Effects of enamel moistening and repositioning guide color on tooth whitening outcomes: A clinical trial.

This clinical trial investigated the effects of pre-application enamel moistening on the impact of a 37% carbamide peroxide whitener on tooth color changes and the influence of repositioning guide colors. Forty participants were randomly assigned to in-office tooth bleaching with either moistened enamel (experimental) or dry enamel (control). The whitener was applied for 45 min over two sessions. Tooth color was visually measured or assessed using a spectrophotometer with purple or green silicone guides. Tooth bleaching was assessed using CIE76 (ΔEab ) and CIEDE2000 (ΔE00 ) formulas and by whitening and bleaching index score changes. Moistening the enamel did not significantly affect tooth color. However, the guide color choice only impacted tooth color when measured instrumentally. At baseline, the green guide resulted in statistically significantly whiter teeth than the purple guide. Less pronounced differences in the b* coordinate between baseline and final measurements were found using the green guide. The green guide also produced lower ΔEab values and less change in indexes. In conclusion, moistening the enamel did not significantly impact tooth color changes. However, the repositioning guide color influenced the tooth bleaching measured instrumentally, except for ΔE00 .

Influence of a gray background and the illuminant on tooth shade selection.

STATEMENT OF PROBLEM: Visual shade selection in dentistry may be influenced by factors that include the background color and the illuminant. PURPOSE: The purpose of this clinical study was to evaluate the influence of using a gray background and a light-correcting device on visual shade selection. MATERIAL AND METHODS: Two experienced clinicians assessed the incisor color of 30 volunteers using the VITA 3D-MASTER shade guide. Visual analyses were carried out using or not (control) a gray background, with and without (control) a light-correcting device (Smile Lite). Furthermore, the use of a polarizing filter was evaluated. Data from a clinical spectrophotometer were defined as the standard instrumental analysis. The agreement and the similarity (based on the whitening indexes of tabs) were evaluated between instrumental and visual analyses. Statistical testing was conducted through ordinal logistic regression and repeated-measures ANOVA. The Shapiro-Wilk test was used to confirm the data distribution, and homogeneity of variance was assessed with the Levene test (α=.05) RESULTS: The use of Smile Lite resulted in lighter tabs than indicated by the instrumental analysis, and the opposite was observed in its absence. The polarizing filter did not affect the results (P>.05). For similarity, the illuminant improved the results (P<.001). The gray background reduced the differences between visual and instrumental analysis only in the absence of the Smile Lite (P<.001). CONCLUSIONS: The color similarity between visual and instrumental analysis improved with the use of a light-correcting device with or without a polarization filter. A gray background was useful only without the light-correcting device.

Effect of gingival barrier brands on operator perception, cervical adaptation, and patient comfort during in-office tooth bleaching: a randomized clinical trial.

BACKGROUND: Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort. OBJECTIVE: This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort. METHODS: Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05). RESULTS: Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall). CONCLUSIONS: This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality. CLINICAL TRIAL REGISTRATION: The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.

Effectiveness of the pharmacological treatments for sialorrhea in patients with Parkinson's disease: a systematic review and network meta-analysis.

OBJECTIVES: The present systematic review and network meta-analysis of randomized control trials (RCTs) aimed to establish whether there are evidence-based differences in the pharmacological agents used to manage sialorrhea in patients with Parkinson's disease (PD). MATERIAL AND METHODS: The authors searched the databases: MEDLINE via PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library for clinical trials. Unpublished trials were searched on clinicaltrials.gov and the Brazilian Clinical Trials Registry. Means and standard deviations of changes in the salivary flow or drooling reported by participants due to the interventions were recorded. RESULTS: The authors analyzed 13 RCTs. Compared to the placebo, types A and B of the botulinum toxin effectively reduced the salivary flow and the severity or frequency of drooling. However, the network meta-analysis did not differentiate between the botulinum toxin types. Ipratropium bromide and glycopyrrolate did not differ from the placebo. Indirect evidence showed that ipratropium had similar results to those obtained with both types of botulinum toxin. The CINeMA approach estimated the quality of the evidence as very low for all comparisons. CONCLUSION: The best treatment for sialorrhea in patients with PD is not fully elucidated yet. Therefore, more well-conducted randomized clinical trials are required to increase the level of evidence. CLINICAL RELEVANCE: There needs to be more evidence defining the best intervention to treat sialorrhea in patients with PD. However, botulinum toxin types A and B seem to reduce sialorrhea in patients effectively.

