Marginal discrepancy of lithium disilicate crowns made with digital and conventional technologies.

STATEMENT OF PROBLEM: Digital technologies have brought different workflows to prosthetic rehabilitations, but analyses of the available processes and their influence on the marginal fit of complete crowns are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the marginal discrepancy of lithium disilicate complete crowns made with different workflows. MATERIAL AND METHODS: Fifty lithium disilicate crowns were made with 5 different workflows (n=10): G1-Analog (control): conventional flow/pressed crown; G2-Hybrid: hybrid flow/milled crown; G3-Hybrid: hybrid flow/pressed crown; G4-Hybrid: hybrid flow/printed wax pattern/pressed crown; G5-Digital: digital flow/milled crown. The specimens were analyzed by scanning electron microscopy, and the data were analyzed for normality and submitted to analysis of variance (ANOVA). Multiple comparisons were made by using the Tukey HSD test (α=.05). RESULTS: G4H (18.1 ±6.6 µm) had the lowest mean ±standard deviation marginal discrepancy values, statistically different from G2H (217.9 ±81.4 µm), G5D (236.4 ±89 µm), and G3H (661.8 ±61.9 µm) (P<.05). G3H had the highest marginal discrepancy values and were statistically similar to each other (P>.05). G1A (163.2 ±10.9 µm) had intermediate values, statistically similar to those of other groups (P>.05). CONCLUSIONS: The conventional method showed no statistical differences in marginal discrepancy compared with methods using digital technology (scanner, software, 3D printer, or milling machine).

Stress distribution with extra-short implants in an angled frictional system: A finite element analysis study.

STATEMENT OF PROBLEM: Short and extra-short implants with Morse taper connections were developed to avoid grafting procedures. How the stresses around these implants differ with abutments of different angulations is unclear. PURPOSE: The purpose of this finite element study was to analyze the stress distribution in different structures (abutment, implant, and bone) of an extra-short implant with a Morse taper connection to the abutment (Arcsys-FGM-Brazil) (5.0×5.0 mm and 4.3×5.0 mm) when different abutment degrees were used. MATERIAL AND METHODS: Eight 3D models were designed according to each group under analysis: group 5DS (5.0×5.0-mm implants with straight abutment), group 5DA (5.0×5.0-mm implants with 20-degree angled abutments), group 4DS (4.3×5.0-mm implants with straight abutments), and group 4DA (4.3×5.0-mm implants with 20-degree angled abutments). Axial and oblique loads of 150 N were applied on the mandibular molar crowns. RESULTS: The oblique loads and angled abutments had higher stress values in the whole model (implant, abutment, and bone) than the axial loads and straight abutments. Implants with a different diameter had almost the same stress distribution on the implant, abutment, and bone. The yield limit was exceeded in the cortical bone with oblique loads and was also exceeded in implant models when an angled abutment with oblique loads was used. CONCLUSIONS: Extra-short implants with Morse taper connections to the abutment had higher stress concentrations with an angled abutment on oblique loads, and the peri-implant bone was the most damaged structure.

The impact of chitosan in experimental resin with different photoinitiator systems.

OBJECTIVE: to investigate the effect of different concentrations of chitosan added to experimental resins containing either BAPO or camphorquinone (CQ) as photoinitiators, regarding degree of conversion (DC), flexural strength (FS), flexural elastic modulus (E), Knoop microhardness (KHN), cytotoxicity, genotoxicity and antimicrobial activity. METHODS: Experimental resins with polymeric matrix of BisGMA and TEGDMA was added either 0.5 wt% BAPO or 0.5 wt% camphorquinone/0.2% amine along with and chitosan concentrations of 0.5%; 1.0% or 2.0%. Degree of conversion was measured using Fourier transformed infrared spectroscopy. Flexural strength and elastic modulus were obtained through three-point bending test and Knoop microhardness was measured in a microidenter. Direct cytotoxicity was performed in human keratinocytes and genotoxicity test was done in murine macrophages cells. Antimicrobial activity was acessed against Staphylococcus aureus and Streptococcus mutans through the inhibition halo. Data were analyzed using two-way ANOVA and Tukey teste (α = 0.05). RESULTS: The materials containing photoinitiator BAPO showed higher values of DC, FS, E, and KHN compared to resins with CQ. The addition of chitosan did not affect the properties of these materials. However, in resins containing CQ, the addition of chitosan improve these properties compared to control group. For the groups containing BAPO the chitosan reduced cytotoxicity and genotoxicity compared to materials with camphorquinone. The materials with 1.0% and 2.0% chitosan showed increased antibacterial activity in the materials containing BAPO as photoinitiator for both bacteria. SIGNIFICANCE: The alternative photoinitiator BAPO and chitosan can improve physical and biological properties of photoactivated resins when compared with the materials with photoinitiator camphorquinone.

