Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives.

The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Influence of a gray background and the illuminant on tooth shade selection.

STATEMENT OF PROBLEM: Visual shade selection in dentistry may be influenced by factors that include the background color and the illuminant. PURPOSE: The purpose of this clinical study was to evaluate the influence of using a gray background and a light-correcting device on visual shade selection. MATERIAL AND METHODS: Two experienced clinicians assessed the incisor color of 30 volunteers using the VITA 3D-MASTER shade guide. Visual analyses were carried out using or not (control) a gray background, with and without (control) a light-correcting device (Smile Lite). Furthermore, the use of a polarizing filter was evaluated. Data from a clinical spectrophotometer were defined as the standard instrumental analysis. The agreement and the similarity (based on the whitening indexes of tabs) were evaluated between instrumental and visual analyses. Statistical testing was conducted through ordinal logistic regression and repeated-measures ANOVA. The Shapiro-Wilk test was used to confirm the data distribution, and homogeneity of variance was assessed with the Levene test (α=.05) RESULTS: The use of Smile Lite resulted in lighter tabs than indicated by the instrumental analysis, and the opposite was observed in its absence. The polarizing filter did not affect the results (P>.05). For similarity, the illuminant improved the results (P<.001). The gray background reduced the differences between visual and instrumental analysis only in the absence of the Smile Lite (P<.001). CONCLUSIONS: The color similarity between visual and instrumental analysis improved with the use of a light-correcting device with or without a polarization filter. A gray background was useful only without the light-correcting device.

Effect of gingival barrier brands on operator perception, cervical adaptation, and patient comfort during in-office tooth bleaching: a randomized clinical trial.

BACKGROUND: Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort. OBJECTIVE: This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort. METHODS: Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05). RESULTS: Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall). CONCLUSIONS: This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality. CLINICAL TRIAL REGISTRATION: The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.

Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives

Abstract The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools.

The aim of this paper was to present a summary of the process of developing and preparing the final documents of the national consensus for teaching undergraduate Brazilian dental students the dental caries curriculum in the Portuguese language. The final document was developed in three steps: a) The ABENO and LAOHA cariology group invited experts from all five regions of Brazil to participate in the discussion. The theoretical support for crafting the first draft of the consensus was based on two publications: National Curriculum Guidelines of the Dentistry graduation in Brazil, Ministry of Education (2021) and the competences described in the European Core Curriculum for Cariology (ORCA-ADEE, 2011); b) The group of experts was divided into 5 working groups: G1-Domain, Main and Specific Competences, G2-Essential knowledge, G3-Life course perspective, G4-Social determinants and dental caries, G5- Glossary. The document was finalized by thoroughly reviewing the process using Delphi methodology; c) The 5-chapter document (one from each working group) was submitted to three open public consultations in 2022 (May-June, August, and October) using Google-forms. The suggestions (content/wording) were discussed within the group as: totally accepted, partially accepted, and rejected. A total of 192 suggestions were registered from 31 dental schools in all regions of Brazil. The number of suggestions received per Group were: 84, 28, 26, 24, 30 suggestions for G1, G2, G3, G4 and G5, respectively. The majority of suggestions were totally accepted by the group of experts (n = 172, 89.6%), 15 were partially accepted (7.8%), and 5 were rejected. Conclusion The final document could be considered to be the first national consensus for teaching the dental caries curriculum in Brazil.

Luting laminate veneers: Do resin-composites produce less polymerization stress than resin cements?

