Clinical Oral Investigations最新文献

Objective: To evaluate the effect of polishing systems on the color and roughness of conventional and bulk-fill nanofilled resins, compared to conventional and bulk-fill nano-hybrid resins with S-PRG fillers.

Materials and methods: Discs (n = 12) were fabricated from the following resin composites: conventional nanofilled resin (Filtek Z350 XT, 3 M), bulk-fill nanofilled resin (Filtek One Bulk-Fill, 3 M), conventional nano-hybrid resin with S-PRG fillers (Beautifil II LS, Shofu), and bulk-fill nano-hybrid resin with S-PRG filler (Beautifil Bulk Restorative, Shofu). Polishing was conducted using multi-grit aluminum oxide abrasive discs (Sof-Lex Pop On, 3 M) or a single-grit aluminum oxide tip (OneGloss, Shofu). Roughness (Ra) and color (CIEL*a*b*, ΔE_ab and ΔE₀₀) were assessed at baseline, post-polishing, and post-coffee staining. Surface micromorphology was analyzed using scanning electron microscopy (SEM).

Results: Roughness increased after polishing with the aluminum oxide tip for all materials (p < 0.0001; Mann-Whitney). Bulk-fill nanofilled resin showed increased roughness, while conventional nano-hybrid resin with S-PRG filler showed decreased roughness after multi-grit disc polishing (p < 0.0001; Mann-Whitney). Coffee staining significantly increased the roughness in resin composites with S-PRG filler (p < 0.0001; Mann-Whitney). All resin composites exhibited reduced L* and b* (p < 0.05; generalized linear mixed models for repeated measures) and increased a* (p < 0.05; Friedman and Nemenyi) values after coffee staining. ΔE_ab and ΔE₀₀ were significantly higher for bulk-fill nano-hybrid containing S-PRG filler, irrespective of polishing type (p < 0.0001; Friedman and Nemenyi). SEM analysis revealed surface degradation and/or particle loss in resin composites with S-PRG filler (conventional and bulk-fill) post-polishing. Single-grit polishing resulted in greater surface irregularities across all resins.

Conclusion: Polishing systems significantly influence resin composite roughness based on their composition, with single-grit polishing causing the highest roughness. Bulk-fill nano-hybrid resin composite with S-PRG filler exhibited the greatest color and roughness changes post-staining.

Clinical relevance: Bulk-fill resin composite with S-PRG filler demonstrated lower color and surface stability. Importantly, these changes were significantly mitigated when polished using a multi-stage polishing system.

Background: To measure the actual moving direction and displacement of the root and crown of maxillary teeth before and after treatment in molar distalization cases using clear aligners(CAs).

Materials and methods: This retrospective study included 28 adult patients who received maxillary distalization treatment with CAs. The pre- and post-treatment CBCT were superimposed and the crown and root of all maxillary teeth were marked. Achieved and predicted three-dimensional displacement of maxillary teeth were then compared using the paired t test. Mixed-effect model was used to explore the influence of different staging design (one-molar distalization vs. two-molar distalization) and anchorage (TAD vs. Class II elastic vs. no extra anchorage management).

Results: Labial displacement happened to the anterior teeth even the palatal displacement was prescribed. Body distalization of maxillary posterior teeth could not be fully achieved as predicted. The premolars and molars achieved greater distal tipping, buccal inclination, and less distal displacement than predicted. In buccal-palatal dimension, the greatest buccal tipping tendency happened to the 2nd premolar and decreased toward the distal portion of the aligner. In the mesial-distal dimension, the highest accuracy of molar distalization was found in the 2nd molars while the lowest in the 1st premolars. No significant difference was found between two molar distalization patterns. Extra anchorage management devices could not diminish the difference between the predicted and achieved displacement.

Conclusions: The achieved molar distalization displacement and anterior teeth retraction is not as good as expected using CAs. The anterior and posterior anchorage loss cannot be completely avoided despite extra anchorage management devices are adopted. The potential reason for the correction of class II malocclusion needs further exploration.

