Synthesis of Submicrometric Chitosan Particles Loaded with Calcium Phosphate for Biomedical Applications.

Chitosan particles loaded with dibasic calcium phosphate anhydrous (DCPA) is a promising strategy for combining antimicrobial and osteoconduction properties in regenerative medicine. However, mostly micrometer-sized particles have been reported in the literature, limiting their use and reducing their effect in the biomedical field. We have recently overcome this limitation by developing submicrometer-sized particles with electrospray technique. The objective of this study was to understand how the process parameters control the size and properties of submicrometer chitosan particles loaded with DCPA. Solutions of 10 mg/mL chitosan and 2.5 mg/mL DCPA in a 90% acetic acid were electrosprayed under three distinct flow rate conditions: 0.2, 0.5, and 1.0 mL/h. The particles were crosslinked in a glutaraldehyde atmosphere and characterized in terms of their morphology, inorganic content, zeta potential, and minimum inhibitory concentration (MIC) against S. mutans. All conditions showed particles with two similar morphologies: one small-sized with a spherical shape and another larger-sized with a bi-concave shape. All generated a broad particle size distribution, with a similar mean size of ~ 235 nm. The addition of DCPA decreased the zeta potential for all the samples, but it was above 30 mV, indicating a low aggregation potential. The lower flow rate showed the worst efficacy for DCPA incorporation. Antimicrobial activity was greater in chitosan/DCPA particles with flow rate of 0.5 mL/h. It can be concluded that the flow rate of 0.5 mL/h presents the best compromise solution in terms of morphology, zeta potential, MIC, and inorganic content.

Relationship between toothpastes properties and patient-reported discomfort: crossover study.

OBJECTIVES: This study aims to correlate patient-reported reactions with in vitro analyses of the pH, abrasive quality, and cytotoxicity of four toothpastes. MATERIALS AND METHODS: One hundred twenty-one patients received non-identified samples of toothpaste to be used for 6 days and answered a questionnaire about their sensations. In vitro analysis: the pH of toothpastes was measured with a pH meter. The abrasivity of toothpastes was evaluated against composite resin specimens (n = 10). A toothbrushing machine was used to simulate wear, which was indirectly measured by mass loss using a scale. Cell culture media conditioned with toothpaste were used to assess the cytotoxicity. Confluent cells were kept in contact with the conditioned media or control for 24 h. The cell viability was measured using the 3-(bromide, 4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium (MTT)-reduction assay. The obtained data on the pH, weight loss, and cell viability were compared by ANOVA/Tukey's tests (p < 0.05). RESULTS: With the exception of the bleaching effect paste, the Oral B® paste produced the highest frequencies of irritation reports, tooth sensitivity, taste discomfort, and texture discomfort in the clinical study; patients also reported rougher teeth, soft tissue peeling, dry mouth, thrush, tingling, and taste changes in response to this paste. The in vitro analysis demonstrated that Oral B® had the lowest pH, the highest abrasivity, and produced the lowest cell viability (p < 0.01). CONCLUSION: Results suggest that low pH toothpastes that are highly abrasive and cytotoxic may cause undesirable reactions in patients. CLINICAL RELEVANCE: Toothpaste's properties should be well known for indication to patient therefore minimizing discomfort reports.

The impact of chitosan in experimental resin with different photoinitiator systems.

OBJECTIVE: to investigate the effect of different concentrations of chitosan added to experimental resins containing either BAPO or camphorquinone (CQ) as photoinitiators, regarding degree of conversion (DC), flexural strength (FS), flexural elastic modulus (E), Knoop microhardness (KHN), cytotoxicity, genotoxicity and antimicrobial activity. METHODS: Experimental resins with polymeric matrix of BisGMA and TEGDMA was added either 0.5 wt% BAPO or 0.5 wt% camphorquinone/0.2% amine along with and chitosan concentrations of 0.5%; 1.0% or 2.0%. Degree of conversion was measured using Fourier transformed infrared spectroscopy. Flexural strength and elastic modulus were obtained through three-point bending test and Knoop microhardness was measured in a microidenter. Direct cytotoxicity was performed in human keratinocytes and genotoxicity test was done in murine macrophages cells. Antimicrobial activity was acessed against Staphylococcus aureus and Streptococcus mutans through the inhibition halo. Data were analyzed using two-way ANOVA and Tukey teste (α = 0.05). RESULTS: The materials containing photoinitiator BAPO showed higher values of DC, FS, E, and KHN compared to resins with CQ. The addition of chitosan did not affect the properties of these materials. However, in resins containing CQ, the addition of chitosan improve these properties compared to control group. For the groups containing BAPO the chitosan reduced cytotoxicity and genotoxicity compared to materials with camphorquinone. The materials with 1.0% and 2.0% chitosan showed increased antibacterial activity in the materials containing BAPO as photoinitiator for both bacteria. SIGNIFICANCE: The alternative photoinitiator BAPO and chitosan can improve physical and biological properties of photoactivated resins when compared with the materials with photoinitiator camphorquinone.

