Glutaraldehyde-based desensitizer does not influence postoperative sensitivity and clinical performance of posterior restorations: A 24-month randomized clinical trial.

OBJECTIVES: To evaluate the influence of a glutaraldehyde-based desensitizer (GL) on postoperative sensitivity (POS) in posterior bulk-fill resin composite restorations using an adhesive applied in the self-etch (SE) and etch-and-rinse (ER) strategies; and to assess the clinical performance of the restorations. METHODS: Posterior resin composite restorations (n = 228) at least 3 mm deep were inserted in 57 subjects using a split-mouth design. The adhesive was applied with/without prior application of a GL. A resin composite was used for all restorations. Spontaneous POS (risk and intensity), as well as POS caused by stimulation with an air blast and assess the response to horizontal and vertical percussion was assessed using two scales in the baseline and after 7, 14, and 30 days. In addition, some parameters were evaluated using FDI criteria up to 24 months of clinical service. RESULTS: No significant POS was observed (p > 0.05). A higher absolute risk and intensity of spontaneous POS was observed within 7 days (35.1%), without statistically significant differences among groups. At 24 months 5 restorations were considered clinically unsatisfactory, and 73 restorations showed minor discrepancies in adaptation, with no significant differences between groups (p > 0.05). SIGNIFICANCE: A GL agent does not influence POS in posterior restorations with bulk-fill resin composite. It may be considered a dispensable clinical step in the restorative protocol.

Evaluation of application protocol of the 4% hydrogen peroxide for at-home bleaching: A randomized clinical trial.

OBJECTIVE: Few studies evaluated low concentrations of hydrogen peroxide protocols. The aim of this paper was evaluated two application protocols using 4% hydrogen peroxide in at-home bleaching. MATERIALS AND METHODS: Eighty-six patients with upper canines' shade A2 or darker were randomly allocated under two experimental conditions: two daily applications of 1 h each or a 2-h single application. Color change was evaluated using Vita Classical, Vita Bleachedguide, and digital spectrophotometer weekly and 1 month after the bleaching procedure through one-way ANOVA. The risk and intensity of tooth sensitivity (TS) was assessed through visual and numeric rating scale and measured by Fisher's exact test, Mann-Whitney test and one-way ANOVA respectively. RESULTS: After 3 weeks, the mean difference for the ΔSGU Vita Classical (1.0; 95% CI -0.1 to 2.0), ΔEab (0.7; 95% CI -1.4 to 2.8), ΔE00 (0.1; 95% CI -1.4 to 1.6) and Wi (1.8; 95% CI -1.9 to 5.5) presented no difference (p > 0.08). The relative risk for TS was 0.91 (0.72 to 1.14) without significant difference neither in the risk (p = 0.6) nor in the TS intensity for both pain scales (p > 0.65). CONCLUSIONS: The application protocols evaluated (two daily applications of 1 h each or a 2-h single application) for at-home bleaching with 4% hydrogen peroxide did not showed differences in color change and tooth sensitivity. CLINICAL RELEVANCE: Higher amount of active hydrogen peroxide in two daily applications for at-home bleaching neither accelerate bleaching nor increase the risk or intensity of tooth sensibility.

Postoperative sensitivity in posterior resin composite restorations with prior application of a glutaraldehyde-based desensitizing solution: A randomized clinical trial.

OBJECTIVES: To evaluate the effect of a glutaraldehyde-based desensitizer on the postoperative sensitivity (POS) in posterior resin composite restorations up to 12 months using a universal adhesive (Tetric N-Bond Universal) with selective enamel etching (SE) or an etch-and-rinse (ER) strategy. METHODS: Class I and class II resin composite restorations (n = 220) at least 3 mm deep were inserted in 55 subjects. The universal adhesive was applied using the SE (self-etch strategy on dentin with selective enamel etching) or the ER strategy, with or without prior application of a glutaraldehyde-based desensitizer (Gluma Desensitizer - GL) to form groups SEGL and ERGL. A bulk-fill resin composite (Tetric NCeram Bulk Fill) was used for all restorations. Spontaneous POS was assessed 7 days after the restorative procedure using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). After 7, 14, and 30 days of completing each restoration, the subjects were reassessed to evaluate POS caused by stimulation with an air blast, horizontal and vertical percussion. In addition, marginal discoloration, marginal adaptation, fracture, and recurrence of caries were evaluated using the FDI (World Dental Federation) criteria after 7 days and at 12 months. RESULTS: No significant spontaneous or stimuli-induced POS was observed when restorations with or without GL were compared (p>0.05). A higher risk of spontaneous POS was observed within 7 days (40.0%; 95% CI 28.1 to 53.1), without statistically significant differences among groups. None of the participants reported POS at 12 months, however five restorations were considered clinically unsatisfactory (p > 0.05). CONCLUSIONS: The previous application of GL did not significantly reduce spontaneous or stimuli-induced POS in posterior resin composite restorations at any time, regardless of the adhesive strategy used. CLINICAL SIGNIFICANCE: The use of a glutaraldehyde-based desensitizing agent did not generate lower incidence of postoperative sensitivity in resin composite posterior restorations.

