Conscious sedation in Spanish dental schools: Current situation.

The current Spanish curricula for degrees in dentistry include conscious sedation (CS) as a basic training competency. However, is the CS training delivered by Spanish dental schools a consensus-based educational framework enabling students to use this anesthetic technique after graduation? To answer this research question, a study was designed aiming to identify the strategies used to teach this competency in Spanish dental schools and the characteristics of teaching. The authors reviewed legislation concerning officially established requirements for a degree in dentistry as well as curricula currently taught in Spain. Our analysis identified clear discrepancies among the schools of dentistry studied. The only overlap was observed in reference to the level of proficiency imparted, which prevents Spanish dentistry students from using this anesthetic technique after graduation. Specific features of the normative framework and of the Spanish legislative system underlying the design of the present curricula of degrees in dentistry would explain the discrepancies in CS competencies taught at our schools of dentistry. Almost 10 years since its implementation and in light of the new demands of the complex society in which we live, Spanish universities must unify their educational criteria regarding CS training to ensure the appropriate qualification of our new dentists in this technique.

Double acid etching treatment of dental implants for enhanced biological properties.

BACKGROUND: The topographical features on the surface of dental implants have been considered as a critical parameter for enhancing the osseointegration of implants. In this work, we proposed a surface obtained by a combination of shot blasting and double acid etching. The double acid etching was hypothesized to increase the submicron topography and hence further stimulate the biological properties of the titanium implant. METHODS: The topographical features (surface roughness and real surface area), wettability and surface chemical composition were analyzed. RESULTS: The results showed that the proposed method produced a dual roughness, mainly composed of randomly distributed peaks and valleys with a superimposed nanoroughness, and hence with an increased specific surface area. Despite the fact that the proposed method does not introduce significant chemical changes, this treatment combination slightly increased the amount of titanium available on the surface, reducing potential surface contaminants. Furthermore, the surface showed increased contact angle values demonstrating an enhanced hydrophobicity on the surface. The biological behavior of the implants was then assessed by culturing osteoblast-like cells on the surface, showing enhanced osteoblast adhesion, proliferation and differentiation on the novel surface. CONCLUSIONS: Based on these results, the described surface with dual roughness obtained by double acid etching may be a novel route to obtain key features on the surface to enhance the osseointegration of the implant. Our approach is a simple method to obtain a dual roughness that mimics the bone structure modified by osteoclasts and increases surface area, which enhances osseointegration of dental implants.

In-vitro comparative study of the use of 2 % chlorhexidine on microtensile bond strength of different dentin adhesives: a 6 months evaluation / Estudio comparativo in vitro del uso de clorhexidina al 2 % sobre la resistencia de unión microtensil de diferentes adhesivos dentinarios: una evaluación de 6 meses

The aim of this study was to evaluate the effect of chlorhexidine (CHX) dentin treatment on microtensile bond strength (µTBS) of adhesive systems in different storage times. Occlusal enamel was removed from ninety third-molars and flat surfaces of middle dentin were exposed. Teeth were randomly divided in 6 groups according to adhesive system (etch-and-rinse : Adper Scotchbond 1XT - ASB ; self-etch: Adper Prompt L-Pop ­ APP; and universal: Single Bond Universal - SBU) and chlorhexidine (CHX) dentin treatment (2 % CHX application for 20 s prior Primer). After resin composite build up, teeth were sectioned to obtain beam specimens and divided in 3 subgroups (n=5): 72h, 3 and 6 months storage times. After the storage times, teeth were tested in tension until failure (0.5 mm/min). SEM was performed to observe hybrid layer of adhesive systems. Data were analyzed using one-way ANOVA and Tukey tests. At 72 h, all equivalent groups (same adhesive system, different dentin treatments) maintained their µTBS when compared CHX-treatment. At 3 and 6 months, non-treated CHX groups showed less µTBS than CHX-treated ones. Six months storage time did not significantly decrease µTBS, except for G2-ASB. The effect of CHX on dentin µTBS depends on storage times and adhesive systems. While immediate µTBS was not affected by CHX treatment, CHX improved dentin µTBS after 3 and 6 months.

