Salivary Changes, Systemic Conditions, and Medication Use in Independently-Living Aged: A Cross-Sectional Study

ABSTRACT Objective: To determine the unstimulated salivary flow, pH, and buffering capacity and their associations with systemic conditions and medication use in independently living aged. Material and Methods: This cross-sectional study included 72 participants with a minimum of 60 years recruited in Belo Horizonte, Brazil. A questionnaire was used to collect age, sex, presence of systemic diseases, and medications in continuous use. Salivary data collection was performed to determine unstimulated salivary flow, pH, and buffering capacity. Descriptive, bivariate, and multivariate analyses were performed (p<0.05). Results: Most of the sample had at least one systemic disease (81.9%) and used at least one medication (79.2%). Female participants (p=0.01), those with five or more systemic diseases (p<0.01), and hypertension (p=0.04) had reduced salivary flow. Participants with systemic diseases (p=0.02), taking any medication (p=0.04), in a polypharmacy regimen, and presenting hypertension (p=0.02) had more acidic salivary pH. Participants with diabetes had average salivary buffering capacity (p=0.02). In the adjusted multiple regression models, no explanatory variable was significantly associated with the salivary outcomes. Conclusion: Systemic alterations and medication use appear to be related to salivary changes in older adults. Integrative assessment of older adults is fundamental to identifying and controlling the factors that may modify their salivary characteristics.

A new way of analyzing tooth movement using universal coordinate system geometry single point superposition in a 3D model

ABSTRACT Introduction: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. Objective: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. Methods: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg's formula, and t-test (p<0.05). Results: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. Conclusions: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

RESUMO Introdução: A sobreposição de modelos 3D é uma necessidade iminente. No entanto, os métodos atuais dependem da marcação de múltiplos pontos na maxila e na mandíbula, o que pode aumentar a incorporação de erros no processo de sobreposição. Objetivo: O objetivo desse estudo foi desenvolver um método para sobrepor modelos 3D das arcadas superior e inferior utilizando o software de engenharia Autodesk Inventor®, por meio da marcação de um único ponto em cada arcada, usando o sistema de coordenadas universal (UCS). Métodos: No total, 104 modelos STL das arcadas superior e inferior exportados da plataforma My iTero® foram selecionados retrospectivamente, onde T0 foi o período inicial e T1, o de refinamento (n=26 por grupo). As coordenadas X, Y e Z associadas a um único ponto em cada arcada foram inseridas nos modelos usando o software SlicerCMF®. Os modelos com os pontos UCS demarcados foram transferidos para o software Autodesk Inventor® para realizar a sobreposição e medir os movimentos dentários realizados durante o tratamento com Invisalign®. Os movimentos de expansão, intrusão e rotação foram analisados por dois examinadores. A análise estatística foi realizada usando os coeficientes de correlação intra-classe (ICC), fórmula de Dahlberg e teste t (p<0,05). Resultados: Foi desenvolvido um método confiável de sobreposição de modelos digitais 3D usando um único ponto UCS na maxila e mandíbula. O ICC apresentou excelente correlação intra e inter-avaliadores (ICC>0,90). Não foi encontrado erro sistemático nas medidas lineares e angulares (<1mm e <1,5°, respectivamente). Os movimentos dentários puderam ser analisados por meio do método proposto, incluindo expansão da arcada, intrusão e rotação dentária. Conclusão: O método desenvolvido provou ser confiável e reprodutível para sobreposição de modelos 3D das arcadas superior e inferior usando o sistema UCS com marcação de ponto único.

A multilevel analysis model for dental caries determinants in independently-living elderly

To evaluate the prevalence of untreated caries and its association with biological, individual, and environmental variables in independently-living elderly people. Methods: This cross-sectional study included 72 elderly (≥60 years) patients of a university dental clinic in Belo Horizonte, Brazil. Sociodemographic data, systemic diseases, medications, and free sugar intake were collected. Visible plaque, Decayed, Missing, and Filled Teeth (DMFT), and Decayed and Filled Root (DFR) indexes were assessed through clinical examination. Unstimulated saliva was collected to determine salivary flow, pH, and buffering capacity. Descriptive analysis and multilevel logistic regression analysis were performed following a dental caries theoretical model (p <0.05, 95% CI). Results: The mean DMFT and DFR were 24.44 (SD=4.59) and 3.21 (SD=2.93), respectively. The prevalence of untreated caries was 61.11%. In the adjusted multilevel regression model involving 1639 teeth, untreated dental caries was significantly associated with the presence of biofilm (OR = 1.84; 95% CI: 1.24­2.74), salivary buffering capacity (OR = 0.87; 95% CI: 0.77­0.99) and per capita income (OR = 0.06; 95% CI: 0.004­0.74). Conclusion: The experience of dental caries was widespread among independently-living elderly patients, and its variability was best explained by the presence of biofilm, reduced salivary buffering capacity, and low per capita income. A comprehensive assessment is needed of the biological, individual, and environmental factors related to the presence of dental caries in independently-living elderly people

Short-term effect of adhesive system on clinical performance of bulk fill composite: randomized clinical trial

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p<0.05). Considering the same restorative technique, the use of the self-etching adhesive system showed a significant decrease in color and translucency (p<0.05). Conclusion: All groups showed favorable clinical performance, and promising results were found for the conventional adhesive system and high viscosity bulk fill protocol

