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RESUMO Objetivo: Descrição do passo a passo de um caso clínico no qual foi empregado a técnica "Yonsei Point" para tratamento do sorriso gengival. Utilizou-se esta técnica por tratar-se de uma metodologia indicada para para redução da diferentes tipos de sorriso gengival, que utiliza apenas um ponto de cada lado da face, minimizando o risco de intercorrências de assimetrias, com custo reduzido e de fácil reprodução. Métodos: Uma paciente do sexo feminino com 6,0 mm de exposição gengival durante o sorriso foi tratada com a utilização da toxina botulínica do tipo A (TBA) aplicada no "Yonsei Point". O "Yonsei Point" é definido com base nos três músculos (levantador do lábio superior (LLS), levantador do lábio superior e asa do nariz (LLSAN) e o zigomático menor (ZMi)) que convergem na área lateral à asa do nariz. Os três vetores destes músculos passam perto de uma região triangular formada por três pontos de referência na superfície. O centro deste triângulo, foi denominado ‘‘Yonsei Point’’. E, foi sugerido como um ponto apropriado de injeção de toxina botulínica do tipo A para correção de sorriso gengival. Para acompanhamento do caso, realizou-se um protocolo de fotos do caso antes da aplicação da TBA e após 15 dias, e a mensuração da distância entre a borda inferior do lábio superior e a margem gengival cervical dos dentes incisivos centrais superiores foi realizada nestes tempos operatórios. Após 15 dias da aplicação da TBA houve redução do sorriso gengival de 6mm para 3 mm na região do incisivo central. Conclusão: A técnica para TBA aplicada no “Yonsei Point” no presente caso clinico mostrou-se segura, pouco invasiva, indolor, eficiente, e de fácil replicação, e reversível para o tratamento do sorriso gengival.

Introduction: Aesthetic applications of botulinum toxin type A (BoNT-A) may lead to some complications, including unwanted muscle paralysis. Moreover, BoNT-A effects may last several months, and there is no medical intervention so far to accelerate muscle function recovery. Case Report: A female patient with a movement disorder of the mimic muscles resulting from BoNT-A injections received daily sessions of photobiomodulation therapy (PBMT). A fast improvement in both facial asymmetry and muscle function was noted within a few weeks. After nine weeks, almost complete recovery was achieved. Conclusion: According to the current case, PMBT seems to be an effective intervention to accelerate muscle function recovery following BoNT-A use.

Background Botulinum toxin type A (BTX-A) is recent technique for the treatment of gummy smile. Objectives The aim of this randomized controlled preliminary clinical trial was to evaluate the effects of BTX-A on excessive gingiva display (EGD) reduction, muscle activity, and patient satisfaction at 2, 8, 12, 16, 21, and 25 weeks. Methods Group 1 (G1) received 4 points of BTX-A application (2 U/point) for relaxation of the levator labii superioris alaeque nasi and levator labii superioris muscles; Group 2 (G2) received 2 points of BTX-A (2 U/point) for relaxation of only the levator labii superioris alaeque nasi muscle. Results A high dropout of patients from follow-up sessions occurred. Therefore, because of this data limitation, the results were considered a preliminary outcome. At 2 weeks, there was a significant difference between baseline regarding the reduction of EGD in G1 and G2, reduction in muscle activity in G1, and increased satisfaction in G1 and G2. At 2 weeks, there was no difference between the 2 groups. Statistically significant EGD reduction was maintained until 16 weeks in G2 and 25 weeks in G1. After 14 days there was a gradual recovery of muscle activity in both groups until recovery of baseline values by 25 weeks. Patients’ satisfaction with treatment lasted 21 weeks in G1 and 16 weeks in G2. Conclusions Increasing the number of BTX-A injection points resulted in a prolonged effect regarding EGD reduction and patient satisfaction but did not increase the intensity of the outcome. However, due to the high dropout of patients, this is a preliminary conclusion and further studies are necessary to confirm these results. Level of Evidence: 2

Objetive: This study aimed to compare procedure time and patient discomfort and satisfaction between endocrowns or partial coverage ceramic restorations with fiber post and filling (PCCR+Post). Materials and Methods: A double-blind RCT was carried out according to eligibility criteria: 1) Endodontic treatment; 2) Molars or premolars; 3) Minimum of one cusp with 3-mm thick; 4) Dental antagonists; 5) Supragingival margins; 6) Good oral hygiene; and 7) Minimum of 18 years. Patients were allocated to two groups: Endocrown or PCCR+Post. Each session was timed; discomfort and satisfaction were assessed. Poisson regression analysis and two-way repeated-measures analysis of variance were performed. Results: Forty patients were selected (20 per group). 90% and 82.5% of participants in the PCCR+Post and Endocrown group, respectively, reported little or no discomfort. There was no association between the explanatory variables and the discomfort reported by patients. The level of satisfaction was 100%. Procedure time in the Endocrown (129.7 min±29.78) was similar to PCCR+Post (134.1 min±29.64). Endocrown and PCCR+Post had similar procedure time and patient perception, however, endocrowns allow less clinical steps. Conclusions: Endocrown and PCCR+Post had similar procedure time and patient perception, however, endocrowns allow less clinical steps. Trial registration- clinicaltrials.gov (NCT03064516). Funding- Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP-2017/24153-1).

This review aimed to illustrate the utility of additive manufacturing technologies for the fabrication of polymer, metal, and ceramic components within the confines of their current and potential clinical applications in dentistry. The literature reviewed on five additive manufacturing technologies, namely, vat-polymerization, material jetting, material extrusion, powder-based fusion, and binder jetting, have been investigated in relevance to their dental applications. These technologies have the following existing or potential clinical applications: diagnostic and definitive casts, custom trays, positioning guides for custom abutments, tooth preparation guides, interim dental restorations, all-ceramic crowns, metal crowns and copings, silicone indices, occlusal devices, complete dentures, wax patterns for intra- and extra-coronal restorations, surgical guides, removable partial dentures, and tooth- or implant-supported frameworks. Vat-polymerization, material jetting, and powder-based fusion technologies have existing clinical applications utilizing mainly polymers and metals. Additive manufacturing technologies need further development to be used with ceramic materials for dental applications.

To conduct a systematic review to determine the efficacy of violet led in promoting dental bleaching by itself or accelerating dental bleaching when associated with peroxides.Clinical and in vitro studies were identified by a search on November 27th 2020 in the PubMed and Scopus databases. Inclusion criteria were: 1) studies related to bleaching; 2) studies related to violet LED Light (405-410nm); and 3) studies that analyzed efficacy. The authors assessed the studies for risk of bias independently. Authors extracted outcomes including color change evaluation and pain assessment independently.During the search process, 895 articles were found in the previously cited databases. After the first screening consisting of title and abstract evaluations, 18 articles were selected. Finally, 13 articles met the eligibility criteria and were included in this review, being 5 clinical trial/case series and 8 in vitro studies. In vitro studies showed a high risk of bias and interventional studies showed a low risk of bias.The violet Led seems to have the potential to bleach teeth without peroxides, with a clinical perceptible color alteration. However, the effect is small in comparison to bleaching using peroxides. When Violet Led is used in association with peroxides, it seems to potentialize the bleaching result. However, due to the high heterogeneity between studies, a small number of clinical studies, and the high risk of bias of the in vitro included studies, the results are not definitive, and further well-designed studies are needed to reach safe evidence.

