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OBJECTIVE: The present in vitro study incorporated niobium oxyhydroxide fillers into an experimental high-viscosity bulk-fill resin composite to improve its mechanical performance and provide it a bioactive potential. METHODOLOGY: Scanning electron microscopy synthesized and characterized 0.5% niobium oxyhydroxide fillers, demonstrating a homogeneous morphology that represented a reinforcement for the feature. Fillers were weighed, gradually added to the experimental resin composite, and homogenized for one minute, forming three groups: BF (experimental high-viscosity bulk-fill resin composite; control), BF0.5 (experimental high-viscosity bulk-fill resin composite modified with 0.5% niobium oxyhydroxide fillers), and BFC (commercial bulk-fill resin composite Beautifil Bulk U, Shofu; positive control). In total, 10 specimens/groups (8 × 2 × 2 mm) underwent flexural strength (FS) tests in a universal testing machine (Instron) (500N). Resin composites were also assessed for Knoop hardness (KH), depth of cure (DoC), degree of conversion (DC), elastic modulus (E), and degree of color change (ΔE). The bioactive potential of the developed resin composite was evaluated after immersing the specimens into a simulated body fluid in vitro solution and assessing them using a Fourier-transformed infrared spectroscope with an attenuated total reflectance accessory. One-way ANOVA, followed by the Tukey's test (p<0.05), determined FS, DC, KH, and ΔE. For DoC, ANOVA was performed, which demonstrated no significant difference between groups (p<0.05). CONCLUSIONS: The high-viscosity bulk-fill resin composite with 0.5% niobium oxyhydroxide fillers showed promising outcomes as reinforcement agents and performed well for bioactive potential, although less predictable than the commercial resin composite with Giomer technology.

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Abstract Objective The present in vitro study incorporated niobium oxyhydroxide fillers into an experimental high-viscosity bulk-fill resin composite to improve its mechanical performance and provide it a bioactive potential. Methodology Scanning electron microscopy synthesized and characterized 0.5% niobium oxyhydroxide fillers, demonstrating a homogeneous morphology that represented a reinforcement for the feature. Fillers were weighed, gradually added to the experimental resin composite, and homogenized for one minute, forming three groups: BF (experimental high-viscosity bulk-fill resin composite; control), BF0.5 (experimental high-viscosity bulk-fill resin composite modified with 0.5% niobium oxyhydroxide fillers), and BFC (commercial bulk-fill resin composite Beautifil Bulk U, Shofu; positive control). In total, 10 specimens/groups (8 × 2 × 2 mm) underwent flexural strength (FS) tests in a universal testing machine (Instron) (500N). Resin composites were also assessed for Knoop hardness (KH), depth of cure (DoC), degree of conversion (DC), elastic modulus (E), and degree of color change (ΔE). The bioactive potential of the developed resin composite was evaluated after immersing the specimens into a simulated body fluid in vitro solution and assessing them using a Fourier-transformed infrared spectroscope with an attenuated total reflectance accessory. One-way ANOVA, followed by the Tukey's test (p<0.05), determined FS, DC, KH, and ΔE. For DoC, ANOVA was performed, which demonstrated no significant difference between groups (p<0.05). Conclusions The high-viscosity bulk-fill resin composite with 0.5% niobium oxyhydroxide fillers showed promising outcomes as reinforcement agents and performed well for bioactive potential, although less predictable than the commercial resin composite with Giomer technology.

