Effect of nonsteroidal anti-inflammatory drugs (NSAIDs) association on physicochemical and biological properties of tricalcium silicate-based cement

Abstract The aim of this study was to investigate the physicochemical and biological properties of an experimental tricalcium silicate-based repair cement containing diclofenac sodium (CERD). For the physicochemical test, MTA, Biodentine and CERD were mixed and cement disc were prepared to evaluate the setting time and radiopacity. Root-end cavity were performed in acrylic teeth and filled with cements to analyze the solubility up to 7 days. Polyethylene tubes containing cements were prepared and calcium ions and pH were measured at 3h, 24h, 72h and 15 days. For the biological test, SAOS-2 were cultivated, exposed to cements extracts and cell proliferation were investigated by MTT assay at 6h, 24h and 48h. Polyethylene tubes containing cements were implanted into Wistar rats. After 7 and 30 days, the tubes were removed and processed for histological analyses. Parametric and nonparametric data were performed. No difference was identified in relation to setting time, radiopacity and solubility. Biodentine released more calcium ion than MTA and CERD; however, no difference between MTA and CERD were detected. Alkaline pH was observed for all cements and Biodentine exhibited highest pH. All cements promoted a raise on cell proliferation at 24h and 48h, except CERD at 48h. Biodentine stimulated cell metabolism in relation to MTA and CERD while CERD was more cytotoxic than MTA at 48h. Besides, no difference on both inflammatory response and mineralization ability for all cement were found. CERD demonstrated similar proprieties to others endodontic cements available.

Resumo O objetivo deste estudo foi investigar as propriedades físico-químicas e biológicas de um cimento reparador experimental à base de silicato de tricálcio contendo diclofenaco de sódio (CERD). Para o teste físico-químico, MTA, Biodentine e CERD foram manipulados e discos de cimentos foram preparados para avaliar o tempo de presa e a radiopacidade. Retrocavidades foram feitas em dentes de acrílico e preenchidas com cimentos para análise de solubilidade por 7 dias. Tubos de polietileno contendo cimentos foram preparados e os íons cálcio e o pH foram mensurados às 3h, 24h, 72h e 15 dias. Para o teste biológico, SAOS-2 foram cultivadas, expostas aos extratos de cimentos e a proliferação celular foi investigada pelo ensaio de MTT às 6h, 24h e 48h. Tubos de polietileno contendo cimentos foram implantados em ratos Wistar. Após 7 e 30 dias, os tubos foram removidos e processados para análises histológicas. Dados paramétricos e não paramétricos foram realizados. Nenhuma diferença foi identificada em relação ao tempo de presa, radiopacidade e solubilidade. Biodentine liberou mais íons de cálcio do que MTA e CERD; no entanto, nenhuma diferença entre MTA e CERD foi detectada. O pH alcalino foi observado para todos os cimentos e o Biodentine exibiu o pH mais alto. Todos os cimentos promoveram aumento na proliferação celular às 24h e 48h, exceto o CERD às 48h. Biodentine estimulou o metabolismo celular em relação ao MTA e CERD, enquanto CERD foi mais citotóxico do que MTA em 48h. Além disso, nenhuma diferença foi encontrada na resposta inflamatória e na capacidade de mineralização para todos os cimentos. CERD demonstrou propriedades semelhantes a outros cimentos endodônticos disponíveis.

Effect of nonsteroidal anti-inflammatory drugs (NSAIDs) association on physicochemical and biological properties of tricalcium silicate-based cement.

