The use of fiberglass posts in dentistry: a literature review / O uso de pinos de fibra de vidro na odontologia: uma revisão de literatura

The choice of retaining material that will replace the lost properties of the tooth, in which it is fragile and with loss of dentin structure, is important. The success of the treatment will depend on the qualities presented in it. Therefore, the objective of this work, through a literature review, is to present the advantages and disadvantages observed in the use of fiberglass post intraradicular retainer. This paper reviews the most relevant articles on the specificities presented in the fiberglass post retaining material, published in the period (2003 to 2020). The bibliographic search was performed in PubMed, Lilacs, Scielo, Google Scholar databases. In view of the selected articles on the subject, it is possible to observe the authors' acceptance of the application of the use of retainers, highlighting that in the treatment of cases with extensive coronary destruction, the aim is to have the functional and retentive capacity returned, in addition to the tension resistance. Therefore, theThe use of fiberglass posts in weakened teeth is effective as the material of choice. In cases that require reconstruction and return of tissue integrity, it has sufficient advantages for its selection. Despite the disadvantages it has, these do not outweigh the benefits to the point of making its use unfeasible. However, knowing when, where and how to treat is always important in any procedure for a satisfactory final outcome.

A escolha do material retentor que irá substituir as propriedades perdidas do dente, no qual este se apresenta de forma fragilizada e com perca de estrutura dentinária é importante. O sucesso do tratamento irá depender das qualidades apresentadas no mesmo. Sendo assim, o objetivo deste trabalho por meio de uma revisão de literatura é apresentar as vantagens e desvantagens observadas no uso do retentor intrarradicular de pino de fibra de vidro. Este trabalho revisa os artigos mais relevantes sobre as especificidades apresentadas no material retentor de pino de fibra de vidro, publicadas no período (2003 até 2020). A busca bibliográfica foi realizada nos bancos de dados PubMed, Lilacs, Scielo, Google Scholar. Diante dos artigos selecionados referentes ao tema, pode-se observar a aceitação dos autores sobre a aplicação do uso de retentores, destacando-se que no tratamento de casos com destruição coronária extensa o intuito é dispor da devolução da capacidade funcional, retentiva, além da resistência a tensão. Portanto, a utilização de pinos de fibra de vidro em dentes fragilizados apresenta efetividade como material de escolha. Em casos que necessitam de reconstrução e devolução de sua integridade tecidual, possui consigo vantagens suficientes para sua seleção. Apesar das desvantagens que possui, essas não se sobrepõem aos benefícios a ponto de tornarem inviáveis ao seu uso. Entretanto, saber quando, onde e como tratar é sempre importante em qualquer procedimento para um desfecho final satisfatório.

Effects of surrounding and underlying shades on the color adjustment potential of a single-shade composite used in a thin layer.

Objectives: This study aimed to evaluate the surrounding and underlying shades' effect on the color adjustment potential (CAP) of a single-shade composite used in a thin layer. Materials and Methods: Cylinder specimens (1.0 mm thick) were built with the Vittra APS Unique composite, surrounded (dual specimens) or not (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built only with the control composites. Each specimen's color was measured against white and black backgrounds or the simple control specimens with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) and translucency parameters (TP00) were calculated for simple specimens. Differences (ΔE00) in color between the simple/dual specimens and the controls were calculated. The CAP was calculated based on the ratios between data from simple and dual specimens. Results: The Vittra APS Unique composite showed higher WID and TP00 values than the controls. The highest values of ΔE00 were observed among simple specimens. The color measurements of Vittra APS Unique (simple or dual) against the control specimens presented the lowest color differences. Only surrounding the single-shade composite with a shaded composite barely impacted the ΔE00. The highest CAP values were obtained using a shaded composite under simple or dual specimens. Conclusions: The CAP of Vittra APS Unique was strongly affected by the underlying shade, while surrounding this composite with a shaded one barely affected its color adjustment.

Background and surrounding colors affect the color blending of a single-shade composite

Abstract This study evaluated the background and effect of surrounding colors on the color blending of a single-shade composite used in a thin layer. Disc-shaped specimens (1.0 mm thickness) were built with the Vittra APS Unique composite surrounded (dual specimens) or not surrounded (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built with only control composites. The specimen color was measured against white and black backgrounds with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) was calculated for simple specimens. Differences (ΔE00) in color and translucency parameters (ΔTP00) between the simple/dual specimens and the controls were calculated. The translucency adjustment potential (TAP) and color adjustment potential (CAP) were estimated based on the ratios between data from simple and dual specimens. The Vittra APS Unique composite showed higher WID values than the controls. No differences between ΔTP00_SIMPLE and ΔTP00_DUAL were observed for any of the shades. The composite shade did not affect TAP values. The lowest values of ΔE00_SIMPLE and ΔE00_DUAL were observed for shade A1 regardless of the background color. For the white background, ΔE00_SIMPLE values did not differ from those of ΔE00_DUAL for all shades. Only A1 showed ΔE00_DUAL values lower than ΔE00_SIMPLE when the black background was used. The highest modulus of CAP (negative values for the white background) was observed when shade A1 surrounded the Vittra APS Unique composite. The color blending ability of the single-shade resin composite used in a thin layer was affected by both the surrounding shade and background color.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

