A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention.

OBJECTIVES: This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. METHODS: This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low. CONCLUSION: Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. CLINICAL SIGNIFICANCE: The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies.

The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.

Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis (SRM) was to answer the question as to whether the use of ultrasonic irrigation (UI) results in better antimicrobial activity in root canal disinfection compared to conventional irrigation (CI). METHODS: A literature search was performed in the main scientific databases, carried out until October 2021. The eligibility criteria were randomized clinical trials (RCTs). Two meta-analyses were conducted using R software with the "META" package. The mean difference (MD) and odds ratio (OR) measure of effect were calculated. The fixed effect model was applied with a 95% confidence interval. The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: A total of 1782 records were screened, and 12 studies meeting the criteria were included in this review. A low risk of bias was observed for most domains, except allocation concealment that was considered unclear. The certainty of evidence was classified as moderate in the OR meta-analyses and low in the MD meta-analyses. Ultrasonic irrigation resulted in a better antimicrobial effect in both meta-analyses, MD 1.42 [1.60; 1.23] p < 0.0001, I2 = 80%; and OR 3.86 [1.98; 7.53] p< 0.0001, I2 = 28.7%. CONCLUSION: Within the limitations of this SRM, UI presented better antimicrobial efficacy than CI. CLINICAL RELEVANCE: UI should be used by clinicians as it promotes better antimicrobial efficacy in patients undergoing endodontic treatment.

Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials.

The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.

Postoperative pain in root canal treatment with ultrasonic versus conventional irrigation: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The objective of this systematic review and meta-analysis (SRM) was to answer the question whether the use of ultrasonic irrigation (UI) results in less postoperative pain (PP) compared to conventional irrigation (CI). METHODS: A literature search was performed within the main scientific databases carried out until May 2021. The eligibility criteria were randomized clinical trials (RCTs). Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: Six RCTs were included for systematic review and four for meta-analysis. UI resulted in less PP in 3 of 5 periods, at 6 h (MD - 1.40 [CI - 2.38 to - 0.42] p = 0.0052), 24 h (MD - 0.73 [CI - 1.07 to - 0.39] p = 0.0001), and 48 h (MD - 0.36 [CI - 0.59 to - 0.13] p = 0.022). However, PP showed no significant differences between the groups at 72 h and 7 days (p > 0.05). A low risk of bias was observed for most domains, except allocation that was considered unclear. The certainty of evidence was classified as moderate (24 h, 48 h, and 7 days) and low (6 and 72 h). CONCLUSION: Within the limitations of this SRM, UI presented less occurrence of PP than CI. Further randomized clinical trials are needed to corroborate these findings. CLINICAL RELEVANCE: UI should be used by clinicians as it reduces postoperative pain in patients undergoing endodontic treatment.

Effect of previous photoactivation of the adhesive system on the color stability and mechanical properties of resin components in ceramic laminate veneer luting.

STATEMENT OF PROBLEM: The color stability and mechanical properties of luting agents influence the esthetics and longevity of ceramic restorations. However, studies evaluating the color changes and mechanical properties of luting agents under ceramic laminates activated by using different methods are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effects of different modes of photoactivation on the nanohardness and elastic modulus of resin cements and dental adhesives and on the color stability of ceramic laminate veneers. MATERIAL AND METHODS: Forty-four lithium disilicate blocks (7×8×0.6 mm) were cemented onto bovine enamel and divided into 4 groups according to the polymerization light (Radii-Cal or Valo) used and the mode of activation of the dental adhesive (no previous photoactivation or previous photoactivation). Single Bond Universal dental adhesive and RelyX Veneer resin cement were used in all experimental groups. Color stability was measured using a UV-2450 ultraviolet-visible spectrophotometer before and after ultraviolet-B artificial accelerated aging (n=8). The nanohardness and the elastic modulus of the adhesive and resin cement were measured using a nanohardness tester (n=3). The color stability and mechanical properties were measured and analyzed using ANOVA and the Tukey least significant difference test (α=.05). RESULTS: No difference in color stability or mechanical properties of the resin cement among the polymerization lights was detected (P>.05). Specimens that underwent previous photoactivation of the adhesive using the Valo polywave unit exhibited higher elastic modulus values than those that did not undergo previous photoactivation (P<.001). CONCLUSIONS: The Valo polywave polymerization light improved mechanical properties and color stability more than the Radii-Cal unit. Previous activation of the dental adhesive in the dental enamel with the Valo polywave polymerization light yielded more satisfactory results.

