Ethanol-wet bonding technique: 18-month clinical evaluation / Técnica de adhesión húmeda en etanol: evaluación clínica a los 18 meses

The objective of this randomized clinical trial was to evaluate the clinical performance up to 18 months of restorations placed using ethanol-wet bonding technique (EWBT) compared with the three-step etch-and-rinse (TSER) and one-step self-etching (OSSE) approaches. Ninety-three non-carious cervical lesions (31 for each group) were restored by one experienced operator in 17 patients under relatively dry conditions using gingival retraction cord, cotton rolls and saliva ejector. Each adhesive system was randomly allocated to one of randomized cervical lesions until the three groups were present in the same subject in equal amounts. The restorations were evaluated at baseline, 6, 12 and 18 months by two blinded and calibrated examiners using the modified US Public Health Service guidelines (USPHS) for the following outcomes: retention (kappa= 1.00), staining and marginal adaptation (kappa=0.81) and analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups after 18 months for any of the assessed criteria (p>0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the time intervals baseline/18 months in marginal adaptation (p= 0.0117) and retention (p= 0.0101) for OSSE and in marginal staining for TSER (0.0051) and EWBT (p= 0.0277) groups. The survival analysis for retention criteria and the overall clinical success were performed using a log-rank test and did not show significant differences among groups (p> 0.05). All three adhesives protocols presented similar clinical performance up to 18 months.

El propósito de este ensayo clínico aleatorizado fue evaluar, durante 18 meses, el éxito clínico de las restauraciones realizadas por la técnica de adhesión húmeda en etanol (TAHE) en comparación con las técnicas de grabado independiente de tres pasos (GTP) y de autograbado de un paso (AUP). Un solo operador, especializado en odontología restaurativa, realizó sobre 17 pacientes 93 restauraciones en lesiones cervicales no cariosas (31 para cada grupo). Los diferentes protocolos adhesivos se distribuyeron aleatoriamente en las lesiones cervicales hasta que los tres grupos estuviesen presentes en el mismo paciente y en cantidades iguales. Las restauraciones fueron evaluadas a los 6, 12 y 18 meses, por dos examinadores calibrados y que no participaron del procedimiento restaurador. Las directrices modificadas del Servicio de Salud Pública de Estados Unidos (SSPEU) fueron la base para las evaluaciones de las siguientes variables: retención (kappa= 1,00), adaptación y decoloración marginal (kappa= 0,81). Estas variables fueron analizadas mediante la prueba exacta de Fisher y Kruskal-Wallis, respectivamente. No se observó diferencia significativa entre los grupos después de 18 meses en las tres variables evaluadas (p >0,05). El análisis intra-grupo hecho por la prueba de Cochran (para la retención) y la prueba de Wilcoxon (para la adaptación y decoloración marginal) revelaron diferencias significativas entre los intervalos de tiempo de la línea de base / 18 meses para la retención (p= 0,0101) y adaptación marginal en el grupo AUP (p= 0,0117), y para la decoloración marginal en los grupos GTP (p= 0,0051) e TAHE (p= 0,0277). El análisis de supervivencia para la retención, así como la comparación del éxito clínico de los protocolos adhesivos, fueron realizados con la prueba de log-rank, y no hubo diferencias significativas (p >0,05) entre los grupos. No hubo diferencia en el éxito clínico de los tres protocolos adhesivos después de 18 meses.

Conditions for oral health in patients with autism / Condiciones de salud oral en pacientes con autismo

Autism is characterized as a behavioral disorder. The autistic patient has some difficulties with common life routines, such as oral hygiene and also improper diet. As a consequence the refusal of physical contact, the implementation of brushing and flossing by caregivers is difficult. The present study aimed to conduct an epidemiological study of autistic patients in treatment at the Rehabilitation Center and Neurological Organization in North of Brazil, adopting the CPO-D and ceo-d. The clinical examination has been performed with the patient sitting in chairs, at the Rehabilitation Centre itself, under artificial fluorescent light intended for room lighting. From 26 patients included in the study, 76.9 % of subjects were male with a mean age of 13 years. Fifty percent had caries, and 11.5% had lesions on the gums. The mean ceo-d of children 2­8 years was 0.67. In patients 10­15 years and 20­40 years, the mean CPO-D was 0.70, and 3.00, respectively. From the study, the most significant data, seen was that half of autistic patients had carious lesions. It is vital to improve oral health conditions in these patients and by using preventive dentistry, analyze their susceptibility to oral diseases.

