Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses / Influência da composição do cimento endodôntico na dor pós-operatória de dentes permanentes tratados endodonticamente: uma revisão sistemática e meta-análise

Postoperative pain is a frequent complication after root canal treatment. Its management is an important aspect of endodontic practice. Some treatment-related parameters were associated with the development of postoperative pain, including the sealer composition and extrusion. Objective: This systematic review aimed to answer the clinical question: Do root canal sealers composition influence postoperative pain after endodontic treatment of permanent teeth? Material and Methods: Electronic searches were conducted in PubMed, Scopus, Web of Science, Cochrane, LILACS, and grey literature databases until September 2021. The studies were qualitatively assessed using the RoB2 tool (Cochrane) and the certainty of evidence (GRADE). Sensitivity and pooled estimates were calculated using a random-effects model. Twelve articles were included. Results: The risk of bias was high in one study, low in nine, and two had some concerns. Qualitative analyses showed no influence of sealer extrusion on postoperative pain. Meta-analyses showed no significant difference in postoperative pain with moderate to very low levels of certainty between AH Plus and calcium silicate-based sealers, in a 95% confidence interval. Analysis between AH Plus, Zinc Oxide and Eugenol (ZOE), and calcium hydroxide (Ca(OH)2)-based sealers were not performed due to heterogeneity and lack of data. Conclusion: Literature showed contrasting results in postoperative pain between AH Plus and ZOE-based sealers, with low to moderate certainty of evidence. Regarding Ca(OH)2-based sealers, a single study with a low level of certainty concluded that AH Plus presented less postoperative pain than Apexit Plus. Therefore, further studies are needed to assess the influence of these sealers on postoperative pain. Evidence showed no difference in postoperative pain between AH Plus and calcium silicate-based sealers. Sealer extrusion is a variable that requires further studies (AU)

A dor pós-operatória é uma complicação frequente após o tratamento endodôntico. O seu manejo é um importante aspecto na prática endodôntica. Algumas variáveis relacionados ao tratamento foram associados com o desenvolvimento da dor pós-operatória, incluindo a composição e extrusão dos cimentos endodônticos. Objetivo: Esta revisão sistemática objetivou responder a seguinte pergunta clínica: A composição dos cimentos endodônticos podem influenciar a dor pós-operatória de dentes permanentes tratados endodonticamente?Material e Métodos: Buscas eletrônicas foram realizadas nas bases de dados no PubMed, Scopus, Web of Science, Cochrane, LILACS, e literatura cinzenta até setembro de 2021. Os estudos foram avaliados qualitativamente usando a ferramenta RoB2 (Cochrane) e a certeza de evidência (GRADE). A sensibilidade e as estimativas agrupadas foram calculadas usando um modelo de efeitos aleatórios. Doze artigos foram incluídos. Resultados: O risco de viés foi alto em um estudo, baixo em nove e dois tiveram algumas preocupações. A análise qualitativa mostrou que não há influência da extrusão do cimento na dor pós-operatória. A meta-análise mostrou que não houve diferença estatisticamente significante na dor pós-operatória entre o AH Plus e os cimentos a base de silicato de cálcio com moderada a muito baixa certeza de evdência. Análises entre os cimentos AH Plus, óxido de zinco e eugenol (OZE) e hidróxido de cálcio não foram realizados devido a heterogeneidade e falta de dados. Conclusão:A literatura sugere resultados contrastantes com relação a dor pós-operatória e entre os cimentos AH Plus e OZE, com baixa a moderada certeza de evidência. Já os cimentos a base de hidróxido de cálcio, um único estudo com baixa certeza de evidência concluiu que o AH Plus apresentou menos dor pós tratamento endodôntico do que o Apexit Plus. Portanto,mais estudos são necessários para avaliar a influência desses tipos de cimentos na dor pós-operatória. Com relação ao cimento AH Plus e os cimentos a base de silicato de cálcio não houve diferença estatística entre eles e a dor. A extrusão dos cimentos é uma variável que requer mais estudos (AU)

Effect of sodium hypochlorite and calcium hypochlorite on the apical sealing ability of endodontic sealers

Aim: This study aimed to compare the influence of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2 ] on the apical sealing capacity of AH Plus (Dentsply Maillefer) and Bio-C Sealer (Angelus) endodontic sealers. Methods: Sixty permanent human lower incisors were randomly allocated (http://www.randomized.org), according to the irrigant used, into three groups (n=20): 0.9% sodium chloride (NaCl/Control); 2.5% NaOCl; and 2.5% Ca(OCl)2 . The root canal was prepared with rotary files under 10 mL of the solution corresponding to the experimental group. Each group was subdivided into two (n=10) according to the sealer used for filling: AH Plus (Dentsply Maillefer) or Bio-C Sealer (Angelus). Then, all samples were immersed in black India ink for one week. After the storage period, the roots were then grooved longitudinally and split, and the ink penetration was measured from the apical part to the coronal part of the root canal into which the ink penetrated using a stereomicroscope. Data were analyzed by one-way ANOVA and Tukey's post-hoc tests. Results: There was no statistical difference in ink penetration between the different endodontic sealers tested for the same irrigating solution (p > 0.05). However, when the Bio-C Sealer (Angelus) was used, the group treated with 2.5% Ca(OCl)2 was associated with lower values of apical leakage, compared to 2.5% NaOCl (p < 0.05). For the AH Plus sealer (Dentsply Maillefer), there was no difference between the irrigants (p > 0.05). Conclusions: Associating Ca(OCl)2 irrigant with Bio-C Sealer (Angelus) seems to be a good option to reduce apical leakage

Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement / Descoloração dentária ex vivo induzida por materiais à base de silicato de cálcio: análise de um cimento experimental

