Short-term effect of adhesive system on clinical performance of bulk fill composite: randomized clinical trial

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p<0.05). Considering the same restorative technique, the use of the self-etching adhesive system showed a significant decrease in color and translucency (p<0.05). Conclusion: All groups showed favorable clinical performance, and promising results were found for the conventional adhesive system and high viscosity bulk fill protocol

Adhesión a dentina part II: estrategias para optimizar la adhesión a dentina y protocolos adhesivos / Dentin bonding part II: strategies to optimize dentin bonding and adhesive protocols

La adhesión a dentina con sistemas adhesivos polimé-ricos representa un desafío que surge de la necesi-dad de vincular un sustrato dentario heterogéneo y variable con materiales que presentan todavía cier-tos aspectos a atender para poder conseguir el máxi-mo desempeño. El propósito del presente artículo es evaluar algunas de las estrategias propuestas para mejorar la adhesión a dentina, y sugerir un protocolo de trabajo con los diferentes tipos de sistemas adhesivos (AU)

Dentin bonding with polymeric adhesive systems represents a challenge that arises from the need to link a heterogeneous and variable dental substrate with materials that still have certain aspects to be addressed in order to achieve maximum performance. The aim of this article is to evaluate some of the proposed strategies to improve dentin bonding and to suggest a protocol for each different type of bonding systems (AU)

Caracterización microscópica de la dentina de dientes temporales / Microscopic characterization of the dentin of temporary teeth

La dentina se compone de un mineral de fosfato de calcio identificado como dahllita, que se dispone en pequeños cristales de hidroxiapatita carbonatada con dimensiones de 36 × 25 × 4 nm, y por una fase orgánica cuyo principal componente es el colágeno tipo 1 en 90%, que se orienta en forma de malla. Esta conformación corresponde a los dientes permanentes. Dentro de las estructuras, encontramos túbulos dentinarios que miden, aproximadamente, entre 0.5-1 µm de diámetro en la periferia y hasta 3-5 µm cerca de la pulpa. En el presente estudio, realizado en dentina de dientes temporales, el lumen de dichos túbulos es más grande cuando se encuentra cerca de la pulpa dental. Asimismo, se encontraron cambios elementales importantes de acuerdo con las diferentes profundidades en las que se observó, encontrando un aumento en el peso porcentual de carbono cuando se encuentra a mayor profundidad, lo que indica una composición orgánica mayor en la dentina pulpar. En estudios de dientes permanentes esta composición es disminuida y con mayor concentración en la dentina cercana a la unión amelodentinaria. En dentina de dientes temporales se encontraron diferencias en el recuento de túbulos dentinarios por mm2, comparado a la dentina de dientes permanentes, donde el número de túbulos no varía mucho (AU)

Dentin is composed of a calcium phosphate mineral identified as dahllite, which is arranged in small crystals of carbonated hydroxyapatite with dimensions of 36 × 25 × 4 nm, and by an organic phase whose main component is type l collagen in 90%, which is oriented in the form of a mesh. This conformation corresponds to permanent teeth. Within the structures, we find dentin tubules that measure approximately 0.5-1 µm in diameter at the periphery and up to 3-5 µm near the pulp. In the present study, carried out in dentin of primary teeth, the lumen of these tubules is larger when it is close to the dental pulp. Likewise, important elemental changes were found according to the different depths in which it was observed, finding an increase in the percentage weight of carbon when it is at a greater depth, indicating a greater organic composition in the pulp dentin. In studies of permanent teeth, this composition is decreased and with a higher concentration in the dentin near the amelodentinal junction. In dentin of primary teeth, differences were found in the count of dentin tubules per mm2, compared to dentin of permanent teeth, where the number of tubules did not vary much (AU)

Eficacia del cementado indirecto / Indirect bonding efficiency

La aparición de aparatología preadjustada ha colaborado en la efectividad de los tratamientos de ortodoncia, pero para que la expresión de esta aparatología se logre, es necesario una correcta colocación de los brackets y la permanencia de estos en boca durante todo el tratamiento. La precisión en la colocación mejora con la técnica de cementado indirecta, ya que permite el acceso a las zonas posteriores, a lugares donde se ve disminuida la visión y además disminuye la condensación de aliento y contaminación salival. Si bien esta técnica requiere tiempo extra de laboratorio, es más rápida en la etapa clínica (AU)

Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel

ABSTRACT Objective: To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern. Methods: A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively. Results: For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52). Conclusions: The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.

