Effect of the Combination of Restorative Material and the Etching Protocol in Enamel Microleakage in Class II Cavities after Thermocycling.

This study is aimed at evaluating the marginal microleakage of bulk-fill class II restorations after thermocycling. Thirty-two human third molars received class II cavities prepared on mesial and distal faces. The cavities were bonded according to the adhesive protocol (total or self-etching). The cavities were then restored with composite and divided into 8 groups based on the composite combination: layering technique with Filtek Z350XT (G1 and G5), first layer with Filtek Z350 XT Flowable Restorative and then Filtek Z350XT (G2 and G6), bulk-fill technique with Filtek One Bulk Fill (G3 and G7), and first layer with Filtek One Bulk Fill Flow and Filtek Z350 XT (G4 and G8). The restorations were then subjected to thermocycling (2000 cycles, 5°C and 55°C, dwell time of 30 s). After aging, the restored teeth were immersed in methylene blue for 48 hours. The restorations (n = 32) were sectioned in the middle (two sections). The microleakage results were analyzed by two-way ANOVA followed by Tukey's post hoc test (α = 0.05). The groups did not differ statistically from each other in terms of marginal microleakage (p = 0.295). It can be concluded that there is no difference in the percentage of microleakage between conventional and bulk-fill resins on both consistencies, as well as there is also no statistically significant difference when the adhesive system is used in a conventional or self-etching mode.

Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta-analysis.

BACKGROUND: The evidence on the relationship between anxiety and depression and patients with distinct subtypes of temporomandibular disorder (TMD) is uncertain, so a thorough review study on the topic is still missing. OBJECTIVES: This systematic review investigated the distribution and severity of anxiety and depression in patients diagnosed with different subtypes of TMD. METHODS: The study is registered in PROSPERO (CRD42020150562) and it followed the PRISMA 2020 Statement. We searched in PubMed, Web of Science, Scopus and SciELO databases (last search: 12 March 2021) and the reference list from the included studies. Study eligibility criteria consisted of: (i) patients diagnosed with TMD using the Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) instruments; (ii) assessment of anxiety and/or depression with validated psychological instruments and (iii) allocation of patients into a minimum of two distinct TMD subtypes with at least one group having myofascial pain (comparison group). Analyses were carried out using RevMan 5.3.5 statistical package and random- or fixed-effects models (α = 0.05). The quality of evidence was assessed based on review authors' judgment derived from a 10-item appraisal tool for prevalence studies and with the Newcastle-Ottawa scale. RESULTS: Of the 4086 records identified in total, 24 were eligible for inclusion; meta-analyses were conducted with 20 studies. In total, 3678 subjects were included in the review. Most of the studies found that patients with myofascial pain showed similar occurrence and severity of anxiety/depression as compared to other subtypes of TMD, although the average prevalence seemed to be higher among the diagnoses consisting of myofascial pain (muscular TMD). Despite the moderate-to-high heterogeneity, anxiety and depression were more frequently distributed within patients with myofascial pain (p = .001). TMD patients without myofascial pain presented less severe levels of anxiety and depression than patients with only myofascial pain (p ≤ .01). The type of psychological instrument seems to affect the assessment of both anxiety and depression emotional states. CONCLUSION: The findings of this review suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD. IMPLICATIONS: Considering that anxiety and depression are differently distributed within the TMD population, a proper assessment of the psychological state of patients seems essential to offer an adequate treatment and management of each specific subtype of TMD.

Biosafety in Dental Practices Versus COVID-19 Outbreak

ABSTRACT Objective: To evaluate the dentists' knowledge about biosafety considering the SARS-CoV-2 and the risks of increasing the COVID-19 outbreak by dental practices during the pandemic in Brazil. Material and Methods: A cross-sectional study was performed by internet-based snowball sampling technique. A questionnaire with questions about different content was applied, and then analyzed the following two parameters: participants' Brazilian region and professional's specialty. Results: A total of 413 e-questionnaires from all Brazilian regions were considered valid. There were no significant differences among biosafety measures adopted by participants from different Brazilian regions (p≥0.05), except for those from North region, which have applied less previous oral antisepsis, temperature screening, and specific anamnesis tracking COVID-19 symptoms (p<0.05). The unique use of N95 mask was positively associated with North region (p<0.05). Expert participants of Groups 2 (oral surgery and correlate areas) and 4 (orthodontics, oral radiology and facial jaw orthopedics) were more updated than other ones (p<0.05). Conclusion: The biosafety protocols applied by participants were not adequate for the epidemiologic status of COVID-19 in each region of Brazil, from 13th May to 17th June 2020. Specialties linked to microbiology area or structured social networks have better applied preventive measures for COVID-19.

