Comparative Analysis of Endodontic 0.15 Stainless-Steel K-Files: Exploring Design, Composition, and Mechanical Performance.

To establish a glide path, smaller files (up to size 0.15) with tapers of 2% are commonly used as pathfinding files. They pre-shape the root canal space before transitioning to larger taper endodontic instruments, aiming to prevent procedural errors. This study aimed to compare the design, metal wire composition, and mechanical characteristics of seven different ISO size 15 stainless-steel hand files (K-File and C-File+). Ninety-one new stainless-steel ISO 15 K-files were mechanically tested. All files were inspected for deformations before the assessment. Dental operating microscope, scanning electron microscope (SEM), and optical microscope analyses were conducted on four randomly selected instruments from each group, and two instruments per group underwent an energy-dispersive X-ray spectroscopy (EDS) analysis. Buckling mechanical tests were performed using an Instron universal testing machine, and microhardness was assessed using a Vickers hardness tester. The statistical analysis employed the nonparametric Mood's median test, with a significance level set at 0.05. The instrument design analysis unveiled variations in the active blade area length and the number of spirals, while maintaining consistent cross-sections and symmetrical blades. Distinct tip geometries and surface irregularities were observed. While the energy-dispersive X-ray spectroscopy confirmed similar compositions, the buckling strength and microhardness values exhibited variability across for all tested files. Notably, the Dentsply ReadySteel C-File+ recorded the highest buckling value (2.10 N), and the Dentsply ReadySteel K-File exhibited the lowest (1.00 N) (p < 0.05). Moreover, the Dentsply ReadySteel K-File recorded the highest microhardness value (703 HVN), while the SybronEndo Triple-Flex had the lowest (549 HVN) (p < 0.05). While similarities in cross-section design and metal wire composition were noted among the files, variations in the number of spirals and mechanical performance were also observed. Thus, all of these factors should be considered when selecting suitable files for an efficient root canal treatment.

Comparison between digital superimposition and microcomputed tomography methods of fit assessment of removable partial denture frameworks.

STATEMENT OF PROBLEM: The fit of removable partial denture frameworks should be assessed to optimize clinical adaptation. Potential discrepancies between framework and supporting structures are typically precisely measured with negative subtracts and high-resolution equipment. The growth of computer-aided engineering technology allows the development of new methods for the direct evaluation of discrepancies. However, how the methods compare is unclear. PURPOSE: The purpose of this in vitro study was to compare 2 digital methods of fit assessment based on direct digital superimposition and microcomputed tomography indirect analysis. MATERIAL AND METHODS: Twelve cobalt chromium removable partial denture frameworks were fabricated by conventional lost-wax casting or additive manufacturing techniques. The thickness of the gap between occlusal rests and respective definitive cast rest seats (n=34) was evaluated by using 2 different digital methods. Silicone elastomer impressions of the gaps were obtained, and microcomputed tomography measurements were used as controls for validation purposes. Digitization of the framework, the respective definitive cast, and the combination was followed by digital superimposition and direct measurements with the Geomagic Control X software program. Because normality and homogeneity of variance were not verified (Shapiro-Wilk and Levene tests, P<.05), the data were analyzed with Wilcoxon signed rank and Spearman correlation tests (α=.05). RESULTS: The thicknesses measured by microcomputed tomography (median=242 µm) and digital superimposition (median=236 µm) did not reveal statistically significant differences (P=.180). A positive correlation (ρ=0.612) was detected between the 2 methods of assessing fit. CONCLUSIONS: The frameworks presented median gap thicknesses under the limit of clinical acceptability without differences between the proposed methods. The digital superimposition method was determined to be as acceptable as the high-resolution microcomputed tomography method for assessing removable partial denture framework fit.

Understanding the Mechanical, Surface, and Color Behavior of Oral Bioactive Prosthetic Polymers under Biodegradation Processes.

