• New online submission system and acknowledgements Editorial

    Santos, Carlos F.
  • Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review Systematic Review

    Maia, Mila Leite de Moraes; Bonjardim, Leonardo Rigoldi; Quintans, Jullyana de Souza Siqueira; Ribeiro, Maria Amália Gonzaga; Maia, Luiz Guilherme Martins; Conti, Paulo César Rodrigues

    Abstract in English:

    Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected. Objective: To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. Material and Methods: The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. Results: After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo. Conclusion: Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.
  • The influence of "C-factor" and light activation technique on polymerization contraction forces of resin composite Original Articles

    Ishikiriama, Sérgio Kiyoshi; Valeretto, Thiago Majolo; Franco, Eduardo Batista; Mondelli, Rafael Francisco Lia

    Abstract in English:

    OBJECTIVES: This study evaluated the influence of the cavity configuration factor ("C-Factor") and light activation technique on polymerization contraction forces of a Bis-GMA-based composite resin (Charisma, Heraeus Kulzer). MATERIAL AND METHODS: Three different pairs of steel moving bases were connected to a universal testing machine (emic DL 500): groups A and B - 2x2 mm (CF=0.33), groups C and D - 3x2 mm (CF=0.66), groups e and F - 6x2 mm (CF=1.5). After adjustment of the height between the pair of bases so that the resin had a volume of 12 mm³ in all groups, the material was inserted and polymerized by two different methods: pulse delay (100 mW/cm² for 5 s, 40 s interval, 600 mW/cm² for 20 s) and continuous pulse (600 mW/cm² for 20 s). Each configuration was light cured with both techniques. Tensions generated during polymerization were recorded by 120 s. The values were expressed in curves (Force(N) x Time(s)) and averages compared by statistical analysis (ANOVA and Tukey's test, p<0.05). RESULTS: For the 2x2 and 3x2 bases, with a reduced C-Factor, significant differences were found between the light curing methods. For 6x2 base, with high C-Factor, the light curing method did not influence the contraction forces of the composite resin. CONCLUSIONS: Pulse delay technique can determine less stress on tooth/restoration interface of adhesive restorations only when a reduced C-Factor is present.
  • Peel bond strength of resilient liner modified by the addition of antimicrobial agents to denture base acrylic resin Original Articles

    Alcântara, Cristiane S.; Macêdo, Allana F.C. de; Gurgel, Bruno C.V.; Jorge, Janaina H.; Neppelenbroek, Karin H.; Urban, Vanessa M.

    Abstract in English:

    In order to prolong the clinical longevity of resilient denture relining materials and reduce plaque accumulation, incorporation of antimicrobial agents into these materials has been proposed. However, this addition may affect their properties. OBJECTIVE: This study evaluated the effect of the addition of antimicrobial agents into one soft liner (Soft Confort, Dencril) on its peel bond strength to one denture base (QC 20, Dentsply). MATERIAL AND METHODS: Acrylic specimens (n=9) were made (75x10x3 mm) and stored in distilled water at 37ºC for 48 h. The drug powder concentrations (nystatin 500,000U - G2; nystatin 1,000,000U - G3; miconazole 125 mg - G4; miconazole 250 mg - G5; ketoconazole 100 mg - G6; ketoconazole 200 mg - G7; chlorhexidine diacetate 5% - G8; and 10% chlorhexidine diacetate - G9) were blended with the soft liner powder before the addition of the soft liner liquid. A group (G1) without any drug incorporation was used as control. Specimens (n=9) (75x10x6 mm) were plasticized according to the manufacturers' instructions and stored in distilled water at 37ºC for 24 h. Relined specimens were then submitted to a 180-degree peel test at a crosshead speed of 10 mm/min. Data (MPa) were analyzed by analysis of variance (α=0.05) and the failure modes were visually classified. RESULTS: No significant difference was found among experimental groups (p=0.148). Cohesive failure located within the resilient material was predominantly observed in all tested groups. CONCLUSIONS: Peel bond strength between the denture base and the modified soft liner was not affected by the addition of antimicrobial agents.
  • Push-out bond strength and SEM evaluation of a new bonding approach into the root canal Original Articles

    Carvalho, Carlos Augusto; Breschi, Lorenzo; Navarro, Maria Fidela; Atta, Maria Teresa; Ferrari, Marco

    Abstract in English:

