The objective of this randomized clinical trial was to evaluate the clinical performance of adhesive restorations using a three-step etch-and-rinse adhesive (TSER), a one-step self-etching adhesive (OSSE), and a simplified ethanol-wet bonding technique (EWBT) prior to the application of a composite resin in non-carious cervical lesions. Ninety-three restorations (31 for each group) were placed in 17 patients by a single operator. No cavity preparation was performed. After 6 and 12 months, the restorations were assessed by two previously trained examiners using modified Ryge criteria for retention (kappa=1.00) and marginal adaptation/staining (kappa=0.81), and the results were analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups at the 6-and 12-month time points for any of the assessed criteria (p≥0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the baseline/12-month time intervals in marginal adaptation in OSSE (p=0.0180) and in marginal staining in TSER (p=0.0117). The survival analysis for retention criteria performed using a logrank test did not show significant differences (p>0.05). The restorations placed using the simplified EWBT performed equally well as the other adhesive strategies employed.

ResumoIntrodução: O clareamento dental representa uma manobra conservadora na recuperação estética de dentes com alterações cromáticas. Contudo, os tratamentos clareadores são passíveis de causar efeitos adversos, quando não bem planejados e executados. Objetivo: Este estudo avaliou a influência do gel clareador no aumento da temperatura intra-câmara pulpar através da técnica de clareamento dental fotoativado realizado em consultório. Material e método: Um incisivo central superior humano foi seccionado na porção radicular 3 mm abaixo da junção cemento-esmalte. O canal radicular foi alargado para permitir a introdução do sensor do termômetro na câmara pulpar, a qual foi preenchida com pasta térmica, favorecendo a transferência de calor das paredes dentárias para o sensor do termômetro digital com termopar tipo K (MT-401A) durante o clareamento. Três agentes clareadores fotossensíveis (peróxido de hidrogênio a 35%) foram utilizados, sendo: Whiteness HP (FGM), Whiteness HP Maxx (FGM) e Lase Peroxide Sensy (DMC). Um aparelho fotopolimerizador de led (Flash Lite -Discus Dental) foi empregado para a ativação dos géis clareadores. Seis ciclos de clareamento foram realizados para cada grupo testado. Os resultados foram submetidos à ANOVA de um critério e ao teste t (LSD) (α≤0,05). Resultado: A menor média de variação de temperatura (°C) foi observada com o Lase Peroxide Sensy (0,20), enquanto que a maior com o Whiteness HP (1,50). Conclusão: Os géis clareadores Whiteness HP e Whiteness HP Maxx interferiram significativamente no aumento da temperatura intra-câmara pulpar durante o clareamento, sendo esta variação dependente do tipo de gel clareador empregado.Descritores: Clareamento dental; temperatura alta; cavidade pulpar. AbstractIntroduction: Dental bleaching is a conservative method for the aesthetic restoration of stained teeth. However, whitening treatments are likely to cause adverse effects when not well planned and executed. Objective: This study evaluated the influence of whitening gel on temperature rise in the pulp chamber, using the in-office photoactivated dental bleaching technique. Material and method: The root portion of an upper central human incisor was sectioned 3mm below the cemento-enamel junction. The root canal was enlarged to permit the insertion of the K-type thermocouple sensor (MT-401) into the pulp chamber, which was filled with thermal paste to facilitate the transfer of heat during bleaching. Three photosensitive whitening agents (35% hydrogen peroxide) were used: Whiteness HP (FGM), Whiteness HP Maxx (FGM) and Lase Peroxide Sensy (DMC). An LED photocuring light (Flash Lite -Discus Dental) was used to activate the whitening gels. Six bleaching cycles were performed on each group tested. The results were submitted to one-way ANOVA and LSD t-test (α≤0.05). Result: The lowest mean temperature variation (°C) was detected for Lase Peroxide Sensy (0.20), while the highest was recorded for Whiteness HP (1.50). Conclusion: The Whiteness HP and Whiteness HP Maxx whitening gels significantly affect...

ABSTRACT:The objective of this randomized clinical trial was to evaluate the clinical performance up to 18 months of restorations placed using ethanol-wet bonding technique (EWBT) compared with the three-step etch-and-rinse (TSER) and one-step self-etching (OSSE) approaches. Ninety-three non-carious cervical lesions (31 for each group) were restored by one experienced operator in 17 patients under relatively dry conditions using gingival retraction cord, cotton rolls and saliva ejector. Each adhesive system was randomly allocated to one of randomized cervical lesions until the three groups were present in the same subject in equal amounts. The restorations were evaluated at baseline, 6, 12 and 18 months by two blinded and calibrated examiners using the modified US Public Health Service guidelines (USPHS) for the following outcomes: retention (kappa= 1.00), staining and marginal adaptation (kappa=0.81) and analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups after 18 months for any of the assessed criteria (p>0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the time intervals baseline/18 months in marginal adaptation (p= 0.0117) and retention (p= 0.0101) for OSSE and in marginal staining for TSER (0.0051) and EWBT (p= 0.0277) groups. The survival analysis for retention criteria and the overall clinical success were performed using a log-rank test and did not show significant differences among groups (p> 0.05). All three adhesives protocols presented similar clinical performance up to 18 months.

The ethanol wet-bonding technique (EWBT) was introduced in an attempt to overcome the problems caused by high hydrophilicity and/or incomplete penetration of most commercially available adhesive systems. This strategy provides better conditions for the inter-diffusion of hydrophobic dentin monomers. Today, there are many EWBT protocols, which yield bonding interfaces with minimal degradation and longer durability compared with commercial hydrophilic adhesive systems. The aim of this review is to discuss in greater detail the EWBT, focused on the following aspects: dentin saturation, hydrophobic primer preparation, inactivation of metalloproteinases (MMPs), dentin biomimetic remineralization and the clinical perspectives of this technique. The present review on the EWBT provides support for a better understanding of the behavior of dentin when exposed to dehydration and hydrophobic monomer interaction. Moreover, additional studies are suggested to investigate the long-term stability of this type of hybrid layer.

Bleaching procedures can interfere on adhesive bonding of methacrylate-based restorative materials. After introduction of silorane-based composites, little information is available about this interaction. The objective is evaluate the influence of bleaching on enamel shear bond strength of silorane-based restorative system. Forty sound incisive bovine teeth were randomly divided into 04 groups (n= 10), being: G1 (control) -not bleached + Clearfil SE Bond (CSEB)/Filtek Z250 (Z250), G2 (control) -not bleached + Silorane Adhesive (SA)/Filtek P90 (P90), G3 -bleached + CSEB/Z250; G4 -bleached + SA/P90. The teeth were sectioned, had crowns included in a PVC rings, and the enamel surfaces gridded and polished with silicon carbide abrasive papers. G1 and G2 were stored in artificial saliva (37 ºC), daily renewed, for a period of 04 days. G3 and G4 were exposed to 02 sessions of 38% hydrogen peroxide (38HP), with 03 applications of 15 min in each session. Composite resin cylinders were built up on the enamel surfaces. Bonding procedures were performed according the manufacturer's instructions. After storage in distilled water for 24 h (37 ºC), the samples were submitted to shear bond test. Data were analyzed by two-way ANOVA and t (LSD) tests (5%). Intra group comparison showed significant difference for Z250 after bleaching, but not for P90. Shear strength was significant lower for P90, despite bleaching procedures. In conclusion, 38HP bleaching had no influence on the enamel bond strength of P90, even though presenting lower bond strength than Z250.