Whitening efficacy of activated charcoal-based products: A single-blind randomized controlled clinical trial

OBJECTIVE

This randomized controlled clinical trial evaluated the whitening efficacy, tooth sensitivity (TS), and volunteers' satisfaction following the use of activated charcoal powder and toothpaste.

METHODS

Fifty-six volunteers were randomly allocated into 4 groups (n = 14) according to a 14-day toothbrushing or whitening treatment with activated charcoal powder (ACPW), activated charcoal toothpaste (ACT), regular fluoridated toothpaste (RT), and 10 % carbamide peroxide (CP). Objective (ΔE00) and subjective (ΔSGU) color and whiteness index (ΔWID) changes were calculated. Patients self-reported the risk and intensity of TS using a visual analogue scale and the volunteer's satisfaction was determined by a questionnaire. Color assessments were analyzed by Kruskal-Wallis followed by Dwas-Steel-Crithlow-Fligner, and absolute TS risk and volunteer's satisfaction by Fisher exact test (p < 0.05).

RESULTS

ACPW and ACT promoted similar effects in ΔE00, ΔSGU, and ΔWID to that observed for RT. No significant difference was found in terms of TS risk intensity. TS risk became high after 7 and 14 days, with higher TS prevalence in CP. Volunteers reported that ACPW exhibited the lowest ease-of-use, comfort, and whitening satisfaction among groups (p < 0.05).

CONCLUSION

Activated charcoal-based products presented a minor and unsatisfactory whitening effect while CP resulted in optimal tooth whitening and the highest level of satisfaction among volunteers. Risk was higher from 7 days onwards and was more pronounced in the CP.

CLINICAL RELEVANCE

Based on the whitening effect and patient satisfaction, this controlled-randomized clinical evidence supports that the use of activated charcoal-based products should be discouraged.

Dental aesthetic perception of patients submitted to activated charcoal-based bleaching agents: A randomized clinical trial

OBJECTIVE

To evaluate the effects of activated charcoal-based products used in two presentation forms (powder or toothpaste), compared to 10 % carbamide peroxide and conventional toothpaste on aesthetic perception and psychosocial impact before and after treatment.

METHODS

Fifty-six participants were divided into 4 experimental groups (n = 14). Activated charcoal-based powder (PW); Activated charcoal-based dentifrice (AC); Conventional fluoride toothpaste (CD) and 10 % carbamide peroxide (CP). All products were used for 14 days. Psychosocial impact on dental esthetics (PIDAQ), oral health impact profile (OHIP- Esthetics) and orofacial esthetics scale (OES) questionnaires were applied before and after treatment. Descriptive and exploratory data analyses were performed and analyzed using linear mixed models for repeated measures over time considering significance level of α = 0.05.

RESULTS

For PIDAQ, the CP group showed significant decrease in psychological impact, aesthetic perception domains and overall score, while in the PW group, there was only a significant decrease in the psychological impact domain. Decrease in OHIP was observed for the functional limitation domain scores for treatments with CP and PW, in the psychological discomfort domain, decrease was observed for all groups, while for the OES questionnaire, significant increase in the color domain was observed for the CP group.

CONCLUSION

Activated charcoal-based products showed lower scores in all questionnaires when compared with carbamide peroxide; thus, charcoal-based products promoted lower impact on quality of life and aesthetic perception.

CLINICAL RELEVANCE

In this randomized clinical trial, charcoal-based OTC products had inferior quality of life and aesthetic perception results compared to conventional carbamide peroxide bleaching.

In vitro assessment of activated charcoal-based dental products

OBJECTIVE

Assess the effects of activated charcoal-based products on whitening and changes on dental enamel surface.

MATERIAL AND METHODS

Fifty-two blocks of bovine dental enamel were randomly distributed in four groups (n = 13): brushing with activated charcoal-based powder (PW); brushing with activated charcoal-based dentifrice (AC); brushing with a conventional dentifrice containing 1450 ppm of fluoride (CD); and whitening with 10% carbamide peroxide (CP). Color, microhardness, and surface alteration were analyzed at baseline and after 14 days of treatment. Three samples per group were randomly selected and examined using scanning electron microscopy (SEM) to analyze the morphology.

RESULTS

PW exhibited greater color change for the ΔE₀₀ , ΔWID, Δb* and ΔL* parameters than other groups (p < 0.05). After treatment, microhardness decreased in AC and CP groups (p < 0.05). Also, PW and AC groups showed more surface alteration than CD and CP (p < 0.001). Changes in the morphology of dental enamel were observed by SEM in PW and AC groups.

CONCLUSION

Activated charcoal-based products showed a lower whitening effect than 10% carbamide peroxide. These products also influenced dental enamel microhardness, resulting in greater surface alteration.

CLINICAL SIGNIFICANCE

Activated charcoal-based products promoted minimum whitening effects with significant enamel surface alteration. The 10% carbamide peroxide was more effective for whitening and caused slight enamel surface alteration.

Evaluating changes in the color and luminosity of dental enamel after orthodontic treatment: A clinical study

The aims of this clinical study were to evaluate the Color change - ΔE (based on spectrophotometry and visual analysis) and luminosity - L* (based on spectrophotometry) of dental enamel surface (after orthodontic treatment) around the area where orthodontic brackets were fixed, based on different cementing materials such as a resin (R group) and resin-modified glass ionomer cement (RMGIC group). The split-mouth study initially comprised 14 patients. Orthodontic brackets were fixed to the upper central incisors with resin or RMGIC. The color of the buccal surface of each tooth was measured through spectrophotometry and visual examination before the bracket-fixation process. Four individuals were excluded during the follow-up; thus 10 patients were evaluated (n=10). Brackets were removed after 12 months of orthodontic treatment, tooth color measurement and visual examination were performed again, and Adhesive Remaining Index (ARI) was also measured. ΔE and L* results were subjected to Student's t-test and by repeated-measures analysis of variance, respectively (α=0.05). ARI data were analyzed in percentages. There was statistically significant difference in ΔE between groups; the R group showed statistically higher values of L* after orthodontic treatment. ARI of 2 and 3 prevailed in the RMGIC group, whereas the R group presented 0 and 1. After orthodontic treatment, the RMGIC group presented smaller changes in ΔE, and the increase in the white scale was observed on the enamel surface around the area where brackets were fixed in the R group. The visual analysis did not show color change on the evaluated teeth.

Evaluation of Removal Force in Prosthetic Components of Morse Taper Dental Implants

The longevity of prosthetic rehabilitation is determined by the stability of the implant and abutment interfaces. True morse taper connections on dental restorations have been effective, however activation force still empirical. This work compared the activation strength and internal contact of Morse taper system according to the removal force. Eighty sets, composed of implants and prosthetic abutments, were evaluated with different internal contact areas; 15.12mm2 (G3.3) and 21.25mm2 (G4.3). The specimens were activated at 0° and 30°, with loads of 10, 20, 40 and 60N. The specimens were submitted to tensile test and the data to ANOVA and Tukey's tests (α=0.05). Representative specimens were examined under SEM. Removal force of G3.3 (2.15±1.33MPa) did not differed to G4.3 (1.99±1.03MPa). The activation at 0º (2.95±0.98MPa) statistically differed to 30º (1.19±0.54MPa). The 60N load was statistically superior for G3.3 and there was no statistical difference between 20N to 60N in G4.3. The values of 10N at 30o and 20N at the long axis of the morse taper implant, independent of the frictional contact area showed the best settlement.

Effect of 0.2% Chitosan Associated with Different Final Irrigant Protocols on the Fiber Post Bond Strength to Root Canal Dentin of Bovine Teeth: An In-vitro Study

Objective:

This in-vitro study investigated the effect of 0.2% Chitosan associated with different final irrigant protocols on the bond strength of fiber posts (FP) to root canal dentin.

Methods:

Fifty bovine incisors roots were prepared using the ProTaper Universal system, irrigated with 2.5% sodium hypochlorite, and divided into one control group (n=10) with no final irrigant protocol and four experimental groups (n=10), which were defined according to the combination of chelating solution (17% EDTA and 0.2% Chitosan) and irrigant activation/delivery method [conventional irrigation (CI), and passive ultrasonic irrigation (PUI)]. Post spaces were prepared to a depth of 12 mm using #1-5 Largo drills, and the FP were cemented using self-adhesive resin cement. Two slices of 2 mm in thickness from each third were obtained and submitted to the micropush-out test. After testing the push-out strength, the slices were analyzed under a stereomicroscope at 40× magnification for bond failure patterns determination. Statistical analysis was performed using three-way ANOVA followed by Tukey’s test (α = 0.05).

Results:

The control and 17% EDTA + CI groups exhibited significantly lower bond strength than 0.2% Chitosan + CI, 17% EDTA + PUI, and 0.2% Chitosan + PUI groups in the cervical third (P = 0.00). The cervical third had higher values than the middle and apical thirds in control (P = 0.00), 17% EDTA + PUI (P = 0.00), and 0.2% Chitosan + PUI groups (P = 0.00). Adhesive cement-dentin failure type was predominant in all groups.

Conclusion:

The use of 0.2% chitosan did not affect the bond strength of FP to root dentin. Passive ultrasonic activation of chelating solutions resulted in an improvement in bonding strength.

