Does Acid Etching Influence the Adhesion of Universal Adhesive Systems in Noncarious Cervical Lesions? A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the adhesion of universal adhesive systems to the dentin of noncarious cervical lesions (NCCLs) by comparing the etch-and-rinse and self-etch strategies through a systematic review and meta-analysis. METHODS: Systematic electronic searches were performed by two independent reviewers into the following databases: PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library until December of 2021. Only randomized clinical trials were selected, comparing etch-and-rinse and self-etch strategies and using universal adhesive systems in NCCLs. This systematic review was conducted according to the PRISMA guidelines and registered into PROSPERO. RESULTS: After the removal of duplicates, 170 articles were identified. In an initial screening of titles and abstracts, 146 records did not satisfy the inclusion criteria and were, therefore, excluded. Twenty-four studies were eligible for evaluation of the full text, and four were excluded after this step. Finally, 20 randomized clinical trials were included in this systematic review and meta-analysis. CONCLUSION: This systematic review and meta-analysis revealed that applying universal adhesive systems in the etch-and-rinse strategy could lead to better medium-term (>12 to 36 months) retention of NCCL restorations than the self-etch strategy, as well as resulting in lower percentages of marginal discoloration, marginal adaptation, and secondary caries. However, the use of a self-etching strategy can lead to lower postoperative sensitivity.

Clinical Efficacy of Mouthwashes with Potassium Salts in the Treatment of Dentinal Hypersensitivity: A Systematic Review and Meta-analysis.

AIM: This systematic review and meta-analysis evaluated whether the home use of mouthwashes containing potassium salts is effective in reducing and controlling dentin hypersensitivity (DH). METHODS AND MATERIALS: This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and was registered in PROSPERO (CRD42021228410). Randomized clinical trials evaluating the use of mouthwashes containing potassium salt for daily household mouthwash for at least four weeks to reduce DH compared with a control mouthwash were selected, with no limitation on year of publication. Electronic research was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library by two independent researchers. One hundred thirty-three articles were obtained, and nine were selected according to the inclusion criteria. RESULTS: The selected studies evaluated DH through tests of sensitivity to tactile and evaporative stimuli and showed that, for the tactile stimulus, there were no baseline differences between groups (p=0.12; mean difference: -0.33; confidence intervals [CI]: -0.73 to 0.08). However, there were significant differences after two weeks of use (p=0.00001; mean difference: 4.67; CI: 4.53 to 4.81), after four weeks (p=0.00001; mean difference: 13.29; CI: 13.03 to 13.55), and after eight weeks (p=0.00001; mean difference: 8.88; CI: 5.73 to 12.02) favoring the experimental group. The results of the evaporative test showed no differences in the baseline assessment between the two groups (p=0.50; mean difference: -0.02; CI: -0.09 to 0.04), but after four weeks (p=0.00001; mean difference: -0.32; CI: -0.44 to -0.20), and eight weeks of use (p=0.00001; mean difference: -0.42; CI: -0.57 to -0.27) there were differences favoring the experimental group. The incidence of side effects showed no differences between the two groups (p=0.89; mean difference: 1.03; CI: 0.67 to 1.58). CONCLUSION: The daily use of mouthwashes containing potassium salt is effective in the treatment of dentinal hypersensitivity, as a complementary step to brushing at least twice a day for two weeks, four weeks, and up to eight weeks, without presenting side effects.

Effect of Preoperative Use of Nonsteroidal Anti-inflammatory Drugs on Dental Sensitivity Induced by Dental Bleaching in the Dental Office: A Systematic Review and Meta-analysis.

AIM: This systematic review and meta-analysis evaluated the effect of using nonsteroidal anti-inflammatory drugs (NSAIDs) before dental bleaching sessions in the dental office on postoperative sensitivity. METHODS: The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and registered on International Prospective Register of Systematic Reviews under number CRD42020210054. Randomized clinical trials published in the English language that compared the preventive use of NSAIDs with a placebo on the sensitivity resulting from dental bleaching in the dental office were selected, with no limitation on the year of publication. The electronic searches took place in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library and were carried out independently by two researchers. A total of 30 articles were obtained; seven were selected according to the inclusion criteria. RESULTS: No significant differences were found in the reduction of dental sensitivity between the experimental group compared to the placebo during the session (p=0.32; mean difference [MD]=-0.30; 95% CI, -0.88 to 0.29), immediately after the session (p=0.22; MD=-0.29; 95% CI, -0.75 to 0.17), up to 1 hour later (p=0.10; MD=-0.94; 95% CI, -2.06 to 0.18), and between 1 and 24 hours after the procedure (p=0.78; MD=-0.11; 95% CI, -0.90 to 0.68). The incidence of sensitivity between the groups also did not show statistically relevant differences (p=0.60; MD=1.15; 95% CI, 0.69-1.92). Furthermore, none of the studies reported side effects in any patient. CONCLUSION: This systematic review and meta-analysis indicates that the use of NSAIDs before dental office bleaching is not effective in reducing dental sensitivity during or up to 24 hours after the procedure. In addition, there was no difference in the incidence of sensitivity between the experimental and placebo groups.

