Surface roughness average and scanning electron microscopic observations of resin luting agents

The objective of this work was to evaluate the surface roughness changes of three current resin cements after tooth brushing simulation, as well as discuss its relation with scanning electron microscopic observations. The materials employed were Enforce Sure Cure (Dentsply), Rely X (3M-ESPE) and Variolink II (Vivadent). They were subjected to brushing abrasion (100,000 strokes for each specimen) and the surface roughness alterations (before and after strokes) were detected. For each roughness test condition, specimens were coated with gold-palladium and observed on a DSM 900 Zeiss scanning electron microscope. Roughness changes values (Ra) were statistically increased after brushing strokes. Based on the microscopic observations and roughness changes analysis, all cements studied became rougher after brushing strokes.O objetivo desse estudo foi avaliar a alteração de rugosidade superficial de três cimentos resinosos após submetê-los a ciclos de escovação simulada e analisar qualitativamente a sua superfície através de observações microscópicas. Os materiais empregados neste estudo foram Enforce Sure Cure (Dentsply), Rely X (3M-ESPE) e Variolink II (Vivadent). Estes foram submetidos à ciclos de escovação simulada (100.000 ciclos para cada espécime) e a alteração de sua rugosidade superficial (antes e após escovação) foi avaliada. Para cada material e condição de rugosidade, espécimes foram selecionados, metalizados e observados em microscopia eletrônica de varredura (DSM 900 Zeiss). Baseado nas observações microscópicas e nos valores de alteração de rugosidade, todos os materiais apresentaram aumento de rugosidade aritmética (Ra) após ciclos de escovação simulada

Avaliação clínica de restaurações de lesões cervicais não cariosas

The purpose of this study was to assess the clinical performance of bonded composite (Excite/Tetric Ceram - Vivadent) versus a resin-modified glass ionomer cement (Vitremer - 3M) for restoring non-carious cervical lesions. A total of 70 restorations (thirty-five per material) were placed in 30 patients, 18-50 aged, by one operator. Rubber dam was employed in all cases, lesions were pumiced, enamel margins were not beveled, and no mechanical retention was placed. The restorations were directly assessed by two independent evaluators using modified-USPHS criteria for six clinical categories. The ratings for clinical acceptability restorations (alfa plus bravo) were as follows (Tetric Ceram/Vitremer): retention (86%/100%), marginal integrity (100%/100%), marginal discoloration (100%/100%), wear (97%/100%), postoperative sensitivity (100%/100%) and recurrent caries (100%/100%). Statistical analysis was completed with Fisher's exact or Pearson Chi-square tests at a significance level of 5% (PAvaliou-se o desempenho clínico de um sistema restaurador adesivo (Excite - Tetric Ceram/ Vivadent) e do cimento de ionômero de vidro modificado por resina (Vitremer/ 3M) na restauração de lesões cervicais não cariosas por meio do sistema de avaliação do USPHS modificado. Um total de setenta restaurações, trinta e cinco por material, foi realizado por um único operador em trinta pacientes voluntários com idades de 18 a 50 anos. Previamente à execução das restaurações, foi realizada uma profilaxia com pedra-pomes e água a fim de remover quaisquer resíduos. As lesões cervicais não foram submetidas a qualquer tipo de preparo cavitário, sendo restauradas sob isolamento absoluto e de acordo com as instruções do fabricante. Todas as restaurações foram avaliadas pelo método direto por dois examinadores usando os critérios de retenção (R), integridade marginal (IM), descoloração marginal (DM), desgaste (D), sensibilidade pós-operatória (S) e incidência de cárie (IC). Ao final de um ano, os resultados de restaurações clinicamente satisfatórios (escores Alfa e Bravo) obtidos para resina composta e cimento de ionômerto de vidro modificado por resina foram respectivamente: R (86%/100%), IM (100%/100%), DM (100%/100%), D (97%/100%), S (100%/100%) e IC (100%/100%). Os resultados foram submetidos à análise estatística com o teste exato de Fisher ou o teste Qui-quadrado de Pearson com o nível de significância de 5% (

