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The widespread application of CAD/CAM technology in contemporary dentistry led to the development of promising restorative materials, such as resin composite blocks (RCBs). Thus, the present study aims to evaluate the mechanical properties of RCBs, comparing this material to the direct composite resin from the same manufacturer. Samples retrieved from three CAD/CAM resin composite blocks (Tetric CAD (TC), Ivoclar Vivadent, Grandio blocs (GB), VOCO GmbH and Brilliant Crios (BC), Coltene/Whaledent) and four direct composite resins (Tetric EvoCeram (TEC), Ivoclar Vivadent, GrandioSO (GS), VOCO GmbH, Brilliant EverGlow Translucent (BET) and Universal Shade (BEU), Coltene/Whaledent) were submitted to three-point bending flexural test and Vickers microhardness test. The resulting data of the flexural strength were analyzed using one-way ANOVA considering Bonferroni correction for post hoc tests (α = 0.05). The flexural modulus and Vickers microhardness results were analyzed using Welch’s ANOVA considering Games–Howell correction for post hoc tests (α = 0.05). Regarding results, flexural strength and flexural modulus values ranged from 81.1 MPa (BEU) to 246.5 MPa (GB) and 10.6 GPa (BEU) to 20.3 GPa (GB), respectively. GS (121.2) and GB (136.2) groups were associated with the highest microhardness values. According to the post hoc tests, statistically significant differences in flexure strength were found in RCBs (BC, GB, and TC) compared to all direct composite resins. Flexural modulus and Vickers microhardness of RCBs (BC, GB, TC) were also significantly different from the direct composite resin (BET, BED, and TEC), except when comparing GS and GB for microhardness. In conclusion, differences between RCBs and direct composite resins were observed regarding flexural strength, flexural modulus, and microhardness, revealing that RCBs have enhanced mechanical properties compared to direct composite resins.

Kidney transplantation is the gold standard treatment for end-stage renal disease, improving survival and quality of life compared to dialysis. However, the use of immunosuppressive therapy to prevent allograft rejection renders recipients vulnerable to infections, a major concern in the posttransplant period. Prophylaxis strategies are indispensable in minimizing infectious risks and optimizing patient outcomes. This narrative review synthesizes current prophylaxis strategies across pretransplant, peritransplant, and posttransplant phases, providing a comprehensive overview of indications, timing, dosing, and adverse effects. Pretransplant prophylaxis involves thorough screening for infections, updating immunization status, and managing latent infections. Peritransplant prophylaxis focuses on tailored antimicrobial approaches to mitigate surgical and donor-related infection risks during the perioperative period. Posttransplant prophylaxis is a crucial component against opportunistic infections, particularly focusing on preventing Pneumocystis jirovecii pneumonia and cytomegalovirus infection. This discussion encompasses the nuances of prophylactic regimens, highlighting the efficacy and challenges associated with the agents available and used in clinical practice. This review emphasizes the pivotal role of prophylaxis in minimizing infectious risks and optimizing outcomes in kidney transplant recipients, advocating for a proactive and multifaceted approach to infectious disease management in the transplant setting.

The purpose of this study was to evaluate the effect of two finishing and polishing methods on the surface roughness of different resin composites. Twenty-two disk-shaped specimens of five resin composites Zirconfill® (ZF), Filtek™ Supreme XTE (FS), Brilliant EverGlow™ (BG), Ceram.X® Duo (CD), and Harmonize™ (HA) were prepared for each one using a silicon mold. Both surfaces of each specimen were first grinded with 600-grit silicon carbide paper in a moistened environment. The polishing methods used included the two-step Enhance® and PoGo® polishing system (E/P) or the four-step SwissFlex® discs (SFD). Surface roughness was evaluated using a noncontact 3D-optical profilometer. Surface morphology was examined by scanning electron microscopy. Data were analyzed using two-way analysis of variance and pairwise comparisons with Tukey’s test (α=0.050). Surface roughness was affected by both the type of resin composite (p