Obliteration of Dentinal Tubules by Desensitizing Agents Based on Silver Fluoride/Potassium Iodide or Pre-Reacted Glass Particles: An in Vitro Study

Abstract Objective: To evaluate the efficacy of desensitizing agents for the obliteration of dentinal tubules subjected or not to a simulated oral environment. Material and Methods: Dentinal discs (n=8) treated with Riva-Star (RS) or PRG-Barrier-Coat (PRG) were submitted (cycled) or not submitted (control) to erosive-abrasive-thermal cycles and evaluated using scanning electron microscopy/energy dispersive spectroscopic analysis. The variables analyzed were tubule obliteration and dentin surface chemical composition. Data were analyzed by non-parametric tests (p<0.05). Results: The cycled and control groups did not differ significantly for the responses in each material. The PRG control and cycled groups had fewer visible tubules and a higher proportion of totally obliterated tubules than the RS groups. The percentages of silver coverage were higher in the RS-control than in the RS-cycled. There was a significant inverse correlation between the presence of silver and non-obliterated tubules (R=-0.791; p<0.001). The percentages of carbon, aluminum, strontium, and potassium were significantly higher in the PRG-control and PRG-cycled compared to the RS control. The percentages of calcium, phosphorus, and silver were significantly higher in the RS compared to the PRG groups. PRG-control showed a higher percentage of boron than RS-control. Conclusion: PRG promoted greater tubule obliteration than SR. Simulated stress did not affect the obliterating effect of each agent. Greater silver coverage corresponded to a lower proportion of non-obliterated tubules in RS. Carbon, aluminum, strontium, boron, and potassium predominated in the dentin surface treated with PRG, while calcium, phosphorus, and silver prevailed in RS groups (AU).

Avaliação da alteração de cor de uma resina composta "beautiful bulk" submetida à imersão em soluções pigmentantes / Color change evaluation of a composite resin "beautiful bulk" submitted to immersion in pigmentant solutions

Objetivo:O objetivo do estudo foi verificar, in vitro, a alteração de cor da resina composta Beautiful-Bulk®, exposta aos líquidos pigmentantes. Métodos:Foram confeccionados 60 espécimes da resina (15,0 mm de diâmetro e 1,0 mm de espessura, n = 5) nas cores A2, B2 e C2. Os espécimes foram mantidos em uma sala escura por sete dias, em ambiente seco, a 37 °C e, em seguida, foram fotografados com aparelho celular iPhone 6S®. Os espécimes foram divididos aleatoriamente e submetidos a ciclos de imersão em quatro líquidos: água destilada (controle), suco de açaí, Coca-Cola® e molho de tomate. As imersões foram realizadas em sete e quatorze dias de forma cíclica, após a confecção dos espécimes, três vezes ao dia, durante 20 minutos. Ao fim de cada ciclo, novas fotografias foram realizadas. As imagens foram analisadas no programa Adobe Photoshop® e os dados convertidos em L*a*b através de um histograma. A variação de cor (∆E) foi analisada pela escala CIE-Lab. Resultados:A análise dos resultados (One-way ANOVA, Teste de Tukey, p < 0,05) demonstrou que o grupo controle produziu maior alteração de cor (p < 0,05) em sete e quatorze dias na cor A2. A cor B2, no ciclo de quatorze dias, apresentou maior alteração de cor (p < 0,05) para os espécimes imersos em molho de tomate sem diferença estatística (p > 0,05) do controle. Para a cor C2, os espécimes imersos em molho de tomate tiveram maior alteração de cor (p < 0,05) em sete dias. Conclusão:Conclui-se que todas as substâncias pigmentantes e a água destilada foram capazes de produzir grandes alterações de cor na resina Beautifil Bulk®. Existe uma interação significativa entre a cor da resina e agentes pigmentantes.

Aim: This study sought to verify, in vitro, the color change of the nanoparticle composite resin, Beautiful Bulk®, exposed directly to pigmented liquids. Methods: Sixty test specimens were made in a Metal matrix (15.0 mm X 1.0 mm) using composite resin (n = 5) in colors A2, B2, and C2. The specimens were photographed with a smartphone (iPhone 6S®) seven days after the preparation. The specimens were kept in the dark for seven days, dry, at 37°C. The specimens were then randomly divided and immersed in four liquids: distilled water (control), açaí juice, Coca-Cola®, and tomato sauce. The immersions were performed in seven and fourteen days cyclically, three times a day, for 20 minutes. At the end of each immersion cycle, new photographs were taken with the same smartphone. The images were analyzed in the Adobe Photoshop® program, and the data was converted to L* a* b* through a histogram. The color variation (∆E) was analyzed by the CIE-Lab scale. Results: Analysis of the results (Tukey's test, p < 0.05) showed that the control group produced a greater color change (p < 0.05) in seven and fourteen days in the A2 shade. The B2 shade, in fourteen days, showed a greater color change (p < 0.05) for the specimens immersed in tomato sauce with no statistical difference (p > 0.05) of the control. For the C2 shade, the specimens immersed in tomato sauce presented a greater color change (p < 0.05) at seven days. Conclusion: It could therefore be concluded that there is a significant interaction between the composite resin and pigment agents. All pigmented substances produced color changes in the composite resin.

