Effect of different design and surface treatment on the load-to-failure of ceramic repaired with composite.

Glass ceramics are widely used to manufacture esthetic veneers, inlays, onlays, and crowns. Although the clinical survival rates ofglass-ceramic restorations arefavorable,fractures or chips are common. Certain cases can be repaired with direct composite. AIM: The aim of this study was to investigate the interaction effect of different designs and surface treatments on the load-to-failure of lithium disilicate glass-ceramic repaired with nanofilled composite. MATERIALS AND METHOD: Lithium-disilicate glass-ceramic slabs (IPS e.max Press, Ivoclar Vivadent) with three different designs of the top surface (flat, single plateau, or doubleplateau) (n=U) received 'no treatment', '5% HF etching', or "AI2O3 sandblasting". HF-etched and sandblasted slabs also received silane and universal one-step adhesive application. All slabs were incrementally repaired with nanofilled composite (Filtek Z350, 3M ESPE) up to6 mm above the highest ceramic top plateau. Specimens were stored in artificial saliva at 37 °C for 21 days and then subjected to 1,000 thermocycles between 5 and 55 °C. The interface composite-ceramic of each specimen was tensile tested until failure in a universal testing machine and the mode of failure was determined under a stereomicroscope. The ceramic surface morphology of one representative tested specimen from each subgroup (design/surface treatment) was observed through scanning electron microscopy (SEM). RESULTS: Regardless of ceramic design, the absence of surface treatment resulted in significantly lower load-to-failure values. No significant differences in load-to-failure values were observed between HF-etched and sandblasted specimens for the flat design; however, HF etching resulted in significantly higher load-to-failure values than sandblasting for both single plateau and double plateau designs. The majority (60%) of HF-etched specimens with single plateau or double plateau presented mixed failures. SEM photomicrographs showed that HF-etched specimens had smoother surfaces than sandblasted specimens. CONCLUSION: The surface treatment of a defective lithium disilicate glass-ceramic restoration has more influence than its macroscopic design on the retention of the composite repair. HF etching seems to provide higher bond strength to the composite repair.

Embora fraturas e lascamento de restauragoes vitrocerámicas sejam comuns, alguns casos podem ser reparados com compósito direto. OBJETIVO: investigar o efeito da interagao de diferentes formas e tratamentos de superficie na carga de ruptura de uma vitrocerámica reforgada com dissilicato de litio reparada com compósito nanoparticulado. MATERIAIS E MÉTODOS: A superficie superior de espécimes de vitroceramica (IPS e.max Press, Ivoclar Vivadent) foi preparada com tres formas (plana, plato único, ou duplo) e recebeu (n=11): 'nenhum tratamento', 'condicionamento com ácido hidrofluoridrico 5%', ou 'jateamento com AfOf. Ambos espécimes condicionados e jateados receberam silano e adesivo universal. Todos os espécimes foram reparados incrementalmente com compósito (Filtek Z350, 3M ESPE) até6 mm acima do plato cerámico mais alto, armazenados em saliva artificial á 37 °C por 21 dias, e submetidos á 1.000 termociclos (5 e 55 °C). A interface compósito-cerámica de cada amostra foi testada á tragao até sua falha em máquina universal e o modo de falha foi determinado com estereomicroscópio. A morfologia da superficie de uma amostra representativa de forma/tratamento de superficie foi observada através de microscopia eletronica de varredura (MEV). RESULTADOS: Independentemente da forma ceramica, a ausencia de tratamento superficial resultou em valores de carga de ruptura significativamente menores. Nao foi observada differenga significativa entre os espécimes planos condicionados ou jateados; no entanto, o condicionamento resultou em valores significativamente maiores que o jateamento para espécimes com plato único e duplo. A maioria (60%) dos espécimes condicionados e com plato único ou duplo apresentou falhas mistas. Imagens SEM demonstraram rugosidade superficial mais regular dos espécimes condicionados que os jateados. CONCLUSÕES: O tratamento superficial de uma restauragao defeituosa de vitrocerámica reforgada por dissilicato de litio tem maior influencia na retengao do reparo de compósito do que sua forma macroscópica; ainda, o condicionamento com ácido hidrofluoridrico parece proporcionar maior resistencia de uniao ao reparo com compósito.

Effect of brushing simulation on the wear behavior of repaired CAD-CAM restorations.

