A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention.

OBJECTIVES: This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. METHODS: This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low. CONCLUSION: Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. CLINICAL SIGNIFICANCE: The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

The impact of methylene blue photosensitizer, aPDT and a calcium hydroxide-based paste on the physicochemical and mechanical characteristics of root canal dentin and the bonding interface of fiberglass posts.

PURPOSE: To investigate the influence of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) and calcium hydroxide (CH) medication on the mechanical characteristics, degree of conversion (DC), quantification, and volume of gaps at the adhesive interface of glass fiber posts (GFPs) luted to distinct thirds of root canal dentin. Additionally, the microhardness (MH), elastic modulus (Eit), morphology, and chemical structure of the intraradicular dentin were assessed. MATERIALS AND METHODS: 6 experimental groups were formed by sorting 102 bovine incisors. Canals receiving deionized water irrigation as a negative control; canals receiving deionized water irrigation and filled with CH as a positive control; groups treated with CH + MB at 50 and 100 mg/L without irradiation; and groups treated with CH + MB at 50 and 100 mg/L irradiated by red laser for 60 s (660 nm; 100 mW; 6.5 J; 72 J/cm2). MH, Eit, and DC properties were evaluated for both the resin cement layer and root dentin substrate (n = 8). Volume and quantification of gaps at the bonding interface (n = 6), and dentin morphology and chemical content were investigated (n = 3). Data were analyzed using a repeated-measures 2-way ANOVA followed by Tukey post hoc analysis (α = 0.05). RESULTS: The distinct intraradicular thirds and treatment with MB-mediated aPDT, whether activated or not, in combination with CH, had a significant impact on the mechanical characteristics of the root dentin. This effect was also observed in the MH, Eit, DC, quantification, and volume of gaps at the luting interface (P < .05). In general, a higher concentration of MB, whether activated by a red laser or not, led to lower values in the mechanical properties of the root dentin, as well as in MH, Eit, and DC at the adhesive interface (P < .05). Additionally, these groups exhibited higher values for quantification and volume of gaps at the luting substrate (P < .05). Scanning electron micrographs and energy dispersive X-ray spectra showed qualitative similarity among all groups, except for the negative experimental control group. CONCLUSIONS: MB-mediated aPDT at 50 mg/L, in combination with CH, demonstrated favorable physico-chemical and mechanical characteristics in intraradicular dentin, along with satisfactory mechanical features and the adhesive interface integrity for GFPs at all intraradicular depths. CLINICAL SIGNIFICANCE: MB-mediated aPDT at a concentration of 50 mg/L combined to CH medication represents a suitable choice for photosensitization in the context of intracanal disinfection following the biomechanical procedure and prior to luting of intraradicular restorations.

Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies.

The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.

Hydrofluoric acid concentration and etching time affect differently the microstructure and surface properties of pressed lithium disilicate glass ceramics.

OBJECTIVE: To evaluate the effect of different hydrofluoric acid concentrations and etching times on the surface, chemical composition and microstructure of lithium disilicate. MATERIAL AND METHODS: Ninety specimens of pressed lithium disilicate (LDS) were obtained (IPS e.max Press, Rosetta SP and LiSi Press). The specimens of each material were divided in two groups according to the hydrofluoric acid concentration: 5% and 10% (n = 15/group), and subdivided according to the etching time: 20, 40 and 60 s (n = 5/group). Crystalline evaluations and chemical composition were performed through x-ray diffraction (XRD) and energy-dispersive x-ray spectroscopy (EDS), respectively. Microstructural analyses were performed by scanning electron microscope (SEM), surface roughness (Ra), and material thickness removal evaluation. Thickness removal and Ra data were analyzed by ANOVA and Tukey test (p < 0.05). RESULTS: XRD demonstrated characteristic peaks of lithium disilicate crystals, lithium phosphate and of a vitreous phase for all materials. EDS identified different compositions and SEM confirmed different surface responses to acid etching protocols. Material and etching time influenced Ra and material thickness removal (p < 0.05). CONCLUSION: Hydrofluoric acid concentration and etching time affect the surface characteristics of LDS differently. LiSi Press presented higher resistance to hydrofluoric acid etching compared to e.max Press and Rosetta SP. CLINICAL SIGNIFICANCE: Applying the appropriate etching protocol is pivotal to avoid excessive material removal and to prevent jeopardize the mechanical and optical properties of the material.

