Orthognathic surgery in a patient with von Willebrand disease: case report

Aim: This study aims to report the perioperative management of a patient with von Willebrand disease (vWd) who underwent orthognathic surgery. The report follows the guidelines of the Case Report Guidelines (CARE) and focuses on the steps taken to prevent bleeding during the surgical procedure. Methods: A 39-year-old female patient with skeletal Class III was treated with maxillary advancement and mandibular setback. Despite normal test results for ristocetin cofactor activity, measures were taken to prevent bleeding, including atraumatic surgical techniques, use of antifibrinolytic medication, induced hypotension during anesthesia, and preparation of blood products for transfusion during trans and postoperative periods if needed. In the end, these measures were not required. Results: The patient did not experience any bleeding during the surgical procedure or postoperative period, demonstrating the effectiveness of the measures taken to manage their blood dyscrasia. Two years after the surgery, the patient had satisfactory aesthetic and functional results and no evidence of relapse. Conclusion: Thus, this case report demonstrates that vWd does not prevent largescale oral and maxillofacial surgeries such as orthognathic surgery as long as proper precautions are taken pre-, intraand postoperatively

Development of functional fillers as a self-healing system for dental resin composite.

OBJECTIVES: To evaluate the incorporation of repairing capsules containing different monomers and polymerization modulators on the self-healing efficiency of an experimental photopolymerizable resin-based composite. METHODS: Self-healing capsules containing different monomers and polymerization modulators were prepared by emulsion polymerization: TCDHEPT (TEGDMA and DHEPT), BTCDHEPT (Bis-GMA, TEGDMA, and DHEPT), and BTCBPO (Bis-GMA, TEGDMA, and BPO). The capsules were analyzed through Fourier transform infrared spectroscopy and scanning electron microscopy. The capsules were added into experimental photopolymerizable resin composites establishing the following groups: ER (Control without capsules), ER+BPO, ER+BPO+TCDHEPT, and ER+BTCBPO+BTCDHEPT. Filtek Z350 resin composite (3 M ESPE) was used as a commercial reference. The materials were tested for degree of conversion (DC), flexural strength (σf), elastic modulus (Ef), fracture toughness (virgin KIC), self-healing efficiency (healed KIC), and roughness. For statistical analysis, the significance value was established at an a = 0.05 level. RESULTS: When compared to the control material, the incorporation of repairing capsules did not affect DC, σf, and Ef. Fracture toughness was statistically similar between the experimental groups (p ≤ 0.05). Healed KIC was statistically different between the groups ER+TCDHEP and ER+BTCBPO+BTCDHEPT; the self-healing efficiency was higher for ER+TCDHEPT. Surface roughness was statistically similar among all groups. CONCLUSIONS: The use of self-healing capsules promoted repair of the material. Studies with material aging after the self-healing process are necessary to better demonstrate the effectiveness of this system. CLINICAL SIGNIFICANCE: The self-healing system seemed to be a promising technology to be used in self-repaired restorative materials, which may prevent restoration fractures.

Effect of Different Desensitizers on Shear Bond Strength of Self-Adhesive Resin Cements to Dentin.

The sealing and bonding characteristics of luting cements may be affected by the application of desensitizers containing ingredients that induce chemical interaction with dentin organic matrix. This study evaluated the effect of different desensitizers on the immediate and long-term shear bond strength (SBS) of a self-adhesive resin cement (SARC) to dentin. Healthy bovine dentin specimens were used for the study. Gluma® Desensitizer, Desensibilize Nano P®, and Soothe® desensitizer were used in study groups, while the control group did not receive any treatment. Next, SARC (RelyXTM U200) in cylindrical mold was applied to the sample surface. All specimens were stored at 37 °C for 24 h or six months and tested for SBS. Additionally, water contact angle was measured using an optical tensiometer. Results were analyzed by analysis of variance and Student-t tests (p ˂ 0.05). Application of the different types of desensitizers had no significant influence on immediate or long-term SBS of SARC to dentin (p > 0.05). Differences for water contact angle were not statistically significant among the tested groups (p = 0.450). Within the limitations of the present study, it can be concluded that the application of the different types of desensitizers had no significant influence on the SBS of a SARC to dentin.

Salivary characteristics may be associated with burning mouth syndrome?

