Discrimination and dental students: What is the reality in Brazilian institutions?

INTRODUCTION: This study aimed to evaluate whether there is discrimination in the dental educational environment, assess the main reasons for the discriminatory events, and if there is an association between discriminatory episodes and sociodemographic characteristics of undergraduate dental students. MATERIALS AND METHODS: This observational cross-sectional study was conducted with a self-administered questionnaire to students enrolled in three Brazilian dental schools. Questions included sociodemographic characteristics and the occurrence of discriminatory episodes in the dental academic environment. Descriptive analysis was performed in RStudio 1.3 (R Core Team, RStudio, Inc., Boston, USA) software and the associations were tested using Pearson's chi-square test, considering 95% confidence intervals. RESULTS: A total of 732 dental students were included, with a response rate of 70.2%. The vast majority of students were female (66.9%), with white/yellow skin colour (67.9%), and with a mean age of 22.6 (SD 4.1) years. Sixth-eight percent of students reported having experienced some discrimination in the academic environment and most reported feeling uncomfortable with the episode. The main reasons to have been discriminated against raised by students were specific behaviour/habit, have specific moral, ethical, and aesthetic values, gender, and socioeconomic status or social class. The occurrence of discriminatory episodes was associated with female gender (p = .05), non-heterosexual sexual orientation (p < .001), studying in public institutions (p < .001), receiving an institutional scholarship (p = .018), and being in the final undergraduate cycle (p < .001). CONCLUSION: The occurrence of discriminatory episodes was common in Brazilian dental higher education. Discriminatory situations generate traumas and psychological marks, causing a loss of diversity within the academic environment that leads to loss of productivity, creativity, and innovation. Thus, strong institutional policies against discrimination are crucial to create a healthy dental academic environment.

Fatores que influenciam o perfil de conhecimento dos cirurgiões-dentistas brasileiros sobre sistemas adesivos / Factores que influyen en el perfil de conocimiento de los odontólogos brasileños sobre los sistemas adhesivos / Factors that influence the knowledge profile of Brazilian dental professionals about dental adhesive systems

Os sistemas adesivos estão diretamente envolvidos nos procedimentos mais corriqueiros da prática clínica odontológica, o que torna o seu conhecimentoindispensável para os profissionais. O objetivo do presente estudo foi avaliar o perfil de conhecimento sobre sistemas adesivos e verificar os fatores que influenciam nesse desfecho, com ênfase na formação profissional. A coleta de dados foi realizada pormeio de um questionário levando em consideração: I. Perfil do profissional; II. Conhecimento, uso e preferências sobre os sistemas adesivos. A amostra foi composta por 501 cirurgiões-dentistas brasileiros e os dados foram analisados no programa Sigma Stat5.0 (p<0,05). O percentual mínimo de acertos das questões considerado adequado foi definido como 80%. Os resultados mostraram que apenas 46,3% dos profissionais demonstraram conhecimento adequado sobre o assunto. Além disso, verificou-se associação estatisticamente significativa entre o baixo nível de acertos e profissionais com preferência por sistemas adesivos simplificados (p=0,046), especialistas em ortodontia [OR=0,24 (0,08-0,67)] e cirurgiões-dentistas graduados em instituições privadas [OR=1,58 (1,03-2,42)]. Esse cenário alerta para a necessidade iminente de sanar essa fragilidade por meio de melhorias nas matrizes curriculares, além da educação continuada de docentes e constante atualização dos profissionais (AU).

Los sistemas adhesivos están directamente involucrados en los procedimientos más comunes de la práctica clínica dental, lo que hace que su conocimiento sea fundamental para los profesionales. El objetivo del presente estudio fue evaluar el perfil de conocimiento sobre sistemas adhesivos y verificar los factores que influyen en ese resultado, con énfasis en la formación profesional. La recolección de datos se realizó a través de un cuestionario teniendo en cuenta: I. Perfil del profesional; II. Conocimiento,uso y preferencias sobre los sistemas adhesivos. La muestra estuvo compuesta por 501 dentistas brasileños y los datos fueron analizados mediante el programa Sigma Stat 5.0 (p<0,05). El porcentaje mínimo de respuestas correctas a las preguntas considerado adecuado se definió en el 80%. Los resultados mostraron que sólo el 46,3% de los profesionales demostraron conocimientos adecuados sobre el tema. Además, hubo una asociación estadísticamente significativa entre el bajo nivel de aciertos y los profesionalescon preferencia por los sistemas adhesivos simplificados (p=0,046), especialistas en ortodoncia [OR=0,24 (0,08-0,67)] y odontólogos egresados de instituciones privadas [OR=1,58 (1,03-2,42)]. Este escenario advierte de la inminente necesidad de subsanar esta debilidad a través de mejoras en las matrices curriculares, además de la formación continua de los docentes y la constante actualización de los profesionales (AU).

