Comparison of a resin-based sealant with a nano-filled flowable resin composite on sealing performance of marginal defects in resin composites restorations: a 36-months clinical evaluation.

OBJECTIVES: Our goal was to evaluate the clinical behavior of resin-based composite (RBC) restorations with sealed marginal defects using nano-filled flowable RBCs (FRS) compared with resin-based sealant (RBS); this work used marginal adaptation, marginal staining, and secondary caries according to the World Dental Federation (FDI) criteria. MATERIALS AND METHODS: This was a prospective, randomized, double-blind, controlled trial. Fifty-four patients who met the inclusion criteria (older than 18 years old; with high cariogenic risk determined by Cariogram software; and restorations with marginal defects, 3 and 4 according to FDI criteria) were randomly divided into three groups. There were three defective RBC restorations per patient and were repaired (n = 162). The groups were RBS-marginal sealing using a resin-based sealant (Clinpro Sealant, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); FRS-sealing using flowable resin (Filtek Flow Z350XT, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); and control-no repair treatment. All procedures were performed under complete isolation. Evaluations were evaluated at 1-week post treatment (baseline) as well as at 18 and 36 months after treatment regarding marginal adaptation, marginal staining, and secondary caries according to FDI criteria. The data were analyzed using the Wilcoxon test (α = 0.05) to compare the differences in each treatment group at different evaluation times. RESULTS: Marginal adaptation of micro-repaired RBC restorations were seen in patients with a high risk of caries using flowable resin composite or resin-based sealants. There were differences (P < 0.001) when baseline was compared at 18 and 36 months. Marginal staining showed differences when baseline was compared to 18 months (P < 0.001) and 36 months (P = 0.001) for both treatments. Secondary caries parameters for RBS treatment showed differences when baseline was compared to 36 months (P = 0.025) and when 18 months was compared to 36 months (P = 0.046). CONCLUSIONS: Micro-repair of RBC restorations resulted in clinical deterioration of marginal adaptation and marginal staining. Nano-filled flowable resin composites were sealed on defective restorations; 3 and 4 FDI marginal defects have better clinical performance to prevent secondary caries than resin-based sealants after 36 months. CLINICAL RELEVANCE: Micro-repair with RBS does not seem to be an effective treatment to prevent secondary caries.

Intervenciones para la prevención del suicidio en adolescentes y jóvenes. Revisión sistemática / Interventions for the prevention of suicide in adolescents and young people. Systematic review

El suicido en adolescentes y jóvenes constituye un problema de salud mental pública que requiere el desarrollo de los correspondientes programas de intervención. Al respecto, se hizo un estudio de sistematización bibliográfica con enfoque cualitativo, empleando una estrategia de tipo PICO y los lineamientos básicos del modelo PRISMA. Se partió de la identificación de 237 artículos y luego de aplicar los diferentes filtros de selección se incluyeron 30 de estos. Los autores concluyeron que los programas de intervención en poblaciones con factores de riesgo y que se realizan en ambientes con mayor posibilidad de control, tales como: áreas de hospitalización y entornos escolares, incrementan sus probabilidades de efectividad en la disminución de la ideación y conducta suicida.

Suicide in adolescents and young people constitutes a public mental health problem that requires the development of the corresponding intervention programs. In this regard, a bibliographic systematization study was carried out with a qualitative approach, using a PICO-type strategy and the basic guidelines of the PRISMA model. It was started from the identification of 237 articles and after applying the different selection filters, 30 of these were included. The authors concluded that intervention programs in populations with risk factors and that are carried out in environments with a greater possibility of control (hospitalization areas and school environments) increase their probability of effectiveness in reducing suicidal ideation and behavior.

Mechanical Properties of Teeth Restored After Selective Caries Excavation. Systematic Review and Meta-Analysis

ABSTRACT: The aim of this study was to systematically review the literature of in vitro studies comparing the mechanical properties of teeth restored after selective caries excavation (SCE) and complete caries excavation (CCE). The PubMed/MEDLINE and EMBASE electronic databases were searched systematically. In vitro studies investigating the mechanical properties of teeth restored after SCE, were independently checked by two authors. Inclusion criteria were: (1) performing SCE (2) mentioning the teeth were later restored, and (3) evaluating mechanical properties of the restored teeth. Meta-analysis was performed with and without discriminating between shallow and deep lesions. From 1,859 potentially eligible studies, 14 were selected for full text analysis and 5 were included in the meta- analysis. Fracture resistance was significantly lower after SCE than after CCE in overall analysis (SMD[95%CI]=-1.62[-3.04,-0.20]) and for deep lesion (SMD[95%CI]=-1.62[-2.62,-0.61]), whereas cuspal deflection at 200 and 400N was significantly higher after SCE than after CCE for discriminated and non- discriminated analyses. Furthermore, for shallow lesions the risk of catastrophic fracture was significantly lower after SCE than CCE (RR[95%CI]=0.58[0.43,0.78]). The included studies presented low and medium risk of bias. The mechanical behavior of restored teeth seems to be affected by the excavation strategy. Although there is a tendency for lower fracture resistance and higher cuspal deflection after SCE, there is a lower risk of catastrophic failure when compared to CCE. However, this conclusion is based on very few in vitro studies.