OBJECTIVE: The aim of the present study was to evaluate the influence of multidirectional brushing on the surface roughness, morphology, and bonding interface of resin-repaired CAD-CAM ceramic and composite restorations. MATERIALS AND METHODS: Twelve (N = 12) blocks (4 mm × 4 mm × 2 mm for parallel axis; 5 mm × 4 mm × 2 mm for perpendicular axis) of lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar AG) and CAD-CAM resin composite (Tetric CAD, Ivoclar AG) were obtained and repaired with direct resin composite (Clearfil AP-X, Kuraray). An abrasive slurry was prepared and the brushing was performed according to each restorative material and axis of brushing (n = 6; perpendicular to repair interface and parallel to repair interface) during 3,650 cycles (240 strokes per minute) to simulate 3 years of brushing. The surface roughness (Ra) and the profile variation for each material (restoration and direct repair resin composite) were measured at the baseline condition and after brushing, and the mean roughness and presence of steps at the repair interface were evaluated through factorial analysis of Variance (ANOVA). Scanning Electron Microscopy (SEM) images were taken to evaluate the surface topography of the repaired materials after brushing. RESULTS: The mean roughness of the repaired CAD-CAM restorations was affected by the brushing (P < .05), mainly when evaluating the repair material and the interface (P < .05), while the restorative CAD-CAM materials presented more stable values. The profile evaluation showed higher steps at the interface when repairing lithium disilicate than for CAD-CAM resin composite. CONCLUSION: Repaired CAD-CAM restorations were susceptible to wear after brushing simulation. The surface roughness of the direct resin composite was the most affected leading to step development at the interface, particularly in the repaired lithium disilicate samples. Cinical maintenance recalls and polishing protocols must be considered to enhance the longevity of such restorations.

Effect of different design and surface treatment on the load-to-failure of ceramic repaired with composite / Efeito de diferentes tratamentos de superficie e formas do preparo de cerámicas na resistencia de uniao de reparos em resina composta

ABSTRACT Glass ceramics are widely used to manufacture esthetic veneers, inlays, onlays, and crowns. Although the clinical survival rates ofglass-ceramic restorations arefavorable,fractures or chips are common. Certain cases can be repaired with direct composite. Aim The aim of this study was to investigate the interaction effect of different designs and surface treatments on the load-to-failure of lithium disilicate glass-ceramic repaired with nanofilled composite. Materials and Method Lithium-disilicate glass-ceramic slabs (IPS e.max Press, Ivoclar Vivadent) with three different designs of the top surface (flat, single plateau, or doubleplateau) (n=U) received 'no treatment', '5% HF etching', or "AI2O3 sandblasting". HF-etched and sandblasted slabs also received silane and universal one-step adhesive application. All slabs were incrementally repaired with nanofilled composite (Filtek Z350, 3M ESPE) up to6 mm above the highest ceramic top plateau. Specimens were stored in artificial saliva at 37 °C for 21 days and then subjected to 1,000 thermocycles between 5 and 55 °C. The interface composite-ceramic of each specimen was tensile tested until failure in a universal testing machine and the mode of failure was determined under a stereomicroscope. The ceramic surface morphology of one representative tested specimen from each subgroup (design/surface treatment) was observed through scanning electron microscopy (SEM). Results Regardless of ceramic design, the absence of surface treatment resulted in significantly lower load-to-failure values. No significant differences in load-to-failure values were observed between HF-etched and sandblasted specimens for the flat design; however, HF etching resulted in significantly higher load-to-failure values than sandblasting for both single plateau and double plateau designs. The majority (60%) of HF-etched specimens with single plateau or double plateau presented mixed failures. SEM photomicrographs showed that HF-etched specimens had smoother surfaces than sandblasted specimens. Conclusion The surface treatment of a defective lithium disilicate glass-ceramic restoration has more influence than its macroscopic design on the retention of the composite repair. HF etching seems to provide higher bond strength to the composite repair.

RESUMO Embora fraturas e lascamento de restauragoes vitrocerámicas sejam comuns, alguns casos podem ser reparados com compósito direto. Objetivo investigar o efeito da interagao de diferentes formas e tratamentos de superficie na carga de ruptura de uma vitrocerámica reforgada com dissilicato de litio reparada com compósito nanoparticulado. Materials e Método A superficie superior de espécimes de vitroceramica (IPS e.max Press, Ivoclar Vivadent) foi preparada com tres formas (plana, plato único, ou duplo) e recebeu (n=11): 'nenhum tratamento', 'condicionamento com ácido hidrofluoridrico 5%', ou 'jateamento com AfOf. Ambos espécimes condicionados e jateados receberam silano e adesivo universal. Todos os espécimes foram reparados incrementalmente com compósito (Filtek Z350, 3M ESPE) até6 mm acima do plato cerámico mais alto, armazenados em saliva artificial á 37 °C por 21 dias, e submetidos á 1.000 termociclos (5 e 55 °C). A interface compósito-cerámica de cada amostra foi testada á tragao até sua falha em máquina universal e o modo de falha foi determinado com estereomicroscópio. A morfologia da superficie de uma amostra representativa de forma/tratamento de superficie foi observada através de microscopia eletronica de varredura (MEV). Resultados Independentemente da forma ceramica, a ausencia de tratamento superficial resultou em valores de carga de ruptura significativamente menores. Nao foi observada differenga significativa entre os espécimes planos condicionados ou jateados; no entanto, o condicionamento resultou em valores significativamente maiores que o jateamento para espécimes com plato único e duplo. A maioria (60%) dos espécimes condicionados e com plato único ou duplo apresentou falhas mistas. Imagens SEM demonstraram rugosidade superficial mais regular dos espécimes condicionados que os jateados. Conclusoes O tratamento superficial de uma restauragao defeituosa de vitrocerámica reforgada por dissilicato de litio tem maior influencia na retengao do reparo de compósito do que sua forma macroscópica; ainda, o condicionamento com ácido hidrofluoridrico parece proporcionar maior resistencia de uniao ao reparo com compósito.