RESUMO Objetivo: Comparar a efetividade do pré-tratamento com jateamento e desproteinização com NaOCl na resistência de união (SBS), grau de conversão in situ (GC) dos braquetes metálicos ao esmalte fluorótico e o padrão de condicionamento do esmalte. Métodos: Foi utilizado um total de 90 pré-molares superiores livres de cárie. Os dentes foram divididos em seis grupos experimentais, de acordo com: superfície do esmalte (Esmalte Sadio e Fluorótico); tratamento de superfície (Condicionamento com ácido fosfórico a 37% [ER]; Hipoclorito de sódio a 5,2% + ácido fosfórico [NaOCl + ER]; e jateamento + ácido fosfórico [Jateamento + ER]). Após armazenamento em água destilada (37oC/24 h), os espécimes foram testados a 1 mm/min até a falha (SBS). As interfaces esmalte-cimento foram avaliadas para GC usando espectroscopia micro-Raman. O padrão do condicionamento do esmalte foi avaliado sob microscopia eletrônica de varredura. Os dados da SBS e GC foram analisados utilizando ANOVA dois fatores e teste de Tukey (α= 0,05). O padrão de condicionamento do esmalte foi avaliado apenas qualitativamente. Resultados: Para o esmalte sadio, o ER apresentou os maiores valores de SBS, quando comparado aos grupos NaOCl + ER e Jateamento + ER (p< 0,01). Em relação ao GC, apenas a média do grupo NaOCl + ER foi comprometida significativamente em comparação aos outros grupos (p= 0,002). Para o esmalte fluorótico, Jateamento + ER aumentou significativamente a média dos valores de SBS, em comparação com o grupo ER (p= 0,01) e nenhuma mudança significativa foi observada no GC (p> 0,52). Conclusões: A aplicação de NaOCl ou jateamento associado ao ácido fosfórico melhorou a SBS dos braquetes no esmalte fluorótico sem comprometer o GC do cimento resinoso, com a melhoria do condicionamento interprismático do esmalte.

Sellado marginal aplicando hipoclorito de sodio versus ácido fosfórico como acondicionador dental / Marginal sealing applying sodium hypochlorite versus phosphoric acid as dental conditioner

RESUMEN Introducción: La microfiltración es uno de los problemas principales de todas las obturaciones a base de resina. Muchos estudios buscan optimizar un buen sellado marginal utilizando diversos acondicionadores, como el hipoclorito de sodio, que permite que el adhesivo penetre bien, al generar desproteinización, y el ácido fosfórico que permite remover el barro dentinario, y así de esta manera formar una capa híbrida al colocar el adhesivo. Objetivo: Evaluar el grado de sellado marginal de la resina Bulk Fill aplicando gel de hipoclorito de sodio 10 por ciento comparado con el gel de ácido fosfórico al 37 por ciento en el acondicionamiento dental in vitro. Métodos: El universo fue de 72 dientes con cavidades clase I; se separaron en 4 grupos por muestra de 18 dientes cada uno; después de obturar se realizó el termociclaje a 500 ciclos entre 5 °C a 55 °C; luego se sumergieron en azul de metileno 2 por ciento, durante 12 h y 24 h a temperatura de 37 °C. Finalmente se evaluó el sellado marginal en el estereomicroscopio, según el ISO / TS 11405: 2015, con los criterios siguientes: grado 0 (sin microfiltración), grado 1 (microfiltración hasta esmalte), grado 2 (microfiltración hasta dentina) y grado 3 (microfiltración hasta piso pulpar). Resultados: El acondicionamiento con ácido fosfórico 37 por ciento a las 12 h presentó grado 0 (55,6 por ciento) y grado 1 (33,3 por ciento), y a las 24 h, grado 1 (55,6 por ciento). Con respecto al hipoclorito de sodio 10 por ciento a las 12 h, grado 0 (44.4 por ciento) y a las 24 h predominó grado 1 (55,6 por ciento). Para la contrastación de hipótesis en muestras relacionadas se obtuvo en ácido fosfórico 37 por ciento e hipoclorito de sodio al 10 por ciento a las 12 h y 24 h un p= 0,052 y p= 0,584, respectivamente. Para comparaciones entre muestras independientes a las 12 h y 24 h se obtuvo p= 0,462 y p= 0,406, respectivamente. Conclusiones: El gel de hipoclorito de sodio al 10 por ciento presenta similar eficacia en el sellado marginal respecto al gel de ácido fosfórico al 37 por ciento, al utilizarlo como acondicionador dental(AU)