Dental adhesive systems are directly involved in common procedures of clinical dentistry, which makes knowledge about this topic indispensable for professionals. The objectives of the current study are to analyze the knowledge profile of dental professionals about dental adhesive systems and verify factors that influence this closure, with emphasis on professional education. The data was collected using a list of questions that consider: I) Professional profile and II) Knowledge, use, and preferences of adhesive systems. The sample considers 501 Brazilian dentists and the data was analyzed using the software Sigma Stat 5.0 (p<0.05). The minimum percentual of correct questions considered adequate was defined as 80%. The results show that only 46.3% of the professionals demonstrated satisfactory knowledge on the subject. In addition, it verified relevant statistical association between low level of correct questions and professionals with preferences for simplified adhesive systems (p=0.046), orthodontic specialists [OR=0.24 (0.08­0.67)], and dentists with private education degrees [OR=1.58 (1.03­2.42)]. This context indicates the imminent necessity to resolve this weakness through improvements in the educational curriculum, as well as continuing education of faculty and constant updating of professionals (AU).

Deep occlusal carious lesions clinical management by Brazilian dentists: a nationwide e-survey / Manejo clínico de lesões cariosas oclusais profundas por cirurgiões-dentistas brasileiros: uma pesquisa eletrônica nacional

Objective: To investigate the clinical management of deep occlusal carious lesions in permanent teeth by Brazilian dentists. Material and Methods: This cross-sectional study included a sample of 732 Brazilian dentists who responded to an electronic questionnaire composed of 20 questions addressing socio-demographic information, training and professional activity characteristics, and clinical management of deep carious lesions. Descriptive analysis was performed, considering relative and absolute frequencies and 95% confidence intervals. The association between the dentists' variables of interest (age group, type of higher education institution, years in practice, highest academic degree completed and main sector of professional activity) and the mean number of incorrect answers regarding deep carious lesions management was analyzed by Analysis of Variance (ANOVA), followed by the Bonferroni post-test (p<0.005). Results: Stepwise removal was the strategy pointed out by most dentists (42.8%). However, 16% of the dentists selected nonselective carious tissue removal. Furthermore, 45.6% of the dentists disagreed with maintaining carious tissue over the pulp in deep lesions with a risk of pulpal exposure. When using instruments to remove carious dentine, 17% of the dentists chose a diamond burn while 13% preferred tungsten carbide burs. Dentists who graduated from public institutions had a lower mean of non-conservative decisions than those from private institutions. Dentists with master's or doctoral degrees were more conservative, as well as dentists from public service compared to those from the private sector. Conclusion: The dissemination of conservative approaches in the management of deep carious lesions needs to be strengthened and increasingly based on updated scientific literature.(AU)

Objetivo: Investigar o manejo clínico de lesões cariosas oclusais profundas em dentes permanentes por cirurgiões-dentistas brasileiros. Material e Métodos: Este estudo transversal incluiu uma amostra de 732 dentistas brasileiros que responderam a um questionário eletrônico composto por 20 questões abordando informações sociodemográficas, formação, características da atividade profissional e manejo clínico de lesões cariosas profundas. Foi realizada análise descritiva, considerando frequências relativas e absolutas, e intervalos de confiança de 95%. A associação entre as variáveis de interesse (faixa etária, tipo de instituição de ensino superior, anos de prática, maior titulação acadêmica concluída e principal setor de atividade profissional) dos cirurgiões-dentistas e a média de acertos no manejo de lesões cariosas profundas foi analisada pela Análise de Variância (ANOVA), seguida do pós-teste de Bonferroni (p<0,005). Resultados: A remoção seletiva foi a estratégia apontada pela maioria dos cirurgiões-dentistas (42,8%). No entanto, 16% dos dentistas selecionaram a remoção não seletiva do tecido cariado. Além disso, 45,6% dos dentistas discordaram da manutenção de tecido cariado sobre a polpa em lesões profundas com risco de exposição pulpar. Ao usar instrumentos para remover a dentina cariada, 17% dos dentistas escolheram uma broca diamantada, enquanto 13% preferiram brocas de carboneto de tungstênio. Cirurgiões-dentistas formados em instituições públicas apresentaram menor média de decisões não conservadoras do que os de instituições privadas. Os cirurgiões-dentistas com mestrado ou doutorado foram mais conservadores, assim como os cirurgiões-dentistas do serviço público em relação aos do setor privado. Conclusão: A disseminação de abordagens conservadoras no manejo de lesões cariosas profundas precisa ser fortalecida e cada vez mais baseada em literatura científica atualizada (AU)

