Abstract The present in vitro study evaluated the effect of titanium dioxide nanotubes (nTiO2) incorporated into glass ionomer cement (GIC) on the growth and viability of Lactobacillus acidophilus (L. acidophilus). GIC (Ketac Molar EasyMix® = KM) was added to concentrations of 0%, 3%, 5%, 7% by weight of nTiO2 (20 nm in size). L. acidophilus strains (1x108 CFU/mL) were cultivated on GIC discs with or without the addition of nTiO2 for 1, 3 and 7 days, and the following parameters were evaluated: inhibition zone (mm) (n = 6); cell viability (Live/Dead) (n = 6); cell morphology (SEM) (15 KV, 2000X, n = 3). The data were submitted to ANOVA and the Tukey and Dunnett tests (α = 0.05). Regarding the agar diffusion test, there was no difference between GIC and the groups containing nTiO2 (p > 0.05). As for bacterial viability, the percentage of viable bacteria was lower for GIC+7% nTiO2 (p ≤ 0.05). There was no difference in the percentage of non-viable bacteria (p > 0.05). In addition, the morphology of L. acidophilus did not change in the presence of nTiO2. It can be concluded that the incorporation of titanium dioxide nanotubes into GIC, particularly at 5%, reduced L. acidophilus viability, and might hence interfere negatively with the initial colonization process of the bacterial biofilm.

Abstract This study aimed to assess the clinicopathological characteristics of medication-related osteonecrosis of the jaw (MRONJ), addressing histopathological features and bone structure. Twenty-two MRONJ patients were retrospectively evaluated for osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines. Specific staining and fluorescence and polarized light microscopy assessments were also performed. The mandible was significantly more affected by MRONJ. There was a predominance of African-Brazilian women aged sixty and older. Osteomyelitis was present in 82% of patients. Actinomycosis was observed in 36.4% of MRONJ patients. Osteoclasts were absent in MRONJ but bone resorption was often seen. Basophilic lines were observed in more than 80% of the patients. The MRONJ patients exhibited lamellar bone with osteon-like structures. This study provided important insight into MRONJ, demonstrating a diverse histopathological spectrum and infection with Actinomyces and fungi. The condition was characterized by a necrotized lamellar bone structure and more frequently affected the mandible of older women.

Abstract This study aimed to analyze the factors associated with the perception among Brazilian dentists of the preventive or therapeutic use of sealants on permanent molars. A cross-sectional web-based survey was conducted with Brazilian dentists between July and October 2021 to examine their use of social media and gather data regarding sealant-related practices. A structured questionnaire was developed and applied to collect information on participants’ professional profiles, clinical indications, materials, techniques, and perceptions of pit and fissure sealants. The study outcomes were the positive perception of sealant use as: (a) a preventive measure, or (b) a therapeutic approach to carious lesions. Responses were dichotomized into positive perception (“strongly agree” or “agree”) and negative perception (“neither agree nor disagree,” “disagree” or “strongly disagree”). Independent variables included sociodemographic, educational, professional, and technical characteristics. Multiple logistic regression models were used to analyze associations (p < 0.05). A total of 2,394 dentists participated in the study, 82.5% of whom had a positive perception of sealants for prevention, and 83.1%, for therapeutic purposes. A greater likelihood of positive perception of preventive sealant use was observed among educators, those employed in public health services, dentists who “always” performed sealant application, and those who used resin sealant, glass ionomer cement, or flowable resin. Conversely, professionals working in capital cities had a lower likelihood of a positive perception. Professionals from cities with populations exceeding 500,000 inhabitants, interior areas, or metropolitan regions were less likely to have a positive perception of therapeutic sealant use. However, those who used resin sealants, glass ionomer cement, or flowable resin were more likely to perceive sealants positively. In conclusion, the positive perception of sealant use for prevention was associated with educational, professional, and technical factors, whereas the positive perception of therapeutic use was associated with professional and technical factors.

