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OBJECTIVE: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. METHOD: 9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles. RESULTS: Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids. Conclusion: The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.

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OBJECTIVE: The efficiency of rotary, manual and ultrasonic root canal instrumentation techniques was investigated in proximally flattened root canals. MATERIAL AND METHODS: Forty human mandibular left and right central incisors, lateral incisors and premolars were used. The pulp tissue was removed and the root canals were filled with red die. Teeth were instrumented using three techniques: (i) K3 and ProTaper rotary systems; (ii) ultrasonic crown-down technique; and (iii) progressive manual technique. Roots were bisected longitudinally in a buccolingual direction. The instrumented canal walls were digitally captured and the images obtained were analyzed using the Sigma Scan software. Canal walls were evaluated for total canal wall area versus non-instrumented area on which dye remained. RESULTS: No statistically significant difference was found between the instrumentation techniques studied (p<0.05). CONCLUSION: The findings of this study showed that no instrumentation technique was 100% efficient to remove the dye.

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The aim of this study was to evaluate the influence of a low-viscosity bonding resin applied over a self-etching adhesive system on the microtensile bond strength (µTBS) of indirect restorations. Comparisons were made using One Up Bond F (OB) self-etching adhesive system, Single Bond (SB) one-bottle adhesive system and Scotchbond Multi Purpose Plus (SMP) bonding component. Thirty bovine incisors were extracted and decoronated at the cementoenamel junction. The labial surfaces were ground so that superficial dentin and deep dentin were exposed. The specimens were randomized to three groups (n=10): G1- OB; G2- OB + SMP; G3- SB. In G2, a layer of the SMP bonding was applied over the OB adhesive system. Indirect composite restorations were bonded using dual-cure cement under 500 g load for 5 min. The specimens were serially sectioned with a bonding area of ± 1.0 mm² in 3 regions: enamel (E), superficial dentin (SD) and deep dentin (DD). The sticks were fixed with cyanoacrylate adhesive and submitted to µTBS test at a crosshead speed of 0.5 mm/min in a mechanical testing machine (EMIC DL 2000). The fractured specimens were examined under scanning electron microscopy to determine the failure mode. Data were analyzed by one-way ANOVA followed by Tukey's test (p<0.05). µTBS means (in MPa) were: G1/E: 15.5 ± 3.5b; G1/SD: 22.7 ± 7.6a; G1/DD: 19.4 ± 9.4a; G2/E: 15.9 ± 5.8b; G2/SD: 19.9 ± 6.9a; G2/DD: 15.3 ± 4.9a; G3/E: 23.2 ± 7.3a; G3/SD: 20.4 ± 8.2a; G3/DD: 19.1 ± 8.7a. The results showed that the use of a low viscosity bonding resin did not affect the µTBS means when associated with a self-etching adhesive system. The self-etching adhesive system was significantly more efficient in dentin than in enamel, while the one-bottle system was significantly more efficient in enamel when compared to the self-etching adhesive system.

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OBJECTIVE: The purpose of this investigation was to evaluate the applicability of the methods proposed by Nolla and by Nicodemo and colleagues for assessing dental age and its correlation to chronological age. METHODS: Panoramic radiographs of 360 patients from the city of Fortaleza (CE, Brazil) aged 7-15 years were used to assess the associations between dental and chronological age. Data were submitted to statistical analysis using the BioEstat 2.0 (2000) software. Student-Neuman-Keuls test was performed and Pearson's correlation coefficients were calculated at 5% significance level. RESULTS: When the Nolla method was applied, the mean difference between true and estimated age for males and females was underestimated. The use of the method proposed by Nicodemo and colleagues also resulted in underestimation, although it was more evident in male subjects. The correlation coefficients between chronological age and estimated dental age were high, with mean values ranging between 0.87 and 0.91 for males and between 0.84 and 0.93 for females. CONCLUSION: Although both methods proved to be reliable in estimating age, the use of correction factors is recommended.

