Operative dentistry最新文献

Background: Various techniques, products, and protocols are used for the bleaching of non-vital teeth. The walking bleach technique involves sealing the bleaching agent in the pulp chamber. In the inside/outside technique, a low-concentration bleaching agent is applied at home using a custom tray. In the in-office technique, a high-concentration bleaching agent is applied by a dental professional. Limited research has compared the effectiveness of these techniques.

Objective: This clinical trial aimed to evaluate the effectiveness of the walking bleach, the inside/outside, and the in-office bleaching techniques.

Methods and materials: Fifty-four discolored teeth were selected according to eligibility criteria, randomized, and assigned to three treatment groups (n=18): walking bleach (sodium perborate - SP), inside/outside bleaching (7.5% hydrogen peroxide -HP7.5), and in-office bleaching (35% hydrogen peroxide - HP35). A cervical seal was placed in all the teeth, and nonvital bleaching was performed according to each technique. The CIELab color coordinates were measured using a clinical spectrophotometer at baseline, weekly, and at the 1-week follow-up. ΔE00 and ΔWID were calculated between the baseline and each evaluation time point. The ANOVA, Fisher exact, and Kruskal-Wallis tests were used to compare the quantitative variables, and the Fisher exact test, to determine the association among categorical variables. Bleaching effectiveness was interpreted by 50:50% perceptibility and acceptability thresholds.

Results: As the treatment progressed, all techniques presented a significant increase in L* and WID (p<0.001), and a significant decrease in a* and b* (p<0.001). HP7.5 and HP35 presented greater increases in WID mean values, in comparison with SP (p=0.006). No significant differences were observed among the techniques for ΔE00 after treatment completion (p=0.383). There were no statistical differences in bleaching effectiveness among the techniques after treatment completion (p=0.098).

Conclusion: All techniques presented excellent effectiveness after treatment completion. However, HP7.5 and HP35 techniques provided a more rapid whitening response.

Objective: Evaluate the impact of adjustment procedures - cut-out-rescan (COR) and data exchange by over-scanning (DEOS) techniques - through CAD/CAM software on the marginal fit outcome of ceramic crowns.

Methods and materials: Twenty-eight de-identified teeth were adapted in a mandibular typodont set. Tooth #19 was prepared for a lithium disilicate crown and seven groups, G0 to G6 (n=10), were created based on the rescanned areas (mesial and/or buccal) on the typodont using an intraoral scanner through COR or DEOS techniques. A digital workflow was used to design and mill 70 crowns according to the groups. Each crown was temporarily cemented on tooth #19 and scanned with micro-computed tomography to measure the marginal fit. The data were analyzed statistically by the Kruskal-Wallis test followed by the Mann-Whitney test to compare the groups pairwise as a post-hoc (α=0.05).

Results: Statistically significant differences were found for vertical misfit (μm) between the groups for Marginal Gap Buccal (MGB) and Marginal Gap Mesial (MGM) (p=0.003 and p=0.029, respectively). No significant difference was found for Finish Line Buccal (FLB) and Finish Line Mesial (FLM) (p=0.062 and p=0.092, respectively). G3 (COR buccal and mesial) had the highest MGB (57.75 μm), statistically different from all other groups. G4 (DEOS buccal) (41.60 μm) was different from G6 (DEOS buccal and mesial) (44.21 μm) (p=0.023). For MGM, G0 (control) (53.96 μm) was different from G5 (DEOS mesial) (45.76 μm) and G6 (DEOS buccal and mesial) (48.56 vm) (p=0.013 and p=0.041, respectively) and G2 (COR mesial) (58.43 μm) was different from G5 (DEOS mesial) (45.76 μm) (p=0.016).

Conclusions: Despite a statistically significant difference in certain groups for both techniques, COR and DEOS techniques are viable options for image editing during acquisition. Lithium disilicate crowns can be produced with satisfactory marginal gap values utilizing a chairside CAD/CAM system.