Assessing the bleaching effect of an experimental stabilized chlorine dioxide agent used for internal bleaching purposes

Aim: Assessing the intracoronal bleaching effectiveness of an experimental chlorine dioxide product, based on the walking bleach technique. Methods: Extracted bovine incisors were artificially stained with bovine blood and filled with zinc phosphate cement at cementoenamel junction level. Teeth were divided into 3 groups (n=10): (SP) sodium perborate added with distilled water, (CD) chlorine dioxide and (C) control – dry cotton inserted into the pulp chamber. Bleaching agents were used at 0, 7 and 14 days. VITA Easyshadetm (ΔEab) was used to analyze tooth color at the 7th, 14th and 21st days, based on the CIE2000 system. Data were analyzed through ANOVA and Tukey’s test. Results: There were no statistically significant differences in Δb, ΔE, ΔE00 and ΔWID between CD and the control group. These parameters have shown significant differences between CD and SP, which differed from the control. However, they did not show significant differences either in the control group or in CD at the 7th, 14th and 21st days. Values recorded for SP at the 7th day differed from those recorded at the 14th and 21st days. Δa has shown differences within the same group at the 7th, 14th and 21st days. There was no difference between groups, when they were compared at the same day (7th and 14th). The control group differed from SP at the 21st day. CD did not differ from the other two groups. ΔL did not show differences between groups and times. Conclusion: Stabilized chlorine dioxide (0.07%, at pH 3.5) should not be used as intracoronal bleaching agent along with the walking bleach technique.

Evaluation of enamel roughness after the removal of brackets bonded with different materials: In vivo study

The aims of this in vivo study were to evaluate the effect of bonding with resin-modified glass ionomer cement (RMGIC) and to assess enamel surface roughness before and after the removal of brackets bonded with composite or RMGIC from the maxillary central incisors. Fifteen orthodontic patients were selected for the study. For each patient, the teeth were rinsed and dried, and brackets were bonded with composite (Transbond XT) and RMGIC (Vitremer Core Buildup/Restorative). At the conclusion of orthodontic treatment, their brackets were removed. Dental replicas were made of epoxy resin in initial conditions (before bonded) and after polishing with an aluminum oxide disc system. Adhesive remnant index (ARI) and surface roughness was measured on the dental replicas and data were evaluated statistically by Mann-Whitney and paired t-test, respectively. No bracket debonding occurred during patients' treatment periods. It was verified that the ARI values of the two maxillary central incisors were similar (p = 0.665). For both bonding materials, the ARI value of 3 was predominant. After polishing, surface roughness was similar in the composite and RMGIC groups (0.245 μm and 0.248 μm, respectively; p = 0.07). In both groups, enamel surface roughness values were significantly lower after polishing compared with the initial condition (p < 0.001). RMGIC promoted efficiency in cementing brackets without fail during treatment; the choice of composite or RMGIC materials was not a factor that influenced the roughness of the enamel surface, however, polishing led to smoother surfaces than those found at the beginning of the treatment.

Effect of Protein-Based Treatment on Chemical Composition, Hardness and Bond Strength of Remineralized Enamel

This study evaluated the chemical composition and microhardness of human enamel treated with an Enamel Matrix Derivative (EMD) solution, and the bond strength between composite resin and this enamel. Thirty human enamel samples were randomly divided into three groups: Untouched Enamel (UE), Demineralized Enamel (DE) and Demineralized Enamel Treated with EMD (ET). DE and ET groups were subjected to acid challenge and ET treated with EMD (EMD was directly applied over conditioned enamel and left for 15 min). Samples from each group (n=4) had chemical composition assessed through to attenuated total reflectance Fourier transform infrared (ATR-FTIR). Knoop microhardness of enamel samples from each group (n=10) was measured. For the microshear bond strength, the samples were etched for 30 s, and the adhesive was applied and cured for 10 s. Two matrixes were placed on the samples, filled with Filtek Z350 XT composite and cured for 20 s, each. The matrix was removed, and the microshear bond strength of each group (n=10) was tested. Data were subjected to Kruskal-Wallis test (for microhardness), to analysis of variance and to Tukey's test (for microshear bond strength); (α=0.05). FTIR results have shown phosphate (hydroxyapatite indicator) in 900-1200 cm-1 bands in the UE and ET groups, which were different from the DE group. Microhardness and microshear analyses recorded higher statistical values for the UE and ET groups than for DE. EMD application to demineralized enamel seems to have remineralized the enamel; thus, the microhardness and bond strength was similar between UE and ET groups.

Can silver diamine fluoride or silver nanoparticle-based anticaries agents to affect enamel bond strength?

Objectives

The aim of the current study is to investigate the effect of different anticaries agents, such as experimental agents based on silver nanoparticles (SNPs) and silver diamine fluoride (SDF), on the micro-shear bond strength (μ-SBS) of composite resin applied to intact enamel (IE) or demineralized enamel (DE).

Materials and Methods

Sixty dental enamel fragments were collected from human third molars and categorized into 6 groups (n = 10): positive control (IE), negative control (DE), IE + SDF, DE + SDF, IE + SNP and DE + SNP. Samples from DE, DE + SDF and DE + SNP groups were subjected to pH cycling; superficial microhardness test was performed to confirm demineralization. Resin composite build-ups were applied to the samples (0.75-mm diameter and 1-mm height) after the treatments (except for IE and DE groups); μ-SBS was also evaluated. Samples were analyzed under a stereomicroscope at 40× magnification to identify failure patterns. Data were subjected to one-way analysis of variance, followed by Tukey's and Dunnett's tests (p < 0.05).

Results

There was no significant difference among the IE, IE + SNP, DE + SDF, and DE + SNP groups. The IE + SDF and DE groups recorded the highest and the lowest μ-SBS values, respectively. Adhesive-type failures were the most frequent for all treatments.

Conclusions

Anticaries agents did not have a negative effect on the μ-SBS of composite resin when it was used on IE or DE.

Photoelastic stress analysis of different types of anterior teeth splints

BACKGROUND/AIMS

Traumatic dental injuries are highly prevalent and are considered an important health problem. The aim of this study was to evaluate the in vitro stress distribution around simulated traumatized teeth subjected to different types of splints by photoelastic analysis.

MATERIALS AND METHODS

For each group, five models of maxillary and mandibular arches were made in photoelastic resin using prefabricated teeth models, which were fixed and adjusted in a semi-adjustable articulator. All splints were bonded with composite resin on the labial surfaces of the maxillary central incisors, the lateral incisors and the canine teeth, simulating trauma to the 11. The groups were divided according to the type of splint: control-without splint; rigid-brackets and 0.021 × 0.025 inch stainless steel wire; semi-rigid-brackets and 0.016 × 0.016 inch cobalt-chromium wire; fiber-fiberglass ribbon; and flexible-nylon thread. The groups were submitted to an occlusal force in a special device attached to a universal test machine in balanced, protrusive, and lateral occlusions. Then, the incisal edge of the 11 was ground to simulate infra-occlusion, and the tests were performed again. Five points were analyzed around tooth 11 with a polariscope, and the data were submitted to ANOVA and Tukey tests at a 5% level of significance.

RESULTS

When centric occlusion was analyzed by comparing normal occlusion to infra-occlusion, all groups showed high stress values in infra-occlusion with statistical differences-except for the control group. When lateral occlusion was analyzed, the nylon splint showed lower statistical differences compared with the control, fiberglass, and rigid splint groups, which did not differ between each other. The semi-rigid splint did not differ from any group.

CONCLUSIONS

Fiberglass and semi-rigid splints showed better stress distribution around the traumatized tooth under occlusal loads. The nylon splint showed characteristics of non-stress distribution.

Reabilitação estética anterior associando cirurgia periodontal com laminados cerâmicos : Relato de caso

Objetivo: Este trabalho teve como objetivo relatar um caso de reabilitação estética através de laminados cerâmicos e cirurgia periodontal como forma de tratamento para a agenesia do elemento dental 22 e sorriso gengival associado à retração labial. Relato do Caso: Paciente, gênero feminino procurou a Clínica Multidisciplinar da Unipar (Sede/Umuarama) relatando insatisfação com a harmonia estética do sorriso, apresentando coroas curtas e agenesia do elemento dental 22. Com base na anatomia do contorno gengival, foi indicada cirurgia de gengivectomia (bisel interno com osteotomia) para a região ântero-superior. Através do enceramento diagnóstico projetou-se o aumento de coroa clínica, obtendo-se assim uma guia, que foi utilizado para a realização do ensaio diagnóstico intrabucal, mock-up, e auxílio na cirurgia periodontal. Após 60 dias a paciente foi encaminhada para a realização dos procedimentos restauradores com a confecção de laminados cerâmicos. Conclusão: Pôde-se concluir através dos resultados clínicos obtidos, que a atuação multidisciplinar devolveu a harmonia estética do sorriso e melhora na qualidade de vida da paciente.

Molecular Subtype Classification in Lower-Grade Glioma with Accelerated DTI

BACKGROUND AND PURPOSE

Image-based classification of lower-grade glioma molecular subtypes has substantial prognostic value. Diffusion tensor imaging has shown promise in lower-grade glioma subtyping but currently requires lengthy, nonstandard acquisitions. Our goal was to investigate lower-grade glioma classification using a machine learning technique that estimates fractional anisotropy from accelerated diffusion MR imaging scans containing only 3 diffusion-encoding directions.

MATERIALS AND METHODS

Patients with lower-grade gliomas (n = 41) (World Health Organization grades II and III) with known isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status were imaged preoperatively with DTI. Whole-tumor volumes were autodelineated using conventional anatomic MR imaging sequences. In addition to conventional ADC and fractional anisotropy reconstructions, fractional anisotropy estimates were computed from 3-direction DTI subsets using DiffNet, a neural network that directly computes fractional anisotropy from raw DTI data. Differences in whole-tumor ADC, fractional anisotropy, and estimated fractional anisotropy were assessed between IDH-wild-type and IDH-mutant lower-grade gliomas with and without 1p/19q codeletion. Multivariate classification models were developed using whole-tumor histogram and texture features from ADC, ADC + fractional anisotropy, and ADC + estimated fractional anisotropy to identify the added value provided by fractional anisotropy and estimated fractional anisotropy.

RESULTS

ADC (P = .008), fractional anisotropy (P < .001), and estimated fractional anisotropy (P < .001) significantly differed between IDH-wild-type and IDH-mutant lower-grade gliomas. ADC (P < .001) significantly differed between IDH-mutant gliomas with and without codeletion. ADC-only multivariate classification predicted IDH mutation status with an area under the curve of 0.81 and codeletion status with an area under the curve of 0.83. Performance improved to area under the curve = 0.90/0.94 for the ADC + fractional anisotropy classification and to area under the curve = 0.89/0.89 for the ADC + estimated fractional anisotropy classification.

