Brazilian primary dental care in a universal health system: Challenges for training and practice.

OBJECTIVES: To report the challenges for training and practice for the Brazilian primary dental care in a universal health system. METHODS: Health, education and protection rights against poverty are guaranteed by the 1988 Brazilian Constitution and public health in Brazil is provided by the Unified Health System (SUS), one of the largest public health systems in the world. According to SUS, every Brazilian citizen has the right to free primary oral health care as secondary and tertiary care, offering a unique opportunity to integrate oral care within general health care. RESULTS: The Brazilian undergraduate Dental curriculum was updated in 2021 aiming to graduate general practitioners with a major in comprehensive health care in primary health care, integrated with public and general health. This curriculum update requires at least 20% of the academic hours to be exercised outside the university walls (extramural or community work), preferably within the SUS. CONCLUSIONS: Considering the World Health Organization (WHO) agenda, Brazil needs to advance the innovative oral health workforce, the integration of oral health into primary care, the population access to essential dental medicines and optimal fluorides for caries control. CLINICAL SIGNIFICANCE: It is necessary political action and the engagement of multiple stakeholders, mainly from the health and education sectors, to improve primary health care.

Influence of printing orientation on mechanical properties of aged 3D-printed restorative resins.

OBJECTIVE: To evaluate the influence of printing orientation on flexural strength (σf) and elastic modulus (E) of different 3D printing dental restorative resins. METHODS: Bar-shaped specimens (n = 20) were fabricated from two SLA-printed resins (FT- Formlabs Temporary, and FP- Formlabs Permanent) and two DLP-printed resins (DFT- Detax Freeprint Temp, and GCT- GC Temporary) using two building orientations (0º and 90º). The 3D-printed structures were aged (14 d) before submitted to three-point bending in 37ºC distilled water at a crosshead speed of 1.0 ± 0.3 mm/min until fracture to calculate the σf and the E values. The fractured surfaces were evaluated using stereomicroscopy and scanning electron microscopy (SEM) following fractography principles. Data were statistically analyzed using two-way ANOVA and Tukey post-hoc (α = 0.001). RESULTS: FP and FT showed significantly higher E values than DFT and GCT, irrespectively of printing orientation (p < 0.001). There was no statistical difference between the building orientations (0º and 90º) for the mean σf and E values for the resin materials evaluated. Fractographic characteristics were similar for the surface fracture from all the materials evaluated, showing typical brittle fracture behavior. SIGNIFICANCE: Printing orientation did not influence of flexural strength and elastic modulus values for the 3D-printed resin structures evaluated. Surface topography was mostly governed by the 3D printer type.

Biomechanical Behavior of a 3D-Printed Denture Base Material.

PURPOSE: To evaluate relevant material properties (flexural strength [σf], elastic modulus [E], water sorption [Wsp] and solubility [Wsl], and biocompatibility) of an additive manufacturing (AM) polymer vs a heat-curing acrylic resin (AR; control) for the manufacture of complete dentures, testing the hypothesis that fabrications from both materials would present acceptable material properties for clinical use. MATERIALS AND METHODS: The σf, E, Wsp, and Wsl were evaluated according to the ISO 20795-1:2013 standard, and the biocompatibility was evaluated using MTT and SRB assays. Disk-shaped specimens were fabricated and used for Wsp (n = 5), Wsl (n = 5), and biocompatibility (n = 3) testing. For assessment of σf and E, bar-shaped specimens (n = 30) were fabricated and stored in 37°C distilled water for 48 hours or 6 months before flexural testing in a universal testing machine with a constant displacement rate (5 ± 1 mm/minute). Data from σf, E, Wsp, Wsl, and biocompatibility tests were statistically analyzed using Student t test (α = .05). Weibull analysis was also used for σf and E data. RESULTS: Significant differences between the two materials were found for the evaluated material properties. Water storage for 6 months did not affect the flexural strength of the AM polymer, but this material showed inadequate σf and Wsl values. CONCLUSIONS: Despite adequate biocompatibility and strength stability after 6 months of water storage, the AM polymer recommended for complete dentures needs further development to improve the material properties evaluated in this study.

Structural and torque changes in implant components of different diameters subjected to mechanical fatigue.

