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OBJECTIVES: To evaluate different restorative techniques for non-carious cervical lesions (NCCLs) and the activity of matrix metalloproteinases (MMPs) in gingival crevicular fluid. MATERIALS AND METHODS: Two hundred restorations were performed in 50 patients using resin composite restorative system without (I) and with selective enamel conditioning (II) and resin-modified glass-ionomer cement without (III) and with EDTA pretreatment (IV). Gingival crevicular fluid samples were collected in 15 patients. Restorations were evaluated using USPHS criteria at baseline and after 2 years. Percentages of MMP activity were assessed by zymography as a surrogate outcome. Equality tests of two proportions, logistic regression analysis, survival analysis, ANOVA repeated measures, and Fisher tests were used. RESULTS: No differences in clinical performance were found among groups. Group I had lower retention at 2 years than at baseline. Decreased alpha scores for marginal integrity and marginal discoloration were observed for all groups after 2 years. MMP-2 decreased after 1 year, and its activity increased back to the initial level after 2 years, mainly for groups I, II, and III. MMP-9 increased after 1 year, and it was reduced to the initial level after 2 years, mainly for group I. CONCLUSIONS: All restorative techniques performed similarly in NCCLs after 2 years with initial marginal defect alterations. MMP-2 reestablished its initial levels after 2 years, and MMP-9 had few alterations over time in crevicular fluid. Clinical relevance The different restorative techniques are equally successful in NCCLs after 2 years of clinical functioning and have similar effects on MMPs present in crevicular fluid.

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Objective: The aim of this study was to evaluate the effect of STMP as biomimetic analog of dentin matrix on the dentin bond strength submitted to artificial cariogenic challenge over time. Material and Methods: The total number of teeth used in the experiment was 60 teeth, which were divided into 6 groups (n = 10). Of these total amount, 10 teeth were not submitted to the artificial cariogenic challenge (ACC), serving as control group (Sound Dentin - SD) while the other 50 were submitted to an ACC (7d/37ºC), being treated with treatment solutions according to each group: SD- deionized water/sound dentin, CD- deionized water/ artificial caries dentin, GIII- STMP, GIV- STMP + Ca(OH)2, GV- STMP + NaF, and GVI- NaF. After treatments (24h), the specimens were restored (Adper Single Bond Universal + Filtek Z250), to obtain resin­dentin sticks with a cross sectional area of 0.8mm2, approximately. Two-third of these sticks were stored in artificial saliva (37°C) for analyzes after 6 and 12 months. The 1/3 remains were subjected to µTBS test (baseline). Data were analyzed by two-way ANOVA and Tukey tests (p<0.05). Results: In general, the highest µTBS values were obtained in sound condition (SD), while the artificial caries condition (CD) determined minimum values. Groups treated with NaF (with or without STMP- GV and GVI) were not able to improve adhesion over time. Only the use of STMP + Ca(OH)2(GIV) improved the µTBS compared to the others caries-challenged dentin after 1 year. The adhesive failure pattern was predominant in all time. Conclusion: The use of the STMP associated with Ca(OH)2 seems to be a viable therapeutic strategy conciliating the biomimetizing capacity to the adhesive process satisfactorily even its performance is not superior to initial condition (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito do STMP como análogo biomimético da matriz dentinária na resistência de união à dentina submetida a desafio cariogênico artificial ao longo do tempo. Material e Métodos:foram utilizados um total de 60 dentes neste experimento, os quais foram divididos em 6 grupos (n = 10). Desse total, 10 dentes não foram submetidos ao desafio cariogênico artificial (DCA), servindo como grupo controle (Dentina Hígida - DH) enquanto os outros 50 foram submetidos ao DCA (7d / 37ºC), sendo tratados com soluções de tratamento específicas para cada grupo: DH- água deionizada / dentina hígida, DC- água deionizada / dentina submetida ao DCA, GIII- STMP, GIV- STMP + Ca(OH)2, GV- STMP + NaF e GVI- NaF. Após os tratamentos (24h), os corpos-de-prova foram restaurados (Adper Single Bond Universal + Filtek Z250), para obtenção de palitos de resina-dentina com área transversal de aproximadamente 0,8mm2. Dois terços desses palitos foram armazenados em saliva artificial (37°C) para análises após 6 e 12 meses. Os outros 1/3 foram submetidos ao teste µTBS (baseline). Os dados foram analisados por ANOVA a dois fatores e testes de Tukey (p <0,05). Resultados:Em geral, os maiores valores de µTBS foram obtidos em condição hígidas (DH), enquanto a condição subtmetidas ao DCA determinou os menores valores. Os grupos tratados com NaF (com ou sem STMP associado -GV e GVI) não foram capazes de melhorar a resistência de união, ao longo do tempo. Somente o uso de STMP + Ca (OH)2(GIV) melhorou o µTBS em comparação com as outras condições desafiadas por cárie após 1 ano. O padrão de falha adesiva foi predominante em todos os tempos. Conclusão: O uso do STMP associado ao Ca (OH)2 parece ser uma estratégia terapêutica viável conciliando a capacidade biomimetizante ao processo adesivo de forma satisfatória mesmo que seu desempenho não seja superior à condição inicial.(AU)