Exploring Zirconia Adhesion: Pre and Postsintering Physical Surface Treatment, Chemical Treatment, and Cement Interactions.

Background: Adhesion to zirconia remains a significant dental challenge. This study is aimed at assessing the bond strength of zirconia based on surface treatment with pre or postsintering sandblasting associated with different chemical treatments and resin cements. Methods: Zirconia blocks were divided into 12 experimental groups based on the surface treatment (presintering sandblasting or postsintering sandblasting/tribochemical abrasion treatment), chemical treatment (none, Single Bond Universal, or Signum Zirconia Bond), and choice of cement (Panavia F or RelyX™ U200). The bond strength was measured by shear tests using a universal testing machine. The fracture analysis was performed using stereomicroscopy. Data were analyzed using three-way ANOVA and Tukey's test (α = 5%). Results: Triple and double factor's interactions were not significant (p > 0.05). Regarding the surface treatment factor, the bond strength following postsintering sandblasting treatment associated with tribochemical abrasion (9.15 ± 3.62 MPa) was significantly higher than presintering sandblasting treatment (5.24 ± 3.53 MPa). Concerning the chemical treatment factor, bond strengths were ranked as follows: Signum Zirconia Bond > Single Bond Universal > no treatment. The bond strength of the resin cements did not differ among them. Most fractures (67%) were classified as adhesive, and 32% were categorized as mixed fractures. Conclusion: Surface treatment via postsintering sandblasting combined with tribochemical abrasion demonstrated superior efficacy than in presintering sandblasting. Additionally, chemical treatment with zirconia primer increased the bond strength of zirconia irrespective of the surface physical treatment.

Physicochemical and biological properties of dental materials and formulations with silica nanoparticles: A narrative review.

OBJECTIVE: Silica nanoparticles (SNPs) have been extensively studied and used in different dental applications to promote improved physicochemical properties, high substance loading efficiency, in addition to sustained delivery of substances for therapeutic or preventive purposes. Therefore, this study aimed to review the SNPs applications in nanomaterials and nanoformulations in dentistry, discussing their effect on physicochemical properties, biocompatibility and ability to nanocarry bioactive substances. DATA RESOURCES: Literature searches were conducted on PubMed, Web of Science, and Scopus databases to identify studies examining the physicochemical and biological properties of dental materials and formulations containing SNPs. Data extraction was performed by one reviewer and verified by another STUDY SELECTION: A total of 50 were reviewed. In vitro studies reveal that SNPs improved the general properties of dental materials and formulations, such as microhardness, fracture toughness, flexural strength, elastic modulus and surface roughness, in addition to acting as efficient nanocarriers of substances, such as antimicrobial, osteogenic and remineralizing substances, and showed biocompatibility CONCLUSIONS: SNPs are biocompatible, improve properties of dental materials and serve as effective carriers for bioactive substances CLINICAL SIGNIFICANCE: Overall, SNPs are a promising drug delivery system that can improve dental materials biological and physicochemical and aesthetic properties, increasing their longevity and clinical performance. However, more studies are needed to elucidate SNPs short- and long-term effects in the oral cavity, mainly on in vivo and clinical studies, to prove their effectiveness and safety.

PLLA Membranes Enriched with Chitosan/DCPA: Innovative Approach to Bone Tissue Engineering.