Minimally processed recycled yttria-stabilized tetragonal zirconia for dental applications: Effect of sintering temperature on glass infiltration.

This study aimed to develop a recycling process for the remnants of milled 3Y-TZP and enhance their properties using glass infiltration. 3Y-TZP powder was gathered from the vacuum system of CAD-CAM milling equipment, calcined and sieved (x < 75 µm). One hundred twenty discs were fabricated and pre-sintered at 1000 °C/h. These specimens were then divided into four groups, categorized by glass infiltration (non-infiltrated [Zr] or glass-infiltrated [Zr-G]) and sintering temperature (1450 °C [Zr-1450] or 1550 °C [Zr-1550]/2h). After sintering, the specimens were characterized by X-Ray Diffraction (XRD), relative density measurement, and scanning electron microscopy and energy dispersive spectroscopy (SEM-EDS). The biaxial flexural strength test was performed according to the ISO 6872 and followed by fractographic analysis. Subsequent results were analyzed using Weibull statistics. Relative density values of the sintered specimens from Zr-1450 and Zr-1550 groups were 86.7 ± 1.5% and 92.2 ± 1.7%, respectively. Particle size distribution revealed particles within the range of 0.1-100 µm. XRD analysis highlighted the presence of the ZrO2-tetragonal in both the Zr-1450 and Zr-1550 groups. Glass infiltration, however, led to the formation of the ZrO2-monoclinic of 9.84% (Zr-1450-G) and 18.34% (Zr-1550-G). SEM micrographs demonstrated similar microstructural characteristics for Zr-1450 and Zr-1550, whereas the glass-infiltrated groups exhibited comparable infiltration patterns. The highest characteristic strength was observed in the glass-infiltrated groups. Fractographic analyses suggested that fracture origins were related to defects on the tensile side, which propagated to the compression side of the samples. Both the sintering temperature and glass infiltration significantly influenced the mechanical properties of the 3Y-TZP recycled.

Do different adhesives influence the color stability and fluorescence of composite restorations after aging?

This study aimed to evaluate the influence of dental adhesive color on the chromatic stability and fluorescence intensity of composite resin restorations of different thicknesses. Ninety bovine enamel samples were obtained and restored with resin composite varying thicknesses of restorative material and enamel (1.0 mm enamel and 1.0 mm composite; 1.5 mm enamel and 0.5 mm composite; 0.5 mm enamel and 1.5 mm composite). The restorations were made of composite resin (Opallis E-bleach H) using different types of dental adhesives: Ambar, Ambar APS, and Single Bond Universal (n=10). The samples were subjected to color measurement tests in a spectrophotometer using CIEDE2000 and fluorescence intensity measurements before and after aging in a red wine coloring solution. Data were subjected to analysis of variance (ANOVA) and Tukey's test (α = 0.05). There were no statistically significant changes in color stability or fluorescence intensity for restorations made of different materials or thicknesses (p>0.05). Single Bond Universal showed greater color stability at 0.5 mm thickness (ΔE00 = 4.4 ± 1.6) compared to other thicknesses of the same material (p=0.003), as well as a greater difference in fluorescence intensity after aging at 1.5 mm thickness (-414.9 ± 103.8) compared to other materials (p=0.0002). Overall, it was concluded that the different adhesive systems did not influence the color stability and fluorescence of restorations of different thicknesses.

Cranial anatomical structures with high sexual dimorphism in metric and morphological evaluation: A systematic review.

