Long-term influence of associating an antibacterial agent with GIC on bond strength to caries-affected dentin

Aim: To evaluate the bond strength of a GIC associated with chlorhexidine (CHX) to sound and caries-affected dentin, immediately and after six months of storage. Methods: Sixty molars were assigned to two groups of 30 teeth. One had flat dentin surfaces produced and submitted to caries induction to obtain a caries-affected dentin. In the other group dentin was maintained sound. Teeth of each group were randomly reassigned to three subgroups (n=10) according to the concentration of CHX added to the GIC (0%, 1% and 2% by weight). Two specimens (1mm diameter x 1 mm high) of the same material were constructed on each dentin surface. One was submitted to the microshear bond strength (µSBS) test after 24 hours and the other after 6 months of storage in water at 37oC. Failure modes were analyzed under a stereomicroscope. Bond strength data were analyzed by three-way ANOVA followed by Games-Howell tests for multiple comparisons, and failure modes by the Chi-square test (α = 0.05). Results: The µSBS values obtained to sound dentin were higher compared with those to caries-affected dentin (p≤0.001). In sound dentin, the group with 2% CHX showed lower µSBS values compared with 0% and 1% CHX after 24 hours (p=0.005 and p=0.032 respectively). In caries-affected dentin, after 24 hours, µSBS in group with 1% CHX was statistically higher than the values in groups with 2% CHX after 24 hours (p=0.001) and 1% CHX after 6 months (p=0.024). Irrespective of the condition of substrate, comparisons showed no statistically significant differences between the other groups (p≥0.053). Cohesive in material and mixed failures prevailed for all groups. Conclusions: The addition of CHX at concentrations of up to 2% to the GIC did not affect the bond strength of the material to sound and caries-affected dentin in a long-term evaluation (AU)

Bond strength of a composite resin to glass ionomer cements using different adhesive systems / Resistência de união de uma resina composta a cimentos de ionômeros de vidro utilizando diferentes sistemas adesivos

Introduction: Glass ionomer cements are often used as a base or cavity lining prior to restorative material. Objective: To evaluate the bond strength of a composite resin to different glass ionomer cements, when using a two-step conventional and self-etching adhesive systems. Material and method: Three glass ionomer cements (Ketac Molar Easymix, Vitremer and Vitrebond), the composite resin Filtek Z350 XT and the adhesive systems Adper Single Bond 2, Clearfil SE Bond and Adper Easy One were used. As negative control, resin was bonded to cement without using an adhesive system. Holes (4 mm diameter, 2 mm deep) prepared in acrilic bloks were filled with the glass ionomer cements (n=12/group). On the surface, an area of 1mm in diameter was delimited, the adhesive system was applied, and a specimen of composite resin with 1 mm height was made. After 24 hours storage (37 °C and 100% humidity), the microshear test was performed. Data were analyzed using two-way ANOVA and Tukey test for comparison between groups (α=0.05). Result: The adhesive systems significantly improved the bond strenght of composite resin to glass ionomer cements (p≤0.001). There was no significant difference in bond strength when self-etching adhesive systems were compared with the simplified etch-and-rinse adhesive, except for Vitrebond where Clearfil SE Bond determined higher bond strength when compared to Adper Single Bond 2 (p=0.003). Conclusion: Self-etching adhesive systems are a good option for establishing the bond between the composite resin and the glass ionomer cement.

Introdução: Os cimentos de ionômero de vidro são frequentemente usados como base ou forramento cavitário, previamente ao material restaurador. Objetivo: Avaliar a resistência de união da resina composta a diferentes cimentos de ionômero de vidro, utilizando sistemas adesivos convencional simplificado e auto-condicionantes. Material e método: Foram utilizados três cimentos (Ketac Molar Easymix, Vitremer e Vitrebond), a resina Filtek Z350 XT e os sistemas adesivos Adper Single Bond 2, Clearfil SE Bond e Adper Easy One. Como controle negativo, a resina foi aplicada sobre o cimento sem a utilização de sistema adesivo. Cavidades (4 mm de diâmetro e 2 mm de profundidade), confeccionadas em blocos acrílicos, foram preenchidas com os cimentos ionoméricos (n=12/grupo). Na superfície foi delimitada uma área de 1mm de diâmetro, aplicado o sistema adesivo e confeccionado um espécime de resina composta com 1 mm de altura. Após 24 horas de armazenamento (37 °C e 100% de umidade), foi realizado o ensaio de microcisalhamento. Os dados foram analisados usando ANOVA a dois fatores, e teste de Tukey para comparação entre grupos (α=0,05). Resultado: Os sistemas adesivos melhoraram significativamente a resistência de união resina/cimento de ionômero de vidro (p≤0,001). Não houve diferença significativa na resistência de união quando os sistemas adesivos auto-condicionantes foram comparados com o convencional simplificado, com exceção no Vitrebond onde o Clearfil SE Bond determinou maior resistência de união quando comparado com o Adper Single Bond 2 (p=0,003). Conclusão: Os sistemas adesivos auto-condicionantes constituem uma boa opção para estabelecer a união entre resina composta e cimento de ionômero de vidro.

Effect of dietary sugars on dual-species biofilms of Streptococcus mutans and Streptococcus sobrinus – a pilot study / Efeito dos açucares da dieta em biofilme dupla espécie de Streptococcus mutans e Streptococcus sobrinus – um estudo piloto

Introduction: Frequent consumption of sugars and the presence of Streptococcus mutans and Streptococcus sobrinus are correlated with higher caries experience. Objective: The aim of this pilot study was to elucidate the effect of different fermentable carbohydrates on biomass formation and acidogenicity of S. mutans and S. sobrinus biofilms. Material and method: Single and dual-species biofilms of S. mutans ATCC 25175 and S. sobrinus ATCC 27607 were grown at the bottom of microtiter plates at equal concentrations for 24 h at 37 °C under micro-aerobic atmosphere. Carbohydrates were added at 2% concentration: maltose, sucrose, glucose and lactose. BHI Broth (0.2% glucose) was used as negative control. Acidogenicity was assessed by measuring the pH of spent culture medium after 24 h, immediately after refreshing the culture medium and for the next 1 h and 2 h. Crystal violet staining was used as an indicator of the total attached biofilm biomass after 24 h incubation. Data were analyzed by two-way ANOVA followed by Bonferroni post hoc test. Significance level was set at 5%. Result: All carbohydrates resulted in higher biomass formation in single- and dual-species biofilms when compared to the control group. Sucrose, lactose and maltose showed higher acidogenicity than the control group in both single- and dual-species biofilms after 24 h. Conclusion: These findings indicate that the type of biofilm (single- or dual-species) and the carbohydrate used may influence the amount of biomass formed and rate of pH reduction.