The aim of this study was to investigate the physicochemical and biological properties of an experimental tricalcium silicate-based repair cement containing diclofenac sodium (CERD). For the physicochemical test, MTA, Biodentine and CERD were mixed and cement disc were prepared to evaluate the setting time and radiopacity. Root-end cavity were performed in acrylic teeth and filled with cements to analyze the solubility up to 7 days. Polyethylene tubes containing cements were prepared and calcium ions and pH were measured at 3h, 24h, 72h and 15 days. For the biological test, SAOS-2 were cultivated, exposed to cements extracts and cell proliferation were investigated by MTT assay at 6h, 24h and 48h. Polyethylene tubes containing cements were implanted into Wistar rats. After 7 and 30 days, the tubes were removed and processed for histological analyses. Parametric and nonparametric data were performed. No difference was identified in relation to setting time, radiopacity and solubility. Biodentine released more calcium ion than MTA and CERD; however, no difference between MTA and CERD were detected. Alkaline pH was observed for all cements and Biodentine exhibited highest pH. All cements promoted a raise on cell proliferation at 24h and 48h, except CERD at 48h. Biodentine stimulated cell metabolism in relation to MTA and CERD while CERD was more cytotoxic than MTA at 48h. Besides, no difference on both inflammatory response and mineralization ability for all cement were found. CERD demonstrated similar proprieties to others endodontic cements available.

An unusual repair of perforating internal inflammatory root resorption; a case report of endodontic treatment

Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma which leads to progressive loss of the root structure. An early diagnosis could influence the therapeutic approach, but endodontic treatment becomes a challenge with a doubtful prognosis. The present report described an unusual clinical presentation of an IIRR with perforation resulting from a trauma four years previous. A 15-year-old female patient was presented to our service with pain in the maxillary incisor region. Intraoral radiography revealed a large radioloucent area compatible with IIRR, communicating with the periodontium in the middle third on the distal root face of the right central incisor. The root canal of the right central incisor was chemo-mechanically prepared. The calcium hydroxide (CH) intracanal medication was used and renewed periodically four times. The root canal was filled only in the cervical region to the level of resorption by the inverted gutta-percha cone technique. Clinically and radiographically, all follow-up examinations revealed an asymptomatic tooth, evidencing periapical tissue repair and new bone formation. The tooth remained asymptomatic 3 years afterwards. The present case report supports the idea of executing satisfactory intracanal decontamination by chemo-mechanical preparation, thus creating a favourable environment for tissue repair.

Effect of simulated brushing on surface roughness and wear of bis-acryl-based materials submitted to different polishing protocols.

BACKGROUND: Provisional materials must have enough strength to withstand masticatory loads without suffering deformation or fracture, and their surfaces must have good finishing and polishing characteristics to reduce biofilm accumulation. Thus, the purpose of this study was to investigate the best polishing protocol for different bis-acryl composite resins in comparison with a conventional resin composite and a self-curing acrylic resin aiming to obtain a smooth restoration surface and resistance to wear. MATERIAL AND METHODS: One hundred and four samples (15 mm length x 5 mm width x 4 mm depth) were prepared and divided into four groups according to the material tested: Protemp 4 and Structur 3 bis-acryl composite resins, Dencor self-curing acrylic resin, Filtek Z350XT conventional composite resin. The polishing procedures were performed with Sof-Lex Pop-On discs or Sof-Lex spirals and abrasion procedures were performed on a brushing machine. The surface roughness was analyzed at three periods (initial, post-polishing and post-brushing) and the wear was evaluated after simulated brushing. The results were submitted to ANOVA followed by the Tukey (α = 0.05). RESULTS: Filtek Z350XT groups showed the lowest values of initial surface roughness followed by Structur 3, Protemp 4 and Dencor groups. After polishing and simulated brushing, Filtek Z350XT groups also presented the lowest roughness values, followed by bis-acryl groups (Structur 3 and Protemp 4) and Dencor groups demonstrated the highest surface roughness. Sof-Lex Pop-On discs system exhibited lower roughness values for all groups. CONCLUSIONS: Sof-Lex Pop-On discs system promoted the best polishing for all groups. Overall, Filtek Z350XT groups presented lower results for both roughness and wear for all periods evaluated, followed by Protemp 4 and Structur 3, meanwhile Dencor groups presented the highest roughness and wear values for all periods. Key words:Acrylic resin, bis-acryl, brushing, composite resin, polishing, roughness, wear.

