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Objectives: To evaluate through the visual analog scale (VAS) the pain in patients undergoing total knee replacement (TKR) with different pressures of the pneumatic tourniquet., Methods: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard) and the other with systolic blood pressure plus 100 mmHg (P + 100). These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM), complications, and blood drainage volume in each group; the data were subjected to statistical analysis., Results: After data analysis, there was no statistical difference regarding the incidence of complications ( p  = 0.612), ROM ( p  = 0.202), bleeding after 24 and 48 h ( p  = 0.432 and p  = 0.254) or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding., Conclusions: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

Objectives: To evaluate bleeding and the estimated blood loss in patients who underwent total knee replacement (TKR) with different closed suction drains (3.2-mm and 4.8-mm gauge)., Methods: This was a randomized controlled trial with 22 patients who underwent TKR and were divided into two groups: Group I, with 11 patients in whom the 3.2-mm suction drain was used, and Group II, with 11 patients in whom the 4.8-mm suction drain was used. The hematocrit was measured after 24, 48 and 72 h after surgery in order to calculate the estimated blood loss. The drained volume was measured 3, 6, 12, 24, and 48 h after TKR, and thereafter both groups were compared., Results: Regarding the hematocrit, there were no differences between groups in measured periods (24, 48, and 72 h after surgery). The total bleeding measured at the suction drains within 48 h was higher in Group II, with a statistically significant difference ( p  = 0.005); in the first 24 h, there was major bleeding in Group II (mean 893 mL), with a significant difference ( p  = 0.004). Between 24 and 48 h, there was no statistically significant difference in both groups ( p  = 0.710). The total estimated bleeding was higher in Group I, with mean of 463 mL, versus 409 mL in Group II, with no statistical significance ( p  = 0.394)., Conclusions: Bleeding was higher in the group that used the 4.8 mm gauge suction drain, with no differences in hematocrit and estimated blood loss.

Context: Early observations of enamel surfaces prepared by erbium lasers motivated clinicians to use laser as an alternative to chemical etching., Aims: Evaluate shear bond strength (SBS) values of different dental adhesives on Erbium:Yttrium Aluminum Garnet (Er:YAG) laser prepared enamel and to evaluate possible etching patterns correlations between dental adhesives and SBS values., Subjects and Methods: One hundred bovine incisors were randomly assigned to SBS tests on enamel (n = 15) and to enamel morphology analysis (n = 5) after Er:YAG laser preparation as follows: Group I - 37% phosphoric acid (PA)+ ExciTE(®); Group II - ExciTE(®); Group III - AdheSE(®) self-etching; Group IV - FuturaBond(®) no-rinse. NR; Group V - Xeno(®) V. Teeth were treated with the adhesive systems and subjected to thermal cycling. SBS were performed in a universal testing machine at 5 mm/min., Statistical Analysis Used: One-way ANOVA and post-hoc tests (P < 0.05). For the morphology evaluation, specimens were immersed in Ethylenediamine tetraacetic acid (EDTA) and the etching pattern analyzed under Scanning Electron Microscope (SEM)., Results: Mean bond strengths were Group I - 47.17 ± 1.61 MPa (type I etching pattern); Group II - 32.56 ± 1.64 MPa, Group III - 29.10 ± 1.34 MPa, Group IV - 23.32 ± 1.53 MPa (type III etching pattern); Group V - 24.43 MPa ± 1.55 (type II etching pattern)., Conclusions: Different adhesive systems yielded significantly different SBSs. Acid etching significantly increased the adhesion in laser treated enamel. No differences in SBS values were obtained between AdheSE(®) and ExciTE(®) without condition with PA. FuturaBond(®) NR and Xeno(®) V showed similar SBS, which was lower in comparison to the others adhesives. No correlation between enamel surface morphology and SBS values was observed, except when PA was used.

The esthetic success of a dental treatment depends on the correct diagnosis, treatment plan and clinical and laboratory procedures. This clinical report describes a diagnostically based protocol for conservative preparations on anterior teeth for adhesively retained composite and porcelain restorations. The diagnostic additive wax-up, periodontal esthetic crown-lengthening, direct acrylic mock-up, conservative preparations for ceramic laminate veneers, luting procedures, direct restorations with composite resin used for the esthetic rehabilitation of a patient presenting conoid lateral incisors, and an unsatisfactory class IV restoration in the left central incisor are presented. An accurate diagnostic and interdisciplinary approach is necessary for obtaining improved, conservative and predictable esthetic results in esthetically compromised areas, such as the anterior maxillary dentition.

