Continuous torque system with control of the reaction unit

This article describes an orthodontic system used to obtain active continuous torque with movement control of both active and reactive units; the system relies on principles of the segmented technique. A cantilever system with .017 x .025-in beta-titanium alloy wire was designed to provide the desirable moment on the active unit. A transpalatal bar or a lingual arch increases the anchorage and neutralizes the side effects on the reactive unit. This technique is an efficient approach for major corrections of buccolingual inclinations of certain teeth. © 2010 American Association of Orthodontists.

Effect of toothbrushing with different manual toothbrushes on the shear bond strength of orthodontic brackets

The aim of this study was to evaluate the effect of brushing with a Colgate 360° or Oral B Indicator 35 toothbrush on the shear bond strength of orthodontic brackets bonded to extracted human teeth. The bristle wear and bristle tip morphology were also examined after simulated tooth-brushing. Orthodontic brackets (Roth-P/1 st and 2 nd pre-molar S/D- Slot 0.18) were bonded (Transbond XT ®) to the smoothest surface of each of 45 extracted human molar and premolar teeth. Test specimens were randomly divided into three groups: Group 1, control group with no brushing; Group 2, brushing with the Oral B Indicator 35; Group 3, brushing with the Colgate 360°. Samples were adapted to a machine that simulated tooth-brushing. The bond strength of each bracket to each tooth was assessed with a mechanical testing machine. The bristle wear and bristle tip morphology indices were also assessed. Statistically significant differences were defined for p ≤ 0.05. The average bond strengths (range: 90.18-90.89 kgf/cm 2) did not differ among the three groups. The Colgate 360° showed less bristle wear and a better bristle tip morphology than the Oral B Indicator 35 toothbrush. However, use of either toothbrush did not decrease the bond strength of the orthodontic brackets. Therefore, patients undergoing orthodontic therapy can safely use either toothbrush.

Effect of surface treatments on the bond strength of a resin cement to commercially pure titanium

Investigation of the effectiveness of surface treatments that promote a strong bond strength of resin cements to metals can contribute significantly to the longevity of metal-ceramic restorations. This study evaluated the effect of surface treatments on the shear bond strength (SBS) of a resin cement to commercially pure titanium (CP Ti). Ninety cast CP Ti discs were divided into 3 groups (n=30), which received one of the following airborne-particle abrasion conditions: (1) 50 μm Al2O3 particles; (2) 30 μm silica-modified Al2O3 particles (Cojet Sand); (3) 110 μm silica-modified Al2O3 particles (Rocatec). For each airborne-particle abrasion condition, the following post-airborne-particle abrasion treatments were used (n=10): (1) none; (2) adhesive Adper Single Bond 2; (3) silane RelyX Ceramic Primer. RelyX ARC resin cement was bonded to CP Ti surfaces. All specimens were thermally cycled before being tested in shear mode. Failure mode was determined. The best association was Rocatec plus silane. All groups showed 100% adhesive failure. There were combinations that promote higher SBS than the protocol recommended by the manufacturer of RelyX ARC.

Effects of five carbamide peroxide bleaching gels on composite resin microhardness.

The purpose of this study was to evaluate the effects of five home bleaching products containing 15-16% carbamide peroxide on the microhardness of microhybrid composite resin Z-250 (3M/Espe). A total of 72 specimens were fabricated in cylindrical acrylic matrices (4 x 2 mm), filled with composite resin and photo-activated for 40 seconds. They were divided in 6 study groups (n = 12), according to the bleaching product: Review (SS White), Magic Bleaching (Vigodent), Opalescence (Ultradent), Whiteness Perfect (FGM), Claridex (Biodinâmica), and a control group (not bleached). Specimens were exposed to 1 cc of bleaching gel for 6 hours daily for 2 weeks. The control group specimens were kept in artificial saliva throughout this time. All the specimens were then analyzed in a microhardness tester. Knoop hardness measurements were performed, and the results were submitted to parametric statistical analysis (analysis of variance and Tukey's test). Mean Knoop values and standard deviation were: baseline, 68.52a (4.28); control, 63.42b (7.16); Whiteness Perfect, 57.57c (1.81); Magic Bleaching, 57.22c (3.84); Opalescence, 57.03cd (4.00); Claridex, 53.64de (3.33); Review 51.45e (2.82). Identical letters mean statistical equality according to Tukey's test at the 5% significance level. The products significantly decreased Z-250 (3M/Espe) microhardness.

