Use of over-the-counter mouthwashes as an additional measure in individual oral prophylaxis on adults with plaque-induced gingivitis: a double-blind, parallel, randomized controlled trial.

BACKGROUND: Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis. METHODS: The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18-75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1). RESULTS: For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant. CONCLUSION: The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn. TRIAL REGISTRATION: ACTRN12622000215729, 07/02/2022.

Multidisciplinary evaluation of the remineralization potential of three fluoride-based toothpastes on natural white spot lesions.

OBJECTIVES: This in vitro study aimed assessing the remineralization potential of three commercial fluoride-based toothpastes in permanent teeth with natural white spot lesions (WSLs). A multidisciplinary approach based on Raman microspectroscopy (RMS), Scanning electron microscopy (SEM), Energy-dispersive x-ray spectroscopy (EDS), and Vickers microhardness (VMH) was exploited. METHODS: N = 12 human molars with natural WSLs in the proximal-vestibular zone were selected and divided into 4 groups (n = 3) according to the different treatments: HAF (hydroxyapatite with fluoride ions); SMF (sodium monofluorophosphate with arginine); SF (sodium fluoride with enzymes), and CTRL (untreated group). All toothpastes tested contained 1450 ppm of fluoride. Teeth samples were submitted to the following protocol: a 7-day pH cycling treatment, with two daily exposures (2 min each time) to the commercial toothpastes described above. The surface micromorphology (SEM), the chemical/elemental composition (RMS and EDS), and the Vickers microhardness (VMH) were evaluated. Statistical analysis was performed. RESULTS: A remarkable remineralization of WSLs in SEM images was observed in all treated groups compared to CTRL. In particular, HAF and SF displayed higher values of VMH, phosphates amount (I960), crystallinity (FWHM960), and lower ones of C/P (I1070/I960) with respect to CTRL. Intermediate values were found in SMF, higher than CTRL but lower with respect to HAF and SF. As regards the Ca/P ratio, statistically significant differences (p < 0.05) were found between SF and the other groups. CONCLUSIONS: All the tested dentifrices have shown to remineralize the WSLs. SF and HAF have comparable capability in hardness recovery and crystallinity; however, SF shows the best remineralizing potential according to both micromorphological and chemical analyses. Clinical relevance The daily use of toothpastes containing hydroxyapatite partially replaced with fluoride, sodium monofluorophosphate with arginine and sodium fluoride toothpaste associated with enzymes represents a preventive, therapeutic, effective, and non-invasive tool for remineralize WSLs.

Assessment of the Remineralizing Potential of Biomimetic Materials on Early Artificial Caries Lesions after 28 Days: An In Vitro Study.

This study aimed to evaluate the loss of mineral content in the enamel surface in early artificial lesions and to assess the remineralizing potential of different agents by means of SEM coupled with energy-dispersive X-ray analysis (EDX). The analysis was performed on the enamel of 36 molars divided into six equal groups, in which the experimental ones (3-6) were treated using remineralizing agents for a 28-day pH cycling protocol as follows: Group 1, sound enamel; Group 2, artificially demineralized enamel; Group 3, CPP-ACP treatment; Group 4, Zn-hydroxyapatite treatment; Group 5, NaF 5% treatment; and Group 6, F-ACP treatment. Surface morphologies and alterations in Ca/P ratio were evaluated using SEM-EDX and data underwent statistical analysis (p < 0.05). Compared with the sound enamel of Group 1, the SEM images of Group 2 clearly showed loss of integrity, minerals, and interprismatic substances. Groups 3-6 showed a structural reorganization of enamel prisms, interestingly comprising almost the entire enamel surface. Group 2 revealed highly significant differences of Ca/P ratios compared with other groups, while Groups 3-6 showed no differences with Group 1. In conclusion, all tested materials demonstrated a biomimetic ability in remineralizing lesions after 28 days of treatment.

Advances in diastema closure and tooth shape change using direct composite restorations: the Front Wing Technique.

