Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials.

Background: High-alert medication (HAM) is more predictable to cause significant harm to the patient, even when used as intended. The damage related to the HAM lead not only suffering to the patient, but also raise the additional costs associated with care. Objective: Evaluate the incidence of drug-related adverse events related to the use of high-alert medications. Methods: It was conducted an active search for information through COCHRANE databases, LILACS, SciELO, SCOPUS, PubMed/MEDLINE and WEB OF SCIENCE. The search strategy included the following terms: "Patient safety", "Medication errors" and "Hospital" and "High Alert Medications" or "Dangerous Drugs" in different combinations. Then two reviewers independently conducted a preliminary evaluation of relevant titles, abstracts and finally full-text. Studies quality was evaluated according to PRISMA declaration. Results: The systematic review evaluated seven articles, which showed that only 11 HAM identified in the literature could have serious events. The most frequently cited were warfarin (22.2%) which progressed from deep vein thrombosis to gangrene, suggesting lower initial doses, followed by cyclophosphamide (22.2%) and cyclosporine (22.2%) which presented invasive fungal infection and death. In addition to these, morphine was compared with its active metabolite (M6G), with M6G causing fewer serious clinical events related to nausea and vomiting, reducing the need for concomitant use of antiemetics. Conclusions: The most reported drug classes in the articles included that were related to incidence of drug-related adverse events in use of high-alert medications: morphine, M6G-glucuronide, haloperidol, promethazine, ivabradine, digoxin, warfarin, ximelagatran, cyclophosphamide, cyclosporine, and ATG. The formulate protocols for the use of these medications, with importance placed on evaluating, among the classes, the medication that causes the least harm.

Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review.

BACKGROUND: Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE: To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS: A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS: The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION: In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.

The Pharmacoeconomic Impact of Pharmaceutical Care in the Hospital: Protocol for an Overview of Systematic Reviews.

BACKGROUND: The clinical activities developed by pharmacists in a hospital environment can improve health outcomes and generate savings for hospitals. However, to determine whether pharmaceutical interventions are cost effective, it is essential to define a method according to which cost-effectiveness is intended to be measured. In addition, the quality of economic assessments and the amount of information present in systematic reviews in the literature make it difficult to analyze the effects of this intervention. OBJECTIVE: This paper aims to provide an overview of systematic reviews on the pharmacoeconomic impact of the performance of pharmaceutical care in hospitals. METHODS: A systematic search of the Cochrane Library databases, PubMed or MEDLINE, LILACS, Scopus, Web of Science, Google Scholar, and Open Thesis will be performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search will involve the use of keywords determined using the Medical Subject Headings database to define the search terms and include the following terms: "pharmacoeconomics," "pharmaceutical care," and "hospital." The study designs to be included will be systematic reviews of good quality. Studies will be included that address pharmacoeconomics; studies that evaluated pharmaceutical care in hospitals; and studies published in Portuguese, English, or Spanish. The primary outcome sought in the systematic reviews will be the cost ratio in monetary units and the outcomes in monetary or natural units. The secondary economic outcomes considered will be determined based on factors associated with the drugs and translated into benefit, efficacy, or utility. RESULTS: It is intended to start this overview in January 2023. Thus far, only previous searches have been carried out to contextualize the theme and build the protocol. CONCLUSIONS: This overview will determine the pharmacoeconomic impact of pharmaceutical care interventions in the hospital environment. In addition, this study will point out which clinical outcomes in natural units are impacted by the performance of pharmaceutical care and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. TRIAL REGISTRATION: PROSPERO CRD42019140665; https://tinyurl.com/bddwnz43.

Cost-effectiveness of medication reconciliation performed by a pharmacist in pediatrics of a hospital: A randomized clinical trial protocol linked to a pharmacoeconomic study.

INTRODUCTION: Each patient admitted to the hospital is subject to one medication error per day, since the occurrence of this one with the potential to cause harm is three times more common in pediatric hospitalized patients than in adults. These harms can result from inaccurate or incomplete drug use histories when patients undergo a clinical evaluation, which jeopardizes patient safety and compromises hospitalization costs. Thus, medication reconciliation (MC) emerges as a possible solution to avoid the occurrence of these in pediatric patients and directly contributes to reducing costs in the hospital environment and increasing quality of life). Therefore, this study proposes to determine whether pharmacist-led medication reconciliation is a cost-effective strategy to improve health outcomes in pediatric patients. METHODS: A randomized clinical trial will be carried out, over eight months, to carry out the cost analysis. Micro-costing pharmacoeconomic model through a questionnaire and clinical interview to collect the variables necessary for the study and comparison of the control and intervention groups. Participants in this study will be children aged 0 days to 12 years, admitted to the hospital. The perspective adopted will be that of the hospital. To assess the economic outcomes of MC, the cost-effect pairs will be categorized and visually represented in the cost-effectiveness plan to compare the intervention and control groups. Monte Carlo simulation and univariate sensitivity analysis will be performed to test the robustness of the findings. ETHICS AND DISSEMINATION: The clinical trial was approved by the Research Ethics Committee of the Federal University of Sergipe (CAAE: 19625319.6.0000.5546 and opinion number: 3,630,579). This protocol fully adhered to the recommendations of the 2010 CONSORT Declaration and was registered in the Brazilian Registry of Clinical Trials (ReBEC): RBR-25dnqsk.