Effect of photodynamic therapy on the mechanical properties and bond strength of glass-fiber posts to endodontically treated intraradicular dentin.

STATEMENT OF PROBLEM: The use of photosensitizers in photodynamic therapy promotes intraradicular microbial reduction during nonsurgical endodontic therapy. However, studies are lacking on the consequences of the application of these agents on the mechanical properties of intraradicular dentin and on the bond strength of glass-fiber posts. PURPOSE: The purpose of this in vitro study was to evaluate the influence of photodynamic therapy on the bond strength of glass-fiber posts using a push-out test and, additionally, to measure the Martens hardness (MH) and elastic indentation modulus (Eit) of intraradicular dentin when different photosensitizers are used. MATERIAL AND METHODS: Eighty bovine teeth were used to simulate experimental endodontic treatments. Biomechanical instrumentation was performed for all root canals, and the teeth were distributed into 5 groups: control-deionized water; methylene blue 50 mg/L + red laser; methylene blue 100 mg/L + red laser; curcumin 500 mg/L + blue LED; and curcumin 1000 mg/L + blue LED. The MH and Eit of intraradicular dentin were measured using an ultramicrohardness tester under a load of 3 mN (n=8). The push-out bond strength of glass-fiber posts to dentin was measured using a universal testing machine (n=8). Mechanical properties and bond strength data were subjected to the Kruskal-Wallis test, ANOVA, and Fisher least significant difference test (α=.05). Images of representative specimens were obtained using a scanning electron microscope. RESULTS: The MH, Eit, and bond strength of intraradicular dentin were influenced by the photosensitizer used. In general, curcumin promoted lower mechanical properties values but higher bond strength values. CONCLUSIONS: Photosensitizers influenced the mechanical properties of intraradicular dentin and the bond strength of glass-fiber posts, and methylene blue at 50 mg/L had no marked effect on the mechanical properties of the dentin or the bond strength values.

The effect of photoinitiator type and filler load on physicochemical and mechanical properties of experimental light-cured resin cements through lithium disilicate ceramics of different shades and thicknesses.

OBJECTIVE: This study investigated the influence of photoinitiator types on degree of conversion (DC), rate of polymerization (RP), flexural strength (FS), flexural modulus (FM), and light transmittance (LT) of filled and unfilled light-curable resin cements through different thicknesses and shades of lithium disilicate ceramics. METHODS: Lithium disilicate ceramic discs (IPS Emax Press, background [0.0], 0.5, 1.0, 2.0, 3.0, and 4.0 mm, shades A1 and BL3) were prepared. Experimental resin-based cements [TEGDMA/BisGMA (50/50 mass%)] were prepared using either camphorquinone (CQ)/amine (0.44/1.85 mol%) or TPO (0.44 mol%)], and a micro and nanofiller loads of nil (unfilled); 40/10 mass%; and 50/10 mass%). Resin cements (0.2 mm thick) were placed on the lower surface of the ceramic specimens and light-activated for 30 s from the upper surface using a Bluephase Style curing light (exitance at tip: 1236 mW/cm2 ± 1.20). LT and distribution of irradiance through the ceramics were measured using a UV-vis spectrometer and a beam profile camera, respectively (n = 3). The DC and RP were measured in real-time using mid infrared spectroscopy in attenuated total reflectance (ATR) mode (n = 3). FS and FM were measured using a universal testing machine (n = 5). Statistical analyses were performed on LT, DC, RP, FS, and FM data using a general linear model, and supplementary ANOVA and post hoc Tukey multiple comparison test were also performed (α = .05). RESULTS: Thicknesses, shades, photoinitiator type, and fillers load significantly influenced the optical and mechanical characteristics of the resin-based materials (p < 0.05). The BL3 shade ceramic provided higher values of DC, RP, FS, FM, and LT compared with the A1 shade (p < 0.05). Increasing ceramic thickness decreased the properties of the resin-based materials (p < 0.05). Generally, TPO improved mechanical properties of the resin cement compared with CQ (p < 0.05). SIGNIFICANCE: The luting process of indirect restorations may be improved by using high molar absorptivity, more reactive, and more efficient photoinitiators such as TPO, as opposed to conventional CQ. The use of such initiator may allow the placement of thicker and more opaque indirect restorations.

