Color stability of dual-cured and light-cured resin cements: A systematic review and meta-analysis of in vitro studies.

PURPOSE: This systematic review and meta-analysis aimed to evaluate the difference in the color stability of light-cured and dual-cured resin cements. MATERIALS AND METHODS: Two separate reviewers used the PubMed, Scopus, Web of Science, Embase, and Scielo databases to execute the systematic review. For the analysis, studies that evaluated the color stability of dual-cured and light-cured resin cements over time were used. The random effects model was used in the meta-analysis. Analyses of subgroups were carried out based on the aging technique. The methodological quality of each in vitro study was evaluated in accordance with the parameters of a prior systematic review. RESULTS: From all databases, a total of 2223 articles were retrieved. Following the screening of titles and abstracts, 44 studies were selected for full text review, and a total of 27 articles were used for the qualitative analysis. Finally, 23 articles remained for the qualitative analysis. The majority of studies were labeled as having a medium risk of bias. The global analysis showed that the dual-cure resin cements had considerably greater differences in the color change (p = 0.006). A high heterogeneity index (86%) was found in the analysis. CONCLUSIONS: The best available in vitro evidence suggests that dual-polymerizing cement has higher color variation than light-polymerized materials. To reduce the likelihood of color change after the luting of thin ceramic restorations, clinicians should employ light-polymerizable resin cements.

Antibacterial activity and physicochemical properties of a sealer containing copaiba oil.

This study aimed to evaluate the antimicrobial activity and physicochemical properties of a novel dual-cure endodontic sealer containing copaiba oil. The copaiba oil was obtained and characterized by gas chromatography (GC), and the minimum inhibitory concentration (MIC) was performed. The experimental sealers were formulated with copaiba oil concentrations of 0, 0.5, 1, and 2%, and the RealSeal™ (Sybron endo, Orange, USA) and AH Plus (Dentsply De Trey Gmbh, Konstanz, Germany) were used as the commercial references. The antimicrobial activity of the sealers was evaluated by the direct contact test for 1h and 24h. To evaluate the physicochemical properties of the sealers, the degree of conversion, setting time, film thickness, dimensional stability, and radiopacity tests were performed. The data were statistically analyzed by one-way ANOVA and Tukey's test (α = 0.05). Concerning the results, the sealers containing copaiba oil showed antimicrobial activity without harming the physicochemical properties.

Synthesis and characterization of calcium-releasing elastomeric resin-based endodontic sealers.

OBJECTIVES: To evaluate the incorporation of halloysite nanotubes (HNTs) loaded with one of two calcium sources (i.e., calcium hydroxide/CaOH2 or beta-tricalcium phosphate/ß-TCP) on the physicochemical and biological properties of an experimental resin-based dual-cured endodontic sealer. MATERIALS AND METHODS: HNTs were encapsulated with CaOH2 or ß-TCP at 10 wt.%. HNTs containing CaOH2 or ß-TCP were added into the experimental sealers at 50 wt.%. The control sealers were the calcium-free HNT-modified resin-based experimental sealer and AH Plus™, a commercially available endodontic sealer. Degree of conversion, setting time, flow, film thickness, radiopacity, dimensional stability, and calcium ions release were determined. Antibiofilm properties and cytocompatibility of the formulated sealers and commercial control were also evaluated. One and two-way ANOVA analysis followed by Tukey's post hoc test was conducted to evaluate the effect of the independent variable on the evaluated properties. RESULTS: FTIR confirmed the encapsulation of calcium sources into HNTs. Regarding flow and film thickness, the values obtained from these sealers were in accordance with the specifications provided by ISO 6876. For radiopacity, AH Plus™ achieved the highest radiopacity (p<0.05). Among the experimental formulations, all experimental HNT-containing compositions exhibited values below 3 mm Al. The experimental sealers showed greater dimensional changes when compared to the commercial (AH Plus™) control. The release of calcium ions was observed for the HNT_CaOH2 and HNT_ß-TCP sealers without statistical differences. Experimental sealers containing HNT_CaOH2 and HNT_ß-TCP significantly reduced the CFU/mL count and showed cell compatibility. CONCLUSIONS: The findings of this study demonstrate that the incorporation of HNT_CaOH2 or HNT_ß-TCP into resin-based experimental sealers promoted antimicrobial effects and gradual calcium release without impairing cytocompatibility or physicochemical properties of the sealers. Still, an adjustment to reach the minimal radiopacity established by ISO 6876 is needed. CLINICAL RELEVANCE: The experimental resin-based sealers seemed to be an alternative for endodontics. The incorporation of calcium sources exerts promising antimicrobial effects while displaying low cell toxicity.