CONCLUSIONS

Fractional anisotropy estimates made from accelerated 3-direction DTI scans add value in classifying lower-grade glioma molecular status.

Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype

BACKGROUND AND PURPOSE

Diffuse lower-grade gliomas are classified into prognostically meaningful molecular subtypes. We aimed to determine the impact of surgical resection on overall survival in lower-grade glioma molecular subtypes.

MATERIALS AND METHODS

For 172 patients with lower-grade gliomas (World Health Organization grade II or III), pre- and postsurgical glioma volumes were determined using a semiautomated segmentation software based on FLAIR or T2-weighted MR imaging sequences. The association of pre- and postsurgical glioma volume and the percentage of glioma resection with overall survival was determined for the entire cohort and separately for lower-grade glioma molecular subtypes based on isocitrate dehydrogenase (IDH) and 1p/19q status, after adjustment for age, sex, World Health Organization grade, chemotherapy administration, and radiation therapy administration.

RESULTS

For the entire cohort, postsurgical glioma volume (hazard ratio, 1.80; 95% CI, 1.18-2.75; P = .006) and the percentage of resection (hazard ratio, 3.22; 95% CI, 1.79-5.82; P < .001) were associated with overall survival. For IDH-mutant 1p/19q-codeleted oligodendrogliomas, the percentage of resection (hazard ratio, 6.69; 95% CI, 1.57-28.46; P = .01) was associated with overall survival. For IDH-mutant 1p/19q-noncodeleted astrocytomas, presurgical glioma volume (hazard ratio, 3.20; 95% CI, 1.22-8.39; P = .018), postsurgical glioma volume (hazard ratio, 2.33; 95% CI, 1.32-4.12; P = .004), and percentage of resection (hazard ratio, 4.34; 95% CI, 1.74-10.81; P = .002) were associated with overall survival. For IDH-wild-type lower-grade gliomas, pre-/postsurgical glioma volume and percentage of resection were not associated with overall survival.

CONCLUSIONS

The extent of surgical resection has a differential survival impact in patients with lower-grade gliomas based on their molecular subtype. IDH-mutant lower-grade gliomas benefit from a greater extent of surgical resection, with the strongest impact observed for IDH-mutant 1p/19q-noncodeleted astrocytomas.

Evaluation of the effects of whitening mouth rinses combined with conventional tooth bleaching treatments

Objectives

The aim of the present study was to evaluate the effect of whitening mouth rinses alone and in combination with conventional whitening treatments on color, microhardness, and surface roughness changes in enamel specimens.

Materials and Methods

A total of 108 enamel specimens were collected from human third molars and divided into 9 groups (n = 12): 38% hydrogen peroxide (HP), 10% carbamide peroxide (CP), 38% HP + Listerine Whitening (LW), 10% CP + LW, 38% HP + Colgate Plax Whitening (CPW), 10% CP + CPW, LW, CPW, and the control group (CG). The initial color of the specimens was measured, followed by microhardness and roughness tests. Next, the samples were bleached, and their color, microhardness, and roughness were assessed. Data were analyzed through 2-way analysis of variance (ANOVA; microhardness and roughness) and 1-way ANOVA (color change), followed by the Tukey post hoc test. The Dunnett test was used to compare the roughness and microhardness data of the CG to those of the treated groups.

Results

Statistically significant color change was observed in all groups compared to the CG. All groups, except the LW group, showed statistically significant decreases in microhardness. Roughness showed a statistically significant increase after the treatments, except for the 38% HP group.

Conclusions

Whitening mouth rinses led to a whitening effect when they were used after conventional treatments; however, this process caused major changes on the surface of the enamel specimens.

Influência de antioxidantes na resistência de união de substratos clareados

A busca permanente pela estética tem levado muitos pacientes ao consultório odontológico com a intenção de obterem sorrisos mais harmônicos em relação à forma, tamanho, posicionamento e cor dos dentes. O clareamento de dentes vitais é uma alternativa conservadora, não invasiva quando comparado à microabrasão, facetas e coroas, além de proporcionar elevado índice de sucesso para o tratamento de dentes escurecidos. Por outro lado, restaurações pré-existentes em resina composta normalmente necessitam ser substituídas após o clareamento dental, visto que o agente clareador não altera a sua coloração. Sendo assim, a espera de 14-21 dias para a realização de novas restaurações é de suma importância, uma vez que o efeito oxidante nos tecidos dentários pode gerar alterações estruturais no esmalte e redução da resistência de união, bem como microinfiltrações. Este intervalo de tempo muitas vezes, não condiz com a expectativa dos pacientes, gerando desconforto. Diante disso, estudos tem sido conduzido com o objetivo de minimizar ou até mesmo anular o efeito adverso do oxigênio residual e com isso possibilitar a execução pós-clareamento de restaurações adesivas com segurança e eficácia, em tempo reduzido de espera. Uma das alternativas tem sido a utilização de agentes antioxidantes. Sendo assim, esse trabalho teve como objetivo revisar a literatura em relação aos agentes antioxidantes utilizados bem como a eficácia dos mesmos na resistência adesiva de materiais restauradores ao substrato dental clareado. Esta revisão foi realizada através de buscas por artigos científicos, em bases de dados como Scielo, Pubmed/Medline e Cochrane Library, com artigos em língua portuguesa e inglesa, sem limitação de data. Foram abrangidos, no estudo, trabalhos que envolvessem os temas “clareamento dental”, “clareadores”, “esmalte dentário”, “dentina”, “antioxidantes” e “resistência à tração”, buscando analisar sua relevância clínica e científica. Avaliações que não se enquadravam no assunto principal e respectivos itens avaliados, foram excluídos da revisão. Foi possível concluir que a utilização de compostos antioxidantes influenciam de forma positiva na resistência de união ao substrato dental clareado.

Evaluation of bond strength durability on bleached human dentin

This study evaluated the effect of aging on the microtensile bond strength (μTBS) between composite resin and human dentin bleached with 35% hydrogen peroxide (HP) or 10% carbamide peroxide (CP). Thirty intact extracted third molars were selected for the study. After the dentin surface was exposed, the smear layer was abraded with silicon carbide paper to ensure standardization. The teeth were randomly divided into 3 groups: 1 (G1), no treatment (control); 2 (G2), dentin bleached with CP (at-home bleaching); and 3 (G3), dentin bleached with HP (in-office bleaching). G2 and G3 were bleached according to the manufacturers' instructions and stored in distilled water for 21 days. The teeth in all 3 groups were then bonded with a dental bonding agent and nanohybrid composite resin. Each tooth was sectioned and divided into groups to allow evaluations at 3 time periods: 24 hours, 6 months, and 12 months. The specimens were stored in distilled water at 37°C ± 1°C until use. The μTBS of the specimens was tested on a universal testing machine. Fracture mode analysis was performed with a stereoscopic loupe. The data were analyzed statistically by 2-way analyses of variance and Tukey tests. After 24 hours, G3 had a significantly lower mean [SD] μTBS value (20.00 [5.67] MPa) than G1 (31.14 [8.83] MPa), but their means were statistically similar at 6 months (29.42 [7.72] MPa vs 22.97 [7.48] MPa, respectively). Tukey tests revealed that there was no statistically significant change in μTBS over time for G2 or G3. After 12 months of aging, only G1 specimens showed statistically lower μTBS values compared with the 24-hour time period (P < 0.05). Based on the results, the durability of the bond between composite resin and dentin is not affected by the choice of bleaching treatment.

Evaluation of physico-chemical and mechanical properties of MTA-based root canal sealer

Aim: The aim of this study was to evaluate and compare the setting times (ST), flow (FW), radiopacity (RP), dimensional stability (DS), solubility (SB), and polymerization stress (PS) of the MTA Fillapex and AH Plus root canal sealers. Methods: The above qualities were tested according to ISO 6876/2001 standardization. The water used in the dimensional stability test was evaluated to verify the presence of released materials. For the photoelastic analysis, 20 photoelastic resin rings were prepared, and the root canal sealers were inserted. After 24 hours, the specimens were analyzed in a Polariscope. Data of the setting times, flow tests, radiopacity, dimensional stability, and solubility tests were submitted to a Kolgomorov–Smirnov test and then to a Student’s t-test at the 5% significance level. Results: The data derived from photoelastic analyses were submitted to an ANOVA and Tukey’s test with a significance level of 5%. MTA Fillapex and AH Plus complied with ISO 6876/2001. However, there were significant differences (p < 0.05) between the two cements for ST, FW, RP, DS, and SB. MTA Fillapex showed higher FW, SB, and PS when compared with AH Plus. Conclusions: MTA Fillapex and AH Plus complied with ISO 6876/2001 in terms of ST, FW, RP, DS, and SB. MTA Fillapex showed higher PS when compared to AH Plus.