Changes in the properties of resin-based polymers exposed to the oral environment can emerge when chlorhexidine (CHX) is incorporated to develop bioactive systems for treating denture stomatitis. Three reline resins loaded with CHX were prepared: 2.5 wt% in Kooliner (K), 5 wt% in Ufi Gel Hard (UFI), and Probase Cold (PC). A total of 60 specimens were submitted to physical aging (1000 cycles of thermal fluctuations, 5-55 °C) or chemical aging (28 days of pH fluctuations in artificial saliva, 6 h at pH = 3, 18 h at pH = 7). Knoop microhardness (30 s, 98 mN), 3-point flexural strength (5 mm/min), and surface energy were tested. Color changes (ΔE) were determined using the CIELab system. Data were submitted to non-parametric tests (α = 0.05). After aging, bioactive K and UFI specimens were not different from the controls (resins without CHX) in mechanical and surface properties. Thermally aged CHX-loaded PC specimens showed decreased microhardness and flexural strength but not under adequate levels for function. The color change was observed in all CHX-loaded specimens that underwent chemical aging. The long-term use of CHX bioactive systems based on reline resins generally does not impair removable dentures' proper mechanical and aesthetic functions.

Wear of Titanium Implant Platforms with Different Abutment Connections and Abutment Materials: A Pilot Study.

The most commonly used material in dental implants and their abutments is titanium. Zirconia is a more aesthetic alternative to titanium abutments; however, it is much harder. There are concerns that zirconia could damage the surface of the implant over time, especially in less stable connections. The aim was to evaluate the wear of implants with different platforms connected to titanium and zirconia abutments. A total of six implants were evaluated, two of each connection type: external hexagon, tri-channel, and conical connections (n = 2). Half of the implants were connected to zirconia abutments, and the other half to titanium abutments (n = 3). The implants were then cyclically loaded. The implant platforms were evaluated by digital superimposing micro CT files and calculating the area of the loss surface (wear). In all the implants, a statistically significant loss of the surface area (p = 0.028) was observed when comparing the area before and after cyclic loading. The average lost surface area was 0.38 mm2 with titanium abutments and 0.41 mm2 with zirconia abutments. The average lost surface area was 0.41 mm2 with the external hexagon, 0.38 mm2 with the tri-channel, and 0.40 mm2 with the conical connection. In conclusion, the cyclic loads induced implant wear. However, neither the type of abutment (p = 0.700) nor the connection (p = 0.718) influenced the amount of surface area lost.

Development of a chlorhexidine delivery system based on dental reline acrylic resins.

The high recurrence rate of common denture stomatitis after antifungal treatment is still concerning. This condition is caused by low patient compliance and incomplete local elimination of the main etiological factor - Candida albicans, often associated with other microorganisms, such as Streptococcus species. Impregnating denture materials with antimicrobials for local delivery is a strategy that can overcome the side effects and improve the efficacy of conventional treatments (topical and/or systemic). In this work, we describe the development of three hard autopolymerizing reline acrylic resins (Kooliner, Ufi Gel Hard, and Probase Cold) loaded with different percentages of chlorhexidine (CHX). The novel formulations were characterized based on their antimicrobial activity, mechanical, morphological and surface properties, in-vitro drug release profiles, and cytotoxicity. The addition of CHX in all resins did not change their chemical and mechanical structure. Among all the tested formulations, Probase Cold loaded with 5 wt% CHX showed the most promising results in terms of antimicrobial activity and lack of serious detrimental mechanical, morphological, surface, and biological properties.

Should local drug delivery systems be used in dentistry?

