The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

A study of sister chromatid exchange in patients with dental amalgam restorations.

Study Background: Dental amalgam is still widely used as a restorative material in developing countries due to its low cost and ease of manipulation. The health risks associated with the components of this restorative material has always been a matter of concern. Our study was designed to address this question regarding dental amalgam. Objective: To study sister chromatid exchange (SCE) as an indicator of systemic genotoxicity, due to the exposure from the components of amalgam restorations during its placement and chronic use. Materials and Methods: Systemic genotoxicity in subjects exposed to amalgam during its placement (Group II; n = 5) and subjects with chronic exposure to amalgam (Group III; n = 5) were compared with controls (Group I; n = 5) by SCE assay in cultured peripheral blood lymphocytes. Result: Subjects exposed to amalgam during its placement and subjects having chronic exposure to amalgam showed an increase in the frequency of SCE, but the change was not statistically significant (P = 0.84, P = 0.123 respectively). Conclusion: Systemic genotoxicity was not observed due to the components of amalgam restorations released during its placement and chronic use. The findings of this study can be considered as preliminary information on the systemic toxicity due to the components of amalgam restorations.

O que o cirurgião-dentista que pratica a Odontologia deve saber a respeito do amálgama dentário / What the dentist should know about dental amalgam

Muitas organizações não governamentais, cientistas, docentes, dentistas, médicos, ativistas e advogados tem trabalhado incansavelmente para legislar sobre o fim do amálgama como material restaurador odontológico, cujos artigos e opiniões contribuem para incentivar a “terceira guerra” contra o amálgama. O UNEP concluiu as discussões sobre um acordo internacional, a Convenção de Minamata sobre o Mercúrio, que tem como objetivo reduzir os impactos ambientais significativos para a saúde devido … poluição atmosférica por mercúrio e inclui disposições que tratam de diversos produtos que contêm esse elemento químico. Alguns desses produtos deverão ser banidos a partir de 2020. As restaurações de am álgama não foram atingidas pela proibição, no entanto, o tratado sugere algumas disposições relativas … diminuição gradual de uso desse material, sem exigir medidas proibitivas ou prazo de banimento. Segundo o recente relatório do UNEP de 2013, as maiores fontes antropogônicas (atividades humanas) de contaminação ambiental pelo mercúrio estão associadas … mineração artesanal de ouro, … queima de carvão, produção de cimentos, metais ferrosos e não ferrosos. A quantidade de vapor liberado das restaurações de amálgama pela cremação para a atmosfera por ano em escala mundial não chega a atingir 1% do total emitido pelos demais setores de poluição. Com relação a possíveis vapores provocados por resíduos de amálgama, não existe nenhum dado registrado até 2013 pelo UNEP. Nos sistemas aquáticos pode-se encontrar a forma mais tóxica de mercúrio, o metilmercúrio ou orgânico, que pode se acumular nos peixes e mamíferos marinhos consumidos pelos seres humanos; além disso, neste ambiente o mercúrio inorgânico, não tóxico, e o elementar, menos tóxico, podem ser transformados no metilmercúrio. A maior parte da exposição humana aos riscos … saúde devido ao mercúrio ocorre a partir do consumo de alimentos como peixes marinhos e/ou de água doce.

Many non-governmental organizations, scientists, professors, physicians, dentists, lawyers and activists have been working tirelessly to legislate on the end of amalgam as a dental restorative material, their articles and opinions contribute to encourage the “third war” against amalgam. The UNEP concluded discussions on an international agreement, the Minamata Convention on Mercury, which aims to reduce the health impacts due to environmental impacts due to air pollution by mercury, and includes provisions dealing with various products containing this chemical element. Some of these products may be banned by 2020. Amalgam fillings were not affected by the ban, however, the treaty suggests some provision for gradual reduction of use of this material, but without requiring prohibitive measures or a term of banishment. According to the recent report of UNEP (2013), the largest anthropogenic sources (human activity) of environmental mercury contamination are associated with gold mining, burning of coal and cement, ferrous and nonferrous metals production. The amount of vapor released annually to atmosphere from cremation of amalgam does not reach 1% of the total issued by other sectors of pollution. Regarding possible vapor caused by amalgam residues, there is no data recorded until 2013 by UNEP. In aquatic ecosystems the most toxic form of mercury, methylmercury or organic mercury, can be found, it can accumulate in fish and marine mammals that are consumed by humans, also in this environment the inorganic mercury (non-toxic) and the elemental mercury (less toxic) can be converted into methylmercury.