    OBJECTIVE: This study evaluated the performance of different adhesive systems in fiber post placement aiming to clarify the influence of different hydrophobic experimental blend adhesives, and of one commercially available adhesive on the frictional retention during a luting procedure. MATERIAL AND METHODS: One luting agent (70 Wt% BisGMA, 28.5% TEGDMA; 1.5% p-tolyldiethanolamine) to cement fiber posts into root canals was applied with 4 different adhesive combinations: Group 1: The etched roots were rinsed with water for 30 s to remove the phosphoric acid, then rinsed with 99.6% ethanol for 30 s, and blotdried. A trial adhesive (base to catalyst on a 1:1 ratio) was used with an experimental luting agent (35% Bis-GMA, 14.37% TeGDMA, 0.5% eDMAB, 0.13% CQ); Group 2: A trial adhesive (base to catalyst on a 1:2 ratio) was luted as in Group 1; Group 3: One-Step Plus (OSP, Bisco Inc.) following the ethanol bonding technique in combination with the luting agent as in Group 1; Group 4: OSP strictly following the manufacturer's instructions using the luting agent as in Group 1. The groups were challenged with push-out tests. Posted root slices were loaded until post segment extrusion in the apical-coronal direction. Failure modes were analyzed under scanning electron microscopy. RESULTS: Push-out strength was not significantly influenced by the luting agent (p>0.05). No statistically significant differences among the tested groups were found as Group 1 (exp 1 - ethanol-wet bonding technique)=Group 2 (exp 2 - ethanol-wet bonding technique)=Group 3 (OSP - ethanol-wet bonding technique)=Group 4 (control, OSP - water-wet bonding technique) (p>0.05). The dominating failure modes in all the groups were cohesive/adhesive failures, which were predominantly observed on the post/luting agent interface. CONCLUSIONS: The results of this study support the hypothesis that the proposal to replace water with ethanol to bond fiber posts to the root canal using highly hydrophobic resin is plausible, but this seems to be more the proof of a concept than a clinically applicable procedure.
  • Antibacterial effect of water-soluble chitosan on representative dental pathogens Streptococcus mutans and Lactobacilli brevis Original Articles

    Chen, Chih-Yu; Chung, Ying-Chien

    Abstract in English:

    Dental caries is still a major oral health problem in most industrialized countries. The development of dental caries primarily involves Lactobacilli spp. and Streptococcus mutans. Although antibacterial ingredients are used against oral bacteria to reduce dental caries, some reports that show partial antibacterial ingredients could result in side effects. OBJECTIVES: The main objective is to test the antibacterial effect of water-soluble chitosan while the evaluation of the mouthwash appears as a secondary aim. MATERIAL AND METHODS: The chitosan was obtained from the Application Chemistry Company (Taiwan). The authors investigated the antibacterial effects of water-soluble chitosan against oral bacteria at different temperatures (25-37ºC) and pH values (pH 5-8), and evaluated the antibacterial activities of a self-made water-soluble chitosan-containing mouthwash by in vitro and in vivo experiments, and analyzed the acute toxicity of the mouthwashes. The acute toxicity was analyzed with the pollen tube growth (PTG) test. The growth inhibition values against the logarithmic scale of the test concentrations produced a concentrationresponse curve. The IC50 value was calculated by interpolation from the data. RESULTS: The effect of the pH variation (5-8) on the antibacterial activity of water-soluble chitosan against tested oral bacteria was not significant. The maximal antibacterial activity of water-soluble chitosan occurred at 37ºC. The minimum bactericidal concentration (MBC) of water-soluble chitosan on Streptococcus mutans and Lactobacilli brevis were 400 µg/mL and 500 µg/mL, respectively. Only 5 s of contact between water-soluble chitosan and oral bacteria attained at least 99.60% antibacterial activity at a concentration of 500 µg/mL. The water-soluble chitosan-containing mouthwash significantly demonstrated antibacterial activity that was similar to that of commercial mouthwashes (>99.91%) in both in vitro and in vivo experiments. In addition, the alcohol-free mouthwash exhibited no cytotoxicity and no oral stinging. To the best of our knowledge, this was the first study to combine in vitro and in vivo investigations to analyze the antibacterial properties of water-soluble chitosan-containing mouthwash. CONCLUSIONS: This study illustrated that water-soluble chitosan may be a viable alternative to commercial mouthwashes in the future.
  • Addition of bone morphogenetic protein type 2 to ascorbate and β-glycerophosphate supplementation did not enhance osteogenic differentiation of human adipose-derived stem cells Original Articles

