A protocol for an overview of systematic reviews to map photodynamic inactivation evidence in different dental specialties.

This is a protocol for an overview to summarize the findings of Systematic Reviews (SR) dealing with Photodynamic Inactivation (PDI) for control of oral diseases. Specific variables of oral infectious will be considered as outcomes, according to dental specialty. Cochrane Database of Systematic Reviews (CDSR), MEDLINE, LILACS, Embase, and Epistemonikos will be searched, as well as reference lists. A search strategy was developed for each database using only terms related to the intervention (PDI) aiming to maximize sensitivity. After checking for duplicate entries, selection of reviews will be performed in a two-stage technique: two authors will independently screening titles and abstracts, and then full texts will be assessed for inclusion/exclusion criteria. Any disagreement will be resolved through discussion and/or consultation with a third reviewer. Data will be extracted following the recommendations in Chapter V of Cochrane Handbook and using an electronic pre-specified form. The evaluation of the methodological quality and risk of bias (RoB) of the SR included will be carried out using the AMSTAR 2 and ROBIS. Narrative summaries of relevant results from the individual SR will be carried out and displayed in tables and figures. A specific summary will focus on PDI parameters and study designs, such as the type and concentration of photosensitizer, pre-irradiation time, irradiation dosimetry, and infection or microbiological models, to identify the PDI protocols with clinical potential. We will summarize the quantitative results of the SRs narratively.

Effectiveness of Fluoride Varnishes for White Spot Lesion Prevention and Remineralization during Orthodontic Treatment: A Randomized Controlled Trial.

INTRODUCTION: This study investigated the effectiveness of titanium tetrafluoride (TiF4) varnish compared to sodium fluoride (NaF) varnish for preventing and remineralizing white spot lesions (WSLs) in individuals undergoing orthodontic treatment. METHODS: This randomized, placebo-controlled, and double-blinded study was conducted with sixty-five adolescents who were selected based on caries activity and then randomized into three parallel groups: G1 (placebo varnish), G2 (5%-NaF varnish) and G3 (4%-TiF4 varnish). Volunteers received varnish application weekly for the first 4 weeks, after 6 (T1) and 12 (T2) months. The measured outcomes included: prevention of new WSLs, and reversal/progression of WSLs, assessed by Nyvad and ICDAS indices, as well as quantitative light-induced fluorescence (QLF). Chi-square, ANOVA, and Kruskall-Wallis tests were applied. The level of significance was set at 0.05, and post hoc Bonferroni test for p values were performed to correct for multiple comparisons. RESULTS: 1,274 teeth were included; 70.5% were Nyvad 0, and 29.5% were Nyvad 1, with no differences between the groups at baseline (T0). Regarding ICDAS, 70.5% were ICDAS 0, 21.6% were ICDAS 1, and 7.9% were ICDAS 2. G1 showed an increasing prevalence of WSLs at T1 and maintained stable at T2; G2 exhibited a decline at T2, while G3 experienced a decrease at T1 and T2 (p < 0.01). Incidence of WSLs at T2 was 10.2% (G1), 5.6% (G2) and 1.4% (G3). The percentage of teeth initially scored as Nyvad 0 that progressed to Nyvad 1 was 13%, 6.8%, and 1% for G1, G2, and G3, respectively. Conversely, the percentage of teeth initially scored as Nyvad 1 that regressed to Nyvad 0 or Nyvad 2 (T0-T2) was 14%, 49.3%, and 74.4%, respectively (p < 0.001). As for ICDAS index, regression was observed in 6.5%, 17.8% and 24%, while progression was observed in 14.9%, 7.7% and 0.9% for G1, G2 and G3, respectively (p < 0.001). Significant differences among the 3 groups for integrated fluorescence loss (mean±SD, G1: -14.28±9.47, G2: -11.10±11.49 and G3: -6.77±11.00) were found at T2 (p < 0.01). CONCLUSION: Both varnishes demonstrated the ability to prevent and remineralize WSLs. However, TiF4 varnish exhibited the most effective control over WSLs during the 12-month orthodontic treatment.