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The effect of sodium trimetaphosphate (STMP) as an antiproteolytic and remineralizing agent on demineralized dentin was evaluated in vitro. The inhibitory potential of STMP at 0.5, 1.5, 3.5, and 5% against recombinant matrix metalloproteinases (MMPs) MMPs-2 and -9 was assessed by zymography. To investigate its remineralization potential, 40 bovine root specimens were obtained and subjected to a demineralization protocol to produce caries-like dentin lesions. After that, dentin surfaces were divided into 3 areas: (1) mineralized (no treatment); (2) demineralized; and (3) demineralized/treated with STMP and submitted to a pH-cycling associated or not with STMP (1.5, 3.5, or 5% STMP, 10 min of treatment). After that, superficial hardness (SH) and cross-sectional hardness (CSH) were determined. Polarized light microscopy (PLM) was used to qualitatively evaluate mineralization within the caries-like lesions. The zymographic analysis showed that STMP solution is a potent inhibitor of the gelatinolytic activity of MMPs-2 and -9 depending on the dose, since the lowest concentration (0.5%) partially inhibited the enzyme activity, while the higher concentrations completely inhibited enzyme activity. Regarding remineralization effect, only 1.5% STMP solution enhanced both the SH and CSH. PLM showed that the area treated with 1.5% STMP presented similar birefringence as mineralized sound dentin. In conclusion, 1.5% STMP solution is effective as an antiproteolytic agent against MMPs and promotes dentin remineralization.

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OBJECTIVES: Enzyme inhibitors minimize the degradation of unprotected collagen of dentin promoted by matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs). As the evidence of their effect on the root canal is limited, this study aimed to evaluate the role of EDTA, chlorhexidine and E-64 as antiproteolytic agents on the bond strength (BS) of glass-fiber posts in root canals. MATERIALS AND METHODS: Ninety-six bovine roots were distributed in groups for each time point (n = 8). Adper Scotchbond Multipurpose (MP)/ RelyX ARC system was used to lute the post according to the treatment: negative control (NC)- water, EDTA- 17% ethylenediaminetetraacetic acid, CHX- 2% digluconate chlorhexidine, E-64-5- 5µM E-64, E-64-10- 10µM E-64 and positive control (PC)- MP associated with activator/ catalyst. Then, slices were subjected to push-out test (0.5mm/min) after 24h/6 mons. Data were analyzed by three-way ANOVA/Tukey tests. Failure modes were analyzed (40×). RESULTS: The factors treatment, time, root canal third and the interaction between treatment and time were statistically significant. At 24h, no negative interactions were observed among the root dentin, bonding system and post. At 6 mons, CHX improved the BS for middle and apical root thirds. CONCLUSIONS: CHX was able to promote beneficial BS after 6 mons, which was not noted for any other tested enzyme inhibitors.

