Rubric vs. numeric rating scale: agreement among evaluators on endodontic treatments performed by dental students.

BACKGROUND: Students´ assessment should be carried out in an effective and objective manner, which reduces the possibility of different evaluators giving different scores, thus influencing the qualification obtained and the consistency of education. The aim of the present study was to determine the agreement among four evaluators and compare the overall scores awarded when assessing portfolios of endodontic preclinical treatments performed by dental students by using an analytic rubric and a numeric rating scale. METHODS: A random sample of 42 portfolios performed by fourth-year dental students at preclinical endodontic practices were blindly assessed by four evaluators using two different evaluation methods: an analytic rubric specifically designed and a numeric rating scale. Six categories were analyzed: radiographic assessment, access preparation, shaping procedure, obturation, content of the portfolio, and presentation of the portfolio. The maximum global score was 10 points. The overall scores obtained with both methods from each evaluator were compared by Student's t, while agreement among evaluators was measured by Intraclass correlation coefficients (ICC). The influence of the difficulty of the endodontic treatment on the evaluators´ scores was analyzed by one-way ANOVA. Statistical tests were performed at a pre-set alpha of 0.05 using Stata 16. RESULTS: Difficulty of canal treatment did not influence the scores of evaluators, irrespective of the evaluation method used. When the analytic rubric was used, inter-evaluator agreement was substantial for radiographic assessment, access preparation, shaping procedure, obturation, and overall scores. Inter-evaluator agreement ranged from moderate to fair with the numeric rating scale. Mean higher overall scores were achieved when numeric rating scale was used. Presentation and content of the portfolio showed slight and fair agreement, respectively, among evaluators, regardless the evaluation method applied. CONCLUSIONS: Assessment guided by an analytic rubric allowed evaluators to reach higher levels of agreement than those obtained when using a numeric rating scale. However, the rubric negatively affected overall scores.

Effect of an additional bonding resin on the 5-year performance of a universal adhesive: a randomized clinical trial.

OBJECTIVES: To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years. MATERIALS AND METHODS: Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05). RESULTS: The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004). CONCLUSIONS: The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode. TRIAL REGISTRATION: This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.

Antibacterial efficacy of several intracanal medicaments for endodontic therapy.

The antibacterial efficacy of intracanal medicaments for 2 and 7 days, in open apex root canals contaminated with Enterococcus faecalis biofilms was compared. One hundred and thirty-eight standardized uniradicular human roots were inoculated with E. faecalis. Colony forming units (CFU) were recorded before and after medication. Samples were divided in two (2/7 days), and subdivided (n=8/group): triple antibiotic paste (TAP); double antibiotic paste (DAP); dental base paste (DBP), consisting of calcium hydroxide, propylene glycol and calcium carbonate; DBP+0.2% chlorhexidine (CHX); DBP+0.2% cetrimide (CTR); DBP+0.2% CHX+0.2% CTR; 2.5% sodium hypochlorite (NaOCl); and distilled water. At both periods TAP, DAP, DBP+0.2% CHX, DBP+0.2% CTR and DBP+0.2% CHX+0.2% CTR exhibited no growth (NG) of E. faecalis. Distilled water and 2.5% NaOCl obtained the lowest CFU reduction. No growth with DBP was reached only at 7 days. CHX and/or CTR pastes were as effective as DAP and TAP. A 2-day period provided an effective disinfection.

Efecto del termociclado y del grabado ácido previo en la resistencia adhesiva al esmalte de distintos adhesivos autograbadores / Effect of thermocycling and acid pre-etch on the bond strength to enamel of self-etch adhesives

Introducción: Los adhesivos autograbadores se emplean cada vez más. Su acidez, que puede variar mucho, determina el grado de infiltración en los tejidos duros dentales y condiciona su capacidad adhesiva. Objetivo: Determinar el efecto que el termociclado y el grabado previo con ácido ortofosfórico tienen sobre la resistencia adhesiva de distintos adhesivos autograbadores. Método: Sobre el esmalte vestibular de incisivos bovinos se colocaron los siguientes adhesivos: 1) Filtek Silorane (FS), 2) Filtek Silorane con grabado ácido previo (AFS), 3) Adper Scotchbond 1XT (XT), 4) Adper Scotchbond SE (SE) y 5) Adper Scotchbond SE con grabado ácido previo (ASE). Todos ellos se aplicaron siguiendo las instrucciones del fabricante. Los dientes restaurados fueron almacenados en agua (24 h, 37 °C) o termociclados (5000 y 10000 ciclos) antes de ser seccionados y sometidos a la prueba de microtracción. Los tests ANOVA de dos vías y Student-Newman-Keuls fueron empleados en el análisis estadístico (α=0.05). Resultados: XT consiguió los ciclos de los valores más altos y FS los más bajos, tras los ciclos de envejecimiento artificial. Termociclar 10000x redujo significativamente la resistencia adhesiva de todos los sistemas. La resistencia adhesiva de AFS fue un 25,7% superior a la de FS, mientras que la de ASE fue un 3,8% mayor que la de SE. Conclusiones: El material y el envejecimiento influyeron sobre la resistencia adhesiva. El sistema con el adhesivo autograbador ultrasuave, FS, obtuvo los valores más bajos tras todos los tratamientos de envejecimiento. Para FS el grabado previo resultó especialmente beneficioso (AU)

