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Objectives: This study investigates the dentin permeability (by hydraulic conductance) and tubule occlusion (by confocal and scanning electron microscopies) of in-office desensitizing materials., Materials and Methods: Bovine dentin blocks were immersed in EDTA to open dentinal tubules. Placebo varnish (PLA), fluoride varnish (FLU), NaF 5% + 5% nanoparticulate sodium trimetaphosphate varnish (TMP), universal adhesive system (SBU), S-PRG filler varnish (SPRG), Biosilicate (BIOS), and amelotin (AMTN) solution were the materials tested. After application, the specimens underwent an erosive-abrasive challenge. Dentin permeability was evaluated at T0 (initial), T1 (after treatment), and T2 (after challenge). Confocal and scanning electron microscopy (SEM) were used to evaluate, respectively, length and number of dentinal tubule occlusions and opened dentinal tubules, after challenge. Permeability and SEM data were analyzed by two-way repeated measures ANOVA and Tukey's tests. Confocal data were analyzed by one-way ANOVA, Tukey's test, and Kruskal-Wallis and Dunn's tests. Spearman and Pearson's correlation tests were also used. Significance level was set at 5%., Results: At T1, the AMTN group showed the lowest permeability value, following the increasing order at T2: AMTN = SBU < BIOS = SPRG < TMP < FLU < PLA. The SBU group had the highest value of occluded dentinal tubule length. The AMTN group presented more occluded dentinal tubules compared to PLA and FLU. AMTN and SBU had the lowest values of opened dentin tubules. Results showed a negative correlation between the analyses., Conclusion: The SBU and AMTN solution were more effective in reducing dentin permeability by occluding dentin tubules., Clinical Relevance: All materials reduced permeability after challenge, except fluoride varnish., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This randomized, prospective, and split-mouth study aimed to evaluate flowable bulk-fill resin composites in class II restorations, comparing it with a conventional layering technique after 4-year follow-up., Materials and Methods: Fifty-three subjects received three class II restorations according to the restorative systems: conventional microhybrid composite resin (PA - Peak Universal + Amelogen Plus, Ultradent); flowable bulk-fill and nanoparticulate composite resins (ABF - Adper Single Bond 2 + Filtek Bulk Fill Flow + Filtek Z350XT, 3M/Espe); and flowable bulk-fill and microhybrid composite resins, (XST - XP Bond + SDR + TPH3, Dentsply). The clinical performance and interproximal contacts were evaluated. Statistical analyses were performed using the Kaplan-Meier, equality test of two proportions, Friedman, Wilcoxon, Kruskal-Wallis, Mann-Whitney, and Logistic regression analysis tests (alpha = 0.05)., Results: In total, 106 restorations were evaluated at 4 years. Both systems with bulk-fill composites presented higher marginal discoloration than PA. About surface texture, ABF restorative system showed superior bravo scores being statistically similar to XST. Better performance for wear and surface staining was found for XST restorative system. All restorative systems resulted in the decreased interproximal contacts, occurring early for XST., Conclusions: The restorative systems that used flowable bulk-fill resin composites showed satisfactory clinical performance compared with conventional resin composite after 4 years. All restorative systems had decreased proximal contact after 4 years., Clinical Relevance: Initial marginal discoloration was observed in more than 50% of class II restorations performed with restorative systems that used flowable bulk-fill resin composite. All restorative systems had decreased proximal contact strength over time., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Although bleaching therapy is considered a dose-dependent treatment, the effect of the volume of product used is yet to be studied. This study thus aimed to evaluate the influence of bleaching gel volume on chromatic alteration and postoperative sensitivity., Methodology: Thirty patients were selected and allocated into three groups; the lower canines were analyzed according to the volume of gel used: GI-0.025 mL, GII-0.05 mL, and GIII-0.10 mL. Chromatic alteration analysis was performed using a portable digital spectrophotometer by calculating the ΔE, ΔE00, ΔL*, Δa*, and Δb* values and the whiteness index (W ID ). Spontaneous sensitivity was assessed using a questionnaire, and sensitivity was stimulated by thermo-sensory analysis. Analyses were conducted in five stages: baseline, after 1st, 2nd, and 3rd bleaching sessions, and 14 days after the end. Data were analyzed using the two-way ANOVA test with repeated measures and Tukey's post hoc test (p < 0.05)., Results: It was observed that ΔE, ΔE00, and ΔL* were similar between groups at the end of the bleaching therapy; and