Evaluation of Proanthocyanidin-based dentifrices on dentin-wear after erosion and dental abrasion - In situ study.

Background: Proanthocyanidin has been considered as a preventive agent against erosion because of its properties, which involves remineralization, reduction of demineralization and matrix metalloproteinases (MMPs) inhibition. Thus, the aim of this in situ study was to evaluate the effect of proanthocyanidin-based dentifrices on wear resistance of dentin specimens subjected to erosion associated with abrasion. Material and Methods: This crossover double-blinded study was performed in 5 phases of 5 days each, with 10 healthy volunteers who wore 5 palatal devices (1 for each phase) with 4 dentin specimens. The groups under study were: G1 - placebo dentifrice (negative control group); G2 - 0.012% chlorhexidine dentifrice (1st positive control group); G3 - NaF 1110 ppm fluoride dentifrice (2nd positive control group); G4 - 10% purified proanthocyanidin dentifrice (1st test group); G5 - fluoride + proanthocyanidin dentifrice (2nd test group). Erosion was performed by palatal device immersion in acid beverage (Coca-cola®), 3 times daily for 5 minutes during 5 days. Abrasion was applied after the first and third erosive cycles by using a eletric toothbrush during 15 seconds in each specimen with the application of the studied dentifrices slurry. The response variable was depth of dentin loss (µm) measured by profilometry. Data were analyzed by Repeated Measures Analysis of Variance followed by LSD Fisher's test (p<0.05). Results: Data (G1: 1.76 ± 0.55A; G2: 1.19 ± 0.42B; G3: 1.29 ± 0.34B; G4: 0.93 ± 0.38C; G5: 0.82 ± 0.34C) showed that G4 and G5 did not presented significant difference between them, but showed less dentine loss when compared to all other groups. G1 presented the highest dentin wear. Conclusions: Proanthocyanidin and the combination of proanthocyanidin and fluoride dentifrices revealed the best results, showing that these formulations could be a promising alternative for patients who suffer with dentin erosion. Key words:Dentin, erosion, cross-liking agent, metalloproteinases, toothpastes.

Dentin bond strength evaluation between a conventional and universal adhesive using etch-and-rinse strategy

Aim: The aim of this study was to compare the microtensile bond strength (µTBS) and the characteristics of the adhesive interface of Scotchbond Universal - SU ­ etch-and-rise mode (3M ESPE) and Adper Scotchbond Multi-Purpose - MP (3M ESPE) to dentin over time. Methods: Class I cavity preparations were performed in 60 human molars that were randomly divided according to the dentin bonding system (DBS) used (n=30): (1) Acid conditioning + SU and (2) Acid conditioning + MP. For bonding strength (BS) analysis, 30 teeth (n = 15) were sectioned into sticks and submitted to the microtensile test in a universal testing machine after 24 hours and 12 months. The adhesive interface of the others 30 teeth was analyzed in a confocal microscope after 24 hours and 12 months. The data of µTBS were analyzed by two-way repeated measures ANOVA and Tukey's HSD (α = 0.05). Results: SU presented the lowest DBS compared to MP (p=0.000). Time did not influenced DBS for both adhesive systems (p=0.177). Confocal microscopy analysis showed no cracks between both adhesive systems tested. Conclusion: The results indicate that MP - µTBS showed a better performance compared to SU in total-etch mode

Caso clínico de confecção de laminados cerâmicos minimamente invasivos: importância do domínio do sistema CAD-CAM como um dos fatores de sucesso / Case report of manufacturing of minimally invasive ceramic laminates: importance of the CAD-CAM system domain as one of the success factors

