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SUMMARY Objectives The aim of this randomized double-blind controlled clinical trial was to evaluate different protocols for at-home use of 10% hydrogen peroxide in whitening effectiveness and tooth sensitivity. Methods Seventy-two patients were selected according to the inclusion and exclusion criteria, with the upper central incisors having color A2 or darker according to the Vita Classical scale (VITA Zahnfabrik, Bad Säckingen, Germany) and randomized into two groups: 10% hydrogen peroxide applied once daily for 15 minutes (HP 15) or applied once daily for 30 minutes (HP 30). Bleaching was performed for 14 days in both groups. The color was evaluated before bleaching, during bleaching (1st and 2nd weeks), and 1 month after the bleaching treatment using the Vita Classical, Vita Bleachedguide 3D-MASTER, and Vita Easyshade spectrophotometer (VITA Zahnfabrik). Dental sensitivity was recorded by the patients using the numerical rating scale (0–4) and visual analogue scale (0–10 cm). Color data were evaluated by two-way analysis of variance (ANOVA) of repeated measures (group vs. treatment time). The Mann-Whitney test was performed to contrast the means (α=0.05). Tooth sensitivity was assessed by Fisher’s exact test (p=1.00) and intensity of tooth sensitivity was evaluated by the Mann-Whitney test (α=0.05) for both scales. Results A significant whitening effect was observed after 2 weeks of bleaching for all color measurements (p=0.01), with no difference between HP 15 and HP 30 (p>0.05). Also, the absolute risk and intensity of tooth sensitivity were similar (47%; p>0.05). Conclusions The effectiveness and tooth sensitivity of at-home bleaching carried out with 10% hydrogen peroxide applied for 15 minutes or 30 minutes are similar.

SUMMARY Objective: This single-blind, split-mouth, randomized trial was aimed at evaluating the bleaching efficacy (BE) and tooth sensitivity (TS) of a 20% hydrogen peroxide (HP) bleaching agent used under active or passive application. Methods and Materials: Twenty-two patients with canines darker than C2 were selected. Teeth were bleached in two sessions, with a one-week interval between treatments. The bleaching agent was applied using active (HPactive) or passive (HPpassive) application. Each tooth in the HPactive-allocated hemiarch received bleaching gel with sonic activation after 10 and 30 minutes from the start of treatment, with rounded movements all over the buccal surface. The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (VITA Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. TS was recorded up to 48 hours after treatment using a 0-10 visual analog scale. Color change in shade guide units (SGUs) and ΔE was analyzed using a Wilcoxon test (α=0.05). The absolute risk and intensity of TS were evaluated using McNemar test and a Wilcoxon test, respectively (α=0.05). Results: Significant whitening was observed in both groups after 30 days of clinical evaluation. The activation did not significantly influence BE (ΔSGU HPpassive=5.6 and HPActive=5.8; p=0.98; and ΔE HPpassive=10.6 and HPactive=10.3; p=0.83). Absolute risk of TS (HPactive=36.4% and HPpassive=31.8%; p=0.94) was similar for both groups (Fisher exact test). TS intensity (visual analogue scale) was higher during the bleaching sessions and up to 24 hours thereafter for both groups, with no differences between groups (two-way analysis of variance and Tukey). Conclusion: The active application of a 20% HP gel did not improve BE and TS.

Clinical Relevance Non-carious cervical lesion restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse mode showed satisfactory clinical performance after 18 months. SUMMARY Objectives: The objective of this multicenter, double-blind, split-mouth randomized clinical trial was to evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco GmBH) when applied using different strategies over a period of 18 months. Methods and Materials: Fifty patients participated in this study. Two hundred non-carious cervical lesions were restored using the adhesive Futurabond U according to four adhesive strategies (n=50 per group): only self-etch (SEE), selective enamel etching + self-etch (SET), etch-and-rinse with dry dentin (ERDry), and etch-and-rinse with wet dentin (ERWet). After the adhesive application, cavities were restored using Admira Fusion composite resin. These restorations were evaluated according to FDI World Dental Federation criteria for the following characteristics: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity, and caries recurrence. Results: After 18 months, only four patients (12 months: one patient, n=4 restorations; and 18 months: three patients, n=12 restorations) were not evaluated. Fourteen restorations were lost after 18 months of clinical evaluation (four for SEE, three for SET, three for ERDry, and four for ERWet). The retention rates for 18 months (95% confidence interval) were 92% (81%–97%) for SEE, 94% (83%–97%) for SET, 94% (83%–97%) for ERDry, and 92% (81%–97%) for ERWet (p>0.05). Thirty-eight restorations were considered to have minor discrepancies in marginal adaptation at the 18-month recall (13 for SEE, 13 for SET, six for ERDry, and six for ERWet; p>0.05). Fourteen restorations were detected as a minor marginal discoloration at the 18-month recall (six for SEE, six for SET, one for ERDry, and one for ERWet; p>0.05). However, all were considered clinically acceptable. No restorations showed postoperative sensitivity or caries recurrence at the time. Conclusion: The clinical performance of the Futurabond U did not depend on the bonding strategy used, and it was considered reliable after 18 months of clinical evaluation, although more marginal discrepancy was observed in the self-etch group.

Clinical Relevance The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions. SUMMARY Objective: The aim of this meta-analysis was to investigate the clinical performance of filled vs unfilled adhesive systems when applied in noncarious cervical lesions. Methods and Materials: A systematic search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. Gray literature was also screened. Only randomized controlled clinical trials were included. The risk of bias of the studies was evaluated using the Cochrane Collaboration’s tool. A random-effects meta-analysis was conducted to compare the retention rate, marginal discoloration, and secondary caries of noncarious cervical lesions restored with filled adhesives vs unfilled adhesives. The quality of the body of evidence was assessed using the GRADE approach. Results: A total of 3662 studies were identified after removal of duplicates. Twenty-nine studies remained for qualitative analyses and 28 studies for the meta-analysis. Only one study was judged to have a low risk of bias, and the other 28 were considered to have unclear risk of bias. There was no statistically significant difference between filled adhesives compared with unfilled adhesives in relation to loss of retention, marginal discoloration, or secondary caries at any of the follow-up periods (12–18 months, 24–30 months, 3 years, and 5 years or longer). The quality of evidence was graded as moderate for most outcomes at the respective follow-ups, except when there was an explained heterogeneity, which occurred mainly for loss of retention at the 12-month to 3-year follow-up. The results did not depend on whether microfilled or nanofilled adhesives had been investigated. Conclusions: The addition of fillers into the composition of adhesive systems did not increase the clinical performance (retention rates, marginal discoloration, or secondary caries) of composite restorations placed in noncarious cervical lesions when compared with unfilled adhesives.

SUMMARY Objective: This in vitro study aimed to quantify the penetration of hydrogen peroxide (HP) into the pulp chamber in teeth submitted to in-office bleaching with varied pH and application techniques. The color change and pH of the in-office bleaching product during application was also evaluated. Methods and Materials: Ninety-six human premolars were used and randomly divided into 10 groups (n=9) according to the following combination of factors: pH of in-office bleaching agents (two neutral/alkaline pH: Opalescence Boost 38% and Whiteness HP Blue 35% and three acidic pH: Whiteness HP Maxx 35%, Lase Peroxide Sensy 35%, and Total Blanc Office 35%) and application modes (for 3 × 15 minutes [3×15] and 1 × 45 minutes [1×45]). An additional group of non-bleached teeth (control; n=6) was added. First, all teeth were sectioned 3 mm from the cementoenamel junction and the pulp tissue was removed. An acetate buffer was placed in the pulp chamber of all teeth. After bleaching, this solution was transferred to a glass tube in which HP was allowed to react with other components, resulting in a pink solution. The optical density of this pink solution was measured using ultraviolet-visible spectroscopy and converted into amount of HP. Color change before and 1 week after bleaching was evaluated using a digital spectrophotometer. A pH meter with a 6-mm circular and flat surface was used in contact with the enamel surface to quantify the pH of the bleaching gels during application. Data were analyzed using two-way analysis of variance and Tukey tests (α=0.05). Results: Overall, lower mean HP penetration values were observed for Opalescence Boost 38% and Whiteness HP Blue 35% compared with other bleaching gels (p0.05). However, lower mean HP penetration values were observed for Whiteness HP Maxx 35%, Total Blanc Office 35%, and Lase Peroxide Sensy 35% when using the 3×15 application technique compared with the 1×45 technique (p0.54). The pH did not change during the 3×15 application technique; however, all acidic bleaching gels significantly decreased in pH when applied for 1×45 (p Conclusions: The amount of HP that reaches the pulp chamber was lower when neutral/alkaline pH gels were used, independently of the application technique. When considering acidic pH gels, it is preferable to use the 3×15 application technique, mainly because longer application time (1×45) results in lower pH. No difference was observed between groups with regards to color change.