Closing a diastema with a direct composite restoration still represents a real challenge for clinicians, mainly due to the need to create a correct contact point and emergence profile at the cervical level. The present article describes a novel anterior direct composite restoration technique for closing diastemata and changing tooth shape. The proposed technique, called the Front Wing Technique (FWT), does away with the use of the traditional wax-up and silicone index-based procedures. To date, there has been no effective way to transfer the anatomy modeled in the wax to the interproximal cervical area of anterior restorations every time these areas need to be corrected or restored. Therefore, the FWT provides a new approach to freehand model the emergence profile without gap formation. The cases in this article demonstrate the closure of maxillary and mandibular incisal diastemata, with the rationale behind each clinical step of the FWT described. This technique should be considered an alternative approach for the direct composite restoration of anterior teeth, saving chair time and cost.

Micro-computed tomography for assessing the internal and external voids of bulk-fill composite restorations: A technical report.

Purpose: This technical report aims to describe and detail the use of micro-computed tomography for a reliable evaluation of the bulk-fill composite/tooth interface. Materials and Methods: Bulk-fill composite restorations in tooth cavities were scanned using micro-computed tomography to obtain qualitatively and quantitatively valuable information. Two-dimensional information was processed using specific algorithms, and ultimately a 3-dimensional (3D) specimen reconstruction was generated. The 3D rendering allowed the visualization of voids inside bulk-fill composite materials and provided quantitative measurements. The 3D analysis software VG Studio MAX was used to perform image analysis and assess gap formation within the tooth-restoration interface. In particular, to evaluate internal adaptation, the Defect Analysis add-on module of VG Studio Max was used. Results: The data, obtained with the processing software, highlighted the presence and the shape of gaps in different colours, representing the volume of porosity within a chromatic scale in which each colour quantitatively represents a well-defined volume. Conclusion: Micro-computed tomography makes it possible to obtain several quantitative parameters, providing fundamental information on defect shape and complexity. However, this technique has the limit of not discriminating materials without radiopacity and with low or no filler content, such as dental adhesives, and hence, they are difficult to visualise through software reconstruction.

Remineralization Efficacy of Four Remineralizing Agents on Artificial Enamel Lesions: SEM-EDS Investigation.

Dental remineralization represents the process of depositing calcium and phosphate ions into crystal voids in demineralized enamel, producing net mineral gain and preventing early enamel lesions progression. The aim of the present study was to qualitatively and quantitatively compare the remineralizing effectiveness of four commercially available agents on enamel artificial lesions using Scanning Electron Microscopy (SEM) combined with Energy Dispersive Spectroscopy (EDS) techniques. Thirty-six extracted third molars were collected and randomly assigned to six groups (n = 6), five of which were suspended in demineralizing solution for 72 h to create enamel artificial lesions, and one serving as control: G1, treated with a mousse of casein phosphopeptide and amorphous calcium−phosphate (CPP-ACP); G2, treated with a gel containing nano-hydroxyapatite; G3, treated with a 5% SF varnish; G4, treated with a toothpaste containing ACP functionalized with fluoride and carbonate-coated with citrate; G5, not-treated artificial enamel lesions; G6, not demineralized and not treated sound enamel. G1−G4 were subjected to pH cycling over a period of seven days. Analyses of the specimens' enamel surfaces morphology were performed by SEM and EDS. Data were statistically analyzed for multiple group comparison by one-way ANOVA/Tukey's test (p < 0.05). The results show that the Ca/P ratio of the G5 (2.00 ± 0.07) was statistically different (p < 0.05) from G1 (1.73 ± 0.05), G2 (1.76 ± 0.01), G3 (1.88 ± 0.06) and G6 (1.74 ± 0.04), while there were no differences (p > 0.05) between G1, G2 and G6 and between G4 (2.01 ± 0.06) and G5. We concluded that G1 and G2 showed better surface remineralization than G3 and G4, after 7 days of treatment.

Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review.

BACKGROUND: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. METHODS: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. RESULTS: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. CONCLUSIONS: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.