Bone tissue engineering has been very promising. The use of scaffolds of synthetic and natural materials is an alternative to combine the advantages of both types of materials. This study aimed to evaluate electrospun polymeric matrices of pure PLLA or associated with 5% or 10% of chitosan particles loaded or not with DCPA in bone proliferation and differentiation of periodontal ligament stem cells (PDLSC). The particles and matrices were characterized by scanning electron microscopy. PDLSC were isolated from periodontal ligament fragments of human permanent teeth using the explant technique. Cell proliferation assay (Alamar Blue) was performed from 1 to 21 days of culture in clonogenic medium and Alizarin Red assay was performed after 21 days of culture in osteogenic medium. The data were analyzed using Kruskal-Wallis test, and the comparison between media was given by the Student-Newman-Keuls test (α = 0.05). On days 1 and 7 there were no statistical difference between materials regarding cell proliferation (p>0.05). The materials with 5 and 10% chitosan / DCPA showed greater proliferation than PLLA control on days 14 and 21 and the material with 10% pure chitosan was greater than the control in 21 days. Regarding the alizarin red assay, PLLA 5% chitosan, PLLA 5 and 10% chitosan / DCPA showed a greater degree of mineralization than the control and the PLLA 10% chitosan material, and they were similar to each other. We conclude that PLLA 5 and 10% chitosan / DCPA materials were able to increase both, cell proliferation and differentiation of PDLSC in bone cells. Key words:Chitosan, PLLA, polymeric matrix, electrospinning.

Development, characterization and antimicrobial activity of multilayer silica nanoparticles with chlorhexidine incorporated into dental composites.

OBJECTIVE: In this study a dentistry nanocomposite with prolonged antibacterial activity using silica nanoparticles (SNPs) loaded with chlorhexidine (CHX) was developed. METHODS: SNPs were coated with the Layer-by-Layer technique. Dental composites were prepared with organic matrix of BisGMA/TEGDMA and SNPs with or without CHX (0, 10, 20 or 30% w/w). The physicochemical properties of the developed material were evaluated and agar diffusion method was used to test the antibacterial. In addition, the biofilm inhibitory activity of the composites was evaluated against S. mutans. RESULTS: SNPs were rounded with diameters about 50 nm, the organic load increased with increasing deposited layers. Material samples with SNPs loaded with CHX (CHX-SNPs) showed the highest values of post-gel volumetric shrinkage, that ranged from 0.3% to 0.81%. Samples containing CHX-SNPs 30% w/w showed the highest values of flexural strength and modulus of elasticity. Only samples containing SNPs-CHX showed growth inhibition against S. mutans, S. mitis and S. gordonii in a concentration-dependent manner. The composites with CHX-SNPs reduced the biofilm formation of S. mutans biofilm at 24 h and 72 h. SIGNIFICANCE: The nanoparticle studied acted as fillers and did not interfere with the evaluated physicochemical properties while providing antimicrobial activity against streptococci. Therefore, this initial study is a step forward to the synthesis of experimental composites with improved performance using CHX-SNPs.

Effects of the crosslinking of chitosan/DCPA particles in the antimicrobial and mechanical properties of dental restorative composites.

The development of restorative materials containing antibacterial agents is an alternative to reduce the progression of caries lesions. OBJECTIVE: to compare the influence of the degree of crosslinking of chitosan particles loaded with dibasic calcium phosphate (DCPA) on the mechanical properties, degree of conversion (DC), and antimicrobial properties of experimental composites. METHODS: Chitosan/DCPA particles were synthesized by the electrospraying, crosslinked by 0, 8, or 16 h in glutaraldehyde, and characterized by zeta potential and minimum inhibitory concentration (MIC) against S. mutans. Experimental resin composites of Bis-GMA and TEGDMA and 59.5% of barium glass were synthesized, chitosan/DCPA particles were added at 0 or 0.5 wt% with the different crosslinking time. The materials were subject to DC analysis, three-point bending test at 24 h and 7 days, and antimicrobial assays. Data were submitted to one-way ANOVA and Tukey test (α = 0.05). RESULTS: The particles with longer crosslinking time presented higher zeta potential and MIC, and the composite containing these particles showed significantly higher biofilm inhibition than the control group. The other two groups were similar to each other and the control. The composite containing particles with 88 h crosslinking time showed the lowest flexural strength at 7 days in water, and materials with non-crosslinked particles and longer crosslinking time presented flexural strength similar to control. The flexural modulus and DC showed no statistical difference among groups. SIGNIFICANCE: composite resin containing 0.5% chitosan/DCPA particles crosslinked by 16 h showed a reduction of biofilm formation without affecting the mechanical properties in relation to the control.