OBJECTIVES: Regular composites could produce less polymerization stress than resin cements when luting laminate veneers but there is no proper evidence to support this theory. The current study aimed to determine the degree of conversion, volumetric shrinkage, polymerization stress and the resultant elastic moduli of materials currently used for adhesive cementation and to determine possible correlations. METHODS: The study considered (i) regular resin composites (Admira Fusion, Gradia, Grandioso, Palfique, Sirius Z, Viscalor and Z100) at room and pre-warmed (PW) at 69ºC, (ii) flowable composites (Sigma Flow and Grandioso Flow); (iii) solely light-activated cements (AllCem Veneer, Variolink Esthetic and RelyX Veneer); and (iv) one dual-activated resin cement (SpeedCEM). Degree of conversion (DC, n = 3) was accessed with FTIR 1 h after irradiation. Bonded-disk and Bioman II instruments were used to access polymerization shrinkage strain and shrinkage stress, respectively, for 60 min at 23 ± 1◦C (n = 3). The elastic modulus was determined by 3-point bending flexural test (n = 6). The results were submitted to analyse s of variance, Tukey's, and correlation tests. RESULTS: For regular composites, the pre-warming did not affect DC, shrinkage and modulus but significantly increased the stress magnitude. Correlation tests indicated a significant relationship only between stress and polymerization shrinkage (r = 0.811343). SIGNIFICANCE: Regular composites can produce less polymerization stress than resin cements when luting laminate veneers. Polymerization stress was dependent on the shrinkage magnitude, but not on the degree of conversion nor the elastic modulus.

Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools

Abstract The aim of this paper was to present a summary of the process of developing and preparing the final documents of the national consensus for teaching undergraduate Brazilian dental students the dental caries curriculum in the Portuguese language. The final document was developed in three steps: a) The ABENO and LAOHA cariology group invited experts from all five regions of Brazil to participate in the discussion. The theoretical support for crafting the first draft of the consensus was based on two publications: National Curriculum Guidelines of the Dentistry graduation in Brazil, Ministry of Education (2021) and the competences described in the European Core Curriculum for Cariology (ORCA-ADEE, 2011); b) The group of experts was divided into 5 working groups: G1-Domain, Main and Specific Competences, G2-Essential knowledge, G3-Life course perspective, G4-Social determinants and dental caries, G5- Glossary. The document was finalized by thoroughly reviewing the process using Delphi methodology; c) The 5-chapter document (one from each working group) was submitted to three open public consultations in 2022 (May-June, August, and October) using Google-forms. The suggestions (content/wording) were discussed within the group as: totally accepted, partially accepted, and rejected. A total of 192 suggestions were registered from 31 dental schools in all regions of Brazil. The number of suggestions received per Group were: 84, 28, 26, 24, 30 suggestions for G1, G2, G3, G4 and G5, respectively. The majority of suggestions were totally accepted by the group of experts (n = 172, 89.6%), 15 were partially accepted (7.8%), and 5 were rejected. Conclusion The final document could be considered to be the first national consensus for teaching the dental caries curriculum in Brazil.

Stress as worsening of the signs and symptoms of the geographic tongue during the COVID-19 pandemic: a pilot study.

BACKGROUND: Geographic Tongue (GT) is a benign inflammatory disorder of unknown etiology, which is characterized by the loss of epithelium due to the atrophy of filiform papillae. It usually occurs on the dorsum of the tongue and may extend to its lateral edges. It appears as an erythematous area surrounded by whitish and slightly elevated margins. In most cases, the condition is asymptomatic, although some individuals may report symptoms that include a burning sensation of the tongue. OBJECTIVE: Assess whether there was a change in the clinical aspect of Geographic Tongue (GT) during the COVID-19 pandemic. METHODS: Thirty-two participants were recruited from Dentistry School Universidade Federal Fluminense. Anamnesis and oral examination were performed to collect medical history. The participants were split into two groups: control group (no GT) n = 20 and test group (with GT) n = 12. In the second step, nine participants from a 12 (75%) of the test group were contacted by phone and answered a questionnaire about changes in the signs and symptoms of GT during the pandemic. The subjects were subdivided into two groups: GT with and without signs and symptoms exacerbation. RESULTS: In the first phase of the research, no statistical difference between control and test groups was observed regarding clinical criteria such as age (p + 0.72), gender (p = 0.24), and systemic diseases (p = 0.58). In the second phase, there was a statistical difference between GT groups with or without symptom exacerbation in terms of age and stress as a factor of the oral symptoms (p = 0.3 and 0.2), respectively. Younger patients showed a worsening of the oral lesions related to GT (p = 0.3) and reported stress during the pandemic (p = 0.02). CONCLUSION: Younger patients were more susceptible to stress and presented more exacerbation of the oral lesions related to GT.