Hydrogen Peroxide Release Kinetics of Four Tooth Whitening Products-In Vitro Study.

Tooth whitening efficacy can be influenced by several factors, of which concentration and application time are two of the most important. This in vitro study aimed to evaluate the initial content and release kinetics of the hydrogen peroxide (HP) content, or the carbamide peroxide (CP) content as converted to its HP equivalent, of four tooth whitening products with different concentrations (6% HP, 16% CP, 10% CP, and 5% CP). Titrations with Cerium Sulphate IV were performed to determine HP concentration. HP release kinetics were evaluated by a spectrophotometric technique. The results were expressed as the mean values and 95% confidence interval of the percentage of hydrogen peroxide content during release kinetics. One sample t-test, one-way ANOVA, Tukey post hoc testing, and Pearson correlation testing were used, as appropriate, with a significance level of α = 0.05. The concentration of titrated HP was higher than that indicated by the manufacturers in all tested products (p < 0.01). At the minimum application times indicated by the manufacturers, all products released at least 85% of HP content; the gel containing 10% CP registered the lowest release at 85.49 (81.52-89.46). There was a significant HP release in all products during the application times indicated by the manufacturers. Further studies are needed to assess in vitro release kinetics.

Comparison of three different bulk-filling techniques for restoring class II cavities: µCT, SEM-EDS combined analyses for margins and internal fit assessments.

OBJECTIVE: Evaluation of the behavior of three different bulk-filling techniques in terms of internal adaptation and external marginal sealing for restoring class II cavities. METHODS: Fifteen extracted sound molar teeth were used. Two standardized class II mesio/disto-occlusal (MO/DO) slot cavities, 4 mm long, 4 mm wide and 3 mm deep were prepared in each tooth, obtaining n=30 cavity preparations. The cavities were randomly assigned into three groups (n=10 per group) according to three bulk filling techniques: Bulk Traditional (BT), Bulk&Go (BG) and Bulk&Flow (BF). The teeth were analyzed by scanning electron microscopy (SEM) to investigate the external marginal seal. Thereafter, the chemical composition of tooth-restoration interface was analyzed by energy-dispersive X-ray spectroscopy (EDS). Complementary information to the SEM and EDS were obtained by micro-computed tomography (µCT) to assess the internal fit. RESULTS: SEM analysis showed a proper external marginal seal for all groups tested as confirmed by the EDS investigation, highlighting the presence of adhesive layer at the tooth-restoration interface. The internal marginal adaptation by means of µCT analysis revealed gaps formation at the tooth-restoration interface only for BT group, while an intimate contact free of gaps were found in the other two groups. Moreover, in BT and BF groups voids were present within the restoration. SIGNIFICANCE: BG and BF techniques can be considered as reliable alternatives to BT technique, as they simplify the class II restoration without transforming it into class I, thus ensuring a successful result.

A Comparative Evaluation of Nanohydroxyapatite-Enriched Hydrogen Peroxide Home Bleaching System on Color, Hardness and Microstructure of Dental Enamel.

This study aimed to evaluate two hydrogen peroxide (HP)-based at-home bleaching systems in order to analyze whether nano-hydroxyapatite (nHA) addition may represent a reliable and safe solution for tooth whitening without altering dental microstructure and hardness. Human third molars (N = 15) were treated with two bleaching agents, one containing 6%HP (6HP) and the other 6% HP nHA-enriched (6HP-nHA) with average particle diameter ranging from 5-20 nm. Their effects on enamel were assessed using a spectrophotometer, Vickers microhardness (VMH) test and Scanning Electron Microscopy (SEM), comparing the treated groups with the non-treated control group (CTR). Color analysis revealed improvement in whiteness in both groups compared to CTR. VMH test results showed no differences among the groups. SEM analysis highlighted no evident changes in the enamel microstructure of tested groups compared to CTR. At high magnification, in 6HP group, a slight increase in irregularities of enamel surface morphology was observed, while 6HP-nHA group displayed removal of the aprismatic layer but preservation of the intact prismatic structure. These results suggest that the 6HP-nHA agent may be recommended to provide reliable whitening treatment, without damaging the enamel micromorphology and hardness.