RESUMEN: El objetivo de este estudio fue revisar sistemáticamente la literatura de estudios in vitro que comparan las propiedades mecánicas de los dientes restaurados después de la excavación selectiva de caries (ESC) y la excavación de caries completa (ECC). Se realizaron búsquedas sistemáticas en las bases de datos electrónicas PubMed / MEDLINE y EMBASE. Los estudios in vitro que investigan las propiedades mecánicas de los dientes restaurados después de la ESC fueron verificados de forma independiente por dos autores. Los criterios de inclusión fueron: (1) realizar ESC (2) mencionar que los dientes fueron posteriormente restaurados y (3) evaluar las propiedades mecánicas de los dientes restaurados. El metanálisis se realizó con y sin discriminación entre lesiones superficiales y profundas. De 1.859 estudios potencialmente elegibles, se seleccionaron 14 para el análisis de texto completo y 5 se incluyeron en el metanálisis. La resistencia a la fractura fue significativamente menor después de ESC que después de CCE en el análisis general (DME [IC del 95 %] = - 1,62 [-3,04, -0,20]) y para la lesión profunda (DME [IC del 95 %] = - 1,62 [-2,62, - 0,61]), mientras que la deflexión de las cúspides a 200 y 400 N fue significativamente mayor después de ESC que después de CCE para análisis discriminados y no discriminados. Además, para las lesiones superficiales, el riesgo de fractura catastrófica fue significativamente menor después de ESC que de CCE (RR [IC 95 %] = 0,58 [0,43,0,78]). Los estudios incluidos presentaron riesgo de sesgo bajo y medio. El comportamiento mecánico de los dientes restaurados parece verse afectado por la estrategia de excavación. Aunque existe una tendencia a una menor resistencia a la fractura y una mayor deflexión de la cúspide después de la ESC, existe un menor riesgo de falla catastrófica en comparación con la CCE. Sin embargo, esta conclusión se basa en muy pocos estudios in vitro.

Radiopacidad de Resinas Acrílicas y Bisacrílicas Usadas como Restauraciones Provisionales

RESUMEN: Una adecuada radiopacidad de los materiales para restauraciones provisorias permite su evaluación en el examen radiográfico. Sin embargo, existe gran desconocimiento sobre el cumplimiento de los requerimientos establecidos por la norma ISO 4049. El objetivo del siguiente estudio fue determinar la radiopacidad de los materiales para provisionalización presentes en el mercado nacional y corroborar si estos cumplen con el valor mínimo requerido por la normativa. Se realizó un estudio experimental in vitro, en el cual se prepararon muestras en forma de discos de 10 mm de diámetro y 1 mm de espesor de resinas acrílicas: Acrílico Autocurable (Marché®), Duralay (Reliance), Caulkâ (Dentsply), ALIKE™ (GC) y resinas bisacrílicas: Protemp™4 (3M, 2008), LuxatempStar (DMG), Luxacrown (DMG), Structur Premium (VOCO), ExperTemp™ (Ultradent) y Acrytemp (Zhermack). Las muestras fueron radiografiadas junto a una cuña de aluminio escalonada. Las imágenes fueron analizadas para determinar el valor en escala de grises y su respectivo valor en mm de aluminio. Los datos fueron analizados para verificar si cumplen con la normativa ISO. Se encontraron diferencias estadísticamente significativas. La radiopacidad equivalente de las resinas acrílicas en mm de Al en orden descendente fue de 0,85 ± 0,08 para ALIKE™, 0,72 ± 0,32 para acrílico Marché®, 0,65 ± 0,25 para Caulkâ y 0,56 ± 0,05 para Duralay, siendo todos menores a lo requerido por la norma. La radiopacidad equivalente de las resinas bisacrílicas fue de 1,75 ± 0,2 para Acrytemp, 1,51± 0,27 para Luxacrown, 1,47 ± 0,14 para Structur Premium, 1,43 ± 0,23 para LuxatempStar, 1,02 ± 0,28 para Protemp™4 y 1± 0,1 para ExperTemp™, los cuales son mayores a lo exigido por la norma. En conclusión, las resinas bisacrílicasevaluadas en este estudio cumplen con el requisito de radiopacidad exigido, a diferencia de las acrílicas que no lo cumplen.

ABSTRACT: An adequate radiopacity of materials for provisionalization allows its proper evaluation on the radiographicexam. However, there is a lack of knowledge about compliance with the requirements established by the ISO 4049 norm. The aim of this study was to determine the radiopacity of provisionalization materials available in the national market and verify if they comply with the minimum requirements of ISO regulations. An in vitro experimental study was carried out, samples of 10 mm in diameter and 1 mm thickness of acrylic resins: Self-Cure Acrylic (Marché®), Duralay (Reliance), Caulkâ (Dentsply), Alike™ (GC) and by sacrilic resins: Protemp™4 (3M), Luxatemp Star (DMG), Luxacrown (DMG), Structur Premium (VOCO), ExperTemp™ (Ultradent), Acrytemp (Zhermack) were prepared. The samples were x-rayed together with a stepped aluminum wedge. The images were analyzed to determine the gray scale value and its equivalent value in mm of Aluminum. The data was analyzed to verify compliance with the ISO standard. Statistically significant differences were found. The equivalent radiopacity of acrylicresins in mm of Al in descending order was 0.85± 0.08 for ALIKE™, 0.72 ± 0.32 for acrylic Marché®, 0.65 ± 0.25 forCaulkâ and 0.56 ± 0.05 forDuralay, all being less than the required by norm. The equivalent radiopacity of by sacrilic resins was 1.75 ± 0.2 for Acrytemp, 1.51± 0.27 for Luxacrown, 1.47 ± 0.14 for Structur Premium, 1.43 ± 0.23 for LuxatempStar, 1.02 ± 0.28 forProtemp™4 and 1± 0.1 forExperTemp™,which are greater than the requirements. In conclusion, the bisacrylic resins evaluated in this study comply with the radiopacity standard, however the acrylic resins evaluated do not comply.