Evaluation of composite reinforcement on the fracture resistance of teeth with unsupported cusps / Evaluación del reforzamiento con resina compuesta sobre la resistencia a la fractura de dientes con cúspides sin soporte

This study evaluated the fracture resistance of maxillary premolars with wide Mesial-Occlusal-Distal (MOD) cavity preparations and unsupported cusps restored by four ways, compared with intact teeth. Thirty five human teeth were divided into five groups: control (G1 - intact teeth) and four experimental groups of MOD-prepared teeth: with buccal (B) and lingual (L) cusps reinforced with composite (Z-250) and restored with silver amalgam (Permite C) (G2); teeth with B and L cusps reinforced and linked with composite (P-60) and restored with silver amalgam (Permite C) (G3); teeth restored with composite (Z-250) by incremental fill technique (G4); and teeth with B and L cusps reinforced and linked with composite (P-60) and restored with composite (Z-250) by incremental fill technique (G5). After thermal cycling (500 cycles, 5°C to 55°C), fracture resistance was tested in a universal testing machine. Statistical analysis of the results (ANOVA) revealed no significant difference (p>0.5) among the groups (G1=157.78Kgf, G2=183.99Kgf, G3=152.53Kgf, G4=182.61Kgf and G5=155.96Kgf). Visual analysis of the teeth tested showed predominance of oblique failure pattern. The four types of restoration evaluated provide fracture resistance with values equivalent to intact teeth in MOD-prepared intact teeth with parallel walls and composite-reinforced cusps

Se evaluó la resistencia a la fractura de los premolares maxilares con preparaciones amplias de cavidades Mesio-Ocluso-Distal (MOD) y cúspides sin soporte restauradas por medio de cuatro formas, en comparación con dientes intactos. Treinta y cinco dientes humanos se dividieron en cinco grupos: control (G1 - dientes intactos) y cuatro grupos experimentales preparados con cavidades MOD: con cúspides bucales (B) y linguales (L) reforzadas con resina compuesta (Z-250) y restaurada con amalgama de plata (Permite C) (G2); dientes concúspides B y L reforzadas y unidas con composite (P-60) y restaurado con amalgama de plata (Permite C) (G3); dientes restaurados con composite (Z-250) a través de la técnica incremental (G4), y dientes con cúspides B y L reforzadas y unidas con resina compuesta (P-60) y restauradas con composite (Z-250) mediante la técnica incremental (G5). Después del ciclado térmico (500 ciclos, 5°C a 55°C), la resistencia a la fractura fue probada en una máquina de ensayo universal. El análisis estadístico de los resultados (ANOVA) no reveló diferencias significativas (p> 0,5) entre los grupos (G1 = 157,78 Kgf, G2 = 183,99 Kgf, G3 = 152,53 Kgf, G4 = 182,61 Kgf y G5 = 155,96 Kgf). El análisis visual de los dientes probados mostró un predominio de patrón de falla oblicua. Los cuatro tipos de restauración evaluados proporcionaron resistencia a fractura con valores equivalentes a los dientes intactos con preparaciones MOD, paredes paralelas y cúspides reforzadas con resina compuesta

Bacteriology of deep carious lesions underneath amalgam restorations with different pulp-capping materials - an in vivo analysis

Microorganisms remaining in dentin following cavity preparation may induce pulp damage, requiring the use of pulp-capping agents with antimicrobial activity underneath permanent restorations. OBJECTIVE: The aims of this study were to analyze the bacteriological status of carious dentin and to assess the efficacy of different base underneath silver amalgam restorations. MATERIAL AND METHODS: This study was conducted on 50 patients aged 13 to 30 years. Sterile swabs were used to take samples after cavity preparation, which was assessed by microbiological culture to identify the microorganisms present. Following this, cavities were restored with silver amalgam, using one of the materials being investigated, as the base: calcium hydroxide (Group II), polyantibiotic paste (Group III), a novel light-cured fluoride-releasing hydroxyapatite-based liner (Group IV) and mineral trioxide aggregate - MTA (Group V). In Group I, the cavities were restored with silver amalgam, without any base. After 3 months, the amalgam was removed and samples taken again and analyzed for the microbial flora. RESULTS: Lactobacilli were the most commonly isolated microorganisms in the samples of carious dentin. Groups IV and V showed negative culture in the 3-month samples. There was no statistically significant difference between Groups I, II and III. There was no significant difference between Groups IV and V (p>0.05). Both Groups IV and V showed significantly better results when compared to Groups I, II and III (p<0.05). CONCLUSIONS: The hydroxyapatite-based liner and MTA performed significantly better in terms of antibacterial activity than the other materials.

