Abstract This study aimed to evaluate the effect of an elastomeric urethane monomer (Exothane-24) in different concentrations on physicochemical properties, gap formation, and polymerization shrinkage stress of experimental resin composites. All experimental composites were prepared with 50 wt.% of Bis-GMA and 50 wt.% of TEGDMA, to which 0 wt.% (control), 10 wt.%, 20 wt.%, 30 wt.%, and 40 wt.% of Exothane-24 were added. Filler particles (65 wt.%) were then added to these resin matrixes. Ultimate tensile strength (UTS: n = 10), flexural strength (FS: n = 10), flexural modulus (FM: n = 10), hardness (H: n = 10), hardness reduction (HR: n = 10), degree of conversion (DC: n = 5), gap width (GW: n = 10), and polymerization shrinkage stress in Class I (SS-I: n = 10) and Class II (SS-II: n = 10) simulated configuration. All test data were analyzed using one-way ANOVA and Tukey’s test (α = 0.05; β= 0.2). Exothane-24 in all concentrations decreased the H, HR, DC, GW, SS-I, and SS-II (p < 0.05) without affecting the UTS, and FS (p > 0.05). Reduction in FM was observed only in the Exothane 40% and 30% groups compared to the control (p < 0.05). Exothane-24 at concentrations 20% and 30% seems suitable since it reduced GW and polymerization SS without affecting the properties of the composite resins tested, except for H.

Resumo Este estudo teve como objetivo avaliar o efeito de um monômero elastomérico de uretano (Exothane-24) em diferentes concentrações em propriedades físico-químicas, formação de fenda e tensão de contração de polimerização de resinas compostas experimentais. Todos os compósitos experimentais foram preparados com 50% em peso de Bis-GMA e 50% em peso de TEGDMA, nos quais 0% (controle), 10%, 20%, 30% e 40% em peso de Exothane-24 foram adicionados. Partículas de carga (65% em peso) foram então adicionadas as matrizes resinosas. Resistência coesiva (RC: n = 10), resistência à flexão (RF: n = 10), módulo de flexão (MF: n = 10), dureza (D: n = 10), redução de dureza (RD: n = 10), grau de conversão (GC: n = 5), largura de fenda (LF: n = 10) e tensão de contração de polimerização em simulações de cavidades Classe I (TC-I: n = 10) e Classe II (TC-II: n = 10). Todos os dados do teste foram analisados usando one-way ANOVA e teste de Tukey (α = 0,05; β = 0,2). O Exothane-24 em todas as concentrações diminuiu a D, RD, GC, LF, TC-I e TC-II (p < 0,05) sem afetar o RC e RF (p > 0,05). A redução da MF foi observada apenas nos grupos Exothane 40% e 30% em relação ao controle (p < 0,05). O Exothane-24 nas concentrações de 20% e 30% pareceu ser adequado, pois reduziu LF e TC de polimerização sem afetar as propriedades das resinas compostas testadas, exceto para D.

Abstract The objective of this study was to observe patients’ satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients’ to clinicians’ frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients’ most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients’ satisfaction and dissatisfaction rates to clinicians’ evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients’ opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients’ evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Resumo O objetivo deste estudo foi observar a satisfação dos pacientes com suas restaurações dentárias anteriores diretas e compará-las com a avaliação clínica do dentista usando os critérios FDI (Federation Dental International). Os pacientes pontuaram suas restaurações dentárias (n=106) anteriores em relação à satisfação (satisfatória / insatisfatória). Quando insatisfatória, ele foi entrevistado sobre a queixa. Na mesma sessão, as restaurações dentárias foram avaliadas clinicamente por dois dentistas utilizando os critérios FDI (escore 1-5) quanto aos aspectos estéticos, funcionais e biológicos. Estatística descritiva foi usada para frequências de escores atribuídos por pacientes e clínicos. Para comparar as frequências dos pacientes e dos clínicos, foi aplicado o teste Qui-quadrado (p ≤ 0,05). Os pacientes relataram suas restaurações como 52,8% satisfatórias e 47,8% insatisfatórias. Os clínicos reportaram as mesmas restaurações, 82,3% satisfatória e 17,6% insatisfatória. As queixas mais frequentes dos pacientes referiam-se à cor, seguida da forma anatômica, fratura e retenção do material e forma anatômica proximal. Comparando os índices de satisfação e insatisfação dos pacientes com os clínicos, não houve diferença em relação à estética. A frequência de restaurações insatisfatórias por dentistas foi significativamente menor quando as propriedades funcionais e biológicas foram comparadas com as opiniões dos pacientes. As restaurações foram mais frequentemente relatadas como satisfatórias pelos pacientes, sendo as principais queixas relacionadas a questões estéticas. Quando as avaliações dos clínicos e dos pacientes foram comparadas, observou-se que as frequências de restaurações satisfatórias por pacientes e clínicos foram semelhantes em relação às propriedades estéticas e significativamente diferentes em relação às propriedades funcionais e biológicas.

Resumo O objetivo deste estudo foi avaliar o efeito da lei de reciprocidade de um diodo emissor de luz (LED) multi-wave na transmitância de luz (LT), profundidade de cura (DOC) e grau de conversão em profundidade (DC) de um compósito bulk fill. Material e Métodos: Um compósito bulk fill (EvoCeram®, Ivoclar Vivadent) foi fotoativado utilizando um LED multi-wave (VALO ™ Cordless, Ultradent). O LED foi previamente caracterizado usando um espectrofotômetro para padronizar o tempo de exposição utilizando os modos Standard ou Xtra-Power com a mesma dose de energia de 20 J/cm 2. A LT foi avaliada através de amostras do compósito bulk fill a cada milímetro até 4 mm de profundidade. O DOC foi avaliado de acordo com a ISO 4049. O DC foi realizado em forma de mapeamento da seção transversal longitudinal central de cada amostra do teste de DOC utilizando microscopia FT-NIR. Os dados foram analisados estatisticamente de acordo com o delineamento experimental (α=0,05; ß=0,2). A exposição radiante na faixa de comprimento de onda violeta para os modos Standard e Xtra-Power foi de 4,5 e 5,0 J/cm2, respectivamente; e para a faixa de comprimento de onda azul, a exposição radiante para os modos Standard e Xtra-Power foi de 15,5 e 15,0 J/cm2, respectivamente. Não houve diferença estatística no DOC utilizando os modos de fotopolimerização Standard ou Xtra-Power, mas o DOC foi menor do que o reivindicado pelo fabricante (4 mm). O DC não foi afetado significativamente pelo modo de fotopolimerização até 4 mm de profundidade (p>0,05). De acordo com a lei de reciprocidade da exposição, a redução no tempo de exposição utilizando a mesma exposição radiante não afetou a profundidade de cura do compósito bulk fill.

Abstract The objective of this study was to evaluate the effect of the exposure reciprocity law of a multi-wave light-emitting diode (LED) on the light transmittance (LT), depth of cure (DOC) and degree of conversion in-depth (DC) of a bulk fill composite. A bulk fill composite (EvoCeram® bulk fill, Ivoclar Vivadent) was photoactivated using the multi-wave LED (VALO™ Cordless, Ultradent). The LED was previously characterized using a spectrophotometer to standardize the time of exposure when using the Standard or Xtra-Power modes with the same radiant exposure of 20J/cm2. LT was evaluated through samples of the bulk fill composite every millimeter till 4 mm in-depth. DOC was evaluated according to the ISO 4049. DC of the central longitudinal cross-section from each sample of the DOC test was mapped using FT-NIR microscopy. Data were statistically analyzed according to the experimental design (α=0.05; ß=0.2). The radiant exposure in the violet wavelength range for Standard and Xtra-Power was 4.5 and 5.0 J/cm2, respectively; for the blue wavelength range the radiant exposure for Standard and Xtra-Power was 15.5 and 15.0 J/cm2, respectively. There was no statistical difference in the DOC using Standard or Xtra-Power light-curing modes, but the DOC was lower than the claimed by the manufacturer (4 mm). The DC was not significantly affected by the light-curing mode up to 4 mm in depth (p>0.05). According to exposure reciprocity law, the reduction in exposure time using the same radiant exposure did not affect the depth of cure of the bulk fill composite.

Abstract This systematic review assessed the literature to evaluate the efficiency of polymerization of bulk-fill composite resins at 4 mm restoration depth. PubMed, Cochrane, Scopus and Web of Science databases were searched with no restrictions on year, publication status, or article’s language. Selection criteria included studies that evaluated bulk-fill composite resin when inserted in a minimum thickness of 4 mm, followed by curing according to the manufacturers’ instructions; presented sound statistical data; and comparison with a control group and/or a reference measurement of quality of polymerization. The evidence level was evaluated by qualitative scoring system and classified as high-, moderate- and low- evidence level. A total of 534 articles were retrieved in the initial search. After the review process, only 10 full-text articles met the inclusion criteria. Most articles included (80%) were classified as high evidence level. Among several techniques, microhardness was the most frequently method performed by the studies included in this systematic review. Irrespective to the “in vitro” method performed, bulk fill RBCs were partially likely to fulfill the important requirement regarding properly curing in 4 mm of cavity depth measured by depth of cure and / or degree of conversion. In general, low viscosities BFCs performed better regarding polymerization efficiency compared to the high viscosities BFCs.

Resumo O objetivo deste estudo foi avaliar a resistência de união à microtração (µTBS) de sistemas adesivos auto-condicionantes e convencionais comparados por entre diferentes regiões dentinárias (central-DC ou proximal-DP) em um preparo cavitário classe II. Um preparo cavitário classe II (mesio-ocluso-distal) foi simulado em 20 terceiros molares humanos (4 mm largura/3 mm profundidade). Adesivos convencionais (Scotchbond Multi Purpose, n=5, SBMP e Optibond FL, n=5, OPFL) e adesivos auto-condicionantes (Clearfil SE Bond, n=5, CSE e Optibond XTR, n=5, OPXTR foram aplicados. As restaurações classe II foram realizadas usando a técnica incremental e fotoativadas (Bluephase/G2). As amostras foram seccionadas em forma de palito (1 mm2 secção transversal), posicionadas no dispositivo de Geraldeli para o teste µTBS (velocidade transversal de 0,5 mm/min). O padrão de fratura foi analisado em estereoscópio e classificado em coesivo-resina, adesivo, misto/resina, misto/dentina. Amostras (n=4) foram preparadas para observação em microscópio eletrônico de varredura. Os dados foram submetidos a ANOVA um fator e teste de Turkey (α=0,05). Não houve diferença estatística significante entre SBMP, OPFL, CSE, e OPXTR em DC (p>0,05). Entretanto, para SBMP e OPFL em DP, valores µTBS foram significativamente menores comparados com CSE e OPXTR (p<0,05). Em todos os grupos, o padrão de fratura misto foi o mais frequentemente observado, exceto em SBMP/CD (adesivo). Em um preparo classe II, a localização da DP influenciou negativamente a resistência de união de sistemas adesivos convencionais. Oposto aos adesivos auto-condicionantes, que em DP apresentaram valores de resistência de união maiores comparados com adesivos convencionais.

Abstract The aim of this study was to evaluate microtensile bond strength (µTBS) of self-etch and etch-and-rinse adhesives systems compared in different dentin regions (central-CD or proximal-PD) in a class II cavity configuration. A class II (mesial-oclusal-distal) cavity configuration was simulated on 20 extracted human third-molars (4 mm wide/3 mm deep). Etch-and-rinse adhesive (Scotchbond Multi Purpose, n=5, SBMP and Optibond FL, n=5, OPFL) and self-etch adhesives (Clearfil SE Bond, n=5, CSE and Optibond XTR, n=5, OPXTR) were applied. Class II restorations were performed by incremental technique and photo-activated (Bluephase/G2). Samples were sectioned to beam shape (1 mm² cross-section), placed on Geraldeli’s device for µTBS test (0.5 mm/min cross-head speed). Fracture patterns were analyzed on stereomicroscope and classified as cohesive-resin, adhesive, mixed/resin or mixed/dentin. Samples (n=4) were prepared for scanning electron microscope observation. Data were submitted to one-way ANOVA with Split-Plot arrangement and Tukey’s test (α=0.05). There were no statistically significant differences among SBMP, OPFL, CSE and OPXTR on CD (p>0.05). However, on PD for SBMP and OPFL, µTBS values were significantly lower compared to CSE and OPXTR (p<0.05). In all groups, mixed failure pattern was more frequently observed, except for SBMP/CD (adhesive). In class II type cavity configuration, PD location negatively influenced bond strength of etch-and-rinse adhesive systems. Opposite to self-etching adhesives, which presented higher bond strength values compared to etch-and-rinse adhesives in PD.

Abstract The effect of restoration depth on the curing time of a conventional and two bulk-fill composite resins by measuring microhardness and the respective radiosity of the bottom surface of the specimen was investigated. 1-, 3- and 5-mm thick washers were filled with Surefil SDR Flow–U (SDR), Tetric EvoCeram Bulk Fill-IVA (TEC) or Esthet-X HD–B1 (EHD), and cured with Bluephase® G2 for 40s. Additional 1-mm washers were filled with SDR, TEC or EHD, placed above the light sensor of MARC®, stacked with pre-cured 1-, 3- or 5-mm washer of respective material, and cured for 2.5~60s to mimic 2-, 4- and 6-mm thick composite curing. The sensor measured the radiosity (EB) at the bottom of specimen stacks. Vickers hardness (VH) was measured immediately at 5 locations with triplicate specimens. Nonlinear regression of VH vs EB by VH=α[1-exp(-EB/β)] with all thickness shows that the values of α, maximum hardness, are 21.6±1.0 kg/mm2 for SDR, 38.3±0.6 kg/mm2 for TEC and 45.3±2.6 kg/mm2 for EHD, and the values of β, rate parameter, are 0.40±0.06 J/cm2 for SDR, 0.77±0.04 J/cm2 for TEC and 0.58±0.09 J/cm2 for EHD. The radiosity of the bottom surface was calculated when the bottom surface of each material attained 80% of α of each material. The curing times for each material are in agreement with manufacturer recommendation for thickness. It is possible to estimate time needed to cure composite resin of known depth adequately by the radiosity and microhardness of the bottom surface.