OBJECTIVES: To evaluate torque maintenance and structural damage in implant components of different diameters subjected to a fatigue challenge. METHODS: Thirty 10-mm-long, morse taper connection, titanium dental implants and their corresponding one-piece abutments were divided into three groups (n = 10) according to implant diameter: 4.3 mm (I4.3), 3.5 mm (I3.5), and 2.9 mm (I2.9). The implants were placed into a load-bearing fixture simulating bone tissue (modified G10), and the abutments were screwed into the implants to a final torque of 20 Ncm for the I4.3 and I3.5 and 15 Ncm for I2.9. The torque was secured by a digital torque meter. Cone-beam computed tomography (CBCT) scans were acquired and post-processed (e-Vol DX software) for all implant/abutment sets before and after subjecting them to fatigue in 37 °C distilled water (2 million cycles, constant load and frequency). The removal torque was measured using the same digital torque meter to calculate the difference in torque before and after fatigue. RESULTS: I2.9 showed substantial structural deformation compared with the other implant diameters (I3.5 and I4.3). However, the experimental groups did not show statistical differences for abutment loosening. SIGNIFICANCE: Implants smaller than 3.5 mm in diameter have a higher probability of structural deformation than standard-diameter implants. The association between tomographic scans and e-Vol DX software showed satisfactory consistency with the direct assessment using the digital torque meter, offering an additional tool to evaluate implant component loosening and structural deformations.

Chroma-dependence of CIEDE2000 acceptability thresholds for dentistry.

OBJECTIVES: Determine visual 50:50% color difference acceptability thresholds (AT) for regions of the dental color space with varying chromaticity. METHODS: A 40-observer panel belonging to two different groups (dentists and laypersons) evaluated 144 dental resin composites pairs (divided in three different sets of 48 pairs according to chroma value: Low Chroma (LC), Medium Chroma (MC) and High Chroma (HC) placed 40 cm away and inside of a viewing cabinet (D65 Standard light source; diffuse/0° geometry). A Takagi-Sugeno-Kang (TSK) fuzzy approximation was used for fitting the data points and calculate the 50:50% acceptability thresholds in CIEDE2000. A paired t-test was used to evaluate the statistical significance between thresholds differences and Bonferroni correction was applied. RESULTS: The CIEDE2000 50:50% AT were ∆E00 = 2.84, ∆E00 = 2.31 and ∆E00 = 1.80 for LC, MC and HC sets of sample pairs, respectively. The 50:50% AT values were statistically significant between the different sets of sample pairs, as well as the 50:50% AT values obtained for different observer groups. CONCLUSIONS: 50:50% CIEDE2000 acceptability thresholds for dentistry are significantly different depending on the chromaticity of the samples. Observers show higher acceptability for more achromatic samples (low chroma value) than for more chromatic samples. CLINICAL SIGNIFICANCE: The difference in the AT for distinct regions of the dental color space can assist professionals as a quality control tool to assess clinical performance and interpret visual and instrumental findings in clinical dentistry, dental research, and subsequent standardization processes.

Biomechanical performance of endocrown and core-crown restorations: A systematic review.

OBJECTIVE: To assess and compare, through a systematic review of the literature, the biomechanical performance of endocrowns and traditional core-crowns (with and without intracanal post) for the rehabilitation of endodontically treated teeth with severe coronal structure damage. MATERIALS AND METHODS: A systematic search was performed in MEDLINE/PubMed, Scopus, and Web of Science databases. In-vitro studies comparing endocrowns with (post-)core-crown restorations were selected and screened by two independent reviewers. The included studies were submitted to the risk of bias analysis using the RoBDEMAT tool and the biomechanical outcomes were collected for qualitative analysis. The extracted data were presented based on comparative analyses among the included studies. RESULTS: Thirty-one studies were included: 9 studies evaluated restorations of molars, 14 for premolars, and 8 studies evaluated anterior restorations. For the majority of the studies, endocrowns showed either similar or greater survival rates under fatigue and monotonic load than (post-)core-crown restorations, irrespectively of the tooth. The endocrowns showed more favorable failure patterns than (post-)core-crowns, irrespectively of the tooth. Endocrowns produced lower stresses in the restorative material for molars and premolars and in the luting material for premolars than (post-)core-crown restorations. The included studies presented adequate information for most items of the RoBDEMAT risk of bias tool. CONCLUSION: Endocrowns showed similar or greater biomechanical performance than the traditional (post-)core-crown restorations in most of the evaluated studies. CLINICAL SIGNIFICANCE: This systematic review showed that endocrowns present either similar or greater biomechanical performance than core-crown restorations for anterior and posterior endodontically treated teeth with severe structural damage.

