Adesão à dentina: influência da oclusão tubular e da desproteinização

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em OdontologiaO objetivo deste estudo in vitro foi avaliar a influência da oclusão tubular e da desproteinização dentinária na adesão entre dentina e resina composta. As metodologias utilizadas foram: análise em microscopia eletrônica de varredura (MEV) das superfícies dentinárias tratadas, antes da aplicação do sistema adesivo; teste de resistência de união à microtração; análise em MEV das interfaces resina-dentina formadas; teste de microinfiltração marginal. Conclui-se que a técnica da oclusão tubular não afeta a resistência de união, nem a microinfiltração quando comparada ao protocolo tradicional. A desproteinização, quando não associada à oclusão tubular, pode aumentar a resistência de união e reduzir a microinfiltração

Influência da coloração do substrato, espessura e translucidez da cerâmica na cor de facetas laminadas produzidas com o sistema CEREC inLab

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Odontologia.O objetivo deste estudo in vitro foi investigar, espectrofotométrica e visualmente, a cor de facetas produzidas com um sistema CAD/CAM, com diferentes níveis de descoloração de substrato, espessuras de material e graus de translucidez das cerâmicas. Para isso, incisivos centrais superiores esquerdos de um modelo dental acrílico foram preparados para facetas com 0,4, 0,7 e 1,00mm de desgaste axial. Esses foram replicados em três diferentes colorações que simulavam substratos normal, escurecido e severamente escurecido. As facetas cerâmicas foram produzidas com o sistema CEREC inLab pelo método de correlação à anatomia hígida para cada tipo de preparo, com blocos dos materiais EmpressCAD HT (HT), EmpressCAD LT (LT) e EmpressCAD Multi (MU) e e.maxCAD HT (EH). Todas as restaurações receberam caracterização extrínseca e glazeamento padronizados. A união das facetas aos preparos foi simulada com um gel try-in padrão. As diferentes combinações de profundidade e preparo, coloração do substrato e cerâmica foram estandardizadamente fotografadas e tiveram sua cor mensurada por um espectrofotômetro clínico. As coordenadas de cor (CIELAB) instrumentalmente mensuradas foram comparadas às de uma restauração-referência (preparo normal, 0,7mm de espessura e cerâmica HT), para a determinação da diferença de cor (?E). As fotografias foram analisadas por 7 avaliadores que determinaram se a diferença de cor entre espécimes e restauração-padrão era aceitável ou inaceitável. Os resultados das análises espectrofotométrica e visual permitiram estabelecer um limite de aceitabilidade de diferença de cor para o estudo igual a ?E=3,3. Substratos normais foram restaurados de maneira aceitável com preparos conservadores (0,4mm) e cerâmicas translúcidas (HT, EH e MU). Substratos escurecidos obtiveram bons resultados com 0,4mm de espessura e cerâmica LT ou 0,7mm e cerâmicas MU e LT. O escurecimento severo só foi mascarado adequadamente com espessura de 1,0mm e cerâmica LT. Cor do substrato, espessura e grau de translucidez da cerâmica afetam significativamente a cor final de facetas laminadas. Cerâmicas menos translúcidas e preparos mais invasivos colaboram no poder de mascaramento das facetas sobre substratos escurecidos.The aim of this study was evaluating, spectrophotometric- and visually, the color of veneers fabricated by a CAD/CAM system, with different levels of stump discoloration, material thickness and translucency degrees of the ceramics. Acrylic upper-left central incisors of a dental model received veneer preparations with 0.4, 0.7 or 1.0mm of axial reduction and were reproduced in three different levels of discoloration, simulating normal, discolored and severely discolored stump shades. The ceramic veneers were produced by the CEREC inLab system using correlation mode. Milling blocks used were EmpressCAD HT (HT), EmpressCAD LT (LT), EmpressCAD Multi (MU) and e.maxCAD HT (EH). All restorations were standardly stained and glazed. Cementation was simulated with a standard try-in paste. The different combinations of preparation depth, stump shade and ceramic translucency degree were standardly photographed and analyzed by a clinical spectrophotometer. The measured CIELAB coordinates were compared to a reference-restoration (normal stump shade, 0.7mm thickness and HT ceramic) to determine de color difference (?E). The photographs were analyzed by seven observers that judged the color difference between test-specimens and reference-restoration acceptable or not. Results from instrumental and visual analysis allowed an acceptability threshold of ?E=3,3 to be determined for this study. Normal stump shades were acceptably restored with conservative preparations (0.4mm) and translucent ceramics (HT, MU and EH). Discolored stumps presented good results with 0.4mm/LT, and 0.7mm/MU or 0.7mm/LT. Severe discoloration was only masked by 1.0mm preparation and LT. Stump shade, thickness and translucency degree of the ceramic significantly affect the final color of laminate veneers. Less translucent ceramics and more invasive preparations increase the masking power of veneers on discolored substrates