Atualmente, os procedimentos minimamente invasivos vêm sendo cada vez mais realizados, tanto para restaurações diretas quanto para restaurações indiretas. O surgimento dos laminados cerâmicos minimamente invasivos, comumente conhecidos como "lentes de contatos", permitem a confecção de restaurações cerâmicas com o mínimo de espessura para a cimentação. O sistema CAD/CAM possui muitas vantagens sendo possível confeccionar uma restauração indireta em poucos minutos, diminuindo etapas laboratoriais e, principalmente, a possibilidade de fresar restaurações cerâmicas com pouca espessura. No entanto, o conhecimento e o treinamento prático para utilização desse sistema são fundamentais para o sucesso clínico em casos de facetas minimamente invasivas. O presente relato de caso clínico destaca o insucesso de restaurações minimamente invasivas em dentes anteriores inferiores confeccionadas pelo sistema CAD/CAM e discute a necessidade do conhecimento do software do sistema para evitar o fracasso das restaurações (AU).

Nowadays, the minimally invasive procedures have been realized, for direct restorations as well as for indirect restorations. The appearance of the minimally invasive ceramic laminate veneers, commonly known as "contact lens", allow the construction of ceramic restorations with minimum thickness for cementation. The CAD/CAM system has many advantages being possible to make an indirect restoration obtaining in a few minutes, reducing laboratorial steps and, mainly, the possibility of milling a restoration with little thickness. However, the knowledge and the practical training of this system are fundamental to have clinical success in cases of minimally invasive veneer. The present case report emphasizes the failure of minimally invasive restorations in lower anterior teeth made in the CAD/CAM system and discusses the need to know the system software to avoid failure of restorations (AU).

Estratégias para realização de clareamento e restaurações adesivas em sessão única ­ relato de casos / Strategies to perform bleaching and adhesive restoration in one session ­ cases report

Tratamentos estéticos com demanda por excelência são corriqueiros nas clínicas odontológicas especializadas, sendo cada vez mais procurados e realizados em sessão única de tratamento. Esses procedimentos com sessão única podem ser indicados por imediatismo, urgência dos pacientes ou pela indisponibilidade de locomoção, uma vez que muitos pacientes buscam tratamentos especializados em cidades distantes de suas residências. O presente relato de dois casos clínicos descreve as técnicas e estratégias de tratamento para realização do clareamento dentário e de restaurações adesivas na mesma sessão, por meio da utilização de agentes antioxidantes. O clareamento em consultório foi realizado com gel de peróxido de hidrogênio 35% (Lase peróxido de Flex, DMC), ativado com LED (Laser BrightMax Quattro, MMO). Em função da presença de íons oxigênio na matriz do esmalte e dentina após o clareamento dental, esses íons podem inibir a adequada polimerização dos sistemas adesivos e da resina composta, comprometendo o procedimento restaurador. Sendo água bicarbonatada (Neutralize, Lase peróxido Flex Kit, DMC) aplicada para remover o oxigênio residual, após preparo cavitário e antes do condicionamento ácido e aplicação do adesivo. As restaurações foram realizadas com técnica incremental e resina composta cor A2/B2 de dentina (NG brilhante, Coltene) e A1/B1 de esmalte (NG brilhante, Coltene). Os procedimentos de acabamento e polimento também foram realizados na mesma sessão. Após 3 meses de controle foi possível observar, que em ambos os casos, o tratamento estético obteve bastante sucesso, sem qualquer deterioração visível da interface resina-esmalte (AU).

Aesthetic treatments with demand for excellence are commonplace in specialized dental clinics, increasingly popular and performed in a single treatment session. These procedures performed in a single session may be indicated by immediacy, patients urgency or unavailability of transportation, since many patients seek specialized treatment in cities far away from their homes. This report of two cases describes treatment techniques and strategies to perform dental bleaching and adhesive restorations in the same session through the use of antioxidants. Bleaching was carried out in-office with 35% hydrogen peroxide gel (Lase Peroxide Flex, DMC), activated with LED (Laser BrightMax Quattro, MMO). Due to the presence of oxygen ions in the enamel matrix and dentin after bleaching, these ions can inhibit the proper polymerization of the adhesive systems and composite resin, compromising the restorative procedure. Bicarbonated water (Neutralize, Lase Peroxide Flex Kit, DMC) is applied to remove residual oxygen after cavity preparation and before the acid etching and adhesive application. Restorations were performed with incremental technique and composite dentin color A2/B2 (bright NG, Coltene) and A1/B1 enamel (bright NG, Coltene). Finishing and polishing procedures were also performed in the same session. After 3 months, it was observed that in both cases, the aesthetic treatment achieved great success without any visible deterioration of the resin/enamel interface (AU).