Effect of Aging on Fracture Load and Reliability of Cemented Glass-Ceramics.

PURPOSE: Lithium disilicate (LD) and lithium silicate (LS) glass-ceramics may show a different acid etching behavior and mechanical integrity after aging. This study evaluated the influence of aging on the fracture load and reliability of glass-ceramics after different etching protocols. MATERIALS & METHODS: Specimens were fabricated and divided according to the etching time (10% hydrofluoric acid (HF) for 20s, 40s, and 60s). Etched surfaces were examined under microscopy. The ceramics were resin cemented to a dentin analog material. Samples were tested after 24 h (I) (n=20) or stored in 37°C water for 1 year (A)(n=20). A compressive load (0.1 mm/min) was applied to the samples until failure was detected by acoustic emission. The influence of aging on the fracture load (Lf) was tested by 2-way ANOVA and Tukey tests (α=0.05). The characteristic fracture load (L0) and Weibull modulus (m) values were calculated. RESULTS: LS etching for 20 s resulted in the highest immediate Lf, which was significantly decreased after aging (P≤0.05). Water-storage had no effect in this glass-ceramic Lf etched for 40 and 60s (P0.05). For LD, the etching time had no significant effect on the immediate and aged Lf (P0.05). The Lf was significantly reduced after aging (A) for LD (P≤0.05). Radial cracks were the predominant failure mode. Surface topography was more regular after lower etching times for LD, at after higher times for LS. CONCLUSIONS: After 1-year water-assisted aging, the evaluated etching times had no influence on the load-bearing capacity and structural reliability of resin-bonded glass-ceramics.

Optical behavior of 3D-printed dental restorative resins: Influence of thickness and printing angle.

OBJECTIVES: To evaluate the influence of thickness and printing angle on the optical properties of 3D-printed dental restorative resins. METHODS: Four 3D printing resin systems were evaluated: DFT-Detax Freeprint Temp; FP- Formlabs Permanent Crown; FP- Formlabs Temporary CB; and GCT- GC Temporary-. Samples from each material were printed at 0° and 90°, and polished up to 0.5, 1.0, 1.5 and 2.0 mm thickness. Scattering (S), absorption (K) and albedo (a) coefficients, transmittance (T%), light reflectivity (RI) and infinite optical thickness (X∞) were calculated using Kubelka-Munk's model. Data were statistically analyzed using Kruskal-Wallis¸ Mann-Whitney tests, and VAF coefficient. RESULTS: The spectral distribution on S, K, T%, RI,X∞ were wavelength dependent. Although the spectral behaviors were similar for all the specimens evaluated, the values of S, K, T% andX∞ presented significant differences between specimen thicknesses for all the materials used and for both printing orientations. Values for S and K increased, and T% and X∞ decreased. Significant differences between 0° and 90° were found for RI values at 0.5 and 1.0 mm thick samples, for S and K at 2.0 mm, for X∞ at 0.5 and 1.0 mm for DFT, and at 0.5 mm for FT. CONCLUSIONS: Optical properties of 3D-printed restorative resins vary between thicknesses, and could be affected by the building orientation. Therefore, these factors should be considered in order to improve the biomimetic potential of 3D-printed dental restorative resins. CLINICAL SIGNIFICANCE: Understanding the optical behavior of the 3D-printed restorative resins is essential to optimize their clinical performance.

Genotoxicity in the oral cells of older people from a Brazilian rural area: a population-based study.

The purpose of this population-based, observational, and cross-sectional study was to evaluate alterations in the oral cells of a population of older people from a Brazilian rural area, using the micronucleus technique to investigate possible associated genotoxic factors. A questionnaire was applied and clinical examination and collection of oral mucosal cells were performed for all older people (≥ 60 years) from a town in southern Brazil. Demographic and socioeconomic variables, deleterious habits (drinking and tobacco use), presence of gastro-oesophageal reflux disease (GERD), and the use of proton pump inhibitors (PPIs) were considered the exposure variables, whereas metanuclear changes (MCs) and the prevalence of cell micronuclei (MN) were considered outcomes. Out of 489 older people, 447 were included in the study, among whom 50.8% were men with a mean age of 70.9 years and 83.9% had a monthly family income greater than US$ 500.00. GERD symptoms were present in 36.2% of the individuals, and 29.1% used PPIs daily, 53.3% consumed alcoholic beverages, and 46.7% used tobacco. The analysis of 1,000 oral mucosal cells per subject showed a MN frequency of 0-2 per individual, and MCs were detected with an average of 15 units per individual (median = 11 per individual). Poisson regression did not show statistical association between the exposure variables and the outcomes (presence of MN and MCs), except for the use of PPIs, which was a protective factor for the prevalence of MN [PR 0.6 (CI 0.3-0,9)]. Age, sex, family income, tobacco use and drinking, and GERD were not associated with the number of MN and MCs in oral mucosal cells of the investigated older people.