A clinical evaluation of zirconia reinforced lithium silicate glass-ceramic CAD/CAM onlay: a two-year case report / Avaliação clínica de onlay cerâmica do tipo CAD / CAM de silicato de lítio reforçado com zircônia: um relato de caso de dois anos

ABSTRACT The CAD/CAM technology arose from the need to develop materials with better mechanical and optical properties that could be used for making monolithic restorations. Several materials have been used for milling indirect restorations in prefabricated blocks. Among them, lithium silicate reinforced with zirconia. Due to its recent introduction in the market, this case report aimed to present a detailed clinical protocol for the execution of a ceramic onlay of this material using CAD/CAM technology. A 57-year-old female patient sought care with extensive restoration in composite resin (BOMD) of tooth 15 maintained for almost two years. However, due to bruxism, constant dental tightening, the extension of the direct restoration and the need for improved esthetics, it was proposed to replace it with an indirect ceramic onlay restoration. Prophylaxis and choice of the color of the patient's dental substrate were performed. Afterwards, the dental preparation was made and polished. Subsequently, the molding was made with addition silicone and the provisional restoration confectioned. Once the stone model was obtained, it was scanned and the ceramic onlay restoration was milled using CAD/CAM technology. Finally, the restoration was stained and cemented over the preparation. After 2 years, the restoration remained stable, with no evidence of color mismatch, marginal discoloration, marginal cleft, caries or fracture, proving the effectiveness of the treatment in this time interval. The correct indication of the ceramic material combined with the use of CAD/CAM technology facilitated the restorative process, restoring function and the esthetics desired by the patient.

RESUMO A tecnologia CAD/CAM surgiu da necessidade de desenvolvimento de materiais com melhores propriedades mecânicas e ópticas que pudessem ser utilizados para confecção de restaurações monolíticas. Diversos materiais têm sido utilizados para fresagem de restaurações indiretas em blocos pré-fabricados. Dentre eles, o silicato de lítio reforçado com zircônia. Devido a sua recente introdução no mercado, este relato de caso objetivou apresentar um protocolo clínico detalhado para a execução de uma onlay cerâmica desse material utilizando a tecnologia CAD/CAM. Paciente, 57 anos, sexo feminino, procurou atendimento com extensa restauração em resina composta envolvendo as faces (MODV) do dente 15 mantida por quase dois anos. Contudo, em virtude do bruxismo, do apertamento dental constante, da extensão da restauração direta e da necessidade de melhora na estética, foi proposto a substituição por uma restauração indireta em cerâmica do tipo onlay. Foi realizada a profilaxia e escolha da cor do substrato dental da paciente. Em seguida o preparo dental foi confeccionado e polido. Posteriormente foi feita a moldagem com silicone de adição e a confecção do provisório. Com a obtenção do modelo, este foi escaneado e fresada a onlay cerâmica pela tecnologia CAD/CAM, que posteriormente foi maquiada e cimentada sobre o preparo. Após 2 anos, a restauração permaneceu estável, sem evidência de incompatibilidade de cor, descoloração marginal, fenda marginal, cárie ou fratura, comprovando a eficácia do tratamento neste intervalo de tempo. A correta indicação do material cerâmico aliada ao uso da tecnologia CAD-CAM facilitou o processo restaurador devolvendo função e a estética desejada pela paciente.

Short-term effect of adhesive system on clinical performance of bulk fill composite: randomized clinical trial

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p<0.05). Considering the same restorative technique, the use of the self-etching adhesive system showed a significant decrease in color and translucency (p<0.05). Conclusion: All groups showed favorable clinical performance, and promising results were found for the conventional adhesive system and high viscosity bulk fill protocol

Factors associated with decision-making for replacing the temporary coronal restoration after endodontic treatment

Aim: This study aimed to evaluate the decision-making by patients to replace temporary restorations with permanent restorations after endodontic treatment and to verify the associated factors and evaluate the quality/integrity of the temporary restorative material within one month. Methods: This is a cross-sectional study using non-probabilistic sampling which analyzed patients after one month of endodontic treatment. The self-administered questionnaire contained sociodemographic, treatment decision-making and endodontic treatment questions. The restoration present in the mouth was evaluated in the clinical oral examination. The Poisson Regression test was used to verify the prevalence ratio. Results: The prevalence failure to perform permanent restorations was 61.1% of patients, and 42.7% reported not having adhered. The reasons are lack of time and not knowing the importance of replacing the restoration with a definitive one. The glass ionomer temporary restorative frequency was higher among those who chose not to replace the temporary restoration with a permanent one (PR=5.19; 95%CI 2.10-12.33). In addition, there was an association between the quality of the restorative material and the type of material, and the best clinical quality of the restoration was statistically associated with glass ionomer and composite resin. Conclusions: The findings show the importance of guidance by the dental surgeon in helping patients decide to replace their temporary restoration

Clinical performance of resin composite restorations placed by dental students: a retrospective, cross-sectional, and observational study

