Management of Pulp Canal Obliteration-Systematic Review of Case Reports.

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a "watchful waiting" approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The "watchful waiting" approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

Validity and reliability of a Portuguese version of the Summated Xerostomia Inventory-5.

OBJECTIVES: The aim of this study was to validate and determine the reliability of the Portuguese version of the Summated Xerostomia Inventory. BACKGROUND: Many conditions such as head and neck radiation, autoimmune diseases or polypharmacy are characterised by hyposalivation which can affect oral and systemic quality of life. As such, this condition must be assessed, and the English version of the Xerostomia Inventory has been increasingly used to determine the severity of dry mouth perception. MATERIALS AND METHODS: This was a descriptive cross-sectional study, which employed volunteers suffering from hyposalivation after local ethical committee clearance. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analysed using Cronbach's α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Significance was set at .05. RESULTS: A sample of 103 volunteers was recruited. Cronbach's α was .84 and .87 for the first and second test administrations, respectively. The intraclass correlation coefficient value for the test-retest reliability was .93, and scores for the individual items ranged from .79 to .90. The correlation between the total score of the questionnaire and standard single dry mouth question was .66, indicating a very good correlation. CONCLUSION: Demonstrating excellent psychometric properties, the Summated Xerostomia Inventory (Portuguese Version) is a valid tool for quantifying Xerostomia in a dry mouth-afflicted population.

Microtensile Bond Strength and Micromorphology of Bur-cut Enamel Using Five Adhesive Systems.

PURPOSE: This study compared the microtensile bond strengths (µTBS) of two etch-and-rinse (ER) (OptiBond FL [OBFL]; Prime & Bond NT [PBNT]) and three self-etching (SE) (Clearfil SE Bond [CSEB]; Xeno III [XIII]; Xeno V+ [XV+]) adhesives systems to bur-prepared human enamel considering active (AA) and passive (PA) application of the self-etching systems. MATERIALS AND METHODS: Ninety-six enamel surfaces were prepared with a medium-grit diamond bur and randomly allocated into 8 groups to receive adhesive restorations: G1: OBFL; G2: PBNT; G3: CSEB/PA; G4: CSEB/ AA; G5: XIII/PA; G6: XIII/AA; G7: XV+/PA; G8: XV+/AA. After composite buildup, samples were sectioned to obtain a total of 279 bonded sticks (1 mm2) that were submitted to microtensile testing (µTBS; 0.5 mm/min) after 24-h water storage (37°C). Etching patterns and adhesive interfacial ultramorphology were also evaluated with confocal laser scanning (CLSM) and scanning electron microscopy (SEM). Data was analyzed with one-way ANOVA (α = 0.05). Weibull probabilistic distribution was also determined. RESULTS: Regarding µTBS, both adhesive system and application mode yielded statistically significant differences (p < 0.05) among groups. ER adhesive systems together with CSEB/AA and XIII/PA recorded the highest and statistically similar bond strength results. XV+ presented very low bond strength values, regardless of the application mode. Among self-etching adhesives, CSEB produced significantly higher µTBS values when applied actively. Qualitative evaluation by SEM and CLSM revealed substantial differences between groups both in adhesive interfaces and enamel conditioning patterns. CONCLUSIONS: ER and SE adhesive systems presented distinctive bond strengths to bur-cut enamel. The application mode effect was adhesive dependent. Active application improved etching patterns and resin interfaces micromorphology.

Microtensile Bond Strength of Three Different Adhesive Systems to Primary Enamel: An In Vitro Study.

Purpose: The purpose of this in vitro study was to assess and compare the microtensile bond strength of three adhesive systems to primary enamel. Methods: This laboratory study involved the preparation of 16 primary molars, randomly distributed over three groups, using the following adhesive systems: GI-Prime&Bond® XP (PBXP); GII-Clearfil™ SE Protect Bond (CSEPB); and GIII-Clearfil™ S3Bond Plus (CSB). After applying each adhesive system on enamel as recommended, Ceram. X™ Universal composite blocks were built. Samples were then cross-sectioned into quadrangular test specimens and subjected to microtensile tests. Fracture patterns were classified by optical microscopy examination. Statistical analysis was performed using IBM SPSS 24.0 software (five percent significance level). Results: PBXP showed statistically higher levels of microtensile adhesion than CSEPB and CSB, which, in turn, did not significantly differ from each other. Fracture patterns observed were, for the majority, adhesive fractures across all groups. There was no statistically significant association between group and type of failures. Conclusions: Bond strength of the etch-rinse adhesive to primary prepared enamel was statistically higher than for the two self-etch systems tested, which, in turn, did not significantly differ from each other.

