Pharmacological PI3K inhibition in head and neck squamous cell carcinoma: A systematic review

BACKGROUND

This systematic review aimed to investigate the in vitro and in vivo effects of phosphatidylinositol-3-kinase (PI3K) inhibitors on head and neck squamous cell carcinoma (HNSCC). Considering the role of PI3K and its downstream effectors in cell proliferation, invasion, and survival, it is reasonable to expect that treatment with PI3K inhibitors could control HNSCC onset and progression. Thus, the research question for our review was whether pharmacological inhibition of PI3K affects HNSCC progression.

METHODS

In vitro and in vivo studies were selected from six databases. We collected data regarding cell viability, apoptosis, and the regulation of protein expression levels from in vitro studies. For the in vivo studies, we analyzed the reduction in tumor size or gene and protein expression.

RESULTS

The included studies showed reduced cell proliferation and apoptosis after treatment with PI3K inhibitors. PI3K inhibitors in combination with other drugs had an enhanced anticancer effects compared to those of single-drug treatments.

CONCLUSIONS

The results support the potential of PI3K inhibitors as candidates for clinical trials in HNSCC.

Retention of Manually or CAD/CAM-customized Fiberglass Posts Luted to Enlarged Root Canals with Different Resin Cements

The aim of this laboratory study was to evaluate the pull-out force of a prefabricated fiberglass post (PP), relined fiberglass post (RP), or milled fiberglass post (MP) luted with Multilink N (MN), RelyX Unicem 2 (RXU2) or RelyX Ultimate (RU) to enlarged root canals. The thickness of the resin cements and the presence of voids in the resin cement film were observed. The root canals of 90 bovine incisors were enlarged, endodontically treated, and randomly divided into 9 groups (n=10) according to the post type and resin cement. The specimens were scanned using micro-CT to analyze the thickness of the resin cement and the presence of voids. The specimens were submitted to mechanical cyclic loading (500,000 cycles at 50 N load) and subjected to pull-out force testing. Two-way ANOVA and Tukey's test analyzed the pull-out force and resin cement thickness data. Kruskal-Wallis and Bonferroni tests analyzed the void scores. The interaction between factors (post x resin cement) was significant (p=0.0001) for the pull-out force. Higher pull-out forces were obtained for RP and MP compared to PP. The post factor was significant (p=0.0001) for resin cement thickness, which was higher for PP (1054 μm), followed by MP (301 μm) and RP (194 μm). More void formation occurred for PP, being less for RP, differing significantly among the posts. Post customization (RP and MP) decreased resin cement thickness and void formation, favoring a higher pull-out force. Resin cements requiring an adhesive application (MN and RU) favored higher pull-out force than self-adhesive resin cement (RXU2).

Pharmacological PTEN inhibition: potential clinical applications and effects in tissue regeneration

Although the human body can heal, it takes time, and slow healing and chronic wounds often occur. Thus, identifying novel therapies to aid regeneration is needed. Here, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews guidelines and assessed preclinical studies on phosphatase and tensin homolog (PTEN) inhibitors and their effects on tissue repair and regeneration. In conditions associated with neurodegeneration, tissue injury and ischemia, the PTEN-regulated PI3K/AKT signaling pathway is activated. The use of PTEN inhibitors resulted in better tissue response by reducing the healing time and lesion sizes or inducing neuronal regeneration. Notably, all studies included in this systematic review indicated that pharmacological inhibition of PTEN enhanced the repair process of the eye, lung, muscle and nervous system.

Effect of pH Cycling Followed by Simulated Toothbrushing on the Surface Roughness and Bacterial Adhesion of Bulk-fill Composite Resins