Effect of surface treatments on staining and roughness of bleached enamel

Background: The objectives were to evaluate the effect of surface treatments and waiting time before contact with dye on bleached enamel staining and surface treatments on roughness. Methods: One hundred bleached teeth were randomly assigned to G1 artificial saliva, G2 2% sodium fluoride (Flugel, Nova DFL), G3 casein phosphopeptide-amorphous calcium phosphate fluoride paste (MI Paste Plus, GC America), G4 rinse for bleached color maintenance (Keep White Rinse, DMC), and G5 polishing with impregnated disks (SuperBuff Disk, Shofu). Fifty specimens were immersed in coffee immediately after treatment; the others 1 h after. Color difference (ΔE) was evaluated with a spectrophotometer (Vita EasyShade) and roughness (Ra, Rq) with an optical profilometer (NewView 7300). Effects were analyzed with two-way ANOVA, Friedman, and Kruskal–Wallis test (P < 0.05). Results: Surface treatments (P = 0.878), waiting time (P = 0.105), and interaction (P = 0.145) were not significant to bleached color maintenance. Roughness was different among the evaluation time points (2nd evaluation >1st evaluation >3rd evaluation) (P < 0.001); not among surface treatments (G1, G2, G3, G4, G5) (P > 0.05). Conclusions: Surface treatments were similar to saliva for bleached enamel color maintenance. Immediate or 1-h postponed contact with coffee did not affect bleached enamel color. Bleaching increased enamel roughness; surface treatments and artificial saliva decreased it.

Ultramorphology of pre-treated adhesive interfaces between self-adhesive resin cement and tooth structures / Ultramorfologia de interfaces adesivas entre cimento resinoso auto-adesivo e estruturas dentárias pré-tratadas

Introduction: Convencional resin cements can be used in combination with a total-etch system in a conventional mode or as self-adhesive resin cements. The latter are less technique sensitive and able to bond to dental tissues without previous treatment or adhesive layer and requires only a single step to be applied to dental structures. Objective: To compare qualitatively the adhesive interfaces of two self-adhesive resin cements and one conventional resin cement after different tooth surface treatments under scanning electron microscopy. Material and method: 42 crowns of bovine incisors were sectioned and flattened exposing enamel (E) or dentine (D) substrate. Subgroups were defined according to conditioning type and time: E1—no treatment, E2—37% phosphoric acid for 15 seconds, E3—37% phosphoric acid for 30 seconds; D1—no treatment, D2—37% phosphoric acid for 5 seconds; D3—11.5% polyacrylic acid for 15 seconds. A resin block was bonded to each substrate using the self-adhesive resin cements RelyX U100 (3M ESPE) and RelyX U200 (3M ESPE). As a reference hybrid layer, six resin blocks were luted with RelyX ARC and Scotchbond Multi-Purpose adhesive system (3M ESPE) (enamel—EA; dentine—DA). After aging for 7 days in a moist environment at 37±1°C, samples were prepared for microscopy analysis. Result and Discussion: In the ARC specimens, there was hybrid layer formation in both EA and DA. U100 E1 showed gaps at the adhesive interface, while E2 and E3 showed interaction for both self-adhesive cements. There was superficial interaction with bothU100 and U200 in D1, while in D2 and D3, resin tags were only observed in the case of U100. Conclusion: It was concluded that substrate conditioning may enhance the interaction between self-adhesive resin cements and dental tissues, although this is not the case for RelyX U200 and dentine.

Introdução: Restaurações estéticas indiretas são preferencialmente cimentadas utilizando-se cimentos resinosos convencionais e sistema adesivo de condicionamento total ou cimentos resinosos autoadesivos. Estes últimos são tecnicamente menos sensíveis e aderem aos tecidos dentários sem tratamento prévio ou aplicação de adesivo, com um único passo para sua aplicação aos tecidos dentários. Objetivo: Comparar qualitativamente as interfaces adesivas de dois cimentos resinosos autoadesivos e um cimento resinoso convencional, sob microscopia eletrônica de varredura. Material e método: 42 coroas de incisivos bovinos foram seccionadas e as faces vestibulares planificadas expondo esmalte (E) ou dentina (D). Os subgrupos foram definidos de acordo com o tipo e tempo de condicionamento: E1-sem tratamento, E2-37% de ácido fosfórico por 15 segundos, E3-37% de ácido fosfórico por 30 segundos; D1-sem tratamento, D2-37% de ácido fosfórico durante 5 segundos; D3-11,5% de ácido poliacrílico durante 15 segundos. Um bloco de resina foi unido a cada substrato usando os cimentos resinosos autoadesivos RelyX U100 e RelyX U200 (3M ESPE) (n=3). Como referência de camada híbrida, foram cimentados seis blocos de resina com RelyX ARC e o sistema adesivo Scotchbond Multi-Purpose(esmalte-EA, dentina-DA). Após armazenamento (7 dias, umidade, 37±1°C), as amostras foram preparadas para análise microscópica. Resultado: Nos espécimes ARC, houve formação de camada híbrida em EA e DA. U100 E1 mostrou lacunas na interface adesiva, enquanto E2 e E3 apresentaram boa interação para ambos os cimentos autoadesivos. Houve interação superficial com U100 e U200 em D1, enquanto em D2 e ​​D3, foram observadas tags de resina apenas para U100. Conclusão: Concluiu-se que o condicionamento do substrato pode aumentar a interação entre cimentos resinosos autoadesivos e os tecidos dentários, embora este não seja o caso do RelyX U200 e da dentina.

