Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years. METHODS: A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05). RESULTS: After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe). SIGNIFICANCE: Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

Five-year clinical evaluation of universal adhesive applied following different bonding techniques: A randomized multicenter clinical trial.

OBJECTIVES: To evaluate the clinical performance of a universal adhesive system (Futurabond U, Voco) when applied following different adhesive strategies in non-carious cervical lesions (NCCLs) after 5 years. METHODS: Fifty participants were included. Futurabond U (Voco) was applied in NCCLs using four adhesive strategies (n = 50 each): only self-etch (SE); selective enamel etching + self-etch (SET + SE); etch-and-rinse with dry dentin (ERD); and etch-and-rinse with wet dentin (ERW). All cavities were restored with Admira Fusion composite resin (Voco). Restorations were evaluated after 1, 3, and 5 years using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. RESULTS: After 5 years, retention rates were 81 % (65.8-90.5) for SE, 87 % (73.2-94.4) for SET + SE, 84 % (69.6-92.6) for ERD, and 78 % (63.6-88.9) for ERW (p > 0.05). Thirty-five restorations were considered to have minor discrepancies in marginal adaptation at the 5-year recall (14 for SE, 9 for SET + SE, 6 for ERD, and 6 for ERW; p > 0.05). Sixteen restorations were detected as a minor marginal discoloration (6 for SE, 4 for SET + SE, 1 for ERD, and 5 for ERW; p > 0.05) and one restoration showed a recurrence of caries (1 for ERW; p > 0.05) at the 5-year recall. No restorations showed postoperative sensitivity after 5 years. SIGNIFICANCE: NCCLs restorations using a universal adhesive showed satisfactory clinical performance after 5 years, regardless of the adhesive strategy.

Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial.

OBJECTIVES: This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. METHODOLOGY: A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. RESULTS: After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). CONCLUSION: Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

A 24-month clinical evaluation of composite resins with different viscosity and chemical compositions: a randomized clinical trial.

OBJECTIVES: To evaluate the clinical performance of two methacrylate-based flowable composites and an ormocer-based flowable composite in noncarious cervical lesions (NCCLs) in adult participants. METHOD AND MATERIALS: In total, 183 restorations were performed on NCCLs. All cavities were restored using a universal adhesive system (Futurabond U, Voco) with selective enamel etching and with one of the three evaluated flowable composites (n = 61): low-viscosity methacrylate-based composite (GrandioSO Flow, LV), high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 24 months. Kruskall-Wallis analysis of variance rank (α = .05) was used for statistical analysis. RESULTS: After 24 months of clinical evaluation, 16 restorations were lost (LV = 3, HV = 10, ORM = 3) and the retention rates (95% confidence interval) were 95.0% for LV, 82.2% for HV, and 95.0% for ORM, with statistical differences observed between HV and LV as well as HV and ORM (P < .05). When secondary parameters were evaluated, no significant differences between groups were observed (P > .05). Thirty-three restorations (LV = 8, HV = 13, ORM = 12) showed minor marginal staining, 71 restorations (LV = 26, HV = 20, ORM = 25) presented small marginal adaptation defects, and one restoration for HV presented recurrence of caries. CONCLUSION: The universal adhesive associated with the ormocer-based and methacrylate-based flowable composite showed promising clinical performance after 24 months. However, the heavy-flow restorations showed significantly more failures. (Quintessence Int 2023;54:186-199; doi: 10.3290/j.qi.b3631841).

Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial

Abstract Objectives This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. Results After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). Conclusion Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Universal Simplified Adhesive applied under different bonding technique's: 36-month Randomized Multicentre Clinical Trial.

