Lawrence Gonzaga Lopes

A retrospective study of Traumatic Dental Injuries in a Brazilian dental urgency service

Epidemiologic aspects of traumatic dental injuries (TDI) were evaluated in the permanent dentition in a sample of 847 patients treated at the Dental Urgency Service of the Dental School of the Federal University of Goiás, Brazil, between May 2000 and May 2008. The statistical treatment analyzed data from frequency distribution and chi-square test. The level of significance was set at 5% for all analyses. The results showed a higher incident among males (610; 72.01%) with mean age of 6-10 year-old. Uncomplicated crown fracture (without pulp exposure) (502; 26.95%), avulsion (341; 18.30%) and complicated crown fracture (with pulp exposure) (330; 17.71%) were the most prevalent TDI. The prevalence of trauma throughout the years showed proportionality, being observed a larger number of cases between July and September (249; 29.39%). The most affected teeth were the maxillary central incisors (65.65%), followed by the maxillary left lateral incisors (19.67%). In 311 participants (18.25%), only one tooth was involved, while in most patients (536; 81.75%), TDI occurred in more than one tooth. Significant proportion (82.27%) of traumatized teeth presented completely formed root apex. The main etiologic factors involved in TDI were falls (51.71%), traffic accidents (22.90%) and violence (5.67%). Based on the obtained data, it may be concluded that accurate policies of TDI prevention must be established, capable of stimulating the exposure of appropriate protocols for management of these lesions. The prevalence of TDI in Goiânia subpopulation is compared to the prevalence reported in epidemiological studies in others populations.

Effect of light-curing units and activation mode on polymerization shrinkage and shrinkage stress of composite resins

The aim of this study was to evaluate the polymerization shrinkage and shrinkage stress of composites polymerized with a LED and a quartz tungsten halogen (QTH) light sources. The LED was used in a conventional mode (CM) and the QTH was used in both conventional and pulse-delay modes (PD). The composite resins used were Z100, A110, SureFil and Bisfil 2B (chemical-cured). Composite deformation upon polymerization was measured by the strain gauge method. The shrinkage stress was measured by photoelastic analysis. The polymerization shrinkage data were analyzed statistically using two-way ANOVA and Tukey test (p≤0.05), and the stress data were analyzed by one-way ANOVA and Tukeys test (p≤0.05). Shrinkage and stress means of Bisfil 2B were statistically significant lower than those of Z100, A110 and SureFil. In general, the PD mode reduced the contraction and the stress values when compared to CM. LED generated the same stress as QTH in conventional mode. Regardless of the activation mode, SureFil produced lower contraction and stress values than the other light-cured resins. Conversely, Z100 and A110 produced the greatest contraction and stress values. As expected, the chemically cured resin generated lower shrinkage and stress than the light-cured resins. In conclusion, The PD mode effectively decreased contraction stress for Z100 and A110. Development of stress in light-cured resins depended on the shrinkage value.

Nanosilver Application in Dental Cements

Streptococcus mutans is the microorganism mostly responsible for initiation of tooth decay and also for the progression of an established lesion. Silver has been used for its antibacterial properties for many years, in different forms: ionised and elementary forms, as silver zeolites or as nanoparticles. The purpose of this study was to evaluate the antibacterial activity of three dental cements modified by nanosilver. Three cements were used: Sealapex, RelyX ARC, and Vitrebond. The cements were incorporated with 0.05 mL of silver nanoparticles solution. Control groups were prepared without silver. Six Petri plates with BHI were inoculated with S. mutans using sterile swabs. Three cavities were made in each agar plate (total = 18) and filled with the manipulated cements. They were incubated at 37∘C for 48 h, and the inhibition halos were measured. The paired t-Test was used for statistical analysis (𝑃<0.05). No inhibition halos were obtained for Sealapex and Rely X, but Vitrebond showed bactericidal activity without silver and enhanced effect with silver incorporation.

Three-dimensional image contribution for evaluation of operative procedural errors in endodontic therapy and dental implants

Acceptable therapeutic protocol in dentistry depends on the outcomes obtained with follow up. Operative procedural errors (OPE) may occur and they represent risk factors able to compromise a tooth or a dental implant. The aim of this study was to detect the OPE in endodontically treated teeth and dental implants, using cone beam computed tomography (CBCT).Eight hundred and sixteen CBCT exams were performed between January 2009 and October 2010, and only those which presented endodontically treated teeth and/or dental implants were selected. The sample was as follows: 195 CBCT exams (n=200 teeth and 200 dental implants), 72 male, 123 female, with mean age of 51 years.In endodontically treated teeth, OPE included underfilling, overfilling, and root perforation; OPEin dental implants were thread exposures, contact with anatomical structures, and contact with adjacent teeth. Kolmogorov-Smirnov test was used for statistical analysis, with significance level set at α=0.05. Underfilling, overfilling, and root perforations were detected in 33.5%, 8% and 4.5% of the teeth, respectively. Dental implants with thread exposures, contact with important anatomical structures and contact with adjacent teeth were seen in 37.5%, 13% and 6.5% of the cases, respectively. OPE were detected in endodontically treated teeth and dental implants, and underfilling and thread exposures were the most frequent occurrences, respectively.

