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There is little evidence on the effectiveness of psychotherapeutic interventions in reducing new suicide attempts. This article aims to evaluate the effectiveness of psychotherapeutic interventions in reducing suicide attempts among patients with a history of previous attempts. We selected 17 articles from four databases: PubMed, Cochrane, APA PsycInfo and LILACS, in 2023. Six studies showed statistical differences that favored psychotherapeutic intervention at some point during the follow-up period. These psychotherapies addressed: problem-solving, hope induction, skills training. When comparing psychotherapy with usual care, a meta-analysis revealed an odds ratio of 0.41 (95 % CI, 0.17-0.99, p = .05) in the analysis up to 12 months of follow-up, and an odds ratio of 0.48 (95 % CI, 0.30-0.78, p < .001) after 12 months of follow-up. The results indicate the efficacy of these interventions in reducing additional suicide attempts, but they should be analyzed with caution, given the heterogeneity of the sample, treatments, and comparators. This review supports the development of prevention strategies indicated for patients who have attempted suicide.
Hay poca evidencia sobre la eficacia de las psicoterapias para reducir los nuevos intentos de suicidio. Este artículo tiene como objetivo evaluar la efectividad de las intervenciones psicoterapéuticas en la reducción de los intentos de suicidio entre pacientes con intentos previos. Se seleccionaron 17 artículos de cuatro bases de datos: PubMed, Cochrane, APA PsycInfo y LILACS. Seis estudios mostraron diferencias estadísticas que favorecieron la intervención psicoterapéutica en algún momento durante el período de seguimiento. Estas psicoterapias abordaron: resolución de problemas, inducción de esperanza y entrenamiento de habilidades. Al comparar la psicoterapia con el tratamiento habitual, el metanálisis reveló un odds ratio de 0.41 (IC del 95 %, 0.17 a 0.99, p = .05) en el análisis hasta los 12 meses de seguimiento, y un odds ratio de 0.48 (IC del 95 %, 0.30 a 0.78, p < .001) después de 12 meses de seguimiento. Los resultados apuntan a la eficacia de estas intervenciones para reducir los intentos de suicidio adicionales, pero deben analizarse con cautela, dada la heterogeneidad de la muestra, los tratamientos y los comparadores. Esta revisión apoya el desarrollo de estrategias de prevención indicadas para pacientes que han intentado suicidarse.
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INTRODUCTION: DNA hypomethylation in patients with systemic lupus erythematosus (SLE) has been recently documented in the literature. Low levels of DNA methylation have been observed globally and in genes associated with immune and inflammatory pathways in SLE's CD4+T lymphocytes. Given that certain micronutrients can either donate methyl groups within one-carbon metabolism pathways or serve as cofactors for enzymes involved in the DNA methylation process, this randomised, double-blind, placebo-controlled trial aims to investigate whether a 3-month supplementation of folic acid and vitamin B12 will modulate the DNA methylation profile in subcutaneous adipose tissue (primary outcome) of women with SLE and normal weight or excess body weight. As secondary objectives, we will assess gene expression, telomere length and phenotypic characteristics (ie, clinical parameters, body weight and composition, abdominal circumference, food intake and disordered eating attitude, physical activity, lipid profile, serum concentrations of leptin, adiponectin, and cytokines). METHODS AND ANALYSIS: Patients will be classified according to their nutritional status by body mass index in normal weight or excess body weight. Subsequently, patients in each group will be randomly assigned to either a placebo or an intervention group (folic acid (400 mcg) and vitamin B12 (2000 mcg) supplementation). Endpoint evaluations will be conducted using both intention-to-treat and per-protocol analyses. This study has the potential to design new personalised nutritional approaches as adjunctive therapy for patients with SLE. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Ethical Committee from Clinical Hospital of the School of Medicine of the University of Sao Paulo, Brazil (CAAE.: 47317521.8.0000.0068). TRIAL REGISTRATION NUMBER: NCT05097365 (first version).