Objectives: Cytokines are critical role in the pathogenesis of periodontal diseases. Meteorin-like (Metrnl), a protein released in the oral mucosa, is a novel cytokine associated with various inflammatory diseases. This study aimed to evaluate levels of salivary and gingival crevicular fluid (GCF), interleukin - 1 beta (IL-1β), interleukin - 10 (IL-10), and Metrnl in periodontal disease.

Materials and methods: It was formed three groups of 20 individuals each: the healthy, gingivitis, and periodontitis (Stage III, Grades A and B) groups. The enzyme-linked immunosorbent assay method measured IL-1β, IL-10, and Metrnl levels in salivary and GCF samples. Clinical periodontal measurement including probing pocket depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI) and percentage of bleeding on probing (%BOP); and biochemical parameters were evaluated using statistical analysis.

Results: Salivary concentrations and GCF total amount of IL-1β were significantly higher in the periodontal disease groups (p < 0.001). There was no significant difference among the groups in either salivary concentrations or GCF total amount of IL-10 (p > 0.05). Salivary Metrnl concentrations were significantly lower in the periodontitis group (p = 0.002). Salivary Metrnl concentrations had significant negative correlations with %BOP, PD, and CAL (p < 0.05). GCF total amount of Metrnl had significant negative correlations with GCF total amount of IL-1β (p = 0.03). The receiver operating characteristics curve showed: area under the curve (AUC) = 0.731 for salivary Metrnl concentrations to discriminate periodontitis from periodontal health and gingivitis.

Conclusion: Based on the findings of this study, Metrnl, as an immunoregulatory cytokine, may have an important relationship with periodontitis. Additional studies are needed to fully elucidate the functional effect of Metrnl in periodontal disease.

Clinical relevance: Background In knock-out experimental studies, it has been reported that Metrnl acts as an inflammation-related immunoregulatory cytokine. The findings relating it to inflammatory diseases support the idea that Metrnl may play a role in the pathogenesis of a variety of inflammatory diseases.

Added value of this study: Although Metrnl is a protein abundantly secreted in the oral mucosa, to the authors' knowledge there has been no study evaluating it in gingivitis and periodontitis, inflammatory diseases. In this study, the levels of Metrnl in oral fluids, such as GCF and saliva, were examined in the presence of different periodontal diseases.

Clinical implications: Metrnl can be useful in distinguishing periodontal destruction from periodontal health.

Objectives: This study aimed to evaluate the effect of different irrigation protocols on the viability and metabolism of stem cells from the apical papilla (SCAP) using a new in vitro protocol that simulates the clinical situation.

Materials and methods: Forty-eight bovine dentin cylinders were obtained and prepared to simulate teeth with incomplete rhizogenesis, positioned under a three-dimensional (3D) culture of SCAPs to mimic the apical papilla. The cylinders were divided into four groups (n = 8) according to the irrigating solution: Control; NaOCl (Sodium hypochlorite 1%); EDTA (17% ethylenediaminetetraacetic acid); and NaOCl + EDTA. Subsequently, the viability (Live/Dead n = 2) and metabolism (Alamar Blue n = 6) of the cells were assessed (ISO 10993). Data were analyzed using Kruskal-Wallis and Dunn tests (p < 0.05).

Results: In the 1 to 3 days period, Control and EDTA had significantly higher increases in metabolism compared to NaOCl and NaOCl + EDTA (p < 0.05). In the 3- to 7-day period, metabolism significantly decreased in NaOCl + EDTA compared to EDTA (p < 0.05) but was similar to Control and NaOCl. Additionally, significant differences were observed within groups Control, EDTA, and NaOCl + EDTA across the two periods (p < 0.05).

Conclusions: The tested in vitro model allows for the analysis of the response of SCAPs to different irrigating solutions, simulating the clinical situation. Sodium hypochlorite 1% demonstrated high cytotoxicity to SCAPs, whose effects were partially reversed by 17% EDTA.

Clinical relevane: The methodology developed provides a tool for future investigations, allowing for the assessment of new irrigants and techniques that may optimize tissue regeneration.

Objective: To evaluate the Cost-Efficiency of Atraumatic Restorative Treatment (ART) with a chemical-mechanical caries removal agent (CMCRA, Papacárie Duo Gel^Ⓡ) compared to conventional ART, based on pain perceived and time for selective removal of carious tissue, from the perspective of the Brazilian Unified Health System (SUS).

