Antipsychotics in first-episode psychosis: Patterns of prescription in an inpatient unit

Introduction

The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.

Objectives/aims

To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.

Methods

We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.

Results

A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.

Conclusions

Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

555 Right ventricular longitudinal strain of patients with pulmonary hypertension

Introduction

Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients.

Methods

We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients referred to an expert tertiary care referral centre from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®.

Results

Of the 97 included patients, 76% were female. The mean age was 65 ± 15 years. Most patients were in NYHA class II. Median time between TTE and RHC was 70 days [IQR 34 - 184]. Group 2 PH was the most frequent aetiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7.

Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, Tricuspid S wave, RV diastolic diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time and presence of RV outflow tract notching. Strain parameters were also associated with pulmonary artery pressures and pulmonary vascular resistance (PVR) measured by RHC. Strain parameters did not correlate with PECP (p > 0.05).

In multivariate analysis, RV global longitudinal strain predicted invasive mean pulmonary artery pressure and PVR independently of TAPSE and FAC (β=1.38, p < 0.001). RV global strain > -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02, AUC 0.72) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51, AUC 0.78). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72).

Conclusion

RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures and PVR.

Abstract 555 Figure.

P1289 Echocardiograhic prediction of pulmonary arterial capacitance in patients with heart failure with preserved ejection fraction

Background

Pulmonary arterial capacitance (PAC) has emerged as one of the strongest hemodynamic predictors of adverse outcomes in a wide spectrum of cardiovascular diseases, including pulmonary hypertension in heart failure with preserved ejection fraction (HFpEF-PH). We aimed to study non-invasive surrogates for PAC using transthoracic echocardiography in this population.

Methods

We retrospectively evaluated consecutive patients referred to an expert tertiary care referral centre from December 2016 to November 2018. Transthoracic echocardiography (TTE) was performed within 1 year of right heart catheterization (RHC). Echo-Pac software from GE Healthcare® was used to perform echocardiographic analysis. PAC was calculated dividing right ventricular stroke volume by pulmonary arterial pulse (systolic – diastolic) pressure, measured by RHC.

Results

Of the 105 enrolled patients, 43 were had HFpEF-PH. Among these, 72% were female and mean age was 68.9 ± 11.2 years. Median time between TTE and RHC was 68 (IQR 34 – 191) days. Most patients were in NYHA class II (60.5%) and class III (34.9%). Fifty eight percent of the patients had history of paroxysmal or permanent atrial fibrillation. This population presented borderline parameters of right ventricle (RV) systolic dysfunction: fractional area change (FAC) 35.3 ± 9.2%, tricuspid annular plane systolic excursion (TAPSE) 18.3 ± 5.1 mm, tricuspid S’ wave 10.4 ± 2.9 and RV global longitudinal strain -15.5 ± 4.0. Regarding invasive assessment, this population presented mean pulmonary artery pressures of 38.8 ± 13.9 mmHg, pulmonary artery wedge pressure of 21.6 ± 6.4 mmHg, pulmonary vascular resistance of 3.9 ± 2.7 Wood and median PAC of 0.13 (IQR 0.09 – 0.19) ml/mmHg. The TAPSE / Pulmonary arterial systolic pressure (PASP) ratio and the Right ventricular outflow track velocity time integral (RVOT VTI) / PASP ratio were the parameters that best correlated with PAC (r = 0.69, p = 0.002 for both parameters) (table 1). These parameters were obtainable in the majority of patients (31/43). Blant-Altman analysis revealed good agreement between these measures and PAC with a mean difference of - 0.17 (CI -0.21 - -0.13) for RVOT VTI / PASP ratio and -0.23 (CI -0.28 - -0.18) for TAPSE /PASP ratio.

Conclusion

In a HFpEF – PH population, TAPSE / PASP and RVOT VTI / PASP are easily obtainable in most patients and significantly correlate with PAC.

Abstract P1289 Figure.

P1505 Echocardiographic assessment of different pulmonary hypertension groups

Introduction

Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Different etiology groups might have different echocardiographic phenotypes. In this study, we aimed to study echocardiographic characterization of the different PH groups and its ability to predict pulmonary vascular disease severity.

Methods

We collected echocardiographic and right heart catheterization (RHC) data from 97 (75% female, age 65 ± 15 years) consecutive patients referred to an expert tertiary care referral PH centre from 12/2016 to 11/2018. Echocardiographic analysis was performed using Echo-Pac software from GE Healthcare®. Group 3 and 5 were not included in the group comparison analysis due to few patients included.

Results

Group 2 PH was the most frequent etiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population as a whole showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7.

PH group 1 had a significantly lower FAC (26 ± 4%, p = 0.0025), higher eccentricity index (IE) (1.5 ± 0.1, p = 0.01), and more frequently RV outflow tract (RVOT) notching than other groups (62%, p = 0.012). Group 4 presented an intermedium echocardiographic phenotype between group 1 and 2, and showed more abnormal strain values than the other groups. Group 2 had fewer patients in sinus rhythm (atrial fibrillation in 34% of patients, p = 0.02), presented a thicker interventricular septum (11.3 ± 1.8, p = 0.014), a higher FAC (35 ± 3%, p = 0.0025), higher E mitral wave velocity (72 ± 6 cm/s, p < 0.001) and E/E’ ratio (12.7 ± 10.2, p = 0.006), and larger left (45 ± 3 cm3/m3, p < 0.01) and right atria (25 ± 2 cm2, p = 0.03).

PH groups 1 and 4 had higher Pulmonary Vascular Resistance (PVR) and Pulmonary Mean Arterial Pressure (PMAP) values than group 2, which significantly correlated with echocardiographic RV function parameters as TAPSE, FAC, RV global strain and IE. In PH group 2, eccentricity index was the only predictor of PVR (β=4.1, p = 0.018). In this population, a left atria volume < 32.7 cm3/m2 (OR 4.25, CI 1.71 - 10.55) and a E/e’ ratio < 12 (OR 4.72, CI 2.05 - 10.87) predicted PECP < 15 mmHg. RV global strain > -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72).

Conclusion

Different PH groups present mild echocardiographic differences between them. PH group 1 presented with more echocardiographic signs of RV disfunction, and PH group 2 had higher FAC, E/E’ and larger right and left atria. RV function parameters predicted PVR in PH groups 1 and 4, and EI was the only predictor of PVR in PH group 2.

Abstract P1505 Figure.