Treatment of Dental Caries with Diamine Silver Fluoride: Literature Review

AbstractBrazilian health care programs recommend the use of cariostatic solutions of silver diamine fluoride (SDF) or sodium fluoride varnishes for children 0 to 3 years old with high or moderate caries activity for the control of caries lesions. SDF is a safe, economical, efficient and non-invasive coadjuvant agent, exerting an antibacterial action capable of reducing superficial mineral loss of the enamel and can be used in the treatment of deciduous and permanent teeth. The objective of this literature review was to gather current information on describing the mechanism of SDF action’ and its clinical application in young children in caries prevention and paralysis. The PubMed / Medline and Cochrane Library databases were accessed by identifying the relevant studies published in English from 1960 to May 2017. The search strategy employed the keywords: “Silver diamine fluoride” and “Children “or “Infant” and “Caries prevention”. Data extraction was performed in: 19 in vitro studies; 10 review articles and 8 in vivo studies. It was possible to conclude that SDF is almost twice as effective compared to fluoride varnish in caries paralysis. However, the contact time of the solution and the optimal frequency of application of the SDF are still undefined, inducing new projects and clinical studies in the search for an adequate clinical protocol of this cariostatic.Keywords: Preventive Dentistry. Children. Dental Caries.Resumo Os programas de assistência à saúde brasileiros recomendam para o controle das lesões de cárie a utilização de soluções cariostáticas de diamino fluoreto de prata - DFP ou vernizes de fluoreto de sódio para crianças de 0 a 3 anos com atividade de cárie alta ou moderada. O DFP é agente coadjuvante seguro, econômico, eficiente e não invasivo, exercendo ação antibacteriana capaz de reduzir a perda mineral superficial do esmalte e, pode ser utilizado no tratamento de dentes decíduos e permanentes. O objetivo desta revisão de literatura foi reunir informações atuais sobre descrever o mecanismo de ação do DFP e sua aplicação clínica em crianças de pouca idade na prevenção e paralisação da cárie. As bases de dados PubMed/Medline e Cochane Library foram acessadas identificando os estudos relevantes publicados em inglês, no período de 1960 a maio de 2017. A estratégia de busca empregou as palavras-chave: “Silver diamine fluoride” and “Children” or “Infant” and “Caries prevention”. A extração dos dados foi realizada em: 19 estudos in vitro; 10 artigos de revisão e 8 estudos in vivo. Foi possível concluir que o DFP apresenta-se quase duas vezes tão eficaz comparado ao verniz fluoretado na paralização de cárie. Porém, o tempo de contato da solução e a frequência ótima de aplicação do DFP ainda estão indefinidos, suscitando novos projetos e estudos clínicos na busca de adequado protocolo clínico deste cariostático.Palavra-chave: Odontologia Preventiva. Criança. Carie Dentária. 

Use of BRIX-3000 Enzymatic Gel in Mechanical Chemical Removal of Caries: Clinical Case Report

AbstractLess traumatic alternative methods for removal of decayed tissue has been developed. A non-invasive technique, which consists of applying a proteolytic substance that softens the infected dentin tissue and preserves healthy tooth tissue was released in the market. Thus, this work intended to describe a clinical case of caries removal using BRIX 3000 papaine-based enzymatic gel. A 6-year-old male patient attend to a Univesity Dental Clinic complaining of painful sensitivity during mastication. After examination, acute deep carious lesion was found in dental elements 64 and 65. The caries removal procedure was performed for both teeth without anesthesia, under relative isolation, following the principles of atraumatic restorative treatment - ART. The gel was taken into the cavity and leaved to act for 2 minutes and the infected tissue was excavated. Caries lesion was then detected below the OM cusp with undercut enamel, needing to enlarge the cavity in the occlusal region with rotating cutting instruments and reapply the gel. After the second application, all the infected tissue had been removed and the teeth restoration with chemical ionomer cement was performed. At the end of the treatment, the discomfort during the performed procedure was asked to the patient using the Wong-Baker Face Scale. The child pointed to score 1, indicating mild pain for both treatments. It can be concluded that the use of enzymatic papaine gel-based was an efficient alternative for caries removal, easy to use, and preserve to the maximum the dental structure healthy, showing promise to be used as atraumatic caries removal technique.Keywords: Dental Caries. Papain. Pediatric Dentistry.ResumoMétodos alternativos menos traumáticos para remoção de cárie vem sendo desenvolvidos. Uma técnica não invasiva, que consite na aplicação de uma substância proteolítica que amolece a dentina infectada e preserva o tecido dental hígido foi lançado no mercado. Sendo assim, este trabalho visa relatar um caso clínico de remoção da lesão de cárie através do gel enzimático a base de papaína, BRIX-3000. Paciente do gênero masculino, 6 anos, compareceu à Clínica Odontológica Universitária com queixa de sensibilidade dolorosa durante a mastigação. Após avaliação, constatou-se lesão cariosa profunda aguda nos elementos dentais 64 e 65. O procedimento de remoção de cárie foi realizado sem anestesia e sob isolamento relativo, seguindo os princípios do tratamento restaurador atraumático (ART). O gel foi levado à cavidade, deixado agir por 2 minutos e realizado a escavação do tecido infectado. Foi detectado lesão de cárie abaixo da cúspide OM com esmalte socavado, necessitando de ampliação da cavidade na região oclusal com instrumentos cortantes rotatórios e reaplicação do gel. Após a segunda aplicação, todo o tecido infectado foi removido e realizada a restauração dos dentes com cimento de ionômero químico. Ao final do tratamento, foi aplicado a escala de faces de Wong-Baker. A criança apontou score 1, indicando dor leve para ambos os tratamentos. Pôde se concluir que a utilização do gel enzimático a base de papaína é uma alternativa eficiente para remoção do tecido cariado, de fácil utilização, preservando ao máximo a estrutura dental sadia, sendo promissor para ser utilizado na técnica atraumática de remoção da cárie.Palavras-chave: Cárie Dentária. Papaína. Odontopediatria.

Influence of chloramine-T disinfection on elastomeric impression stability

Objective:

The aim of this study was to evaluate the stability of elastomer through detail reproduction and its dimensional stability (DS) after disinfection with 0.2% chloramine-T.

Materials and Methods:

The elastomeric impression dental materials used in this study were polydimethylsiloxane (Oranwash L), polyvinyl siloxane (Express), polysulfide (Permlastic), and polyether (Impregum Soft). The entire press procedure was performed on a matrix in accordance with the ISO 4823. Detail reproduction was analyzed using an optical microscope (Stereozoom Microscope) over the 20-μm line with 25 mm of length at a magnification of ×4. DS was measured using an optical microscope (Scanning Tunneling Microscope) by subtracting the distance between the lines X and X' over the 20-μm line on the matrix (DM) from the distance between the lines on the impression material (DI) divided by DM and multiplied by 100 establishing the equation: DS = ([DI – DM]/DM) ×100; then, 100% was added to the results of the equation. The detail reproduction values were subsequently subjected to descriptive analysis by percentage (%), and the DS values (%) were submitted to Kolmogorov–Smirnov test, two-way ANOVA (material × disinfectant), and Tukey's test (α = 0.05).

Results:

All elastomeric impression materials showed 100% of detail reproduction, regardless of the disinfection procedure. Polysulfide (not disinfected) and polysulfide and polydimethylsiloxane (after disinfection with 0.2% chloramine-T) showed the smaller mean values of DS.

Conclusion:

According to the stability properties analyzed, chloramine-T can be used for disinfection of elastomer molds.

Influência do Antioxidante Resveratrol nas Propriedades Físicas e Mecânicas do Esmalte Clareado

O objetivo deste estudo foi avaliar o efeito do antioxidante resveratrol associado ao peróxido de hidrogênio a 38%. 80 terceiros molares foram divididos em 8 grupos (n10): SC – Sem clareamento em 24h, SC21 – sem clareamento em 21 dias, SCR – Sem clareamento e com resveratrol em 24h, SCR21 – Sem clareamento e com resveratrol em 21dias, C – com clareamento sem resveratrol em 24h, C21 – com clareamento sem resveratrol em 21 dias, CR – com clareamento e com resveratrol em 24h, CR21 – com clareamento e com resveratrol em 21dias. Nos grupos com resveratrol, o mesmo foi aplicado por 1 min após o clareamento. As amostras foram submetidas aos testes de microdureza Knoop, rugosidade, microcisalhamento e avaliação de cor (e). Os dados foram submetidos   a ANOVA e ao teste de Tukey (5%). Foi observada redução (p<0.05) de dureza somente para os grupos com resveratrol (SCR - 256±51, SCR21 - 276±54, CR - 272±42 e CR21 - 258±49). Foi observado diferença (p<0.05) na rugosidade somente no grupo C (0,13±0,05). Os grupos com resveratrol tiveram redução nos valores em MPa (p<0.05) em 24h (SCR – 4,00±1,53, CR – 3,97±4,69), entretanto aumento em 21d (SCR21 – 8,02±2,80, CR – 10,82±4,69) (p>0.05). Houve variação de e (p<0.05) somente para os grupos clareados. Houve uma diminuição nas falhas mistas para os grupos com resveratrol após 21dias e uma diminuição para os demais. O resveratrol apresentou um efetivo potencial antioxidante sem influenciar na alteração de cor gerado pelo clareamento.Palavras-chave: Antioxidantes. Microcisalhamento. Clareamento Dental.

Avaliação in vivo da Rugosidade do Esmalte após Remoção de Braquetes Colados com Diferentes Materiais Cimentantes

O objetivo foi avaliar a rugosidade superficial do esmalte dentário utilizando rugosímetro antes e após polimento com diferentes materiais cimentantes. Quinze pacientes ortodônticos foram selecionados para o estudo e réplicas dos dentes 11 e 21 foram confeccionadas com resina epóxica. Nos dentes de um lado da boca foram colados braquetes com resina composta (Transbond XT [T] n 15). Dentes do outro lado foram colados com cimento de ionômero de vidro modificado por resina (Vitremer [V] n 15). Todos os dentes foram acabados e polidos com discos de óxido de alumínio (Sof-Lex). Na conclusão do tratamento ortodôntico, os braquetes foram removidos e réplicas dentárias após o polimento dos dentes foram obtidas. Três mensurações de rugosidade superficial foram efetuadas, e uma média para cada réplica dental foi calculada. Os dados foram avaliados estatisticamente rugosidade pela análise- medidas repetidas de variância. Após a remoção dos cimentos com os discos de óxido de alumínio, nos dois grupos estudados   com diferentes materiais cimentantes, observou-se que a rugosidade média da superfície do esmalte (T – 0,245 V – 0,248) foi significativamente menor quando comparado com a rugosidade superficial do esmalte antes do início do tratamento (T – 0,370  V – 0,372) não houve diferença estatística entre os materiais cimentantes. O sistema de polimento de disco de óxido de alumínio proporcionou menor rugosidade superficial do esmalte comparado à rugosidade antes do início do tratamento, independentemente do material cimentante utilizado.Palavras-chave: Esmalte Dentário. Polimento Dentário. Descolagem Dentária.