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Objective: Evaluate a fluoride varnish modified by nanostructures with the bioactive qualities of silica (SiO2) and niobium pentoxide (Nb2O5), testing its remineralizing potential by surface hardness (SH) and energy-dispersive X-ray spectroscopy (EDX). Material and Methods: Bovine enamel specimens (6×4×2mm) were prepared and submitted to a demineralizing/remineralizing process to produce a subsurface caries-like lesion, evaluated by transversal microradiography image (TMR) and subsequently distributed randomly into three groups: fluoride varnish (VZ); fluoride varnish + silica gelatin (VZ-SiO2) and fluoride varnish + niobium nanoparticles (VZ-Nb2O5). The specimens were subjected to a pH-cycling demineralizing/remineralizing process for 7 days at 37ºC. The %SH loss and %SH recovery (after the pH-cycling regimen) were calculated (n=10/group). The Ca/P weight ratio before and after the pH-cycling regimen was evaluated through SEM/EDX. A two-way ANOVA followed by Tukey's test (p<0.05) was performed for hardness and EDX. Results: TMR image showed the formation of an artificial subsurface lesion, and a significant SH increase was observed in the VZ-Nb2O5 group (p<0.05). Regarding the %SHL and %SHR, the VZ-Nb2O5 and VZ-SiO2 were significantly different compared to the VZ group (p<0.001), but VZ-Nb2O5 presented higher values. The Ca/P ratio showed that blocks treated with VZ-SiO2 and VZ-Nb2O5 showed greater ion deposition, particularly in the presence of Nb. Conclusion: The bioactivity of niobium facilitated greater interaction between the enamel and the varnish, leading to a slow release of nanoparticles and a longer-lasting remineralizing effect (AU)

Objetivo: Avaliar um verniz fluoretado modificado por nanoestruturas com a bioatividade da sílica (SiO2) e pentóxido de nióbio (Nb2O5), testando seu potencial remineralizador pela dureza de superfície (SH) e espectroscopia de energia dispersiva de raios-X (EDX). Material e Métodos: Espécimes de esmalte bovino (6×4×2mm) foram preparados e submetidos à desmineralização/remineralização para produzir uma lesão subsuperficial semelhante a cárie, avaliada por imagem de microrradiografia transversal (TMR) sendo distribuída em três grupos: verniz fluoretado (VZ); verniz fluoretado+gelatina de sílica (VZ-SiO2) e verniz fluoretado+nanopartículas de nióbio (VZ-Nb2O5). As amostras foram submetidas à desmineralização/remineralização por ciclagem de pH durante 7 dias a 37°C. A porcentagem de perda e recuperação de SH foram calculadas (n=10/grupo). A relação em peso Ca/P antes e depois da ciclagem foi avaliada através de MEV/EDX. ANOVA a dois critérios seguida do teste de Tukey (p<0,05) foi realizada para dureza e EDX. Resultados: A TMR mostrou a formação de uma lesão subsuperficial e um aumento significativo de SH foi observado no grupo VZ-Nb2O5 (p<0,05). Em relação ao %SHL e %SHR, o VZ-Nb2O5 e o VZ-SiO2 foram significativamente diferentes em relação ao grupo VZ (p<0,001), mas o VZ-Nb2O5 apresentou valores maiores. A relação Ca/P mostrou que os blocos tratados com VZ-SiO2 e VZ-Nb2O5 apresentaram maior deposição de íons, principalmente na presença de Nb. Conclusão: A bioatividade do nióbio facilitou maior interação entre o esmalte e o verniz, levando a uma liberação lenta de nanopartículas e a um efeito remineralizante mais duradouro (AU)

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This systematic review provides an update on the effect of nanofibers as reinforcement on resin-based dental materials. A bibliographic search was conducted in MEDLINEPubMed, Embase, Web of Science, Scopus, BVS (LILACS, BBO e IBECS), Cochrane, LIVIVO, and gray literature (BDTD) to identify relevant articles up to May 2021. In vitro studies that evaluated and compared the mechanical properties of nanofibers resin-based composite materials, were eligible. No publication year or language restriction was applied, and methodological quality was assessed using two methods. In a total of 6100 potentially eligible studies, 81 were selected for full-text analysis and 35 were included for qualitative analysis. Of the 35 included studies, a total of 29 studies evaluated the flexural strength (FS) of the materials. These groups were distinguished according to the resin-based materials tested and nanofiber types. Most of the studies evaluated materials composed of glass fibers and demonstrated higher values of FS when compared to resin-based materials without nanofibers. The incorporation of nanofibers into resin-based dental materials improved the mechanical properties compared to resin-based materials without nanofibers, suggesting better performance of these materials in high-stressbearing application areas. Further clinical studies are required to confirm the efficacy of resin-based materials with nanofibers.