Influência de agentes antioxidantes na resistência de união de substratos clareados / Influence of antioxidants on bond strength of bleached dental substrates

A busca pela estética tem levado muitos pacientes ao consultório odontológico, sendo o clareamento de dentes vitais alternativa não invasiva, quando comparado à microabrasão, facetas e coroas, além de proporcionar elevado índice de sucesso para o tratamento de dentes escurecidos. Porém, há necessidade de espera de 14-21 dias para a realização de novas restaurações após o clareamento, uma vez que o efeito oxidante nos tecidos dentários pode gerar alterações estruturais no esmalte e redução da resistência de união. Este intervalo de tempo muitas vezes, não condiz com a expectativa dos pacientes, gerando insatisfação. Diante disso, estudos têm sido conduzidos com o objetivo de minimizar ou até mesmo anular o efeito adverso do oxigênio residual, possibilitando a execução pós-clareamento de restaurações adesivas com segurança e eficácia, reduzindo o tempo de espera. Uma das alternativas tem sido a utilização de agentes antioxidantes. Sendo assim, esse trabalho teve como objetivo revisar a literatura em relação aos agentes antioxidantes utilizados, bem como a eficácia dos mesmos na resistência adesiva de materiais restauradores ao substrato dental clareado. Esta revisão foi realizada através de buscas por artigos científicos, em bases de dados como Scielo, Pubmed/ Medline e Cochrane Library, sem limitação de data. Foram abrangidos, no estudo, trabalhos que envolvessem os temas "clareamento dental", "clareadores", "esmalte dentário", "dentina", "antioxidantes" e "resistência à tração", buscando analisar sua relevância clínica e científica. Avaliações que não se enquadravam no assunto principal e respectivos itens avaliados foram excluídas da revisão. Concluiu-se que a utilização de compostos antioxidantes, como o ascorbato de sódio 10% (gel e solução), proantocianidinas, catalase, chá verde 10% e alfa-tocoferol tem demonstrado efetividade na reversão dos valores de resistência de união ao esmalte clareado quando aplicados por 10 minutos (ascorbato em solução e proantocianidinas), 20 minutos (catalase), 60 minutos (chá verde, ascorbato gel e alfa-tocoferol), após o clareamento.

The search for esthetic has led many patients to the dental office, becoming the whitening of vital teeth a noninvasive alternative when compared to microabrasion, veneers and crowns, besides providing high success rate for the treatment of discolored teeth. However, there is a necessity to wait for 14-21 days to carry out new restorations after bleaching, since the oxidizing effect on dental tissues can cause structural changes in the enamel and reduction of bond strength. This time interval often does not match the expectations of patients, causing dissatisfaction. In view of this, studies have been conducted in order to minimize or even cancel the adverse effect of residual oxygen, enabling the post-bleaching performance of adhesive restorations safely and effectively, reducing the waiting time. One of the alternatives has been the use of antioxidant agents. Thus, this study aimed to review the literature in relation to the antioxidant agents used as well as their effectiveness in bond strength of restorative dental materials to the bleached substrates. This review was performed by searching for scientific articles in databases such as Scielo, PubMed / Medline and Cochrane Library, without limitation of date. It was included in the study, researches involving the themes "Tooth whitening", "Bleaching agents", "Enamel", "Dentin", "Antioxidants" and "Tensile Strength", searching to analyze its clinical and scientific relevance. The assessments that did not fit the main subject and adjacent items evaluated were excluded from the review. It can be concluded that the use of antioxidant compounds, such as 10% sodium ascorbate (gel and solution), proanthocyanidins, catalase, 10% green tea and alpha-tocopherol, have shown effectiveness in reversion of the bond strength values to bleached enamel when applied for 10 minutes (ascorbate solution and proanthocyanidins), 20 minutes (catalase), 60 minutes (green tea, gel ascorbate and alpha-tocopherol), after bleaching.