Aim: A retrospective, cross-sectional study was carried out to evaluate the performance of resin composite restorations placed by undergraduate dental students with 1 to 15 years of placement based on dental records. Methods: Four calibrated operators evaluated 498 restorations (anterior and posterior) of 120 patients according to Ryge's validated criteria (USPHS). Results: The criteria that showed the smallest changes between the types of failures were color matching, marginal discoloration and surface texture. Regarding the longevity, the surface texture showed an increase in the frequency of failures from the second time interval (3.1 to 6 years). Higher prevalence of failure was found in class II and III restorations, with secondary caries being the main reason. No significant differences were found for anatomic form, marginal adaptation, and color matching. Class V restorations showed a higher fracture rate with total displacement of the restoration, with no increase in the frequency of fracture over time. Conclusion: High rate of restoration failure was observed, possibly due to the lack of experience and skills of the students. This outcome highlight the need for continuous revision and improvements of teaching practice regarding the development of clinical competences and skills by dental students

Análise da aplicação ativa de sistemas adesivos na resistência de união à dentina e ao esmalte: uma revisão sistemática e meta-análise de estudos in vitro / Effect of active application of dental adhesives on dentin and enamel bond strength: a systematic review and meta-analysis of in vitro studies

A forma de aplicação do sistema adesivo pode interferir na resistência de união imediata e a longo prazo dos diferentes sistemas adesivos. Portanto, o objetivo deste estudo foi de revisar sistematicamente a literatura identificando trabalhos in vitro que avaliaram a resistência de união de sistemas adesivos, independente da sua classificação, aplicados de forma ativa comparado a aplicação de forma passiva, tanto para esmalte quanto para dentina. A busca foi realizada nas plataformas Pubmed/Medline, Embase, Scopus, Web of Science, Lilacs e literatura cinzenta, em abril de 2022. Estudos in vitro que avaliaram a resistência de união de sistemas adesivos aplicados de forma ativa comparado com a forma passiva foram incluídos neste estudo. As meta-análises foram separadas por substrato (esmalte e dentina) e por modo de aplicação (modo convencional ou modo autocondicionante), utilizado um intervalo de confiança de 95%, um modelo de efeito randômico, e a heterogeneidade determinada pelo índice I2. O risco de viés foi acessado por uma versão modificada de "Joanna Briggs Institute". Dos 3022 artigos encontrados, foram incluídos 22 artigos após a remoção das duplicatas, seleção por título e leitura completa dos artigos selecionados. A meta-análise da aplicação de adesivos universais em esmalte após condicionamento ácido (aplicado no modo convencional) demonstrou que a aplicação passiva favorece os resultados de resistência de união. Já para os adesivos convencionais ou universais aplicados no modo convencional, quando aplicados de forma ativa na dentina favorecem os resultados de resistência de união. Para os adesivos autocondicionantes ou universais aplicados no modo autocondicionante, a aplicação ativa, tanto em esmalte quanto em dentina, favorece os resultados de resistência de união. Poucos estudos avaliaram a longevidade, mas os que avaliaram também observaram respostas favoráveis à aplicação ativa do adesivo. Apenas um adesivo universal autopolimerizável apresentou resultados expressivamente divergente. Uma substancial (I2 = 65%) e considerável (I2 = 87%) heterigeinidade fora obtidas nas meta-análises dos adesivos aplicados no modo autocondicionante, respectivamente, em esmalte e em dentina. A aplicação ativa dos sistemas adesivos fotopolimerizáveis no modo convencional favorece a resistência de união à dentina, e no modo autocondicionante favorece a resistência de união ao esmalte não condicionado e à dentina.

The way the adhesive system is applied can interfere with the immediate and long- term bond strength of different dental adhesives. Therefore, the aim of this study was to systematically review the literature, identifying in vitro studies that evaluated the bond strength of adhesives, regardless of their classification, applied actively compared to the passive application, in enamel and dentin. The search was done in Pubmed/Medline, Embase, Scopus, Web of Science, Lilacs, and Gray platforms in April 2022. In vitro studies that evaluated the bond strength of adhesive systems applied actively compared to the passive form were included in this study. Meta- analyses were separated by substrate (enamel and dentin) and application mode (conventional or self-etching), using a 95% confidence interval, a random effect model, and heterogeneity determined by the I2 index. The risk of bias was assessed by a modified version of the "Joanna Briggs Institute". From the 3022 articles found, 22 articles were included after removing the duplicates, selecting by title, and fully reading the selected articles. Meta-analysis of the application of universal adhesives to enamel after acid etching (applied in the etch-and-rinse mode) demonstrated that passive application favors bond strength results. For conventional or universal adhesives applied in etch-and-rinse mode, when actively applied to dentin, they favor bond strength results. For self-etching or universal adhesives applied in self-etching mode, active application, both on enamel and dentin, favors bond strength results. Few studies have evaluated longevity, but those that have evaluated have also observed favorable responses to active application of the adhesives. Only one self-curing universal adhesive showed significantly divergent results. Substantial (I2 = 65%) and considerable (I2 = 87%) heterogeneity were obtained for the meta-analyses of adhesives applied in the self-etching mode, respectively, to enamel and dentin. The active application of light-curing adhesive systems in etch-and-rinse mode favors bond strength to dentin, and in self-etching mode it favors bond strength to unconditioned enamel and dentin.