Emerging variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) may have an impact on the virus's transmissibility and pathogenicity and an increased risk of reinfection. Antimicrobial photodynamic therapy (aPDT) is a promising technique to decontaminate the oral cavity to minimize and inactivate microorganisms' load. This article reports through a case series, a proposal for efficient oral decontamination for hospitalized patients with COVID 19 using aPDT. Samples of oral tissues were obtained after aPDT and analyzed using two methods of RT-qPCR to elucidate qualitative and quantitative viral profiles of SARS-CoV-2 RNA in the oral cavity. There was a reduction of viral load in the oral cavity immediately or one hour after the use of aPDT. This method could be a good option to decontaminate the oral cavity to minimize and inactivate microorganism load.

Introduction: Fixed drug eruption (FDE), a very specific adverse drug reaction and one of the most common types of drug eruption, generally resolves spontaneously within 7-10 days upon withdrawal of the causative agent; however, extensive and severe cases may also require systemic drug therapy. The present study aimed to report a case in which a broad spectrum of severe, painful lesions of FDE was managed with photobiomodulation therapy (PBMT). Case Report:A 31-year-old Caucasian woman presented with many extremely painful mucocutaneous lesions of FDE which had arisen 8 days before, following a long period of hospitalization. The lesions were not responsive to either corticosteroids or analgesics within 5 days, and then seven daily sessions of PBMT were proposed. Pain alleviation was achieved on the 1st day of PBMT, and the lesions showed an advanced course of healing on the 3rd day. Within 7 days of PBMT, the lesions were almost completely repaired. In a 3-month follow-up period, no relapse of any FDE lesion was reported. Conclusion: PBMT may be a promising strategy for the management of painful lesions of FDE refractory to conventional medication therapy. However, further studies are needed to confirm this hypothesis.

Aim: The aim of this study is to verify the type of scaffold effect on tissue engineering for dentine regeneration in animal models. Materials & methods: Strategic searches were conducted through MEDLINE/PubMed, Web of Science and Scopus databases. The studies were included with the following eligibility criteria: studies evaluating dentine regeneration, and being an in vivo study. Results: From 1392 identified potentially relevant studies, 15 fulfilled the eligibility criteria. All studies described characteristics of neoformed dentine, being that the most reported reparative dentine formation. Most of included studies presented moderate risk of bias. Conclusion: Up to date scientific evidence shows a positive trend to dentine regeneration when considering tissue engineering in animal models, regardless the type of scaffolds used.

O objetivo deste estudo foi propor um novo Sistema de Identificação Odonto-legal para a Polícia Militar do Estado de São Paulo (PMESP) baseado no protocolo DVI (Disaster Victim Identification) da INTERPOL (International Criminal Police Organization). Para comparar a percepção sobre o preenchimento e interpretação dos dados, 10 oficiais dentistas preencheram a ficha odonto-legal (FOL) em uso atualmente na PMESP e a nova ficha baseada na da INTERPOL. Também, um questionário estruturado sobre a nova FOL foi respondido por um perito criminal cirurgião-dentista do Núcleo de Odontologia Legal do Instituto Médico-Legal (IML) da Superintendência da Polícia Técnico Científica (SPTC) do Estado de São Paulo. Após a análise dos dados, constatou-se que a nova FOL proposta com base no protocolo da INTERPOL parece ser de preenchimento simples e interpretação mais fácil que a atualmente utilizada, além de ser mais rápida e precisa, atendendo a parâmetros aceitos internacionalmente. Ademais, o exame imaginológico (radiografia do tipo panorâmica) foi citado como sendo muito importante na elaboração da FOL. This study aimed to propose a new Dental Forensic Identification System for the Military Police of the State of São Paulo (PMESP) based on the DVI (Identification of Victims of Disasters) protocol of INTERPOL (International Criminal Police Organization). In order to compare the perception about the filling and interpretation, 10 dental officers completed the dental-legal form (FOL) in use currently at the PMESP and the new form based on the INTERPOL’s protocol. A structured questionnaire about the new FOL was also answered by a criminal expert dentist of the Forensic Dentistry Nucleus of the Legal Medicine Institute (IML) of the Superintendence of the Scientific Technical Police (SPTC) of the State of São Paulo. After analyzing the data collected, it was suggested that the new form proposed based on the INTERPOL’s protocol is simpler to complete and easier to interpret than the form currently used, besides being faster and more accurate, meeting internationally accepted parameters. Furthermore, the imaging exam (panoramic radiography) was mentioned as a very important tool in the elaboration of the FOL. El objetivo de este estudio fue proponer un nuevo Sistema de Identificación Odontológico-Forense a la Policía Militar del Estado de São Paulo (PMESP) basado en el protocolo DVI (Disaster Victim Identification) de la INTERPOL (Organización Internacional de Policía Criminal). Con el fin de comparar la percepción sobre el llenado e interpretación de datos, 10 odontólogos completaron el formulario odontologico-legal (FOL) actualmente en uso en el PMESP y el nuevo formulario basado en la INTERPOL. Además, un cuestionario estructurado sobre el nuevo FOL fue contestado por un odontólogo especialista en criminalística del Núcleo de Odontología Forense del Instituto de Medicina Legal (IML) de la Superintendencia de la Policía Técnica Científica (SPTC) del Estado de São Paulo. Luego de analizar los datos recolectados por la investigación, se encontró que el nuevo FOL propuesto en base al protocolo de la INTERPOL parece ser sencillo de llenar y más fácil de interpretar que lo que se usa actualmente, además de ser más rápido y preciso, cumpliendo con parámetros aceptados internacionalmente. Lo examen de imagen (radiografía panorámica) fue mencionado también como muy importante en la elaboración de la FOL.

Background To clinically evaluate the effect of 35% hydrogen peroxide gel renewal in association with violet LED (405-410nm) through a split-mouth randomized controlled clinical trial. Methods The treatment consisted in 3 bleaching sessions of 15 min each, with an interval of 7 days between them, using 35% hydrogen peroxide combined to violet LED irradiation. Selected patients had two experimental segments for the split-mouth design: No change of the bleaching gel during each session (NBGR) and 3 changes of the bleaching gel every 5 min for each session (BGR). During the 3 bleaching sessions, the selected quadrant received the same treatment. Patients had their upper canines and central incisors teeth color measured with a subjective (color scale - VITA Classical) and an objective (spectrophotometer - VITA Easyshade) method and their teeth sensitivity measured using a Visual Analog Scale (VAS) before, immediately after each bleaching session, and 14 days and 2 months (60 days) after the end of the treatment. Results The protocol adopted in the present study reached satisfactory results regarding color change. No statistical difference between groups was observed immediately after the end of the treatment and in the follow-up analysis for both subjective and objective color evaluation. No difference in tooth sensitivity between segments was observed. Conclusion There is no need for bleaching gel renewal when following the clinical protocol of 3 sessions of 15 min in a bleaching protocol of 35% hydrogen peroxide combined with violet LED.

Localizado no terço médio da face, o corpo adiposo da bochecha é uma estrutura adiposa arredondada, biconvexa e delimitada por uma cápsula fina. Indivíduos com volume excessivo do corpo adiposo da bochecha podem apresentar uma aparência infantil ou de que estão em sobrepeso, porém a excisão cirúrgica é capaz de esculpir os ângulos faciais e melhorar a estética da face como um todo. Apesar deste procedimento (também conhecido como “bichectomia”) ter se tornado muito popular nos dias de hoje, as evidências e os estudos que fornecem detalhes técnicos são bastante limitados. Desta forma, a presente revisão narrativa da literatura teve como objetivo compilar o máximo de informações relativas à excisão do corpo adiposo da bochecha com finalidade de recontorno estético da face. De acordo com os estudos levantados, o manejo cirúrgico do corpo adiposo da bochecha pode ser considerado um procedimento relativamente simples e que apresenta ótimos resultados estéticos quando bem indicado e realizado por profissional experiente na técnica. Entretanto, considerando a carência de evidências científicas de alto nível principalmente relacionadas aos efeitos em longo prazo, estudos bem delineados e com seguimento apropriado são ainda necessários para maiores esclarecimentos e fundamentação da técnica no cotidiano clínico.