Development and implementation of a medication reconciliation during pediatric transitions of care in a public hospital.

OBJECTIVES: To generate effective changes in the work processes of an institution, such as hospitals, strategies are needed for the implementation of services. These should be based on the needs of the practice scenario and evidence that may develop programs applied to the routine of health care. This study aimed to implement medication reconciliation (MR) at the transition of care in the pediatric department of a public hospital located in Northeast Brazil. SETTING: A step-by-step approach was adopted to implement MR in the studied hospital and conducted from March 2019 to December 2019. PRACTICE INNOVATION: The implementation of MR used the "Model for Improvement" framework. The processes were built and tested in the Plan-Do-Study-Act (PDSA) cycles. Children admitted to the hospital's pediatrics department were included in the study. The objective of the PDSA cycles was to reach 75% of the patients included, with the service performed in at least one transition of care episode. EVALUATION: This study used the following indicators: number of steps performed, number of discrepancies identified, and resolution of discrepancies. Descriptive statistical analysis was performed for all variables. RESULTS: In the first cycle, all patients (n = 34) had the best possible medication history (BPMH) completed, and 26.4% went through all the MR stages. Seventy-two discrepancies were identified and 90.3% of them were resolved. In the second cycle, all patients (n = 35) had the BPMH completed, and 20% went through all the stages. A total of 32 discrepancies were identified and 96.8% of them were resolved. In the third cycle, all patients (n = 30) had the BPMH completed, and 56.6% of patients went through all the stages. Twenty-four discrepancies were identified and resolved. CONCLUSION: The use of the "Model for Improvement" framework effectively contributed to the implementation of the service according to the characteristics of the studied hospital.

Effect of Nd:YAG Laser with/without Graphite Coating on Bonding of Lithium Disilicate Glass-Ceramic to Human Dentin.

This study evaluated the effect of different surface treatments on the tensile bond strength between lithium disilicate glass-ceramics, resin cement, and dentin. Fifty truncated cone-shape glass-ceramics were divided into five groups (n = 10): G1, control: 10% hydrofluoric acid (HF); G2, Nd:YAG laser + silane; G3, Sil + Nd:YAG laser; G4, graphite + Nd:YAG laser + Sil; and G5, graphite + Sil + Nd:YAG laser. Fifty human third-molars were cut to cylindrical shape and polished to standardize the bonding surfaces. The glass-ceramic specimens were bonded to dentin with a dual-cured resin cement and stored in distilled water for 24 h at 37ºC. Tensile testing was performed on a universal testing machine (10 Kgf load cell at 1 mm/min) until failure. The bond strength values (mean ± SD) in MPa were G1 (9.4 ± 2.3), G2 (9.7 ± 2.0), G3 (6.7 ± 1.9), G4 (4.6 ± 1.1), and G5 (1.2 ± 0.3). Nd:YAG laser and HF improve the bond strength between lithium disilicate glass-ceramics, resin cement, and dentin. The application of a graphite layer prior to Nd:YAG laser irradiation negatively affects this bonding and presented inferior results.

Late clinical outcomes of myocardial hybrid revascularization versus coronary artery bypass grafting for complex triple-vessel disease: Long-term follow-up of the randomized MERGING clinical trial.

OBJECTIVES: This article aimed to compare the outcomes after hybrid revascularization with conventional coronary artery bypass grafting (CABG) surgery. BACKGROUND: The concept of hybrid coronary revascularization combines the advantages of CABG and percutaneous coronary intervention to improve the treatment of patients with complex multivessel disease. METHODS: The Myocardial hybrid revascularization versus coronary artERy bypass GraftING for complex triple-vessel disease-MERGING study is a pilot randomized trial that allocated 60 patients with complex triple-vessel disease to treatment with hybrid revascularization or conventional CABG (2:1 ratio). The primary outcome was the composite of all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization at 2 years. RESULTS: Clinical and anatomical characteristics were similar between groups. After a mean follow-up of 802 ± 500 days, the primary endpoint rate was 19.3% in the hybrid arm and 5.9% in the CABG arm (p = NS). The incidence of unplanned revascularization increased over time in both groups, reaching 14.5 versus 5.9% in the hybrid and in the CABG groups, respectively (p = .4). Of note, in the hybrid group, there were no reinterventions driven by the occurrence of stent restenosis. CONCLUSIONS: Hybrid myocardial was feasible but associated with increasing rates of major adverse cardiovascular events during 2 years of clinical follow-up, while the control group treated with conventional surgery presented with low rates of complications during the same period. In conclusion, before more definitive data arise, hybrid revascularization should be applied with careful attention in practice, following a selective case-by-case indication.

A randomized clinical trial of class II composite restorations using direct and semidirect techniques.