Influência do Primer e Sistema Adesivo Sobre a Resistência de União do Cimento Resinoso Quimicamente Ativado à Liga Dental Co-Cr

O objetivo foi avaliar os efeitos de primers e sistemas adesivos sobre a resistência de união ao microcisalhamento do cimento resinoso quimicamente ativado à liga de Co-Cr. Setenta e dois blocos retangulares de liga metálica Co-Cr foram fabricados e pré-tratados com partículas de dióxido de alumínio (50 µm) por 15 segundos. Aplicaram-se os primers (Alloy Primer - AP ou Clearfil Ceramic Primer - CP), adesivos (Adper Scotchbond Multi-Purpose Adhesive ativado por Adper Scotchbond Multi-Purpose Adhesive Catalyst - SASC ou Primer & Bond 2.1 ativado pelo Self Cure Activator - PBCA) e subsequentemente divididos em seis grupos (SASC AP / SASC CP / SASC PBCAAP / PBCA CP / PBCA), n 12. Em seguida, foi aplicado o cimento de resina (Enforce). Os dados para os valores resistência de união foram estatisticamente avaliados por análise de variância e teste de Tukey. A resistência de união ao microcisalhamento (MPa) foi menor (p<0,001) em grupos com sistema adesivo somente (SASC- 5,02 e PBCA- 13,38) em comparação com os grupos com adição de primers Alloy Primer (AP / SASC- 15,81 e AP / PBCA- 15,36) e Ceramic Primer (CP / SASC- 16,92 e CP / PBCA- 16,30). A aplicação de primers melhora a resistência à união do cimento resinoso à liga de metal Co-Cr.Palavras-chave: Resistência ao Cisalhamento. Cimentos de Resina. Cimentação.

Facetas Cerâmicas Estéticas Associadas a Próteses Metalocerâmicas: Relato de Caso

Facetas cerâmicas fornecem resultados estéticos satisfatórios, preservando a estrutura dentária. A cerâmica dental pode melhorar a aparência estética e restabelecer a resistência e a função dos dentes. Nos dentes anteriores restaurados, as superfícies funcionais, por exemplo, em orientação anterior e lateral podem ser restauradas efetivamente. As características da cerâmica dental, como a estabilidade da cor e as propriedades mecânicas e ópticas, tornam este material uma boa escolha para restaurações indiretas, especialmente, quando são necessárias funções ótimas e a estética. Além disso, o dissilicato de lítio é uma cerâmica dental, que imita a estética e a resistência da estrutura dentária natural e foi utilizado no presente relato de caso clínico.Palavras-chave: Prótese Dentária. Estética Dentária. Cerâmica.AbstractCeramic veneers provide satisfactory esthetic outcomes while preserving the dental structure. Dental ceramics can both improve the esthetic appearance and reestablish the teeth’s strength and function. In restored anterior teeth, functional surfaces, for example, anterior and lateral guidance, can be restored effectively. The characteristics of dental ceramics, such as color stability and mechanical and optical properties, make this material a good choice for indirect restorations, especially when optimum function and esthetics are required. Moreover, lithium disilicate is a dental ceramic that mimics the esthetics and strength of the natural tooth structure and it was used in the present clinical case report.Keywords: Dental Prosthesis. Esthetics, Dental. Ceramics.

Uso e Necessidade de Prótese Dentária em Idosos de Londrina, Paraná

Este estudo avaliou a necessidade e uso de prótese entre 504 idosos independentes, cadastrados nas Unidades Básicas de Saúde (UBS) do município de Londrina, Paraná. As características sociodemográficas foram também analisadas. A situação quanto às próteses dentárias foi avaliada a partir de informações sobre seu uso e necessidade nos arcos superior e inferior. As observações ao exame levaram em conta os códigos e critérios preconizados pela Organização Mundial de Saúde (OMS). As informações sociodemográficas foram obtidas pela aplicação de um formulário estruturado, avaliando: sexo, idade, nível de escolaridade, estado conjugal, tipo de moradia, número de pessoas na casa, renda familiar. A idade dos 504 idosos avaliados envolveu entre 60 e 75 anos, sendo a maioria entre 65 e 74 anos (54,2%), do gênero feminino (66,3%), de procedência rural (53,8%), cor branca (62,1%) e com até 4 anos de estudo (80,6%). Destes idosos, 15,1% não usam qualquer tipo de prótese, 24,6% usam em uma arcada e 60,3% usam algum tipo de prótese nas duas arcadas. Quanto à necessidade de prótese, observou-se que 21,6% não necessitam de qualquer tipo de prótese, 19,4% necessitam em uma arcada e a maioria (58,9%) necessita nas duas arcadas. Somente houve dependência, estatisticamente significante, entre as variáveis de necessidade de prótese dentária e gênero, cor da pele e procedência. Sendo assim, pode-se concluir que a prevalência de necessidade de prótese é acentuada e existe uma demanda populacional para reabilitação protética.Palavras-chave: Epidemiologia. Idosos. Saúde Bucal.AbstractThis study evaluated the need and use of prosthesis among 504 independent elderly, registered in the Basic Health Units (BHU) of the city of Londrina, Paraná. Sociodemographic characteristics were also evaluated. The situation regarding dental prosthesis was evaluated based on information about their use and need in the upper and lower arches. The observations were performed according to the codes and criteria recommended by the World Health Organization (WHO). The sociodemographic information was obtained by applying a structured form, evaluating: gender, age, educational level, marital status, housing type, number of people living in the residence, family income. The age of the 504-elderly studied was between 65 and 74 years (54.2%), female (66.3%), rural origin (53.8%), white skin color (62.1%) and up to 4 years of schooling (80.6%). Of these elderly, 15.1% do not use any type of prosthesis, 24.6% use only in one dental arch and 60.3% use some type of prosthesis in both arches. Regarding the need of prosthesis, it was observed that 21.6% do not require any type of prosthesis, 19.4% need in one arch and the majority (58.9%) needs in both arches. There was only statistically significant dependence among the variables of need for dental prosthesis and gender, skin color and origin. Thus, it can be concluded that the prevalence of need for prosthetic is high and there is a population demand for prosthetic rehabilitation.Keywords: Epidemiology. Elderly. Oral Health.

Avaliação da Resistência de União Entre Resina Composta e Substrato Dentinário Exposto à Quitosana

Em endodontia, indicam-se substâncias quelantes para a remoção da lama dentinária. O objetivo deste estudo foi avaliar, in vitro, por meio do microcisalhamento, a resistência de união da resina composta com superfícies dentinárias tratadas com EDTA (17%) e quitosana (0,2%). De 30 coroas de dentes bovinos foram removidas as paredes palatina, mesial e distal, expondo a superfície dentinária da parede vestibular da câmara coronária, que abrasionada produziu a camada de esfregaço. Após, a superfície foi tratada, estabelecendo-se 3 grupos (n=10): G1 (controle) com aplicação de água destilada (1min); G2 com aplicação de EDTA (3 min.), e lavagem com água destilada (1 min.); e G3 com aplicação de quitosana (3 min.), lavagem com água destilada (1 min.). Na sequência foram aplicados 2 ml de NaOCl (2,5%), 2 ml de água destilada (1 min), armazenando-as em água destilada (37 °C). Retiradas da água destilada (24 h), fixaram –se 3 tubos Tygon (1mmX1mm) na dentina após o condicionamento local com sistema adesivo convencional de 2 passos. Preenchidos com resina composta e após fotoativação, os tubos foram removidos obtendo-se cilindros que foram submetidos ao microcisalhamento em máquina de ensaio universal. Os resultados de resistência de união (MPa) foram submetidos a Análise de Variância e Tukey, com nível de significância 5%. Observou-se que a resistência de união de G2 e G3 foram equivalentes estatisticamente (p>0,05), porém significativamente maiores que em G1 (p<0,05). Conclui-se que quitosana e EDTA promovem resistência de união semelhante nas condições testadas.Palavras-chave: Camada de Esfregaço. Dentina. Endodontia.AbstractIn endodontics, chelating substances are indicated for smear layer removal. This study evaluated, by micro-shear, the bond strength between composite resin and dentin surfaces treated with EDTA (17%) and chitosan (0.2%). The palatal, mesial and distal walls were removed from 30 crowns of bovine teeth, to expose buccal dentin of coronary chamber, whose abrasion produced the smear layer. The surface was treated, considering 3 groups (n = 10): G1 (control) distilled water (1min); G2 EDTA application (3 min), and distilled water (1 min); and G3 chitosan application (3 min.), distilled water (1 min.). All groups received 2 ml of NaOCl (2.5%), 2 ml of distilled water (1 min), and then stored in distilled water (37 °C). After that (24 h), 3 Tygon matrix (1 mmX1 mm) were fixed to the dentin after surface storing them with a two-step adhesive system. Then, the matrixes were filled with composite resin, and once photoactivated, the matrix were removed resulting in cylinders that were submitted to micro-shear bond test in universal test machine. The results (MPa) were submitted to ANOVA and Tukey, with significance level of 5%. It was observed that G2 and G3 bond strength were statistically equivalent (p> 0.05), but significantly higher than G1 (p <0.05). It is concluded that chitosan and EDTA resulted in similar bond strength under the conditions tested.Keywords: Smear Layer. Dentin. Endodontics.

Rubbing time and bonding performance of one-step adhesives to primary enamel and dentin

Objectives:

This study investigated whether increasing the concentration of acidic monomers in one-step adhesives would allow reducing their application time without interfering with the bonding ability to primary enamel and dentin.

Material and methods:

Experimental one-step self-etch adhesives were formulated with 5 wt% (AD5), 20 wt% (AD20), or 35 wt% (AD35) acidic monomer. The adhesives were applied using rubbing motion for 5, 10, or 20 s. Bond strengths to primary enamel and dentin were tested under shear stress. A commercial etch-and-rinse adhesive (Single Bond 2; 3M ESPE) served as reference. Scanning electron microscopy was used to observe the morphology of bonded interfaces. Data were analysed at p<0.05.

