Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

Health changes during Covid-19: a nationwide study with dental students.

OBJECTIVE: To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. METHODS: An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). RESULTS: A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = -0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). CONCLUSIONS: Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Health changes during Covid-19: a nationwide study with dental students

ABSTRACT OBJECTIVE To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. METHODS An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). RESULTS A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = −0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). CONCLUSIONS Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Repair Bond Strength and Leakage of Non-Aged and Aged Bulk-fill Composite.

PURPOSE: This study evaluated repair protocols of a non-aged and aged bulk-fill composite in terms of bond strength and leakage. MATERIALS AND METHODS: Ninety-six bulk-fill resin specimens were constructed; half were submitted to thermocycling. Specimens were divided into six groups (n = 16) according to the repair treatments: CG: no repair (control group); Ad: adhesive; DbAd: abrasion with diamond bur + adhesive; SbAd: sandblasting + adhesive; DbSiAd: abrasion with diamond bur + silane + adhesive; and SbSiAd: sandblasting + silane + adhesive. Resin blocks were bonded to the treated surfaces to simulate repair, and the specimens were submitted to microtensile bond strength testing. The failure area was evaluated under a stereomicroscope (40X magnification), and leakage after specimen immersion in silver nitrate solution for 24 h was evaluated under a microscope (200X magnification). Three-way ANOVA (surface treatment, chemical agent, aging) and Tukey's test were performed. RESULTS: Ad and DbAd groups showed the lowest bond strengths, while Ad was the only group negatively influenced by aging. The other groups were statistically similar to the CG in both conditions. All groups exhibited leakage, but groups without silane presented a greater percentage of leakage, mainly when diamond burs were used. Thermocycling did not influence leakage, nor did surface treatment in groups with silane. CONCLUSION: For composite repair, the use of silane is recommended, mainly when diamond burs are used as a mechanical surface treatment.

Effect of cleaning protocol on silica deposition and silica-mediated bonding to Y-TZP.

OBJECTIVES: To evaluate the effect of cleaning methods on the deposition of silica on yttria-stabilized zirconium dioxide (Y-TZP) surface and on the silane-silica mediated bond strength between Y-TZP and resin cement. METHODS: Y-TZP slabs were air-abraded with 30µm silica-coated alumina particles and distributed in three groups: no cleaning, cleaning with a stream of oil-free air/water spray for 5s and cleaning with an ultrasonic bath in water for 10min. The distribution of Si on the Y-TZP surfaces was recorded using energy dispersive spectroscopy (EDS). After the treatment was applied, Y-TZP slabs (n=20) received a primer application and resin cement cylinders were built on the surface. After storage (24h) in water storage or 3 months plus thermocycling; n=10), microshear bond strength test (µSBS) was performed. X- ray Photoelectron Spectroscopy (XPS) characterized the chemical bonds between the silica layer and the silane-containing primer. Data were analyzed using ANOVA and Tukey test, as well as Weibull analysis (α=0.05). RESULTS: Cleaning method had a significant effect on the amount of Si deposited on zirconia surface (p<0.001) and, consequently, on bond strength (p<0.001). Storage/aging also had a significant effect on bond strength (p<0.001). Low values of Weibull moduli for bond strength were observed for all groups after aging. XPS showed silane-silica chemical interaction for all groups. SIGNIFICANCE: The silica deposited by tribochemical coating to Y-TZP was removed by the cleaning methods evaluated, compromising bond strength. Stability of the bonding is also a concern when no cleaning method is applied.

Effect of silane and MDP-based primers on physico-chemical properties of zirconia and its bond strength to resin cement.

OBJECTIVE: To evaluate the effect of surface treatments on yttria-tetragonal zirconia polycrystal (Y-TZP) characteristics and on resin-mediated zirconia bond. METHODS: Y-TZP slabs were grit blasted with 45µm alumina or with 30µm silica-coated alumina particles. The chemical treatments were: no-chemical treatment (NC), silane-containing primer (SP), MDP (10-Methacryloyloxydecyl dihydrogen phosphate) and silane-containing primer (MPS), MDP-containing primer (MP) and MDP and silane-containing adhesive (MPA). Contact angle as a function of surface roughness (θm) and surface roughness parameter (Sdr) were measured using Fringe Projection Phase Shifting (FPPS). Surface free energy (γsTOT) was calculated with a goniometer. Chemical interaction between primers/adhesive and zirconia was analyzed using time-of-flight secondary ion mass spectrometry (ToF-SIMS). Resin cement microshear bond strength (µSBS) was analyzed at either 24-h or 8-months water storage (37°C). θm values, Sdr values, γsTOT and µSBS values were analyzed using Analysis of variance (ANOVA) and post hoc Tukey test (α=0.05). RESULTS: Chemical treatment had an effect (p<0.001) on all surface parameters analyzed: θm, γsTOT and Sdr. MP-treated group showed higher incidence of P-O-Zr bonds than the other groups, indicating more chemical linkages. Grit blasting (p<0.001) and the interaction chemical treatment*storage (p<0.001) did not affect µSBS; all silane-containing primers showed significant drop in µSBS after aging. SIGNIFICANCE: MDP and/or silane-based solutions affect the physicochemical properties of blasted-zirconia. An MDP-based primer is fundamental to achieve a stable resin-zirconia bonding, but the chemical reactivity of MDP is impaired when this molecule is present in a multicomponent system.