Bond strength of a composite resin to an adhesive luting cement

This study evaluated the influence of surface treatment on the shear bond strength of a composite resin (CR), previously submitted to the application of a temporary cement (TC), to an adhesive luting cement. Eight-four CR cylinders (5 mm diameter and 3 mm high) were fabricated and embedded in acrylic resin. The sets were divided into 6 groups (G1 to G6) (n=12). Groups 2 to 6 received a coat of TC. After 24 h, TC was removed and the CR surfaces received the following treatments: G2: ethanol; G3: rotary brush and pumice; G4: air-abrasion; G5: air-abrasion and adhesive system; G6: air-abrasion, acid etching and adhesive system. G1 (control) did not receive TC or any surface treatment. The sets were adapted to a matrix and received an increment of an adhesive luting cement. The specimens were subjected to the shear bond strength test. ANOVA and Tukey's tests showed that G3 (8.53 MPa) and G4 (8.63 MPa) differed significantly (p=0.001) from G1 (13.34 MPa). The highest mean shear bond strength values were found in G5 (14.78 MPa) and G6 (15.86 MPa). Air-abrasion of CR surface associated with an adhesive system provided an effective bond of the CR to the adhesive luting cement, regardless the pre-treatment with the phosphoric acid.

Effect of drying on the reproducibility of DIAGNOdent to detect caries-like lesions

The aim of this study was to verify the drying effect on the reproducibility of DIAGNOdent (Dd) devices to detect caries-like lesions. Three areas were created in each of the 34 bovine incisors: sound (S), demineralized (DE) and remineralized (RE). One examiner measured each area with two Dd devices (denominated X and Y), twice under humid, and twice under dry condition. Intra-rater agreement according each device and inter-device agreement were estimated by kappa statistics (κ). Intra-rater agreement for device Y was substantial under humid (κ DE=0.68 and κ RE+S=0.68) and dry condition (κ DE=0.64 and κ RE+S=0.67). For device X, it was substantial under humid condition (κ DE=0.57 and κ RE+S=0.49), and it was almost perfect after air drying (κ DE=1.0 and κRE+S=1.0). Inter-device agreement was slight (κ =0.17) under humid condition, and it was substantial under dry condition (κ =0.62). As reproducibility increased under dry condition, drying is advised to detect caries-like lesions on free smooth surfaces when different devices are used.

Enamel remineralization by fluoride-releasing materials: Proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH 1). Artificial caries lesions were induced and surface microhardness test (SMH 2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer 1/4 diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH 3) was assessed to calculate percent recovery of surface microhardness (%SMH R). Fluoride present in enamel (μg F/mm 3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (ΔZ). There was no significant difference between Z 100 and control groups on analysis performed on - %SMH R, ΔZ, μ F and μ F/mm 3 (p>0.05). Results showed a positive correlation between %SMH R and μg F/mm 3 (r=0.9770; p=0.004), %SMH R and μg F (r=0.9939; p=0.0000001), DZ and μg F/mm 3 (r=0.9853; p=0.0002), ΔZ and μg F (r=0.9975; p=0.0000001) and between μg F/mm 3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Influence of high insertion torque on implant placement - an anisotropic bone stress analysis