SUMMARY Objectives: A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity (TS) after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel in adult patients. Color change and risk of gingival sensitivity was also evaluated. Methods: A comprehensive search was performed MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), EMBASE and Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions to identify randomized clinical trials. Abstracts from the annual conference of the International Association for Dental Research (1990–2016), unpublished and ongoing trials registries, dissertations, and theses were also searched. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development and Evaluation (GRADE) approach. Data: After duplicates were removed, 1352 articles were identified. After title and abstract screening, only 47 studies remained for qualitative evaluation. Most of the studies had unclear risk of bias. No difference between groups were observed for the risk ratio of TS (risk ratio = 0.99; 95% confidence interval [CI] = 0.74–1.33); intensity of TS (standardized difference in means [SMD] = 0.04; 95% CI = 0.79–0.70); color change in shade guide units (SMD – 0.04; 95% CI = 0.50–0.42); color change in ΔE* (SMD = 0.41 (95% CI = 0.07–0.89); and risk ratio of gingival irritation (SMD = 1.05; 95% CI = 0.81–1.36). Except for the risk of TS, graded as moderate quality of evidence, all other outcomes were rated as low and very low quality. Conclusions: Incorporating desensitizers in the bleaching gel did not reduce the risk of TS, and the quality of this evidence was considered moderate. On the other hand, the intensity of TS, color change, and risk of gingival irritation was similar between groups, but the quality of the evidence for these outcomes was graded as low or very low, thus reducing the level of confidence in these outcomes.

SUMMARY Objectives: This study aimed to evaluate the desensitizing effect of a prefilled disposable tray containing potassium nitrate and fluoride on the self-reported tooth sensitivity (TS) and the bleaching efficacy of 40% hydrogen peroxide bleaching agent used for in-office bleaching in comparison with potassium nitrate and fluoride gel applied in a conventional-delivered tray system in an equivalence clinical trial. Methods and Materials: Seventy-eight patients, with a right maxillary canine darker than A3, were selected for this single-blind (evaluators), randomized clinical trial. Teeth were bleached in two sessions with a one-week interval in between. Before in-office bleaching, the prefilled disposable tray or conventional tray containing potassium nitrate and fluoride was used for 15 minutes. Subsequently, the bleaching agent was applied in two 20-minute applications (per the manufacturer's directions) in each session. The color change was evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Advance Spectrophotometer) methods at baseline and 30 days after the first bleaching session. TS was recorded for up to 48 hours using a 0-10 visual analog scale. The absolute risk was evaluated by chi-square test, while the intensity of TS was evaluated by McNemar test (α=0.05). Color change in shade guide units and ΔE was analyzed by Student t-test for independent samples (α=0.05). Results: Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of different methods of desensitizer in a tray did not influence the absolute risk and intensity of TS (p>0.05), although a tendency of lower risk of TS with the prefilled disposable tray containing potassium nitrate and fluoride was observed. Conclusion: The use of a prefilled disposable tray containing potassium nitrate and fluoride before the application of the in-office bleaching product did not affect the whitening degree and decreased self-reported TS when compared with a conventional-delivered tray system.

Clinical RelevanceBleaching performed at-home while under the supervision of a dentist provides greater color alteration compared with whitening strips when evaluated with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.SUMMARYObjective:A systematic review and meta-analysis were performed to answer the following research question: Does the use of whitening strips (WS) lead to an equivalent color change compared with supervised dental bleaching in patients with permanent dentition?Methods:A search was performed on August 10, 2017 (updated on March 22, 2019), in PubMed, the Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature database, Cochrane Library, Scopus, Web of Science, and grey literature, without restrictions regarding date or language. Abstracts from the International Association for Dental Research, unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (parallel or split mouth) in patients with permanent dentition that compared WS with dentist-supervised dental bleaching performed at-home (AH) or in-office (IO) were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A meta-analysis with subgroup analysis (low and high peroxide concentration) was conducted for color change ΔE* (spectrophotometer) and ΔSGU (shade guide units), risk and intensity of tooth sensitivity (TS), gingival irritation (GI), and patient satisfaction using a random effects model. Heterogeneity was assessed with the Cochran's Q test and I2 statistics. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of the evidence.Results:After the removal of duplicates, followed by title and abstract screening, 20 studies remained. Only two studies were considered to have a low RoB; 11 had a high RoB, and seven had an unclear RoB. For WS versus IO, data were not available for the meta-analysis. For WS versus AH bleaching, a significant difference in ΔE* favoring the AH group was observed (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI] −0.79 to −0.21), but the risk (risk ratio = 0.78, 95% CI 0.65 to 0.93) and intensity of TS (SMD = −0.30, 95% CI −0.56 to −0.04) were lower in the WS group. Color change in ΔSGU, risk and intensity of GI, and patient satisfaction were not significantly different between groups (p>0.20). The quality of evidence for ΔE*, risk and intensity of TS, and intensity of GI were graded as moderate.Conclusion:Although the risk and intensity of TS were lower in the WS group, dentist-supervised at-home bleaching led to a better color change when measured with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.

SUMMARY Objectives: The aim of this study was to compare the bleaching efficacy and tooth sensitivity (TS) of a 38% hydrogen peroxide bleaching agent used for in-office bleaching, applied under different time protocols: a 40-minute application or two 20-minute applications. Methods and Materials: Forty-four patients from Brazil and Colombia, with right superior canines darker than C2, were selected for this multicenter, single-blind, randomized trial. The teeth were bleached in two sessions, with a one-week interval between them, in a split-mouth design. The bleaching agent was applied in two 20-minute (2×20) applications or one 40-minute (1×40) application in each session according to the manufacturer's instructions. The color changes were evaluated by using subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. Tooth sensitivity was recorded up to 48 hours with a 0-10 visual analog scale. Also, the pH values during the application of bleaching were recorded. Color change in shade guide units and ΔE were analyzed by using the Student t-test (α=0.05). The absolute risk and intensity of TS were evaluated with the McNemar test, the Wilcoxon signed-rank test, and the Friedman test, respectively (α= 0.05). Results: Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of a 40-minute application did not significantly influence the absolute risk of TS (68%, 95% confidence interval [CI] = 53-80) as well as the intensity of TS compared with the acid bleaching gel (absolute risk of 82%, 95% CI = 68-91). The pH values did not differ significantly between groups and at the different assessment periods (p=0.42). Conclusion: The use of a 40-minute in-office bleaching agent gel application produced the same whitening degree and TS that the two 20-minute bleaching agent applications did. The former preferably should be applied because one 40-minute application does not require gel refreshing.

SUMMARY Objective: The purpose of this study was to investigate the immediate and three-month water storage behavior of adhesives when used for immediate dentin sealing (IDS). Methods and Materials: Four adhesive systems were used to perform IDS: a one-step self-etch (Xeno V), a two-step self-etch (Clearfil SE Bond), a two-step etch-and-rinse (XP Bond), and a three-step etch-and-rinse (Optibond FL). For the control group, IDS was not performed. The self-adhesive resin cement RelyX Unicem was used for the luting procedures. After seven days of water storage, specimens (n=6) were sectioned into beams (n=5) with an approximately 1-mm2 cross-sectional area. Half of the specimens were tested in tension after seven days of water storage at 37°C, while the other half was stored for three months prior to testing in tension using a universal testing machine (1 mm/min). The failure pattern was determined using a stereomicroscope and scanning electron microscopy. Microtensile bond strength (μTBS) data were statistically analyzed by two-way analysis of variance and Tukey post hoc test (α=0.05). Results: After seven days, the control group presented the lowest μTBS but did not differ from XP Bond and Clearfil SE Bond. After three months, there was no μTBS difference between the IDS groups and the control. Conclusions: After seven days of water storage, the groups with IDS presented higher μTBS values than the control group, although XP Bond and Clearfil SE Bond did not present significant differences. However, after three months of storage in water, IDS groups did not differ significantly from control group, which did not receive IDS.