Biological response to endodontic treatment in one versus two-visit: a systematic review and meta-analysis of animal studies.

OBJECTIVES: To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits. MATERIALS AND METHODS: This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR). RESULTS: Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025). CONCLUSIONS: When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics. CLINICAL RELEVANCE: A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries.

OBJECTIVE: Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. METHODS: A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. RESULTS: When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167). CONCLUSION: Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. CLINICAL RELEVANCE: The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial.

INTRODUCTION: Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method. MATERIALS AND METHODS: This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05). RESULTS: There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570). CONCLUSION: The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.

Brazilian undergraduates' and dentists' knowledge on preventing, diagnosing and managing dentin hypersensitivity: A cross-sectional questionnaire study.

OBJECTIVES: To analyse the knowledge of dental undergraduates and dentists on the prevention, diagnosis and management of dentin hypersensitivity (DH); to compare their knowledge scores; and to understand the related variables using a regression model. METHODS: An original online questionnaire investigated the attitudes, self-reported knowledge ('how much they thought they knew') and real knowledge ('how much they really knew') of 132 students and 338 dentists. Data were analysed descriptively, both knowledge scores were compared using Mann-Whitney and Wilcoxon signed-rank tests and data were subjected to two multiple linear regression analyses considering real knowledge scores as the dependent variable (α < 0.05). RESULTS: The self-reported knowledge on DH was higher than the real knowledge for both students and dentists, but dentists presented the highest scores. Gingival recession and acidic diet were reported as the main predisposing factors for DH by undergraduates and dentists. Students normally managed DH with dietary and hygiene instructions followed by a desensitizing agent application, while dentists managed with occlusal adjustments. The mechanism of glutaraldehyde/HEMA and bioactive fillers on DH is widely unknown by students and dentists. The majority of the questioned individuals cannot differentiate DH from sensitivity of caries or molar-incisor hypomineralization. CONCLUSION: Both students and dentists overestimate their knowledge of DH, revealing deficiencies in prevention, diagnosis and management. Students' knowledge improves towards the end of the Dentistry course, while younger dentists and PhD holders are more knowledgeable. Institutions should implement ongoing DH education for undergraduates and conduct interventions for experienced professionals, especially older ones.

CLINICAL EFFICACY OF PHOTODYNAMIC THERAPY IN MANAGEMENT OF ORAL POTENTIALLY MALIGNANT DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVES: Despite phototherapy (in the form of photodynamic therapy (PDT)-mediated oxidative stress) being utilized in the management of oral potentially malignant disorders (OPMDs), the evidence of certainty remains unclear. Hence, this systematic review and meta-analysis (PROSPERO # CRD42021218748) is aimed to evaluate the clinical efficacy of PDT-induced oxidative stress in OPMDs METHODS: PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched without restriction of language or year of publication. In addition, gray literature was searched and a manual search was performed. Two independent reviewers screened all the studies, assessing data extraction, risk of bias and certainty of evidence. A narrative synthesis was carried out. For the meta-analysis, random effects were considered to determine the prevalence of a total and a partial remission (PR) of oral potentially malignant disorders (OPMDs). The certainty of evidence was explored using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-three studies were included in the qualitative and quantitative syntheses. A total of 880 patients were included (564 males; 218 females) with an age range between 24 and 89-years-old. The results showed the prevalence of the total and partial remissions respectively for the following OPMLs: actinic cheilitis (AC): 69.9% and 2.4%; oral leukoplakia (OL): 44% and 36.9%; oral verrucous hyperplasia (OVH): 98.5%; oral erythroleukoplakia (OEL): 92.1% and 7.9%. The prevalence of no remission of OL was 18.8%. CONCLUSIONS: PDT demonstrated significant results in clinical remission of OPMDs and most of the eligible studies have shown a total or a partial remission of the included lesions, but at a low or a very low certainty of evidence. Hence, further clinical studies with robust methodology are warranted to offer further validated data. Also, further evidence is required to understand further the mechanism of PDT-induced oxidative stress.

