Randomized clinical trial of four adhesion strategies: A 42 month study.

CONTEXT: The adhesives clinical effectiveness has been extensively reported for noncarious cervical lesions (NCCLs). However, there is a lack of information about the adhesive systems strategies and their effect on NCCL restoration longevity. AIMS: This study aims to evaluate a 42-month performance of four dentin adhesive systems used for the restorative treatment of NCCLs. SETTINGS AND DESIGN: NCCLs were randomly divided into four groups: (1) Scotchbond multi-purpose (MP); 2: Single bond plus (SB); 3: Scotchbond SE (SE); and 4: Easy bond (EB). SUBJECTS AND METHODS: NCCLs (125) were randomly distributed: (1) MP; (2) SB; (3) SE; and (4) EB and were restored with a nanofilled resin-composite, evaluated along 18-36-42 months. STATISTICAL ANALYSIS USED: Kruskal-Wallis test: Comparison among the adhesive systems in each period. Friedman analysis: Comparison along the periods. Kaplan-Meier: Survival analysis. RESULTS: Baseline and 42-month retention (RET) rates (%) were 100/100 for MP; 100/94.74 for SB; 100/87.5 for SE; and 100/100 for EB. The cumulative failure percentage was 9.52% for MP, 9.52% SB, 15.8% SE, and 10% EB. Restorations survival was not dependent on the used adhesive type. Marginal adaptation (MA) was similar to each group, but EB presented noticeable marginal deterioration. Wear was noticed in the 3-step etch-and-rinse (MP) restorations evaluated after 42 months. For the EB, baseline and 18-month wear evaluation were statistically similar. After 36 and 42 months, wear was also similar for EB. CONCLUSIONS: Adhesive systems showed similar performance within most important adhesive bonding efficiency achievement parameters: RET, MA, interfacial staining, recurrent caries, and postoperative sensitivity evaluated during 42 months.

Effect of chlorhexidine on the 18-month clinical performance of two adhesives.

PURPOSE: This study tested the hypothesis that 2% chlorhexidine (CHX) does not affect the 18-month clinical performance of two dentin adhesives, XP Bond (XPB) and XENO V (XEN). MATERIALS AND METHODS: A total of 120 noncarious cervical lesions (NCCL) were selected and assigned to 4 groups: (1) XPB; (2) CHX prior to the application of XPB; (3) XEN; (4) CHX prior to the application of XEN. A hybrid composite resin, Esthet•X, was used for all restorations. Restorations were evaluated blindly at 6 and 18 months by two evaluators using the University of North Carolina (UNC)-modified USPHS criteria. Statistical analyses included the Mann Whitney and McNemar nonparametric tests (p < 0.05). RESULTS: At 6 months, 91 (75.2%) restorations were evaluated, while 92 (76.7%) restorations were evaluated at 18 months. The 6-month/18-month overall retention rates (%) were 100/100 for XPB, 96.0/95.0 for CHX+XPB, 100/91.3 for XEN, and 100/95.8 for CHX+XEN with no statistical difference between any pair of groups at each recall. Sensitivity to air improved significantly for groups XPB, XEN, and CHX+XEN from pre-operative conditions to 1 week after insertion, to 6 and to 18 months after inserting. For group CHX+XPB, there was a statistically significant difference only between pre-operative conditions and 1 week after insertion. Marginal adaptation deteriorated for all groups, but no statistically significant differences were found. All other criteria remained statistically similar. CONCLUSION: The application of CHX prior to the dentin adhesive did not influence the 6-month/18-month clinical performance of the two adhesives.

Recuperação da estética do sorriso: cirurgia plástica periodontal e reabilitação protética / Creating an aesthetic smile with periodontal plastic surgery and prosthetic rehabilitation

A estética do sorriso relaciona a cor, o formato e as características do contorno gengival, associando-os ao posicionamento labial e à face do paciente. A erupção passiva alterada é uma condição que leva à ocorrência de coroas clínicas curtas, com tamanhos diferentes, e pode dificultar a obtenção da estética em casos de reabilitação protética. Este trabalho apresenta um caso clínico que restabelece a harmonia do sorriso por meio de associação de cirurgia plástica periodontal e reabilitação protética. Uma paciente queixou-se da cor do elemento dental 21, como também da diferença no tamanho das coroas clínicas de seus dentes ao sorrir. Clinicamente, diagnosticaram-se a presença de erupção passiva alterada com envolvimento apenas do tecido gengival ao redor dos dentes 11 e 22 e a necessidade de substituir a coroa toral do elemento 21. Realizou-se a cirurgia plástica periodontal por meio da técnica de gengivectomia para correção de erupção passiva alterada e restabelecimento adequado do zênite gengival. Após 30 dias , removeu-se a coroa total do elemento 21 e um provisório caracterizado foi confeccionado. Após 45 dias, a coroa total metal-free foi cimentada e a paciente relatou satisfação com o resultado do tratamento. No dia a dia clínico, a associação de procedimentos protéticos e periodontais torna-se necessária para harmonizar a relação entre o elemento dental e os tecido moles ao seu redor e restabelecer a estética do sorriso