Surface evaluations of a nanocomposite after different finishing and polishing systems for anterior and posterior restorations.

This study aims to evaluate the effects of different finishing and polishing (F/P) systems on gloss and surface morphology of a new nanocomposite. Thirty discs of Filtek Universal Restorative material (3 M, ESPE) were prepared and divided into six groups (n = 5). Group A and B followed F/P protocols for anterior restorations, whereas Group C and D for posterior ones. Group E represented the control (covered by Mylar strip) and Group F represented the nanocomposite placement by means of clinical hand instruments; Groups E and F did not undergo F/P procedures. Among the polished groups, Group B showed the highest values (68.54 ± 7.54 GU), followed by Group A and D (46.87 ± 5.52 GU; 53.76 ± 2.65 GU). Finally, Group C (37.38 ± 4.93 GU) displayed the lowest results. Overall, Group E showed the highest gloss values (93.45 ± 8.27 GU), while Group F presented the lowest ones (1.74 ± 0.64 GU). Surface analysis revealed that Group A, C, and D displayed a smooth surface. Group B showed the lowest irregularities. Group E exhibited the most uniform superficial morphology. On the other hand, Group F displayed the most irregular one. In conclusion, using the tested material, only two protocols achieved appropriate gloss values. Then, clinicians might use the protocols of Group B and Group D, for anterior and posterior restorations, respectively.

New insights from Raman MicroSpectroscopy and Scanning Electron Microscopy on the microstructure and chemical composition of vestibular and lingual surfaces in permanent and deciduous human teeth.

Teeth are characterized by a specific chemical composition and microstructure, which are related to their nature, permanent and deciduous, and to the sides, lingual and vestibular. Deeper knowledge in this topic could be useful in clinical practice to develop new strategies in restorative dentistry and in the choice of materials with the best performances. In this study, Raman MicroSpectroscopy (RMS), Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectrometry (EDS), and Vickers MicroHardness (VMH) were exploited to: (1) identify the microstructure and the chemical/elemental composition of permanent and deciduous human teeth, also characterizing their lingual and vestibular sides, and (2) validate a new multidisciplinary analytical approach, for obtaining multiple information on calcified tissues. All applied techniques evidenced differences between permanent and deciduous teeth both in the lingual and vestibular sides. In particular, scanning electron micrographs identified areas with an irregular appearance in the vestibular and lingual sides, which presented also different VMH values. Moreover, RMS and EDS displayed a different chemical/elemental composition in outer and inner enamel and dentin, in terms of Mineral/Matrix, Crystallinity, Carbonates/phosphates, and concentrations by weight (%) of calcium, phosphorous, carbon, magnesium, and sodium. A good linear correlation was found between RMS spectral profiles and EDS and VMH measurements, suggesting that RMS may be considered a useful and non-destructive diagnostic tool for obtaining multiple information on calcified tissues.

Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations.

There is a continuing increase in demand for the direct restoration of posterior teeth with resin-based composites. However, the execution of these restorations, especially the reproduction of the anatomical details of the tooth, still presents difficulties for most clinicians. Nowadays, resin-based composite restorations have become increasingly popular due to the development of new materials and filling techniques. Direct composite restorations are usually performed using the time-consuming incremental filling technique, which minimizes polymerization shrinkage. With this technique, the composite is built up in individually cured increments. Due to the superior physical and chemical properties of the newer bulk-fill composites, it is possible to replace this incremental filling technique with a more time-efficient bulk-fill technique, whereby the composite is placed and modeled in a single layer up to the occlusal surface. This article presents this novel technique for direct posterior composite restorations. The technique, called Essential Lines, is simple, esthetic, and time saving. It combines the advantages of the bulk-fill technique with a modeling technique that utilizes minimal so-called diagram lines to restore the tooth anatomy. This procedure can be used by beginners and expert practitioners alike in various clinical situations to produce direct posterior composite restorations with optimal function and esthetics.

ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles.

BACKGROUND: Tooth whitening is one of the most requested dental treatments, but it still presents some side effects. Indeed, the bleaching agent can generate patients' discomfort and dental hard tissue damages, not achieving an efficient and long-lasting treatment with optimum whitening effect. To overcome these limitations, the bleaching agents containing nano-hydroxyapatite can represent a reliable solution to avoid these detrimental effects. METHODS: In this study, human third molars were treated with commercial bleaching agents, containing nano-hydroxyapatite (nHA) and 6% (at-home treatment), 12% and 18% (in-office treatments) of hydrogen peroxide (HP), named respectively G1, G2 and G3. The results were evaluated descriptively and analytically using Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (ATR-FTIR), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray spectroscopy (EDS), comparing the treated groups with a commercial gel containing 10% carbamide peroxide (CONV) and with a non-treated control group (CTRL). RESULTS: ATR-FTIR analysis revealed a similar composition in carbonates and phosphates for CTRL, G1 and G2 groups, which showed no significant differences in their spectral profiles; an increased amount of organic matter was found in G3, while CONV displayed an intermediate behavior. SEM analysis did not highlight significant changes in the enamel microstructure of G1 and CONV when compared to CTRL; the pattern observed in G2 presented a slight increase of enamel irregularities, while G3 displayed a partial removal of the aprismatic layer and microporosities. No evident effects due to nHA were observed in the structure of the hydroxyapatite component of G1, G2 and CONV, if compared to CTRL, while G3 showed a slight loss of crystallinity. In all groups, EDS identified slight changes in the concentration of chemical elements O and Ca, while the Ca/P ratio was similar when compared to CTRL. CONCLUSION: The obtained results suggest that the application of the tested commercial bleaching agents, with a concentration of HP up to 12%, does not alter the morphological and chemical composition of the enamel surface and maintains its crystallinity.

Comparison of two curing protocols during adhesive cementation: can the step luting technique supersede the traditional one?

This study aims to compare the degree of conversion of two different curing protocols used during adhesive cementation. The following resin luting agents were tested: Hri Flow (MF) and pre-heated Hri Micerium (MH); light-cure Nexus Third Generation (NX3L) and dual-cure Nexus Third Generation (NX3D); dual cured RelyX Ultimate (RXU) and light-cure RelyX Veneers (RXL). For each tested material, ten samples were prepared and divided into two groups which had different curing protocols (P1 and P2): in P1, samples were cured for 40 s; in P2, samples were cured for 5 s, and then, after 20 s, cured again for additional 40 s. The degree of conversion (DC) was evaluated both during the first 5 min of the curing phase and after 1, 2, 7, 14 and 28 days (p = 0.05). Different trends were observed in DC values after 5 min by comparing P1 and P2. In both P1 and P2, DC decreased as follows, MH > MF > NX3L > RXL > RXU > NX3D. There were significant differences of DC values among all resin luting agents (p < 0.05) in P1, while no significant differences existed between MH and MF, and NX3L and RXL in P2. At 1, 2, 7, 14 and 28 days the light curing luting agents had a higher DC than the dual luting agents (p < 0.05). P1 and P2 were not statistically different at each time point (p > 0.05). Both P1 and P2 protocols let achieve an acceptable DC after 28 days. The tested P2 can be safely used to lute indirect restorations, simplifying the removal of cement excesses.

Microleakage Analysis of Different Bulk-Filling Techniques for Class II Restorations: µ-CT, SEM and EDS Evaluations.