Restoration-repair potential of resin-modified glass ionomer cement

Abstract: This in vitro study aimed to evaluate the repair bond strength of resin-modified glass ionomer cement using either the same material or a universal adhesive in the etch-and-rinse and self-etch modes plus resin composite. Twenty-four resin-modified glass ionomer cement blocks were stored in distilled water for 14 d and thermocycled. Sandpaper ground specimens were randomly assigned to three experimental groups according to the repair protocol: resin-modified glass ionomer cement (Riva Light Cure, SDI) and universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care) in etch-and-rinse or self-etch modes and nanohybrid resin composite (Z350 XT, 3M Oral Care). After 24 h of water storage, the blocks were sectioned, and bonded sticks were subjected to the microtensile bond strength (μTBS) test. One-way ANOVA and Tukey's test were used to analyze the data. The failure mode was descriptively analyzed. The highest μTBS values were obtained when the resin-modified glass ionomer cement was repaired using the same material (p < 0.01). In addition, the mode of application of the universal adhesive system did not influence the repair bond strength of the resin-modified glass ionomer cement. Adhesive/mixed failures prevailed in all groups. Repair of resin-modified glass ionomers with the same material appears to be the preferred option to improve bond strength.

EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS.

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.

Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. MATERIALS AND METHODS: The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and certainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. RESULTS: From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. CONCLUSION: Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. CLINICAL RELEVANCE: Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Diferentes técnicas de reparo de cerâmicas vítreas com resina composta afetam a sobrevida da restauração e a resistência de união do reparo? Uma revisão sistemática e meta-análise / Do different protocols affect the success rate or bond strength of glass-ceramics repaired with composite resin? A systematic review and meta-analysis

As cerâmicas vítreas apresentam uma combinação de propriedades estética e mecânica satisfatórias, as quais viabilizam o seu uso na maioria das restaurações indiretas. No entanto, estes materiais estão sujeitos a falhas em sua estrutura, e podem lascar, trincar ou fraturar. O procedimento de reparo parece ser um recurso importante para a manutenção e aumento da sobrevida dessas restaurações na cavidade bucal. Porém, a falta de consenso no protocolo clínico ainda gera bastante confusão entre os profissionais. Portanto, objetivou-se avaliar, por meio de uma revisão sistemática e meta-análise, a influência dos diferentes tratamentos de superfície empregados no reparo de cerâmicas vítreas com resinas compostas. Buscas computadorizadas foram realizadas nas bases de dados PubMed, Scopus, Web of Science e Embase. Foi utilizada uma combinação de termos MeSH e termos livres com operadores booleanos OR e AND, seguindo as regras de sintaxe de cada base de dados. Uma busca complementar no Google Scholar e no OpenGrey também foi realizada, e não houve restrição de idioma ou ano de publicação. Após a identificação dos registros em cada base de dados, os resultados de busca foram exportados para o Rayyan QCRI. As etapas de identificação, seleção, elegibilidade e inclusão dos estudos foram realizadas respeitando-se o PRISMA statement. A qualidade metodológica dos estudos incluídos foi avaliada seguindo as Diretrizes da Ferramenta de Risco de Viés (OHAT Risk of Bias Rating Tool for Human and Animal Studies). Os resultados das meta-análises foram fornecidos pela diferença das médias com intervalo de confiança de 95%. A heterogeneidade estatística foi avaliada pelo I2, e o modelo randômico foi utilizado. A busca identificou 5.037 estudos e 165 foram avaliados quanto à elegibilidade. Finalmente, 123 estudos in vitro foram incluídos na revisão sistemática e 48 na meta-análise. Considerando as diferentes cerâmicas vítreas, os diferentes testes de resistência de união utilizados, e o envelhecimento ou não dos corpos de prova, 37 meta-análises evidenciaram o efeito de protocolos de reparo, incluindo apenas a aplicação de um sistema adesivo; a utilização do silano associado ao adesivo, precedidos ou não do ácido fluorídrico (AF), abrasão a ar (AA) com partículas de óxido de alumínio, jateamento (J) com partículas de trióxido de alumínio revestidas com sílica, ponta diamantada (PD) ou irradiação a laser (IL). Para as cerâmicas feldspáticas, AF, AA, J ou PD melhoram a retenção micromecânica do reparo; a aplicação do silano é essencial para a superfície condicionada com AF, porém o uso do adesivo é facultativo quando o silano é aplicado. Para as cerâmicas reforçadas com leucita ou com dissilicato de lítio, os resultados foram insuficientes para sugerir outro tratamento além do AF, seguido da aplicação de silano e adesivo.