Introduction: Self-etch adhesives are increasingly used. They are able to infiltrate hard dental tissues due to their acidity, which varies greatly between different adhesives, being a determinant factor in the bonding ability. Objective: To determine the effect of thermocycling and prior phosphoric-acid etch on the micro-tensile bond strength to enamel of different self-etch adhesives. Method: Enamel surfaces of bovine incisors were exposed and restored with five different adhesives: 1) Filtek Silorane (FS), 2) Filtek Silorane with acid pre-etch (AFS), 3) Adper Scotchbond 1XT (XT), 4) Adper Scotchbond SE (SE) and 5) Adper Scotchbond SE with acid pre-etch (ASE). All materials were applied following manufacturers´ instructions. Composite build-ups were constructed and the bonded teeth were then stored in water (24 h, 37 °C) or thermocycled (5000 and 10000 cycles) before being sectioned and submitted to tensile bond strength test. Statistical analysis were performed with Twoway ANOVA and Student-Newman-Keuls tests (α=0.05). Results: XT achieved the highest scores cycles and FS the lowest ones after the aging treatments. Bond strength of all the materials was significantly reduced after thermocycling 10000x, although SE and ASE also decreased after 5000x. Tensile values of AFS were 25,7% higher than those of FS, while ASE scores were 3,8% higher than those of SE (AU)

Five-year clinical performance of a silorane- vs a methacrylate-based composite combined with two different adhesive approaches.

OBJECTIVES: The objective of this study was to compare the 5-year clinical performance in posterior restorations of three restorative systems including a low-shrinkage system and a methacrylate-based composite combined either with an etch-and-rinse or a self-etch adhesive. MATERIALS AND METHODS: Each of 25 patients received three class I (occlusal) or class II restorations performed with each one of the three restorative systems: Filtek Silorane Restorative System including a two-step self-etch adhesive, Adper Scotchbond 1 XT (two-step etch-and-rinse adhesive) + Filtek Z250, and Adper Scotchbond SE (two-step self-etch adhesive) + Filtek Z250. All materials were applied as per manufacturer's instructions. Two blind observers evaluated the restorations at four different moments (baseline, after 1, 2, and 5 years) according to the USPHS-modified criteria. Kruskal-Wallis and Mann-Whitney U tests were conducted to compare the behavior of the restorative systems, while Friedman and Wilcoxon tests were applied to analyze the intrasystem data (p < 0.05). RESULTS: After 5 years, marginal staining around the restorations with Adper Scotchbond SE + Filtek Z250 was statistically more frequent and severe than that of the restorations performed with the other two systems. Intrasystem comparisons revealed a deterioration of the marginal adaptation after 5 years for all systems. A significant number of restorations bonded with self-etch adhesives showed marginal staining after 5 years of clinical service. A deterioration of the color appearance and an increase of the surface roughness were also detected in the restorations performed with Adper Scotchbond SE + Filtek Z250. CONCLUSIONS: A deterioration of the marginal adaptation was evidenced for all restorative systems, while marginal staining was more frequently seen only around the restorations performed with self-etch adhesives. CLINICAL RELEVANCE: No advantage was found of the silorane- over the methacrylate-based composite when combined with an etch-and-rinse adhesive.

Effect of low-concentration bleaching products on enamel bond strength at different elapsed times after bleaching treatment.

This study evaluated the effects of several low-concentration bleaching products on microtensile bond strength (µTBS) to enamel at different elapsed times after the bleaching treatment. One hundred and fifty bovine incisors were divided into five groups: No treatment, 10% carbamide peroxide (Opalescence), 10% hydrogen peroxide (Opalescence Treswhite Supreme), 3% carbamide peroxide plus lactoperoxidase (WhiteKin), or 3% carbamide peroxide plus 2.7% carbamide peroxide (Clysiden Kit Express). All treatments lasted 4 weeks. After bleaching treatment or non-treatment, teeth were restored immediately, at 1, 3, 7, or 14 days after bleaching and submitted to µTBS test. Data were analyzed by ANOVA and Tukey's test (p<0.05). For WhiteKin and Clysiden, µTBS to enamel was significantly reduced immediately, at 1, 3 and 7 days after bleaching. At 14 days after bleaching, similar µTBS values were obtained regardless of bleaching product. Therefore, while over-the-counter (OTC) products might affect bond strength to enamel, this effect was no longer observed after 14 days.