Materials and methods: The Cost-Efficiency analysis was conducted using TreeAgePro software, considering a 12-month horizon and a hypothetical cohort based on Monte Carlo microsimulation. ART + CMCRA was compared to ART in deciduous teeth, based on 26,700 treatments performed on children attended by SUS in Rio de Janeiro. Direct costs were calculated in Brazilian currency using the microcosting technique. Efficiency measures related to pain and caries removal time were extracted from a high-quality randomized clinical trial. Probabilistic simulation considered a 95% confidence interval and a 5% variation in parameters, generating acceptability curves to estimate the probability of treatment choice.

Results: ART + CMCRA proved superior (p < 0,001) in terms of benefit. For pain perceived efficiency, ART + CMCRA resulted in a cost increase of R$ 0.23 per procedure, with an additional benefit of 47.53%. For time efficiency, there was a cost increase of R$ 0.24 per procedure, with an additional benefit of 14.19%.

Conclusion: ART + CMCRA is a cost-efficient option for SUS. The implementation of this technique in Rio de Janeiro's public health system can be recommended due to the reduced pain, despite requiring a higher willingness to pay for the additional benefits.

Clinical relevance: The adoption of ART + CMCRA in SUS can significantly improve the experience of pediatric patients by reducing pain, making dental treatment more efficient and humane.

Aim: The surface gloss of restorative materials can be greatly impacted by abrasion from tooth brushing. This study aimed to evaluate the effect of simulated tooth brushing using regular and abrasive toothpaste on the surface gloss of glazed monolithic all-ceramic restorations.

Materials and methods: In this, in vitro study, four different monolithic all-ceramic materials were used: Cerec Tessera (advanced lithium disilicate), Celtra Due (zirconia reinforced lithium silicate), Cerec Zirconia+ (Translucent Zirconia), and Cerec Blocs (Feldspathic). Eighty rectangular shaped specimens were made (20 of each material) using a low-speed diamond disc with the following dimensions (12/10/ 1 mm). The samples were polished using polishing kit & paste (DIAPOL, EVE). A glaze (Universal overglaze, Dentsply Sirona) was applied to all the samples then a toothbrushing simulator was used for 10.000 cycles using two different toothpastes. Surface gloss was assessed before and after simulated tooth brushing using glossmeter.

Results: The results showed a significant reduction in the mean surface gloss of the four materials after the use of regular and abrasive toothpastes (P < 0.001). In all materials, the use of abrasive toothpaste was associated with more reduction of surface gloss (P < 0.001).

Conclusion: Simulated tooth brushing and toothpaste type affect the surface gloss of glazed monolithic all-ceramic materials.

Clinical significance: The surface characteristics of monolithic all-ceramic materials is affected by abrasion from toothbrushing which could impact the surface of the materials and possibly alter the glaze coating, compromising the restoration's longevity and esthetics. This effect was greater with the use of abrasive toothpaste.

Objectives: The study aimed to develop and evaluate in vitro a varnish containing fluoride-doped glass ceramics capable of inhibiting oral microorganisms, releasing hydroxyapatite-forming ions, and ensuring biocompatibility.

Materials and methods: For the production of the experimental varnish (VE), composed of hydrogenated rosin, 10% and 20% by weight of glass ceramics with composition S53P4 (CF0) and doped with F- ions (CF5 and CF10) were incorporated. The EVs were characterized by Rheology, Scanning Electron Microscopy (SEM), FTIR, ion release (fluoride and calcium ions), cytotoxicity on VERO cells, and antimicrobial effect on S. mutans, S. aureus and C. albicans and anti-biofilm effect on S. mutans. The data were analyzed by One-Way ANOVA and Kruskal-Wallis test (P = 0.05).

Results: Homogeneous varnishes with good viscosity were obtained. Varnishes with 20% CF demonstrated biocompatibility and minimum inhibitory concentration (MIC) at concentrations lower than 10 mg/mL and 3.12 mg/mL, respectively, except for C. albicans. An anti-biofilm effect on S. mutans was observed for the varnishes with 20% CF. All varnishes with CF released more F- than the commercial varnish, with V20CF10 standing out, which released 4 times more F- ions in a quarter of the time.