Nanotopography and oral bacterial adhesion on titanium surfaces: in vitro and in vivo studies.

The present study aimed to evaluate the influence of titanium surface nanotopography on the initial bacterial adhesion process by in vivo and in vitro study models. Titanium disks were produced and characterized according to their surface topography: machined (Ti-M), microtopography (Ti-Micro), and nanotopography (Ti-Nano). For the in vivo study, 18 subjects wore oral acrylic splints containing 2 disks from each group for 24 h (n = 36). After this period, the disks were removed from the splints and evaluated by microbial culture method, scanning electron microscopy (SEM), and qPCR for quantification of Streptococcus oralis, Actinomyces naeslundii, Fusobacterium nucleatum, as well as total bacteria. For the in vitro study, adhesion tests were performed with the species S. oralis and A. naeslundii for 24 h. Data were compared by ANOVA, with Tukey's post-test. Regarding the in vivo study, both the total aerobic and total anaerobic bacteria counts were similar among groups (p > 0.05). In qPCR, there was no difference among groups of bacteria adhered to the disks (p > 0.05), except for A. naeslundii, which was found in lower proportions in the Ti-Nano group (p < 0.05). In the SEM analysis, the groups had a similar bacterial distribution, with a predominance of cocci and few bacilli. In the in vitro study, there was no difference in the adhesion profile for S. oralis and A. naeslundii after 24 h of biofilm formation (p > 0.05). Thus, we conclude that micro- and nanotopography do not affect bacterial adhesion, considering an initial period of biofilm formation.

Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies.

Atopic dermatitis (AD) is a pervasive and multifaceted dermatological disorder causing daily distress to afflicted individuals worldwide. This comprehensive review synthesizes the historical and contemporary advancements in therapeutic strategies, offering a critical analysis of their efficacy, safety profiles, and adaptability. The enduring role of topical corticosteroids in managing AD is examined, acknowledging their potent anti-inflammatory properties alongside their potential adverse side effects, particularly in extended usage. The article explores the utilization of topical calcineurin inhibitors like tacrolimus and pimecrolimus, highlighting their novel anti-inflammatory pathways while also scrutinizing concerns over potential malignancies that relegate them to second-line therapy. The present investigation features the emergence of crisaborole, a phosphodiesterase four inhibitor. Its innovative mode of action, benign safety profile, and applicability to mild and moderate AD are thoroughly evaluated. The review also includes challenges, particularly cost considerations, which constrain accessibility and necessitate nuanced implementation in therapeutic regimens. This study underscores the need for persistent investigation, teamwork, and innovations in managing AD. In this regard, AD requires a united approach between clinicians, researchers, affected individuals, and policymakers to refine patient-focused treatment and develop precise, economical strategies to address this chronic and frequently life-altering health condition.

Influence of photoactivation method and mold for restoration on the Knoop hardness of resin composite restorations.