The aim was to evaluate, in vitro, quantitatively and qualitatively, the effect of pH cycling and simulated toothbrushing on surface roughness (Ra) and bacterial adhesion (Cn) of bulk-fill composite resins. Thirty specimens of each composite resin, 5 mm wide and 4 mm high, were obtained: group 1 (control): Filtek Z250 (Z250); group 2: Filtek Bulk-Fill (FTK); group 3: Tetric N-Ceram Bulk-Fill (TTC); and group 4: Aura Bulk-Fill (AUR). After 24 hours, the specimens were polished and then alternated with demineralization/remineralization solutions for 15 cycles of 24 hours each at 37°C. Then the specimens were submitted to simulated toothbrushing. The Ra and Cn measurements were quantitatively analyzed in three stages: after polishing (Ra0 and Cn0), after pH cycling (Ra1 and Cn1), and after simulated toothbrushing (Ra2 and Cn2). The Ra values were submitted to two-way analysis of variance, followed by the Tukey test (α=0.05). The Kruskal-Wallis test, followed by multiple comparisons, was applied for Cn analysis. Surface topography and bacterial adhesion were observed by scanning electron microscopy (SEM). Z250, FTK, and TTC showed no significant change in Ra regardless of the treatment performed; AUR obtained increased Ra at Ra2 (p<0.05). FTK differed from the others at Cn0 and Cn1 (p<0.05). At Cn2, there was no difference among the composite resins. SEM images showed the exposure of fillers and microcavities at Ra1 and Ra2. There was greater bacterial adhesion at Cn1 for Z250 and FTK. It was concluded that the pH cycling caused surface degradation of all composite resins, which was potentiated by simulated toothbrushing. However, only AUR presented an increased Ra. Bacterial adhesion occurred on all composite resins after pH cycling; however, after simulated toothbrushing, adhesion of dispersed bacteria was similar for all the composite resin groups.

Effect of Different Computer-aided Design/Computer-aided Manufacturing (CAD/CAM) Materials and Thicknesses on the Fracture Resistance of Occlusal Veneers

The aim was to evaluate, in vitro, the influence of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials (IPS e.max CAD, Vita Enamic, and Lava Ultimate) and thicknesses (0.6 mm and 1.5 mm) on the fracture resistance of occlusal veneers. Sixty human third molars were prepared to simulate advanced erosion of the occlusal surface, and the teeth were randomly divided into six experimental groups (n=10) according to the material and thickness used to build the veneers. Ten sound teeth formed the control group. The veneers were adhesively luted and submitted to mechanical cyclic loading (1 million cycles at 200-N load). The fracture resistance test was performed in a universal testing machine. The failures were classified as "reparable" and "irreparable." According to two-way analysis of variance and the Tukey test, the interaction (material × thickness) was significant ( p=0.013). The highest fracture resistance was obtained for IPS e.max CAD at a 1.5-mm thickness (4995 N) and was significantly higher compared to the other experimental groups ( p<0.05). The lowest fracture resistance was obtained for Vita Enamic at 0.6 mm (2973 N), although this resistance was not significantly different from those for IPS e.max CAD at 0.6 mm (3067 N), Lava Ultimate at 0.6 mm (3384 N), Vita Enamic at 1.5 mm (3540 N), and Lava Ultimate at 1.5 mm (3584 N) ( p>0.05). The experimental groups did not differ significantly from the sound teeth (3991 N) ( p>0.05). The failures were predominantly repairable. The occlusal veneers of IPS e.max CAD, Vita Enamic, and Lava Ultimate, with thicknesses of 0.6 mm and 1.5 mm, obtained fracture resistances similar to those associated with sound teeth.

Effect of Hydrofluoric Acid Concentration and Etching Time on Bond Strength to Lithium Disilicate Glass Ceramic

The aim of this study was to evaluate the influence of different concentrations of hydrofluoric acid (HF) associated with varied etching times on the microshear bond strength (μSBS) of a resin cement to a lithium disilicate glass ceramic. Two hundred seventy-five ceramic blocks (IPS e.max Press [EMX], Ivoclar Vivadent), measuring 8 mm × 3 mm thickness, were randomly distributed into five groups according to the HF concentrations (n=50): 1%, 2.5%, 5%, 7.5%, and 10%. Further random distribution into subgroups was performed according to the following etching times (n=10): 20, 40, 60, 120, and 20 + 20 seconds. After etching, all blocks were treated with a silane coupling agent followed by a thin layer of an unfilled resin. Three resin cement cylinders (∅=1 mm) were made on each EMX surface, which was then stored in deionized water at 37°C for 24 hours before testing. The μSBS was in a universal testing machine at a crosshead speed of 1 mm/min until failure. Data were submitted to two-way analysis of variance, and multiple comparisons were performed using the Tukey post hoc test (α=0.05). One representative EMX sample was etched according to the description of each subgroup and evaluated using scanning electron microscopy for surface characterization. The HF concentrations of 5%, 7.5%, and 10% provided significantly higher μSBS values than 1% and 2.5% (p<0.05), regardless of the etching times. For 1% and 2.5% HF, the etching times from 40 to 120 seconds increased the μSBS values compared with 20 seconds (p<0.05), but etching periods did not differ within the 5%, 7.5%, and 10% HF groups (p>0.05). The effect of re-etching was more evident for 1% and 2.5% HF (p<0.05). Different HF concentrations/etching times directly influenced the bond strength and surface morphology of EMX.