Use of Botulinum Toxin Before Surgical Lip Repositioning: A Randomized Clinical Trial.

This study aimed to determine whether administering botulinum toxin type A (BT) prior to surgery would stabilize surgical lip repositioning. A randomized controlled parallel-group clinical trial was performed. A total of 18 participants with excessive gingival display (EGD) were divided into two groups. For the test group (TG), BT was injected into the smile muscle locations 15 days before the surgical procedure. For the control group (CG), only lip repositioning surgery was performed. Gingival display (GD) and upper lip displacement (LD) were measured 3 and 6 months postoperatively. Data were submitted to ANOVA, Tukey, and t tests. For GD and LD, the changes were statistically significant between the measurements taken at the baseline, 3-month, and 6-month marks. The GD presented a reduction of 5.2 ± 1.1 mm in TG and 3.2 ± 1.4 mm in CG after 6 months. The LD measurements reduced 45% for TG and 26% for CG in 6 months. The injection of BT 15 days before lip repositioning surgery provided more stable results and effectively reduced the GD at 6 months.

Effectiveness of Supportive Care in the Prevention of Peri-implant Diseases in Brånemark Protocol Rehabilitations: A Retrospective Cohort Study.

This retrospective cohort study aimed to evaluate the efficiency of supportive periodontal treatment (SPT) on peri-implant disease prevention. A total of 63 rehabilitated patients with 504 implants were selected with both maxillary and mandibular Brånemark-type protocols (all-on-four system) placed between 2004 and 2014 in a private practice with 5 to 15 years of follow-up. Study participants were divided into those who adhered to SPT with regular intervals of two or more times a year (Group 1) and those with irregular intervals with more than 1 year without attending SPT (Group 2). The implants placed were evaluated clinically and radiographically to assess peri-implant diseases. The prevalence of mucositis and peri-implantitis in the total population was 64.7% (326 implants) and 3.7% (19 implants), respectively. Group 2 had higher rates of mucositis (181 implants) and peri-implantitis (16 implants) than Group 1 (145 and 3 implants, respectively) (P < .05). The odds ratio for peri-implantitis in Group 2 was 7.1. The results suggest that patients who regularly received SPT had lower chances of developing peri-implant diseases.

Alternative treatment to orthognatic surgery by the application of digital smile planning.

Through the use of the application of a mathematical proportion and a digital golden ratio compass associated with computer software, Digital Smile Planning (DSP) can assist clinicians to achieve the fundamentals of esthetic treatment. The present clinical report describes the application of this technique to propose an alternative and more conservative treatment for a patient who refused the option of orthognathic surgery. To address the diagnosis of a gingival smile with vertical maxillary excess, the alternative treatment comprised crown lengthening surgery, ceramic veneers on the maxillary teeth, and the application of botulinum toxin to reduce lip hyperactivity. Considering the successful resolution of the patient's situation from the perspective of both the dentist and the patient, the application of DSP was considered to be useful to achieve predictable harmony between the face and the dental structures.

Can bulk-fill compromise the curing potential in deep cavities? / Bulkfill pode comprometer o potencial de polimerização em cavidades profundas?