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OBJECTIVES: The purpose of this in vitro study was to evaluate the bonding ability and monomer conversion of a universal adhesive system applied to dentin as functions of different curing times and storage. The results were compared among a variety of commercial adhesives. MATERIALS AND METHODS: Flat superficial dentin surfaces were exposed on human molars and assigned into one of the following adhesives (n = 15): total-etch Adper Single Bond 2 (SB) and Optibond Solo Plus (OS), self-etch Optibond All in One (OA) and Clearfil SE Bond (CSE), and Scotchbond Universal Adhesive in self-etch mode (SU). The adhesives were applied following the manufacturers' instructions and cured for 10, 20, or 40s. Specimens were processed for the microtensile bond strength (µTBS) test in accordance with the non-trimming technique and tested after 24h and 2 years. The fractured specimens were classified under scanning electron microscopy (SEM). Infrared (IR) spectra were obtained and monomer conversion (%) was calculated by comparing the aliphatic-to-aromatic IR absorption peak ratio before and after polymerization (n=5). Data were analyzed by 2-way ANOVA/Tukey's tests (α = 0.05). RESULTS: At 24-h evaluation, OA and CSE presented similar bond strength means irrespective of the curing time, whereas SB and SU exhibited significantly higher means when cured for 40s as did OS when cured for 20 or 40s (p < 0.05). At 2-year evaluation, only OA exhibited significantly higher bond strength when cured for 20 and 40s (p < 0.05). When the evaluation times were compared, OA also exhibited the same bonding ability when cured for longer periods of time (20 and 40s). All of the adhesives tested exhibited significantly lower monomer conversion when photoactivated according to the manufacturers' instructions (10s). CONCLUSIONS: Higher monomer conversions obtained with longer light exposure allow only higher immediate bond strength for most of the adhesives tested. After 2-year storage, only the self-etching adhesive Optibond All-In-One exhibited the same bonding ability when cured for longer periods of time.

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It has been hypothesized that cysteine cathepsins (CTs) along with matrix metalloproteases (MMPs) may work in conjunction in the proteolysis of mature dentin matrix. The aim of this study was to verify simultaneously the distribution and presence of cathepsins B (CT-B) and K (CT-K) in partially demineralized dentin; and further to evaluate the activity of CTs and MMPs in the same tissue. The distribution of CT-B and CT-K in sound human dentin was assessed by immunohistochemistry. A double-immunolabeling technique was used to identify, at once, the occurrence of those enzymes in dentin. Activities of CTs and MMPs in dentin extracts were evaluated spectrofluorometrically. In addition, in situ gelatinolytic activity of dentin was assayed by zymography. The results revealed the distribution of CT-B and CT-K along the dentin organic matrix and also indicated co-occurrence of MMPs and CTs in that tissue. The enzyme kinetics studies showed proteolytic activity in dentin extracts for both classes of proteases. Furthermore, it was observed that, at least for sound human dentin matrices, the activity of MMPs seems to be predominant over the CTs one.

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High- and low-speed rotary dental handpieces have been used for a long time in restorative dentistry for cavity preparation. However, problems inherent to conventional burs, such as noise, heat and vibration, have led to the development of new dental burs, such as the chemical vapor deposition diamond-coated bur. Its advantages are many, such as less noise, less pain for the patient, precise cutting, conservative cavity preparation, longer lifetime, less injury to the dental structures, no cutting of soft tissues and easier access of the carious lesion. This case report uses a chemical vapor deposition diamond-coated bur to prepare a cavity by direct proximal access, preserving the marginal ridge. The cavity was then filled with glass ionomer cement. The clinical outcome was satisfactory. Direct access to the cavity was possible because of the chemical vapor deposition diamond-coated bur, resulting in comfort for the patient and dentist.

Os instrumentos rotatórios convencionais têm sido utilizados em alta e/ou baixa velocidade há tempos para a confecção de cavidades na odontologia restauradora. Contudo, problemas inerentes a estes equipamentos, como o ruído, calor e vibração mecânica levaram ao desenvolvimento de novos instrumentos, como a ponta de diamante pela tecnologia Deposição Química por Vapor. Esta apresenta uma série de vantagens como menor ruído, procedimento menos doloroso, desgaste preciso e preparo conservador, maior durabilidade da ponta, menor injúria à estrutura dentária, não corta os tecidos moles e acesso facilitado à lesão cariosa. Este trabalho apresenta um relato de caso clínico demonstrando o uso da ponta de diamante Deposição Química por Vapor para a confecção de um preparo cavitário proximal com acesso direto, com preservação da crista marginal, restauração com cimento de ionômero de vidro. O resultado clínico satisfatório foi conseguido, com acesso direto à cavidade em detrimento à configuração das pontas utilizadas, proporcionando conforto para o paciente e cirurgião dentista.

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Glass ionomer based materials are clinically popular in several areas of restorative dentistry, but restoration of cervical lesions has proven particularly successful. Various etiologies, conformations, locations and structural characteristics make non-carious cervical lesions more challenging to adhesive restorative procedures and marginal seal in the long run. Due to their characteristics, glass ionomer cements (GICs) have precise indication for these cases. Moreover, the use of a GIC base underneath composite resin, the so-called 'sandwich' or mixed technique, allows associating the good characteristics of composite resins and GICs, and has been considered quite useful in the restoration of non-carious cervical defects. The aim of this paper is to critically review the literature and discuss peculiar features of GICs regarding their role in the restoration of non-carious cervical lesions.