Cytotoxicity of three light-cured resin cements on 3T3 fibroblasts / Citotoxicidade de três cimentos resinosos fotopolimerizáveis sobre fibroblastos 3T3

Introduction: Light-cured resin cements are the first choice for the cementation of laminate veneers. Ideally, they should be biocompatible and offer minimum risks to patients. Objective: The aim of this study was to evaluate, in vitro, the cytotoxicity of three resin cements: Variolink II, Ivoclar Vivadent (C1), Allcem Veneer, FGM (C2), and Rely X Veneer, 3M ESPE (C3). Material and method: Twenty four samples of each of the cements were fabricated in a standardized metal mold, light activated, and transferred to a 96-well cell plate with culture of fibroblasts. After 24, 48, and 72h of incubation, cytotoxicity was assessed and cell viability was calculated by the methyl-thiazol-tetrazolium (MTT) colorimetric assay. Absorbance was measured at 570 nm using a microplate spectrophotometer. Result: The following results were found: Variolink II presented viability of 72.24% (SD 6.80) after 24h, 83.92% (SD 5.26) after 48h, and 92.77% (SD 5.59) after 72h; Allcem Veneer exhibited viability of 70.46% (SD 12.91) after 24h, 85.03% (SD 21.4) after 48h, and 70.46% (SD 12.91) after 72h; Rely X Veneer showed viability of 5.06% (SD 0.88) after 24h, 5.84% (SD 1.18) after 48h, and 6.99% (SD 1.34) after 72h. Conclusion: Under these testing conditions, Rely X Veneer presented significantly higher cytotoxicity compared with those of the other light-cured resin cements assessed.

Introdução: Cimentos resinosos fotopolimerizáveis são materiais de eleição para a cimentação de facetas laminadas. Devem ser biocompatíveis oferencendo riscos mínimos ao uso clínico em pacientes. Objetivo: O objetivo desse trabalho foi avaliar in vitro a citotoxicidade de três cimentos resinosos: Variolink II (Ivoclar Vivadent), Allcem Veneer, (FGM) e Rely X Veneer (3M ESPE). Material e método: Vinte e quatro corpos de prova de cada cimento foram confeccionados em matrizes metálicas padronizadas e inseridos em placa de cultura de células de noventa e seis poços contendo fibroblastos da linhagem 3T3. As células foram cultivadas em meio de cultivo celular RPMI 1640 com 5% de soro fetal bovino, com 0,1% de penicilina/estreptomicina em estufa a 37◦C, em atmosfera úmida com 5% de CO2. O grau de citotoxicidade de cada cimento foi avaliado após os tempos de contato de 24h, 48h e 72h através do método MTT (3-(4,5-dimetiltiazol-2yl)-2,5- difenil brometo de tetrazolina), que avalia a viabilidade celular pela função mitocondrial. Após os tempos estabelecidos, as amostras foram removidas, tratadas e levadas ao espectofotômetro de microplaca para leitura da absorbância em 570nm. Resultado: O cimento Variolink apresentou em 24h viabilidade de 72,24% (±6,80), em 48h de 83,92% (± 5,26) e de 92,77% (±5,59) em 72h. Allcem Veneer apresentou viabilidade de 70,46% (± 12,91) em 24h; 85,03% (± 21,4) em 48h e 70,46% (± 12,91) em 72h. O RelyX Veneer demonstrou viabilidade de 5,06% (± 0,88) em 24h; 5,84% (± 1,18) em 48h e 6,99% (± 1,34) em 72h. Conclusão: Estes resultados demonstraram que o cimento Rely-X se apresentou significativamente mais citotóxico nas condições testadas.

Degradação química e citotoxicidade in vitro de cimentos resinosos fotopolimerizáveis / Chemical degradation and in vitro cytotoxicity of light-cured resin cements