The aim of this study was to evaluate in vitro the Knoop hardness in the top and bottom of composite photo activated by different methods when different mold materials were used. Z250 (3M ESPE) and XL2500 halogen unit (3M ESPE) were used. For hardness test, conical restorations were made in extracted bovine incisors (tooth mold) and also metal mold (approximately 2 mm top diameter × 1.5 mm bottom diameter × 2 mm in height). Different photoactivation methods were tested: high-intensity continuous (HIC), low-intensity continuous (LIC), soft-start, or pulse-delay (PD), with constant radiant exposure. Knoop readings were performed on top and bottom restoration surfaces. Data were submitted to two-way ANOVA and Tukey's test (p = 0.05). On the top, regardless of the mold used, no significant difference in the Knoop hardness (Knoop hardness number, in kilograms-force per square millimeter) was observed between the photoactivation methods. On the bottom surface, the photoactivation method HIC shows higher means of hardness than LIC when tooth and metal were used. Significant differences of hardness on the top and in the bottom were detected between tooth and metal. The photoactivation method LIC and the material mold can interfere in the hardness values of composite restorations.

Effect of photoactivation mode on the hardness and bond strength of methacrylate- and Silorane monomer-based composites.

PURPOSE: To evaluate the Knoop hardness (KH) and the bond strength (BS) at the tooth/restoration interface of conventional methacrylate- (Filtek Supreme) and silorane-based (Filtek P90) composites photoactivated by different methods using an LED Freelight 2. MATERIALS AND METHODS: Bond strength was tested in a universal testing machine by the "push-out" test in restored cavities measuring 2 × 1.5 × 2 mm with a C-factor of 2.2, prepared in 60 bovine teeth. To restore the cavities, the respective adhesive system of each composite was used (Single Bond 2 and P90 system adhesives). The composites were photoactivated by 3 different methods: continuous light: 40 s at 1000 mW/cm²; soft-start: 10 s at 150 mW/cm² + 38 s at 1000 mW/cm²; pulse delay: 5 s at 150 mW/cm², followed by a 3-min wait (without photoactivation) and 39 s at 1000 mW/cm². Before the push-out test was performed, the KH was analyzed at the top and bottom of the restorations. Data were statistically anaylzed using ANOVA and Tukey's test. RESULTS: The photoactivation methods produced no differences in BS or KH in the same composite, while Filtek P90 (28.0 MPa) showed higher BS values than Filtek Supreme (22.3 MPa) and a lower KH. CONCLUSION: The composite Filtek P90 was capable of increasing bond strength, but presented lower Knoop hardness.

Influence of the curing mode on the degree of conversion of a dual-cured self-adhesive resin luting cement beneath ceramic.

OBJECTIVE: To evaluate the effect of the delayed photoactivation and ceramic barrier on the degree of conversion (DC) of self-adhesive resin cement. MATERIALS AND METHODS: Circular specimens (5 mm in diameter × 1 mm in thickness) of the RelyX U-100 resin cement were made using the following curing protocols (n = 10): (G1) 40 s beneath a IPS Empress II ceramic; (G2) 40 s of direct photocuring; (G3) 80 s beneath the ceramic; (G4) 80 s of direct photocuring; (G5) self-curing; (G6) 5 min in the absence of light (self-curing) followed by transceramic photocuring for 40 s; (G7) 5 min in the absence of light (self-curing) followed by transceramic photocuring for 80 s. All the specimens were photoactivated by LED (800 mW/cm(2)). After 24 h of dry storage, the DC was measured by FTIR, on the top surface of the specimens. Data were submitted to one-way ANOVA and Tukey test (p ≤ 0.05). RESULTS: Direct photocuring with no ceramic interposition, regardless of the curing time (40 s and 80 s) promoted the highest conversion mean (56.79 ± 1.19 and 59.98 ± 2.93, respectively) and the 5 min delay time for the transceramic photocuring presented a similar mean compared to the immediate transceramic photocuring. The DC was influenced by the ceramic barrier, decreasing the conversion values (49.72 ± 1.91 for 40 s and 52.36 ± 2.50 for 80 s), with no statistical difference from the groups with the previous 5 min of photoactivation delay. The self-cure only showed the worst DC values. CONCLUSION: Direct photocuring provided a higher degree of conversion for the self-adhesive resin cement. The delayed light activation did not influence the degree of conversion for the resin cement tested.

Physical analysis of an acrylic resin modified by metal and ceramic nanoparticles.