Evaluación de la autopercepción de estética dental en pacientes tratados con dos modalidades distintas de blanqueamiento dental / Evaluation of dental esthetics self-perception in patients treated with two different types of tooth whitening

RESUMEN Objetivo: Determinar la influencia en la variación de la autopercepción estética dental, al someterse a dos modalidades distintas de blanqueamiento dental. Métodos: Investigación descriptiva transversal con 48 pacientes que fueron tratados con dos sistemas de blanqueamiento. Se aplicó la encuesta "Perfil de impacto de salud oral", versión en español (OHIP-e, por sus siglas en inglés), con el fin de medir la autopercepción estética previamente al tratamiento de blanqueamiento. Estos pacientes fueron asignados a uno de los dos grupos de tratamiento, grupo de blanqueamiento "ambulatorio" o grupo de blanqueamiento "clínico". La encuesta OHIP-e volvió a ser aplicada una semana luego del término de la intervención. Se analizaron los puntajes obtenidos en la escala de autopercepción de estética bucal, antes y después de la intervención, en ambos grupos de estudio. Se realizó la prueba Z de Kolmogórov-Smirnov para determinar la normalidad de los puntajes promedio de OHIP-e. Se realizó una prueba t de Student, que evaluó el cambio de la autopercepción de estética dental antes y después al blanqueamiento. Los análisis estadísticos se realizaron aceptando una probabilidad de error tipo I de 0,05 (p< 0,05). Resultados: Los puntajes de OHIP-e inicialmente fueron distintos en ambos grupos y mejoraron (disminuyeron no significativamente con la aplicación de los tratamientos de blanqueamiento en ambos grupos, p< 0,05), excepto en la dimensión dolor físico en el grupo "clínico" (p= 0,03). Conclusiones: El blanqueamiento dental "ambulatorio" y "clínico", presentan un cambio en la autopercepción estética dental similar, luego de una semana de realizado el tratamiento. Ambos tratamientos presentaron un impacto positivo en la autopercepción estética dental de los pacientes(AU)

ABSTRACT Objective: Determine the effect of two different types of tooth whitening on dental esthetics self-perception. Methods: A descriptive cross-sectional study was conducted of 48 patients treated with two whitening systems. The Spanish version of the Oral Health Impact Profile (OHIP-e) was used to measure esthetic self-perception before the whitening treatment. The patients were assigned to one of two treatment groups: ambulatory whitening group and clinical whitening group. The OHIP-e survey was applied again one week after completion of the intervention. The scores obtained by both groups were analyzed with the oral esthetics self-perception scale before and after the intervention. The Kolmogorov-Smirnov Z test was applied to determine the normality of mean OHIP-e scores. Student's t test was used to evaluate the change in dental esthetics self-perception before and after whitening. The statistical analyses performed accepted a type I error probability of 0.05 (p< 0.05). Results: OHIP-e scores were initially different in the two groups and improved in both (decreased non-significantly with the application of the whitening treatments, p< 0.05), except for the physical pain dimension in the clinical group (p= 0.03). Conclusions: Ambulatory and clinical tooth whitening bring about a similar change in dental esthetics self-perception a week after completion of the treatment. Both treatments had a positive impact on the patients' dental esthetics self-perception(AU)

Inflammatory markers IL-1ß and RANK-L assessment after non-vital bleaching: A 3-month follow-up.

OBJECTIVE: This study assessed IL-1ß and RANK-L levels in vivo and color stability of non-vital teeth bleached using hydrogen (35%) and carbamide (37%) peroxides 3 months after treatment. MATERIALS AND METHODS: Fifty teeth were randomly divided into two groups(n = 25):35% hydrogen peroxide (HP) or 37% carbamide peroxide (CP). Four sessions of intracoronal walking-bleach procedure were performed. IL-1ß and RANK-L levels were assessed from gingival crevicular fluid samples (from three vestibular and three palatines sites) at eight different time-points: at the beginning of the study (baseline), after four sessions of intracanal bleaching, and at 1 week, 1 month, and 3 months posttreatment. The color variations were visually detected using Vita bleach shade guide (ΔSGU). RESULTS: Significant increases of IL-1ß and RANK-L levels were detected at all time-points (all P < .05) when comparing each time-point to baseline, and a high correlation (>0.8-Spearman) between variables. According the ΔSGU values, a color change of five for HP and four for CP were detected. CONCLUSIONS: Non-vital walking bleach technique promotes an increase in IL-1ß and RANKL levels in periodontal tissues and also, it is maintained until the third-month posttreatment. CLINICAL SIGNIFICANCE: The internal whitening of teeth increases the levels of cytokines associated with inflammation and bone resorption 3 months after the whitening procedure is finished; this should warn of possible harmful effects of this whitening technique.

