Digital photography vs. clinical assessment of resin composite restorations.

PURPOSE: To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Clinical, double blind, randomized controlled trial of experimental adhesive protocols in caries-affected dentin.

OBJECTIVE: To evaluate the clinical performance of posterior resin composite restorations regarding experimental and regular adhesive protocols in caries affected-dentin (CAD). MATERIAL AND METHODS: A total of 92 class I and class II cavities with carious lesions were selected and randomly assigned to the following groups: (1) bioactive glass-ceramic powder/two-step etch and rinse system, (2) control/two-step etch and rinse system, (3) bioactive glass-ceramic powder/two-step self-etching system, and (4) control/two-step self-etching system. Two operators carried out the adhesive protocols and restored the cavities with a nano-hybrid resin composite. Participants were followed up at 1 week and 6, 12, and 18 months for clinical evaluation performed by two blinded examiners and calibrated according to FDI criteria. Data were analyzed using Kruskal-Wallis and Dunn tests with a confidence of 95%. RESULTS: The clinical performance of resin composite restoration was not affected by the experimental use of an adhesive protocol including a bioactive glass-ceramic powder for 18 months post-procedure. However, there was a significant difference between group 2 and group 4 (p < 0.05) for marginal adaptation (18 months). Group 2 was significantly different from group 3 (p < 0.05) for fracture of material/retention (18 months) and marginal adaptation (1 week); group 2 showed a better performance. CONCLUSION: Adhesive protocols can alter the clinical performance of posterior restorations in terms of marginal adaptation and the fracture of material/retention in CAD. CLINICAL SIGNIFICANCE: Adhesive protocols may influence the success of resin composite restorations in CAD; this is important because failure can lead to caries, re-incidence, and/or clinical re-work.

The effect of electronic cigarettes on dental enamel color.

OBJECTIVE: The use of electronic cigarettes (ECIGs) has recently increased as an alternative to conventional smoking tobacco products. The literature is scarce on the effects of ECIGs on dental and oral structures. Therefore, the objective of this study was to observe whether ECIG aerosol could alter the color of dental enamel. MATERIALS AND METHODS: Sixty-three bovine enamel specimens were randomly separated into groups (n = 7) and treated with aerosols with different e-liquid flavors (neutral, menthol, and tobacco) and nicotine content (0, 12, and 18 mg). The initial color assessment was performed using a spectrophotometer (Easy Shade-Vita). Dental enamel was exposed to 20 cycles of ECIG aerosol in a smoking machine, and the final color was measured. The color change was evaluated using ΔEab, ΔE00, and Whiteness Index (WID ) formulae. Differences in L* a* b* coordinates were calculated, and data were analyzed (two-way ANOVA, uncorrected Fisher's LSD post hoc test, α = 0.05). RESULTS: Luminosity (ΔL) was reduced by aerosols with almost all levels of nicotine content and neutral and menthol flavors. Flavored e-liquids caused more color change (P < .05) according to ΔEab and ΔE00. ΔE values from both formulae exceeded the thresholds for perceptible visual alterations of color. WID increased after ECIGs exposure for menthol and tobacco and decreased for neutral flavors. CONCLUSIONS: ECIG aerosol from e-liquids with different nicotine contents and flavors altered enamel color. Menthol and tobacco e-liquids may alter the enamel color decreasing the yellowness of the enamel compared to neutral e-liquid. CLINICAL SIGNIFICANCE: Electronic cigarettes can cause perceptible changes in tooth color, altering dental esthetics.

Patients´ satisfaction concerning direct anterior dental restoration.

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation.

OBJECTIVE: This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators. METHODS: Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers. RESULTS: The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers. CONCLUSIONS: In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly. CLINICAL SIGNIFICANCE: Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Patients´ satisfaction concerning direct anterior dental restoration