Antibacterial resin-based composite containing chlorhexidine for dental applications.

OBJETICVE: The aim of this study was to develop a composite material with antibacterial activity using MMT loaded with clorhexidine (CHX). For that it was used a BisGMA/TEGDMA matrix and added low concentration of MMT/CHX. The aim was to evaluate the drug release capacity of MMT, and not to provide reinforcement. METHODS: Six experimental composites were made with organic matrix of BisGMA/TEGDMA in equal proportions by weight. The composites received organophlizated montmorillonite with or without CHX. The concentrations were 2,5; 5 or 10% by weight. Degree of conversion (DC) was evaluated using FTIR (peak 6165 cm-1; n=5). Specimens for flexural properties (10×2×1mm) were immediate tested (24h). Elastic modulus(E) and flexural strength (FS) was measured using the three point bending test (n=10). Inibition halo was used to test the antibacterial activity against Staphylococcus aureus, Streptococcus mutans, and Porphyromonas gingivalis (n=5 for each bacteria). The inhibition of biofilm formation (BF) was evaluated by inserting polymerized disc of composite in to a culture media colonized with Streptococcus mutans (n=10). The release of CHX was measured using ultraviolet (255nm) for 10 days (n=5). The data of degree of conversion was analysed using Kruskal-Wallis/ Mann-Whitney, and the other variables using two-way ANOVA/Tukey, always considering a global level of significance of 5%. RESULTS: DC ranged from 71% to 74%. E ranged from 5.7 to 8.1GPa. FS ranged from 61.4 to 74.7MPa. There were no statistical differences among the groups for all the variables. For the three bacteria tested the composites with CHX loaded presented inhibition of growth for all concentration, except for 2,5% that did not inihibited the growth of P. gingivalis. BF was lower for the groups with 10% MMT/CHX, all groups presented BF, even those without CHX loaded. All concentrations presented release off CHX during all the 28 days analyzed. CONCLUSIONS: Within the limitation of this study it can be concluded that: all concentrations tested presented release of CHX and reduced BF. All concentration presented antibacterial activity for the three bacteria tested, except for 2,5% that did not inhibit the growth of P. gingivalis. The presence of MMT with CHX loaded did not interfere in the properties evaluated.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion.

INTRODUCTION: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. OBJECTIVE: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. METHODS: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. RESULTS: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. CONCLUSION: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

A comparative study of bulk-fill composites: degree of conversion, post-gel shrinkage and cytotoxicity.

Bulk-fill composites are claimed to be restorative materials used in deep preparations and effectively photoactivated in layers up to 4 mm. The aim of the present study was to evaluate the degree of conversion, post-gel volumetric shrinkage, and cytotoxicity of six bulk-fill and two conventional composites. Degree of conversion was determined by FTIR spectroscopy; post-gel volumetric shrinkage was determined using the strain gauge method; and cytotoxicity in human fibroblasts was evaluated indirectly by the MTT assay. Data were subjected to one-way ANOVA/Tukey's test (α = 0.05). All materials, including bulk-fill and conventional composites, were classified as non-toxic, with cell viability higher than 70%. Bulk-fill composites exhibited volumetric shrinkage similar to or lower (1.4 to 0.4%) than that of conventional composites (1.7-2.1%). However, only four of the bulk-fill composites were able to sustain a homogeneous conversion at the 4-mm depth. Despite their non-toxicity and shrinkage similar to that of conventional materials, not all commercial bulk-fill materials were able to maintain a conversion as high as 80% of the superficial layer, at the 4-mm depth, indicating some failure in the bulk-fill design of some commercial brands. Therefore, the use of bulk-fill materials in dental practice is advantageous, but special attention should be given to the selection and correct use of the materials.

Polymerization stress related to radiant exposure and its effect on microleakage of composite restorations.