Minimally processed recycled yttria-stabilized tetragonal zirconia for dental applications: Effect of sintering temperature on glass infiltration.

This study aimed to develop a recycling process for the remnants of milled 3Y-TZP and enhance their properties using glass infiltration. 3Y-TZP powder was gathered from the vacuum system of CAD-CAM milling equipment, calcined and sieved (x < 75 µm). One hundred twenty discs were fabricated and pre-sintered at 1000 °C/h. These specimens were then divided into four groups, categorized by glass infiltration (non-infiltrated [Zr] or glass-infiltrated [Zr-G]) and sintering temperature (1450 °C [Zr-1450] or 1550 °C [Zr-1550]/2h). After sintering, the specimens were characterized by X-Ray Diffraction (XRD), relative density measurement, and scanning electron microscopy and energy dispersive spectroscopy (SEM-EDS). The biaxial flexural strength test was performed according to the ISO 6872 and followed by fractographic analysis. Subsequent results were analyzed using Weibull statistics. Relative density values of the sintered specimens from Zr-1450 and Zr-1550 groups were 86.7 ± 1.5% and 92.2 ± 1.7%, respectively. Particle size distribution revealed particles within the range of 0.1-100 µm. XRD analysis highlighted the presence of the ZrO2-tetragonal in both the Zr-1450 and Zr-1550 groups. Glass infiltration, however, led to the formation of the ZrO2-monoclinic of 9.84% (Zr-1450-G) and 18.34% (Zr-1550-G). SEM micrographs demonstrated similar microstructural characteristics for Zr-1450 and Zr-1550, whereas the glass-infiltrated groups exhibited comparable infiltration patterns. The highest characteristic strength was observed in the glass-infiltrated groups. Fractographic analyses suggested that fracture origins were related to defects on the tensile side, which propagated to the compression side of the samples. Both the sintering temperature and glass infiltration significantly influenced the mechanical properties of the 3Y-TZP recycled.

Biaxial flexural strength of hydrothermally aged resin-based materials.

PURPOSE: The strength of temporary restorations plays a vital role in full-mouth reconstruction, and it can be impacted by the aging process. The aim of this in vitro study was to evaluate the biaxial flexural strength and fractographic features of different resin-based materials submitted to thermal aging. MATERIAL AND METHODS: One hundred and ninety-two resin disc-shaped specimens (6.5 mm in diameter and 0.5 mm in thickness) were fabricated and divided into six experimental groups according to the resin-based materials (Filtek Bulk-Fill flowable resin; J-Temp temporary resin; and Fuji Lining glass ionomer cement) and aging process (before and after thermal cycling). Biaxial flexural strength test was performed using a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling (5 °C and 55 °C, 5760 cycles, 30 s). The mechanical properties were assessed using Weibull parameters (characteristic strength and Weibull modulus) (n = 30). Fractured specimens were examined under a polarized light stereomicroscope to identify crack origin and propagation direction. The surface microstructure of the resin-based materials was assessed by scanning electron microscopy (n = 2). The Weibull modulus (m), characteristic strength, and reliability properties were calculated, and a contour plot was used to detect differences among groups (95% confidence interval). RESULTS: The Weibull modulus (m), characteristic strength, and reliability of the resin-based compounds were influenced by material type and thermal aging (p < 0.05). Weibull modulus (m) revealed no differences when comparing the materials and aging process (p > 0.05), except for the preceding aging period where Filtek Bulk-Fill exhibited higher values compared to J-Temp (p < 0.05). Filtek Bulk-Fill demonstrated superior characteristic strength and reliability compared to J-Temp and Fuji Lining before and after thermal cycling (p < 0.05). Fractography of the resin-based materials showed fractures originating from surface defects exposed to tensile side and their propagation toward the compressive side. Generally, no differences in surface microstructure were observed on micrographs before and after thermal aging for Filtek Bulk-Fill and Fuji Lining. However, the aging process developed flaws in J-Temp. CONCLUSION: Resin-based material composition resulted in different flexural strength performance, impacting the Weibull modulus (m), characteristic strength, and reliability of the resin-based restorations.

