Abstract Eugenol is a phenolic compound with numerous biological activities. It is widely used in dentistry to treat toothache and pulpitis. In particular, eugenol may be used for tooth whitening procedures to minimize dental sensitivity in patients. However, eugenol has some disadvantages such as its volatility, its photosensitivity, and immediate effect, which can be avoided by using pharmaceutical nanotechnology. The aim of the present study was to obtain, characterize, quantify, and evaluate the physicochemical stability of eugenol-loaded Eudragit RS100 nanocapsules. The nanocapsules (NCs) were prepared by interfacial deposition of the preformed polymer method. The NCs were characterized through morphological and spectroscopic studies. The encapsulation efficiency was achieved by quantifying the non-encapsulated eugenol using a previously developed and validated analytical method. The physicochemical stability of NCs was assessed at predetermined time intervals for 90 days after preparation. The nanocapsules were successfully prepared by the chosen method and had a predominantly spherical shape with a smooth surface. The mean size, the polydispersion index, and the zeta potential were in agreement to literature data. Infrared spectra ensured that the nanoencapsulation process did not result in chemical reactions between the drug and the polymer. The formulations showed encapsulation efficiency higher than 90% and remained stable after 60 days of preparation. Thus, eugenol-loaded Eudragit RS100 nanocapsules may be further considered as an alternative formulation for dental sensitivity in order to provide a controlled release, a decreased toxicity, and a better dental sensitivity relief.

Abstract Objectives This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson’s Chi-square test were used (α=0.05) for statistical analysis. Results After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). Conclusion Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations’ improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Abstract Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. Objective This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception. Methodology Sixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05). Results The groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001). Conclusions Regardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed.

ABSTRACT Introduction: Edentulism is total or partial tooth loss mainly caused by dental caries and periodontal disease. It is a gradual process often associated to aging. At present edentulism is considered to be a disability, due to the functional limitations undergone by sufferers. Objective: Describe the multidisciplinary, functional and esthetic rehabilitation treatment provided to a patient with occlusal disharmony. Case presentation: A 74-year-old male patient was diagnosed with bimaxillary partial edentulism based on clinical and radiographic examination. The patient underwent generalized periodontal therapy, pre-prosthetic surgery, direct and indirect occlusal plane restoration, and oral rehabilitation with total upper and partial lower removable prostheses, as a result of which he recovered his functionality, esthetic appearance and self-esteem. Conclusions: Edentulism triggers changes in the functional and emotional state of patients. Comprehensive diagnosis and orderly multidisciplinary treatment led to success in the case herein presented.

RESUMEN Introducción: El edentulismo es la pérdida total o parcial de dientes, ocasionado principalmente por la caries y la enfermedad periodontal; es un proceso gradual que está comúnmente asociado al aumento de edad. Actualmente es considerado una discapacidad debido a la limitación funcional que ocasiona en quien lo presenta. Objetivo: Exponer el tratamiento rehabilitador multidisciplinario, funcional y estético en un paciente con desarmonías oclusales. Presentación del caso: Paciente masculino de 74 años, diagnosticado con edentulismo parcial bimaxilar, mediante examen clínico y radiológico. Se sometió a terapia periodontal generalizada, cirugía preprotésica, restauración de plano oclusal de forma directa e indirecta y rehabilitación bucal con prótesis removibles total superior y parcial inferior; lo cual le permitió recuperar funcionalidad, estética y autoestima. Conclusiones: El edentulismo desencadena alteración en el estado funcional y emocional del paciente. Un diagnóstico integral y plan de tratamiento multidisciplinario y ordenado desencadenó éxito en el presente caso.

