Abstract Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, “Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?” A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54–1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57–4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37–2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.

OBJETIVO: Avaliar o grau de resistência de união à dentina dos sistemas adesivos de condicionamento ácido total Adper Single Bond (3M ESPE) e XP Bond (Dentsply) e autocondicionante Adper SE Plus (3M ESPE). MÉTODOS: Quinze terceiros molares humanos hígidos foram utilizados, divididos aleatoriamente em três grupos de cinco dentes cada, conforme o adesivo que seria utilizado. A porção oclusal foi removida com o auxílio de um disco flexível diamantado sob refrigeração, até expor uma área de dentina que não apresentasse ilhas de esmalte, comprovado em lupa esterioscópica em aumento de 40X. A smear layer foi padronizada em lixa d'água n°600. Na sequência os sistemas adesivos foram aplicados conforme as recomendações do fabricante, exceto o Adper SE Plus que teve seu tempo de polimerização triplicado. Sobre os dentes preparados foram construídos blocos de resina composta com 5mm de altura. As amostras foram armazenadas por 24 horas a 37°C em água destilada. Utilizando o disco flexível diamantado, foram obtidos corpos de prova com formato de palitos com área adesiva menor que 1mm². Em seguida o teste de microtração foi realizado numa Máquina de Ensaios Universal numa velocidade de 0,5 mm/min. Foram utilizados o teste ANOVA e comparações pareadas de Tukey. RESULTADOS: Os valores da resistência de união para cada sistema adesivo em Mpa foram: 96,24 (XP Bond); 72,39 (Adper Single Bond) e 49,91 (Adper SE Plus). CONCLUSÃO: Dessa forma, em relação à resistência de união à dentina, os adesivos convencionais apresentaram desempenho superior ao autocondicionante.

OBJECTIVE: To assess the bond strength to dentin of the Single Bond (3M ESPE) and XP Bond (Dentsply) total-etch and Adper SE Plus (3M ESPE) self-etch adhesive systems. METHODS: Fifteen healthy human third molars were randomly allocated across three different groups of five teeth each according to the adhesive system. The occlusal portion of each tooth was removed under refrigeration using a flexible diamond disc (EXTEC, Enfield, CT, USA) down to an area of dentin that did not reveal enamel, as confirmed under a 40X stereo microscope (Ramsor, São Paulo, Brazil). A standardized smear layer was created with #600 grit silicon-carbide paper. The adhesive systems were applied as per manufacturer recommendations, with the exception of the Adper SE Plus system, which was triple-polymerized. Composite resin blocks (5 mm) were placed on the dentin surface. The specimens were stored in distilled water for 24 hours at 37ºC. Using a flexible diamond disc (EXTEC, Enfield, CT, USA), toothpick-like specimens with an adhesive area of less than 1 mm² were obtained. A microtensile bond test was then carried out using a universal testing machine (KRATOS) with a crosshead speed of 0.5 mm/min. Analysis of variance (ANOVA) and Tukey's test were used for comparisons. RESULTS: The bond strength values obtained with each adhesive system were as follows: XP Bond, 96.24 MPa; Adper Single Bond, 72.39 MPa; Adper SE Plus, 49.91 MPa. CONCLUSION: In terms of bond strength to dentin, conventional adhesives outperform self-etching systems.

Este trabalho avaliou o impacto de tempos aumentados de condicionamento ácido e da estratégia adesiva na resistência de união por microcisalhamento de três materiais utilizados como selantes de fóssulas e fissuras. Dois tradicionais selantes, [FluroShield, Dentsply (fotoativado) e AlphaSeal, DFL (quimicamente ativado)] e uma resina composta de baixa viscosidade (Permaflo, Ultradent) foram utilizados de acordo com diferentes tempos de condicionamento ácido (15 s e 30 s) e diferentes estratégias de união (sem aplicação de sistema adesivo, aplicação de um primer + resina hidrófoba, e aplicação apenas de uma resina hidrófoba). Fragmentos de esmalte intacto foram obtidos de incisivos bovinos e os materiais foram aplicados respeitando-se os protocolos anteriormente descritos. Após 24 h, o teste de microcisalhamento foi executado utilizando-se uma máquina de ensaio universal, com velocidade de 0,5 mm/min. O padrão de fratura foi classificado com auxílio de lupa estereoscópica. Os dados foram submetidos aos testes ANOVA a três critérios e de Tukey (α=0.05). Não houve diferenças estatisticamente significantes entre os materiais. Permaflo apresentou maior resistência de união quando o esmalte foi condicionado por 30 s apenas. O sobrecondicionamento do esmalte diminuiu a resistência de união do selante fotopolimerizável. O tratamento prévio do esmalte com primer + resina hidrófoba melhorou a performance adesiva para o AlphaSeal. Todos os materiais apresentaram valores de resistência de união estatisticamente similares em relação ao protocolo adesivo e ao tempo de condicionamento ácido. A resina composta de baixa viscosidade poderá ser utilizada como selante de fóssulas e fissuras. A aplicação de um sistema adesivo de três passos é essencial durante o selamento com selante quimicamente ativado.

This study evaluated the impact of extended etching and bonding strategies on the microshear bond strength of three sealant materials. Two pit-and-fissure sealants [FluroShield, Dentsply (light-cured) and AlphaSeal, DFL (self-cured)] and one light-cured flowable composite resin (Permaflo, Ultradent) were evaluated according to different enamel etching times (15 s or 30 s) and bonding procedures (no adhesive application, application of primer/hydrophobic resin or hydrophobic resin only). Intact enamel blocks were obtained from bovine teeth and sealed via the tested protocols. After 24 h, the microshear bond strength test was performed in a universal testing machine at a crosshead speed of 0.5 mm/min. Failure modes were classified by stereomicroscopy. Data were submitted to a three-way ANOVA and to Tukey's test (α=0.05). There was no statistically significant difference (p>0.05) among the materials. Permaflo showed higher bond strength when etched for 30 s alone. Enamel overetching decreased the bond strength of the light-cured sealant. Primer/bond previous treatment improved bond performance for AlphaSeal. In conclusion, from the tested conditions, all sealant materials presented similar bond strength values in relation to bonding protocol and etching time. The flowable composite can be used as a pit-and-fissure sealant. The use of a three-step adhesive system was essential for the self-cured sealant application.

We evaluated the influence of photoactivation method and hydrophobic resin (HR) application on the marginal and internal adaptation, hardness (KHN), and crosslink density (CLD) of a resin-based fissure sealant. Model fissures were created in bovine enamel fragments (n = 10) and sealed using one of the following protocols: no adhesive system + photoactivation of the sealant using continuous light (CL), no adhesive system + photoactivation of the sealant using the soft-start method (SS), HR + CL, or HR + SS. Marginal and internal gaps and KHN were assessed after storage in water for 24 h. The CLD was indirectly assessed by repeating the KHN measurement after 24 h of immersion in 100% ethanol. There was no difference among the samples with regard to marginal or internal adaptation. The KHN and CLD were similar for samples cured using either photoactivation method. Use of a hydrophobic resin prior to placement of fissure sealants and curing the sealant using the soft-start method may not provide any positive influence on integrity or crosslink density.

Linear polymerization shrinkage (LPS), flexural strength (FS) and modulus of elasticity (ME) of low-viscosity resin composites (Admira Flow™, Grandio Flow™/VOCO; Filtek Z350 Flow™/3M ESPE; Tetric Flow™/Ivoclar-Vivadent) was evaluated using a well-established conventional micro-hybrid composite as a standard (Filtek Z250™/3M ESPE). For the measurement of LPS, composites were applied to a cylindrical metallic mould and polymerized (n = 8). The gap formed at the resin/mould interface was observed using SEM (1500×). For FS and ME, specimens were prepared according to the ISO 4049 specifications (n = 10). Statistical analysis of the data was performed with one-way ANOVA and the Tukey test. The conventional resin presented significantly lower LPS associated with high FS and ME, but only the ME values of the conventional resin differed significantly from the low-viscosity composites. The relationship between ME and LPS of low-viscosity resin composites when used as restorative material is a critical factor in contraction stress relief and marginal leakage.

Linear polymerization shrinkage (LPS), flexural strength (FS) and modulus of elasticity (ME) of 7 dental composites (Filtek Z350™, Filtek Z250™/3M ESPE; Grandio™, Polofil Supra™/VOCO; TPH Spectrum™, TPH3™, Esthet-X™/Denstply) were measured. For the measurement of LPS, composites were applied to a cylindrical metallic mold and polymerized (n = 8). The gap formed at the resin/mold interface was observed using scanning electron microscopy (1500×). For FS and ME, specimens were prepared according to the ISO 4049 specifications (n = 10). Statistical analysis of the data was performed with one-way ANOVA and the Tukey test. TPH Spectrum presented significantly higher LPS values (29.45 µm). Grandio had significantly higher mean values for FS (141.07 MPa) and ME (13.91 GPa). The relationship between modulus of elasticity and polymerization shrinkage is the main challenge for maintenance of the adhesive interface, thus composites presenting high shrinkage values, associated with a high modulus of elasticity tend to disrupt the adhesive interface under polymerization.

This study investigated the alteration of surface roughness of the nanofill composite Filtek Z350 3M/ESPE®, caused by simulated brushing associated with the use of mouthrinses with or without alcohol. Sixty specimens were prepared and distributed into six groups: distilled water, ethylic alcohol, Listerine® Vanilla Mint, Plax® without alcohol, Oral B® without alcohol and a control group. Each group was submitted to two intercalary 5,000 simulated brushing cycles. At the end of each cycle, the specimens were washed in tap water and immersed for two cycles of six hours equivalent to one year of daily use of the solution for 2 minutes. It was possible to verify significant alteration in surface roughness of the composite influenced by ethylic alcohol. It was not significant for distilled water and the mouthrinses.