Efecto de diferentes condiciones y modos de aplicación sobre la fuerza de unión de los adhesivos a la dentinaEffect of different conditions and modes of application on bond strength of adhesives to dentine / Effect of different conditions and modes of application on bond strength of adhesives to dentine

Objective: To evaluate the microtensile bond strength in different dentine conditions (etched-E, non-etched-N, dry-D and wet-W) of a multimode adhesive (Scotchbond Universal-SU, 3M/ESPE) and a total etching adhesive (Ambar-AB, FGM) using a sonic device (Smart Sonic Device-SD, FGM). Material and methods: In this in vitro study, ninety six sound extracted human molars were divided into 12 groups (n=8) according to different dentine conditions and adhesive systems. Enamel was removed and the middle dentine surfaces were polished. Each adhesive system was applied according to the different dentine conditions, and composite resin blocks were incrementally built up and stored for 24 hours. Specimens were sectioned into sticks and bond strength data were analyzed with the Kruskal-Wallis test and Mann-Whitney U tests. Results: No effects of sonic application and were observed. In general, AB showed lower results compared to the SU. E and N conditions did not statistically affect the bond strength of SU groups. Dry dentine presented statistically superior bond strength values when compared to wet dentine for SU/E/SD group. Conclusion: Adhesion of dry dentine with multimode adhesive system may be superior to wet dentine with sonic application. The modes of application had no influence in bond strength of studied adhesives.

Objetivo: Evaluar la resistencia de la unión microtensil en diferentes condiciones de dentina (grabado-E, sin grabado-N, seco-D y húmedo-W) de un adhesivo multimodo (Scotchbond Universal-SU, 3M/ESPE) y un adhesivo de grabado total (Ambar-AB, FGM) utilizando un dispositivo sónico (Smart Sonic Device-SD, FGM). Material y Métodos: En este estudio in vitro, noventa y seis molares humanos extraídos sanos se dividieron en 12 grupos (n=8) de acuerdo con diferentes condiciones de dentina y sistemas adhesivos. Se eliminó el esmalte y se pulieron las superficies centrales de la dentina. Cada sistema adhesivo se aplicó de acuerdo con las diferentes condiciones de dentina, y los bloques de resina compuesta se acumularon de forma incremental y se almacenaron durante 24h. Las muestras se seccionaron en barras y los datos de resistencia de la unión se analizaron con la prueba de Kruskal-Wallis y la prueba de U de Mann-Whitney. Resultado: No se observaron efectos de la aplicación sónica. En general, AB mostró resultados más bajos en comparación con el SU. Las condiciones E y N no afectaron estadísticamente la fuerza de unión de los grupos SU. La dentina seca presentó valores de fuerza de adhesión estadísticamente superiores en comparación con la dentina húmeda para el grupo SU/E/SD. Conclusión: La adhesión de la dentina seca con un sistema adhesivo multimodo puede ser superior a la dentina húmeda con aplicación sónica. Los modos de aplicación no tuvieron influencia en la resistencia de la unión de los adhesivos estudiados.

Application of proanthocyanidin in the treatment and repair of deep caries / 口腔疾病防治

@#Proanthocyanidin (PA), as a kind of natural plant polyphenol, have a variety of biological functions, such as promoting remineralization, inducing collagen cross-linking, inhibiting protease activity and inhibiting bacteria. Therefore, PA could be broadly used in the clinical application of treatment and repair of deep caries in the future; for example, PA could promote dentin remineralization, improve resin-dentin bonding durability and improve the dentin acid erosion effect. This application potential of PA arises from several features, firstly, PA can not only promote dentin remineralization on its own or with other remineralizers but also exhibits antibacterial effects, which can inhibit acid production while reducing the formation of cariogenic pathogens and their biofilms. Based on the above features, PA can reduce the incidence of caries disease; thus, PA improves deep caries and long-term effects after treatment. In addition, PA added to adhesives or etch agents can improve the etching and bonding effect of dentin by inducing collagen cross-linking and inhibiting protease activity, thus achieving the ultimate goal of improving the bonding performance of deep caries. This paper summarizes recent progress of research on PA for the treatment and repair of deep caries, including the promotion of dentin remineralization and antibacterial activity as well as the improvement in dentin bonding and acid etching effect, to provide a more comprehensive reference for treating and restoring deep caries in clinical practice.

Dentin permeability after pretreatment with titanium tetrafluoride and self-etching or universal adhesive systems

Aim: To evaluate dentin permeability after pretreatment with 2.5% aqueous solution of titanium tetrafluoride (TiF4), followed by a self-etching universal adhesive system. Methods: Forty dentin discs (1.5 mm thick) were randomly divided into groups according to the application or non-application of a pretreatment, and the type of adhesive system to be tested (two-step self-etching/ Clearfil SE Bond/ Kuraray Medical, or universal adhesive system/ Single Bond Universal/ 3M ESPE). Both sides of the discs were conditioned with 37% phosphoric acid to remove the smear layer. The first hydraulic conductivity measurement (L1) was performed in a permeability machine, under 5 PSI pressure. The samples were sanded again to form a standardized smear layer. The teeth designated for pre-treatment with TiF4 received the TiF4 solutions applied actively for 60 seconds, and the adhesive systems were applied according to the manufacturer's instructions. Then, a new hydraulic conductivity measurement (L2) was performed for the purpose of calculating the hydraulic conductance at a later time, considering the water viscosity and the thickness of the specimen. The percentage (L) of dentin permeability after application of the adhesive system was obtained (L (%) = [(L1-L2) x100] / L1). The Mann-Whitney non-parametric test was applied. Results: There was no difference between the two adhesive systems, or between the groups with or without pretreatment, as regards dentin permeability (p>0.05). Conclusion: Pretreatment with 2.5% TiF4 did not influence dentin permeability, irrespective of the adhesive system used

Effect of endodontic sealers on push-out bond strength of CAD-CAM or prefabricated fiber glass posts