    Cruz, Ariadne Cristiane Cabral; Silva, Mariana Lúcia; Caon, Thiago; Simões, Cláudia Maria Oliveira

    Abstract in English:

    Bone morphogenetic protein type 2 (BMP-2) is a potent local factor, which promotes bone formation and has been used as an osteogenic supplement for mesenchymal stem cells. OBJECTIVES: This study evaluated the effect of a recombinant BMP-2 as well as the endogenous BMP-4 and BMP-7 in the osteogenic differentiation of adipose-derived stem cells (ASCs) in medium supplemented with ascorbate and β-glycerophosphate. MATERIAL AND METHODS: Human ASCs were treated with osteogenic medium in the presence (ASCs+OM+BMP-2) or absence (ASCs+OM) of BMP-2. The alkaline phosphatase (ALP) activity was determined and the extracellular matrix mineralization was evaluated by Von Kossa staining and calcium quantification. The expressions of BMP-4, BMP-7, Smad1, Smad4, and phosphorylated Smad1/5/8 were analyzed by western blotting. Relative mRNA expressions of Smad1, BMP receptor type II (BMPR-II), osteonectin, and osteocalcin were evaluated by qPCR. Results: ASCs+OM demonstrated the highest expression of BMP-4 and BMP-7 at days 21 and 7, respectively, the highest levels of BMPR-II mRNA expression at day 28, and the highest levels of Smad1 mRNA at days 14 and 28. ASCs+OM+BMP-2 demonstrated the highest levels of Smad1 mRNA expression at days 1, 7, and 21, the highest expression of Smad1 at day 7, the highest expression of Smad4 at day 14, the highest ALP activity at days 14 and 21, and expression of phosphorylated Smad1/5/8 at day 7. ASCs+OM and ASCs+OM+BMP2 showed similar ALP activity at days 7 and 28, similar osteonectin and osteocalcin mRNA expression at all time periods, and similar calcium depositions at all time periods. CONCLUSIONS: We concluded that human ASCs expressed endogenous BMP-4 and BMP-7. Moreover, the supplementation of ASCs with BMP-2 did not increase the level of osteogenic markers in the initial (ALP activity), intermediate (osteonectin and osteocalcin), or final (calcium deposition) phases, suggesting that the exogenous addition of BMP-2 did not improve the in vitro osteogenesis process of human ASCs.
  • Effects of etching and adhesive applications on the bond strength between composite resin and glass-ionomer cements Original Articles

    Pamir, Tijen; Şen, Bilge Hakan; Evcin, Özgür

    Abstract in English:

    OBJECTIVE: This study determined the effects of various surface treatment modalities on the bond strength of composite resins to glass-ionomer cements. MATERIAL AND METHODS: Conventional (KetacTM Molar Quick ApplicapTM) or resin-modified (PhotacTM Fil Quick AplicapTM) glass-ionomer cements were prepared. Two-step etch-rinse & bond adhesive (AdperTM Single Bond 2) or single-step self-etching adhesive (AdperTM PromptTM L-PopTM) was applied to the set cements. In the etch-rinse & bond group, the sample surfaces were pre-treated as follows: (1) no etching, (2) 15 s of etching with 35% phosphoric acid, (3) 30 s of etching, and (4) 60 s of etching. Following the placement of the composite resin (FiltekTM Z250), the bond strength was measured in a universal testing machine and the data obtained were analyzed with the two-way analysis of variance (ANOVA) followed by the Tukey's HSD post hoc analysis (p=0.05). Then, the fractured surfaces were examined by scanning electron microscopy. RESULTS: The bond strength of the composite resin to the conventional glass-ionomer cement was significantly lower than that to the resin-modified glass-ionomer cement (p<0.001). No significant differences were determined between the self-etching and etch-rinse & bond adhesives at any etching time (p>0.05). However, a greater bond strength was obtained with 30 s of phosphoric acid application. CONCLUSIONS: The resin-modified glass-ionomer cement improved the bond strength of the composite resin to the glass-ionomer cement. Both etch-rinse & bond and self-etching adhesives may be used effectively in the lamination of glass-ionomer cements. However, an etching time of at least 30 s appears to be optimal.
  • Effect of an acrylic resin combined with an antimicrobial polymer on biofilm formation Original Articles

    Marra, Juliê; Paleari, André Gustavo; Rodriguez, Larissa Santana; Leite, Andressa Rosa Perin; Pero, Ana Carolina; Compagnoni, Marco Antonio