Novel polymethyl methacrylate modified with metal methacrylate monomers: biological, physicomechanical, and optical properties.

This study sought to evaluate the physical and antimicrobial properties of a thermopolymerizable acrylic resin (PMMA) modified with metallic methacrylate monomers -zirconia (ZM), tin (TM), and di-n-butyl (DNTMB) methacrylates. Color stability was evaluated before and after immersion of samples in a staining solution by a digital spectrophotometer. The mechanical brushing test was evaluated by the roughness test. The flexural strength test used a mechanical testing machine. Human keratinocytes were used to assess cell viability and the biofilm formation assay was carried out for 5 days, in a microcosms model after one year of specimen storage. For statistical analysis, the method chosen was based on adherence to the normal distribution model and equality of variances (p < 0.05). The addition of DNTMB to PMMA promoted great antimicrobial action, acceptable cytocompatibility, without hampering the physical-mechanical properties of the commercial material. Therefore, the modified PMMA proved to be a promisor alternative to conventional resins.This study sought to evaluate the physical and antimicrobial properties of a thermopolymerizable acrylic resin (PMMA) modified with metallic methacrylate monomers -zirconia (ZM), tin (TM), and di-n-butyldimethacrylate-tin (DNTMB) methacrylates. Color stability was evaluated before and after immersion of samples in a staining solution using a digital spectrophotometer. The mechanical brushing test was evaluated by the roughness test. The flexural strength test used a mechanical testing machine. Human keratinocytes were used to assess cell viability and the biofilm formation assay was carried out for 5 days in a microcosm model after one year of specimen storage. For statistical analysis, the method chosen was based on adherence to the normal distribution model and equality of variances (p < 0.05). The addition of DNTMB to PMMA promoted great antimicrobial action, acceptable cytocompatibility, without hampering the physical-mechanical properties of the commercial material. Therefore, the modified PMMA proved to be a promising alternative to conventional denture base resins for dental use.

Bond strength of self-adhesive flowable composite resins to dental tissues: A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: Although the clinical use of self-adhesive flowable composite resins is convenient, the decision to use flowable or conventional composite resin remains controversial. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the in vitro bond strength of self-adhesive flowable composite resins to enamel or dentin compared with conventional composite resins using etch-and-rinse or self-etch adhesive systems. MATERIAL AND METHODS: Two independent reviewers performed searches in the PubMed (MEDLINE), Cochrane Wiley, Web of Science, Scopus, and Google Scholar databases for studies reporting on the bond strength of self-adhesive flowable and conventional composite resins to enamel and dentin published from January 2010 up to September 2020. A meta-analysis software program was used for the meta-analysis. Comparisons were conducted using standardized mean differences considering the random-effects model (α=.05). RESULTS: Twenty-two studies were considered for the meta-analysis. Immediate and long-term bond strength to enamel was improved when a conventional composite resin was used in combination with an adhesive system (P<.001). Bond strength to dentin was improved by using an adhesive system in combination with a conventional composite resin (P<.001). CONCLUSIONS: The bond strength of self-adhesive flowable composite resins is lower than that of conventional composite resins, indicating limited ability to bond to enamel and dentin.

In vitro efficacy of commercial and experimental proteolytic enzyme-based whitening dentifrices on enamel whitening and superficial roughness.