The mastoid process has attracted the attention of several researchers due to its protected position at the base of the skull and the fact that it is relatively compact, in addition to being highly resistant and dimorphic, considered as a gold standard anatomical structure in the determination of the sexual dimorphism of skulls. However, intrinsic and extrinsic factors may influence this anatomical structure over time, providing contradictory and ambiguous data. Therefore, other anatomical structures need to be evaluated concurrently with the mastoid process to provide better accuracy and reliability of skull sexual dimorphism data. Thus, the objective of this systematic review was to evaluate the degree of reliability of the mastoid process to determine sexual dimorphism compared to other dimorphic structures, since there are still no systematic reviews on the subject in the literature. This review follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD 42023395167 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Are skull anatomical structures reliable as alternatives to determine sexual dimorphism compared to the mastoid process?". A literature search for studies was performed in the MEDLINE Scopus, Web of Science, LILACS, and Cochrane Library databases. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 13 ex-vivo studies published between 2008 and 2023. The risk of bias was considered low in 12 of the studies, and high in 1 study. Based on the findings, it can be concluded that even with the limitations of this systematic review, quantitative and qualitative analyses are essential in sexual identification of human skulls, and different anatomical structures can be used as references in addition to the mastoid process, with high reliability and precision, among them the; glabella, frontal profile, superciliary arch, bizygomatic width, maximum cranial length, and nasal height.

In vitro assessment of the effect of luting agents, abutment height, and fatigue on the retention of zirconia crowns luted to titanium base implant abutments.

STATEMENT OF PROBLEM: The bonding of implant-supported prostheses is determined by abutment material, convergence angle, height, surface treatment, and luting agents. However, studies evaluating the bonding of luting agents to titanium base abutments with different heights under fatigue conditions are scarce. PURPOSE: The purpose of this in vitro study was to evaluate the retention of zirconia crowns bonded with different luting agents to titanium base abutments of different heights before and after fatigue testing. MATERIAL AND METHODS: Zirconia crowns were designed, milled, and distributed into 4 experimental groups according to the luting agents (G-Multi Primer/G-Cem LinkForce [MP/GC] and Scotchbond Universal/RelyX Ultimate [SU/RU]) and titanium base abutment heights (2.5 mm and 4 mm) (n=10). Pull-out testing was performed in a universal testing machine at a crosshead speed of 1 mm/min until crown displacement. Fatigue testing was performed by an electric precision fatigue simulator (1×106 cycles; 100 N; and 15 Hz), followed by pull-out testing of fatigued specimens. Collected data were statistically evaluated by using a linear mixed model after post hoc comparisons by the least significant difference test (α=.05). RESULTS: Luting agents, abutment heights, and fatigue influenced the bonding retention of zirconia crowns to titanium base abutments. SU/RU agents promoted higher pull-out compared with MP/GC for both abutment heights before and after fatigue. Higher abutment height increased pull-out regarding lower abutment height for SU/RU materials before and after fatigue testing. Although fatigue had no significant effect on the pull-out of MP/GC, lower bond retention was observed for SU/RU after fatigue, regardless of abutment height. CONCLUSIONS: Luting agent composition and the interaction with abutment height and fatigue influenced the retention of zirconia crowns to titanium base abutments.

Does the use of antioxidant agents after dental bleaching compromise the aesthetic results of ceramic laminate veneers?