ABSTRACT Introduction: Microfiltration is one of the main problems of all resin sealings. Many studies aim to optimize marginal sealing using a variety of conditioners, such as sodium hypochlorite, which allows good penetration of the adhesive by generating deproteinization, and phosphoric acid, which allows removal of the dental smear layer, thus creating a hybrid layer when the adhesive is placed. Objective: Evaluate the marginal sealing degree of Bulk Fill resin applying 10 percent sodium hypochlorite gel versus 37 percent phosphoric acid gel in in vitro dental conditioning. Methods: The study universe was 72 teeth with class I cavities, divided into four groups of 18 teeth. Upon sealing, thermal cycling was performed at 500 cycles from 5 ºC to 55 ºC. Next the teeth were submerged in 2 percent methylene blue for 12 h and 24 h at a temperature of 37 ºC. Finally marginal sealing was evaluated in the stereo microscope according to ISO / TS 11405: 2015, using the following scale: grade 0 (no microfiltration), grade 1 (microfiltration as far as the enamel), grade 2 (microfiltration as far as the dentin), and grade 3 (microfiltration as far as the pulp floor). Results: Conditioning with 37 percent phosphoric acid was grade 0 (55.6 percent) and grade 1 (33.3 percent) at 12 h, and grade 1 (55.6 percent) at 24 h, whereas conditioning with 10 percent sodium hypochlorite was grade 0 (44.4%) at 12 h, and predominantly grade 1 (55.6 percent) at 24 h. Hypothesis contrast in related samples yielded 37 percent phosphoric acid and 10 percent sodium hypochlorite at 12 h and 24 h, p= 0.052 and p= 0.584, respectively. Comparison between independent samples at 12 h and 24 h yielded p= 0.462 and p= 0.406, respectively. Conclusions: The 10 percent sodium hypochlorite gel has similar marginal sealing effectiveness as the 37 percent phosphoric acid gel when used as dental conditioners(AU)

Evaluación de la adhesión de sistemas adhesivos de grabado total en esmalte dental bovino usando un agente desproteinizante: un estudio in vitro / Evaluation of adhesion of total etch adhesive systems on bovine dental enamel using a deproteinizing agent: an in vitro study

Introducción: Hoy en día, la mayoría de los pacientes requieren tratamiento de ortodoncia fija convencional, la cual utiliza procedimientos adhesivos afines con la superficie amelodentinaria. Aunque existen diferentes técnicas adhesivas que pueden ofrecer adecuados niveles de resistencia al desalojo, el uso del hipoclorito de sodio (NaClO) como agente desproteinizante no ha sido bien definido en materiales de cementación en aparatología ortodóncica convencional. Objetivo: El objetivo de este estudio fue determinar los niveles de resistencia al desalojo con pruebas de microtensión y análisis topográfico con microscopia electrónica de barrido. Material y métodos: 20 bloques de esmalte bovino fueron expuestos superficialmente a soluciones acondicionadoras (ácido ortofosfórico al 37%) con y sin agente desproteinizante (NaClO al 5.25%); finalmente, brackets individuales de ortodoncia fueron cementados con sistemas adhesivos y resinas compuestas de casas comerciales (Ormco y 3M). Las pruebas de resistencia al desalojo fueron realizadas con una máquina de fuerzas universales y el análisis topográfico con microscopia electrónica de barrido. Resultados: El uso del NaClO al 5.25% y la marca Ormco tuvieron estadísticamente los mejores niveles de adhesión que el grupo sin desproteinización y la casa comercial 3M, respectivamente. La topografía adamantina expuesta al agente desproteinizante mostró características de superficie relacionadas con el patrón de grabado tipo I. Conclusión: El uso de un agente desproteinizante (NaClO 5.25%) así como una marca comercial (Ormco) en particular podrían definir el aumento en los niveles de adhesión en superficies adamantinas con aparatología ortodóncica convencional (AU)

Introduction: Nowadays, patients require conventional fixed orthodontic treatment, which uses adhesive procedures related to the dentinal denture surface. Although there are different adhesive techniques that can offer adequate levels of bonding resistance, the use of NaClO as a deproteinizing agent has not been well defined in cementing materials in conventional orthodontic appliances. Objective: The objective of this study was to determine the levels of bond resistance using micro tension tests and topographic analysis with scanning electron microscopy. Material and methods: Twenty-blocks of bovine enamel were exposed superficially to conditioning solutions (37% orthophosphoric acid) with and without deproteinizing agent (5.25% NaClO); finally, individual orthodontic brackets were cemented with adhesive systems and resin composites of different trademarks (Ormco and 3M). Bonding resistance tests were performed with a universal force machine and topographic analysis was made with scanning electron microscopy. Results: The use of 5.25% NaClO and the Ormco brand had statistically better levels of adhesion than the group without deproteinization and the 3M brand, respectively. Adamantine topography exposed to the deproteinizing agent showed surface characteristics related to the type I etching pattern. Conclusion: The use of a deproteinizing agent (NaClO 5.25%) as well as a trademark (Ormco) in particular conditions could define the increase in adhesion levels on adamantine surfaces with conventional orthodontic appliances (AU)