Supplementary use of the XP-endo Finisher on postoperative pain in posterior teeth with periapical lesions: a randomized clinical trial.

OBJECTIVE: This study evaluated the effect of the supplementary use of the XP-endo Finisher on postoperative endodontic pain. METHODS: This study was a randomized clinical trial with a parallel design. Ninety-two posterior teeth with necrotic pulps and apical periodontitis were instrumented with a single file (Reciproc) in a reciprocating movement followed or not (control) by additional instrumentation with XP-endo Finisher. Postoperative pain was assessed 24 h, 48 h, 72 h, and 7 days after the endodontic treatment (single session) using a universal pain assessment tool. The pain level was scored as absent, mild, moderate, or severe. The occurrence of sealer extrusion and flare-up was also recorded. Data on postoperative pain were analyzed through chi-square analysis, and the odds ratio was adjusted using a logistic regression model (α = 0.05). RESULTS: Similar levels and risks of postoperative pain were observed for both interventions, regardless of the assessment time. Approximately half of the participants presented any postoperative pain in the first 24 h after the endodontic treatment, and this occurrence reduced by less than 20% after 72 h. The extrusion of root filling material was observed in 36% of cases, and no participant presented flared-up. CONCLUSIONS: The supplementary use of the XP-endo Finisher file did not affect the incidence or level of postoperative pain reported after the endodontic treatment of posterior teeth with periapical lesions. CLINICAL RELEVANCE: The supplementary use of the XP-endo Finisher did not affect postoperative pain following the endodontic treatment of posterior teeth using a single-file reciprocating system. CLINICAL TRIAL REGISTRATION: The study protocol was registered in the Brazilian Clinical Trials Registry under identification number RBR-76w7cj (June 19, 2018).

Impact XP-endo finisher on the 1-year follow-up success of posterior root canal treatments: a randomized clinical trial.

OBJECTIVE: To evaluate the clinical relevance of using the XP-endo Finisher as a supplementary tool to improve the success of root canal treatment of posterior teeth with apical periodontitis, as assessed by 1-year follow-up. METHODS: A randomized clinical trial was conducted with 92 posterior teeth with apical periodontitis. Root canal treatment was performed using a single reciprocating file, with or without the supplementary use of the XP-endo Finisher. The status of apical periodontitis was assessed using the periapical index (PAI) at baseline and 1 year follow-up. Changes on PAI indicated that the lesions were healed, healing, or not healed. Successful treatments were defined as healed or healing lesions without clinical symptoms. Chi-square analysis and logistic regression were used for data analysis (α = 0.05). RESULTS: There was no significant difference in the distribution of healing status between the XP-endo Finisher group and the control group (p = 0.690). The success rates were also similar, with 81% in the XP-endo Finisher group and 78% in the control group. However, gender had a significant impact on success rates, with higher rates observed in females. CONCLUSIONS: The use of the XP-endo Finisher file as a supplementary tool did not affect the success rate of root canal treatment in posterior teeth with apical periodontitis. The findings indicate that the XP-endo Finisher file has limited clinical relevance in improving treatment outcomes for root canal treatment in posterior teeth with apical periodontitis. CLINICAL TRIAL REGISTRATION: The study protocol was registered in the Brazilian Clinical Trials Registry under identification number RBR-76w7cj (June 19, 2018).

The role of interface distance and underlying substrate on the color adjustment potential of single-shade composites.