PURPOSE: This in vitro study aimed to evaluate the aesthetic compromise generated in adhesive interface of ceramic laminate veneer luted after tooth bleaching and the use of antioxidant agents. Thus, the chromatic coordinates and whitening index (WID) were evaluated, comparing whiteness changes (ΔWID) results to perceptibility and acceptability thresholds. MATERIAL AND METHODS: In total, 88 bovine enamel samples (7 × 8 × 4 mm; n = 8) were submitted to the ceramic laminate veneer luting protocol according to surface treatment (unbleached and bleached enamel), antioxidant agents (control; 10% ascorbic acid and 10% α-tocopherol), and luting periods (after 24 h and after 14 days). To lute IPS e.max ceramic restorations (7 × 8 × 0.6 mm), Tetric N-Bond Universal adhesive system and Variolink Aesthetic LC resin cement were used. An ultraviolet-visible spectrophotometer (UV-VIS) was utilized to measure CIE L*a*b* coordinates prior to and after UV-B artificial accelerated aging for 252, 504, and 756 h. L*, a*, and b* axes were evaluated separately, and the whitening stability (ΔWID) effect was assessed by varying the whiteness index for dentistry (WID). The 50:50% visual threshold was used to evaluate ΔWID values (whiteness perceptibility [WPT] and whiteness acceptability [WAT]). Color parameters changes (ΔL*Δa*Δb*), WID, and ΔWID data were subjected to 2-way repeated measures ANOVA followed by Tukey's test (α = 0.05). RESULTS: Different UV-aging periods influenced the chromatic coordinates, WID, and ΔWID of the ceramic restorations regardless of the bleaching treatment, antioxidant solutions and luting periods (P < .05). In general, ΔWID values after UV-aging periods were above perceptibility and acceptability thresholds (WPT = 0.72 and WAT = 2.62, respectively) for all experimental groups (P < .05). Unbleached and 10% ascorbic acid-treated enamels luted after 14 days of the antioxidant action exhibited lower ΔL* and Δb* values, while control group showed lower Δa* values. All experimental groups showed similar performance on ΔWID compared to the control group, regardless of the UV-aging period analyzed (P > .05). CONCLUSION: α-tocopherol is a suitable antioxidant solution to be used 24 h post enamel bleaching not compromising clinical acceptability of ceramic laminate veneers. CLINICAL RELEVANCE: The adhesive interface of ceramic laminate veneers may appear darker after the use of antioxidant agents affecting the clinical acceptability of the restorations.

Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials.

The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.

A systematic review of photogrammetry as a reliable methodology in gender identification of human skull.

One of the most important parameters in the identification process in forensic Medicine and Dentistry is the determination of sex through the skull, based on morphological and metric dimorphism. Photogrammetry is an affordable option that allows the reconstruction of position, orientation, shape, and size, allowing the performance of quantitative and qualitative analyzes to identify the sex of the individual. However, there are few systematic reviews in the literature validating whether photogrammetry is a reliable methodology for sexual identification using human skulls. Therefore, the objective of the current systematic review was to validate whether photogrammetry of dry skulls is reliable as a method for calculating sex in human identification. This revision follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD420223 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Is test photogrammetry reliable as a method for estimating sex in human identification?". A literature search for studies was performed in the databases MEDLINE Scopus, Web of Science, LILACS, and the Cochrane Library. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 11 ex-vivo studies published between 2001 and 2021. The risk of bias was considered low in 8 of the studies, and high in 3 studies. Based on this systematic review, it can be concluded that the photogrammetry method is viable and reliable in identifying sexual dimorphism.

Effect of Antioxidant Agents After Dental Bleaching on Color Stability and Mechanical Properties of Bonding Interface Components in Ceramic Laminate Veneer Luting.

PURPOSE: Few studies have evaluated the influence of antioxidant agents on the optical and mechanical properties of ceramic laminate veneers after dental bleaching. Thus, this in vitro study aimed to evaluate the influence of antioxidant agents on the color stability and mechanical properties, such as nanohardness (HIT), elastic modulus (Eit*), and degree of conversion (DC) of the bonding interface components after dental bleaching in ceramic laminate veneer luting. METHODS AND MATERIALS: A total of 143 bovine teeth were distributed into experimental groups, according to the procedure method (unbleached or bleached with Whiteness HP Maxx 35%), antioxidant type (control, 10% ascorbic acid, or 10% α-tocopherol), and luting period (24 hours or 14 days) (n=13). The Tetric N-Bond Universal adhesive system and Variolink Esthetic LC resin cement were used as luting agents to lute IPS e.max ceramic restorations (0.6 mm in thickness) to enamel. A UV-visible spectrophotometer was used to assess color stability before and after UV-B artificial accelerated aging for 252, 504, and 756 hours (n=8). The HIT and Eit* of the adhesive and resin cement were measured using a nanohardness tester under a load of 1000 µN, and the DC was measured using a micro-Raman spectrometer (n=5). The color stability and mechanical properties were measured and evaluated by twoway and one-way ANOVA, respectively, and Tukey test (α=0.05). RESULTS: Distinct aging periods exerted significant changes on the color stability of the restorations luted in enamel associated with ascorbic acid, bleached and unbleached, and the bleached enamel under no antioxidant agent action, for the experimental groups evaluated after 14 days (p<0.05). The use of the α-tocopherol antioxidant solution after the bleaching process for 24 hours did not alter the optical and mechanical properties of the adhesive interface of the laminate restorations compared to those of the control group (p>0.05). CONCLUSION: The use of a 10% α-tocopherol antioxidant solution produced promising results, suggesting that it could be mediately used after tooth bleaching to lute ceramic laminate veneers.

