3-year clinical effectiveness of one-step adhesives in non-carious cervical lesions.

OBJECTIVES: Despite representing an important component of current dental adhesives, HEMA has been said to negatively influence the long-term stability of adhesion to dentine and enamel. The aim of this randomised clinical trial was to evaluate the 3-year clinical performance of two one-step self-etch adhesives. METHODS: Thirty patients had 175 non-carious cervical lesions restored with composite (Gradia Direct Anterior, GC) using either the HEMA-rich adhesive Clearfil Tri-S Bond (C3S; Kuraray) or the HEMA-free adhesive G-Bond (GB; GC). The restorations were evaluated by two examiners at baseline, 6, 12, 24 and 36 months regarding retention, caries recurrence, marginal integrity and discoloration and post-operative sensitivity. The data were statistically analysed with GEE and McNemar tests (p<0.05). RESULTS: The recall rate at 6 and 12 months was 100% and decreased to 96.7% at 24 and 36 months. At 3 years, the retention rate was 93.8% for C3S and 98.8% for GB (p=0.14). A pairwise comparison showed no significant differences between the two adhesives for all the parameters evaluated, irrespective of the recall (p>0.05). After 3 years, both adhesives presented an increase in the percentage of clinically acceptable marginal discoloration (C3S: 32.9% and GB: 26.8%) normally associated to clinically acceptable marginal defects (C3S: 35.8% and GB: 26.5%). Only 1 dentine margin of a GB restoration presented a severe marginal defect (1.2%) and 1 C3S restoration presented caries recurrence. The overall 3-year clinical success rate was 92.6% for C3S and 97.6% for GB (p=0.16). CONCLUSION: Both one-step self-etch adhesives presented an equally favourable clinical effectiveness at 3 years. CLINICAL SIGNIFICANCE: HEMA is a monomer frequently present in dental adhesives in order to increase their wettability and hydrophilicity. However, this monomer negatively influences hydrolytic stability and durability of the adhesive interface complex. In this 3-year clinical trial no significant difference in bonding effectiveness was noticed between a HEMA-rich and HEMA-free one-step adhesive.

RCT comparing minimally with moderately rough implants. Part 1: clinical observations.

AIM: This 1-year prospective RCT compared the outcome of minimally (turned) and moderately rough (TiUnite) implant surfaces. MATERIAL AND METHODS: Two subgroups of patients were formed; one group (n = 10) where all teeth had been extracted due to severe periodontitis, another group (n = 8) with teeth in the antagonistic jaw with a history of periodontitis and some remaining medium pockets (4-6 mm). Implants (n = 85, 43 turned & 42 TiUnite) were installed randomly in each patient. After 3-6 months of submerged healing, healing abutments were connected, followed by final abutments 2 weeks later, all with the same surface characteristics as the supporting implant. Peri-implant parameters and intra-oral radiographs were recorded up to 1 year after abutment connection. RESULTS: Two turned implants failed in the partial edentulous group during the initial healing period (CSR: 95%) and none of the TiUnite (CSR: 100%) surface. No statistically significant differences in clinical parameters could be observed between both surfaces. The partial edentulous subgroup showed more bone loss compared to the full edentulous subgroup. CONCLUSION: Moderately rough implants have a similar clinical outcome (at 1 year of loading in periodontitis susceptible patients) compared to minimally rough implants.

Current aspects on bonding effectiveness and stability in adhesive dentistry.

Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel-dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch-and-rinse and a self-etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two-step etch-and-rinse and one-step (self-etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user-friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one-step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi-step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.

Surface roughness of etched composite resin in light of composite repair.