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The aim of this in vitro study was to evaluate the susceptibility of a hybrid composite resin (Filtek Z250 - 3M ESPE) to staining, when light cured in four different modes and immersed in two different media. Composite resin specimens were randomly prepared and polymerized according to the experimental groups (conventional - 550 mW/cm² / 30 seconds; soft start - 300mW/cm² / 10 seconds + 550 mW/cm² / 20 seconds; high intensity - 1060 mW/cm² - 10 seconds; pulse delay - 550 mW/cm² - 1 seconds + 60 seconds of waiting time + 550 mW/cm² - 20 seconds) and immersed in one of two media (distilled water or absolute ethanol) for 24h. Next, the specimens were immersed in a 2% methylene blue solution for 12 hours. Afterwards, the specimens were washed and prepared for the spectrophotometric analysis. For statistical analysis, two-way ANOVA (4X2) and Tukey's test were performed on the data at 0.05 confidence level. Soft start showed the least staining, and was statistically different from the high intensity and pulse delay light curing modes (p<0.05). Conventional light curing unit did not show statistically significant differences from any other groups (p>0.05). There were no significant differences between the two immersion media (p>0.05). The soft start polymerization mode showed lower susceptibly of the composite resin to staining than high intensity and pulse delay, irrespective of the immersion medium.

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OBJECTIVE: The aims of this study were to compare the prevalence of temporomandibular disorders (TMD) in individuals submitted to either orthodontic or ortho-surgical Class III malocclusion treatment and to assess the influence of occlusal aspects on TMD severity. MATERIAL AND METHODS: The sample consisted of 50 individuals divided into two groups, according to the type of treatment (orthodontic or orthodontic with orthognathic surgery). The presence of signs and symptoms of TMD was evaluated by an anamnestic questionnaire and a clinical examination, including TMJ and muscle palpation, active mandibular range of motion, joint noises and occlusal examination. RESULTS: Based on the anamnestic questionnaire, 48% had no TMD, 42% had mild TMD and 10% had moderate TMD. The presence and severity of TMD did not show any relationship with the type of orthodontic treatment (p>0.05). The chi-square test showed a positive association (p<0.05) between TMD and non-working side occlusal interferences. CONCLUSION: Based on the methodology used and the results obtained, it may be concluded that Class III orthodontic treatment was not associated with the presence of TMD signs and symptoms and the non-working side contacts can be occlusal factors of risk. There was no significant difference in TMD prevalence between the studied groups (orthodontically treated patients and patients treated with orthodontics followed by orthognathic surgery).

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Quantification of the expectation of craniofacial growth during the pubertal growth spurt (PGS) is helpful in orthodontic diagnosis and treatment planning. Thus, this study investigated whether the stages of the vertebral maturation index (VMI) would be valid for estimating cranial and mandibular growth during the initial stages of PGS, testing the null hypothesis that these structures do not demonstrate differential growth dependent on the maturation stage. A study population of 45 patients of both genders with 2 lateral cephalometric radiographs, taken at a 12-month interval, was selected from files. All patients should not have been previously submitted to orthodontic treatment and should be before or during the peak stage of PGS. The S-N and Co-Gn cephalometric measurements were traced on both radiographs of each patient, by computed cephalometric tracings, for evaluation of skull and mandible, respectively. The growth of these structures was established by the difference between the measurements obtained on both tracings. The VMI stage was also estimated on the radiographs, determining the position of patients on the PGS curve at two periods, baseline and after 12 months. Cephalometric tracings and VMI estimates were performed by two calibrated examiners. Descriptive statistics revealed that both cephalometric measurements increased during the study period, especially Co-Gn, which demonstrated (ANOVA and Tukey's test; 5% significance level), a statistically significant peak of development (p = 0.001), when the patient was in the VMI stage representing the PGS peak. It was concluded that the VMI stages were valid for the analysis of cranial growth and especially of mandibular growth at the initial stages of PGS, thus rejecting the null hypothesis.