The treatment of mandibular angle fractures presents several possibilities for fixation methods and surgical approaches which can be intraoral or can be accessed through the skin. An important point would be intraoperative occlusal restoration. We present a method that replaces the traditional form using an erich bar and which, in our view, is a fast and effective method for intraoperative occlusal restoration.Descriptors: Inter Maxillary Fixation (IMF); Occlusion; Arch Bar Fixation.ReferencesJohnson AW. Dental occlusion ties: A rapid, safe, and non-invasive maxillo-mandibular fixation technology. Laryngoscope Investig Otolaryngol. 2017;2(4):178-83.Abbasi AJ, Parvin M. New method of arch bar fixation. Br J Oral Maxillofac Surg. 2017;55(6):631-32.Shinohara EH, Mitsuda ST, Miyagusko JM, Horikawa FK. Mandibular fracture reduction without intraoperative intermaxillary fixation: a technique using two modified reduction forceps. J Contemp Dent Pract. 2006;7(1):150-56.

BACKGROUND The aim of this study was to correlate the self-report oral health, oral hygiene and dental assistance with clinic intercurrences with hospitalization in adults in End-Stage Kidney Disease patients. METHODS Seventy-seven patients were interviewed during dialysis therapy concerning their self-report oral health, oral hygiene habits and available dental assistance. Clinical intercurrences were assessed in clinical records. Pearson correlations and linear regression tests were applied for statistical analysis. RESULTS There was a strong negative correlation between the number of brushing times/day and patient hospitalization; there was a negative correlation between oral health and patient hospitalization, there was a positive correlation between the number of teeth in the mouth and oral diseases. CONCLUSIONS The study shows an important correlation between oral health, oral hygiene habits, dental assistance and clinical intercurrences with hospitalization in dialysis patients. The results are weighty to establish protocols that can, directly improve, critical health outcomes of end-stage kidney disease patients under dialysis treatment.

O absenteísmo por doenças é reconhecido como um problema de saúde pública mundial, tendo grandes impactos econômicos e sociais. Ademais, informações a respeito destas condições em bombeiros, políciais e outros profissionais de serviços armados são muito escassas. Desta forma, o presente estudo teve como objetivo analisar os afastamentos odontológicos do quadro de servidores da Polícia Militar do Estado de São Paulo em 2017. Para isso, foram coletados os dados demográficos, funcionais e relacionados ao tipo de afastamento (plataforma logística SIGs – Saúde) para cálculo das razões de chances entre as variáveis sócio-demográficas e funcionais e convalescença (afastamentos de até 10 dias). Foi calculado também o índice de gravidade, de frequência e de duração média das ausências odontológicas, bem como o comparativo com os afastamentos por motivos médicos no mesmo período. Foram identificados 80.928 afastamentos relacionados a condições bucais. As características funcionais, sócio-demográficas e da doença odontológica estiveram associadas a convalescença, ou seja, policiais acima de 50 anos, do interior de SP e afastados por lesões de cárie, condições pulpares ou doença periodontal estiveram associados à presença de afastamento de até 10 dias. Na Polícia Militar, em 2017, houve uma média de perda de serviço de 2h/pessoa/ano exclusivamente por motivo odontológico. A duração média das ausências foi de 2,21 dias. Assim, parece que quanto maior a idade e mais distante da capital paulista, maior o número de dias de absenteísmo. Ademais, o envelhecimento no contexto ocupacional é um forte fator para o absenteísmo. Cárie e doença periodontal também estão altamente relacionadas ao absenteísmo quando comparadas às demais doenças odontológicas.

Objectives To evaluate the survival rate of ceramic and indirect composite inlays, onlays, and overlays manufactured according to different methods (CAD/CAM, pressable, and stratified). MEDLINE, EMBASE, and Cochrane Library databases were searched for published articles. Risk of bias, data extraction, subgroup analysis, meta‐analysis, and GRADE was performed. Materials and methods Prospective, retrospective, or RCT studies, without restriction of language, from 1983 to 2019, with follow‐up ≥5 years, reporting survival rates were screened independently by two reviewers in accordance with eligibility criteria. Results A total of 13 articles (12 for ceramic, one for indirect composite) met the inclusion criteria. No articles were included regarding crystalline ceramic. The estimated cumulative survival rate for CAD/CAM was 97% after 5 years and 89% after 10 years; for pressable was 95% after 5 years, and for stratified was 88% after 5 years and 93% after 10 years. Conclusions Regardless of the manufacturing method, vitreous ceramic inlays, onlays, and overlays showed high survival, providing evidence that these restorations are a safe treatment. Clinical relevance Vitreous ceramic inlays, onlays, and overlays showed high survival, regardless of the manufacturing method, providing evidence that these restorations are a safe treatment.

SummaryBackground Individuals with special needs are often affected by oral disorders such as dental caries and periodontal disease. Current data regarding prevalence of these conditions in individuals with autism spectrum disorders (ASD) are controversial. Aim To conduct a systematic review and meta-analysis to verify the prevalence of dental caries and periodontal disease in individuals with ASD, especially children and young adults. Design Searches were conducted through MEDLINE/PubMed, Web of Science, and Scopus databases in December 2015. Studies were included if fulfilled the following eligibility criteria: to evaluate the oral health status of individuals with ASD; to be an observational study; and to assess the prevalence of dental caries and/or periodontal disease. Meta-analyses were conducted considering prevalence of dental caries and periodontal disease in individuals as outcome. Results Search strategy identified 928 potentially relevant articles and seven of them were included in this review. All included studies reported dental caries prevalence, and the pooled prevalence was 60.6% (95% CI: 44.0–75.1). Moreover, only three studies showed prevalence of periodontal disease, resulting in pooled prevalence of 69.4% (95% CI: 47.6–85.0). Conclusion Prevalence of dental caries and periodontal disease in children and young adults with ASD can be considered as high, pointing to the need for oral health policies focused on these individuals.

This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y ( n = 5,811 restorations) and were 91% at 10 y ( n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.