OBJECTIVE: This study assessed how the distance from the composite interface and the underlying chromatic substrate affect the color adjustment potential (CAP) of two single-shade composites. MATERIALS AND METHODS: Cylinder-shaped specimens were created using Vittra APS Unique (VU), Charisma Diamond One (DO), and a shaded (A3) composite. Some single-shade specimens were surrounded by the A3 composite, forming dual specimens. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. All specimens were positioned at a 45° angle in a viewing booth under illuminant D65, and images were captured with a DSLR camera against gray or A3 backgrounds. Image colors were measured using image processing software and converted to CIELAB coordinates. Color differences (ΔE00 ) between the single-shade composites and the A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens. RESULTS: No clinically significant differences were observed between color measurements obtained from images and the spectrophotometer. CAP was higher for DO compared to VU and increased as the distance from the composite interface decreased and when specimens were positioned against an A3 background. CONCLUSION: The color adjustment potential increased with decreased distance from the composite interface and against a chromatic background. CLINICAL SIGNIFICANCE: Achieving satisfactory color match in restorations using single-shade composites is crucial, and selecting an appropriate underlying substrate is essential. The color adjustment gradually decreases from the restoration margins towards its center.

Is the quality of root canal filling obtained by cone-beam computed tomography associated with periapical lesions? A systematic review and meta-analysis.

AIM: To evaluate the influence of root canal filling quality on periapical lesion status using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The bibliographic search was conducted in electronic databases of PubMed, Embase, Scopus, and Web of Science without restrictions related to the year of publication and language. Inclusion criteria were prospective or retrospective cohort studies that followed periapical pathosis for, at least, 1 year. Three reviewers independently evaluated the eligibility for inclusion, extracted data, and assessed the risk of bias. The quality of the studies was based on the Newcastle-Ottawa Scale. This meta-analysis was performed to evaluate the quality of treatment by the homogeneity and apical extension of the filling. RESULTS: Of the 1179 studies initially recovered, six cohort studies were included, out of which four were considered with a low risk of bias. The results showed that the absence of gaps in the filling reduced the chance of unhealed periapical lesions by 2.39 times (RR = 2.39; 95% CI: 1.62-3.53; p < 0.00001; I2 = 55%). An apical filling extension of 0-2 mm below the apex also contributed significantly to the absence of unhealed periapical lesions (RR = 1.49; 95% CI: 1.15-1.94; p = 0.003; I2 = 2%). CONCLUSION: The homogeneity and apical extension of the filling influenced the presence of unhealed periapical lesions in endodontically treated teeth evaluated using CBCT. CLINICAL RELEVANCE: Apical extension of the filling ranging between 0 and 2 mm short of the apical foramen and the homogeneity of the filling without gaps are directly related to the success rate of root canal treatment.

Color heterogeneity and individual color changes in dentin and enamel bleached in the presence of a metallic orthodontic bracket.

OBJECTIVE: This in-vitro study evaluated the color changes in enamel and dentin bleached in the presence of an orthodontic bracket, as well as the heterogeneity of the color and contribution of each tissue to the color change (CTCC). MATERIALS AND METHODS: Enamel-dentin specimens from extracted bovine teeth were bleached before or after bracket removal or maintained without any treatment (control). The colors of the dentin and enamel were measured individually and after recombining these substrates. The changes in the color (ΔE00 ) and whitening index (ΔWID) were estimated by the color difference between the bleached specimens and those of the control. The CTCC was also calculated by recombining the tissues from different treatments. Images of specimens obtained from a stereomicroscope were used to analyze the color homogeneity within each tissue. RESULTS: The highest values of ΔE00 and ΔWID were observed in the specimens bleached in the absence of a bracket. Bleaching in the presence of a bracket resulted in enamel with a center that was whiter than the periphery. Dentin and enamel presented similar CTCC values. CONCLUSIONS: Tooth bleaching performed in the presence of a metallic bracket resulted in a reduced bleaching effect and increased color heterogeneity within both tissues. CLINICAL SIGNIFICANCE: Tooth bleaching before the orthodontic bracket removal reduces the bleaching effect in both dentin and enamel. Moreover, a heterogeneous color of enamel surface can be observed after tooth bleaching in the presence of a nickel-free metallic orthodontic bracket.

Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study.

