Bulk-Fill Resins versus Conventional Resins: An Umbrella Review.

Currently, composite resins have become the material of choice for the restoration of posterior teeth. Although bulk-fill resins represent a tempting alternative due to their lower complexity and faster use, some dentists are reluctant to use this material. The objective is to compare the performance of bulk-fill resins and conventional resins in direct restorations of posterior teeth based on the literature. The databases that were used to carry out the research were PubMed/MEDLINE, Embase, the Cochrane Library and the WOS. This umbrella literature review complies with PRISMA standards and assesses the quality of studies using the AMSTAR 2 tool. With the application of the criteria of the AMSTAR 2 tool, the reviews were considered low to moderate. The overall meta-analysis, although without statistical significance, favours mostly the use of conventional resin, as it is about five times more likely to obtain a favourable result than bulk-fill resin. Bulk-fill resins result in a simplification of the clinical process of posterior direct restorations, which is an advantage. The performance in terms of several properties of bulk-fill resins and conventional resins showed that they present similar behaviour.

Microleakage Evaluation of Temporary Restorations Used in Endodontic Treatment-An Ex Vivo Study.

(1) Background: Coronal microleakage can lead to endodontic treatment failure. This study aimed to compare the sealing ability of different temporary restorative materials used during endodontic treatment. (2) Methods: Eighty sheep incisors were collected, uniformized in length, and access cavities were performed, except for in the negative control group, where the teeth were left intact. The teeth were divided into six different groups. In the positive control group, the access cavity was made and left empty. In the experimental groups, access cavities were restored with three different temporary materials (IRM®, Ketac™ Silver, and Cavit™) and with a definitive restorative material (Filtek Supreme™). The teeth were submitted to thermocycling, and two and four weeks later, they were infiltrated with 99mTcNaO4, and nuclear medicine imaging was performed. (3) Results: Filtek Supreme™ obtained the lowest infiltration values. Regarding the temporary materials, at two weeks, Ketac™ Silver presented the lowest infiltration, followed by IRM®, whereas Cavit™ presented the highest infiltration. At four weeks, Ketac™ Silver remained with the lowest values, whereas Cavit™ decreased the infiltration, comparable to IRM®. (4) Conclusion: Regarding temporary materials, Ketac™ Silver had the lowest infiltration at 2 and 4 weeks, whereas the highest infiltration was found in the Cavit™ group at two weeks and in the IRM® group at 4 weeks.

Effect of Different Cavity Disinfectants on Adhesion to Dentin of Permanent Teeth.

After the elimination of dental caries lesions, some microorganisms may remain viable in the tooth structure. Thus, cavity disinfection is an important procedure. The aim of this study was to evaluate the effect of cavity disinfectants on the adhesion to dentin of permanent teeth. Sixty molars were ground flat and randomly assigned to six groups: control; chlorhexidine; Aloe vera; glutaraldehyde; EDTA; ethanol. Cavity disinfectants were applied, rinsed, and air-dried. The restorations were performed with the aid of polyethylene tubes. Shear bond strength, work to detachment, and shear modulus were evaluated. All data were statistically analyzed and the level of significance was set at 5%. The control group showed the lowest shear bond strength (8.34 ± 2.68 MPa). Aloe vera showed the lowest work to debonding (2284 J/m2) while chlorhexidine showed the highest (9347 J/m2). Regarding the shear modulus, ethanol, chlorhexidine, and EDTA presented similar values to the control group (216.11 kPa), and glutaraldehyde and Aloe vera presented values twice as high. The use of chlorhexidine, ethanol, EDTA, glutaraldehyde, and Aloe vera did not impair the adhesion established between the dentin of permanent teeth and composite resin. Even though there is a need for clinical studies to support these findings, all disinfectants seem to be good choices as pretreatment agents.

CAMBRA Protocol Efficacy: A Systematic Review and Critical Appraisal.