OBJECTIVE: This prospective study evaluated the clinical performance of large class II restorations made with different techniques over 24 months. MATERIALS AND METHODS: Thirty patients received two class II restorations (n = 60) using a nanohybrid composite and different restorative techniques (direct (DT), semidirect (SDT)), in a split-mouth randomized design. The same adhesive system was applied for all restorations. For DT, the restorative material was applied directly inside the tooth preparation. For SDT, a tooth preparation impression was obtained using alginate and a silicone flexible die was prepared. The restoration was made chairside on the model and additionally light cured. After that, it was cemented in preparation using resinous cement. All restorations were evaluated using the FDI criteria after 7 days, 6, 12, and 24 months postoperatively. RESULTS: After 24 months, 24 patients attended the recall and 48 restorations were evaluated. Fisher's statistical analysis (5%) showed no difference between the techniques. Nevertheless, Friedman's test showed significant differences for some criteria after 12 months of evaluation for both techniques. Postoperative sensitivity was reported in one DT restoration. Also, after 24 months, one SDT restoration presented marginal fracture, which was deemed unsatisfactory. CONCLUSIONS: After a 24-month follow-up, no significant difference between the tested techniques was detected. The restorations performed with both techniques produced clinically acceptable restorations. CLINICAL RELEVANCE: This study demonstrated the viability of applying two different operatory techniques (direct and semidirect) for class II resin composite restorations.

Influence of the addition of glass fibers reinforcements in the flexural strength of acrylic resin / Influência da adição de reforço de fibra de vidro na resistência flexural de resina acrílica

Objective: To evaluate the influence of glass fiber reinforcements used in nautical and sports products on the flexural strength of acrylic resin. Materials and methods: Thirty thermos activated acrylic resin bars (25 x 10.5 x 3.3 mm) were used. The samples were shared in 3 groups: bars with no glass fiber (control group, n = 10), bars reinforced with glass fiber and 0.18 mm thickness (group F1, n = 10) and bars reinforced with glass fiber and 0.80 mm thickness (group F2, n = 10). After 48 hours, samples were submitted to compression test in order to evaluate flexural strength. Obtained data were statistically analyzed with significance level of 5 %. Results: It was observed that the use of glass fiber effectively increased the flexural strength compared to the control group; the thickness of the glass fiber, however, did not present statistical differences. Conclusion: The use of fiber glass is a simple and cost-effective alternative to improve acrylic resin performance. (AU)

Objetivo: Avaliar a influência do reforço de fibra de vidro usada em produtos esportivos náuticos na resistência flexural da resina acrílica. Materiais e métodos: Trinta barras de resina acrílica termoativadas (25 x 10.5 x 3.3 mm) foram confeccionadas. As amostras foram divididas em 3 grupos: barras sem fibra de vidro (grupo controle, n = 10), barras com reforço de fibra de vidro com espessura de 0.18 mm (grupo F1, n = 10) e barras com reforço de fibra de vidro com espessura de 0.80 mm (grupo F2, n = 10). Após 48 horas, as amostras foram submetidas ao ensaio de compressão para avaliar a resistência flexural. Os dados obtidos foram analisados estatisticamente com nível de significância de 5%. Resultados: Foi observado que o uso de fibra de vidro aumentou efetivamente a resistência à compressão comparado com o grupo controle; a espessura da fibra de vidro, no entanto, não apresentou diferença estatisticamente significante. Conclusão: O uso de fibra de vidro é uma alternativa simples e de baixo custo para aprimorar a performance das resinas acrílicas. (AU)

Biosafety measures in dental practice: Literature Review / Medidas de biossegurança em consultório odontológico: revisão de literatura

Objective: There is a great concern with biosafety nowadays, given the knowledge of diseases and potential complications in health practice. In this context, this review aims to provide information capable of improving good health practices and consequent minimization of operational risks in dental practice. Material and Methods: A review of biosafety literature was carried out covering the last seven years considering the health descriptors: "odontologia" and "biossegurança" / "Contenção de Riscos Biológicos" in the following Databases: Biblioteca Virtual em Saúde - BVS (Virtual Health Library); Bibliografia Brasileira de Odontologia - BBO (- Brazilian Bibliography of Dentistry ) and Literatura Latino-Americana e do Caribe em Ciências da Saúde ­ LILACS (Latin American and Caribbean Literature in Health Sciences); and with the descriptors "dentistry" and "biosecurity" / "Containment of Biohazards" in the Databases: Scientific Electronic Library Online (SciELO), National Library of Medicine (MEDLINE), US National Library of Medicine National Institutes of Health Search (PubMed) and SCOPUS. Results: There were found 33 articles that met the criteria established for this research. Conclusion: From the literature, it is concluded that the evaluation of procedures, knowledge and constant study, the improvement of procedures and joint action of all staff is of fundamental importance so that health improvement can go beyond health care and the resolution of a specific problem (AU)