Comparison of Resin Cement Insertion Techniques for Luting Fiberglass Posts

Objective: To evaluate the effect of two insertion techniques of self-adhesive dual resin cement on the bond strength of fiberglass posts in different portions of the root. The homogeneity of the cement layer along the root canal was also evaluated. Material and Methods: The root canals of 28 bovine teeth were instrumented, filled, and 14mm-space was prepared for luting fiberglass posts (Reforpost #3, Angelus), maintaining 4mm of apical sealing. The roots were randomly allocated into two groups according to the cement insertion technique (n=14): Lentulo Drill (Dentsply/Maillefer) or Centrix syringe (Dentsply). The posts were fixed with self-adhesive resin cement (RelyX U200, 3M ESPE). After 7 days, the roots were cross-sectioned to obtain three 1.0-mm-thick samples of each third of the space prepared for the post. Two samples of each third were subjected to push-out test (0.5 mm/min; 200N) and the third specimen was used for the analysis of cementation layer homogeneity. Images of specimens (40x magnification) were assessed and classified by two calibrated examiners (Kappa = 0.87) according to the presence or absence of voids and misfit. Data were analyzed by two-way ANOVA and Pearson Chi-Square test. Results: There was no statistically significant effect of insertion technique (p=0.278) or post-space thirds (p = 0.521) on bond strength of fiberglass posts. Chi-Square test showed that cement insertion with the Lentulo drill produced more cement voids than Centrix syringe (p = 0.023). Conclusion: The cement insertion technique did not influence bond strength of fiberglass posts in bovine root dentin. The use of Centrix syringe for cement insertion is preferred since it produced more homogenous cement layer.

LED and Halogen Light Transmission through a CAD/CAM Lithium Disilicate Glass-Ceramic

The effect of thickness, shade and translucency of CAD/CAM lithium disilicate glass-ceramic on light transmission of light-emitting diode (LED) and quartz-tungsten-halogen units (QTH) were evaluated. Ceramic IPS e.max CAD shades A1, A2, A3, A3.5, high (HT) and low (LT) translucency were cut (1, 2, 3, 4 and 5 mm). Light sources emission spectra were determined. Light intensity incident and transmitted through each ceramic sample was measured to determine light transmission percentage (TP). Statistical analysis used a linear regression model. There was significant interaction between light source and ceramic translucency (p=0.008) and strong negative correlation (R=-0.845, p<0.001) between ceramic thickness and TP. Increasing one unit in thickness led to 3.17 reduction in TP. There was no significant difference in TP (p=0.124) between shades A1 (ß1=0) and A2 (ß1=-0.45) but significant reduction occurred for A3 (ß1=-0.83) and A3.5 (ß1=-2.18). The interaction QTH/HT provided higher TP (ß1=0) than LED/HT (ß1=-2.92), QTH/LT (ß1=-3.75) and LED/LT (ß1=-5.58). Light transmission was more effective using halogen source and high-translucency ceramics, decreased as the ceramic thickness increased and was higher for the lighter shades, A1 and A2. From the regression model (R2=0.85), an equation was obtained to estimate TP value using each variable ß1 found. A maximum TP of 25% for QTH and 20% for LED was found, suggesting that ceramic light attenuation could compromise light cured and dual cure resin cements polymerization.

Resumo Avaliou-se o efeito da espessura, cor e translucidez de uma cerâmica vítrea a base de dissilicato de lítio para CAD / CAM sobre a transmissão da luz de unidades de diodos emissores de luz (LED) e de quartzo-tungstênio-halogênio (QTH). Cerâmica IPS e.max CAD nas cores A1, A2, A3, A3.5 de translucidez alta (HT) e baixa (LT) foram cortadas (1, 2, 3, 4, 5 mm). Os espectros de emissão das fontes de luz foram determinados. A intensidade da luz incidente e transmitida através de cada espécime de cerâmica foi medida para determinar a percentagem de transmissão de luz (TP). Um modelo de regressão linear foi utilizado para a análise estatística. Houve interação significativa entre a fonte de luz e translucidez cerâmica (p = 0.008) e forte correlação negativa (r = -0.845, p <0.001) entre a espessura da cerâmica e TP. O aumento da espessura em uma unidade levou a uma redução média de 3.17 em TP. Não houve diferença significativa em TP (p = 0.124) entre as cores A1 (ß1 = 0) e A2 (ß1 = -0.45), mas ocorreu redução significativa para as cores A3 (ß1 = -0.83) e A3.5 (ß1 = -2.18). A interação QTH/HT proporcionou maior TP (ß1 = 0) do que LED/HT (ß1 = -2.92), QTH/LT (ß1 = -3.75) e LED/LT (ß1 = -5.58). A transmissão de luz foi mais eficaz utilizando QTH e cerâmica de alta translucidez, diminuiu à medida que a espessura de cerâmica aumentou, e foi maior para as cores A1 e A2. A partir do modelo de regressão (R2 = 0.85), obteve-se uma equação para estimar o valor de TP utilizando os valores de ß1 encontrado. Foi observada TP máxima de 25% para QTH e 20% para LED, sugerindo que a atenuação promovida pela cerâmica pode comprometer a ativação de um cimento resinoso fotoativado e de ativação dupla.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.