Abstract Dual-cured buildup composites and simplified light-cured adhesive systems are mixed with a chemical activator to prevent the incompatibility between them. Objective: To evaluate microshear bond strength (μSBS) and nanoleakage (NL) of three universal adhesives used under buildup composites using different curing modes, at baseline and after 6-months (6m). Methodology: Dentin specimens of 55 molars were assigned to: Clearfil Universal Bond[CFU], Prime&Bond Elect[PBE] and One Coat 7 Universal[OCU]. All-Bond Universal[ABU] and Adper Scotchbond Multi-Purpose[SMP] were used as controls. CFU, PBE, and OCU were: light-cured [LC], dual-cured using a self-curing activator [DC], and self-cured, using a self-curing activator and waiting for 20 min [SC]. Upon the application of the adhesive, transparent matrices were filled with a dual-cured buildup composite and light cured, then tested in mSBS. For NL, the specimens were submersed in ammoniacal silver nitrate and sectioned to observe under the SEM. Three-way ANOVA and Tukey's test were applied (α=0.05). Results: OCU/LC-PBE/LC resulted in higher mean μSBS than ABU/LC. For SMP/DC higher mean μSBS were obtained than for both CFU/DC and OCU/DC (baseline). No universal adhesive was significantly affected by curing mode or storage time. CFU, PBE, and OCU did not undergo significant changes in any curing mode (p>0.05). NL (baseline) PBE/LC resulted in higher %NL compared to ABU/LC. SMP/DC resulted in higher %NL than CFU/DC-OCU/DC. CFU/LC/DC resulted in lower %NL than CFU/SC. PBE/SC resulted in lower %NL than PBE/DC. OCU/LC/SC showed lower %NL than OCU/DC. OCU showed significant lower %NL than CFU and PBE. All CFU groups, as well as OCU/SC, resulted in increased %NL at 6m when compared with baseline. Conclusion: For universal adhesives used in etch-and-rinse mode, self-cured activator and different curing modes did not influence μSBS. However, some interactions were observed for NL, but this influence was material-specific.

Abstract Objectives This randomized, split-mouth, single-blinded trial assessed whether the use of reservoirs in at-home bleaching trays is equivalent to non-reservoir trays. Our choice of an equivalence trial was based on the expectation that a non-reservoir tray is sufficient to produce a color change. Secondary outcomes such as tooth sensitivity (TS) and gingival irritation (GI) were also assessed. Methodology Forty-six patients were selected with canines shade A2 or darker. In half of the patient’s arch, bleaching trays were made with reservoirs and the other half, without reservoirs. At-home bleaching was performed with carbamide peroxide (CP) 10% (3 h daily; 21 days). Color change was evaluated with a digital spectrophotometer (ΔE, ΔE00, and Whiteness Index) and shade guide units (ΔSGU) at baseline, during and one-month post-bleaching. TS and GI were assessed with a numeric scale (NRS) and a visual analog scale (VAS). Results After one month, the equivalence of reservoir and non-reservoir groups were observed in all color instruments (p>0.05). Fifteen and sixteen patients presented pain (absolute risk: 33% and 35%, 95%, confidence interval (CI) 21-46% and 23-49%) in the reservoir and non-reservoir side, respectively. The odds ratio for pain was 0.8 (95%CI 0.2-3.0) and the p-value was non-significant (p=1.0). TS intensity was similar between both groups in any of the pain scales (p>0.05). No difference in the GI was observed (p>0.05). Conclusions The protocol with reservoirs is equivalent in color change to the non-reservoir, although no superiority of the latter was observed in terms of reduced TS and GI with at-home 10% carbamide peroxide bleaching. Clinical Relevance The presence of reservoirs in a bleaching tray did not improve color change or affect tooth sensitivity and gingival irritation.