Marginal Adaptation and Quality of Interfaces in Lithium Disilicate Crowns — Influence of Manufacturing and Cementation Techniques

Purpose: To evaluate the cement line thickness and the interface quality in milled or injected lithium disilicate ceramic restorations and their influence on marginal adaptation using different cement types and different adhesive cementation techniques.

Methods and Materials: Sixty-four bovine teeth were prepared for full crown restoration (7.0±0.5 mm in height, 8.0 mm in cervical diameter, and 4.2 mm in incisal diameter) and were divided into two groups: CAD/CAM automation technology, IPS e.max CAD (CAD), and isostatic injection by heat technology, IPS e.max Press (PRESS). RelyX ARC (ARC) and RelyX U200 resin cements were used as luting agents in two activation methods: initial self-activation and light pre-activation for one second (tack-cure). Next, the specimens were stored in distilled water at 23°C ± 2°C for 72 hours. The cement line thickness was measured in micrometers, and the interface quality received scores according to the characteristics and sealing aspects. The evaluations were performed with an optical microscope, and scanning electron microscope images were presented to demonstrate the various features found in the cement line. For the cement line thickness, data were analyzed with three-way analysis of variance (ANOVA) and the Games-Howell test (α=0.05). For the variable interface quality, the data were analyzed with the Mann-Whitney U-test, the Kruskal-Wallis test, and multiple comparisons nonparametric Dunn test (α=0.05).

Results: The ANOVA presented statistical differences among the ceramic restoration manufacturing methods as well as a significant interaction between the manufacturing methods and types of cement (p&lt;0.05). The U200 presented lower cement line thickness values when compared to the ARC with both cementation techniques (p&lt;0.05). With regard to the interface quality, the Mann-Whitney U-test and the Kruskal-Wallis test demonstrated statistical differences between the ceramic restoration manufacturing methods and cementation techniques. The PRESS ceramics obtained lower scores than did the CAD ceramics when using ARC cement (p&lt;0.05).

Conclusions: Milled restorations cemented with self-adhesive resin cement resulted in a thinner cement line that is statistically different from that of CAD or pressed ceramics cemented with resin cement with adhesive application. No difference between one-second tack-cure and self-activation was noted.

Relined Fiberglass Post: Effect of Luting Length, Resin Cement, and Cyclic Loading on the Bond to Weakened Root Dentin

This study evaluated the effects of luting length of the post, the resin cement, and cyclic loading on pull-out bond strength of fiberglass posts relined with composite resin in weakened roots. The canals of 80 bovine incisors were endodontically treated and weakened with diamond burs. The teeth were randomly divided into eight groups (n=10) according to the luting procedures of the relined fiberglass post (RFP): In groups 1, 2, 3, and 4, the RFPs were luted with RelyX ARC, and in groups 5, 6, 7, and 8 they were luted with RelyX U200. In groups 1, 3, 5, and 7, the RFPs were luted at a length of 5 mm, and in groups 2, 4, 6, and 8 they were luted at a length of 10 mm. Specimens from groups 3, 4, 7, and 8 were submitted to cyclic loading. Specimens were subjected to a pull-out bond strength test in a universal testing machine. The results (MPa) were analyzed by three-way analysis of variance and the Tukey post hoc test (α=0.05). Six human upper anterior teeth were used to analyze the bond interface by confocal laser scanning microscopy (CLSM). The pull-out bond strength of RFPs luted with RelyX U200 was statistically higher than that of RelyX ARC. Cyclic loading influenced the bond strength only for the luting length of 5 mm. CLSM analysis revealed the formation of resin cement tags for both materials. Luting length is an important factor in retaining RFPs in weakened roots when they are subjected to cyclic loading, and RelyX U200 resulted in greater bond strengths to the root canal in comparison with RelyX ARC.

