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We aimed to optimize the mechanical and biological properties of a conventional methacrylate-based dental polymer by loading it with double- and triple-walled carbon nanotubes as growth (DTWCNTG).A formulation of bisphenol A-glycidyl methacrylate and triethylene glycol dimethacrylate (mass ratio = 2:1) was mixed with DTWCNTG at concentrations of 0.0% (control), 0.001%, 0.005%, and 0.010%. The concentrations were physicochemical and morphologically evaluated, and antibacterial activity was assessed by seeding a Streptococcus mutans strain (ATCC 25175) on the experimental polymeric surfaces. Cellular survival and osteodifferentiation were evaluated in epithelial (HaCat) and preosteoblast cells (MC3T3-E1).The 0.001% DTWCNTG concentration yielded higher compressive strength, elastic modulus, flexural strength, flexural modulus, water sorption, and solubility than the control. The degree of conversion and color did not significantly change with a low amount of DTWCNTG incorporated into the polymer. Antibacterial activity significantly improved when tested on the 0.001% DTWCNTG discs. No groups showed cytotoxicity in a short-term analysis and adding DTWCNTG favored MC3T3-E1 mineralization over the control, particularly in the 0.001% formulation.The micro-addition of 0.001% DTWCNTG confers mechanical resistance, antimicrobial properties, and bioactivity to methacrylate-based polymers without significantly compromising color. Incorporating DTWCNTG improved dental composite properties and could be a biomodified material for minimally invasive procedures.

Aim: To systematically review the literature for observational studies evaluating periodontal outcomes in pre- and post-liver transplant (LT) individuals compared to a control group. Methods: Specific strategies were designed to search five databases and the grey literature. Hand-searches were also performed. The following periodontal outcomes were analyzed in pre-LT, post-LT and control groups: plaque index (PI), gingival index (GI), gingival growth (GO), alveolar bone loss (ABL) probing depth (PD) and clinical attachment level (CAL). Meta-analyses and subgroup analyses were conducted. Results: Among the 257 studies retrieved, 11 studies were included. Four studies were incorporated into the meta-analysis and showed that PI (mean difference=0.15, 95%CI: 0.12-0.18) and GI (mean difference=0.31, 95%CI: 0.06-0.56) were significantly higher in post-LT individuals compared to the control group. There was no significant mean difference of PD (mean difference=0.49, 95%CI: -0.26-1.25) but CAL (mean differ- ence=1.47, 95%CI: 0.19-2.75) were significantly higher in pre-LT individuals compared to the control group. Conclusion: The higher means of PI and GI in post-LT and CAL in pre-LT compared to healthy individuals suggest a relationship between the periodontal condition and the transplantation status.

Background The fiber posts require a cut in the coronal portion to adjust it to the available clinical space. The cutting of posts cemented may generate tension via bur vibrations of drill on the bonding interface, with the possibility of decreasing the bond strength. Thus, this study aimed to evaluate if the moment of cutting the fiber posts has an effect on its bond strength when fixed with self-adhesive resin cement. Material and methods Thirty-six bovine teeth were randomly divided into three groups after endodontic treatment and post space preparation (n = 12): IAC- the fiber posts were cutting immediately after cementation; ACR - the fiber posts were cutting after coronal reconstruction with resin; Control - the fiber posts were not cut. The fiber posts were cemented with self-adhesive cement (RelyX U200 - 3M ESPE). After 24 h, the teeth were sectioned perpendicularly and the push-out test was performed in a universal testing machine at a speed of 0.5 mm/min, until failure. Data were analyzed using two-way ANOVA and Tukey's post-hoc test. Results The effect of moment of fiber posts cutting (p = 0.44) and the interaction between the factors moment of post cutting and third root (p = 0.81) had no significant. The root third factor showed a significant effect (p = 0.01). The bond strength in the apical third was significantly lower than in the middle (p = 0.00) and coronal (p = 0.01) thirds. Conclusions The moment of post cutting has no effect on the bond strength of fiber posts fixed with self-adhesive cement to the root canal. Key words:Fiber post, self-adhesive resin cement, push-out bond strength, operative dentistry.

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p

OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the experience of dental caries in individuals pre- or postliver transplant. MATERIALS AND METHODS Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases' inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta-analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. RESULTS The search retrieved 1990 references. Twenty-four cross-sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre-liver transplant and healthy individuals (mean difference = 1.65, confidence interval = -0.87 to 4.17). The prevalence of dental caries among pre-liver transplant individuals was 73.82% and in the post-transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. CONCLUSIONS Dental caries may be a relevant issue in pre- and postliver transplant individuals. Oral health counseling should be included in the care of pre- and/or postliver transplant individuals.

Introduction This study radiographically analyzed the prevalence of root canal treatment (RCT) and apical periodontitis (AP) in type 1 diabetes mellitus (T1DM) and nondiabetic individuals and its association with the history/current status of T1DM. Methods In a cross-sectional paired study, the radiographic records of 50 individuals with T1DM and 100 age- and sex-matched nondiabetic subjects were examined. The presence of RCT and AP was evaluated. Information regarding the history and current status of T1DM was collected from the medical records of each patient. Results One or more RCTs were found in 76% and 44% of diabetic and nondiabetic subjects, respectively (P = .000). AP in 1 or more teeth was found in most T1DM patients (58%) and in 15% of the control subjects (P = .000). One or more RCTs associated with AP were found in 52% and 8% of T1DM and nondiabetic subjects, respectively (P = .000). Bivariate logistic regression analyses suggested that RCT (odds ratio [OR] = 10.435, P = .000), AP (OR = 3.508, P = .011), and RCT + AP (OR = 7.220, P = .000) were significantly associated with the presence of T1DM. Multivariate logistic regression showed that among T1DM individuals, there is an association between 11–15 years of diagnosis time and at least 1 RCT (OR = 46.316, P = .038) and an association between T1DM control and at least 1 tooth with AP (OR = 15.611, P = .016). Conclusions RCT, AP, and RCT with AP were more prevalent in individuals with T1DM than in nondiabetic individuals. RCT and AP were associated with the presence of T1DM, specifically RCT with diagnostic time and AP with glycemic control.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Maxillofacial prosthetic rehabilitation is almost always indicated after surgical treatment of affected individuals with oral cavity and pharynx cancers. Few articles have described in detail the technical sequence of maxillofacial prosthesis fabrication. The first case is a 56-year-old woman who was rehabilitated with pharyngeal obturator prosthesis after a partial maxillectomy, including soft palate, tonsil, oropharynx, and retromolar space regions. The second case is an 83-year-old man who was rehabilitated with hard palatal obturator prosthesis after a maxillectomy, including hard palate and nasal floor. In both cases, the patients complained of oronasal regurgitation and difficulty in chewing, swallowing, and speaking. A multi-professional approach including oral rehabilitation should be part of the treatment plan for individuals with oral and pharyngeal cancer after tumor resection.

