Effect of mouthwashes on the microhardness of aesthetic composite restorative materials / Efecto de colutorios bucales sobre la dureza del composite empleado en la reparación dental estética

Background: Mouthwashes are increasingly being used worldwide. However, these preparations are known to have a negative impact on composite resin dental restorations. In this study, we aim to evaluate the effect of mouthwashes on the microhardness of such restorations. Methods: Thirty specimens of Tetric NCeram composite were prepared. Each composite specimen was cured for 40 seconds and kept in saline solution for 24 hours at 37 °C. Baseline microhardness of each specimen was recorded using an Innovatest Vickers Micro Hardness Tester. Composite specimens were randomly placed in 20 mL of the selected mouthwashes (Colgate® Plax, Listerine® Teeth & Gum Defence, and Closeup® Antibacterial Mouthwash Cool Breeze) and stored in an incubator for 24 hours at 37 °C. Next, microhardness values were rechecked. pH measurements were recorded for each type of mouthwash using a digital pH meter. Results: Due to the acidic nature of Colgate® and Listerine®, the microhardness of the restorations decreased with these mouthwashes; Listerine® caused the greatest decrease in microhardness and had the lowest pH reading (4.34). For Closeup®, with a neutral pH (7.02), no negative effect on microhardness was found; on the contrary, due to the presence of zinc in this latter mouthwash, an increase of the microhardness was found. Conclusions: We confirm the negative effect of acidic mouthwashes on the microhardness of composite dental restorations.(AU)

Fundamento: El uso de colutorios bucales está aumentando a nivel mundial. Sin embargo, es conocido que afectan negativamente a las reparaciones dentales de composite, por lo que el objetivo de este estudio es evaluar el efecto de los colutorios bucales sobre la microdureza de estas reparaciones. Métodos: Se prepararon treinta muestras de composite Tetric NCeram. Cada muestra compuesta se curó durante 40 segundos y se mantuvo en solución salina durante 24 horas a 37 °C. La microdureza inicial de cada muestra se registró utilizando un probador de microdureza Innovatest Vickers. Las muestras se sumergieron aleatoriamente en 20 mL de los colutorios bucales seleccionados (Colgate® Plax, Listerine® Teeth & Gum Defence y Closeup® Antibacterial Mouthwash Cool Breeze) y se incubaron a 37 °C durante 24 horas. A continuación, se volvieron a comprobar los valores de microdureza. El pH de cada colutorio bucal empleado se midió con un pHmetro digital. Resultados: Debido a la naturaleza ácida de Colgate® y Listerine®, la microdureza de las muestras de composite sumergidas en estos colutorios disminuyó; Listerine® causó la mayor disminución de microdureza y mostró el pH más bajo (4,34). Closeup®, con pH neutro (7,02), no mostró ningún efecto negativo sobre la microdureza; por el contrario, su contenido en zinc aumentó la microdureza de las muestras. Conclusiones: Los colutorios bucales ácidos mostraron un efecto negativo sobre la microdureza de las restauraciones dentales de composite.(AU)

Teaching of composite restoration repair in Brazilian dental schools.

OBJECTIVES: The aim was to investigate aspects of the teaching of restoration repair as a minimally invasive alternative to replacing defective direct composite restorations in undergraduate curricula teaching programs in Brazilian dental schools. METHODS: A 14-item validated survey questionnaire was mailed to directors/coordinators of operative/restorative dentistry teachers of Brazilian Dental Schools. Data were collected on demographic characteristics of the teachers and institutions, together with questions on the teaching of the repair of defective resin-based composite restorations as part of the school curriculum; the rationale behind the teaching; the nature of the teaching (preclinical and/or clinical); how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability and expected longevity of completed repairs. RESULTS: Two hundred and twenty-two (94%) directors/ coordinators of dental curricula in Brazil were contacted. One hundred and thirty-one directors/coordinators (59%) replied, providing the e-mail address from the teacher responsible for the operative/restorative dentistry program in their school. Of these, 104 responded to the questionnaire (79% response rate). Ninety-three (89%) of the participating schools reported teaching composite repairs as an alternative to replacing restorations. Of the theoretical content, 43% was taught at preclinical and clinical levels, whereas most practical experience (53%) was acquired at clinical levels. Eighty-eight schools (95%) reported tooth substance preservation being the main reason for teaching repair techniques. All schools that taught repairs reported high patient acceptability. CONCLUSIONS: The teaching of composite restoration repair as an alternative to restoration replacement is established in undergraduate programs in most of the Brazilian dental schools surveyed. CLINICAL SIGNIFICANCE: The reasons for teaching restoration repair in Brazil were found to be quite unanimous among teachers, especially regarding the preservation of tooth structure. Variations were found in the clinical indications for repair, suggesting the need for further investigations. Monitoring repaired restorations should be encouraged and could contribute to future studies.