This study aimed to compare two different bulk-filling techniques, evaluating the internal and external adaptation of class II resin-composite restorations, by analysing the gap formation using microcomputed tomography (µ-CT) and scanning electronic microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDS). Two standardized mesio/disto-occlusal (MO/DO) cavities were prepared in eight extracted human third molars that were divided, according to the filling technique used, in the following two groups (n = 4): BG (Bulk&Go group) and BT (Bulk Traditional group). After universal bonding application, followed by the light curing, all teeth were restored using a bulk-fill composite. Specimens were scanned with µ-CT to evaluate 3D interfacial gaps. Acquired µ-CT data were analysed to quantify the gap formation. Complementary information to the µ-CT analysis were obtained by SEM. Thereafter, the chemical composition of tooth-restoration interface was analysed using EDS. The µ-CT analysis revealed gaps formation at the tooth-restoration interface for both the BG and BT groups, while within the restoration, only in the BT group there was evidence of microleakage formation. The scanning electron micrographs of both groups showed that the external marginal integrity of the restoration was preserved, while EDS showed the three different structures (tooth surface, adhesive layer and resin composite) of the tooth-restoration interface, highlighting the absence of gap formation. In both BG and BT, the two filling techniques did not show significant differences regarding the internal and external marginal adaptation of the restoration. To achieve a successful restoration, the clinician could be advised to restore a class II cavity using a single increment bulk-filling technique (BG), thus treating it as a class I cavity.

Can Desensitizing Toothpastes Also Have an Effect on Gingival Inflammation? A Double-Blind, Three-Treatment Crossover Clinical Trial.

BACKGROUND: Many desensitizing toothpastes exist commercially; however, few clinical trials have investigated their anti-inflammatory effects. This study aimed to evaluate the anti-inflammatory effect and patient appreciation of two toothpastes containing desensitizing agents: (1) a zinc-carbonate-hydroxyapatite nanoparticle (CHA) and (2) a calcium sodium phosphosilicate bioactive glass (CSPS). METHODS: CHA and CSPS were compared with an anti-inflammatory and antibacterial herbal based toothpaste (HB). The aims were accomplished by comparing the following outcomes: (1) the reduction in plaque and bleeding score (Full Mouth Plaque Score (FMPS) and Full Mouth Bleeding Score (FMBS), respectively); (2) the antibacterial activity (AbA) of the toothpaste by saliva samples; (3) the patient appreciation score (Visual Analogue Scale; VAS). Clinical parameters were assessed at baseline and 14 days post-treatment. RESULTS: The final sample consisted of 25 subjects, aged between 20 and 58 years. Although no differences in FMPS were reported (p > 0.05), both desensitizing toothpastes showed an improvement in FMBS. CSPS and HB recorded more AbA compared to CHA (p < 0.05). Moreover, HB resulted in a higher VAS score than both desensitizing toothpastes (p < 0.05). CONCLUSION: In conclusion, only CSPS displayed a similar anti-inflammatory effect compared to HB. Despite the low VAS score, CSPS could be considered as a valid and effective toothpaste in subjects with both dentin hypersensitivity and inflamed gums, highlighting its utility in clinical practice.

The Effect of Different Bleaching Protocols, Used with and without Sodium Ascorbate, on Bond Strength between Composite and Enamel.

This in vitro study aims to evaluate whether a solution of 10% sodium ascorbate (SA) may exert a beneficial effect on the bonding of composite to enamel after using different bleaching agents and protocols. Microtensile bond strength (µTBS) was evaluated on 72 freshly extracted human central incisors, divided into eight experimental groups and one control group (total n = 9): Group 1 serves as control (nonbleached). Group 2 was bleached with 5% carbamide peroxide. Group 3 was bleached with 5% carbamide peroxide and then treated with 10% SA. Group 4 was bleached with 10% carbamide peroxide. Group 5 was bleached with 10% carbamide peroxide, then treated with 10% SA. Group 6 was bleached with 16% carbamide peroxide. Group 7 was bleached with 16% carbamide peroxide, then treated with 10% SA. Group 8 was bleached with 6% hydrogen peroxide. Group 9 was bleached with 6% hydrogen peroxide, then treated with 10% SA. All groups were restored immediately after the different treatments using a resin composite. The µTBS values were measured using a universal testing machine and statistical analysis was performed by means of normality and variance analyses, SIDAK test for univariate test and multiple comparisons, and Student test to compare µTBS values of each group with the control. The mean µTBS values in groups 2, 4, 6, 8 were significantly lower than controls. For groups 3, 5, 7, 9, subjected to antioxidant (10% SA) application, all µTBS values increased significantly. However, only for Groups 3 and 5 there was no significant difference with the control. Applying 10% SA for 10 min may improve the bond strength composite/bleached enamel just when whitening is performed with 5% and 10% carbamide peroxide.

