Tooth wear and bruxism: A scoping review.

OBJECTIVE: This study presents a scoping review to determine the association between tooth wear and bruxism. DATA: A protocol was developed a priori (Open Science Framework (DOI 10.17605/OSF.IO/CS7JX)). Established scoping review methods were used for screening, data extraction, and synthesis. Risk of bias was assessed using JBI tools. Direct associations between tooth wear and bruxism were assessed. SOURCES: Embase, SCOPUS, Web of Science, Cochrane, and PubMed were searched. STUDY SELECTION: Any clinical study containing tooth wear and bruxism assessment done on humans in any language was included. Animal, in-vitro studies and case reports were excluded. CONCLUSIONS: Thirty publications reporting on the association between tooth wear and bruxism were included. The majority of publications were cross-sectional studies (90%) while only three were longitudinal (10%). Eleven papers assessed definitive bruxism for analysis (instrumental tools), one paper assessed probable bruxism (clinical inspection with self-report) and eighteen assessed possible bruxism (self-report). Of the eleven papers assessing definitive bruxism, eight also reported outcomes of non-instrumental tools. Tooth wear was mostly scored using indexes. Most studies reported no or weak associations between tooth wear and bruxism, except for the studies done on cervical tooth wear. When bruxism assessment was done through self-report, more often an association was found. Studies using multivariate analyses did not find an association between tooth wear and bruxism, except the cervical wear studies. Evidence shows inconclusive results as to whether bruxism and tooth wear are related or not. Therefore, well-designed longitudinal trials are needed to address this gap in the literature. CLINICAL SIGNIFICANCE: Based on the evidence, dental clinicians should not infer bruxism activity solely on the presence of tooth wear.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients.

OBJECTIVES: Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years. METHODS: Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05). RESULTS: 568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7). SIGNIFICANCE: Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Single crown vs. composite for glass fiber post-retained restorations: An 8-year randomized clinical trial.

OBJECTIVES: This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post. METHODS: A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05). RESULTS: Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05). CONCLUSIONS: Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs. CLINICAL SIGNIFICANCE: Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning.

Postoperative pain after endodontic reintervention: a randomized clinical trial

Resumo O objetivo deste ensaio clínico randomizado foi comparar a prevalência e a intensidade da dor pós-operatória em casos de retratamento endodôntico, utilizando instrumentos manuais ou reciprocantes (automatizados). O tempo necessário para desobturação e reinstrumentação do canal radicular também foi avaliado. Quarenta e oito indivíduos possuindo um dente unirradicular tratado endodonticamente e portador de periodontite apical assintomática foram incluídos no estudo. Os pacientes foram aleatoriamente distribuídos em dois grupos (n=24/grupo): retratamento com instrumentos manuais de aço inoxidável ou um sistema reciprocante de níquel-titânio (Reciproc; VDW, Munique, Alemanha). A reintervenção endodôntica foi realizada em duas consultas, sendo aplicada medicação intracanal à base de hidróxido de cálcio por 14 dias, antes da obturação. O tempo clínico gasto com os protocolos de desobturação e reinstrumentação do canal radicular foi registrado com um cronômetro digital. Após cada visita, a intensidade da dor pós-operatória foi avaliada em 12, 24, 48 horas e 7 dias por meio da escala de estimativa numérica (Numerical Rating Scale - NRS). Além do registro da dor, os pacientes foram questionados quanto ao uso de analgésicos. Os dados obtidos foram analisados por testes Qui-quadrado e Mann-Whitney (α=0.05). Não foi detectada diferença significativa entre os grupos quanto à prevalência e intensidade da dor ou uso de analgésicos em nenhum dos períodos avaliados. O tempo clínico foi significativamente menor no grupo reciprocante (18 versus 41 minutos). Pode-se concluir que os instrumentos manuais e reciprocantes foram equivalentes quanto à prevalência e intensidade de dor pós-operatória e uso de analgésicos, mas a desobturação e reinstrumentação do canal radicular foram duas vezes mais rápidas com o sistema reciprocante.

Abstract The present randomized clinical trial compared the prevalence and intensity of postoperative pain in cases of endodontic reintervention using manual or engine-driven reciprocating instruments. As secondary objectives, the analgesic intake and time required for the root canal filling removal and re-instrumentation were also evaluated. Forty-eight individuals with an endodontically treated single-rooted tooth diagnosed with asymptomatic apical periodontitis were included in the study. Patients were randomly assigned to two comparison groups (n=24/group): reintervention with stainless steel manual instruments or a nickel-titanium reciprocating system (Reciproc; VDW, Munich, Germany). The endodontic reintervention was performed in two sessions with a calcium hydroxide-based intracanal medication applied for 14 days before root canal obturation. Working time for the root canal filling removal and re-instrumentation was recorded with a digital stopwatch. After each visit, postoperative pain intensity was assessed at 12, 24, and 48 hours and seven days using the Numerical Rating Scale (NRS). The patients were also asked about analgesic intake. Data were analyzed using Pearson chi-square, T and Mann-Whitney U tests (α=0.05). No significant differences between groups were found regarding the prevalence and intensity of pain or the need for analgesic intake at any time point (P > 0.05). Working time was significantly shorter in the reciprocating group (18 versus 41 minutes). In conclusion, manual and reciprocating instruments achieved the same results in terms of prevalence and intensity of postoperative pain and analgesic intake. However, filling material removal and re-instrumentation of the root canals were more than twice as fast when using the reciprocating system.