Sorption, solubility and residual monomers of a dental adhesive cured by different light-curing units

The aim of this study was to assess polymerization ability of three light-curing units by evaluating the influence of the light source, curing regimen and permeant (water or ethanol) on sorption, solubility and amount of residual monomers of a dental adhesive. Specimens of Adper Single Bond 2 were fabricated using a stainless steel circular matrix (8 mm x 1 mm). One quartz-tungsten-halogen (QTH) lamp and two light-emitting diode (LED) device at three different curing regimes (L1 = 12 J; L2 = 24 J; L3 = 24 J) were used to cure the specimens. Specimens were stored in two types of permeants - deionized water or 75% ethanol - for two storage times (G1 =7 days; G2 = 30 days). The specimens underwent water sorption and solubility tests, according to ISO 4049:2000 standard. After storage, residual monomers were identified and quantified by high performance liquid chromatography (HPLC). For sorption, L1 showed the highest values and QTH, the lowest. For solubility, in ethanol-stored groups, L1 had also the highest values, and QTH, the lowest, and findings were significantly different from the other curing regimens. L1 leached significantly more monomers than the others, and QTH had the lowest results. In conclusion, the type of light source, the curing regimen and the permeant affected sorption, solubility and amount of residual monomers of the adhesive under study.

Influence of pulse-delay curing on sorption and solubility of a composite resin

The purpose of this study was to evaluate the sorption and solubility of a composite resin (TPH3; Dentsply) cured with halogen light due to different storage media and curing modes. The methodology was based on the ISO 4049 standard. Two independent groups were established according to the storage time (7 days-G1; 60 days-G2). A stainless steel mould (2 mm x 8 mm ø) was used. The selected curing modes were: I (Conventional - C): 40s - 600 mW/cm2; II (Pulse I - PD): 3 s - 200 mW/cm2 + 2 min (delay) + 39 s - 600 mW/cm2; III (Pulse II): 10 s - 200 mW/cm2 + 2 min (delay) + 37 s - 600 mW/cm2; IV (Pulse III): 3 s- 600 mW/cm2 + 2 min (delay) + 37 s -600 mW/cm2. The media used were: distilled water, 75% ethanol and 100% chlorophorm. Five repetitions were made for each group. The specimens were placed in a desiccator at 37°C for 24 h and, after that, at 23°C for 1 h to be weighed until a constant mass (m1) was obtained. The discs were immersed separately into the 3 media for 7 days (G1) and 60 days (G2), and thereafter reweighed (m2). The reconditioning in the desiccator was done until a constant mass (m3) was obtained. Sorption and solubility were calculated and the data of G1 and the sorption data of G2 were subjected to two-way ANOVA and Tukeys tests (p=0.05). The solubility data of G2 were analyzed by Kruskal-Wallis test (p=0.05). For G1 and G2, no statistically significant differences were found in sorption among curing techniques (p>0.05). The solubility values were negative, which means that there was mass gain. Regarding the storage media, in G2 chlorophorm had the highest sorption values. It may be concluded that the curing modes (C and PD I, II and III) did not affect the sorption of the tested composite resin. However, different storage media influenced sorption behavior. The solubility test demonstrated negative data, masking the real solubility.

Evaluation of internal adaptation of Class V resin composite restorations using three techniques of polymerization.

Objective: The purpose of this in vitro study was to evaluate the internal adaptation of Class V composite restorations to the cavity walls using three different techniques of polymerization. Methods: Standard cavities were prepared on the buccal and lingual surfaces of 24 extracted human third molars with margins located above and below the cementoenamel junction. Restorations were placed in one increment using two restorative systems: 3M Filtek A110/ Single Bond (M) and 3M Filtek Z250/ Single Bond (H) in the same tooth, randomly in the buccal and lingual surfaces. Resin composites were polymerized using three techniques: Group 1 – Conventional (60 s - 600 mW/cm2); Group 2 – Soft-start (20 s – 200 mW/cm2, 40 s - 600 mW/cm2); Group 3 – Pulse Activation (3 s - 200 mW/cm2, 3-min hiatus, 57 s - 600 mW/cm2). Buccolingual sections were polished, impressions taken and replicated. Specimens were assessed under scanning electron microscopy up to X1000 magnification. Scores were given for presence or absence of gaps (0 – no gap; 1 – gap in one wall; 2 – gap in two walls; 3 – gap in three walls). Results: The mean scores of the groups were (±SD) were: G1M–3.0 (± 0.0); G2M–2.43 (± 0.8); G3M– 1.71 (± 0.9); G1H– 2.14 (± 1.2); G2H- 2.00 (± 0.8); G3H- 1.67 (± 1.1). Data were analyzed using Kruskal-Wallis and Dunnet’s tests. No statistically significant difference (p>0.05) was found among groups. Gaps were observed in all groups. Conclusions: The photocuring technique and the type of resin composite had no influence on the internal adaptation of the material to the cavity walls. A positive effect was observed when the slow polymerization techniques were used.