Objective: This study aimed to investigate of bioactive materials with specific properties, particularly highly plastic bioceramic cements. These materials are being studied extensively due to their potential to maintain pulp vitality and promote tissue regeneration. Material and Methods: Tooth discoloration induced by an experimental tricalcium silicate-based cement (EC) was evaluated and compared with that of Biodentine (BD) and white MTA-Angelus (MTA). Cavities were prepared on the lingual surfaces of thirty-two blocks of healthy bovine incisors. The blocks were chemically cleaned and then subjected to an initial color evaluation (CIELab values) using a spectrophotometer and randomly divided into three experimental groups (n=10); two additional blocks served as controls. After manipulation, the cements were placed in the cavities, which were subsequently restored with composite restorations. After another color measurement (baseline), they were immersed in bottles of distilled water; they were stored at 37 °C and 100% humidity for the entire test period. The color change (ΔE) was measured after 14, 30, 120 and 150 days. ANOVA and Tukey tests showed significant differences after 14 days (EC vs. MTA), 30 days (EC vs. BD) and 120/150 days (EC vs. BD/MTA) (p < 0.05). Results: All tested materials induced ΔE changes, with the EC group showing the least change at the end of the experiment (ΔE=4.08). Conclusion: EC induced less color change over a 5-month period and thus showed color stability over the entire period, whereas BD and MTA showed progressive discoloration. (AU)

Objetivo: O objetivo deste estudo foi investigar materiais bioativos com propriedades específicas, particularmente cimentos biocerâmicos altamente plásticos. Esses materiais estão sendo amplamente estudados devido ao seu potencial para manter a vitalidade da polpa e promover a regeneração dos tecidos. Material e Métodos: A descoloração dentária induzida por um cimento experimental à base de silicato tricálcico (CE) foi avaliada e comparada com a do Biodentine (BD) e do MTA-Angelus branco (MTA). Foram preparadas cavidades nas superfícies linguais de trinta e dois blocos de incisivos bovinos saudáveis. Os blocos foram quimicamente limpos e, em seguida, submetidos a uma avaliação inicial de cor (valores CIELab) usando um espectrofotômetro e divididos aleatoriamente em três grupos experimentais (n=10); dois blocos adicionais serviram como controles. Após a manipulação, os cimentos foram colocados nas cavidades, que foram posteriormente restauradas com compósito. Após outra medição de cor (valor de referência), eles foram imersos em frascos de água destilada; oram armazenados a 37 °C e 100% de umidade durante todo o período de teste. A alteração de cor (ΔE) foi medida após 14, 30, 120 e 150 dias. Os testes ANOVA e Tukey mostraram diferenças significativas após 14 dias (CE vs. MTA), 30 dias (CE vs. BD) e 120/150 dias (CE vs. BD/MTA) (p < 0,05). Resultados: Todos os materiais testados induziram alterações de ΔE, sendo que o grupo EC apresentou a menor alteração no final do experimento (ΔE=4,08). Conclusão: O EC induziu menos alterações de cor em um período de 5 meses e, portanto, apresentou estabilidade de cor durante todo o período, enquanto o BD e o MTA apresentaram descoloração progressiva.(AU)

Is Cavity Lining Really Necessary After Selective Caries Removal in Primary Teeth?

ABSTRACT Objective: To evaluate the clinical and radiographic response of pulp-dentin complex after selective caries removal with or without pulp lining in primary teeth. Material and Methods: Twenty-four primary molars with deep occlusal caries lesions and without pulpal alterations were selected from children, both genders, aged between 5 and 9 years old. After selective caries removal, the teeth were divided into three groups: without cavity liner (Group I), calcium hydroxide cement - CH (Group II), and Mineral trioxide aggregate - MTA (Group III). The final restoration was performed with resin-modified glass ionomer cement. Clinical and radiographic assessments were conducted at 6-month follow-up. The Kappa test determined intraexaminer reliability. Fisher's exact test evaluated intergroup comparisons (p<0.05). Results: All teeth showed clinical and radiographic success at the 6-month follow-up without statistically significant differences (p>0.05). Conclusion: Selective caries removal without cavity lining was acceptable for deep caries lesions in primary teeth.

The Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate Containing Bonding Agents on Dentin Shear Bond Strength and Remineralization Potential: An in Vitro Study

ABSTRACT Objective: To assess the effect of Casein Phosphopeptide-Amorphous Calcium Phosphate (ACP) containing bonding agents on dentin shear bond strength and remineralization potential. Material and Methods: This in vitro study evaluated 45 extracted human premolars. The teeth were decoronated, and the tooth crown was split into buccal and lingual halves. The specimens were then flat-grounded by a 180-grit abrasive. The specimens were then randomized into three groups (n=15). Adper Scotchbond Multi-Purpose (SBMP) primer and adhesive were used for bonding in the control group. ACP in 10wt% and 20wt% concentrations was added to SBMP adhesive and used in groups 2 and 3, respectively. After the application of primer and adhesive and light-curing them for 10 s, a transparent silicon cylinder was placed on a dentin surface and cured for 10 s; then, the cylinder was filled with composite resin and was cured for the 40s from each side. The specimens underwent 3000 thermal cycles, and a universal testing machine measured the SBS. To assess the remineralization quality, a total of 6 dentin samples (2 specimens for group) were prepared and underwent X-ray diffraction, attenuated total reflection Fourier-transform infrared spectroscopy, and scanning electron microscopy-energy dispersive X-ray analysis. One-way analysis of variance was used to analyze the data. The level of p<0.05 was considered significant. Results: No significant difference in dentin shear bond strength was noted between the groups (p>0.05) - the addition of ACP to SBMP adhesive enhanced dentin remineralization. Increasing the ACP concentration from 10% to 20% increased the formation of hydroxyapatite. Conclusion: Adding amorphous calcium phosphate confers remineralizing property to SBMP adhesive without compromising its shear bond strength to dentin.

