Adhesive systems modified with antimicrobial agents: a literature review

A cárie secundária é a principal causa de falha da restauração. Assim, o desenvolvimento de adesivos com ação antimicrobiana é uma opção vantajosa para sua inibição. No entanto, esse efeito deve ser comprovado, bem como que o benefício adicional não interfere nas propriedades mecânicas do material ou na biocompatibilidade. Analisamos adesivos com ação antimicrobiana por meio de testes microbiológicos, resistência de união, grau de conversão e citotoxicidade. Analisamos 32 estudos com adesivos antimicrobianos disponíveis comercialmente (Clearfil ™ SE Protect Bond / MDPB, Gluma 2Bond / glutaraldeído, Peak Universal Bond / clorexidina) e materiais experimentais ou adesivos comerciais modificados com agentes antimicrobianos, incluindo materiais com metacrilato de amônio quaternário (QAM) [metacrilato de dimetilaminododecil (DMADDM) e metacrilato de dimetilaminohexadecil (DMAHDM)], nanopartículas [prata (NAg), dióxido de titânio (TiO2), óxido de zinco (ZnO)], vidro bioativo dopado com prata ou zinco (BAG), titânio, iodo de titânio, cobre e compostos como triclosan, quercetina, extrato de semente de uva, entre outros. O uso de agentes antimicrobianos é uma perspectiva favorável para a funcionalização de sistemas adesivos para inibir a cárie secundária. No entanto, mais estudos clínicos precisam provar a eficácia desses materiais.Secondary caries is the primary cause of restoration failure. Thus, the development of adhesives with antimicrobial action is an advantageous option for their inhibition. However, this effect must be proven, as well as that the additional benefit does not interfere with material mechanical properties or biocompatibility. We analyzed adhesives with antimicrobial action by microbiological tests, bond strength, degree of conversion, and cytotoxicity. We analyzed 32 studies with commercially available antimicrobial adhesives (Clearfil™ SE Protect Bond/ MDPB, Gluma 2Bond/ glutaraldehyde, Peak Universal Bond/chlorhexidine), and experimental materials or commercial adhesives modified with antimicrobial agents, including materials with quaternary ammonium methacrylate (QAM) [dimethylaminododecyl methacrylate (DMADDM) and dimethylaminohexadecyl methacrylate (DMAHDM)], nanoparticles [silver (NAg), titanium dioxide (TiO2), zinc oxide (ZnO)], silver or zinc doped bioactive active glass (BAG), titanium, copper iodide, and compounds such as triclosan, quercetin, grape seed extract, among others. The use of antimicrobial agents is a favorable perspective for the functionalization of adhesive systems to inhibit secondary caries. However, more clinical studies need to prove the efficacy of these materials

Bond strength of resin composites to dentin associated to filled and unfilled adhesive systems

Este trabalho analisou in vitro duas marcas de adesivos de quarta geração do sistema simplificado (Optisolo - Kerr, com carga, e Single Bond - 3M, sem carga) e duas marcas de resinas compostas (Prodigy - Kerr e Z100 - 3M), com o objetivo de verificação da adesividade na dentina. Oitenta corpos-de-prova, confeccionados a partir de molares humanos extraídos, foram incluídos em resina acrílica e desgastados até exposição de dentina no sentido longitudinal, e divididos em 4 grupos. Cones de resina composta foram aderidos a estes corpos-de-prova precedidos dos sistemas adesivos, seguindo a orientação dos fabricantes. Os corpos-de-prova foram submetidos a teste de tração numa máquina de ensaios Universal Mini-Instron 4442, a uma velocidade de 0,5 mm/min. Os resultados obtidos foram transformados em MPa de acordo com a área de adesão e submetidos a análise estatística pela ANOVA. Pelos resultados obtidos, concluiu-se que houve diferença estatisticamente significante (p ; 0,05).This study analyzed in vitro two brands of one-step adhesive systems of fourth generation (Optisolo - Kerr, filled; and Single Bond - 3M, unfilled) and two composite resins (Prodigy - Kerr and Z100 - 3M), aiming at evaluating their bond strength to dentin. Eighty human extracted molars were embedded in acrylic resin and grounded until dentin was exposed in longitudinal direction. The specimens were divided in 4 groups. Composite resin cones were bonded to the specimens using the mentioned adhesive systems, following the instructions of the manufacturers. The test-specimens were submitted to tensile tests using a 4442 Universal Mini-Instron Machine with the speed of 0.5 mm/min. The results were converted into MPa, according to the area of adhesion, and submitted to statistical analysis with ANOVA. There was significant statistical difference (p ; 0.05) between the composites (F = 0.43)

Avaliação da contração de polimerização de três resinas compactáveis, medida por picnômetro a gás

