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This study aimed to evaluate the antimicrobial properties, cell viability, and matrix metalloproteinase (MMP) inhibition capacity of several endodontic materials aimed at vital pulp therapy: Pro Root MTA®, EndoSequence®, Biodentine®, MTA Angelus®, TheraCal LC®, and BioC Repair®. The materials were prepared according to the manufacturer's instructions. Antimicrobial tests were conducted using a microcosm biofilm model, cell viability was assessed using murine fibroblasts (L929), and MMP activity was analyzed through electrophoresis. The results showed that BioC Repair®, Biodentine®, and EndoSequence® exhibited similar antimicrobial properties, while MTA Angelus® and ProRoot MTA® had inferior results but were comparable to each other. In terms of cell viability, no significant differences were observed among the materials. EndoSequence® demonstrated the highest MMP inhibition capacity. In conclusion, BioC Repair®, Biodentine®, EndoSequence®, and TheraCal® showed better antimicrobial properties among the tested materials. The materials did not exhibit significant differences in terms of cytotoxicity. However, EndoSequence® displayed superior MMP inhibition capacity.

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BACKGROUND: Elderly people frequently report tooth loss, affecting their nutritional status. There is a gap in the scientific evidence about the influence of prosthodontic rehabilitation on nutritional status. OBJECTIVE: To investigate the influence of prosthodontic rehabilitation combinates or not with dietary advice on nutritional status in elderly patients. METHODS: A systematic literature search was conducted in three electronic databases to identify randomized clinical trials that evaluated the effect of prosthetic rehabilitation on nutritional status in subjects aged 60 years or older, with a follow-up of at least 1 month after prosthesis rehabilitation. RESULTS: Of the 1517 articles identified in the initial search, 12 were selected for the final review. No significant difference between the types of prosthesis were found regarding the chewing by the elderly population. Although patients who received prosthetic treatment had significant improvement in chewing ability, a consistent pattern of improvement in nutritional status was not observed when they did not receive dietary advice. In addition, the association between the condition of the dentition, the masticatory performance and nutritional change of elderly patients has been found. Studies that evaluated simultaneous complete denture treatment and simple dietary advice showed an improvement of nutrient intake in elderly patients. CONCLUSIONS: Isolated prosthetic rehabilitation may not have the effect of exerting a change in nutritional status of edentulous elderly patients. In general, simultaneous dietary consulting and prosthetic treatment in combination may improve dietary habits, since masticatory capacity and efficiency are not the only factors that influence the nutritional status of a patient.

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OBJECTIVES: This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). MATERIALS AND METHODS: The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values. RESULTS: Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05). CONCLUSION: The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management. CLINICAL SIGNIFICANCE: VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.

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OBJECTIVES: This systematic review investigated the hypothesis that preheated resin composites (RCs) used as luting agents improve the mechanical properties, physicochemical performance, and color of indirect ceramic restorations. MATERIALS AND METHODS: Literature search was performed in three databases (Medline/PubMed, Scopus, and Web of Science) and in the grey literature (OpenGrey, ProQuest, and Catalog of Theses & Dissertations from CAPES). Eligibility criteria included only studies comparing at least one preheated RC used as a luting agent with resin cements. RESULTS: Data regarding the mechanical properties, physicochemical characteristics, and color were analyzed qualitatively, and the microtensile bond strength and film thickness were also evaluated by meta-analysis. The search strategy identified 3894 papers, and 28 were full-text screened. Seven studies were included in the review, and 5 were included in the meta-analysis. No significant difference was found for microtensile bond strength (P = 0.14). Preheated RCs showed significantly higher film thickness than resin cements (P = 0.001). CONCLUSION: Overall, the use of preheated RCs as luting agents offers similar to poorer performance than using resin cements for bonding indirect restorations. CLINICAL RELEVANCE: Despite the claim that preheated RC could be used as a luting agent, further studies should investigate the effect of clinically unacceptable film thickness.