Tratamento de perfuração iatrogênica de furca com técnica de inserção modificada do mta: relato de caso / Iatrogenic furca perforation treatment with modified mta insertion technique: case report

As perfurações endodônticas podem ocorrer patologicamente por lesão cariosa profunda, bem como durante o acesso ou na instrumentação dos canais radiculares, que em sua grande maioria estão relacionadas com a negligência ou desconhecimento das variações anatômicas internas do dente. O presente trabalho descreve um caso clínico de perfuração de furca, onde o tratamento inicial foi baseado na descontaminação e selamento da comunicação com uma técnica de inserção modificada do MTA. Após a anestesia, foi realizado o isolamento absoluto e remoção de tecido infectado presente na câmara pulpar. Feita a limpeza da perfuração utilizando soro fisiológico e modelagem do canal com o instrumento reciprocante, a obturação foi concebida com cone de guta percha e cimento biocerâmico. Em seguida, o MTA foi manipulado, de acordo com recomendações do fabricante usando água destilada na proporção 1:1 e inserido na canaleta de uma régua endodôntica com a espátula de inserção nº1. O material foi removido da canaleta e inserido na perfuração, finalizando o vedamento da mesma. Portanto, concluiu-se que o selamento da perfuração apresentou um resultado satisfatório, tanto clínico como radiográfico, destacado pela proservação de 5 meses, evidenciando discreta formação de trabeculado ósseo na região de furca(AU)

Endodontic perforations can occur pathologically due to a deep carious lesion, as well as during access or instrumentation of root canals, which are mostly related to negligence or ignorance of the internal anatomical variations of the tooth. The present work describes a clinical case of furcation perforation, where the initial treatment was based on decontamination and sealing of the communication with a modified MTA insertion technique. After anesthesia, absolute isolation and removal of infected tissue present in the pulp chamber was performed. After cleaning the perforation using saline solution and modeling the canal with the reciprocating instrument, the filling was designed with a gutta-percha cone and bioceramic cement. Then, the MTA was manipulated, according to the manufacturer's recommendations, using distilled water in a 1:1 ratio and inserted into the groove of an endodontic ruler with the #1 insertion spatula. The material was removed from the channel and inserted into the perforation, finishing its sealing. Therefore, it was concluded that the sealing of the perforation presented a satisfactory result, both clinical and radiographic, highlighted by the 5-month followup, evidencing a slight formation of bone trabeculate in the furcation region(AU)

Bond strength of composite resin/universal adhesive to dentin submitted to radiotherapy / Fuerza de unión de resina compuesta/adhesivo universal a dentina sometida a radioterapia

Aim: To evaluate the bond strength of a universal adhesive system to dentin submitted to radiotherapy. Materials and Methods: Sixty extracted human teeth were divided into two groups (n = 30): without radiotherapy (control); with radiotherapy, according to the adhesive protocol (n=15): ER-etch-and-rinse (acid + Single Bond Uni-versal); SE-self-etch (Single Bond Universal). The analyzes were shear bond strength (SBS) (n=10), failure pattern (n=10) and scanning electron microscopy (n=5). Data was analyzed by a two-way ANOVA (α =0.05). Results: The radiotherapy decreased SBS of the restorative material to dentin (p<0.0001). The ER protocol provided lower bond strength values (p<0.001). The predominant type of fracture without radiotherapy was mixed (SE), cohesive to the material (ER). Both protocols presented adhesive failures with radiotherapy. Teeth had a hybrid layer and long resin tags (without radiotherapy) and few tags (with radiotherapy). Conclusions: The SE adhesive mode favors the shear bond strength of resin to dentin in teeth submitted to radiotherapy.

Objetivo: Evaluar la fuerza de adhesión de un sistema adhesivo universal a la dentina sometida a radioterapia. Materiales y Métodos: Sesenta dientes humanos extraídos se dividieron en dos grupos (n = 30): sin radioterapia (control); con radioterapia, según protocolo adhesivo (n=15): ER-grabado y enjuague (ácido + Single Bond Universal); autograbado SE (Single Bond Universal). Los análisis ejecutados fueron resistencia al cizallamiento (SBS) (n=10), patrón de falla (n=10) y microscopía electrónica de barrido (n=5). Los datos se sometieron al test de ANOVA de dos vías (α =0,05). Resultados: La radioterapia disminuyó la SBS del material restaurador a la dentina (p<0,0001). El protocolo ER proporcionó valores de fuerza de unión más bajos (p<0,001). El tipo de fractura predominante sin radioterapia fue mixta (SE), cohesiva al material (ER). Ambos protocolos presentaron fallas adhesivas con radioterapia. Los dientes tenían una capa híbrida y colas de resina largas (sin radioterapia) o pocas colas de resina (con radioterapia). Conclusión: El modo adhesivo SE favorece la resistencia al corte de la resina a la dentina en dientes sometidos a radioterapia.

Is the adhesive or mechanical behavior of glass ceramics influenced by the adhesive layer application after etching and silanization? A literature review

Aim: This review investigated the effect of applying an adhesive after surface treatment of glass-ceramics on the bonding, mechanical or clinical behavior. Methods: Studies comparing the adhesive, mechanical or clinical behavior of glass-ceramics, with or without adhesive application after surface treatment, were included. Searches were performed in PubMed, Scopus, and Web of Sciences databases (January 2022), resulting in 15 included studies. Results: Regarding the evaluated outcomes, 13 studies assessed bond strength, 2 studies assessed biaxial flexural strength and 1 study assessed fatigue failure load, while no study evaluating clinical outcomes was included. It was possible to observe that the adhesive application after ceramic surface treatment was unfavorable or did not influence the evaluated outcomes. Conclusion: Most of the evidence available in the literature shows that the adhesive application after surface treatment does not improve the adhesive and mechanical behavior of glass-ceramics

Análise de metodologias para avaliação da solubilidade do cimento à base de silicato de cálcio Bio-C Sealer / Analysis of methodologies for evaluating the solubility of calcium silicate-based sealer Bio-C Sealer