SUMMARY Objectives: To evaluate the effects of addition of diacetate chlorhexidine (CHX) at different concentrations into two etch-and-rinse adhesive systems on CHX release, as well as the immediate (IM) and two-year (2-Y) resin-dentin microtensile bond strength (μTBS) and nanoleakage (NL). Methods: CHX was added to XP Bond (XP) and Ambar (AM) at concentrations of 0.0 wt% (control); 0.01 wt%; 0.05 wt%; and 0.1 to 0.2 wt%. To assess the cumulative CHX release, adhesive disks were made in a metallic matrix and after light-curing were stored in water. Ultraviolet spectrophotometric measurements of the storage solution were performed to examine the release kinetics of CHX. For μTBS and NL, the occlusal enamel of molars was removed and the adhesives were applied to the dentin surface after acid etching. After composite resin build-up, specimens were sectioned to obtain μTBS sticks. The specimens were subjected to μTBS and NL at IM and after 2-Y. In addition, specimens underwent examination for CHX using micro–Raman spectroscopy. All data were submitted to statistical analysis (α=0.05). Results: With regard to CHX release, AM showed a slower and gradual release of CHX while XP released CHX more quickly (p

SUMMARY Objective: This clinical study evaluated the color longevity after 30 months of at-home bleaching with 10% carbamide peroxide (CP) in smokers and nonsmokers. Methods: Sixty patients, 30 smokers and 30 nonsmokers, were subjected to bleaching with 10% CP (Whiteness Perfect–FGM) for three hours daily for three weeks. The color was measured at baseline and at one month and 30 months after the completion of dental bleaching using the shade guide Vita classical organized by value (ΔSGU) and the shade guide Vita Bleachedguide 3D-MASTER. At the 30-month recall, the color was assessed before and after dental prophylaxis. Data from color evaluation were analyzed by two-way repeated-measures analysis of variance and Tukey test for the contrast of means (α=0.05). Results: Twenty-one smokers and 22 nonsmokers attended the 30 month recall. For both shade guides, only the main factor of assessment time was statistically significant (p Conclusion: Thirty months after at-home bleaching with 10% CP gel, dental darkening was detected in both groups, which cannot be solely attributed to stains caused by extrinsic staining from daily food, drinks, and smoke (in smokers).

SUMMARY Purpose: This double blind, randomized clinical trial compared the postoperative sensitivity of the placement technique (incremental and bulk fill) in posterior composite resin restorations bonded with two different adhesive strategies (self-etch and etch-and-rinse). Methods: Posterior dental cavities of 72 participants (n=236), with a cavity depth of at least 3 mm, were randomly divided into four groups. The restorations were bonded using either the etch-and-rinse Tetric N-Bond (Ivoclar Vivadent) or the self-etch Tetric N-Bond SE (Ivoclar Vivadent). The composite resin Tetric N-Ceram Bulk Fill (Ivoclar Vivadent) was placed either incrementally or using the bulk-fill technique. Two experienced and calibrated examiners evaluated the restorations using World Dental Federation criteria after one week of clinical service. Spontaneous postoperative sensitivity was assessed using a 0-4 numerical rating scale and a 0-10 and 0-100 visual analog scale up to 48 h after the restorative procedure and after one week. Results: The risk (p>0.49) and intensity of spontaneous postoperative sensitivity (p>0.38) was not affected by the adhesive strategy or the filling technique. The overall risk of postoperative sensitivity was 20.3% (95% confidence interval 15.7-25.9) and typically occurred within 48 hours after the restorative procedure. Conclusions: The overall risk of immediate postoperative sensitivity was 20.3% and was not affected by either the adhesive strategy (etch-and-rinse/self-etch) or the filling technique (incremental/ bulk).

SUMMARYObjectives:To evaluate the efficacy of a new light-cured anesthetic gel for pain control in adults undergoing rubber dam isolation for the restorative treatment of noncarious cervical lesions (NCCLs).Methods and Materials:This study was a randomized, split-mouth, triple-blind, controlled trial. The sample comprised 50 adults with at least one pair of NCCLs located in the same arch but on opposite sides. Simple randomization defined the tooth to receive the light-cured tetracaine-based anesthetic gel or the placebo gel. After cotton roll isolation, the gels were applied in the gingival tissue around the tooth with the aid of the applicator tip of a syringe, left in place for 15 seconds, and light-cured for 15 seconds. Then, a #212 clamp was positioned on the tooth. If the patient reported pain, the clamp was removed, the patient filled out a pain intensity form (a 0-10 visual analog scale [VAS] and a 0-4 verbal rating scale [VRS]) and an injectable anesthetic was applied before rubber dam isolation for the restorative procedure. The absolute risk, intensity of pain, and need for rescue anesthesia were analyzed by the McNemar test and the Wilcoxon signed rank test (α=5%).Results:The odds ratio [OR] for pain (OR=3.5; 95% confidence interval [CI]=1.1 to 14.6; p=0.03) showed lower reports of pain for the light-cured anesthetic gel. One in five patients will benefit from placement of the light-cured anesthetic gel. On average, pain intensity was one VAS unit lower in those using the light-cured anesthetic gel than in those using the placebo gel. For the VRS, the pain intensity for the light-cured anesthetic gel was 0.4 units lower than the pain intensity for the placebo gel (95% CI=–0.9 to 0.07). The OR for rescue anesthesia was 2.5 (95% CI=0.7 to 10.9; p=0.18).Conclusions:The light-cured, tetracaine-based anesthetic gel reduced the absolute risk of pain by 20% in NCCLs.

Clinical Relevance Achieving durable bonding to zirconia is fundamental for the application of a methacryloyloxydecyl dihydrogen phosphate (MDP)–containing silane solution or an MDP-containing silane solution associated with an MDP-containing universal adhesive. SUMMARY Objectives: To evaluate the effect of a methacryloyloxydecyl dihydrogen phosphate (MDP)–containing silane coupling agent and universal adhesive, used alone or in combination, on the microshear bond strength (μSBS) to zirconia after 24 hours of water storage (24h) and after 10,000 thermocycles (TC), complemented with chemical analysis of the surface to establish the presence of MDP on the surface of the zirconia after bonding procedures. Methods and Materials: Thirty computer-aided design/computed-aided manufacturing blocks of zirconia were cut into four sections (6×6×6 mm) and sintered. Zirconia sections (n=96) were assigned to 24 groups according to three factors: 1) silane (no silane, Monobond S [MBS], Monobond P [MB+]), 2) adhesive + resin cement (no adhesive + Enforce [ENF], no adhesive + RelyX Ultimate [REX], Prime&Bond Elect + Enforce [PBE/ENF], Scotchbond Universal + RelyX Ultimate [SBU/REX]), and 3) thermocycling (no thermocycling [24h], 10,000 thermocycles [TC]). Upon silane/adhesive application, cylinder-shaped matrices were filled with resin cement and light cured. Specimens were tested in μSBS (1.0 mm/min) after 24h or TC. The μSBS data were analyzed using twoway ANOVA and Tukey’s post hoc test (α=0.05). In addition, micro-Raman spectroscopy was used to analyze the zirconia surface for immediate chemical interaction analysis (n=24). Results: For the 24h condition, PBE/ENF resulted in lower mean μSBS than both groups with silane without PBE (MBS and MB+ groups; p0.05). However, the application of MB+ alone or MB+ associated to SBU resulted in higher mean μSBS (p Conclusions: The results of the current study support the use of an MDP-containing silane solution or an MDP-containing silane solution associated with an MDP-containing universal adhesive for bonding to air-abraded zirconia, as a more stable bonding after thermocycling.

SUMMARY Objective Compare the risk/intensity of tooth sensitivity (TS) and color change of a 30-minute vs. the recommended 120-minute application time of 4% hydrogen peroxide (HP) for at-home bleaching. Methods A single-blind, parallel, randomized clinical trial was conducted with 92 adult patients with caries and restoration-free anterior teeth A2 or darker, randomly allocated to two groups. Bleaching trays containing 4% HP were used for three-weeks. A four-week regimen was also offered to the patients for the 30-min group after the end of the 3-week protocol. The color change was assessed with the Vita Classical (VITA Zahnfabrik, Bad Säckingen, Germany) and Vita Bleachedguide shade guides (VITA Zahnfabrik) and the Vita Easyshade spectrophotometer (VITA Zahnfabrik) at baseline, weekly, and 30 days after the bleaching. The absolute risk and the intensity of TS were assessed daily using the 0–10 visual analogue scale (VAS) and 5-point Numerical Rating Scale (NRS) scale, and patient satisfaction was recorded with a Likert 0–7 scale. Risk of TS (Fisher’s test), intensity of TS in NRS scale (Mann-Whitney test), VAS scale (t-test), and a color change (t-test) were compared. Results The 30-minute group saw color change of around 1 SGU inferior to the 120-minute group in all-time assessments (p0.05). Patient satisfaction was high for both groups (p>0.05). Conclusions A four-week protocol of at-home dental bleaching with 4% HP for 30 minutes/day whitened teeth similarly to the 120 minutes/day protocol, with low intensity of dental sensitivity and high patient satisfaction.