Techniques for removing root canal posts: an vitro study / Técnicas para remoção de pinos intrarradiculares: um estudo in vitro

Objetivo: O objetivo deste estudo foi responder qual é a melhor técnica para remoção de pinos de fibra de vidro e pinos metálicos fundidos considerando tempo, preservação da estrutura dentária e custos. Métodos: Foi realizado um estudo in vitro, randomizado e cego. Sessenta dentes tratados endodonticamente foram randomizados em dois grupos de acordo com o tipo de pino. Uma segunda randomização foi realizada para cada tipo de técnica de remoção (ultrassom, broca ou combinada; n=10). One-way ANOVA foi usado para comparar o tempo de remoção do pino, teste t pareado comparou a quantidade de estrutura dentária removida e Kruskal Wallis seguido pelo teste post hoc de Mann-Whitney foram usados para análise de custo (P = 0,05). Resultados: Não houve diferença no tempo de remoção do pino considerando o tipo ou técnica do pino (P=0,630). A perda média de estrutura dentária na região cervical foi superior a 30% quando apenas uma ponta diamantada foi usada para remover pino de fibra de vidro (P<0,00001) e pino metálico fundido (P=0,008). Conclusão: De acordo com os resultados deste estudo, podemos concluir que a seleção da técnica de remoção dependerá da habilidade do operador, e sempre ocorrerá alguma perda de estrutura dentária, embora seja esperada uma perda maior quando apenas pontas diamantadas são usadas para este fim.(AU)

Objective: The aim of this study was to answer which is the best technique to removing glass fiber post and cast metal post considering time, preservation of tooth structure, and costs. Methods: An in vitro, randomized, blinded study was conducted. Sixty endodontically treated teeth were randomized into two groups according to post type. A second randomization was performed for each type of removal technique (ultrasound, drill, or combined; n=10). One-way ANOVA was used to compare the time to post removal, paired t-test compared the amount of tooth structure removed and Kruskal Wallis followed by post hoc Mann-Whitney test were used for cost analysis (P=0.05). Results: There was no difference in post removal time considering post type or technique (P=0.630). The average loss of tooth structure in the cervical region was greater than 30% when only a diamond bur was used to remove fiber glass post (P<0.00001) and cast metal post (P=0.008). Conclusion: According to the results of this study, we can conclude that the selection of the removal technique will depend on the skill of the operator, and some loss of tooth structure will always occur, although greater loss is expected when only diamond burs are used for this purpose.(AU)

Short vs standard implants associated with sinus floor elevation: a randomized controlled trial / Implantes curtos versus implantes convencionais associados à elevação do seixo maxilar: um ensaio clínico randomizado

Objective: the present equivalence two-arm parallel randomized controlled trial aimed to compare survival and marginal bone loss (MBL) of short implants (≤6 mm) and standard implants (≥8.5 mm) associated with sinus floor elevation (SFE). Methods: adult patients with partial edentulism with occlusal stability in the sinus area and intermediate bone height were selected in this double-blind trial (patient and outcome assessment). Patients were randomly allocated into two groups: standard length implants with SFE (control) or short implants (test). Clinical and radiographic assessments were made at the time of implant placement, 6 months, and annually thereafter up to 2 years after loading. The inter-examiner agreement was analyzed using intraclass correlation coefficient (ICC). One-way ANOVA, Kaplan-Meier, and Log-rank tests were used to compare implant survival (primary outcome) and MBL (secondary outcome) (P<0.05). Results: eight short implants and six standard implants were placed (mean age of patients was 47 ±12.5 years). The implant survival rates were 87.5% for short (one 5 mm implant failed at 7 months) and 100% for standard implants with no statistically significant difference between groups (P=0.4). The mean MBL after 1 year was 0.30 ±0.62 mm for short and 0.21 ±0.36 mm for standard implants (P=0.123). The inter-examiner agreement was set in 0.831. Conclusion: survival of short implants and standard implants associated with SFE was similar after two years of clinical service. Trial registration: Registered on 27-03-2018 at ClinicalTrials.gov (NCT03479333). Funding: This study was partially funded by Capes Finance Code 001 and #88881.187933/2018-01. TPC is partially funded by National Council for Scientific and Technological Development (CNPq - Brazil). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.(AU)

Objetivo: o presente ensaio clínico randomizado de dois braços de equivalência comparou a taxa de sobrevivência e a perda óssea marginal de implantes curtos (≤ 6 mm) e implantes convencionais (≥ 8.5 mm) associados à elevação do seio maxilar. Métodos: edêntulos parciais adultos, com estabilidade oclusal e altura óssea intermediária na região do seio maxilar, foram selecionados neste estudo duplo-cego e alocados randomicamente em dois grupos: implante de comprimento convencional associado à elevação do seio maxilar (controle) ou implante curto (teste). Avaliações clínicas e radiográficas foram realizadas logo após a instalação do implante, seis meses e anualmente por até dois anos. A concordância interexaminador foi avaliada através do coeficiente de correlação intraclasse. Os testes ANOVA de uma via, Kaplan-Meier e Log-rank foram utilizados para comparar a sobrevivência do implante e a perda óssea marginal (P<0.05). Resultados: oito implantes curtos e seis implantes de comprimento convencional foram instalados em onze pacientes (média de idade dos pacientes: 47 ± 12.5 anos). As taxas de sobrevivência dos implantes foram de 87,5% para implantes curtos (um implante de 5 mm falhou aos sete meses), e 100% para implantes convencionais, sem diferença estatisticamente significativa entre os grupos (P=0.4). A perda óssea marginal média após um ano foi de 0.30 ±0.62 mm para implantes curtos e 0.21 ±0.36 mm para implantes convencionais (P=0.123). A concordância interexaminador foi de 0.831. Conclusão: a taxa de sobrevivência de implantes curtos e convencionais associados ao seio maxilar foi semelhante após dois anos de acompanhamento. Registro do estudo: Registrado em 27-03-2018 no ClinicalTrials.gov (NCT03479333).(AU)

