Avaliação clínica de uma resina flow como uma camada intermediária em restaurações de lesões cervicais não cariosas: 48 meses

PURPOSE: In this case report, the clinical performance of a microhybrid resin composite placed with or without a flowable resin composite was compared, over a 48-month period. CASE DESCRIPTION: The patient of this case report presented 2 pairs of equivalent cervical abfraction lesions, under occlusion. Four restorations were placed in teeth 34, 35, 44 and 45. The restorations were divided into groups (Single Bond + Filtek-Flow + Filtek Z250 or Single Bond + Filtek Z250) and the materials were applied according to the manufactures instructions. Two previously calibrated operators placed the restorations and two other independent examiners evaluated the restorations at baseline and after 48 months, according to the USPHS criteria and modified criteria for color match. CONCLUSION: After 48 months of evaluation the lesions restored with Filtek-Flow as a liner under Filtek Z250 did not show better clinical performance than the restorations without Filtek-Flow. All restorations showed a trend toward dark yellowing after 48 months.OBJETIVO: Este relato de caso compara o desempenho clínico após 48 meses de restaurações de lesões cervicais não cariosas com uma resina composta microhíbrida associada ou não a uma camada de resina flow como um agente intermediário. DESCRIÇÃO DO CASO: O paciente do presente caso apresentava 2 pares de lesões cervicais não cariosas ocasionadas por abfração sob oclusão. Nos elementos dentários 35 e 44 as restaurações foram feitas com Single Bond + Filtek-Flow + Filtek Z250 e nos elementos 45 e 34 com Single Bond + Filtek Z250, sendo os materiais empregados de acordo com as recomendações do fabricante. Dois operadores previamente calibrados colocaram as restaurações e dois outros examinadores avaliaram as restaurações no período imediato (baseline) e após 48 meses, de acordo os critérios USPHS modificado para o critério cor. CONCLUSÃO: Após 48 meses as lesões restauradas com a resina flow como uma camada intermediária não demonstraram melhor desempenho clínico em relação às restaurações sem a resina flow. Todos os grupos apresentaram uma tendência à descoloração após 48 meses de acompanhamento clínico

The smokeless tobacco habit and DNA damage : a systematic review and meta-analysis

The aim of this systematic review was to evaluate the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. We searched PubMed, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE. We also surveyed gray literature. We included only clinical trials that compare the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. Quality assessments of the selected trials were evaluated by two independent reviewers, using the Effective Public Health Practice Project ? (EPHPP) with modifications. After the database screening and removal of duplicates, 2574 studies were identified. After title screening, 172 studies remained, and this number was reduced to 25 after careful examination of the abstracts. The standardized mean difference of the frequency of micronuclei between groups was 1.88, with a 95% confidence interval of 1.40 to 2.36 (p< 0.00001). In all analyses heterogeneity was detected. Despite the heterogeneity of studies, the frequency of micronuclei was significant bigger in adults who have the smokeless tobacco habit when compared to those not have this habit. The same occurred with the frequency of binucleated cells, karyolisis and karyorrhexis

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

The objective of this study was to evaluate the effectiveness of a therapeutic sealant to arrest non-cavitated proximal carious lesion progression. The study population comprised 44 adolescents who had bitewing radiographs taken for caries diagnosis. Non-cavitated lesions extending up to half of dentin thickness were included in the sample. In the experimental group (n = 33), the proximal caries-lesion surfaces were sealed with an adhesive (OptiBond Solo, Kerr) after tooth separation. The control group (n = 11) received no treatment, except for oral hygiene instructions including use of dental floss. Follow-up radiographs were taken after one year and were analyzed in comparison with baseline radiographs. In a blind study setting, visual readings were performed by two examiners, blinded to whether the examined radiograph was baseline or follow-up, and whether it concerned a test or control lesion. The efficacy of sealing treatment was evaluated by the McNemar test (0.05). About 22% of the sealed lesions showed reduction, 61% showed no change and 16% showed progression. For the control lesions, the corresponding values were 27%, 36% and 36% respectively. The number of lesions that showed reduction and no changes were merged and therefore 83.3% of the sealed lesions and 63.6% of the control lesions were considered clinically successful. No statistical significance was detected (p > 0.05). In the course of 1 year, sealing proximal caries lesions was not shown to be superior to lesion monitoring.Dr. Priscila Bresciani, Dr. Bernardo Hahn and Dr. Franciele Loeblein for the help provided in the clinical part of this stud

Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial

This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery. A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects. Significant differences in pain intensity were observed in the different times (p<0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p<0.001), the need of antiemetic were greater in Group K+T+A (p<0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A. The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant

Dimensional alteration of silver amalgam and gallium-based alloy

As ligas de gálio surgiram como alternativa à problemática da toxicidade do mercúrio. Apresentam propriedades semelhantes às do amálgama, mas as pesquisas apontam duas características desfavoráveis: corrosão excessiva e grande magnitude de expansão de presa, podendo causar fraturas e rachaduras nas estruturas dentais. O objetivo foi avaliar in vitro a alteração dimensional durante 7 dias de uma liga de gálio (Galloy, SDI, Austrália), comparativamente com uma liga de amálgama contendo zinco (F-400, SDI, Austrália), em função do contato e/ou contaminação com solução salina (NaCl 0,9%) nos estágios iniciais da cristalização. As condições experimentais de armazenagem foram em: ambiente seco; armazenagem em solução salina e contaminação com solução salina durante a condensação. Para o amálgama, foi ainda estudada a condição de contaminação introduzida na cápsula durante a trituração e para a liga de gálio, a proteção com resina fluida durante as primeiras 24 h ou durante todo o experimento. Os corpos-de-prova foram mantidos à temperatura de 37ºC ± 1ºC e suas dimensões monitoradas a cada 24 h, durante sete dias. O contato da liga de gálio com a solução salina durante a condensação ou nas primeiras horas após a condensação desencadeou uma expansão significantemente maior que as outras condições experimentais ao fim dos 7 dias. A aplicação de uma resina fluida para proteger a superfície dos cilindros foi capaz de evitar o aumento da expansão provocado pela umidade superficial. O amálgama não apresentou alterações significantes em nenhuma das condições experimentais, exceto quando contaminado durante a trituração.Gallium-based dental alloys were created with the aim of solving the problem of toxicity of mercury. The material shows mechanical properties similar to those of dental amalgam, but researches point out two unfavorable characteristics: great corrosion and excessive post-setting expansion, and the latter is capable of cracking dental structures. The aim of this study was to evaluate, during 7 days, the in vitro dimensional alteration of a gallium dental alloy (Galloy, SDI, Australia), in comparison with a dental amalgam containing zinc (F400, SDI, Australia), as a function of the contact with saline solution (0.9% NaCl) during the setting period. The storage experimental conditions were: storage in dry environment, immersion in saline solution and contamination during condensation. Additionally, the effects of contamination during the trituration of dental amalgam and the effects of protecting the surface of the gallium alloy with a fluid resin were studied. Specimens were stored at 37ºC ± 1ºC, and measuring was carried out, sequentially, every 24 h during 7 days. When the gallium alloy was either contaminated or immersed, an expansion significantly greater than that observed in the other experimental conditions was noticed after 7 days. The application of a fluid resin to protect the surface of the cylinders was able to avoid the increase in expansion caused by superficial moisture. The amalgam alloy did not show significant dimensional alterations, except when it was contaminated during trituration

Evaluation of reservoirs in bleaching trays for at-home bleaching: a split-mouth single-blind randomized controlled equivalence trial

Objectives: This randomized, split-mouth, single-blinded trial assessed whether the use of reservoirs in at-home bleaching trays is equivalent to non-reservoir trays. Our choice of an equivalence trial was based on the expectation that a non-reservoir tray is sufficient to produce a color change. Secondary outcomes such as tooth sensitivity (TS) and gingival irritation (GI) were also assessed. Methodology: Forty-six patients were selected with canines shade A2 or darker. In half of the patient’s arch, bleaching trays were made with reservoirs and the other half, without reservoirs. At-home bleaching was performed with carbamide peroxide (CP) 10% (3 h daily; 21 days). Color change was evaluated with a digital spectrophotometer (ΔE, ΔE00, and Whiteness Index) and shade guide units (ΔSGU) at baseline, during and one-month post-bleaching. TS and GI were assessed with a numeric scale (NRS) and a visual analog scale (VAS). Results: After one month, the equivalence of reservoir and non-reservoir groups were observed in all color instruments (p&gt;0.05). Fifteen and sixteen patients presented pain (absolute risk: 33% and 35%, 95%, confidence interval (CI) 21-46% and 23-49%) in the reservoir and non-reservoir side, respectively. The odds ratio for pain was 0.8 (95%CI 0.2-3.0) and the p-value was non-significant (p=1.0). TS intensity was similar between both groups in any of the pain scales (p&gt;0.05). No difference in the GI was observed (p&gt;0.05). Conclusions: The protocol with reservoirs is equivalent in color change to the non-reservoir, although no superiority of the latter was observed in terms of reduced TS and GI with at-home 10% carbamide peroxide bleaching. Clinical Relevance: The presence of reservoirs in a bleaching tray did not improve color change or affect tooth sensitivity and gingival irritation