Review of follow-up of clinical success of implant-supported complete dental prostheses / Revisão do sucesso clínico longitudinal dos implantes pilares de prótese total

OBJECTIVE: The aim of this study was to assess the clinical success rate of implant-supported complete dental prostheses, which are being used as a feasible alternative in planning of oral rehabilitation. Over the years, the two-stage surgical protocol has increasingly been replaced by immediate loading procedures, especially in the mandibular anterior region in cases of rehabilitation of completely edentulous patients. This procedure has become feasible due to the high success rate of the technique with very satisfactory results. METHODS: By means of a literature review focused on published articles with clinical follow-up between 8 and 15 years. RESULTS: Implants placed in the mandible had higher success rates than those inserted in the maxilla. Cases with longer follow-up periods, 15 years, showed higher success rates in comparison with follow-up periods of 8 and 10 years. CONCLUSION: Success rates of implant-supported complete dental prostheses are very high. .

OBJETIVO: Avaliar o índice de sucesso clínico dos implantes pilares de próteses totais implantossuportadas. As próteses implantossuportadas vêm sendo utilizadas como uma alternativa viável ao planejamento de reabilitação oral. O protocolo de dois estágios cirúrgicos, ao passar dos anos, vem sendo cada vez mais substituídos pelos procedimentos de carga imediata, principalmente na região anterior inferior, nos casos de reabilitação de pacientes totalmente desdentados. Tal procedimento torna-se viável devido ao alto índice de sucesso da técnica com resultados bastante satisfatórios. MÉTODOS: Por meio de uma revisão de literatura focada em trabalhos publicados com acompanhamento clínico entre 8 e 15 anos. RESULTADOS: Os implantes instalados em mandíbula apresentaram índices de sucesso maiores que os instalados em maxila. Os casos com acompanhamento mais longos, com 15 anos, apresentaram índices de sucesso maiores do que quando comparados aos acompanhamentos de 8 e 10 anos. CONCLUSÃO: O índice de sucesso dos implantes pilares de prótese total é bastante alto. .

Silorane-based composite as repair material: a six-month randomizedclinical trial / Resina composta à base de silorano como material de reparo: estudo clínico randomizado de seis meses

Objective: This study investigated the clinical performance of a silorane-based composite resin when used for repairing conventional composite restorations. Methods: Defective dimethacrylate-based composite resin restorations were randomly assigned to one of two treatment groups: Control group - Adper SE Plus + Filtek P60 (3M/ESPE, St. Paul, EUA) and Test Group - P90 Adhesive System + Filtek P90 (3M/ESPE, St. Paul, EUA). All repaired restorations were evaluated at baseline, and at six-month recall. The parameters examined were marginal adaptation, anatomic form, surface roughness, marginal discoloration, post-operative sensitivity and secondary caries. The restorations were classified according to modified USPHS criteria. Mann-Whitney and Wilcoxon tests were used to compare the groups. Results: Of the 100 restorations repaired in this study, 93 were reexamined at baseline and 91 at 6-month recall. Drop-out was about 9%. No statistically significant differences were found between the materials for all clinical criteria, at baseline and at 6-month recall (p > 0.05). No statistically significant differences were registered (p > 0.05) for each material when compared for all clinical criteria, at baseline and at 6-month recall. The hypothesis tested in this randomized controlled clinical trial was accepted. Conclusion: After the six-month evaluations, silorane-based composite exhibit a similar performance compared to dimethacrylate-based composite when used as repair material.

Objetivo: Investigar o desempenho clínico de uma resina de baixa contração à base de silorano quando utilizada para reparar restaurações convencionais de resina composta. Métodos: Restaurações defeituosas de resina composta à base de dimetacrilato foram aleatoriamente reparadas por um de dois grupos de tratamento: Grupo Controle - Adper SE Plus + Filtek P60 (3M/ESPE, St. Paul, EUA) e Grupo Teste - Sistema adesivo P90 + Filtek P90 (3M/ESPE, St. Paul, EUA). Todas as restaurações reparadas foram avaliadas em baseline e ao longo de 6 meses. Os parâmetros analisados foram a adaptação marginal, forma anatômica, rugosidade superficial, descoloração marginal, sensibilidade pós-operatória e lesões de cárie. As restaurações foram classificadas de acordo com os critérios do Serviço de Saúde Público dos Estados Unidos modificados. Os testes de Mann-Whitney e Wilcoxon foram utilizados para comparar os grupos. Resultados: Das 100 restaurações reparadas neste estudo, 93 foram examinadas uma semana após terem sido reparadas - baseline e 91 após 6 meses. A perda foi de aproximadamente 9%. Nenhuma diferença estatisticamente significativa foi encontrada entre os materiais para todos os critérios clínicos, em baseline e ao longo de 6 meses (p> 0,05). Conclusão: A hipótese testada neste ensaio clínico controlado randomizado foi aceita. Após 6 meses de avaliações, resinas compostas à base de silorano apresentaram desempenho clínico semelhante às resinas compostas à base de dimetacrilato quando utilizadas para reparar restaurações de resina composta à base de dimetacrilato.