Caries risk assessment in schoolchildren - a form based on Cariogram® software

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904;

Selective carious tissue removal using subjective criteria or polymer bur: study protocol for a randomised controlled trial (SelecCT)

Introduction: Selective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains 'soft' or 'leathery' dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet). Methods and analysis: A community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6-8 years with >= 1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020). Ethics and dissemination: This trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasilia (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences

Influence of the combined effect of desensitizing dentifrices and universal adhesives on dentin bond strength under erosive conditions

Objective: This study aimed to evaluate whether the use of desensitizing dentifrices containing obliterating agents can affect bond strength of eroded/abraded dentin. Methodology: A total of 100 dentin samples were obtained from human molars. The teeth were cut into 3 mm-thickness discs and allocated in five groups (n=20), according to the toothpaste used: WoF – abrasion with fluoride-free toothpaste (Cocoricó); Arg – toothpaste containing arginine (Colgate Sensitive Pro-Relief); Nov – calcium sodium phosphosilicate toothpaste (Sensodyne Repair and Protect); SnF – fluoride-containing toothpaste (AmF/SnCl2/SnF2 – Elmex Erosion); and Control (no erosive/abrasive process). The erosive/abrasive cycle consisted of immersion in citric acid (1%, pH 2.6, 5 min, 4×/day) and abrasion (2×/day, 120–20 sec abrasion, 100 sec immersion) with each toothpaste. During intervals, samples were immersed in artificial saliva. This cycle was performed for five days. Two resin cylinders (2 mm in diameter) were constructed on each sample for the shear bond strength test using a universal adhesive system. The self-etch and etch-and-rinse (Scotchbond Universal) strategies were employed, each in half of the total sample (n=10). Bond strength (MPa) was measured in a shear test and failure modes were assessed with a stereomicroscope. Statistical analysis was performed using the two-way analysis of variance (ANOVA) and Tukey tests (p<0.05). Results: A statistically significant difference was found between the adhesive strategies tested (p<0.001), with the self-etching form showing higher values than the etch-and-rinse. Moreover, no significant differences were observed between the tested toothpastes (p=0.750) and interactions (p=0.438). Conclusion: The use of toothpaste containing obliterating agents does not affect bond strength to dentin subjected to erosive/abrasive conditions when a universal adhesive is used. However, the self-etch strategy might be preferred for eroded/abraded dentin

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Objective: This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren. Methodology:Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis. Results:The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth. Conclusions: No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.&nbsp

Effects of solvent evaporation on water sorption/solubility and nanoleakage of adhesive systems

Objective: To evaluate the influence of solvent evaporation in the kinetics of water diffusion (water sorption-WS, solubility-SL, and net water uptake) and nanoleakage of adhesive systems. Material and Methods: Disk-shaped specimens (5.0 mm in diameter x 0.8 mm in thickness) were produced (N=48) using the adhesives: Clearfil S3 Bond (CS3)/Kuraray, Clearfil SE Bond - control group (CSE)/Kuraray, Optibond Solo Plus (OS)/Kerr and Scotchbond Universal Adhesive (SBU)/3M ESPE. The solvents were either evaporated for 30 s or not evaporated (N=24/per group), and then photoactivated for 80 s (550 mW/cm2). After desiccation, the specimens were weighed and stored in distilled water (N=12) or mineral oil (N=12) to evaluate the water diffusion over a 7-day period. Net water uptake (%) was also calculated as the sum of WS and SL. Data were submitted to 3-way ANOVA/Tukey's test (α=5%). The nanoleakage expression in three additional specimens per group was also evaluated after ammoniacal silver impregnation after 7 days of water storage under SEM. Results: Statistical analysis revealed that only the factor "adhesive" was significant (

Effects of solvent evaporation on water sorption/solubility and nanoleakage of adhesive systems