Solutions Containing a Statherin-Derived Peptide Reduce Enamel Erosion in vitro.

The effect of solutions containing a statherin-derived peptide (Stn15pSpS) on the protection against enamel erosion in vitro was evaluated. Bovine enamel specimens were divided into 4 groups (n = 15/group): (1) deionized water (negative control), (2) Elmex Erosion Protection™ (positive control), (3) 1.88 × 10-5 M Stn15pSpS, and (4) 3.76 × 10-5 M Stn15pSpS. The solutions were applied on the specimens for 1 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH-cycling protocol 4 times/day, for 7 days (0.01 M HCl pH 2.0/45 s, artificial saliva/2 h, and artificial saliva overnight). The solutions were applied again during pH-cycling, 2 times/day for 1 min after the first and last erosive challenges. Enamel loss (µm) was assessed by contact profilometry. Data were analyzed by Kruskal-Wallis and Dunn's test (p < 0.05). The best protection against erosion was conferred by Elmex Erosion Protection that significantly differed from all the other treatments, followed by the solutions containing Stn15pSpS, regardless of the concentration. However, 3.76 × 10-5 M Stn15pSpS did not differ from the negative control. The solution containing the lower concentration of Stn15pSpS protected against erosion in vitro, which should be confirmed using protocols that more closely resemble the clinical condition.

Polymorphisms in hormonal-related genes might be associated with variations in permanent tooth crown size.

BACKGROUND: The variability in tooth crown size (TCS) is influenced by genetic factors and might be regulated by the difference in hormonal response. MATERIALS AND METHODS: This study aimed to evaluate the association between variations in TCS of permanent teeth with associated factors and genetic polymorphisms in hormonal-related genes (ESR1, ESR2 and PTH). This cross-sectional study involved dental casts from 86 individuals of both sexes. Dental casts were used to determine the maximum TCS of all fully erupted permanent teeth (except third molars) in the mesiodistal (MD) and buccolingual (BL) dimensions. Data such as sex, ethnicity, dental group (incisor, canine, premolar and molar), dental arch (upper and lower) and genetic polymorphisms of hormonal-related genes were used. The DNA from each patient was collected to evaluate the genetic polymorphisms in ESR1 (rs2234693 and rs9340799), ESR2 (rs1256049 and rs4986938) and PTH (rs694, rs6256 and rs307247) through real-time PCR. The data were submitted to statistical analysis with a significance level of 0.05. RESULTS: In the MD dimension, the sex, dental group and dental arch were associated with variation in TCS (P < .05). In the BL dimension, the sex, dental group, dental arch and polymorphism in rs694 and rs307247 were associated with variation in TCS. CONCLUSIONS: In short, this study suggests that genetic polymorphisms of PTH are associated with variations in the BL TCS of permanent human teeth.

Effects of oral administration of Bifidobacterium animalis subsp. lactis HN019 on the treatment of plaque-induced generalized gingivitis.

OBJECTIVES: This double-blind, randomized, placebo-controlled clinical trial evaluated the adjuvant effects of Bifidobacterium lactis HN019 on the treatment of plaque-induced generalized gingivitis. MATERIALS AND METHODS: Sixty patients were submitted to professional supragingival scaling and prophylaxis. They were randomly assigned to test (probiotic lozenges containing B. lactis HN019, n = 30) or control (placebo lozenges, n = 30) groups. Lozenges were consumed twice a day for 8 weeks. Bleeding on probing (BoP), Gingival Index (GI), Plaque Index (PI), probing depth (PD), and clinical attachment level (CAL) were evaluated at baseline and after 2 and 8 weeks. Gingival crevicular fluid (GCF) was collected at baseline and at 8 weeks for analysis of the inflammatory mediators IL-1ß, IL-1α, IL-8, MCP-1, and MIP-1ß. Data were statistically analyzed (p < 0.05). RESULTS: After 8 weeks, both groups showed reduction in the percentage of PI, with no significant difference between groups (p = 0.7423). The test group presented a lower percentage of BoP and a higher percentage of sites with GI ≤ 1 when compared with the control group at the end of the study (p < 0.0001). At 8 weeks, the test group had a greater number of patients without generalized gingivitis than the control group (20 and 11 patients, respectively; p < 0.05). The test group presented significantly lower levels of IL-1α, IL-1ß, and MCP-1 in GCF than the control group at the end of the study (p < 0.05). CONCLUSION: The adjunct use of B. lactis HN019 promotes additional clinical and immunological benefits in the treatment of generalized gingivitis. CLINICAL RELEVANCE: B. lactis HN019 can be an efficient and side-effect-free adjunct strategy in the treatment of generalized gingivitis.

