Exploring the role of flavonoids in caries-affected dentin adhesion: A comprehensive scoping review

OBJECTIVES

The aim of this scoping review was to evaluate the available scientific evidence regarding the use of flavonoids in the treatment of caries-affected dentin focusing on bonding to dentin.

METHODS

A comprehensive literature search was performed in five databases from March 2022 and updated in April 2023: PubMed, EMBASE, Scopus, Web of Science, and Scielo. Additionally, the references of included studies were manually searched. Gray literature was excluded from the review.

STUDY SELECTION

Inclusion criteria included in vitro, in situ, and in vivo studies (animal or human) published in English. Abstracts, reviews, case reports, book chapters, doctoral dissertations, guidelines, and studies using pure plant extracts were excluded. Data collected from the selected studies were summarized and subjected to narrative and descriptive analysis. Out of the 91 studies identified, only 16 studies met the inclusion criteria.

RESULTS

The review analyzed eight different flavonoids (hesperidin, galardin, proanthocyanidin, genipin, quercetin, naringin, epigallocatechin-3-gallate, and other catechins subtypes) used as pretreatment or loaded into adhesive systems, primers, and phosphoric acid. The use of flavonoids improved the mechanical properties of the materials and modified the biological properties of the dentin, reducing collagen loss by the inhibition of proteolytic activity of matrix metalloproteinases (MMPs).

CONCLUSIONS

Based on the findings of this scoping review, it can be concluded that the use of flavonoids as pretreatment or incorporation into dental materials preserves collagen in the hybrid layer, inhibiting the MMPs activities, modifying the collagen fibrils of the dentin matrix and improving the mechanical properties of the dental adhesive systems. Therefore, it represents a promising approach for promoting dentin biomodification. This can result in more stable bonding of adhesive restorations to caries-affected dentin.

Teaching pulpectomy in paediatric dentistry: A national cross-sectional survey of dental schools in Brazil

BACKGROUND

Pulpectomy is used to treat primary teeth with irreversibly inflamed or necrotic pulp tissue. There is, however, a lack of consensus on clinical protocols for teaching pulpectomy at dental schools.

AIM

To determine what faculty members at Brazilian dental schools are teaching about pulpectomy in primary teeth.

DESIGN

A cross-sectional, observational study was conducted using a 39-question survey available via the Google Forms® platform. A snowball sampling strategy was used for recruitment. Invitations to participate were sent via e-mail, WhatsApp® and Instagram®. The data were analysed descriptively.

RESULTS

A total of 177 (58.4%) responses were obtained. Most faculty members recommended the use of Kerr hand files (66.1%), and 1% sodium hypochlorite was the most common choice for the irrigating solution (35.3%). Iodoform pastes were the first choice of faculty members (41.6%), and 60.5% of the faculty members recommended composite resin as the definitive restoration.

CONCLUSION

Similarities were found in the teaching of pulpectomy for primary teeth among faculty members at dental schools in Brazil.

The Self Assembling peptide P11-4 influences viability and osteogenic differentiation of stem cells of the apical papilla (SCAP)

OBJECTIVE

to analyze the effect of P₁₁-4 self-assembly peptide on cell viability and osteogenic capacity of SCAPs through mineral deposition and gene expression of osteogenic markers. .

METHODS

SCAPs were seeded in contact with P₁₁-4 (10 µg/ml, 100 µg/ml and 1 mg/ml) solution. Cell viability was evaluated using a colorimetric assay MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) in an experimental time of 24, 48 and 72 h (n=7). Mineral deposition and quantification provided by the cells was tested using the Alizarin Red staining and Cetylpyridinium Chloride (CPC), respectively, after 30 days (n=4). Gene expression of Runt-related transcription factor 2 (RUNX2), Alkaline phosphatase (ALP) and Osteocalcin (OCN) was quantified using quantitative polymerase chain reaction (RT-qPCR), at 3 and 7 days with Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as the housekeeping gene, and relative gene expression was measured using the ΔΔCq method. Data were analyzed using Kruskall-Wallis followed by multiple comparisons, and T-test for gene expression with α=0.05.

RESULTS

All tested concentrations (10 µg/ml, 100 µg/ml and 1 mg/ml) were not cytotoxic at time 24 and 48 h. After 72 h, a slight decrease in cell viability was observed for the lowest concentration (10 µg/ml). The concentration of 100 µg/ml P11-4 showed the highest mineral deposition. However, qPCR analysis of P11-4 (10 µg/ml) showed upregulation of RUNX2 and OCN at 3 days, with downregulation of ALP at 3 and 7d.

CONCLUSION

P11-4 did not affect cell viability, induced mineral deposition in SCAPs, and upregulated the expression of RUNX2 and OCN genes at 3 days, while downregulating ALP expression at 3 and 7 days.

CLINICAL SIGNIFICANCE

Based on the results obtained in this study it can be stated that self-assembling peptide P11-4 is a potential candidate to induce mineralization on dental stem cells for regenerative purposes and also for a clinical use as a capping agent without compromising the cells health.

TiO2 nanotube-containing glass ionomer cements display reduced aluminum release rates

Titanium dioxide nanotubes (TiO2-nts) were incorporated into a glass ionomer cement (GIC) with improved mechanical properties and antibacterial activity. The aims of the present in vitro study were to define the elemental characterization, aluminum (Al) release rate, and initial working time for GIC reinforced with TiO2-nts, in an experimental caries model. TiO2-nts were incorporated into GIC powder components at 5% by weight, and compared with unblended GIC. Experimental approaches used energy-dispersive spectrometry (EDS), atomic absorption spectrophotometry (AAS), and brightness loss to define surface element properties, Al release rates, and initial working time, respectively. Statistical analysis was performed by 2-way ANOVA, Tukey's test, generalized linear models, and Student's t test (a = 0.05). EDS data analysis revealed that TiO2-nts incorporated into GIC had no significant impact on the typical elemental composition of GICs in an in vitro caries model. Regarding the demineralizing solution, GIC with TiO2-nt significantly decreased the Al release rate, compared with the control group (p < 0.0001). Moreover, TiO2-nt incorporated into GIC did not alter the initial working time of the material (p > 0.05). These findings add information to our scientific body of knowledge concerning the potential impact of TiO2-nt on the performance of conventional GICs.

Self-assembly peptide P11-4 induces mineralization and cell-migration of odontoblast-like cells

OBJECTIVES

Self-assembling peptide P11-4 is amphiphilic and pH-triggered, effective on repairing early enamel carious lesions and dentin remineralization. However, P11-4 effects on dentin biomineralization and repair ability remain unexplored. Thus, cytocompatibility and effectiveness of P11-4 on inducing mineralization and migration of odontoblast-like cells (MDPC-23) were investigated.

METHODS

MDPC-23 were seeded in contact with P11-4 (0.5 and 1 µg/ml), Dentin Matrix Protein 1 (DMP1 0.5 and 1 µg/ml) or Calcium hydroxide (Ca(OH)2 100 µg/ml) solutions. Cell viability was verified using MTT (n = 6/group). Mineral deposition was tested using Alizarin Red (n = 4/group). Cell migration was assessed by light microscopy (n = 2/group). MTT and Alizarin Red data were compared using Kruskal-Wallis and Mann-Whitney (α=0.01).

RESULTS

P11-4 (0.5 and 1 µg/ml) and DMP1 (0.5 and 1 µg/ml) resulted the highest cell viability; Ca(OH)2 presented the lowest. 1 µg/ml DMP1 and 1 µg/ml P11-4 promoted the highest mineral deposition. Ca(OH)2 presented lower values of mineral deposits than DMP1 1 µg/ml (p < 0.01), but similar to P11-4 1 µg/ml. P11-4 and DMP1 at 0.5 µg/ml induced lesser mineral precipitation than P11-4 and DMP1 at 1 µg/ml (p < 0.01), with no difference to Ca(OH)2. All materials stimulated cell migration, however, lower concentrations of DMP1 and P11-4 demonstrated a higher migration potential.

CONCLUSION

P11-4 did not affect cell viability, induces mineral deposition and MDPC-23 migration like DMP1.

CLINICAL SIGNIFICANCE

Self-assembling peptide P11-4 does not affect the cell viability and induces mineral deposition comparable to native protein involved in biomineralization. Combined with its ability to bind type I collagen, P11-4 is a promising bioinspired molecule that provides native-tissue conditions and foster further studies on its ability to form dentin bridges in pulp-capping strategies.