Abstract This study aimed to evaluate the effect of endodontic sealer (ES) on bond strength (BS) of prefabricated or milled-CAD-CAM (computer-aided design and computer-aided manufacturing) glass-fiber-posts (GFP). Canals of 90 single-rooted teeth were prepared for filling by the single-cone technique with gutta-percha and one of the following ES: AH Plus (epoxy resin), Endofill (zinc-oxide and eugenol), and Bio-C Sealer (calcium-silicate). After post-space preparation, tooth-specimens were equally divided in half according to type of GFP to be used. In the half to receive milled-CAD-CAM posts, tooth specimens were molded with acrylic resin to obtain replicas. These were scanned to enable the laboratory to produce the milled-CAD-CAM GFPs (Fiber CAD Lab, Angelus) by the subtractive technique. The other half of samples received prefabricated GFPs (Exacto, Angelus) (n=15). The GFPs were cemented with dual-cure resin cement (Panavia F2.0, Kuraray). Each root was sectioned into two slices per root region (cervical, middle, apical) that were subjected to the push-out BS test, in a universal testing machine. Failure mode (FM) was classified by scores. The BS data were submitted to generalized linear model analyses, while FM was analyzed using the chi-square test (a=0.05). BS showed no significant difference among the three ES (p > 0.05). BS was significantly higher for prefabricated (mean 10.84 MPa) versus milled-CAD-CAM GFPs (mean 6.94 MPa) (p <0.0001), irrespective of ES. The majority showed mixed failures. It could be concluded that type of ES did not affect BS of GFPs to dentin, and prefabricated-GFPs had higher bond-strength than customized-milled-CAD-CAM GFPs.

Do different adhesives influence the color stability and fluorescence of composite restorations after aging?

Abstract This study aimed to evaluate the influence of dental adhesive color on the chromatic stability and fluorescence intensity of composite resin restorations of different thicknesses. Ninety bovine enamel samples were obtained and restored with resin composite varying thicknesses of restorative material and enamel (1.0 mm enamel and 1.0 mm composite; 1.5 mm enamel and 0.5 mm composite; 0.5 mm enamel and 1.5 mm composite). The restorations were made of composite resin (Opallis E-bleach H) using different types of dental adhesives: Ambar, Ambar APS, and Single Bond Universal (n=10). The samples were subjected to color measurement tests in a spectrophotometer using CIEDE2000 and fluorescence intensity measurements before and after aging in a red wine coloring solution. Data were subjected to analysis of variance (ANOVA) and Tukey's test (α = 0.05). There were no statistically significant changes in color stability or fluorescence intensity for restorations made of different materials or thicknesses (p>0.05). Single Bond Universal showed greater color stability at 0.5 mm thickness (ΔE00 = 4.4 ± 1.6) compared to other thicknesses of the same material (p=0.003), as well as a greater difference in fluorescence intensity after aging at 1.5 mm thickness (-414.9 ± 103.8) compared to other materials (p=0.0002). Overall, it was concluded that the different adhesive systems did not influence the color stability and fluorescence of restorations of different thicknesses.

Resumo O objetivo deste estudo foi avaliar a influência da cor do adesivo dental na estabilidade cromática e intensidade de fluorescência das restaurações de resina composta de diferentes espessuras. Foram obtidos noventa amostras de esmalte bovino que foram restaurados com resina composta, variando a espessura do material restaurador e do esmalte (1,0 mm de esmalte e 1,0 mm de compósito; 1,5 mm de esmalte e 0,5 mm de compósito; 0,5 mm de esmalte e 1,5 mm de compósito). As restaurações foram feitas de resina composta (Opallis E-bleach H) utilizando diferentes tipos de adesivos odontológicos: Ambar, Ambar APS, e Single Bond Universal (n=10). As amostras foram submetidas a testes de medição de cor em um espectrofotômetro usando CIEDE2000 e medições de intensidade de fluorescência antes e depois do envelhecimento em uma solução de coloração de vinho tinto. Os dados foram submetidos à análise de variância (ANOVA) e ao teste de Tukey (α = 0,05). Não houve mudanças estatisticamente significativas na estabilidade da cor ou intensidade de fluorescência para restaurações feitas de diferentes materiais ou espessuras (p>0,05). O Single Bond Universal mostrou maior estabilidade de cor a 0,5 mm de espessura (ΔE00 = 4,4 ± 1,6) em comparação com outras espessuras do mesmo material (p=0,03), bem como uma maior diferença na intensidade de fluorescência após o envelhecimento a 1,5 mm de espessura (-414,9 ± 103,8) em comparação com outros materiais (p=0,0002). Em geral, concluiu-se que os diferentes sistemas adesivos não influenciaram a estabilidade de cor e a intensidade de fluorescência das restaurações de diferentes espessuras.

Influence of self-etching adhesive on the bond strength of irradiated teeth / Influência do adesivo autocondicionante na resistência de união em dentes submetidos à radiação

ABSTRACT This study aimed to conduct a literature review about the influence of self-etching adhesives on the bond strength of restorative procedures for irradiated teeth. The search for articles was carried out on six databases (PubMed, Scopus, Web of Science, Embase, LILACS, Cochrane). Gray literature (Google Scholar) and reference lists of included studies were evaluated. The keywords used were: "Radiotherapy" OR "Radiation Therapy" OR "Radiation Treatment" OR "Radiation Effects" OR "Radioterapia" OR "Terapia por radiação" OR "Tratamento por radiação" OR "Efeitos da Radiação" OR "Terapia por Radiación" OR "Tratamiento por Radiación" OR "Efectos de Radiación" AND "Dentin-Bonding agent" OR "Adesivos Dentinários" OR "Recubrimientos Dentinarios". The inclusion criteria were laboratory and clinical studies, dissertations, literary and systematic reviews, and no time and language restrictions. Three hundred and eighteen studies were identified in the databases, 30 in the gray literature, and 5 from the reference list of included articles. 40 were excluded for being duplicates. After reading the title and abstract, 28 articles remained for complete analysis. In the end, 21 articles were included in this study. Self-etching could be a good option for irradiated teeth restorations. However, further clinical studies are needed.

RESUMO O objetivo deste trabalho foi realizar uma revisão integrativa da literatura sobre a influência de adesivos autocondicionantes na resistência de união de restaurações de dentes submetidos à radiação. A busca da literatura foi realizada em seis bases de dados (PubMed, Scopus, Web of Science, Embase, LILACS, Cochrane). A literatura cinza (Google Scholar) e as listas de referências dos estudos incluídos foram avaliadas. A pesquisa foi realizada com as palavras-chave: "Radiotherapy" OR "Radiation Therapy" OR "Radiation Treatment" OR "Radiation Effects" OR "Radioterapia" OR "Terapia por radiação" OR "Tratamento por radiação" OR "Efeitos da Radiação" OR "Terapia por Radiación" OR "Tratamiento por Radiación" OR "Efectos de Radiación" AND "Dentin-Bonding agent" OR "Adesivos Dentinários" OR "Recubrimientos Dentinarios". Os critérios de inclusão foram estudos in vitro e clínicos, dissertações, revisões sistemáticas e literárias, sem restrições de período e de idiomas. Foram identificados 318 estudos nas diferentes bases de dados, 30 na literatura cinzenta e 5 da lista de referências dos artigos incluídos, dos quais 40 foram excluídos por serem duplicatas. Após a leitura do título e do resumo, permaneceram 28 artigos para análise completa. Ao final, 21 artigos foram incluídos neste trabalho. Os adesivos autocondicionantes podem ser uma boa alternativa em restaurações de dentes submetidos à radiação. Todavia, ainda existem poucos trabalhos sobre o tema e ratifica-se a necessidade de mais estudos clínicos.