Comparison between two molar incisor hypomineralization detection criteria in epidemiological surveys.

BACKGROUND: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. AIM: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH-Severity Scoring System (MIH-SSS) in classifying and diagnosing MIH. DESIGN: This cross-sectional study assessed the indices in a homogeneous group of 680 6- to 10-year-old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. RESULTS: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH-SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH-SSS (chi-squared test; p < .01). The MIH-SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p < .05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. CONCLUSION: All systems effectively diagnosed MIH and its characteristics.

Burnout and quality of life in nursing staff during the COVID-19 pandemic.

OBJECTIVE: To investigate the association between burnout and quality of life among nursing staff at intensive care units during the new coronavirus pandemic and identify the influence of sociodemographic variables. METHODS: A cross-sectional study was conducted with 109 nursing staff members at intensive care units of a public hospital in Brazil. Data collection involved the administration of a sociodemographic questionnaire as well as the WHOQOL-Bref and Oldenburg Burnout Inventory. RESULTS: The participants presented a high state of burnout and a low score in the physical domain of the quality-of-life instrument. Men (p = 0.037), income (p = 0.011) and burnout (p < 0.001) independently influenced quality-of-life (p < 0.01). Age, being a nursing technician and working at two hospitals exerted an influence on burnout status (p < 0.05). A negative association was found between quality of life and burnout (p < 0.01). CONCLUSION: Our findings showed that burnout due to occupational circumstances affected negatively the quality of life perceptions of nursing staff working at intensive care units during the COVID-19 pandemic.

Effect of thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites.

This study evaluated the effect of the material thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites. Six commercial composites were selected based on their different technologies: Two conventional (C1, C2), two high-viscosity bulk-fill (HVB1, HVB2), and two low-viscosity bulk-fill (LVB1, LVB2). Shrinkage stress was analyzed for five specimens with 2 mm thickness (C-factor 0.75 and volume 24 mm3 ) and five specimens with 4 mm thickness (C-factor 0.375 and volume 48 mm3 ) for 300 s in a universal testing machine. Bottom-to-top hardness ratio values were obtained from Knoop microhardness measurements in specimens with 2- and 4-mm thickness (n = 5). Thickness increase resulted in significantly higher shrinkage stress for all materials with the exception of HVB2 and LVB1. C1, C2, HVB2, and LVB1 showed lower bottom-to-top hardness ratios at 4 mm than at 2 mm. Only LVB2 presented a bottom-to-top hardness ratio lower than 80% at 2 mm, while HVB1 surpassed this threshold at 4 mm of depth. The results suggest that the increase of composite thickness affected the shrinkage stress values. Also, thickness increase resulted in lower bottom-to-top hardness ratio. HVB1 showed better behavior than other bulk-fill materials, with low stress and adequate bottom-to-top hardness ratio at 4 mm thickness.

Solutions and Gels Containing a Sugarcane-Derived Cystatin (CaneCPI-5) Reduce Enamel and Dentin Erosion in vitro.