The aim of this study was to compare the color change of the Giomer resin composite (Beautifil-Bulk) by using photographs obtained with a smartphone (iPhone 6S) associated with Adobe Photoshop software (digital method), with the spectrophotometric method (Vita Easyshade) after immersion in different pigment solutions.Twenty resin composite samples with a diameter of 15.0 mm and thickness of 1.0 mm were confectioned in A2 color (The analysis (2-way analysis of variance, Holm-Sidak,Only the tomato sauce produced a color change above the acceptability threshold using both methods of color assessment. The spectrophotometric and digital methods produce different patterns of color change. According to our results, the spectrophotometric method is more recommended in color change assessment.

Aim The aim of this systematic review and meta-analysis was to analyse the clinical performance of GIOMER restorative composites and compare them with other conventional restorative materials in permanent teeth.Methods Searches in PubMed, Web of Science, Scopus, Ovid and Cochrane Library were conducted. Grey literature search was also performed. Clinical trials that evaluated the clinical performance of restorations with GIOMER restorative composites in permanent teeth compared to those using composite resin, glass ionomer cement, resin-modified glass ionomer cement (RMGIC) and other GIOMERs were included. Meta-analyses comparing GIOMER restorative composites with RMGIC at 6- and 12-month follow-ups and comparing two types of GIOMER were feasible.Results Ten studies fulfilled the inclusion criteria. In these studies, GIOMER was compared to different types of dental restoration materials. Dental restorations were evaluated by United States Public Health Service criteria in all included studies. Four studies were suitable for meta-analysis, which showed significant differences between GIOMER and RMGIC surface roughness at 6-month (odds ratio [OR] = 6.56; 95% confidence interval [CI] = 2.38-18.13) and 12-month (OR = 8.76; CI = 3.19-24.07) follow-ups. No significant differences between GIOMER restorative composites and RMGIC for marginal adaptation were found at 6- and 12-month follow-ups. When comparing two GIOMERs, significant differences were seen between Beautifil II and Beautifil Flowable Plus F00 for marginal staining (OR = 2.58; CI = 1.42-23.27; I

Dental implants are a common and successful option for the rehabilitation of edentulous areas. However, there are some limitations to their use. The present clinical report describes a 5-year follow-up of maxillary rehabilitation using an attachment-retained removable partial denture (RPD) associated with fixed partial denture (FPD) units as an alternative to orthodontic treatment associated with orthognathic surgery and dental implant placement. Rehabilitation with fixed prosthodontics associated with a removable partial prosthesis was proposed. For greater precision and stability, a gold attachment was prepared. The patient was very satisfied with the rehabilitation and has been clinically followed for 5 years. In cases where the use of dental implants and/or conventional FPDs is limited or not indicate the association between an FPD and an RPD by means of attachments remains an important alternative to conventional clasp-retained RPDs.

This study goal is to present a case report of tooth bleaching treatment with the combination of the custom tray and in-office techniques, and to discuss about the considerations for result maintenance. A treatment approach was planned involving exogenous bleaching with custom trays with 7.5% hydrogen peroxide, and in-office bleaching with 35% hydrogen peroxide. The in-office bleaching agent was applied in two 15-minute applications, without led light. The patient was instructed to use the custom trays only a day after, with one drop of the bleaching agent for each tooth space. After the application of the bleaching agent, the patient used the trays for 1 hour per day, continuously for 30 days, 15 days for each arch. Considering the executed treatment approach, we may conclude that when correctly indicated, tooth bleaching with the combination of the in-office and custom trays techniques can be an acceptable choice of treatment, capable of enhancing the smile esthetics with a simple technique that preserves the sound dental structure. The patient should be instructed for the maximum color preservation and esthetic result maintenance, and should be advised that retreatments may become necessary depending on the oral hygiene and frequence of coloured food and drinks intake. RESUMO O objetivo deste estudo é apresentar um relato de caso em que foi realizado o clareamento dentário com a combinação das técnicas de consultório e de moldeiras e discutir sobre considerações para a manutenção do resultado. Um plano de tratamento foi proposto envolvendo clareamento exógeno com moldeiras com peróxido de hidrogênio 7,5% e o clareamento em consultório com peróxido de hidrogênio 35%. O gel clareador de clareamento em consultório foi aplicado 2 vezes, por 15 minutos cada aplicação, sem luz do tipo Led. A paciente foi orientada a usar as moldeiras customizadas para o clareamento caseiro apenas a partir do dia seguinte, sendo uma gota de gel clareador no espaço equivalente a cada dente. Após a dosagem do gel, ela usou as moldeiras por 1 hora por dia, ininterruptamente por 30 dias, sendo 15 dias para cada arco. Diante do planejamento e terapia executados no caso clínico apresentado, pode-se concluir que a técnica clareadora utilizando a combinação de clareamento em consultório e clareamento com moldeiras customizadas, quando corretamente indicada, pode ser considerada uma alternativa de tratamento bastante satisfatória por ser uma técnica simples capaz de melhorar a estética do sorriso preservando a estrutura dental hígida. O paciente deve ser orientado para a máxima preservação da cor e manutenção estética alcançada, e deve ser ressaltado que retratamentos podem ser necessários dependendo da higiene oral e da frequência de ingestão de alimentos e bebidas corantes.