Introdução: Cimentos endodônticos à base de silicato de cálcio demonstram maior solubilidade em água destilada. Emprego de metodologias alternativas pode auxiliar em melhor compreensão sobre a solubilidade desses materiais. Objetivo: Avaliar o efeito da solução de imersão e do tipo de modelo experimental na solubilidade de cimento pronto para uso Bio-C Sealer. Material e método: Modelos circulares de polietileno ou dentina bovina (n = 16) foram confeccionados. Após inserção do cimento, os espécimes foram mantidos em estufa a 37 °C por 48 horas. Posteriormente, as amostras foram pesadas em balança de precisão para determinação da massa inicial. Na sequência, os espécimes foram imersos em 7,5 mL de água destilada (pH 6,5) ou PBS (pH 7,0) (n = 8) por 28 dias. Após isso, as amostras foram removidas das soluções e pesadas a cada 24 horas até a estabilização da massa final (0,001g). Corpos de prova confeccionados com Bio-C Sealer foram empregados como controle. A solubilidade foi avaliada de acordo com a diferença entre a massa inicial e final em porcentagem. Teste ANOVA Two-Way e teste post-hoc de Tukey foram realizados (α = 0,05). Resultado: Imersão em água destilada proporcionou maior solubilidade em comparação com PBS, independentemente do modelo experimental (p < 0,05). Corpos de prova apresentaram maior solubilidade, seguidos dos modelos de polietileno e dentina imersos em água destilada (p < 0,05). Não houve diferença entre os modelos experimentais imersos em PBS (p > 0,05). Conclusão: Bio-C Sealer apresenta solubilidade significativamente maior em água destilada do que em PBS em todas condições. Modelo experimental empregando dentina bovina e PBS como solução de imersão demonstra diminuir a perda de massa de Bio-C Sealer e pode ser uma alternativa valiosa para avaliar a solubilidade de cimentos biocerâmicos

Introduction: Calcium silicate-based sealers demonstrate greater solubility in distilled water. The use of alternative methodologies can help at better understanding the solubility of these materials. Objective: To evaluate the effect of the immersion solution and the type of experimental model on the solubility of readyto-use Bio-C Sealer. Material and method: Circular models of polyethylene or bovine dentin (n = 16) were made. After insertion of the sealer, the specimens were kept in an oven at 37°C and 95% humidity for 48h. Subsequently, the samples were weighed on a precision balance to determine the initial mass. Next, the specimens were immersed in 7.5 mL of distilled water (pH 6.5) or PBS (pH 7.0) (n = 8) for 28 days. After that, the samples were removed from the solutions and weighed every 24 hours until the final mass stabilized (0.001g). Test specimens made with Bio-C Sealer were used as a control. Solubility was evaluated according to the difference between the initial and final mass in percentage. Two-Way ANOVA test and Tukey post-hoc tests were performed (α=0.05). Result: Immersion in distilled water provided greater solubility compared to PBS regardless of the experimental model (p<0.05). The test specimens showed greater solubility, followed by polyethylene and dentin models immersed in distilled water (p<0.05). There was no difference between the experimental models immersed in PBS (p>0.05). Conclusion: Bio-C Sealer presents significantly greater solubility in distilled water than in PBS under all conditions. Experimental model using bovine dentin and PBS as an immersion solution demonstrates reduction in the mass loss of Bio-C Sealer and can be a valuable alternative for evaluating the solubility of bioceramic sealers

Evaluation of short- and long-term bond strength of zirconia after different surface treatments / Avaliação da resistência de adesão de curto e longo prazo de zircônia após diferentes tratamentos de superfície

Objective: The aim of the study was to evaluate the short and long-term effects of different surface treatments on the bond strengths of zirconia. Material and Methods: 225 blocks of sintered zirconia samples (4 x 4 x 3 mm) were divided into five groups and subjected to different surface treatments: control group (without surface treatment), alumina group (sandblasting [25-µm-aluminum-oxide]), alumina+Ambar Universal-APS (AU) group, CoJet group (silica-coated [30-µm silica-modified aluminum particles]), and CoJet+AU group. Subsequently, zirconia samples were cemented against resin samples (total dimensions: 8x8x6mm) and assigned to three storage conditions: dry, humid (artificial saliva at 37°C for 30-days) or thermocycling [100.000-cycles] (n=15 per group). The microtensile bond strength (µTBS) was determined using a universal testing machine. The failure modes were observed and analyzed using a stereomicroscope. Normality tests, descriptive statistics, and two-way ANOVA, followed by post-hoc comparisons, were performed to evaluate the effect of surface treatments and storage conditions on µTBS (α=0.05). Results: µTBS was influenced by surface treatment in the short and long-term (P<0.0001). The highest values were found in CoJet+AU in dry (33.51 ±2.48 MPa), humid (32.87 ±2.68 MPa) and thermocycling (21.37 ±1.68 MPa) storage conditions compared with others. Interestingly, no significant differences in µTBS were found among alum +AU and CoJet alone under any of the three storage conditions. Adhesive failure increased in all groups after thermocycling, but CoJet+AU had the lowest values of adhesive failure compared with others. Conclusion: The combination of CoJet and Ambar universal as a surface treatment for zirconia specimens provides significantly higher short and long-term bond strengths of adhesive cementation (AU)

Objetivo: O objetivo do estudo foi avaliar os efeitos de curto e longo prazo de diferentes tratamentos de superfície na resistência de adesão da zircônia. Material e Métodos: 225 blocos de amostras de zircônia sinterizada (4 x 4 x 3 mm) foram divididos em cinco grupos e submetidos a diferentes tratamentos de superfície: grupo controle (sem tratamento de superfície), grupo de alumina (jateamento de 25 µm de óxido de alumínio), grupo alumina+Ambar Universal-APS (AU), grupo CoJet (partículas de alumínio modificadas por sílica de 30 µm), e grupo CoJet+AU. Posteriormente, as amostras de zircônia foram cimentadas em amostras de resina (dimensões totais: 8x8x6mm) e designadas para três condições de armazenamento: seco, úmido (saliva artificial a 37°C por 30 dias) ou ciclagem térmica (100.000 ciclos) (n=15 por grupo). A resistência de adesão de microtensão (µTBS) foi determinada usando uma máquina de teste universal. Os modos de falha foram observados e analisados usando um estereomicroscópio. Testes de normalidade, estatísticas descritivas e ANOVA de duas vias, seguidas de comparações pos-hoc, foram realizados para avaliar o efeito dos tratamentos de superfície e das condições de armazenamento na µTBS (α=0.05). Resultados: A µTBS foi influenciada pelo tratamento de superfície a curto e longo prazo (P<0.0001). Os valores mais altos foram encontrados em CoJet+AU nas condições de armazenamento a seco (33.51 ±2.48 MPa), úmido (32.87 ±2.68 MPa) e ciclagem térmica (21.37 ±1.68 MPa) em comparação com os outros. Curiosamente, não foram encontradas diferenças significativas na µTBS entre alum +AU e CoJet sozinho em nenhuma das três condições de armazenamento. A falha adesiva aumentou em todos os grupos após a ciclagem térmica, mas CoJet+AU teve os valores mais baixos de falha adesiva em comparação com os outros. Conclusão: A combinação de CoJet e Ambar Universal como tratamento de superfície para espécimes de zircônia proporciona resistências de adesão significativamente mais altas a curto e longo prazo para cimentação adesiva. (AU)

