Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: Preliminary results

Objective: To evaluate the effect of early fetoscopictracheal occlusion (FETO) (22–24 weeks’ gestation) onpulmonary response and neonatal survival in cases ofextremely severe isolated congenital diaphragmatic hernia(CDH). Methods: This was a multicenter study involving fetuseswith extremely severe CDH (lung-to-head ratio < 0.70,liver herniation into the thoracic cavity and no otherdetectable anomalies). Between August 2010 and December 2011, eight fetuses underwent early FETO. Datawere compared with nine fetuses that underwent standard FETO and 10 without fetoscopic procedure fromJanuary 2006 to July 2010. FETO was performed undermaternal epidural anesthesia, supplemented with fetalintramuscular anesthesia. Fetal lung size and vascularitywere evaluated by ultrasound before and every 2 weeksafter FETO. Postnatal therapy was equivalent for bothtreated fetuses and controls. Primary outcome was infantsurvival to 180 days and secondary outcome was fetalpulmonary response. Results: Maternal and fetal demographic characteristicsand obstetric complications were similar in the threegroups (P > 0.05). Infant survival rate was significantlyhigher in the early FETO group (62.5%) comparedwith the standard group (11.1%) and with controls(0%) (P < 0.01). Early FETO resulted in a significantimprovement in fetal lung size and pulmonary vascularitywhen compared with standard FETO (P < 0.01). Conclusions: Early FETO may improve infant survival byfurther increases of lung size and pulmonary vascularityin cases with extremely severe pulmonary hypoplasia inisolated CDH. This study supports formal testing of thehypothesis with a randomized controlled trial.

Reestablishment of occlusion with prosthesis and composite resin restorations

Here, we present a case report on prosthetic reconstruction of posterior teeth and composite resin restoration of anterior teeth yielding considerable esthetic improvement, reestablishment of disocclusion guides and function.

Multi-step adhesive cementation versus one-step adhesive cementation: push-out bond strength between fiber post and root dentin before and after mechanical cycling

This study evaluated the effects of mechanical cycling on resin push-out bond strength to root dentin, using two strategies for fiber post cementation. Forty bovine roots were embedded in acrylic resin after root canal preparation using a custom drill of the fiber post system. The fiber posts were cemented into root canals using two different strategies (N = 20): a conventional adhesive approach using a three-step etch-and-rinse adhesive system combined with a conventional resin cement (ScotchBond Multi Purpose Plus + RelyX ARC ), or a simplified adhesive approach using a self-adhesive resin cement (RelyX U100). The core was built up with composite resin and half of the specimens from each cementation strategy were submitted to mechanical cycling (45 degree angle; 37 degrees C; 88 N; 4 Hz; 700,000 cycles). Each specimen was cross-sectioned and the disk specimens were pushed-out. The means from every group (n = 10) were statistically analyzed using a two-way ANOVA and a Tukey test (P = 0.05). The cementation strategy affected the push-out results (P < 0.001), while mechanical cycling did not (P = 0.3716). The simplified approach (a self-adhesive resin cement) had better bond performance despite the conditioning. The self-adhesive resin cement appears to be a good option for post cementation. Further trials are needed to confirm these results.

Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target?

Composite restorations have higher failure rates, more recurrent caries and increased frequency of replacement as compared to dental amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and failure. The gingival margin of composite restora tions is particularly vulnerable to decay and at this margin, the adhesive and its seal to dentin provides the primary barrier between the prepared tooth and the environment. The intent of this article is to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Dentin bond strength: influence of Er:YAG and Nd:YAG lasers