Background The aim of the present study was to investigate pain perception and anxiety within the context of surgery for the placement of mandibular block bone and to evaluate the causality effect between theses variables. Material and methods A total of 13 patients were recruited for the study and were submitted to mandibular autogenous block bone surgery. Demographic data were collected and the anxiety level was determined using the State-Trait Anxiety Inventory (STAI). The STAI was administered on the day of surgery and on the 14th postoperative day. Pain was determined using the visual analogue scale (VAS) and limitation of daily activities and postoperative symptoms were also reported. Data were analyzed using parametric tests (α=0.05) and cross-lagged analysis was performed to verify a causality effect. Results Few patients reported interference with daily activities or the presence of postoperative symptoms. A significant association of bad breath/taste with STAI-State was detected on the 14th postoperative day. No evidence of causality between STAI and VAS was detected. Conclusions The patient's self-evaluation indicates that the pain and anxiety level felt during treatment was not directly associated with the clinical aspects of the surgical procedure or with postoperative activities/symptoms limitations. Key words:Anxiety pain, questionnaires, autogenous bone block, treatment, outcomes.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais This in vitro study aimed to assess the effects of different pretreatments used to adapt glass-fiber posts cemented to root canals with different resin cements, regarding porosity percentage and bond strength. Twelve bovine incisor roots were prepared with Largo drills. After post space preparation, the specimens were randomized into two types of pretreatment groups (n = 3): water-wet bonding and ethanol-wet bonding. After the post were cemented, the roots were stored in 100% humidity at room temperature for 7 days. The samples were scanned by microcomputed tomography (micro-CT). Images were reconstructed by NRecon software, and CTAn software was used to analyze the porosity percentage (%) at the luting interface. Evaluation of the push-out bond strength was performed by serially cutting the roots, and submitting the slices to testing. Additionally, the resin cement post-gel shrinkage values (%) were measured using the strain-gauge method (n = 10). Data were analyzed by two-way ANOVA, Tukey's test and Student's t test (a = 0.05). The roots prepared with ethanol-wet bonding using RelyX™ U200 had significantly lower porosity in the coronal and apical thirds (p < 0.05). The group prepared with ethanol-wet bonding using RelyX™ ARC presented better bond strength results in the coronal and apical thirds (p < 0.05). RelyX™ ARC (0.97%) produced a higher post-gel shrinkage value than RelyX™ U200 (0.77%). Canals pretreated with ethanol-wet bonding presented better outcomes in regard to porosity percentage and push-out bond strength

Objetivo:O objetivo do estudo foi verificar, in vitro, a alteração de cor da resina composta Beautiful-Bulk®, exposta aos líquidos pigmentantes. Métodos: Foram confeccionados 60 espécimes da resina (15,0 mm de diâmetro e 1,0 mm de espessura, n = 5) nas cores A2, B2 e C2. Os espécimes foram mantidos em uma sala escura por sete dias, em ambiente seco, a 37 °C e, em seguida, foram fotografados com aparelho celular iPhone 6S®. Os espécimes foram divididos aleatoriamente e submetidos a ciclos de imersão em quatro líquidos: água destilada (controle), suco de açaí, Coca-Cola® e molho de tomate. As imersões foram realizadas em sete e quatorze dias de forma cíclica, após a confecção dos espécimes, três vezes ao dia, durante 20 minutos. Ao fim de cada ciclo, novas fotografias foram realizadas. As imagens foram analisadas no programa Adobe Photoshop® e os dados convertidos em L*a*b através de um histograma. A variação de cor (∆E) foi analisada pela escala CIE-Lab. Resultados: A análise dos resultados (One-way ANOVA, Teste de Tukey, p < 0,05) demonstrou que o grupo controle produziu maior alteração de cor (p < 0,05) em sete e quatorze dias na cor A2. A cor B2, no ciclo de quatorze dias, apresentou maior alteração de cor (p < 0,05) para os espécimes imersos em molho de tomate sem diferença estatística (p > 0,05) do controle. Para a cor C2, os espécimes imersos em molho de tomate tiveram maior alteração de cor (p < 0,05) em sete dias. Conclusão: Conclui-se que todas as substâncias pigmentantes e a água destilada foram capazes de produzir grandes alterações de cor na resina Beautifil Bulk®. Existe uma interação significativa entre a cor da resina e agentes pigmentantes Aim: This study sought to verify, in vitro, the color change of the nanoparticle composite resin, Beautiful Bulk®, exposed directly to pigmented liquids. Methods: Sixty test specimens were made in a Metal matrix (15.0 mm X 1.0 mm) using composite resin (n = 5) in colors A2, B2, and C2. The specimens were photographed with a smartphone (iPhone 6S®) seven days after the preparation. The specimens were kept in the dark for seven days, dry, at 37°C. The specimens were then randomly divided and immersed in four liquids: distilled water (control), açaí juice, Coca-Cola®, and tomato sauce. The immersions were performed in seven and fourteen days cyclically, three times a day, for 20 minutes. At the end of each immersion cycle, new photographs were taken with the same smartphone. The images were analyzed in the Adobe Photoshop® program, and the data was converted to L* a* b* through a histogram. The color variation (∆E) was analyzed by the CIE-Lab scale. Results: Analysis of the results (Tukey’s test, p < 0.05) showed that the control group produced a greater color change (p < 0.05) in seven and fourteen days in the A2 shade. The B2 shade, in fourteen days, showed a greater color change (p < 0.05) for the specimens immersed in tomato sauce with no statistical difference (p > 0.05) of the control. For the C2 shade, the specimens immersed in tomato sauce presented a greater color change (p < 0.05) at seven days. Conclusion: It could therefore be concluded that there is a significant interaction between the composite resin and pigment agents. All pigmented substances produced color changes in the composite resin

Objective To evaluate studies assessing the prevalence of dental caries and developmental defects of enamel (DDE) in individuals with chronic kidney disease (CKD) in comparison with individuals without CKD. Materials and methods Electronic searches were performed in PubMed, Web of Science, Scopus, Medline via Ovid, and ProQuest databases from their inception date until February 2018. Two review authors independently selected the studies, extracted data, and assessed the methodological quality. Meta-analysis was performed. Results Twenty-seven studies were included in this study. For permanent teeth, 14 studies found that individuals without CKD had higher dental caries scores than those with CKD. However, only five studies presented results with a statistically significant difference between groups. Among the studies evaluating primary teeth, five showed that individuals without CKD had higher dental caries scores than those with CKD. Five studies showed that individuals with CKD had a significantly higher prevalence of DDE than individuals without CKD. The meta-analyses showed that individuals without CKD had significantly higher scores of dental caries teeth and surfaces than individuals with CKD. For DDE, no statistical difference between groups was observed. Conclusions Individuals with CKD present lower dental caries scores and a higher prevalence of DDE in comparison with individuals without CKD.