The effects of TiO2 nanotubes on bond strength and radiopacity of a self-adhesive resin cement in self-curing mode / Os efeitos de nanotubos de TiO2 na resistência de união e radiopacidade de um cimento resinoso auto-adesivo no modo auto-polimerizável

Objective: The aim of this in vitro study w as t o analyze the influence of the titanium dioxide nanotubes i n a self-cure mode polymerization of a dual resin luting agent through push out bond strength and radiopacity tests. Material and Methods: After mixed with a commercial du al self-adhesive resin cement, three concentrations o f tit anium dioxide nanotubes (0.3, 0.6, and 0.9% by weight) we re analyzed in self-curing mode. T he bond strength to bovine root dentin and fi berglass posts was assessed with the push out bond str ength t est and was evaluated in three thirds (cervical, middle and apical) (n=10), followed by failure mode analysis (SEM), and the ISO standard 9917-2 was followed for radiopacity test (n=10). Data were statistically analyzed by one-way ANOVA test, followed by Tukey's test (α=0.05). Results: Reinforced self-adhesive resin cement with 0.6% titanium dioxide nanotubes showed significant difference compared to the control gr oup for push out test (p=0.00158). The modified groups did not s how significant difference among thirds (p=0.782). Radiopacity sh owed higher value for group w ith 0.9% titanium dioxide nanotubes in comparison w ith control group (p<0.001). Conclusion: The addition of titanium dioxide nanotubes to a self-adhesive resin cement increased the bond strength to dentin and radiopacity values in the self-cure polymerization mode (AU)

Objetivo: O objetivo deste estudo in vitro foi analisar a influência de nanotubos de dióxido de titânio na polimerização química de um agente cimentante resinoso dual através de testes de resistência à união e radiopacidade. Material e Métodos: Após misturado com um cimento resinoso auto-adesivo comercial, três concentrações de nanotubos de dióxido de titânio (0,3, 0,6 e 0,9% em peso) foram analisadas. A resistência da união para a dentina da raiz bovina e os pinos de fibra de vidro foi avaliada pelo teste de push-out e avaliada em três terços (cervical, médio e apical) (n = 10), seguido pelo análise de modo de falha (MEV) e a norma ISO 9917-2 foi seguido para teste de radiopacidade (n = 10). Os dados foram analisados estatisticamente pelo teste ANOVA um fator seguido do teste de Tukey (α = 0,05). Resultados: O cimento resinoso auto-adesivo reforçado com nanotubos de dióxido de titânio a 0,6% mostrou diferença significativa em comparação com o grupo controle para teste de push-out (p=0,00158). Os grupos modificados não mostraram diferença significativa entre os terços (p=0,782). A radiopacidade mostrou maior valor para o grupo com nanotubos de dióxido de titânio 0,9% em comparação com o grupo controle (p<0,001). Conclusão: A adição de nanotubos de dióxido de titânio a um cimento resinoso auto-adesivo aumentou a os valores de resistência de união à dentina e radiopacidade no modo de polimerização química do agente cimentante (AU)

Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Clinical follow-up at 18 months of two bulk fill occlusal composite resins: a double-blind randomized clinical study / Seguimiento clínico a 18 meses de dos resinas compuestas oclusales bulk fill: estudio clínico aleatorio doble ciego

Objetive: To compare the clinical behavior of two types of Bulk Fill composite resins and a nanohybrid resin at 18 months in occlusal restorations. Material and Methods: Three occlusal restorations were performed in each one of the 55 participants. They were randomly distributed into three groups, TN: Tetric-N-Ceram Bulk-Fill, FK: Filtek Bulk-Fill, and Z350: Filtek Z350XT. Adhesive techniques and restorative procedures were performed according to the manufacturer's instructions for each restorative material used. In TN and FK an increment of 4mm was applied, and in Z350 increments of ≤2mm depth were applied. Two calibrated operators evaluated the restorations at baseline and at 18 months using the FDI World Dental Federations system (1: excellent, 2: good, 3: satisfactory, 4: unsatisfactory, 5: poor) for clinical marginal staining (MS) properties, fracture-retention (FR), superficial texture (ST), marginal integrity (MI), postoperative sensitivity (PS) and caries (C). Kruskal-Wallis and Wilcoxon were used to compare the 3 groups at 18 months (5% significance). Results: 38 patients with a total of 114 restorations were assessed, being evaluated with excellent clinical behavior; MI, 78.9% in Z350, 89.51% in TN and 81.6% in FK; ST 73.5% in Z350, 86.8% in TN, and 84.2% in FK; MS 84.2% in Z350, 84.2% in TN, and 91.2% in FK; PS 100% in Z350 and 97.3% in TN and FK; in C and FR, 100% in the 3 groups. There were no significant differences between the three groups (p>0.05). Conclusion: The three resins studied presented a good clinical performance at 18 months without showing significant differences in the clinical properties evaluated.