OBJECTIVES: Verify the influence of radiant exposure (dose) on polymerization stress and microleakage of composite restorations using two adhesive systems. METHODS: An experimental composite (1BisGMA:1TEGDMA, 75wt.% filler) was subjected to 3, 6, 12 or 24J/cm(2) under 500mW/cm(2). Stress was measured in 1-mm height specimens placed between two glass rods (Ø=5mm) attached to a testing machine. Microleakage was assessed in cylindrical restorations (Ø=5mm, h=2mm) with enamel margins, using Adper Single Bond 2 (SB) or Adper Prompt (PR). After storage, specimens were subjected to dye penetration (50% AgNO(3)) and sectioned twice, perpendicularly. Microleakage of the 8tooth/composite interfaces was recorded in millimeters. KHN was measured at both surfaces of cylindrical specimens (Ø=5mm, 1 or 2mm height). ANOVA/Tukey test were used (alpha=0.05). KHN top and bottom were compared using paired t-tests. RESULTS: Stress increased significantly with dose (3J/cm(2): 1.4+/-0.3(c); 6J/cm(2): 4.3+/-0.5(b); 12J/cm(2): 9.3+/-0.6(a); 24J/cm(2): 9.9+/-0.7(a), in MPa). For both average and maximum microleakage, interactions were not statistically significant (p>0.05). Tooth average microleakage was influenced by the adhesive system (SB

Combination of Bioactive Polymeric Membranes and Stem Cells for Periodontal Regeneration: In Vitro and In Vivo Analyses.

Regeneration of periodontal tissues requires a concerted effort to obtain consistent and predictable results in vivo. The aim of the present study was to test a new family of bioactive polymeric membranes in combination with stem cell therapy for periodontal regeneration. In particular, the novel polyester poly(isosorbide succinate-co-L-lactide) (PisPLLA) was compared with poly(L-lactide) (PLLA). Both polymers were combined with collagen (COL), hydroxyapatite (HA) and the growth factor bone morphogenetic protein-7 (BMP7), and their osteoinductive capacity was evaluated via in vitro and in vivo experiments. Membranes composed of PLLA/COL/HA or PisPLLA/COL/HA were able to promote periodontal regeneration and new bone formation in fenestration defects in rat jaws. According to quantitative real-time polymerase chain reaction (qRT-PCR) and Alizarin Red assays, better osteoconductive capacity and increased extracellular mineralization were observed for PLLA/COL/HA, whereas better osteoinductive properties were associated with PisPLLA/COL/HA. We concluded that membranes composed of either PisPLLA/COL/HA or PLLA/COL/HA present promising results in vitro as well as in vivo and that these materials could be potentially applied in periodontal regeneration.

Influence of polymeric matrix on the physical and chemical properties of experimental composites.

Nowadays, the main reasons for replacement of resin-based composite restorations are fracture or problems with the integrity of their interface, such as marginal staining, microleakage, or secondary caries. The aim of the present study was to evaluate the influence of the organic matrix on polymerization stress (PS), degree of conversion (DC), elastic modulus (E), flexural strength (FS), Knoop hardness (KHN), sorption (SP), and solubility (SL). In order to obtain a material which combines better mechanical properties with lower PS, seven experimental composites were prepared using BisGMA to TEGDMA molar ratios of 2:8, 3:7, 4:6, 5:5, 6:4, 7:3 and 8:2 and 40% of silica. PS was obtained in a universal testing machine, using acrylic as bonding substrate. DC was determined using Fourier Transform Raman spectroscopy. E and FS were obtained by the three-point bending test. KHN was measured by a microindentation test using a load of 25 g for 30 s. SP and SL were assessed according to ISO 4049. The data were submitted to one-way ANOVA. The increase in BisGMA concentration resulted in the decrease of PS, DC, E, FS and KHN. However, it did not change the SP and SL values. FS, E and KHN showed a strong and direct relationship with the DC of the materials. The composite material with a BisGMA to TEGDMA molar ratio of 1:1 was the one with better mechanical properties and lower PS.

Experimental and FE displacement and polymerization stress of bonded restorations as a function of the C-Factor, volume and substrate stiffness.