Evaluation of Microleakage at the Junction Between Combined Amalgam/Composite Resin Restorations Using Different Bonding Systems in Class II Cavities

Abstract Objective: To evaluate the microleakage at the junction between amalgam-composite resin restorations using different bonding systems. Material and Methods: In this in-vitro study, standard class II cavities were prepared on 40 human maxillary premolars. The axial and gingival floor depths of the cavities were 2 mm and 1 mm below (cementoenamel junction), respectively. The samples were divided into 4 groups (n = 10). In all groups, a layer of 1-mm thick amalgam was used as a coating for the initial part of the gingival floor. In group 1, no bonding system was used for amalgam restoration. In group 2, G-Premio Bond was applied. G-Premio bond + alloy primer and single bond + alloy primer were used in group 3 and group 4, respectively. The rest of the cavities in all groups were then repaired using FiltekZ250 composite. The samples were thermocycled at 500 rpm and immersed in 1% methylene blue solution for 24 hours to allow dye penetration. Once cut, the samples were placed under a stereomicroscope (40X) to determine the microleakage rate. Data analysis was carried out using post-hoc and Chi-square tests (p<0.05). Results: The highest and lowest microleakage rate was related to groups 1 and 3, respectively. There was a significant difference between groups (1,2) and (1,3), and (1,4), and groups (2,3) (p<0.05). Conclusion: The use of alloy primer and bonding could reduce the microleakage between the two restorations (AU).

Pain perception of children after restorative treatments: Atraumatic restorative treatment versus chemomechanical removal - A noninferiority randomized clinical trial.

BACKGROUND: Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques. AIMS: To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal. SETTINGS AND DESIGN: A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil. METHODS: Children between 4 and 9 years old were selected. In both groups - ART (n = 20) and chemomechanical caries removal (Papaya® gel) (n = 20) - oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique. STATISTICAL ANALYSIS: Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables. RESULTS: No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013). CONCLUSION: Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

Diferença de cor entre resinas compostas de marcas comerciais diferentes / Color difference between composites of different commercial brands

Este estudo avaliou a cor de duas resinas compostas universais produzidas por diferentes fabricantes. Noventa e seis espécimes das resinas compostas Filtek Z350XT (3M ESPE) e IPS Empress Direct (Ivoclar Vivadent) (n=48 cada) da cor A2E foram confeccionados com 5 mm de diâmetro X 6 mm de altura. Cada camada de 2 mm de espessura de resina inserida foi fotoativada com uma unidade fotoativadora LED com 900 mW/cm2 por 20 s. Os espécimes foram polidos com o sistema Sof-lex Pop-On (3M ESPE). A cor foi aferida com um espectrofotômetro digital portátil Easyshade (Vita Zahnfabrik, Bad Säckingen), com base nos eixos tridimensionais do sistema CIEL*a*b*, e sua diferença entre as resinas foi determinada em cada eixo, calculando o seu respectivo Δ (ΔL*, Δa* e Δb*) e os parâmetros de variação total de cor ΔE* e ΔE00. A diferença de cor entre as resinas em cada eixo foi analisada estatisticamente pelo Teste t de amostras independentes (α=0,05), além de considerar os limiares de 50%:50% de perceptibilidade e aceitabilidade da variação total de cor. Diferenças estatisticamente significativas foram observadas no ΔL* e no Δb* (p<0,001). Os valores de ΔE foram de três a quatro vezes superiores ao limite de perceptibilidade e em até duas vezes ao limite de aceitabilidade da variação total de cor. Verificou-se que diferenças importantes de cor podem ocorrer em resinas da mesma cor, porém, de fabricantes diferentes. Essas diferenças podem ser visualmente perceptíveis e acima dos limites de aceitabilidade, podendo comprometer o resultado estético da restauração.(AU)

This study assessed the color of two universal composites produced by different manufacturers. Ninety-six specimens of Filtek Z350XT (3M ESPE) and IPS Empress Direct (Ivoclar Vivadent) (n=48 each) colored A2E were made with 5 mm of diameter X 6 mm of height. Each 2 mm-thick composite layer inserted was light cured with a LED light curing unit with 900 mW/cm2 for 20 s. The specimens were polished with Sof-lex Pop-On (3M ESPE). The color was measured with a portable digital spectrophotometer Easyshade (Vita Zahnfabrik, Bad Säckingen) based on the tridimensional axes of the CIEL*a*b* system, and the difference between composites was determined in each axis by determining the respective Δs (ΔL*, Δa* e Δb*), along with the parameters for total color variation ΔE* and ΔE00. The color difference between composite in each axis was analyzed statistically using the t-test (α=0,05), besides considering the 50%:50% thresholds for visual perceptibility and acceptability of total color variation. Statistically significant differences were observed in ΔL* and Δb* (p<0.001). The ΔE values were three to four times higher than the perceptibility threshold and twice higher than the acceptability threshold for total color variation. Relevant color differences may occur in composites of the same color, yet, made by different manufacturers. These differences may be visually perceptible and higher than acceptance limits, and may compromise the esthetic result of dental restorations.(AU)

Clinical effectiveness of pre-treatment with chlorhexidine in adhesive dental restorations: systematic review and meta-analysis / Eficacia clínica del pretratamiento con clorhexidina en restauraciones dentales adhesivas: revisión sistemática y metanálisis

Objective: To determine, by means of a systematic review and meta-analysis, the clinical effectiveness of pre-treatment with chlorhexidine (CHX) in adhesive dental restorations. Material and Methods: A literature search was conducted until February 2020, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, Scopus, SIGLE, LILACS, Google Scholar and the Cochrane Central Registry of Clinical Trials. The selection criteria of the studies were defined, which were: randomized and controlled clinical trials, without language and time restrictions, and reporting the clinical effects (retention, marginal discoloration, marginal adaptation, postoperative sensitivity and secondary caries) of pre-CHX treatment in adhesive dental restorations. Study risk of bias was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions. Results:The search strategy resulted in six articles of which five entered a meta-analysis. The studies reported that there was no difference in retention, marginal discoloration, marginal adaptation, postoperative sensitivity, and secondary caries from pre-treatment with CHX in adhesive dental restorations. Conclusion: The reviewed literature suggests that pretreatment with CHX does not influence the clinical effectiveness in adhesive dental restorations.

