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PURPOSE: To evaluate denture cleansing solutions regarding the surface roughness and color stability of two resilient liners with distinct optical characteristics used for the maximum recommended period of use. METHODS: The specimens of each resilient liner, transparent and white, were randomly distributed into groups (n= 15) of a daily 20-minute immersion simulation of 0.25%, 0.5% and 1% sodium hypochlorite (SH) and 4% acetic acid solutions. Surface roughness (Ra) and color stability (ΔE CIELab formula and NBS systems) were measured after 7, 14, 21, 30, 60, 90, 180, and 270 days. The factors of variations analyzed were material, solutions, and time of immersion. Statistical analysis used three-way ANOVA and Tukey tests (Ra), and repeated measure ANOVA (ΔE and NBS systems), P< 0.05. RESULTS: For Ra analysis, the variations occurred regardless of time and solution, as the white liner showed the greatest changes (P< 0.001). Regarding interactions between solution and time, in the period of 21 days until 270 days, Ra was equivalent for all solutions (P= 0.001). ΔE analysis showed a difference between solutions (P= 0.000) and interaction between time and solution (P= 0.000). For the transparent liner, the greatest changes were found for 1% SH after 60 days, however, at 270 days there was a color change equivalence with 0.5% SH, while 4% acetic acid solution showed intermediate values. For the white liner, 1% SH showed the highest color changes for all evaluated times, and the other evaluated solutions were similar after 270 days. For both resilient liners, 0.25% SH showed the smallest changes for the evaluated properties. CLINICAL SIGNIFICANCE: The changes found were dependent on the concentration of the solution used, as well as the length of exposure to the solution. In addition, the white resilient liner showed to be less susceptible to color changes. For both resilient liners, 0.25% sodium hypochlorite showed the least changes for the evaluated properties.

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OBJECTIVES: This work sought to formulate photocrosslinkable chlorhexidine (CHX)-laden methacrylated gelatin (CHX/GelMA) hydrogels with broad spectrum of action against endodontic pathogens as a clinically viable cell-friendly disinfection therapy prior to regenerative endodontics procedures. METHODS: CHX/GelMA hydrogel formulations were successfully synthesized using CHX concentrations between 0.12 % and 5 % w/v. Hydrogel microstructure was evaluated by scanning electron microscopy (SEM). Swelling and enzymatic degradation were assessed to determine microenvironmental effects. Compression test was performed to investigate the influence of CHX incorporation on the hydrogels' biomechanics. The antimicrobial and anti-biofilm potential of the formulated hydrogels were assessed using agar diffusion assays and a microcosms biofilm model, respectively. The cytocompatibility was evaluated by exposing stem cells from human exfoliated deciduous teeth (SHEDs) to hydrogel extracts (i.e., leachable byproducts obtained from overtime hydrogel incubation in phosphate buffer saline). The data were analyzed using One- and Two-way ANOVA and Tukey's test (α = 0.05). RESULTS: CHX/GelMA hydrogels were effectively prepared. NMR spectroscopy confirmed the incorporation of CHX into GelMA. The addition of CHX did not change the micromorphology (pore size) nor the swelling profile (p > 0.05). CHX incorporation reduced the degradation rate of the hydrogels (p < 0.001); whereas, it contributed to increased compressive modulus (p < 0.05). Regarding the antimicrobial properties, the incorporation of CHX showed a statistically significant decrease in the number of bacteria colonies at 0.12 % and 0.5 % concentration (p < 0.001) and completely inhibited the growth of biofilm at concentration levels 1 %, 2 %, and 5 %. Meanwhile, the addition of CHX, regardless of the concentration, did not lead to cell toxicity, as cell viability values were above 70 %. SIGNIFICANCE: The addition of CHX into GelMA showed significant antimicrobial action against the pathogens tested, even at low concentrations, with the potential to be used as a cell-friendly injectable drug delivery system for root canal disinfection prior to regenerative endodontics.