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OBJECTIVES: Calcium hydroxide cements have been largely used in deep cavities due to their abilities to stimulate dentin formation. However, their resistance can be relatively low and their solubility relatively high, in many instances. This study evaluated water sorption and solubility of different calcium hydroxide cements, in order to show alterations that may reduce their effectiveness. MATERIAL AND METHODS: Five discs (20 mm in diameter and 1.5 mm thick) of three different materials (Biocal, Dycal and Hidro C) were prepared with the aid of a ring-shaped metallic matrix. After being stored at 37 degrees C for 24 h, the discs were weighed on a precision weight scale, dehydrated and weighed again. Immediately after weighing, discs were stored for a week in 50 mL of distilled water at 37 degrees C and, then, weighed again, dehydrated and submitted to a new weighing. The loss of soluble material and its water sorption was obtained from the difference between the initial and the final dry mass of each disc, after 1 week of immersion in water. Data were analyzed for significant differences by two-way ANOVA and Tukey's test (p<0.05). RESULTS: Mean water sorption values (g) +/- standard deviation and percentage (%), for each evaluated cement, were: Biocal (0.006 +/- 0.001 / 2.15); Dycal (0.016 +/- 0.004 / 5.49); and Hidro C (0.025 +/- 0.003 / 8.27). Mean solubility values (g) +/- standard deviation and percentage (%), for each evaluated cement, were: Biocal (0.002 +/- 0.001 / 0.72); Dycal (0.013 +/- 0.004 / 4.21); and Hidro C (0.023 +/- 0.004 / 7.65). CONCLUSIONS: Biocal absorbed less water and was less soluble than the other evaluated cements; Hidro C exhibited the highest water sorption and solubility values; and there were significant differences among all evaluated experimental groups.

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Glass ionomer based materials are clinically popular in several areas of restorative dentistry, but restoration of cervical lesions has proven particularly successful. Various etiologies, conformations, locations and structural characteristics make non-carious cervical lesions more challenging to adhesive restorative procedures and marginal seal in the long run. Due to their characteristics, glass ionomer cements (GICs) have precise indication for these cases. Moreover, the use of a GIC base underneath composite resin, the so-called "sandwich" or mixed technique, allows associating the good characteristics of composite resins and GICs, and has been considered quite useful in the restoration of non-carious cervical defects. The aim of this paper is to critically review the literature and discuss peculiar features of GICs regarding their role in the restoration of non-carious cervical lesions.

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OBJECTIVES: Calcium hydroxide cements have been largely used in deep cavities due to their abilities to stimulate dentin formation. However, their resistance can be relatively low and their solubility relatively high, in many instances. This study evaluated water sorption and solubility of different calcium hydroxide cements, in order to show alterations that may reduce their effectiveness. MATERIAL AND METHODS: Five discs (20 mm in diameter and 1.5 mm thick) of three different materials (Biocal®, Dycal® and Hidro C®) were prepared with the aid of a ring-shaped metallic matrix. After being stored at 37ºC for 24 h, the discs were weighed on a precision weight scale, dehydrated and weighed again. Immediately after weighing, discs were stored for a week in 50 mL of distilled water at 37ºC and, then, weighed again, dehydrated and submitted to a new weighing. The loss of soluble material and its water sorption was obtained from the difference between the initial and the final dry mass of each disc, after 1 week of immersion in water. Data were analyzed for significant differences by two-way ANOVA and Tukey's test (p<0.05). RESULTS: Mean water sorption values (g) ± standard deviation and percentage ( percent), for each evaluated cement, were: Biocal® (0.006 ± 0.001 / 2.15); Dycal® (0.016 ± 0.004 / 5.49); and Hidro C® (0.025 ± 0.003 / 8.27). Mean solubility values (g) ± standard deviation and percentage ( percent), for each evaluated cement, were: Biocal® (0.002 ± 0.001 / 0.72); Dycal® (0.013 ± 0.004 / 4.21); and Hidro C® (0.023 ± 0.004 / 7.65). CONCLUSIONS: Biocal® absorbed less water and was less soluble than the other evaluated cements; Hidro C® exhibited the highest water sorption and solubility values; and there were significant differences among all evaluated experimental groups.