Introdução: O consumo frequente de açucares e a presença de Streptococcus mutans e Streptococcus sobrinus estão correlacionados com maior experiência de cárie. Objetivo: Elucidar o efeito de diferentes carboidratos fermentáveis na biomassa e acidogenicidade de biofilmes formados por S. mutans e S. sobrinus. Material e método: Biofilmes única e dupla- espécie de S. mutans ATCC 25175 e S. sobrinus ATCC 27607 em concentrações iguais cresceram no fundo de placas de microtitulação por 24 h a 37 °C em microaerofilia. Maltose, sacarose, glicose e lactose foram adicionados a 2%. BHI caldo (0.2% glicose) foi usado como controle negativo. Acidogenicidade foi avaliada por meio da medição do pH do meio de cultura após 24 h, imediatamente após troca de meio e nas próximas 1 h e 2 h. Coloração por cristal violeta foi usada como indicador do total de biomassa aderida, após 24 h de incubação. Os dados foram analisados por teste ANOVA two way e Teste de Bonferroni. O nível de significância foi de 5%. Resultado: Todos os carboidratos resultaram em maior formação de biomassa em ambos os tipos de biofilme (única ou dupla- espécie), quando comparado ao grupo controle. Sacarose, lactose e maltose mostraram maior acidogenicidade que o grupo controle após 24 h nos biofilmes única ou dupla-espécie, apenas após 24 h. Conclusão: Os achados indicam que o tipo de biofilme (única ou dupla- espécie) e o tipo de carboidrato usado podem influenciar tanto na quantidade de biomassa formada quanto na taxa de redução do pH.

Perfil do atendimento odontológico no Serviço de Urgência para crianças e adolescentes da Faculdade de Odontologia de Araraquara (FOAr) - UNESP / Treatment profile at dental urgent care clinic for children and teenagers from Faculdade de Odontologia de Araraquara (FOAr) - UNESP

Introdução: Atendimentos de urgência são uma prática comum em Odontopediatria, porém pouco se sabe sobre o perfil desses atendimentos. Objetivo: Avaliar o perfil dos atendimentos de urgência de crianças de 0 a 13 anos de idade realizados na Clínica Infantil da FOAr, no período de 1997 a 2012, a fim de se quantificarem os pacientes e os procedimentos realizados no Serviço, além de identificar os tratamentos mais realizados. Material e método: Neste estudo transversal observacional, os relatórios desse Serviço, fornecidos pelo Sistema Integrado de Clínicas, foram analisados quanto ao número de pacientes, aos atendimentos e ao tipo de procedimentos realizados. Os procedimentos foram classificados em sete categorias: Diagnóstico, Preventivos, Anestesia, Endodônticos, Restauradores, Cirúrgicos e Outros. Esses dados foram tabulados e submetidos a uma análise descritiva. Resultado: De 1997 a 2012, foi atendido um total de 13.849 pacientes e foram realizados 25.786 atendimentos e 86.279 procedimentos. Houve diminuição do número de pacientes atendidos a partir de 2001, mas o número de consultas e de procedimentos não diminuiu na mesma proporção. Observou-se que, durante o período de 2007 a 2012, os procedimentos de diagnóstico foram os mais realizados, seguidos pelos preventivos. Dentre os procedimentos operatórios, o mais realizado foi o restaurador, seguido dos endodônticos. Procedimentos cirúrgicos estão entre os menos realizados. Conclusão: Conclui-se que houve uma mudança no perfil dos atendimentos dentro desse Serviço. Apesar de haver uma redução no número de pacientes atendidos, o número de consultas e a quantidade de procedimentos realizados permaneceram estáveis. Os procedimentos realizados estão de acordo com o perfil do Serviço de Urgência.

Introduction: Urgency care is a common practice in pediatric dentistry but little is known about the profile of these visits. Objective: To evaluate the profile of patients aged between 0 and 13 years assisted at the Urgency Unit offered by FOAr, from 1997 to 2012, in order to quantify patients and procedures performed and identify the most frequently treatments performed. Material and method: In this observational transversal study, the reports of urgency service provided by the Integrated Clinical System were analyzed for the number of patients, treatments and type of procedures performed. The procedures were classified into seven categories: Diagnosis, Preventive, Anesthesia, Endodontic, Restorative, Surgical and Others. The data were organized and analyzed descriptively. Results: From 1997 to 2012, a total of 13,849 patients were treated in 25,786 visits and 86,279 procedures were conducted. A decrease in the number of patients assisted was observed. However, the number of appointments and the number of procedures did not decrease at the same ratio. Diagnosis procedures were the most frequent procedure performed, followed by preventive procedures. Restorative and endodontic treatments were the most frequent operative procedure performed. Dental surgeries were done less frequently. Conclusion: A profile change in the dental urgent treatment was observed throughout the years. Despite a reduction in the number of patients assisted, the number of visits and the amount of procedures performed remained stable. The procedures performed are in agreement with the profile of a dental urgent care clinic.