Impact of Resin Composite Viscosity and Fill-technique on Internal Gap in Class I Restorations: An OCT Evaluation

The aim of this in vitro study was to quantitatively evaluate the internal gap of resin composites of high-and low-viscosity used in single- and incremental-fill techniques in Class I cavities exposed to thermal cycling (TC) using optical coherence tomography (OCT). Cavities of 4-mm depth and 3-mm diameter were prepared in 36 third molars randomly distributed into four groups, according to viscosity of restorative resin-based composite (high or low viscosity, all from 3M Oral Care) and technique application (bulk or incremental fill) used (n=9): RC, high-viscosity, incremental-fill, resin-based composite (Filtek Z350 XT Universal Restorative); BF, high-viscosity, bulk-fill, resin-based composite (Filtek One Bulk Fill); LRC, low-viscosity, incremental-fill, resin-based composite (Filtek Z350 XT Flowable Universal Restorative); and LBF, low-viscosity, bulk-fill, resin-based composite (Filtek Flowable Restorative). Single Bond Universal Adhesive system (3M Oral Care) was used in all the experimental groups. The incremental-fill technique was used for RC and LRC groups (2-mm increments), and a single-layer technique was used for BF and LBF groups, as recommended by the manufacturer. The internal adaptation of the resin at all dentin walls was evaluated before and after TC (5000 cycles between 5°C and 55°C) using OCT images. Five images of each restored tooth were obtained. Images were analyzed using ImageJ software that measured the entire length of the gaps at the dentin-restoration interface. The length of gaps (μm) was analyzed using two-way repeated measures ANOVA and the Tukey tests (α=0.05). There was a significant interaction between material types and TC (p=0.006), and a significant difference among all material types (p<0.0001), before and after TC (p<0.0001). Increased internal gaps at the dentin-restoration interface were noticed after TC for all groups. RC presented the lowest value of internal gap before and after TC, while LBF showed the highest values of internal gap after TC. In conclusion, TC negatively affected the integrity of internal gap, whereas high-viscosity, incremental-fill, resin-based composite presented better performance in terms of internal adaptation than low-viscosity, bulk-fill materials in Class I cavities.

CHX Stabilizes the Resin/demineralized Dentin Interface

The aim of this study was to evaluate the effect of 2% chlorhexidine digluconate (CHX) on microtensile bond strength (µTBS) between an adhesive system and under 3 dentin conditions. For that, this study evaluated the adhesive interface at initial, after 6 months and 1 year of storage. Forty-eight human third molars were prepared and randomly divided into 3 groups, according to dentin substrates: sound dentin (Sd), caries-infected dentin (Ci) and caries-affected dentin (Ca). The groups were subdivided into two according to the dentin pre-treatment: application of 2% CHX or without pre-treatment (control). The dentin surfaces were etched with 35% phosphoric acid gel and bonded with Adper Single Bond 2 (3M ESPE) adhesive system according to manufacturer's instructions. Subsequently, the specimens were stored in deionized water at 37°C for 24h, 6 months and 1 year. Two additional teeth were used to analyze the bonding interfaces by SEM. Data was submitted to three-way ANOVA in a split plot design and Tukey's test (α = 0.05). The results showed that Ci decreased µTBS values when compared to Ca and Sd, regardless storages time or treatment. Stored samples for 6 months and 1 year decreased the µTBS for the control group, but no difference was found between storages time for the CHX group. As a conclusion, the 2% CHX application after etching showed improved dentin bond strength in the storage time, regardless of the substrates evaluated.

Limited Etching Time Increases Self-adhesive Resin Cement Adhesion to Enamel

AIM

To evaluate the influence of different enamel etching times on the bond strength of two self-adhesive resin cements (RCs) with and without thermocycling (TMC).

METHODS

One hundred twenty bovine teeth were used. Blocks of enamel (8×4×2mm) were obtained, polished, and randomly divided into two groups, according to the RC used: MaxCem Elite or RelyX U200. Groups were subdivided into four groups (n=16), according to the etching time: Control (0 seconds), 5 seconds, 10 seconds, and 20 seconds. Three RC cylinders (1-mm diameter) were built on each enamel block. The specimens were submitted to two storage conditions: 24 hours in distilled water or TMC (5000 cycles/5°C-55°C). Afterward, the specimens were submitted to the shear bond strength (SBS) test. The failure modes and adhesive interfaces were analyzed by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Data were analyzed with three-way analysis of variance (ANOVA) and Tukey test (α=0.05).

RESULTS

Etching increased the SBS for both the RCs,especially forthe groups etched for 5 and 10 seconds. TMC affected negatively the SBS of the control groups (p<0.05). No resin tags were observed in control groups, and the formation of tags was time dependent.

CONCLUSION

The 10 seconds etching time was more effective in increasing the enamel-resin bond strength. TMC negatively affected bond strength in specimens without acid etching.

Titanium dioxide nanotubes added to glass ionomer cements affect S. mutans viability and mechanisms of virulence

This in vitro study evaluated the impact of TiO2 nanotubes (n-TiO2) incorporated into glass ionomer cement (GIC) on Streptococcus mutans (S. mutans) characteristics at cellular and molecular levels. n-TiO2, synthesized by the alkaline method (20 nm in size), was added to Ketac Molar EasyMix® at 0%, 3%, 5%, and 7% by weight. S. mutans strains were cultured on GIC disks with addition or not of n-TiO2 for 1, 3, and 7 days and the following parameters were assessed: inhibition halo (mm) (n=3/group); cell viability (live/dead) (n=5/group); cell morphology (SEM) (n=3/group); and gene expression by real-time PCR (vicR, covR, gtfB, gtfC, and gtfD) (n=6/group). The data were analyzed by the Kruskal-Wallis test, repeated-measures ANOVA or two-way ANOVA, and Tukey's and Dunn's post-hoc tests (α=0.05). The agar diffusion test showed a higher antibacterial property for 5% n-TiO2 compared with 3% and 7% (p<0.05) with no effect of time (1, 3, and 7 days). The cell number was significantly affected by all n-TiO2 groups, while viability was mostly affected by 3% and 5% n-TiO2, which also affected cell morphology and organization. Real-time PCR demonstrated that n-TiO2 reduced the expression of covR when compared with GIC with no n-TiO2 (p<0.05), with no effect of time, except for 3% n-TiO2 on vicR expression. Within-group and between-group analyses revealed n-TiO2 did not affect mRNA levels of gtfB, gtfC, and gtfD (p>0.05). Incorporation of n-TiO2 at 3% and 5% potentially affected S. mutans viability and the expression of key genes for bacterial survival and growth, improving the anticariogenic properties of GIC.

Analysis of enamel/restoration interface submitted cariogenic challenge and fluoride release

The treatment of high-risk patients still is a challenge. The understanding and development non-invasive, non-destructive, and non-ionizing techniques, can help to guide the treatment and the diagnosis of primary and recurrent caries. The present study evaluated the behavior of enamel/restoration interface after a cariogenic challenge by Fourier domain optical coherence tomography (FD-OCT), scanning electron microscopy (SEM) examination, and the fluoride release of the different restorative materials. Cavities (1.5 × 0.5 mm) were performed in enamel surface and divided into groups (n = 8): glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and resin composite (RC). The samples were submitted to pH-cycling, and the solutions analyzed for cumulative fluoride by ion-analyzer. The morphology was analyzed by SEM through replicas. The optical attenuation coefficient (OAC) was calculated through exponential decay from the images generated by FD-OCT. Data were analyzed considering α = 0.05. OAC values increased for all groups after pH-cycling indicating demineralization (p < .05). Considering the remineralizing solution, RMGIC presented higher fluoride release rate, followed by GIC, while RC did not release any fluoride. Yet for the demineralizing solution, RMGIC and GIC released similar fluoride rates, overcoming RC (p < .05). Micrographs revealed no changes on the restorations margins, although enamel detachment was observed for RC and GIC after pH-cycling.

Impact of biomineralization on resin/biomineralized dentin bond longevity in a minimally invasive approach: An "in vitro" 18-month follow-up

OBJECTIVES

To determine the impact of treating caries-affected dentin (CAD) with: 0.2% sodium fluoride (NaF), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP/MI Paste™) or peptide P₁₁-4 (Curodont™ Repair) on the longevity of resin/CAD interface at storage times of 24 -h, 6- and 18-month.

