How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review.

INTRODUCTION: The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" MATERIAL AND METHODS: Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. RESULTS: Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. CONCLUSIONS: From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. CLINICAL RELEVANCE: Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis.

OBJECTIVE: To summarize and evaluate critically the results of clinical trials comparing the risk of failure of restorations after chemomechanical and mechanical carious tissue removal. MATERIALS AND METHODS: The PubMed/MEDLINE, EMBASE, Scopus, LILACS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, and grey literature were searched to identify studies related to the research question and published up to January 2022. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the certainty of evidence. Meta-analysis was performed using a random effects model to compare the effect of chemomechanical and mechanical excavation on the outcome (restorative failure), considering the type of carious tissue removal (selective and complete) as subgroups. RESULTS: From 443 potentially eligible studies, 58 clinical studies were selected for full-text analysis, and 6 were included in the review. There was no statistically significant difference in the risk for failure of restorations performed after chemomechanical and mechanical excavation (RR: 1.26, 95% CI 0.93; 1.72, p = 0.14) either for complete (p = 0.97) or selective (p = 0.11) carious tissue removal. The heterogeneity found was null. The risk of bias was high and the certainty of evidence was low. CONCLUSION: Based on the low certainty of evidence, the risk of failure of restorations performed after chemomechanical and mechanical carious tissue removal is similar. CLINICAL RELEVANCE: Chemomechanical carious tissue removal may be performed before restoration placement, without jeopardizing the short-term longevity. Further studies are required before definitive conclusions can be drawn.

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

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

Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis.

OBJECTIVE: To investigate the influence of an intermediate layer of a flowable resin composite in class II resin composite restorations. MATERIALS AND METHODS: The authors searched MEDLINE via PubMed, Scopus, LILACS, Embase, and Web of Science electronic databases, and the ClinicalTrials.gov website to identify laboratory and clinical studies that evaluated class II cavities with resin composite restorations with or without an intermediate layer of flowable resin composite. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the quality of the evidence. Meta-analyses were performed using RevMan5.3 with fixed-effects model comparing bond strength (MPa), fracture strength (Newton), and clinical (number of failures) outcomes between restorative techniques (with or without flowable resin composite as an intermediate layer). RESULTS: From 1707 potentially eligible studies, 140 in vitro studies and 14 clinical studies were selected for full-text analysis, and 11 were included in the systematic review, being 7 in vitro and 4 clinical studies. There was no statistically significant difference between the restorative techniques considering the outcomes evaluated. The heterogeneity found was null. The risk of bias was classified as medium for in vitro studies and unclear in most clinical studies. The quality of the evidence of the clinical studies was low. CONCLUSION: The use of flowable resin composite as an intermediate layer does not improve the effectiveness of the class II restorations based on laboratory and clinical outcomes. CLINICAL RELEVANCE: Flowable resin composite as an intermediate layer may be used for class II restorations; however, this technique does not improve the effectiveness of the class II restorations.

Repair increases the survival of failed primary teeth restorations in high-caries risk children: a university-based retrospective study.

OBJECTIVES: We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children. MATERIALS AND METHODS: The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05). RESULTS: A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%). CONCLUSIONS: Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time. CLINICAL RELEVANCE: Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

Sleep bruxism and oral health-related quality of life in children: A systematic review.

Sleep bruxism (SB) is a masticatory muscle activity during sleep that can cause several consequences to the stomatognathic system. This systematic review investigated the impact of SB on oral health-related quality of life (OHRQoL) of 0- to 6-year-old children. Literature search was undertaken through PubMed/MEDLINE, LILACS, Scopus, TRIP, Livivo databases, and grey literature. The search was conducted with no publication year or language limits. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias. The quality of evidence was assessed using GRADE. From 185 potentially eligible studies, three were included in the review. All studies were conducted in Brazil, published between 2015 and 2017, and used the B-ECOHIS instrument to evaluate OHRQoL. Two studies found no association between SB and OHRQoL, whereas one showed a significant negative impact of SB on the OHRQoL of children. SB was associated with respiratory problems, presence of tooth wear, dental caries, malocclusion as well as income and pacifier use. Risk of bias ranged from moderate to high, and the quality of evidence was judged as very low. The evidence is currently insufficient for definitive conclusions about the impact of SB on OHRQoL of children.