The Caries Management by Risk Assessment (CAMBRA) protocol consists of analyzing the patient's profile by assessing the risk and protective factors and assigning a risk level to the patient to allow an individualized treatment plan, which combines restorative treatments with a preventive chemical therapy. This systematic review and critical appraisal aim to evaluate the effectiveness of the CAMBRA protocol in reducing the incidence of caries lesions and oral bacterial load. An electronic search was carried out in the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases. Clinical studies evaluating the incidence of dental caries lesions and/or the reduction of cariogenic bacterial load (Streptococcus mutans and/or Lactobacilli spp.), with at least an intervention group that follows the CAMBRA protocol and a control group published up until January 2022, were included. The methodological quality assessment of the included clinical studies was assessed through the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The quality of the case-control study was evaluated according to the Methodological Index for Non-Randomized Studies (ROBINS-I). There is currently no scientific evidence to recommend the integration of the CAMBRA protocol into clinical practice. The results reported by the studies included in the systematic review do not suggest a decrease in the incidence of dental caries lesions and/or bacterial load. There is a clear need for the development of new clinical studies with an adequate methodology and follow-up, both for the CAMBRA protocol and for its components individually.

Effects of Adper™ Scotchbond™ 1 XT, Clearfil™ SE Bond 2 and Scotchbond™ Universal in Odontoblasts.

This study aimed to assess the cytotoxicity of commercially available adhesive strategies-etch-and-rinse (Adper™ Scotchbond™ 1 XT, 3M ESPE, St. Paul, MN, USA, SB1), self-etch (Clearfil™ SE Bond 2, Kuraray Noritake Dental Inc., Tokyo, Japan, CSE), and universal (Scotchbond™ Universal, 3M Deutschland GmbH, Neuss, Germany, SBU). MDPC-23 cells were exposed to adhesives extracts in different concentrations and exposure times. To access cell metabolic activity, viability, types of cell death, and cell cycle, the MTT assay, SRB assay, double labeling with annexin V and propidium iodide, and labeling with propidium iodide/RNAse were performed, respectively. Cultures were stained with May-Grünwald Giemsa for qualitative cytotoxicity assessment. The SB1, CSE, and SBU extracts determined a significant reduction in cell metabolism and viability. This reduction was higher for prolonged exposures, even for less concentrated extracts. CSE extracts significantly reduced the cell's metabolic activity at higher concentrations (50% and 100%) from 2 h of exposure. After 24 and 96 h, a metabolic activity reduction was verified for all adhesives, even at lower concentrations. These changes were dependent on the adhesive, its concentration, and the incubation time. Regarding cell viability, SBU extracts were the least cytotoxic, and CSE was significantly more cytotoxic than SB1 and SBU. The adhesives determined a reduction in viable cells and an increase in apoptotic, late apoptosis/necrosis, and necrotic cells. Moreover, on cultures exposed to SB1 and CSE extracts, a decrease in the cells in S and G2/M phases and an increase in the cells in G0/G1 phase was observed. Exposure to SBU led to an increase of cells in the S phase. In general, all adhesives determined cytotoxicity. CSE extracts were the most cytotoxic and were classified as having a higher degree of reactivity, leading to more significant inhibition of cell growth and destruction of the cell's layers.

Resin infiltration in white spot lesions caused by orthodontic hypomineralisation: a minimally invasive therapy.

Objective White spot lesions are characterised by the presence of clinically detectable opaque lesions due to enamel demineralisation. These frequently present in patients following fixed orthodontic treatment, mostly due to the prolonged accumulation of bacterial plaque on the dental surface. When remineralisation is not achieved through good oral hygiene and prophylaxis with fluoride products, the infiltration of lesions with low-viscosity photopolymerised resin has proved to be a valid micro-invasive alternative compared to traditional conservative therapy.Clinical considerations A case series will be presented, where the chosen approach was resin infiltration, a micro-invasive and aesthetic technique.Clinical significance Infiltrative resin therapies are single-session procedures that reduce the need for more invasive therapies such as the use of rotary instruments for greater patient comfort. The need for periodic fluoride applications is also avoided. This approach increases the durability of the infiltrated lesion without compromising its mechanical properties and impedes the development of recurrent or secondary caries.Conclusions Resin infiltration might be considered as a routine procedure in the treatment of post-eruptive hypomineralised lesions. This follows the line of thought of minimally invasive dentistry, is an excellent treatment option and prevents the lesion's progression.

Accessing the Cytotoxicity and Cell Response to Biomaterials.