Aim To systematically assess the current dental literature comparing the accuracy of computer-aided implant surgery when using different supporting tissues (tooth, mucosa, or bone). Material and Methods Two reviewers searched PubMed (1972 to January 2015) and the Cochrane Central Register of Controlled Trials (Central) (2002 to January 2015). For the assessment of accuracy, studies were included with the following outcome measures: (i) angle deviation, (ii) deviation at the entry point, and (iii) deviation at the apex. Results Eight clinical studies from the 1602 articles initially identified met the inclusion criteria for the qualitative analysis. Four studies (n = 599 implants) were evaluated using meta-analysis. The bone-supported guides showed a statistically significant greater deviation in angle (P

Objective The aim of this systematic review was to evaluate the most appropriate hydrogel scaffold type (natural, synthetic or hybrid) to be applied with stem cells for dental pulp regeneration. The findings should help clinicians make an informed choice about the appropriate scaffold to be applied for this approach. Design Three electronic databases were searched (Medline, Web of Science and Scopus). The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Results From 4990 potentially relevant studies initially identified, 18 papers fulfilled the eligibility criteria and were considered for this review. Natural scaffolds were applied in most studies. Collagen was the most studied scaffold. In 5 of 10 studies, only growth factors were added to the constructs. Even without growth factors, these scaffolds containing stem cells were able to support the formation of dentin. The synthetic scaffolds were the least studied. Only 4 studies were selected, and in 3 of them, the same scaffold (Puramatrix) was evaluated. Puramatrix by itself was unable to form dental pulp when dental pulp stem cells were not present. Synthetic and hybrid hydrogels were unable to attract stem cells from the host. The presence of growth factors in these constructs seems to be of relevance since dental pulp tissue formation was achieved only when the hybrid scaffold was applied with growth factors. Conclusion All types of hydrogel-based scaffolds, when containing mesenchymal stem cells, are able to form connective tissue with different degrees of similarity to dental pulp. However, current data is too heterogeneous to compare and identify the advantages of any specific scaffold.

Some microorganisms are associated with the formation and deposition of pigmentation on dental surfaces, and its localization, intensity and recurrence persistence can introduce aesthetic disorders. Carbamide peroxide is a bleaching agent that also presents antimicrobial properties. This case report addresses a ten-year clinical follow-up, showing a possible influence of a bleaching procedure protocol on alterations of oral microbiota. Although a bleaching treatment does not have the purpose to alter the oral microbiota, a drastic reduction and recurrence of black tooth stains was observed in this case.

Background Musculoskeletal disorders (MSD) are an occupational health problem that demands a high cost and may also reduce the quality of life and productivity of the dentists. The aim of this study was to evaluate the prevalence of MSD and its association with self-reported joint damage in dentists from Sao Paulo (Brazil). Methods This was a cross-sectional study performed from two self-administered questionnaires - the Nordic Musculoskeletal Questionnaire and the other containing demographic and occupational data - in 6072 dentists. Between April and May 2014, 5885 questionnaires were distributed via e-mail through Sao Paulo Regional Board of Dentistry (CRO-SP) and 187 in Congress and public offices. Multivariable logistic regression was used to assess the association between explanatory variables (sex, age, level of education, duration of practice in years, number of patients seen per day, previous receipt of information about ergonomics, physical activity, and the presence of joint damage) and MSD. Results Two hundred eighty-six valid questionnaires were returned. The prevalence of MSD was 63.6% (N.=182). Multivariable logistic regression showed that only the factor of self-reported joint damage has a significant association with MSD (OR 0.001; 95% CI: 0.000-0.007). Concerning the self-reported joint damage (60.1%), the carpal tunnel syndrome was the most frequent (13.2%). Conclusions The prevalence of MSD in dentists from Sao Paulo is high, and carpal tunnel syndrome is the most common self-reported joint damage.

Various types of dental preparations for laminate veneers have been proposed,depending on factors such as the properties of the ceramic material, remaining dental structure color, need for altering the dental contour, laboratory fabrication technique, and occlusal relationships. Clinical observations of successes and failures associated with the development of techniques and materials have allowed some safe parameters to be delineated for effectively performing dental preparations for ceramic veneers or even placing veneers without any preparation. This article describes the use of an additive diagnostic wax-up that is transferred to the mouth by means of an intraoral mock-up (aesthetic pre-evaluative temporary) with associated mathematic parameters to guide dental preparations. This technique, called Do the Math and presented here in the form of a clinical case report, aims to avoid excessive or incorrect tooth preparation by indicating the exact amount and location of the tooth reduction necessary to attain the desired color and shape.

Objective: The aim of this study was to detect the influence of application mode of cleansing agents, on enamel and dentin during the adhesion process of a one-step adhesive system.Materials and Methods: 24 human molars were sectioned into halves along the long axis for enamel and dentin tests. The cleansing agents used were hydrogen peroxide, anionic detergent, and antiseptic solution. In the experiment, these agents were applied with and without friction on enamel and dentin surfaces. A one-step adhesive system (Clearfil S3 Bond) was applied on dental surface and composite resin cylinders were built using Tygon tubing molds. After 24 h, ?SBS test (1 mm/ min) and fracture analysis were performed. Results: There was no statistically significant difference in bond strength values regarding the application mode of cleansing agents for enamel and dentin (p?0,05).Conclusions: Regarding bond strength, application mode of the cleansing agents used in this study presented the same behavior.

The purpose of this study was to evaluate the failure rates of porcelain laminate veneers (PLVs) and the influence of clinical parameters on these rates in a retrospective survey of up to 12 years. Five hundred eighty laminate veneers were bonded in 66 patients. The following parameters were analyzed: type of preparation (depth and margin), crown lengthening, presence of restoration, diastema, crowding, discoloration, abrasion, and attrition. Survival was analyzed using the Kaplan-Meier method. Cox regression modeling was used to determine which factors would predict PLV failure. Forty-two veneers (7.2%) failed in 23 patients, and an overall cumulative survival rate of 86% was observed. A statistically significant association was noted between failure and the limits of the prepared tooth surface (margin and depth). The most frequent failure type was fracture (n = 20). The results revealed no significant influence of crown lengthening apically, presence of restoration, diastema, discoloration, abrasion, or attrition on failure rates. Multivariable analysis (Cox regression model) also showed that PLVs bonded to dentin and teeth with preparation margins in dentin were approximately 10 times more likely to fail than PLVs bonded to enamel. Moreover, coronal crown lengthening increased the risk of PLV failure by 2.3 times. A survival rate of 99% was observed for veneers with preparations confined to enamel and 94% for veneers with enamel only at the margins. Laminate veneers have high survival rates when bonded to enamel and provide a safe and predictable treatment option that preserves tooth structure.

Purpose: The purpose of this study is to verify the influence of light curing type on retention force of direct technique and direct-indirect technique. Materials and Methods: Fourth bovine single root teeth with 12mm of length were used in this study. The roots were endodontically treated and randomly divided in four groups according to the light curing unit and technique used: group 1(direct technique, halogen lamp), group 2(direct technique, LED), group 3(direct-indirect technique, halogen lamp), group 4(direct-indirect technique, lamp). The retention force was determined sing a Universal Testing Machine (Instron). All data were analyzed using one-way analysis of variance (ANOVA) and Tukey test. After the test, the failure was examined and classified according to the fracture place: post/ resin; resin/dentin; mix. Results: Group 3 (246,05N ± 29,51) and 4(241,60N ± 28,95)4 (95,18N) did not show statistically difference but presented higher retention force than group 1 (142,30N ± 25,60) and 2 (178,56N ± 25,67). Most of fracture occurred in interface between dentin/resin. Conclusion: Based on the obtained results, it was concluded that adhesive cementation technique influenced in the retention of glass fiber post.