Modern restorative dentistry has been playing an outstanding role lately since composite resins, allied to adhesive systems, have been widely applied on anterior and posterior teeth restorations. The evolution of composite resins has mostly been verified due to the improvement of their aesthetic behavior and the increase in their compressive and abrasive strengths. In spite of these developments, the polymerization shrinkage inherent to the material has been a major deficiency that, so far, has been impossible to avoid. Using a gas pycnometry, this research investigated the polymerization shrinkage of three packable composite resins: Filtek P60 (3M), Prodigy Condensable (Kerr), and SureFil (Dentsply/Caulk), varying the distance from the light source to the surface of the resins (2 mm or 10 mm). The pycnometer Accupyc 1330 (Micromeritics, USA) precisely records helium displacement, allowing fast and reliable measurements of the volume of composite resin immediately before and after polymerization, without interference of temperature or humidity. Results were not found to be statistically different for the three tested resins, either for 2 mm or 10 mm-distance from the light source to the composite surface.A Odontologia Restauradora moderna tem se destacado nos últimos anos e as resinas compostas, aliadas aos sistemas adesivos, têm sido muito empregadas para restaurações de dentes anteriores e posteriores. A evolução das resinas compostas tem sido constatada na melhoria do seu comportamento estético e no aumento da sua resistência à compressão e à abrasão. Apesar dos avanços mencionados, a contração de polimerização, inerente a esse material, continua sendo uma grande deficiência e, por enquanto, impossível de ser evitada. Nesta pesquisa a contração de polimerização de três resinas compostas compactáveis, Filtek P60 (3M), Prodigy Condensável (Kerr) e SureFil (Dentsply/Caulk), variando-se a distância entre a fonte de luz e a superfície das resinas em 2 mm e 10 mm, foi avaliada pelo método da picnometria a gás. O aparelho picnômetro Accupyc 1330 (Micromeritics, EUA) mede o deslocamento de gás hélio com grande precisão, permitindo medições rápidas e fiéis do volume das resinas compostas antes e após a polimerização, sem interferência da temperatura e da umidade. Os resultados mostraram que não houve diferenças estatisticamente significantes entre as três resinas avaliadas. Independentemente do tipo de resina composta, também não houve diferenças significantes para as distâncias de polimerização de 2 mm e 10 mm

Microdureza de resina composta: efeito de aparelhos e tempos de polimerização em diferentes profundidades

The properties of composite resins have been frequently studied, as well as the factors that might influence the polymerization degree. Considering the evolution of composites and the need to improve their clinical performance, this study intends to evaluate the efficacy of two high-intensity and one low-intensity photocuring units, as a function of exposure time (20 and 40seconds) and composite depth (from 1 to 4 millimeters). Composite properties were evaluated via Knoop Microhardness Test. Statistical analysis (1 way ANOVA, p < 0.05) of the obtained results showed that there was statistically significant difference regarding the time factor. The 40-seconds polymerization time showed the best results, for the four depths. Concerning the photocuring unit factor, there was statistically significant (1- way ANOVA, p < 0.05) difference between the tested devices. The high-intensity units demonstrated better results than the low-intensity one. There were statistically significant differences between the analysed composite depths, being the highest microhardness values achieved for the lowest depths.As propriedades das resinas compostas têm sido estudadas com freqüência, bem como os fatores que podem influenciar seu grau de polimerização. Diante da evolução desses materiais e da necessidade de buscarmos melhora do seu comportamento na cavidade bucal, objetivamos, por meio deste estudo avaliar a eficácia de dois aparelhos fotopolimerizadores do tipo pistola (de alta intensidade de luz), comparando com a de um aparelho a cabo (de baixa intensidade de luz), com tempos de exposição de 20 e de 40 segundos e em profundidades de 1 a 4 milímetros. Os testes avaliaram o grau de polimerização da resina por meio de testes de microdureza Knoop. Os resultados mostraram haver diferença estatisticamente significante entre os tempos, sendo que com 40 segundos a dureza foi maior que com 20 segundos para as 4 diferentes profundidades. Para o fator aparelhos, os dois aparelhos tipo pistola se comportaram superiores ao do tipo cabo Fibralux (Dabi Atlante), e entre eles, o XL 1500 (3M) promoveu dureza maior que o Optilight II (Gnatus) no tempo de polimerização de 40 segundos. As profundidades de 1, 2, 3 e 4 milímetros mostraram estatisticamente diferença entre si tendo sido encontrada maior dureza para as menores profundidades (p < 0,05)

Finite elements study of the Flexi Post and Flexi Flange post systems in a maxillary central incisor