SUMMARY Purpose: The objective of this double-blind, randomized clinical trial was to evaluate the six-month clinical performance of a new universal adhesive (Xeno Select, Dentsply) in noncarious cervical lesions (NCCLs) using two evaluation criteria: World Dental Federation (FDI) and the US Public Health Service (USPHS). Methods and Materials: A total of 124 restorations were randomly placed in 31 patients according to the following groups: ER-D = etch-and-rinse/dry dentin; ER-M = etch-and-rinse/moist dentin; SE-et = selective enamel etching; and SET = self-etch. The composite resin EVOLUX (Dentsply) was placed incrementally. The restorations were evaluated after one week (baseline) and at six months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α=0.05). Results: Fifteen restorations were lost or fractured at six months (one for ER-D, three for ER-M, five for SE-et, and six for SET) (p>0.05 at six-month recall). When ER (ER-D and ER-M) was compared with SE (SE-et and SET) there was a significant difference in the retention rate after six months (p=0.001). Marginal staining and postoperative sensitivity to air were only observed in three (one for ER-M and two for SET) and two restorations (two for ER-D) in both evaluation criteria (p>0.05), respectively. Forty-seven restorations were considered to have minor discrepancies in marginal adaptation at the six-month recall using the FDI criteria (13 for ER-D, 10 for ER-M, 11 for SE-et, and 13 for SET; p>0.05 between groups). However, for all groups, a significant difference was detected when baseline and six-month data were compared (p Conclusions: The six-month clinical behavior of Xeno Select Universal Adhesive depends on the bonding strategy used. The universal adhesive did not fulfill the American Dental Association criteria for full approval when used in the self-etch mode.

SUMMARY Knowledge about the stability of fiber posts cemented in widened canal spaces over time is scarce in the literature. Thus, the purpose of this case report was to evaluate the performance of a direct anatomical post in a widened canal space over the course of four years. The present clinical case describes the rehabilitation of a widened canal space using a direct anatomical post (a resin composite combined with a prefabricated glass fiber post) associated with an all-ceramic crown and other restorative procedures. This technique is easy to perform and may solve some of the problems associated with the cementation of a poorly adapted fiber post in a widened canal space.

SUMMARY Objective: The object of this study was to evaluate the simulated pulpal pressure (SPP) and immediate dentin sealing technique (IDS) effects on the microtensile bond strength (μTBS) and nanoleakage of interfaces produced by different luting agents. Methods and Materials: Two self-adhesive luting agents (RelyX Unicem [UC] and Clearfil SA Luting [SA]) and two conventional luting agents (Rely X ARC [RX] and Panavia F [PF]) were evaluated. Eighty human molars were divided in four groups according to luting agents. Each group was subdivided according to SPP (with or without) and dentin sealing (immediate or delayed) using Clearfil SE Bond (n=5). After IDS was performed, specimens were stored in water for seven days before luting procedures. Composite blocks were luted according to the manufacturers' instructions. One half of the specimens were subjected to 15 cm H2O of hydrostatic pressure for 24 hours before cementation procedures and continued for 24 hours afterward. Then, restored teeth were sectioned into beams and tested in tension. Two additional teeth per group were prepared for nanoleakage evaluation with scanning electron microscopy. Bond strength data were statistically analyzed by three-way analysis of variance and Tukey test. Results: μTBS of RX decreased when it was subjected to SPP without IDS. However, in the same conditions, μTBS of UC increased. The IDS prevented negative influence of SPP on μTBS of RX and PF; however, a decrease in μTBS of SA and UC was observed. Except for RX, IDS increased μTBS for all resin cements. Conclusion: Independent of SPP, the IDS technique obtained higher μTBS for PF, SA, and UC and did not influence RX μTBS.

SUMMARY Objectives: The objective of the present study was to compare the bleaching efficacy (BE) and tooth sensitivity (TS) of in-office bleaching applied under different time protocols. Methods and Materials: Fifty-three patients were randomly distributed into three groups: the bleaching agent was applied in one (1×15), two (2×15), or three (3×15) 15-minute applications. The labial surfaces of the anterior teeth were bleached using a 35% hydrogen peroxide gel. Two bleaching sessions with a one-week interval between were performed. The shade evaluation was performed with a visual shade guide and spectrophotometer before and 30 days after bleaching. Participants recorded TS with a five-point verbal scale. Color change was analyzed by one-way analysis of variance and Tukey tests. The absolute risk of TS and TS intensity were evaluated by the Fisher exact and Friedman/Kruskal-Wallis tests, respectively (α= 0.05). Results: Significant whitening was observed in all groups, with statistically lower BE for the 1×15 group (p Conclusions: A single 15-minute application produced less TS but reduced BE. The protocol with 2×15 produced a degree of BE similar to that of the 3×15 group, but with reduced overall TS intensity.

SUMMARY The following case report describes the three-year follow-up after rehabilitation of a flared root canal using a direct anatomic post (a resin composite combined with a prefabricated glass fiber post) associated with metal-free ceramic restoration. The report presents the clinical protocol for the fabrication of the posts, which provide an intimate fit to the remaining root and mechanical properties similar to those of the dental structure. These posts serve as an alternative to conventional metal cores.

SUMMARY Objectives: This study aimed to compare the tooth sensitivity, gingival irritation, and bleaching efficacy of at-home whitening performed with 10% hydrogen peroxide (HP) using a conventional tray-delivered system or two different bleaching systems (strips or prefilled disposable trays). Methods and Materials: Sixty patients, with maxillary incisors darker than A2 were selected for this single-blind, parallel randomized clinical trial. Teeth were bleached during 14 days with a 30-minute gel contact with teeth per day. The 10% HP was delivered in a bleaching tray (White Class, FGM) in strips (White Strips, Oral-B) or prefilled disposable trays (Opalescence Go, Ultradent). The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second bleaching session. Tooth sensitivity was recorded during 14 days with a five-point numeric rating scale (NRS) and 0-10 visual analog scale (VAS). The risk of gingival irritation was also recorded during 14 days on a dichotomous scale. All data were submitted to appropriate statistical analysis (α=0.05). Results: No significant difference was observed in the risks of tooth sensitivity among groups (p>0.09). However, the conventional bleaching tray produced a higher intensity of tooth sensitivity when compared with the strips and prefilled disposable tray systems (p0.06). Conclusions: All 10% HP bleaching systems showed similar whitening after a 14-day use. However, the strips and prefilled disposable trays produced lower intensity of tooth sensitivity than the conventional bleaching tray system. The prefilled disposable tray produced lower risk of gingival irritation when compared to the conventional bleaching tray.

SUMMARY Objective: To perform a systematic review to answer the following research question: Is at-home bleaching in adults with more concentrated carbamide peroxide (CP) gels as effective and safe as bleaching performed with 10% carbamide peroxide gels? Methods and Materials: A comprehensive search was carried out in the MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (1990 to 2016) and unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periodicos Capes Theses Databases) were also searched. The risk of bias of the included studies was analyzed using the Cochrane Risk of Bias tool from the Cochrane Collaboration. We meta-analyzed the data using the random effects model to compare 10% CP and more concentrated CP gels in terms of color change (ΔSGU or ΔE) and risk and intensity of tooth sensitivity (TS). The quality of the evidence was rated using the GRADE approach. Results: After the database screening, 182 articles remained, and this number was reduced to 17 after examination of the abstracts and/or full texts. Four articles were follow-ups of earlier studies, and thus we collected 13 studies. Ten studies were at unclear risk of bias, while three were at low risk of bias. Lower risk and intensity of TS was observed for 10% CP. The odds ratio for the risk of TS was 0.41 (95% CI 0.20 to 0.84, p=0.01), and the difference in means for TS intensity was 0.44 (95% CI 0.67 to −0.20, p=0.0003). No significant difference was observed in terms of color change in ΔSGU (difference in means 0.29; 95% CI 0.25 to 0.83, p=0.29) and for ΔE (difference in means −0.16; 95% CI 0.38 to 0.06, p=0.16). Except from the ΔSGU, for which the evidence was graded as low quality, the other outcomes were considered at moderate quality. Conclusions: At-home bleaching with 10% CP showed similar bleaching efficacy with lower risk and intensity of TS in comparison with more concentrated carbamide peroxide gels.

SUMMARY The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed (p

SUMMARYBleaching-induced tooth sensitivity (TS) is highly prevalent. Objective: This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect. Method: A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05). Results: No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change (p>0.05) for any scale. Conclusion: The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.