Abstract The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Resumo O objetivo deste estudo foi observar a satisfação dos pacientes com suas restaurações dentárias anteriores diretas e compará-las com a avaliação clínica do dentista usando os critérios FDI (Federation Dental International). Os pacientes pontuaram suas restaurações dentárias (n=106) anteriores em relação à satisfação (satisfatória / insatisfatória). Quando insatisfatória, ele foi entrevistado sobre a queixa. Na mesma sessão, as restaurações dentárias foram avaliadas clinicamente por dois dentistas utilizando os critérios FDI (escore 1-5) quanto aos aspectos estéticos, funcionais e biológicos. Estatística descritiva foi usada para frequências de escores atribuídos por pacientes e clínicos. Para comparar as frequências dos pacientes e dos clínicos, foi aplicado o teste Qui-quadrado (p ≤ 0,05). Os pacientes relataram suas restaurações como 52,8% satisfatórias e 47,8% insatisfatórias. Os clínicos reportaram as mesmas restaurações, 82,3% satisfatória e 17,6% insatisfatória. As queixas mais frequentes dos pacientes referiam-se à cor, seguida da forma anatômica, fratura e retenção do material e forma anatômica proximal. Comparando os índices de satisfação e insatisfação dos pacientes com os clínicos, não houve diferença em relação à estética. A frequência de restaurações insatisfatórias por dentistas foi significativamente menor quando as propriedades funcionais e biológicas foram comparadas com as opiniões dos pacientes. As restaurações foram mais frequentemente relatadas como satisfatórias pelos pacientes, sendo as principais queixas relacionadas a questões estéticas. Quando as avaliações dos clínicos e dos pacientes foram comparadas, observou-se que as frequências de restaurações satisfatórias por pacientes e clínicos foram semelhantes em relação às propriedades estéticas e significativamente diferentes em relação às propriedades funcionais e biológicas.

Effect of whitening dentifrices: a double-blind randomized controlled trial.

The aim of this clinical study was to evaluate tooth color changes (ΔE) and tooth sensitivity (TS) associated with whitening dentifrices. Sixty participants were selected according to inclusion and exclusion criteria and then allocated to three groups (n = 20): Colgate Luminous White (G1), Close Up White Now (G2) and Sorriso dentifrice (G3-control). The participants were instructed to use only the provided dentifrice and toothbrush in standardized oral hygiene procedures for 4 weeks. ΔE was assessed by spectrophotometry (CIELab System) whereas TS was determined by a visual analog scale at baseline and weekly using four assessment points. The data were analyzed by two-way ANOVA and Tukey's post-hoc test and Friedman test (α = 0.05). ΔE (baseline-assessment point 4) showed no significant difference (p>0.05) across the groups: G1 (ΔE = 5.1), G2 (ΔE = 6.8), and G3 (ΔE = 4.4). Δb (baseline-assessment point 4) was significantly different (p < 0.05) in G2 (3.8) when compared to G1 (-0.2) and G3 (0.3). There was no significant difference (p > 0.05) in TS at baseline. Both the control and whitening dentifrices caused similar tooth color changes (ΔE). There was no significant TS during the study period.

The effect of home-use and in-office bleaching treatments combined with experimental desensitizing agents on enamel and dentin.

OBJECTIVE: This study aimed to evaluate in vitro the effect of formulations containing Biosilicate to treat enamel and dentin bovine samples exposed to dental bleaching agents. MATERIALS AND METHODS: On enamel and dentin bleached with commercial gels containing 16% carbamide peroxide (CP) (14 days/4 h) or 35% hydrogen peroxide (single session/45 min), desensitizing dentifrices (Sensodyne(®); experimental dentifrice of Biosilicate(®); Odontis RX(®); Sorriso(®)) were applied along 14 days and desensitizing pastes (Biosilicate(®)/water 1:1; Dessensebilize NanoP(®); Bioglass type 45S5/water 1:1) were applied on days 1, 3, 7, 10 and 14. Distilled water was the control. Microhardness (MH) and roughness measurements were the variables measured on the samples before and after the treatments. Student's t-test analyzed differences before and after the treatments. Two-way analysis of variance and post-hoc Tukey test analyzed differences among the factors desensitizing, bleaching agents and substrate. RESULTS: Tukey test showed no differences in roughness for both bleaching treatments and among the desensitizing agents (P > 0.05). Differences in MH appeared on enamel treated with in-home bleaching when control group (lower values) was compared with Sensodyne, Biosilicate dentifrice, Biosilicate paste, and Bioglass paste (higher values). Comparisons between desensitizing agents on dentin treated with both bleaching gels showed no statistical differences. CONCLUSIONS: The effect of formulations containing Biosilicate (Biosilicate dentifrice and paste) was significant in the MH of enamel bleached with 16% CP.

A clinical, randomized, controlled study on the use of desensitizing agents during tooth bleaching.