El objetivo de este estudio fue evaluar el efecto del tratamiento con clorhexidina (CHX) de la dentina sobre la resistencia de la unión microtensil (mTBS) de los sistemas adhesivos en diferentes tiempos de almacenamiento. Se retiró el esmalte oclusal de noventa terceros molares y se expusieron superficies planas de la dentina media. Los dientes se dividieron al azar en 6 grupos de acuerdo con el sistema adhesivo (con grabado ácido: Adper Scotchbond 1XT-ASB, auto-grabado: Adper Prompt L-Pop-APP y universal: Single Bond Universal- SBU) y el tratamiento de la dentina con clorhexidina (CHX) (aplicación de CHX al 2 % 20 s antes del Primer). Después de la aplicación de la resina compuesta, los dientes fueron seccionados para obtener muestras en forma de barras y divididos en 3 subgrupos (n = 5) con tiempos de almacenamiento de 72 h, 3 y 6 meses. Después de los tiempos de almacenamiento, los dientes se sometieron a tensión hasta la fractura (0,5 mm / min). SEM se realizó para observar la capa híbrida de sistemas adhesivos. Los datos se analizaron mediante ANOVA unidireccional y pruebas de Tukey. A las 72 h, todos los grupos equivalentes (el mismo sistema adhesivo, diferentes tratamientos de dentina) mantuvieron su mTBS cuando se comparó el tratamiento CHX. A los 3 y 6 meses, los grupos CHX no tratados mostraron menos mTBS que los tratados con CHX. Seis meses de tiempo de almacenamiento no disminuyó significativamente el mTBS, excepto para el G2-ASB. El efecto de CHX sobre la dentina mTBS depende del tiempo de almacenamiento y de los sistemas adhesivos. Mientras que el mTBS inmediato no se vio afectado por el tratamiento con CHX, CHX mejoró la mTBS a dentina después de 3 y 6 meses.

Effect of 2 % chlorhexidine on dentin shear bond strength of different adhesive systems: a 6 months evaluation / Efecto de la clorhexidina al 2 % sobre la resistencia al cizallamiento de diferentes sistemas adhesivos: una evaluación de 6 meses

This study evaluated the effect of chlorhexidine dentin treatment on shear bond strength (SBS) of adhesive systems after different storages. The work included 144 third molars that had their dentin exposed and were divided in 6 groups: G1 (ASB+CHX: Adper Scotchbond 1XT + chlorhexidine 2 % prior Primer); G2(ASB); G3 (APP+CHX: Adper Prompt L-Pop + CHX); G4(APP); G5 (SBU+CHX: Single Bond Universal + CHX); and G6(SBU). Resin build-up was performed and teeth were subdivided regarding storage times (n=8): 72 h, 3 and 6 months. Next, SBS test was performed. At 72 hours, all equivalent groups (same adhesive system, different dentin treatment) showed no significant difference in SBS (P.05). Self-etch adhesive groups (with or without CHX) presented lower SBS compared to other systems (P.05). After 3 and 6 months, all CHX-treated groups presented significantly higher SBS compared to equivalent non-treated groups (P.05). For both storage times, Single Bond Universal presented the highest SBS values within the same dentin treatment (P.05), while Adper Scotchbond and Adper Prompt-L-Pop were not significantly different among them, also within the same dentin treatments [3 months (with CHX: P=.966; without: P=.958) and 6 months (with CHX: P =.887; without: P=.990)]. CHX Dentin disinfection is indicated for all classes of adhesives studied.