Biomechanical behavior of a 3D-printed denture base material.

PURPOSE: To evaluate relevant material properties (flexural strength (σf), elastic modulus (E), water sorption (Wsp) and solubility (Wsl), and biocompatibility) of a 3D-printed resin (3D) and a heat cured acrylic resin (AR-control) used for complete denture manufacturing, testing the hypothesis that constructs from both materials would present acceptable material properties for clinical use. MATERIALS AND METHODS: The σf, E, Wsp and Wsl were evaluated according to the ISO 20795-1:2013 standard, and the biocompatibility was evaluated using 3-4,5-dimethyl-thiazol-2-yl-2.5-diphenyltetrazolium bromide (MTT) and sulforhodamine B (SRB) assays. Disk-shaped specimens were fabricated and used for Wsp (n = 5), Wsl (n = 5), and biocompatibility (n = 3). Bar-shaped specimens (n = 30) were fabricated and stored in 37° C distilled water for 48 hours and 6 months before flexural testing in a universal testing machine with constant displacement rate (5 ± 1 mm/min) until fracture. Data from σf, E, Wsp, Wsl and biocompatibility were statistically analyzed using Student t test (α= 0.05), Weibull analysis was also used for σf and E data. RESULTS: Significant differences between the two polymers were found for the evaluated material properties. Water storage for 6 months did not affect the flexural strength of 3D. Yet, the additive manufactured polymer showed inadequate flexural strength and water solubility values. CONCLUSION: Despite adequate biocompatibility and strength stability after 6 months of water storage, the additive manufactured polymer recommended for complete denture needs further development to improve the remaining material properties evaluated in this study.

Three-dimensional (3D) printing in dental practice: Applications, areas of interest, and level of evidence.

OBJECTIVES: The aim of this review to overview three-dimensional (3D) printing technologies available for different dental disciplines, considering the applicability of such technologies and materials development. MATERIALS AND METHODS: Source Arksey and O'Malley's five stages framework using PubMed, EMBASE, and Scopus (Elsevier) databases managed this review. Papers focusing on 3D printing in dentistry and written in English were screened. Scientific productivity by the number of publications, areas of interest, and the focus of the investigations in each dental discipline were extracted. RESULTS: Nine hundred thirty-four studies using 3D printing in dentistry were assessed. Limited clinical trials were observed, especially in Restorative, endodontics, and pediatric dentistry. Laboratory or animal studies are not reliable for clinical success, suggesting that clinical trials are a good approach to validate the new methods' outcomes and ensure that the benefits outweigh the risk. The most common application for 3D printing technologies is to facilitate conventional dental procedures. CONCLUSIONS: The constantly improving quality of 3D printing applications has contributed to increasing the popularity of these technologies in dentistry; however, long-term clinical studies are necessary to assist in defining standards and endorsing the safe application of 3D printing in dental practice. CLINICAL RELEVANCE: The recent progress in 3D materials has improved dental practice capabilities over the last decade. Understanding the current status of 3D printing in dentistry is essential to facilitate translating its applications from laboratory to the clinical setting.

The influence of smoking on the effectiveness of at-home bleaching: A prospective clinical study.