OBJECTIVES: In search for clinically effective composite repair protocols, the effect of various etching protocols on the surface roughness of composite resins with different filler composition were investigated. METHODS: Of two composite resins (hybrid-filled Clearfil AP-X; nano-filled Filtek Supreme XT) specimens of 3mm thick with a diameter of 7 mm were prepared (n=24). The top surface was polished with 4000-grit SiC-abrasive paper and subjected to one of eight surface treatments: (n=3): negative control (NC), 37% phosphoric acid for 20s (37PA-20s), 3% hydrofluoric acid for 20s (3HF-20s), for 120 s (3HF-120 s), 9.6% hydrofluoric acid for 20s (9.6HF-20s), for 120 s (9.6%HF-120 s), 37PA-20s followed by 9.6%HF for 120 s (37PA-20s/9.6HF-120 s) and 9.6%HF for 120 s followed by 37PA-20s (9.6HF-120s/37PA-20s). Roughness (S(a)) was measured using a 3D noncontact optical interferometer (WYKO) and surface topography imaged by SEM. Multilevel models were used to estimate the variances within a sample and between samples in each group. Using the resulting overall variances and the means for each group, the eight groups were compared consecutively using t-tests (p<0.05). RESULTS: The hybrid-filled composite resin demonstrated a significantly rougher surface than the nano-filled (p<0.05). For both composites 9.6%HF-120 s, 37PA-20s/9.6HF-120 s and 9.6%HF-120 s/37PA-20s resulted in a large increase in roughness compared to the other groups (p<0.05). For the hybrid-filled, the succeeding groups (37PA-20s, 3HF-20s, 3HF-120 s and 9.6HF-20s) resulted in a statistically significant increase in surface roughness (p<0.02). For the nano-filled only a statistically significant increase in roughness was found between 3HF-20s and 3HF-120 s (p<0.001) and between 9.6HF-20s and 9.6HF-120 s (p<0.001). SEM surface characterization revealed that the hybrid-filled composite resin was much more affected by etching than the nano-filled. SIGNIFICANCE: Composite resins should not be seen as a group of materials having identical properties when it comes to repair. The effect of etching will depend on the composition of the filler particles.

Nanoleakage distribution at adhesive-dentin interfaces in 3D.

In spite of its role in the degradation of tooth-biomaterial interfaces, reports on nanoleakage are largely inconsistent. The aim of this work was to assess nanoleakage patterns qualitatively and quantitatively in 3D, to determine the influence of direction, position, and inclination of the field-of-view. Therefore, we applied a gold-standard 3-step etch-and-rinse adhesive to bur-cut dentin surfaces, after which interface samples were sectioned, infiltrated with an ammoniacal silver-nitrate solution, and embedded by common TEM procedures. High-resolution 3D models of interfaces were then generated by FIB and electron tomography, following strict conditions determined by Monte Carlo simulations. Inverted images in FIB tomography disclosed morphological characteristics analogous to those revealed by TEM. Quantitative analysis revealed large variations in silver-nitrate uptake between 2D image projections in different directions. Furthermore, silver-nitrate fractions in individual 2D image projections were seldom related to the total 3D volumetric fraction. Electron tomography showed that inclination also affected the morphology of silver-nitrate patterns. In conclusion, conventional nanoleakage evaluation is heavily influenced by direction, position, and inclination of the field-of-view, and thus may contain artifacts.

Oral appliance treatment for obstructive sleep apnoea patients with severe dental condition.

This clinical report introduces and evaluates the use of a mandibular advancement oral appliance (OA) attached to a denture base for the treatment of obstructive sleep apnoea syndrome (OSAS) in a patient presenting severe dental problems and multiple missing teeth. It concerned a 58-year-old man with moderate OSAS (apnoea index (AI): 15·9 h(-1) ; apnoea hypopnea index (AHI): 21·7 h(-1) ), presenting ten remaining teeth (maxilla: 5, mandible: 5) and important dental and periodontal problems. A treatment OA comprising both maxillary and mandibular parts was fabricated with an acrylic resin base, simulating the structure of a conventional removable partial denture (RPD). The polysomnography examination performed after the use of the OA showed the treatment induced a significant decrease in OSAS symptoms (AI: 0·7 h(-1) , AHI: 8·2 h(-1) ). All the necessary dental and periodontal treatments were performed to assure the reestablishment of oral health. The treatment OA was modified after each treatment to adapt it to each new oral condition. After 18 months, once the oral health was reestablished with seven remaining teeth (maxilla: 5, mandible: 2), final RPDs and final OA were fabricated. Polysomnography with final OA showed a similar positive result with respect to OSAS symptoms. No side effects related to the OA treatment were detected during the 3-year follow-up. To keep a sound oral condition, periodical dental care was performed by specialists in both periodontal and prosthodontic clinics. This clinical report shows the feasibility of treating OSAS patients with OA even in the presence of severe oral conditions and multiple missing teeth.