Prevalence of defective restorations and factors associated with re-intervention in primary teeth: A retrospective university-based study.

AIM: This retrospective study investigated the prevalence of defective restorations in a public dental service and factors associated with re-intervention in primary teeth. DESIGN: The sample consisted of all clinical records (census) of children presenting restorations in primary teeth, who had undergone dental treatment in a public set during 1-year period. For analysis, only restorations presenting defects related to esthetic, functional, or biological reasons at first clinical examination were included. The outcome 'Success' was set when the restoration received no treatment (monitored), refurbishing, sealing of margins, or was repaired. Otherwise, 'Failure' was set whenever the restoration was either replaced or if another treatment affecting the restoration was necessary (endodontic treatment or tooth extraction). Poisson regression model was used to assess the prevalence of patient- and tooth-related factors that may influence the re-intervention decision (repair or replacement). RESULTS: From a total of 302 restorations placed in 114 children, 37.7% presented some type of defect. Restorations with recurrent caries were more frequently present in caries-active patients (P = 0.03) and were frequently replaced (95% CI, 1.05-3.22, RR = 1.84, P = 0.03). CONCLUSION: Presence of recurrent caries influences the re-intervention decision, leading to restoration replacement in most cases.

Phosphoric Acid Containing Chlorhexidine Compromises Bonding of Universal Adhesive.

PURPOSE: To examine the influence of phosphoric acid containing chlorhexidine on the dentin bond stability of a universal and a 2-step etch-and-rinse adhesive. MATERIALS AND METHODS: Eighty sound bovine incisors were randomly assigned to 8 groups (n = 10) according to: phosphoric acid (37% phosphoric acid [CTR] or 37% phosphoric acid with 2% chlorhexidine [CHX]); adhesive (Scotchbond Universal Adhesive [SBU]or Adper Single Bond 2 [SB2]); and water storage time (24 h and 6 months). Both acids and adhesives were applied to flat dentin surfaces (following manufacturer's instructions) upon which composite cylinders were built up (0.72 mm2). After storage in distilled water at 37°C for 24 h or 6 months, the composite cylinders were submitted to microshear bond strength (µSBS) testing. Bond strength data (MPa) were analyzed using three-way ANOVA and post-hoc Tukey's test (α = 5%). RESULTS: The interaction among factors was significant (p = 0.012). Both adhesives showed similar 24-h bond strengths regardless of the phosphoric acid. After 6 months, similar values were found for both materials when control phosphoric acid was used, but CHX phosphoric acid produced statistically significantly lower bond strengths for SBU. SB2 bond strength was not affected by acid type. CONCLUSION: Phosphoric acid containing chlorhexidine induced premature bond strength degradation of Scotchbond Universal Adhesive.

Can Endodontic Irrigating Solutions Influence the Bond Strength of Adhesives to Coronal Dental Substrates? A Systematic Review and Meta-Analysis of In Vitro Studies.

PURPOSE: To systematically review the literature to analyze the influence of endodontic irrigating solutions on the bond strength of adhesives to coronal enamel or dentin. MATERIALS AND METHODS: The PubMed/MEDLINE, Web of Science and Scopus electronic databases were used to select laboratory studies related to the research question, without publication year or language limits. From 2461 potentially eligible studies, 2451 were selected for full-text analysis, and 97 were included in the systematic review. Two authors independently selected the studies, extracted the data, and assessed the risk of bias. Pooling bond strength data were calculated using RevMan5.1 with random effects model (α = 0.05), comparing control (no endodontic irrigating solution) and experimental groups (one or more endodontic solutions). RESULTS: No significant difference was found between the control and experimental groups (p = 0.12) in the overall meta-analysis and in the meta-analysis excluding chlorhexidine (p = 0.06). High heterogeneity was found in the meta-analyses. Most included studies in the systematic review were scored as having a high risk of bias. CONCLUSION: The different endodontic irrigating solutions evaluated showed no negative influence on the bond strength of dental adhesives to coronal dental substrates.

Is Adhesive Bond Strength Similar in Primary and Permanent Teeth? A Systematic Review and Meta-analysis.