OBJECTIVE: To investigate whether patients' skin color could exert an influence on the dentist's decision-making for treatment, in four different cities in Brazil. MATERIAL AND METHODS: Lists of dentists were obtained and the sample selection was performed systematically. Two questionnaires were produced for the same clinical case, but the images were digitally manipulated to obtain a patient with a black and a white skin color. Dentists were free to choose treatment without any restrictions, including the financial aspects. A random sequence (white or black) was generated which was placed at random in sealed, opaque envelopes. Dentists were questioned about the decision on the treatment of a severely decayed tooth and an ill-adapted amalgam restoration. RESULTS: A total of 636 dentists agreed to participate in the study. After adjustments (multinomial logistic regression), it was observed that the black patient with a decayed tooth had a 50% lower risk of being referred for prosthetic treatment (p = 0.023) and a 99% higher risk of receiving a composite resin restoration, compared to the white patient (p = 0.027). No differences were observed regarding recommendation for tooth extraction (p = 0.657). In relation to an ill-adapted amalgam, the black patient had less risk of receiving a referral replacement with composite resin (0.09 95%CI [0.01-0.82]) and finishing and polishing (0.11 5%CI [0.01-0.99]) compared with the white patient. CONCLUSION: Patient skin color influenced the dentist's choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures. CLINICAL SIGNIFICANCE: Skin color played an important role in dentists' treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.

Effects of adhesive used as modeling liquid on the stability of the color and opacity of composites.

OBJECTIVE: This study evaluated the effects of adhesive type used as modeling liquid on the stability of the color and opacity of composites submitted to thermal cycling in staining solutions followed by a bleaching procedure. METHODS: Thirty cylinder-shaped composite specimens (10 mm diameter × 1.5 mm thickness) were built using or not using (control) an adhesive (Adper Universal or Scotchbond Multipurpose) as the modeling liquid. After polishing procedures, the color and opacity were measured, and the specimens were submitted to 200 thermal cycles with 10 s of dwell time in baths of grape juice at 5°C, water at 37°C, and coffee at 55°C. Changes in opacity and color caused by the staining solutions were measured. Then, the specimens were bleached with 35% hydrogen peroxide for 45 minutes followed by color/opacity measurements. Data were analyzed by ANOVA and Tukey's test (α = 0.05). RESULTS: The use of modeling liquids did not affect the initial color and opacity of composite. Reduced changes to color (E00 = 3.44) and opacity (+2.67%) were observed for specimens modeled using Adper Universal. Bleaching procedures reduced the color (E00 = 1.9-3.8) and opacity (-2.3 to 3.1%) alterations caused by staining solutions but were unable to restore the values observed at baseline. CONCLUSION: The use of universal adhesive as modeling liquid significantly reduced the color and opacity changes caused by staining solutions, and the bleaching procedure partially re-established the opacity and color of the composites. CLINICAL SIGNIFICANCE: This study evaluates whether using adhesive systems for modeling a composite affects the color and opacity changes caused by staining solutions followed by a bleaching procedure. The findings suggest that the use of a universal adhesive as modeling liquid can reduce the alterations in optical properties caused by staining solutions, and the application of high-concentrated hydrogen peroxide over the composite reduce the color changes without fully recover the initial color.

An Experimental Thermally Deposited Coating for Improved Bonding to Glass-fiber Posts.

PURPOSE: To determine whether an experimental thermally deposited siloxane-methacrylate coating for use in industrial scale applications would improve the bond strength of resin-based materials to glass fiber posts (GFPs) without affecting their mechanical properties. MATERIALS AND METHODS: An experimental 5% (w/v) solution of methacryloxypropyltrimethoxysilane was prepared. Two types of GFPs (Exacto, Angelus; White Post DC, FGM) were divided into the following groups: S: silane; SA: silane and adhesive; HS: 35% H2O2 and silane; HSA: 35% H2O2, silane and adhesive; Exp: siloxane-methacrylate coating (Si-O) via post immersion in experimental solution followed by heating; Exp-S: silane after Si-O treatment; Exp-A: adhesive after Si-O treatment; and Exp-SA: silane and adhesive after Si-O treatment. The posts were positioned in a mold to allow insertion of a dual-curing resin core, serially sectioned into beams, and subjected to microtensile bond strength (µTSB) testing. The three-point bending test and SEM/EDX analysis were used to assess the mechanical and surface properties of untreated GFPs that were etched with H2O2 or treated with Si-O. RESULTS: Surface treatments affected the µTSB only for the Exacto GFPs. The highest µTBS (MPa) was observed in Exp-S and Exp-SA groups, whereas H2O2 etching resulted in intermediate values. The mechanical properties were not affected by surface treatments. Exacto GFPs had significantly higher flexural strength (σf) and flexural modulus (Ef) than did the White Post DC GFPs, but the latter were significantly stiffer (S) than Exacto, regardless of the surface treatment tested. H2O2 promoted morphological changes in post surfaces. The experimental treatment promoted deposition of Si onto the post surface, improving bond strengths of Exacto posts. CONCLUSION: The proposed novel coating technique is a viable procedure for fiber post manufacturers to improve the µTSB of resin-based materials.

