Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial

Abstract Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Marginal integrity of restorations produced with a model composite based on polyhedral oligomeric silsesquioxane (POSS)

Marginal integrity is one of the most crucial aspects involved in the clinical longevity of resin composite restorations.Objective To analyze the marginal integrity of restorations produced with a model composite based on polyhedral oligomeric silsesquioxane (POSS).Material and Methods A base composite (B) was produced with an organic matrix with UDMA/TEGDMA and 70 wt.% of barium borosilicate glass particles. To produce the model composite, 25 wt.% of UDMA were replaced by POSS (P25). The composites P90 and TPH3 (TP3) were used as positive and negative controls, respectively. Marginal integrity (%MI) was analyzed in bonded class I cavities. The volumetric polymerization shrinkage (%VS) and the polymerization shrinkage stress (Pss - MPa) were also evaluated.Results The values for %MI were as follows: P90 (100%) = TP3 (98.3%) = B (96.9%) > P25 (93.2%), (p<0.05). The %VS ranged from 1.4% (P90) to 4.9% (P25), while Pss ranged from 2.3 MPa (P90) to 3.9 MPa (B). For both properties, the composite P25 presented the worst results (4.9% and 3.6 MPa). Linear regression analysis showed a strong positive correlation between %VS and Pss (r=0.97), whereas the correlation between Pss and %MI was found to be moderate (r=0.76).Conclusions The addition of 25 wt.% of POSS in methacrylate organic matrix did not improve the marginal integrity of class I restorations. Filtek P90 showed lower polymerization shrinkage and shrinkage stress when compared to the experimental and commercial methacrylate composite.

Radiant exposure effects on physical properties of methacrylate - and silorane-composites

AIM: To evaluate the effect of different radiant exposures on the degree of conversion (DC), Knoop hardness number (KHN), plasticization (P), water sorption (WS), and solubility (S) of different monomer resin-based composites. METHODS: Circular specimens (5 x 2 mm) were manufactured from methacrylate and silorane composite resins, and light-cured at 19.8, 27.8, 39.6, and 55.6 J/cm2, using second-generation LED at 1,390 mW/cm2. After 24 h, DC was obtained using a FT-Raman spectrometer equipped with a Nd:YAG laser, KHN was measured with 50-g load for 15 s, and P was evaluated on the top and bottom surfaces by the percentage of hardness reduction after 24 h immersed in absolute alcohol. WS and S were determined according to ISO 4049. Data were subjected to statistical analysis (α=0.05). RESULTS: Methacrylate material presented higher DC, KHN, P, and WS than silorane (p<0.05). There was no difference in the S values (p>0.05). The increased radiant exposures improved only the KHN (p<0.05). In general, top surfaces showed higher DC and KHN than bottom, for both materials (p<0.05). The increase of the radiant exposure did not improve most physical properties of the composites and were monomer-base dependent. CONCLUSIONS: Chemical composition of the composite resins resulted in different physical properties behavior and could affect the clinical longevity of dental restorations, but overall these properties were not influenced by the different radiant exposures evaluated in the study...

Reacción del tejido celular subcutáneo de la rata a un sellador endodóntico a base de metacrilatos hidrófilos / Response of the subcutaneous connective tissue of the rat to a methacrylate-based endodontic sealer

Analizar la respuesta del tejido celular subcutáneo de la rata a la implantación de Epiphany, un sellador endodóntico a base de metacrilatos hidrófilos. Se implantaron tubos de silicona obturados a ras en ambos extremos con una preparación fresca de Epiphany o AH 26 en el tejido celular subcutáneo de veinte ratas; el AH 26 fue considerado como control positivo. Como control negativo se utilizaron tubos de silicona sin obturar. A los 14 días y a los 84 días posimplantación, los animales fueron sacrificados, los implantes junto con los tejidos circundantes fueron removidos, fijados en solución de formol al 10 por ciento y, finalmente, procesados para su estudio histológico. A los 14 días el análisis histológico reveló la presencia de una reacción inflamatoria severa compuesta por: polimorfonucleares neutrófilos, linfocitos, plasmocitos, macrófagos, fibroblastos y vasos de neoformación en contacto directo con Epiphany y AH 26. A los 84 días posimplantación, la reacción inflamatoria se redujo, pero persistió y fue considerada como moderada. En ambos períodos se observaron numerosas partículas de los dos materiales, dispersas en los tejidos, muchas de ellas fagocitadas por macrófagos, células gigantes multinucleadas y fibroblastos. En contacto con los controles negativos, la reacción de los tejidos fue considerada como mínima a los 14 días posimplantación, pero los tejidos retornaron a la normalidad al finalizar la experiencia. En ambos períodos se observaron diferencias significativas P<0.01 entre Epiphany/AH 26 y el control negativo, mientras que no las hubo P>0.05 entre ambos selladores. Cuando se compararon los resultados obtenidos en cada uno de los períodos experimentales 14 y 84 días, la diferencia fue estadísticamente significativa P<0.05 para cada uno de los materiales analizados.