Bond strength of self-adhesive resin cements to different treated indirect composites.

OBJECTIVES: The objective of this study was to determine microtensile bond strength (µTBS) to dentin of three self-adhesive and a total-etch resin cements used for luting different treated indirect composites. MATERIALS AND METHODS: Composite overlays (Filtek Z250) were prepared. Their intaglio surfaces were ground with 600-grit SiC papers and randomly assigned to three different surface treatments: no treatment, silane application (RelyX Ceramic Primer), and silane agent followed by a bonding agent (Adper Scotchbond 1 XT). The composite overlays were luted to flat dentin surfaces of extracted human third molars using the following self-adhesive resin cements: RelyX Unicem, Maxcem Elite and G-Cem, and a total-etch resin cement, RelyX ARC. The bonded assemblies were stored in water (24 h, 37 °C) and subsequently prepared for µTBS testing. Beams of approximately 1 mm(2) were tested in tension at 1 mm/min in a universal tester (Instron 3345). Data were analyzed by two-way ANOVA and Student-Newman-Keuls tests (α = 0.05). RESULTS: A significant influence of the resin cement used was detected. Composite surface treatment and the interaction between the resin cement applied and surface treatment did not affect µTBS. CONCLUSIONS: Surface treatment of indirect resin composite did not improve the µTBS results of dentin/composite overlay complex. Self-adhesive resin cements tested obtained lower µTBS than the total-etch resin cement RelyX ARC. Specimens luted with Maxcem Elite exhibited the highest percentage of pretesting failures. CLINICAL RELEVANCE: Surface treatment of indirect resin composite with silane or silane followed by a bonding agent did not affect bond strength to dentin.

Effect of thermal aging on the tensile bond strength at reduced areas of seven current adhesives.

The purpose of this study was to determine the micro-tensile bond strength (MTBS) to dentin of seven adhesive systems (total and self-etch adhesives) after 24 h and 5,000 thermocycles. Dentin surfaces of human third molars were exposed and bonded with two total-etch adhesives (Adper Scotchbond 1 XT and XP Bond), two two-step self-etch adhesives (Adper Scotchbond SE and Filtek Silorane Adhesive System) and three one-step self-etch adhesives (G-Bond, Xeno V and Bond Force). All adhesive systems were applied following manufacturers' instructions. Composite buildups were constructed and the bonded teeth were then stored in water (24 h, 37 °C) or thermocycled (5,000 cycles) before being sectioned and submitted to MTBS test. Two-way ANOVA and subsequent comparison tests were applied at α = 0.05. Characteristic de-bonded specimens were analyzed using scanning electron microscopy (SEM). After 24 h water storage, MTBS values were highest with XP Bond, Adper Scotchbond 1 XT, Filtek Silorane Adhesive System and Adper Scotchbond SE and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. After thermocycling, MTBS values were highest with XP Bond, followed by Filtek Silorane Adhesive System, Adper Scotchbond SE and Adper Scotchbond 1 XT and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. Thermal aging induced a significant decrease in MTBS values with all adhesives tested. The resistance of resin-dentin bonds to thermal-aging degradation was material dependent. One-step self-etch adhesives obtained the lowest MTBS results after both aging treatments, and their adhesive capacity was significantly reduced after thermocycling.

Microtensile bond strength of several adhesive systems to different dentin depths.

PURPOSE: To determine the bond strength of five adhesives systems to either superficial or deep dentin. METHODS: Extracted human third molars had their crowns transversally sectioned either next to the occlusal DEJ or next to the pulp, to expose flat, superficial or deep dentin surfaces. The surfaces were bonded with: 1) three two-step, total-etch, self-priming adhesives (Single Bond, Prime&Bond NT, and Excite), 2) a two-step, self-etching primer (Clearfil SE Bond), and 3) a single-step, self-etching all-in-one adhesive (Etch & Prime 3.0) according to manufacturers' directions. Composite build-ups were constructed incrementally with Z250. After storage for 24 hours in water at 37 degrees C, the teeth were sectioned to obtain several bonded beams of 1.0 mm2 cross-sectional area. Each beam was tested in tension in an Instron machine at 0.5 mm/minute. Results were analyzed by two-way ANOVA and post-hoc multiple comparisons (P = 0.05). Bonded interfaces were also examined by TEM. Nanoleakage was examined using a silver-staining technique. RESULTS: Single Bond, Prime&Bond NT and Clearfil SE Bond performed equally when were bonded to superficial dentin; the lowest value was obtained with Etch & Prime 3.0. On deep dentin, the highest bond strengths were attained with Clearfil SE Bond and Prime & Bond NT. The bond strengths of Prime & Bond NT and Excite were significantly higher to deep than to superficial dentin and the rest of the adhesives showed similar bond strength to both dentin depths. Nanoleakage was manifested to variable extent within all hybrid layers examined.