Results:

In enamel, AD35 had higher bond strength when rubbed for at least 10 s, while application for 5 s generated lower bond strength. In dentin, increased acidic monomer improved bonding only for 20 s rubbing time. The etch-and-rinse adhesive yielded higher bond strength to enamel and similar bonding to dentin as compared with the self-etch adhesives. The adhesive layer was thicker and more irregular for the etch-and-rinse material, with no appreciable differences among the self-etch systems.

Conclusion:

Overall, increasing the acidic monomer concentration only led to an increase in bond strength to enamel when the rubbing time was at least 10 s. In dentin, despite the increase in bond strength with longer rubbing times, the results favoured the experimental adhesives compared to the conventional adhesive. Reduced rubbing time of self-etch adhesives should be avoided in the clinical setup.

Bone mineral density and inflammatory bowel disease severity

Inflammatory bowel disease (IBD) is associated with low bone mineral density (BMD). In this study, the association between disease severity and BMD in patients with IBD was evaluated. Associations between BMD and the Montreal classification, disease activity and drug therapy were also tested. A cross-sectional prevalence study with a comparison group was conducted. One hundred and twenty-eight patients were evaluated: 68 patients with ulcerative colitis (UC), and 60 with Crohn's disease (CD). The control group consisted of 67 healthy subjects. All patients and controls had BMD measured and in IBD patients, current medications, hospitalization, and disease location, extent and phenotype, according to the Montreal classification, were recorded. Multiple correspondence analysis was applied to evaluate categorical variables. In the CD group, most patients were diagnosed between 17–40 years of age. Ileocolonic and non-stricturing non-penetrating disease were the most frequent disease location and behavior, respectively. In UC patients, extensive colitis was the most frequent disease location. UC and CD patients were more likely to have osteopenia than controls (OR=14.93/OR=24.38, respectively). In the CD group, male patients, perianal disease, penetrating behavior and age at diagnosis >40 years were associated with low BMD. Taking azathioprine and infliximab also seemed to be associated with osteopenia. In the UC group, we observed an association between low BMD and male patients, left colitis, corticosteroid use and hospitalization. Disease activity was not associated with osteopenia or osteoporosis in CD and UC patients. Disease severity seems to be associated with osteopenia in IBD patients.

Microtensile Bond Strength and Microhardness of Composite Resin Restorations Using a Sonic-Resin Placement System

The aim of this study was to evaluate the efficacy of applying sonic energy on microtensile bond strength and microhardness after the restoration process. A total of 40 human third molars were extracted. Class II cavities were prepared and restored with composite SonicFill or Filtek Z350 XT with and without the application of sonic energy. After the teeth were stored in water for 24 h, the teeth were sectioned into sticks (1.0 mm2) and subjected to tensile testing. For a depth Knoop hardness test, the samples were cut and indentations were made sequentially from the surface of the samples to the bottom of the samples in three intervals of 1 mm each. The samples were then subjected to a load of 50 g for 10 s. The results from the tensile (factors: placement system and composite) and hardness (factors: placement system, composite and depth) tests were subjected to the Kolmogorov-Smirnov normality test, followed by analysis of variance and Tukey's test (5% significance). For the placement system factor, higher bond strength was observed for the cavities that were restored with sonic energy (p < 0.001). For depth Knoop hardness, the hardness at 1 mm depth was significantly greater than that at 3 mm depth just for the restorations with Filtek Z350 XT composite without the application of sonic energy. Therefore, the use of sonic energy during the restorative process improved bonding, yet it did not markedly affect the depth hardness for both composites.

From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal

The classification of neoplasms of adenohypophysial cells is misleading because of the simplistic distinction between adenoma and carcinoma, based solely on metastatic spread and the poor reproducibility and predictive value of the definition of atypical adenomas based on the detection of mitoses or expression of Ki-67 or p53. In addition, the current classification of neoplasms of the anterior pituitary does not accurately reflect the clinical spectrum of behavior. Invasion and regrowth of proliferative lesions and persistence of hormone hypersecretion cause significant morbidity and mortality. We propose a new terminology, pituitary neuroendocrine tumor (PitNET), which is consistent with that used for other neuroendocrine neoplasms and which recognizes the highly variable impact of these tumors on patients.

Prótese adesiva à base de compósito reforçado por fibra de vidro como opção estética para perda de elemento dental posterior – relato de caso

Com advento das resinas compostas de segunda geração que apresentam características mecânicas e estéticas superiores às das resinas convencionais, principalmente com relação a resistência à abrasão, surge a possibilidade de utilizá-las associadas a fibras, como o sistema da Ivoclar Targis/Vectris. O objetivo deste trabalho foi apresentar a confecção de uma prótese adesiva livre de metal como resolução protética para a substituição do elemento dental 35, ausente. Paciente M.A.S., 38 anos, sexo feminino, buscou tratamento restaurador por motivo de estética e necessidade de substituição das restaurações antigas. Após anamnese, exame clínico, exame radiográfico e exame dos modelos de estudo foi proposto a reposição do elemento dental 35 através de prótese adesiva confeccionada em cerômero (Sistema Targis/Vectris. Foi realizado um repreparo do tipo onlay no elemento dental 34 e repreparo para coroa total do dente 36.  Após o término dos preparos foi feita a moldagem utilizan­do-se a técnica da dupla moldagem e confecção da restauração provisória envolvendo os três elementos com resina acrílica. Na segunda sessão, a peça protética foi cimentada, a oclusão verificada e ajustada. Uma vez que os cerômeros têm resistência de união boa e semelhante à das cerâmicas, além de apresentarem caraterísticas mecânicas muito semelhantes à estrutura dental, conseguem atuar de forma satisfatória na distribuição das cargas oclusais em dentes posteriores. Assim, pode-se concluir que as restaurações livres de metal são ótimas alternativas para proporcionar a paciente uma melhora estética e funcional, além de integridade das margens e do periodonto, estabilidade estrutural, retenção e resistência da restauração.

Influence of Surface Treatments and Adhesive Systems on Lithium Disilicate Microshear Bond Strength

The purpose of this study was to evaluate the microshear bond strength of ceramic prosthetic structures reinforced by lithium disilicate cemented with resin cement under conditions of different surface treatments and adhesive systems. Seventy-two rectangular blocks of lithium disilicate (6.5 mm long × 5 mm wide × 1 mm thick) were fabricated, air abraded with 50-μm Al2O3 particles and divided into six groups (n=12) depending on the surface pretreatments. The groups were as follows: 10HF/S/SBM: 10% hydrofluoric acid etched for 20 s (10HF) + silane (S) + Adper Scotchbond Multi-Purpose (SBM); 10HF/S/SB: 10HF + S + Single Bond Universal (SB); 10HF/SBM; 10HF/SB; S/SBM and S/SB. Two 1-mm-long plastic tubes were placed on the specimens, filled with RelyX ARC resin cement and cured for 20 s per tube. The plastic tube was removed, and the microshear bond strength was tested. Data were submitted to analysis of variance and Tukey's tests (α=0.05). Fractured specimens were observed under optical microscopy. For both adhesives, the bond strengths (MPa) of groups treated with acid-etching and silane (10HF/S/SB: 24.82, 10HF/S/SBM: 24.90) were higher (p<0.001) than those of groups treated with acid-etching (10HF/SB: 16.47, 10HF/SBM: 19.94) only or only silane (S/SB: 18.42, S/SBM: 13.24). All groups showed a predominance of failure adhesive. The silanization should be a clinical step in cementing ceramic structures reinforced by lithium disilicate, even with the application of universal adhesive that contains silane in its formulation.

Correlation between antioxidant activity and bonding strength on bleached enamel

Objective: This study used the 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) method to evaluate the percentage of antioxidant activity (%AA) of green tea (GT) and sodium ascorbate (SA) gel in three concentrations (10%, 20% and 30%), and the influence of these concentrations on the microshear bond strength (μ-SBT) values of bleached enamel, using 10% carbamide peroxide (CP).

Materials and methods: Eighty intact third molars were selected to perform the μ-SBT test, and were randomly divided into eight experimental groups: G1: positive control – no treatment; G2: negative control – bleached with CP; G3: PC +10% GT; G4: PC +20% GT; G5: PC +30% GT; G6: PC +10% SA; G7: PC +20% SA and G8: PC +30% SA. After applying the treatments, adhesive procedures were performed using Single Bond 2 and Filtek Z350XT. After 24 h, the samples were tested in a universal testing machine until fracture. The %AA was assessed in triplicate by DDPH method using a UV–VIS spectrophotometer.

Results: In the μ-SBT, ANOVA revealed no significant difference between the antioxidants evaluated (p = .625), but did reveal significant effects of the concentrations studied (p = .007). A negative correlation was observed between μ-SBT and solution concentrations. The values of %AA were from 90.58 to 96.75.

Conclusions: The reverse results occurred in μ-SBT values, only when the antioxidants were used in a 10% concentration and, %AA did not influence μ-SBT.

Effects of green tea on the shear bond strength of orthodontic brackets after in-office vital bleaching

The application of bleaching agents before placement of resin-bonded fixed appliances significantly, but temporarily, reduces bond strength to tooth structure. Antioxidants have been studied as a means to remove residual oxygen that compromises bonding to bleached enamel. This in vitro study evaluated whether green tea (GT) could restore the shear bond strength between bonded orthodontic brackets and bleached enamel. Six experimental groups were compared: group 1, no bleaching plus bracket bonding (positive control); group 2, bleaching with 35% hydrogen peroxide (HP) plus bracket bonding (negative control); group 3, 35% HP plus 10% sodium ascorbate (SA) plus bracket bonding; group 4, 35% HP plus 10% GT plus bracket bonding; group 5, no bleaching plus 10% SA plus bracket bonding; group 6, no bleaching plus 10% GT plus bracket bonding. Results suggested that GT, like SA, may be beneficial for bracket bonding immediately after bleaching.