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OBJECTIVE: The aim of this study was to assess the bond strength of indirect composite restorations cemented with a resin-based cement associated with etch-and-rinse and self-etching primer adhesive systems to dentin treated or not with a bioactive material. MATERIALS AND METHOD: Twenty bovine incisor crowns had the buccal enamel removed and the dentin ground flat. The teeth were assigned to 4 groups (n=5): Group I: acid etching + Prime & Bond NT (Dentsply); Group II: application of a bioactive glass (Biosilicato®)+ acid etching + Prime & Bond NT; Group III: One-up Bond F (J Morita); Group IV: Biosilicato® + One-up Bond F. Indirect composite resin (Artglass, Kulzer) cylinders (6x10mm) were fabricated and cemented to the teeth with a dual-cure resin-based cement (Enforce, Dentsply). After cementation, the specimens were stored in artificial saliva at 37ºC for 30 days and thereafter tested in tensile strength in a universal testing machine (EMIC) with 50 kgf load cell at a crosshead speed of 1 mm/min. Failure modes were assessed under scanning electron microscopy. Data were analyzed statistically by ANOVA and Tukey's test (95% level of confidence). RESULTS: Groups I, II and III had statistically similar results (p>0.05). Group IV had statistically significant higher bond strength means (p<0.05) than the other groups. The analysis of the debonded surfaces showed a predominance of adhesive failure mode for Group III and mixed failure mode for the other groups. CONCLUSION: The use of desensitizing agent did not affect negatively the bonding of the indirect composite restorations to dentin, independently of the tested adhesive systems.

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The purpose of the present study was to evaluate the shear bond strength to enamel and the adhesive remnant index (ARI) of both metallic and polycarbonate brackets bonded under different conditions. Ninety bovine permanent mandibular incisors were embedded in acrylic resin using PVC rings as molds and assigned to 6 groups (n=15). In Groups 1 (control) and 3, metallic and polycarbonate orthodontic brackets were, respectively, bonded to the enamel surfaces using Transbond XT composite according to the manufacturer's recommendations. In Groups 2 and 4, both types of brackets were bonded to enamel with Transbond XT composite, but XT primer was replaced by the OrthoPrimer agent. In Groups 5 and 6, the polycarbonate bracket bases were sandblasted with 50-mm aluminum-oxide particle stream and bonded to the enamel surfaces prepared under the same conditions described in Groups 3 and 4, respectively. After bonding, the specimens were stored in distilled water at 37ºC for 24 hours and then submitted to shear bond strength test at a crosshead speed of 0.5 mm/min. The results (MPa) showed no statistically significant difference between Groups 4 and 6 (p>0.05). Likewise, no statistically significant differences (p>0.05) were found among Groups 1, 2, and 5, although their results were significantly lower than those of Groups 4 and 6 (p<0.05). Group 3 had statistically significant lower bond strength than Groups 2, 4, and 6, but no statistically significant differences were found on comparison to Groups 1 and 5. A larger number of fractures at the bracket/composite interface were evidenced by the ARI scores. OrthoPrimer bonding agent yielded higher bond strength in the groups using either conventional or sandblasted polycarbonate brackets, which was not observed in the groups using metallic brackets.

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OBJECTIVE: The aim of this study was to evaluate the thermoplasticity of three commercial brands of gutta-percha (Tanari, Dentsply 0.06, and Roeko), and of the TC system. MATERIALS AND METHODS: Standardized specimens were fabricated from the materials to be evaluated. Specimens were placed in water at 70ºC for 60 seconds. Following that, they were positioned between two glass slabs and each set was compressed by a 5kg weight. Images of the specimens before and after compression were digitized and analyzed by the Image Tool software. The flow capacity of each material was confirmed by the difference between the initial and final areas of each sample. RESULTS: The resulting data were analyzed by ANOVA. The TC system presented the greatest thermoplasticity values (p<0.05). Among the gutta-percha cones, the Roeko brand showed higher thermoplasticity than the others (p<0.05). CONCLUSION: The gutta-percha from TC system present good thermoplasticity capacity.

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OBJECTIVE: The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation. MATERIALS AND METHODS: CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden's J index; p<0.05). The clinical and/or surgical findings (medical records) were considered as the gold standard to corroborate the diagnosis of the anatomical localization of the orbital fracture. RESULTS: 3D-CT scanning presented sensitivity of 78.9%, which was not superior to that of MPR (84.0%), axial/MPR/3D (90.5%) and coronal images (86.1%). On the other hand, the diagnostic value of axial images was considered limited for orbital fractures region, with sensitivity of 44.2%. CONCLUSIONS: Except for the axial images, which presented a low sensitivity, all methods evaluated in this study showed high specificity and sensitivity for the diagnosis of orbital fractures according to the proposed methodology. This protocol can add valuable information to the diagnosis of fractures using the association of axial/MPR/3D with multislice CT.

