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BACKGROUND: Students´ assessment should be carried out in an effective and objective manner, which reduces the possibility of different evaluators giving different scores, thus influencing the qualification obtained and the consistency of education. The aim of the present study was to determine the agreement among four evaluators and compare the overall scores awarded when assessing portfolios of endodontic preclinical treatments performed by dental students by using an analytic rubric and a numeric rating scale. METHODS: A random sample of 42 portfolios performed by fourth-year dental students at preclinical endodontic practices were blindly assessed by four evaluators using two different evaluation methods: an analytic rubric specifically designed and a numeric rating scale. Six categories were analyzed: radiographic assessment, access preparation, shaping procedure, obturation, content of the portfolio, and presentation of the portfolio. The maximum global score was 10 points. The overall scores obtained with both methods from each evaluator were compared by Student's t, while agreement among evaluators was measured by Intraclass correlation coefficients (ICC). The influence of the difficulty of the endodontic treatment on the evaluators´ scores was analyzed by one-way ANOVA. Statistical tests were performed at a pre-set alpha of 0.05 using Stata 16. RESULTS: Difficulty of canal treatment did not influence the scores of evaluators, irrespective of the evaluation method used. When the analytic rubric was used, inter-evaluator agreement was substantial for radiographic assessment, access preparation, shaping procedure, obturation, and overall scores. Inter-evaluator agreement ranged from moderate to fair with the numeric rating scale. Mean higher overall scores were achieved when numeric rating scale was used. Presentation and content of the portfolio showed slight and fair agreement, respectively, among evaluators, regardless the evaluation method applied. CONCLUSIONS: Assessment guided by an analytic rubric allowed evaluators to reach higher levels of agreement than those obtained when using a numeric rating scale. However, the rubric negatively affected overall scores.

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BACKGROUND: The first state of alarm due to COVID-19 in Spain led to limit dental treatment exclusively to emergencies. The objective of the survey was to evaluate the amount and type of emergencies attended during this period, as well as to know how they were solved, and what measures were adopted to carry out dental care in these exceptional circumstances. MATERIAL AND METHODS: This cross-sectional study included 312 Spanish dentists, who fulfilled an online questionnaire with 22 closed questions, divided into five sections regarding to various aspects of professional dental profile and emergency care. Descriptive statistic and Chi-square tests were performed (p<0.05). RESULTS: 75.64% of respondents attended emergencies in person only when required, being dental pain the main emergency (90.38%). Dental emergency care in person involved a prior telephone triage of the patient to identify possible COVID-19 symptoms, as well as protective measures implementation for both, the patient and the dentist, at dental office. CONCLUSIONS: The number of dental emergencies decreased during the state of alarm, being dental pain the main cause of dental assistance via telephone or in person. Triage of patients before scheduling an in-person appointment and protective measures implementation were common features in dental emergency care during the first state of alarm period. Key words:Dental emergencies, COVID-19, state of alarm, survey.

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The aim of this study was to analyse changes in radicular dentine composition after different irrigation regimes using attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR). Dentine slices from human single-root teeth were immersed in: (i) 5.25% sodium hypochlorite (NaOCl) for 1, 5 and 20 min; (ii) 17% EDTA for 1 min; and (iii) 5.25% NaOCl for 20 min, and 17% EDTA and 5.25% NaOCl, both for 1 min. Carbonate/mineral, Amide I/mineral and Amide III/CH2 ratios were determined using ATR-FTIR before and after immersion in the irrigation solutions tested. Results showed that 5.25% NaOCl significantly decreased carbonate/mineral, Amide I/mineral and Amide III/CH2 ratios (P < 0.05). Application of 17% EDTA produced no change in carbonate/mineral ratio (P = 0.120), while an increase in Amide I/mineral in apical third (P = 0.002) and Amide III/CH2 (P < 0.001) was observed. The combination of NaOCl, EDTA and NaOCl increased carbonate/mineral ratio in coronal third (P = 0.037), and Amide I/mineral (P = 0.003) and Amide III/CH2 (P = 0.001) ratios. In conclusion, irrigation solutions tested significantly affected radicular dentine composition.

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BACKGROUND: No specific indications about the pre-treatment of indirect composite restorations is provided by the manufacturers of most self-adhesive resin cements. The potential effect of silane treatment to the bond strength of the complete tooth/indirect restoration complex is not available.The aim of this study was to determine the contribution of different surface treatments on microtensile bond strength of composite overlays to dentin using several self-adhesive resin cements and a total-etch one. MATERIAL AND METHODS: Composite overlays were fabricated and bonding surfaces were airborne-particle abraded and randomly assigned to two different surface treatments: no treatment or silane application (RelyX Ceramic Primer) followed by an adhesive (Adper Scotchbond 1 XT). Composite overlays were luted to flat dentin surfaces using the following self-adhesive resin cements: RelyX Unicem, G-Cem, Speedcem, Maxcem Elite or Smartcem2, and the total-etch resin cement RelyX ARC. After 24 h, bonded specimens were cut into sticks 1 mm thick and stressed in tension until failure. Two-way ANOVA and SNK tests were applied at α=0.05. RESULTS: Bond strength values were significantly influenced by the resin cement used (p<0.001). However, composite surface treatment and the interaction between the resin cement applied and surface treatment did not significantly affect dentin bond strength (p>0.05). All self-adhesive resin cements showed lower bond strength values than the total-etch RelyX ARC. Among self-adhesive resin cements, RelyX Unicem and G-Cem attained statistically higher bond strength values. Smartcem2 and Maxcem Elite exhibited 80-90% of pre-test failures. CONCLUSIONS: The silane and adhesive application after indirect resin composite sandblasting did not improve the bond strength of dentin-composite overlay complex. Selection of the resin cement seems to be a more relevant factor when bonding indirect composites to dentin than its surface treatment. KEY WORDS: Bond strength, self-adhesive cement, silane, dentin, indirect composite.

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Activity of tigecycline against nosocomial secondary peritonitis isolates collected along 18 months in 29 Spanish hospitals was tested by Etest in a central laboratory, considering Food and Drug Administration (FDA)/British Society for Antimicrobial Chemotherapy (BSAC)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. A total of 600 facultative/aerobic isolates (392 Gram negative, 208 Gram positive) and 100 anaerobes were tested. None of the 220 Escherichia coli isolates was resistant to tigecycline (MIC(50)/MIC(90) = 0.25/0.5 microg/mL), with 0.5% (FDA breakpoint) and 3.6% (BSAC/EUCAST breakpoint) intermediate strains. All Extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (15 strains), all Klebsiella pneumoniae, and Klebsiella oxytoca isolates (42 strains) were susceptible to tigecycline. No isolates resistant to tigecycline were found among Streptococcus viridans, Staphylococcus aureus, and Enterococcus faecium, but 18.9% of Enterococcus faecalis strains were intermediate following BSAC/EUCAST breakpoints. All (but 1) isolates of the Bacteroides fragilis group (n = 45) were tigecycline susceptible, as well as Gram-positive anaerobes. Tigecycline offers an adequate activity profile against isolates from secondary peritonitis when tested by Etest regardless of the breakpoints used for categorization.

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A 1-year prospective multicenter study was performed to explore the significance of the presence of enterococci in cultures of peritoneal fluid from patients with secondary bacterial peritonitis in seven Spanish hospitals. The clinical records of patients with positive peritoneal fluid cultures were reviewed and distributed into cases (patients with cultures yielding enterococci) and controls (patients with cultures not yielding enterococci). Of a total of 158 records, 38 (24.1%) were cases and 120 (75.9%) were controls. The percentages or the scores (cases versus controls) for the variables included in the multivariate analysis were as follows: age of >50 years, 89.5% versus 68.3%; malignancy, 39.5% versus 18.3%; chronic obstructive pulmonary disease (COPD), 15.8% versus 4.2%; postoperative peritonitis, 55.3% versus 30.1%; nosocomial onset, 57.9% versus 34.2%; a higher Charlson comorbidity index, 3.29 +/- 3.38 versus 1.84 +/- 2.31; APACHE II score, 10.71 +/- 4.37 versus 8.76 +/- 5.49; ultimately or rapidly fatal disease, 63.2% versus 34.8%; need for surgical reintervention, 36.1% versus 15.1%; and admission to an intensive care unit, 45.9% versus 30.8%. In the multivariate analysis, enterococci were associated only with postoperative peritonitis (P = 0.009; odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.49 to 16.80), a higher Charlson comorbidity index (P = 0.002; OR = 1.30; 95% CI = 1.11 to 1.54), and COPD (P = 0.046; OR = 6.50; 95% CI = 1.04 to 40.73). The results of this study showed that enterococci were associated with comorbidity. An association with mortality could not be demonstrated.

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OBJECTIVES: To determine C(max) tigecycline activity in the presence/absence of physiological concentrations of human albumin with free fraction concentrations as controls. METHODS: Killing curves (final inoculum: 1.0-5.0 x 10(7) cfu/mL) were performed with 0.88 mg/L final concentrations (serum C(max) after a 100 mg 1 h infusion) in Mueller-Hinton broth supplemented with Ca(2+) and Mg(2+) (MH) and in MH with 4 g/dL human albumin. Controls were curves in MH with concentrations similar to the free fraction (fC(max) = 0.17 mg/L) calculated using protein binding. Activity was measured as log(10) initial inoculum reduction (log(10) initial inoculum-log(10) at 12 h/24 h). Target strains (tigecycline MIC/MBC; mg/L) were: methicillin-resistant Staphylococcus aureus heteroresistant to vancomycin (0.12/0.25); Enterococcus faecium (0.12/0.25); Escherichia coli producing extended-spectrum beta-lactamase (0.12/0.25); and Acinetobacter baumannii (0.25/1). RESULTS: At 24 h the fC(max) produced mean decreases of < or =0.1 cfu/mL for all strains, in contrast to the bactericidal activity (mean >3 log(10) reduction) provided by C(max) concentrations in the presence or absence of albumin for E. coli and E. faecium, and an activity nearly bactericidal for S. aureus (mean approximately 2.8 log(10) reduction). In the case of the A. baumannii isolate the C(max) in the presence or absence of albumin produced a mean reduction of 2.56 log(10) cfu/mL at 12 h (time of one dosing interval), with a bacteriostatic profile when considering 24 h colony counts (similar counts at 0 and 24 h). CONCLUSIONS: Correcting the total concentration for the reported literature binding values is unreliable since tigecycline antibacterial activity was greater than that suggested by the free fraction of the drug.

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PURPOSE: To test the null hypothesis that three self-adhesive luting materials had the same microtensile bond strength when used to lute ceramic IPS Empress II disks to the dentin of perfused teeth. MATERIALS AND METHODS: Occlusal enamel and the roots of 9 human third molars were removed and crown segments connected to a perfusion system (30 cm H2O). Nine ceramic disks (IPS Empress II) were prepared, conditioned with 5% HF (20 s), rinsed with water, and air dried. A primer silane agent was applied (Monobond-S) for 60 s and air dried. Teeth were bonded to disks using one of three materials: Multilink System, RelyX Unicem, or Panavia F light. Specimens were vertically sectioned to obtain square bars. Each bar was fixed to a rigid custom-made tensile device and submitted to tensile force until debonding. Microtensile bond strength (microTBS) was given in MPa. Because the means of bonded areas (BA) were different between groups, it was impossible to compare microTBS results directly. Thus, the regression line TBS(MPa) = -2.15 + [19.92 / BA (mm(2))] was calculated to correlate microTBS results and BA. Residuals (difference between the value estimated by the regression line and the actual value) were stored as "distances". ANOVA was performed to examine the statistical significance of differences between means distances of the groups', and the Tamhane's post hoc test was used to locate eventual differences. RESULTS: The number of bars used in the analysis was n = 147. Residuals should not be statistically different if the null hypothesis (represented by the regression line) was credible. ANOVA showed statistically significant differences between the distances of the groups' means (p < 0.00001). Tamhane's post hoc test (p < 0.05) showed that different group means were RelyX < Multilink < Panavia F. CONCLUSION: The null hypothesis was rejected: materials showed different tensile bond strengths. Panavia F obtained highest bonding values, followed by Multilink System. RelyX Unicem, the only material that does not require pretreatment of dentin, achieved the lowest TBS values under these study conditions.

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It is a known fact that there is a relationship between magnitude of bonded area and laboratory tensile test results. This relationship has been described for a range of areas between 1 and 10 mm(2), in extracted, nonperfused teeth. The aim of this study is to test this relationship in perfused teeth, with bonded areas ranging from 0.7 to 110.9 mm(2). Dentin of 92 sound third human molars was exposed and perfused, and three groups of bonded areas (BA) were delimited: small (0.69-1.89 mm(2)), medium (8.66-19.54 mm(2)), and large (58.91-110.86 mm(2)). Tensile bond strength (TBS) of three adhesive restorative systems was found. The best nonlinear curve estimation was searched (SPSS 9.0) between TBS and BA, for each and all materials. The best estimation was, for all materials, TBS = 4.17 + 10.35/BA (p < 0.0001).

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Dentin permeability was measured alternatively with two methods: a 10-microl capillary method with visual evaluation (PC) and a motorized automatic measuring device (Flodec, FD), both interposed in a simulated perfusion system. Eight human third molar coronal fragments were connected to systems, and their permeability to distilled water measured at 0, 5, 10, 15, 20, 25, and 29 cm H(2)O pressure. Resultant permeabilities (in microl/s) for both techniques were interrelated with the use of the Passing and Bablok nonparametric method, which gives information about the range of constant and proportional errors and their 95% confidence intervals (95CI). The relationship between the methods is described by the regression formula: FD = -0.0003 + 0.945.PC, with 95CI for constant (-0.0015-0.0009) and for slope (0.738-1.168), indicating that both methods are interchangeable, although not identical.

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