Caracterização dos pacientes e procedimentos executados no serviço de atendimento a pacientes com necessidades especiais da Faculdade de Odontologia de Araraquara - UNESP / Characterization of patients and procedures performed in the service to patients with special needs of Araraquara School of Dentistry - UNESP

Objetivo: Caracterizar os pacientes atendidos e os procedimentos realizados no Serviço de Atendimento a Pacientes com Necessidades Especiais da Faculdade de Odontologia de Araraquara (FOAr) - UNESP. Metodologia: A partir dos prontuários odontológicos dos pacientes atendidos em nível ambulatorial entre 2007 e 2013, foram obtidas informações em relação a idade no início do tratamento, tipo de deficiência, medicamentos usados, número de sessões de atendimento e número e tipo de procedimentos odontológicos realizados. Resultado: Dos 232 prontuários analisados, observou-se que mais da metade dos pacientes (56,0%) apresentava deficiência mental, paralisia cerebral ou anomalias congênitas determinadas por agentes infecciosos, com deficiência mental associada. Entre as anomalias congênitas, a mais prevalente foi a Síndrome de Down (9,9%). Apenas 20% dos pacientes iniciaram o tratamento antes dos dez anos de idade e 62,0% faziam uso de anticonvulsivantes, antipsicóticos, ansiolíticos, antiepilépticos e antidepressivos. Foram realizados 4.506 procedimentos odontológicos, sendo 37,6% preventivos e 62,4% curativos (Restauradores, 28,0%; Periodontais, 13,9%; Endodônticos, 9,7%; Cirúrgicos, 9,1%; Protéticos, 1,7%). Observou-se também que, para a maior parte dos pacientes (63%), foram necessárias até dez sessões para a realização do tratamento. Conclusão: Os pacientes que procuraram tratamento odontológico no Serviço de Atendimento a Pacientes com Necessidades Especiais da FOAr apresentavam, na sua maioria, deficiências com envolvimento neurológico. Apesar de esse serviço priorizar os procedimentos preventivos, a maior parte dos procedimentos executados foi curativa, o que está diretamente relacionado com a procura tardia pelo tratamento odontológico.

Objective: To characterize the patients and dental procedures performed in Service to Patients with Special Needs of Araraquara School of Dentistry (FOAr) - UNESP. Methodology: From the dental records of patients treated at outpatient basis between 2007 and 2013, information regarding age at the beginning of treatment, type of disability, controlled medications used, number of dental sessions, and number and type of dental procedures performed was obtained. Result: Of the 232 records analyzed, more than half of the patients (56.0%) had mental retardation, cerebral palsy or congenital abnormalities caused by infectious agents associated with mental retardation. Among the congenital abnormalities, the most prevalent was the Down syndrome (9.9%). Only 20% of patients started treatment before the age of ten and 62.0% used anticonvulsants, antipsychotics, anxiolytics, antidepressants and antiepileptics. A total of 4,506 dental procedures were performed, 37.6% were preventive procedures and 62.4% curative procedures (restorative, 28.0%; periodontal, 13.9%; endodontic, 9.7%; surgical, 9.1%, and prosthetic 1.7%). Also was observed that for most patients (63%) up to 10 sessions were required for the completion of treatment. Conclusion: Most patients with special needs who sought dental treatment at FOAr presented neurological involvement. Despite this service prioritize preventive procedures; most of the procedures carried out were curative, fact directly linked to late search for the dental treatment.

Oral rehabilitation in a patient with special needs / Tratamento reabilitador em paciente especiaL

Cerebral palsy is a disorder caused by central nervous system injuries that can occur during the prenatal, perinatal, or postnatal periods. It is characterized by multiple abnormalities, including impairment of speech, body and motor coordination, balance, intelligence, mastication, and swallowing. Due to abnormal movements of the facial muscles, compounded by impairment of the self-cleansing mechanism of the oral cavity, patients with this condition can develop oral diseases such as caries, periodontal disease, and tooth loss. The aim of this paper is to report a case of a patient with cerebral palsy who presented with absence of the maxillary central incisors, removable prosthesis wear, and oral candidiasis. Impressions of the upper and lower arches and periapical radiographs were obtained. The lateral incisors were found to exhibit root resorption, which contraindicated their use as abutment teeth for fixed prosthodontics. In view of the patient's socioeconomic status and cerebral palsy-related limitations, a resin-bonded fixed partial denture was fabricated and nystatin solution was used for treatment of oral candidiasis. The patient had an esthetically and functionally adequate outcome.

A paralisia cerebral é uma anormalidade causada por lesões no sistema nervoso central que podem ocorrer durante o período pré, peri ou pós-natal. É caracterizada por alterações múltiplas como o comprometimento da fala, da coordenação motora e corporal, do equilíbrio, do intelecto e da mastigação e deglutição. Devido aos movimentos anormais da musculatura facial, juntamente com o comprometimento da função de autolimpeza, o paciente pode apresentar quadros de patologia bucal como a cárie, a doença periodontal e a perda dental. O objetivo deste trabalho foi relatar o caso clínico de um paciente portador de paralisia cerebral com ausência dos incisivos centrais superiores, portador de prótese removível e com um quadro de candidose bucal. Foi realizada a moldagem dos arcos superior e inferior e as radiografias periapicais. Pôde-se observar que os incisivos laterais apresentavam reabsorção radicular, o que contra indicava a sua utilização como pilares para prótese fixa. Devido às condições sócio-econômicas e limitações relacionadas a paralisia cerebral, foi confeccionada uma prótese adesiva e, para a candidose bucal foi instituído o tratamento com solução de Nistatina. O resultado do tratamento foi estética e funcionalmente adequado para o paciente.

Effect of finishing and polishing on color stability of a nanofilled resin immersed in different media / Efeito do acabamento e polimento na estabilidade de cor de uma resina composta nanoparticulada imersa em diferentes meios

Objective: The purpose of this study was to evaluate the effect of finishing and polishing on color stability of a nanofilled composite resin (Filtek Z350 XT) according to different immersion media. Material and Method: Composite disks (10 mm diameter, 2 mm thickness) were prepared for each group (n = 6) using a stainless steel mold. The groups were divided according to the presence or absence of finishing and polishing procedure and immersion media (artificial saliva, artificial juice- KAPO(r) Coca-Cola(r) flavors: pineapple, orange, strawberry and grape). The finishing and polishing procedures were performed using Super -Snap(r) disks. The specimens were stored in artificial saliva for 24 hours (baseline) and were analyzed using a color spectrophotometer by CIELab system. Then, they were immersed in different media for 5 minutes, 3 times a day, every 4 hours during 60 days. They were stored in artificial saliva at 37 ± 1°C during the immersion intervals. After this time, new measure of color was performed. The data were analyzed using Kruskall-Wallis test and Mann- Whitney test. The significance level was 5%. Result: The results showed that the finishing/polishing not significantly influence the color stability of resin composite (p >0.05). There was no statistically significant difference in the color stability of the studied resin after immersion in different media (p > 0.05). Conclusion: The finishing and polishing procedures and the immersion media did not have influence on color stability of nanofilled resin Filtek Z350 XT. .