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

Reparar ou substituir? quando e como intervir em restaurações defeituosas / Repair or replace? when and how to intervene in defective restorations

A alta prevalência de cárie ao redor do mundo faz com que os tratamentos restauradores figurem entre os procedimentos mais executados pelos cirurgiõesdentistas. Também é bastante comum os profissionais relatarem novas lesões de cárie ao redor das restaurações ou até mesmo fraturas parciais ou totais das mesmas, fatores que podem ser considerados como "falhas" do procedimento restaurador. Diante dessas situações, a maioria dos profissionais entende que é necessário realizar a substituição completa da restauração. No entanto, existem outras técnicas mais conservadoras e que podem ser tão efetivas quanto a substituição/troca, como por exemplo a realização de reparo das restaurações apresentando defeitos. O objetivo deste artigo é apresentar de forma clara e objetiva aos clínicos que se deparam diariamente com este cenário, qual seria o melhor momento para intervir, e quais as alternativas de tratamento, baseadas na melhor evidência científica disponível, a se realizar frente às falhas dos procedimentos restauradores, sempre alinhadas com a filosofia de Mínima Intervenção.

The high prevalence of caries worldwide makes restorative treatments some of the most commonly performed dental treatments. It is pretty common to find new caries lesions around the restorations or even partial or total fractures, factors that can be considered a "failure" for the restorative procedure. In these situations, most professionals understand that it is necessary to replace the restoration, but other more conservative techniques are as effective as a replacement, such as repairing the restorations. This article aims to present a clear and evidence-based when is the best time to intervene and what is the best treatment to be carried out in case of failure of the restorative procedures, in line with Minimal Intervention principles.

Fixed Partial Denture Designed by Combining the Whole 3D Digital Surface Morphology of the Provisional Restoration and Abutment Teeth Surfaces.

We introduce a new digital workflow to fabricate a fixed partial denture (FPD) utilizing the three-dimensional surface morphology of provisional restoration (PR) and abutment teeth. Scanned images of the full maxilla with abutment teeth, full maxilla with PR, and PR alone were superimposed. The surfaces of the final FPD were designed based on the entire morphology of the PR and abutment teeth surfaces. The inner and outer surfaces converged at the margin lines of the abutment teeth. Fine modifications to the final FPD design were performed manually, and the final FPD was fabricated and successfully installed in the patient.

Bone Dimensional Change Following Immediate Implant Placement in Posterior Teeth with CBCT: A 6-Month Prospective Clinical Study.

This prospective clinical study aimed to evaluate the peri-implant hard tissue dimensional change at 6 months of immediate implant placement with bone graft materials in the posterior area using cone-beam computed tomography (CBCT). Twelve dental implants were placed concurrently following tooth extraction in the posterior area and filled with xenograft particles. The CBCT images were taken immediately after surgical procedures and then at 6 months follow-up. To evaluate the hard tissue changes, the vertical and horizontal bone thickness were analyzed and measured using ImageJ software. Paired t-test or Wilcoxon match-pair signed-rank test was done to analyze the changes of hard tissue values at the same level between immediately and 6 months following immediate implant placement. Independent t-test or Mann-Whitney U test was used to analyze the dimensional change in the vertical and horizontal direction in buccal and lingual aspects. The level of significance was set at p value = 0.05. All implants were successfully osseointegrated. At 6 months follow-up, the vertical bone change at the buccal aspect was -0.69 mm and at the lingual aspect -0.39 mm. For horizontal bone thickness, the bone dimensional changes at 0, 1, 5, and 9 mm levels from the implant platform were -0.62 mm, -0.70 mm, -0.24 mm, and -0.22 mm, respectively. A significant bone reduction was observed in all measurement levels during the 6 months after implant placement (p value < 0.05). It was noted that even with bone grafting, a decrease in bone thickness was seen following the immediate implant placement. Therefore, this technique can be an alternative method to place the implant in the posterior area.