Clinical Efficiency of Self-etching One-Step and Two-Step Adhesives in NCCL: A Systematic Review and Meta-analysis.

CLINICAL RELEVANCE: One-step self-etch adhesive systems provide a clinical time gain, decreasing the number of clinical steps. When a clinician is able to follow a simpler process of adhesion there is less chance of adhesive failure. SUMMARY: Objective: A systematic review and meta-analyses were performed to evaluate whether one-step self-etching (1SSE) adhesive systems are as effective as two-step self-etching (2SSE) adhesives in noncarious cervical lesion (NCCL) restorations.Methods: This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recorded in the PROSPERO (CRD42018096747). Electronic systematic searches were conducted in the following databases: PubMed/MEDLINE, Scopus, and Cochrane Library for published articles. Only randomized clinical trials that compared 1SSE with 2SSE adhesives systems were selected. The outcomes were retention, postoperative sensitivity, secondary caries, color match, marginal discoloration, marginal adaptation, and anatomical form.Results: The searches resulted in 476 studies. After applying the eligibility criteria, five randomized controlled trials were selected in which 822 restorations in NCCLs were distributed in 237 patients. The results showed no statistical difference between 1SSE and 2SSE in relation to retention (p=0.23; relative risk [RR]=1.55; 95% confidence interval [CI]=0.76, 3.19), postoperative sensitivity ( p=0.50; RR=3.00; 95% CI=0.13, 70.64), Secondary caries (p=0.63; RR=0.68; 95% CI=0.14, 3.31), color match (p=0.41; RR=0.64; 95% CI=0.23, 1.83), marginal discoloration (p=0.93; RR=1.02; 95% CI=0.65, 1.61), and anatomical form (p=0.56; RR=1.38; 95% CI=0.46, 4.13). However there was statistical difference in relation to marginal adaptation ( p=0.01; RR=1.95; 95% CI=1.14, 3.34).Conclusion: This systematic review with meta-analysis revealed that both 1SSE and 2SSE adhesive systems have comparable clinical effectiveness in a follow-up period of 12 to 24 months, except in relation to marginal adaptation.

Fracture Resistance of Endodontically Treated Maxillary Premolars Restored With Different Methods.

PURPOSE:: The purpose of this in vitro study was to evaluate the resistance and patterns of fracture of endodontically treated maxillary premolars (ETPs) restored with different methods. METHODS AND MATERIALS:: Mesio-occluso-distal cavities were prepared in 50 extracted caries-free human maxillary premolars after endodontic treatment. The teeth were divided into five groups (n=10), according to the restorative method. G1: intact teeth (control group); G2: conventional composite resin; G3: conventional composite resin with a horizontal glass fiber post inserted between buccal and palatal walls; G4: bulk-fill flowable and bulk-fill restorative composites; and G5: ceramic inlay. For direct restorations, Filtek Z350 XT, Filtek Bulk Fill Flowable Restorative, and Filtek Bulk Fill Posterior Restorative were used. Indirect restorations were fabricated from a pressable lithium disilicate glass-ceramic (IPS e-max Press) and adhesively cemented (RelyX Ultimate). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles) and additionally submitted to cyclic loading 50,000 times in an Electro-Mechanical Fatigue Machine. Next, the specimens were subjected to a compressive load at a crosshead speed of 1 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern using a stereomicroscope, and then representative specimens were carbon coated to allow for the studying of the fracture surface under scanning electron microscopy. One-way analysis of variance (ANOVA) was used to compare fracture resistance of the groups. The results of fracture patterns were submitted to the Fisher exact test (α=0.05). RESULTS:: All specimens survived fatigue. Mean (standard deviation) failure loads (N) for groups were as follows: G1: 949.6 (331.5); G2: 999.6 (352.5); G3: 934.5 (233.6); G4: 771.0 (147.4); and G5: 856.7 (237.5). The lowest fracture resistance was recorded for G4, and the highest ones were recorded for G2, followed by that of G1 and G3. One-way ANOVA did not reveal significant differences between groups ( p>0.05). The highest repairable fracture rates were observed in G1 (100%) and G3 (80%). CONCLUSIONS:: ETPs restored with conventional composite resin with or without horizontal fiber post, bulk-fill composite, and ceramic inlay showed fracture resistance similar to that of sound teeth. Conventional composite resin restorations exhibited the highest prevalence of unrepairable fractures, and the insertion of a horizontal fiber post decreased this prevalence. Intact teeth showed 100% of repairable fractures. It is difficult to extrapolate the results directly to a clinical situation due to the limitations of this study.