Objetivo: O objetivo deste estudo foi avaliar o efeito do acabamento e polimento na estabilidade de cor da resina nanoparticulada Filtek Z350 XT em função de diferentes meios de imersão. Material e Método: Espécimes circulares (10 mm de diâmetro e 2 mm de espessura) foram preparados para cada grupo (n=6) utilizando uma matriz de aço inoxidável. Os grupos experimentais foram divididos de acordo com a presença ou ausência de acabamento e polimento e diferentes meios de imersão (saliva artificial, Suco artificial pronto KAPO(r) da Coca Cola(r) sabores: abacaxi, laranja, morango e uva). Os procedimentos de acabamento e polimento foram realizados com discos de lixa Super-Snap(r). Os espécimes permaneceram em saliva artificial por 24 horas (baseline) e foram submetidos à análise da cor usando um espectrofotômetro pelo sistema CIELab. Em seguida, foram imersos nos diferentes meios por 5 minutos, 3 vezes ao dia, com intervalos de 4 horas, durante 60 dias. Os espécimes foram mantidos em saliva artificial a 37±1°C nos intervalos entre as imersões. Após este período foi realizada nova leitura de cor. Os dados foram analisados com os testes de Kruskall-Wallis e Mann-Whitney. O nível de significância foi de 5%. Resultado: Os resultados mostraram que o acabamento/polimento não influenciou significativamente a estabilidade de cor da resina composta (p>0,05). Não houve diferença estatisticamente significativa na estabilidade de cor da resina estudada após a imersão nos diferentes meios (p>0,05). Conclusão: O acabamento e polimento e os meios de imersão não apresentaram influência na estabilidade de cor da resina nanoparticulada Filtek Z350 XT. .

Effect of chlorhexidine gluconate on porosity and compressive strength of a glass ionomer cement / Efeito da adição de gluconato de clorexidina na porosidade e resistência à compressão de um cimento de ionômero de vidro

Introduction: For presenting wide antibacterial activity, chlorhexidine (CHX) has been extensively used in dentistry and can be easily incorporated into the glass ionomer cement (GIC) and consequently released into the oral cavity. Aim: The aim of this study was porosity and compression strength of a GIC, that was added to different concentrations of CHX. Material and Method: Specimens were prepared with GIC (Ketac Molar Esaymix) and divided into 4 groups according to the concentration of CHX: control, 0.5% and 1% and 2% (n = 10). For analysis of pores specimens were fractured with the aid of hammer and chisel surgical, so that the fracture was performed in the center of the specimens, dividing it in half and images were obtained from a scanning electron microscope (SEM) analyzed in Image J software. The compressive strength test was conducted in a mechanical testing machine (EMIC - Equipment and Testing Systems Ltd., Joseph of the Pines, PR, Brazil). Statistical analysis was performed by ANOVA, Tukey test. Significance level of 5%. Result: No statistically significant changes between the study groups was observed both for the number of pores as well as for the compressive strength. Conclusion: The use of GIC associated with CHX gluconate 1% and 2% is the best option to be used in dental practice. .

Introdução: Por apresentar ampla atividade antibacteriana, a clorexidina (CHX) tem sido amplamente utilizada em odontologia, podendo ser facilmente incorporada ao cimento de ionômero de vidro (CIV) e liberada consequentemente na cavidade bucal. Objetivo: O objetivo neste estudo foi avaliar a porosidade e resistência à compressão de um CIV, ao qual foi adicionado diferentes concentrações de CHX. Material e Método: Os espécimes foram preparados com CIV (Ketac Molar Esaymix) e divididos em 4 grupos de acordo com a concentração de CHX: controle, 0,5% e 1% e 2% (n=10). Para análise dos poros os espécimes foram fraturados com auxílio de martelo e cinzel cirúrgicos, de modo que a fratura era realizada no centro do corpo de prova, dividindo-o ao meio e as imagens obtidas no microscópio eletrônico de varredura (MEV) analisadas no software Image J. O teste de resistência à compressão foi realizado na máquina de ensaios mecânicos (EMIC - Equipamentos e Sistemas de Ensaios Ltda, São José dos Pinhais, PR, Brazil). A análise estatística foi realizada por ANOVA, complementada pelo teste de Tukey. Nível de significância adotado de 5%. Resultado: Não se observou alteração estatisticamente significante entre os grupos estudados tanto para o número de poros quanto para a resistência à compressão. Conclusão: O uso de CIV associado ao gluconato de CLX a 1% e 2% é a melhor opção para ser utilizada na clínica odontológica. .

In Vivo study of an intracanal dressing of calcium hydroxide/chlorhexidine in necrotic primary teeth

AIM: To evaluate the clinical and radiographic success of endodontic treatment in human primary teeth with necrotic pulp with and without radiographically visible furcal/periapical lesion treated with a calcium hydroxide (CH) and chlorhexidine (CHX) intracanal dressing. The tested hypothesis was that there is no difference in the clinical and radiographic success in primary teeth medicated with CH pastes prepared with polyethylene glycol (PEG) or CHX. METHODS: Thirty-two teeth with necrotic pulp were used in this randomized clinical study: 12 without and 20 with lesion. Canals were prepared and medicated with CH pastes with polyethylene glycol (CH/PEG) (n=16) or 2% CHX gel (CH/CHX) (n=16). Definitive filling was done after 30 days. The teeth were clinically and radiographically examined during 12 months to determine the success of the endodontic therapy. Data from clinical and radiographic examination of the initial condition and 12 months after treatment were compared using the Z test (α = 0.05). RESULTS: There was no significant difference (p>0.05) in the success rate of teeth with and without lesion medicated with CH/PEG or CH/CHX. No significant difference (p>0.05) was found between the pastes regardless of the presence of lesion. CONCLUSIONS: Combination of CHX and CH was not more effective than the CH/PEG paste, as similar clinical and radiographic success rate was observed in teeth medicated with either type of intracanal dressing.