The purpose of this in vitro study was to compare the bond strength between fiber post and laser-treated root canals. Forty single-rooted bovine teeth were endodontically treated and randomly divided into four groups of equal size according to the root canal treatment: group 1 conventional treatment (without laser irradiation); group 2 Nd:YAG laser (1.5 W, 10 Hz, 100 mJ); group 3 Er,Cr:YSGG laser (0.75 W, 20 Hz); and group 4 Nd:YAG + Er,Cr:YSGG lasers. The fiber posts were cemented with an adhesive system + resin cement, in accordance with the manufacturer’s instructions. A mini acrylic pipe was fixed on the coronal section of the post using a light-polymerized resin. Specimens were mounted on an acrylic pipe with a self-polymerized resin. Retention forces were determined using a universal testing machine (0.5 mm/min). Data were analyzed using one-way ANOVA and Tukey tests (p

This study evaluated the fracture strength of teeth restored with bonded ceramic inlays and overlays compared to sound teeth. Thirty sound human maxillary premolars were assigned to 3 groups: 1- sound/unprepared (control); 2- inlays and 3- overlays. The inlay cavity design was Class II MOD preparation with an occlusal width of 1/2 of the intercuspal distance. The overlay cavity design was similar to that of the inlay group, except for buccal and palatal cusp coverage The inlay and overlay groups were restored with feldspathic porcelain bonded with adhesive cement. The specimens were subjected to a compressive load until fracture. Data were analyzed statistically by the Kruskal-Wallis test at 5% significance level. The fracture strength means (KN) were: Sound/unprepared group = 1.17, Inlay group= 1.17, and Overlay group = 1.14. There were no statistically significant differences (p>0.05) among the groups. For inlays and overlays, the predominant fracture mode involved fragments of one cusp (70% of simple fractures). The fracture strength of teeth restored with inlay and overlay ceramics with cusp coverage was similar to that of intact teeth. Este estudo avaliou a resistência à fratura de dentes restaurados com inlays e overlays de cerâmicas comparadas a dentes íntegros. Trinta pré-molares humanos íntegros foram divididos em 3 grupos: 1-Dentes sem preparo cavitário (controle), 2-Inlays e 3-Overlays. O preparo para as inlays apresentava uma cavidade de Classe II MOD tendo caixa oclusal com largura de metade da distância intercuspídica. O preparo para as overlays era semelhante ao das inlays; porém com cobertura das cúspides vestibular e palatina. Os grupos 2 e 3 foram restaurados com porcelanas feldspáticas fixadas com cimento resinoso. As amostras foram submetidas à compressão até a fratura. Os valores médios de fratura (KN) foram: grupo 1 = 1,17, grupo 2 = 1,17 e grupo 3 = 1,14. O teste de Kruskal-Wallis não revelou diferença estatisticamente significante entre os 3 grupos (p>0,05). Para as inlays e overlays, a predominância das fraturas envolveu fragmentos de uma das cúspides (70% de fraturas simples). Concluiu-se que os dentes restaurados com inlays e overlays apresentaram resistência da cúspide comparável aos dentes intactos.

Background There is no consensus on whether incisal coverage is a risk or a protective factor in preparations for ceramic veneers. Objective The aim of this systematic review and meta-analysis was to evaluate the survival rates of preparation designs for ceramic veneers with and without incisal coverage. Methods Primary clinical studies with the following characteristics were included: 1) studies related to ceramic laminate veneers and 2) prospective or retrospective studies conducted in humans. From the selected studies, the survival rates and failures rates for ceramic veneers were extracted according to preparation design, with or without incisal coverage. The Cochran Q test and the I 2 statistic were used to evaluate heterogeneity. Metaregression, meta-analysis were performed. Two reviewers searched in the MEDLINE (Pubmed) and Cochrane Central Register of Controlled Trials (Central) electronic databases, from 1977 to June 5, 2016, without language restrictions. Results Eight studies out of 1145 articles initially identified were included for risk of bias and systematic assessment. No study was identified for crystalline ceramic veneers. The estimated survival rate for laminate veneers with incisal coverage was 88% and 91% for those without incisal coverage. Incisal coverage presented an OR of 1.25. Conclusions Irrespective of the preparation designs, with or without incisal coverage, ceramic veneers showed high survival rates. As regard implications for future clinical research studies, randomized clinical studies are necessary to compare preparation designs with and without incisal coverage, and to provide clear descriptions of these preparation designs.

The aim of this study was to evaluate the influence of the physical assessment of different light-curing units from 55 dental offices on the irradiance and composite microhardness top/bottom ratio, and the influence of the radiometers for LED or QTH light sources on irradiance measurement. The irradiance of each light-curing unit was evaluated with two radiometers, either for LED or QTH light. A questionnaire regarding the type of source (LED or QTH), time of use, date of last maintenance and light-curing performance assessment applied. The physical assessments were evaluated regarding damage or debris on the light tip. For each light-curing unit, three composite specimens were made (diameter = 7 mm; thickness = 2 mm) with polymerizing time of 20 s, in order to perform the microhardness (Knoop) test. Data were analyzed by Kruskal-Wallis and Dunn test (α = 0.01). There was wide variation in irradiance (0-1000 mW/cm(2)). Approximately 50 % of the light-curing units presented radiation lower than 300 mW/cm(2); 10 % of light-curing units, especially those with LED source, presented values higher than 800 mW/cm(2), and 43 % of light-curing units worked with adequate irradiance between 301 and 800 mW/cm(2). In almost 60 % of cases, no maintenance of light-curing units was performed in a period of 3 to 10 years. The age of the light-curing units and the use of inadequate tips interfered negatively in irradiance. The data emphasize the importance of periodic maintenance of light-polymerizing, light-curing units.

This article evaluates the long-term clinical performance of porcelain laminate veneers bonded to teeth prepared with the use of an additive mock-up and aesthetic pre-evaluative temporary (APT) technique over a 12-year period. Sixty-six patients were restored with 580 porcelain laminate veneers. The technique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protocol. The influence of several factors on the durability of veneers was analyzed according to pre- and postoperative parameters. With utilization of the APT restoration, over 80% of tooth preparations were confined to the dental enamel. Over 12 years, 42 laminate veneers failed, but when the preparations were limited to the enamel, the failure rate resulting from debonding and microleakage decreased to 0%. Porcelain laminate veneers presented a successful clinical performance in terms of marginal adaptation, discoloration, gingival recession, secondary caries, postoperative sensitivity, and satisfaction with restoration shade at the end of 12 years. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the restorative treatment. Limiting the preparation depth to the enamel surface significantly increases the performance of porcelain laminate veneers.

This study evaluated, in vivo, the efficacy of a denture glazing material (Palaseal) in modifying plaque colonization of dentures. Ten subjects were selected and received maxillary temporary partial removable dentures, with complete acrylic palatal coverage. The right half of the fitting surface of the denture bases were glazed with Palaseal, whereas the other half was not glazed. One month after insertion, two fragments of the resin base of all dentures were removed (one from the glazed side and another from the non-glazed side). These samples were prepared and examined by scanning electron microscopy. Three months after insertion, other fragments were obtained and analyzed. Microscopic observation at 1 month revealed that, for all patients, the plaque film was thinner on the treated side in comparison to the non-treated side. However, at the 3-month evaluation, some areas of the glaze showed cracking, and both glazed and non-glazed sides were covered by a dense bacterial plaque film. In conclusion, the findings of this clinical experiment showed that glazing denture's fitting surface did not prevent bacterial colonization, but favored plaque removal while the glaze layer remained intact. After three months, glaze cracks created microretentive areas that increased plaque accumulation. Este estudo avaliou, in vivo, a eficiência de um glaze para bases protéticas (Palaseal) em modificar a colonização microbiana de próteses. Dez indivíduos foram selecionados e receberam próteses removíveis maxilares provisórias, com cobertura total do palato em acrílico. A metade direita da superfície interna das bases protéticas foi glazeada com Palaseal enquanto a outra metade ficou sem glaze. Um mês após a instalação, dois fragmentos foram removidos de todas as bases protéticas (um do lado glazeado, outro do lado não glazeado). Estas amostras foram preparadas e examinadas em microscopia eletrônica de varredura. Três meses após a instalação, outros fragmentos foram removidos e analisados. Observações microscópicas após 1 mês revelaram que, para todos os pacientes, a placa era menos espessa do lado tratado, em comparação ao lado não-tratado. Entretanto, observações aos 3 meses mostraram que áreas do glaze haviam trincado e, tanto o lado glazeado como o lado não-glazeado estavam cobertos por uma densa camada de placa bacteriana. Os achados desse estudo clínico demonstraram que o glazeamento da superfície interna da prótese não impediu a colonização bacteriana, mas favoreceu a remoção da placa enquanto a camada de glaze esteve intacta. Decorridos 3 meses, o glaze sofreu trincas, criando áreas de microretenção que aumentaram o acúmulo de placa.