In vitro study on how photodynamic therapy and calcium hydroxide medication influence adhesive interface properties of glass-fiber posts to intraradicular dentin.

PURPOSE: This in vitro study evaluated the influence of antimicrobial photodynamic therapy (aPDT), using methylene blue (MB) as photosensitizer (PS) and calcium hydroxide (CH) as intracanal medication on adhesive bond strength, sealing, and integrity of the luting interface of glass-fiber posts to different thirds of endodontically treated root canal dentin. MATERIAL AND METHODS: 102 incisors were sorted into 6 groups: a negative control irrigated with deionized water; a positive control irrigated with deionized water and filled with CH; CH + MB 50 mg/L without laser radiation; CH + MB 100 mg/L without laser radiation; CH + MB 50 mg/L radiated by red laser; and CH + MB 100 mg/L radiated by red laser. Push-out bond strength (n = 8), adhesive interface sealing (n = 3), and volume and quantification of voids (n = 6) were assessed using a universal testing machine, confocal laser scanning microscope, and computerized microtomography, respectively. Scanning electron micrographs were obtained from representative samples to qualify the fracture patterns. Push-out bond strength and adhesive interface integrity data were subjected to 2-way ANOVA for repeated measures followed by Tukey's test (α = 0.05). Adhesive interface sealing was evaluated by the inter-examiner Kappa test and submitted to Kruskal-Wallis and Dunns tests (α = 0.05). RESULTS: Assessing the apical region, the positive control and MB100WA + Ca(OH)2 groups showed lower adhesive bond strength compared to the MB100A + Ca(OH)2 group (P < 0.05). The cervical third showed higher bond strength than the apical third for the positive control, MB50WA + Ca(OH)2, MB100WA + Ca(OH)2, and MB50A + Ca(OH)2 groups (P < 0.05). A prevalence of mixed failure was observed in all experimental groups. There were no statistically significant differences in adhesive interface sealing for any of the parameters assessed (P > 0.05). MB100WA + Ca(OH)2 and MB100A + Ca(OH)2 groups promoted a higher volume and quantification of voids compared to the negative control group evaluating the cervical third (P < 0.05). In general, there were no differences in the quantification of voids comparing the intraradicular thirds (P > 0.05), differently to the volume of voids in which, in general, the cervical third promoted higher values compared to the middle and apical thirds (P < 0.05). CONCLUSION: aPDT with methylene blue PS at 50 mg/L associated with calcium hydroxide as intracanal medication demonstrated satisfactory bond strength, sealing, and integrity of the adhesive interface at any intraradicular depth.

Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis (SRM) was to answer the question as to whether the use of ultrasonic irrigation (UI) results in better antimicrobial activity in root canal disinfection compared to conventional irrigation (CI). METHODS: A literature search was performed in the main scientific databases, carried out until October 2021. The eligibility criteria were randomized clinical trials (RCTs). Two meta-analyses were conducted using R software with the "META" package. The mean difference (MD) and odds ratio (OR) measure of effect were calculated. The fixed effect model was applied with a 95% confidence interval. The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: A total of 1782 records were screened, and 12 studies meeting the criteria were included in this review. A low risk of bias was observed for most domains, except allocation concealment that was considered unclear. The certainty of evidence was classified as moderate in the OR meta-analyses and low in the MD meta-analyses. Ultrasonic irrigation resulted in a better antimicrobial effect in both meta-analyses, MD 1.42 [1.60; 1.23] p < 0.0001, I2 = 80%; and OR 3.86 [1.98; 7.53] p< 0.0001, I2 = 28.7%. CONCLUSION: Within the limitations of this SRM, UI presented better antimicrobial efficacy than CI. CLINICAL RELEVANCE: UI should be used by clinicians as it promotes better antimicrobial efficacy in patients undergoing endodontic treatment.