Objetivo: Atualmente existe uma grande preocupação com a biossegurança, devido ao conhecimento das doenças e das potenciais complicações na prática de saúde. Nesse contexto, esta revisão tem como objetivo fornecer informações capazes de melhorar as boas práticas de saúde e consequente minimização dos riscos operacionais na prática odontológica. Material e métodos: Foi realizada uma revisão da literatura sobre biossegurança, abrangendo os últimos sete anos, considerando os descritores de saúde: "Odontologia" e "Biossegurança" / "Contenção de Riscos Biológicos" nas seguintes Bases de Dados: Biblioteca Virtual em Saúde - BVS; Bibliografia Brasileira de Odontologia - BBO (Literatura Brasileira de Odontologia) e Literatura Latino-Americana e do Caribe em Ciências da Saúde - LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde); e com os descritores "Odontologia" e "Biossegurança" / "Contenção de Riscos Biológicos" nas Bases de Dados: Scientific Electronic Library Online (SciELO), National Library of Medicine (MEDLINE), National Library of Medicine National Institutes of Health Search (PubMed) e SCOPUS. Resultados: Foram encontrados 33 artigos que atenderam aos critérios estabelecidos para esta pesquisa. Conclusão: A partir da literatura, concluise que a avaliação de procedimentos, conhecimento e estudo constante, a melhoria dos procedimentos e a ação conjunta de todos os funcionários é de fundamental importância para que a melhoria da saúde possa ir além dos cuidados de saúde e a resolução de um problema específico (AU)

The impact of at home and in-office bleaching agents on the color stability of bulk-fill composite resins / Impacto de agentes clareadores caseiros e de consultório na estabilidade de cor de resinas compostas bulk fill

Objective: This study compared different composites for color stability after exposure to at home and in-office bleaching gels. Material and Methods: Composite resin specimens (6mm diameterx2mm thickness) were manufactured according to the following groups (n=20): RC- Conventional; BF-Bulk Fill; RF-Flow; BFF-Bulk-Fill Flow. The surfaces were stained with coffee solution for 36h. A spectrophotometer was used to record the initial color (L*a*b*). Half of the specimens from each group underwent bleaching with 35% hydrogen peroxide (in-office) in three 45-minute applications. New color measurements were performed after 7, 14 and 21 days. The other half of the specimens underwent bleaching with 22% carbamide peroxide (at home) in 14 1-hour applications. Further color measurements were performed after 7 and 14 days. For comparison between the color coordinates in different periods, ANOVA for repeated measures was applied (α=5%). The color variation (ΔE) was calculated for each group. Results: For in-office bleaching, there were no significant differences between the periods b* coordinate of the RF group, and for L* and b* coordinates of the BFF group. For at home bleaching the groups BF and BFF showed no differences for the L* coordinate. For the other coordinates, there was difference between the initial periods and after 14 days. The ΔE variation presented higher values for the at home bleaching groups. For both whiteners the bulk-fill resins presented the greatest color variations. Conclusions: Bulk Fill resins do not guarantee greater color stability than the other composite resins tested, including conventional flow resin. The conventional composite resin showed the lower ΔE. (AU)

Objetivo: Esse estudo comparou diferentes resinas compostas quanto a estabilidade de cor após exposição a géis clareadores de uso caseiro e de consultório. Material e Métodos: Espécimes de resina composta (6mm diâmetro x 2mm espessura) foram confeccionados de acordo com os seguintes grupos (n=20): RC- Convencional; BFBulk Fill; RF-Flow; BFF-Bulk-Fill Flow. As superfícies foram manchadas com solução de café por 36 horas. Um espectrofotômetro foi utilizado para mensurar a cor inicial (L*a*b*). Metade dos espécimes de cada grupo foi submetida ao clareamento com peróxido de hidrogênio 35% (clareamento de consultório) durante três aplicações de 45 minutos. Novas mensurações de cor foram realizadas após as aplicações de 7, 14 e 21 dias. A outra metade dos espécimes foi submetida ao clareamento com peróxido de carbamida 22% (clareamento caseiro) em 14 aplicações de 1 hora durante 14 dias. Novas mensurações de cor foram realizadas após 7 e 14 dias. Para comparação entre as coordenadas nos diferentes períodos foi aplicada a análise de variância ANOVA para medidas repetidas (α=5%). A variação de cor (ΔE) foi calculada para cada grupo. Resultados: Para o clareamento de consultório não houve diferenças significativas para a coordenada b* do grupo RF, e para L* e b* no grupo BFF. Para o clareamento caseiro os grupos BF e BFF não apresentaram diferenças para a coordenada L*. Para as outras coordenadas, houve diferenças entre os períodos inicial e após 14 dias. A variação de ΔE apresentou maiores valores para o grupo submetido ao clareamento caseiro. Para ambos clareadores a resina composta bulk fill apresentou as maiores variações de cor. Conclusões: As resinas compostas bulk fill não garantiram uma maior estabilidade de cor quando comparadas as resinas compostas tradicionais testadas, incluindo a resina flow. A resina composta convencional apresentou a menor variação de ΔE. (AU)

Effect of high-power-laser with and without graphite coating on bonding of resin cement to lithium disilicate ceramic.