Transferring ART research into education in Brazil

The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. MATERIALS AND METHODS: A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the followig subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. RESULTS: A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3%), and in most of these schools it is taught both in theory and in clinical practice (62.9%). The majority (35.3%) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6%). It has been taught for the last 7 to 10 years in 34.3% of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. CONCLUSIONS: It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil

Push-out bond strength and SEM evaluation of a new bonding approach into the root canal

Objective: This study evaluated the performance of different adhesive systems in fiber post placement aiming to clarify the influence of different hydrophobic experimental blend adhesives, and of one commercially available adhesive on the frictional retention during a luting procedure. Material and Methods: One luting agent (70 Wt% BisGMA, 28.5% TEGDMA; 1.5% p-tolyldiethanolamine) to cement fiber posts into root canals was applied with 4 different adhesive combinations: Group 1: The etched roots were rinsed with water for 30 s to remove the phosphoric acid, then rinsed with 99.6% ethanol for 30 s, and blot-dried. A trial adhesive (base to catalyst on a 1: 1 ratio) was used with an experimental luting agent (35% Bis-GMA, 14.37% TEGDMA, 0.5% EDMAB, 0.13% CQ); Group 2: A trial adhesive (base to catalyst on a 1: 2 ratio) was luted as in Group 1; Group 3: One-Step Plus (OSP, Bisco Inc.) following the ethanol bonding technique in combination with the luting agent as in Group 1; Group 4: OSP strictly following the manufacturer's instructions using the luting agent as in Group 1. The groups were challenged with push-out tests. Posted root slices were loaded until post segment extrusion in the apical-coronal direction. Failure modes were analyzed under scanning electron microscopy. Results: Push-out strength was not significantly influenced by the luting agent (p>0.05). No statistically significant differences among the tested groups were found as Group 1 (Exp 1 - ethanol-wet bonding technique)=Group 2 (Exp 2 - ethanol-wet bonding technique)= Group 3 (OSP - ethanol-wet bonding technique)= Group 4 (control, OSP - water-wet bonding technique) (p>0.05). The dominating failure modes in all the groups were cohesive/adhesive failures, which were predominantly observed on the post/luting agent interface. Conclusions: The results of this study support the hypothesis that the proposal to replace water with ethanol to bond fiber posts to the root canal using highly hydrophobic resin is plausible, but this seems to be more the proof of a concept than a clinically applicable procedure

Avaliação de seis meses de restaurações ART de classe I em uma comunidade de alta experiência de cárie no Brasil

The aim of this study to evaluate the success rate in one-surface ART restorations placed in permanent molars using a glass ionomer cement especially developed for ART in a community with high caries experience; to evaluate the operator influence on its success, post-operative sensitivity and technique acceptance by patients. Prior to placement of the restorations, the Gingival Bleeding Index, Visible Plaque Index, DMFT, dmft indices and treatment needed were assessed. One hundred and fifty five one-surface restorations were placed in permanent molars of school children, according to the WHO ART manual, 1997. After 6 months, the success rate was verified clinically and by slides. At baseline, the mean DMFT was 2.56 (±1.08) and the mean dmft, 2.53 (±2.33). Operators A and B have placed 102 and 53 ART restorations respectively. The mean time of placement was 16 minutes and 25 seconds to operator A and 14 minutes and 43 seconds to operator B. At 6-month follow up, 152 ART restorations were evaluated and 97.3% were assessed to be successful. Two restorations were excluded from the sample because the ART restorations were replaced by amalgam fillings. Only 4 restorations have failed, in which 2 due to caries, 1 due to fistula presence and the other because the restoration was lost. Four patients reported postoperative sensitivity. At this study period, ART treatment seems to be suitable for its purpose. Further evaluations are necessary to the new glass ionomer cements especially developed for ART technique provided good results at 6-month follow up in a community with high DMFT and dmft indices. The success rate for one-surface cavities in permanent molars was 97.3%, and the studied indices seemed to have no influence in this early evolution period.O objetivo deste estudo foi avaliar o índice de sucesso de restaurações de cavidade de classe I, realizadas em molares permanentes, utilizando-se a técnica do ART e um cimento de ionômero de vidro desenvolvido especialmente para a técnica, em uma comunidade de alto risco à cárie; avaliar a influência do operador no sucesso da técnica e avaliar a sensibilidade pós-operatória e a aceitação da técnica por parte dos pacientes. Antes da realização do tratamento verificou-se o índice de placa visível e o índice de sangramento gengival, CPOD, ceo-d e necessidade de tratamento. Um total de 155 restaurações de uma superfície foram realizadas em molares permanentes de escolares, de acordo com o manual de ART da OMS. Após 6 meses, realizou-se o acompanhamento clínico e por diapositivos. Inicialmente, o CPOD foi de 2,56 ( ±1,08) e o ceod de 2,53 ( ±2,33 ). Os operadores A e B realizaram 102 e 53 restaurações de ART respectivamente. O tempo médio para o tratamento foi de 16 minutos e 25 segundos para A e 14 minutos e 43 segundos para B. Aos seis meses. 152 restaurações foram avaliadas e 97,3% consideradas sucesso. Duas restaurações foram excluídas da amostra pois foram substituídas por amálgama. Somente 4 restaurações falharam, duas por recidiva de cárie, 1 por presença de fistula e a última por perda da restauração. Quatro pacientes relataram sensibilidade pós-operatória. O tratamento ART cumpriu seus objetivos no período analisado. Avaliações futuras são necessárias, especialmente para os cimentos de ionômero de vidro de alta viscosidade, devido aos bons resultados nesta comunidade de alto índice de cárie. O índice de sucesso foi de 97,3% e os índices de cárie parecem não influenciar no sucesso do tratamento