Inflammatory response of human dental pulp to at-home and in-office tooth bleaching

ABSTRACT Tooth bleaching is a technique of choice to obtain a harmonious smile, but bleaching agents may damage the dental pulp. Objective: This study evaluated the inflammatory responses of human dental pulp after the use of two bleaching techniques. Material and Methods: Pulp samples were collected from human third molars extracted for orthodontic reasons and divided into three groups: control - no tooth bleaching (CG) (n=7); at-home bleaching with 15% carbamide peroxide (AH) (n = 10), and in-office bleaching with 38% hydrogen peroxide (IO) (n=12). Pulps were removed and stained with hematoxylin-eosin for microscopic analysis of inflammation intensity, collagen degradation, and pulp tissue organization. Immunohistochemistry was used to detect mast cells (tryptase+), blood vessels (CD31+), and macrophages (CD68+). Chi-square, Kruskal-Wallis, and Mann Whitney tests were used for statistical analysis. The level of significance was set at p<.05. Results: The inflammation intensity and the number of macrophages were significantly greater in IO than in AH and CG (p<0.05). The results of CD31+ (blood vessels per mm2) were similar in CG (61.39±20.03), AH (52.29±27.62), and IO (57.43±8.69) groups (p>0.05). No mast cells were found in the pulp samples analyzed. Conclusion: In-office bleaching with 38% hydrogen peroxide resulted in more intense inflammation, higher macrophages migration, and greater pulp damage then at-home bleaching with 15% carbamide peroxide, however, these bleaching techniques did not induce migration of mast cells and increased the number of blood vessels.

Effect of light sources and curing mode techniques on sorption, solubility and biaxial flexural strength of a composite resin

Adequate polymerization plays an important role on the longevity of the composite resin restorations. Objectives The aim of this study was to evaluate the effect of light-curing units, curing mode techniques and storage media on sorption, solubility and biaxial flexural strength (BFS) of a composite resin. Material and Methods Two hundred and forty specimens were made of one composite resin (Esthet-X) in a stainless steel mold (2 mm x 8 mm Ø), and divided into 24 groups (n=10) established according to the 4 study factors: light-curing units: quartz tungsten halogen (QTH) lamp and light-emitting diodes (LED); energy densities: 16 J/cm2 and 20 J/cm2; curing modes: conventional (CM) and pulse-delay (PD); and permeants: deionized water and 75% ethanol for 28 days. Sorption and solubility tests were performed according to ISO 4049:2000 specifications. All specimens were then tested for BFS according to ASTM F394-78 specification. Data were analyzed by three-way ANOVA followed by Tukey, Kruskal-Wallis and Mann-Whitney tests (α=0.05). Results In general, no significant differences were found regarding sorption, solubility or BFS means for the light-curing units and curing modes (p>0.05). Only LED unit using 16 J/cm2 and PD using 10 s produced higher sorption and solubility values than QTH. Otherwise, using CM (16 J/cm2), LED produced lower values of BFS than QTH (p<0.05). 75% ethanol permeant produced higher values of sorption and solubility and lower values of BFS than water (p<0.05). Conclusion Ethanol storage media produced more damage on composite resin than water. In general the LED and QTH curing units using 16 and 20 J/cm2 by CM and PD curing modes produced no influence on the sorption, solubility or BFS of the tested resin.

Marginal microleakage of class II composite resin restorations due to restorative techniques

PURPOSE: To evaluate the marginal microleakage of class II composite resin (CR) restorations due to restorative techniques. METHODS: Forty human extracted premolars were assigned to 4 groups (n=10). Class II cavities were prepared (4-mm wide, 2-mm axially, with the gingival margin located 1 mm beyond the cementum-enamel-junction), and the restorative adhesive system Prime & Bond 2.1/TPH3 (Dentsply) was used. CR was inserted by the oblique incremental technique (OIT) and cured in continuous exposure. The restoratives techniques were: group 1 (control): OIT; group 2: flowable resin (1 mm) applied in the gingival wall + OIT; group 3: OIT + three pre-cured spheres inserted in the first increment of CR; and, group 4: OIT + strip of fiberglass inserted in the first increment of CR. The specimens were subjected to a thermocycling regimen of 500 cycles (1 min at 5o-37o-55oC), coated with two layers of nail varnish up to 1 mm from the restoration margins, and immersed in 0.5% basic fuchsine solution for 24 h. The extension of dye penetration at the cervical wall (µm) was evaluated using an optic microscope at x40. Data were analyzed using analysis of variance (ANOVA) (α=0.05). RESULTS: The microleakage values were: G1: 370 µm ± 241; G2: 398 µm ± 354; G3: 205 µm ± 119; and G4: 413 µm ± 340. No statistically significant differences were found among the restorative techniques (P=0.081). CONCLUSION: Marginal microleakage values were not influenced by the different restorative techniques tested.