A finite element thermal analysis of various dowel and core materials.

Aim: Thermal analysis of the temperature and stress distribution of parallel sided, threaded and non-threaded dowels and core materials under thermal loading within a maxillary central incisor using a three dimensional finite element study. Materials and Methods: 3D models of endodontically treated maxillary central incisor with parallel sided, threaded and non- threaded post and core materials were simulated using the ANSYS software. Materials simulated were parallel sided cast gold post and core, parallel sided fibre reinforced composite (FRC) post and core, and parallel sided, threaded, prefabricated stainless steel post and amalgam core. Thermal loads simulating hot (60 degree C/ 333K) and cold (15 degree C/288K) liquid were applied for 15 seconds at the incisal edge. The temperature changes at the selected nodes were obtained on the various post and core materials, interface between post and dentin, interface between core and dentin, within the dentin and within the cement layer. Results: Temperature and stress distribution pattern were represented in numerical and color coding and results interpreted. Thermal stresses arises as a result of temperature changes. A decreased temperature gradient of the metallic dowels and core (T1 hot - 0.002K, T3 hot - 1.071K, T1 cold -0.99K, T3 cold - 0K) were obtained than that of the FRC dowel and core of 1.982K(hot) and1.55K(cold) respectively due to the higher thermal conductivity of the metals. Higher thermal stress values of 3.567 Mpa(hot) and 3.092 Mpa(cold) respectively were obtained for the FRC dowels and higher stress values of 39.679 Mpa(hot) and 57.855 Mpa(cold) respectively were also obtained for the FRC cores. These values indicated that thermal stresses of the FRC dowel and core were greater than that of cast gold dowel and core and prefabricated stainless steel dowel and amalgam core due to its high coefficient of thermal expansion. Maximum stress values of the FRC dowel and core of 1.87 Mpa(hot) and 2.57 Mpa(cold) respectively were also generated in the cement layer, core and metal ceramic crown. The junction of the metal ceramic crown and dentin demonstrated the maximum stress. Higher thermal stress values of 59.162 ± 10 Mpa were obtained in the restoration and the coronal portion of the dentin than the stress levels of .0039 ± 10Mpa in the supporting bone due to an increased thermal expansion. Conclusion: Non-metallic dowel and core materials such as fibre reinforced composite dowels (FRC) generate greater stress than metallic dowel and core materials. This emphasized the preferable use of the metallic dowel and core materials in the oral environment.

Human Exposure and Health Effects of Inorganic and Elemental Mercury / 예방의학회지

Mercury is a toxic and non-essential metal in the human body. Mercury is ubiquitously distributed in the environment, present in natural products, and exists extensively in items encountered in daily life. There are three forms of mercury, i.e., elemental (or metallic) mercury, inorganic mercury compounds, and organic mercury compounds. This review examines the toxicity of elemental mercury and inorganic mercury compounds. Inorganic mercury compounds are water soluble with a bioavailability of 7% to 15% after ingestion; they are also irritants and cause gastrointestinal symptoms. Upon entering the body, inorganic mercury compounds are accumulated mainly in the kidneys and produce kidney damage. In contrast, human exposure to elemental mercury is mainly by inhalation, followed by rapid absorption and distribution in all major organs. Elemental mercury from ingestion is poorly absorbed with a bioavailability of less than 0.01%. The primary target organs of elemental mercury are the brain and kidney. Elemental mercury is lipid soluble and can cross the blood-brain barrier, while inorganic mercury compounds are not lipid soluble, rendering them unable to cross the blood-brain barrier. Elemental mercury may also enter the brain from the nasal cavity through the olfactory pathway. The blood mercury is a useful biomarker after short-term and high-level exposure, whereas the urine mercury is the ideal biomarker for long-term exposure to both elemental and inorganic mercury, and also as a good indicator of body burden. This review discusses the common sources of mercury exposure, skin lightening products containing mercury and mercury release from dental amalgam filling, two issues that happen in daily life, bear significant public health importance, and yet undergo extensive debate on their safety.