Dual-cured adhesive system improves adhesive properties of dentin cavities restored with a bulk-fill resin composite

Aim: To evaluate the impact of a dual-cured adhesive system on the in situ degree of conversion (DC), bond strength (BS) and failure mode (FM) of adhesive interfaces in dentin cavities restored with a bulk-fill resin composite. Methods: 4-mm-deep dentin cavities with a 3.1 C-factor were created in 68 bovine incisors (n = 17 per group). The lightcured (Scotchbond™ Universal) or the dual-cured (Adper™ Scotchbond™ Multi-purpose Plus) adhesive system was applied to the cavities, which were then restored with a bulkfill resin composite (Filtek™ Bulk Fill). In situ DC analysis was performed by means of micro Raman spectroscopy at the top and bottom interfaces. Push-out BS was measured in a universal testing machine after 24-h or 6-month water storage. FM was determined with a stereomicroscope. Data of in situ DC and BS were analyzed by two-way analysis of variance (ANOVA) and Tukey test (p<0.05), while the FM was analyzed descriptively. Results: The groups that received the dual-cured adhesive system showed statistically higher in situ DC and BS than those that received the light-cured adhesive system. Cohesive failure mode was the most frequent in all conditions. Conclusion: In situ DC and BS were influenced by the curing strategies of the adhesive systems with better performance of the dual-cured material

Universal adhesives applied to deep dentin with different bonding treatments / Adhesivos universales aplicados a dentina profunda con diferentes tratamientos de unión

ABSTRACT Eighth-generation adhesives may be applied with total etch, selective-etch or self-conditioning, and serve as primers for non-dental substrates. Aim: To determine the bonding characteristics of universal adhesives applied to the deep pulp wall with different strategies, by means of shear bond strength and laser microscopy. Materials and Method: Cavities 4 mm deep and maximum width were carved in 36 extracted molars. Nine groups were formed according to dental substrate treatment and adhesives, as follows: Total-etch: group 1-Monobond 7 self-etch, group 2-One coat 7 universal, and group 3-Single bond universal; Adamantine etch: group 4-Monobond 7 self-etch, group 5-One coat 7 universal, and group 6-Single bond universal; Self-conditioning: group 7-Monobond 7 self-etch, group 8-One coat 7 universal, and group 9-Single bond universal. Molars were filled following the manufacturer's instructions. Three specimens per group (27 altogether) were used to determine shear bond strength using a universal testing machine, while layer thicknesses were measured on the remaining specimens using microscope images and Olympus LEXT 3D Software. Analysis of variance was used to compare data. Results: Mean (standard deviation) bond strength in megapascals (MPa) was: group 1: 7.06±3.01; group 2: 10.74±4.36; group 3: 8.20±3.92; group 4: 7.41±2.23; group 5: 6.84±1.50; group 6: 5.86±2.10; group 7: 5.83±1.94; group 8: 7.14±2.37; group 9: 8.06±3.51. Bond strength was higher (p=0.049) for total-etch (8.61±3.96) than for selective etch (6.71±1.98) and self-conditioning (6.91±2.68). No significant difference was found among the three adhesives (p=0.205). Adhesive layer in micrometers (μm) was total-etch 8.71±4.93, selective etch 5.49±1.70 and self-conditioning 6.27±3.01, with no significant difference. Conclusions: There were significant differences among bonding strategies, with the highest values for total-etch. No significant difference was observed between self-conditioning and selective etch. No significant difference was found among the adhesives, which all behaved similarly. The greatest adhesive layer thicknesses were recorded in the total-etch group, with no significant difference among the various adhesive approaches.

RESUMEN Los adhesivos universales de octava generación pueden ser aplicados con diferentes estrategias de unión: grabado total, grabado selectivo o autoacondicionamiento. Además, imprimen sustratos no dentales. Objetivo: Determinar las caracteristicas de unión de adhesivos universales con diferentes estrategias en pared pulpar profunda mediante resistencia adhesiva al corte y microscopía laser. Materiales y Método: En 36 molares se tallaron cavidades de 4 mm de profundidad y ancho máximo. Se dividieron en 9 grupos según tratamientos y adhesivos. Grabado total: grupo 1-Monobond 7 self-etching, grupo 2-One coat 7 universal y grupo 3-Single bond universal; Grabado selectivo: grupo 4-Monobond 7 self-etching; grupo 5-One coat 7 universal y grupo 6-Single bond universal y Autoacondicionamiento: grupo 7-Monobond 7 self-etching; grupo 8-One coat 7 universal y grupo 9-Single bond universal. Las obturaciones se realizaron siguiendo las instrucciones del fabricante. La resistencia adhesiva al corte se determinó utilizando una máquina de ensayo universal sobre 27 especímenes mientras que los restantes fueron empleados para evaluar los espesores de la capa generado sobre imágenes obtenidas con microscopía y con el software Olympus LEXT 3D. Se ultilizó análisis de varianza. Resultados: Resistencia adhesiva en megapascal (MPa) media (desviación estándar): grupo 1: 7,06±3,01; grupo 2: 10,74±4,36; grupo 3: 8,20±3,92; grupo 4: 7,41±2,23; grupo 5: 6,84±1,50; grupo 6: 5,86±2,10; grupo 7: 5,83±1,94; grupo 8: 7,14±2,37; grupo 9: 8,06±3,51. Grabado total (8,61±3,96) registró los valores mayores (p=0,049) en comparación a grabado selectivo (6,71±1,98) y autoacondicionamiento (6,91±2,68). Los adhesivos no tuvieron diferencias significativas (p=0,205). Capa adhesiva en μm: Grabado total (8,71±4,93); grabado selectivo (5,49±1,70) y autoacondicionamiento (6,27±3,01) sin diferencias significativas (p=0,073). Conclusiones: Las estrategias de unión mostraron diferencias significativas; los valores más altos se obtuvieron con grabado total y entre autoacondicionamiento y grabado selectivo no hubo significancia. Los adhesivos evidenciaron comportamientos similares sin registrar diferencias significativas. Los mayores espesores de capa fueron con grabado total sin diferencias significativas entre las técnicas.