OBJECTIVES: To evaluate the efficacy of experimental proposals of desensitizing agents during tooth bleaching. METHODS: 140 participants without tooth sensitivity (TS) received 16% carbamide peroxide (14 days-04 h each) (T1) or 35% hydrogen peroxide (single session-45 min) (T2). Participants used concomitantly (10 per group): desensitizing dentifrices (D1-experimental bioactive glass-ceramic; D2-commercial potassium nitrate; D3-commercial calcium and sodium phosphosilicate) in-home, daily and, desensitizing pastes (D4-experimental bioactive glass-ceramic; D5-experimental Bioglass type 45S5; D6-commercial calcium phosphate), in-office, immediately after the treatment and more 4 times. Participants in the control group did not use any desensitizing agent. We assessed TS with Visual Analogue Scale. Assessment point 1 was immediately after the first participant's exposure to the treatments; and points 2, 3, 4, and 5 were every 72 h along the period of the study. Two-way ANOVA (considering time and desensitizing as factors) and post-hoc Tukey test (α=0.05) analyzed the data. RESULTS: In the control group treated with 35% hydrogen peroxide, TS increased significantly on assessment points 1 and 2. The participants who used a 5% potassium nitrate dentifrice and in-office experimental pastes did not experience TS because of the 35% in-office bleaching treatment. CONCLUSIONS: TS caused by 35% hydrogen peroxide in-office tooth bleaching was controlled by experimental products prepared as pastes D4-experimental bioactive glass-ceramic and D5-experimental Bioglass type 45S5, but not by D1-experimental dentifrice containing bioactive glass-ceramic. CLINICAL SIGNIFICANCE: There is no a gold standard protocol for TS caused by tooth bleaching. The study of novel desensitizing agents that can obliterate the dentinal tubules in a faster-acting and long-lasting way may help meet this clinical need.

Anterior lingual mandibular bone cavity: a case report / Cavidade óssea mandibular lingual anterior: um relato de caso

Stafne's bone cavity (SBC) is an asymptomatic lingual bone cavity situated near the angle of the mandible. The anterior variant of SBC, which shows a radiolucent unilateral ovoid lingual bone concavity in the canine-premolar mandibular region, is uncommon. A 73-year-old man was referred for assessment of loss of mandibular bone. Panoramic radiographs and computerized tomography scans showed a well-defined lingual bony defect in the anterior mandible. Analysis of imaginological documentation, made 14 years ago, revealed a progressive increase in mesiodistal diameter and intraosseous bony defect. The soft tissue obtained within the bony defect, microscopically revealed fibrous stroma containing blood vessels of varied caliber. The current anterior lingual mandibular bone defect case is probably caused by the salivary gland entrapped or pressure resorption, which can explain the SBC pathogenesis (AU)

A cavidade óssea de Stafne (COS) é uma cavidade assintomática, localizada próximo ao ângulo da mandíbula, por lingual. A variante anterior da COS, a qual apresenta uma concavidade óssea lingual radiolúcida, ovoide e unilateral na região do caninopré-molar mandibular, é incomum. Um homem de 73 anos foi encaminhado para avaliação da perda óssea mandibular. A radiografia panorâmica e a tomografia computadorizada mostraram um defeito ósseo lingual bem definido na região anterior da mandibula. A análise da documentação imaginológica, realizada há 14 anos, revelou um aumento progressivo do diâmetro mesiodistal e defeito ósseo intraósseo. A biópsia do tecido mole obtido do defeito ósseo revelou microscópicamente estroma fibroso contendo vasos sanguíneos de calibre variado. O presente caso de defeito ósseo mandibular na região lingual anterior é provavelmente causado por glândula salivar aprisionada ou reabsorção por pressão, o que pode explicar a patogênese da COS. (AU)

Effect of whitening dentifrices: a double-blind randomized controlled trial

Abstract The aim of this clinical study was to evaluate tooth color changes (ΔE) and tooth sensitivity (TS) associated with whitening dentifrices. Sixty participants were selected according to inclusion and exclusion criteria and then allocated to three groups (n = 20): Colgate Luminous White (G1), Close Up White Now (G2) and Sorriso dentifrice (G3-control). The participants were instructed to use only the provided dentifrice and toothbrush in standardized oral hygiene procedures for 4 weeks. ΔE was assessed by spectrophotometry (CIELab System) whereas TS was determined by a visual analog scale at baseline and weekly using four assessment points. The data were analyzed by two-way ANOVA and Tukey's post-hoc test and Friedman test (α = 0.05). ΔE (baseline-assessment point 4) showed no significant difference (p>0.05) across the groups: G1 (ΔE = 5.1), G2 (ΔE = 6.8), and G3 (ΔE = 4.4). Δb (baseline-assessment point 4) was significantly different (p < 0.05) in G2 (3.8) when compared to G1 (-0.2) and G3 (0.3). There was no significant difference (p > 0.05) in TS at baseline. Both the control and whitening dentifrices caused similar tooth color changes (ΔE). There was no significant TS during the study period.