Randomized clinical trial of five adhesive systems in occlusal restorations: One-year results.

This randomized clinical trial evaluated the efficacy of five different adhesive systems in the restoration of occlusal cavities after one year of function. Two etch-and-rinse (Optibond™FL, Prime&Bond®NT™) and three self-etch (Clearfil™SE Bond, Xeno®III, Xeno®V+) adhesive systems were evaluated on 159 occlusal restorations, incrementally filled with a microhybrid composite resin. Restorations were assessed using the FDI criteria at baseline, 6 months and 1 year. Statistical analysis was performed with Friedman-test and Kruskal-Wallis test (p<0.05). At 1 year, 153 restorations were evaluated. A statistically significant decrease in the number of restorations with marginal adaptation classified as excellent occurred for the self-etch adhesives (p<0.01). Etch-and-rinse adhesives presented better performance than any of the self-etch systems (p<0.01) in terms of marginal adaptation. All cases were considered no less than satisfactory. Marginal adaptation was the most influent parameter on the distinctive performance of the adhesives where etch-and-rinse systems performed significantly better than self-etch systems.

Polymerization Shrinkage Evaluation of Restorative Resin-Based Composites Using Fiber Bragg Grating Sensors.

The purpose of this study was to compare the linear polymerization shrinkage of different restorative resin-based composites (RBCs) using fiber Bragg grating (FBG) sensors. Five RBCs were evaluated: Zirconfill® (ZFL); Aura Bulk-Fill (ABF); Tetric® N-Ceram Bulk-Fill (TBF); FiltekTM Bulk-Fill (FBF); and Admira Fusion-Ormocer® (ADF). Ten samples per resin were produced in standardized custom-made half-gutter silicone molds. Two optical FBG sensors were used to assess temperature and polymerization shrinkage. Light curing was performed for 40 s and polymerization shrinkage was evaluated at 5, 10, 40, 60, 150, and 300 s. Statistical analysis was accomplished for normal distribution (Shapiro-Wilk, p > 0.05). Two-way repeated measures ANOVA with Greenhouse-Geisser correction followed by Bonferroni's post-hoc test was used to analyze the linear shrinkage data (p < 0.05). ZFL showed the highest linear shrinkage and ADF the lowest. Shrinkage increased for all RBCs until 300 s, where significant differences were found between ADF and all other resins (p < 0.05). Among bulk-fill RBCs, TBF showed the lowest shrinkage value, but not statistically different from FBF. The ADF presented lower linear shrinkage than all other RBCs, and restorative bulk-fill composites exhibited an intermediate behavior.

Pulp Temperature Rise Induced by Light-Emitting Diode Light-Curing Units Using an Ex Vivo Model.

The aim of this research was to compare the pulp temperature (PT) rise induced by four light-emitting diode light-curing units (LED LCUs) (Bluephase 20i, Demi Ultra, SPEC 3, and Valo) in different curing modes. Immediately after extraction, the pulp chamber of 11 premolars was accessed from the palatal cervical third of the crown for insertion of fiber Bragg grating (FBG) sensors for temperature measurement and kept in a 37.0° water bath. The teeth were then submitted to a random sequence of curing modes with four irradiations at 30 s intervals. Care was taken to ensure complete pulp temperature reset between curing modes. The curing modes were classified as high-energy (above 80 J/cm²) or low-energy (below 40 J/cm²) according to the total energy density delivered. Statistical analysis was performed with repeated ANOVA measures and Pearson's correlation for the association between energy density and temperature variation. The significance level was set to 0.05. All curing units promoted a statistically significant PT rise (p < 0.01). After four emissions, the PT rise was higher than 5.0 °C for the high-energy curing modes. The low-energy modes induced approximately a 2.5 °C rise. A strong positive correlation was found between energy density and PT increase (R = 0.715; p = 0.01). Exposure of intact premolars to LED LCUs induced significant and cumulative PT rise. Curing modes emitting high energy densities produced higher PT variations. Radiant exposure was positively correlated to PT variation.

Six-Month Color Stability Assessment of Two Calcium Silicate-Based Cements Used in Regenerative Endodontic Procedures.