Abstract Introduction: Type 1 diabetes mellitus is associated with an increased risk of coronary artery disease, which is frequently asymptomatic. This risk increases significantly in those with nephropathy. In selected patients, simultaneous pancreas-kidney transplantation is the renal and pancreatic replacement therapy of choice, as it increases longevity and stabilizes diabetic complications. Despite essential, universal screening protocols are still controversial for coronary artery disease in this population. Methods: We retrospectively analysed 99 simultaneous pancreas-kidney recipients from our centre from 2011 to 2018 and selected 77 patients who underwent coronary angiography during the pre-transplant evaluation. Our aim was to identify potential risk factors associated with significant lesions on coronary angiography. Results: Almost half of our cohort of 77 candidates submitted to coronary angiography had coronary artery disease. Of these, nearly 30% underwent revascularization, although only one of them reported symptoms of myocardial ischemia. In a univariate analysis, the presence of smoking habits was the only risk factor for coronary artery disease. We also found that 20 or more years of type 1 diabetes mellitus was significantly associated with the presence of coronaropathy. Discussion: Selection of diabetic candidates with acceptable cardiac risk before simultaneous pancreas-kidney transplantation is imperative. Given the impact of a correct diagnosis and a low procedural risk, we defend the routine use of coronary angiography as the initial screening method for coronary artery disease in this population. Particularly care must be taken in evaluating asymptomatic patients with long-term type 1 diabetes mellitus and smokers.

Up to this moment, there is no guideline regarding the materials to produce mouthguards. The most used is Ethylene-Vinyl Acetate (EVA). Studies indicate that laminating EVA sheets with rigid components could increase the protection capacities of the mouthguards whereas other studies suggest that only replacement of the material within it structure can increase energy absorption. The aim of this work is to evaluate the impact response of four different foils when compared to a 4 mm thickness EVA sheet. Five groups of different materials were subjected to impact tests with energies of 1.72 J, 2.85 J and 4.40 J. In this context was considered the following materials: EVA foils (G1), EVA foils with an EVA foam core (G2), EVA foils with an acetate core (G3), Foils of Erkoloc-pro (G4) and Foils of Ortho IBT resin (G5). Comparisons between the materials were made by qualitative analysis of the average energy-time and load-displacement curves, as well as by comparison of the peak load, maximum displacement, contact time and absorbed energy using the Kruskal-Wallis test. It was possible to conclude that statistically significant differences were found in the energy absorbed (p=0.001). Laminated foils with a soft core (G2) are a good option to produce mouthguards, while EVA foils with an acetate core (G3) and foils of Ortho IBT resin (G5) were declared unsuitable.

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

Experimental research studies have shown that wearing a mouthguard (MG) is an effective way to prevent tooth or maxillofacial trauma. However, there is a lack of scientific information regarding how the material arrangement within the mouthguard can modify its mechanical response during an impact. Hence, this study aimed to evaluate the influence of material arrangement within custom-made mouthguards on stress transmitted to anterior teeth, bone, and soft tissue after impact. Four 3D finite element models of a human maxilla were reconstructed based on the CBCT of a young patient and analyzed according to the presence or absence of a mouthguard and the type of material arrangement within those with a mouthguard: model NMG with no mouthguard; model CMG representing the conventional arrangement with a single 4 mm-thick ethylene-vinyl acetate (EVA) foil; model FMG presenting layer arrangement with two 1 mm-thick foils of EVA in the outer shell and one 2 mm-thick foil of EVA foam in the core; model HMG presenting a 1 mm-thick compact inner and outer shell of EVA and a 2 mm wide air-filled zone in the core. Linear quasi-static analysis and frontal load were used to simulate an impact with an energy of 4.4 J. Isotropic linear elastic properties were assumed for the bone and teeth but not for the mouthguard protection and oral soft tissues. The results were evaluated and compared in terms of displacement, stretches, and stresses. All the mouthguards analyzed reduced the risk of injury to teeth and bone, reducing the displacement and stress of these structures. However, the implementation of a honeycomb structured layer allowed more significant displacement and deformation of the mouthguard’s external layer, thus promoting higher protection of the anatomic structures, namely the root dentin and the bone tissue. Nevertheless, the results also indicate that improving the mouthguard flexibility might increase the soft tissue injuries.