Clinical Effects of Desensitizing Prefilled Disposable Trays in In-office Bleaching: A Randomized Single-blind Clinical Trial

Objectives:

This study aimed to evaluate the desensitizing effect of a prefilled disposable tray containing potassium nitrate and fluoride on the self-reported tooth sensitivity (TS) and the bleaching efficacy of 40% hydrogen peroxide bleaching agent used for in-office bleaching in comparison with potassium nitrate and fluoride gel applied in a conventional-delivered tray system in an equivalence clinical trial.

Methods and Materials:

Seventy-eight patients, with a right maxillary canine darker than A3, were selected for this single-blind (evaluators), randomized clinical trial. Teeth were bleached in two sessions with a one-week interval in between. Before in-office bleaching, the prefilled disposable tray or conventional tray containing potassium nitrate and fluoride was used for 15 minutes. Subsequently, the bleaching agent was applied in two 20-minute applications (per the manufacturer's directions) in each session. The color change was evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Advance Spectrophotometer) methods at baseline and 30 days after the first bleaching session. TS was recorded for up to 48 hours using a 0-10 visual analog scale. The absolute risk was evaluated by chi-square test, while the intensity of TS was evaluated by McNemar test (α=0.05). Color change in shade guide units and ΔE was analyzed by Student t-test for independent samples (α=0.05).

Results:

Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of different methods of desensitizer in a tray did not influence the absolute risk and intensity of TS (p>0.05), although a tendency of lower risk of TS with the prefilled disposable tray containing potassium nitrate and fluoride was observed.

Conclusion:

The use of a prefilled disposable tray containing potassium nitrate and fluoride before the application of the in-office bleaching product did not affect the whitening degree and decreased self-reported TS when compared with a conventional-delivered tray system.

Efficacy of a Light-cured Tetracaine-based Anesthetic Gel for Rubber Dam Clamp Placement: A Triple-blind Randomized Clinical Trial

OBJECTIVES

To evaluate the efficacy of a new light-cured anesthetic gel for pain control in adults undergoing rubber dam isolation for the restorative treatment of noncarious cervical lesions (NCCLs).

METHODS AND MATERIALS

This study was a randomized, split-mouth, triple-blind, controlled trial. The sample comprised 50 adults with at least one pair of NCCLs located in the same arch but on opposite sides. Simple randomization defined the tooth to receive the light-cured tetracaine-based anesthetic gel or the placebo gel. After cotton roll isolation, the gels were applied in the gingival tissue around the tooth with the aid of the applicator tip of a syringe, left in place for 15 seconds, and light-cured for 15 seconds. Then, a #212 clamp was positioned on the tooth. If the patient reported pain, the clamp was removed, the patient filled out a pain intensity form (a 0-10 visual analog scale [VAS] and a 0-4 verbal rating scale [VRS]) and an injectable anesthetic was applied before rubber dam isolation for the restorative procedure. The absolute risk, intensity of pain, and need for rescue anesthesia were analyzed by the McNemar test and the Wilcoxon signed rank test (α=5%).

RESULTS

The odds ratio [OR] for pain (OR=3.5; 95% confidence interval [CI]=1.1 to 14.6; p=0.03) showed lower reports of pain for the light-cured anesthetic gel. One in five patients will benefit from placement of the light-cured anesthetic gel. On average, pain intensity was one VAS unit lower in those using the light-cured anesthetic gel than in those using the placebo gel. For the VRS, the pain intensity for the light-cured anesthetic gel was 0.4 units lower than the pain intensity for the placebo gel (95% CI=-0.9 to 0.07). The OR for rescue anesthesia was 2.5 (95% CI=0.7 to 10.9; p=0.18).

CONCLUSIONS

The light-cured, tetracaine-based anesthetic gel reduced the absolute risk of pain by 20% in NCCLs.

Effects of pH and Application Technique of In-office Bleaching Gels on Hydrogen Peroxide Penetration into the Pulp Chamber

Objective:

This in vitro study aimed to quantify the penetration of hydrogen peroxide (HP) into the pulp chamber in teeth submitted to in-office bleaching with varied pH and application techniques. The color change and pH of the in-office bleaching product during application was also evaluated.

Methods and Materials:

Ninety-six human premolars were used and randomly divided into 10 groups (n=9) according to the following combination of factors: pH of in-office bleaching agents (two neutral/alkaline pH: Opalescence Boost 38% and Whiteness HP Blue 35% and three acidic pH: Whiteness HP Maxx 35%, Lase Peroxide Sensy 35%, and Total Blanc Office 35%) and application modes (for 3 × 15 minutes [3×15] and 1 × 45 minutes [1×45]). An additional group of non-bleached teeth (control; n=6) was added. First, all teeth were sectioned 3 mm from the cementoenamel junction and the pulp tissue was removed. An acetate buffer was placed in the pulp chamber of all teeth. After bleaching, this solution was transferred to a glass tube in which HP was allowed to react with other components, resulting in a pink solution. The optical density of this pink solution was measured using ultraviolet-visible spectroscopy and converted into amount of HP. Color change before and 1 week after bleaching was evaluated using a digital spectrophotometer. A pH meter with a 6-mm circular and flat surface was used in contact with the enamel surface to quantify the pH of the bleaching gels during application. Data were analyzed using two-way analysis of variance and Tukey tests (α=0.05).

Results:

Overall, lower mean HP penetration values were observed for Opalescence Boost 38% and Whiteness HP Blue 35% compared with other bleaching gels (p<0.05). Opalescence Boost 38% and Whiteness HP Blue 35% were not influenced by the application technique (p>0.05). However, lower mean HP penetration values were observed for Whiteness HP Maxx 35%, Total Blanc Office 35%, and Lase Peroxide Sensy 35% when using the 3×15 application technique compared with the 1×45 technique (p<0.05). Significant whitening was detected and no significant difference of color change was observed between groups (p>0.54). The pH did not change during the 3×15 application technique; however, all acidic bleaching gels significantly decreased in pH when applied for 1×45 (p<0.01).

Conclusions:

The amount of HP that reaches the pulp chamber was lower when neutral/alkaline pH gels were used, independently of the application technique. When considering acidic pH gels, it is preferable to use the 3×15 application technique, mainly because longer application time (1×45) results in lower pH. No difference was observed between groups with regards to color change.

Health Literacy questionnaire development for 9 and 10 years old: a discussion of assessment tools!