Objective: To determine the effect of the restorative technique, material's opacity and the selected light sources on the curing potential (CP) in deep cavities. Material and Methods: The radiant exitance (mW/cm2) of two light curing units (Bluephase G2 and Radii-Cal) was determined at 0 and 8 mm distance from a power meter sensor (Ophir). Two bulk-fill composites of regular consistency (Opus, FGM; and Filtek One, 3M) and a conventional one (Sirius-Z, DFL) were considered and the level of their opacity were determined by a sphere-based spectrophotometer (SP60, X-Rite). The degree of C=C conversion (DC) was determined by spectroscopy (FTIR-ATR) at 0.05 and 8 mm depths and the CP considered the ratio between them. The "incremental technique" considered 4 increments of 2mm thickness each, whereas the "bulk-fill technique considered 2 increments of 4mm-thickness. Data were submitted to analysis of variance and Tukey's test (95%). Pearson's correlation tests were performed to calculate the possible relation between curing potential and materials' opacity. Results: With the incremental technique it was possible to achieve high CP regardless of the light source. The CP of bulk-fill composites was dependent on the light source, whereas Radii-Cal compromised the DC at 8 mm for both materials. The correlation between opacity and CP was dependent on the light source (r = 0.891707246 for Radii-Cal; r = 0.515703768 for Bluephase G2). Conclusion: The bulk-fill technique was dependent on the light source while the incremental was not. The influence of materials' opacity was dependent on the light curing unit.(AU)

Objetivo: Determinar o efeito da técnica restauradora, a opacidade do material e as fontes de luz selecionadas sobre o potencial de cura (PC) em cavidades profundas. Materiais e métodos: A saída radiante (mW/cm2) de duas unidades de cura por luz (Bluephase G2 e Radii-Cal) foi determinada a 0 e 8 mm de distância de um sensor de potência (Ophir). Dois compósistos bulkfill de consistência regular (Opus, FGM; e Filtek One, 3M) e um convencional (Sirius-Z, DFL) foram considerados e o nível de sua opacidade foi determinado por um espectrofotômetro (SP60, X-Rite). O grau de conversão C=C (DC) foi determinado por espectroscopia (FTIR-ATR) a 0,05 e 8 mm de profundidade e o PC considerou a relação entre eles. A técnica incremental considerou 4 incrementos de 2 mm de espessura cada, enquanto que a técnica bulkfill considerou 2 incrementos de 4 mm de espessura. Os dados foram submetidos à análise de variância e ao teste de Tukey (95%). Os testes de correlação de Pearson foram realizados para calcular a possível relação entre o potencial de cura e a opacidade dos materiais. Resultados: Com a técnica incremental foi possível obter um PC elevado, independentemente da fonte de luz. O PC de compósitos bulkfill foi dependente da fonte de luz, enquanto que Radii-Cal comprometeu o DC em 8 mm para ambos os materiais. A correlação entre opacidade e PC foi dependente da fonte de luz (r = 0,891707246 para Radii-Cal; r = 0,515703768 para Bluephase G2). Conclusão: O potencial de polimerização para a técnica bulkfill foi dependente da fonte de luz, enquanto para a técnica incremental não. A influência da opacidade dos materiais sobre a capacidade de polimerização foi dependente da unidade de fotoativação. (AU)

Color change, tooth sensitivity, aesthetic self-perceptions and quality of life after at-home dental bleaching / Mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro

Objective: The aim of this study was to determine the color change, tooth sensitivity, aesthetic self-perception and quality of life after at-home dental bleaching. Material and Methods: Dental examination was performed and the initial color of the upper right incisor was recorded using a spectrophotometer (Easyshade Compact, Vita Zahnfabrik) and CIELab parameters. Individual vinyl trays were delivered to the patients (n=37) who were instructed to use the carbamide peroxide 16% (Total Blanc Home C16%, DFL) for 2 hours daily for 2 weeks. One-week after the end of treatment, measurements were repeated to calculate color (ΔEab,ΔE00) and whiteness index (ΔWID) variations. Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires were applied before and 30 days after treatment. Tooth sensitivity was by checked by visual analogue scale (VAS). Spearnan's correlation tests were used to verify the possible relation between color change parameters and sensitivity. The Wilcoxon test was applied for results obtained by OHIP and PIDAQ questionnaires. Results: Significant color change was observed after 14 days, regardless of the considered parameter. There was no significant correlation between sensitivity and color change. The dental self-confidence domain increased after bleaching (p = 0.029) and the psychological impact decreased (p = 0.001). Conclusion:At-home dental bleaching was effective on the overall whitening and the color change was not related to tooth sensitivity. The bleaching treatment had a positive impact on the quality of life, reducing psychological discomfort and improving dental self-confidence and aesthetic self-perception. (AU)