The aim of this study was to evaluate the influence of the high values of insertion torques on the stress and strain distribution in cortical and cancellous bones. Based on tomography imaging, a representative mathematical model of a partial maxilla was built using Mimics 11.11 and Solid Works 2010 softwares. Six models were built and each of them received an implant with one of the following insertion torques: 30, 40, 50, 60, 70 or 80 Ncm on the external hexagon. The cortical and cancellous bones were considered anisotropic. The bone/implant interface was considered perfectly bonded. The numerical analysis was carried out using Ansys Workbench 10.0. The convergence of analysis (6%) drove the mesh refinement. Maximum principal stress (σ max) and maximum principal strain (ε max) were obtained for cortical and cancellous bones around to implant. Pearson's correlation test was used to determine the correlation between insertion torque and stress concentration in the periimplant bone tissue, considering the significance level at 5%. The increase in the insertion torque generated an increase in the σ max and ε max values for cortical and cancellous bone. The σmax was smaller for the cancellous bone, with greater stress variation among the insertion torques. The ε max was higher in the cancellous bone in comparison to the cortical bone. According to the methodology used and the limits of this study, it can be concluded that higher insertion torques increased tensile and compressive stress concentrations in the periimplant bone tissue.

Effect of unilateral misfit on preload of retention screws of implant-supported prostheses submitted to mechanical cycling

Purpose: The aim of this study was to evaluate the effect of different levels of unilateral angular misfit on preload maintenance of retention screws of single implant-supported prostheses submitted to mechanical cycling. Materials and methods: Premachined UCLA abutments were cast with cobalt-chromium alloy to obtain 48 crowns divided into four groups (n=12). The crowns presented no misfit in Group A (control group) and unilateral misfits of 50μm, 100μm and 200μm in the groups B, C and D, respectively. The crowns were attached to external hexagon implants with a titanium retention screw with torque of 30N/cm. Oblique loading of 130N at 2Hz was applied on each replica, totalizing 5×104 and 1×106cycles. Detorque values were measured initially and after each cycling period. Data were evaluated by analysis of variance and Tukey's HSD test (p<0.05). Results: All groups presented reduced initial detorque values (p< 0.05) in comparison to the insertion torque (30. ± 0.5. N/cm) and Group A (25.18. N/cm) exhibited the lowest reduction. After mechanical cycling, all groups presented detorque values from 19.5. N/cm to 22.38. N/cm and the mechanical cycling did not statistically influence the detorque values regardless the misfit level of the replicas. Conclusion: The unilateral misfit influenced the preload maintenance only before mechanical cycling. The mechanical cycling did not influence the torque reduction. © 2010 Japan Prosthodontic Society.

Effect of hydrofluoric acid etching duration on the roughness and flexural strength of a lithium disilicate-based glass ceramic

The aim of this study was to examine the effect of different acid etching times on the surface roughness and flexural strength of a lithium disilicate-based glass ceramic. Ceramic bar-shaped specimens (16 mm x 2 mm x 2 mm) were produced from ceramic blocks. All specimens were polished and sonically cleaned in distilled water. Specimens were randomly divided into 5 groups (n=15). Group A (control) no treatment. Groups B-E were etched with 4.9% hydrofluoric acid (HF) for 4 different etching periods: 20 s, 60 s, 90 s and 180 s, respectively. Etched surfaces were observed under scanning electron microscopy. Surface profilometry was used to examine the roughness of the etched ceramic surfaces, and the specimens were loaded to failure using a 3-point bending test to determine the flexural strength. Data were analyzed using one-way ANOVA and Tukey's test (α=0.05). All etching periods produced significantly rougher surfaces than the control group (p<0.05). Roughness values increased with the increase of the etching time. The mean flexural strength values were (MPa): A=417 ± 55; B=367 ± 68; C=363 ± 84; D=329 ± 70; and E=314 ± 62. HF etching significantly reduced the mean flexural strength as the etching time increased (p=0.003). In conclusion, the findings of this study showed that the increase of HF etching time affected the surface roughness and the flexural strength of a lithium disilicate-based glass ceramic, confirming the study hypothesis.