Background: Renal involvement in rheumatoid arthritis (RA) is common and has a negative impact on patient survival. Only few cases have been reported of necrotizing glomerulonephritis (GN) associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) in patients with RA. Case Presentation: We report a patient with RA who developed a necrotizing GN associated with ANCA-MPO, treated with rituximab (RTX). A 55-year-old man with a 27-year history of RA under secukinumab was referred to our nephrology clinic with worsening renal function associated with microhematuria and proteinuria. Our laboratory evaluation showed hypocomplementemia and positive titers for MPO-ANCA (615 U/mL). A renal biopsy demonstrated pauci-immune necrotizing GN. The patient was treated with 3 consecutive pulses of methylprednisolone followed by oral prednisolone (1 mg/Kg) and rituximab (1000 mg, repeated 14 days later). After a 10-month follow-up, the arthritis remains well-controlled, renal function stabilized, proteinuria improved and MPO-ANCA titer normalized (6.3 U/mL). Conclusions: Necrotizing GN is a rare but a serious condition and an early diagnosis is essential to treatment. This is the first case of necrotizing GN (without extra-renal manifestations of vasculitis) in a patient with active RA, successfully treated with RTX.

The main purpose of this work was to analyze the stress distribution in premolars restored with indirect IPS Empress® CAD onlays or inlays. The three-dimensional geometry of a human first premolar was created using modeling software. The tooth fixation system was simulated through box geometry, comprising a cortical bone layer with 2 mm of thickness over a layer of trabecular bone with 15 mm of thickness. The tooth had the following approximated crown dimensions: 10.35 mm buccolingual length; 7.1 mm mesiodistal width; and 7.0 mm cervico-occlusal height. The mesio-occluso-distal (MOD) cavity preparations followed the suggestions available in the literature. The cement geometry was modified to include cohesive zone models (CZM) to perform the adhesive joint’s strength prediction. The loading body was created assuming contact between the food bolus and the tooth surface. Numerical solutions were obtained by performing static analysis and damage analysis using the finite element method. Von Mises stress values generated in the ceramic inlay restoration ranged from 1.39–181.47 MPa, which were on average 4.4% higher than those of the onlay ceramic restoration. The fracture strength of the onlay restoration was about 18% higher than that of the inlay restoration. The onlay design seems to contribute to higher homogenization of the adhesive resin cement strain and higher tooth structure protection.

The main purpose of this work was to construct a clinically valid numerical model of a mandibular Kennedy class I patient rehabilitated with a conventional removable partial denture and another two with implant-assisted removable partial dentures at two different implant locations. The selected patient was classified as ASA I and its mandible geometry reconstruction was performed by the conversion of the Cone-Beam computed Tomography (CBCT) scan raw medical data into a 3D model and subsequent conversion to a CAD file by reverse engineering methods. The soft tissue and removable denture geometries were also included in the CAD model as well as implants, ball attachments and matrix. Moreover, periodontal ligament was modelled by offsetting the mesh of the root surface of each tooth. The finite element results showed that the installation of a dental implant in each of the bilateral edentulous regions helps providing support and retention to the extension bases of the Removable Partial Denture (RPD) and significantly reduces the vertical and anterior-posterior displacements, regardless of its position.

Polymerization shrinkage is a major concern to the clinical success of direct composite resin restorations. The aim of this study was to compare the effect of polymerization shrinkage strain of two resin composites on cuspal movement based on the use of fiber Bragg grating (FBG) sensors. Twenty standardized Class II cavities prepared in upper third molars were allocated into two groups (n=10). Restorations involved the bulk fill placement of conventional microhybrid resin composite (Esthet•X® HD, Dentsply DeTrey) (Group 1) or flowable “low-shrinkage” resin composite (SDR™, Dentsply DeTrey) (Group 2). Two FBG sensors were used per restoration for real-time measurement of cuspal linear deformation and temperature variation. Group comparisons were determined using ANCOVA (α=0.05) considering temperature as the covariate. A statistically significant correlation between cuspal deflection, time, and material was observed (p