OBJECTIVE: To evaluate the whiteness index (WID ) and surface roughness (Ra) of bovine enamel after simulated tooth brushing with different commercial and experimental whitening dentifrices. MATERIALS AND METHODS: Cylindrical enamel bovine specimens were acid etched, stained, and divided in nine groups (n = 8): Colgate® Optic White®, Crest® Baking Soda and Peroxide, Arm and Hammer® Advanced White™ Extreme Whitening, Rembrandt® Deeply White® + Peroxide, Close up® White Attraction Natural Glow, Hinode Prowhite, and experimental dentifrice containing papain (PP), bromelain (PB), or papain and bromelain (PPB). Ra and WID were obtained initially and after 600, 1200, and 3,600 cycles of simulated tooth brushing. Data were analyzed using two-way analysis of variance test (α = 0.05). RESULTS: Ra was significantly influenced by both dentifrice (p = 0.043) and period of tooth-brushing simulation (p < 0.001). Except for PP and PPB, all groups showed a statistically significant increase in Ra after simulated tooth brushing. After staining and brushing, none of the materials tested increased the initial WID . CONCLUSIONS: The effect of commercial whitening dentifrices may be related to their high abrasiveness. Experimental formulations tested provided a similar effect without undesired wear of enamel. Whitening dentifrices only act through an abrasive effect rather than bleaching the tooth structures. When used, special care must be taken for avoid undesired wear of enamel. Experimental dentifrices provided similar removal of extrinsic stains without undesired abrasiveness; however, this effect may be due to the use of less aggressive abrasives in their formulations.

Anti-biofilm activity of a novel pit and fissure self-adhesive sealant modified with metallic monomers.

Dental plaque is a biofilm composed of a complex oral microbial community. The accumulation of plaque in the pit and fissures of dental elements often leads to the development of tooth decay (dental caries). Here, potent anti-biofilm materials were developed by incorporating zinc methacrylates or di-n-butyl-dimethacrylate-tin into the light-curable sealant and their physical, mechanical, and biological properties were evaluated. The data revealed that 5% di-n-butyl-dimethacrylate-tin (SnM 5%) incorporated sealant showed strong anti-biofilm efficacy against various single-species (Streptococcus mutans or Streptococcus oralis or Candida albicans) and S. mutans-C. albicans cross-kingdom dual-species biofilms without either impairing the mechanical properties of the sealant or causing cytotoxicities against mouse fibroblasts. The findings indicate that the incorporation of SnM 5% in the experimental pit and fissure self-adhesive sealant may have the potential to be part of current chemotherapeutic strategies to prevent the formation of cariogenic oral biofilms that cause dental caries.

Efficacy of natural, peroxide-free tooth-bleaching agents: A systematic review, meta-analysis, and technological prospecting.

The aim of this study is to analyze the efficacy of natural bleaching agents and the current technological development in this research field. Two reviewers performed a literature search up to July 2019 in 15 databases. Five laboratory studies and 25 patents were included. Data regarding natural bleaching agent used, application protocol, and the main findings of studies were analyzed. Laboratory studies that evaluated natural bleaching agents' peroxide-free or associated to peroxides and patents related to natural bleaching agents were included. The studies evaluated papain, bromelain, chlorine dioxide, sodium chloride plus vinegar and sodium bicarbonate as peroxide-free agents; and sweet potato extract, lactoperoxidase, and peroxidase associated to peroxide used were included. Twenty-five patents were included; among the most cited are the papain and the chlorine. The addition of non-peroxide agents into peroxide showed improvement in bleaching effect with the incorporation of these non-peroxide agents (p < .05). On the other hand, peroxide-free agents did not show an improvement in bleaching effect (p < .05). The evidence in literature suggested that natural bleaching agents incorporated to peroxide may improve the bleaching. Therefore, the current literature does not support the use of natural agents as dental bleaching.

Bonding Strength of Universal Adhesives to Indirect Substrates: A Meta-Analysis of in Vitro Studies.