Addition of Chlorhexidine Gluconate to a Glass Ionomer Cement: A Study on Mechanical, Physical and Antibacterial Properties

The objective of this work was to determine the effect of different concentrations of chlorhexidine digluconate (CHX) on setting time, surface hardness, maximum tensile bond strength and antibacterial activity of a glass ionomer cement (GIC). The material used as control was Ketac Molar Easymix GIC. CHX was incorporated into the GIC during its manipulation at concentrations of 0.5, 1.0 and 2.0%. Antimicrobial activity against S. mutans and L. acidophilus was evaluated by means of agar diffusion test. Tensile bond strength data were analyzed statistically using Analysis of variance and Tukey's test. Setting time, Vickers hardness and agar diffusion test were analyzed using Kruskal-Wallis and Mann-Whitney tests at a significance level of 5%. It was observed that adding CHX at concentrations of 1% and 2% increased significantly the setting time of the material (p=0.012 and p=0.003, respectively). There was no significant difference between control and 0.5% CHX groups regarding the setting time. Addition of 2% CHX decreased significantly the surface hardness in relation to the control group (p=0.009), followed by the 1% CHX group (p=0.009). The tensile bond strength of the material also decreased significantly after adding CHX at a concentration of 2% (p=0.001). Addition of CHX promoted formation of an inhibition halo in both bacterial strains for all concentrations. The results showed that the best option for clinical use of GIC with CHX is at 0.5% concentration, since antibacterial activity increased and the physical-mechanical properties remained unchanged.

O objetivo deste trabalho foi determinar o efeito de diferentes concentrações de gluconato de clorexidina (CLX) sobre o tempo de presa, dureza superficial, resistência máxima a tração e atividade antibacteriana de um cimento de ionômero de vidro (CIV). O material utilizado como controle foi o CIV Ketac Molar Easymix. O gluconato de CHX foi incorporado no CIV durante a sua manipulação, em concentrações de 0,5, 1,0 e 2,0%. Atividade antimicrobiana contra S. mutans e L. acidophilus foi avaliada por meio de teste de difusão em ágar. Análise de variância (ANOVA) e teste de Tukey foram usadas para avaliar a resistência a tração do material. Para avaliar tempo de presa, dureza Vickers e teste de difusão em ágar foram usados os testes de Mann-Whitney e Kruskal-Wallis ao nível de significância de 5%. Observou-se que a adição de CHX, em concentrações de 1% e 2%, aumentou significativamente o tempo de presa do material (p = 0,012 e p = 0,003, respectivamente). Não houve diferença significativa entre os grupos controle e CHX 0,5% em relação ao tempo de presa. A adição de 2% de CHX diminuiu significativamente a dureza superficial, em relação ao grupo controle (p = 0,009), seguido pelo grupo 1% de CHX (p = 0,009). A resistência à tração do material também diminuiu significativamente após a adição de CHX a uma concentração de 2% (p = 0,001). A adição de CHX promoveu formação de halo de inibição em ambas as linhagens bacterianas para todas as concentrações. Os resultados mostraram que a melhor opção para o uso clínico de CIV com CHX está numa concentração de 0,5%, uma vez que a atividade antibacteriana aumentada e as propriedades físico-mecânicas permaneceram inalteradas.

Influence of the addition of chlorhexidine diacetate on bond strength of a high-viscosity glass ionomer cement to sound and artificial caries-affected dentin / Influência da adição do diacetato de clorexidina na resistência de união de um cimento de ionômero de vidro de alta viscosidade à dentina sadia e afetada por cárie artificial

Introduction: The aim of adding chlorhexidine (CHX) to glass ionomer cements (GIC) is to improve their antibacterial property, but it may interfere with their bond to dentin. Objective: To evaluate the influence of adding chlorhexidine diacetate at different concentrations to a high-viscosity GIC on its bond to sound and artificial caries-affected dentin. Material and Method: Eighty human third molars were used, on which an area of dentin was exposed on the occlusal surface. Half of the specimens were kept sound and the other half were subjected to artificially induced caries. CHX was mixed with GIC powder at 0.5%, 1% and 2% (w/w). GIC without CHX was used as control. On each dentin surface a specimen measuring 1 mm in diameter and 1 mm high was made. The samples were kept at 37 °C and 100% humidity for 24 hours and subject to microshear testing. The results were analyzed using Kruskal-Wallis and Mann Whitney tests (α=0.05). Result: There was no significant difference between bond strength of sound and caries-affected dentin (p>0.05). For both substrate conditions, groups GIC, GIC+0.5% CHX and GIC+1% CHX showed statistically similar bond strength (p>0.05), and higher than that of GIC+2% CHX (p≤0.025). Cohesive and mixed failures were predominant in all groups. Conclusion: The addition of 0.5% and 1% chlorhexidine did not result in negative changes in the bond strength of GIC to caries-affected and sound dentin. .

Introdução: A adição da clorexidina (CLX) ao cimento de ionômero de vidro (CIV) visa melhorar a sua propriedade antibacteriana, podendo contudo interferir na adesão à dentina. Objetivo: Avaliar a influência da adição de diacetato de CLX em diferentes concentrações a um CIV de alta viscosidade, na sua adesão à dentina sadia e afetada por cárie artificial. Material e Método: Foram utilizados 80 terceiros molares, que tiveram a superfície de dentina exposta na face oclusal. Metade dos dentes foram mantidos hígidos e a outra metade foi submetida à indução artificial de cárie. A CLX foi misturada ao pó do CIV nas concentrações de 0,5%, 1% e 2%. O CIV sem CLX foi usado como controle. Em cada superfície dentinária foi confeccionado um espécime com 1 mm de diâmetro e 1 mm de altura. Estes foram mantidos a 37 °C com 100% de umidade por 24 horas, e, submetidos ao teste de microcisalhamento. Os resultados foram analisados pelos testes de Kruskal-Wallis e Mann Whitney (α=0.05). Resultado: Não houve diferença estatística entre os valores de resistência de união para dentina hígida e afetada (p>0,05). Para as duas condições do substrato, os grupos CIV, CIV+CLX 0,5% e CIV+CLX 1% apresentaram resistência de união estatisticamente semelhante (p>0,05), e superior ao CIV+CLX 2% (p≤0.025). Houve predominância de fraturas mistas e coesivas do material para todos os grupos. Conclusão: A adição de CLX nas concentrações de 0,5% e 1% não influenciou negativamente na resistência de união de um CIV de alta viscosidade à dentina sadia e afetada por cárie. .