PURPOSE: To systematically review the literature on laboratory studies to determine whether the bond strength of adhesives to primary teeth is similar to that to permanent teeth. MATERIALS AND METHODS: This systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42014015160). A comprehensive literature search was conducted considering in vitro studies published up to June 2015 in the PubMed/MEDLINE database, with no limit on year of publication. Two reviewers independently selected papers, extracted data and assessed the risk of bias. From 422 eligible studies, 42 were fully analyzed. Thirty-seven studies were ultimately included in the systematic review and meta-analysis. A global comparison was performed with a random-effects model at a significance level of p < 0.05, expressed by the difference of means between the groups. The mean bond strengths and standard deviations were tabulated and statistical analyses were conducted in RevMan 5.1 (The Cochrane Collaboration). RESULTS: There was a significant difference between groups, with permanent teeth presenting higher bond strength than primary teeth (p = 0.0005). When the enamel and dentin substrates were considered separately, dentin presented the same trend (p = 0.002), while for enamel there was no significant difference between the dentitions (p = 0.11). The majority of the studies had a high bias risk. CONCLUSION: Adhesives have higher bond strengths when applied to permanent than to primary teeth. This difference was also valid when the comparison was made between permanent and primary dentin.

Performance of resin composite restorations in the primary dentition: a retrospective university-based study.

BACKGROUND: Limited data is available on variables influencing the survival of composite restorations in primary teeth. AIM: This retrospective university-based study assessed the survival and risk factors associated with failures of resin composite restorations performed in primary teeth. DESIGN: The sample was composed of 961 restorations from records of 337 patients (178 girls and 159 boys) attended in a university dental clinic. The restorations' longevity up to 48 months of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P < 0.05). RESULTS: Mean survival time was 41.5 months (95% CI: 39.7-43.3), with 70.6% of the restorations surviving after 48 months of evaluation. The overall annual failure rate up to 48 months follow-up was 8.3%. Restorations placed in lower arch had lower survival rate than those in upper arch (HR: 1.82, 95% CI: 1.02-3.28). Restorations involving two or more surfaces had more risk of failure than restorations placed in cavities involving only one surface (HR: 2.55 95% CI: 1.34- 4.83). Girls had less risk of failure in their restorations (HR: 0.43, 95% CI: 0.19-0.96). CONCLUSION: Individual and dental variables such as gender, arch type and number of restored surfaces were associated with failure of composite restorations performed in children under daily life clinical environment.

The Bonding Performance of a Universal Adhesive to Artificially-created Caries-affected Dentin.

PURPOSE: To evaluate the bonding performance of a universal adhesive to sound and artificially-created caries-affected dentin, using either the etch-and-rinse or self-etch strategy. MATERIALS AND METHODS: Flat midcoronal dentin surfaces from 48 third molars were randomly assigned to eight groups according to the substrate (sound dentin and artificially-created caries-affected dentin [pH cycling for 14 days]) and the adhesive or application mode (Scotchbond Universal: self-etch or etch-and-rinse strategies; Adper Single Bond 2 and Clearfil SE Bond, a two-step etch-and-rinse adhesive and a two-step self-etch adhesive as controls, respectively). Then, composite blocks were constructed, the specimens were further stored in water for 24 h, and composite-dentin sticks were prepared (0.8 mm2) and tested under tension at 1.0 mm/min. Data were analyzed with two-way ANOVA and Tukey's test (α = 0.05). RESULTS: All adhesives tested on artificially-created caries-affected dentin presented similar µTBS (p > 0.05), and inferior bonding performance when compared to sound dentin (p = 0.000). On sound dentin, Scotchbond Universal presented higher bond strengths when applied in the etch-and-rinse than self-etch mode, but comparable bond strength in each application mode in relation to the respective control adhesive (p = 0.04). CONCLUSION: Scotchbond Universal can be used in different application modes when bonded to artificially-created caries-affected dentin; however, the etch-and-rinse strategy improves its bonding ability to sound dentin. Moreover, Adper Single Bond 2 and Clearfil SE Bond presented similar bond strengths, regardless of the dentin condition and comparable performance in relation to each strategy of Scotchbond Universal.

Role of Etching Mode on Bonding Longevity of a Universal Adhesive to Eroded Dentin.