Radiopacidad de Cementos de Resina Compuesta Evaluados con Técnica Radiográfica Digital / "Radiopacity of Resin Cements Evaluated with Digital Radiographic Technique"

RESUMEN: Objetivo: comparar la radiopacidad de distintos cementos de resina y corroborar si cumplen con los requisitos de normativas ISO. Material y método: Se prepararon muestras de 1 mm de grosor de los cementos de resina: RelyX U200 (3M ESPE), Calibra (Dentsply Sirona), Calibra Universal (Dentsply Sirona) y Bifix SE (VOCO). Las muestras fueron radiografiadas junto a una cuña de aluminio escalonada. Las imágenes fueron analizadas para determinar el valor en escala de grises y su respectivo valor en mm de Al. Los datos fueron analizados para comparar la radiopacidad de los materiales entre sí y con los requisitos establecidos por normas ISO. Resultados: La radiopacidad equivalente en mm de Al en orden descendiente fue de 2,84 ± 0,18 para Calibra, 2,37 ± 0,15 para Bifix SE, 2,26 ± 0,14 para Calibra Universal y de 1,67 ± 0,07 para RelyX U200. Estos valores son todos mayores al mismo grosor de aluminio exigido por la norma ISO 4049. Se establecieron diferencias estadísticamente significativas entre los cementos. Conclusiones: Se determinó que existen diferencias en la radiopacidad entre los cementos de resina compuesta estudiados. Sin embargo, todos los cementos evaluados cumplen con la norma ISO-4049 de radiopacidad.

ABSTRACT: Objective: Compare the radiopacity of different resin cements and verify their compliance with the requirements of ISO regulations. Material and method: Samples -10 mm in diameter and 1 mm thickness- of the resin cements RelyX U200 (3M ESPE), Calibra (Dentsply Sirona), Universal Calibra (Dentsply Sirona) and Bifix SE (VOCO) were prepared. Radiographies of the samples with a stepped aluminum wedge were obtained. For each sample, the grayscale and mm of Al values were calculated. The data were analyzed to compare the radiopacity of the materials and to contrast them with the requirements established by ISO standards. Results: The equivalent radiopacity in mm of Al in descending order was 2.84 ± 0.18 for Calibra, 2.37 ± 0.15 for Bifix SE, 2.26 ± 0.14 for Calibra Universal and 1.67 ± 0.07 for RelyX U200. These values exceed the value required by ISO 4049 standard. Statistically significant differences were established between the cements. Conclusion: There are differences in the radiopacity of the resin cements studied. However, all the cements complied with ISO 4049 radiopacity standards.

Prevalencia, severidad de caries dental y necesidad de tratamiento restaurador en escolares de 6 a 12 Años de la Provincia de Santiago, Región Metropolitana / Prevalence, severity of dental caries, and treatments needs, among 6 to 12 years old school children, in Santiago-Metropolitan Region

RESUMEN: Objetivo: el objetivo de este estudio epidemiológico, fue determinar la prevalencia y severidad de caries dental, expresados en el índice de dientes definitivos con caries, obturados y perdidos (COPD), índice de dientes primarios con caries, extraídos y obturados (ceod) e Índice Significante de Caries (ISC) además establecer la necesidad de tratamiento restaurador y recursos humanos necesarios para ello, en una población escolar de 6 a 12 años de la Provincia de Santiago, Región Metropolitana. Metodología: Este estudio de corte transversal se realizó en 7 colegios entre públicos y privados que se encontraban debidamente registrados en la base de datos de la Secretaría Regional Ministerial de Educación pertenecientes a Provincia de Santiago, Región Metropolitana. Se seleccionó mediante un muestreo aleatorio estratificado por nivel socioeconómico, sexo y edad, una muestra de 1333 escolares de entre 6 a 12 años los cuales fueron evaluados previo asentimiento y con el consentimiento de sus tutores legales, por dos dentistas calibrados (Kappa 0.94). Para el diagnóstico de caries se utilizaron los criterios OMS. Los datos fueron recolectados en una ficha diseñada especialmente para ello y analizados utilizando el programa estadístico SPSS realizando pruebas no paramétricas de Kruskal-Wallis y U Mann-Whitney con un valor de significancia estadística del 95% (p<0,05). Resultados La prevalencia de caries encontrada en esta población, en dentición permanente fue de 24,5%, mientras que para dentición primaria 47,8%, los valores obtenidos del Índice COPD 0,48; ceod 1,67; ISC para COPD 1,45 y ISC para ceod 4,52. Las horas profesionales de odontólogos/as con sus respectivos/as asistentes, necesarias destinadas sólo a tratamiento restaurador para dar solución al daño encontrado en la muestra de estudio al momento del examen, corresponden a 167 horas para dentición permanente y 689 horas para dentición primaria. Conclusiones: La prevalencia y distribución de caries dental en escolares de 6 a 12 años de la Provincia de Santiago correspondió a cifras menores a las consignadas en el Diagnóstico de Salud Oral del Ministerio de Salud del año 2007, y menores a los índices propuestos por las organizaciones internacionales. Para resolver la necesidad de tratamiento restaurador en esta muestra se necesitarán 856 horas odontológicas.

