Brazilian undergraduates' and dentists' knowledge on preventing, diagnosing and managing dentin hypersensitivity: A cross-sectional questionnaire study.

OBJECTIVES: To analyse the knowledge of dental undergraduates and dentists on the prevention, diagnosis and management of dentin hypersensitivity (DH); to compare their knowledge scores; and to understand the related variables using a regression model. METHODS: An original online questionnaire investigated the attitudes, self-reported knowledge ('how much they thought they knew') and real knowledge ('how much they really knew') of 132 students and 338 dentists. Data were analysed descriptively, both knowledge scores were compared using Mann-Whitney and Wilcoxon signed-rank tests and data were subjected to two multiple linear regression analyses considering real knowledge scores as the dependent variable (α < 0.05). RESULTS: The self-reported knowledge on DH was higher than the real knowledge for both students and dentists, but dentists presented the highest scores. Gingival recession and acidic diet were reported as the main predisposing factors for DH by undergraduates and dentists. Students normally managed DH with dietary and hygiene instructions followed by a desensitizing agent application, while dentists managed with occlusal adjustments. The mechanism of glutaraldehyde/HEMA and bioactive fillers on DH is widely unknown by students and dentists. The majority of the questioned individuals cannot differentiate DH from sensitivity of caries or molar-incisor hypomineralization. CONCLUSION: Both students and dentists overestimate their knowledge of DH, revealing deficiencies in prevention, diagnosis and management. Students' knowledge improves towards the end of the Dentistry course, while younger dentists and PhD holders are more knowledgeable. Institutions should implement ongoing DH education for undergraduates and conduct interventions for experienced professionals, especially older ones.

Analysis of color stability and degree of conversion of different types of resin composites.

Resin composites containing surface pre-reacted glass (S-PRG) have been introduced to reduce demineralization and improve remineralization of the tooth structure. However, water diffusion within the material is necessary for its action, which can impair its overall physicomechanical properties over time, including color stability. This study aimed to evaluate the color stability and related degree of conversion (DC) of four resin composites. Discs (6 x 4 mm, n = 5/group) of microhybrid (MH), nanofilled (NF), nanohybrid (NH), and S-PRG-based nanohybrid (S-PRG-NH) composites with two opacities (A2/A2E and A2O/A2D) were prepared. Color (CIELab and CIEDE2000) was evaluated with a spectrophotometer after aging in grape juice (2 x 10 min/10mL/7days). The DC was analyzed by using Fourier transform infrared spectroscopy before and after light-curing. Data were statistically analyzed by using two-way analysis of variance and post-hoc least significant difference tests (p<0.05). In the color stability analysis, the interaction between filler type and opacity was significant (CIELab, p = 0.0015; CIEDE2000, p = 0.0026). NH presented the highest color stability, which did not differ from that of MH. The greatest color alteration was observed for S-PRG-NH. S-PRG fillers also influenced DC (p < 0.05). The nanohybrid resin composite presented favorable overall performance, which is likely related to its more stable organic content. Notwithstanding the benefits of using S-PRG-based nanohybrid resins, mostly in aesthetic procedures, professionals should consider the susceptibility of such resins to color alteration, probably due to the water-based bioactive mechanism of action.

Analysis of color stability and degree of conversion of different types of resin composites

Abstract Resin composites containing surface pre-reacted glass (S-PRG) have been introduced to reduce demineralization and improve remineralization of the tooth structure. However, water diffusion within the material is necessary for its action, which can impair its overall physicomechanical properties over time, including color stability. This study aimed to evaluate the color stability and related degree of conversion (DC) of four resin composites. Discs (6 x 4 mm, n = 5/group) of microhybrid (MH), nanofilled (NF), nanohybrid (NH), and S-PRG-based nanohybrid (S-PRG-NH) composites with two opacities (A2/A2E and A2O/A2D) were prepared. Color (CIELab and CIEDE2000) was evaluated with a spectrophotometer after aging in grape juice (2 x 10 min/10mL/7days). The DC was analyzed by using Fourier transform infrared spectroscopy before and after light-curing. Data were statistically analyzed by using two-way analysis of variance and post-hoc least significant difference tests (p<0.05). In the color stability analysis, the interaction between filler type and opacity was significant (CIELab, p = 0.0015; CIEDE2000, p = 0.0026). NH presented the highest color stability, which did not differ from that of MH. The greatest color alteration was observed for S-PRG-NH. S-PRG fillers also influenced DC (p < 0.05). The nanohybrid resin composite presented favorable overall performance, which is likely related to its more stable organic content. Notwithstanding the benefits of using S-PRG-based nanohybrid resins, mostly in aesthetic procedures, professionals should consider the susceptibility of such resins to color alteration, probably due to the water-based bioactive mechanism of action.