Objective: To evaluate the influence of solvent evaporation in the kinetics of water diffusion (water sorption-WS, solubility-SL, and net water uptake) and nanoleakage of adhesive systems. Material and Methods: Disk-shaped specimens (5.0 mm in diameter x 0.8 mm in thickness) were produced (N=48) using the adhesives: Clearfil S3 Bond (CS3)/Kuraray, Clearfil SE Bond - control group (CSE)/Kuraray, Optibond Solo Plus (OS)/Kerr and Scotchbond Universal Adhesive (SBU)/3M ESPE. The solvents were either evaporated for 30 s or not evaporated (N=24/per group), and then photoactivated for 80 s (550 mW/cm2). After desiccation, the specimens were weighed and stored in distilled water (N=12) or mineral oil (N=12) to evaluate the water diffusion over a 7-day period. Net water uptake (%) was also calculated as the sum of WS and SL. Data were submitted to 3-way ANOVA/Tukey's test (α=5%). The nanoleakage expression in three additional specimens per group was also evaluated after ammoniacal silver impregnation after 7 days of water storage under SEM. Results: Statistical analysis revealed that only the factor "adhesive" was significant (

Subjective versus objective, polymer bur-based selective carious tissue removal: 1-year interim analysis of a randomized clinical trial

We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7–8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children’s satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404–462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients’ satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S

Manejo de cárie radicular: um guia para o dentista brasileiro baseado na tradução e adaptação cultural do consenso internacional/ORCA E EFCD

Aim: Root caries are a problem in modern dentistry, but the lack of guidelines regarding their management is notable. We aim to develop and adapt a guide based on the translation of the recommendations of the international consensus as outlined by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) for clinical decision-making in the intervention of the caries process in the elderly, with a focus on root caries. Materials and methods: The protocol for translating the recommendations of the international consensus consisted of the following steps: (1) initial translation, (2) synthesis of the translation, (3) back-translation, (4) review by an expert committee with cultural adaptation. Based on the translation, a guide was developed with guidelines for the treatment of root caries in Brazil. Results: To prevent new lesions, daily brushing with toothpaste >1,500ppm/F is recommended. Toothpaste with 5,000ppm/F or varnishes (>20,000ppm/F) may be recommended to paralyze active root lesions and for prevention in elderly people with high susceptibility to root caries, and Silver Diamine Fluoride (>30%) to paralyze active lesions. Direct invasive interventions are indicated depending on the clinical situation. Discussion: There is a lack of interest in primary studies on treatments for root caries, thus creating a gap in relation to its management, which is reflected by the level of evidence detected in the consensus. Conclusion: Clinical guidelines are important to reduce the gap between research and clinical practice. This translation into Portuguese will facilitate access by Brazilian dentists to the consolidated evidence gathered to date for the management of root caries.Objetivo: A cárie radicular é um problema da Odontologia moderna, porém é notável a falta de diretrizes sobre o seu manejo. Objetivamos elaborar e adaptar um guia a partir da tradução das recomendações do consenso internacional European Organization for Caries Research (ORCA) e European Federation of Conservative Dentistry (EFCD) para as tomadas de decisão clínica na intervenção do processo de cárie na pessoa idosa, com foco na cárie radicular. Materiais e métodos: O protocolo de tradução das recomendações do consenso internacional consistiu nas etapas: (1) tradução inicial, (2) síntese da tradução, (3) retradução, (4) revisão por comitê de especialistas, com adaptação cultural. A partir da tradução, foi desenvolvido um guia com diretrizes para tratamento de cárie radicular no Brasil. Resultados: Para prevenção de novas lesões é recomendada a escovação diária com dentifrício >1.500ppm/F. Dentifrícios com 5.000ppm/F ou vernizes (>20.000ppm/F) podem ser indicados para paralisar lesões radiculares ativas e para prevenção em pessoas idosas com alta suscetibilidade à cárie radicular, e o Diamino Fluoreto de Prata (>30%) para paralisar lesões ativas. Intervenções invasivas diretas são indicadas dependendo da situação clínica. Discussão: Nota-se uma falta de interesse em estudos primários sobre tratamentos para cárie radicular, criando assim uma lacuna em relação ao seu manejo, que reflete no nível de evidência detectado pelo consenso. Conclusão: Guias clínicos são importantes para reduzir a lacuna entre a pesquisa e a prática clínica. Essa tradução para o português facilitará o acesso dos dentistas brasileiros em relação a evidência consolidada até o momento para o manejo de cárie radicular