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.

Effect of occlusal restoration on stresses around class V restoration interface: A finite-element study.

Background: Causes of failures in class V restorations have always been controversial until now, since the biomechanical aspects of these restorations have been understood. Aims and Objective: This study was aimed to verify the hypothesis that eccentric forces are the cause of cuspal flexure, which lead to excessive stresses at the periphery of a class V restoration, further it identifies the amount of the stress and the flexure increase in the presence of an occlusal restoration using different restorative materials to restore (both cervical and occlusal) along with their comparison with respect to amount of stresses around the cervical restorations. Materials and Methods : The study was done by modeling a mandibular first premolar which was sectioned bucco-lingually, in the NISA, EMRC II finite element software. A 100N eccentric load was applied on the tooth structure and stresses were observed at the peripheries of the class V restoration when it was restored with composite and with glass ionomer cement. The stresses were further analyzed in the presence of occlusal restorations with different materials and configurations. Results: It was seen that the stresses at the gingival wall interface in case of class V glass ionomer cement was more than that for composite. In the presence of an occlusal amalgam restoration, the cuspal flexure was more than that of occlusal composite and the stresses at the class V peripheries were also statistically significant. Conclusion: It was suggested that lower modulus composites can flex with the tooth structure decreasing the bond failure and that the stresses are much lesser when there is absence of an occlusal restoration. Occlusal composite restorations reinforce the tooth structure and reduce the cuspal flexure as compared to silver amalgam.

Microleakage of bonded amalgam restorations using different adhesive agents with dye under vacuum: An in vitro study.

Aim: In an effort to minimize tooth preparation, yet provide additional retention to compromised tooth structure, bonded amalgam restorations were introduced. Various resin-based adhesives have been tried earlier under bonded amalgam restorations. Still there are controversies regarding the outcome of bonded amalgam restorations regarding their adaptability to the tooth structure and microleakage. Therefore, this study was undertaken to compare the microleakage of bonded amalgam restorations using different adhesive materials. Materials and Methods: Standard Class I cavities were prepared on occlusal surfaces of 60 human molars. Teeth (n=60) were divided into three groups according to the material employed, as follows: group I: amalgam with glass ionomer cement (GIC) (type I); group II: amalgam with resin cement (Panavia F 2.0) and group III: amalgam with Copalex varnish as a control. Following restoration, the teeth were submitted to thermal cycling. The teeth were subsequently immersed in 2% rhodamine B dye under vacuum for 48 hours and sectioned to allow the assessment of microleakage under stereomicroscope. Results: The values were tabulated and the results were statistically analyzed using analysis of variance (ANOVA), Tukey's post hoc test and Kruskal-Wallis test. Amalgam with type I GIC showed the least leakage with no statistically significant difference (P value 0.226) when compared to amalgam with Panavia F 2.0 and amalgam with varnish (P value 0.107). Conclusion: It can be concluded that bonded amalgam with type I GIC is a good alternative to amalgam with resin cement (Panavia F 2.0) and amalgam with varnish for large restorations, with the added advantages of GICs. Clinical Significance: Bonded amalgam restorations prevent over-preparation and reduce the tooth flexure. GIC type I under amalgam provides chemical bonding in between amalgam and tooth structure and thus reduces the microleakage.

Effect of alkaline vs acid surface treatment on bond strength of adhesives used for amalgam repair

To assess the effect of alkaline versus acid surface treatment on bond strength of adhesives used for amalgam repair. Sixty cylindrical samples were prepared by condensing amalgam into plastic tubes 0/ 4mm diameter and 10mm length. Tubes were filled up to 5.0mm with admixed amalgam. They were allowed to set hard for three months. The samples were divided into Al, A2 andA3. Al and A2 had 25 samples each and A3 bad 10 samples. Flat exposed surfaces of the samples in Al were treated with 35% Phosphoric acid for 3 minutes. The samples in A2 were treated with 10% solution of Ca ['OH]2. A dentine adhesive containing 4-META, Amalgabond was applied on the treated surfaces. The adhesive-coated surfaces, with the help of a probe were pushed inside the tubes such that uncoated surfaces came in level with the margins of the tubes on the other end. Samples in A3 were not treated with acid or alkali and were kept as control group. Freshly mixed amalgam was packed against the coated surfaces to completely fill the transparent tubes. The samples were subjected to electromechanical testing machine at the crosshead speed of 10mm/minute to collect the data. Mean bond strength of the control samples was 3.0 MPa. It decreased with 35% phosphoric acid and increased with 10% Calcium Hydroxide in the range of 4.5 MPa. The results of the present study revealed that alkaline treatment brings more hardness to the sample surface, whereas acid softens the surface

