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ObjectivesTo evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months.Materials and methodsScotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal–Wallis, Mann–Whitney U, Friedman, and Wilcoxon non-parametric tests were computed.ResultsThe cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall.ConclusionsThe 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies.Clinical relevancePhosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Abstract Objectives To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years.Materials and methodsScotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann–Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan–Meier and log-rank tests (p < 0.05).ResultsThe recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004).ConclusionsThe addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode.Trial registrationThis manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.

Background Students´ assessment should be carried out in an effective and objective manner, which reduces the possibility of different evaluators giving different scores, thus influencing the qualification obtained and the consistency of education. The aim of the present study was to determine the agreement among four evaluators and compare the overall scores awarded when assessing portfolios of endodontic preclinical treatments performed by dental students by using an analytic rubric and a numeric rating scale. Methods A random sample of 42 portfolios performed by fourth-year dental students at preclinical endodontic practices were blindly assessed by four evaluators using two different evaluation methods: an analytic rubric specifically designed and a numeric rating scale. Six categories were analyzed: radiographic assessment, access preparation, shaping procedure, obturation, content of the portfolio, and presentation of the portfolio. The maximum global score was 10 points. The overall scores obtained with both methods from each evaluator were compared by Student’s t, while agreement among evaluators was measured by Intraclass correlation coefficients (ICC). The influence of the difficulty of the endodontic treatment on the evaluators´ scores was analyzed by one-way ANOVA. Statistical tests were performed at a pre-set alpha of 0.05 using Stata 16. Results Difficulty of canal treatment did not influence the scores of evaluators, irrespective of the evaluation method used. When the analytic rubric was used, inter-evaluator agreement was substantial for radiographic assessment, access preparation, shaping procedure, obturation, and overall scores. Inter-evaluator agreement ranged from moderate to fair with the numeric rating scale. Mean higher overall scores were achieved when numeric rating scale was used. Presentation and content of the portfolio showed slight and fair agreement, respectively, among evaluators, regardless the evaluation method applied. Conclusions Assessment guided by an analytic rubric allowed evaluators to reach higher levels of agreement than those obtained when using a numeric rating scale. However, the rubric negatively affected overall scores.

[Abstract] The purpose of this study was to determine the micro-tensile bond strength (MTBS) to dentin of seven adhesive systems (total and self-etch adhesives) after 24 h and 5,000 thermocycles. Dentin surfaces of human third molars were exposed and bonded with two total-etch adhesives (Adper Scotchbond 1 XT and XP Bond), two two-step self-etch adhesives (Adper Scotchbond SE and Filtek Silorane Adhesive System) and three one-step self-etch adhesives (G-Bond, Xeno V and Bond Force). All adhesive systems were applied following manufacturers' instructions. Composite buildups were constructed and the bonded teeth were then stored in water (24 h, 37℃) or thermocycled (5,000 cycles) before being sectioned and submitted to MTBS test. Two-way ANOVA and subsequent comparison tests were applied at α=0.05. Characteristic de-bonded specimens were analyzed using scanning electron microscopy (SEM). After 24 h water storage, MTBS values were highest with XP Bond, Adper Scotchbond 1 XT, Filtek Silorane Adhesive System and Adper Scotchbond SE and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. After thermocycling, MTBS values were highest with XP Bond, followed by Filtek Silorane Adhesive System, Adper Scotchbond SE and Adper Scotchbond 1 XT and lowest with the one-step self-etch adhesives Bond Force, Xeno V and G-Bond. Thermal aging induced a significant decrease in MTBS values with all adhesives tested. The resistance of resin-dentin bonds to thermal-aging degradation was material dependent. One-step self-etch adhesives obtained the lowest MTBS results after both aging treatments, and their adhesive capacity was significantly reduced after thermocycling.