Addition of ammonium-based methacrylates to an experimental dental adhesive for bonding metal brackets: Carious lesion development and bond strength after cariogenic challenge.

INTRODUCTION: In this study, we evaluated the caries inhibition and shear bond strength achieved with the addition of the antibacterial monomer [2-(Methacryloyloxy)ethyl] trimethylammonium chloride (MADQUAT) to an adhesive used to bond orthodontic brackets. METHODS: Experimental adhesives were formulated with addition of 0% (control), 5%, or 10% MADQUAT followed by measurement of the degree of conversion. These adhesives were used to lute brackets to the enamel of premolars (n = 30). Biofilm from a microcosm model was cultivated in half of the specimens under cariogenic challenge for 5 days. The brackets were subjected to a shear bond strength test followed by measurement of the internal hardness of the enamel around the brackets to calculate the integrated mineral loss. RESULTS: The addition of MADQUAT slightly increased the degree of conversion. Adhesive containing 10% MADQUAT significantly reduced the integrated mineral loss around the bracket but also resulted in the lowest values of bond strength. No effects on bond strength and integrated mineral loss were observed with the addition of 5% MADQUAT to the adhesive. The cariogenic challenge did not affect the bond strength and the failure mode. CONCLUSIONS: MADQUAT was effective to reduce the integrated mineral loss only when added to the adhesive at a concentration of 10% despite the reduction of bond strength.

Effect of Dentin Pretreatment on Bond Strength Stability of Self-etching and Etch-and-Rinse Adhesives to Intracoronally Bleached Dentin.

PURPOSE: To evaluate the effect of chlorhexidine or glutaraldehyde pretreatment on the bonding stability of selfetching and etch-and-rinse adhesives to bleached dentin. MATERIALS AND METHODS: The occlusal surface of 80 third molars was abraded to expose a flat mid-dentin surface, which was then subjected to a bleaching procedure using 20% hydrogen peroxide and sodium perborate for 14 days. Afterwards, the specimens were kept in distilled water, followed by application of either a three-step etchand- rinse (Adper Scotchbond Multi-Purpose Plus, SBMP) or a two-step self-etching (Clearfil SE Bond, CSE) adhesive system. For each approach, the bleached dentin was treated with chlorhexidine or glutaraldehyde, or left untreated, prior to the adhesive procedure. Unbleached dentin was used as a control. Composite cylinders were built up over the adhesive-covered dentin followed by parallel sectioning of specimens to obtain 1-mm slices. The slices were trimmed to obtain hourglass-shaped specimens with approximately 1.0 mm2 of bonding interface. Half of the specimens were subjected to microtensile bond strength (µTBS) testing after 24 h, while the other half were stored in distilled water for 3 months prior to the µTBS test. The mode of failure was analyzed using optical microscopy. RESULTS: For the SBMP protocol, the highest µTBS was achieved with glutaraldehyde-treated dentin, and the same µTBS values were maintained after 3 months of storage. For the CSE protocol, the highest µTBS was obtained with chlorhexidine-treated dentin. CONCLUSION: Glutaraldehyde and chlorhexidine pretreatment should be considered to improve the µTBS of adhesives to bleached dentin, while the pretreatment effect was adhesive dependent.

Color discrepancy of single-shade composites at different distances from the interface measured using cell phone images.