Glass-ceramics have a combination of satisfactory aesthetic and mechanical properties, which possibility their indication for most indirect restorations. However, these materials are subject to structural failures, and can chip, crack or fracture. The repair procedures seem to be an important resource to keep and increase the restorations survival in the oral cavity. However, the lack of consensus on the clinical repair protocol still generates a lot of confusion among professionals. Therefore, the objective was to evaluate, through a systematic review and meta-analysis, the influence of different treatments used in glass-ceramics surfaces to repair with composite resins. Computerized searches were performed in PubMed, Scopus, Web of Science and Embase databases. A combination of MeSH and free terms with the Boolean operators OR and AND, following the syntax rules of each database was used. A complementary search on Google Scholar and OpenGrey was also performed, and there were no restrictions on language or publication year. After identifying the records in each database, the search results were exported to the Rayyan QCRI. The identification, selection, eligibility and inclusion steps of studies were carried out respecting the PRISMA statement. The included studies methodological quality was assessed following the OHAT Risk of Bias Rating Tool for Human and Animal Studies. The results of meta-analysis were provided in mean difference and 95% confidence interval. Statistical heterogeneity was assessed with the I2, and the random effect model was used. The search identified 5037 studies and 165 were assessed for eligibility. Finally, 123 in vitro studies were included in the systematic review and 48 in the meta-analysis. Considering different glass-ceramics, bond strength tests, and the specimens aging or not, 37 meta-analyses showed the effect of repair protocols including only an adhesive system application; silane plus adhesive system alone or preceded by hydrofluoric acid (HF), air abrasion (AA) with aluminum oxide particles, sandblasting (SB) with aluminum trioxide particles coated with silica, diamond bur (DB) or laser irradiation (LI). For feldspathic ceramics, HF acid, AA, SB, or DB improve repair micromechanical retention; applying silane is essential to HF conditioned surface, but adhesive is facultative when silane is applied. For leucite and lithium disilicate- reinforced ceramics, the results were insufficient to suggest another treatment besides HF acid plus silane and adhesive application.

Fatores que influenciam na decisão de alunos de graduação para abordagem de restaurações defeituosas em dentes decíduos / Influence factors on treatment decision of undergraduate students regarding defective restorations in primary teeth

Este estudo se propôs a avaliar fatores que influenciam estudantes de graduação na decisão de tratamento frente a restaurações defeituosas em dentes decíduos. Alunos de graduação em Odontologia de universidades públicas e privadas receberam um email, encaminhado por professores e colegiados, contendo o link do questionário online. Ele continha questões relacionadas aos estudantes, instituição de ensino e cinco pares de casos clínicos de pacientes com restaurações defeituosas em dentes decíduos. Os pares de casos clínicos continham as mesmas informações sobre o elemento dentário e o paciente, com exceção de uma característica da criança que poderia influenciar na decisão de tratamento (sexo, cor da pele, comportamento, risco de cárie e renda). As opções de resposta eram: 'acompanhamento', 'recontorno e polimento', 'reparo' ou 'troca da restauração defeituosa'. As respostas das abordagens para cada par de caso clínico foram comparadas entre si considerando as características das crianças utilizando o teste de McNemar. Posteriormente, para as análises múltiplas, cada par de casos clínicos foi criada uma variável resposta: "alterou o tratamento" e "não alterou o tratamento em função das características da criança". Modelos multiníveis de regressão logística foram usados para estimar a associação entre os diferentes desfechos de possibilidades de tratamento (alterar ou não alterar) e variáveis preditoras dos estudantes e das instituições. Levando em conta o nível contextual, os estudantes (1º nível) foram agrupados nas suas respectivas universidades (2º nível). O nível de significância estatística para as análises foi de 5%. Participaram do estudo 341 estudantes de graduação, 73,9% eram do sexo feminino. A decisão de tratamento para restaurações defeituosas em dentes decíduos variou de acordo com o sexo, comportamento, risco de cárie da criança, do percurso formativo do estudante e a região da instituição de ensino. 20,2% dos estudantes se mostraram mais invasivos quando o paciente era do sexo masculino. 72,4% e 68,6% foram mais invasivos em crianças com comportamento difícil e alto risco de cárie, respectivamente. Pode-se concluir que tanto características do paciente quanto do estudante e da instituição foram capazes de influenciar a decisão de tratamento para restaurações defeituosas em dentes decíduos.