The impact of methylene blue photosensitizer, aPDT and a calcium hydroxide-based paste on the physicochemical and mechanical characteristics of root canal dentin and the bonding interface of fiberglass posts.

PURPOSE: To investigate the influence of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) and calcium hydroxide (CH) medication on the mechanical characteristics, degree of conversion (DC), quantification, and volume of gaps at the adhesive interface of glass fiber posts (GFPs) luted to distinct thirds of root canal dentin. Additionally, the microhardness (MH), elastic modulus (Eit), morphology, and chemical structure of the intraradicular dentin were assessed. MATERIALS AND METHODS: 6 experimental groups were formed by sorting 102 bovine incisors. Canals receiving deionized water irrigation as a negative control; canals receiving deionized water irrigation and filled with CH as a positive control; groups treated with CH + MB at 50 and 100 mg/L without irradiation; and groups treated with CH + MB at 50 and 100 mg/L irradiated by red laser for 60 s (660 nm; 100 mW; 6.5 J; 72 J/cm2). MH, Eit, and DC properties were evaluated for both the resin cement layer and root dentin substrate (n = 8). Volume and quantification of gaps at the bonding interface (n = 6), and dentin morphology and chemical content were investigated (n = 3). Data were analyzed using a repeated-measures 2-way ANOVA followed by Tukey post hoc analysis (α = 0.05). RESULTS: The distinct intraradicular thirds and treatment with MB-mediated aPDT, whether activated or not, in combination with CH, had a significant impact on the mechanical characteristics of the root dentin. This effect was also observed in the MH, Eit, DC, quantification, and volume of gaps at the luting interface (P < .05). In general, a higher concentration of MB, whether activated by a red laser or not, led to lower values in the mechanical properties of the root dentin, as well as in MH, Eit, and DC at the adhesive interface (P < .05). Additionally, these groups exhibited higher values for quantification and volume of gaps at the luting substrate (P < .05). Scanning electron micrographs and energy dispersive X-ray spectra showed qualitative similarity among all groups, except for the negative experimental control group. CONCLUSIONS: MB-mediated aPDT at 50 mg/L, in combination with CH, demonstrated favorable physico-chemical and mechanical characteristics in intraradicular dentin, along with satisfactory mechanical features and the adhesive interface integrity for GFPs at all intraradicular depths. CLINICAL SIGNIFICANCE: MB-mediated aPDT at a concentration of 50 mg/L combined to CH medication represents a suitable choice for photosensitization in the context of intracanal disinfection following the biomechanical procedure and prior to luting of intraradicular restorations.

Does the use of antioxidant agents after dental bleaching compromise the aesthetic results of ceramic laminate veneers?

