Microtensile Bond Strength of Bulk-fill Resin Composite Restorations in High C-factor Cavities.

AIM: To evaluate the microtensile bond strength (µTBS) and the fracture modes of four bulk-fill resin composites (Tetric EvoCeram Bulk Fill/Ivoclar Vivadent, Filtek Bulk Fill/3M ESPE, Venus Bulk Fill/Heraus Kulzer, and Filtek Bulk Fill Flow/3M ESPE) and one conventional incrementally filled resin composite (Filtek Z250/3M ESPE) inserted in class I cavities, after 24 hours and 6 months of water storage. MATERIALS AND METHODS: In all, 30 sound human extracted molars were divided into five restorative groups. Standardized class I cavities were prepared and restored following the manufacturer's instructions. The restored teeth were then assigned into one of the storage times (24 hours or 6 months). The molars were then cut into 1 mm2 sticks and submitted to µTBS. All fractured specimens were analyzed under a stereomicroscope (40×). Data were submitted to analysis of variance (ANOVA) and the Tukey post hoc test was applied for comparison between groups; and paired t test for comparison within storage times (p = 0.05). RESULTS: After 24 hours of storage, statistically significant differences were observed between Filtek Z250 and Filtek Bulk Fill Flow groups. However, after 6 months, no statistical differences were observed between groups. Additionally, no differences were observed for the µTBS between the storage times. Adhesive failures were the most frequent fracture mode after 24 hours (54%) and 6 months (43%), the resin cohesive fracture mode showed 16% for 24 hours and 14% for 6 months, the dentin cohesive fracture mode showed 14% for 24 hours and 26% for 6 months, and the mixed fracture mode showed 16% for 24 hours and 17% for 6 months. CONCLUSION: Bulk-fill resin composites obtained similar µTBS in high C-factor cavities as conventional incrementally filled resin composites. No bond strength reduction was observed after 6 months of storage. CLINICAL SIGNIFICANCE: Single increment restorations in high C-factor cavities with bulk-fill resin composites did not reduce µTBS after 24 hours or 6 months of storage. The comparable results to the conventional incrementally filled resin composites and the reduction in the operative time, make the bulk-fill resin composites a restorative option for posterior teeth restorations.

Satisfação dos usuários atendidos na Clínica Integral de Odontologia da Universidade Federal de Pernambuco e fatores associados / Patients satisfaction in Dental School Clinics of the Federal University of Pernambuco and associated factors

Objetivo: avaliar a satisfação dos usuários atendidos nas clínicas integrais do curso de Odontologia da Universidade Federal de Pernambuco e a associação com fatores relacionados ao paciente, ao acesso e ao atendimento. Método: trata-se de um estudo descritivo, quantitativo, de corte transversal, partindo de uma amostra de conveniência, realizado com 81 pacientes adultos, de ambos os sexos. Foi aplicado um questionário semiestruturado com questões do Questionário de Avaliação dos Serviços de Saúde Bucal (QASSAB), uma questão de ansiedade ao tratamento odontológico (Dental Anxiety Question modificada) e dados individuais do paciente, como sexo, idade, escolaridade, local de residência e procedimentos realizados. Resultados: os resultados demonstraram que os usuários consideraram a obtenção de uma vaga como razoável ou fácil (75,3%), e o tempo na fila de espera como razoável ou curto (66,7%). A maioria dos participantes respondeu que o motivo da procura por atendimento na clínica era o fato de não ter dinheiro para pagar o tratamento particular, e 40,7% dos pacientes manifestaram algum sinal de ansiedade. Houve uma avaliação positiva do ambiente físico do serviço por parte dos usuários, para a maioria das variáveis pesquisadas. No entanto, apenas a variável organização foi significativamente associada com a satisfação dos usuários. Conclusão: de forma geral, os resultados encontrados nesta pesquisa indicam um bom nível de satisfação, porém, tornam-se necessárias reavaliações periódicas para obtenção de informações importantes que possibilitem melhorias na estrutura e no atendimento das clínicas.(AU)