Effect of additives on the compressive strength and setting time of a Portland cement

Improvements in strength and setting time of Portland cements (PC) are needed to enhance their performance as endodontic and load bearing materials. This study sought to enhance the compressive strength and setting time of a PC by adding one of the following additives: 20 percent and 30 percent poly-methylmethacrylate (PMMA), 20 percent and 30 percent irregular and spherical amalgam alloys, and 10 percent CaCl2. The control consisted of unreinforced PC specimens. Setting time was determined using a Gillmore apparatus according to standardized methods while compressive strength was measured using a universal testing machine after 21 hours or 60 days of water storage. Data were analyzed by ANOVA, Tukey and Games-Howell tests (á = 5 percent). All additives significantly decreased both initial and final setting times as compared with the PC-control (p < .05). 30 percent PMMA and 30 percent irregular alloy had the lowest values of initial setting time. 30 percent irregular alloy also produced the lowest values of final setting time while 30 percent spherical alloy yielded the highest (p < .05). No differences were detected between the compressive strength values of 21 hours and 60 days. While 10 percent CaCl2, 20 percent and 30 percent PMMA produced values significantly lower than the PC-control, 30 percent spherical alloy significantly improved the compressive strength of the reinforced PC (p < .05). In summary, all additives significantly reduced the setting time and 30 percent spherical amalgam alloy yielded a significant increase in compressive strength for the tested PC, which might represent an improved composition for PCs to expand their use as endodontic and potentially load bearing materials.

Recovery of silver residues from dental amalgam

Dental amalgam residues are probably the most important chemical residues generated from clinical dental practice because of the presence of heavy metals among its constituents, mainly mercury and silver. OBJECTIVE: The purpose of this study was to develop an alternative method for the recovery of silver residues from dental amalgam. MATERIAL AND METHODS: The residue generated after vacuum distillation of dental amalgam for the separation of mercury was initially diluted with 32.5 percent HNO3, followed by precipitation with 20 percent NaCl. Sequentially, under constant heating and agitation with NaOH and sucrose, the sample was reduced to metallic silver. However, the processing time was too long, which turned this procedure not viable. In another sequence of experiments, the dilution was accomplished with concentrated HNO3 at 90ºC, followed by precipitation with 20 percent NaCl. After washing, the pellet was diluted with concentrated NH4OH, water and more NaCl in order to facilitate the reaction with the reducer. RESULTS: Ascorbic acid was efficiently used as reducer, allowing a fast reduction, thus making the procedure viable. CONCLUSIONS: The proposed methodology is of easy application and does not require sophisticated equipment or expensive reagents.

Influence of different restorative techniques on marginal seal of class II composite restorations

OBJECTIVE: To evaluate the gingival marginal seal in class II composite restorations using different restorative techniques. MATERIAL AND METHODS: Class II box cavities were prepared in both proximal faces of 32 sound human third molars with gingival margins located in either enamel or dentin/cementum. Restorations were performed as follows: G1 (control): composite, conventional light curing technique; G2: composite, soft-start technique; G3: amalgam/composite association (amalcomp); and G4: resin-modified glass ionomer cement/composite, open sandwich technique. The restored specimens were thermocycled. Epoxy resin replicas were made and coated for scanning electron microscopy examination. For microleakage evaluation, teeth were coated with nail polish and immersed in dye solution. Teeth were cut in 3 slices and dye penetration was recorded (mm), digitized and analyzed with Image Tool software. Microleakage data were analyzed statistically by non-parametric Kruskal-Wallis and Mann-Whitney tests. RESULTS: Leakage in enamel was lower than in dentin (p<0.001). G2 exhibited the lowest leakage values (p<0.05) in enamel margins, with no differences between the other groups. In dentin margins, groups G1 and G2 had similar behavior and both showed less leakage (p<0.05) than groups G3 and G4. SEM micrographs revealed different marginal adaptation patterns for the different techniques and for the different substrates. CONCLUSION: The soft-start technique showed no leakage in enamel margins and produced similar values to those of the conventional (control) technique for dentin margins.

Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage

This in vitro study evaluated the effect of different apicoectomy angles, instruments used in root-end preparation, and dental materials used in retrofilling on apical sealing. Root ends were resected at 45 or 90 degrees in 80 single-rooted teeth. For each type of apicoectomy, root-end cavities were prepared with either a round carbide #2 bur or an S12/90D ultrasonic tip. The root-end cavities in each subgroup (apicoectomy + root-end preparation) were filled with silver amalgam without zinc (Am) or with gray mineral trioxide aggregate -Angelus (MTA), and the specimens were immediately immersed in 0.2 percent rhodamine B for 24 h. Sealing was evaluated based on the dyed cross-sectional dentin area. Data were analyzed statistically by the Kruskal-Wallis test at 5 percent significance level. No group showed complete sealing of root-end areas. The only significant factor affecting microleakage was dental material, with MTA exhibiting less leakage.

Este estudo in vitro avaliou o efeito de diferentes ângulos de apicectomia, instrumentos utilizados na retrocavitação e materiais odontológicos usados na retrobturação sobre selamento apical. Oitenta dentes unirradiculares, tratados endodonticamente, foram apicectomizados. Quarenta raízes tiveram seu ápice radicular seccionado com angulação de 45º e a outra metade com angulação de 90º. Para cada tipo de apicectomia realizou-se retrocavidades com broca esférica carbide nº 2 ou com retroponta ultra-sônica S12/90D. Cada subgrupo (apicectomia/retrocavidade) foi retrobturado com MTA ou amálgama, sendo os espécimes imediatamente imersos no corante Rodamina B a 0,2 por cento por 24 h. O selamento apical foi avaliado com base na área transversal de dentina corada ao redor da retrobturação. Os dados foram submetidos á análise estatística utilizando os testes de Kruskal-Wallis e Mann-Whitney. Nenhum grupo foi capaz de selar totalmente a região apical. O tipo de material utilizado na retrobturação foi o único fator que mostrou significativa diferença no selamento apical em relação à infiltração de corante.

Hydrogen peroxide bleaching: effect of various concentrations on mercury and other metal ions release from dmixed and spherical dental amalgam / Clareamento por peróxido de hidrogênio: efeito de várias concentrações de mercúrio e liberação de outros íons metálicos pelos amálgamas dentais misturado e esférico

OBJECTIVE: The aim of this study was to determine the effect of different hydrogen peroxide concentrations (HP) on mercury and other metal ions release from admixed and spherical dental amalgam. MATERIALS AND METHODS: Dental amalgam discs were prepared from GS.80 and Lojic+ alloys (Southern Dental Industries, Australia) according to manufacturer’s instructions in stainless steel moulds (10mm diameter and 2mm thickness). The discs (n=25 of each alloy) were divided into five equal groups for each alloy. Each group was immersed in 20 ml of 38%, 24%, 10%, or 3% HP solution for 24 h at 37ºC with 0% (distilled water) as control. Following immersion procedure, solutions were taken for metal ion release determination (Hg, Ag, Sn and Cu) using inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was conducted using one and two way ANOVA tests to determine significance of differences between test groups. Bonferroni Post Hoc test was conducted for multiple comparisons. RESULTS: Metal ion release for the elements (Hg, Ag, Sn and Cu) increased with exposure to increasing concentrations of HP for both GS.80 and Lojic+ amalgam alloys. The differences in concentration of metal ions released after treatment with 0% (control), 3%, 10%, 24% or 38% HP were statistically significant (p <0.05). CONCLUSION: Metal ions (Hg, Ag, Cu and Sn) were released from dental amalgam following treatment with all HP concentrations. Metal ion release increased with increasing HP concentration. Even with exposure of dental amalgam to relatively high HP concentration (38%), released Hg did not exceed the maximum acceptable limit.