Objetivo: Comparar el comportamiento clínico a 18 meses en restauraciones oclusales entre dos tipos de resinas compuestas Bulk Fill y una resina nanohíbrida. Material y Métodos: En 55 participantes se realizaron 3 restauraciones oclusales en cada paciente, distribuidas aleatoriamente en 3 grupos, TN: Tetric-N-Ceram Bulk-Fill, FK: Filtek Bulk-Fill y Z350: Filtek Z350XT. Las técnicas adhesivas y procedimientos restauradores fueron realizados según las instrucciones de los fabricantes de cada material restaurador utilizado. En TN y FK se aplicó un incremento de 4mm y en Z350 se aplicó incrementos ≤ 2 mm de profundidad. Dos operadores calibrados evaluaron las restauraciones al baseline y a los 18 meses mediante el sistema FDI World Dental Federations (1: excelente, 2: aceptable, 3: suficiente, 4: insatisfactorio, 5: inaceptable) en las propiedades clínicas de tinción marginal (TM), fractura-retención (FR), textura superficial (TS), integridad marginal (IM), sensibilidad postoperatoria (SP) y caries (C). Se utilizó Kruskal-Wallis y Wilcoxon para la comparación de los 3 grupos a 18 meses (significancia de 5%). Resultados: Se controlaron 38 pacientes con un total de 114 restauraciones, siendo evaluados con comportamiento clínico excelente; IM, 78.9% en Z350, 89.51% en TN y 81.6% en FK; TS 73.5%, en Z350, 86.8% en TN y 84.2% en FK; TM, 84.2% en Z350, 84.2% en TN y 91.2% en FK; SP 100% en Z350 y 97,3% en TN y FK; en C y FR 100% en los 3 grupos. No hubo diferencias significativas entre los 3 grupos (p>0,05). Conclusión: Las 3 resinas estudiadas presentaron un buen desempeño clínico a 18 meses sin mostrar diferencias significativas en las propiedades clínicas evaluadas.

Effect of alternative self-etch applications on dentin bond strength of "No Wait Concept" universal adhesives / Efecto de distintas alternativas de aplicación de los adhesivos universales con concepto de "no espera" en la resistencia adhesiva a la dentina

Abstract This study evaluated the effects of alternative self-etch application modes on resin-dentin microtensile bond strength (µTBS) of three commercially available "no wait" concept universal adhesives. In this study extracted impacted non-carious human third molars were used. The flat surfaces were prepared in mid-coronal dentin and prepared with a 600-grit SiC paper. The three universal adhesives that were used are as follows: Clearfil Universal Bond Quick (CUQ, Kuraray Noritake, Japan), G-Premio Bond (GPB, GC Corp, Japan), and a self-curing universal adhesive "Tokuyama Universal Bond" (TUB; Tokuyama Dental, Japan). The following three different application procedures were used for the dentin surfaces: the adhesives were applied and immediately subjected to air-dry; the adhesives were applied followed by a 10-second wait; or the adhesives were rubbed for 10 seconds. Then composite resin was applied to the dentin surface and light cured. After storage in 37°C distilled water for 24 h, all the bonded teeth were cut into 1mm² sections using a low-speed diamond saw (Micracut 125 Low Speed Precision Cutter, Metkon, Bursa, Turkey) under running water (n=15). The sections were subjected to a tensile force at a crosshead speed of 1mm/min in a testing apparatus (Microtensile Tester, Bisco, IL, USA) and µTBS values were measured. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test. Failure modes were analyzed under a stereomicroscope. Prolonged application time significantly affected the µTBS (p<0.005). A significant increase of µTBS on active application was observed for CUQ and GPB. The TUB with an active application had a significantly lower µTBS value compared with the other adhesives. Prolonged application time caused significant improvement of bond strength in all adhesives. The active application is effective at increasing the dentin bond strength except for TUB.

Resumen Este estudio evaluó los efectos de los modos alternativos de aplicación de adhesivos de autograbado en la resistencia de la unión microtensil entre resina y dentina (µTBS) de tres adhesivos universales de concepto "no espera" disponibles en el mercado. En este estudio se utilizaron terceros molares humanos impactados que fueron extraídos. Las superficies planas se prepararon en la dentina coronal media y se prepararon con un papel SiC de 600 granos. Los tres adhesivos universales que se utilizaron son los siguientes: Clearfil Universal Quick Bond (CUQ, Kuraray Noritake, Japón), G-Premio Bond (GPB, GC Corp, Japón), y un adhesivo universal autopolimerizable "Tokuyama Universal Bond" (TUB; Tokuyama Dental, Japón). Se utilizaron los tres procedimientos de aplicación siguientes para las superficies dentinarias: se aplicaron los adhesivos y se sometieron inmediatamente a un secado al aire; se aplicaron los adhesivos y se esperó 10 segundos; o se frotaron los adhesivos durante 10 segundos. Luego se aplicó resina compuesta a la superficie dentinaria y se fotopolimerizó. Después de su almacenamiento en agua destilada a 37°C durante 24 h, todos los dientes unidos se cortaron en secciones de 1mm² utilizando una sierra de diamante de baja velocidad (Micracut 125 Low Speed Precision Cutter, Metkon, Bursa, Turquía) bajo agua corriente (n=15). Las secciones fueron sometidas a una fuerza de tracción a una velocidad de cruceta de 1mm/min en una máquina de prueba universal (Microtensile Tester, Bisco, IL, USA) y se midieron los valores de µTBS. Los datos fueron analizados utilizando la prueba de Kruskal-Wallis y la prueba U de Mann-Whitney. Los modos de falla fueron analizados bajo un estereomicroscopio. El prolongado tiempo de aplicación afectó significativamente a los µTBS (p<0,005). Se observó un aumento significativo de µTBS en la aplicación activa para el CUQ y el GPB. El TUB con una aplicación activa tuvo un valor de µTBS significativamente más bajo comparado con los otros adhesivos. El tiempo de aplicación prolongado causó una mejora significativa de la fuerza de adhesión en todos los adhesivos. La aplicación activa es efectiva para aumentar la fuerza de adhesión de la dentina, excepto para el TUB.