Objectives: This study aimed to evaluate the impact of substrate color and interface distance on the color adjustment of 2 single-shade composites, Vittra APS Unique and Charisma Diamond One. Materials and Methods: Dual disc-shaped specimens were created using Vittra APS Unique or Charisma Diamond One as the center composite, surrounded by shaded composites (A1 or A3). Color measurements were taken with a spectrophotometer against a gray background, recording the color coordinates in the CIELAB color space. Illumination with a light-correcting device and image acquisition using a polarizing filter-equipped cell phone were performed on specimens over the same background. Image processing software was used to measure the color coordinates in the center and periphery of the inner composite and in the outer composite. The color data were then converted to CIELAB coordinates and adjusted using data from the spectrophotometer. Color differences (ΔE00) between the center/periphery of single-shade and outer composites were calculated, along with color changes in single-shade composites caused by different outer composites. Color differences for the inner composites surrounded by A1 and A3 were also calculated. Data were analyzed using repeated-measures analysis of variance (α = 0.05). Results: The results showed that color discrepancies were lowest near the interface and when the outer composite was whiter (A1). Additionally, Charisma Diamond One exhibited better color adjustment ability than Vittra APS Unique. Conclusions: Color discrepancies between the investigated single-shade composites diminished towards the interface with the surrounding composite, particularly when the latter exhibited a lighter shade.

Reliability of the color measurement of resin composites using images obtained using a stereoscopic loupe.

This study assessed the reliability of a color measurement method using images obtained from a charge-coupled device (CCD) camera and a stereoscopic loupe. Disc-shaped specimens were created using the composite Filtek Z350 XT (shades DA1, DA2, DA3, and DA4) (n = 3). CIELAB color coordinates of the specimens were measured using the spectrophotometer SP60 over white and black backgrounds. Images of the same specimens were taken using a CCD camera attached to a stereoscopic loupe. The color of the image was measured (red-green-blue [RGB]) using an image processing software and converted to CIELAB coordinates. For each color coordinate, data from images were adjusted using linear regressions predicting those values from SP60. The whiteness index for dentistry (WID) and translucency parameter (TP00) of the specimens as well as the color differences (ΔE00) among pairwise shades were calculated. Data were analyzed via repeated-measures analysis of variance and Tukey's post hoc test (α = 0.05). Images obtained using the loupe tended to be darker and redder than the actual color. Data adjustment resulted in similar WID, ΔE00, and TP00 values to those observed for the spectrophotometer. Differences were observed only for the WID of shade DA3 and ΔE00 for comparing DA1 and DA3 over the black background. However, these differences were not clinically relevant. The use of adjusted data from images taken using a stereoscopic loupe is considered a feasible method for color measurement.

Influence of repositioning guides' color and usage on precision in tooth color measurement with a clinical spectrophotometer.

BACKGROUND: Repositioning guides are commonly employed in clinical studies to ensure consistent tooth color measurements. Yet, their influence on measured color remains uncertain. OBJECTIVE: This study evaluated the impact of repositioning guides' color and usage on tooth color measurement using a clinical spectrophotometer. METHODOLOGY: In total, 18 volunteers participated in this study, in which the color of their upper left central incisor and upper left canine was measured with or without repositioning guides (control). The guides were made from pink, blue, or translucent silicone, as well as an acetate-based bleaching tray. Tooth color was measured in triplicates using a clinical spectrophotometer based on the CIELAB system. The standard deviations of these readings were used to estimate reproducibility, and color differences (ΔE00) between the measurements with guides and the control were calculated. RESULTS: Repositioning guides had a minimal effect on L* values and no effect on b* values. The use of pink silicone increased a* values, whereas blue or translucent silicone reduced them. Irrespective of the evaluated tooth, the lowest ΔE00 values were observed for the translucent silicone and bleaching tray. The usage of guides only affected data variability for the L* color coordinate. CONCLUSION: Using repositioning guides can significantly impact the precision of tooth color measurement with a clinical spectrophotometer.

Effect of Periodontal Instrumentation on Tooth Structure Exposure to Ionizing Radiation: In Vitro Study.