Effects of primer excess on marginal adaptation, nanoleakage and bond strength of adhesive systems after aging

There is no consensus about the amount of primer inserted into the cavity. Aim: This study aimed to evaluate the effects of the amount of primer used on dentin microtensile bond strength (µTBs), nanoleakage and marginal sealing, following thermomechanical aging. Methods: 48 human third molars were selected and a box-shaped class I cavity was constructed to maintain enamel margins. Teeth were randomly assigned to 6 experimental groups (n=8). For the bonding protocols of the restorative procedure, two adhesive systems were used: three-step etch-and-rinse and two-step self-etch. Epoxy resin replicas of the occlusal surface were made, and the specimens were submitted to thermomechanical aging. Newer replicas were obtained after thermomechanical aging, and marginal adaptation was observed using SEM. To obtain sections (0.7 x 0.7 mm) for testing at a tension of 0.5 mm/min, teeth were serially sectioned in the buccallingual direction, parallel to the occlusal surface. Failure mode was then obtained. For nanoleakage evaluation, one section of each tooth was immersed in AgNO3 and evaluated using SEM. The µTBs data were submitted to a two-way ANOVA and Tukey's test (α= 0.05) Results: One drop of primer promoted higher µTBs than two or three drops. Besides, the three-step etch-and-rinse promoted greater µTBs (19.78) than the two-step self-etch adhesive (12.23). The increase in the amount of primer was directly proportional to the increase of infiltration. All groups exhibited more gaps after thermomechanical aging. Conclusion: Using an excess of primer is not recommended because it reduces the µTBs and forms an unsatisfactory hybrid layer

Influence of whitening dentifrices and mechanical brushing on color change and surface roughness of bulk fill resins

The use of whitening dentifrices during oral hygiene may cause surface modifications such as color change (ΔE) and increase surface roughness (Ra) of composite resin. Aim: This study aimed to evaluate the effect of whitening dentifrices and mechanical brushing on color change and surface roughness of Bulk Fill (Filtek Bulk Fill - F) and (Aura Bulk Fill - A) composite resins. Materials and methods: Sixty cylindrical specimens were fabricated of each composite resin. After initial color evaluations (Konica Minolta CM-700d), with D65 standard illuminant, and the surface roughness (Surfcorder SE 1700, Kosalab), the specimens were assigned (n=10) according to the whitening dentifrice used: True White (T), Colgate Total 12 Professional Whitening (D), Luminous White Advanced (L). Specimens were submitted to mechanical brushing (10,000 cycles); new color and surface roughness evaluations were taken. Data were analyzed by ANOVA, Duncan test and Dunnet test were used to identify differences between groups (α=5%). Results: The results showed that the tooth brushing time promoted a significant increase in ΔE of the FT group. The FD group exhibited intermediate values of ΔE and was similar to all groups tested. There was a significant increase in the surface roughness of the AD and AT groups after the mechanical tooth brushing. Conclusion: The results showed no significant changes were observed in surface roughness for F groups after toothbrushing. It be concluded that the color change and surface roughness of the composite resins after toothbrushing are dependent on the interaction between the composition of the composite resin and the characteristics of the dentifrice

Reabilitação da estética na recuperação da harmonia do sorriso: relato de caso / Rehabilitation of esthetics in recovering smile harmony: case report

Objetivo: este trabalho tem o objetivo de relatar um caso clínico no qual a abordagem restauradora direta com resina composta foi empregada para remodelação estética após tratamento ortodôntico em uma pacientecom os incisivos laterais superiores com morfologia conoide. Relato de caso: o paciente, 24 anos, gênero feminino, procurou tratamento odontológico queixando-se da aparência dos incisivos laterais superiores, que se apresentavam fora dos padrões de tamanho e forma devido à existência de uma alteração de estrutura. No exame clínico, constatou-se a presença dos incisivos laterais conoides, dentes 12 e 22. Após o exame radiográfico, que demonstrou ausência de alteração da forma radicular desses elementos, foi planejada a reabilitação funcional e a recuperação estética por meio de restaurações diretas com resina composta. Para reabilitar os elementos estética e funcionalmente, optou-se pela reanatomização, utilizando-se resina composta pela técnica da mão livre, por ser um procedimento mais rápido e de menor custo, por dispensar a etapa de enceramento e moldagem. Todavia, essa técnica apresenta comodesvantagem a necessidade de mais habilidade e treinamento do operador. Considerações finais: as resinas compostas permitem uma resolução de maneira rápida e com elevado desempenho estético, apresentando resultado satisfatório, desde que sejam respeitadas suas indicações, compreendidas suas limitações e que a etapa de ajuste oclusal não seja negligenciada.