Longevidade de laminados cerâmicos em preparos conservadores: revisão da literatura / Longevity of veneer in conservatine preparations: literature review

Com o objetivo de melhor aproveitamento clínico, durabilidade, estética e possibilidade de devolução de forma e função, observa-se um aumento no número de procedimentos restauradores indiretos, juntamente com o uso de cerâmicas odontológicas. O desgaste da estrutura dental é necessário, mas em excesso pode reduzir a durabilidade da união e da restauração devido à exposição da dentina que, diferen- temente do esmalte, tem menor capacidade de adesão ao material cimentante. Neste contexto, o presente trabalho teve como objetivo a revisão e discussão da durabilidade dos laminados cerâmicos. Foi realizado uma revisão bibliográfica, utilizando os repositórios: Pub- Med, SciELO e Periódicos CAPES. Como critério de inclusão, os artigos deverão ter no máximo 10 anos de publicação e serem relevantes em termos de delineamento das informações desejadas. Foram adotados os escritos na língua inglesa, espanhola e portuguesa. Informações presentes em livros foram adicionadas, considerando os 10 anos estipulados. Dentro destes critérios, um total de 28 artigos, 2 TCC e 4 livros foram consultados. Observou-se que há uma heterogeneidade entre os desenhos de estudos de pesquisa na literatura consultada e, poucos estudos conclusivos quanto a longevidade das facetas laminadas de porcelana além de 20 anos, havendo uma limitação em termos de tamanho da amostra e duração do acompanhamento. Concluiu-se que, apesar da longevidade não depender de situações iso- ladas e sim de um conjunto de fatores, é preferível o uso de cimento resinoso autoadesivo, aliado à facetas reforçadas por dissilicato de lítio e, os preparos com recobrimento de incisal apresentam a melhor opção.

Ellagic acid on the quality of the adhesive interface of class I composite resin restorations after aging

To evaluate the effect of ellagic acid on the inhibition of matrix metalloproteinase by analyzing the quality of the adhesive interface with bond strength measures in periods of 24 hours and six months of storage. Method: 40 healthy human third molars were prepared with class I cavities (5x4x3mm). The teeth were divided into four experimental groups: Group 1- without application of ellagic acid and storage time of 24 hours; Group 2- with ellagic acid/24 hours; G3- without ellagic acid/six months; Group 4- with ellagic acid/six months. Then, the cavities were restored with Single Bond Universal adhesive and Z350 composite resin, with and without the previous application of ellagic acid. Subsequently, hourglass-shaped specimens were obtained and subjected to the bond strength (BS) test (n = 10) in a universal testing machine. The bond test was performed after 24 hours and six months of storage. For the standard evaluation (n = 3) the samples were infiltrated with silver nitrate and placed in a developing solution for analysis in a Scanning Electron Microscope (SEM). The data obtained were analyzed with the Kruskal-Wallis non-parametric test, showing a statistically significant difference. Results: The highest bond strength values were found for the 24-hour groups followed by the groups with six months of storage. For nano-infiltration, groups G1 and G2 showed lower infiltration than groups G3 and G4. Conclusion: The previous application of ellagic acid did not affect the BS of the adhesive interface of the adhesive system analyzed, regardless of storage time.

Effects of dentinary contamination by endodontic irrigants on bonding strength of adhesive systems

This study aimed to evaluate if 2.5% sodium hypochlorite compromises the adhesion of bonding materials. The factors in the study were the irrigation solutions in two levels: 2.5% sodium hypochlorite and saline solution; and the adhesive systems used in three levels: three-step adhesive, universal adhesive, and two-step self-etch adhesive systems. The answer variable used was the microshear bond strength obtained through a universal testing machine and fracture mode. Six groups were obtained (n=10) : Etch-and-rinse/Saline (saline solution + 3-step adhesive system - Scotchbond Multipurpose, 3M ESPE); Universal/saline (saline solution + universal adhesive system ­ Prime&Bond,); Self-etch/saline (saline solution + 2-step self-etch adhesive systems - Clearfil SE Bond); Etch-and-rinse/Hypo (sodium hypochlorite 2,5% + 3-step adhesive system - Scotchbond Multiuso); Universal/Hypo (sodium hypochlorite 2,5% + universal adhesive system ­ Prime&Bond); Self-etch/Hypo (sodium hypochlorite 2,5% + 2-step self-etch adhesive system - Clearfil Se Bond). The specimens were obtained from 60 healthy bovine incisors. The crowns were separated from the roots, and the regularization of the buccal surface was performed. The groups received saline solution and 2.5% sodium hypochlorite for 30 minutes, respectively. A matrix of 1mm and 3mm oh height was stabilized by Scotch tape to obtain the resin sticks. Afterward, the bond strength test was performed in a universal testing machine at 1mm/min speed. The data were analyzed with normality Shapiro-Wilk, two-way ANOVA, and Tukey's tests (p<0.001). Etch-and-rinse and Self-etch adhesives presented the highest bond strength values after irrigation with saline solution and 2.5% sodium hypochlorite, respectively (P < 0.01). The irrigation with 2.5% sodium hypochlorite decreased the bond strength values of Etch-and-rinse and Universal (P < 0.01). On the other hand, 2.5% sodium hypochlorite improved the bond strength values of Self-etch (P < 0.01). In conclusion, 2.5% sodium hypochlorite negatively impacted the bond strength of Etch-and-rinse and Universal but improved the adhesion of Self-etch.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.