PURPOSE: This in vitro study aimed to evaluate the aesthetic compromise generated in adhesive interface of ceramic laminate veneer luted after tooth bleaching and the use of antioxidant agents. Thus, the chromatic coordinates and whitening index (WID) were evaluated, comparing whiteness changes (ΔWID) results to perceptibility and acceptability thresholds. MATERIAL AND METHODS: In total, 88 bovine enamel samples (7 × 8 × 4 mm; n = 8) were submitted to the ceramic laminate veneer luting protocol according to surface treatment (unbleached and bleached enamel), antioxidant agents (control; 10% ascorbic acid and 10% α-tocopherol), and luting periods (after 24 h and after 14 days). To lute IPS e.max ceramic restorations (7 × 8 × 0.6 mm), Tetric N-Bond Universal adhesive system and Variolink Aesthetic LC resin cement were used. An ultraviolet-visible spectrophotometer (UV-VIS) was utilized to measure CIE L*a*b* coordinates prior to and after UV-B artificial accelerated aging for 252, 504, and 756 h. L*, a*, and b* axes were evaluated separately, and the whitening stability (ΔWID) effect was assessed by varying the whiteness index for dentistry (WID). The 50:50% visual threshold was used to evaluate ΔWID values (whiteness perceptibility [WPT] and whiteness acceptability [WAT]). Color parameters changes (ΔL*Δa*Δb*), WID, and ΔWID data were subjected to 2-way repeated measures ANOVA followed by Tukey's test (α = 0.05). RESULTS: Different UV-aging periods influenced the chromatic coordinates, WID, and ΔWID of the ceramic restorations regardless of the bleaching treatment, antioxidant solutions and luting periods (P < .05). In general, ΔWID values after UV-aging periods were above perceptibility and acceptability thresholds (WPT = 0.72 and WAT = 2.62, respectively) for all experimental groups (P < .05). Unbleached and 10% ascorbic acid-treated enamels luted after 14 days of the antioxidant action exhibited lower ΔL* and Δb* values, while control group showed lower Δa* values. All experimental groups showed similar performance on ΔWID compared to the control group, regardless of the UV-aging period analyzed (P > .05). CONCLUSION: α-tocopherol is a suitable antioxidant solution to be used 24 h post enamel bleaching not compromising clinical acceptability of ceramic laminate veneers. CLINICAL RELEVANCE: The adhesive interface of ceramic laminate veneers may appear darker after the use of antioxidant agents affecting the clinical acceptability of the restorations.

Cranial anatomical structures with high sexual dimorphism in metric and morphological evaluation: A systematic review.

The mastoid process has attracted the attention of several researchers due to its protected position at the base of the skull and the fact that it is relatively compact, in addition to being highly resistant and dimorphic, considered as a gold standard anatomical structure in the determination of the sexual dimorphism of skulls. However, intrinsic and extrinsic factors may influence this anatomical structure over time, providing contradictory and ambiguous data. Therefore, other anatomical structures need to be evaluated concurrently with the mastoid process to provide better accuracy and reliability of skull sexual dimorphism data. Thus, the objective of this systematic review was to evaluate the degree of reliability of the mastoid process to determine sexual dimorphism compared to other dimorphic structures, since there are still no systematic reviews on the subject in the literature. This review follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD 42023395167 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Are skull anatomical structures reliable as alternatives to determine sexual dimorphism compared to the mastoid process?". A literature search for studies was performed in the MEDLINE Scopus, Web of Science, LILACS, and Cochrane Library databases. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 13 ex-vivo studies published between 2008 and 2023. The risk of bias was considered low in 12 of the studies, and high in 1 study. Based on the findings, it can be concluded that even with the limitations of this systematic review, quantitative and qualitative analyses are essential in sexual identification of human skulls, and different anatomical structures can be used as references in addition to the mastoid process, with high reliability and precision, among them the; glabella, frontal profile, superciliary arch, bizygomatic width, maximum cranial length, and nasal height.

A systematic review of photogrammetry as a reliable methodology in gender identification of human skull.

