ABSTRACT Objective: To evaluate the effect of thermocycling on the Knoop internal microhardness of high- and low viscosity bulk fill resins applied in Class I cavities. Methods: Thirty third molars with Class I cavity preparations were randomly divided into 3 groups according to the restorative system: nanoparticulated composite resin (Filtek™ Z350 XT 3M ESPE) (oblique increments of 2mm); low viscosity bulk fill resin (Filtek™ Bulk fill Flow, 3M ESPE) (3mm increments covered with a 1-mm layer of nanoparticulated resin); high viscosity bulk fill resin (Filtek™ Bulk fill, 3M ESPE) (single 4-mm increment). After 24h, half of samples was submitted to thermocycling (1,000 cycles). All samples (n=5) were sectioned in half to measure the internal microhardness at bottom and top of restoration. Results: Analysis of variance indicated that, for nanoparticulated composite resin, without thermocycling, the microhardness at the top was statistically lower than at the bottom. After thermocycling, there was no difference in microhardness between the top and the bottom. For low viscosity bulk fill resin, without thermocycling, there was no significant difference in microhardness means between the top and the bottom. After thermocycling, significantly higher microhardness was found at the top than at the bottom (p <0.05). For high viscosity bulk fill resin there was no significant difference between the microhardness values at the top and bottom, regardless of thermocycling (p> 0.05). In all composite resins, an increase in microhardness was observed after thermocycling (p <0.05). Conclusion: Thermocycling increased the internal microhardness of resin restorations, and, for the low viscosity bulk fill resin, the microhardness at the top was higher than at the bottom after thermocycling.

RESUMO Objetivo: Avaliar o efeito da termociclagem na microdureza Knoop interna de resinas bulk fill de alta e baixa viscosidade aplicadas em cavidades classe I. Métodos: Trinta terceiros molares com cavidades Classe I foram divididos aleatoriamente em três grupos de acordo com o sistema restaurador: Resina composta nanoparticulada (Filtek™ Z350 XT 3M ESPE) (incrementos oblíquos de 2mm); resina bulk fill de baixa viscosidade (Filtek™ Bulk fill Flow, 3M ESPE) (incremento de 3mm mais 1mm de resina nanoparticulada); resina bulk fill de alta viscosidade (Filtek ™ Bulk fill, 3M ESPE) (único incremento de 4mm). Após 24h, metade das amostras foi submetida a termociclagem (1.000 ciclos). Todas as amostras (n=5) foram seccionadas ao meio para mensuração da microdureza interna na base e topo da restauração. Resultados: Análise de variância indicou que, para a resina composta nanoparticulada e antes da termociclagem, a microdureza no topo foi estatisticamente inferior do que na base (p<0,05). Após a termociclagem, não houve diferença entre topo e base. Já para a resina bulk fill de baixa viscosidade, antes da termociclagem, não se constatou diferença significativa nos valores de microdureza entre topo e base. Após termociclagem, valores significativamente mais elevados de microdureza foram encontrados no topo do que na base (p<0,05). Para resina bulk fill de alta viscosidade, não houve diferença significativa na microdureza entre topo e base, realizando-se ou não termociclagem (p>0,05). Em todas as resinas compostas foi verificado aumento de microdureza após termociclagem (p<0,05). Conclusão: A termociclagem aumentou a microdureza para todas as resinas compostas, sendo que para a resina bulk fill de baixa viscosidade a microdureza no topo foi maior do que na base após termociclagem.

Abstract Titanium dioxide nanotubes (TiO2-nts) were incorporated into a glass ionomer cement (GIC) with improved mechanical properties and antibacterial activity. The aims of the present in vitro study were to define the elemental characterization, aluminum (Al) release rate, and initial working time for GIC reinforced with TiO2-nts, in an experimental caries model. TiO2-nts were incorporated into GIC powder components at 5% by weight, and compared with unblended GIC. Experimental approaches used energy-dispersive spectrometry (EDS), atomic absorption spectrophotometry (AAS), and brightness loss to define surface element properties, Al release rates, and initial working time, respectively. Statistical analysis was performed by 2-way ANOVA, Tukey’s test, generalized linear models, and Student’s t test (a = 0.05). EDS data analysis revealed that TiO2-nts incorporated into GIC had no significant impact on the typical elemental composition of GICs in an in vitro caries model. Regarding the demineralizing solution, GIC with TiO2-nt significantly decreased the Al release rate, compared with the control group (p < 0.0001). Moreover, TiO2-nt incorporated into GIC did not alter the initial working time of the material (p > 0.05). These findings add information to our scientific body of knowledge concerning the potential impact of TiO2-nt on the performance of conventional GICs.