SUMMARYIt was possible to restore the shape and function of a severely ankylosed tooth by fabricating a ceramic crown for placement on a resin reconstruction supported by mini fiberglass posts. By increasing the retention of the morphological reconstruction for the future support of indirect restorations, cementable intradentinal fiberglass posts enhance the longevity of these restorations. Ultimately, all proposals that seek to improve the long-term prognosis of restorations on ankylosed teeth, especially severely impacted ones, are of extreme clinical relevance.

The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides. Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p

Purpose Biomechanical behavior of tooth-implant-supported prostheses (TISPs) with external and internal implants was compared. Materials and methods Two 3-D models of TISP were designed by varying the implant: external (Model EH) and internal hexagons (Model IH). After loading, von Mises stresses were obtained in implants, abutments, and screws. Principal maximum (σmax) and minimum (σmin) stresses were analyzed in periodontal ligament (PL), alveolar bone, and periimplant bone. Results Model IH showed lower stress peaks in axial loading in the implant and in the screw but higher in abutment. In oblique loading, Model IH had lower stresses in the implant, but higher in the abutment and in the screw. In the σmax analysis for axial and oblique loads, stress peaks in Model IH were lower in PL, alveolar bone, and periimplant bone. In the σmin analysis for axial load, stress peaks in Model IH were lower in PL, but higher in alveolar bone and in periimplant bone. In oblique load, Model IH showed lower stress peaks in PL and alveolar bone, but higher stress peaks in periimplant bone. Conclusions TISPs with IH implants do present lower risk of biomechanical failure.

Purpose To assess the effect of acid etching (AE) and adhesive systems on the microtensile bond strength of conventional glass ionomer cement (GIC) and a nanofilled composite resin. Materials and methods Specimens of conventional GIC (RIVA, Self-cure, SDI) were prepared in a bipartite Teflon mold and randomly assigned (n=12) to G1- GIC+Single Bond 2 (SB2) (3M-ESPE); G2- GIC+Acid etching (AE) (37% phosphoric acid, Condac, FGM) + SB2; G3- GIC+Single Bond Universal (SBU) (3M-ESPE); and G4- GIC+AE+SBU. The adhesive systems and the composite (Filtek Z350XT, 3M-ESPE) were inserted into the mold. After 7 days stored in a humid environment, the specimens were sectioned into five slices (Isomet 1000, Buehler). Hourglass slices were trimmed and subjected to microtensile bond strength testing (BISCO®; Schaumburg, USA) with 0.5 mm/min crosshead speed. Data were analyzed by two-way ANOVA and the Tukey test (SPSS 17.0, α=5%). Results The microtensile bond strength (MPa) means (standard deviation) were G1=9.46(3.79), G2=6.27(3.21), G3=9.35(3.91), and G4=10.13(3.53). G2 differed significantly from the other groups (p 0.05). There were 83% mixed fractures, 9.5% cohesive and 7.5% adhesive. Conclusion GIC etching promoted higher microtensile bond strength with universal adhesive than with a total-etch adhesive system. Acid etching is not necessary to enhance the universal adhesive bond strength and negatively affected the bond strength of the total-etch adhesive system. Without etching the GIC, there is no difference in microtensile bond strength between the adhesive systems.

The aim of this study was to evaluate the clinical performance of silorane-based composite restorations applied after different surface treatments. This controlled and randomized clinical trial included 26 patients with class I restoration indications. The teeth were randomly assigned to the following treatments: control 1/G1, silorane specific self-etching adhesive (P90 self-etch primer and bond) + silorane-based composite resin (Filtek™ P90 low shrink posterior restorative); G2, 37% phosphoric acid + silorane specific self-etching adhesive + silorane-based composite resin; G3, blasting with aluminum oxide + silorane specific self-etching adhesive + silorane-based composite resin; and control 2/G4, self-etching adhesive (Adper™ SE Plus self-etch adhesive) + dimethacrylate-based composite resin (Filtek™ P60 posterior restorative). The clinical performance was evaluated at baseline and after 1 year. A total of 141 restorations were made and evaluated. For all clinical criteria evaluated, no significant difference was found between the surface treatments at baseline and after 1 year (p > 0.05). After 1 year, only the group with 37% phosphoric acid + silorane specific self-etching adhesive (G2) showed a significant reduction in marginal adaptation (p

This clinical report describes an 8-year follow-up evaluation using different thicknesses of porcelain laminate veneers of diastema and malformed anterior teeth. Minimally invasive treatment with no preparation or minimal reduction options could be considered and chosen based on the characteristics of each case. Laminate veneers with or without reduction can offer an excellent result regarding esthetics and function. Despite its failure without reduction, this treatment is indicated because it can be applied regardless of the structure of the teeth. At first, no tooth preparation with rotatory instruments was performed, and porcelain laminates of minimum thickness were made for the four maxillary anterior teeth. After 6 years, the adhesive interfaces were stained, and the patient was unsatisfied with the esthetics of her smile. Therefore, at that time, the professional decided to prepare the anterior teeth for porcelain laminate veneers. Diastema closure and/or correction of malformed anterior teeth using porcelain laminate veneers is a viable option for the clinician because it restores esthetic harmony. The patient was very pleased with the new laminate veneers.