PURPOSE: To evaluate the in vitro bond strength of universal adhesive systems to indirect substrates. MATERIAL AND METHODS: Two reviewers performed a literature search up to March 2018 in seven databases: PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO. The review included studies that compared the bond strength of universal adhesives and well-established material-specific primers to indirect substrates: lithium disilicate ceramic, yttrium-stabilized zirconium dioxide ceramic, leucite-reinforced ceramic, feldspathic porcelain, polymer infiltrated ceramic material, resin composite or metal alloys. Analyses were carried out using RevMan 5.3.5. A global comparison was performed with the standardized mean difference using a random-effects models at a significance level of p < 0.05. RESULTS: A total of 45 studies were included in the qualitative analysis, and the meta-analysis was performed with 42 studies. Bond strength to glass-based ceramics and alloys was improved with the use of a specific-primer as separate step before the bonding procedures (lithium disilicate, p < 0.001; alloys, p < 0.001). The bond strength to zirconium substrates was improved with the use of universal adhesives (p < 0.001). For bond strength to composite resin as indirect substrate, universal adhesives performed in a manner similar to that of the material-specific primer (p = 0.11). CONCLUSIONS: The clinical procedure of luting zirconia and resin composite restorations could be simplified by using single-bottle universal adhesives. However, the ability of universal adhesives to achieve an adequate and durable bond to glass-based ceramics and alloys appears to be limited.

Efficacy of rhBMP-2 in Cleft Lip and Palate Defects: Systematic Review and Meta-analysis.

The aim of this study was to analyze the efficacy of using rhBMP-2 (recombinant human morphogenetic protein-2) in the treatment of patients with cleft lip and palate defects (CLPD). Seven databases were screened: PubMed (Medline), Lilacs, Ibecs, Web of Science, BBO, Scopus, and The Cochrane Library. Clinical trials that evaluated the use of bioactive treatment with rhBMP-2 in the treatment of patients with CLPD were included. Statistical analyses were performed by comparing the standardized mean difference of bone formation volume and bone filling percentage (p = 0.05). Ten studies compared the use of rhBMP-2 and iliac crest bone graft (ICBG). The global analysis for bone formation volume and bone filling percentage showed that bioactive materials were similar to ICBG with a standardized mean difference of respectively 0.07 (95% CI - 0.41 to 0.56) and 0.24 (95% CI - 0.32 to 0.80). The available literature suggested that use of rhBMP-2 presented similar bone formation results to those of ICBG in secondary alveolar bone grafting for patients with CLPD.

Bonding Performance of Universal Adhesives: An Updated Systematic Review and Meta-Analysis.

PURPOSE: To evaluate through a systematic review and meta-analysis whether the immediate and long-term bonding performance of universal adhesives would be improved by prior acid etching. MATERIALS AND METHODS: Two reviewers performed a literature search up to April 2018 in eight databases: PubMed, Web of Science, Cochrane Library, SciELO, Scopus, LILACS, IBECS, and BBO. Only studies that evaluated the dentin or enamel bond strength of universal adhesives using a self-etch or etch-and-rinse strategy were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis comparing self-etch or etch-and-rinse strategies and the influence of aging on bonding performance was performed with random-effects models at a significance level of p < 0.05. RESULTS: A total of 59 in vitro studies were included in the meta-analysis. The enamel bond strength of universal adhesives was improved by the etch-and-rinse approach (p < 0.05). In dentin, this effect was observed for ultra-mild and intermediately strong universal adhesives (p < 0.05). Irrespective of the strategy employed, intermediately strong adhesives showed a decrease in bond strength after all types of aging. This effect was also observed for ultra--mild universal adhesives used in the etch-and-rinse approach (p < 0.05). Mild universal adhesives showed bond strength stability in both strategies (p > 0.05). CONCLUSIONS: The in vitro evidence suggests that bonding performance of mild universal adhesives can be improved by using the selective enamel-etch strategy. Mild universal adhesives seem to be the more stable materials, in both etch-and-rinse or self-etch strategies.