Resumen: Antecedentes: la pandemia de COVID-19 ha desatado un ataque sin precedentes contra la humanidad en todo el mundo. El escenario en Bangladesh empeora día a día, y todos los aspectos de la sociedad están observando su impacto. Los profesionales de la salud corren un mayor riesgo de contraer la enfermedad mientras atienden a los pacientes. Objetivo: El objetivo de la investigación es explorar el conocimiento, la conciencia y las prácticas de los dentistas registrados con respecto a la epidemiología y transmisión de COVID-19 durante el rápido brote de este virus altamente contagioso en Bangladesh. Material y Métodos: Se realizó una encuesta transversal basada en la web entre los dentistas inscritos con su número de registro único válido del Consejo Médico y Dental de Bangladesh (BMDC). Se distribuyó un cuestionario estructurado entre los dentistas a través de diferentes plataformas de redes sociales. Un total de 184 dentistas participaron en la encuesta entre marzo y abril de 2020. Se realizó tanto análisis descriptivo como análisis de regresión logística multivariable. Resultados: La edad media de los odontólogos fue de 31,75 años, con una desviación estándar de 6,5 años. Aproximadamente el 29,3% de los dentistas habían completado su título de posgrado y el 76% de ellos se dedicaba a la práctica privada en el momento de la recopilación de datos. En comparación con los dentistas con educación universitaria, los dentistas con educación de posgrado tienen tres veces (OR = 3,1, IC del 95%: 1,2 - 7,9 y más de 5 veces (OR = 5,3, IC del 95%: 1,2 - 23,3) más probabilidades de tener) mejores conocimientos y prácticas hacia COVID-19 respectivamente. Los dentistas de 26 a 30 años tienen menos probabilidades de tener buenas prácticas que los dentistas más jóvenes (OR: .1; IC del 95%: .01 - .5). Sin embargo, los dentistas con menos de cinco años de experiencia tienen 10,3 (1,6 - 68,9) veces más probabilidades de tener buenas prácticas en comparación con los dentistas con más experiencia. Conclusión: La mayoría de los dentistas de Bangladesh han demostrado un buen conocimiento, conciencia y práctica con respecto a COVID-19. Recomendamos que las autoridades sanitarias, las organizaciones profesionales y los hospitales coordinen y lleven a cabo una formación avanzada obligatoria sobre enfermedades infecciosas para todos los dentistas en ejercicio del país.

Metodologías complementarias para la evaluación de dientes tratados endodónticamente restaurados con pernos prefabricados: revisión narrativa de la literatura / Complementary methodologies' evaluation of endodontically treated teeth restored with precast posts. A literature review

La restauración de dientes tratados endodónticamente (RDTE) es una temática en constante estudio, con la finalidad de que se obtengan protocolos clínicos seguros, que puedan mejorar la longevidad de los tratamientos. En los últimos años es creciente la búsqueda por metodologías complementarias a la resistencia de unión, para la evaluación de las RDTE. No obstante, es importante conocer las ventajas y desventajas de cada uno de los métodos complementarios más empleados para evaluar las RDTEs, permitiendo ampliar los conocimientos obtenidos en una investigación. El objetivo de este estudio fue presentar los diferentes métodos utilizados como complementarios a las pruebas de resistencia de la unión y resistencia a la fractura tras una revisión narrativa de la literatura. Se realizó una búsqueda en las bases de datos electrónicas PUBMED, BBO (Biblioteca Dental Brasileña), LILACS (Literatura de Salud de América Latina y el Caribe), SciELO y Medline, utilizando las palabras clave "dientes tratados endodónticamente" y "perno prefabricado", de 1990 hasta el 2020. De los 360 artículos se excluyeron 295 que no pre- sentaban información relevante para nuestra investigación, donde las metodologías com- prendieron pruebas microbiológicas, moleculares, biológicas, metodologías de imagen y métodos de análisis de superficies. Al final de la selección de artículos, se enumeraron las técnicas utilizadas en cada estudio y, a partir de ahí, se realizó una nueva búsqueda bibliográfica, con el objetivo de revisar las técnicas y sus potenciales usos, ventajas y desventajas. Se concluye que las técnicas presentadas son valiosas para incrementar los resultados obtenidos con las pruebas mecánicas en la evaluación de la RDTE con pernos prefabricados.