PURPOSE: To assess the immediate and six-month microshear bond strength (µSBS) of a universal adhesive applied using different etching strategies on sound and eroded dentin. MATERIALS AND METHODS: Eighty bovine incisors were polished to obtain flat buccal dentin. Forty teeth were submitted to a pH-cycling model to simulate artificial erosion (3x/day cola drink for 7 days). Teeth from both dentin conditions (sound and eroded) were randomly assigned to four groups according to the adhesive and etching approach: a universal adhesive in self-etch and etch-and-rinse modes (Scotchbond Universal Adhesive), and as controls a two-step etch-and-rinse adhesive (Adper Single Bond Plus), and a two-step self-etch adhesive (Clearfil SE Bond). Four composite restorations (Z250) were built up on each dentin surface, using the area delimitation technique. Half of the specimens were evaluated in the µSBS test after 24 h of water storage, and the other half were evaluated six months later. Data (MPa) were analyzed with three-way repeated measures ANOVA and Tukey's post-hoc tests (α = 0.05). RESULTS: The µSBS values of all adhesives significantly decreased after six months of aging (p = 0.01). Lower µSBS values were obtained in eroded dentin (p = 0.04). The universal adhesive showed similar µSBS to the self-etch adhesive used as control, irrespective of the etching strategy. However, Scotchbond Universal Adhesive applied in self-etch mode performed better than the control etch-and-rinse adhesive (p = 0.02). CONCLUSION: The universal adhesive does not provide the same bonding efficacy on eroded dentin as on sound dentin, and its performance does not depend on the etching mode.

The Thickness of the Adhesive Layer Increases the Misdiagnosing of the Radiolucent Zones and Restoration Replacement Indication.

OBJECTIVE: To evaluate the influence of the thickness of the adhesive layer and demineralized dentin on the decision to replace composite restoration. MATERIALS AND METHODS: Eighty human third molars with occlusal preparations (Class I) were randomly assigned to eight groups (n = 10): adhesive system (Clearfil SE Bond [CSE] or Scotchbond Universal Adhesive [SBU]); the number of adhesive layers (one or two); and substrate (sound or demineralized dentin). A blinded examiner evaluated radiographs of each restored tooth. Obtained scores for the presence or absence of radiolucent zone under restoration were submitted to a relative risk (RR) calculus and Z-test, and the scores for the decision to replace restorations were submitted to Fisher's exact test (p < 0.05). RESULTS: The relative risk of identifying a radiolucent zone under restoration in sound and demineralized dentin were, respectively, 2 and 1.85 times higher when two layers of adhesive were applied. Demineralized dentin did not increase the probability of identifying a radiolucent zone. A higher relative (1.6, p = 0.01) was observed when two layers of SBU were applied. The number of layers did not influence the relative risk for CSE (RR = 1.3, p = 0.13). CONCLUSION: Thicker layers of SBU increase the relative risk of identifying a radiolucent layer under restoration and the decision to replace a/composite restoration, irrespective of the substrate. The presence of demineralized dentin did not increase the probability of identifying a radiolucent zone when compared to sound dentin. CLINICAL SIGNIFICANCE: The results of this in vitro study suggest that thicker layers of a particular adhesive under resin composite restorations can negatively influence the decision to replace them. (J Esthet Restor Dent 29:193-200, 2017).

ART is an alternative for restoring occlusoproximal cavities in primary teeth - evidence from an updated systematic review and meta-analysis.

BACKGROUND: A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. AIM: To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. DESIGN: The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. RESULTS: The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574-1.371). CONCLUSION: ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.

Does Bonding Approach Influence the Bond Strength of Universal Adhesive to Dentin of Primary Teeth?