O objetivo deste estudo foi investigar o efeito degradante da saliva artificial e do ácido lático sobre diferentes cimentos resinosos fotopolimerizáveis e avaliar os efeitos citotóxicos dos extratos da degradação em saliva artificial sobre fibroblastos Balb/c 3T3 de ratos. Os cimentos Variolink II (base), AllCem Veneer e RelyX Veneer foram testados. Para caracterização microestrutural destes materiais, análise termogravimétrica (TGA), cálculo do grau de conversão (GC) e análise da distribuição granulométrica das partículas de carga, foram realizados. O GC foi calculado utilizando-se a espectroscopia infravermelha por transformada de Fourier (FTIR). Dez amostras de cada cimento foram construídas em matriz teflon (0,5 mm x 5 mm) e fotoativadas pelo diodo emissor de luz (LED) Elipar S10 (3M ESPE). Após obtenção dos espectros FTIR iniciais (24h após a fotopolimerização), 5 amostras de cada cimento foram, individualmente, imersas em 10 ml de saliva artificial (pH = 7,0) e outras 5 em 10 ml de solução de ácido lático (pH = 4,0), por 18 dias, a 37°C. Depois, as amostras foram submetidas a novas análises espectroscópicas FTIR, sob as mesmas condições iniciais, e posteriormente, seus espectros foram comparados qualitativamente aos obtidos antes do processo de degradação. A viabilidade celular de fibroblastos 3T3, frente aos possíveis efeitos citotóxicos dos resíduos dos cimentos livres na solução de saliva artificial após 18 dias de degradação, foi testada através da redução do brometo de dimetiltiazol-difeniltetrazólico (MTT). As culturas foram expostas aos extratos salivares por 24h e 72h. Células controle foram expostas à solução de saliva artificial pura. Dados foram submetidos a ANOVA e teste Tukey. Os resultados demonstraram maior conteúdo de partículas de carga significante ao cimento Variolink II (65,86%±0,17; p<0,05) quando comparado aos cimentos RelyX Veneer (62,29%±0,30) e AllCem Veneer (62,15%±37,84); distribuição granulométrica trimodal aos cimentos Variolink II (0,2 ­ 3,3µm) e RelyX Veneer (0,6 ­ 29µm), e monomodal ao AllCem Veneer (1 ­ 4,1µm); maior GC ao cimento AllCem Veneer (71,23%±5,53; p<0,05), enquanto RelyX Veneer (66,00%±6,84) e Variolink II (62,24%±2,45) não diferiram entre si (p=0,1306). A solução de ácido lático contribuiu para maiores alterações sobre o conteúdo inorgânico do cimento Variolink II, porém este material demonstrou maior degradação polimérica após imersão em saliva artificial. O cimento RelyX Veneer degradou tanto em saliva artificial quanto em ácido lático, não havendo diferenças em relação à solução degradante. O cimento AllCem Veneer não revelou degradação química após imersão em ambos os meios testados. Em 24h de exposição, os resíduos do cimento AllCem Veneer garantiram a maior viabilidade celular para fibroblastos 3T3 (90,0±6,3), enquanto os do cimento Variolink II a menor (7,43±0,17). Após 72h de exposição, todos os extratos salivares ofereceram citotoxicidades importantes aos fibroblastos. Concluiu-se que os cimentos resinosos avaliados são passíveis de sofrerem degradação em condições que simulam o ambiente oral. Existiu uma relação direta entre degradação química dos cimentos resinosos e efeitos citotóxicos in vitro a fibroblastos 3T3.

The aim of this study was to evaluate the degradation of different light-activated resin cements after aging in artificial saliva and lactic acid solutions, and the in vitro cytotoxicity of salivary extracts obtained from the resin cements degradation on mouse fibroblast (Balb/c 3T3). The resin cements Variolink II, AllCem Veneer and RelyX Veneer were tested. For microstructure characterization, TGA, degree of conversion (DC) and granulometric distribution of filler particles were employed. The DC was calculated from baseline FTIR spectra obtained from uncured and cured samples of each resin cement. These samples were development on teflon mold (0.5 mm x 5.0 mm) and photoactivated by a LED (Elipar S10; 3M ESPE). After baseline FTIR spectra obtaining, 5 samples of each cement were immersed in 10 ml of artificial saliva (pH = 7.0) and the others 5 samples were immersed in 10 ml of lactic acid solution (pH = 4.0), individually, for 18 days, at 37°C. Then, the samples were submitted to new FTIR analyzes, at the same anterior conditions, and their new spectra were compared with the baselines by qualitative FTIR method. The cell viability of 3T3 fibroblast was evaluated of MTT test. The cells were exposed to salivary extracts for 24 h and 72 h. Control cells were exposed to pure artificial saliva solution. The data were submitted to ANOVA and Tukey's test. The results revealed significant higher mass percentage of filler particles for Variolink II (65.86%±0.17; p<0.05) when compared with RelyX Veneer (62.29%±0.30) and AllCem Veneer (62.15%±37.84); trimodal granulometric distribution for Variolink II (0.2 ­ 3.3 µm) and RelyX Veneer (0.6 ­ 29.0 µm), and monomodal distribution for AllCem Veneer (1.0 ­ 4.1 µm); significant higher baseline DC for AllCem Veneer (71.23%; p<0,05), while RelyX Veneer (66.00%±6.84) and Variolink II (62.24%±2.45) were not different from each other (p=0.1306). The lactic acid solution contributed to higher changes of the inorganic matrix for Variolink II cement. However, this cement revealed more polymeric degradation after aging in artificial saliva when compared with lactic acid solution. RelyX Veneer had chemical degradation in both solutions. AllCem Veneer not showed any chemical degradation after aging in both solutions. Within 24 h of exposure, the chemical wastes of the AllCem Veneer cement guaranteed the higher cell viability to 3T3 fibroblasts (90.0±6.30) and there was no difference with the control group (80.3±8.70). The chemical wastes of the Variolink II cement guaranteed the smaller cell viability at the same time (7.43±0.17). After 72 h of exposure, all salivary extracts, except for control group, caused important cytotoxic effects to 3T3 fibroblasts. Then, the resin cements evaluated in this study can suffer chemical degradation under conditions that simulate the oral environment. There was a direct relationship between chemical degradation and in vitro cytotoxicity.