Biomaterials contact directly or indirectly with the human tissues, making it important to evaluate its cytotoxicity. This evaluation can be performed by several methods, but a high discrepancy exists between the approaches used, compromising the reproducibility and the comparison among the obtained results. In this paper, we propose a protocol to evaluate biomaterials cytotoxicity using soluble extracts, which we use for dental biomaterials. The extracts preparation is detailed, from pellets production to its extraction in a culture medium. The biomaterials cytotoxicity evaluation is based on metabolic activity using the MTT assay, cell viability using the Sulphorhodamine B (SBR) assay, cell death profile by flow cytometry, and cell morphology using May-Grünwald Giemsa. Additional to cytotoxicity evaluation, a protocol to evaluate cell function is described based on the expression of specific markers assessed by immunocytochemistry and PCR. This protocol provides a comprehensive guide for biomaterials cytotoxicity and cellular effects evaluation, using the extracts methodology, in a reproducible and robust manner.

Aesthetic restoration of posterior teeth using different occlusal matrix techniques.

The occlusal matrix technique appears as an alternative to the conventional restorative technique. The aim of this study is to present treatment options for the decayed occlusal surface of posterior teeth by means of an occlusal matrix made with different materials, for an accurate reproduction of the tooth surface. This paper presents five clinical cases using five different materials, such as Bite-Perf, flowable composite, self-curing acrylic resin, silicone and thermoforming foil. Before light-curing, the last layer of composite resin, the matrix, is repositioned and firmly pressed so the replication of the original occlusal anatomy can be achieved. When using an occlusal matrix, minimal or no finishing and polishing procedures are needed and the offered aesthetics are clearly an advantage. Moreover, this technique makes up for the additional chairside work time. The occlusal matrix technique is demonstrated to be effective for direct composite resin restorations in posterior teeth, allowing a reliable and predictable reproduction of the occlusal anatomy and clinical adjustment. For this purpose, a clear material is preferable since it allows light transmission.

Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus.

AIM: To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. METHODOLOGY: A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto-Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. RESULTS: The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p < .001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p < .001) and triglycerides levels (p < .05) and area under the curve (AUC) during the insulin tolerance test at t21 (p < .001). AP area was significantly greater in GK rats (p < .05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21 days after AP induction (p < .08; p < .07). GK rats had intrinsically lower levels of VEGF than control rats (p < .05), which did not change after AP. CONCLUSION: Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.

The Influence of Irrigation during the Finishing and Polishing of Composite Resin Restorations-A Systematic Review of In Vitro Studies.

The surface smoothness of composite restorations affects not only their esthetic appearance but also other properties. Thus, rough surfaces can lead to staining, plaque accumulation, gingival irritation, recurrent caries, abrasiveness, wear kinetics, and tactile perception by the patient. The aim of this study was to evaluate the influence of irrigation during the finishing and polishing of composite resin restorations. A systematic search of the PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials databases was conducted. Papers published up to 11 February 2021 were considered. The quality of each study was assessed using the modified Consolidated Standards of Reporting Trials checklist for reporting in vitro studies on dental materials. No clinical studies were identified. Six in vitro studies were included, reporting changes in physical and esthetic properties. After performing a methodological quality assessment of the studies, some limitations were identified, the main limitation being the heterogeneous methodology across studies. The evidence resulting from this systematic review did not favor either wet or dry finishing/polishing procedures. There is a clear need for well-designed studies focusing on the comparison of dry/wet finishing/polishing with standard protocols to evaluate the differences among different materials and methods.

Effect of Cavity Disinfectants on Adhesion to Primary Teeth-A Systematic Review.

Some authors have been proposing the use of cavity disinfectants in order to reduce, or even eliminate, the effect of the microorganisms present in a dental cavity before a restoration is placed. The aim of this study was to evaluate the effect of different cavity disinfectants on bond strength and clinical success of composite and glass ionomer restorations on primary teeth. The research was conducted using Cochrane Library, PubMed/MEDLINE, SCOPUS, and Web of Science for articles published up to February 2021. The search was performed according to the PICO strategy. The evaluation of the methodological quality of each in vitro study was assessed using the CONSORT checklist for reporting in vitro studies on dental materials. Sixteen in vitro studies and one in situ study fulfilled the inclusion criteria and were analyzed. Chlorhexidine was the most studied cavity disinfectant, and its use does not compromise dentin bonding. Sodium hypochlorite is a promising alternative, but more research on its use is required to clearly state that it can safely be used as a cavity disinfectant for primary teeth. Although other disinfectants were studied, there is a low-level evidence attesting their effects on adhesion, therefore their use should be avoided.

Cytotoxic Effects of Zoom® Whitening Product in Human Fibroblasts.