The aim of this study was to investigate the effects of Er:YAG and Nd:YAG lasers on the shear bond strength of composite resin to dentin. The coronal portion of 56 human molars was divided into three parts, and the dentin thickness was standardized at 2 mm. A 3-mm hole was marked in the center of each tooth with sealing tape paper. The specimens (n = 14) were then divided into four groups: (1) acid etching + Single Bond (SB) (control), (2) acid etching + SB + Nd:YAG laser irradiation (before adhesive curing), (3) thermal etching with the Er:YAG laser + SB, and (4) thermal etching with the Er:YAG laser + SB + Nd:YAG laser irradiation (before adhesive curing). A composite resin cylinder was built into the delimited area for conducting the shear bond strength test on the universal testing machine. The means ± standard deviations were: group 1, 17.05 ± 4.15 MPa; group 2, 16.90 ± 3.36 MPa; group 3, 12.12 ± 3.85 MPa; and group 4, 12.92 ± 2.73 MPa. Groups 1 and 2 presented significantly higher values than groups 3 and 4. It was concluded that conventional etching with 37% phosphoric acid yielded significantly higher bond strength values compared to thermal etching with the Er:YAG laser. The Nd:YAG laser did not significantly influence the bond strength.

Effects of dental bleaching on the color, translucency and fluorescence properties of enamel and dentin

The objective of this study was to evaluate the color, translucency and fluorescence of bovine enamel and dentin submitted to different bleaching modalities. Pairs of enamel and dentin discs (3 mm in diameter) were obtained from 150 bovine teeth. In 75 of the pairs, one specimen had the enamel removed (Dentin Group). The dentin was removed from one specimen of the remaining 75 pairs (Enamel Group) and the other specimen was left unaltered (Enamel + Dentin). The evaluation of color, translucency and fluorescence was performed with a spectrophotometer using the CIE L* a* b*. Each group was subdivided into three subgroups: Control, composed of specimens that were not bleached, and two experimental subgroups, bleached with either 10% carbamide peroxide (CP10%) or 35% hydrogen peroxide (HP35%). The CP10% bleaching gel was applied 2 h/day for 14 days. The HP35% bleaching agent was applied using two applications of 30 min each, with a one week interval between each application. When not being bleached, the specimens were immersed in artificial saliva. The color, translucency and fluorescence ratings were assessed using spectrophotometry 7 days after the treatment. Regarding color, significant differences were found between bleaching techniques in the groups Enamel and Enamel + Dentin, with a higher color difference for HP35%. Bleaching did not change the translucency of the dental tissues. There were significant differences for fluorescence for the HP35% subgroups of Dentin and Enamel + Dentin, and for the CP10% subgroup of Enamel. Dental bleaching changed the color and fluorescence of the dental tissues, however translucency was not affected.

Effect of collagen matrix saturation on the surface free energy of dentin using different agents

The surface free energy of conditioned-dentin is one of the factors that interfere with monomeric infiltration of the interfibrillar spaces. Saturation of the tooth matrix with different substances may modulate this energy and, consequently, the wettability of the dentin. To evaluate the influence of different substances used to saturate conditioned-dentin on surface free energy (SFE) of this substrate. Dentin blocks (4 × 7 × 1 mm, n = 6/ group), obtained from the roots of bovine incisors, were etched using phosphoric acid for 15 seconds, rinsed and gently dried. The surfaces were treated for 60 seconds with: ultra-purified water (H20-control); ethanol (EtOH), acetone (ACT), chlorhexidine (CHX), ethylenediaminetetraacetic acid (EDTA); or sodium hypochlorite (NaOCl). The tooth surfaces were once again dried with absorbent paper and prepared for SFE evaluation using three standards: water, formamide and bromonaphthalene. Analysis of variance (ANOVA) and Dunnet's tests (a = 0.05) were applied to the data. Ethylenediaminetetraacetic acid was the only substance that caused a change to the contact angle for the standards water and formamide, while only EtOH influenced the angles formed between formamide and the dentin surface. None of the substances exerted a significant effect for bromonaphtha-lene. In comparison to the control, only EDTA and NaOCl altered both polar components of the SFE. Total SFE was increased by saturation of the collagen matrix by EDTA and reduced when NaOCl was used. Saturation of the collagen matrix by EDTA and EtOH changed the surface free energy of the dentin. In addition, the use of NaOCl negatively interfered with the properties evaluated. The increase of surface free energy and wettability of the dentin surface would allow higher penetration of the the adhesive system, which would be of importance to the clinical success of resin-dentin union.