Influência da técnica de polimento na rugosidade superficial e perfilometria de materiais à base de resina bisacrílica / Influence of the polishing technique on the roughness and profile of bis-acryl-based materials

Problematização. É de grande importância a escolha da técnica e do material a serem utilizados para a confecção das restaurações provisórias. O material deve apresentar espessura suficiente e resistência para suportar as cargas mastigatórias sem sofrer deformação ou fratura, bem como, sua superfície deve apresentar um bom acabamento e polimento, reduzindo assim o acúmulo de biofilme, facilitando a higienização pelo paciente. Objetivo. Investigar qual o melhor protocolo de polimento para as diferentes resinas bisacrílicas com a intenção de obter uma superfície lisa. Material e métodos. Um total de 104 amostras foram confeccionadas (15mm de comp. x 5mm de largura x 4mm de altura) e foram divididos em três fatores de estudo: material (Protemp 4, Structur 3, Dencor, Z350XT), polimento (discos Sof-Lex Pop On e Sof-Lex Spiral) e período (inicial, pós polimento, pós escovação). Foram confeccionadas 13 amostras por grupo de material, sendo que em cada etapa foi retirado uma amostra aleatoriamente com a finalidade de submeter à análise de microscopia eletrônica de varredura (MEV), totalizando 24 amostras para serem submetidas a este teste, e assim, resultando em 80 amostras para serem escovadas, e em 10 amostras por grupo para análise estatística (n=10). Em todas as amostras foram realizadas leituras (µm) da rugosidade de superfície (Ra) em todos os períodos, ou seja, logo após serem confeccionadas, após o polimento e após escovação, através do rugosímetro (Hommel tester). Ao final, as 80 amostras foram submetidas a leitura no perfilômetro, para análise do desgaste superficial. Os resultados para a rugosidade foram submetidos a ANOVA a três critérios seguido pelo teste de Tukey (α = 0,05). E para o desgaste superficial os resultados foram submetidos a ANOVA a dois critérios seguido pelo teste de Tukey (α = 0,05). Resultados. A resina bisacrílica Protemp 4 mostrou maiores valores de rugosidade superficial (Ra) quando polidos com os discos Sof-Lex Spiral (0,284 µm), quando comparado ao polimento com discos Sof-Lex Pop On (0,075 µm), após a escovação houve aumento da rugosidade superficial para ambos os tipos de polimentos, tanto os discos Sof-Lex Spiral (0,375 µm) quanto para o polimento com os discos Sof-Lex Pop On (0,359 µm), mas não houve diferença estatística significativa (p>0,05). Para os resultados de desgaste superficial, não houve diferença estatística entre os grupos: da resina bisacrílica Protemp 4 com polimento Sof-Lex Pop On (13,95 µm), e com o polimento com os discos Sof-Lex Spiral (14,91µm) e o grupo da resina composta Z350XT polidos com os dois sistemas de polimento ­ Sof-Lex Pop On e Sof- Lex Spiral (12,61µm, 12,70 µm respectivamente). A resina bisacrílica Structur 3 mostrou menores valores de rugosidade de superfície quando polidos com os discos Sof-Lex Pop On (0,113 µm) em comparação ao polimento com os discos Sof-Lex Spiral (0,223 µm). Para os resultados de desgaste superficial, não houve diferença entre os grupos da resina bisacrílica Structur 3, porem os valores tanto para o grupo polido com os discos Sof-Lex Pop On (15,77 µm) e o grupo polido com os discos Sof-Lex Spiral (15,40 µm) foram bem próximos aos valores do grupo da resina bisacrílica Protemp 4 e ao grupo da resina composta Z350XT, com diferença estatística. As duas resinas bisacrílicas testadas, a Protemp 4 e a Structur 3 nos dois sistemas de polimentos mostraram melhores valores de rugosidade superficial (Ra) e menores valores de desgaste superficial que a resina acrílica Dencor. Conclusão. Através do polimento é possível melhorar a rugosidade superficial dos materiais resinosos, entretanto, a técnica, o operador, os materiais a serem polidos e o sistema de acabamento e polimento estão diretamente correlacionados. Para este estudo, o sistema que obteve os melhores resultados foi o dos discos Sof-Lex Pop On, e a resina bisacrílica que apresentou o menor número de Ra foi a resina bisacrílica Structur 3. Para o desgaste superficial a resina bisacrílica Structur 3 mostrou valores maiores comparados aos resultados do grupo da resina bisacrílica Protemp 4, esta, por sua vez, mostrou valores de desgaste superficial próximos ao do grupo da resina composta Z350 XT.(AU)