Impact strength of denture base and reline acrylic resins subjected to long-term water immersion

Water may influence the mechanical properties of the acrylic resins. Thus, the effect of water storage on the impact strength (IS) of one denture base (Lucitone 550 - L) and four reline resins (Tokuyama Rebase II - T; UfiGel Hard - U; Kooliner - K; New Truliner - NT) was evaluated. Bars of L were made (60 x 6 x 2 mm) and relined (2 mm) with T, U, K, NT and L. Intact specimens of each material (60 x 6 x 4 mm) were also fabricated for comparative purposes. Specimens were submitted to Charpy impact tests without water storage (control) and after immersion in water for 7, 90 and 180 days. Data (kJ/m 2) analyzed by two-way ANOVA and Tukey's test (p=0.05) revealed that after 90 days, U exhibited an increase in the IS (0.93) compared to 7 days (0.58). K (1.48) and L/K (7.21) exhibited a decrease at the 7-day period (1.01 and 3.23, respectively). NT (0.60) showed an increase in the IS after 180 days (1.52), whereas L/ NT (7.70) showed a decrease (3.17). Water immersion improved the IS of U and NT, and decreased the IS of K, L/K, and L/NT. Water may affect differently the IS of acrylic resins and, consequently, the resistance to fracture of relined denture bases.

Mechanisms of action of fluoride for caries control

Fluoride was introduced into dentistry over 70 years ago, and it is now recognized as the main factor responsible for the dramatic decline in caries prevalence that has been observed worldwide. However, excessive fluoride intake during the period of tooth development can cause dental fluorosis. In order that the maximum benefits of fluoride for caries control can be achieved with the minimum risk of side effects, it is necessary to have a profound understanding of the mechanisms by which fluoride promotes caries control. In the 1980s, it was established that fluoride controls caries mainly through its topical effect. Fluoride present in low, sustained concentrations (sub-ppm range) in the oral fluids during an acidic challenge is able to absorb to the surface of the apatite crystals, inhibiting demineralization. When the pH is re-established, traces of fluoride in solution will make it highly supersaturated with respect to fluorhydroxyapatite, which will speed up the process of remineralization. The mineral formed under the nucleating action of the partially dissolved minerals will then preferentially include fluoride and exclude carbonate, rendering the enamel more resistant to future acidic challenges. Topical fluoride can also provide antimicrobial action. Fluoride concentrations as found in dental plaque have biological activity on critical virulence factors of S. mutans in vitro, such as acid production and glucan synthesis, but the in vivo implications of this are still not clear. Evidence also supports fluoride's systemic mechanism of caries inhibition in pit and fissure surfaces of permanent first molars when it is incorporated into these teeth pre-eruptively. © 2011 S. Karger AG, Basel.

Biaxial flexural strength of CAD/CAM ceramics.

Aim of the study was to evaluate the biaxial flexural strength of ceramics processed using the Cerec inLab system. The hypothesis was that the flexural strength would be influenced by the type of ceramic. Ten samples (ISO 6872) of each ceramic (N.=50/n.=10) were made using Cerec inLab (software Cerec 3D) (Ø:15 mm, thickness: 1.2 mm). Three silica-based ceramics (Vita Mark II [VM], ProCad [PC] and e-max CAD ECAD]) and two yttria-stabilized tetragonal-zirconia-polycrystalline ceramics (Y-TZP) (e-max ZirCad [ZrCAD] and Vita In-Ceram 2000 YZ Cubes [VYZ]) were tested. The samples were finished with wet silicone carbide papers up to 1200-grit and polished in a polishing machine with diamond paste (3 μm). The samples were then submitted to biaxial flexural strength testing in a universal testing machine (EMIC), 1 mm/min. The data (MPa) were analyzed using the Kruskal-Wallis and Dunn (5%) tests. Scanning electronic microscopy (SEM) was performed on a representative sample from each group. The values (median, mean±sd) obtained for the experimental groups were: VM (101.7, 102.1±13.65 MPa), PC (165.2, 160±34.7 MPa), ECAD (437.2, 416.1±50.1 MPa), ZrCAD (804.2, 800.8±64.47 MPa) and VYZ (792.7, 807±100.7 MPa). The type of ceramic influenced the flexural strength values (P=0.0001). The ceramics ECADa, e-max ZrCADa and VYZa presented similar flexural strength values which were significantly higher than the other groups (PCb and VM IIb), which were similar statistically between them (Dunn's test). The hypothesis was accepted. The polycrystalline ceramics (Y-TZP) should be material chosen for make FPDs because of their higher flexural strength values.