El autismo se caracteriza como un trastorno conductual. El paciente autista tiene algunas dificultades en las rutinas ordinarias de la vida, tales como la higiene oral. Como consecuencia, la negativa al contacto físico, la implementación del cepillado y uso de hilo dental es difícil para los cuidadores. Este estudio tuvo como objetivo llevar a cabo un estudio epidemiológico de los pacientes autistas en el Centro de Rehabilitación y la organización neurológica en el norte de Brasil, adoptando el CPOD y ceod. El examen clínico se realizó con el paciente sentado en una silla en el propio Centro de Rehabilitación, bajo una luz fluorescente artificial para la iluminación de la habitación. Veintiseis pacientes fueron incluidos en el estudio, el 76,9 % de los sujetos eran varones con una edad media de 13 años con un 50 % de caries, y en un 11,5 % se observaron lesiones gingivales. La media ceod de los niños de 2 a 8 años fue de 0,67. En los pacientes de 10­15 años y 20­40 años, el promedio CPOD fue de 0,70 y 3,00, respectivamente. A partir del estudio se pudo determinar que la mitad de los pacientes autistas tienen caries. Es importante la educación de estos pacientes para mejorar la salud oral y la aplicación de la odontología preventiva.

Manifestaciones orales en pacientes reumatológicos: una revisión de los conocimientos / Oral manifestations of rheumatologic patients: a knowledge review

La cavidad oral a través de sus estructuras, dientes y mucosas, desempeñan diversas funciones orgánicas. Actúan en el proceso masticatorio, en la percepción de los sabores, además de servir de vía respiratoria. La relación entre alteraciones sistémicas y manifestaciones orales está bien relatada en la literatura. Observándose en numerosos estudios, palabras claves de morbilidades primariamente bucales, seguidas del diagnóstico de trastornos sistémicos. Las enfermedades reumáticas pueden manifestarse con alteraciones de la condición bucal, además de las presentaciones clínicas peculiares a cada morbilidad. Para la realización de este trabajo fueron investigados en la literatura estudios que evidencien la presencia de manifestaciones orales en enfermedades reumáticas a través de la búsqueda en las bases de datos Lilacs, PubMed y Bireme, incluidos en el año 2009-2015. Las evidencias existentes en la literatura nos revelan la importancia de la inclusión de la evaluación clínica de la boca y sus estructuras anexas, como elemento importante en el diagnóstico auxiliar y orientación para el manejo adecuado de las quejas de estos pacientes.

The oral cavity has several physiological functions through their structures. Such structures act in the chewing process, the perception of flavors, besides serving airway. The relationship between systemic diseases and oral manifestations is well reported in the literature. It is observed in numerous studies, morbidity descriptions primarily mouth followed by a diagnosis of systemic disorders. Rheumatic diseases exemplify that these can manifest with changes in oral health in addition to the peculiar clinical presentations to each morbidity. For this work we investigated in the literature studies that provided evidence of the presence of oral manifestations in rheumatic diseases by searching Lilacs, PubMed and Bireme databases, included in the year 2009­2015. The available evidence in the literature, reveal the importance of including clinical evaluation of the mouth and its associated structures as an important element for the diagnosis and guidance for the proper handling of complaints of these patients.

One-year evaluation of a simplified ethanol-wet bonding technique: a randomized clinical trial.