Objective: To evaluate the shade-matching ability of single-shade resin-based composite restorations in different thicknesses using both instrumental and visual techniques.

Methods and materials: Cavities with 4 mm diameter and 2 mm (n=96) or 3 mm (n=96) depth were prepared in acrylic incisor teeth of shades A2, A3, B3, and C2 and restored with three single-shade resin composites, Omnichroma (Tokuyama Dental America, Encinitas, CA, USA [OM]), Vittra APS Unique (FGM Dental Group, Joinville, SC, Brazil [VU]), Zenchroma (President Dental, Allershausen, Germany [ZC]), and a microhybrid resin composite (Filtek 3M Z250 3M ESPE, St Paul, MN, USA [FZ]) of A2, A3, B3, and C2 shades. Readings were obtained using VITA Easyshade V spectrophotometer for the teeth and restorations. The CIEDE2000 (ΔE00) color difference formula was used, and the values were assessed using three-way analysis of variance (ANOVA). Forty-eight evaluators graded the shade match of 32 different specimens visually as (A) best shade match, (B) intermediate shade match, and (C) poor shade match.

Results: FZ material achieved satisfactory matches for both thicknesses, across all shades, and OM material demonstrated statistically significant lower shade matches than the ZC and the FZ materials (p<0.05). VU exhibited poor shade match with the highest ΔE00 value on C2 shade. According to the visual examination, the best shade matches were observed for FZ on A3-shade and ZC on C2-shade teeth.

Conclusions: Shade matching for 2 mm and 3 mm-thick composite resin restorations is material- and tooth-shade dependent.

Background: Marginal adaptation and retention of endocrowns are crucial for the success and survival of endocrowns. This study aimed to investigate the effect of different materials and intracoronal depth on the retention and marginal adaptation of CAD/CAM fabricated all-ceramic endocrowns.

Methods: Thirty-six mandibular premolar teeth with an average surface area of 64.49 mm2 were prepared to receive CAM/CAM fabricated endocrowns. Samples were divided randomly and equally into groups of lithium disilicate with 2 mm intracoronal depth (LD2), lithium disilicate with 4 mm intracoronal depth (LD4), polymer infiltrated ceramic network with 2 mm intracoronal depth (PICN2) and polymer infiltrated ceramic network with 4 mm intracoronal depth (PICN4). All endocrowns were cemented using ParaCore resin cement with 14N pressure and cured for 20 seconds. Fifty measurements of absolute marginal discrepancy (AMD) were done using a stereomicroscope after cementation. After 24 hours, all samples were subjected to thermocycling before the retention test. This involved using a universal testing machine with a crosshead speed of 0.5 mm/min and applying a load of 500N. The maximum force to detach the crown was recorded in newtons and the mode of failure was identified.

Results: Two-way ANOVA revealed that the AMD for PICN was statistically significantly better than lithium disilicate (p=0.01). No statistically significant difference was detected in the AMD between the two intracoronal depths (p=0.72). PICN and endocrowns with 4 mm intracoronal depth had statistically significant better retention (p<0.05). 72.22% of the sample suffered from cohesive failures and 10 LD endocrowns suffered adhesive failures.

Conclusions: Within the limitations of this study, we found that different materials and intracoronal depths can indeed influence the retention of CAD/CAM fabricated endocrowns. Based on the controlled setting findings, PICN was found to have better retention and better marginal adaptation than similar lithium disilicate premolar endocrowns.

Objectives: Using a wetting resin or adhesive system as an instrument lubricant when placing composite layers is commonly practiced to improve handling. This study investigated whether instrument lubricants affected strength, stiffness, or hardness.