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Metilación de ADN , Suplementos Dietéticos , Ácido Fólico , Lupus Eritematoso Sistémico , Estado Nutricional , Vitamina B 12 , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Femenino , Método Doble Ciego , Vitamina B 12/uso terapéutico , Ácido Fólico/uso terapéutico , Ácido Fólico/sangre , Adulto , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto Joven , Índice de Masa CorporalRESUMEN
OBJECTIVES: This study investigated altmetrics, citations, and field-normalized impact of dental articles reporting randomized clinical trials (RCTs) published within a one-year period. METHODS: Data were collected in 2024 from PubMed-indexed RCTs published in 2019. Dependent variables included Altmetric Attention Scores (AAS), PlumX citations, and Field-Weighted Citation Impact (FWCI). Independent variables encompassed article-, author-, and journal-related variables. Adjusted quasi-Poisson regression models were used to assess associations. Point-biserial correlation evaluated the relationship between Journal Impact Factor (JIF) and selected reporting variables. RESULTS: A total of 653 RCTs were included, with periodontology, implantology, and oral and maxillofacial surgery comprising 50.4 % of the sample. Only 28.6 % of the articles reported CONSORT use, 49.6 % pre-registered their protocol, and 68.8 % reported a sample size calculation. Most articles (63.6 %) reported no conflicts of interest, with unclear sponsorship being the most frequent (34.6 %). Regression analyses revealed significant associations for AAS, PlumX citations, and FWCI with various factors. JIF increased AAS by 17 % per unit, PlumX citations by 13 %, and FWCI by 6 %. Protocol pre-registration boosted AAS by 132 %, while mixed or no sponsorship increased PlumX citations by up to 47 %. First author H-index increased PlumX citations and FWCI by 1 % per unit, while first author continent impacted AAS, citations, and FWCI. Weak positive correlations between JIF and both protocol pre-registration and CONSORT use were observed. No significant differences were observed across different dental fields for any metric. CONCLUSION: An interplay among article-, author-, and journal-related variables collectively influenced the online attention, citations, and impact of dental RCT articles. CLINICAL SIGNIFICANCE: Understanding the factors that influence the visibility and impact of dental RCTs can guide researchers in improving the design, reporting, and dissemination of their studies, ultimately enhancing the quality and reach of dental research.
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OBJECTIVE: Compare the tooth sensitivity (TS) and bleaching efficacy (BE) of in-office dental bleaching performed with 35% hydrogen peroxide (HP) or 37% carbamide peroxide (CP). MATERIALS AND METHODS: Sixty-six participants were randomly divided into two groups according to the bleaching gel applied to the right hemiarch: 35% HP, or 37% CP. TS was recorded immediately after, up to 1, 24, and 48 h after bleaching, using the VAS and NRS scales. BE was assessed before bleaching and 1 month after using color guide units (ΔSGUs) and a spectrophotometer (ΔEab, ΔE00, and ΔWID). TS was assessed using McNemar's and paired t-test (VAS) or Wilcoxon signed rank (NRS). The paired t-test was used to analyze BE (α = 0.05). RESULTS: TS risk and intensity were lower for the 37% CP (p = 0.003 and p < 0.005). Despite significant differences between the groups after 1 month (ΔSGU and ΔE00; p < 0.05), the color measurements of both groups exceeded the 50%:50% perceptibility/acceptability threshold. CONCLUSION: In-office dental bleaching using 37% CP resulted in reduced risk and TS intensity, without prejudice to the BE. CLINICAL RELEVANCE: The use of 37% CP for in-office dental bleaching could decrease TS risk and intensity without affecting BE. TRIAL REGISTRATION: ClinicalTrials.gov identifier: RBR-683qhf.
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This study offers a detailed analysis of clinical trials conducted in Ecuador from 2010 to 2022 to assess alignment with the country's disease burden as indicated by the Global Burden of Disease study. Utilizing data from five registries, including ARCSA and Clinicaltrials.gov, we analyzed characteristics and coverage of 75 CTs after removing duplicates and ineligible studies. Findings reveal a 50% research gap across disease groups, with neoplasms being the only category matching disease burden. The scarcity of clinical research highlights the disparity between CTs and prevalent diseases such as cardiovascular and kidney diseases, diabetes, and other non-communicable conditions. Our results underscore the urgent need for increased clinical research investment addressing these critical health challenges in Ecuador.