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.

Sellado de lesiones de caries: reporte de caso / Selamento de lesões de cárie: relato de caso / Sealing of caries lesions: case report

El objetivo de este estudio fue informar un caso clínico de sellado de lesiones activas de caries, puntuación 5 del Sistema Internacional de Detección y Evaluación de Caries - ICDAS, en los primeros molares permanentes de un chico de 9 años. En el examen clínico, se identificaron lesiones activas, código 5 y 3 en los dientes 16 y 26, respectivamente. Sin embargo, en el examen radiográfico se observó que la lesión del diente 26 también se encontraba en la mitad externa de la dentina. Por lo tanto, ambas lesiones fueron consideradas como código 5. Así, para el sellado de las lesiones, se realizó un tratamiento de intervención mínima, usando sellante resinoso con capa intermedia de adhesivo. Después de 6 meses de acompañamiento, se observó la pérdida de la integridad del sellado del diente 16 realizándose la reparación del mismo; después de un año ambas lesiones estaban inactivas. Por lo tanto, el sellado de las lesiones de caries parece ser adecuado para las lesiones del esmalte que alcanzan la mitad exterior de la dentina

O objetivo deste estudo foi relatar um caso clínico de selamento de lesões de cárie ativas, escore 5 do International Caries Detection and Assessment System- ICDAS, em primeiros molares permanentes de um menino de 9 anos. Ao exame clínico, foram identificadas lesões ativas, escore 5 e 3 nos elementos 16 e 26, respectivamente. Entretanto, no exame radiográfico observou-se que a lesão do dente 26 também estava em metade externa de dentina. Dessa forma, ambas as lesões eram escore 5. O tratamento de mínima intervenção com o selamento das lesões de cárie foi realizado, usando selante resinoso com camada intermediária de adesivo. Em 6 meses de acompanhamento, observou-se perda de integridade do selante no dente 16, sendo realizado o reparo; após um ano, as lesões estavam paralisadas. Portanto, o selamento de lesão de cárie parece ser adequado para lesões em esmalte atingindo metade externa de dentina

The aim of this study was to report a clinical case of sealing active caries lesions, score 5 of the International Caries Detection and Assessment System- ICDAS, in the first permanent molars of a 9-year-old boy. On clinical examination, active lesions were identified, score 5 and 3 in molars 16 and 26, respectively. However, radiographic examination determined that the lesion of tooth 26 was also in the external half of dentin. Thus, both lesions were score 5. The minimal intervention treatment with the sealing of the carious lesions was performed, using resinous sealant with an intermediate layer of adhesive. In 6 months of follow-up, loss of integrity of the sealant was observed on tooth 16, and the repair was carried out; after one year, the lesions were paralyzed. Therefore, the sealing of caries lesions seems to be suitable for enamel lesions reaching the external half of dentin

Effect of Light Sources on Bond Strength of Different Composite Resins Repaired with Bulk-Fill Composite / Efecto del tipo de fuente luz en la resistencia adhesiva de distintas resinas compuestas reparados con una resina bulk-fill

Abstract: The aim of this study was to evaluate and compare the effects of different light sources on shear bond strength when bulk-fill composite was used for the repair of different composite resins. A total of 126 samples made from six resin composites with different properties were aged (thermal-cycling with 5000 cycle), exposed to the same surface treatments and adhesive procedure. Then, they were repaired with a bulk-fill composite. At the polymerization step, each group was divided into three subgroups (n=7) and light cured with a QTH light source for 40s and two different LED light sources for 20s. Subsequently, the specimens were aged in distilled water at 37 ºC for 4 weeks and then subjected to shear bond strength test. Then, the specimens were examined under a stereomicroscope to identify modes of failure and visualized by Scanning Electron Microscope. Data obtained from the study were analyzed using ANOVA and Tukey HSD Test (α=0.05). In all groups, the light curing units had an impact on shear bond strength (p<0.05). Among the study groups, the greatest bond strength values were observed in the specimens repaired using the LED and the specimens repaired with the QTH light curing unit had the lowest bond strength values. It was concluded that the content of composite resins and light curing units may influence bond strength of different composites repaired with the bulk-fill composite.