Parental divorce is one of the most common adverse events in childhood and can cause children emotional problems and influence their oral health. To explore differences in possible bruxism, state anxiety, coping and parenting styles between a group of divorced parents and a group of cohabiting parents. A cross-sectional study was conducted, with data collected through self-report questionnaires filled in by 186 patients (8-16 years) and their parents. Children completed State Trait Anxiety Inventory (STAI), Self-Report Coping Measure (SRCM) and Parenting Style Scale. The Self-Reported Bruxism Questionnaire (SBQ) was completed by their parents. The results showed significant differences were seen between the group of divorced parents (n=93) and the control group (n=93), with higher levels of state anxiety and possible bruxism in the group of children of divorced parents. In addition, in terms of coping strategies, externalisation and problem-solving deficits stood out. In terms of parenting style, autonomy promotion was higher. Additionally, possible bruxism was influenced by coping strategies (seeking social support), attachment-based parenting style and communication, behavioural control and state anxiety. Finally, it was found that high anxiety may act as a moderating variable in the relationship between divorced parents and possible bruxism. Children of divorced parents showed more possible bruxism, anxiety, coping and behavioural problems.

Objectives The objective of this study was to compare the 5-year clinical performance in posterior restorations of three restorative systems including a low-shrinkage system and a methacrylate-based composite combined either with an etch-and-rinse or a self-etch adhesive. Materials and methods Each of 25 patients received three class I (occlusal) or class II restorations performed with each one of the three restorative systems: Filtek Silorane Restorative System including a two-step self-etch adhesive, Adper Scotchbond 1 XT (two-step etch-and-rinse adhesive) + Filtek Z250, and Adper Scotchbond SE (two-step self-etch adhesive) + Filtek Z250. All materials were applied as per manufacturer’s instructions. Two blind observers evaluated the restorations at four different moments (baseline, after 1, 2, and 5 years) according to the USPHS-modified criteria. Kruskal-Wallis and Mann-Whitney U tests were conducted to compare the behavior of the restorative systems, while Friedman and Wilcoxon tests were applied to analyze the intrasystem data ( p  < 0.05). Results After 5 years, marginal staining around the restorations with Adper Scotchbond SE + Filtek Z250 was statistically more frequent and severe than that of the restorations performed with the other two systems. Intrasystem comparisons revealed a deterioration of the marginal adaptation after 5 years for all systems. A significant number of restorations bonded with self-etch adhesives showed marginal staining after 5 years of clinical service. A deterioration of the color appearance and an increase of the surface roughness were also detected in the restorations performed with Adper Scotchbond SE + Filtek Z250. Conclusions A deterioration of the marginal adaptation was evidenced for all restorative systems, while marginal staining was more frequently seen only around the restorations performed with self-etch adhesives. Clinical relevance No advantage was found of the silorane- over the methacrylate-based composite when combined with an etch-and-rinse adhesive.

Paediatric cancers are rare, yet, Italy has previously shown some of the highest incidence rates in Europe as a leading cause of death in children and adolescents. This study updates data from Italy for 2008–2017, analyses trends from 1998, and compares findings with other European regions. A population-based approach was used, leveraging data from the Italian Association of Cancer Registries (AIRTUM). Thirty-one cancer registries covering 77 % of the Italian paediatric population contributed data on tumour type, age, sex, residence, and diagnosis date. Cancers were classified using the International Classification of Childhood Cancer, Third Edition (ICCC-3). Age-specific (IR) and age-standardized incidence rates (ASR) were computed, while trends were analysed with Joinpoint regression to estimate annual (APC) and average annual percentage change (AAPC). From 2008–2017, 17,322 malignant paediatric cancer cases were reported in Italy. The age-standardized incidence rate (ASR) was 166.8 per million for ages 0–14 and 294.3 per million for adolescents 15–19. Over the study period, incidence rates were generally stable, but a significant increase was observed for bone tumours in children and thyroid and melanoma in adolescents. Central Italy showed higher incidence rates compared to other Italian regions. Italy still shows one of the highest incidence rates in Europe. While the study confirms overall stable incidence trends in Italy, it also highlights an increase in specific cancers such as melanoma and thyroid tumours in adolescents. Central Italy exhibited higher incidence rates, potentially due to environmental and/or diagnostic factors. Continuous monitoring and further research are needed to clarify regional variations and evaluate the impact of early diagnosis and environmental exposures. •17,322 paediatric cancer cases recorded in Italy (2008–2017).•ASR: 166.8/million in children; IR: 294.3/million in adolescents.•Central Italy had highest incidence, esp. melanoma and epithelial tumours.•Italy shows higher paediatric cancer rates than other European regions.•Stable trends; increased bone tumours (children), thyroid and melanoma (adolescents).