Clinical effectiveness of direct anterior restorations-A meta-analysis.

OBJECTIVES: This is the first meta-analysis on the efficacy of composite resin restorations in anterior teeth. The objective of the present meta-analysis was to verify whether specific material classes, tooth conditioning methods and operational procedures influence the result for Class III and Class IV restorations. MATERIAL AND METHODS: The database SCOPUS and PubMed were searched for clinical trials on anterior resin composites without restricting the search to the year of publication. The inclusion criteria were: (1) prospective clinical trial with at least 2 years of observation; (2) minimal number of restorations at last recall=20; (3) report on drop-out rate; (4) report of operative technique and materials used in the trial, and (5) utilization of Ryge or modified Ryge evaluation criteria. For the statistical analysis, a linear mixed model was used with random effects to account for the heterogeneity between the studies. p-Values smaller than 0.05 were considered to be significant. RESULTS: Of the 84 clinical trials, 21 studies met the inclusion criteria, 14 of them for Class III restorations, 6 for Class IV restorations and 1 for closure of diastemata; the latter was included in the Class IV group. Twelve of the 21 studies started before 1991 and 18 before 2001. The estimated median overall success rate (without replacement) after 10 years for Class III composite resin restorations was 95% and for Class IV restorations 90%. The main reason for the replacement of Class IV restorations was bulk fractures, which occurred significantly more frequently with microfilled composites than with hybrid and macrofilled composites. Caries adjacent to restorations was infrequent in most studies and accounted only for about 2.5% of all replaced restorations after 10 years irrespective of the cavity class. Class III restorations with glass ionomer derivates suffered significantly more loss of anatomical form than did fillings with other types of material. When the enamel was acid-etched and no bonding agent was applied, significantly more restorations showed marginal staining and detectable margins compared to enamel etching with enamel bonding or the total etch technique; fillings with self-etching systems were in between of these two outcome variables. Bevelling of the enamel was associated with a significantly reduced deterioration of the anatomical form compared to no bevelling but not with less marginal staining or less detectable margins. The type of isolation (absolute/relative) had a statistically significant influence on marginal caries which, however, might be a random finding.

Meta-analysis of the influence of bonding parameters on the clinical outcome of tooth-colored cervical restorations

PURPOSE: To meta-analyze the literature on the clinical performance of Class V restorations to assess the factors that influence retention, marginal integrity, and marginal discoloration of cervical lesions restored with composite resins, glass-ionomer-cement-based materials [glass-ionomer cement (GIC) and resin-modified glass ionomers (RMGICs)], and polyacid-modified resin composites (PMRC). MATERIALS AND METHODS: The English literature was searched (MEDLINE and SCOPUS) for prospective clinical trials on cervical restorations with an observation period of at least 18 months. The studies had to report about retention, marginal discoloration, marginal integrity, and marginal caries and include a description of the operative technique (beveling of enamel, roughening of dentin, type of isolation). Eighty-one studies involving 185 experiments for 47 adhesives matched the inclusion criteria. The statistical analysis was carried out by using the following linear mixed model: log (-log (Y /100)) = β + α log(T ) + error with β = log(λ), where β is a summary measure of the non-linear deterioration occurring in each experiment, including a random study effect. RESULTS: On average, 12.3% of the cervical restorations were lost, 27.9% exhibited marginal discoloration, and 34.6% exhibited deterioration of marginal integrity after 5 years. The calculation of the clinical index was 17.4% of failures after 5 years and 32.3% after 8 years. A higher variability was found for retention loss and marginal discoloration. Hardly any secondary caries lesions were detected, even in the experiments with a follow-up time longer than 8 years. Restorations placed using rubber-dam in teeth whose dentin was roughened showed a statistically significantly higher retention rate than those placed in teeth with unprepared dentin or without rubber-dam (p < 0.05). However, enamel beveling had no influence on any of the examined variables. Significant differences were found between pairs of adhesive systems and also between pairs of classes of adhesive systems. One-step self-etching had a significantly worse clinically index than two-step self-etching and three-step etch-and-rinse (p = 0.026 and p = 0.002, respectively). CONCLUSION: The clinical performance is significantly influenced by the type of adhesive system and/or the adhesive class to which the system belongs. Whether the dentin/enamel is roughened or not and whether rubberdam isolation is used or not also significantly influenced the clinical performance. Composite resin restorations placed with two-step self-etching and three-step etch-and-rinse adhesive systems should be preferred over onestep self-etching adhesive systems, GIC-based materials, and PMRCs.