Background

With Health literacy (HL) investments - to promote health and self-care during people’s life cycles (childhood, especially) - health professionals approach is multi-dimensional: within the family, school settings and community. The objective of this study is to explore the feasibility and usability of a questionnaire to characterize HL levels among 9 and 10 years old. It is expected that this will help health care personal to better focus health promotion initiatives in the school setting.

Methods

The CrAdLiSa project in conjunction with the HLCA German Consortium, implemented a field test for the newly developed HL assessment tool for children in the Portuguese context. This is a deductive-inductive, exploratory-descriptive study including 16 children, with 9 and 10 years old, from 2 different elementary schools in Santarém District (rural and urban areas). Semi-structured interviews aim at exploring the cognitive appraisal of concepts and indicators at the base of the questionnaire developed to assess HL levels. Data was subjected to content analysis, with a priori and a posteriori categorization.

Results

Preliminary results point to the cognitive comprehension by children of the feasibility of an instrument to assess their HL levels. It depicts discriminatory capabilities (to allow characterization of low, medium or high levels of HL). Children living in urban areas, having better financial resources are less likely to develop obesity, or low weight. Better self-perception of school performance, good relationship with family members, parents with higher education or higher levels of HL appear to have better quality of life.

Conclusions

Results suggest the need to invest in children’s and families’ HL, while taking into consideration personal, environmental and socioeconomic determinants. School settings should be considered as a natural arena to improve children’s (and, as a result, families’ and communities’) HL levels.

Communicating with migrants: children’s health literacy, digital technology, health promotion tools

Background

Being a migrant can enact road blocks in the process of integration, if language barriers persist in the communication between health professionals and migrants. Moreover, health literacy levels (HL) can differ, based on different cultural contexts or conceptions of health and illness. This research aims at exploring migrants (digital) HL and the mediating role of migrant’s children in primary health care setting. Health professionals’ resort to migrants’ children as interpreters and mediators has been highlighted with the younger generations’ digital literacy, as critical tools to overcome such barriers. Assessing and promoting migrant’s HL is a public health mandate in the promotion of individual and family health to establish a common ground base for communication.

Methods

A qualitative and ethnographic study based on narratives, participant observation, focus group and ethno biographic interviews with nurses, migrants, medical doctors and intercultural mediators, involved 52 participants in a primary health care setting in Santarém district, Portugal. Partnership with the Observatory for Migration, the High Commission for Migration (ACM) and with migrant associations, enabled the completion by migrants of an online questionnaire focusing on digital HL.

Results

Migrants’ children were identified as facilitators in the clinical setting at three levels: the communication, HL promotion and adherence to continuity of care.

Conclusions

Improve migrant’s HL and health decisions is feasible when considering several strategies to overcome cultural barriers. Migrants’ children are potential mediators in the process of communication between health professionals and adults. Awareness of their potential allows adjustments in the primary health care sector. The need to further investigate migrants’ HL and digital HL (e.g. telephone translation services, Internet-based tools for scheduling health appointments) are some tasks that need further research.

Migration and integration: the case of health literacy (HLS-EU-PT) as a foundation to promote cultural sensitiveness

Background

Portugal has experienced trough-out his recent history successive migration patterns. Lately, with instability in Syria and the Mediterranean routes of migration between Africa and Europe, new challenges have emerged. One of them is related to migrants’ health and their navigation of health care system. In order to better understand cultural patterns of migrants, this research aims to explore their health literacy (HL) in the context of the European Health Literacy Survey framework (HLS-EU).

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores <30). In order to access the migrant condition, a proxy variable considered the participant’s parents origin: at least one of the parents was born in a foreign country.

Results

Out of the 748 participants, 4.1% (n = 31) were considered migrants. Of the migrant participants, 6.9% have inadequate, 51.7% problematic, 24.1% sufficient and 17.2% excellent HL (HLS-EU-PT). Migrants have lower levels of HL when compared with nationals in this sample (respectively 58.6% and 45.8% for insufficient HL) but this difference is not statistically significant.

Conclusions

Although results didn’t show an association between being migrant and lower levels of HL (when compared with nationals), it is nevertheless relevant to consider that more than 1 in every two migrants (58.6%) have insufficient HL levels. Special consideration should be given to this group to promote HL levels and further research is needed to better understand how HL and cultural sensitiveness may work for a better integration of migrants.

Randomized 36-month follow-up of posterior bulk-filled resin composite restorations

OBJECTIVE

The aim of this double blind, randomized controlled trial was to evaluate the 36-month clinical performance of the layering technique (incremental [IF] vs. bulk-fill [BF]) in posterior composite resin restorations bonded with self-etch (SE) and etch-and-rinse (ER) strategies.

METHODS

Posterior dental cavities of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. The restorations were bonded using either the Tetric N-Bond ER or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either IF or using BF. Two experienced and calibrated examiners evaluated the restorations using FDI criteria in the baseline and after 12, 24 and 36-month. The statistical analyses were performed using the Wilcoxon Signed rank test (α = 0.05) RESULTS: After 36-month, 14, 21 and 33 restorations showed minor fractures, marginal desadaptation and color mismatch, respectively (p > 0.05). Thirty-three restorations showed some marginal discoloration after 36-month with significant difference between ER (3 for ER-IF; 3 for ER-BF) and SE (14 for SE-IF; 12 for SE-BF; p < 0.05).

CONCLUSION

The BF technique showed excellent clinical performance, which was comparable during the 36-month of clinical evaluation with the 2-mm IF and it was not affected by the adhesive strategy. However, using the ER strategy reduces the risk of some marginal discoloration, irrespectively of the filling technique.

CLINICAL RELEVANCE

The bulk-fill material showed excellent clinical behavior when compared to its use in an incremental filling technique, mainly when associated to etch-and-rinse adhesive material after 3 years of clinical evaluation.

Tooth Sensitivity After Dental Bleaching With a Desensitizer-containing and a Desensitizer-free Bleaching Gel: A Systematic Review and Meta-analysis

Objectives:

A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity (TS) after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel in adult patients. Color change and risk of gingival sensitivity was also evaluated.

Methods:

A comprehensive search was performed MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), EMBASE and Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions to identify randomized clinical trials. Abstracts from the annual conference of the International Association for Dental Research (1990–2016), unpublished and ongoing trials registries, dissertations, and theses were also searched. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development and Evaluation (GRADE) approach.