Email vs. instagram recruitment strategies for online survey research

Abstract In this study, we describe a method for reaching a target population (i.e., dentists practicing in Brazil) to engage in survey research using traditional e-mail invites and recruitment campaigns created on Instagram. This study addresses methodological aspects and compares respondents reached by different methods. A pre-tested questionnaire was used and participants were recruited for 10 days via a source list of email addresses and two discrete Instagram organic open campaigns. A total of 3,122 responses were collected: 509 participants were recruited by email (2.1% response rate) and 2,613 by the two Instagram campaigns (20.7% and 11.7% conversion rates), respectively. Response/min collection rates in the first 24 h ranged between 0.23 (email) and 1.09 (first campaign). In total, 98.8% of all responses were received in the first 48 h for the different recruitment strategies. There were significant differences for all demographic variables (p< 0.001) between email and Instagram respondents, except for sex (p=0.37). Instagram respondents were slightly older, had more professional experience (years in practice), and a higher graduate education level than email respondents. Moreover, most email and Instagram respondents worked in the public sector and private practice, respectively. Although both strategies could collect responses from all Brazilian regions, email responses were slightly better distributed across the five territorial areas compared to Instagram. This study provides evidence that survey recruitment of a diverse, large population sample using Instagram is feasible. However, combination of email and Instagram recruitment led to a more diverse population and improved response rates.

Resumo Neste estudo, descrevemos um método para atingir uma população-alvo (dentistas atuando no Brasil) para se engajar em pesquisa do tipo enquete (survey) utilizando convites tradicionais por e-mail e campanhas de recrutamento criadas no Instagram. Este estudo aborda aspectos metodológicos e compara as pessoas entrevistadas alcançadas por diferentes métodos. Foi utilizado um questionário pré-testado e os(as) participantes foram recrutados(as) por 10 dias por meio de uma lista de endereços de e-mail e duas campanhas abertas orgânicas independentes no Instagram. Foram coletadas 3122 respostas: 509 participantes foram recrutados(as) por e-mail (taxa de resposta 2,1%) e 2613 pelas duas campanhas do Instagram (taxas de conversão 20,7% e 11,7%), respectivamente. As taxas de coleta de resposta/min nas primeiras 24h variaram entre 0,23 (e-mail) e 1,09 (primeira campanha). No total, 98,8% das respostas foram recebidas nas primeiras 48h para as diferentes estratégias de recrutamento. Houve diferenças significativas para todas as variáveis demográficas (p<0,001) entre recrutados(as) por e-mail e Instagram, com exceção de sexo (p=0,37). As pessoas recrutadas via Instagram eram um pouco mais velhas, tinham mais experiência profissional (anos na prática) e nível de pós-graduação superior às entrevistadas por e-mail. Além disso, a maioria dos entrevistados por e-mail e Instagram trabalhava no setor público e na prática privada, respectivamente. Embora ambas estratégias tenham sido capazes de coletar respostas de todas as regiões brasileiras, as respostas por e-mail foram ligeiramente melhor distribuídas nas cinco áreas territoriais em comparação ao Instagram. Este estudo fornece evidências de que o recrutamento de uma amostra de população diversificada e grande usando o Instagram é viável. No entanto, a combinação de e-mail e Instagram no recrutamento levou a uma população mais diversificada e melhores taxas de resposta.

Influence of root canal preparation on formation of dentinal microcracks: a systematic review

Abstract The effect of root canal preparation technique on microcrack initiation is a controversial issue. This systematic review aimed to assess the role of root canal preparation techniques with different kinematics (manual, rotary, reciprocating, adaptive, self-adjusting file) on microcrack initiation. In vitro and in situ studies comparing the influence of at least two different root canal preparation techniques on the initiation of dentin microcracks were searched in PubMed/MEDLINE and SCOPUS up to June 5, 2018 without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and the included studies were assessed for bias. Fifty-four (n=54) articles met the eligibility criteria. The results were classified according to the method used for microcrack evaluation, and most studies that used micro-computed tomography showed no formation of new cracks after root canal preparation. In general, the instrumentation techniques induced microcrack formation when the methods were destructive, irrespective of kinematics. In relation to the apex region, when the preparation working length was set as the root canal length subtracted of 1 mm, the risk of microcrack initiation reduces. The majority of the included studies had low risk of bias for all assessed domains. Our results seem to indicate that the various root canal preparation techniques considered in this study will not cause damage to the dental structure when adequately employed and the proper methodology is applied.