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Introduction: A systematic review and meta-analysis were conducted to evaluate the physicomechanical properties of tertiary monoblock obturation with different obturation techniques. Methods and Materials: PubMed (MEDLINE), Web of Science, Scopus, the Cochrane Library, LILACS, IBECS, and BBO were searched time. PICO question was: "In extracted human teeth (Population), does tertiary monoblock obturation (Intervention) have superior physicomechanical properties (Outcome) compared to conventional obturation systems (Comparison)?". Statistical analyses for push-out bond strength were performed with RevMan software by comparing the mean differences of each study, with a 95% confidence interval. Inverse variance was used as statistical method, random-effects models as analysis model, and heterogeneity between studies was assessed by Cochran's Q test and I2 statistic (P <0.05). Results: Of 2162 studies retrieved, 31 were included in this review for "Study Characteristics". Ten studies were included in the meta-analysis. Analysis demonstrated that conventional obturation had significantly higher push-out bond strength than tertiary monoblock obturation (P <0 .01), with a mean difference of -1.00 (95% CI, -1.41 to -0.58; I2=100%). Subgroups using single-cone and cold lateral condensation techniques showed significantly lower push-out bond strength for tertiary monoblock obturation (P <0.01), respectively with a mean difference of -0.09 (95% CI, -1.13 to -0.67; I2=97%) and of -1.97 (95% CI, -3.19 to -0.75; I2=100%). The warm vertical compaction subgroup showed no statistically significant difference between tertiary monoblock and conventional systems (P =0.13), with a mean difference of 0.49 (95% CI, -0.14 to 1.12; I2=10%). Conclusion: Tertiary monoblock systems have a push-out bond strength similar to conventional systems when used with warm vertical compaction.

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INTRODUCTION: This review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP). METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded. RESULTS: A total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)2-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)2- and CHX-based formulations) seemed to present dubious importance in the control of infection. CONCLUSIONS: TAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.

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Objectives: To evaluate (1) the effect of a salivary substitute prepared using chamomile (Matricaria chamomilla L.) flower and flax (Linum usitatissimum L.) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect. Subjects: 40 women aging >40 years with diagnosis of primary BMS. Settings/Location: Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil. Design: This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately. Interventions: Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min. Outcome measures: A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively. Results: After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (p < 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects. Conclusion: This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.

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PURPOSE: To evaluate the in vitro bond strength of universal adhesive systems to indirect substrates. MATERIAL AND METHODS: Two reviewers performed a literature search up to March 2018 in seven databases: PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO. The review included studies that compared the bond strength of universal adhesives and well-established material-specific primers to indirect substrates: lithium disilicate ceramic, yttrium-stabilized zirconium dioxide ceramic, leucite-reinforced ceramic, feldspathic porcelain, polymer infiltrated ceramic material, resin composite or metal alloys. Analyses were carried out using RevMan 5.3.5. A global comparison was performed with the standardized mean difference using a random-effects models at a significance level of p < 0.05. RESULTS: A total of 45 studies were included in the qualitative analysis, and the meta-analysis was performed with 42 studies. Bond strength to glass-based ceramics and alloys was improved with the use of a specific-primer as separate step before the bonding procedures (lithium disilicate, p < 0.001; alloys, p < 0.001). The bond strength to zirconium substrates was improved with the use of universal adhesives (p < 0.001). For bond strength to composite resin as indirect substrate, universal adhesives performed in a manner similar to that of the material-specific primer (p = 0.11). CONCLUSIONS: The clinical procedure of luting zirconia and resin composite restorations could be simplified by using single-bottle universal adhesives. However, the ability of universal adhesives to achieve an adequate and durable bond to glass-based ceramics and alloys appears to be limited.

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The aim of this study is to analyze the efficacy of natural bleaching agents and the current technological development in this research field. Two reviewers performed a literature search up to July 2019 in 15 databases. Five laboratory studies and 25 patents were included. Data regarding natural bleaching agent used, application protocol, and the main findings of studies were analyzed. Laboratory studies that evaluated natural bleaching agents' peroxide-free or associated to peroxides and patents related to natural bleaching agents were included. The studies evaluated papain, bromelain, chlorine dioxide, sodium chloride plus vinegar and sodium bicarbonate as peroxide-free agents; and sweet potato extract, lactoperoxidase, and peroxidase associated to peroxide used were included. Twenty-five patents were included; among the most cited are the papain and the chlorine. The addition of non-peroxide agents into peroxide showed improvement in bleaching effect with the incorporation of these non-peroxide agents (p < .05). On the other hand, peroxide-free agents did not show an improvement in bleaching effect (p < .05). The evidence in literature suggested that natural bleaching agents incorporated to peroxide may improve the bleaching. Therefore, the current literature does not support the use of natural agents as dental bleaching.

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