Filler debonding & subhybrid-layer failures in self-etch adhesives.

The mechanisms behind bond degradation are still largely unknown, in particular with respect to self-etch adhesives. One-step adhesives have been especially documented with problems, such as insufficient polymerization, water-uptake and subsequent plasticization, water- and enzyme-induced nanoleakage, and/or the presence of voids due to phase-separation or osmosis. It was hypothesized that these shortcomings may weaken the adhesive layer and, as such, may jeopardize long-term bonding. In contrast to the control three-step etch & rinse adhesive, the bond strength to dentin of both one-step and two-step self-etch adhesives decreased after six-month water storage. TEM revealed not only that they exhibited filler de-bonding within the adhesive resin layer, due to hydrolysis of the filler-matrix coupling, but also that they failed predominantly directly under the hybrid layer at dentin, in spite of the presence of interfacial droplets and nanoleakage in the adhesive layer. These failures just under the hybrid layer may be attributed to insufficient encapsulation of surface smear.

Use of pcr-rflp of thefla a gene for detection and subtyping of Campylobacter jejuni strains Potentially related to Guillain-barré syndrome, isolated from humans and animals

The objectives of the present study were the subtyping of Campylobacter jejuni subsp. jejuni strains obtained from humans and different animal species using PCR-RFLP, and the detection, by means of the same technique, of strains related to serotype PEN O19:LIO 7, the main C. jejuni serotype linked to Guillain-Barré Syndrome (GBS). Seventy C. jejuni strains isolated from human feces (n=33), primates (n=15), dogs (n=5), swine (n=2), bovines (n=1), abortion material from goats (n=2) and poultry carcasses (n=12), all collected in the state of São Paulo, were subtyped by means of PCR-RFLP of fla A gene, using restriction endonucleases Hae III, Afa I and Mbo I. Seven subtypes were observed when using the enzyme Hae III; eight when using Mbo I; and seven when using Afa I. The combination of the three endonucleases led to 16 fla-RFLP subtypes, from which ten subtypes shared strains of human and animal origin. From these, seven subtypes were observed in human and broiler strains. In eight subtypes, the other animal species shared patterns with human strains. It was inferred that, besides broilers, swine, goats, dogs and primates may be sources of infection for human in São Paulo. PCR-RFLP is a highly discriminatory technique that may be applied to molecular epidemiology studies of samples from different origins. Besides, the study also enabled the detection of two human strains and two primate strains related to serotype PEN O19: LIO 7.

Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer.

UNLABELLED: Glass-ionomers (GIs) exhibit excellent clinical bonding effectiveness, but still have shortcomings such as polishability and general aesthetics. The aims of this study were (1) to determine the micro-tensile bond strength (microTBS) to enamel and dentin of a nano-filled resin-modified GI (nano-RMGI; Ketac N100, 3M-ESPE), and (2) to characterize its interfacial interaction with enamel and dentin using transmission electron microscopy (TEM). METHODS: The nano-RMGI was used both with and without its primer, while a conventional RMGI restorative material (conv-RMGI; Fuji II LC, GC) and a packable conventional GI cement (conv-GI; Fuji IX GP, GC) were used as controls. After bonding to freshly extracted human third molars, microspecimens of the interfaces were machined into a cylindrical hourglass shape and tested to failure in tension. Non-demineralized TEM sections were prepared and examined from additional teeth. RESULTS: The microTBS to both enamel and dentin of nano-RMGI and conv-GI were not statistically different; the microTBS of non-primed nano-RMGI was significantly lower, while that of conv-RMGI was significantly higher than that of all other groups. TEM of nano-RMGI disclosed a tight interface at enamel and dentin without surface demineralization and hybrid-layer formation. A thin filler-free zone (<1 microm) was formed at dentin. A high filler loading and effective filler distribution were also evident, with localized areas exhibiting nano-filler clustering. CONCLUSIONS: The nano-RMGI bonded as effectively to enamel and dentin as conv-GI, but bonded less effectively than conv-RMGI. Its bonding mechanism should be attributed to micro-mechanical interlocking provided by the surface roughness, most likely combined with chemical interaction through its acrylic/itaconic acid copolymers.