BACKGROUND: Burning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesis of this condition. This case-control study aimed to trace the salivary profile of women with burning mouth syndrome (BMS). MATERIAL AND METHODS: 40 women with BMS and 40 control women were recruited. Unstimulated salivary flow rate (uSFR), pH, salivary cortisol levels, salivary viscosity, and oral health impact profile (OHIP-14 questioner) were determined. P< 0.05 was considered statistically significant. RESULTS: For uSFR, mean values obtained for BMS and for control group respectively were 0.35 and 0.61 mL/min; for pH, 7.23 and 7.34; for cortisol levels, 0.36 and 0.15 µg/dL; for viscosity values, 31.1 and 45.01 mPas and for OHIP-14 scores, 21.7 and 5.7. To uSFR, cortisol levels, viscosity values and OHIP-14 scores, differences were statistically significant. Salivary cortisol levels and OHIP-14 scores were correlated positively (rho = 0.624; p< 0.05). CONCLUSIONS: BMS women have lower uSFR and salivary viscosity and higher salivary cortisol levels that were associated with worse quality of life, compared with the control group. Key words:Xerostomia, Burning mouth syndrome, Viscosity.

Avaliação do efeito da termociclagem na estabilidade de cor e rugosidade superficial de duas resinas compostas comerciais / Evaluation of thermocycling effect on color stability and surface roughness of two commercial resin composite

Objetivo: Avaliar o efeito do envelhecimento térmico por termociclagem na estabilidade de cor e rugosidade superficial de duas resinas compostas, avaliar grau de conversão (GC), sorção (SO), solubilidade (SL) e microdureza. Material e método: Foram confeccionados 10 espécimes (6 mm x 1 mm) para cada resina: Filtek Z350 XT (Z350XT) e Estelite Sigma Quick (ES). Foram avaliados: GC, utilizando um espectrofotômetro no infravermelho, SO e SL. A avaliação da microdureza Vickers (MV) e densidade de ligações cruzadas foi realizada antes e após a imersão em etanol por 24 h. A rugosidade superficial e a estabilidade de cor (CIEDE2000) foram avaliadas antes e após envelhecimento térmico por 2000 ciclos, alternando 30 s a 5°, 37° e 55° C. A estabilidade de cor e translucidez foram avaliadas com um espectrofotômetro. Os dados foram submetidos ao teste t (α=0,05). Resultados: ES apresentou resultados de GC maiores (62,5% ± 3,7) que Z350XT (48,7% ± 6,9) (p=0,004). Ambas resinas apresentaram resultados de SO e SL similares. A MV final da ES diminuiu 13% com relação a inicial (p=0,115). Z350XT apresentou diminuição de 17% (p=0,004). ES apresentou aumento de 115% na rugosidade superficial após a termociclagem (p=0,001), enquanto a Z350XT apresentou diminuição de 35% (p=0,299). ES apresentou menor alteração de cor (0,280 ± 0,093), quando comparada a Z350XT (0,549 ± 0,183). A translucidez foi similar para ambos materiais (ES=30,80; Z350XT=30,35). Conclusão: A termociclagem influenciou na alteração de cor e rugosidade superficial das resinas compostas, demonstrando que podem ser alteradas pela degradação na matriz polimérica.

Objective: To evaluate the thermocycling effect on color stability and surface roughness of two resin composites and also evaluate the degree of conversion (GC), sorption (SO), solubility (SL) and microhardness. Material and method: 10 specimens (6 mm x 1 mm) were made for each resin: Filtek Z350 XT (Z350XT) and Estelite Sigma Quick (ES). The following were evaluated: GC, using an infrared spectroscopy, SO and SL. Vickers microhardness (MV) and cross-link density evaluation was performed before and after immersion in ethanol for 24 hours. Surface roughness and color stability (CIEDE2000) were evaluated before and after thermal aging for 2000 cycles, alternating between 30 s at 5°, 37° and 55° C. Color stability and translucency were assessed with a spectrophotometer. Data were submitted to t test (α= 0.05). Results: ES presented higher GC results (62.5% ± 3.7) than Z350XT (48.7% ± 6.9) (p= 0.004). Both resins showed similar SO and SL results. The final MV of ES decreased 13% in relation to the initial (p= 0.115). Z350XT decreased by 17% (p= 0.004). ES showed a 115% increase in surface roughness after thermocycling (p= 0.001), while the Z350XT showed a 35% decrease (p= 0.299). ES showed less color change (0.280 ± 0.093) when compared to Z350XT (0.549 ± 0.183). The translucency was similar for both materials (ES= 30.80; Z350XT= 30.35). Conclusion: Thermocycling influenced the change in color stability and surface roughness of composite resins, demonstrating that they may be altered by degradation in the polymer matrix.