OBJETIVO: O objetivo deste trabalho foi determinar os efeitos de diferentes concentrações de peróxido de hidrogênio na liberação de íons de Hg e outros metais de amálgamas misturados e esféricos. MATERIAIS E MÉTODOS: Discos de amálgama dental foram preparados com ligas GS.80 e Lojic+, de acordo com instruções dos fabricantes, em moldes de aço inoxidável (10 mm de diâmetro e 2 mm de espessura). Os discos (n=25 de cada liga) foram divididos em cinco grupos iguais para cada liga. Cada grupo foi imerso em 20 ml de solução HP a 38%, 24%, 10% ou 3% a 37ºC, por 24 h a 37ºC, e com água destilada 0% como controle. Após os procedimentos de imersão, soluções foram tomadas para determinação da liberação de íons metálicos (Hg, Ag, Sn and Cu) utilizando-se espectometria da massa de plasma pareadas por indução (ICP-MS). Análise estatística foi conduzida utilizando-se ANOVA testes para determinar significância das diferenças entre os grupos testes. Bonferroni Post Hoc foram feitos para comparações múltiplas. RESULTADOS: A liberação de íons metálicos para os elementos (Hg, Ag, Sn e Cu) aumentou com a exposição a concentrações aumentadas de peróxido de hidrogênio após o tratamento, tanto para a liga de amálgama GS 80 como para aLojic +. As diferenças de concentração dos íons liberados após tratamento com concentrações de peróxido de H a 0%, 3%, 10% ou 38 % foram estatisticamente significantes (p < 0.05). CONCLUSÕES: Íons metálicos (Hg, Ag, Cu e Sn) foram liberados de amálgamas dentais seguindo-se tratamento com todas as concentrações de H2O2. A liberação de ions metálicos aumentou com a elevação da concentração do peróxido de hidrogênio. Mesmo com exposição de amálgama dental a concentrações relativamente altas de peróxido de hidrogênio (38%), a liberação de Hg não excedeu o limite máximo aceitável.

Fluoride release frompolyacid modified composites (compomers) in artificial saliva and lactic acid / Liberação de flúor por compósitos poliácidos modificados (compômeros) em saliva artifical e ácido lático

OBJECTIVES: The aim of this study was to assess the effect of different extraction media and time on the amount and pattern of fluoride release from compomers. MATERIAL AND METHOD: 42 specimens (n = 7 per group) in disc forms (7 mm diameter, 2 mm thickness) from three different compomers (were placed in artificial saliva (pH = 7.0) and lactic acid (pH = 5.2). The amount of the fluoride in these solutions were measured at 1st, 7th, 14th, 21th and 28th day time intervals by means of the fluoride ion selective electrode. The fluoride amount was calculated by concentration (ppm). The amount and the pattern of fluoride release was dependent on both the material, the storage medium and time. RESULTS: Fluoride release was evident for all the compomers but the rate of release varied considerably between the materials. Significant differences were also found between the different types of compomer (p < 0.01). A time dependent increase in the fluoride content was observed for all the compomers in both media. For all the tested materials, the fluoride release was higher in the lactic acid (p < 0.01). The amount of fluoride release was the most from Compoglass followed by Dyract AP and Glasiosite at 28th days, in both artificial saliva and lactic acid respectively. The least amount of fluoride release was observed at the first day.

OBJETIVOS: O objetivo deste estudo foi determinar o efeito de diferentes meios e tempo na quantidade e padrão de liberação de flúor por compômeros. MATERIAL E MÉTODO: 42 espécimes (n = 7 por grupo) em discos (7 mm de diâmetro, 2 mm de espessura), três compômeros diferentes, foram colocados em saliva artificial (pH 7,0) e ácido lático (pH 5,2). A quantidade de flúor nas soluções foram medidas a intervalos semanais, do 1º ao 28º dias (quatro semanas) por meio de eletrodos seletivos para íons flúor. A quantidade de flúor foi calculdada por concentração(ppm). A quantidade e o padrão da liberação de flúor variou consideravelmente tanto do material, do meio de armazenamento e tempo. RESULTADOS: A liberação de flúor foi evidente por todos os compômeros, mas a taxa de liberação variou consideravelmente entre os diferentes tipos de compômeros (p < 0.01). Um aumento relacionado com o tempo no conteúdo de flúor foi observado para todos os compômeros em ambos os meios. Para todos os materiais testados, a liberação de flúor foi maior no ácido lático (p < 0.01). A quantidade de liberação de flúor foi maior pelo Compoglass®, seguido pelo Duract AP® e Glasiosite® aos 28 dias, tanto na saliva artificial como no ácido lático respectivamente. A menor liberação de flúor foi observada no primeiro dia.