Objective: to evaluate patient satisfaction at the Dental School Clinics at the Federal University of Pernambuco, Brazil, and the association with factors related to the patient, access and care. Method: this is a descriptive, quantitative, cross-sectional study, based on a convenience sample, conducted with 81 adult patients, of both sexes. A semi-structured questionnaire was applied with questions from the Oral Health Services Assessment Questionnaire (QASSAB), a question of anxiety to dental treatment (modified Dental Anxiety Question) and individual patient data, such as sex, age, education, place of residence and procedures performed. Results: the results showed that users considered obtaining a place as reasonable or easy (75.3%) and the time in the queue as reasonable or short (66.7%), most participants answered that the reason why they chose theservice was the fact that they did not have the money to pay for private treatment and 40.7% of the patients showed some sign of anxiety. There was a positive evaluation of the physical stucture of the service by users, for most of the variables surveyed. However, only the organization variable was significantly associated with user satisfaction. Conclusion: in general, the results found in this research indicate a good level of satisfaction, however, periodic reassessments are necessary to obtain important information that will allow improvements in the structure and care of clinics.(AU)

In Vitro Evaluation of Physical and Mechanical Properties of Light-Curing Resin Cement: A Comparative Study.

OBJECTIVE: The aim of study was to evaluate in vitro the surface hardness, sorption, solubility, and color stability of three light-cured resin cements, namely RelyX Veneer (RLX), Variolink Veneer (VLK), and All Cem Veneer (ACV). MATERIALS AND METHODS: Cylindrical samples (15 × 1 mm) were made for each group using a metallic mold (n = 10). Vickers microhardness test was performed, and average hardness was calculated from three indentations (300 gf/15s) per sample. The sorption and solubility of the materials were evaluated according to ISO 4049:2009 based on three samples weighing: initial (m 1), after immersion in distilled water for 7 days (m 2), and final (after removal of all moisture [m 3]). The color change was observed using a digital spectrophotometer, at three different time points, baseline, 1 day, and 1 week of immersion in coffee and distilled water (control). STATISTICAL ANALYSIS: Shapiro-Wilk test was used to analyze the normality of the data, and groups were compared using Kruskal-Wallis and Mann-Whitney tests. A significance level of 5% was used. RESULTS: RLX showed the highest microhardness mean values (36.96 VHN), but higher sorption (23.2 µg/mm3) and solubility (2.40 µg/mm3), with statistically significant differences with the other groups. For color stability, higher ∆E was observed for the samples immersed in coffee (p = 0.009). The VLK resin cement presented statistically significant differences from the other groups, with higher color changes in coffee at 1 day (15.14) and after 1 week (23.65). CONCLUSION: RLX resin cement showed better hardness results. All materials tested performed satisfactorily for sorption and solubility according to ISO 4049:2009. All materials showed high-staining values after 1 week of immersion in coffee.

High Thyrotropin Is Critical for Cardiac Electrical Remodeling and Arrhythmia Vulnerability in Hypothyroidism.

Background: Hypothyroidism, the most common endocrine disease, induces cardiac electrical remodeling that creates a substrate for ventricular arrhythmias. Recent studies report that high thyrotropin (TSH) levels are related to cardiac electrical abnormalities and increased mortality rates. The aim of the present work was to investigate the direct effects of TSH on the heart and its possible causative role in the increased incidence of arrhythmia in hypothyroidism. Methods: A new rat model of central hypothyroidism (low TSH levels) was created and characterized together with the classical propylthiouracil-induced primary hypothyroidism model (high TSH levels). Electrocardiograms were recorded in vivo, and ionic currents were recorded from isolated ventricular myocytes in vitro by the patch-clamp technique. Protein and mRNA were measured by Western blot and quantitative reverse transcription polymerase chain reaction in rat and human cardiac myocytes. Adult human action potentials were simulated in silico to incorporate the experimentally observed changes. Results: Both primary and central hypothyroidism models increased the L-type Ca2+ current (ICa-L) and decreased the ultra-rapid delayed rectifier K+ current (IKur) densities. However, only primary but not central hypothyroidism showed electrocardiographic repolarization abnormalities and increased ventricular arrhythmia incidence during caffeine/dobutamine challenge. These changes were paralleled by a decrease in the density of the transient outward K+ current (Ito) in cardiomyocytes from animals with primary but not central hypothyroidism. In vitro treatment with TSH for 24 hours enhanced isoproterenol-induced spontaneous activity in control ventricular cells and diminished Ito density in cardiomyocytes from control and central but not primary hypothyroidism animals. In human myocytes, TSH decreased the expression of KCND3 and KCNQ1, Ito, and the delayed rectifier K+ current (IKs) encoding proteins in a protein kinase A-dependent way. Transposing the changes produced by hypothyroidism and TSH to a computer model of human ventricular action potential resulted in enhanced occurrence of early afterdepolarizations and arrhythmia mostly in primary hypothyroidism, especially under ß-adrenergic stimulation. Conclusions: The results suggest that suppression of repolarizing K+ currents by TSH underlies most of the electrical remodeling observed in hypothyroidism. This work demonstrates that the activation of the TSH-receptor/protein kinase A pathway in the heart is responsible for the cardiac electrical remodeling and arrhythmia generation seen in hypothyroidism.