The objective of this randomized clinical trial was to evaluate the clinical performance of adhesive restorations using a three-step etch-and-rinse adhesive (TSER), a one-step self-etching adhesive (OSSE), and a simplified ethanol-wet bonding technique (EWBT) prior to the application of a composite resin in non-carious cervical lesions. Ninety-three restorations (31 for each group) were placed in 17 patients by a single operator. No cavity preparation was performed. After 6 and 12 months, the restorations were assessed by two previously trained examiners using modified Ryge criteria for retention (kappa=1.00) and marginal adaptation/staining (kappa=0.81), and the results were analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups at the 6- and 12-month time points for any of the assessed criteria (p≥0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the baseline/12-month time intervals in marginal adaptation in OSSE (p=0.0180) and in marginal staining in TSER (p=0.0117). The survival analysis for retention criteria performed using a log-rank test did not show significant differences (p>0.05). The restorations placed using the simplified EWBT performed equally well as the other adhesive strategies employed.

A clinical report of Type III dens invaginatus: relevant aspects of a combined therapeutic approach.

Dens invaginatus is a developmental abnormality that alters dental morphology; as a result, treating this condition is a challenge for endodontic practices. This article describes how a combination of nonsurgical and surgical therapies was utilized to treat a maxillary central incisor with Type III dens invaginatus and vital pulp. The treatment plan included using computed tomography (CT) for a detailed analysis of the dental anatomy and periapical area, endodontic and surgical procedures, and a 4-year follow-up period that included periodic clinical and radiographic examinations. The follow-up examinations revealed a regression of the apical lesion and no other signs or symptoms. Based on the present case report, the authors concluded that this combination of surgical and nonsurgical approaches was effective and that CT is a valuable auxiliary tool for the study of dental anatomy.

Adhesive systems: important aspects related to their composition and clinical use.

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Adhesive systems: important aspects related to their composition and clinical use

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Desgaste dos instrumentos K3 e Protaper após simulação de uso clinico em canais curvos / Wear of K3 and ProTaper files after simulated clinical use in curved canals

Objetivo: Avaliar o desgaste, após simulação de uso clínico, de instrumentos K3 (SybronEndo, Orange, CA, EUA) e ProTaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA) em 46 raízes mesiovestibulares de primeiros molares superiores humanos, recém-extraídos e com angulação média de 40º. Métodos: Os dentes foram divididos em: a) K3 (SybronEndo, Orange, CA, EUA) (com bandas radiais) e b) ProTaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA) (sem bandas radiais). Os instrumentos foram avaliados em microscopia eletrônica de varredura antes do primeiro uso, para visualização de defeitos de fabricação, após 7 e 13 ciclos de instrumentação nos canais. A instrumentação foi realizada de acordo com as recomendações do fabricante, sendo K3 (SybronEndo, Orange, CA, EUA) e Protaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA). Os critérios para avaliação de desgaste foram: defeitos (estiramento, encurtamento/ inversão das espiras, presença de crateras), trincas oblíquas e fratura. Após a avaliação em microscopia eletrônica de varredura antes do uso, foram constatadas em todos os instrumentos, farpas metálicas na crista das espiras e ranhuras oblíquas provenientes do processo de usinagem. Resultados: Após sete usos, no sistema K3 (SybronEndo, Orange, CA, EUA), todos os instrumentos apresentaram defeitos nos ângulos de corte e, 25/08 e 25/10 apresentaram trincas oblíquas no corpo da parte ativa levando à fratura dúctil desta última após o oitavo uso. No sistema ProTaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA), em sete usos, além de defeitos nos ângulos de corte, os instrumentos também apresentaram trincas, e a fratura rúptil ocorreu em F3 no 13º uso. Ao final do preparo foram observadas crateras ao longo da parte ativa dos instrumentos. Conclusão: Na análise final, foi evidenciado que os sistemas se equivalem quanto aos defeitos encontrados, independentemente do desenho da parte ativa, sendo proporcionais à quantidade de ciclos de uso, e que estes defeitos podem funcionar como...