One of the most important parameters in the identification process in forensic Medicine and Dentistry is the determination of sex through the skull, based on morphological and metric dimorphism. Photogrammetry is an affordable option that allows the reconstruction of position, orientation, shape, and size, allowing the performance of quantitative and qualitative analyzes to identify the sex of the individual. However, there are few systematic reviews in the literature validating whether photogrammetry is a reliable methodology for sexual identification using human skulls. Therefore, the objective of the current systematic review was to validate whether photogrammetry of dry skulls is reliable as a method for calculating sex in human identification. This revision follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD420223 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Is test photogrammetry reliable as a method for estimating sex in human identification?". A literature search for studies was performed in the databases MEDLINE Scopus, Web of Science, LILACS, and the Cochrane Library. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 11 ex-vivo studies published between 2001 and 2021. The risk of bias was considered low in 8 of the studies, and high in 3 studies. Based on this systematic review, it can be concluded that the photogrammetry method is viable and reliable in identifying sexual dimorphism.

Influence of antimicrobial photodynamic therapy on the bond strength of endodontic sealers to intraradicular dentin: A systematic review and meta-analysis.

BACKGROUND: The objective of this systematic review and meta-analysis (SRMA) was to investigate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of endodontic sealers to intraradicular dentin. METHODS: This SRMA followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42022319856). A population, intervention, control, and outcome (PICO) question was formulated: "Does antimicrobial photodynamic therapy decrease the bond strength of root canal sealers?". A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases until July 2022. Joanna Briggs Institute Critical Assessment Guidelines for Quasi-Experimental Studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (p<0.05). RESULTS: Out of an initial 345 articles, 8 in vitro studies were included, published between 2013 and 2022. The studies were qualitatively analyzed; two studies showed a positive effect, two studies a negative effect, and the other studies showed no effect on bond strength of endodontic sealers to intraradicular dentin. Seven of the studies were included in the SRMA, which indicated that there was no significant difference in bond strength when using aPDT (P = 0.90; MD: -0.03; 95% CI: -0.46 to -0.41). There was a high level of evidence for each meta-analysis outcome. CONCLUSION: It can be concluded that the use of aPDT as a method of root canal disinfection does not negatively influence the bond strength of endodontic sealers in the root canal.

In vitro study on how photodynamic therapy and calcium hydroxide medication influence adhesive interface properties of glass-fiber posts to intraradicular dentin.

PURPOSE: This in vitro study evaluated the influence of antimicrobial photodynamic therapy (aPDT), using methylene blue (MB) as photosensitizer (PS) and calcium hydroxide (CH) as intracanal medication on adhesive bond strength, sealing, and integrity of the luting interface of glass-fiber posts to different thirds of endodontically treated root canal dentin. MATERIAL AND METHODS: 102 incisors were sorted into 6 groups: a negative control irrigated with deionized water; a positive control irrigated with deionized water and filled with CH; CH + MB 50 mg/L without laser radiation; CH + MB 100 mg/L without laser radiation; CH + MB 50 mg/L radiated by red laser; and CH + MB 100 mg/L radiated by red laser. Push-out bond strength (n = 8), adhesive interface sealing (n = 3), and volume and quantification of voids (n = 6) were assessed using a universal testing machine, confocal laser scanning microscope, and computerized microtomography, respectively. Scanning electron micrographs were obtained from representative samples to qualify the fracture patterns. Push-out bond strength and adhesive interface integrity data were subjected to 2-way ANOVA for repeated measures followed by Tukey's test (α = 0.05). Adhesive interface sealing was evaluated by the inter-examiner Kappa test and submitted to Kruskal-Wallis and Dunns tests (α = 0.05). RESULTS: Assessing the apical region, the positive control and MB100WA + Ca(OH)2 groups showed lower adhesive bond strength compared to the MB100A + Ca(OH)2 group (P < 0.05). The cervical third showed higher bond strength than the apical third for the positive control, MB50WA + Ca(OH)2, MB100WA + Ca(OH)2, and MB50A + Ca(OH)2 groups (P < 0.05). A prevalence of mixed failure was observed in all experimental groups. There were no statistically significant differences in adhesive interface sealing for any of the parameters assessed (P > 0.05). MB100WA + Ca(OH)2 and MB100A + Ca(OH)2 groups promoted a higher volume and quantification of voids compared to the negative control group evaluating the cervical third (P < 0.05). In general, there were no differences in the quantification of voids comparing the intraradicular thirds (P > 0.05), differently to the volume of voids in which, in general, the cervical third promoted higher values compared to the middle and apical thirds (P < 0.05). CONCLUSION: aPDT with methylene blue PS at 50 mg/L associated with calcium hydroxide as intracanal medication demonstrated satisfactory bond strength, sealing, and integrity of the adhesive interface at any intraradicular depth.