The restoration of endodontically treated teeth (RETT) is a subject in constant study, in order to obtain safe clinical protocols that can improve treatments longevity. In recent years, the search for complementary methodologies to bond-strength proves has been growing for evaluating RETTE, being important to know the most used complemen- tary methods' advantages and disadvantages to evaluate this. The aim of this study is to present a literature review on complementary methods to bond strength and the fracture strength tests. The articles search was done in databases: PUBMED, BBO (Brazilian Dental Library), LILACS (Health Literature of Latin America and the Caribbean), SciELO and Medline, using the keywords "endodontically treated teeth" and "prefabricated post" from 1990 to 2020. Out of 360 articles 295 were excluded because they did not present relevant information for this research, since the methodologies included micro- biological, molecular, biological tests, imaging methodologies, and surface analysis methods. The techniques used in each selected article were listed, and starting from them, a new bibliographic search was carried out, with the aim of reviewing the techniques and their potential uses, advantages and disadvantages. It was concluded that the presented techniques were valuable to increase the obtained results with the mechanical proves in RETT evaluation with prefabricated posts.

Remoção seletiva de tecido cariado e proteção pulpar indireta: relato de casos clínicos / Selective caries removal and indirect pulp capping: clinical cases report

Objetivo: este artigo se propõe a discutir o tratamento de lesões profundas de cárie em molares permanentes, através da técnica de remoção seletiva de tecido cariado e restauração de resina composta, em dois casos clínicos, utilizando apenas sistema adesivo (caso 1) ou proteção pulpar indireta com cimento de hidróxido de cálcio (caso 2). Relato de casos: os indivíduos foram diagnosticados com dentes apresentando lesões profundas de cárie, isto é, com mais de 50% em profundidade da dentina, confirmada pelo exame radiográfico interproximal. O conjunto de resultados de testes de sensibilidade pulpar positivo ao frio e teste de percussão horizontal e vertical negativos, juntamente com a ausência de dor espontânea e normalidade do periápice (radiografia periapical), completaram os requisitos exigidos para execução da técnica de remoção seletiva de dentina cariada amolecida. Os dentes receberam restaurações adesivas na mesma sessão, sobre a dentina cariada amolecida da parede pulpar que havia recebido forramento de cimento de hidróxido de cálcio ou não, dependentes de uma randomização. Ambos os casos apresentados mostraram sucesso clínico em acompanhamento de 18 meses, tanto na manutenção da vitalidade pulpar quanto na sobrevivência da restauração. Considerações finais: com base nos casos apresentados, sabendo das limitações deste modelo de estudo, e em concordância com a literatura, a remoção seletiva de tecido cariado pode ser executada com sucesso no tratamento de lesões profundas de cárie, respeitando-se todos os passos da técnica, e parece não haver necessidade de uso de proteção pulpar indireta.(AU)

Objective: this article aims to discuss the treatment of deep caries lesions in permanent molars through the selective caries tissue removal technique and composite resin restoration of two clinical cases, using only an adhesive system (case 1) or an indirect pulp protection of calcium hydroxide cement (case 2). Cases report: the participants were diagnosed with deep caries lesions, that is, more than 50% in depth of the dentin involved, which was confirmed by the interproximal radiography. In both cases, it was obtained positive response to cold test, negative response to horizontal and vertical percussion tests, absence of spontaneous pain and no periapical lesion (periapical radiography), which completed the requirements for performing the selective caries removal of soft dentin. These teeth received adhesive restorations in the same session, under the softened carious dentin of the pulp wall that had received calcium hydroxide cement or not, depending on randomization. Both cases had clinical success in the 18-month follow- -up, showing pulp vitality and restoration survival. Final considerations: based on the clinical cases reported, considering de limitations of this study model, and in agreement with the literature, the selective removal of carious tissue can be successfully performed in the treatment of deep carious lesions, respecting all the steps of the technique and indirect pulp protection seems to be unnecessary.(AU)

Three-year follow-up of flowable bulk-fill resin restorations in posterior teeth: a double-blind randomized controlled clinical trial / Acompanhamento de três anos de restaurações do tipo bulk-fill flow em dentes posteriores: ensaio clínico controlado randomizado duplo-cego

Objetivo: Este ensaio clínico randomizado avaliou o comportamento de restaurações com resina composta bulk-fill flow em dentes posteriores após três anos do tratamento restaurador. Métodos: Dezessete pacientes (12 mulheres, 5 homens, idade 23-59) foram selecionados para ter pelo menos duas restaurações de amálgama ou de resina composta substituídas, ou receber tratamento restaurador para lesão cariosa. As cavidades foram aleatoriamente alocadas para receberem o compósito bulk-fill flow Suferil SDR Flow, oclusamente coberto por uma resina composta convencional nano-híbrida Esthet-X HD (técnica bulk and body), ou serem preenchidas exclusivamente com Esthet-X HD, inseridas em incrementos de 2mm cada técnica incremental). Um adesivo convencional de dois passos foi aplicado em todas as cavidades. Trinta e quatro restaurações Classes I ou II foram realizados em dentes posteriores (n=17) no início do estudo (baseline). Após 03 anos, os critérios do USPHS modificado e FDI foram utilizados para avaliar as restaurações. Os dados foram submetidos à análise estatística Mann-Whitney (p<0,05). Resultados: No acompanhamento de 3 anos, vinte e quatro restaurações (17 Classes I e 7 Classes II) foram avaliadas. Não foram detectadas diferenças entre as técnicas restauradoras (p>0,05). Não houve falha em nenhuma restauração ao longo do tempo. Conclusão: Após 03 anos de serviço clínico, todas restaurações utilizando um compósito bulk-fill flow em dentes posteriores demonstraram uma performance satisfatória. Significância Clínica: A qualidade geral das restaurações em dentes posteriores realizadas com a técnica bulk and body foi similar ao das restaurações incrementais utilizando um compósito nano-híbrido. (AU)

