Rubric vs. numeric rating scale: agreement among evaluators on endodontic treatments performed by dental students.

BACKGROUND: Students´ assessment should be carried out in an effective and objective manner, which reduces the possibility of different evaluators giving different scores, thus influencing the qualification obtained and the consistency of education. The aim of the present study was to determine the agreement among four evaluators and compare the overall scores awarded when assessing portfolios of endodontic preclinical treatments performed by dental students by using an analytic rubric and a numeric rating scale. METHODS: A random sample of 42 portfolios performed by fourth-year dental students at preclinical endodontic practices were blindly assessed by four evaluators using two different evaluation methods: an analytic rubric specifically designed and a numeric rating scale. Six categories were analyzed: radiographic assessment, access preparation, shaping procedure, obturation, content of the portfolio, and presentation of the portfolio. The maximum global score was 10 points. The overall scores obtained with both methods from each evaluator were compared by Student's t, while agreement among evaluators was measured by Intraclass correlation coefficients (ICC). The influence of the difficulty of the endodontic treatment on the evaluators´ scores was analyzed by one-way ANOVA. Statistical tests were performed at a pre-set alpha of 0.05 using Stata 16. RESULTS: Difficulty of canal treatment did not influence the scores of evaluators, irrespective of the evaluation method used. When the analytic rubric was used, inter-evaluator agreement was substantial for radiographic assessment, access preparation, shaping procedure, obturation, and overall scores. Inter-evaluator agreement ranged from moderate to fair with the numeric rating scale. Mean higher overall scores were achieved when numeric rating scale was used. Presentation and content of the portfolio showed slight and fair agreement, respectively, among evaluators, regardless the evaluation method applied. CONCLUSIONS: Assessment guided by an analytic rubric allowed evaluators to reach higher levels of agreement than those obtained when using a numeric rating scale. However, the rubric negatively affected overall scores.

Effect of an additional bonding resin on the 5-year performance of a universal adhesive: a randomized clinical trial.

OBJECTIVES: To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years. MATERIALS AND METHODS: Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05). RESULTS: The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004). CONCLUSIONS: The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode. TRIAL REGISTRATION: This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.

Impact of COVID-19 on the work of Spanish dentists: An early response to the pandemic.

BACKGROUND: This study aimed to assess the quality of the information about COVID-19 that Spanish dentists felt they were provided; their opinion about the actions by Health Institutions; their perception of the risk infection at work; and the security measures implemented to prevent contagion. MATERIAL AND METHODS: A specific questionnaire was developed and made available online from March 18th to 20th 2020. Dentists working in Spain were invited to answer. Questions were divided in 4 sections: demographic data and professional activity; specific information on COVID-19 and opinion about the decisions taken by Dental Councils and Health Authorities; risk assessment for SARS-CoV-2 in dental practices; and implementation of new ways of working. Chi-square tests were computed (p<0.05). 873 dentists answered the survey. RESULTS: A majority of dentists considered that Health Authorities did not take right decisions during the outbreak (86.37%), and were concerned both about getting infected at work (83.16%) and being a potential carrier to their patients (72.97%). Due to COVID-19, 59.11% of the dentists incorporated new protective measures in the dental practice, 60.17% began dealing with emergencies only and 39.18% stopped working. CONCLUSIONS: Most dentists were worried about infection in their workplaces, particularly women and dentists from the most affected regions by COVID-19. Almost 90% of the participants considered that this pandemic will change the way they provide dental care in the future. Key words:COVID-19, pandemic, disease transmission, dentists´ behavior, dental practice.

Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive-a randomized clinical trial.

OBJECTIVES: To evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months. MATERIALS AND METHODS: Scotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon non-parametric tests were computed. RESULTS: The cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall. CONCLUSIONS: The 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies. CLINICAL RELEVANCE: Phosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Effect of indirect composite treatment microtensile bond strength of self-adhesive resin cements.