Introduction Convencional resin cements can be used in combination with a total-etch system in a conventional mode or as self-adhesive resin cements. The latter are less technique sensitive and able to bond to dental tissues without previous treatment or adhesive layer and requires only a single step to be applied to dental structures. Objective To compare qualitatively the adhesive interfaces of two self-adhesive resin cements and one conventional resin cement after different tooth surface treatments under scanning electron microscopy. Material and method 42 crowns of bovine incisors were sectioned and flattened exposing enamel (E) or dentine (D) substrate. Subgroups were defined according to conditioning type and time: E1—no treatment, E2—37% phosphoric acid for 15 seconds, E3—37% phosphoric acid for 30 seconds; D1—no treatment, D2—37% phosphoric acid for 5 seconds; D3—11.5% polyacrylic acid for 15 seconds. A resin block was bonded to each substrate using the self-adhesive resin cements RelyX U100 (3M ESPE) and RelyX U200 (3M ESPE). As a reference hybrid layer, six resin blocks were luted with RelyX ARC and Scotchbond Multi-Purpose adhesive system (3M ESPE) (enamel—EA; dentine—DA). After aging for 7 days in a moist environment at 37±1°C, samples were prepared for microscopy analysis. Result and Discussion In the ARC specimens, there was hybrid layer formation in both EA and DA. U100 E1 showed gaps at the adhesive interface, while E2 and E3 showed interaction for both self-adhesive cements. There was superficial interaction with bothU100 and U200 in D1, while in D2 and D3, resin tags were only observed in the case of U100. Conclusion It was concluded that substrate conditioning may enhance the interaction between self-adhesive resin cements and dental tissues, although this is not the case for RelyX U200 and dentine. Resumo Introdução Restaurações estéticas indiretas são preferencialmente cimentadas utilizando-se cimentos resinosos convencionais e sistema adesivo de condicionamento total ou cimentos resinosos autoadesivos. Estes últimos são tecnicamente menos sensíveis e aderem aos tecidos dentários sem tratamento prévio ou aplicação de adesivo, com um único passo para sua aplicação aos tecidos dentários. Objetivo Comparar qualitativamente as interfaces adesivas de dois cimentos resinosos autoadesivos e um cimento resinoso convencional, sob microscopia eletrônica de varredura. Material e método 42 coroas de incisivos bovinos foram seccionadas e as faces vestibulares planificadas expondo esmalte (E) ou dentina (D). Os subgrupos foram definidos de acordo com o tipo e tempo de condicionamento: E1-sem tratamento, E2-37% de ácido fosfórico por 15 segundos, E3-37% de ácido fosfórico por 30 segundos; D1-sem tratamento, D2-37% de ácido fosfórico durante 5 segundos; D3-11,5% de ácido poliacrílico durante 15 segundos. Um bloco de resina foi unido a cada substrato usando os cimentos resinosos autoadesivos RelyX U100 e RelyX U200 (3M ESPE) (n=3). Como referência de camada híbrida, foram cimentados seis blocos de resina com RelyX ARC e o sistema adesivo Scotchbond Multi-Purpose(esmalte-EA, dentina-DA). Após armazenamento (7 dias, umidade, 37±1°C), as amostras foram preparadas para análise microscópica. Resultado Nos espécimes ARC, houve formação de camada híbrida em EA e DA. U100 E1 mostrou lacunas na interface adesiva, enquanto E2 e E3 apresentaram boa interação para ambos os cimentos autoadesivos. Houve interação superficial com U100 e U200 em D1, enquanto em D2 e D3, foram observadas tags de resina apenas para U100. Conclusão Concluiu-se que o condicionamento do substrato pode aumentar a interação entre cimentos resinosos autoadesivos e os tecidos dentários, embora este não seja o caso do RelyX U200 e da dentina.

This study aimed to investigate anxiety in patients attended at a university dental clinic. The present cross-sectional study included 49 patients recruited at the undergraduate dental clinics, Federal University of Juiz de Fora, Governador Valadares campus, Minas Gerais, Brazil, from September 2016 to August 2017. Information regarding gender, age, family income, educational level, frequency of dental consultations and dental procedure causing discomfort were collected using a questionnaire. The level of anxiety was evaluated by the Dental Anxiety Scale. A mild level of anxiety (median=6) was observed, with a minimum level of 4 (not anxious) and a maximum level of 19 (extremely anxious). Women had higher anxiety than men (p=0.047). Individuals with 9-11 years of schooling presented a lower level of dental anxiety than those with 0-8 years of schooling (p=0.025). Participants who attributed a greater discomfort to surgeries and the use of high-speed burs had a greater anxiety (p=0.002). Light anxiety is present in patients undergoing dental treatment in university clinics, and women are more anxious than men. Patients with higher education were less anxious than lower education level. The report of a greater discomfort with surgeries and procedures with high-speed burs were associated with a greater anxiety. Este estudo objetivou investigar a ansiedade em pacientes atendidos em clínicas odontológicas universitárias. O presente estudo transversal incluiu 49 pacientes recrutados nas clínicas odontológicas da Universidade Federal de Juiz de Fora, campus Governador Valadares, Minas Gerais, Brasil, de setembro de 2016 a agosto de 2017. Informações sobre sexo, idade, renda familiar, escolaridade, frequência de consultas odontológicas e procedimentos odontológicos causadores de desconforto foram coletadas por meio de questionário. O nível de ansiedade foi avaliado pela Dental Anxiety Scale. Observou-se um nível de ansiedade leve (mediana = 6), com mínimo de 4 (não ansioso) e máximo de 19 (extremamente ansioso). As mulheres apresentaram maior ansiedade que os homens (p = 0,047). Indivíduos com 9 a 11 anos de escolaridade apresentaram menor nível de ansiedade odontológica do que aqueles com 0 a 8 anos de estudo (p = 0,025). Os participantes que atribuíram maior desconforto às cirurgias e ao uso de alta rotação apresentaram maior ansiedade (p = 0,002). Conclui-se que a ansiedade leve está presente em pacientes submetidos a tratamento odontológico em clínicas universitárias, sendo as mulheres mais ansiosas do que os homens. Pacientes com maior grau de instrução foram menos ansiosos. O relato de maior desconforto com cirurgias e procedimentos alta rotação pode estar associado a uma maior ansiedade