SUMMARYObjectivesTo evaluate the retention rates, gingival damage, and patients' preferences for adhesive restorations in noncarious cervical lesions (NCCL) associated with the use of rubber dam vs cotton rolls/retraction cord isolation.MethodsThirty patients having one pair of similar NCCL on opposing sides of the same arch were enrolled in this study. A total of 60 restorations were placed. In each patient one restoration was placed under rubber dam isolation (RD) using dental retainers, and the other one was placed using cotton rolls/retraction cord (CR/RC) isolation. Dental residents with more than 10 years of clinical experience restored all NCCL using the same adhesive (GO!, SDI Limited, Bayswater, Australia) and composite resin (Ice, SDI). The patients' preferences were recorded. The gingival condition (bleeding, gingival laceration, and gingival insertion level) was evaluated immediately after the restorative procedure and after one week. Gingival sensitivity was also assessed one week after the end of the restorative procedures. The clinical time required to perform each restoration was recorded. The performance of the restorations was assessed using the FDI criteria at baseline and six, 12, and 18 months after clinical service. All criteria evaluated were submitted to appropriate statistical analysis (α=0.05).ResultsThe retention rates of the restorations at each recall time were not affected by the isolation method (p>0.05). No significant difference between isolation methods was found in regard to patients' preferences (p=0.86), gingival bleeding (p=0.57), laceration (p=0.64), insertion (p>0.52), gingival sensitivity (p=0.52), or chairside time (p=0.77).ConclusionsThe use of CR/RC was shown to be similar to the use of RD in terms of retention rates, patient's preference, gingival damage, and chairside time for adhesive restorations in NCCL.

SUMMARY Objective This single-blind controlled study evaluated the genotoxicity and efficacy of at-home bleaching in smokers and nonsmokers. Methods We selected 60 patients with central incisors A2 or darker: 30 smokers (experimental group) and 30 nonsmokers (control group). The bleaching was carried out with 10% carbamide peroxide for three hours a day for three weeks. The color was evaluated using a shade guide, Vita Bleachedguide 3D-Master, at baseline, during bleaching (first, second, and third weeks), and one week and one month after bleaching. Smears were obtained with a moistened wooden spatula from marginal gingiva. All the cytologic smears were stained with Giemsa solution. From each slide, 1000 cells were examined under 40× magnification and where micronuclei (MN) were located, they were examined under 100× magnification. The change in shade guide units at the different assessment periods and the frequency of MN were subjected to a two-way repeated measures analysis of variance and Tukey test (α=0.05). Results In both groups we detected a whitening of approximately 4 to 5 shade guide units, without color rebound after one month (p>0.05). The frequency of MN was significantly higher in the experimental group than in the control group, regardless of the bleaching treatment (p>0.001). Conclusion The efficacy of bleaching does not appear to be affected by the smoking habit. Additionally, at-home bleaching did not induce DNA damage to the gingival tissue during the bleaching period.

SUMMARY In tooth whitening, the hydrogen peroxide (HP) diffuses in the enamel and dentin, reaching the pulp. This in vitro study aimed to quantify the penetration of HP in the pulp chamber in teeth submitted to bleaching agents of different concentrations of HP without calcium (HP 20% [20CF], HP 35% [35CF]) and with calcium (HP 20% [20CC], HP 35% [35CC]). Method Fifty human premolars were sectioned 3 mm from the cemento-enamel junction and the pulp tissue was removed. The teeth were divided into five groups according to treatment and with a control group (n=10). An acetate buffer solution was placed in the pulp chamber of all teeth. The control group was exposed only to distilled water, while the other groups were treated with a bleaching procedure, according to the manufacturer's recommendations. After treatment, the acetate buffer solution was transferred to a glass tube in which leuco-crystal violet and peroxidase solutions were added, resulting in a blue solution. The optical density of this blue solution was determined spectrophotometrically and converted into micrograms equivalent to the HP. Data were analyzed using analysis of variance and Tukey tests (α=0.05). Results The HP concentration did not affect the HP inside the pulp chamber, but the presence of calcium significantly reduced it (p Conclusion The amount of HP that reaches the pulp chamber depends on the bleaching protocol and the product employed, and it seems to be less affected by HP concentration.

SUMMARY Objectives: The aim of this study was to investigate the effect of different protocols of 17% ethylene diamine tetra-acetic acid (EDTA) conditioning on the etching pattern and immediate bond strength of universal adhesives to enamel and sclerotic dentin. Methods and Materials: Forty bovine teeth with sclerotic dentin and 20 human third molars were randomly divided into eight groups resulting from the combination of the main factors surface treatment (none, two-minute EDTA conditioning manual application, 30-second EDTA manual application, 30-second EDTA sonic application) and adhesives systems (Scotchbond Universal Adhesive [SBU] and Prime & Bond Elect [PBE]). Resin-dentin and enamel-dentin bond specimens were prepared and tested under the microtensile bond strength (μTBS) and microshear bond strength (μSBS) tests, respectively. The etching pattern produced on the unground enamel and the sclerotic dentin surfaces under the different protocols and adhesive systems was evaluated under scanning electron microscopy. Results: For enamel, only the main factor adhesive was significant (p Conclusions: EDTA conditioning improves the bonding performance of universal adhesives in the self-etch mode on sclerotic dentin, mainly when applied for 30 seconds with the aid of a sonic device. EDTA pretreatment also improves the retentive etching pattern of enamel, but it does not result in higher enamel bond strength.

SUMMARY Objectives This study evaluated several bonding (microtensile bond strengths [μTBS], nanoleakage [NL], and in situ degree of conversion [ISDC] on dentin) and mechanical properties (ultimate tensile strength [UTS], degree of conversion [DC], water sorption [WS], and solubility [SL] in water) of four three-step etch-and-rinse adhesives in the short term. Methods A total of 28 molars were used in this study. The dentin surfaces were bonded with the following adhesives: All-Bond 3 (ALB3); Fusion Duralink (FSDL); Optibond FL (OBFL), and Scotchbond Multi-Purpose (SBMP). After each adhesive-system application, composite resin build-ups were added. For bonding tests, specimens were sectioned in order to obtain bonded sticks. The sticks were divided to be tested for μTBS (0.5 mm/min), for NL (n=2), and ISDC (n=2). For NL, they were immersed in 50% silver nitrate and analyzed by scanning election microscopy. For ISDC, the hybrid layer was evaluated by micro-Raman spectroscopy. An hourglass-shaped matrix (UTS) or disk-shaped matrix (WS and SL) was filled with primer and adhesive (1:1 ratio) and light-polymerized. For UTS evaluation, the specimens were tested under tension. For WS and SL, specimens were desiccated and stored in distilled water to evaluate water diffusion kinetics over a 28-day period. The DC of the adhesives was evaluated by Fourier transformed infrared spectroscopy. The data from each test were analyzed by appropriate statistical methods. Results OBFL resulted in the highest μTBS, lower NL, higher ISDC and DC, and higher UTS than other adhesives (p0.05). ALB3 showed a higher NL and the lowest DC value. FSDL showed the highest NL and SL and the lowest ISDC. SBMP showed the lowest pattern of WS (p Conclusion OBFL showed the best results in all the properties evaluated, and it can be considered the gold standard of the three-step etch-and-rinse adhesive systems.

SUMMARY The aim of this study was to evaluate the permeability (PE), microhardness (KHN), and mineral change in enamel after LED/laser activated in-office bleaching. For PE, the coronal portion of premolars (n=51) was subjected to bleaching with 35% hydrogen peroxide (Whiteness HP Maxx, FGM Dental Products, Joinville, SC, Brazil). The samples were stained via the histochemical method, which involves a copper sulphate solution and rubeanic acid. The penetration of dye into the enamel was measured. The KHN of enamel was assessed before treatment, immediately after the bleaching treatment, and again after one week. The calcium and phosphorus content were analyzed with a scanning electron microscope with energy-dispersive X-ray (JSM 6360LV, Jeol Ltd, Tokyo, Japan). The data set from each test was subjected to appropriate parametric statistical analysis (α=0.05). No significant differences were observed for PE in NLA and LA compared to the control group (p=0.98), as well as for calcium (p=0.16) and phosphorus (p=0.80) content. Significant reduction of KHN after bleaching occurred for both groups (p

SUMMARY Objectives To evaluate the effect of acid etching and application of a hydrophobic resin coat on the enamel/dentin bond strengths and degree of conversion (DC) within the hybrid layer of a universal adhesive system (G-Bond Plus [GB]). Methods A total of 60 extracted third molars were divided into four groups for bond-strength testing, according to the adhesive strategy: GB applied as a one-step self-etch adhesive (1-stepSE); GB applied as in 1-stepSE followed by one coat of the hydrophobic resin Heliobond (2-stepSE); GB applied as a two-step etch-and-rinse adhesive (2-stepER); GB applied as in 2-stepER followed by one coat of the hydrophobic resin Heliobond (3-stepER). There were 40 teeth used for enamel microshear bond strength (μSBS) and DC; and 20 teeth used for dentin microtensile bond strength (μTBS) and DC. After restorations were constructed, specimens were stored in water (37°C/24 h) and then tested at 0.5 mm/min (μTBS) or 1.0 mm/min (μSBS). Enamel-resin and dentin-resin interfaces from each group were evaluated for DC using micro-Raman spectroscopy. Data were analyzed with two-way analysis of variance for each substrate and the Tukey test (α=0.05). Results For enamel, the use of a hydrophobic resin coat resulted in statistically significant higher mean enamel μSBS only for the ER strategy (3-stepER vs 2-stepER, p For dentin, the use of a hydrophobic resin coat resulted in significantly higher dentin mean μTBS only for the SE strategy (2-stepSE vs 1-stepSE, p Conclusions The use of a hydrophobic resin coat may be beneficial for the selective enamel etching technique, because it improves bond strengths to enamel when applied with the ER strategy and to dentin when used with the SE adhesion strategy. The application of a hydrophobic resin coat may improve DC in resin-dentin interfaces formed with either the SE or the ER strategy. On enamel, DC may benefit from the application of a hydrophobic resin coat over 1-stepSE adhesives.