Influência dos cimentos obturadores biocerâmicos versus o AH Plus® na dor pós-operatória, penetração em túbulos dentinários e atividade antimicrobiana: revisões sistemáticas e meta-análises / Influence of bioceramic root canal sealer versus AH Plus® on postoperative pain, penetration into dentinal tubules and antimicrobial activity: systematic reviews and meta-analyses

O objetivo desse estudo de revisões sistemáticas e meta-análises foi responder se os cimentos biocerâmicos resultam melhores efeitos para a dor pós operatória, capacidade em penetração em túbulos dentinários e atividade antimicrobiana em comparação ao cimento AH Plus®. Foram conduzidas duas revisões sistemáticas, orientadas pelas diretrizes PRISMA e foram registradas na PROSPERO (CRD4202125928) (Capítulo 1) e na Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Capítulo 2). Uma pergunta foi feita com base na população, intervenção, comparação e resultado (PICO), Capítulo 1: "O uso dos cimentos biocerâmicos resulta em menos dor pós operatória em comparação ao uso do cimento AH Plus® em pacientes tratados endodonticamente?"; Capítulo 2: "Os cimentos obturadores biocerâmicos apresentam superioridade na penetração em túbulos dentinários e atividade antimicrobiana ao cimento obturador AH Plus®?". Foram definidas as estratégias de buscas e realizadas buscas nas bases de dados: PubMed, Scopus, Web of Science, Embase, Cochrane Library, e OpenGrey. O Capítulo 1 utilizou a escala Cochrane para avaliar o risco de viés e a ferramenta GRADE para avaliar a qualidade das evidências. Enquanto, o Capítulo 2 utilizou a escala The Joanna Briggs para avaliar o risco de viés de estudos in vitro. As metaanálises foram conduzidas usando o "Meta" package, version 3.6.3, a diferença média (MD) medida de efeito foi calculada para variáveis quantitativas e odds ratio (OR) (Capítulo 1) e diferenças de médias padronizadas (SMD) (Capítulo 2), com um intervalo de confiança (IC) de 95%. Os resultados do Capítulo 1, foram incluídos 13 artigos na revisão sistemática, 11 foram incluídos na meta-análise. Para as variáveis quantitativas, o cimento biocerâmico apresentou menor ocorrência de dor pós-operatória do que o cimento AH Plus® em 24h (MD - 0,4101 [-0,80; -0,02], p = 0,0386) e 48h (MD -0,31 [-0,59; -0,03], p = 0,0295). Para as variáveis binárias, não houve diferença observada entre os cimentos avaliados: 24h (OR 1,12 [0,69; 1,80] p = 0,6476), 48h (OR 1,56 [0,76; 3,20] p = 0,2267), 72h (OR 1,38 [0,55; 3,45] p = 0,4893) e 7 dias (OR 2,10 [0,55; 8,01], p = 0,2790). Em relação à análise de risco de viés, observou-se baixo risco para a maioria dos domínios, exceto alocação que foi considerada pouco clara, enquanto a certeza da evidência variou de moderada a baixa. Os resultados do Capítulo 2, foram um total de 54 estudos foram incluídos, e 16 estudos foram incluídos na meta-análise. De modo geral, os estudos apresentaram baixo risco de viés. Não foi observado diferença estatística entre os cimentos avaliados para penetração em túbulos dentinários, independentemente dos terços: coronal SMD 0.58 [0.14; 1.31], p = 0.12; médio SMD 0.07 [0.54; 0.39], p = 0.75; e apical: SMD 0.08 [0.73; 0.56], p = 0.80. Os cimentos biocerâmicos e AH Plus® demonstraram similar ação antimicrobiana SMD [3.42; 5.32], p = 0.67 e SMD 0.67 [1.89; 0.55], p = 0.2825. Dessa forma, conclui-se que os cimentos biocerâmicos apresentam menor dor pós operatória nas primeiras 24 e 48 horas, e apresentam respostas similares para penetração em túbulos dentinários e atividade antimicrobiana quando comparado ao cimento AH Plus®(AU)

The aim of this study of systematic reviews and meta-analyses was to answer whether bioceramic sealers have better effects on postoperative pain, ability to penetrate dentinal tubules and antimicrobial activity compared to AH Plus® sealer. Two systematic reviews, guided by PRISMA guidelines, were conducted and registered in PROSPERO (CRD4202125928) (Chapter 1) and Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Chapter 2). A question was asked based on population, intervention, comparison and outcome (PICO), Chapter 1: "Does the use of bioceramic sealers result in less postoperative pain compared to the use of AH Plus® sealer in endodontically treated patients?"; Chapter 2: "Do bioceramic filling sealers have superior penetration into dentinal tubules and antimicrobial activity compared to AH Plus® filling sealer?". Search strategies were defined and searches performed in the following databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, and OpenGrey. Chapter 1 used the Cochrane scale to assess the risk of bias and the GRADE tool to assess the quality of evidence. Meanwhile, Chapter 2 used The Joanna Briggs scale to assess the risk of bias from in vitro studies. Meta-analyses were conducted using the "Meta" package, version 3.6.3, the mean difference (MD) effect measure was calculated for quantitative variables and odds ratio (OR) (Chapter 1) and standardized mean differences (SMD) (Chapter 2), with a 95% confidence interval (CI). The results of Chapter 1 were included 13 articles in the systematic review, 11 were included in the meta-analysis. For quantitative variables, the bioceramic sealer had a lower occurrence of postoperative pain than the AH Plus® sealer in 24 hours (MD - 0.4101 [-0.80; - 0.02], p = 0.0386) and 48h (MD -0.31 [-0.59; -0.03], p = 0.0295). For the binary variables, there was no difference observed between the sealers evaluated: 24h (OR 1.12 [0.69; 1.80] p = 0.6476), 48h (OR 1.56 [0.76; 3.20] p = 0.2267), 72h (OR 1.38 [0.55; 3.45] p = 0.4893) and 7 days (OR 2.10 [0.55; 8.01], p = 0 .2790). Regarding the risk of bias analysis, a low risk was observed for most domains, except for allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results of Chapter 2 were a total of 54 studies included, and 16 studies were included in the meta-analysis. Overall, the studies had a low risk of bias. There was no statistical difference between the sealers evaluated for penetration into dentinal tubules, regardless of the thirds: coronal SMD 0.58 [0.14; 1.31], p = 0.12; average SMD 0.07 [0.54; 0.39], p = 0.75; and apical: SMD 0.08 [0.73; 0.56], p = 0.80. Bioceramic sealers and AH Plus® demonstrated similar antimicrobial action to SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.2825. Thus, it is concluded that bioceramic sealers have less postoperative pain in the first 24 and 48 hours, and have similar responses for penetration into dentinal tubules and antimicrobial activity when compared to AH Plus® sealer(AU)