Resumo O efeito da técnica de preparo do canal radicular na iniciação e/ou propagação de microfissuras dentinárias é um tema controverso. Essa revisão sistemática teve como objetivo avaliar o papel das técnicas de preparo do canal radicular com diferentes cinemáticas (manual, rotatória, reciprocante, adaptativa e self-adjusting file) na iniciação e/ou propagação de microfissuras dentinárias. Estudos in vitro e in situ comparando a influência de pelo menos duas técnicas diferentes de preparo do canal radicular foram identificados no PubMed/MEDLINE e SCOPUS até 05 de junho de 2018 sem restrição de idioma e tempo. Dois autores revisaram de maneira independente todos títulos e resumos para elegibilidade dos estudos. Tabelas foram criadas para sumarizar os estudos incluídos e os estudos foram avaliados quanto ao risco de viés. Cinquenta e quatro (54) estudos enquadraram-se nos critérios de elegibilidade. Os resultados foram classificados de acordo com o método utilizado para avaliação das microfissuras. A maioria dos estudos que utilizaram micro-tomografia não demonstraram formação de novas microfissuras após preparo do canal radicular. Em geral, técnicas de instrumentação induziram formação de microfissuras quando os métodos de avaliação foram destrutivos, independente da cinemática. Em relação a região do ápice, quando comprimento de trabalho foi definido como o comprimento do canal menos 1 mm, o risco de indução de microfissuras é reduzido. A maioria dos estudos incluídos apresentaram baixo risco de viés para todos os domínios apresentados. Nossos resultados parecem indicar que as diferentes técnicas de preparo do canal radicular não causam danos a estrutura dental quando adequadamente utilizadas e a metodologia adequada é utilizada.

Failure of miniscrews installed in maxilla and mandible: a systematic review and meta-analysis / Falha de mini-implantes instalados em maxila e mandíbula: uma revisão sistemática e meta-análise

Objective: The aim of this systematic review was to compare the clinical failure rate of orthodontic miniscrews in maxilla and mandible. Material and Methods: Randomized controlled trials of patients in orthodontic treatment, which required miniscrews for orthodontic intervention reporting the failure rate of miniscrews in the maxilla and mandible were searched in Pubmed database. Two authors independently reviewed all identified titles and abstracts for eligibility. Comparison between failures in maxilla and mandible were estimated using pairwise meta-analysis to calculate the relative risk (RR) of failure and the 95% confidence intervals using a random-effect model. The reports of randomized trials were assessed for bias using the Cochrane risk of bias tool. Results: Four studies fulfilled the eligibility criteria. 299 patients with a total of 628 miniscrews installed were included in the analysis. The analysis showed a 0.55 RR (95% CI 0.23­1.29) and I2 = 85%. All studies had an unclear risk of bias regarding to the two following items: allocation concealment, blinding of participants and personnel. All studies had a low risk of bias with regard to incomplete outcome data and selective reporting. The results did not demonstrate statistical difference between risk of failure of miniscrew between maxilla and mandible. Conclusion: The results of the meta-analysis showed that miniscrews installed in maxilla presents reduced risk of failure. A tendency of higher number of failures in mandible was also demonstrated. However, results should be interpreted with caution because of the very low quality of included studies and the differences among methodologies. (AU)

Objetivo: A presente revisão sistemática objetivou comparar a taxa de falha clínica de mini-implantes ortodônticos instalados em maxila e mandíbula. Materiais e Métodos: Ensaios clínicos controlados e randomizados que reportaram a taxa de falha de mini-implantes instalados em maxila e mandíbula de pacientes necessitando tratamento ortodôntico foram pesquisados na base de dados do Pubmed. Dois autores revisaram independentemente os títulos e resumos identificados com base nos critérios de elegibilidade. Comparações entre as falhas na maxila e mandíbula foram estimadas utilizando meta-análise pareada para cálculo do risco relativo (RR) de falha e dos intervalos de confiança de 95%, usando um modelo de efeito aleatório. Os reportes dos estudos incluídos foram avaliados quanto ao risco de viés seguindo os critérios da Cochrane para ensaios clínicos randomizados. Resultados: Quatro estudos preencheram os critérios de elegibilidade. No total, 299 pacientes e 628 mini-implantes instalados foram incluídos na análise. A análise apresentou um RR 0,55 (IC 95% 0,23-1,29) e I2 = 85%. Todos os estudos apresentaram um risco claro de viés em relação aos dois itens seguintes: ocultação de alocação, cegamento dos participantes e profissionais. Todos os estudos apresentaram um baixo risco de viés no que diz respeito a dados de desfecho incompletos e reporte seletivo. Não foi demonstrada diferença estatisticamente significativa entre mini-implantes instalados em maxila e mandíbula. Conclusão: Os resultados da meta-análise demonstraram um menor risco de falhas em mini-implantes instalados na maxila e uma tendência para maior número de falhas na mandíbula. Contudo, os resultados devem ser interpretados com cautela, dadas a baixa qualidade dos estudos incluídos e as diferenças entre suas metodologias (AU)

New material perspective for endocrown restorations: effects on mechanical performance and fracture behavior