Methods: Composite beams (TPH Spectra) were fabricated using a stainless steel mold (25×2.5×2 mm) in two steps, where the second half (12.5 mm) was added and cured against a cured first half (n=15). The composite surface at the open end of the first half was smoothed using an instrument lubricated with wetting resin (Ultradent) or universal adhesive (ScotchBond Universal), enough to prevent sticking, or without lubrication. An additional beam of each group was characterized using scanning electron microscopy. Monolithic specimens were also fabricated. After 24 hour storage (37°C, 100% humidity), the beams' flexural strength and stiffness were determined by four-point bending. Vickers surface hardness was measured on 24-hour composite samples in 2 mm deep acrylic cavities, cured after the surface was smoothed with the two instrument lubricants or no lubricant (n=10). Hardness was remeasured after finishing with a series of contouring and polishing discs. Data were statistically analyzed using ANOVA followed by Student-Newman-Keuls post hoc test at 0.05 significance level.

Results: There were significant differences (p<0.001) in flexural strength and stiffness among groups. While strength and stiffness were not affected by using a wetting resin as instrument lubricant, use of a universal adhesive increased strength and stiffness significantly, achieving monolithic values. Scanning electron micrographs showed less porosities at the interface when using instrument lubricants. Surface hardness was significantly reduced in groups in which instrument lubricants were used, but finishing/polishing restored original hardness (p<0.001).

Conclusions: Lubricating an instrument with a wetting agent did not adversely affect physical or surface properties, provided the surface was finished and polished. If a universal adhesive was used as lubricant, the strength and stiffness of a layered composite could be increased, reaching monolithic values.

Aim: This systematic review and meta-analysis evaluated theobromine's (Theobroma cacao) potential in remineralizing white spot lesions in dental enamel. Methods: This study is reported according to the PRISMA checklist and was registered in PROSPERO (CRD42023414371). In vitro tests that evaluated the remineralizing potential of theobromine compared to fluoride ion after demineralization for the formation of white spot lesions on enamel were selected, with no limitation on the year of publication. Electronic searches were performed in PubMed/MEDLINE, Scopus, and Web of Science by two independent researchers. Thirty articles were received of which six were selected according to the inclusion criteria.

Results: The selected studies evaluated the Enamel Surface Microhardness (SMH), Vickers or Knoop, before and after treatment with theobromine and fluoride solutions. For the SMH Vickers, there were no differences between groups at baseline (p=1.00; mean difference: -0.00; CI: -11.36 to 11.36) and after treatment (p=0.51; mean difference: 4.12; CI: -8.16 to 16.41). The results of SMH Knoop showed differences between groups at baseline, favoring the experimental group (p=0.002; mean difference: 9.84; CI: 3.65 to 16.02) and after treatment favoring the control group (p=0.00001; mean difference: -5.45; CI: -7.62 to -3.27).

Conclusion: The use of theobromine increases the microhardness of dental enamel subjected to a demineralization process, thus being effective in the remineralization of this tissue with success equivalent to that obtained with the use of fluoride.

Objective: To assess the color change of demineralized enamel lesions of different severities after resin infiltration using both clinical spectrophotometry and digital photography.

Methods and materials: Sixty sound human premolars were randomly divided into 3 groups according to the demineralization level. All the teeth were immersed in a demineralizing solution of a pH adjusted to 4.4 at 37°C. Three levels of demineralization were obtained (D1 shallow, D2 moderate, D3 deep) according to the demineralization time. The demineralized area was then infiltrated by low-viscosity resin (ICON, DMG, Germany). Two instrumental methods were utilized to assess the color difference, a clinical spectrophotometer and digital photography at three time points (sound, demineralized, and infiltrated enamel) to calculate the color difference between sound and demineralized enamel (ΔE1) and between sound and infiltrated enamel (ΔE2). Statistical analysis was performed by ANOVA, followed by Tukey's post hoc test. The correlation was analyzed using linear regression.