the values of Δa*, Δb*, and WID were higher in the GIII group. For sensitivity, it was found that the GI was the one with the lowest values; o GII intermediate values; while the GIII group presents the highest values of spontaneous and stimulated sensitivity., Conclusion: Gel volume influenced the response to bleaching and significantly influenced the spontaneous sensitivity and cold stimulus., Clinical Relevance: The amount of bleaching gel used during therapy is key to both the response to color change and postoperative sensitivity., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate different restorative techniques for non-carious cervical lesions (NCCLs) and the activity of matrix metalloproteinases (MMPs) in gingival crevicular fluid., Materials and Methods: Two hundred restorations were performed in 50 patients using resin composite restorative system without (I) and with selective enamel conditioning (II) and resin-modified glass-ionomer cement without (III) and with EDTA pretreatment (IV). Gingival crevicular fluid samples were collected in 15 patients. Restorations were evaluated using USPHS criteria at baseline and after 2 years. Percentages of MMP activity were assessed by zymography as a surrogate outcome. Equality tests of two proportions, logistic regression analysis, survival analysis, ANOVA repeated measures, and Fisher tests were used., Results: No differences in clinical performance were found among groups. Group I had lower retention at 2 years than at baseline. Decreased alpha scores for marginal integrity and marginal discoloration were observed for all groups after 2 years. MMP-2 decreased after 1 year, and its activity increased back to the initial level after 2 years, mainly for groups I, II, and III. MMP-9 increased after 1 year, and it was reduced to the initial level after 2 years, mainly for group I., Conclusions: All restorative techniques performed similarly in NCCLs after 2 years with initial marginal defect alterations. MMP-2 reestablished its initial levels after 2 years, and MMP-9 had few alterations over time in crevicular fluid. Clinical relevance The different restorative techniques are equally successful in NCCLs after 2 years of clinical functioning and have similar effects on MMPs present in crevicular fluid., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study evaluated the 10-year clinical performance of high-viscosity glass-ionomer cement placed in posterior permanent teeth by means of the Atraumatic Restorative Treatment (ART) approach. One operator placed 167 single- and 107 multiple-surface restorations in 43 high-risk caries pregnant women (mean decayed teeth = 9.8 ± 5.5). Examinations were performed at 1-, 2-, and 10-year intervals according to ART criteria. In the last evaluation, the US Public Health Service (USPHS) criteria were also used. After 10 years, 129 restorations (47.1%) were evaluated and achieved a cumulative survival rate of 49.0% (SE 7.2%). The 10-year survival of single- and multiple-surface ART restorations assessed using the ART criteria were 65.2% (SE 7.3%) and 30.6% (SE 9.9%), respectively. This difference was significant (jackknife SE of difference; p < 0.05). Using the USPHS criteria, the 10-year survival of single- and multiple-surface ART restorations were 86.5% and 57.6%, respectively. The primary causes of failure were total loss (9.3%) and marginal defects (5.4%). The survival rates observed, especially for the single-surface restorations, confirm the potential of the ART approach for restoring and saving posterior permanent teeth.

The clinical performance of two packable posterior composites, Alert (A)-Jeneric/Pentron and SureFil (S)-Dentsply, was evaluated in 33 patients. Each patient received one A and one S restoration, resulting in a total of 66 restorations. The restorations were placed by one operator according to the manufacturer's specifications and were finished and polished after 1 week. Photographs were taken at baseline and after 2 years. Two independent evaluators conducted the clinical evaluation by using modified United States Public Health Service criteria. After 2 years, 60 restorations (30 A and 30 S), 27 class I (16 A and 11 S) and 33 class II (14 A and 19 S) were evaluated in 30 patients. Criterion A for recurrent caries, vitality, and retention was applicable to all 60 restorations. Criterion B was distributed among 40 restorations as follows: surface texture (15 A; 2 S), color (5 A; 6 S), postoperative sensitivity (1 S), marginal discoloration (8 A), marginal adaptation (3 A), and wear resistance (2 A). Data were analyzed using the Exact Fisher and McNemar tests. After 2 years, S showed a significantly better performance than A with respect to surface texture and marginal discoloration. The clinical performance of both materials was considered acceptable over the 2-year period. Further evaluations are necessary for a more in-depth analysis.