Influence of antimicrobial photodynamic therapy on the bond strength of endodontic sealers to intraradicular dentin: A systematic review and meta-analysis.

BACKGROUND: The objective of this systematic review and meta-analysis (SRMA) was to investigate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of endodontic sealers to intraradicular dentin. METHODS: This SRMA followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42022319856). A population, intervention, control, and outcome (PICO) question was formulated: "Does antimicrobial photodynamic therapy decrease the bond strength of root canal sealers?". A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases until July 2022. Joanna Briggs Institute Critical Assessment Guidelines for Quasi-Experimental Studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (p<0.05). RESULTS: Out of an initial 345 articles, 8 in vitro studies were included, published between 2013 and 2022. The studies were qualitatively analyzed; two studies showed a positive effect, two studies a negative effect, and the other studies showed no effect on bond strength of endodontic sealers to intraradicular dentin. Seven of the studies were included in the SRMA, which indicated that there was no significant difference in bond strength when using aPDT (P = 0.90; MD: -0.03; 95% CI: -0.46 to -0.41). There was a high level of evidence for each meta-analysis outcome. CONCLUSION: It can be concluded that the use of aPDT as a method of root canal disinfection does not negatively influence the bond strength of endodontic sealers in the root canal.

Do different adhesives influence the color stability and fluorescence of composite restorations after aging?

Abstract This study aimed to evaluate the influence of dental adhesive color on the chromatic stability and fluorescence intensity of composite resin restorations of different thicknesses. Ninety bovine enamel samples were obtained and restored with resin composite varying thicknesses of restorative material and enamel (1.0 mm enamel and 1.0 mm composite; 1.5 mm enamel and 0.5 mm composite; 0.5 mm enamel and 1.5 mm composite). The restorations were made of composite resin (Opallis E-bleach H) using different types of dental adhesives: Ambar, Ambar APS, and Single Bond Universal (n=10). The samples were subjected to color measurement tests in a spectrophotometer using CIEDE2000 and fluorescence intensity measurements before and after aging in a red wine coloring solution. Data were subjected to analysis of variance (ANOVA) and Tukey's test (α = 0.05). There were no statistically significant changes in color stability or fluorescence intensity for restorations made of different materials or thicknesses (p>0.05). Single Bond Universal showed greater color stability at 0.5 mm thickness (ΔE00 = 4.4 ± 1.6) compared to other thicknesses of the same material (p=0.003), as well as a greater difference in fluorescence intensity after aging at 1.5 mm thickness (-414.9 ± 103.8) compared to other materials (p=0.0002). Overall, it was concluded that the different adhesive systems did not influence the color stability and fluorescence of restorations of different thicknesses.

Resumo O objetivo deste estudo foi avaliar a influência da cor do adesivo dental na estabilidade cromática e intensidade de fluorescência das restaurações de resina composta de diferentes espessuras. Foram obtidos noventa amostras de esmalte bovino que foram restaurados com resina composta, variando a espessura do material restaurador e do esmalte (1,0 mm de esmalte e 1,0 mm de compósito; 1,5 mm de esmalte e 0,5 mm de compósito; 0,5 mm de esmalte e 1,5 mm de compósito). As restaurações foram feitas de resina composta (Opallis E-bleach H) utilizando diferentes tipos de adesivos odontológicos: Ambar, Ambar APS, e Single Bond Universal (n=10). As amostras foram submetidas a testes de medição de cor em um espectrofotômetro usando CIEDE2000 e medições de intensidade de fluorescência antes e depois do envelhecimento em uma solução de coloração de vinho tinto. Os dados foram submetidos à análise de variância (ANOVA) e ao teste de Tukey (α = 0,05). Não houve mudanças estatisticamente significativas na estabilidade da cor ou intensidade de fluorescência para restaurações feitas de diferentes materiais ou espessuras (p>0,05). O Single Bond Universal mostrou maior estabilidade de cor a 0,5 mm de espessura (ΔE00 = 4,4 ± 1,6) em comparação com outras espessuras do mesmo material (p=0,03), bem como uma maior diferença na intensidade de fluorescência após o envelhecimento a 1,5 mm de espessura (-414,9 ± 103,8) em comparação com outros materiais (p=0,0002). Em geral, concluiu-se que os diferentes sistemas adesivos não influenciaram a estabilidade de cor e a intensidade de fluorescência das restaurações de diferentes espessuras.