Associações entre fatores de risco e complicações bucais em pacientes com câncer de cabeça e pescoço tratados com radioterapia associada ou não à quimioterapia / Association between risk factors and oral complications in patients with head and neck cancer treated with radiotherapy combined or not with chemotherapy

Objetivo: descrever as reações adversas que ocorreram em pacientes durante a radioterapia associada ou não à quimioterapia, bem como avaliar suas possíveis associações com fatores de risco. Métodos: neste estudo longitudinal prospectivo foram examinados 28 pacientes antes, durante e após completar seis meses do término do tratamento oncológico. Os dados coletados foram idade, gênero, cor da pele, tabagismo, etilismo. Sobre o tumor, foram registrados a localização, a classificação TNM (tamanho do tumor, presença de linfonodo acometido e metástase à distância), o tipo histológico, o grau de diferenciação, o número de frações da radioterapia e o tratamento oncológico proposto. Os pacientes foram encaminhados ao Projeto de Oncologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais e receberam adequação do meio bucal antes do tratamento oncológico. Durante a radioterapia foram coletados dados relativos à presença de mucosite, xerostomia, disfagia, ardência e candidose. Após análise descritiva dos dados, as associações entre efeitos adversos durante a radioterapia e fatores de risco foram verificadas usando os testes do Qui-quadrado e Exato de Fisher (p menor que 0,05). Resultados: foi encontrada maior frequência de pacientes do sexo masculino (78,6%), leucoderma (71,4%) com carcinoma de células escamosas (78,6%). A prevalência da mucosite grau I, II e III, xerostomia, disfagia, candidose e ardência foram de 10,7%; 82,2%; 7,1%; 96,4%; 53,6%; 28,6% e 57,1%, respectivamente. Associação estatisticamente significativa foi encontrada somente entre presença ou ausência de maxilares irradiados e mucosite (p=0,03). Conclusão: efeitos adversos ocorreram durante a radioterapia associada ou não à quimioterapia em pacientes com câncer em região de cabeça e pescoço. Associação significativa foi verificada entre o local de irradiação e a presença de mucosite.

Objective: This study described the adverse reactions that occurred in patients during radiotherapy combined or not with chemotherapy, and assessed their possible associations with risk factors. Method: Using a prospective cross-sectional design, 28 patients were evaluated before, during and six months after the end of cancer treatment. The following data were collected: age, gender, ethnicity, smoking and alcohol consumption. Information recorded about the tumor included primary site of tumor, TNM classification (tumor size, lymph node status and distant metastasis), histological type, differentiation grade, number of fractions of radiotherapy and oncologic treatment protocol. The patients were referred to the Oncology Project of the School of Dentistry of the Federal University of Minas Gerais, and had their oral cavity prepared for cancer treatment. During radiotherapy, data were collected with respect to mucositis, xerostomia, dysphagia, burning sensation, and candidosis. After descriptive analysis of data, the associations between adverse effects raised during radiotherapy and risk factors were verified using the Chi-square and Fisher's Exact Test (p less than 0.05). Results: There was a predominance of male (78.6%), Caucasian (71.4%) patients with squamous cell carcinoma (78.6%). The prevalence of mucositis grades I, II, III, xerostomia, dysphagia, candida infections and burning sensation was 10.7%, 82.2%, 7.1%, 96.4%, 53.6%, 28.6% and 57.1%, respectively. A statistically significant association was found only between the presence or absence of irradiation of jaws and mucositis (p=0.03). Conclusion: Oral complications occurred during radiotherapy in combination or not with chemotherapy in patients with cancer in the head and neck region. A significant association was found between the site of irradiation and the presence of mucositis.

Uso de dentes humanos extraídos e os bancos de dentes nas instituições brasileiras de ensino de odontologia / Use of extracted human teeth and the human tooth bank in brazilian dental schools

Objetivo: Avaliar aspectos relacionados ao uso de dentes humanos extraídos nos cursos de graduação e pós-graduação do Brasil e a existência de Banco de Dentes Humanos (BDH) nas Instituições de Ensino Superior (IES) em Odontologia. Método: Foi realizado um estudo transversal, por meio de um questionário semiestruturado enviado, via endereço eletrônico, aos Coordenadores e/ou Diretores dos Cursos de Odontologia cadastrados no Ministério da Educação (MEC). Após envio do questionário, no caso da não-resposta após três tentativas, o instrumento impresso foi enviado às IES pelo correio. O instrumento foi testado por um coordenador de um curso de Odontologia de uma instituição diferente daquela na qual o projeto foi desenvolvido, para verificação de problemas de entendimento e formatação. Os dados foram analisados por meio da estatística descritiva (distribuições absolutas e percentuais). Resultados: Das 187 instituições localizadas junto ao MEC, 57 (30,48%) responderam. Os dentes humanos são utilizados para treinamento em 55 IES (96,5%): (87,70% em Endodontia; 63,20% em Dentística; 56,10% em Prótese, 47,40% em Anatomia Dental e 5,30% em Periodontia). A Endodontia é a disciplina que utiliza maior número de dentes (1.299 dentes/semestre). Em 42% das IES, os dentes foram fornecidos pelo BDH; em 44% pelos alunos; em 12% por ambos. O BDH foi também a principal fonte de dentes humanos para pesquisa para 64,3% de 46 IES (19.570 dentes/ano). Das 50 IES com cursos de Pós-graduação, 21 relataram utilizar dentes extraídos. Declararam conhecer a origem dos dentes 44 instituições e oito utilizam termo de doação, quando o dente não é proveniente do BDH. Possuem BDH 37 (64,91%) IES com 3,1±2,5 anos de existência. O BDH foi considerado autossuficiente em 16 delas. Conclusão: Embora o uso de dentes extraídos seja frequente no ensino e na pesquisa, nas diferentes áreas da Odontologia, a existência de BDH é fenômeno recente e incompletamente difundido nas IES.