Flared Roots Reinforced With Bulk-fill Flowable Composite - Case Report.

This article presents a case report for the treatment of a patient with a flared root. The patient was treated with a bulk-fill flowable composite. This innovative approach seems to be efficient in reinforcing flared roots. The advantages and disadvantages of the technique are presented.

Ramos do arco aórtico e da aorta torácica em bicho-preguiça (Bradypus variegatus) / Branches of the aortic arch and thoracic aorta of the sloth (Bradypus variegatus)

As preguiças são mamíferos arborícolas, bem específicos quanto aos hábitos e à morfofisiologia. Essa condição faz delas ainda mais vulneráveis aos impactos ambientais. Com o objetivo de fornecer informações que auxiliem na clínica médico-cirúrgica desses Xenarthras, realizou-se um estudo do arco aórtico e da artéria aorta torácica, a fim de se identificarem seus principais ramos. Foram utilizados 10 animais da espécie Bradypus variegatus, sendo uma fêmea e três machos submetidos a dissecação, por meio da qual foram obtidas medidas de diâmetro e comprimento dos vasos, enquanto três fêmeas e três machos destinaram-se à técnica de radiografia digital com contraste. Constatou-se uma sintopia uniforme do arco, bem como da porção descendente da artéria aorta no tórax. No entanto, a topografia difere consideravelmente. Com base nos ramos, percebeu-se, independentemente do sexo, uma maior variação naqueles originados do arco e dos que emergem da artéria aorta torácica e irrigam estruturas medianas e do antímero direito do tórax. Foram obtidos valores maiores para o diâmetro das artérias na fêmea do que nos machos e, para o comprimento da artéria aorta torácica, foram encontrados valores correspondentes em ambos. Toda essa variação dos bradipodídeos apresenta diferenças em relação a outros mamíferos.(AU)

Sloths are arboreal mammals, very specific, regarding their habits and morphology. This condition makes them even more vulnerable to environmental impacts. In order to provide information to assist in the medical and surgical assistance to these Xenarthras, a study of the aortic arch and thoracic portion of the descending aorta was carried out with the purpose of identify its main branches. Ten animals of the Bradypus variegatus species were used. One female and three males were submitted to dissection, where measurements of vessel diameter and length were obtained, while three females and three males were submitted to the digital contrast x-ray technique. There was a uniform syntopy of the arch, as well as of the descending portion of the aorta in the thorax. However, the topography differs considerably. Based on the branches, regardless of gender, a greater variation was observed in those originating from the arch, and those that emerge from the thoracic aorta and irrigate medial structures and the right antimere of the thorax. Greater values were obtained for the diameter of the arteries in the female than in the males and corresponding values for the length of the thoracic aorta in both. All this variation is possibly related to the adaptive processes of Bradipodidae over time.(AU)

Drought sensitivity of Amazonian carbon balance revealed by atmospheric measurements.

Feedbacks between land carbon pools and climate provide one of the largest sources of uncertainty in our predictions of global climate. Estimates of the sensitivity of the terrestrial carbon budget to climate anomalies in the tropics and the identification of the mechanisms responsible for feedback effects remain uncertain. The Amazon basin stores a vast amount of carbon, and has experienced increasingly higher temperatures and more frequent floods and droughts over the past two decades. Here we report seasonal and annual carbon balances across the Amazon basin, based on carbon dioxide and carbon monoxide measurements for the anomalously dry and wet years 2010 and 2011, respectively. We find that the Amazon basin lost 0.48 ± 0.18 petagrams of carbon per year (Pg C yr(-1)) during the dry year but was carbon neutral (0.06 ± 0.1 Pg C yr(-1)) during the wet year. Taking into account carbon losses from fire by using carbon monoxide measurements, we derived the basin net biome exchange (that is, the carbon flux between the non-burned forest and the atmosphere) revealing that during the dry year, vegetation was carbon neutral. During the wet year, vegetation was a net carbon sink of 0.25 ± 0.14 Pg C yr(-1), which is roughly consistent with the mean long-term intact-forest biomass sink of 0.39 ± 0.10 Pg C yr(-1) previously estimated from forest censuses. Observations from Amazonian forest plots suggest the suppression of photosynthesis during drought as the primary cause for the 2010 sink neutralization. Overall, our results suggest that moisture has an important role in determining the Amazonian carbon balance. If the recent trend of increasing precipitation extremes persists, the Amazon may become an increasing carbon source as a result of both emissions from fires and the suppression of net biome exchange by drought.