Resumen: El objetivo de este estudio fue evaluar y comparar los efectos de diferentes fuentes de luz sobre la resistencia de la unión al cizallamiento cuando se utiliza una resina bulk-fill para la reparación de diferentes resinas compuestas. Se envejecieron un total de 126 muestras fabricadas con seis compuestos de resina con diferentes propiedades (ciclo térmico con 5000 ciclos), expuestas a los mismos tratamientos de superficie y procedimiento adhesivo. Luego, fueron reparadas con una resina bulk- fill. En el paso de polimerización, cada grupo fue dividido en tres subgrupos (n=7) y fotopolimerizado con una fuente de luz QTH por 40s y dos fuentes de luz LED por 20s. Posteriormente, los especímenes se envejecieron en agua destilada a 37 ºC durante 4 semanas y luego se sometieron a una prueba de resistencia adhesiva de cizalla. Luego, los especímenes fueron examinados bajo un estereomicroscopio para identificar los modos de falla y visualizados por el Microscopio Electrónico de Barrido. Los datos obtenidos del estudio fueron analizados usando el ANOVA y la prueba Tukey HSD (α=0.05). En todos los grupos, las unidades de fotopolimerización tuvieron un impacto en la fuerza de adhesión al cizallamiento (p<0,05). Entre los grupos de estudio, los mayores valores de fuerza de adhesión se observaron en los especímenes reparados utilizando el LED y los especímenes reparados con la unidad de fotopolimerización QTH tuvieron los valores de fuerza de adhesión más bajos. Se llegó a la conclusión de que el contenido de las resinas compuestas y las unidades de fotopolimerización pueden influir en la fuerza de adhesión de los diferentes compuestos reparados con resinas bulk-fill.

Defective restoration repair or replacement: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Clinicians often encounter defective restorations and are faced with the difficult decision of whether to repair the existing restoration or replace it. METHODS: An electronic survey on repairing or replacing defective restorations was developed to assess how clinicians are making these decisions and the technical aspects considered when making a repair. E-mails containing the survey link were sent to the American Dental Association Clinical Evaluators (ACE) Panel on August 14, 2019, and the survey remained open for 2 weeks. Nonrespondents were sent reminders 1 week after deployment. RESULTS: Approximately 4 of every 5 respondents repair defective restorations. The top 3 conditions for making these repairs were noncarious marginal defects (87%), partial loss or fracture of the restoration (79%), and crown margin repair due to carious lesions (73%). Among respondents who repair defective restorations, almost all repair direct resin composite (98%), whereas approximately one-third do not repair the other restorative materials (that is, amalgam, glass ionomer, and fractured indirect all-ceramic crowns). Resin composite is used most often to repair resin direct composite restorations, and likewise, glass ionomer is used most often to repair glass ionomer restorations. Only 54% of respondents use amalgam to repair amalgam restorations. Surface treatments varied among the 3 available restorations types. CONCLUSIONS: Many dentists are actively making restoration repairs, but choosing clinical scenarios to make these repairs is material dependent. PRACTICAL IMPLICATIONS: The repair of defective restorations is an acceptable and more conservative alternative than restoration replacement, and its success depends on proper case selection, material, and technique.

The use of different adhesive filling material and mass combinations to restore class II cavities under loading and shrinkage effects: a 3D-FEA.

3D tooth models were virtually restored: flowable composite resin + bulk-fill composite (A), glass ionomer cement + bulk-fill composite (B) or adhesive + bulk-fill composite (C). Polymerization shrinkage and masticatory loads were simulated. All models exhibited the highest stress concentration at the enamel-restoration interfaces. A and C showed similar pattern with lower magnitude in A in comparison to C. B showed lower stress in dentine and C the highest cusps displacement. The use of glass ionomer cement or flowable composite resin in combination with a bulk-fill composite improved the biomechanical behavior of deep class II MO cavities.

Challenges in diagnosing and managing non-cavitated occlusal caries lesions. A Literature overview and a report of a case.