Abstract The aim of this study was to investigate the mechanical performance and the fracture behavior of endocrown restorations prepared using distinct restorative materials. A total of 42 sound molars with similar crown size and shape were cut at 2 mm above the cementoenamel junction and endodontically treated. They were categorized according to the restorative material used to fabricate endocrown restorations (n=7), namely, conventional composite (Filtek™ Z350 XT), bulk fill composite (Filtek™ Bulk Fill), conventional composite modeled using resin adhesives (SBMP: Scotchbond™ Multipurpose Adhesive; or SBU: Scotchbond™ Universal Adhesive), and IPS e.max lithium disilicate (Ivoclar Vivadent; positive control). Unprepared sound teeth were used as negative control. All endocrowns were bonded using a self-adhesive cement (Rely-X™ U200). The teeth were submitted to fatigue (Byocycle) and fracture (EMIC DL500) testing. Load-to-fracture (in N) and work-of-fracture (Wf, in J/m2) values were analyzed by ANOVA (p < 0.05). The endocrowns did not fracture or de-bond upon fatigue, showing similar load-to-fracture and work-of-fracture values, regardless of the restorative material (p > 0.05). The endocrowns fabricated by combining Z350 and SBMP had the least harsh fractures, in contrast to endocrowns prepared using Z350 only, which exhibited an equilibrium between repairable and irrepairable fractures. The e.max endocrowns exhibited more aggressive failures (root fracture) than other groups, resulting in higher rates of irrepairable fractures. In conclusion, dental practitioners may satisfactorily restore severely damaged nonvital teeth using the endocrown technique. Composite endocrowns prepared using resin adhesive as modeler liquid or using bulk fill material may result in less aggressive failures, thus providing a new material perspective for endocrown restorations.

Impact of temporomandibular disorders on oral health-related quality of life of institutionalized elderly people / Impacto da disfunção temporomandibular na qualidade de vida relacionada à saúde bucal em idosos institucionalizados

Objective: to assess the characteristics associated withtemporomandibular disorders (TMD) and their impacton oral health-related quality of life (OHRQoL) of institutionalizedelderly people. Subjects and method: itwas a cross-sectional study performed in 30 private institutionsfor the elderly. The data collected included theTMD questionnaire and clinical evaluation assessed bythe Research Diagnostic Criteria/TemporomandibularDisorders (RDC/TMD), as well as the OHIP-49 questionnairefor OHRQoL. Results: twenty-four institutionsaccepted to participate in the study (n = 375 with 133fit for answering both questionnaires). Considering thecharacteristics, tinnitus was the most frequent symptomreported, while 98.5% of the research participants didnot present myofascial pain. Disc displacement wasobserved in 26.3%, while 93% of individuals did notpresent chronic pain. Severe depression was found in23.3% of the elderly with 24.1% presenting moderatelevels of non-specific physical symptoms, includingpain. Poisson regression analysis showed that the characteristicsreported were associated with a negativeimpact on OHRQoL. Conclusion: the domain-specificanalysis showed that all domains were affected negativelyby TMD characteristics and higher levels of depressionare associated with a negative impact on OHRQoL. (AU)

Objetivo: avaliar as características associadas às disfunções temporomandibulares (DTM) e seu impacto na qualidade de vida relacionada a saúde bucal (OHRQoL) em idosos institucionalizados. Sujeitos e método: este foi um estudo transversal, realizado em trinta instituições privadas de idosos. Os dados coletados incluíram um questionário e uma avaliação clínica de DTM por meio do instrumento Research Diagnostic Criteria/ Temporomandibular Disorders (RDC/TMD) e do questionário OHIP 49 para OHRQoL. Resultados: vinte e quatro instituições autorizaram a realização do estudo, (n = 375 com 133 idosos aptos a responder ambos os questionários). Dentre as características, o agravo mais frequentemente relatado foi a ocorrência de zumbido no ouvido, enquanto 98,5% dos participantes da pesquisa não apresentaram dor miofascial. Deslocamento de disco foi observado em 26,3%, enquanto 93% dos indivíduos não apresentaram dor crônica. Depressão severa foi encontrada em 23,3% dos idosos avaliados, com 24,1% apresentando grau moderado de sintomas físicos não específicos, incluindo dor. Análise da regressão de Poisson apresentou que as características relatadas estiveram associadas a impacto negativo na qualidade de vida relacionada à saúde bucal. Conclusão: realizando a análise por domínios, todos os domínios foram negativamente afetados pelas características da DTM, e os níveis maiores de depressão estão associados a um impacto negativo na OHRQoL. (AU)

Research Reporting Guidelines in Dentistry: A Survey of Editors

Abstract The use of reporting guidelines has an important role in the development of health research, improving the quality and precision of the publications. This study evaluated how dental journals use reporting guidelines. All editors of dental journals registered on the 2013 Journal Citation Reports list (n=81) were invited to participate. The data were collected by a self-reported web-based questionnaire. Information about the profile of journal/editor and on the use of reporting guidelines by journals was gathered. Information/recommendations about the use of reporting guidelines were collected from the websites of all journals. Data were descriptively analyzed and frequencies were summarized. Thirty-four (42%) editors completed the questionnaire. Most journals are members of Committee on Publication Ethics (64.7%) and/or follow the International Committee of Medical Journal Editors recommendations (20.6%), while 26.5% are not members of any editorial group. Most editors are unfamiliar with the EQUATOR Network (55.9%), do not work full time (85.3%) and 88.2% have some income/payment. Most of them received educational training for this position (55.9%). The CONSORT Statement was endorsed by 61.8% of journals. Information from websites showed that 44.4% journals do not recommend any reporting guideline, 51.9% mention CONSORT Statement in the website and 28.4% only recommend the use of CONSORT Statement. There is clearly room for improving the use of reporting guidelines in dental journals. Broadening the understanding and the endorsement/adherence/implementation of reporting guidelines by journals may promote quality and transparence of published dental research.