Inorganic elemental analysis and identification of residual monomers released from different glass ionomer cements in cell culture medium / Análise elementar inorgânica e identificação de monômeros residuais orgânicos liberados por diferentes cimentos de ionômero de vidro

Introduction: Glass ionomer cements (GICs) release inorganic elements and organic residual monomers with the potential for deleterious effects on pulp cells. Objective: To identify and quantify inorganic elements present in different GICs and released components from these materials in cell culture medium. Material and Method: Samples of two resin-modified GICs for base/liner (Vitrebond and Fuji Lining LC), two resin-modified restorative GICs (Vitremer and Fuji II LC) and two conventional restorative GICs (Ketac Fil Plus and Ketac Molar Easymix) were prepared and analyzed by Energy-Dispersive X-Ray Fluorescence Spectrometry (EDXRF). Extracts of these materials were obtained by immersion of each sample in separate containers of DMEM for 24 h (total surface-liquid ratio = 45.7 mm²/mL). The extracts were analyzed by EDXRF and Gas Chromatography-Mass Spectrometry (GC-MS). Result: Higher percentages of strontium, silicon and aluminum were identified in Vitrebond, Vitremer, Fuji Lining LC, Fuji II LC, and Ketac Fil Plus, while zinc was detected only in Vitrebond. Ketac Molar Easymix presented a greater atomic composition of lanthanum, calcium, aluminum and silicon. Strontium was detected in the extracts from all materials except Ketac Molar Easymix; calcium was present in extracts from Ketac Fil Plus; zinc only in Vitrebond; and silicon in Fuji II LC extract. The analysis by GC-MS detected 2-hydroxyethyl-methacrylate (HEMA) in the extracts from all resin-modified GICs, and iodine benzene was detected only in the Vitrebond extract. Conclusion: Of the GICs sampled, Vitrebond released the highest number of components with cytotoxic potential.

Introdução: Os cimentos de ionômero de vidro (CIVs) liberam elementos inorgânicos e monômeros orgânicos residuais que têm o potencial de causar efeitos deletérios sobre as células pulpares. Objetivo: Identificar e quantificar os elementos inorgânicos presentes em diferentes CIVs, bem como os componentes liberados por estes materiais em meio de cultura celular. Material e Método: Espécimes cilindricos de dois CIVs modificados por resina para base/forramento (Vitrebond e Fuji Lining LC), dois CIVs modificados por resina restauradores (Vitremer e Fuji II LC) e dois CIVs convencionais restauradores (Ketac Fil Plus e Ketac Molar Easymix) foram preparados e analisados por Espectrometria de Fluorescência de Raios X por Energia Dispersiva (EDXRF). Em seguida, extratos de 24h desses materiais foram obtidos e analisados por EDXRF e por Cromatografia Gasosa/Espectrometria de Massa (CG/EM). Resultado: Os elementos inorgânicos identificados em maior porcentagem nos CIVs Vitrebond, Fuji Lining LC, Vitremer, Fuji II LC e Ketac Fil Plus foram estrôncio, silício e alumínio, enquanto o zinco foi detectado apenas no Vitrebond. O Ketac Molar Easymix apresentou maior porcentagem dos elementos lantânio, cálcio, alumínio e silício. Estrôncio foi detectado nos extratos de todos os materiais, exceto no Ketac Molar Easymix; cálcio estava presente no extrato do Ketac Fil Plus; zinco apenas no Vitrebond; e silício no extrato do Fuji II LC . O HEMA foi identificado nos extratos de todos os CIVs modificados por resina, e o iodobenzeno, somente no Vitrebond. Conclusão: Entre os CIVs estudados, o Vitrebond é o que libera mais componentes com potencial citotóxico.

Schwartz-Jampel Syndrome: a paediatric dentistry approach / Síndrome de Schwartz-Jampel: uma abordagem odontopediátrica

Schwartz-Jampel syndrome (SJS) is a rare recessive disorder characterized mainly by myotonia. As the clinical signs and symptoms are manifested in the oromaxillofacial region, paediatric dentists may be first choice of parents that seek information and assistance to their children. A female patient diagnosed with SJS was brought to our clinic for dental treatment with main complain of difficulty on oral hygiene and mastication due to tooth crowding. The treatment included preventive measures, extraction of a supernumerary tooth and the maxillary primary second molars. Furthermore, the patient was referred to orthodontic treatment for correction of tooth crowding. When dealing with children with confirmed diagnosis of SSJ, paediatric dentists should be understand the need of planning the dental treatment considering the characteristics and possible complications associated with the syndrome in order to reduce the risks to patients, especially when surgical procedures are necessary

A síndrome de Schwartz Jampel (SSJ) é uma desordem autossômica recessiva rara, caracterizada principalmente pela miotonia. Desde que alguns dos sinais clínicos e sintomas são manifestados na região oromaxilofacial, o odontopediatra pode ser o primeiro profissional a se deparar com um paciente portador desta síndrome. Um paciente do sexo feminino diagnosticado com SJS procurou a nossa clínica para tratamento dental com queixa principal de dificuldade na realização da higiene oral e mastigação, devido ao mau posicionamento dentário. O tratamento incluiu medidas preventivas, extração de um dente supranumerário e dos segundos molares decíduos e encaminhamento para tratamento ortodôntico. Quando uma criança possui o diagnóstico confirmado para SSJ, o odontopediatra deve ter conhecimento específico para planejar e realizar o tratamento odontológico de forma adequada, considerando as características da síndrome e as possíveis complicações associadas, a fim de reduzir os riscos ao paciente, especialmente quando procedimentos cirúrgicos são necessários.