Dual-cured adhesive system improves adhesive properties of dentin cavities restored with a bulk-fill resin composite

Aim: To evaluate the impact of a dual-cured adhesive system on the in situ degree of conversion (DC), bond strength (BS) and failure mode (FM) of adhesive interfaces in dentin cavities restored with a bulk-fill resin composite. Methods: 4-mm-deep dentin cavities with a 3.1 C-factor were created in 68 bovine incisors (n = 17 per group). The lightcured (Scotchbond™ Universal) or the dual-cured (Adper™ Scotchbond™ Multi-purpose Plus) adhesive system was applied to the cavities, which were then restored with a bulkfill resin composite (Filtek™ Bulk Fill). In situ DC analysis was performed by means of micro Raman spectroscopy at the top and bottom interfaces. Push-out BS was measured in a universal testing machine after 24-h or 6-month water storage. FM was determined with a stereomicroscope. Data of in situ DC and BS were analyzed by two-way analysis of variance (ANOVA) and Tukey test (p<0.05), while the FM was analyzed descriptively. Results: The groups that received the dual-cured adhesive system showed statistically higher in situ DC and BS than those that received the light-cured adhesive system. Cohesive failure mode was the most frequent in all conditions. Conclusion: In situ DC and BS were influenced by the curing strategies of the adhesive systems with better performance of the dual-cured material

In-vitro models of biocompatibility testing for restorative dental materials: From 2D cultures to organs on-a-chip.

Dental caries is a biofilm-mediated, diet-modulated, multifactorial and dynamic disease that affects more than 90% of adults in Western countries. The current treatment for decayed tissue is based on using materials to replace the lost enamel or dentin. More than 500 million dental restorations are placed annually worldwide, and materials used for these purposes either directly or indirectly interact with dentin and pulp tissues. The development and understanding of the effects of restorative dental materials are based on different in-vitro and in-vivo tests, which have been evolving with time. In this review, we first discuss the characteristics of the tooth and the dentin-pulp interface that are unique for materials testing. Subsequently, we discuss frequently used in-vitro tests to evaluate the biocompatibility of dental materials commonly used for restorative procedures. Finally, we present our perspective on the future directions for biological research on dental materials using tissue engineering and organs on-a-chip approaches. STATEMENT OF SIGNIFICANCE: Dental caries is still the most prevalent infectious disease globally, requiring more than 500 million restorations to be placed every year. Regrettably, the failure rates of such restorations are still high. Those rates are partially based on the fact that current platforms to test dental materials are somewhat inaccurate in reproducing critical components of the complex oral microenvironment. Thus, there is a collective effort to develop new materials while evolving the platforms to test them. In this context, the present review critically discusses in-vitro models used to evaluate the biocompatibility of restorative dental materials and brings a perspective on future directions for tissue-engineered and organs-on-a-chip platforms for testing new dental materials.

Is dentin biomodification with collagen cross-linking agents effective for improving dentin adhesion? A systematic review and meta-analysis.

Objectives: The aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures. Materials and Methods: In this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected. Results: The selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period. Conclusions: This systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.

Cashew nut shell liquids: Antimicrobial compounds in prevention and control of the oral biofilms.

OBJECTIVE: The aim was to evaluate the antibacterial and antibiofilm activity of natural (n-CNSL) and technical (t-CNSL) cashew nut shell liquid against streptococci and enterococci related to dental caries and chronic apical periodontitis, respectively. MATERIAL AND METHODS: Minimum inhibitory concentrations (MIC) and minimal bactericidal concentration (MBC) were determined to assess the antimicrobial effect of both CNSLs (n-CSNL and t-CNSL) against S. oralis ATCC 10557, S. sobrinus ATCC 6715, S. parasanguinis ATCC 903, S. mutans UA 159 and E. faecalis ATCC 19433. The antibiofilm activity was evaluated by total biomass quantification, colony forming unit (CFU) counting and scanning electron microscopy (SEM). Furthermore, cytotoxic effect of the substances was evaluated on L929 and HaCat cell lines by MTS assay. RESULTS: The n-CNSL and t-CNSL showed inhibitory and bactericidal effect against all strains tested in this study, with MIC and MBC values ranging from 1.5 to 25 µg/mL. Overall, both CNSLs showed significant reduction in biomass quantification and enumeration of biofilm-entrapped cells for the strains analyzed, in biofilm formation and preformed biofilms (p < 0.05). In biofilm inhibition assay, the t-CNSL and n-CNSL showed reduction in biomass and CFU number for all bacteria, except in cell viability of S. parasanguinis treated with t-CNSL (p > 0.05). Indeed, SEM images showed a reduction in the amount of biomass, bacterial cells and changes in cellular morphology of S. mutans. CONCLUSION: In conclusion, both substances showed effective antibacterial and antibiofilm activity against the strains used in the study, except in viability of S. parasanguinis cells treated with t-CNSL.