Hydrofluoric acid concentration, time and use of phosphoric acid on the bond strength of feldspathic ceramics

Abstract The objective of this study was to evaluate the influence of hydrofluoric acid (HF) concentration, etching time, and application of phosphoric acid (PA) followed by neutralization with sodium bicarbonate on the bond strength between a feldspar ceramic and resin cement. Thus, 80 blocks (10 x 12 x 2 mm) of glass ceramic (VM - Vita Mark II - Vita Zahnfabrik) were made and randomly assigned to eight groups (n = 10) according to the factors: HF concentration (5 and 10%), etching time (60 and 120 s), and use of phosphoric acid (PA) (with and without). According to the experimental group, 37% PA (Condac, FGM) was applied after HF etching for 60s. Afterwards, samples were immersed in sodium bicarbonate for 1 min then in an ultrasonic bath in distilled water (5 min) for cleaning. After surface bonding treatment, cylinders (Ø = 2 mm; h = 2 mm) of dual resin cement (AllCem / FGM) were made in the center of each block. The samples were then stored in water (37ºC) for 90 days and submitted to the shear bond test (50 KgF, 1 mm/min). Failure analysis was performed by stereomicroscope and scanning electron microscopy. Data (MPa) were analyzed with 3-way ANOVA and Tukey's test. Only the factor "HF concentration" was significant (p = 0.02). Most failures were of cohesive in ceramic (40%) and mixed types (42.5%). The 10% HF resulted in higher shear bond strength value than the 5% HF. Surface cleaning with phosphoric acid followed by sodium bicarbonate and HF time (60 or 120 seconds) did not influence the resin bond strength to feldspar ceramic.

Efectividad de un gel remineralizante / Efectiveness of a remineralizing gel

Este es un estudio ex vivo donde se evalúa la variación en peso de veintiún piezas dentarias sometidas a un ácido dental de uso dental y, posteriormente, a la acción del gel remineralizante, objeto de este estudio, obteniéndose por diferencia de peso la cantidad de material mineral, que queda retenida en la pieza. La acción del ácido ortofosfórico ha producido una disminución del peso entre 28-30% de la pieza dentaria. Luego de la aplicación del gel remineralizante, ésta aumentó entre 15-18% del peso, considerando este aumento como significativo (p menor 0.05). Este aumento demuesta la acción remineralizante, ya que después del lavado este aumento se mantiene (AU)

This is an in vitro study where the variation in weight of twenty-one dental pieces subjected to a dental acid and subsequently to the action of the remineralizing gel is evaluated, obtaining by weight difference the amount of hydroxyapatite that is retained in the piece. The action of orthophosphoric acid causes a decrease in weight between 28-30% of the tooth. After the application of the remineralizing gel, it increases between 15-18% by weight considering this significant increase (p less 0.05) (AU)

Dental implant surfaces treated with phosphoric acid can modulate cytokine production by blood MN cells

Abstract: The study characterizes dental implant surfaces treated with phosphoric acid to assess the effects of acid treatment on blood cells and correlate them with cytokine levels. The implant surfaces examined were divided into untreated metal surface (US; n = 50), metal surface treated with phosphoric acid (ATS; n = 50) and cement surface (CS; n = 50) groups. The samples were characterized by scanning electron microscopy (SEM) and rheometry. The implants were incubated with human blood mononuclear cells for 24 h, with surface rinsing in the ATS treatment. Cell viability was determined by colorimetric methods and cytokines in the culture supernatant were quantified using flow cytometry. In the ATS group, the surface porosity and contact surface were increased and plaques were observed on the surface. The blood flow and viscosity curves were similar among the treatments, and the high cell viability rates indicate the biocompatibility of the materials used. An increase in the levels of IL-2, IL-4, IL-6, IL-10 and TNF-α was observed in the ATS and CS groups. There were positive correlations between IL-10 and IL-2 levels and between IL-10 and IL-4 levels in the culture supernatant of the ATS group. The results suggest that implant surface treatment with phosphoric acid activates the production of inflammatory cytokines. The increased cytokine levels can modulate the immune response, thereby improving biofunctional processes and promoting the success of dental implants.