Resumo O uso de guias de reporte tem um papel importante no desenvolvimento das pesquisas na saúde, melhorando a qualidade e a precisão das publicações. Esse estudo avaliou como periódicos de odontologia usam os guias de reporte. Todos editores de periódicos de odontologia registrados na lista do 2013 Journal of Citation Reports (n=81) foram convidados a participar. Dados foram coletados através de um questionário online autoaplicável. Informações sobre o perfil do periódico/editor e do uso de guias de reporte pelos periódicos foram coletados. Informações/recomendações sobre o uso de guias de reporte foram também coletados dos sites de todos os periódicos. Dados foram analisados descritivamente e frequências foram sumarizadas. Trinta e quatro (42%) editores completaram o questionário. Maioria dos periódicos é membro do Committee on Publication Ethics (64,7%) e/ou seguem as recomendações do International Committee of Medical Journal Editors (20,6%), enquanto 26,5% dos periódicos não são membros de nenhum grupo editorial. A maioria dos editores não é familiar com o EQUATOR Network (55,9%), não trabalha em tempo integral como editor (85,3%) e 88,2% recebem algum pagamento. A maioria deles recebeu treinamento para a posição de editor (55,9%). O CONSORT Statement foi endossado por 61,8% dos periódicos. Informações oriundas dos sites demonstraram que 44,4% dos periódicos não recomendam nenhum guia de reporte, 51,9% mencionam o CONSORT Statement no site e 28,4 apenas recomenda o CONSORT Statement. Existe um espaço claro para melhora no uso de guias de reporte em periódicos de odontologia. Um maior entendimento e endosso/aderência/implementação de guias de reporte por periódicos de odontologia pode promover a qualidade e transparência das pesquisas odontológicas publicadas.

Translucency and color stability of resin composite and dental adhesives as modeling liquids - A one-year evaluation

Abstract The aim of this study is to evaluate the influence of modeling liquids on the translucency and color shade of resin composites (RCs) after one year of storage. RC specimens were prepared using either a conventional insertion technique (control; without modeling liquid) or a restorative dental modeling insertion technique (RDMIT) with dental adhesives as modeling liquids (Scotchbond™ Multi-Purpose [SBMP; 3M ESPE] or Adper™ Single Bond 2 [SB; 3M ESPE]). The initial colors of the specimens were obtained with a digital spectrophotometer and the CIEL*a*b* color system, after which specimens were stored (37°C) in distilled water or red wine for 12 months. Color measurements were reassessed after 6 and 12 months of storage, and scanning electron microscopy was performed after 12 months. Translucency and color change (ΔE*) were calculated and analyzed using ANOVA and Tukey's test (α = 5%). RC samples prepared via RDMIT showed a translucency similar to that of control samples. ΔE* was also less intense for RCs containing SBMP than for RCs containing SB. Specimens stored in wine showed a clear pattern of degradation, especially in the control group, and surface degradation seemed to be less intense for specimens prepared with SBMP and SB than for specimens without. Specimens stored in water did not show clear evidence of surface degradation. RDMIT appears to be an interesting approach to reduce ΔE* in RCs over time without negative effects on the translucency of the material. However, the modeling liquid should feature a hydrophobic composition, similar to that used in the SBMP group, the achieve the best results.

Knowledge and attitudes of students and dentists about the use and cementation of intra-radicular posts / Conhecimentos e atitudes de estudantes e dentistas sobre o uso e cimentação de pinos intrarradiculares

Objectives: The aim of the study was assess the knowledge and attitudes of students and dentists about the use and cementation of intra-radicular posts. Material and Methods: This cross-sectional study interviewed 150 students and 150 dentists in the city of Pelotas (Brazil). A questionnaire containing questions regarding restorative choice in teeth with large coronal destruction, level of confidence for the use of post and resin cement, function of intra-radicular posts and social-demographic characteristics was applied. Data were analysed using descriptive analysis and associations were tested through logistic regression using 95% confidence intervals. Results: The analysis showed that students presented an odd to choose prefabricated posts 127% greater than the dentists for anterior teeth, 105% greater to choose self-adhesive resin cement and 46% greater to choose conventional resin cement. Considering posterior teeth, students presented an odd to choose prefabricated posts 40% smaller than the dentists and an odd 51% greater to choose conventional resin cement. Conclusion: The formation level (students or dentists) was directly related to clinical choices of the interviewed. The use of prefabricated posts seems to be related to the location of the tooth in the arch, with pre-fabricated posts being more indicated for anterior teeth. Use of pre-fabricated posts in teeth with large coronal destruction is accepted in the literature. However, dentists are still not confident to use of pre-fabricated fiber posts especially in posterior teeth with large coronal destruction. (AU)

Objetivo: o objetivo do estudo foi avaliar o conhecimento e as atitudes dos alunos e dentistas sobre o uso e cimentação de pinos intra-radiculares. Material e Métodos: este estudo transversal entrevistou 150 estudantes e 150 dentistas na cidade de Pelotas (Brasil). Foi aplicado um questionário contendo perguntas sobre a escolha restauração em dentes com grande destruição coronária, nível de confiança para o uso de pinos e cimento resinoso, função dos pinos intra-radiculares e características sociodemográficas. Os dados foram analisados utilizando análise descritiva e as associações foram testadas através de regressão logística usando intervalos de confiança de 95%. Resultados: A análise mostrou que os alunos apresentaram uma chance para escolher pinos pré-fabricados 127% maior que os dentistas para dentes anteriores, 105% maior para escolher cimento resinoso autoadesivo e 46% maior para escolher o cimento resinoso convencional. Considerando os dentes posteriores, os estudantes apresentaram uma chance para escolher os pinos pré-fabricados 40% menor do que os dentistas e uma chance 51% maior para escolher o cimento resinoso convencional. Conclusão: O nível de formação (estudantes ou dentistas) está diretamente relacionado às escolhas clínicas dos entrevistados. O uso de pinos pré- fabricados parece estar relacionado à localização do dente no arco, com pinos pré-fabricados sendo mais indicados para os dentes anteriores. O uso de pinos pré-fabricados em dentes com grande destruição coronária é aceito na literatura. No entanto, os dentistas ainda não estão confiantes para o uso de pinos pré-fabricados de fibra, especialmente em dentes posteriores com grande destruição coronária. (AU)

Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study

Abstract Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.

