Fracture strength of extended class I composite restorations with different restorative techniques.

To evaluate the fracture strength of extended Class I restorations with different restorative techniques using nanofilled and nanohybrid composites. Sixty extracted human third molars were prepared with extended Class I cavities and divided into six groups: groups FS-F (Filtek bulk-fill Flow + Filtek Supreme Ultra, 3 M) and GR-F (X-tra base + GrandioSO, VOCO), restored with a flowable bulk-fill composite as a base covered by a nanofilled or nanohybrid composite; groups FB (Filtek One Bulk-Fill, 3 M) and AF (Admira Fusion X-tra, VOCO), restored with a bulk-fill resin composite; and groups FS (Filtek Supreme Ultra, 3 M) and GR (GrandioSO, VOCO), restored incrementally with a nanofilled or nanohybrid composite. Sound extracted teeth (n = 10) were used as a control group (CTL). The specimens were axially loaded until failure. Data were analyzed using one-way ANOVA and Games Howell test (α = 0.05). Groups CTL and GR-F demonstrated significantly higher mean fracture strength when compared to FS, AF, and GR (p < 0.05). Group AF obtained more repairable fractures than the other groups. Restorations made with a nanofilled bulk-fill composite or with conventional resin composites associated with a flowable bulk-fill base were able to reestablish the fracture strength to that of sound teeth.

Occlusal problems, mental health issues and non-carious cervical lesions.

Non-carious cervical lesions (NCCLs) are characterized by a loss of hard dental tissue near the cement-enamel junction with multifactorial etiology. The aim of this study was to demonstrate that occlusal factors as attrition, malocclusion, and bruxism, and mental disorders as depression, stress, and anxiety are involved in the etiology of NCCLs. Salivary samples and clinical data of 340 individuals selected from 6,112 participants were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository project. The affected group was formed by individuals with NCCL (34 females, 34 males, mean age 55.34 years). In addition, the comparison group was formed by individuals without NCCL (136 females, 136 males, mean age 55.14 years). Eleven single-nucleotide polymorphisms (SNPs) previously associated with mental disorders were genotyped and tested for association with NCCLs. When all occlusal factors were combined there was found a significant association with NCCL (p = 0.000001/adjusted OR 4.38, 95% CI 2.50-7.69). Attrition (OR 3.56, 95% CI 2.00-6.32) and malocclusion (OR 5.09, 95% CI 1.65-15.68) as separate variables showed statistically significant associations with NCCL. There was a significant difference in stress history between the two groups (OR 2.17, 95% CI 1.08-4.39). No associations between NCCLs and the SNPs selected were found. However, when the occlusal factors were analyzed as covariates, associations were found between bruxism and seven of the selected SNPs. Our results suggest that occlusal factors might be associated with NCCLs.

Assessment of the configuration of the mandibular canal using cone beam computed tomography.

BACKGROUND: During dental implants placement and bone augmentation procedures, it is important to determine the presence and location of mandibular canal anatomical variation in order to avoid injuries to inferior alveolar bundle. This study aimed to describe the prevalence and configuration of mandibular canal branching in the posterior region of the mandible using cone beam computed tomography (CBCT). METHODS: The interpretation of the images was conducted according to the presence, classification and location of the mandibular canal. Horizontal and vertical distances from mandibular canal in the ramus region to the molar region was recorded. CBCT images of 751 patients, 486 women (64.7%) and 265 men (35.3%), with a mean age of 54.57 (±13.23; 14-93) years, were interpreted by one calibrated examiner. RESULTS: Out of 1502 hemi-mandibles images, mandibular canal variations were observed in 130 (8.6%). Sixty-four (49.2%) mandibular canal variations were identified on the right side and 66 (50.8%) on the left side. The mean distances between superior cortical of the mandibular canal and the base of mandible, buccal cortical of mandibular canal and buccal cortical bone, and superior cortical of mandibular canal and alveolar ridge were 12.16 mm (±2.68), 4.17 mm (±1.30), and 12.97mm (±4.01), respectively. Type I mandibular canal variation was the most frequent (68; 52.2%), followed by type III (34; 26.1%). CONCLUSIONS: Prevalence of mandibular canal variations was 8.6%, type I was the most common and its direction showed proximity with lingual surface in the second molar region.