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8% retention rate was recorded for RC restorations, while 100% retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.Esse estudo avaliou o desempenho clínico de restaurações de lesões cervicais não-cariosas por um período de 2 anos empregando um sistema adesivo de condicionamento total (Excite/Tetric Ceram) e um cimento de ionômero de vidro modificado por resina (Vitremer). Setenta restaurações (35 por material) foram realizadas por um único operador. Todas as lesões cervicais não-cariosas foram restauradas sem a execução de preparo cavitário e sob isolamento absoluto. As restaurações foram avaliadas por 2 examinadores independentes usando os critérios USPHS modificados nos períodos inicial, 6, 12 e 24 meses. A análise estatística foi realizada pelos testes de Fisher e McNemar. Cinquenta e nove restaurações foram avaliadas após 2 anos, obtendo-se um índice de retenção de 78,8% para resina composta e 100% para o cimento de ionômero de vidro modificado por resina. O teste exato de Fischer detectou diferença significante (p=0,011) para retenção entre os dois materiais. Contudo, não houve diferença significante para integridade marginal, descoloração marginal, forma anatômica e cárie secundária. O teste de McNemar detectou diferença estatística para o sistema Excite/Tetric Ceram entre o período inicial e 2 anos para os critérios de retenção (p=0,02), integridade marginal (p=0,002) e forma anatômica (p=0,04). Portanto, o sistema adesivo de condicionamento total apresentou um desempenho clínico inferior comparado ao cimento de ionômero de vidro modificado por resina