Anaplastic extramedullary cervical ependymoma with leptomeningeal metastasis

We present a rare extramedullary ependymoma with diffuse spinal metastatic disease, and review the previous reports of extramedullary spinal ependymomas. Ependymomas are the most common intramedullary spinal cord tumor in adults. These tumors rarely present as extramedullary masses. We treated a 23-year-old man with a history of progressive neck, shoulder and arm pain, with sensory and motor symptoms in the C7 dermatome. MRI of the cervical spine demonstrated a ventral contrast-enhancing lesion with evidence of enhancement along the dura and spinal cord of the upper cervical spine, thoracic spine, and cauda equina. He underwent a tumor debulking procedure without complications. Following surgery, he received craniospinal radiation to treat the remaining tumor and diffuse leptomeningeal disease. The final pathology of the tumor revealed that is was a World Health Organization Grade III anaplastic ependymoma. At the 1 year follow-up, the patient had stable imaging and had returned to his preoperative functional status. Of the 19 reported patients with primary intradural, extramedullary spinal ependymomas, two had extradural components and seven had anaplastic grades. Only one tumor with an anaplastic grade resulted in metastatic disease, but without spinal recurrence. To our knowledge, this is the first report of an intradural, extramedullary spinal ependymoma with an anaplastic grade, presenting with concomitant diffuse, nodular leptomeningeal metastasis involving the upper cervical spine, thoracic spine, conus medullaris, and cauda equina. Similar to the treatment of intramedullary ependymomas with metastasis, this patient underwent an aggressive debulking procedure followed by radiation therapy to the entire neuroaxis.

Stress Generated by Customized Glass Fiber Posts and Other Types by Photoelastic Analysis

Endodontic posts are necessary to provide adequate retention and support when no sufficient remaining structure is available to retain the core. There are different materials and techniques to construct post-and-core, but there is no consensus about which one promotes better stress distribution on the remaining tooth structure. This study aimed to quantify and evaluate the distribution of stress in the root produced by customized glass fiber posts compared to different endodontic posts. Twenty-five simulated roots from photoelastic resin were made and divided into 5 groups: CPC, cast post-and-core; SP, screw post; CF, carbon fiber post; GF, glass fiber post; and CGF, customized glass fiber post. After cementing CPC and SP posts with zinc phosphate cement, and CF, GF and CGF posts with resin cement, resin cores were made for groups 2-5. Specimens were evaluated with vertical or 45° oblique loading. To analyze the fringes, the root was divided into 6 parts: palatal cervical, palatal middle, palatal apical, vestibular cervical, vestibular middle, and vestibular apical. The formed fringes were photographed and quantified. Data were recorded and subjected to two-way ANOVA and Tukey's test (5%). SP (1.95±0.60) showed higher stress (p<0.05) compared to the others (CPC-0.52±0.74; CF-0.50±0.75, GF-0.23±0.48 and CGF-0.45±0.83). All posts showed high stress in apical third (CPC-1.40±0.65; SP-2.30±0.44, CF-1.80±0.45, GF-1.20±0.45, CGF-1.70±1.03) Low stress was found in cervical third (CPC-0.20±0.45; CF-0.00±0.00, GF-0.00±0.00, CGF-0.00±0.00), except by SP (1.90±0.65), which showed statistical difference (p<0.05). Customized post showed high stress concentration at the root and conventional glass fiber posts showed more favorable biomechanical behavior.

Effects of Green Tea Application Time on Bond Strength after Enamel Bleaching

This study evaluated the effect of green tea application time on the bond strength of enamel after enamel bleaching. Enamel samples were obtained from 80 third molars and randomly divided into 7 experimental groups (G1-G7) and 1 group without treatment (G8): G1, bleached with 10% carbamide peroxide (CP); G2, CP + 10% sodium ascorbate gel (SA) for 15 min; G3, CP + SA for 30 min; G4, CP + SA for 60 min; G5, CP + 10% green tea gel (GT) for 15 min; G6, CP + GT for 30 min; G7, CP + GT for 60 min. The CP was applied onto the enamel surface for 8 h for 14 days. The SA was applied in groups 2, 3 and 4, and the GT was applied in groups 5-8 according to the above described application times. Immediately after treatment, the specimens were bonded with Adper Single Bond 2 and Filtek Z350XT. The specimens were prepared to microtensile bond strength analysis. Fracture mode analysis was performed using a stereoscopic loupe. The data were statistically analyzed by two-way analysis of variance, the Tukey's and Dunnett's tests (=5%). The means (standard deviation) were: G1, 23.3 (3.2); G2, 25.2 (3.9); G3, 26.4 (5.4); G4, 30.2 (4.5); G5, 26.6 (3.4); G6, 22.0 (5.4); G7, 31.4 (3.3); G8, 31.4 (3.2). All groups had a high percentage of adhesive failures. In conclusion, the bond strength values were higher than the value in the bleached group only when the antioxidants were applied for 60 min.

Comparison of frictional resistance between self-ligating and conventional brackets tied with elastomeric and metal ligature in orthodontic archwires

Objective

To compare the frictional resistance between self-ligating and conventional brackets tied to different types of wire.

Material and Methods

Abzil Kirium Capelozza (Pattern I) and Easy Clip (Roth prescription) incisor brackets were used. An elastomeric ligature or a ligating wire 0.10-in was used to ligate the wire to the Abzil bracket. Three types of orthodontic archwire alloys were assessed: 0.016-in NiTi wire, 0.016 x 0.021-in NiTi wire and 0.019 x 0.025-in steel wire. Ten observations were carried out for each bracket-archwire angulation combination. Brackets were mounted in a special appliance, positioned at 90 degrees in relation to the wire and tested in two angulations. Frictional test was performed in a Universal Testing Machine at 5 mm/min and 10 mm of displacement. The means (MPa) were submitted to ANOVA and Tukey's test set at 5% of significance. The surfaces of wires and brackets were observed at SEM.

Results

Steel-tied brackets (16.48 ± 8.31) showed higher means of frictional resistance than elastomeric-tied brackets (4.29 ± 2.16 ) and self-ligating brackets (1.66 ± 1.57) (P < 0.05), which also differed from each other (P < 0.05). As for the type of wire, 0.019 x 0.025-in steel wire (5.67 ± 3.97) showed lower means (P < 0.05) than 0.16-in NiTi wire (8.26 ± 10.92) and 0.016 x 0.021-in NiTi wire (8.51 ± 7.95), which did not differ from each other (P > 0.05). No statistical differences (P > 0.05) were found between zero (7.76 ± 8.46) and five-degree (7.19 ± 7.93) angulations.

Conclusions

Friction was influenced not only by the type of bracket, but also by the ligating systems. Different morphological aspects were observed for the brackets and wires studied

Evaluation of contraction stress, conversion degree, and cross-link density in low-shrinkage composites

OBJECTIVE

The contraction stress, degree of conversion, and cross-link density (CLD) of the Venus Diamond (low-shrinkage), Filtek P90 (low-shrinkage) and Filtek Z350 XT composites were evaluated after photopolymerization by quartz tungsten halogen or light-emitting diode light curing units.

MATERIALS AND METHODS

Contraction stress measurements were performed on 60 samples fabricated in rings of photoelastic resin. The adhesive was applied and photoactivated, followed by insertion and photoactivation of the composites. The contraction stress (MPa) was measured using a polariscope. The measurements of degree of conversion (%DC) were determined from Fourier transform infrared (FTIR) spectra of the top and bottom surfaces on 60 specimens. Cross-link density was estimated from hardness measurements performed at the top and bottom surfaces on 60 specimens. The Knoop hardness number was measured, and the specimens were placed in absolute ethanol for 24 h. The hardness was again determined and the CLD was estimated from the percentage decrease in hardness (PD) occurring during ethanol exposure for each surface. The contraction stress and PD data were subjected to ANOVA and Tukey's test (5%). The DC data were subjected to one way analysis of variance on ranks followed by pairwise multiple comparisons using Tukey's test (5%).

RESULTS

The Venus Diamond composite exhibited lower contraction stress than other composites, with degrees of conversion similar to those of Filtek Z350 XT at both surfaces, and independent of the light curing unit. The PD value of Venus Diamond was also lower than that for the other composites.

CONCLUSIONS

The low-shrinkage Venus Diamond composite may potentially reduce stress at the restoration/tooth interface.

Influence of different photo-activation distances on cytotoxicity of a dental adhesive model resin

AIM

This study evaluated the cytotoxicity of a dental bonding model resin (DBMR) submitted to different photo-activation distances.

METHODS

A monomer mixture based on Bis-GMA and HEMA was used to assess the cytotoxicity in a mouse fibroblast-cell line. To promote different photo-activation distances glass slides were interposed between DBMR surface and halogen light curing unit (LCU) tip. Afterwards, the specimens were immersed in RPMI culture medium for 24 h to obtain extracts. The extracts were incubated in contact with the cells for 24 h. Finally, an MTT colorimetric assay was used to assess the cytotoxicity. The cell viability data (absorbance) were analyzed by one way ANOVA followed by Tukey's test (P<0.05).

RESULTS

The light output decreased according to the increase in the number of glass slides between the halogen LCU tip and DBMR surface. Yet, the distance between the tip of the curing light system and the specimens had significant influence on the cytotoxicity. All extracts produced by groups submitted to different photo-activation distances showed cytotoxic effect after 24h of incubation.

CONCLUSION

The photo-activation distance and the interposition of glass slides between LCU tip and DBMR was shown to play an important role in the cytotoxic effect.

Bond strength and morphology of resin materials applied to the occlusal surface of primary molars

BACKGROUND

Hydrophilic adhesives may be used as pit and fissure sealants (sealants), but there is concern about the ability of self-etching adhesives to bond sealants to enamel.