One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions.

OBJECTIVE: The aim of this double-blind, randomized trial was to evaluate the 1-year clinical performance of a bulk-fill flowable and a regular nanofilled composite in non-carious cervical lesions (NCCLs). METHODS: Twenty-two subjects with at least two NCCLs were enrolled in the study. A total of 89 restorations were performed by a single operator using Filtek Supreme (FS) Ultra Universal or Filtek Bulk (FB) Fill Flowable. A universal adhesive (Scotchbond™ Universal Adhesive) was used with a self-etching approach in dentin. The restorations were evaluated by two independent and previously calibrated examiners at baseline (7 days), 6 months and 1 year, according to the USPHS modified criteria. Mann-Whitney U test was used to analyze the differences between composites and Wilcoxon signed rank test for comparisons between the baseline and follow-ups (α = 5%). RESULTS: One restoration was considered clinically unacceptable due to loss of retention after 6 months in the FS group. FS presented statistically high scores for surface roughness when compared to FB after 1 year (p < 0.05), but both were considered clinically acceptable. After 1 year, the frequency of clinically unacceptable rates was 3.3% for anatomical form in the FB group, 1.1% for retention in the FS group, and 2.2% for marginal adaptation in both groups. All restorations, in both groups, presented score 0 over the 1-year period for marginal staining, postoperative sensitivity, and secondary caries. CONCLUSION: Both composite resins showed acceptable clinical performances for the restoration of NCCLs after 1 year. CLINICAL RELEVANCE: Both bulk-fill flowable and regular nanofilled composites showed good clinical performances for the restoration of NCCLs after 1 year.

Behaviour and Prevention of 5'Fluorouracil and Doxorubicin-induced Oral Mucositis in Immunocompetent Patients with Solid Tumors: A Randomised Trial.

PURPOSE: This study evaluated the efficacy of four methods to prevent chemotherapy-induced oral mucositis (OM) in patients with solid tumors (ST). In addition, the behaviour of OM was investigated in these oncological patients. MATERIALS AND METHODS: Forty-eight patients, aged 27-84, were randomly allocated to different groups from the first day of chemotherapy (CT), in the following sequence: group 1: intensive oral care programme (IOCP); group 2: 0.12% chlorhexidine mouthrinse; group 3: 0.03% triclosan mouthrinse; group 4: low-level laser therapy (LLLT). Oral mucositis was evaluated on the 7th and 14th days by means of the Oral Mucositis Assessment Scale (OMAS). RESULTS: Thirty-one (64.5%) patients developed OM in the first cycle of CT and the pain was significantly associated with OM severity (p < 0.0001). The statistically significantly worst OMAS score was found for the lips and buccal mucosa (p < 0.0001). Despite a lack of statistical significance, IOCP and LLLT notably demonstrated potential effects to prevent OM in patients who presented with only oral erythema (75%) and lower peak of severity during the follow up, respectively. CONCLUSIONS: Improved oral care awareness is needed in patients undergoing 5'fluorouracil and doxorubicin, mainly to avoid pain caused by oral mucositis. Oral mucositis was more prevalent and aggressive in oral sites exposed to chronic trauma. The IOCP and LLLT approaches showed positive results to prevent oral mucositis and should be further investigated in similar and larger samples.

Sialometric and Sialochemical Changes in Morbidly Obese Patients before and after Bariatric Surgery.