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A realizações de restaurações estéticas de resina composta tem sido amplamente difundida na prática odontológica atual. Com o aperfeiçoamento dos sisitemas adesivos e das resinas compostas, é possível realizar preparos cada vez menos invasivos, com segurança quanto às suas aplicações e indicações. Restaurações de resina composta em dentes posteriores têm apresentado resultados satisfatórios de resistência e longevidade, uma vez que apresentam propriedades mecânicas aprimoradas. Dessa forma, este artigo tem como objetivo demonstrar e discutir os principais fatores relacionados à confecção de uma restauração de resina composta em dentes posteriores por meio da substituição insatisfatória, abordando os aspectos de contração de polimerização das resinas e formas de minimizar seus danos.

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As cerâmicas à base de zircônia (Y-TZP) apresentam propriedades mecânicas superiores às das demais cerâmicas odontológicas. Entretanto, o aumento do conteúdo cristalino modificou suas características de adesão a cimentos resinosos, tornando necessário o desenvolvimento de métodos mais efetivos de união a estes materiais. Este trabalho in vitro pretende, portanto, avaliar a influência de diferentes tratamentos de superfície e de diferentes agentes de união na resistência ao cisalhamento entre uma zircônia estabilizada por ítrio e um agente cimentante autoadesivo (RelyX U100®/3M ESPE). Para tal, cilindros de PROCERA® Allzircon receberam como tratamento de superfície jateamento com óxido de alumínio (Al2O3 - 50 µm) ou jateamento com o sistema Rocatec. Sobre a superfície tratada dos cilindros foram aplicados, de acordo com os diferentes grupos experimentais, o sistema adesivo Clearfil SE Bond® (Kuraray Co.), e os primers Metal Zirconia Primer (Ivoclar Vivadent) e Alloy Primer (Kuraray Co.) e, finalmente, o cimento resinoso adotado. Cada espécime foi, então, submetido ao teste de cisalhamento (0,05 mm/min), por meio da ação de uma alça de fio ortodôntico passando o mais próximo possível da interface adesiva. A análise de variância a um critérios (ANOVA) e o teste de Tukey (p < 0,05) mostraram que a realização do tratamento de superfície aumentou os valores de resistência de união entre a cerâmica e o cimento resinoso.

O jateamento com o sistema Rocatec (15,33 MPa) apresentou valores significantemente maiores que o jateamento com Al2O3 (11,93 MPa). A aplicação dos agentes de união resultou em uma maior resistência adesiva, sendo que o sistema adesivo Clearfill SE Bond (17,07 MPa) teve um comportamento estatisticamente superior aos demais materiais. Entre os primers, o Metal Zircônia Primer (11,26 MPa) apresentou maior valor de resistência de união que o Alloy Primer (10,01 MPa). Portanto, a associação de um tratamento superficial com um agente de união é valida, já que promoveu os maiores valores de resistência adesiva.

Yttrium-stabilized tetragonal zircon polycrystal (Y-TZP) ceramics show better mechanical properties than other dental ceramics. However, the high crystalline content modified their adhesiveness to resin cements, making it extremely necessary to develop a more effective adhesive strategy between them. This in vitro study intends to evaluate the influence of different surface treatments and different bond agents on the shear bond strength between a Y-TZP and self-adhesive resin cement. PROCERA® Allzircon cylinders (3.5 mm in diameter) received a surface airborne abrasion treatment with 50 µm aluminum-oxide (Al2O3) particles or with the Rocatec system. According to the experimental groups, the adhesive system Clearfil SE Bond® (Kuraray Co.), and the primers Metal Zirconia Primer (Ivoclar Vivadent) and Alloy Primer (Kuraray Co.) were applied on the treated surface of the cylinders, before the application of the adopted resin cement (RelyX U100®/3M ESPE). Each specimen was submitted to the shear bond strength test (0.5 mm/min), by the action of an orthodontic stainless steel ligature wire (0.5 mm in diameter) loop, wrapped around the resin cement, as close as possible to the adhesive interface. One way- ANOVA and Tukey´s post hoc tests (p < 0.05) revealed that surface treatment increased bond strength between the ceramic and the resin cement. Silica coating with the Rocatec system (15.33 MPa) showed significantly higher values than airborne abrasion with Al2O3 (11.93 MPa). Application of all bond agents improved shear bond strength: adhesive system Clearfil SE Bond (17.07 MPa) showed better performance than the other evaluated materials, and Metal Zirconia Primer (11.26 MPa) showed higher bond strength values than Alloy Primer (10.01 MPa). Therefore, the association of a surface treatment with a bond agent is suitable, once it resulted in higher values of adhesive strength.

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