The present study evaluated the effect of different high-power-laser surface treatments on the bond strength between resin cement and disilicate ceramic. Lithium disilicate ceramic specimens with truncated cones shape were prepared and divided into 5 groups: HF (hydrofluoric acid-etching), Er:YAG laser + HF, Graphite + Er:YAG laser + HF, Nd:YAG laser + HF, and Graphite + Nd:YAG laser + HF. The treated ceramic surfaces were characterized with scanning electron microscopy and surface roughness measurement. Hourglasses-shaped ceramic- resin bond specimens were prepared, thermomechanically cycled and stressed to failure under tension. The results showed that for both the factors "laser" and "graphite", statistically significant differences were observed (p < 0.05). Multiple-comparison tests performed on the "laser" factor were in the order: Er:YAG > Nd:YAG (p < 0.05), and on the "graphite" factor were in the order: graphite coating < without coating (p < 0.05). The Dunnett test showed that Er:YAG + HF had significantly higher tensile strength (p = 0.00). Higher surface roughness was achieved after Er:YAG laser treatment. Thus Er:YAG laser treatment produces higher bond strength to resin cement than other surface treatment protocols. Surface-coating with graphite does not improve bonding of the laser-treated lithium disilicate ceramic to resin cement.

Effects of Contamination by Hemostatic Agents and Use of Cleaning Agent on Etch-and-Rinse Dentin Bond Strength.

The aim of this study was to evaluate the influence of contamination by hemostatic agents and rinsing with chlorhexidine on bond strength between dentin and resin composite. Ninety-six bovine teeth were sectioned to expose a flat dentin surface area. A standardized cavity with 2.0 mm in thickness, superficial diameter of 4.0 mm and bottom diameter of 3.0 mm was prepared with a diamond bur in each dentin specimen. The teeth were divided into four groups according to the hemostatic employed: G1: control; G2: use of ViscoStat, Ultradent; G3: Hemosthasegel, FGM; and G4: Hemostop, Dentsply. The groups were divided into two subgroups according to the cleaning protocol method (n=12): A: without any further cleaning; and B: cleaning with chlorhexidine at 0.2%. All cavities were filled using a dentin adhesive and a resin composite, following the manufacturer's instructions. After 24 h, the specimens were aged by thermal and mechanical cycling. The bond strength was determined by the push out bond test (MPa), Statistical analysis was performed using two-way ANOVA and Tukey test (p<0.05). Statistically significant differences were detected among all groups treated with hemostatic agents and the control group. The post-hoc test showed that cleaning the cavity with chlorhexidine significantly improves the bond strength between dentin and resin composite. Our results suggested that the use of chlorhexidine can reestablish the bond strength between dentin and resin composite when a hemostatic agent was applied.

Effects of Contamination by Hemostatic Agents and Use of Cleaning Agent on Etch-and-Rinse Dentin Bond Strength

Abstract The aim of this study was to evaluate the influence of contamination by hemostatic agents and rinsing with chlorhexidine on bond strength between dentin and resin composite. Ninety-six bovine teeth were sectioned to expose a flat dentin surface area. A standardized cavity with 2.0 mm in thickness, superficial diameter of 4.0 mm and bottom diameter of 3.0 mm was prepared with a diamond bur in each dentin specimen. The teeth were divided into four groups according to the hemostatic employed: G1: control; G2: use of ViscoStat, Ultradent; G3: Hemosthasegel, FGM; and G4: Hemostop, Dentsply. The groups were divided into two subgroups according to the cleaning protocol method (n=12): A: without any further cleaning; and B: cleaning with chlorhexidine at 0.2%. All cavities were filled using a dentin adhesive and a resin composite, following the manufacturer's instructions. After 24 h, the specimens were aged by thermal and mechanical cycling. The bond strength was determined by the push out bond test (MPa), Statistical analysis was performed using two-way ANOVA and Tukey test (p<0.05). Statistically significant differences were detected among all groups treated with hemostatic agents and the control group. The post-hoc test showed that cleaning the cavity with chlorhexidine significantly improves the bond strength between dentin and resin composite. Our results suggested that the use of chlorhexidine can reestablish the bond strength between dentin and resin composite when a hemostatic agent was applied.

Resumo O objetivo desse estudo foi avaliar a influência da contaminação por agentes hemostáticos e da lavagem com clorexidina na resistência de união entre dentina e resina composta. 96 dentes bovinos foram seccionados para a exposição de uma área plana de dentina. Em cada bloco, uma cavidade cônica de 2 mm de espessura, diâmetro externo de 4 mm e diâmetro interno de 3 mm, foi confeccionado com uma ponta diamantada. Os dentes foram divididos em 4 grupos de acordo com o hemostático empregado, como descrito: G1- controle, G2- uso de ViscoStat - Ultradent, G3- uso de Hemosthasegel - FGM, G4- uso de Hemostop - Dentsply. Os grupos foram divididos em 2 subgrupos de acordo com o protocolo de limpeza utilizado (n=12): A - nenhum agente de limpeza; B - limpeza com clorexidina 0.2%. Todas as cavidades foram preenchidas utilizando adesivo dentinário e resina composta, seguindo as instruções dos fabricantes. Após 24 h, os espécimes foram submetidos a protocolo de envelhecimento em cicladora termomecânica. A resistência de união foi determinada pelo teste mecânico de push-out (MPa), as análises estatísticas foram realizadas utilizando ANOVA 2-fatores e teste de Tukey (p<0.05). Diferenças estatisticamente significativas foram detectadas entre todos os grupos tratados com agentes hemostáticos e o grupo controle. O teste post-hoc mostrou que a limpeza da cavidade com clorexidina aumenta significativamente a resistência de união entre dentina e resina composta. Os resultados sugerem que o uso da clorexidina pode restabelecer a resistência de união entre dentina e resina composta quando um agente hemostático é aplicado.

