Wellington Luiz de Oliveira da Rosa

Bond strength of universal adhesives: A systematic review and meta-analysis.

OBJECTIVES A systematic review was conducted to determine whether the etch-and-rinse or self-etching mode is the best protocol for dentin and enamel adhesion by universal adhesives. DATA This report followed the PRISMA Statement. A total of 10 articles were included in the meta-analysis. SOURCES Two reviewers performed a literature search up to October 2014 in eight databases: PubMed, Web of Science, Scopus, BBO, SciELO, LILACS, IBECS and The Cochrane Library. STUDY SELECTION In vitro studies evaluating the bond strength of universal adhesives to dentin and/or enamel by the etch-and-rinse and self-etch strategies were eligible to be selected. Statistical analyses were conducted using RevMan 5.1 (The Cochrane Collaboration, Copenhagen, Denmark). A global comparison was performed with random-effects models at a significance level of p<0.05. RESULTS The analysis of dentin micro-tensile bond strength showed no statistically significant difference between the etch-and-rinse and self-etch strategies for mild universal adhesives (p≥0.05). However, for the ultra-mild All-Bond Universal adhesive, the etch-and-rinse strategy was significantly different than the self-etch mode in terms of dentin micro-tensile bond strength, as well as in the global analysis of enamel micro-tensile and micro-shear bond strength (p≤0.05). CONCLUSIONS The enamel bond strength of universal adhesives is improved with prior phosphoric acid etching. However, this effect was not evident for dentin with the use of mild universal adhesives with the etch-and-rinse strategy. CLINICAL SIGNIFICANCE Selective enamel etching prior to the application of a mild universal adhesive is an advisable strategy for optimizing bonding.

A systematic review about antibacterial monomers used in dental adhesive systems: Current status and further prospects.

OBJECTIVES This study systematically review the literature to assess the effectiveness of antibacterial monomers incorporated into dental adhesive systems against major oral bacteria; as well as the research advances and the future prospects of this technology. METHODS The following seven databases were screened: MedLine (PubMed), Lilacs, Ibecs, Web of Science, Scopus, Scielo, and The Cochrane Library. Furthermore, the online system Questel Orbit (Paris, France) was accessed to obtain patent data. The inclusion criteria were articles and patents that investigated the antimicrobial activity of antibacterial monomers in dental adhesive systems. Only documents written in English, Spanish or Portuguese were included. RESULTS After screening, 33 studies and eight patents fulfilled all the criteria and were included. Antibacterial agents, such as QA, MDPB, DMAHM and DMADDM were found in patents, which claimed their incorporation into adhesive compositions, dental cements, composite resins. MDPB was the only antimicrobial monomer incorporated into a commercially available adhesive system, Clearfil Protect Bond™ (Kuraray Co. Ltd., Japan). All studies reported the inclusion of antimicrobial monomers in adhesive systems to be an effective dental treatment strategy. SIGNIFICANCE There are potential areas to be explored with antibacterial monomers for dentistry, and their use could have important implications for future more conservative dental treatments. Although there is evidence of antibacterial activity from in vitro studies, clinical studies must be conducted to confirm the effectiveness of these materials in the prevention of dental pathologies.

Endocrown restorations: A systematic review and meta-analysis

OBJECTIVES A systematic review was conducted to evaluate clinical (survival) and in vitro (fracture strength) studies of endocrown restorations compared to conventional treatments (intraradicular posts, direct composite resin, inlay/onlay). DATA This report followed the PRISMA Statement. A total of 8 studies were included in this review. SOURCES Two reviewers performed a literature search up to February 2016 in seven databases: PubMed, Web of Science, Scopus, BBO, SciELO, LILACS and IBECS. STUDY SELECTION Only clinical trials and in vitro studies that evaluated endocrowns were included. Case reports, case series, pilot studies, reviews and in vitro studies that evaluated properties other than fracture strength of endocrowns were excluded. From the 103 eligible articles, 8 remained in the qualitative analysis (3 clinical trials and 5 in vitro studies), and the meta-analysis was performed for the 5 in vitro studies. A global comparison was performed with random-effects models at a significance level of p<0.05. RESULTS Clinical trials showed a success rate of endocrowns varying from 94 to 100%. The global analysis in posterior and anterior teeth demonstrated that endocrowns had higher fracture strength than conventional treatments (p=0.03). However, when comparing endocrowns to conventional treatments only in posterior teeth (subgroup analyses), no statistically significant differences were found between treatments (p=0.07; I(2)=62%). CONCLUSION The literature suggests that endocrowns may perform similarly or better than the conventional treatments using intraradicular posts, direct composite resin or inlay/onlay restorations. CLINICAL SIGNIFICANCE Although further studies are still necessary to confirm the present findings, endocrowns show potential application for the rehabilitation of severely compromised, endodontically treated teeth.