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The purpose of this study was two-fold: (i) to investigate whether the thermal treatment of direct dental resin composites (RCs) using microwave or autoclave heating cycles would modify the materials' strength as compared to the protocol without heating (control); and (ii) to compare the mechanical performance of direct and indirect RCs. Three RCs (from 3M ESPE) were tested: one indirect (Sinfony); and two direct materials (microhybrid - Filtek Z250; and nanofilled - Filtek Z350). Specimens from the direct RCs were prepared and randomly allocated into three groups according to the thermal treatment (n = 10): Control - no thermal treatment was performed; Microwave - the wet heating was performed using a microwave oven; and Autoclave - the wet heating was performed in an autoclave oven. The indirect RC was prepared following the instructions of the manufacturer. All materials were tested using flexural strength, elastic modulus, work of fracture (Wf), microhardness, and scanning electron microscopy (SEM) analyses. Data were analyzed with ANOVA and Tukey as well as Weibull analysis (α = 0.05). The thermal treatments tended to produce slight changes in the topography of direct RCs, especially by the autoclave' wet heating. Overall, the physico-mechanical properties changed after thermal treatment, although this effect was dependent on the type of RC and on the heating protocol. Sinfony showed the lowest modulus and hardness of the study, although it was the most compliant system (higher work of fracture). The load-deflection ability was also greater for the indirect RC. Reliability of the tested materials was similar among each other (p > 0.05). In conclusion, the alternative thermal treatments suggested here may significantly influence some aspects of the mechanical behavior of dental resin composites, with negative effects relying on both the chemical composition of the restorative material as well as on the wet heating protocol used. Clinicians should be aware of the possible effects that additional wet heating of direct resin composites using microwave or autoclave thermal protocols as performed here could have on the overall fracture and mechanical responses during loading circumstances.

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OBJECTIVES: This study aimed to evaluate the effects of nanohydroxyapatite (nHAp) particles on the morphological, chemical, physical, and biological properties of chitosan electrospun nanofibers. MATERIALS AND METHODS: nHAp particles with a 1.67 Ca/P ratio were synthesized via the aqueous precipitation method, incorporated into chitosan polymer solution (0.5 wt%), and electrospun into nHAp-loaded fibers (ChHa fibers). Neat chitosan fibers (nHAp-free, Ch fibers) were used as the control. The electrospun fiber mats were characterized using morphological, topographical, chemical, thermal, and a range of biological (antibacterial, antibiofilm, cell viability, and alkaline phosphatase [ALP] activity) analyses. Data were analyzed using ANOVA and Tukey's test (α = 0.05). RESULTS: ChHa fibers demonstrated a bead-like morphology, with thinner (331 ± 110 nm) and smoother (Ra = 2.9 ± 0.3 µm) distribution as compared to the control fibers. Despite showing similar cell viability and ALP activity to Ch fibers, the ChHa fibers demonstrated greater antibacterial potential against most tested bacteria (except for P. intermedia), and higher antibiofilm activity against P. gingivalis biofilm. CONCLUSIONS: The incorporation of nHAp particles did not jeopardize the overall morphology, topography, physical, and biological characteristics of the chitosan nanofibers. CLINICAL RELEVANCE: The combination of nHAp particles with chitosan can be used to engineer bioactive, electrospun composite nanofibers with potential applications in regenerative dentistry.

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Despite all the advances in adhesive dentistry, dental bonds are still fragile due to degradation events that start during application of adhesive agents and the inherent hydrolysis of resin-dentin bonds. Here, we combined two outstanding processing methods (electrospinning and cryomilling) to obtain bioactive (antimicrobial and anti-metalloproteinase) fiber-based fillers containing a potent matrix metalloproteinase (MMP) inhibitor (doxycycline, DOX). Poly(ε)caprolactone solutions containing different DOX amounts (0, 5, 25, and 50 wt%) were processed via electrospinning, resulting in non-toxic submicron fibers with antimicrobial activity against Streptococcus mutans and Lactobacillus. The fibers were embedded in a resin blend, light-cured, and cryomilled for the preparation of fiber-containing fillers, which were investigated with antibacterial and in situ gelatin zymography analyzes. The fillers containing 0, 25, and 50 wt% DOX-releasing fibers were added to aliquots of a two-step, etch-and-rinse dental adhesive system. Mechanical strength, hardness, degree of conversion (DC), water sorption and solubility, bond strength to dentin, and nanoleakage analyses were performed to characterize the physico-mechanical, biological, and bonding properties of the modified adhesives. Statistical analyses (ANOVA; Kruskal-Wallis) were used when appropriate to analyze the data (α = 0.05). DOX-releasing fibers were successfully obtained, showing proper morphological architecture, cytocompatibility, drug release ability, slow degradation profile, and antibacterial activity. Reduced metalloproteinases (MMP-2 and MMP-9) activity was observed only for the DOX-containing fillers, which have also demonstrated antibacterial properties against tested bacteria. Adhesive resins modified with DOX-containing fillers demonstrated greater DC and similar mechanical properties as compared to the fiber-free adhesive (unfilled control). Concerning bonding performance to dentin, the experimental adhesives showed similar immediate bond strengths to the control. After 12 months of water storage, the fiber-modified adhesives (except the group consisting of 50 wt% DOX-loaded fillers) demonstrated stable bonds to dentin. Nanoleakage was similar among all groups investigated. DOX-releasing fibers showed promising application in developing novel dentin adhesives with potential therapeutic properties and MMP inhibition ability; antibacterial activity against relevant oral pathogens, without jeopardizing the physico-mechanical characteristics; and bonding performance of the adhesive.