METHODS

255 caries-free third molars were used, and CAD was produced by a biological method. The teeth were randomly distributed into: G1- Sound dentin (SD); G2- CAD; G3- CAD + 0.2% NaF (CAD/NaF); G4- CAD + CPP-ACP (CAD/ACP); G5- CAD + Curodont™ Repair (CAD/P₁₁-4). The Filtek Z350 composite resin block was bonded to dentin using Adper™ Single 2 (4 mm/height). Resin/dentin blocks were stored in a solution of Simulated Body Fluid at 37 °C, pressures were modified to simulate natural pulpal pressures. Specimens were investigated by microtensile bond strength (μTBS) (n = 8), Scanning Electron Microscopy (to assess the failure mode) (n = 8), nanoinfiltration (to assess the interface sealing) (n = 3), in situ zymography (to assess the gelatinolytic activity) (n = 3) and micro-computed microtomography (μ-CT) (to assess the mineralization) (n = 3). Data from μTBS, μ-CT and, nanoinfiltration and hybrid layer formation/degradation were submitted to two-way ANOVA and Tukey tests, and failure patterns and in situ zymography to Kruskal-Wallis and Dunn tests (α = 5%).

RESULTS

The highest mineral density change by μ-CT, smallest silver nitrate infiltration and proteolytic activity in the adhesive layer were obtained significantly for the groups SD, CAD/ACP and CAD/P₁₁-4, with most mixed fractures at 18-month (p < 0.001). CAD/NaF showed significantly similar values to CAD, CAD and CAD/NaF which presented a high percentage of adhesive fracture (p < 0.001) at all time periods.

SIGNIFICANCE

Treating caries-affected dentin with remineralizing agents CPP-ACP and Curodont™ Repair, has the potential to be a clinically relevant treatment protocol to increase the longevity of adhesive restorations.

Consensus on glass-ionomer cement thresholds for restorative indications

OBJECTIVE

The aim of this paper is to present the results of a consensus meeting on the threshold property requirements for the clinical use of conventional glass-ionomer cements (GICs) for restorative indications.

METHODS

Twenty-one experts on GICs evaluated the results of tests on mechanical and optical properties of 18 different brands of restorative GICs: Bioglass R [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z [IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [MA], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. All experiments were carried out by a team of researchers from Brazil and England following strict protocols, under the same laboratory conditions throughout, and maintaining data integrity.

RESULTS

There was consensus on: determining as primary properties of the material: compressive strength, microhardness, acid erosion and fluoride release, and as secondary properties: contrast ratio and translucency parameter, in order to rank the materials. Seven brands were below the thresholds for restorative indications: IZ, IM, IG, MA, VF, B and MG.

CONCLUSIONS

Based on the primary properties adopted as being essential for restorative indications, the conventional restorative GICs that met the thresholds and could be considered suitable as long-term restorative materials were: EF, GI, GL9, KM, IP, GL2, IS, CR, V, VM and R. A decision-making process to select the best GIC must also include results from clinical trials.

CLINICAL SIGNIFICANCE

This study provides a ranking of GICs that could be considered suitable as long-term restorative materials based on their main properties.

Fluoride release and remineralizing potential of varnishes in early caries lesions in primary teeth

This study evaluated the fluoride (F) release and remineralizing potential of varnishes containing sodium fluoride (5% NaF), 5% NaF with CPP-ACP and 5% NaF with TCP in early caries lesions in primary teeth. To determine the F release at 1, 4, 6, 24, 72, and 168 hr, strips were covered with the varnishes and immersed in purified water (n = 7). The varnishes and purified water (negative control) were applied on enamel blocks with early caries lesions (n = 16). Enamel blocks were stored in artificial saliva and submitted to a pH-cycling. The area of enamel hardness loss (ΔS) was analyzed by microhardness, lesion depth by polarized light microscopy (PLM) and the chemical analysis by Energy-dispersive X-ray spectroscopy. Data were submitted to Shapiro-Wilk, two-way and one-way ANOVA, Tukey and paired t-tests (α = 5%). All varnishes released F, but 5% NaF with CPP-ACP had the highest release at 4, 6, 24, and 72 hr (p < .05) followed by 5% NaF with TCP and 5% NaF. No significant difference in ΔS was observed among varnishes (5% NaF = 4,098.4 ± 1,407.9; 5% NaF with CPP-ACP = 4,164.0 ± 1,019.3; 5% NaF with TCP = 4,183.2 ± 1,527.2; p = .999), but all of them differed from the negative control group (6,757.8 ± 2,274.7; p < .001). Lesion depth was lower in varnishes groups compared to negative control (% reduction: 5% NaF = 41.8%, 5% NaF with CPP-ACP = 38.8%, and 5% NaF with TCP = 36.3%; p < .001). Similar Ca, P, and Ca/P ratio percentages among groups and F was not detected after the treatments. All fluoride varnishes showed potential to enhance remineralization of early caries lesions in primary teeth.

Physical-Mechanical Properties of Bulk Fill Composites Submitted to Biodegradation by Streptococcus mutans

The aim of this study was to evaluate the Streptococcus mutans biofilm influence on the roughness (Ra), gloss (GU), surface hardness (KHN) and flexural strength (FS) of high viscosity bulk fill composites. Filtek Bulk Fill (FBF), Tetric N Ceram Bulk Fill (TNC), X-tra fil Bulk Fill (XF) and Filtek Z350 (FZ) were used. Ten discs of each composite were prepared for Ra, KHN and GU and 20 bars for the FS. After 24 h, specimens were polished and initial analyzes performed. Samples were sterilized and subjected to biodegradation for 7 days and final analyzes performed. Representative samples of each group were evaluated in Scanning Electron Microscope. Data were submitted to ANOVA two factors and Tukey test. XF presented the highest values (p<0.05) of Ra before and after biodegradation (0.1251; 0.3100), and FZ (0.1443) the lowest after biodegradation (p<0.05). The highest GU values (p<0.05) were observed for FZ (71.7; 62) and FBF (69.0; 64.6), and the lowest (p<0.05) for TNC (61.4; 53.3) and XF (58.5; 53.5), both before and after biodegradation. For KHN the highest values were obtained by XF (151.7; 106), and the (p< 0.05) lowest values for TNC (62.2; 51.8), both before and after biodegradation. The highest values (p<0.05) of FS were observed for FZ (127.6) and the lowest (p<0.05) for TNC (86.9); after biodegradation, XF (117.7) presented the highest (p<0.05) values compared to TNC and FZ." In conclusion, biodegradation increased Ra and decreased GU and KHN for all. Concerning FS, degradation provided a significant decreased value only for FZ.

Effect of Intracanal Medicaments and Irrigants on the Release of Transforming Growth Factor Beta 1 and Vascular Endothelial Growth Factor from Cervical Root Dentin

INTRODUCTION

This study aimed to evaluate (1) the effect of irrigating solutions and intracanal medicaments on the release of transforming growth factor beta 1 (TGF-β1) and vascular endothelial growth factor (VEGF) from cervical root dentin and (2) the effect of associating triple antibiotic paste (TAP) and calcium hydroxide paste (CH) with 2% chlorhexidine (CHX) on TGF-β1 release.

METHODS

First, 119 specimens from roots (cervical thirds) were obtained and were distributed into 5 groups: 2% CHX, 2.5% sodium hypochlorite, TAP, CH, and 10% EDTA by each growth factor (TGF-β1 [n = 8] and VEGF [n = 8]). Then, specimens were distributed as follows (n = 13): TAP + 2% CHX, CH + 2% CHX, and 10% EDTA and treated with irrigating solutions and intracanal medicaments. After the treatments, the specimens were immersed in 10% EDTA (20 minutes), and the solution was analyzed using the enzyme-linked immunosorbent assay. The data were submitted to normality, homogeneity of variance, and Mann-Whitney tests (P < .05).

RESULTS

Significant differences were found between the irrigating solutions (P < .05) and intracanal medicaments for TGF-β1 (P < .05). No VEGF release was detected for any group. Our results showed no significant differences among the TAP + 2% CHX and EDTA groups for TGF-β1 but a significant difference between CH + 2% CHX and the other groups (P < .05).