AIM: Aim of this literature overview was to analyze the diagnostic procedures of hidden caries lesions and to present a restorative protocol. METHODS: A literature overview was performed in order to evaluate hidden caries etiological hypothesis and the reported prevalence. The diagnostic procedure is performed with the aid of an intra-oral fluorescence based camera and the restorative procedure is completed with the use of a novel bisphenol-A free composite. RESULTS: Non cavitated occlusal caries lesions prevalence is high in young adults population. Diagnosis of hidden caries requires both high sensitivity and specificity. CONCLUSIONS: The novel diagnostic and restorative protocol showed to be highly effective in hidden caries assessment and restoration.

Machinability of Zirconia Toughened Mica Glass Ceramics for Dental Restorations / Usinabilidade de cerâmica de vidro de mica temperada com zircônia para restaurações dentárias

Objective: For a dental material to be machinable for CAD/CAM technology, it must offer convenient machining, under a given set of cutting conditions. Quantitative evaluation of machinability has been assessed in literature through various parameters such as tool wear, penetration rates, surface roughness, cutting force and power. A machinable ceramic will typically demonstrate a higher tool penetration rate with signs of reduced diamond tool wear and edge chipping. The purpose of this in vitro study was to evaluate the feasibility of machining an experimental ceramic, 20 wt.% zirconia reinforced mica glass ceramics (G20Z) for indirect dental restorations and compare the tool penetration rates of G20Z to commercially available dental ceramics, Presintered Zirconia (PSZ) and IPS emax CAD. Material and Methods: Precursors of base glass (SiO2 -Al2O3 -K2O -MgO-B2O3 -F) were melted at 15000C for 2 h in a platinum crucible and quenched in deionised water. The glass frit was ball milled with 20 wt. % YSZ (G20Z) and subject to two stage heat treatment in a muffle furnace. Specimens of G20Z (12 X 2 mm) were evaluated for their feasibility of machining under varying spindle speed, depth of cut, and feed rates. Influence of depth of cut, spindle speed and feed rate (vc=8000-16000 rpm, d=0.4-0.8 mm, f=0.1- 0.3 mm/tooth) on cutting forces, material response, surface roughness and tool wear were investigated. Tool penetration rates, tool wear and margin chipping were also evaluated and compared with Pre-sintered Zirconia (PSZ) and e.max CAD in a custom dental milling surveyor at 30,000 rpm with a load of 0.98 N under water lubrication for 6 min. Tool penetration rates were calculated as the ratio of length of cut and milling time with a measuring microscope and scanning electron microscope was used for tool wear and edge chipping. ANOVA and Tukey Kramer tests were used for statistically comparing the means of each group. Results: Spindle speed and feed rate play a significant role in influencing surface roughness, thrust force, cutting forces and tool wear. Penetration rates of G20Z (0.32 ±0.12 mm/min) was significantly greater than PSZ (0.26 ±0.06 mm/min) and IPS e.max CAD (0.21 ±0.05 mm/min). SEM observations reveal tool abrasion and edge chipping regardless of the ceramic type. Conclusion: High spindle speeds delivers low cutting forces with an average surface roughness of 1.61 µm, with abrasive wear of the tool insert and brittle fracture of zirconia mica glass ceramic composites. G20Z with its machinable nature demonstrates greater tool penetration rates than PSZ and IPS e.max CAD. Tool wear and edge chipping is seen in all the investigated ceramics. (AU)