OBJECTIVES: To evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco) when applied using different application strategies in non-carious cervical lesions (NCCLs) after 36 months. MATERIAL AND METHODS: Futurabond U was applied in NCCLs of 50 subjects using four adhesion strategies (n = 50 restorations per group): only self-etch (SEE); selective enamel etching + self-etch (SET); etch-and-rinse with dry dentin (ERDry); and etch-and-rinse with wet dentin (ERWet). All cavities were restored using Admira Fusion composite resin (Voco). Restorations were evaluated after 36 months using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. RESULTS: The after 36-month retention rates were 87% (75-92%) for SEE, 94% (83-98%) for SET, 91% (80-97%) for ERDry, and 94% (83-98%) for ERWet. Forty-three restorations were considered to have minor discrepancies in marginal adaptation at the 36-month recall (18 for SEE, 12 for SET, 7 for ERDry, and 6 for ERWet; p > 0.05). One restoration was detected as a minor marginal discoloration at the 36-month recall (1 for SET; p > 0.05). No restorations showed postoperative sensitivity and caries recurrence at 36 months. CONCLUSION: The clinical performance of the Futurabond U did not depend on the employed bonding strategy, and it was considered reliable after 36 months of clinical evaluation. However, greater marginal discrepancy was observed in the self-etch groups. CLINICAL RELEVANCE: NCCLs restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse modes showed satisfactory clinical performance after 36 months.

Thirty-six-month follow-up of cervical composite restorations placed with an MDP-free universal adhesive system using different adhesive protocols: a randomized clinical trial.

OBJECTIVES: To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months. MATERIALS AND METHODS: Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four groups: We used the self-etch strategy on groups with (SE-et) and without (SET) selective enamel etching, and the etch-and-rinse strategy on groups with dry (ER-D) and moist (ER-M) dentin. After applying the MDP-free universal adhesive (Xeno Select universal adhesive, Dentsply Sirona), cavities were filled using EvoluX composite resin (Dentsply Sirona). The restorations were evaluated at baseline and after 36 months according to World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. Friedman's repeated-measures analysis of variance rank (α = 0.05) was used for statistical analysis. RESULTS: We evaluated the 31 patients after 36 months. Forty-two restorations were lost (ER-D = 5, ER-M = 7, SE-et = 14, SET = 16). The 36-month retention/fracture rates (95% confidence interval) were 83.9% for ER-D, 77.4% for ER-M, 54.9% for SE-et, and 48.4% for SET. ER strategy showed better retention rate than SE strategy (p < 0.05). Thirty-four restorations (ER-D = 6, ER-M = 10, SE-et = 10, SET = 8) showed marginal staining per FDI criteria and 15 restorations (ER-D = 1, ER-M = 2, SE-et = 6, SET = 6) showed marginal staining per USPHS criteria. No restorations showed postoperative sensitivity or recurrence of caries. CONCLUSION: The retention rate of Xeno Select universal adhesive was poor, mainly in the self-etch strategy. TRIAL REGISTRATION: REBEC clinical registry under protocol RBR-4wh4sh. CLINICAL RELEVANCE: MDP-free universal adhesive behavior depends on the bonding strategy used.

In vitro analysis of the pH stability of dental bleaching gels during in-office procedures.

BACKGROUND: Previous studies have shown that acidic bleaching gels could lead to worse collateral effects during an in-office bleaching procedure, while neutral or basic products leads towards a better experience. Considering this fact, the main purpose of this study was to evaluate the pH behavior of 6 in-office bleaching gels, compared to the information provided by their manufacturers. MATERIAL AND METHODS: Thirty enamel discs of bovine teeth were prepared, the initial colors of which were measured by a spectrophotometer and then divided into 6 groups. A pH meter was used to measure the pH every 30 seconds until the end of each procedure, when a new color evaluation was then made. The Tukey test was used for statistical analysis of the results. RESULTS: There was no difference in the color variation (ΔE) between the groups (p> 0.05). In two groups, the pH variation (ΔpH) showed neutral stability, with initial and final pH averages of 7.04 and 7.11 (p = 0.08) and 7.21 and 7.19 (p = 0.55), respectively; in another, there was alkaline stability, with an initial and final pH average of 8.54 and 8.37 (p = 0.14). In the other three brands, however, the results showed acidification, with initial and final pH averages of 6.14 and 5.22 (p = 0.001), 6.05 and 5.16 (p = 0.001) and 7.14 and 5.83 (p = 0.001), respectively. CONCLUSIONS: In 3 of the evaluated gels, a discrepancy existed between the manufacturer's information and the data obtained, which could lead, considering previous studies discussed throughout this article, to unexpected collateral effects on the patients, especially dental sensitivity. Thus, clinicians and researchers should be aware about pH stability studies of in-office bleaching gels for better predictability and safety on their clinical usage. Key words:Tooth bleaching, Bleaching agents, Hydrogen-ion concentration, Dentin sensitivity, Hydrogen peroxide.