Objetivo: O objetivo deste estudo foi determinar a mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro. Material e Métodos: Uma consulta inicial foi realizada e a cor inicial do incisivo superior direito foi registrada usando um espectrofotômetro (Easyshade Compact, Vita Zahnfabrik) e parâmetros CIELab. Moldeiras individuais confeccionadas em vinil foram entregues aos pacientes participantes (n = 37), que foram instruídos a usar o gel à base de peróxido de carbamida 16% (Total Blanc Home C16%, DFL) durante 2 horas diárias durante 2 semanas. Uma semana após o término do tratamento, as medidas foram repetidas para calcular a variação de cor (ΔEab, ΔE00) e o índice de brancura (ΔWID). Os questionários OHIP (Oral Health Impact Profile) e PIDAQ (Psychosocial Impact of Dental Aesthetics Questionnaire) foram aplicados antes e 30 dias após o tratamento. A sensibilidade dental foi verificada por meio da escala visual análoga (VAS). Os testes de correlação de Spearnan foram utilizados para verificar a possível relação entre os parâmetros de mudança de cor e sensibilidade. O teste Wilcoxon foi aplicado para os resultados obtidos pelos questionários OHIP e PIDAQ. Resultados: Mudança de cor significativa foi observada após 14 dias, independentemente do parâmetro considerado. Não houve correlação significativa entre a sensibilidade e a mudança de cor. O domínio da autoconfiança dental aumentou após o branqueamento (p = 0,029) e o impacto psicológico diminuiu (p = 0,001). Conclusão: O clareamento dental caseiro foi eficaz no branqueamento geral e a mudança de cor não estava relacionada à sensibilidade dental. O tratamento clareador teve um impacto positivo na qualidade de vida, reduzindo o desconforto psicológico e melhorando a autoconfiança dental e a autopercepção estética.(AU)

A HUMANIZAÇÃO NO ESCOPO DA FORMAÇÃO ACADÊMICA DOS GRADUANDOS EM ODONTOLOGIA, ENFERMAGEM E MEDICINA À LUZ DOS PROJETOS POLÍTICO-PEDAGÓGICOS / HUMANIZATION IN THE SCOPE OF ACADEMIC TRAINING OF UNDERGRADUATE STUDENTS IN DENTISTRY, NURSING AND MEDICINE IN THE LIGHT OF PEDAGOGICAL POLITICAL PROJECTS

Um dos maiores desafios na formação acadêmica do profissional de saúde é a conscientização da importância da humanização no atendimento, que, além de valorizar o cuidado em suas dimensões técnicas e científicas, reconhece também o direito dos pacientes, sua subje-tividade, individualidade e autonomia. Este trabalho objetivou identificar e analisar, por meio de uma pesquisa documental, a pre - sença do termo humanização nos Projetos Político-Pedagógicos e Diretrizes Curriculares dos cursos de: Odontologia, Enfermagem e Medicina da Universidade Federal Fluminense em Niterói, no estado do Rio de Janeiro. Foi realizada uma pesquisa exploratória descritiva, com abordagem qualitativa. A análise documental dos currículos evi- denciou uma aproximação com o tema nos três cursos estudados, porém com variações importantes no que se refere ao método de aplicação dos conteúdos teórico-práticos, ao longo do processo de formação. Nessa perspectiva, o curso de Medicina apresentou uma distribuição mais homogênea dos conteúdos relacionados ao termo humanização encontrado nas suas disciplinas obrigatórias. Foi pos- sível, também, perceber o empenho dos cursos em contemplar as Novas Diretrizes Curriculares tendo a humanização como elemento prioritário no que se refere à construção de novas relações entre alunos, docentes, usuários dos serviços e a rede do Sistema Único de Saúde (SUS) local. Conclui-se que os três cursos estudados apresen- tam uma aproximação com o tema, esforçam-se em incorporar os pressupostos da humanização, tais como: ética, respeito, acolhimento, e procuram uma maior aproximação entre os sujeitos envolvidos na construção de novas relações entre alunos, docentes e usuários dos serviços e a rede SUS local.