Could the application of bioactive molecules improve vital pulp therapy success? A systematic review

This study aimed to systematically review the literature of animal studies to evaluate whether bioactive dentin proteins could improve vital pulp therapy success. The review is reported in accordance with the PRISMA Statement. Two reviewers independently conducted a literature search of seven databases: PubMed (Medline), Lilacs, IBECS, BBO, Web of Science, Scopus, and SciELO. Animal experiments in which bioactive dentin proteins were applied directly or indirectly to the pulp tissue were included. Data regarding the characteristics of the proteins evaluated, the delivery systems used and the main findings from each study were tabulated to assess the outcomes of interest (tertiary dentin formation, inflammatory response, intratubular mineralization). After screening, 32 papers were subjected to qualitative analysis. In 75% of the studies, direct pulp capping was performed. Additionally, the most studied proteins were BMP-7, TGF-β1, and extracted soluble dentin matrix proteins. In conclusion, there is evidence in the literature suggesting that bioactive dentin molecules could enhance tertiary dentin formation with fewer initial inflammatory responses in direct and indirect pulp therapy in animal models. There are potential areas to be explored for novel therapeutic approaches for dental tissue repair and regeneration with bioactive materials.

Polymerization shrinkage stress of resin-based dental materials: A systematic review and meta-analyses of technique protocol and photo-activation strategies

PURPOSE A systematic review was conducted to determine whether there were any alternative technique or additional step strategies available to reduce and control polymerization shrinkage stress development in dental resin-based restorative materials. DATA SOURCES This report followed the PRISMA Statement. A total of 36 studies were included in this review. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO. STUDY SELECTION Only in vitro studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis or mathematical models were excluded. Of the 6.113 eligible articles, 36 studies were included in the qualitative analysis, and the meta-analysis was performed with 25 studies. A global comparison was performed with random-effects models (α = 0.05). The strategies were subdivided as follows: the use of an alternative technique protocol of placing the material inside the tooth cavity; the modification of the irradiation intensity or total energy delivered to the material; the use of an alternative light-curing source; or the use of an alternative photo-activation mode. All alternative strategies showed statistically significant differences when compared with their respective controls (p < 0.05). CONCLUSION The use of alternative light-curing sources contributed more to minimizing stress development than placing the material by means of an alternative technique protocol or by modifying the irradiant intensity or total energy delivered to the material during photo-activation. Moreover, the use of an alternative photo-activation mode (intermittent light, exponential, soft-start or pulse delay modes) was shown to be an effective strategy for reducing and controlling stress development in resin-based dental materials.

Synthesis of silver-containing calcium aluminate particles and their effects on a MTA-based endodontic sealer

OBJECTIVE To synthetize calcium aluminate (C3A) and silver-containing C3A particles (C3A+Ag) testing their effects on the properties of a MTA-based endodontic sealer in comparison to an epoxy resin- and a calcium silicate-based sealer. METHODS Pure C3A and C3A+Ag particles were synthesized by a chemical method and characterized using XRD to identify crystalline phases. SEM/EDS analysis investigated morphology, particle size, and elemental composition of particles. Setting time, flow, radiopacity, water sorption and solubility of commercial and modified sealers were evaluated according to ISO 6876/2012. The pH and ions release were measured using a pHmeter and a microwave induced plasma optical emission spectrometer. The inhibition of biofilm growth was evaluated by confocal laser scanning microscopy (CLSM). Data were rank transformed and analyzed by ANOVA and Tukey test (P<0.05). RESULTS The C3A particles showed an irregular grain agglomerated structure with voids and pores. In C3A+Ag particles, Ag modified the material morphology, confirming the deposition of Ag. The physicochemical properties of the modified MTA-based sealer were similar to the commercial material, except for the significant increase in Ca+2 release. However, there was no Ag release. Setting time, flow, radiopacity, water sorption and solubility were adequate for all materials. All the materials showed alkaline pH. Antibiofilm effect was improved in the presence of C3A particles, while the biofilm inhibition was lower in the presence of Ag. SIGNIFICANCE The modified sealer presented improved antibiofilm properties and calcium release, without dramatic effects on the other characteristics. It is expected a positive effect in its antimicrobial behavior.