In dentistry, the use of biomaterial-based drug delivery systems (DDS) aiming the release of the active compounds directly to the site of action is slowly getting more awareness among the scientific and medical community. Emerging technologies including nanotechnological platforms are offering novel approaches, but the majority are still in the proof-of-concept stage. This study critically reviews the potential use of DDS in anesthesiology, oral diseases, cariology, restorative dentistry, periodontics, endodontics, implantology, fixed and removable prosthodontics, and orthodontics with a special focus on infections. It also stresses the gaps and challenges faced. Despite numerous clinical and pharmacological advantages, some disadvantages of DDS pose an obstacle to their widespread use. The biomaterial's biofunctionality may be affected when the drug is incorporated and may cause an additional risk of toxicity. Also, the release of sub-therapeutic levels of drugs such as antibiotics may lead to microbial resistance. Multiple available techniques for the manufacture of DDS may affect drug release profiles and their bioavailability. If the benefits outweigh the costs, DDS may be potentially used to prevent or treat oral pathologies as an alternative to conventional strategies. A case-by-case approach must be followed.

Polymerizable Matrix Metalloproteinases' Inhibitors with Potential Application for Dental Restorations.

Collagen cleavage by matrix metalloproteinase (MMP) is considered a major cause of dental resins long term failure. Most MMP inhibitors display significant toxicity and are unsuitable for dental resins' applications. Here we report a study of a new class of inhibitors that display the unique property of being co-polymerizable with other vinyl compounds present in commercial dental resins, limiting their release and potential toxicity. Computational affinity towards the active site of different MMP-1; -2; -8; -9 and -13 of several compounds showed interesting properties and were synthesized. These free compounds were tested concerning their toxicity upon contact with two different cell types, with no substantial decrease in cell viability at high concentrations. Even so, compound's safety can be further improved upon copolymerization with commercial dental resins, limiting their release.

COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment.

Coronavirus disease 2019 (COVID-19), a viral disease declared a pandemic by the World Health Organization (WHO) in March 2020, has posed great changes to many sectors of society across the globe. Its virulence and rapid dissemination have forced the adoption of strict public health measures in most countries, which, collaterally, resulted in economic hardship. This article is the first in a series of 3 that aims to contextualise the clinical impact of COVID-19 for the dental profession. It presents the epidemiological conditions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), namely, its modes of transmission, incubation, and transmissibility period, signs and symptoms, immunity, immunological tests, and risk management in dental care. Individuals in dental care settings are exposed to 3 potential sources of contamination with COVID-19: close interpersonal contacts (<1 m), contact with saliva, and aerosol-generating dental procedures. Thus, a risk management model is propsoed for the provision of dental care depending on the epidemiological setting, the patient's characteristics, and the type of procedures performed in the office environment. Although herd immunity seems difficult to achieve, a significant number of people has been infected throughout the first 9 months of the pandemic and vaccination has been implemented, which means that there will be a growing number of presumable "immune" individuals that might not require many precautions that differ from those before COVID-19. In conclusion, dental care professionals may manage their risk by following the proposed model, which considers the recommendations by local and international health authorities, thus providing a safe environment for both professionals and patients.

Challenges in Matrix Metalloproteinases Inhibition.

Matrix metalloproteinases are enzymes that degrade the extracellular matrix. They have different substrates but similar structural organization. Matrix metalloproteinases are involved in many physiological and pathological processes and there is a need to develop inhibitors for these enzymes in order to modulate the degradation of the extracellular matrix (ECM). There exist two classes of inhibitors: endogenous and synthetics. The development of synthetic inhibitors remains a great challenge due to the low selectivity and specificity, side effects in clinical trials, and instability. An extensive review of currently reported synthetic inhibitors and description of their properties is presented.

Bonding Performance of Simplified Dental Adhesives with Three Application Protocols: An 18-month In Vitro Study.