Homogenous demineralized dentin matrix and platelet-rich plasma for bone tissue engineering in cranioplasty of diabetic rabbits: biochemical, radiographic, and histological analysis

This study evaluated the effects of homogenous demineralized dentin matrix (HDDM) slices and platelet-rich plasma (PRP) in surgical defects created in the parietal bones of alloxan-induced diabetic rabbits, treated with a guided bone regeneration technique. Biochemical, radiographic, and histological analyses were performed. Sixty adult New Zealand rabbits were divided into five groups of 12: normoglycaemic (control, C), diabetic (D), diabetic with a PTFE membrane (DM), diabetic with a PTFE membrane and HDDM slices (DM-HDDM), and diabetic with PTFE membrane and PRP (DM-PRP). The quantity and quality of bone mass was greatest in the DM-HDDM group (respective radiographic and histological analyses: at 15 days, 71.70±16.50 and 50.80±1.52; 30 days, 62.73±16.51 and 54.20±1.23; 60 days, 63.03±11.04 and 59.91±3.32; 90 days, 103.60±24.86 and 78.99±1.34), followed by the DM-PRP group (respective radiographic and histological analyses: at 15 days 23.00±2.74 and 20.66±7.45; 30 days 31.92±6.06 and 25.31±5.59; 60 days 25.29±16.30 and 46.73±2.07; 90 days 38.10±14.04 and 53.38±9.20). PRP greatly enhanced vascularization during the bone repair process. Abnormal calcium metabolism was statistically significant in the DM-PRP group (P<0.001) for all four time intervals studied, especially when compared to the DM-HDDM group. Alkaline phosphatase activity was significantly higher in the DM-HDDM group (P<0.001) in comparison to the C, D, and DM-PRP groups, confirming the findings of intense osteoblastic activity and increased bone mineralization. Thus, HDDM promoted superior bone architectural microstructure in bone defects in diabetic rabbits due to its effective osteoinductive and osteoconductive activity, whereas PRP stimulated angiogenesis and red bone marrow formation.

Influence of Nd:YAG laser on intrapulpal temperature and bond strength of human dentin under simulated pulpal pressure

The aim of this study was to evaluate the effects of simulated pulpal pressure (SPP) on the variation of intrapulpal temperature (ΔT) and microtensile bond strength (μTBS) to dentin submitted to an adhesive technique using laser irradiation. One hundred sound human molars were randomly divided into two groups (n = 50), according to the presence or absence of SPP (15 cm H2O). Each group was divided into five subgroups (n = 10) according to Nd:YAG laser energy (60, 80, 100, 120, 140 mJ/pulse). The samples were sequentially treated with the following: 37 % phosphoric acid, adhesive (Scotchbond Universal), irradiation with Nd:YAG laser (60 s), and light curing (10 s). ΔT was evaluated during laser irradiation using a type K thermocouple. Next, a composite resin block was build up onto the irradiated area. After 48 h, samples were submitted to microtensile test (10 kgf load cell, 0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey tests (p = 0.05). ANOVA revealed significant differences for ΔT and TBS in the presence of SPP. For ΔT, the highest mean (14.3 ± 3.23 °C)(A) was observed in 140 mJ and without SPP. For μTBS, the highest mean (33.4 ± 4.15 MPa)(A) was observed in 140 mJ and without SPP. SPP significantly reduced both ΔT and μTBS during adhesive procedures, lower laser energy parameters resulted in smaller ΔT, and the laser parameters did not influence the μTBS values.

Effect of peroxide bleaching on the biaxial flexural strength and modulus of bovine dentin

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of light-activation on the antibacterial activity of dentin bonding agents

Aim: This study evaluated the effect of light-activation on the antibacterial activity of dentin bonding systems. Methods: Inocula of Streptococcus mutans and Lactobacillus casei cultures were spread on the surface of BHI agar and the materials were applied and subjected or not to light-activation. Zones of bacterial growth inhibition around the discs were measured. Results: Excite, Single Bond and the bond of Clearfil SE Bond (SE) and Clearfil Protect Bond (CP) did not show any antibacterial activity. The strongest inhibitory activity was observed for the primers of CP and Prompt (PR) against S. mutans and the primers of SE and PB against L. casei. Conclusion: Light-activation significantly reduced or suppressed the antibacterial activity of the initially active uncured dentin bonding systems.