Repair bond strength of bulk-fill resin composite: Effect of different adhesive protocols.

This study evaluated the effect of different adhesive protocols on the shear bond strength (SBS) of bulk-fill resin composite repaired with bulk-fill or conventional composite. Cylindrical bulk-fill resin composite specimens were prepared and allocated into groups according to the bonding strategy: no treatment, Silane+Scotch Bond Multipurpose (S+SBMP), Tetric N Bond Universal, and Single Bond Universal. Following bonding strategy, bulk-fill or conventional composite buildups were performed. After 24 h of storage in distilled water at 37°C, shear force was applied to the interface using a universal testing machine. The data were analyzed by two-way ANOVA and Tukey test (α=0.05). SBS was influenced by the bonding strategy and the composite used (p<0.001). Irrespective of the composite used, the group S+SBMP yielded the highest SBS values (p<0.001). Repair bond strength of bulk-fill composites can be improved by using a silane coupling agent followed by a hydrophobic resin.

Long-term bonding efficacy of adhesives containing benzodioxioles as alternative co-initiators.

This study evaluated the three-year lifespan of the bond to dentin of experimental self-etch adhesives containing benzodioxole derivatives - 1,3-benzodioxole (BDO) and piperonyl alcohol (PA) - as co-initiator alternative to amines. Adhesive resins were formulated using Bis-GMA, TEGDMA, HEMA, camphorquinone and different co-initiators: BDO, PA or ethyl 4-dimethylamino benzoate (EDAB - amine). An experimental self-etch primer was used to complete the two-step, self-etch adhesive system. Clearfil SE Bond (CSE) was used as commercial reference. Bond strength to human dentin was assessed by microtensile bond strength (µTBS) test, and failure mode was classified. Morphology of the dentin bonding interface was assessed via scanning electron microscopy (SEM). Irrespective of the dental adhesives evaluated, µTBS was higher after 24 hours compared with that after 1.5 and 3 years (p ≤ 0.001). However, adhesives with BDO and PA as co-initiators showed significantly higher bond strength than the bonding resin with EDAB (p ≤ 0.002), independent of the time evaluated. The commercial adhesive CSE showed similar bond strength compared with the other groups (p ≥ 0.05). Mixed failures were mainly observed after 24 hours, while adhesive failures were more frequently observed after 1.5 and 3 years. No notable differences in homogeneity and continuity along the bonded interfaces were detected among the materials in the SEM analysis. In conclusion, benzodioxole derivatives are feasible alternative co-initiators to tertiary amine in camphorquinone-based self-etching dental adhesive formulations.

Piperonyl methacrylate: Copolymerizable coinitiator for adhesive compositions.

OBJECTIVES: This study describes the synthesis of piperonyl methacrylate (PipM) and evaluates its effect when used as coinitiator in the photoinitiated radical polymerization of experimental adhesive resins. METHODS: PipM was synthetized through an esterification reaction and characterized by FTIR and 1H NMR spectroscopy. Adhesive resins containing camphorquinone as photoinitiator and PipM or ethyl-4-dimethyl amine benzoate (EDAB) as coinitiators were formulated. Scotchbond Multipurpose (SBMP) adhesive was used as commercial reference. All materials were analyzed for polymerization kinetics, flexural strength, elastic modulus, water sorption/solubility, shear bond strength to bovine enamel and dentin, characterization of hybrid layer by scanning electron microscopy (SEM), microbiological direct contact test, and cytotoxicity. RESULTS: The adhesive with PipM presented higher degree of conversion and lower sorption/solubility when compared with other groups. Shear bond strength to enamel and dentin were similar for PipM and EDAB materials. The percentage of cellular viability was close to 100% and similar in the experimental groups and the commercial reference. CONCLUSIONS: PipM presented similar or superior performance to the tertiary amine used as control, representing a potential alternative coinitiator for photopolymerizable dental materials. CLINICAL SIGNIFICANCE: PipM could be potentially useful in the formulations of adhesive systems with enhanced chemical properties, which could mean improvement in the longevity of composite resin restorations.