Effect of thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites.

This study evaluated the effect of the material thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites. Six commercial composites were selected based on their different technologies: Two conventional (C1, C2), two high-viscosity bulk-fill (HVB1, HVB2), and two low-viscosity bulk-fill (LVB1, LVB2). Shrinkage stress was analyzed for five specimens with 2 mm thickness (C-factor 0.75 and volume 24 mm3 ) and five specimens with 4 mm thickness (C-factor 0.375 and volume 48 mm3 ) for 300 s in a universal testing machine. Bottom-to-top hardness ratio values were obtained from Knoop microhardness measurements in specimens with 2- and 4-mm thickness (n = 5). Thickness increase resulted in significantly higher shrinkage stress for all materials with the exception of HVB2 and LVB1. C1, C2, HVB2, and LVB1 showed lower bottom-to-top hardness ratios at 4 mm than at 2 mm. Only LVB2 presented a bottom-to-top hardness ratio lower than 80% at 2 mm, while HVB1 surpassed this threshold at 4 mm of depth. The results suggest that the increase of composite thickness affected the shrinkage stress values. Also, thickness increase resulted in lower bottom-to-top hardness ratio. HVB1 showed better behavior than other bulk-fill materials, with low stress and adequate bottom-to-top hardness ratio at 4 mm thickness.

Tratamento estético por meio de restaurações diretas em resina composta para hipocalcificação de esmalte: 18 meses de controle clínico / Aesthetic treatment through direct composite resin restorations for enamel hypocalcification: 18 months of clinical control

Atualmente, tem se tornado rotina a busca por procedimentos que realcem o sorriso. Neste contexto, técnicas de clareamento dental, microabrasão, restaurações diretas em resina composta, bem como indiretas em cerâmica, são abordagens viáveis para restabelecer alterações do esmalte na região anterior. O objetivo deste caso clínico é relatar uma alternativa de tratamento às lesões de mancha branca extensa em dentes anteriores, compatíveis com hipocalcificação de esmalte, em uma paciente jovem, por meio de restaurações diretas em resina composta. Devido à profundidade e extensão das lesões, restaurações utilizando a técnica de inserção incremental foram realizadas, uma vez que proporcionam menor contração volumétrica do material. Além disso, a estratificação com compósitos para dentina, esmalte e translúcido garantiu a obtenção de um resultado estético harmônico. Após o controle clínico de 18 meses, foi possível verificar que as restaurações apresentavam-se satisfatórias, ausência do comprometimento da interface adesiva, necessitando apenas de repolimento para manutenção do brilho superficial. Desta maneira, na atual Odontologia de mínima intervenção, a abordagem com resina composta foi uma alternativa restauradora estética, conservadora e eficaz para o tratamento de lesões de hipocalcificação de esmalte na região anterior (AU).

Nowadays, the search for procedures that highlight the smile has become routine. In this context, dental bleaching, microabrasion, direct composite resin restorations techniques, as well as indirect ceramics resin are viable approaches to reestablish enamel alterations in the anterior region. The objective of this clinical case is to report an alternative treatment for lesions of extensive white spot in anterior teeth, compatible with enamel hypocalcification in a young patient with direct composite resin restorations. Due to lesions depth and extent, restorations using the incremental insertion technique were performed, as they provide less volumetric contraction of the material. In addition, the stratification with composites for dentin, enamel and translucent established a harmonious aesthetic result. After clinical control of 18 months, it was possible to verify that the restorations were satisfactory, there was absence of adhesive interface deterioration, only requiring repolishing to maintain the superficial brightness. So in the current minimal intervention Dentistry the composite resin approach was an aesthetic, conservative and effective restorative alternative for treatment of enamel hypocalcification lesions in anterior region (AU).