Importância da abordagem precoce no tratamento odontológico de pacientes com necessidades especiais / Importance of the early dentistry treatment of pacients with specials necessities

Os pacientes portadores de necessidades especiais requerem um tratamento odontológico diferenciado devido às limitações determinadas por sua deficiência. A qualidade da higiene bucal está relacionada ao quadro clínico do paciente, tendo os indivíduos com problemas de motricidade e inteligência, a higiene bucal comprometida.Objetivo: realizar uma revisão da literatura a respeito da importância da abordagem precoce no tratamento odontológico de pacientes com necessidades especiais.Metodologia: a revisão de literatura foi realizada por meio de levantamento bibliográfico no Pubmed e Bireme. Estudos epidemiológicos da condição de cárie e doenças gengivais de pacientes com necessidades especiais demonstram índice de cárie e problemas periodontais elevados. Desse modo, é importante que haja profissionais capacitados e abordagem multidisciplinar adequada, para suprir as barreiras impostas durante o seu atendimento, como a ansiedade dos pais, problemas sistêmicos, discriminação, entre outras.Conclusão: a busca por auxílio, o mais cedo possível, resulta em maior cooperação frente ao tratamento odontológico, e na aquisição de cuidados que se perpetuam por toda a vida do paciente. Um programa de promoção de saúde bucal voltado especificamente a esses pacientes, envolvendo orientações de higiene bucal, dieta, controle de placa, motivação e interação dos pacientes com o profissional, a família e a sociedade, mostra-se como o melhor caminho...

Introduction: the patients with specials necessities need a singular dentistry treatment because they have limitations due to theirs deficiency. The quality of oral health is related to the clinical situation of patient. The individuals with motor and understanding problems have poor oral health.Aim: this study aimed to review the literature about the importance of the early dentistry treatment of pacients with specials necessities.Methodology: the review of literature was made through the Pubmed and Bireme. Studies about dental caries and periodontal disease of patients with specials necessities had shown high index of caries and periodontal disease. Therefore it is important that there are capacity professionals and multidisciplinary treatment. It is necessary to supply the dificulties of treatment like anxiety of parents, systemic problems and discrimination.Conclusion: the early treatment results in good coperation during the treatment, and the aquisition of cares for all life. The best way is a program of oral health with instructions about diet, oral hygiene, control of bacterials, motivation and interaction between patients and professionals...

Sequelas em dentes permanentes após trauma nos predecessores decíduos e sua implicação clínica / Sequelaes in permanent teeth following traumatic injuries to primary predecessors and clinical implication

A necrose pulpar representa a cessação dos processos metabólicos do tecido pulpar, desestruturação e concomitante perda de suas defesas naturais. A partir da necrose pulpar, a cavidade pulpar torna-se progressivamente colonizada por vários micro-organismos habitantes da cavidade bucal e sistemas interligados. Assim, os dentes com necrose pulpar e áreas radiolúcidas periapicais apresentam inúmeros morfotipos microbiológicos no sistema de canais radiculares. Não obstante, de longa data, tem sido questionada a sobrevivência de micro-organismos nos granulomas periapicais. Nesta revisão, verificou-se que na atualidade, pela técnica da cultura microbiológica ou por métodos moleculares, cocos, bacilos e filamentosos, gram-negativos e positivos, predominantemente anaeróbios estritos, identificados no sistema de canais radiculares, também são recuperados na região periapical. Esses micro-organismos também são identificados pela coloração de Brown e Brenn ou pela microscopia eletrônica de varredura no ápice radicular e na estrutura da lesão, numa frequência que oscila de 4% a 100%. Estruturalmente, organizam-se num material amorfo, iodoso, de composição polissacarídica - os biofilmes periapicais.

Starting from the pulp necrosis the pulp cavity becomes progressively colonized by several microorganisms' inhabitants of the oral cavity and interconectives systems. Thus, the teeth with pulp necrosis and radiolucencies periapical areas present countless microbiological morfotypes in the root canal system. Nevertheless, of long date, the survival of the microorganisms in the periapical granuloms has been questioned. In this review it was verified that currently, by culture or molecular methods that the coccus, bacilli and filamentous, gram-negative and positive, predominantly strict anaerobes, identified in the root canal system also are recovered in the periapical lesions. Such microorganisms are also identified for the coloration of Brown and Brenn or for the scanning electronic microscopy in the root apex and in the structure of the lesion, in a frequency that oscillates from 4% to 100%. Structurally, they are organized in an amorphous material, muddy, of polysaccharide composition- the periapical biofilms.

Effects of light-curing time on the cytotoxicity of a restorative composite resin on odontoblast-like cells

This in vitro study evaluated the cytotoxicity of an experimental restorative composite resin subjected to different light-curing regimens. METHODS: Forty round-shaped specimens were prepared and randomly assigned to four experimental groups (n=10), as follows: in Group 1, no light-curing; in Groups 2, 3 and 4, the composite resin specimens were light-cured for 20, 40 or 60 s, respectively. In Group 5, filter paper discs soaked in 5 µL PBS were used as negative controls. The resin specimens and paper discs were placed in wells of 24-well plates in which the odontoblast-like cells MDPC-23 (30,000 cells/cm²) were plated and incubated in a humidified incubator with 5 percent CO2 and 95 percent air at 37ºC for 72 h. The cytotoxicity was evaluated by the cell metabolism (MTT assay) and cell morphology (SEM). The data were analyzed statistically by Kruskal-Wallis and Mann-Whitney tests (p<0.05). RESULTS: In G1, cell metabolism decreased by 86.2 percent, indicating a severe cytotoxicity of the non-light-cured composite resin. On the other hand, cell metabolism decreased by only 13.3 percent and 13.5 percent in G2 and G3, respectively. No cytotoxic effects were observed in G4 and G5. In G1, only a few round-shaped cells with short processes on their cytoplasmic membrane were observed. In the other experimental groups as well as in control group, a number of spindle-shaped cells with long cytoplasmic processes were found. CONCLUSION: Regardless of the photoactivation time used in the present investigation, the experimental composite resin presented mild to no toxic effects to the odontoblast-like MDPC-23 cells. However, intense cytotoxic effects occurred when no light-curing was performed.