PURPOSE: To evaluate the influence of application protocol on the shear bond strength (SBS) and nanoleakage of simplified adhesives over 18 months. MATERIALS AND METHODS: 810 dentin slices were obtained from 405 caries-free human molars. They were randomly assigned to 54 experimental groups resulting from the combination of "adhesive" (Adper Scotchbond 1XT [S1XT], Solobond M [SM], Scotchbond Universal Adhesive in etch-and-rinse mode [SUER] and self-etch mode [SUSE], Adper Easy Bond [EB], Clearfil S3 Bond Plus [CS3]), "application protocol" (manufacturer's instructions [MI], two extra layers of adhesive [EL], hydrophobic resin layer [HL]), and "aging time" (24 h [24H], 6 months [6M], and 18 months [18M] in water). SBS tests were carried out using a Watanabe device followed by failure mode analysis. For the nanoleakage study, specimens from 54 additional molars were prepared as previously described, immersed in ammoniacal silver nitrate, and evaluated with SEM. SBS data were analyzed with ANOVA followed by Tukey's post-hoc tests; failure mode data were analyzed using chi-squared tests (α = 0.05). Nanoleakage data were analyzed with the Kruskal-Wallis test followed by LSD tests (α = 0.05). RESULTS: After 18M, S1XT and SUSE achieved the highest mean SBS (p < 0.05). Regarding the application protocols, EL and HL provided higher mean SBS than those obtained with MI (p < 0.05). HL resulted in the highest mean SBS and the lowest mean nanoleakage after 18M. CONCLUSION: Simplified adhesives may need an extra hydrophobic resin layer to achieve a stable and durable adhesive interface. The self-etch approach should be recommended for the universal adhesive.

Effect of saliva contamination and artificial aging on different primer/cement systems bonded to zirconia.

STATEMENT OF PROBLEM: Saliva contamination has been shown to decrease bonding to zirconia. Adopting a less contamination-sensitive cement system may be an alternative to decontamination. PURPOSE: The purpose of this in vitro study was to assess the ability of different primer/cement systems to promote a durable bond to zirconia after saliva contamination. MATERIAL AND METHODS: Zirconia blocks (Lava Plus) (N=320) were airborne-particle abraded (50 µm Al2O3) and divided into 32 experimental groups (n=10) according to the variables in the study: saliva contamination; primer/cement system (Panavia SA [PSA]; RelyX Unicem 2 [RU2]; Bifix SE [BSE]; Panavia F2.0 [PF2]; Scotchbond Universal + RelyX Ultimate [SBU+RXU]; Futurabond M+ + Bifix QM [FBM+BQM]; All-Bond Universal + Duo-link [ABU+DL]; Z-Prime Plus + Duo-link [ZPP+DL]; and aging period (72 hours; 30 days with 10 000 thermocycles at 5°C to 55°C). After half of the blocks had been contaminated with fresh human saliva for 10 minutes, rinsed with water, and air-dried, each primer/cement was applied. Polymerized composite resin disks were then placed over the cement, and the resin cement was light-polymerized for 20 seconds each at 2 opposite margins. After the aging time, the specimens were tested in shear (1 mm/min). The failure mode was classified as adhesive, cohesive, or mixed. Statistical analysis of the shear bond strength (SBS) data was performed with ANOVA followed by Tukey honest significant difference post hoc tests. Chi-square tests were used to analyze the failure mode data (α=.05). RESULTS: The mean SBS ranged between 4.2 and 34.5 MPa. Shear bond strength was influenced (P<.001) by all the factors studied (cement system, saliva contamination, aging time). SBU+RXU and FBM+BQM showed a higher mean SBS than those of the other experimental groups (P<.05) and were the only groups not affected by saliva contamination (P>.05). Failure was predominantly classified as adhesive. CONCLUSIONS: In general, saliva contamination and aging decreased bonding efficacy. Two systems, combining an application of a universal adhesive and a resin cement (SBU+RXU and FBM+BQM) were not affected by saliva contamination.

Resin-bonded fixed dental prosthesis with a modified treatment surface in a zirconia framework: a case report.