One of the greatest challenges in the health professional training is to be aware of the importance of humanization in care, in which, in addition to valuing care in its technical and scientific dimensions, they also recognize patients' rights, their subjectivity, individuality and autonomy. This work aimed to identify and analyze, through documentary research, the presence of the term humanization in the Political Pedagogical Projects and Curricular Guidelines of the Medicine, Dentistry and Nursing courses of the Federal Fluminense University. A descriptive exploratory research was carried out with a qualitative approach. The documentary analysis showed an approximation with the theme in the three courses studied, but with important variations regarding the method of application of the theoretical-practical content, throughout the training process. In this perspective, the Medicine course presented a more homogeneous distribution of the contents related to the term humanization found in its obligatory subjects. It was also possible to perceive the commitment of the courses to contemplate the New Curricular Guidelines, with humanization as a priority element in the construction of new relationships among students, teachers, users of the services and the local Public Health System (Sistema Único de Saúde - SUS). It is concluded that the three courses studied present an approxima-tion with the theme, strive to incorporate the presuppositions of humanization, such as: ethics, respect, acceptance, and seek a closer approximation between the subjects involved in the construction of new relations among students, teachers and users of the services and the local SUS.

The Impact of Tooth Whitening Procedures on the Quality of Life: a Topic Review / O Impacto na Qualidade de Vida do Procedimento de Clareamento Dental: uma Revisão Sobre o Tema

A estética em odontologia é uma das metas a ser alcançada visando à melhoria da qualidade de vida do paciente. O clareamento dental é um procedimento de baixo custo que pode ser realizado no consultório ou pelo próprio paciente em casa. Vários trabalhos científicos comprovaram sua eficácia e outros estudos foram realizados para avaliar essa eficácia com o impacto psicossocial. Entre as ferramentas que têm sido utilizadas para esse fim estão os questionários Oral Health Impact Profile (OHIP), Oral Impact on Daily Performance (OIDP) e Psicossocial Impact of Dental Esthetics (PIDAQ). O presente estudo tem como objetivo fazer uma revisão da literatura sobre o impacto do clareamento dental na qualidade de vida dos pacientes. As bases de dados PubMed, Cochrane Central, Scopus e Embase foram pesquisadas. Foram identificados 224 artigos e selecionados 40, dos quais 13 eram estudos clínicos. Parece haver um consenso na literatura pesquisada em relação ao clareamento dentário e à melhora da qualidade de vida. Por outro lado, sensibilidade dentária e irritação gengival também foram relatadas, o que pode levar a um impacto negativo na vida das pessoas. Porém, esse efeito negativo pode ser evitado ou minimizado pela associação do diagnóstico correto da mudança de cor, a utilização da técnica ideal e a concentração do agente clareador recomendada pelo dentista.

One of the goals to be achieved in cosmetic dentistry is the improvement of a patient's quality of life. Tooth whitening is a low-cost procedure that can be performed either in- office or by the patients themselves, at home. Several scientific papers have proven its effectiveness and other studies have been conducted to evaluate its psychosocial impact. Among the tools that have been used for this purpose are the questionnaires Oral Health Impact Profile (OHIP), Oral Impact on Daily Performance (OIDP) and Psycho-social Impact of Dental Aesthetics (PIDAQ). The present study aims to review the literature regarding the impact tooth whitening has on a patients' quality of life. PubMed, Cochrane Central, Scopus and Embase databases were searched. 224 articles were identified, and 40 articles were selected, of which 13 were clinical studies. There seems to be a consensus in the literature researched associating tooth whitening to improvement in quality of life. On the other hand, some negative impacts have been reported, such as dental sensitivity and gingival irritation. However, these negative effects can be minimized or even avoided with the combination of correct diagnosis of the color change, ideal technique application, and the appropriate concentration of whitening agent as recommended by the dentist.

Light and viscosity effects on the curing potential of bulk-fill composites placed in deep cavities.