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BACKGROUND: Asthma is a leading cause of pediatric hospitalization and morbidity, necessitating the development of educational interventions for its management and control. OBJECTIVE: To evaluate the effectiveness of an educational intervention in promoting parent/caregiver self-efficacy in the management and control of their children's asthma. METHODS: A clinical trial was conducted in Fortaleza, Ceará, Brazil, involving two randomized groups of parents/caregivers of children: the comparison group (CG) (n = 42) and the intervention group (IG) (n = 42). Data collection took place in two phases: the first included face-to-face sessions followed by the educational intervention in the IG, and the second included telephone follow-up. The educational intervention included the use of an educational booklet and a brief motivational interview. RESULTS: The groups were homogeneous at baseline. After the intervention, the mean self-efficacy scores of the IG were significantly higher than those of the CG (p < 0.05), and children whose parents/caregivers were in the CG were 1.43 times more likely to experience an asthma crisis than those in the IG. CONCLUSIONS: The educational intervention proved effective in increasing parent/caregiver self-efficacy in asthma management and control. Furthermore, children whose parents/caregivers did not receive the educational intervention were more likely to experience an asthma crisis.
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PURPOSE OF REVIEW: This review is a critical analysis of treatment results obtained in clinical trials conducted in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT), hyperphosphatemia, or both. RECENT FINDINGS: Patients with CKD have a high mortality rate. The disorder of mineral and bone metabolism (CKD-MBD), which is commonly present in these patients, is associated with adverse outcomes, including cardiovascular events and mortality. Clinical trials aimed at improving these outcomes by modifying CKD-MBD associated factors have most often resulted in disappointing results. The complexity of CKD-MBD, where many players are closely interconnected, might explain these negative findings. We first present an historical perspective of current knowledge in the field of CKD-MBD and then examine potential flaws of past and ongoing clinical trials targeting SHPT and hyperphosphatemia respectively in patients with CKD.
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Hiperparatiroidismo Secundario , Hiperfosfatemia , Insuficiencia Renal Crónica , Humanos , Hiperfosfatemia/etiología , Hiperparatiroidismo Secundario/etiología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapiaRESUMEN
INTRODUCTION: The dynamic arterial elastance (EaDyn), calculated as pulse pressure variation divided by stroke volume variation, has been studied as a predictor of vasopressor weaning. However, its potential as a haemodynamic tool for tapering off vasopressors in patients with sepsis remains unexplored. Therefore, our study aimed to assess whether using EaDyn for weaning vasopressor support could reduce the duration of vasopressor support in patients with sepsis. METHODS AND ANALYSIS: This pragmatic single-centre controlled clinical trial will take place at Fundación Santa Fe de Bogotá, Colombia. Adult patients diagnosed with septic shock according to the sepsis-3 criteria and a Sequential Organ Failure Assessment score ≥4 will be included. A total of 114 patients (57 per group) will undergo conventional critical care monitoring, and the weaning of vasopressor support will be initiated based on the EaDyn or mean arterial pressure (MAP), depending on the assigned group. EaDyn will be estimated based on the measurements obtained from a PiCCO device connected to a PulsioFlex Monitoring Platform (PULSION Medical Systems SE, Feldkirchen, Germany). Our primary outcome is the difference in vasopressor support duration between the EaDyn and MAP groups.Participants and statisticians performing the statistical analysis will be blinded to the group allocation. Dependent and independent variables will be analysed through univariate and multivariate statistical tests. Since we will perform three repeated measurements for analysis, we will implement a Bonferroni post hoc correction. Additionally, Cox regression and Kaplan-Meier analyses will be conducted to address objectives related to time. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee at Fundación Santa Fe de Bogotá (CCEI-16026-2024). Written informed consent will be obtained from all participants. The results will be disseminated through publication in peer-reviewed journals and presentations at national and international events. TRIAL REGISTRATION NUMBER: NCT06118775.
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Choque Séptico , Vasoconstrictores , Humanos , Choque Séptico/tratamiento farmacológico , Choque Séptico/fisiopatología , Vasoconstrictores/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Sistólico , Masculino , Colombia , Femenino , Presión Arterial/efectos de los fármacos , Cuidados Críticos/métodos , AdultoRESUMEN
Objective: To evaluate the efficacy of density-33 (D33) sealed foam in preventing skin injuries from surgical positioning. Approach: The study, reported according to the Consolidated Standards of Reporting Trials, is characterized as a randomized clinical trial, double mask, with 64 adult patients undergoing elective surgery, 35 allocated to the control group (CG), positioned on a conventional surgical table, and 29 to the experimental group (EG), positioned on a conventional surgical table overlaid with a D33 sealed foam support surface (SS) in the occipital, sacral, and heel regions. Simple randomization was carried out, as was masking of the researcher who evaluated the skin of the patient and the statistician. Data collection was carried out immediately preoperatively, intraoperatively, and postoperatively until the third day or until patient discharge. Statistical analysis included measures of association in contingency tables, χ2, and relative risk to compare the incidence of injuries between groups. Results: Skin injuries were greater in the CG, with blanchable erythema being the main injury. The use of D33 sealed foam reduced the incidence of injury in the EG by 61.2% (relative risk: 0.39; 95% confidence interval: 0.220-0.684; p < 0.001). Innovation: One of the first clinical studies to demonstrate that using a D33 sealed foam SS decreased the incidence of blanchable erythema from surgical positioning. Conclusion: D33 sealed foam was effective in preventing skin injury from surgical positioning in patients undergoing elective surgeries.