Data:

After duplicates were removed, 1352 articles were identified. After title and abstract screening, only 47 studies remained for qualitative evaluation. Most of the studies had unclear risk of bias. No difference between groups were observed for the risk ratio of TS (risk ratio = 0.99; 95% confidence interval [CI] = 0.74–1.33); intensity of TS (standardized difference in means [SMD] = 0.04; 95% CI = 0.79–0.70); color change in shade guide units (SMD – 0.04; 95% CI = 0.50–0.42); color change in ΔE* (SMD = 0.41 (95% CI = 0.07–0.89); and risk ratio of gingival irritation (SMD = 1.05; 95% CI = 0.81–1.36). Except for the risk of TS, graded as moderate quality of evidence, all other outcomes were rated as low and very low quality.

Conclusions:

Incorporating desensitizers in the bleaching gel did not reduce the risk of TS, and the quality of this evidence was considered moderate. On the other hand, the intensity of TS, color change, and risk of gingival irritation was similar between groups, but the quality of the evidence for these outcomes was graded as low or very low, thus reducing the level of confidence in these outcomes.

The smokeless tobacco habit and DNA damage: A systematic review and meta-analysis

BACKGROUND

The aim of this systematic review was to evaluate the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits.

MATERIAL AND METHODS

We searched PubMed, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE. We also surveyed gray literature. We included only clinical trials that compare the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. Quality assessments of the selected trials were evaluated by two independent reviewers, using the Effective Public Health Practice Project - (EPHPP) with modifications.

RESULTS

After the database screening and removal of duplicates, 2574 studies were identified. After title screening, 172 studies remained, and this number was reduced to 25 after careful examination of the abstracts. The standardized mean difference of the frequency of micronuclei between groups was 1.88, with a 95% confidence interval of 1.40 to 2.36 (p < 0.00001). In all analyses heterogeneity was detected.

CONCLUSIONS

Despite the heterogeneity of studies, the frequency of micronuclei was significant bigger in adults who have the smokeless tobacco habit when compared to those not have this habit. The same occurred with the frequency of binucleated cells, karyolisis and karyorrhexis.

Inflammation-induced glycolytic switch controls suppressivity of mesenchymal stem cells via STAT1 glycosylation

Mesenchymal stem cells (MSCs) represent key contributors to tissue homeostasis and promising therapeutics for hyperinflammatory conditions including graft-versus-host disease. Their immunomodulatory effects are controlled by microenvironmental signals. The MSCs' functional response towards inflammatory cues is known as MSC-"licensing" and includes indoleamine 2,3-dioxygenase (IDO) upregulation. MSCs use tryptophan-depleting IDO to suppress T-cells. Increasing evidence suggests that several functions are (co-)determined by the cells' metabolic commitment. MSCs are capable of both, high levels of glycolysis and of oxidative phosphorylation. Although several studies have addressed alterations of the immune regulatory phenotype elicited by inflammatory priming metabolic mechanisms controlling this process remain unknown. We demonstrate that inflammatory MSC-licensing causes metabolic shifts including enhanced glycolysis and increased fatty acid oxidation. Yet, only interfering with glycolysis impacts IDO upregulation and impedes T-cell-suppressivity. We identified the Janus kinase (JAK)/signal transducer and activator of transcription (STAT)1 pathway as a regulator of both glycolysis and IDO, and show that enhanced glucose turnover is linked to abundant STAT1 glycosylation. Inhibiting the responsible O-acetylglucosamine (O-GlcNAc) transferase abolishes STAT1 activity together with IDO upregulation. Our data suggest that STAT1-O-GlcNAcylation increases its stability towards degradation thus sustaining downstream effects. This pathway could represent a target for interventions aiming to enhance the MSCs' immunoregulatory potency.

Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial

BACKGROUND

This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery.

MATERIAL AND METHODS

A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects.

RESULTS

Significant differences in pain intensity were observed in the different times (p < 0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p < 0.001), the need of antiemetic were greater in Group K+T+A (p < 0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A.

CONCLUSIONS

The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant.

Effectiveness of and Dental Sensitivity to At-home Bleaching With 4% and 10% Hydrogen Peroxide: A Randomized, Triple-blind Clinical Trial

OBJECTIVES

To evaluate the risk for and intensity of tooth sensitivity and color change of at-home dental bleaching with 4% and 10% hydrogen peroxide (HP).

METHODS

For this study, 78 patients were selected according to the inclusion and exclusion criteria and randomized into two groups: HP 4 (White Class 4%, FGM) and HP 10 (White Class 10%, FGM). In both groups, the at-home bleaching was performed for a period of 30 minutes twice a day for two weeks. The color was assessed by Vita Classical, Vita Bleachedguide 3D-MASTER and spectrophotometer Vita Easyshade (Vita Zahnfabrik) at baseline, during bleaching (first and second weeks) and after bleaching (one month). Patients recorded their tooth sensitivity using a numeric rating scale (0-4) and visual analog scale (0-10). Data from color change (DeltaE data) was submitted to two-way analysis of variance. The color change data in Delta SGU from the two shade guide units were compared with the Mann Whitney test. The risk of tooth sensitivity was evaluated by χ² test and the intensity of tooth sensitivity from both scales was evaluated by a Mann-Whitney test (α=0.05).

RESULTS

The absolute risk and intensity of tooth sensitivity was higher in the group that used HP 10 than the one that used HP 4. Data from change in the number of shade guide units and color variation after one month of bleaching for both groups showed significant whitening, with no difference between groups.

CONCLUSIONS

At-home bleaching is effective with 4% and 10% HP concentrations, but 10% HP increased the absolute risk and intensity of tooth sensitivity during at-home bleaching.

Two-year Effects of Chlorhexidine-containing Adhesives on the In Vitro Durability of Resin-dentin Interfaces and Modeling of Drug Release

OBJECTIVES

To evaluate the effects of addition of diacetate chlorhexidine (CHX) at different concentrations into two etch-and-rinse adhesive systems on CHX release, as well as the immediate (IM) and two-year (2-Y) resin-dentin microtensile bond strength (μTBS) and nanoleakage (NL).

METHODS

CHX was added to XP Bond (XP) and Ambar (AM) at concentrations of 0.0 wt% (control); 0.01 wt%; 0.05 wt%; and 0.1 to 0.2 wt%. To assess the cumulative CHX release, adhesive disks were made in a metallic matrix and after light-curing were stored in water. Ultraviolet spectrophotometric measurements of the storage solution were performed to examine the release kinetics of CHX. For μTBS and NL, the occlusal enamel of molars was removed and the adhesives were applied to the dentin surface after acid etching. After composite resin build-up, specimens were sectioned to obtain μTBS sticks. The specimens were subjected to μTBS and NL at IM and after 2-Y. In addition, specimens underwent examination for CHX using micro-Raman spectroscopy. All data were submitted to statistical analysis (α=0.05).