Although resin-bonded fixed dental prostheses (RBFDPs) were developed almost 40 years ago, their implementation in clinical practice did not achieve success due to biomechanical failures of the restorative materials. Nowadays, the evolution of ceramic materials and bonding procedures has allowed for the revival of the dental prosthesis. Zirconia is the dental ceramic with the highest flexural strength under compression. However, there are still some concerns regarding the bonding strength of zirconia to enamel that require further research. In this article, through the presentation of three clinical cases, the authors show how modifying the surface of zirconia frameworks by applying a feldspathic veneering on the retainer's buccal surface allows for a bonding procedure to dental structures. The goal of this treatment method is to simultaneously improve structural strength, esthetic integration, and bonding optimization to enamel. In a 3-year prospective evaluation, this framework modification shows promising results, with a survival rate of 100% and no biological or mechanical complications.

Ceramic repair: influence of chemical and mechanical surface conditioning on adhesion to zirconia.

AIMS: To evaluate the influence of mechanical surface treatment and chemical primer application on the composite shear bond strength to zirconia. METHODS: Eighty blocks of Lava Frame Zirconia were randomly assigned to the experimental groups, according to the several possible combinations between mechanical (untreated/aluminum oxide sandblast) and chemical treatment (no primer/Monobond Plus/Experimental Zirkon-Primer/Z-Prime Plus) (n=10). Adhesive system and composite resin were then applied, and samples were thermal cycled (5°C-55°C, 500 cycles). Shear bond strength tests and failure mode analysis were performed. SBS data were analyzed by two-way ANOVA, followed by Student-Newman-Keuls post-hoc tests, and failure mode by Kruskal-Wallis and Mann-Whitney tests (p<0.05). RESULTS: Shear bond strength mean values ranged from 6.9 to 23.2 MPa. Surface treatment with aluminum oxide sandblasting allowed a statistically significant increase (p<0.05) in bond strength values. The group treated with Z-Prime Plus achieved (p<0.05) higher bond strength results than the other chemical treatments. CONCLUSIONS: The surface mechanical treatment almost doubled the bond strength values. Z-Primer Plus have enhanced bond strength values of composite to zirconia.

Influence of multimode universal adhesives and zirconia primer application techniques on zirconia repair.

STATEMENT OF PROBLEM: More information is needed on the efficacy of the new universal adhesives and on the best 10-methacryloyloxydecyl dihydrogen phosphate- (MDP)-containing primer protocol to promote adhesion to zirconia. PURPOSE: The aim of this study was to evaluate the influence of 2 new multimode MDP-containing adhesives and several application protocols of a zirconia primer on the shear bond strength (SBS) of composite resin to zirconia. MATERIAL AND METHODS: Sixty zirconia (3Y-TZP) blocks were abraded (50 µm Al2O3) and divided into 6 experimental groups (n=10): one Z-Prime Plus coat without light polymerization; one Z-Prime Plus light-polymerized coat; two Z-Prime Plus coats without light polymerization; two Z-Prime Plus light-polymerized coats; All-Bond Universal; and ScotchBond Universal Adhesive. Multimode adhesives were applied according to the manufacturers' recommendations. After composite resin (Filtek Z250) light polymerization, the specimens were stored in distilled water (37°C/48 hours) and tested in shear (1 mm/min). Failure mode was classified as adhesive or mixed. Statistical analysis of the SBS data was performed with 1-way ANOVA followed by the Student-Newman-Keuls post hoc tests. Nonparametric tests (Kruskal-Wallis) were used to analyze the failure mode data (α=.05). RESULTS: The ScotchBond Universal Adhesive, All-Bond Universal, and two Z-Prime Plus light-polymerized coats groups showed a higher mean SBS than the other experimental groups (P<.05). The 3 groups with the lowest mean SBS registered 100% of adhesive failures. CONCLUSIONS: The new multimode adhesives tested were effective in promoting adhesion between composite resin and zirconia. Z-Prime Plus should be applied in 2 light-polymerized coats to promote SBS values similar to those of the new multimode adhesives.

Effect of changes to the manufacturer application techniques on the shear bond strength of simplified dental adhesives.