To determine the influence of light curing units (LCUs) and material viscosity on the degree of conversion (DC) of bulk-fill (BF) resin-based composites (RBCs) placed in deep cavity preparations. Four LCUs were tested: Valo cordless, Bluephase-G2, Poly wireless and Radii-cal. Light irradiance was determined at 0 mm and 6 mm distance to the reading sensor. The following RBCs were considered: Filtek BF, Filtek BF Flow, Opus BF, Opus BF Flow, Tetric N-Ceram BF and Surefil SDR Flow. Sirius-Z was used with the incremental technique. DC (n = 3) was evaluated by spectroscopy both at top and bottom regions of deep preparations with 6 mm depth. The data were submitted to ANOVA and Tukey's test (α = 0.05). Pearson's correlation (95%) was used to verify the relation between the LCUs and the curing potential of RBCs. The DC at 6 mm depth was reduced when Opus BF, Opus BF Flow and Tetric N-Ceram BF were activated with Radii-cal. There was a positive correlation between the LCU irradiance and the bottom/top conversion ratios. The materials' viscosities did not affect the curing potential. Bulk-fill composites did not present higher curing potential than the conventional composite used with the incremental technique; the most important aspect of the LCU was the irradiance ratio; and the materials' viscosity did not affect the curing potential as a function of depth. Radii-cal negatively impacted the degree of conversion at 6 mm depth for most bulk-fill resin composites. Depending on the brand, bulk-fill composites may present reduced curing potential due to the light source when placed in deep cavities. Dentists should avoid LCU with acrylic tips to photoactivate bulk-fill resin-based composites.

Physicochemical properties and biological effects of quaternary ammonium methacrylates in an experimental adhesive resin for bonding orthodontic brackets.

METHODOLOGY: Fixed orthodontic appliances may lead to biofilm accumulation around them that may increase caries risk. This study aimed to evaluate the influence of quaternary ammonium methacrylates (QAMs) on the physicochemical properties, cytotoxicity, and antibacterial activity of adhesive resins for orthodontic purposes. A base resin was prepared with a comonomer blend and photoinitiator/co-initiator system. Two different QAMs were added to the base adhesive: dimethylaminododecyl methacrylate at 5 wt.% (DMADDM) or dimethylaminohexadecyl methacrylate (DMAHDM) at 10 wt.%. The base adhesive, without QAMs, (GC) and the commercial Transbond™ XT Primer 3M (GT) were used as control. The resins were tested immediately and after six months of aging in the water regarding the antibacterial activity and shear bond strength (SBS). The antibacterial activity was tested against Streptococcus mutans via metabolic activity assay (MTT test). The groups were also tested for the degree of conversion (DC) and cytotoxicity against keratinocytes. RESULTS: The resins containing QAM showed antibacterial activity compared to the commercial material by immediately reducing the metabolic activity by about 60%. However, the antibacterial activity decreased after aging (p<0.05). None of the groups presented any differences for SBS (p>0.05) and DC (p>0.05). The incorporation of DMADDM and DMAHDM significantly reduced the keratinocyte viability compared to the GT and GC groups (p<0.05). CONCLUSION: Both adhesives with QAMs showed a significant reduction in bacterial metabolic activity, but this effect decreased after water aging. Lower cell viability was observed for the group with the longer alkyl chain-QAM, without significant differences for the bonding ability and degree of conversion. The addition of QAMs in adhesives may affect the keratinocytes viability, and the aging effects maybe decrease the bacterial activity of QAM-doped materials.

In vitro analysis of the pH stability of dental bleaching gels during in-office procedures.