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OBJECTIVES: Although mechanical oral hygiene is widely practiced, it faces several challenges. Mouthwashes, such as chlorhexidine (CHX), are being explored as adjuncts to biofilm control, but their prolonged use has several side effects. Consequently, there is ongoing research into natural alternatives. This randomized crossover clinical study aimed to compare the antiplaque and antigingivitis efficacy of 0.12 % CHX and a 5 % Malva sylvestris. METHODS: Forty-four participants were involved in two phases, each comprising three stages with variations in the mouthwash solution used only. During the study, participants refrained from mechanical plaque removal for seven days. At first day, they received whole-mouth prophylaxis and oral health assessment. After three days, gingival inflammation assessment and prophylaxis in were performed in contralateral quadrants. Participants then used a randomly assigned mouthwash solution for four days. On the 7th day, they completed a questionnaire about their perception and appreciation of the mouthwash. Additionally, gingival inflammation and plaque index were also performed by a calibrated examiner. After a minimum 21-day washout period, participants entered the second phase, repeating the three stages. RESULTS: Results showed no statistically significant differences between the Malva sylvestris and CHX groups regarding inflammation and plaque formation. However, CHX demonstrated a significantly greater mean reduction (7th - 4th day) in gingival inflammation compared to Malva (p = 0.02) (0.01 ± 0.19 and 0.00 ± 0.19, respectively). Additionally, participants using CHX reported a more pleasant taste and considered higher plaque control perception (p < 0.05). CONCLUSIONS: In conclusion, both products exhibited similar antiplaque effects, but CHX outperformed Malva in controlling gingival inflammation. CLINICAL SIGNIFICANCE: Mouthwashes with Malva sylvestris may be a good alternative, in a short-term period, to control biofilm. However, lower antigingivitis efficacy may be expected when compared to chlorhexidine.
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Antiinfecciosos Locales , Clorhexidina , Estudios Cruzados , Índice de Placa Dental , Placa Dental , Gingivitis , Antisépticos Bucales , Humanos , Clorhexidina/uso terapéutico , Clorhexidina/análogos & derivados , Antisépticos Bucales/uso terapéutico , Gingivitis/prevención & control , Gingivitis/tratamiento farmacológico , Placa Dental/prevención & control , Masculino , Femenino , Adulto , Antiinfecciosos Locales/uso terapéutico , Adulto Joven , Índice Periodontal , Resultado del Tratamiento , Extractos Vegetales/uso terapéuticoRESUMEN
BACKGROUND: A clinical trial was conducted to measure the effectiveness of a combined wavelength of 660 nm and 808 nm Low-Level Laser Therapy (LLLT) in reducing postoperative pain in partially and totally edentulous patients who underwent dental implant surgery. MATERIALS AND METHODS: The study included 20 blinded individuals divided in a randomized split-mouth fashion; the experimental group in one hemiarch and the control group in the other hemiarch. The experimental group received a total of 22.5 Joules (J) of LLLT divided into 5 points per implant immediately after surgery. The control group received a placebo treatment. At 24 h, 72 h, and 7 days, a blinded surveyor administered a pain questionnaire using a Numerical Rating Scale (NRS) combined with a Verbal Rating Scale (VRS) to assess pain onset after surgery, duration of the first pain episode, and pain evolution. Group data were analyzed with an ANOVA test for repeated measures and a paired t-test at defined time intervals. RESULTS: The experimental group showed a significant decrease in postoperative pain at 24 h and at 72 h for fully edentulous patients. There was a non-significant difference in the duration of the first pain episode. The mean pain levels decreased over time for both the experimental and control treatments, but only statistically significantly for the experimental group in the 24-72 h and 24 h to 7 days intervals. The same was true for the control group when comparing 24 and 72 h and between 24 h and 1 week. The time range between 72 h and 1 week showed no statistically significant differences. CONCLUSION: Within the limitations of this study, a single dose of 22.5 J LLLT per implant helps to decrease postoperative pain in dental implant surgery at 24 h for partially edentulous patients and at 24 and 72 h for fully edentulous patients.