Use of pcr-rflp of the fla a gene for detection and subtyping of Campylobacter jejuni strains Potentially related to Guillain-barré syndrome, isolated from humans and animals.

The objectives of the present study were the subtyping of Campylobacter jejuni subsp. jejuni strains obtained from humans and different animal species using PCR-RFLP, and the detection, by means of the same technique, of strains related to serotype PEN O19:LIO 7, the main C. jejuni serotype linked to Guillain-Barré Syndrome (GBS). Seventy C. jejuni strains isolated from human feces (n=33), primates (n=15), dogs (n=5), swine (n=2), bovines (n=1), abortion material from goats (n=2) and poultry carcasses (n=12), all collected in the state of São Paulo, were subtyped by means of PCR-RFLP of fla A gene, using restriction endonucleases Hae III, Afa I and Mbo I. Seven subtypes were observed when using the enzyme Hae III; eight when using Mbo I; and seven when using Afa I. The combination of the three endonucleases led to 16 fla-RFLP subtypes, from which ten subtypes shared strains of human and animal origin. From these, seven subtypes were observed in human and broiler strains. In eight subtypes, the other animal species shared patterns with human strains. It was inferred that, besides broilers, swine, goats, dogs and primates may be sources of infection for human in São Paulo. PCR-RFLP is a highly discriminatory technique that may be applied to molecular epidemiology studies of samples from different origins. Besides, the study also enabled the detection of two human strains and two primate strains related to serotype PEN O19: LIO 7.

A randomized controlled clinical trial of a HEMA-free all-in-one adhesive in non-carious cervical lesions at 1 year.

OBJECTIVES: One-step self-etch adhesives are the most recent generation of adhesives introduced onto the market. The objective of this randomized controlled clinical trial was to test the hypothesis that a one-step self-etch adhesive performs equally well as a conventional three-step etch&rinse adhesive (gold standard). METHODS: Fifty-two patients had 267 non-carious cervical lesions restored with Gradia Direct Anterior (GC). These composite restorations were bonded either with the 'all-in-one' adhesive G-Bond (GC) or with the three-step etch&rinse adhesive Optibond FL (Kerr). The restorations were evaluated after 6 and 12 months clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. Retention loss, severe marginal defects and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. A logistic regression analysis with generalized estimating equations was used to account for the clustered data (multiple restorations per patient). RESULTS: The recall rate at 1 year was 98%. The statistical analysis revealed a relatively low patient factor, indicating that supplementary information could be obtained from the additional restorations placed per patient. The retention rate for G-Bond was 98.5% compared to 99.3% for Optibond FL, due to the retention loss of two and one restorations, respectively. There were no significant differences between the two adhesives regarding the evaluated parameters except for the presence of small enamel marginal defects with G-Bond. CONCLUSIONS: After 12 months, the simplified one-step G-Bond and the three-step Optibond FL were clinically equally successful, even though both adhesives were characterized by progressive degradation of marginal adaptation, and G-Bond exhibited more small enamel marginal defects.

Ureaplasma diversum and reproductive disorder in Brazilian cows and heifers; first report.

The species Ureaplasma diversum is associated with bovine reproductive illnesses, in particular granular lesions of the vulva and vagina or granular vulvovaginitis (GVV). In Brazil, this pathology is unknown and, until this point in time, the presence of U. diversum in the Brazilian herds has been ignored. With the intention of detecting the microorganism, vulvovaginal mucuses of 152 animals located on seven farms in the São Paulo State, Brazil were analyzed. Those animals had evidence of reproductive disorders at the time of the sample collection. The technique used for microorganism detection was bacterial isolation. Statistical analysis assessed: the exposure of studied farms to U. diversum, relative risks for different symptoms, susceptibility of the animals according to age and breed. The frequency of that microorganism in tested animals was 38.8% and this frequency suggests that U. diversum can be related to GVV in Brazilian herds and possibly with other reproductive illnesses. As a result, the U. diversum differential diagnosis could be very important.