Este estudio evaluó el efecto del tratamiento de la dentina con clorhexidina sobre la resistencia al cizallamiento (SBS) de sistemas adhesivos después de diferentes almacenamientos. Se removió el esmalte oclusal a 144 terceros molares y se dejó su dentina media expuesta, posteriormente se dividieron al azar en 6 grupos: G1 (ASB + CHX: Adper Scotchbond 1XT + clorhexidina 2 % antes del Primer); G2 (ASB); G3 (APP + CHX: L-Pop + CHX de Adper); G4 (APP); G5 (SBU + CHX: Single Bond Universal + CHX); y G6 (SBU). Se realizó la aplicación de la resina compuesta y se subdividieron los grupos con respecto a los tiempos de almacenamiento (n = 8): 72h, 3 y 6 meses. A continuación, se realizó la prueba SBS. A las 72 horas, todos los grupos equivalentes (el mismo sistema adhesivo, diferentes tratamientos de dentina) no mostraron diferencias significativas en los valores de SBS (P.05). Los grupos de adhesivo de auto-grabado (con o sin CHX) presentaron valores de SBS más bajos en comparación con otros sistemas (P.05). Después de 3 y 6 meses, todos los grupos tratados con CHX presentaron valores de SBS significativamente mayores en comparación con los grupos no tratados equivalentes (P.05). Para ambos tiempos de almacenamiento, Single Bond Universal presentó los valores de SBS más altos dentro del mismo tratamiento dentinario (P.05), mientras que el Adper Scotchbond y el Adper Prompt-L-Pop no fueron significativamente diferentes entre ellos, también dentro de los mismos tratamientos dentinarios 3 meses (con CHX: P = .966, sin: P = .958) y 6 meses (con CHX: P = .887; sin: P = .990). La desinfección de la dentina con CHX está indicada para todas las clases de adhesivos estudiados.

Direct oral anticoagulants and its implications in dentistry. A review of literature.

BACKGROUND: Four novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously. MATERIAL AND METHODS: A comprehensive search of the PubMed, Scopus and ISI Web of Science databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The quality of the reported information was assessed following the PRISMA statement. RESULTS: Eleven studies that met the inclusion criteria were included in the review: 2 randomized clinical trials, 3 prospective studies, 3 retrospective studies, 2 case series and 1 case report. CONCLUSIONS: DOACs are safe drugs in terms of bleeding. The possible postoperative bleeding complications are manageable with conventional haemostasis measurements. The bridging approach with heparin does not seem to be recommended. Consensus among the professionals involved in the management of the patient is fundamental in invasive dental treatments and in complex patients. Key words:Oral anticoagulants, DOAC, NOAC, dabigatran, rivaroxaban, apixaban, edoxaban, bleeding, oral surgery.

Comparison of enamel-bracket bond strength using direct- and indirect-bonding techniques with a self-etching ion releasing S-PRG filler.

This in vitro study compared the shear bond strength (SBS) and adhesive remnant index (ARI) of two systems for bonding orthodontic brackets to enamel. The first system involved a self-etching primer (Beauty Ortho Bond, BO) containing surface pre-reacted glass filler. The second involved a primer applied with phosphoric acid etching (Transbond XT, TX). Ninety-six extracted human premolars were divided into eight groups: Group I (TX/direct bonding), Group II (TX/indirect bonding), Group III (BO/direct bonding), and Group IV (BO/indirect bonding). Groups V-VIII were identical to Groups I-IV, respectively, but were also subjected to 1,500 thermal cycles between 5 and 55°C. ARI was scored by binocular microscopy. SBS was analyzed by three-way ANOVA and the Bonferroni test. ARI was analyzed by the chi-squared test. The BO groups showed lower SBS and ARI results than the TX groups. SBS was significantly influenced by the primer material, bonding technique, and thermal cycling.

Adhesive restoration of anterior endodontically treated teeth: influence of post length on fracture strength.