Objective: The purpose of this study was to evaluate aspects related to the use of extracted human teeth in Brazilian undergraduate and graduate dental courses and the existence of a Human Tooth Bank (HTB) at the higher education institutions. Method: A semi-structured questionnaire was sent by e-mail to the coordinators and/or directors of dental courses registered with the Ministry of Education (MEC). In case of no response after three attempts, the questionnaire was sent to the institutions by mail. To check if there were understanding and formatting problems, the questionnaire was tested by a coordinator from a different institution from the one where it was designed. The data were analyzed and reported descriptively. Results: Out of the 187 institutions listed by MEC, 57 (30.48%) responded. Human teeth are used for training in 55 (96.5%) institutions (87.70% in endodontics; 63.20% in dentistry, in prosthodontics 56.10%, 47.40% in dental anatomy and 5.30% in periodontics). Endodontics is the discipline that uses the largest number of teeth (1,299 teeth/semester). In 42% of the institutions, the teeth were supplied by HTB, 44% by students; 12% by both. The HTB was also the main source for 64.3% of the 46 institutions that conduct research with human teeth (19,570 teeth/year). Out of the 50 institutions with graduate courses, 21 reported using extracted teeth. Forty-four institutions affirmed to know the origin of the teeth and 8 use a donation form, when the tooth is not coming from HTB. Thirty-seven institutions (64.91%) have HTB that are 3.1 ± 2.5 years old. The HTB was considered to be self-sufficient by 16 of them. Conclusion: Although the use of extracted teeth is common in teaching and research activities in the different s of dentistry, the existence of HTB is a new phenomenon, but yet not sufficiently disseminated among the higher education institutions.

Standard of disocclusion in complete dentures supported by implants without free distal ends: analysis by the finite elements method

OBJECTIVE: The occlusal patterns are key requirements for the clinical success of oral rehabilitation supported by implants. This study compared the stresses generated by the disocclusion in the canine guide occlusion (CGO) and bilateral balanced occlusion (BBO) on the implants and metallic infrastructure of a complete Brånemark protocol-type denture modified with the inclusion of one posterior short implant on each side. MATERIAL AND METHODS: A three-dimensional model simulated a mandible with seven titanium implants as pillars, five of them installed between the mental foramen and the two posterior implants, located at the midpoint of the occlusal surface of the first molar. A load of 15 N with an angle of 45° was applied to a tooth or distributed across three teeth to simulate the CGO or BBO, respectively. The commercial program ABAQUS® was used for the model development, before and after the processing of the data. The results were based on a linear static analysis and were used to compare the magnitude of the equivalent stress for each of the simulations. RESULTS: The results showed that the disocclusion in CGO generated higher stresses concentrated on the working side in the region of the short implant. In BBO, the stresses were less intense and more evenly distributed on the prosthesis. The maximum stress found in the simulation of the disocclusion in CGO was two times higher than that found in the simulation of the BBO. The point of maximum stress was located in the neck of the short implant on the working side. CONCLUSIONS: Under the conditions of this study, it was concluded that the BBO pattern was more suitable than CGO for the lower complete denture supported by implants without free distal ends.

Repair of amalgam restorations with composite resin and bonded amalgam: A microleakage study.

Background: Total replacement is the most common technique for defective amalgam restorations, and it represents a major part of restorative dental treatment. Repair is an alternative option for amalgam restorations with localized defects. Aims: This study compared microleakage of amalgam restorations repaired by bonded amalgam or composite resin. Materials and Methods: Thirty extracted human pre-molars were prepared and restored with class I amalgam. A simulated defect was prepared that included the cavosurface margin on restorations, and the pre-molars were assigned to two treatment groups (n=15): In group 1, premolars were treated by composite resin (34% Tooth Conditioner Gel + Adper Single Bond 2 + Z100) and in group 2, premolars were repaired by bonded amalgam (34% Tooth Conditioner Gel + Prime and Bond 2.1 + Permite C). The teeth were immersed in a 50% silver nitrate solution, thermocycled, sectioned longitudinally and then observed by three examiners using a stereomicroscope. Microleakage was evaluated using a 0-4 scale for dye penetration, and data was analyzed by Kruskal Wallis and Dunn tests. Results: Neither of the two methods eliminated microleakage completely. Composite resin was significantly the most effective for repair/tooth interface sealing (score 0 = 80.0%; P=0.0317). For the repair/restoration interface, composite resin was also statistically more effective as a sealant (score 0=66%; P=0.0005) when compared to the bonded amalgam technique (score 0=13%; P=0.0005). Conclusions: The use of adhesive systems significantly affected the ability to seal the repair/ tooth interface. However, at the level of the repair/restoration interface, the bonded amalgam technique may increase microleakage.

Atenção odontológica e práticas de higiene bucal em instituições de longa permanência geriátricas / Dental care and oral hygiene practices in long-term geriatric care institutions

Este estudo avaliou a atuação de cirurgiões-dentistas (CD) nas instituições de longa permanência de Belo Horizonte (MG) e as práticas de higiene bucal adotadas. Questionários semiestruturados foram entregues aos coordenadores das 37 instituições filantrópicas e trinta privadas e coletados após uma semana. Os resultados foram comparados pelos testes Qui-quadrado e Exato de Fisher (p<0,05). Houve retorno de 81 por cento dos questionários. A maioria das instituições privadas (74,2 por cento) e filantrópicas (87 por cento) não possui CD na equipe de saúde (p=0,21). A localização da instituição, o tempo de fundação, o tipo e o número de residentes não interferiram na presença de CD (p>0,05). Nas instituições filantrópicas com consultório, 67 por cento possuíam CD, e nenhum CD trabalhava onde não havia consultório. Mesmo sem consultório, 13 por cento das instituições privadas possuíam CD. 69,6 por cento das filantrópicas encaminhavam o idoso em caso de necessidade para centros de saúde e, nas privadas, 58,1 por cento direcionavam ao familiar (p=0,00). Maior percentual de instituições privadas adotava medidas sistematizadas de higiene bucal (p=0,01), com grande variabilidade nas condutas relatadas. Há necessidade da incorporação do CD na equipe de saúde das instituições e da sistematização das práticas de higiene bucal.