Deproteinization of primary enamel with sodium hypochlorite before phosphoric acid etching

The aim of this study was to evaluate the deproteinization of primary enamel by analyzing etching pattern types, with and without the application of 5% NaOCl before acid etching with 37% H3PO4. Fifteen extracted human primary molars were randomly selected for the present in vitro study; 1mm x 1mm blocks were prepared and divided into two groups (n = 21). These groups were treated as follows: Group AAcid Etching with 37% H3PO4 gel for 15 s; Group B5% NaOCl for 60 s + Acid Etching with 37% H3PO4for 15 s. The specimens were prepared for scanning electron microscopy analysis. The images were evaluated for quality types I and II etching of the enamel surface using ImageJ software. Datasets were checked for normality by KolgomorvSmirnov test and the nonparametric unpaired MannWhitney test was applied. The mean surface area of type I and II etching pattern values was 1922.314 µm2for Group A and 3840.473 µm2Group B. We conclude that deproteinization with 5% NaOCl prior to acid etching can be used to increase the area of adhesion and the quality of the etching pattern (AU)

El objetivo del estudio fue evaluar la desproteinización del esmalte primario a través de los tipos de patrones de grabado, con y sin NaOCl 5% utilizado antes del grabado ácido con H3PO4 37%. Quince dientes primarios humanos extraídos se seleccionaron al azar para el presente estudio in vitro, se prepararon bloques de 1mm x 1 mm y se dividieron en dos grupos (n = 21). Estos grupos se trataron de la siguiente manera: Grupo A: Grabado ácido con H3PO4 37% en gel durante 15 segundos; Grupo B: NaOCl 5% durante 60 segundos + Grabado ácido con H3PO4 37% durante 15 segundos. Las muestras se prepararon para el análisis de microscopía electrónica de barrido. Las imágenes obtenidas se evaluaron principalmente por la calidad de los grabados tipo I y II de la superficie del esmalte primario, utilizando el software Image J. Los datos se analizaron en cuanto a su normalidad mediante la prueba de KolgomorvSmirnov, se utilizó pruebas no paramétricas: Prueba de MannWhitney no pareada. Como resultado, se encontró que el área de superficie media de los valores de patrón de grabado de tipo I y II para el Grupo A era 1922,314 µm2 y el Grupo B era 3840,473 µm2. Finalmente, llegamos a la conclusión de que se puede usar la desproteinización con NaOCl 5% antes del grabado ácido para aumentar el área de adhesión y la calidad del patrón de grabado (AU)

Effect of grape seed extract-containing phosphoric acid formulations on bonding to enamel and dentin

Abstract The aim was to evaluate the effect of 2% grape seed extract (GSE) containing phosphoric acid (PhA) on the bond strength to enamel and dentin. The control group was 37% PhA. The following three PhA formulations with 2% GSE and 20% ethanol were obtained: GSE5 = 5% PhA; GSE10 = 10% PhA; and GSE20 = 20% PhA. The enamel and dentin surfaces of molars were etched with the acid solutions, followed by Scotchbond Multi-Purpose adhesive and composite resin application. The tensile bond strength (TBS) test evaluated the bond to enamel after 24 h, and the microtensile bond strength (μTBS) test evaluated the bond to dentin after 24 h and 12-month water storage. Etched enamel and dentin were observed by scanning electron microscopy (SEM) and atomic force microscopy (AFM), respectively. The TBS data were submitted to one-way ANOVA, while µTBS data were submitted to two-way ANOVA and Tukey's test (α = 0.05). The TBS (MPa) to enamel did not significantly differ among the control (48.1 ± 15.7), GSE5 (46.1 ± 9.6), GSE10 (49.8 ± 13.6) and GSE20 (44.1 ± 11.9) groups (p = 0.537). The µTBS (MPa) to dentin of the control (28.4 ± 14.4) and GSE20 (24.1 ± 8.1) groups were significantly higher than those of the GSE5 (16.8 ± 7.4) and GSE10 (17.5 ± 6.6) groups at 24 h (p < 0.006). After 12-month storage, only GSE5 (21.0 ± 7.8) and GSE10 (17.6 ± 8.0) did not show significantly decreased μTBS (p > 0.145). SEM micrographs showed a shallower enamel etching pattern for GSE5. AFM images showed the formation of collagenous globular structures for GSE5 and GSE10. The different acid solutions did not influence the TBS to enamel, and the µTBS to dentin was stable over time when dentin was etched with GSE5 and GSE10.