This study aimed to evaluate factors that influence undergraduate students in the treatment decision for defective restorations in primary teeth. Undergraduate dental students from public and private universities received an e-mail, forwarded by professors and colleges, containing the link to the online questionnaire. It contained questions related to students, teaching institution, and five pairs of clinical cases of patients with defective restorations in primary teeth. The pairs of clinical cases contained the same information about the dental element and the patient, except for one characteristic of the child that could influence the treatment decision (gender, skin color, behavior, caries risk, and income). The response options were: 'follow-up', 'recontouring and polishing', 'repair' or 'replace defective filling'. The responses of the approaches for each clinical case pair were compared with each other considering the characteristics of the children using McNemar test. Subsequently, for the multiple analyses, each clinical cases pair, a response variable was created: 'changed treatment' and 'did not change treatment depending on the characteristics of the child. Multilevel logistic regression models were used to estimate the association between the different outcomes of treatment possibilities (do not change and change) and predictor variables of students and institutions. Taking into account the contextual level, students (1st level) were grouped into their respective universities (2nd level). The level of statistical significance for the analyses was 5%. A total of 341 undergraduate students participated in the study, 73.9% were female. The treatment decision for defective restorations in primary teeth varied according to gender, behavior, caries risk of the child, the student's educational background, and the region of the educational institution. 20.2% of the students were more invasive when the patient was male. 72.4% and 68.6% were more invasive in children with difficult behavior and high caries risk, respectively. It can be concluded that both patient, student and institution characteristics were able to influence the treatment decision for defective restorations in primary teeth.

Minimum intervention oral care: defining the future of caries management

Abstract It is not uncommon that oral healthcare professionals and researchers interchange the use of the terms minimum/minimal intervention and minimally invasive dentistry. However, these terms apply to two different, but related, concepts. Minimum intervention dentistry, to be more appropriately addressed in this paper as minimum intervention oral care (MIOC), is an oral healthcare delivery framework that encompasses four interlinked clinical domains. These domains are: identifying disease - detection, longitudinal risk/susceptibility assessment, investigation, diagnosis and the development of a personalized care plan; prevention of lesions/control of disease - patient behaviour management, non-invasive remineralisation of the enamel and dentine, biofilm and diet control, micro-invasive sealants and infiltration techniques to arrest and reverse incipient lesions; minimally invasive operative procedures including selective carious dentine removal, the "5Rs" management of the tooth-restoration complex (review, refurbish, re-seal, repair and replace) amongst other restorative interventions; and tailored recall/review/re-assessment consultations. This framework includes that minimally invasive operative dentistry (MID), that although a critical operative clinical domain, should be viewed as one of the pillars of minimum intervention oral healthcare (MIOC), applied across all disciplines of restorative dentistry, not just caries management. The aim of this review is to clarify these differences and emphasize the importance of minimally invasive operative dentistry (MID) within the context of minimum intervention oral care (MIOC). MIOC is applicable to all disciplines within restorative dentistry, including clinical caries management.

Percepción de estudiantes respecto al recambio de restauraciones / Students' perception regarding the replacement of restorations

Introducción: El reemplazo de restauraciones defectuosas representa la mayor parte de la práctica del odontólogo, lo que lleva a una perdida mayor del remanente dentario ante cada reemplazo. Objetivo: Determinar si existe variación del criterio clínico en alumnos frente a la decisión de recambio en restauraciones de resina compuesta previo y posterior al reacondicionamiento. Material y Métodos: Estudio analítico transversal. Se contó con una muestra de 40 estudiantes de quinto año de un universo de 72. Se utilizó un set fotográfico, que contaba con restauraciones defectuosas, en uno o más parámetros según los criterios RYGE/USPHS, las cuales posteriormente se reacondicionaron, por lo que se contaba con las fotografías del antes y del después del tratamiento conservador. Se realizó una encuesta a partir de las fotografías mostradas en la cual debían indicar la elección de tratamiento. Resultados: Se observó que hay una gran variación de elección de tratamiento previo a ser reparadas con tratamientos conservadores: 38 por ciento y no conservador de 62 por ciento y frente a la misma restauración de resina posterior a haber sido intervenida la elección de tratamiento conservador fue de 83 por ciento y no conservador 17 por ciento. Mediante el Test de McNemar se obtuvo un p<0.0001 entre elección de tratamiento conservador por sobre el no conservador posterior a haber sido realizada el reacondicionamiento de la restauración. Conclusiones: Existe un cambio en la percepción sobre la indicación de tratamiento de restauraciones defectuosas, a favor de una alternativa conservadora, después de que han sido intervenidas con procedimientos mínimamente invasivos(AU)