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AIM: The present study aimed to investigate the total number of visits required to conclude root canal treatments (RCTs) as well as the motivations associated to the choice of dentists practicing in low-income areas of Brazil. MATERIALS AND METHODS: A total of 3,103 questionnaires were electronically and individually delivered to professionals of Salvador, Sergipe, and Alagoas (Brazil). The questionnaire encompassed sociodemographic data and questions regarding the number of sessions required to conclude RCT. Also, postoperative pain, professional qualification, the use of technological resources, and time for one-visit treatment were evaluated. Data were analyzed using Chi-square and Poisson regression analyses (p < 0.05). RESULTS: A total of 326 responses were obtained with higher prevalence of specialists in the field of endodontics (36.8%). Dentists reported greater preference for rotary instrumentation (Alagoas 54.6%, Aracaju 62.1%, and Salvador 83.5%), and most of the participants reported multiple visits to treat root canals with the necrotic pulp tissue associated or not to periapical radiolucency, excluding Salvador (53.8%). Dentists who graduated in public dental schools were less likely to perform RCT of necrotic teeth with periapical lesion in one clinical appointment (p = 0.034). The single-session therapy was positively associated to continuing education attendance (p = 0.004) and to the occurrence of clinical complications (p < 0.001). Dentists who graduated in lato sensu programs were more likely to conclude RCT in less than 60 minutes (p < 0.001), although the occurrence of postoperative pain was more likely observed upon this scenario (p < 0.001). CONCLUSION: Despite the social inequalities in the analyzed area, professionals have been seeking for knowledge by means of continuing education programs and the implementation of technological resources in their clinical routine, although this fact has poorly influenced the acceleration of RCT. Clinical significances: The total number of visits to conclude endodontic treatment may be influenced by both professional and biological parameters such as the attendance to postgraduation programs and the use of technology as well as to the biological condition of the pulp and the occurrence of postoperative complications.

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INTRODUCTION: This review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP). METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded. RESULTS: A total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)2-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)2- and CHX-based formulations) seemed to present dubious importance in the control of infection. CONCLUSIONS: TAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.

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This study aimed to synthesize and characterize non-woven acrylonitrile butadiene styrene (ABS), polyamide-6 (P6), and polystyrene (PS) nanofibers, and evaluate their effects on the flexural strength and fracture resistance of fiber-modified polymethyl methacrylate (PMMA) resin. ABS, P6, and PS polymer solutions were prepared and electrospun into fiber mats, which were characterized by means of morphological, chemical, physical, and mechanical analyses. The fiber mats were then used to modify a thermally-activated PMMA resin, resulting in four testing groups: one unmodified group (control) and three fiber-modified groups incorporated with ABS, P6, or PS fiber mats. Flexural strength, work of fracture, and fractographic analysis were performed for all groups. Data were analyzed using Kruskal-Wallis or ANOVA tests (α = 0.05). The fiber diameter decreased, respectively, as follows: ABS > P6 > PS. Only the P6 fiber mats demonstrated a crystalline structure. Wettability was similar among the distinct fiber mats, although tensile strength was significantly greater for P6, followed by ABS, and then PS mats. Flexural strength of the fiber-modified PMMA resins was similar to the control, except for the weaker P6-based material. The work of fracture seemed to be greater and lower when the P6 and PS fibers were used, respectively. The fiber-modified groups exhibited a rougher pattern in the fractured surfaces when compared to the control, which may suggest that the presence of fibers deviates the direction of crack propagation, making the fracture mechanism of the PMMA resin more dynamic. While the neat PMMA showed a typical brittle response, the fiber-modified PMMA resins demonstrated a ductile response, combined with voids, suggesting large shear deformation during fracture. Altogether, despite the lack of direct reinforcement in the mechanical strength of the PMMA resin, the use of electrospun fibers showed promising application for the improvement of fracture behavior of PMMA resins, turning them into more compliant materials, although this effect may depend on the fiber composition.