The effect of solutions and gels containing a sugarcane-derived cystatin (CaneCPI-5) on the protection against enamel and dentin erosion in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 135 and 153/group for enamel and dentin, respectively) that were treated with solutions or chitosan gels containing 0.1 or 0.25 mg/mL CaneCPI-5. The positive controls for solutions and gels were Elmex Erosion Protection™ solution and NaF gel (12,300 ppm F), respectively. Deionized water and chitosan gel served as controls, respectively. The solutions were first applied on the specimens for 1 min and the gels for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.1% citric acid pH 2.5/90 s, artificial saliva/2 h, and artificial saliva overnight). The solutions and gels were applied again during pH cycling, 2 times/day for 1 min and 4 min, respectively, after the first and last erosive challenges. Enamel and dentin losses (µm) were assessed by contact profilometry. Data were analyzed by 2-way ANOVA and Tukey's test (p < 0.05). All the treatments significantly reduced enamel and dentin loss in comparison with controls. Both CaneCPI-5 concentrations had a similar protective effect against enamel erosion, but only the higher concentration was as effective against dentin erosion as the positive control. Regarding the vehicles, only the 0.1 mg/mL gel performed worse than the positive control for dentin. CaneCPI-5 reduced enamel and dentin erosion to a similar extent as the fluoride-containing vehicles. However, dentin requires higher CaneCPI-5 concentrations, in the case of gels. Solutions or gels containing CaneCPI-5 might be a new approach to protect against dental erosion.

A case-control study of oral diseases and quality of life in individuals with rheumatoid arthritis and systemic lupus erythematosus.

OBJECTIVE: To evaluate the impact of oral alterations on the quality of life (QoL) of individuals with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). METHODS: A case-control study in 32 individuals with RA, 28 with SLE, and 29 in the control group (CG). The questionnaire SF-36 (Medical Outcomes Study Short-Form 36) was used to evaluate the health-related quality of life (HRQoL), and OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the oral health-related quality of life (OHRQoL). The severity of xerostomia was evaluated by the Xerostomia Inventory (XI). In the clinical examination, decayed (D-T), missing(M-T), and filled teeth (F-T) (DMF-T), periodontal status, plaque index (PI), gingival index (GI), unstimulated whole salivary flow rate (UWSFR), and stimulated whole salivary flow rate (SWSFR) were also assessed. Data were analyzed by Student's t tests, chi-square test, Kruskal-Wallis test, ANOVA, Pearson's correlation, and Spearman's correlation. RESULTS: Individuals with RA had a higher caries index (D-T/p = 0.004) and more frequent periodontal disease (PI/p = 0.017). In the SLE group, there was a significant lower salivary flow (SFR/p = 0.016, SFMS/p = 0.004) and severe xerostomia (p = 0.002). The impact of ORHQoL in individuals with RA occurred due to oral candidiasis, halitosis, and xerostomia, compromising the HRQoL. Overall, OHRQoL and HRQoL were more compromised in individuals with SLE, with xerostomia being the main oral problem. CONCLUSION: Individuals with RA and SLE present oral diseases with negative impact on their QoL. CLINICAL RELEVANCE: This study shows the main oral manifestations in rheumatic autoimmune diseases, with mainly xerostomia compromising the quality of life.

Comparison of marginal adaptation and internal fit of monolithic lithium disilicate crowns produced by 4 different CAD/CAM systems.

OBJECTIVES: To evaluate the marginal adaptation and internal space of crowns produced by 4 CAD/CAM systems using microcomputed tomography (µCT) and replica technique (RT). MATERIALS AND METHODS: Monolithic lithium disilicate crowns were milled (Ceramill, Cerec, EDG, and Zirkonzahn) (n = 10). The cement film obtained with low viscosity silicone was scanned by the µCT system and captured by a stereomicroscope, according to RT. Two-way ANOVA followed by Tukey's test were used for statistical analysis (α = 0.05). A uniformity index (UI) was idealized to describe the distribution of crowns' internal space and submitted to the Kruskal-Wallis and Tukey's test (α = 0.05). The correlation between µCT and RT was performed by Pearson's Correlation Coeficient (α = 0.05). RESULTS: Marginal adaptation and internal space were statistically significant different between the experimental groups for the µCT and RT (p < 0.05). The medians of the 4 systems tested were within clinically acceptable range and the mean (± SD) highest marginal discrepancy was recorded in the Ceramill group at 133.0 ± 71.5 µm (µCT) and 90.6 ± 38.5 µm (RT). For internal fit, the UI disclosed a better distribution of the internal space for the Zirkonzahn group (p < 0.001). There was a strong correlation between the methods (p = 0.01 and r = 0.69). CLINICAL RELEVANCE: Because of the variability of the CAD/CAM systems available, evaluating their accuracy is of clinical interest. The 4 systems are capable to produce restorations adaptated within clinically appropriate levels. The µCT and RT are efficient adaptation methodologies.