RESULTS

With regard to CHX release, AM showed a slower and gradual release of CHX while XP released CHX more quickly ( p<0.05), and CHX was still present in the hybrid layers after 2-Y. Both adhesives showed CHX release at 2-Y water storage. Both CHX-containing adhesives showed higher μTBS values than did the control group ( p<0.05).

Combination of Acetaminophen/Codeine Analgesics Does Not Avoid Bleaching-Induced Tooth Sensitivity: A Randomized, Triple-Blind Two-Center Clinical Trial

Bleaching-induced tooth sensitivity (TS) is highly prevalent.

OBJECTIVE

This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect.

METHOD

A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05).

RESULTS

No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change ( p>0.05) for any scale.

CONCLUSION

The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.

Clinical Evaluation of Different Delivery Methods of At-Home Bleaching Gels Composed of 10% Hydrogen Peroxide

OBJECTIVES:

This study aimed to compare the tooth sensitivity, gingival irritation, and bleaching efficacy of at-home whitening performed with 10% hydrogen peroxide (HP) using a conventional tray-delivered system or two different bleaching systems (strips or prefilled disposable trays).

METHODS AND MATERIALS:

Sixty patients, with maxillary incisors darker than A2 were selected for this single-blind, parallel randomized clinical trial. Teeth were bleached during 14 days with a 30-minute gel contact with teeth per day. The 10% HP was delivered in a bleaching tray (White Class, FGM) in strips (White Strips, Oral-B) or prefilled disposable trays (Opalescence Go, Ultradent). The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second bleaching session. Tooth sensitivity was recorded during 14 days with a five-point numeric rating scale (NRS) and 0-10 visual analog scale (VAS). The risk of gingival irritation was also recorded during 14 days on a dichotomous scale. All data were submitted to appropriate statistical analysis (α=0.05).

RESULTS:

No significant difference was observed in the risks of tooth sensitivity among groups ( p>0.09). However, the conventional bleaching tray produced a higher intensity of tooth sensitivity when compared with the strips and prefilled disposable tray systems ( p<0.04). Regarding gingival irritation, the prefilled disposable tray system showed a lower risk of gingival irritation when compared with the conventional bleaching tray ( p=0.003). Significant whitening was observed in all groups after 30 days of clinical evaluation with no significant difference between them ( p>0.06).

CONCLUSIONS:

All 10% HP bleaching systems showed similar whitening after a 14-day use. However, the strips and prefilled disposable trays produced lower intensity of tooth sensitivity than the conventional bleaching tray system. The prefilled disposable tray produced lower risk of gingival irritation when compared to the conventional bleaching tray.

At-home Bleaching With 10% vs More Concentrated Carbamide Peroxide Gels: A Systematic Review and Meta-analysis

Objective:

To perform a systematic review to answer the following research question: Is at-home bleaching in adults with more concentrated carbamide peroxide (CP) gels as effective and safe as bleaching performed with 10% carbamide peroxide gels?

Methods and Materials:

A comprehensive search was carried out in the MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (1990 to 2016) and unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periodicos Capes Theses Databases) were also searched. The risk of bias of the included studies was analyzed using the Cochrane Risk of Bias tool from the Cochrane Collaboration. We meta-analyzed the data using the random effects model to compare 10% CP and more concentrated CP gels in terms of color change (ΔSGU or ΔE) and risk and intensity of tooth sensitivity (TS). The quality of the evidence was rated using the GRADE approach.

Results:

After the database screening, 182 articles remained, and this number was reduced to 17 after examination of the abstracts and/or full texts. Four articles were follow-ups of earlier studies, and thus we collected 13 studies. Ten studies were at unclear risk of bias, while three were at low risk of bias. Lower risk and intensity of TS was observed for 10% CP. The odds ratio for the risk of TS was 0.41 (95% CI 0.20 to 0.84, p=0.01), and the difference in means for TS intensity was 0.44 (95% CI 0.67 to −0.20, p=0.0003). No significant difference was observed in terms of color change in ΔSGU (difference in means 0.29; 95% CI 0.25 to 0.83, p=0.29) and for ΔE (difference in means −0.16; 95% CI 0.38 to 0.06, p=0.16). Except from the ΔSGU, for which the evidence was graded as low quality, the other outcomes were considered at moderate quality.

Conclusions:

At-home bleaching with 10% CP showed similar bleaching efficacy with lower risk and intensity of TS in comparison with more concentrated carbamide peroxide gels.

Effectiveness of In-office Hydrogen Peroxide With Two Different Protocols: A Two-center Randomized Clinical Trial

Objectives:

The aim of this study was to compare the bleaching efficacy and tooth sensitivity (TS) of a 38% hydrogen peroxide bleaching agent used for in-office bleaching, applied under different time protocols: a 40-minute application or two 20-minute applications.

Methods and Materials:

Forty-four patients from Brazil and Colombia, with right superior canines darker than C2, were selected for this multicenter, single-blind, randomized trial. The teeth were bleached in two sessions, with a one-week interval between them, in a split-mouth design. The bleaching agent was applied in two 20-minute (2×20) applications or one 40-minute (1×40) application in each session according to the manufacturer's instructions. The color changes were evaluated by using subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. Tooth sensitivity was recorded up to 48 hours with a 0-10 visual analog scale. Also, the pH values during the application of bleaching were recorded. Color change in shade guide units and ΔE were analyzed by using the Student t-test (α=0.05). The absolute risk and intensity of TS were evaluated with the McNemar test, the Wilcoxon signed-rank test, and the Friedman test, respectively (α= 0.05).

Results:

Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of a 40-minute application did not significantly influence the absolute risk of TS (68%, 95% confidence interval [CI] = 53-80) as well as the intensity of TS compared with the acid bleaching gel (absolute risk of 82%, 95% CI = 68-91). The pH values did not differ significantly between groups and at the different assessment periods (p=0.42).