Influence of chlorhexidine 2% and sodium hypochlorite 5. 25% on micro-tensile bond strength of Universal adhesive system (G-Premio Bond)

Aim One of the reasons for the failure of adhesion in composite restorations and secondary caries may be the chemical irrigants used during the endodontic treatment. NaOCl is widely used for the biomechanical preparation of root canals due to its antimicrobial properties and capacity to dissolve organic material. In addition, another very effective decontamination solution is chlorhexidine 2%. There are few studies about the effect of root canal irrigation solutions on bond strength of universal adhesives therefore, in this study we have investigated the influence of CHX 2% and NaOCl 5.25% on micro-tensile bond strength of G-Premio Bond. Methods Twenty-four human teeth were randomly allocated to the following groups: G1, immersion in saline solution 0.9% for 30 minutes (control); G2, immersion in CHX 2% for 30 minutes; G3, immersion in NaOCl 5.25% for 30 minutes. After restoration, the dentin/resin interface was tested by micro-tensile bond strength. The surfaces morphology was analyzed by Scanning Electron Microscopy. Data were analyzed by ANOVA followed by Tukey test in SPSS software Version 24. Results There was a statistically significant difference between G3 and G1 (P < 0.05). There were no statistically significant differences among G1 and G2, G2 and G3. Conclusion Root canal irrigation with NaOCl 5.25% significantly reduced the micro-tensile bond strength in the G-Premio Bond at self-etch mode, but the use of CHX did not make a significant difference.

Uso de adhesivo universal con pregrabado y autograbado en tejidos duros del diente / Use of universal adhesive with pre-etch and self etch strategies on hard tooth tissues

RESUMEN Introducción: Buscando satisfacer la demanda con procedimientos adhesivos más rápidos, menos sensibles a la técnica y facilidad de uso, se han desarrollado los adhesivos universales, que brindan al profesional la opción de seleccionar la estrategia de adhesión con diferentes modos de grabado, ya sea con grabado y enjuague, autograbado o grabado selectivo. Debido a la poca información existente, se han generado dudas sobre el rendimiento, propiedades y la aplicación de una técnica adhesiva adecuada sobre los tejidos dentales. Objetivo: Determinar el nivel de adhesión con el uso de adhesivos universales en modo de grabado y enjuague y autograbado. Métodos: Se realizó una revisión de la literatura, a través de la búsqueda electrónica en las bases de datos: SciELO, Scopus, PubMed, Springer y EBSCO. Inicialmente se seleccionaron por título y resumen, artículos duplicados se consideraron solo una vez, se incluyeron artículos de acceso libre y pagos, escritos en idioma español e inglés, publicados desde el año 2015, de los cuales 39 artículos fueron seleccionados para el estudio. Conclusiones: El uso de adhesivos universales sobre dentina presenta un nivel de adhesión mayor cuando se aplica en modo de autograbado. La aplicación activa del adhesivo universal en esmalte mejora la fuerza y resistencia de unión. El nivel de adhesión en el esmalte es mayor cuando se aplica en modo de grabado y enjuague. La resistencia inicial y por fatiga del adhesivo, no mejora con los tiempos prolongados del grabado ácido.

ABSTRACT Introduction: universal adhesives have been developed to satisfy the demand with faster adhesive procedures, less sensitive to the technique and ease of use, which offer the professional the option of selecting the adhesion strategy with different etching modes, either with etch-and-rinse, self-etch or selective etching ones. Doubts have been generated about the performance, properties and application of an adequate adhesive technique on dental tissues due to the little existing information. Objective: to determine the level of adhesion with the use of universal adhesives in etch-and-rinse and self-etch modes Methods: an electronic search of the literature was carried out in SciELO, Scopus, PubMed, Springer and EBSCO databases. Initially, articles were selected by title and abstract, duplicate ones were considered only once, free and paid access articles, written in Spanish and English and published since 2015 were included; 39 of them were selected for the study. Conclusions: the use of universal adhesives on dentin presents a higher level of adhesion when applied in self-etch mode. The active application of the universal adhesive improves the enamel bond strength. The level of adhesion on the enamel is higher when applied in etch-and-rinse. The initial fatigue resistance of the adhesive does not improve with prolonged acid etching times.

Effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots / Efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar raíces debilitadas

Background: This study evaluated the effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots. Material and Methods: Sixty-four roots of extracted human maxillary canines were weakened, prepared and filled with two different endodontic sealers (Endofill and AH Plus). In half of the sample, set aside for each respective sealer, excess filling material was cleaned. In the other half, the weakened areas were not cleaned, and the excess of sealer was spread on the intraradicular dentin. Intentionally worn areas inside each root were restored with a microhybrid light-cure composite resin (Z100) to reinforce them, with and without acid etching. Prefabricated metal posts were fixed with a dual resin cement (RelyX ARC), and the specimens were submitted to a pull-out test. Statistical analysis was performed by means of Shapiro-Wilk, analysis of variance (one-way ANOVA) and Tukey-Kramer tests (p<0.05). Results: The groups filled with Endofill (GI, GII, GIII, GIV) had the lowest bond strength values, which were similar among each other (p>0.05).The greatest bond strength values were observed in roots filled with AH Plus (GV, GVI, GVII, GVIII), mainly without cleaning of the weakened areas, and followed by acid etching (GVII), and also with cleaning of the weakened areas, however, with no acid etching (GVI) (p<0.05). Conclusion: The greatest bond strength values were observed in roots filled with AH Plus; (1) without cleaning of the weakened areas and with acid etching, and; (2) with cleaning of the weakened areas, but without acid etching.