This study evaluated the activities of dentists, dental care and oral hygiene practices in the long-term care institutions of Belo Horizonte (Minas Gerais, Brazil). A semi-structured questionnaire was handed out to the coordinators of 37 philanthropic and 30 private institutions. The data was compared by the chi-square and Fisher's Exact Tests. 81 percent of the questionnaires were answered. The majority of the private (74.2 percent) and philanthropic institutions (87 percent) do not have a dentist (p=0.21). The location, period of existence, type institution kind and number of residents weren't factors regarding the presence of a dentist (p>0.05). 67 percent of the philanthropic institutions with equipped consultation rooms had dentists, though there were none when there was no consultation room. Even without consultation rooms, 13 percent of the private institutions had dentists. When necessary, 69.6 percent of the philanthropic institutions refer the elderly to public health centers, while 58.1 percent of the private institutions refer them to their family dentists. A higher percentage of the private institutions adopted systematic oral hygiene procedures (p=0.01), with a considerable divergence of treatment reported. There is a need to include a dentist on the health staff in the institutions and for systematization of oral hygiene practices.

Validity of two occlusal indices for determining orthodontic treatment needs of patients treated in a public university in Belo Horizonte, Minas Gerais State, Brazil / Validade de dois índices oclusais na determinação de necessidade de tratamento ortodôntico em pacientes tratados em uma universidade pública em Belo Horizonte, Minas Gerais, Brasil

The aim of the present study was to validate the dental aesthetic index (DAI) and index of complexity, outcome and need (ICON) based on the opinions of a panel of Brazilian orthodontists. A comparison of these two orthodontic treatment need indices was carried out based on the consensus of a panel of 20 experienced orthodontists. A set of 108 study casts representing the full spectrum of malocclusions was selected. A calibrated examiner scored the casts for both indices. The orthodontists individually rated the casts regarding the degree of orthodontic treatment need. The panel's mean rating of the need for treatment was used as the gold standard for evaluating the validity of the indices. The accuracy of the indices, as reflected in the area under receiver-operating characteristic curves, was high: DAI = 81.83 percent (95 percentCI: 71.21-92.44); ICON = 88.75 percent (95 percentCI: 78.57-98.92). Although the accuracy of the ICON was higher than that of the DAI, both indices are recommended for determining orthodontic treatment need in Brazil.

O objetivo do presente estudo foi validar os índices dental aesthetic index (DAI) e index of complexity, outcome and need (ICON) a partir da opinião de um painel de ortodontistas brasileiros. A comparação desses dois índices de necessidade de tratamento ortodôntico foi feita baseada no consenso de um painel de 20 experientes ortodontistas. Um conjunto de 108 modelos de estudo representando uma grande variedade de tipos de maloclusão foi selecionado. Um examinador calibrado mensurou os modelos para ambos os índices. Os ortodontistas, de forma individual, avaliaram a necessidade de tratamento ortodôntico de cada modelo. O valor médio do painel de ortodontistas em relação à necessidade de tratamento foi utilizado como padrão-ouro para validação dos índices. Os valores de acurácia dos índices, medidos pela curva de característica de operação do receptor, foram altos: DAI = 81,83 por cento (IC95 por cento: 71,21-92,44); ICON = 88,75 por cento (IC95 por cento: 78,57-98,92). Embora a acurácia do ICON tenha sido mais alta do que a do DAI, ambos os índices são recomendados para determinar a necessidade de tratamento ortodôntico no Brasil.

Personalização de pilar em zircônia por meio de cerâmica injetada: alternativa para casos estéticos / Customized zirconia abutment using pressable, injection-molded ceramics: an alternative for esthetic cases

A utilização de pilares personalizados em zircônia permite a possibilidade da reabilitação implantossuportada funcional e estética, principalmente na região anterior. No entanto, o custo de tais pilares protéticos pode limitar sua aplicação rotineira na clínica. O objetivo do presente estudo foi relatar um caso clínico onde a reanatomização de um pilar pré-fabricado em zircônia foi realizado por meio de cerâmica injetada. Buscando perfil emergente adequado e margens subgengivais que permitissem acesso à higienização, um pilar em zircônia foi sobre-encerado e posteriormente incluído para injeção de cerâmica prensada. Com isto, os princípios biológicos, mecânicos e estético foram alcançados para a resolução do caso, com custo reduzido.

The use of zirconia customized abutments allows the possibility of the esthetic rehabilitation on implant-supported restorations. However, considerable costs of such custom zirconia abutments may limit their daily clinical use. The aim of this paper was to report a clinical case in which recontouring of a standard zirconia abutment was performed using pressable, injection-molded ceramic. Aiming for an adequate emergence profile and finishing margins that provide hygiene access, a standard zirconia abutment was waxed-up and then pressed with fluorapatite glass-ceramic ingot. Then, the clinical case could be finalized, and the biological, mechanical, and esthetic principles reached.