Objective: This randomized clinical trial evaluated the behavior of restorations with flowable bulk-fill resin composite in posterior teeth three years after the restorative treatment. Methods: Seventeen patients (12 women, 5 men, age 23-59) were selected to have at least two failing amalgam or resin restorations replaced and/or to have a carious lesion restored. The cavities were randomly allocated to receive either the flowable bulk-fill composite Surefil SDR Flow occlusally covered with the conventional nano-hybrid composite Esthet-X HD (bulk and body technique) or filled exclusively with Esthet-X HD placed in 2 mm increments (incremental technique). A two-step etch-and-rinse adhesive was applied in all cavities. Thirty-four Class I or II restorations were performed in posterior teeth (n=17) during baseline. After 03 years, modified USPHS and FDI criteria were used to evaluate the restorations. Data were subjected to Mann-Whitney statistical analysis (p<0.05). Results: At the 3-year follow-up, twenty-four restorations (17 Class I and 7 Class II) were evaluated. No diff erences were detected between the bulk and body and the incremental restorations (p>0.05). No restoration failures were observed over time. Conclusion: After 03 years of clinical service, all restorations using a flowable bulk-fill composite in posterior teeth showed an acceptable performance. Clinical Significance: The overall quality of posterior restorations made with the bulk and body technique was similar to that of restorations made with a nano-hybrid composite incrementally placed. (AU)

Multidisciplinary conservative management of dental fracture in young patient: case report

The management of fractured permanent teeth due to dental trauma in young patients is a challenge that requires an efficient approach. Objective: Describe a conservative and multidisciplinary treatment of a case of dental trauma in a 13 years-old boy. Case report: At clinical examination was verified enamel and dentin fracture in the left upper central incisor and a fracture with pulp exposure in the right upper lateral incisor, with subgingival extension of its margin at lingual surface, and no swelling or tooth displacement was observed. At radiographic evaluation, no pulp or periradicular disturbances were verified. It was proposed the surgical lengthening of the clinical crown of the right upper lateral incisor for later performing endodontic treatment. It was decided to make direct composite resin restorations in both fractured teeth, instead of doing a prosthetic treatment in the affected lateral incisor, such as the placement of a full ceramic crown, in an attempt to perform a less invasive treatment, mainly due to the age of the patient. At a two years follow-up visit was observed the maintenance of the health of periapical tissues and the absence of clinical alterations. Conclusion: The restorations were kept in good conditions and aesthetics was considered satisfactory by professionals, patient and parents.

Introdução: O manejo de dentes permanentes fraturados por traumatismo dentário em pacientes jovens é desafiador e requer uma abordagem eficiente. Objetivo: Descrever o tratamento conservador e multidisciplinar em um caso de traumatismo dentário de um menino de 13 anos de idade. Relato do caso: Ao exame clínico foi verificada uma fratura de esmalte e dentina no incisivo central superior esquerdo e uma fratura complicada no incisivo lateral superior direito, com extensão subgengival da margem na face palatina, e não foram observados edema ou deslocamento dentário. Ao exame radiográfico, não foram verificadas alterações pulpares ou perirradiculares. Foi proposta realização de aumento da coroa clínica do incisivo lateral superior direito para posterior realização do tratamento endodôntico. Para os dois dentes traumatizados foi proposta a realização de restauração direta com resina composta, proporcionando um tratamento menos invasivo ao incisivo lateral superior direito, ao invés de submetê-lo a um tratamento protético, como a colocação de uma coroa total cerâmica, principalmente devido à pouca idade do paciente. Na visita de dois anos de acompanhamento, observou-se a manutenção da saúde dos tecidos periapicais e ausência de alterações clínicas. Conclusão: As restaurações se mantiveram em boas condições e a estética foi considerada satisfatória pelos profissionais, paciente e pais.

Desenvolvimento de instrumental para a padronização do volume e da forma dos incrementos de resina composta direta e relato de caso clínico / Development of instruments for the standardization of volume and shape of direct composite resin increments and clinical case report

Objetivo: O presente trabalho teve por objetivo desenvolver um protótipo de instrumental clínico que possibilita a padronização do volume e forma da massa de resina composta para o uso em procedimentos restauradores direto, além de relato de caso demonstrando a aplicabilidade do protótipo. Para isso, foi selecionada uma empresa produtora de instrumentos odontológicos e ativa no mercado nacional com registro na ANVISA. Tendo como base um calcador de Holemback número 6, esse, foi reconfigurado geometricamente afim de atingir os requisitos necessários para o desenho pretendido. Após a etapa de desenvolvimento, esse novo instrumento foi utilizado para o relato de um caso clínico de restauração direta de resina composta envolvendo esmalte e dentina das superfícies ocluso-distal do dente 15 e oclusal do dente 16. Os tecidos dentais foram hibridizados pela técnica adesiva associada de condicionamento seletivo do esmalte com ácido fosfórico e aplicação de sistema adesivo auto-condicionate (Clearfil SE Bond, Kuraray, Japão) em esmalte e dentina. A restauração foi realizada com a resina composta Z350 XT (3M ESPE, USA) nas cores A1 e A2B. Conclusão: A utilização do protótipo de instrumental auxilia na execução de restaurações direta de resina composta com o favorecimento ao controle das tensões geradas pela contração de polimerização e poderá ter papel importante no treinamento restaurador dos profissionais(AU)