ABSTRACT: Objective: The aim of the study was to determine prevalence and severity of dental caries, treatment needs and human resources required, in a school population aged 6 to 12 years in province of Santiago. Methodology: This cross-sectional study was conducted in seven schools. A stratified random sample was selected by socioeconomic level, sex and age. 1333 school children were evaluated by two calibrated dentists (Kappa 0.94). WHO criteria were used for caries diagnosis. Data were statistically analyzed by nonparametric tests of Kruskal-Wallis and U Mann-Whitney, statistical significance value of 95% (p <0.05). Results: 1333 patients fit the inclusion criteria. Caries prevalence was 24.5% for permanent teeth and 47.8% for primary teeth. DMFT index was 0.48, dmft index was 1.67. SiC was 1.45 for DMFT and 4.52 for dmft. A total of 167 and 689 hours of restorative treatment were required for permanent dentition and primary dentition, respectively. Conclusions: The prevalence and severity distribution of dental caries in school children aged 6 to 12 years in the Province of Santiago were lower than those recorded in the past, and lower than the rates proposed by the international organizations. To restore damaged founded in this sample 856 hours will be needed.

Effects of Sealing Marginal Occlusal Defects of Composite Restorations with a Nanofiller-Reinforced Flowable Resin Composite: A Double-Blind, Randomised Clinical Trial with One-Year Follow-Up.

PURPOSE: To evaluate the 6-and 12-month performance of microrepairs of marginal occlusal microdefects of resin composite restorations in a group of patients with high caries risk. MATERIALS AND METHODS: Thirty-five patients with at least three resin composite restorations with marginal occlusal defects were randomly distributed into three treatment groups: (1) sealed with flowable resin composite; (2) sealed with resin-based sealant; or (3) control. Restorations in all groups were assessed using World Dental Federation (FDI) criteria at three time points: baseline, and at 6 and 12 months after sealing. RESULTS: After 1 year, 32 patients were examined. Of all the repaired restorations, those of the flowable resin composite (RC) group maintained an FDI value of 1 for marginal occlusal adaptation for 81.3% of the restorations at 6 and 78.1% at 12 months. The resin-based sealant group kept a value of 1 for the same parameter on 65.6% of restorations at 6 and 50% at 12 months with a statistically significant difference (p= 0.024) between the two time periods. There was a statistically significant difference between the two groups at the 12-month comparison (p = 0.015). CONCLUSIONS: Occlusal RC restorations that were sealed using either a resin-based sealant or a nanofilled flowable RC benefited from improved clinical status after 12 months. Use of the latter presented the better clinical performance of the two by providing a higher rate of total retention of sealing materials.

Radiopacity and Chemical Assessment of New Commercial Calcium Silicate-Based Cements / Radiopacidad y Evaluación Química de Cementos Comerciales en Base a Silicato de Calcio

ABSTRACT: The aim of the study was to evaluate the chemical composition and radiopacity of new calcium-silicatebased cements. Discs of 10 mm x 1 ± 0.1mm were prepared of BiodentineTM, TheraCal, Dycal and GC Fuji IX (n=5). The samples were radiographed directly on an PSP occlusal plate adjacent to an aluminium step wedge. The radiopacity of each specimen was determined according to ISO 9917/2007. Statistical analyses were carried out using ANOVA and Tukey's test at a significance level of 5 %. The chemical constitution of materials was determined by scanning electron microscopy (SEM) and energy dispersive x-ray element mapping. The radiopacities of the materials in decreasing order were: GC Fuji IX (3.45 ± 0.16 mm), Dycal (3.18 ± 0.17), BiodentineTM (2.79 ± 0.22), and TheraCal (2.17 ± 0.17). TheraCal showed the lowest radiopacity compared to the other materials, followed by BiodentineTM. Dycal and GC Fuji IX radiopacity values did not present significant statistical differences. Scanning electron microscopy and energy dispersive X-ray analysis revealed the presence of zirconium in BiodentineTM; and strontium, barium and zirconium in TheraCal as radiopacifying elements. The new calcium silicate cements present distinctive chemical composition. BiodentineTM contains zirconium as a radiopacifying element and has higher radiopacity values than TheraCal, which contains barium and strontium as radiopacifiers.

RESUMEN: El objetivo de este estudio fue evaluar la composición química y la radiopacidad de nuevos cementos en base a silicato de calcio. Discos de 10 mm x 1 ± 0,1 mm fueron preparados con BiodentineTM, TheraCal, Dycal y GC Fuji IX (n=5). Las muestras fueron radiografiadas directamente en una película PSP oclusal adyacente a una cuña escalonada de aluminio. La radiopacidad de cada espécimen fue determinada de acuerdo a la norma ISO 9917/ 2007. Se realizaron los análisis estadísticos con las pruebas ANOVA y test de Tukey con un nivel de significancia de 5 %. La constitución química de los materiales fue determinada con microscopía electrónica de barrido y con mapeo por análisis con dispersión de energía de rayos X. La radiopacidad de los materiales en orden decreciente fue: GC Fuji IX (3,45 ± 0,16 mm), Dycal (3,18 ± 0,7 mm), BiodentineTM (2,79 ± 0,22 mm), y TheraCal (2,17 ± 0,17 mm). TheraCal mostró la menor radiopacidad comparada con los otros materiales, seguido de BiodentineTM. Los valores de radiopacidad de Dycal y GC Fuji IX no presentaron diferencias estadísticas significativas. Los análisis de microscopía electrónica de barrido y mapeo por análisis con dispersión de energía de rayos X revelaron la presencia de zirconio en BiodentineTM; y de estroncio, bario y zirconio en TheraCal, como elementos radiopacos. Los nuevos cementos en base a silicato de calcio presentan una composición química distintiva. BiodentineTM contienen zirconio como elemento que provee radiopacidad y tiene mayor valor de radiopacidad que TheraCal, el cual contiene bario y estroncio como agente radiopaco.