BACKGROUND: Nanoparticles (NPs) have gained significant attention in various fields due to their unique properties and potential applications. Polymethyl methacrylate (PMMA) is an acrylic resin widely used in dentistry and medicine. However, the effect of different types of NP fillers on the physical properties of PMMA-based resins has not been thoroughly explored in the literature. OBJECTIVES: The present study aimed to evaluate the effects of 3 different types of NP fillers on the physical properties of an experimental PMMA-based resin as a function of the NP content and concentration. MATERIAL AND METHODS: Ten groups (n = 10) were designed. The specimens were composed of an acrylic resin, silicon dioxide (SiO2), cerium dioxide (CeO2), and titanium dioxide (TiO2) at the following ratios (wt%): group 1 (G1) - control; group 2 (G2) - 0.5% SiO2; group 3 (G3) - 1% SiO2; group 4 (G4) - 3% SiO2; group 5 (G5) - 0.5% CeO2; group 6 (G6) - 1% CeO2; group 7 (G7) - 3% CeO2; group 8 (G8) - 0.5% TiO2; group 9 (G9) - 1% TiO2; and group 10 (G10) - 3% TiO2. Transmission electron microscopy (TEM) was used to assess the quality of NP dispersion. Thermal stability was assessed with thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The effects of the abovementioned NPs on the properties of the resin were evaluated using the Archimedes principle for density, the Vickers hardness (VH) test and the impact strength (IS) test. Data analysis employed the oneand two-way analysis of variance (ANOVA), followed by Duncan's post hoc test at a significance level of 0.05. RESULTS: Transmission electron microscopy showed partial NP dispersion. All types of NPs enhanced the mechanical properties of the acrylic resin except for IS, which was similar to that of the control group. Among the types of NPs, irrespective of the weight percentage, CeO2 showed higher thermal stability and higher IS for 0.5 wt% and 1 wt% as compared to other groups, as well as the highest values of density at 0.5 wt%, 1 wt% and 3 wt%. Titanium oxide at 1 wt% presented a higher VH as compared to other groups. The fracture pattern was the same for all groups. CONCLUSIONS: Incorporating the tested NPs into the acrylic resin resulted in enhanced physical properties, primarily attributed to a lower NP content.

Degree of conversion of simplified contemporary adhesive systems as influenced by extended air-activated or passive solvent volatilization modes.

This study evaluated the effect of five methods of solvent volatilization on the degree of conversion (DC) of nine one-bottle adhesive systems using Fourier transform infrared/attenuated total reflectance (FTIR/ATR) analysis. Nine adhesives were tested: Adper Single Bond 2 (SB), Adper Easy One (EO), One Up Bond F Plus (OUP), One Coat Bond SL (OC), XP Bond (XP), Ambar (AM), Natural Bond (NB), GO, and Stae. The adhesive systems were applied to a zinc-selenide pellet and 1) cured without solvent volatilization, 2) left undisturbed for 10 seconds before curing, 3) left undisturbed for 60 seconds before curing, 4) air-dried with an air stream for 10 seconds before curing, and 5) air-dried with an air stream for 60 seconds before curing. FTIR/ATR spectra were obtained, and the DC was calculated by comparing the aliphatic bonds/reference peaks before and after light activation for 10 seconds (FlashLite 1401). The DC means of each material were analyzed by one-way analysis of variance and post hoc Tukey test (p<0.05). The DC of GO and Stae adhesive systems was not affected by the five evaporation conditions. Air-drying for 60 seconds before curing yielded the highest DC for SB, EO, and OC. Extended solvent volatilization time (60 seconds) either with or without air-drying before curing provided the highest DC for AM, NB, XP, and OUP. Thus, the monomer conversion of adhesive systems was material dependent. In general, the 60-second passive or active air-drying modes to volatilize solvents before curing enhanced the degree of conversion for the one-bottle simplified adhesive systems.

Influence of re-using reversible hydrocolloids on the linear alteration of coating models.