Statement of the problem. The choice of technique and material for making provisional restorations is important. The material must have enough strength to withstand the masticatory loads without suffering deformation or fracture and its surface must have good finishing and polishing to reduce biofilm accumulation. Objective. The aim of this study was to investigate what is the best polishing protocol for different bis-acryl materials with the intention to obtain a smooth surface. Materials and methods. A total of 104 samples were made (15mm long x 5mm wide x 4mm high) and were divided into three study factors: material (Protemp 4, Structur 3, Dencor, Z350XT), polishing (Sof-Lex Pop On and Sof-Lex Spiral discs) and period (initial, postpolishing, post-brushing). Thirteen samples were made per material group, and at each step, a sample was randomly taken for the purpose of submitting to scanning electron microscopy (SEM) analysis, totaling 24 samples to be submitted to this test, and thus, resulting in 80 samples to be brushed, and 10 samples per group for statistical analysis (n = 10). In all samples, surface roughness readings (µm) were performed at all periods, that is, after they were made, after polishing and after brushing through the rugosimeter (Hommel tester). At the end, the 80 samples were read in a profilometer for analysis of surface wear. The results for the roughness were submitted to ANOVA for three criteria followed by the Tukey`s test (α = 0.05), and for the surface wear test, the results were submitted to ANOVA for two criteria followed by the Tukey`s test (α = 0.05). Results. Protemp 4 bis-acryl showed higher values of surface roughness when polished with Sof-Lex Spiral discs (0.284 µm) when compared to Sof-Lex Pop On discs polishing (0.075 µm). After brushing, there was an increase of surface roughness for both types of polishing. Sof-Lex Spiral discs (0.375 µm) and Sof-Lex Pop On discs (0.359 µm), but with no significant differences (p>0.05). For the surface wear results, there was no statistical difference between the groups: Protemp 4 bis-acryl resin with Sof-Lex Pop On polishing (13.95 µm) and polishing with the Sof-Lex Spiral discs (14.91 µm ) and the Z350XT composite resin group polished with the two polishing systems - Sof-Lex Pop On and Sof-Lex Spiral (12.61µm, 12.70µm, respectively). Structur 3 bis-acryl resin showed lower surface roughness results when polished with Sof-Lex Pop On discs (0.113 µm) compared to Sof-Lex Spiral discs (0.223 µm). For the surface wear results, there was no difference between the groups of the Structur 3 bis-acryl resin, but the values for both the polished group with Sof-Lex Pop On discs (15.77µm) and the group polished with the Sof-Lex discs Spiral (15.40 µm) were very close to the values of the group of the Protemp 4 bis-acryl resin and the Z350XT composite resin group, with statistical difference. The two tested bis-acryl resins, the Protemp 4 and Structur 3 in the two polishing systems, showed better surface roughness values (Ra) and lower surface wear values than the Dencor acrylic resin. Dencor acrylic resin group showed the highest values of surface roughness at all times. However, after polishing and brushing, the surface roughness presented lower values, when compared to Ra initial values, but this material showed the highest surface wear values (31.21 µm).The resin composite group Z350XT which polishing procedure was Sof-Lex Pop On discs showed lower values (0.039 µm). There were no statistically significant differences in surface roughness at all periods and the surface roughness increased after brushing, followed by lower values also for surface wear (12.61 µm). Conclusion. By polishing it is possible to improve the surface roughness of the resinous materials, however, the technique, the operator, the materials to be polished and the finishing and polishing system are directly correlated. For the present study, the system that obtained the best results was the Sof-Lex Pop On discs, and the bis-acryl resin that presented the lowest Ra number was the Structur 3 bis-acryl resin. For surface wear, the Structur 3 bis-acryl resin showed higher values compared to the results of the Protemp 4 bis-acryl resin group, which, in turn, showed surface wear values close to that of the Z350 XT composite resin group.(AU)