AIM: The purpose of the present study is to assess the color stability of two calcium silicate-based cements (CSCs) used in regenerative endodontic procedures (REPs). METHODS: A total of 40 acrylic single-rooted transparent teeth, with immature apex, were used. Root canals were filled up to 3 mm below the level of the cementoenamel junction, with either saline solution (Mineral Trioxide Aggregate (MTA)/saline and Biodentine/saline) or blood (MTA/blood and Biodentine/blood). Subsequently, ProRoot MTA® or BiodentineTM was placed in the root canal to create a cervical barrier. Color measurement was carried out at four different evaluation periods (3 h, 72 h, 7 days, and 6 months). Shade analysis within the L* a* b* color space was performed and color variation (∆E) calculated. The significance level for statistical analysis was set at p < 0.05. RESULTS: The four groups showed a significant decrease in L* values over time. The ΔE value increased over time for all groups but was not statistically significant for the Biodentine/blood group. Two-way ANOVA showed no interaction between the CSC and treatment (contact with saline solution or blood). CSC used was the factor responsible for ΔE over time, inducing statistically significant color variations from T3H to T7D (p = 0.04) and T3H to T6M (p < 0.01). After 6 months, MTA/saline had 5.08 (p = 0.001) higher ΔE than Biodentine/Saline and the MTA/blood had 3.65 (p = 0.009) higher than Biodentine/blood. CONCLUSIONS: After 6 months, regardless of blood exposure, Biodentine exhibits superior color stability compared to MTA. Biodentine might be a suitable alternative to MTA as a cervical barrier material in REPs.

Does Delayed Restoration Improve Shear Bond Strength of Different Restorative Protocols to Calcium Silicate-Based Cements?

The purpose of the present study was to assess the proper time to perform a restoration (immediately or delayed) after placement of two calcium silicate-based cements (CSCs) and to test the performance of two different restorative protocols regarding shear bond strength (SBS). Seventy-five acrylic blocks were randomly divided into five groups (n = 15). Specimens were filled with either ProRoot MTA (Dentsply Tulsa Dental) or Biodentine (Septodont). The restoration was performed at an immediate (12 min) or delayed (seven days) timeframe, using a resin-based flowable composite (SDR) (bonded to the CSC using a universal bonding system) or glass ionomer cement (GIC) as restorative materials. SBS was measured using a universal testing machine. Fractured surfaces were evaluated, and the pattern was registered. Statistical analysis was performed using the Dunn⁻Sidak post hoc test (P < 0.05). Biodentine/immediate SDR showed the highest mean SBS value (4.44 MPa), with statistically significant differences when compared to mineral trioxide aggregate (MTA)/GIC (1.14 MPa) and MTA/immediate SDR (1.33 MPa). MTA/GIC and MTA/immediate SDR did not present significant differences regarding SBS. No statistical differences were verified concerning mean SBS between both CSCs within the 7 day groups. MTA/delayed SDR (3.86 MPa) presented statistical differences compared to MTA/immediate SDR, whereas no differences were observed regarding Biodentine performance (Biodentine/immediate SDR and Biodentine/delayed SDR (3.09 MPa)). Bonding procedures directly on top of MTA might be preferably performed at a delayed timeframe, whereas Biodentine might allow for immediate restoration.

Cuspal Displacement Induced by Bulk Fill Resin Composite Polymerization: Biomechanical Evaluation Using Fiber Bragg Grating Sensors.

Polymerization shrinkage is a major concern to the clinical success of direct composite resin restorations. The aim of this study was to compare the effect of polymerization shrinkage strain of two resin composites on cuspal movement based on the use of fiber Bragg grating (FBG) sensors. Twenty standardized Class II cavities prepared in upper third molars were allocated into two groups (n = 10). Restorations involved the bulk fill placement of conventional microhybrid resin composite (Esthet•X® HD, Dentsply DeTrey) (Group 1) or flowable "low-shrinkage" resin composite (SDR™, Dentsply DeTrey) (Group 2). Two FBG sensors were used per restoration for real-time measurement of cuspal linear deformation and temperature variation. Group comparisons were determined using ANCOVA (α = 0.05) considering temperature as the covariate. A statistically significant correlation between cuspal deflection, time, and material was observed (p < 0.01). Cuspal deflection reached 8.8 µm (0.23%) and 7.8 µm (0.20%) in Groups 1 and 2, respectively. When used with bulk fill technique, flowable resin composite SDR™ induced significantly less cuspal deflection than the conventional resin composite Esthet•X® HD (p = 0.015) and presented a smoother curve slope during the polymerization. FBG sensors appear to be a valid tool for accurate real-time monitoring of cuspal deformation.