OBJECTIVES: To determine the free surface displacement of resin-composite restorations as a function of the C-Factor, volume and substrate stiffness, and to compare the results with interfacial stress values evaluated by finite element analysis (FEA). METHODS: Surface displacement was determined by an extensometer using restorations with 4 or 6mm diameter and 1 or 2mm depth, prepared in either bovine teeth or glass. The maximum displacement of the free surface was monitored for 5 min from the start of photoactivation, at an acquisition rate of 1s(-1). Axisymmetric cavity models were performed by FEA. Structural stiffness and maximum stresses were investigated. RESULTS: For glass, displacement showed a stronger correlation with volume (r=0.771) than with C-Factor (r=0.395, p<0.001 for both). For teeth, a stronger correlation was found with C-Factor (r=0.709; p<0.001) than with volume (r=0.546, p<0.001). For similar dimensions, stress and displacement were defined by stiffness. Simultaneous increases in volume and C-Factor led to increases in stress and surface displacement. Maximum stresses were located at the cavosurface angle, internal angle (glass) and at the dentine-enamel junction (teeth). The displacement of the restoration's free surface was related to interfacial stress development. CONCLUSIONS: Structural stiffness seems to affect the shrinkage stress at the tooth/resin-composite interface in bonded restorations. Deep restorations are always problematic because they showed high shear stress, regardless of their width. FEA is the only tool capable of detecting shear stress due to polymerization as there is still no reliable experimental alternative.

Correlation between polymerization stress and interfacial integrity of composites restorations assessed by different in vitro tests.

OBJECTIVE: to correlate polymerization stress data obtained under two compliance conditions with those from different interfacial quality tests. METHODS: Six commercial composites were tested (Filtek Z250/3M ESPE, Heliomolar/Ivoclar Vivadent, Aelite LS Posterior/Bisco, Filtek Supreme/3M ESPE, ELS/Saremco and Venus Diamond/Heraeus Kulzer). Bond strength (BS) was evaluated by push-out test on slices of bovine dentin (2-mm thick) with tapered cavities. For microleakage (ML) and gap analysis, cylindrical cavities in bovine incisors (4-mm diameter and 1.5-mm height) were restored and epoxy replicas of the cavo-surface margins were prepared for analysis under scanning electron microscopy (200×). The same specimens were submitted to a microleakage protocol using AgNO3 as tracer. After sectioned twice perpendicularly, ML was determined under a stereomicroscope (60×). Polymerization stress (PS, n=5) was determined by the insertion of the composite (h=1.5mm) between poly(methyl methacrylate), PMMA, or glass rods (Ø=4 mm) attached to a universal testing machine. Data were analyzed using Kruskal-Wallis (ML and gaps), and ANOVA/Tukey (BS and PS, α=5%). Pearson's correlation test was used to verify correlations between stress and interfacial quality. RESULTS: BS varied from 4.7 to 7.9 MPa. Average ML data ranged from 0.34 to 0.89 mm. Maximum ML varied from 0.61 to 1.34 mm. Gap incidence varied from 13 to 47%. PS ranged from 2.5 to 4.4 MPa in PMMA, and between 2.1 and 8.2 in glass. Statistically significant correlations were observed between stress and interfacial quality, except between BS and PS in glass. These correlations were stronger when PMMA was used as bonding substrate. CONCLUSIONS: PS data obtained using a high compliance testing system showed a stronger correlation with "in vitro" interfacial integrity results, compared to data from a low compliance system.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

ABSTRACT Introduction: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. Objective: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. Methods: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. Results: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. Conclusion: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

RESUMO Introdução: a expansão rápida da maxila assistida cirurgicamente (ERMAC) é um procedimento que reduz a resistência das suturas, corrigindo a mordida cruzada posterior em adultos. Objetivo: o objetivo deste estudo foi avaliar o status periodontal de 17 adultos submetidos a esse procedimento. Métodos: o nível clínico de inserção (NCI), a recessão gengival, gengiva inserida e sangramento foram avaliados nos primeiros pré-molares, molares, incisivos centrais e laterais superiores dos lados direito e esquerdo antes da cirurgia, e depois de 5 dias e 6 meses. Médias, desvios-padrão, medianas, valores mínimos e máximos foram comparados entre as avaliações, usando os testes de Friedman e McNemar. Resultados: houve aumento estatisticamente significativo no NCI no incisivo central direito, pré-molares direito e esquerdo e molares direito e esquerdo. Houve aumento estatisticamente significativo na recessão gengival nos pré-molares e nos molares direito e esquerdo. A quantidade de gengiva inserida diminuiu significativamente nos pré-molares direitos e molares direitos e esquerdos. Houve aumento no sangramento na maioria dos dentes. Conclusão: os resultados indicaram que a ERMAC pode causar alterações no tecido periodontal.