Introduction: The replacement of defective restorations, which leads to a greater loss of the dental remnant before each replacement, represents the large majority of the dentist's practice. Objective: To determine if there is any variation in students´ clinical criterion in relation to the decision of replacement of composite resin restorations prior to and following reconditioning. Material and Methods: A cross-sectional analytical study was conducted. The sample was composed of 40 fifth-year students in a universe of 72. A set of photographs showing defective restorations in one or more parameters evaluated according to RYGE / USPHS criteria was used. They were later reconditioned, so there were photographs prior to and following conservative treatment. Based on the photographs shown, a survey in which they had to indicate the choice of treatment was performed. Results: We observed that there is a great variation in the choice of treatment prior to the repair with conservative treatments (38 percent) and non-conservative ones (62 percent), compared to the same resin restoration after the choice of conservative treatment (83 percent) and non-conservative one (17 percent). Using the McNemar Test, p<0.0001 was obtained between the choice of conservative treatment over the non-conservative one after the restoration reconditioning had been performed. Conclusions: There is a change in perception of the indication of treatment to repair defective restorations towards a conservative alternative after they have undergone minimally invasive procedures(AU)

Recomendaciones sobre la reparación de restauraciones de amalgama / Recommendations about the repair of dental amalgam restorations

Introducción: La reparación de restauraciones de amalgama, los materiales, las caras de los dientes de preferencia para realizarlas y su controversia con la contraparte de realizar reemplazos, es algo que amerita atención por los investigadores para lograr definiciones y protocolos precisos. Objetivo: Sistematizar sobre las recomendaciones de la literatura con respecto a la reparación de restauraciones de amalgama. Métodos: Se realizó una revisión cualitativa. Se plantearon criterios de inclusión y exclusión para la selección de los artículos. La búsqueda se realizó en Scopus y Pubmed. De las investigaciones resultantes de la búsqueda fueron decantados los artículos que no coincidían con el problema de investigación en cuestión, luego los que no cumplían los criterios de inclusión y exclusión. Se realizó una evaluación de la calidad y validez de los artículos seleccionados para ser incluidos en esta investigación y, finalmente, se le dio lectura a los textos completos y resúmenes para extraer los datos necesarios para completar la base de datos de la investigación. Quedaron un total de 27 artículos que fueron tamizados en una base de datos Excel, la que luego se exportó al software SPSS para su procesamiento estadístico. Resultados: El 44,4 por ciento y 55,6 por ciento de los artículos recomiendan reparar las restauraciones con amalgama y resina compuesta, respectivamente. Casi la mitad de los artículos (48,1 por ciento) no precisaron una cara del diente susceptible o no para realizar reparaciones. El 44,4 por ciento concluyen con que es un tratamiento recomendable. Conclusiones: Es recomendable realizar reparaciones de restauraciones de amalgama con amalgama dental y con resina compuesta. No está claramente definido cuál cara del diente es susceptible o no a recibir reparaciones y es un tratamiento que puede formar parte del arsenal terapéutico de los odontólogos(AU)

Introduction: The repair of amalgam restorations, the materials used, the tooth sides preferred to perform them, and the controversy with the replacement option, are all topics deserving the attention of researchers with a view to achieving accurate definitions and protocols. Objective: Systematize the recommendations available in the literature about the repair of amalgam restorations. Methods: A qualitative review was carried out. Inclusion and exclusion criteria were established for the selection of papers. The search was conducted in Scopus and Pubmed. Papers not related to the research problem at hand were the first to be discarded. Then those not meeting the inclusion and exclusion criteria. An evaluation was performed of the quality and validity of the remaining papers, and finally their full texts and abstracts were read to retrieve the data required to complete the database of the study. The 27 papers thus obtained were sifted in an Excel database, which was then exported to the SPSS software for statistical processing. Results: 44.4 percent and 55.6 percent of the papers recommend to repair restorations with amalgam and composite resin, respectively. Almost half (48.1 percent) do not state any preference for a specific tooth side to perform the repair. 44.4 percent recommend the treatment. Conclusions: It is advisable to perform repairs of amalgam restorations with dental amalgam and with composite resin. It is not clearly defined which tooth side is preferred to undergo the repair. This treatment may be part of the therapeutic arsenal of dentists(AU)

Digital photography vs. clinical assessment of resin composite restorations.

PURPOSE: To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Como reparar uma restauração oclusal de resina composta em dentes decíduos? Relato de caso / How to repair an occlusal composite resin restoration on primary teeth? Case report

Frente à necessidade de reintervenção em restaurações insatisfatórias, os clínicos podem, em geral, optar pela substituição ou reparo. Este artigo relata um caso clínico de reparo de uma restauração de resina composta com falha em dente decíduo. Após profilaxia e isolamento relativo, a porção da resina composta a ser reparada foi asperizada com uma ponta diamantada em alta rotação com o intuito de melhorar a união mecânica entre a resina envelhecida e a nova (reparo). Foi realizado o condicionamento com gel de ácido fosfórico a 34% por 15 segundos, seguido de lavagem e secagem. Uma camada do sistema adesivo Single Bond Universal (3M ESPE) foi aplicada ativamente durante 20 segundos, seguido de jato de ar comprimido por 5 segundos e fotoativação por 10 segundos. Por fim, a resina composta fluida (Filtek Z350 XT Flow; 3M ESPE) foi inserida e fotoativada por 20 segundos. A realização de um adequado protocolo clínico envolvendo tratamentos físicos e químicos de superfície é fundamental para a efetividade da intervenção e a manutenção do dente decíduo clinicamente funcional até a esfoliação fisiológica.