The Effect of Hydrofluoric Acid Concentration on the Bond Strength and Morphology of the Surface and Interface of Glass Ceramics to a Resin Cement

The purpose of this study was to evaluate the influence of various concentrations of hydrofluoric acid (HF) on the surface/interface morphology and μ-shear bond strength (μSBS) between IPS Empress Esthetic (EST) (Ivoclar Vivadent) and IPS e.max Press (EMX) (Ivoclar Vivadent) ceramics and resin cement. Ceramic blocks were divided into 12 groups for each kind of ceramic. Six different HF concentrations were evaluated: 1%, 2.5%, 5%, 7.5%, 10%, and 15%. All groups were silanated after etching, and half of the specimens within each group received a thin layer of unfilled resin (UR). Three resin cement cylinders were prepared on each ceramic block for μSBS testing. The specimens were stored in distilled water at 37°C for 24 hours. The μSBS test was carried out in a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. The data were submitted to three-way analysis of variance and multiple comparisons were performed using the Tukey post hoc test (p<0.05). The etched surfaces and bonded interfaces were evaluated using scanning electron microscopy. μSBS means (MPa) for 1%, 2.5%, 5%, 7.5%, 10%, and 15% HF concentrations were, respectively, 25.2, 27.2, 30.1, 31.4, 33.3, and 31.8. μSBS means with or without UR application measured 32.24 and 27.4, respectively; EST and EMX measured 29.8 and 29.9, respectively. For the HF concentrations, 10% and 15% showed higher μSBS means than did 1% and 2.5% (p<0.05); 7.5% was higher than 1% (p<0.05); and no statistical differences were found among the other concentrations (p>0.05). When evaluating UR, μSBS mean was significantly higher and better infiltration was observed on the etched surfaces. No statistical difference was found between the ceramics. The HF concentration and UR influenced the bond strength and surface/interface morphology.

Influence of immediate dentin sealing techniques on cuspal deflection and fracture resistance of teeth restored with composite resin inlays

SUMMARY This research evaluated the influence of immediate dentin sealing (IDS) techniques on cuspal deflection and fracture resistance of teeth restored with composite resin inlays. Forty-eight maxillary premolars were divided into four groups: G1, sound teeth (control); G2, without IDS; G3, IDS with Clearfil SE Bond (CSE); and G4, IDS with CSE and Protect Liner F. The teeth from groups 2, 3, and 4 received mesio-distal-occlusal preparations. The impressions were made with vinyl polysiloxane, followed by provisional restoration and storage in water for seven days. The impressions were poured using type IV die stone, and inlays with Filtek Z250 composite resin were built over each cast. The inlays were luted with Panavia F. After storage in water for 72 hours, a 200-N load was applied on the occlusal surface using a metal sphere connected to a universal testing machine, and the cuspal deflection was measured with a micrometer. The specimens were then submitted to an axial load until failure. The following mean cuspal deflection (μm) and mean fracture resistance (N) followed by the same lowercase letter represent no statistical difference by analysis of variance and Tukey (p<0.05): cuspal deflection: G1, 3.1 ± 1.5(a); G2, 10.3 ± 4.6(b); G3, 5.5 ± 1.8(ac); and G4, 7.7 ± 5.1(bc); fracture resistance: G1, 1974 ± 708(a); G2, 1162 ± 474(b); G3, 700 ± 280(b); and G4, 810 ± 343(b). IDS with CSE allowed cuspal deflection comparable with that associated with sound teeth. The application of Protect Liner F did not contribute to a decrease in cuspal deflection. The IDS techniques did not influence the fracture resistance of teeth.

Effects of Surface Treatments, Thermocycling, and Cyclic Loading on the Bond Strength of a Resin Cement Bonded to a Lithium Disilicate Glass Ceramic

Objectives

The aim of this present study was to investigate the effect of two surface treatments, fatigue and thermocycling, on the microtensile bond strength of a newly introduced lithium disilicate glass ceramic (IPS e.max Press, Ivoclar Vivadent) and a dual-cured resin cement.

Methods

A total of 18 ceramic blocks (10 mm long × 7 mm wide × 3.0 mm thick) were fabricated and divided into six groups (n=3): groups 1, 2, and 3—air particle abraded for five seconds with 50-μm aluminum oxide particles; groups 4, 5, and 6—acid etched with 10% hydrofluoric acid for 20 seconds. A silane coupling agent was applied onto all specimens and allowed to dry for five seconds, and the ceramic blocks were bonded to a block of composite Tetric N-Ceram (Ivoclar Vivadent) with RelyX ARC (3M ESPE) resin cement and placed under a 500-g static load for two minutes. The cement excess was removed with a disposable microbrush, and four periods of light activation for 40 seconds each were performed at right angles using an LED curing unit (UltraLume LED 5, Ultradent) with a final 40 second light exposure from the top surface. All of the specimens were stored in distilled water at 37°C for 24 hours. Groups 2 and 5 were submitted to 3,000 thermal cycles between 5°C and 55°C, and groups 3 and 6 were submitted to a fatigue test of 100,000 cycles at 2 Hz. Specimens were sectioned perpendicular to the bonding area to obtain beams with a cross-sectional area of 1 mm2 (30 beams per group) and submitted to a microtensile bond strength test in a testing machine (EZ Test) at a crosshead speed of 0.5 mm/min. Data were submitted to analysis of variance and Tukey post hoc test (p≤0.05).