Monobond Etch & Prime, primer acondicionador monocomponente que permite el grabado y la silanización de las superficies cerámicas en un solo paso / Monobond Etch & Prime, first single bottle conditioner for one step etching and silanization of ceramic surfaces

Las propiedades mecánicas de los materiales, han hecho que la técnica de cementación de las carillas sea tan cambiante y tan estudiada. Esta técnica ha sido modifi cada basados en investigaciones de diversos estudios clínicos. Lo cambiante de la técnica, no solamente es para el substrato del órgano dental, sino también para el material de la cerámica elegida. Esto confunde al clínico al estar modifi cando los procedimientos de cementación. En años recientes, como resultado del rápido progreso en la tecnología CAD/CAM, existe una gran cantidad de nuevas cerámicas y materiales híbridos en el mercado odontológico, esto se refl eja en benefi cios para los pacientes, al poder seleccionar distintas clases de materiales restaurativos. A su vez, las indicaciones se han expandido, esto hace que se incremente la difi cultad para los clínicos y ceramistas para mantenerse actualizados en la selección del material, lo que es más importante en los protocolos correctos de adhesión para el tratamiento en distintas superfi cies. En este artículo, se presenta el reporte de un caso clínico a nueve meses de seguimiento con la fi nalidad de evaluar la efi cacia del nuevo acondicionador monocomponente, para grabar y silanizar en un solo paso para Disilicato de Litio (DL), el nuevo Monobond Etch & Prime (MBEP) en el mismo frasco contiene la cantidad sufi ciente de ácido acondicionador y silano. Esto simplifi ca los procedimientos de adhesión, reduciendo no sólo el número de pasos, sino también el tiempo de trabajo (AU)

The mechanical properties of the materials have made the technique of veneer cementation, so changing and so studied. This technique has been modifi ed due to several clinical studies; especially in investigations that have been carried out in this respect. The changes made in the cementation technique, have not been only for the substrate of the dental organ, but also for the chosen ceramic material. This confuses the clinician by modifying the cementing procedures. In recent years, as a result of the rapid progress in CAD/CAM technology, a large number of new ceramics and hybrid materials, have been introduced into the dental market. This is refl ected in benefi t to the patients, because we have more opportunities to off er diff erent kinds of restorative materials; and at the same time, their indications have expanded, but this, increases the diffi culty for clinicians and ceramists to stay up-to-date on material selection, and the most important in the correct adhesion protocols for the treatment of diff erent surfaces. This paper presents, a nine months clinical case report to evaluate the effi cacy of the new monocomponent conditioner, for etching and silanizing in a single step the Lithium Disilicate (LD), the new Monobond Etch & Prime (MBEP), contains in the same bottle suffi cient amount of conditioning acid and silane. This simplifi es the adhesion procedures by reducing, not only the number of steps but also the working time (AU)

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Effect of different bonding protocols on degree of monomer conversion and bond strength between orthodontic brackets and enamel

Abstract The objective of the present study was to evaluate the effect of different surface treatments and polymerization protocols on the bond strength of brackets to enamel, and the degree of conversion of the bonding agents. 120 bovine crowns were embedded in acrylic resin blocks and sanded. Next, the blocks were randomly assigned into 12 groups. Metal brackets were bonded to enamel according to the "surface treatment" factor (A: Phosphoric Acid; ATxt: Phosphoric Acid + Transbond XT Primer®; Tse: Transbond Plus Self Etching Primer®; and SBU: Scotchbond Universal®) and "polymerization" factor (R20: Radii-Cal®/20 seconds; V20: Valo Cordless®/20 seconds; and V3: Valo Cordless®/3 seconds). All samples were stored for 6 months (water, 37ºC) and then subjected to a shear bond strength test (SBS). Bond failures were classified according to the Adhesive Remnant Index (ARI) and analyzed with the Kruskal-Wallis and Mann-Whitney tests (5%). Using the same factors, 120 resin discs were made to assess the degree of conversion (DC) of the monomer. Data from the SBS (MPa) and DC (%) were analyzed by analysis of variance (2 factors) and Tukey's test (5%). For the SBS, the factors "polymerization" (R20 = 8.1B; V20 = 13.2A; V3 = 5.2C, p = 0.0001) and "surface treatment" (A = 3.1C; ATxt = 13.6A; Tse = 12.3A; SBU = 6.3B, p = 0.0001) were statistically significant among groups. The highest adhesion value were found for the ATxt/V20 group (22.2A) and the lowest value for the A/R20 group (1.2E). Regarding ARI, score 2 was the most prevalent in groups A, ATxt, V20 and V3, while score 4 was the most prevalent in the Tse, SBU and R20 groups, with no significant difference between them (p = 1.0). Regarding DC, the factors "polymerization" (R20 = 66.6A; V20 = 58.4B; V3 = 45.1C, p = 0.0001) and "surface treatment" (A = 52B, ATxt = 59.7A, Tse = 51.4B, SBU = 63.8A, p = 0.0001) were statistically significant. Tse was more sensitive to the variations in polymerization protocols than the other surface treatments. Treatment A did not present suitable bond strength or degree of conversion.