Purpose: The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic porcelain laminate veneers. Materials and Methods: A systematic search was carried out in Cochrane and PubMed databases. From the selected studies, the survival rates for porcelain and glassceramic veneers were extracted, as were complication rates of clinical outcomes: debonding, fracture/chipping, secondary caries, endodontic problems, severe marginal discoloration, and influence of incisal coverage and enamel/dentin preparation. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity. Results: Out of the 899 articles initially identified, 13 were included for analysis. Metaregression analysis showed that the types of ceramics and follow-up periods had no influence on failure rate. The estimated overall cumulative survival rate was 89% (95% CI: 84% to 94%) in a median follow-up period of 9 years. The estimated survival for glass-ceramic was 94% (95% CI: 87% to 100%), and for feldspathic porcelain veneers, 87% (95% CI: 82% to 93%). The meta-analysis showed rates for the following events: debonding: 2% (95% CI: 1% to 4%); fracture/chipping: 4% (95% CI: 3% to 6%); secondary caries: 1% (95% CI: 0% to 3%); severe marginal discoloration: 2% (95% CI: 1% to 10%); endodontic problems: 2% (95% CI: 1% to 3%); and incisal coverage odds ratio: 1.25 (95% CI: 0.33 to 4.73). It was not possible to perform meta-analysis of the influence of enamel/dentin preparation on failure rates. Conclusion: Glass-ceramic and porcelain laminate veneers have high survival rates. Fracture/ chipping was the most frequent complication, providing evidence that ceramic veneers are a safe treatment option that preserve tooth structure.

Os pacientes portadores de câncer de cabeça e pescoço realizam tratamento, de radioterapia podendo ou não estar associados à quimioterapia e/ou cirurgias. A qualidade de vida dos mesmos é afetada em função dos efeitos colaterais causados pelos tratamentos. Mucosite, hiposalivação, perda do paladar, trismo e osteorradionecrose são os efeitos colaterais que mais acomentem os pacientes em tratamento para câncer de cabeça e pescoço. A osteorradionecrose é considerada um evento tardio e a maior complicação pós tratamento de radioterapia. Foi realizada uma busca sistemática nas bases de dados eletrônicas MEDLINE / PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray e busca manual, sem restrição de idioma e tempo. Os critérios de elegibilidade foram os seguintes: 1) ser revisão sistemática; 2) abordar sobre os efeitos orais e complicações após quimioterapia e/ou radioterapia em pacientes adultos portadores de câncer de cabeça e pescoço e 3) RS baseadas em estudos clínicos prospectivos/ retrospectivos e ECR (estudo clínico randomizado). A elegibilidade foi determinada de acordo com os critérios de exclusão para:1) RS que descrevessem a o tratamento para as sequelas da ORN; 2) as RS baseadas em relatos de casos ou estudos in vitro sobre ORN; 3) ORN em ossos não gnáticos (temporal); 4) não abordarem sobre incidência, tratamento ou prevenção da ORN e 5) revisão da classificação da ORN. Foram identificados 1321 artigos, mas apenas 13 foram considerados elegíveis. A fase de elegibilidade, qualidade metodológica (AMSTAR 2) foi conduzida por dois examinadores independentes e calibrados (RMS e GS), e um terceiro examinador (MSANM) foi consultado para a resolução de incongruências. O número de pacientes avaliados para o desenvolvimento de ORN ao longo do tratamento foi 33.762 sendo que desses, 2.094 desenvolveram a lesão, representando uma incidência de 6,2%. Quanto a localização a mandíbula é o local de maior acometimento. A exodontia após a radioterapia foi apontada como o maior fator causal para o desenvolvimento de ORN. A abordagem de tratamento para a ORN com pentoxifilina e tocoferol demonstrou eficácia superior em relação ao uso de antibioticoterapia e câmera hiperbárica. Baseado no risco de viés, é baixo o nível atual de evidência para as abordagens preventivas e curativas da ORN. Patients with head and neck cancer undergo treatment, radiation therapy, which may or may not be associated with chemotherapy and/ or surgery. Their quality of life is affected due to the side effects caused by the treatments. Mucositis, hyposalivation, loss of taste, trismus and osteoradionecrosis are the side effects that most affect patients undergoing treatment for head and neck cancer. Osteoradionecrosis is considered a late and highly complicating event after radiotherapy and chemotherapy treatment. A systematic search was performed in the electronic databases MEDLINE/ PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray and manual search, without restriction of language. The eligibility criteria were: 1) to be a systematic review; 2) to address the oral effects and complications after chemotherapy and/or radiotherapy in adult patients with head and neck cancer and 3) SR based on prospective studies and RCT (randomized clinical trial). Eligibility was determined according to the exclusion criteria for: 1) SR who described rehabilitation to repair ORN sequelae; 2) SR based on case reports or in vitro studies on ORN; 3) ORN in non-gnathic (temporal) bone; 4) do not address the incidence, treatment or prevention of ORN and 5) review of the ORN classification. The Systematic review identified 1321 articles, but only 13 were eligible. The eligibility phase, methodological quality (AMSTAR 2) was conducted by two independent and calibrated examiners, and a third examiner was consulted to resolve inconsistencies. The number of patients treated for the development of ORN during the treatment was 33,762 of which 2,094 developed a lesion, representing an occurrence of 6.2%. As for the location of the ORN the mandible is the site of greatest involvement and, single lesions were more observed than multiple. Extraction after radiotherapy was identified as the major causa factor for the development of ORN. Prevention, based on the studies evaluated is achieved through hyperbaric oxygenation (HBO), being more effective when compared to the use of antibiotic therapy (ATB). The treatment of ORN showed greater effectiveness with the use of PENTO (Pentoxifylline and Tocopherol) in relation to antibiotic therapy in the studies evaluated in the review. This study concluded that for the treatment of ORN, PENTO was considered more effective comparable to antibiotic therapy or hyperbaric oxygenation. Although, there is no evidence as to which period is best for extractions in patients undergoing treatment for head and neck cancer, the risk of developing ORN is increased in the face of the procedure.