Histological Evaluation of Bone Repair with Hydroxyapatite: A Systematic Review.

The aim of this study was to evaluate the morphological bone response in animal experiments by applying hydroxyapatite grafts in critical and non-critical size bone defects. Current report followed the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Animal experiments were selected by assessing repair of bone defects with hydroxyapatite as bone graft and with blood clot only as control. Eight articles were identified in specialized literature and included in the meta-analysis. Statistical analysis was carried out with a random-effect model (p = 0.05). Subgroup analyses were further performed to investigate bone repair in critical and non-critical bone defects. Comprehensive analysis of bone repair outcome showed a statistically significant difference between hydroxyapatite and blood clot control (p < 0.05). Subgroup analyses showed statistically significant difference for critical bone defects (p < 0.05). No statistically significant difference was reported in non-critical bone defects (p > 0.05). Although animal studies revealed a high risk of bias and results should be interpreted with caution, the literature suggests that non-critical bone defects may heal spontaneously and without the need of a bone graft. Conversely, when critical-size defects are present, the use of hydroxyapatite bone graft improves the bone repair process.

Synthesis and characterization of CaO-loaded electrospun matrices for bone tissue engineering.

OBJECTIVES: This study aims to synthesize and characterize biodegradable polymer-based matrices loaded with CaO nanoparticles for osteomyelitis treatment and bone tissue engineering. MATERIALS AND METHODS: Poly(ε-caprolactone) (PCL) and PCL/gelatin (1:1, w/w) solutions containing CaO nanoparticles were electrospun into fibrous matrices. Scanning (SEM) and transmission (TEM) electron microscopy, Fourier transformed infrared (FTIR), energy dispersive X-ray spectroscopy (EDS), contact angle (CA), tensile testing, and antibacterial activity (agar diffusion assay) against Staphylococcus aureus were performed. Osteoprecursor cell (MC3T3-E1) response (i.e., viability and alkaline phosphatase expression/ALP) and infiltration into the matrices were evaluated. RESULTS: CaO nanoparticles were successfully incorporated into the fibers, with the median fiber diameter decreasing after CaO incorporation. The CA decreased with the addition of CaO, and the presence of gelatin made the matrix very hydrophilic (CA = 0°). Increasing CaO concentrations progressively reduced the mechanical properties (p ≤ 0.030). CaO-loaded matrices did not display consistent antibacterial activity. MC3T3-E1 cell viability demonstrated the highest levels for CaO-loaded matrices containing gelatin after 7 days in culture. An increased ALP expression was consistently seen for PCL/CaO matrices when compared to PCL and gelatin-containing counterparts. CONCLUSIONS: Despite inconsistent antibacterial activity, CaO nanoparticles can be effectively loaded into PCL or PCL/gelatin fibers without negatively affecting the overall performance of the matrices. More importantly, CaO incorporation enhanced cell viability as well as differentiation capacity, as demonstrated by an increased ALP expression. CLINICAL SIGNIFICANCE: CaO-loaded electrospun matrices show potential for applications in bone tissue engineering.

Experimental self-etching HEMA-free adhesive systems: cytotoxicity and degree of conversion.

The aim of this study was to evaluate the effect of replacing 2-hydroxyethyl methacrylate (HEMA) by methacrylate surfactant monomers on the cytotoxicity and degree of conversion of two-step self-etching dentin adhesive systems. Five HEMA-free adhesive systems were tested: Bis-EMA 10, Bis-EMA 30, PEG400, PEG400UDMA, PEG1000, and a HEMA group was used as positive control. The cytotoxicity of the experimental primers, with different monomer concentrations (2 or 20 wt%), and bond resins, containing 25 wt% surfactant, was assessed using murine fibroblast cell line 3T3 and the tetrazolium assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)). The degree of conversion of the bond resins was analyzed using Fourier transform infrared spectroscopy. The data were submitted to statistical analysis using level of significance set at P < 0.05. The PEG 1000 group obtained higher cell viability in comparison with HEMA in the 2 % primer. The cell survival rate using 20 % primer showed that PEG1000 and BIS-EMA 10 were less cytotoxic than HEMA. With regard to the eluate from bond resin, the data showed that the groups BIS-EMA 10, BIS-EMA 30 and PEG400UDMA were less cytotoxic than HEMA. No statistically significant difference was found among degrees of conversion of the experimental groups and HEMA. PEG 1000, BIS-EMA 10 and 30 monomers showed the biological potential for use in new adhesive system formulations since they showed lower cytotoxicity and similar degree of conversion when compared with the HEMA-containing group.