Objetivo: Para que um material odontológico seja usinável para a tecnologia CAD / CAM, ele deve oferecer uma usinagem conveniente, sob um determinado conjunto de condições de corte. A avaliação quantitativa da usinabilidade tem sido avaliada na literatura por meio de vários parâmetros, como desgaste da ferramenta, taxas de penetração, rugosidade da superfície, força de corte e potência. Uma cerâmica usinável normalmente demonstrará uma maior taxa de penetração da ferramenta com sinais de desgaste reduzido da ferramenta de diamante e lascamento da borda. O objetivo deste estudo in vitro foi avaliar a viabilidade da usinagem de uma cerâmica experimental, 20% em peso de cerâmica de vidro de mica reforçada com zircônia (G20Z) para restaurações dentárias indiretas e comparar as taxas de penetração da ferramenta de G20Z com as cerâmicas dentais comercialmente disponíveis, Zircônia Presinterizada (PSZ) e IPS emax CAD. Material e Métodos: Precursores de vidro base (SiO2-Al2O3-K2O -MgO-B2O3 -F) foram fundidos a 15000C por 2 h em um cadinho de platina e temperados em água deionizada. A frita de vidro foi moída com 20% em peso de YSZ (G20Z) e submetida a tratamento térmico em duas fases em mufla. Amostras de G20Z (12 x 2 mm) foram avaliadas quanto à sua viabilidade de usinagem sob variação de velocidade do fuso, profundidade de corte e taxas de avanço. A influência da profundidade de corte, velocidade do fuso e taxa de avanço (vc = 8000-16000 rpm, d = 0,4-0,8 mm, f = 0,1- 0,3 mm / dente) nas forças de corte, resposta do material, rugosidade da superfície e desgaste da ferramenta foram investigadas. As taxas de penetração da ferramenta, o desgaste da ferramenta e o lascamento da margem também foram avaliados e comparados com Zircônia pré-sinterizada (PSZ) e e.max CAD em um topógrafo de fresamento dentário personalizado a 30.000 rpm com uma carga de 0,98 N de lubrificação subaquática por 6 min. As taxas de penetração da ferramenta foram calculadas como a razão entre o comprimento de corte e o tempo de fresamento com um microscópio de medição e um microscópio eletrônico de varredura foi usado para o desgaste da ferramenta e lascamento da borda. Os testes ANOVA e Tukey Kramer foram usados para comparar estatisticamente as médias de cada grupo. Resultados: a velocidade do fuso e a taxa de avanço desempenham um papel significativo em influenciar a rugosidade da superfície, força de impulso, forças de corte e desgaste da ferramenta. As taxas de penetração de G20Z (0,32 ± 0,12 mm / min) foram significativamente maiores do que PSZ (0,26 ± 0,06 mm / min) e IPS e.max CAD (0,21 ± 0,05 mm / min). As observações do SEM revelam a abrasão da ferramenta e o lascamento da borda, independentemente do tipo de cerâmica. Conclusão: As altas velocidades do fuso proporcionam baixas forças de corte com uma rugosidade superficial média de 1,61 µm, com desgaste abrasivo do inserto da ferramenta e fratura frágil de compósitos de cerâmica de vidro de zircônia. G20Z com sua natureza usinável demonstra maiores taxas de penetração da ferramenta do que PSZ e IPS e.max CAD. O desgaste da ferramenta e o lascamento da borda são vistos em todas as cerâmicas investigadas. (AU)

Reparación comparada con reemplazo de restauraciones directas posteriores defectuosas en pacientes con dentición permanente / Repair versus complete replacement for defective direct restorations in permanent teeth

RESUMEN: Introducción: Las restauraciones directas posteriores defectuosas han sido tratadas tradicionalmente a través del reemplazo de la restauración. Sin embargo, por las posibles complicaciones de este procedimiento, la reparación de las restauraciones ha sido ampliamente utilizado en la práctica clínica, pero su uso sigue siendo controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos una revisión sistemática que incluyó nueve estudios primarios, todos correspondientes a ensayos aleatorizados. Como conclusión podemos señalar que la reparación comparado con el reemplazo de restauraciones directas posteriores defectuosas podría aumentar el riesgo de necesidad de reintervención, podría resultar en poca o nula diferencia en el riesgo de sensibilidad postoperatoria y podría aumentar el riesgo de caries secundaria, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Traditionally, restoration replacement has been widely used for the treatment of defective restorations in permanent teeth. Due to complications related to total replacement, restoration repair has been incorporated into dental practice. However, the use of repair over replacement for defective restorations is still controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified one systematic review including nine studies overall, of which all were randomized trials. We conclude that repair versus complete replacement may improve the risk of reintervention, may make little or no difference to risk of postoperative sensibility and may improve the risk of secondary caries, but the certainty of the evidence has been assessed as low.

Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study.

BACKGROUND: Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks. METHODS: Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar-containing liquid medication, in adults with IDs compared with age-sex-neighbourhood deprivation-matched general population controls. RESULTS: A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar-containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]). CONCLUSION: Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead.

Inverse gas chromatography in the examination of adhesion between tooth hard tissues and restorative dental materials.