Abstract This in vitro study evaluated the impact of TiO2 nanotubes (n-TiO2) incorporated into glass ionomer cement (GIC) on Streptococcus mutans (S. mutans) characteristics at cellular and molecular levels. n-TiO2, synthesized by the alkaline method (20 nm in size), was added to Ketac Molar EasyMix® at 0%, 3%, 5%, and 7% by weight. S. mutans strains were cultured on GIC disks with addition or not of n-TiO2 for 1, 3, and 7 days and the following parameters were assessed: inhibition halo (mm) (n=3/group); cell viability (live/dead) (n=5/group); cell morphology (SEM) (n=3/group); and gene expression by real-time PCR (vicR, covR, gtfB, gtfC, and gtfD) (n=6/group). The data were analyzed by the Kruskal-Wallis test, repeated-measures ANOVA or two-way ANOVA, and Tukey’s and Dunn’s post-hoc tests (α=0.05). The agar diffusion test showed a higher antibacterial property for 5% n-TiO2 compared with 3% and 7% (p<0.05) with no effect of time (1, 3, and 7 days). The cell number was significantly affected by all n-TiO2 groups, while viability was mostly affected by 3% and 5% n-TiO2, which also affected cell morphology and organization. Real-time PCR demonstrated that n-TiO2 reduced the expression of covR when compared with GIC with no n-TiO2 (p<0.05), with no effect of time, except for 3% n-TiO2 on vicR expression. Within-group and between-group analyses revealed n-TiO2 did not affect mRNA levels of gtfB, gtfC, and gtfD (p>0.05). Incorporation of n-TiO2 at 3% and 5% potentially affected S. mutans viability and the expression of key genes for bacterial survival and growth, improving the anticariogenic properties of GIC.

RESUMO O objetivo do presente estudo é apresentar uma abordagem de tratamento em um caso de cárie na primeira infância (CPI). Uma menina de 5 anos foi encaminhada à área de Odontopediatria com múltiplas perdas dentárias precoces, dificuldades mastigatórias, amamentação prolongada e baixa qualidade de vida, com diagnóstico de CPI severa. Um plano de tratamento em três fases foi implementado: 1. Controle da doença – consistindo em mudanças comportamentais nos hábitos de higiene bucal, orientação alimentar, remoção profissional do biofilme seguida de aplicação de flúor e restaurações provisórias; 2. Controle de infecção – exodontias e pulpotomia; e 3. Reabilitação funcional – restaurações diretas e semi-indiretas de resina, próteses parcial e total removíveis nos maxilares inferior e superior, respectivamente. Em conclusão, a abordagem multidisciplinar proposta resultou em um impacto positivo na nutrição e crescimento do paciente, produção da fala, comunicação, autoimagem e socialização, levando a uma melhoria da qualidade de vida.

ABSTRACT The aim of the current study is to present a treatment approach in a case of severe early childhood caries (ECC). A 5-year-old girl was referred to the Pediatric Dentistry Division with multiple premature tooth loss, masticatory difficulties, prolonged breast-feeding, and low quality of life, who was diagnosed with severe ECC. A three-phased treatment plan was implemented: 1. Disease control – consisting of behavioral changes in oral hygiene habits, diet guidance, professional biofilm removal followed by fluoride application and temporary restorations; 2. Infection control – teeth extractions and pulpotomy; and 3. Functional rehabilitation – direct and semi-indirect resin restorations, a removable partial and total prostheses in the lower and upper jaws, respectively. In conclusion, the proposed multidisciplinary approach resulted in a positive impact on the patient’s nutrition and growth, speech production, communication, self-image, and social functioning leading to an improved quality of life.