Do different adhesives influence the color stability and fluorescence of composite restorations after aging?

This study aimed to evaluate the influence of dental adhesive color on the chromatic stability and fluorescence intensity of composite resin restorations of different thicknesses. Ninety bovine enamel samples were obtained and restored with resin composite varying thicknesses of restorative material and enamel (1.0 mm enamel and 1.0 mm composite; 1.5 mm enamel and 0.5 mm composite; 0.5 mm enamel and 1.5 mm composite). The restorations were made of composite resin (Opallis E-bleach H) using different types of dental adhesives: Ambar, Ambar APS, and Single Bond Universal (n=10). The samples were subjected to color measurement tests in a spectrophotometer using CIEDE2000 and fluorescence intensity measurements before and after aging in a red wine coloring solution. Data were subjected to analysis of variance (ANOVA) and Tukey's test (α = 0.05). There were no statistically significant changes in color stability or fluorescence intensity for restorations made of different materials or thicknesses (p>0.05). Single Bond Universal showed greater color stability at 0.5 mm thickness (ΔE00 = 4.4 ± 1.6) compared to other thicknesses of the same material (p=0.003), as well as a greater difference in fluorescence intensity after aging at 1.5 mm thickness (-414.9 ± 103.8) compared to other materials (p=0.0002). Overall, it was concluded that the different adhesive systems did not influence the color stability and fluorescence of restorations of different thicknesses.

Effects of methylene blue and curcumin photosensitizers on the color stability of endodontically treated intraradicular dentin.

BACKGROUND: Photodynamic therapy with photosensitizers can reduce the microbial load. However, few studies have evaluated the effects of photosensitizers on the color stability of endodontically treated intraradicular dentin. This in vitro study investigated the effects of methylene blue and curcumin photosensitizers used in photodynamic therapy on the color stability of intraradicular dentin. METHODS: Sixty human incisors were divided into three experimental groups according to the photosensitizer solutions used and their concentrations: methylene blue (25 mg/L), curcumin (1000 mg/L), and curcumin (1500 mg/L). The color stability of endodontically treated intraradicular dentin was evaluated using a portable reflectance spectrophotometer before and after the samples been storage in 2 mL of the photosensitizer solutions during 5 min (n = 20). Color stability data were subjected to a normality test, and statistical analysis was performed using the one-way analysis of variance and Tukey least significant difference test (α = 0.05). RESULTS: Samples treated with 25 mg/L methylene blue photosensitizer showed a higher level of color alteration than those stored in 1000 mg/L curcumin (p = .03322). However, there was no significant difference in the color alteration profiles between the samples treated with 25 mg/L methylene blue and 1500 mg/L curcumin (p = .36428). Furthermore, there was no difference in the color alteration profiles between the dentin samples immersed in 1000 mg/L and 1500 mg/L curcumin photosensitizer solutions (p = .45321). CONCLUSIONS: Methylene blue and curcumin photosensitizers influenced the color stability of endodontically treated intraradicular dentin, and this color alteration exceeded the clinical acceptability threshold. Samples treated with 25 mg/L methylene blue showed the highest level of color alteration.

In vitro study on how antioxidant solutions affect enamel surface characteristics and bonding interface of ceramic laminate veneers luting after dental bleaching.