CONCLUSIONS

The use of 2% CHX as the irrigating solution, CH as the intracanal medicament, and 10% EDTA as the final irrigation provides higher TGF-β1 release from the cervical root dentin, whereas VEGF was not detected. Moreover, TAP and 2% CHX with 10% EDTA as the final irrigation resulted in greater TGF-β1 release from cervical root dentin than CH + 2% CHX.

Can composition and preheating improve infiltrant characteristics and penetrability in demineralized enamel?

The composition of infiltrants can influence their physical properties, viscosity and depth of penetration (DP). Strategies are used to increase the DP, such as the addition of diluents or the use of heat. This study aimed to evaluate the effect of preheating and composition on physical properties and DP of infiltrants in demineralized enamel. The groups were assigned, and the following experimental formulations were made: 25%BisEMA +75%TEGDMA; 25%BisEMA +65%TEGDMA +10%ethanol; 25%BisEMA +65%TEGDMA +10%HEMA; 100%TEGDMA; 90%TEGDMA +10%ethanol; 90%TEGDMA +10%HEMA. The samples were photoactivated at two temperatures (25°C and 55°C). Degree of conversion (DC) was performed using an infrared spectrophotometer. Elastic modulus (E), flexural strength (FS) and contact angle (CA) tests were also performed. The DP of an infiltrant in demineralized enamel was determined by confocal laser scanning microscopy (CLSM) using an indirect labeling technique. The data were analyzed by two-way ANOVA and Tukey's test. DC increased after preheating in all the groups; however, 90%TEGDMA+10%ethanol showed the lowest DC for both temperatures, and the lowest E. Preheating did not influence E or FS. The CA increased at 55°C for most groups, but decreased for groups containing HEMA. Temperature did not seem to influence DP, and Icon showed the lowest DP values. The 100%TEGDMA composition showed more homogeneous penetration, whereas Icon showed heterogeneous and superficial penetration. The preheating technique does not improve all properties in all the material compositions. The composition of a material can influence and improve its properties.

Dental Caries Investigation in Children Controlled for an Educative and Preventive Oral Health Programme

PURPOSE

To evaluate the association of dental caries with behavioural, socioeconomic and cultural factors; and Streptococcus mutans (SM) levels in the saliva and oral hygiene index of children aged 4 and 6 years old placed in an oral health programme.

MATERIALS AND METHODS

This study was an analytic cross-sectional oral health survey conducted over a 9-month period. A total of 466 children aged 4 and 6 years old were included for evaluation of SM levels in saliva, simplified oral hygiene index and dental caries activity.

RESULTS

High SM levels were associated with dmft index, toothbrushing without parental assistance, deficient oral hygiene and ingestion of sweet foods. Deficient oral hygiene was found in children aged 4 years old and with three or more siblings. Dental caries was associated with low family income, deficient oral hygiene, sucrose ingestion by children younger than three years old, bottle-feeding habit and low parental compliance.

CONCLUSIONS

High SM levels in saliva, deficient oral hygiene and high frequency of sucrose ingestion had association with dental caries in children. Cultural, socioeconomic and behaviour factors indirectly influenced the onset of dental caries.

Color Stability and Gloss of Esthetic Restorative Materials after Chemical Challenges

Abstract This study evaluated gloss and color changes of esthetic restorative materials subjected to different acidic beverages. Specimens of resin composites (Z350XT (Z350), IPS Empress Direct (ED), Charisma Diamond (CD)) were prepared and the initial surface gloss and color (ΔE) were measured (n=10). Then, the specimens were immersed in 4 mL of each of the different beverages (cranberry juice; Coca-Cola; coffee or artificial saliva) during 15 min, 3x/day for 14 days and new gloss and color readings were obtained. Color change was evaluated with the ΔE formula and gloss change values were obtained by the formula: (final gloss - initial gloss). Data was submitted to two-way ANOVA followed by Tukey’s post hoc test (a=0.05). CD showed the lowest color change among resin composites. The highest ΔE values were obtained after immersion in coffee and cranberry juice. Coffee promoted the highest gloss change (worst gloss retention), followed by cranberry juice, Coca-cola and artificial saliva (p<0.05). The type of beverage significantly influenced the gloss of resin composites. Coca-cola reduced gloss of the three resin composites in a similar manner. Coffee affected the ED gloss more than that of Z350 and CD, while cranberry juice affected Z350 more than ED and CD. Saliva had a more pronounced effect on the gloss retention of CD than ED. The beverages used in this study influenced the optical surface properties of the composites studied.

Doxycycline-containing glass ionomer cement for arresting residual caries: an in vitro study and a pilot trial

In a previous study, we demonstrated that the incorporation of doxycycline hyclate (DOX) into resin-modified glass ionomer cement (RMGIC) inhibited important cariogenic microorganisms, without modifying its biological and mechanical characteristics. In this study, we keep focused on the effect of that experimental material as a potential therapy for arresting residual caries by analyzing other in vitro properties and conducting a pilot clinical trial assessing the in vivo effect of DOX-containing RMGIC on residual mutans streptococci after partial carious removal in primary molars. Specimens of the groups RMGIC (control); RMGIC + 1.5% DOX; RMGIC + 3% DOX; and RMGIC + 4.5% DOX were made to evaluate the effect of DOX incorporation on surface microhardness and fluoride release of RMGIC and against biofilm of Streptococcus mutans. Clinical intervention consisted of partial caries removal comparing RMGIC and RMGIC + 4.5% DOX as lining materials. After 3 months, clinical and microbiologic evaluations were performed. Data were submitted to ANOVA/Tukey or Wilcoxon/Mann-Whitney set as α=0.05. Fluoride release and surface microhardness was not influenced by the incorporation of DOX (p>0.05). There was a significant reduction of S. mutans biofilm over the material surface with the increase of DOX concentration. After clinical trial, the remaining dentin was hard and dry. Additionally, mutans streptococci were completely eliminated after 3 months of treatment with RMGIC + 4.5% DOX. The incorporation of DOX provided better antibiofilm effect, without jeopardizing fluoride release and surface microhardness of RMGIC. This combination also improved the in vivo shortterm microbiological effect of RMGIC after partial caries removal.

A novel Triclosan Methacrylate-based composite reduces the virulence of Streptococcus mutans biofilm

The use of antimicrobial monomers, linked to the polymer chain of resin composites, is an interesting approach to circumvent the effects of bacteria on the dental and material surfaces. In addition, it can likely reduce the incidence of recurrent caries lesions. The aim of this study was to evaluate the effects of a novel Triclosan Methacrylate (TM) monomer, which was developed and incorporated into an experimental resin composite, on Streptococcus mutans (S. mutans) biofilms, focusing on the analyses of vicR, gtfD, gtfC, covR, and gbpB gene expression, cell viability and biofilm characteristics. The contact time between TM-composite and S. mutans down-regulated the gbpB and covR and up-regulated the gtfC gene expression, reduced cell viability and significantly decreased parameters of the structure and characteristics of S. mutans biofilm virulence. The presence of Triclosan Methacrylate monomer causes harmful effects at molecular and cellular levels in S. mutans, implying a reduction in the virulence of those microorganisms.

Resistência da União de um Sistema Adesivo Etch & Rinse ao Substrato Dentinario Modificado

O objetivo deste estudo foi avaliar a efetividade do pré-tratamento da dentina afetada por cárie (DAC) com NaOCl ou EDTA na resistência de união a tração (RUT) de um sistema adesivo etch & rinse. Dezoito (n6) molares humanos tiveram o terço oclusal removido e submetidos ao modelo biológico de produção de cárie (S. Mutans). Previamente ao procedimento restaurador, as superfícies dentinárias foram distribuídas quanto ao tratamento da superfície em: NaOCl à 6%, EDTA a 0,1 M e um grupo sem tratamento (GC). Após o tratamento, foi aplicado sobre a superfície, o adesivo Single Bond 2 e foram construídos blocos de resina (Charisma) com altura de 4 mm. Os blocos foram armazenados por 24 h em água deionizada, e posteriormente seccionados em palitos com área média de 2 mm2 para realização do teste de RUT. Os padrões de fratura foram analisados em Microscopia Eletrônica de Varredura (MEV). Os dados foram submetidos ao teste ANOVA e de Tukey post-hoc (p<0,05). Os tratamentos com EDTA/DAC (10, 26 MPa) e NaOCl/DAC (8,22 MPa), apresentaram médias de µTBS significativamente maiores que o GC (7,93 MPa) e os maiores percentuais de padrão de fratura foram mistos. Conclui-se que o tratamento da DAC com NaOl ou EDTA previamente ao procedimento restaurador aumentou os valores de µTBS.Palavras-chave: Dentina Afetada por Cárie. Agentes Antioxidantes. Resistência de União.