OBJECTIVES: To evaluate the effect of smoking on tooth whitening and color change after at-home bleaching. MATERIALS AND METHODS: This prospective clinical study evaluated two groups of participants: NS-non-smokers (n = 24) and S-smokers (n = 16). All subjects were treated with at-home bleaching using 22% carbamide peroxide (CP) for 1 h/day for 14 days. Color coordinates (L*-luminosity, a*-red-green axis and b*-yellow-blue axis) were obtained before bleaching (D0-baseline), 1 day (D1), 15 days (D15), and 1 month (D30) after bleaching. The whiteness index (WID ) and CIEDE2000 color differences (ΔE00 ) were calculated for S and NS. Color changes between S and NS subjects for specific teeth (CI-Central Incisors, LI-Lateral Incisors, and C-Canines) were analyzed using the Mann-Whitney test (α = 0.05). RESULTS: There was no significant difference in WID between S and NS subjects at baseline. NS participants showed higher WID than S at D1, D15, and D30 (p < 0.05). NS showed higher ΔWID for CI and C between D0 and the other evaluation times (D1, D15, and D30) compared to S. Smokers showed higher darkening of CI than NS in ΔWID D30-D1 (p < 0.05). Color changes showed similar overall behavior for ΔWID . For all evaluation times, ΔWID and ΔE00 values were below the corresponding acceptability thresholds. CONCLUSION: At-home bleaching was effective on smokers and nonsmokers. Smoking negatively affected color stability after bleaching. ΔE00 and ΔWID were acceptable for both groups. CLINICAL SIGNIFICANCE: Although smoking negatively affected color stability after bleaching, the observed changes were clinically acceptable.

Influence of piston material on the fatigue behavior of a glass-ceramic.

STATEMENT OF PROBLEM: The lack of standardization regarding the loading piston material used in fatigue tests could limit the interpretation of study findings. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the piston material on the fatigue behavior of a lithium disilicate glass-ceramic. MATERIAL AND METHODS: Plate-shaped, 1.2-mm-thick, lithium disilicate glass-ceramic specimens were cemented onto a dentin analog substrate with resin cement. The specimens were divided into 4 groups according to the piston material used in the fatigue test (n=30): metal, glass fiber-reinforced epoxy resin, ceramic, and human tooth. The fatigue test was performed in a mechanical cycling machine by using the boundary technique at 2 Hz in distilled water at 37 °C. The fatigue data were analyzed by using the Weibull distribution and a lifetime-inverse power law relationship. Failures were evaluated with fractography and transillumination. RESULTS: The Weibull modulus (ß) was similar among groups. The exponent of crack growth (n) was significantly greater for glass fiber-reinforced epoxy resin and tooth groups than for metal and ceramic; therefore, the probability of failure (Pf) of glass-ceramic specimens loaded by resin and tooth pistons depended more on load amplitude. Specimens tested with tooth showed the highest value of K (characteristic lifetime), which is an indication of greater survival. Radial crack was the only failure mode observed for all experimental groups. CONCLUSIONS: The piston material influenced the fatigue survival of the lithium disilicate glass-ceramic. The glass fiber-reinforced epoxy resin piston closely simulated the fatigue behavior induced by the human tooth on the evaluated glass-ceramic.

Assessment of the survival and success rates of lithium disilicate crowns after different surface finishing procedures: An in vitro study.

STATEMENT OF PROBLEM: Evidence is limited for the impact of clinical adjustments and polishing on the longevity of glazed lithium disilicate restorations. PURPOSE: The purpose of this in vitro study was to evaluate the influence of surface finishing on the survival and success rates of lithium disilicate restorations based on fatigue resistance and failure mode. MATERIAL AND METHODS: Lithium disilicate (IPS e.max CAD) maxillary premolar crowns (N=54) were cemented on a dentin analog. The restorations were divided into 3 groups: overglaze (OG), abrasion (GA), and abrasion and polishing (AP). The crowns were submitted to cyclic fatigue in 37 oC water at 100 N and 2 Hz in 2 lifetimes. The load was applied to the occlusal surface by using anatomic pistons to simulate a clinical tripod occlusal contact. After cycling, the crowns were examined for failure (cracking, chipping, or catastrophic fractures) under optical and scanning electron microscopy. Cracking was considered either a structural failure (success analysis) or a survival (clinical criteria - survival analysis). Data were analyzed by using the log rank Kaplan-Meier and Holm-Sidak tests (α=.05). RESULTS: Surface finishing had no influence on the structural integrity of lithium disilicate, with similar success rates (P=.720). The calculated survival rate was higher for AP than that for other groups (P=.028). Cracking was found for GA and AP crowns, mostly initiating from the external surface. Chipping occurred in all experimental groups, and AP crowns did not show catastrophic failures. CONCLUSIONS: Although surface treatments had no influence on the success of lithium disilicate, polishing showed a positive effect on the survival rate of the crowns based on the clinical implications of cracking (no need for replacement).