The adhesion is a crucial issue in the bonding of dental restorative materials to tooth hard tissues. A strong and durable bond between artificial and natural materials is responsible for the success of the restoration in the oral cavity; therefore it has to be thoroughly examined before new restorative material is introduced to the market and used clinically. Among all methods used to examine bonding strength, most of them require a large number of healthy teeth to be conducted. In this paper, the bond strength between tooth hard tissues (dentin and enamel) and an exemplary restorative composite was examined with the non-conventional method, i.e. inverse gas chromatography. Dentin and enamel from bovine teeth were separated and subjected to the standard preparation procedure using the 3-component etch-and-rinse commercial bonding system. Tissues, as well as commercial restorative composite, were examined using inverse gas chromatography. The work of adhesion between dentin/enamel and composite was calculated. Obtained results were compared with the values of shear bond strength of six configurations, i.e. etched dentin/enamel-composite, primed dentin/enamel-composite, and bonded dentin/enamel-composite. All obtained results proved that there is a correlation between the values describing bond strength obtained from inverse gas chromatography and direct mechanical tests (shear bond strength tests). It proves that inverse gas chromatography is a powerful perspective tool for the examination of bond strength between tooth hard tissues and potential dental materials without using a large number of health tooth tissues.

Clinical and radiographic comparative study to evaluate the efficacy of restoring destroyed primary incisors using two different techniques-A pilot study.

OBJECTIVE: The restoration of destroyed maxillary primary incisors is difficult because of the insufficient amount of coronal structure. This pilot study aimed to compare the efficacy of composite posts technique and glass fiber posts technique in restoring destroyed primary incisors. MATERIALS AND METHODS: Thirty-six destroyed maxillary primary incisors in 11 children with early childhood caries were randomly assigned after endodontic treatment into two groups: glass fiber posts (n = 18) and composite resin posts (n = 18). Blinded clinical evaluation was made at 3, 6, 9, and 12 months and Blinded radiographic evaluation was made at 6 and 12 months. The evaluation was according to the FDI criteria. Data were analyzed with Fisher's exact test (α = .05). RESULT: After 12 months post-treatment, the success rates were 88.2% in glass fiber posts group and 70.6% in composite resin posts group. There was no statistically significant difference between the two groups according to the evaluation criteria (p-value >.05). CONCLUSION: Glass fiber posts technique and Composite posts technique may be used in the restoration of destroyed primary incisors.

Clinical efficacy of ceramic versus resin-based composite endocrowns in Chinese adults: study protocol for a randomized controlled trial.

BACKGROUND: Endocrown restoration is widely used to restore endodontically treated teeth. However, the clinical effects of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials for endocrown restoration are not clear. The primary objective of this trial is to compare the clinical efficacy of resin-based bloc and ceramic endocrowns for restoring endodontically treated teeth. METHODS: The proposed resin-based bloc and ceramic endocrown assessment trial is a parallel group-designed randomized controlled trial. We will recruit 156 adults between 18 and 75 years old with a minimum of one such molar. The inclusion criteria were good oral hygiene habits, root apex of molar without evident damage, receipt of standard endodontic treatment, need for endocrown restoration, and only one endocrown restoration performed per patient. Patients participating in another study or those with systemic diseases, disabilities, or known allergies to used materials will be excluded. All patients will be randomized and restored with resin-based bloc and ceramic endocrown according to a random number table. Clinical evaluations will be performed at baseline and after treatment at 6, 12, and 24 months, in accordance with the modified Federation Dentaire Internationale (FDI) criteria, by two independent evaluators. The primary outcome is marginal adaptation; secondary outcomes include wear, tooth integrity, fracture of material and retention, marginal staining, and patient view. All data will be analyzed by an independent statistician. Signed rank-sum tests will be used for intragroup comparisons. Wilcoxon rank-sum tests will be used for intergroup comparisons. Hierarchical logistic regression will be used to adjust the baseline and other important indicators. DISCUSSION: This study will investigate endocrowns of two CAD/CAM materials for endodontically treated molars. The results may help clinicians choose the better CAD/CAM material option and explain to patients the advantages and disadvantages of these two materials with evidence-based support. For patients, the results may lead to improvement in long-term restoration. TRIAL REGISTRATION: ClinicalTrials.gov NCT04033380. Registered on 24 July 2019.

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.