The MeX™ software is a useful tool for tridimensional data collection for surface evaluation and could be relevant to evaluate the same specimen in different phases of the study, assuming repeated measures of dental enamel roughness. The aim of this study was to evaluate the influence of sample metallization for dental enamel roughness analysis with 3D images reconstructed using MeX™ software from Scanning Electron Microscopy (SEM) images. The influence of 74.98% (%mol/mol) argon-oxygen plasma for carbon layer removal on surface roughness of the metallized specimen was also evaluated. Dental enamel specimens were prepared for SEM analysis with and without carbon metallization using conventional or environmental modes. Argon-oxygen plasma for carbon layer removal was used and surface roughness was re-evaluated. Roughness obtained by SEM and MeX™ reconstructed images, with or without metallization, did not differ. No significant alteration on surface roughness after carbon layer removal using plasma was found. SEM baseline evaluation using conventional mode without sample preparation and in environmental mode were not comparable. Roughness of enamel 3D images reconstructed with MeX™ software from SEM images, with or without metallization was similar. The 74.98% (%mol/mol) argon-oxygen plasma removed the carbon layer with no effect on enamel roughness.

Background: The objectives were to evaluate the effect of surface treatments and waiting time before contact with dye on bleached enamel staining and surface treatments on roughness. Methods: One hundred bleached teeth were randomly assigned to G1 artificial saliva, G2 2% sodium fluoride (Flugel, Nova DFL), G3 casein phosphopeptide-amorphous calcium phosphate fluoride paste (MI Paste Plus, GC America), G4 rinse for bleached color maintenance (Keep White Rinse, DMC), and G5 polishing with impregnated disks (SuperBuff Disk, Shofu). Fifty specimens were immersed in coffee immediately after treatment; the others 1 h after. Color difference (ΔE) was evaluated with a spectrophotometer (Vita EasyShade) and roughness (Ra, Rq) with an optical profilometer (NewView 7300). Effects were analyzed with two-way ANOVA, Friedman, and Kruskal–Wallis test (P < 0.05). Results: Surface treatments (P = 0.878), waiting time (P = 0.105), and interaction (P = 0.145) were not significant to bleached color maintenance. Roughness was different among the evaluation time points (2nd evaluation >1st evaluation >3rd evaluation) (P < 0.001); not among surface treatments (G1, G2, G3, G4, G5) (P > 0.05). Conclusions: Surface treatments were similar to saliva for bleached enamel color maintenance. Immediate or 1-h postponed contact with coffee did not affect bleached enamel color. Bleaching increased enamel roughness; surface treatments and artificial saliva decreased it.

Background The increasing demand of tooth bleaching has also increased the need of researches focusing on the durability of the resultant color. The aim of this study was to evaluate the effect of a system based on calcium silicate, sodium phosphate and sodium monofluorophosphate (Regenerate™) on color maintenance of bleached enamel considering two waiting times for the contact with a cola drink. Material and Methods This in vitrostudy was performed on bovine enamel specimens (n = 100), bleached with 35% H2O2 and treated with: G1 Distilled water; G2 Artificial saliva; G3 RegenerateTM Serum and Toothpaste; G4 RegenerateTM Toothpaste; G5 RegenerateTM Serum. The groups G3, G4 and G5 received one application of the respective products for 3 min, in 3 consecutive days. The color parameters (ΔE, L*, a*, b*) were evaluated by spectrophotometry before and after bleaching and after surface treatments and immersion (15min) in cola drink, on the waiting times of 24 hours (T1) and 7 days (T2). The effect of surface treatments and waiting times was evaluated by Two-Way ANOVA, Kruskal-Wallis, Wilcoxon and T test (p

A avaliação do desempenho clínico de estudantes de Odontologia é muito importante para motivar o aprendizado. Este artigo propõe-se a apresentar uma revisão de literatura sobre métodos de avaliação de desempenho clínico e a desenvolver um protocolo para ser aplicado nas disciplinas do curso de Odontologia da UFMG. O Protocolo de Avaliação Clínica (PAC) foi elaborado a partir do Objective Structured Clinical Examination (OSCE) e do Structured Clinical Operative Test (SCOT), métodos de avaliação mais encontrados na literatura, com a finalidade de realizar uma avaliação objetiva do aprendizado do aluno em pontos relacionados a anamnese, diagnóstico, plano de tratamento, controle de infecção, técnicas, habilidade, comunicação e profissionalismo. A autoavaliação realizada pelos alunos também faz parte desse protocolo, sendo interessante para se diagnosticarem pontos fracos e virtudes dos estudantes. O PAC pode ser uma alternativa aos métodos convencionais de avaliação, reduzindo a subjetividade e tornando o processo avaliativo mais confiável e homogêneo Evaluating the performance of dentistry students is essential to motivate learning. This article presents a review of the literature on the main clinical performance evaluation methods available. Based on that review, this work develops a method of clinical evaluation to be applied in the Faculty of Dentistry - UFMG. The Clinical Assessment Protocol (CAP) was developed considering OSCE (Objective Structured Clinical Examination) and SCOT (Structured Clinical Operative Test) methodologies. CAP’s purpose is to objectively assess students’ learning on topics related to medical history investigation, diagnosis, treatment planning, infection control, techniques, skills, communication and professionalism. Students’ self-assessment is also part of this protocol and may be interesting to identify their own weaknesses and strengths, motivating their learning process. CAP can be an alternative to conventional evaluation methods, reducing subjectivity and providing more reliability and equity to the evaluation process

Statement of problem Decementation is one of the most frequent causes of failure in the post-cement system. The bond strength in different parts of the canal may be influenced by technical and anatomic factors. Purpose The purpose of this in vitro study was to assess the effects of anatomic root levels to reach the canal and different resin cements on the bond strength of fiberglass posts along the canal. Material and methods One hundred thirty-five roots of bovine teeth were endodontically treated, prepared with 15-mm-long post spaces and divided according to the anatomic root level: coronal (with 15-mm post space), middle (with 10-mm post space), and apical (with 5-mm post space). Fiberglass posts were luted with the cements (n=15): conventional resin cement with 3-step etch-and-rinse adhesive system (RelyX ARC/SBMP); self-adhesive resin cement (RelyX U200) and autopolymerizing resin cement with etch-and-rinse adhesive system (C&B/All-Bond 2). After 24 hours, specimens were sectioned and subjected to the push-out test. The maximum extrusion load was recorded (0.5 mm/minute, 200 N). Data were analyzed with analysis of variance (ANOVA) and the Tukey test (α=.05). Failure mode was analyzed by using multinomial logistic regression. Results There were no significant effects of resin cements ( P >.05). The bond strength at apical third was higher when the canal was reached at the apical level than at the coronal level ( P =.022). When each root level was directly reached, the coronal bond strength was lower than apical ( P =.001) and middle ( P =.021) for all cements. Conclusions When the canal was reached at the coronal, medium, and apical levels, the bond strength of conventional, self-adhesive and autopolymerizing resin cements was lower in the coronal root third.

