Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration. costeffectiveness cost athome at home discoloration conducted BCD, , (BCD) HPD, (HPD) CD, CD (CD control, control 10 CP10, CP (CP10 consumerpatient consumer patient adopted macrocosting macro costing markets ΔE*ab ΔEab ΔE ab (ΔE*ab obtained CP1 Brazil costeffective effective US Decisionmaking Decision making (BCD (HPD 1 (CP1 (CP

Abstract Objective: To evaluate the impact of radiotherapy on enamel around restorations of glass ionomer cement (GIC) and fluoride tooth paste (FTP). Material and Methods: Eighty enamel blocks were made and randomly distributed into two groups, according to the fluoride therapy, non-fluoride tooth paste (NFTP) and FTP (n=40) and in subgroups in conformity with radiation dose (0, 10, 30 and 60 Gy). Roughness and microhardness enamel analyses were conducted before radiotherapy. Enamel cavities were made and restored with two GIC (Ketac Molar Easy Mix or Vitremer). Enamel blocks were submitted to 10, 30 and 60 Gy. Then, artificial enamel caries lesions were created by a pH-cycling procedure and FTP or NFTP were used as treatment. The restored enamel blocks were submitted to final roughness and microhardness analyses. Roughness increase (∆R) and hardness loss (∆H) values of enamel were submitted to ANOVA and Tukey test (p=0.05). Results: The irradiated enamel group showed statistically higher ∆R (0.44 ±0.2) and ∆H (99.26±7.0) values compared to non-irradiated group (∆R = 0.051±0.02; ∆H=66.16±12.7) when a resin-modified GIC and NFTP were used. Conclusion: Higher radiation dose increased dissolution of bovine enamel. The use of GIC associated with FTP decreased roughness and increased enamel hardness after radiotherapy.

Resumo Introdução Em busca de simplificar a técnica, reduzir o tempo requerido para as restaurações adesivas, resinas compostas bulk-fill (RCBF) estão sendo desenvolvidas para serem aplicadas em incrementos com espessura de até 4 mm. Objetivo Avaliar a alteração de cor (ΔE) e resistência de união (μTBS) de RCBF a dentina após imersão em bebidas e aplicação de um sistema clareador. Método Foram utilizados 45 dentes molares humanos que foram distribuídos aleatoriamente em três grupos de acordo com o material restaurador (n=15): Filtek Bulk Fill, Tetric N Ceram Bulk Fill e Filtek Z100. Os dentes restaurados foram imersos em café, vinho e água destilada (n=5) durante 72 horas. Os parâmetros de cor foram mensurados utilizando um espectrofotômetro, tendo como base o CIE L*a*b*, antes e após o manchamento e aplicação dos agentes clareadores. Consequentemente, os dentes foram seccionados para a obtenção de espécimes para o teste de microtração. Os valores de ΔE foram analisados aplicando os testes de Kruskal-Wallis e Wilcoxon e os valores de μTBS foram analisados aplicando ANOVA e o teste de Bonferroni (p<0,05). Resultado Não houve diferença significante nos valores de ∆E quando as RCBFs foram comparadas a resina composta convencional (RCC) na maioria dos grupos experimentais. Os valores de ∆E não apresentaram diferença estatística antes e após a aplicação do agente clareador para todas as resinas testadas. As RCBFs demonstraram maiores valores de μTBS comparado a RCC após exposição a água destilada, vinho e agente clareador. Conclusão As RCBFs demonstraram uma similar estabilidade de cor quando comparado a RCC. As RCBFs apresentaram maior resistência de união a dentina que a RCC na maioria das condições avaliadas. O agente clareador não foi efetivo no clareamento dos dentes restaurados.