This study aimed to evaluate the effects of different scaling protocols on the morphology and roughness of the root dentin substrate exposure to ionizing radiation. One hundred and thirty extracted bovine incisors were randomly divided into two groups (n=65): non-irradiated (NIR) and irradiated (IR). Each group was initially subdivided into three subgroups according to the type of non-surgical periodontal protocol: NIT: no instrumentation; HS: hand scaling with 15 apical-coronal instrument movements; US: ultrasonic scaling with 15 apical-coronal cycles. Subsequently, all samples were subjected to the prophylaxis protocol, being subdivided into the following groups: NIT/PP: prophylaxis with a fine prophylactic paste using a rubber cup for 15 seconds; HS/PP: Hand scaling followed by the prophylaxis protocol; US/PP: Ultrasonic scaling followed by the prophylaxis protocol. The roughness of the root dentin surface was measured with a profilometer (Ra/Rz - µm), and the morphology of the dentin surfaces was analyzed using scanning electron microscopy (SEM). The analyses were conducted before and after the prophylaxis protocol. In the absence of prophylaxis, the roughest surfaces were observed after ultrasonic instrumentation followed by hand instrumentation for both IR and NIR groups. No difference in Ra and RZ values between HS/PP and US/PP was observed for both substrates. For the IR group, the prophylaxis resulted in similar Ra and RZ values for both instrumentation groups in comparison to no instrumentation. Ordinal logistic regression showed that both HS and US resulted in higher scores than NIT, irrespective of IR presence. In conclusion, the IR showed a rougher root surface for both HS and US in comparison to NIR. However, the prophylaxis procedure significantly reduced the roughness of root surfaces after both instrumentation procedures.

Surrounding and background shades effect on color adjustment of single-shade composites.

This study evaluated the effects of surrounding and background shades on the color adjustment potential (CAP) and visual color match of two single-shade composites, Vittra APS Unique and Charisma Diamond One. Cylinder-shaped specimens were constructed, consisting of either single-shade composites alone (simple) or composites surrounded by the Forma material at shades A1 or A3 (dual). Simple specimens using only the Forma at the specified shades were also prepared. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. For dual specimens, the color of the inner composite was measured against a gray or chromatic (the same shade as the outer composite) background. Color differences (ΔE00) between the single-shade composites and the A1/A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens. Four experienced dentists scored the color match (perfect to unacceptable) for each specimen using a viewing booth illuminated by an illuminant D65. Data were analyzed with repeated-measures ANOVA and the Kruskal-Wallis test. The results showed that both single-shade composites showed the lowest color discrepancies when they were compared to A1 and A3. Using a chromatic background only significantly affected the CAP when the outer composite was A3. The visual analysis showed poor color matches between the single-shade and control chromatic composites, except for Charisma Diamond One surrounded by A1. In conclusion, the CAP values of the evaluated single-shade composites were impacted by both surrounding shade and background color, and the color match of these materials tended to be poor.

Solvent content and dentin bond strengths using water-wet, ethanol-wet and deproteinization bonding techniques.

OBJECTIVES: To evaluate the impact of solvent content in two-step, etch-and-rinse adhesives on the dentin bond strengths obtained via water-wet, ethanol-wet or deproteinization techniques. MATERIALS AND METHODS: A model photocurable Bis-GMA/HEMA blend was diluted in ethanol (7.5, 15 or 30 mass%) or acetone (15, 30 or 60 mass%) (low, medium or high solvent content, respectively). Viscosity of the solutions was measured with an oscillatory viscometer and data analyzed using ANOVA on Ranks (5%). Dentin bond strengths were evaluated using microshear bond test. After acid-etching and rinsing, the dentin was kept wet (water-wet), treated with ascending ethanol concentrations (ethanol-wet) or with 10% NaOCl solution (deproteinization). Composite cylinders built-up on the surfaces for the microshear test. Data from each bonding technique were submitted to two-way ANOVA and Fisher's LSD method (5%). Failure modes were classified under magnification and data analyzed using chi-square tests (5%). RESULTS: Viscosity of ethanol-based agents was remarkably higher than acetone solutions. For the water-wet technique, lower bond strength was observed for the low compared with medium and high ethanol contents. For the ethanol-wet technique, the bond strength for both solvents types was low < medium = high solvent content. For the deproteinization technique, no significant differences were observed among groups. Significant differences in failure modes were observed between the bonding techniques. The ethanol-wet technique had more adhesive failures, whereas the other techniques showed a predominance of mixed failures. CONCLUSIONS: The solvent content may interfere with the dentin bond strengths for the conventional and ethanol bonding techniques.