How Can Different Polishing Timing Influence Methacrylate and Dimethacrylate Bulk Fill Composites? Evaluation of Chemical and Physical Properties.

The polishing procedure is commonly performed after direct composite restorations, and little information exists regarding the right timing during which it should be performed on bulk fill composites. This study investigated the effect of polishing timing on the degree of conversion (DC), Vickers microhardness (VMH), and surface morphology of a methacrylate- (MET-) and dimethacrylate- (DMET-) based bulk fill composite, by using FT-NIR, microhardness tester, and SEM. Composite samples were divided as follows: in Group I (immediate), samples were polished immediately after curing (t 0); in Group D (delayed), samples were polished after 24 h from curing (t 24), whereas the unpolished samples were considered as controls (Group C). The DC and VMH values were evaluated before and after polishing, at t 0 and t 24. Statistical analysis was performed with a significance level set at p < 0.05. At t 0, DC increased after polishing in both tested composites (p < 0.05), while at t 24, Group I and Group D were not different. By considering VMH, in the case of MET, all groups were not different both at t 0 and t 24. On the other hand, at t 0, VMH values of DMET increased after polishing. At t 24, DMET Group I and DMET Group D were not different. Qualitative evaluations of scanning electron micrographs showed that the surface morphology of MET presented a more irregular aspect than the DMET one. In summary, since the immediate polishing of MET can improve the DC, without negatively affecting VMH, but showing an irregular surface, it is suggested to wait 24 hours before proceeding with polishing. Otherwise, for DMET, the immediate polishing could definitively be recommended, since it improves both DC and VMH, also producing a regular surface. Therefore, clinicians may always safely polish a restoration performed using DMET-based bulk fill composites in one-chair appointment, avoiding a second appointment.

Effect of four different finishing and polishing systems on resin composites: roughness surface and gloss retention evaluations.

BACKGROUND: Finishing and polishing procedures play a crucial role to achieve the best aesthetic result of direct restorations. Many manufacturers to the clinicians offer different finishing and polishing systems. This study aims to examine the behavior of four different finishing and polishing systems on the roughness, gloss and morphology surface of one resin composite. METHODS: Twelve Filtek XTE Supreme (3M ESPE) discs were prepared and divided into 4 groups (N.=3), depending on the different finishing and polishing systems: Group 1 (GP1) Sof-Lex Extra-Thin XT discs; Group 2 (GP2) Sof-Lex Coarse black disc, multi-fluted bur, Sof-Lex Diamond Polishing System Spirals; Group 3 (GP3) Sof-Lex Coarse black disc, multi-fluted bur, Sof-Lex Diamond Polishing System Spirals, Diamond Twist SCL; Group 4 (GP4) with Sof-Lex Coarse black disc, multi-fluted bur and Occlubrush. The roughness and gloss were evaluated and then samples examined by Scanning Electron Microscopy (SEM) to analyse the morphology after finishing and polishing. RESULTS: Regarding the surface roughness, GP1 and GP2 showed similar values for Ra, Ry, Rz and Rq parameters; while GP3 displayed the lowest values in all parameters; GP4 had the highest Ra value. Regarding the gloss, the values decreased as follows: GP3>GP2=GP4>GP1 (P<0.05). Scanning electron micrographs showed the abrasion of the samples with an increase in the surface roughness in GP1 and GP4. One-way ANOVA followed by Tukey's Test was used for statistical evaluations (P<0.05). CONCLUSIONS: The roughness and gloss surface of resin composites depend on the finishing and polishing systems used. This study demonstrates that satisfactory gloss outcomes are obtained using a system based on diamond paste.