Conclusion:

The use of a 40-minute in-office bleaching agent gel application produced the same whitening degree and TS that the two 20-minute bleaching agent applications did. The former preferably should be applied because one 40-minute application does not require gel refreshing.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed (p&lt;0.001), as well as range of year (p&lt;0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

Avaliação do Microcisalhamento de um Cimento Resinoso na Zircônia Tratada com Primers com Diferentes Concentrações de 10-MDP

O trabalho teve como objetivo avaliar a resistência de união ao microcisalhamento de um cimento resinoso dual convencional sobre a zircônia tratada com com primers com diversos iniciadores e diferentes concentrações de 10-MDP. Para isso, foram preparados os primers experimentais utilizando o 10-metacriloiloxi-decilo-di-hidrogenofosfato (10-MDP) nas concentrações 5, 10 e 20% como monômero funcional ácido, além da canforoquinona /amina terciária (CQ) ou 1-fenil-1,2-propanodiona (PPD) como sistemas fotoiniciadores. O iniciador cerâmico Clearfil Ceramic Primer (Kuraray) foi utilizado como primer controle comercial. O pH dos primers foi analisado previamente. Depois da aplicação dos primers sobre a zircônia, o cimento resinoso dual (RelyX ARC, 3M) foi aplicado com o auxílio de tubo cilíndrico de borracha e foto-polimerizado. Foi avaliado também o cimento sem primer como controle negativo. Após 24 horas de armazenamento em água destilada foi realizado o teste microcisalhamento (n9). A análise estatística foi realizada por ANOVA e teste de Tukey (p<0,05). O Clearfil (14,0±1,2 MPa), CQ5 (13,4±2,1 MPa) e PPD5(12,8±1,8 MPa) apresentaram as maiores resistências de união sem diferença estatística entre si. O controle negativo apresentou a pior resitência de união. Portanto, a presença do primer para zircônia é de suma importância no protocolo de cimentação e o 10-MDP deve ser utilizado em baixas concentrações.Palavras-chave: 10-methacryloyloxydecyl Dihydrogen Phosphate. Shear Bond Strength. Zirconia. 

Impacto do pH e Tempo de Aplicação do Ácido Meta-Fosfórico na Longevidade da Interface Resina-Dentina

Avaliar o efeito de diferentes pHs do ácido meta-fosfórico 40% (MPA) em comparação com o ácido ortofosfórico convencional 37% (OPA) em diferentes tempos de aplicação na longevidade da resistência da união (µTBS), nanoinfiltração (NL) e alterações químicas (ATR-FTIR) da superfície dentinária. Molares humanos (n84) foram distribuídos aleatoriamente em 12 condições experimentais de acordo com a combinação de variáveis: Ácido [ácido ortofosfórico 37% (OPA), ácido metafosfórico 40% (MPA) em pH 0,5, 1 e 2] e Tempo de Aplicação [7, 15 e 30s]. Os dentes foram restaurados e seccionados para se obter palitos de resina-dentina para µTBS e NL testados imediatamente ou após 6 meses de armazenamento em água. Para NL, 3 palitos de cada dente/período foram analisados. 21 dentes foram utilizados para as análises químicas (ATR-FTIR) de acordo com o tempo de aplicação vs. tempo de armazenamento. Os dados foram submetidos a ANOVA de três fatores e teste de Tukey (a0,05). MPA pH 0,5 mostrou µTBS semelhante ao OPA, independentemente do tempo de aplicação (p> 0,05). Foram observadas diminuições significativas na µTBS e aumentos de NL somente para OPA após 6 meses (p0,001). OPA proporcionou valores de NL estatisticamente mais elevados do que MPA (p 0,003). Em ATR-FTIR, dentina desmineralizada representou picos de brushite e fosfato octacálcico. Contudo, os resultados de MPA foram dependentes do pH/tempo de aplicação. O uso de MPA preservou a interface resina-dentina em um período de 6 meses apresentado a presença de brushite e fosfato octacálcicoPalavras-chave: Adesivos Dentinário. Resistência à Tração. Ácidos Fosfóricos.

A Falta de Neutralização de Primers com 10-MDP pela Zircônia Pode Afetar no Grau de Conversão do Cimento Resinoso

O objetivo deste trabalho foi avaliar diferentes concentrações de 10-MDP incluídas em primers cerâmicos experimentais e comerciais e o efeito sobre o grau de conversão (GC) de um cimento resinoso dual convencional. Os primers cerâmicos experimentais foram formulados utilizando o10-metacriloiloxi-decil-dihidrogenofosfato (10-MDP) nas concentrações 5, 10, 20 e 40% como monômero funcional ácido e canforoquinona /amina terciária (CQ) ou 1-fenil-1,2-propanodiona (PPD) como sistemas fotoiniciadores. O primer cerâmico Clearfil Ceramic Primer (Kuraray) foi utilizado como primer controle comercial. O pH dos primers foi analisado com medidor digital de pH. A espectroscopia Micro-Raman foi usada para avaliar o GC pelas razões das alturas dos picos 1639/1609 cm-1 do cimento resinoso não-polimerizado e polimerizado aplicado após os primers cerâmicos na superfície de um bloco de zircônia. A análise estatística foi realizada por ANOVA one-way e teste de Tukey (p<0,05). A alta concentração (40%) de 10-MDP em primers experimentais não foi tamponada pela ZrO2 e reduziu a GC do cimento resinoso quando utilizado o primer com CQ (63,4 ± 4,9 %) e PPD (44,6 ± 4,2 %), o que não ocorreu com 10-MDP de baixa concentração (5%) no primer comercial (88,9 ± 1,9 %) e nos experimentais CQ (94,7±1,5 %) e PPD (92,0±3,1 %). O monômero 10-MDP deve ser utilizado em baixas concentrações em primers para zircônia para evitar a redução na polimerização do cimento resinoso. Apoio: FGM. Palavras-chave: Metacrilato. Grau de Conversão. Espectroscopia Raman. Zircônia.