Abstract The aim of this ex vivo study was to evaluate the efficacy of the Reciproc, Hyflex CM, and ProDesign Duo Hybrid in the retreatment of mesial root canals with Vertucci Type 4 of mandibular molars with curvatures between 10 and 20 degrees. Forty-five mesial roots of mandibular molars were prepared up to size 25.06 Nickel-Titanium (NiTi) file and filled by the single cone technique. The roots were then divided into 3 groups according to retreatment procedures: Reciproc R25 followed by R40; Hyflex 25.04 followed by 40.04; ProDesign Duo Hybrid 25.06 followed by 40.05. The canals were irrigated with 1 mL 1% sodium hypochlorite, and a final rinse was performed with 5 mL 17% EDTA for 3 minutes. Microcomputed tomography scans were performed in each step of the procedure to evaluate root canal transportation at distances of 2, 4, 6, 8 and 10 mm from the apex and volume of endodontic filling remaining at segments of 1–3, 3–5, and 5–7 mm from the apex. The filling material that was not removed during retreatment was evaluated by confocal laser scanning and the percentage after each procedure was expressed in terms of percentage of the initial root-filling material volume. The time taken to remove the material and re-instrumentation was measured in seconds with a digital chronometer. Statistical analysis was performed with t-paired, ANOVA, Kruskal-Wallis and Friedman tests (p < 0.05). In all groups, sections at 4, 6, 8, and 10 mm from the apex were transported to the danger zone, towards the furcation. However, the section at 2 mm from the apex was transported in opposite direction to the furcation, but no statistically significant differences (p > 0.05) in canal transportation and filling material removal were found between the 3 groups. Filling removal and re-instrumentation took significantly (p < 0.05) less time in the Reciproc group. None of the retreatment techniques completely removed the root fillings. The results suggest that no difference exists between the groups in apical transportation of curved canals. The Reciproc system took less time for filling removal and re-instrumentation and the combination of reciprocating and rotary files in the retreatment of curved canals was as efficient as rotary and reciprocating motion.

Abstract Environmental and systemic factors play a role in the development of hypomineralization characterized by demarcated opacities. This study aimed to investigate the prevalence, distribution, severity, and etiologic factors associated with hypomineralization in all primary teeth, hypomineralized second primary molars (HSPM) and evaluate its association with Molar Incisor Hypomineralization (MIH). A sample of 2,102 male and female Brazilian children aged 3 to 10 years exhibiting good general health was examined by 30 calibrated dentists using WHO probes and clinical mirrors, using the index proposed by Ghanim et al. Data were collected through clinical examinations and a questionnaire answered by mothers, addressing sociodemographic and prenatal, perinatal, and postnatal factors. Prevalence was assessed by calculating frequency, whereas etiologic factors were evaluated using univariate and multivariate Poisson logistic regression with robust adjustment. In addition, multivariate analysis was conducted using nonparametric resampling with Jacknife adjustment. The overall prevalence of hypomineralization in primary teeth was 18.5%, with second molars affected in 17% and canines in 6.7% of the cases, while other teeth were affected at lower rates. Exclusive breastfeeding for six months showed a protective effect against hypomineralization (p = 0.40). Children with HSPM were five times more likely to develop MIH, regardless of sex (OR: 4.92). Furthermore, lower family income increased the likelihood of MIH. In conclusion, hypomineralization in primary teeth is prevalent, exclusive breastfeeding for six months is associated with a lower prevalence of enamel defects, and children with primary dentition defects are at greater risk for similar conditions in their permanent teeth.

Abstract This study evaluated the influence of socioeconomic factors, caregiver characteristics, and early feeding practices on sugar consumption frequency (FSC) during early childhood. Data were collected from dental records of children aged 1 to 5 years old, who were attended at CliBin®, including sex, age, skin color, income level, mother’s age and years of education, primary caregiver, prior instructions on caries prevention, type of early feeding practices (breastfeeding/formula/mixed), exclusive breastfeeding (EB) up to 6 months, children’s dental care and their consumption of sugar-sweetened beverages (SSB) and cookies/sugar (CS), with frequency classified as: never (2 points), ≤ 3 times/day (1 point) and > 3 times/day (0 points). The lower the median score the higher the FSC. Descriptive analysis, Kruskal-Wallis test, and ANOVA were applied considering p < 0.05. A total of 123 records were included. The children were predominantly male (56.1%), and brown (46.5%), with an average age of 2.1 (± 0.9) years. The mother was the primary caregiver (86.1%), with ≤ 30 years of age (52.0%), < 12 years of education (75.2%), and previously instructed on caries prevention (58.2%). Most children were breastfed (45.5%) for 23.2 (±9.7) months on average, received EB (87.1%), consumed SSB (87.6%) and CS (90.9%) 3 times/day. The total FSC mean score was 1.6 ± 0.9 (95%CI: 1.4–1.7). Children of younger mothers (≤ 30 years) had the lowest FSC scores (1.4 ± 0.9; 95%CI: 1.0–1.6; p=0.01). It was observed that among the factors studied, only mothers in the younger age range influenced high sugar consumption during early childhood.

Abstract Head and neck radiotherapy quantitatively and qualitatively compromises salivary flow, and salivary substitutes have the potential to alleviate the symptoms. This study aims to assess the effectiveness of two salivary substitutes in relieving symptoms of radiotherapy-induced xerostomia through a double-blind randomized controlled trial. Twenty-four patients were selected from a dental oncology clinic and randomly assigned to the over-the-counter or compounded mouthwash group. Each patient was instructed to rinse their oral cavity with the assigned solution three times a day for 30 days. Both participants and researchers were blinded to the product used during the trial. The impact of xerostomia was assessed using a numerical rating scale and validated questionnaires on oral health-related quality of life and xerostomia, administered before and after the intervention and subsequently compared. Both groups exhibited a statistically significant reduction in xerostomia symptoms. The studied salivary substitutes produced transient beneficial effects on complaints of radiotherapy-induced xerostomia.

Abstract This study aims to evaluate the mechanical properties of 3D printing resins for occlusal splints (OS) under different preservation conditions based on sleep duration. The study factors (n = 10) included material types: PriZma 3D Bio Splint (PZ), Cosmos Splint (CS), NightGuard Firm (NGF), and self-polymerizing acrylic resin (control group - CG); preservation: artificial saliva (S), natural water (W), 0.12% chlorhexidine (C), and Corega tabs (CTs); and evaluation times: T0 (24 h after fabrication) and 30 d after exposure. Further, the surface roughness (Ra), Knoop microhardness (KH), three-point flexural strength (FS), and flexural modulus (FM) were analyzed. In terms of the time and material, Tukey’s test revealed no significant differences in Ra between the groups at 24 h. After 30 d, PZ showed significantly lower values than the other groups (p < 0.05). For the KH, NGF was significantly higher than that in all groups at 24 h (p < 0.05); after 30 d, the NGF decreased in W and C (p < 0.05), and the NGF and PZ exhibited elevated values in S and CT, respectively. The Kruskal–Wallis test and multiple comparisons showed that the PZ had a higher value at 24 h (p < 0.05). Post 30 d, all 3D-printing resins increased values in CT and S (p < 0.05), and the PZ decreased in the C and W (P < 0.05). Finally, the FM increased under all conditions. The preservation of S and CT partially enhanced the mechanical properties of the OS.

Abstract Social networks consist of a group of individuals connected by family, work, or other interests and facilitated by an online structure or platform. They are also a relatively recent and widely used marketing phenomenon that is constantly evolving. The healthcare field includes professions such as social work, biology, biomedicine, physical education, nursing, pharmacy, physiotherapy, speech therapy, medicine, veterinary medicine, nutrition, dentistry, psychology, and occupational therapy. The present study aimed to analyze the influence of social networks in the process of finding and selecting healthcare professionals. The methodology was a survey using a structured questionnaire created on Google Forms. Descriptive research was carried out with non-probabilistic convenience and snowball sampling, followed by quantitative data analysis. A total of 268 participants who signed the informed consent were included in the study. The findings revealed that the most common way to find healthcare professionals is through recommendations from friends/relatives and other professionals, followed by the use of social networks. The majority of participants used social networks to search for healthcare professionals, with Instagram being the most widely used platform. Sponsored advertisements can be an effective way to reach potential new patients. The most valued characteristics in healthcare content creators were reliability, expertise, and the ability to convey messages, with health-related explanations in an easily understandable manner being the preferred type of content. Therefore, this study revealed that social networks can influence the search for and selection of healthcare professionals.