Estratégias para realização de clareamento e restaurações adesivas em sessão única ­ relato de casos / Strategies to perform bleaching and adhesive restoration in one session ­ cases report

Tratamentos estéticos com demanda por excelência são corriqueiros nas clínicas odontológicas especializadas, sendo cada vez mais procurados e realizados em sessão única de tratamento. Esses procedimentos com sessão única podem ser indicados por imediatismo, urgência dos pacientes ou pela indisponibilidade de locomoção, uma vez que muitos pacientes buscam tratamentos especializados em cidades distantes de suas residências. O presente relato de dois casos clínicos descreve as técnicas e estratégias de tratamento para realização do clareamento dentário e de restaurações adesivas na mesma sessão, por meio da utilização de agentes antioxidantes. O clareamento em consultório foi realizado com gel de peróxido de hidrogênio 35% (Lase peróxido de Flex, DMC), ativado com LED (Laser BrightMax Quattro, MMO). Em função da presença de íons oxigênio na matriz do esmalte e dentina após o clareamento dental, esses íons podem inibir a adequada polimerização dos sistemas adesivos e da resina composta, comprometendo o procedimento restaurador. Sendo água bicarbonatada (Neutralize, Lase peróxido Flex Kit, DMC) aplicada para remover o oxigênio residual, após preparo cavitário e antes do condicionamento ácido e aplicação do adesivo. As restaurações foram realizadas com técnica incremental e resina composta cor A2/B2 de dentina (NG brilhante, Coltene) e A1/B1 de esmalte (NG brilhante, Coltene). Os procedimentos de acabamento e polimento também foram realizados na mesma sessão. Após 3 meses de controle foi possível observar, que em ambos os casos, o tratamento estético obteve bastante sucesso, sem qualquer deterioração visível da interface resina-esmalte (AU).

Aesthetic treatments with demand for excellence are commonplace in specialized dental clinics, increasingly popular and performed in a single treatment session. These procedures performed in a single session may be indicated by immediacy, patients urgency or unavailability of transportation, since many patients seek specialized treatment in cities far away from their homes. This report of two cases describes treatment techniques and strategies to perform dental bleaching and adhesive restorations in the same session through the use of antioxidants. Bleaching was carried out in-office with 35% hydrogen peroxide gel (Lase Peroxide Flex, DMC), activated with LED (Laser BrightMax Quattro, MMO). Due to the presence of oxygen ions in the enamel matrix and dentin after bleaching, these ions can inhibit the proper polymerization of the adhesive systems and composite resin, compromising the restorative procedure. Bicarbonated water (Neutralize, Lase Peroxide Flex Kit, DMC) is applied to remove residual oxygen after cavity preparation and before the acid etching and adhesive application. Restorations were performed with incremental technique and composite dentin color A2/B2 (bright NG, Coltene) and A1/B1 enamel (bright NG, Coltene). Finishing and polishing procedures were also performed in the same session. After 3 months, it was observed that in both cases, the aesthetic treatment achieved great success without any visible deterioration of the resin/enamel interface (AU).