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OBJECTIVE: This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented. CLINICAL CONSIDERATIONS: A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels. CONCLUSION: The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years. CLINICAL SIGNIFICANCE: This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

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O presente trabalho tem como objetivo realizar uma revisão de literatura e discutir os mais atuais conceitos sobre abordagem conservadora de lesões cariosas profundas, facilitando o manejo clínico. Para que essa abordagem conservadora seja implementada, é imprescindível que se conheça a composição estrutural e funcional do biofilme para, assim, entender a evolução da doença cárie que acomete a estrutura dentária. No entanto, quando se trata de um dente com lesão de cárie ativa com grande comprometimento de esmalte e dentina, procedimentos operatórios mais invasivos e restauradores podem ser necessários, mesmo que fundamentados na maior preservação possível de estrutura dentária. As evidências mais atuais encontradas na literatura recomendam a remoção seletiva do tecido cariado que consiste na dentina infectada, ou seja, clinicamente amolecida, e restauração definitiva na mesma sessão. Portanto, desde que o dente apresente vitalidade pulpar clinicamente confirmada, acredita-se que a preservação estratégica da dentina, poderá aumentar as chances de sucesso no tratamento, evitando possível exposição da polpa dentária. Adicionalmente, ao optar por práticas conservadoras no contexto da Odontologia de mínima intervenção, resultará em um significativo aumento na longevidade das restaurações sempre associando promoção de saúde ao paciente(AU)

This paper aims to conduct a literature review and discuss the most current concepts on conservative approach to deep carious lesions in permanent posterior teeth, facilitating clinical management. For this conservative approach to be implemented, it is essential to know the structural and functional composition of the biofilm in order to understand the evolution of the caries disease that affects the dental structure. However, when it comes to a tooth with an active caries lesion with major enamel and dentin compromise, more invasive and restorative surgical procedures may be necessary, even if based on the greatest possible preservation of the dental structure. The most current findings in the literature recommend the selective removal of carious tissue consisting of infected dentin, that is, clinically softened, and definitive restoration in the same session. Therefore, as long as the tooth has clinically confirmed pulp vitality, it is believed that the strategic preservation of dentin may increase the chances of successful treatment, avoiding possible exposure of the dental pulp. Additionally, when opting for conservative practices in the context of Minimally Invasive Dentistry, it will result in a significant increase in the longevity of restorations, always associating health promotion to the patient(AU)

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Increasing prevalence of erosive tooth wear (ETW) is notable mainly due to current knowledge and its early diagnosis. Once teeth are functionally and/or esthetically affected, dental restorations may become necessary. Materials capable of interacting with the eroded dental tissue allied to their resistance to subsequent continuous erosive challenges are desirable. Giomer technology based on S-PRG (surface pre-reactive glass) filler has been launching to provide benefits for the dental treatment due to its innovative multi-ionic release system, which involves fluoride. This case report describes the employment of preventive and restorative materials based on this technology for a patient under frequent erosive challenges and complaining about dental sensitivity. Patient reported immediate reduction on this sensitivity and the restorations has been followed up for 2 years, presenting satisfactory performance. S-PRG-based systems seem to be promissory for preventive and therapeutic management of ETW used simultaneously with the patient compliance. (AU)

O aumento da prevalência do desgaste dentário erosivo (DDE) é notável especialmente devido ao conhecimento atual e seu diagnóstico precoce. Uma vez que os dentes são afetados funcional e/ou esteticamente, restaurações dentárias se tornam necessárias. Materiais focados na habilidade de interagir com o tecido dentário erodido associados com sua resistência aos desafios erosivos contínuos subsequentes são desejáveis. A tecnologia Giomer baseada em partículas S-PRG (superfície de vidro pré-reativo) foi lançada no mercado para oferecer benefícios para o tratamento odontológico devido ao seu sistema inovador de liberação multi-iônica, que envolve o flúor. Esse caso clínico descreve o uso de materiais preventivo e restaurador baseados nessa tecnologia em um paciente em desafio erosivo e com queixa de sensibilidade. O paciente relatou redução imediata da sensibilidade e as restaurações foram acompanhadas por 2 anos apresentando desempenho satisfatório. Sistemas baseados em S-PRG se mostram promissores para manejo preventivo e terapêutico do DDE empregados simultaneamente à colaboração do paciente.(AU)

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OBJECTIVE: The aim of this retrospective study was to evaluate the cephalometric and occlusal changes of orthodontically treated Class III malocclusion patients. METHODS: The experimental groups comprised 37 Class III patients treated: G1) without (n=19) and G2) with extractions (n=18) . The control group (G3), matched by age and sex with the experimental groups, consisted of 18 subjects with untreated Class III malocclusion. Cephalometric (radiographs) and occlusal (study models) changes were assessed between the beginning (T1) and the end (T2) of treatment. Intergroup comparisons were performed with one-way ANOVA followed by Kruskal-Wallis tests (p< 0.05). Occlusal changes were evaluated by the peer assessment rating (PAR) index (ANOVA and Kruskal-Wallis tests), and the treatment outcomes were evaluated by the Objective Grading System (OGS) (t-tests). RESULTS: The experimental groups showed a restrictive effect on mandibular anterior displacement and a discrete improvement in the maxillomandibular relationship. Extraction treatment resulted in a greater retrusive movement of the incisors and significant improvements in the overjet and molar relationship in both groups. The PAR indexes were significantly reduced with treatment, and the OGS scores were 25.6 (G1) and 28.6 (G2), with no significant intergroup difference. CONCLUSIONS: Orthodontic treatment of Class III malocclusion patients with fixed appliances improved the sagittal relationships, with greater incisor retrusion in the extraction group. Both the extraction and non-extraction treatments significantly decreased the initial malocclusion severity, with adequate and similar occlusal outcomes of treatment.

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As resinas Bulk fill surgiram com o intuito de facilitar a restauração de cavidades profundas. A fotoativação adequada é extremamente importante para que a resina bulk fill ofereça propriedades mecânicas satisfatórias e, longevidade na restauração. Este estudo avaliou a influência da espessura do incremento na microdureza Knoop (KHN) de três resinas bulk fill (n = 5). Cinquenta amostras foram divididas de acordo com o material (Filtek Z250, Filtek One Bulk Fill e Filtek Bulk Fill Flow), espessura (2mm e 4 mm) e tempo de fotoativação (20 e 40s) - Z2502mm20s, Z2502mm40s, One2mm20s, One2mm40s, One4mm20s, One4mm40s, Flow2mm20s, Flow2mm40s, Flow4mm20s e Flow4mm40s. As análises KHN foram realizadas no topo e na base de cada amostra. Os dados foram submetidos à ANOVA a 1 critério e ao Teste de Tukey (p< 0,05). A média e desvio padrão (+/-) dos seguintes grupos foram (Z2502mm20s) 0,85 (+/- 0,01); (Z2502mm40s) 0,92 (+/- 0,01); (One2mm20s) 1,05 (+/- 0,08); (One2mm40s) 0,95 (+/- 0,04); (One4mm20s) 0,93 (+/- 0,04); (One4mm40s) 0,97 (+/ - 0,04); (Flow2mm20s) 0,92 (+/- 0,05); (Flow2mm40s) 0,89 (+/- 0,04); (Flow4mm20s) 0,79 (+/- 0,04) e (Flow4mm40s) 0,90 (+/- 0,03). Os grupos da Filtek One Bulk apresentaram um valor significativamente maior, demonstrando uma polimerização suficiente mesmo na base de incrementos com 4 mm. Concluiu-se que o aumento na espessura do incremento de resinas bulk fill não afetou negativamente a fotoativação(AU)