O presente estudo teve como objetivo avaliar a performance dos métodos visual, radiográfico e baseados em fluorescência quanto à detecção de lesões de cárie em dentes permanentes e decíduos, realizar meta-análise com a performance global dos métodos e investigar as possíveis fontes de heterogeneidades. Foram realizadas três revisões distintas relacionadas a cada método diagnóstico. Quatro examinadores avaliaram os trabalhos, sendo pelo menos dois por método. Estes efetuaram a busca e seleção de artigos de modo independente; um pesquisador com experiência em trabalhos de diagnóstico de cárie resolveu os casos de conflito ou dúvida. As bases de dados eletrônicas utilizadas foram MEDLINE, EMBASE e Scopus, visando reduzir o viés de publicação, também foram buscados trabalhos acadêmicos e documentos não publicados, através do OpenSigle e Anais do Congresso ORCA. Após a seleção dos estudos por critérios de inclusão e exclusão bem definidos, os dados foram coletados e anotados, de maneira independente por cada revisor. Foi realizada a avaliação da qualidade metodológica através da ferramenta Quality Assessment of Diagnostic Accuracy Studies (QUADAS) e a análise estatística através do Paired Forest Plot, Summary Receiver Operating Characteristics analysis (SROC), relative diagnostic odds ratio (RDOR), análise de sensibilidade e gráfico de funil, além da investigação e exploração das possíveis fontes de heterogeneidade. Para o método visual, 102 artigos preencheram os critérios de inclusão. Em geral, a análise demonstrou que o método visual teve uma boa acurácia para a detecção de lesões de cárie. Embora estudos laboratoriais e clínicos tenham apresentado acurácias semelhantes, os valores de especificidade obtidos clinicamente foram maiores. Observamos, também, moderada a elevada heterogeneidade e evidência de viés de publicação na maioria dos estudos. Além disso, o uso de sistemas de escores visual resultaram em valores significativamente melhores de acurácia em comparação com estudos que utilizaram os seus próprios critérios. Quanto à relevância clínica dos estudos de acurácia do método visual, 96 estudos foram incluídos. Em geral, a maioria dos estudos falha em considerar alguns aspectos clínicos relevantes: somente 1 estudo incluiu avaliação da atividade das lesões; nenhum estudo considerou o seu prognóstico; 79 estudos não consideraram um desfecho clínico relevante e apenas 1 avaliou um desfecho centrado no paciente. Quanto à qualidade metodológica, a maioria dos estudos presentes apresentou alto risco de viés na seleção da amostra. Quanto ao método radiográfico, 116 artigos foram selecionados. Os métodos radiográficos convencional e digital apresentaram desempenho semelhante, mostrando valores maiores de especificidade comparados aos de sensibilidade, além de maiores valores de AUC no limiar de lesões mais avançadas. Quanto aos métodos baseados em fluorescência, 75 estudos preencheram os critérios de inclusão. Em geral, a análise demonstrou uma tendência a valores de acurácia semelhantes para todos os tipos de dentes, superfícies ou tipos de estudo. Houve uma tendência de melhor desempenho na detecção de lesões de cárie mais avançadas. Observamos, também, moderada a alta heterogeneidade e evidência de viés de publicação. Em conclusão, o método visual de detecção de lesões de cárie tem um bom desempenho geral, mas os estudos deveriam considerar desfechos clínicos relevantes, além da acurácia. Além disso, eles deveriam ser conduzidos com maior qualidade metodológica, principalmente em relação à seleção da amostra. Ainda, a utilização de índices detalhados e validados parece melhorar a acurácia do método. O método radiográfico não apresentou diferença entre os modos de aquisição de imagem (digital ou convencional), demonstrando uma tendência a valores superiores de especificidade e melhor desempenho em lesões avançadas. Quanto aos dispositivos baseados em fluorescência, estes mostraram desempenho global semelhante; no entanto, uma melhor acurácia na detecção de lesões de cárie mais avançadas tem sido observada. This study aimed to evaluate the performance of visual, radiographic and fluorescence-based methods in the detection of caries lesions in permanent and primary teeth, to perform meta-analysis of the overall performance of the methods and to investigate possible sources of heterogeneity. Three distinct systematic reviews related to each diagnostic method were performed. Four observers evaluated the articles, at least two per method. They performed the search and study selection independently; a researcher with experience in caries diagnostic studies solved the cases of conflict or doubt. Electronic databases used were MEDLINE, EMBASE and Scopus, to reduce publication bias, were also pursued academic papers and unpublished documents through OpenSigle and the Annals of ORCA Congress. After the selection of studies by well-defined inclusion and exclusion criteria, data were collected and recorded, independently by each reviewer. Methodological quality assessment was performed through Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS) and statistical analysis using Paired Forest Plot, Summary Receiver Operating Characteristics analysis (SROC), relative diagnostic odds ratio (RDOR), sensitivity analysis and funnel plot, in addition we explored possible sources of heterogeneity. Regarding the accuracy of visual method, 102 articles met the inclusion criteria. In general, visual analysis showed that the method had a good accuracy in the detection of caries lesions. Although laboratory and clinical studies have shown similar accuracies, clinical studies have obtained higher specificities. We also observed moderate to high heterogeneity and evidence of publication bias in most studies. In addition, the use of visual scoring systems resulted in significantly better accuracy compared to studies using their own criteria. Concerning the clinical relevance of accuracy studies of visual method, 96 studies were included. In general, most studies failed to consider some relevant clinical aspects: only 1 study included assessment of activity of the lesions; no study considered their prognosis; 79 studies did not consider a relevant clinical outcome and only 1 evaluated a patient-centered outcome. With regard to the methodological quality, most of the present studies showed a high risk of bias in the selection of the sample. With concern to the radiographic method, 116 articles were selected. Conventional and digital radiographic methods showed similar performance, showing greater specificity values compared to sensitivity, and higher AUC values at the threshold of more advanced caries lesions. Regarding fluorescence-based methods, 75 studies met the inclusion criteria. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias. In conclusion, the visual method of detecting caries lesions has a good overall performance, but studies should consider relevant clinical outcomes, as well as accuracy. In addition, they should be conducted with greater methodological quality, especially in relation to sample selection. Still, the use of detailed and validated indices seems to improve the accuracy of the method. Radiographic method showed no difference between the image acquisition modes (digital or conventional), showing a tendency to higher values of specificity and performance in advanced caries lesions. Fluorescence-based devices showed similar overall performance; however, a better accuracy in detecting more advanced caries has been observed.