Influence of the degree of conversion and Bis-GMA residues of bulk fill resins on tissue toxicity in an subcutaneous model in rats.

AIM: To analyse the influence of the degree of conversion (DC) and light curing residues of different bulk fills (BFs) composites on the inflammatory profile in the subcutaneous tissue of rats. MATERIALS AND METHODS: Resin disks of BF-resins and their active conventional resins (CR; 3M®, Ivoclar®, and Kerr®) were light-cured at 2 mm (BF-superficial) and 4 mm (BF-deep) thicknesses and analyzed by infrared spectroscopy (FTIR; n = 3/group; DC and light curing residues). Then, the disks were implanted in four quadrants in the subcutaneous tissue of Wistar rats (sham, CR, BF-superficial and RF-deep), and after 7, 14, and 28 days, the animals (n = 6/day) were euthanized for histological analysis of the intensity of the inflammatory process (scores 0-3). Kruskal-Wallis/Dunn and ANOVA/Bonferroni tests were used (p < 0.05, Graph Pad Prism 5.0). RESULTS: The DC of CR 3M® did not differ significantly compared to BF-superficial and BF-deep resins (p = 0.235). The Ivoclar® and Kerr® resins showed a higher DC with CR and BF-superficial compared to the BF-deep (p = 0.005 and p = 0.011, rctively). Kerr® resins showed a higher Bis-GMA/UDMA ratio, especially in BF-deep resin (p < 0.05). 3M® and Ivoclar resins did not show high inflammation scores, but for Kerr® BF resins (superficial and deep), the inflammatory process was significantly higher than that in the CR and sham quadrants (p = 0.031). CONCLUSION: The tissue inflammatory response after resin inoculation depends on the DC and light curing residues of Bis-GMA.

Clinically relevant outcomes in dental clinical trials: challenges and proposals.

The impact of clinical trials on patient care depends on the outcomes that they evaluate. In Dentistry, many trials use outcomes that are important to clinicians, but not to the patients. Thus, the aim of the present manuscript is to present an overview of the limitations, challenges, and proposals on the use of clinically relevant outcomes (CRO) in dental trials. Clinically relevant outcomes are variables that directly measure how the patient feels, functions, or survives. Some CROs, such as tooth loss, implant failure, and restorations failure require many years to occur and the number of events is low. The adoption of these variables as primary outcomes results in challenges for the researchers, such as use of large sample sizes and long follow-up periods. Surrogate outcomes, such as biomarkers, radiographic measurements and indexes, are frequently used to replace CROs. However, they present many limitations, since the effect of the treatment on a surrogate does not necessarily reflect a change in the clinical outcome. Some proposals for the adoption of CROs are presented, such as the development of core outcome sets within each dental specialties and the organization of multi-center clinical trials.

Two-year clinical evaluation of a proanthocyanidins-based primer in non-carious cervical lesions: A double-blind randomized clinical trial.

OBJECTIVES: This double-blind randomized clinical trial evaluated the influence of pre-treatment with proanthocyanidins (PA) from grape seed extract on the clinical behavior of a simplified etch-and-rinse adhesive placed in non-carious cervical lesions (NCCLs) over 6- and 24-months. MATERIALS AND METHODS: A total of 135 restorations were randomly inserted in 45 subjects. The NCCLs were etched with 37 % phosphoric acid for 15 s and distributed into 3 groups: Control (PA0) - adhesive ExciTE F applied as per the manufacturer's recommendations; PA2 and PA5 groups - 2 wt% and 5 wt% PA solution, respectively, were applied for 60 s and washed for 30 s prior to application of the adhesive. The resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline, 6 months (6 m) and 24 months (24 m) using both the FDI and USPHS criteria. Statistical analyses were carried out using Friedman repeated-measures analysis of variance by rank and the Wilcoxon test (α = 0.05). RESULTS: The retention rates were 98 % (PA0), 98 % (PA2) and 83 % (PA5) after 6 m and 93 % (PA0), 89 % (PA2) and 70 % (PA5) after 24 m. Only PA5 resulted in a significant lower retention rate at 6 m and at 24 m compared with that of baseline (p = 0.03). All groups resulted in a significantly worse marginal adaptation and marginal staining for the FDI criteria when the baseline vs. the 24 m recall data were compared. These differences were considered clinically acceptable under the FDI criteria. CONCLUSIONS: The application of PA as a primer did not result in clinical advantages after 24 m of clinical service, regardless of the concentration used. CLINICAL RELEVANCE: It has been reported that PA, a collagen crosslinking agent, increases the durability of the dentin-resin interface. However, no effects were found clinically after 24 months.