Response of human dental pulp to calcium hydroxide paste preceded by a corticosteroid/ antibiotic dressing agent

Aim: To evaluate the treatment with corticosteroid/antibiotic dressing in pulpotomy with calciumhydroxide. Methods: Forty-six premolars were pulpotomized and randomly assigned into 3groups. In Group I pulpal wound was directly capped with calcium hydroxide, and Group II and Group III received corticosteroid/antibiotic dressing for 10 min or 48 h, respectively, before pulp capping. Teeth were processed for histological analysis after 7, 30 or 60 days to determine inflammatory cell response, tissue disorganization, dentin bridge formation and presence of bacteria.Attributed scores were analyzed by Kruskal-Wallis and Mann-Whitney tests (á=0.05). Results:On the 7th day, all groups exhibited dilated and congested blood vessels in the tissue adjacent to pulpal wound. The inflammatory cell response was significantly greater in Group III (p<0.05). On the 30th day, in all groups, a thin dentin matrix layer was deposited adjacent to the pulpal wound and a continuous odontoblast-like cell layer underlying the dentin matrix was observed. On the60th day, all groups presented a thick hard barrier characterized by an outer zone of dystrophic calcification and an inner zone of tubular dentin matrix underlined by a defined odontoblast-like celllayer. Conclusions: Within the limitations of present study, considering that the treatment was performed in healthy teeth, it may be concluded that the use of a corticosteroid/antibiotic dressing before remaining tissue protection with calcium hydroxide had no influence on pulp tissue healing.

Toxicity of chlorhexidine on odontoblast-like cells

Chlorhexidine gluconate (CHX) is recommended for a number of clinical procedures and it has been pointed out as a potential cavity cleanser to be applied before adhesive restoration of dental cavities. OBJECTIVE: As CHX may diffuse through the dentinal tubules to reach a monolayer of odontoblasts that underlies the dentin substrate, this study evaluated the cytotoxic effects of different concentrations of CHX on cultured odontoblast-like cells (MDPC-23). MATERIAL AND METHODS: Cells were cultured and exposed to CHX solutions at concentrations of 0.06 percent, 0.12 percent, 0.2 percent, 1 percent and 2 percent. Pure culture medium (á-MEM) and 3 percent hydrogen peroxide were used as negative and positive control, respectively. After exposing the cultured cells to the controls and CHX solutions for 60 s, 2 h or 60 s with a 24-h recovery period, cell metabolism (MTT assay) and total protein concentration were evaluated. Cell morphology was assessed under scanning electron microscopy. CHX had a dose-dependent toxic effect on the MDPC-23 cells. RESULTS: Statistically significant difference was observed when the cells were exposed to CHX in all periods (p<0.05). Significant difference was also determined for all CHX concentrations (p<0.05). The 60-s exposure time was the least cytotoxic (p<0.05), while exposure to CHX for 60 s with a 24-h recovery period was the most toxic to the cells (p<0.05). CONCLUSION: Regardless of the exposure time, all CHX concentrations had a high direct cytotoxic effect to cultured MDPC-23 cells.

Tissue response to direct pulp capping with calcium hydroxide preceded by corticosteroid or corticosteroid/antibiotic dressing: a histological study in rats / Resposta do tecido pulpar à aplicação da pasta à base de hidróxido de cálcio precedida do emprego do curativo de corticosteróide ou corticosteróide/antibiótico: estudo histológico em ratos

Purpose: This study histologically evaluated the reaction of tooth pulp to treatment with calcium hydroxide in distilled water preceded by a corticosteroid (Decadron) or corticosteroid/antibiotic (Otosporin) dressing. Methods: Calcium hydroxide solution was applied to exposed tooth pulp for 5 min or for 72 h, using a sample of 120 molars of rats; histological examination was performed 7, 14, 30 and 60 days after treatment. Results: A mild inflammatory reaction was observed at 7 and 14 days whether the dressings were used for 5 min or for 72 h. When the corticosteroid/antibiotic dressing was used for 5 min, the tissue reaction and the mineralized barrier formed at 30 and 60 days were similar to those of animals in the control group. Use of the corticosteroid dressing for 5 min or 72 h or the corticosteroid/antibiotic dressing for 72 h delayed healing of the pulp tissue. Conclusion: Temporary dressings resulted in a milder inflammatory reaction during the early postoperative period. The tissue reaction and the quality of the barrier formed when the Otosporin temporary dressing was applied for 5 min were similar in the experimental and the control groups at longer postoperative periods. Temporary dressings of Decadron applied for 5 min or 72 h or Otosporin applied for 72 h caused a slight retardation of the healing process of the tissue that was apparent 30 days after the intervention.

Objetivo: Avaliar a reação pulpar à pasta de hidróxido de cálcio em água destilada, precedida de curativo de corticosteróide (Decadron) ou corticosteróide/antibiótico (Otosporin) por 5 min ou 72 h. Metodologia: Em 120 polpas de dentes de ratos expostas, a análise histológica foi realizada após 7, 14, 30 e 60 dias de cada tratamento. Resultados: Nos períodos iniciais observou-se leve reação inflamatória quando os curativos foram aplicados por 5 min ou 72 h. A reação tecidual e a barreira formada sob ação do hidróxido de cálcio após o curativo de Otosporin por 5 min foram semelhantes àquelas do grupo controle aos 30 e 60 dias. Os curativos de demora com Decadron por 5 min e 72 h e Otosporin por 72 h promoveram retardo no processo de reparação. Conclusão: Os curativos de demora promoveram reação inflamatória mais suave nos períodos iniciais de análise. A reação tecidual e a qualidade da barreira formada sob a ação do Otosporin por 5 min foram semelhantes àquelas do grupo controle nos períodos pós-operatórios mais longos. Os curativos de demora com Decadron por 5 min e 72 h e Otosporin por 72 h promoveram ligeiro retardo no processo de reparação tecidual a partir de 30 dias.

DMFT index assessment and microbiological analysis of Streptococcus mutans in institutionalized patients with special needs

Aim: To assess the DMFT (D = decayed; M = missing; F = filled) index of institutionalized patients with mild and moderate physical and mental disabilities and to correlate it with the Streptococcus mutans (S. mutans) counts in the supragingival bacterial biofilm. Methods: Dental examination of 28 patients aged 15 to 25 years was conducted to determine the DMFT index (number of decayed, missing and filled teeth). Supragingival plaque samples were collected from the buccal surfaces of all teeth. The samples were inoculated in SB20 medium and incubated at 37 °C for 48 hours. Spearman’s correlation test was applied (p = 0.05) to evaluate the correlation between the DMFT index and the amount of S. mutans. Results: The mean DMFT recorded was 7.68 and a large mean number of S. mutans colony-forming units (cfu > 106) was found. No statistically significant correlation was found between the DMFT index and the number of S. mutans. Conclusions: Under the conditions of this study, no correlation was found between the DMFT index and the number of S. mutans cfu in institutionalized patients with mental retardation and physical disabilities.