Universal adhesives and dual-cured core buildup composite material: adhesive properties.

OBJECTIVE: Dual-cured buildup composites and simplified light-cured adhesive systems are mixed with a chemical activator to prevent the incompatibility between them. To evaluate microshear bond strength (µSBS) and nanoleakage (NL) of three universal adhesives used under buildup composites using different curing modes, at baseline and after 6-months (6m). METHODOLOGY: Dentin specimens of 55 molars were assigned to: Clearfil Universal Bond[CFU], Prime&Bond Elect[PBE] and One Coat 7 Universal[OCU]. All-Bond Universal[ABU] and Adper Scotchbond Multi-Purpose[SMP] were used as controls. CFU, PBE, and OCU were: light-cured [LC], dual-cured using a self-curing activator [DC], and self-cured, using a self-curing activator and waiting for 20 min [SC]. Upon the application of the adhesive, transparent matrices were filled with a dual-cured buildup composite and light cured, then tested in mSBS. For NL, the specimens were submersed in ammoniacal silver nitrate and sectioned to observe under the SEM. Three-way ANOVA and Tukey's test were applied (α=0.05). RESULTS: OCU/LC-PBE/LC resulted in higher mean µSBS than ABU/LC. For SMP/DC higher mean µSBS were obtained than for both CFU/DC and OCU/DC (baseline). No universal adhesive was significantly affected by curing mode or storage time. CFU, PBE, and OCU did not undergo significant changes in any curing mode (p>0.05). NL (baseline) PBE/LC resulted in higher %NL compared to ABU/LC. SMP/DC resulted in higher %NL than CFU/DC-OCU/DC. CFU/LC/DC resulted in lower %NL than CFU/SC. PBE/SC resulted in lower %NL than PBE/DC. OCU/LC/SC showed lower %NL than OCU/DC. OCU showed significant lower %NL than CFU and PBE. All CFU groups, as well as OCU/SC, resulted in increased %NL at 6m when compared with baseline. CONCLUSION: For universal adhesives used in etch-and-rinse mode, self-cured activator and different curing modes did not influence µSBS. However, some interactions were observed for NL, but this influence was material-specific.

Universal adhesives and dual-cured core buildup composite material: adhesive properties

Abstract Dual-cured buildup composites and simplified light-cured adhesive systems are mixed with a chemical activator to prevent the incompatibility between them. Objective: To evaluate microshear bond strength (μSBS) and nanoleakage (NL) of three universal adhesives used under buildup composites using different curing modes, at baseline and after 6-months (6m). Methodology: Dentin specimens of 55 molars were assigned to: Clearfil Universal Bond[CFU], Prime&Bond Elect[PBE] and One Coat 7 Universal[OCU]. All-Bond Universal[ABU] and Adper Scotchbond Multi-Purpose[SMP] were used as controls. CFU, PBE, and OCU were: light-cured [LC], dual-cured using a self-curing activator [DC], and self-cured, using a self-curing activator and waiting for 20 min [SC]. Upon the application of the adhesive, transparent matrices were filled with a dual-cured buildup composite and light cured, then tested in mSBS. For NL, the specimens were submersed in ammoniacal silver nitrate and sectioned to observe under the SEM. Three-way ANOVA and Tukey's test were applied (α=0.05). Results: OCU/LC-PBE/LC resulted in higher mean μSBS than ABU/LC. For SMP/DC higher mean μSBS were obtained than for both CFU/DC and OCU/DC (baseline). No universal adhesive was significantly affected by curing mode or storage time. CFU, PBE, and OCU did not undergo significant changes in any curing mode (p>0.05). NL (baseline) PBE/LC resulted in higher %NL compared to ABU/LC. SMP/DC resulted in higher %NL than CFU/DC-OCU/DC. CFU/LC/DC resulted in lower %NL than CFU/SC. PBE/SC resulted in lower %NL than PBE/DC. OCU/LC/SC showed lower %NL than OCU/DC. OCU showed significant lower %NL than CFU and PBE. All CFU groups, as well as OCU/SC, resulted in increased %NL at 6m when compared with baseline. Conclusion: For universal adhesives used in etch-and-rinse mode, self-cured activator and different curing modes did not influence μSBS. However, some interactions were observed for NL, but this influence was material-specific.