Objective: To evaluate the effect of two insertion techniques of self-adhesive dual resin cement on the bond strength of fiberglass posts in different portions of the root. The homogeneity of the cement layer along the root canal was also evaluated. Material and Methods: The root canals of 28 bovine teeth were instrumented, filled, and 14mm-space was prepared for luting fiberglass posts (Reforpost #3, Angelus), maintaining 4mm of apical sealing. The roots were randomly allocated into two groups according to the cement insertion technique (n=14): Lentulo Drill (Dentsply/Maillefer) or Centrix syringe (Dentsply). The posts were fixed with self-adhesive resin cement (RelyX U200, 3M ESPE). After 7 days, the roots were cross-sectioned to obtain three 1.0-mm-thick samples of each third of the space prepared for the post. Two samples of each third were subjected to push-out test (0.5 mm/min; 200N) and the third specimen was used for the analysis of cementation layer homogeneity. Images of specimens (40x magnification) were assessed and classified by two calibrated examiners (Kappa = 0.87) according to the presence or absence of voids and misfit. Data were analyzed by two-way ANOVA and Pearson Chi-Square test. Results: There was no statistically significant effect of insertion technique (p=0.278) or post-space thirds (p = 0.521) on bond strength of fiberglass posts. Chi-Square test showed that cement insertion with the Lentulo drill produced more cement voids than Centrix syringe (p = 0.023). Conclusion: The cement insertion technique did not influence bond strength of fiberglass posts in bovine root dentin. The use of Centrix syringe for cement insertion is preferred since it produced more homogenous cement layer.

Objective. This study evaluated the effect of immediate or delayed finishing/polishing using different systems on the surface roughness, hardness, and microleakage of a silorane-based composite.Material and Methods. Specimens were made with silorane-based composite (Filtek P90, 3M ESPE) and assigned to the treatments: control (light-cured); aluminum oxide discs (Sof-Lex, 3M ESPE); diamond-impregnated silicone tips (Astropol, Ivoclar Vivadent); aluminum oxide-impregnated silicone tips (Enhance, Dentsply). Half of the specimens were finished/polished immediately and the rest after 7 days. Surface roughness (Ra,μm;n=20) and Vickers microhardness (50 g; 45 s;n=10) were measured. Cavities were prepared in bovine incisors and filled with Filtek P90. The fillings received immediate or delayed finishing/polishing (n=10) and were subjected to dye penetration test (0.5% basic fuchsin, 24 h). Data were analyzed by ANOVA and Scheffe, Kruskal-Wallis, and Mann-Whitney tests (p<0.05).Results. The finishing/polishing system significantly influenced roughness and microhardness (p<0.0001). For enamel, microleakage was not affected by the finishing/polishing system (p=0.309). For dentin, Sof-Lex discs and Astropol points promoted greater microleakage than Enhance points (p=0.033).Conclusion. Considering roughness, microhardness, and microleakage together, immediate finishing/polishing of a silorane-based composite using aluminum oxide discs may be recommended.

To assess whether bovine teeth can be used as viable alternatives for human teeth in tensile and shear bond strength testing.Articles were selected from Web of Science, PubMed, Scopus, LILACS-Bireme, and BBO electronic databases using keywords obtained from Medical Subject Headings (MeSH). Of 1540 potentially eligible studies, 157 were selected for full text analysis. Five independent reviewers (Kappa = 0.89) selected the studies, abstracted information, and assessed quality based on standardized scales. After the analysis, 78 studies comparing bovine teeth to human teeth were found. Only 18 studies comparing bovine and human substrates in bond strength tests were included in the systematic review and 13 in the meta-analysis. Two authors independently selected the studies, extracted the data and assessed the risk of bias. Mean differences were obtained by comparing tensile and shear bond strengths between human and bovine teeth (permanent and deciduous) and considering enamel and dentin separately (subgroup analysis). Statistical analysis was performed using RevMan5.1, with a random-effect model, at a 5% significance level.No significant difference was found between human and bovine teeth in tensile tests (p = 0.41) for dentin (p = 0.86), but there was a difference for enamel (p = 0.01). Regarding shear bond strength, no significant difference was found between human and bovine teeth (p = 0.16) either for enamel (p = 0.07) or dentin (p = 0.68). Regarding shear bond strength on deciduous teeth, no significant difference was found between human and bovine substrates (p = 0.54), either for enamel (p = 0.42) or dentin (p = 0.05). Most studies were at high (low or unclear) risk of bias.In shear bond strength testing, bovine teeth can be a suitable alternative for permanent and deciduous human teeth, for both enamel and dentin substrates. However, they may not be suitable for enamel tensile bond strength testing. The findings are based on low quality studies (considerable heterogeneity) and should be interpreted with caution.