Efeito do hipoclorito de sódio na resistência de união de um sistema adesivo na dentina superficial e profunda

The objective of this study was to evaluate the bond strength to superficial (SU) and deep (D) dentin, accessed via apical (DA) or occlusal (DO), using One-Step adhesive system applied according to the manufacturer's instructions (C) or following deproteinization with 10% sodium hypochlorite (H) for 60s, after acid etching. Three sound extracted human molars were prepared for each experimental condition. Restorations were performed using Z100 in 2mm increments, each one being light-cured for 40s. Teeth were longitudinally sectioned to obtain stick-shaped specimens with a cross-sectional area of 0.8mm², which were submitted to bond strength test (0.6mm/min). Results obtained after statistical analysis using a two-way ANOVA (substrate vs. surface treatment) and Tukey's test were: SU (35.4 ± 12.3), DO (26.5 ± 8.5), DA (26.1 ± 10.2) following conventional surface treatment, and SU (28.82 ± 12.7), DO (24.3 ± 8.3) and DA (23.5 ± 8.5), after surface treatment using sodium hypochlorite. The interaction of the factors was not significant (p>;0.05). However, the main factors were significant (pO objetivo foi avaliar a resistência de união (RU) de dentina superficial (SU) e profunda (P), obtida por acesso apical (PA) ou oclusal (PO), ao adesivo One-Step com (H) ou sem aplicação de hipoclorito de sódio a 10% (C) após o condicionamento ácido. Para os 6 grupos foram utilizados seis molares hígidos. Nos grupos SUC, PAC e POC, o adesivo e a resina Z100 foram aplicados. Nos grupos SUH, PAH e POH, após condicionamento, aplicou-se H por 60s, adesivo e Z100. Os dentes foram fatiados em cortes paralelos e perpendiculares para a obtenção de cp de 0,8mm² e testados sob tração (0,6mm/min). Os valores de RU foram submetidos a ANOVA de dois fatores. Não se detectou diferença para a interação (p=0,209), porém os fatores principais foram diferentes (

Efeitos de métodos para envelhecimento na microinfiltração de um sistema adesivo usado como selante em superfícies contaminadas

This study evaluated the effects of aging methods on the microleakage of an adhesive system used for sealing pit and fissure surfaces. After acid etching, the occlusal surfaces of 60 permanent teeth were contaminated with 1mL of human plasma and then sealed with OptiBond dual cure, activated in the ramp mode (Optilux 501). The sample was then divided into eight experimental and a control groups. Aging was performed for 20 days in 5, 37, 55 and 5-55ºC (200 cycles/day) under water contact or not. After subjecting the specimens to the AgNO3 technique, they were sectioned twice. Dye penetration was measured and the mean values were subjected to ANOVA. No group provided hermetic seal against dye penetration, even the control group (without treatment). Significant aging x water interaction effect (p=0.033) was observed. The group without water contact at 5ºC (p=0.015) showed the least dye penetration value. The results led to the main conclusions: 1) all groups showed dye penetration, even the control group; 2) storage teeth at 5ºC on dry condition provided the lowest degree of dye penetration; 3) in the presence of water, the temperature variations seem not to affect the microleakage values.Este estudo avaliou os efeitos de métodos para envelhecimento na microinfiltração de um sistema adesivo usado para selar superfícies oclusais. Após o condicionamento com ácido, as superfícies de 60 dentes permanentes foram contaminadas com 1 mL de plasma e seladas com OptiBond dual cure, ativado pelo Optilux 501, no modo rampa. A amostra foi dividida em oito grupos experimentais e um grupo controle ou imediato O envelhecimento dos espécimes foi realizado por 20 dias a 5, 37, 55 e 5-55&deg;C (200 ciclos/dia) em contato com a água ou não. Após submeter os espécimes à técnica de infiltração com AgNO3, eles foram secionados duas vezes e os valores médios da penetração do corante foram tratados por análise de variância. Nenhum grupo apresentou vedamento hermético na interface, nem mesmo o grupo sem envelhecimento (imediato ou controle). O grupo que permaneceu a 5&deg;C sem contato com a água mostrou o menor grau de penetração (p=0,015) e a interação envelhecimento x água foi significante (p=0,033). Os resultados levam às seguintes conclusões: 1) todos os grupos mostram microinfiltração, inclusive o controle; 2) o grupo mantido a 5ºC sem contato com a água mostrou os menores valores de microinfiltração; 3) em contato com a água, as variações térmicas parecem não afetar o grau de penetração do corante