Abstract Titanium dioxide nanotubes are nanostructures that can accelerate the oxidation reaction of bleaching procedures and promote a more effective whitening effect. Objective This study evaluated physicochemical properties of bleaching agents incorporated with titanium dioxide (TiO2) nanotubes, and the effects on tooth color change at different periods. Methodology 40 premolars were treated according to the following groups (n=10): CP - 10% carbamide peroxide (1 hour daily/21 days); CPN - CP incorporated into TiO2; HP - 40% hydrogen peroxide (three 40-minute sessions/7 days apart); HPN - HP incorporated into TiO2. Color shade was evaluated at five different periods (baseline, after 7, 14 and 21 days of bleaching, and 7 days after end of treatment) according to Vita Classical, CIELab and CIEDE2000 scales. Mean particle size (P), polydispersity (PO) and zeta potential (ZP) were evaluated using dynamic light scattering. Data on the different variables were analyzed by mixed model tests for measures repeated in time (ZP e L*), generalized linear models for measures repeated in time (P, PO, Vita Classical and b*), and Friedman and Mann-Whitney tests (a* and color change/ΔE and ΔE00). Results CP and CPN presented higher P, higher PO and lower ZP than HP and HPN (p≤0.05). All groups showed a significant decrease in Vita Classical color scores after 7 days of bleaching (p<0.05), and HPN presented a greater significant reduction than the other groups. L* increased in TiO2 presence, in all groups, without any differences (p>0.05) in bleaching time. A significant reduction occurred in the a* and b* values for all the groups, and HPN presented lower a* and b* values (p<0.05) than CPN. ΔE was clinically noticeable after 7 days, in all groups, and all groups resulted in a perceptible color change according to ΔE00. Conclusion TiO2 did not influence physicochemical properties of the bleaching agents. HPN presented more effective tooth bleaching than CPN.

Abstract: The aim of this study was to evaluate soluble and insoluble fluoride concentrations in commercial varnishes, and their remineralization effect on artificial caries enamel lesions using surface and cross-sectional microhardness evaluations. Forty bovine enamel blocks were separated into four groups (n=10): control (no treatment), Enamelast (Ultradent Products), Duraphat (Colgate-Palmolive) and Clinpro White Varnish (3M ESPE). Surface enamel microhardness evaluations were obtained, artificial enamel caries lesions were developed by dynamic pH-cycling, and the varnishes were then applied every 6 days, after which the enamel blocks were submitted to dynamic remineralization by pH cycles. After removal of the varnishes, the enamel surfaces were reassessed for microhardness. The blocks were sectioned longitudinally, and cross-sectional microhardness measurements were performed at different surface depths (up to 300 μm depth). Polarized light microscopy images (PLMI) were made to analyze subsurface caries lesions. The fluoride concentration in whole (soluble and insoluble fluoride) and centrifuged (soluble fluoride) varnishes was determined using an extraction method with acetone. The data were analyzed to evaluate the surface microhardness, making adjustments for generalized linear models. There was a significant decrease in enamel surface microhardness after performing all the treatments (p<0.0001). Enamelast and Duraphat showed significantly higher enamel microhardness values than the control and the Clinpro groups (p = 0.0002). Microhardness loss percentage was significantly lower for Enamelast (p = 0.071; One-way ANOVA). PLMI showed that subsurface caries lesions were not remineralized with the varnish treatments. No significant differences in the in-depth microhardness levels (p = 0.7536; ANOVA) were observed among the treatments. Enamelast presented higher soluble and insoluble fluoride concentrations than the other varnishes (p < 0.0001; Kruskal-Wallis and Dunn tests). Enamelast and Duraphat varnishes promoted enamel surface remineralization, but no varnish remineralized the subsurface lesion body. Although insoluble and soluble fluoride concentration values did not correspond to those declared by the manufacturer, Enamelast presented higher fluoride concentration than the others.