Influence of viscosity and chemical composition of composite resins in non-carious cervical restorations: 12-month randomized clinical trial / Influência da viscosidade e composição química das resina compostas em restaurações de lesões cervicais não-cariosas: resultados de 12 meses de uma pesquisa clínica randomizada

Objective: The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinical performance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-carious cervical lesions (NCCLs) of adult patients. Material and Methods: 183 restorations were performed on NCCLs using the Futurabond U adhesive system, applied in the selective enamel etching mode in all cavities. After the adhesive application, the cavities were restored with one out of the three evaluated flowable composites (n = 61 per group): ormocer-based flowable composite (Admira Fusion Flow, ORM), low viscosity methacrylate-based composite (GrandioSO Flow, LV) and high viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV). After 12 months of clinical performance, these restorations were evaluated according to FDI and USPHS criteria in the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity and caries recurrence. Results: eight restorations were lost/fractured after 12 months of clinical evaluation (1 in the ORM and 7 in the HV group). The retention rates for 12- months (95% confidence interval) were 98.4% (91.3%-99.7%) for the ORM group, 100% (94.5%-100%) for the LV group and 88.5% (78.1%-94.3%) for the HV group, with no statistical difference identified between any pair of groups (p > 0.05). Five restorations presented small marginal adaptation defects at the 12-months evaluation recall, and all of them were considered clinically acceptable. Conclusion: The clinical performance of the universal adhesive associated to ormocer-based or methacrylate-based flowable composite were found to be promising after 12-month of clinical evaluation (AU)

Objetivo: O objetivo deste estudo clínico duplo-cego randomizado foi comparar as taxas de retenção de um compósito fluido à base de Ormocer versus dois compósitos fluidos à base de metacrilato quando utilizados em lesões cervicais não cariosas (LCNCs) de pacientes adultos. Material e Métodos: 183 restaurações foram realizadas em LCNCs utilizando o sistema adesivo Futurabond U, aplicado no modo de condicionamento seletivo do esmalte em todas as cavidades. Após a aplicação do adesivo, as cavidades foram restauradas com um dos três compósitos fluidos avaliados (n = 61 por grupo): compósito fluido à base de ormocer (Admira Fusion Flow, ORM), compósito à base de metacrilato de baixa viscosidade (GrandioSO Flow, LV) e compósito à base de metacrilato de alta viscosidade (GrandioSO Heavy Flow, HV). Após 12 meses de desempenho clínico, essas restaurações foram avaliadas de acordo com os critérios FDI e USPHS nos seguintes itens: retenção / fratura, adaptação marginal, coloração marginal, sensibilidade pós-operatória e recorrência de cárie. Resultados: oito restaurações foram perdidas / fraturadas após 12 meses de avaliação clínica (1 no grupo ORM e 7 no grupo HV). As taxas de retenção por 12 meses (intervalo de confiança de 95%) foram 98,4% (91,3% -99,7%) para o grupo ORM, 100% (94,5% -100%) para o grupo LV e 88,5% (78,1% -94,3%) para o grupo HV, sem diferença estatística identificada entre nenhum par de grupos (p> 0,05). Cinco restaurações apresentaram pequenos defeitos de adaptação marginais no período de avaliação de 12 meses, e todas foram consideradas clinicamente aceitáveis. Conclusão: O desempenho clínico do adesivo universal associado ao compósito fluido à base de ormocer ou metacrilato mostrou-se promissor após 12 meses de avaliação clínica(AU)