Endodoncia adhesiva. Fundamentos, desarrollo y utilidad del sellador endodóntico a base de metacrilatos EndoREZ / Adhesive endodontics. Development and usefulness of the methacrylate resin-based endodontic sealer EndoREZ

Durante la última década se han incorporado al mercado una nueva generación de selladores endodónticos a base de metacrilatos hidrófilos, los que permiten obtener una adhesión efectiva a las paredes dentinarias y a los conos estandarizados provistos por el fabricante. El objetivoa de este trabajo es informar acerca de las propiedades, características específicas y utilidades del sellador a base de metacrilatos EndoREZ. Las investigaciones con su capacidad de sellado, biocompatibilidad y aplicación clínica sugieren que el EndoREZ es un material potencialmente efectivo para su uso clínico, y que su perfomance puede equipararse a la de los selladores endodónticos tradicionales.

Comparative efficacy of two treatment modalities for dentinal hypersensitivity: A clinical trial.

Background: Dentin hypersensitivity is a recurrent condition causing discomfort and sometimes pain to the patient, which also deters him from maintaining adequate oral hygiene. Home care and office measures are used for treatment of this malady. Aim: To evaluate and compare the efficacy of 2 treatment modalities for dentinal hypersensitivity, iontophoresis with acidulated phosphate gel (APF) gel, and dentin-bonding agent application. Materials and Methods: This split mouth randomized clinical study recruited subjects with a history of hypersensitivity with at least 2 teeth, verified by a light stroke with a dental explorer along the cervical third of the teeth. The patients were subjected to a 1-s air blast and cold water stimuli and their responses were recorded on a verbal rating scale. A total of 30 sites from 15 patients were divided into Group A-1.23% APF gel iontophoresis; and Group B-aqueous solution of hydroxyl-ethyl-methacrylate and glutaraldehyde. The teeth were evaluated immediately after the treatment and at the end of 2 weeks. In case of failure, the tooth was retreated with the same agent as before. Results: The results were statistically analyzed using Kruskal-Wallis analysis of variance and Mann-Whitney U tests. There was no statistically significant difference between the groups at the end of 2 weeks. However, Group A was more effective clinically, with fewer number of failures compared with Group B. Conclusion: Both the agents showed a statistically significant reduction in sensitivity compared with baseline; however, APF gel iontophoresis was more effective in reducing hypersensitivity over a longer time period.

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8 percent retention rate was recorded for RC restorations, while 100 percent retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.

Esse estudo avaliou o desempenho clínico de restaurações de lesões cervicais não-cariosas por um período de 2 anos empregando um sistema adesivo de condicionamento total (Excite/Tetric Ceram) e um cimento de ionômero de vidro modificado por resina (Vitremer). Setenta restaurações (35 por material) foram realizadas por um único operador. Todas as lesões cervicais não-cariosas foram restauradas sem a execução de preparo cavitário e sob isolamento absoluto. As restaurações foram avaliadas por 2 examinadores independentes usando os critérios USPHS modificados nos períodos inicial, 6, 12 e 24 meses. A análise estatística foi realizada pelos testes de Fisher e McNemar. Cinquenta e nove restaurações foram avaliadas após 2 anos, obtendo-se um índice de retenção de 78,8 por cento para resina composta e 100 por cento para o cimento de ionômero de vidro modificado por resina. O teste exato de Fischer detectou diferença significante (p=0,011) para retenção entre os dois materiais. Contudo, não houve diferença significante para integridade marginal, descoloração marginal, forma anatômica e cárie secundária. O teste de McNemar detectou diferença estatística para o sistema Excite/Tetric Ceram entre o período inicial e 2 anos para os critérios de retenção (p=0,02), integridade marginal (p=0,002) e forma anatômica (p=0,04). Portanto, o sistema adesivo de condicionamento total apresentou um desempenho clínico inferior comparado ao cimento de ionômero de vidro modificado por resina.