Clinically relevant outcomes in dental clinical trials: challenges and proposals

Abstract The impact of clinical trials on patient care depends on the outcomes that they evaluate. In Dentistry, many trials use outcomes that are important to clinicians, but not to the patients. Thus, the aim of the present manuscript is to present an overview of the limitations, challenges, and proposals on the use of clinically relevant outcomes (CRO) in dental trials. Clinically relevant outcomes are variables that directly measure how the patient feels, functions, or survives. Some CROs, such as tooth loss, implant failure, and restorations failure require many years to occur and the number of events is low. The adoption of these variables as primary outcomes results in challenges for the researchers, such as use of large sample sizes and long follow-up periods. Surrogate outcomes, such as biomarkers, radiographic measurements and indexes, are frequently used to replace CROs. However, they present many limitations, since the effect of the treatment on a surrogate does not necessarily reflect a change in the clinical outcome. Some proposals for the adoption of CROs are presented, such as the development of core outcome sets within each dental specialties and the organization of multi-center clinical trials.

Ethanol as Dentin Pretreatment on the Bonding Performance of a Two-Step Etch-and-Rinse Adhesive: An In Vivo Study.

OBJECTIVE: The aim of this study was to evaluate the use of 70 vol.% ethanol as a dentin pretreatment on the bond strength (BS) of a two-step etch-and-rinse adhesive. MATERIALS AND METHODS: Resin composite Class I restorations were clinically bonded to acid-etched dentin of human sound third molars using Adper Single Bond 2 (SB, 3M ESPE) and randomly divided into two major groups: dentin saturated with water (control) or 70 vol.% ethanol (ethanol). The teeth were divided into two subgroups: immediately extracted and tested after 24 hours and extraction after 18 months. Bonded teeth (Adper SB 2) were cut into resin-dentin sticks that were tested by microtensile BS, and the failure mode was thereafter evaluated. STATISTICAL ANALYSIS: Data were statistically analyzed using two-way analysis of variance and Holm-Sidak post hoc test (α = 0.05). Additional bonded resin-dentin slabs from each group were examined under light microscopy (LM) using the Masson's trichrome staining technique. RESULTS: The lowest BS was obtained by ethanol pretreated dentin after aging, while other groups presented similar BS. The LM analysis showed the presence of resin-sparse collagen fibrils in groups examined immediately (24 hours) and the presence of several gaps due to collagen degradation at the interfaces of ethanol pretreated aged specimens (18 months). CONCLUSION: The use of 70 vol.% ethanol in dentin before the application of a two-step etch-and-rinse adhesive should be avoided once it resulted in a significant drop on the BS.

Saliva contamination effects at different application steps on bond strength of total etch two-step adhesive / Efeitos da contaminação por saliva em diferentes etapas de aplicação do sistema adesivo convencional de dois passos na resistência de união de restaurações adesivas

Introduction: there are clinical situations in the management of cavities favorable to saliva contamination. Human saliva is a complex mixture of oral fluids and it has been showed that the protein content of the saliva is responsible for the decrease in adhesive bond strength when contamination has occurred. Objective: this study aimed to evaluate the effect of saliva contamination during different steps of application of adhesive system on bond strength of total etch two-step adhesive system. Methods: twenty-five extracted human molars were ground flat to expose occlusal dentin. The bonding system and composite resins were applied to the dentin after etching step under five conditions (n=5/group): G1: control group­no contamination; G2: etching/ contamination/dry/adhesive system application; G3: etching/contamination/wash/dry/adhesive system application; G4: etching/adhesive system application/contamination/wash/dry/adhesive system re-application; and G5: etching/adhesive system application/contamination/dry. Microtensile bond strength was tested after specimens were stored in distilled water at 37ºC for 24h. Data (mean values -µTBS) were analyzed by ANOVA one-way and Tukey tests (α=5%), respectively. Results: Groups G2, G3 and G4 revealed bond strength similar to the control (G1). Group G5 showed significantly lower bond strengths than other groups (p<0.001). Conclusion: the total etch two-step adhesive tolerated salivary contamination except when the contamination occurred after application of the bond and it was only removed with an air jet and adhesive system was not reapplied.