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and a meta-analysis were performed to answer the following research question: Are there differences in the color match and surface texture of nanofilled/nanohybrid and hybrid composite in patients with direct posterior restorations? DATA: Randomized clinical trials that compared nanofilled/nanohybrid and hybrid composite in direct restoration in posterior teeth were included. For the analysis of the bias the risk of bias tool (RoB) was used. Meta-analyses of different pairs (nanofilled vs. hybrid and nanohybrid vs. hybrid composite) were conducted for surface texture and color match and other secondary outcomes at different follow-ups, using a random effects model. Heterogeneity was assessed with the Cochran Q test and I2 statistics. GRADE was used to assess the quality of the evidence. SOURCES: A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (2001-2019), unpublished and ongoing trials registries, dissertations and theses were also searched. STUDY SELECTION: 28 studies remained. No study was considered to be at low RoB; four studies were judged to have high RoB, and the remaining were judged to have unclear RoB. RESULTS: For the primary and secondary outcomes variables no significant differences were detected between nanofilled/nanohybrid restorations and hybrid composite restorations in any of the study follow-ups (p > 0.08). The body of evidence for surface texture and color match was classified as moderate or low. CONCLUSION: No evidence of difference was found between nanofilled/nanohybrid and hybrid composite in any of the clinical parameters evaluated.

Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial.

The objectives of this double-blind randomized clinical trial were to compare (a) the clinical times and (b) the occurrence and severity of postoperative sensitivity, of posterior restoration that used a universal adhesive, in a self-etch or selective enamel-etching technique, along with incremental or bulk-fill composites (presented in syringes or capsules). A total of 295 posterior restorations were placed according to the following groups: SETB - self-etch/bulk-fill in syringe; SETC - self-etch/bulk-fill in capsules; SETI - self-etch/incremental; SEEB - selective enamel-etching/bulk-fill in syringe; SEEC - selective enamel-etching/bulk-fill in capsules; and SEEI - selective enamel-etching/incremental. Clinical time was assessed by a reason (s/mm3) between the total volume of resin inserted and the total time required to perform the restorations. Postoperative sensitivity was evaluated using two scales (Numeric Rating Scale and Visual Analogue Scale). Mean clinical time results, analyzed by Wald's Chi-square, showed significant statistical differences among all groups (p<0.001), indicating that the restorative strategy affected the time required for the restoration. A generalized estimating equation model statistical analysis, performed to compare postoperative sensitivity, showed that neither the restorative technique, the adhesive strategy nor the presentation mode of the bulk-fill composite affected the overall risk of postoperative sensitivity (4.06 [2.22-6.81]). The use of bulk-fill composite, presented in capsules or syringes, is less time consuming and does not increase the risk or intensity of postoperative sensitivity relative to the traditional incremental technique.

Pre-operative use of dexamethasone does not reduce incidence or intensity of bleaching-induced tooth sensitivity. A triple-blind, parallel-design, randomized clinical trial.

OBJECTIVES: This study evaluated the effect of the administration of pre-operative dexamethasone on tooth sensitivity stemming from in-office bleaching. MATERIALS AND METHODS: A triple-blind, parallel-design, randomized clinical trial was conducted on 70 volunteers who received dexamethasone or placebo capsules. The drugs were administered in a protocol of three daily 8-mg doses of the drug, starting 48 h before the in-office bleaching treatment. Two bleaching sessions with 37.5% hydrogen peroxide gel were performed with a 1-week interval. Tooth sensitivity (TS) was recorded on visual analog scales (VAS) and numeric rating scales (NRS) in different periods up to 48 h after bleaching. The color evaluations were also performed. The absolute risk of TS and its intensity were evaluated by using Fisher's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney U test and a two-way repeated measures ANOVA and Tukey's test, respectively. RESULTS: In both groups, a high risk of TS (Dexa 80% x Placebo 94%) was detected. No significant difference was observed in terms of TS intensity. A whitening of approximately 3 shade guide units of the VITA Classical was detected in both groups, which were statistically similar. CONCLUSIONS: It was concluded that the administration pre-operatively of dexamethasone, in the proposed protocol, does not reduce the incidence or intensity of bleaching-induced tooth sensitivity. CLINICAL RELEVANCE: The use of dexamethasone drug before in-office bleaching treatment does not reduce incidence or intensity of tooth sensitivity. CLINICAL TRIAL REGISTRATION NUMBER: NCT02956070.

Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial

Abstract The objectives of this double-blind randomized clinical trial were to compare (a) the clinical times and (b) the occurrence and severity of postoperative sensitivity, of posterior restoration that used a universal adhesive, in a self-etch or selective enamel-etching technique, along with incremental or bulk-fill composites (presented in syringes or capsules). A total of 295 posterior restorations were placed according to the following groups: SETB - self-etch/bulk-fill in syringe; SETC - self-etch/bulk-fill in capsules; SETI - self-etch/incremental; SEEB - selective enamel-etching/bulk-fill in syringe; SEEC - selective enamel-etching/bulk-fill in capsules; and SEEI - selective enamel-etching/incremental. Clinical time was assessed by a reason (s/mm3) between the total volume of resin inserted and the total time required to perform the restorations. Postoperative sensitivity was evaluated using two scales (Numeric Rating Scale and Visual Analogue Scale). Mean clinical time results, analyzed by Wald's Chi-square, showed significant statistical differences among all groups (p<0.001), indicating that the restorative strategy affected the time required for the restoration. A generalized estimating equation model statistical analysis, performed to compare postoperative sensitivity, showed that neither the restorative technique, the adhesive strategy nor the presentation mode of the bulk-fill composite affected the overall risk of postoperative sensitivity (4.06 [2.22-6.81]). The use of bulk-fill composite, presented in capsules or syringes, is less time consuming and does not increase the risk or intensity of postoperative sensitivity relative to the traditional incremental technique.

How do the optical properties of the bulk fill posterior composites change after 2 years of simulated toothbrushing? / Como as propriedades ópticas de compósitos bulk fill se comportam após 2 anos de escovação simulada?

Objective: The objective of this study was to evaluate the alteration of the optical properties of bulk fill resin-based composites after two years of simulated toothbrushing. Material and Methods: Three high-viscosity bulk fill resin composites and one conventional sculptable resin composite (control) were analyzed. Five specimens of each resin composite were prepared, and roughness, color, translucency and gloss were evaluated initially and after one and two years of simulated toothbrushing. The specimens were submitted to electric simulated toothbrushing (14600 strokes / 100 g) using a commercially available soft bristle toothbrush and toothpaste slurry in a proportion of 1:2 by weight. The brushing scheme was of 40 cycles per day (2 cycles per second / 280 cycles in a week). The optical properties and the roughness data were analyzed by a multifactor analysis of variance (MANOVA) and a Tukey post hoc test. Results: The baseline and final values of Ra and Sa were submitted to linear regression analyses, all of which were performed at a significance level of 5%. Gloss and roughness presented statistical differences between the resin-time interactions in all composite resins. The gloss (72.5%) and roughness (89.4%) worsened significantly after brushing, but the authors didn't find statistically significant differences when evaluating translucency and color. Conclusion: Based in the results, it could be concluded that the simulated brushing degraded the gloss and roughness of the used high-viscosity bulk fill composites. (AU)