Successful conservative treatment of a mandibular unicystic ameloblastoma: 13-year follow-up.

Ameloblastoma is an uncommon, locally aggressive benign odontogenic tumor and can reach considerable dimensions causing facial deformity and functional impairment. They are characterized by local aggressiveness. It is recommended that maxillary ameloblastomas be treated aggressively due to proximity of various vital structures. Conservative treatments such as marsupialization, enucleation and curettage while preserving bone integrity seem to be associated with a high rate of recurrence. Treatment evaluation of ameloblastomas is a complex issue, as ideally it should not be so destructive due to the benign nature of this lesion, but should be extensive enough to avoid recurrences. The present study is about a clinical case of a 16-year- old man with a unicystic ameloblastoma treated successfully with marsupialization. Patient was followed up every 12 months. About 13 years after diagnosis, the patient is clinically healthy and radiographically it is possible to observe evidence of bone repair. Key words:Odontogenic tumors, ameloblastoma, marsupialization, unicystic.

Long-term bonding efficacy of adhesives containing benzodioxioles as alternative co-initiators

Abstract This study evaluated the three-year lifespan of the bond to dentin of experimental self-etch adhesives containing benzodioxole derivatives - 1,3-benzodioxole (BDO) and piperonyl alcohol (PA) - as co-initiator alternative to amines. Adhesive resins were formulated using Bis-GMA, TEGDMA, HEMA, camphorquinone and different co-initiators: BDO, PA or ethyl 4-dimethylamino benzoate (EDAB - amine). An experimental self-etch primer was used to complete the two-step, self-etch adhesive system. Clearfil SE Bond (CSE) was used as commercial reference. Bond strength to human dentin was assessed by microtensile bond strength (µTBS) test, and failure mode was classified. Morphology of the dentin bonding interface was assessed via scanning electron microscopy (SEM). Irrespective of the dental adhesives evaluated, µTBS was higher after 24 hours compared with that after 1.5 and 3 years (p ≤ 0.001). However, adhesives with BDO and PA as co-initiators showed significantly higher bond strength than the bonding resin with EDAB (p ≤ 0.002), independent of the time evaluated. The commercial adhesive CSE showed similar bond strength compared with the other groups (p ≥ 0.05). Mixed failures were mainly observed after 24 hours, while adhesive failures were more frequently observed after 1.5 and 3 years. No notable differences in homogeneity and continuity along the bonded interfaces were detected among the materials in the SEM analysis. In conclusion, benzodioxole derivatives are feasible alternative co-initiators to tertiary amine in camphorquinone-based self-etching dental adhesive formulations.

Adhesion strategy and early bond strengths of glass-fiber posts luted into root canals

This study investigated the effect of coinitiator solutions and self-adhesive resin cement on the early retention of glass-fiber posts. Cylindrical glass-fiber posts were luted into 40 incisor roots with different adhesion strategies (n = 10): SB2, Single Bond 2 + conventional resin cement (RelyX ARC); AP, Scotchbond Multipurpose Plus (SBMP) activator + primer + ARC; APC, SBMP activator + primer + catalyst + ARC; and UNI, self-adhesive cement (RelyX Unicem). Pull-out bond strength results at 10 min after cementation showed APC > UNI > SB2 = AP (P < 0.05). The adhesion strategy significantly affected early bonding to root canals.

Adhesion strategy and early bond strengths of glass-fiber posts luted into root canals.

This study investigated the effect of coinitiator solutions and self-adhesive resin cement on the early retention of glass-fiber posts. Cylindrical glass-fiber posts were luted into 40 incisor roots with different adhesion strategies (n = 10): SB2, Single Bond 2 + conventional resin cement (RelyX ARC); AP, Scotchbond Multipurpose Plus (SBMP) activator + primer + ARC; APC, SBMP activator + primer + catalyst + ARC; and UNI, self-adhesive cement (RelyX Unicem). Pull-out bond strength results at 10 min after cementation showed APC > UNI > SB2 = AP (P < 0.05). The adhesion strategy significantly affected early bonding to root canals.