Flexibility and torsional resistance of three nickel-titanium retreatment instrument systems

Aim To assess the dimensional characteristics, flexibility and torsional behaviour of nickel-titanium retreatment instruments. Methodology Using image analysis software and high-resolution digital images, the instrument length, tip angle, diameter at 3mm from the tip and the distance between the blades (pitch length) of the following eight instruments were measured (n=12 for each measurement parameter): the ProTaper Universal retreatment (PTU-R) D1, D2 and D3 instruments; the R-Endo R1, R2 and R3 retreatment instruments; and the Mtwo retreatment (Mtwo-R) sizes 25 and 15 retreatment instruments. Maximum torque and the angular deflection at fracture as well as the bending moment at 45° were measured (n=12) according to the International Standards Organisation (ISO) specification number 3630-1. Data were analysed using the analysis of variance (α=0.05). Results The length of the active part of the instruments was found to vary according to the depth of the canal into which they were designed to reach. The pitch length also increased along the active length. The PTU-R D1 and the Mtwo-R instruments had active tips. Measurements of the bending moment at 45° revealed that the Mtwo-R 15 instrument was the most flexible, whereas the PTU-R D1 was the least flexible. The maximum torque tended to increase as the instrument diameter at 3mm from the tip increased, whereas the angular deflection at fracture varied in the opposite direction. Conclusions The geometrical characteristics of the retreatment instruments and their flexibility and torsion behaviour were consistent with their intended clinical application. © 2011 International Endodontic Journal.

Avaliação de usuários da atenção básica sobre a implantação de protocolo de assistência integral odontológica

Objective: To evaluate the perception of basic attention healthcare users as to the implantation of the Integral Dental Assistance Protocol (PAIO, in Portuguese) and the effect of this program on the oral health condition, oral hygiene, access to and resolubility of the service, in a public basic health unit of João Pessoa-PB. Method: The sample was composed of 32 volunteers, for whom a sixphase intervention was programed: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the health level obtained; and periodic follow-up visits. Data were collected by means of a semistructured interview and a questionnaire, applied before and after PAIO implantation. The interviews were transcribed and analyzed according to the content analysis technique. The effect of PAIO implantation was evaluated by using an increasing scoring system ranging from 1 to 10. The Wilcoxon test was applied with a confidence level of 95%. Results: For the participants that attended the PAIO (n=20), the program contributed to improve oral health condition (100%) and knowledge (100%). The users reported satisfaction (n=12) and had a positive evaluation (n=12), achieved by means of the improvement of oral health condition (n=8), faster and easier access to treatment (n=7), scheduling of dental appoints and warrant of being treated (n=6), welcoming (n=5), motivation for oral care (n=5), and perspective of continuity of PAIO (n=6). The initial evaluation of the users received scores between 5.7 and 7.6. After PAIO implantation, the users' perception was improved (p<0.01), with scores between 9.6 and 9.9. Conclusion: According to the users, the implantation of PAIO contributed to the qualification of health service and oral health care, being a favorable aspect to increase the access to and resolubility of the service.