Conclusions: The V20CF10 varnish is a promising material for dental use in the treatment of early caries lesions, due to its biocompatibility, antimicrobial properties, and release of hydroxyapatite-forming ions.

Clinical relevance: The use of a new varnish that combines antimicrobial properties with hydroxyapatite-forming ion release may prevent or halt the progression of dental caries lesions, offering greater efficacy than currently available varnishes.

Objectives: To investigate the prevalence of the gingival phenotype in the mandibular incisor area and the associated risk indicators.

Materials and methods: This cross-sectional study involved clinical examination to record main periodontal characteristics (gingival phenotypes) at the tooth level. Then, a phenotype at the subject level was defined as fragile (at least one thin phenotype on one of the four incisors) versus resistant (no thin phenotype on the four incisors). Furthermore, orthodontic parameters were assessed based on photographic examination. Two blinded periodontists and two blinded orthodontists were involved in the data collection. Univariate and multivariate logistic regression models were implemented.

Results: A total of 119 students were included, encompassing 476 incisors. The prevalence of gingival phenotypes at the tooth level was as follows: thin/high (63.9%), thick/high (36.3%), thin/reduced (5.9%), and thick/reduced (0.2%). At the subject level, the fragile phenotype predominated (81.5%) and showed a significant correlation with the visibility of roots prominence (OR = 4.09, 95% CI: 1.47-11.41, p = 0.007).

Conclusions: Considering the conditions of this study, in the mandibular incisor area, the thin/high gingival phenotype exhibited the highest prevalence at the tooth level. At the subject level, the presence of visible roots prominence was identified as the only significant risk indicator associated with the fragile phenotype.

Clinical relevance: General practitioners, periodontists and orthodontists should consider the mandibular incisor sector as a vulnerable area. Categorizing the overall gingival phénotype into 4 types improves the diagnostic approach and allows better identification of high-risk phenotypes, especially in cases requiring multidisciplinary management.

Clinicaltrial:

Gov record: Number NCT05813444.

Introduction: Yerba Mate (YM) is a green-colored infusion, derived from the Ilex paraguariensis plant, very popular and commonly consumed in Latin American countries (southern Brazil, Argentina, Paraguay, and Uruguay), rapidly gaining penetration in global markets, It's a beverage rich in polyphenols, alkaloids, and saponins, making its impact on the oral microbiome particularly interesting.

Objectives: This study aimed to characterize the composition of salivary microbiota in Uruguayan YM consumers and non-consumers, exploring potential implications for oral health.

Materials and methods: Salivary samples were collected from 24 YM consumers and 28 non-consumers in Uruguay (n = 52). Participants were dentistry students, aged 18 to 35, with no reported pathologies and who had no oral conditions after visual inspection. 16S rRNA gene metabarcoding Illumina sequencing was employed to analyze their microbial composition. Bioinformatic analysis was conducted to identify and compare microbial taxa between the two groups. Relevant demographic and dietary data were also collected and analyzed.

Results: The salivary microbiome of YM consumers is not completely different from non-consumers, however, several particular characteristics were found in each group. Both YM consumers and non-consumers exhibited a high relative abundance of Streptococcus species, with Streptococcus oralis being more abundant in a subset of non-consumers suggesting that YM may help maintain a balanced oral microbiota. Although no significant differences were observed in the Shannon diversity index, YM consumers might have a more diverse microbiome than non-consumers (YM consumers showed significantly higher species richness (Chao1 index), a greater number of amplicon sequence variants (ASVs), and broader microbial diversity, as confirmed by multivariate analyses). While the presence of Prevotella spp. in YM consumers aligns with previous research on polyphenol-rich beverages, its role in oral health warrants further investigation.

Conclusions: This study highlights the influence of YM consumption on salivary microbiota composition and diversity. YM consumption was associated with increased microbial diversity and species richness, which may contribute to oral microbiome resilience and health. These findings underscore the impact of dietary habits on oral microbial communities and their potential implications for oral health management and disease prevention.