Antecedentes: este estudio evaluó los efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar las raíces debilitadas. Material y Métodos: Sesenta y cuatro raíces de caninos maxilares humanos extraídos fueron debilitadas, preparadas y rellenadas con dos selladores endodónticos diferentes (Endofill y AH Plus). En la mitad de la muestra, reservada para cada sellador respectivo, se limpió el exceso de material de relleno. En la otra mitad, las áreas debilitadas no se limpiaron y el exceso de sellador se esparció sobre la dentina intrarradicular. Las áreas desgastadas intencionalmente dentro de cada raíz se restauraron con una resina compuesta fotopolimerizable microhíbrida (Z100) para reforzarlas, con y sin grabado ácido. Los postes metálicos prefabricados se fijaron con un cemento de resina dual (RelyX ARC) y los especímenes se sometieron a una prueba de extracción. El análisis estadístico se realizó mediante Shapiro-Wilk, análisis de varianza (ANOVA de una vía) y pruebas de Tukey-Kramer (p<0,05). Resultados: Los grupos rellenos con Endofill (GI, GII, GIII, GIV) presentaron los valores más bajos de fuerza de unión, los cuales fueron similares entre sí (p>0,05). Los mayores valores de fuerza de unión se observaron en raíces rellenas con AH Plus (GV, GVI, GVII, GVIII), principalmente sin limpieza de las áreas debilitadas, seguido de grabado ácido (GVII), y también con limpieza de las áreas debilitadas aunque sin grabado ácido (GVI) (p<0.05). Conclusión: Los mayores valores de fuerza de unión se observaron en las raíces rellenas con AH Plus; (1) sin limpieza de las áreas debilitadas y con grabado ácido, y; (2) con limpieza de las áreas debilitadas, pero sin grabado ácido.

Cimentação adesiva de cerâmicas vítreas para CAD/CAM: efeito do tipo de sistema adesivo e do envelhecimento em longo prazo na resistência de união ao cimento resinoso / Adhesive cementation of glass ceramics for CAD/CAM: effect of the type of adhesive system and long-term aging on the bond strength to resin cement

O objetivo desta pesquisa foi avaliar o efeito do tipo de sistema adesivo e do envelhecimento na molhabilidade e resistência de união das cerâmicas vítreas ao cimento resinoso. Blocos de silicato de lítio (SL - Celtra Duo, Dentsply Sirona), feldspática (FD - Vita Mark II, VITA Zahnfabrik) e cerâmica infiltrada por polímero (PIC - Vita Enamic, VITA Zahnfabrik) foram seccionados (N=96, 10 x 12 x 2 mm), incluídos e divididos aleatoriamente em 24 grupos de acordo com os fatores: "Cerâmica" (SL, FD e PIC), "Adesivo" (CONT­sem adesivo; C2P­ adesivo convencional de 2 passos; C3P­adesivo convencional de 3 passos; UNV­adesivo universal) e "Envelhecimento" (SE-sem; CE­com). Após o condicionamento das cerâmicas (HF 5%), silanização e aplicação do sistema adesivo de acordo com o grupo experimental, cilindros (n=15, Ø = 2 mm e altura = 2 mm) de cimento resinoso (RelyX Ultimate, 3M ESPE) foram confeccionados (4 cilindros/bloco), sendo metade das amostras armazenadas em água destilada a 37°C por 24h (SE) e metade foi submetida à termociclagem 10.000 ciclos e armazenamento em água a 37°C por 18 meses (CE). Em seguida, as amostras foram submetidas ao teste de resistência de união ao cisalhamento (RUC - 100 KgF, 1 mm/min), análises de falhas, mensuração do ângulo de contato e análise da interface por meio da microscopia eletrônica de varredura (MEV). Os dados da RUC (MPa) e ângulo de contato foram analisados pelo ANOVA2 fatores e ANOVA-1 fator, respectivamente e Tukey (5%). A análise de Weibull foi realizada para a RUC. ANOVA-2 fatores revelou que o fator "Adesivo" foi significativo apenas para as cerâmicas SL (p<0,0001) e FD (p=0,0079). Já a interação Adesivo/Envelhecimento (p=0,0015) e "Envelhecimento" (p=0,0008) foram significativos apenas para SL. Para SL, após o envelhecimento os grupos CE_UNV (22,18± 7,74CD) e CE_C2P (17,32± 5,86D ) foram inferiores ao controle (30,30± 6,11A ). Apenas o grupo UNV apresentou redução significativa após envelhecimento. Para FD, C2P apresentou a menor RUC em relação aos demais grupos. PIC apresentou similaridade da RUC entre todos os grupos. O ângulo de contato de UNV apresentou o menor valor para SL (55,27°) e FD (51,34°). Para PIC, C3P apresentou o maior ângulo (63,00°) e CONT o menor (49,83°). Portanto, a aplicação de um adesivo não foi benéfica para a adesão da cerâmica ao cimento. Ademais, o uso de C2P e UNV após silanização da cerâmica SL e C2P para FD deve ser avaliada com precaução, já que a resistência de união foi reduzida em comparação ao grupo controle após o envelhecimento (AU).

The aim of this study was to evaluate the effect of the type of adhesive system and aging on the wettability and bond strength of glass ceramics to resin cement. Lithium silicate (SL - Celtra Duo, Dentsply Sirona), feldspathic (FD - Vita Mark II, VITA Zahnfabrik) and polymerinfiltrated ceramic (PIC - Vita Enamic, VITA Zahnfabrik) blocks were sectioned (N=96, 10 x 12 x 2 mm), included and randomly divided into 24 groups according to the factors: "Ceramics" (SL, FD and PIC), "Adhesive" (CONT­without adhesive; C2P­conventional 2-step adhesive; C3P­adhesive conventional 3-step; UNV­universal adhesive) and "Aging" (SE-non-aged; CEaged). After the conditioning of the ceramics (HF 5%), silanization and application of the adhesive system according to the experimental group, cylinders (n=15, Ø = 2 mm and height = 2 mm) of resin cement (RelyX Ultimate, 3M ESPE) were made (4 cylinders/block) and half of the samples were stored in distilled water at 37°C for 24h (SE) and half were subjected to thermocycling 10,000 cycles and storage in water at 37°C for 18 months (EC). Then, the samples were submitted to the shear bond strength test (RUC - 100 KgF, 1 mm/min), failure analysis, contact angle measurement and interface analysis by means of scanning electron microscopy (SEM). RUC (MPa) and contact angle data were analyzed by ANOVA 2-way and ANOVA 1-way, respectively, and Tukey (5%). Weibull analysis was performed for RUC. ANOVA 2-way revealed that the "Adhesive" factor was significant only for SL (p<0.0001) and FD (p=0.0079) ceramics. The Adhesive/Aging interaction (p=0.0015) and "Aging" (p=0.0008) were significant only for SL. For SL, after aging, the CE_UNV (22.18± 7.74CD) and CE_C2P (17.32± 5.86D) groups were lower than the control (30.30± 6.11A). Only the UNV group showed a significant decrease after aging. For FD, C2P had the lowest RUC in relation to the other groups. PIC showed similarity of RUC between all groups. The UNV contact angle presented the lowest value for SL (55.27°) and FD (51.34°). For PIC, C3P presented the highest angle (63.00°) and CONT the smallest (49.83°). Therefore, the application of an adhesive was not beneficial for the adhesion of the ceramic to the resin cement. Furthermore, the use of C2P and UNV after silanization of SL and C2P ceramics for FD should be evaluated with caution, as the bond strength was reduced compared to the control group after aging (AU).