Efeito da Aplicação de MI Paste™ e Diferentes Sistemas Adesivos na μTBS da Dentina Desmineralizada

O objetivo do presente estudo foi avaliar o efeito de MI Paste™ e dois sistemas adesivos (Adper™ Single Bond 2-SB e Clearfil™ SE Bond-CSE) na resistência de união à microtração (µTBS) da dentina desmineralizada. 36 blocos de dentina média obtidos foram distribuídos em 6 grupos (n6): G1 - Dentina Hígida/SB - DH/SB G2 - DH/CSE - DH/CSE G3–Dentina Desmineralizada/SB - DD/ SB G4–DD/CSE G5-DD+MI Paste™-MP/SB - DD+MP/SB e G6–DD+MP/CSE. Blocos de compósito FiltekTM Z350XT (4mm) foram construídos sobre a dentina com SB ou CSE e os conjuntos armazenados por 24h a 37 ºC em água. Palitos (1mm área de secção) foram obtidos e submetidos ao teste de µTBS (1,0mm/min 500N). Os dados foram submetidos à ANOVA e teste de Tukey, e Dunnett (a5%). Os tipos de fraturas foram avaliados por MEV. Houve interação significativa dos dados de µTBS, entre os fatores (Adesivo/Substrato) (p<0,01). DD+MP/SB (45,25) e DD+MP/CSE (48,10) apresentaram os maiores valores de µTBS (p<0.05)   do que os demais grupos e não diferiram entre si (p>0,05). DH/SB (40,8) mostraram maiores valores de µTBS do que DH/CSE (32,9) (p<0.05). Não houve diferença estatisticamente significativa entre DD/SB (26,4) e DD/CSE (25,4) (p>0,05). A maioria das falhas foi do tipo adesiva/mista. O tratamento da dentina desmineralizada com MI Paste™ mostrou uma alternativa favorável aos procedimentos adesivos a curto prazo, independente do adesivo utilizado.Palavras-chave: dentina. Remineralização Dentária. Resistência à Tração.

Influência da Degradação por Biofilme Cariogênico de S.mutans nas Propriedades de Superfíciede Compósitos Bulk Fill

O objetivo neste estudo foi avaliar a influência da degradação pelo biofilme de S. mutans na rugosidade (Ra) e dureza (KNH) de superfície de compósitos Bulk Fill de alta viscosidade. Para tanto, foram confeccionados 20 espécimes circulares (5mm x 2 mm) de cada material: Filtek Bulk-Fill (FBF), Tetric Evo-Ceram Bulk-Fill (TEC), X-traFil (XF) e Filtek Z350 (Z350)e distribuídos em 4 grupos (n10). Após 24 horas, os espécimes foram polidos e as mensurações iniciais de Ra e KHN realizadas. Seguidamente, todos  os  espécimes foram esterilizados em óxido de etileno e  submetidos à degradação biológica por S.  mutans durante 7 dias    e a Ra e KHN novamente mensuradas. Os dados foram submetidos à ANOVA dois fatores para medidas repetidas e teste Tukey (p<0,05). Houve interação signficativa entre os fatores (material x biodegradação). Antes da biodegradação a XF (0,1251) apresentou maiores valores de Ra, quando comparada aos demais materiais, os quais apresentaram valores similares. Após a biodegradação, XF (0,3100) apresentou maiores valores de Ra e Z350 (0,1443) os menores, enquanto o Tetric e e Filtek apresentaram valores similares. Maiores valores de KHN foram obtidos pela XF (151,7 106) e os menores valores pela TEC (62,2 51,8), tanto antes quanto após a biodegradação, enquanto FBF e Z350 apresentaram valores similares. A biodegradação promoveu aumento da Ra e redução da KHN para todos os grupos. Conclui-se que, a degradação por biofilme de S. mutans alterou negativamente as propriedades de superfície de todos os compósitos, sendo dependente da composição do material. Palavras-chave: Biofilmes. Resinas Compostas. Streptococcus mutans. 

Influência de Compósito com Metacrilato de Triclosan na Viabilidade de Células Bacterianas e Humanas

Neste estudo avaliou-se a toxicidade de compósito experimental, com monômero Metacrilato de Triclosan (MT), sobre células bacterianas e humanas. Foram confeccionados discos (2x5 mm) de dois compósitos C1 (TEGDMA/BISEMA + carga) e C2 (C1 + MT). Para a viabilidade bacteriana foi utilizada cepa de S. mutans UA159. Os discos foram colocados em placas de cultura de 24 poços, com 2 ml de BHI e inóculo bacteriano, por 24 h. Decorrido o tempo, os discos foram lavados com PBS e a viabilidade celular avaliada por XTT. A solução de XTT foi dispensada sobre os discos, e armazenada em estufa a 37 ºC, com 10% de CO2, por 4 h. Após a incubação, 200 μl da solução foram dispensados em eppendorfs, centrifugados e o sobrenadante transferido para uma placa de 96 poços para leitura das absorbâncias. Para avaliação em células humanas, foram utilizadas células NOK cultivadas em soro fetal bovino 10% a 37 °C. As células (1X105 células/ml) ficaram em contato com os discos por 24 h. Em seguida, as células foram tratadas com reagente MTT e reincubadas por 4 h. Após, 100 μL de álcool isopropílico foram usados para solubilizar o precipitado e permitir as leituras. As absorbâncias, 450nm (XTT) e 560nm (MTT), foram medidas com leitor de ELISA. A análise estatística foi feita com o teste Mann-Whitney (a0.05). Nas análises de XTT, C2 (0,582 ±0,041) reduziu a viabilidade celular (p0,0076) em relação a C1 (0,634 ±0,030). Nas análises de MTT, C1 (88% ±6,77) apresentou maior viabilidade celular (p0,0219) que C2 (70,6 ±7,67). Conclusão: C1 e C2 não foram tóxicos para NOK (viabilidade >50%) e C2 reduz a viabilidade de S. mutans.Palavras-chave: Compósitos. Viabilidade Celular. Antimicrobianos.

Biological and mechanical degradation affecting the surface properties of aesthetic restorative

Aim: To evaluate the roughness (Ra), Knoop hardness (KHN) and change of color (∆E) of esthetic restorative materials (Filtek Z350-composite nanoparticle; Empress Direct-composite nanohybrid and IPS e.Max-ceramic) subjected to contact with the Streptococcus mutans biofilm (biological degradation) associated with abrasion generated by tooth brushing (mechanical degradation). Methods: Ten specimens of each material were prepared, and the surface properties initial were evaluated. All specimens were exposed to Streptococcus mutans inoculum; after 7 days, surface properties were evaluated.  The specimens were submitted to a 30,000 toothbrushing cycles, using a toothpaste slurry, then, surface properties were evaluated again. Data were analyzed by Proc-Mixed, One-way ANOVA, Tukey-Kramer and Tukey’s tests (α = 0.05). Results: At the baseline, ceramic showed the highest Ra and KHN values; after the biological degradation the composites showed increased Ra, but KHN did not change; after the mechanical degradation, Empress showed decreased Ra and Z350 showed similar Ra, the KHN increased to both composites, and all materials had increased lightness after the mechanical degradation. Conclusions: The results suggest that, when exposed to Streptococcus mutans biofilm and toothbrush abrasion, the ceramics undergoes minimal degradation and the composites exhibited variable degradation, depending on the composition of the material.

