Efficacy of antiseptics and chemomechanical methods for dentin caries lesions: A systematic review with GRADE approach.

Objectives: Selective caries removal aims to remove carious tissue in deep dentin lesions. However, a discussion stands on the value of antiseptics and chemomechanical adjuvant methods to reduce the bacterial load on residual caries lesions. This systematic review has addressed two main clinical questions to compare the antimicrobial efficacy of available methods using (1) antiseptic or (2) chemomechanical agents before restoring dentin carious lesions. Methods: We included randomized and non-randomized controlled trials (RCTs/ NRCTs). We searched eight databases from inception to October 2021. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. The primary outcome was the reduction in the number of total bacterial in dentin, whereas secondary outcomes were reduction in the number of Lactobacillus and Streptococcus. We used the ratio of ratio of post-treatment to baseline means between two interventions in the logarithmic scale as a proper effect measure. Certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation approach. Results: We included 14 RCTs and 9 NRCTs, with nine interventions. Regardless the method, the number of bacteria at baseline was similar or exceeded that after the intervention, particularly in NRCTs. The evidence was inconclusive for most comparisons. Among antiseptic agents, chlorhexidine (CHX) resulted in an average of 1.14 times [95% confidence interval (CI): 1.08-1.21] more total bacterial than photodynamic therapy in RCTs. Among NRCTS, the natural agents resulted in five times more total bacterial than CHX (95% CI: 2-11). For chemomechanical methods, the control resulted in eight times (95% CI: 4-17) more total bacterial than Carisolv (SHAA). Conclusions: The certainty of the evidence was very low for all comparisons showing uncertainty whether one treatment could be more effective than another for dentin disinfection. So far, exclusively removing soft carious dentin would be enough to reduce the bacterial count.

Bleaching effectiveness and cytotoxicity of new experimental formulation of niobium-based bleaching gel.

OBJECTIVES: The development of new bleaching agents with minimum concentration of hydrogen peroxide (HP), without adverse effects, and with bleaching effectiveness, has great clinical relevance. The aim of this study was to evaluate the bleaching efficacy and cytotoxicity of a new niobium-based bleaching gel, compared to already available HP-based gels. MATERIALS AND METHODS: For the bleaching efficacy analysis, 40 bovine incisors were randomly divided into 4 groups according to the established bleaching protocol: control, untreated; 35HP, 35% HP bleaching gel; 6HP, 6% HP bleaching gel; NbHP, niobium gel associated with 3% HP gel. The color variation was measured in a spectrophotometer and the values of ΔL, Δa, Δb, and ΔE obtained. For the cell viability assay by MTT, MC3T3 cells were exposed to bleaching gel extracts (1:500, 1:250, 1:125 dilutions; immediately and 24 h). Statistical tests were performed (P < 0.05). RESULTS: The color alteration for all bleaching gels was significant compared to control (P < 0.05), but the NbHP gel showed a significant ΔE than other gels, with expressive color alteration at 14 days (P < 0.05). The 35HP showed high cytotoxicity regarding control and the most groups in all periods and extracts analyzed (P < 0.05), while the NbHP showed greater cell viability than control in the immediate period, dilution of the 1:500 and superior to 6HP in the most extracts at 24 h. CONCLUSION: The new experimental niobium-based gel has bleaching efficacy similar to that of gels with a high concentration of HP, and it has high cytocompatibility. CLINICAL RELEVANCE: The use of this new generation of niobium-based whitening gel associated with a low concentration of hydrogen peroxide represents the possibility of a tooth whitening with lower dentin sensitivity.

Anatomical post: a simple and safe alternative

Objective: To describe a clinical case that called for an anatomical post to be made to support and retain an indirect restoration in the anterior tooth. Case report: A 72-year-old female patient came to the office complaining that the crown of tooth 22 had come loose. A clinical and radiographic examination of element 22 was performed, and showed a very broad root canal, total displacement of the cast metal crown-core set, and satisfactory endodontic treatment. The restorative planning for this patient included the making of an anatomical post from Exacto # 2 fiberglass post (Angelus, Brazil), and refilling it with Bulk One composite resin (3M, USA), using self-adhesive resin cement U200 (3M, USA). The reconstruction of the coronary portion of the post was also performed with the same composite resin (Bulk One 3M, USA). The preparation for full crown and temporary restoration was performed in the same session, using self-curing acrylic resin. The all-ceramic crown was molded and cemented in subsequent sessions. Conclusion: The use of anatomical posts with composite resin represents a technically viable alternative for rehabilitating endodontically treated teeth with wide root canals, in cases where conventional prefabricated fiber posts cannot be adapted easily. The advantages that stand out are that these posts can be applied easily, at low cost, and in a single session.

Objetivo: Descrever um caso clínico de confecção do pino anatômico para suporte e retenção de restauração indireta em dente anterior. Relato do Caso: Paciente feminina, 72 anos, compareceu ao consultório queixando-se que a coroa do dente 22 havia "soltado". Realizou-se exame clínico e radiográfico do elemento 22, que apresentou conduto radicular bastante amplo, deslocamento total do conjunto núcleo/coroa e tratamento endodôntico satisfatório. O planejamento restaurador para essa paciente incluiu a confecção de pino anatômico, com pino de fibra de vidro Exato #2(Angelus, Brasil) reembasado com resina composta Bulk One (3M, EUA), utilizando o cimento resinoso autoadesivo U200 (3M, EUA). Foi realizada a reconstrução da porção coronária do pino também com resina composta do tipo Bulk. Realizou-se, na mesma sessão de atendimento, o preparo para coroa total e restauração provisória utilizando dente de estoque e resinaacrílica autopolimerizável. Em sessões seguintes foi realizada a moldagem e cimentação da coroa total em cerâmica pura. Conclusão: A utilização de pinos anatômicos com resina composta representa uma alternativa tecnicamente viável, de fácil aplicabilidade, com baixo custo e em única sessão, para reabilitação de dentes tratados endodonticamente com conduto radicular onde os pinos em fibra pré-fabricados convencionais não apresentam boa adaptação.