Evaluation of the effect of chlorhexidine and sodium hypochlorite in adhesive cementation of fiber posts - in vitro study / Avaliação do efeito da clorexidina e do hipoclorito de sódio na cimentação adesiva de pinos - estudo in vitro

Abstract Introduction The attachment of fiberglass posts is achieved through an adhesive process. Failures in adhesion may occur due to the hydrolytic degradation of the adhesives, or to the degradation of the collagen fibres of the hybrid layer by intrinsic enzymes. Objective To evaluate the effect of chlorhexidine and sodium hypochlorite treatment on bond strength to dentin. Material and method Thirty bovine roots were randomly distributed into 3 groups (n=10): a) Control, b) 2% Chlorhexidine, and c) 5% Sodium Hypochlorite. Next, RelyX® ARC resin cement was used to cement the post. Each specimen resulted in samples from the three root thirds that were submitted to the pushout test (MPa) at 24 hours and 12 months. Bond strength values were analysed using the Kolmogorov-Smirnov, 3-way ANOVA and Tukey tests. The fracture mode of the pin was also analysed using stereomicroscopy. Result There were no significant differences between treatments at the immediate time (p=0.0644) or in the interaction of factors (p=0.1935). After one year, the experimental groups showed no significant differences in bond strength in relation to the control group, with the exception of the cervical third of the chlorohexidine group in which there was a significant loss of adhesion. As for the fracture mode, there was a predominance of the mixed type in all groups and thirds. Conclusion The use of chlorhexidine or hypochlorite provides neither benefits nor losses in the adhesive bond strength of fiberglass posts. However, there is an influence of the root thirds, with the worst bond strength in the apical third.

Resumo Introdução A fixação de pinos de fibra de vidro é realizada através de um processo adesivo. Falhas podem ocorrer na adesão devido à degradação hidrolítica dos adesivos, ou pela degradação das fibras colágenas da camada híbrida por enzimas intrínsecas. Objetivo Avaliar o efeito do tratamento com clorexidina e hipoclorito de sódio sobre a resistência de união adesiva à dentina. Material e método Trinta raízes bovinas foram distribuídas aleatoriamente em 3 grupos (n=10): a) Controle, b) Clorexidina 2% e c) Hipoclorito de Sódio 5%. Após, para a cimentação do pino radicular, utilizou-se o cimento resinoso RelyX® ARC. Cada espécime resultou corpos-de-prova dos três terços radiculares, os quais foram submetidos ao teste de pushout (MPa) nos períodos de 24 horas e 12 meses. Valores de resistência de união foram analisados pelos testes de Kolmogorov-Smirnov, ANOVA (three-way) e de Tukey. Analisou-se ainda o modo de fratura do pino, através de estereomicroscopia. Resultado Não houve diferenças significativas entre tratamento no tempo imediato (p=0,0644) ou na interação dos fatores (p=0,1935). Após um ano, os grupos experimentais não promoveram diferença significante na resistência de união em relação ao controle, com exceção do terço cervical do grupo clorexidina, onde houve uma perda significativa de adesão. Quanto ao modo de fratura, houve predominância do tipo mista em todos os grupos e terços. Conclusão O uso de clorexidina ou hipoclorito não promove benefícios ou prejuízos na resistência de união adesiva de pinos de fibra, mas há influência dos terços radiculares, sendo a pior resistência de união no terço apical.