    Abstract in English:

    OBJECTIVES: The purpose of this study was to evaluate the antimicrobial activity of an acrylic resin combined with an antimicrobial polymer poly (2-tert-butylaminoethyl) methacrylate (PTBAEMA) to inhibit Staphylococcus aureus, Streptococcus mutans and Candida albicans biofilm formation. MATERIAL AND METHODS: Discs of a heat-polymerized acrylic resin were produced and divided according to PTBAEMA concentration: 0 (control), 10 and 25%. The specimens were inoculated (10(7) CFU/mL) and incubated at 37ºC for 48 h. After incubation, the wells were washed and each specimen was sonicated for 20 min. Replicate aliquots of resultant suspensions were plated at dilutions at 37ºC for 48 h. The number of colony-forming units (CFU) was counted and expressed as log (CFU+1)/mL and analyzed statistically with α=.05. RESULTS: The results showed that 25% PTBAEMA completely inhibited S. aureus and S. mutans biofilm formation. A significant reduction of log (CFU+1)/mL in count of S. aureus (control: 7.9±0.8A; 10%: 3.8±3.3B) and S. mutans (control: 7.5±0.7A; 10%: 5.1±2.7B) was observed for the group containing 10% PTBAEMA (Mann-Whitney, p<0.05). For C. albicans, differences were not significant among the groups (control: 6.6±0.2A; 10%: 6.6±0.4A; 25%: 6.4±0.1A), (Kruskal-Wallis, p>0.05, P=0.079). CONCLUSIONS: Acrylic resin combined with 10 and 25% of PTBAEMA showed significant antimicrobial activity against S. aureus and S. mutans biofilm, but it was inactive against the C. albicans biofilm.
  • Bond strength between acrylic resin and maxillofacial silicone Original Articles

    Haddad, Marcela Filié; Goiato, Marcelo Coelho; Santos, Daniela Micheline dos; Crepaldi, Nádia de Marchi; Pesqueira, Aldiéris Alves; Bannwart, Lisiane Cristina

    Abstract in English:

    The development of implant dentistry improved the possibilities of rehabilitation with maxillofacial prosthesis. However, clinically it is difficult to bond the silicone to the attachment system. OBJECTIVES: This study aimed to evaluate the effect of an adhesive system on the bond strength between acrylic resin and facial silicone. MATERIAL AND METHODS: A total of 120 samples were fabricated with auto-polymerized acrylic resin and MDX 4-4210 facial silicone. Both materials were bonded through mechanical retentions and/or application of primers (DC 1205 primer and Sofreliner primer S) and adhesive (Silastic Medical Adhesive Type A) or not (control group). Samples were divided into 12 groups according to the method used to attach the silicone to the acrylic resin. All samples were subjected to a T-peel test in a universal testing machine. Failures were classified as adhesive, cohesive or mixed. The data were evaluated by the analysis of variance (ANOVA) and the Tukey's HSD test (α=.05). RESULTS: The highest bond strength values (5.95 N/mm; 3.07 N/mm; 4.75 N/mm) were recorded for the samples that received a Sofreliner primer application. These values were significantly higher when the samples had no scratches and did not receive the application of Silastic Medical Adhesive Type A. CONCLUSIONS: The most common type of failure was adhesive. The use of Sofreliner primer increased the bond strength between the auto-polymerized acrylic resin and the Silastic MDX 4-4210 facial silicone.
  • Assessment of geometrical characteristics of dental endodontic micro-instruments utilizing X-ray micro computed tomography Original Articles

    Al Jabbari, Youssef S.; Tsakiridis, Peter; Eliades, George; Al-Hadlaq, Solaiman M.; Zinelis, Spiros

    Abstract in English:

    OBJECTIVE: The aim of this study was to quantify the surface area, volume and specific surface area of endodontic files employing quantitative X-ray micro computed tomography (mXCT). MATERIAL AND METHODS: Three sets (six files each) of the Flex-Master Ni-Ti system (Nº 20, 25 and 30, taper .04) were utilized in this study. The files were scanned by mXCT. The surface area and volume of all files were determined from the cutting tip up to 16 mm. The data from the surface area, volume and specific area were statistically evaluated using the one-way ANOVA and SNK multiple comparison tests at α=0.05, employing the file size as a discriminating variable. The correlation between the surface area and volume with nominal ISO sizes were tested employing linear regression analysis. RESULTS: The surface area and volume of Nº 30 files showed the highest value followed by Nº 25 and Nº 20 and the differences were statistically significant. The Nº 20 files showed a significantly higher specific surface area compared to Nº 25 and Nº 30. The increase in surface and volume towards higher file sizes follows a linear relationship with the nominal ISO sizes (r²=0.930 for surface area and r²=0.974 for volume respectively). Results indicated that the surface area and volume demonstrated an almost linear increase while the specific surface area exhibited an abrupt decrease towards higher sizes. CONCLUSIONS: This study demonstrates that mXCT can be effectively applied to discriminate very small differences in the geometrical features of endodontic micro-instruments, while providing quantitative information for their geometrical properties.
  • Influence of the apical enlargement size on the endotoxin level reduction of dental root canals Original Articles

    Marinho, Ariane Cassia Salustiano; Martinho, Frederico Canato; Zaia, Alexandre Augusto; Ferraz, Caio Cezar Randi; Gomes, Brenda Paula Figueiredo de Almeida

    Abstract in English:

    Gram-negative bacteria play an essential role in endodontic infections because they have virulence factors such as endotoxin. Due to its potential cytotoxic activity, special attention has been given to the removal/neutralization of this endotoxin in the root canal system. OBJECTIVE: The aim of this study was to evaluate the influence of the apical enlargement size (AES) by using rotary instruments on the endotoxin level reduction of dental root canals. MATERIAL AND METHODS: Forty root canals of the mandibular premolar teeth were used. Escherichia coli endotoxin (055: B55) was inoculated into thirty root canals. Ten teeth served as the negative control group. After the incubation period, the first endotoxin samples were collected from the root canals with a sterile/apyrogenic paper point for the analysis of the endotoxin units (EU/mL) present before instrumentation (S1). Specimen instrumentation was performed with the Mtwo® rotary system in the sequence 10/.04, 15/.05, 20/.06, 25/.06, 30/.05, 35/.04 and 40/.04. To monitor the effectiveness of increasing apical enlargement on endotoxin removal, the second endotoxin samples were collected from all the root canals after instrumentation with the following instruments: #25/.06- (S2); #30/.05- (S3); # 35/.04- (S4); and #40/.04- (S5). Limulus amebocyte lysate (LAL) was used to quantify the levels of endotoxin. The results were statistically compared by using repeated measures of ANOVA with post hoc Tukey testing. RESULTS: Increasing levels of endotoxin removal was achieved by large sized apical enlargement: S2 (AES #25/.06)- 89.2%, S3 (AES #30/.05)- 95.9%, S4 (AES #35/.04)- 97.8% and S5 (AES #40/.04)- 98.2%. Substantial reduction of endotoxin content was obtained in S4 and S5 compared to S2 (p<0.05), however, the root canal preparation was not able to eliminate the endotoxin. CONCLUSIONS: Under the conditions of this study, it was concluded that the reduction of endotoxin levels of the dental root canals could be predicted by increasing the apical enlargement size.
  • Partial maxillary osteotomy following an unsuccessful forced eruption of an impacted maxillary canine: 10 year follow-up. Review and case report Case Reports

    Puricelli, Edela; Morganti, Mário Alexandre; Azambuja, Henrique Voltollini de; Ponzoni, Deise; Friedrisch, Clarice C.

    Abstract in English:

    The maxillary canines are amongst the most frequently impacted teeth, second only to the third molars. Several conservative orthodontic and surgical techniques are available to position the teeth properly in the dental arch, even in severe cases. However, when an extraction is necessary, it often leaves a critical alveolar defect of difficult management. The authors present the technique of Partial Maxillary Osteotomy, in which a dento-alveolar segment is moved mesially, hence closing the remaining space, allowing for the formation of healthy periodontium and resulting in an adequate functional and aesthetic outcome. A case report is presented with a 10 year follow-up, proving the technique's stability in the long term.
  • Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery Case Reports

    Freitas, José Alberto de Souza; Garib, Daniela Gamba; Trindade-Suedam, Ivy Kiemle; Carvalho, Roberta Martinelli; Oliveira, Thais Marchini; Lauris, Rita de Cássia Moura Carvalho; Almeida, Ana Lúcia Pompéia Fraga de; Neves, Lucimara Teixeira das; Yaedú, Renato Yassutaka Faria; Soares, Simone; Mazzottini, Reinaldo; Pinto, João Henrique Nogueira

    Abstract in English:

    This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.
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