Replacing HEMA with alternative dimethacrylates in dental adhesive systems: evaluation of polymerization kinetics and physicochemical properties.

PURPOSE: To evaluate the mechanical and physical properties of experimental HEMA-containing and HEMA-free resin adhesives. MATERIALS AND METHODS: Experimental HEMA-free adhesives containing alternative dimethacrylates (bis-EMA 10 [B10], bis-EMA 30 [B30], PEG 400 [P400], PEG 1000 [P1000], PEG 400 UDMA [UP400]) were formulated and compared with a HEMA-containing adhesive (control). The adhesives were characterized by rheological analysis, polymerization kinetics (PK), water sorption (WS), and solubility (SL) tests. Flexural strength (FS) and flexural modulus (E) tests were performed under dry or wet conditions (distilled water or 70% ethanol solution). One-way and two-way ANOVA as well as Tukey's test were used to evaluate differences between groups (p < 0.05). RESULTS: The control group showed the lowest viscosity and was the only one with a degree of conversion lower than 50%. The control and the P1000 adhesive showed the statistically significantly highest WS (p < 0.05). The control and the UP400 adhesive showed the highest FS and E, and the dry-stored specimens showed more improved mechanical strength than did the wet-stored specimens (p < 0.05). CONCLUSION: The physicomechanical properties of some of the HEMA-free adhesives were substantially improved when compared with those of the control, indicating that they could be potential monomers for the development of HEMA-free adhesive systems.

Anti-Candida, anti-enzyme activity and cytotoxicity of 3,5-diaryl-4,5-dihydro-1H-pyrazole-1-carboximidamides.

Because of the need for more effective and less harmful antifungal therapies, and interest in the synthesis of new carboximidamides, the goal of this study was to determine the antifungal and anti-enzyme activities of some new pyrazole carboximidamides and their cytotoxicity. For this purpose, tests were performed to evaluate: minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC); production of proteinases and phospholipase, and cytotoxicity of the extracts. Data were analyzed by ANOVA and Tukey Tests (α = 5%). The results were: MIC and MFC ≥ 62.5 µg/mL (C. albicans, C. parapsilosis, C. famata, C. glabrata, and Rhodotorula mucillaginosa) and MIC and MFC ≥ 15.6 µg/mL (C. lipolytica). The values of proteinase and phospholipase (Pz) of C. albicans before and after exposure to the compounds were: 0.6 (±0.024) and 0.2 (±0.022) and 0.9 (±0.074) and 0.3 (±0.04), respectively. These proteinase results were not significant (p = 0.69), but those of phospholipase were (p = 0.01), and 15.6 µg/mL was the most effective concentration. The cytotoxicity means were similar among the tests (p = 0.32). These compounds could be useful as templates for further development through modification or derivatization to design more potent antifungal agents. Data from this study provide evidence that these new pyrazole formulations could be an alternative source for the treatment of fungal infections caused by Candida. However, a specific study on the safety and efficacy of these in vivo and clinical trials is still needed, in order to evaluate the practical relevance of the in vitro results.

Light-activated bleaching: effects on surface mineral change on enamel.