Restauración postendodóncica: técnica con postes accesorios de fibra de vidrio / Postendodontic restoration: a technique with accessory fiber glass posts

Utilizar esta técnica implica grandes ventajas, ya que se reduce el volumen de cemento de resina, lo que disminuye la probabilidad de contracción, formación de burbujas y vacíos internos, los cuales representanáreas de debilidad en la restauración postendodóncica. Esta técnica ya ha sido propuesta y debidamente investigada por algunos autores. Se aplica en dientes con conductos radiculares amplios que han sido debilitados por restauraciones defi cientes, desmineralización de la dentina, fi ltraciones en la corona y poste radicular o simplementeconductos amplios en pacientes de corta edad. Tenemos la firme convicciónde que no podemos garantizar la permanencia de un órgano dentalen la cavidad oral, pero sí podemos intentar prolongar su permanenciaen el alvéolo el mayor tiempo posible. La técnica que se describe en elpresente artículo consiste en colocar postes accesorios de fi bra de vidriodespués del poste principal, logrando reducir el espesor de película delagente cementante a un grado ideal.

The use of this technique, shows significant advantages, as the thicknessof the resin cement is reduced, in consequence, the contraction ratio,bubble formation, and internal voids are reduced, which represent areasof weakness in the post-endodontic restoration, this technique has beenalready proposed and properly investigated by certain authors. Thisis applied on teeth with enlarged canals, that have been weakened byineffi cient restorations, dentin demineralization, bacterial fi ltration ofcrown and post, or simply wide canals in young patients. We have afi rm conviction, that we can´t guarantee the permanence of a dentalorgan in the oral cavity, but we can try to lengthen its permanency onthe alveolus as much as possible. The technique that´s described in thisarticle, consists in placing accessory posts of fi ber glass after placingthe main post, achieving a reduction of the cement fi lm thickness toideal thicknesses.

Molecular and morphological surface analysis: effect of filling pastes and cleaning agents on root dentin

Abstract The quality of the dentin root is the most important factor for restoration resin sealing and drives the outcome of endodontic treatment. Objective This study evaluated the effect of different filling pastes and cleaning agents on the root dentin of primary teeth using Fourier-transformed Raman spectroscopy (FT-Raman), micro energy-dispersive X-ray fluorescence (µ-EDXRF) and scanning electron microscopic (SEM) analysis. Material and Methods Eighty roots of primary teeth were endodontically prepared and distributed into 4 groups and filled according to the following filling pastes: Control-no filling (CP), Calen®+zinc oxide (CZ), Calcipex II® (CII), Vitapex® (V). After seven days, filling paste groups were distributed to 4 subgroups according to cleaning agents (n=5): Control-no cleaning (C), Ethanol (E), Tergenform® (T), 35% Phosphoric acid (PA). Then, the roots were sectioned and the dentin root sections were internally evaluated by FT-Raman, µ-EDXRF and SEM. Data was submitted to two-way ANOVA and Tukey tests (α=0.05). Results Regarding filling pastes, there was no significant difference in organic content. CP provided the lowest calcium values and, calcium/phosphoric ratio (Ca/P), and the highest phosphoric values. For cleaning agents there was no difference in organic content when compared to the C; however, T showed significantly higher calcium and Ca/P than PA. All groups showed similar results for phosphorus. The dentin smear layer was present after use of the cleaning agents, except PA. Conclusion The filling pastes changed the inorganic content, however they did not change the organic content. Cleaning agents did not alter the inorganic and organic content. PA cleaned and opened dentin tubules.