Clinical evaluation of two desensitizing treatments in southern Brazil: A 3-month follow-up

Abstract Objective. This study aimed to evaluate and compare the effectiveness of two treatments for dentin hypersensitivity in vivo during 90 days of follow-up. Materials and methods. The sample consisted of 117 teeth (13 patients) that were divided into three groups: control with carbomer 940 gel (n = 32) (placebo treatment), 2% sodium fluoride gel (n = 31) and low-level infrared diode laser (n = 54). Prior to the desensitizing treatment, the dentin hypersensitivity status of each tooth was assessed by an evaporative stimulus; the patients response was evaluated using the Visual Analogue Scale (VAS) and by counting the Exposure Time to Air Blast (ETAB) with a dental air syringe. Re-evaluations of the treatments occurred after 5 min, 7, 15, 30 and 90 days. The statistical analysis was performed using the Kruskal-Wallis test, Friedman test, one-way ANOVA, Tukeys test and Spearmans rank correlation (α = 5%). Results. No significant differences were observed among the low-level laser, 2% topical fluoride and carbomer 940 gel applications. When the methods of evaluation (VAS and ETAB) were compared, there was no difference among the groups with respect to the values for every period of evaluation (p < 0.001), verifying that the scores obtained with the VAS decreased at the same proportion as the remaining time of ETAB increased. Conclusions. This study showed that both tested therapies were efficacious in controlling painful symptoms associated with dentin hypersensitivity over the entire 90-day follow-up period. The treatments were able to reduce the painful symptoms caused by dentin hypersensitivity, including placebo.

New adhesive system based in metals cross-linking methacrylate

This study evaluated the anti-antibiofilm potential of silver methacrylate (Ag) or di-n-butyldimethacrylatetin (Sn) in experimental adhesive systems. Ag and Sn methacrylates were incorporated at 0.5mol%, 1mol% and 2mol% in an adhesive resin. The anti-antibiofilm potential, degree of conversion (DC), microtensile bond strength (μTBS), water sorption/solubility (WSR/SL), bonded interfaces pattern (SEM), cytotoxicity and leaching of Ag and Sn ions were evaluated. Data were statistically analyzed considering α = 0.05. Only Ag at 2% affected DC and μTBS. Ag at 1% and 2% and Sn at 1% and 2% showed anti-biofilm potential against Mutans streptococci. Ag at 1% and 2% and Sn at 2% showed a statistically significant difference to the control in WSR/SL (p < 0.05). The additions of metal methacrylate did not affect cell viability, being the adhesive resins statistically similar to controls. Leached metals of Ag were more than 100x higher than for Sn. Between the concentration tested, Ag and Sn methacrylate at 1% presented an anti-biofilm effect without altering the mechanical properties evaluated.

Bioactive treatments in bone grafts for implant-based rehabilitation: Systematic review and meta-analysis

BACKGROUND The use of bioactive proteins, such as rhBMP-2, may improve bone regeneration in oral and maxillofacial surgery. PURPOSE Analyze the effect of using bioactive proteins for bone regeneration in implant-based rehabilitation. MATERIALS AND METHODS Seven databases were screened. Only clinical trials that evaluated the use of heterologous sources of bioactive proteins for bone formation prior to implant-based rehabilitation were included. Statistical analyses were carried out using a random-effects model by comparing the standardized mean difference between groups for bone formation, and risk ratio for implant survival (P ≤ .05). RESULTS Seventeen studies were included in the qualitative analysis, and 16 in the meta-analysis. For sinus floor augmentation, bone grafts showed higher amounts of residual bone graft particles than bioactive treatments (P ≤ .05). While for alveolar ridge augmentation bioactive treatments showed a higher level of bone formation than control groups (P ≤ .05). At 3 years of follow-up, no statistically significant differences were observed for implant survival (P > .05). CONCLUSIONS Bioactive proteins may improve bone formation in alveolar ridge augmentation, and reduce residual bone grafts in sinus floor augmentation. Further studies are needed to evaluate the long-term effect of using bioactive treatments for implant-based rehabilitation.

Does laser therapy improve the wound healing process after tooth extraction? - A systematic review: Laser therapy and wound healing process

Laser therapy could amplify the oral wound healing process by stimulating cell regeneration after injury, attenuating pain, and modulating the immune system. The purpose of this systematic review was to evaluate whether the application of laser therapy improved alveolar healing after tooth extractions. Eight electronic databases were screened: MedLine (PubMed), The Cochrane Library, Web of Science, Scopus, Lilacs, Ibecs, Scielo, and BBO. Three reviewers independently assessed the title and abstracts of potentially relevant studies. Only clinical trials and animal experiments that evaluated the wound healing effect of laser therapy after tooth extraction were included. A total of 16 studies fulfilled all criteria, thus 8 animal experiments and 8 clinical trials were included. Different types of laser were evaluated, such as CO2, GaAlAs, Nd:YAG, Diode Laser, HeNe, and High‐frequency Pulsed Diode Laser. Although HF, Diode and GaAs lasers were able to enhance wound healing process in clinical studies, four trials and one animal experiment showed no improvement in wound healing with laser therapy after tooth extractions. In general, the current available evidence in the literature showed that laser therapy improved the wound healing process, but these findings were limited to the type of laser applied and its specific settings. Further well‐designed and randomized controlled trials are needed to support a benefit effect of using laser therapy after tooth extraction. PROSPERO registration number: CRD42014007509 (2014).