O estudo da propagação da luz nas porcelanas é importante para entender seu comportamento óptico frente a situações clínicas como fotoativação de cimentos resinosos e sua resposta estética, quando observada sobre diferentes fundos. Este trabalho estudou a influência da espessura, cor, opacidade e marca comercial das porcelanas feldspáticas na propagação da luz visível, através da teoria de KubelkaMunk (KM), nos intervalos de comprimento de onda de 410500nm e de 410700nm. Foram confeccionados discos de 12,5mm por 1 mm de espessura de porcelana feldspática de duas opacidades, corpo (B) e corpo opaco (BO), das marcas Vintage Halo (HALO), Noritake Super Porcelain EX3 (NORI) e IPS dSIGN (IPS), nas cores A1, A35 e B3 (n=7). Os discos foram polidos através de uma série de lixas abrasivas até a granulação 600 e acondicionados individualmente em ambiente seco. Os discos tiveram suas curvas espectrais de refletância obtidos em contato óptico, sobre fundo branco e preto, através do uso de um espectrofotômetro com esfera de integração acoplada, no intervalo de comprimento de onda de 410700nm. As curvas de refletância foram inseridas na teoria KM, para obtenção e análise quantitativa e qualitativa das propriedades ópticas de cada material. As análises qualitativas envolveram a observação do comportamento espectral das curvas de espalhamento, absorção, espessura infinita e reflexão para todos aos materiais em função do comprimento de onda. As análises quantitativas envolveram a obtenção das espessuras ópticas estimadas em extinções crescentes de 50% (X50), 90% (X90), 95% (X95) e infinita 99.9% (X99.9), para o intervalo de comprimento de onda de 410500nm e a obtenção da espessura óptica infinita 99.9% (X) e dos Parâmetros de Translucidez (TP), estimados nas espessuras de 0.5mm (TP0.5), 1.25mm (TP1.25) e 2.00mm (TP2.00), para o intervalo de comprimento de onda de 410700nm. Os Parâmetros de Translucidez foram utilizados para avaliar o efeito de mascaramento da porcelana sobre os fundos utilizados. Os resultados mostraram que todos os fatores (cor, opacidade e marca comercial) exerceram influência para atenuar a propagação da luz através dos espécimes. De maneira geral, a maior atenuação de luz esteve ligada à porcelanas de corpo opaco e mais saturadas (cor A35 e B3). Em relação à marca comercial a porcelana IPS, atenuou de maneira geral mais luz nas cores A35 e B3 em relação às mesmas cores das marcas HALO e NORI nas espessuras ópticas estudadas. Os valores de espessura óptica infinita (espessura onde a energia transmitida é praticamente zero), para ambos os intervalos de comprimento de onda, para todos os materiais, superaram os limites de espessura clínica indicados pela literatura. Isto implicou que, no caso do intervalo de 410 a 500nm, a energia transmitida pode girar de 20 a 5% para as porcelanas de corpo, e de 10 a 5%, para as de corpo opaco e, no caso do mascaramento, as porcelanas serão mais influenciadas por fundos que apresentarem resposta colorimétrica acentuada nas regiões alaranjadas e avermelhadas do espectro visível. As análises qualitativas mostraram que para todos os materiais e espessuras a luz será preferencialmente atenuada no início do espectro, intervalo de 410 a 500nm e menos atenuada em direção ao final do espectro visível. Os resultados também mostraram que com o aumento da espessura, a atenuação aumentou, e que a relação entre espessura e atenuação é não linear. The study of light propagation through porcelains is important to understand its optical behavior in front of clinical situations such as the photoactivation of luting cements and their esthetic responses, when observed against different backgrounds. This research studies the influence of thickness, shade, opacity, and commercial brands of feldspatic porcelains on the propagation of visible light through the Kubelka Munk Theory for the wavelength intervals of 410500nm and 410700nm. Discs with 12,5mm in diameter and thickness of 1mm were prepared with feldspatic porcelain in two opacities, body (B) and opaque body (BO), three commercial brands; Vintage Halo (HALO), Noritake Super Porcelain EX3 (NORI), and IPS dSIGN (IPS), and three shades, A1, A35, and B3 (n=7). The discs were polished with a series of waterproof sandpapers down to a #600 grade sandpaper, and individually stored in a dry environment. The spectral reflectance curves were acquired from the disks on optical contact, against white and black backgrounds, with a spectrometer with a diffuse reflectance attachment (an attached integration sphere), in the wavelength interval of 410700nm. The reflectance spectra were inserted in the KM theory to quantitatively and qualitatively obtain and analyze the optical properties of each material. The qualitative analyses were obtained from the observation of the spectral behavior of scattering, absorption, infinite optical thickness, and reflection spectra for all materials as a function of the wavelength. The quantitative analyses involved obtaining the predicted optical thicknesses in extinctions with increments of 50% (X50), 90% (X90), 95% (X95) and infinite 99.9% (X99.9), for the wavelength interval of 410500nm and the obtaining of the infinite optical thickness 99.9% (X) and the translucency parameter (TP) estimated as 0.5mm (TP0.5), 1.25mm (TP1.25) e 2.00mm (TP2.00) thicknesses, for the wavelength interval of 410700nm. The Translucency parameters were used to evaluate the porcelain masking effect against the tested backgrounds. The results showed that all factors (Shade, Opacity, and Commercial Brand) exerted influence to attenuate the light propagation through the specimens. In general, a higher light attenuation was linked to porcelains exhibiting more saturated shades (A35, and B3) and body opaque types. The commercial brand IPS porcelain shades A35 and B3, generally attenuated more light than the same shades of HALO and NORI for the studied optical thicknesses. The infinite optical thicknesses values (thicknesses where the transmitted light is close to zero) is above the clinical thickness reported in the literature for all materials and both wavelength intervals. This fact implied that regarding the 410500nm interval, the body porcelain could transmit from 20 to 5% of the energy, while the opaque body transmits from 10 to 5%. The masking effect of the porcelains will be increasingly translucid against the background with increased colorimetric response on the Red Orange regions of the visible spectra. The qualitative analysis showed that for all materials and thicknesses, the light will preferably be attenuated in the beginning of the spectra, on the 410500nm interval e and will be less attenuated towards the ending of the visible spectra. The results also showed that the attenuation increased with the increase of the thickness, and the relationship between thickness and attenuation is nonlinear.

Quando um dente anterior é restaurado toda uma técnica de proteção ao tecido remanescente e a recuperação funcional do elemento dental podem ser comprometidas se a escolha da cor do material restaurador empregado não for adequada. A familiaridade com as teorias da cor e da interação da luz com a matéria pode ajudar na tarefa de escolha da tonalidade do material restaurador. O desafio na busca de um material restaurador ideal na sua função estética sempre foi obter a translucidez própria do esmalte dental. Contudo, essa translucidez faz com que o material restaurador sofra influência da cor de fundo, que pode ser da cor do material de proteção, ou mais normalmente da cor da dentina. No que tange as atividades de restauração estética odontológico, através deste trabalho foi possível concluir que: 1) A colorimetria pode ser um importante meio na seleção e na comunicação de tonalidades de materiais restauradores; 2) Os resultados obtidos confirmam que a cor de fundo exerce grande influência sobre a cor do resultado final da restauração; e 3) Os guias de tonalidade devem ser reformulados de tal forma que levem em consideração a espessura do material restaurador e a cor de fundo. When an anterior tooth is restorated, the whole remaining tissue protection technique and functional recuperation of the dental element can be compromised if the choice of the color of the restorative material is not adequate. The familiarity with the color and light interaction with matter theories may help with the task of choosing the restorative material shade. The challenge in searching for an ideal restorative material in its esthetic function was always obtaining the proper translucency of dental enamel. However, this translucency makes the restorative material suffer an influence of the background color, which can be the protection material color or, more commonly, the dentine color. Concerning the odontologic esthetic restorative activities, it was possible to conclude from this work that: 1) Colorimetry can be an important way for the selection and communication of the restorative material shades; 2) The results show that the background color has a large influence on the final color of the restoration; and 3) The shade guides must be reformulated so that it take into consideration the thickness of the restorative material and background color.

Objetivo: Este estudo se propõe a verificar a influência do adesivo, material de preenchimento e hibridização da dentina na força de retenção de pinos intra-radiculares na técnica direta indireta e comparar o teste de tração de push out com o pull out. Métodos: 60 raízes de dentes bovinos com comprimento de 12 mm foram tratadas endodonticamente e divididas aleatoriamente em 6 grupos (n=10): grupo 1 (técnica direta-indireta, adesivo fotopolimerizável, cimento resinoso, teste de pull out); grupo 2 (idem ao grupo 1 porém o cimento resinoso foi substituído pela resina composta); grupo 3 (idem ao grupo anterior porém o adesivo fotopolimerizável foi substituído pelo químico); grupo 4 (idem ao anterior porém o teste utilizado foi o de push out); grupo 5 (idem ao grupo anterior porém o adesivo utilizado foi o auto condicionante); e grupo 6 (idem ao grupo anterior porém a dentina foi pré hibridizada). A força de retenção foi determinada através do teste de tração usando Universal Testing Machine (Instron). Todos os dados foram analisados usando one-way analysis of variance (ANOVA) com a significância de p