Avaliação do manchamento e da rugosidade superficial de materiais restauradores diretos após diferentes sistemas de polimento: estudo in vitro / Assessment of surface staining and roughness of direct restorative materials after different polishing systems: in vitro study

Resumo Introdução Com o avanço estético e tecnológico dos compósitos restauradores diretos, a procura pela Odontologia Éstética tem aumentado. Objetivo Avaliar o manchamento e a rugosidade superficial dos compósitos Filtek Z350 (3M ESPE) e Filtek Bulk Fill (3M ESPE), polidos por diferentes sistemas: Disco SofLex e Disco SofLex diamantado espiral (ambos da 3M ESPE), após exposição repetitiva ao café. Material e método Neste estudo in vitro, um total de 80 discos de resina foi confeccionado, com 40 espécimes para cada compósito avaliado. Os espécimes foram ainda subdivididos em grupos (n=10) de acordo com o método de polimento ‒ SofLex e SofLex diamantado ‒ e a solução de armazenamento ‒ água deionizada (controle) e café (experimental). Após 24 horas de armazenamento em água deionizada, foi realizada a avaliação de cor e rugosidade inicial, bem como a execução dos protocolos de polimento testados. Posteriormente, os espécimes foram expostos ao processo de manchamento em café e água deionizada durante 42 dias. Após esse período, a cor e a rugosidade foram reavaliadas. Resultado A análise estatística paramétrica evidenciou que o manchamento superficial foi influenciado significativamente pelos fatores compósito e solução, mas não pelo fator polidor ou ainda por qualquer interação entre os fatores. Para o fator compósito, Filtek Z350 exibiu maior manchamento, e para o fator solução, foi observado maior manchamento para o café. Já na análise de rugosidade, não houve diferenças significativas. Conclusão Independentemente do sistema de polimento, a solução experimental de café alterou a cor de ambos os compósitos avaliados e verificou-se que a rugosidade não foi alterada.

Abstract Introduction The aesthetic and technological development of direct restorative composites has increased the search for an aesthetic dentistry. Objective Assess the surface staining and roughness of composites: Filtek Z350 (3M ESPE) and Filtek Bulk Fill (3M ESPE), polished by different systems: Disco SofLex and Disco SofLex diamond spiral (both from 3M ESPE), after repeated exposure to coffee. Material and method This study was carried out together with 80 resin discs were made, 40 articles for each study evaluated. The compounds were divided into groups (n = 10) according to the polishing method - Softex and Softex diamond, storage solution - deionized water (control) and coffee (experimental). After 24 hours of storage in deionized water, a color evaluation was performed initially, as well as the execution of the polishing protocols tested. Subsequently, the specimens were exposed to the staining process in coffee and deionized water for 42 days. After this period, the color and roughness were assessed again. Result The parametric statistical analysis showed that surface staining was affected significantly by the composite and solution factors, but not by the polisher factor or by any interaction among factors. For the composite factor, Filtek Z350 showed greater staining and for the solution factor, coffee showed greater staining. In contrast, the roughness analysis did not show significant differences. Conclusion Regardless of the polishing system, differences in composite composition affect the color stability of the composites; and coffee changes the color of both; the roughness was not altered.

Effect of sports drinks on the surface properties of composite resins after prolonged exposure - in vitro study

Aim: Using dietary supplements may affect the properties of composite resins due to their acidic pH. The present in vitro study aimed to assess the surface roughness and color stability of two composite resins - nanohybrid (Empress Direct) and nanoparticulate (Filtek Z350) - after prolonged exposure to dietary supplements. Methods: We produced 30 specimens from each composite (8x2-mm discs) and divided them into six groups (n=10). After the initial measurement of the surface properties (roughness and color), we exposed the specimens to a degradation process in Maltodextrin and Whey Protein for 22.5 and 7.5 days, respectively, using deionized water as the control solution. At the end of 22.5 days, we reassessed the specimens. After verifying data normality with the Kolmogorov-Smirnov test, we performed ANOVA followed by Tukey's test at 5%. Results: We found significant differences for materials immersed in the Whey Protein solution (p<0.05). The roughness of Empress Direct was higher (0.45+0.07) than Filtek Z350 (0.22+0.05). The composites tested also showed color change (ΔE>3.3) after the immersion period (p<0.001). In Maltodextrin, the Empress Direct group presented (4.52+1.23) and Filtek Z350 (4.04+0.66), while after immersion in Whey Protein, they showed (5.34+1.68) and (4.26+1.02), respectively. Conclusion: Sports drinks changed the surface roughness and color stability of the composite resins studied. The Filtek Z350 group showed lower color variation than the Empress Direct composite in both solutions evaluated