Efeitos de lasers de alta potência na superfície de cerâmicas vítreas de dissilicato de lítio e sua resistência de união à dentina humana / Effects of high power laser irradiation on lithium di-silicate glass ceramic surface and bond strength to human dentin

O objetivo desse estudo foi avaliar a eficiência da irradiação com lasers de alta potência e a influência da aplicação do silano previa ou posteriormente à irradiação com os lasers na resistência de união entre cerâmica vítrea de dissilicato de lítio, cimento resinoso e dentina humana. Foram confeccionados 50 espécimes tronco cônicos de cerâmica (n=10), divididos aleatoriamente em 5 grupos: 1- Controle Condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano; 2- Er:YAG – irradiação com laser Er:YAG (200 mJ e 10 Hz), seguido do condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano; 3- Silano + Er:YAG – Condicionamento com ácido hidrofluorídrico 10% por 1 min, aplicação do silano e irradiação com laser Er:YAG nos mesmo parâmetros do grupo anterior; 4- Nd:YAG – irradiação com laser Nd:YAG (120 mJ e 10 Hz), seguido de condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano, 5- Silano + Nd:YAG -Condicionamento com ácido hidrofluorídrico 10% por 1 min, aplicação do silano e irradiação com laser Nd:YAG nos mesmo parâmetros do grupo anterior. Após os tratamentos os espécimes cerâmicos foram cimentados com cimento resinoso de presa dual à superfície de dentina de 50 molares humanos incluídos em resina acrílica ativada quimicamente. Após armazenamento por 24 h foi realizado o ensaio de tração em máquina de ensaios universais com célula de carga de 10 KgF e velocidade constante de 1mm/min. Os dados obtidos foram submetidos à ANOVA 2-fatores e teste de Dunnet (α=5%). A análise dos padrões de fratura foram analisadas em estereomicroscopio. Adicionalmente foram confeccionados 15 espécimes em cerâmica no formato cilíndrico, submetidos aos mesmo tratamentos dos grupos anteriores (n=3) e utilizados para análise do ângulo de contato e análise em microscópio eletrônico de varredura. O teste de Dunnet mostrou diferenças significativas entre o grupo controle (9,42 ± 2,27 MPa) e os grupos Er (19,25 ± 3,7 MPa) e ...

The aim of this study was to evaluate the efficiency of irradiation with high-power lasers and the influence of silane application before or after irradiation with lasers on the bond strength between lithium disilicate glass-ceramic, resin cement and human dentin. Fiftytruncated-cones ceramic specimens (n=10) were randomly divided into 5 groups: Control- etching with hydrofluoric acid 10% for 1 min and application of silane; 2- Er -Er:YAG laser irradiation (200 mJ and 10 Hz), followed by etching with hydrofluoric acid 10% for 1 min and application of silane; 3- Sil + Er - etching with hydrofluoric acid 10%for 1 min, silane application and irradiation with Er: YAG laser in the same parameters as the previous group; 4- Nd:YAG laser - irradiation with Nd: YAG laser (120 mJ and 10 Hz), followed by etching with hydrofluoric acid 10% for 1 min and application of thesilane, 5- Sil + Nd- Etching with hydrofluoric acid 10% for 1 min, silane application and irradiation with Nd: YAG laser on the same parameters as the previous group. After treatment, the ceramic specimens were cemented with dual cure resin cement to the dentin of 50 human molars included in acrylic resin. After storage for 24 h it wassubmitted to tensile test in a universal testing machine with 10 kgf load cell andconstant speed of 1 mm/min. Data were submitted to ANOVA 2-way and Dunnet test (α = 5%). The analysis of fracture patterns were analyzed in stereomicroscope. In addition were made 15 ceramic specimens in cylindrical shape, subjected to the sametreatment of the above groups (n = 3) and used for analysis of the contact angle analysis and scanning electron microscope. The Dunnet test showed significant differences between Control group (9.42 ± 2.27 MPa) and Er group (19.25 ± 3.7 MPa) and Sil + Er (14.11 ± 4.11 MPa). ANOVA 2-way (p <5%) for Laser Type (p <0.0001) and Technical of Silanization (p = 0.0002) showed significant differences for bothfactors, but not for their interaction. ...

