High-viscosity glass-ionomer cement or composite resin for restorations in posterior permanent teeth? A systematic review and meta-analyses.

OBJECTIVES: Answer the PICO question: Do class I and II posterior restorations in permanent teeth placed with high-viscosity glass-ionomer cement (HV-GIC) fail more than composite resin (CR) restorations? DATA: The study was registered in the PROSPERO database (CRD42020138290). Randomized and controlled clinical trials, comparing the performance of HV-GIC and CR in load bearing cavities of posterior permanent teeth were included. Cochrane risk of bias tool and GRADE were used to assess the quality and certainty of the evidence. Meta-analyses were performed for clinical outcomes on USPHS and FDI criteria for 12-, 24- and 36-months follow-ups. SOURCES: PubMed, Scopus and Web of Science were last searched on April 2, 2022, without language or date restrictions. Reference lists of primary studies and their related article link in PubMed were manually searched. STUDY SELECTION: Ten studies were included, while data from 8 were used for the meta-analyses. A total of 849 HV-GIC and 800 CR restorations were followed. The primary outcome was the fracture/retention of the restoration, with a comparable performance for both materials on all follow-ups. The 36 months follow-up for class I restorations (longest) showed risk difference of -0,00 (95%CI -0,03 to 0,03; p = 0,98) and no heterogeneity (p = 0,98, I2=0%). The certainty of the evidence is moderate, as all included studies were at an uncertain risk of bias. CONCLUSIONS: HV-GIC and CR presented comparable clinical performance in posterior permanent teeth up to 36 months. HV-GIV wear in class I restorations followed by 24 months was the only poorer result compared to CR. CLINICAL SIGNIFICANCE: Conservative load bearing cavities in permanent posterior teeth can be restored with HV-GIC with comparable clinical performance to CR expected at least up to 3 years. HV-GIC is a valuable direct restorative option for posterior teeth in high caries risk patients, in which CR is frequently associated with failure.

Produtividade dos estudantes de Odontologia na clínica integrada em duas universidades do Sul do Brasil / Productividad de los estudiantes de Odontología en la clínica integrada en dos universidades del sur de Brasil / Productivity of dental students in integrated clinics attwo universities in Southern Brazil

Este estudo avaliou e comparou a produtividade clínica dos estudantes de Odontologia em duas instituições de ensino privadas, com diferentes tempos de experiência no modelo de clínica integrada, preconizado pelas Diretrizes Curriculares Nacionais (DCN). Asuniversidades utilizam o modelo de clínica integrada desde 2001 [A] e 2009 [B], com cursos de graduação de 5 anos e 4 anos, respectivamente. O estudo foi realizado no período de fevereiro a dezembro de 2019. Foram incluídos dados relativos a 205 estudantes (56 da universidade [A] e 149 da [B]) matriculados nas clínicas de baixa/média (n=99) e alta complexidades (n=106). Avaliou-se a quantidade de procedimentos realizados por nível de complexidade nas duas instituições. Os dados foram submetidos aos testes de Mann-Whitney e qui-quadrado (α=0,05). O número de procedimentos analisados foi de 9706, sendo 4693 na instituição [A] e 5013 na [B]. Nas duas instituições a quantidade de procedimentos curativos (54,8%) foi significativamente maior que a de procedimentos de diagnóstico e atenção à saúde (45,2%) (p<0,001). Nas clínicas de baixa/média complexidade foram observadas diferenças estatísticas na quantidade de procedimentos e/ou na quantidade de estudantes que não realizaram determinados procedimentos clínicos. Nas clínicas de alta complexidade foram observadas diferenças estatísticas entre as instituições na quantidade de procedimentos e/ou na quantidade de alunos que não realizaram determinados procedimentos específicos de Dentística, Cirurgia, Periodontia e Prótese. A instituição com maior tempo de experiência no modelo de clínica integrada apresentou melhores resultados nas especialidades de Dentística, Endodontia e Prótese (AU).