Results: Two-way ANOVA showed statistically significant differences for both levels of the study (p≤0.05). The color change (ΔE1) and (ΔE2) for different demineralization levels showed statistically significant differences between all groups. For both clinical spectrophotometry and digital photography, D3 showed the highest difference followed by D2 and then D1. As for (ΔE1) calculations, digital photography had a significantly higher difference than spectrophotometry for the D1 group (5.47±0.93 vs 2.78±0.58). As for (ΔE2) digital photography had a statistically significantly lower difference than spectrophotometry (5.55±1.05 vs 6.48±0.76) for the D3 group.

Conclusions: Color correction after resin infiltration is affected by the demineralization level of enamel. Clinical spectrophotometry and digital photography can detect similarly the color change of demineralized enamel after resin infiltration in shallow and moderate demineralization. However, in deep demineralization clinical spectrophotometry tends to exaggerate the color change compared to digital photography.

Objective: To evaluate the effect of polyethylene fiber-reinforcement on the fracture resistance and fracture mode of extensive resin-based composite (RBC) restorations in structurally compromised maxillary premolars.

Methods and materials: Maxillary premolars (54) with specific dimensions and extracted for orthodontic reasons were used. Following mesio-occluso-distal (MOD) cavity preparation and endodontic access, teeth were randomly assigned to one of three restorative protocols (n=18): RBC applied incrementally (I) or reinforced with woven polyethylene fibers (Ribbond) placed horizontally (H) or U-shaped (U). Restored teeth were stored for 45 days in distilled water at 37°C and then loaded monotonically until fracture. Half of the specimens in each group received axial loading (A) and the other half was loaded paraxially (PA). Fracture load data was assessed using two-way analysis of variance and Tukey's post hoc test for multiple comparisons (α=0.05). The fracture initiation and propagation path were analyzed using stereomicroscopy and scanning-electron microscopy.

Results: No significant differences were observed for the fracture strength among loading configurations, except for groups IA (825 N) and HA (553 N). Fracture initiated and propagated mainly at and through the RBC restoration in the I group, whereas a shift to the interface was observed in both polyethylene fiber-reinforced groups. Blocking and bridging of cracks were identified around the fibers, especially in specimens of group U.

Conclusions: Incorporation of woven polyethylene fibers to reinforce extensive MOD resin-based composite restorations on endodontically treated premolars reduced the occurrence of cohesive fractures in the restorative material but was unable to increase the fracture resistance of the affected teeth.

Objectives: This study evaluated the depth of cure (DoC) of eight resin-based composites (RBCs) photocured using one multipeak light-curing unit (LCU) on the standard output setting for the manufacturer's RBC recommended exposure time and at a higher irradiance for 3 seconds.

Methods: Three conventional RBCs: Tetric EvoCeram (Evo), Tetric N-Ceram (Cer), Tetric Prime (Pri); and five bulk-fill: Tetric N-Ceram Bulk Fill (CerBF), Opus Bulk Fill APS (OpusBF), Opus Bulk Fill Flow APS (OpusF), Tetric PowerFill (PFill) and Tetric PowerFlow (PFlow) were examined. Only PFill and PFlow are formulated to be photocured in 3 seconds. The RBCs were packed into a metal mold and photocured using a Bluephase PowerCure LCU for the RBC manufacturer's recommended exposure time on the standard mode and using the 3-second high irradiance mode. After photocuring, the specimens were immersed in a solvent for 1 hour. The length of the remaining RBC was measured and divided by 2. Data were analyzed using two-way analysis of variance (ANOVA) followed by the Tukey post hoc multiple comparison test (α=0.05).

Results: There was no significant difference in the DoC values for PFill and PFlow when photocured using the 3-second high irradiance protocol compared to the lower irradiance standard mode protocol. All other RBCs had significantly lower DoC values (p<0.001) when photocured off-label using the 3-second high irradiance mode.

Conclusion: Of the eight RBCs tested, only PFill and PFlow achieved the same DoC when the high irradiance 3-second curing method was used compared to when their longer lower irradiance protocol was used.