Root caries lesions inhibition and repair using commercial high-fluoride toothpastes with or without tri-calcium phosphate and conventional toothpastes containing or not 1.5% arginine CaCO3: an in situ investigation.

OBJECTIVES: This double-blind, crossover, and in situ study evaluated the effect of commercial high-F toothpastes with or without functionalized ß-tri-calcium phosphate (fTCP) and conventional-F toothpaste containing or not 1.5% arginine-CaCO3 in preventing and repairing root caries-like lesions. METHODS: Twelve volunteers wore palatal appliances containing sound (S) and pre-demineralized (PD) bovine root dentin blocks in 4 phases of 14 days/each. They used F toothpastes, 3×/day: (i) 1,450 µg F/g (conventional-F); (ii) 1,450 µg F/g + 1.5% arginine-CaCO3 (conventional-F + arginine/CaCO3); (iii) 5,000 µg F/g (high-F); and (iv) 5,000 µg F/g (high-F + fTCP). Sucrose solution (20%) was dropped 8×/day on the S blocks. The demineralization in the S blocks and the remineralization in the PD ones were estimated by % of surface hardness difference (%SH-S) and % of SH recovery (%SHR-PD), respectively. Caries lesion area (ΔS) was determined in the blocks. Statistical analyses were performed by one-way ANOVA/Kruskal-Wallis and multiple comparisons tests (p < 0.05). RESULTS: Both high-F toothpastes presented similar effect to prevent early caries lesions and it was higher than conventional-F + arginine/CaCO3. All treatments resulted in significantly lower ΔS values compared with conventional-F toothpaste (p < 0.0001). High-F + fTCP showed non-significantly higher preventive and reversible effect compared to high-F. The effect of conventional-F + arginine/CaCO3 was similar to high-F and lower than high-F + fTCP in preventing and reverting in-deep caries lesions. CONCLUSIONS: Overall, high-F toothpastes seem to be more effective and interesting feasible strategy for both prevention and remineralization actions in root dentin. CLINICAL RELEVANCE: With the trend of increasing dentin root caries, this study brings new evidences about the preventive and repair effect of high-F toothpastes with or without fTCP in root caries and support the use of arginine in toothpastes.

CBCT does not reduce neurosensory disturbances after third molar removal compared to panoramic radiography: a systematic review and meta-analysis.

OBJECTIVES: The current dentistry scenario is showing an increase in the availability of cone-beam computed tomography (CBCT) in dental offices. Oral surgeons are using three-dimensional information as an additional tool to assess preoperative data for lower third molar (LTM) removal in moderate and high-risk cases of inferior alveolar nerve (IAN) injury diagnosed through the panoramic radiography (PR). The aim of this study is to identify whether CBCT examination reduces neurosensoric disturbances (ND) following the removal of the LTM when compared to PR. MATERIALS AND METHODS: PubMed, Embase, Web of Science, Science Direct, and Scopus electronic databases were searched for studies published up to February 2019. The gray literature was also searched including papers that eventually met the eligibility criteria. Meta-analysis was performed using the comprehensive meta-analysis software, p < 0.05 considered significant. RESULTS: Among the search, 6 studies met all eligibility criteria. There was no statistically significant difference between the two groups (PR and CBCT) in all six studies regarding reducing ND (95%. Confidence interval, 0,788-1734; heterogeneity: Q = 10,361; I2 = 22.788%). CONCLUSIONS: CBCT was not superior to PR in avoiding ND. However, further studies are necessary with standardized parameters for a better comparability between variables in the studies. CLINICAL RELEVANCE: To better understand the CBCT clinical applicability in LTM removal to avoid unnecessary extra radiation when compared to PR to the patient and to improve patient's prognosis.