AIM

To study the bond strength (BS) and morphology of adhesive systems used as sealants.

DESIGN

OptiBond FL, OptiBond All-in-One, combined OptiBond All-in-One+OptiBond FL adhesive, and Fluroshield were applied to the occlusal surfaces of 16 primary molars (n = 4). Teeth were stored in distilled water (24 h at 37°C) and sectioned through the interface to obtain sticks (0.8 mm(2) ) tested under a tensile load (0.5 mm/min). Failure modes were observed. Data were analysed by ANOVA and Tukey's tests (α = 5%). The morphology of 12 primary molars was examined in terms of the etching pattern and resin reproduction.

RESULTS

Differences in the BS were found (P = 0.001), with OptiBond FL showing the highest (36.84 ± 5.7 MPa), Fluroshield (24.26 ± 2.13 MPa) and OptiBond All-in-One (17.12 ± 4.97 MPa) similar, and OptiBond All-in-One + OptiBond FL adhesive the lowest (9.8 ± 2.94 MPA). OptiBond FL showed the best results in terms of morphology.

CONCLUSION

Under the conditions of this study, OptiBond FL was the best material to be used for sealing.

Evaluation of the coefficient of thermal expansion of human and bovine dentin by thermomechanical analysis

The mismatch of thermal expansion and contraction between restorative materials and tooth may cause stresses at their interface, which may lead to microleakage. The present work compared the coefficient of thermal expansion (CTE) with the thermomechanical behavior of human and bovine teeth and determined if the CTE is a suitable parameter to describe tooth behavior. Fifteen human third molar and 15 bovine incisor tooth slices (6×5×2 mm) were allocated to 3 groups according to the test environment: G1 - room condition, G2 - 100% humidity, G3 - desiccated and tested in dry condition. Each specimen was weighed, heated from 20 to 70ºC at 10ºC min-1 and reweighed. The CTE was measured between 20 and 50ºC. Fresh dentin (human -0.49% ± 0.27, bovine -0.22% ± 0.16) contracted on heating under dry condition. Under wet conditions, only human teeth (-0.05% ± 0.04) showed contraction (bovine 0.00% ± 0.03) accompanied by a significantly lower (p<0.05) weight loss than in dry specimens (human 0.35% ± 0.15, bovine 0.45% ± 0.20). The desiccated dentin expanded on heating without obvious weight changes (0.00% ± 0.00). The CTE found was, respectively, in dry, wet and dissected conditions in ºC(-1): human (-66.03×10(-6), -6.82×10(-6), 5.52×10(-6)) and bovine (-33.71×10(-6), 5.47×10(-6), 4.31×10(-6)). According to its wet condition, the dentin showed different CTEs. The thermal expansion behavior of human and bovine dentin was similar. A simple evaluation of the thermal expansion behavior of tooth structure by its CTE value may not be appropriate as a meaningful consideration of the effects on the tooth-material interface.

Surface detail reproduction and dimensional accuracy of stone models: influence of disinfectant solutions and alginate impression materials

This study compared the surface detail reproduction and dimensional accuracy of stone models obtained from molds disinfected with 2% sodium hypochlorite, 2% chlorhexidine digluconate or 0.2% peracetic acid to models produced using molds which were not disinfected, with 3 alginate materials (Cavex ColorChange, Hydrogum 5 and Jeltrate Plus). The molds were prepared over matrix containing 20-, 50-, and 75-µm lines, performed under pressure with perforated metal tray. The molds were removed following gelation and either disinfected (using one of the solutions by spraying followed by storage in closed jars for 15 min) or not disinfected. The samples were divided into 12 groups (n=5). Molds were filled with dental gypsum Durone IV and 1 h after the start of the stone mixing the models were separated from the tray. Surface detail reproduction and dimensional accuracy were evaluated using optical microscopy on the 50-µm line with 25 mm in length, in accordance with the ISO 1563 standard. The dimensional accuracy results (%) were subjected to ANOVA. The 50 µm-line was completely reproduced by all alginate impression materials regardless of the disinfection procedure. There was no statistically significant difference in the mean values of dimensional accuracy in combinations between disinfectant procedure and alginate impression material (p=0.2130) or for independent factors. The disinfectant solutions and alginate materials used in this study are no factors of choice regarding the surface detail reproduction and dimensional accuracy of stone models.

Effect of different surface penetrating sealants on the roughness of a nanofiller composite resin

This study evaluated the effectiveness of different sealants applied to a nanofiller composite resin. Forty specimens of Filtek Z-350 were obtained after inserting the material in a 6x3 mm stainless steel mold followed by light activation for 20 s. The groups were divided (n=10) according to the surface treatment applied: Control group (no surface treatment), Fortify, Fortify Plus and Biscover LV. The specimens were subjected to simulated toothbrushing using a 200 g load and 250 strokes/min to simulate 1 week, 1, 3 and 6 months and 1 and 3 years in the mouth, considering 10,000 cycles equivalent to 1 year of toothbrushing. Oral-B soft-bristle-tip toothbrush heads and Colgate Total dentifrice at a 1:2 water-dilution were used. After each simulated time, surface roughness was assessed in random triplicate readings. The data were submitted to two-way ANOVA and Tukey's test at a 95% confidence level. The specimens were observed under scanning electron microscopy (SEM) after each toothbrushing cycle. The control group was not significantly different (p>0.05) from the other groups, except for Fortify Plus (p<0.05), which was rougher. No significant differences (p>0.05) were observed at the 1-month assessment between the experimental and control groups. Fortify and Fortify Plus presented a rougher surface over time, differing from the baseline (p<0.05). Biscover LV did not differ (p>0.05) from the baseline at any time. None of the experimental groups showed a significantly better performance (p>0.05) than the control group at any time. SEM confirmed the differences found during the roughness testing. Surface penetrating sealants did not improve the roughness of nanofiller composite resin.

Evaluation of the light energy transmission and bottom/top rate in silorane and methacrylate-based composites with different photoactivation protocols

AIM

This study investigated the influence of different composite resin organic matrix (methacrylate - Filtek Z350 XT and silorane - Filtek P90) on light energy transmission through the composite and bottom/top rate.

MATERIALS AND METHODS

A light-emitting diode (New Blue Phase), light-curing unit was used with different photoactivation protocols (high-continuous mode - HCM, 1400 mW/cm2 for 20 seconds; low-continuous mode - LCM , 700 mW/cm2 for 40 seconds; and soft-start mode - SSM, 140 mW/cm2 for 5s followed by 39 seconds for 700 mW/cm2). Twenty specimens were prepared for each composite. The light energy transmission through the composite was calculated (n=10). The bottom/top rate of the same specimen was calculated (n=10). The data were compared by Tukey's test in different tests (light energy transmission through the composite and bottom/top rate).

RESULTS

The light energy transmission through the Filtek Z350 XT composite (HCM - 576 mW/cm2, LCM - 238 mW/cm2, SSM - 232 mW/cm2) did not show statistical difference when compared with Filtek P90 composite (HCM - 572 mW/cm2, LCM - 233 mW/cm2, SSM - 230 mW/cm2). The bottom/top rate of the Filtek Z350 XT composite (HCM - 88.98%, LCM - 90.94%, SSM - 89.92%) was statistically higher than that of the Filtek P90 composite (HCM-77.29%, LCM-77.51%, SSM- 77.79%).

CONCLUSION

Light energy transmission through the composite was not influenced by the use of different dental composite restoratives. However, the bottom/top rate of the composites was influenced by the use of different dental composite restoratives.

CLINICAL SIGNIFICANCE

Insufficiently polymerized composite resin may present a large number of problems. For this reason, dental composite resins should have the similar deep surface polymerization as the top surface in dental restorations.

Interproximal space recovery using an orthodontic elastic separator before prosthetic restoration: a case report

The presence of a dental contact point is essential to maintain normal occlusion and to preserve the health of periodontal structures. Occasionally dental caries could compromise the interproximal contact point, leading to migration of the adjacent teeth with consequent retention of food, gingival inflammation, pocket formation, bone loss and dental mobility. In order to achieve an adequate restorative treatment, reestablishment of interproximal space is necessary. This report describes the interproximal space recovery between the maxillary first and second molars of a 45-year-old female patient before tooth reconstruction. In this case, an orthodontic elastic separator was indicated as an alternative to fixed orthodontic appliances in order to recover the necessary space. The technique was proven efficient, effective, economical, easy to perform and, above all, less invasive than other methods. The interproximal space was regained and a ceramic onlay was cemented for restoring the maxillary second molar. Periodical clinical and radiographic follow-up should be maintained to ensure long-term success.

Bond strength of HEMA-containing versus HEMA-free self-etch adhesive systems to dentin

This study analyzed the bond strength (BS) of HEMA versus HEMA-free self-etch adhesive systems to dentin. The occlusal surface of 20 third molars was removed and the dentin was abraded with 600-grit silicon carbide paper. The teeth were randomly assigned to 4 groups (n=5) and restored with GO, Adper SE Plus, OptiBond All-In-One, and Clearfil 3S Bond adhesive systems and Filtek Z350 composite. After light curing (600 mW/cm²), the teeth were stored in distilled water at 37ºC for 24 h and were sectioned in the mesiodistal and buccolingual directions to obtain sticks (0.8 mm²). The sticks were subjected to tensile force using a universal testing machine (0.5 mm/min), and the modes of failure were analyzed by scanning electron microscopy and classified as adhesive, cohesive, or mixed. The BS data (in MPa) were treated using one-way ANOVA and Tukey’s tests at 5% significance. GO presented the lowest mean bond strength value (10.57 ± 3.72) and differed significantly from the other materials (p=0.001), which, in turn, presented statistically similar results (p>0.05) among themselves: Adper SE Plus (29.08 ± 8.93), OptiBond All-In-One (28.36 ± 6.49), and Clearfil 3S Bond (28.62 ± 6.97). Mixed fractures were the most prevalent. It was concluded that the influence of HEMA on BS to dentin was material dependent.