A comparative study of bulk-fill composites: degree of conversion, post-gel shrinkage and cytotoxicity

Abstract: Bulk-fill composites are claimed to be restorative materials used in deep preparations and effectively photoactivated in layers up to 4 mm. The aim of the present study was to evaluate the degree of conversion, post-gel volumetric shrinkage, and cytotoxicity of six bulk-fill and two conventional composites. Degree of conversion was determined by FTIR spectroscopy; post-gel volumetric shrinkage was determined using the strain gauge method; and cytotoxicity in human fibroblasts was evaluated indirectly by the MTT assay. Data were subjected to one-way ANOVA/Tukey's test (α = 0.05). All materials, including bulk-fill and conventional composites, were classified as non-toxic, with cell viability higher than 70%. Bulk-fill composites exhibited volumetric shrinkage similar to or lower (1.4 to 0.4%) than that of conventional composites (1.7-2.1%). However, only four of the bulk-fill composites were able to sustain a homogeneous conversion at the 4-mm depth. Despite their non-toxicity and shrinkage similar to that of conventional materials, not all commercial bulk-fill materials were able to maintain a conversion as high as 80% of the superficial layer, at the 4-mm depth, indicating some failure in the bulk-fill design of some commercial brands. Therefore, the use of bulk-fill materials in dental practice is advantageous, but special attention should be given to the selection and correct use of the materials.

Polymerization stress, shrinkage and elastic modulus of current low-shrinkage restorative composites.

OBJECTIVE: To compare currently available low-shrinkage composites with others regarding polymerization stress, volumetric shrinkage (total and post-gel), shrinkage rate and elastic modulus. METHODS: Seven BisGMA-based composites (Durafill/DU, Filtek Z250/FZ, Heliomolar/HM, Aelite LS Posterior/AP, Point 4/P4, Filtek Supreme/SU, ELS/EL), a silorane-based (Filtek LS, LS), a urethane-based (Venus Diamond, VD) and one based on a dimethacrylate-derivative of dimer acid (N'Durance, ND) were tested. Polymerization stress was determined in 1-mm high specimens inserted between two PMMA rods attached to a universal testing machine. Total volumetric shrinkage was measured using a mercury dilatometer. Maximum shrinkage rate was used as a parameter of the reaction speed. Post-gel shrinkage was measured using strain-gages. Elastic modulus was obtained by three-point bending. Data were submitted to one-way ANOVA/Tukey test (p=0.05), except for elastic modulus (Kruskal-Wallis). RESULTS: Composites ranked differently for total and post-gel shrinkage. Among the materials considered as "low-shrinkage" by the respective manufacturers, LS, EL and VD presented low post-gel shrinkage, while AP and ND presented relatively high values. Polymerization stress showed a strong correlation with post-gel shrinkage except for LS, which presented high stress. Elastic modulus and shrinkage rate showed weak relationships with polymerization stress. SIGNIFICANCE: Not all low-shrinkage composites demonstrated reduced polymerization shrinkage. Also, in order to effectively reduce polymerization stress, a low post-gel shrinkage must be associated to a relatively low elastic modulus.

Influence of polymeric matrix on the physical and chemical properties of experimental composites

Nowadays, the main reasons for replacement of resin-based composite restorations are fracture or problems with the integrity of their interface, such as marginal staining, microleakage, or secondary caries. The aim of the present study was to evaluate the influence of the organic matrix on polymerization stress (PS), degree of conversion (DC), elastic modulus (E), flexural strength (FS), Knoop hardness (KHN), sorption (SP), and solubility (SL). In order to obtain a material which combines better mechanical properties with lower PS, seven experimental composites were prepared using BisGMA to TEGDMA molar ratios of 2:8, 3:7, 4:6, 5:5, 6:4, 7:3 and 8:2 and 40% of silica. PS was obtained in a universal testing machine, using acrylic as bonding substrate. DC was determined using Fourier Transform Raman spectroscopy. E and FS were obtained by the three-point bending test. KHN was measured by a microindentation test using a load of 25 g for 30 s. SP and SL were assessed according to ISO 4049. The data were submitted to one-way ANOVA. The increase in BisGMA concentration resulted in the decrease of PS, DC, E, FS and KHN. However, it did not change the SP and SL values. FS, E and KHN showed a strong and direct relationship with the DC of the materials. The composite material with a BisGMA to TEGDMA molar ratio of 1:1 was the one with better mechanical properties and lower PS.