Influence of Different Concentration and Ratio of a Photoinitiator System on the Properties of Experimental Resin Composites

Abstract The aim in this study was to evaluate the influence of different ratio of camphorquinone/tertiary amine concentration on the flexural strength (FS), elastic modulus (EM), degree of conversion (DC), yellowing (YL), water sorption (WS) and water solubility (WSL) of experimental composites. Thus, acrylate blends were prepared with different camphorquinone (CQ) and amine (DABE) concentrations and ratios by weight: (CQ/DABE%): 0.4/0.4% (C1), 0.4/0.8% (C2), 0.6/0.6% (C3), 0.6/1.2% (C4), 0.8/0.8% (C5), 0.8/1.6% (C6), 1.0/1.0% (C7), 1.0/2.0% (C8), 1.5/1.5% (C9), 1.5/3.0% (C10). For the FS and EM, rectangular specimens (7x2x1 mm, n=10) were photo-activated by single-peak LED for 20 s and tested at Instron (0.5 mm/min). Then, the same specimens were evaluated by FTIR for DC measurement. For YL, disks (5x2 mm, n=10) were prepared, light-cured for 20 s and evaluated in spectrophotometer using the b aspect of the CIEL*a*b* system. For WS and WSL, the volume of the samples was calculated (mm³). For WS and WSL, composites disks (5x0.5 mm, n=5) were prepared. After desiccation, the specimens were stored in distilled water for 7 days and again desiccated, in order to measure the WS and WSL. Data were submitted to one-way ANOVA and Tukey’s test (5%). The groups C8, C9 and C10 showed higher DC, EM and YL means, compared to other composites. Therefore, the FS and WS values were similar among all groups. Also, C1, C2 and C3 presented higher WSL in 7 days, compared to other composites. In general, higher concentrations of camphorquinone promoted higher physical-mechanical properties; however, inducing higher yellowing effect for the experimental composites

Periodontitis in Chédiak-Higashi Syndrome: An Altered Immunoinflammatory Response

Chédiak-Higashi syndrome (CHS), a rare autosomal recessive disorder caused by mutations in the lysosomal trafficking regulator gene (LYST), is associated with aggressive periodontitis. It is suggested that LYST mutations affect the toll-like receptor (TLR)-mediated immunoinflammatory response, leading to frequent infections. This study sought to determine the periodontal status of patients with classic (severe) and atypical (milder) forms of CHS and the immunoregulatory functions of gingival fibroblasts in CHS patients. In contrast to aged-matched healthy controls, atypical (n = 4) and classic (n = 3) CHS patients presented with mild chronic periodontitis with no evidence of gingival ulceration, severe tooth mobility, or premature exfoliation of teeth. As a standard of care, all classic CHS patients had undergone bone marrow transplantation (BMT). Primary gingival fibroblasts obtained from atypical and BMT classic CHS patients displayed higher protein expression of TLR-2 (1.81-fold and 1.56-fold, respectively) and decreased expression of TLR-4 (-2.5-fold and -3.85-fold, respectively) at baseline when compared with healthy control gingival fibroblasts. When challenged with whole bacterial extract of Fusobacterium nucleatum, both atypical and classic CHS gingival fibroblasts failed to up-regulate TLR-2 and TLR-4 expression when compared with their respective untreated groups and control cells. Cytokine multiplex analysis following F. nucleatum challenge showed that atypical CHS gingival fibroblasts featured significantly increased cytokine expression (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-10, IL-12, interferon-γ, tumor necrosis factor-α), whereas classic CHS cells featured similar/decreased cytokine expression when compared with treated control cells. Collectively, these results suggest that LYST mutations in CHS patients affect TLR-2 and TLR-4 expression/function, leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients. Furthermore, our results suggest that atypical CHS patients and classic CHS patients who undergo BMT early in life are less susceptible to aggressive periodontitis and that hematopoietic cells play a critical role in mitigating the risk of aggressive periodontitis in CHS. Knowledge Transfer Statement: Results from this study can be used to create awareness among clinicians and researchers that not all CHS patients exhibit historically reported aggressive periodontitis, especially if they have atypical CHS disease or have received bone marrow transplantation. LYST mutations in CHS patients may affect TLR-2 and TLR-4 expression/function leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients.

Computational analysis for GNAQ mutations: New insights on the molecular etiology of Sturge-Weber syndrome

Somatic activating mutations in the GNAQ have been recently associated with several congenital genetic disorders and tumors; however, the molecular mechanism/etiology that leads to GNAQ somatic mosaic mutation are unknown. Here, we reported a case of Sturge-Weber Syndrome (SWS) manifesting cutaneous vascular malformations (hemifacial Port-wine stain), cerebral and ocular vascular abnormalities (including epilepsy and glaucoma) and harboring a c.548G>A (p.R183Q) somatic mosaic mutation in GNAQ. Computational modeling studies were performed to assistant with the comprehension of the functional impact of p.R183Q and p.Q209L mutations in GNAQ, which encodes a G protein subunit alpha q (Gαq). The p.R183Q mutation was predicted to abolish hydrogen bonds between R183 residue and GDP molecule, destabilizing the inactive GDP-bound conformation of the Gαq mutants. Furthermore, replacement of R183 by Q183 residue was predicted to promote conformation changes in protein surface features affecting the switch I region, a key region that undergoes conformational changes triggered by receptor binding during signal transduction. In addition, replacement of Q209 by L209 residue was predicted to affect the molecular interaction between Gαq and Gβ subunit, impairing formation of the inactive heterotrimeric complex. These findings, in association with PPI network analysis, indicate that p.R183Q and p.Q209L mutations result in the over-activation of different downstream effectors, which in turn will determine the distinct cell responses and phenotype. These findings bring new insights on molecular etiology of vascular malformations associated to SWS and on different mechanisms underlying hyperactivation of downstream pathways to Gαq.

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.

Molecular and morphological surface analysis: effect of filling pastes and cleaning agents on root dentin

The quality of the dentin root is the most important factor for restoration resin sealing and drives the outcome of endodontic treatment.

Influence of Different Dentin Substrate (Caries-Affected, Caries-Infected, Sound) on Long-Term μTBS

Abstract The aim of this study was to evaluate the μTBS in different dentin substrates and water-storage periods. Twenty-four dentin blocks obtained from sound third molars were randomly divided into 3 groups: Sound dentin (Sd), Caries-affected dentin (Ca) and Caries-infected dentin (Ci). Dentin blocks from Ca and Ci groups were subjected to artificial caries development (S. mutans biofilm). The softest carious tissue was removed using spherical drills under visual inspection with Caries Detector solution (Ca group). It was considered as Ci (softer and deeply red stained dentin) and Ca (harder and slightly red stained dentin). The Adper Single Bond 2 adhesive system was applied and Z350 composite blocks were built in all groups. Teeth were stored in deionized water for 24 h at 37 ºC and sectioned into beams (1.0 mm2 section area). The beams from each tooth were randomly divided into three storages periods: 24 h, 6 months or 1 year. Specimens were submitted to µTBS using EZ test machine at a crosshead speed of 1.0 mm/min. Failure mode was examined by SEM. Data from µTBS were submitted to split plot two-way ANOVA and Tukey’s HSD tests (a=0.05). The µTBS (MPa) of Sd (41.2) was significantly higher than Ca (32.4) and Ci (27.2), regardless of storage. Ca and Ci after 6 months and 1 year, presented similar µTBS. Mixed and adhesive failures predominated in all groups. The highest µTBS values (48.1±9.1) were found for Sd at 24 h storage. Storage of specimens decreased the µTBS values for all conditions.

Penetration of Filled and Unfilled Resin Sealants on Different Enamel Substrates

PURPOSE

To evaluate the penetration ratio of filled and unfilled resin-based sealants on different enamel substrates and pit and fissure morphologies.

METHODS

Forty-eight occlusal enamel blocks obtained from impacted human third molars were randomly divided (n equals eight) according to enamel substrates (sound; caries-like lesion; caries-like lesion plus topical fluoride application) and sealant material (FluroShield; Helioseal Clear Chroma). Sealants were applied on the enamel surface. The specimens were stored in 100 percent humidity for 24 hours at 37 degrees Celsius, sectioned in a buccal-lingual direction (at approximately 50 μm), and examined to determine the sealant penetration ratio (b x 100/a; a equals total fissure length and b equals sealant penetration length) and pit and fissure morphology (V-, U-, or Y-shaped). Statistical analysis was performed using Friedman and Kruskal-Wallis tests (P<0.05).

RESULTS

Enamel substrate and sealant material did not affect the sealant penetration ratio, with no interactions between these factors. Moreover, the morphology significantly affected the sealant penetration, with the "Y"-shaped fissures presenting the lowest sealant penetration ratio compared to "U-"shaped (P=0.0001) and "V-" shaped fissures (P=0.0018).

CONCLUSIONS

Pit and fissure morphology was a critical factor on sealant's penetration capacity; however, enamel substrate and sealant type did not affect sealant's penetration ratio.