Purpose: The purpose of this study was to compare the microtensile bond strength (microTBS) of three adhesives to bovine enamel prepared with 600-grit silicon carbide paper, diamond rotary instrument, or carbide bur., Materials and Methods: Bovine teeth (n = 36) were randomly divided into three treatment groups and bonded using a total-etch adhesive (Single Bond, 3M ESPE), a self-etching primer system (Clearfil SE Bond, Kuraray), or a self-etching adhesive (One-Up Bond F, Tokuyama). A 4-mm composite crown was built on the bonded surfaces and specimens were stored in water for one day at 37 degrees C. Specimens were sectioned into 0.7-mm-thick slabs, trimmed to a cross-sectional area of 1 mm2, and loaded to failure at a crosshead speed of 1 mm/min using a tabletop tester (EZ-Test, Shimadzu). Microtensile bond strength data were analyzed using ANOVA and Fisher's PLSD test (alpha = 0.05)., Results: The bond strength of each self-etching system was lower when the enamel was prepared using a diamond or carbide bur, rather than with 600-grit silicon carbide paper. Differences in microTBS between carbide- and diamond-prepared surfaces were not significant. The surface preparation method did not affect the total-etch system., Conclusion: Different preparation instruments are unlikely to affect resin-enamel bond strengths.

Purpose: To compare the microtensile bond strength (microTBS) of five adhesives to human dentin prepared with 600-grit SiC abrasive paper (SiC), a diamond rotary instrument, or a carbide bur. The null hypothesis was that different cavity preparation instruments do not affect adhesion of resin adhesives., Materials and Methods: Human molars (n = 45) were randomly divided into three groups according to surface treatment. Each group was bonded using a total-etch adhesive (Single Bond, 3M ESPE), one of three self-etching primer systems (Clearfil SE Bond or ABF, Kuraray; Imperva Fluorobond, Shofu), or a self-etching adhesive (One-Up Bond F, Tokuyama). A 4-mm composite crown was built over the bonded surface. Specimens were stored in water for 24 h at 37 degrees C. They were sectioned into 0.7-mm-thick slabs, trimmed to a cross-sectional area of 1 mm2, and loaded to failure at a crosshead speed of 1 mm/min using a tabletop tester (EZ-Test, Shimadzu). Microtensile bond strength data were analyzed using analysis of variance and Fisher's PLSD test., Results: Surface preparation using a carbide bur generally yielded higher bond strengths than preparation using either a diamond rotary instrument or SiC abrasive paper. SE Bond had the highest mean microTBS of the five adhesives tested., Conclusion: Resin-dentin bond strengths can be affected by the type of instrument used to prepare the tooth. Specifically, higher bond strengths might be achieved by using carbide burs rather than diamond cutting instruments.

Purpose: To compare the repair potential of a packable composite (Filtek P60) to that of a conventional hybrid composite (Pertac II) using three different adhesives: an unfilled resin (EBS-Multi), a one-bottle, acetone-based adhesive (One-Step), and a self-etching adhesive (Prompt L-Pop)., Materials and Methods: 30 composite disks (diameter = 8 mm) of each composite material were fabricated, light-cured, and stored in 37 degrees C for 7 days. The specimens were polished to 600-grit, sandblasted (CoJet-System), silanated, and randomly assigned to three groups (n=10). EBS-Multi, One-Step, and Prompt L-Pop were applied to each composite and cured. Pertac II was applied in a #5 gelatin capsule and light-cured. As controls, Pertac II was applied to freshly cured Filtek P60 and Pertac II specimens, with no additional surface treatment. Specimens were loaded in shear using an Instron testing machine at a crosshead speed of 5 mm/minute, 24 hours after bonding, and the peak shear force at failure was converted to MPa (force/area)., Results: ANOVA showed a significant difference in means at P<0.001. Tukey's test was used for pairwise comparisons. Mean SBS (+/-SD, MPa) were: P60/control: 25.2 (3.0); P60/EBS-Multi: 18.0 (2.3); P60/One-Step: 16.7 (2.3); P60/Prompt: 10.5 (3.3); Pertac/control: 25.5 (3.6); Pertac/EBS-Multi: 18.8 (3.0); Pertac/One-Step: 18.8 (2.4); Pertac/Prompt: 9.7 (3.5). Repair strengths were all significantly less than their respective controls, and repairs made using Prompt L-Pop had significantly lower mean strengths than the repairs made with EBS-Multi and One-Step (P<0.05).

Unlabelled: After removal of caries or a faulty existing restoration in a posterior tooth, frequently the pulpal floor is a dark substrate. Composites are translucent by nature, and even the more opaque shades transmit nearly 60% of visible light, meaning that composites require a certain thickness to maintain their intended shade, especially if the underlying substrate is particularly dark. Depending on the intensity of the dark substrate, even relatively thick composite restorations may not be capable of disguising the discolored dentin underneath. The substrate absorbs a significant part of the light that would otherwise reflect toward the occlusal surface, and the restoration has a nonvital monochromatic grayish color. Opaquers and tints (color modifiers) may be extremely useful to overcome this situation. In this study, composite restorations were placed in extracted teeth to demonstrate that the final esthetic results rely upon the optical properties of the background as well as those of the composite material itself. Preparations with simulated dark pulpal floors were restored without the use of opaquers and tint modifiers. After tooth hydration, the final shade was recorded with photographs. The restoration was removed and a new restoration was placed, but this time with a technique involving opaquer and tints. This article compares and discusses the outcomes of these two procedures., Clinical Significance: This demonstration shows a simple technique that can help dentists obtain predictable esthetic results in their daily practice with posterior composite restorations.