RESUMO A engenharia de tecidos é um campo contemporâneo da ciência, que visa criar condições baseadas em princípios de biologia celular e molecular, bioengenharia e biomateriais para regenerar tecidos. As células tronco mesenquimais apresentam altas taxas de proliferação e são capazes de se diferenciar, sob certas condições, em multi-linhagens, sugerindo que elas têm grande potencial para atuar no campo da regeneração. As células tronco derivadas de tecidos dentais são uma fonte alternativa adequada de células mesenquimais uma vez que são de fácil acesso e têm baixa morbidade para o doador. Estudos demonstraram que elas já foram isoladas e caracterizadas a partir de diversos tecidos tais como polpa dentária, dentes decíduos esfoliados, ligamento periodontal, gengiva, folículo dental e papila apical. Entretanto, os estudos demonstram que há heterogeneidade entre essas populações e não existe um método padrão para selecionar as células-tronco dentais mais apropriadas para procedimentos regenerativos. O objetivo desta revisão é apresentar o conhecimento atual dos vários tipos de células-tronco derivadas de dentes e discutir as novas perspectivas para seu uso na engenharia de tecidos periodontais.

ABSTRACT Tissue engineering is a contemporary field of science, which aims to create conditions based on principles of cell and molecular biology, bioengineering and biomaterials to regenerate tissues. Mesenchymal stem cells present high proliferation rates and are able to differentiate into multilineages under certain conditions, suggesting that they have great potential to act in regeneration field. Tooth derived stem cells are a suitable alternative source of mesenchymal cells once they are easily accessible and have poor morbidity to the donor. Studies showed that they have been isolated and characterized from diverse tissues such as dental pulp, exfoliated deciduous teeth, periodontal ligament, gingiva, dental follicle and apical papilla. However studies show that there is heterogeneity among these populations and there is no standard method to select the most appropriate tooth derived stem cells for regenerative procedures. The aim of this review is to present the current perspective of the multiple types of tooth-derived stem cells and to discuss the basis for their use in periodontal tissue engineering.

Resumo Os efeitos dos fármacos anti-inflamatórios não esteroidais (AINEs) sobre a quantidade e qualidade óssea tem sido investigados ao longo dos anos.Entretanto, há falta de informação sobre o impacto dos AINEs na qualidade do osso alveolar de suporte na ausência de inflamação periodontal. Assim, o objetivo deste estudo foi avaliar, histometricamente, a influência de um AINE seletivo para COX-2 (Meloxicam) na densidade mineral óssea inter-radicular em ratos. Quarenta e nove ratos Wistar, machos e adultos foram divididos aleatoriamente em quatro grupos experimentais: injeções subcutâneas de 0,9% de solução salina estéril por 15 dias (G1, n=12) e 45 dias (G2, n=11); e injeções subcutâneas de Meloxicam por 15 (G3, n=13) e 45 dias (G4, n=13). A densidade mineral foi determinada histometricamente na área inter-radicular dos primeiros molares mandibulares e a análise dos dados realizada por meio de ANOVA (a=5%). Os resultados mostraram nenhuma interação entre tempo e tratamento (p>0,05) e que o meloxicam não afetou a densidade óssea alveolar. Em contraste, foi encontrado que a densidade óssea alveolar inter-radicular aumentou ao longo do tempo (91,88±3,08% e 92,86±2,38% para os grupos 15 e 45 dias, respectivamente) (p<0,05). Dentro dos limites deste estudo, a administração diária de um inibidor seletivo para COX-2 (Meloxicam) não afetou a qualidade do osso alveolar inter-radicular na ausência de infecção periodontal.

Abstract The effects of the non-steroidal anti-inflammatory drugs (NSAIDs) on bone quantity and quality were investigated for years. However, there is lack of information on the impact of NSAIDs on the quality of tooth-supporting alveolar bone in absence of periodontal inflammation. Thus, the aim of this study was to evaluate histometrically the influence of a selective COX-2 NSAID (Meloxicam) on the inter-radicular bone mineral density in rats. Forty-nine adult male Wistar rats were randomly divided into four experimental groups: Subcutaneous injection of 0.9% sterile saline for 15 days (G1; n=12) and 45 days (G2; n=11); and subcutaneous injection of Meloxicam for 15 days (G3; n=13) and 45 days (G4; n=13). Mineral density was histometrically determined in the inter-radicular area of the 1st mandibular molars and data analysis performed by two-way ANOVA (a=5%). Results showed no interaction between time and treatment (p>0.05) and that meloxicam did not affect the alveolar bone density. In contrast, it was found that inter-radicular alveolar bone density increased with time (91.88±3.08% and 92.86±2.38% for groups 15 and 45 days, respectively) (p<0.05). Within the limits of this study, daily administration of a selective COX-2 inhibitor (Meloxicam) did not affect the quality of the inter-radicular alveolar bone in absence of periodontal infection.