Difusão do Peróxido de Hidrogênio em Dentes Submetidos a Diferentes Protocolos de Clareamento

Objetivos: avaliar a concentração de Peróxido de Hidrogênio (PH) que alcança a câmara pulpar, utilizando géis clareadores de mesma marca comercial. Métodos: 90 pré-molares foram divididos em 9 grupos de acordo com o tratamento: Controle (sem tratamento clareador) [C], Peróxido de Carbamida (PC) 10% [PC10%], PC 16% [PC16%], PC 22% [PC22%], Peróxido de Hidrogênio (PH) 4% [PH4%], PH 6% [PH6%], PH 7 ½% [PH7 ½%], PH 10% [PH10%] e PH 35% [PH35%]. Os dentes foram seccionados e inserido tampão de acetato na câmara pulpar. Os géis clareadores foram aplicados de acordo com as recomendações dos fabricantes. A solução de tampão foi removida e adicionada a esta, soluções de leucocristal violeta e enzima peroxidase. Os dados foram submetidos a ANOVA e teste de Tukey para contraste das médias (a 0,05). Resultados: Maior quantidade de PH foi observado em protocolo de consultório [PH 35%] quando comparado com clareamento caseiro (p 0,000). Não houve diferença estatisticamente significante   (p 0,649) entre os protocolos caseiros. O [PC 10%] libera aproximadamente 3,5% de PH, o qual se difunde na câmara pulpar em quantidades semelhantes ao grupo [PH 4%]. Os grupos [PC 22%] e [PH 10%] também foram similares. Conclusões: A quantidade de PH que alcança a câmara pulpar não é proporcional a concentração inicial de PH dos géis clareadores.Palavras-chave: Peróxido de Hidrogênio. Clareamento Dental. Permeabilidade do Esmalte Dentário.

Efeito de Restaurações que Apresentam Resina Composta Fluida em Lesões Cervicais não Cariosas: Revisão Sistemática e Metanálise

O objetivo foi avaliar se a resina composta fluida em lesões cervicais não cariosas (LCNCs) melhora as taxas de retenção, descoloração marginal e adaptação, em pacientes adultos, por meio de uma revisão sistemática e metanálise. Foram pesquisadas sem restrições as bibliotecas Medline, Scopus, Web  of Science, Lilacs, BBO, Cochrane Library e SIGLE (bases cinzentas), resumos do IADR     e registros de ensaios clínicos (REBEC). Dissertações e teses também foram pesquisadas através das bases de dados ProQuest Dissertações e Periódicos Capes Teses. Foram incluídos apenas ensaios clínicos randomizados que compararam as restaurações com resina composta fluida e resina composta de viscosidade regular em LCNCs. A ferramenta da Cochrane Collaboration foi utilizada para avaliar o risco de viés dos estudos elegíveis. A ferramenta GRADE foi usada para avaliar a qualidade da evidência para cada estudo, de acordo com seus resultados. Após a remoção de duplicatas e avaliação por títulos e abstracts, 8 estudos mantiveram-se para a análise qualitativa. Não foi observada diferença significativa entre os grupos quanto a retenção nem descoloração marginal em todos os períodos avaliados (1 a 3 anos). Observou-se melhor adaptação marginal para as restaurações que foram realizadas com resina fluida. A qualidade da evidência foi classificada como moderada para perda ou retenção aos 3 anos e baixa e/ou muito baixa para todos os outros desfechos. Concluiu-se que a viscosidade da resina composta não influencia as taxas de retenção e descoloração marginal das restaurações em LCNCs.Palavras-chave: Lesões Cervicais. Flow. Ensaio Clínico Randomizado. Revisão Sistemática.

Adesivos Universais de Condicionamento Total e Restaurações Indiretas em Resina com Polimerização Dual: Propriedades Adesivas

Avaliou-se a resistência ao microcisalhamento (RUM) e a nanoinfiltração (NI) de adesivos universais aplicados como sistemas convencionais em restaurações indiretas com ou sem ativador de autopolimerização (AA) usando diferentes protocolos de polimerização. Utilizou-se dentina oclusal de 55 molares humanos. Os espécimes foram alocados aleatoriamente para: All-Bond Universal / Core Flo DC [ABU] Clearfil Universal Bond / Clearfil DC Core Plus [CFU] Prime & Bond Elect / FluoroCore 2+ [PBE] e One Coat 7 Universal / ParaCore [OCU]. O Clearfil SE Bond / Clearfil DC Core Plus [CSE] foi utilizado como controle. Para CFU, PBE e OCU, foram utilizados protocolos de fotopolimerização [FP], polimerização dual [DP] e autopolimerização [AP]. Testes ANOVA e Tukey foram utilizados (a 0,05). RUM: Modo FP - ABU resultou em RUM menor do que todos os outros adesivos FP. Modo DP - CSE mostrou resultado maior do que CBU e OCU, porém semelhante ao PBE. Modo AP - PBE resultou em RUM menores que os modos PBE / DP e FP.  Para CBU e OCU, não houve diferença nos modos FP,  DP e AP.  NI: ABU resultou em    NI menor que o modo PBE / FP, mas semelhante ao modo CBU / FP e OCU / FP. O modo CSE / DP resultou em NI maior em comparação com todos os adesivos universais DP. O modo CFU / AP resultou em NI maior que CFU / FP e modo DP. PBE / FP e DP resultaram em NI maior que o modo PBE / AP. O modo OCU / DP resultou em NI maior do que OCU / FP e modo AP. Para os adesivos universais, AA e os diferentes protocolos de polimerização influenciaram o RUM e NI todavia, esta influência foi adesivo- dependente.Palavras-chave: Microcisalhamento. Nanoinfiltração. Restaurações Indiretas.

Influência das Partículas de Carga na Sorção, Solubilidade, Adesão e Micropermeabilidade de Sistemas Adesivos Universais

O objetivo foi avaliar sorção, solubilidade, micropermeabilidade e a resistência de união de um adesivo universal comercial contendo ou não partículas de carga. O adesivo Ambar Universal (FGM) foi usado como convencional (C) ou autocondicionante (A) diferenciando-se apenas na presença (CC e AC) ou não (CS e AS) de partículas de carga. Doze terceiros molares (n3) foram restaurados com rodamina-B no adesivo e foi infiltrada fluoresceína para avaliação da micropermeabilidade por microscopia confocal. Outros vinte e quatro terceiros molares (n6) foram restaurados e cortados em palitos de resina-dentina (1 mm2) para avaliar a resistência de união à microtração (μTBS) após 24h de armazenagem em água. Sorção e solubilidade foram testadas em discos dos adesivos (ISO 4049). Os resultados foram analisados com ANOVA e teste de Tukey (p<0,05). A análise estatística revelou maior sorção de água do adesivo com carga em relação ao sem carga. Maior micropermeabilidade foi observada na interface adesivo- dentina do autocondicionante com carga e os outros apresentaram pouca micropermeabilidade. Independente da presença de carga, os adesivos autocondicionantes apresentaram maior μTBS que os convencionais (p<0,05). Em conclusão, a presença de partículas de carga no adesivo universal leva a maior sorção de água e a maior micropermeabilidade da interface em comparação ao mesmo adesivo sem carga.Palavras-chave: Adesivos Dentinários. Dentina. Microscopia Confocal.