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Terapia por Luz de Baja Intensidad , Dolor Postoperatorio , Humanos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Terapia por Luz de Baja Intensidad/métodos , Femenino , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Adulto , Anciano , Implantes Dentales , Implantación Dental/métodosRESUMEN
INTRODUCTION: Skin ageing is a complex process influenced by various factors. Personal care products claim to address ageing signs, yet clinical efficacy tests lack standardised regulations. Niacinamide (NIA) is known for skin benefits, including managing hyperpigmentation and enhancing the barrier function. The 5 MHz unfocused ultrasound (5-US) is a technological intervention for cutaneous ageing, lacking sufficient literature. This study aimed to clinically assess a topical formulation with NIA, combined with facial application of unfocused 5-US. METHODS: Sixty-seven female subjects (30-60 years) with signs of aged skin participated in the study. They were enrolled and randomised into four groups: (A) placebo formulation, (B) cosmetic formulation, (C) placebo formulation plus 5-US, and (D) cosmetic formulation plus 5-US. Groups C and D performed the aesthetic procedure of 5-US on the entire face, in a total time of 20 minutes per session, once per week (eight total sessions). Clinical, instrumental, and subjective assessments were performed before (T0) and during the eighth week (T8) of the study. RESULTS: The formulation with NIA improved stratum corneum aqueous content and reduced transepidermal water loss. Sebum reduction was observed in groups utilising the formulation. Consumer evaluations indicated improvements in appearance, firmness, elasticity, and reduced wrinkles, notably in Groups C and D. Sensory analysis indicated overall product acceptability. CONCLUSION: The formulation with NIA improved skin hydration and reduced sebum content in mature skin, while subjective evaluations indicated qualitative improvements in skin appearance. Although 5-US alone did not show instrumental improvements, protocol adjustments and longer study periods may yield better results. The comprehensive approach provides an innovative perspective into potential synergies, suggesting future directions for anti-ageing interventions in skin care.
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The evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant 'non-burning barrier film' in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.
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Radiodermatitis , Neoplasias del Recto , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Método Simple Ciego , Neoplasias del Recto/complicaciones , Neoplasias del Recto/radioterapia , Radiodermatitis/prevención & control , Radiodermatitis/tratamiento farmacológico , Radiodermatitis/etiología , Brasil , Aloe , Adulto , Emolientes/uso terapéutico , Emolientes/administración & dosificación , Neoplasias del Ano , Calendula , Resultado del TratamientoRESUMEN
We carried out a comparison of the neuromuscular and clinical effects produced by electrostimulation therapies, as an adjuvant to the use of occlusal splints (removable muscle relaxation apparatus) in patients with temporomandibular disorders In this simple randomized clinical trial, 91 patients were randomly divided into three groups. Group A (GA) received transcutaneous electrostimulation therapy and an occlusal splint, Group B (GB) received percutaneous electrostimulation therapy and an occlusal splint, and Group C (GC) received an occlusal splint. The neuromuscular activity, as well as the signs and symptoms of each patient, were evaluated every week throughout the treatment (T0 = baseline; T1 = 7 days; T2 = 14 days; T3 = 21 days; T4 = 28 days; and T5 = 35 days). Pain was measured with a visual analog scale, and neuromuscular electrical activity was determined by the root mean square of the masseter muscles through the use of a UNAM-CINVESTAV 1.2 electromyograph. Comparisons were made using ANOVA for repeated measures (p-value = 0.05). The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent, and in the short term for the group treated with transcutaneous electrostimulation therapy as an adjuvant to the use of the occlusal splint. The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent and in a shorter term in the GA (calculation therapy, transcutaneous electrostimulation) and GB (occlusal splint). Transcutaneous electrostimulation is a feasible and faster alternative that was accepted by most of the patients for treating temporomandibular disorders.
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OBJECTIVE: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at-home bleaching applied on the buccal surface only or the buccal and lingual surfaces. MATERIALS AND METHODS: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at-home bleaching on the buccal-only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0-10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t-test, McNemar's, and Wilcoxon signed-rank test were used for data analysis (α = 5%). RESULTS: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). CONCLUSION: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. CLINICAL SIGNIFICANCE: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal-only technique is sufficient to achieve the desired efficacy.