Effect of monomer blend and chlorhexidine-adding on physical, mechanical and biological properties of experimental infiltrants

OBJECTIVES

The aim of the study was to evaluate antimicrobial inhibition zone, degree of conversion (DC) and Knoop hardness (KH) of experimental infiltrants. Experimental low viscosity monomer blends were prepared and chlorhexidine diacetate salt (CHX) (0.1% or 0.2%) was added comprising the groups: G1) TEGDMA; G2) TEGDMA/0.1CHX; G3) TEGDMA/0.2CHX; G4) TEGDMA/UDMA; G5) TEGDMA/UDMA/0.1CHX; G6) TEGDMA/UDMA/0.2CHX; G7) TEGDMA/BISEMA; G8) TEGDMA/BISEMA/0.1CHX; G9) TEGDMA/BISEMA/0.2CHX. Icon^® was used as control group.

METHODS

Specimens of resin blends were made (n=9) to accomplished DC and KH. Pour plate was accomplished to evaluate antimicrobial groups' activity against Streptococcus mutans (SM) and Lactobacillus acidophilus (LA). Data obtained were submitted to two-way ANOVA and Tukey tests for blends comparisons and Dunnett's test for comparisons between experimental infiltrants and Icon^® (p<0.05).

RESULTS

In relation to antimicrobial effect, uncured blends showed higher antibacterial activity than cured ones for the most of blends. After polymerization, G5 showed the highest inhibition zone against SM and, G3 and G6 against LA. Concerning KH, TEGDMA/UDMA-based blends showed the highest values of KH number and it was influenced by monomeric base, regardless CHX concentration. DC was not affected by monomer blend composition, neither for CHX concentration. The antimicrobial activity was affected by monomeric base, CHX concentration and polymerization. Experimental infiltrants presented similar or higher performance than Icon^® for the properties evaluated.

SIGNIFICANCE

White spot lesion infiltration with low viscosity monomer blends (infiltrants) is an alternative to stop initial caries lesions progression. The incorporation of an antimicrobial agent as chlorhexidine diacetate salt in infiltrants composition could enhance the performance of these materials.

Microcomputed Tomography Evaluation of Polymerization Shrinkage of Class I Flowable Resin Composite Restorations

The present study aimed to characterize the pattern and volume of polymerization shrinkage of flowable resin composites, including one conventional, two bulk fill, and one self-adhesive. Standardized class I preparations (2.5 mm depth × 4 mm length × 4 mm wide) were performed in 24 caries-free human third molars that were randomly divided in four groups, according to the resin composite and adhesive system used: group 1 = Permaflo + Peak Universal Bond (PP); group 2 = Filtek Bulk Fill + Scotchbond Universal (FS); group 3 = Surefil SDR + XP Bond (SX); and group 4 = Vertise flow self-adhering (VE) (n=6). Each tooth was scanned three times using a microcomputed tomography (μCT) apparatus. The first scan was done after the cavity preparation, the second after cavity filling with the flowable resin composite before curing, and the third after it was cured. The μCT images were imported into three-dimensional rendering software, and volumetric polymerization shrinkage percentage was calculated for each sample. Data were submitted to one-way analysis of variance and post hoc comparisons. No significant difference was observed among PP, FS, and VE. SX bulk fill resin composite presented the lowest values of volumetric shrinkage. Shrinkage was mostly observed along the occlusal surface and part of the pulpal floor. In conclusion, polymerization shrinkage outcomes in a 2.5-mm deep class I cavity were material dependent, although most materials did not differ. The location of shrinkage was mainly at the occlusal surface.

The effect of shade and curing mode on cure efficiency of dual-cure resin cements

Objective: To evaluate the effect of shade and curing mode on cure efficiency of two dual-cure resin cements. Material and Methods: Two shades (A2 and TRANS) of two different dual-cure resin cements (G-CEM, GC Dental and SET PP, SDI) were submitted to different curing modes: light curing through a 2 mm thick ceramic disc (IPS Empress Esthetic, A2, Ivoclar Vivadent) for 20 s (16 J/cm2), 40 s (32 J/cm2) or 80 s (64 J/cm2) performed immediately or with 1 or 5 min of delay. Fourier transform infrared spectroscopy (FT-IR) was used to evaluate the degree of conversion (DC) after 48 h. For the statistical analysis, data were submitted to three-way analysis of variance, followed by Tukey’s test for multiple comparisons (p=0.05). Results: Shade influenced DC (%) for the dual-cure resin cements tested (p=0.00001). TRANS shade showed lower DC (%) for both cements when there was no delay before light-curing (p=0.00001). Curing mode also influenced DC (%) for the dual-cure resin cements tested: radiant exposure greater than 32 J/cm2 and delaying light-curing for 1 to 5 min increased the DC (%) for both dual-cure resin cements evaluated. Conclusions: One min delay prior to light curing improved the cure efficiency and may be a more clinically acceptable approach to increase the degree of conversion of dual-cure resin cements.

Impact of the intermediary layer on sealant retention: a randomized 24-month clinical trial

OBJECTIVES

The aims of this study were to assess long-term impact of tooth eruption stages (ES) on sealant retention on occlusal surfaces previously coated with intermediary bonding layer and to determine caries prevention.

MATERIALS AND METHODS

Sixty-five school children were selected (aged 6-10 years), with four non-carious permanent first molar in different ES (OP (operculum present), ME (marginal edge), CE (completely erupted)). Split-mouth and single-blind study design was used. The teeth (260) were randomly selected according to treatment (sealant/technique): F (Fluroshield), H (Helioseal Clear Chroma), SF (Single Bond + F), EH (Excite + H). Sealant retention, marginal integrity, discoloration, and caries prevention were assessed after 6, 12, 18, and 24 months by calibrated examiner (Spearman = 0.91) using visual inspection. Data were submitted to the Cox proportional hazard model (survival analysis) and Likelihood ratio χ ² test (correlation), p ≤ 0.05.

RESULTS

At baseline, ES was 20 % in OP, 54 % in ME, and 26 % in CE. There was no significant difference on sealant retention between the treatments (p = 0.2774). However, significant differences were found regarding the ES on sealant retention (p = 0.0041). The CE stage showed the highest retention survival rate during the 24 months. The overall sealant prevention average was found to be about 99.4 % and showed no difference between the groups.

CONCLUSIONS

Eruption stages affect sealant retention irregardless of the intermediate layer and type of sealant. However, there was caries prevention on tooth occlusal surfaces after 24 months, regardless of treatment.

CLINICAL RELEVANCE

Sealing is recommended to prevent occlusal caries of newly erupted teeth in high-caries-risk patients. However, its application is critical on moisture limited control surfaces independently of sealer material and technique.

A Clinical Report of Functional and Esthetic Oral Rehabilitation in a High-caries-risk Child: One-year follow-up

This case discusses a multi-disciplinary approach to oral functional and esthetic rehabilitation on a high-caries-risk child with prematurely lost primary teeth due to endodontic complications associated with wide-spread dental caries. The patient was diagnosed with an anterior open bite and atypical swallowing. He exhibited anxiety and low self-esteem due to esthetic impairment. A combination of targeted clinical procedures, a focus on oral home care and active parental involvement was integral to the treatment process. The patient was examined monthly by a pediatric dentist regarding dietary habits, fluoride exposure, biofilm presence, caries prevalence, and malocclusion. Improvement was evident in patient’s masticatory function, facial esthetics, and psychological behavior at a 12-month follow-up evaluation.KeywordsDeciduous; Dental Caries; Mouth Rehabilitation; Tooth.