Este estudio evaluó y comparó la productividad clínica de estudiantes de odontología de dos instituciones de enseñanza privadas, con diferentes tiempos de experiencia en el modelo clínico integrado, recomendado por las Directrices Curriculares Nacionales (DCN). Las universidades han utilizado el modelo clínico integrado desde 2001 [A] y 2009 [B], con carreras de grado de 5 y 4 años, respectivamente. El estudio se realizó de febrero a diciembre de 2019. Se incluyeron datos de 205 estudiantes (56 de la universidad [A] y 149 de la [B]) matriculados en clínicas de baja/media (n=99) y alta complejidad (n=99) n=106). Se evaluó el número de procedimientos realizados por nivel de complejidad en ambas instituciones. Los datos fueron sometidos a las pruebas de Mann-Whitney y chi-cuadrado (α=0,05). Elnúmero de procedimientos analizados fue de 9706, 4693 en la institución [A] y 5013 en la [B]. En ambas instituciones, el número de procedimientos curativos (54,8%) fue significativamente superior al de procedimientos diagnósticos y asistenciales (45,2%) (p<0,001). En las clínicas de baja/media complejidad se observaron diferencias estadísticas en el número de procedimientos y/o en el número de alumnos que no se sometieron a determinados procedimientos clínicos. En las clínicas de alta complejidad se observaron diferencias estadísticas entre las instituciones en cuanto al número de procedimientos y/o el número de alumnos que no se sometieron a determinados procedimientos en Odontología, Cirugía, Periodoncia y Prótesis. La institución con mayor experiencia enel modelo de clínica integrada presentó mejores resultados en las especialidades de Odontología, Endodoncia y Prótesis (AU).

This study assessed and compared the clinical productivity of dental students in two private teaching institutions, with different lengths of experience in the integrated clinical model, recommended by the National Curriculum Guidelines (DCN). The universities have used the integrated clinical model since 2001 [A] and 2009 [B], with 5-year and 4-year undergraduate courses, respectively. The study was carried out from February to December 2019. Data were included for 205 students (56 from [A] and 149 from [B]) enrolled in low/medium (n=99) and high complexity clinics (n=106). The number of procedures performed by level of complexity in both institutions was assessed. Data were submitted to Mann-Whitney and chi-square tests (α=0.05). The number of procedures analyzed was 9706, 4693 in institution [A] and 5013 in [B]. In both institutions, the number of curative procedures (54.8%) was significantly higher than that of diagnostic and health care procedures (45.2%)(p<0.001). In low/medium complexity clinics, statistical differences were observed in the number of procedures and/or in the number of students who did not perform certain clinical procedures. In high-complexity clinics, statistical differences were observed between the institutions in terms of the number of procedures and/or the number of students who did not perform certain specific procedures in restorative dentistry, surgery, periodontics and prostheses. The institution with the longer experience in the integrated clinic model presented better results in the specialties of restorative dentistry, endodontics and prosthesis (AU).

Effect of processing methods on the chipping resistance of veneered zirconia.

OBJECTIVES: To evaluate the edge chipping resistance (ReA) and the fracture toughness (KC) of 3Y-TZP bilayers produced with the following materials/processing combinations: fluorapatite glass-ceramic applied on zirconia using the traditional layering and hot-pressing (press-on) techniques; feldspathic porcelain using rapid layer technology (RLT); and lithium disilicate glass-ceramic using CAD-on method. The influence of the cooling rate (slow and fast) was analyzed for layering and hot-pressing. METHODS: Bilayer bars (25x4x2 mm) were made following manufacturers' instructions. The edge chipping test was performed in an universal testing machine, using a coupled Vickers indenter. ReA was calculated dividing the critical load at fracture by the edge distance. Fracture toughness was calculated by a regression fit with a fixed slope of 1.5 correlating the critical chipping load regarding edge distance and also with indentation fracture (IF) method. Data were statistically analyzed using ANOVA and Tukey's test (α = 5%). RESULTS: ReA and KC was significantly higher for the CAD-on bilayers. RLT showed intermediate ReA means, and layering and hot-pressing techniques showed the lowest ReA values. For both processing methods there was no effect of the cooling protocol on the ReA and fracture toughness. CONCLUSIONS: There is a significant effect of the material/processing association on the edge chipping resistance and fracture toughness of the bilayers. There was no effect of the cooling protocol on the edge chipping resistance and fracture toughness for the specimens processed by both the layering and hot-pressing techniques.