Reusing reversible hydrocolloids too many times may cause alterations of the coating model and produce unsatisfactory RPPs. The aim of this study was to analyze the linear alterations of coating models reproduced from molds obtained with two commercial brands of reversible hydrocolloid (RH) with 15 reuse cycles of the material. A metal model was used with 4 marks (A, B, C and D) on which the distances AB, BC, CD, DA, BD and AC could be measured lineally. Ten models were divided into two groups according commercial brand of RH: group VIPI-Duplicator VIPI and group K27--Duplicator K27l. The RH was heated in a microwave oven and poured into a flask containing the model. The mold was filled with the ethyl silicate coating, and after crystallization, refractory models were obtained. This was repeated in the 15 re-use cycles of each RH. The refractory models obtained from the 1st, 5th, 10th and 15th times of re-use of RHs were measured under a measuring microscope. The means were submitted to the Analysis of Variance, Tukey and Dunnet tests, to a 5% level of significance. Group VIPI showed linear alterations in relation to the plaster models, for distances AB (1 use = -1.25% and 5th re-use = -1.20%); AD (1st use = 0.76%, 10th re-use = 0.65% and 15th re-use = 0.52%); BD (1st use = 0.58%). Both commercial brands analyzed produced coating models with acceptable linear alterations in up to 15 reuse cycles, no statistical difference being observed between them.

Stress distribution in restorations with glass fiber and polyetheretherketone intraradicular posts: An in silico analysis.

This study evaluated stresses generated at maxillary central incisor (21) root restored with lithium disilicate crown (LDC), and glass fiber (GFP) or polyetheretherketone (PEEK) post. 3D models created by computed tomographic image (i-CAT Cone Beam 3D Dental Imaging System) reproduced maxillary central incisor. Each model had prosthetic LDCs (2.0 mm thick) cemented to GFP or PEEK posts with dual resin cement. Different loads were applied to each model (cervical, incisal, axial, middle). At maximum principal stress, PEEK showed higher stress than GFP in all loads, but with qualitative similarity. At minimum principal stress, PEEK and GFP showed qualitative and quantitative similarities, except axial load. Maxillary central incisor restored with GFP or PEEK and LDC presented, in general, similar stress intensity and distribution for main occlusal loads. Only two of sixteen occlusal loads tested (cervical for maximum principal; axial for minimum principal) showed significant quantitative difference.

Microtensile bond strength of resin composite to dentin using different adhesive systems and directions of electric current.

Thisstudy aimed to evaluate the effect of the electric current direction application on the resin composite-dentin bond strength using three adhesive systems. Human molar teeth were distributed according to the adhesive system (two-step self-etch - Clearfil SE Bond, Kuraray [CSE]; one-step self-etch - Single Bond Universal, 3M ESPE [SBU]; and two-step etch-and-rinse - Adper Single Bond 2, 3M ESPE [SB2]), electric current direction (without electric current - control, direct and reverse electric currents - 35µA), and storage time (24h - immediate and 6 months). Resin composite blocks (Filtek Z350XT, 3M ESPE) were bonded to dentin. The teeth/resin composites specimens were stored in distilled water at 37ºC for 24 hours and 6 months for the microtensile bond strength (µTBS) test (n = 10; ~12 sticks for each tooth). Failure patterns were analyzed on a stereomicroscope and classified as cohesive-dentin, cohesive-resin, adhesive or mixed. Adhesive penetration into dentin and hybrid layer formation were evaluated in a scanning electron microscope (n = 6). Data were submitted to a three-way ANOVA followed by Tukey's post hoc test (α = 0.05). There are no differences in µTBS when the adhesive systems were applied under direct and reverse electric currents, but both electric currents increased the µTBS for all adhesive systems. SBU showed the lowest µTBS values for control groups in both storage times and direct electric current in 6 months of storage. The adhesive failure pattern was more frequently observed in all groups. The electric current formed long resin tags for all adhesive systems. Storage for 6 months did not significantly decrease µTBS values. Both directions of electric current (positive and negative charges) at 35µA can increase the µTBS of the adhesive systems tested to dentin.