Objective: To assess wear, after simulated clinical use of K3 (SybronEndo, Orange, CA, EUA) and ProTaper files (Dentsply-Maillefer, Tulsa, Oklahoma, EUA) in 46 mesiovestibular roots of human maxillary first molars, recently extracted and with mean angulation of 40º. Methods: The teeth were divided as follows: a) K3 (SybronEndo, Orange, CA, EUA) (with radial bands) and b) ProTaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA) (without radial bands). The files were assessed by scanning electronic microscopy before first use to visualize fabrication defects, and after 7 and 13 cycles of debridement in the canals. Debridement with files K3 (SybronEndo, Orange, CA, EUA) and ProTaper (Dentsply-Maillefer, Tulsa, Oklahoma, EUA) was performed in accordance with the manufacturers' recommendations. The criteria for wear assessment were: defects (stretching, shortening/spiral inversion, presence of craters), oblique cracks and fracture. After assessment by SEM and before they were used, metal barbs on the crest of the spirals and oblique scratches due to the machining process were found in all the files. Results: In the K3 system (SybronEndo, Orange, CA, USA), after being used seven times, all the instruments showed cutting angle defects, and 25/08 and 25/10 had oblique cracks in the body of the active part leading to ductile fracture after being used for the eighth time. In the ProTaper system (Dentsply-Maillefer, Tulsa, Oklahoma, USA), after being used seven times, in addition to cutting angle defects, the files also presented cracks, and ruptile fracture occurred in F3 during use for the thirteenth time. At the end of preparation, craters were seen along the active part of the files. Conclusion: In the final analysis, it was seen that the system are equivalent with regard to the defects found, irrespective of the active part design, being proportional to the number of cycles of use, and these defects could act as points of greater fragility, favoring fracture.

Evaluation of pH levels and calcium ion release in various calcium hydroxide endodontic dressings.

OBJECTIVE: The purpose of this study was to evaluate Ca(2+) release and pH of 3 calcium hydroxide-based products used routinely as intracanal dressings, as well as the new gutta-percha points with calcium hydroxide. STUDY DESIGN: The pH and Ca(2+) release were assessed using Calen with camphorated paramonochlorophenol, saline calcium hydroxide paste, LC paste (Lopes and Costa paste-calcium hydroxide with olive oil), and calcium hydroxide containing gutta-percha points. The materials were inserted in polyethylene tubes and immersed in deionized water. The pH variation and Ca(2+) release were monitored periodically for 4 weeks. RESULTS: After 72 hours, materials 1 and 2 raise the pH from 9.6 and 8.2 to 11.4 and 11.3, respectively, while a small change was observed for materials 3 and 4. The calcium concentration released from materials 1, 2, 3, and 4 after 72 hours was 6.54, 4.98, 1.31, and 1.74 mg/dL, respectively. CONCLUSION: Calen plus camphorated paramonochlorophenol and saline calcium hydroxide paste exhibited the highest calcium release and pH levels.

Radiopacidade de cimentos endodônticos avaliada pelo sistema de radiografia digital / Digital radiographic assesment of endodontic cements radiopacity

Radiopacidade é uma das propriedades físicas requeridas para os cimentos endodônticos pela qual se avalia o preenchimento do sistema de canais radiculares. Rotineiramente utiliza-se o fotodensitômetro para a leitura de densidades em filmes radiográficos. A finalidade deste trabalho foi utilizar o sistema de imagem digital DIGORA, para determinar a radiopacidade de cinco cimentos endodônticos. Confeccionou-se 12 corpos de prova de 1,5 mm de espessura e 5 de diâmetro dos cimentos com e sem cones de guta-percha, e três fragmentos de dentina, que foram radiografados no sensor do Digora em 3 aparelhos de raios x: Dabi 50kV/4mAs, Siemens 60kV/3mAs e Dabi 70kV/2mAs, a uma distância de 40 cm. Após a leitura da placa de imagem no escaner a laser, o software do Digora 5.1 determinou a radiopacidade das áreas padronizadas fornecendo a média e o desvio-padräo da densidade radiográfica (níveis de cinza). Com os valores obtidos, a ordem dos cimentos do mais radiopaco para o memos foi: Vidrion, N-Rickert, Sealer 26, Endomethasone e Sealapex. Nos cimentos Sealer 26, Endomethasone e Sealapex a adiçäo de guta-percha aumentou a radiopacidade (em torno de 12 por cento), enquanto que nos outros dois houve a diminuiçäo (em torno de 4 por cento). A densidade radiográfica com 50 kV foi mais alta que com 60 e 70 kV devido a menor discriminaçäo dos níveis de cinza nesta quilovoltagem