Introdução: a saliva humana é uma mistura complexa de fluidos orais e tem sido demonstrado que o conteúdo proteico da saliva é responsável pela diminuição da resistência adesiva quando ocorre contaminação. Objetivo: este estudo objetivou avaliar o efeito da contaminação salivar durante diferentes etapas de aplicação do sistema adesivo sobre a resistência de união. Métodos: vinte e cinco molares humanos extraídos foram cortados para exposição da dentina oclusal. O sistema adesivo convencional e as resinas compostas foram aplicados na dentina após a etapa de condicionamento sob cinco condições (n = 5 / grupo): G1: grupo controle - sem contaminação; G2: condicionamento ácido/contaminação/secagem/adesivo; G3: condicionamento ácido/contaminação/lavagem/secagem/adesivo; G4: condicionamento ácido/aplicação do sistema adesivo/contaminação/lavagem/secagem/reaplicação do sistema adesivo; e G5: condicionamento ácido/aplicação do sistema adesivo/contaminação/secagem. A resistência à microtração foi testada após o armazenamento das amostras em água destilada a 37ºC por 24 horas. Os dados (valores médios -µTBS) foram analisados por ANOVA unidirecional e testes de Tukey (α = 5%), respectivamente. Resultados: Os grupos G2, G3 e G4 revelaram resistência de união semelhante ao controle (G1). O grupo G5 apresentou resistência de união significativamente menor que os demais grupos (p <0,001). Conclusão: o adesivo convencional de dois passos não foi afetado pela contaminação salivar, exceto quando a contaminação ocorreu após a aplicação adesiva e foi removida apenas com jato de ar e o sistema adesivo não foi reaplicado.

Different Concentrations of Ethanol as Dentin Pre-treatment to Bonding of an Etch-and-rinse Adhesive / Diferentes Concentrações de Etanol como Pré-Tratamento da Dentina na adesão de um Adesivo Convencional

Objective: to evaluate the bond strength (BS) to dentin pre-treated with ethanol in single application for 20 s after etching and before application of a two-step etch-and-rinse adhesive and to analyze the morphological features at the resin-dentin interface. Methods: twenty four third molars were collected and randomly assigned into four groups (n=5) according to the ethanol concentration: control (traditional water-wet technique), 50vol%, 70vol% and 100vol%. In experimental groups, ethanol was applied for 20 s and gently air-dried for 5 s. Bonding procedures were performed and resin composite was built up incrementally. Bonded teeth were sectioned into 0.8mm2 sticks on average. These specimens were submitted to microtensile bond strength test (µTBS). One-way ANOVA and post hoc Tukey's test were applied to analyze statistical data (α=0 05). Light microscopy (LM) assisted by Masson's trichrome staining was used to observe the features of resin/dentin interfaces. Results: control BS was not different from ethanol 50vol% (p>0.05). However, the pre-treatment using ethanol 70vol% and 100vol% showed increase on BS (p<0.001 and p=0.003 respectively) with no difference between these two groups. LM Showed a discrete decrease in denuded collagen fibrils to teeth treated with 70vol% and 100vol%. Conclusion: the pre-treatment of dentin using ethanol may increase the initial BS of resin/dentin interface when applied using 70vol% or 100vol% ethanol. Ethanol 70vol% is also able to decrease the thickness of the resin-sparse collagen fibrils.

Objetivo: avaliar a resistência de união (RU) à dentina pré-tratada com etanol em aplicação única por 20 s após condicionamento e antes da aplicação de um adesivo convencional de dois passos e analisar as características morfológicas na interface resina-dentina. Métodos: vinte e quatro terceiros molares foram coletados e distribuídos aleatoriamente em quatro grupos (n = 5) de acordo com a concentração de etanol: controle (técnica tradicional - úmida), 50%, 70% e 100%. Em grupos experimentais, o etanol foi aplicado por 20 s e gentilmente seco ao ar por 5 s. Procedimentos de colagem foram realizados e a restauração em resina composta foi construída de forma incremental. Os espécimes foram seccionados em palitos com média de 0,8 mm2 e submetidos ao teste de resistência à microtração (µTBS). One-way ANOVA e teste post hoc de Tukey foram aplicados para analisar os dados (α = 0,05). Microscopia ótica (MO) auxiliada pela coloração tricrômica de Masson foi usada para observar as características das interfaces resina-dentina. Resultados: a RU do controle não foi diferente do etanol a 50% (p > 0,05). No entanto, o pré-tratamento utilizando etanol a 70% e 100% apresentou aumento na RU (p < 0,001 e p = 0,003 respectivamente) sem diferença entre esses dois grupos. MO apresentou uma diminuição discreta nas fibrilas de colágeno desnudadas nos dentes tratados com 70% e 100%. Conclusão: o pré-tratamento da dentina usando etanol pode aumentar a RU inicial da interface resina-dentina quando aplicado nas concentrações de 70% ou 100%. O etanol a 70% também é capaz de diminuir a espessura das fibrilas de colágeno-resina esparsas.

Two-year clinical evaluation of proanthocyanidins added to a two-step etch-and-rinse adhesive.