Effect of MDP concentration and addition of iodonium salt on the dentin bond strength of experimental adhesives / Efeito da concentração de MDP e adição de sal de iodônio na resistência de união à dentina de adesivos experimentais

Objetivo: O objetivo foi avaliar a resistência de união de seis adesivos experimentais contendo sistemas fotoiniciadores binários ou ternários, associados a três diferentes concentrações de MDP (0-12% em peso) após 12 meses de armazenamento em água destilada. Material e Métodos: Adesivos experimentais foram preparados com: bis-GMA, UDMA, bis-EMA, TEGDMA, HEMA, BHT e etanol, contendo sistemas fotoiniciadores binários (CQ/amina) ou ternários (CQ/amina/DPIHFP ­ 0,5% em peso). Foi adicionado a esta composição 0%, 6% ou 12% em peso de MDP. Os sistemas adesivos foram aplicados seguindo o protocolo com condicionamento ácido. Moldes cilíndricos transparentes foram colocados sobre a dentina hibridizada, preenchidos com resina composta e fotopolimerizados. Os corpos-de-prova foram armazenados em água destilada a 37oC por 24h ou 12 meses e submetidos ao ensaio de microcisalhamento (n=6). Os dados foram analisados por ANOVA de três fatores e teste de Tukey (α=5%). Resultados: Para o sistema binário, após 12 meses de armazenamento, todos os valores de resistência de união foram semelhantes. Em relação à degradação da resistência de adesão ao longo do tempo, as formulações de MDP de 6% e 12% mostraram resistência de união mais estável do que 0% de MDP. Para o sistema ternário, todas as formulações (0%, 6% e 12% em massa de MDP) mostraram resistência de união estável em função do tempo. Conclusão: Para o sistema binário, as concentrações de 6 e 12% em massa de MDP foram capazes de manter a resistência de união em função do tempo, enquanto que para o sistema ternário, a estabilidade de união foi obtida independentemente da concentração de MDP. Pode-se concluir que, para a formulação dos adesivos utilizados neste estudo, independente do sistema fotoiniciador, a concentração de 12% MDP apresentou valores de resistência de união mais estáveis após 12 meses de armazenamento em água (AU)

Objective: The aim was to evaluate the bond strength of six experimental adhesives containing binary or ternary photoinitiator systems, associated with three different MDP concentrations (0-12wt%) after 12 months of storage in distilled water. Material and Methods: Experimental adhesives were prepared with: bis-GMA, UDMA, bis-EMA, TEGDMA, HEMA, BHT, and ethanol, containing binary (CQ/amine) or ternary (CQ/amine/DPIHFP (diphenyliodonium hexafluorophosphate) ­ 0.5wt%) photoinitiator systems. It was added to this composition 0wt%, 6wt%, or 12wt% of MDP. The adhesive systems were applied following the etch-and-rinse protocol. Transparent cylindrical molds were placed on the hybridized dentin, filled with composite resin and light-cured. The specimens were stored in distilled water at 37oC for 24h or 12 months and submitted to a microshear bond strength test (n=6). Data were analyzed by three-way ANOVA and Tukey's test (α=5%). Results: For the binary system, after 12 months of storage, all bond strength values were similar. Regarding bond strength degradation over time, 6wt% and 12wt% MDP formulations showed more stable bond strength than 0wt% MDP. For the ternary system, all formulations (0wt%, 6wt% and 12wt%) showed stable bond strength over time. Conclusion: For the binary photoinitiator system, the 6wt% and 12wt% MDP concentrations were able to keep bond strength stable over time, while for the ternary system, bond strength stability was achieved regardless the MDP concentration. (AU)

Dentin bond strength evaluation between a conventional and universal adhesive using etch-and-rinse strategy

Aim: The aim of this study was to compare the microtensile bond strength (µTBS) and the characteristics of the adhesive interface of Scotchbond Universal - SU ­ etch-and-rise mode (3M ESPE) and Adper Scotchbond Multi-Purpose - MP (3M ESPE) to dentin over time. Methods: Class I cavity preparations were performed in 60 human molars that were randomly divided according to the dentin bonding system (DBS) used (n=30): (1) Acid conditioning + SU and (2) Acid conditioning + MP. For bonding strength (BS) analysis, 30 teeth (n = 15) were sectioned into sticks and submitted to the microtensile test in a universal testing machine after 24 hours and 12 months. The adhesive interface of the others 30 teeth was analyzed in a confocal microscope after 24 hours and 12 months. The data of µTBS were analyzed by two-way repeated measures ANOVA and Tukey's HSD (α = 0.05). Results: SU presented the lowest DBS compared to MP (p=0.000). Time did not influenced DBS for both adhesive systems (p=0.177). Confocal microscopy analysis showed no cracks between both adhesive systems tested. Conclusion: The results indicate that MP - µTBS showed a better performance compared to SU in total-etch mode

Influence of laser deproteinization of acid-etched dentin on marginal microleakage of class V composite restoration

Aim: Recent reports indicate that deproteinization of acid-etched dentin surface can extend penetration depth of adhesive agents. The main goal of the present research was to investigate the deproteinization effect of Nd:YAG and diode 940 lasers on acid-etched dentin and microleakage grade in class V composite restorations. Methods: 36 extracted human premolar teeth were selected to make standard buccal and lingual class V cavities. These samples were randomly split into three sub-groups: 1.Control group, in which composite was applied for restoration after etch and bonding process without deproteinization; 2.Nd:YAG laser group, in which the teeth were deproteinized with Nd:YAG laser after etching and painting internal surfaces of cavities with Van Geison stain and then composite restorations applied just as control group; 3.Diode laser group, in which the process was similar to Nd:YAG laser group, but instead, diode 940 laser was irradiated. The teeth were bisected into two equal longitudinal buccal and lingual halves. Marginal microleakage of samples was scored by using a stereomicroscope. Kruskal- Wallis, Mann-Whitney U and Fisher's statistical tests were employed for analysis of the obtained data. Results: A significant reduction in marginal microleakage was observed for both groups treated with laser (Nd:YAG and diode 940)compared to control (p=0.001 & p=0.047). There was no significant difference in marginal microleakage between Nd:YAG laser and diode 940groups (P = 0.333). Conclusion: Nd:YAG and diode 940 laser deproteinization of acid-etched dentin decreased the marginal microleakage of in-vitro class V resin composite restorations