AIM: This study evaluated the in vitro effect of 35% hydrogen peroxide (HP) on surface enamel change when activated with different light curing units (LCUs). MATERIALS AND METHODS: Enamel blocks (4 × 4 × 2 mm) were obtained from bovine incisors. The initial microhardness of the enamel was determined for each specimen. After this enamel blocks were randomly divided into four groups (n = 10) and treated as follows: Control, no bleaching procedure performed; HP - LCU, application of 35% HP gel without light activation; HP + QTH, application of 35% HP gel and light activation with a Quartz Tungsten-Halogen (QTH); and HP + Light Emitting Diode, application of 35% HP gel and light-activation with a LED. New microhardness measurements were obtained, immediately, 7 and 14 days after treatment. The percentage of surface mineral change was calculated according to the baseline and post-treatment microhardness values. Additionally, six samples from each group were randomly selected and prepared for scanning electron microscopy (SEM) characterization. The data were analyzed using an analysis of variance (ANOVA) to detect differences between the three time periods, and an ANOVA and Tukey's test with a confidence level of 95%. RESULTS: There was no significant difference between the initial hardness values and hardness values after treatment in any of the groups or time periods (p > 0.05). No major surface alterations were detected with SEM when comparing control groups to those undergoing bleaching treatments. CONCLUSION: The use of 35% HP in combination to QTH or LED light curing units LCU does not have detrimental effect on the enamel surface topography or in the mineral content, when compared with unbleached enamel or enamel submitted to 35% HP treatment alone.

Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review.

Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.

Enhanced Antibacterial Properties of Titanium Surfaces through Diversified Ion Plating with Silver Atom Deposition.

In this study, we investigate the antibacterial effect of silver atoms implanted into a thin surface layer of titanium at low energies using an alternative ion plating technology called Diversified Ion Plating. Silver atoms were incorporated into titanium samples using reactive low-voltage ion plating at 2 keV and 4 keV. Surface modifications and morphology were evaluated using wettability, profilometry measurements, and energy-dispersive spectroscopy. For a precise determination of the quantity and depth of implanted silver atoms on titanium surfaces, a combination of experimental techniques such as Rutherford Backscattering Spectrometry along with Monte Carlo simulations were utilized. To assess the antibacterial effects of the silver atoms incorporated into pure titanium surfaces, bacterial suspension immersion tests were performed with a standard strain of Staphylococcus aureus (ATCC 12600). The outcomes indicate that titanium surfaces implanted with silver atoms were more effective in inhibiting the growth of Staphylococcus aureus than pure titanium surfaces. Better results were found when the deposition was performed at 4 keV, indicating that a deeper implantation of silver, spanning a few nanometers, can result in a longer and more effective release of silver atoms. These findings suggest the potential for the development of new, cost-effective biomaterials, paving the way for improved implant materials in various health-related applications.

Evaluation of Antimicrobial Properties, Cell Viability, and Metalloproteinase Activity of Bioceramic Endodontic Materials Used in Vital Pulp Therapy.

This study aimed to evaluate the antimicrobial properties, cell viability, and matrix metalloproteinase (MMP) inhibition capacity of several endodontic materials aimed at vital pulp therapy: Pro Root MTA®, EndoSequence®, Biodentine®, MTA Angelus®, TheraCal LC®, and BioC Repair®. The materials were prepared according to the manufacturer's instructions. Antimicrobial tests were conducted using a microcosm biofilm model, cell viability was assessed using murine fibroblasts (L929), and MMP activity was analyzed through electrophoresis. The results showed that BioC Repair®, Biodentine®, and EndoSequence® exhibited similar antimicrobial properties, while MTA Angelus® and ProRoot MTA® had inferior results but were comparable to each other. In terms of cell viability, no significant differences were observed among the materials. EndoSequence® demonstrated the highest MMP inhibition capacity. In conclusion, BioC Repair®, Biodentine®, EndoSequence®, and TheraCal® showed better antimicrobial properties among the tested materials. The materials did not exhibit significant differences in terms of cytotoxicity. However, EndoSequence® displayed superior MMP inhibition capacity.