Caracterização de cimento odontológico obtido a partir de um vidro preparado pelo método dos precursores poliméricos

Glass ionomer cements are glass and polymer composite materials. These materials currently find use in dentistry. The purpose of this work is to obtain glass powders based on the composition 4.5SiO2 - 3Al2O3 - 2CaO to be used in dentistry. The powders were prepared by a chemical route at 700 0C. The properties of glass ionomer cements obtained from powders prepared at 700 ºC were studied. Diametral tensile strength and microhardness were evaluated for the experimental glass ionomer cements and a commercial material. It was concluded that the properties of experimental cements were similar to those of the commercial ones.

Uso das técnicas de infravermelho e de ressonância magnética nuclear na caracterização da reação ácido-base de um cimento odontológico experimental

Glass ionomer cements (GICs) are products of the acid-base setting reaction between an finely fluoro-alumino silicate glass powder and poly(acrylic acid) in aqueous solution. The sol gel method is an adequate route of preparation of the glasses used to obtain the GICs. The objective of this paper was to compare two powders: a commercial and an experimental and to investigate the structural changes during hardening of the cements by FTIR and Al MAS NMR. These analyses showed that the experimental glass powder reacted with organic acid to form the GICs and it is a promising material to manufacture dental cements.

Synthesis and Characterisation of Thermoplastic Ionomers based on Natural Rubber

Chemically modified novel thermo-reversible zinc sulphonated ionomers based on natural rubber (NR), radiation induced styrene grafted natural rubber (RI-SGNR), and chemically induced styrene grafted natural rubber (CI-SGNR) were synthesized using acetyl sulphate/zinc acetate reagent system. Evidence for the attachment of sulphonate groups has been furnished by FTIR spectra. which was supplanted by FTNMR results. Estimation of the zinc sulphonate group was done using spectroscopic techniques such as XRFS and ICPAES. The TGA results prove improvement in the therrno-oxidative stability of the modified natural rubber. Both DSC and DMTA studies show that the incorporation of the ionic groups affect the thermal transition of the base polymer. Retention of the improved physical properties of the novel ionomers even after three repeated cycles of mastication and molding at 120 degree C may be considered as the evidence for the reprocessabiJity of the ionomer. Effect of both particulate (carbon black. silica & zinc stearate) and fibrous fillers (nylon & glass) on the properties of the radiation induced styrene grafted natural rubber ionomer has been evaluated. Incorporation of HAF carbon black results in maximum improvement in physical properties. Silica reinforces the backbone chain and weakens the ionic associations. Zinc stearate plays the dual role of reinforcement and ptasticization. The nylon and glass filled lonorner compounds show good improvement in the physical properties in comparison with the neat ionomer. Dispersion and adhesion of the fillers in the ionomer matrix has been amply supported by their SEM micrographs. Microwave probing of the electrical behavior of the 26.5 ZnSRISGNR ionomer reveals that the maximum relative complex conductivity and the complex permittivity appear at the frequency of 2.6 GHz. The complex conductivity of the base polymer increases from 1.8x 10.12 S/cm to 3.3xlO·4 S/cm. Influence of fillers on the dielectric constant and conductivity of the new ionic thermoplastic elastomer has been studied. The ionomer I nylon compound shows the highest microwave conductivity. Use of the 26.5 ZnS-RISGNR ionomer as a compatibilizer for obtaining the technologically compatible blends from the immiscible SBR/NBR system has been verified. The heat fugitive ionic cross-linked natural rubber may be, therefore, useful as an alternative to vulcanized rubber and thermoplastic elastomer

Synthesis and Characterization of Novel Ionomers based on Styrene Butadiene Copolymer

Novel thermo-reversible zinc sulphonated ionomers based on styrene butadiene rubber (SBR), and high styrene rubber (HSH) were synthesized by sulphonation followed by neutralization with zinc. The sulphonate content of the ionomer was estimated by using x-ray fluorescence spectroscopy. Presence of sulphonate groups has been confirmed by FTIR and FTNMR spectra. The TGA results show improvement in the thermo~oxidative stability of the modified rubber. Both DSC and DMTA studies show that the incorporation of the ionic groups affect the glass rubber transition of the base polymer. lntroduction ol ionic functionality in to the base material improved the physical properties. Retention of the improved physical properties of the novel ionomers even after three repeated cycles of mixing and molding may be considered as the evidence for the reprocessability of the ionomer. Effect of particulate fillers (HAF black, silica and zinc stearate) on the properties of the zinc sulphonated styrene butadiene rubber ionomer has been evaluated. Incorporation of tillers results in improvement in mechanical properties. Zinc stearate plays the dual role of reinforcement and plasticization. The evaluation of dielectric properties of zinc sulphonated styrene butadiene rubber iorpmers at microwave frequencies reveal that the materials show conductivity at semiconductor level. The real and imaginary parts of the complex permittivity increases with increase in ionic functionality. Use of the 38.5 ZnS-SBR ionomer as a compatibiliser for obtaining the technologically compatible blends from the immiscible SBR/NBR system has been discussed.

High Styrene–Rubber Ionomers, an Alternative to Thermoplastic Elastomers

High styrene rubber ionomers were prepared by sulfonating styrene–butadiene rubber of high styrene content (high styrene rubber) in 1,2-dichloroethane using acetyl sulfate reagent, followed by neutralization of the precursor acids using methanolic zinc acetate. The ionomers were characterized using X-ray fluorescence spectroscopy, Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance spectroscopy (NMR), dynamic mechanical analysis (DMA), and also by the evaluation of mechanical properties. The FTIR studies of the ionomer reveal that the sulfonate groups are attached to the benzene ring. The NMR spectra give credence to this observation. Results of DMA show an ionic transition (Ti) in addition to glass–rubber transition (Tg). Incorporation of ionic groups results in improved mechanical properties as well as retention of properties after three cycles of processing

Chlorine tolerant, multilayer reverse-somosis membranes with high permeate flux and high salt rejection

A new class of high molecular weight polyethersulfone ionomers is described in which the ionic content can be varied, at will, over a very wide and fully-controllable range. A novel type of coating process enables these materials to be deposited from alcohol-type solvents as cohesive but very thin (50 – 250 nm) films on porous support-membranes, giving high-flux membranes (3.3 – 5.0 L m-2 h-1 bar-1) with very good, though not outstanding salt rejection (typically 92 - 96%). A secondary layer, of formaldehyde-cross-linked polyvinyl alcohol, can be deposited from aqueous solution on the surface of the ionomer membrane, and this layer increases salt rejection to greater than 99% without serious loss of water permeability. The final multi-layer membrane shows excellent chlorine tolerance in reverse-osmosis operation.

Microblock ionomers: a new concept in high temperature, swelling-resistant membranes for PEM fuel cells

A novel series of polyaromatic ionomers with similar equivalent weights but very different sulphonic acid distributions along the ionomer backbone has been designed and prepared. By synthetically organising the sequence-distribution so that it consists of fully defined ionic segments (containing singlets, doublets or quadruplets of sulphonic acid groups) alternating strictly with equally well-defined nonionic spacer segments, a new class of polymers which may be described as microblock ionomers has been developed. These materials exhibit very different properties and morphologies from analogous randomly substituted systems. Progressively extending the nonionic spacer length in the repeat unit (maintaining a constant equivalent weight by increasing the degree of sulphonation. of the ionic segment) leads to an increasing degree of nanophase separation between hydrophilic and hydrophobic domains in these materials. Membranes cast from ionomers with the more highly phase-separated morphologies show significantly higher onset temperatures for uncontrolled swelling in water. This new type of ionomer design has enabled the fabrication of swelling-resistant hydrocarbon membranes, suitable for fuel cell operation, with very much higher ion exchange capacities (>2 meq g(-1)) than those previously reported in the literature. When tested in a fuel cell at high temperature (120 degrees C) and low relative humidity (35% RH), the best microblock membrane matched the performance of Nafion 112. Moreover, comparative low load cycle testing of membrane -electrode assemblies suggests that the durability of the new membranes under conditions of high temperature and low relative humidity is superior to that of conventional perfluorinated materials.

Effect of Two Restorative Materials on Root Dentine Erosion

This study sought to evaluate the microhardness of root dentine adjacent to glass-ionomer and composite resin restorations after erosive challenge. A crossover study was performed in two phases of 4 consecutive days each. One hundred twelve bovine root dentine slabs were obtained, and standardized box-shaped cavities were prepared at center of each specimen. The prepared cavities were randomly restored with glass-ionomer cement or composite resin. The slabs were randomly assigned among 14 volunteers, which wore intraoral palatal device containing four restored root dentin slabs. Starting on the second day, half of the palatal acrylic devices were immersed extraorally in a lemonade-like carbonated soft drink for 90 s, four times daily for 3 days. Alter 3-day wash-out, dentine slabs restored with the alternative material were placed into palatal appliance and the volunteers started the second phase of this study. After erosive challenges. microhardness measurements were performed. Regardless of the restorative material employed, eroded specimens demonstrated lower microhardness value (p < 0.0001). At eroded condition examined in this study, dentine restored with glass-ionomer cement showed higher microhardness values (p < 0.0001). It may be concluded that the glass-ionomer cement decreases the progression of root dentine erosion at restoration margin. (C) 2010 Wiley Periodicals, Inc J Biomed Mater Res Part B Appl Biomater 93B 304-305, 2010