Bulk fill composites emerged, allowing the restoration of deep cavities easily. Appropriate lightcuring is crucial to bulk fill composite presents satisfactory mechanical properties and restoration longevity. This study evaluated the influence of thickness increment on Knoop microhardness (KHN) of three dental bulk fill composites (n=5). Fifty samples were divided according to composite (Filtek Z250, Filtek One Bulk Fill and Filtek Bulk Fill Flow), thickness (2mm and 4 mm) and time lightcuring (20 and 40 s) - Z2502mm20s, Z2502mm40s, One2mm20s, One2mm40s, One4mm20s, One4mm40s, Flow2mm20s, Flow2mm40s, Flow4mm20s e Flow4mm40s. KHN analysis were performed on the top and the base of each specimen. Data were subjected to one-way ANOVA and Tukey test (p< 0,05). The mean and standard deviation (+/-) of following groups were (Z2502mm20s) 0,85(+/-0,01); (Z2502mm40s) 0,92(+/- 0,01); (One2mm20s) 1,05(+/-0,08); (One2mm40s) 0,95(+/-0,04); (One4mm20s) 0,93 (+/-0,04); (One4mm40s) 0,97(+/-0,04); (Flow2mm20s) 0,92(+/- 0,05); (Flow2mm40s) 0,89(+/-0,04); (Flow4mm20s) 0,79(+/-0,04) e (Flow4mm40s) 0,90(+/-0,03) Filtek One Bulk groups present significantly higher value, demonstrating sufficient polymerization even on the base of 4 mm increments. It was concluded that the increase in the thickness increment of Bulk fill composites did not negatively affect the lightcure(AU)

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STATEMENT OF PROBLEM: Information related to the optical and surface properties, including health compatibility, surface roughness, and esthetics, of 3D-printed dental materials is scarce. PURPOSE: The purpose of this in vitro study was to compare the physical and surface properties of a 3D-printed resin with those of materials used for interim restorations. MATERIAL AND METHODS: A 3D-printed resin (PR) (NextDent C&B MFH; 3D Systems), an autopolymerizing interim material (BA) (Protemp 4; 3M ESPE), and a composite resin (Z350) (Filtek Z350XT; 3M ESPE) were tested for degree of color change (ΔE) (n=7) at different timepoints-24 hours after polishing/baseline (P0), 8 days after polishing (P1), and after artificial aging in water at 60 °C for 24 hours (P2)-by using a CIELab-based colorimeter; flexural strength (σ) (n=10) with a 3-point bend test; Knoop hardness (H) (n=8); and surface roughness (Ra) (n=7) with a profilometer. All specimens were polished 24 hours after polymerization, except for the additional group for surface roughness (BA) without polishing (BANP). A statistical analysis was performed by using 2-way repeated-measures ANOVA followed by the Fischer test for ΔE and 1-way ANOVA followed by the Fisher test for microhardness and surface roughness (α=.05). RESULTS: The Z350 showed the highest values for σ and H, followed by PR. BA showed the lowest results for both tests (P<.05). Considering roughness, the Z350 showed similar values to those of BA but lower than PR; PR showed similar roughness when compared with BA. PR showed the highest color variation among the groups at all timepoints, followed by BA. The Z350 was the most color stable material at all timepoints. CONCLUSIONS: The 3D-printed composite resin had adequate mechanical and surface properties for an interim restorative material. It has the potential to be a low-cost workflow in dentistry, although its color stability could be a concern for long-term use.

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