O objetivo neste estudo foi avaliar o efeito da direção da corrente elétrica na resistência da união resina composta-dentina usando três sistemas adesivos. Dentes molares humanos foram distribuídos de acordo com o sistema adesivo (dois passos autocondicionante - Clearfil SE Bond, Kuraray [CSE]; e um passo autocondicionante - Single Bond Universal, 3M ESPE [SBU]; e dois passos convencional - Adper Single Bond 2, 3M ESPE [SB2]), a direção da corrente elétrica (sem corrente elétrica - controle, correntes elétricas direta e reversa - 35µA) e tempo de armazenamento (24h - imediato e 6 meses). Blocos de resina composta (Filtek Z350XT, 3M ESPE) foram aderidos à dentina. Amostras de dentina-resina foram produzidas e armazenadas em água destilada a 37ºC por 24 horas e 6 meses para o teste de resistência da união à microtração (µTBS) (n = 10; ~12 palitos por dente). Os padrões de fratura foram analisados ​​em estereomicroscópio e classificados em falhas coesiva na dentina, coesiva na resina, adesiva ou mista. A penetração do adesivo na dentina e a formação da camada híbrida foram avaliadas em microscópio eletrônico de varredura (MEV). Os dados foram submetidos à ANOVA três fatores seguidos pelo teste post hoc de Tukey (α = 0,05). Não houve diferenças na µTBS quando os sistemas adesivos foram aplicados sob as correntes elétricas direta e reversa, mas ambas as correntes elétricas aumentaram a µTBS para todos os sistemas adesivos. SBU apresentou os menores valores de µTBS para o grupo controle em ambos os tempos de armazenamento e para a corrente elétrica direta em 6 meses de armazenamento. Falhas adesivas foram mais frequente em todos os grupos. A corrente elétrica formou longos tags resinosos para todos os sistemas adesivos. O armazenamento por 6 meses não diminuiu significativamente os valores de µTBS. Ambos os sentidos da corrente elétrica (cargas positivas e negativas) a 35µA podem aumentar a µTBS dos sistemas adesivos testados à dentina.

Bond strength of self-adhesive resin cement to dentin using different adhesion protocols.

BACKGROUND: The treatment of dentin before the use of self-adhesive cements is still a crucial point to achieve the best bond strength values. The objective of this study was to evaluate the bond strength between dentin and composite resin using different adhesion strategies with self-adhesive resin cement. MATERIAL AND METHODS: Forty healthy third human molars were randomly divided into 4 groups (n = 10): CA (control); application of self-adhesive cement (Rely X U200, 3M ESPE), AD + CA: only application of conventional adhesive (Adper Single Bond 2, 3M ESPE) + self-adhesive cement, AC + AD + CA; conditioning with 37% phosphoric acid for 15 seconds + application of conventional adhesive + self-adhesive cement and AC + CA; conditioning with 37% phosphoric acid for 15s + self-adhesive cement. Blocks made of composite resin (Z250 XT, 3M ESPE) were cemented over dentin. The samples were stored for 24h in distilled water at 37ºC and then were sectioned on a metallographic cutter to obtain tooth picks with approximately 1.0 mm2 in cross section. A universal testing machine was used with a speed of 0.5 mm/min to test the microtensile bond strength,. The fracture patterns were classified as adhesive, cohesive and mixed failures. The data (MPa) were analyzed statistically by One-way ANOVA and Holm-Sidak test (α=5%). RESULTS: The AC + AD + CA and AC + CA groups had the highest averages, while the CA and AD + CA groups had the lowest bond strength values. Adhesive failure was prevalent in all groups. CONCLUSIONS: Conditioning with 37% phosphoric acid for 15s increases the adhesion of the self-adhesive resin cement to the dentin, regardless of the use of dental adhesive system. Key words:Resin cement, microtensile bond strength, acid conditioning.

Photoelastic analysis of the distribution of stress in different systems of overdentures on osseous-integrated implants.