Comparative Histopathological Analysis of Human Pulps after Class I Cavity Preparation with a High-Speed Air-Turbine Handpiece or Er:YAG Laser

The purpose of this study was to comparatively evaluate the response of human pulps after cavity preparation with different devices. Deep class I cavities were prepared in sound mandibular premolars using either a high-speed air-turbine handpiece (Group 1) or an Er: YAG laser (Group 2). Following total acid etching and the application of an adhesive system, all cavities were restored with composite resin. Fifteen days after the clinical procedure, the teeth were extracted and processed for analysis under optical microscopy. In Group 1 in which the average for the remaining dentin thickness (RDT) between the cavity floor and the coronal pulp was 909.5 mu m, a discrete inflammatory response occurred in only one specimen with an RDT of 214 mu m. However, tissue disorganization occurred in most specimens. In Group 2 (average RDT = 935.2 mu m), the discrete inflammatory pulp response was observed in only one specimen (average RDT = 413 mu m). It may be concluded that the high-speed air-turbine handpiece caused greater structural alterations in the pulp, although without inducing inflammatory processes.

Effect of low-level laser irradiation on odontoblast-like cells

Low-level laser therapy (LLLT), also referred to as therapeutic laser, has been recommended for a wide array of clinical procedures, among which the treatment of dentinal hypersensitivity. However, the mechanism that guides this process remains unknown. Therefore, the objective of this study was to evaluate in vitro the effects of LLL irradiation on cell metabolism (MTT assay), alkaline phosphatase (ALP) expression and total protein synthesis. The expression of genes that encode for collagen type-1 (Col-1) and fibronectin (FN) was analyzed by RT-PCR. For such purposes, oclontoblast-like cell line (MDPC-23) was previously cultured in Petri dishes (15000 cells/cm(2)) and submitted to stress conditions during 12 h. Thereafter, 6 applications with a monochromatic near infrared radiation (GaAlAs) set at predetermined parameters were performed at 12-h intervals. Non-irradiated cells served as a control group. Neither the MTT values nor the total protein levels of the irradiated group differed significantly from those of the control group (Mann-Whitney test; p > 0.05). On the other hand, the irradiated cells showed a decrease in ALP activity (Mann-Whitney test; p < 0.05). RT-PCR results demonstrated a trend to a specific reduction in gene expression after cell irradiation, though not significant statistically (Mann-Whitney test; p > 0.05). It may be concluded that, under the tested conditions, the LLLT parameters used in the present study did not influence cell metabolism, but reduced slightly the expression of some specific proteins.

Análise da dentina de dentes decíduos submetidos ao capeamento pulpar indireto

O objetivo do estudo foi avaliar as características da dentina cariada remanescente de molares decíduos quanto à coloração, consistência e microdureza, após um período médio de 3 anos e 8 meses da realização do capeamento pulpar indireto. O estudo clínico constou de 27 dentes que apresentavam lesões cariosas ativas com expressão radiográfica em metade interna de dentina. Aleatoriamente, foi realizado o capeamento pulpar indireto e utilizado como material capeador o hidróxido de cálcio (HC) e o cimento de ionômero de vidro resinoso modificado (CIVRM). As crianças foram acompanhadas através de exames clínicos e radiográficos, e ao longo de um período médio de 3 anos e 8 meses, observou-se um índice de sucesso de 89% para o grupo do HC e de 93% para o CIVRM, não havendo diferença estatisticamente significante entre os dois grupos (p=0,62). Os dentes considerados como sucesso no estudo clínico foram agrupados em um único grupo (grupo teste), que constou de 13 dentes que sofreram esfoliação natural ou exodontia por motivos ortodônticos. Além disso, foram selecionados 15 molares decíduos hígidos (grupo controle positivo) e 15, portadores de lesões cariosas ativas em metade interna de dentina (grupo controle negativo). As amostras do grupo teste tiveram suas respectivas restaurações removidas, a profundidade medida e a dentina remanescente avaliada por um operador calibrado, seguindo critérios descritivos, quanto à consistência e a coloração. Nos dentes do grupo controle positivo, foram realizados preparos cavitários oclusais em até 4 mm de profundidade, enquanto que, no grupo controle negativo, o mesmo operador do estudo clínico realizou a remoção parcial de tecido cariado in vitro. A partir daí, todos os dentes foram preparados para análise de microdureza, que foi realizada por um examinador calibrado, que empregou o princípio de cegamento. Na análise da consistência, todos os dentes do grupo teste (n=13) apresentaram-se endurecidos, enquanto que 9, apresentaram coloração amarela-clara (8 do CIVRM e 1 do HC) e 4, castanho-escura (1 do CIVRM e 3 do HC). Para o teste de microdureza no grupo teste, obteve-se uma média KHN de 40,81 (±16,28) MPa, enquanto que nos grupos controles positivo e negativo, foram alcançados valores médios de 62,73 (±11,24) MPa e 19,15 (±6,99) MPa, respectivamente. A análise estatística mediante o teste ANOVA indicou que houve diferença significativa entre os 3 grupos. Foi constatada a remineralização da dentina de dentes decíduos em que foi realizada a técnica do capeamento pulpar indireto após um período médio de 3 anos e 8 meses, através de critérios clínico (consistência) e laboratorial (análise da microdureza).