Surface characterization of indirect restorative materials submitted to different etching protocols.

OBJECTIVES: This in vitro study aimed to evaluate the effect of different times and concentrations of hydrofluoric acid etching on the surface of indirect restorative materials obtained from blocks used in CAD-CAM technology. METHODS: Specimens (4 mm × 4 mm × 0.8 mm) were obtained for each indirect restorative material: zirconia-reinforced lithium monosilicate ceramic (Celtra Duo), nanoceramic resin (Lava Ultimate), and polymer-infiltrated ceramic network material (Vita Enamic). The materials were submitted to etching with 5% or 10% hydrofluoric acid for 20, 40, 60, or 90 s. A control group for each material was evaluated without any surface treatment, totaling nine experimental groups for each material (n = 10). The specimens were evaluated for surface roughness (Ra and Rz), confocal optical microscopy, the contact angle (θ), surface free energy (γs), total free interaction energy (∆G) using a goniometer, and microshear bond strength to resin cement. Specimen images were obtained using scanning electron microscopy, confocal optical microscopy, and atomic force microscopy. Data on the surface roughness, the contact angle, surface free energy, total free interaction energy, and bond strength were subjected to two-way ANOVA and Tukey´s test (α=0.05). RESULTS: In general, Celtra Duo showed better results after etching with 10% hydrofluoric acid for 40 or 60 s. Lava Ultimate showed better performance after etching with 10% hydrofluoric acid for 20 or 40 s, whereas Vita Enamic showed better results after etching with 5% hydrofluoric acid for 90 s. CONCLUSION: Each material showed different characteristics after etching with hydrofluoric acid. Knowledge of the proper protocol for each material is essential to ensure improvements in the adhesion process and durability of indirect restorations. In general, Celtra Duo presented mechanical properties superior to those of Lava Ultimate and Vita Enamic. CLINICAL SIGNIFICANCE: Specific etching protocols must be recommended for each indirect material because longer exposure to hydrofluoric acid can jeopardize the surface, thus affecting the mechanical and bond strength properties.

Antimicrobial photodynamic therapy in endodontic reintervention: A systematic review and meta-analysis.

BACKGROUND: To evaluate the effectiveness of the use of antimicrobial photodynamic therapy (aPDT) in root canals disinfection in cases of endodontic retreatments. METHODS: This Systematic Review was registered in PROSPERO (CRD42021260013) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Searches were performed in the electronic databases PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials and Cochrane Library. Methodological quality and risk of bias were assessed by the Cochrane Risk of Bias tool for randomized clinical trials (RCT) and by the Newcastle-Ottawa (NOS) qualifier for non-RCT (prospective) studies. Meta-analysis was performed using R software, version 3.6.3 with the "META" package assistant by the RStudio platform. The odds ratio (OR) measure of effect was calculated and the random effect model was applied with a 95% confidence interval, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. RESULTS: Regarding the 1513 studies screened, 10 met the eligibility criteria and were included, and 8 used in the quantitative synthesis. Meta-analysis showed that all of studies data presented a significant difference before and after of antimicrobial photodynamic therapy in the microbial load reduction in secondary endondontic infections (OR 0.15 [0.07; 0.32], p < 0.0001). Overall, the studies had a low risk of bias and, the analysis of evidence by GRADE assessment was rated as moderate. CONCLUSION: It is suggested that aPDT is a beneficial and promising tool, showing efficacy in reducing the microbial load in cases of endodontic retreatment.