Quality of life and stability of tooth color change at three months after dental bleaching.

PURPOSE: Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients' aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique. METHODS: The patients were randomly divided into two groups according to the bleaching agent used: G1 = hydrogen peroxide 35% (n = 25) and G2 = carbamide peroxide 37% (n = 25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires. RESULTS: The color change (ΔE) values at 1 month were G1 = 16.80 ± 6.07 and G2 = 14.09 ± 4.83. These values remained stable until the third month after treatment (p > 0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p < 0.05). This status was maintained through the third month after treatment. CONCLUSIONS: Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

Color stability, psychosocial impact, and effect on self-perception of esthetics of tooth whitening using low-concentration (6%) hydrogen peroxide.

OBJECTIVE: The aim of this study was to assess the bleaching efficacy and impact on psychosocial and esthetics self-perception of a low-concentration (6%) hydrogen peroxide (H2O2) gel compared with a conventional (37.5%) H2O2 gel when used as an in-office treatment. METHOD AND MATERIALS: In total, 35 participants received two sessions of three 12-minute applications of treatment with 37.5% H2O2 on one side of the mouth and 6% H2O2 on the other. Color changes were measured objectively using total variation in color (ΔE) and subjectively using Vita Classical scale (ΔSGU). The Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) esthetic questionnaires were administered to measure self-perception and the psychosocial impact of the whitening procedure. RESULTS: Both gels produced significant changes in tooth color at 1 and 3 months post-whitening. The objective efficacy (ΔE) of 37.5% H2O2 (9.06 ± 2.96) was significantly higher than that of 6% H2O2 (5.69 ± 3.06). The results of the subjective assessment were not statistically different. There was a positive impact on esthetic auto perception (OHIP-14, P < .05) and psychosocial impact (PIDAQ, P < .05) at the 3-month time point. CONCLUSION: Low concentration of H2O2 (6%) achieved effective bleaching (ΔE > 5 units) with good stability at 3 months accompanied by a positive psychosocial impact and enhanced self-perception. However, the traditional 35% concentration was objectively more effective.

Sealing of restorations with marginal defects does not affect their longevity.

PURPOSE: To evaluate sealed amalgam and resin-based composite restorations after 12 years to determine whether sealing minor defects (micro-repairs) enhanced the longevity of restorations. METHODS: 34 subjects aged 18-80 were recruited. This sample group underwent 137 restorations, including 51 resin-based composite (RC) and 86 amalgam (AM) restorations. Existing restorations with localized, marginal defects were assigned to one of two groups: (a) the Sealing group (n=48, 27 AM; 21 RC) or (b) the Control group (n=89, 59 AM; 30 RC). The quality of each restoration was scored according to the modified USPHS criteria by two examiners at the beginning of the study and after 1-5, 10, and 12 years. Kaplan Meier survival curves were created and a Cox regression was applied to investigate survival variables. Mantel Cox, Wilcoxon, and Friedman tests were performed for comparisons within groups. RESULTS: After 12 years, no statistically significant differences were observed for the variables "restorative material" (P= 0.538) or "sealing yes/no" (P= 0.136) with respect to the longevity of the restorations. All groups behaved similarly with regard to marginal adaptation, secondary caries, and tooth sensitivity (P≥ 0.05). Cumulatively, after a 12-year observation period, sealing minor restoration defects did not affect the longevity of the restorations. CLINICAL SIGNIFICANCE: Sealing minor marginal defects for resin composites or amalgam restorations did not affect their longevity. This intervention may be considered over-treatment for patients with low-to-medium risks for developing dental caries.

Effect of Clinical Experience on Accuracy and Reliability of Radiographic Caries Detection / Efecto de la Experiencia Clínica en la Precisión y Concordancia de Detección de Caries en Radiografías

ABSTRACT: The purpose of this study was to investigate the accuracy and interobserver reliability of examiners with different levels of clinical experience, when diagnosing radiographic proximal caries lesions. Bitewing radiographs were selected from a patient attending Operative Dentistry Clinic, Universidad de Chile. Radiographic examination was performed by three different groups: A: third year dentistry students, B: fourth year dentistry students, and C: dentist recently graduated. Thirty-two proximal surfaces were scored as: 0, sound; 1: enamel caries; and 2: dentinal caries. The data were analysed and accuracy and interexaminer reliability were calculated. Accuracy values for enamel caries were: A (0.54), B (0.55) and C (0.58), and dentinal caries were: A (0.55), B (0.61) and C (0.63). Interexaminer reliability denoted marginal agreement for all groups, A (0.249), B (0.213) and C (0.282) for enamel caries and A (0.058), B (0.102), and C (0.344) for dentinal caries. The results of this study indicate that the accuracy and interexaminer reliability of bitewing radiographic examination were influenced by the clinical experience when detecting radiographic proximal caries, however low values of accuracy and interexaminer reliability were noted, reinforcing the necessity of improving education and training in radiographic caries detection.