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Blanqueamiento de Dientes , Humanos , Blanqueamiento de Dientes/métodos , Método Simple Ciego , Femenino , Masculino , Adulto , Peróxido de Hidrógeno/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: To evaluate the decomposition rate of active hydrogen peroxide (HP) and bleaching efficacy during in-office bleaching using high-concentration HP gels with different pHs. METHOD: A randomized, parallel, double-blind controlled trial was conducted with 40 volunteers randomized into four groups (pH 5.4; pH 7.0; pH 7.7, and pH 8.0). During the first session in-office bleaching, approximately 0.01 g of the gel was collected and titrated with potassium permanganate to obtain the concentration of active HP and pH values were measured using an electrode. Bleaching efficacy was assessed using a spectrophotometer [∆Eab, ∆E00, and WID], Vita Classical and Vita Bleachedguide scales [∆SGU]. The decomposition rate of HP concentration and pH values change were calculated using ANOVA one-way. The bleaching efficacy was assessed using two-way repeated measures ANOVA. Tukey's test was applied as a post-hoc test (p < 0.05). RESULTS: All gels experienced decreasing HP concentration over time. pH 5.4 gel showed greatest reduction after 50 min (p < 0.001). pH 8.0 and 7.7 gels remained stable; pH 5.4 remained acidic, while pH 7.0 turned acidic (p < 0.001). No significant difference in bleaching degree was observed among gels. They all showed a similar and clinically important color change after two clinical sessions, remained stable 1-month post-treatment (p > 0.05). CONCLUSIONS: All bleaching gels kept at least 70% of their HP content after 50 min, suggesting that there is a surplus of HP. They provided similar whitening efficacy 1-month after bleaching. PRACTICAL IMPLICATIONS: It is possible that lower HP concentrations may be equally effective in achieving desired results while reducing the potential for side effects. CLINICAL TRIAL REGISTRY NAME: RBR-35q7s3v.
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Geles , Peróxido de Hidrógeno , Blanqueadores Dentales , Blanqueamiento de Dientes , Humanos , Método Doble Ciego , Blanqueadores Dentales/química , Concentración de Iones de Hidrógeno , Peróxido de Hidrógeno/química , Blanqueamiento de Dientes/métodos , Femenino , Masculino , Adulto , Espectrofotometría , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months. METHODS: Fifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05). RESULTS: Both chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05). CONCLUSION: Chemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service. CLINICAL SIGNIFICANCE: The chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch.
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Resinas Compuestas , Restauración Dental Permanente , Sensibilidad de la Dentina , Humanos , Resinas Compuestas/química , Resinas Compuestas/uso terapéutico , Restauración Dental Permanente/métodos , Femenino , Masculino , Método Doble Ciego , Adulto , Persona de Mediana Edad , Curación por Luz de Adhesivos Dentales , Materiales Dentales/química , Cementos de Resina/química , Adulto Joven , Diente MolarRESUMEN
AIM: The positive impact of implant interventions on dental patient-reported outcomes is an essential parameter of treatment effectiveness. This study assessed the 2-year changes in patient satisfaction and oral health-related quality of life (OHRQoL) of edentulous patients treated with a four mini implant mandibular overdenture (IOD) METHODS: The study was planned as a 2 × 2 factorial randomized clinical trial that tested two surgical approaches (flapped or flapless) and two loading protocols (immediate and delayed) using a titanium-zirconium mini implant (Straumann Mini Implant System®) and a PEEK retentive system (Straumann® Optiloc® Retentive System). Outcome measures (OHIP-Edent scores and the McGill Denture Satisfaction questionnaire) were assessed before treatment and at the 3-, 6-, 12-, and 24-month follow-ups. The Friedman test and multiple regression using Generalized Estimating Equations (GEE) were used for data analysis, considering the per-protocol (PP) and intention-to-treat (ITT) approaches RESULTS: Seventy-four patients were randomized to the study groups. No implant failure occurred during the study period. Marked improvement in all post-treatment periods compared to baseline were observed for the two outcomes. No significant effect of patient's gender, age, and surgical protocol on the study outcomes. The effect of treatment provision was significant for the two outcomes in the PP and ITT approaches (p < 0.001). A barely significant positive effect of the immediate loading was observed for OHIP-Edent in the PP approach (p = 0.020) CONCLUSION: IOD treatment significantly improved patient-reported outcomes measures, with sustained benefits over the two years of overdenture use, and can be considered a promising treatment option in for the edentulous mandible.