Objetivo: O objetivo deste estudo foi avaliar a alteração das propriedades ópticas de resinas compostas do tipo bulk fill após dois anos de escovação simulada. Material e Métodos: Foram analisadas três resinas compostas do tipo bulk fill de alta viscosidade e uma resina composta convencional (controle). Cinco corpos-deprova de cada resina composta foram preparados e a rugosidade, cor, translucidez e brilho foram avaliados inicialmente e após um e dois anos de escovação simulada. Os espécimes foram submetidos a escovação dental simulada (14.600 golpes / 100 g) utilizando-se escova de dentes de cerdas macias comercialmente disponíveis e uma pasta composta de dentifrício e água na proporção de 1:2 em peso. O esquema de escovação foi de 40 ciclos por dia (2 ciclos por segundo / 280 ciclos por semana). As propriedades ópticas e os dados de rugosidade foram analisados por uma análise de variância multifatorial (MANOVA) e um teste post hoc de Tukey. Resultados: Os valores iniciais e finais de Ra e Sa foram submetidos a análises de regressão linear, todas realizadas ao nível de significância de 5%. O brilho e a rugosidade apresentaram diferenças estatísticas entre as interações resina-tempo em todas as resinas compostas. O brilho (72,5%) e a rugosidade (89,4%) pioraram significativamente após a escovação, mas os autores não encontraram diferenças estatisticamente significativas ao avaliar a translucidez e a cor. Conclusão: Com base nos resultados, pôde-se concluir que a escovação simulada degradou o brilho e a rugosidade das resinas compostas do tipo bulk fill avaliadas. (AU)

Effect of a dentifrice containing nanohydroxyapatite on the roughness, color, lightness, and brightness of dental enamel subjected to a demineralization challenge.

The dental profession is still pursuing the most effective way to treat white-spot lesions in order to produce a sound and esthetically pleasing enamel surface. The aim of the present research was to evaluate in vitro the effects of a dentifrice with nanohydroxyapatite (nano-HAp) on the roughness, color, lightness, and brightness (gloss) of bovine enamel subjected to pH cycling. Twelve enamel discs prepared from bovine incisors were divided into 2 experimental groups: dentifrice with sodium fluoride (Colgate Total 12 Clean Mint) and dentifrice with nanoHAp (Megasonex). For 14 days, the specimens were subjected to 30 cycles of simulated brushing twice a day as well as to a pH cycling model (6 hours of demineralization and 18 hours of remineralization daily). The roughness, color, lightness, and brightness of all specimens were evaluated at baseline (immediately after specimen preparation) and after 7 and 14 days of treatment. A Tukey test demonstrated that there were no statistically significant differences in the effects of the dentifrices on any parameter after 7 days (P > 0.05). After 14 days, however, there was a statistically significant increase in mean roughness in the group brushed with fluoride dentifrice (P < 0.05). Thus, the nanoHAp containing dentifrice promoted less superficial roughness after 14 days, but both dentifrices were similar in relation to color variation, lightness, and brightness.

Influence of custom adaptation on the characteristics of fiber posts.

In this in vitro study, 3 experiments were conducted to evaluate the influence of customizing the apical portion on the characteristics of fiber posts. In the first experiment, 4 fiber posts were submitted to different custom adaptations (no customization, industrial shaping tool, diamond bur, or paper disc) and were observed with a scanning electron microscope to evaluate the micromorphologic changes. In the second experiment, 60 posts of different sizes were divided into 6 groups (n = 10): 0 (No. 0.5), 1 (No. 1), 2 (No. 2), 3 (No. 3), 4 (No. 4), and 5 (paper disc-remodeled No. 4). The posts were submitted to a 3-point bending test. In the third experiment, the crowns of 20 extracted, healthy permanent human canines were removed, and the teeth were endodontically treated, embedded in acrylic resin, and divided into 2 groups (n = 10): I (control), No. 4 posts cemented into post spaces prepared with a No. 4 drill; and II (test), remodeled No. 4 posts cemented into root spaces prepared with No. 2 and 4 drills. The posts were cemented with self-adhesive dual resin cement, and the specimens received direct resin crowns. Fracture strength was measured with a universal testing machine at 45 degrees until fracture. Results were submitted to analysis of variance (P ≤ 0.05). Customization of fiber posts with diamond burs or paper discs produced acceptable micromorphologic changes. Custom adaptation of fiber posts reduced their flexural strength, which remained at acceptable values. Teeth restored with customized fiber posts had greater fracture strength than those restored with intact posts. The results of this study indicated that post remodeling is a safe means to facilitate adaptation to root walls and preserve tooth structure.