PURPOSE: This in vitro study aimed to determine the effect of antioxidant solutions used after dental bleaching on the shear bond strength and adhesive interface sealing of ceramic laminate veneer luting. Additionally, effects on the enamel surface characteristics of hydrogen peroxide neutralization, surface energy, total free interaction energy, morphology, and chemical composition of enamel were assessed. MATERIAL AND METHODS: Total 127 bovine incisors were divided into experimental groups, according to the surface treatment (unbleached and bleached enamel), antioxidant types (control; 10% ascorbic acid and 10% α-tocopherol), and periods of luting of ceramic laminates (24 h and after 14 days). Shear bond strength was assessed using microtensile test before and after thermal cycling (5760 cycles, 5-55 °C) (n = 6). The sealing of the adhesive interface was assessed using a confocal laser scanning microscope (n = 3). Hydrogen peroxide neutralization analysis was performed using a spectrophotometer (n = 5). The surface energy and total free interaction energy (n = 10) were measured using an automatic goniometer, while enamel morphology and chemical composition were assessed by scanning eletron microscopy (n = 3). Shear bond strength and enamel surface properties data were subjected to ANOVA followed by Tukey's test (α = 0.05). Adhesive interface micrographs were evaluated by the inter-examiner Kappa test and subjected to Kruskal-Wallis and Dunn's tests (α = 0.05). RESULTS: In general, thermal aging decreased the shear bond strength values of the luting agents to enamel (P < .05). The α-tocopherol solution was able to reverse the oxidizing effect from dental bleaching, increasing the shear bond strength values and preserving the integrity of the adhesive interface sealing (P < .05). Moreover, the α-tocopherol antioxidant agent promoted higher hydrogen peroxide neutralization after dental bleaching (P < .05). Dental bleaching influenced the enamel surface, decreasing the surface energy and total free interaction energy values (P < .05). CONCLUSION: α-tocopherol was able to reverse the oxidizing effects of dental bleaching, improving the enamel surface properties, as well as the adhesion and interface sealing of ceramic laminate veneer restorations.

Surface characterization of indirect restorative materials submitted to different etching protocols.

OBJECTIVES: This in vitro study aimed to evaluate the effect of different times and concentrations of hydrofluoric acid etching on the surface of indirect restorative materials obtained from blocks used in CAD-CAM technology. METHODS: Specimens (4 mm × 4 mm × 0.8 mm) were obtained for each indirect restorative material: zirconia-reinforced lithium monosilicate ceramic (Celtra Duo), nanoceramic resin (Lava Ultimate), and polymer-infiltrated ceramic network material (Vita Enamic). The materials were submitted to etching with 5% or 10% hydrofluoric acid for 20, 40, 60, or 90 s. A control group for each material was evaluated without any surface treatment, totaling nine experimental groups for each material (n = 10). The specimens were evaluated for surface roughness (Ra and Rz), confocal optical microscopy, the contact angle (θ), surface free energy (γs), total free interaction energy (∆G) using a goniometer, and microshear bond strength to resin cement. Specimen images were obtained using scanning electron microscopy, confocal optical microscopy, and atomic force microscopy. Data on the surface roughness, the contact angle, surface free energy, total free interaction energy, and bond strength were subjected to two-way ANOVA and Tukey´s test (α=0.05). RESULTS: In general, Celtra Duo showed better results after etching with 10% hydrofluoric acid for 40 or 60 s. Lava Ultimate showed better performance after etching with 10% hydrofluoric acid for 20 or 40 s, whereas Vita Enamic showed better results after etching with 5% hydrofluoric acid for 90 s. CONCLUSION: Each material showed different characteristics after etching with hydrofluoric acid. Knowledge of the proper protocol for each material is essential to ensure improvements in the adhesion process and durability of indirect restorations. In general, Celtra Duo presented mechanical properties superior to those of Lava Ultimate and Vita Enamic. CLINICAL SIGNIFICANCE: Specific etching protocols must be recommended for each indirect material because longer exposure to hydrofluoric acid can jeopardize the surface, thus affecting the mechanical and bond strength properties.