Effect of Restorative System and Thermal Cycling on the Tooth-Restoration Interface – OCT Evaluation

The present study evaluated the tooth/noncarious cervical lesion restoration interface when using different adhesive systems and resin composites, submitted to thermal cycling (TC), using optical coherence tomography (OCT). Noncarious cervical lesion (NCCL) preparations (0.7 mm depth × 2 mm diameter) were performed on 60 human third molars and randomly divided into six groups, according to the adhesive system and resin composite used: group 1 = Adper Single Bond 2 (SB2) + Aelite LS Posterior (AP); group 2 = SB2 + Venus Diamond (VD); group = SB2 + Filtek Z250XT (Z250); group 4 = Clearfil SE Bond (CSE) + AP; group 5 = CSE + VD; group 6 = CSE + Z250. Selective enamel etching was performed for 30 seconds on groups 4, 5, and 6, while groups 1, 2, and 3 were etched for 30 seconds in enamel and 15 seconds in dentin. All groups were evaluated using OCT before and after TC (n=10). Images were analyzed using Image J software; enamel and dentin margins were separately evaluated. Data from OCT were submitted to PROC MIXED for repeated measurements and Tukey Kramer test (α = 0.05). No marginal gaps were observed in etched enamel, either before or after TC, for all adhesive and resin composite systems. A significant interaction was found between adhesive system and TC for the dentin groups; after TC, restorations with CSE showed smaller gaps at the dentin/restoration interface compared with SB2 for all resin composites. Increased gap percentages were noticed after TC compared with the gaps before TC for all groups. In conclusion, TC affected marginal integrity only in dentin margins, whereas etched enamel margins remained stable even after TC. Dentin margins restored with CSE adhesive system showed better marginal adaptation than those restored with SB2. Resin composites did not influence marginal integrity of NCCL restorations.

Influence of Staining Solution and Bleaching on Color Stability of Resin Used for Caries Infiltration

OBJECTIVE

The objective of this study was to evaluate the color stability of Icon-infiltrated white spot lesions after staining and the bleaching effect on the infiltrated and stained surfaces.

METHODS AND MATERIALS

Enamel-dentin specimens (N=30, 5 × 5 × 3 mm, 1-mm enamel + 2-mm dentin thickness) were prepared from bovine incisors and randomly allocated into three groups (n=10): control, demineralized, and infiltrated. Artificial enamel subsurface lesions were created using 50 mL of 0.05 M acetate buffer solution. Specimens were produced by Icon application in enamel caries-like lesions, according to the manufacturer's instruction. Baseline color readings were assessed using a spectrophotometer, and CIE L*a*b* measurements of each specimen were performed using a white background. To simulate extrinsic dietary staining, specimens were placed into a 4-mL coffee infusion, three times daily for 15 minutes, for 14 days. After the staining procedure, color measurements were performed again. Then, bleaching procedures were performed using 16% carbamide peroxide gel for four hours daily for 21 days, and a final color assessment was performed. To compare the baseline and final measurements, t-test was used (α =0.05). The statistical comparison between the groups was performed using the one-way analysis of variance and Tukey tests (α =0.05).

RESULTS

Coffee staining provided a significant reduction of L* values and an increase of a* and b* in all groups (control, decayed, and infiltrated). The bleaching procedure provided a significant increase in L* and decrease of a* and b* values in all groups. There was no significant difference in ΔE values between decayed and infiltrated groups before bleaching, and after bleaching, the infiltrated group showed the lowest ΔE values.

CONCLUSION

It can be concluded that enamel infiltrated with Icon presents significant alteration of color after staining when compared with sound enamel. However, if there is discoloration of the infiltrant, the bleaching treatment can be used successfully.

Antimicrobial Activity of Two Root Canal Filling Pastes in Deciduous Teeth: an in Vitro Study

<p>Endodontic treatment in deciduous teeth is very important so that we can preserve the primary dentition and thus promote appropriate craniofacial development. However, the use of filling pastes that have some important biological properties for the preservation of the tooth is required. The objective this study was to evaluate the in vitro antimicrobial activity of two root canal filling pastes in deciduous teeth, Vitapex® and Calcipex®, on microbial species commonly found in endodontic infections (Candida albicans, Enterococcus faecalis, Streptococcus mutans, Streptococcus sanguinis, Escherichia coli and Staphylococcus aureus), using the agar diffusion test. The experiment was carried out on BHI (Brain Heart Infusion) plates in four equidistant points, which were immediately filled with the sealers Vitapex® and Calcipex®. The<br />chlorhexidine gluconate 1% (CHX) and distilled water were used as positive and negative controls, respectively. After incubation of plates at 37 °C for 24 h, the diameter of the growth inhibition zones around the wells was measured (in millimeters) with a digital caliper with reflected light. The test was performed in triplicate and data were submitted to ANOVA and Tukey’s test (α = 0.05). Both pastes had antimicrobial activity, but Calcipex® was more efficient for most strains. The halo formed in the experiments with S. mutans and S. sanguinis was similar for both pastes. This study suggests that Calcipex® had the highest antimicrobial property with respect to the microorganisms studied.</p>

Bond Strength of Experimental Low-viscosity Resin Materials to Early Enamel Caries Lesions: Effect of Diluent/Solvent Addition

PURPOSE

To evaluate the effect of different concentrations of monomers and solvents/diluents on the microtensile bond strength (μTBS) bond strength of experimental low-viscosity resins (infiltrants) to enamel caries-like lesions (ECLL).

MATERIALS AND METHODS

Flat enamel blocks obtained from sound human third molars were submitted to ECLL formation and randomly distributed into 9 groups (n = 10): G1: TEG-DMA 100%; G2: TEG-DMA 80%, ethanol 20%; G3; TEG-DMA 80%, HEMA 20%; G4: TEG-DMA 75%, UDMA 25%; G5: TEG-DMA 60%, UDMA 20%, ethanol 20%; G6: TEG-DMA 60%, UDMA 20%, HEMA 20%; G7: TEG-DMA 75%, bis-EMA 25%; G8: TEG-DMA 60%, bis-EMA 20%, ethanol 20%; G9: TEG-DMA 60%, bis-EMA 20%, HEMA 20%. After etching with 37% phosphoric acid for 60 s, experimental infiltrants were actively applied and photocured for 60 s, then stored in 100% humidity (24 h, 37°C). Hourglass-shaped specimens were obtained and the μTBS test performed (MPa). The fracture patterns were assessed by SEM. Data were submitted to two way-ANOVA and Tukey's tests (α = 0.05).

RESULTS

The highest μTBS value was observed for G4 (TEG-DMA/UDMA, 19.18 MPa) and the lowest for G5 (TEG-DMA/UDMA/ethanol, 9.00 MPa). A significant decrease in μTBS was observed for all groups containing ethanol (G2, G5, and G8). The addition of HEMA did not affect μTBS values. Most groups showed a high frequency of mixed failure between infiltrant and enamel.

CONCLUSION

The addition of bis-EMA or UDMA to TEG-DMA-based infiltrants did not improve bond strength to carious enamel. The ethanol addition negatively affected the bonding strength of infiltrants to enamel caries-like lesions, regardless of the resin matrix composition of the infiltrant.

Atuação interdisciplinar odontologia/fonoaudiologia no tratamento de paciente com cárie precoce da infância

A integração interdisciplinar entre odontologia e fonoaudiologia pode proporcionar tratamento adequado das alterações dentárias e miofuncionais. Este relato de caso clínico apresenta o tratamento odontológico em criança com três anos de idade com cárie precoce da infância leve, com consequente perda dos incisivos centrais superiores devido a trauma, a reabilitação estética e funcional e tratamento fonoaudiológico. Os procedimentos clínicos odontológicos foram instrução de higiene bucal, aconselhamento dietético e realização das restaurações com resina composta devido ao acometimento por lesão cariosa dos dentes 64, 84, 85, 74, 75 (oclusal); e dentes 51, 61, 52 e 62 (face vestibular). Após um ano de preservação foi realizada a exodontia dos dentes 51 e 61 (com história de trauma anterior à primeira consulta), devido a reabsorção externa avançada. Em seguida, mantenedor de espaço estético-funcional removível foi colocado na região anterior superior. Avaliação fonoaudiológica foi realizada utilizando o protocolo Miofuncional Orofacial (MBGR), sendo verificadas as funções orofaciais, mobilidade e tônus muscular. Foram atribuídos escores para cada item avaliado no protocolo. Confirmou-se dificuldade de mobilidade dos lábios e língua com diminuição do tônus da bochecha e alterações na fala. A terapia fonoaudiológica foi estabelecida durante três meses com periodicidade semanal, havendo melhora em todos os aspectos alterados, confirmados pela adequação dos escores do Protocolo MBGR. No tratamento odontológico foram observados resultados clinicamente satisfatórios para a criança e responsáveis. Concluiu-se que o trabalho interdisciplinar entre a Odontologia e Fonoaudiologia proporcionou tratamento adequado para as condições bucais apresentadas pela criança, proporcionando saúde bucal e prognóstico favorável.