AIM: To evaluate the sialometric and sialochemical changes in morbidly obese patients before and after bariatric surgery. MATERIALS AND METHODS: A total of 74 participants were divided into three groups paired by sex and age: (a) Experimental 1 (E1)-morbid obesity (n = 40)-according to the Fobi-Capella technique, corresponding to the individuals with a body mass index (BMI) of greater than 40 kg/m2 prior to bariatric surgery; (b) Experimental 2 (E2)-the same individuals after surgery; and (c) control (C) (n = 34)-individuals with a BMI of nearly 23 kg/m2. The measure of salivary flow was carried out by collecting stimulated saliva. The pH was evaluated using the pocket pH meter, while the salivary buffer capacity (SBC) was determined by the titration method. Analyses of the salivary concentration of total proteins (TPs), amylase activity, urea, calcium (Ca++), and glucose were evaluated using the calorimetric method. RESULTS: Group E1, as compared with group C, presented the highest pH levels (p = 0.03), amylase activity (p = 0.00), and calcium (p = 0.00). The opposite was observed for glucose (p = 0.00), TP (p = 0.04), and urea (p = 0.04). Group E2, as compared with group C, revealed higher levels of amylase (p = 0.00) and calcium (p = 0.00). The opposite was observed for SBC (p = 0.01), PT (p = 0.00), and glucose (p = 0.00). Group E1, as compared with group E2, presented higher values of SBC (p = 0.00) and urea (p = 0.00). The lowest values were found for calcium and urea (p = 0.03). CONCLUSION: Both weight gain and bariatric surgery are risk factors for the oral condition, causing change in some important salivary components, such as TP, amylase, calcium, and glucose. CLINICAL SIGNIFICANCE: This article is a valuable addition to the scientific literature, due to its novelty. There are no papers that show salivary alterations related to bariatric surgeries.

Clinical efficacy of resin-based materials for dentin hypersensitivity treatment.

PURPOSE: To evaluate the effect of three resin-based materials in the treatment of dentin hypersensitivity (DH) up to a 6-month follow-up. METHODS: 30 participants (179 teeth) with DH were enrolled in this randomized, double-blind, controlled clinical study. The teeth were randomly allocated into one of three groups: CV (resin-modified glass ionomer varnish - Clinpro XT Varnish), CP (fluoride-containing self-etch adhesive - Clearfil SE Protect) and GB (glutaraldehyde-containing etch-and-rinse adhesive - Gluma 2 Bond). The materials were applied according to the manufacturer's instructions. DH was evaluated by subjects' perception measured on a 0-10 visual analog scale (VAS) after evaporative (air blast) stimuli. The scores were recorded at baseline, immediately and at 1, 3 and 6 months after treatment. The data were analyzed by a two-way ANOVA with repeated measures for "time" and Games-Howell test (α = 0.05). RESULTS: ANOVA detected statistically significant differences among the time intervals, but not among the materials or interactions. There was a significant decrease in sensitivity scores from baseline to all the time points (P< 0.05). However, the differences were not statistically significant among the follow-ups, from immediately until 6 months after treatment (P> 0.05). All the resin-based materials were able to reduce DH up to 6 months after treatment. CLINICAL SIGNIFICANCE: Resin-based materials used as desensitizing agents were effective in reducing DH after a 6-month period and so could be recommended as a safe treatment for sensitive teeth.

Effects of Benzodiazepines on Acinar and Myoepithelial Cells.

BACKGROUND: Benzodiazepines (BZDs), the most commonly prescribed psychotropic drugs with anxiolytic action, may cause hyposalivation. It has been previously shown that BZDs can cause hypertrophy and decrease the acini cell number. In this study, we investigated the effects of BZDs and pilocarpine on rat parotid glands, specifically on acinar, ductal, and myoepithelial cells. METHODS: Ninety male Wistar rats were divided into nine groups. Control groups received a saline solution for 30 days (C30) and 60 days (C60), and pilocarpine (PILO) for 60 days. Experimental groups received lorazepam (L30) and midazolam (M30) for 30 days. Another group (LS60 or MS60) received lorazepam or midazolam for 30 days, respectively, and saline for additional 30 days. Finally, other groups (LP60 or MP60) received either lorazepam or midazolam for 30 days, respectively, and pilocarpine for additional 30 days. The expression of calponin in myoepithelial cells and the proliferating cell nuclear antigen (PCNA) in acinar and ductal cells were evaluated. RESULTS: Animals treated with lorazepam showed an increase in the number of positive staining cells for calponin as compared to control animals (p < 0.05). Midazolam administered with pilocarpine (MP60) induced an increase in the proliferation of acinar and ductal cells and a decrease in the positive staining cells for calponin as compared to midazolam administered with saline (MS60). CONCLUSION: We found that myoepithelial cells might be more sensitive to the effects of BZD than acinar and ductal cells in rat parotid glands.

Histomorphometric analysis of salivary gland in wistar rats treated chronically with two benzodiazepines.