Efeitos de lasers de alta potência na superfície de cerâmicas vítreas de dissilicato de lítio e sua resistência de união à dentina humana / Effects of high power laser irradiation on lithium di-silicate glass ceramic surface and bond strength to human dentin

O objetivo desse estudo foi avaliar a eficiência da irradiação com lasers de alta potência e a influência da aplicação do silano previa ou posteriormente à irradiação com os lasers na resistência de união entre cerâmica vítrea de dissilicato de lítio, cimento resinoso e dentina humana. Foram confeccionados 50 espécimes tronco cônicos de cerâmica (n=10), divididos aleatoriamente em 5 grupos: 1- Controle Condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano; 2- Er:YAG – irradiação com laser Er:YAG (200 mJ e 10 Hz), seguido do condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano; 3- Silano + Er:YAG – Condicionamento com ácido hidrofluorídrico 10% por 1 min, aplicação do silano e irradiação com laser Er:YAG nos mesmo parâmetros do grupo anterior; 4- Nd:YAG – irradiação com laser Nd:YAG (120 mJ e 10 Hz), seguido de condicionamento com ácido hidrofluorídrico 10% por 1 min e aplicação do silano, 5- Silano + Nd:YAG -Condicionamento com ácido hidrofluorídrico 10% por 1 min, aplicação do silano e irradiação com laser Nd:YAG nos mesmo parâmetros do grupo anterior. Após os tratamentos os espécimes cerâmicos foram cimentados com cimento resinoso de presa dual à superfície de dentina de 50 molares humanos incluídos em resina acrílica ativada quimicamente. Após armazenamento por 24 h foi realizado o ensaio de tração em máquina de ensaios universais com célula de carga de 10 KgF e velocidade constante de 1mm/min. Os dados obtidos foram submetidos à ANOVA 2-fatores e teste de Dunnet (α=5%). A análise dos padrões de fratura foram analisadas em estereomicroscopio. Adicionalmente foram confeccionados 15 espécimes em cerâmica no formato cilíndrico, submetidos aos mesmo tratamentos dos grupos anteriores (n=3) e utilizados para análise do ângulo de contato e análise em microscópio eletrônico de varredura. O teste de Dunnet mostrou diferenças significativas entre o grupo controle (9,42 ± 2,27 MPa) e os grupos Er (19,25 ± 3,7 MPa)...

The aim of this study was to evaluate the efficiency of irradiation with high-power lasers and the influence of silane application before or after irradiation with lasers on the bond strength between lithium disilicate glass-ceramic, resin cement and human dentin. Fiftytruncated-cones ceramic specimens (n=10) were randomly divided into 5 groups: Control- etching with hydrofluoric acid 10% for 1 min and application of silane; 2- Er -Er:YAG laser irradiation (200 mJ and 10 Hz), followed by etching with hydrofluoric acid 10% for 1 min and application of silane; 3- Sil + Er - etching with hydrofluoric acid 10%for 1 min, silane application and irradiation with Er: YAG laser in the same parameters as the previous group; 4- Nd:YAG laser - irradiation with Nd: YAG laser (120 mJ and 10 Hz), followed by etching with hydrofluoric acid 10% for 1 min and application of thesilane, 5- Sil + Nd- Etching with hydrofluoric acid 10% for 1 min, silane application and irradiation with Nd: YAG laser on the same parameters as the previous group. After treatment, the ceramic specimens were cemented with dual cure resin cement to the dentin of 50 human molars included in acrylic resin. After storage for 24 h it wassubmitted to tensile test in a universal testing machine with 10 kgf load cell andconstant speed of 1 mm/min. Data were submitted to ANOVA 2-way and Dunnet test (α = 5%). The analysis of fracture patterns were analyzed in stereomicroscope. In addition were made 15 ceramic specimens in cylindrical shape, subjected to the sametreatment of the above groups (n = 3) and used for analysis of the contact angle analysis and scanning electron microscope. The Dunnet test showed significant differences between Control group (9.42 ± 2.27 MPa) and Er group (19.25 ± 3.7 MPa) and Sil + Er (14.11 ± 4.11 MPa). ANOVA 2-way (p <5%) for Laser Type (p <0.0001) and Technical of Silanization (p = 0.0002) showed significant differences for bothfactors, but not for their interactio...

Removable partial or complete dentures exposed to beverages and mouthwashes: evaluation of microhardness and roughness / Próteses parciais e totais removíveis expostas a bebidas e enxaguatórios bucais: avaliação da microdureza e rugosidade

Purpose: To evaluate microhardness and roughness of denture base polymethylmethacrylate resinn exposed to acid beverages and mouthwashes. Material and method: Rectangular samples (n=80) were prepared from poly (methyl methacrylate) (PMMA). They were divided into 8 groups and had the initial microhardness and Knoop roughness measured. Samples of each group were immersed for 10 min into a test solution (coffee, lemon juice, chlorhexidine gluconate, red wine, cola-based soft drink, vinegar or antiseptic with and without alcohol) and after stored in artificial saliva for 23 h and 50 min, completing a period of 24 h. This procedure was performed for 14 consecutive days and after this period the microhardness and surface roughness measurements were made again. Data were statistically analyzed using ANOVA non parametric, Kruskal-Walis and the Dunn´s test for microhardness and the t-Student and ANOVA for roughness. Result: For microhardness there were found statistically significant differences among the chlorhexidine gluconate solution, antiseptic without alcohol and cola-based soft drink. For roughness was observed that the mean values between the initial period and after immersion in the test products differed statistically in all groups, without difference among groups. Conclusion: The microhardness of poly(methyl methacrylate) was affected by continue exposition to chlorhexidine gluconate, antiseptic without alcohol and cola-based soft drink. The roughness of poly(methyl methacrylate) is negatively influenced by the exposure to all tested products. It may be concluded that both, microhardness and roughness, were affected by the treatments.