OBJECTIVES: The aim of this study was to determine the effect of environmental conditions on the degradation of ionomeric and resin sealant materials. MATERIAL AND METHODS: FluroShield, Vitremer, and Ketac Molar disc-shaped specimens (n=18/material) were prepared, polished, subjected to initial hardness and roughness readings. Six discs of each material were randomly assigned to one of three different storage solutions: 0.3% citric acid (CA), demineralization solution (DE), and remineralization solution (RE). The specimens were individually immersed in 3 mL of the test solutions, which were daily changed. After 15 days of storage, new surface roughness and hardness readings were done. Fluoride release in the solutions was measured within 15 days. Data were analyzed by ANOVA and Tukey's and Contrast tests (α=0.05). RESULTS: The storage in CA increased the roughness of Vitremer and Ketac Molar. A significant reduction in hardness was observed for all materials after storage in all solutions. For all materials, the greatest amounts of fluoride release occurred during the 1st day. FluroShield presented the same patterns of fluoride release in all solutions. Ketac Molar and Vitremer released the highest amounts of fluoride in the CA solution. CONCLUSIONS: Ionomeric materials are more susceptible to degradation than resin-based materials under acidic conditions. Acidic conditions lead to a higher fluoride release from ionomeric materials.

Este estudo avaliou o efeito da esterilização com raios-gama na liberação de flúor e atividade antibacteriana de materiais resinosos, Fluroshield (FS) e Clearfil Protect Bond (CPB). Quatro grupos foram formados: G1-FS e gama; G2-FS sem gama; G3-CPB e gama; G4-CPB sem gama. Doze discos de cada material foram preparados para análise de liberação de flúor, os quais foram cobertos com esmalte de unha, exceto em um lado com 50,4 mm² de área. G1 e G3 foram esterilizados com dose de 14,5 KGy por 24 h/27ºC, enquanto G2 e G4 (controles) não foram esterilizados e foram mantidos sob as mesmas condições de tempo e temperatura. As leituras de liberação de flúor foram feitas em duplicata (n=6) por um eletrodo específico. A atividade antibacteriana foi avaliada pelo teste de difusão em agar. Os halos de inibição foram medidos após 48 h. Os dados foram analisados pelos testes ANOVA e Tukey (α=5%). A esterilização gama diminuiu a liberação de flúor de FS em cerca de 50%, enquanto CPB não foi afetado. Não houve diferença estatisticamente significante entre os grupos esterilizados e controle no efeito antibacteriano do CPB. FS não apresentou atividade antibacteriana. A esterilização gama diminuiu a liberação de flúor de FS, mas não afetou a atividade antibacteriana dos materiais estudados.

This study evaluated the effect of gamma irradiation on fluoride release and antibacterial activity of FluroShield (FS) and Clearfil Protect Bond (CPB). Four groups were formed: G1-FS + gamma; G2-FS without gamma; G3-CPB + gamma; G4-CPB without gamma. For fluoride release analysis, 12 disks of each material were prepared and covered with nail polish, except for one side (50.4 mm² area). G1 and G3 were sterilized with a 14.5 KGy dose at 27ºC for 24 h, while G2 and G4 (controls) were not sterilized and were maintained under the same time and temperature conditions. Fluoride release measurements were made in duplicate (n=6) by an ion specific electrode. The antibacterial activity of the CPB and FS against Streptococcus mutans after gamma sterilization was evaluated by the agar-disc diffusion method. The diameter of the zones of microbial growth inhibition was recorded after 48 h. Data were analyzed statistically by ANOVA and Tukey's test (α=5%). Gamma sterilization decreased the fluoride release of FS by approximately 50%, while CPB was not affected. There was no statistically significant difference (p>0.05) in the antibacterial effect of CPB between gamma and non-gamma sterilization groups. FS presented no antibacterial activity. Gamma irradiation decreased the fluoride release of FS, but did not affect the antibacterial activity of the studied materials.