O uso da imagem fotográfica como método adicional de diagnóstico para regiões de cicatrículas e fissuras pigmentadas de dentes permanentes / The use of the photographic image as an additional diagnostic Method for regions of pits and fissures of permanent teeth pigmented "evaluation in vivo and in vitro"

O diagnóstico de cárie em estágio inicial é ainda um desafio, principalmente nas regiões oclusais de fóssulas e fissuras, que muitas vezes encontram- se pigmentadas gerando dúvida ao clínico quanto à necessidade de intervenção. O objetivo deste trabalho foi avaliar um método adicional clínico de diagnóstico de lesões cariosas de cicatrículas e fissuras através de imagens fotográficas. Este estudo foi realizado in vivo, em 18 indivíduos selecionados dentre os pacientes em atendimento odontológico nas clínicas de Dentística da FOB-USP e que possuiam molares permanentes com sulcos e fissuras pigmentados. Os dentes (n= 62) foram examinados clinicamente e através das imagens fotográficas digitais com aumento de 1:1 por 3 examinadores independentes que determinaram se o dente deveria receber intervenção terapêutica com preparo cavitário e restauração. Um estudo paralelo foi realizado in vitro, com o exame de 60 molares extraídos e fixados em um manequim odontológico, feito pelos mesmo examinadores da etapa in vivo e, também, pelo exame de fotografias digitais. O exame radiográfico digital foi realizado e, em seguida, os dentes foram seccionados em máquina de corte digital ISOMET® 1000, com disco diamantado dupla face Diamond Wafering Blade, perpendicularmente à superfície oclusal em cortes no sentido do sulco principal e novamente analisados pelos 3 avaliadores para a identificação da presença de lesão cariosa. Os dados foram avaliados pela estatística Kappa e pelo teste Qui-Quadrado (p<0,05). Os valores de Kappa interexaminador para as avaliações in vivo foram para análise visual: 0,65-0,55-0,53 e fotográfico: 0,79-0,89-0,89. Para as análises in vitro, os valores para o exame visual foram: 0,85-0,65-0,78 e fotográfico: 1- 0,86-0,86. Para a etapa in vitro o teste Qui-Quadrado demostrou que somente o exame clínico visual apresentou uma leve associação com as fatias (p= 0,036), porém para o exame fotográfico o valor de p foi de (p= 0,918)...

The diagnosis of caries in early stage is still a challenge, especially in pigmentesd pit and fissure surfaces of posterior teeth. The purpose of this study was to evaluate the use of digital photographic images as an additional method to diagnose caries lesion in early stages.This in vivo and in vitro study was realized by examining 62 molars of 18 patients of the Restorative Dentistry Clinic of FOB- USP. The teeth were examined by 3 independent examiners who determined wether the tooth should be or not submitted to a cavity preparation and restoration. The same teeth were photographed and the digital images with 1:1 increase size were blind examined by the same examiners.The decision of the need of intervention was confronted by the two methods. A parallel study "in vitro" was conducted with 60 extracted human molars fixed in a dental manikin for to use of a digital photographic image as a diagnostic additional method for pit and fissure lesions, a study. The same examiners analyzed the oclusal surface and the correspondent digital photographic images. The decision of the need of intervention was confronted by the 2 methods. The extracted teeth were then sectioned in an ISOMET® 1000 digital cutting machine, witch doublé diamond disc face Diamond Wafering Blade, perpendicular to the occlusal surface cuts and examined by the 3 examers to identifying the presence of carious lesions. Kappa intra and inter examiners were for in vivo visual analysis 0.65- 0.55- 0.53 and in vivo photographic analysis: 0.79 -0.89 - 0.89. For in vitro visual analyzes were: 0.85- 0.65- 0.78 and in vitro photographic analysys: 1-0.86- 0.86. Data were evaluated by chi-square test (p < 0.05) showed that only the visual clinical examination showed as light association with the cuts (p = 0.036) and for the photographic examination (p = 0.918). The decision made by the examiners of the need of intervention on the pit and fissure surfaces was confronted with the examination...