Protocolo das possibilidades técnicas de aplicação dos sistemas adesivos universais: revisão de literatura com relato de caso / Clinical strategies using universal adhesive systems: literature review with case report

Este relato de caso demonstra a utilização clínica de um novo sistema adesivo universal, Xeno Universal (Dentsply DeTrey, Alemanha) descrevendo quatro formas possíveis de aplicação: autocondicionante, com ou sem condicionamento seletivo do esmalte, ou com condicionamento ácido total, seguido da aplicação do adesivo sobre dentina seca ou úmida. Os adesivos universais de uma maneira geral são de fácil aplicação e versáteis, uma vez que o mesmo produto pode ter várias formas de aplicação, reduzindo o tempo clínico e em muitas situações a sensibilidade técnica. No entanto, mais estudos laboratoriais e clínicos que comprovem a eficácia deste novo adesivo universal em particular são necessários, antes que seu uso seja bem indicado aos cirurgiões-dentistas.

This case report describes the clinical application of a new universal adhesive system, Xeno Universal (Dentsply DeTrey, Germany) describing four application modes: self-etching, with or without selective enamel etching, or total etching followed by adhesive application on dry or moist dentin. Universal adhesive systems usually are versatile and easy to use, facilitating the operator, since the same product has several technical possibilities, thus reducing the operating time and the technique sensitivity. However, long-term laboratory studies and more clinical reports and/or clinical trials are needed to prove the quality of this new universal adhesive system, before dentists can start using them in their dental offices.

Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype.

Gingival biotype is a clinical term used to describe the thickness of the gingiva. It has been classified as being thick or thin and may be related to the clinical outcome of root coverage procedures. This study evaluated the impact of gingival biotype on the clinical outcome of root coverage procedures following subepithelial connective tissue graft plus coronally positioned flap. A total of 19 patients, 10 with thin and 9 with thick gingival biotype, were treated for localized Miller Class I or II gingival recessions. After 6 months, 14 patients achieved complete root coverage, 7 from each group. The overall mean pooled root coverage rate was 90.93%. The thin biotype cases yielded a reduced mean root coverage of 88.51% compared with 93.63% for patients who had the thick biotype classification. Although the thin gingival biotype may impair the clinical outcome of root coverage procedures, this limitation does not appear to have a strong influence on the success of the root coverage therapy when subepithelial connective tissue graft was associated with the coronal positioning of the flap.

Low-shrinkage composites: an in vitro evaluation of sealing ability after occlusal loading.

The objective of this in vitro study was to compare the microleakage of a flowable low-shrinkage-stress resin composite--in a Class II fatigue-loading design when used as a 4 mm dentin replacement--to a conventionally layered silorane-based resin composite. Eighty standardized 4 mm deep cavities, divided into 4 subgroups, were restored with the 2 tested materials. Half of the restorations were submitted to mechanical loading, and all of the restorations were prepared for microleakage evaluation. The evaluation of the marginal adaptation to dentin was performed with scanning electron microscopy. The results showed that both silorane-based composite groups had higher rates of microleakage in comparison to the low-shrinkage-stress resin composite groups.

Periodontal plastic microsurgery in the treatment of deep gingival recession after orthodontic movement.

Gingival recession is a condition that affects a large portion of the young and adult population and negatively affects the aesthetic aspects of the smile. Many factors are related to its development, including orthodontic movement beyond the osseous limits. Many treatment options have been proposed to cover the exposed root surface. The aim of this article was to describe three cases where a subepithelial connective tissue graft was performed, using a microsurgical technique, in the treatment of deep gingival recession after orthodontic treatment. This technique resulted in successful root coverage and keratinized tissue gain, improving the gingival esthetic pattern.