The influence of internal surface treatments on tensile bond strength for two ceramic systems.

STATEMENT OF THE PROBLEM: The ceramic composition and surface microstructure of all-ceramic restorations are important components of an effective bonding substrate. Hydrofluoric acid and sandblasting are well-known procedures for surface treatment; however, surface treatment for high alumina-containing and lithium disilicate ceramics have not been fully investigated. PURPOSE: This in vitro study evaluated the tensile bond strength of resin cement to two types of ceramic systems with different surface treatments. METHODS AND MATERIALS: Thirty specimens of each ceramic system were made according to the manufacturer's instructions and embedded in polyester resin. Specimens of In-Ceram Alumina [I] and IPS Empress 2 [E] were distributed to three groups with differing surface treatments (n = 10): sandblasting with 50 microm aluminum oxide (APA); sandblasting with 110 microm aluminum oxide modified with silica particles (ROCATEC System-RS); a combination of sandblasting with APA and 10% hydrofluoric acid etching (HA) for two minutes on In-Ceram and for 20 seconds for IPS Empress 2. After the respective surface treatments, all the specimens were silanated, and Rely-X resin cement was injected onto the ceramic surface and light polymerized. The specimens were stored in distilled water at 37 degrees C for 24 hours and thermally cycled 1,100 times (5 degrees C/55 degrees C). The tensile bond strength test was performed in a universal testing machine at a 0.5 mm/minute crosshead speed. RESULTS: The mean bond strength values (MPa) for IPS Empress 2 were 12.01 +/- 5.93 (EAPA), 10.34 +/- 1.77 (ERS) and 14.49 +/- 3.04 (EHA). The mean bond strength values for In-Ceram Alumina were 9.87 +/- 2.40 (IAPA) and 20.40 +/- 6.27 (IRS). All In-Ceram specimens treated with 10% hydrofluoric acid failed during thermal cycling. CONCLUSION: The Rocatec system was the most effective surface treatment for In-Ceram Alumina ceramics; whereas, the combination of aluminum oxide sandblasting and hydrofluoric acid etching for 20 seconds worked more effectively for Empress 2 ceramics.

Estudo in vitro da interferência do silano na adesão de procelana cimentada com cimento resinoso / In vitro study of the interference of silane on the adhesion of porcelain and luting cement

Introdução - A cimentação adesiva permite a união química e física de uma restauração de porcelana Ro dente. O responsável pela união física é o tratamento da superfície interna da peça, que tem o objetivo de criar microrretençe)es para que esta possa receber o cimento resinoso. Isto é obtido com o jateamento com óxido de alumínio e a otimização das microporosidades obtidas é conseguida com a aplicação de um ácido. A união química é proporcionada pelo silano, que é uma substância que se une à matriz orgânica dos cimentos resinosos. Considerando a grande fluidez do cimento adesivo, o que facilita seu microembricamento na porcelana tratada por ácido e por jateamento o objetivo foi verificar a real necessidade do silano neste processo. Método - Trinta discos de porcelana tipo vidro ceramizado, em formato tronco cônico foram inclusos em cilindros de resina e divididos em três grupos. Todos os grupos sofreram jateamento com óxido de alumínio por 10 segundos e tratamento com ácido hidrofluorídrico a 10 por cento por 20 segundos, sendo que o segundo grupo ainda recebeu duas camadas de silano e o terceiro grupo duas camadas de adesivo. Em seguida sobre os três grupos foi aplicado o cimento resinoso e realizado teste de resistência adesiva. Resultados o Conclusão - Após análise estatística, os resultados indicaram diferenças significantes entre os grupos estudados. Os resultados comprovam que a união somente física promovida pelo jateamento mais o condicionamento ácido da peça de porcelana, com o agente de cimentação resinoso, é inferior à união físico-química, sendo a silanização importante para melhorar a união entre a porcelana e o agente resinoso usado na cimentação.(au)