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OBJECTIVE: To evaluate the prevalence of dental fluorosis in scholars aging 12 to 15 years old, residents in the city of Bauru, State of São Paulo, Brazil. METHODS: 1318 volunteers were enrolled in this study and examined in 18 public schools of the State of São Paulo. The examinations were performed in the schools' court by three dentists (with a Master's degree in Public Health), after toothbrushing supervised by another dentist. The teeth were dried with cotton pellets and examined under natural light by visual inspection, using an explorer as recommended by the WHO, a plane mirror and a tongue depressor. The Thylstrup-Fejerskov (TF) index was used for rating fluorosis. Intra and inter-examiner reproducibility was calculated and data were submitted to descriptive analysis. RESULTS: Approximately 36% of the children presented dental fluorosis, of which 28% was diagnosed as TF1 while the remaining received scores between TF2 and TF4. CONCLUSION: The prevalence of dental fluorosis in Bauru is within the expected range, based on previous studies. Although fluoride is an important resource for caries control, its use must be adequate to the needs of each specific population.

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OBJECTIVE: The purpose of this study was to investigate whether skeletal maturation using cephalometric radiographs could be used in a Brazilian population. MATERIAL AND METHODS: The study population was selected from the files of the Oral Radiological Clinic of the Dental School of Piracicaba, Brazil and consisted of 128 girls and 110 boys (7.0 to 15.9 years old) who had cephalometric and hand-wrist radiographs taken on the same day. Cervical vertebral bone age was evaluated using the method described by Mito and colleagues in 2002. Bone age was assessed by the Tanner-Whitehouse (TW3) method and was used as a gold standard to determine the reliability of cervical vertebral bone age. An analysis of variance and Tukey's post-hoc test were used to compare cervical vertebral bone age, bone age and chronological age at 5% significance level. RESULTS: The analysis of the Brazilian female children data showed that there was a statistically significant difference (p<0.05) between cervical vertebral bone age and chronological age and between bone age and chronological age. However no statistically significant difference (p>0.05) was found between cervical vertebral bone age and bone age. Differently, the analysis of the male children data revealed a statistically significant difference (p<0.05) between cervical vertebral bone age and bone age and between cervical vertebral bone age and chronological age (p<0.05). CONCLUSIONS: The findings of the present study suggest that the method for objectively evaluating skeletal maturation on cephalometric radiographs by determination of vertebral bone age can be applied to Brazilian females only. The development of a new method to objectively evaluate cervical vertebral bone age in males is needed.

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One of the causes of implant failures in cemented implant-retained prostheses is the fracture of abutment screw or UCLA abutment. This article reports a case of simultaneous fracture of two UCLA abutments screws occurring in an implant-supported prosthesis placed in the mandibular molar region. The fractured structures were examined under scanning electron microscopy to investigate the probable causes of the failure, which were not related to failures on materials or fabrication of the screws, but rather were due to shear forces. The misfit in cemented prostheses may be the most likely cause of shear force generation.

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INTRODUCTION: Temporomandibular disorders (TMD) present several signs and symptoms that hinder their correct diagnosis, which is imperative on the elaboration of a treatment plan. Over the past years, several studies have been conducted to characterize and classify TMD to better understand these disorders. Therefore, the purpose of this study was to assess the electromyographic behavior of the masseter and temporal muscles in individuals with and without myogenic, arthrogenic and mixed TMD. METHOD: Forty volunteers of both genders responded to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) Questionnaire, were submitted to clinical exam and underwent bilateral electromyographic exam of the masseter and temporal muscles. RESULTS: No statistically significant difference (p>0.05) was observed during the assessment of isotonic contraction. Regarding isometric contraction, pairing between the mixed TMD group and the asymptomatic subjects did not present significant difference (p>0.05). Comparison between the myogenic and arthrogenic TMD groups and the asymptomatic group showed statistically significant difference (p<0.05). The findings of the present study demonstrated alteration on the muscle contraction pattern of TMD individuals compared to that of asymptomatic patients.