Purpose This study compared the vertical misfit of fixed implant-supported titanium (Ti6Al4V) and yttria-stabilized tetragonal zirconia frameworks milled using the computer-aided design/computer-aided manufacturing (CAD/CAM) Zirkonzahn system. Materials and methods An aluminum mandibular master cast was used, and four analogs of the Regular CrossFit implant for straight multibase titanium alloy abutments (Institut Straumann) were fixed with self-curing acrylic resin in mandibular canine and second premolar tooth locations with the aid of a parallelometer. Scan abutments were placed over the four straight multibase Regular CrossFit abutments to determine their correct three-dimensional (3D) positioning in the virtual model. Implant frameworks were designed virtually, and five frameworks of each material (titanium alloy or yttria-stabilized tetragonal zirconia) were milled using the CAD/CAM system. Scanning electron microscope (SEM) images, with magnifications of 50×, 250×, and 1,000×, were obtained from three points on the buccal surface, three points on the lingual surface, and three points on the mesial surface of each abutment. The measurements were performed in the center of each of the thirds, thus defining points one, two, and three. The degree of vertical misfit at the framework-abutment interface was determined using ImageJ software and analyzed using the Student t test (P = .05). Results The mean misalignment value was 6.011 ± 0.750 μm for the titanium group and 9.055 ± 3.692 μm for the zirconia group. Conclusion Within the limitations of this study, there was no significant difference in vertical misfit between the titanium and zirconia implant frameworks produced using the CAD/CAM system. Regardless of the material used, the CAD/CAM frameworks achieved an adequate vertical fit.

Purpose: Biomechanical behavior of tooth-implant-supported prostheses (TISPs) with external and internal implants was compared. Materials and methods: Two 3-D models of TISP were designed by varying the implant: external (Model EH) and internal hexagons (Model IH). After loading, von Mises stresses were obtained in implants, abutments, and screws. Principal maximum (σmax) and minimum (σmin) stresses were analyzed in periodontal ligament (PL), alveolar bone, and periimplant bone. Results: Model IH showed lower stress peaks in axial loading in the implant and in the screw but higher in abutment. In oblique loading, Model IH had lower stresses in the implant, but higher in the abutment and in the screw. In the σmax analysis for axial and oblique loads, stress peaks in Model IH were lower in PL, alveolar bone, and periimplant bone. In the σmin analysis for axial load, stress peaks in Model IH were lower in PL, but higher in alveolar bone and in periimplant bone. In oblique load, Model IH showed lower stress peaks in PL and alveolar bone, but higher stress peaks in periimplant bone. Conclusions: TISPs with IH implants do present lower risk of biomechanical failure

Objective.To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE).Methods.A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes.Results.IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0–44) vs 2 (0–45), p < 0.0001] and current prednisone (PRED) dose [50 (10–60) vs 10 (2–90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057–1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021–1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969–0.998, p = 0.030) were independent risk factors for IFI (R2 Nagelkerke 0.425).Conclusion.To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.

SUMMARY Objective The aim of this study was to investigate the clinical performance and to validate the Lesion Activity Assessment (LAA) in conjunction with the International Caries Detection and Assessment System (ICDAS) for occlusal caries diagnosis in permanent teeth. Methods Patients with erupted or partially erupted third molars were recruited from the surgery clinic of the School of Dentistry of the Universidade Federal de Minas Gerais, Brazil. A calibrated examiner evaluated 49 teeth using the ICDAS-LAA criteria. The histologic criterion proposed by Ekstrand and others was used to validate severity at the thresholds D1 (outer half of the enamel), D2 (inner half of the enamel and outer third of the dentin), and D3 (inner or middle third of the dentin). Lesion activity was validated using 0.1% methyl red solution. Results The method demonstrated good reliability (weighted kappa for severity=0.60; unweighted kappa for activity=0.61). The ICDAS presented a higher performance for lesion detection (area under the receiver operating characteristic curve [Az]=0.79) using the threshold D3. At the thresholds D1 and D2, the results for Az were 0.57 and 0.74, respectively. Regarding the ICDAS-LAA, Az = 0.59. Conclusions Clinical protocols can use ICDAS for the severity diagnosis of occlusal caries, but the LAA performance was poor.

The aim of this study was to compare the areas of stress concentration in a three-dimensional (3D) premolar tooth model with anisotropic or isotropic enamel using the finite element method. A computed tomography was imported to an image processing program to create the tooth model which was exported to a 3D modeling program. The mechanical properties and loading conditions were prescribed in Abaqus. In order to evaluate stresses, axial and oblique loads were applied simulating realistic conditions. Compression stress was observed on the side of load application, and tensile stress was observed on the opposite side. Tensile stress was concentrated mainly in the cervical region and in the alveolar insertion bone. Although stress concentration analyses of the isotropic 3D models produced similar stress distribution results when compared to the anisotropic models, tensile stress values shown by anisotropic models were smaller than the isotropic models. Oblique loads resulted in higher values of tensile stresses, which concentrate mainly in the cervical area of the tooth and in the alveolar bone insertion. Anisotropic properties must be utilized in enamel stress evaluation in non-carious cervical lesions.

Purpose Different periodontitis case definitions have been used in clinical research and epidemiology. The aim of this study was to determine more accurate criterion for the definition of mild and moderate periodontitis case to be applied to head and neck cancer individuals before radiotherapy. Methods The frequency of periodontitis in a sample of 84 individuals was determined according to different diagnostic criteria: (1) Lopez et al. (2002);(2) Hujoel et al. (2006); (3) Beck et al. (1990); (4) Machtei et al. (1992); (5) Tonetti and Claffey (2005); (6) and Page and Eke (2007). All diagnosis were based on the clinical parameters obtained by a single calibrated examiner (Kw=0.71). The individuals were evaluated before radiotherapy. They received oral hygiene instructions, and the cases diagnosed with periodontitis (Page and Eke 2007) were treated. The gold standard was the definition 6, and the others were compared by means of agreement, sensitivity (SS), specificity (SP), and the area under ROC curve. The kappa test evaluated the agreement between definitions. Results The frequency of periodontitis at baseline was 53.6 % (definition 1), 81.0 % (definition 2), 40.5 % (definition 3), 26.2 % (definition 4), 13.1 % (definition 5), and 70.2 % (definition 6). The kappa test showed a moderate agreement between definitions 6 and 2 (59.0 %) and definitions 6 and 1 (56.0 %). The criterion with higher SS (0.92) and SP (0.73) was definition 1. Conclusion Definition 1 was the most accurate criterion to case periodontitis definition to be applied to head and neck cancer individuals.