Clinical Performance of Non-Carious Cervical Restorations Restored with the "Sandwich Technique" and Composite Resin: A Systematic Review and Meta-analysis.

PURPOSE: To compare the retention rates of non-carious cervical restorations (NCCLs) constructed using the sandwich technique (a lining of glass-ionomer cement [GIC] or resin-modified glass-ionomer cement [RMGIC] and composite resin [CR]) with CR-only restorations. MATERIALS AND METHODS: The search was performed in various databases, including the Cochrane Library, PubMed, Scopus, and Web of Science. Gray literature was inspected, as were ongoing and unpublished abstracts from the IADR (1990-2017). Study quality was evaluated using the Cochrane Collaboration bias risk tool. Data from primary and secondary outcomes were meta-analyzed at 1-, 2- and 3-year follow-ups using the random effects model. The quality of the body of evidence was assessed using the GRADE approach. RESULTS: Initially, a total of 3645 articles were selected. After selection by titles, abstracts, and full texts, 6 articles were retrieved, but three were follow-ups of the same RCT. Therefore, a total of four studies remained for analysis. All studies were at unclear risk for bias. Among all outcomes, only loss of retention was lower for the sandwich technique at the 3-year follow-up (risk ratio [RR]: 7.5; 95% CI: 2.1 to 27.2; p = 0.002). CONCLUSIONS: Based on the limited number of available studies, higher retention rates in NCCL restorations were observed with the sandwich technique compared to CR-only restorations at the 3-year follow-up. Secondary outcomes were not influenced by the restorative technique. Except for retention rates, which were of moderate quality, the evidence quality of all secondary outcomes was low.

Does the Conditioning Mode and Duration of Universal Adhesives Affect the Bonding Effectiveness to Fluorotic Enamel?

PURPOSE: To compare the adhesive-enamel microshear bond strength (µSBS), in situ degree of conversion (DC), and the enamel-etching pattern of universal adhesives when applied for a prolonged period in the self-etch vs the etch-and-rinse mode in fluorotic enamel. MATERIALS AND METHODS: Ninety-six human molars (48 with a Thylstrup and Fejerskov index [TFI] score of 0 and 48 with TFI score of 4) were sectioned into four parts and divided into 24 experimental groups based on enamel surface (sound enamel or fluorotic enamel), adhesive (Clearfil Universal Bond, Futurabond U, iBond Universal, or Scotchbond Universal), and enamel treatment/application time (etch-and-rinse mode [ER] or self-etch mode with application times of 20 s [20SE] and 40 s [40SE]). The specimens were stored for 24 h and tested in shear at 1.0 mm/min (µSBS). Adhesive-enamel interfaces were evaluated for DC using micro-Raman spectroscopy. The enamel-etching pattern was evaluated using SEM. For each adhesive, data from µSBS and DC were analyzed separately using two-way ANOVA and Tukey's post-hoc test at α = 0.05. RESULTS: On sound enamel, 40SE usually resulted in statistically similar mean µSBS (p > 0.52) and statistically significantly improved mean DC values (p < 0.001) compared with the ER mode. Moreover, significantly improved mean µSBS and DC values were obtained compared with 20SE (p < 0.01). On fluorotic enamel, there was no statistically significant difference in µSBS between the experimental groups (p > 0.76). However, for each applied adhesive, 40SE resulted in improved mean DC values compared with 20SE or ER (p < 0.001). The deepest enamel-etching pattern was obtained in ER mode, followed by 40SE in sound and fluorotic enamel. CONCLUSION: Compared with ER mode, the prolonged application time of universal adhesives in SE mode in fluorotic enamel increased the DC, enhanced enamel-etching pattern and promoted similar results in terms of adhesive-enamel bond strength.

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review.

We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review

Abstract We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.