Objective: The objective of this work was to develop a prototype of clinical instruments that allows the standardization of the volume and shape of the composite resin mass for use in direct restorative procedures, besides a case report demonstrating the applicability of the prototype. For this, a company was selected to produce dental instruments and active in the national market with ANVISA registration. Based on a Holemback number 6 presser foot, it was geometrically reconfigured to meet the requirements for the intended design. After the development stage, this new instrument was used to report a clinical case of direct restoration of composite resin involving enamel and dentin of the occlusal-distal surfaces of the tooth 15 and occlusal of the tooth 16. The dental tissues were hybridized by the adhesive technique associated with the selective conditioning of the enamel with phosphoric acid and the application of auto-conditioning adhesive system (Clearfil SE Bond, Kuraray, Japan) in enamel and dentin. The restoration was performed with the composite resin Z350 XT (3M ESPE, USA) in colors A1 and A2B. Conclusion: The use of the prototype of auxiliary instruments in the execution of direct restorations of composite resin with the favoring to control the tensions generated by the polymerization contraction and may play an important role in the restorative training of professional(AU)

A clinical evaluation of direct veneers made with two types of composites

Objectives: the aim of this study was to provide a retrospective clinical evaluation of direct composite veneers performed with microfilled or universal composites, through two evaluation criteria (FDI and USPHS). Materials and methods: patients should be in compliance with the inclusion criteria: having a composite veneer in anterior teeth made either with microfilled or universal using composites (microhybrid/nanohybrid), conventional dentin-bonding agents and for a minimum of 6 months period in service. A calibrated blind examiner assessed the veneers using the FDI and USPHS criteria and the results were subjected to statistical analysis by the Mann-Whitney test (p<0.05). Results: Twenty-eight patients (mean age 42.9 year-old) and seventy-four composite veneers were examined. The mean period of time in service was three years, with periods varying from six months up to ten years. Three cases of total failure (veneers lost, universal composites group) occurred in the surveyed patients, out of 17 failures in total. In general, the veneers showed a clinical satisfactory outcome (77% survival rate). Concerning the two composite types, better clinical performance was observed for microfilled in relation to surface luster, surface staining, colour match and marginal adaptation. Conclusion: In this interim evaluation, direct composite veneers demonstrated an acceptable clinical behavior. Microfilled composite veneers showed a better performance compared to universal composites. The two criteria (USPHS and FDI) were similar in the clinical evaluation process. Clinical relevance: direct composite veneers have a good clinical performance, microfilled composites are interesting options regarding esthetic properties.

Avaliação da taxa de sucesso e de sobrevivência de restaurações cerâmicas realizadas com o sistema CAD-CAM CEREC após 5 anos: projeto piloto / Evaluation of the success rate and survival rate of ceramic restorations performed with the CAD-CAM CEREC system after 5 years: pilot project

O presente estudo teve como objetivo fazer uma avaliação da taxa de sucesso e sobrevivência de restaurações indiretas, realizadas pelo sistema CEREC AC Bluecam após 5 anos. Trata-se de um estudo piloto, com a inclusão de 102 pacientes e um total de 113 restaurações. As restaurações foram feitas a partir de blocos pré-fabricados de cerâmica feldspática (CEREC Blocs). Os prontuários de todos os pacientes foram avaliados. Um total de 36 restaurações foram avaliadas clinicamente usando-se os critérios USPHS e FDI modificados. Além disso, foi criada uma ficha clínica com um questionário abrangendo uma série de informações clínicas relevantes. A taxa de satisfação do paciente foi avaliada através da escala analógica visual. A taxa de sucesso e sobrevivência para as restaurações avaliadas dentro do critério adotado foi de 80,6% e 0,9% respectivamente. Um total de 19 (18,5%) de falhas foi encontrado. A principal razão das falhas foi a fratura da cerâmica, sendo significativamente maior para dentes não vitais. Restaurações indiretas feitas a partir do sistema CEREC AC tiveram um sucesso clínico considerável com taxa de sucesso de 80,6% após 5 anos. A taxa de satisfação dos pacientes frente a esse tipo de tratamento foi bem alta para todos os parâmetros avaliados, chegando a uma média de 96%(AU)

The present study aimed to evaluate the success and survival rate of indirect restorations performed by the CEREC AC Bluecam system after 5 years. This is a pilot study with the inclusion of 102 patients and a total of 113 restorations. The restorations were made from prefabricated feldspar ceramic blocks (CEREC Blocs). The medical records of all patients were evaluated. A total of 36 restorations were clinically evaluated using the modified USPHS and FDI criteria. In addition, a clinical record was created with a questionnaire covering a range of relevant clinical information. Patients' satisfaction rate was assessed using the visual analogue scale. The success and survival rate for the restorations evaluated according to the adopted criteria was 80.6% and 0.9% respectively. A total of 19 (18.5%) failures were found. The main reason for the failures was ceramic fracture, being significantly higher for non vital teeth. Indirect restorations made from the CEREC AC system have had considerable clinical success with a success rate of 80.6% after 5 years. The patients' satisfaction rate regarding this type of treatment was very high for all parameters evaluated, reaching an average of 96%(AU)