The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥ 6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

According to finite element analysis, the zirconia ceramic post created higher stress levels in the post and slightly less in dentin compared with glass fiber posts. Resin cement with a high elastic modulus created higher stress levels in the cement layer. The different film thicknesses of cement did not create significant changes in stress levels. SUMMARYThe current study evaluated the influence of two endodontic post systems and the elastic modulus and film thickness of resin cement on stress distribution in a maxillary central incisor (MCI) restored with direct resin composite using finite element analysis (FEA). A three-dimensional model of an MCI with a coronary fracture and supporting structures was performed. A static chewing pressure of 2.16 N/mm 2 was applied to two areas on the palatal surface of the composite restoration. Zirconia ceramic (ZC) and glass fiber (GF) posts were considered. The stress distribution was analyzed in the post, dentin and cement layer when ZC and GF posts were fixed to the root canals using resin cements of different elastic moduli (7.0 and 18.6 GPa) and different layer thicknesses (70 and 200 µm). The different post materials presented a significant influence on stress distribution with lesser stress concentration when using the GF post. The higher elastic modulus cement created higher stress levels within itself. The cement thicknesses did not present significant changes.

This study was designed to evaluate in vitro the efficacy of a novel at-home bleaching technique using 10% or 16% carbamide peroxide modified by casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and its influence on the microhardness of bleached enamel. A total of 40 bovine incisors were divided into four groups (n=10) according to the bleaching agent used: 10% carbamide peroxide only; a blend of 10% carbamide peroxide and a CPP-ACP paste; 16% carbamide peroxide only; and a blend of 16% carbamide peroxide and a CPP-ACP paste. During the 14-day bleaching regimen, the samples were stored in artificial saliva. The Vickers microhardness and color of the teeth were assessed at baseline (T0) and immediately after the bleaching regimen (T14) using a microhardness tester and a spectrophotometer, respectively. The degree of color change was determined by the Commission Internationale de l'Eclariage (CIE) L*a*b* system (ΔE, ΔL*, Δa*, and Δb*) and Vita shade guide parameters. The data were analyzed by analysis of variance and the Tukey test (p<0.05). The teeth that were bleached with a blend of peroxide (10% or 16%) and the CPP-ACP paste presented increased microhardness values at T14 compared with T0, whereas the samples that were bleached with peroxide only did not show any differences in their microhardness values. All of the bleaching agents were effective at whitening the teeth and did not show a statistically significant difference using the CIEL*a*b* system (ΔE, ΔL*, Δa*, and Δb*) or the Vita shade guide parameters. The use of a CPP-ACP paste with carbamide peroxide bleaching agents increased the bleached enamel's microhardness and did not have an influence on whitening efficacy.

Objective: This study aimed to evaluate the progression of sealed non‐cavitated dentinal occlusal caries in a randomised controlled clinical trial. Materials and methods: Sixty teeth with non‐cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. Results: Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12‐month follow‐up. At the 24‐ and 36‐month recall appointments, neither sealant loss nor caries progression were observed. Conclusion: The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.

SUMMARY Purpose: The purpose of this in vitro study was to evaluate the resistance and patterns of fracture of endodontically treated maxillary premolars (ETPs) restored with different methods. Methods and Materials: Mesio-occluso-distal cavities were prepared in 50 extracted caries-free human maxillary premolars after endodontic treatment. The teeth were divided into five groups (n=10), according to the restorative method. G1: intact teeth (control group); G2: conventional composite resin; G3: conventional composite resin with a horizontal glass fiber post inserted between buccal and palatal walls; G4: bulk-fill flowable and bulk-fill restorative composites; and G5: ceramic inlay. For direct restorations, Filtek Z350 XT, Filtek Bulk Fill Flowable Restorative, and Filtek Bulk Fill Posterior Restorative were used. Indirect restorations were fabricated from a pressable lithium disilicate glass-ceramic (IPS e-max Press) and adhesively cemented (RelyX Ultimate). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles) and additionally submitted to cyclic loading 50,000 times in an Electro-Mechanical Fatigue Machine. Next, the specimens were subjected to a compressive load at a crosshead speed of 1 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern using a stereomicroscope, and then representative specimens were carbon coated to allow for the studying of the fracture surface under scanning electron microscopy. One-way analysis of variance (ANOVA) was used to compare fracture resistance of the groups. The results of fracture patterns were submitted to the Fisher exact test (α=0.05). Results: All specimens survived fatigue. Mean (standard deviation) failure loads (N) for groups were as follows: G1: 949.6 (331.5); G2: 999.6 (352.5); G3: 934.5 (233.6); G4: 771.0 (147.4); and G5: 856.7 (237.5). The lowest fracture resistance was recorded for G4, and the highest ones were recorded for G2, followed by that of G1 and G3. One-way ANOVA did not reveal significant differences between groups (p&gt;0.05). The highest repairable fracture rates were observed in G1 (100%) and G3 (80%). Conclusions: ETPs restored with conventional composite resin with or without horizontal fiber post, bulk-fill composite, and ceramic inlay showed fracture resistance similar to that of sound teeth. Conventional composite resin restorations exhibited the highest prevalence of unrepairable fractures, and the insertion of a horizontal fiber post decreased this prevalence. Intact teeth showed 100% of repairable fractures. It is difficult to extrapolate the results directly to a clinical situation due to the limitations of this study.

None of the restorations evaluated was able to recover the stress distribution of the sound tooth. The models restored with composite resin associated with a glass or carbon fibre post had similar stress distributions to that of the model restored with CR. The different post materials were shown to have a substantial influence on stress distribution, with less stress concentration when fibre posts were used.

Although in-office bleaching has been proven successful for bleaching teeth, controversy exists from morphological alterations in enamel morphology due to mineral loss and tooth sensitivity. This preliminary study aimed to evaluate the efficacy of a novel in-office tooth bleaching technique modified with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (MI paste-MI) and its effect on the enamel morphology and tooth sensitivity. Three patients received a 35% hydrogen peroxide (Whiteness HP-HP) dental bleaching system. HP was prepared and applied on the teeth on one of the hemiarches, whilst teeth on the other hemiarch were bleached with a mixture of HP and MI. Tooth color, epoxy resin replicas, and sensitivity levels were evaluated in the upper incisors. The results were analyzed descriptively. Right and left incisors showed similar color change after bleaching. Incisors bleached with the mixture of HP and MI presented unaltered enamel surfaces and lower sensitivity levels. The currently tested tooth bleaching technique did not reduce the gel effectiveness while decreasing hypersensitivity levels and protecting the enamel against surface alterations caused by the high-concentration bleaching peroxide tested. The concomitant use of MI Paste and high-concentration hydrogen peroxide might be a successful method for decreasing tooth sensitivity and limiting changes in the enamel morphology during in-office bleaching.

Dentin pre-treatment with the CPP-ACP containing paste did not negatively affect bond strength for Clearfil SE Bond/Filtek Z250 and Filtek P90 adhesive system/Filtek P90 composite resin restorative systems and improved bond strength for the Adper SE Plus/Filtek Z250 restorative system.