Tooth whitening procedures are increasing; however, side effects can occur, such as damage to pulp cells, by the whitening products. This study aims to assess the cellular effects promoted by a whitening product, namely, the oxidative stress fostered by the active agent hydrogen peroxide, with and without photoactivation. Additionally, if cellular recovery occurred, we intended to determine the time point where cells recover from the tooth whitening induced damage. Human fibroblasts were exposed to hydrogen peroxide, Zoom®, Zoom® + irradiation, and irradiation alone. The following analysis was performed: metabolic activity evaluation by the MTT assay; cell viability, mitochondrial membrane potential, peroxides production, superoxide radical production, and reduced glutathione expression by flow cytometry. We determined the IC50 value for all groups, and a dose-dependent cytotoxic effect was verified. At the times analyzed, hydrogen peroxide groups showed no metabolic activity recovery while a cell recovery was observed after 24 h (Zoom®) and 48 h (Zoom® + irradiation). Cell death was seen in hydrogen peroxide and Zoom® + irradiation groups, mainly by apoptosis, and the irradiation had a cytotoxic effect per se. This in vitro study supports that whitening products with moderate hydrogen peroxide (HP) concentration have a temporary effect on cells, allowing a cellular recovery.

Dental caries, diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta-analysis.

OBJECTIVE: To analyze articles aimed at evaluating the association between diabetes, metabolic control, diabetes duration, and dental caries. OVERVIEW: A systematic search in PubMed, Cochrane Library, Embase, and Web of Science was conducted to retrieve papers in English, Portuguese, and Spanish, up to April 2019. The research strategy was constructed considering the "PECO" strategy. Only quantitative observational studies were analyzed. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analyses were performed based on random-effects models using the statistical platform R. A total of 69 articles was included in the systematic review and 40 in the meta-analysis. Type 1 diabetics have a significantly higher DMFT compared to controls. No significant differences were found between type 2 diabetics and controls and between well-controlled and poorly controlled diabetics. Concerning diabetes duration, all authors failed to find differences between groups. CONCLUSION: Although there is still a need for longitudinal studies, the meta-analysis proved that type 1 diabetics have a high dental caries risk. CLINICAL SIGNIFICANCE: It is necessary to be aware of all risk factors for dental caries that may be associated with these patients, making it possible to include them into an individualized prevention program.

Cytotoxic effects of a chlorhexidine mouthwash and of an enzymatic mouthwash on human gingival fibroblasts.

The aim of this study was to evaluate the cytotoxic effects of an enzymatic mouthwash and of a chlorhexidine mouthwash on human gingival fibroblasts. The metabolic activity of the fibroblasts exposed to each mouthwash was assessed by the MTT assay and the protein content was assessed by the SRB assay. The flow cytometry was used to evaluate the cell cycle and the types of cell death. The oxidative status was evaluated through the DCF and the DHE probes and the intracellular GSH concentration and the mitochondrial membrane potential through JC-1. The cytotoxicity of both mouthwashes was found to be dependent on the exposure time and on the concentration. However, the cytotoxicity of the enzymatic mouthwash was found to be lower than that of the chlorhexidine mouthwash. A trend towards increased oxidative stress was observed for both mouthwashes. After exposing the fibroblasts to the mouthwashes, a G2/M phase block was observed and cell death occurred predominantly by necrosis. The effects of chlorhexidine on fibroblasts were identified at lower concentrations than those used in clinical practice. Therefore, the use of chlorhexidine as an antiseptic in surgical and postoperative situations should be limited. In order to clarify the clinical significance of the enzymatic mouthwash cytotoxicity new clinical studies will be necessary.

Biocompatibility of Root Canal Sealers: A Systematic Review of In Vitro and In Vivo Studies.

(1) Aim: To perform a systematic review of the literature on the biocompatibility of root canal sealers that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence. (2) Methods: This systematic review has been registered in PROSPERO (ID 140445) and was carried out according to PRISMA guidelines using the following databases: PubMed, Cochrane Library, ClinicalTrials.gov, Science Direct, and Web of Science Core Collection. Studies published between 2000 and 11 June 2019 that evaluated cytotoxicity (cell viability/proliferation) and biocompatibility (tissue response) of root canal sealers were included. (3) Results: From a total of 1249 studies, 73 in vitro and 21 in vivo studies were included. In general, studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility, e.g., material setting condition and time, material concentration, and type of exposure. Bioactive endodontic sealers seem to exhibit a lower toxic potential in vitro. (4) Conclusions: The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level. However, the methodological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility. Further research is crucial to achieve a better understanding of the biological effects of root canal sealers.

[Prevalence of Dental Caries in Patients with Type 1 Diabetes Mellitus Treated with Multiple Insulin Injections and that of Individuals without Diabetes]. / Prevalência de Lesões de Cárie de Doentes com Diabetes Mellitus Tipo 1 Tratados com Múltiplas Administrações de Insulina e de Indivíduos sem Diabetes.

INTRODUCTION: In addition to macro and microvascular complications that are associated with the disease, hyperglycaemia is also a risk factor for several oral complications. The aim of this study is to establish a relationship between dental caries in patients with type 1 diabetes mellitus treated with multiple insulin injections and that of individuals without diabetes. It is also an aim to characterize the oral hygiene habits of this population. MATERIAL AND METHODS: An observational clinical study of analytical and cross-sectional nature was conducted. Thirty patients with type 1 diabetes mellitus and 30 individuals without diabetes were observed and questioned about information regarding their medical history. Oral examination was conducted according to the standards of the World Health Organization and ICDAS was used for caries detection. Statistical analysis was performed and the significance level was set at 5%. RESULTS: Patients with diabetes mellitus showed similar caries levels to that of individuals without diabetes. Patients with diabetes mellitus had a higher dental plaque index. Only 10% of the patients having episodes of nocturnal hypoglycaemia brush their teeth after glucose intake. DISCUSSION: Although there's some controversy in the literature regarding the prevalence of caries in patients with diabetes mellitus, the results are in agreement with a great number of studies. However, patients with diabetes mellitus have a higher plaque index which can be associated with a higher risk for developing certain oral pathologies. CONCLUSION: No statistically significant association was found between type 1 diabetes mellitus and dental caries.

Introdução: A diabetes mellitus apresenta diferentes complicações micro e macrovasculares, sendo também um fator de risco para diversas complicações orais. O objetivo do presente estudo é estabelecer uma relação entre a cárie dentária em doentes com diabetes mellitus do tipo 1 tratados com múltiplas injeções de insulina e em indivíduos sem diabetes. É ainda objetivo caracterizar os hábitos de higiene oral desta população. Material e Métodos: Um estudo clínico e observacional de caráter analítico e transversal foi realizado. Trinta doentes com diabetes mellitus do tipo 1 e 30 indivíduos sem diabetes foram observados e questionados sobre informações referentes à sua histórica médica. O exame oral foi realizado de acordo com as normas da Organização Mundial de Saúde, tendo-se utilizado o índice de cárie ICDAS. A análise estatística foi realizada e foi estabelecido um nível de significância de 5%. Resultados: Os doentes com diabetes mellitus apresentaram um índice de cárie semelhante ao dos indivíduos sem diabetes. Verificou-se, ainda, um índice de placa bacteriana superior nos doentes com diabetes mellitus. Apenas 10% dos doentes que referiam episódios de hipoglicemia noturna escovam os dentes após a ingestão de glicose. Discussão: Apesar de existir alguma controvérsia na literatura quanto à prevalência de cárie em doentes com diabetes mellitus, os resultados obtidos estão de acordo com a maioria dos estudos realizados até à data. No entanto, os doentes apresentam um maior índice de placa bacteriana, o que lhes pode conferir um maior risco para o desenvolvimento de determinadas patologias orais.Conclusão: Não foi encontrada nenhuma associação estatisticamente significativa entre a diabetes mellitus do tipo 1 e o desenvolvimento de cárie dentária.

Histologic evaluation of the effect of mineral trioxide aggregate-Fillapex as a root canal sealer in rat teeth submitted to late replantation.

OBJECTIVE: This study aims to analyze the effect of new root canal based silicate cement, in rat teeth after late replantation, comparing with calcium hydroxide (CH) in preventing tooth root resorption. MATERIALS AND METHODS: The study group included 16 Wistar rats in which the upper right central incisors were extracted and were left on a worktable for 60 min, simulating a case of tooth avulsion, after had been anesthetized. One group, (Group I), the canals were filled with CH past, before replantation. The second groups of teeth, (Group II), the canals were filled with mineral trioxide aggregate-Fillapex (MTAF). After removal, the blood clot of the socket, with saline solution irrigation, the teeth were replanted into their original socket, and splinted with silk 3/0. The rats were sacrificed 8 weeks after replantation and the specimens were prepared for histologic and histomorphometric analyses. The areas of inflammatory and replacement resorptions were selected and quantified. These data for each group of teeth were evaluated and analyzed using the Mann-Whitney test (P = 0.05). RESULT AND CONCLUSION: All the replanted teeth in both groups survived. Although root canal filled with MTAF provide better results than with CH past concerning inflammatory and replacement resorption, there was no statistical difference (P = 0.527).

Therapies for White Spot Lesions-A Systematic Review.

INTRODUCTION: The first sign of dental caries is denoted by white spot lesions (WSLs) which can be defined as a demineralization of the enamel surface and subsurface, although these lesions can be reversed and do not form cavities. The aim of this systematic review was investigate which remineralization agents are effective for the treatment of WSLs. MATERIALS AND METHODS: For this systematic review a literature search was conducted on Pubmed, Cochrane Library and ScienceDirect. RESULTS: The initial search resulted in 273 references. After elimination of duplicate articles, 236 references remained. After reading titles and abstracts, all non-relevant results were excluded, resulting in 45 potentially relevant studies. After reading the full text, 13 references were included. CONCLUSION: More studies are required for scientific evidence in order to reach a conclusion of the most suitable therapeutic method for the treatment of surface and subsurface demineralization of the enamel.

Obturación tridimensional: un factor clave en el pronóstico del tratamiento endodóncico: caso clínico / Tri-dimensional filling: a key factor in the outcome of endodontic treatment: case report

La calidad de la obturación del conducto radicular está considerada en la actualidad como un factor de gran influencia en el resultado del tratamiento endodóncico (TE). La tomografía computerizada de haz cónico (CBCT) puede ser utilizada para confirmar un diagnóstico sobre la morfología del conducto radicular, y está indicada en la evaluación de complicaciones post-tratamiento, cuando el examen radiográfico convencional no aporta suficiente información. Estudios recientes realizados con micro-CT muestran variaciones anatómicas que pueden estar implicadas en el fracaso del TE. Los clínicos deben tener en cuenta las variaciones anatómicas de los dientes y las ventajas de utilizar el CBCT en situaciones específicas. Este caso clínico pretende resaltar la importancia de una obturación tridimensional en el éxito del TE

The quality of the root canal filling is currently recognized as a factor that influences the outcome of the endodontic treatment (ET). Cone beam computerized tomography (CBCT) can be used to confirm a diagnosis of root canal morphology and is indicated in the evaluation of post-treatment complications, when conventional radiographic examination does not provide sufficient information. Recent studies with micro-CT present anatomic variations which can be implicated in the ET failure. Clinicians should be aware of the teeth’s morphological variations and of the advantages of using CBCT in specific situations. This case report aims to highlight the importance of a tri-dimentional filling in the success of the ET

Portuguese Dentists' Attitudes Towards Their Role in Addressing Obesity.

PURPOSE: To determine Portuguese dentists' role in addressing obesity. MATERIALS AND METHODS: For this pilot study, the original version of the Dentists' Role In Addressing Obesity questionnaire was translated from English into Portuguese and validated to ensure that it was culturally adapted for Portuguese dentists. The questionnaire was distributed to a random sample of 400 Portuguese dentists. SPSS Statistics 20 was used to analyse the survey sampling design and assess respondents' attitudes and opinions, outcome expectations and self-efficacy both as ordinal and dichotomised variables. The analysis was a descriptive statistic based on frequencies, without symmetry test. RESULTS: In all, 141 dentists responded. Overall, 22.0% of respondents offered a form of counseling services and 58.9% reported that they were interested in offering obesity-related services. A paucity of trained personnel (58.9%) was cited by the respondents as a major barrier, followed by patients' rejection of weight-loss advice (32.6%) and fears of offending patients (29.1%). 92% of respondents agreed that dentists would be more willing to intervene if obesity were linked to oral disease. CONCLUSION: Healthcare providers must coordinate prevention and interventional efforts for maximum effect. Given the positioning of dentists willing to assist in such an effort, it appears reasonable for experts in obesity intervention in conjunction with dental educators to develop intervention models to be implemented within the scope of the dental practice.