. Conclusion: The intervention is cost-effective, contributing to the reduction of severe complications and the result can provide security for decision making regarding the standardization of the use of ultrasonography as a guideline of the procedure

Effect of erosive challenges on deciduous teeth undergoing restorative procedures with different adhesive protocols - an in vitro study

ABSTRACT Objective: To evaluate the effect of erosive challenges on the tooth- restoration interface of deciduous teeth treated with different adhesive protocols. Material and Methods: Deciduous molars were cut mesiodistally, then embedded, abraded and polished (n=80). Samples were randomly divided according to the adhesive system used into: G1 (Adper Single Bond2®, etch-and-rinse), G2 (Universal Single Bond®, self-etching), G3 (OptibondFL®, etch-and-rinse with Fluoride) and G4 (BondForce®, self-etching with Fluoride). After standardized cavity preparation (2 mm diameter x 2 mm depth), adhesive systems were applied and samples were restored (composite resin Z350®). Half of the samples were exposed to erosive/abrasive cycles (n = 10, each adhesive group), and the other half (control group; n = 10) remained immersed in artificial saliva. For microleakage analysis, samples were submersed in methylene blue and analyzed at 40x magnifications. Cross-sectional microhardness (CSMH) was carried out (50 g/5 s) at 25 μm, 50 μm, and 100 μm from the eroded surface and at 25 μm, 75 μm, and 125 μm from the enamel bond interface. Results: Regarding microleakage, 7.5% of the samples showed no dye infiltration, 30% showed dye infiltration only at the enamel interface, and 62.5% showed dye infiltration through the dentin-enamel junction, with no difference between groups (p≥0.05). No significant difference was observed in CSMH at different depths (two-way ANOVA, p≥0.05). Conclusions: We did not observe significant changes in microleakage or CSMH after erosive/abrasive challenges in deciduous teeth treated with different adhesive protocols (etch-and-rinse and self-etching adhesives, with and without fluoride).

Cateter venoso central de curta permanência: análise de 174 casos em unidade de transplante de medula óssea / Short-term central venous catheters: an analysis of 174 cases in a bone marrow transplant unit

Introdução: O acesso venoso é um procedimento elementar e essencial tanto no atendimento hospitalar quanto no ambulatorial. Tal relevância pode ser destacada na assistência médica de pacientes oncológicos, na qual cateteres venosos para acesso central são utilizados com alta frequência. O objetivo deste trabalho é analisar a utilização de cateteres venosos centrais de curta permanência em uma unidade oncológica, visando identificar o perfil epidemiológico dos pacientes, aspectos relacionados à punção e suas complicações. Método: Foi realizado um estudo retrospectivo, transversal, observacional e analítico. Os dados foram coletados com informações de prontuários de pacientes admitidos em uma Unidade de Transplante de Medula Óssea, durante 1º de julho de 2013 a 30 de julho de 2014. Resultados: Foram analisados 174 acessos venosos centrais com cateter de curta permanência, em 119 pacientes. A idade média foi de 46,2 anos, com prevalência semelhante entre gêneros. Os principais diagnósticos foram mieloma múltiplo (36,97%) e linfoma não hodgkin (33,61%). A veia femoral direita foi o local de escolha em 56,90% dos casos e o cateter venoso central calibroso foi utilizado em 76,44% das punções. As complicações relacionadas à punção ocorreram em 13 casos (7,47%), sendo o hematoma (92,3%) a mais representativa; e as relacionados à presença do cateter em 25 (14,37%), sendo a suspeita clínica de infecção (76,0%) a principal. Conclusão: O cateter venoso central de curta permanência se mostrou um método seguro para utilização de rotina em pacientes com neoplasias hematológicas (AU)

Introduction: Venous access is an elementary and essential procedure in both hospital and outpatient care. Such relevance can be highlighted in the medical care of cancer patients, in which central access venous catheters are used with high frequency. The aim of this study is to analyze the use of short-term central venous catheters in an oncologic unit, aiming to identify the epidemiological profile of the patients, aspects related to the puncture and its complications. Method: A retrospective, transversal, observational and analytical study was carried out. Data were collected from records of patients admitted to a Bone Marrow Transplant Unit, from July 1, 2013 to June 30, 2014. Results: A total of 174 central venous accesses with a short-term catheter were analyzed in 119 patients. The mean age was 46.2 years, with a similar prevalence between genders. The main diagnoses were multiple myeloma (36.97%) and NonHodgkin lymphoma (33.61%). The right femoral vein was the site of choice in 56.90% of the cases and central venous catheter was used in 76.44% of the punctures. Puncture-related complications occurred in 13 cases (7.47%), with hematoma (92.3%) being the most representative one, and those related to the presence of the catheter in 25 (14.37%), with clinical suspicion of infection (76.0%) being the main one. Conclusion: Short-term central venous catheter has proven to be a safe method for routine use in patients with hematological malignancies (AU)

Quantitative and qualitative evaluation of resin-dentin bond strengths: in vitro effects of surface treatment with metalloproteinase inhibitors

AIM: The objective of this study was to evaluate the use of MMPs inhibitors (chlorhexidine and EDTA) in bond strength and quality of the hybrid layer of adhesive restorations in normal dentin using two ethanol-based total-etch adhesive systems. MATERIAL AND METHODS: Thirty-two extracted human molars were coronally sectioned and randomly divided into 8 groups (n=4), depending on the surface pre-treatment and adhesive system used. The total-etch adhesive systems Single Bond 2 (2-step) and Adper Scotchbond Multi-Purpose Plus (3-step) were used as follows: 1) according to manufacturer's instructions (etching with 37% phosphoric acid (H3PO4) for 15 s); 2) etching with H3PO4 for 15 s, followed by 2% chlorhexidine for 120 s; 3) etching with 0.1 M EDTA for 60 s; 4) etching with 0.1 M EDTA followed by 2% chlorhexidine for 120 s. Teeth were incrementally restored with composite resin (Filtek Z350XT). After water storage for 24 h, teeth were double-sectioned, yielding stick specimens of 1.0 mm² bonded area, and then subjected to microtensile bond strength (MTBS) test at 0.5 mm/min. Additional specimens were gold-sputtered to be analyzed under scanning electron microscopy (SEM). Data (in Mega Pascal) were subjected to Kruskal-Wallis and Dunn (p <0.05) tests. RESULTS: The etching protocol (37% H3PO4 or EDTA) interfered with hybrid layer formation, monomer penetration and the MTBS. Funnel shaped resin tags were observed when dentin was etched with 37% H3PO4. In these specimens, MTBS were also higher. EDTA conditioning produced thin hybrid layers and smaller MTBS, regardless the adhesive system used. Chlorhexidine application after conditioning resulted in no apparent differences between both evaluated techniques (37% H3PO4 or EDTA). CONCLUSION: The use of chlorhexidine as a MMP inhibitor does not alter immediate bond strength values and does not interfere with hybrid layer formation.