Resumo Este ensaio clínico avaliou o efeito do uso preemptivo do anti-inflamatório não-esteroidal piroxicam em dose única 30 minutos antes do clareamento de consultório na prevenção de sensibilidade dentária (SD) relatada pelos pacientes. Cinquenta pacientes foram submetidos a duas sessões de clareamento dental em consultório com peróxido de hidrogênio a 35% por 2 sessões, consistindo de aplicação única de 45 minutos, com um intervalo de 7 dias entres as sessões. Trinta minutos antes do procedimento, o paciente recebia aleatoriamente dose única de piroxicam (200 mg) ou do placebo em um desenho duplo-cego, randomizado e cruzado. A SD foi avaliada usando a escalas de gradação verbal (EGV) e visual analógica (EVA) durante o procedimento clareador e 24h após o procedimento. As mudanças de cor foram avaliadas usando a escala Vita Bleachedguide uma semana após cada sessão de clareamento. O risco de SD foi calculado a partir de EGV a analisado pelo teste de McNemar, enquanto o nível de SD foi analisada pelo teste de Mann-Whitney. Para EVA, testes T foram usados para comparar dados dos tratamentos em cada tempo de avaliação. Dados de mudança de cor foram submetidos aos testes de Wilcoxon e Mann-Whitney (α=0.05). A administração preemptiva de piroxicam não afetou o risco e nível de SD quando comparado ao placebo, independentemente do tempo de avaliação. A sequencia de tratamento não afetou a efetividade do clareamento. Como conclusão, a administração de dose única de piroxicam previamente ao clareamento dental de consultório não foi efetiva em reduzir significantemente o risco e nível de SD.

Abstract This clinical trial evaluated the effect of preemptive use of the non-steroidal anti-inflammatory drug piroxicam in a single dose 30 min prior to in-office bleaching on the prevention of tooth sensitivity (TS) reported by patients. Fifty patients were submitted to two sessions of in-office tooth bleaching with 35% hydrogen peroxide used for 2 sessions, each consisting of a single 45-min application, with an interval of 7 days between session. Thirty minutes prior to the procedure, the patient randomly received a single dose of piroxicam (200 mg) or placebo in a double-blind, randomized, crossover design. The TS was evaluated using verbal rate (VRS) and visual analog (VAS) scales during the bleaching procedure and at 24 h after each session. The color changes were assessed by the Vita Bleachedguide scale 1 week after each bleaching session. Risk of TS was calculated from the VRS and analyzed by the McNemar test, while the level of TS was analyzed by the Mann-Whitney test. For the VAS, t-tests were used to compare data from the treatments at each assessment time. Data regarding color changes were subjected to Wilcoxon and Mann-Whitney tests (α=0.05). The preemptive administration of piroxicam did not affect the risk and level of TS compared to placebo, irrespective of the assessment time. The treatment sequence did not affect bleaching effectiveness. In conclusion, the administration of a single dose of piroxicam prior to in-office tooth bleaching was unable to significantly reduce the risk and level of TS.

Resumo Para responder a seguinte questão de pesquisa através de uma revisão sistemática: "O risco e a intensidade de sensibilidade dentária (SD) e eficácia de clareamento são diferentes entre pacientes adultos que realizam clareamento caseiro usando moldeiras com reservatórios e aqueles que usam moldeiras sem reservatórios?”. Uma pesquisa abrangente foi realizada no MEDLINE via PubMed, Scopus, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Cochrane e literatura cinzenta, sem restrições. Os resumos da conferência anual da Associação Internacional para Pesquisa Dental além de estudos registrados ou em andamento também foram pesquisados. Dissertações e Teses foram pesquisados utilizando o Capes Journal Dissertações e Teses ProQuest. Apenas ensaios clínicos randomizados (ECR) foram incluídos. Usamos a ferramenta Risk of Bias (RoB) da Cochrane para avaliação de qualidade. Após a remoção de duplicatas, triagem de título e resumo e exame de texto completo, nove ECRs permaneceram para análises qualitativas. A grande maioria dos estudos não relatou o método de randomização, ocultação de alocação e cegamento do examinador durante a avaliação de cores. Dos nove estudos, oito estavam sob risco claro de viés. Em relação à mudança de cor, quatro estudos não relataram nenhuma mudança e dois relataram melhora na mudança de cor com reservatórios. Apenas quatro estudos registraram a sensibilidade dentária e não relataram diferenças significativas. Apenas um estudo relatou maior irritação gengival com reservatórios. A falta de relatórios de dados nos impediu de executar uma meta-análise. Outros ECR bem desenhados devem ser conduzidos para responder a esta questão de pesquisa. Até agora não há evidências que sustentem que reservatórios em moldeiras de clareamento melhorem a mudança de cor. PROSPERO - CRD42016037628

Abstract To answer the following focused question through a systematic review: “Are the risk and intensity of tooth sensitivity (TS) and bleaching efficacy different between adult patients who undergo at-home bleaching using trays with reservoirs and those who use trays without reservoirs?”. A comprehensive search was performed in the MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and grey literature without restrictions. Abstracts from conferences; unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periódicos Capes Theses databases) were searched. Only randomized clinical trials (RCTs) were included. We used the Risk of Bias tool (RoB) from the Cochrane Collaboration for quality assessment. After the removal of duplicates, title and abstract screening and full-text examination, nine RCTs remained for qualitative analyses. The great majority of the studies did not report the method of randomization, allocation concealment, and examiner blinding during color assessment. From the nine studies, eight were at unclear risk of bias. In regard to color change, four studies reported no change and two reported improved color change with reservoirs. Only four studies recorded tooth sensitivity and they reported no significant differences. Only one study reported greater gingival irritation with reservoirs. Lack of data reporting prevented us from running a meta-analysis. Further well-designed RCT should be conducted to answer this research question. So far there is not evidence to support that reservoirs in bleaching trays improve color change. PROSPERO - CRD42016037628

Abstract The objective of this study is to compare the resin-enamel bond strength (mμSBS), in-situ degree of conversion (DC), and the enamel-etching pattern (SEM/EDX) of universal adhesive systems when applied to sound and fluorotic enamel. Ninety-eight human molars were sectioned into 4 parts and divided into 24 groups according to 1) enamel surface (sound or fluorotic enamel), 2) adhesive system (Clearfil Universal Bond [CUB], Futurabond U [FBU], iBond Universal [IBU], and Scotchbond Universal [SBU]), and 3) application mode (etch-and-rinse [ER], active self-etch [Active-SE], and passive self-etch [Passive-SE]). Specimens were stored at 37 °C, for 24 hours and tested at 1.0 mm/min (μSBS). Enamel–resin interfaces were evaluated for in-situ DC. The enamel-etching pattern was evaluated under a SEM/EDX. Data from mμSBS and in-situ DC was analyzed using a three-way ANOVA and Tukey’s test at 5 % level of significance. For all adhesives, the ER resulted in a statistically significant higher mean mμSBS than the passive-SE in both substrates (p < 0.001). For all adhesives, active-SE resulted in mean mμSBS (p > 0.31) and in-situ DC (p > 0.45) that were statistically similar to those obtained with the ERs in both substrates. A statistically significant, higher mean mμSBS and in-situ DC were obtained in sound enamel (p < 0.001) than in fluorotic enamel. In general, SBU showed higher mean values for mμSBS and in-situ DC compared to those of CUB and IBU (p < 0.001). ER and active-SE showed the deepest enamel-etching pattern in both substrates. A higher amount of fluor was observed in fluorotic enamel. The active application of universal adhesives in the SE-mode may be a viable alternative to increase the adhesive properties in sound and fluorotic enamel.

Abstract This study evaluated microtensile bond strength (µTBS), degree of conversion, modulus of elasticity and ultramicrohardness of three etch-and-rinse adhesives systems. The materials evaluated were: Ambar (FGM), Optibond (Kerr) and Magic Bond (Vigodent). The degree of conversion was analyzed by FTIR/ATR. To evaluate bond strength (μTBS) in dentin, 15 teeth (n = 5) were restored and sliced to obtain the specimens (0.8mm2). The dynamic ultra microhardness tester was used to evaluate the hardness and modulus of elasticity. The Magic Bond adhesive system showed lower µTBS than Ambar and Optibond (p <0.001). For degree of conversion, comparisons between groups of adhesive systems evaluated showed statistically significant difference (p<0.001), with higher values for Ambar and Optibond when compared a Magic Bond. For modulus of elasticity and ultramicrohardness, Ambar and Magic Bond showed lower values than Optibond. The best results in all properties evaluated were obtained by the Optibond adhesive system.