Results

The microtensile bond strength values (MPa) were 26.9 ± 6.9, 22.2 ± 7.8, and 21.2 ± 9.1 for groups 1–3 and 35.0 ± 9.6, 24.3 ± 8.9, and 23.9 ± 6.3 for groups 4–6. For the control group, fatigue testing and thermocycling produced a predominance of adhesive failures. Fatigue and thermocycling significantly decreased the microtensile bond strength for both ceramic surface treatments when compared with the control groups. Etching with 10% hydrofluoric acid significantly increased the microtensile bond strength for the control group.

In vitro marginal fit of three all-ceramic crown systems before and after cementation

STATEMENT OF THE PROBLEM

Full-coverage all-ceramic restorations are widely used. The impact of various classifications of luting agent on marginal discrepancies is not well understood.

PURPOSE

The purpose of this study was to evaluate the cervical fit of all ceramic crowns (IPS e.maxPress, Cergogold, and In Ceram) on bovine teeth with two luting agents before and after cementation.

MATERIALS AND METHODS

Ninety bovine incisors were embedded in resin. The coronal portions of the teeth were prepared to receive full-coverage crowns. Thirty crowns of 7.0 ± 0.5 mm height, 8.0 mm cervical diameter, and 4.2 mm incisal diameter were fabricated for each ceramic system. The crowns were seated on the teeth, and the marginal discrepancy was measured using a measuring microscope. Then, 15 crowns of each ceramic system were luted on the teeth with resin cement (Variolink II) or resin-modified glass ionomer cement (Rely X luting), and the marginal discrepancy was measured. The results were submitted to analysis of variance, t test and Tukey's test (p<0.05).

RESULTS

The three ceramic systems showed cervical fits after cementation statistically inferior to cervical fits before cementation for the two cements. The IPS e.maxPress showed values for cervical fit statistically superior to Cergogold before cementation. No statistically significant difference was found between IPS e.maxPress and In Ceram and In Ceram and Cergogold. After cementation, no statistically significant difference was found for the three ceramics systems when luted with resin or resin-modified glass ionomer luting agents.

CONCLUSIONS

Within the limitations of this study, it can be concluded that both cements studied increase the marginal discrepancy between the crown and the preparation for the three ceramic systems evaluated.

Influence of Glazed Zirconia on Dual-Cure Luting Agent Bond Strength

Treatment of yttrium-stabilized tetragonal zirconia ceramic surfaces with a low-fusing porcelain layer as a glaze significantly increased the bond strength of dual-cure resin cement to the ceramic surface.

Effect of refrigeration on tensile bond strength of three adhesive systems

The purpose of this study was to investigate the tensile bond strengths of three adhesive systems applied to dentin at refrigerated and room temperatures. Ninety bovine incisor teeth were obtained, embedded in self-cured acrylic resin, abraded on a lathe under water spray and polished to 400 and 600 grit to form standardized dentin surfaces before randomly assigning to six groups (n = 15). The adhesive systems Scotchbond Multi-Purpose, Single Bond and Prime & Bond NT were applied to dentin according to the manufacturers' instructions at refrigerated temperature (4 degrees C) and at room temperature (23 degrees C), before bonding resin-based composite (Z 100). The specimens were stored in distilled water at 37 degrees C for 24 hours and submitted to tensile bond strength tests on a universal testing machine (EMIC DL-2000) at a crosshead speed of 0.5 mm/min. The resulting data were statistically analyzed using analysis of variance and Tukey's test. No statistical differences were found when the adhesive systems were applied at refrigerated and room temperatures. Scotchbond Multi-Purpose and Single Bond had significantly stronger tensile bond strengths than Prime & Bond NT at room and refrigerated temperatures (p < 0.01). Scotchbond Multi-Purpose and Single Bond were statistically similar. No adverse effects upon tensile bond strength were observed when adhesive systems were taken directly from refrigerated storage.