OBJECTIVE: To compare the clinical behavior of Proanthocyanidins (PA)-free and PA-containing two-step etch-and-rinse adhesive used underneath resin composite restorations in non-carious cervical lesions (NCCLs) over a 6- (6 M) and 24-month (24 M) period. METHODS: 135 restorations were randomly placed in 45 subjects. The NCCLs were conditioned (37% phosphoric acid for 15 s) and distributed into 3 groups: Control (EX0) - ExciTE F (Ivoclar Vivadent) adhesive applied following the manufacturer's recommendations; EX2 and EX5 - 2 wt% and 5 wt% of PA were added to ExciTE F, respectively, and applied as in EX0. Resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline, 6 M and 24 M, using FDI and USPHS criteria. Statistical analyses were performed using Friedman and Wilcoxon tests (α = 0.05). RESULTS: The retention rates were 98% (95% confidence interval 88-99%) for EX0, 92% (80-97%) for EX2; and 85% (72-93%) for EX5 at 6 M. A significant difference was found only for EX5 at 6 M when compared with the respective baseline findings (p = 0.03) and when compared with EX0 and EX2 (p = 0.001) at 6 M. After 24 M, the retention rates were 98% (88-99%) for EX0, 73% (59-84%) for EX2, and 71% (56-82%) for EX5. Only EX0 did not result in significant difference in retention rate at 24 M when compared with baseline but showed a significant higher retention rate when compared with those of EX2 and EX5 (p = 0.001). CONCLUSION: Adding proanthocyanidins to the adhesive solution jeopardized the retention of composite resins restorations in non-carious cervical lesions after 24 months. CLINICAL RELEVANCE: In spite of being user-friendlier than when used separately, the incorporation of proanthocyanidins into the adhesive solution impairs the longevity of composite restorations.

Resistência de união de um sistema restaurador à base de silorano ao esmalte bovino / Bond strength of a Silorane-based composite to bovine enamel

O objetivo do presente estudo foi avaliar a resistência de união ao esmalte bovino de um sistema adesivo para compósitos à base de silorano, com e sem condicionamento prévio. Para isso, foram selecionados 12 incisivos bovinos com superfície de esmalte planificada e, então, divididos em dois grupos: Grupo 1 (P90) - realizado um platô em esmalte com o sistema restaurador P90; Grupo 2 (P90A) - realizado um platô com condicionamento ácido prévio à utilização do sistema adesivo, utilizando ácido fosfórico a 37% por 15s. Os espécimes (n=6) foram seccionados nos eixos "x" e "y" para obtenção de palitos para o teste de microtração com velocidade de 0,5mm/min. Os dados obtidos foram submetidos aos testes ANOVA One-way e Tukey. Os testes de microtração mostraram um aumento na resistência de união, quando utilizado o condicionamento ácido prévio ao sistema adesivo adotado no estudo (p<0,05). Concluiu-se que o condicionamento prévio com ácido fosfórico a 37% aumentou a resistência de união do sistema restaurador à base de silorano ao esmalte bovino.

The purpose of this study was to evaluate the bond strength produced by a Silorane-based restorative system to enamel with or without prior acid etching. Twelve bovine incisors were selected. Then, the enamel was planned. The teeth were divided into two groups: Group 1 - a plateau was built in the enamel planned with P90 system (P90); Group 2 - a plateau was built in the enamel with prior etching using 37% phosphoric acid for 15s (P90A). Specimens (n=6) were sectioned in enamel/composite sticks to microtensile testing. The cross-sectional area of the sticks was measured. Beams were pulled until failure and bond strength was calculated. Data were statistically analyzed using ANOVA One-way and Tukey (p=0,05). Microtensile bond strength showed higher values to group 2 (P90A), that used prior etching to the adhesive system tested in the study. In conclusion prior etching with phosphoric acid increased microtensile bond strength values of the Silorane-based composite on bovine enamel.

Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review.

PURPOSE: To conduct a systematized review of the literature about the main methodologies used to evaluate the biomechanical fixation systems with titanium plates in fractures of the mandibular condyle. METHODS: A systematized review of literature was performed in the electronic databases PubMed, EMBASE, LILACS and MEDLINE without restriction of the publication date. The eligibility criteria were laboratory studies involving mandibular condyle fractures, studies using titanium plates, biomechanical studies, in vitro and computational studies involving the finite element method (FEM). RESULTS: Eleven articles that met the eligibility criteria were selected, including seven articles involving in vitro studies and four studies with biomechanical analysis by using FEM. CONCLUSION: Although few articles have used the finite element method, the results of in vitro studies were similar to those found in computational studies, regarding to the stable use of two titanium miniplates.

Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review / Análise biomecânica de sistemas de placas de titânio em fraturas de côndilo mandibular: uma revisão sistematizada da literatura

PURPOSE: To conduct a systematized review of the literature about the main methodologies used to evaluate the biomechanical fixation systems with titanium plates in fractures of the mandibular condyle. METHODS: A systematized review of literature was performed in the electronic databases PubMed, EMBASE, LILACS and MEDLINE without restriction of the publication date. The eligibility criteria were laboratory studies involving mandibular condyle fractures, studies using titanium plates, biomechanical studies, in vitro and computational studies involving the finite element method (FEM). RESULTS: Eleven articles that met the eligibility criteria were selected, including seven articles involving in vitro studies and four studies with biomechanical analysis by using FEM. CONCLUSION: Although few articles have used the finite element method, the results of in vitro studies were similar to those found in computational studies, regarding to the stable use of two titanium miniplates.

OBJETIVO: Realizar uma revisão sistematizada da literatura sobre as principais metodologias empregadas na avaliação biomecânica de sistemas de fixação com placas de titânio em fraturas de côndilo mandibular. MÉTODOS: Foi realizada uma revisão sistematizada da literatura nas bases de dados eletrônicas PubMed, EMBASE, LILACS e MEDLINE sem restrição quanto à data de publicação. Os critérios de elegibilidade foram estudos laboratoriais envolvendo fraturas de côndilo mandibular, estudos utilizando placas de titânio, estudos biomecânicos, estudos in vitro e estudos computacionais envolvendo o método de elementos finitos (MEF). RESULTADOS: Foram selecionados 11 artigos que se enquadraram nos critérios de elegibilidade, incluindo sete artigos envolvendo estudos in vitro e quatro utilizando análise biomecânica através do MEF. CONCLUSÃO: Embora poucos artigos tenham utilizado o método de elementos finitos, os resultados das pesquisas in vitro assemelham-se aos encontrados nos estudos computacionais, com relação ao uso estável de duas miniplacas de titânio.

Oficinas de promoção de saúde com adolescentes: relato de experiência / Workshops for the promotion of health with adolescents: experience report

A necessidade de desenvolvimento de ações direcionadas a saúde dos adolescentes tornou-se imperativa diante da expressividade destes em relação ao contingente populacional, assim como sua significância em termos de geração futura. Objetiva-se relatar o trabalho de educação em saúde com adolescentes, realizado por meio de oficinas, com vistas à promoção da saúde. Estudo descritivo referente a atividades do Programa em Educação para o Trabalho em Saúde (PET Saúde), realizada de outubro a dezembro/ 2009. As oficinas ocorreram em escola estadual de Fortaleza-CE. Os temas trabalhados, sugeridos pelos adolescentes, foram: Sexualidade, drogas, violência, saúde do adolescente. Evidenciou-se a necessidade de adoção de práticas educativas de caráter dialógico com ativa participação dos adolescentes para que estes se sintam sujeitos, co-responsáveis por sua saúde e melhoria em sua qualidade de vida. Destacou-se a importância da articulação com as escolas e do trabalho intersetorial e multidisciplinar.

Avaliação da infiltração marginal em restaurações com compósitos à base de metacrilato e à base de silorano / Evaluation of marginal leakage on restorations of methacrilate and silorane-based composites

Objetivo: O objetivo deste estudo in vitro foi avaliar o nível de infiltração marginal em restaurações realizadas com sistemas restauradores à base de metacrilato e à base de silorano. Materiais e método: Cavidades classe V em forma de caixa (4 x 4 x 2mm) foram preparadas na junção cemento-esmalte nas faces vestibular, lingual, mesial e distal com margens em esmalte e dentina de vinte molares humanos hígidos. Os dentes foram divididos aleatoriamente em dois grupos e restaurados da seguinte forma: Grupo 1 (G1) - Clearfil SE, aplicado se-gundo as instruções do fabricante e restaurado com re-sina composta Filtek Z250, e Grupo 2 (G2) - P90 Bond, aplicado segundo as instruções do fabricante e restau-rado com resina composta Filtek P90. Resina composta foi aplicada em incremento único e fotopolimerizada por 40s. Os espécimes foram imersos em solução de azul de metileno a 2% por 4h e seccionados longitu-dinalmente no centro da restauração. A penetração de corante na interface adesiva foi avaliada usando-se lupa esterioscópica e escores de 0 a 3 foram atribuídos às margens de esmalte e dentina. A significância dos dados foi analisada utilizando-se os testes estatísticos Kruskall Wallis e Student-Newman-Keuls. Resultados: Não houve diferença estatística entre os dois sistemas restauradores testados tanto nas margens de dentina (P = 0,19) quanto nas margens de esmalte (P = 0,97). Conclusão: Não houve diferença na capacidade sela-dora dos materiais restauradores testados.