Avaliação das Propriedades Adesivas de Sistemas Adesivos Universais na Interface Resina- Dentina Erosionada

Avaliar a resistência de união (TBS) e nanoinfiltração (NL) de sistemas adesivos universais em dentina erosionada (DE) na estratégia self-etch e etch-and-rinse. Duzentos molares foram aleatoriamente distribuídos de acordo com a combinação das variáveis independentes: Superfície dentinária (dentina sadia e dentina erosionada) vs. Sistema adesivo [1) All Bond Universal 2) Ambar Universal 3) Clearfil Universal 4) Futurabond Universal 5) One Coat 7 Universal 6) Peak Universal Bond 7) Prime & Bond Elect 8) Scotchbond Universal 9) Tetric N-Bond Universal 10) Xeno Select] vs. estratégia adesiva [self-etch (SE) e etch-and-rinse (ER)]. Para desafio erosivo, foram realizados ciclos de/remineralização por 10 dias com ácido cítrico. Após aplicação e fotoativação dos sistemas adesivos de acordo as instruções do fabricante, os dentes foram restaurados, armazenados em água por 24 h, seccionados em “palitos” e submetidos ao teste de microtração sob tensão (0,5 mm/min). 3 palitos de cada dente foram imersos em solução de nitrato de prata para análise de NL por microscopia eletrônica de varredura. Os dados foram analisados por ANOVA três fatores    e teste de Tukey (5%). Os valores de TBS em DE foi estatisticamente inferior à dentina sadia, independente da estratégia adesiva (p<0,01). Em DE não houve diferença entre as estratégias adesivas (p>0,61). Uma maior deposição de nitrato de prata foi observada em DE (p <0,002). A erosão diminuiu a TBS, aumentou a NL independente da estratégia adesiva e as variações na composição dos adesivos produziu diferentes desempenhos.Palavras-chave: Adesivos Dentinários. Resistência à Tração. Erosão Dentária.

Evidence for genetic overlap between adult onset Still's disease and hereditary periodic fever syndromes

OBJECTIVE

Adult onset Still's disease (AOSD) is a severe, autoimmune disease that can be challenging to treat with conventional therapeutics and biologicals in a considerable number of cases. Therefore, there is a high need to understand its pathogenesis better. As major clinical symptoms overlap between AOSD and hereditary periodic fever syndromes (HPFS), we analysed four known HPFS genes in AOSD.

METHODS

We performed Sanger sequencing and quantitative analysis of all coding regions of MEFV, TNFRSF1A, MVK and NLRP3 in 40 AOSD patients. All rare coding variants (n = 6) were evaluated for several aspects to classify them as benign to pathogenic variants. Statistical analysis was performed to analyse whether variants classified as (likely) pathogenic were associated with AOSD.

RESULTS

We identified three rare variants in MEFV, one previously not described. Association to the three likely pathogenic MEFV variants was significant (p _c = 2.34E- 03), and two of the three carriers had a severe course of disease. We observed strong evidence for significant association to mutations in TNFRSF1A (p _c = 2.40E- 04), as 5% of patients (2/40) carried a (likely) pathogenic variant in this gene. Both of them received a biological for treatment.

CONCLUSION

Our results indicate TNFRSF1A as a relevant gene in AOSD, especially in patients with a more challenging course of disease, while causal variants remain to be identified in the majority of patients.

Effects of At-home Bleaching in Smokers: 30-month Follow-up

Objective:

This clinical study evaluated the color longevity after 30 months of at-home bleaching with 10% carbamide peroxide (CP) in smokers and nonsmokers.

Methods:

Sixty patients, 30 smokers and 30 nonsmokers, were subjected to bleaching with 10% CP (Whiteness Perfect–FGM) for three hours daily for three weeks. The color was measured at baseline and at one month and 30 months after the completion of dental bleaching using the shade guide Vita classical organized by value (ΔSGU) and the shade guide Vita Bleachedguide 3D-MASTER. At the 30-month recall, the color was assessed before and after dental prophylaxis. Data from color evaluation were analyzed by two-way repeated-measures analysis of variance and Tukey test for the contrast of means (α=0.05).

Results:

Twenty-one smokers and 22 nonsmokers attended the 30 month recall. For both shade guides, only the main factor of assessment time was statistically significant (p&lt;0.001). Effective whitening was observed in both groups at the baseline, which was stable at one month. However, color rebound was observed after 30 months for both groups of participants when color was measured before and after dental prophylaxis.

Conclusion:

Thirty months after at-home bleaching with 10% CP gel, dental darkening was detected in both groups, which cannot be solely attributed to stains caused by extrinsic staining from daily food, drinks, and smoke (in smokers).

Genetic Breast Cancer Susceptibility Variants and Prognosis in the Prospectively Randomized SUCCESS A Study

Large-scale genotyping studies have identified over 70 single nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk. However, knowledge regarding genetic risk factors associated with the prognosis is limited. The aim of this study was therefore to investigate the prognostic effect of nine known breast cancer risk SNPs. BC patients (n = 1687) randomly sampled in an adjuvant, randomized phase III trial (SUCCESS A study) were genotyped for nine BC risk SNPs: rs17468277 (CASP8) , rs2981582 (FGFR2) , rs13281615(8q24), rs3817198 (LSP1) , rs889312 (MAP3K1) , rs3803662 (TOX3) , rs13387042(2q35), rs4973768 (SLC4A7) , rs6504950 (COX11) . Cox proportional hazards models were used to test the SNPs' association with overall survival (OS) and progression-free survival (PFS). Additional analyses were carried out for molecular subgroups. rs3817198 in LSP1 (lymphocyte-specific protein 1) was the only SNP that significantly influenced OS (p = 0.01) and PFS (p < 0.01) in the likelihood ratio test comparing the genetic survival model with the clinical survival model. In the molecular subgroups, triple-negative patients with two minor alleles in rs3817198 had a much better prognosis relative to OS (adjusted HR 0.03; 95% CI 0.002 - 0.279) and PFS (HR 0.09; 95% CI 0.02 - 0.36) than patients with the common alleles. The same effect on PFS was shown for patients with luminal A tumors (HR 0.19; 95% CI 0.05 - 0.84), whereas patients with luminal B tumors had a poorer PFS with two minor alleles (HR 2.13; 95% CI 1.02 - 4.40). The variant in rs3817198 has a prognostic effect particularly in the subgroup of patients with triple-negative BC, suggesting a possible link with immunomodulation and BC.