OBJECTIVE: To evaluate the effect of bonding strategy on microtensile bond strength (µTBS) of a new universal adhesive system to primary tooth dentin. STUDY DESIGN: Flat dentin surfaces from 25 primary molars were assigned to 5 groups according to the adhesive and bonding approach: Adper Single Bond 2 (two-step etch-and-rinse adhesive) and Clearfil SE Bond (two-step self-etch system), as controls; Scotchbond Universal Adhesive-self-etch, dry or wet-bonding etch-and-rinse strategies. Composite buildups were constructed and the teeth were sectioned to obtain bonded sticks (0.8 mm2) to be tested under tension at 1mm/min. The µTBS means were analyzed by one-way ANOVA and Tukey's tests (α = 0.05). Failure mode was evaluated using a stereomicroscope (400×). RESULTS: Universal adhesive applied following both dry and wet-bonding etch-and-rinse strategies showed similar bond strength compared with control adhesive systems. Self-etch approach resulted in the lowest µTBS values. For all groups, adhesive/mixed failure prevailed. The percentage of premature debonded specimens was higher when the universal adhesive was used as self-etch mode. CONCLUSION: The universal adhesive does not share the same versatility of being used in the etch-and-rinse and self-etch approaches; however, the use of the new adhesive following either wet or dry-bonding may be a suitable option as alternative to two-step etch-and-rinse adhesive protocol.

Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis.

BACKGROUND: Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects. AIM: The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects. MATERIAL AND METHODS: The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model. RESULTS: The WMD in PD reduction [-0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) -0.24, -0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (-0.14 mm, n = 9, p = 0.11, 95% CI -0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI -0.04, 8.07; and -1.91%, n = 7, p = 0.39, 95% CI -6.32, 2.51 respectively) did not favour adjunctive antibiotic use. CONCLUSION: Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects.

Selective Acid Etching Improves the Bond Strength of Universal Adhesive to Sound and Demineralized Enamel of Primary Teeth.

PURPOSE: To evaluate the influence of enamel condition and etching strategy on bond strength of a universal adhesive in primary teeth. MATERIALS AND METHODS: Thirty-six primary molars were randomly assigned to six groups (n = 6) according to the enamel condition (sound [S] and demineralized [DEM]/cariogenic challenge by pH cycling prior to restorative procedures) and adhesive system (Scotchbond Universal Adhesive [SBU]) used in either etch-and-rinse (ER) or selfetching (SE) mode, with Clearfil SE Bond as the self-etching control. The adhesives were applied to flat enamel surfaces and composite cylinders (0.72 mm2) were built up. After 24-h storage in water, specimens were subjected to the microshear test. Bond strength (MPa) data were analyzed using two-way ANOVA and Tukey's post-hoc tests (α = 0.05). RESULTS: Significant differences were found considering the factors adhesive system (p = 0.003) and enamel condition (p = 0.001). Demineralized enamel negatively affected the bond strength, with µSBS values approximately 50% lower than those obtained for sound enamel. SBU performed better in etch-and-rinse mode, and the bond strength found for SBU applied in self-etching mode was similar to that of CSE. CONCLUSIONS: Enamel etching with phosphoric acid improves the bond strength of a universal adhesive system to primary enamel. Demineralized primary enamel results in lower bond strength.

Is There a Best Protocol to Optimize Bond Strength of a Universal Adhesive to Artificially Induced Caries-affected Primary or Permanent Dentin?

PURPOSE: To evaluate whether the etch-and-rinse or self-etching mode of a universal adhesive is the best protocol to optimize bond strength to primary and permanent artificially-induced caries-affected dentin. MATERIALS AND METHODS: Flat midcoronal dentin surfaces were exposed in 24 primary and 24 permanent molars and submitted to pH cycling for 14 days to induce artificial caries-affected dentin. For each tooth type (primary and permanent), the teeth were randomly assigned to 4 different groups according to the adhesive systems and bonding strategy: a universal adhesive, Scotchbond Universal Adhesive, in self-etching and etch-and-rinse modes; a twostep etch-and-rinse adhesive, Adper Single Bond 2 (control); and two-step self-etching system, Clearfil SE Bond (control). After bonding and restorative procedures, specimens were sectioned to obtain rectangular sticks (0.8 mm2) that were submitted to microtensile tests (crosshead speed: 1 mm/min). The data were analyzed using two-way ANOVA (α = 0.05). RESULTS: The universal adhesive showed bond strengths similar to those of the control groups, irrespective of the bonding strategy. Likewise, statistically similar bonding performance was observed for all adhesives to either artificially- induced caries-affected primary or permanent dentin. CONCLUSION: The new universal adhesive, Scotchbond Universal Adhesive, can be used in both application modes in artificially-induced caries-affected primary and permanent dentin, as the bond strength was not influenced by the different substrates or application mode.