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PURPOSE OF REVIEW: To present an overview on the main agents (i.e., biomolecules and nanocompounds) and/or strategies currently available to amplify or stabilize resin-dentin bonding. RECENT FINDINGS: According to studies retrieved for full text reading (2014-2017), there are currently six major strategies available to overcome resin-dentin bond degradation: (i) use of collagen crosslinking agents, which may form stable covalent bonds with collagen fibrils, thus strengthening the hybrid layer; (ii) use of antioxidants, which may allow further polymerization reactions over time; (iii) use of protease inhibitors, which may inhibit or inactivate metalloproteinases; (iv) modification of the bonding procedure, which may be performed by using the ethanol wet-bonding technique or by applying an additional adhesive (hydrophobic) coating, thereby strengthening the hybrid layer; (v) laser treatment of the substrate prior to bonding, which may cause specific topographic changes in the surface of dental substrates, increasing bonding efficacy; and (vi) reinforcement of the resin matrix with inorganic fillers and/or remineralizing agents, which may positively enhance physico-mechanical properties of the hybrid layer. SUMMARY: With the present review, we contributed to the better understanding of adhesion concepts and mechanisms of resin-dentin bond degradation, showing the current prospects available to solve that problematic. Also, adhesively-bonded restorations may be benefited by the use of some biomolecules, nanocompounds or alternative bonding strategies in order to minimize bond strength degradation.

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OBJECTIVES: This study reports on the synthesis, materials characterization, antimicrobial capacity, and cytocompatibility of novel ZnO-loaded membranes for guided tissue/bone regeneration (GTR/GBR). METHODS: Poly(ɛ-caprolactone) (PCL) and PCL/gelatin (PCL/GEL) were dissolved in hexafluoropropanol and loaded with ZnO at distinct concentrations: 0 (control), 5, 15, and 30wt.%. Electrospinning was performed using optimized parameters and the fibers were characterized via scanning and transmission electron microscopies (SEM/TEM), energy dispersive X-ray spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR), contact angle (CA), mechanical testing, antimicrobial activity against periodontopathogens, and cytotoxicity test using human dental pulp stem cells (hDPSCs). Data were analyzed using ANOVA and Tukey (α=5%). RESULTS: ZnO nanoparticles were successfully incorporated into the overall submicron fibers, which showed fairly good morphology and microstructure. Upon ZnO nanoparticles' incorporation, the PCL and PCL/GEL fibers became thicker and thinner, respectively. All GEL-containing membranes showed lower CA than the PCL-based membranes, which were highly hydrophobic. Overall, the mechanical properties of the membranes were reduced upon ZnO incorporation, except for PCL-based membranes containing ZnO at the 30wt.% concentration. The presence of GEL enhanced the stretching ability of membranes under wet conditions. All ZnO-containing membranes displayed antibacterial activity against the bacteria tested, which was generally more pronounced with increased ZnO content. All membranes synthesized in this study demonstrated satisfactory cytocompatibility, although the presence of 30wt.% ZnO led to decreased viability. SIGNIFICANCE: Collectively, this study suggests that PCL- and PCL/GEL-based membranes containing a low content of ZnO nanoparticles can potentially function as a biologically safe antimicrobial GTR/GBR membrane.

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Composite resins may undergo wear by the action of chemical substances (e.g., saliva, alcohol, bacterial acids) of the oral environment, which may affect the material's structure and surface properties. This study evaluated the effect of acidic substances on the surface properties of a micro-hybrid composite resin (Filtek Z-250). Eighty specimens were prepared, and baseline hardness and surface roughness (KMN0 and Ra0, respectively) were measured. The specimens were subjected to sorption (SO) and solubility (SL) tests according to ISO 4049:2009, but using different storage solutions: deionized water; 75/25 vol% ethanol/water solution; lactic acid; propionic acid; and acetic acid. The acids were used in two concentrations: PA and 0.02 N. pH was measured for all solutions and final hardness (KMN1) and surface roughness (Ra1) were measured. Data were analyzed with paired t-tests and one-way ANOVA and Tukey's test (a=5%). All solutions decreased hardness and increased the Ra values, except for the specimens stored in water and 0.02 N lactic acid, which maintained the hardness. All solutions produced similar SO and SL phenomena, except for the 0.02 N lactic acid, which caused lower solubility than the other solutions. Ethanol showed the highest pH (6.6) and the 0.02 N lactic acid the lowest one (2.5). The solutions affected negatively the surface properties of the composite resin; in addition, an acidic pH did not seem to be a significant factor that intensifies the surface degradation phenomena.