1-year In Vitro Evaluation of Tooth Discoloration Induced by 2 Calcium Silicate-based Cements.

INTRODUCTION: The purpose of this study was to compare tooth discoloration that occurs in teeth filled with ProRoot MTA (DENTSPLY Tulsa Dental Specialties, Tulsa, OK) or Biodentine (Septodont, Saint Maur des Fossés, France) over the course of 1 year. METHODS: Twenty-eight intact premolars were resected 2 mm apical to the cementoenamel junction and the pulp tissues extirpated via the cervical cut. After the preparation of occlusal access to the pulp chamber, specimens were assigned into 4 groups according to a stratified randomization sampling process: group 1, negative control (dry sterile cotton pellet); group 2, positive control (blood-moistened cotton pellet); group 3, ProRoot WMTA (DENTSPLY Tulsa Dental Specialties); and group 4, Biodentine. The experimental materials were condensed into the crowns and the access sealed with glass ionomer restorative cement. Color was assessed at baseline (before placement of the materials), immediately after material filling, after 6 weeks of storage, and after 1 year using the Commission International de I'Eclairage L*a*b* system. Change in color, ΔE, was compared among groups and over time using analysis of variance. RESULTS: The 4 groups showed a significant decrease in L* values over time. Differences between Biodentine and WMTA were detected after 1 year, with the greater variation associated with WMTA (P = .001). The 4 groups presented a significant increase in ΔE from baseline to 1 year. All groups revealed perceptible color changes (ΔE > 2.3) between immediately after material filling and after 6 weeks and after 6 weeks and 1 year. After 1 year, no differences could be detected between Biodentine and WMTA. CONCLUSIONS: Delayed tooth discoloration was detected for the 2 materials at the 1-year evaluation, but it was more evident for ProRoot MTA than Biodentine. Luminance was the most affected parameter, with a higher decrease for ProRoot MTA.

Mandibular condylar hyperplasia: diagnosis and management. Case report / Hiperplasia da cabeça mandibular: diagnóstico e tratamento. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Mandibular condylar hyperplasia is a disease where excessive growth of mandibular condyle, ramus and body elicits facial asymmetry. Its therapeutic management is not a consensus and, due to its complexity, is a challenge for maxillofacial surgeons and orthodontists. This study aimed at discussing clinical, diagnostic and therapeutic aspects of the management of this disease, and at explaining the role of condylectomy. CASE REPORT: Female patient, 19 years old, Caucasian, looked for maxillofacial surgeon assistance due to facial asymmetry and pain on right temporomandibular joint. Patient had no medical, gestational or family history of facial deformity, or history of previous joint trauma or infection. This was a case of hemimandibular elongation treated with condylectomy. CONCLUSION: Condylectomy is a safe and effective procedure, without functional joint sequelae, which prevents dentalfacial deformity progression, minimizing its psychosocial impact and helping future treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A hiperplasia da cabeça mandibular é uma doença na qual há um crescimento excessivo da cabeça, ramo e corpo mandibulares que causa assimetria facial. A sua abordagem terapêutica não apresenta um consenso e, dada a sua complexidade, constitui um desafio para o cirurgião maxilofacial e para o ortodontista. O objetivo deste estudo foi discutir os aspectos clínicos, diagnósticos e terapêuticos envolvidos na abordagem dessa doença, clarificando o papel da condilectomia. RELATO DO CASO: Paciente do gênero feminino, 19 anos, caucasiana, procurou atendimento de um Cirurgião Maxilofacial devido a assimetria facial e dor na articulação temporomandibular direita. Não possuía antecedentes médicos ou gestacionais ou familiares de deformidade facial, nem história de trauma ou infecção articular prévios. Apresenta-se um caso clínico de alongamento hemimandibular tratado com condilectomia. CONCLUSÃO: A condilectomia é um procedimento seguro e eficaz, sem sequelas articulares funcionais, que evita a progressão da deformidade dentofacial, minimizando o seu impacto psicossocial e facilitando o tratamento posterior.