Avaliação dos métodos para análise da microinfiltração marginal em restaurações de resina composta classe V in vitro / The methods evaluation for marginal microleakage analysis in class V resin composite restorations in vitro

O objetivo deste estudo foi comparar os resultados da microinfiltração marginal obtidos por diferentes meios de aquisição de imagens e métodos de mensuração da penetração de prata em restaurações de resina composta classe V, in vitro. Dezoito pré-molares humanos hígidos, recém extraídos, foram divididos em três grupos, de acordo com o tipo de instrumento para preparação cavitária utilizado. Grupo 1: ponta diamantada número 3100, em alta rotação. Grupo 2: broca carbide número 330, em alta rotação. Grupo 3: ponta CVDentus código 82137, em aparelho de ultrassom. Foram realizados preparos cavitários padronizados (3x4x2mm) classe V nas faces vestibular e lingual de todos os dentes, com margens oclusais em esmalte e cervicais em dentina/cemento. As cavidades foram restauradas com o sistema adesivo Solobond M (VOCO) e resina composta Grandio (VOCO), a qual foi inserida e fotoativada em três incrementos. Os corpos de prova ficaram imersos em água destilada por 24h a 37oC; receberam acabamento e polimento com discos SofLex (3M) e foram novamente armazenados em água destilada, por sete dias. Posteriormente, as superfícies dentárias foram coberta com duas camadas de esmalte para unhas vermelho, exceto as áreas adjacentes às restaurações. Os espécimes ficaram imersos em solução aquosa de nitrato de prata a 50% por 24h e em solução fotorreveladora por 2h e foram seccionados no sentido vestíbulo-lingual, passando pelo centro das restaurações, com disco diamantado em baixa rotação. As amostras foram polidas em politriz horizontal e analisadas por diferentes métodos. À extensão da microinfiltração foi atribuído escores de 0 a 3 através de análises por meio de estereomicroscópio tradicional e com leds e microscópio ótico. As imagens obtidas na lupa com leds e no microscópio ótico tiveram as áreas infiltradas medidas através do software AxioVision. O teste χ2 de McNemar-Bowker revelou concordância estatística entre estereomicroscópio tradicional e o com leds (p=0,809) ...

The aim of this study is compare the results of marginal microleakage got through different images acquiring methods and measuring methods related to silver leakage in class V resin composite restorations, in vitro. Eighteen intact human pre-molars were divided into three groups, according to the instruments for cavity preparation: 1- diamond tip, number 3100, in a turbine of high-speed; 2- carbide bur, number 330, in a turbine of high-speed; and 3- diamond tip (CVD), number 82137, coupled with an ultra-sound device. Class V cavities were prepared on buccal and lingual surfaces of the teeth, with occlusal margins in enamel and gingival margins in dentin. The cavities were treated with adhesive Solobond M (VOCO) and restored with composite Grandio (VOCO) through incremental technique. The samples were stored for 24h at 37oC in water, finished and polished with Soflex (3M) discs and stocked in water at 37oC for a week. Then, the surrounding tooth surfaces were coated with nail varnish, except in the areas adjacent to the restorations. The samples were immersed in a 50% solution of silver nitrate for 24h, exposed to photodeveloping solution for 2h, and cut in the buccal-lingual direction on restoration center. These sections were polished and the extent of microleakage was ranked using a 0-3 scale through tradicional stereomicroscope, with leds one and optical microscope. The images obtained through these latest devices had its leakage area measured with aid of AxioVision software. The χ2 McNemar-Bowker test revealed statistical agreement between tradicional stereomicroscope and with leds one (p=0,809) during semiquantitative analysis, but there were significant differences between optical microscope and stereomicroscopes (p<0,001). There were good correlation between semiquantitatives and quantitatives analysis according to Spearmann’s test (p<0,001). The Kruskall-Wallis test showed no statistically significant difference (p=0,174) between three ...