OBJECTIVE: The aim of this study was to evaluate the distribution of generated stress around implants and adjacent bone tissue using different implant-retained overdenture designs through photoelastic analysis. METHODS: Over an edentulous human mandible, achieved from a human model, 2 or 4 microunit analog abutments were embedded (Master; Conexao Systems Prosthodontics, São Paulo, Brazil), settled in the interforaminal region. Three models of photoelastic resin (Araltec Chemicals Ltda, Hunstman, Guarulhos, São Paulo, Brazil), with 2 or 4 incorporated implants and microunit abutments, were obtained from molds using silicone for duplication. Inclusion, finishing, and polishing procedures were applied on the frameworks. This study was based on 3 different mechanisms of implant-retained mandibular overdentures: O'ring (GI), bar-clip (GII) (both with 2 implants), and their association (GIII) (with 4 implants). After the adaptation of each overdenture system on the photoelastic models, 100-N alternate occlusal loads were applied on back-side and front-side regions. The photoelastic analysis was made with the aid of a plain polariscope linked to a digital camera, Sony Cybershot α100, which allowed visualization of the fringes and registration of images on digital photographs. RESULTS: The results demonstrated higher tension concentrated over the GIII, with a flat distribution of stress to the posterior ridge and overload on the posterior implants. GI showed the smaller stress level, and GII, intermediate level; there was distribution of stress to the posterior ridge in these 2 groups. CONCLUSION: The use of bar attachment proved to be a better alternative, because it showed a moderate level of tension with a more uniform stress distribution and possessed higher retention than did the ball system.

Physical and Mechanical Properties of Resins Blends Containing a Monomethacrylate with Low-polymerization Shrinkage.

OBJECTIVES: The aim of this study was to evaluate the Knoop hardness (KH), cross-link density (CLD), water sorption (WS), water solubility (WSB), and volumetric shrinkage (VS) of experimental resins blends containing a monomethacrylate with low-polymerization shrinkage. MATERIALS AND METHODS: A blend of bisphenol glycidyl methacrylate (BisGMA) as base monomer was formulated with (Bis-GMA)/triethyleneglycol dimethacrylate (TEGDMA), Bis-GMA/isobornyl methacrylate (IBOMA), or Bis-GMA/TEGDMA/IBOMA in different concentrations (40, 50, or 60 wt%). The camphorquinone (CQ)/2-(dimethylamino) ethyl methacrylate (DMAEMA) was used as the photoinitiator system. The KH and CLD were measured at the top surface using an indenter. For WS and WSB, the volume of the samples was calculated in mm3. The samples were transferred to desiccators until a constant mass was obtained (m1) and were subsequently immersed in distilled water until no alteration in mass was detected (m2). The samples were reconditioned to constant mass in desiccators (m3). WS and WSB were determined using the equations m2 - m3/V and m1 - m3/V, respectively. VS results were calculated with the density parameters before and after curing. STATISTICAL ANALYSIS: Data were submitted to ANOVA and Tukey's test (α = 0.05). RESULTS: The resins containing IBOMA showed lower VS results. TEGDMA 40% and TEGDMA/IBOMA 20/20 wt% showed higher KH values. The IBOMA groups showed lower CLD, while TEGDMA groups had higher values of CLD. The BisGMA/TEGDMA resin presented the highest values of WS, and for WSB, all groups showed no significant differences among themselves. CONCLUSION: The monomethacrylate with low-polymerization shrinkage IBOMA used alone or in combination with TEGDMA may decrease VS, WS, and CLD values.

Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement.

OBJECTIVE: This study aimed to evaluate the bond strength between lithium disilicate ceramic and resinous cement when silane (Prosil, FGM) was applied in different amounts of layers under heating or not. MATERIALS AND METHODS: Sixty IPS E-max CAD ceramic (Ivoclar) was used. They were conditioned with 10% hydrofluoric acid for 20 seconds. The samples were distributed in six groups (n = 10): 1Sil, 1 layer of silane without heating; 1SilAq, 1 layer of silane with heating; 2Sil, 2 layers without heating; 2SilAq, 2 layers with heating; 3Sil, 3 layers without heating; and 3SilAq, 3 layers with heating. After each layer, a jet of cold air was applied for 20 seconds in groups 1Sil, 2Sil, 3Sil, and jet of hot air (50°C) in groups 1SilAq, 2SilAq, and 3SilAq. Subsequently, an adhesive layer was applied, and fourcylinders were made on the ceramic with a resin cement AllCemVeneer and photoactivated for 20 seconds. The samples were stored at 37°C for 24 hours and analyzed to the microshear test at EMIC. STATISTICAL ANALYSIS: Data were submitted to ANOVA and Tukey's test (α = 0.05). RESULTS: The results showed that there was no statistical interaction between the factors studied. The "heating" factor was not statistically significant; however, the "silane layers" factor showed differences between groups. The analysis of the results showed that the use of one (66%) or two layers (67%) of silane regardless of heating, produced higher values of bond strength, when compared with the group of three layers (62%). CONCLUSION: The use of silane with one or two layers provided a greater bond strength between lithium disilicate ceramic and resinous cement and that the heating did not influence the results.

Finite Element Analysis of Stress in Anterior Prosthetic Rehabilitation with Zirconia Implants with and without Cantilever.

OBJECTIVES: The aim of this study was to evaluate using finite element analysis (FEA), the stress distribution in prostheses (lithium disilicate crowns) on monotype zirconia implants with and without cantilever in the anterior region of the maxilla. MATERIALS AND METHODS: From a virtual reconstruction of bone model of the toothed maxilla from a computed tomography, three models (groups) were created: Zr (11-21)-implants placed in the area of 11 and 21 with cantilever; Zr (12-22)-implants placed in the area of 12 and 22 without cantilever; and Zr (11-22)-implants intercalated placed in the area of 11 and 22. In all models, monotype zirconia implant (4.1 × 12.0 mm) was used in single-body configuration. Lithium disilicate crowns were designed on the implants and pontics for all groups. A 150-N load was applied to the prostheses. The materials used were considered isotropic, homogeneous, and linearly elastic. FEA was performed to evaluate the maximum (tensile) and minimum (compressive) principal stresses in the implant, crowns, and bone tissue. Data were analyzed qualitatively and quantitatively. RESULTS: For all groups, the highest maximum principal stress occurred in the palatal cervical area of the implant, with the high values for the Zr (12-22) group and the low values for the Zr (11-21) group. The maximum principal stress was concentrated in the cervical palatal area of the crown, with the Zr (11-21) group presented the highest values and the Zr (12-22) group showed the lowest values. In the bone tissue all the groups presented similar values of maximum and minimal principal stress, with the palatal (maximum principal) and vestibular (minimum principal) close to the cervical of the implants the area with the highest concentration of stresses. CONCLUSIONS: The position of monotype zirconia implant did not interfere in the bone tissue stress, and the implants placed in the 11-21 present lower stress in implants and higher in the crown. The cantilever does not increase the stress in the implants, crown, and bone tissue.

Urothelial carcinoma: stem cells on the edge.

Tumors are heterogeneous collections of cells with highly variable abilities to survive, grow, and metastasize. This variability likely stems from epigenetic and genetic influences, either stochastic or hardwired by cell type-specific lineage programs. That differentiation underlies tumor cell heterogeneity was elegantly demonstrated in hematopoietic tumors, in which rare primitive cells (cancer stem cells (CSCs)) resembling normal hematopoietic stem cells are ultimately responsible for tumor growth and viability. Because of the compelling clinical implications CSCs pose--across the entire spectrum of cancers--investigators applied the CSC model to cancers arising in tissues with crudely understood differentiation programs. Instead of relying on differentiation, these studies used empirically selected markers and statistical arguments to identify CSCs. The empirical approach has stimulated important questions about "stemness" in cancer cells as well as the validity and stoichiometry of CSC assays. The recent identification of urothelial differentiation programs in urothelial carcinomas (UroCas) supports the idea that solid epithelial cancers (carcinomas) develop and differentiate analogously to normal epithelia and provides new insights about the spatial localization and molecular makeup of carcinoma CSCs. Importantly, CSCs from invasive UroCas (UroCSCs) appear well situated to exchange important signals with adjacent stroma, to escape immune surveillance, and to survive cytotoxic therapy. These signals have potential roles in treatment resistance and many participate in druggable cellular pathways. In this review, we discuss the implications of these findings in understanding CSCs and in better understanding how UroCas form, progress, and should be treated.