Is the dentifrice containing calcium silicate, sodium phosphate, and fluoride able to protect enamel against chemical mechanical wear? An in situ/ex vivo study.

OBJECTIVES: The aim of this study was to investigate the effect of a dentifrice that contains calcium silicate, sodium phosphate, and fluoride on erosive-abrasive enamel wear. MATERIAL AND METHODS: This randomized, single-blind in situ/ex vivo study was conducted with four crossover phases of 5 days (one group tested per phase). Bovine enamel blocks (n = 256) were allocated to 16 volunteers and 8 groups. The groups under study were test dentifrice, with calcium silicate, sodium phosphate, and 1450 ppm sodium monofluorophosphate; tin dentifrice, with 3500 ppm stannous chloride, 700 ppm amine fluoride, and 700 ppm sodium fluoride; conventional dentifrice, with 1450 ppm sodium monofluorophosphate; and control (deionized water). Half of the enamel blocks were subjected to erosion and the other half to erosion plus abrasion. The daily extraoral protocol consisted in four citric acid exposures (2 min) and two applications of dentifrice slurry on all blocks for 30 s; after, half of the blocks were brushed for 15 s. The response variable was enamel loss. Data were analyzed by two-way ANOVA and Fisher's test (p < 0.05). RESULTS: For erosion, the test dentifrice promoted less enamel loss than water (4.7 ± 3.1 and 5.8 ± 2.5 µm, respectively, p < 0.05), and did not differ from tin (4.8 ± 2.5 µm) and conventional (4.8 ± 1.4 µm) dentifrices (p > 0.05). However, the test dentifrice (7.7 ± 3.8 µm) promoted higher wear after erosive plus abrasive procedures than tin (5.4 ± 1.5 µm) and conventional (6.2 ± 1.7 µm, p < 0.05) dentifrices, and did not differ from water (6.9 ± 2.0 µm). CONCLUSIONS: The investigated dentifrice reduced enamel loss against acid challenge but had no effect against acid and brushing challenge. CLINICAL RELEVANCE: Little is known regarding the preventive effect of dentifrices indicated for dental erosion. The tested anti-erosive dentifrice was unable to protect enamel when erosion was associated to toothbrushing abrasion.

Sodium Trimetaphosphate as a Novel Strategy for Matrix Metalloproteinase Inhibition and Dentin Remineralization.

The effect of sodium trimetaphosphate (STMP) as an antiproteolytic and remineralizing agent on demineralized dentin was evaluated in vitro. The inhibitory potential of STMP at 0.5, 1.5, 3.5, and 5% against recombinant matrix metalloproteinases (MMPs) MMPs-2 and -9 was assessed by zymography. To investigate its remineralization potential, 40 bovine root specimens were obtained and subjected to a demineralization protocol to produce caries-like dentin lesions. After that, dentin surfaces were divided into 3 areas: (1) mineralized (no treatment); (2) demineralized; and (3) demineralized/treated with STMP and submitted to a pH-cycling associated or not with STMP (1.5, 3.5, or 5% STMP, 10 min of treatment). After that, superficial hardness (SH) and cross-sectional hardness (CSH) were determined. Polarized light microscopy (PLM) was used to qualitatively evaluate mineralization within the caries-like lesions. The zymographic analysis showed that STMP solution is a potent inhibitor of the gelatinolytic activity of MMPs-2 and -9 depending on the dose, since the lowest concentration (0.5%) partially inhibited the enzyme activity, while the higher concentrations completely inhibited enzyme activity. Regarding remineralization effect, only 1.5% STMP solution enhanced both the SH and CSH. PLM showed that the area treated with 1.5% STMP presented similar birefringence as mineralized sound dentin. In conclusion, 1.5% STMP solution is effective as an antiproteolytic agent against MMPs and promotes dentin remineralization.