Parameters Associated with Marginal Bone Loss around Implant after Prosthetic Loading

Abstract This study evaluated retrospectively the association among occlusal, periodontal and implant-prosthetic parameters and marginal bone loss (MBL) around implants and survival rate at 5.7 ±3.2 years of follow-up after prosthetic loading. Eighty-two patients received 164 external hexagon implants. After the standard healing period (3 to 6 months), the implants were restored with single-tooth or up to three splinted crowns. All patients were followed according to a strict maintenance program with regular recalls and clinically evaluated by a calibrated examiner. The MBL measurements taken from standardized radiographs made at permanent crown placement (baseline) and after the last evaluation were calculated considering occlusal, periodontal and implant-prosthetic parameters. Veneer fractures and abutment loosening were not considered failure. Two implants failed during the follow-up period, resulting in a survival rate of 98.8%. Cox regression analyses showed MBL associated with non-working side contacts (p=0.047), inadequate anterior guidance (p=0.001), lateral group guidance involving teeth and implants (p=0.015), periimplant plaque index (p=0.035), prosthetic design (p=0.030) and retention (p=0.006). Inadequate occlusal pattern guide, presence of visible plaque, and cemented and splinted implant-supported restoration were associated with greater MBL around the implant.

Resumo Este estudo avaliou retrospectivamente a associação entre os parâmetros oclusais, periodontais e implante-protéticos e perda óssea marginal (POM) ao redor de implantes e taxa de sobrevivência, em 5,7 ± 3,2 anos de acompanhamento após o carregamento protético. Oitenta e dois pacientes receberam um total de 164 implantes com hexágono externo. Após o período de cicatrização (3 à 6 meses), os implantes foram restaurados com coroa unitária ou até três coroas ferulizadas. Todos os pacientes seguiram um programa de manutenção rigoroso, com consultas regulares e avaliações clinicas realizadas por um examinador calibrado. As medições de POM obtidas de radiografias padronizadas realizadas na colocação da coroa permanente (baseline) e após a última avaliação foram calculadas considerando os parâmetros oclusais, periodontais e àqueles relacionados ao implante e prótese. Fratura na cerâmica de cobertura e afrouxamento do pilar não foram considerados falhas. Dois implantes falharam durante o período de acompanhamento, resultando em uma taxa de sobrevivência de 98,8%.A análise de regressão de Cox mostrou POM associado com contatos no lado de balanceio (p= 0,047), inadequada guia anterior (p=0,001), guia lateral em grupo envolvendo dentes e implantes (p=0,015), índice de placa visível em torno do implante (p=0,035), tipo de prótese (p= 0,030) e retenção (p=0,006). Guia de padrão oclusal inadequado, presença de placa visível e restaurações implanto-suportadas cimentadas e ferulizadas resultaram em maior POM ao redor do implante.

Survival of Restored Endodontically Treated Teeth in Relation to Periodontal Status

Abstract The aim of the present study was to investigate the success and survival of restored endodontically treated teeth (ETT) in a general practice environment related to periodontal parameters. Data from 360 restored ETT treated between 2000 and 2011 were collected. Dates of interventions like restorations, repairs, replacements and extractions were recorded. Additionally, general information about patients and dentitions as well as periodontal status was recorded. Success was analyzed using Kaplan-Meier statistics and a multivariate Cox regression analysis was performed to assess variables influencing success and survival. After a mean observation time of 4.34 years (range 0.6 - 11.6 years), 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure (p=0.012). In conclusion, periodontal pocket depth was found to be a significant factor in the survival of restored ETT.

Resumo O objetivo do presente estudo foi investigar a taxa de sucesso e de sobrevivência de dentes restaurados e tratados endodonticamente (DTE) em uma clínica privada e relacionar com índices periodontais. Dados de 360 restaurações realizadas em DTE realizadas entre 2000 e 2011 foram coletados. As datas das intervenções, como restaurações, reparos, substituições e extrações foram registradas. Ainda, informações gerais relacionadas aos pacientes, aos dentes envolvidos e ao estado periodontal foram também coletadas. A taxa de sucesso foi analisada utilizando o método estatístico Kaplan-Meier e uma análise multivariada do tipo regressão de Cox foi realizada para avaliar variáveis que influenciaram na taxa de sucesso e de sobrevivência. Depois de um período de observação médio de 4,34 anos (0,6-11,6 anos), 19 dentes foram extraídos e 27 restaurações precisaram de reparo ou substituição. De acordo com a regressão de Cox, o aumento na profundidade de bolsa periodontal do dente resulta em um maior risco de falha (p=0,012). Em conclusão, a profundidade de bolsa periodontal foi considerada como um fator significativo na sobrevivência de dentes restaurados e tratados endodonticamente.