Adhesive systems used for sealing contaminated surfaces: a microleakage evaluation

O propósito deste estudo foi comparar dois sistemas adesivos (OptiBond FLTM e OptiBond SOLOTM) utilizados como material único para selar superfícies oclusais contaminadas com relação à infiltração marginal. Após condicionamento ácido, 56 dentes hígidos foram contaminados com 1 µl de plasma e aleatoriamente divididos em 8 grupos (n = 7). Os adesivos foram fotoativados por 30 s sob duas condições (Optilux VCL-403TM e VCL-500TM). Cada espécime foi exposto a um de dois tratamentos de envelhecimento: ciclos térmicos (4.000 x a 5-55°C por 60 s) mais ciclos mecânicos (225.000 x com carga de 83,3 N); ou ciclos térmicos, mecânicos e de pH (soluções mineralizante/desmineralizante). Os espécimes foram imersos em solução aquosa de AgNO3 a 50%, secionados, e a penetração do corante foi medida em imagem digitalizada. Usou-se ANOVA para determinar os principais efeitos dos fatores e suas interações. Os resultados indicaram diferença significante entre os adesivos (p < 0,05), sugerindo que o OptiBond FLTM apresenta um desempenho melhor com relação à microinfiltração e poderia ser indicado como material único para selamento em condições de umidade ou contaminação acidental.

Evolución de las lentes intraoculares y los viscoelásticos / Intraocular lenses and viscoelastic evolution review

Se hace una revisión de la literatura y se relata la evolución de las lentes intraoculares, de sus materiales y diseños, así como de los viscoelásticos.

The modulatory effect of antigen- and PAF-induced asthmatic reaction by aerosol administration of OKY-046 in guinea pigs.

The therapeutic effect of a thromboxane A2 (TXA2) synthetase inhibitor on asthma is still controversial. This study was aimed at clarifying its effect on asthmatic reactions in guinea pigs. Both ovalbumin (OVA)- and platelet activating factor (PAF)-induced dual phase airway spasm and hyperreactivity in guinea pigs were used as the asthma model. Our results demonstrated that aerosol administration of OKY-046 could inhibit both OVA- and PAF-induced late phase bronchoconstriction and airway hyperreactivity to methacholine in OVA sensitized guinea pigs. PAF administration could also induced dual phase bronchoconstriction in normal guinea pigs. Similarly, late phase airway spasm and airway hyperreactivity after PAF exposure was also blocked by OKY-046. In conclusion, aerosol administration of OKY-046 is a safe and effective way to modulate OVA- and PAF-induced asthmatic reactions. The protective effect of OKY-046 on OVA- and PAF-induced late phase bronchoconstriction and airway hyperreactivity indicates that TXA2 might play an important role in the late phase asthmatic reaction and airway hyperreactivity. The normalization of PAF-induced airway hyperreactivity by OKY-046 also indicates that PAF induced airway inflammation might be through the generation of TXA2.

Vertebroplastia acrílica percutánea: técnica, indicaciones y resultados / Vertebroplasty with acrylic cement: indication and results

Ciertas afecciones raquídeas son responsables de dolores y/o de complicaciones neurológicas secundarias al aplastamiento vertebral que ellas producen. Con el fin de consolidar la vértebra y aliviar el dolor surge la Vertebroplastia Acrílica Percutánea, que consiste en la inyección de cemento acrílico por vía percutánea, propuesta inicialmente en el tratamiento de los angiomas vertebrales agresivos. Luego de realizar una punción biopsia de la vértebra, se inserta una aguja de 10 G en el cuerpo vertebral y se inyectan una mezcla de polvo de tantalio y de metil-metacrilato (3 a 5 ml). Fueron tratados exitosamente con este método 31 pacientes portadores de hemangiomas vertebrales y 10 pacientes con dolores severos debidos al aplastamiento vertebral de origen osteoporótico. Siendo el resultado clínico y radiológico estable con un seguimiento de 6 años para los angiomas vertebrales y de 30 meses en 7 pacientes tratados con osteoporosis. Un efecto analgésico significativo permitió desarrollar una actividad normal a 12 pacientes de los 20 tratados con tumores vertebrales. El efecto analgésico fue durable en 10 de ellos con un seguimiento de 6 meses

Torax volantea anterior bilateral: tratamiento mediante barras de acrílico / Bilateral flail chest: treatment with acrylic drawbars

Se presentan 2 enfermos que por accidente de tránsito sufren fracturas condrocostales anteriores bilaterales y del esternón, que provocan tórax volante grave, no dominable por la traqueostomía, ni asistencia respiratoria mecánica. Para su fijación se utilizaron barras de acrílico que se confeccionan en el mismo acto quirúrgico, de acuerdo a la conformación torácica del paciente y son de fácil colocación. La evolución de los 2 enfermos fue excelente, sin dejar deformidades torácicas ni déficit en la función respiratoria