BACKGROUND: No specific indications about the pre-treatment of indirect composite restorations is provided by the manufacturers of most self-adhesive resin cements. The potential effect of silane treatment to the bond strength of the complete tooth/indirect restoration complex is not available.The aim of this study was to determine the contribution of different surface treatments on microtensile bond strength of composite overlays to dentin using several self-adhesive resin cements and a total-etch one. MATERIAL AND METHODS: Composite overlays were fabricated and bonding surfaces were airborne-particle abraded and randomly assigned to two different surface treatments: no treatment or silane application (RelyX Ceramic Primer) followed by an adhesive (Adper Scotchbond 1 XT). Composite overlays were luted to flat dentin surfaces using the following self-adhesive resin cements: RelyX Unicem, G-Cem, Speedcem, Maxcem Elite or Smartcem2, and the total-etch resin cement RelyX ARC. After 24 h, bonded specimens were cut into sticks 1 mm thick and stressed in tension until failure. Two-way ANOVA and SNK tests were applied at α=0.05. RESULTS: Bond strength values were significantly influenced by the resin cement used (p<0.001). However, composite surface treatment and the interaction between the resin cement applied and surface treatment did not significantly affect dentin bond strength (p>0.05). All self-adhesive resin cements showed lower bond strength values than the total-etch RelyX ARC. Among self-adhesive resin cements, RelyX Unicem and G-Cem attained statistically higher bond strength values. Smartcem2 and Maxcem Elite exhibited 80-90% of pre-test failures. CONCLUSIONS: The silane and adhesive application after indirect resin composite sandblasting did not improve the bond strength of dentin-composite overlay complex. Selection of the resin cement seems to be a more relevant factor when bonding indirect composites to dentin than its surface treatment. KEY WORDS: Bond strength, self-adhesive cement, silane, dentin, indirect composite.

Five-year clinical performance of a silorane- vs a methacrylate-based composite combined with two different adhesive approaches.

OBJECTIVES: The objective of this study was to compare the 5-year clinical performance in posterior restorations of three restorative systems including a low-shrinkage system and a methacrylate-based composite combined either with an etch-and-rinse or a self-etch adhesive. MATERIALS AND METHODS: Each of 25 patients received three class I (occlusal) or class II restorations performed with each one of the three restorative systems: Filtek Silorane Restorative System including a two-step self-etch adhesive, Adper Scotchbond 1 XT (two-step etch-and-rinse adhesive) + Filtek Z250, and Adper Scotchbond SE (two-step self-etch adhesive) + Filtek Z250. All materials were applied as per manufacturer's instructions. Two blind observers evaluated the restorations at four different moments (baseline, after 1, 2, and 5 years) according to the USPHS-modified criteria. Kruskal-Wallis and Mann-Whitney U tests were conducted to compare the behavior of the restorative systems, while Friedman and Wilcoxon tests were applied to analyze the intrasystem data (p < 0.05). RESULTS: After 5 years, marginal staining around the restorations with Adper Scotchbond SE + Filtek Z250 was statistically more frequent and severe than that of the restorations performed with the other two systems. Intrasystem comparisons revealed a deterioration of the marginal adaptation after 5 years for all systems. A significant number of restorations bonded with self-etch adhesives showed marginal staining after 5 years of clinical service. A deterioration of the color appearance and an increase of the surface roughness were also detected in the restorations performed with Adper Scotchbond SE + Filtek Z250. CONCLUSIONS: A deterioration of the marginal adaptation was evidenced for all restorative systems, while marginal staining was more frequently seen only around the restorations performed with self-etch adhesives. CLINICAL RELEVANCE: No advantage was found of the silorane- over the methacrylate-based composite when combined with an etch-and-rinse adhesive.

Effect of thermal aging on the tensile bond strength at reduced areas of seven current adhesives.

The purpose of this study was to determine the micro-tensile bond strength (MTBS) to dentin of seven adhesive systems (total and self-etch adhesives) after 24 h and 5,000 thermocycles. Dentin surfaces of human third molars were exposed and bonded with two total-etch adhesives (Adper Scotchbond 1 XT and XP Bond), two two-step self-etch adhesives (Adper Scotchbond SE and Filtek Silorane Adhesive System) and three one-step self-etch adhesives (G-Bond, Xeno V and Bond Force). All adhesive systems were applied following manufacturers' instructions. Composite buildups were constructed and the bonded teeth were then stored in water (24 h, 37 °C) or thermocycled (5,000 cycles) before being sectioned and submitted to MTBS test. Two-way ANOVA and subsequent comparison tests were applied at α = 0.05. Characteristic de-bonded specimens were analyzed using scanning electron microscopy (SEM). After 24 h water storage, MTBS values were highest with XP Bond, Adper Scotchbond 1 XT, Filtek Silorane Adhesive System and Adper Scotchbond SE and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. After thermocycling, MTBS values were highest with XP Bond, followed by Filtek Silorane Adhesive System, Adper Scotchbond SE and Adper Scotchbond 1 XT and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. Thermal aging induced a significant decrease in MTBS values with all adhesives tested. The resistance of resin-dentin bonds to thermal-aging degradation was material dependent. One-step self-etch adhesives obtained the lowest MTBS results after both aging treatments, and their adhesive capacity was significantly reduced after thermocycling.