BACKGROUND: Previous studies have shown that acidic bleaching gels could lead to worse collateral effects during an in-office bleaching procedure, while neutral or basic products leads towards a better experience. Considering this fact, the main purpose of this study was to evaluate the pH behavior of 6 in-office bleaching gels, compared to the information provided by their manufacturers. MATERIAL AND METHODS: Thirty enamel discs of bovine teeth were prepared, the initial colors of which were measured by a spectrophotometer and then divided into 6 groups. A pH meter was used to measure the pH every 30 seconds until the end of each procedure, when a new color evaluation was then made. The Tukey test was used for statistical analysis of the results. RESULTS: There was no difference in the color variation (ΔE) between the groups (p> 0.05). In two groups, the pH variation (ΔpH) showed neutral stability, with initial and final pH averages of 7.04 and 7.11 (p = 0.08) and 7.21 and 7.19 (p = 0.55), respectively; in another, there was alkaline stability, with an initial and final pH average of 8.54 and 8.37 (p = 0.14). In the other three brands, however, the results showed acidification, with initial and final pH averages of 6.14 and 5.22 (p = 0.001), 6.05 and 5.16 (p = 0.001) and 7.14 and 5.83 (p = 0.001), respectively. CONCLUSIONS: In 3 of the evaluated gels, a discrepancy existed between the manufacturer's information and the data obtained, which could lead, considering previous studies discussed throughout this article, to unexpected collateral effects on the patients, especially dental sensitivity. Thus, clinicians and researchers should be aware about pH stability studies of in-office bleaching gels for better predictability and safety on their clinical usage. Key words:Tooth bleaching, Bleaching agents, Hydrogen-ion concentration, Dentin sensitivity, Hydrogen peroxide.

Adhesion and optics: The challenges of esthetic oral rehabilitation on varied substrates-Reflections based on a clinical report.

Patients with challenging prosthodontic conditions require rehabilitation with a biological, functional, and esthetic approach. When one or more teeth are badly discolored, their restoration is problematic because poor appearance affects not only the crown but also the periodontal tissues. This clinical report describes a complex esthetic rehabilitation with conservative tissue management and ceramic restorations. Subepithelial connective tissue graft surgery and the replacement of a cast metal post with a glass fiber post addressed the problem of a discolored maxillary central incisor. The discolored right maxillary incisor was restored with a combination of a medium-opaque, lithium-disilicate ceramic coping to mask the dark root and to approximate the color of the other incisors. Subsequently, 6 ceramic veneers were placed. A knowledge of the materials' optical properties and adhesion possibilities helped solve this complex problem.

Silane content influences physicochemical properties in nanostructured model composites.

OBJECTIVE: To determine the effect of organosilane content on the physicochemical properties of model composites formulated with nano-sized fillers. METHODS: Model composites were formulated with dimethacrylate-based monomers, a photoinitiator/co-initiator system and silicon dioxide nano-sized fillers treated with different amounts of 3-methacryloxypropyltrimethoxysilane (MPTS): 1.0 (G1%), 2.0 (G2%), 5.0 (G5%), 7.5 (G7.5%) and 10 (G10%) wt.% relative to SiO2. Non-silanized fillers (G0%) were used in the control group. Degree of conversion (DC) was assessed by Fourier-transformed infrared spectroscopy (ATR-FTIR). Knoop hardness (KHN) and elastic modulus were determined before and after water storage for 4 months. Water sorption (Wsp) and solubility (Wsl) were calculated by successive mass determinations in analytical balance. Surface gloss and roughness were characterized before and after toothbrushing simulation. RESULTS: With the exception of those fillers treated with 1% MPTS, DC was not dependent on the silane content. Within the silanized groups, G1% showed the lowest initial and final KHN, without statistical difference from G0%. The elastic modulus was not affected by the silane content, regardless of the storage condition, but those groups formulated with at least 5% silane presented improved values after storage. Silane content did not affect the WSl, but affected Wsp, in which those groups formulated with at least 2 wt.% of MPTS produced a more resistant material than G0%. The use of treated particles with at least 2 wt.% of silane was able to produce materials that did not change their gloss after the brushing process. Additionally, these materials presented lower surface roughness than G0% after the brushing process (p < 0.05). SIGNIFICANCE: The concentration of MPTS affected the physicochemical properties of nano-filled composites. Therefore, 2 wt.% of silane was the optimized quantity to produce materials resistant to degradation, both in bulk and surface properties.