Micro-sized erosions in a nanofilled composite after repeated acidic beverage exposures: consequences of clusters dislodgments

Objective: To evaluate the hardness (KHN), color stability (DE), and superficial micromorphology of two categories of composites after immersion in either distilled water or grape juice for up to 45 days. MATERIAL AND METHODS: Cylindrical specimens (6 mm diameter x 2 mm thick) were obtained according to the factors: composite [Opallis (FGM) and Filtek Z350XT (3M ESPE)]; immersion solution (distilled water and grape juice); and evaluation time: 24 h and 7, 14, 21, 28, and 45 days. After photoactivation, the specimens were stored at 37ºC for 24 h. KHN (50 g/15 s) and ΔE were then repeatedly assessed according to the immersion solutions. Data were analyzed (three-way ANOVA/Tukey's test). Scanning electron microscopy (SEM) topographic analysis was also performed. RESULTS: In general, KHN of both composites reduced after 24 h, irrespective of the immersion solution and time. A significantly lower KHN was noted for Opallis compared with Filtek Z350XT in all parameters. An increase in ΔE over time was noted for both composites, irrespective of the immersion solution. Significantly higher ΔE was noted for Filtek Z350XT immersed in grape juice compared with Opallis, regardless of the evaluation time. The grape juice caused significantly higher DE compared with water in all periods. SEM analysis showed eroded areas for Filtek Z350XT but not for Opallis. CONCLUSIONS: The compositions and immersion solutions influence the composite hardness and the color stability. In spite of the higher hardness, the nanofilled composite is more susceptible to color change than the microhybrid when immersed in an acidic dyed solution. .

Micro-sized erosions in a nanofilled composite after repeated acidic beverage exposures: consequences of clusters dislodgments.

OBJECTIVE: To evaluate the hardness (KHN), color stability (DE), and superficial micromorphology of two categories of composites after immersion in either distilled water or grape juice for up to 45 days. MATERIAL AND METHODS: Cylindrical specimens (6 mm diameter x 2 mm thick) were obtained according to the factors: composite [Opallis (FGM) and Filtek Z350XT (3M ESPE)]; immersion solution (distilled water and grape juice); and evaluation time: 24 h and 7, 14, 21, 28, and 45 days. After photoactivation, the specimens were stored at 37 ºC for 24 h. KHN (50 g/15 s) and ΔE were then repeatedly assessed according to the immersion solutions. Data were analyzed (three-way ANOVA/Tukey's test). Scanning electron microscopy (SEM) topographic analysis was also performed. RESULTS: In general, KHN of both composites reduced after 24 h, irrespective of the immersion solution and time. A significantly lower KHN was noted for Opallis compared with Filtek Z350XT in all parameters. An increase in ΔE over time was noted for both composites, irrespective of the immersion solution. Significantly higher ΔE was noted for Filtek Z350XT immersed in grape juice compared with Opallis, regardless of the evaluation time. The grape juice caused significantly higher DE compared with water in all periods. SEM analysis showed eroded areas for Filtek Z350XT but not for Opallis. CONCLUSIONS: The compositions and immersion solutions influence the composite hardness and the color stability. In spite of the higher hardness, the nanofilled composite is more susceptible to color change than the microhybrid when immersed in an acidic dyed solution.