Efeito da concentração de clorexidina na resistência de união à dentina em dentes decíduos

PURPOSE: To evaluate the effect of the use of 0.5% and 2% chlorhexidine digluconate on the immediate bond strength of a conventional adhesive system to dentin in primary teeth. METHODS: Twenty-one healthy primary molars were divided into three groups (n=7), being one control (A) and two experimental groups (B and C). After dentin exposure, in Group (A) the adhesive procedure was performed using 37% phosphoric acid gel (15 s); dentin was washed (15 s), air dried (30 s) and rehydrated with water. Groups B and C followed similar procedures but for re-hydration with 0.5% and 2% chlorhexidine, respectively, for 30 s. A resin composite block was built simulating a restoration, and the teeth were stored in distilled water at 37°C for 24 h before the microtensile bond strength test. The bond strength data were analyzed by analysis of variance. RESULTS: No statistically significant difference in bond strength was found among the tested groups (P>0.05) CONCLUSION: The 0.5% and 2% concentrations of chlorhexidine presented similar behavior and caused no adverse effects on the bond strength to dentin in primary teeth.OBJETIVO: Avaliar o efeito do uso de digluconato de clorexidina 0,5% e 2% na resistência de união imediata à dentina de dentes decíduos para um sistema adesivo convencional. METODOLOGIA: Vinte e um molares decíduos hígidos foram divididos em três grupos (n=7), sendo um controle e dois experimentais. Após a exposição da dentina, foi realizado no grupo controle (A) o procedimento adesivo utilizando ácido fosfórico gel a 37% (15 s); a superfície foi então lavada (15 s), seca com ar (30 s) e reidratada com água. Os grupos B e C foram idênticos ao grupo A, apenas com diferença no reumidecimento de clorexidina 0,5% e 2% respectivamente, por 30 s. Após a confecção do bloco de resina composta, os dentes foram armazenados em água destilada a 37°C por 24 h antes do teste de microtração. Os dados de resistência de união foram avaliados através de análise de variância. RESULTADOS: Os dados apresentaram distribuição homogênea, não havendo diferença estatisticamente significante entre os grupos (P>0,05). CONCLUSÃO: As concentrações de clorexidina a 0,5% e 2% apresentaram comportamentos similares e não causaram efeitos adversos na resistência de união em dentina de dentes decíduos, quando comparadas ao grupo controle

Evaluating resin-enamel bonds by microshear and microtensile bond strength tests: effects of composite resin

OBJECTIVES: The aims of this study were to evaluate the effect of resin composite (Filtek Z250 and Filtek Flow Z350) and adhesive system [(Solobond Plus, Futurabond NR (VOCO) and Adper Single Bond (3M ESPE)] on the microtensile (&#956;TBS) and microshear bond strength (&#956;SBS) tests on enamel, and to correlate the bond strength means between them. MATERIAL AND METHODS: Thirty-six extracted human molars were sectioned to obtain two tooth halves: one for &#956;TBS and the other one for &#956;SBS. Adhesive systems and resin composites were applied to the enamel ground surfaces and light-cured. After storage (37(0)C/24 h) specimens were stressed (0.5 mm/min). Fracture modes were analyzed under scanning electron microscopy. The data were analyzed using two-way ANOVA and Tukey's test (&#945;=0.05). RESULTS: The correlation between tests was estimated with Pearson's product-moment correlation statistics (&#945; =0.05). For both tests only the main factor resin composite was statistically significant (p<0.05). The correlation test detected a positive (r=0.91) and significant (p=0.01) correlation between the tests. CONCLUSIONS: The results were more influenced by the resin type than by the adhesives. Both microbond tests seem to be positive and linearly correlated and can therefore lead to similar conclusions.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq