Experimental self-etching resin infiltrants on the treatment of simulated carious white spot lesions.

OBJECTIVES: To evaluate the penetration depth (µm) of experimental resin infiltrants containing different percentages of triethylene glycol dimethacrylate (TEGDMA) and phosphoric acid 2-hydroxyethyl methacrylate ester (PAM) in artificial carious white spot lesions (WSL). METHODS: WSL were produced in 65 bovine flat enamel specimens by pH cycling protocol, which were treated with either Icon (control) or experimental acidic infiltrants based on different percentages of TEGDMA and PAM monomers (acidic), and their association or not with previous acid-etching with phosphoric acid. Ten readings using Confocal Laser Scanning Microscopy were conducted on each specimen and the penetration depth was calculated from the surface until the deepest point with the fluorescent dye Rhodamine B (0.02 mg/mL). The pH and the viscosity of the experimental infiltrants were also tested. Data were statistically analyzed with two-way ANOVA and Tukey tests (α < 0.05). RESULTS: The material factor and the interaction material*acid-etching were statistically significant. The lowest penetration depth was observed for the samples treated with the commercial infiltrant after etching with 15% hydrochloric acid. When specimens were pre-treated with PA, highest penetration was seen for specimens treated with 100% TEGDMA, which differed from all other groups. The lowest penetration was seen for those treated with 50:50 TEGDMA:PAM infiltrants. When specimens were not previously etched, highest penetration was seen for Icon, which differed only from those treated with 25% TEGDMA 75% PAM, where the lowest values were seen. The values of viscosity increased and the pH decreased with the addition of PAM in the infiltrant formulations. CONCLUSION: the association between TEGDMA and PAM seems to allow similar infiltration depth reached by Icon infiltrant without acid etching the enamel surface.

Proximal retention grooves may increase early fracture strength of ART restorations / Sulcos de retenção proximal podem aumentar a resistência a fratura precoce de restaurações de ART

Objective: To evaluate the fracture resistance (RF) of Class II Glass-ionomer Cement (GIC) ART restorations with and without proximal retentions. Material and Methods: 20 freshly extracted human molars were used. Forty (40) standard Mesial-Occlusal (MO) and DistalOcclusal (DO) preparations (20 for each material) were performed with a 245 bur. The unprepared surfaces of the teeth were protected with nail polish and the specimens submerged in 0.5Mol EDTA solution, pH 7.4 for 8h under stirring. The preparations were finished with dentine spoons and 50% received proximal retention with # 3 excavators. 20 cavities were restored with Chemfil Rock (10 with retention and 10 without retention) and 20 cavities were restored with Equia Fil (10 with retention and 10 with no retention) and were stored in an oven at 37ºC and 100% relative humidity for 24h and submitted to axial compression loading in Test Machine - EMIC at a rate of 0.5 mm / minute, until restoration fracture occurred. The values were analyzed by two-way ANOVA (p<0.05). Results: ChemFil Rock presented 300.84 (69.20) (without retention) and 361.70 (81.08) (with retention) and Equia Fil showed 314.60 (69.97) (without retention) and 366.67 (103.38) (with retention). Data obtained with retention were statistically superior to those obtained with non-retained ART restorations (p=0.014). No statistical differences were detected between materials (p=0.761). Conclusion: Retentive grooves improved fracture resistance of Class II GIC ART restorations. (AU)

Objetivo: avaliar a resistência à fratura (FR) de restaurações de ART de Classe II de Cimento de ionômero de vidro (CIV) com e sem retenções proximais. Material e Métodos: Foram utilizados 20 molares humanos recém-extraídos. 40 cavidades padronizadas no sentido Mesial-Oclusal (MO) e Oclusal-Distal (OD) (20 para cada material) foram realizadas com uma broca 245. Os preparos cavitários foram submersos em solução 0,5 mol Mol EDTA, pH 7,4 por 8h sob agitação e foram finalizados com colheres de dentina, nos quais 50% receberam retenções proximais com escavadores #3. 20 cavidades foram restauradas com Chemfil Rock (10 com e 10 sem retenção) e 20 cavidades foram restauradas com Equia Fil (10 com e 10 sem retenção) e armazenadas em estufa a 37ºC e 100% de umidade relativa por 24h e submetidos a carga axial de compressão na máquina de ensaios EMIC a uma taxa de 0,5mm/min, até que a fratura de restauração ocorresse. Os valores foram analisados por ANOVA twoway (p<0,05). Resultados: ChemFil Rock apresentou 300.84 (69.20) (sem retenção) e 361.70 (81.08) (com retenção) e o Equia Fil apresentou 314.60 (69.97) (sem retenção) e 366.67 (103.38) (com retenção). Os dados obtidos com retenção foram estatisticamente superiores àqueles sem retenção (p=0.014). Não houve diferença estatística entre os materiais (p=0.761). Conclusão: Os sulcos retentivos melhoraram a resistência à fratura de restaurações de ART de Classe II de Cimento de ionômero de vidro (CIV).(AU)

In vitro effect of a resin infiltrant on different artificial caries-like enamel lesions.

OBJECTIVES: A resin infiltrant was employed for the treatment of active white spot lesions due to its ability to penetrate into the enamel pores and prevent the progression of the lesion. However, limited information is available about its mechanical effect on different artificial enamel lesions as well as on its resistance to further demineralization. Therefore, this study aimed to evaluate the effects of the Icon® infiltrant on different artificial caries-like enamel lesions and its resistance to new acid challenges. DESIGN: Artificial lesions were produced in bovine enamel using three different protocols (demineralization/remineralization cycling, DE-RE; 8% methylcellulose gel, MC; and methyl ethyl diphosphonate solution, MHDP; n = 13). The specimens were treated with Icon® and subjected to a new acid challenge using DE-RE cycling. The surface and cross-sectional hardness were evaluated in sound, demineralized, treated and further demineralized enamel areas. Data were statistically analyzed using ANOVA and Tukey's test (p < 0.05). RESULTS: All of the demineralizing protocols produced subsurface artificial caries lesions. The infiltrant was able to partially recover the surface hardness and prevent further surface hardness loss in enamel previously demineralized using the DE-RE and MHDP protocols. In regard to cross-sectional hardness, no positive effect was found. CONCLUSIONS: The effect of the infiltrant depends on the type of lesion created in vitro, and its action is limited to the lesion surface.

Randomized clinical trial of encapsulated and hand-mixed glass-ionomer ART restorations: one-year follow-up.

This prospective, randomized, split-mouth clinical trial evaluated the clinical performance of conventional glass ionomer cement (GIC; Riva Self-Cure, SDI), supplied in capsules or in powder/liquid kits and placed in Class I cavities in permanent molars by the Atraumatic Restorative Treatment (ART) approach. A total of 80 restorations were randomly placed in 40 patients aged 11-15 years. Each patient received one restoration with each type of GIC. The restorations were evaluated after periods of 15 days (baseline), 6 months, and 1 year, according to ART criteria. Wilcoxon matched pairs, multivariate logistic regression, and Gehan-Wilcoxon tests were used for statistical analysis. Patients were evaluated after 15 days (n=40), 6 months (n=34), and 1 year (n=29). Encapsulated GICs showed significantly superior clinical performance compared with hand-mixed GICs at baseline (p=0.017), 6 months (p=0.001), and 1 year (p=0.026). For hand-mixed GIC, a statistically significant difference was only observed over the period of baseline to 1 year (p=0.001). Encapsulated GIC presented statistically significant differences for the following periods: 6 months to 1 year (p=0.028) and baseline to 1 year (p=0.002). Encapsulated GIC presented superior cumulative survival rate than hand-mixed GIC over one year. Importantly, both GICs exhibited decreased survival over time. Encapsulated GIC promoted better ART performance, with an annual failure rate of 24%; in contrast, hand-mixed GIC demonstrated a failure rate of 42%.

Randomized clinical trial of encapsulated and hand-mixed glass-ionomer ART restorations: one-year follow-up

Abstract Objective This prospective, randomized, split-mouth clinical trial evaluated the clinical performance of conventional glass ionomer cement (GIC; Riva Self-Cure, SDI), supplied in capsules or in powder/liquid kits and placed in Class I cavities in permanent molars by the Atraumatic Restorative Treatment (ART) approach. Material and Methods A total of 80 restorations were randomly placed in 40 patients aged 11-15 years. Each patient received one restoration with each type of GIC. The restorations were evaluated after periods of 15 days (baseline), 6 months, and 1 year, according to ART criteria. Wilcoxon matched pairs, multivariate logistic regression, and Gehan-Wilcoxon tests were used for statistical analysis. Results Patients were evaluated after 15 days (n=40), 6 months (n=34), and 1 year (n=29). Encapsulated GICs showed significantly superior clinical performance compared with hand-mixed GICs at baseline (p=0.017), 6 months (p=0.001), and 1 year (p=0.026). For hand-mixed GIC, a statistically significant difference was only observed over the period of baseline to 1 year (p=0.001). Encapsulated GIC presented statistically significant differences for the following periods: 6 months to 1 year (p=0.028) and baseline to 1 year (p=0.002). Encapsulated GIC presented superior cumulative survival rate than hand-mixed GIC over one year. Importantly, both GICs exhibited decreased survival over time. Conclusions Encapsulated GIC promoted better ART performance, with an annual failure rate of 24%; in contrast, hand-mixed GIC demonstrated a failure rate of 42%.

Effect of enamel pretreatment on the fluoride remineralization of artificial white spot lesions / Efeito do pré-tratamento do esmalte na remineralização de lesões brancas de cárie artificiais com fluoreto

Objective: The topical fluoride application is the main strategy to remineralize white spots lesions (WSL). It is assumed that increasing its retention in the surface can favor remineralization. Therefore, previous treatments of the enamel surface are purposed to optimize its efficacy. This study aimed to evaluate the remineralization capacity of the fluoride without and with the pre-treatment of the enamel with phosphoric acid and aluminum nitrate and then, the enamel acid-resistance after new acid challenge. Material and Methods: Twenty-four enamel bovine blocks were obtained and selected by means of initial surface microhardness (SMH) measurements. In sequence, WSL were artificially inducted by DE-RE cycling and randomized in two groups according to the enamel pretreatment to be tested (n=12): F (1.23% fluoride gel - APF- 4min) and P-Al-F (37% phosphoric acid- 30s + 0.05M aluminum nitrate 1min + APF- 4min). After then, a new acid challenge was equally performed. Additional SMH assessments were performed in each step. The values were processed and the percentage of SH loss (%SHL) was obtained. Data were statically analyzed by two-way ANOVA and Tukey tests (p <0.05). Results: There was no difference between evaluated protocols. For both groups, a significant difference among the steps of study was detected: it was observed a decrease of %SHL after the treatment and increase of %SHL after the new acid challenge. Conclusion: Enamel pretreatment with phosphoric acid associated with aluminum nitrate promoted similar protective effect compared to fluoride itself on the remineralization of artificial WSL, partially recovering the surface hardness. After new challenge, they also offered partial resistance. (AU)

Objetivos: A aplicação tópica de flúor é a principal estratégia para remineralizar lesões de mancha branca (MB). Foi proposto que o aumento na retenção deste íon na superfície pode favorecer a remineralização. Portanto, o tratamento prévio da superfície do esmalte foi proposto para otimizar sua eficácia. Material e Métodos: Este estudo objetivou avaliar a capacidade de remineralização do fluoreto com e sem pré-tratamento do esmalte com ácido fosfórico e nitrato de alumínio e a resistência do esmalte após novo desafio ácido. Vinte e quatro blocos de esmalte bovino foram obtidos e selecionados pela média inicial de microdureza de superfície (MS). Em seguida, MB foram artificialmente induzidas através de ciclagem DES-RE e os espécimes aleatorizados em dois grupos de acordo com o pré-tratamento do esmalte a ser avaliado (n=12): F (flúor gel acidulado 1,23% - APF - 4 min) e P-Al-F (ácido fosfórico 37% - 30s + nitrato de alumínio 0,05M 1min + APF por 4 min). Após o tratamento, um novo desafio ácido semelhante ao inicial foi realizado. Novas avaliações de MS foram obtidas em cada etapa. Os valores foram processados e a porcentagem de perda mineral da superfície (%PDS) foi obtida. Os dados foram analisados estatisticamente por ANOVA dois critérios e teste de Tukey (p <0,05). Resultados: Não houveram diferenças entre os protocolos avaliados. Para ambos grupos, uma diferença significante entre as fases do estudo foi detectada: observouse uma queda no %PDS após o tratamento e aumento do %PDS após novo desafio ácido. Conclusão: O pré-tratamento do esmalte com ácido fosfórico associado com nitrato de alumínio promoveu efeito similar à aplicação isolada do APF na remineralização das MB artificiais, recuperando parcialmente a dureza de superfície. Após o novo desafio ácido, os dois grupos ofereceram resistência parcial. (AU)

Influence of Erosive and Abrasive Cycling on Bonding of Different Adhesive Systems to Enamel: An In situ Study.

This study evaluated the impact of orange juice on the bond strength (BS) of dentin bonding systems (DBSs) to enamel surface after simulation with an in situ/ ex vivo erosive cycling. One hundred and ninety two bovine enamel fragments (4x4x2mm) were obtained and randomized regarding superficial microhardness and distributed to palatal devices for 8 volunteers, in three phases (one for each DBS), containing 8 blocks, which were, allocated in 4 pairs. Daily, these pairs were subjected extraorally to the following conditions: CONT- neither erosive nor abrasive challenge; ERO- erosive challenge only; ABR- abrasive challenge only and ERO + ABR- with erosive and abrasive challenges. Erosive cycles (immersion in orange juice, 3 times/day/5 min/5 days) or/and abrasive challenges (electric toothbrush, 3 times/day/1 min/5 days) were performed. After these cycles, all specimens were restored with the adhesive systems Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) or Clearfil SE Bond (SE), and the composite resin Filtek Z250. After 7 days, sticks (area ≅1 mm2) were obtained and subjected to the microtensile bond strength test (µTBS) at 0.5 mm/min. Data was statistically analyzed by ANOVA and Tukey tests (a=0.05). Failure modes were determined using a digital microscope (40´). DBS was the only statistical significant factor. SE was the unique DBS not affected in any challenge, whereas MP and SB performed according to the scenario. The adhesive and mixed failures were predominant in all groups. Overall performance suggested that BS to enamel after erosive /abrasive challenged by orange juice was not affected and it was material-dependent.

Influence of Erosive and Abrasive Cycling on Bonding of Different Adhesive Systems to Enamel: An In situ Study

Abstract This study evaluated the impact of orange juice on the bond strength (BS) of dentin bonding systems (DBSs) to enamel surface after simulation with an in situ/ ex vivo erosive cycling. One hundred and ninety two bovine enamel fragments (4x4x2mm) were obtained and randomized regarding superficial microhardness and distributed to palatal devices for 8 volunteers, in three phases (one for each DBS), containing 8 blocks, which were, allocated in 4 pairs. Daily, these pairs were subjected extraorally to the following conditions: CONT- neither erosive nor abrasive challenge; ERO- erosive challenge only; ABR- abrasive challenge only and ERO + ABR- with erosive and abrasive challenges. Erosive cycles (immersion in orange juice, 3 times/day/5 min/5 days) or/and abrasive challenges (electric toothbrush, 3 times/day/1 min/5 days) were performed. After these cycles, all specimens were restored with the adhesive systems Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) or Clearfil SE Bond (SE), and the composite resin Filtek Z250. After 7 days, sticks (area ≅1 mm2) were obtained and subjected to the microtensile bond strength test (μTBS) at 0.5 mm/min. Data was statistically analyzed by ANOVA and Tukey tests (a=0.05). Failure modes were determined using a digital microscope (40´). DBS was the only statistical significant factor. SE was the unique DBS not affected in any challenge, whereas MP and SB performed according to the scenario. The adhesive and mixed failures were predominant in all groups. Overall performance suggested that BS to enamel after erosive /abrasive challenged by orange juice was not affected and it was material-dependent.

Resumo Este estudo avaliou o impacto de suco de laranja na resistência de união (RU) de sistemas adesivos dentinários (SAD) à superfície do esmalte após a simulação com uma ciclagem erosiva in situ/ex vivo. Cento e noventa e dois fragmentos de esmalte bovino (4x4x2mm) foram obtidos e randomizados considerando a microdureza superficial, e distribuídos em dispositivos palatinos para 8 voluntários, em três fases (uma para cada SAD), contendo 8 blocos, os quais foram alocados em 4 pares. Diariamente, esses pares eram submetidos às seguintes condições extraoralmente: CONT- sem desafio erosivo ou abrasivo; ERO- desafio erosivo somente; ABR- desafio abrasivo somente; e ERO+ABR- com desafio erosivo e abrasivo. A ciclagem erosiva (imersão em suco de laranja, 3 vezes/dia/5 min/5 dias) e/ou ciclagem abrasiva (escova dentária elétrica, 3 vezes/dia/1 min/5 dias) foram feitas. Após estas ciclagens, todos os espécimes foram restaurados com os sistemas adesivos Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) ou Clearfil SE Bond (SE), e com a resina composta Filtek Z250. Após 7 dias, palitos (área ≈1 mm) eram obtidos e submetidos ao teste de resistência de união por microtração (μTBS) a 0,5 mm/min. Os dados foram estatisticamente analisados por ANOVA e teste de Tukey (a=0,05). Os modos de fratura foram determinados utilizando um microscópio digital (40×). SAD foi o único fator estatisticamente significante. SE foi o único SAD não afetado por qualquer desafio, enquanto o MP e o SB apresentaram um desempenho de acordo com o cenário. As fraturas do tipo mista e adesiva foram predominantes em todos os grupos. O desempenho geral sugeriu que RU ao esmalte após desafio erosivo/abrasivo por suco de laranja não foi afetada e foi material-dependente.

Efeito de um infiltrante resinoso no tratamento de lesões de mancha branca: análise in vitro e in situ / Efffect of a resinous infiltrant on the tratment of white spot lesions: in vitro and in situ analysis

Dentre as estratégias de tratamento de lesões incipientes de cárie, no estágio de mancha branca ativa, o infiltrante resinoso tem sido empregado, preenchendo os poros do esmalte e impedindo a sua progressão. O objetivo deste trabalho foi avaliar o efeito do infiltrante de cárie (Icon®) sobre lesões cariosas artificiais produzidas por diferentes protocolos e a eficiência deste tratamento após novo desafio ácido por modelos experimentais in vitro e in situ, utilizando a microdureza de superfície (MS) e longitudinal (ML). Na fase in vitro, lesões cariosas artificiais foram produzidas em 45 espécimes de esmalte bovino (6x4mm) através de três diferentes protocolos (ciclagem DES-RE, gel MC e solução MHDP). Os espécimes foram tratados com o infiltrante e submetidos a novo desafio ácido por ciclagem DES-RE. Este delineamento resultou em 4 condições em um mesmo espécime: hígida (H), após a desmineralização (D), após o tratamento com o infiltrante (I) e após o novo desafio ácido (N). Na fase in situ, 15 voluntários usaram dispositivos palatinos contendo dois espécimes por 14 dias, induzindo a lesão por meio de gotejamento de solução de sacarose 8x/dia. Nas duas fases, a MS e ML foram avaliadas em todas as condições dos espécimes até 220μm. Os dados foram coletados e processados pela porcentagem da diferença com os valores iniciais da condição hígida para serem analisados estatisticamente de acordo com ANOVA (medidas repetidas) e teste de Tukey (p<0,05). No estudo in vitro e in situ todos os protocolos de desmineralização foram capazes de produzir lesões de cárie de subsuperfície. Todos os protocolos in vitro promoveram perda de dureza de superfície maior que 75%, enquanto o protocolo in situ promoveu quase 40%. Há uma redução da perda de dureza à medida que a profundidade aumenta em todos os casos, sendo as particularidades mais observadas até 50 μm. O infiltrante avaliado em todas as condições foi capaz de re-equilibrar parcialmente a dureza interna...

Among the strategies for early caries lesions treatment as active white spot, the resin infiltrant has been employed filling the enamel pores and preventing their progression. The aim of this study was to evaluate the effect of caries infiltrant (Icon®) on artificial carious lesions produced by different protocols, and the efficiency of this treatment after new challenge acid by in vitro and in situ experimental models, using the surface microhardness (SH) and cross-sectional microhardness (CSH). In the in vitro phase, artificial carious lesions were performed on 45 enamel bovine specimens (6x4mm) by three different protocols (DE-RE cycling, MC gel and MHDP solution). The specimens were treated with the infiltrant and subjected to a new challenge by DE-RE cycling. This design resulted in four conditions at the same specimen: sound (S), after demineralization (D), after the treatment with infiltrant (I) and after the new acid challenge (N). In the in situ phase, 15 volunteers wore intraoral appliances containing two specimens for 14 days, inducing the lesion formation by sucrose solution dripping 8x/day. In both models, SH and CSH were evaluated in all conditions of the specimens up to 220μm. Data were collected and processed as percentage from the difference to each condition compared to sound stage to be statistically analyzed with ANOVA (repeated measures) and Tukey test (p <0.05). For all tested conditions, demineralization protocols were able to produce subsurface carious lesions. All in vitro protocols promoted hardness loss higher than 75% while in situ protocol promoted almost 40%. There is a reduction in the hardness loss as the depth increases, in which the main differences can be noticed up to 50μm. The infiltrant evaluated in all conditions was able to partially re-balance the internal hardness, however its strength and effect after the new challenge acid had been limited...

Efeito de um infiltrante resinoso no tratamento de lesões de mancha branca: análise in vitro e in situ / Efffect of a resinous infiltrant on the tratment of white spot lesions: in vitro and in situ analysis

Dentre as estratégias de tratamento de lesões incipientes de cárie, no estágio de mancha branca ativa, o infiltrante resinoso tem sido empregado, preenchendo os poros do esmalte e impedindo a sua progressão. O objetivo deste trabalho foi avaliar o efeito do infiltrante de cárie (Icon®) sobre lesões cariosas artificiais produzidas por diferentes protocolos e a eficiência deste tratamento após novo desafio ácido por modelos experimentais in vitro e in situ, utilizando a microdureza de superfície (MS) e longitudinal (ML). Na fase in vitro, lesões cariosas artificiais foram produzidas em 45 espécimes de esmalte bovino (6x4mm) através de três diferentes protocolos (ciclagem DES-RE, gel MC e solução MHDP). Os espécimes foram tratados com o infiltrante e submetidos a novo desafio ácido por ciclagem DES-RE. Este delineamento resultou em 4 condições em um mesmo espécime: hígida (H), após a desmineralização (D), após o tratamento com o infiltrante (I) e após o novo desafio ácido (N). Na fase in situ, 15 voluntários usaram dispositivos palatinos contendo dois espécimes por 14 dias, induzindo a lesão por meio de gotejamento de solução de sacarose 8x/dia. Nas duas fases, a MS e ML foram avaliadas em todas as condições dos espécimes até 220μm. Os dados foram coletados e processados pela porcentagem da diferença com os valores iniciais da condição hígida para serem analisados estatisticamente de acordo com ANOVA (medidas repetidas) e teste de Tukey (p<0,05). No estudo in vitro e in situ todos os protocolos de desmineralização foram capazes de produzir lesões de cárie de subsuperfície. Todos os protocolos in vitro promoveram perda de dureza de superfície maior que 75%, enquanto o protocolo in situ promoveu quase 40%. Há uma redução da perda de dureza à medida que a profundidade aumenta em todos os casos, sendo as particularidades mais observadas até 50 μm. O infiltrante avaliado em todas as condições foi capaz de re-equilibrar parcialmente a dureza interna...

Among the strategies for early caries lesions treatment as active white spot, the resin infiltrant has been employed filling the enamel pores and preventing their progression. The aim of this study was to evaluate the effect of caries infiltrant (Icon®) on artificial carious lesions produced by different protocols, and the efficiency of this treatment after new challenge acid by in vitro and in situ experimental models, using the surface microhardness (SH) and cross-sectional microhardness (CSH). In the in vitro phase, artificial carious lesions were performed on 45 enamel bovine specimens (6x4mm) by three different protocols (DE-RE cycling, MC gel and MHDP solution). The specimens were treated with the infiltrant and subjected to a new challenge by DE-RE cycling. This design resulted in four conditions at the same specimen: sound (S), after demineralization (D), after the treatment with infiltrant (I) and after the new acid challenge (N). In the in situ phase, 15 volunteers wore intraoral appliances containing two specimens for 14 days, inducing the lesion formation by sucrose solution dripping 8x/day. In both models, SH and CSH were evaluated in all conditions of the specimens up to 220μm. Data were collected and processed as percentage from the difference to each condition compared to sound stage to be statistically analyzed with ANOVA (repeated measures) and Tukey test (p <0.05). For all tested conditions, demineralization protocols were able to produce subsurface carious lesions. All in vitro protocols promoted hardness loss higher than 75% while in situ protocol promoted almost 40%. There is a reduction in the hardness loss as the depth increases, in which the main differences can be noticed up to 50μm. The infiltrant evaluated in all conditions was able to partially re-balance the internal hardness, however its strength and effect after the new challenge acid had been limited.

Incipient caries lesions: from concept to actual treatment approaches

The concepts introduced by the Minimally Invasive Dentistry (MID) allowed the rising of new conservative treatment and assessment system for caries lesions' classification. In this context, the approaches of the incipient caries lesions surpass the use of only traditional restorative techniques. The aim of this study was to review the new caries classifications criteria (ICDAS and CAST), the importance of the early diagnosis of caries lesions and the clinical procedures for treatment in MID.

Multidisciplinary approach to the establishment and maintenance of an esthetic smile: a 9-year follow-up case report.

In addition to providing functionality to patients, contemporary dentistry strives for esthetic excellence. Patients with anterior impairments, such as shape, size, and position alterations, have compromised smile harmony. A multidisciplinary orthodontic-operative dentistry approach has improved the treatment of these patients, since the use of orthodontic appliances in association with direct composite restorations can solve many esthetic problems. Although this treatment strategy is rather widespread, professional skills are necessary for the correct reproduction of the main features of teeth. Moreover, treatment success is directly related to its longevity. With the aid of a 9-year follow-up case report, a simple direct technique associated with an orthodontic treatment for restoring the esthetic appearance of an impaired smile, with good short- and long-term outcomes, based on minimal but essential esthetic repair interventions is discussed. Such coordinated treatment proved to be effective for the establishment and maintenance of an esthetic and pleasant smile.

Ten-year survival of ART restorations in permanent posterior teeth.

This study evaluated the 10-year clinical performance of high-viscosity glass-ionomer cement placed in posterior permanent teeth by means of the Atraumatic Restorative Treatment (ART) approach. One operator placed 167 single- and 107 multiple-surface restorations in 43 high-risk caries pregnant women (mean decayed teeth = 9.8 ± 5.5). Examinations were performed at 1-, 2-, and 10-year intervals according to ART criteria. In the last evaluation, the US Public Health Service (USPHS) criteria were also used. After 10 years, 129 restorations (47.1%) were evaluated and achieved a cumulative survival rate of 49.0% (SE 7.2%). The 10-year survival of single- and multiple-surface ART restorations assessed using the ART criteria were 65.2% (SE 7.3%) and 30.6% (SE 9.9%), respectively. This difference was significant (jackknife SE of difference; p < 0.05). Using the USPHS criteria, the 10-year survival of single- and multiple-surface ART restorations were 86.5% and 57.6%, respectively. The primary causes of failure were total loss (9.3%) and marginal defects (5.4%). The survival rates observed, especially for the single-surface restorations, confirm the potential of the ART approach for restoring and saving posterior permanent teeth.

Avaliação de cimentos de ionômero de vidro modificados por resina frente à incorporação de nanopartículas de vitrocerâmica bioativa / Resin modified glass ionomer cements evaluation with additional bioactive glass-ceramics nanoparticles

Os materiais bioativos são materiais sintéticos que possuem superfícies ativas em que os minerais presentes em tecidos duros podem se ligar quimicamente. Há alguns estudos em Odontologia, onde partículas desses materiais foram incorporadas aos Cimentos de Ionômero de Vidro (CIVs) e Cimentos de Ionômero de Vidro modificados por resina (CIVMRs) com o objetivo de se obter bioatividade, e conseqüente remineralização dentária. O presente estudo teve como objetivo avaliar os efeitos da incorporação de nanopartículas de vitrocerâmica bioativa nas propriedades de resistência à compressão e rugosidade de CIVMRs. Fuji II LC e Vitremer foram considerados os grupos controles. Materiais experimentais foram feitos através da incorporação de 2, 5 e 10% em peso de Biosilicato nestes CIVMRs. Seis corpos-de-prova de cada material foram confeccionados para o teste de resistência à compressão, que foi realizado em máquina de ensaios universal (Emic), a uma velocidade de 1,0 mm/min, depois de mantidos por 24 horas em água destilada a 37°C. Para análise da rugosidade, foram confeccionados dois corpos-de-prova de cada material, armazenados em água destilada por sete dias, para terem suas superfícies analisadas por meio de Microscopia de Força Atômica. Os dados da resistência à compressão e rugosidade foram submetidos à análise estatística por meio da Análise de Variância (ANOVA) a dois critérios e para comparações múltiplas foi aplicado o teste de Tukey, com nível de significância de 5%. Apenas os cimentos com 2% de nanopartículas de vitrocerâmica bioativa obtiveram resistência à compressão semelhante ao grupo controle, as demais concentrações contribuíram para a diminuição dessa resistência. A incorporação de 5% de nanopartículas de vitrocerâmica bioativa aumentou a rugosidade superficial dos CIVMRs estudados.

Bioactive materials are synthetic materials that have active surfaces that are capable to chemically bond to dental structures. There are some studies where particles of these materials were incorporated in Glass-ionomer cements (GIC) and Resin-modified glass-ionomer cements (RMGIC) trying to achieve bioactivity and dental remineralization. The aim of this study was to evaluate the effects of the incorporation of bioactive glass-ceramics nanoparticles on the compressive strength and roughness of RMGIC. Fuji II LC and Vitremer were considered the control groups. Experimental materials were made adding 2, 5 and 10% (weight) of Biosilicate into these RMGIC. Six specimens of each material were made to be tested on compressive strength performed with a universal testing machine (Emic) at a crosshead speed of 1.0 mm / min, after they were stored in distilled water for 24 hour at 37°C. To roughness analysis, two specimens of each material were made and stored in distilled water for 7 days and their surfaces were analyzed with a Atomic Force Microscope. Data of compressive strength and roughness were statistically analyzed by ANOVA and Tukey test for multiple comparisons. Only the RMGICs with 2% of bioactive glass-ceramic nanoparticles obtained compressive strength similar to the control RMGICs, the other concentrations decreased their compressive strength values. The incorporation of 5% of bioactive glass-ceramic nanoparticles increased the roughness of the RMGICs.

Transferring ART research into education in Brazil.

UNLABELLED: The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. MATERIALS AND METHODS: A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the following subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. RESULTS: A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3%), and in most of these schools it is taught both in theory and in clinical practice (62.9%). The majority (35.3%) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6%). It has been taught for the last 7 to 10 years in 34.3% of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. CONCLUSIONS: It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil.

Transferring ART research into education in Brazil

The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. MATERIALS AND METHODS: A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the followig subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. RESULTS: A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3 percent), and in most of these schools it is taught both in theory and in clinical practice (62.9 percent). The majority (35.3 percent) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6 percent). It has been taught for the last 7 to 10 years in 34.3 percent of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. CONCLUSIONS: It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil.