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OBJECTIVES: One of the key components of ERAS is adequate pain control in the postoperative period. There are no rational schemes for postoperative pain relief. At the same time, adequate postoperative pain relief promotes early activation and early rehabilitation of patients and shortens the duration of the postoperative stay, and does not cause postoperative complications associated with analgesia (weakness, intestinal paresis, nausea and vomiting). The aims of the present study are to assess the possible association of CYP2D6 and CYP2C9 polymorphisms with the efficacy and safety of tramadol and ketorolac in postoperative pain. METHODS: A total of 107 patients were genotyped for CYP2D6 and CYP2C9 polymorphisms. All patients underwent laparoscopic cholecystectomy. Postoperative pain relief was carried out with ketorolac and tramadol. Postoperative pain syndrome was assessed using a visual analogue scale and McGill pain questionnaire. The profile of side effects was assessed by the dynamics of red blood counts as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers. RESULTS: Pain was statistically significantly lower in CYP2C9*2 carriers, according to visual analogue scale (VAS): after 12 h - by 1.5 (p=0.002); after 24 h - by 1.1 (p=0.012); after 36 h - by 1.05 (p=0.004); after 48 h - by 0.7 (p=0.026). In CYP2C9*3 carriers the results were not statistically significant. In carriers of CYP2D6*4 pain syndromes were higher at all-time intervals, but statistically reliable results were obtained only after 2 h - by 1.01 (p=0.054) and after 24 h - by 0.8 (p=0.035). The profile of adverse reactions for NSAIDs was evaluated by the dynamics of hemoglobin and erythrocyte indices. A more pronounced decrease in the relative difference in hemoglobin levels was noted in CYP2C9*2 and CYP2C9*3 polymorphism carriers - by 1.7 (p=0.00268) and-by 2.2 (p=0.000143), respectively. CONCLUSIONS: CYP2D6 and CYP2C9 can predict analgesic effectiveness of tramadol and ketorolac. CYP2C9 can predict the risk of gastrointestinal bleeding, including those hidden to ketorolac.

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OBJECTIVES: One of the key components of ERAS is adequate pain control in the postoperative period. There are no rational schemes for postoperative pain relief. At the same time, adequate postoperative pain relief promotes early activation and early rehabilitation of patients and shortens the duration of the postoperative stay, and does not cause postoperative complications associated with analgesia (weakness, intestinal paresis, nausea and vomiting). The aims of the present study are to assess the possible association of CYP2D6 and CYP2C9 polymorphisms with the efficacy and safety of tramadol and ketorolac in postoperative pain. METHODS: A total of 107 patients were genotyped for CYP2D6 and CYP2C9 polymorphisms. All patients underwent laparoscopic cholecystectomy. Postoperative pain relief was carried out with ketorolac and tramadol. Postoperative pain syndrome was assessed using a visual analogue scale and McGill pain questionnaire. The profile of side effects was assessed by the dynamics of red blood counts as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers. RESULTS: Pain was statistically significantly lower in CYP2C9*2 carriers, according to visual analogue scale (VAS): after 12 h - by 1.5 (p=0.002); after 24 h - by 1.1 (p=0.012); after 36 h - by 1.05 (p=0.004); after 48 h - by 0.7 (p=0.026). In CYP2C9*3 carriers the results were not statistically significant. In carriers of CYP2D6*4 pain syndromes were higher at all-time intervals, but statistically reliable results were obtained only after 2 h - by 1.01 (p=0.054) and after 24 h - by 0.8 (p=0.035). The profile of adverse reactions for NSAIDs was evaluated by the dynamics of hemoglobin and erythrocyte indices. A more pronounced decrease in the relative difference in hemoglobin levels was noted in CYP2C9*2 and CYP2C9*3 polymorphism carriers - by 1.7 (p=0.00268) and-by 2.2 (p=0.000143), respectively. CONCLUSIONS: CYP2D6 and CYP2C9 can predict analgesic effectiveness of tramadol and ketorolac. CYP2C9 can predict the risk of gastrointestinal bleeding, including those hidden to ketorolac.

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PURPOSE: The aim of the study was to compare the 36-month clinical performances of a micro-hybride resin based composites (RBC) and a type II resin modified glass ionomer cement (RMGIC) in the treatment of cervical caries lesions. METHODS: Thirty-three patients (23 females,  10 males) with at least two cervical caries lesions participated in this study. A total of 110 restorations were randomly placed, half using RBC (Spectrum TPH3, Dentsply Sirona) with respective adhesive system (Prime & Bond NT, Dentsply Sirona) the other half using the RMGIC (Riva Light Cure, SDI, Bayswater, Victoria, Australia). Restorations were assessed at baseline, and after 6, 12, 18, 24 and 36 months using modified USPHS criteria. The data were analyzed statistically (p < 0.05). RESULTS: Recall rate was 90.91% at 36 months. Of the RBC lesions 84.3% (n = 43) and of the RMGIC restorations 92.2% (n = 47) were fully retained at 36 months. There was no significant difference between two materials in terms of retention and marginal adaptation (p > 0.05). No relation was found between caries activity, cavity dimensions and marginal adaptation (p > 0.05) but RMGIC restorations showed significantly more discoloration than RBC restorations after 36 months (p < 0.001). CONCLUSIONS: Considering the middle-term outcomes, both materials showed clinically successful performance in the treatment of cervical caries lesions.

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BACKGROUND: The aim of the present study was to compare bulk-filled composite resins with conventional composites in terms of cuspal movement and micro-leakage scores. METHODS: Ninety-six maxillary premolar teeth with mesial-occclusal-distal cavities were allocated to four groups. Twelve teeth in each group was treated etch-and-rinse, self-etch or selective-etch (N.=8) protocols with respective adhesive system. Bucco-palatal cusp measurements were performed before and after preparation, and 180s after curing and then subjected to 5000 thermocyclws. After immersed in 0.2% basic fuchsin dye for 24h, cervical micro-leakage was evaluated. The data was analyzed by One-way ANOVA and post-hoc Tukey's honest Test (P<0.05). RESULTS: All groups and bonding protocols revealed no significant differences in total cuspal deflection measurement and micro-leakage scores. After preparation, a significant increase was found in bucco-palatal width of the teeth compared to baseline (P=0.002). There were no significant relationship among composite resins and adhesives (P>0.05). CONCLUSIONS: Cuspal relief after cavity preparation should be taken into account when evaluating deflection.

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PURPOSE: This randomized controlled clinical trial compared the efficacy of a desensitizer containing calcium phosphate with a two-step self-etch adhesive and placebo over a 6-month period. METHODS: 50 subjects aged between 21-64 years with a sensitivity score of 6 or higher according to the Visual Analog Scale (VAS) in at least three teeth participated in this study. Teethmate Desensitizer, Clearfil SE Bond 2, and placebo (distilled water) were applied randomly to three teeth of each patient. Recall reviews were performed at baseline, 1 week, 1 month, 3 months, and 6 months after treatment, and the sensitivity scores were assessed by air-blast application. The normality of data was analyzed with Shapiro-Wilk. Since the placebo treatment was successful only in a small number of teeth, the three materials could only be compared 10 minutes after the treatment. Data were analyzed with Wilcoxon Test, Friedman and Dunn post-hoc tests (P= 0.05). RESULTS: Sensitivity decreased significantly after application for each of the three test groups when compared to the pretreatment condition (P< 0.05). There were no significant differences between the Teethmate Desensitizer and Clearfil SE Bond 2, and both materials were more effective than the placebo (P< 0.05). CLINICAL SIGNIFICANCE: Teethmate Desensitizer and Clearfil SE Bond 2 had similar desensitizing effects; both of them could be applied to treat dentin hypersensitivity for a 6-month period.

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BACKGROUND: The aim of this study was to analyze the bond strength of aged resin based nanocomposites repaired with the same and bulk fill composites. MATERIAL AND METHODS: Seventy-two disc shaped resin composites consisted of three different nanocomposite resins (Filtek Ultimate/FU, Herculite XRV Ultra/HXRV, and Reflectys/R) were produced. After storing the samples for 8 weeks in distilled water, each material was combined with the same material or the bulk-fill composite resin system (Filtek Ultimate+Filtek Ultimate/Group-1; Filtek Ultimate+Tetric BF/Group-2; Herculite XRV+Herculite XRV/Group-3; Herculite XRV+Tetric BF/ Group-4; Reflectys+Reflectys/Group 5; Reflectys+Tetric BF/Group-6), for repair. Then specimens were subjected to shear bond strength testing(SBS), and the debonded surfaces were examined. RESULTS: There was a significant difference among three materials(repaired with itself+bulk fill) for SBS testing values (p=0.001). FU and R were found to be similar, while HXRV was significantly different from them. A significant difference between group-1 and 2 (p=0.006) was detected, while there were no differences between group 3 and 4 (p= 0.142), and 5 and 6 (p=0.346). Among the six groups, repair SBS testing values with TBF were higher than repair with itself except for FU. CONCLUSIONS: The bulk-fill repaired materials showed higher bond strength except for FU, which showed the highest SBS value when repaired with itself. An increased incidence of adhesive fracture was observed at low strengths. Key words:Resin-based composites, nanofillers, surface treatment, macro-shear, repair.