Efetividade do flúor e da escovação e eficácia dos materiais de colagem ionômero de vidro e resina composta na reversão das microporosidades criadas pelo condicionamento ácido no esmalte dentário

The objectives of this clinical study was to evaluate the use of the toothpaste with fluoride and without fluoride and the daily tooth brushing are effective in the reversion of the dental enamel conditioned by acid. Another objective of this clinical study was to evaluate if the positioning of orthodontic accessories with glass ionomer cement helps in the reversion of the dental enamel conditioned by acid, when compared to composed resin. One hundred and twenty teeth were selected with indication of extraction by orthodontic reasons. The 30 volunteers were divided, randomly, in two groups. A group used toothpaste without fluoride and the other with it. The teeth of the sample were shuffled, in each volunteer. The teeth were conditioned by the 37% orthophosphoric acid. One of the conditioned teeth stayed in the mouth and suffered action of the abrasion for the tooth brushing, in another teeth a stainless steel mesh protection was positioned with glass ionomer cement, in another tooth the screen was glued with composed resin, in a fourth tooth (the control) was only conditioned after the extractions, 60 days later. All the teeth were appraised through DIAGNOdent, MEVA and EDS. In the obtained data it was possible to observe that there were not statistic significant differences in any comparison, even in the group that did not have access to the fluoride in the toothpaste as in the other that had. According with the used methodology, it was possible to observe too that there was not statistic significant differences in any comparison, even in the group that had the stainless steel mesh positioned with glass ionomer cement as in the group that the stainless steel mesh was positioned with composed resin. However, it was observed that there was an improvement in the topography of the enamel in all the teeth. The accomplishment of this study was facilitated due to the participation of the researchers' of the health area (dentistry), materials engineer, physics and chemistry. The researchers were originating from the Federal University of Rio Grande do Norte and of the University of Queensland, in Australia. This interdisciplinary group was decisive in the accomplishment of the study. It can be concluded that the enamel tends to return to its initial aspect, even if the patient does not have access to fluoride. That is probably due the action of the abrasion for the tooth brushing and mastication. In spite of it not being significant, it is suggested that the conditioned enamel was more resistant to the abrasion in the group that had access to fluoride. It was also possible to conclude that the fluoride liberated by the glass ionomer was not enough to provide a significant difference in the enamel conditioned by the acid, when compared with the composed resin, even in the group that did not use fluoride in the toothpaste as in the group that used

Synthesis of poly(styrene-co-methyl methacrylate)-based ionomers and their Langmuir and Langmuir-Blodgett (LB) film formation

Poly(styrene-co-methyl methacrylate) (PS-PMMA) ionomers with several degrees of sulfonation were synthesized and characterized by infrared, UV-vis, and NMR spectroscopies, elemental analysis, and differential scanning calorimetry (DSC). Stable Langmuir films could be produced with PS-PMMA with 3 and 6 mol % of sulfonation, while PS-PMMA 8% exhibited material loss to the water subphase, probably due to its higher solubility. Surface pressure and surface potential isotherms with PS-PMMA 3% spread onto salt-containing subphases pointed to a film behavior characteristic of the polyelectrolyte effect, where charge repulsion governs the film properties. The Langmuir-Blodgett films of this ionomer were successfully transferred onto various substrates, as confirmed by UV-vis and FTIR spectroscopies. Using cycling voltammetry, we show that LB films from PS-PMMA 3% can be applied in selective sensing of dopamine, even in the presence of interferents such as ascorbic acid.