Abstract We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at “low” risk; 62.1% were classified as “unclear”; and 30.3% as “high” risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.

The purpose of this study was to evaluate the effects of long-term storage on the microtensile bond strength (µTBS) to dentin of two self-adhesive and three multi-step resin cements. Two self-adhesive cements RelyX U100 (U100) and seT PP (SET), and 3 multi-step resin cements, one using 2-step etch-and-rinse adhesive AllCem (ALC), and two conventional resin cements with self-etching primer Panavia F (PAN) and Multilink (MULT) were used. Human molars were restored (n=5), sectioned and subjected to the μTBS test after 24 h and 6 months. Fractured specimens were examined by stereomicroscope and SEM. The µTBS were analyzed by one-way ANOVA and Tukey test (α=0.05). ANOVA revealed a difference between groups (p<0.0001). All multi-step resin cements ALC, MULT and PAN showed statistically similar bond strength values that were higher than those of the U100 and SET groups. The bond strength value of ALC, MULT and PAN decreases significantly after 6 months. The majority of the failures were adhesive for all the groups. The µTBS produced by the self-adhesive cements were significantly lower than those observed for multi-step luting agents. Regardless of the numbers of steps of resin cements, the storage time reduces µTBS values to dentin only to multi-step luting agents.

Laser Doppler flowmetry (LDF) is a noninvasive method capable of evaluating variations in pulp blood flow (PBF) and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS) in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

The study aimed to evaluate the effectiveness of in-office bleaching and associated tooth sensitivity on application of nano-calcium phosphate paste as desensitizing agent. Bleaching was performed with 35% hydrogen peroxide gel in 40 patients who were randomly divided into placebo and nano-calcium phosphate paste groups. Bleaching efficacy (BE) was evaluated using a value-oriented Vita shade guide. Tooth sensitivity was recorded using a numeric rating scale (0–4) during bleaching and up to 48 h after each session. The primary outcome of absolute risk of tooth sensitivity was compared using the Fisher’s exact test (α = 0.05). The intensity of tooth sensitivity and the efficacy of in-office bleaching were also statistically evaluated. No significant differences in absolute risk and intensity of tooth sensitivity were detected between the groups (p = 1.0 and p = 0.53, respectively). BE was also found to be similar between the groups (p = 0.67). Although the use of a nano-calcium phosphate paste associated with fluoride and potassium nitrate did not influence the whitening outcome, but it also did not reduce bleaching-induced tooth sensitivity.

Dental bleaching has become one of the most frequently requested esthetic treatments in dental offices. Despite the high clinical success observed with this procedure, some adverse effects have been reported, including a potential for developing premalignant lesions, root resorption and tooth sensitivity, especially when misused. The aim of this study was to evaluate the genotoxic response using a micronucleus (MN) assay, after the application of two concentrations of carbamide peroxide. Thirty-seven patients were divided into two groups and randomly received either a 10% carbamide peroxide (CP) (19) or a 16% carbamide peroxide (18) concentration for 21 days in individual dental trays. Gingival margin cells were collected immediately before the first use (baseline), and then 15 and 45 days after baseline. The cells were placed on a histological slide, stained by the Feulgen technique, and evaluated by an experienced blinded examiner. One thousand cells per slide were counted, and the MN rate was determined. The two groups were analyzed by the Wilcoxon rank-sum test and the Kruskal-Wallis equality-of-populations rank test. A slight increase in MN was observed for both groups, in comparison with the baseline, at 15 days. However, no difference was observed between the two groups (10% and 16%), at either 15 or 45 days (p = 0.90). When bleaching is not prolonged or not performed very frequently, bleaching agents containing carbamide peroxide alone will not cause mutagenic stress on gingival epithelial cells.