Dual-cured etch-and-rinse adhesive systems increase the bond durability of direct coronal dentin restorations.

This study aimed to evaluate the bond durability of dentin restorations bonded with light- or dual-cured etch-and-rinse adhesive systems. A three-step adhesive system (Scotchbond Multipurpose Plus), an acetone-based two-step adhesive system (Prime & Bond 2.1), and an ethanol-based two-step adhesive system (Excite) were tested. Both the light- and the dual-cured versions were evaluated. High C-factor dentin cavities were prepared on 120 bovine incisors, which were then restored with resin composite (n=10). The samples were stored in water for 24 hours, and half of them were subjected to additional degradation with 10% NaOCl for five hours. The push-out bond strength test was performed in a universal testing machine until failure. Failure modes were evaluated by scanning electron microscopy. Data were analyzed by three-way analysis of variance and Tukey tests (p<0.05). The dual-cured adhesive system presented a higher immediate bond strength and durability than those that were light cured. The three-step adhesive system produced the highest values, whereas the acetone-based adhesive system produced the lowest result. Therefore, the use of dual-cured etch-and-rinse adhesive systems can induce increased bond durability to direct coronal dentin restorations.

Efficacy of a novel at-home bleaching technique with carbamide peroxides modified by CPP-ACP and its effect on the microhardness of bleached enamel.

This study was designed to evaluate in vitro the efficacy of a novel at-home bleaching technique using 10% or 16% carbamide peroxide modified by casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and its influence on the microhardness of bleached enamel. A total of 40 bovine incisors were divided into four groups (n=10) according to the bleaching agent used: 10% carbamide peroxide only; a blend of 10% carbamide peroxide and a CPP-ACP paste; 16% carbamide peroxide only; and a blend of 16% carbamide peroxide and a CPP-ACP paste. During the 14-day bleaching regimen, the samples were stored in artificial saliva. The Vickers microhardness and color of the teeth were assessed at baseline (T0) and immediately after the bleaching regimen (T14) using a microhardness tester and a spectrophotometer, respectively. The degree of color change was determined by the Commission Internationale de l'Eclariage (CIE) L*a*b* system (ΔE, ΔL*, Δa*, and Δb*) and Vita shade guide parameters. The data were analyzed by analysis of variance and the Tukey test (p<0.05). The teeth that were bleached with a blend of peroxide (10% or 16%) and the CPP-ACP paste presented increased microhardness values at T14 compared with T0, whereas the samples that were bleached with peroxide only did not show any differences in their microhardness values. All of the bleaching agents were effective at whitening the teeth and did not show a statistically significant difference using the CIEL*a*b* system (ΔE, ΔL*, Δa*, and Δb*) or the Vita shade guide parameters. The use of a CPP-ACP paste with carbamide peroxide bleaching agents increased the bleached enamel's microhardness and did not have an influence on whitening efficacy.

Biomechanical behaviour of a fractured maxillary incisor restored with direct composite resin only or with different post systems.

AIM: To compare stress distribution between a fractured maxillary central incisor restored with direct composite resin only (CR) or associated with different post materials, using finite element analysis. METHODOLOGY: A three-dimensional model of a sound maxillary central incisor and supporting structures was constructed, using data from the dental literature. Changes were made in the crown region to create a tooth with a restored crown fracture. A composite resin restoration only and restorations associated with different tapered post systems (glass fibre, carbon fibre, titanium and zirconia ceramic) were also evaluated, resulting in six experimental models. A static chewing pressure of 2.16Nmm(-2) was applied to two areas of the palatal surface of the tooth. Stress distribution was analysed under a general condition and in the structures of the models separately. RESULTS: The maximum stresses were concentrated as follows: at the cemento-enamel junction in the model with a sound maxillary central incisor, restored with CR and with a composite resin restoration associated with fibre posts; in the enamel at the post-enamel interface on the palatal surface of the model with a titanium post; and in the post of the model with zirconia ceramic post. CONCLUSIONS: None of the restorations evaluated was able to recover the stress distribution of the sound tooth. The models restored with composite resin associated with a glass or carbon fibre post had similar stress distributions to that of the model restored with CR. The different post materials were shown to have a substantial influence on stress distribution, with less stress concentration when fibre posts were used.

Influence of post and resin cement on stress distribution of maxillary central incisors restored with direct resin composite.