Sistemas adesivos universais ­ há 10 anos no Brasil: revisão de literatura / Universal adhesive systems ­ 10 years in Brasil: literature review

Objetivo: analisar, a partir da literatura publicada, os sistemas adesivos universais, conceituando sobre seu desempenho nos diferentes substratos, assim como potenciais estudos executados com eles após 10 anos no Brasil. Materiais e métodos: para esta revisão narrativa, foram pesquisados artigos na língua inglesa nas bases de dados eletrônicas PubMed/Medline, SciELO e Scopus, publicados de 2012 a 2022, período considerado por ser a última década, além dos 10 anos da chegada do sistema adesivo universal ao Brasil. Utilizaram-se os seguintes descritores: universal adhesives (adesivos universais) OR universal adhesive system (sistemas adesivos universais). Realizou-se a inclusão de estudos laboratoriais (in vitro), ensaios clínicos, revisões de literatura e sistemáticas com meta-análise. Resultados: após análise meticulosa, foram selecionados 56 estudos. Os adesivos universais são considerados mais "amigáveis" ao usuário, pois permitem ao clínico a utilização no modo condicione e lave e autocondicionante, principalmente devido à inclusão do monômero MDP ou de monômeros similares. No esmalte, o condicionamento ácido seletivo antes da aplicação do adesivo é recomendado. Permite ser utilizado com uma diversidade de substratos, a aplicação de forma ativa do adesivo melhora a resistência de união. Conclusão: os sistemas adesivos universais foram lançados para tornar os procedimentos de adesão mais simples. Entretanto, mais ensaios clínicos com maiores tempos de acompanhamento são necessários, para avaliar adequadamente a efetividade desse material.(AU)

Objective: To evaluate, from published literature, the universal adhesive systems, conceptualizing their performance, as well as potential studies performed using this material. MATERIAL AND METHODS: This narrative review considered articles in the English language searched on Pubmed/ Medline, Scielo and Scopus from 2012 to 2022, considered period to be the last decade, besides ten years of the universal adhesive system arrived in Brazil. The descriptors "universal adhesive" or "universal adhesive systems" were used. Laboratorial studies (in vitro), clinical trials, literature review and systematic review with meta-analysis were included. RESULTS: 56 studies were included. The universal adhesives are considered more user-friendly, allowing for etch & rinse and self-etch modes, mostly due to MDP monomer or similar monomers inclusion. In enamel selective acid etching before adhesive application is recommended. The system can be used with great amount of substrates and results in superior bond strength when applied through active mode. CONCLUSION: Universal adhesive systems were launched to simplify the adhesion procedure, however more clinical trials with longer follow-ups are required using this material, with adequate evaluation of their effectiveness.(AU)

Evaluation of The Cleaning Protocol of Post Space on Bond Strength of Glass Fiber Posts / Evaluación del Protocolo de Limpieza del Conducto Radicular sobre la Resistencia de la Unión de Postes de Fibra de Vidrio

This study aimed to compare the effect of four irrigation solutions for post space cleaning on the bond strength between glass fiber post and root dentine. Forty bovine roots were root-filled and randomly divided into four groups (n=10), according to the irrigation solution: CG (Control Group): saline solution; SH (Sodium Hypochlorite Group); CLX (Chlorhexidine group) and EDTA (ethylenediaminetetraacetic acid group). Specimens were submitted to mechanical aging and push-out test. Statistical analysis (ANOVA two-way and Tukey test; p<0.05) was performed. A stereomicroscope was used for failure mode classification. EDTA showed higher bond strength values, differing statistically from SH and CG (p<0.05). Adhesive failure between dentin and resinous cement was predominant, followed by mixed failures. SEM images showed pronounced smear layer removal in the EDTA group. 17 % EDTA was better than other solutions for cleaning of post space when using glass fiber posts.

Este estudio tuvo como objetivo comparar el efecto de cuatro soluciones de irrigación para la limpieza del espacio del poste sobre la fuerza de unión entre el poste de fibra de vidrio y la dentina radicular. Se rellenaron cuarenta raíces bovinas y se dividieron aleatoriamente en cuatro grupos (n = 10), según la solu- ción de riego: CG (Grupo Control): solución salina; SH (Gru- po de hipoclorito de sodio); CLX (grupo clorhexidina) y EDTA (grupo ácido etilendiaminotetraacético). Las muestras se sometieron a una prueba de envejecimiento mecánico y de expulsión. Se realizó análisis estadístico (ANOVA bidireccional y prueba de Tukey; p <0,05). Se utilizó un microscopio estereoscópico para la clasificación del modo de falla. EDTA mostró valores de fuerza de unión más altos, difiriendo estadísticamente de SH y CG (p <0,05). Pre-dominó la falla adhesiva entre dentina y cemento resinoso, seguida de fallas mixtas. Las imágenes SEM mostraron una eliminación pronunciada de la capa de frotis en el grupo de EDTA. El EDTA al 17 % fue mejor que otras soluciones para la limpieza del espacio de los postes cuando se utilizan postes de fibra de vidrio.

Assessment of permeability of eroded dentin after the use of universal, self-etch, and conventional systems / Avaliaçao da permeabilidade da dentina com erosao, após o uso de sistemas universais, autocondicionantes e convencionais

ABSTRACT Dentin hypersensitivity is caused by increased dentinal permeability due to total or partial exposure of dentinal tubules, which in turn can be produced by alterations of dental structures or failure of restorative procedures. The purpose of this in vitro study was to evaluate the efficacy of the application of different kinds of adhesive systems to prevent dentin permeability before and after an erosive challenge. Fifty bovine dentin discs (6x1 mm) were prepared and the specimens were divided into 5 groups (n=10): (SB2) Single Bond 2, (SBU) Universal Single Bond, (CSB) Clearfil SE Bond, (SM) Scotchbond Multipurpose and (C) Control. Hydraulic conductance of dentin was recorded after adhesive application (HC-1) and after erosive challenge (HC-2). Dentin surface images of post-treatment and post-erosive challenge were obtained by scanning electron microscopy (SEM). Data were analyzed using Kruskal Wallis, Mann-Whitney with Bonferroni correction and Wilcoxon tests (p<0.05). Reduction in dentin permeability was observed with the application of adhesive systems (p<0.05). After the erosive challenge, dentin permeability increased for SBU and CSB (p<0.05), while SB2 and SM did not differ in HC-1 or HC-2 (p>0.05). The conventional, self-etching and universal adhesive systems reduce dentinal permeability by more than 80%, and dentin demineralization may contribute to the increased permeability of universal and self-etching systems.