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Composite resins may undergo wear by the action of chemical substances (e.g., saliva, alcohol, bacterial acids) of the oral environment, which may affect the material's structure and surface properties. This study evaluated the effect of acidic substances on the surface properties of a micro-hybrid composite resin (Filtek Z-250). Eighty specimens were prepared, and baseline hardness and surface roughness (KMN0 and Ra0, respectively) were measured. The specimens were subjected to sorption (SO) and solubility (SL) tests according to ISO 4049:2009, but using different storage solutions: deionized water; 75/25 vol% ethanol/water solution; lactic acid; propionic acid; and acetic acid. The acids were used in two concentrations: PA and 0.02 N. pH was measured for all solutions and final hardness (KMN1) and surface roughness (Ra1) were measured. Data were analyzed with paired t-tests and one-way ANOVA and Tukey's test (a=5%). All solutions decreased hardness and increased the Ra values, except for the specimens stored in water and 0.02 N lactic acid, which maintained the hardness. All solutions produced similar SO and SL phenomena, except for the 0.02 N lactic acid, which caused lower solubility than the other solutions. Ethanol showed the highest pH (6.6) and the 0.02 N lactic acid the lowest one (2.5). The solutions affected negatively the surface properties of the composite resin; in addition, an acidic pH did not seem to be a significant factor that intensifies the surface degradation phenomena.

Resinas compostas podem sofrer desgaste pela ação de substâncias químicas (saliva, álcool, ácidos bacterianos) presentes no ambiente oral, que podem afetar a estrutura e as propriedades superficiais do material. Assim, este estudo avaliou o efeito de substâncias ácidas nas propriedades superficiais de uma resina composta micro-híbrida (Filtek Z-250). Oitenta espécimes foram preparados e mensurados quanto à dureza e rugosidade superficial iniciais (KMN0 e Ra0, respectivamente). Os espécimes foram submetidos a testes de sorção (SO) e solubilidade (SL) de acordo com a ISO 4049:2009, porém usando diferentes soluções de armazenamento: água deionizada, solução etanol/água 75/25% em volume, ácido lático, ácido propiônico e ácido acético. Os ácidos foram utilizados em duas concentrações: PA e 0,02 N. O pH foi mensurado para todas as soluções e a dureza e rugosidade superficial finais (KMN1 e Ra1, respectivamente) foram mensuradas. Os dados foram analisados com testes t-pareado e ANOVA a um fator, e teste de Tukey (p<0,05). Todas as soluções reduziram a dureza e aumentaram os valores de Ra, exceto para os espécimes armazenados em água e ácido lático 0,02 N, que mantiveram a dureza. Todas as soluções produziram fenômenos de SO e SL similares, exceto o ácido lático 0,02 N, que causou menor solubilidade do que as outras soluções. Etanol mostrou o maior pH (6,6) e o ácido lático 0,02 N o menor deles (2,5). As soluções afetaram negativamente as propriedades superficiais da resina composta; além disso, um pH ácido não parece ser um fator significante para intensificar os fenômenos de degradação superficial.

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The ethyl-4-dimethylaminobenzoate (EDAB) is widely used as a coinitiator of the camphorquinone (CQ), but in acidic circumstances it might present some instability, reducing the polymerization efficiency of the material. Considering this, new coinitiators are being evaluated. Hence, this study evaluated the kinetic of polymerization (KP), the degree of conversion (DC), and the rate of polymerization (RP ) of experimental resin adhesives containing 1,3-diethyl-2-thiobarbituric acid (TBA) as a coinitiator of the CQ. The experimental monomeric blend was prepared with bisphenol A glycidyl dimethacrylate, 2-hydroxyethyl methacrylate, and acidic monomers. CQ was added at 1 mol % as photoinitiator. Six groups were formulated: four containing concentrations of 0.1, 0.5, 1, and 2 mol % of TBA, one without coinitiator, and the last one containing 1 mol % of EDAB (control group). The KP and the RP were performed using real-time Fourier Transform infrared spectroscopy. The group without coinitiator has not formed a polymer, whereas the addition of TBA resulted in the conversion of monomers in polymer. The DC of the adhesives was as higher as the increase in the TBA content. The group with 2 mol % of TBA presented improved DC and reactivity (RP ) than the other groups and the control one. Hence, the TBA has performed as a coinitiator of the CQ for the radical polymerization of methacrylate resin adhesives and it has improved the DC and the reactivity of the materials. Thus, it is a potential coinitiator for the photopolymerization of dental materials.

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