PURPOSE: The aim of this work was to assess the shear bond strength (SBS) between a composite resin and dentin, promoted by two dental adhesive systems (one-step self-etching adhesive Easy Bond [3M ESPE], and two-step etch-and-rinse adhesive Scotchbond 1XT [3M ESPE]) with different application protocols (per manufacturer's instruction (control group); with one to four additional adhesive layers; or with an extra hydrophobic adhesive layer). METHODS: Proximal enamel was removed from ninety caries-free human molars to obtain two dentin discs per tooth, which were randomly assigned to twelve experimental groups (n=15). After adhesion protocol, the composite resin (Filtek Z250 [3M ESPE]) was applied. Specimens were mounted in the Watanabe test device and shear bond test was performed in a universal testing machine with a crosshead speed of 5 mm/min. Data were analyzed with ANOVA followed by Student-Newman-Keuls tests (P<0.05). RESULTS: The highest SBS mean value was attained with the Easy Bond three layers group (41.23±2.71 MPa) and the lowest with Scotchbond 1XT per manufacturer's instructions (27.15±2.99 MPa). Easy Bond yielded higher SBS values than Scotchbond 1XT. There were no statistically significant differences (P>0.05) between the application protocols tested, except for the three and four layers groups, that presented higher SBS results compared to manufacturer's instruction groups (P<0.05). No statistically significant differences were detected between the three and four layers groups (P≥0.05). CONCLUSION: It is recommendable to apply three adhesive layers when using Easy Bond and Scotchbond 1XT adhesives, since it improves SBS values without consuming much time.

Avaliação ds diferentes variáveis prognósticas durante o ecocardiograma de estresse com dipiridamol e atropina / Evoluation of different prognostic variables during dipyridamol-atropine stress echocardiogram

Fundamentos: Com o envelhecimento da população, no Brasil e no mundo, cresce o número de doenças crônicas, dentre elas a doença arterial coronariana. Faz-se, portanto, necessária a adoção de estratégias racionais na avaliação dessa população. Objetivo: Avaliar o impacto prognóstico do ecocardiograma de estresse com dipiridamol e atropina (Eco-Dip-Atro) e determinar as variáveis durante o exame com maior poder para estratificação. Métodos: Foram realizados, consecutivamente, 151 ecocardiogramas de estresse com dipiridamol (até 0,84mg/kg em 10min) e atropina (até 1mg em 4 min) em pacientes com suspeita ou com coronariopatia conhecida. O tempo mediano de acompanhamento foi de 596 dias. Resultados: Na análise univariada, a idade não foi preditiva para eventos combinados...

Segurança e resposta hemodinâmica durante o ecocardiograma de estresse com dipiridamol e atropina: comparação entre jovens e idosos / Safety and hemodynamic response dipyridamole-atropine echocardiogram: comparison between young and old people

Fundamentos: Com o envelhecimento da população, no Brasil e no mundo, cresce o número de doenças crônicas, dentre elas a doença arterial coronariana. Faz-se, portanto, necessária a adoção de estratégias racionais na avaliação dessa população. Objetivos: Avaliar segurança, exequibilidade e resposta hemodinâmica do ecocardiograma de estresse com dipiridamol e atropina (Eco-Dip-Atro) num grupo de idoso (maior ou menor que 65 anos - Grupo I), comparando os achados com um grupo jovem (menor que 65 anos - Grupo II). Métodos: Um total de 203 pacientes consecutivos com suspeita ou com coronariopatia conhecida (Grupo I - n igual 69; Grupo II - n igual 134) realizaram o Eco-Dip-Atro seguindo o protocolo do estudo EPIC 2, ou seja, dipiridamol (até 0,84mg/kg em 10min) e atropina (até 1mg em 4 min).Resultados: O índice de exames conclusivos ou em que o protocolo pôde ser completado foi de 78,9 por cento no Grupo I e 92,5 por cento no Grupo II (p menor que 0,0001)...