Accuracy of color measurement of endondontically treated teeth after aging / Precisão da medição de cor de dentes tratados endodonticamente após envelhecimento

Objective: The aim of this study was to compare the accuracy of three different modes of a spectrophotometer (Vita Classical, 3D-Master and CIE L*a*b* system) in the evaluation of color alteration in endodontically treated teeth. Material and Methods: The root canal treatment of forty-five sound human canines was performed. Color measurements were performed before the endodontic treatment (baseline), and after 6 months of water storage. Shade matching was performed using a spectrophotometer (Vita Easyshade) in three different modes: Vita Classical, 3D-Master and CIE L*a*b* coordinates. The color change (ΔE value) for the three methods were assessed in each sample and analyzed by multiple linear regression analysis. L*, a* and b* values were analyzed by t-test. The significance level was set at 5%. Results: According to the digital evaluation, no statistically significant differences were found between the CIE L*a*b*,Vita Classical and 3D-Mastermodes. However, a significant difference was found (p < 0.001) for the ΔE values, with the CIE L*a*b* mode presenting greater accuracy to detect color alterations. Conclusion: CIE L *a*b* method properly correlates to Vita Classical and 3D-Master modes. However, Easyshade can easier detect color changes if used in the CIE L*a*b* mode, which leads to more accurate results.

Objetivo: O objetivo deste estudo foi comparar a precisão de três modos diferentes de um espectrofotômetro (Vita Classical, 3D-Master e sistema CIE L*a*b*) na avaliação da alteração de cor em dentes tratados endodonticamente. Materiais e Métodos: O tratamento endodôntico de quarenta e cinco caninos humanos foi realizado. Medições de cor foram realizadas, antes do tratamento endodôntico (imediatamente), e após 6 meses de armazenamento em água. Análise de cor foi realizado utilizando um espectrofotômetro (Vita Easyshade) em três diferentes modos: Vita Classical, 3D-Master e sistema CIE L*a*b*. A mudança de cor (valor ΔE) para os três métodos foram avaliadas em cada amostra e analisados através de análise de regressão linear múltipla. Valores de L*, a* e b* foram analisados através do teste-t. O nível de significância estabelecido foi de 5%. Resultados: De acordo com a avaliação digital, não foram encontradas diferenças significativas entre os métodos CIE L*a*b*,Vita Classical e 3D-Master. No entanto, uma diferença significativa foi encontrada (p < 0,001) para os valores de ΔE, com o modo CIE L*a*b* apresentando uma maior precisão para detectar alterações de cor. Conclusão: O método CIE L *a*b* correlaciona corretamente para os modos Vita Classical e 3D-Master. No entanto, o Easyshade pode detectar alterações de cor, mais facilmente quando utilizado no modo CIE L *a*b*, permitindo resultados mais precisos.

Cleaning methods for removable dentures: a critical reviewof the literature

A literature review was performed including studies that evaluated the use of cleaning protocols for removable dentures through questionnaires, clinical trials, randomized clinical trials, and systematic reviews. Twenty studies were included and the results showed that bad preservation of the prostheses is mainly due to low knowledge about cleaning habits and methods. Also, a wide variety of effective cleaning methods were presented. However, there is no standard protocol for all patients and it should be customized for each patient. It is important to highlight that dentists should give adequate instructions concerning maintenance and hygiene of the prosthesis.

Uma revisão da literatura foi realizada incluindo estudos que avaliaram o uso de protocolos de limpeza para próteses removíveis através de questionários, ensaios clínicos, estudos clínicos randomizados e revisões sistemáticas. Vinte estudos foram incluídos e os resultados mostraram que a má preservação das próteses é principalmente devido ao baixo conhecimento sobre os hábitos e métodos de limpeza. Além disso, foram apresentados uma grande variedade de métodos de limpeza eficazes. No entanto, não existe um protocolo padrão para todos os pacientes, devendo ser personalizado para cada paciente. É importante destacar que os dentistas devem dar instruções adequadas quanto a manutenção e higiene das próteses.

Effects of modeling liquid/resin and polishing on the color change of resin composite

Abstract Modeling liquids/resins have been used to build up resin composite (RC) restorations, although there is a lack of information regarding their effects on the color stability of the latter. Therefore, the purpose of the present study was to evaluate the effects of the presence of modeling liquid between layers of RC and the finishing/polishing state of the material on color change in specimens exposed to red wine staining over time. Specimens were prepared by placing four increments (±0.5 mm thick) of RC (Filtek™ Z350 XT, 3M ESPE) into molds; half of which were prepared by applying modeling liquid (Scotchbond™ Multi-Purpose™ Adhesive, SBMP, 3M ESPE) between the layers of RC, whereas the other half were prepared without SBMP (control). Light-activation was performed after application of the final RC layer using a light-emitting diode (Radii, SDI) curing unit with an irradiance of 900 mW/cm2 for 20 s. Each group was divided according to the surface finishing protocol (n = 7): nothing (non-polished) or polishing with Sof-Lex™/diamond paste (polished). Initial colors of the specimens were evaluated with a digital spectrophotometer and the CIEL*a*b* color system. The specimens were stored in wine (37°C) for 12 months, and the color measurements were reassessed after 4, 6, and 12 months of storage. Scanning electron microscopy (SEM) analysis was performed at the end. Data were analyzed using ANOVA and Tukey's test (α = 5%). The presence of SBMP resulted in lower overall color change of the RC as compared with the control. The non-polished specimens exhibited a significantly higher color change than the polished specimens. SEM images corroborated the previous findings. In summary, the use of modeling liquid between layers of RC shows potential for application to reduce or delay the staining process of RC over time. Moreover, polishing is essential to provide increased color stability of the RC restoration.