Association between masticatory dysfunction and gastroesophageal reflux disease: A population-based study in the elderly.

BACKGROUND: Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favour the development of gastroesophageal reflux disease (GERD). OBJECTIVE: This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil. METHODS: This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analysed based on the chewing difficulty for some food groups. Tooth loss and chewing self-perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR (95% confidence interval)]. RESULTS: The response rate was 93.1% (n = 455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR = 1.54), meats (PR = 1.34) and cereals (PR = 1.43) but not with poor chewing self-perception (PR = 0.80) and tooth loss (PR = 1.22). GERD was also associated with xerostomia (PR = 1.63) and the female gender (PR = 1.35). CONCLUSION: Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction.

Genotoxicity in the oral cells of older people from a Brazilian rural area: a population-based study

Abstract The purpose of this population-based, observational, and cross-sectional study was to evaluate alterations in the oral cells of a population of older people from a Brazilian rural area, using the micronucleus technique to investigate possible associated genotoxic factors. A questionnaire was applied and clinical examination and collection of oral mucosal cells were performed for all older people (≥ 60 years) from a town in southern Brazil. Demographic and socioeconomic variables, deleterious habits (drinking and tobacco use), presence of gastro-oesophageal reflux disease (GERD), and the use of proton pump inhibitors (PPIs) were considered the exposure variables, whereas metanuclear changes (MCs) and the prevalence of cell micronuclei (MN) were considered outcomes. Out of 489 older people, 447 were included in the study, among whom 50.8% were men with a mean age of 70.9 years and 83.9% had a monthly family income greater than US$ 500.00. GERD symptoms were present in 36.2% of the individuals, and 29.1% used PPIs daily, 53.3% consumed alcoholic beverages, and 46.7% used tobacco. The analysis of 1,000 oral mucosal cells per subject showed a MN frequency of 0-2 per individual, and MCs were detected with an average of 15 units per individual (median = 11 per individual). Poisson regression did not show statistical association between the exposure variables and the outcomes (presence of MN and MCs), except for the use of PPIs, which was a protective factor for the prevalence of MN [PR 0.6 (CI 0.3-0,9)]. Age, sex, family income, tobacco use and drinking, and GERD were not associated with the number of MN and MCs in oral mucosal cells of the investigated older people.

Biomechanical properties of a 3D printing polymer for provisional restorations and artificial teeth.

OBJECTIVES: To characterize a resin-based polymer used for 3D printing (3D) provisional restorations and artificial teeth by evaluating relevant material's properties (flexural strength (σf), elastic modulus (E), water sorption (Wsp) and solubility (Wsl)) and biocompatibility, and comparing to a bis-acryl composite resin (BA) and a heat-cured acrylic resin (AR). METHODS: Structures were fabricated from 3D, BA and AR. Bar-shaped specimens (n = 30) were submitted to three-point flexure (in 37ºC water and constant displacement rate: 1 ± 0.3 mm/min) until fracture to calculate σf and E. Additional specimens (n = 30) were aged in 37ºC distilled water for six months before testing for σf. Disc-shaped specimens (n = 5) were dried in desiccators and oven until weight stability was reached, then they were immersed in distilled water for seven days, weighed and submitted to the drying process to obtain Wsp and Wsl. SRB and MTT assays were used to evaluate biocompatibility. Data were statistically analyzed using Kruskal Wallis, Student-Newman-Keuls (α = .05), and Weibull distribution. ANOVA and Tukey (α = .05) were used to evaluate the biocompatibility data. RESULTS: 3D structures showed higher σf than AR after aging. The BA showed the lowest values for σf and E, at baseline and after aging. All materials showed Wsp and Wsl values within the recommended standard values. AR structures showed lower cell viability (71.9%) than 3D (92.9%) and BA (90.8%) when using the SRB test. No difference was found when using MTT (p > .05). SIGNIFICANCE: The evaluated polymer-based 3D printing material showed adequate biomechanical behavior for using as a provisional restoration and artificial teeth.

RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews.