Abstract The aim of this study was to compare the esthetic, functional, and psychosocial impact of mandibular crowding and maxillary midline diastema in black adolescents. A cross-sectional study was conducted with 420 black (brown and black, distinguished according to Brazilian Institute of Geography and Statistics – IBGE) adolescents aged 12 with normal occlusal relationships. Esthetic (OASIS) and functional/psychosocial (OHIP-14) impact related to the need for orthodontic treatment in groups with mandibular crowding and maxillary midline diastema, and those without these conditions: G1, without crowding and diastema (n 113); G2, without crowding and with diastema (n 67); G3, with crowding and without diastema (n 202); and G4, diastema, and crowding (n 38) were evaluated. Generalized linear models were estimated for the effects of diastema, crowding, and the interaction between them, with a significance level of 5%. There was no significant influence of crowding and diastema on the OHIP-14 (p>0.05). However, the groups with diastema had higher OASIS scores, irrespective of crowding (p<0.05). The maxillary midline diastema influenced the esthetic perception of black adolescents.

Abstract This study evaluated the microtensile bond strength (μTBS) and fracture pattern of direct composite resin reinforced with polyethylene fiber (Ribbond®) on dentin substrate after thermomechanical cycling (TMC). Dentin blocks (dentin thickness=2 mm) were obtained from forty human third molars and randomly divided into four groups (n=10) according to type of restoration (composite resin with or without Ribbond®) and to whether they were or were not subjected to TMC (100,000 cycles of 50 N / 2 Hz / 1-minute baths of 5 and 55ºC). The 1-mm-thick square-shaped specimens were submitted to μTBS testing in a universal testing machine at 0.5 mm/min. The fracture patterns were assessed by stereoscopic magnifying glass (30X magnification). The μTBS (in MPa) and failure pattern data were subjected to the generalized linear model and G tests (a=0.05). Neither the polyethylene fiber nor TMC had any statistically significant effect (p=0.196 and p=0.136, respectively) on the μTBS of the composite resin to dentin. Adhesive failures were more prevalent in the composite resin group compared with the Ribbond-containing group when subjected to TMC. Additionally, the composite resin containing Ribbond® showed a higher proportion of cohesive failures in composite resin than the resin groups not containing this fiber, irrespective of TMC. It was concluded that reinforcing the direct layer of composite resin with Ribbond® polyethylene fiber did not influence the adhesive resistance to dentin, even when subjected to TMC. However, its incorporation did result in a higher frequency of cohesive failures in resin after TMC.

Abstract The aim of this study was to assess the impact of orthodontic treatment with orthodontic aligners (OAs) and fixed appliances (FAs) on oral health-related quality of life (OHRQoL). This parallel randomized clinical trial included 40 male and female patients aged 13 to 35 years diagnosed with Angle’s Class I malocclusion. Participants were assigned to two groups: OA (n = 20) and FA (n = 20). OHRQoL was assessed using the Brazilian OHIP-14, which was administered before treatment (T0), at 1 month (T1), 6 months (T2), and 12 months (T3) after treatment initiation. Data were analyzed using the independent t test, the chi-square test, the Mann-Whitney test, and Friedman test (p < 0.05). FAs had a significantly (p < 0.05) higher impact on OHRQoL at T1 in terms of functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and overall score. Within-group comparison showed higher scores for the FA group in comparison to the OA group. Functional limitation scores were higher at T1 than at T0 (p = 0.034), while physical pain scores were higher at T1 compared to T0 (p = 0.034) and T2 (p = 0.010). Psychological discomfort scores were higher at T1 than at T2 (p = 0.015). Physical disability scores were higher at T1 compared to T0 (p = 0.008). Overall scores were higher at T1 than at T2 (p = 0.003). No significant changes were observed in the OA within-group comparison. Patients treated with OAs had less impact on OHRQoL compared to those treated with FAs in the first month. There was no difference between the groups at the 6-month follow-up.

Abstract The objective of this study was to evaluate the occlusion potential of in-office desensitizing agents, and characterize the human dentin elements after acid exposure. Twelve human dentin discs were sectioned into four specimens each, and randomized into treatments (n = 20): no treatment (negative control); no treatment and 6% citric acid exposure (positive control); application of Gluma desensitizer (Heraeus Kulzer) or PRG Barrier Coat (Shofu), followed by 6% citric acid exposure. Occlusion and dentin surface characteristics were determined by scanning electron microscopy (SEM, n = 10), and elemental composition (at%), by energy-dispersive X-ray spectroscopy (EDS, n = 10). Three calibrated, blinded evaluators used SEM to categorize the occlusion potential: 1 = occluded, 2 = partially unoccluded, 3 = equally occluded/unoccluded, 4 = partially occluded, 5 = unoccluded. Data were analyzed by weighted kappa, Friedman, and Nemenyi tests (α = 0.05). For SEM, mean occlusion scores were higher for the PRG Barrier Coat than the positive control (p = 0.0235). Most specimens in the controls scored 4 or 5. The most frequent scores for PRG Barrier Coat were 1(60%) and 2(20%), while 30% of Gluma specimens scored 1 and 2. Gluma showed intratubular precipitation, while PRG Barrier Coat covered dentinal tubules totally or partially. For EDS, the K% was lower for Gluma than the negative control (p = 0.0046), with Si peaks in dentin treated with PRG Barrier Coat. The bioactive in-office desensitizing agent with S-PRG filler (PRG Barrier Coat) promoted dentin tubule occlusion, and persisted after exposure to acid.

Abstract This study carried out a critical review of the principles of radioprotection, including the ALARA, ALADA, and ALADAIP principles. The Google Scholar and PubMed databases were the search resources, and the following keywords were searched: Linear No-Threshold (LNT); Biologic Effects of Ionizing Radiation (BEIR VII); As Low As Reasonably Achievable (ALARA); As Low As Diagnostically Acceptable (ALADA); As Low As Diagnostically Acceptable, being Indication-oriented and Patient-specific (ALADAIP). This critical review included studies with historical references, reviews, position papers, and clinical and experimental studies. Regarding data extraction, only original articles were selected after the screening process. Much of the current evolution of X-ray machines and radioprotection protocols has stemmed from legitimate concerns about this topic. This development has grown out of the relevant work of organizations like ICRP, UNSCEAR, and other renowned international organizations. Low doses of radiation, such as those used for diagnosis, also occur naturally and are present in everyday life. Although there is no agreement on the actual risk involving low doses, the recommendations of ALARA, ALADA, and ALADAIP prevail, in line with the trend to uphold principles that balance the importance of X-ray diagnostic imaging with the intention of keeping the doses as low as possible. The benefits of X-ray exams, when justified, tend to outweigh the low risks attributed to them.

Abstract This study aim was to evaluate the need for orthodontic treatment of mixed to permanent dentition using the Dental Aesthetic Index (DAI) in a 4-year follow-up. A longitudinal study was conducted with 353 children in the stages from mixed (T1) to permanent (T2) dentition. The need for orthodontic treatment was assessed using the DAI categorized into: DAI 1 (absence of malocclusion and orthodontic treatment need; DAI ≤ 25); DAI 2 (malocclusion is defined and elective orthodontic treatment is needed; DAI = 26 to 30); DAI 3 (severe malocclusion and a desirable orthodontic treatment need; DAI = 31 to 35) and DAI 4 (severe malocclusion and a mandatory orthodontic treatment need; DAI ≥ 36). The Bowker symmetry test was used to determine agreement in the categorization of DAI at T1 and T2, with a significance level of 5%. The results showed a significant disagreement in the need for orthodontic treatment between T1 and T2 (p<0.05). In 34.6% of children evaluated in T1, the same need for orthodontic treatment was maintained in T2. According to the DAI, in 60.8% of the children, the need decreased, and in 39.2% their need for orthodontic treatment increased. This preliminary longitudinal study using DAI, showed a decrease in malocclusion and need for orthodontic treatment as the dentition transitioned from mixed to permanent occurred. This finding has valuable implications for epidemiological data in orthodontics.