Comparación clínica de sistemas adhesivos con grabado selectivo en piezas primarias / A clinical comparison of bonding systems with selective etching in primary teeth

Objetivo: comparar el comportamiento clínico de restauraciones realizadas en piezas primarias con resinas compuestas utilizando un sistema adhesivo universal y un autoacondicionante de un solo frasco, ambos con grabado selectivo a esmalte. Métodos: Estudio experimental. Los datos obtenidos en 39 pacientes (5.47+1.67 años) con una o más piezas primarias vitales con lesiones amelodentinarias en 1 o 2 superficies restauradas con resinas compuestas utilizando Adper™ Easy One (AAG1 n= 66 restauraciones)fueron comparados con los obtenidos en 58 pacientes (5,76+ 1.58 años) utilizando Single Bond Universal 3M/ESPE (AAG2 n=81). En ambos grupos se realizó acondicionamiento del esmalte durante 30” con ácido fosfórico al 37 por ciento, previo a la aplicación de los sistemas adhesivos. Las 147 restauraciones fueron realizadas y evaluadas clínicamente por tres docentes calibrados (Kappa 0.96) en condiciones basales y en 2 controles posteriores (Ryge modificado). Se calcularon porcentajes y promedios de los porcentajes de fracasos de las restauraciones analizando los resultados a través del Test Normal para diferencia de medias. El proyecto fue aprobado por el Comité de Ética de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA) (120809-5). Resultados: El porcentaje medio de fracasos antes del primer control resultó 7.21 por ciento y 6.25 por ciento (p=0.85) y antes del segundo control 13.89 por ciento y 9.65 por ciento (p=0,50) en AAG1 yAAG2, respectivamente. Conclusión: El comportamiento clínico de las restauraciones realizadas con resinas compuestas utilizando un sistema adhesivo universal y un auto-acondicionante de un solo frasco, ambos con grabado selectivo a esmalte, reveló resultados similaresdurante el período bajo estudio.

Objective: to compare clinical performance of composite restorations placed in primary dentition using an universal adhesive and an onebottleself-etching system, both of them with selective enamel etching. Method: Experimental Design. Data obtained from 39 patients(5.47+1.67 years.) with one or more small and moderate carious lesions in vital deciduous teeth restored with resin composites usingAdper™ Easy One (AAG1 n= 66), were compared with the obtained in 58 patients (5,76+ 1.58 years) using Universal Single Bond3M/ESPE (AAG2 n=81). In both groups enamel was etched with phosphoric acid 37% during 30” prior to the application ofadhesive systems. Composite resin restorations (N=147) were placed and assessed by 3 calibrated operators (Kappa: 0.96) at baselineand after two appointments (Modified Ryge Criteria). Percentages and average of percentages of failures of restorations were calculated.Statistical analysis: Two sample normal test for the difference in means. Project approved by FOUBA Ethics Committee. (120809-5).Results: The average percentage of failures before the first control was 7.21 % and 6.25 % (p=0.85) and before the second control was13.89 % and 9.65% (p=0.50) in AAG1 and AAG2, respectively. Conclusions: In this work clinical performance of compositerestorations using two single components adhesive systems with previous enamel acid conditioning showed similar results during the periodunder study.

Effect of green tea extract on bonding durability of an etch-and-rinse adhesive system to caries-affected dentin

ABSTRACT Objective Green tea extract has been advocated as a matrix metalloproteinase (MMP) inhibitor; however, its effect on bond durability to caries-affected dentin has never been reported. Thus, the aim of this in vitro study was to evaluate the effect of two MMP inhibitors (2% chlorhexidine and 2% green tea extract), applied after acid etching, on bond durability of an etch-and-rinse adhesive system to caries-affected dentin. Material and Methods Occlusal enamel was removed from third molars to expose the dentin surface, and the molars were submitted to a caries induction protocol for 15 days. After removal of infected dentin, specimens were conditioned with 37% phosphoric acid (15 seconds) and randomly divided into three groups, according to the type of dentin pretreatment (n=10): NT: no treatment; GT: 2% green tea extract; CLX: 2% chlorhexidine. The etch-and-rinse adhesive system (Adper™ Single Bond 2, 3M ESPE, St. Paul, MN, USA) was applied according to the manufacturer's instructions, and composite resin restorations were built on the dentin. After 24 hours, at 37°C, the resin-tooth blocks were sectioned perpendicularly to the adhesive interface in the form of sticks (0.8 mm2 of adhesive area) and randomly subdivided into two groups according to when they were to be submitted to microtensile bond strength (μTBS) testing: immediately or 6 months after storage in distilled water. Data were reported in MPa and submitted to two-way ANOVA for completely randomized blocks, followed by Tukey’s test (α=0.05). Results After 24 hours, there was no significant difference in the μTBS of the groups. After 6 months, the GT group had significantly higher μTBS values. Conclusion It was concluded that the application of 2% green tea extract was able to increase bond durability of the etch-and-rinse system to dentin. Neither the application of chlorhexidine nor non-treatment (NT - control) had any effect on bond strength after water storage.