Facing need for reintervention in unsatisfactory resto-rations, clinicians may generally choose for replacement or repair. This paper reports a clinical case of repair of a composite resin restoration with failure in primary tooth. After prophylaxis and relative isolation, the portion of the composite resin to be repaired was roughed with a high-speed diamond bur to improve the mechanical bond between the aged and new resin (repair). Conditioning with 34% phosphoric acid gel was performed for 15 seconds, followed by washing and drying. One layer of the adhesive system Single Bond Universal (3M ESPE) was actively applied for 20 seconds and light- cured for 10 seconds. Finally, the flowable composite resin (Filtek Z350 XT Flow; 3M ESPE) was inserted and light-cured for 20 seconds. An adequate clinical protocol involving physical and chemical surface treatments is essential for the effectiveness of the intervention and the main-tenance of the primary tooth clinically functional until physiological exfoliation.

The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial.

Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children's oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov ( NCT03520309) on 9 May 2018.

Does use of silane-containing universal adhesive eliminate the need for silane application in direct composite repair?

Abstract This in vitro study aimed to evaluate the effect of a silane-containing universal adhesive used with or without a silane agent on the repair bond strength between aged and new composites. Forty nanohybrid composite resin blocks were stored in distilled water for 14 d and thermo-cycled. Sandpaper ground, etched, and rinsed speciments were randomly assigned into four experimental groups: silane + two-step etch-and-rinse adhesive system, two-step etch-and-rinse adhesive system, silane + silane-containing universal adhesive system, and silane-containing universal adhesive system. Blocks were repaired using the same composite. After 24 h of water storage, the blocks were sectioned and bonded sticks were submitted to microtensile testing. Ten unaged, non-repaired composite blocks were used as a reference group to evaluate the cohesive strength of the composite. Two-way ANOVA and Tukey's tests were used to analyze average µTBS. One-way ANOVA and Dunnet post-hoc tests were used to compare the cohesive strength values and bond strength obtained in the repaired groups (α = 0.05). The µTBS values were higher for the silane-containing universal adhesive compared to the two-step etch-and-rinse adhesive system (p = 0.002). Silane application improved the repair bond strength (p = 0.03). The repair bond strength ranged from 39.3 to 65.8% of the cohesive strength of the reference group. Using universal silane-containing adhesive improved the repair bond strength of composite resin compared to two-step etch-and-rinse adhesive. However, it still required prior application of a silane agent for best direct composite resin repair outcomes.

Efeito da aplicação de plasma não-térmico atmosférico no reparo de cerâmicas CAD/CAM de matriz resinosa com resina composta / Effect of non-thermal atmospheric plasma application on the resin composite repair of resin matrix CAD/CAM ceramics

O objetivo deste trabalho foi avaliar o efeito do plasma atmosférico não-térmico (PANT), sozinho ou associado ao jateamento ou adesivo, e do tempo de armazenamento em água na resistência de união por cisalhamento (RUC) do reparo de cerâmicas CAD/CAM de matriz resinosa (CMR) com resina composta. Amostras de 14x7x1mm de três CMRs, Enamic (VITA Zahnfabrik), Cerasmart (GC Corp.) e Lava Ultimate (3M Oral Care), foram obtidas e submetidas ao envelhecimento artificial (EQ-UV, Equilam) por 300 horas. Os seguintes tratamentos de superfície foram realizados: (1- Controle) jateamento + silano + adesivo; (2) PANT; (3) PANT + adesivo; (4) jateamento + PANT. Cilindros de resina composta (Spectra Smart, Dentsply Sirona, 1,5 mm diâmetro e altura) foram aderidos às superfícies tratadas e a RUC foi avaliada em uma máquina de ensaio universal (EZ Test, Shimadzu) após 24 horas ou 1 ano de imersão em água, a 37oC (n=10). No geral, o tratamento controle obteve os melhores resultados de RUC, comparado aos grupos tratados com PANT. Houve redução da RUC após 1 ano de imersão em água para a maioria dos grupos, entre eles para o controle do Enamic e Lava Ultimate, enquanto Cerasmart não mostrou redução. O tratamento com PANT, sozinho ou associado a outro tratamento, não foi capaz de aumentar a RUC do reparo das CMRs com resina composta. O tratamento controle parece ser o melhor método de reparo das CMRs, principalmente considerando-se a longevidade do tratamento.