An in-vitro study of the physico-mechanical properties of a new esthetic restorative versus dental amalgam / Estudo in vitro das propriedades mecânicas de uma nova restauração estética versus amálgama dentário

OBJECTIVES: The aim of this study was to determine the compressive strength (CS), diametraltensile strength (DTS), surface hardness (SH), and surface roughness (SR) of a ceramic-reinforcedglass ionomer in comparison to a high-copper dental amalgam. The microstructure was alsoexamined. MATERIAL AND METHODS: A ceramic-reinforced glass ionomer (AmalgomerCR), and a spherical high-copper dental amalgam (GS.80) were used in this study. Specimens werefabricated from the tested materials according to the instructions of each manufacturer. The CS,DTS, SH, and SR were measured after storing the specimens for 1 day and 1 week in water at 37oC. Independent-samples t-test and paired–samples t-test were used to determine which specimengroups were significantly different for each test. One representative specimen of each materialwas prepared and examined for microstructure using scanning electron microscopy (SEM).RESULTS: At 1 day, ceramic-reinforced glass ionomer exhibited significantly-higher CS and DTS,lower SR. At 1 week, it exhibited significantly-higher CS and lower SR. The results of SH were notsignificantly different between the tested materials at both storage periods. CONCLUSION: Thephysico-mechanical properties of the tooth-colored ceramic-reinforced glass ionomer were soclose and sometimes significantly superior to dental amalgam.

OBJETIVOS: O propósito deste estudo foi determinas a resistência à compressão, resistência àtensão diametral, dureza de superfície e aspereza de superfície de um ionômero de vidro reforçadocom cerâmica em comparação com amálgama dentário com alto conteúdo de cobre. Amicroestrutura foi também examinada. MATERIAL E MÉTODO: Um ionômero de vidroreforçado com cerâmica (Amalgomer CR) e um amálgama com limalha esférica com alto conteúdode cobre (GS.80) foram utilizados neste estudo. Os corpos de prova foram produzidos com osmateriais testados, de acordo com instruções dos fabricantes. O CS, DTS, SH e SR foram medidosapós estocagem dos corpos de prova por um dia e uma semana em água a 37 o C. Amostrasforam testadas (t-test e t-test emparceiradas), usadas para determinar qual grupo de corpos deprova foram diferentes significativamente para cada teste. Um espécime representativo de cadamaterial foi preparado para avaliação da microestrutura utilizando microscopia eletrônica (SEM).RESULTADOS: Após um dia, o ionômero de vidro reforçado por cerâmica exibiusignificativamente maiôs CS e DTS e menor SR. Após uma semana, exibiu significativamentemaior CS e menor SR. Os resultados do SH não foram significativamente diferentes entre osmateriais testados em ambos os períodos de estocagem. CONCLUSÃO: As propriedades físicomecânicasdo ionômero de vidro com cor de dente, reforçado com cerâmica, foram semelhantes ealgumas vezes superiores ao amálgama dentário.

Materiales restauradores con desprendimiento de fluoruro y la reincidencia de caries: parte I: antecedentes / Fluoride releasing restorative materials and caries re-incidence: part I: background

El desarrollo de los materiales dentales restauradores con desprendimiento de fluoruro y la prevención de la reincidencia de caries, depende de muchos factores y no necesariamente sólo del efecto terapéutico del fluoruro sobre la estructura del diente. La relación de estos materiales con la presencia de caries secundaria es revisada en este artículo, así como también la evolución de la incorporación de fluoruro a distintos materiales dentales restauradores.

Influence of thermal stress on marginal integrity of restorative materials

The aim of this study was to evaluate the influence of thermal stress on the marginal integrity of restorative materials with different adhesive and thermal properties. Three hundred and sixty Class V cavities were prepared in buccal and lingual surfaces of 180 bovine incisors. Cervical and incisal walls were located in dentin and enamel, respectively. Specimens were restored with resin composite (RC); glass ionomer (GI) or amalgam (AM), and randomly assigned to 18 groups (n=20) according to the material, number of cycles (500 or 1,000 cycles) and dwell time (30 s or 60 s). Dry and wet specimens served as controls Specimens were immersed in 1 percent basic fuchsine solution (24 h), sectioned, and microleakage was evaluated under x40 magnification. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests: Thermal cycling regimens increased leakage in all AM restorations (p<0.05) and its effect on RC and GI restorations was only significant when a 60-s dwell time was used (p<0.05). Marginal integrity was more affected in AM restorations under thermal cycling stress, whereas RC and GI ionomer restoration margins were only significantly affected only under longer dwell times.