SUMMARY Purpose To evaluate the 18-month clinical performance of a multimode adhesive (Scotchbond Universal Adhesive, SU, 3M ESPE, St Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria. Materials and Methods Thirty-nine patients participated in this study. Two-hundred restorations were assigned to four groups: ERm, etch-and-rinse + moist dentin; ERd, etch-and-rinse + dry dentin; Set, selective enamel etching; and SE, self-etch. The composite resin, Filtek Supreme Ultra (3M ESPE), was placed incrementally. The restorations were evaluated at baseline, and at 18 months, using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed using Friedman repeated-measures analysis of variance by rank and McNemar test for significance in each pair (α=0.05). Results Five restorations (SE: 3; Set: 1; and ERm: 1) were lost after 18 months (p>0.05 for either criteria). Marginal staining occurred in four and 10% of the restorations evaluated (p>0.05), respectively, for USPHS and FDI criteria. Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38%, 40%, 36%, and 44% for groups ERm, ERd, Set, and SE, respectively, when the FDI criteria were applied (p>0.05). However, when semiquantitative scores (or SQUACE) for marginal adaptation were used, SE resulted in a significantly greater number of restorations, with more than 30% of the total length of the interface showing marginal discrepancy (28%) in comparison with the other groups (8%, 6%, and 8%, respectively, for ERm, ERd, and Set). Conclusions The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy. The only differences between strategies were found for the parameter marginal adaptation, for which the FDI criteria were more sensitive than the USPHS criteria.

SUMMARY Objective: This study determined the effect of the administration of perioperative ibuprofen 400 mg on tooth sensitivity caused by in-office bleaching. Methods: A triple-blind, parallel-design, randomized clinical trial was conducted on 30 adults who received placebo or ibuprofen before and after bleaching. The drugs were administered three times per day for 48 hours; the first dose was given one hour prior to the bleaching treatment. Two bleaching sessions with 35% hydrogen peroxide gel were performed with a one-week interval. Tooth sensitivity was recorded on two scales: visual analogue and five-point verbal rating scale up to 48 hours after bleaching. The shade evaluation was performed with a visual shade guide and spectrophotometer, before and 30 days after bleaching. The absolute risk of tooth sensitivity and its intensity were evaluated by Fisher exact and Mann-Whitney tests, respectively. The shade changes were evaluated by Student's t-test. Results: Both groups showed similar absolute risk of tooth sensitivity (p>0.05). Lower tooth sensitivity was observed in the experimental group only up to one hour postbleaching (p=0.04). Similar tooth sensitivity was observed in the other periods of time. Conclusion: The perioperative use of the anti-inflammatory ibuprofen was not able to avoid tooth sensitivity but reduced its intensity up to one hour after bleaching.

SUMMARY The purpose of the present study was to evaluate whether exposure to coffee during bleaching treatment with 16% carbamide peroxide (CP) affects the degree of whitening and tooth sensitivity. Forty patients with central incisors darker than A2 were selected. Participants who did not drink coffee were assigned to the control group (CG), while participants who drink coffee at least twice a day were assigned to the experimental group (EG). For CG, foods with dyes were restricted. For EG there was no restriction on food and patients were asked to make coffee rinses for 30 seconds, four times daily. For both groups 16% CP was used for a period of three hours daily for three weeks. Shade evaluation was assessed visually by Vita classical shade guide and by the Easyshade spectrophotometer at baseline, during bleaching (first, second, and third weeks), and postbleaching (one week and one month). Patients recorded their sensitivity perceptions by means of the numerical rating scale and 0-10 visual analog scales. Variation in shade guide units and the two colors (ΔE) were evaluated by two-way analysis of variance and Tukey tests (α=0.05). Absolute risk of tooth sensitivity and intensity of tooth sensitivity was evaluated by Fisher exact and Mann-Whitney tests (α=0.05). Effective bleaching was observed for both groups after three weeks, without statistical difference. No difference in terms of risk of tooth sensitivity and intensity of tooth sensitivity was detected between groups. Approximately 57% of the participants experienced tooth sensitivity, which was recorded mainly as “mild.” Exposure to coffee during bleaching treatment does not seem to affect the degree of bleaching and tooth sensitivity.

Purpose: To evaluate the effect of bur roughness on bond strength values and conditioner pattern of two-step self-etch adhesives applied on sclerotic dentin. Methods: The roots of 48 bovine incisors were removed and the crowns were divided into four groups: the control group (CO) teeth were left untreated or the teeth were slightly roughened with coarse-, medium-, or fine-grit diamond burs. Next, the teeth were subdivided and Clearfil SE Bond (CSE) and Adper SE Bond (ASE) were applied according to the manufacturers' instructions. Composite resin (Opallis) buildups were incrementally constructed on the bonded surfaces. After storage for 24 hours in distilled water at 37°C, the teeth were sectioned into sticks (area of 0.8 mm2). The sticks were stressed until failure by tensile forces (0.5 mm/min). Additionally, eight bovine teeth were treated as previously described, and after adhesive application, the surface was rinsed off and examined by scanning electron microscopy to measure the relative number of open tubules (OT). Data (MPa) were analyzed by two-way analysis of variance and Tukey test (p=0.05). Results: CO showed the highest bond strength values (p

SUMMARY Objective: The aim of this study was to evaluate the genotoxicity of in-office bleaching with 35% hydrogen peroxide in epithelial cells from the gingival and lip tissues. Methods and Materials: Thirty volunteers with central incisors shade A1 or darker were selected for this study. The gingival tissue of the teeth to be bleached was isolated with a light-polymerized resin dam, and the 35% hydrogen peroxide gel was administered during three 15-minute applications over the course of the 45-minute application period. Two bleaching sessions with a one-week interval in between were performed. Exfoliated oral mucosa gingival epithelial cells and upper lip lining were collected at baseline and one month after the in-office dental bleaching. The scraped cells were placed on clean glass slides and smears were prepared. After staining with Giemsa solution, two blinded examiners performed cell and micronuclei counts under a 100× optical microscope. Tooth sensitivity was evaluated using the Visual Analogue Scale (VAS). Shade evaluation was recorded before and one month after the bleaching treatment with the value-oriented shade guide Vita Bleachedguide 3D-MASTER and the spectrophotometer Vita Easyshade. Data from the shade guide units and the micronuclei (MN) frequency were subjected to a Mann-Whitney test (α=0.05). The overall difference between before and one month after the bleaching treatment (ΔE and ΔSGU), absolute risk, and intensity of tooth sensitivity (TS) were calculated, as was the 95% confidence interval (CI). Results: The frequency of MN was not increased after bleaching with 35% hydrogen peroxide in both study groups (p>0.05). The absolute risk of TS of the participants was 93% (95% CI, 79%-98%), with a mean VAS intensity of 5.7 ± 2.9 (95% CI, 4.6-6.8). Meaningful whitening was observed after bleaching. The change in shade guide units in the Bleachedguide 3D-MASTER was 2.3 ± 1.4. In terms of ΔE, the change in color was 7.7 ± 3.5. Conclusions: The in-office bleaching did not induce DNA damage to the gingival and lip tissue during the bleaching period. Although effective whitening was observed, most of the participants experienced TS.