Benzodiazepines (BZDs), the most commonly prescribed psychotropic drugs with anxiolytic action, may cause hyposalivation. Therefore, this study sought to quantify the acini (N) in parotid glands of Wistar rats treated chronically with two BZDs (Lorazepam and Midazolan) and to verify the action of the pilocarpine when administered with these drugs. Ninety male Wistar rats were distributed in 9 groups according to the administration of: a) S30 - saline solution for 30 days; b) S60 - saline solution for 60 days; c) P60 - pilocarpine for 60 days; d) L30 - Lorazepam for 30 days; e) M30 - Midozolam for 30 days; f) LS60 - Lorazepam for 60 days and, after this period, 30 more days of saline solution; g) MS60 - Midazolam for 30 days and, after this period, 30 more days of saline solution; h) LP60 - Lorazepam and Pilocarpine for 60 days; i) MP60 - Midazolam and Pilocarpine for 60 days. A surgery was performed on the animals to remove the glands. After this, histological cuts were stained by hematoxylin and eosin, from which the N was quantified. The ANOVA and Games-Howell tests were used for statistical analysis. The L30 and M30 groups presented less N than did the S30 group (p<0.05). The LS60, MS60, and LP60 groups presented less N than did the S60 and P60 groups (p<0.05). No differences could be observed between the MP60 and S60 groups. The chronic administration of Midazolam and Lorazepam reduced acini, which may well have collaborated in the reduction of salivary flow previously verified. The association of Midazolam with Pilocarpine led to the reestablishment of acinar cells, which may have favored the restoration of the salivary flow formerly shown.

Oral health in Brazilian patients with chronic renal disease.

BACKGROUND: Poor oral health status may have an impact on the health status of patients with chronic renal failure. AIM: To describe the oral health status of a group of Brazilian patients with chronic renal failure. MATERIAL AND METHODS: Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index. RESULTS: The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. CONCLUSIONS: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Oral health in Brazilian patients with chronic renal disease / Salud oral en pacientes brasileños con insuficiencia renal crónica

Background: Poor oral health status mayhave an impact on the health status of patients with chronic renal failure. Aim: To describe the oral health status of a group of Brazilian patients with chronic renal failure. Material and methods: Retrospective review of the medical records of patients with chronic renal failure, ofwhom 13 (4.5 percent) werein apre dialysis stage, 158 (55 percent) were on hemodialysis, 23 (8.4 percent) were on peritoneal dialysis and 92 (32.1 percent) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) índex. Resulte: The sample was composed of 152 men (53 percent) and 134 women (47 percent), aged 42±13 years. Oral health status was considered defective in most patients (83 percent). Eighty-seven percent had dental calculus and 55 percent had halitosis. Transplant patients reponed significantly less halitosis (40.2 percent) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. Conclusions: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Introducción: Las alteraciones de la cavidad oral pueden tener impacto en la salud de pacientes con insuficiencia renal crónica. Objetivo: Describir la salud oral de pacientes brasileños con insuficiencia renal crónica. Material y métodos: Revisión retrospectiva de las fichas dentales de pacientes con insuficiencia renal crónica, de los cuales 13 (4,5 por ciento) estaban en etapa prediálisis, 158 (55 por ciento) estaban en hemodiálisis, 23 (8,4 por ciento) estaban en peritoneodiálisis y 92 (32,1 por ciento) habían sido trasplantados. Se registró la salud oral general, la presencia de tártaro y halitosis. El número de piezas faltantes y obturadas fue analizado utilizando el índice DMF-T (Decayed, Missed and Filled Teeth o dientes con cañes, faltantes y obturados). Resultados: La muestra estaba constituida por 152 hombres y 134 mujeres con una edad promedio de 42±13 años. La salud dental general era deficitaria en 83 por ciento y 87 por ciento tenía tártaro. El 55 por ciento tenía halitosis y ¡os pacientes trasplantados tenían este problema con una frecuencia significativamente menor que el resto de ¡os grupos. El índice DMF-T global fue 20,6 y tuvo una correlación positiva con la edad. Conclusiones: La salud oral de estos pacientes con insuficiencia renal crónica es mala. Es importante implementar programas de tratamiento dental para estos pacientes para evitarla exposición a patógenos que pueden causar complicaciones sistémicas.