Abstract Introduction In order to simplify the technique, reduce the time required for direct adhesive restorations, bulk-fill resin composites have been developed be applied in bulk placement up to 4 mm increments. Objective Evaluating the color change (ΔE) and the microtensile bond strength (μTBS) of bulk fill resin composites (BFRC) to dentin after the immersion in regular beverages and the application of bleaching systems. Method Forty-five human molar teeth were randomly distributed in three groups according to the filling material (n=15): Filtek Bulk Fill, Tetric N Ceram Bulk Fill and Filtek Z100. The restored teeth were immersed in coffee, wine and distilled water (n=5) for 72 hours. The color parameters were measured using a spectrophotometer, having as basis the CIE L*a*b*, before and after tooth staining and application of bleaching processes. Subsequently, the teeth were sectioned to obtain the specimens for the microtensile testing. The ΔE values were analyzed applying the Kruskal-Wallis and the Wilcoxon tests, and the μTBS values were analyzed applying the ANOVA and the Bonferroni tests (p<0.05). Result There were no significant differences in the ∆E values when comparing the BFRCs to the conventional resin composite (CRC) in most of the experimental groups. The ∆E values did not present significant differences before and after the application of bleaching processes for all the tested resin composites. The BFRCs presented higher μTBS values than the CRC after exposure to distilled water, wine and bleaching agent. Conclusion The studied BFRCs presented similar color stability to the CRC. The BFRCs presented higher bond strength to the dentin than the CTC in most of the evaluated conditions. The bleaching agent was not effective in whitening the stained restored teeth.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Introdução A classe dos compósitos Bulk-Fill tem obtido popularidade com a promessa de ser fotopolimerizado efetivamente em camadas de até quatro milímetros, fato que contrasta com os dois milímetros requisitados para os compósitos convencionais para manutenção da adesividade da restauração. Objetivo O objetivo deste estudo foi analisar a resistência de união à dentina de restaurações confeccionadas com compósitos do tipo Bulk-Fill. Material e método Foram utilizados 15 terceiros molares humanos, cuja superfície oclusal foi cortada e a dentina foi exposta. Esses elementos dentários foram divididos em três grupos conforme o material restaurador utilizado. O sistema adesivo usado foi o mesmo para todos os grupos. Posteriormente, os dentes restaurados foram cortados para originar palitos de aproximadamente 1 mm de largura, 1 mm de profundidade e 8 mm de altura, que foram fixados às garras do dispositivo de microtração. Foram utilizados dez palitos de cada dente, totalizando 50 palitos por grupo. Os dados de resistência de união à microtração foram expressos em megapascal (MPa). As fraturas foram analisadas em microscópio óptico. Os dados foram analisados através dos testes ANOVA e Tukey (p<0,05). Resultado Os três compósitos estudados diferiram estatisticamente entre si (p<0,000). Os compósitos Bulk-Fill apresentaram resistências de união semelhantes e superiores ao convencional (p<0,000). A fratura mais encontrada foi a mista, em todos os grupos. Conclusão Os compósitos Bulk-Fill apresentaram maiores valores de resistência de união com a técnica restauradora utilizada.

Abstract Introduction The class of the Bulk Fill composites has gotten popularity with the promise of been cured effectively of layers up to 4 mm, a fact with contrasts with the 2 mm required for the convencional composites for maintance of the restoration’s adhesion. Objective The aim of this study was evaluate the microtensile bond strength to dentine of restorations made with Bulk Fill composites. Material and method 15 thirds molars teeth were utilized, whose occlusal layer was cut, exposing the teeth dentine. The teeth were divided in three groups according to the type of restoration materials. All groups were treated with the adhesive system Adper Single Bond 2. Subsequently they were cut in sticks with approximately 1 mm wide, 1 mm depth and 8 mm high, that were fixated at a universal microtensile maching. 10 sticks of each tooth were used in the experiment totaling 50 sticks per group. The data of bond strength microtensile were expressed in MPa. The failures mode was evaluated at an optical microscope. The Data were statistically analyzed through ANOVA and Tukey test (p<0.05). Result The three composites studied differed statistically among themselves (p<0.000). The Bulk Fill composites had microtensile bond strength similar and higher than the convencional (p<0.000). The pattern failure mode found in all groups studied was the mixed. Conclusion The Bulk Fill composites showed the highest values of microtensile bond strength with the restorative technique used.

The aim of this study was to evaluate the bleaching effect of two mouth rinses containing hydrogen peroxide. Thirty premolars were randomly divided into two groups (n = 15): Listerine Whitening (LW) and Colgate Plax Whitening (PW). The teeth were fixed on a wax plate and with acrylic resin, at a distance of 5 mm between each other, exposing the buccal surfaces. All teeth were stored in artificial saliva for 45 days, being removed twice a day to be immersed for 1 min in each mouthwash, followed by 10-second washing in tap water. The pH of each product was measured. Digital images of each tooth were captured under standardized conditions. These images were cut in areas previously demarcated and analyzed in Adobe Photoshop 7.0 using the CIEL*a*b* color space system. Data were statistically analyzed by a paired t test and an independent samples t test (p < 0.05). The pH values were 5.6 and 3.4 for LW and PW, respectively. Both treatment groups showed a decrease in the b* parameter (p < 0.01), but a decrease of a* was observed only for PW (p < 0.01). While the LW group showed an improvement in lightness (L*) (p = 0.03), the PW group had a decrease in the L* parameter (p = 0.02). Within the limitations of this study, it is possible to conclude that both products caused some degree of whitening; however, extreme care should be taken when using Colgate Plax Whitening, since its decline in luminosity might be due to its lower pH.

OBJECTIVES: This in vitro study evaluated the effectiveness of three carbamide peroxide concentrations used for tooth bleaching treatments. MATERIAL AND METHODS: Sixty bovine dental slabs (6x6x3 mm) were obtained, sequentially polished, submitted to artificial staining (baseline) and randomized into four groups (n=15), according to the bleaching agent concentration: distilled water (control), 10% (CP10), 16% (CP16) or 37% (CP37) carbamide peroxide. CP10 and CP16 were covered with 0.2 mL of the respective bleaching gels, which were applied on enamel surface for 4 h/day during two weeks. Samples of CP37 were covered with 0.2 mL of the bleaching gel for 20 min. The gel was light activated by two 40-s applications spaced by 10-min intervals. The gel was renewed and applied 3 times per clinical session. This cycle was repeated at 3 sessions with 5 days of interval between them. Tooth shade evaluations were done with a digital spectrophotometer at T0 (baseline), T1 (after 1-week of treatment) and T2 (1-week post-bleaching). Tooth shade means were statistically analyzed by Kruskal-Wallis and Friedman's tests and color parameters were analyzed by two-way ANOVA and Tukey's test (p<0.05). RESULTS: At T1 and T2 evaluations, tooth shade was significantly lighter than at baseline for all treatment groups, considering the color parameters ΔL*, Δa*, Δb*, ΔE* (p<0.001) or tooth shade means (p<0.001). CP37 group showed lower shade mean change than CP10 and CP16 at T1 (p<0.01), but this difference was not statistically significant at T2 (p>0.05). CONCLUSIONS: One week after the end of the treatment, all carbamide peroxide concentrations tested produced similar tooth color improvement.

OBJECTIVE: The aim of this in vitro study was to evaluate the color stability of a nanofill composite resin (Filtek Z350) in different immersion media. MATERIALS AND METHODS: Twelve resin-based composite specimens were prepared using a silicon cylindrical mold measuring ≅1mm of thickness and ≅ 10mm of diameter. Specimens were light-cured for 40 s from both sides using a LED Radii at 1400 mW/cm² and were randomized into 4 groups (n= 3) according to immersion media: coffee, yerba mate, grape juice or water (control solution). A digital spectrophotometer was used to evaluate the color changes at baseline and at 1-week after immersion in each solution. Specimens were stored in the different staining media for 4 h/day during 1 week. The color differences (DE) were analyzed by paired t-test and one-way ANOVA with complementary Tukey test (p<0.05). RESULTS: After 1-week of immersion, a perceptive color change for the group stored in the grape juice compared to baseline (p=0.008) was observed. Coffee and yerba mate did not show any color changes visible for the human eyes or significantly different from the control group (p>0.05) CONCLUSIONS: The findings of the present study suggest that the tested nanofill resin-based composite was susceptible to staining by substances present in the grape juice.

Tooth discoloration is commonly found in the dental clinic and tooth bleaching has been considered the preferred esthetic alternative, being more conservative, safe and with predictable results. Supervised home-use of 10% Carbamide Peroxide (CP) bleaching with custom-trays is the most common bleaching procedure dispensed by dentists to their patients. The good results obtained with this technique stimulated the flourishing of new products and techniques. Over-the-counter (OTC) bleaching products appeared as a low-cost alternative to bleach discolored teeth without dentist supervision. Different OTC products are available in supermarkets, drug stores or on the Internet, including rinses, paint-on brushes, toothpastes, chewing guns, dental floss, and whitening strips. There is lack of clinical evidence regarding the safety and effectiveness of these products, being most of the studies supported by the manufacturers'. Basically, toothpastes, chewing gums, and dental floss are removal agents of superficial stains. Rinses and paint-on brushes with low levels of hydrogen peroxide have some whitening effect, but without clinical relevance. Strips present similar esthetic results and side-effects, compared to bleaching with 10% CP using trays; however, the studies have financial support from the manufacturers and were based on short term evaluations. Legislation varies widely in different countries regarding OTC dental bleaching. Concerns have appeared due to the potential abusive use of these self-medication agents, especially in young patients, with potential harmful results. Dentists should be acquainted with this kind of products to be able to inform their patients. In conclusion, there is a need for independent clinical trials to provide sufficient evidence regarding the use of OTC bleaching products.