OBJECTIVES: This study aims to evaluate the fracture resistance of endodontically treated anterior teeth restored with crowns made of composite or ceramic and retained without the use of a post (endocrowns) or with posts of 5 mm (short) and 10 mm in length (long). MATERIAL AND METHODS: Forty-eight intact maxillary incisors were selected for the study. After endodontic treatment, the crowns were sectioned 2 mm coronally to the cementoenamel junction provided with a ferrule of 2 mm. The roots were randomly divided into six groups (n = 8) according to the post length and type of coronary restoration. The crowns were fabricated with the chairside economical restoration of esthetic ceramics system. Group 1 was restored with a 10-mm glass fiber post, composite core, and a full-coverage ceramic crown (LPCer); group 2, with a 5-mm glass fiber post, composite core, and a full-coverage ceramic crown (SPCer); group 3, with a 10-mm glass fiber post, composite core, and a full-coverage composite crown (LPCpr); group 4, with a 5-mm glass fiber post, composite core, and a full-coverage composite crown (SPCpr); and groups 5 (EndoCer) and 6 (EndoCpr) were restored with ceramic and composite endocrowns, respectively. The teeth were then thermomechanically loaded in a chewing machine. After fatigue, the specimens were loaded to fracture. Data were analyzed with ANOVA and chi-square test. Mode of failure was defined as repairable or non-repairable. RESULTS: Presence of post, post length, and crown material had no significant effect on the fracture resistance. Groups restored with endocrowns presented a higher number of repairable fractures in respect to the other groups. CONCLUSIONS: Presence of a post had no effect on the restorations' fracture strength. CLINICAL RELEVANCE: Although this in vitro study has some limitations in respect to its clinical relevance, the restoration of largely destroyed anterior teeth with the use of an endocrown or a short glass fiber post might have advantages over a large glass fiber post.

Comparative study of the cutting efficiency and working life of carbide burs.

PURPOSE: The aim of this study was to establish the wear and cutting efficiency of tungsten carbide burs from different manufacturers by performing cutting tests with machinable glass ceramic. MATERIALS AND METHODS: Cutting tests were performed with 70 tungsten carbide burs from seven manufacturers: (A) Coltene/Whaledent, (B) CEI, (C) Meisinger, (D) Axis, (E) Komet, (F) Kerr, (G) Edenta. All groups were examined under scanning electron microscope (SEM) before and after the cutting efficiency test for similarities and differences. A specially designed cutting device was used. An electric handpiece was operated at 200,000 rpm with a 120 ml/min coolant water supply rate. The burs were tested under a 165 g constant load using 3 mm wide Macor ceramic as substrate. For each bur the cutting procedure involved a total of five cuts of 3 minutes on every cut, with a total cutting time for each bur of 15 minutes. Data were analyzed using one-way ANOVA at 95.0% confidence level. RESULTS: Significant differences (p < 0.05) were found in the mean cutting rates of the different groups. Groups A and B showed the highest cutting rates. Higher cutting rates were associated with a longer bur lifespan. SEM photomicrographs of the burs and substrates revealed significant changes on the surfaces after the cutting process. CONCLUSIONS: The morphology characteristics of tungsten carbide burs are related to their effectiveness. The group that presented the worst working life also showed substantial wear on its surface according to the results of SEM.

Clinical changes in periodontal subjects with the probiotic Lactobacillus reuteri Prodentis: a preliminary randomized clinical trial.

OBJECTIVES: The aim of this study was to assess the clinical effect of the administration of Lactobacillus reuteri Prodentis as a probiotic agent in the treatment of initial to moderate chronic periodontitis. Secondary objectives were to evaluate the patient 'compliance' factor and to observe the potential side-effects of the probiotic agent. MATERIALS AND METHODS: Twenty systemically healthy, non-smoking subjects with initial-to-moderate chronic periodontitis were enrolled in this 1-month double-blind, placebo-controlled, randomized clinical trial. Subjects were randomly assigned to receive tablets containing Lactobacillus reuteri Prodentis or placebo once a day for 30 days. Clinical parameters were collected at baseline and 30 days post-treatment. RESULTS: Periodontal clinical parameters were improved in the test group after a 30-day intervention. The test group demonstrated a statistically significant reduction (p < 0.05) in all the periodontal parameters included in the study (plaque index, bleeding on probing and pocket probing depths), while the control group treated with placebo did not show any statistically significant change in periodontal parameters. CONCLUSIONS: These data indicate that oral administration of Lactobacillus reuteri Prodentis improved the short-term clinical outcomes in non-smoking patients with initial-to-moderate chronic periodontitis.