OBJECTIVES: To develop a risk of bias tool for pre-clinical dental materials research studies that aims to support reporting of future investigations and improve assessment in systematic reviews. METHODS: A four-stage process following EQUATOR network recommendations was followed, which included project launch, literature review, Delphi process and the tool finalization. With the support of the European Federation of Conservative Dentistry (EFCD) and the Dental Materials Group of the International Association for Dental Research (DMG-IADR), a total of 26 expert stakeholders were included in the development and Delphi vote of the initial proposal. The proposal was built using data gathered from the literature review stage. During this stage, recent systematic reviews featuring dental materials research, and risk of bias tools found in the literature were comprehensively scanned for bias sources. The experts thus reached a consensus for the items, domains and judgement related to the tool, allowing a detailed guide for each item and corresponding signalling questions. RESULTS: The tool features nine items in total, spread between 4 domains, pertaining to the following types of bias: bias related to planning and allocation (D1), specimen preparation (D2), outcome assessment (D3) and data treatment and outcome reporting (D4). RoBDEMAT, as presented, features signalling questions and a guide that can be used for RoB judgement. Its use as a checklist is preferred over a final summary score. CONCLUSION: RoBDEMAT is the first risk of bias tool for pre-clinical dental materials research, supported and developed by a broad group of expert stakeholders in the field, validating its future use. CLINICAL SIGNIFICANCE: This new tool will contribute the study field by improving the scientific quality and rigour of dental materials research studies and their systematic reviews. Such studies are the foundation and support of future clinical research and evidence-based decisions.

Color and optical properties of 3D printing restorative polymer-based materials: A scoping review.

OBJECTIVE: Color and optical properties are particularly crucial to mimic natural tooth. This scoping review aimed to present an overview of the literature published on color and optical properties of 3D printing restorative polymer-based materials. The literature search was performed in MED-LINE/Pubmed, Scopus and Web of Science. MATERIALS AND METHODS: The literature search was conducted in the three databases based on the question: "Are the optical properties and color adequately reported on polymer-based 3D printing dental restorative materials studies?" with no restriction on year of publication. Data were reported and synthesized following PRISMA-ScR statement. RESULTS: Nine studies fit the inclusion criteria. Five studies focused on evaluating only color stability; three articles assessed the color stability along with mechanical and morphological properties and only one study compared color parameters of 3D printed to conventional polymers. Two studies evaluated translucency parameter and no study was found evaluating scattering, absorption, and transmittance. CONCLUSIONS: Color and optical properties of 3D printed polymers that can be used in restorative dentistry are not adequately evaluated and characterized. Future studies on the influence of experimental printing conditions should include these physical properties to assist on improving esthetics. CLINICAL SIGNIFICANCE: This review shows the scarce literature existing on color and optical properties of 3D printing restorative polymer-based materials. These properties and their study are of outmost importance to create materials that mimic natural tooth to allow clinicians to obtain esthetically pleasant restorations.

Accuracy and repeatability of different intraoral instruments on shade determination compared to visual shade selection.

OBJECTIVE: To evaluate the accuracy and repeatability of intraoral instruments used for shade determination compared to visual shade selection (VSS). MATERIALS AND METHODS: A total of 20 subjects and 10 observers, balanced by gender, participated in the study. Observers performed VSS of the upper right central incisor from each subject. Instrumental shade determination of the same teeth was performed using a spectrophotometer (Easyshade V) and intraoral scanners (CEREC Omnicam, Primescan, Trios 3 and Trios 4). Vita Classical shade nomenclature was used to record the shade designation for all instruments and VSS. The accuracy of the instruments was determined by comparing the instrument readings with the most frequent visual shade selected. The percentage of accuracy was obtained by comparing the number of agreements with the number of comparisons. The percentage of repeatability was obtained by comparing the number of repeated shades with the number of shade measurements in each group. Accuracy was compared using Cochran Q test followed by pairwise comparisons using multiple McNemar's tests with Bonferroni correction. Repeatability of the instruments was evaluated using Cronbach's alpha. RESULTS: Omnicam showed a significant lower accuracy than the other instruments (p < 0.05). No statistical difference on repeatability was found among the different instruments (p > 0.05). It was not found any statistical differences for VSS accuracy among the observers (p = 0.437) and between genders (p = 0.867). CONCLUSION: Instrumental repeatability (≥75%) and similar accuracy between the best performed instruments (69%-77.5%) and the observers performance (65%-90%) supports the use of high-performance instruments for dental shade determination. CLINICAL SIGNIFICANCE: Most instruments (Easyshade V, Primescan, Trios 3, and Trios 4) showed similar accuracy performance to observers in the VSS.