A utilização de pinos intra-radiculares tem se mostrado uma excelente alternativa para dentes endodonticamente tratados. Este trabalho teve como objetivo avaliar, utilizando o Método dos Elementos Finitos (MEF), como pinos intra-radiculares pré-fabricados metálicos podem alterar o padrão das tensões geradas de von Mises e de máxima tração e compressão na raiz dental. A comparação foi realizada entre os pinos pré-fabricados Flexi Post/Flexi Flange de aço inoxidável e titânio com preenchimento coronário em resina composta. Os pinos intra-radiculares foram fixados com um cimento resinoso e recobertos por uma coroa total cerâmica. A partir de fotografias da peça anatômica e dos pinos estudados, foram criados modelos matemáticos bidimensionais no programa MSC/Nastran 4.5 e, após aplicação de uma força de 100 N a 45 graus na superfície palatina dos modelos, foi avaliada a distribuição das tensões geradas. Com base nos resultados obtidos, pode-se concluir que os pinos intra-radiculares alteram o padrão das tensões geradas dependendo do desenho do pino intra-radicular e do tipo de material constituinte.The use of post and core systems has become an excellent alternative for restoring endodontically treated teeth. The aim of this study was to evaluate the von Mises, maximal compressive and tensile stresses distribution using the Finite Element Method (FEM) on human teeth restored with different post and core systems. The analysis was made on endodontically treated maxillary central incisors. The post systems used in this investigation were the stainless steel or titanium Flexi Post/Flexi Flange. Composite resin was used as core material and resin cement was the cement material of choice to seat a full porcelain crown. The bi-dimensional mathematical model was created from pictures taken from an intact human maxillary central incisor and prefabricated posts. This image was transferred to a personal computer in the MSC/Nastran 4.5 software. A static and linear analysis treatment was performed when a 45º load of 100 N was applied on the lingual surface of the tooth. Based on the results obtained, it can be concluded that the post design and its material can alter the stress pattern distribution

Influência do eugenol na microdureza da resina composta utilizando sistemas adesivos atuais

O objetivo deste trabalho foi avaliar, in vitro, se a utilização do cimento de óxido de zinco e eugenol exerce influência na microdureza da restauração de resina composta (Z100) realizada com dois sistemas adesivos (Scotchbond Multi-Purpose Plus® - sistema que remove o "smear layer", e o Clearfil Liner Bond 2® - adesivo que promove o tratamento do "smear layer", sem removê-lo totalmente). Para isto, foram utilizados 40 molares humanos hígidos que foram divididos igualmente em 4 grupos. Para cada adesivo havia um grupo controle (sem óxido de zinco e eugenol) e outro onde foram realizadas e removidas as restaurações provisórias com cimento de óxido de zinco e eugenol. Após sete dias de armazenamento em estufa a 37ºC, os dentes foram cortados e mediu-se a microdureza da resina composta na região a 0,3 mm da interface dente-restauração em um microdurômetro SHIMADZU HMV 2000, com ponta penetradora Knoop de 50 gramas por 45 segundos. Os resultados obtidos foram analisados estatisticamente pela ANOVA (alfa = 1%), e verificou-se não haver diferença estatisticamente significante na microdureza da resina composta entre os grupos estudados.The zinc oxide-eugenol cement is still widely used as a temporary restorative material. Its use is known, however, to disturb the curing process of composite resins used in the final restoration. Nevertheless, with the development of dentin bonding systems, total etch is used to remove or treat the smear layer before the construction of the composite resin restoration. The purpose of this study was to evaluate if the zinc oxide-eugenol cement influenced the microhardness of composite resin (Z100) restorations used in association with either one of two bonding systems (Scotchbond Multi-Purpose Plus® and Clearfil Liner Bond 2®). Forty molars were divided into four groups. For each bonding material there was a control group that did not receive cement and a group that received a temporary zinc oxide-eugenol restoration that was removed after seven days. The specimens were stored in a dry heat sterilizer at 37ºC, for seven days before the sectioning procedure. Microhardness was measured 0.3 mm far from the tooth-restoration interface by means of a SHIMADZU HMV 2000 apparatus, with a Knoop hardness tip of 50 g, for 45 seconds. Statistical analysis of the results was performed using ANOVA (alpha = 1%) and revealed no statistically significant differences in the microhardness of the composite resin, among the studied groups

The effect of powdered juice on human dental enamel dissolution

Aim: The aim of this in vitro study was to evaluate the dissolution potential of an artificial powdered juice in human dental enamel. Methods: Three commercially available beverages were tested by first evaluating the pH and the titratable acidity. After this, 40 enamel specimens were individually immersed in the respective solutions for 120 min (n = 8) as follows: C+: distilled water (positive control); TAN: artificial powdered orange juice; DEL: natural orange juice, CC: Coca-Cola and C-: citric acid solution 1% (negative control). At the end, each solution was analyzed for the amount of calcium (Ca) released and the data obtained were analyzed using ANOVA followed by Tukey test (p &lt;0.05). Results: All solutions had low pH values. The C- group had the highest titratable acidity, followed by DEL, TAN and CC. TAN (0,92)a resulted in a lower release of Ca, being statistically similar to C+ group (0,46)a, while CC (6,32)c resulted in the higher release of calcium, followed by C- (4,17)bc and DEL (3,13)b groups. Relevance: The artificial powdered juice tested, although acid and high titratable acidity caused no enamel dissolution

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.