RESUMO Diversos pacientes apresentam hipersensibilidade dentaria ou falha nos procedimentos restauradores, devido á exposigao total ou parcial de túbulos dentinários. O objetivo deste estudo in vitro foi o de avaliar a influencia da aplicagao de diferentes tipos de sistemas adesivos na permeabilidade da dentina e após o desafio erosivo. Cinquenta discos de dentina bovina (6x1 mm) foram confeccionados e os espécimes foram divididos em 5 grupos (n = 10): (SB2) Single Bond 2, (SBU) Universal Single Bond, (CSB) Clearfil SE Bond, (SM) ScotchbondMultiuso e (C) Controle. A condutáncia hidráulica da dentina foi registrada após a aplicagao do adesivo (HC-1) e após o desafio erosivo (HC-2). Imagens da superficie da dentina de pós-tratamento e pós-desafio erosivo foram obtidas por microscopia eletronica de varredura (MEV). Os dados foram analisados pelos testes de Kruskal Wallis, Mann-Whitney com correçâo de Bonferroni e Wilcoxon (p <0,05). Reduçâo da permeabilidade dentinária foi observada com a aplicaçâo dos sistemas adesivos (p <0,05). Após o desafio erosivo, a permeabilidade dentinária aumentou para SBU e CSB (p <0,05), enquanto SB2 e SM nao diferiram em HC-1 e HC-2 (p> 0,05). Os sistemas adesivos convencionais, autocondicionantes e universais reduzem a permeabilidade dentinária em mais de 80%, e a dentina desmineralizada pode gerar um aumento da permeabilidade dos sistemas adesivos universais e autocondicionantes.

Micro-push-out bond strength of mineral­based root canal sealer in canals with different tapers / Fuerza de unión por micro-expulsión del sellador de conductos radiculares a base de minerales en conductos con diferentes ahusamientos

Objective: The aim of this study was to assess the micro-push-out bond strength of a mineral-based root canal sealer, BioRoot RCS in canals prepared by K3XF rotary systems of two different tapers. Material and Methods: Eighty caries free maxillary central incisors were used in this study. The samples were allocated into 4 groups (n=20) according to the root canal sealer and taper of the rotary instruments. The samples were obturated using single cone obturation technique. From each root 1mm thick slices at coronal, middle and apical thirds were collected using hard tissue microtome under continuous water coolant. Push-out tests were done for these sections using a Universal testing machine (INSTRON 8801) at a crosshead speed of 1mm/min. One-way analysis of variance (ANOVA) was used to compare the bond strengths within groups and Tukey's multiple post hoc analysis was used for pair-wise comparison of bond strengths. Results: AH Plus exhibited higher micro-push-out bond strength than BioRootRCS though they did not differ significantly (p>0.05). Preparation of root canals with 6% taper rotary instruments showed higher bond strength than 4% though they did not differ significantly (p>0.05). Conclusion: There was no significant difference between micro-push-out bond strength values of BioRoot RCS and AH Plus. The bond strength values were high in 6% taper canals than 4% canals though the difference was not significant statistically.

Objetivo: El objetivo de este estudio fue evaluar la fuerza de unión por micro-expulsión de un sellador de conductos radiculares de base mineral, BioRoot RCS, en conductos preparados por sistemas rotativos K3XF con dos conos diferentes. Material y Métodos: En este estudio se utilizaron 80 incisivos centrales superiores libres de caries. Las muestras se distribuyeron en cuatro grupos (n = 20) de acuerdo al sellador del conducto radicular y al cono de los instrumentos rotativos. Las muestras se obturaron mediante la técnica de obturación de un solo cono. De cada raíz se recogieron rodajas de 1 mm de grosor en los tercios coronal, medio y apical utilizando un micrótomo de tejido duro con refrigeración continua por agua. Posteriormente, se realizó una prueba de expulsión para estas secciones utilizando una máquina de prueba universal (INSTRON 8801) a una velocidad del cabezal transversal de 1mm/min. Se utilizó el análisis de varianza unidireccional (ANOVA) para comparar las resistencias de la unión dentro de los grupos y el análisis post hoc multiple de Tukey se utilizó para la comparación por pares de las resistencias de la unión. Resultados: AH Plus exhibió una fuerza de unión de micro-expulsión más alta que BioRootRCS, aunque no difirieron significativamente (p>0,05). La preparación de los conductos radiculares con instrumentos rotativos ahusados al 6% mostró una fuerza de unión superior al 4%, aunque no difirieron significativamente (p>0,05). Conclusión: No hubo diferencias significativas entre los valores de fuerza de unión de micro-expulsión de BioRoot RCS y AH Plus. Los valores de la fuerza de unión fueron más altos en canales cónicos al 6% que en canales al 4%, aunque la diferencia no fue significativa estadísticamente.

Direct and Indirect Bonding Techniques: A Systematic Review

ABSTRACT Objective: To assess the scientific evidence on direct and indirect bonding techniques to analyse the differences related to treatment time, number of appointments and number of bracket detachments. Material and Methods: The MEDLINE and Cochrane Library databases were searched through to March 2021. Reference lists from the retrieved publications were also examined. The following article types that described data on the different types of direct and indirect bonding techniques in orthodontics were included: prospective and retrospective cohort studies, case-control studies and randomized controlled clinical trials (RCCTs). Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies. Results: The search strategy initially resulted in 824 articles, and after a careful selection comprising the inclusion criteria, 12 articles were picked for the final review, specifically 2 cohort studies, 4 case-control studies and 6 RCCTs. The methodological quality was low in 4 studies, medium in 2, and high in 6 articles. Conclusion: The evidence currently available suggests that the use of computer-aided bonding is related to a reduction in treatment time and the number of appointments compared to direct and manual indirect bonding. However, the total bonding time for computer-aided bonding technique, including digital bracket placement, was longer than for direct bonding. Further high-quality RCTs on the differences between direct and indirect bonding are necessary to determine more precise data, as well as additional advantages and disadvantages.