SUMMARY Objective: To compare the bleaching efficacy and tooth sensitivity (TS) of two hydrogen peroxide (HP) concentrations (20% and 35%) used for in-office bleaching associated or not with a light-emitting diode (LED)/laser light activation. Method: Seventy-seven patients with a right maxillary canine darker than A3 were selected for this single-blind randomized trial. The participants were distributed in four groups: bleaching with 35% HP, 35% HP + LED/laser, 20% HP, and 20% HP + LED/laser. The anterior teeth were bleached in two sessions, using a 35% or 20% HP gel with a one-week interval. Each session had three applications of 15 minutes. For the light-activated groups, the LED/laser energy (Whitening Laser Light Plus, DMC) was employed according to the manufacturer's instructions. The color change was evaluated by subjective and objective methods. Participants recorded TS with five-point verbal and visual analog scales. Color change in ΔE was evaluated by analysis of variance and Tukey tests (α=0.05) and in ΔSGU with Kruskall-Wallis and Dunn test. The absolute risk of TS and TS intensity were evaluated by Fisher exact test and Kruskall-Wallis test, respectively (α=0.05). Results: All groups achieved the same level of whitening, except for the 20% HP group, which showed the lowest degree of whitening in the subjective analysis. The use of light did not increase the absolute risk or intensity of TS. No significant difference among groups was observed when color changes were assessed with the spectrophotometer. Conclusion: According to the value-oriented shade guide, the use of LED/laser light activation was able to increase the degree of whitening of the 20% HP group, but this association was not useful for the 35% HP gel. The spectrophotometer, however, did not detect significant differences among groups.

SUMMARYObjective: A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity during in-office and at-home bleaching in adult patients. The efficacy of dental bleaching was also evaluated.Methods: A comprehensive search was performed in the MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and System for Information on Grey Literature in Europe without restrictions. The annual conference of the International Association for Dental Research abstracts (1990-2014) and unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periódicos Capes Theses databases. Only randomized clinical trials that compared the prevalence or intensity of tooth sensitivity during in-office and at-home bleaching in adult patients were included and studies that evaluated the efficacy of these dental bleaching techniques, in terms of shade guide units (ΔSGU) and in terms of color difference measured with a spectrophotometer (ΔE*).Results: After the removal of duplicates, 1139 articles were identified. After title and abstract screening, 29 studies remained. Fifteen studies were further excluded, whereas 12 studies remained for qualitative analyses and 8 for the meta-analysis of the primary and secondary outcomes. No significant difference in the risk/intensity of tooth sensitivity or in bleaching efficacy was observed in the present study.Conclusion: In an overall comparison of at-home and in-office bleaching, no differences were detected, either regarding risk/intensity of tooth sensitivity or the effectiveness of the bleaching treatment. This comparison, however, does not take into consideration variations in the protocols (daily usage time, number of bleaching sessions, and product concentration) of the bleaching techniques in the studies included.

SUMMARY Objectives: The aim of this study was to evaluate the efficacy, color stability, risk, and intensity of tooth sensitivity (TS) of combined bleaching techniques performed with 20% or 35% hydrogen peroxide for an in-office protocol. Methods: Thirty patients were randomly divided into two groups and submitted to a single 45-minute in-office bleaching session with 35% hydrogen peroxide or 20% hydrogen peroxide. At-home bleaching was performed with 10% carbamide peroxide for two hours daily over the course of two weeks. The color was evaluated with the value-oriented shade guide Vita Classical at different periods up to 12 months after bleaching. Patients recorded the intensity of TS using a five-point verbal scale. Color change data were submitted to a two-way repeated-measures analysis of variance and Tukey test (α=0.05). The absolute risk and intensity of TS were compared with the Fisher exact test and Mann-Whitney test, respectively (α=0.05). Results: On average, an effective and similar whitening of three units in shade guide was observed for both groups, which remained stable for 12 months. When both protocols were compared, the one with hydrogen peroxide 35% showed a higher risk (p=0.02) and intensity of TS (p=0.04). In regard to the TS intensity, no significant difference was observed up to 48 hours after in-office bleaching (p=0.09) and during the at-home bleaching phase of the study (p=0.71). Conclusion: The combined bleaching technique using at-home bleaching associated with in-office bleaching was effective and stable over the course of 12 months, regardless of the concentration of the hydrogen peroxide used for in-office bleaching. However, the protocol with 20% hydrogen peroxide produced lower risk and intensity of TS.

SUMMARY Objectives: To evaluate the effect of minocycline and chlorhexidine pretreatment of acid-etched dentin on the longevity of resin-dentin bond strength (μTBS) and nanoleakage of two-step etch-and-rinse adhesives. Methods: Before application of Prime & Bond NT and Adper Single Bond 2 in occlusal dentin, the dentin surfaces were treated with 37% phosphoric acid, rinsed, air-dried, and rewetted with water (control group), 2% minocycline, or 2% chlorexidine digluconate. Composite buildups were constructed incrementally, and specimens were longitudinally sectioned to obtain bonded sticks (0.8 mm2) to be tested in tension (0.5 mm/min) immediately or after 24 months of water storage. For nanoleakage, two specimens of each tooth/period were immersed in the silver nitrate solution, photo-developed, and polished with SiC paper for analysis under energy-dispersive X-ray spectroscopy/scanning electron microscopy. Results: Reductions of the μTBS and increases in the nanoleakage were observed for both adhesives when the rewetting procedure was performed with water. Stable bonds were observed for the 2% minocycline and 2% chlorexidine digluconate groups after 24 months. Conclusions: The use of 2% minocycline as pretreatment of acid-etched dentin is one alternative to retard the degradation of resin-dentin interfaces over a 24-month period as well as 2% chlorexidine digluconate.

SUMMARY Objectives: To evaluate the effect of application protocol in resin–enamel microshear bond strength (μSBS), in situ degree of conversion, and etching pattern of three universal adhesive systems. Methods and Materials: Sixty-three extracted third molars were sectioned in four parts (buccal, lingual, and proximals) and divided into nine groups, according to the combination of the main factors—Adhesive (Clearfil Universal, Kuraray Noritake Dental Inc, Tokyo, Japan; Futurabond U, VOCO, Cuxhaven, Germany; and Scotchbond Universal Adhesive, 3M ESPE, St Paul, MN, USA)—and enamel treatment/application time (etch-and-rinse mode [ER], self-etch [SE] application for 20 seconds [SE20], and SE application for 40 seconds [SE40]). Specimens were stored in water (37°C/24 h) and tested at 1.0 mm/min (μSBS). The degree of conversion of the adhesives at the resin–enamel interfaces was evaluated using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data were analyzed with two-way analysis of variance and Tukey test (α=0.05). Results: In general, the application of the universal adhesives in the SE40 produced μSBS and degree of conversion that were higher than in the SE20 (p Conclusions: The active and prolonged application of universal adhesives in the SE mode may be a viable alternative to increase the degree of conversion, etching pattern, and resin–enamel bond strength.

SUMMARY Objective: The aim of this randomized, controlled prospective clinical trial was to evaluate the clinical effectiveness of restoring noncarious cervical lesions with two self-etching adhesive systems applied with or without selective enamel etching. Methods: A one-step self-etching adhesive (Xeno V+) and a two-step self-etching system (Clearfil SE Bond) were used. The effectiveness of phosphoric acid selective etching of enamel margins was also evaluated. Fifty-six cavities were restored with each adhesive system and divided into two subgroups (n=28; etch and non-etch). All 112 cavities were restored with the nanohybrid composite Esthet.X HD. The clinical effectiveness of restorations was recorded in terms of retention, marginal integrity, marginal staining, caries recurrence, and postoperative sensitivity after 3, 6, 12, 18, and 24 months (modified United States Public Health Service). Results: The Friedman test detected significant differences only after 18 months for marginal staining in the groups Clearfil SE non-etch (p=0.009) and Xeno V+ etch (p=0.004). One restoration was lost during the trial (Xeno V+ etch; p>0.05). Conclusions: Although an increase in marginal staining was recorded for groups Clearfil SE non-etch and Xeno V+ etch, the clinical effectiveness of restorations was considered acceptable for the single-step and two-step self-etching systems with or without selective enamel etching in this 24-month clinical trial.

To evaluate the performance of All Bond SE used in a one- or two-step protocol in a 24-month randomized clinical study.Thirty-three patients with two similarly sized non-carious cervical lesions participated in this study. A total of 66 restorations were placed, half using the one-step All Bond SE protocol (SE-1) and the other half using the two-step All Bond SE protocol (SE-2). The restorations were evaluated at baseline and after 6, 12 and 24 months following the modified USPHS criteria and analyzed by the McNemar's test and Fisher's exact test (alpha = 0.05).After 24 months, six SE-1 and four SE-2 restorations were rated as Bravo in marginal discoloration The retention rates for SE-1 and SE-2 were 84.8% and 90.9%, respectively, after 24 months. Compared to baseline, the retention rate for SE-1 was statistically lower.All Bond SE used in the one- or two-step protocol resulted in high retention rates after 24 months.