The current study evaluated the influence of two endodontic post systems and the elastic modulus and film thickness of resin cement on stress distribution in a maxillary central incisor (MCI) restored with direct resin composite using finite element analysis (FEA). A three-dimensional model of an MCI with a coronary fracture and supporting structures was performed. A static chewing pressure of 2.16 N/mm2 was applied to two areas on the palatal surface of the composite restoration. Zirconia ceramic (ZC) and glass fiber (GF) posts were considered. The stress distribution was analyzed in the post, dentin and cement layer when ZC and GF posts were fixed to the root canals using resin cements of different elastic moduli (7.0 and 18.6 GPa) and different layer thicknesses (70 and 200 microm). The different post materials presented a significant influence on stress distribution with lesser stress concentration when using the GF post. The higher elastic modulus cement created higher stress levels within itself. The cement thicknesses did not present significant changes.

Effect of light reduction on the incidence of retinopathy of prematurity.

The effect of ocular protection on the incidence of retinopathy of prematurity was tested in 188 newborns weighing less than 1600 g in a randomised controlled trial. No effect of ambient light reduction on the incidence of retinopathy of prematurity was shown.

[Prevalence of serologic markers of hepatitis B virus in hospital personnel]. / Prevalência de marcadores sorológicos do vírus da hepatite B em trabalhadores do serviço hospitalar.

OBJECTIVE: To verify the prevalence of the anti-HBc, anti-HBs and HBsAg markers of hepatitis B virus, and to identify the risk factors determining occupational infection with this virus among hospital personnel. METHODS: Samples of serum from 210 persons both male and female who work in different occupations at a hospital university, were analysed. The technique employed was the immunoenzymatic assay using commercial kits. RESULTS: As a control group, samples of serum from 45 volunteer blood donors were utilized. It was verified that 20.5% of the hospital personnel presented a positive reaction to at least one of the markers songht, as against 6.6% of the control group. The prevalence of each marker separately was: anti-HBc 8.1%, anti-HBs 5.2%, and HBsAg 2.9% in the hospital personnel; and 4.4%, 2.2% and 0.0% in the control group. The simultaneous presence of the anti-HBc and anti-HBs markers was detected in 4.3% of the workers. In the control group, the presence of the anti-HBc and anti-HBs markers was detected, isolately, with respective prevalences of 4.4% and 2.2%. Those who presented the highest rates of positivite reaction were: laboratory technicians 24.0%, nurses 23.6%, physicians 20.8%, and cleaning personnel 18.2%. CONCLUSIONS: The findings suggest that direct contact with patients and handling of blood and other body fluids are risk factors related to occupational infection with HBV. Therefore, it is recommended that hospital personnel be vaccinated against hepatitis B.

Sonographic organometry in Brazilian and Sudanese patients with hepatosplenic schistosomiasis mansoni and its relation to the risk of bleeding from oesophageal varices.

Fifty-nine patients with hepatosplenic schistosomiasis mansoni were investigated by sonography in Northeast Brazil and Central Sudan. The sizes of the organs usually involved in this disease were quantitatively assessed according to a standardized protocol, and measurements were adjusted to the body height of the individual. The results were compared with those of healthy controls matched by sex, age, geographical origin and socio-economic status. Considerable differences were found between patients and controls as well as between residents from the two areas. The liver of both patients and controls from the Sudan was significantly smaller than that of patients and controls from Brazil. Only in Brazil, but not in the Sudan, was the left liver lobe larger in patients than in the controls. The diameter of the portal and the splenic vein, the spleen size and the thickness of the gallbladder wall were significantly increased in patients from both areas. The increase of the portal and splenic vein diameter was significantly correlated with the degree of hepatic periportal fibrosis and the frequency of bleeding from endoscopically proven oesophageal varices in the patients, irrespective of their geographic origin. In contrast, such correlations were not found for the degree of splenomegaly nor for the degree of gallbladder-wall thickening. It is concluded that standardized sonographic organometry permits the assessment of morbidity in hepatosplenic schistosomiasis mansoni under different endemic conditions. Especially the measurement of the portal vein diameter may allow estimation of the risk of gastrointestinal haemorrhage in these patients.

Resistance to Trypanosoma cruzi infection in relation to the timing of IgG humoral response.

The Biozzi "high" (BH) and "low" (BL) responder mice (Selection III) differed in their susceptibility to Trypanosoma cruzi. The BH strain responded quickly to the infection, similar to the reaction of (CBA X C57B1/10)F1 mice but in contrast to the susceptible BL strain. We suggest that the IgG response mounted by the host during the prepatent period of the infection is crucial to the outcome of the infection.