RESUMEN:El objetivo de este trabajo fue evaluar la precisión y concordancia entre examinadores con distinto nivel de experiencia clínica, al diagnosticar lesiones de caries proximales en radiografías. Un set de radiografías bitewing fue seleccionado de un paciente que acudió a la Clínica de Operatoria de la Facultad de Odontología, Universidad de Chile. El examen radiográfico fue realizado por tres grupos distintos: A: estudiantes de Odontología de tercer año, B: estudiantes de Odontología de cuarto año, y C: dentistas recientemente graduados. Treinta y dos superficies proximales fueron analizadas y evaluadas como: 0, sana; 1: lesión de caries de esmalte, 2: lesión de caries dentinaria. Los datos obtenidos fueron analizados y la precisión y concordancia entre examinadores fueron calculadas. Los valores de precisión en lesiones de esmalte fueron: A (0,54), B (0,55) y C (0,58), y para lesiones dentinarias fueron: A (0,55), B (0,61) y C (0,63). La concordancia entre examinadores denotó ser marginal para todos los grupos, A (0,249), B (0,213) y C (0,282) en lesiones de esmalte y A (0,058), B (0,102), y C (0,344) en lesiones dentinarias. Los resultados de este estudio indican que la precisión y la concordancia entre examinadores está influenciada por la experiencia clínica, sin embargo los valores encontrados fueron bajos, lo que refuerza la necesidad de mejorar la educación y entrenamiento en detección de lesiones de caries en radiografías

Long-term Performance of Refurbished Amalgam Restorations: 10-year Follow-up.

PURPOSE: This prospective, blinded clinical trial assessed the performance of amalgam restorations that were refurbished, replaced, or not treated. MATERIALS AND METHODS: Twenty-three patients were included, ages 18-80 years, with 63 amalgam restorations that had one or more defects in their clinical features, such as defective anatomic form, roughness and/or luster according to United State Public Health Service (USPHS) criteria. Restorations were randomly assigned to either refurbishment (A: n = 21), replacement (B: n = 21) or untreated (C: n = 21) groups. Two calibrated examiners evaluated the restorations at baseline (Kappa = 0.74) and after 10 years (Kappa = 0.84), according to eight parameters: anatomy, roughness, luster, secondary caries, marginal adaptation, occlusal contact, marginal staining and tooth sensitivity. Wilcoxon tests were performed for within-group comparisons, and Friedman tests were used for multiple within-group comparisons. The Mantel-Cox test was used to compare survival curves. RESULTS: After 10 years, 49 restorations (77.8%) were assessed (group A: n = 19; group B: n = 13; group C: n = 17). Over a decade, the three groups showed similar clinical performances for all studied parameters: anatomy (p = 0.410), roughness (p = 0.930), luster (p = 0.984), secondary caries (p = 1.0), marginal adaptation (p = 0.433), occlusal contact (p = 0.33), marginal staining (p = 0.470), and tooth sensitivity (p = 0.784). CONCLUSIONS: Amalgam restorations that have defective anatomic form, roughness and/or luster performed similarly for all studied parameters, whether they were refurbished, replaced or left untreated after 10 years in patients with low and intermediate caries risk. Most of the restorations were classified as clinically acceptable after ten years. Restorations in all three groups tended to deteriorate over time.

The current state of calcium silicate cements in restorative dentistry: a review / Revisión del estado actual de cementos de silicato de calcio en odontología restauradora

ABSTRACT Calcium silicate cements have been used as dental materials for more than twenty years; however, their use in restorative dentistry is more recent. Better mechanical properties and shorter curing times make them suitable for a variety of applications in which they are used as a substitute of dentin, including direct/indirect pulp capping and as cavity base/liner. These materials may also be used to restore enamel temporarily. This article seeks to review the available scientific evidence with a focus on their applications in restorative dentistry. The information was gathered by reviewing original scientific research articles and literature reviews published in journals available in databases such as Medline/Pubmed and Scielo, along with technical information provided by the manufacturers of these cements. This article describes the composition, instructions for use, and curing reaction of calcium silicate cements, as well as the scientific evidence on their applications in restorative dentistry.

RESUMEN Los cementos de silicato de calcio se han aplicado como materiales dentales desde hace más de veinte años; sin embargo, su uso en el área de la odontología restauradora es más reciente. Mejores propiedades mecánicas y menores tiempos de endurecimiento le permiten ser indicados para una variedad de aplicaciones en las que este material se utiliza como sustituto dentinario, entre ellas el recubrimiento pulpar directo/indirecto y como base/liner cavitario. A su vez, también se podría utilizar como material para restaurar esmalte de manera temporal. El presente artículo busca revisar la evidencia científica disponible, enfocándola a sus aplicaciones en odontología restauradora. La información se obtuvo a partir de artículos originales de investigación científica y revisiones de literatura, publicados en revistas disponibles en bases de datos como Medline/Pubmed y Scielo, junto a la información técnica otorgada por los fabricantes de estos cementos. El presente trabajo describe la composición, el modo de empleo, la reacción de fraguado y la evidencia científica sobre las aplicaciones de los cementos de silicato de calcio en odontología restauradora.

Increased longevity of resins based composite restorations and their adhesive bond: a literature review / Aumento de longevidad de restauraciones de resinas compuestas y de su unión adhesiva: revisión de tema

ABSTRACT. Introduction: the goal of this literature review is to analyze the findings included in the literature concerning different alternatives to increase longevity of resin-based composite restorations and their adhesive bond. Methods: bibliographies in the EBSCO database (Elton B Stephens Company) were reviewed using the following key words: "composite repair bond strength"; "restorations sealing"; composite restorations longevity"; "restorations refurbishment"; "composite bond strategy"; "dental adhesive collagen cross linking"; "proanthocyanidin dentin bond strength"; "multiple layer dentin bond strength", and "dentin adhesive evaporation bond strength". Clinical and laboratory results were analyzed in terms of repairing, sealing, and refurbishing defective restorations, in addition to improvements in impregnation of adhesive surfaces, resistance of adhesive polymers, and the progress recently made concerning resistance to hydrolytic collagen degradation. Results: repairing, sealing, or refurbishing defective restorations allow keeping tooth structure healthy, reducing potential damage to dental pulp, as well as operatory pain, often caused without anesthetics. New bonding management techniques provide adhesive procedures with increased longevity. Conclusions: repairing, refurbishing, or sealing defective composite resins increase the longevity of restorations and restored teeth by using minimally invasive dental techniques. Other methods, such as improving impregnation of adhesive surfaces, increasing adhesive polymers strength, and hydrolytic degradation of collagen are promising advances that modify the management of bonding techniques, providing patients with restorative treatments of increased longevity.

RESUMEN. Introducción: el objetivo de esta revisión es analizar los resultados de las diferentes alternativas que presenta la literatura para incrementar la longevidad de las restauraciones con base a resinas compuestas. Métodos: fueron revisadas las bibliografías en la base de datos EBSCO (Elton B Stephens Company), en idioma inglés bajo los siguientes acrónimos " composite repair bond strengh"; "restorations sealing"; composite restorations longevity; "restorations refurbishment"; "composite bond estrategy"; "dental adhesive collagen cross linking"; "proanthocyanidin dentin bond strength";" multiple layer dentin bond strength"; and "dentin adhesive evaporation bond strength". Se examinan los resultados clínicos y de laboratorio de reparación, sellado y remodelado de restauraciones defectuosas, además de las mejoras en la impregnación de las superficies adhesivas, la resistencia de los polímeros adhesivos y los avances en el aumento de la resistencia a la degradación hidrolítica del colágeno. Resultados: la reparación, sellado y remodelado de restauraciones defectuosas permite la preservación de estructura dentaria sana, reducción del potencial daño a la pulpa dental y reducción del dolor operatorio, la mayoría de las veces efectuado sin uso de anestésicos. Nuevas técnicas para el manejo de la adhesión proporcionan incremento en la longevidad de los procedimientos adhesivos. Conclusiones: la reparación, remodelado y sellado de resinas compuestas defectuosas, incrementa la longevidad de las restauraciones y de los dientes restaurados con la aplicación de técnicas de odontología mínimamente invasiva. Adicionalmente otras metodologías, tales como mejoras en la impregnación de las superficies adhesivas, aumento de la resistencia de los polímeros adhesivos e incremento de la resistencia a la degradación hidrolítica del colágeno constituyen promisorios avances que modifican el manejo de las técnicas adhesivas, que permitirá ofrecer tratamientos restauradores de mayor longevidad a la población.

Does refurbishing composites lead to short-term effects or long-lasting improvement?

PURPOSE: To evaluate the clinical performance of refurbished resin composite restorations compared to untreated (negative control) restorations over a period of 10 years. METHODS: 26 subjects (having a total of 52 composite restorations) were recruited. All restorations in the refurbished group showed clinical features rated bravo according to modified USPHS criteria. Untreated restorations were those that had been deemed acceptable (alpha or bravo rated); these were used as controls. Two examiners performed assessments at baseline and during the 5th and 10th years after the intervention. Wilcoxon tests were performed for within-group comparisons, Friedman tests were used for multiple within-group comparisons, and Mann Whitney tests were used for between-groups comparisons. Kaplan-Meier survival curves were calculated, and the Mantel-Cox test was used to compare curves. P < 0.05 was considered statistically significant. RESULTS: In both groups, 10-year scores were significantly different from baseline scores in all clinical parameters except secondary caries. There were no statistically significant differences in the survival analysis of groups (log-rank test, P = 0.376). Refurbishing treatment improved the anatomy, roughness, luster, and marginal adaptation of restorations with a short-term effect, with most properties rated acceptable after 10 years of clinical service. The clinical characteristics were similar for all groups at the 10th year.

Management of Class I and Class II Amalgam Restorations with Localized Defects: Five-Year Results.

Replacement of dental restorations has been the traditional treatment for defective restorations. This five-year prospective clinical trial evaluated amalgam restorations with localized defects that were treated by means of repair or refurbishing. Fifty-two patients (50% female and 50% male, mean age 28.3 ± 18.1 years, range 18-80) with 160 class I and class II defective restorations were included. The study focused on the application of two minimally invasive treatments for localized restoration defects and compared these with no treatment and total replacement as negative and positive controls, respectively. Restorations were assessed by two calibrated examiners according to modified U.S. Public Health Service criteria, including marginal adaptation, anatomic form, secondary caries, and roughness. At five years, recall was examined in 45 patients with 108 restorations (67.5%). The results suggest that repair treatment is as effective as total replacement of restorations with localized defects, reducing biological costs to the patient and providing new tools to the clinician. Refinishing restoration is a useful treatment for localized anatomic form defects.