Influence of the Restorative Strategy on Push-out Bond Strength of the Self-adhesive Composite.

AIM: This study evaluated the influence of the resin composite and bonding strategy on the push-out bond strength of the self-adhesive, Fusio liquid dentin (FUS) (Pentron Clinical), and of two conventional resin composites of different viscosities, Filtek Z250 (3M ESPE) and tetric flow (Ivoclar Vivadent). MATERIALS AND METHODS: Thirty-two bovine incisors were used after disinfection. The roots were sectioned and the buccal and lingual surfaces were polished until a 2-mm slab was achieved, maintaining enamel at the buccal surface and dentin at the lingual surface. Standardized cavities were then prepared (2.0 × 1.5 mm) and restored according to the following bonding strategies: Fusio liquid dentin with selective etching (FUSSE) in enamel, FUS, Filtek Z250, and tetric flow-total etching (TET). All groups were restored in bulk. After 24 hours of storage in distilled water, finishing and polishing were performed. The push-out test was conducted on a universal testing machine (0.05 mm/minute). Data were analyzed through Kruskal-Wallis and Mann-Whitney tests (p = 0.05). The extruded restorations were evaluated under a stereomicroscope (10×) for failure-mode evaluation. RESULTS: There were no statistically significant differences between the groups TET, Z250, and FUS, with 145.59, 108.91, and 104.12 MPa means, respectively. The FUSSE group (40.92 MPa) showed a statistically significant lower bond strength. The predominant failure mode was a mixed failure for all groups. CONCLUSION: The self-adhesive resin composite achieved a satisfactory result on bond strength when compared to conventional composites with regular and low viscosities, except when selective enamel etching was done. CLINICAL SIGNIFICANCE: This study shows that the clinicians must be aware of the viscosity of the phosphoric acid to avoid dentin contamination whenever performing selective enamel etching. And the self-adhesive resin composite studied presented as another restorative alternative.

Transtorno depressivo maior: relato de caso com tratamento homeopático em monoterapia

Report of a patient with major depressive disorder, without previous antidepressant treatment and with indiscriminated use of benzodiazepine who presented an important improvement in the depressive simptoms as well as in quality of life and behaviors after the intake of de Natrum Muriaticum CH30 XX/10, prescribed aftar a 20 minute interview in a psichiatric Emergence Room. Further evaluations using de HAM-AD17 scale showed sustainable improvement in the depressive simptoms and in quality of life concluing that homoeopathy is a valuable option for the treatment of major depressive disorder.(AU)

Transtorno depressivo maior: relato de caso com tratamento homeopático em monoterapia / Major depressive disorder: case report with homeopathic treatment in monoteraphy

Report of a patient with major depressive disorder, without previous antidepressant treatment and with indiscriminated use of benzodiazepine who presented an important improvement in the depressive simptoms as well as in quality of life and behaviors after the intake of de Natrum Muriaticum CH30 XX/10, prescribed aftar a 20 minute interview in a psichiatric Emergence Room. Further evaluations using de HAM-AD17 scale showed sustainable improvement in the depressive simptoms and in quality of life concluing that homoeopathy is a valuable option for the treatment of major depressive disorder. (AU)