This study evaluated the effect of the application mode on the microtensile resin-dentin bond strength (microTBS) and silver nitrate uptake (SNU) of three one-step self-etch adhesives systems (Clearfil S3 Bond [S3], Xeno III [XE] and Adper Prompt L-Pop [AD]).The occlusal enamel of 30 caries-free extracted molars was removed with a slow-speed diamond saw under copious water-cooling in order to expose a flat dentin surface. The adhesives were applied passively or with agitation. After light-curing (600 mW/cm2 for 10 seconds), composite buildups were constructed incrementally and the specimens were stored in water (37 degrees C/24 hours). The specimens were longitudinally sectioned in the "x" and "'y" direction to obtain bonded sticks (0.8 mm2) to be tested immediately in tension at 0.5 mm/minute. For SNU, two bonded sticks from each tooth were coated with nail varnish, placed in silver nitrate and polished down with SiC paper. The microTBS and SNU data were submitted to two-way ANOVA and Tukey's test (alpha=0.05).Regarding the microTBS, only the main factor mode of application was statistically significant (p = 0.01). All adhesives showed higher microTBS when applied with agitation. Regarding SNU, only the main factor adhesive was statistically significant (p = 0.001). A higher amount of silver nitrate uptake, located in both the hybrid and adhesive layer, occurred for AD, regardless of the mode of application.Application with agitation on the dentin surface is a clinical tool capable of improving the resin-dentin bond strength of one-step self-etch adhesives; however, this clinical approach does not improve the hybrid layer resistance to silver nitrate uptake.

To evaluate the effects of surface treatment and intermediate agent hydrophilicity on durability of the composite repair by means of the microtensile bond strength test (microTBS) and silver nitrate uptake (SNU) and the effects of surface treatment on composite roughness (Ra) and micromorphological features (SEM).Thirty resin composite blocks (4x6x6 mm) (Opallis, FGM) were polished after seven days and divided into three groups: no treatment (NT); roughening with a fine-grit diamond bur (DB); 50 microm aluminum oxide sandblasting (AO). A hydrophobic (Adhesive bottle, Scotchbond MultiPurpose [SBMP]) or hydrophilic adhesive (Adper Single Bond 2 [SB]) was then applied. The same composite was used for repair. Composite-composite bonded sticks (0.6 mm2) were tested immediately ([IM) or after six months (6 M) of water storage in tension (1.0 mm/minute). Two bonded sticks from each resin composite block were immersed in a 50% (w/v) solution of silver nitrate, photo-developed and analyzed by SEM. The composite specimens after surface treatments were analyzed with a contact profilometer (Ra) and SEM. Three-way repeated measures and one-way ANOVA were used to analyze data from the microTBS and Ra, respectively (alpha = 0.05).AO showed the highest composite repair strength (MPa) and Ra (microm) (52.7 +/- 6.4; 4.1 +/- 0.5), while the no treatment group (36.1 +/- 6.1; 0.57 +/- 0.5) showed the low est. DB (44.1 +/- 5.6; 1.5 +/- 0.2) had an intermediate performance. The Ra results were confirmed by SEM images. SNU was observed only in SB specimens after 6M for all groups.Aluminum oxide treatment provides the highest composite repair strength, regardless of the hydrophilicity of the intermediate agent and storage period. Early signs of degradation were detected for SB after six months as silver nitrate deposits within the adhesive layer.

This double-blind randomized clinical trial compared different ethanol/water and acetone-based systems in non-carious cervical lesions over 36 months.Eighty-four patients having at least one non-carious cervical lesion [NCCL] under occlusion were enrolled in this study. A total of 84 restorations were placed, half for each group (Adper Single Bond [SB] + FiltekA110 or One Step [OS] + MicroNew). All the materials were placed by two calibrated operators. Two other independent examiners evaluated the restorations at baseline, 6, 12, 18 and 36 months, according to slightly modified USPHS criteria. Statistical analysis between materials in each period was conducted using the Fisher's exact test (alpha=0.05), and performance of the materials in the baseline in comparison to each period was evaluated by McNemar's test (alpha=0.05).The 12-, 18- and 36-month retention rates for SB were 95.2% (12 and 18 months) and 92.3% (36 months). For OS, the retention rates were 83.3%, 73.8% and 56.4%, respectively, for each recall period. After 36 months, 10 OS restorations (25.7%) and seven SB restorations (17.9%) were rated as Bravo in the marginal discoloration item.The ethanol/water-based adhesive (Single Bond) that was evaluated showed a higher retention rate than the acetone-based system (One Step) after 36 months of clinical service.

This study assessed the nanohardness (NH) and Young's modulus (YM) of resin-dentin bonding components formed by an ethanol/water-based (Adper Single Bond Plus [SBP]) and an acetone-based system (One Step Plus [OSP]) under different moisture conditions and application methods.On 24 human molars, a flat, superficial dentin surface was exposed by wet abrasion. After acid-etching, two coats of SBP or OSP adhesive were applied on either a dry or rewetted dentin surface under vigorous rubbing action or inactive application. After polymerization of the adhesives (600 mW/cm2/20 seconds), composite buildups were constructed incrementally and the specimens were stored in water (37 degrees C/24 hours). They were cross-sectioned perpendicular to the resin-dentin interface to obtain 1.5 mm-thick slices that were embedded and polished before the test. Nano-indentations were made on the resin composite, adhesive system, hybrid layer and mineralized dentin. The results of NH and YM (GPa) of the adhesive system and hybrid layer were analyzed using three-way repeated measures ANOVA and Tukey's multiple comparison tests (alpha = 0.05).When the dentin was kept wet, the mode of application did not affect the studied properties within the hybrid layer. On the other hand, the vigorous application mode increased the NH and YM of both adhesives applied in air-dried dentin. In the adhesive layer, the highest NH and YM were observed only for SBP, especially when applied in wet dentin under vigorous action.It was concluded that: 1) the vigorous application of both adhesives in dry dentin resulted in high nanohardness and Young's modulus values in the hybrid layer and 2) in the adhesive layer, the moisture associated with the vigorous application mode increased the nanohardness and Young's modulus values of Adper Single Bond Plus.

This study evaluated the influence of adhesive layer thickness (ADL) on the resin-dentin bond strength of two adhesive systems (AS) after thermal and mechanical loading (TML). A flat superficial dentin surface was exposed with 600-grit SiC paper on 40 molars. After primer application, the adhesive layer of Scotchbond Multipurpose (SBMP) or Clearfil SE Bond (CSEB) was applied in one or two layers to a delimited area (52 mm2) and resin blocks (Filtek Z250) were built incrementally. Half of the sample was stored in distilled water (37 degrees C, 24 hours) and submitted to thermal (1,000; 5 degrees -55 degrees C) and mechanical cycles (500,000; 10kgf) [TML]. The other half was stored in distilled water (72 hours). The teeth were then sectioned to obtain sticks (0.8 mm2) to be tested under tensile mode (1.0 mm/minute). The fracture mode was analyzed at 400x. The BS from all sticks from the same tooth was averaged for statistical purposes. The data was analyzed by three-way ANOVA. The chi2 test was used (p0.05) to compare the frequency of pre-testing failure specimens. Higher BS values were observed for SBMP regardless of the ADL. The TML reduced the BS values irrespective of the adhesive employed and the ADL. A higher frequency of pre-testing failure specimens was observed for the cycled groups. A thicker adhesive layer, acting as an intermediate flexible layer, did not minimize the damage caused by thermal/mechanical load cycling for a three-step etch-and-rinse and two-step self-etch system.

To compare the response of human dental pulp capped with a mineral trioxide aggregate (MTA) and Ca(OH)2 powder.Pulp exposures were performed on the occlusal floor of 40 permanent premolars. The pulp was then capped with either Ca(OH)2 powder (CH) or MTA and restored with resin composite. After 30 days (groups CH30 and MTA30) and 60 days (groups CH60 and MTA60), the teeth were extracted and processed for HE and categorized in a histological score system. The data were subjected to Kruskal-Wallis and Conover tests (alpha = 0.05).In regard to dentin bridge formation, CH30 showed a tendency towards superior performance compared to MTA30 (p0.05), although the products showed comparable results at day 60. In the item "Inflammation" and "General State of the Pulp" (p0.05), CH showed a tendency towards presenting a higher inflammatory response. In the item "Other Pulpal Findings," MTA and Ca(OH)2 showed equal and excellent performance after 30 and 60 days (p0.05).After 30 days, Ca(OH)2 powder covered with calcium hydroxide cement showed faster hard tissue bridge formation compared to MTA. After 60 days, Ca(OH)2 powder or MTA materials showed a similar and excellent histological response with the formation of a hard tissue bridge in almost all cases with low inflammatory infiltrate.