Objetivo: Avaliar a rugosidade e microdureza de uma resina acrílica utilizada para base de prótese quando submetidas a diferentes bebidas e enxaguatórios bucais. Material e método: Oitenta amostras retangulares foram confeccionadas com polimetilmetacrilato, e separados em 8 grupos. As amostras foram avaliadas quanto à microdureza e rugosidade (Knoop) superficiais e imersas por 10 minutos em um dos seguintes produtos: café, suco artificial de limão, gluconato de clorexidina, vinho tinto, refrigerante a base de cola, vinagre e antissépticos com e sem álcool. Após a imersão nas soluções, as amostras foram acondicionados em saliva artificial por 23 horas e 50 minutos, completando o período de 24 horas. Esse procedimento ocorreu por 14 dias consecutivos e após esse período outras mensurações de microdureza e rugosidade foram realizadas. Os dados obtidos foram analisados estatisticamente pela ANOVA não paramétrico, Kruskal-Walis e teste de Dunn para a microdureza e ANOVA e t-student (alfa=5%) para rugosidade. Resultado: Para microdureza foram encontradas diferenças significativas entre os grupos onde houve imersão em clorexidina, antisséptico sem álcool e refrigerante de coca-cola. Para a rugosidade foi observado que a media entre os valores antes e após a imersão nos produtos diferiu estatisticamente em todos os grupos, porém sem diferença entre eles. Conclusão: A microdureza do polimetilmetacrilato foi afetada pela exposição ao gluconato de clorexidina, antisseptico sem álcool e refrigerante à base de coca-cola. A rugosidade da superfície do polimetilmetacrilato foi afetada por todos os produtos estudados.

Color stability of artificial teeth after exposure to acid and staining agents / Estabilidade de cor de dentes artificiais após a exposição a agentes ácidos e corantes

Alterações na cor dos dentes artificiais ocorrem principalmente devido à ingestão de bebidas e uso de produtos de limpeza e desinfecção de próteses. Soluções mais agressivas de limpeza devem ser identificadas e o paciente deve ser informado, a fim de evitar ou reduzir a frequência de seu uso, para maior longevidade de próteses. O objetivo deste estudo foi avaliar as alterações na cor de dentes artificiais antes e após imersão em bebidas e soluções desinfetantes. Material e Métodos: noventa e seis dentes artificiais de resina foram aleatoriamente divididos em 8 grupos. Cada grupo foi imerso por 10 min em uma solução de teste (café, suco de limão, gluconato de clorexidina, vinho tinto, refrigerantes à base de cola, vinagre ou antisséptico com e sem álcool) e, em seguida, os espécimes foram armazenados em saliva artificial durante 23 horas e 50 min, perfazendo um período de 24 h. Este procedimento foi realizado durante 14 dias consecutivos e depois desse período a segunda medição de cor foi feita. Os dados obtidos com o espectrofotômetro usando o CIEL * a * b * foram analisados através de ANOVA não paramétrico, Kruskal-Walis e o teste de Dunn. Resultados: Foram verificadas diferenças na variação de cor para cada grupo experimental após o desafio. As diferenças estatisticamente significativas foram encontradas entre os grupos de café, vinho tinto e suco de limão. Conclusão: Todas as substâncias mudaram a cor dos dentes artificiais; café foi a substância que causou mais descoloração dos dentes artificiais, alterando a cor e luminosidade; os antissépticos bucais com e sem álcool promoveram clareamento dos dentes artificiais...

Changes in color of artificial teeth mainly occur due to ingestion of beverages and use of products for cleaning and disinfection. More aggressive solutions must be identified and the patient provided with explanations in order to avoid or reduce the frequency of their use, to higher longevity of dentures. The purpose of this study was to evaluate changes in color of artificial teeth before and after immersion in beverages and disinfectants. Material and Methods: 96 artificial resin teeth were randomly divided into 8 groups. Each group was immersed for 10 min into a test solution (coffee, lemon juice, chlorhexidine gluconate, red wine, cola-based soft drink, vinegar or antiseptic with and without alcohol) and then the specimens were stored in artificial saliva for 23 h and 50 min, completing a period of 24 h. This procedure was performed for 14 consecutive days and after this period the second color measurement was made. Data obtained with the spectrophotometer using the CIEL*a*b* system were statistically analyzed using ANOVA non parametric, Kruskal-Walis and the Dunn test. Results: There were found differences in color variation for each experimental group after the challenge. Statistically significant differences were found among coffee, red wine and lemon juice groups. Conclusion: All substances changed the color of artificial teeth; coffee was the substance that caused most staining of artificial teeth, altering color and luminosity; the oral antiseptics with and without alcohol promoted whitening of the artificial teeth...