Resistência à compressão e à tração diametral de cimentos de ionômero de vidro

The aim of this study was to compare, in different periods of time, the compressive and diametral tensile strength of a traditional high viscous glass ionomer cement: Fuji IX (GC Corporation), with two new Brazilian GIC's: Vitro-Molar (DFL) and Bioglass R (Biodinamica), all indicated for the Atraumatic Restorative Treatment (ART) technique. Fifteen disk specimens (6.0mm diameter x 3.0mm height) for the diametral tensile strength (DTS) test and fifteen cylindrical specimens (6.0mm diameter x 12.0mm height) for the compressive strength (CS) test were made of each GIC. Specimens were stored in deionized water at 37º C and 100% of humidity in a stove until testing. Five specimens of each GIC were submitted to CS and DTS test in each period, namely 1 hour, 24 hours and 7 days. The specimens were tested in a testing machine (Emic) at a crosshead speed of 1.0mm/min for CS and 0.5mm/min for the DTS test until failure occurred. The data were submitted to two-way ANOVA and Tukey tests (alpha=0.05). The mean CS values ranged from 42.03 to 155.47MPa and means DTS from 5.54 to 13.72 MPa, with test periods from 1h to 7 days. The CS and DTS tests showed no statistically significant difference between Fuji IX and Vitro Molar, except for CS test at 1-hour period. Bioglass R had lowest mean value for CS of the cements tested. In DTS test Bioglass R presented no statistically significant differences when compared with all others tested GICs at 1-hour period and Bioglass R presented no difference at 24-hour and 7-day periods when compared to Vitro-Molar. Further studies to investigate other physical properties such as fracture toughness and wear resistance, as well as chemical composition and biocompatibility, are now needed to better understand the properties of these new Brazilian GIC's.Comparou-se a Resistência à Compressão (RC) e à Tração Diametral (TD) de um cimento de ionômero de vidro de alta viscosidade [Fuji IX (GC Corporation)] e de dois novos cimentos Brasileiros [Vitro Molar (DFL) e Bioglass R (Biodinamica)], recentemente lançados no mercado, ambos indicados para o Tratamento Restaurador Atraumático (ART), em diferentes períodos de tempo. Foram confeccionados quinze corpos-de-prova com 6,0 mm de diâmetro x 3,0 mm de altura para o teste de TD e quinze com 6,0 mm de diâmetro e 12,0 mm de altura para o teste de RC, para cada ionômero a ser testado. Os corpos-de-prova foram armazenados em recipientes plásticos, com água deionizada, e mantidos em estufa a 37ºC e 100% de umidade, até a realização dos testes. Cinco corpos-de-prova de cada material foram submetidos aos testes de TD e RC em cada período de tempo: 1-hora, 24-horas e 7-dias, em uma máquina de testes universal (EMIC - DL 500) a uma velocidade de 1,0 mm/min para RC e 0,5mm/min para TD. Os dados obtidos foram submetidos aos testes ANOVA a dois critérios e Tukey (á=0,05). Os valores médios de RC e TD variaram de 42,03 a 155.47 MPa e de 5,54 a 13,72 MPa, respectivamente para os períodos analisados. O Fuji IX e o Vitro Molar não apresentaram diferenças em relação aos testes de RC e TD, exceto para RC no período de 1-hora. O Bioglass R apresentou os menores valores de RC dos cimentos testados. Na TD o Bioglass R não apresentou diferença em relação aos outros cimentos testados no período de 1-hora e não foi diferente do Vitro-Molar nos períodos de 24-horas e 7-dias. Mais estudos são necessários para avaliar outras propriedades mecânicas desses novos cimentos de ionômero de vidro brasileiros, tais como: tenacidade e desgaste, bem como composição química e biocompatibilidade

Effect of resin-modified glass-ionomer cement lining and composite layering technique on the adhesive interface of lateral wall

Interface integrity can be maintained by setting the composite in a layering technique and using liners. Objective The aim of this in vitro study was to verify the effect of resin-modified glass-ionomer cement (RMGIC) lining and composite layering technique on the bond strength of the dentin/resin adhesive interface of lateral walls of occlusal restorations. Material and Methods Occlusal cavities were prepared in 52 extracted sound human molars, randomly assigned into 4 groups: Group 2H (control) – no lining + two horizontal layers; Group 4O: no lining + four oblique layers; Group V-2H: RMGIC lining (Vitrebond) + two horizontal layers; and Group V-4O: RMGIC lining (Vitrebond) + four oblique layers. Resin composite (Filtek Z250, 3M ESPE) was placed after application of an adhesive system (Adper™ Single Bond 2, 3M ESPE) dyed with a fluorescent reagent (Rhodamine B) to allow confocal microscopy analysis. The teeth were stored in deionized water at 37oC for 24 hours before being sectioned into 0.8 mm slices. One slice of each tooth was randomly selected for Confocal Laser Scanning Microscopy (CLSM) analysis. The other slices were sectioned into 0.8 mm x 0.8 mm sticks to microtensile bond strength test (MPa). Data were analyzed by two-way ANOVA and Fisher's test. Results There was no statistical difference on bond strength among groups (p>;0.05). CLSM analysis showed no significant statistical difference regarding the presence of gap at the interface dentin/resin among groups. Conclusions RMGIC lining and composite layering techniques showed no effect on the microtensile bond strength and gap formation at the adhesive interface of lateral walls of high C-factor occlusal restorations