The objective of this study was to evaluate the effect of nonthermal atmospheric plasma (NTAP), alone or combined with sandblasting or adhesive, and water-storage time on the shear bond strength (SBS) of resin composite repair of resin matrix ceramics (RMC). Samples (14x7x1mm) of three RMCs, Enamic (VITA Zahnfabrik), Cerasmart (GC Corp.), and Lava Ultimate (3M Oral Care), were prepared and submitted to artificial aging (EQ-UV, Equilam) for 300 h. The following surface treatments were performed: (1- Control) sandblasting + silane + adhesive; (2) NTAP; (3) NTAP + adhesive; (4) sandblasting + NTAP. Resin composite cylinders (Spectra Smart, Dentsply Sirona, 1,5 mm diameter and height) were bonded to the treated surfaces and the SBS was evaluated in a universal testing machine (EZ Test, Shimadzu) after 24 h or 1 year of water storage, at 37oC (n=10). In general, the control treatment obtained the best SBS results, compared to groups treated with NTAP. There was a decrease in SBS after 1 year of water immersion for most groups, including the control treatment for Enamic and Lava Ultimate, while Cerasmart presented no reduction. The treatment with NTAP alone or combined with another treatment, was not capable of increasing the SBS of resin composite repair to RMCs. Control treatment seems to be the best method for repairing CMRs, mainly considering the treatment longevity.

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

Influência do uso do silano na resistência de união e no padrão de fratura nos reparos da resina indireta Ceramage com a resina direta Filtek Z350 / Influence of silane on bond strength and fracture pattern for indirect resin Ceramage repair with direct resin Filtek Z350

Pouca informação encontra-se disponível sobre a influência dos diferentes tratamentos de superfície das restaurações de resina indireta na resistência de união com as resinas diretas usadas para reparo. O objetivo deste estudo foi avaliar a influência de diferentes técnicas com uso do silano no reparo da resina indireta Ceramage na resistência ao cisalhamento e no padrão de fratura com a resina composta direta Filtek Z350. Blocos de resina composta indireta Ceramage (SHOFU) foram confeccionados e envelhecidos por 3 semanas em água destilada à 37°C. Posteriormente, foram jateados com óxido de alumínio e distribuídos aleatoriamente em 4 grupos de 10. No grupo 1, a superfície da resina Ceramage recebeu o adesivo convencional Adper Single Bond 2 (3M ESPE). No grupo 2 foi aplicado adesivo universal Adper Single Bond Universal (3M ESPE). Nos grupos 3 e 4, foi feita a aplicação do silano Silano Mais (Dentsply Sirona) e dos adesivos convencional e universal respectivamente. Foram confeccionados cilindros de resina composta direta Filtek Z350 (3M ESPE) na superfície da resina indireta Ceramage em todos os espécimes. Em seguida foi feito o teste de cisalhamento na máquina de teste universal (EMIC) após o armazenamento dos espécimes em água destilada à 37°C por 24 horas. O estereomicroscópio foi utilizado para analisar as falhas. A análise estatística foi feita pelo teste estatístico de Kruskal-Wallis. Não houve uma diferença estatisticamente significativa (p>0,05) na resistência de união e no padrão de fratura entre as diferentes técnicas de aplicação do silano no tratamento de superfície. Concluiu-se que o uso do silano pode não ser imprescindível para aumentar a resistência de união do reparo da resina indireta Ceramage com a resina direta Filtek Z350. No entanto, clinicamente é provável que se tenha uma maior chance de sucesso no reparo com a aplicação do silano. (AU)

Just few information is available about the influence of different surface treatments of indirect resin restorations on bond strength to direct resins used for repair. The objective of this study was to evaluate the influence of different techniques with the use of silane on the shear bond strength and fracture pattern of indirect resin Ceramage to Filtek Z350 direct composite resin. Ceramage indirect composite blocks (SHOFU) were made and aged in distilled water at 37 ° C for 3 weeks. Subsequently, they were sandblasted with aluminum oxide and randomly divided into 4 groups of 10. In group 1, the surface of the Ceramage resin received the conventional adhesive Adper Single Bond 2 (3M ESPE). In group 2, Adper Universal Bond universal adhesive (3M ESPE) was applied. In groups 3 and 4, the Silano Mais silane (Dentsply Sirona) and the conventional and universal adhesives were applied respectively. Composite resins cylinder of Filtek Z350 (3M ESPE) were made on the surface of the indirect resin Ceramage in all specimens. The shear test was then performed on the universal test machine (EMIC) after their storage in destilled water at 37°C for 24 hours. The stereomicroscope was used to analyze the fractures. Statistical analysis was done by Kruskal-Wallis test. There were no statistically significant differences (p>0,05) in bond strength values and in fracture pattern between the different techniques of application of silane in surface treatment. It was concluded that the silane coupling agent would not be necessary for repairing indirect resin Ceramage with composte resin Filtek Z350. However, clinically it is likely to have a better chance of successful repair with silane application. (AU)

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study

Abstract The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.